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Noseda R, Bedussi F, Panchaud A, Ceschi A. Safety of Monoclonal Antibodies Inhibiting PCSK9 in Pregnancy: Disproportionality Analysis in VigiBase®. Clin Pharmacol Ther 2024. [PMID: 38637956 DOI: 10.1002/cpt.3269] [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] [Received: 12/18/2023] [Accepted: 03/23/2024] [Indexed: 04/20/2024]
Abstract
Safety data on the use of monoclonal antibodies inhibiting proprotein convertase subtilisin/kexin type 9 in pregnancy are scarce. This study queried VigiBase®, the World Health Organization global pharmacovigilance database, to search for signals of disproportionate reporting for pregnancy outcomes with alirocumab and evolocumab. As of November 22, 2023, there were 45 safety reports of exposure to evolocumab (N = 31) and alirocumab (N = 14) in pregnancy. Most of them originated from Europe (N = 25, 55.6%) and were more frequently reported by healthcare professionals (N = 35, 77.8%). Median patient age was 37 years (25th-75th percentiles; 32-41 years). Drug exposure occurred during pregnancy in 36 (80.0%) safety reports, via paternal exposure during pregnancy in four (8.9%), during lactation in three (6.7%), and in two safety reports the time of drug exposure remained unknown. Twenty safety reports (57.8%) merely reported drug exposure, while 19 (42.2%) also reported pregnancy outcomes, however, without specific maternal toxicities or patterns of birth defects. Spontaneous abortion was reported in eight safety reports without representing a signal of disproportionate reporting compared with either the full database (reporting odds ratio, ROR, 0.06 95% confidence interval, CI 0.03-0.12) or statins (ROR 0.16, 95% CI 0.08-0.32). In conclusion, this study showed that, currently, there are no signals of increased reporting of spontaneous abortion with alirocumab and evolocumab compared with the full database and statins in VigiBase®. Notwithstanding, lack of disproportionality is not synonymous with safety and, as disproportionality analyses depend on the number of safety reports that progressively accumulate in VigiBase®, they should be repeated at regular intervals to confirm the results of the present study.
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Affiliation(s)
- Roberta Noseda
- Division of Clinical Pharmacology and Toxicology, Institute of Pharmacological Sciences of Southern Switzerland, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Francesca Bedussi
- Division of Clinical Pharmacology and Toxicology, Institute of Pharmacological Sciences of Southern Switzerland, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Alice Panchaud
- Service of Pharmacy, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Alessandro Ceschi
- Division of Clinical Pharmacology and Toxicology, Institute of Pharmacological Sciences of Southern Switzerland, Ente Ospedaliero Cantonale, Lugano, Switzerland
- Clinical Trial Unit, Ente Ospedaliero Cantonale, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera italiana, Lugano, Switzerland
- Department of Clinical Pharmacology and Toxicology, University Hospital Zurich, Zurich, Switzerland
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Noseda R, Bedussi F, Gobbi C, Ceschi A, Zecca C. Calcitonin gene-related peptide antagonists in pregnancy: a disproportionality analysis in VigiBase ®. J Headache Pain 2024; 25:10. [PMID: 38243189 PMCID: PMC10799383 DOI: 10.1186/s10194-024-01715-4] [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: 12/21/2023] [Accepted: 01/11/2024] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND Current evidence on the safety of calcitonin gene-related peptide antagonists (CGRP-A) in pregnancy for the treatment of both episodic and chronic migraine is scarce and does not yet provide definitive information. By querying VigiBase®, the World Health Organization global pharmacovigilance database, this study aimed to detect differences in the reporting frequency between CGRP-A and triptans in relation to pregnancy. METHODS Disproportionality analyses on de-duplicated safety reports collected in VigiBase® as of 31.05.2023 reporting exposure to CGRP-A in pregnancy with or without pregnancy outcomes. A Reporting Odds Ratio (ROR) with a 95% confidence interval (CI) was used as a measure of disproportionality and the threshold for the detection of a signal of disproportionate reporting was set with a 95% CI lower limit > 1. FINDINGS Four hundred sixty-seven safety reports reported exposure to CGRP-A in pregnancy, mostly originating from the United States of America (360/467, 77%), more frequently reported by patients (225/467, 48%), who were mainly females (431/467, 92%), and more frequently reported exposure to CGRP-A during pregnancy (400/467, 86%). Compared to triptans, no signals of disproportionate reporting were detected with CGRP-A either for the overall reporting of pregnancy-related safety reports (ROR 0.91, 95% CI 0.78-1.06), for the reporting of pregnancy outcomes (maternal and/or foetal/neonatal, ROR 0.54, 95% CI 0.45-0.66), or for the reporting of foetal/neonatal outcomes (ROR 0.53, 95% CI 0.41-0.68). CONCLUSIONS This study showed that, to date, there are no signals of increased reporting with CGRP-A compared to triptans in relation to pregnancy in VigiBase®. Future pharmacovigilance studies are needed to confirm these findings.
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Affiliation(s)
- Roberta Noseda
- Division of Clinical Pharmacology and Toxicology, Institute of Pharmacological Sciences of Southern Switzerland, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Francesca Bedussi
- Division of Clinical Pharmacology and Toxicology, Institute of Pharmacological Sciences of Southern Switzerland, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Claudio Gobbi
- Department of Neurology, Neurocenter of Southern Switzerland, Ente Ospedaliero Cantonale, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
- Department of Neurology, University Hospital Basel, Basel, Switzerland
| | - Alessandro Ceschi
- Division of Clinical Pharmacology and Toxicology, Institute of Pharmacological Sciences of Southern Switzerland, Ente Ospedaliero Cantonale, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
- Clinical Trial Unit, Ente Ospedaliero Cantonale, Lugano, Switzerland
- Department of Clinical Pharmacology and Toxicology, University Hospital Zurich, Zurich, Switzerland
| | - Chiara Zecca
- Department of Neurology, Neurocenter of Southern Switzerland, Ente Ospedaliero Cantonale, Lugano, Switzerland.
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland.
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Noseda R, Bedussi F, Gobbi C, Ceschi A, Zecca C. Safety profile of monoclonal antibodies targeting the calcitonin gene-related peptide system in pregnancy: Updated analysis in VigiBase®. Cephalalgia 2023; 43:3331024231158083. [PMID: 36855950 DOI: 10.1177/03331024231158083] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
BACKGROUND Safety data on the use of migraine preventive monoclonal antibodies targeting the calcitonin gene-related peptide (CGRP) system in pregnancy are limited. METHODS Updated pharmacovigilance assessment of the safety reports related to pregnancy associated with erenumab, galcanezumab, fremanezumab and eptinezumab, retrieved from VigiBase® as of 31 December 2021. As primary outcome, the whole group of monoclonal antibodies targeting the CGRP system was considered and sex and age subgroup disproportionality analyses using the reporting odds ratio (ROR) were conducted. RESULTS 286 safety reports were found: 116 (40.6%) on erenumab, 125 (43.7%) on galcanezumab, 39 (13.6%) on fremanezumab, 6 (2.1%) on eptinezumab. One hundred and forty-nine (52.1%) safety reports reported only drug exposure in relation to pregnancy while 137 (47.9%) also included ≥1 pregnancy outcomes: maternal outcomes (n = 64), spontaneous abortion (n = 63), foetal growth restriction (n = 1), prematurity (n = 8), neonatal outcomes (n = 13), and poor breastfeeding (n = 1). No specific patterns of maternal, foetal and neonatal toxicity were observed. Spontaneous abortion was not disproportionally more frequently reported with erenumab, galcanezumab, fremanezumab and eptinezumab compared with the entire database (ROR 1.1, 95% confidence interval, CI, 0.8-1.5), the entire database since 2018 (ROR 1.3, 95% CI 1.0-1.8), and triptans (ROR 1.2, 95% CI 0.8-1.9). CONCLUSIONS This updated safety analysis on erenumab, galcanezumab, fremanezumab and eptinezumab in pregnancy showed no signals of foeto-maternal toxicity according to VigiBase® safety reports.
