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Carpenè S, Silvestri B, Bertinazzi M, Armato E, Amadori M, Spinato R, de Terlizzi F, Azzarello G. Electrochemotherapy as adjuvant treatment in a sinonasal mucosal melanoma in elderly patient: a case report. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08606-z. [PMID: 38634895 DOI: 10.1007/s00405-024-08606-z] [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: 10/20/2023] [Accepted: 02/29/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND Sinonasal Mucosal Melanoma (SNMM) is a rare but aggressive disease. Surgery with free margins, when feasible, is the treatment of choice. In the last three decades, electrochemotherapy (ECT) has emerged as a local ablative procedure, performed with the Cliniporator, for cutaneous and mucosal tumours of different histology. We present a case report of an ECT treatment performed by means of a new endoscopic electrode, on an elderly patient affected by primary SNMM. METHODS An 88-year-old man with a diagnosis of SNMM (cT4aN0M0)-Stage IV, of the left nasal fossa presented at our institution. Symptoms were epistaxis and complete left nasal obstruction. He refused sinonasal extended surgery and radiotherapy. He underwent a tumor debulking followed by ECT exclusively for symptom control, with palliative intent. RESULTS The patient underwent SNMM debulking under general anaesthesia, followed by ECT on tumour margins. After the procedure, he had been free from symptoms for 5 months, with a good quality of life. Local recurrence was controlled with a new local debulking and ECT procedure on margins. The patient remained symptom free for the next 4 months. Seventeen months after diagnosis, the patient is mild symptomatic for sinonasal disease. Therefore, he developed a systemic disease progression. CONCLUSIONS In our experience, ECT can be used as an adjuvant tool for symptom and local control in SNMM when extended surgery is out of curative intent or unfeasible. As expected, ECT does not appear to have any effect on systemic disease progression.
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Affiliation(s)
- Silvia Carpenè
- Otolaryngology Unit, Azienda Unità Sanitaria Locale Socio Sanitaria (AULSS) 3 Serenissima - Ospedale di Mirano, Venice, Italy
| | - Barbara Silvestri
- Oncology and Haematology Unit, Azienda Unità Sanitaria Locale Socio Sanitaria (AULSS) 3 Serenissima - Ospedale di Mirano, Venice, Italy.
| | - Martina Bertinazzi
- Otolaryngology Unit, Azienda Unità Sanitaria Locale Socio Sanitaria (AULSS) 3 Serenissima - Ospedale di Mirano, Venice, Italy
| | - Enrico Armato
- Otolaryngology Unit, Azienda Unità Sanitaria Locale Socio Sanitaria (AULSS) 3 Serenissima - Ospedale di Mirano, Venice, Italy
| | - Maurizio Amadori
- Otolaryngology Unit, Azienda Unità Sanitaria Locale Socio Sanitaria (AULSS) 3 Serenissima - Ospedale di Mirano, Venice, Italy
| | - Roberto Spinato
- Otolaryngology Unit, Azienda Unità Sanitaria Locale Socio Sanitaria (AULSS) 3 Serenissima - Ospedale di Mestre, Venice, Italy
| | | | - Giuseppe Azzarello
- Oncology and Haematology Unit, Azienda Unità Sanitaria Locale Socio Sanitaria (AULSS) 3 Serenissima - Ospedale di Mirano, Venice, Italy
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Calamelli S, Noto S, Baldoni A, Casarin A, Calzavara A, Bolgan I, Coccato S, Saccà S, Laurino L, Azzarello G, Ausoni S. Cardiac wasting in head and neck cancer and in cardiac autopsies from different cancer types: A study in a chemo-naïve setting. J Cachexia Sarcopenia Muscle 2023. [PMID: 36999538 DOI: 10.1002/jcsm.13217] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 02/15/2023] [Accepted: 02/16/2023] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND Cardiac wasting is a detrimental consequence of cancer that has been traditionally ignored and often misinterpreted as an iatrogenic effect. METHODS We conducted a retrospective study on 42 chemo-naive patients affected by locally advanced head and neck cancer (HNC). Based on unintentional weight loss, patients were divided into cachectic and non-cachectic. Left ventricular mass (LVM), LV wall thickness (LVWT), interventricular septal (IVS) thickness, left ventricular internal diameter diastolic (LVIDd), left ventricular internal diameter systolic (LVIDs), internal ventricular septum diastolic (IVSd), left ventricular posterior wall thickness diastolic (LVPWd) and LV ejection fraction (LVEF) were analysed by echocardiography. In parallel, we retrospectively analysed 28 cardiac autoptic specimens of patients who either died of cancer before chemotherapy or with a diagnosis of cancer at autopsy. Presence or absence of myocardial fibrosis at microscopic observation was used for sample stratification. Conventional histology was performed. RESULTS Cachectic and non-cachectic patients had a significantly different value of LVWT and IVS thickness and LVPWd. LVWT was 9.08 ± 1.57 versus 10.35 ± 1.41 mm (P = 0.011) in cachectic and non-cachectic patients, IVS was 10.00 mm (8.50-11.00) versus 11.00 mm (10.00-12.00) (P = 0.035), and LVPWd was 9.0 (8.5-10.0) and 10.00 mm (9.5-11.0) (P = 0.019) in cachectic and non-cachectic patients. LVM adjusted for body surface area or height squared did not differ between the two populations. Similarly, LVEF did not show any significant decline. At multivariate logistic regression analysis for some independent predictors of weight loss, only LVWT maintained significant difference between cachectic and non-cachectic patients (P = 0.035, OR = 0.240; P = 0.019). The secondary analysis on autoptic specimens showed no significant change in heart weight, whereas LVWT declined from 9.50 (7.25-11.00) to 7.50 mm (6.00-9.00) in cardiac specimens with myocardial fibrosis (P = 0.043). These data were confirmed in multivariate logistic regression analysis (P = 0.041, OR = 0.502). Histopathological analysis confirmed severe atrophy of cardiomyocytes, fibrosis and oedema as compared with controls. CONCLUSIONS Subtle changes in heart structure and function occur early in HNC patients. These can be detected with routine echocardiography and may help to select appropriate cancer treatment regimens for these patients. Histopathological analysis provided conclusive evidence that atrophy of cardiomyocytes, oedema and fibrosis occur during cancer progression and may precede the onset of overt cardiac pathology. To our knowledge, this is the first clinical study that establishes a direct relationship between tumour progression and cardiac remodelling in HNCs and the first pathological study conducted on human cardiac autopsies from selected chemo-naïve cancer patients.
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Affiliation(s)
- Sara Calamelli
- Department of Cardiology, Local Health Unit 3 Serenissima, Mirano, Venice, Italy
| | - Samantha Noto
- Department of Pathology, Local Health Unit 3 Serenissima, Mestre, Venice, Italy
| | - Alessandra Baldoni
- Department of Oncology, Local Health Unit 3 Serenissima, Mirano, Venice, Italy
| | - Alessandra Casarin
- Department of Oncology, Local Health Unit 3 Serenissima, Mirano, Venice, Italy
| | - Alessandro Calzavara
- Department of Information Systems, Local Health Unit 3 Serenissima, Dolo, Venice, Italy
| | - Irene Bolgan
- Department of Information Systems, Local Health Unit 3 Serenissima, Dolo, Venice, Italy
| | - Silvia Coccato
- Department of Oncology, Local Health Unit 3 Serenissima, Mirano, Venice, Italy
| | - Salvatore Saccà
- Department of Cardiology, Local Health Unit 3 Serenissima, Mirano, Venice, Italy
| | - Licia Laurino
- Department of Pathology, Local Health Unit 3 Serenissima, Mestre, Venice, Italy
| | - Giuseppe Azzarello
- Department of Oncology, Local Health Unit 3 Serenissima, Mirano, Venice, Italy
| | - Simonetta Ausoni
- Department of Biomedical Science, University of Padova, Padova, Italy
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Maddalena G, Prete A, Buggin F, Zustovich F, Cadau J, Azzarello G, Procaccio L, Soldà C, Rizzato MD, Rasola C, Galante C, Bergo E, Montelatici S, Longobardi C, Boscolo G, Graziani F, Boni L, Lonardi S, Zagonel V, Bergamo F. Prognostic value of baseline G8 geriatric assessment in a real-life population of elderly metastatic colorectal cancer patients: The Gold Study. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e24015] [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
e24015 Background: Colorectal cancer (CRC) is the second most frequent malignancy in patients (pts) aged 70. Elderly patients are often excluded by clinical trials; however, improvements in quality of life and comorbidities management led to expand the access to anticancer treatments irrespectively of age per se. Finding new tools to stratify vulnerability in elderly pts is crucial to guide clinicians in therapeutic decisions. G8 and timed up and go test (TUG) have been related to prognosis and functional decline in patients affected by several solid tumors. However, no studies focused on TUG and G8 prognostic value in CRC pts are available. In this study, we assessed the prognostic value of G8 and TUG in a cohort of real-life elderly pts with metastatic CRC (mCRC). Methods: GOLD was a multicentre, observational, prospective study in which pts aged 70 with mCRC and eligible to 1st line therapy were enrolled. G8 and TUG were performed at screening and at the first documented disease progression (PD). G8 cutoff was 14, as reported in literature; TUG8,5 sec (cutoff set with ROC curve using MedCalc software v 20.027). PFS and OS were described with Kaplan-Meyer curve. All analyzed variables were then compared with multivariate models. Primary endpoint of the study was to assess prognostic value of G8 in OS and PFS. Secondary endpoints were to assess prognostic value of TUG in OS and PFS. Results: Since Oct 2017 to Apr 2019, 109 pts were evaluated in 4 different Oncology Units in Veneto (IT); 4 were not eligible to anticancer treatments and where thus excluded. 105 pts were finally enrolled. Clinical, histological and molecular characteristics were well balanced between pts with G814 vs > 14, with the exception of RASmut, more represented in the G8 > 14 group (p = 0,0195). 39 (37%) pts were aged80; 46 (44%) had ECOG PS1; 55 (53%) had RASmut; 15 (15%) had BRAFmut. 81 (77%) had G814; 78 (75%) had TUG8,5. At a median follow up time of 41,2 months, median OS was 19,41 months (95%CI 15,46-23,19) and median PFS 8,78 months (95% CI 7,53-10,07). OS was longer in patients with G814 (HR 0,61; 95%CI 0,39-0,97; p= 0,0584) and TUG8,5 (HR 0,55; 95%CI 0,35- 0,86; p= 0,0201). PFS was not influenced by G8 (HR 0,86; 95%CI 0,55-1,34; p= 0,5125) nor by TUG (HR 0,71; 95%CI 0,47-1,08). G814 and TUG8,5 conferred better OS also in the subgroup of RASmut (respectively p= 0,0133 and p= 0,0088). Worse OS was observed in presence of > 1 metastatic site (HR = 1,71; 95%CI 1,11 to 2,64; p= 0,0161). At the multivariate analysis, G814 ( p= 0,0202) and single metastatic site ( p= 0,0200) were related to better OS; none of the analysed variables had effect on PFS. Conclusions: In our study G814 and TUG8,5 had prognostic value in OS, but not in PFS, in a real-life population of elderly pts affected by mCRC. G8 and single metastatic site involvement were related to better OS, irrespectively of other clinical, histological and molecular variables.
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Affiliation(s)
- Giulia Maddalena
- Medical Oncology 1, Veneto Institute of Oncology IOV–IRCCS, Padua, Italy
| | - Alessandra Prete
- Medical Oncology 1, Veneto Institute of Oncology IOV–IRCCS, Padua, Italy
| | - Federica Buggin
- Medical Oncology 1, Veneto Institute of Oncology IOV–IRCCS, Padua, Italy
| | - Fable Zustovich
- UOC Oncologia di Belluno, Dipartimento di Oncologia Clinica, AULSS 1 Dolomiti, Ospedale S. Martino,, Belluno, Italy
| | - Jessica Cadau
- Department of Oncology, San Bortolo General Hospital, Azienda ULSS8 Berica, Vicenza, Italy, Vicenza, Italy
| | - Giuseppe Azzarello
- Oncology and Hemato-Oncology UOC - AULSS 3 Serenissima - Mirano (Venice), Venice, Italy
| | - Letizia Procaccio
- Medical Oncology 1, Veneto Institute of Oncology IOV–IRCCS, Padua, Italy
| | - Caterina Soldà
- Medical Oncology 1, Veneto Institute of Oncology IOV–IRCCS, Padua, Italy
| | | | - Cosimo Rasola
- Medical Oncology 1, Veneto Institute of Oncology IOV–IRCCS, Padua, Italy
| | - Claudia Galante
- Medical Oncology 1, Veneto Institute of Oncology IOV–IRCCS, Padua, Italy
| | - Eleonora Bergo
- Medical Oncology 1, Veneto Institute of Oncology IOV–IRCCS, Padua, Italy
| | - Silvia Montelatici
- UOC Oncologia di Belluno, Dipartimento di Oncologia Clinica, AULSS 1 Dolomiti, Ospedale S. Martino,, Belluno, Italy
| | - Ciro Longobardi
- UOC Oncologia di Belluno, Dipartimento di Oncologia Clinica, AULSS 1 Dolomiti, Ospedale S. Martino,, Belluno, Italy
| | - Giorgia Boscolo
- Oncology and Hemato-Oncology UOC - AULSS 3 Serenissima - Mirano (Venice), Venice, Italy
| | - Filomena Graziani
- Department of Oncology, San Bortolo General Hospital, Azienda ULSS8 Berica, Vicenza, Italy, Vicenza, Italy
| | - Luca Boni
- Clinical Epidemiology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Sara Lonardi
- Veneto Institute of Oncology, IRCCS, Padua, Italy
| | - Vittorina Zagonel
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Francesca Bergamo
- Medical Oncology 1, Veneto Institute of Oncology IOV–IRCCS, Padua, Italy
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Dieci MV, Azzarello G, Zagonel V, Bassan F, Gori S, Aprile G, Chiarion-Sileni V, Lonardi S, Oliani C, Zaninelli M, Chiari R, Favaretto A, Pavan A, Di Liso E, Mioranza E, Baldoni A, Bergamo F, Maruzzo M, Ziampiri S, Inno A, Graziani F, Sinigaglia G, Celestino M, Conte P, Guarneri V. Clinical profile and mortality of Sars-Cov-2 infection in cancer patients across two pandemic time periods (Feb 2020-Sep 2020; Sep2020- May 2021) in the Veneto Oncology Network: the ROVID study. Eur J Cancer 2022; 167:81-91. [PMID: 35398759 PMCID: PMC8930432 DOI: 10.1016/j.ejca.2022.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 03/03/2022] [Accepted: 03/07/2022] [Indexed: 11/26/2022]
Abstract
Introduction We analyzed a cohort of patients with cancer and Sars-Cov-2 infection from the Veneto Oncology Network registry across two pandemic time periods. Materials and methods 761 patients with cancer and SARS-CoV-2 infection were included. Results 198 patients were diagnosed during the first pandemic time period (TP1; February 2020 September 2020), 494 during TP2 before the vaccination campaign (TP2/pre-vaccination; September 2020-21 February 2021) and 69 in TP2/post-vaccination (22 February 2021-15 May 2021). TP2 vs TP1 patients were younger (p = 0.004), showed more frequently a good performance status (p < 0.001) and <2 comorbidities (p = 0.002), were more likely to be on active anticancer therapy (p = 0.006). Significantly fewer patients in TP2 (3-4%) vs TP1 (22%) had an in-hospital potential source of infection (p < 0.001). TP2 patients were more frequently asymptomatic (p = 0.003). Significantly fewer patients from TP2 were hospitalized (p < 0.001) or admitted to intensive care unit (p = 0.006). All-cause mortality decreased from 30.3% in TP1, to 8.9% and 8.7% in the two TP2 periods (p < 0.001), reflected by a significant reduction in Sars-Cov-2-related mortality (15.2%, 7.5% and 5.8% in the three consecutive time periods, p = 0.004). Conclusions Differences in clinical characteristics and features of Sars-Cov-2 infection between TP1 and TP2 reflect the effects of protective measures and increased testing capacity. The lower mortality in TP2 is in line with a less frail population. However, the vast majority of death events in TP2 were related to COVID-19, reinforcing the priority to protect cancer patients.
