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Incorvaia L, Badalamenti G, Novo G, Gori S, Cortesi L, Brando C, Cinieri S, Curigliano G, Ricciardi GR, Toss A, Chiari R, Berardi R, Ballatore Z, Bono M, Bazan Russo TD, Gristina V, Galvano A, Damerino G, Blasi L, Bazan V, Russo A. Anthracycline-related cardiotoxicity in patients with breast cancer harboring mutational signature of homologous recombination deficiency (HRD). ESMO Open 2024; 9:102196. [PMID: 38118367 PMCID: PMC10837774 DOI: 10.1016/j.esmoop.2023.102196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/22/2023] Open
Abstract
BACKGROUND The BRCA proteins play a key role in the homologous recombination (HR) pathway. Beyond BRCA1/2, other genes are involved in the HR repair (HRR). Due to the prominent role in the cellular repair process, pathogenic or likely pathogenic variants (PV/LPVs) in HRR genes may cause inadequate DNA damage repair in cardiomyocytes. PATIENTS AND METHODS This was a multicenter, hospital-based, retrospective cohort study to investigate the heart toxicity from anthracycline-containing regimens (ACRs) in the adjuvant setting of breast cancer (BC) patients carrying germline BRCA PV/LPVs and no-BRCA HRR pathway genes. The left ventricular ejection fraction (LVEF) was assessed using cardiac ultrasound before starting ACR therapy and at subsequent time points according to clinical indications. RESULTS Five hundred and three BC patients were included in the study. We predefined three groups: (i) BRCA cohort; (ii) no-BRCA cohort; (iii) variant of uncertain significance (VUS)/wild-type (WT) cohort. When baseline (T0) and post-ACR (T1) LVEFs between the three cohorts were compared, pre-treatment LVEF values were not different (BRCA1/2 versus HRR-no-BRCA versus VUS/WT cohort). Notably, during monitoring (T1, median 3.4 months), patients carrying BRCA or HRR no-BRCA germline pathogenic or likely pathogenic variants showed a statistically significant reduction of LVEF compared to baseline (T0). To assess the relevance of HRR on the results, we included the analysis of the subgroup of 20 BC patients carrying PV/LPVs in other genes not involved in HRR, such as mismatch repair genes (MUTYH, PMS2, MSH6). Unlike HRR genes, no significant differences in T0-T1 were found in this subgroup of patients. CONCLUSION Our data suggest that deleterious variants in HRR genes, leading to impaired HR, could increase the sensitivity of cardiomyocytes to ACR in early BC patients. In this subgroup of patients, other measurements, such as the global longitudinal strain, and a more in-depth assessment of risk factors may be proposed in the future to optimize cardiovascular risk management and improve long-term survival.
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Affiliation(s)
- L Incorvaia
- Department of Surgical, Oncological and Oral Sciences, Section of Medical Oncology, University of Palermo, Palermo
| | - G Badalamenti
- Department of Surgical, Oncological and Oral Sciences, Section of Medical Oncology, University of Palermo, Palermo
| | - G Novo
- Division of Cardiology, University Hospital Paolo Giaccone, Palermo; Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE) "G. D'Alessandro", University of Palermo, Palermo
| | - S Gori
- Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella
| | - L Cortesi
- Department of Oncology and Hematology, Azienda Ospedaliero-Universitaria di Modena, Modena
| | - C Brando
- Department of Surgical, Oncological and Oral Sciences, Section of Medical Oncology, University of Palermo, Palermo
| | - S Cinieri
- Complex Medical Oncology Unit, ASL Brindisi Senatore Antonio Perrino Hospital, Brindisi
| | - G Curigliano
- Division of Early Drug Development for Innovative Therapy, European Institute of Oncology, IRCCS, Milan; Department of Oncology and Hemato-Oncology, University of Milan, Milan
| | - G R Ricciardi
- Medical Oncology Unit, A.O. Papardo & Department of Human Pathology, University of Messina, Messina
| | - A Toss
- Department of Oncology and Hematology, Azienda Ospedaliero-Universitaria di Modena, Modena
| | - R Chiari
- Medical Oncology, Ospedali Riuniti Padova Sud, Monselice
| | - R Berardi
- Medical Oncology, AOU Ospedali Riuniti Umberto I-GM Lancisi-G Salesi, Polytechnic University of the Marche Region, Ancona
| | - Z Ballatore
- Medical Oncology, AOU Ospedali Riuniti Umberto I-GM Lancisi-G Salesi, Polytechnic University of the Marche Region, Ancona
| | - M Bono
- Department of Surgical, Oncological and Oral Sciences, Section of Medical Oncology, University of Palermo, Palermo
| | - T D Bazan Russo
- Department of Surgical, Oncological and Oral Sciences, Section of Medical Oncology, University of Palermo, Palermo
| | - V Gristina
- Department of Surgical, Oncological and Oral Sciences, Section of Medical Oncology, University of Palermo, Palermo
| | - A Galvano
- Department of Surgical, Oncological and Oral Sciences, Section of Medical Oncology, University of Palermo, Palermo
| | - G Damerino
- Division of Cardiology, University Hospital Paolo Giaccone, Palermo
| | - L Blasi
- Medical Oncology Unit, ARNAS Civico, Palermo
| | - V Bazan
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (Bind), Section of Medical Oncology, University of Palermo, Palermo, Italy
| | - A Russo
- Department of Surgical, Oncological and Oral Sciences, Section of Medical Oncology, University of Palermo, Palermo.
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Cortesi L, Venturelli M, Cortesi G, Caggia F, Toss A, Barbieri E, De Giorgi U, Guarneri V, Musolino A, De Matteis E, Zambelli A, Bisagni G, Dominici M. A phase II study of pembrolizumab plus carboplatin in BRCA-related metastatic breast cancer (PEMBRACA). ESMO Open 2023; 8:101207. [PMID: 37028000 PMCID: PMC10163155 DOI: 10.1016/j.esmoop.2023.101207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 02/25/2023] [Accepted: 02/28/2023] [Indexed: 04/09/2023] Open
Abstract
BACKGROUND BRCA1/2-related metastatic breast cancers (mBC) are sensitive to DNA-damage agents and show high tumor-infiltrated lymphocytes. We hypothesized that the association between pembrolizumab and carboplatin could be active in BRCA-related mBC. PATIENTS AND METHODS In this phase II Simon's design multicenter single-arm study, BRCA1/2-related mBC patients received carboplatin at area under the curve 6 every 3 weeks for six courses associated with 200 mg pembrolizumab every 3 weeks until disease progression or unacceptable toxicity. The primary aim at first stage was overall response rate (ORR) ≥70%. Disease control rate (DCR), time to progression (TTP), duration of response (DOR), and overall survival (OS) were the secondary aims. RESULTS Among 22 patients enrolled at the first stage, 5 BRCA1 and 17 BRCA2, 16 (76%) were luminal tumors and 6 (24%) triple-negative BC (TNBC). In 21 patients, ORR and DCR were 43% and 76% (47% and 87% in luminal, 33% and 50% in TNBC), respectively. TTP was 7.1 months, DOR was 6.3 months, and median OS was not reached. Grade ≥3 adverse events (AEs) or serious AEs occurred in 5/22 patients (22.7%). Since the primary aim was not met, the study was terminated at the first stage. CONCLUSIONS Although the primary aim was not reached, data on efficacy and safety of pembrolizumab plus carboplatin in first-line visceral disease BRCA-related luminal mBC were provided and they need to be further investigated.
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Affiliation(s)
- L Cortesi
- Department of Oncology and Haematology, University Hospital Modena, Modena.
| | - M Venturelli
- Department of Oncology and Haematology, University Hospital Modena, Modena
| | - G Cortesi
- Department of Oncology and Haematology, University Hospital Modena, Modena
| | - F Caggia
- Department of Oncology and Haematology, University Hospital Modena, Modena
| | - A Toss
- Department of Oncology and Haematology, University Hospital Modena, Modena
| | - E Barbieri
- Department of Oncology and Haematology, University Hospital Modena, Modena
| | - U De Giorgi
- Department of Medical Oncology, "Dino Amadori Scientific Institute of Romagna for the Study of Cancer", Meldola
| | - V Guarneri
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padova; Division of Oncology, Istituto Oncologico Veneto IRCCS, Padova
| | - A Musolino
- Department of Medicine and Surgery, University of Parma, Parma; Medical Oncology, Breast Unit and Cancer Genetics Service, University Hospital of Parma, Parma
| | | | - A Zambelli
- Papa Giovanni XXIII Cancer Center Hospital, Bergamo
| | - G Bisagni
- Oncology Department, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - M Dominici
- Department of Oncology and Haematology, University Hospital Modena, Modena
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Riccò B, Meduri B, Venturelli M, Cortesi L, Barbieri E, Ponzoni O, Moscetti L, Omarini C, Piacentini F, Dominici M, Toss A. 190P Staging strategies of newly diagnosed triple-negative breast cancer (TNBC): Comparison between CT scan and 18F-FDG-PET/CT. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Pellegrino B, Llop-Guevara A, Solinas C, Campanini N, Tommasi C, Michiara M, Boggiani D, Sikokis A, Frassoldati A, Casarini C, Cretella E, Zoppoli G, Lambertini M, Dieci M, Cortesi L, Silini E, Balmaña J, Willard-Gallo K, Serra V, Musolino A. 146P HRD/TIL-low high-risk breast cancer is characterized by good prognosis (the RADIMMUNE trial). Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Incorvaia L, Fiorino A, Gori S, Cinieri S, Curigliano G, Toss A, Cortesi L, Ricciardi G, Chiari R, Peri M, Brando C, Bazan Russo T, Gristina V, Galvano A, Damerino G, Carreca I, Novo G, Badalamenti G, Bazan V, Russo A. 904MO Anthracycline-related cardiotoxicity in breast cancer patients carrying mutational signature of homologous recombination deficiency (HRD). Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Spinella A, Toss A, Isca C, De Pinto M, Vacchi C, Magnani L, Lumetti F, Macripo’ P, Ficarra G, Fabbiani L, Iannone A, Gasparini E, Piana S, Cortesi L, De Santis G, Maiorana A, Dominici M, Salvarani C, Giuggioli D. POS0919 MOLECULAR AND BIOLOGICAL PATHWAYS OF BREAST CANCER IN PATIENTS WITH SYSTEMIC SCLEROSIS: IMMUNOHISTOCHEMICAL INVESTIGATIONS FROM THE SCLERO-BREAST STUDY. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.4603] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundSystemic Sclerosis (SSc) is a life-threatening connective tissue disease characterized by endothelial dysfunction, autoimmune abnormalities and aberrant fibrosis. Several reports showed an increased risk of cancer in SSc compared to general population, including breast cancer (BC). The relationship between BC and SSc has long been discussed with contradictory results. In our recent Sclero-Breast study we analyzed clinical-pathological features of BC in SSc; we finally observed the development of BC with early stages and good prognosis among these patients.ObjectivesThe aim of this project was to explore the immunohistochemical (IHC) expression of potential biomarkers involved in the molecular pathways at the basis of SSc and BC etiophatogenesis as update analysis from the Sclero-Breast study.MethodsOur observational multicenter retrospective study, performed at Modena University Hospital and Reggio Emilia Hospital in northern Italy, enrolled 33 SSc women with a personal history of BC between January 2017 and December 2019. Clinical and pathological characteristics of BC and SSc were collected. For 22 patients, BC tissues were available and IHC analysis was performed using specific antibodies to evaluate biomarkers and pathways potentially involved. The antibodies used included: PI3K/mTOR/TGFβ/PDGFRα/PDGFRβ/VEGF/EGFR/IL-6/CTLA-4/PDL1. We also reported TILs percentage (stromal tumor-infiltrating lymphocytes) of each sample. The following scores were assigned for general IHC analysis: (-) negative, (1+) positive tumor cells <20%, (2+) positive tumor cells 20-50%, (3+) positive tumor cells >50%. For PDL1 we considered a positivity in case of PD-L1 expression ≥1% in infiltrating inflammatory cells. For TILs quantification we applied the score: 0 (negative), ≤ 50% (low-median expression), >50% (high expression).ResultsThe first IHC analysis was performed on the samples of invasive BC patients (20 pts) and showed a prevalence of high PI3K expression (score of 3+ in 55% of cases) with mTOR overexpression in 45%. A PDL1 positivity was detected in 30%, with high TILs expression in 30%. Biopsies from the 2 pts with ductal carcinoma in situ were characterized by a negativity of almost all parameters, except for a medium-high TILs expression reported (40%/90% respectively). See Figure 1. IHC analysis was also performed according to BC subtypes. The group of HR+/HER2 negative showed high PI3K expression (score 3+) in most of cases (59%) with mTOR overexpression in 50%. CTLA-4 and PDL1 were positive in 25%, with high TILs expression in 25%. HER2 positive patients showed a high PI3K positivity in 50% of cases with mTOR positivity (score 3+) in 25% and high TGFβ expression (score 3+) in 25%. PDL1 was positive in 50% with high TILs expression in 25%. In Triple Negative group, PI3K overexpression was found in 75% of pts with half of cases represented by mTOR score 3+. PDL1 was positive in 50% with high TILs representation (80% of total cell count) in 50% of pts.Figure 1.IHC analysis and TILs% expression in histological samples of SSc patients with invasive BC.ConclusionAccording to our results, SSc patients with BC showed high positivity for PDL1 and high TILs representations in all subtypes. Furthermore, the high expression of PI3K, did not always correlate with mTOR overexpression. Further investigations on larger numbers are needed; however, these aspects seem to confirm that SSc subjects might develop BC at good prognosis, suggesting again a de-escalation strategy of cancer therapies. Finally, the possibility to personalize oncological targeted treatments in this subset of fragile patients could be promising.Disclosure of InterestsNone declared
