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Nocco S, Concas L, Fei M. Large Left Atrial Thrombus in a Patient With Severe Mitral Stenosis and Atrial Fibrillation Despite Anticoagulant Therapy: A Case Report. Cureus 2024; 16:e52634. [PMID: 38374839 PMCID: PMC10875398 DOI: 10.7759/cureus.52634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2024] [Indexed: 02/21/2024] Open
Abstract
This case report highlights a patient with atrial fibrillation, severe mitral stenosis, and left atrial dilatation who developed a large thrombus, despite being on anticoagulant therapy. The complexity of thrombus formation in patients with multiple risk factors is described, emphasising the need for regular echocardiographic assessments to detect and monitor thrombi, even in patients undergoing anticoagulant treatment. The interplay between atrial fibrillation, mitral stenosis, and left atrial dilatation contributes to thrombus formation, requiring a multidisciplinary approach to the management of these patients. Further research is needed to improve our understanding of the optimal treatment strategies for such cases. Timely identification and intervention are critical to mitigate the risk of thromboembolic complications in these high-risk patients.
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Affiliation(s)
- Silvio Nocco
- Department of Cardiology, Sirai Hospital, Carbonia, ITA
| | - Laura Concas
- Department of Cardiology, Sirai Hospital, Carbonia, ITA
| | - Marco Fei
- Department of Cardiology, Sirai Hospital, Carbonia, ITA
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2
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Pusceddu S, Vernieri C, Di Maio M, Marconcini R, Spada F, Massironi S, Ibrahim T, Brizzi MP, Campana D, Faggiano A, Giuffrida D, Rinzivillo M, Cingarlini S, Aroldi F, Antonuzzo L, Berardi R, Catena L, De Divitiis C, Ermacora P, Perfetti V, Fontana A, Razzore P, Carnaghi C, Davì MV, Cauchi C, Duro M, Ricci S, Fazio N, Cavalcoli F, Bongiovanni A, La Salvia A, Brighi N, Colao A, Puliafito I, Panzuto F, Ortolani S, Zaniboni A, Di Costanzo F, Torniai M, Bajetta E, Tafuto S, Garattini SK, Femia D, Prinzi N, Concas L, Lo Russo G, Milione M, Giacomelli L, Buzzoni R, Delle Fave G, Mazzaferro V, de Braud F. Metformin Use Is Associated With Longer Progression-Free Survival of Patients With Diabetes and Pancreatic Neuroendocrine Tumors Receiving Everolimus and/or Somatostatin Analogues. Gastroenterology 2018; 155:479-489.e7. [PMID: 29655834 DOI: 10.1053/j.gastro.2018.04.010] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 03/21/2018] [Accepted: 04/06/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND & AIMS Metformin seems to have anticancer effects. However, it is not clear whether use of glycemia and metformin affect outcomes of patients with advanced pancreatic neuroendocrine tumors (pNETs). We investigated the association between glycemia and progression-free survival (PFS) of patients with pNETs treated with everolimus and/or somatostatin analogues, as well as the association between metformin use and PFS time. METHODS We performed a retrospective analysis of 445 patients with advanced pNET treated at 24 medical centers in Italy from 1999 through 2015. Data on levels of glycemia were collected at time of diagnosis of pNET, before treatment initiation, and during treatment with everolimus (with or without somatostatin analogues), octreotide, or lanreotide. Diabetes was defined as prior or current use of glycemia control medication and/or fasting plasma glucose level ≥ 126 mg/dL, hemoglobin A1c ≥ 6.5% (48 mmol/L), or a random sample of plasma glucose ≥ 200 mg/dL (11.1 mmol/L), with reported classic symptoms of hyperglycemia or hyperglycemic crisis. Patients were assigned to groups based on diagnosis of diabetes before or during antitumor therapy. PFS was compared between patients with vs without diabetes. Among patients with diabetes, the association between metformin use and PFS was assessed. We performed sensitivity and landmark analyses to exclude patients who developed diabetes while receiving cancer treatment and to exclude a potential immortal time bias related to metformin intake. RESULTS PFS was significantly longer in patients with diabetes (median, 32.0 months) than without diabetes (median, 15.1 months) (hazard ratio for patients with vs without diabetes, 0.63; 95% confidence interval, 0.50-0.80; P = .0002). PFS of patients treated with metformin was significantly longer (median PFS, 44.2 months) than for patients without diabetes (hazard ratio for survival of patients with diabetes receiving metformin vs without diabetes, 0.45; 95% confidence interval, 0.32-0.62; P < .00001) and longer than for patients with diabetes receiving other treatments (median PFS, 20.8 months; hazard ratio, 0.49; 95% confidence interval, 0.34-0.69; P < .0001). In multivariable analysis, adjusted for other factors associated with outcomes, metformin was associated with longer PFS but level of glycemia was not. Metformin was associated with increased PFS of patients receiving somatostatin analogues and in those receiving everolimus, with or without somatostatin analogues. Sensitivity and landmark analyses produced similar results. CONCLUSIONS In a retrospective study of patients with pNETs, we found a significant association between metformin use and longer PFS.
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Affiliation(s)
- Sara Pusceddu
- Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, ENETS Center of Excellence, Milan, Italy.