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Guarneri V, Caccese M, Azzarello G, Bassan F, Chiarion-Sileni V, Chiari R, Favaretto AG, Zaninelli M, Pavan A, Zagonel V, Pastorelli D, Roma A, Oliani C, FUMAGALLI ARIANNA, Bernardi D, Gori S, Celestino M, Dieci MV, Conte P. Epidemiology and clinical course of SARS-CoV-2 infection in cancer patients in the Veneto Oncology Network during the first and second pandemic waves. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.6511] [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
6511 Background: Since the beginning of the COVID-19 outbreak, the Veneto Oncology Network ROV licensed dedicated guidelines for cancer patients care during the pandemic, and developed a regional registry (ROVID) aimed at describing epidemiology and clinical course of SARS-CoV-2 infection in cancer patients. Preliminary data on 170 patients mainly diagnosed during the first pandemic wave have been published (Guarneri V, Eur J Cancer 2021). Here we report the data of additional 270 patients, comparing clinical data and outcomes between first (W1) and second (W2) pandemic waves. Methods: All patients with cancer diagnosis and documented SARS-CoV-2 infection are eligible. Data on diagnosis, comorbidities, anticancer treatments, details on SARS-CoV-infection including source of contagion, clinical presentation, hospitalization, treatments and fate of the infection are recorded. Results: 440 patients have been enrolled, 196 diagnosed during W1 (until September 2020) and 244 during W2. The most common cancer type was breast cancer (n = 116). Significant differences in clinical characteristics between W1 and W2 were the followings: ECOG PS 0 (34% vs 58%), presence of cardiac comorbidities (30% vs 13%), presence of any co-morbidities (81% vs 62%), smoking habits (23% vs 13%). Patients diagnosed in W1 were less likely on active anticancer therapy (54% vs 73%) at the time of SARS-CoV-2 infection. Distribution per stage, presence of lung metastases, disease setting (curative vs palliative), active treatment discontinuation due to infection were similar between W1 and W2. Patients diagnosed in W1 were more likely symptomatic for SARS-CoV-2 infection (80% vs 67%), and reported more frequently an in-hospital contact as potential source of infection (44% vs 9%). Significantly more patients diagnosed in W1 were hospitalized (76% vs 25%). All-cause mortality rates were 30.6% for patients diagnosed in W1 vs 12% for patients diagnosed in W2 (p < 0.001). However, deaths due to SARS-CoV-2 infection were more frequent in patients diagnosed in W2 (86% vs 54%, odds ratio 3.22; 95% CI 1.97-5.279). Conclusions: Differences in clinical characteristics between W1 and W2 reflect different pattern of virus circulation. The dramatic reduction of in-hospital contact as a source of infection reflects the efforts put in place to protect this vulnerable population from in-hospital exposure. The lower all-cause mortality rate observed in W2 is in line with the observed less frail population. However, the higher relative risk of death due to SARS-CoV-2 infection observed in W2 reinforces the need to adopt protective measures including vaccination in cancer patients, irrespectively of age, stage, and comorbidities.
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Affiliation(s)
- Valentina Guarneri
- Department of Surgery, Oncology and Gastroenterology, University of Padua, and Division of Medical Oncology 2, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Mario Caccese
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Giuseppe Azzarello
- Department of Oncology AULSS 3 Serenissima Mirano (Venice) Italy, Mirano (Venice), Italy
| | - Franco Bassan
- AULSS 7 Pedemontana, Santorso Hospital and Bassano Hospital, Vicenza, Italy
| | - Vanna Chiarion-Sileni
- Head of Melanoma Cancer Unit, Melanoma Oncology Unit, Veneto Institute of Oncology IOV–IRCCS, Padua, Italy
| | - Rita Chiari
- Medical Oncology, AULSS 6 Euganea, South Padova Hospital, Monselice (PD), Italy., Monselice, Italy
| | - Adolfo G. Favaretto
- Department of Medical Oncology, AULSS 2 Marca Trevigiana, Ca'Foncello Hospital, Treviso, Italy
| | - Marta Zaninelli
- Medical Oncology, AULSS 9 Scaligera, Villafranca Hospital, Villafranca (VR), Villafranca (VR), Italy
| | - Alberto Pavan
- Medical Oncology Department, Ulss 3 Serenissima,Sant’Angelo General Hospital, Mestre and SS Giovanni e Paolo General Hospital, Venezia, Italy
| | - Vittorina Zagonel
- Medical Oncology Unit 1, Department of Oncology, Istituto Oncologico Veneto IOV IRCCS, Padua, Italy
| | - Davide Pastorelli
- Department of Oncology, Santa Maria del Prato Hospital ULSS 1 Dolomiti, Feltre, Italy
| | - Anna Roma
- U.O. Oncologia Medica 3, Istituto Oncologico Veneto-IRCCS, Padua, Italy
| | - Cristina Oliani
- Medical Oncology, AULSS 5 Polesana, Santa Maria della Misericordia Hospital, Rovigo, Italy
| | - ARIANNA FUMAGALLI
- Section of Oncology, Department of Medicine, University and Hospital Trust, Verona, Italy
| | - Daniele Bernardi
- 19 Oncology Unit, AULSS 4 Veneto Orientale, San Donà Di Piave, Italy
| | - Stefania Gori
- Oncology Unit, Ospedale Sacro Cuore-don Calabria, Negrar, Italy
| | | | - Maria Vittoria Dieci
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padua, Italy
| | - Pierfranco Conte
- Department of Surgery, Oncology and Gastroenterology, University of Padua and Oncology Unit 2, Veneto Institute of Oncology IOV – IRCCS, Padua, Italy
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Guarneri V, Bassan F, Zagonel V, Milella M, Zaninelli M, Cattelan AM, Vianello A, Gori S, Aprile G, Azzarello G, Chiari R, Favaretto A, Oliani C, Scola A, Pastorelli D, Mandarà M, Zustovich F, Bernardi D, Chiarion-Sileni V, Morandi P, Toso S, Di Liso E, Ziampiri S, Caccese M, Zampiva I, Puccetti O, Celestino M, Dieci MV, Conte P. Epidemiology and clinical course of severe acute respiratory syndrome coronavirus 2 infection in cancer patients in the Veneto Oncology Network: The Rete Oncologica Veneta covID19 study. Eur J Cancer 2021; 147:120-127. [PMID: 33647547 PMCID: PMC7857033 DOI: 10.1016/j.ejca.2021.01.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 12/04/2020] [Revised: 12/28/2020] [Accepted: 01/05/2021] [Indexed: 11/03/2022]
Abstract
Introduction Coronavirus disease 2019 (COVID-19) pandemic started in Italy with clusters identified in Northern Italy. The Veneto Oncology Network (Rete Oncologica Veneta) licenced dedicated guidelines to ensure proper care minimising the risk of infection in patients with cancer. Rete Oncologica Veneta covID19 (ROVID) is a regional registry aimed at describing epidemiology and clinical course of Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in patients with cancer. Materials and methods Patients with cancer diagnosis and documented SARS-CoV-2 infection are eligible. Data on cancer diagnosis, comorbidities, anticancer treatments, as well as details on SARS-CoV-2 infection (hospitalisation, treatments, fate of the infection), have been recorded. Logistic regression analysis was applied to calculate the association between clinical/laboratory variables and death from any cause. Results One hundred seventy patients have been enrolled. The median age at time of the SARS-CoV infection was 70 years (25–92). The most common cancer type was breast cancer (n = 40). The majority of the patients had stage IV disease. Half of the patients had two or more comorbidities. The majority of the patients (78%) presented with COVID-19 symptoms. More than 77% of the patients were hospitalized and 6% were admitted to intensive care units. Overall, 104 patients have documented resolution of the infection. Fifty-seven patients (33%) have died. In 29 cases (17%), the cause of death was directly correlated to SARS-CoV-2 infection. Factors significantly correlated with the risk of death were the following: Eastern Cooperative Oncology Group performance status (PS), age, presence of two or more comorbidities, presence of dyspnoea, COVID-19 phenotype ≥ 3, hospitalisation, intensive care unit admission, neutrophil/lymphocyte ratio and thrombocytopenia. Conclusions The mortality rate reported in this confirms the frailty of this population. These data reinforce the need to protect patients with cancer from SARS-CoV-2 infection.
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Affiliation(s)
- Valentina Guarneri
- Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova, Italy; Department of Surgery, Oncology and Gastroenterology, University of Padova, Italy
| | - Franco Bassan
- Medical Oncology, AULSS 7 Pedemontana, Santorso Hospital and Bassano Hospital, Vicenza, Italy
| | | | - Michele Milella
- Section of Oncology, Department of Medicine, University and Hospital Trust, Verona, Italy
| | - Marta Zaninelli
- Medical Oncology, AULSS 9 Scaligera, Villafranca Hospital, Villafranca (VR), Italy
| | - Anna Maria Cattelan
- Infectious and Tropical Diseases Division, University Hospital, Padova, Italy
| | - Andrea Vianello
- Department of Cardiological, Thoracic and Vascular Sciences, Respiratory Pathophysiology Unit, University of Padova, Italy
| | - Stefania Gori
- Medical Oncology, IRCCS Ospedale Don Calabria-Sacro Cuore di Negrar, Verona, Italy
| | - Giuseppe Aprile
- Department of Oncology, San Bortolo General Hospital, AULSS 8 Berica, Vicenza, Italy
| | - Giuseppe Azzarello
- Department of Medical Oncology, AULSS 3 Serenissima, Mirano Hospital, Mirano, (VE), Italy
| | - Rita Chiari
- Medical Oncology, AULSS 6 Euganea, South Padova Hospital, Monselice, (PD), Italy
| | - Adolfo Favaretto
- Department of Medical Oncology, AULSS 2 Marca Trevigiana, Ca'Foncello Hospital, Treviso, Italy
| | - Cristina Oliani
- Medical Oncology, AULSS 5 Polesana, Santa Maria Della Misericordia Hospital, Rovigo, Italy
| | - Annamaria Scola
- Onco-hematology, AULSS 3 Serenissima, Chioggia Hospital, Chioggia, (VE), Italy
| | - Davide Pastorelli
- Department of Oncology, AULSS 1 Dolomiti, S. Maria Del Prato Hospital, Feltre, (BL), Italy
| | - Marta Mandarà
- Unit of Oncology, San Bonifacio Hospital-ULSS 9 Scaligera, Verona, Italy
| | - Fable Zustovich
- Clinical Oncology Department, AULSS 1 Dolomiti, San Martino Hospital, Belluno, Italy
| | | | | | - Paolo Morandi
- Medical Oncology Department, Ulss 3 Serenissima,Sant'Angelo General Hospital, Mestre and SS Giovanni e Paolo General Hospital, Venezia, Italy
| | - Silvia Toso
- Medical Oncology, AULSS 5 Polesana, Adria Hospital, Adria, Italy
| | | | - Stamatia Ziampiri
- Medical Oncology, AULSS 7 Pedemontana, Santorso Hospital and Bassano Hospital, Vicenza, Italy
| | - Mario Caccese
- Medical Oncology 1, Istituto Oncologico Veneto IRCCS, Padova, Italy
| | - Ilaria Zampiva
- Section of Oncology, Department of Medicine, University and Hospital Trust, Verona, Italy
| | - Oliviero Puccetti
- Medical Oncology, AULSS 7 Pedemontana, Santorso Hospital and Bassano Hospital, Vicenza, Italy
| | | | - Maria Vittoria Dieci
- Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova, Italy; Department of Surgery, Oncology and Gastroenterology, University of Padova, Italy
| | - PierFranco Conte
- Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova, Italy; Department of Surgery, Oncology and Gastroenterology, University of Padova, Italy.
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Abstract
Since it came into being as a discipline, cardio-oncology has focused on the prevention and treatment of cardiotoxicity induced by antitumor chemotherapy and radiotherapy. Over time, it has been proved that even more detrimental is the direct effect generated by cancer cells that release pro-cachectic factors in the bloodstream. Secreted molecules target different organs at a distance, including the heart. Inflammatory and neuronal modulators released by the tumor bulk, either as free molecules or through exosomes, contribute to the pathogenesis of cardiac disease. Progressive cancer causes cachexia and severe cardiac muscle wasting accompanied by cardiomyocyte atrophy, tissue fibrosis, and several functional impairments up to heart failure. The molecular mechanisms responsible for such a cardiac muscle wasting have been partially elucidated in animal models, but minimally investigated in humans, although severe cardiac dysfunction exacerbates global cachexia and hampers efficient anti-cancer treatments. This review provides an overview of cancer-induced structural cardiac and functional damage, drawing on both clinical and scientific research. We start by looking at the pathophysiological mechanisms and evolving epidemiology and go on to discuss prevention, diagnosis, and a multimodal policy of intervention aimed at providing overall prognosis and global care for patients. Despite much interest in the cardiotoxicity of cancer therapies, the direct tumor effect on the heart remains poorly explored. There is still a lack of diagnostic criteria for the identification of the early stages of cardiac disease in cancer patients, while the possibilities that there are for effective prevention are largely underestimated. Research on innovative therapies has claimed considerable advances in preclinical studies, but none of the molecular targets suitable for clinical application has been approved for therapy. These issues are critically discussed here.
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Affiliation(s)
- Simonetta Ausoni
- Department of Biomedical Sciences, University of Padua, Padova, Italy.
| | - Sara Calamelli
- Department of Cardiology, Local Health Unit 3 Serenissima, Mirano Hospital, Mirano, Venice, Italy
| | - Salvatore Saccà
- Department of Cardiology, Local Health Unit 3 Serenissima, Mirano Hospital, Mirano, Venice, Italy
| | - Giuseppe Azzarello
- Department of Medical Oncology, Local Health Unit 3 Serenissima, Mirano Hospital, Mirano, Venice, Italy.
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Ausoni S, Azzarello G. Development of Cancer in Patients With Heart Failure: How Systemic Inflammation Can Lay the Groundwork. Front Cardiovasc Med 2020; 7:598384. [PMID: 33195486 PMCID: PMC7649135 DOI: 10.3389/fcvm.2020.598384] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 09/30/2020] [Indexed: 12/15/2022] Open
Abstract
In the last decade, cardiologists and oncologists have provided clinical and experimental evidence that cancer, and not only chemotherapeutic agents, can cause detrimental effects on heart structure and function, a consequence that has serious clinical implications for patient management. In parallel, the intriguing idea that heart failure (HF) may be an oncogenic condition has also received growing attention. A number of epidemiological and clinical studies have reported that patients with HF have a higher risk of developing cancer. Chronic low-grade systemic inflammation has been proposed as a major pathophysiological process linking the failing heart to the multi-step process of carcinogenesis. According to this view, pro-inflammatory mediators secreted by the damaged heart generate a favorable milieu that promotes tumor development and accelerates malignant transformation. HF-associated inflammation synergizes with tumor-associated inflammation, so that over time it is no longer possible to distinguish the effects of one or the other. Experimental studies have just begun to search for the molecular effectors of this process, with the ultimate goal that of identifying mechanisms suitable for anti-cancer target therapy to reduce the risk of incident cancer in patients already affected by HF. In this review we critically discuss strengths and limitations of clinical and experimental studies that support a causal relationship between HF and cancer, and focus on HF-associated inflammation, cardiokines and their endocrine functions linking one and the other disease.
