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Remon J, Auclin E, Zubiri L, Schneider S, Rodriguez-Abreu D, Minatta N, Gautschi O, Aboubakar F, Muñoz-Couselo E, Pierret T, Rothschild SI, Cortiula F, Reynolds KL, Thibault C, Gavralidis A, Blais N, Barlesi F, Planchard D, Besse BMD. Immune checkpoint blockers in solid organ transplant recipients and cancer: the INNOVATED cohort. ESMO Open 2024; 9:103004. [PMID: 38653155 DOI: 10.1016/j.esmoop.2024.103004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Revised: 03/08/2024] [Accepted: 03/18/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Patients with solid organ transplant (SOT) and solid tumors are usually excluded from clinical trials testing immune checkpoint blockers (ICB). As transplant rates are increasing, we aimed to evaluate ICB outcomes in this population, with a special focus on lung cancer. METHODS We conducted a multicenter retrospective cohort study collecting real data of ICB use in patients with SOT and solid tumors. Clinical data and treatment outcomes were assessed by using retrospective medical chart reviews in every participating center. Study endpoints were: overall response rate (ORR), 6-month progression-free survival (PFS), and grade ≥3 immune-related adverse events. RESULTS From August 2016 to October 2022, 31 patients with SOT (98% kidney) and solid tumors were identified (36.0% lung cancer, 19.4% melanoma, 13.0% genitourinary cancer, 6.5% gastrointestinal cancer). Programmed death-ligand 1 expression was positive in 29% of tumors. Median age was 61 years, 69% were males, and 71% received ICB as first-line treatment. In the whole cohort the ORR was 45.2%, with a 6-month PFS of 56.8%. In the lung cancer cohort, the ORR was 45.5%, with a 6-month PFS of 32.7%, and median overall survival of 4.6 months. The grade 3 immune-related adverse events rate leading to ICB discontinuation was 12.9%. Allograft rejection rate was 25.8%, and risk of rejection was similar regardless of the type of ICB strategy (monotherapy or combination, 28% versus 33%, P = 1.0) or response to ICB treatment. CONCLUSIONS ICB could be considered a feasible option for SOT recipients with some advanced solid malignancies and no alternative therapeutic options. Due to the risk of allograft rejection, multidisciplinary teams should be involved before ICB therapy.
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Affiliation(s)
- J Remon
- Paris-Saclay University, Department of Cancer Medicine, Gustave Roussy, Villejuif.
| | - E Auclin
- Department of Cancer Medicine, Hôpital Européen Georges-Pompidou, Paris, France
| | - L Zubiri
- Massachusetts General Hospital Cancer Center, Division of Hematology/Oncology, Department of Medicine, Massachusetts General Hospital, Boston, USA
| | - S Schneider
- Department Pneumology, Hôpital de Bayonne, Bayonne, France
| | - D Rodriguez-Abreu
- Medical Oncology Department, Complejo Hospitalario Universitario Insular-Materno Infantil de Gran Canaria, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - N Minatta
- Department of Oncology Hospital Italiano Buenos Aires, Buenos Aires, Argentina
| | - O Gautschi
- Department of Cancer Medicine, University of Berne and Cantonal Hospital of Lucerne, Lucerne, Switzerland
| | - F Aboubakar
- Department of Pneumology, Cliniques Universitaires Saint Luc, Brussels, Belgium
| | - E Muñoz-Couselo
- Department of Oncology, Hospital Vall d'Hebron de Barcelona, VHIO Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - T Pierret
- Department of Pneumology, CHU Grenoble Alpes, Grenoble, France
| | - S I Rothschild
- Medical Oncology Department, University Hospital Basel, Basel; Division Oncology/Hematology, Department of Medicine, Cantonal Hospital Baden, Baden, Switzerland
| | - F Cortiula
- Department of Oncology, University Hospital of Udine, Udine, Italy
| | - K L Reynolds
- Massachusetts General Hospital Cancer Center, Division of Hematology/Oncology, Department of Medicine, Massachusetts General Hospital, Boston, USA
| | - C Thibault
- Department of Cancer Medicine, Hôpital Européen Georges-Pompidou, Paris, France
| | - A Gavralidis
- Massachusetts General Hospital Cancer Center, Division of Hematology/Oncology, Department of Medicine, Massachusetts General Hospital, Boston, USA; Division of Hematology/Oncology, Department of Medicine, Massachusetts General Hospital, Boston; Salem Hospital, Salem, USA
| | - N Blais
- Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Canada
| | - F Barlesi
- Paris-Saclay University, Department of Cancer Medicine, Gustave Roussy, Villejuif
| | - D Planchard
- Paris-Saclay University, Department of Cancer Medicine, Gustave Roussy, Villejuif
| | - B M D Besse
- Paris-Saclay University, Department of Cancer Medicine, Gustave Roussy, Villejuif
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Bartolomeo V, Cortiula F, Hendriks LEL, De Ruysscher D, Filippi AR. A Glimpse Into the Future for Unresectable Stage III Non-Small Cell Lung Cancer. Int J Radiat Oncol Biol Phys 2024; 118:1455-1460. [PMID: 38159097 DOI: 10.1016/j.ijrobp.2023.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 10/26/2023] [Accepted: 11/02/2023] [Indexed: 01/03/2024]
Affiliation(s)
- Valentina Bartolomeo
- Radiation Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy; Department of Radiation Oncology (Maastro Clinic), Maastricht University Medical Center, GROW School for Oncology and Reproduction, Maastricht, The Netherlands
| | - Francesco Cortiula
- Department of Radiation Oncology (Maastro Clinic), Maastricht University Medical Center, GROW School for Oncology and Reproduction, Maastricht, The Netherlands; Department of Medical Oncology, Udine University Hospital, Udine, Italy
| | - Lizza E L Hendriks
- Department of Pulmonary Diseases, GROW School for Oncology and Reproduction, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Dirk De Ruysscher
- Department of Radiation Oncology (Maastro Clinic), Maastricht University Medical Center, GROW School for Oncology and Reproduction, Maastricht, The Netherlands
| | - Andrea R Filippi
- Radiation Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy.
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Remon J, Saw SPL, Cortiula F, Singh PK, Menis J, Mountzios G, Hendriks LEL. Perioperative Treatment Strategies in EGFR-Mutant Early-Stage NSCLC: Current Evidence and Future Challenges. J Thorac Oncol 2024; 19:199-215. [PMID: 37783386 DOI: 10.1016/j.jtho.2023.09.1451] [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: 06/12/2023] [Revised: 08/21/2023] [Accepted: 09/27/2023] [Indexed: 10/04/2023]
Abstract
Treatment with 3 years of adjuvant osimertinib is considered a new standard in patients with completely resected stage I to IIIA NSCLC harboring a common sensitizing EGFR mutation. This therapeutic approach significantly prolonged the disease-free survival and the overall survival versus placebo and revealed a significant role in preventing the occurrence of brain metastases. However, many unanswered questions remain, including the optimal duration of this therapy, whether all patients benefit from adjuvant osimertinib, and the role of adjuvant chemotherapy in this population. Indeed, there is a renewed interest in neoadjuvant strategies with targeted therapies in resectable NSCLC harboring oncogenic drivers. In light of these considerations, we discuss the past and current treatment options, and the clinical challenges that should be addressed to optimize the treatment outcomes in this patient population.
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Affiliation(s)
- Jordi Remon
- Department of Cancer Medicine, Gustave Roussy, Villejuif, France.
| | - Stephanie P L Saw
- Department of Medical Oncology, National Cancer Centre Singapore, Duke-National University of Singapore Oncology Academic Clinical Programme, Singapore
| | | | - Pawan Kumar Singh
- Pandit Bhagwat Dayal Sharma Postgraduate Institute of Medical Science, Rothak, India
| | - Jessica Menis
- Medical Oncology Department, University and Hospital Trust of Verona, Verona, Italy
| | - Giannis Mountzios
- Fourth Department of Medical Oncology and Clinical Trials Unit, Henry Dunant Hospital Center, Athens, Greece
| | - Lizza E L Hendriks
- Department of Respiratory Medicine, Maastricht University Medical Centre, GROW School for Oncology and Reproduction, Maastricht, The Netherlands
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Cereser L, Cortiula F, Simiele C, Peruzzi V, Bortolot M, Tullio A, Como G, Zuiani C, Girometti R. Assessing the impact of structured reporting on learning how to report lung cancer staging CT: A triple cohort study on inexperienced readers. Eur J Radiol 2024; 171:111291. [PMID: 38218064 DOI: 10.1016/j.ejrad.2024.111291] [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: 01/03/2024] [Indexed: 01/15/2024]
Abstract
PURPOSE To assess the clinical utility of chest computed tomography (CT) reports for non-small-cell lung cancer (NSCLC) staging generated by inexperienced readers using structured reporting (SR) templates from the Royal College of Radiologists (RCR-SR) and the Italian Society of Medical and Interventional Radiology (SIRM-SR), compared to traditional non-systematic reports (NSR). METHODS In a cohort of 30 NSCLC patients, six third-year radiology residents reported CT examinations in two 2-month-apart separate sessions using NSR in the first and NSR, RCR-SR, or SIRM-SR in the second. Couples of expert radiologists and thoracic oncologists in consensus evaluated completeness, accuracy, and clarity. All the quality indicators were expressed on a 100-point scale. The Wilcoxon signed ranks, and Wilcoxon-Mann Whitney tests were used for statistical analyses. RESULTS Results showed significantly higher completeness for RCR-SR (90 %) and SIRM-SR (100 %) compared to NSR (70 %) in the second session (all p < 0.001). SIRM-SR demonstrated superior accuracy (70 % vs. 55 %, p < 0.001) over NSR, while RCR-SR and NSR accuracy did not significantly differ (60 % vs. 62.5 %, p = 0.06). In the second session, RCR-SR and SIRM-SR surpassed NSR in completeness, accuracy, and clarity (all p < 0.001, except p = 0.04 for accuracy between RCR-SR and NSR). SIRM-SR outperformed RCR-SR in completeness (100 % vs. 90 %, p < 0.001) and accuracy (70 % vs. 62.5 %, p = 0.002), with equivalent clarity (90 % for both, p = 0.27). CONCLUSIONS Inexperienced readers using RCR-SR and SIRM-SR demonstrated high-quality reporting, indicating their potential in radiology residency programs to enhance reporting skills for NSCLC staging and effective interaction with all the physicians involved in managing NSCLC patients.
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Affiliation(s)
- L Cereser
- Institute of Radiology, Department of Medicine, University of Udine, Italy.
| | - F Cortiula
- Department of Oncology, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Italy; Department of Radiation Oncology (Maastro), GROW School for Oncology and Reproduction, Maastricht University Medical Centre, The Netherlands.
| | - C Simiele
- Institute of Radiology, Department of Medicine, University of Udine, Italy.
| | - V Peruzzi
- Institute of Radiology, Department of Medicine, University of Udine, Italy.
| | - M Bortolot
- Department of Oncology, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Italy.
| | - A Tullio
- Institute of Hygiene and Evaluative Epidemiology, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Italy.
| | - G Como
- Institute of Radiology, Department of Medicine, University of Udine, Italy.
| | - C Zuiani
- Institute of Radiology, Department of Medicine, University of Udine, Italy.
| | - R Girometti
- Institute of Radiology, Department of Medicine, University of Udine, Italy.
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Cortiula F, Hendriks LEL, Wijsman R, Houben R, Steens M, Debakker S, Canters R, Trovò M, Sijtsema NM, Niezink AGH, Unipan M, Urban S, Michelotti A, Dursun S, Bootsma G, Hattu D, Nuyttens JJ, Moretti E, Taasti VT, De Ruysscher D. Proton and photon radiotherapy in stage III NSCLC: Effects on hematological toxicity and adjuvant immune therapy. Radiother Oncol 2024; 190:110019. [PMID: 38000689 DOI: 10.1016/j.radonc.2023.110019] [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: 09/01/2023] [Revised: 11/09/2023] [Accepted: 11/11/2023] [Indexed: 11/26/2023]
Abstract
BACKGROUND AND PURPOSE Concurrent chemo-radiotherapy (CCRT) followed by adjuvant durvalumab is standard-of-care for fit patients with unresectable stage III NSCLC. Intensity modulated proton therapy (IMPT) results in different doses to organs than intensity modulated photon therapy (IMRT). We investigated whether IMPT compared to IMRT reduce hematological toxicity and whether it affects durvalumab treatment. MATERIALS AND METHODS Prospectively collected series of consecutive patients with stage III NSCLC receiving CCRT between 06.16 and 12.22 (staged with FDG-PET-CT and brain imaging) were retrospectively analyzed. The primary endpoint was the incidence of lymphopenia grade ≥ 3 in IMPT vs IMRT treated patients. RESULTS 271 patients were enrolled (IMPT: n = 71, IMRT: n = 200) in four centers. All patients received platinum-based chemotherapy. Median age: 66 years, 58 % were male, 36 % had squamous NSCLC. The incidence of lymphopenia grade ≥ 3 during CCRT was 67 % and 47 % in the IMRT and IMPT group, respectively (OR 2.2, 95 % CI: 1.0-4.9, P = 0.03). The incidence of anemia grade ≥ 3 during CCRT was 26 % and 9 % in the IMRT and IMPT group respectively (OR = 4.9, 95 % CI: 1.9-12.6, P = 0.001). IMPT was associated with a lower rate of Performance Status (PS) ≥ 2 at day 21 and 42 after CCRT (13 % vs. 26 %, P = 0.04, and 24 % vs. 39 %, P = 0.02). Patients treated with IMPT had a higher probability of receiving adjuvant durvalumab (74 % vs. 52 %, OR 0.35, 95 % CI: 0.16-0.79, P = 0.01). CONCLUSION IMPT was associated with a lower incidence of severe lymphopenia and anemia, better PS after CCRT and a higher probability of receiving adjuvant durvalumab.
