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Pino MS, Cheli S, Perna M, Fabbroni V, Giordano C, Martella F, Lanini F, Ribecco AS, Scoccianti S, Bacci C, Baldazzi V, Bertolini I, Di Leonardo G, Fulignati C, Grifoni R, Molinara E, Rangan S, Tassi R, Furlan F, Goldzweig G, Bassetti A, Fioretto L. The national COVID-19 vaccination campaign targeting the extremely vulnerable: the Florence Medical Oncology Unit experience in patients with cancer. Eur J Cancer 2022; 170:149-157. [PMID: 35635936 PMCID: PMC9020512 DOI: 10.1016/j.ejca.2022.04.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 03/19/2022] [Accepted: 04/01/2022] [Indexed: 01/17/2023]
Abstract
BACKGROUND International and national oncology societies had released recommendations in favor of COVID-19 vaccination in cancer patients. In the context of the national vaccination campaign targeting the so called extremely vulnerable, we aimed to assess the safety and efficacy of the mRNA vaccines in a cohort of 623 patients. METHODS Between March 26 and April 04, 2021, the Pfizer and BioNTech BNT162b2 mRNA and the Moderna mRNA-1273 vaccines were given as a two-dose prime-boost regimen. Starting on September 25th 2021 a third dose was offered to patients in whom a suboptimal immunogenicity with COVID-19 vaccination could be expected. Safety assessments were performed by phone call 7 days after each dose. Electronic health records were accessed to review demographic information, disease history, treatment detail, and outcome events of participants patients'. FINDINGS No toxicities were reported in 63.7%, 54%, and in 48.7% patients with cancer after each dose. Mild-to-moderate pain at the injection site was the most commonly adverse event. After the second dose, 46% of the 610 patients reported toxicity, with more systemic side-effects observed. Fever was reported in 45% of patients, with a temperature ≥ 38 °C in 21.4% of them. Of the 335 patients receiving a third vaccine dose, 51% reported toxicity, with 13% of patients reporting more than one effect. Logistic regression analysis reported mixed results, with limited variables or categories reporting a significant odd ratio. The type of vaccine reported a significant value at first dose (OR = 0.12; CI 0.52, 0.26; p = 0.00). Thirty-four cases of COVID-19 infection were reported with only one patient requiring a short-term hospitalization for monitoring. INTERPRETATION The safety profile of the mRNA vaccines does not raise any specific concerns and support prioritization of vaccination for cancer patients.
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Affiliation(s)
- Maria S Pino
- Medical Oncology Unit - Florence, Department of Oncology, Azienda USL Toscana Centro, Italy.
| | - Simone Cheli
- School of Human Health Sciences, University of Florence, Italy
| | - Marco Perna
- Medical Oncology Unit - Florence, Department of Oncology, Azienda USL Toscana Centro, Italy
| | - Valentina Fabbroni
- Medical Oncology Unit - Florence, Department of Oncology, Azienda USL Toscana Centro, Italy
| | - Clara Giordano
- Medical Oncology Unit - Florence, Department of Oncology, Azienda USL Toscana Centro, Italy
| | - Francesca Martella
- Medical Oncology Unit - Florence, Department of Oncology, Azienda USL Toscana Centro, Italy
| | - Fabio Lanini
- Medical Oncology Unit - Florence, Department of Oncology, Azienda USL Toscana Centro, Italy
| | - Angela S Ribecco
- Medical Oncology Unit - Florence, Department of Oncology, Azienda USL Toscana Centro, Italy
| | - Silvia Scoccianti
- Radiation Oncology Unit - Florence, Department of Oncology, Azienda USL Toscana Centro, Italy
| | - Carlotta Bacci
- Medical Oncology Unit - Florence, Department of Oncology, Azienda USL Toscana Centro, Italy
| | - Valentina Baldazzi
- Medical Oncology Unit - Florence, Department of Oncology, Azienda USL Toscana Centro, Italy
| | - Ilaria Bertolini
- Medical Oncology Unit - Florence, Department of Oncology, Azienda USL Toscana Centro, Italy
| | - Greta Di Leonardo
- Medical Oncology Unit - Florence, Department of Oncology, Azienda USL Toscana Centro, Italy
| | - Chiara Fulignati
- Medical Oncology Unit - Florence, Department of Oncology, Azienda USL Toscana Centro, Italy
| | - Raffaella Grifoni
- Medical Oncology Unit - Florence, Department of Oncology, Azienda USL Toscana Centro, Italy
| | - Elena Molinara
- Medical Oncology Unit - Florence, Department of Oncology, Azienda USL Toscana Centro, Italy
| | - Sheila Rangan
- Medical Oncology Unit - Florence, Department of Oncology, Azienda USL Toscana Centro, Italy
| | - Renato Tassi
- Medical Oncology Unit - Florence, Department of Oncology, Azienda USL Toscana Centro, Italy
| | - Federica Furlan
- Direzione Sanitaria, Santa Maria Annunziata Hospital, Azienda USL Toscana Centro, Italy
| | - Gil Goldzweig
- The Academic College of Tel Aviv - Yaffo, Tel Aviv, Israel
| | - Andrea Bassetti
- Direzione Sanitaria, Santa Maria Annunziata Hospital, Azienda USL Toscana Centro, Italy
| | - Luisa Fioretto
- Medical Oncology Unit - Florence, Department of Oncology, Azienda USL Toscana Centro, Italy
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2
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Crucitta S, Restante G, Del Re M, Bertolini I, Bona E, Rofi E, Fontanelli L, Gianfilippo G, Fogli S, Stasi I, Ghilli M, Fontana A, Danesi R. Endothelial nitric oxide synthase c.-813C>T predicts for proteinuria in metastatic breast cancer patients treated with bevacizumab-based chemotherapy. Cancer Chemother Pharmacol 2019; 84:1219-1227. [PMID: 31529205 DOI: 10.1007/s00280-019-03933-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 08/21/2019] [Indexed: 02/03/2023]
Abstract
PURPOSE To investigate the association between single nucleotide polymorphisms (SNPs) in endothelial nitric oxide synthase (eNOS) and interleukin-8 (IL-8) genes and risk of developing bevacizumab-related adverse events in metastatic breast cancer (mBC) patients. PATIENTS AND METHODS mBC patients candidate to receive bevacizumab-based chemotherapy were enrolled in this pharmacogenetic study. eNOS c.-813C>T and c.894G>T, and IL-8 c.-251A>T were analyzed by real time PCR on genomic DNA extracted from peripheral blood. Univariate analysis was performed to test the association between each SNP and treatment-related toxicities. RESULTS Seventy-six mBC patients were enrolled in the present study. Patients carrying the homozygous variant eNOS c.-813TT genotype showed a statistically significant occurrence of any grade proteinuria when compared to CT or CC genotypes (p = 0.004). No significant association of proteinuria with IL-8 SNP or hypertension with selected eNOS and IL-8 SNPs was found. CONCLUSIONS These findings suggest an association between the eNOS c.-813C>T polymorphism and the development of proteinuria in mBC patients receiving a bevacizumab-based chemotherapy.
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Affiliation(s)
- Stefania Crucitta
- Unit of Clinical Pharmacology and Pharmacogenetics, Department of Clinical and Experimental Medicine, University of Pisa, 55, Via Roma, 56126, Pisa, Italy
| | - Giuliana Restante
- Unit of Clinical Pharmacology and Pharmacogenetics, Department of Clinical and Experimental Medicine, University of Pisa, 55, Via Roma, 56126, Pisa, Italy
| | - Marzia Del Re
- Unit of Clinical Pharmacology and Pharmacogenetics, Department of Clinical and Experimental Medicine, University of Pisa, 55, Via Roma, 56126, Pisa, Italy.
