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Cremante M, Pastorino A, Ponzano M, Grassi M, Martelli V, Puccini A, Catalano F, Murianni V, Iaia ML, Puglisi S, Gandini A, Fornarini G, Caprioni F, Andretta V, Pessino A, Comandini D, Sciallero MS, Mammoliti S, Sormani MP, Sobrero A. Reliability of patient-reported toxicities during adjuvant chemotherapy. Eur J Cancer 2023; 182:115-121. [PMID: 36758476 DOI: 10.1016/j.ejca.2023.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 01/02/2023] [Accepted: 01/06/2023] [Indexed: 01/15/2023]
Abstract
BACKGROUND Patient-reported outcomes (PROs) are validated tools to assess the impact of efficacy and toxicities of cancer treatments on patients' health status. Because of the demonstrated little reliability of humans in reporting memories of painful experiences, this work explores the reliability of cancer patients in reporting chemotherapy-related toxicities. AIM This study aims to evaluate the concordance between toxicities experienced by the patients during chemotherapy and toxicities reported to the doctor at the end of the cycles. METHODS Questionnaires concerning chemotherapy-related toxicities were administered on days 2, 5, 8, 11, 14, and 17 of each chemo cycle and at the end of the same cycle to patients undergoing adjuvant chemotherapy. The co-primary end-points were Lins's concordance correlation coefficient (CCC) and mean difference between real-time and retrospective toxicity assessments. RESULTS In total, 7182 toxicity assessments were collected from 1096 questionnaires. Concordance was observed between the retrospective evaluations and the toxicity assessments at early (day 2), peak (maximum toxicity), late (day 14 or 17), and mean real-time evaluations for each chemotherapy cycle (CCC for mean ranging from 0.52 to 0.77). No systematic discrepancy was found between real-time and retrospective evaluations, except for peak, which was systematically underestimated retrospectively. CONCLUSIONS Toxicities reported by the patients to the doctor at the end of each chemotherapy cycle reflect what they actually experienced without any substantial distortion. This result is very relevant both for the clinical implications in daily patients' management and in the light of the current growing impact on digital monitoring of PROs.
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Affiliation(s)
- Malvina Cremante
- Medical Oncology Unit 1, IRCCS Ospedale Policlinico San Martino, 16132, Genoa, Italy
| | - Alessandro Pastorino
- Medical Oncology Unit 1, IRCCS Ospedale Policlinico San Martino, 16132, Genoa, Italy
| | - Marta Ponzano
- Department of Health Sciences (DISSAL), University of Genova, 16132 Genova, Italy
| | - Massimiliano Grassi
- Medical Oncology Unit 1, IRCCS Ospedale Policlinico San Martino, 16132, Genoa, Italy
| | - Valentino Martelli
- Medical Oncology Unit 1, IRCCS Ospedale Policlinico San Martino, 16132, Genoa, Italy
| | - Alberto Puccini
- Medical Oncology Unit 1, IRCCS Ospedale Policlinico San Martino, 16132, Genoa, Italy
| | - Fabio Catalano
- Medical Oncology Unit 1, IRCCS Ospedale Policlinico San Martino, 16132, Genoa, Italy
| | - Veronica Murianni
- Medical Oncology Unit 1, IRCCS Ospedale Policlinico San Martino, 16132, Genoa, Italy
| | - Maria L Iaia
- Medical Oncology Unit 1, IRCCS Ospedale Policlinico San Martino, 16132, Genoa, Italy
| | - Silvia Puglisi
- Medical Oncology Unit 1, IRCCS Ospedale Policlinico San Martino, 16132, Genoa, Italy
| | - Annalice Gandini
- Medical Oncology Unit 1, IRCCS Ospedale Policlinico San Martino, 16132, Genoa, Italy
| | - Giuseppe Fornarini
- Medical Oncology Unit 1, IRCCS Ospedale Policlinico San Martino, 16132, Genoa, Italy
| | - Francesco Caprioni
- Medical Oncology Unit 1, IRCCS Ospedale Policlinico San Martino, 16132, Genoa, Italy
| | - Valeria Andretta
- Medical Oncology Unit 1, IRCCS Ospedale Policlinico San Martino, 16132, Genoa, Italy
| | - Annamaria Pessino
- Medical Oncology Unit 1, IRCCS Ospedale Policlinico San Martino, 16132, Genoa, Italy
| | - Danila Comandini
- Medical Oncology Unit 1, IRCCS Ospedale Policlinico San Martino, 16132, Genoa, Italy
| | - Maria S Sciallero
- Medical Oncology Unit 1, IRCCS Ospedale Policlinico San Martino, 16132, Genoa, Italy
| | - Serafina Mammoliti
- Medical Oncology Unit 1, IRCCS Ospedale Policlinico San Martino, 16132, Genoa, Italy
| | - Maria P Sormani
- Department of Health Sciences (DISSAL), University of Genova, 16132 Genova, Italy
| | - Alberto Sobrero
- Medical Oncology Unit 1, IRCCS Ospedale Policlinico San Martino, 16132, Genoa, Italy.