| | - Claudio Vernieri
- Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, ENETS Center of Excellence, Milan, Italy; Fondazione Istituto FIRC di Oncologia Molecolare (IFOM), Milan, Italy
| | - Massimo Di Maio
- Dipartimento di Oncologia, Università degli Studi di Torino, A. O. Ordine Mauriziano, Turin, Italy
| | - Riccardo Marconcini
- Dipartimento di Oncologia, Santa Chiara Hospital, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Francesca Spada
- IEO - Istituto Europeo di Oncologia, ENETS Center of Excellence, Milan, Italy
| | - Sara Massironi
- Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Toni Ibrahim
- Centro di Osteoncologia e Tumori Rari, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Maria Pia Brizzi
- Azienda Ospedaliera Universitaria San Luigi Gonzaga, Orbassano, Italy
| | | | - Antongiulio Faggiano
- Unità di chirurgia tiroidea e paratiroidea, Istituto Nazionale per lo studio e la cura dei tumori "Fondazione G. Pascale" - IRCCS, Naples, Italy
| | | | - Maria Rinzivillo
- Azienda Ospedaliera Universitaria Sant'Andrea, ENETS Center of Excellence, Rome, Italy
| | | | | | | | - Rossana Berardi
- Azienda Ospedaliero Universitaria Ospedali Riuniti, Ancona, Italy
| | | | | | - Paola Ermacora
- Azienda Ospedaliero Universitaria Santa Maria della Misericordia, Udine, Italy
| | | | | | - Paola Razzore
- Unit of Endocrinology, Ospedale Mauriziano, Torino, Italy
| | - Carlo Carnaghi
- Istituto Clinico Humanitas, Rozzano, ENETS Center of Excellence, Italy
| | | | | | | | - Sergio Ricci
- Dipartimento di Oncologia, Santa Chiara Hospital, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Nicola Fazio
- IEO - Istituto Europeo di Oncologia, ENETS Center of Excellence, Milan, Italy
| | - Federica Cavalcoli
- Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Alberto Bongiovanni
- Centro di Osteoncologia e Tumori Rari, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Anna La Salvia
- Azienda Ospedaliera Universitaria San Luigi Gonzaga, Orbassano, Italy
| | | | - Annamaria Colao
- Endocrinology Section, Department of Clinical Medicine and Surgery, "Federico II" University of Naples, Italy
| | | | - Francesco Panzuto
- Azienda Ospedaliera Universitaria Sant'Andrea, ENETS Center of Excellence, Rome, Italy
| | | | | | | | | | | | - Salvatore Tafuto
- IRCCS Fondazione Pascale, ENETS Center of Excellence, Naples, Italy
| | | | - Daniela Femia
- Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, ENETS Center of Excellence, Milan, Italy
| | - Natalie Prinzi
- Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, ENETS Center of Excellence, Milan, Italy
| | - Laura Concas
- Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, ENETS Center of Excellence, Milan, Italy
| | - Giuseppe Lo Russo
- Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, ENETS Center of Excellence, Milan, Italy; Medical-Surgical Science and Traslational Medicine Departement, Sapienza University, Rome, Italy
| | - Massimo Milione
- Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, ENETS Center of Excellence, Milan, Italy
| | - Luca Giacomelli
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Italy
| | - Roberto Buzzoni
- Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, ENETS Center of Excellence, Milan, Italy
| | - Gianfranco Delle Fave
- Azienda Ospedaliera Universitaria Sant'Andrea, ENETS Center of Excellence, Rome, Italy
| | - Vincenzo Mazzaferro
- Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, ENETS Center of Excellence, Milan, Italy; Universita' degli Studi di Milano, Milan, Italy
| | - Filippo de Braud
- Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, ENETS Center of Excellence, Milan, Italy; Universita' degli Studi di Milano, Milan, Italy
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3
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Milione M, Maisonneuve P, Pellegrinelli A, Pusceddu S, Centonze G, Dominoni F, Brambilla C, Rubino M, Faggiano A, Buzzoni R, Concas L, Giacomelli L, Coppa J, Mazzaferro V, de Braud F. Loss of succinate dehydrogenase subunit B (SDHB) as a prognostic factor in advanced ileal well-differentiated neuroendocrine tumors. Endocrine 2017; 57:512-517. [PMID: 27905048 DOI: 10.1007/s12020-016-1180-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 11/10/2016] [Indexed: 12/26/2022]
Abstract
PURPOSE Abnormal expression of succinate dehydrogenase, (SDH), in particular of the B subunit (SDHB), is implicated in the pathogenesis of neuroendocrine tumors. This study evaluates the distribution of SDHB in WHO grading G1 and G2 intestinal, well-differentiated neuroendocrine tumors and corresponding lymph node or liver metastases. METHODS We collected ileal well-differentiated neuroendocrine tumors specimens from consecutive patients with prior primary resection and distant synchronous or metachronous liver metastases. We obtained 195 specimens from primary tumors (n = 106) and metastases (n = 89). The expression (E) of SDHB and the immunostaining intensity (I) were evaluated semiquantitatively and combined into a single score. SDHB score was evaluated in primitive tumor and metastatic specimens. RESULTS SDHB was found in all tumor cells. Mean SDHB expression was 72.7 % ± 17.1 % in primitive specimens and 27.9 % ± 24.6 % in metastatic specimens (p < 0.0001). SDH intensity was higher in primitive specimens (p < 0.0001). SDHB score was 9-12 in 96 specimens of the primitive group and 2 metastatic specimens (p < 0.0001). None of the analyzed parameters was predictive of overall survival in the primitive subset. In the metastatic subset, loss of SDHB expression, intensity, and score were prognostic factors for survival. Lower expression and intensity of SDHB in metastatic lesions were associated with longer overall survival. When combining SDHB score and Ki-67 % in the metastatic subset, a lower SDHB score was associated with prolonged overall survival, independently from Ki-67 %. CONCLUSIONS SDHB score was different in primitive and metastatic specimens. The combination of SDHB score and Ki-67 % was a stronger predictor of overall survival than Ki-67 % alone. This stratification might help predict survival.
