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Leonetti A, Perrone F, Puntoni M, Maglietta G, Bordi P, Bria E, Vita E, Gelsomino F, De Giglio A, Gelibter A, Siringo M, Mazzoni F, Caliman E, Genova C, Bertolini F, Guaitoli G, Passiglia F, Delcuratolo MD, Montrone M, Cerea G, Pasello G, Roca E, Belluomini L, Cecere FL, Guida A, Manzo A, Adamo V, Rastelli F, Bulotta A, Citarella F, Toschi L, Zoratto F, Cortinovis DL, Berardi R, Follador A, Carta A, Camerini A, Salerno F, Silva RR, Baldini E, Cortellini A, Brighenti M, Santoni M, Malorgio F, Caminiti C, Tiseo M. Real-world outcomes of Italian patients with advanced non-squamous lung cancer treated with first-line pembrolizumab plus platinum-pemetrexed. Eur J Cancer 2024; 202:114006. [PMID: 38489861 DOI: 10.1016/j.ejca.2024.114006] [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: 02/29/2024] [Accepted: 03/03/2024] [Indexed: 03/17/2024]
Abstract
PURPOSE The aim of this multi-center, retrospective/prospective cohort observational study was to evaluate outcomes in routine clinical practice of first-line chemo-immunotherapy with cis/carboplatin, pemetrexed and pembrolizumab in patients with advanced non-squamous non-small cell lung cancer (NSCLC) in 33 Italian centers. METHODS The outcome measure was to evaluate overall survival (OS) in a real-world patient population. Secondary endpoints were: progression-free survival (PFS), objective response rate (ORR), duration of response (DoR) and incidence of treatment-related adverse events (AEs). RESULTS 1068 patients were enrolled at the time of data cut-off (January 31st, 2023), and 812 (76.0%) belonged to the retrospective cohort. Median age was 66 years (27-85), ECOG PS was ≥ 2 in 91 (8.6%) patients; 254 (23.8%) patients had brain metastases at baseline; 38 (3.6%) patients had tumor with PD-L1 expression ≥ 50%. After a median follow-up of 17.0 months (95% CI, 16.1-17.9), median OS was 16.1 months (95% CI, 14.4-18.8) and PFS was 9.9 months (95% CI, 8.8-11.2). Median DoR (n = 493) was 14.7 months (95% CI, 13.6-17.1). ORR was 43.4% (95% CI, 40.4-46.4). Any-grade AEs occurred in 636 (59.6%) patients and grade ≥ 3 in 253 (23.7%) patients. Most common grade ≥ 3 AEs were neutropenia (6.3%) and anemia (6.3%). CONCLUSIONS First-line chemo-immunotherapy was effective and tolerable in this large, real-world Italian study of patients with advanced non-squamous NSCLC. Our results were in line with the KEYNOTE-189 registration study, also considering the low number of PD-L1 ≥ 50% patients included in our study.
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Affiliation(s)
| | - Fabiana Perrone
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy.
| | - Matteo Puntoni
- Clinical & Epidemiological Research Unit, University Hospital of Parma, Parma, Italy
| | - Giuseppe Maglietta
- Clinical & Epidemiological Research Unit, University Hospital of Parma, Parma, Italy
| | - Paola Bordi
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Emilio Bria
- UOSD Oncologia Toraco-Polmonare, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Medical Oncology, Department of Traslational Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Emanuele Vita
- UOSD Oncologia Toraco-Polmonare, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Medical Oncology, Department of Traslational Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Gelsomino
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Andrea De Giglio
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Alain Gelibter
- Medical Oncology (B), Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Marco Siringo
- Medical Oncology (B), Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | | | - Enrico Caliman
- Medical Oncology Unit, Careggi University Hospital, Florence, Italy
| | - Carlo Genova
- Academic Oncology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy; Department of Internal Medicine and Medical Specialties, University of Genoa, Genoa, Italy
| | - Federica Bertolini
- Division of Medical Oncology, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy
| | - Giorgia Guaitoli
- Division of Medical Oncology, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy
| | - Francesco Passiglia
- Department of Oncology, University of Turin, AOU San Luigi Gonzaga, Orbassano, Turin, Italy
| | | | - Michele Montrone
- Medical Thoracic Oncology Unit, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Giulio Cerea
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Giulia Pasello
- Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padua, Italy; Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Elisa Roca
- Thoracic Oncology - Lung Unit, Pederzoli Hospital, Peschiera del Garda, Italy
| | - Lorenzo Belluomini
- Medical Oncology, Department of Medicine, University of Verona Hospital Trust, Verona, Italy
| | | | - Annalisa Guida
- Department of Medical Oncology, St. Mary's Hospital, Terni, Italy
| | - Anna Manzo
- Thoracic Medical Oncology, Istituto Nazionale Tumori IRCCS "Fondazione G. Pascale", Naples, Italy
| | - Vincenzo Adamo
- Medical Oncology Unit, Azienda Ospedaliera Papardo, Messina, Italy
| | - Francesca Rastelli
- Medical Oncology, AST (Azienda Sanitaria Territoriale) of Ascoli Piceno, Ascoli Piceno, Italy
| | - Alessandra Bulotta
- Department of Oncology, Istituto di Ricerca a Carattere Scientifico (IRCCS) San Raffaele Hospital, Milan, Italy
| | - Fabrizio Citarella
- Department of Medical Oncology, Campus Bio-Medico University, Rome, Italy
| | - Luca Toschi
- IRCCS Humanitas Clinical and Research Center - Humanitas Cancer Center, Rozzano, Milan, Italy
| | | | - Diego Luigi Cortinovis
- SC Medical Oncology, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy; Medicine and Surgery Department, University of Milano Bicocca, Milan, Italy
| | - Rossana Berardi
- Oncology Clinic, Università Politecnica Delle Marche, Ospedali Riuniti Di Ancona, Ancona, Italy
| | - Alessandro Follador
- Medical Oncology Unit San Daniele - Tolmezzo, ASUFC Azienda Sanitaria Universitaria Friuli Centrale, Italy
| | - Annamaria Carta
- Pathology and Oncology Unit, Businco Oncological Hospital, Cagliari, Italy
| | - Andrea Camerini
- Medical Oncology, Versilia Hospital, Azienda USL Toscana Nord Ovest, Lido di Camaiore, Italy
| | - Flavio Salerno
- Department of Oncology, University of Turin, Ordine Mauriziano Hospital, Turin, Italy
| | - Rosa Rita Silva
- Department of Oncology, ASUR Marche, Area Vasta 2, Fabriano, Italy
| | | | - Alessio Cortellini
- Operative Research Unit of Medical Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128, Roma, Italy; Department of Surgery and Cancer, Hammersmith Hospital Campus, Imperial College London, London, UK
| | | | | | | | - Caterina Caminiti
- Clinical & Epidemiological Research Unit, University Hospital of Parma, Parma, Italy
| | - Marcello Tiseo
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy; Department of Medicine and Surgery, University of Parma, Parma, Italy
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2
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Gallina FT, Cecere FL, Tajè R, Forcella D, Melis E, Cappuzzo F, Facciolo F. Could the molecular profile aid in predicting occult nodal metastasis in early-stage lung adenocarcinoma? Surg Today 2024; 54:288-289. [PMID: 37733185 DOI: 10.1007/s00595-023-02750-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 08/24/2023] [Indexed: 09/22/2023]
Affiliation(s)
- Filippo Tommaso Gallina
- Thoracic Surgery Unit, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy.
| | | | - Riccardo Tajè
- Thoracic Surgery Unit, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Daniele Forcella
- Thoracic Surgery Unit, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Enrico Melis
- Thoracic Surgery Unit, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Federico Cappuzzo
- Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Francesco Facciolo
- Thoracic Surgery Unit, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
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Chu Q, Perrone F, Greillier L, Tu W, Piccirillo MC, Grosso F, Lo Russo G, Florescu M, Mencoboni M, Morabito A, Cecere FL, Ceresoli GL, Dawe DE, Zucali PA, Pagano M, Goffin JR, Sanchez ML, Gridelli C, Zalcman G, Quantin X, Westeel V, Gargiulo P, Delfanti S, Tu D, Lee CW, Leighl N, Sederias J, Brown-Walker P, Luo Y, Lantuejoul S, Tsao MS, Scherpereel A, Bradbury P, Laurie SA, Seymour L. Pembrolizumab plus chemotherapy versus chemotherapy in untreated advanced pleural mesothelioma in Canada, Italy, and France: a phase 3, open-label, randomised controlled trial. Lancet 2023; 402:2295-2306. [PMID: 37931632 DOI: 10.1016/s0140-6736(23)01613-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 07/29/2023] [Accepted: 08/01/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND Pleural mesothelioma usually presents at an advanced, incurable stage. Chemotherapy with platinum-pemetrexed is a standard treatment. We hypothesised that the addition of pembrolizumab to platinum-pemetrexed would improve overall survival in patients with pleural mesothelioma. METHODS We did this open-label, international, randomised phase 3 trial at 51 hospitals in Canada, Italy, and France. Eligible participants were aged 18 years or older, with previously untreated advanced pleural mesothelioma, with an Eastern Cooperative Oncology Group performance status score of 0 or 1. Patients were randomly assigned (1:1) to intravenous chemotherapy (cisplatin [75 mg/m2] or carboplatin [area under the concentration-time curve 5-6 mg/mL per min] with pemetrexed 500 mg/m2, every 3 weeks for up to 6 cycles), with or without intravenous pembrolizumab 200 mg every 3 weeks (up to 2 years). The primary endpoint was overall survival in all randomly assigned patients; safety was assessed in all randomly assigned patients who received at least one dose of study therapy. This trial is registered with ClinicalTrials.gov, NCT02784171, and is closed to accrual. FINDINGS Between Jan 31, 2017, and Sept 4, 2020, 440 patients were enrolled and randomly assigned to chemotherapy alone (n=218) or chemotherapy with pembrolizumab (n=222). 333 (76 %) of patients were male, 347 (79%) were White, and median age was 71 years (IQR 66-75). At final analysis (database lock Dec 15, 2022), with a median follow-up of 16·2 months (IQR 8·3-27·8), overall survival was significantly longer with pembrolizumab (median overall survival 17·3 months [95% CI 14·4-21·3] with pembrolizumab vs 16·1 months [13·1-18·2] with chemotherapy alone, hazard ratio for death 0·79; 95% CI 0·64-0·98, two-sided p=0·0324). 3-year overall survival rate was 25% (95% CI 20-33%) with pembrolizumab and 17% (13-24%) with chemotherapy alone. Adverse events related to study treatment of grade 3 or 4 occurred in 60 (27%) of 222 patients in the pembrolizumab group and 32 (15%) of 211 patients in the chemotherapy alone group. Hospital admissions for serious adverse events related to one or more study drugs were reported in 40 (18%) of 222 patients in the pembrolizumab group and 12 (6%) of 211 patients in the chemotherapy alone group. Grade 5 adverse events related to one or more drugs occurred in two patients on the pembrolizumab group and one patient in the chemotherapy alone group. INTERPRETATION In patients with advanced pleural mesothelioma, the addition of pembrolizumab to standard platinum-pemetrexed chemotherapy was tolerable and resulted in a significant improvement in overall survival. This regimen is a new treatment option for previously untreated advanced pleural mesothelioma. FUNDING The Canadian Cancer Society and Merck & Co.
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Affiliation(s)
- Quincy Chu
- Cross Cancer Institute, Edmonton, AB, Canada
| | - Francesco Perrone
- Istituto Nazionale Tumori Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione G Pascale, Napoli, Italy
| | - Laurent Greillier
- Aix Marseille Univ, Marseille, France; Assistance publique - Hôpitaux de Marseille, Marseille, France; L'Institut National de la Santé et de la Recherche Médicale, Marseille, France; Centre National de la Recherche Scientifique, Marseille, France; Cancer Research Centre of Marseille, Marseille, France; Hôpital Nord, Multidisciplinary Oncology and Therapeutic Innovations, Marseille, France
| | - Wei Tu
- Canadian Cancer Trials Group, Queen's University, Kingston, ON, Canada
| | - Maria Carmela Piccirillo
- Istituto Nazionale Tumori Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione G Pascale, Napoli, Italy
| | - Federica Grosso
- Mesothelioma and Rare Cancer Unit, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | | | - Marie Florescu
- Centre Hospitalier de l'Université de Montreal, Montreal, QC, Canada
| | - Manlio Mencoboni
- Unit di Oncologia Ospedale Villa Scassi, Genova Sampierdarena, Italy
| | - Alessandro Morabito
- Oncologia Clinica e Sperimentale Toraco-polmonare, Istituto Nazionale Tumori IRCCS Fondazione G Pascale, Napoli, Italy
| | | | | | | | - Paolo Andrea Zucali
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy; Department of Oncology, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Maria Pagano
- Oncologia Medica IRCCS Arcispedale Maria Nuova Reggio Emilia, Reggio Emilia, Italy
| | - John R Goffin
- Juravinski Cancer Centre at Hamilton Health Sciences, Hamilton, ON, Canada
| | | | - Cesare Gridelli
- Azienda Ospedaliera San Giuseppe Moscati Dipartimento di Oncologia Medica, Avellino, Italy
| | - Gerard Zalcman
- Université Paris Cité, Hôpital Bichat-Claude Bernard, Thoracic Oncology Department, Assistance publique-Hôpitaux de Paris Nord, Paris, France
| | - Xavier Quantin
- Montpellier Cancer Institute and Montpellier Cancer Research Institute, INSERM U1194, University of Montpellier, Montpellier, France
| | | | - Piera Gargiulo
- Istituto Nazionale Tumori Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione G Pascale, Napoli, Italy
| | - Sara Delfanti
- Mesothelioma and Rare Cancer Unit, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Dongsheng Tu
- Canadian Cancer Trials Group, Queen's University, Kingston, ON, Canada
| | | | - Natasha Leighl
- Princess Margaret Cancer Centre, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada
| | - Joana Sederias
- Canadian Cancer Trials Group, Queen's University, Kingston, ON, Canada
| | | | | | - Sylvie Lantuejoul
- Grenoble Alpes University and Department of Biopathology, Centre Léon Bérard and Netmeso Mesopath Network, Lyon, France
| | - Ming-Sound Tsao
- Princess Margaret Cancer Centre, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada
| | | | - Penelope Bradbury
- Princess Margaret Cancer Centre, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada
| | - Scott A Laurie
- Ottawa Hospital Research Institute, Ottawa, ON, Canada; University of Ottawa, Ottawa, ON, Canada
| | - Lesley Seymour
- Canadian Cancer Trials Group, Queen's University, Kingston, ON, Canada.
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4
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Marinelli D, Gallina FT, Pannunzio S, Di Civita MA, Torchia A, Giusti R, Gelibter AJ, Roberto M, Verrico M, Melis E, Tajè R, Cecere FL, Landi L, Nisticò P, Porciello N, Occhipinti M, Brambilla M, Forde PM, Liu SV, Botticelli A, Novello S, Ciliberto G, Cortesi E, Facciolo F, Cappuzzo F, Santini D. Surgical and survival outcomes with perioperative or neoadjuvant immune-checkpoint inhibitors combined with platinum-based chemotherapy in resectable NSCLC: A systematic review and meta-analysis of randomised clinical trials. Crit Rev Oncol Hematol 2023; 192:104190. [PMID: 37871779 DOI: 10.1016/j.critrevonc.2023.104190] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 10/04/2023] [Accepted: 10/16/2023] [Indexed: 10/25/2023] Open
Abstract
The use of neoadjuvant or perioperative anti-PD(L)1 was recently tested in multiple clinical trials. We performed a systematic review and meta-analysis of randomised trials comparing neoadjuvant or perioperative chemoimmunotherapy to neoadjuvant chemotherapy in resectable NSCLC. Nine reports from 6 studies were included. Receipt of surgery was more frequent in the experimental arm (odds ratio, OR 1.39) as was pCR (OR 7.60). EFS was improved in the experimental arm (hazard ratio, HR 0.55) regardless of stage, histology, PD-L1 expression (PD-L1 negative, HR 0.74) and smoking exposure (never smokers, HR 0.67), as was OS (HR 0.67). Grade > = 3 treatment-related adverse events were more frequent in the experimental arm (OR 1.22). The experimental treatment improved surgical outcomes, pCR rates, EFS and OS in stage II-IIIB, EGFR/ALK negative resectable NSCLC; confirmatory evidence is warranted for stage IIIB tumours and with higher maturity of the OS endpoint.