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Affiliation(s)
- Roberta Noseda
- Division of Clinical Pharmacology and Toxicology, Institute of Pharmacological Sciences of Southern Switzerland, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Francesca Bedussi
- Division of Clinical Pharmacology and Toxicology, Institute of Pharmacological Sciences of Southern Switzerland, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Claudio Gobbi
- Department of Neurology, Neurocenter of Southern Switzerland, Ente Ospedaliero Cantonale, Lugano, Switzerland.,Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland.,Department of Neurology, University Hospital Basel, Basel, Switzerland
| | - Alessandro Ceschi
- Division of Clinical Pharmacology and Toxicology, Institute of Pharmacological Sciences of Southern Switzerland, Ente Ospedaliero Cantonale, Lugano, Switzerland.,Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland.,Clinical Trial Unit, Ente Ospedaliero Cantonale, Lugano, Switzerland.,Department of Clinical Pharmacology and Toxicology, University Hospital Zurich, Zurich, Switzerland
| | - Chiara Zecca
- Department of Neurology, Neurocenter of Southern Switzerland, Ente Ospedaliero Cantonale, Lugano, Switzerland.,Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
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Ekobena P, Rothuizen LE, Bedussi F, Guilcher P, Meylan S, Ceschi A, Girardin F, Dao K. Four cases of audio-vestibular disorders related to immunisation with SARS-CoV-2 mRNA vaccines. Int J Audiol 2022:1-5. [PMID: 35510657 DOI: 10.1080/14992027.2022.2056721] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To gain medical insight into the clinical course and safety of otolaryngologic disorders following immunisation with severe acute respiratory coronavirus (SARS-CoV-2) mRNA-based vaccines. DESIGN Case description. STUDY SAMPLE We report four cases of transient audio-vestibular symptoms, which occurred shortly after inoculation of two BNT162b2 (Pfizer-BioNTech®) and mRNA-1273 (Moderna®) vaccines. RESULTS Hearing loss was unilateral in all cases and recovered at least partially: it was associated with persistent gait instability in two cases, after 1 and 7 months. Trigger mechanisms underpinning audio-vestibular impairment remain uncertain. Immune tolerance mechanisms with off-target innate activation of T-lymphocytes may be involved in vestibulocochlear nerve disorders, as for other cranial nerves involvement. CONCLUSIONS The occurrence of audio-vestibular manifestations following mRNA-based vaccines needs ENT monitoring to support their causality in such rare vaccine-related adverse events. Audio-vestibular disorders appeared of transitory nature, including hearing loss, and should not deter further efforts in large-scale vaccination campaigns against SARS-CoV-2.
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Affiliation(s)
- Pierre Ekobena
- Department of Laboratory Medicine and Pathology, Service of Clinical Pharmacology, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Laura E Rothuizen
- Department of Laboratory Medicine and Pathology, Service of Clinical Pharmacology, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Francesca Bedussi
- Division of Clinical Pharmacology and Toxicology, Institute of Pharmacological Sciences of Southern Switzerland, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Pierre Guilcher
- Department of Otorhinolaryngology, Head & Neck Surgery, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Sylvain Meylan
- Department of Medicine, Infectious Diseases Service, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Alessandro Ceschi
- Division of Clinical Pharmacology and Toxicology, Institute of Pharmacological Sciences of Southern Switzerland, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - François Girardin
- Department of Laboratory Medicine and Pathology, Service of Clinical Pharmacology, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Kim Dao
- Department of Laboratory Medicine and Pathology, Service of Clinical Pharmacology, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
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Noseda R, Bedussi F, Gobbi C, Zecca C, Ceschi A. Reply to the Letter to the Editor by Kessler Y et al. regarding the manuscript "Safety profile of erenumab, galcanezumab and fremanezumab in pregnancy and lactation: Analysis of the WHO pharmacovigilance database.". Cephalalgia 2021; 41:1130-1131. [PMID: 33938247 DOI: 10.1177/03331024211006849] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Roberta Noseda
- Division of Clinical Pharmacology and Toxicology, Institute of Pharmacological Sciences of Southern Switzerland, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Francesca Bedussi
- Division of Clinical Pharmacology and Toxicology, Institute of Pharmacological Sciences of Southern Switzerland, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Claudio Gobbi
- Neurocenter of Southern Switzerland, Ente Ospedaliero Cantonale, Lugano, Switzerland.,Faculty of Biomedical Sciences, University of Southern Switzerland, Lugano, Switzerland.,Department of Neurology, University Hospital Basel, Basel, Switzerland
| | - Chiara Zecca
- Neurocenter of Southern Switzerland, Ente Ospedaliero Cantonale, Lugano, Switzerland.,Faculty of Biomedical Sciences, University of Southern Switzerland, Lugano, Switzerland
| | - Alessandro Ceschi
- Division of Clinical Pharmacology and Toxicology, Institute of Pharmacological Sciences of Southern Switzerland, Ente Ospedaliero Cantonale, Lugano, Switzerland.,Faculty of Biomedical Sciences, University of Southern Switzerland, Lugano, Switzerland.,Department of Clinical Pharmacology and Toxicology, University Hospital Zurich, Zurich, Switzerland
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Rampolli FI, Kamler P, Carnevale Carlino C, Bedussi F. The Deceptive Mushroom: Accidental Amanita muscaria Poisoning. Eur J Case Rep Intern Med 2021; 8:002212. [PMID: 33768066 DOI: 10.12890/2021_002212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 01/08/2021] [Indexed: 11/05/2022] Open
Abstract
Amanita muscaria is considered to be one of the most remarkable and beautiful mushrooms. It has a red or orange cap covered with small white plaques and its distinctive appearance makes accidental and severe intoxication very rare. Its consumption is sometimes used as a means of suicide or it can be consumed for its psychedelic effects, and in some cases, it can be mistaken for edible species. In this paper, we will discuss a patient who fell into a coma after accidental Amanita muscaria poisoning. Rapid identification of the mushroom allowed the regression of symptoms and discharge from the hospital on the fourth day after consumption. LEARNING POINTS Amanita muscaria is one of the most remarkable mushrooms for its distinctive appearance, but sometimes it can be mistaken for edible species.Amanita muscaria is a highly poisonous mushroom; the primary effects usually involve the central nervous system, and in severe poisoning, symptoms may manifest with coma and in rare cases lead to death.The rapid and correct identification of this mushroom is important for optimal risk assessment and in order to prescribe the best therapy.