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Lazzaro C, Barone C, Caprioni F, Cascinu S, Falcone A, Maiello E, Milella M, Pinto C, Reni M, Tortora G. An Italian cost-effectiveness analysis of paclitaxel albumin (nab-paclitaxel) + gemcitabine vs gemcitabine alone for metastatic pancreatic cancer patients: the APICE study. Expert Rev Pharmacoecon Outcomes Res 2018; 18:435-446. [DOI: 10.1080/14737167.2018.1464394] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | | | - Giampaolo Tortora
- Azienda Ospedaliera Universitaria Integrata Borgo Roma, Verona, Italy
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Lazzaro C, Barone C, Caprioni F, Cascinu S, Falcone A, Maiello E, Milella M, Pinto C, Reni M, Tortora G. An Italian cost-effectiveness analysis of paclitaxel albumin (nab®-paclitaxel) + gemcitabine vs gemcibatine alone for metastatic pancreatic cancer patients: The APICE study. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw377.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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4
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Lazzaro C, Barone C, Caprioni F, Cascinu S, Falcone A, Maiello E, Milella M, Pinto C, Reni M, Tortora G. An Italian Cost-Effectiveness Analysis of Paclitaxel Albumin (nab®-paclitaxel) + Gemcitabine vs Gemcibatine alone for Metastatic Pancreatic Cancer Patients: The APICE Study. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw333.07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Faloppi L, Bianconi M, Giampieri R, Sobrero A, Labianca R, Ferrari D, Barni S, Aitini E, Zaniboni A, Boni C, Caprioni F, Mosconi S, Fanello S, Berardi R, Bittoni A, Andrikou K, Cinquini M, Torri V, Scartozzi M, Cascinu S. The value of lactate dehydrogenase serum levels as a prognostic and predictive factor for advanced pancreatic cancer patients receiving sorafenib. Oncotarget 2016; 6:35087-94. [PMID: 26397228 PMCID: PMC4741511 DOI: 10.18632/oncotarget.5197] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 08/28/2015] [Indexed: 12/12/2022] Open
Abstract
Although lactate dehydrogenase (LDH) serum levels, indirect markers of angiogenesis, are associated with a worse outcome in several tumours, their prognostic value is not defined in pancreatic cancer. Moreover, high levels are associated even with a lack of efficacy of tyrosine kinase inhibitors, contributing to explain negative results in clinical trials. We assessed the role of LDH in advanced pancreatic cancer receiving sorafenib. Seventy-one of 114 patients included in the randomised phase II trial MAPS (chemotherapy plus or not sorafenib) and with available serum LDH levels, were included in this analysis. Patients were categorized according to serum LDH levels (LDH ≤vs.> upper normal rate). A significant difference was found in progression free survival (PFS) and in overall survival (OS) between patients with LDH values under or above the cut-off (PFS: 5.2 vs. 2.7 months, p = 0.0287; OS: 10.7 vs. 5.9 months, p = 0.0021). After stratification according to LDH serum levels and sorafenib treatment, patients with low LDH serum levels treated with sorafenib showed an advantage in PFS (p = 0.05) and OS (p = 0.0012). LDH appears to be a reliable parameter to assess the prognosis of advanced pancreatic cancer patients, and it may be a predictive parameter to select patients candidate to receive sorafenib.