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Affiliation(s)
- Francesco Cortiula
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Reproduction, Maastricht University Medical Center+, Maastricht, the Netherlands; Department of Medical Oncology, University Hospital of Udine, Udine, Italy.
| | - Lizza E L Hendriks
- Department of Pulmonary Diseases, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Robin Wijsman
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Ruud Houben
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Reproduction, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Michelle Steens
- Department of Pulmonary Diseases, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Sarah Debakker
- Department of Pulmonary Diseases, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Richard Canters
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Reproduction, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Marco Trovò
- Department of Radiation Oncology, University Hospital of Udine, Udine, Italy
| | - Nanna M Sijtsema
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Anne G H Niezink
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Mirko Unipan
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Reproduction, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Susanna Urban
- Department of Medical Oncology, University Hospital of Udine, Udine, Italy
| | - Anna Michelotti
- Department of Medical Oncology, University Hospital of Udine, Udine, Italy
| | - Safiye Dursun
- Department of Pulmonary Diseases, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Gerben Bootsma
- Department of Pulmonary Diseases, Zuyderland Medical Centre, the Netherlands
| | - Djoya Hattu
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Reproduction, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Joost J Nuyttens
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Eugenia Moretti
- Medical Physics Unit, University Hospital of Udine, Udine, Italy
| | - Vicki T Taasti
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Reproduction, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Dirk De Ruysscher
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Reproduction, Maastricht University Medical Center+, Maastricht, the Netherlands
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Peruzzi V, Torresan S, Cortiula F, Fanelli M, Ermacora P, Girometti R, Cereser L. Unveiling the Potential of Venn Diagrams as a Helpful Tool for Clinical Reasoning: An Illustrative Case-based Discussion. Curr Probl Diagn Radiol 2023; 52:478-481. [PMID: 37438231 DOI: 10.1067/j.cpradiol.2023.06.002] [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: 06/15/2023] [Accepted: 06/28/2023] [Indexed: 07/14/2023]
Abstract
Venn diagrams graphically represent a cognitive approach that can assist in highlighting information shared by different data sets while eliminating nonoverlapping conditions. When applied to clinical reasoning, such an approach helps physicians visually focus on data pertaining to differential diagnoses. We present and discuss a 3-step reasoning pathway derived from a real-life case in which we used Venn diagrams to diagnose drug-related pneumonitis in a 67-year-old man with advanced bladder cancer and nodular lung findings at chest CT. This education paper supports using Venn diagrams in Radiology.
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Affiliation(s)
- Valeria Peruzzi
- Institute of Radiology, Department of Medicine, University of Udine, University Hospital S. Maria della Misericordia, Udine, Italy
| | - Sara Torresan
- Department of Oncology, University Hospital S. Maria della Misericordia, Udine, Italy; Department of Medicine, University of Udine, Udine, Italy
| | - Francesco Cortiula
- Department of Oncology, University Hospital S. Maria della Misericordia, Udine, Italy; Department of Radiation Oncology (Maastro), GROW School for Oncology and Reproduction, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Martina Fanelli
- Department of Oncology, University Hospital S. Maria della Misericordia, Udine, Italy
| | - Paola Ermacora
- Department of Oncology, University Hospital S. Maria della Misericordia, Udine, Italy
| | - Rossano Girometti
- Institute of Radiology, Department of Medicine, University of Udine, University Hospital S. Maria della Misericordia, Udine, Italy
| | - Lorenzo Cereser
- Institute of Radiology, Department of Medicine, University of Udine, University Hospital S. Maria della Misericordia, Udine, Italy.
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Zeng H, Tohidinezhad F, De Ruysscher DKM, Willems YCP, Degens JHRJ, van Kampen-van den Boogaart VEM, Pitz C, Cortiula F, Brandts L, Hendriks LEL, Traverso A. The Association of Gross Tumor Volume and Its Radiomics Features with Brain Metastases Development in Patients with Radically Treated Stage III Non-Small Cell Lung Cancer. Cancers (Basel) 2023; 15:cancers15113010. [PMID: 37296973 DOI: 10.3390/cancers15113010] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 05/22/2023] [Accepted: 05/26/2023] [Indexed: 06/12/2023] Open
Abstract
PURPOSE To identify clinical risk factors, including gross tumor volume (GTV) and radiomics features, for developing brain metastases (BM) in patients with radically treated stage III non-small cell lung cancer (NSCLC). METHODS Clinical data and planning CT scans for thoracic radiotherapy were retrieved from patients with radically treated stage III NSCLC. Radiomics features were extracted from the GTV, primary lung tumor (GTVp), and involved lymph nodes (GTVn), separately. Competing risk analysis was used to develop models (clinical, radiomics, and combined model). LASSO regression was performed to select radiomics features and train models. Area under the receiver operating characteristic curves (AUC-ROC) and calibration were performed to assess the models' performance. RESULTS Three-hundred-ten patients were eligible and 52 (16.8%) developed BM. Three clinical variables (age, NSCLC subtype, and GTVn) and five radiomics features from each radiomics model were significantly associated with BM. Radiomic features measuring tumor heterogeneity were the most relevant. The AUCs and calibration curves of the models showed that the GTVn radiomics model had the best performance (AUC: 0.74; 95% CI: 0.71-0.86; sensitivity: 84%; specificity: 61%; positive predictive value [PPV]: 29%; negative predictive value [NPV]: 95%; accuracy: 65%). CONCLUSION Age, NSCLC subtype, and GTVn were significant risk factors for BM. GTVn radiomics features provided higher predictive value than GTVp and GTV for BM development. GTVp and GTVn should be separated in clinical and research practice.
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Affiliation(s)
- Haiyan Zeng
- Department of Radiation Oncology (Maastro), GROW School for Oncology and Reproduction, Maastricht University Medical Centre+, 6229 ET Maastricht, The Netherlands
| | - Fariba Tohidinezhad
- Department of Radiation Oncology (Maastro), GROW School for Oncology and Reproduction, Maastricht University Medical Centre+, 6229 ET Maastricht, The Netherlands
| | - Dirk K M De Ruysscher
- Department of Radiation Oncology (Maastro), GROW School for Oncology and Reproduction, Maastricht University Medical Centre+, 6229 ET Maastricht, The Netherlands
| | - Yves C P Willems
- Department of Radiation Oncology (Maastro), GROW School for Oncology and Reproduction, Maastricht University Medical Centre+, 6229 ET Maastricht, The Netherlands
| | - Juliette H R J Degens
- Department of Respiratory Medicine, Zuyderland Medical Center, 6419 PC Heerlen, The Netherlands
| | | | - Cordula Pitz
- Department of Pulmonary Diseases, Laurentius Hospital, 6043 CV Roermond, The Netherlands
| | - Francesco Cortiula
- Department of Radiation Oncology (Maastro), GROW School for Oncology and Reproduction, Maastricht University Medical Centre+, 6229 ET Maastricht, The Netherlands
- Department of Medical Oncology, University Hospital of Udine, 33100 Udine, Italy
| | - Lloyd Brandts
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center+, 6229 HX Maastricht, The Netherlands
| | - Lizza E L Hendriks
- Department of Pulmonary Diseases, Maastricht, GROW School for Oncology and Reproduction, Maastricht University Medical Center+, 6202 AZ Maastricht, The Netherlands
| | - Alberto Traverso
- Department of Radiation Oncology (Maastro), GROW School for Oncology and Reproduction, Maastricht University Medical Centre+, 6229 ET Maastricht, The Netherlands
- School of Medicine, Vita-Salute San Raffaele University, 20132 Milan, Italy
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Cortiula F, Naidoo J. A brave NEO world: Neoadjuvant osimertinib in resectable EGFR-mutant NSCLC. Lung Cancer 2023; 181:107256. [PMID: 37267713 DOI: 10.1016/j.lungcan.2023.107256] [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] [Received: 04/23/2023] [Revised: 05/15/2023] [Accepted: 05/17/2023] [Indexed: 06/04/2023]
Affiliation(s)
- F Cortiula
- University Hospital of Udine, Department of Oncology, Udine, Italy; Maastricht University, School for Oncology and Reproduction (GROW), Maastricht, the Netherlands.
| | - J Naidoo
- Beaumont Hospital and RCSI University of Health Sciences, Dublin, Ireland; Sidney Kimmel Comprehensive Cancer Centre at Johns Hopkins University, Baltimore, USA.
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Cortiula F, De Ruysscher D, Steens M, Wijsman R, van der Wekken A, Alberti M, Hendriks LEL. Adjuvant durvalumab after concurrent chemoradiotherapy for patients with unresectable stage III NSCLC harbouring uncommon genomic alterations. Eur J Cancer 2023; 184:172-178. [PMID: 36931075 DOI: 10.1016/j.ejca.2023.02.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 02/13/2023] [Indexed: 02/23/2023]
Abstract
Adjuvant durvalumab is the standard of care for patients with stage III unresectable non-small cell lung cancer (NSCLC), without progression after concurrent chemo-radiation (CCRT). Patients with stage III NSCLC harbouring epidermal growth factor receptor (EGFR) mutations and anaplastic lymphoma kinase rearrangements do not seem to benefit from durvalumab. Data are lacking about patients harbouring other driver genomic alterations (dGA). We performed a multicentre (N = 4, Netherlands and Italy) retrospective study including consecutive patients with unresectable stage III NSCLC and treated with CCRT-with or without adjuvant durvalumab-between 2016 and 2022. We enrolled 271 patients; 130 of which received adjuvant durvalumab. Sixty-six patients had dGA (41 KRAS mutations, 4 EGFR common mutations and 21 uncommon dGA). In the entire population, the median PFS was 24.9 months (95% CI 17.5-32.4) and 12.6 months (95% CI 9.0-16.1) with and without durvalumab (p = 0.001). In the dGA group (excluding common EGFR), mPFS was 12.3 months (95% CI 7.8-16.8) with and 7.6 (95% CI 3.4-11.9) without durvalumab (p = 0.038). For patients with KRAS mutations, mPFS was 12.3 months (95% CI 3.6-20.9) with and 7.2 months (95% CI 1.8-12.6) without durvalumab (p = 0.12). Among patients with uncommon dGA, mPFS was 12.9 months (95% CI 8.4-17.4) with and 7.6 months (95% CI 1.4-14) without durvalumab (p = 0.23). We have shown a meaningful survival benefit of adjuvant durvalumab in patients harbouring KRAS mutations and uncommon dGA. This is the largest stage III NSCLC cohort showing the efficacy of durvalumab in patients with uncommon dGA. Further prospective studies are needed to confirm our results.
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Affiliation(s)
- Francesco Cortiula
- Department of Oncology, University Hospital of Udine, Udine, Italy; Department of Radiation Oncology (Maastro Clinic), Maastricht University Medical Center, School for Oncology and Reproduction (GROW), Maastricht, the Netherlands.
| | - Dirk De Ruysscher
- Department of Radiation Oncology (Maastro Clinic), Maastricht University Medical Center, School for Oncology and Reproduction (GROW), Maastricht, the Netherlands
| | - Michelle Steens
- Department of Pulmonology, GROW School for Oncology and Reproduction, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Robin Wijsman
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Anthonie van der Wekken
- Department of Pulmonary Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Martina Alberti
- Department of Oncology, University Hospital of Udine, Udine, Italy
| | - Lizza E L Hendriks
- Department of Pulmonology, GROW School for Oncology and Reproduction, Maastricht University Medical Center, Maastricht, the Netherlands. https://twitter.com/@HendriksLizza
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10
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Lisanti C, Basile D, Garattini SK, Parnofiello A, Corvaja C, Cortiula F, Bertoli E, Ongaro E, Foltran L, Casagrande M, Di Nardo P, Cardellino GG, Fasola G, Buonadonna A, Pella N, Aprile G, Puglisi F. The SAFFO Study: Sex-Related Prognostic Role and Cut-Off Definition of Monocyte-to-Lymphocyte Ratio (MLR) in Metastatic Colorectal Cancer. Cancers (Basel) 2022; 15:cancers15010175. [PMID: 36612170 PMCID: PMC9818397 DOI: 10.3390/cancers15010175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 12/12/2022] [Accepted: 12/26/2022] [Indexed: 12/31/2022] Open
Abstract
Background: Emerging data suggest that gender-related immune system composition affects both immune response and efficacy of immunotherapy in cancer patients (pts). This study aimed to investigate the sex-related prognostic role of MLR in metastatic colorectal cancer (mCRC) pts. Methods: We analyzed a retrospective consecutive cohort of 490 mCRC patients treated from 2009 to 2018 at the Oncology Departments of Aviano and Pordenone (training set) and Udine (validation set), Italy. The prognostic impact of MLR on overall survival (OS) was evaluated with uni- and multivariable Cox regression models. The best cut-off value to predict survival was defined through ROC analyses. Results: Overall, we identified 288 males (59%) and 202 females (41%); 161 patients (33%) had a right-sided, 202 (42%) a left-sided primary, and 122 (25%) a rectal tumor. Interestingly, gender was associated with MLR (p = 0.004) and sidedness (p = 0.006). The obtained cut-off value for MLR in females and males was 0.27 and 0.49, respectively. According to univariate analysis of the training set, MLR (HR 9.07, p ≤ 0.001), MLR > 0.27 in females (HR 1.95, p = 0.003), and MLR > 0.49 in males (HR 2.65, p = 0.010) were associated with poorer OS, which was also confirmed in the validation set. In multivariate analysis, MLR > 0.27 in females (HR 2.77, p = 0.002), MLR > 0.49 in males (HR 5.39, p ≤ 0.001), BRAF mutation (HR 3.38, p ≤ 0.001), and peritoneal metastases (HR 2.50, p = 0.003) were still independently associated with worse OS. Conclusions: Males and females have a different immune response. Our study showed that high MLR, both in males and females, is an unfavorable Independent prognostic factor. Further prospective studies are needed to confirm these data.