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Affiliation(s)
- Massimo Milione
- 1st Division of Pathology, Department of Pathology and Laboratory Medicine, IRCCS, Milan, Italy.
| | - Patrick Maisonneuve
- Division of Epidemiology and Biostatistics, European Institute of oncology (IEO), Milan, Italy
| | - Alessio Pellegrinelli
- 1st Division of Pathology, Department of Pathology and Laboratory Medicine, IRCCS, Milan, Italy
| | - Sara Pusceddu
- Departement of Medical Oncology, IRCCS Foundation National Cancer Institute, Milan, Italy
| | - Giovanni Centonze
- 1st Division of Pathology, Department of Pathology and Laboratory Medicine, IRCCS, Milan, Italy
| | - Francesca Dominoni
- 1st Division of Pathology, Department of Pathology and Laboratory Medicine, IRCCS, Milan, Italy
| | - Cecilia Brambilla
- 1st Division of Pathology, Department of Pathology and Laboratory Medicine, IRCCS, Milan, Italy
| | - Manila Rubino
- Istituto Nazionale per lo studio e la cura dei tumori "Fondazione G. Pascale"-IRCCS, Naples, Italy
| | - Antongiulio Faggiano
- Istituto Nazionale per lo studio e la cura dei tumori "Fondazione G. Pascale"-IRCCS, Naples, Italy
| | - Roberto Buzzoni
- Departement of Medical Oncology, IRCCS Foundation National Cancer Institute, Milan, Italy
| | - Laura Concas
- Departement of Medical Oncology, IRCCS Foundation National Cancer Institute, Milan, Italy
| | | | - Jorgelina Coppa
- Department of Surgery, G.I. Surgery and Liver Transplantation, Istituto Nazionale Tumori (National Cancer Institute), Milan, Italy
| | - Vincenzo Mazzaferro
- Department of Surgery, G.I. Surgery and Liver Transplantation, Istituto Nazionale Tumori (National Cancer Institute), Milan, Italy
| | - Filippo de Braud
- Departement of Medical Oncology, IRCCS Foundation National Cancer Institute, Milan, Italy
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4
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Pusceddu S, Prinzi N, Lo Russo G, Femia D, Milione M, Perrone F, Tamborini E, Concas L, Pulice I, Vernieri C, Corti F, Buzzoni R, de Braud F. Rationale and protocol of MetNET-2 trial: Lanreotide Autogel plus metformin in advanced gastrointestinal or lung neuroendocrine tumors. Future Oncol 2017; 13:1677-1683. [PMID: 28580793 DOI: 10.2217/fon-2017-0132] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Metformin (MET) has recently emerged as a potentially active agent in cancer prevention and treatment. MET is thought to exert its antitumor effects either via modification of systemic metabolism or through cell-autonomous effects (e.g., activation of AMPK and inhibition of the mTOR pathway). Preliminary findings of the PRIME-NET study suggest that the addition of MET to treatment with everolimus (EVE) and/or somatostatin analogs (SSAs) can provide clinical benefit in diabetic neuroendocrine tumor (NET) patients. In light of this and other retrospective evidence of MET's anticancer activity in NETs, prospective studies are needed. A pilot, single-arm, open-label, prospective study (MetNET-2 trial, NCT02823691) was designed to evaluate the safety of MET in combination with lanreotide in well-differentiated gastrointestinal (WD GI) and lung NETs.
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Affiliation(s)
- Sara Pusceddu
- Department of Medical Oncology, Unit 1, ENET Center of Excellence, Fondazione IRCCS Istituto Nazionale Tumori, Via G. Venezian 1, 20133 Milan, Italy
| | - Natalie Prinzi
- Department of Medical Oncology, Unit 1, ENET Center of Excellence, Fondazione IRCCS Istituto Nazionale Tumori, Via G. Venezian 1, 20133 Milan, Italy
| | - Giuseppe Lo Russo
- Department of Medical Oncology, Unit 1, ENET Center of Excellence, Fondazione IRCCS Istituto Nazionale Tumori, Via G. Venezian 1, 20133 Milan, Italy
| | - Daniela Femia
- Department of Medical Oncology, Unit 1, ENET Center of Excellence, Fondazione IRCCS Istituto Nazionale Tumori, Via G. Venezian 1, 20133 Milan, Italy
| | - Massimo Milione
- Department of Pathology, ENET Center of Excellence, Fondazione IRCCS Istituto Nazionale Tumori, Via G. Venezian 1, 20133 Milan, Italy
| | - Federica Perrone
- Department of Pathology, Laboratory of Experimental Molecular Pathology, ENET Center of Excellence, Fondazione IRCCS Istituto Nazionale Tumori, Via G. Venezian 1, 20133 Milan, Italy
| | - Elena Tamborini
- Department of of Diagnostic Pathology & Laboratory Medicine ENET Center of Excellence, Fondazione IRCCS Istituto Nazionale Tumori, Via G. Venezian 1, 20133 Milan, Italy
| | - Laura Concas
- Department of Medical Oncology, Unit 1, ENET Center of Excellence, Fondazione IRCCS Istituto Nazionale Tumori, Via G. Venezian 1, 20133 Milan, Italy
| | - Iolanda Pulice
- Department of Medical Oncology, Unit 1, ENET Center of Excellence, Fondazione IRCCS Istituto Nazionale Tumori, Via G. Venezian 1, 20133 Milan, Italy
| | - Claudio Vernieri
- Department of Medical Oncology, Unit 1, ENET Center of Excellence, Fondazione IRCCS Istituto Nazionale Tumori, Via G. Venezian 1, 20133 Milan, Italy
| | - Francesca Corti
- Department of Medical Oncology, Unit 1, ENET Center of Excellence, Fondazione IRCCS Istituto Nazionale Tumori, Via G. Venezian 1, 20133 Milan, Italy
| | - Roberto Buzzoni
- Department of Medical Oncology, Unit 1, ENET Center of Excellence, Fondazione IRCCS Istituto Nazionale Tumori, Via G. Venezian 1, 20133 Milan, Italy
| | - Filippo de Braud
- Department of Medical Oncology, Unit 1, ENET Center of Excellence, Fondazione IRCCS Istituto Nazionale Tumori, Via G. Venezian 1, 20133 Milan, Italy
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5
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Berardi R, Torniai M, Pusceddu S, Spada F, Ibrahim T, Brizzi MP, Antonuzzo L, Ferolla P, Panzuto F, Silvestris N, Partelli S, Ferretti B, Freddari F, Gucciardino C, Testa E, Concas L, Murgioni S, Bongiovanni A, Zichi C, Riva N, Rinzivillo M, Brunetti O, Giustini L, Di Costanzo F, Delle Fave G, Fazio N, De Braud F, Falconi M, Cascinu S. Prognostic impact of the cumulative dose and dose intensity of everolimus in patients with pancreatic neuroendocrine tumors. Cancer Med 2017; 6:1493-1499. [PMID: 28547856 PMCID: PMC5504331 DOI: 10.1002/cam4.1028] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 12/18/2016] [Accepted: 12/30/2016] [Indexed: 12/19/2022] Open
Abstract
The aim of this work is to assess if cumulative dose (CD) and dose intensity (DI) of everolimus may affect survival of advanced pancreatic neuroendocrine tumors (PNETs) patients. One hundred and sixteen patients (62 males and 54 females, median age 55 years) with advanced PNETs were treated with everolimus for ≥3 months. According to a Receiver operating characteristics (ROC) analysis, patients were stratified into two groups, with CD ≤ 3000 mg (Group A; n = 68) and CD > 3000 mg (Group B; n = 48). The response rate and toxicity were comparable in the two groups. However, patients in group A experienced more dose modifications than patients in group B. Median OS was 24 months in Group A while in Group B it was not reached (HR: 26.9; 95% CI: 11.0-76.7; P < 0.0001). Patients who maintained a DI higher than 9 mg/day experienced a significantly longer OS and experienced a trend to higher response rate. Overall, our study results showed that both CD and DI of everolimus play a prognostic role for patients with advanced PNETs treated with everolimus. This should prompt efforts to continue everolimus administration in responsive patients up to at least 3000 mg despite delays or temporary interruptions.