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Affiliation(s)
| | - Premila Kamler
- Department of Internal Medicine, Ospedale Regionale di Lugano, Switzerland
| | | | - Francesca Bedussi
- Division of Clinical Pharmacology and Toxicology, Institute of Pharmacological Sciences of Southern Switzerland, Ospedale Regionale di Lugano, Switzerland
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Noseda R, Bedussi F, Gobbi C, Zecca C, Ceschi A. Safety profile of erenumab, galcanezumab and fremanezumab in pregnancy and lactation: Analysis of the WHO pharmacovigilance database. Cephalalgia 2021; 41:789-798. [PMID: 33435709 DOI: 10.1177/0333102420983292] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To assess the safety profile of erenumab, galcanezumab and fremanezumab in pregnancy and lactation. METHODS Safety reports of suspected adverse drug reactions were retrieved from VigiBase as of 31 December 2019, for a case-by-case assessment and disproportionality analysis using the reporting odds ratio (ROR). RESULTS There were 94 safety reports: 50 (53.2%) on erenumab, 31 (33.0%) on galcanezumab, and 13 (13.8%) on fremanezumab. In five (5.3%) safety reports, drug exposure occurred prior to pregnancy, in 85 (90.4%) during pregnancy, in one (1.1%) during lactation, in one (1.1%) via paternal exposure, and in two (2.1%) the exposure time was unknown. Out of 94 safety reports, 51 (54.3%) consisted only of drug exposure, while 43 (45.7%) additionally reported 47 adverse drug reactions including maternal toxicities (n = 18), poor breastfeeding (n = 1), spontaneous abortion (n = 23), preterm birth/prematurity (n = 3), and birth defects (n = 2). There was no signal of disproportionate reporting for spontaneous abortion compared to the full database (reporting odds ratio 1.46, 95% confidence interval 0.97-2.20). When triptans were used as a comparator group, a signal of disproportionate reporting for spontaneous abortion was detected in association with erenumab, galcanezumab, and fremanezumab (reporting odds ratio 1.86, 95% confidence interval 1.12-3.13), which was not statistically significant after excluding confounded safety reports (reporting odds ratio 1.21, 95% confidence interval 0.67-2.21). CONCLUSIONS No specific maternal toxicities, patterns of major birth defects, or increased reporting of spontaneous abortion were found. However, because of the relatively limited number of adverse drug reactions reported and the lack of long-term safety data, continuous surveillance is required in pregnant and lactating women exposed to these drugs.
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Affiliation(s)
- Roberta Noseda
- Division of Clinical Pharmacology and Toxicology, Institute of Pharmacological Sciences of Southern Switzerland, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Francesca Bedussi
- Division of Clinical Pharmacology and Toxicology, Institute of Pharmacological Sciences of Southern Switzerland, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Claudio Gobbi
- Neurocenter of Southern Switzerland, Ente Ospedaliero Cantonale, Lugano, Switzerland.,Faculty of Biomedical Sciences, University of Southern Switzerland, Lugano, Switzerland.,Department of Neurology, University Hospital Basel, Basel, Switzerland
| | - Chiara Zecca
- Neurocenter of Southern Switzerland, Ente Ospedaliero Cantonale, Lugano, Switzerland.,Faculty of Biomedical Sciences, University of Southern Switzerland, Lugano, Switzerland
| | - Alessandro Ceschi
- Division of Clinical Pharmacology and Toxicology, Institute of Pharmacological Sciences of Southern Switzerland, Ente Ospedaliero Cantonale, Lugano, Switzerland.,Faculty of Biomedical Sciences, University of Southern Switzerland, Lugano, Switzerland.,Department of Clinical Pharmacology and Toxicology, University Hospital Zurich, Zurich, Switzerland
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8
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Bedussi F, Acerbis E, Noseda R, Demagistri D, Zamprogno E, Ceschi A. False-positive urine screen test for MDMA in a patient exposed to mebeverine. Br J Clin Pharmacol 2020; 87:2397-2398. [PMID: 33200465 DOI: 10.1111/bcp.14624] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 10/13/2020] [Accepted: 10/15/2020] [Indexed: 11/30/2022] Open
Affiliation(s)
- Francesca Bedussi
- Division of Clinical Pharmacology and Toxicology, Institute of Pharmacological Sciences of Southern Switzerland, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Elisabetta Acerbis
- Emergency Department, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale, Lugano, Switzerland.,Service of Internal Medicine, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Roberta Noseda
- Division of Clinical Pharmacology and Toxicology, Institute of Pharmacological Sciences of Southern Switzerland, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Davide Demagistri
- Emergency Department, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale, Lugano, Switzerland.,Department of Surgery, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Emanuela Zamprogno
- Emergency Department, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Alessandro Ceschi
- Division of Clinical Pharmacology and Toxicology, Institute of Pharmacological Sciences of Southern Switzerland, Ente Ospedaliero Cantonale, Lugano, Switzerland.,Department of Clinical Pharmacology and Toxicology, University Hospital Zurich, Zurich, Switzerland.,Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
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Eleftheriou G, Butera R, Gallo M, Bedussi F, Faraoni L, Giampreti A, Bacis G. #2 Oxatomide use in pregnancy and neonatal abstinence syndrome: A case report. Reprod Toxicol 2019. [DOI: 10.1016/j.reprotox.2019.05.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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10
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Tucci M, Roca E, Ferrari L, Pia A, Dalla Volta A, Bedussi F, Buttigliero C, Vittorio Scagliotti G, Sigala S, Berruti A. Abiraterone and prednisone therapy may cause severe hypoglycemia when administered to prostate cancer patients with type 2 diabetes receiving glucose-lowering agents. Endocrine 2019; 64:724-726. [PMID: 31065911 DOI: 10.1007/s12020-019-01947-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 04/29/2019] [Indexed: 02/04/2023]
Affiliation(s)
- Marcello Tucci
- Medical Oncology, Cardinal Massaia Hospital, Corso Dante Alighieri, 202, 14100, Asti, Italy
| | - Elisa Roca
- Medical Oncology, ASST-Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - Laura Ferrari
- Medical Oncology, ASST-Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - Anna Pia
- Endocrinology Unit, San Luigi Gonzaga Hospital, Regione Gonzole 10, 10043, Orbassano, Turin, Italy
| | - Alberto Dalla Volta
- Medical Oncology, ASST-Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - Francesca Bedussi
- Section of Pharmacology, Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Consuelo Buttigliero
- Medical Oncology, Department of Oncology, University of Turin at San Luigi Ginzaga Hospital, Regione Gonzole 10, 10043, Orbassano, Italy
| | - Giorgio Vittorio Scagliotti
- Medical Oncology, Department of Oncology, University of Turin at San Luigi Ginzaga Hospital, Regione Gonzole 10, 10043, Orbassano, Italy
| | - Sandra Sigala
- Section of Pharmacology, Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Alfredo Berruti
- Medical Oncology, ASST-Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy.
