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Iacovelli R, Ciccarese C, Buti S, Zucali PA, Fantinel E, Bimbatti D, Verzoni E, Accettura C, Bonomi L, Buttigliero C, Fornarini G, Pipitone S, Atzori F, Masini C, Massari F, Primi F, Strusi A, Giudice GC, Perrino M, Maruzzo M, Milella M, Giannarelli D, Brunelli M, Procopio G, Tortora G. Avelumab Plus Intermittent Axitinib in Previously Untreated Patients with Metastatic Renal Cell Carcinoma. The Tide-A Phase 2 Study. Eur Urol 2024:S0302-2838(24)02132-8. [PMID: 38521617 DOI: 10.1016/j.eururo.2024.02.014] [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: 12/04/2023] [Revised: 02/16/2024] [Accepted: 02/26/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND Combinations of vascular endothelial growth factor receptor (VEGFR) tyrosine kinase inhibitors (TKIs) plus immune checkpoint inhibitor (ICI) against PD1/PD-L1 are the standard first-line therapy for patients with metastatic renal cell carcinoma (mRCC), irrespective of the prognostic class. OBJECTIVE To investigate the feasibility and safety of withdrawing VEGFR-TKI but continuing anti-PD1/PD-L1 in patients who achieve a response to their combination. DESIGN, SETTING, AND PARTICIPANTS This was a single-arm phase 2 trial in patients with treatment-naïve mRCC with prior nephrectomy, without symptomatic/bulky disease and no liver metastases. INTERVENTION Enrolled patients received axitinib + avelumab; after 36 wk of therapy those who achieved a tumour response interrupted axitinib and continued avelumab maintenance until disease progression. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The primary endpoint was the rate of patients without progression 8 wk after the axitinib interruption. The secondary endpoints were the median value for progression-free (mPFS) and overall (mOS) survival and the safety in the overall population. RESULTS AND LIMITATIONS Seventy-nine patients were enrolled and 75 were evaluated for efficacy. A total of 29 (38%) patients had axitinib withdrawn, as per the study design, with 72% of them having no progression after 8 wk and thus achieving the primary endpoint. The mPFS of the overall population was 24 mo, while the mOS was not reached. The objective response rate was 76% (12% complete response and 64% partial response), with 19% of patients having stable disease. In the patients who discontinued axitinib, the incidence of adverse events of any grade was 59% for grade 3 and 3% for grade 4. This study was limited by the lack of a comparative arm. CONCLUSIONS The TIDE-A study demonstrates that the withdrawal of VEGFR-TKI with ICI maintenance is feasible for selected mRCC patients with evidence of a response to the VEGFR-TKI + ICI combination employed in first-line therapy. Axitinib interruption with avelumab maintenance leads to decreased side effects and should be investigated further as a new strategy to delay tumour progression. PATIENT SUMMARY We evaluated whether certain patients with advanced kidney cancer treated with the fist-line combination of axitinib plus avelumab can interrupt the axitinib in case of a tumour response after 36 wk of therapy. We found that axitinib interruption improved the safety of the combination, while the maintenance with avelumab might delay tumour progression.