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Affiliation(s)
- Daniele Marinelli
- Department of Experimental Medicine, Sapienza University, Rome, Italy; Division of Medical Oncology B, Policlinico Umberto I, Rome, Italy.
| | | | - Sergio Pannunzio
- Comprehensive Cancer Center, Medical Oncology Unit, IRCCS Fondazione Policlinico Universitario "Agostino Gemelli", Rome, Italy
| | - Mattia Alberto Di Civita
- Department of Radiological, Oncological and Anatomopathological Sciences, Sapienza University, Rome, Italy; Division of Medical Oncology A, Policlinico Umberto I, Rome, Italy
| | - Andrea Torchia
- Department of Radiological, Oncological and Anatomopathological Sciences, Sapienza University, Rome, Italy; Division of Medical Oncology A, Policlinico Umberto I, Rome, Italy
| | - Raffaele Giusti
- Division of Medical Oncology, Sant'Andrea Hospital, Rome, Italy
| | | | - Michela Roberto
- Division of Medical Oncology A, Policlinico Umberto I, Rome, Italy
| | - Monica Verrico
- Division of Medical Oncology A, Policlinico Umberto I, Rome, Italy
| | - Enrico Melis
- Thoracic Surgery Unit, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy
| | - Riccardo Tajè
- Thoracic Surgery Unit, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy
| | - Fabiana Letizia Cecere
- Division of Medical Oncology 2, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy
| | - Lorenza Landi
- Clinical Trials Center: Phase 1 and Precision Medicine, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy
| | - Paola Nisticò
- Tumor Immunology and Immunotherapy Unit, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy
| | - Nicla Porciello
- Tumor Immunology and Immunotherapy Unit, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy
| | - Mario Occhipinti
- Department of Experimental Medicine, Sapienza University, Rome, Italy; Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Marta Brambilla
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Patrick M Forde
- Bloomberg-Kimmel Institute for Cancer Immunotherapy, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD, USA
| | - Stephen V Liu
- Division of Hematology and Oncology, Georgetown University, Washington, DC, USA
| | - Andrea Botticelli
- Department of Radiological, Oncological and Anatomopathological Sciences, Sapienza University, Rome, Italy
| | - Silvia Novello
- Department of Oncology, University of Turin, San Luigi Hospital, Turin, Italy
| | - Gennaro Ciliberto
- Scientific Direction, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy
| | - Enrico Cortesi
- Division of Medical Oncology B, Policlinico Umberto I, Rome, Italy; Department of Radiological, Oncological and Anatomopathological Sciences, Sapienza University, Rome, Italy
| | - Francesco Facciolo
- Thoracic Surgery Unit, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy
| | - Federico Cappuzzo
- Division of Medical Oncology 2, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy
| | - Daniele Santini
- Division of Medical Oncology A, Policlinico Umberto I, Rome, Italy; Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy
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5
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Gallina FT, Marinelli D, Tajè R, Forcella D, Alessandrini G, Cecere FL, Fusco F, Visca P, Sperduti I, Ambrogi V, Cappuzzo F, Melis E, Facciolo F. Analysis of predictive factors of unforeseen nodal metastases in resected clinical stage I NSCLC. Front Oncol 2023; 13:1229939. [PMID: 38023117 PMCID: PMC10661928 DOI: 10.3389/fonc.2023.1229939] [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: 05/27/2023] [Accepted: 08/25/2023] [Indexed: 12/01/2023] Open
Abstract
Background Despite notable advances made in preoperative staging, unexpected nodal metastases after surgery are still significantly detected. In this study we aim to analyze the upstaging rate in patients with clinical stage I NSCLC without evidence of nodal disease in the preoperative staging who underwent lobectomy and radical lymphadenectomy. Methods Patients who underwent lobectomy and systematic lymphadenectomy for clinical stage I NSCLC were evaluated. Exclusion criteria included the neoadjuvant treatment, incomplete resection and no adherence to preoperative guidelines. Results A total of 297 patients were included in the study. 159 patients were female, and the median age was 68 (61 - 73). The variables that showed a significant correlation with the upstaging rate at the univariate analysis were the number of resected lymph nodes and micropapillar/solid adenocar-cinoma subtype. This result was confirmed in the multivariate analysis with a OR= 2.545 (95%CI 1.136-5.701; p=0.02) for the number of resected lymph nodes and a OR=2.717 (95%CI 1.256-5.875; p=0.01) for the high-grade pattern of adenocarcinoma. Conclusion Our results showed that in a homogeneous cohort of patients with clinical stage I NSCLC, the number of resected lymph nodes and the histological subtype of adenocarcinoma can significantly be associated with nodal metastasis.
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Affiliation(s)
| | - Daniele Marinelli
- Department of Experimental Medicine, Sapienza University, Rome, Italy
| | - Riccardo Tajè
- Thoracic Surgery Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Daniele Forcella
- Thoracic Surgery Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | | | | | - Francesca Fusco
- Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Paolo Visca
- Department of Pathology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Isabella Sperduti
- Biostatistics, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Vincenzo Ambrogi
- Department of Thoracic Surgery, Tor Vergata Policlinic, Rome, Italy
| | - Federico Cappuzzo
- Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Enrico Melis
- Thoracic Surgery Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Francesco Facciolo
- Thoracic Surgery Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
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6
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Giacomini P, Valenti F, Allegretti M, Pallocca M, De Nicola F, Ciuffreda L, Fanciulli M, Scalera S, Buglioni S, Melucci E, Casini B, Carosi M, Pescarmona E, Giordani E, Sperati F, Jannitti N, Betti M, Maugeri-Saccà M, Cecere FL, Villani V, Pace A, Appetecchia M, Vici P, Savarese A, Krasniqi E, Ferraresi V, Russillo M, Fabi A, Landi L, Minuti G, Cappuzzo F, Zeuli M, Ciliberto G. The Molecular Tumor Board of the Regina Elena National Cancer Institute: from accrual to treatment in real-world. J Transl Med 2023; 21:725. [PMID: 37845764 PMCID: PMC10577953 DOI: 10.1186/s12967-023-04595-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 10/05/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND Molecular Tumor Boards (MTB) operating in real-world have generated limited consensus on good practices for accrual, actionable alteration mapping, and outcome metrics. These topics are addressed herein in 124 MTB patients, all real-world accrued at progression, and lacking approved therapy options. METHODS Actionable genomic alterations identified by tumor DNA (tDNA) and circulating tumor DNA (ctDNA) profiling were mapped by customized OncoKB criteria to reflect diagnostic/therapeutic indications as approved in Europe. Alterations were considered non-SoC when mapped at either OncoKB level 3, regardless of tDNA/ctDNA origin, or at OncoKB levels 1/2, provided they were undetectable in matched tDNA, and had not been exploited in previous therapy lines. RESULTS Altogether, actionable alterations were detected in 54/124 (43.5%) MTB patients, but only in 39 cases (31%) were these alterations (25 from tDNA, 14 from ctDNA) actionable/unexploited, e.g. they had not resulted in the assignment of pre-MTB treatments. Interestingly, actionable and actionable/unexploited alterations both decreased (37.5% and 22.7% respectively) in a subset of 88 MTB patients profiled by tDNA-only, but increased considerably (77.7% and 66.7%) in 18 distinct patients undergoing combined tDNA/ctDNA testing, approaching the potential treatment opportunities (76.9%) in 147 treatment-naïve patients undergoing routine tDNA profiling for the first time. Non-SoC therapy was MTB-recommended to all 39 patients with actionable/unexploited alterations, but only 22 (56%) accessed the applicable drug, mainly due to clinical deterioration, lengthy drug-gathering procedures, and geographical distance from recruiting clinical trials. Partial response and stable disease were recorded in 8 and 7 of 19 evaluable patients, respectively. The time to progression (TTP) ratio (MTB-recommended treatment vs last pre-MTB treatment) exceeded the conventional Von Hoff 1.3 cut-off in 9/19 cases, high absolute TTP and Von Hoff values coinciding in 3 cases. Retrospectively, 8 patients receiving post-MTB treatment(s) as per physician's choice were noted to have a much longer overall survival from MTB accrual than 11 patients who had received no further treatment (35.09 vs 6.67 months, p = 0.006). CONCLUSIONS MTB-recommended/non-SoC treatments are effective, including those assigned by ctDNA-only alterations. However, real-world MTBs may inadvertently recruit patients electively susceptible to diverse and/or multiple treatments.
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Affiliation(s)
- Patrizio Giacomini
- Clinical Trial Center, Biostatistics and Bioinformatics, IRCCS-Regina Elena National Cancer Institute, 00144, Rome, Italy.
| | - Fabio Valenti
- UOC Translational Oncology Research, IRCCS-Regina Elena National Cancer Institute, 00144, Rome, Italy
| | - Matteo Allegretti
- UOC Translational Oncology Research, IRCCS-Regina Elena National Cancer Institute, 00144, Rome, Italy
| | - Matteo Pallocca
- Clinical Trial Center, Biostatistics and Bioinformatics, IRCCS-Regina Elena National Cancer Institute, 00144, Rome, Italy
| | - Francesca De Nicola
- SAFU, Department of Research, Advanced Diagnostics, and Technological Innovation, IRCCS-Regina Elena National Cancer Institute, 00144, Rome, Italy
| | - Ludovica Ciuffreda
- SAFU, Department of Research, Advanced Diagnostics, and Technological Innovation, IRCCS-Regina Elena National Cancer Institute, 00144, Rome, Italy
| | - Maurizio Fanciulli
- SAFU, Department of Research, Advanced Diagnostics, and Technological Innovation, IRCCS-Regina Elena National Cancer Institute, 00144, Rome, Italy
| | - Stefano Scalera
- Clinical Trial Center, Biostatistics and Bioinformatics, IRCCS-Regina Elena National Cancer Institute, 00144, Rome, Italy
| | - Simonetta Buglioni
- Department of Pathology, IRCCS-Regina Elena National Cancer Institute, 00144, Rome, Italy
| | - Elisa Melucci
- Department of Pathology, IRCCS-Regina Elena National Cancer Institute, 00144, Rome, Italy
| | - Beatrice Casini
- Department of Pathology, IRCCS-Regina Elena National Cancer Institute, 00144, Rome, Italy
| | - Mariantonia Carosi
- Department of Pathology, IRCCS-Regina Elena National Cancer Institute, 00144, Rome, Italy
| | - Edoardo Pescarmona
- Department of Pathology, IRCCS-Regina Elena National Cancer Institute, 00144, Rome, Italy
| | - Elena Giordani
- UOC Translational Oncology Research, IRCCS-Regina Elena National Cancer Institute, 00144, Rome, Italy
| | - Francesca Sperati
- Clinical Trial Center, Biostatistics and Bioinformatics, San Gallicano Dermatological Institute IRCCS, 00144, Rome, Italy
| | - Nicoletta Jannitti
- Pharmacy Unit, Medical Direction, IRCCS-Regina Elena National Cancer Institute and San Gallicano Institute, 00144, Rome, Italy
| | - Martina Betti
- Clinical Trial Center, Biostatistics and Bioinformatics, IRCCS-Regina Elena National Cancer Institute, 00144, Rome, Italy
| | - Marcello Maugeri-Saccà
- Clinical Trial Center, Biostatistics and Bioinformatics, IRCCS-Regina Elena National Cancer Institute, 00144, Rome, Italy
- Medical Oncology 2, IRCCS-Regina Elena National Cancer Institute, 00144, Rome, Italy
| | | | - Veronica Villani
- Neuro-Oncology Unit, IRCCS-Regina Elena National Cancer Institute, 00144, Rome, Italy
| | - Andrea Pace
- Neuro-Oncology Unit, IRCCS-Regina Elena National Cancer Institute, 00144, Rome, Italy
| | - Marialuisa Appetecchia
- Oncological Endocrinology Unit, IRCCS-Regina Elena National Cancer Institute, 00144, Rome, Italy
| | - Patrizia Vici
- Phase IV Studies, IRCCS-Regina Elena National Cancer Institute, 00144, Rome, Italy
| | - Antonella Savarese
- Medical Oncology 1, IRCCS-Regina Elena National Cancer Institute, 00144, Rome, Italy
| | - Eriseld Krasniqi
- Phase IV Studies, IRCCS-Regina Elena National Cancer Institute, 00144, Rome, Italy
| | - Virginia Ferraresi
- Sarcomas and Rare Tumors Departmental Unit, IRCCS-Regina Elena National Cancer Institute, 00144, Rome, Italy
| | - Michelangelo Russillo
- Sarcomas and Rare Tumors Departmental Unit, IRCCS-Regina Elena National Cancer Institute, 00144, Rome, Italy
| | - Alessandra Fabi
- Precision Medicine Unit in Senology, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168, Rome, Italy
| | - Lorenza Landi
- Clinical Trial Center: Phase 1 and Precision Medicine, IRCCS-Regina Elena National Cancer Institute, 00144, Rome, Italy
| | - Gabriele Minuti
- Clinical Trial Center: Phase 1 and Precision Medicine, IRCCS-Regina Elena National Cancer Institute, 00144, Rome, Italy
| | - Federico Cappuzzo
- Medical Oncology 2, IRCCS-Regina Elena National Cancer Institute, 00144, Rome, Italy
| | - Massimo Zeuli
- Clinical Trial Center, Biostatistics and Bioinformatics, IRCCS-Regina Elena National Cancer Institute, 00144, Rome, Italy
- Medical Oncology 1, IRCCS-Regina Elena National Cancer Institute, 00144, Rome, Italy
| | - Gennaro Ciliberto
- Scientific Direction, IRCCS-Regina Elena National Cancer Institute, 00144, Rome, Italy
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Gallina FT, Marinelli D, Melis E, Forcella D, Taje R, Buglioni S, Visca P, Torchia A, Cecere FL, Botticelli A, Santini D, Ciliberto G, Cappuzzo F, Facciolo F. KRAS G12C mutation and risk of disease recurrence in stage I surgically resected lung adenocarcinoma. Lung Cancer 2023; 181:107254. [PMID: 37253296 DOI: 10.1016/j.lungcan.2023.107254] [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: 03/26/2023] [Revised: 05/08/2023] [Accepted: 05/15/2023] [Indexed: 06/01/2023]
Abstract
KRAS G12C mutations are found in about 12-13% of LUAD samples and it is unclear whether they are associated with worse survival outcomes in resected, stage I LUAD. We assessed whether KRAS-G12C mutated tumours had worse DFS when compared to KRAS-nonG12C mutated tumours and to KRAS wild-type tumours in a cohort of resected, stage I LUAD (IRE cohort). We then leveraged on publicly available datasets (TCGA-LUAD, MSK-LUAD604) to further test the hypothesis in external cohorts. In the stage I IRE cohort we found a significant association between the KRAS-G12C mutation and worse DFS in multivariable analysis (HR: 2.47). In the TCGA-LUAD stage I cohort we did not find statistically significant associations between the KRAS-G12C mutation and DFS. In the MSK-LUAD604 stage I cohort we found that KRAS-G12C mutated tumours had worse RFS when compared to KRAS-nonG12C mutated tumours in univariable analysis (HR 3.5). In the pooled stage I cohort we found that KRAS-G12C mutated tumours had worse DFS when compared to KRAS-nonG12C mutated tumours (HR 2.6), to KRAS wild-type tumours (HR 1.6) and to any other tumours (HR 1.8); in multivariable analysis, the KRAS-G12C mutation was associated with worse DFS (HR 1.61). Our results suggest that patients with resected, stage I LUAD with a KRAS-G12C mutation may have inferior survival outcomes..