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11
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Bedussi F, Relli V, Faraoni L, Eleftheriou G, Giampreti A, Gallo M, Lorenzi F, Sangiovanni A, Chiara F, Maccioni R, Pilloni PP, Falchi G, Scanu M, Butera R, Bacis G. Normocytic Normochromic Anaemia and Asymptomatic Neutropenia in a 40-Day-Old Infant Breastfed by an Epileptic Mother Treated With Lamotrigine: Infant's Adverse Drug Reaction. J Paediatr Child Health 2018; 54:104-105. [PMID: 29314386 DOI: 10.1111/jpc.13805] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 11/09/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Francesca Bedussi
- Poison Centre and Teratology Information Service, Papa Giovanni XXIII Hospital, Bergamo
| | - Valentina Relli
- Department of Pediatrics, Iglesias C.T.O. Hospital Centre, ASSL Carbonia, Italy
| | - Lorella Faraoni
- Poison Centre and Teratology Information Service, Papa Giovanni XXIII Hospital, Bergamo
| | - Georgios Eleftheriou
- Poison Centre and Teratology Information Service, Papa Giovanni XXIII Hospital, Bergamo
| | - Andrea Giampreti
- Poison Centre and Teratology Information Service, Papa Giovanni XXIII Hospital, Bergamo
| | - Mariapina Gallo
- Poison Centre and Teratology Information Service, Papa Giovanni XXIII Hospital, Bergamo
| | - Federica Lorenzi
- Poison Centre and Teratology Information Service, Papa Giovanni XXIII Hospital, Bergamo
| | - Anna Sangiovanni
- Poison Centre and Teratology Information Service, Papa Giovanni XXIII Hospital, Bergamo
| | - Francesca Chiara
- Poison Centre and Teratology Information Service, Papa Giovanni XXIII Hospital, Bergamo
| | - Rosella Maccioni
- Department of Pediatrics, Iglesias C.T.O. Hospital Centre, ASSL Carbonia, Italy
| | - Pier P Pilloni
- Department of Pediatrics, Iglesias C.T.O. Hospital Centre, ASSL Carbonia, Italy
| | - Giovanna Falchi
- Poison Centre and Teratology Information Service, Papa Giovanni XXIII Hospital, Bergamo
| | - Mariapiera Scanu
- Department of Pediatrics, Iglesias C.T.O. Hospital Centre, ASSL Carbonia, Italy
| | - Raffaella Butera
- Poison Centre and Teratology Information Service, Papa Giovanni XXIII Hospital, Bergamo
| | - Giuseppe Bacis
- Poison Centre and Teratology Information Service, Papa Giovanni XXIII Hospital, Bergamo
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12
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Bedussi F, Galli D, Fragni M, Valcamonico F, Rossini E, Dalla Volta A, Vezzoli S, Roca E, Ferrari V, Lazzari B, Memo M, Sigala S, Berruti A. Amiloride Is Effective in the Management of Abiraterone-Induced Mineralocorticoid Excess Syndrome without Interfering with Its Antineoplastic Activity. Pharmacology 2017; 100:261-268. [DOI: 10.1159/000477547] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 05/15/2017] [Indexed: 02/04/2023]
Abstract
Background: The administration of abiraterone acetate (abiraterone) leads to an adrenocorticotropic hormone (ACTH)-driven increase in mineralocorticoid hormones, requiring glucocorticoid supplementation that may stimulate the growth of prostate cancer (PCa). Amiloride is a drug that selectively reduces the aldosterone-sensitive Na+/K+ exchange and could be effective in the management of mineralocorticoid excess syndrome (MCES). Methods: The efficacy of amiloride + hydrochlorothiazide (HCT) in the clinical management of abiraterone-induced MCES was assessed in 5 consecutive patients with castration-resistant PCa (CRPC). Then, using the in vitro experimental model of PCa cell lines, the possible effects of drugs usually used in the clinical management of CRPC patients on PCa cell viability were investigated. Results: Amiloride/HCT led to a complete disappearance of all clinical and biochemical signs of abiraterone-induced MCES in the 5 treated patients. The in vitro study showed that abiraterone treatment significantly decreased cell viability of both androgen receptor (AR)-expressing VCaP (vertebral-cancer of the prostate) and LNCaP (lymph node carcinoma of the prostate) cells, with no effect on AR-negative PC-3 cells. Prednisolone, spironolactone, and eplerenone increased LNCaP cell viability, while amiloride reduced it. The non-steroid aldosterone antagonist PF-03882845 did not modify PCa cell viability. Conclusions: The combination of amiloride/HCT was effective in the management of abiraterone-induced MCES. Amiloride did not negatively interfere with the abiraterone inhibition of PCa cell viability in vitro.
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Bedussi F, Valcamonico F, Mosca A, Sigala S, Ferrari L, Terrone C, Volta AD, Marchioro G, Ferrari V, Alabiso O, Memo M, Berruti A. Docetaxel plus androgen deprivation withdrawal may restore sensitivity to luteinizing hormone-releasing hormone analog therapy in castration-resistant prostate cancer patients. Endocrine 2016; 54:830-833. [PMID: 26690656 DOI: 10.1007/s12020-015-0827-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 12/07/2015] [Indexed: 01/21/2023]
Affiliation(s)
- Francesca Bedussi
- Oncology Unit, Department of Surgery, Radiology, and Public Health, University of Brescia, Spedali Civili of Brescia, Brescia, Italy
- Section of Pharmacology, Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Francesca Valcamonico
- Oncology Unit, Department of Surgery, Radiology, and Public Health, University of Brescia, Spedali Civili of Brescia, Brescia, Italy.