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Affiliation(s)
- Roberto Iacovelli
- Oncology Unit, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy; Department of Medicine and Translational Surgery, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Chiara Ciccarese
- Oncology Unit, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Sebastiano Buti
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Paolo Andrea Zucali
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy; Medical Oncology, Humanitas Research Hospital Humanitas Cancer Center, Rozzano, Italy
| | - Emanuela Fantinel
- Medical Oncology, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Davide Bimbatti
- Oncology Unit 1, Istituto Oncologico Veneto, IOV - IRCCS, Padua, Italy
| | - Elena Verzoni
- SSD Oncologia Medica Genitourinaria, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Lucia Bonomi
- Department of Oncology and Hematology, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Consuelo Buttigliero
- Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy
| | - Giuseppe Fornarini
- UO Oncologia Medica 1, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Stefania Pipitone
- Department of Oncology and Haematology, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Francesco Atzori
- Medical Oncology, University Hospital and University of Cagliari, Cagliari, Italy
| | - Cristina Masini
- Medical Oncology, Comprehensive Cancer Centre IRCCS - AUSL Reggio Emilia, Reggio Emilia, Italy
| | - Francesco Massari
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Francesca Primi
- Medical Oncology, Central Hospital of Belcolle, Viterbo, Italy
| | - Alessandro Strusi
- Department of Medicine and Translational Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Matteo Perrino
- Medical Oncology, Humanitas Research Hospital Humanitas Cancer Center, Rozzano, Italy
| | - Marco Maruzzo
- Oncology Unit 1, Istituto Oncologico Veneto, IOV - IRCCS, Padua, Italy
| | - Michele Milella
- Medical Oncology, Azienda Ospedaliera Universitaria Integrata, Verona, Italy; Department of Medicine, University of Verona, Verona, Italy
| | - Diana Giannarelli
- Biostatistics Unit, Scientific Directorate, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Matteo Brunelli
- Department of Diagnostics and Public Health, Pathology Unit, Azienda Ospedaliera Universitaria Integrata di Verona, University of Verona, Verona, Italy
| | - Giuseppe Procopio
- SSD Oncologia Medica Genitourinaria, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giampaolo Tortora
- Oncology Unit, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy; Department of Medicine and Translational Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
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2
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Ceresoli GL, Rossi G, Agustoni F, Bonomi L, Borghetti P, Bulotta A, Casartelli C, Cerea G, Colonese F, Del Signore E, Finocchiaro G, Gianoncelli L, Grisanti S, Maiolani M, Pagni F, Proto C, Rijavec E, Vittimberga I, Arcangeli S, Filippi AR. Management of patients with extensive small-cell lung cancer in the immunotherapy era: an Italian consensus through a Delphi approach. Crit Rev Oncol Hematol 2024:104247. [PMID: 38307393 DOI: 10.1016/j.critrevonc.2023.104247] [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: 01/30/2023] [Revised: 12/06/2023] [Accepted: 12/19/2023] [Indexed: 02/04/2024] Open
Abstract
BACKGROUND Immunotherapy represented a turning point for treating extensive small-cell lung cancer (ES-SCLC). Although, many issues remain debated. METHODS A group of Italian medical and radiation oncologists with expertise in managing patients with ES-SCLC developed a list of statements divided in six areas of interest. The Delphi method was used to assess the consensus on the defined list of statements. RESULTS 32 statements were included in the final list to be voted by the Delphi panel, and 26 reached a consensus on the agreement. A prompt involvement of a multidisciplinary team is a priority to provide an integrated treatment strategy. First-line recommended treatment is immunotherapy in combination with platinum-based chemotherapy and etoposide for four cycles followed by maintenance immunotherapy. CONCLUSIONS While awaiting new data from clinical trials and real-world studies, these recommendations can represent a useful tool to guide the management of ES-SCLC patients in daily practice.
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Affiliation(s)
| | - Giulio Rossi
- Pathology Unit, Hospital Institute Fondazione Poliambulanza, Via Bissolati 57, 25124 Brescia, Italy