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Affiliation(s)
- F T Gallina
- Thoracic Surgery Unit, IRCCS "Regina Elena" National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy.
| | - D Marinelli
- Department of Experimental Medicine, Sapienza University, Viale Regina Elena 324, 00161 Roma RM, Italy.
| | - E Melis
- Thoracic Surgery Unit, IRCCS "Regina Elena" National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
| | - D Forcella
- Thoracic Surgery Unit, IRCCS "Regina Elena" National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
| | - R Taje
- Thoracic Surgery Unit, IRCCS "Regina Elena" National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
| | - S Buglioni
- Department of Pathology, IRCCS "Regina Elena" National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
| | - P Visca
- Department of Pathology, IRCCS "Regina Elena" National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
| | - A Torchia
- Department of Radiological, Oncological and Anatomopathological Sciences, Sapienza University, Viale Regina Elena 324, 00161 Roma RM, Italy
| | - F L Cecere
- Medical Oncology Unit 2, IRCCS "Regina Elena" National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
| | - A Botticelli
- Department of Radiological, Oncological and Anatomopathological Sciences, Sapienza University, Viale Regina Elena 324, 00161 Roma RM, Italy
| | - D Santini
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Corso della Repubblica 79, 04100 Latina, Italy
| | - G Ciliberto
- Scientific Direction, IRCCS "Regina Elena" National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
| | - F Cappuzzo
- Medical Oncology Unit 2, IRCCS "Regina Elena" National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
| | - F Facciolo
- Thoracic Surgery Unit, IRCCS "Regina Elena" National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
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8
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Tommaso Gallina F, Tajè R, Letizia Cecere F, Forcella D, Landi L, Minuti G, Fusco F, Buglioni S, Visca P, Melis E, Sperduti I, Ciliberto G, Cappuzzo F, Facciolo F. ALK rearrangement is an independent predictive factor of unexpected nodal metastasis after surgery in early stage, clinical node negative lung adenocarcinoma. Lung Cancer 2023; 180:107215. [PMID: 37126920 DOI: 10.1016/j.lungcan.2023.107215] [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: 01/23/2023] [Revised: 03/28/2023] [Accepted: 04/19/2023] [Indexed: 05/03/2023]
Abstract
OBJECTIVES Despite notable advances made in preoperative staging, unexpected nodal metastases after surgery are still significantly detected. Given the promising role of neoadjuvant targeted treatments, the definition of novel predictive factors of nodal metastases is an extremely important issue. In this study we aim to analyze the upstaging rate in patients with early stage NSCLC without evidence of nodal disease in the preoperative staging who underwent lobectomy and radical lymphadenectomy. MATERIAL AND METHODS Patients who underwent lobectomy and systematic lymphadenectomy for early stage LUAD without evidence of nodal disease at the preoperative staging using NGS analysis for actionable molecular targets evaluation after surgery were evaluated. Exclusion criteria included the neoadjuvant treatment, incomplete resection and no adherence to preoperative guidelines. RESULTS A total of 359 patients were included in the study. 172 patients were female, and the median age was 68 (61-72). The variables that showed a significant correlation with the upstaging rate at the univariate analysis were the ALK rearrangement, the number of resected lymph nodes and the diameter of the tumor. This result was confirmed in the multivariate analysis, with an OR of 8.052 (CI95% 3.123-20.763, p = 0.00001) for ALK rearrangement, 1.087 (CI95% 1.048-1.127, p = 0.00001) for the number of resected nodes and 1.817 (CI95% 1.214-2.719, p = 0.004) for cT status. CONCLUSION Our results showed that in a homogeneous cohort of patients with clinical node early stage LUAD the ALK rearrangement, the number of resected lymph nodes and the tumor diameter can significantly predict nodal metastasis.
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Affiliation(s)
| | - Riccardo Tajè
- Thoracic Surgery Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | | | - Daniele Forcella
- Thoracic Surgery Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Lorenza Landi
- Clinical Trials Center: Phase 1 and Precision Medicine, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Gabriele Minuti
- Clinical Trials Center: Phase 1 and Precision Medicine, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Francesca Fusco
- Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Simonetta Buglioni
- Department of Pathology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Paolo Visca
- Department of Pathology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Enrico Melis
- Thoracic Surgery Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Isabella Sperduti
- Biostatistics, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Gennaro Ciliberto
- Scientific Direction, IRCSS Regina Elena National Cancer Institute, Rome, Italy
| | - Federico Cappuzzo
- Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Francesco Facciolo
- Thoracic Surgery Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
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9
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Piccirillo MC, Chu Q, Bradbury P, Tu W, Coschi CH, Grosso F, Florescu M, Mencoboni M, Goffin JR, Pagano M, Ciardiello F, Cecere FL, Vincent M, Ferrara R, Dawe DE, Hao D, Lee CW, Morabito A, Gridelli C, Cavanna L, Iqbal M, Blais N, Leighl NB, Wheatley-Price P, Tsao MS, Ugo F, El-Osta H, Gargiulo P, Gaudreau PO, Tu D, Sederias J, Brown-Walker P, Perrone F, Seymour L, Laurie SA. Brief Report: Canadian Cancer Trials Group IND.227: A Phase 2 Randomized Study of Pembrolizumab in Patients With Advanced Malignant Pleural Mesothelioma (NCT02784171). J Thorac Oncol 2023; 18:813-819. [PMID: 36841541 DOI: 10.1016/j.jtho.2023.02.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [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: 12/21/2022] [Revised: 01/25/2023] [Accepted: 02/03/2023] [Indexed: 02/27/2023]
Abstract
Immune checkpoint inhibitors have activity in mesothelioma. IND.227 was a phase 2 trial (120 patients planned) comparing progression-free survival of standard platinum and pemetrexed (CP) versus CP + pembrolizumab (pembro) versus pembro. Accrual to the pembro arm was discontinued on the basis of interim analysis (IA-16 wk disease control rate). CP + pembro was tolerable, with progression-free survival similar between arms and median survival and overall response rate higher than those of CP alone (19.8 mo [95% confidence interval or CI: 8.4-41.36] versus 8.9 mo [95% CI: 5.3-12.8] and 47% [95% CI: 24%-71%] versus 19% [95% CI: 5%-42%], respectively). The subsequent phase 3 trial has completed accrual; results are expected in 2023.
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Affiliation(s)
- Maria Carmela Piccirillo
- Clinical Trials Unit, Istituto Nazionale Tumori Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione G Pascale, Napoli, Italy
| | - Quincy Chu
- Cross Cancer Institute, Edmonton, Alberta, Canada
| | | | - Wei Tu
- Canadian Cancer Trials Group, Kingston, Ontario, Canada
| | | | - Federica Grosso
- Mesothelioma Unit (FG) & Department of Integrated Activities Research and Innovation (FU), SS. Antonio e Biagio C. Arrigo Hospital, Alessandria, Italy
| | - Marie Florescu
- Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada
| | | | | | - Maria Pagano
- Medical Oncology, Comprehensive Cancer Centre, AUSL Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) of Reggio Emilia, Reggio Emilia, Italy
| | - Fortunato Ciardiello
- Oncology and Hematology Unit, University of Campania "Luigi Vanvitelli," Naples, Italy
| | - Fabiana Letizia Cecere
- Oncology Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituti Fisioterapici Ospitalieri (IFO) Istituto Regina Elena, Rome, Italy
| | - Mark Vincent
- London Regional Cancer Program, London, Ontario, Canada
| | - Roberto Ferrara
- Thoracic Oncology Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale Tumori, Milano, Italy
| | - David E Dawe
- Department of Medical Oncology and Hematology, CancerCare Manitoba, Winnipeg, Canada
| | - Desiree Hao
- Tom Baker Cancer Centre and Cumming School of Medicine, Calgary, Alberta, Canada
| | | | - Alessandro Morabito
- Thoracic Oncology Unit, Istituto Nazionale Tumori Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione G. Pascale, Napoli, Italy
| | - Cesare Gridelli
- Oncology Unit, S. Giuseppe Moscati Hospital, Avellino, Italy
| | - Luigi Cavanna
- Oncology and Hematology Department, USL Piacenza, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | | | - Normand Blais
- Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada
| | | | - Paul Wheatley-Price
- Ottawa Hospital Research Institute and Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Francesca Ugo
- Mesothelioma Unit (FG) & Department of Integrated Activities Research and Innovation (FU), SS. Antonio e Biagio C. Arrigo Hospital, Alessandria, Italy
| | | | - Piera Gargiulo
- Clinical Trials Unit, Istituto Nazionale Tumori Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione G Pascale, Napoli, Italy
| | | | - Dongsheng Tu
- Canadian Cancer Trials Group, Kingston, Ontario, Canada
| | | | | | - Francesco Perrone
- Clinical Trials Unit, Istituto Nazionale Tumori Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione G Pascale, Napoli, Italy
| | - Lesley Seymour
- Canadian Cancer Trials Group, Kingston, Ontario, Canada.
| | - Scott A Laurie
- Ottawa Hospital Research Institute and Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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Terrenato I, Ercolani C, Di Benedetto A, Gallo E, Melucci E, Casini B, Rollo F, Palange A, Visca P, Pescarmona E, Melis E, Gallina F, Sacconi A, Cecere FL, Landi L, Cappuzzo F, Ciliberto G, Buglioni S. A Real-World Systematic Analysis of Driver Mutations' Prevalence in Early- and Advanced-Stage NSCLC: Implications for Targeted Therapies in the Adjuvant Setting. Cancers (Basel) 2022; 14:cancers14122971. [PMID: 35740637 PMCID: PMC9221477 DOI: 10.3390/cancers14122971] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 06/09/2022] [Accepted: 06/09/2022] [Indexed: 12/10/2022] Open
Abstract
Simple Summary The development of oncogene-targeted drugs has radically changed the course of non small cell lung carcinoma (NSCLC) in the advanced stage. Recently, the ADAURA trial demonstrated the efficacy of Osimertinib also in the adjuvant setting of EGFR-mutated NSCLC. This raises the question regarding whether the same paradigm applies also to currently approved drugs directed against non-EGFR NSCLC drivers. Herein we compared actionable genomic alterations in early- and advanced-stage NSCLC in 1961 unselected single-institution cases analyzed by routine molecular diagnostics procedures. Our data add significantly to the currently limited real-world data on actionable mutations in surgically resectable NSCLC. Our finding that distinct NSCLC genomic drivers are mutated at similar frequencies in early- and advanced-stage tumors implies that the relative biological potency of currently actionable NSCLC genomic drivers is conserved throughout clinical evolution and supports the hypothesis that genotype-matched therapies are likely to provide significant benefit in an adjuvant setting Abstract The approval of osimertinib for adjuvant treatment of stage I–II–III EGFR-mutated NSCLC (early stage) represents a paradigm shift, raising the question of whether other genotype-matched therapeutics approved for advanced-stage NSCLC can also provide clinical benefit in the adjuvant setting. However, there is a paucity of real-world data on the prevalence of actionable genomic alterations (GAs) in early-stage NSCLC. We used next-generation sequencing, complemented by immunohistochemistry and fluorescence in situ hybridization, to screen our single-institution cohort of 1961 NSCLC consecutive cases for actionable molecular targets. The prevalence of actionable GAs was comparable in early versus advanced-stage NSCLC, the only exception being KRAS mutations (more frequent in early-stage cases). Consistent with advanced-stage tumors being more aggressive, co-occurrence of TP53 and EGFR GAs as well as copy number gains were less frequent in early-stage tumors. EGFR mutations and high expression of PD-L1 were inversely associated, whereas KRAS mutations and high PD-L1 reactivity showed positive association. Recapitulating advanced-stage tumors, early-stage NSCLC had the highest share of EGFR mutations in lepidic and acinar subtypes. Resected lepidic tumors contained the highest proportion of the KRAS G12C actionable variant. These results, obtained with routine diagnostic technologies in an unselected clinical setting, provide a significant addition of real-world data in early-stage NSCLC.
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Affiliation(s)
- Irene Terrenato
- UOSD Clinical Trial Center, Biostatistics and Bioinformatics, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy; (I.T.); (A.S.)
| | - Cristiana Ercolani
- Pathology Unit, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy; (C.E.); (A.D.B.); (E.G.); (E.M.); (B.C.); (F.R.); (A.P.); (P.V.); (E.P.)
| | - Anna Di Benedetto
- Pathology Unit, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy; (C.E.); (A.D.B.); (E.G.); (E.M.); (B.C.); (F.R.); (A.P.); (P.V.); (E.P.)
| | - Enzo Gallo
- Pathology Unit, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy; (C.E.); (A.D.B.); (E.G.); (E.M.); (B.C.); (F.R.); (A.P.); (P.V.); (E.P.)
| | - Elisa Melucci
- Pathology Unit, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy; (C.E.); (A.D.B.); (E.G.); (E.M.); (B.C.); (F.R.); (A.P.); (P.V.); (E.P.)
| | - Beatrice Casini
- Pathology Unit, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy; (C.E.); (A.D.B.); (E.G.); (E.M.); (B.C.); (F.R.); (A.P.); (P.V.); (E.P.)
| | - Francesca Rollo
- Pathology Unit, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy; (C.E.); (A.D.B.); (E.G.); (E.M.); (B.C.); (F.R.); (A.P.); (P.V.); (E.P.)
| | - Aldo Palange
- Pathology Unit, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy; (C.E.); (A.D.B.); (E.G.); (E.M.); (B.C.); (F.R.); (A.P.); (P.V.); (E.P.)
| | - Paolo Visca
- Pathology Unit, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy; (C.E.); (A.D.B.); (E.G.); (E.M.); (B.C.); (F.R.); (A.P.); (P.V.); (E.P.)
| | - Edoardo Pescarmona
- Pathology Unit, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy; (C.E.); (A.D.B.); (E.G.); (E.M.); (B.C.); (F.R.); (A.P.); (P.V.); (E.P.)
| | - Enrico Melis
- Thoracic Surgery, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy; (E.M.); (F.G.)
| | - Filippo Gallina
- Thoracic Surgery, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy; (E.M.); (F.G.)
| | - Andrea Sacconi
- UOSD Clinical Trial Center, Biostatistics and Bioinformatics, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy; (I.T.); (A.S.)
| | - Fabiana Letizia Cecere
- Division of Medical Oncology 1, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy;
| | - Lorenza Landi
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy; (L.L.); (F.C.)
| | - Federico Cappuzzo
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy; (L.L.); (F.C.)
| | - Gennaro Ciliberto
- Scientific Direction, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy;
| | - Simonetta Buglioni
- Pathology Unit, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy; (C.E.); (A.D.B.); (E.G.); (E.M.); (B.C.); (F.R.); (A.P.); (P.V.); (E.P.)
- Correspondence: ; Tel.: +39-0652-662-923
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Popat S, Felip E, Kim ES, de Marinis F, Cho BC, Wermke M, De Langen A, Ferrara R, Kanzler S, Cecere FL, Galetta D, Lee DH, Gregorc V, Rodrigues A, Britschgi C, Rahman A, Ndunda D, Noe J, Lu D, Besse B. AcceleRET Lung: A phase 3 study of first-line pralsetinib in patients with RET fusion–positive advanced/metastatic NSCLC. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.tps9159] [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
TPS9159 Background: RET gene fusions have been identified as oncogenic drivers in multiple tumor types, including 1–2% of non-small cell lung cancer (NSCLC). Pralsetinib is a potent, selective RET inhibitor, approved in the US and EU for the treatment of metastatic RET fusion–positive NSCLC based on the phase 1/2 ARROW study (NCT03037385). In the ARROW study (data cutoff: Nov 6, 2020), patients who initiated 400 mg once daily (QD) of pralsetinib after platinum-based chemotherapy achieved an overall response rate (ORR) of 62%, per independent central review. In the treatment-naïve group, the ORR was 79%. Most treatment-related adverse events were grade 1–2 across the entire safety population treated at 400 mg QD (n=471). AcceleRET Lung, an international, open-label, randomized, phase 3 study (NCT04222972), will evaluate the efficacy and safety of pralsetinib versus standard of care (SOC) for first-line treatment of advanced/metastatic RET fusion–positive NSCLC. Abstracts for this study were previously submitted to the European Lung Cancer Congress 2020, the American Society of Clinical Oncology 2020 annual meeting, and 2020 World Conference on Lung Cancer. Methods: Approximately 226 patients with metastatic RET fusion–positive NSCLC will be randomized 1:1 to oral pralsetinib (400 mg QD) or SOC (non-squamous histology: platinum/pemetrexed ± pembrolizumab followed by maintenance pemetrexed ± pembrolizumab [at investigator’s discretion]; squamous histology: platinum/gemcitabine or platinum + pembrolizumab + paclitaxel/nab-paclitaxel followed by maintenance pembrolizumab). Stratification factors include intended use of pembrolizumab, history of brain metastases, and Eastern Cooperative Oncology Group Performance Status. Key eligibility criteria include no prior systemic treatment for advanced/metastatic NSCLC; RET fusion–positive tumor by local or central assessment; no additional actionable oncogenic drivers; no prior selective RET inhibitor; measurable disease per Response Evaluation Criteria in Solid Tumors (RECIST) v1.1. Patients with central nervous system metastases were permitted if asymptomatic and on a stable dose of corticosteroids. Cross-over to receive pralsetinib upon disease progression will be permitted for patients randomized to SOC. The primary endpoint is progression-free survival (blinded independent central review; RECIST v1.1). Secondary endpoints include ORR, overall survival, duration of response, disease control rate, clinical benefit rate, time to intracranial progression, intracranial ORR, safety/tolerability and quality of life evaluations. Identification of potential biomarkers of antineoplastic activity and resistance was an exploratory endpoint. Recruitment has begun with sites (active or planned) in North America, Central America, Europe and Asia. Clinical trial information: NCT04222972.