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Affiliation(s)
- Camilla Lisanti
- Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, 33081 Aviano, Italy
- Correspondence: ; Tel.: +39-0434-659136
| | - Debora Basile
- Department of Medical Oncology, San Giovanni di Dio Hospital, 88900 Crotone, Italy
| | | | - Annamaria Parnofiello
- Sandro Pitigliani Medical Oncology Department, Hospital of Prato, 59100 Prato, Italy
| | - Carla Corvaja
- Department of Medicine (DAME), University of Udine, 33100 Udine, Italy
| | | | - Elisa Bertoli
- Department of Medicine (DAME), University of Udine, 33100 Udine, Italy
| | - Elena Ongaro
- Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, 33081 Aviano, Italy
| | - Luisa Foltran
- Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, 33081 Aviano, Italy
| | | | - Paola Di Nardo
- Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, 33081 Aviano, Italy
| | | | - Gianpiero Fasola
- Department of Oncology, ASUFC University Hospital, 33100 Udine, Italy
| | - Angela Buonadonna
- Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, 33081 Aviano, Italy
| | - Nicoletta Pella
- Department of Oncology, ASUFC University Hospital, 33100 Udine, Italy
| | - Giuseppe Aprile
- Department of Medical Oncology, San Bortolo Hospital, Azienda ULSS8 Berica, 36100 Vicenza, Italy
| | - Fabio Puglisi
- Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, 33081 Aviano, Italy
- Department of Medicine (DAME), University of Udine, 33100 Udine, Italy
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11
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Pelizzari G, Caggiari L, Battiston M, Cortiula F, Targato G, Buriolla S, Bortolot M, Torresan S, Alberti M, Michelotti A, Bortolus G, Urban S, Pizzolitto S, Fasola G, Follador A, De Maglio G. EP11.01-004 An Effective Two-step Reflex Test for 10 Biomarkers Analysis in Non-small Cell Lung Cancer. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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12
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Dal Maso A, Del Bianco P, Cortiula F, Nardo G, Zulato E, Bonanno L, Follador A, De Maglio G, Pasello G, Indraccolo S. EGFR T790M testing through repeated liquid biopsy over time: a real-world multicentric retrospective experience. J Thorac Dis 2022; 14:3364-3375. [PMID: 36245580 PMCID: PMC9562526 DOI: 10.21037/jtd-22-745] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 07/22/2022] [Indexed: 01/09/2023]
Abstract
Background About 15% of non-small cell lung cancers (NSCLCs) harbor epidermal growth factor receptor (EGFR) mutations. Upfront treatment with first and second generation EGFR tyrosine kinase inhibitors (1-2gen TKIs) is superior to chemotherapy. The most frequent resistance mechanism to 1-2gen TKIs is EGFR T790M mutation, which is targeted by osimertinib. T790M mutation can be revealed by liquid biopsy (LB) or by tissue rebiopsy (TB). LB is easily feasible but less sensitive than TB. We focused on repeated LBs and analyzed clinical features associated with EGFR T790M detection. Methods This is a retrospective multicenter observational study including EGFR-mutant NSCLC consecutive patients with disease progression (PD) after 1-2gen TKIs and with a first EGFR LB negative for T790M mutation, referred between 2016 and 2019. Aims of the study were to determine the prevalence of T790M mutation using LB in a real-life setting and the prevalence of T790M mutation by repeated LBs. We explored the association of T790M with clinical-pathological features and, through a survey, we evaluated the decision-making process behind LB request. Data on TBs were also collected. Results One hundred and ten patients were included in the study, for a total of 326 LBs. Median number of LB per patient was 3.0. The T790M prevalence through LB was 34.5%. Over time, significantly more LBs were requested "at clinical and radiological PD" and "at radiological PD" compared to "arbitrarily". The probability of finding the T790M mutation for a patient across each subsequent LB did not significantly change. Liver and lymph node PD were significantly correlated to T790M positivity. Notably, "at PD" compared to "arbitrarily" LB request and liver, bone or lymph node PD were correlated to the detection of any EGFR mutation in cfDNA. TB was performed in 59.7% of patients with a T790M negative LB and 18.8% of them were T790M positive. In most cases, TB was not feasible due to anatomical reasons. In our study population, the overall T790M prevalence-detected with both LB and TB-was 42.7%. Conclusions Repeated LB testing can be useful in a real-life scenario to detect EGFR T790M mutation.
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Affiliation(s)
- Alessandro Dal Maso
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy;,Medical Oncology 2, Veneto Institute of Oncology IOV-IRCCS, Padova, Italy
| | - Paola Del Bianco
- Clinical Research Unit, Veneto Institute of Oncology IOV-IRCCS, Padova, Italy
| | - Francesco Cortiula
- Department of Oncology, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Giorgia Nardo
- Basic Experimental and Translational Oncology Unit, Veneto Institute of Oncology IOV-IRCCS, Padova, Italy
| | - Elisabetta Zulato
- Basic Experimental and Translational Oncology Unit, Veneto Institute of Oncology IOV-IRCCS, Padova, Italy
| | - Laura Bonanno
- Medical Oncology 2, Veneto Institute of Oncology IOV-IRCCS, Padova, Italy
| | - Alessandro Follador
- Department of Oncology, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Giovanna De Maglio
- Department of Pathology, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Giulia Pasello
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy;,Medical Oncology 2, Veneto Institute of Oncology IOV-IRCCS, Padova, Italy
| | - Stefano Indraccolo
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy;,Basic Experimental and Translational Oncology Unit, Veneto Institute of Oncology IOV-IRCCS, Padova, Italy
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13
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Cortiula F, Hendriks L, Wijsman R, Debakker S, Steens M, Peeters S, Michelotti A, Sijtsema N, Urban S, Niezink A, Dursun S, Bootsma G, Canters R, Tohidinezhad F, Fasola G, Rinaldi I, Taasti V, Houben R, De Ruysscher D. 957P Proton-therapy and concurrent chemotherapy in stage III NSCLC: Effects on toxicity and immune therapy. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1083] [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: 11/01/2022] Open
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14
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Cortiula F, Reymen B, Peters S, Van Mol P, Wauters E, Vansteenkiste J, De Ruysscher D, Hendriks LEL. Immunotherapy in unresectable stage III non-small-cell lung cancer: state of the art and novel therapeutic approaches. Ann Oncol 2022; 33:893-908. [PMID: 35777706 DOI: 10.1016/j.annonc.2022.06.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 06/21/2022] [Accepted: 06/21/2022] [Indexed: 12/11/2022] Open
Abstract
The standard of care for patients with stage III non-small-cell lung cancer (NSCLC) is concurrent chemoradiotherapy (CCRT) followed by 1 year of adjuvant durvalumab. Despite the survival benefit granted by immunotherapy in this setting, only 1/3 of patients are alive and disease free at 5 years. Novel treatment strategies are under development to improve patient outcomes in this setting: different anti-programmed cell death protein 1/programmed death-ligand 1 [anti-PD-(L)1] antibodies after CCRT, consolidation immunotherapy after sequential chemoradiotherapy, induction immunotherapy before CCRT and immunotherapy concurrent with CCRT and/or sequential chemoradiotherapy. Cross-trial comparison is particularly challenging in this setting due to the different timing of immunotherapy delivery and different patients' inclusion and exclusion criteria. In this review, we present the results of clinical trials investigating immune therapy in unresectable stage III NSCLC and discuss in-depth their biological rationale, their pitfalls and potential benefits. Particular emphasis is placed on the potential mechanisms of synergism between chemotherapy, radiation therapy and different monoclonal antibodies, and how this affects the tumor immune microenvironment. The designs and questions tackled by ongoing clinical trials are also discussed. Last, we address open questions and unmet clinical needs, such as the necessity for predictive biomarkers (e.g. radiomics and circulating tumor DNA). Identifying distinct subsets of patients to tailor anticancer treatment is a priority, especially in a heterogeneous disease such as stage III NSCLC.
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Affiliation(s)
- F Cortiula
- Department of Radiation Oncology (Maastro), Maastricht University Medical Centre(+), GROW School for Oncology and Reproduction, Maastricht, the Netherlands; Department of Medical Oncology, Udine University Hospital, Udine, Italy
| | - B Reymen
- Department of Radiation Oncology (Maastro), Maastricht University Medical Centre(+), GROW School for Oncology and Reproduction, Maastricht, the Netherlands
| | - S Peters
- Oncology Department, Lausanne University Hospital, Lausanne, Switzerland
| | - P Van Mol
- Department of Respiratory Diseases KU Leuven, Respiratory Oncology Unit, University Hospitals KU Leuven, Leuven, Belgium
| | - E Wauters
- Department of Respiratory Diseases KU Leuven, Respiratory Oncology Unit, University Hospitals KU Leuven, Leuven, Belgium
| | - J Vansteenkiste
- Department of Respiratory Diseases KU Leuven, Respiratory Oncology Unit, University Hospitals KU Leuven, Leuven, Belgium.
| | - D De Ruysscher
- Department of Radiation Oncology (Maastro), Maastricht University Medical Centre(+), GROW School for Oncology and Reproduction, Maastricht, the Netherlands
| | - L E L Hendriks
- Department of Pulmonary Diseases, Maastricht University Medical Centre(+), GROW School for Oncology and Reproduction, Maastricht, the Netherlands
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15
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Cortiula F, De Ruysscher D, Dursun S, Steens M, Bootsma G, Canters R, Rinaldi I, Taasti V, Houben R, Reynders K, Peeters S, Angrisani A, Hattu D, Hendriks L. 113P Proton-therapy and concurrent chemotherapy in stage III NSCLC: Effects on durvalumab eligibility and safety profile. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.02.140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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16
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Cortiula F, Hendriks LEL, van de Worp WRPH, Schols AMWJ, Vaes RDW, Langen RCJ, De Ruysscher D. Physical exercise at the crossroad between muscle wasting and the immune system: implications for lung cancer cachexia. J Cachexia Sarcopenia Muscle 2022; 13:55-67. [PMID: 35014216 PMCID: PMC8818640 DOI: 10.1002/jcsm.12900] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 11/11/2021] [Accepted: 11/28/2021] [Indexed: 02/06/2023] Open
Abstract
Cachexia is a syndrome characterized by involuntary weight loss and wasting of skeletal muscle mass. It is associated with worse overall survival and quality of life. The cancer-induced systemic inflammation and the consequent host derived catabolic stimuli, trigger cachexia by inhibiting muscle protein synthesis and enhancing muscle catabolism. The muscle itself may further promote chronic inflammation, introducing a vicious catabolic circle. Nutritional support alone plays a limited role in the treatment of cancer cachexia and should be combined with other interventions. Physical exercise lowers systemic inflammation and promotes muscle anabolism. It also attenuates the age-related physical decline in elderly and it might counteract the muscle wasting induced by the cancer cachexia syndrome. This review describes how cancer-induced systemic inflammation promotes muscle wasting and whether physical exercise may represent a suitable treatment for cancer-induced cachexia, particularly in patients with non-small cell lung cancer. We summarized pre-clinical and clinical studies investigating whether physical exercise would improve muscle performance and whether this improvement would translate in a clinically meaningful benefit for patients with cancer, in terms of survival and quality of life. Moreover, this review describes the results of studies investigating the interplay between physical exercise and the immune system, including the role of the intestinal microbiota.
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Affiliation(s)
- Francesco Cortiula
- Department of Radiation Oncology (MAASTRO), Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht, The Netherlands.,Department of Medicine (DAME), University of Udine, Udine, Italy
| | - Lizza E L Hendriks
- Department of Respiratory Medicine, GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center +, Maastricht, The Netherlands
| | - Wouter R P H van de Worp
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Annemie M W J Schols
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Rianne D W Vaes
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Ramon C J Langen
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Dirk De Ruysscher
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
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17
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Fassan M, Milione M, Maddalena G, Cremolini C, Schirripa M, Pietrantonio F, Pella N, Dell'Aquila E, Sperti E, Zichi C, Bergamo F, Volante M, Boccaccino A, Morano F, Cortiula F, De Maglio G, Rimassa L, Smiroldo V, Calvetti L, Aprile G, Salvatore L, Santini D, Salmaso R, Centonze G, Biason P, Borga C, Lonardi S, Zagonel V, Dei Tos AP, Di Maio M, Loupakis F. Synaptophysin expression in V600EBRAF-mutated advanced colorectal cancers identifies a new subgroup of tumours with worse prognosis. Eur J Cancer 2021; 146:145-154. [PMID: 33607478 DOI: 10.1016/j.ejca.2021.01.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 12/29/2020] [Accepted: 01/10/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Neuroendocrine differentiation has been extensively associated with worse prognosis and to mechanisms of therapy resistance in several epithelial cancers. A high prevalence of neuroendocrine differentiation was recently described in V600EBRAF-mutated (BRAFmt) metastatic colorectal cancers (mCRCs) but no data are available about its prognostic impact in this setting. METHODS We assessed synaptophysin immunohistochemical expression in a multi-institutional series of 159 BRAFmt mCRCs with matched clinical and pathological information. Tumours were dichotomized as synaptophysin high and low. Overall survival (OS) and progression-free survival (PFS) were evaluated by Kaplan-Meier and log-rank tests. RESULTS Thirty-five tumours (22.0%) showed any level of positivity for synaptophysin, and 18 (11.3%) were characterized by positivity in at least 20% of tumour cells. Four cases resulted 100% synaptophysin positive. The histotype of synaptophysin-positive tumours (i.e. ≥20%) was not otherwise specified in 11 cases (61.1%) and mucinous adenocarcinoma in 4 cases (22.2%). Four cases were DNA mismatch repair deficient (22.2%) and 7 (38.9%) were characterized by a high number of tumour-infiltrating lymphocytes. At multivariate analysis, high synaptophysin expression was a negative independent prognostic factor for both PFS (HR = 2.00, 95% confidence interval [CI] 1.21-3.33, p = 0.006) and OS (HR = 2.27, 95% CI 1.35-3.85, p = 0.001). CONCLUSIONS Among BRAFmt mCRCs, synaptophysin-positive tumours are characterized by worse PFS and OS. Further studies should investigate the molecular mechanisms involved in the acquisition of the neuroendocrine phenotype to identify novel-targeted treatment strategies.