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Affiliation(s)
- Simonetta Ausoni
- Department of Biomedical Sciences, University of Padua, Padua, Italy
| | - Giuseppe Azzarello
- Local Health Unit 3 Serenissima, Department of Medical Oncology, Mirano Hospital, Venice, Italy
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9
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Pantano F, Manca P, Armento G, Zeppola T, Onorato A, Iuliani M, Simonetti S, Vincenzi B, Santini D, Mercadante S, Marchetti P, Cuomo A, Caraceni A, Mediati RD, Vellucci R, Mammucari M, Natoli S, Lazzari M, Dauri M, Adile C, Airoldi M, Azzarello G, Blasi L, Chiurazzi B, Degiovanni D, Fusco F, Guardamagna V, Liguori S, Palermo L, Mameli S, Masedu F, Mazzei T, Melotti RM, Menardo V, Miotti D, Moroso S, Pascoletti G, De Santis S, Orsetti R, Papa A, Ricci S, Scelzi E, Sofia M, Aielli F, Valle A, Tonini G. Breakthrough Cancer Pain Clinical Features and Differential Opioids Response: A Machine Learning Approach in Patients With Cancer From the IOPS-MS Study. JCO Precis Oncol 2020; 4:2000158. [PMID: 33283139 PMCID: PMC7713587 DOI: 10.1200/po.20.00158] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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] [Accepted: 10/02/2020] [Indexed: 11/20/2022] Open
Abstract
PURPOSE A large proportion of patients with cancer suffer from breakthrough cancer pain (BTcP). Several unmet clinical needs concerning BTcP treatment, such as optimal opioid dosages, are being investigated. In this analysis the hypothesis, we explore with an unsupervised learning algorithm whether distinct subtypes of BTcP exist and whether they can provide new insights into clinical practice. METHODS Partitioning around a k-medoids algorithm on a large data set of patients with BTcP, previously collected by the Italian Oncologic Pain Survey group, was used to identify possible subgroups of BTcP. Resulting clusters were analyzed in terms of BTcP therapy satisfaction, clinical features, and use of basal pain and rapid-onset opioids. Opioid dosages were converted to a unique scale and the BTcP opioids-to-basal pain opioids ratio was calculated for each patient. We used polynomial logistic regression to catch nonlinear relationships between therapy satisfaction and opioid use. RESULTS Our algorithm identified 12 distinct BTcP clusters. Optimal BTcP opioids-to-basal pain opioids ratios differed across the clusters, ranging from 15% to 50%. The majority of clusters were linked to a peculiar association of certain drugs with therapy satisfaction or dissatisfaction. A free online tool was created for new patients’ cluster computation to validate these clusters in future studies and provide handy indications for personalized BTcP therapy. CONCLUSION This work proposes a classification for BTcP and identifies subgroups of patients with unique efficacy of different pain medications. This work supports the theory that the optimal dose of BTcP opioids depends on the dose of basal opioids and identifies novel values that are possibly useful for future trials. These results will allow us to target BTcP therapy on the basis of patient characteristics and to define a precision medicine strategy also for supportive care.
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Affiliation(s)
- Francesco Pantano
- Medical Oncology Department, Campus Bio-Medico University of Rome, Rome, Italy
| | - Paolo Manca
- Medical Oncology Department, Campus Bio-Medico University of Rome, Rome, Italy.,IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Grazia Armento
- Medical Oncology Department, Campus Bio-Medico University of Rome, Rome, Italy
| | - Tea Zeppola
- Medical Oncology Department, Campus Bio-Medico University of Rome, Rome, Italy
| | - Angelo Onorato
- Medical Oncology Department, Campus Bio-Medico University of Rome, Rome, Italy
| | - Michele Iuliani
- Medical Oncology Department, Campus Bio-Medico University of Rome, Rome, Italy
| | - Sonia Simonetti
- Medical Oncology Department, Campus Bio-Medico University of Rome, Rome, Italy
| | - Bruno Vincenzi
- Medical Oncology Department, Campus Bio-Medico University of Rome, Rome, Italy
| | - Daniele Santini
- Medical Oncology Department, Campus Bio-Medico University of Rome, Rome, Italy
| | - Sebastiano Mercadante
- Anesthesia and Intensive Care and Pain Relief and Supportive Care, La Maddalena, Palermo, Italy
| | - Paolo Marchetti
- Molecular and Clinical Medicine Medical Oncology, La Sapienza University of Rome, Rome, Italy
| | - Arturo Cuomo
- Anesthesiology, Resuscitation, and Pain Therapy Department, National Cancer Institute, IRCCS Foundation Pascale, Naples, Italy
| | - Augusto Caraceni
- Palliative Care, Pain Therapy, and Rehabilitation, National Cancer Institute, IRCCS Foundation, Milan, Italy
| | | | - Renato Vellucci
- Palliative Care and Pain Therapy Unit, Careggi Hospital, Florence, Italy
| | | | - Silvia Natoli
- Department of Clinical Science and Translational Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Marzia Lazzari
- Department of Clinical Science and Translational Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Mario Dauri
- Department of Clinical Science and Translational Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Claudio Adile
- Anesthesia and Intensive Care and Pain Relief and Supportive Care, La Maddalena, Palermo, Italy
| | - Mario Airoldi
- Second Medical Oncology Division, Città della Salute e della Scienza Hospital of Turin, Turin, Italy
| | - Giuseppe Azzarello
- Medical Specialties Department, Oncology and Oncologic Hematology, ASL 13 Mirano, Venice, Italy
| | - Livio Blasi
- Medical Oncology Unit, ARNAS Ospedale Civico Di Cristina Benfratelli, Palermo, Italy
| | | | | | - Flavio Fusco
- Palliative Care Unit, Department of Primary and Community Care, ASL 3 Genovese, Genoa, Italy
| | - Vittorio Guardamagna
- Palliative Care and Pain Therapy Unit, European Oncology Institute IRCCS, Milan, Italy
| | - Simeone Liguori
- Palliative Care and Pain Therapy Unit, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Loredana Palermo
- Medical Oncology Unit, National Cancer Research Center "Giovanni Paolo II", Bari, Italy
| | - Sergio Mameli
- Pain Therapy Unit, "A. Businco" Hospital, ASL 8, Cagliari, Italy
| | - Francesco Masedu
- Department of Biotechnological and Applied Clinical Sciences, Section of Clinical Epidemiology and Environmental Medicine, University of L'Aquila, L'Aquila, Italy
| | - Teresita Mazzei
- Section of Clinical Pharmacology and Oncology, Department of Health Sciences, University of Florence, Florence, Italy
| | - Rita Maria Melotti
- Department of Medicine and Surgery Sciences, University of Bologna, Bologna, Italy
| | | | - Danilo Miotti
- Pain Therapy ICS Maugeri, IRCCS Foundation, Pavia, Italy
| | - Stefano Moroso
- Medical Oncology, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
| | - Gaetano Pascoletti
- Medical Oncology, Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | - Stefano De Santis
- Palliative Care and Oncologic Pain Service, S. Camillo-Forlanini Hospital, Rome, Italy
| | - Remo Orsetti
- Pain Medicine Unit, S. Camillo-Forlanini Hospital, Rome, Italy
| | - Alfonso Papa
- Pain Relief, A.O. Dei Colli, Monaldi Hospital, Naples, Italy
| | - Sergio Ricci
- Division of Medical Oncology, Department of Oncology, S. Chiara University Hospital, Pisa, Italy
| | - Elvira Scelzi
- Medical Oncology, Castelfranco Veneto Hospital, Treviso, Italy
| | - Michele Sofia
- Department of Palliative Care, Hospice and Pain Therapy Unit, "G. Salvini" Hospital, Milan, Italy
| | - Federica Aielli
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | | | - Giuseppe Tonini
- Medical Oncology Department, Campus Bio-Medico University of Rome, Rome, Italy
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10
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Corli O, Iorno V, Legramandi L, Rulli E, Roberto A, Azzarello G, Schiavon S, Cavanna L, De Santis S, Cartoni C, Di Marco P, Dauri M, Mistretta R, Bortolussi R, Clerico M, Pacchioni M, Crispino C, Marabese M, Corsi N. Oral prolonged-release Oxycodone-Naloxone: analgesic response, safety profile, and factors influencing the response in advanced cancer patients. Pain Pract 2019; 19:633-643. [PMID: 30917409 DOI: 10.1111/papr.12784] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 03/19/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND Oxycodone-Naloxone (OXN) aims to reduce opioid-related constipation while being successfully analgesic. METHODS We evaluated the analgesic response, prevalence, and severity of side effects in 176 cancer patients with moderate to severe pain and treated with OXN. Patients were followed for 28 days and evaluated every seven. Pain intensity, changes of therapy, and adverse drug reactions were recorded at each visit. The primary efficacy endpoint was the proportion of responders (≥30% reduction of pain intensity from baseline to final) and final average pain score ≤4 on a 0-10 scale. RESULTS Average and worst pain intensity, and breakthrough pain (BTP) prevalence decreased over time and 81.3% of patients were responders. The starting daily dose of OXN was raised from 25.1±13.0 mg to 44.1±29.9 mg, and dose escalation >5%/day was observed in 19.4% of patients; 40.8-46.2% and 11.0-17.0% experienced any and severe grade of constipation during the follow-up visit, respectively. Digestive system tumor, thyroid endocrinopathies, psychological irritability, and BTP increased the risk of analgesic non-response. CONCLUSIONS OXN had strong analgesic effect in moderate to severe cancer pain patients: the safety profile is in line with the common adverse effects of opioids and severe constipation was uncommon. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Oscar Corli
- Pain and Palliative Care Research Unit, Oncology Department, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Vittorio Iorno
- Centre for Pain Medicine M. TIENGO, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Lorenzo Legramandi
- Methodology for Clinical Research Laboratory, Oncology Department, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Eliana Rulli
- Methodology for Clinical Research Laboratory, Oncology Department, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Anna Roberto
- Methodology for Clinical Research Laboratory, Oncology Department, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | | | - Stefania Schiavon
- Pain Therapy and Palliative Care Unit, Veneto Institute of Oncology IOV-IRCSS, Padua, Italy
| | - Luigi Cavanna
- Oncohematology Department, U.O. Oncology, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - Stefano De Santis
- Palliative Care and Oncologic Pain Service, S. Camillo-Forlanini Hospital, Rome, Italy
| | | | - Pierangelo Di Marco
- Department of Cardiovascular Surgery, Respiratory Medicine, Nephrology, Anesthesiology and Geriatrics, Faculty of Medicine and Dentistry, Sapienza University, Rome, Italy
| | - Mario Dauri
- Department of Anesthesia and Intensive Care, PTV (Tor Vergata Policlinic Foundation), Rome, Italy
| | | | - Roberto Bortolussi
- Palliative Care and Pain Therapy Unit, Aviano National Cancer Institute, Aviano, Italy
| | - Mario Clerico
- Department of Medical Oncology, Hospital of Biella, Biella, Italy
| | | | - Carlo Crispino
- UOSD Treatment of Lung Cancer Complications, AO Dei Colli Monaldi Cotugno CTO Ospedale Monaldi, Napoli, Italy
| | - Mirko Marabese
- Molecular Genetics Unit, Oncology Department, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Nicole Corsi
- Pain and Palliative Care Research Unit, Oncology Department, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
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11
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Bossi P, Depenni R, cossu rocca M, Ferrari D, Azzarello G, Alù M, Nolè F, Codecà C, Boscolo G, Piccininni M, Cavalieri S, Pugliese G, Licitra L. Clinical prognostic factors in patients (pts) with recurrent and/or metastatic (RM) head and neck carcinoma (HNC) treated with cetuximab plus chemotherapy. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy287.050] [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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12
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Ghi MG, Paccagnella A, Ferrari D, Foa P, Alterio D, Codecà C, Nolè F, Verri E, Orecchia R, Morelli F, Parisi S, Mastromauro C, Mione CA, Rossetto C, Polsinelli M, Koussis H, Loreggian L, Bonetti A, Campostrini F, Azzarello G, D'Ambrosio C, Bertoni F, Casanova C, Emiliani E, Guaraldi M, Bunkheila F, Bidoli P, Niespolo RM, Gava A, Massa E, Frattegiani A, Valduga F, Pieri G, Cipani T, Da Corte D, Chiappa F, Rulli E. Induction TPF followed by concomitant treatment versus concomitant treatment alone in locally advanced head and neck cancer. A phase II-III trial. Ann Oncol 2018; 28:2206-2212. [PMID: 28911070 DOI: 10.1093/annonc/mdx299] [Citation(s) in RCA: 101] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background Platinum-based chemoradiation (CCRT) is the standard treatment for Locally Advanced Head and Neck Squamous-Cell Carcinoma (LAHNSCC). Cetuximab/RT (CET/RT) is an alternative treatment option to CCRT. The efficacy of induction chemotherapy (IC) followed by chemoradiation compared to chemoradiation alone has not been demonstrated in randomized clinical trials. The goals of this phase II-III trial were to assess: (i) the overall survival (OS) of IC versus no-induction (no-IC) and (ii) the Grade 3-4 in-field mucosal toxicity of CCRT versus CET/RT. The present paper focuses on the analysis of efficacy. Materials and methods Patients with LAHNSCC were randomized to receive concomitant treatment alone [CCRT (Arm A1) or CET/RT (Arm A2)], or three cycles of induction docetaxel/cisplatin/5 fluorouracil (TPF) followed by CCRT (Arm B1) or followed by CET/RT (Arm B2). The superiority hypothesis of OS comparison of IC versus no-IC (Arms B1 + B2 versus A1 + A2) required 204 deaths to detect an absolute 3-year OS difference of 12% (HR 0.675, with 80% power at two-sided 5% significance level). Results 414 out of 421 patients were finally analyzed: 206 in the IC and 208 in the no-IC arm. Six patients were excluded because of major violation and one because of metastatic disease at diagnosis. With a median follow-up of 44.8 months, OS was significantly higher in the IC arm (HR 0.74; 95% CI 0.56-0.97; P = 0.031). Complete Responses (P = 0.0028), Progression Free Survival (P = 0.013) and the Loco-regional Control (P = 0.036) were also significantly higher in the IC arm. Compliance to concomitant treatments was not affected by induction TPF. Conclusions IC followed by concomitant treatment improved the outcome of patients with LAHNSCC without compromising compliance to the concomitant treatments. The degree of the benefit of IC could be different according to the type of the subsequent concomitant strategy. Clinical Trial Number NCT01086826, www.clinicaltrials.gov.