| | - Ilaria Bertolini
- Unit of Medical Oncology, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Eleonora Bona
- Unit of Medical Oncology, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Eleonora Rofi
- Unit of Clinical Pharmacology and Pharmacogenetics, Department of Clinical and Experimental Medicine, University of Pisa, 55, Via Roma, 56126, Pisa, Italy
| | - Lorenzo Fontanelli
- Unit of Clinical Pharmacology and Pharmacogenetics, Department of Clinical and Experimental Medicine, University of Pisa, 55, Via Roma, 56126, Pisa, Italy
| | - Giulia Gianfilippo
- Unit of Clinical Pharmacology and Pharmacogenetics, Department of Clinical and Experimental Medicine, University of Pisa, 55, Via Roma, 56126, Pisa, Italy
| | - Stefano Fogli
- Unit of Clinical Pharmacology and Pharmacogenetics, Department of Clinical and Experimental Medicine, University of Pisa, 55, Via Roma, 56126, Pisa, Italy
| | - Irene Stasi
- Unit of Medical Oncology, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Matteo Ghilli
- Unit of Breast Surgery, Breast Cancer Centre, University Hospital of Pisa, Pisa, Italy
| | - Andrea Fontana
- Unit of Medical Oncology, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Romano Danesi
- Unit of Clinical Pharmacology and Pharmacogenetics, Department of Clinical and Experimental Medicine, University of Pisa, 55, Via Roma, 56126, Pisa, Italy
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3
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Cantini L, Pistelli M, Merloni F, Fontana A, Bertolini I, De Angelis C, Bastianelli L, Della Mora A, Santinelli A, Savini A, Maccaroni E, Diodati L, Falcone A, Berardi R. Body Mass Index and Hormone Receptor Status Influence Recurrence Risk in HER2-Positive Early Breast Cancer Patients. Clin Breast Cancer 2019; 20:e89-e98. [PMID: 31378534 DOI: 10.1016/j.clbc.2019.06.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 06/06/2019] [Accepted: 06/20/2019] [Indexed: 11/18/2022]
Abstract
INTRODUCTION A reliable risk stratification on the basis of tumor biology and host factors of HER2-positive (HER2+) early breast cancer (eBC) patients is needed. The aim of our study was to assess the prognostic role of body mass index (BMI) and hormone receptor (HR) expression in this setting. PATIENTS AND METHODS We retrospectively evaluated 238 women with stage I to III HER2+ breast cancer who completed adjuvant chemotherapy (CHT) and 1 year of treatment with trastuzumab. The end point was 3-year distant disease-free survival (3yDDFS). Survival analysis was evaluated using the Kaplan-Meier method. Multivariate analysis was performed using Cox proportional-hazards model adjusting for HR status, BMI, tumor staging, size, nodal status, and type of adjuvant CHT. Association among categorical variables was assessed using χ2 test. RESULTS The early recurrence rate after 3 years resulted as 4.2% (40% HR+ patients and 60% HR- patients). Neither HR status nor BMI alone showed an association with 3yDDFS in multivariate analysis. However, the hazard ratios for patients with HR- tumors who had also BMI ≥25 (3yDDFS 86.9%; 95% confidence interval [CI], 75.0%-97.7%) were amplified compared with patients with HR+ tumors and with BMI <25 (3yDDFS 98%; 95% CI, 94.8%-100.0%) and other subgroups (P = .003). This observation was confirmed in multivariate analysis (hazard ratio, 1.79; 95% CI, 1.04-3.07; P = .03). CONCLUSION Our real-life data highlight a different risk of eBC recurrence after grouping patients according to HR status and BMI. These results might help clinicians to identify correct treatment strategies. Patients who are HR- and have BMI ≥25 might benefit from escalation approaches, whereas those who are HR+ and have BMI <25 might be eligible for a shorter duration of adjuvant treatment with anti-HER2 agents.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Biomarkers, Tumor/analysis
- Biomarkers, Tumor/metabolism
- Body Mass Index
- Breast/pathology
- Breast/surgery
- Breast Neoplasms/mortality
- Breast Neoplasms/pathology
- Breast Neoplasms/therapy
- Chemotherapy, Adjuvant/statistics & numerical data
- Disease-Free Survival
- Female
- Follow-Up Studies
- Humans
- Mastectomy
- Middle Aged
- Neoplasm Recurrence, Local/epidemiology
- Neoplasm Recurrence, Local/prevention & control
- Neoplasm Staging
- Prognosis
- Receptor, ErbB-2/analysis
- Receptor, ErbB-2/antagonists & inhibitors
- Receptor, ErbB-2/metabolism
- Receptors, Estrogen/analysis
- Receptors, Estrogen/metabolism
- Receptors, Progesterone/analysis
- Receptors, Progesterone/metabolism
- Retrospective Studies
- Risk Assessment/methods
- Time Factors
- Trastuzumab/therapeutic use
- Young Adult
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Affiliation(s)
- Luca Cantini
- Clinica Oncologica, Università Politecnica delle Marche, AOU Ospedali Riuniti, Ancona, Italy
| | - Mirco Pistelli
- Clinica Oncologica, Università Politecnica delle Marche, AOU Ospedali Riuniti, Ancona, Italy
| | - Filippo Merloni
- Clinica Oncologica, Università Politecnica delle Marche, AOU Ospedali Riuniti, Ancona, Italy
| | - Andrea Fontana
- Oncology Unit II, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Ilaria Bertolini
- Oncology Unit II, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | | | - Lucia Bastianelli
- Clinica Oncologica, Università Politecnica delle Marche, AOU Ospedali Riuniti, Ancona, Italy
| | - Arianna Della Mora
- Clinica Oncologica, Università Politecnica delle Marche, AOU Ospedali Riuniti, Ancona, Italy
| | - Alfredo Santinelli
- Anatomia Patologica e Citologia, AO Ospedali Riuniti Marche Nord, Pesaro, Italy
| | - Agnese Savini
- Clinica Oncologica, Università Politecnica delle Marche, AOU Ospedali Riuniti, Ancona, Italy
| | - Elena Maccaroni
- Clinica Oncologica, Università Politecnica delle Marche, AOU Ospedali Riuniti, Ancona, Italy
| | - Lucrezia Diodati
- Oncology Unit II, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Alfredo Falcone
- Oncology Unit II, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Rossana Berardi
- Clinica Oncologica, Università Politecnica delle Marche, AOU Ospedali Riuniti, Ancona, Italy.
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La Ferla M, Lessi F, Aretini P, Pellegrini D, Franceschi S, Tantillo E, Menicagli M, Marchetti I, Scopelliti C, Civita P, De Angelis C, Diodati L, Bertolini I, Roncella M, McDonnell LA, Hochman J, Del Re M, Scatena C, Naccarato AG, Fontana A, Mazzanti CM. ANKRD44 Gene Silencing: A Putative Role in Trastuzumab Resistance in Her2-Like Breast Cancer. Front Oncol 2019; 9:547. [PMID: 31297336 PMCID: PMC6607964 DOI: 10.3389/fonc.2019.00547] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 06/04/2019] [Indexed: 12/11/2022] Open
Abstract
Trastuzumab is an effective therapeutic treatment for Her2-like breast cancer; despite this most of these tumors develop resistance to therapy due to specific gene mutations or alterations in gene expression. Understanding the mechanisms of resistance to Trastuzumab could be a useful tool in order to identify combinations of drugs that elude resistance and allow a better response for the treated patients. Twelve primary biopsies of Her2+/hormone receptor negative (ER-/PgR-) breast cancer patients were selected based on the specific response to neoadjuvant therapy with Trastuzumab and their whole exome was sequenced leading to the identification of 18 informative gene mutations that discriminate patients selectively based on response to treatment. Among these genes, we focused on the study of the ANKRD44 gene to understand its role in the mechanism of resistance to Trastuzumab. The ANKRD44 gene was silenced in Her2-like breast cancer cell line (BT474), obtaining a partially Trastuzumab-resistant breast cancer cell line that constitutively activates the NF-kb protein via the TAK1/AKT pathway. Following this activation an increase in the level of glycolysis in resistant cells is promoted, also confirmed by the up-regulation of the LDHB protein and by an increased TROP2 protein expression, found generally associated with aggressive tumors. These results allow us to consider the ANKRD44 gene as a potential gene involved in Trastuzumab resistance.