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Affiliation(s)
- Matteo Fassan
- Surgical Pathology Unit, Department of Medicine (DIMED), University of Padua, Padua, Italy.
| | - Massimo Milione
- 1st Pathology Division, Department of Pathology and Laboratory Medicine, Fondazione IRCCS - Istituto Nazionale dei Tumori, Milan, Italy
| | - Giulia Maddalena
- Unit of Oncology 1, Department of Oncology, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - Chiara Cremolini
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Marta Schirripa
- Unit of Oncology 1, Department of Oncology, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - Filippo Pietrantonio
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - Nicoletta Pella
- Department of Oncology, University and General Hospital, Udine, Italy
| | - Emanuela Dell'Aquila
- Department of Medical Oncology, Campus Bio-Medico University of Rome, Rome, Italy
| | - Elisa Sperti
- Department of Oncology, University of Turin at Umberto I "Ordine Mauriziano" Hospital, Turin, Italy
| | - Clizia Zichi
- Department of Oncology, University of Turin at Umberto I "Ordine Mauriziano" Hospital, Turin, Italy
| | - Francesca Bergamo
- Unit of Oncology 1, Department of Oncology, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - Marco Volante
- Department of Oncology, University of Turin at San Luigi Hospital, Orbassano (TO), Italy
| | - Alessandra Boccaccino
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Federica Morano
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Francesco Cortiula
- Department of Oncology, University and General Hospital, Udine, Italy; Department of Medicine (DAME), University of Udine, Italy
| | | | - Lorenza Rimassa
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Valeria Smiroldo
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Lorenzo Calvetti
- Department of Oncology, San Bortolo General Hospital, AULSS8 Berica, Vicenza, Italy
| | - Giuseppe Aprile
- Department of Oncology, San Bortolo General Hospital, AULSS8 Berica, Vicenza, Italy
| | - Lisa Salvatore
- U.O.C Oncologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Daniele Santini
- Department of Medical Oncology, Campus Bio-Medico University of Rome, Rome, Italy
| | - Roberta Salmaso
- Surgical Pathology Unit, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - Giovanni Centonze
- 1st Pathology Division, Department of Pathology and Laboratory Medicine, Fondazione IRCCS - Istituto Nazionale dei Tumori, Milan, Italy
| | - Paola Biason
- Unit of Oncology 1, Department of Oncology, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - Chiara Borga
- Surgical Pathology Unit, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - Sara Lonardi
- Unit of Oncology 1, Department of Oncology, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - Vittorina Zagonel
- Unit of Oncology 1, Department of Oncology, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - Angelo P Dei Tos
- Surgical Pathology Unit, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - Massimo Di Maio
- Department of Oncology, University of Turin at Umberto I "Ordine Mauriziano" Hospital, Turin, Italy
| | - Fotios Loupakis
- Unit of Oncology 1, Department of Oncology, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy.
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18
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Pelizzari G, Cortiula F, Giavarra M, Bartoletti M, Lisanti C, Buoro V, Cattaneo M, Rossetto C, Rizzato S, Puglisi F, Macerelli M, Fasola G, Follador A. Platinum-Based Chemotherapy in Older Patients with Non-Small Cell Lung Cancer: What to Expect in the Real World. Drugs Aging 2020; 37:677-689. [PMID: 32681401 DOI: 10.1007/s40266-020-00785-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND The role of platinum-based chemotherapy (PBC) for the treatment of older patients with non-small cell lung cancer (NSCLC) is still a matter of debate, despite the advent of immunotherapy. OBJECTIVE The aim of the study was to identify factors associated with first-line PBC prescription and, secondly, to evaluate the impact of first-line PBC on survival, treatment intensity, risk of hospitalization, and subsequent treatments. PATIENTS AND METHODS We reviewed a consecutive series of 474 older patients (age ≥ 70 years) diagnosed with stage IIIB-IV NSCLC at the Department of Oncology, University Hospital of Udine, Italy from January 2009 to March 2017. RESULTS Overall, 198 patients were deemed eligible, and 65.2% received a PBC. At multivariate analysis, older age was the only factor associated with PBC prescription. In the whole cohort, 46 patients (23.2%) were hospitalized for chemotherapy-related toxicity. Both PBC prescription (odds ratio [OR] 2.23, 95% confidence interval [CI] 1.02-4.87, p = 0.04) and tumor burden (OR 2.39, 95% CI 1.07-5.32, p = 0.03) emerged as independent risk factors for hospitalization. Moving to significant predictors of patterns of care, Eastern Cooperative Oncology Group (ECOG) performance status > 0 was associated with greater risk of first-line failure (OR 2.20, 95% CI 1.15-4.20, p = 0.02), while bone metastases (OR 0.29, 95% CI 0.12-0.69, p = 0.005) and a Charlson Comorbidity Index score ≥ 3 (OR 0.40, 95% CI 0.19-0.84, p = 0.016) independently predicted lower probability of receiving second-line therapy. Remarkably, PBC did not significantly impact overall survival (hazard ratio [HR] 0.83, 95% CI 0.61-1.14, p = 0.24) and progression-free survival (HR 0.95, 95% CI 0.70-1.28, p = 0.73) compared to single-agent chemotherapy (SAC). However, according to an exploratory landmark analysis, patients who received four cycles of treatment or maintenance therapy experienced prolonged overall survival, regardless of PBC use. CONCLUSIONS This study evaluated the real-world use of PBC in older patients with NSCLC, offering an insight into the determinants of its prescription and the pattern of care of these patients. Of note, PBC use was associated with a higher likelihood of hospitalization for chemotherapy-related toxicity, with no benefit on survival compared to SAC.
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Affiliation(s)
- Giacomo Pelizzari
- Department of Medicine (DAME), University of Udine, 33100, Udine, Italy. .,Department of Oncology, Santa Maria Della Misericordia Hospital (ASUFC), 33100, Udine, Italy.
| | - Francesco Cortiula
- Department of Medicine (DAME), University of Udine, 33100, Udine, Italy.,Department of Oncology, Santa Maria Della Misericordia Hospital (ASUFC), 33100, Udine, Italy
| | - Marco Giavarra
- Department of Medicine (DAME), University of Udine, 33100, Udine, Italy.,Department of Oncology, Santa Maria Della Misericordia Hospital (ASUFC), 33100, Udine, Italy
| | - Michele Bartoletti
- Department of Medicine (DAME), University of Udine, 33100, Udine, Italy.,Department of Oncology, Santa Maria Della Misericordia Hospital (ASUFC), 33100, Udine, Italy
| | - Camilla Lisanti
- Department of Medicine (DAME), University of Udine, 33100, Udine, Italy.,Department of Oncology, Santa Maria Della Misericordia Hospital (ASUFC), 33100, Udine, Italy
| | - Vanessa Buoro
- Department of Medicine (DAME), University of Udine, 33100, Udine, Italy.,Department of Oncology, Santa Maria Della Misericordia Hospital (ASUFC), 33100, Udine, Italy
| | - Monica Cattaneo
- Department of Medicine (DAME), University of Udine, 33100, Udine, Italy.,Department of Oncology, Santa Maria Della Misericordia Hospital (ASUFC), 33100, Udine, Italy
| | - Ciro Rossetto
- Department of Oncology, Santa Maria Della Misericordia Hospital (ASUFC), 33100, Udine, Italy
| | - Simona Rizzato
- Department of Oncology, Santa Maria Della Misericordia Hospital (ASUFC), 33100, Udine, Italy
| | - Fabio Puglisi
- Department of Medicine (DAME), University of Udine, 33100, Udine, Italy.,Dipartimento Di Oncologia Medica, Oncologia Medica E Prevenzione Oncologica, Centro Di Riferimento Oncologico Di Aviano (CRO), IRCCS, 33081, Aviano, Italy
| | - Marianna Macerelli
- Department of Oncology, Santa Maria Della Misericordia Hospital (ASUFC), 33100, Udine, Italy
| | - Gianpiero Fasola
- Department of Oncology, Santa Maria Della Misericordia Hospital (ASUFC), 33100, Udine, Italy
| | - Alessandro Follador
- Department of Oncology, Santa Maria Della Misericordia Hospital (ASUFC), 33100, Udine, Italy
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19
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Cortiula F, Pasello G, Follador A, Nardo G, Polo V, Scquizzato E, Conte AD, Miorin M, Giovanis P, D’Urso A, Girlando S, Settanni G, Picece V, Veccia A, Corvaja C, Indraccolo S, De Maglio G. A Multi-Center, Real-Life Experience on Liquid Biopsy Practice for EGFR Testing in Non-Small Cell Lung Cancer (NSCLC) Patients. Diagnostics (Basel) 2020; 10:diagnostics10100765. [PMID: 32998450 PMCID: PMC7601690 DOI: 10.3390/diagnostics10100765] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 09/24/2020] [Accepted: 09/27/2020] [Indexed: 02/07/2023] Open
Abstract
Background: circulating tumor DNA (ctDNA) is a source of tumor genetic material for EGFR testing in NSCLC. Real-word data about liquid biopsy (LB) clinical practice are lacking. The aim of the study was to describe the LB practice for EGFR detection in North Eastern Italy. Methods: we conducted a multi-regional survey on ctDNA testing practices in lung cancer patients. Results: Median time from blood collection to plasma separation was 50 min (20–120 min), median time from plasma extraction to ctDNA analysis was 24 h (30 min–5 days) and median turnaround time was 24 h (6 h–5 days). Four hundred and seventy five patients and 654 samples were tested. One hundred and ninety-two patients were tested at diagnosis, with 16% EGFR mutation rate. Among the 283 patients tested at disease progression, 35% were T790M+. Main differences in LB results between 2017 and 2018 were the number of LBs performed for each patient at disease progression (2.88 vs. 1.2, respectively) and the percentage of T790M+ patients (61% vs. 26%).
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Affiliation(s)
- Francesco Cortiula
- Dipartimento di Oncologia, Azienda Sanitaria Universitaria Friuli Centrale, 33100 Udine, Italy; (A.F.); (C.C.)
- Dipartimento di Medicina (DAME), Università degli Studi di Udine, 33100 Udine, Italy
- Correspondence: (F.C.); (S.I.)
| | - Giulia Pasello
- Oncologia Medica 2, Istituto Oncologico Veneto IOV IRCCS, 35128 Padova, Italy;
| | - Alessandro Follador
- Dipartimento di Oncologia, Azienda Sanitaria Universitaria Friuli Centrale, 33100 Udine, Italy; (A.F.); (C.C.)
| | - Giorgia Nardo
- U.O.C. Immunologia e Diagnostica Molecolare Oncologica, Istituto Oncologico Veneto IOV IRCCS, 35128 Padova, Italy;
| | - Valentina Polo
- Dipartimento di Oncologia, AULSS 2 Marca Trevigiana, Ospedale Ca’ Foncello, 31100 Treviso, Italy;
| | - Elisa Scquizzato
- Dipartimento interaziendale di Anatomia Patologica, ULSS 2 Marca Trevigiana, 31100 Treviso, Italy;
| | - Alessandro Del Conte
- S.O.C. Oncologia Medica e dei Tumori Immunocorrelati, Centro di Riferimento Oncologico (CRO) IRCCS, 33081 Aviano, Italy;
| | - Marta Miorin
- SSD Genetica medica, Azienda Sanitaria Friuli Occidentale, Presidio Ospedaliero di Pordenone, 33170 Pordenone, Italy;
| | - Petros Giovanis
- U.O.C. Oncologia, ULSS1 Dolomiti, Presidio Ospedaliero di Feltre, 32032 Feltre, Italy;
| | - Alessandra D’Urso
- U.O.C. Anatomia Patologica, ULSS1 Dolomiti, Presidio Ospedaliero di Feltre, 32032 Feltre, Italy;
| | - Salvator Girlando
- U.O. Anatomia Patologica, Ospedale Santa Chiara, 38122 Trento, Italy;
| | - Giulio Settanni
- Servizio di Anatomia-Istologia Patologica, IRCCS Ospedale Sacro Cuore Don Calabria, 37024 Negrar, Italy;
| | - Vincenzo Picece
- Dipartimento di Oncologia Medica, IRCCS Ospedale Sacro Cuore Don Calabria, 37024 Negrar, Italy;
| | - Antonello Veccia
- U.O. Oncologia Medica, Ospedale Santa Chiara, 38122 Trento, Italy;
| | - Carla Corvaja
- Dipartimento di Oncologia, Azienda Sanitaria Universitaria Friuli Centrale, 33100 Udine, Italy; (A.F.); (C.C.)
- Dipartimento di Medicina (DAME), Università degli Studi di Udine, 33100 Udine, Italy
| | - Stefano Indraccolo
- U.O.C. Immunologia e Diagnostica Molecolare Oncologica, Istituto Oncologico Veneto IOV IRCCS, 35128 Padova, Italy;
- Correspondence: (F.C.); (S.I.)
| | - Giovanna De Maglio
- SOC Anatomia Patologica, Azienda Sanitaria UniversitariaFriuli Centrale, 33100 Udine, Italy;
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20
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Basile D, Polano M, Buriolla S, Gallois C, Cortiula F, Corvaja C, De Scordilli M, Michelotti A, Pelizzari G, Ongaro E, Casagrande M, Foltran L, Toffoli G, Pella N, Buonadonna A, Zaanan A, Fasola G, Aprile G, Taieb J, Puglisi F. 416P A novel prognostic tool based on lymphocyte ratios in patients with stage III colon cancer. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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21
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Garattini SK, Bonotto M, Porcu L, Ongaro E, Gerratana L, Basile D, Parnofiello A, Pelizzari G, Cortiula F, Corvaja C, Casagrande M, Cardellino GG, Buonadonna A, Aprile G, Puglisi F, Fasola G, Pella N. Determinants of choice in offering drug holidays during first-line therapy for metastatic colorectal cancer. Future Oncol 2020; 16:2645-2660. [PMID: 32776795 DOI: 10.2217/fon-2020-0270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: 'Drug holidays' (DH) for metastatic colorectal cancer (mCRC) were introduced to preserve quality of life. We studied factors associated to a DH offer in first line. Materials & methods: We retrospectively analyzed 754 consecutive patients treated with chemotherapy for mCRC in two Italian institutions between 2005 and 2017. Associations between baseline clinical-pathological factors and DH (56 or more days of treatment interruption) were investigated. Results: In 754 patients, previous metastasectomy, previous thermoablation and previous surgery of primary tumor were independently associated with DH. Excluding procedures or clinical trials: primary rectal cancer and resection of primary tumor were significantly associated to DH. Conclusions: DH was offered to patients with lower burden of disease, but further investigations are needed to safely guide a holiday strategy.