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Affiliation(s)
- M G Ghi
- Medical Oncology Department, Ospedale dell'Angelo, Venezia
| | - A Paccagnella
- Medical Oncology Department, Ospedale dell'Angelo, Venezia
| | - D Ferrari
- Medical Oncology Unit, Ospedale San Paolo, Milano
| | - P Foa
- Medical Oncology Unit, Ospedale San Paolo, Milano
| | | | - C Codecà
- Medical Oncology Unit, Ospedale San Paolo, Milano
| | - F Nolè
- Unit of Urogenital and Head and Neck Oncology, Istituto Europeo di Oncologia, Milano
| | - E Verri
- Unit of Urogenital and Head and Neck Oncology, Istituto Europeo di Oncologia, Milano
| | | | | | - S Parisi
- U.O.C. Radiation Oncology, IRCCS Casa Sollievo della Sofferenza, San Giovanni, Rotondo
| | - C Mastromauro
- Medical Oncology Department, Ospedale dell'Angelo, Venezia
| | - C A Mione
- Radiotherapy Department, Ospedale SS Giovanni e Paolo, Venezia
| | | | - M Polsinelli
- S.O.C. Radiation Oncology, Azienda Ospedaliero-Universitaria S.Maria della Misericordia, Udine
| | - H Koussis
- Medical Oncology Department 2, Istituto Oncologico Veneto- IRCCS, Padova
| | - L Loreggian
- Radiotherapy Department, Istituto Oncologico Veneto - IRCCS, Padova
| | - A Bonetti
- Medical Oncology Department, Ospedale Mater Salutis, Legnago
| | - F Campostrini
- Radiotherapy Department, Ospedale Mater Salutis, Legnago
| | - G Azzarello
- Oncology Unit, Department of Internal Medical Sciences, Mirano
| | | | - F Bertoni
- Radiotherapy Department, Azienda Ospedaliero Universitaria, Modena
| | | | - E Emiliani
- Radiotherapy Department, Azienda USL, Ravenna
| | - M Guaraldi
- Medical Oncology Department, Policlinico Sant'Orsola-Malpighi, Bologna
| | - F Bunkheila
- Radiotherapy Department, Policlinico Sant'Orsola-Malpighi, Bologna
| | - P Bidoli
- Medical Oncology Department, Ospedale San Gerardo, Monza
| | - R M Niespolo
- Radiotherapy Department, Ospedale San Gerardo, Monza, Ospedale San Gerardo, Monza
| | - A Gava
- Radiotherapy Department, Ospedale Ca' Foncello, Treviso
| | - E Massa
- Department of Medical Science, Università degli Studi di Cagliari, Cagliari
| | - A Frattegiani
- Radiation Oncology Department, Ospedale S. Maria della Misericordia, Perugia
| | - F Valduga
- Medical Oncology Department, Ospedale S. Chiara, Trento
| | - G Pieri
- Medical Oncology Department, AO Triestina, Trieste
| | - T Cipani
- Niguarda Cancer Center, Ospedale Niguarda Cà Granda, Milano
| | - D Da Corte
- Oncology Department, Ospedale S. Martino, Belluno
| | - F Chiappa
- Laboratory of Clinical Research, Istituto di Ricerche Farmacologiche "Mario Negri," Milano, Italy
| | - E Rulli
- Laboratory of Clinical Research, Istituto di Ricerche Farmacologiche "Mario Negri," Milano, Italy
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13
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Balducci E, Azzarello G, Valori L, Toffolatti L, Bolgan L, Valenti MT, Bari M, Pappagallo GL, Ausoni S, Vinante O. A New Nested Primer Pair Improves the Specificity of Ck-19 Mrna Detection by Rt-Pcr in Occult Breast Cancer Cells. Int J Biol Markers 2018; 20:28-33. [PMID: 15832770 DOI: 10.1177/172460080502000105] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Reverse transcription polymerase chain reaction (RT-PCR) of cytokeratin-19 (CK-19) has been widely used to detect small numbers of circulating malignant epithelial cells in the bone marrow or the peripheral blood of patients with breast cancer. However, a high percentage of false positive results has been recorded and conflicting reports question the clinical relevance of this technical approach. We demonstrate that the use of a new nested primer pair for CK-19 RT-PCR avoids false positive results without affecting the sensitivity of the assay. Our experiments were carried out using MCF-7 cells alone or mixed with peripheral blood mononuclear cells (PBMNC) of healthy donors. The results were also validated in a large series of healthy donors and in a preliminary study on a limited number of patients with breast cancer, thus suggesting that our assay is feasible for application in the clinical evaluation of occult malignant epithelial cells.
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Affiliation(s)
- E Balducci
- Department of Oncology and Hemato-Oncology, P.F. Calvi Hospital, Noale, Venice, Italy
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14
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Spinato G, Stellin M, Azzarello G, Bonazza D, Zanconati F, Politi D, Cocuzza S, Di Mauro P, Ausoni S, Tonoli G, Costantini G, Maiolino L, Spinato R, Da Mosto MC, Baboci L, Del Mistro A, Serra A, Tirelli G. Multicenter research into the quality of life of patients with advanced oropharyngeal carcinoma with long-term survival associated with human papilloma virus. Oncol Lett 2017; 14:185-193. [PMID: 28693152 PMCID: PMC5494809 DOI: 10.3892/ol.2017.6152] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 11/28/2016] [Indexed: 01/22/2023] Open
Abstract
The treatment of advanced-stage oropharyngeal squamous cell carcinoma may utilize various modes, including combining surgery with chemoradiotherapy (CTRT), or primary CTRT followed by rescue surgery. In previous literature it has been revealed how patients treated with combined modes report a low quality of life (QoL) and severe consequences following surgery, radiotherapy and chemotherapy, in the short and in the long-term. The decrease in the QoL of patients treated with high-intensity multi-modal strategies highlights the necessity of modifying treatments, particularly for young HPV-positive patients, where an increased survival rate has already been reported. The modified treatment for HPV-positive tumors in the tonsils and at the base of the tongue is based on the deintensification of therapies aiming to reduce toxicity and thereby improve QoL in the long term, whilst still maintaining therapeutic effectiveness. The aim of the present study was to evaluate the QoL in patients with a long-term survival, who were treated with combined therapy for squamous cell tumors in the tonsils and at the base of the tongue, and to compare the results observed in HPV-positive and HPV-negative patients. According to statistical analysis, differences in the general QoL and in the single scales of the European Organization for the Research and Treatment of Cancer questionnaires were not correlated with the type of therapy selected for the particular patient. QoL considered the presence of HPV, the type of treatment, the subregion of the tonsils vs. the base of the tongue and the disease stage at the time of diagnosis, and was determined to be non-influential with regard to these specific variables.
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Affiliation(s)
- Giacomo Spinato
- Ear, Nose and Throat Department, Rovigo Provincial Hospital, I-45100 Rovigo, Italy
| | - Marco Stellin
- Department of Neurosciences, Ear, Nose and Throat Clinic and Regional Center for Head and Neck Cancer, University of Padua, Treviso Provincial Hospital, I-35122 Padua, Italy
| | | | - Deborah Bonazza
- Pathology Department, Cattinara Hospital, University of Trieste, I-34149 Trieste, Italy
| | - Fabrizio Zanconati
- Pathology Department, Cattinara Hospital, University of Trieste, I-34149 Trieste, Italy
| | - Doriano Politi
- Provincial Ear, Nose and Throat Department of Venice, Mestre Hospital, I-30174 Venice, Italy
| | - Salvatore Cocuzza
- Ear, Nose and Throat Department, University of Catania, I-95125 Catania, Italy
| | - Paola Di Mauro
- Ear, Nose and Throat Department, University of Catania, I-95125 Catania, Italy
| | - Simonetta Ausoni
- Department of Biomedical Sciences, University of Padua, I-35122 Padua, Italy
| | - Giovanni Tonoli
- Ear, Nose and Throat Department, Rovigo Provincial Hospital, I-45100 Rovigo, Italy
| | - Giulio Costantini
- Psychology Department, University of Milano-Bicocca, I-20126 Milan, Italy
| | - Luigi Maiolino
- Ear, Nose and Throat Department, University of Catania, I-95125 Catania, Italy
| | - Roberto Spinato
- Provincial Ear, Nose and Throat Department of Venice, Mestre Hospital, I-30174 Venice, Italy
| | - Maria Cristina Da Mosto
- Department of Neurosciences, Ear, Nose and Throat Clinic and Regional Center for Head and Neck Cancer, University of Padua, Treviso Provincial Hospital, I-35122 Padua, Italy
| | - Lorena Baboci
- Veneto Institute of Oncology IOV-IRCCS, Immunology and Molecular Oncology Unit, Padua, I-35128 Padova, Italy
| | - Annarosa Del Mistro
- Veneto Institute of Oncology IOV-IRCCS, Immunology and Molecular Oncology Unit, Padua, I-35128 Padova, Italy
| | - Agostino Serra
- Ear, Nose and Throat Department, University of Catania, I-95125 Catania, Italy
| | - Giancarlo Tirelli
- Ear, Nose and Throat Department, Cattinara Hospital, University of Trieste, I-34149 Trieste, Italy
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Mercadante S, Marchetti P, Cuomo A, Caraceni A, Mediati RD, Mammucari M, Natoli S, Lazzari M, Dauri M, Airoldi M, Azzarello G, Bandera M, Blasi L, Cartenì G, Chiurazzi B, Costanzo BVP, Degiovanni D, Fusco F, Guardamagna V, Iaffaioli V, Liguori S, Lorusso V, Mameli S, Mattioli R, Mazzei T, Melotti RM, Menardo V, Miotti D, Moroso S, De Santis S, Orsetti R, Papa A, Ricci S, Sabato AF, Scelzi E, Sofia M, Tonini G, Aielli F, Valle A. Breakthrough Cancer Pain: Preliminary Data of The Italian Oncologic Pain Multisetting Multicentric Survey (IOPS-MS). Adv Ther 2017; 34:120-135. [PMID: 27873235 PMCID: PMC5216057 DOI: 10.1007/s12325-016-0440-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Indexed: 11/29/2022]
Abstract
Introduction An ongoing national multicenter survey [Italian Oncologic Pain multiSetting Multicentric Survey (IOPS-MS)] is evaluating the characteristics of breakthrough cancer pain (BTP) in different clinical settings. Preliminary data from the first 1500 cancer patients with BTP enrolled in this study are presented here. Methods Thirty-two clinical centers are involved in the survey. A diagnosis of BTP was performed by a standard algorithm. Epidemiological data, Karnofsky index, stage of disease, presence and sites of metastases, ongoing oncologic treatment, and characteristics of background pain and BTP and their treatments were recorded. Background pain and BTP intensity were measured. Patients were also questioned about BTP predictability, BTP onset (≤10 or >10 min), BTP duration, background and BTP medications and their doses, time to meaningful pain relief after BTP medication, and satisfaction with BTP medication. The occurrence of adverse reactions was also assessed, as well as mucosal toxicity. Results Background pain was well controlled with opioid treatment (numerical rating scale 3.0 ± 1.1). Patients reported 2.5 ± 1.6 BTP episodes/day with a mean intensity of 7.5 ± 1.4 and duration of 43 ± 40 min; 977 patients (65.1%) reported non-predictable BTP, and 1076 patients (71.7%) reported a rapid onset of BTP (≤10 min). Higher patient satisfaction was reported by patients treated with fast onset opioids. Conclusions These preliminary data underline that the standard algorithm used is a valid tool for a proper diagnosis of BTP in cancer patients. Moreover, rapid relief of pain is crucial for patients’ satisfaction. The final IOPS-MS data are necessary to understand relationships between BTP characteristics and other clinical variables in oncologic patients. Funding Molteni Farmaceutici, Italy.
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Affiliation(s)
- Sebastiano Mercadante
- Anesthesia and Intensive Care and Pain Relief and Supportive Care, La Maddalena Cancer Center, Via San Lorenzo 312, 90146, Palermo, Italy.
| | - Paolo Marchetti
- Molecular and Clinical Medicine, Medical Oncology, La Sapienza University of Rome, Rome, Italy
| | - Arturo Cuomo
- Anesthesiology, Resuscitation, and Pain Therapy Department, National Cancer Institute, IRCCS Foundation Pascale, Naples, Italy
| | - Augusto Caraceni
- Palliative Care, Pain Therapy and Rehabilitation, National Cancer Institute IRCCS Foundation, Milan, Italy
| | | | | | - Silvia Natoli
- Department of Clinical Science and Translational Medicine, University of Rome Tor Vergata, Rome, Italy
- Department of Emergency, Admission and Critical Area, Policlinic of Tor Vergata, Rome, Italy
| | - Marzia Lazzari
- Department of Clinical Science and Translational Medicine, University of Rome Tor Vergata, Rome, Italy
- Department of Emergency, Admission and Critical Area, Policlinic of Tor Vergata, Rome, Italy
| | - Mario Dauri
- Department of Clinical Science and Translational Medicine, University of Rome Tor Vergata, Rome, Italy
- Department of Emergency, Admission and Critical Area, Policlinic of Tor Vergata, Rome, Italy
| | - Mario Airoldi
- 2nd Medical Oncology Division, Città della Salute e della Scienza Hospital of Turin, Turin, Italy
| | - Giuseppe Azzarello
- Medical Specialties Department, Oncology and Oncologic Hematology, ASL 13 Mirano, Venice, Italy
| | - Mauro Bandera
- Medical Oncology Unit, Ospedale di Circolo e Fondazione Macchi Hospital, Varese, Italy
| | - Livio Blasi
- Medical Oncology Unit, ARNAS Ospedale Civico, Di Cristina, Benfratelli, Palermo, Italy
| | | | | | | | | | - Flavio Fusco
- Palliative Care Unit, Department of Primary and Community Care, ASL3 Genovese, Genoa, Italy
| | - Vittorio Guardamagna
- Palliative Care and Pain Therapy Unit, European Oncology Institute IRCCS, Milan, Italy
| | - Vincenzo Iaffaioli
- Abdominal Medical Oncology, National Cancer Institute, IRCCS Foundation Pascale, Naples, Italy
| | - Simeone Liguori
- Palliative Care and Pain Therapy Unit, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Vito Lorusso
- Medical Oncology Unit, National Cancer Research Centre "Giovanni Paolo II", Bari, Italy
| | - Sergio Mameli
- Pain Therapy Unit, "A. Businco" Hospital, ASL 8, Cagliari, Italy
| | | | - Teresita Mazzei
- Section of Clinical Pharmacology and Oncology, Department of Health Sciences, University of Florence, Florence, Italy
| | - Rita Maria Melotti
- Department of Medicine and Surgery Sciences, University of Bologna, Bologna, Italy
| | | | - Danilo Miotti
- Palliative Care Unit, Salvatore Maugeri-IRCCS Foundation, Pavia, Italy
| | - Stefano Moroso
- Medical Oncology, Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | - Stefano De Santis
- Palliative Care and Oncologic Pain Service, S. Camillo-Forlanini Hospital, Rome, Italy
| | - Remo Orsetti
- Pain Medicine Unit, S. Camillo-Forlanini Hospital, Rome, Italy
| | - Alfonso Papa
- Pain Relief, A.O. Dei Colli, Monaldi Hospital, Naples, Italy
| | - Sergio Ricci
- Division of Medical Oncology, Department of Oncology, S. Chiara University Hospital, Pisa, Italy
| | - Alessandro Fabrizio Sabato
- Department of Clinical Science and Translational Medicine, University of Rome Tor Vergata, Rome, Italy
- Department of Emergency, Admission and Critical Area, Policlinic of Tor Vergata, Rome, Italy
| | - Elvira Scelzi
- Medical Oncology, Castelfranco Veneto Hospital, Treviso, Italy
| | - Michele Sofia
- Department of Palliative Care with Hospice and Pain Therapy Unit, "G.Salvini" Hospital, Garbagnate Milanese, Milan, Italy
| | - Giuseppe Tonini
- Department of Medical Oncology, Campus Bio-Medico University of Rome, Rome, Italy
| | - Federica Aielli
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
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Ausoni S, Boscolo-Rizzo P, Singh B, Da Mosto MC, Spinato G, Tirelli G, Spinato R, Azzarello G. Targeting cellular and molecular drivers of head and neck squamous cell carcinoma: current options and emerging perspectives. Cancer Metastasis Rev 2016; 35:413-26. [PMID: 27194534 PMCID: PMC5524458 DOI: 10.1007/s10555-016-9625-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Despite improvements in functional outcomes attributable to advances in radiotherapy, chemotherapy, surgical techniques, and imaging techniques, survival in head and neck squamous cell carcinoma (HNSCC) patients has improved only marginally during the last couple of decades, and optimal therapy has yet to be devised. Genomic complexity and intratumoral genetic heterogeneity may contribute to treatment resistance and the propensity for locoregional recurrence. Countering this, it demands a significant effort from both basic and clinical scientists in the search for more effective targeted therapies. Recent genomewide studies have provided valuable insights into the genetic basis of HNSCC, uncovering potential new therapeutic opportunities. In addition, several studies have elucidated how inflammatory, immune, and stromal cells contribute to the particular properties of these neoplasms. In the present review, we introduce recent findings on genomic aberrations resulting from whole-genome sequencing of HNSCC, we discuss how the particular microenvironment affects the pathogenesis of this disease, and we describe clinical trials exploring new perspectives on the use of combined genetic and cellular targeted therapies.
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Affiliation(s)
- Simonetta Ausoni
- Department of Biomedical Sciences, University of Padua, Padova, Italy
| | - Paolo Boscolo-Rizzo
- Department of Neurosciences, ENT Clinic and Regional Center for Head and Neck Cancer, University of Padua, Treviso Regional Hospital, Treviso, Italy
| | - Bhuvanesh Singh
- Laboratory of Epithelial Cancer Biology, Head and Neck Service, Memorial Sloan-Kettering Cancer Center, New York, USA
| | - Maria Cristina Da Mosto
- Department of Neurosciences, ENT Clinic and Regional Center for Head and Neck Cancer, University of Padua, Treviso Regional Hospital, Treviso, Italy
| | - Giacomo Spinato
- Department of Otorhinolaryngology, Head and Neck Surgery, Cattinara Hospital, Trieste, Italy
| | - Giancarlo Tirelli
- Department of Otorhinolaryngology, Head and Neck Surgery, Cattinara Hospital, Trieste, Italy
| | - Roberto Spinato
- Department of Otorhinolaryngology, Head and Neck Surgery, Dell'Angelo Hospital, Mestre, Venezia, Italy
| | - Giuseppe Azzarello
- Department of Medical Oncology, Mirano Hospital, Local Health Unit 13, Mirano, Venezia, Italy.