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Affiliation(s)
- Marco La Ferla
- Fondazione Pisana per la Scienza - Genomic Section, Pisa, Italy
| | - Francesca Lessi
- Fondazione Pisana per la Scienza - Genomic Section, Pisa, Italy
| | - Paolo Aretini
- Fondazione Pisana per la Scienza - Genomic Section, Pisa, Italy
| | - Davide Pellegrini
- Fondazione Pisana per la Scienza - Proteomic Section, Pisa, Italy.,NEST, Scuola Normale Superiore, Pisa, Italy
| | - Sara Franceschi
- Fondazione Pisana per la Scienza - Genomic Section, Pisa, Italy
| | - Elena Tantillo
- Fondazione Pisana per la Scienza - Genomic Section, Pisa, Italy.,Scuola Normale Superiore, Pisa, Italy
| | | | - Ivo Marchetti
- Cytopathology Section, Azienda Ospedaliero-Universitaria Pisana (AOUP), Pisa, Italy
| | | | - Prospero Civita
- Fondazione Pisana per la Scienza - Genomic Section, Pisa, Italy
| | - Claudia De Angelis
- Medical Oncology Unit, Azienda Ospedaliero-Universitaria Pisana (AOUP), Pisa, Italy
| | - Lucrezia Diodati
- Medical Oncology Unit, Azienda Ospedaliero-Universitaria Pisana (AOUP), Pisa, Italy
| | - Ilaria Bertolini
- Medical Oncology Unit, Azienda Ospedaliero-Universitaria Pisana (AOUP), Pisa, Italy
| | - Manuela Roncella
- Breast Cancer Center, Azienda Ospedaliero-Universitaria Pisana (AOUP), Pisa, Italy
| | - Liam A McDonnell
- Fondazione Pisana per la Scienza - Proteomic Section, Pisa, Italy
| | - Jacob Hochman
- Department of Cell and Developmental Biology, the Hebrew University of Jerusalem, Jerusalem, Israel
| | - Marzia Del Re
- Unit of Clinical Pharmacology and Pharmacogenetics, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Cristian Scatena
- Department of Translational Research and New Technologies in Medicine and Surgery, University Hospital of Pisa, Pisa, Italy
| | - Antonio G Naccarato
- Department of Translational Research and New Technologies in Medicine and Surgery, University Hospital of Pisa, Pisa, Italy
| | - Andrea Fontana
- Medical Oncology Unit, Azienda Ospedaliero-Universitaria Pisana (AOUP), Pisa, Italy
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5
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Crucitta S, Del Re M, Fontana A, Bertolini I, Rofi E, De Angelis C, Diodati L, Cavallero D, Salvadori B, Falcone A, Morganti R, Danesi R. Expression of TK1 and CDK9 in plasma-derived exosomes is associated with clinical response to CDK4/6 inhibitors in breast cancer. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy269.143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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6
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Storaci A, Bertolini I, Caroli M, Ferrero S, Vaira V. PO-080 V-ATPase G1 expression in human glioma stem cells correlates with ERK activation. ESMO Open 2018. [DOI: 10.1136/esmoopen-2018-eacr25.123] [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: 11/04/2022] Open
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7
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Garrone O, Giarratano T, Saggia C, Bertolini I, Beano A, Blondeaux E, Riva F, D'Onofrio L, Merlini L, Coltelli L, La Verde NM, Vandone AM, Milani A, Collovà E, Ardito R, Airoldi M, De Conciliis E, Blasi L, Di Maio M, Merlano MC. Moving from the CLEOPATRA study to real life: Results from the G.O.N.O. SUPER trial. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e13006] [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)
- Ornella Garrone
- Medical Oncology, S. Croce and Carle Teaching Hospital, Cuneo, Italy
| | | | - Chiara Saggia
- Medical Oncology, A.O.U. Ospedale Maggiore della Carità, Novara, Italy
| | - Ilaria Bertolini
- Medical Oncology Unit II, Azienda Ospedaliera Universitaria, Pisa, Italy
| | - Alessandra Beano
- Oncology Department AOU Città della salute e della scienza, Torino, Italy
| | | | | | | | | | - Luigi Coltelli
- Medical Oncology Az USL NordOvest Toscana, Pontedera, Italy
| | - Nicla Maria La Verde
- ASST Fatebenefratelli Sacco PO Fatebenefratelli Deparment of Oncology, Milano, Italy
| | | | - Andrea Milani
- Investigative Clinical Oncology - Candiolo Cancer Institute-FPO IRCCS, Candiolo, Italy
| | | | - Raffaele Ardito
- IRCCS-CROB Referral Cancer Center of Basilicata, Rionero in Vulture, Italy
| | - Mario Airoldi
- 2nd Medical Oncology Division, A. O. Città della Salute e della Scienza di Torino, Torino, Italy
| | | | - Livio Blasi
- Medical Oncology ARNAS Civico di Cristina Benfratelli, Palermo, Italy
| | - Massimo Di Maio
- Medical Oncology Mauriziano Hospital, University of Torino, Torino, Italy
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8
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Del Re M, Fontana A, Crucitta S, Bertolini I, Rofi E, De Angelis C, Diodati L, Cavallero D, Salvadori B, Falcone A, Morganti R, Danesi R. Correlation of expression of TK1 in plasma-derived exosomes with clinical response to CDK4/6 inhibitors in breast cancer. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.12037] [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)
- Marzia Del Re
- Clinical Pharmacology and Pharmacogenetics Unit, Department of Clinical and Experimental Medicine, Pisa, Italy
| | | | - Stefania Crucitta
- Clinical Pharmacology and Pharmacogenetics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Ilaria Bertolini
- Medical Oncology Unit II, Azienda Ospedaliera Universitaria, Pisa, Italy
| | - Eleonora Rofi
- Clinical Pharmacology and Pharmacogenetics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | | | - Diletta Cavallero
- Medical Oncology Unit, Department of Translational Research and NewTechnologies in Medicine, University of Pisa, Pisa, Italy
| | | | - Alfredo Falcone
- Department of Translational Research and New Technologies in Medicine and Surgery, Unit of Medical Oncology 2, Azienda Ospedaliera Universitaria Pisana, Istituto Toscano Tumori, Pisa, Italy
| | | | - Romano Danesi
- Clinical Pharmacology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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9
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Pizzuti L, Sergi D, Sperduti I, Lauro LD, Mazzotta M, Botti C, Izzo F, Marchetti L, Tomao S, Marchetti P, Natoli C, Grassadonia A, Gamucci T, Mentuccia L, Magnolfi E, Vaccaro A, Cassano A, Rossi E, Botticelli A, Sini V, Sarobba MG, Fabbri MA, Moscetti L, Astone A, Michelotti A, De Angelis C, Bertolini I, Angelini F, Ciliberto G, Maugeri-Saccà M, Giordano A, Barba M, Vici P. Body mass index in HER2-negative metastatic breast cancer treated with first-line paclitaxel and bevacizumab. Cancer Biol Ther 2018; 19:328-334. [PMID: 29336662 DOI: 10.1080/15384047.2017.1416938] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
The evidence emerged from the TOURANDOT trial encourages evaluating the role of anthropometric determinants on treatment outcomes in HER2-negative metastatic breast cancer patients treated with bevacizumab-including regimens. We thus analyzed data from a subgroup of these patients from a larger cohort previously assessed for treatment outcomes. Patients were included in the present analysis if body mass index values had been recorded at baseline. Clinical benefit rates, progression free survival and overall survival were assessed for the overall study population and subgroups defined upon molecular subtype. One hundred ninety six patients were included (N:196). Body mass index showed no impact on clinical benefit rates in the overall study sample and in the luminal cancer subset (p = 0.12 and p = 0.79, respectively), but did so in the triple negative subgroup, with higher rates in patients with body mass index ≥25 (p = 0.03). In the overall study sample, body mass index did no impact progression free or overall survival (p = 0.33 and p = 0.67, respectively). Conversely, in triple negative patients, progression free survival was significantly longer with body mass index ≥25 (6 vs 14 months, p = 0.04). In this subset, overall survival was more favorable (25 vs 19 months, p = 0.02). The impact of the molecular subtype was confirmed in multivariate models including the length of progression free survival, and number of metastatic sites (p < 0.0001). Further studies are warranted to confirm our findings in more adequately sized, ad hoc, prospective studies.
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Affiliation(s)
- Laura Pizzuti
- a Division of Medical Oncology 2 , IRCCS Regina Elena National Cancer Institute , Rome , Italy
| | - Domenico Sergi
- a Division of Medical Oncology 2 , IRCCS Regina Elena National Cancer Institute , Rome , Italy
| | - Isabella Sperduti
- b Biostatistics Unit and Clinical Trial Center, IRCCS Regina Elena National Cancer Institute , Rome , Italy
| | - Luigi Di Lauro
- a Division of Medical Oncology 2 , IRCCS Regina Elena National Cancer Institute , Rome , Italy
| | - Marco Mazzotta
- c Medical Oncology Unit, Policlinico Sant'Andrea , Rome , Italy
| | - Claudio Botti
- d Department of Surgery , IRCCS Regina Elena National Cancer Institute , Rome , Italy
| | - Fiorentino Izzo
- a Division of Medical Oncology 2 , IRCCS Regina Elena National Cancer Institute , Rome , Italy
| | - Luca Marchetti
- e Division of Medical Oncology, Villa San Pietro Hospital , Rome , Italy
| | - Silverio Tomao
- f Department of Medical-Surgical Sciences and Biotechnologies , La "Sapienza" University of Rome , Italy
| | - Paolo Marchetti
- c Medical Oncology Unit, Policlinico Sant'Andrea , Rome , Italy
| | - Clara Natoli
- g Department of Medical , Oral and Biotechnological Sciences and CeSI-MeT, G. D'Annunzio University , Chieti , Italy
| | - Antonino Grassadonia
- g Department of Medical , Oral and Biotechnological Sciences and CeSI-MeT, G. D'Annunzio University , Chieti , Italy
| | - Teresa Gamucci
- h Medical Oncology Unit, ASL Frosinone , Frosinone , Italy
| | | | | | - Angela Vaccaro
- h Medical Oncology Unit, ASL Frosinone , Frosinone , Italy
| | - Alessandra Cassano
- i Department of Medical Oncology , Catholic University of Sacred Heart , Rome , Italy
| | - Ernesto Rossi