| | - Alessandra Mosca
- Medical Oncology, Maggiore della Carità University Hospital, University of Eastern Piedmont, Novara, Italy
| | - Sandra Sigala
- Section of Pharmacology, Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Laura Ferrari
- Oncology Unit, Department of Surgery, Radiology, and Public Health, University of Brescia, Spedali Civili of Brescia, Brescia, Italy
| | - Carlo Terrone
- Urology, Maggiore della Carità University Hospital, University of Eastern Piedmont, Novara, Italy
| | - Alberto Dalla Volta
- Oncology Unit, Department of Surgery, Radiology, and Public Health, University of Brescia, Spedali Civili of Brescia, Brescia, Italy
| | - Giansilvio Marchioro
- Urology, Maggiore della Carità University Hospital, University of Eastern Piedmont, Novara, Italy
| | - Vittorio Ferrari
- Oncology Unit, Department of Surgery, Radiology, and Public Health, University of Brescia, Spedali Civili of Brescia, Brescia, Italy
| | - Oscar Alabiso
- Medical Oncology, Maggiore della Carità University Hospital, University of Eastern Piedmont, Novara, Italy
| | - Maurizio Memo
- Section of Pharmacology, Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Alfredo Berruti
- Oncology Unit, Department of Surgery, Radiology, and Public Health, University of Brescia, Spedali Civili of Brescia, Brescia, Italy
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Generali D, Ardine M, Strina C, Milani M, Cappelletti MR, Zanotti L, Forti M, Bedussi F, Martinotti M, Amoroso V, Sigala S, Simoncini E, Berruti A, Bottini A. Neoadjuvant Treatment Approach: The Rosetta Stone for Breast Cancer? J Natl Cancer Inst Monogr 2016; 2015:32-5. [PMID: 26063883 DOI: 10.1093/jncimonographs/lgv019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Breast cancer represents a heterogeneous group of diseases with varied biological features, behavior, and response to therapy; thus, management of breast cancer relies on the availability of robust predictive and prognostic factors to support therapy decision-making. Traditionally, neoadjuvant treatment for breast cancer was preserved for locally advanced, converting an inoperable to a surgical resectable cancer. Neoadjuvant trials, additionally, offer: 1) the opportunity to evaluate new treatment options in a faster way and with fewer patients than large adjuvant trials; 2) to identify and validate the prognostic and predictive value of a marker with its association with clinical outcome in relation to the administered treatment. In this setting, thanks to new, affordable technologies which help to detail the molecular profiles of tumors, new trial designs based on new target therapies, like window-of-opportunity, are also suggested, as they represent the chance to identify tumor sensitivity or to overcome tumor resistance to the treatment used, based on its interaction with tumor biology in early tumor stages. However, clinicians and researchers should pay particular attention: In this setting, the safety of patients is paramount, given the exposure of potentially curable patients to investigational agents with limited safety experience, the definition of the study population and the study design, such as adaptive strategies, should limit patient exposure to ineffective agents, and intensify safety monitoring in the course of the treatment. Here, issues related to outcome determination in breast cancer, including some critical points of view, are presented.
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Affiliation(s)
- Daniele Generali
- U.O. Multidisciplinare di Patologia Mammaria, U.S Terapia Molecolare e Farmacogenomica, A.O. Istituti Ospitalieri di Cremona, Cremona, Italy (DG, MA, CS, MMi, MRC, LZ, MF, FB, MMa, ABo); U.O. Oncologia Medica, Spedali Civili si Brescia, Brescia, Italy (VA, ES, ABe); Section of Pharmacology, Department of Molecular and Translational Medicine, University of Brescia Medical School, Brescia, Italy (FB, SS).
| | - Mara Ardine
- U.O. Multidisciplinare di Patologia Mammaria, U.S Terapia Molecolare e Farmacogenomica, A.O. Istituti Ospitalieri di Cremona, Cremona, Italy (DG, MA, CS, MMi, MRC, LZ, MF, FB, MMa, ABo); U.O. Oncologia Medica, Spedali Civili si Brescia, Brescia, Italy (VA, ES, ABe); Section of Pharmacology, Department of Molecular and Translational Medicine, University of Brescia Medical School, Brescia, Italy (FB, SS)
| | - Carla Strina
- U.O. Multidisciplinare di Patologia Mammaria, U.S Terapia Molecolare e Farmacogenomica, A.O. Istituti Ospitalieri di Cremona, Cremona, Italy (DG, MA, CS, MMi, MRC, LZ, MF, FB, MMa, ABo); U.O. Oncologia Medica, Spedali Civili si Brescia, Brescia, Italy (VA, ES, ABe); Section of Pharmacology, Department of Molecular and Translational Medicine, University of Brescia Medical School, Brescia, Italy (FB, SS)
| | - Manuela Milani
- U.O. Multidisciplinare di Patologia Mammaria, U.S Terapia Molecolare e Farmacogenomica, A.O. Istituti Ospitalieri di Cremona, Cremona, Italy (DG, MA, CS, MMi, MRC, LZ, MF, FB, MMa, ABo); U.O. Oncologia Medica, Spedali Civili si Brescia, Brescia, Italy (VA, ES, ABe); Section of Pharmacology, Department of Molecular and Translational Medicine, University of Brescia Medical School, Brescia, Italy (FB, SS)
| | - Maria Rosa Cappelletti
- U.O. Multidisciplinare di Patologia Mammaria, U.S Terapia Molecolare e Farmacogenomica, A.O. Istituti Ospitalieri di Cremona, Cremona, Italy (DG, MA, CS, MMi, MRC, LZ, MF, FB, MMa, ABo); U.O. Oncologia Medica, Spedali Civili si Brescia, Brescia, Italy (VA, ES, ABe); Section of Pharmacology, Department of Molecular and Translational Medicine, University of Brescia Medical School, Brescia, Italy (FB, SS)
| | - Laura Zanotti
- U.O. Multidisciplinare di Patologia Mammaria, U.S Terapia Molecolare e Farmacogenomica, A.O. Istituti Ospitalieri di Cremona, Cremona, Italy (DG, MA, CS, MMi, MRC, LZ, MF, FB, MMa, ABo); U.O. Oncologia Medica, Spedali Civili si Brescia, Brescia, Italy (VA, ES, ABe); Section of Pharmacology, Department of Molecular and Translational Medicine, University of Brescia Medical School, Brescia, Italy (FB, SS)
| | - Michela Forti
- U.O. Multidisciplinare di Patologia Mammaria, U.S Terapia Molecolare e Farmacogenomica, A.O. Istituti Ospitalieri di Cremona, Cremona, Italy (DG, MA, CS, MMi, MRC, LZ, MF, FB, MMa, ABo); U.O. Oncologia Medica, Spedali Civili si Brescia, Brescia, Italy (VA, ES, ABe); Section of Pharmacology, Department of Molecular and Translational Medicine, University of Brescia Medical School, Brescia, Italy (FB, SS)
| | - Francesca Bedussi
- U.O. Multidisciplinare di Patologia Mammaria, U.S Terapia Molecolare e Farmacogenomica, A.O. Istituti Ospitalieri di Cremona, Cremona, Italy (DG, MA, CS, MMi, MRC, LZ, MF, FB, MMa, ABo); U.O. Oncologia Medica, Spedali Civili si Brescia, Brescia, Italy (VA, ES, ABe); Section of Pharmacology, Department of Molecular and Translational Medicine, University of Brescia Medical School, Brescia, Italy (FB, SS)
| | - Mario Martinotti
- U.O. Multidisciplinare di Patologia Mammaria, U.S Terapia Molecolare e Farmacogenomica, A.O. Istituti Ospitalieri di Cremona, Cremona, Italy (DG, MA, CS, MMi, MRC, LZ, MF, FB, MMa, ABo); U.O. Oncologia Medica, Spedali Civili si Brescia, Brescia, Italy (VA, ES, ABe); Section of Pharmacology, Department of Molecular and Translational Medicine, University of Brescia Medical School, Brescia, Italy (FB, SS)
| | - Vito Amoroso
- U.O. Multidisciplinare di Patologia Mammaria, U.S Terapia Molecolare e Farmacogenomica, A.O. Istituti Ospitalieri di Cremona, Cremona, Italy (DG, MA, CS, MMi, MRC, LZ, MF, FB, MMa, ABo); U.O. Oncologia Medica, Spedali Civili si Brescia, Brescia, Italy (VA, ES, ABe); Section of Pharmacology, Department of Molecular and Translational Medicine, University of Brescia Medical School, Brescia, Italy (FB, SS)
| | - Sandra Sigala