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Corli O, Floriani I, Roberto A, Montanari M, Galli F, Greco MT, Caraceni A, Kaasa S, Dragani TA, Azzarello G, Luzzani M, Cavanna L, Bandieri E, Gamucci T, Lipari G, Di Gregorio R, Valenti D, Reale C, Pavesi L, Iorno V, Crispino C, Pacchioni M, Apolone G. Are strong opioids equally effective and safe in the treatment of chronic cancer pain? A multicenter randomized phase IV 'real life' trial on the variability of response to opioids. Ann Oncol 2016; 27:1107-1115. [PMID: 26940689 DOI: 10.1093/annonc/mdw097] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [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: 11/04/2015] [Accepted: 02/16/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Guidelines tend to consider morphine and morphine-like opioids comparable and interchangeable in the treatment of chronic cancer pain, but individual responses can vary. This study compared the analgesic efficacy, changes of therapy and safety profile over time of four strong opioids given for cancer pain. PATIENT AND METHODS In this four-arm multicenter, randomized, comparative, of superiority, phase IV trial, oncological patients with moderate to severe pain requiring WHO step III opioids were randomly assigned to receive oral morphine or oxycodone or transdermal fentanyl or buprenorphine for 28 days. At each visit, pain intensity, modifications of therapy and adverse drug reactions (ADRs) were recorded. The primary efficacy end point was the proportion of nonresponders, meaning patients with worse or unchanged average pain intensity (API) between the first and last visit, measured on a 0-10 numerical rating scale. (NCT01809106). RESULTS Forty-four centers participated in the trial and recruited 520 patients. Worst pain intensity and API decreased over 4 weeks with no significant differences between drugs. Nonresponders ranged from 11.5% (morphine) to 14.4% (buprenorphine). Appreciable changes were made in the treatment schedules over time. Each group required increases in the daily dose, from 32.7% (morphine) to 121.2% (transdermal fentanyl). Patients requiring adjuvant analgesics ranged from 68.9% (morphine) to 81.6% (oxycodone), switches varied from 22.1% (morphine) to 12% (oxycodone), discontinuation of treatment from 27% ( morphine) to 14.5% (fentanyl). ADRs were similar except for effects on the nervous system, which significantly prevailed with morphine. CONCLUSION The main findings were the similarity in pain control, response rates and main adverse reactions among opioids. Changes in therapy schedules were notable over time. A considerable proportion of patients were nonresponders or poor responders. CLINICAL TRIAL REGISTRATION NCT01809106 (https://clinicaltrials.gov/ct2/show/NCT01809106?term=cerp&rank=2).
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Affiliation(s)
- O Corli
- Department of Oncology, Unità di Ricerca nel Dolore e Cure Palliative.
| | - I Floriani
- Department of Oncology, Laboratorio di Ricerca Clinica, IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Milan
| | - A Roberto
- Department of Oncology, Unità di Ricerca nel Dolore e Cure Palliative
| | - M Montanari
- Department of Oncology, Unità di Ricerca nel Dolore e Cure Palliative
| | - F Galli
- Department of Oncology, Laboratorio di Ricerca Clinica, IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Milan
| | - M T Greco
- Department of Oncology, Unità di Ricerca nel Dolore e Cure Palliative; Department of Statistics, Università di Milano, Milan
| | - A Caraceni
- Palliative Care Complex Structure, Terapia del dolore e Riabilitazione, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - S Kaasa
- Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology, Norway
| | - T A Dragani
- S.S.D. Epidemiology, Genetics and Pharmacogenomics, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
| | - G Azzarello
- Department of Hematology and Oncology, Ospedale di U.O.C. di Oncologia Mirano-ASL 13 Regione Veneto, Mirano
| | - M Luzzani
- Department of Orthogeriatrics, S.S.D. Cure Palliative, riabilitazione e stabilizzazione E.O. Ospedali Galliera, Genova
| | - L Cavanna
- Oncology Unit, Ospedale di Piacenza, Piacenza
| | - E Bandieri
- Unit of Supportive and Simultaneous Care, Medical Oncology Division USL, Modena
| | - T Gamucci
- UOC Medical Oncology, Ospedale SS Trinità, Sora
| | - G Lipari
- Palliative Care, P.O. di Salemi-ASP 9, Trapani
| | - R Di Gregorio
- U.O.S Obstetric Anasthesia and Pain Therapy, Opedale Sacro Cuore di Gesù - Fatebenefratelli, Benevento
| | - D Valenti
- Palliative Care Unit, Azienda Ospedaliera Valtellina e Valchiavenna, Morbegno
| | - C Reale
- Department of Cardiovascular Sciences, Respiratory, Nephrological, Anaesthetics and Geriatrics, Policlinico Universitario Umberto I, Rome
| | - L Pavesi
- Unit of Oncology, RCCS-Fondazione Salvatore Maugeri, Pavia
| | - V Iorno
- Centre for Pain Medicine M. TIENGO, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan
| | - C Crispino
- UOSD Treatment of Lung Cancer Complications, AO Dei Colli Monaldi Cotugno CTO Ospedale Monaldi, Napoli
| | - M Pacchioni
- Department of Oncology, Ospedale San Raffaele IRCCS, Milan
| | - G Apolone
- Scientific Direction, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Ghi CM, Paccagnella A, Ferrari D, Foa P, Cossu Rocca M, Verri E, Morelli F, Azzarello G, D'Ambrosio C, Casanova C, Guaraldi M, Massa E, Rossetto C, Bonetti A, Siena S, Frattegiani A, Koussis H, Pieri G, Gava A, Floriani I. OC-006: Concomitant treatment (CRT or cetuximab/RT) with or without induction TPF in Locally Advanced head and neck. Radiother Oncol 2015. [DOI: 10.1016/s0167-8140(15)34766-6] [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: 10/23/2022]
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19
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Ghi MG, Paccagnella A, Ferrari D, Foa P, Cossu Rocca M, Verri E, Morelli F, Azzarello G, D'Ambrosio C, Cruciani G, Guaraldi M, Massa E, Rossetto C, Bonetti A, Siena S, Minotti V, Koussis H, Pieri G, Baggio V, Floriani I. Concomitant chemoradiation (CRT) or cetuximab/RT (CET/RT) versus induction Docetaxel/ Cisplatin/5-Fluorouracil (TPF) followed by CRT or CET/RT in patients with Locally Advanced Squamous Cell Carcinoma of Head and Neck (LASCCHN). A randomized phase III factorial study (NCT01086826). J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.6004] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [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)
| | | | - Daris Ferrari
- Medical Oncology Unit, San Paolo Hospital, Milan, Italy
| | - Paolo Foa
- Medical Oncology, San Paolo Hospital, Milano, Italy
| | - Maria Cossu Rocca
- Medical Oncology Unit of Urogenital and Head and Neck Tumors- European Institute of Oncology, Milano, Italy
| | - Elena Verri
- Medical Oncology Unit of Urogenital and Head and Neck Tumors- European Institute of Oncology, Milano, Italy
| | - Franco Morelli
- U.O.C. Oncologia, IRCCS Caa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Giuseppe Azzarello
- Department of Internal Medical Sciences,Oncology Unit ASL 13, Mirano, Italy
| | | | | | - Monica Guaraldi
- Medical Oncology Department, Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | - Elena Massa
- Dipartimento di Scienze Mediche Internistiche, Cagliari, Italy
| | - Ciro Rossetto
- Department of Oncology University Hospital - Udine, Udine, Italy
| | - Andrea Bonetti
- Department of Oncology, Mater Salutis Hospital-AULSS 21 della Regione Veneto, Legnago, Italy
| | | | - Vincenzo Minotti
- Division of Medical Oncology, Azienda Ospedaliera, Perugia, Italy
| | | | - Gabriella Pieri
- Oncology Department, Oncology Unit, Ospedali Riuniti di Trieste, Trieste, Italy
| | - Vittorio Baggio
- Division of Medical Oncology, Ospedale Cà Foncello, Treviso, Italy
| | - Irene Floriani
- Laboratory of Clinical Trials, Oncology Department, Istituto di Ricerche Farmacologiche, Milano, Italy
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20
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Ghi MG, Paccagnella A, Ferrari D, Foa P, Cossu Rocca M, Verri E, Maiello E, Azzarello G, D'Ambrosio C, Casanova C, Guaraldi M, Mantovani G, Rossetto C, Bonetti A, Cipani T, Crino L, Koussis H, Pieri G, Gava A, Floriani I. A phase II-III study comparing concomitant chemoradiotherapy (CRT) versus cetuximab/RT (CET/RT) with or without induction docetaxel/cisplatin/5-fluorouracil (TPF) in locally advanced head and neck squamous cell carcinoma (LASCCHN): Efficacy results (NCT01086826). J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.6003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
6003 Background: This is the first phase III study directly comparing CRT vs CET/RT in LASCCHN. Primary endpoints of this study were to compare: 1) overall survival (OS) of induction vs. no induction arms; 2) Grade 3-4 in-field toxicity of CRT vs. CET/RT. Preliminary toxicity results of concomitant treatments (primary endpoint for this comparison) were reported at the 2012 ASCO meeting. Here we present response rate and survival data for the two concomitant treatments (CRT vs. CET/RT), irrespective of induction chemotherapy. Methods: Untreated patients with unresectable LASCCHN, stage III-IV, ECOG PS 0–1 were randomized to a 2x2 factorial design: Arm A1: CRT (2 cycles of cisplatin/5fluorouracil concomitant to RT); Arm A2: CET/RT; Arm B1: 3 cycles of TPF followed by the same CRT; Arm B2:3 cycles of TPF followed by CET/RT. Results: A total of421 patients were randomized: 261 received CRT (131 Arm A1+ 130 Arm B1) and 160 received CET/RT (80 Arm A2+ 80 Arm B2). 82% were male; median age was 60y; PS of 0 (79%) or 1 (21%). Stage was III (32%) or IV (68%). Sites of disease were: oral cavity 20%, oropharynx 57%, hypopharynx: 23%. No significant differences were observed in patients’ characteristics distribution. At a median follow-up of 32.9 months, a total of 174 deaths occurred (204 required for final OS analysis). Data on activity and efficacy of CRT and CET/RT are shown in the Table. Conclusions: No significant differences were observed in response rate, progression free survival and OS between CRT and CET/RT. Pts are still being followed-up to assess OS of induction vs. no induction arms. Clinical trial information: NCT01086826. [Table: see text]
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Affiliation(s)
| | | | | | - Paolo Foa
- Medical Oncology, San Paolo Hospital, Milano, Italy
| | | | - Elena Verri
- European Institute of Oncology, Milano, Italy
| | - Evaristo Maiello
- IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Giuseppe Azzarello
- Department of Internal Medical Sciences,Oncology Unit ASL 13, Mirano, Italy
| | | | | | - Monica Guaraldi
- Medical Oncology Department, Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | | | - Ciro Rossetto
- Department of Oncology University Hospital, Udine, Italy
| | - Andrea Bonetti
- Department of Oncology, Mater Salutis Hospital-AULSS 21 della Regione Veneto, Legnago, Italy
| | - Tiziana Cipani
- Department of Oncology, Ospedale Niguarda Ca' Granda, Milano, Italy
| | - Lucio Crino
- Medical Oncology, S. Maria della Misericordia Hospital, Perugia, Italy
| | | | - Gabriella Pieri
- Oncology Department, Oncology Unit, Ospedali Riuniti di Trieste, Trieste, Italy
| | - Alessandro Gava
- Radiotherapy Department, Ospedale Ca' Foncello, Treviso, Italy
| | - Irene Floriani
- Laboratory of Clinical Trials, Oncology Department, Istituto di Ricerche Farmacologiche, Milano, Italy
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Ghi M, Paccagnella A, Ferrari D, Rocca MC, Verri E, Morelli F, Azzarello G, D'Ambrosio C, Casanova C, Floriani I. Concomitant Chemoradiotherapy (CT/RT) or CETUXIMAB/RT (CET/RT) with or Without Induction Docetaxel/Cisplatin/5-Fluorouracil (TPF) in Locally Advanced Head and Neck Cancer (LASCCHN). Preliminary Toxicity Results of a Randomized, 2x2 Factorial, Phase II-III Study. (NCT01086826). Ann Oncol 2012. [DOI: 10.1016/s0923-7534(20)33614-0] [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: 11/28/2022] Open
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22
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Ghi MG, Paccagnella A, Ferrari D, Foa P, Nole F, Morelli F, Azzarello G, D'Ambrosio C, Casanova C, Guaraldi M, Mantovani G, Rossetto C, Bonetti A, Siena S, Crino L, Buffoli A, Koussis H, Pieri G, Gava A, Floriani I. Cetuximab/radiotherapy (CET+RT) versus concomitant chemoradiotherapy (cCHT+RT) with or without induction docetaxel/cisplatin/5-fluorouracil (TPF) in locally advanced head and neck squamous cell carcinoma (LASCCHN): Preliminary results on toxicity of a randomized, 2x2 factorial, phase II-III study (NCT01086826). J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.5513] [Citation(s) in RCA: 4] [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
5513 Background: The standard treatment options for LASCCHN are cCHT+RT or CET+RT. Strategies to improve the efficacy with the integration of induction chemotherapy are being investigated. Primary endpoints of this study were to compare: 1) the overall survival (OS) of induction vs. no induction arms; 2) the Grade(G)3-4 in-field toxicity of cCHT+RT vs. CET+RT. Methods: Patients (pts) with unresectable LASCCHN, stage III-IV, ECOG PS 0–1 were randomized to a 2x2 factorial design: Arm A1: cCHT+RT (2 cycles of ciplatin/5fluorouracil); Arm A2: CET+RTX; Arm B1: 3 cycles of TPF followed by the same cCHT+RT; Arm B2: 3 cycles of TPF followed by CET+RT. A total of 204 deaths over 420 pts ( including the 101 randomized in the phase II part of the study comparing cCHT+RT with or w/o induction TPF) were required to detect a HR of death of 0.675 (A1+A2 vs. B1+B2; 2-sided a=0.05; b=0.20) and a 10% difference in G3-4 in-field mucosal toxicity (A1+B1 vs. A2+B2). Results: By February 2012, 387 pts over 413 pts were evaluable for toxicity. 82% of pts were male; median age was 60y; PS: 0=77.8% and 1=22.2%. Disease stage was III (31%) or IV (69%). Sites of disease were oral cavity (21.7%), oropharynx (54.8%), hypopharynx (23.5%). At a median follow-up of 21 months, 126 deaths occurred. Data on G3-4 in-field toxicity (primary endpoint) and compliance to cCHT+RT vs CET+RT are shown in the table. Conclusions: No advantage for CET+RT over cCHT+RT was observed regarding G3-4 in-field toxicities and feasibility. Pts are still being followed-up to assess OS. [Table: see text]
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Affiliation(s)
| | | | | | | | - Franco Nole
- Unit for Medical Care, European Institute of Oncology, Milan, Italy
| | - Franco Morelli
- Oncology Unit, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Giuseppe Azzarello
- Department of Internal Medical Sciences,Oncology Unit ASL 13, Mirano, Italy
| | | | | | - Monica Guaraldi
- Medical Oncology Department, Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | | | - Ciro Rossetto
- Department of Oncology University Hospital, Udine, Italy
| | - Andrea Bonetti
- Department of Oncology, Mater Salutis Hospital, Legnago, Italy
| | - Salvatore Siena
- Department of Oncology, Ospedale Niguarda Ca' Granda, Milan, Italy
| | - Lucio Crino
- Medical Oncology, S. Maria della Misericordia Hospital, Perugia, Italy
| | | | | | - Gabriella Pieri
- Oncology Department, Oncology Unit, Ospedali Riuniti di Trieste, Trieste, Italy
| | | | - Irene Floriani
- Laboratory of Clinical Trials, Oncology Department, Istituto di Ricerche Farmacologiche, Milan, Italy
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Wabersich J, Artioli G, Giordano R, De Lorenzi F, Azzarello G, Garbin F. Laparoscopic total fallopian tube removal at the time of bilateral salpingo-oophorectomy in BRCA2 positive women. EUR J GYNAECOL ONCOL 2011; 32:328-330. [PMID: 21797127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
About 10% of all serous ovarian cancer has BRCA1 and/or BRCA2 mutations. Recent data showed that following the SEE FIM protocol it is possible to evidence more fimbriae cancers. Due to those studies, fallopian tube cancer in recent years has become the predominant site of cancer in BRCA1 and/or 2 mutation carriers. The pathological study of the fallopian tube is not complete during salpingo-oophorectomy because a small part (intramural site) is situated inside the uterus. In this case report we demonstrate how it is possible to remove the tubes entirely for pathological analysis without hysterectomy by laparoscopic surgery.