| | - Francesco Agustoni
- Department of Internal Medicine and Medical Therapy, University of Pavia, Pavia, Italy; Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Lucia Bonomi
- Unit of Oncology, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Paolo Borghetti
- Radiation Oncology Department, ASST Spedali Civili and University of Brescia, Brescia, Italy
| | - Alessandra Bulotta
- Department of Oncology, IRCCS San Raffaele, via Olgettina 60, Milan, Italy
| | | | - Giulio Cerea
- Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | | | - Ester Del Signore
- Division of Thoracic Oncology, European Institute of Oncology, IEO, Milan, Italy
| | - Giovanna Finocchiaro
- Medical Oncology and Hematologic Unit, Humanitas Cancer Center, Istituto Clinico Humanitas-IRCCS, Rozzano, Italy
| | - Letizia Gianoncelli
- Medical Oncology Unit, San Paolo Hospital, ASST Santi Paolo e Carlo, Milan, Italy
| | - Salvatore Grisanti
- Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Martina Maiolani
- U.O.C Oncologia Medica ASST Valtellina e Alto Lario, Sondrio, Italy
| | - Fabio Pagni
- Pathology, Department of Medicine and Surgery, University Milan Bicocca, Via Cadore 48, 20900 Monza
| | - Claudia Proto
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Erika Rijavec
- Unit of Medical Oncology, Ospedale di Circolo e Fondazione Macchi, ASST Sette Laghi, Varese, Italy
| | | | - Stefano Arcangeli
- Department of Radiation Oncology, University of Milan Bicocca, Milan, Italy
| | - Andrea Riccardo Filippi
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy; Radiation Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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3
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Passaro A, Russo GL, Passiglia F, D'Arcangelo M, Sbrana A, Russano M, Bonanno L, Giusti R, Metro G, Bertolini F, Grisanti S, Carta A, Cecere F, Montrone M, Massa G, Perrone F, Simionato F, Guaitoli G, Scotti V, Genova C, Lugini A, Bonomi L, Attili I, de Marinis F. Pralsetinib in RET fusion-positive non-small-cell lung cancer: A real-world data (RWD) analysis from the Italian expanded access program (EAP). Lung Cancer 2022; 174:118-124. [PMID: 36379124 DOI: 10.1016/j.lungcan.2022.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 10/25/2022] [Accepted: 11/06/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVES The selective RET-inhibitor pralsetinib has shown therapeutic activity in early clinical trials in patients with non-small cell lung cancer (NSCLC) harboring rearranged during transfection (RET) gene fusions. To date, the real-world efficacy of pralsetinib in this population is unknown. MATERIALS AND METHODS A retrospective efficacy and safety analysis was performed on data from patients with RET-fusion positive NSCLC enrolled in the pralsetinib Italian expanded access program between July 2019 and October 2021. RESULTS Overall, 62 patients with RET-fusion positive NSCLC received pralsetinib at 20 Italian centers. Next-generation sequencing was used to detect RET alterations in 44 patients (73 %). The most frequent gene fusion partner was KIF5B (75 % of 45 evaluable). Median age was 62 years (range, 36-90), most patients were female (57 %) and never smokers (53 %). Brain metastases were known in 18 patients (29.5 %) at the time of pralsetinib treatment. 13 patients were treatment naïve (unfit for chemotherapy), 48 were pretreated (median number of previous lines: 1, range, 1-4). The objective response rate (ORR) was 66 % [95 % confidence interval (CI), 53-81] in the evaluable population (n = 59). The disease control rate (DCR) was 79 %. After a median follow-up of 10.1 months, the median progression free survival was 8.9 months (95 %CI, 4.7-NA). In patients with measurable brain metastases (n = 6) intracranial ORR was 83 %, intracranial DCR was 100 %. Overall, 83.6 % of patients experienced any-grade treatment-related adverse events (TRAEs), 39 % grade 3 or greater (G ≥ 3). The most common G ≥ 3 TRAEs were neutropenia (9.8 %), dry mouth/oral mucositis (8.2 %), and thrombocytopenia (6.6 %). Seven patients (12 %) discontinued pralsetinib due to TRAEs, twenty-six had at least one dose level modification due to TRAEs. Two treatment-related deaths were observed (1 sepsis, 1 typhlitis). CONCLUSIONS In the real-world setting, pralsetinib confirmed durable systemic activity and intracranial response in RET-fusion positive NSCLC. Toxicity profile was consistent with previous reports.
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Affiliation(s)
- Antonio Passaro
- Division of Thoracic Oncology, European Institute of Oncology IRCCS, Milan, Italy.