- i Department of Medical Oncology , Catholic University of Sacred Heart , Rome , Italy
| | | | - Valentina Sini
- c Medical Oncology Unit, Policlinico Sant'Andrea , Rome , Italy.,j Oncology Unit , ASL Roma 1, Santo Spirito Hospital , Rome , Italy
| | | | - Maria Agnese Fabbri
- l Division of Oncology, Complesso Ospedaliero Belcolle, AUSL Viterbo , Viterbo , Italy
| | - Luca Moscetti
- m Division of Medical Oncology , Department of Oncology and Hematology, University Hospital of Modena , Modena , Italy
| | - Antonio Astone
- e Division of Medical Oncology, Villa San Pietro Hospital , Rome , Italy.,i Department of Medical Oncology , Catholic University of Sacred Heart , Rome , Italy
| | - Andrea Michelotti
- n Oncology Unit I, Azienda Ospedaliera Universitaria Pisana , Pisa , Italy
| | - Claudia De Angelis
- n Oncology Unit I, Azienda Ospedaliera Universitaria Pisana , Pisa , Italy
| | - Ilaria Bertolini
- n Oncology Unit I, Azienda Ospedaliera Universitaria Pisana , Pisa , Italy
| | - Francesco Angelini
- o Medical Oncology Unit, Regina Apostolorum Hospital , Albano, Rome , Italy
| | - Gennaro Ciliberto
- p Scientific Direction, IRCCS Regina Elena National Cancer Institute , Rome , Italy
| | - Marcello Maugeri-Saccà
- a Division of Medical Oncology 2 , IRCCS Regina Elena National Cancer Institute , Rome , Italy.,p Scientific Direction, IRCCS Regina Elena National Cancer Institute , Rome , Italy
| | - Antonio Giordano
- q Sbarro Institute for Cancer Research and Molecular Medicine e del Center for Biotechnology, College of Science and Technology, Temple University , Philadelphia , USA
| | - Maddalena Barba
- a Division of Medical Oncology 2 , IRCCS Regina Elena National Cancer Institute , Rome , Italy.,p Scientific Direction, IRCCS Regina Elena National Cancer Institute , Rome , Italy
| | - Patrizia Vici
- a Division of Medical Oncology 2 , IRCCS Regina Elena National Cancer Institute , Rome , Italy
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10
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Martel S, Poletto E, Ferreira AR, Lambertini M, Sottotetti F, Bertolini I, Montemurro F, Bernardo A, Risi E, Zanardi E, Ziliani S, Mura S, Dellepiane C, Del Mastro L, Minisini AM, Puglisi F. Impact of body mass index on the clinical outcomes of patients with HER2-positive metastatic breast cancer. Breast 2018; 37:142-147. [DOI: 10.1016/j.breast.2017.11.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 10/31/2017] [Accepted: 11/09/2017] [Indexed: 10/18/2022] Open
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Diodati L, De Angelis C, Bertolini I, Montagnani I, Salvadori B, Ferrari P, Fontana A. Prognostic value of lymph node ratio in early breast cancer: a restrospective single institution analysis of clinical-pathological characteristics and outcomes. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx424.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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12
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De Angelis C, Diodati L, Bertolini I, Montagnani I, Fontana A, Ferrarini I, Salvadori B, Ferrari P, Michelotti A, Landucci E, Falcone A. Safety and efficacy of non-pegylated liposomal doxorubicin (NPLD) in HER2 negative metastatic breast cancer (mBC) patients (PTS) as second-line (2L) and beyond: a restrospective single institution analysis. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx424.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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13
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Garrone O, Cursano M, De Angelis C, Giarratano T, Saggia C, Beano A, Cazzaniga M, La Verde N, Milani A, Collovà E, Coltelli L, de Conciliis E, Vandone A, Airoldi M, D'Onofrio L, Bertolini I, Guarneri V, Donadio M, Riva F, Merlano M. From the CLEOPATRA study to real life: preliminary results from the G.O.N.O. SUPER trial. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx424.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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14
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Bertolini I, Diodati L, Fontana A, De Angelis C, Cantini L, Cecconi S, Montagnani I, Salvadori B, Ferrarini I, Ferrari P, Michelotti A, Landucci E, Fanelli G, Scatena C, Naccarato A, Berardi R, Pistelli M, Falcone A. Are anti-HER2 agents the best choice in metastatic breast cancer with an HER2 positive switch from primary tumour? A retrospective multi institution analysis of clinical-pathological characteristics and outcomes. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx424.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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15
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Gamucci T, Mentuccia L, Natoli C, Sperduti I, Cassano A, Michelotti A, Di Lauro L, Sergi D, Fabi A, Sarobba MG, Marchetti P, Barba M, Magnolfi E, Maugeri‐Saccà M, Rossi E, Sini V, Grassadonia A, Pellegrini D, Astone A, Nisticò C, Angelini F, Vaccaro A, Pellegrino A, De Angelis C, Palleschi M, Moscetti L, Bertolini I, Buglioni S, Giordano A, Pizzuti L, Vici P. A Real-World Multicentre Retrospective Study of Paclitaxel-Bevacizumab and Maintenance Therapy as First-Line for HER2-Negative Metastatic Breast Cancer. J Cell Physiol 2017; 232:1571-1578. [PMID: 27861874 PMCID: PMC6220933 DOI: 10.1002/jcp.25685] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [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: 10/25/2016] [Accepted: 11/10/2016] [Indexed: 01/04/2023]
Abstract
Bevacizumab in combination with taxanes in HER2-negative metastatic breast cancer (MBC) patients has shown improved progression-free survival (PFS), despite the lack of clear overall survival (OS) benefit. We performed a retrospective analysis to evaluate the impact of paclitaxel-bevacizumab and of maintenance therapy with bevacizumab (BM) and endocrine therapy (ET) in the real-world practice. We identified 314 HER2-negative MBC patients treated in 12 cancer centers. Overall, the median PFS and OS were 14 and 40 months, respectively. Among the 254 patients potentially eligible for BM, 183 received BM after paclitaxel discontinuation until progression/toxicity. PFS and OS were improved in patients who had received BM in comparison with those potentially eligible but who did not receive BM (P< 0.0001 and P = 0.001, respectively). Results were confirmed when adjusting for propensity score. Among the 216 hormone-receptor positive patients eligible for BM, a more favorable PFS and OS were observed when maintenance ET was administered (P < 0.0001). Multivariate analysis showed that PS, BM, number of disease sites and maintenance ET were related to PFS, while response and maintenance ET were related to OS. In hormone-receptor positive patients, BM produced a significant PFS and a trend towards OS benefit only in absence of maintenance ET (P = 0.0007 and P = 0.06, respectively). In the triple-negative subgroup, we observed a trend towards a better OS for patients who received BM (P = 0.06), without differences in PFS (P = 0.21). Our results confirmed the efficacy of first-line paclitaxel-bevacizumab in real-world practice; both BM and maintenance ET significantly improved PFS and OS compared to no maintenance therapies. J. Cell. Physiol. 232: 1571-1578, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
| | | | - Clara Natoli
- Department of Medical, Oral and Biotechnological SciencesCentro Scienze dell’ Invecchiamento e Medicina Traslazionale ‐ CeSI‐MeTChietiItaly
| | - Isabella Sperduti
- Bio‐Statistics Unit, Regina Elena National Cancer InstituteRomeItaly
| | - Alessandra Cassano
- Department of Medical OncologyPoliclinico Universitario A. GemelliRomeItaly
| | | | - Luigi Di Lauro
- Division of Medical Oncology 2Regina Elena National Cancer InstituteRomeItaly
| | - Domenico Sergi
- Division of Medical Oncology 2Regina Elena National Cancer InstituteRomeItaly
| | - Alessandra Fabi
- Division of Medical Oncology 1Regina Elena National Cancer InstituteRomeItaly
| | | | - Paolo Marchetti
- Department of Clinical and Molecular Medicine“Sapienza” University of RomeAzienda Ospedaliera Sant'AndreaRomeItaly
| | - Maddalena Barba
- Division of Medical Oncology 2Regina Elena National Cancer InstituteRomeItaly
- Scientific DirectionRegina Elena National Cancer InstituteRomeItaly
| | | | - Marcello Maugeri‐Saccà
- Division of Medical Oncology 2Regina Elena National Cancer InstituteRomeItaly
- Scientific DirectionRegina Elena National Cancer InstituteRomeItaly
| | - Ernesto Rossi
- Department of Medical OncologyPoliclinico Universitario A. GemelliRomeItaly
| | - Valentina Sini
- Department of Clinical and Molecular Medicine“Sapienza” University of RomeAzienda Ospedaliera Sant'AndreaRomeItaly
| | - Antonino Grassadonia
- Department of Medical, Oral and Biotechnological SciencesCentro Scienze dell’ Invecchiamento e Medicina Traslazionale ‐ CeSI‐MeTChietiItaly
| | - Domenica Pellegrini
- Division of Medical Oncology 1Regina Elena National Cancer InstituteRomeItaly
| | - Antonino Astone
- Department of Medical OncologyPoliclinico Universitario A. GemelliRomeItaly
| | - Cecilia Nisticò
- Division of Medical Oncology 1Regina Elena National Cancer InstituteRomeItaly
| | - Franco Angelini
- Medical Oncology UnitRegina Apostolorum HospitalAlbano, RomeItaly
| | | | | | | | | | - Luca Moscetti
- Medical Oncology Unit, Belcolle HospitalViterboItaly
- Department of Medical and Surgical Sciences for Children and AdultsAzienda Ospedaliero‐Universitaria Policlinico di ModenaModenaItaly
| | - Ilaria Bertolini
- Oncology Unit IAzienda Ospedaliera Universitaria PisanaPisaItaly
| | | | - Antonio Giordano
- Sbarro Institute for Cancer Research and Molecular Medicine and Center for BiotechnologyCollege of Science and TechnologyTemple UniversityPhiladelphiaPennsylvania
| | - Laura Pizzuti
- Division of Medical Oncology 2Regina Elena National Cancer InstituteRomeItaly
| | - Patrizia Vici
- Division of Medical Oncology 2Regina Elena National Cancer InstituteRomeItaly