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Affiliation(s)
- Silvio Ken Garattini
- Department of Oncology, ASUFC University Hospital of Udine, 33100 Udine, Italy.,Department of Medicine, University of Udine, 33100 Udine, Italy
| | - Marta Bonotto
- Department of Oncology, ASUFC University Hospital of Udine, 33100 Udine, Italy
| | - Luca Porcu
- Department of Oncology, Laboratory of Methodology for Clinical Research, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, 20156 Milan, Italy
| | - Elena Ongaro
- Department of Medical Oncology, Unit of Medical Oncology & Cancer Prevention, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, 33081 Aviano, Italy
| | - Lorenzo Gerratana
- Department of Medicine, University of Udine, 33100 Udine, Italy.,Department of Medical Oncology, Unit of Medical Oncology & Cancer Prevention, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, 33081 Aviano, Italy
| | - Debora Basile
- Department of Medicine, University of Udine, 33100 Udine, Italy.,Department of Medical Oncology, Unit of Medical Oncology & Cancer Prevention, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, 33081 Aviano, Italy
| | - Annamaria Parnofiello
- Department of Oncology, ASUFC University Hospital of Udine, 33100 Udine, Italy.,Department of Medicine, University of Udine, 33100 Udine, Italy
| | - Giacomo Pelizzari
- Department of Medicine, University of Udine, 33100 Udine, Italy.,Department of Medical Oncology, Unit of Medical Oncology & Cancer Prevention, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, 33081 Aviano, Italy
| | - Francesco Cortiula
- Department of Oncology, ASUFC University Hospital of Udine, 33100 Udine, Italy.,Department of Medicine, University of Udine, 33100 Udine, Italy
| | - Carla Corvaja
- Department of Medicine, University of Udine, 33100 Udine, Italy.,Department of Medical Oncology, Unit of Medical Oncology & Cancer Prevention, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, 33081 Aviano, Italy
| | | | | | - Angela Buonadonna
- Department of Medical Oncology, Unit of Medical Oncology & Cancer Prevention, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, 33081 Aviano, Italy
| | - Giuseppe Aprile
- Department of Oncology, Azienda ULSS8 Berica, 36100 Vicenza, Italy
| | - Fabio Puglisi
- Department of Medicine, University of Udine, 33100 Udine, Italy.,Department of Medical Oncology, Unit of Medical Oncology & Cancer Prevention, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, 33081 Aviano, Italy
| | - Gianpiero Fasola
- Department of Oncology, ASUFC University Hospital of Udine, 33100 Udine, Italy
| | - Nicoletta Pella
- Department of Oncology, ASUFC University Hospital of Udine, 33100 Udine, Italy
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22
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Garutti M, Cortiula F, Puglisi F. Seven Shades of Black Thoughts: COVID-19 and Its Psychological Consequences on Cancer Patients. Front Oncol 2020; 10:1357. [PMID: 32766162 PMCID: PMC7381263 DOI: 10.3389/fonc.2020.01357] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 06/29/2020] [Indexed: 12/19/2022] Open
Abstract
An outbreak of novel coronavirus disease (COVID-19) that started in China at the end of 2019 has rapidly spread all over the world. COVID-19 is plaguing people not only physically but also psychologically, and cancer patients are particularly exposed to this emotional threat. Herein, we describe the psychological threats posed by COVID-19 to cancer patients. Our analysis is based on the concerns of our patients during our daily clinical interactions in both outpatient and inpatient settings. We have summarized the patients' psychological issues: logistic overload, loneliness, fear, oxymoronic thoughts, helplessness, frustration, and emotional siege. We describe these psychological threats, provide clinical context for them, and offer practical suggestions for managing them, for the benefit of patients, their caregivers, and clinicians. Our hope is that, by sharing our clinical experience, we can help other oncologists increase their awareness of the psychological impact of the pandemic on cancer patients and implement solutions. Managing these challenges now should translate into improved standards of care when this infective storm is over. Paradoxically, COVID-19 could be an opportunity to learn how to better manage cancer care.
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Affiliation(s)
- Mattia Garutti
- Dipartimento di Oncologia Medica, Centro di Riferimento Oncologico di Aviano, IRCCS, Aviano, Italy
| | - Francesco Cortiula
- Dipartimento di Oncologia Medica, Centro di Riferimento Oncologico di Aviano, IRCCS, Aviano, Italy.,Department of Medicine, University of Udine, Udine, Italy
| | - Fabio Puglisi
- Dipartimento di Oncologia Medica, Centro di Riferimento Oncologico di Aviano, IRCCS, Aviano, Italy.,Department of Medicine, University of Udine, Udine, Italy
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23
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Di Nardo P, Guardascione M, Basile D, Foltran L, Ongaro E, Miolo G, Fanotto V, Lisanti C, Michele B, Parnofiello A, Cortiula F, Bertoli E, Buriolla S, De Scordilli M, Michelotti A, Puglisi F, Buonadonna A. P-246 Taxane cross-resistance: An exploratory analysis of second-line chemotherapy for metastatic gastric cancer. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.04.328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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24
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Iacono D, Vitale MG, Cortiula F, Macerelli M, Cinausero M, Minisini AM, Valent F, Tullio A, Palmero L, Targato G, Zara D, Fasola G. Management of immune-related adverse events: A single-center retrospective analysis in a real-world scenario. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e15163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e15163 Background: Immune checkpoint inhibitors (ICI), anti CTLA-4 and anti PD-1/PD-L1 agents, have demonstrated an improvement in survival outcome in several malignancies. Therapy with ICI is characterized by immune-related adverse events (irAEs) as a result of exuberant immune system activation. Despite good tolerance for ICI, the potentially severe and life-threatening irAEs underscore the importance of investigating optimal management strategies. Methods: A retrospective series of 130 consecutive patients (pts) treated with ICI from Jan 2012 to Dec 2017 was analyzed. Adverse events with a potential immunological etiology were defined as irAEs and graded according to CTCAE v.4.0. The aim of the study was to evaluate irAEs management in an academic hospital center. Results: Pts with a diagnosis of NSCLC n = 64 (49%), melanoma n = 55 (42%), kidney n = 9 (7%) and others n = 2 (2%) were investigated. Baseline ECOG PS was ≤ 1 in 96% of the pts. ICI represented first line treatment for 27% pts, second line for 57% and third or further line for the remaining 16%. 18% were treated with ipilimumab and 82% with anti PD-1/PD-L1 agents (nivolumab 60%, pembrolizumab 21%, atezolizumab 1%). Overall, 50 (38% of pts) developed an irAE.42% of irAEs were grade 1, 38% grade 2, 14% grade 3 and 6% grade 4. The most frequent irAEs were endocrinopathies in 17 pts (34%), followed by cutaneous toxicity in 9 pts (18%) and colitis and diarrhea in 7 pts (14%). A total of 373 unscheduled accesses were observed, 89 (24%) of them were due to irAEs: 78 were unplanned consultations in the oncology department and 11 in the emergency department. irAEs led to hospitalization in 14 pts for 118 days, cumulatively. Grade ≥ 2 colitis was the most frequent irAE associated with hospitalization, it occurred in 4 pts (29%). Colitis and diarrhea required the longest hospitalization (range 4-31 days). 48% (24 pts) required immunosuppressive treatment. Systemic steroids were the most common immunosuppressive agents used. Only one patient received infliximab as second line immunosuppressive treatment after steroid failure. Totally, irAEs required 67 specialist consultancies and additional diagnostic examinations. 15 pts required ICI discontinuation because of irAEs. Conclusions: In our center prevalence and severity of irAEs were similar to literature data. Considered the complexity of irAEs management, multidisciplinary approach and a trained hospital network plays a key role for a more efficient diagnostic and treatment work-up in pts who received ICI therapy and experienced irAEs.
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Affiliation(s)
- Donatella Iacono
- Department of Oncology, University Hospital of Udine, Udine, Italy
| | | | - Francesco Cortiula
- Azienda Sanitaria Universitaria Integrata di Udine, Dipartimento di Oncologia, Udine, Italy
| | | | - Marika Cinausero
- Department of Oncology, University Hospital of Udine, Udine, Italy
| | | | - Francesca Valent
- Institute of Hygiene and Clinical Epidemiology,University Hospital of Udine, Udine, Italy
| | - Annarita Tullio
- Institute of Hygiene and clinical Epidemiology, University Hospital of Udine, Udine, Italy
| | | | - Giada Targato
- Department of Oncology, University Hospital of Udine - Santa Maria della Misericordia, Udine, Italy
| | - Diego Zara
- University Hospital of Udine, Department of Oncology, Udine, Italy
| | - Gianpiero Fasola
- Department of Oncology, University Hospital of Udine - Santa Maria della Misericordia, Udine, Italy
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25
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Basile D, Polano M, Buriolla S, Gallois C, Cortiula F, Corvaja C, de Scordilli M, Michelotti A, Parnofiello A, Gerratana L, Ongaro E, Andreuzzi E, Toffoli G, Buonadonna A, Mongiat M, Zaanan A, Aprile G, Canzonieri V, Taieb J, Puglisi F. Prognostic role of macrophage infiltration and monocyte-to-lymphocyte ratio in stage III colon cancer: The MIRROR study. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e16118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e16118 Background: Changes in peripheral blood cells composition may reflect immune microenvironment and its role in cancer growth. High monocyte-to-lymphocyte ratio (MLR) could be a marker of tumor’s recruitment of suppressive cells, showing a prognostic role. This study aimed to assess the prognostic impact of macrophage infiltration and MLR in stage III colon cancer (CC) patients (pts). Methods: This multicentric study retrospectively analyzed a consecutive cohort of 423 CC pts treated between 2008-2019 at the Cancer Centre of Aviano (Italy) (n = 300) and at the European Georges Pompidou Hospital of Paris (France) (n = 123). The association of MLR with disease-free survival (DFS) and overall survival (OS) was evaluated with Cox regression analyses. Random Forrest was implemented on python using h2oai. Performance was assessed in terms of accuracy (ACC) and Matthews Coefficient (MCC). Analyses was adjusted on classical prognostic factors of stage III CC such as pT, pN, grade, location, ECOG PS. Results: Overall, 77% had pT1-3, 30% pN2 and 73% G1-2 tumors. Interestingly, 25% had a lymphatic and vascular invasion, 42/230 (18%) had MSI status, 69/152(45%) and 19/114 (13%) were KRAS and BRAF mutant. 56% had CEA > 5. Pts were treated with fluoropyrimidine and oxaliplatin as adjuvant therapy. Notably, 130 cases were analyzed according to lymphocytic and macrophage infiltration (CD163, CD68, CD3, CD8). Of them, 78% had a CD163/CD8 ratio ≤3 and 74% a CD8/CD3 ratio ≤1.5. At median follow-up of 57 months, median DFS and OS were not reached, 31% of pts relapsed and 23% dead. By multivariate analysis, including statistically significant prognostic variables, CD163/CD8 ratio (HR 1.15, p = 0.039, 95%C.I. 1.1-1.32) and MLR > 0.45 (HR 2.98, p = 0.008, 95%C.I. 1.33-6.67) were associated with worse DFS. By multivariate analysis for OS, including statistically significant confounding variables, MLR > 0.45 (HR4.32, P = 0.012, 95%C.I. 1.37-9) and BRAF mutation predicted worse OS. According random survival forest for OS, CD68/CD3 were the first variable of importance (0.06), followed by MLR (0.009) and CD8 (0.007). Interestingly, high MLR followed by CEA, MSI, KRAS were the features linked with organotropism on liver (ACC 0.6 ±0.3), while high MLR, KRAS, pN, pT were mainly linked with lung colonization (ACC 0.6 ±0.2). Conclusions: High pre-treatment levels of MLR and CD163/CD8 ratio in stage III CC are independently associated with worse prognosis. The present study paves the way to a prospective validation of these promising cost-effective biomarkers.