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Affiliation(s)
- Sanjay Popat
- Lung Cancer Unit, Department of Medicine, The Royal Marsden Hospital, London, United Kingdom
| | - Enriqueta Felip
- Vall d’Hebron University Hospital and Institute of Oncology (VHIO), Medical Oncology Department, Barcelona, Spain
| | | | | | - Byoung Chul Cho
- Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Martin Wermke
- University Hospital Carl Gustav Carus, Dresden, Germany
| | | | - Roberto Ferrara
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Stephan Kanzler
- Leopoldina Krankenhaus-Medizinische Klinik 2, Schweinfurt, Germany
| | - Fabiana Letizia Cecere
- Fabiana Letizia Cecere Medical Oncology 1, IRCCS Regina Elena National Cancer Institute Rome, Rome, Italy
| | | | - Dae Ho Lee
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | | | | | - Christian Britschgi
- University Hospital of Zürich - Department of Medical Oncology and Hematology, Comprehensive Cancer Center Zurich, Zürich, Switzerland
| | | | | | | | - Danny Lu
- F. Hoffmann-La Roche, Ltd., Mississauga, ON, Canada
| | - Benjamin Besse
- Cancer Medicine Department, Gustave Roussy, Villejuif, France
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12
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Gallina FT, Tajè R, Forcella D, Corzani F, Cerasoli V, Visca P, Coccia C, Pierconti F, Sperduti I, Cecere FL, Cappuzzo F, Melis E, Facciolo F. Oncological Outcomes of Robotic Lobectomy and Radical Lymphadenectomy for Early-Stage Non-Small Cell Lung Cancer. J Clin Med 2022; 11:jcm11082173. [PMID: 35456265 PMCID: PMC9025272 DOI: 10.3390/jcm11082173] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/10/2022] [Accepted: 04/11/2022] [Indexed: 12/14/2022] Open
Abstract
Background: While the thoracotomy approach was considered the gold standard until two decades ago, robotic surgery has increasingly strengthened its role in lung cancer treatment, improving patients’ peri-operative outcomes. In this study, we report our experience in robotic lobectomy for early-stage non-small cell lung cancer, with particular attention to oncological outcomes and nodal upstaging rate. Methods: We retrospectively reviewed patients who underwent lobectomy and radical lymphadenectomy at our Institute between 2016 and 2020. We selected 299 patients who met the inclusion criteria of the study. We analyzed the demographic features of the groups as well as their nodal upstaging rate after pathological examination. Then, we analyzed disease-free and overall survival of the entire enrolled patient population and we compared the same oncological outcomes in the upstaging and the non-upstaging group. Results: A total of 299 patients who underwent robotic lobectomy were enrolled. After surgery, 55 patients reported nodal hilar or mediastinal upstaging. The 3-year overall survival of the entire population was 82.8%. The upstaging group and the non-upstaging group were homogeneous for age, gender, smoking habits, clinical stage, tumor site, tumor histology. The non-upstaging group had better OS (p = 0.004) and DFS (p < 0.0001). Conclusion: Our results show that robotic surgery is a safe and feasible approach for the treatment of early-stage NSCLC, especially for its accuracy in mediastinal lymphadenectomy. The oncological outcomes were encouraging and consistent with previous findings.
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Affiliation(s)
- Filippo Tommaso Gallina
- Thoracic Surgery Unit, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy; (R.T.); (D.F.); (F.C.); (V.C.); (E.M.); (F.F.)
- Correspondence: ; Tel.: +39-0652665218
| | - Riccardo Tajè
- Thoracic Surgery Unit, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy; (R.T.); (D.F.); (F.C.); (V.C.); (E.M.); (F.F.)
| | - Daniele Forcella
- Thoracic Surgery Unit, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy; (R.T.); (D.F.); (F.C.); (V.C.); (E.M.); (F.F.)
| | - Felicita Corzani
- Thoracic Surgery Unit, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy; (R.T.); (D.F.); (F.C.); (V.C.); (E.M.); (F.F.)
| | - Virna Cerasoli
- Thoracic Surgery Unit, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy; (R.T.); (D.F.); (F.C.); (V.C.); (E.M.); (F.F.)
| | - Paolo Visca
- Department of Pathology, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy;
| | - Cecilia Coccia
- Anesthesiology and Intensive Care Unit, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy; (C.C.); (F.P.)
| | - Federico Pierconti
- Anesthesiology and Intensive Care Unit, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy; (C.C.); (F.P.)
| | - Isabella Sperduti
- Biostatistics, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy;
| | | | - Federico Cappuzzo
- Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy;
| | - Enrico Melis
- Thoracic Surgery Unit, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy; (R.T.); (D.F.); (F.C.); (V.C.); (E.M.); (F.F.)
| | - Francesco Facciolo
- Thoracic Surgery Unit, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy; (R.T.); (D.F.); (F.C.); (V.C.); (E.M.); (F.F.)
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13
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Ercolani C, Di Benedetto A, Bonomo C, Visca P, Palange A, Assisi D, Forcella D, Terrenato I, Pescarmona E, Ciliberto G, Cecere FL, Cappuzzo F, Buglioni S. Not enough can be enough: feasibility of the Idylla EGFR mutation test when reuse of stained tissue slides is the only option available. J Clin Pathol 2021; 75:844-850. [PMID: 34400544 DOI: 10.1136/jclinpath-2021-207726] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 06/03/2021] [Accepted: 07/27/2021] [Indexed: 11/03/2022]
Abstract
AIMS The minimally invasive procedures used in the diagnostic workup of patients with advanced non-small cell lung cancer (NSCLC) often provide poor yields of pathological material suitable for molecular analyses. Not infrequently, the DNA yield from small biopsies/cytological samples is insufficient for the assessment of genomic biomarkers that inform personalised therapies. The Idylla EGFR mutation test (IEMT) has been specifically designed to process formalin-fixed paraffin-embedded sections without requiring preliminary DNA extraction.This study aims to evaluate the diagnostic accuracy of IEMT when used to analyse archival histopathology material. More specifically, our objective was to establish whether or not different staining procedures could affect assay performance. METHODS Twenty NSCLC samples were selected accordingly to EGFR mutational status. To mimic archived stained material, sections were subjected to H&E staining, fluorescent in situ hybridisation analyses or immunodetection by immunohistochemistry before being processed for IEMT. RESULTS Parallel assessment of EGFR mutational status by IEMT on stained sections and next-generation sequencing on DNA yielded a concordant result in 50 out of 60 tests (83.3%). The discoloration of H&E of the archived sample was found to be the optimal procedure to highlight all the actionable alterations of EGFR. CONCLUSIONS IEMT can provide remarkable diagnostic accuracy for the assessment of EGFR mutational status also when the only source of pathological material available for molecular analyses is represented by H&E stained sections. Ad hoc supervision by a qualified molecular biologist is in any case recommended.
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Affiliation(s)
- Cristiana Ercolani
- Pathology Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Anna Di Benedetto
- Pathology Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Claudia Bonomo
- Pathology Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Paolo Visca
- Pathology Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Aldo Palange
- Pathology Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Daniela Assisi
- Department of Digestive Endoscopy, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Daniele Forcella
- Thoracic Surgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Irene Terrenato
- Biostatistics-Scientific Direction, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Edoardo Pescarmona
- Pathology Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Gennaro Ciliberto
- Scientific Direction, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Fabiana Letizia Cecere
- Division of Medical Oncology 1, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Federico Cappuzzo
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Simonetta Buglioni
- Pathology Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
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14
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Gallina FT, Melis E, Forcella D, Mercadante E, Marinelli D, Ceddia S, Cappuzzo F, Vari S, Cecere FL, Caterino M, Vidiri A, Visca P, Buglioni S, Sperduti I, Marino M, Facciolo F. Nodal Upstaging Evaluation After Robotic-Assisted Lobectomy for Early-Stage Non-small Cell Lung Cancer Compared to Video-Assisted Thoracic Surgery and Thoracotomy: A Retrospective Single Center Analysis. Front Surg 2021; 8:666158. [PMID: 34277693 PMCID: PMC8280310 DOI: 10.3389/fsurg.2021.666158] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 02/09/2021] [Accepted: 05/18/2021] [Indexed: 12/25/2022] Open
Abstract
Introduction: The standard surgical procedures for patients with early-stage NSCLC is lobectomy-associated radical lymphadenectomy performed by using the thoracotomy approach. In the last few years, minimally invasive techniques have increasingly strengthened their role in lung cancer treatment, especially in the early stage of the disease. Although the lobectomy technique has been accepted, controversy still surrounds lymph node dissection. In our study, we analyze the rate of upstaging early non-small cell lung cancer patients who underwent radical surgical treatment using the robotic and the VATS techniques compared to the standard thoracotomy approach. Methods and Materials: We retrospectively reviewed patients who underwent a lobectomy and radical lymphadenectomy at our Institute between 2010 and 2019. We selected 505 patients who met the inclusion criteria of the study: 237 patients underwent robotic surgery, 158 patients had thoracotomy, and 110 patients were treated with VATS. We analyzed the demographic features between the groups as well as the nodal upstaging rate after pathological examination, the number of dissected lymph nodes and the ratio of dissected lymph nodes to metastatic lymph nodes of the three groups. Results: The patients of the three groups were homogenous with respect to age, sex, and histology. The postoperative major morbidity rate was significantly higher in the thoracotomy group, and hospital stay was significantly longer. The percentage of the mediastinal nodal upstaging rate and the number of dissected lymph nodes was significantly higher in the robotic group compared with the VATS group. The ratio of dissected lymph nodes to metastatic lymph nodes was significantly lower compared with the VATS group and the thoracotomy group. Discussion: The prognostic impact of the R(un) status is still highly debated. A surgical approach that allows better results in terms of resection has still not been defined. Our results show that robotic surgery is a safe and feasible approach especially regarding the accuracy of mediastinal lymphadenectomy. These findings can lead to defining a more precise pathological stage of the disease and, if necessary, to more accurate postoperative treatment.
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Affiliation(s)
| | - Enrico Melis
- Thoracic Surgery Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Daniele Forcella
- Thoracic Surgery Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Edoardo Mercadante
- Thoracic Surgery Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Daniele Marinelli
- Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Serena Ceddia
- Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Federico Cappuzzo
- Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Sabrina Vari
- Medical Oncology 1, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | | | - Mauro Caterino
- Radiology Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Antonello Vidiri
- Radiology Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Paolo Visca
- Department of Pathology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Simonetta Buglioni
- Department of Pathology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Isabella Sperduti
- Department of Biostatistics, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Mirella Marino
- Department of Pathology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Francesco Facciolo
- Thoracic Surgery Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
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15
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Bassanelli M, Ricciuti B, Giannarelli D, Cecere FL, Roberto M, Giacinti S, Barucca V, Santarelli M, Ruggeri EM, Marchetti P, Cognetti F, Gelibter A, Cortesi E, Chiari R, Milella M, Ceribelli A. Systemic effect of radiotherapy before or after nivolumab in lung cancer: an observational, retrospective, multicenter study. Tumori 2021; 108:250-257. [PMID: 33818208 DOI: 10.1177/03008916211004733] [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: 11/15/2022]
Abstract
BACKGROUND The combination of radiotherapy (RT) and programmed death 1 inhibitors seems to increase antitumor immune responses. OBJECTIVE To assess the outcome and the role of the best combination sequence, i.e. immunotherapy given before, during, and/or after RT, in patients with non-small cell lung cancer (NSCLC). METHODS We conducted an observational, retrospective analysis of 95 consecutive patients with advanced NSCLC who received any radiotherapy treatment and nivolumab, as clinically indicated. Median overall survival (OS) and the 95% confidence interval (CI) were estimated with the Kaplan-Meier method. Cox model was used to obtain hazard ratio (HR) and associated 95% CI with statistical inference by log-rank statistic. RESULTS Median OS was 11.9 months (95% CI, 6.6-17.2). Patients who received radiotherapy during an immune checkpoint inhibitor treatment started more than 60 days before showed a better outcome than patients who started immunotherapy over 60 days after RT ending (HR, 2.90 [1.37-6.12], p = 0.005; median OS, 22.4 months vs 8.6 months, p = 0.005). Median progression-free survival was 6.3 months (95% CI, 4.6-8.0). CONCLUSIONS This study shows that combining irradiation with nivolumab for the treatment of advanced NSCLC leads to improved OS. The optimal time window for the combination of RT and immunotherapy seems to play a critical role for therapeutic antitumor response derived by abscopal effect.
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Affiliation(s)
- Maria Bassanelli
- Department of Oncology, San Camillo de Lellis Hospital, Rieti, Italy
| | - Biagio Ricciuti
- Department of Oncology, Santa Maria della Misericordia Hospital, Azienda Ospedaliera di Perugia, Perugia, Italy
| | - Diana Giannarelli
- Biostatistic Unit, IRCSS Regina Elena National Cancer Institute, Rome, Italy
| | - Fabiana Letizia Cecere
- Division of Medical Oncology 1, IRCSS Regina Elena National Cancer Institute, Rome, Italy
| | - Michela Roberto
- Department of Oncology, University of Rome "Sapienza," Rome, Italy
| | - Silvana Giacinti
- Department of Oncology, Belcolle Hospital-Viterbo, Viterbo, Italy
| | - Viola Barucca
- Department of Oncology, Misericordia Hospital, Grosseto, Italy
| | - Mario Santarelli
- Department of Radiotherapy, San Camillo de Lellis Hospital, Rieti, Lazio, Italy
| | | | - Paolo Marchetti
- Department of Oncology, University of Rome "Sapienza," Rome, Italy
| | - Francesco Cognetti
- Division of Medical Oncology 1, Regina Elena National Cancer Institute, Rome, Italy.,Department of Clinical and Molecular Medicine, La Sapienza University, Rome, Italy
| | - Alain Gelibter
- Medical Oncology Unit, Policlinico Umberto I, Rome, Italy
| | - Enrico Cortesi
- Medical Oncology Unit, Policlinico Umberto I, Rome, Italy
| | - Rita Chiari
- Department of Medical Oncology, Santa Maria della Misericordia Hospital, Azienda Ospedaliera di Perugia, Perugia, Italy
| | - Michele Milella
- Division of Oncology, Integrated University Hospital of Verona, Verona, Italy
| | - Anna Ceribelli
- Department of Oncology, San Camillo de Lellis Hospital, Rieti, Italy
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16
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Berardi R, Torniai M, Cona MS, Cecere FL, Chiari R, Guarneri V, La Verde N, Locati L, Lorusso D, Martinelli E, Giannarelli D, Garassino MC. Social distress among medical oncologists and other healthcare professionals during the first wave of COVID-19 pandemic in Italy. ESMO Open 2021; 6:100053. [PMID: 33601297 PMCID: PMC7900700 DOI: 10.1016/j.esmoop.2021.100053] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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: 12/16/2020] [Accepted: 01/03/2021] [Indexed: 11/30/2022] Open
Abstract
Background Coronavirus disease 2019 (COVID-19) has rapidly spread to every country around the world taking on pandemic proportions. Since 8 March 2020, the Italian government ordered a nationwide lockdown with unavoidable social isolation. Healthcare professionals (HCPs) represent the most physically and emotionally involved category. The aim of this study is to assess the social distress among HCPs in Italy. Patients and methods In this online, totally anonymous survey, 24 multiple choice questions were posed to medical staff employed in the Italian Healthcare System during the COVID-19 pandemic. Data collection was performed from 30 March to 24 April 2020. Results A total of 600 HCPs completed the questionnaire. The majority of respondents expressed the fear of being at higher risk of contagion than the general population (83.3%) and the weighty concern of infecting their families (72.5%). An insufficient supply of personal protective equipment (PPE; P = 0.0003) and inadequate training about procedures to follow (P = 0.0092) were seen to significantly coincide with these worries. More than two-thirds declared a change in family organisation, which showed a significant correlation with the concern of infecting their relatives (P < 0.0001). Conclusions This is the first Italian survey on social distress among HCPs during the COVID-19 pandemic. The unavailability of PPE, screening procedures and adequate training strongly affected HCPs' emotional status. Although there was a predominance of oncologists (especially from the North of Italy), which impairs the generalisation of our findings, this survey underlined the social impact that this health emergency has had on HCPs. This is the first Italian survey on healthcare professionals’ (HCPs) social distress during the coronavirus disease 2019 (COVID-19) pandemic. The majority expressed the fear of being at high risk of contagion and the weighty concern of infecting their families. Insufficient supply of personal protective equipment and inadequate training about procedures correlate with these worries. Reducing workers’ psychological distress will certainly yield significant positive benefits for HCPs and health system.