- U.O. Multidisciplinare di Patologia Mammaria, U.S Terapia Molecolare e Farmacogenomica, A.O. Istituti Ospitalieri di Cremona, Cremona, Italy (DG, MA, CS, MMi, MRC, LZ, MF, FB, MMa, ABo); U.O. Oncologia Medica, Spedali Civili si Brescia, Brescia, Italy (VA, ES, ABe); Section of Pharmacology, Department of Molecular and Translational Medicine, University of Brescia Medical School, Brescia, Italy (FB, SS)
| | - Edda Simoncini
- U.O. Multidisciplinare di Patologia Mammaria, U.S Terapia Molecolare e Farmacogenomica, A.O. Istituti Ospitalieri di Cremona, Cremona, Italy (DG, MA, CS, MMi, MRC, LZ, MF, FB, MMa, ABo); U.O. Oncologia Medica, Spedali Civili si Brescia, Brescia, Italy (VA, ES, ABe); Section of Pharmacology, Department of Molecular and Translational Medicine, University of Brescia Medical School, Brescia, Italy (FB, SS)
| | - Alfredo Berruti
- U.O. Multidisciplinare di Patologia Mammaria, U.S Terapia Molecolare e Farmacogenomica, A.O. Istituti Ospitalieri di Cremona, Cremona, Italy (DG, MA, CS, MMi, MRC, LZ, MF, FB, MMa, ABo); U.O. Oncologia Medica, Spedali Civili si Brescia, Brescia, Italy (VA, ES, ABe); Section of Pharmacology, Department of Molecular and Translational Medicine, University of Brescia Medical School, Brescia, Italy (FB, SS)
| | - Alberto Bottini
- U.O. Multidisciplinare di Patologia Mammaria, U.S Terapia Molecolare e Farmacogenomica, A.O. Istituti Ospitalieri di Cremona, Cremona, Italy (DG, MA, CS, MMi, MRC, LZ, MF, FB, MMa, ABo); U.O. Oncologia Medica, Spedali Civili si Brescia, Brescia, Italy (VA, ES, ABe); Section of Pharmacology, Department of Molecular and Translational Medicine, University of Brescia Medical School, Brescia, Italy (FB, SS)
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Valcamonico F, Bedussi F, Galli D, Dalla Volta A, Fragni M, Vezzoli S, Ferrari VD, Lazzari B, Ferrari L, De Ferrari F, Memo M, Berruti A, Sigala S. Amiloride effects on abiraterone antiproliferative activity in prostate cancer cells in vitro and on clinical management of abiraterone induced mineralocorticoid excess syndrome. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.2_suppl.175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
175 Background: Abiraterone acetate (AA) deeply inhibits androgen synthesis but leads to an ACTH driven increase in mineralocorticoid hormones requiring glucocorticoid supplementation that may impair its antineoplastic efficacy. New strategies for the management of the AA induced mineral corticoid excess syndrome (MCES) are warranted. Methods: We analyzed in vitro the interaction in terms of proliferative activity of AA plus/minus prednisone with the steroid aldosterone receptor antagonists: eplerenone, spironolactone, a non-steroidal aldosterone receptor antagonist (PF-03882845) and the epithelial sodium channel antagonist amiloride. LNCaP were grown in a medium with charcoal-treated serum and concentration-response curves for each studied drug were performed. Besides, the activity of amiloride plus hydrochlorothiazide was assessed in the clinical management of AA induced MCES in 5 consecutive patients with castrate resistant prostate cancer. The recovery of AA induced MCES symptoms and signs was the primary end point. Results: Prednisone, spironolactone and eplerenone induced an increase in the LNCAP proliferation rate and antagonized the AA-induced reduction of the cell proliferation in a concentration-dependent manner, while PF-03882845 did not. Amiloride at high concentrations induced cell death. When combined with AA +/- prednisone, amiloride at low concentration did not interfere with AA anti-proliferative activity however an additive inhibitory effect was observed at higher concentrations. The association of amiloride with hydrochlorothiazide led to a complete disappearance of all clinical and biochemical signs of abiraterone induced MCES in the 5 treated patients. Conclusions: Amiloride and PF-03882845 do not negatively interfere with the AA inhibition of proliferative activity of prostate cancer cells in vitro. The association of amiloride plus hydrochlorothiazide is efficacious in the management AA induced MCES.
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Affiliation(s)
- Francesca Valcamonico
- Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Francesca Bedussi
- Section of Pharmacology, Dept of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Diego Galli
- Section of Pharmacology, Dept of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Alberto Dalla Volta
- Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Martina Fragni
- Section of Pharmacology, Dept of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Sara Vezzoli
- Section of Pharmacology, Dept of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Vittorio D. Ferrari
- Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Barbara Lazzari
- Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Laura Ferrari
- Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Francesco De Ferrari
- Forensic Medicine Inst, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Maurizio Memo
- Section of Pharmacology, Dept of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Alfredo Berruti
- Medical Oncology, University of Brescia, Spedali Civili Hospital, Brescia, Italy
| | - Sandra Sigala
- Section of Pharmacology, Dept of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
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Generali D, Berruti A, Cappelletti MR, Zanotti L, Brugnoli G, Forti M, Bedussi F, Vailati ME, Milani M, Strina C, Ardine M, Aguggini S, Allevi G, Ferrero G, Bertoni R, Bottini A, Harris AL, Fox SB. Effect of Primary Letrozole Treatment on Tumor Expression of mTOR and HIF-1α and Relation to Clinical Response. J Natl Cancer Inst Monogr 2015; 2015:64-6. [PMID: 26063890 DOI: 10.1093/jncimonographs/lgv018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2024] Open
Abstract
INTRODUCTION Recently the combination of the mammalian target of rapamycin (mTOR) inhibitor everolimus and the aromatase inhibitor exemestane has been shown to double the progression-free survival rate in advanced breast cancer. However, the effect of the interrelated pathways of hypoxia-inducible factor-1α (HIF-1α) and mTOR signaling, both of which are associated with a more aggressive breast cancer phenotype and endocrine resistance, on response in the neoadjuvant setting is unknown. We, therefore, have investigated the influence of these pathways with the aim of better defining those patients most likely to benefit from an endocrine-based therapy associated with/without mTOR inhibitors. PATIENTS AND METHODS A total of 107 women with T2-4 N0-1 and estrogen receptor-positive breast cancer were randomly assigned to 6 months of primary letrozole (2.5 mg/daily) (LET) or LET plus oral "metronomic" cyclophosphamide (50mg/daily) (LET-CYC). Phospo-mTOR and HIF-1α were evaluated in tumor specimens collected before and after treatment using a tissue microarray format. RESULTS LET-based therapy induced a downregulation of phospho-mTOR and HIF-1α expression (P = .0001 and P < .004, respectively). The reduction of HIF-1α expression observed was positively correlated with phospho-mTOR reduction (P < .03); however, no treatment interaction between the two proteins was detected. HIF-1α expression was significantly modulated by the treatment (P < .004) with a reduction both in the LET arm (45%, n = 36/80) (P = .05) and LET-CYC arm (55%, n = 44/80) (P = .04). HIF-1α reduction showed a relationship with clinical response confined in LET arm only (P < .03). CONCLUSIONS In this neoadjuvant population, LET was able to modulate the phospho-mTOR and HIF-1α pathways and may define a subpopulation of nonresponders who may be most likely to benefit from mTOR inhibitors.