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Affiliation(s)
- Debora Basile
- Department of Medicine (DAME), University of Udine; Department of Digestive Oncology, European Georges Pompidou, Paris, Udine, Italy
| | | | - Silvia Buriolla
- Scuola Di Specializzazione in Oncologia Medica, Universit Degli Studi Di Udine, Sesto Al Reghena, Italy
| | | | - Francesco Cortiula
- Azienda Sanitaria Universitaria Integrata di Udine, Dipartimento di Oncologia, Udine, Italy
| | - Carla Corvaja
- Department of Oncology, University Hospital of Udine - Santa Maria della Misericordia, Udine, Italy
| | - Marco de Scordilli
- Department of Medical Area, University of Udine; Department of Medical Oncology, IRCCS, CRO of Aviano, Udine, Italy
| | - Anna Michelotti
- Department of Medical Area, University of Udine; Department of Medical Oncology, IRCCS, CRO of Aviano, Udine, Italy
| | - Annamaria Parnofiello
- Department of Medical Area, University of Udine; Department of Medical Oncology, IRCCS, CRO of Aviano, Udine, Italy
| | - Lorenzo Gerratana
- Department of Medicine-Hematology and Oncology, Feinberg School of Medicine, Northwestern University; Department of Medicine (DAME), University of Udine, Chicago, IL
| | - Elena Ongaro
- Department of Oncology, Medical Oncology and Cancer Prevention, Centro di Riferimento Oncologico (CRO) di Aviano, IRCCS, Aviano, Italy
| | - Eva Andreuzzi
- Department of Research and Diagnosis, Division of Molecular Oncology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Giuseppe Toffoli
- Experimental and Clinical Pharmacology, National Cancer Institute, Aviano, Italy
| | - Angela Buonadonna
- Oncologia Medica e Prevenzione Oncologica, Centro di Riferimento Oncologico (CRO), IRCCS, Aviano (PN), Italy
| | - Maurizio Mongiat
- Department of Research and Diagnosis, Division of Molecular Oncology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy, Aviano, Italy
| | - Aziz Zaanan
- Department of Medical Oncology, Saint Antoine Hospital, UPMC University Paris 06, Paris, France
| | - Giuseppe Aprile
- Dipartimento di Oncologia, Ospedale San Bortolo, Vicenza, Italy
| | | | - Julien Taieb
- Hôpital Européen Georges Pompidou, Paris, France
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Macerelli M, Rizzato S, Giavarra M, Valent F, Cattaneo M, Cortiula F, Targato G, Rossetto C, Bozza C, Corvaja C, Fioraso R, Fasola G. The impact of prior chemotherapy (PrC) on immunotherapy outcomes in non-small cell lung cancer (NSCLC) patients: Real data from a mono-institutional study. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e21639] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e21639 Background: Immunotherapy has changed the paradigm on NSCLC treatment. No widespread and reproducible predictive biomarkers have been established. We analyzed how PrC could affect ICI outcomes. Methods: We conducted a retrospective observational study and analyzed all NSCLC patients (pts) treated with ICI (nivolumab or atezolizumab or pembrolizumab) in our institution from 2015 to 2018 and followed until January 2020. All pts had received at least one PrC. We recorded clinical features of pts both before and after ICI treatment. Results: A total of 83 pts were included, with a median age of 69 (range, 47-82). Sixty pts (73%) were male, 74 (89%) were smokers and 81 (97%) had ECOG PS 0-1. Thirteen (15.7%) pts had a immune-related toxicity (iRT, G1-G2 76.9% and G3-G4 23.1%) and 21 (25.3%) continued ICI therapy beyond progression disease (PD). Patients with a PD as best response to PrC had more probability to reach a PD with ICI (p = 0.06). Median Progression-Free Survival (PFS) on ICI was 2.9 months (interquartile range, 1.9-9.4) with no statistical difference between pts with oligo- or diffuse progression (≤ or > 5 metastasis) during PrC (p = 0.42). Corticosteroids use was associated with worse PFS (p < 0.01). Median Overall Survival (OS) was 9.1 months (interquartile range, 3.3-26.5), with a benefit for pts with a stable disease (SD) or partial response (PR) to PrC (p = 0.02), for pts who experimented iRT (p = 0.04) and who didn’t receive corticosteroids (p < 0.01). In multivariate analysis liver or brain metastases (HR 8.8, 95% CI 2.9-26.8 and HR 2.2, 95% CI 0.6-8.1), coticosteroids use (HR 3.7, 95% CI 1.3-10.5) or previous cisplatin-based chemotherapy (HR 8.4, 95% CI 2.3-30.1) were associated with worse OS. Instead, pts whit iRT (HR 0.4, 95% CI 0.1-1.3) and PR as best response to PrC (HR 0.8, 95% CI 0.3-2.0) had a better OS. Conclusions: Our study confirms literature data and suggests that PrC could affect ICI outcomes. Tumor burden seems not to influence ICI outcomes, unlike response rate to PrC. Systemic corticosteroids use and iRT predicts ICI outcomes.
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Affiliation(s)
| | - Simona Rizzato
- Department of Oncology, University Hospital of Udine - Santa Maria della Misericordia, Udine, Italy
| | - Marco Giavarra
- Department of Medicine, University of Udine and Department of Oncology, University Hospital of Udine, Udine, Italy
| | - Francesca Valent
- Institute of Hygiene and Clinical Epidemiology,University Hospital of Udine, Udine, Italy
| | - Monica Cattaneo
- Department of Oncology, University Hospital of Udine - Santa Maria della Misericordia, Udine, Italy
| | - Francesco Cortiula
- Department of Oncology, University Hospital of Udine - Santa Maria della Misericordia, Udine, Italy
| | - Giada Targato
- Department of Oncology, University Hospital of Udine - Santa Maria della Misericordia, Udine, Italy
| | - Ciro Rossetto
- Department of Oncology, University Hospital of Udine - Santa Maria della Misericordia, Udine, Italy
| | - Claudia Bozza
- Department of Oncology, University Hospital of Udine - Santa Maria della Misericordia, Udine, Italy
| | - Carla Corvaja
- Department of Oncology, University Hospital of Udine - Santa Maria della Misericordia, Udine, Italy
| | - Roberto Fioraso
- Department of Oncology, University Hospital of Udine - Santa Maria della Misericordia, Udine, Italy
| | - Gianpiero Fasola
- Department of Oncology, University Hospital of Udine - Santa Maria della Misericordia, Udine, Italy
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Cortiula F, Pettke A, Bartoletti M, Puglisi F, Helleday T. Managing COVID-19 in the oncology clinic and avoiding the distraction effect. Ann Oncol 2020; 31:553-555. [PMID: 32201224 PMCID: PMC7174827 DOI: 10.1016/j.annonc.2020.03.286] [Citation(s) in RCA: 122] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 03/13/2020] [Indexed: 11/30/2022] Open
Affiliation(s)
- F Cortiula
- Department of Medicine (DAME), University of Udine, Udine, Italy; Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy.
| | - A Pettke
- Science for Life Laboratory, Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - M Bartoletti
- Department of Medicine (DAME), University of Udine, Udine, Italy; Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - F Puglisi
- Department of Medicine (DAME), University of Udine, Udine, Italy; Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - T Helleday
- Science for Life Laboratory, Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden; Weston Park Cancer Centre, Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK.
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Basile D, Garattini SK, Corvaja C, Montico M, Cortiula F, Pelizzari G, Gerratana L, Audisio M, Lisanti C, Fanotto V, Ongaro E, Iacono D, Cardellino GG, Foltran L, Pella N, Buonadonna A, Aprile G, Di Maio M, Fasola G, Puglisi F. The MIMIC Study: Prognostic Role and Cutoff Definition of Monocyte-to-Lymphocyte Ratio and Lactate Dehydrogenase Levels in Metastatic Colorectal Cancer. Oncologist 2020; 25:661-668. [PMID: 32202020 DOI: 10.1634/theoncologist.2019-0780] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Accepted: 02/05/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Monocyte-to-lymphocyte ratio (MLR) and lactate dehydrogenase (LDH) levels are circulating biomarkers that provide information about tumor-related inflammation and immune suppression. This study aimed to evaluate the prognostic role of MLR and LDH in metastatic colorectal cancer (mCRC). MATERIAL AND METHODS This multicentric study analyzed a consecutive cohort of 528 patients with mCRC treated in 2009-2017. The whole population was randomly divided in training and validation cohort. The first was used to identify a threshold for MLR and to create the prognostic model with MLR and MLR-LDH combined (group 1: MLR-LDH low; group 2: MLR or LDH high; group 3: MLR-LDH high). The second cohort was used to validate the model. RESULTS At the median follow-up of 55 months, median overall survival (OS) was 22 months. By multivariate analysis, high MLR >0.49 (hazard ratio [HR], 2.37; 95% confidence interval [C.I.], 1.39-4.04), high LDH (HR, 1.73; 95% C.I., 1.03-2.90) in the first model, group 2 (HR, 2.74; 95% C.I.; 1.62-4.66), and group 3 (HR, 3.73; 95% C.I., 1.94-7.18) in the combined model, had a worse prognosis in terms of OS. These data were confirmed both in the validation set and then in the whole cohort. CONCLUSION MLR and LDH are circulating cost-effective biomarkers, readily available in clinical practice, that can be useful for predicting the prognosis of patients with mCRC. IMPLICATIONS FOR PRACTICE High monocyte-to-lymphocyte ratio (MLR) and lactate dehydrogenase (LDH) levels could be a sign of a tumor's recruitment of suppressive and inflammatory cells worsening prognosis of different types of cancer, including colorectal cancer (CRC). Currently, no data are available for metastatic CRC regarding a cutoff definition for MLR or the prognostic impact of MLR and MLR-LDH combined. The present study showed in the training cohort and confirmed in the validation and whole cohort that MLR is a reliable and independent laboratory biomarker, which is easy to use, to predict clinical outcomes in patients with mCRC. Moreover, MLR and composite MLR-LDH could potentially result in an incremental improvement in the prognostic value of these biomarkers, being used as stratification tools for patients with mCRC.
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Affiliation(s)
- Debora Basile
- Department of Medicine, University of Udine, Udine, Italy
- Department of Medical Oncology, Unit of Medical Oncology and Cancer Prevention, Centro di Riferimento Oncologico di Aviano, IRCCS, Aviano, Italy
| | - Silvio Ken Garattini
- Department of Medicine, University of Udine, Udine, Italy
- Department of Oncology, ASUIUD University Hospital of Udine, Udine, Italy
| | - Carla Corvaja
- Department of Medicine, University of Udine, Udine, Italy
- Department of Medical Oncology, Unit of Medical Oncology and Cancer Prevention, Centro di Riferimento Oncologico di Aviano, IRCCS, Aviano, Italy
| | - Marcella Montico
- Scientific Directorate, Centro di Riferimento Oncologico di Aviano, IRCCS, Aviano, Italy
| | - Francesco Cortiula
- Department of Medicine, University of Udine, Udine, Italy
- Department of Oncology, ASUIUD University Hospital of Udine, Udine, Italy
| | - Giacomo Pelizzari
- Department of Medicine, University of Udine, Udine, Italy
- Department of Medical Oncology, Unit of Medical Oncology and Cancer Prevention, Centro di Riferimento Oncologico di Aviano, IRCCS, Aviano, Italy
| | - Lorenzo Gerratana
- Department of Medicine, University of Udine, Udine, Italy
- Department of Medical Oncology, Unit of Medical Oncology and Cancer Prevention, Centro di Riferimento Oncologico di Aviano, IRCCS, Aviano, Italy
| | - Marco Audisio
- Department of Oncology, University of Turin at Umberto I "Ordine Mauriziano" Hospital, Turin, Italy
| | - Camilla Lisanti
- Department of Medicine, University of Udine, Udine, Italy
- Department of Medical Oncology, Unit of Medical Oncology and Cancer Prevention, Centro di Riferimento Oncologico di Aviano, IRCCS, Aviano, Italy
| | - Valentina Fanotto
- Department of Medicine, University of Udine, Udine, Italy
- Department of Medical Oncology, Unit of Medical Oncology and Cancer Prevention, Centro di Riferimento Oncologico di Aviano, IRCCS, Aviano, Italy
| | - Elena Ongaro
- Department of Medical Oncology, Unit of Medical Oncology and Cancer Prevention, Centro di Riferimento Oncologico di Aviano, IRCCS, Aviano, Italy
| | - Donatella Iacono
- Department of Oncology, ASUIUD University Hospital of Udine, Udine, Italy
| | | | - Luisa Foltran
- Department of Medical Oncology, Unit of Medical Oncology and Cancer Prevention, Centro di Riferimento Oncologico di Aviano, IRCCS, Aviano, Italy
| | - Nicoletta Pella
- Department of Oncology, ASUIUD University Hospital of Udine, Udine, Italy
| | - Angela Buonadonna
- Department of Medical Oncology, Unit of Medical Oncology and Cancer Prevention, Centro di Riferimento Oncologico di Aviano, IRCCS, Aviano, Italy
| | - Giuseppe Aprile
- Department of Oncology, San Bortolo General Hospital, Vicenza, Italy
| | - Massimo Di Maio
- Department of Oncology, University of Turin at Umberto I "Ordine Mauriziano" Hospital, Turin, Italy
| | - Gianpiero Fasola
- Department of Oncology, ASUIUD University Hospital of Udine, Udine, Italy
| | - Fabio Puglisi
- Department of Medicine, University of Udine, Udine, Italy
- Department of Medical Oncology, Unit of Medical Oncology and Cancer Prevention, Centro di Riferimento Oncologico di Aviano, IRCCS, Aviano, Italy
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Cinausero M, Rihawi K, Cortiula F, Follador A, Fasola G, Ardizzoni A. Emerging therapies in malignant pleural mesothelioma. Crit Rev Oncol Hematol 2019; 144:102815. [PMID: 31670225 DOI: 10.1016/j.critrevonc.2019.102815] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 06/22/2019] [Accepted: 09/24/2019] [Indexed: 01/29/2023] Open
Abstract
Malignant pleural mesothelioma (MPM) is a rare cancer of the pleural surfaces frequently related to asbestos exposure. It is characterized by a poor prognosis even for patients treated with trimodality therapy, including surgery, chemotherapy and radiotherapy. Moreover, the majority of patients are not candidates for surgery due to disease advanced stage or medical comorbidities. For these patients, the survival rate is even lower and few therapeutic options are currently available. Nevertheless, many interesting novel approaches are under investigation, among which immunotherapy represents one of the most promising emerging strategies. In this review, we will discuss the role of new therapeutic options, particularly immunotherapy, and present the results of the most important and promising clinical trials.