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Affiliation(s)
- R Berardi
- Clinica Oncologica, Università Politecnica Marche - Ospedali Riuniti, Ancona, Italy.
| | - M Torniai
- Clinica Oncologica, Università Politecnica Marche - Ospedali Riuniti, Ancona, Italy
| | - M S Cona
- Department of Oncology, Ospedale Luigi Sacco - ASST Fatebenefratelli Sacco, Milan, Italy
| | - F L Cecere
- IRCCS Regina Elena, National Cancer Institute, Rome, Italy
| | - R Chiari
- UOC Oncologia Padova Sud-AULSS 6 Euganea, Padova, Italy
| | - V Guarneri
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy; Medical Oncology 2, Istituto Oncologico Veneto IOV IRCCS, Padova, Italy
| | - N La Verde
- Department of Oncology, Ospedale Luigi Sacco - ASST Fatebenefratelli Sacco, Milan, Italy
| | - L Locati
- Head and Neck Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - D Lorusso
- Gynecologic Oncology Unit and Scientific Directorate, Fondazione Policlinico Universitario Gemelli IRCCS, Catholic University of Sacred Heart, Rome, Italy
| | - E Martinelli
- Oncologia Medica, Dipartimento di Medicina di Precisione, Università degli Studi della Campania 'L. Vanvitelli', Napoli, Italy
| | - D Giannarelli
- Biostatistical Unit, Regina Elena National Cancer Institute, IRCCS, Rome, Italy
| | - M C Garassino
- Thoracic Oncology Unit, Medical Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
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17
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Ganzinelli M, Linardou H, Alvisi MF, Caiola E, Lo Russo G, Cecere FL, Bettini AC, Psyrri A, Milella M, Rulli E, Fabbri A, De Maglie M, Romanelli P, Murray S, Broggini M, Marabese M, Garassino MC. Single-arm, open label prospective trial to assess prediction of the role of ERCC1/XPF complex in the response of advanced NSCLC patients to platinum-based chemotherapy. ESMO Open 2021; 6:100034. [PMID: 33422766 PMCID: PMC7809372 DOI: 10.1016/j.esmoop.2020.100034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 11/24/2020] [Accepted: 12/06/2020] [Indexed: 11/05/2022] Open
Abstract
Background Platinum-based therapy, combined or not with immune checkpoint inhibitors, represents a front-line choice for patients with non-small-cell lung cancer (NSCLC). Despite the improved outcomes in the last years for this malignancy, only a sub-group of patients have long-term benefit. Excision repair cross-complementation group 1 (ERCC1) has been considered a potential biomarker to predict the outcome of platinum-based chemotherapy in NSCLC. However, the ERCC1 gene is transcribed in four splice variants where the isoform 202 was described as the only one active and able to complex Xeroderma pigmentosum group F-complementing protein (XPF). Here, we prospectively investigated if the active form of ERCC1, as assessed by the ERCC1/XPF complex (ERCC1/XPF), could predict the sensitivity to platinum compounds. Patients and methods Prospectively enrolled, patients with advanced NSCLC treated with a first-line regimen containing platinum were centrally evaluated for ERCC1/XPF by a proximity ligation assay. Overall survival (OS), progression-free survival (PFS) and objective response rate (ORR) were analyzed. Results The absence of the ERCC1/XPF in the tumor suggested a trend of worst outcomes in terms of both OS [hazard ratio (HR) 1.41, 95% confidence interval (CI) 0.67-2.94, P = 0.373] and PFS (HR 1.61, 95% CI 0.88-3.03, P = 0.123). ORR was marginally influenced in ERCC1/XPF-negative and -positive groups [odds ratio (stable disease + progressive disease versus complete response + partial response) 0.87, 95% CI 0.25-3.07, P = 0.832]. Conclusion The lack of ERCC1/XPF complex in NSCLC tumor cells might delineate a group of patients with poor outcomes when treated with platinum compounds. ERCC1/XPF absence might well identify patients for whom a different therapeutic approach could be necessary. This is the first study investigating the ERCC1/XPF complex as a platinum-based therapy response biomarker in NSCLC. The lack of ERCC1/XPF complex might delineate a group of patients with poor outcomes when treated with platinum compounds. ERCC1/XPF absence might identify tumors for whom a different therapeutic approach than platinum compounds could be necessary.
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Affiliation(s)
- M Ganzinelli
- Unit of Thoracic Oncology, Medical Oncology Department 1, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - H Linardou
- 4th Oncology Department, Metropolitan Hospital, Athens, Greece
| | - M F Alvisi
- Laboratory of Methodology for Clinical Research, Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - E Caiola
- Laboratory of Molecular Pharmacology, Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - G Lo Russo
- Unit of Thoracic Oncology, Medical Oncology Department 1, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - F L Cecere
- Division of Medical Oncology 1, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - A C Bettini
- UO Oncologia Medica, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - A Psyrri
- Section of Oncology, Department of Internal Medicine, Attikon Hospital, National Kapodistrian University of Athens, Athens, Greece
| | - M Milella
- Department of Medicine, Section of Medical Oncology, University and Hospital Trust of Verona, Verona, Italy
| | - E Rulli
- Laboratory of Methodology for Clinical Research, Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - A Fabbri
- Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - M De Maglie
- Mouse and Animal Pathology Lab, Fondazione Filarete, Milan, Italy; Department of Veterinary Medicine, University of Milan, Milan, Italy
| | - P Romanelli
- Mouse and Animal Pathology Lab, Fondazione Filarete, Milan, Italy; Department of Veterinary Medicine, University of Milan, Milan, Italy
| | - S Murray
- Biomarker Solutions Ltd, London, UK
| | - M Broggini
- Laboratory of Molecular Pharmacology, Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy.
| | - M Marabese
- Laboratory of Molecular Pharmacology, Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - M C Garassino
- Unit of Thoracic Oncology, Medical Oncology Department 1, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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18
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Malapelle U, Rossi G, Pisapia P, Barberis M, Buttitta F, Castiglione F, Cecere FL, Grimaldi AM, Iaccarino A, Marchetti A, Massi D, Medicina D, Mele F, Minari R, Orlando E, Pagni F, Palmieri G, Righi L, Russo A, Tommasi S, Vermi W, Troncone G. BRAF as a positive predictive biomarker: Focus on lung cancer and melanoma patients. Crit Rev Oncol Hematol 2020; 156:103118. [PMID: 33038627 DOI: 10.1016/j.critrevonc.2020.103118] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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: 08/28/2020] [Revised: 09/25/2020] [Accepted: 09/28/2020] [Indexed: 02/06/2023] Open
Abstract
In the era of personalized medicine, BRAF mutational assessment is mandatory in advanced-stage melanoma and non-small cell lung cancer (NSCLC) patients. The identification of actionable mutations is crucial for the adequate management of these patients. To date various drugs have been implemented in clinical practice. Similarly, various methods may be adopted for the identification of BRAF mutations. Here, we briefly review the current literature on BRAF in melanoma and NSCLC, focusing attention in particular on the different methods and drugs adopted in these patients. In addition, an overview of the real-world practice in different Italian laboratories with high expertise in molecular predictive pathology testing is provided.
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Affiliation(s)
- Umberto Malapelle
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Giulio Rossi
- Pathology Unit, Azienda USL Romagna, St. Maria delle Croci Hospital, Ravenna, Italy
| | - Pasquale Pisapia
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Massimo Barberis
- Unit of Histopathology and Molecular Diagnostics, European Institute of Oncology IRCCS, Milano, Italy
| | - Fiamma Buttitta
- Center for Advanced Studies and Technology (CAST) - Department of Medical, Oral and Biotechnological Sciences, University of Chieti, Italy
| | - Francesca Castiglione
- Section of Anatomic Pathology, Department of Health Sciences, University of Florence, Florence, Italy
| | | | - Antonio Maria Grimaldi
- Unit of Melanoma, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Italy
| | - Antonino Iaccarino
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Antonio Marchetti
- Center for Advanced Studies and Technology (CAST) - Department of Medical, Oral and Biotechnological Sciences, University of Chieti, Italy
| | - Daniela Massi
- Section of Anatomic Pathology, Department of Health Sciences, University of Florence, Florence, Italy
| | - Daniela Medicina
- Section of Pathology, Asst Spedali Civili di Brescia, Brescia, Italy
| | - Fabio Mele
- Pathology Department, IRCCS-Istituto Tumori 'Giovanni Paolo II', Bari, Italy
| | - Roberta Minari
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Elisabetta Orlando
- Department of Health Promotion, Mother and Child care, Internal Medicine and Medical Specialties (ProMISE), Unit of Anatomic Pathology, University of Palermo, Palermo, Italy
| | - Fabio Pagni
- Department of Medicine and Surgery, Pathology, University Milan Bicocca, Milan, Italy
| | - Giuseppe Palmieri
- Unit of Cancer Genetics, Institute of Genetic and Biomedical Research (IRGB), National Research Council (CNR), Sassari, Italy
| | - Luisella Righi
- Department of Oncology, San Luigi Hospital, University of Turin, Turin, Italy
| | | | - Stefania Tommasi
- Pathology Department, IRCCS-Istituto Tumori 'Giovanni Paolo II', Bari, Italy
| | - William Vermi
- Section of Pathology, Asst Spedali Civili di Brescia, Brescia, Italy
| | - Giancarlo Troncone
- Department of Public Health, University of Naples Federico II, Naples, Italy.
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19
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Alvisi MF, Ganzinelli M, Linardou H, Caiola E, Lo Russo G, Cecere FL, Bettini AC, Psyrri A, Milella M, Rulli E, Fabbri A, De Maglie M, Romanelli P, Murray S, Ndembe G, Broggini M, Garassino MC, Marabese M. Predicting the Role of DNA Polymerase β Alone or with KRAS Mutations in Advanced NSCLC Patients Receiving Platinum-Based Chemotherapy. J Clin Med 2020; 9:jcm9082438. [PMID: 32751518 PMCID: PMC7465625 DOI: 10.3390/jcm9082438] [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: 06/26/2020] [Revised: 07/27/2020] [Accepted: 07/28/2020] [Indexed: 01/17/2023] Open
Abstract
Clinical data suggest that only a subgroup of non-small cell lung cancer (NSCLC) patients has long-term benefits after front-line platinum-based therapy. We prospectively investigate whether KRAS status and DNA polymerase β expression could help identify patients responding to platinum compounds. Prospectively enrolled, advanced NSCLC patients treated with a first-line regimen containing platinum were genotyped for KRAS and centrally evaluated for DNA polymerase β expression. Overall survival (OS), progression-free survival (PFS), and the objective response rate (ORR) were recorded. Patients with KRAS mutations had worse OS (hazard ratio (HR): 1.37, 95% confidence interval (95% CI): 0.70–2.27). Negative DNA polymerase β staining identified a subgroup with worse OS than patients expressing the protein (HR: 1.43, 95% CI: 0.57–3.57). The addition of KRAS to the analyses further worsened the prognosis of patients with negative DNA polymerase β staining (HR: 1.67, 95% CI: 0.52–5.56). DNA polymerase β did not influence PFS and ORR. KRAS may have a negative role in platinum-based therapy responses in NSCLC, but its impact is limited. DNA polymerase β, when not expressed, might indicate a group of patients with poor outcomes. KRAS mutations in tumors not expressing DNA polymerase β further worsens survival. Therefore, these two biomarkers together might well identify patients for whom alternatives to platinum-based chemotherapy should be used.
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Affiliation(s)
- Maria Francesca Alvisi
- Laboratory of Methodology for Clinical Research, Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, 20156 Milan, Italy; (M.F.A.); (E.R.)
| | - Monica Ganzinelli
- Unit of Thoracic Oncology, Medical Oncology Department 1, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (M.G.); (G.L.R.); (M.C.G.)
| | - Helena Linardou
- 4th Oncology Department, Metropolitan Hospital, 18547 Athens, Greece;
| | - Elisa Caiola
- Laboratory of Molecular Pharmacology, Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, 20156 Milan, Italy; (E.C.); (G.N.)
| | - Giuseppe Lo Russo
- Unit of Thoracic Oncology, Medical Oncology Department 1, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (M.G.); (G.L.R.); (M.C.G.)
| | - Fabiana Letizia Cecere
- Division of Medical Oncology 1, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy;
| | | | - Amanda Psyrri
- Section of Oncology, Department of Internal Medicine, Attikon Hospital, National Kapodistrian University of Athens, 12462 Athens, Greece;
| | - Michele Milella
- Department of Medicine, Section of Medical Oncology, University and Hospital Trust of Verona, 37126 Verona, Italy;
| | - Eliana Rulli
- Laboratory of Methodology for Clinical Research, Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, 20156 Milan, Italy; (M.F.A.); (E.R.)
| | - Alessandra Fabbri
- Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy;
| | - Marcella De Maglie
- Mouse & Animal Pathology Lab, Fondazione Filarete, 20139 Milan, Italy; (M.D.M.); (P.R.)
- Department of Veterinary Medicine, University of Milan, 20122 Milan, Italy
| | - Pierpaolo Romanelli
- Mouse & Animal Pathology Lab, Fondazione Filarete, 20139 Milan, Italy; (M.D.M.); (P.R.)
- Department of Veterinary Medicine, University of Milan, 20122 Milan, Italy
| | | | - Gloriana Ndembe
- Laboratory of Molecular Pharmacology, Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, 20156 Milan, Italy; (E.C.); (G.N.)
| | - Massimo Broggini
- Laboratory of Molecular Pharmacology, Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, 20156 Milan, Italy; (E.C.); (G.N.)
- Correspondence: (M.B.); (M.M.); Tel.: +39-0239014585 (M.B.); +39-0239014236 (M.M.)
| | - Marina Chiara Garassino
- Unit of Thoracic Oncology, Medical Oncology Department 1, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (M.G.); (G.L.R.); (M.C.G.)
| | - Mirko Marabese
- Laboratory of Molecular Pharmacology, Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, 20156 Milan, Italy; (E.C.); (G.N.)
- Correspondence: (M.B.); (M.M.); Tel.: +39-0239014585 (M.B.); +39-0239014236 (M.M.)