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Russo A, Incorvaia L, Capoluongo E, Tagliaferri P, Gori S, Cortesi L, Genuardi M, Turchetti D, De Giorgi U, Di Maio M, Barberis M, Dessena M, Del Re M, Lapini A, Luchini C, Jereczek-Fossa BA, Sapino A, Cinieri S. Implementation of preventive and predictive BRCA testing in patients with breast, ovarian, pancreatic, and prostate cancer: a position paper of Italian Scientific Societies. ESMO Open 2022; 7:100459. [PMID: 35597177 PMCID: PMC9126927 DOI: 10.1016/j.esmoop.2022.100459] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [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: 01/10/2022] [Revised: 02/22/2022] [Accepted: 03/02/2022] [Indexed: 12/11/2022] Open
Abstract
Constitutional BRCA1/BRCA2 pathogenic or likely pathogenic variants (PVs) are associated with an increased risk for developing breast and ovarian cancers. Current evidence indicates that BRCA1/2 PVs are also associated with pancreatic cancer, and that BRCA2 PVs are associated with prostate cancer risk. The identification of carriers of constitutional PVs in the BRCA1/2 genes allows the implementation of individual and family prevention pathways, through validated screening programs and risk-reducing strategies. According to the relevant and increasing therapeutic predictive implications, the inclusion of BRCA testing in the routine management of patients with breast, ovarian, pancreatic and prostate cancers represent a key requirement to optimize medical or surgical therapeutic and prevention decision-making, and access to specific anticancer therapies. Therefore, accurate patient selection, the use of standardized and harmonized procedures, and adherence to homogeneous testing criteria, are essential elements to implement BRCA testing in clinical practice. This consensus position paper has been developed and approved by a multidisciplinary Expert Panel of 64 professionals on behalf of the AIOM–AIRO–AISP–ANISC–AURO–Fondazione AIOM–SIAPEC/IAP–SIBioC–SICO–SIF–SIGE–SIGU–SIU–SIURO–UROP Italian Scientific Societies, and a patient association (aBRCAdaBRA Onlus). The working group included medical, surgical and radiation oncologists, medical and molecular geneticists, clinical molecular biologists, surgical and molecular pathologists, organ specialists such as gynecologists, gastroenterologists and urologists, and pharmacologists. The manuscript is based on the expert consensus and reports the best available evidence, according to the current eligibility criteria for BRCA testing and counseling, it also harmonizes with current Italian National Guidelines and Clinical Recommendations. The rapid technologic and medical progress on BRCA-related cancers produced a clinical need for BRCA testing optimization. To incorporate BRCA testing in the routine management is a key requirement to help medical or surgical decision-making Standardized procedures and harmonized testing criteria are needed to implement BRCA testing in clinical practice. Adequate training and qualification for multidisciplinary team members are crucial for the success of the patient care path.
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Affiliation(s)
- A Russo
- Department of Surgical, Oncological and Oral Sciences, Section of Medical Oncology, University of Palermo, Palermo, Italy.
| | - L Incorvaia
- Department of Surgical, Oncological and Oral Sciences, Section of Medical Oncology, University of Palermo, Palermo, Italy
| | - E Capoluongo
- Department of Molecular Medicine and Medical Biotechnology, "Federico II" University of Naples, Naples, Italy; Department of Clinical Pathology- Cannizzaro Hospital, Catania, Italy
| | - P Tagliaferri
- Medical and Translational Oncology Unit, Department of Experimental and Clinical Medicine, Magna Graecia University, Catanzaro, Italy
| | - S Gori
- Department of Oncology, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar di Valpolicella, Italy
| | - L Cortesi
- Department of Oncology and Hematology, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - M Genuardi
- University Hospital Foundation "A. Gemelli", IRCCS - Medical Genetics Unit, Rome, Italy; Section of Genomic Medicine, Department of Life Sciences and Public Health, Catholic University Sacro Cuore, Rome, Italy
| | - D Turchetti
- Department of Medical and Surgical Sciences, Center for Studies on Hereditary Cancer, University of Bologna, Bologna, Italy; Unit of Medical Genetics, IRCCS Azienda Ospedaliero-Universitaria of Bologna, Bologna, Italy
| | - U De Giorgi
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - M Di Maio
- Department of Oncology, University of Turin, Division of Medical Oncology, Ordine Mauriziano Hospital, Turin, Italy
| | - M Barberis
- Unit of Histopathology and Molecular Diagnostics, Division of Pathology and Laboratory Medicine, IEO, European Institute of Oncology, IRCCS, Milan, Italy
| | - M Dessena
- S.C. Experimental Surgery, Oncology Hospital, Brotzu Hospital, Cagliari, Italy
| | - M Del Re
- Unit of Clinical Pharmacology and Pharmacogenetics, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa, Italy
| | - A Lapini
- Department of Urology, University of Florence, University Hospital of Florence, Florence, Italy
| | - C Luchini
- Department of Diagnostics and Public Health, Section of Pathology, University and Hospital Trust of Verona, Verona, Italy; ARC-Net Research Center, University and Hospital Trust of Verona, Verona, Italy
| | - B A Jereczek-Fossa
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy; Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - A Sapino
- Candiolo Cancer Institute, FPO-IRCCS Candiolo, Candiolo, Italy; Department of Medical Sciences, University of Torino, Torino, Italy
| | - S Cinieri
- Medical Oncology Division and Breast Unit, Senatore Antonio Perrino Hospital, ASL Brindisi, Brindisi, Italy
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Roeske J, Mostafavi H, Lehmann M, Morf D, Cortesi L, Zhu L, Wagstaff P, Kaur M, Kang H, Harkenrider M. Initial Clinical Evaluation of Fast-kV Dual Energy Imaging for Markerless Tumor Tracking of Lung Tumors in Stereotactic Body Radiation Therapy (SBRT). Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.128] [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: 10/20/2022]
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Venturelli M, Toss A, Civallero M, Piombino C, Domati F, Combi F, Tazzioli G, Dominici M, Cortesi L. 204P Predictive factors for relapse in triple-negative breast cancer (TNBC) patients without pathologic complete response (PCR). Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.486] [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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Toss A, Isca C, Venturelli M, Nasso C, Ficarra G, Bellelli V, Armocida C, Barbieri E, Cortesi L, Moscetti L, Piacentini F, Omarini C, Andreotti A, Gambini A, Battista R, Dominici M, Tazzioli G. Two-month stop in mammographic screening significantly impacts on breast cancer stage at diagnosis and upfront treatment in the COVID era. ESMO Open 2021; 6:100055. [PMID: 33582382 PMCID: PMC7878116 DOI: 10.1016/j.esmoop.2021.100055] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [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: 12/18/2020] [Revised: 01/09/2021] [Accepted: 01/12/2021] [Indexed: 12/14/2022] Open
Abstract
Introduction The present analysis aims to evaluate the consequences of a 2-month interruption of mammographic screening on breast cancer (BC) stage at diagnosis and upfront treatments in a region of Northern Italy highly affected by the severe acute respiratory syndrome-related coronavirus-2 (SARS-CoV-2) virus. Methods This retrospective single-institution analysis compared the clinical pathological characteristics of BC diagnosed between May 2020 and July 2020, after a 2-month screening interruption, with BC diagnosed in the same trimester of 2019 when mammographic screening was regularly carried out. Results The 2-month stop in mammographic screening produced a significant decrease in in situ BC diagnosis (−10.4%) and an increase in node-positive (+11.2%) and stage III BC (+10.3%). A major impact was on the subgroup of patients with BC at high proliferation rates. Among these, the rate of node-positive BC increased by 18.5% and stage III by 11.4%. In the subgroup of patients with low proliferation rates, a 9.3% increase in stage III tumors was observed, although node-positive tumors remained stable. Despite screening interruption, procedures to establish a definitive diagnosis and treatment start were subsequently carried out without delay. Conclusion Our data showed an increase in node-positive and stage III BC after a 2-month stop in BC screening. These findings support recommendations for a quick restoration of BC screening at full capacity, with adequate prioritization strategies to mitigate harm and meet infection prevention requirements. Due to the COVID19 pandemic, several mammographic screening services were disrupted. A 2-month stop in BC screening led to decreased in situ BC and increased node-positive and stage III BC diagnosis. A major impact was on the subgroup of patients with BC at high proliferation rates. Despite screening interruption, procedures to start treatments were subsequently carried out without delay. Restoration of BC screening at full capacity with infection prevention requirements is recommended.
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Affiliation(s)
- A Toss
- Department of Oncology and Hematology, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy; Department of Surgery, Medicine, Dentistry and Morphological Sciences with Transplant Surgery, Oncology and Regenerative Medicine Relevance, University of Modena and Reggio Emilia, Modena, Italy.
| | - C Isca
- Department of Oncology and Hematology, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - M Venturelli
- Department of Oncology and Hematology, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - C Nasso
- Department of Oncology and Hematology, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - G Ficarra
- Pathology Unit, University Hospital of Modena, Modena, Italy
| | - V Bellelli
- Breast Cancer Screening Service, AUSL Modena, Modena, Italy
| | - C Armocida
- Breast Cancer Screening Service, AUSL Modena, Modena, Italy
| | - E Barbieri
- Department of Oncology and Hematology, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - L Cortesi
- Department of Oncology and Hematology, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - L Moscetti
- Department of Oncology and Hematology, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - F Piacentini
- Department of Oncology and Hematology, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy; Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - C Omarini
- Department of Oncology and Hematology, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - A Andreotti
- Unit of Breast Surgical Oncology, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - A Gambini
- Unit of Breast Surgical Oncology, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - R Battista
- Department of Diagnostic Imaging, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - M Dominici
- Department of Oncology and Hematology, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy; Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - G Tazzioli
- Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, Modena, Italy; Unit of Breast Surgical Oncology, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
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Proietti M, Cortesi L, Spagnoli F, Nobili A, Marengoni A. Prevalence of drug-drug interactions for oral anticoagulant drugs in patients with atrial fibrillation and relationship with outcomes: a population-based cohort study. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3376] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
The introduction of non-vitamin K antagonist oral anticoagulants (NOACs) changed the treatment of atrial fibrillation (AF) patients, promising a better safety profile and a lower chance of interaction with drugs than vitamin K antagoniste (VKA).
Aim
To evaluate the prevalence of possible drug-drug interactions (DDIs) in a cohort of newly anticoagulated AF patients, their impact on outcomes and possible differences between VKA and NOACs users.
Methods
We performed an analysis derived from administrative databases in Lombardy Italian region. All patients ≥40 years admitted from 01/06/2013 to 30/06/2018 with an AF diagnosis that were VKA or NOACs new users were included in this analysis. Possible DDIs were evaluated according to the prescription of OAC therapy, on the basis of current available evidence. Stroke, intracerebral hemorrhage (ICH), any bleeding and all-cause death were the study outcomes.
Results
Among the 122816 patients included in the analysis, mean (SD) age 76.3 (9.6) with 47.3% females, a mean (SD) CHA2DS2-VASc of 3.5 (1.4) was found. A total of 70180 (57.1%) patients were prescribed with VKA and 52636 (42.9%) with NOACs. A possible DDI was recorded in 63273 (51.5%). Patients exposed to DDIs were older and less likely female (both p<0.0001) and with a higher mean (SD) CHA2DS2-VASc (p<0.0001). Rate of stroke, ICH, any bleeding and all-cause death were higher in those patients exposed to DDIs (all p<0.001). After full adjustment, exposure to possible DDIs was associated with an increased risk for any bleeding (HR: 1.08, 95% CI: 1.05–1.12) and all-cause death (HR: 1.10, 95% CI: 1.07–1.13), with no differences for stroke and ICH. Comparing VKA and NOACs patients exposed to possible DDIs, we found that VKA users exposed to possible DDIs, after adjustments, were at higher risk for all the outcomes (Table).