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Affiliation(s)
- Marika Cinausero
- Department of Oncology, University Hospital of Udine, Italy; School of Medical Oncology, Department of Medicine, University of Udine, Italy.
| | - Karim Rihawi
- Department of Oncology, University Hospital of Udine, Italy; Department of Experimental, Diagnostic and Specialty Medicine - DIMES, University of Bologna, Italy
| | - Francesco Cortiula
- Department of Oncology, University Hospital of Udine, Italy; School of Medical Oncology, Department of Medicine, University of Udine, Italy
| | | | | | - Andrea Ardizzoni
- Department of Oncology, Policlinico S. Orsola-Malpighi, University of Bologna, Bologna, Italy
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De Maglio G, Pasello G, Follador A, Nardo G, Cortiula F, De Conte A, D’Urso A, Petros G, Girlando S, Miorin M, Polo V, Scquizzato E, Settanni G, Picece V, Veccia A, Indraccolo S. Liquid biopsy in clinical pratice of non-small cell lung cancer (NSCLC): A multi-institutional experience. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz260.086] [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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31
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Lisanti C, Basile D, Garattini S, Parnofiello A, Corvaja C, Cortiula F, Pelizzari G, Cattaneo M, Andreotti V, Bertoli E, Ongaro E, Iacono D, Foltran L, Casagrande M, Miolo G, Cardellino G, Fasola G, Pella N, Buonadonna A, Puglisi F. The SAFFO study: Sex-related prognostic role and cut-oFf deFinition of monocyte-to-lymphocyte ratio (MLR) in metastatic colOrectal cancer. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz246.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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32
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Garattini S, Bonotto M, Basile D, Porcu L, Ongaro E, Gerratana L, Cortiula F, Pelizzari G, Parnofiello A, bertoli E, Corvaja C, Lisanti C, Casagrande M, Iacono D, Cardellino G, Buonadonna A, Aprile G, Pella N, Puglisi F, Fasola G. Drug holidays and overall survival in patients treated for metastatic colorectal cancer. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz246.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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33
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Loupakis F, Biason P, Prete AA, Cremolini C, Pietrantonio F, Pella N, Dell'Aquila E, Sperti E, Zichi C, Intini R, Dadduzio V, Schirripa M, Bergamo F, Antoniotti C, Morano F, Cortiula F, De Maglio G, Rimassa L, Smiroldo V, Calvetti L, Aprile G, Salvatore L, Santini D, Munari G, Salmaso R, Guzzardo V, Mescoli C, Lonardi S, Rugge M, Zagonel V, Di Maio M, Fassan M. CK7 and consensus molecular subtypes as major prognosticators in V600EBRAF mutated metastatic colorectal cancer. Br J Cancer 2019; 121:593-599. [PMID: 31474758 PMCID: PMC6889398 DOI: 10.1038/s41416-019-0560-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [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] [Received: 05/30/2019] [Accepted: 08/09/2019] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND V600EBRAF mutated metastatic colorectal cancer (mCRC) is a subtype (10%) with overall poor prognosis, but the clinical experience suggests a great heterogeneity in survival. It is still unexplored the real distribution of traditional and innovative biomarkers among V600EBRAF mutated mCRC and which is their role in the improvement of clinical prediction of survival outcomes. METHODS Data and tissue specimens from 155 V600EBRAF mutated mCRC patients treated at eight Italian Units of Oncology were collected. Specimens were analysed by means of immunohistochemistry profiling performed on tissue microarrays. Primary endpoint was overall survival (OS). RESULTS CDX2 loss conferred worse OS (HR = 1.72, 95%CI 1.03-2.86, p = 0.036), as well as high CK7 expression (HR = 2.17, 95%CI 1.10-4.29, p = 0.026). According to Consensus Molecular Subtypes (CMS), CMS1 patients had better OS compared to CMS2-3/CMS4 (HR = 0.37, 95%CI 0.19-0.71, p = 0.003). Samples showing less TILs had worse OS (HR = 1.72, 95%CI 1.16-2.56, p = 0.007). Progression-free survival analyses led to similar results. At multivariate analysis, CK7 and CMS subgrouping retained their significant correlation with OS. CONCLUSION The present study provides new evidence on how several well-established biomarkers perform in a homogenousV600EBRAF mutated mCRC population, with important and independent information added to standard clinical prognosticators. These data could be useful to inform further translational research, for patients' stratification in clinical trials and in routine clinical practice to better estimate patients' prognosis.
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Affiliation(s)
- Fotios Loupakis
- Department of Oncology, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy.
| | - Paola Biason
- Department of Oncology, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | | | - Chiara Cremolini
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Filippo Pietrantonio
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.,Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - Nicoletta Pella
- Department of Oncology, University and General Hospital, Udine, Italy
| | - Emanuela Dell'Aquila
- Department of Medical Oncology, Campus Bio-Medico University of Rome, Rome, Italy
| | - Elisa Sperti
- Department of Oncology, University of Turin at Umberto I "Ordine Mauriziano" Hospital, Turin, Italy
| | - Clizia Zichi
- Department of Oncology, University of Turin at Umberto I "Ordine Mauriziano" Hospital, Turin, Italy
| | - Rossana Intini
- Department of Oncology, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Vincenzo Dadduzio
- Department of Oncology, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Marta Schirripa
- Department of Oncology, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Francesca Bergamo
- Department of Oncology, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Carlotta Antoniotti
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Federica Morano
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Francesco Cortiula
- Department of Oncology, University and General Hospital, Udine, Italy.,Department of Medicine (DAME), University of Udine, Udine, Italy
| | | | - Lorenza Rimassa
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, Humanitas Clinical and Research Center-IRCCS Rozzano, Milan, Italy
| | - Valeria Smiroldo
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, Humanitas Clinical and Research Center-IRCCS Rozzano, Milan, Italy
| | - Lorenzo Calvetti
- Department of Oncology, General Hospital San Bortolo, Unità Locale Socio-Sanitaria 8 Berica, Vicenza, Italy
| | - Giuseppe Aprile
- Department of Oncology, General Hospital San Bortolo, Unità Locale Socio-Sanitaria 8 Berica, Vicenza, Italy
| | - Lisa Salvatore
- Unit of Oncology, Polyclinic GB Rossi, AOUI, Verona, Italy.,U.O.C Oncologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Daniele Santini
- Department of Medical Oncology, Campus Bio-Medico University of Rome, Rome, Italy
| | - Giada Munari
- Department of Oncology, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy.,Surgical Pathology & Cytopathology Unit, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - Roberta Salmaso
- Surgical Pathology & Cytopathology Unit, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - Vincenza Guzzardo
- Surgical Pathology & Cytopathology Unit, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - Claudia Mescoli
- Surgical Pathology & Cytopathology Unit, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - Sara Lonardi
- Department of Oncology, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Massimo Rugge
- Surgical Pathology & Cytopathology Unit, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - Vittorina Zagonel
- Department of Oncology, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Massimo Di Maio
- Department of Oncology, University of Turin at Umberto I "Ordine Mauriziano" Hospital, Turin, Italy
| | - Matteo Fassan
- Surgical Pathology & Cytopathology Unit, Department of Medicine (DIMED), University of Padua, Padua, Italy.
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Basile D, Pelizzari G, Corvaja C, Lisanti C, Bartoletti M, Buriolla S, Garattini S, Gerratana L, Bortot L, Cortiula F, Parnofiello A, Ongaro E, Borghi M, Miolo G, Cardellino G, Giaretta R, Schiavo G, Buonadonna A, Puglisi F, Aprile G. SUN-PO094: The Role of Nutritional Interventions in Surgically Treated Pancreatic Cancer Patients: Comparative Efficacy in a Network Meta-Analysis (NMA). Clin Nutr 2019. [DOI: 10.1016/s0261-5614(19)32728-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Basile D, Parnofiello A, Vitale MG, Cortiula F, Gerratana L, Fanotto V, Lisanti C, Pelizzari G, Ongaro E, Bartoletti M, Garattini SK, Andreotti VJ, Bacco A, Iacono D, Bonotto M, Casagrande M, Ermacora P, Puglisi F, Pella N, Fasola G, Aprile G, Cardellino GG. The IMPACT study: early loss of skeletal muscle mass in advanced pancreatic cancer patients. J Cachexia Sarcopenia Muscle 2019; 10:368-377. [PMID: 30719874 PMCID: PMC6463465 DOI: 10.1002/jcsm.12368] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 11/03/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Pancreatic cancer (PC) patients have multiple risk factors for sarcopenia and loss of skeletal muscle mass (LSMM), which may cause greater treatment toxicities, reduced response to cancer therapy, prolonged hospitalization, impaired quality of life, and worse prognosis. METHODS This is a retrospective study on advanced PC patients treated at the Department of Oncology of Udine, Italy, from January 2012 to November 2017. Among 162 patients who received chemotherapy, 94 consecutive patients with an available computed tomography (CT) scan were retrospectively analyzed. The primary objective of our study was to explore if an early LSMM ≥ 10% (measured at first radiological evaluation and compared with baseline) and/or baseline sarcopenia may impact prognosis. Baseline sarcopenia was defined according to Prado's criteria. Skeletal muscle area was measured as cross-sectional areas (cm2 ) using CT scan data through the Picture archiving and communication system (PACS) image system. RESULTS In the whole cohort, 48% of patients were ≤70 years old, and 50% had metastatic disease. At baseline, 73% of patients had sarcopenia, and 16% presented a visceral fat area ≥ 44 cm2 /m2 . Overall, 21% experienced an early LSMM ≥ 10%. Approximately 33% of sarcopenic patients at baseline and ~35% of patients with early LSMM ≥ 10% had a body mass index > 25 kg/m2 . Of note, 71% of patients were evaluated by a nutritionist, and 56% received a dietary supplementation (oral and/or parenteral). After a median follow-up of 30.44 months, median overall survival (OS) was 11.28 months, whereas median progression-free survival (PFS) was 5.72 months. By multivariate analysis, early LSMM ≥ 10% was significantly associated with worse OS [hazard ratio (HR): 2.16; 95% confidence interval (CI) 1.23-3.78; P = 0.007] and PFS (HR: 2.31; 95% CI 1.30-4.09; P = 0.004). Moreover, an exploratory analysis showed that inflammatory indexes, such as neutrophil-lymphocyte ratio variation, impact early LSMM ≥ 10% (odds ratio 1.31, 95% CI 1.06-1.61, P = 0.010). CONCLUSIONS Early LSMM ≥ 10% has a negative prognostic role in advanced PC patients. Further prospective investigations are needed to confirm these preliminary data.
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Affiliation(s)
- Debora Basile
- Department of Medicine (DAME), University of Udine, Udine, UD, Italy.,Department of Oncology, ASUIUD University Hospital of Udine, Udine, UD, Italy
| | - Annamaria Parnofiello
- Department of Medicine (DAME), University of Udine, Udine, UD, Italy.,Department of Oncology, ASUIUD University Hospital of Udine, Udine, UD, Italy
| | - Maria Grazia Vitale
- Department of Medicine (DAME), University of Udine, Udine, UD, Italy.,Department of Oncology, ASUIUD University Hospital of Udine, Udine, UD, Italy
| | - Francesco Cortiula
- Department of Medicine (DAME), University of Udine, Udine, UD, Italy.,Department of Oncology, ASUIUD University Hospital of Udine, Udine, UD, Italy
| | - Lorenzo Gerratana
- Department of Medicine (DAME), University of Udine, Udine, UD, Italy.,Department of Oncology, ASUIUD University Hospital of Udine, Udine, UD, Italy
| | - Valentina Fanotto
- Department of Medicine (DAME), University of Udine, Udine, UD, Italy.,Department of Oncology, ASUIUD University Hospital of Udine, Udine, UD, Italy
| | - Camilla Lisanti
- Department of Medicine (DAME), University of Udine, Udine, UD, Italy.,Department of Oncology, ASUIUD University Hospital of Udine, Udine, UD, Italy
| | - Giacomo Pelizzari
- Department of Medicine (DAME), University of Udine, Udine, UD, Italy.,Department of Oncology, ASUIUD University Hospital of Udine, Udine, UD, Italy
| | - Elena Ongaro
- Department of Medicine (DAME), University of Udine, Udine, UD, Italy.,Department of Oncology, ASUIUD University Hospital of Udine, Udine, UD, Italy
| | - Michele Bartoletti
- Department of Medicine (DAME), University of Udine, Udine, UD, Italy.,Department of Oncology, ASUIUD University Hospital of Udine, Udine, UD, Italy
| | - Silvio Ken Garattini
- Department of Medicine (DAME), University of Udine, Udine, UD, Italy.,Department of Oncology, ASUIUD University Hospital of Udine, Udine, UD, Italy
| | - Victoria Josephine Andreotti
- Department of Medicine (DAME), University of Udine, Udine, UD, Italy.,Department of Oncology, ASUIUD University Hospital of Udine, Udine, UD, Italy
| | - Anna Bacco
- Department of Endocrinology, University Hospital of Udine, Udine, UD, Italy
| | - Donatella Iacono
- Department of Oncology, ASUIUD University Hospital of Udine, Udine, UD, Italy
| | - Marta Bonotto
- Department of Oncology, ASUIUD University Hospital of Udine, Udine, UD, Italy
| | | | - Paola Ermacora
- Department of Oncology, ASUIUD University Hospital of Udine, Udine, UD, Italy
| | - Fabio Puglisi
- Department of Medicine (DAME), University of Udine, Udine, UD, Italy.,Unit of Medical Oncology and Cancer Prevention, Centro di Riferimento Oncologico (CRO), IRCCS, Aviano, PN, Italy
| | - Nicoletta Pella
- Department of Oncology, ASUIUD University Hospital of Udine, Udine, UD, Italy
| | - Gianpiero Fasola
- Department of Oncology, ASUIUD University Hospital of Udine, Udine, UD, Italy
| | - Giuseppe Aprile
- Department of Oncology, San Bortolo General Hospital, ULSS8 Berica, East District, Vicenza, VI, Italy
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Cortiula F, De Maglio G, Cangi MG, Gerratana L, Lisanti C, Bonura S, Fasola G, Follador A. Third-generation tyrosine kinase inhibitor in the treatment of epidermal growth factor receptor mutated squamous cell lung cancer: a tailored therapy approach. Ann Transl Med 2019; 7:14. [PMID: 30788361 DOI: 10.21037/atm.2018.12.42] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
We reported the case of a male patient suffering from a metastatic squamous cell carcinoma, harboring a complex inframe deletion in exon 19 of epidermal growth factor receptor (EGFR), treated with erlotinib and osimertinib and subsequently with immunotherapy. A 54-year-old male, with a light smoking history, presented in October 2015 with metastatic squamous cell lung cancer (SqCLC). Deletion p.E746_S752>V in EGFR exon 19 was found and after progression to erlotinib treatment, the liquid biopsy-based re-assessment highlighted a p.T790M EGFR mutation. Osimertinib was then started. After 5 cycles disease progression was detected and nivolumab was started. A subsequent clinical and radiological progression occurred after 3 nivolumab administrations. Next-generation sequencing (NGS) analysis, performed on metastatic tissue, confirmed the original EGFR deletion and showed also the presence of EGFR p.G724S and TP53 p.P152L mutations. Patient died in December 2017. The reported case highlighted tumor's molecular features prominent role over histology, offering further insights about druggable mutations in SqCLC. Furthermore, we confirm the emerging role of EGFR p.G724S mutation as a Osimertinib resistence mechanism.