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16
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Vici P, Pizzuti L, Michelotti A, Sperduti I, Natoli C, Mentuccia L, Di Lauro L, Sergi D, Marchetti P, Santini D, Magnolfi E, Iezzi L, Moscetti L, Fabbri A, Cassano A, Grassadonia A, Omarini C, Piacentini F, Botticelli A, Bertolini I, Scinto AF, Zampa G, Mauri M, D'Onofrio L, Sini V, Barba M, Maugeri-Saccà M, Rossi E, Landucci E, Tomao S, Alberti AM, Giotta F, Ficorella C, Adamo V, Russo A, Lorusso V, Cannita K, Barni S, Laudadio L, Greco F, Garrone O, Della Giulia M, Marolla P, Sanguineti G, Di Cocco B, Ciliberto G, De Maria R, Gamucci T. A retrospective multicentric observational study of trastuzumab emtansine in HER2 positive metastatic breast cancer: a real-world experience. Oncotarget 2017; 8:56921-56931. [PMID: 28915642 PMCID: PMC5593613 DOI: 10.18632/oncotarget.18176] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 04/21/2017] [Indexed: 01/07/2023] Open
Abstract
We addressed trastuzumab emtansine (T-DM1) efficacy in HER2+ metastatic breast cancer patients treated in real-world practice, and its activity in pertuzumab-pretreated patients. We conducted a retrospective, observational study involving 23 cancer centres, and 250 patients. Survival data were analyzed by Kaplan Meier curves and log rank test. Factors testing significant in univariate analysis were tested in multivariate models. Median follow-up was 15 months and median T-DM1 treatment-length 4 months. Response rate was 41.6%, clinical benefit 60.9%. Median progression-free and median overall survival were 6 and 20 months, respectively. Overall, no differences emerged by pertuzumab pretreatment, with median progression-free and median overall survival of 4 and 17 months in pertuzumab-pretreated (p=0.13), and 6 and 22 months in pertuzumab-naïve patients (p=0.27). Patients who received second-line T-DM1 had median progression-free and median overall survival of 3 and 12 months (p=0.0001) if pertuzumab-pretreated, and 8 and 26 months if pertuzumab-naïve (p=0.06). In contrast, in third-line and beyond, median progression-free and median overall survival were 16 and 18 months in pertuzumab-pretreated (p=0.05) and 6 and 17 months in pertuzumab-naïve patients (p=0.30). In multivariate analysis, lower ECOG performance status was associated with progression-free survival benefit (p<0.0001), while overall survival was positively affected by lower ECOG PS (p<0.0001), absence of brain metastases (p 0.05), and clinical benefit (p<0.0001). Our results are comparable with those from randomized trials. Further studies are warranted to confirm and interpret our data on apparently lower T-DM1 efficacy when given as second-line treatment after pertuzumab, and on the optimal sequence order.
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Affiliation(s)
- Patrizia Vici
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Laura Pizzuti
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Andrea Michelotti
- UO Oncologia Medica I, Ospedale S. Chiara, Dipartimento di oncologia, dei trapianti e delle nuove tecnologie, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Isabella Sperduti
- Bio-Statistics Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Clara Natoli
- Department of Medical, Oral and Biotechnological Sciences, Centro Scienze dell'Invecchiamento e Medicina Traslazionale (CeSI-MeT), Chieti, Italy
| | | | - Luigi Di Lauro
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Domenico Sergi
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | | | - Daniele Santini
- Medical Oncology, Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | | | - Laura Iezzi
- Department of Medical, Oral and Biotechnological Sciences, Centro Scienze dell'Invecchiamento e Medicina Traslazionale (CeSI-MeT), Chieti, Italy
| | - Luca Moscetti
- Division of Medical Oncology, Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
| | - Agnese Fabbri
- Division of Oncology, Complesso Ospedaliero Belcolle, AUSL Viterbo, Viterbo, Italy
| | - Alessandra Cassano
- Department of Medical Oncology, Catholic University of Sacred Heart, Rome, Italy
| | - Antonino Grassadonia
- Department of Medical, Oral and Biotechnological Sciences, Centro Scienze dell'Invecchiamento e Medicina Traslazionale (CeSI-MeT), Chieti, Italy
| | - Claudia Omarini
- Division of Medical Oncology, Department of Medical and Surgical Sciences for Children & Adults, University Hospital of Modena, Modena, Italy
| | - Federico Piacentini
- Division of Medical Oncology, Department of Medical and Surgical Sciences for Children & Adults, University Hospital of Modena, Modena, Italy
| | | | - Ilaria Bertolini
- UO Oncologia Medica I, Ospedale S. Chiara, Dipartimento di oncologia, dei trapianti e delle nuove tecnologie, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | | | - Germano Zampa
- Oncology Unit, Nuovo Regina Margherita Hospital, Rome, Italy
| | - Maria Mauri
- Division of Oncology, San Giovanni Hospital, Rome, Italy
| | - Loretta D'Onofrio
- Medical Oncology, Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Valentina Sini
- Medical Oncology Unit, Policlinico Sant'Andrea, Rome, Italy
| | - Maddalena Barba
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Marcello Maugeri-Saccà
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Ernesto Rossi
- Department of Medical Oncology, Catholic University of Sacred Heart, Rome, Italy
| | - Elisabetta Landucci
- UO Oncologia Medica I, Ospedale S. Chiara, Dipartimento di oncologia, dei trapianti e delle nuove tecnologie, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Silverio Tomao
- Department of Medico-Surgical Sciences and Biotechnologies, "Sapienza" University of Rome, Oncology Unit, Istituto Chirurgico Ortopedico Traumatologico, Latina, Italy
| | | | - Francesco Giotta
- Division of Medical Oncology, IRCCS, Giovanni Paolo II Hospital, Bari, Italy
| | - Corrado Ficorella
- Medical Oncology, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Vincenzo Adamo
- Medical Oncology Unit AOOR Papardo-Piemonte, Department of Human Pathology of Adult And Evolutive Age "Gaetano Barresi", University of Messina, Messina, Italy
| | - Antonio Russo
- Department of Surgical, Oncological and Oral Sciences, Section of Medical Oncology, University of Palermo, Palermo, Italy
| | - Vito Lorusso
- Division of Medical Oncology, IRCCS, Giovanni Paolo II Hospital, Bari, Italy
| | - Katia Cannita
- Medical Oncology, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Sandro Barni
- Medical Oncology, ASST Bergamo Ovest, Ospedale di Treviglio, Bergamo, Italy
| | | | - Filippo Greco
- Department of Pathology, Surgery and Oncology, "Mater Salutis" Hospital, ULSS21, Verona, Italy
| | - Ornella Garrone
- Medical Oncology, A.O. Ospedale di Insegnamento S. Croce e Carle, Cuneo, Italy
| | - Marina Della Giulia
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Paolo Marolla
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Giuseppe Sanguineti
- Department of Radiotherapy, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | | | - Gennaro Ciliberto
- Scientific Direction, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Ruggero De Maria
- Institute of General Pathology, Catholic University of the Sacred Heart, Rome, Italy
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17
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Garrone O, Saggia C, Beano A, Cicchiello F, Milani A, Bertolini I, Coltelli L, La Verde NM, Collovà E, De Conciliis E, Pedani F, Vandone AM, Donadio M, Cazzaniga ME, Michelotti A, Merlano MC. From the CLEOPATRA study to real life: An observational study from 11 Italian Centres; Preliminary report from the G.O.N.O. SUPER trial. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.e12510] [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
e12510 Background: Approximately 20% of breast cancers (BC) are HER-2+. Trastuzumab (T) has substantially improved the outcome, both in early and in advanced settings, in HER-2+BC. Pertuzumab (P), combined with T and taxanes, ameliorated progression free survival (PFS) and overall survival (OS) in the phase III CLEOPATRA study. In order to verify the results of the trial in unselected patients (pts), we performed a multicenter, retrospective-prospective, observational study, in HER-2+ metastatic BC (MBC) pts. Methods: We analyze the outcome of all HER-2+ MBC pts treated with P+T and taxanes, as first line therapy since the availability of P in Italy, at 11 general and university hospitals. Results: Up to February 1stdata from 103 HER-2+ MBC pts were recorded. Main pts’ characteristics were: median (M) age 52 y (28-78), m ECOG PS 0 (0-2), ER/PgR positive 68 pts (66%). Most common metastatic sites: liver 51 pts (49.5%), bone 64 pts (62.1%), lung 26 pts (25.2%). Thirty pts (29.1%) had bone and soft tissue disease only; 78 pts (75.7%) had metastatic disease on presentation. m number of metastatic sites was 3 (1-7); 25 pts (24.3%) received neo/adjuvant chemotherapy (CT) + T and 36 pts (34.9%) adjuvant endocrine therapy; 71 pts (69%) and 32 pts (31%) received docetaxel (D) and paclitaxel (P) respectively. m number of CT cycles was 6 for both drugs (D range 3-12; P range 1-18).At the time of the present analysis 12 pts are still on CT and 78 on maintenance; response is available for 91 pts and ORR is 80.2% (22 pts and 51 pts obtained CR and PR respectively), 6 pts experienced PD during CT. Median PFS is 13.9 months (1.5+ - 33.8+).Among hematological toxicities leucopenia (any grade) was recorded in 29 pts (28.1%), g 3 febrile neutropenia in 6 pts (5.8%). No change of left ventricular ejection fraction (LVEF) was recorded during CT; 4 pts interrupted maintenance P due to drop in LVEF and 1 due to rash. Onicopathy, nausea, alopecia, rash and arthro-myalgia were the most common non-hematological toxicities. Conclusions: Our preliminary results highlight the activity and the safety of the combination of CT plus P and T in unselected HER2+ MBC patients. The study is ongoing and updated results will be presented.