| | - Giuseppe Lo Russo
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Francesco Passiglia
- Department of Oncology, University of Turin, S. Luigi Gonzaga Hospital, Orbassano (TO), Italy
| | | | - Andrea Sbrana
- Department of Surgical, Medical and Molecular Pathology and Critical Area Medicine, University of Pisa, Pisa, Italy
| | - Marco Russano
- Medical Oncology, Campus Bio-Medico University, Rome, Italy
| | - Laura Bonanno
- Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padua, Italy
| | | | - Giulio Metro
- Department of Medical Oncology, Santa Maria della Misericordia Hospital, Perugia, Italy
| | - Federica Bertolini
- Department of Oncology and Hematology, Modena University Hospital, Modena, Italy
| | - Salvatore Grisanti
- Department of Medical Oncology, ASST Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - Annamaria Carta
- SC Oncologia Medica, Ospedale Businco - ARNAS G. Brotzu, Cagliari, Italy
| | - Fabiana Cecere
- Oncology 1, Regina Elena National Cancer Institute - IRCCS, Roma, Italy
| | - Michele Montrone
- Medical Thoracic Oncology Unit, IRCCS Istituto Tumori "Giovanni Paolo II", Bari 70124, Italy
| | - Giacomo Massa
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Fabiana Perrone
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Francesca Simionato
- Department of Oncology, San Bortolo General Hospital, Azienda ULSS8 Berica, Vicenza, Italy
| | - Giorgia Guaitoli
- PhD Program Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Vieri Scotti
- Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Carlo Genova
- Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italia; Dipartimento di Medicina Interna e Specialità Mediche, Università degli Studi di Genova, Italia
| | - Antonio Lugini
- AO San Giovanni Addolorata, UOC Oncologia Medica, Roma, Italy
| | - Lucia Bonomi
- Oncology, Department of Oncology and Hematology, ASST Papa Giovanni XXIII, Bergamo, Lombardia, Italy
| | - Ilaria Attili
- Division of Thoracic Oncology, European Institute of Oncology IRCCS, Milan, Italy
| | - Filippo de Marinis
- Division of Thoracic Oncology, European Institute of Oncology IRCCS, Milan, Italy
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4
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Zambelli A, Chiudinelli L, Fotia V, Negrini G, Bosetti T, Callegaro A, Di Croce A, Caremoli ER, Moro C, Milesi L, Poletti P, Tasca C, Mandalà M, Merelli B, Mosconi S, Arnoldi E, Bettini A, Bonomi L, Messina C, Ghilardi L, Chirco A, Maracino M, Tondini C. Prevalence and Clinical Impact of SARS-CoV-2 Silent Carriers Among Actively Treated Patients with Cancer During the COVID-19 Pandemic. Oncologist 2021; 26:341-347. [PMID: 33355953 PMCID: PMC8018331 DOI: 10.1002/onco.13654] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 12/09/2020] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION In Europe, the SARS-CoV-2 pandemic had its first epicenter in Italy. Despite a significant mortality rate, the severity of most cases of COVID-19 infection ranges from asymptomatic to mildly symptomatic, and silent infection affects a still-unknown proportion of the general population. No information is available on the prevalence and clinical impact of SARS-CoV-2 silent infection among patients with cancer receiving anticancer treatment during the pandemic. MATERIALS AND METHODS From April 1, 2020, to the end of the same month, 560 consecutive patients with cancer, asymptomatic for COVID-19 and on anticancer treatment at Papa Giovanni XXIII Hospital in Bergamo, were evaluated and tested for SARS-CoV-2. We implemented a two-step diagnostics, including the rapid serological immunoassay for anti-SARS-CoV-2 immunoglobulin (Ig) G/IgM and the nasopharyngeal swab reverse transcriptase-polymerase chain reaction (RT-PCR) test in case of seropositivity to identify SARS-CoV-2 silent carriers. RESULTS In 560 patients, 172 (31%) resulted positive for anti-SARS-CoV-2 IgM/IgG antibodies, regardless of different type of cancer, stage, and treatment. The Ig-seropositive patients were then tested with RT-PCR nasopharyngeal swabs, and 38% proved to be SARS-CoV-2 silent carriers. At an early follow-up, in the 97 SARS-CoV-2-seropositive/RT-PCR-negative patients who continued their anticancer therapies, only one developed symptomatic COVID-19 illness. CONCLUSION Among patients with cancer, the two-step diagnostics is feasible and effective for SARS-CoV-2 silent carriers detection and might support optimal cancer treatment strategies at both the individual and the population level. The early safety profile of the different anticancer therapies, in patients previously exposed to SARS-CoV-2, supports the recommendation to continue the active treatment, at least in cases of RT-PCR-negative patients. IMPLICATIONS FOR PRACTICE This is the first study evaluating the prevalence and clinical impact of SARS-CoV-2 silent infection in actively treated patients with cancer, during the epidemic peak in one of the worst areas of the COVID-19 pandemic. Lacking national and international recommendations for the detection of asymptomatic SARS-CoV-2 infection, a pragmatic and effective two-step diagnostics was implemented to ascertain SARS-CoV-2 silent carriers. In this series, consisting of consecutive and unselected patients with cancer, the prevalence of both SARS-CoV-2-seropositive patients and silent carriers is substantial (31% and 10%, respectively). The early safety profile of the different anticancer therapies, in patients previously exposed to SARS-CoV-2, supports the recommendation to continue the active treatment, at least in case of RT-PCR-negative patients.