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Affiliation(s)
- Luca Faloppi
- Medical Oncology Unit, Università Politecnica delle Marche, AOU "Ospedali Riuniti", Ancona, Italy
| | - Maristella Bianconi
- Medical Oncology Unit, Università Politecnica delle Marche, AOU "Ospedali Riuniti", Ancona, Italy
| | - Riccardo Giampieri
- Medical Oncology Unit, Università Politecnica delle Marche, AOU "Ospedali Riuniti", Ancona, Italy
| | | | | | - Daris Ferrari
- Medical Oncology Unit, Ospedale S. Paolo, Milano, Italy
| | - Sandro Barni
- Medical Oncology Unit, Treviglio Hospital, Treviglio, Italy
| | - Enrico Aitini
- Medical Oncology Unit, C. Poma Hospital, Mantova, Italy
| | | | - Corrado Boni
- Medical Oncology Unit, Arcispedale S. Maria Nuova IRCCS, Reggio Emilia, Italy
| | | | | | - Silvia Fanello
- Medical Oncology Unit, Arcispedale S. Maria Nuova IRCCS, Reggio Emilia, Italy
| | - Rossana Berardi
- Medical Oncology Unit, Università Politecnica delle Marche, AOU "Ospedali Riuniti", Ancona, Italy
| | - Alessandro Bittoni
- Medical Oncology Unit, Università Politecnica delle Marche, AOU "Ospedali Riuniti", Ancona, Italy
| | - Kalliopi Andrikou
- Medical Oncology Unit, Università Politecnica delle Marche, AOU "Ospedali Riuniti", Ancona, Italy
| | - Michela Cinquini
- New Drug Development Strategies Laboratory, Mario Negri Institute, Milano, Italy
| | - Valter Torri
- New Drug Development Strategies Laboratory, Mario Negri Institute, Milano, Italy
| | - Mario Scartozzi
- Medical Oncology Unit, Università degli Studi di Cagliari, Azienda Ospedaliero Universitaria, Cagliari, Italy
| | - Stefano Cascinu
- Medical Oncology Unit, Università Politecnica delle Marche, AOU "Ospedali Riuniti", Ancona, Italy
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Cascinu S, Berardi R, Sobrero A, Bidoli P, Labianca R, Siena S, Ferrari D, Barni S, Aitini E, Zagonel V, Caprioni F, Villa F, Mosconi S, Faloppi L, Tonini G, Boni C, Conte P, Di Costanzo F, Cinquini M. Sorafenib does not improve efficacy of chemotherapy in advanced pancreatic cancer: A GISCAD randomized phase II study. Dig Liver Dis 2014; 46:182-6. [PMID: 24189171 DOI: 10.1016/j.dld.2013.09.020] [Citation(s) in RCA: 37] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Revised: 09/10/2013] [Accepted: 09/21/2013] [Indexed: 12/11/2022]
Abstract
BACKGROUND The RAF-MEK-ERK pathway is commonly activated in pancreatic cancer because of a high frequency of KRAS-BRAF mutations. A phase II randomized trial was designed to investigate the activity of sorafenib in combination with chemotherapy in advanced pancreatic cancer. METHODS Locally advanced or metastatic pancreatic adenocarcinoma patients were randomized in a 1:1 ratio to receive cisplatin plus gemcitabine with sorafenib 400mg bid (arm A) or without sorafenib (arm B). RESULTS One hundred and fourteen patients were enrolled; of these, 43 (74.6%) patients progressed in arm A and 44 (82.4%) in arm B. Median progression-free survival was 4.3 months (95% CI: 2.7-6.5) and 4.5 months (95% CI: 2.5-5.2), respectively (HR=0.92; 95% CI: 0.62-1.35). Median overall survival was 7.5 (95% CI: 5.6-9.7) and 8.3 months (95% CI: 6.2-8.7), respectively (HR=0.95; 95% CI: 0.62-1.48). Response rates were 3.4% in arm A and 3.6% in arm B. CONCLUSIONS Sorafenib does not significantly enhance activity of chemotherapy in advanced pancreatic cancer patients, and therefore should not be assessed in phase III trials.