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Affiliation(s)
- J Wabersich
- Department of Gynecology and Obstetrics, Mirano, Italy
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Toffoli G, Cecchin E, Gasparini G, D'Andrea M, Azzarello G, Basso U, Mini E, Pessa S, De Mattia E, Lo Re G, Buonadonna A, Nobili S, De Paoli P, Innocenti F. Genotype-driven phase I study of irinotecan administered in combination with fluorouracil/leucovorin in patients with metastatic colorectal cancer. J Clin Oncol 2009; 28:866-71. [PMID: 20038727 DOI: 10.1200/jco.2009.23.6125] [Citation(s) in RCA: 140] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
PURPOSE We aimed to identify the maximum-tolerated dose (MTD) of irinotecan in patients with cancer with UGT1A1*1/*1 and *1/*28 genotypes. We hypothesize that the patients without the *28/*28 genotype tolerate higher doses of irinotecan. PATIENTS AND METHODS Patients undergoing first-line treatment for metastatic colorectal cancer (CRC) eligible for treatment with irinotecan plus infusional fluorouracil/leucovorin (FOLFIRI) were screened for the UGT1A1*28/*28 genotype and excluded from the study. Fifty-nine white patients with either the *1/*1 or the *1/*28 genotype were eligible for dose escalation of irinotecan. The starting dose of biweekly irinotecan was 215 mg/m(2) for both genotype groups, whereas the dose of infusional fluorouracil was fixed. Pharmacokinetic data of irinotecan and metabolites were also obtained. Results The dose of irinotecan was escalated to 370 mg/m(2) in patients with the *1/*28 genotype and to 420 mg/m(2) in those with the *1/*1 genotype. Dose-limiting toxicities (DLTs) were observed in two of four of *1/*28 patients at 370 mg/m(2) and in two of three of *1/*1 patients at 420 mg/m(2). No DLTs were observed in 10 *1/*28 patients at 310 mg/m(2) and in 10 *1/*1 patients at 370 mg/m(2); hence these dose levels were the MTD for each genotype group. The most common grade 3 to 4 toxicities were neutropenia and diarrhea. The pharmacokinetics of irinotecan and SN-38 exhibit linear kinetics. CONCLUSION The recommended dose of 180 mg/m(2) for irinotecan in FOLFIRI is considerably lower than the dose that can be tolerated when patients with the UGT1A1*28/*28 genotype are excluded. Prospective genotype-driven studies should test the efficacy of higher irinotecan doses in the FOLFIRI schedule.
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Affiliation(s)
- Giuseppe Toffoli
- Experimental and Clinical Pharmacology Unit, Centro di Riferimento Oncologico National Cancer Institute, via Pedemontana Occidentale 12, Aviano 33081, Italy.
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25
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Sarto P, Balducci E, Balconi G, Fiordaliso F, Merlo L, Tuzzato G, Pappagallo GL, Frigato N, Zanocco A, Forestieri C, Azzarello G, Mazzucco A, Valenti MT, Alborino F, Noventa D, Vinante O, Pascotto P, Sartore S, Dejana E, Latini R. Effects of exercise training on endothelial progenitor cells in patients with chronic heart failure. J Card Fail 2008; 13:701-8. [PMID: 17996817 DOI: 10.1016/j.cardfail.2007.06.722] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2007] [Revised: 05/04/2007] [Accepted: 06/13/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND The enhancement of circulating endothelial progenitor cells (EPCs) obtained by exercise training can be beneficial to patients with cardiac disease. Changes in the levels and differentiation of CD34(pos)/KDR(pos) EPCs, as well as the plasma concentration of vascular endothelial growth factor (VEGF) and stromal cell-derived factor (SDF)-1 EPC-mobilizing cytokines, were evaluated in patients with chronic heart failure after 8 weeks of supervised aerobic training (SAT) and 8 weeks of subsequent discontinued SAT (DSAT). METHODS AND RESULTS The levels of circulating EPC and EPC differentiation potential of 22 patients who underwent SAT were studied by fluorescence-activated cell sorter analysis and colony forming-unit assay, respectively. The plasma levels of VEGF and SDF-1 were measured by enzyme-linked immunosorbent assay. In response to SAT, the levels of both EPC and VEGF/SDF-1 markedly increased (P < .001 vs baseline) but returned to the baseline levels after DSAT. A similar change was observed with the EPC clonogenic potential, but on DSAT the baseline level was incompletely attained. CONCLUSIONS In response to SAT, patients with chronic heart failure show enhanced EPC levels and clonogenic potential that is mirrored by increased plasma VEGF and SDF-1 levels. DSAT can interfere with the maintenance of training-acquired VEGF/SDF-1-related EPC levels and clonogenic potential.
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Affiliation(s)
- Patrizio Sarto
- Department of Cardiology and Sports Medicine, Mirano Hospital, Mirano, Venice, Italy
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26
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Dalle Carbonare L, Valenti MT, Bertoldo F, Fracalossi A, Balducci E, Azzarello G, Vinante O, Lo Cascio V. Amino-bisphosphonates decrease hTERT gene expression in breast cancer in vitro. Aging Clin Exp Res 2007; 19:91-6. [PMID: 17446718 DOI: 10.1007/bf03324673] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND AIMS Human telomerase reverse transcriptase (hTERT) is the catalytic subunit of telomerase. hTERT expression and telomerase activity are elevated in most human tumors. Bisphosphonates play an important role in the management of tumors with the secondary involvement of bone. METHODS We investigated the effect on hTERT gene expression of clodronate, alendronate, and pamidronate (from 10(-6) M to 10(-5) M) on MCF-7 and T47D human breast cancer cells, using real time RTPCR. RESULTS At 10(-5) M, amino-bisphosphonates (alendronate and pamidronate) inhibited breast cancer cell viability and induced a significant decrease in hTERT gene expression with respect to controls (82% and 71% in MCF-7 cells; 74% and 60% in T47D, p<0.0001). No effect was observed with clodronate. CONCLUSIONS Amino-bisphosphonates down-regulate hTERT gene expression. The role of hTERT is a new finding, which gives an alternative explanation for the direct effect of bisphosphonates on tumor cells.
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Affiliation(s)
- Luca Dalle Carbonare
- Department of Biomedical and Surgical Sciences, Medicina Interna D, University of Verona, Verona, Italy.
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27
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Valenti MT, Bertoldo F, Dalle Carbonare L, Azzarello G, Zenari S, Zanatta M, Balducci E, Vinante O, Cascio VL. The effect of bisphosphonates on gene expression: GAPDH as a housekeeping or a new target gene? BMC Cancer 2006; 6:49. [PMID: 16515701 PMCID: PMC1473200 DOI: 10.1186/1471-2407-6-49] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2005] [Accepted: 03/03/2006] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND RT-PCR has been widely used for the analysis of gene expression in many systems, including tumor samples. GAPDH (Glyceraldehyde-3-phosphate dehydrogenase) has been frequently considered as a constitutive housekeeping gene and used to normalize changes in specific gene expression. However, GAPDH has been shown to be up-regulated in many cancers and down-regulated by chemotherapic drugs. Bisphosphonates, potent inhibitors of bone resorption, have recently shown a direct and indirect antitumor effect in vitro and in animal models. They exert their effects mainly by inhibiting the mevalonate pathway but also by modulating the expression of many genes not only in osteoclasts but also in cancer cells. METHODS We evaluated GAPDH gene expression by real time RT PCR in breast (MCF-7 and T47D) and prostate (PC3 and DU-145) cancer cell lines treated with amino and non-amino bisphosphonates. RESULTS Our results showed that amino-bisphosphonates significantly decrease in a dose-dependent manner the expression of GAPDH gene. CONCLUSION Therefore, GAPDH is inaccurate to normalize mRNA levels in studies investigating the effect of bisphosphonates on gene expression and it should be avoided. On the other hand, this gene could be considered a potential target to observe the effects of bisphosphonates on cancer cells.
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Affiliation(s)
- Maria Teresa Valenti
- Medicina Interna D, Department of Biomedical and Surgical Sciences, University of Verona, Italy
| | - Francesco Bertoldo
- Medicina Interna D, Department of Biomedical and Surgical Sciences, University of Verona, Italy
| | - Luca Dalle Carbonare
- Medicina Interna D, Department of Biomedical and Surgical Sciences, University of Verona, Italy
| | | | - Sonia Zenari
- Medicina Interna D, Department of Biomedical and Surgical Sciences, University of Verona, Italy
| | - Mirko Zanatta
- Medicina Interna D, Department of Biomedical and Surgical Sciences, University of Verona, Italy
| | - Elena Balducci
- Department of Oncology and Hematologic Oncology - Noale Hospital, Italy
| | - Orazio Vinante
- Department of Oncology and Hematologic Oncology - Noale Hospital, Italy
| | - Vincenzo Lo Cascio
- Medicina Interna D, Department of Biomedical and Surgical Sciences, University of Verona, Italy
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Briguori C, Reimers B, Sarais C, Napodano M, Pascotto P, Azzarello G, Bregni M, Porcellini A, Vinante O, Zanco P, Peschle C, Condorelli G, Colombo A. Direct intramyocardial percutaneous delivery of autologous bone marrow in patients with refractory myocardial angina. Am Heart J 2006; 151:674-80. [PMID: 16504630 DOI: 10.1016/j.ahj.2005.04.033] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2005] [Accepted: 04/28/2005] [Indexed: 01/22/2023]
Abstract
BACKGROUND Intramyocardial injection of autologous bone marrow (ABM) may induce angiogenesis. We tested the safety and feasibility of catheter-based direct percutaneous intramyocardial delivery of ABM in patients with refractory angina pectoris. METHODS Ten patients (9 men, 67 +/- 8 years) with refractory angina (Canadian Cardiovascular Society class III-IV) and documented myocardial ischemia were enrolled. After left ventricular electromechanical mapping, freshly aspirated and filtered ABM was percutaneously injected into target myocardial ischemic areas. Clinical symptoms (as assessed according to the Canadian Cardiovascular Society class), quality of life, and myocardial perfusion were evaluated before the procedure and through the follow-up. RESULTS In all patients, ABM was successfully injected into the target regions. No periprocedural complications occurred. At 12 months, no major cardiac events (death, acute myocardial infarction, stroke, and malignant ventricular arrhythmias) occurred. Severity of angina improved of > or = 2 classes in 3 patients. Quality of life showed a significant improvement in all patients. Myocardial perfusion in the target regions improved in 4 of 8 patients. CONCLUSIONS Direct percutaneous intramyocardial delivery of ABM appears feasible and safe. Further evaluation is warranted to test its clinical efficacy.
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Affiliation(s)
- Carlo Briguori
- Vita-Salute University School of Medicine, San Raffaele Hospital, Milan, Italy
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29
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Maione P, Perrone F, Gallo C, Manzione L, Piantedosi F, Barbera S, Cigolari S, Rosetti F, Piazza E, Robbiati SF, Bertetto O, Novello S, Migliorino MR, Favaretto A, Spatafora M, Ferraù F, Frontini L, Bearz A, Repetto L, Gridelli C, Barletta E, Barzelloni ML, Iaffaioli RV, De Maio E, Di Maio M, De Feo G, Sigoriello G, Chiodini P, Cioffi A, Guardasole V, Angelini V, Rossi A, Bilancia D, Germano D, Lamberti A, Pontillo V, Brancaccio L, Renda F, Romano F, Esani G, Gambaro A, Vinante O, Azzarello G, Clerici M, Bollina R, Belloni P, Sannicolò M, Ciuffreda L, Parello G, Cabiddu M, Sacco C, Sibau A, Porcile G, Castiglione F, Ostellino O, Monfardini S, Stefani M, Scagliotti G, Selvaggi G, De Marinis F, Martelli O, Gasparini G, Morabito A, Gattuso D, Colucci G, Galetta D, Giotta F, Gebbia V, Borsellino N, Testa A, Malaponte E, Capuano MA, Angiolillo M, Sollitto F, Tirelli U, Spazzapan S, Adamo V, Altavilla G, Scimone A, Hopps MR, Tartamella F, Ianniello GP, Tinessa V, Failla G, Bordonaro R, Gebbia N, Valerio MR, D'Aprile M, Veltri E, Tonato M, Darwish S, Romito S, Carrozza F, Barni S, Ardizzoia A, Corradini GM, Pavia G, Belli M, Colantuoni G, Galligioni E, Caffo O, Labianca R, Quadri A, Cortesi E, D'Auria G, Fava S, Calcagno A, Luporini G, Locatelli MC, Di Costanzo F, Gasperoni S, Isa L, Candido P, Gaion F, Palazzolo G, Nettis G, Annamaria A, Rinaldi M, Lopez M, Felletti R, Di Negro GB, Rossi N, Calandriello A, Maiorino L, Mattioli R, Celano A, Schiavon S, Illiano A, Raucci CA, Caruso M, Foa P, Tonini G, Curcio C, Cazzaniga M. Pretreatment quality of life and functional status assessment significantly predict survival of elderly patients with advanced non-small-cell lung cancer receiving chemotherapy: a prognostic analysis of the multicenter Italian lung cancer in the elderly study. J Clin Oncol 2005; 23:6865-72. [PMID: 16192578 DOI: 10.1200/jco.2005.02.527] [Citation(s) in RCA: 395] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
PURPOSE To study the prognostic value for overall survival of baseline assessment of functional status, comorbidity, and quality of life (QoL) in elderly patients with advanced non-small-cell lung cancer treated with chemotherapy. PATIENTS AND METHODS Data from 566 patients enrolled onto the phase III randomized Multicenter Italian Lung Cancer in the Elderly Study (MILES) study were analyzed. Functional status was measured as activities of daily living (ADL) and instrumental ADL (IADL). The presence of comorbidity was assessed with a checklist of 33 items; items 29 and 30 of the European Organisation for Research and Treatment of Cancer (EORTC) core questionnaire QLQ-C30 (EORTC QLQ-C30) were used to estimate QoL. ADL was dichotomized as none versus one or more dependency. For IADL and QoL, three categories were defined using first and third quartiles as cut points. Comorbidity was summarized using the Charlson scale. Analysis was performed by Cox model, and stratified by treatment arm. RESULTS Better values of baseline QoL (P = .0003) and IADL (P = .04) were significantly associated with better prognosis, whereas ADL (P = .44) and Charlson score (P = .66) had no prognostic value. Performance status 2 (P = .006) and a higher number of metastatic sites (P = .02) also predicted shorter overall survival. CONCLUSIONS Pretreatment global QoL and IADL scores, but not ADL and comorbidity, have significant prognostic value for survival of elderly patients with advanced non-small-cell lung cancer who were treated with chemotherapy. Using these scores in clinical practice might improve prognostic prediction for treatment planning.