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Affiliation(s)
- Rossana Berardi
- Clinica di Oncologia Medica, Università Politecnica delle Marche, AOU Ospedali Riuniti di, Ancona, Italy
| | - Mariangela Torniai
- Clinica di Oncologia Medica, Università Politecnica delle Marche, AOU Ospedali Riuniti di, Ancona, Italy
| | - Sara Pusceddu
- Medicina Oncologica 1, ENETS Center of excellence, Fondazione IRCCS Istituto Tumori, Milano, Italy
| | - Francesca Spada
- Unità di Oncologia Medica Gastrointestinale e Tumori Neuroendocrini (Unit of Gastrointestinal Medical Oncology and Neuroendocrine Tumors), IEO Istituto Europeo di Oncologia, Milano, Italy
| | - Toni Ibrahim
- Osteoncology and Rare Tumors Center, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | | | - Lorenzo Antonuzzo
- SC di Oncologia Medica, Azienda Opedaliero-Universitaria Careggi, Firenze, Italy.,Doctorate Course in Genetics, Oncology and Clinical Medicine, University of Siena, Siena, Italy
| | - Piero Ferolla
- Multidisciplinary NET Group, Umbria Regional Cancer Network, Perugia, Italy
| | - Francesco Panzuto
- Digestive and Liver Disease, Sapienza University of Rome, Sant'Andrea Hospital, Rome, Italy
| | - Nicola Silvestris
- Medical Oncology Unit, National Cancer Institute Giovanni Paolo II, Bari, Italy
| | - Stefano Partelli
- Chirurgia del Pancreas, Università Politecnica delle Marche, AOU Ospedali Riuniti di, Ancona, Italy.,Chirurgia del Pancreas, Ospedale San Raffaele IRCCS, Università Vita e Salute, Milano, Italy
| | - Benedetta Ferretti
- Oncologia Medica, Ospedale di San Severino, San Severino Marche (MC), Italy
| | | | | | - Enrica Testa
- Oncologia Medica, Ospedale di Urbino, Urbino, Italy
| | - Laura Concas
- Medicina Oncologica 1, ENETS Center of excellence, Fondazione IRCCS Istituto Tumori, Milano, Italy
| | - Sabina Murgioni
- Unità di Oncologia Medica Gastrointestinale e Tumori Neuroendocrini (Unit of Gastrointestinal Medical Oncology and Neuroendocrine Tumors), IEO Istituto Europeo di Oncologia, Milano, Italy
| | - Alberto Bongiovanni
- Osteoncology and Rare Tumors Center, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Clizia Zichi
- Oncologia Medica, A.O.U. San Luigi, Orbassano (TO), Italy
| | - Nada Riva
- Osteoncology and Rare Tumors Center, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Maria Rinzivillo
- Digestive and Liver Disease, Sapienza University of Rome, Sant'Andrea Hospital, Rome, Italy
| | - Oronzo Brunetti
- Medical Oncology Unit, National Cancer Institute Giovanni Paolo II, Bari, Italy
| | | | | | - Gianfranco Delle Fave
- Digestive and Liver Disease, Sapienza University of Rome, Sant'Andrea Hospital, Rome, Italy
| | - Nicola Fazio
- Unità di Oncologia Medica Gastrointestinale e Tumori Neuroendocrini (Unit of Gastrointestinal Medical Oncology and Neuroendocrine Tumors), IEO Istituto Europeo di Oncologia, Milano, Italy
| | - Filippo De Braud
- Medicina Oncologica 1, ENETS Center of excellence, Fondazione IRCCS Istituto Tumori, Milano, Italy
| | - Massimo Falconi
- Chirurgia del Pancreas, Università Politecnica delle Marche, AOU Ospedali Riuniti di, Ancona, Italy.,Chirurgia del Pancreas, Ospedale San Raffaele IRCCS, Università Vita e Salute, Milano, Italy
| | - Stefano Cascinu
- Clinica di Oncologia Medica, Università Politecnica delle Marche, AOU Ospedali Riuniti di, Ancona, Italy.,Oncologia Medica, Università di Modena e Reggio Emilia, Modena, Italy
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6
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Pusceddu S, Verzoni E, Prinzi N, Mennitto A, Femia D, Grassi P, Concas L, Vernieri C, Lo Russo G, Procopio G. Everolimus treatment for neuroendocrine tumors: latest results and clinical potential. Ther Adv Med Oncol 2017; 9:183-188. [PMID: 28344663 PMCID: PMC5349426 DOI: 10.1177/1758834016683905] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
Abstract
Neuroendocrine tumors (NETs) are a heterogeneous class of diseases characterized by challenging management. Preclinical evidence shows that the PI3K/AKT/mTOR signaling pathway plays a central role in the pathogenesis and progression of NETs. Everolimus is a direct inhibitor of this pathway, and therefore this molecule appears to be a well-grounded strategy for the treatment of NETs, capable of changing clinical practice. The efficacy and safety of everolimus was demonstrated in the RADIANT trials. In this work, we comment on the results of the RADIANT trials, and other recent key evidence from fully published clinical trials on everolimus, and we discuss the current role of everolimus in the treatment of NETs.