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Affiliation(s)
- Stefano Cascinu
- Medical Oncology Unit, Università Politecnica delle Marche, Ospedali Riuniti di Ancona, Ancona, Italy.
| | - Rossana Berardi
- Medical Oncology Unit, Università Politecnica delle Marche, Ospedali Riuniti di Ancona, Ancona, Italy
| | | | - Paolo Bidoli
- Medical Oncology Unit, Ospedale S. Gerardo, Monza, Italy
| | | | - Salvatore Siena
- Niguarda Cancer Center, Ospedale Niguarda Ca' Granda, Milan, Italy
| | - Daris Ferrari
- Medical Oncology Unit, Ospedale S. Paolo, Milano, Italy
| | - Sandro Barni
- Medical Oncology Unit, Treviglio Hospital, Treviglio, Italy
| | - Enrico Aitini
- Medical Oncology Unit, C. Poma Hospital, Mantova, Italy
| | | | | | - Federica Villa
- Medical Oncology Unit, Ospedale S. Gerardo, Monza, Italy
| | | | - Luca Faloppi
- Medical Oncology Unit, Università Politecnica delle Marche, Ospedali Riuniti di Ancona, Ancona, Italy
| | - Giuseppe Tonini
- Medical Oncology Unit, University Campus Bio-Medico, Rome, Italy
| | - Corrado Boni
- Medical Oncology Unit, Arcispedale S. Maria Nuova IRCCS, Reggio Emilia, Italy
| | | | | | - Michela Cinquini
- New Drug Development Strategies Laboratory, Mario Negri Institute, Milano, Italy
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Mammoliti S, Andretta V, Bennicelli E, Caprioni F, Comandini D, Fornarini G, Guglielmi A, Pessino A, Sciallero S, Sobrero AF, Mazzola G, Lambiase A, Bordignon C. Two doses of NGR-hTNF in combination with capecitabine plus oxaliplatin in colorectal cancer patients failing standard therapies. Ann Oncol 2010; 22:973-978. [PMID: 20855468 PMCID: PMC3065876 DOI: 10.1093/annonc/mdq436] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: asparagine-glycine-arginine-human tumour necrosis factor (NGR-hTNF), an agent selectively damaging the tumour vasculature, showed a biphasic dose–response curve in preclinical models. Previous phase I trials of NGR-hTNF indicated 0.8 and 45 μg/m2 as optimal biological and maximum-tolerated dose, respectively. Patients and methods: Two sequential cohorts of 12 colorectal cancer (CRC) patients who had failed standard therapies received NGR-hTNF 0.8 or 45 μg/m2 in combination with capecitabine–oxaliplatin (XELOX). Results: Median number of prior treatment lines was 3 in the low-dose and 2 in the high-dose cohort. Overall, 21 patients had been pretreated with oxaliplatin-based regimens. No grade 3–4 NGR-hTNF-related toxicities were observed. Grade 1–2 chills were reported in 43% and 40% of cycles in the low-dose and high-dose cohorts, respectively. In the low-dose cohort, one patient achieved a partial response and five had stable disease for a median of 4.6 months. In the high-dose cohort, six patients had stable disease for a median of 3.6 months. Three-month progression-free survival (PFS) rates were 50% and 33% in the low-dose and high-dose cohort, respectively. Three patients in low-dose cohort experienced PFS longer than PFS on last prior therapy. Conclusions: Both NGR-hTNF doses were safely combined with XELOX in pretreated CRC patients. Hint of activity was apparent only with low-dose NGR-hTNF.