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Affiliation(s)
- Francesco Cortiula
- Department of Medical Oncology, University Hospital of Udine, P.le S.M. Misericordia, Udine, Italy.,Department of Medicine (DAME), The University of Udine, Udine, Italy
| | - Giovanna De Maglio
- Department of Pathology, University Hospital of Udine, P.le S.M. Misericordia, Udine, Italy
| | - Maria Giulia Cangi
- Unit of Pathology, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Lorenzo Gerratana
- Department of Medical Oncology, University Hospital of Udine, P.le S.M. Misericordia, Udine, Italy.,Department of Medicine (DAME), The University of Udine, Udine, Italy
| | - Camilla Lisanti
- Department of Medical Oncology, University Hospital of Udine, P.le S.M. Misericordia, Udine, Italy.,Department of Medicine (DAME), The University of Udine, Udine, Italy
| | - Salvatore Bonura
- Department of Medical Oncology, ASL5 Bassa Friulana, Via Vittorio Veneto, Gorizia, Italy
| | - Gianpiero Fasola
- Department of Medical Oncology, University Hospital of Udine, P.le S.M. Misericordia, Udine, Italy
| | - Alessandro Follador
- Department of Medical Oncology, University Hospital of Udine, P.le S.M. Misericordia, Udine, Italy
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Basile D, Gerratana L, Corvaja C, Pelizzari G, Garattini S, Lisanti C, Bartoletti M, Bortot L, Fanotto V, Ongaro E, Cortiula F, Parnofiello A, Vitale M, Da Ros L, Di Nardo P, Torrisi E, Guardascione M, Miolo G, Buonadonna A, Puglisi F. Monocyte-to-lymphocye ratio (MLR) and LDH level in metastatic colorectal cancer (mCRC) patients (pts). Ann Oncol 2018. [DOI: 10.1093/annonc/mdy493.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Garattini S, Bonotto M, Porcu L, Ongaro E, Basile D, Cortiula F, Pelizzari G, Cattaneo M, Parnofiello A, Andreotti V, Corvaja C, Cardellino G, Ermacora P, Casagrande M, Iacono D, Pella N, Buonadonna A, Minisini A, Puglisi F, Fasola G. Determinants of oncologist’s choice in offering drug holidays during first line therapy for patients with metastatic colorectal cancer. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy281.140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Basile D, Lisanti C, Borghi M, Bartoletti M, Gerratana L, Bortot L, Pelizzari G, Corvaja C, Ongaro E, Garattini S, Fanotto V, Parnofiello A, Cortiula F, Cattaneo M, Andreotti V, Bertoli E, Guardascione M, Miolo G, Puglisi F, Buonadonna A. The SLICE study: The prognostic role of visceral fat in metastatic colorectal cancer. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy281.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Iacono D, Vitale M, Cortiula F, Cinausero M, Tullio A, Valent F, Macerelli M, Follador A, Vogrig A, Minisini A, Puglisi F, Fasola G. Serum markers as predictors of immune checkpoint inhibitors (ICI) related adverse events in a real-world scenario. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy288.071] [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: 11/13/2022] Open
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41
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Basile D, Garattini S, Pelizzari G, Cortiula F, Gerratana L, Cattaneo M, Corvaja C, Parnofiello A, Andreotti V, Bertoli E, Lisanti C, Iacono D, Casagrande M, Cardellino G, Miolo G, Pella N, Aprile G, Buonadonna A, Fasola G, Puglisi F. Monocyte-to-lymphocyte ratio in metastatic colorectal cancer: Prognostic role evaluation and cut-off definition. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy281.086] [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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42
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Lisanti C, Basile D, Garattini S, Pelizzari G, Parnofiello A, Cortiula F, Ongaro E, Cattaneo M, Corvaja C, Andreotti V, Bartoletti M, Casagrande M, Iacono D, Bonotto M, Ermacora P, Pella N, Buonadonna A, Puglisi F, Fasola G, Miolo G. The SENECA study: Prognostic role of serum biomarkers in elderly metastatic colorectal cancer patients. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy281.139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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De Carlo E, Gerratana L, De Maglio G, Buoro V, Cortiula F, Gurrieri L, Isola M, Fasola G, Puglisi F, Pizzolitto S, Rizzato S. Defining a prognostic score based on O6-methylguanine-DNA methyltransferase cut-off methylation level determined by pyrosequencing in patients with glioblastoma multiforme. J Neurooncol 2018; 140:559-568. [PMID: 30132165 DOI: 10.1007/s11060-018-2981-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Accepted: 08/14/2018] [Indexed: 02/06/2023]
Abstract
PURPOSE Epigenetic variations in the O6-methylguanine-methyltransferase gene had been widely associated with a favorable impact on survival in patients affected by glioblastoma multiforme (GBM). Aim of this study is to explore a scoring system based on the gene promoter methylation in order to predict patients' prognosis. METHODS A series of 128 patients with GBM was retrospectively analyzed. A training set and a validations set were then generated. The methylation level of CpGi from 74 to 83 was determined by pyrosequencing. In accordance to previous literature, each island was assigned with 1 point if the corresponding methylation level was higher than 9%. The sum consisted in a score that went from 0 (all CpGi < 9%) to 10 (all CpGi ≥ 9%). A threshold capable to detect a favorable outcome (overall survival, OS > 24 months) was identified by ROC analysis. RESULTS Median OS and follow-up were 14 and 32.6 months respectively. Among the total population, 35% of the pts had a score of 0, while 29% had a score of 10. A score ≥ 6 was associated with a favorable prognosis also when corrected for age (> 70 vs. ≤ 70 years) and ECOG performance status (0-1 vs. 2-3). Similar results were observed also in terms of PFS. Results were consistent in the training and in the validation set. CONCLUSIONS The present manuscript explored a novel scoring system capable to take into consideration the methylation status of each single CpGi, capable to better predict prognosis in GBM patients.
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Affiliation(s)
- Elisa De Carlo
- Department of Oncology, University Hospital of Udine, P.le S.M. Misericordia, 15, 33100, Udine, Italy.,Department of Clinical Oncology, IRCCS CRO Aviano National Cancer Institute, Aviano, PN, Italy
| | - Lorenzo Gerratana
- Department of Oncology, University Hospital of Udine, P.le S.M. Misericordia, 15, 33100, Udine, Italy. .,Department of Medicine (DAME), The University of Udine, Udine, Italy.
| | | | - Vanessa Buoro
- Department of Oncology, University Hospital of Udine, P.le S.M. Misericordia, 15, 33100, Udine, Italy.,Department of Medicine (DAME), The University of Udine, Udine, Italy
| | - Francesco Cortiula
- Department of Oncology, University Hospital of Udine, P.le S.M. Misericordia, 15, 33100, Udine, Italy.,Department of Medicine (DAME), The University of Udine, Udine, Italy
| | - Lorena Gurrieri
- Department of Oncology, ASUITS University Hospital, Trieste, Italy
| | - Miriam Isola
- Department of Medicine (DAME), The University of Udine, Udine, Italy
| | - Gianpiero Fasola
- Department of Oncology, University Hospital of Udine, P.le S.M. Misericordia, 15, 33100, Udine, Italy
| | - Fabio Puglisi
- Department of Clinical Oncology, IRCCS CRO Aviano National Cancer Institute, Aviano, PN, Italy.,Department of Medicine (DAME), The University of Udine, Udine, Italy
| | | | - Simona Rizzato
- Department of Oncology, University Hospital of Udine, P.le S.M. Misericordia, 15, 33100, Udine, Italy
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Schirripa M, Biason P, Cortiula F, Pino M, Urbano F, Antoniotti C, Corallo S, Gelsomino F, Orlandi A, Lonardi S, Bergamo F, Munari G, Malapelle U, Rugge M, Mescoli C, Reggiani Bonetti L, Lanza G, Dei Tos A, De Maglio G, Zagonel V, Loupakis F, Fassan M. Clinico-pathological and molecular characterization of BRAF mutant metastatic colorectal cancer (mCRC): Are all mutations created equal? Ann Oncol 2018. [DOI: 10.1093/annonc/mdy151.206] [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: 11/14/2022] Open
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45
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Basile D, Bacco A, Parnofiello A, Vitale M, Cortiula F, Garattini S, Gerratana L, Andreotti V, Lisanti C, Bartoletti M, Bonotto M, Fanotto V, Cattaneo M, Iacono D, Ermacora P, Puglisi F, Aprile G, Pella N, Cardellino G, Fasola G. Early loss of skeletal muscle mass as prognostic factor in metastatic pancreatic cancer patients. Nutrition 2018. [DOI: 10.1016/j.nut.2018.03.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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46
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Schirripa M, Biason P, Cortiula F, Pino MS, Urbano F, Antoniotti C, Corallo S, Gelsomino F, Orlandi A, Munari G, Malapelle U, Rugge M, Mescoli C, Reggiani Bonetti L, Lanza G, Dei Tos AP, De Maglio G, Zagonel V, Loupakis F, Fassan M. Clinico-pathological and molecular characterisation of BRAF mutant metastatic colorectal cancer (mCRC): Are all mutations created equal? J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.3590] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Marta Schirripa
- Unit of Medical Oncology 1, Department of Clinical and Experimental Oncology, Veneto Institute of Oncology IOV – IRCCS, Padua, Italy
| | - Paola Biason
- Unit of Medical Oncology 1, Department of Clinical and Experimental Oncology, Veneto Institute of Oncology IOV – IRCCS, Padova, IT
| | - Francesco Cortiula
- Azienda Sanitaria Universitaria Integrata di Udine, Dipartimento di Oncologia, Udine, Italy
| | | | - Federica Urbano
- Medical Oncology, Policlinico Umberto I - Sapienza University of Rome, Rome, Italy
| | - Carlotta Antoniotti
- Department of Translational Research and New Technologies in Medicine and Surgery, Unit of Medical Oncology 2, Azienda Ospedaliera Universitaria Pisana, Istituto Toscano Tumori, Pisa, Italy
| | | | | | - Armando Orlandi
- Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
| | - Giada Munari
- Surgical Pathology Unit, Department of Medicine (DIMED) University of Padua, Italy, Padova, Italy
| | | | - Massimo Rugge
- Department of Medicine, Pathology and Cytopathology Unit, University of Padova, Padova, Italy
| | - Claudia Mescoli
- Surgical Pathology and Cytopathology Unit, Department of Medicine DIMED, University of Padova, Padova, Italy, Padova, Italy
| | - Luca Reggiani Bonetti
- Department of Laboratory Integrated Activities, Anatomic Pathology and Legal Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Giovanni Lanza
- Department of Experimental and Diagnostic Medicine, Section of Anatomic Pathology, Ferrara, Italy
| | - Angelo Paolo Dei Tos
- Department of Pathology, General Hospital of Treviso, Treviso, Italy., Treviso, Italy
| | | | - Vittorina Zagonel
- Department of Clinical and Experimental Oncology, Medical Oncology 1, Veneto Institute of Oncology, IOV-IRCCS, Padua, Italy
| | - Fotios Loupakis
- Medical Oncology Unit 1, Clinical and Experimental Oncology Department, Veneto Institute of Oncology IOV – IRCCS, Padua, Italy
| | - Matteo Fassan
- Department of Medicine (DIMED), Pathology Unit, University of Padua, Padova, Italy, Padova, Italy
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Ongaro E, De Maglio G, Gerratana L, Bonotto M, Garattini S, Basile D, Cattaneo M, Andreotti V, Cortiula F, Parnofiello A, Fanotto V, Pizzolitto S, Cardellino G, Casagrande M, Ermacora P, Giovannoni M, Iacono D, Puglisi F, Aprile G, Pella N, Fasola G. Mutational status and metastatic patteRn in a cohort Of ADvanced colorectal cancer patients: the ROAD study. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx422.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Bozza C, Gerratana L, Basile D, De Carlo E, Cortiula F, Pella N, Vitale M, Bartoletti M, Russo S, Bonotto M, Cinausero M, Fanotto V, Pelizzari G, Minisini A, Andreetta C, Mansutti M, Iacono D, Sottile R, Fasola G, Puglisi F. Final results from CAMEO-PRO study: complementary and alternative medicine in oncology. physicians inform oncological patients. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx436.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Basile D, Parnofiello A, Vitale M, Cortiula F, Garattini S, Gerratana L, Andreotti V, Ongaro E, Lisanti C, Bartoletti M, Bonotto M, Fanotto V, Cattaneo M, Iacono D, Bacco A, Ermacora P, Puglisi F, Aprile G, Pella N, Cardellino G, Fasola G. Early loss of skeletal muscle mass (LSMM) as prognostic factor in metastatic pancreatic cancer (PC) patients. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx425.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Pelizzari G, Gerratana L, Cattaneo M, Cortiula F, Lisanti C, Bartoletti M, Giavarra M, Buoro V, De Carlo E, Macerelli M, Poletto E, Rossetto C, Rizzato S, Puglisi F, Fasola G. First-line platinum-based chemotherapy in elderly patients with NSCLC: determinants of therapeutic choice and outcome. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx426.024] [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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