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20
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Gelsomino F, Lamberti G, Tiseo M, Rocco D, Pasello G, Cecere FL, Chella A, Grilli G, Mandruzzato M, Tognetto M, Garassino MC, Macerelli M, Novello S, Roila F, Colantonio I, Grossi F, Fiorentino M, Ardizzoni A. Atezolizumab in a CoHort of pretreated, advanced, non-small cell lung cancer patients with rare HistologiCal SubtypEs (CHANCE trial). Ther Adv Med Oncol 2020; 12:1758835920915983. [PMID: 32733604 PMCID: PMC7372524 DOI: 10.1177/1758835920915983] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 10/26/2019] [Accepted: 02/24/2020] [Indexed: 12/26/2022] Open
Abstract
Background Although immunotherapy with immune-checkpoint inhibitors (ICIs) has profoundly changed the therapeutic scenario in the treatment of advanced non-small cell lung cancer (NSCLC), trials of ICIs only enrolled NSCLC patients with common histology. Atezolizumab was approved by the United States Food and Drug Administration (US FDA) in October 2016 and by the European Medicines Agency (EMA) in September 2017 for the treatment of patients with metastatic NSCLC whose disease progressed during or following platinum-containing chemotherapy, regardless of PD-L1 expression. Methods We designed a single-arm, multicenter, two-stage phase II study and plan to enroll 43 patients. The primary objective of the study is to evaluate the antitumor activity of atezolizumab in advanced NSCLC patients with rare histology subtypes. Patients with prior atezolizumab or ICI treatment and with untreated, symptomatic, or progressing brain metastases will be excluded. The primary endpoint is disease control rate. Secondary objectives are toxicity and safety, overall response rate, progression-free survival, overall survival, and time to progression. Diagnosis of NSCLC with rare histology will be confirmed by central pathology revision, and will include: colloid carcinoma, fetal adenocarcinoma, non-endocrine large cell carcinoma, sarcomatoid carcinoma, salivary gland-type tumor, lymphoepithelioma-like carcinoma, and NUT-nuclear protein in testis carcinoma. Archival tumor tissue is required for correlative studies of PD-L1 expression on tumor cells and tumor infiltrating lymphocytes. Conclusions Therapeutic options in NSCLC with rare histology subtypes, to be assessed in specifically designed trials, are an unmet need. This trial will help elucidate the role of atezolizumab as a viable option in this setting.
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Affiliation(s)
- Francesco Gelsomino
- Medical Oncology Unit, Policlinico S.Orsola-Malpighi, Via Albertoni 15, Bologna, 40138, Italy
| | - Giuseppe Lamberti
- Medical Oncology Unit, Policlinico S.Orsola-Malpighi, Bologna, Italy
| | - Marcello Tiseo
- Medical Oncology Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Danilo Rocco
- Onco-Pneumology Unit, AORN Monaldi-Cotugno Hospital, Napoli, Italy
| | - Giulia Pasello
- Medical Oncology Unit 2, Istituto Oncologico Veneto, Padova, Italy
| | | | - Antonio Chella
- Pneumology Unit, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Giada Grilli
- Medical Oncology Unit, Policlinico S.Orsola-Malpighi, Bologna, Italy
| | | | - Michele Tognetto
- Medical Oncology Unit, Policlinico S.Orsola-Malpighi, Bologna, Italy
| | | | - Marianna Macerelli
- Medical Oncology Unit, Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | - Silvia Novello
- Thoracic Oncology Unit, Azienda Ospedaliero-Universitaria S. Luigi Gonzaga di Orbassano, Torino, Italy
| | - Fausto Roila
- Medical Oncology Unit, Azienda Ospedaliera di Perugia, Perugia, Italy
| | - Ida Colantonio
- Medical Oncology Department, Azienda Ospedaliera S. Croce e Carle, Cuneo, Italy
| | - Francesco Grossi
- Medical Oncology Unit, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milano, Italy
| | | | - Andrea Ardizzoni
- Medical Oncology Unit, Policlinico S.Orsola-Malpighi, Bologna, Italy
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21
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Naldi G, Bergomi S, Visca P, Cecere FL. Ovarian metastasis from malignant pleural mesothelioma. Tumori 2020; 106:NP49-NP51. [PMID: 32684102 DOI: 10.1177/0300891620941610] [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] [Indexed: 11/15/2022]
Abstract
BACKGROUND Malignant pleural mesothelioma (MPM) is a rare and aggressive disease of the pleura with a dismal prognosis. Distant metastases most commonly occur in the liver, spleen, and thyroid gland. To our knowledge, ovarian metastases have never been described. CASE DESCRIPTION We describe a case of a woman with recurrent malignant pleural mesothelioma presenting a single ovarian metastasis, surgically resected. CONCLUSIONS This case report highlights the importance of using a complete staging protocol in patients with MPM to improve patient management. A whole-body computed tomography (CT) scan with contrast enhancement and possibly positron emission tomography-CT should be performed to identify any distant metastases before deciding on treatment strategy.
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Affiliation(s)
- Giuseppe Naldi
- Division of Thoracic Surgery, IRCCS-Regina Elena National Cancer Institute, La Sapienza University of Rome, Rome, Italy
| | - Serenella Bergomi
- Division of Nuclear Medicine, IRCCS-Regina Elena National Cancer Institute, Rome, Italy
| | - Paolo Visca
- Division of Clinical Pathology, IRCCS-Regina Elena National Cancer Institute, Rome, Italy
| | - Fabiana Letizia Cecere
- Division of Medical Oncology 1, IRCCS-Regina Elena National Cancer Institute, Rome, Italy
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22
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Melis E, Gallo E, di Martino S, Gallina FT, Laquintana V, Casini B, Visca P, Ganci F, Alessandrini G, Caterino M, Cecere FL, Mandoj C, Papadantonakis A, De Bello N, Lattanzio R, Palmieri G, Garassino MC, Girard N, Conti L, Blandino G, Fazi F, Facciolo F, Pescarmona E, Ciliberto G, Marino M. Thymic Epithelial Tumors as a Model of Networking: Development of a Synergistic Strategy for Clinical and Translational Research Purposes. Front Oncol 2020; 10:922. [PMID: 32760665 PMCID: PMC7372300 DOI: 10.3389/fonc.2020.00922] [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: 02/06/2020] [Accepted: 05/11/2020] [Indexed: 12/23/2022] Open
Abstract
Among the group of thymic epithelial tumors (TET), thymomas often show either uncertain or explicit malignant biological behavior, local invasiveness, and intrathoracic relapse and are often difficult to manage. From the initial stages, thymic carcinomas tend to show aggressive behavior and extrathoracic spread. Moreover, the interplay of epithelial cells and thymocytes in thymomas causes complex immune derangement and related systemic autoimmune diseases. Due to their rare occurrence and to the limited funding opportunities available for rare tumors, it is challenging to make advances in clinical and translational research in TET. The authors of this paper are all members of a multidisciplinary clinical and research thoracic tumor team. Strong input was given to the team by long-standing expertise in TET in the Pathology Department. In addition, thanks to the collaboration between research units at our Institute as well as to national collaborations, over the last 10 years we were able to perform several tissue-based research studies. The most recent studies focused on microRNA and on functional studies on the thymic carcinoma cell line 1889c. The recent implementation of our biobank now provides us with a new tool for networking collaborative research activities. Moreover, the participation in a worldwide community such as ITMIG (International Thymic Malignancy Interest Group) has allowed us to significantly contribute toward fundamental projects/research both in tissue-based studies (The Cancer Genome Atlas) and in clinical studies (TNM staging of TET). Our achievements derive from constant commitment and long-standing experience in diagnosis and research in TET. New perspectives opened up due to the establishment of national [the Italian Collaborative Group for ThYmic MalignanciEs (TYME)] and European reference networks such as EURACAN, for an empowered joint clinical action in adult solid rare tumors. The challenge we face still lies in the advancement of clinical and basic science in thymic epithelial malignancies.
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Affiliation(s)
- Enrico Melis
- Thoracic Surgery Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Enzo Gallo
- Department of Pathology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Simona di Martino
- Department of Pathology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | | | - Valentina Laquintana
- Department of Pathology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Beatrice Casini
- Department of Pathology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Paolo Visca
- Department of Pathology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Federica Ganci
- Oncogenomic and Epigenetic Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | | | - Mauro Caterino
- Radiology Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | | | - Chiara Mandoj
- Clinical Pathology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | | | - Nicoletta De Bello
- Thoracic Surgery Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Rossano Lattanzio
- University “G. d'Annunzio,” Department of Medical, Oral and Biotechnological Sciences, Center for Advanced Studies and Technology (CAST), Chieti, Italy
| | - Giovannella Palmieri
- Scientific Direction, Department of Clinical Medicine and Surgery, Rare Tumors Reference Center, University Federico II, Naples, Italy
| | - Marina Chiara Garassino
- Thoracic Oncology Unit, Division of Medical Oncology, Foundation IRCCS–Italian National Cancer Institute, Milan, Italy
| | - Nicolas Girard
- Institut du Thorax Curie-Montsouris, Institut Curie, Paris, France
| | - Laura Conti
- Clinical Pathology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Giovanni Blandino
- Oncogenomic and Epigenetic Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Francesco Fazi
- Department of Anatomical, Histological, Forensic & Orthopedic Sciences, Section of Histology & Medical Embryology, Sapienza University of Rome, Laboratory Affiliated to Instituto Pasteur Italia-Fondazione Cenci Bolognetti, Rome, Italy
| | - Francesco Facciolo
- Thoracic Surgery Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Edoardo Pescarmona
- Department of Pathology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Gennaro Ciliberto
- Scientific Direction, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Mirella Marino
- Department of Pathology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
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23
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Grimaldi A, Cammarata I, Martire C, Focaccetti C, Piconese S, Buccilli M, Mancone C, Buzzacchino F, Berrios JRG, D'Alessandris N, Tomao S, Giangaspero F, Paroli M, Caccavale R, Spinelli GP, Girelli G, Peruzzi G, Nisticò P, Spada S, Panetta M, Letizia Cecere F, Visca P, Facciolo F, Longo F, Barnaba V. Combination of chemotherapy and PD-1 blockade induces T cell responses to tumor non-mutated neoantigens. Commun Biol 2020; 3:85. [PMID: 32099064 PMCID: PMC7042341 DOI: 10.1038/s42003-020-0811-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 02/06/2020] [Indexed: 12/16/2022] Open
Abstract
Here, we developed an unbiased, functional target-discovery platform to identify immunogenic proteins from primary non-small cell lung cancer (NSCLC) cells that had been induced to apoptosis by cisplatin (CDDP) treatment in vitro, as compared with their live counterparts. Among the multitude of proteins identified, some of them were represented as fragmented proteins in apoptotic tumor cells, and acted as non-mutated neoantigens (NM-neoAgs). Indeed, only the fragmented proteins elicited effective multi-specific CD4+ and CD8+ T cell responses, upon a chemotherapy protocol including CDDP. Importantly, these responses further increased upon anti-PD-1 therapy, and correlated with patients' survival and decreased PD-1 expression. Cross-presentation assays showed that NM-neoAgs were unveiled in apoptotic tumor cells as the result of caspase-dependent proteolytic activity of cellular proteins. Our study demonstrates that apoptotic tumor cells generate a repertoire of immunogenic NM-neoAgs that could be potentially used for developing effective T cell-based immunotherapy across multiple cancer patients.
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MESH Headings
- Aged
- Antigen Presentation/drug effects
- Antigen Presentation/immunology
- Antigens, Neoplasm/immunology
- Antigens, Neoplasm/isolation & purification
- Antineoplastic Agents, Immunological/administration & dosage
- Antineoplastic Agents, Immunological/pharmacology
- Antineoplastic Combined Chemotherapy Protocols/pharmacology
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Carcinoma, Non-Small-Cell Lung/immunology
- Carcinoma, Non-Small-Cell Lung/pathology
- Carcinoma, Non-Small-Cell Lung/therapy
- Case-Control Studies
- Cell Line, Tumor
- Cisplatin/administration & dosage
- Cisplatin/pharmacology
- Combined Modality Therapy
- Drug Screening Assays, Antitumor/methods
- Female
- Humans
- Immunity, Cellular/drug effects
- Immunotherapy/methods
- Lung Neoplasms/immunology
- Lung Neoplasms/pathology
- Lung Neoplasms/therapy
- Male
- Middle Aged
- Programmed Cell Death 1 Receptor/antagonists & inhibitors
- Programmed Cell Death 1 Receptor/immunology
- T-Lymphocytes/drug effects
- T-Lymphocytes/physiology
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Affiliation(s)
- Alessio Grimaldi
- Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, 00161, Rome, Italy
| | - Ilenia Cammarata
- Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, 00161, Rome, Italy
| | - Carmela Martire
- Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, 00161, Rome, Italy
| | - Chiara Focaccetti
- Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, 00161, Rome, Italy
| | - Silvia Piconese
- Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, 00161, Rome, Italy
| | - Marta Buccilli
- Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, 00161, Rome, Italy
| | - Carmine Mancone
- Dipartimento di Medicina Molecolare, Sapienza Università di Roma, 00161, Rome, Italy
| | - Federica Buzzacchino
- Dipartimento di Scienze Radiologiche, Oncologiche e Anatomo Patologiche, Oncologia Medica, Università di Roma, 00161, Rome, Italy
| | - Julio Rodrigo Giron Berrios
- Dipartimento di Scienze Radiologiche, Oncologiche e Anatomo Patologiche, Oncologia Medica, Università di Roma, 00161, Rome, Italy
| | - Nicoletta D'Alessandris
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Silverio Tomao
- Dipartimento di Scienze Radiologiche, Oncologiche e Anatomo Patologiche, Oncologia Medica, Università di Roma, 00161, Rome, Italy
| | - Felice Giangaspero
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
- IRCCS Neuromed, Pozzilli, Isernia, Italy
| | - Marino Paroli
- Dipartimento di Scienze e Biotecnologie Medico-Chirurgiche, Sapienza Università di Roma - Polo Pontino, 04100, Latina, Italy
| | - Rosalba Caccavale
- Dipartimento di Scienze e Biotecnologie Medico-Chirurgiche, Sapienza Università di Roma - Polo Pontino, 04100, Latina, Italy
| | - Gian Paolo Spinelli
- UOC Oncologia Universitaria, ASL Latina (distretto Aprilia), Sapienza Università di Roma, Via Giustiniano snc, 04011, Aprilia, Latina, Italy
| | - Gabriella Girelli
- Dipartimento di Medicina Molecolare, Sapienza Università di Roma, 00161, Rome, Italy
| | - Giovanna Peruzzi
- Center for Life Nano Science@Sapienza, Istituto Italiano di Tecnologia, 00161, Rome, Italy
| | - Paola Nisticò
- Tumor Immunology and Immunotherapy Unit, IRCCS-Regina Elena National Cancer Institute, Rome, Italy
| | - Sheila Spada
- Tumor Immunology and Immunotherapy Unit, IRCCS-Regina Elena National Cancer Institute, Rome, Italy
| | - Mariangela Panetta
- Tumor Immunology and Immunotherapy Unit, IRCCS-Regina Elena National Cancer Institute, Rome, Italy
| | | | - Paolo Visca
- Unit of Pathology, IRCCS-Regina Elena National Cancer Institute, Rome, Italy
| | - Francesco Facciolo
- Thoracic Surgery Unit, IRCCS-Regina Elena National Cancer Institute, Rome, Italy
| | - Flavia Longo
- Dipartimento di Scienze Radiologiche, Oncologiche e Anatomo Patologiche, Oncologia Medica, Università di Roma, 00161, Rome, Italy
| | - Vincenzo Barnaba
- Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, 00161, Rome, Italy.
- Center for Life Nano Science@Sapienza, Istituto Italiano di Tecnologia, 00161, Rome, Italy.
- Istituto Pasteur - Fondazione Cenci Bolognetti, 00185, Rome, Italy.