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Affiliation(s)
- S Mammoliti
- Medical Oncology Unit, Ospedale San Martino, Genoa
| | - V Andretta
- Medical Oncology Unit, Ospedale San Martino, Genoa
| | - E Bennicelli
- Medical Oncology Unit, Ospedale San Martino, Genoa
| | - F Caprioni
- Medical Oncology Unit, Ospedale San Martino, Genoa
| | - D Comandini
- Medical Oncology Unit, Ospedale San Martino, Genoa
| | - G Fornarini
- Medical Oncology Unit, Ospedale San Martino, Genoa
| | - A Guglielmi
- Medical Oncology Unit, Ospedale San Martino, Genoa
| | - A Pessino
- Medical Oncology Unit, Ospedale San Martino, Genoa
| | - S Sciallero
- Medical Oncology Unit, Ospedale San Martino, Genoa
| | - A F Sobrero
- Medical Oncology Unit, Ospedale San Martino, Genoa
| | | | | | - C Bordignon
- Clinical Development, MolMed, Milan; Hematology, Università Vita-Salute San Raffaele, Milan, Italy.
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Pessino A, Andretta V, Guglielmi A, Mammoliti S, Caprioni F, Fornarini G, Comandini D, Sciallero S, Ansaldi F, Sobrero A. 6075 A triple combination of Imatinib, Bevacizumab and Cetuximab plus modified FOLFOX-6 in advanced untreated colorectal cancer. EJC Suppl 2009. [DOI: 10.1016/s1359-6349(09)71170-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Sobrero A, Pessino A, Andretta V, Bennicelli E, Fornarini G, Caprioni F, Comandini D, Orsino L, Lambiase A, Bordignon C. 6066 Phase II study of two doses of NGR-hTNF, a vascular targeting agent (VTA), combined with capecitabine/oxaliplatin (XELOX) in colorectal cancer (CRC) patients failing standard regimens. EJC Suppl 2009. [DOI: 10.1016/s1359-6349(09)71161-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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10
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Sobrero AF, Bennicelli E, Pessino A, Guglielmi A, Mammoliti S, Caprioni F, Fornarini G, Comandini D, Sciallero S, Ansaldi F. Phase II trial of imatinib, bevacizumab and cetuximab plus modified FOLFOX-6 in advanced untreated colorectal cancer. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.e15030] [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
e15030 Background: Imatinib inhibits PDGFR interfering with pericytes, the structural support to newly formed tumor blood vessels. It may thus synergize with bevacizumab. Microenvironment and tumor targeted agents along with chemotherapy could be a promising add-on approach. Methods: cetuximab 500 mg/m2, bevacizumab 5 mg/kg and modified FOLFOX-6 were given i.v. on day 1 and repeated every 2 weeks. Imatinib 400 mg/day per os was given continuously. Due to the cost and potential toxicity of the combination, the endpoint for this phase II study was very ambitious: at least 25% of complete response (medically or surgically achieved), lasting a minimum of 12 months in advanced untreated colorectal cancer patients with clearly unresectable disease. Results: Of 26 patients (16 with 1 site of disease), 17 completed the first 4 months of treatment according to the protocol, while 9 had to discontinue one biologic drug due to side effects (5 cetuximab, 3 imatinib and 1 bevacizumab). Grade 3–4 toxicity: diarrhea 12%, neutropenia 24%, skin rash 24%, hypersensitivity reactions 16%, asthenia 8%, neuro 8%. All patients were evaluable for response. Eleven responses ( 1 CR and 10 PR), 13 SD and 2 PD were observed, corresponding to 42% RR ( 95% CI = 23–61). The minimum follow up is 12 months; median PFS is 10 months. One patient among responders underwent radiofrequency ablation and 17 patients underwent surgery: 8 R-0, 3 R-1, 5 R-2 and one exploratory laparotomy. Major post surgical complications occurred in 5/17 patients. No evidence of macroscopic disease after the entire treatment plan was obtained in 13/26 patients: 12 surgical and 1 medical CR. Seven/13 were disease free at 6 months, but only 3 were still disease free at 12 months. ERCC1, ERCC2/XDP, GSTP1,TS,EGF, COX2, CYCLIN D, FCgR polymorphisms and K-RAS mutations were evaluated on all 26 patients, but no correlations were found with clinical outcome. Conclusions: The triple combination of biologics with modified FOLFOX-6 is feasible and tolerable as initial aggressive treatment. The primary endpoint of the study was not met . In fact the activity, 42% RR, was not outstanding and the high resectability rate, 69%, is misleading in the light of the short duration of the surgically induced CR. [Table: see text]