Conclusions
In a large cohort of AF patients newly prescribed with OAC, possible DDIs were largely prevalent, in particular in VKA users. Presence of a possible DDI is associated with an increased risk of any bleeding and all-cause death. VKA users exposed to a possible DDI were at higher risk for any outcome than NOACs users exposed to a possible DDI.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
| | - L Cortesi
- Institute of Pharmacological Research Mario Negri IRCCS, Milan, Italy
| | - F Spagnoli
- University of Brescia, Department of Clinical and Experimental Sciences, Brescia, Italy
| | - A Nobili
- Institute of Pharmacological Research Mario Negri IRCCS, Milan, Italy
| | - A Marengoni
- University of Brescia, Department of Clinical and Experimental Sciences, Brescia, Italy
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Pasina L, Novella A, Cortesi L, Nobili A, Tettamanti M, Ianes A. Drug prescriptions in nursing home residents: an Italian multicenter observational study. Eur J Clin Pharmacol 2020; 76:1011-1019. [DOI: 10.1007/s00228-020-02871-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 04/01/2020] [Indexed: 12/18/2022]
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Omarini C, Sperduti I, Barbolini M, Isca C, Bocconi A, Toss A, Cortesi L, Barbieri E, Piacentini F, Cascinu S, Moscetti L. Endocrine therapy alone versus targeted combination strategy as first line treatment in elderly patients with hormone receptor-positive advanced breast cancer: Meta-analysis of phase II and III randomized clinical trials. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz242.018] [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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Haytmyradov M, Mostafavi H, Morf D, Cortesi L, Wang A, Surucu M, Zhu L, Patel R, Cassetta F, Harkenrider M, Roeske J. Markerless Tumor Tracking using Fast-kV Switching Dual Energy Imaging with the On-Board Imager of a Commercial Linac. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Molinaro E, Venturelli M, Toss A, Piombino C, Barbieri E, Marcheselli L, Marchi I, Tagliafico E, Cascinu S, Cortesi L. BRCA mutations among triple negative breast cancer without family history of breast and ovarian cancer: The Modena family cancer clinic experience. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz095.045] [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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Toss A, Venturelli M, Sperduti I, Isca C, Molinaro E, Barbieri E, Piacentini F, Omarini C, Cortesi L, Cascinu S, Moscetti L. Abstract P1-18-06: First-line treatment for endocrine sensitive bone-only metastatic breast cancer: Is more always better? Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p1-18-06] [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
The standard first-line for endocrine sensitive metastatic breast cancer (BC) is represented by endocrine therapy. Several phase III clinical trials searched for more effective endocrine strategies. Nevertheless, the use of combinations for the first-line treatment of bone-only disease (BoD) is widely discussed, due to its indolent course. Our meta-analysis aims to explore the role of new endocrine strategies in BoD.
A systematic review of electronic databases was conducted to identify the phase III clinical trials comparing the standard AI to novel experimental strategies. The hazard ratios (HR) for PFS were pooled in a meta-analysis. The heterogeneity of the data was evaluated by Chi-square Q test and I2 statistic.
8 studies were included in the analyses. 4 trials explored the role of CDK4/6 inhibitors (Monaleesa2 and 7, Monarch3 and Paloma2), 2 trials analyzed Fulvestrant + AI (SWOG and FACT), one trial studied Fulvestrant monotherapy (FALCON), while one trial evaluated the association between Bevacizumab and Letrozole (ALLIANCE). 6 trials reported data regarding the BoD, while 2 trials included the BoD in the non-visceral disease. Overall, the meta-analyses showed a PFS advantage for the experimental arms [HR 0.70 p 0.012], with a significant moderate/high heterogeneity [I2 66.48% p 0.004]. Only the FALCON and Paloma2 showed a significant improvement in PFS, respectively for Fulvestrant and Palbociclib + Letrozole. Considering only trials reporting data for BoD, the experimental arms significantly improved the PFS [HR 0.66 p 0.005], with a low/moderate non-significant heterogeneity [I2 44.95% p 0.106].
The novel strategies showed to be able to improve the PFS of BoD. Nonetheless, only Palbociclib + Letrozole provided statistically significant data of advantage in this setting. In clinical trials, BoD is often included in the non-visceral disease subgroup. Future clinical trials should take into account the differences in natural history and better prognosis of BoD, in order to define the best approach to these patients.
Citation Format: Toss A, Venturelli M, Sperduti I, Isca C, Molinaro E, Barbieri E, Piacentini F, Omarini C, Cortesi L, Cascinu S, Moscetti L. First-line treatment for endocrine sensitive bone-only metastatic breast cancer: Is more always better? [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-18-06.
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Affiliation(s)
- A Toss
- Azienda Ospedaliero - Universitaria Policlinico di Modena, Modena, Italy; IRCCS Regina Elena National Cancer Institute, Roma, Italy
| | - M Venturelli
- Azienda Ospedaliero - Universitaria Policlinico di Modena, Modena, Italy; IRCCS Regina Elena National Cancer Institute, Roma, Italy
| | - I Sperduti
- Azienda Ospedaliero - Universitaria Policlinico di Modena, Modena, Italy; IRCCS Regina Elena National Cancer Institute, Roma, Italy
| | - C Isca
- Azienda Ospedaliero - Universitaria Policlinico di Modena, Modena, Italy; IRCCS Regina Elena National Cancer Institute, Roma, Italy
| | - E Molinaro
- Azienda Ospedaliero - Universitaria Policlinico di Modena, Modena, Italy; IRCCS Regina Elena National Cancer Institute, Roma, Italy
| | - E Barbieri
- Azienda Ospedaliero - Universitaria Policlinico di Modena, Modena, Italy; IRCCS Regina Elena National Cancer Institute, Roma, Italy
| | - F Piacentini
- Azienda Ospedaliero - Universitaria Policlinico di Modena, Modena, Italy; IRCCS Regina Elena National Cancer Institute, Roma, Italy
| | - C Omarini
- Azienda Ospedaliero - Universitaria Policlinico di Modena, Modena, Italy; IRCCS Regina Elena National Cancer Institute, Roma, Italy
| | - L Cortesi
- Azienda Ospedaliero - Universitaria Policlinico di Modena, Modena, Italy; IRCCS Regina Elena National Cancer Institute, Roma, Italy
| | - S Cascinu
- Azienda Ospedaliero - Universitaria Policlinico di Modena, Modena, Italy; IRCCS Regina Elena National Cancer Institute, Roma, Italy
| | - L Moscetti
- Azienda Ospedaliero - Universitaria Policlinico di Modena, Modena, Italy; IRCCS Regina Elena National Cancer Institute, Roma, Italy
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DeCensi A, Puntoni M, Guerrieri Gonzaga A, Avino F, Cortesi L, Donadio M, Pacquola M, Falcini F, Gulisano M, Digennaro M, Tienghi A, Cagossi K, Pinotti G, Varicchio C, Caviglia S, Boni L, Bonanni B. Abstract GS3-01: A randomized placebo controlled phase III trial of low dose tamoxifen for the prevention of recurrence in women with operated hormone sensitive breast ductal or lobular carcinoma in situ. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-gs3-01] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Tamoxifen is an effective drug for breast cancer prevention and treatment, but the risk of endometrial cancer and venous thromboembolism has limited its broader use. We have repeatedly shown in biomarker trials that the minimal effective dose of tamoxifen is lower than 20 mg/day, but a definitive answer on efficacy and safety required a phase III trial. The optimal treatment of ductal carcinoma in situ (DCIS) is still controversial.
Methods: We conducted a phase III trial of tamoxifen (T), 5 mg/day versus placebo (P) in women with operated hormone sensitive breast intraepithelial neoplasia (DCIS or LCIS). Women with G3, positive margins or comedo/necrosis DCIS received radiotherapy. Women were seen every 6 months with an annual mammography for at last 5 years after randomization. Initial statistical calculations were revised according to the lower than expected accrual, and the Independent Data Safety Monitoring Board recommended the disclosure of results as 80% of the originally expected events were observed.
Results: Between November 1, 2008 and March 31, 2015 a total of 500 women were randomized to either T, 5 mg/day or P for 3 years. A total of 10 patients are not assessable becuse of consent withdrawal or drop out. The main subject characteristics were well balanced between arms. As of May 31, 2018, after a median follow-up of 5.1 years (interquartile range, 3.9-6.3), there were 14 recurrences in the T arm and 29 in the P arm (hazard ratio=0.48, 95% CI, 0.25-0.89, p=0.02). The incidence rate of events was 11.8/1000 py in the T arm and 24.9/1000 py in the P arm. Most recurrences were invasive breast cancers: 11/14 (78%) in the T arm and 16/29 (55%) in the P arm. There were 8 serious adverse events in the T arm and 12 in the P arm, including 2 arterial events in each arm, 2 superficial phlebitis in the T arm and 1 endometrial cancer (annual rate 0.85/1000 py) in the T arm. There were 6 versus 4 second primary cancers in the T and P arm, respectively, and 2 deaths in the P arm. Menopausal symptoms were more frequent in the T arm and will be reported in details at the conference.
Baseline characteristics Tamoxifen (n=246)Placebo (n=244) mean (SD)mean (SD)Age (yrs) 54.0 (9.4)53.7 (9.1)Body Mass Index (kg/m2) 25.7 (4.8)25.3 (4.2) n (%)n (%)Menopausal statusPre-110 (45)107 (44) Post-136 (55)137 (56)Type of lesionDCIS221 (89)220 (90) LCIS25 (10)24 (10)Type of surgeryConservative (Q/L)206 (84)200 (82) Mastectomy39 (16)44 (18) Axillary dissection1 (0)-SD=standard deviation; DCIS=ductal carcinoma in situ; LCIS=lobular carcinoma in situ; Q=quadrantectomy; L=lumpectomy
Conclusions: Tamoxifen at the dose of 5 mg/day can halve the incidence of recurrence in women with operated hormone sensitive DCIS or LCIS with a limited toxicity, providing a valid treatment option in women with disease. In addition, this study has important implications for the preventive therapy of high risk unaffected women.
ClinicalTrials.gov Identifier: NCT01357772; Supported by the Italian Ministry of Health - RFPS-2006-1-339898 and the Italian Association for Cancer Research (AIRC) - IG 2008 Grant no. 5611.
Citation Format: DeCensi A, Puntoni M, Guerrieri Gonzaga A, Avino F, Cortesi L, Donadio M, Pacquola M, Falcini F, Gulisano M, Digennaro M, Tienghi A, Cagossi K, Pinotti G, Varicchio C, Caviglia S, Boni L, Bonanni B. A randomized placebo controlled phase III trial of low dose tamoxifen for the prevention of recurrence in women with operated hormone sensitive breast ductal or lobular carcinoma in situ [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr GS3-01.