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Affiliation(s)
- Ornella Garrone
- Medical Oncology, S. Croce and Carle Teaching Hospital, Cuneo, Italy
| | - Chiara Saggia
- Medical Oncology, A.O.U. Ospedale Maggiore della Carità, Novara, Italy
| | - Alessandra Beano
- Oncology Department AOU Città della salute e della scienza, Torino, Italy
| | | | - Andrea Milani
- Investigative Clinical Oncology - Candiolo Cancer Institute-FPO IRCCS, Candiolo, Italy
| | - Ilaria Bertolini
- Medical Oncology Unit II, Azienda Ospedaliera Universitaria, Pisa, Italy
| | - Luigi Coltelli
- Medical Oncology Az USL NordOvest Toscana, Pontedera, Italy
| | | | | | | | - Fulvia Pedani
- Medical Oncology AOU Città della Salute e della Scienza, Torino, Italy
| | | | - Michela Donadio
- Oncology Department AOU Città della salute e della scienza, Torino, Italy
| | | | - Andrea Michelotti
- Oncology Unit I, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Marco Carlo Merlano
- Medical Oncology, Oncology Department, S. Croce and Carle Teaching Hospital, Cuneo, Italy
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18
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Vici P, Pizzuti L, Sperduti I, Frassoldati A, Natoli C, Gamucci T, Tomao S, Michelotti A, Moscetti L, Gori S, Baldini E, Giotta F, Cassano A, Santini D, Giannarelli D, Di Lauro L, Corsi DC, Marchetti P, Sini V, Sergi D, Barba M, Maugeri-Saccà M, Russillo M, Mentuccia L, D'Onofrio L, Iezzi L, Scinto AF, Da Ros L, Bertolini I, Basile ML, Rossi V, De Maria R, Montemurro F. "Triple positive" early breast cancer: an observational multicenter retrospective analysis of outcome. Oncotarget 2017; 7:17932-44. [PMID: 26910921 PMCID: PMC4951261 DOI: 10.18632/oncotarget.7480] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 02/11/2016] [Indexed: 01/18/2023] Open
Abstract
We recently found that trastuzumab benefit may be lower in a small subset of early breast cancer (BC) patients (pts) with tumors expressing high levels of both hormonal receptors (HRs), i.e. triple positive (TP). To better investigate the role of HRs in HER2 positive BC, we retrospectively identified 872 TP BC pts treated with adjuvant chemotherapy alone (cohort A-366 pts), or plus trastuzumab (cohort B-506 pts). Relapse-free-survival (RFS) and breast-cancer-specific-survival (BCSS) were evaluated. Trastuzumab improved RFS and BCSS in all the subsets analyzed, but the effect on BCSS in tumors expressing both HRs in >30% of cells (TP30), and even on RFS in tumors with both HRs expressed in >50% of cells (TP50) was not significant. Distinct patterns of relapse were observed in TP50 and no-TP50 tumors, the former showing low and constant risk in the first 5 years, a late increase beyond 5 years and modest trastuzumab effect. Trastuzumab effect tended to disappear in pts whose tumors expressed ER in >50% of cells. Multivariate analysis of RFS confirmed a significant interaction between trastuzumab and ER expression, with benefit confined to pts whose tumors expressed ER in ≤50% of cells. Our data suggest that the pattern of relapse of TP tumors with high HRs is similar to that of "luminal", HER2 negative tumors, without clear benefit from adjuvant trastuzumab, which remains the standard treatment even in TP tumors. Confirmatory findings on the extent to which quantitative expression of HRs may impact clinical behavior of HER2 positive BC are warranted.
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Affiliation(s)
- Patrizia Vici
- Division of Medical Oncology 2, "Regina Elena" National Cancer Institute, Rome, Italy
| | - Laura Pizzuti
- Division of Medical Oncology 2, "Regina Elena" National Cancer Institute, Rome, Italy
| | - Isabella Sperduti
- Biostatistics Unit, "Regina Elena" National Cancer Institute, Rome, Italy
| | | | - Clara Natoli
- Department of Experimental and Clinical Sciences, University "G. d'Annunzio", Chieti, Italy
| | | | - Silverio Tomao
- Department of Medico-Surgical Sciences and Biotechnologies, "Sapienza" University of Rome, Oncology Unit, Istituto Chirurgico Ortopedico Traumatologico, Latina, Italy
| | - Andrea Michelotti
- Oncology Unit I, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Luca Moscetti
- Department of Oncology, Division of Medical Oncology, Belcolle Hospital, ASL Viterbo, Viterbo, Italy
| | - Stefania Gori
- Department of Oncology, Ospedale Sacro Cuore Don Calabria, Negrar, Verona, Italy
| | - Editta Baldini
- Department of Medical Oncology, S. Luca Hospital, Lucca, Italy
| | - Francesco Giotta
- Division of Medical Oncology, IRCCS, Giovanni Paolo II Hospital, Bari, Italy
| | | | - Daniele Santini
- Department of Medical Oncology, University Campus Bio-Medico, Rome, Italy
| | - Diana Giannarelli
- Biostatistics Unit, "Regina Elena" National Cancer Institute, Rome, Italy
| | - Luigi Di Lauro
- Division of Medical Oncology 2, "Regina Elena" National Cancer Institute, Rome, Italy
| | | | - Paolo Marchetti
- Oncology Unit, Sant'Andrea Hospital, "Sapienza" University of Rome, Rome, Italy
| | - Valentina Sini
- Oncology Unit, Sant'Andrea Hospital, "Sapienza" University of Rome, Rome, Italy.,Medical Oncology, S. Spirito Hospital, Rome, Italy
| | - Domenico Sergi
- Division of Medical Oncology 2, "Regina Elena" National Cancer Institute, Rome, Italy
| | - Maddalena Barba
- Division of Medical Oncology 2, "Regina Elena" National Cancer Institute, Rome, Italy.,Scientific Direction, "Regina Elena" National Cancer Institute, Rome, Italy
| | - Marcello Maugeri-Saccà
- Division of Medical Oncology 2, "Regina Elena" National Cancer Institute, Rome, Italy.,Scientific Direction, "Regina Elena" National Cancer Institute, Rome, Italy
| | | | | | - Loretta D'Onofrio
- Department of Medical Oncology, University Campus Bio-Medico, Rome, Italy
| | - Laura Iezzi
- Department of Experimental and Clinical Sciences, University "G. d'Annunzio", Chieti, Italy
| | | | - Lucia Da Ros
- Division of Oncology, S. Anna Hospital, Ferrara, Italy
| | - Ilaria Bertolini
- Oncology Unit I, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Maria Luisa Basile
- Department of Molecular Medicine, "Umberto I", "Sapienza" University of Rome, Roma, Italy
| | - Valentina Rossi
- Investigative Clinical Oncology, Fondazione del Piemonte per l'Oncologia-Candiolo Cancer Institute (IRCCs), Candiolo, Italy.,Division of Medical Oncology, Ospedale Civile di Saluzzo, Saluzzo, Italy
| | - Ruggero De Maria
- Scientific Direction, "Regina Elena" National Cancer Institute, Rome, Italy
| | - Filippo Montemurro
- Investigative Clinical Oncology, Fondazione del Piemonte per l'Oncologia-Candiolo Cancer Institute (IRCCs), Candiolo, Italy
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Diodati L, Salvadori B, Molinaro E, Ferrarini I, Bertolini I, De Angelis C, Montagnani I, Aontana A, Landucci E, Pfanner E, Michelotti A, Ferrari P, Falcone A. Prognostic role of pregnancy in breast cancer patients. a single institution experience. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw337.41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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20
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Bertolini I, De Angelis C, Diodati L, Ilaria F, Bianco M, Fontana A, Michelotti A, Salvadori B, Landucci E, Pfanner E, Ferrari P, Orlandini C, Falcone A. Retrospective observational analysis of bevacizumab (BV) plus paclitaxel (TXL) as first line treatment in metastatic HER2 negative breast cancer (BC): are BV long responders a different subgroup? Ann Oncol 2016. [DOI: 10.1093/annonc/mdw337.34] [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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21
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De Angelis C, Bertolini I, Ferrarini I, Diodati L, Montagnani I, Fontana A, Salvadori B, Michelotti A, Landucci E, Paola F, Pfanner E, Lo Russo M, Roncella M, Falcone A. Adjuvant endocrine therapy in elderly patient in early Breast Cancer, a less toxic therapy, is it really true? A single institution, “real life” experience. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw337.51] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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22
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Ferrarini I, Fontana A, Bertolini I, Diodati L, De Angelis C, Montagnani I, Salvadori B, Ghilli M, Landucci E, Lo Russo M, Pfanner E, Rossetti E, Ferrari P, Fustaino L, Michelotti A, Roncella M, Falcone A. Neoadjuvant Chemotherapy among Breast Cancer subtypes: a single-institution retrospective study. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw337.43] [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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23
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Spugnesi L, Gabriele M, Scarpitta R, Tancredi M, Maresca L, Gambino G, Collavoli A, Aretini P, Bertolini I, Salvadori B, Landucci E, Fontana A, Rossetti E, Roncella M, Naccarato GA, Caligo MA. Germline mutations in DNA repair genes may predict neoadjuvant therapy response in triple negative breast patients. Genes Chromosomes Cancer 2016; 55:915-924. [PMID: 27328445 DOI: 10.1002/gcc.22389] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 06/08/2016] [Accepted: 06/13/2016] [Indexed: 12/25/2022] Open