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Affiliation(s)
- A. F. Sobrero
- Azienda Ospedale Universita, San Martino, Genova, Italy
| | - E. Bennicelli
- Azienda Ospedale Universita, San Martino, Genova, Italy
| | - A. Pessino
- Azienda Ospedale Universita, San Martino, Genova, Italy
| | - A. Guglielmi
- Azienda Ospedale Universita, San Martino, Genova, Italy
| | - S. Mammoliti
- Azienda Ospedale Universita, San Martino, Genova, Italy
| | - F. Caprioni
- Azienda Ospedale Universita, San Martino, Genova, Italy
| | - G. Fornarini
- Azienda Ospedale Universita, San Martino, Genova, Italy
| | - D. Comandini
- Azienda Ospedale Universita, San Martino, Genova, Italy
| | - S. Sciallero
- Azienda Ospedale Universita, San Martino, Genova, Italy
| | - F. Ansaldi
- Azienda Ospedale Universita, San Martino, Genova, Italy
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Rimassa L, Sobrero AF, Santoro A, Andretta V, Gregorc V, Sclafani F, Caprioni F, Caligaris-Cappio F, Lambiase A, Bordignon C. Phase II study of NGR-hTNF, a selective vascular targeting agent (VTA), administered as single agent in patients (pts) with colorectal cancer (CRC) refractory to standard regimens. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.4088] [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
4088 Background: NGR-hTNF is a VTA exploiting a tumor-homing peptide (NGR) that selectively binds to an aminopeptidase N/CD13 overexpressed by tumor blood vessels. In preclinical models, NGR-hTNF showed antitumor activity both at low and at high doses. Methods: Pts with CRC resistant/refractory to standard treatments, including biological agents, were treated with low-dose NGR-hTNF given intravenously at 0.8 μg/m2 as 1-hour infusion every 3 weeks (q3w). This phase II trial had a 2-stage design with 16 and 27 pts to be enrolled after first and second stage, respectively. Progression-free survival (PFS) was the primary end-point with reassessment performed q6w. Results: From January to May 2007, 33 pts with radiologically- documented progressive disease after last therapy were evaluated over 111 cycles (range, 1–10). Pts characteristics were: median age: 65 years (range, 53 to 79); M/F 16/17; PS 0/1 26/7. Median number of prior regimens was 3 (range, 2 to 5). Eight pts (25%) were pre-treated with ≥4 lines and 22 (67%) with biological agents. Neither grade 3–4 treatment-related adverse events nor toxicity-related deaths were observed. Main grade 1–2 toxicities per patient were infusion-related chills (47%) and transient blood pressure increase (9%). One partial response (3%) lasting 5 months and 12 stable diseases (36%) were reported. Median PFS was 2.5 months (95% CI, 2.2–2.8). In a post-hoc analysis, no differences in PFS were detected according to baseline characteristics. With a median follow-up time of 18.4 months (95% CI, 18.3–18.5), 11 pts (33%) were still alive. Median overall survival (OS) was 13.1 months and the 2-year OS rate was 22%. In the subset of stable or responder pts, the median PFS and OS were 3.8 months and 15.4 months, respectively. The 6-month PFS rate in the prior-biological and biological-naïve cohorts was 5% and 20%, respectively, whereas 1-year OS rate was 41% and 72%, respectively. Conclusions: Based on the favorable toxicity profile and disease control in heavily pre-treated CRC patients, NGR-hTNF will be further developed in combination with standard chemotherapy. [Table: see text]
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Affiliation(s)
- L. Rimassa
- Istituto Clinico Humanitas, Rozzano, Italy; Ospedale San Martino, Genoa, Italy; Istituto Scientifico San Raffaele, Milan, Italy; MolMed, Milan, Italy
| | - A. F. Sobrero
- Istituto Clinico Humanitas, Rozzano, Italy; Ospedale San Martino, Genoa, Italy; Istituto Scientifico San Raffaele, Milan, Italy; MolMed, Milan, Italy