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Dalle Carbonare L, Valenti MT, Azzarello G, Balducci E, Crepaldi G, Realdi G, Vinante O, Giannini S. Bisphosphonates decrease telomerase activity and hTERT expression in MCF-7 breast cancer cells. Mol Cell Endocrinol 2005; 240:23-31. [PMID: 15978718 DOI: 10.1016/j.mce.2005.03.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2004] [Revised: 03/07/2005] [Accepted: 03/08/2005] [Indexed: 10/25/2022]
Abstract
Bisphosphonates are important in the management of tumours with secondary bone involvement. Recent findings have suggested that these drugs also have an effect on primary tumour burden. Telomerase is a cellular ribonucleoprotein reverse transcriptase responsible for elongation of the telomere. Telomerase expression is increased in many cancers. We studied the direct effects of clodronate, alendronate, and pamidronate (from 10(-6) to 10(-4) M) on MCF-7 human breast cancer cell line. In particular, we investigated their effect on viability, proliferation, apoptosis, human telomerase reverse transcriptase expression (h-TERT) by RT-PCR and telomerase activity. Alendronate and pamidronate showed an inhibition of viability (-63 and -35%, respectively; p < 0.0001) and proliferation of cancer cells, while no effect was observed with clodronate. Amino-bisphosphonates induced a significant increase of apoptosis in MCF-7. In addition, they showed a significant decrease in telomerase expression and activity with respect to control and to clodronate.
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Affiliation(s)
- Luca Dalle Carbonare
- Department of Medical and Surgical Sciences, Clinica Medica I, University of Padova, Italy.
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31
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Aragona F, Pepe P, Motta M, Saita A, Raciti G, La Rosa P, Nicolosi D, Dammino A, Minaldi G, Rizza G, Azzarello G, Aragona C, Rotondo S, Orestano L, Serrao A, Amico F, Dibenedetto G, Cosentino V, Iurato C, Raffino S, Gulletta M, Calarco A, Paola Q, Barbera M, Gulino V, Capizzi G, Orestano F. Incidence of Prostate Cancer in Sicily: Results of a Multicenter Case-Findings Protocol. Eur Urol 2005; 47:569-74. [PMID: 15826745 DOI: 10.1016/j.eururo.2004.11.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2004] [Accepted: 11/17/2004] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To establish the incidence of prostate cancer (PCa) in Sicily in patients who entered an early detection protocol. METHODS From February 2002 to February 2004, 16,298 subjects aged 40-75 entered the protocol. Patients with suspicious DRE, PSA>10 ng/ml, PSA<or=2.5 ng/ml, from 2.6 to 4 ng/ml or from 4.1 to 10 ng/ml with F/T PSA of <or=15%, <or=20% and <or=25% respectively underwent needle biopsy according to an extensive protocol. RESULTS 3266 patients were eligible for biopsy; PSA was <or=4 in 12.7% and <or=10 ng/ml in 63.9% of patients. A PCa was found in 1171 cases (36.9%) with a relationship between PCa incidence and PSA and age respectively (chi2-test, p<0.0001); 51.8% of patients with PCa had a PSA<10 and 8.8% a PSA<4 ng/ml; 49% were clinically staged as T1c. The estimated odds ratios for each age group showed increased risk for PCa in the fourth decade with PSA between 2.6 and 4 ng/ml (12.5 times higher) and in the fifth decade with PSA between 4.1 and 10 ng/ml (6.2 times higher). CONCLUSIONS Age and serum PSA levels are the major risk factors for PCa. On their basis it is possible to modulate the most suitable timing for early diagnosis in individual patients.
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Affiliation(s)
- F Aragona
- Urology Unit, Azienda Ospedaliera Cannizzaro, Via Messina 829, 95126 Catania, Italy.
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32
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Bari M, Rosario D???Andrea M, Azzarello G, Pappagallo GL, Sartori D, Iop A, Gaion F, Rosetti F, Silvestri B, Bonura S, D???Alessio A, Vinante O. Salvage Therapy with Capecitabine Plus Weekly Paclitaxel in Heavily Pretreated Advanced Breast Cancer. ACTA ACUST UNITED AC 2005. [DOI: 10.2165/00024669-200504050-00003] [Citation(s) in RCA: 4] [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: 11/02/2022]
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Di Cataldo A, Azzarello G, Lanteri R, Licitra E, Licata A. [Alcohol sclerotherapy of biliary cysts. Our experience]. G Chir 2005; 26:17-20. [PMID: 15847088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
AIM OF THE STUDY To evaluate if percutaneous ethanol injection treatment, introduced twelve years ago as palliative therapy for inoperable hepatocellular carcinoma, can be used with curative intent to treat biliary cysts with good results. MATERIALS AND METHODS For the study were observed 13 symptomatic patients (M 4; F 9 - age 38-71, medium 54 years). All the patients were treated by percutaneous alcoholization under ultrasonographic control. RESULTS Better technique and protocol standardisation give us the possibility to utilise percutaneous ethanol injection like a good treatment for symptomatic patients. CONCLUSIONS Easy technique, low cost and very small number of complications gives to percutaneous ethanol injection the possibility to become the gold standard for the treatment of biliary cysts.
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Affiliation(s)
- A Di Cataldo
- Service de Chirurgie Generale, Université de Catania
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34
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Barbato F, Marchioro G, Bari M, Azzarello G, Vattemi E, Sartori D, Dandrea M, Minotto C, Anzolin C, Vinante O. Premorbidity personality traits and coping strategies in chemotherapy-treated cancer patients. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.8202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- F. Barbato
- Department of Oncology & Haemato-Oncology, PF Calvi Hospital Noale (VE), Italy
| | - G. Marchioro
- Department of Oncology & Haemato-Oncology, PF Calvi Hospital Noale (VE), Italy
| | - M. Bari
- Department of Oncology & Haemato-Oncology, PF Calvi Hospital Noale (VE), Italy
| | - G. Azzarello
- Department of Oncology & Haemato-Oncology, PF Calvi Hospital Noale (VE), Italy
| | - E. Vattemi
- Department of Oncology & Haemato-Oncology, PF Calvi Hospital Noale (VE), Italy
| | - D. Sartori
- Department of Oncology & Haemato-Oncology, PF Calvi Hospital Noale (VE), Italy
| | - M. Dandrea
- Department of Oncology & Haemato-Oncology, PF Calvi Hospital Noale (VE), Italy
| | - C. Minotto
- Department of Oncology & Haemato-Oncology, PF Calvi Hospital Noale (VE), Italy
| | - C. Anzolin
- Department of Oncology & Haemato-Oncology, PF Calvi Hospital Noale (VE), Italy
| | - O. Vinante
- Department of Oncology & Haemato-Oncology, PF Calvi Hospital Noale (VE), Italy
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35
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Balducci E, Azzarello G, Valenti MT, Capuzzo GM, Pappagallo GL, Pilotti I, Ausoni S, Bari M, Rosetti F, Sartori D, Ciappa A, Porcellini A, Vinante O. The impact of progenitor enrichment, serum, and cytokines on the ex vivo expansion of mobilized peripheral blood stem cells: a controlled trial. Stem Cells 2003; 21:33-40. [PMID: 12529549 DOI: 10.1634/stemcells.21-1-33] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The aim of this study was to verify, and possibly improve, culture conditions to expand human mobilized peripheral blood stem cells (PBSCs). We investigated the role of three parameters: A) the culture medium (serum-free versus serum-dependent); B) the initial cell population (Ficoll-separated mononucleated cells versus CD34(+)-selected cells), and C) the low concentration of recombinant cytokines, flt3 ligand, and thrombopoietin in association with a basic cocktail of stem cell factor, interleukin (IL)-6, IL-3, GM-CSF, and erythropoietin. Eighteen leukapheresis samples were monitored in static culture for 15 days. The expansion potential was assessed at day 10 and 15 by total nuclear cells, colony-forming-units (CFUs) (burst-forming units-erythroid [BFU-E], colony-forming units-granulocyte-macrophage [CFU-GM], and colony-forming units-granulocyte-erythroid-macrophage-megakaryocyte [CFU-GEMM]), and flow cytometry immunophenotyping (CD34(+)/CD38(-), CD38(+), CD33(+), CD41(+), GlyA(+) progenitor cells). The results, evaluated by multivariate analysis of variance, emphasize that some variables affected the outcome of stem and progenitor cell expansion. CD34(+) enrichment increased expansion of total nuclear cells, number of CD38(+) and CD33(+) late precursors, and number of the CFU-GM compartment. Interestingly, however, quantitative expansion of GlyA(+) and the early progenitor cells (CD34(+)/CD38(-), CFU-GEMM, BFU-E) are favored by the use of unselected mononucleated cells. Regarding the role of serum, no significant difference was observed except for expansion of total nuclear cells, CFU-GM, and BFU-E. Cytokine combinations, in particular the use of flt3 ligand, stimulated expansion of almost all the cellular subsets, reaching a statistical significance for total nuclear cells and CFU-GM. Our study indicates that progenitor and late precursor multilineage cell compartments of mobilized PBSCs may be significantly expanded in short-term cultures by well-defined experimental conditions. Furthermore, these data might be useful when evaluating ex vivo expansion of hematopoietic cells for clinical purposes.
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Affiliation(s)
- Elena Balducci
- Department of Oncology and Hemato-Oncology, PF Calvi Hospital, Noale (VE), Italy
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Di Carlo I, Fraggetta F, Lombardo R, Azzarello G, Vasquez E, Puleo S. CD 34 expression in chronic and neoplastic liver diseases. Panminerva Med 2002; 44:365-7. [PMID: 12434120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Abstract
BACKGROUND Capillarisation of hepatic sinusoids is a well recognized phenomen occurring in long standing liver disease, in hepatic cirrhosis as well as in hepatocellular carcinoma. To study immunohistochemically the expression and distribution of CD34 in chronic liver disease and hepatocellular carcinoma in order to evaluate the possible diagnostic implication of this marker. METHODS Sixty-five samples of liver tissue showing normal liver, different degrees of chronic inflammation, cirrhosis and histological features of hepatocellular adenoma and carcinoma (HCC) were included in the study. The specimens were fixed in formalin and embedded in paraffin and an immunohistochemical investigation was performed by the standard avidin-biotin-peroxidase complex method with CD34. RESULTS The sinusoids of normal liver showed no immunoreactivity. The sinusoids of liver affected by different degrees of chronic active hepatitis showed no or focal immunostaining for CD34; an increased immunoreactivity was observed in the periportal sinusoids of the cirrhotic nodules whereas diffuse and strong staining was observed in the overall HCC as well as in the hepatocellular adenoma tested. CONCLUSIONS In HCC, immunoreactivity for CD34 represents an effective method to evaluate angiogenesis and to distinguish well-differentiated HCC from non-neoplastic liver. Its role in clinical stage and prognostic evaluation needs further investigation.
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Affiliation(s)
- I Di Carlo
- Department of Surgical Sciences, Organ Transplantation and Advanced Technologies, University of Catania, Catania, Italy.
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Valenti MT, Sartore S, Azzarello G, Balducci E, Amadio M, Sandri M, Pappagallo GL, Tacchetti G, Bari M, Manconi R, D'Andrea MR, Silvestri B, Vinante O. Human fibroblasts from normal and malignant breast tissue grown in vitro show a distinct senescence profile and telomerase activity. Histochem J 2002; 34:403-10. [PMID: 12814188 DOI: 10.1023/a:1023635521069] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The telomerase activity and the senescence profile of cultured breast fibroblasts from normal human interstitial and malignant stromal tissue were studied in comparison with their proliferation and differentiation pattern. Fibroblasts were grown either in the presence or absence of a conditioned medium (CM) obtained from cultures of the oestrogen receptor-positive breast cancer MCF-7 cell line. At different passages (from the 2nd up to the 48th), fibroblasts were examined for the telomerase activity by the Telomerase Repeats Amplification Protocol (TRAP) assay, for proliferation profile by Ki-67 antigen expression, and the myofibroblast or smooth muscle cell-like differentiation pattern by immunofluorescence with monoclonal antibodies specific for smooth muscle markers. Serial passages of fibroblasts from normal or tumour breast reveal that the relationship between the levels of telomerase activity and phenotypic/proliferation profile changes with cell subcultivation in a different manner in the two cell populations. The fibroblasts from normal tissue completed 12 passages in a CM-independent way prior to senescence whereas fibroblasts from tumour stroma senescence were attained after 48 passages. These cells showed a marked decrease of telomerase activity, growth rate and smooth muscle alpha-actin expressing myofibroblasts after the 32nd passage. CM treatment of this fibroblast population induces a decline in the myofibroblast content, which precedes the changes in telomerase activity. Passaged fibroblasts from normal breast tissue can be converted to myofibroblasts upon CM treatment whereas those from tumour stroma were CM-insensitive. Taken together our data suggest that a heterogeneous fibroblast population with different life span is activated/recruited in the breast interstitium and poses the problem of a unique activation/recruitment of fibroblasts in neoplastic conditions.
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Affiliation(s)
- Maria Teresa Valenti
- Department of Oncology and Haematoncology, PF Calvi Hospital, Noale (Venice), Italy
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Valenti MT, Azzarello G, Balducci E, Sartore S, Sandri M, Manconi R, Sicari U, Bari M, Vinante O. Conditioned medium from MCF-7 cell line induces myofibroblast differentiation, decreased cell proliferation, and increased apoptosis in cultured normal fibroblasts but not in fibroblasts from malignant breast tissue. Histochem J 2001; 33:499-509. [PMID: 12005021 DOI: 10.1023/a:1014927305775] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
We studied the effect of conditioned medium (CM) obtained from cultures of oestrogen-receptor positive breast cancer MCF7 cell line on the differentiation, proliferation and apoptosis patterns of cultured breast fibroblasts from normal interstitial and malignant stromal tissue. Fibroblasts were grown in the presence or absence of CM and examined for the differentiation pattern by immunofluorescence and Western blotting procedures, for proliferation profile by Ki67 expression, and for apoptosis by the terminal deoxynucleotidyl transferase-mediated dUTP nick-end labelling technique. Monoclonal antibodies specific for non-muscle (NM), smooth muscle (SM) lineage and differentiation markers were applied to these cultures. CM is able to induce a SM-like differentiation in interstitial fibroblasts, i.e., essentially myofibroblast formation. Fibroblasts from tumour stroma showed the presence of a small number of smooth muscle cells (SMC) along with a large number of myofibroblasts. Treatment of these cultures with CM was unable to change this pattern. Only normal fibroblasts were responsive to the proliferation/apoptotic-inhibitory effect of the CM. These data suggest that structural and functional differences exist between stromal fibroblasts from normal breast and breast cancer with respect to the responsiveness to soluble factors present in the CM. We hypothesize that the lack of in vitro sensitivity to CM shown by 'tumour' fibroblasts is the result of an in vivo inherent and stable phenotypic change on the fibroblasts surrounding breast tumour cells occurring via a paracrine mechanism.
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Affiliation(s)
- M T Valenti
- Department of Oncology and Haematological Oncology, P.F. Calvi Hospital, Noale, Venice, Italy
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Puleo S, Lombardo R, Li Destri G, Azzarello G, Rinzivillo C, Di Carlo I. Multimodal therapy of hepatocarcinoma: personal experience on 90 cases. Hepatogastroenterology 2000; 47:1379-81. [PMID: 11100356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
BACKGROUND/AIMS In recent years, surgical and non-surgical options have been developed in the treatment of hepatocellular carcinoma in cirrhotic patients. We review our personal series from 1995-1999, in order to assess the choice of treatment. METHODOLOGY Of 90 cases of hepatocellular carcinoma observed in the years 1995-1999, 15 underwent curative resective surgery; in 42 cases TAE, PEI or RITA were utilized (9 of them as multimodal therapy). In the remaining 33 patients any kind of therapy was scheduled. RESULTS The mean survival of the 15 resected patients was 18 months, non-statistically better than RITA survival, compared by Log-Rank test. Perioperative mortality calculated in all procedures was 5.2% (2 pts surgery, 1 pt TAE). CONCLUSIONS The high percentage of not treated hepatocellular carcinomas in our series is generally due to large tumor size diagnosed in advanced Child's stage. PEI, TAE and RITA have to be considered effective and safe for palliation for HCCs. However, surgical resection represents the curative therapy in selected cirrhotic patients affected by HCC.