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Affiliation(s)
- Sara Pusceddu
- Medical Oncology, Istituto Nazionale Tumori, Milan, Italy
| | - Elena Verzoni
- Medical Oncology, Istituto Nazionale Tumori, Milan, Italy
| | | | | | - Daniela Femia
- Medical Oncology, Istituto Nazionale Tumori, Milan, Italy
| | - Paolo Grassi
- Medical Oncology, Istituto Nazionale Tumori, Milan, Italy
| | - Laura Concas
- Medical Oncology, Istituto Nazionale Tumori, Milan, Italy
| | | | | | - Giuseppe Procopio
- Medical Oncology, Istituto Nazionale Tumori, Via Venezian 1, 20100, Milan, Italy
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7
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Milione M, Maisonneuve P, Spada F, Pellegrinelli A, Spaggiari P, Albarello L, Pisa E, Barberis M, Vanoli A, Buzzoni R, Pusceddu S, Concas L, Sessa F, Solcia E, Capella C, Fazio N, La Rosa S. The Clinicopathologic Heterogeneity of Grade 3 Gastroenteropancreatic Neuroendocrine Neoplasms: Morphological Differentiation and Proliferation Identify Different Prognostic Categories. Neuroendocrinology 2017; 104:85-93. [PMID: 26943788 DOI: 10.1159/000445165] [Citation(s) in RCA: 156] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 03/02/2016] [Indexed: 01/02/2023]
Abstract
BACKGROUND/AIMS Gastroenteropancreatic (GEP) neuroendocrine carcinomas (NECs) are defined as neuroendocrine neoplasms (NENs) with a Ki-67 index >20% according to the 2010 WHO classification. Some reports suggest that this category is heterogeneous. We retrospectively studied a series of 136 patients affected by grade 3 GEP-NECs with the aim to clarify the prognostic role of tumor morphological differentiation, proliferation, defect in mismatch repair proteins (MMRd), CD117 expression, and site of origin. The primary endpoint was the correlation between these parameters and the overall survival (OS). METHODS Univariate and multivariable Cox proportional hazards regression analyses were used to assess the prognostic significance of various clinical and histopathologic features. RESULTS With a median follow-up of 81 months, the median OS was 12.9 months. At multivariate analysis, morphological differentiation, Ki-67 index, MMRd, stage, and CD117 expression were independent prognostic markers in NECs. Three different prognostic categories of NECs were identified according to the degree of morphologic differentiation (well vs. poorly differentiated) and Ki-67 index (<55% vs. ≥55%). On this basis, median OS was 43.6 months in well-differentiated neoplasms with a Ki-67 index 20-55% (named type A), 24.5 months in poorly differentiated neoplasms with a Ki-67 index 20-55% (type B), and 5.3 months (p < 0.0001) in poorly differentiated neoplasms with a Ki-67 index ≥55% (type C). CONCLUSIONS The present study suggests that GEP-NECs represent a heterogeneous group of neoplasms which can be better classified in different prognostic categories using both tumor morphology and Ki-67 index.
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Affiliation(s)
- Massimo Milione
- Anatomic Pathology, Department of Pathology and Laboratory Medicine, IRCCS Foundation National Cancer Institute, Milan, Italy
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Vernieri C, Femia D, Pusceddu S, Capella C, Rosai J, Calareso G, Concas L, Prinzi N, Lo Russo G, de Braud F, Buzzoni R. Primary Cerebellar Neuroendocrine Tumors: Chimeras or Real Entities? A Case Report with a 6-Year Follow-Up. Case Rep Oncol 2016; 9:432-439. [PMID: 27721764 PMCID: PMC5043191 DOI: 10.1159/000447771] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 06/22/2016] [Indexed: 11/19/2022] Open
Abstract
We report the case of a 38-year-old patient who was diagnosed with a cerebellar well-differentiated neuroendocrine tumor (WDNET) in 2009. At first glance, we believed that it was a metastasis from an unrecognized WDNET arising outside the cerebellum. However, despite a prolonged follow-up of 6 years, an extracranial WDNET has never been found. During this time, the tumor recurred locally twice, and the patient was treated with surgery and radiotherapy. At the moment, he enjoys good general conditions and his tumor is under control. Due to the histopathological characteristics and clinical behavior of the tumor, we believe that this is the first report to date of a primary cerebellar WDNET.