| | - A. Santoro
- Istituto Clinico Humanitas, Rozzano, Italy; Ospedale San Martino, Genoa, Italy; Istituto Scientifico San Raffaele, Milan, Italy; MolMed, Milan, Italy
| | - V. Andretta
- Istituto Clinico Humanitas, Rozzano, Italy; Ospedale San Martino, Genoa, Italy; Istituto Scientifico San Raffaele, Milan, Italy; MolMed, Milan, Italy
| | - V. Gregorc
- Istituto Clinico Humanitas, Rozzano, Italy; Ospedale San Martino, Genoa, Italy; Istituto Scientifico San Raffaele, Milan, Italy; MolMed, Milan, Italy
| | - F. Sclafani
- Istituto Clinico Humanitas, Rozzano, Italy; Ospedale San Martino, Genoa, Italy; Istituto Scientifico San Raffaele, Milan, Italy; MolMed, Milan, Italy
| | - F. Caprioni
- Istituto Clinico Humanitas, Rozzano, Italy; Ospedale San Martino, Genoa, Italy; Istituto Scientifico San Raffaele, Milan, Italy; MolMed, Milan, Italy
| | - F. Caligaris-Cappio
- Istituto Clinico Humanitas, Rozzano, Italy; Ospedale San Martino, Genoa, Italy; Istituto Scientifico San Raffaele, Milan, Italy; MolMed, Milan, Italy
| | - A. Lambiase
- Istituto Clinico Humanitas, Rozzano, Italy; Ospedale San Martino, Genoa, Italy; Istituto Scientifico San Raffaele, Milan, Italy; MolMed, Milan, Italy
| | - C. Bordignon
- Istituto Clinico Humanitas, Rozzano, Italy; Ospedale San Martino, Genoa, Italy; Istituto Scientifico San Raffaele, Milan, Italy; MolMed, Milan, Italy
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Santoro A, Andretta V, Gregorc V, Rimassa L, Bennicelli E, Sclafani F, Caprioni F, Caligaris-Cappio F, Lambiase A, Bordignon C. A phase II study of NGR-hTNF, a novel vascular targeting agent (VTA), administered as single agent at low dose in patients (pts) with colorectal cancer (CRC) refractory to standard regimens. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.4110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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13
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Pessino A, Artale S, Sciallero S, Guglielmi A, Fornarini G, Andreotti I, Mammoliti S, Comandini D, Caprioni F, Bennicelli E, Andretta V, Siena S, Sobrero A. First-line single-agent cetuximab in patients with advanced colorectal cancer. Ann Oncol 2008; 19:711-6. [DOI: 10.1093/annonc/mdm516] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Wiedenmann B, Malfertheiner P, Friess H, Ritch P, Arseneau J, Mantovani G, Caprioni F, Van Cutsem E, Richel D, DeWitte M, Qi M, Robinson D, Zhong B, De Boer C, Lu JD, Prabhakar U, Corringham R, Von Hoff D. A multicenter, phase II study of infliximab plus gemcitabine in pancreatic cancer cachexia. J Support Oncol 2008; 6:18-25. [PMID: 18257397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
To evaluate the safety and efficacy of infliximab administered with gemcitabine to treat cancer cachexia and to explore a functional measure of clinical benefit, investigators involved in this multicenter, phase II, placebo-controlled study randomized 89 patients with stage II-IV pancreatic cancer and cachexia to receive either placebo or 3 mg/ kg or 5 mg/kg of infliximab at weeks 0, 2, and 4 and then every 4 weeks to week 24; patients also received 1,000 mg/m2 of gemcitabine weekly from weeks 0-6 and then for 3 of every 4 weeks until their disease progressed. The primary endpoint was change in lean body mass (LBM) at 8 weeks from baseline; major secondary endpoints included overall survival, progression-free survival, Karnofsky performance status, and 6-minute walk test distance. In addition, quality of life was measured. The mean change in LBM at 8 weeks was +0.4 kg for patients receiving placebo, +0.3 kg for those receiving 3 mg/kg of infliximab, and +1.7 kg for those receiving 5 mg/kg of infliximab. No statistically significant differences in LBM or secondary endpoints were observed among the groups. Safety findings were similar in all groups. Adding infliximab to gemcitabine to treat cachexia in advanced pancreatic cancer patients was not associated with statistically significant differences in safety or efficacy when compared with placebo.