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Affiliation(s)
- A DeCensi
- E.O. Ospedali Galliera, Genoa, Italy; European Institute of Oncology, Milan, Italy; Istituto Nazionale Tumori "Fondazione Pascale, Naples, Italy; A. O. Universitaria Policlinico di Modena, Modena, Italy; A.O. Universitaria S. Giovanni Battista - “Le Molinette”, Turin, Italy; Ospedale SS Antonio e Margherita-ASL AL, Tortona, Italy; Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (I.R.S.T.), Meldola, Italy; ULSS 6 Vicenza, Vicenza, Italy; Ospedale Oncologico di Bari - Istituto Tumori “G. Paolo II”, Bari, Italy; Ospedale Santa Maria delle Croci, Ravenna, Italy; Ospedale Bernardino Ramazzini, Carpi (MO), Italy; Asst Sette Laghi, Varese, Italy; AOU Careggi, Firenze, Italy
| | - M Puntoni
- E.O. Ospedali Galliera, Genoa, Italy; European Institute of Oncology, Milan, Italy; Istituto Nazionale Tumori "Fondazione Pascale, Naples, Italy; A. O. Universitaria Policlinico di Modena, Modena, Italy; A.O. Universitaria S. Giovanni Battista - “Le Molinette”, Turin, Italy; Ospedale SS Antonio e Margherita-ASL AL, Tortona, Italy; Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (I.R.S.T.), Meldola, Italy; ULSS 6 Vicenza, Vicenza, Italy; Ospedale Oncologico di Bari - Istituto Tumori “G. Paolo II”, Bari, Italy; Ospedale Santa Maria delle Croci, Ravenna, Italy; Ospedale Bernardino Ramazzini, Carpi (MO), Italy; Asst Sette Laghi, Varese, Italy; AOU Careggi, Firenze, Italy
| | - A Guerrieri Gonzaga
- E.O. Ospedali Galliera, Genoa, Italy; European Institute of Oncology, Milan, Italy; Istituto Nazionale Tumori "Fondazione Pascale, Naples, Italy; A. O. Universitaria Policlinico di Modena, Modena, Italy; A.O. Universitaria S. Giovanni Battista - “Le Molinette”, Turin, Italy; Ospedale SS Antonio e Margherita-ASL AL, Tortona, Italy; Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (I.R.S.T.), Meldola, Italy; ULSS 6 Vicenza, Vicenza, Italy; Ospedale Oncologico di Bari - Istituto Tumori “G. Paolo II”, Bari, Italy; Ospedale Santa Maria delle Croci, Ravenna, Italy; Ospedale Bernardino Ramazzini, Carpi (MO), Italy; Asst Sette Laghi, Varese, Italy; AOU Careggi, Firenze, Italy
| | - F Avino
- E.O. Ospedali Galliera, Genoa, Italy; European Institute of Oncology, Milan, Italy; Istituto Nazionale Tumori "Fondazione Pascale, Naples, Italy; A. O. Universitaria Policlinico di Modena, Modena, Italy; A.O. Universitaria S. Giovanni Battista - “Le Molinette”, Turin, Italy; Ospedale SS Antonio e Margherita-ASL AL, Tortona, Italy; Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (I.R.S.T.), Meldola, Italy; ULSS 6 Vicenza, Vicenza, Italy; Ospedale Oncologico di Bari - Istituto Tumori “G. Paolo II”, Bari, Italy; Ospedale Santa Maria delle Croci, Ravenna, Italy; Ospedale Bernardino Ramazzini, Carpi (MO), Italy; Asst Sette Laghi, Varese, Italy; AOU Careggi, Firenze, Italy
| | - L Cortesi
- E.O. Ospedali Galliera, Genoa, Italy; European Institute of Oncology, Milan, Italy; Istituto Nazionale Tumori "Fondazione Pascale, Naples, Italy; A. O. Universitaria Policlinico di Modena, Modena, Italy; A.O. Universitaria S. Giovanni Battista - “Le Molinette”, Turin, Italy; Ospedale SS Antonio e Margherita-ASL AL, Tortona, Italy; Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (I.R.S.T.), Meldola, Italy; ULSS 6 Vicenza, Vicenza, Italy; Ospedale Oncologico di Bari - Istituto Tumori “G. Paolo II”, Bari, Italy; Ospedale Santa Maria delle Croci, Ravenna, Italy; Ospedale Bernardino Ramazzini, Carpi (MO), Italy; Asst Sette Laghi, Varese, Italy; AOU Careggi, Firenze, Italy
| | - M Donadio
- E.O. Ospedali Galliera, Genoa, Italy; European Institute of Oncology, Milan, Italy; Istituto Nazionale Tumori "Fondazione Pascale, Naples, Italy; A. O. Universitaria Policlinico di Modena, Modena, Italy; A.O. Universitaria S. Giovanni Battista - “Le Molinette”, Turin, Italy; Ospedale SS Antonio e Margherita-ASL AL, Tortona, Italy; Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (I.R.S.T.), Meldola, Italy; ULSS 6 Vicenza, Vicenza, Italy; Ospedale Oncologico di Bari - Istituto Tumori “G. Paolo II”, Bari, Italy; Ospedale Santa Maria delle Croci, Ravenna, Italy; Ospedale Bernardino Ramazzini, Carpi (MO), Italy; Asst Sette Laghi, Varese, Italy; AOU Careggi, Firenze, Italy
| | - M Pacquola
- E.O. Ospedali Galliera, Genoa, Italy; European Institute of Oncology, Milan, Italy; Istituto Nazionale Tumori "Fondazione Pascale, Naples, Italy; A. O. Universitaria Policlinico di Modena, Modena, Italy; A.O. Universitaria S. Giovanni Battista - “Le Molinette”, Turin, Italy; Ospedale SS Antonio e Margherita-ASL AL, Tortona, Italy; Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (I.R.S.T.), Meldola, Italy; ULSS 6 Vicenza, Vicenza, Italy; Ospedale Oncologico di Bari - Istituto Tumori “G. Paolo II”, Bari, Italy; Ospedale Santa Maria delle Croci, Ravenna, Italy; Ospedale Bernardino Ramazzini, Carpi (MO), Italy; Asst Sette Laghi, Varese, Italy; AOU Careggi, Firenze, Italy
| | - F Falcini
- E.O. Ospedali Galliera, Genoa, Italy; European Institute of Oncology, Milan, Italy; Istituto Nazionale Tumori "Fondazione Pascale, Naples, Italy; A. O. Universitaria Policlinico di Modena, Modena, Italy; A.O. Universitaria S. Giovanni Battista - “Le Molinette”, Turin, Italy; Ospedale SS Antonio e Margherita-ASL AL, Tortona, Italy; Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (I.R.S.T.), Meldola, Italy; ULSS 6 Vicenza, Vicenza, Italy; Ospedale Oncologico di Bari - Istituto Tumori “G. Paolo II”, Bari, Italy; Ospedale Santa Maria delle Croci, Ravenna, Italy; Ospedale Bernardino Ramazzini, Carpi (MO), Italy; Asst Sette Laghi, Varese, Italy; AOU Careggi, Firenze, Italy
| | - M Gulisano
- E.O. Ospedali Galliera, Genoa, Italy; European Institute of Oncology, Milan, Italy; Istituto Nazionale Tumori "Fondazione Pascale, Naples, Italy; A. O. Universitaria Policlinico di Modena, Modena, Italy; A.O. Universitaria S. Giovanni Battista - “Le Molinette”, Turin, Italy; Ospedale SS Antonio e Margherita-ASL AL, Tortona, Italy; Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (I.R.S.T.), Meldola, Italy; ULSS 6 Vicenza, Vicenza, Italy; Ospedale Oncologico di Bari - Istituto Tumori “G. Paolo II”, Bari, Italy; Ospedale Santa Maria delle Croci, Ravenna, Italy; Ospedale Bernardino Ramazzini, Carpi (MO), Italy; Asst Sette Laghi, Varese, Italy; AOU Careggi, Firenze, Italy
| | - M Digennaro
- E.O. Ospedali Galliera, Genoa, Italy; European Institute of Oncology, Milan, Italy; Istituto Nazionale Tumori "Fondazione Pascale, Naples, Italy; A. O. Universitaria Policlinico di Modena, Modena, Italy; A.O. Universitaria S. Giovanni Battista - “Le Molinette”, Turin, Italy; Ospedale SS Antonio e Margherita-ASL AL, Tortona, Italy; Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (I.R.S.T.), Meldola, Italy; ULSS 6 Vicenza, Vicenza, Italy; Ospedale Oncologico di Bari - Istituto Tumori “G. Paolo II”, Bari, Italy; Ospedale Santa Maria delle Croci, Ravenna, Italy; Ospedale Bernardino Ramazzini, Carpi (MO), Italy; Asst Sette Laghi, Varese, Italy; AOU Careggi, Firenze, Italy
| | - A Tienghi
- E.O. Ospedali Galliera, Genoa, Italy; European Institute of Oncology, Milan, Italy; Istituto Nazionale Tumori "Fondazione Pascale, Naples, Italy; A. O. Universitaria Policlinico di Modena, Modena, Italy; A.O. Universitaria S. Giovanni Battista - “Le Molinette”, Turin, Italy; Ospedale SS Antonio e Margherita-ASL AL, Tortona, Italy; Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (I.R.S.T.), Meldola, Italy; ULSS 6 Vicenza, Vicenza, Italy; Ospedale Oncologico di Bari - Istituto Tumori “G. Paolo II”, Bari, Italy; Ospedale Santa Maria delle Croci, Ravenna, Italy; Ospedale Bernardino Ramazzini, Carpi (MO), Italy; Asst Sette Laghi, Varese, Italy; AOU Careggi, Firenze, Italy
| | - K Cagossi
- E.O. Ospedali Galliera, Genoa, Italy; European Institute of Oncology, Milan, Italy; Istituto Nazionale Tumori "Fondazione Pascale, Naples, Italy; A. O. Universitaria Policlinico di Modena, Modena, Italy; A.O. Universitaria S. Giovanni Battista - “Le Molinette”, Turin, Italy; Ospedale SS Antonio e Margherita-ASL AL, Tortona, Italy; Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (I.R.S.T.), Meldola, Italy; ULSS 6 Vicenza, Vicenza, Italy; Ospedale Oncologico di Bari - Istituto Tumori “G. Paolo II”, Bari, Italy; Ospedale Santa Maria delle Croci, Ravenna, Italy; Ospedale Bernardino Ramazzini, Carpi (MO), Italy; Asst Sette Laghi, Varese, Italy; AOU Careggi, Firenze, Italy
| | - G Pinotti
- E.O. Ospedali Galliera, Genoa, Italy; European Institute of Oncology, Milan, Italy; Istituto Nazionale Tumori "Fondazione Pascale, Naples, Italy; A. O. Universitaria Policlinico di Modena, Modena, Italy; A.O. Universitaria S. Giovanni Battista - “Le Molinette”, Turin, Italy; Ospedale SS Antonio e Margherita-ASL AL, Tortona, Italy; Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (I.R.S.T.), Meldola, Italy; ULSS 6 Vicenza, Vicenza, Italy; Ospedale Oncologico di Bari - Istituto Tumori “G. Paolo II”, Bari, Italy; Ospedale Santa Maria delle Croci, Ravenna, Italy; Ospedale Bernardino Ramazzini, Carpi (MO), Italy; Asst Sette Laghi, Varese, Italy; AOU Careggi, Firenze, Italy
| | - C Varicchio
- E.O. Ospedali Galliera, Genoa, Italy; European Institute of Oncology, Milan, Italy; Istituto Nazionale Tumori "Fondazione Pascale, Naples, Italy; A. O. Universitaria Policlinico di Modena, Modena, Italy; A.O. Universitaria S. Giovanni Battista - “Le Molinette”, Turin, Italy; Ospedale SS Antonio e Margherita-ASL AL, Tortona, Italy; Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (I.R.S.T.), Meldola, Italy; ULSS 6 Vicenza, Vicenza, Italy; Ospedale Oncologico di Bari - Istituto Tumori “G. Paolo II”, Bari, Italy; Ospedale Santa Maria delle Croci, Ravenna, Italy; Ospedale Bernardino Ramazzini, Carpi (MO), Italy; Asst Sette Laghi, Varese, Italy; AOU Careggi, Firenze, Italy
| | - S Caviglia
- E.O. Ospedali Galliera, Genoa, Italy; European Institute of Oncology, Milan, Italy; Istituto Nazionale Tumori "Fondazione Pascale, Naples, Italy; A. O. Universitaria Policlinico di Modena, Modena, Italy; A.O. Universitaria S. Giovanni Battista - “Le Molinette”, Turin, Italy; Ospedale SS Antonio e Margherita-ASL AL, Tortona, Italy; Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (I.R.S.T.), Meldola, Italy; ULSS 6 Vicenza, Vicenza, Italy; Ospedale Oncologico di Bari - Istituto Tumori “G. Paolo II”, Bari, Italy; Ospedale Santa Maria delle Croci, Ravenna, Italy; Ospedale Bernardino Ramazzini, Carpi (MO), Italy; Asst Sette Laghi, Varese, Italy; AOU Careggi, Firenze, Italy
| | - L Boni
- E.O. Ospedali Galliera, Genoa, Italy; European Institute of Oncology, Milan, Italy; Istituto Nazionale Tumori "Fondazione Pascale, Naples, Italy; A. O. Universitaria Policlinico di Modena, Modena, Italy; A.O. Universitaria S. Giovanni Battista - “Le Molinette”, Turin, Italy; Ospedale SS Antonio e Margherita-ASL AL, Tortona, Italy; Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (I.R.S.T.), Meldola, Italy; ULSS 6 Vicenza, Vicenza, Italy; Ospedale Oncologico di Bari - Istituto Tumori “G. Paolo II”, Bari, Italy; Ospedale Santa Maria delle Croci, Ravenna, Italy; Ospedale Bernardino Ramazzini, Carpi (MO), Italy; Asst Sette Laghi, Varese, Italy; AOU Careggi, Firenze, Italy
| | - B Bonanni
- E.O. Ospedali Galliera, Genoa, Italy; European Institute of Oncology, Milan, Italy; Istituto Nazionale Tumori "Fondazione Pascale, Naples, Italy; A. O. Universitaria Policlinico di Modena, Modena, Italy; A.O. Universitaria S. Giovanni Battista - “Le Molinette”, Turin, Italy; Ospedale SS Antonio e Margherita-ASL AL, Tortona, Italy; Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (I.R.S.T.), Meldola, Italy; ULSS 6 Vicenza, Vicenza, Italy; Ospedale Oncologico di Bari - Istituto Tumori “G. Paolo II”, Bari, Italy; Ospedale Santa Maria delle Croci, Ravenna, Italy; Ospedale Bernardino Ramazzini, Carpi (MO), Italy; Asst Sette Laghi, Varese, Italy; AOU Careggi, Firenze, Italy
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Toss A, Venturelli M, Sperduti I, Isca C, Barbieri E, Piacentini F, Omarini C, Cortesi L, Cascinu S, Moscetti L. First-line treatment for endocrine sensitive bone-only metastatic breast cancer: Is more always better? Ann Oncol 2018. [DOI: 10.1093/annonc/mdy272.327] [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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Cesari M, Franchi C, Cortesi L, Nobili A, Ardoino I, Mannucci PM. Implementation of the Frailty Index in hospitalized older patients: Results from the REPOSI register. Eur J Intern Med 2018; 56:11-18. [PMID: 29907381 DOI: 10.1016/j.ejim.2018.06.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 05/08/2018] [Accepted: 06/04/2018] [Indexed: 01/16/2023]
Abstract
BACKGROUND Frailty is a state of increased vulnerability to stressors, associated to poor health outcomes. The aim of this study was to design and introduce a Frailty Index (FI; according to the age-related accumulation of deficit model) in a large cohort of hospitalized older persons, in order to benefit from its capacity to comprehensively weight the risk profile of the individual. METHODS Patients aged 65 and older enrolled in the REPOSI register from 2010 to 2016 were considered in the present analyses. Variables recorded at the hospital admission (including socio-demographic, physical, cognitive, functional and clinical factors) were used to compute the FI. The prognostic impact of the FI on in-hospital and 12-month mortality was assessed. RESULTS Among the 4488 patients of the REPOSI register, 3847 were considered eligible for a 34-item FI computation. The median FI in the sample was 0.27 (interquartile range 0.21-0.37). The FI was significantly predictive of both in-hospital (OR 1.61, 95%CI 1.38-1.87) and overall (HR 1.46, 95%CI 1.32-1.62) mortality, also after adjustment for age and sex. CONCLUSIONS The FI confirms its strong predictive value for negative outcomes. Its implementation in cohort studies (including those conducted in the hospital setting) may provide useful information for better weighting the complexity of the older person and accordingly design personalized interventions.