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Affiliation(s)
- Daniele Generali
- U.O. Multidisciplinare di Patologia Mammaria/ US Terapia Molecolare (DG, MRC, LZ, GB, MF, FB, MEV, MM, CS, MA, SA, GA, ABo), and Anatomia Patologica (GF, RB), Azienda Istituti Ospitalieri di Cremona, Cremona, Italy; Oncologia Medica, Università di Brescia, Spedali Civili di Brescia, Brescia, Italy (ABe, GB); Weatherall Molecular Oncology Laboratories, Institute of Molecular Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK (ALH); Department of Pathology, Peter MacCallum Cancer Centre, East Melbourne, Australia (SBF).
| | - Alfredo Berruti
- U.O. Multidisciplinare di Patologia Mammaria/ US Terapia Molecolare (DG, MRC, LZ, GB, MF, FB, MEV, MM, CS, MA, SA, GA, ABo), and Anatomia Patologica (GF, RB), Azienda Istituti Ospitalieri di Cremona, Cremona, Italy; Oncologia Medica, Università di Brescia, Spedali Civili di Brescia, Brescia, Italy (ABe, GB); Weatherall Molecular Oncology Laboratories, Institute of Molecular Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK (ALH); Department of Pathology, Peter MacCallum Cancer Centre, East Melbourne, Australia (SBF)
| | - Maria Rosa Cappelletti
- U.O. Multidisciplinare di Patologia Mammaria/ US Terapia Molecolare (DG, MRC, LZ, GB, MF, FB, MEV, MM, CS, MA, SA, GA, ABo), and Anatomia Patologica (GF, RB), Azienda Istituti Ospitalieri di Cremona, Cremona, Italy; Oncologia Medica, Università di Brescia, Spedali Civili di Brescia, Brescia, Italy (ABe, GB); Weatherall Molecular Oncology Laboratories, Institute of Molecular Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK (ALH); Department of Pathology, Peter MacCallum Cancer Centre, East Melbourne, Australia (SBF)
| | - Laura Zanotti
- U.O. Multidisciplinare di Patologia Mammaria/ US Terapia Molecolare (DG, MRC, LZ, GB, MF, FB, MEV, MM, CS, MA, SA, GA, ABo), and Anatomia Patologica (GF, RB), Azienda Istituti Ospitalieri di Cremona, Cremona, Italy; Oncologia Medica, Università di Brescia, Spedali Civili di Brescia, Brescia, Italy (ABe, GB); Weatherall Molecular Oncology Laboratories, Institute of Molecular Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK (ALH); Department of Pathology, Peter MacCallum Cancer Centre, East Melbourne, Australia (SBF)
| | - Giulia Brugnoli
- U.O. Multidisciplinare di Patologia Mammaria/ US Terapia Molecolare (DG, MRC, LZ, GB, MF, FB, MEV, MM, CS, MA, SA, GA, ABo), and Anatomia Patologica (GF, RB), Azienda Istituti Ospitalieri di Cremona, Cremona, Italy; Oncologia Medica, Università di Brescia, Spedali Civili di Brescia, Brescia, Italy (ABe, GB); Weatherall Molecular Oncology Laboratories, Institute of Molecular Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK (ALH); Department of Pathology, Peter MacCallum Cancer Centre, East Melbourne, Australia (SBF)
| | - Michela Forti
- U.O. Multidisciplinare di Patologia Mammaria/ US Terapia Molecolare (DG, MRC, LZ, GB, MF, FB, MEV, MM, CS, MA, SA, GA, ABo), and Anatomia Patologica (GF, RB), Azienda Istituti Ospitalieri di Cremona, Cremona, Italy; Oncologia Medica, Università di Brescia, Spedali Civili di Brescia, Brescia, Italy (ABe, GB); Weatherall Molecular Oncology Laboratories, Institute of Molecular Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK (ALH); Department of Pathology, Peter MacCallum Cancer Centre, East Melbourne, Australia (SBF)
| | - Francesca Bedussi
- U.O. Multidisciplinare di Patologia Mammaria/ US Terapia Molecolare (DG, MRC, LZ, GB, MF, FB, MEV, MM, CS, MA, SA, GA, ABo), and Anatomia Patologica (GF, RB), Azienda Istituti Ospitalieri di Cremona, Cremona, Italy; Oncologia Medica, Università di Brescia, Spedali Civili di Brescia, Brescia, Italy (ABe, GB); Weatherall Molecular Oncology Laboratories, Institute of Molecular Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK (ALH); Department of Pathology, Peter MacCallum Cancer Centre, East Melbourne, Australia (SBF)
| | - Maria Elena Vailati
- U.O. Multidisciplinare di Patologia Mammaria/ US Terapia Molecolare (DG, MRC, LZ, GB, MF, FB, MEV, MM, CS, MA, SA, GA, ABo), and Anatomia Patologica (GF, RB), Azienda Istituti Ospitalieri di Cremona, Cremona, Italy; Oncologia Medica, Università di Brescia, Spedali Civili di Brescia, Brescia, Italy (ABe, GB); Weatherall Molecular Oncology Laboratories, Institute of Molecular Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK (ALH); Department of Pathology, Peter MacCallum Cancer Centre, East Melbourne, Australia (SBF)
| | - Manuela Milani
- U.O. Multidisciplinare di Patologia Mammaria/ US Terapia Molecolare (DG, MRC, LZ, GB, MF, FB, MEV, MM, CS, MA, SA, GA, ABo), and Anatomia Patologica (GF, RB), Azienda Istituti Ospitalieri di Cremona, Cremona, Italy; Oncologia Medica, Università di Brescia, Spedali Civili di Brescia, Brescia, Italy (ABe, GB); Weatherall Molecular Oncology Laboratories, Institute of Molecular Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK (ALH); Department of Pathology, Peter MacCallum Cancer Centre, East Melbourne, Australia (SBF)
| | - Carla Strina
- U.O. Multidisciplinare di Patologia Mammaria/ US Terapia Molecolare (DG, MRC, LZ, GB, MF, FB, MEV, MM, CS, MA, SA, GA, ABo), and Anatomia Patologica (GF, RB), Azienda Istituti Ospitalieri di Cremona, Cremona, Italy; Oncologia Medica, Università di Brescia, Spedali Civili di Brescia, Brescia, Italy (ABe, GB); Weatherall Molecular Oncology Laboratories, Institute of Molecular Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK (ALH); Department of Pathology, Peter MacCallum Cancer Centre, East Melbourne, Australia (SBF)
| | - Mara Ardine
- U.O. Multidisciplinare di Patologia Mammaria/ US Terapia Molecolare (DG, MRC, LZ, GB, MF, FB, MEV, MM, CS, MA, SA, GA, ABo), and Anatomia Patologica (GF, RB), Azienda Istituti Ospitalieri di Cremona, Cremona, Italy; Oncologia Medica, Università di Brescia, Spedali Civili di Brescia, Brescia, Italy (ABe, GB); Weatherall Molecular Oncology Laboratories, Institute of Molecular Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK (ALH); Department of Pathology, Peter MacCallum Cancer Centre, East Melbourne, Australia (SBF)
| | - Sergio Aguggini
- U.O. Multidisciplinare di Patologia Mammaria/ US Terapia Molecolare (DG, MRC, LZ, GB, MF, FB, MEV, MM, CS, MA, SA, GA, ABo), and Anatomia Patologica (GF, RB), Azienda Istituti Ospitalieri di Cremona, Cremona, Italy; Oncologia Medica, Università di Brescia, Spedali Civili di Brescia, Brescia, Italy (ABe, GB); Weatherall Molecular Oncology Laboratories, Institute of Molecular Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK (ALH); Department of Pathology, Peter MacCallum Cancer Centre, East Melbourne, Australia (SBF)