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Affiliation(s)
- Alberto Zambelli
- Department of Medical Oncology, Ospedale Papa Giovanni XXIIIBergamoItaly
| | - Lorenzo Chiudinelli
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, LombardyItaly
| | - Vittoria Fotia
- Department of Medical Oncology, Ospedale Papa Giovanni XXIIIBergamoItaly
| | - Giorgia Negrini
- Department of Medical Oncology, Ospedale Papa Giovanni XXIIIBergamoItaly
| | - Tommaso Bosetti
- Department of Medical Oncology, Ospedale Papa Giovanni XXIIIBergamoItaly
| | | | - Andrea Di Croce
- Department of Medical Oncology, Ospedale Papa Giovanni XXIIIBergamoItaly
| | | | - Cecilia Moro
- Department of Medical Oncology, Ospedale Papa Giovanni XXIIIBergamoItaly
| | - Laura Milesi
- Department of Medical Oncology, Ospedale Papa Giovanni XXIIIBergamoItaly
| | - Paola Poletti
- Department of Medical Oncology, Ospedale Papa Giovanni XXIIIBergamoItaly
| | - Cristina Tasca
- Department of Medical Oncology, Ospedale Papa Giovanni XXIIIBergamoItaly
| | - Mario Mandalà
- Department of Medical Oncology, Ospedale Papa Giovanni XXIIIBergamoItaly
| | - Barbara Merelli
- Department of Medical Oncology, Ospedale Papa Giovanni XXIIIBergamoItaly
| | - Stefania Mosconi
- Department of Medical Oncology, Ospedale Papa Giovanni XXIIIBergamoItaly
| | | | - Anna Bettini
- Department of Medical Oncology, Ospedale Papa Giovanni XXIIIBergamoItaly
| | - Lucia Bonomi
- Department of Medical Oncology, Ospedale Papa Giovanni XXIIIBergamoItaly
| | - Caterina Messina
- Department of Medical Oncology, Ospedale Papa Giovanni XXIIIBergamoItaly
| | | | | | - Michela Maracino
- Department of Medical Oncology, Ospedale Papa Giovanni XXIIIBergamoItaly
| | - Carlo Tondini
- Department of Medical Oncology, Ospedale Papa Giovanni XXIIIBergamoItaly
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5
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Mandala M, Lorigan P, De Luca M, Bianchetti A, Merelli B, Bettini AC, Bonomi L, Nahm S, Vitale MG, Negrini G, Di Croce A, Ascierto PA, Rulli E, Tondini CA. SARS-CoV-2 infection and adverse events in patients with cancer receiving immune checkpoint inhibitors: an observational prospective study. J Immunother Cancer 2021; 9:jitc-2020-001694. [PMID: 33593827 PMCID: PMC7887862 DOI: 10.1136/jitc-2020-001694] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND In ambulatory patients with cancer with asymptomatic or pauci-symptomatic SARS-CoV-2 infection, the safety of targeted therapies (TTs), chemotherapy (CT) or immune checkpoint inhibitors (ICIs) therapy is still unknown. MATERIAL AND METHODS From the start of the first epidemic wave of SARS-CoV-2 in Bergamo, Italy, we have prospectively screened all consecutive outpatients who presented for treatment to the Oncology Division of the Papa Giovanni XXIII Hospital, Bergamo for SARS-CoV-2 antigen expression. We identified patients treated with ICIs and compared these to patients with the same cancer subtypes treated with TTs or CT. RESULTS Between March 5 and May 18, 293 consecutive patients (49% melanoma, 34% non-small cell lung cancer, 9% renal cell carcinoma, 8% other) were included in this study: 159 (54%), 50 (17%) and 84 (29%) received ICIs, CT or TTs, respectively. Overall 89 patients (30.0%) were SARS-CoV-2 positive. Mortality of SARS-CoV-2-positive patients was statistically significantly higher compared with SARS-CoV-2 negative patients (8/89 vs 3/204, respectively, Fisher's exact test p=0.004). All deaths were due to COVID-19. Serious adverse events (SAEs) were more frequent in SARS-CoV-2-positive patients compared with SARS-CoV-2-negative cases (Cochran-Mantel-Haenszel (CMH) test p=0.0008). The incidence of SAEs in SARS-CoV-2 positive compared with SARS-CoV-2 negative patients was similar in ICI and CT patients (17.3% and 3.7% for positive and negative patients in ICIs and 15.4% and 2.7% in CT, Breslow-Day test p=0.891). No COVID-19-related SAEs were observed in the TTs patients. CONCLUSIONS The incidence of SAEs was higher for SARS-CoV-2-positive patients treated with ICIs and CT, mostly in advanced disease. No SAEs were observed in patients treated with TTs. SAEs were COVID-19 related rather than treatment related. Treatment with ICIs does not appear to significantly increase risk of SAEs compared with CT. This information should be considered when determining treatment options for patients.