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Affiliation(s)
- M Cesari
- Department of Clinical Sciences and Community Health, University of Milan, Italy; Geriatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy.
| | - C Franchi
- Department of Neuroscience, IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milano, Italy
| | - L Cortesi
- Department of Neuroscience, IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milano, Italy
| | - A Nobili
- Department of Neuroscience, IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milano, Italy
| | - I Ardoino
- Department of Clinical Sciences and Community Health, University of Milan, Italy
| | - P M Mannucci
- Scientific Direction, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
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Venturelli M, Toss A, Piacentini F, Bernardis I, Tenedini E, Omarini C, Moscetti L, Cascinu S, Tagliafico E, Cortesi L. ERBB2 and PI3KCA mutations in endocrine resistant breast cancer (BC). Ann Oncol 2018. [DOI: 10.1093/annonc/mdy314.035] [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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21
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Musolino A, Falcini F, Sikokis A, Boggiani D, Rimanti A, Pellegrino B, Silini EM, Campanini N, Barbieri E, Zamagni C, Degli Esposti R, Cortesi L, Bisagni G, Cavanna L, Frassoldati A, Sgargi P, Michiara M. Prognostic impact of interval breast cancer detection in women with pT1a N0M0 breast cancer with HER2-positive status: Results from a multicentre population-based cancer registry study. Eur J Cancer 2017; 88:10-20. [PMID: 29175735 DOI: 10.1016/j.ejca.2017.10.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Revised: 10/18/2017] [Accepted: 10/22/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Although human epidermal growth factor receptor 2 (HER2) overexpression is associated with poor prognosis, patients (pts) with pT1a N0M0 breast cancers (BCs) have an excellent outcome across all subtypes. Interval cancers (ICs) have poorer survival than screen-detected (SD) tumours, and an association has been reported between ICs and HER2 overexpression. We aimed to determine, in a general population of pT1a N0M0 BCs with known screening status, whether HER2-positive ICs have a poorer outcome than HER2-positive SD cancers. METHODS We evaluated all incident pT1a N0M0 BCs (n = 874) collected in the Emilia-Romagna region (Italy) from 2003 to 2009 and diagnosed in women aged 50-69. Pts unexposed to screening, with unknown HER2 status and/or treated with adjuvant trastuzumab were excluded from analysis. RESULTS Sixty-one percent of the BCs were SD, whereas 19% were ICs. BCs with high histologic grade, hormone receptor-negative or HER2-positive status (odds ratio=1.7; 95% confidence interval [CI]: 1.1-2.7) were more likely ICs. Median follow-up was 115 months. The 10-year invasive disease-free survival (iDFS) for HER2-positive ICs was lower than that for HER2-positive SD cancers: 75.0% (95% CI: 55.5%-94.5%) versus 93.8% (95% CI: 86.5%-100%). An interaction between ICs and HER2-positive status was found for poorer iDFS after adjusting for prognostic variables (HR = 5.3; 95% CI: 1.6-16.7). CONCLUSIONS IC detection may identify pts with HER2-positive pT1a N0M0 tumours in whom the rate of recurrence justifies consideration for conventional, anti-HER2, adjuvant treatment.
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Affiliation(s)
- A Musolino
- Medical Oncology Unit and Cancer Registry of Parma Province, University Hospital of Parma, Italy.
| | - F Falcini
- Romagna Cancer Registry, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), IRCCS, Meldola, Forlì, Italy; Azienda USL Della Romagna, Forlì, Italy
| | - A Sikokis
- Medical Oncology Unit and Cancer Registry of Parma Province, University Hospital of Parma, Italy
| | - D Boggiani
- Medical Oncology Unit and Cancer Registry of Parma Province, University Hospital of Parma, Italy
| | - A Rimanti
- Medical Oncology Unit and Cancer Registry of Parma Province, University Hospital of Parma, Italy
| | - B Pellegrino
- Medical Oncology Unit and Cancer Registry of Parma Province, University Hospital of Parma, Italy
| | - E M Silini
- Section of Anatomy and Pathology, University Hospital of Parma, Italy
| | - N Campanini
- Section of Anatomy and Pathology, University Hospital of Parma, Italy
| | - E Barbieri
- SSD Oncologia Medica Addarii, Policlinico S.Orsola-Malpighi, Bologna, Italy
| | - C Zamagni
- SSD Oncologia Medica Addarii, Policlinico S.Orsola-Malpighi, Bologna, Italy
| | - R Degli Esposti
- Medical Oncology Unit, Azienda USL-IRCCS Scienze Neurologiche, Bologna, Italy
| | - L Cortesi
- Department of Oncology, Hematology and Respiratory Diseases, University Hospital of Modena, Italy
| | - G Bisagni
- Department of Oncology and Advanced Technologies, Oncology Unit, IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | - L Cavanna
- Department of Oncology-Hematology, G. da Saliceto Hospital, Piacenza, Italy
| | - A Frassoldati
- Division of Medical Oncology, University Hospital of Ferrara, Italy
| | - P Sgargi
- Medical Oncology Unit and Cancer Registry of Parma Province, University Hospital of Parma, Italy
| | - M Michiara
- Medical Oncology Unit and Cancer Registry of Parma Province, University Hospital of Parma, Italy
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Damanti S, Cortesi L, Pasina L, Mari D, Marcucci M. Does rhythm or rate control strategy influence anticoagulant treatment in older patients with atrial fibrillation? Data from REPOSI. Eur J Intern Med 2017; 44:e18-e19. [PMID: 28679484 DOI: 10.1016/j.ejim.2017.06.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 06/26/2017] [Accepted: 06/28/2017] [Indexed: 10/19/2022]
Affiliation(s)
- S Damanti
- Nutritional Sciences PhD, Università degli studi di Milano, Italy; Geriatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - L Cortesi
- IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy
| | - L Pasina
- IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy
| | - D Mari
- Geriatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - M Marcucci
- Geriatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
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Toss A, Venturelli M, Pipitone S, Marchi I, Tenedini E, Medici V, Tagliafico E, Razzaboni E, Spaggiari F, De Matteis E, Cascinu S, Cortesi L. Family history of pancreatic cancer in BRCA1/2 testing criteria. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx425.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Venturelli M, Toss A, Pipitone S, Marchi I, Tenedini E, Medici V, Tagliafico E, Razzaboni E, Spaggiari F, De Matteis E, Cascinu S, Cortesi L. Should pancreatic cancer be included in BRCA1/2 testing criteria? Ann Oncol 2017. [DOI: 10.1093/annonc/mdx369.116] [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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25
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Riva S, Mancuso ME, Cortesi L, Nobili A, Santagostino E, Peyvandi F, Mannucci PM. Polypharmacy in older adults with severe haemophilia. Haemophilia 2017; 24:e1-e3. [DOI: 10.1111/hae.13262] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2017] [Indexed: 01/05/2023]
Affiliation(s)
- S. Riva
- Angelo Bianchi Bonomi Haemophilia and Thrombosis Centre; IRCCS Ca’ Granda Ospedale Maggiore Policlinico Foundation and University of Milan; Milan Italy
- Department of Oncology and Hematology; University of Milan; Milan Italy
| | - M. E. Mancuso
- Angelo Bianchi Bonomi Haemophilia and Thrombosis Centre; IRCCS Ca’ Granda Ospedale Maggiore Policlinico Foundation and University of Milan; Milan Italy
| | - L. Cortesi
- IRCCS Istituto di Ricerche Farmacologiche ‘Mario Negri’; Milan Italy
| | - A. Nobili
- IRCCS Istituto di Ricerche Farmacologiche ‘Mario Negri’; Milan Italy
| | - E. Santagostino
- Angelo Bianchi Bonomi Haemophilia and Thrombosis Centre; IRCCS Ca’ Granda Ospedale Maggiore Policlinico Foundation and University of Milan; Milan Italy
| | - F. Peyvandi
- Angelo Bianchi Bonomi Haemophilia and Thrombosis Centre; IRCCS Ca’ Granda Ospedale Maggiore Policlinico Foundation and University of Milan; Milan Italy
| | - P. M. Mannucci
- Angelo Bianchi Bonomi Haemophilia and Thrombosis Centre; IRCCS Ca’ Granda Ospedale Maggiore Policlinico Foundation and University of Milan; Milan Italy
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26
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Baviera M, Avanzini F, Marzona I, Tettamanti M, Vannini T, Cortesi L, Fortino I, Bortolotti A, Merlino L, Trevisan R, Roncaglioni MC. Cardiovascular complications and drug prescriptions in subjects with and without diabetes in a Northern region of Italy, in 2002 and 2012. Nutr Metab Cardiovasc Dis 2017; 27:54-62. [PMID: 27956023 DOI: 10.1016/j.numecd.2016.10.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 09/30/2016] [Accepted: 10/16/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND AND AIMS In contrast to the well-documented global prevalence of diabetes, much less is known about the epidemiology of cardiovascular (CV) complications in recent years. We describe the incidence of major CV events, deaths and drug prescribing patterns from 2002 to 2012 in subjects with (DM) or without diabetes mellitus (No DM). METHODS AND RESULTS Subjects and outcomes were identified using linkable health administrative databases of Lombardy, a region in Northern Italy. A logistic regression model was used to compare myocardial infarction (MI), stroke, major amputation and death between DM and No DM in 2002 and 2012 and between the two index years in each population. The interaction between years and diabetes was introduced in the model. From 2002 to 2012 the incidence of major CV complications and death fell in both groups with a larger reduction among DM only for CV events: OR (95% CI) for the interaction 0.86 (0.79-0.93) for MI, 0.89 (0.82-0.96) for stroke, 0.78 (0.57-1.06) for major amputations. CV prevention drugs rose considerably from 2002 to 2012 particularly in DM and a switch towards safer antihyperglycemic drugs was also observed. CONCLUSIONS Major CV complications and death declined from 2002 to 2012 in both DM and No DM. This might be due to a larger increase in prescriptions of CV drugs in DM and a relevant change toward recommended antihyperglycemic drugs.