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Affiliation(s)
- Claudio Vernieri
- Istituto Nazionale Tumori, Milan, Italy; IFOM - Istituto FIRC di oncologia molecolare, Milan, Italy
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De Braud F, Buzzoni R, Concas L, Femia D, Prinzi N, Milione M, Tamborini E, Perrone F, Russo G, Vernieri C, Pulice I, Piras F, Dinoi G, Pusceddu S. Safety of lanreotide 120 mg ATG in combination with metformin in patients with advanced well-differentiated gastro-intestinal (GI) or lung carcinoids. A pilot, one-arm, open-label, prospective study: The MetNET-2 trial. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw369.35] [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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Femia D, Prinzi N, Pusceddu S, Concas L, Lo Russo G, Claudio V, Milione M, Dinoi G, Raimondi A, Michele P, Filippo D, Buzzoni R. Complete response to avelumab in Merkel Cell Carcinoma, and potential correlation with toxicity: a case report. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw345.42] [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: 11/13/2022] Open
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Buzzoni R, Filippo D, Femia D, Prinzi N, Concas L, Milione M, Tamborini E, Perrone F, Lo Russo G, Vernieri C, Pulice I, Piras F, Dinoi G, Pusceddu S. Safety of Lanreotide 120 mg ATG in combination with metformin in patients with progressive advanced well-differentiated gastro-intestinal (GI) or lung carcinoids. A pilot, one-arm, open-label, prospective study: the MetNET-2 trial. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw333.28] [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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Pusceddu S, Femia D, Lo Russo G, Ortolani S, Milione M, Maccauro M, Vernieri C, Prinzi N, Concas L, Leuzzi L, De Braud F, Buzzoni R. Update on medical treatment of small intestinal neuroendocrine tumors. Expert Rev Anticancer Ther 2016; 16:969-76. [PMID: 27353232 DOI: 10.1080/14737140.2016.1207534] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Small intestinal (SI) neuroendocrine tumors (NETs) are relatively rare tumors. Due to the lack of symptom or specific symptoms, SI-NETs are often diagnosed at an advanced stage, making therapy challenging. The management of patients with advanced stage SI-NETS requires a multidisciplinary approach that combines surgical and medical treatment including novel targeted molecular therapies. AREAS COVERED This article summarizes current strategies for the medical treatment of SI-NETS. Expert commentary: The treatment plan of advanced-stage SI-NETs should be tailored in a case-by-case manner with the adoption of a multidisciplinary approach that combines different treatment options, including biological targeted therapies. In particular, we believe that the identification of the optimal treatment sequence(s), correct treatment timing and the selection of patients eligible to different treatments need specific investigation in controlled clinical trials.
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Affiliation(s)
- Sara Pusceddu
- a Department of Medical Oncology , Fondazione IRCCS 'Istituto Nazionale dei Tumori' , Milan , Italy
| | - Daniela Femia
- a Department of Medical Oncology , Fondazione IRCCS 'Istituto Nazionale dei Tumori' , Milan , Italy
| | - Giuseppe Lo Russo
- a Department of Medical Oncology , Fondazione IRCCS 'Istituto Nazionale dei Tumori' , Milan , Italy
| | - Silvia Ortolani
- b Department of Medical Oncology , Azienda Ospedaliera Universitaria Integrata, University of Verona , Verona , Italy
| | - Massimo Milione
- c Department of Phatology , Fondazione IRCCS 'Istituto Nazionale dei Tumori' , Milan , Italy
| | - Marco Maccauro
- d Department of Nuclear Medicine , Fondazione IRCCS 'Istituto Nazionale dei Tumori' , Milan , Italy
| | - Claudio Vernieri
- a Department of Medical Oncology , Fondazione IRCCS 'Istituto Nazionale dei Tumori' , Milan , Italy
| | - Natalie Prinzi
- e Department of Experimental Medicine , 'Sapienza' University of Rome , Rome , Italy
| | - Laura Concas
- a Department of Medical Oncology , Fondazione IRCCS 'Istituto Nazionale dei Tumori' , Milan , Italy
| | - Livia Leuzzi
- a Department of Medical Oncology , Fondazione IRCCS 'Istituto Nazionale dei Tumori' , Milan , Italy
| | - Filippo De Braud
- a Department of Medical Oncology , Fondazione IRCCS 'Istituto Nazionale dei Tumori' , Milan , Italy
| | - Roberto Buzzoni
- a Department of Medical Oncology , Fondazione IRCCS 'Istituto Nazionale dei Tumori' , Milan , Italy
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Pusceddu S, Buzzoni R, Vernieri C, Concas L, Marceglia S, Giacomelli L, Milione M, Leuzzi L, Femia D, Formisano B, Mazzaferro V, de Braud F. Metformin with everolimus and octreotide in pancreatic neuroendocrine tumor patients with diabetes. Future Oncol 2016; 12:1251-60. [PMID: 26890290 DOI: 10.2217/fon-2015-0077] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [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: 01/28/2023] Open
Abstract
A bidirectional relationship seems to exist between diabetes mellitus and development of pancreatic tumors. Metformin, the most widely used drug in the treatment of Type 2 diabetes mellitus, has recently emerged as a potentially active agent in cancer chemoprevention and treatment. In this article, we discuss the potential correlation between glycemic status, administration of antiglycemic treatments, such as metformin or insulin, and prognosis of pancreatic neuroendocrine tumors patients treated with everolimus and octreotide, on the basis of existing evidence and our experience.
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Affiliation(s)
- Sara Pusceddu
- Medical Oncology Unit 1, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Roberto Buzzoni
- Day Hospital/Outpatient Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Claudio Vernieri
- Medical Oncology Unit 1, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.,IFOM, FIRC Institute of Molecular Oncology, 20139 Milan, Italy
| | - Laura Concas
- Day Hospital/Outpatient Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Sara Marceglia
- Department of Information & Bioengineering, Politecnico University, Milan, Italy
| | - Luca Giacomelli
- Department of Surgical Sciences & Integrated Diagnostics, School of Medicine, Genova University, Genoa, Italy
| | - Massimo Milione
- Department of Pathology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Livia Leuzzi
- Day Hospital/Outpatient Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Daniela Femia
- Day Hospital/Outpatient Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Barbara Formisano
- Medical Oncology Unit 1, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Vincenzo Mazzaferro
- Gastro-Intestinal Surgery, Liver Transplantation & Hepatology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Filippo de Braud
- Medical Oncology Unit 1, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Pusceddu S, Buzzoni R, Concas L, Bregant C, Leuzzi L, Milione M, Seregni E, Formisano B, Consonni P, De Braud F. Abstract 1189: The impact of metformin on progression-free survival in patients with advanced pancreatic well differentiated neuroendocrine tumor receiving everolimus plus somatostatin analogue treatment. Cancer Res 2015. [DOI: 10.1158/1538-7445.am2015-1189] [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
Introduction: Abnormal PI3K-Akt-mTOR pathway signaling and autocrine activation of the mTOR pathway, mediated through insulin-like growth factor 1 (IGF1), has been implicated in the proliferation of pNET cells. Everolimus (EVE), an inhibitor of mTOR (a central regulator of growth/proliferation, cellular metabolism and angiogenesis) has shown antitumor benefit in pNETs alone and in combination with Octreotide LAR (OCT) in RADIANT-1 and RADIANT-3 trials. An increasing number of studies have identified diabetic patients (pts) as having increased risk for the development of cancer and have associated Metformin (MET) treatment with a decrease of cancer risk. MET has also been associated with improved outcomes in cancer pts. MET has recently shown some anti-cancer activity, both in vitro and in vivo studies by antisecretory properties to decrease insulin and IGF1 levels and by antitumor effect due to AMPK activation and consequently inhibition to TSC1-2/mTOR complex, mediated to LKB1 oncogene expression.