Abstract
Triple negative breast cancers (TNBCs) represent about 15-20% of all breast cancer cases and are characterized by a complex molecular heterogeneity. Some TNBCs exhibit clinical and pathological properties similar to BRCA-mutated tumors, without actually bearing a mutation in BRCA genes. This "BRCAness" phenotype may be explained by germline mutations in other genes involved in DNA repair. Although respond to chemotherapy with alkylating agents, they have a high risk of recurrence and progression. Some studies have shown the efficacy of neoadjuvant therapy in TNBC patients with DNA repair defects, but proper biomarkers of DNA repair deficiency are still needed. Here, we investigated if mutations in DNA repair genes may be correlated with anthracyclines/taxanes neoadjuvant therapy response. DNA from 19 TNBC patients undergoing neoadjuvant therapy were subjected to next generation sequencing of a panel of 24 genes in DNA repair and breast cancer predisposition. In this study, 5 of 19 patients (26%) carried a pathogenic mutation in BRCA1, PALB2, RAD51C and two patients carried a probable pathogenic missense variant. Moreover, VUS (Variants of Unknown Significance) in other genes, predicted to be deleterious by in silico tools, were detected in five patients. Germline mutations in DNA repair genes were found to be associated with the group of TNBC patients who responded to therapy. We conclude that a subgroup of TNBC patients have defects in DNA repair genes, other than BRCA1, and such patients respond favourably to neoadjuvant anthracyclines/taxanes therapy. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Laura Spugnesi
- Section of Genetic Oncology, Department of Laboratory Medicine, University Hospital of Pisa, Pisa, Italy
| | - Michele Gabriele
- Section of Genetic Oncology, Department of Laboratory Medicine, University Hospital of Pisa, Pisa, Italy
| | - Rosa Scarpitta
- Section of Genetic Oncology, Department of Laboratory Medicine, University Hospital of Pisa, Pisa, Italy
| | - Mariella Tancredi
- Section of Genetic Oncology, Department of Laboratory Medicine, University Hospital of Pisa, Pisa, Italy
| | - Luisa Maresca
- Section of Genetic Oncology, Department of Laboratory Medicine, University Hospital of Pisa, Pisa, Italy
| | - Gaetana Gambino
- Section of Genetic Oncology, Department of Laboratory Medicine, University Hospital of Pisa, Pisa, Italy
| | - Anita Collavoli
- Section of Genetic Oncology, Department of Laboratory Medicine, University Hospital of Pisa, Pisa, Italy
| | | | - Ilaria Bertolini
- UO Medical Oncology, Department of Oncology, University Hospital of Pisa, Pisa, Italy
| | - Barbara Salvadori
- UO Medical Oncology, Department of Oncology, University Hospital of Pisa, Pisa, Italy
| | - Elisabetta Landucci
- UO Medical Oncology, Department of Oncology, University Hospital of Pisa, Pisa, Italy
| | - Andrea Fontana
- UO Medical Oncology, Department of Oncology, University Hospital of Pisa, Pisa, Italy
| | | | | | | | - Maria Adelaide Caligo
- UO Medical Genetics, Department of Laboratory Medicine, University Hospital of Pisa, Pisa, Italy.
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24
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Ferrarini I, Raoufi A, Bertolini I, Fancelli S, De Angelis C, Diodati F, Fontana A, Salvadori B, Landucci E, Michelotti A, Antonuzzo A, Roncella S, Falcone A. Evaluation of safety and activity of everolimus plus exemestane in metastatic breast cancer: A single institution experience. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.e14554] [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)
- Ilaria Ferrarini
- Division of Medical Oncology, Pisa University Hospital, Pisa, Italy
| | | | - Ilaria Bertolini
- Medical Oncology Unit, Department of Translational Research and New Technology in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Sara Fancelli
- Medical Oncology Unit, Department of Translational Research and New Technology in Medicine and Surgery, University of Pisa, Pisa, Italy
| | | | | | | | | | | | - Andrea Michelotti
- Oncology Unit I, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
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Salvadori B, Caligo A, Montagnani I, Spugnesi L, Fontana A, landucci E, Michelotti A, Ferrarini I, Bertolini I, De Angelis C, Fancelli S, Pfanner E, Falcone A. Inherited mutations in breast cancer susceptibility genes among a triple negative breast cancer cohort unselected for family history of breast cancer. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv336.47] [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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26
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Poletto E, Minisini A, Ferreira A, Lambertini M, Poggio F, Sottotetti F, Montemurro F, Pozzi E, Rossi V, Risi E, Dellepiane C, Sini V, Ziliani S, Minuti G, Mura S, Grasso D, Bertolini I, Del Mastro L, Puglisi F. Does body mass index impact on clinical outcomes in her-2 positive metastatic breast cancer? Ann Oncol 2015. [DOI: 10.1093/annonc/mdv336.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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27
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La Ferla M, Cantini L, Aretini P, Scatena C, Bertolini I, Fancelli S, Ferrarini I, De Angelis C, Salvadori B, Michelotti A, Landucci E, Ghilli M, Fustaino L, Lo Russo M, Roncella M, Falcone A, Bevilacqua G, Naccarato G, Mazzanti C, Fontana A. Whole-exome sequencing of HER-2 positive human breast cancers: potential molecular mechanisms of response to neoadjuvant chemotherapy plus trastuzumab. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv336.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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28
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Conte L, Fabiani I, Pugliese N, De Angelis C, Bertolini I, Ferrarini I, Fancelli S, Fontana A, Salvadori B, Landucci E, Michelotti A, Falcone A, Di Bello V. Incremental value of 3D echocardiography and two-dimensional speckle tracking in the early detection of cardiotoxicity linked to chemotherapy and trastuzumab in patients with HER-2 positive breast cancer. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv336.42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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29
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Ferrarini I, Bertolini I, Fancelli S, De Angelis C, Fontana A, Salvadori B, Landucci E, Michelotti A, Falcone A. Evaluation of safety and activity of everolimus plus exemestane in metastatic breast cancer: a single institution experience. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv336.41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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30
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Bertolini I, Ferrarini I, Fancelli S, De Angelis C, Fontana A, Salvadori B, Landucci E, Michelotti A, Falcone A. T-DM1 for HER2 positive advanced breast cancer: a single institution, “real life” experience. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv336.59] [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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31
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Spugnesi L, Gabriele M, Tancredi M, Gaetana G, Maresca L, Salvadori B, Bertolini I, Caligo M. 465: A possible genetic signature of DNA repair genes in triple negative breast cancers by a NGS approach. Eur J Cancer 2014. [DOI: 10.1016/s0959-8049(14)50416-9] [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: 11/17/2022]
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32
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Del Re M, Fontana A, Generali DG, Pistilli B, Citi V, Ulivi P, Zoli W, Bona E, Salvadori B, Ferrarini I, Landucci E, Fancelli S, Bertolini I, Michelotti A, Latini L, Bottini A, Falcone A, Danesi R. Association of eNOS polymorphisms with clinical outcome in bevacizumab-treated breast cancer patients. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.e22075] [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)
- Marzia Del Re
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Andrea Fontana
- Division of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Istituto Toscano Tumori, Pisa, Italy
| | - Daniele Giulio Generali
- U.O. Multidisciplinare di Patologia Mammaria, A.O. Istituti Ospitalieri di Cremona, Cremona, Italy
| | | | - Valentina Citi
- Clinical Pharmacology Unit, Department of Experimental Medicine, University of Pisa, Pisa, Italy
| | - Paola Ulivi
- IRCCS, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Meldola, Italy
| | - Wainer Zoli
- IRCCS, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Meldola, Italy
| | - Eleonora Bona
- Division of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Istituto Toscano Tumori, Pisa, Italy
| | | | - Ilaria Ferrarini
- Division of Medical Oncology, Pisa University Hospital, Pisa, Italy
| | - Elisabetta Landucci
- Medical Oncology Unit, Department of Translational Research and New Technology in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Sara Fancelli
- Medical Oncology Unit, Department of Translational Research and New Technology in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Ilaria Bertolini