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Cecere FL, Aguilar A, Rosell R. Lung cavitation in lung metastases of gastric and non-small-cell lung cancer patients treated with apatinib. Transl Lung Cancer Res 2019; 8:317-318. [PMID: 31556408 DOI: 10.21037/tlcr.2019.08.20] [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: 11/06/2022]
Affiliation(s)
| | - Andres Aguilar
- Institute of Oncology Rosell (IOR), Quirón-Dexeus University Institute, Barcelona, Spain
| | - Rafael Rosell
- Institute of Oncology Rosell (IOR), Quirón-Dexeus University Institute, Barcelona, Spain.,Germans Trias i Pujol Research Institute and Hospital (IGTP), Badalona, Spain
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Dal Maso A, Lorenzi M, Roca E, Pilotto S, Macerelli M, Polo V, Cecere FL, Del Conte A, Nardo G, Buoro V, Scattolin D, Monteverdi S, Urso L, Zulato E, Frega S, Bonanno L, Indraccolo S, Calabrese F, Conte P, Pasello G. Clinical Features and Progression Pattern of Acquired T790M-positive Compared With T790M-negative EGFR Mutant Non-small-cell Lung Cancer: Catching Tumor and Clinical Heterogeneity Over Time Through Liquid Biopsy. Clin Lung Cancer 2019; 21:1-14.e3. [PMID: 31601525 DOI: 10.1016/j.cllc.2019.07.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [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: 05/02/2019] [Revised: 06/18/2019] [Accepted: 07/26/2019] [Indexed: 01/15/2023]
Abstract
BACKGROUND Clinical-pathologic predictors of acquired T790M epidermal growth factor receptor (EGFR) mutation in Caucasian patients with non-small-cell lung cancer (NSCLC) progressing after first-/second-generation tyrosine kinase inhibitors (TKIs) is an open field for research. Similarly, the best time point for T790M detection by liquid or tissue biopsy after disease progression is currently matter of debate. PATIENTS AND METHODS This is an observational study at 7 Italian centers enrolling patients with EGFR-mutant NSCLC progressing after first-/second-generation EGFR TKIs, between 2014 and 2018, aiming at comparing baseline clinical-pathologic features and progression patterns in acquired T790M-positive compared with T790M-negative cases. RESULTS A total of 235 patients received first-line treatment with gefitinib (N = 126; 53%), erlotinib (N = 51; 22%), or afatinib (N = 58; 25%). In 120 (51%) cases, T790M was detected in liquid biopsy, tissue biopsy, or both. Age younger than 65 years (P = .037), the presence of common mutations (P = .004), and better response to first-line TKI (P = .023) were correlated with T790M positivity. T790M detection was associated with higher number of new progressing sites (P = .04), liver progression (P = .002), and a lower frequency of lung metastases (P = .027). When serial liquid biopsies were performed (N = 15), an oligoprogressive disease was correlated with a negative test outcome, whereas systemic progression was observed at the time of T790M positivity. CONCLUSION This study on a Caucasian population showed that age, type of EGFR mutation at diagnosis, response to first-line treatment, and peculiar progression pattern are associated with T790M status. Serial liquid biopsy might be useful for treatment selection, especially when tissue rebiopsy is not feasible.
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Affiliation(s)
- Alessandro Dal Maso
- Department of Oncology 2, Istituto Oncologico Veneto - IRCCS, Padova, Italy; Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Martina Lorenzi
- Department of Oncology 2, Istituto Oncologico Veneto - IRCCS, Padova, Italy; Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Elisa Roca
- Department of Medical Oncology, ASST - Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Sara Pilotto
- Department of Medical Oncology, University of Verona, AOUI Verona, Verona, Italy
| | - Marianna Macerelli
- Department of Medical Oncology - ASUIUD Santa Maria della Misericordia, Udine, Italy
| | - Valentina Polo
- Oncology Unit, AULSS 2 Marca Trevigiana, Ca' Foncello Hospital, Treviso, Italy
| | - Fabiana Letizia Cecere
- Department of Oncology 1, Regina Elena National Cancer Institute IRCCS Rome, Rome, Italy
| | - Alessandro Del Conte
- Department of Medical Oncology and Immunorelated Tumors, Centro di Riferimento Oncologico (CRO) - IRCCS, Aviano (PN), Italy
| | - Giorgia Nardo
- Immunology and Molecular Oncology Unit, Istituto Oncologico Veneto - IRCCS, Padova, Italy
| | - Vanessa Buoro
- Department of Medical Oncology - ASUIUD Santa Maria della Misericordia, Udine, Italy
| | - Daniela Scattolin
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Sara Monteverdi
- Department of Medical Oncology, University of Verona, AOUI Verona, Verona, Italy
| | - Loredana Urso
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Elisabetta Zulato
- Immunology and Molecular Oncology Unit, Istituto Oncologico Veneto - IRCCS, Padova, Italy
| | - Stefano Frega
- Department of Oncology 2, Istituto Oncologico Veneto - IRCCS, Padova, Italy
| | - Laura Bonanno
- Department of Oncology 2, Istituto Oncologico Veneto - IRCCS, Padova, Italy
| | - Stefano Indraccolo
- Immunology and Molecular Oncology Unit, Istituto Oncologico Veneto - IRCCS, Padova, Italy
| | - Fiorella Calabrese
- Pathology Unit, Department of Cardio-Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - PierFranco Conte
- Department of Oncology 2, Istituto Oncologico Veneto - IRCCS, Padova, Italy; Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Giulia Pasello
- Department of Oncology 2, Istituto Oncologico Veneto - IRCCS, Padova, Italy.
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Bassanelli M, Giannarelli D, Migliorino MRITA, Russano M, Gelibter A, Cecere FL, Barucca V, Giacinti S, Bria E, Ruggeri E, Calabro F, Santini D, Rauco A, Ceribelli A. Immunotherapy discontinuation and outcome: A multicenter real-life experience. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e14075] [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
e14075 Background: Unlike chemotherapy, the optimum treatment duration with Immune checkpoint inhibitors (ICIs) is not clearly established. The aim of this study was to assess the outcome of patients (pts) who discontinued immune-based therapies for any reason except progressive disease. Methods: We conducted an observational, retrospective analysis of 46 consecutive pts with advanced cancer who received ICIs as clinically indicated, at eight Italian institutions. Tumor response to treatment was defined according to RECIST. Median overall survival (OS) and the 95% confidence interval (CI) were estimated with the Kaplan -Meier method. Results: 46 pts (median age 68 years [range 41-86]; male: 65.2%) with advanced cancer (n.39 non-small-cell lung cancer, n.15 renal cell carcinoma and n.2 melanoma) were treated with ICIs: 44 pts received programmed death 1 (PD-1) inhibitors (n.31 nivolumab, n.13 pembrolizumab) and 2 pts programmed death ligand 1 (PD-L1) (n.1 durvalumab, n.1 atezolizumab). A median of 8 cycles were administered [range 1 to 52]. 36 pts discontinued ICIs due to toxicities (diarrhoea, pneumonitis, hepatotoxicity) and 10 pts for reasons non immune-related. The median progression free survival (PFS) from the beginning of ICIs was 12.4 months (mo) [95% CI: 8.2-16.6] and the median OS was 20.0 mo (95% CI: 11.8-28.2). Median PFS from discontinuation of therapy was 5.0 mo [95% CI: 2.7-7.3] and median OS was 16.1 mo (95% CI: 5.4-26.8). Best response achieved according RECIST criteria were: 1 complete response (CR), 18 partial response, 21 stable disease (SD), 2 progressive disease (PR) and 3 non evaluable (NE). During interruption of ICIs 1 pts achieved a PR. Conclusions: This study shows the activity of ICIs, in terms of outcome and durable immune-response, in pts with advanced cancer even after treatment discontinuation.
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Affiliation(s)
| | | | | | - Marco Russano
- Department of Medical Oncology Campus Bio-Medico University, Rome, Italy
| | | | | | - Viola Barucca
- Department of Medical Oncology, San Camillo Forlanini Hospital, Rome, Italy
| | | | - Emilio Bria
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | | | | | - Daniele Santini
- Department of Medical Oncology, Campus Bio-Medico - University of Rome, Rome, Italy
| | - Annamaria Rauco
- Department of Oncology-San Camillo de Lellis Hospital,, Rieti, Italy
| | - Anna Ceribelli
- Department of Oncology. San Camillo de Lellis Hospital, Rieti, Italy
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Bassanelli M, Giannarelli D, Ricciuti B, Magri V, Cecere FL, Roberto M, Giacinti S, Barucca V, Cassese R, De Giglio A, Scagnoli S, Milella M, Santarelli M, Bengala C, Ruggeri EM, Marchetti P, Cognetti F, Gelibter A, Chiari R, Ceribelli A. Updated outcomes of previously irradiated non-small-cell lung cancer (NSCLC) patients (pts) receiving programmed death 1 (PD-1) inhibitors. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e15158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | - Biagio Ricciuti
- Clinical Oncology, S. Maria della Misericordia Hospital, Perugia, Italy
| | | | | | - Michela Roberto
- Sant Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | | | - Viola Barucca
- Department of Oncology; Misericordia Hospital, Grosseto, Italy
| | - Raffaele Cassese
- department of Radiotherapy- San Camillo de Lellis Hospital, Rieti, Italy
| | - Andrea De Giglio
- Medical Oncology, Santa Maria della Misericordia Hospital, Perugia, Italy
| | | | - Michele Milella
- Medical Oncology A, Regina Elena National Cancer Institute, Rome, Italy
| | | | | | | | - Paolo Marchetti
- S. Andrea Hospital, Sapienza University of Rome, Rome, Italy
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Bassanelli M, Giannarelli D, Gelibter A, Cecere FL, Chiari R, Giacinti S, Scagnoli S, Milella M, Ricciuti B, Roberto M, Magri V, Ferraresi V, Brambilla M, Santarelli M, Marchetti P, Cortesi E, Ceribelli A. Systemic effect of radiotherapy (RT) followed by programmed death 1 (PD-1) inhibitors in non-small-cell lung cancer (NSCLC). J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.5_suppl.177] [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
177 Background: RT-induced abscopal effect seems increase the efficacy of immunotherapy. The aim of this study was to evaluate the outcome of patients (pts) with NSCLC previously undergone to RT before receiving PD-1 inhibitors. Methods: We conducted an observational, retrospective analysis of 63 consecutive pts with advanced NSCLC who received RT followed by PD-1 inhibitors at five Italian institutions. Tumor response to treatment was defined according to Response Evaluation Criteria in Solid Tumors version 1.1. Median overall survival (OS) and the 95% confidence interval (CI) were estimated with the Kaplan -Meier method. Results: 63 pts (median age 66 years; male:60.3%) with advanced NSCLC (adenocarcinoma [adc]:71.4%; squamous cells [sqc]:28.6%) were treated with PD-1 inhibitors after RT. RT was delivered a median of 70 days before the start of immunotherapy.47 pts(74.5%)received extracranical RT and 16 pts (25.7%) performed cranial irradiation. Median OS was 11.7 months (mo) [95% CI, 4.7-18.7] (adc: 13.0 mo [95% CI,7.3-18.7], sqc 5.1 mo [95%CI,2.9-7.3]). Median progression free survival (PFS) was 5.1 mo [95% CI,2.5-7.7] (adc: 9.0 mo[ 95% CI,2.6-15.3]; sqc: 3.5 mo [95% CI,2.0-5.1]). A better performance status (PS) according to ECOG scale was associated with an improved OS (PS 0[21 pts]: 15.4 mo [95% CI,10.8-19.9]; PS1[33 pts]: 11.7 mo [95%CI,4.0-19.4]; PS2[9 pts]: 4.1 mo [95% CI,0.9-7.3]). Median OS in 46 pts who received ≤ 1 previous systemic therapy was 13.0 mo [95% CI, 9.4-16.6] and in 17 pts who received ≥2 previous treatments was 7.4 mo [95% CI, 3.1-11.7]. Median OS in 45 pts aged < 70 years was 11.7 mo [95% CI, 4.7-18.7] and in 18 elderly (≥ 70 years) was 6.5 mo [95% CI, 0.0-17.7]. 9(14.3%) partial response, 23(36.5%) stable disease and 25(39.7%) progressive disease have been observed. Conclusions: The synergic combination of RT and PD-1 inhibitors leads to an enhancement of systemic antitumor immune responses, triggering the abscopal effect, resulting in prolonged OS.
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Affiliation(s)
| | | | | | | | | | - Silvana Giacinti
- Department of Clinical and Molecolar Medicine, Sapienza University of Rome, Rome, Italy
| | | | | | - Biagio Ricciuti
- Clinical Oncology, S. Maria della Misericordia Hospital, Perugia, Italy
| | - Michela Roberto
- Saint Andrea Hospital, Sapienza University of Rome, Rome, Italy
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Mazzoni F, Cecere FL, Meoni G, Giuliani C, Boni L, Camerini A, Lucchesi S, Martella F, Amoroso D, Lucherini E, Torricelli F, Di Costanzo F. Phase II trial of customized first line chemotherapy according to ERCC1 and RRM1 SNPs in patients with advanced non-small-cell lung cancer. Lung Cancer 2013; 82:288-93. [DOI: 10.1016/j.lungcan.2013.08.018] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2013] [Revised: 08/23/2013] [Accepted: 08/24/2013] [Indexed: 10/26/2022]
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Mazzoni F, Cecere FL, Meoni G, Giuliani C, Camerini A, Allegrini G, Amoroso D, Boni L, Martella F, Ranchicchio P, Giommoni E, Torricelli F, Di Costanzo F. Customized first-line chemotherapy according to ERCC1 and RRM1 SNPs in advanced NSCLC patients: A phase II study. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.e18074] [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
e18074 Background: Excision repair cross complementing group 1 (ERCC1) and ribonucleotide reductase1 (RRM1) expression levels are predictive of CT efficacy in some malignancies. “Customized” CT has several advantages: (1) pts are more likely to be treated with agents that they will respond to, (2) pts can be spared the toxicity of agents that they are resistant to, (3) effective treatment can be delivered early in the course of disease. Methods: We planned a phase II multicentric open label study in two steps (based on Simon design) to evaluate ERCC1 SNPs (T118C and C8092A) and RRM1 SNPs (-37C>A and -524T>C) in advanced NSCLC pts. Here we report the first step for futility. Pts received first line CT according to the assessed ERCC1 and RRM1 SNPs status and the correlated expression levels: treatment A (low ERCC1 and low RRM1) Cisplatin plus Gemcitabine; treatment B (low ERCC1 and high RRM1) Cisplatin plus Docetaxel; treatment C (high ERCC1 and low RRM1) Gemcitabine plus Docetaxel; treatment D (high ERCC1 and high RRM1) Docetaxel plus Vinorelbine. Results: 42 pts were enrolled from Jan. 2010 to Oct. 201, 40 pts received at least 1 cycle of CT; median age was 66 yrs (range 47-73); 33 pts were males; 23(55%) pts were ECOG PS 0, 19(45%) PS 1; all pts had stage IV; 23(55%) pts had adenoca, 13(31%) squamous, 6(14%) other types; 25(62%) pts received treatment A, 3(8%) treatment B, 11(27%) treatment C, 1(3%) treatment D. As primary end-point we assessed the overall best response: 18(45%) pts achieved PR, 12(30%) SD, 8(20%) PD, 2(5%) pts were not evaluable. Updated information on OS and PFS will be presented. CT was well tolerated, there were no treatment related deaths. Conclusions: We observed an improved RR in this setting of NSCLC pts treated with CT according to ERCC1 and RRM1 SNPs status. We are planning to continue the second step of this trial (total 110 pts).
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Affiliation(s)
- Francesca Mazzoni
- Medical Oncology 1 - Azienda Ospedaliero Universitaria Careggi, Firenze, Italy
| | | | - Giulia Meoni
- Medical Oncology 1 - Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Costanza Giuliani
- Genetic Diagnosis - Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | | | - Giacomo Allegrini
- U.O. Oncologia Medica, Azienda USL-5, Istituto Toscano Tumori, Pontedera, Italy
| | | | - Luca Boni
- Istituto Toscano Tumori, Firenze, Italy
| | | | - Prabha Ranchicchio
- Medical Oncology 1 - Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Elisa Giommoni
- Medical Oncology 1 - Azienda Ospedaliero Universitaria Careggi, Florence, Italy
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Meoni G, Cecere FL, Chaib I, Giommoni E, Di Costanzo F. Prolonged response to trabectedin in a heavily pretreated patient with metastatic endometrial carcinoma: A case report and literature review. Gynecol Oncol Case Rep 2011; 2:23-5. [PMID: 24371606 DOI: 10.1016/j.gynor.2011.11.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2011] [Accepted: 11/23/2011] [Indexed: 11/15/2022]
Abstract
► We report the case of a heavily pretreated woman affected by metastatic endometrial carcinoma. ► Patient received Trabectedin as 10th line of treatment with an impressive clinical response. ► We evaluated BRCA1 and ERCC1 gene status which could be involved in Trabectedin sensitivity.