| | - Giovanni Allevi
- U.O. Multidisciplinare di Patologia Mammaria/ US Terapia Molecolare (DG, MRC, LZ, GB, MF, FB, MEV, MM, CS, MA, SA, GA, ABo), and Anatomia Patologica (GF, RB), Azienda Istituti Ospitalieri di Cremona, Cremona, Italy; Oncologia Medica, Università di Brescia, Spedali Civili di Brescia, Brescia, Italy (ABe, GB); Weatherall Molecular Oncology Laboratories, Institute of Molecular Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK (ALH); Department of Pathology, Peter MacCallum Cancer Centre, East Melbourne, Australia (SBF)
| | - Giuseppina Ferrero
- U.O. Multidisciplinare di Patologia Mammaria/ US Terapia Molecolare (DG, MRC, LZ, GB, MF, FB, MEV, MM, CS, MA, SA, GA, ABo), and Anatomia Patologica (GF, RB), Azienda Istituti Ospitalieri di Cremona, Cremona, Italy; Oncologia Medica, Università di Brescia, Spedali Civili di Brescia, Brescia, Italy (ABe, GB); Weatherall Molecular Oncology Laboratories, Institute of Molecular Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK (ALH); Department of Pathology, Peter MacCallum Cancer Centre, East Melbourne, Australia (SBF)
| | - Ramona Bertoni
- U.O. Multidisciplinare di Patologia Mammaria/ US Terapia Molecolare (DG, MRC, LZ, GB, MF, FB, MEV, MM, CS, MA, SA, GA, ABo), and Anatomia Patologica (GF, RB), Azienda Istituti Ospitalieri di Cremona, Cremona, Italy; Oncologia Medica, Università di Brescia, Spedali Civili di Brescia, Brescia, Italy (ABe, GB); Weatherall Molecular Oncology Laboratories, Institute of Molecular Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK (ALH); Department of Pathology, Peter MacCallum Cancer Centre, East Melbourne, Australia (SBF)
| | - Alberto Bottini
- U.O. Multidisciplinare di Patologia Mammaria/ US Terapia Molecolare (DG, MRC, LZ, GB, MF, FB, MEV, MM, CS, MA, SA, GA, ABo), and Anatomia Patologica (GF, RB), Azienda Istituti Ospitalieri di Cremona, Cremona, Italy; Oncologia Medica, Università di Brescia, Spedali Civili di Brescia, Brescia, Italy (ABe, GB); Weatherall Molecular Oncology Laboratories, Institute of Molecular Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK (ALH); Department of Pathology, Peter MacCallum Cancer Centre, East Melbourne, Australia (SBF)
| | - Adrian L Harris
- U.O. Multidisciplinare di Patologia Mammaria/ US Terapia Molecolare (DG, MRC, LZ, GB, MF, FB, MEV, MM, CS, MA, SA, GA, ABo), and Anatomia Patologica (GF, RB), Azienda Istituti Ospitalieri di Cremona, Cremona, Italy; Oncologia Medica, Università di Brescia, Spedali Civili di Brescia, Brescia, Italy (ABe, GB); Weatherall Molecular Oncology Laboratories, Institute of Molecular Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK (ALH); Department of Pathology, Peter MacCallum Cancer Centre, East Melbourne, Australia (SBF)
| | - Stephen B Fox
- U.O. Multidisciplinare di Patologia Mammaria/ US Terapia Molecolare (DG, MRC, LZ, GB, MF, FB, MEV, MM, CS, MA, SA, GA, ABo), and Anatomia Patologica (GF, RB), Azienda Istituti Ospitalieri di Cremona, Cremona, Italy; Oncologia Medica, Università di Brescia, Spedali Civili di Brescia, Brescia, Italy (ABe, GB); Weatherall Molecular Oncology Laboratories, Institute of Molecular Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK (ALH); Department of Pathology, Peter MacCallum Cancer Centre, East Melbourne, Australia (SBF)
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Fiorentini C, Bodei S, Bedussi F, Fragni M, Bonini SA, Simeone C, Zani D, Berruti A, Missale C, Memo M, Spano P, Sigala S. GPNMB/OA protein increases the invasiveness of human metastatic prostate cancer cell lines DU145 and PC3 through MMP-2 and MMP-9 activity. Exp Cell Res 2014; 323:100-111. [DOI: 10.1016/j.yexcr.2014.02.025] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Revised: 01/21/2014] [Accepted: 02/22/2014] [Indexed: 01/03/2023]
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Bedussi F, Bottini A, Memo M, Fox SB, Sigala S, Generali D. Targeting fibroblast growth factor receptor in breast cancer: a promise or a pitfall? Expert Opin Ther Targets 2014; 18:665-78. [PMID: 24833241 DOI: 10.1517/14728222.2014.898064] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
INTRODUCTION Fibroblast growth factors (FGFs) along with their receptors (FGFRs) are involved in several cellular functions, from embryogenesis to metabolism. Because of the ability of FGFR signalling to induce cell proliferation, migration and survival in cancer, these have been found to become overactivated by several mechanisms, including gene amplification, chromosomal translocation and mutations. New evidences indicate that FGFs and FGFRs may act in an oncogenic fashion to promote multiple steps of cancer progression by inducing mitogenic and survival signals, as well as promoting epithelial-to-mesenchymal transition, invasion and tumour angiogenesis. This review focuses on the predictive and prognostic role of FGFRs, the role of FGFR signalling and how it may be most appropriately therapeutically targeted in breast cancer. AREAS COVERED Activation of the FGFR pathway is a common event in many cancer types and for this reason FGFR is an important potential target in cancer treatment. Relevant literature was reviewed to identify current and future role of FGFR family as a possible guide for selecting those patients who would be poor or good responders to the available or the upcoming target therapies for breast cancer treatment. EXPERT OPINION The success of a personalised medicine approach using targeted therapies ultimately depends on being capable of identifying the patients who will benefit the most from any given drug. Outlining the molecular mechanisms of FGFR signalling and discussing the role of this pathway in breast cancer, we would like to endorse the incorporation of specific patient selection biomakers with the rationale for therapeutic intervention with FGFR-targeted therapy in breast cancer.
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Affiliation(s)
- Francesca Bedussi
- University of Brescia Medical School, Department of Molecular and Translational Medicine, Section of Pharmacology , Brescia , Italy
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