The aims of this retrospective study, even if in a limited number of pts is to evaluate the effect of concomitant MET administered during EVE plus OCT therapy in pts with pWDNETs and diabetes.
Methods: We retrospectively evaluated the difference in terms of progression-free survival (PFS) between consecutive diabetic pts on MET and those on insulin (INS) as concomitant drugs during EVE plus OCT therapy. Normoglycemic pts served as controls.
Results: Between 2009 and 2012, 31 pts (age 55.5 years; 22 males) were treated with EVE plus OCT. Six pts received MET, 6 received INS and 19 pts were normolgycemic. In the overall population, median PFS was 12 months (mo) (95%CI 6.3-17.7); mPFS was 24 mo (95% CI 8.6-59.9) in diabetic pts and 12 mo (95% CI 8.7- 15.3) in normoglycemic pts (HR 3.17, 95% CI 1.18-8.49; p = 0.016).
Median PFS in pts on MET was “not achieved” versus 12.2 mo in pts treated with INS (95% CI 0-28). At the time of this analysis, 4 pts (67%) on MET are still receiving EVE plus OCT, with a median duration of treatment of 19.5 mo (range 10-27+ mo).
Conclusion: Although the limited number of pts hampers the analysis, a prospective evaluation is required to either confirm or discard these preliminary findings. With the aim to evaluate the antiproliferative effect of MET in combination with EVE and OCT LAR in pWDNET pts, a single arm, prospective, single center phase II study was designed (MetNET-1 trial; NCT02294006). Forty-three patient will expect to be evaluated. The study is currently ongoing, and the recruitment is estimated to be completed in August 2016. The results will be anticipated in 2017.
Citation Format: Sara Pusceddu, Roberto Buzzoni, Laura Concas, Cristina Bregant, Livia Leuzzi, Massimo Milione, Ettore Seregni, Barbara Formisano, Paola Consonni, Filippo De Braud. The impact of metformin on progression-free survival in patients with advanced pancreatic well differentiated neuroendocrine tumor receiving everolimus plus somatostatin analogue treatment. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 1189. doi:10.1158/1538-7445.AM2015-1189
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Affiliation(s)
- Sara Pusceddu
- Fondazione IRCCS Istituto tumori, ENETs Center of Excellence, Milan, Italy
| | - Roberto Buzzoni
- Fondazione IRCCS Istituto tumori, ENETs Center of Excellence, Milan, Italy
| | - Laura Concas
- Fondazione IRCCS Istituto tumori, ENETs Center of Excellence, Milan, Italy
| | - Cristina Bregant
- Fondazione IRCCS Istituto tumori, ENETs Center of Excellence, Milan, Italy
| | - Livia Leuzzi
- Fondazione IRCCS Istituto tumori, ENETs Center of Excellence, Milan, Italy
| | - Massimo Milione
- Fondazione IRCCS Istituto tumori, ENETs Center of Excellence, Milan, Italy
| | - Ettore Seregni
- Fondazione IRCCS Istituto tumori, ENETs Center of Excellence, Milan, Italy
| | - Barbara Formisano
- Fondazione IRCCS Istituto tumori, ENETs Center of Excellence, Milan, Italy
| | - Paola Consonni
- Fondazione IRCCS Istituto tumori, ENETs Center of Excellence, Milan, Italy
| | - Filippo De Braud
- Fondazione IRCCS Istituto tumori, ENETs Center of Excellence, Milan, Italy
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Nocco S, Concas L, Aste R. Left atrial myxoma with an extremely mobile thread-like offshoot. J Echocardiogr 2015; 13:116-7. [PMID: 26184751 DOI: 10.1007/s12574-015-0254-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 06/20/2015] [Accepted: 06/30/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Silvio Nocco
- Department of Cardiology, Sirai Hospital, Via Ospedale, 09013, Carbonia, Italy,
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Pusceddu S, De Braud F, Festinese F, Bregant C, Lorenzoni A, Maccauro M, Milione M, Concas L, Formisano B, Leuzzi L, Mazzaferro V, Buzzoni R. Evolution in the treatment of gastroenteropancreatic-neuroendocrine neoplasms, focus on systemic therapeutic options: a systematic review. Future Oncol 2015; 11:1947-59. [DOI: 10.2217/fon.15.86] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
ABSTRACT Neuroendocrine neoplasms (NENs) are a group of heterogeneous tumors. The present review discusses current therapeutic strategies for the treatment of gastro-entero-pancreatic NEN. Several systemic options are currently available, including medical systemic chemotherapy, biological drugs, somatostatin analogs and peptide receptor radionuclide therapy. The carcinoid syndrome can be adequately controlled with somatostatin analogs; chemotherapy has shown positive outcomes in poor prognosis patients, and peptide receptor radionuclide therapy is a promising treatment based on the use of radioisotopes for advanced disease expressing somatostatin receptors. Targeted therapies, such as multikinase inhibitors and monoclonal antibodies are also recommended or under evaluation for the treatment of advanced NENs, but some critical issues in clinical practice remain unresolved. Depending upon the development of the disease, a multimodal approach is recommended. The treatment strategy for metastatic patients should be planned by a multidisciplinary team in order to define the optimal sequence of treatments.