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Affiliation(s)
- Giulia Meoni
- Medical Oncology 1, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | | | - Imane Chaib
- Laboratory of Molecular Biology, Universitary Hospital Germans Trial I Pujol, Badalona, Spain
| | - Elisa Giommoni
- Medical Oncology 1, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
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Ruggeri EM, Cecere FL, Moscetti L, Doni L, Padalino D, Di Costanzo F. Severe rhabdomyolysis during sunitinib treatment of metastatic renal cell carcinoma. A report of two cases. Ann Oncol 2010; 21:1926-1927. [PMID: 20729535 DOI: 10.1093/annonc/mdq395] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- E M Ruggeri
- Department of Medical Oncology, Ospedale Belcolle, Viterbo.
| | - F L Cecere
- Department of Medical Oncology, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - L Moscetti
- Department of Medical Oncology, Ospedale Belcolle, Viterbo
| | - L Doni
- Department of Medical Oncology, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - D Padalino
- Department of Medical Oncology, Ospedale Belcolle, Viterbo
| | - F Di Costanzo
- Department of Medical Oncology, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
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Bria E, Milella M, Sperduti I, Alessandrini G, Visca P, Corzani F, Giannarelli D, Cerasoli V, Cuppone F, Cecere FL, Marchetti A, Sacco R, Mucilli F, Malatesta S, Guetti L, Vitale L, Ceribelli A, Rinaldi M, Terzoli E, Cognetti F, Facciolo F. A novel clinical prognostic score incorporating the number of resected lymph-nodes to predict recurrence and survival in non-small-cell lung cancer. Lung Cancer 2009; 66:365-71. [PMID: 19327866 DOI: 10.1016/j.lungcan.2009.02.024] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2008] [Revised: 02/05/2009] [Accepted: 02/25/2009] [Indexed: 11/15/2022]
Abstract
BACKGROUND The number of resected lymph-nodes (#RNs) has proven prognostic in breast and colorectal cancer. Here we evaluated its prognostic impact in a series of resected NSCLC patients. METHODS A panel of established prognostic factors plus (1) #RNs or (2) the ratio between the number of metastatic nodes and #RNs (NR) were correlated to overall- (OS), cancer-specific- (CSS), and disease-free-survival (DFS), using the Cox-model. Risk-classes according to hazard ratios (HR) were generated. Internal and external validation was accomplished. RESULTS A dataset of 415 resected NSCLC patients was retrieved. At multivariate analysis, #RNs and NR were independent factor for longer OS, CSS and DFS (p<0.0001). Patients with a #RNs>10 (identified optimal cut-off) had a statistically significant OS (p=0.02) and DFS (p=0.0005) benefit. In node-positive patients, a NR<9% significantly correlated with better outcome. Stratification into High-, Medium-, and Low-Risk classes, based on High- (HRFs: stage, N-status, age, #RNs) and Intermediate-Risk Factors (IRFs: sex, grading, histology), efficiently predicted outcomes (p<0.0001). The risk class model performance was externally validated in and independent dataset of 297 patients. CONCLUSIONS These results contribute to complete the panel of prognostic factors for resected NSCLC. A prospective larger validation and comparison with molecular prognostic tools is warranted.
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Affiliation(s)
- Emilio Bria
- Department of Medical Oncology, Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy.
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Bria E, Visca P, Novelli F, Casini B, Diodoro MG, Perrone-Donnorso R, Botti C, Sperduti I, Facciolo F, Milella M, Cecere FL, Cognetti F, Mottolese M. Nuclear and cytoplasmic cellular distribution of survivin as survival predictor in resected non-small-cell lung cancer. European Journal of Surgical Oncology (EJSO) 2008; 34:593-8. [PMID: 17693049 DOI: 10.1016/j.ejso.2007.06.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2007] [Accepted: 06/11/2007] [Indexed: 11/17/2022]
Abstract
AIM Survivin is a member of the inhibitors of apoptosis (IAP) gene family that acts through pathways different from those involving the bcl-2 family. Largely undetectable in normal adult tissues, survivin is deregulated in most human cancers including non-small-cell lung cancer (NSCLC) and may represent a tumor marker with prognostic and therapeutic implications. Aim of our study was to determine the prognostic role of survivin as an apoptosis-related biomarker in a series of resected NSCLC patients. METHODS A retrospective series of resected NSCLC patients were retrieved from the files of the Regina Elena National Cancer Institute. Survivin was detected by immunohistochemistry (IHC) using a polyclonal antibody. Survivin displayed two kinds of immunoreactivity: (i) a diffuse cytoplasmic staining and (ii) a distinct nuclear staining. A score-scale to distinguish positive (score 1-2) vs. negative (score 0) pattern was applied. Clinical and biological (nuclear and cytoplasmic survivin staining) covariables were screened for a prognostic relationship with overall survival (OS) and disease-free survival (DFS) into the univariate and multivariate analyses. RESULTS Data referring to 116 NSCLC patients who underwent surgery for stage I-IIIA NSCLC were collected. Multivariate analyses identified tumor size, nodal status and nuclear, but not cytoplasmic, expression of survivin as significant independent predictors of OS, with a hazard ratio of 2.40 (95% CI 1.44, 3.99, p=0.001), 2.03 (95% CI 1.26, 3.26, p=0.003) and 1.83 (95% CI 1.01, 3.30, p=0.044), respectively. Median OS for nuclear survivin positive (score 1-2) and negative (score 0) patients were 23 months (95% CI 15, 31) and 36 months (95% CI 1, 76), respectively (p=0.01); five-year survival for score 1-2 and score 0 patients were 20% and 44.5%, respectively. Conversely, no significant impact on survival is found when patients are stratified according to cytoplasmic survivin expression. CONCLUSIONS Data presented herein open the issue that prognosis of stage I-IIIA NSCLC can be linked to the cellular pattern of distribution of survivin.
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Affiliation(s)
- E Bria
- Medical Oncology, Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy.
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Carlini P, Bria E, Giannarelli D, Felici A, Papaldo P, Fabi A, Ruggeri EM, Milella M, Nuzzo C, Cecere FL, Gelibter A, Pino MS, Nisticò C, Cuppone F, Metro G, Terzoli E, Cognetti F, Ferretti G. Aromatase inhibitors in post-menopausal metastatic breast carcinoma. Expert Opin Investig Drugs 2007; 16:1023-36. [PMID: 17594187 DOI: 10.1517/13543784.16.7.1023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
To summarise the advances in the hormonal treatment of post-menopausal metastatic breast cancer, this paper reviews the published literature regarding the randomised trials comparing aromatase inhibitors (AIs) versus tamoxifen as a first-line therapeutic choice, or AIs versus megestrole acetate (MEG) as a second-line option. The pooled analysis of these authors on AI versus MEG as a second-line option for post-menopausal metastatic breast cancer suggested that AIs do not add any significant benefit over MEG in terms of overall response rate (ORR) and time to progression. According to the Cochrane Database, use of an AI as a second-line therapy versus any other endocrine therapy (mostly MEG) has shown a significant benefit in terms of overall survival, but not for progression-free survival, clinical benefit (CB) or ORR. Concerning the authors' comparisons between AIs versus tamoxifen as a first-line endocrine option in post-menopausal women with metastatic breast carcinoma, AIs seem to be superior to tamoxifen, with a significant benefit in terms of ORR, CB and time to progression being observed in favour of AIs over tamoxifen with fixed effects estimates. According to the Cochrane Database, there was an advantage to the use of AIs over tamoxifen in terms of progression-free survival and CB, but not for overall survival or ORR. With regards to toxicity, AIs show similar levels of hot flushes and arthralgia, increased risks of nausea, diarrhoea and vomiting, but a decreased risk of vaginal bleeding and thromboembolic events compared with other endocrine therapies. Weight gain, dyspnoea and peripheral oedema seem to be more frequent with MEG. At present, there is no proved overall survival difference in patients who are treated first with an AI and then with tamoxifen compared with the opposite sequence. In the metastatic setting, results are limited and are based on retrospective analyses.
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Affiliation(s)
- Paolo Carlini
- Regina Elena Cancer Institute, Division of Medical Oncology A, Rome, Italy.
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Abstract
Cisplatin must be considered the treatment standard for lung cancer chemotherapy, whatever the disease setting, at least in the Western world. After the seminal meta-analysis published in 1995, 12 randomized clinical trials (RCTs) exploring the benefits of adjuvant cisplatin-based chemotherapy have been completed, published, or presented. Although all these RCTs differ in patient features, two common suggestions emerge when the stage is taken into account: a significant benefit for chemotherapy is demonstrated for stage II and IIIA patients and none of these trials showed any significant benefit for adjuvant chemotherapy in stage IB patients. Ten years after this meta-analysis, a further individual patient data-pooled analysis exploring the eventual benefits of adjuvant cisplatin-based chemotherapy after surgery for early stage non-small cell lung cancer in the more recent RCTs has been presented. The 5-year overall survival benefit in favor of cisplatin-based chemotherapy was 5.3% (48.8% versus 43.3%, p = 0.004), with a relative risk reduction of 11%. These results confirm those reported by previous meta-analyses performed according to a literature-based approach. Advances are emerging in the selection of those patients who are likely to benefit more from such treatment. In this respect, the customized therapy based on molecular/genetic patient and disease features constitutes a new avenue to pursue.
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Affiliation(s)
- Emilio Bria
- Department of Medical Oncology, Regina Elena National Cancer Institute, Rome, Italy.
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Affiliation(s)
- Anna Ceribelli
- Division of Medical Oncology A, Regina Elena National Cancer Institute, Rome, Italy.
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Bellmunt J, Paz-Ares L, Cuello M, Cecere FL, Albiol S, Guillem V, Gallardo E, Carles J, Mendez P, de la Cruz JJ, Taron M, Rosell R, Baselga J. Gene expression of ERCC1 as a novel prognostic marker in advanced bladder cancer patients receiving cisplatin-based chemotherapy. Ann Oncol 2007; 18:522-8. [PMID: 17229776 DOI: 10.1093/annonc/mdl435] [Citation(s) in RCA: 249] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Customizing chemotherapy on the basis of chemosentitivity prediction may improve outcome in advanced bladder cancer patients. Since DNA damaging agents are the cornerstones of therapy, we hypothesized that levels of DNA repair genes could predict survival. PATIENTS AND METHODS Messenger RNA expression levels of excision repair cross complementing 1 (ERCC1), breast cancer 1 (BRCA1), ribonucleotide reductase subunit M1 (RRM1) and caveolin-1 were determined by RT-PCR in tumor DNA from 57 advanced and metastatic bladder cancer patients treated with either gemcitabine/cisplatin or gemcitabine/cisplatin/paclitaxel (Taxol). Levels were correlated with survival, time to disease progression and chemotherapy response. RESULTS Median survival was significantly higher in patients with low ERCC1 levels (25.4 versus 15.4 months; P = 0.03) (median follow-up 19 months). A trend towards longer time to progression was observed in patients with tumors expressing low levels of all markers. Levels of RRM1, BRCA1 and caveolin-1, however, failed to predict the survival and a clear link with chemotherapy response could not be established. On multivariate analysis with pretreatment prognostic factors, ERCC1 emerged as an independent predictive factor for survival. CONCLUSION The results of the study indicate that ERCC1 may predict survival in bladder cancer treated by platinum-based therapy.
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Affiliation(s)
- J Bellmunt
- Vall d'Hebron University Hospital, Barcelona, Spain.
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Ferretti G, Bria E, Giannarelli D, Carlini P, Felici A, Mandalà M, Papaldo P, Fabi A, Ciccarese M, Cuppone F, Cecere FL, Nuzzo C, Terzoli E, Cognetti F. Is Recurrent Venous Thromboembolism After Therapy Reduced by Low-Molecular-Weight Heparin Compared With Oral Anticoagulants? Chest 2006; 130:1808-16. [PMID: 17167001 DOI: 10.1378/chest.130.6.1808] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
PURPOSES To evaluate whether the incidence of recurrent venous thromboembolism (VTE) events after therapy differs for patients treated with long-term low-molecular-weight heparin (LMWH) or oral anticoagulant therapy (OAT). METHODS All randomized studies were searched through computerized queries of MEDLINE, the Cochrane Controlled Trials Register, the American Society of Hematology abstract database, and the American Society of Clinical Oncology abstract database. RESULTS Eleven studies including 2,907 patients were identified. Seven studies evaluated a period of 3 to 9 months after cessation of the allocated treatment: 5.4% of patients in the LMWH group vs 4% in the arm allocated to OAT had an episode of recurrent symptomatic VTE. Combined analysis showed a nonsignificant trend in lowering recurrent symptomatic VTE in favor of OAT (relative risk [RR], 1.29; 95% confidence interval [CI], 0.82 to 2.02; p = 0.27). By contrast, during active treatment, a statistically significant reduction of the risk of recurrent symptomatic VTE in favor of LMWH over OAT was registered (RR, 0.63; 95% CI, 0.47 to 0.83; p = 0.001). Regarding cancer patients only, 37 of 569 patients (6.5%) in the LMWH group had recurrent symptomatic VTE vs 69 of 546 patients (12.6%) in the OAT group, with a statistically significant reduction of the risk of recurrent symptomatic VTE in favor of LMWH (RR, 0.52; 95% CI, 0.35 to 0.76; p = 0.001). CONCLUSIONS Despite the significant reduction of the risk of recurrent symptomatic VTE in favor of LMWH over OAT during treatment, patients treated with long-term LMWH do not seem to have more frequently recurrent VTE events compared with OAT after cessation of therapy. The significant difference favoring LMWH over OAT among all patients receiving treatment comes mostly from studies enrolling cancer patients.
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Affiliation(s)
- Gianluigi Ferretti
- Division of Medical Oncology A, Regina Elena Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy.
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Ferretti G, Bria E, Giannarelli D, Felici A, Papaldo P, Fabi A, Di Cosimo S, Ruggeri EM, Milella M, Ciccarese M, Cecere FL, Gelibter A, Nuzzo C, Cognetti F, Terzoli E, Carlini P. Second- and third-generation aromatase inhibitors as first-line endocrine therapy in postmenopausal metastatic breast cancer patients: a pooled analysis of the randomised trials. Br J Cancer 2006; 94:1789-96. [PMID: 16736002 PMCID: PMC2361349 DOI: 10.1038/sj.bjc.6603194] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
The purpose of this study was to estimate in all randomised trials the relative risk of overall response rate (ORR), clinical benefit (CB), time to progression (TTP), overall survival (OS), and toxicity of aromatase inhibitors (AI), compared with tamoxifen (Tam) as first-line endocrine therapy in postmenopausal metastatic breast cancer (PMBC) women. Prospective randomised studies were searched through computerised queries of MEDLINE, EMBASE, and the American Society of Clinical Oncology (ASCO) abstract database. Relative risk, 95% confidence interval, and heterogeneity were derived according to the inverse variance and Mantel–Haenszel method and Q statistics. Six phase III prospective randomised trials including 2787 women were gathered. A significant advantage in ORR (P=0.042), TTP (P=0.007), and CB (P=0.001) in favour of AI over Tam was detected at the fixed effects model. These results were not significant at the random effects model, owing to the significant heterogeneity. On the contrary, no difference was registered for OS (P=0.743) with no significant heterogeneity. Regarding toxicity, Tam caused more frequently thromboembolic events (P=0.005) and vaginal bleeding (P=0.001) compared with AI. Aromatase inhibitors appear to be superior to Tam as first-line endocrine option in PMBC women. Owing to a component of variability between the six studies analysed, the random effects estimates differed from corresponding fixed ones. Investigators should assess heterogeneity of trial results before deriving summary estimates of treatment effect.
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Affiliation(s)
- G Ferretti
- Department of Medical Oncology, Regina Elena Cancer Institute, Rome, Italy.
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Affiliation(s)
- Anna Ceribelli
- Division of Medical Oncology A, Regina Elena Cancer Institute, Via Elio Chianesi, 53, 00144 Rome, Italy.
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