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Affiliation(s)
- Bertram Wiedenmann
- Department of Internal Medicine, Charité, Humboldt University, Berlin, Germany.
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Abstract
Angiogenesis is essential for tumor growth and metastasis, and has become a useful target for novel biological agents. Vascular endothelial growth factor (VEGF) is one of the most important angiogenesis regulators. Bevacizumab is a recombinant humanized anti-VEGF monoclonal antibody recently approved in Europe and the USA for first- and second-line therapy (in combination with chemotherapy) for metastatic colorectal cancer. It has a proven impact on survival, as demonstrated in large Phase III clinical trials. Treatment with bevacizumab is generally well tolerated, with hypertension and arterial thromboembolic events being the main side effects. Currently, its role in the adjuvant setting, in combination with chemotherapy, is being evaluated in large Phase III clinical trials.
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Affiliation(s)
- Francesco Caprioni
- Azienda Ospedaliera, Universitaria San Martino, L.go Rosanna Benzi 10, 16132 Genova, Italy.
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Sobrero A, Caprioni F, Fornarini G, Mammoliti S, Comandini D, Baldo S, Decian F. Pemetrexed in gastric cancer. Oncology (Williston Park) 2004; 18:51-5. [PMID: 15655938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
Gastric cancer is a major clinical challenge, with poor overall prognosis and limited life expectancy for patients with advanced disease. Even with surgery and other modalities, palliation is often difficult. Improvement of response rates has evolved with the development of standard regimens and those incorporating newer chemotherapy agents, such as oral fluoropyrimidines, the taxanes, camptothecins, novel platinums (eg, oxaliplatin [Eloxatin]), and antifolates (eg, pemetrexed [Alimta]). Ongoing trials with these regimens aim toward improving survival, as well as improving the safety profile. It is hoped that in conjunction with molecular research in the pathogenesis of gastric cancer and development of targeted therapies in this disease, these trial data might lead to the evolution of treatment strategies that could prove effective.
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Affiliation(s)
- Alberto Sobrero
- Divisione di Oncologia Medica Ospedale San Martino, Genova, Italy.
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Cortesi E, Caleno MP, Caprioni F, Fornarini G, Ramponi S. Biological Aspects and Follow-up. Tumori 1997. [DOI: 10.1177/03008916970831s106] [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: 11/16/2022]
Affiliation(s)
- Enrico Cortesi
- Medical Oncology, Department of Experimental Medicine and Pathology, University “La Sapienza”, Rome, Italy
| | - Maria Paola Caleno
- Medical Oncology, Department of Experimental Medicine and Pathology, University “La Sapienza”, Rome, Italy
| | - Francesco Caprioni
- Medical Oncology, Department of Experimental Medicine and Pathology, University “La Sapienza”, Rome, Italy
| | - Giuseppe Fornarini
- Medical Oncology, Department of Experimental Medicine and Pathology, University “La Sapienza”, Rome, Italy
| | - Sara Ramponi
- Medical Oncology, Department of Experimental Medicine and Pathology, University “La Sapienza”, Rome, Italy
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