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Affiliation(s)
- M Baviera
- Laboratory of Cardiovascular Prevention, IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy.
| | - F Avanzini
- Laboratory of Cardiovascular Prevention, IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy
| | - I Marzona
- Laboratory of Cardiovascular Prevention, IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy
| | - M Tettamanti
- Laboratory of Geriatric Epidemiology, IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy
| | - T Vannini
- Laboratory of Cardiovascular Prevention, IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy
| | - L Cortesi
- Laboratory of Quality Assessment of Geriatric Therapies and Services, IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy
| | - I Fortino
- Regional Health Ministry, Lombardy Region, Milan, Italy
| | - A Bortolotti
- Regional Health Ministry, Lombardy Region, Milan, Italy
| | - L Merlino
- Regional Health Ministry, Lombardy Region, Milan, Italy
| | - R Trevisan
- Diabetology Unit, Department of Internal Medicine, Ospedali Riuniti di Bergamo, Italy
| | - M C Roncaglioni
- Laboratory of Cardiovascular Prevention, IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy
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Cazzaniga ME, Cortesi L, Ferzi A, Scaltriti L, Cicchiello F, Ciccarese M, Della Torre S, Villa F, Giordano M, Verusio C, Nicolini M, Gambaro AR, Zanlorenzi L, Biraghi E, Legramandi L, Rulli E. Metronomic chemotherapy with oral vinorelbine (mVNR) and capecitabine (mCAPE) in advanced HER2-negative breast cancer patients: is it a way to optimize disease control? Final results of the VICTOR-2 study. Breast Cancer Res Treat 2016; 160:501-509. [PMID: 27752847 PMCID: PMC5090011 DOI: 10.1007/s10549-016-4009-3] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 10/03/2016] [Indexed: 11/29/2022]
Abstract
Purpose The VICTOR-1 study demonstrated that the all-oral metronomic combination of vinorelbine and capecitabine is highly active and well tolerated in hormone receptor-positive/HER2-negative patients. The VICTOR-2 study was designed to confirm these results. Methods Patients received mVNR 40 mg three times a week and mCAPE 500 mg three times a day, continuously. The primary endpoint was the clinical benefit rate (CBR); secondary endpoints were toxicity, objective response rate (ORR), and progression-free survival (PFS). Results Eighty patients were evaluable for the primary efficacy analysis. Median age was 65.3 years; most patients had HR-positive tumors (65 %). The CBR was 45.7 % (95 % CI 28.8–63.4) and 51.1 % (95 % CI 35.8–66.3) in first- and ≥ second-line therapy, respectively. The ORR was 35.5 % in first-line (95 % CI 19.2–54.6) and 25.6 % in ≥second-line (95 % CI 13.5–41.2). The median duration of response was 11.3 and 6.4 months and PFS rates at 1 year were 24.3 and 22.2 %, respectively. In triple-negative breast cancer patients (N = 28, 35 %) a lower, but clinically relevant CBR (35.7, 95 % CI 18.6–55.9) was observed. The main toxicities per cycle were non-febrile neutropenia (1.1 %), hand-foot syndrome (1.0 %), nausea and vomiting (1.0 %), leucopenia (0.8 %), fatigue (0.7 %), and diarrhea (0.4 %). Conclusion The VICTOR-2 study confirms the clinical activity of mVNR and mCAPE in HER2-negative breast cancer patients, suggesting that the easy schedule of administration, which requires monthly blood tests and limits patients’ dependence on hospitals, and the low cost of the drugs are valuable elements, even for countries with limited access to innovative or expensive drugs.
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Affiliation(s)
- M E Cazzaniga
- Oncology Unit, ASST Monza, Via Pergolesi, 33 20900, Monza, MB, Italy.
| | - L Cortesi
- Haematology and Oncology Unit, Azienda Ospedaliero-Universitaria Policlinico di Modena, Modena, Italy
| | - A Ferzi
- Oncology Unit, ASST Ovest Milanese, Ospedale di Legnano, Legnano, Italy
| | - L Scaltriti
- Oncology Day Hospital Unit, Ospedale Civile di Guastalla, Guastalla, Italy
| | - F Cicchiello
- Oncology Unit, ASST Monza, Via Pergolesi, 33 20900, Monza, MB, Italy
| | - M Ciccarese
- Oncology Unit, Ospedale Vito Fazzi, Lecce, Italy
| | - S Della Torre
- Oncology Unit, ASST Rhodense-Presidio di Garbagnate Milanese e Presidio di Rho, Garbagnate, Italy
| | - F Villa
- Oncology Unit, ASST, Lecco, Italy
| | - M Giordano
- Oncology Unit, ASST Lariana, Como, Italy
| | - C Verusio
- Oncology Unit, ASST della Valle Olona, Saronno, Italy
| | - M Nicolini
- Oncology Day Hospital Unit, Azienda USL Romagna, Cattolica, Italy
| | - A R Gambaro
- Oncology Unit, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - L Zanlorenzi
- Oncology Unit, ASST della Valle Olona, Busto Arsizio, Italy
| | - E Biraghi
- Oncology Unit, ASST Melegnano e Martesana, Gorgonzola, Italy
| | - L Legramandi
- Methodology for Clinical Research Laboratory, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - E Rulli
- Methodology for Clinical Research Laboratory, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
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Musolino A, Sikokis A, Boggiani D, Rimanti A, Pellegrino B, Silini E, Campanini N, Barbieri E, Cortesi L, Panebianco M, Porzio R, Frassoldati A, Sgargi P, Falcini F, Michiara M. Prognostic impact of interval breast cancer detection in women with pT1aN0M0 breast cancer with HER2-positive status: results from a multicenter population-based cancer registry study. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw364.08] [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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Boggiani D, Sikokis A, Rimanti A, Pellegrino B, Silini E, Campanini N, Barbieri E, Cortesi L, Panebianco M, Porzio R, Frassoldati A, Sgargi P, Falcini F, Michiara M, Musolino A. Prognostic Impact of Interval Breast Cancer Detection in Women with pT1aN0M0 Breast Cancer with HER2-positive Status: Results from a Multicenter Population-based Cancer Registry Study. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw337.09] [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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Toss A, Grandi G, Pavesi S, Marcheselli L, De Matteis E, Razzaboni E, Tomasello C, Cagnacci A, Cortesi L. The impact of reproductive factors and oral contraception on breast cancer risk in women with brca mutation or family history of breast cancer. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw337.03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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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Ottini L, Rizzolo P, Zanna I, Silvestri V, Saieva C, Falchetti M, Masala G, Navazio AS, Capalbo C, Bianchi S, Manoukian S, Barile M, Peterlongo P, Caligo MA, Varesco L, Tommasi S, Russo A, Giannini G, Cortesi L, Cini G, Montagna M, Radice P, Palli D. Association of SULT1A1 Arg²¹³His polymorphism with male breast cancer risk: results from a multicenter study in Italy. Breast Cancer Res Treat 2014; 148:623-8. [PMID: 25385181 DOI: 10.1007/s10549-014-3193-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Accepted: 10/31/2014] [Indexed: 12/31/2022]
Abstract
Male breast cancer (MBC) is rare and poorly understood. Like female breast cancer (FBC), MBCs are highly sensitive to hormonal changes, and hyperestrogenism, specifically, represents a major risk factor for MBC. MBC is considered similar to late-onset, post-menopausal estrogen/progesteron receptors positive FBC (ER+/PR+). Sulfotransferase 1A1 (SULT1A1) is an enzyme involved in the metabolism of estrogens. Recently, SULT1A1 common functional polymorphism Arg(213)His (638G>A) variant has been found to be associated with increased breast cancer (BC) risk, particularly in post-menopausal women. For this reason, we decided to explore whether SULT1A1 Arg(213)His could exert an effect on MBC development. The primary aim of this study was to evaluate the influence of the SULT1A1 Arg(213)His polymorphism on MBC risk. The secondary aim was to investigate possible associations with relevant clinical-pathologic features of MBC. A total of 394 MBC cases and 786 healthy male controls were genotyped for SULT1A1 Arg(213)His polymorphism by PCR-RFLP and high-resolution melting analysis. All MBC cases were characterized for relevant clinical-pathologic features. A significant difference in the distribution of SULT1A1 Arg(213)His genotypes was found between MBC cases and controls (P < 0.0001). The analysis of genotype-specific risk showed a significant increased MBC risk in individuals with G/A (OR 1.97, 95% CI 1.50-2.59; P < 0.0001) and A/A (OR 3.09, 95% CI 1.83-5.23; P < 0.0001) genotypes in comparison to wild-type genotype, under co-dominant model. A significant association between SULT1A1 risk genotypes and HER2 status emerged. Results indicate that SULT1A1 Arg(213)His may act as a low-penetrance risk allele for developing MBC and could be associated with a specific tumor subtype associated with HER2 overexpression.
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Affiliation(s)
- L Ottini
- Department of Molecular Medicine, "Sapienza" University of Rome, Viale Regina Elena, 324, 00161, Rome, Italy,
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Rizzolo P, Silvestri V, Giannini G, Varesco L, Viel A, Cortesi L, Montagna M, Radice P, Palli D, Ottini L. 962: Association of SULT1A1 Arg213His polymorphism with male breast cancer risk: a case−control study in Italy. Eur J Cancer 2014. [DOI: 10.1016/s0959-8049(14)50854-4] [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: 10/25/2022]
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Sebastiani F, Cortesi L, Sant M, Lucarini V, Cirilli C, De Matteis E, Marchi I, Negri R, Gallo E, Federico M. Increased incidence and poor prognosis of breast cancer in postmenopausal women with high body mass index attending a mammography screening program in the province of Modena (Italy). Gynecol Oncol 2014. [DOI: 10.1016/j.ygyno.2014.03.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Monesi L, Tettamanti M, Cortesi L, Baviera M, Marzona I, Avanzini F, Monesi G, Nobili A, Riva E, Fortino I, Bortolotti A, Fontana G, Merlino L, Trevisan R, Roncaglioni MC. Elevated risk of death and major cardiovascular events in subjects with newly diagnosed diabetes: findings from an administrative database. Nutr Metab Cardiovasc Dis 2014; 24:263-270. [PMID: 24418374 DOI: 10.1016/j.numecd.2013.08.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Revised: 07/16/2013] [Accepted: 08/05/2013] [Indexed: 11/28/2022]
Abstract
AIMS To investigate the incidence of major cardiovascular complications and mortality in the first years of follow-up in patients with newly diagnosed diabetes. METHODS AND RESULTS We examined incidence rates of hospitalization for cardiovascular reasons and death among new patients with diabetes using the administrative health database of the nine million inhabitants of Lombardy followed from 2002 to 2007. Age and sex-adjusted rates were calculated and hazard ratios (HR) were estimated with a matched population without diabetes of the same sex, age (± 1 year) and general practitioner. There were 158,426 patients with newly diagnosed diabetes and 314,115 subjects without diabetes. Mean follow-up was 33.0 months (SD ± 17.5). 9.7% of patients with diabetes were hospitalized for cardiovascular events vs. 5.4% of subjects without diabetes; mortality rate was higher in patients with diabetes (7.7% vs. 4.4%). The estimated probability of hospitalization during the follow up was higher in patients with diabetes than in subjects without for coronary heart disease (HR 1.4, 95% CI 1.3-1.4), cerebrovascular disease (HR 1.3.95% CI 1.2-1.3), heart failure (HR 1.4, 95% CI 1.3-1.4) as was mortality (HR 1.4, 95% CI 1.4-1.4). Younger patients with diabetes had a risk of death or hospital admission for cardio-cerebrovascular events similar to subjects without diabetes ten years older. CONCLUSIONS The elevated morbidity and mortality risks were clear since the onset of diabetes and rose over time. These data highlight the importance of prompt and comprehensive patients care in addition to anti-diabetic therapy in patients with newly diagnosed diabetes.
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Affiliation(s)
- L Monesi
- Laboratory of General Practice Research, IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Via Giuseppe La Masa, 19, 20156 Milan, Italy
| | - M Tettamanti
- Laboratory of Geriatric Neuropsychiatry, IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - L Cortesi
- Laboratory of General Practice Research, IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Via Giuseppe La Masa, 19, 20156 Milan, Italy
| | - M Baviera
- Laboratory of General Practice Research, IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Via Giuseppe La Masa, 19, 20156 Milan, Italy
| | - I Marzona
- Laboratory of General Practice Research, IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Via Giuseppe La Masa, 19, 20156 Milan, Italy
| | - F Avanzini
- Laboratory of General Practice Research, IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Via Giuseppe La Masa, 19, 20156 Milan, Italy
| | - G Monesi
- Diabetes Unit, "S. Maria della Misericordia" Hospital, Rovigo, Italy
| | - A Nobili
- Laboratory for Quality Assessment of Geriatric Therapies and Services, IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - E Riva
- Laboratory of Geriatric Neuropsychiatry, IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - I Fortino
- Regional Health Ministry, Lombardy Region, Milan, Italy
| | - A Bortolotti
- Regional Health Ministry, Lombardy Region, Milan, Italy
| | - G Fontana
- Regional Health Ministry, Lombardy Region, Milan, Italy
| | - L Merlino
- Regional Health Ministry, Lombardy Region, Milan, Italy
| | - R Trevisan
- Diabetology Unit, Department of Internal Medicine, Ospedali Riuniti di Bergamo, Italy
| | - M C Roncaglioni
- Laboratory of General Practice Research, IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Via Giuseppe La Masa, 19, 20156 Milan, Italy.