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Affiliation(s)
- S Puleo
- Ia Clinica Chirurgica, Università di Catania, Italy
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40
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Marchioro G, Azzarello G, Viviani F, Barbato F, Pavanetto M, Rosetti F, Pappagallo GL, Vinante O. Hypnosis in the treatment of anticipatory nausea and vomiting in patients receiving cancer chemotherapy. Oncology 2000; 59:100-4. [PMID: 10971166 DOI: 10.1159/000012144] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
AIMS AND BACKGROUND In addition to nausea and vomiting following chemotherapy treatment, cancer patients can experience these side effects prior to a treatment session, the so-called anticipatory nausea and vomiting. As various psychological and neurophysiological aspects have been claimed to be implied in its etiopathogenesis, the present paper aims to shortly review the etiological, epidemiological and therapeutical assumptions on the topic, in particular the psychological-behavioral therapies. PATIENTS AND METHODS The present study was carried out on 16 consecutive adult cancer patients affected by chemotherapy-induced anticipatory nausea and vomiting who had received at least four treatment cycles. All of them were submitted to induction of relaxation followed by hypnosis. RESULTS In all subjects anticipatory nausea and vomiting disappeared, and major responses to chemotherapy-induced emesis control were recorded in almost all patients. CONCLUSIONS The experience highlights the potential value of hypnosis in the management of anticipatory nausea and vomiting; furthermore, the susceptibility to anticipatory nausea and vomiting is discussed under the psychoanalytic point of view.
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Affiliation(s)
- G Marchioro
- Department of Oncology, Local Health Unit No. 13, Noale, Italy
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41
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Pennisi F, Farina R, Ponzio R, Fragione D, Lombardo R, Azzarello G, Puleo S. [Role of color Doppler ultrasonography with contrast media in the monitoring of hepatocarcinoma after intralesional treatment]. Radiol Med 1999; 97:144-7. [PMID: 10363055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
INTRODUCTION We investigated the accuracy of contrast-enhanced color Doppler US in the assessment of the effectiveness of intralesional treatment of hepatocarcinomas. MATERIAL AND METHODS Eight cirrhotic patients (HCV+), Child-Pugh class B, with a single hepatocarcinoma (< 4 cm O) and ineligible for surgical resection for various reasons (age > 70 years, reduced partial hepatic reserve, esophageal varices at risk, postoperative recurrence, no consent to the operation) were submitted to radiohyperthermia (6 patients) and percutaneous alcoholization (2 patients). The diagnosis was made with alpha-fetoprotein titration. CT, B-mode and color Doppler US with the administration of Levovist (Schering AG, Berlin, Germany). Thirty and 60 days after the treatment, both the alpha-fetoprotein titration and contrast-enhanced color Doppler US were repeated. RESULTS Baseline color Doppler was carried out before intralesional treatment in the 8 patients and was followed by Levovist color Doppler which showed some intralesional signals, afferent vessels and rich vascularization in all the lesions. At the first follow-up (30 days), no intralesional vascular signals or afferent vessels were detected in any patient, while rich peripheral vascularization persisted in all cases, even after radiofrequency and alcoholization treatments. At 60 days' follow-up, the color Doppler pattern of all cases was the same as at 30 days. CONCLUSIONS The absence of any intralesional vascular signals in all the treated patients and the possible demonstration of complete tumor necrosis seem to confirm the important role of contrast-enhanced color Doppler US in monitoring focal hepatic lesions after intralesional treatment.
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Affiliation(s)
- F Pennisi
- Istituto di Radiologia, Università degli Studi, Catania
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42
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Azzarello G, Pappagallo G, Vinante O. Infiltrating Bladder Cancer: Chemotherapy. Urologia 1998. [DOI: 10.1177/039156039806500405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Radical cystectomy associated with bilateral pelvic lymphadenectomy is the elective treatment for infiltrating urothelial carcinoma. Although it may be curative, about 50% of patients have recurrences after 2 years, generally at a systemic level. Pelvic node recurrence, however, accounts for a certain rate of mortality. With regard to prognosis, the most important factor for survival is the stage, with overall survival at 5 years varying from 60–80% for pT2 lesions down to 0–18% for pT4 lesions and for patients with positive lymph nodes from 4 to 30%. Adjuvant and neo-adjuvant chemotherapy programmes have therefore been developed in an attempt to improve the percentages of recurrences and of overall survival and perhaps later to increase the possibilities of organ preservation. Chemotherapeutic indications in metastatic and locally advanced disease are therefore reviewed.
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Affiliation(s)
- G. Azzarello
- Dipartimento di Oncologia ed Ematologia Oncologica - ULSS N. 13 Regione Veneto - Presidio Ospedaliero - Noale (Venezia)
| | - G.L. Pappagallo
- Dipartimento di Oncologia ed Ematologia Oncologica - ULSS N. 13 Regione Veneto - Presidio Ospedaliero - Noale (Venezia)
| | - O. Vinante
- Dipartimento di Oncologia ed Ematologia Oncologica - ULSS N. 13 Regione Veneto - Presidio Ospedaliero - Noale (Venezia)
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Valenti MT, Azzarello G, Vinante O, Manconi R, Balducci E, Guidolin D, Chiavegato A, Sartore S. Differentiation, proliferation and apoptosis levels in human leiomyoma and leiomyosarcoma. J Cancer Res Clin Oncol 1998; 124:93-105. [PMID: 9654192 DOI: 10.1007/s004320050140] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A comparative analysis of the differentiation pattern, the proliferative behaviour, and the level of apoptosis between human benign and malignant neoplasms of smooth-muscle (SM) tissue is lacking. The clinical, histopathological, immunochemical, and immunocytochemical features of leiomyomas (LM) and leiomyosarcomas (LMS) were investigated by a panel of monoclonal antibodies specific for some differentiation markers of SM tissue (SM myosin and alpha-actin, desmin, and SM22) and for markers of non-muscle tissue (vimentin and non-muscle myosin). Proliferating normal and neoplastic cells were identified by proliferating-cell nuclear antigen (PCNA)/Ki67 immunostainings and the apoptotic cells were revealed by means of the terminal-deoxynucleotidyltransferase-mediated dUTP nick-end labelling technique. Gel electrophoresis and Western blotting, performed with anti-(SM1/SM2 myosin isoform) antibody, indicated quantitative differences between LMS and LM, which mirrored higher positive to negative nuclear ratios for PCNA, Ki67 and apoptosis in malignant as opposed to benign neoplasms. With LM, however, a similar SM1 to SM2 ratio could be associated with different proliferation levels. Uterine, gastric and intestinal LMS displayed specific patterns of SM1/SM2 and/or non-muscle myosin expression that were not paralleled by different levels of proliferation/apoptosis. While the level of PCNA/Ki67 correlated with the level of apoptosis in normal SM tissues and LM, that of LMS did not. In vivo at the cellular level, LM and uterine LMS displayed a near-uniform SM tissue differentiation, whereas the other LMS displayed a lesser or a heterogeneous immunoreactivity. In vitro, cultured LMS cells showed a limited and peculiar expression of SM myosin. In conclusion, there is no reciprocal relationship between degree of differentiation and the level of proliferation, as exemplified by the finding that the less differentiated intestinal LMS displays the lowest proliferative behaviour and that the relatively more differentiated gastric LMS/metastasis is more proliferative.
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Affiliation(s)
- M T Valenti
- Department of Medical Oncology, U.L.S.S. 13, Noale, Venice, Italy
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Capriani A, Chiavegato A, Franch R, Azzarello G, Vinante O, Sartore S. Oestrogen-dependent expression of the SM2 smooth muscle-type myosin isoform in rabbit myometrium. J Muscle Res Cell Motil 1997; 18:413-27. [PMID: 9276335 DOI: 10.1023/a:1018642713934] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Ovarectomized rabbits displayed a decreased SM1 to SM2 ratio of smooth muscle-type myosin heavy chain isoforms compared to unoperated, virgin females which was reversed after 17beta-oestradiol administration to a value similar to that of control animals. When this steroid was given to sexually immature animals or to adult virgin rabbits, SM2 expression was not induced, as also happened with proliferating myometrial smooth muscle cells grown in vitro. In growing rabbit, the 17beta-oestradiol administration induced the formation of the circular and the longitudinal muscle layers, characteristics of sexually competent females. The SM2 isoform was up-regulated during postnatal development and the SM1 to SM2 ratio changed during pregnancy and post-partum period but not with human gonadotropin treatment which increases the level of circulating progesterone. Immunofluorescence staining of adult myometrium with anti-SM2 antibody indicated that this isoform is localized to the longitudinal layer exclusively and, in contrast to the circular layer, its expression was independent of oestrogen level. Difference in oestrogen sensitivity between the two layers was also detected for the expression of the intermediate filament protein vimentin and the thin filament protein calponin. Changes of SM2 expression in the myometrium correlated with variations in the oestrogen receptor density as also confirmed by decreased SM2 content/oestrogen receptor density in the circular layer when ovarectomized females were treated with the oestrogen antagonist ICI 182,780. Our results indicate that: (1) a specific distribution of myosin heavy chain exists within rabbit myometrium, and (2) SM2 myosin expression in this smooth muscle is under oestrogen control.
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Affiliation(s)
- A Capriani
- Department of Biomedical Sciences, University of Padua, Italy
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Marchioro G, Azzarello G, Checchin F, Perale M, Segati R, Sampognaro E, Rosetti F, Franchin A, Pappagallo GL, Vinante O. The impact of a psychological intervention on quality of life in non-metastatic breast cancer. Eur J Cancer 1996; 32A:1612-5. [PMID: 8911127 DOI: 10.1016/0959-8049(96)00134-7] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The aim of this study was to determine whether psychological intervention had a beneficial effect on the quality of life and behaviour of women diagnosed with breast cancer. 36 consecutive patients with non-metastatic breast cancer assigned to surgery and systemic chemotherapy were randomised to receive either psychological intervention (weekly cognitive individual psychotherapy and bimonthly family counselling) or standard follow-up. Personality (16-PF and IIQ), quality of life (FLIC), and depression (BDI) scores were the endpoints for this study, and the questionnaires were completed by the patients at diagnosis, and up to 9 months after diagnosis. Cognitive psychotherapy and family counselling improved both depression and quality of life indexes compared with the control group. Better emotional coping behaviours were also revealed by some changes in personality traits in the intervention group.
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Affiliation(s)
- G Marchioro
- Centro Oncologico Multizonale, ULSS No. 13, Noale (VE), Italy
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Chiavegato A, Capriani A, Azzarello G, Vinante O, Pauletto P, Sartore S. Expression of non-muscle myosin isoforms in rabbit myometrium is estrogen-dependent. Cell Tissue Res 1996; 283:7-18. [PMID: 8581961 DOI: 10.1007/s004410050507] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The putatative effects of different estrogen levels on the expression of non-muscle myosin isoforms in rabbit myometrium have been investigated using three monoclonal anti-platelet myosin heavy chain (MyHC) antibodies (NM-F6, NM-G2, and NM-A9). Western blotting analysis of proteolytic digests of human platelet actomyosin indicates that these antibodies are specific for three distinct epitopes. Comparative immunofluorescence tests on cultered human fibroblasts with polyclonal sequence-specific anti-MyHCA antibody suggest that the patterns of NM-F6, NM-.G2 and NM-A9, although similar, do not overlap with that of type-A MyHC. Distribution of NM myosin isoforms has been studied in indirect immunofluorescence assays using cryosections of tissues from rabbits at various stages of development, pregnancy, or from ovariectomized, 17beta-estradiol-treated ovariectomized, and human chorionic gonadotropin-treated animals. Non-muscle myosin antigenicity is still present in the myometrium when the female becomes sexually competent. The immunoreactivity of non-muscle myosin for NM-F6 is steroid-independent, since it does not change with pregnancy or ovariectomy, but that of NM-G2 is estrogen-dependent; the latter disappears during pregnancy and in ovariectomized animals treated with estradiol, whereas it is expressed in ovariectomized rabbits. Although non-muscle myosin immunoreactivity for NM-A9 is detectable under all the experimental conditions, it can assume different patterns of intracellular distribution in vitro (punctate vs filamentous), depending on culture conditions and the presence of estrogens.
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Affiliation(s)
- A Chiavegato
- Department of Biomedical Sciences, University of Padua, Padua, Italy
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Segati R, Bari M, Azzarello G, Signorelli C, Marchini M, Fiaccavento G, Longo M, Pappagallo GL, Vinante O. Carboplatin monochemotherapy in elderly patients with nonoperable transitional cell carcinoma of the bladder: a two-stage, phase II study. Eur Urol 1996; 29:312-6; discussion 317. [PMID: 8740038 DOI: 10.1159/000473767] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Elderly patients with nonoperable transitional cell carcinoma of the bladder need a rather active, but less toxic treatment than full-dose polychemotherapy. This study was designed to determine whether the cisplatin-analogue carboplatin (which is less nephrotoxic and less neurotoxic than the parent compound) has sufficient activity against T2-T4 neoplasms (both nonmetastatic and metastatic) to warrant further development in phase III trials. Carboplatin dose was adjusted according to creatinine clearance, with a maximum dose of 300 mg/m2. The patient selection for this screening for activity was adjusted by the use of the 'optimal' two-stage design. Seventeen patients were enrolled, with a median age of 78 years (range: 70-85), a median performance status of 80% (range: 70-90%); 13 patients were lymph node-negative (10 T2, 2 T3, 1 T4) and 4 had locoregional or distant node metastases. Nine patients had a complete response (3 in the first, 9-patient, stage, and 6 in the second, 8-patient, stage), demonstrating that carboplatin had sufficient activity (at the 'desirable' target level of 35%); almost all responses were observed in T2 patients. Six patients had stable disease, and 2 had disease progression during treatment. The toxicity was acceptable, with only 41% of patients having grade II-III hematologic toxicity. More than 30% of patients were estimated to be free from progressive disease (54% alive) at 24 months. In our opinion carboplatin is suitable to be tested-in a phase III testing versus full-dose radiation therapy-as adjuvant after initial transurethral resection of the prostate in elderly patients with T2 transitional cell carcinoma of the bladder considered radically nonoperable for medical problems.
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Toffoli G, Vinante O, Rosetti F, Azzarello G, Gigante M, Zanuttini D, Viel M, Nicolosi GL, Sartori F, Pascotto P, Fantin D, Frustaci S, Boiocchi M. Racemic verapamil (VER) as a chemosensitizer agent of doxorubicin (DOX) in human colorectal cancer (HCC). Anticancer Drugs 1994. [DOI: 10.1097/00001813-199409001-00144] [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]
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49
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Bari M, Segati R, Azzarello G, Sampognaro E, Rosetti F, Pappagallo G, Manconi R, Lodi P, Vinante O. Primary cutaneous B-cell lymphoma (CBCL). Eur J Cancer 1994. [DOI: 10.1016/0959-8049(94)90841-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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50
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Vinante O, Bari M, Segati R, Azzarello G, Sampognaro E, Rosetti F, Pappagallo GL. The combination of mitomycin, vinblastine and cisplatin is active in the palliation of stage IIIB-IV non-small-cell lung cancer. Oncology 1993; 50:1-4. [PMID: 8380631 DOI: 10.1159/000227137] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Twenty-eight patients with stage IIIB-IV non-small-cell lung cancer were treated with mitomycin C, vinblastine and cisplatin (MVP) in a phase II--minimax 2-stage design--randomized trial (with cisplatin plus etoposide as control arm). As indicated by the study design, the accrual was stopped after the 11th responder, and the combination was considered as active at the 40% level. Forty-six percent of patients had an improvement of their initial Karnofsky performance score, lasting a median of 24 weeks, and about 38% had a complete relief of symptoms. Hematologic toxicity was moderate to severe in about 50% of patients, and neurologic toxicity in about 18%; no grade 4 toxicity was observed. The estimated median progression-free survival was of 25 weeks. The observed activity and manageability, together with the positive effect on patient quality of life, account for a positive evaluation of MVP as a palliative treatment in advanced non-small-cell lung cancer.
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Affiliation(s)
- O Vinante
- Centro Oncologico Multizonale, ULSS17, Noale, Italia
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