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Affiliation(s)
- Sara Pusceddu
- Department of Medical Oncology, ENETS Center of Excellence, Fondazione IRCCS ‘Istituto Nazionale dei Tumori‘, Milan, Italy
| | - Filippo De Braud
- Department of Medical Oncology, ENETS Center of Excellence, Fondazione IRCCS ‘Istituto Nazionale dei Tumori‘, Milan, Italy
| | - Fabrizio Festinese
- Department of Pharmacy, ENETS Center of Excellence, Fondazione IRCCS ‘Istituto Nazionale dei Tumori’, Milan, Italy
| | - Cristina Bregant
- Department of Medical Oncology, ENETS Center of Excellence, Fondazione IRCCS ‘Istituto Nazionale dei Tumori‘, Milan, Italy
| | - Alice Lorenzoni
- Department of Nuclear Medicine, ENETS Center of Excellence, Fondazione IRCCS ‘Istituto Nazionale dei Tumori’, Milan, Italy
| | - Marco Maccauro
- Department of Nuclear Medicine, ENETS Center of Excellence, Fondazione IRCCS ‘Istituto Nazionale dei Tumori’, Milan, Italy
| | - Massimo Milione
- Department of Pathology, ENETS Center of Excellence, Fondazione IRCCS ‘Istituto Nazionale dei Tumori’, Milan, Italy
| | - Laura Concas
- Department of Medical Oncology, ENETS Center of Excellence, Fondazione IRCCS ‘Istituto Nazionale dei Tumori‘, Milan, Italy
| | - Barbara Formisano
- Department of Medical Oncology, ENETS Center of Excellence, Fondazione IRCCS ‘Istituto Nazionale dei Tumori‘, Milan, Italy
| | - Livia Leuzzi
- Department of Medical Oncology, ENETS Center of Excellence, Fondazione IRCCS ‘Istituto Nazionale dei Tumori‘, Milan, Italy
| | - Vincenzo Mazzaferro
- Department of Surgery & liver transplantation, ENETS Center of Excellence, Fondazione IRCCS ‘Istituto Nazionale dei Tumori’, Milan, Italy
| | - Roberto Buzzoni
- Department of Medical Oncology, ENETS Center of Excellence, Fondazione IRCCS ‘Istituto Nazionale dei Tumori‘, Milan, Italy
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Pusceddu S, de Braud F, Concas L, Bregant C, Leuzzi L, Formisano B, Buzzoni R. Rationale and protocol of the MetNET-1 trial, a prospective, single center, phase II study to evaluate the activity and safety of everolimus in combination with octreotide LAR and metformin in patients with advanced pancreatic neuroendocrine tumors. Tumori 2015; 100:e286-9. [PMID: 25688512 DOI: 10.1700/1778.19298] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Abnormal PI3K-AKT-mTOR pathway signalling and autocrine activation of the mTOR pathway, mediated through insulin-like growth factor-1, have been implicated in the proliferation of pancreatic neuroendocrine tumor (pNET) cells. Everolimus, an mTOR inhibitor, has shown antitumor benefit in pNETs alone and in combination with octreotide LAR in RADIANT-1 and RADIANT-3 studies. Although everolimus-based phase II/III trials have improved progression-free survival for pNET, its use has not impacted on prolonging overall survival. Metformin has recently shown some anti-cancer activity in both in vitro and in vivo studies by its indirect properties to decrease insulin and insulin-like growth factor-1 (IGF-1) levels and by its antitumour effect to promote AMPK activation and consequently inhibition to TSC1-2/mTOR complex. In light of even more retrospective evidence of metformin's anticancer activity, a prospective evaluation is required to either confirm or discard these preliminary findings. With the aim to evaluate the antiproliferative effect of metformin in combination with everolimus and octreotide LAR in pancreatic well-differentiated neuroendocrine tumor patients, a single arm, prospective, single center phase II study was designed (MetNET-1 trial, NCT 02294006). Forty-three patients are expected to be evaluated. The study is ongoing, and recruitment is estimated to be completed in August 2016. The results will be anticipated in 2017.
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De Braud F, Pusceddu S, Formisano B, Consonni P, Pacifici M, Pulice J, Concas L, Festinese F, Bregant C, Martinetti A, Buzzoni R. Activity and Safety of Everolimus in Combination with Octreotide Lar and Metformin in Patients with Advanced Pancreatic Well-Differentiated Neuroendocrine Tumors (Pwdnets): a Single–Center, Open-Label, Phase Ii, Proof-Of-Concept Study (Metnet1 Trial). Ann Oncol 2014. [DOI: 10.1093/annonc/mdu345.32] [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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Pusceddu S, De Braud F, Concas L, Bregant C, Festinese F, Giacomelli L, D'Autilia E, Formisano B, Mazzaferro V, Buzzoni R. Metformin Impact on Progression-Free Survival in Advanced Pancreatic Well-Differentiated Neuroendocrine Tumors (Pwdnets). Retrospective Evaluation in Diabetic Patients Receiving Everolimus Plus Octreotide Lar Treatment. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu345.15] [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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Pusceddu S, Buzzoni R, Giacomelli L, Mazzaferro V, Concas L, Milione M, Formisano B, D'Autilia E, Festinese F, De Braud FG. The impact of metformin on progression-free survival of patients with advanced pancreatic well-differentiated neuroendocrine tumor receiving everolimus plus somatostatin analog treatment. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.e15172] [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)
- Sara Pusceddu
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Roberto Buzzoni
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | | | - Laura Concas
- Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Massimo Milione
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Pusceddu S, Vitali M, Haspinger E, Tavecchio L, Giovannetti R, Bille A, Concas L, Garassino M, Milione M, Braud FD, Buzzoni R. Update on Therapeutic Strategy in Lung Carcinoids. ACTA ACUST UNITED AC 2013. [DOI: 10.4236/jct.2013.410176] [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: 11/20/2022]
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