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Cortesi L, Razzaboni E, Toss A, De Matteis E, Marchi I, Medici V, Tazzioli G, Andreotti A, De Santis G, Pignatti M, Federico M. A rapid genetic counselling and testing in newly diagnosed breast cancer is associated with high rate of risk-reducing mastectomy in BRCA1/2-positive Italian women. Ann Oncol 2013; 25:57-63. [PMID: 24276029 DOI: 10.1093/annonc/mdt422] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Risk-reducing mastectomy (RRM) decreases breast cancer (BC) risk in BRCA1/2 mutation carriers by up to 95%, but the Italian attitude towards this procedure is reluctant. PATIENTS AND METHODS This is an observational study with retrospective design, using quantitative and qualitative research methods, aimed at evaluating the attitude towards RRM by rapid genetic counselling and testing (RGCT), at the time of BC diagnosis, compared with traditional genetic counselling and testing (TGCT), after previous BC surgery. Secondary aims were to investigate patient satisfaction after RRM and the rate of occult tumour in healthy breasts. A total of 1168 patients were evaluated: 1058 received TGCT, whereas 110 underwent RGCT. RESULTS In TGCT, among 1058 patients, 209 (19.7%) mutation carriers were identified, with the rate of RRM being 4.7% (10 of 209). Conversely in RGCT, among 110 patients, 36 resulted positive, of which, 15 (41.7%) underwent bilateral mastectomy at the BC surgery time, showing an overall good satisfaction, measured by interpretative phenomenological analysis 12 months after the intervention. CONCLUSIONS Our study shows that RGCT in patients with a hereditary profile is associated with a high rate of RRM at the BC surgery time, this being the pathway offered within a multidisciplinary organization.
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Affiliation(s)
- L Cortesi
- Department of Oncology, Haematology and Respiratory Diseases, University of Modena and Reggio Emilia, Modena, Italy
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Pedroni M, Di Gregorio C, Cortesi L, Reggiani Bonetti L, Magnani G, Simone ML, Medici V, Priore Oliva C, Marino M, Ponz de Leon M. Double heterozygosity for BRCA1 and hMLH1 gene mutations in a 46-year-old woman with five primary tumors. Tech Coloproctol 2013; 18:285-9. [DOI: 10.1007/s10151-013-1030-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Accepted: 05/07/2013] [Indexed: 01/13/2023]
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Ottini L, Silvestri V, Saieva C, Rizzolo P, Zanna I, Falchetti M, Masala G, Navazio AS, Graziano V, Bianchi S, Manoukian S, Barile M, Peterlongo P, D'Amico C, Varesco L, Tommasi S, Russo A, Giannini G, Cortesi L, Viel A, Montagna M, Radice P, Palli D. Association of low-penetrance alleles with male breast cancer risk and clinicopathological characteristics: results from a multicenter study in Italy. Breast Cancer Res Treat 2013; 138:861-8. [PMID: 23468243 DOI: 10.1007/s10549-013-2459-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Accepted: 02/18/2013] [Indexed: 10/27/2022]
Abstract
It is well-known that male breast cancer (MBC) susceptibility is mainly due to high-penetrance BRCA1/2 mutations. Here, we investigated whether common low-penetrance breast cancer (BC) susceptibility alleles may influence MBC risk in Italian population and whether variant alleles may be associated with specific clinicopathological features of MBCs. In the frame of the Italian Multicenter Study on MBC, we genotyped 413 MBCs and 745 age-matched male controls at 9 SNPs annotating known BC susceptibility loci. By multivariate logistic regression models, we found a significant increased MBC risk for 3 SNPs, in particular, with codominant models, for rs2046210/ESR1 (OR = 1.71; 95 % CI: 1.43-2.05; p = 0.0001), rs3803662/TOX3 (OR = 1.59; 95 % CI: 1.32-1.92; p = 0.0001), and rs2981582/FGFR2 (OR = 1.26; 95 % CI: 1.05-1.50; p = 0.013). Furthermore, we showed that the prevalence of the risk genotypes of ESR1 tended to be higher in ER- tumors (p = 0.062). In a case-case multivariate analysis, a statistically significant association between ESR1 and ER- tumors was found (OR = 1.88; 95 % CI: 1.03-3.49; p = 0.039). Overall, our data, based on a large and well-characterized MBC series, support the hypothesis that common low-penetrance BC susceptibility alleles play a role in MBC susceptibility and, interestingly, indicate that ESR1 is associated with a distinct tumor subtype defined by ER-negative status.
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Affiliation(s)
- L Ottini
- Department of Molecular Medicine, "Sapienza" University of Rome, Viale Regina Elena 324, 00161 Rome, Italy.
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Monesi L, Baviera M, Marzona I, Avanzini F, Monesi G, Nobili A, Tettamanti M, Cortesi L, Riva E, Fortino I, Bortolotti A, Fontana G, Merlino L, Roncaglioni MC. Prevalence, incidence and mortality of diagnosed diabetes: evidence from an Italian population-based study. Diabet Med 2012; 29:385-92. [PMID: 21913971 DOI: 10.1111/j.1464-5491.2011.03446.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [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] [Indexed: 12/31/2022]
Abstract
AIMS To describe trends in diagnosed diabetes prevalence, incidence and mortality from 2000 to 2007 in the most heavily populated Italian region. METHODS We examined the prevalence and incidence rates of Type 1 and Type 2 diabetes and yearly mortality rates among individuals with diabetes from 2000 to 2007 using an administrative health database of prescription, disease-specific exemption and hospitalization records of more than 9 million inhabitants of Lombardy. Age- and sex-specific rates were calculated and temporal trends for subjects aged ≥ 30 years were analysed. RESULTS The crude point diabetes prevalence rose from 3.0% in 2000 to 4.2% in 2007, a 40% increase. The incidence remained stable during the study period with a rate of 4/1000 per year. Overall mortality declined from 43.2/1000 in 2001 to 40.3/1000 in 2007 (6.7% decrease) at a rate slightly higher than that of the general population (4.8% decrease). Our projection in subjects aged ≥ 30 years indicates that the prevalence will rise continuously over the next years, reaching 11.1% in 2030. CONCLUSIONS The prevalence of diabetes increased substantially between 2000 and 2007, mainly because there are more patients with a new diagnosis each year than those who die. The increase observed by 2007 almost reached the World Health Organization prediction for 2030. Our analyses suggest that the increase will continue over the next few decades. These data are important for defining the burden of diabetes in the near future, to help in planning health services and ensure proper allocation of resources.
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Affiliation(s)
- L Monesi
- Laboratory of General Practice Research, Mario Negri Institute for Pharmacological Research, Milan, Italy.
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Cortesi L, De NA, Medici V, Marino M, Turchetti D, Pradella LM, Rossi G, Parisini E, Federico M. P2-07-03: Collective Evidence Suggests Neutrality for BRCA1 V1687I, a Novel Sequence Variant in the Conserved THV Motif of the First BRCT Repeat. Cancer Res 2011. [DOI: 10.1158/0008-5472.sabcs11-p2-07-03] [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: Unequivocal classification of BRCA1 and BRCA2 variants of uncertain significance (VUS) with respect to their effect on protein function is a challenge with consequent implications for clinical decision-making. Currently, integration of different types of evidence derived from independent sources appears to be the most reliable approach to help define disease relevance for each single VUS. During a routine screening for BRCA1 and BRCA2 mutations carried out by the Modena study group for familial breast and ovarian cancer we identified a novel BRCA1 sequence change (c.5178G>A) that causes a valine to isoleucine (V to I) substitution at position 1687. The sequence alteration was found in a patient diagnosed with early onset breast cancer and it was present neither in other breast/ovarian cancer families screened nor in unaffected control individuals. No co-occurrence of the variant with any known clinically relevant BRCA1 mutations was observed.
The C-terminally located BRCA1 V1687I lies in the conserved THV motif of the first BRCT repeat. Disease-causality has previously been suggested for two neighbouring sequence alterations, BRCA1 V1688del, whose repercussions on protein stability and function were also reported (De Nicolo et al., 2009), and BRCA1 H1686Q (Giannini et al, 2008). We aimed at garnering evidence that, together with family and genetic data, could help assess the clinical significance of the V1687I variant.
Methods: We employed a multimodal approach that included immunohistochemistry on tumor sections, in silico analyses, comparative structural modeling, and ascertainment of BRCT-mediated functional associations.
Results: Whereas tumor histology, receptor and HER2/neu status were compatible with a BRCA1-deficient phenotype, most algorithms we used to assess sequence and structure variation based on evolutionary conservation predicted the BRCA1 V1687I variant to be benign. In line with this prediction, analysis of the modeled BRCA1 V1687I BRCT domain did not reveal any major structural changes relative to the wild type counterpart and suggested that BRCA1 V1687I leaves the local architecture and overall stability of the protein largely unaltered. Consistently, the BRCA1 V1687I protein was properly expressed and localized to the nucleus, and it was still capable of binding BRIP1/FANCJ, CtIP and Abraxas, three BRCT-interacting, DNA damage response and repair partner proteins.
Conclusions: Based on our collected evidence, the BRCA1 V1687I amino acid change, although occurring in an evolutionary conserved region, does not seem to affect the function of the correspondingly encoded protein, and hence it is a likely benign sequence alteration.
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P2-07-03.
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Affiliation(s)
- L Cortesi
- 1University of Modena and Reggio Emilia, Modena, Italy; Dana-Farber Cancer Institute, Boston, MA; Harvard Medical School, Boston, MA; University of Bologna, Bologna, Italy; Italian Institute of Technology, Milan, Italy; These Authors Contributed Equally to This Work
| | - Nicolo A De
- 1University of Modena and Reggio Emilia, Modena, Italy; Dana-Farber Cancer Institute, Boston, MA; Harvard Medical School, Boston, MA; University of Bologna, Bologna, Italy; Italian Institute of Technology, Milan, Italy; These Authors Contributed Equally to This Work
| | - V Medici
- 1University of Modena and Reggio Emilia, Modena, Italy; Dana-Farber Cancer Institute, Boston, MA; Harvard Medical School, Boston, MA; University of Bologna, Bologna, Italy; Italian Institute of Technology, Milan, Italy; These Authors Contributed Equally to This Work
| | - M Marino
- 1University of Modena and Reggio Emilia, Modena, Italy; Dana-Farber Cancer Institute, Boston, MA; Harvard Medical School, Boston, MA; University of Bologna, Bologna, Italy; Italian Institute of Technology, Milan, Italy; These Authors Contributed Equally to This Work
| | - D Turchetti
- 1University of Modena and Reggio Emilia, Modena, Italy; Dana-Farber Cancer Institute, Boston, MA; Harvard Medical School, Boston, MA; University of Bologna, Bologna, Italy; Italian Institute of Technology, Milan, Italy; These Authors Contributed Equally to This Work
| | - LM Pradella
- 1University of Modena and Reggio Emilia, Modena, Italy; Dana-Farber Cancer Institute, Boston, MA; Harvard Medical School, Boston, MA; University of Bologna, Bologna, Italy; Italian Institute of Technology, Milan, Italy; These Authors Contributed Equally to This Work
| | - G Rossi
- 1University of Modena and Reggio Emilia, Modena, Italy; Dana-Farber Cancer Institute, Boston, MA; Harvard Medical School, Boston, MA; University of Bologna, Bologna, Italy; Italian Institute of Technology, Milan, Italy; These Authors Contributed Equally to This Work
| | - E Parisini
- 1University of Modena and Reggio Emilia, Modena, Italy; Dana-Farber Cancer Institute, Boston, MA; Harvard Medical School, Boston, MA; University of Bologna, Bologna, Italy; Italian Institute of Technology, Milan, Italy; These Authors Contributed Equally to This Work
| | - M Federico
- 1University of Modena and Reggio Emilia, Modena, Italy; Dana-Farber Cancer Institute, Boston, MA; Harvard Medical School, Boston, MA; University of Bologna, Bologna, Italy; Italian Institute of Technology, Milan, Italy; These Authors Contributed Equally to This Work
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Cortesi L, De Matteis E, Razzaboni E, Medici V, Tazzioli G, Andreotti A, Federico M. Effect of rapid genetic testings on the rate of bilateral prophylactic mastectomy in BRCA1/2 mutation carriers. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.1511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Cortesi L, Cirilli C, Rashid I, Artioli E, Federico M. Changes in survival from metastatic breast cancer during the last twenty-years: A population based study in Northern Italy. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.1125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
1125 Background: A significant improvement in overall survival was observed in the last two decades in patients with breast cancer due to early diagnosis and more effective therapies. However, a significant improvement in metastatic setting has been questioned. Our population based study was aimed to investigate the outcome of metastatic breast cancer from 1988 to 2005. Methods: Women with stage IV de novo or relapsed breast cancer diagnosed between 1988 and 2005 were identified by the Modena Cancer Registry (MCR). For all patients overall survival (OS) was measured from the date of first distant metastases to the date of death from any cause or last follow-up and compared across groups for four periods of similar duration time: 1988–1993 (A), 1994–1997(B), 1998–2001(C), 2002–2005(D). Results: Among 8,654 patients with breast cancer identified by the MCR, 409 had an initial metastatic disease (4.8%) and 693 (8.4%) had a distant recurrence. Median age at onset was 66 versus 59 years in de novo vs relapsed disease (p = 0.001). Significant differences for postmenopausal age (80% vs 71%) and for positive estrogen receptors (72% vs 63%) were registered in de novo and relapsed disease, respectively (p = 0.001). After a 27 months median follow-up for initial metastatic disease, the five-year OS was 12%, 14%, 9%, and 13% in the A, B, C, and D periods, respectively, (p = 0.5). Conversely, in relapsed breast cancer, after a 29 months median follow-up, a significant survival improvement was observed between the first and the other three periods, being the 5 year-survival rate after recurrence 10%, 22%, 30%, and 25%, respectively (p = 0.001). A survival improvement was seen in the last ten years for relapsed breast cancer using aromatase inhibitors (p < 0.0001) while for initial metastatic disease the same treatment provided a better outcome only in the last 4 years (p < 0.0001). Conclusions: Data from our study show that the outcome of initial metastatic breast cancer is still discouraging, despite the availability of several new drugs in recent years. A limited improvement was observed in relapsed breast cancer with the aromatase inhibitors introduction. In any case, the finish line is still far away, and robust investments in basic and translational research are still absolutely necessary. No significant financial relationships to disclose.