- Medical Oncology Unit, Department of Translational Research and New Technology in Medicine and Surgery, University of Pisa, Pisa, Italy
| | | | | | - Alberto Bottini
- U.O. Multidisciplinare di Patologia Mammaria, A.O. Istituti Ospitalieri di Cremona, Cremona, Italy
| | - Alfredo Falcone
- U.O. Oncologia Medica 2, Azienda Ospedaliero-Universitaria Pisana, Istituto Toscano Tumori, Pisa, Italy
| | - Romano Danesi
- Clinical Pharmacology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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Del Re M, Fontana A, Del Re I, Bona E, Salvadori B, Ferrarini I, Landucci E, Fancelli S, Bertolini I, Michelotti A, Falcone A, Danesi R. Abstract P1-08-31: Putative role of genetic variants of eNOS in survival and toxicity of patients given antiangiogenic therapy. Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-p1-08-31] [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
Abstract
Background: The development of tumor angiogensis is mainly driven by vascular endothelial growth factor (VEGF), which is strongly overexpressed in many cancers. VEGF induces the expression of the endothelial nitric oxide (NO) synthase (eNOS) and the resultant overproduction of NO may be associated with recruitment of inflammatory cells, disruption of endothelial barrier, edema and impaired drug delivery within tumors (1). Functional polymorphisms in the eNOS gene, including -786C>T and 894G>T, have been associated with impaired production of NO and higher incidence of hypertension (HT) (2), diabetic nephropathy (3) and glaucoma (4). Since suppression of VEGF-eNOS signal transduction by antiangiogenic drugs may normalize tumor vasculature by restoring interstitial fluid pressure and drug distribution in tumors, but may induce HT in patients, the purpose of this study was to examine the association between the major eNOS variants -786C>T and 894G>T with treatment outcome and risk of HT in metastatic breast cancer (MBC) patients given bevacizumab. Methods: Sixty-five MBC patients given bevacizumab as per approved indication were enrolled. Main characteristics were: mean age 49.5 years (range 29-73) at first diagnosis, 53 years (range 34-74) at metastatic progression and PS 0-1. Four subjects with HT and 1 patient with compensated cardiovascular disease were also included. First-line chemotherapy for metastatic disease was taxol plus bevacizumab. Germline DNA was extracted from peripheral blood with the Qiamp Mini Kit (Qiagen, Milano, Italy) and examined for eNOS -786C>T and 894G>T variants by Real Time PCR (Life Sciences 7900HT platform) and automatic sequencing (Life Sciences 3100 Avant). The study was approved by the local Ethics Committee. Results: Genotype frequencies are reported below (Table 1). The presence of -786TT genotype was associated with longer PFS compared with the other genotypes (median PFS 95%CI, CC/CT = 9 vs TT = 12 months, Log-rank [Mantel Cox] test p = 0.0066), but not with any grade of HT. Also the 894GT/TT was associated with longer PFS compaed with the GG homozygous wild-type genotype (median PFS 95%CI, GG = 7,5 vs GT/TT = 10 months, Log-rank [Mantel-Cox] test p = 0,0497). The incidence and severity of HT did not vary among genotypes. Conclusion: Patients bearing deficient eNOS variant did not experience higher risk or severity of HT with respect to the wild-type allele but enjoied a longer PFS.
Table 1. Genotype frequenciesSNPFrequencies%Frequencies%Frequencies%-786C>TCCCTTT 37%33.8%26.2%894G>TGGGTTT 41.5%53.8%4.6%
References
1. Goel S et al. Physiol Rev 2011;91:1071
2. Niu W, Qi Y. PLoS One 2011;6:e24266
3. Rahimi Z et al. Dis Markers 2013;34:437
4. Awadalla MS et al. Invest Ophtalmol Vis Sci 2013;54:2108.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P1-08-31.
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Affiliation(s)
- M Del Re
- University of Pisa, Pisa, Italy; Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - A Fontana
- University of Pisa, Pisa, Italy; Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - I Del Re
- University of Pisa, Pisa, Italy; Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - E Bona
- University of Pisa, Pisa, Italy; Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - B Salvadori
- University of Pisa, Pisa, Italy; Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - I Ferrarini
- University of Pisa, Pisa, Italy; Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - E Landucci
- University of Pisa, Pisa, Italy; Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - S Fancelli
- University of Pisa, Pisa, Italy; Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - I Bertolini
- University of Pisa, Pisa, Italy; Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - A Michelotti
- University of Pisa, Pisa, Italy; Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - A Falcone
- University of Pisa, Pisa, Italy; Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - R Danesi
- University of Pisa, Pisa, Italy; Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
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Del Re M, Ferrarini I, Fontana A, Santoro M, Bona E, Del Re I, Stasi I, Bertolini I, Laurà F, Landucci E, Salvadori B, Falcone A, Danesi R. Abstract P5-17-06: The deficient eNOS c.894G>T genotype is not associated with increased severity of hypertension and proteinuria in breast cancer patients receiving bevacizumab. Cancer Res 2012. [DOI: 10.1158/0008-5472.sabcs12-p5-17-06] [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
Abstract
Background. Tumor angiogenesis is a complex process involving a wide array of effector molecules and stromal cells. In tumor tissue, vasculature is structurally and functionally abnormal, causing elevated interstitial pressure and irregular perfusion. The expression of vascular endothelial growth factor (VEGF), the most important angiogenic factor, is enhanced in many tumors. VEGF may induce nitric oxide (NO) production via up-regulation of the endothelial NO synthase (eNOS, NOS3) and the resultant overproduction of NO is associated with vasodilation and edema within tumors (Goel S et al. Physiol Rev 2011;91:1071). eNOS plays an important physiologic role in maintaining blood pressure homeostasis and vascular integrity by providing constitutive release of NO in endothelial cells. Functional variants of the eNOS gene, including the single-nucleotide polymorphism rs1799983 (c.894G>T, p. Asp298Glu) at codon 298, have been associated with reduced function of eNOS and higher incidence of hypertension (HT) (Niu W, Qi Y. PLoS One 2011;6:e24266).
Purpose. Since suppression of VEGF-eNOS axis by anti-angiogenic therapies is considered a causative factor of HT in patients, the purpose of this study was to examine whether the major eNOS non-synonymous variant c.894G>T may be associated with increased risk of developing hypertension (HT) and proteinuria (PU) in breast cancer patients treated with bevacizumab.
Patients and methods. Forty-one metastatic breast cancer patients given bevacizumab as per standard of care were enrolled. Main characteristics were: median age 49.5 years (range 29–73) at first diagnosis, 53 years (range 34–74) at metastatic disease; PS 0–1 in all patients; 4 subjects with hypertension and 1 patient with compensated cardiovascular disease at diagnosis. Twenty-six subjects had received neoadjuvant or adjuvant chemotherapy based on anthracycline and taxane; first-line chemotherapy for metastatic disease was paclitaxel plus bevacizumab for all patients; 14 subjects received hormone-therapy for metastatic disease (range 1–5 lines). Germline DNA was extracted from peripheral blood and used to screen patients for eNOS c.894G>T variant by automatic sequencing. The study was approved by the local Ethics Committee.
Results. Three patients (7.3%) were homozygous variant c.894TT, 12 (29.3%) homozygous wild-type c.894GG and the remaining 26 (63.4%) were heterozygous c.894GT. The c.894TT patients had no HT or PU at baseline and developed grade (G) 1, 2, 2 HT, respectively, and in one case PU during treatment. G1, 2 and 3 HT developed in 4, 5 and 2 c.894GG subjects, respectively, while PU was observed in 7/12 (58%) patients. The full range of HT grades and PU were observed in heterozygous subjects. Thirty-seven patients achieved one of the following: partial remission, minimal response or stable disease upon treatment with bevacizumab in combination with chemotherapy; 3 subjects had progressive disease and 1 was not evaluable.
Conclusions. The presence of the mutant T allele of c.894G>T is not associated with increased severity of HT and PU; therefore, bevacizumab can be administered at no increased risk in TT patients with respect to the wild-type GG population.
Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P5-17-06.
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Affiliation(s)
- M Del Re
- University Hospital, Pisa, Italy
| | | | | | | | - E Bona
- University Hospital, Pisa, Italy
| | - I Del Re
- University Hospital, Pisa, Italy
| | - I Stasi
- University Hospital, Pisa, Italy
| | | | - F Laurà
- University Hospital, Pisa, Italy
| | | | | | | | - R Danesi
- University Hospital, Pisa, Italy
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