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Affiliation(s)
- L. Cortesi
- Azienda Policlinico Modena, Modena, Italy; Modena Cancer Registry, Modena, Italy; University of Modena and Reggio Emilia, Modena, Italy
| | - C. Cirilli
- Azienda Policlinico Modena, Modena, Italy; Modena Cancer Registry, Modena, Italy; University of Modena and Reggio Emilia, Modena, Italy
| | - I. Rashid
- Azienda Policlinico Modena, Modena, Italy; Modena Cancer Registry, Modena, Italy; University of Modena and Reggio Emilia, Modena, Italy
| | - E. Artioli
- Azienda Policlinico Modena, Modena, Italy; Modena Cancer Registry, Modena, Italy; University of Modena and Reggio Emilia, Modena, Italy
| | - M. Federico
- Azienda Policlinico Modena, Modena, Italy; Modena Cancer Registry, Modena, Italy; University of Modena and Reggio Emilia, Modena, Italy
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Cortinovis F, Cortesi L, Sileo F. Protocol for blood glucose control during enteral nutrition induction in patients with diabetes mellitus. Mediterranean Journal of Nutrition and Metabolism 2009. [DOI: 10.3233/s12349-008-0024-1] [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: 11/15/2022]
Affiliation(s)
- F. Cortinovis
- USSD Dietologia Clinica, AO Ospedali Riuniti Bergamo, Largo Barozzi 1, 24128 Bergamo, Italy. e-mail:
| | - L. Cortesi
- USSD Dietologia Clinica, AO Ospedali Riuniti Bergamo, Largo Barozzi 1, 24128 Bergamo, Italy. e-mail:
| | - F. Sileo
- USSD Dietologia Clinica, AO Ospedali Riuniti Bergamo, Largo Barozzi 1, 24128 Bergamo, Italy. e-mail:
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Cortinovis F, Cortesi L, Sileo F. Protocol for blood glucose control during enteral nutrition induction in patients with diabetes mellitus. Mediterr J Nutr Metab 2009. [DOI: 10.1007/s12349-008-0024-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Attanasio R, Mainolfi A, Grimaldi F, Cozzi R, Montini M, Carzaniga C, Grottoli S, Cortesi L, Albizzi M, Testa RM, Fatti L, De Giorgio D, Scaroni C, Cavagnini F, Loli P, Pagani G, Ghigo E. Somatostatin analogs and gallstones: a retrospective survey on a large series of acromegalic patients. J Endocrinol Invest 2008; 31:704-10. [PMID: 18852531 DOI: 10.1007/bf03346419] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [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] [Indexed: 12/30/2022]
Abstract
CONTEXT Development of gallstones (GS) is reported during the use of somatostatin analogs (SA) that are at present the mainstay for the medical treatment of acromegaly. OBJECTIVE To review the prevalence and clinical and biochemical correlates of GS in acromegalic patients. DESIGN AND SETTING Retrospective survey on hospital records in acromegalic patients followed up in the last 20 yr in tertiary referral centers. PATIENTS Four hundred and fifty-nine patients (272 females). MAIN OUTCOME MEASURES According to SA use and GS occurrence, patients were divided in 4 groups: 1) treated with SA without GS (SA+GS-), 2) GS developed while on SA (SA+GS+), 3) GS without SA use (SA-GS+), 4) neither GS nor SA (SA-GS-). RESULTS Patients were unevenly distributed in the 4 groups: 232, 125, 38, 64, respectively, pointing to a prevalence of GS in acromegaly of 8.3% at diagnosis with an additional 35% developing GS during SA. GS occurred after 3 months-18 yr (median 3 yr) of SA treatment, were diagnosed after symptoms in 17.6%, were associated to steatosis, ultrasound biliary dilation, and biochemical cholestasis, in 25.6%, 12.8%, and 4% of patients, respectively. Ursodehoxicolic acid was administered after GS occurrence, causing their dissolution in 39% of patients after 3-48 months (median 12). Cholecystectomy was performed in 16.8%of patients in group 2. At multivariate analysis obesity, dyslipidemia, and SA treatment were independent predictors of GS onset, whereas gender and age were not. CONCLUSIONS GS are a frequent occurrence in acromegalic patients treated with SA, may occur at any time, but are seldom symptomatic or prompt acute surgery. Obesity and dyslipidemia appear to play a major role in the occurrence of GS in acromegalic patients on SA treatment.
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Affiliation(s)
- R Attanasio
- Endocrinology, Ospedali Riuniti, Bergamo, Italy.
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Contegiacomo A, Pensabene M, Capuano I, Tauchmanova L, Federico M, Turchetti D, Cortesi L, Marchetti P, Ricevuto E, Cianci G, Barbieri V, Venuta S, Silingardi V. Comment on ‘Cancer genetic counselling’ by P. Mandich et al. (Ann Oncol 2005; 16: 171). Ann Oncol 2005; 16:1208-9. [PMID: 15870089 DOI: 10.1093/annonc/mdi219] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Cortesi L, Chiuri VE, Ruscelli S, Bellelli V, Negri R, Rashid I, Cirilli C, Gallo E, Federico M. Early assessment of a population-based breast cancer screening program. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.1018] [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)
- L. Cortesi
- Azienda Policlinico Modena, Modena, Italy
| | | | | | | | - R. Negri
- Azienda Policlinico Modena, Modena, Italy
| | - I. Rashid
- Azienda Policlinico Modena, Modena, Italy
| | - C. Cirilli
- Azienda Policlinico Modena, Modena, Italy
| | - E. Gallo
- Azienda Policlinico Modena, Modena, Italy
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Contegiacomo A, Pensabene M, Capuano I, Tauchmanova L, Federico M, Turchetti D, Cortesi L, Marchetti P, Ricevuto E, Cianci G, Venuta S, Barbieri V, Silingardi V. An oncologist-based model of cancer genetic counselling for hereditary breast and ovarian cancer. Ann Oncol 2004; 15:726-32. [PMID: 15111339 DOI: 10.1093/annonc/mdh183] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [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: 11/14/2022] Open
Abstract
BACKGROUND We describe a multistep model of cancer genetic counselling designed to promote awareness, and disease surveillance and preventive measures for hereditary and familial breast and ovarian cancer. PATIENTS AND METHODS Step T0 of the model entails information giving; this is followed by pedigree analysis and risk estimation (T1), risk communication and genetic testing (T2), and genetic test result communication (T3). User consent was required to proceed from one step to the next. Surveillance and preventive measures are proposed to at-risk users. Of the 311 subjects who requested cancer genetic counselling, consent data to each counselling step were available for 295: 93 were disease-free, 187 had breast cancer, 12 had ovarian cancer and three had breast plus ovarian cancer. RESULTS Consent was high at T0 (98.39%), T1 (96.40%) and T2 (99.65%). Consent decreased at the crucial points of counselling: T2 (87.71%) and T3 [genetic test result communication (85.08%), and extension of counselling to and testing of relatives (65.36%)]. CONCLUSIONS The model fosters the user's knowledge about cancer and favours identification of at-risk subjects. Furthermore, by promoting awareness about genetic testing and surveillance measures, the algorithm enables users to make a fully informed choice of action in case of predisposing or familial cancer risk.
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Affiliation(s)
- A Contegiacomo
- Department of Molecular and Clinical Endocrinology and Oncology, University of Naples Federico II, Via Pansini 5, 80131 Naples, Italy.
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Cozzi R, Attanasio R, Montini M, Pagani G, Barausse M, Albizzi M, Cortesi L, Dallabonzana D. Restoration of gonadal function in males during long-term primary treatment with octreotide-LAR in acromegaly. Exp Clin Endocrinol Diabetes 2004. [DOI: 10.1055/s-2004-832884] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Marroni F, Aretini P, D'Andrea E, Caligo MA, Cortesi L, Viel A, Ricevuto E, Montagna M, Cipollini G, Ferrari S, Santarosa M, Bisegna R, Bailey-Wilson JE, Bevilacqua G, Parmigiani G, Presciuttini S. Evaluation of widely used models for predicting BRCA1 and BRCA2 mutations. J Med Genet 2004; 41:278-85. [PMID: 15060102 PMCID: PMC1735736 DOI: 10.1136/jmg.2003.013623] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Cortesi L, Canossi B, De Santis M, Panizza P, Rossi G, Turchetti D, Del Maschio A, Ferrari S, Romagnoli R, Federico M, Silingardi V. Usefulness of breast MRI in a patient with genetic risk. J Exp Clin Cancer Res 2002; 21:131-6. [PMID: 12585667] [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: 02/28/2023]
Abstract
We describe an interesting case-report represented by a patient carrying BRCA1 mutation, recruited for the study "Multicenter evaluation of Magnetic Resonance Imaging (MRI) in early diagnosis and prevention of breast cancer in high risk population", diagnosed with breast cancer on the basis of MRI findings but not with conventional mammography and ultrasound (US). She was already affected at 53 years of age by a multifocal Ductal Infiltrating Carcinoma (DIC) in the left breast; then, she had an axillary and sovraclavear nodal recurrence of the disease, three years after the initial diagnosis. Since other relatives were affected by breast cancer (mother, sister and niece) and two arose at early age (< 40 years), BRCA1 mutational analysis was offered to the patient, identifying a nonsense mutation on the exon 13. Furthermore, this patient was recruited to study contralateral breast and at the second round, two little foci, suspicious of malignancy, were identified only with MRI, but not with mammography and ultrasonography. The final diagnosis was multifocal Ductal Carcinoma in situ (DCIS); the major focus measured 3 mm. In our patient MRI has shown a major sensitivity with respect to conventional radiology and US and has provided a very early diagnosis in this woman at genetic risk.
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MESH Headings
- Biopsy, Needle
- Breast Neoplasms/diagnosis
- Breast Neoplasms/genetics
- Breast Neoplasms/metabolism
- Carcinoma, Ductal, Breast/diagnosis
- Carcinoma, Ductal, Breast/genetics
- Carcinoma, Ductal, Breast/metabolism
- Carcinoma, Ductal, Breast/surgery
- DNA Mutational Analysis
- Female
- Genes, BRCA1
- Genetic Predisposition to Disease
- Humans
- Lymphatic Metastasis
- Magnetic Resonance Imaging/methods
- Mammography
- Middle Aged
- Mutation
- Neoplasm Recurrence, Local/pathology
- Pedigree
- Radiographic Image Enhancement
- Stereotaxic Techniques
- Ultrasonography, Mammary
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Affiliation(s)
- L Cortesi
- Dipartimento di Oncologia ed Ematologia, Università di Modena e Reggio Emilia, Modena, Italy
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