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Affiliation(s)
- Mario Mandala
- Unit of Medical Oncology, University of Perugia, Perugia, Italy
| | - Paul Lorigan
- Medical Oncology-Melanoma, The Christie Hospital NHS Trust, Manchester, UK.,Division of cancer sciences, The University of Manchester, Manchester, UK
| | - Matilde De Luca
- Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Lombardia, Italy
| | - Andrea Bianchetti
- Oncology, Fondazione per la Ricerca Ospedale Maggiore, Bergamo, Italy
| | - Barbara Merelli
- Unit of Medical Oncology, Department of Oncology and Hematology, ASST Papa Giovanni XXIII, Bergamo, Lombardia, Italy
| | - Anna Cecilia Bettini
- Oncology, Department of Oncology and Hematology, ASST Papa Giovanni XXIII, Bergamo, Lombardia, Italy
| | - Lucia Bonomi
- Oncology, Department of Oncology and Hematology, ASST Papa Giovanni XXIII, Bergamo, Lombardia, Italy
| | - Sharon Nahm
- Medical Oncology-Melanoma, The Christie Hospital NHS Trust, Manchester, UK
| | - Maria Grazia Vitale
- Unit of Melanoma, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Naples, Italy
| | - Giorgia Negrini
- Oncology, Department of Oncology and Hematology, ASST Papa Giovanni XXIII, Bergamo, Lombardia, Italy
| | - Andrea Di Croce
- Unit of Medical Oncology, Department of Oncology and Hematology, ASST Papa Giovanni XXIII, Bergamo, Lombardia, Italy
| | - Paolo Antonio Ascierto
- Unit of Melanoma, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Naples, Italy
| | - Eliana Rulli
- Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Lombardia, Italy
| | - Carlo Alberto Tondini
- Unit of Medical Oncology, Department of Oncology and Hematology, ASST Papa Giovanni XXIII, Bergamo, Lombardia, Italy
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6
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Laganà M, Gurizzan C, Roca E, Cortinovis D, Signorelli D, Pagani F, Bettini A, Bonomi L, Rinaldi S, Berardi R, Filetti M, Giusti R, Pilotto S, Milella M, Intagliata S, Baggi A, Cortellini A, Soto Parra H, Brighenti M, Petrelli F, Bennati C, Bidoli P, Garassino MC, Berruti A. High Prevalence and Early Occurrence of Skeletal Complications in EGFR Mutated NSCLC Patients With Bone Metastases. Front Oncol 2020; 10:588862. [PMID: 33282740 PMCID: PMC7689017 DOI: 10.3389/fonc.2020.588862] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 10/19/2020] [Indexed: 11/13/2022] Open
Abstract
Objectives The prevalence of Skeletal Related Adverse Events (SREs) in EGFR mutated non-small cell lung cancer (NSCLC) patients with bone metastases, treated with modern tyrosine kinase inhibitors (TKIs), has been scarcely investigated. Materials and Methods We retrospectively evaluated the data of EGFR mutated NSCLC patients with bone metastases treated with TKIs in 12 Italian centers from 2014 to 2019, with the primary aim to explore type and frequency of SREs. Results Seventy-seven out of 274 patients enrolled (28%) developed at least one major SRE: 55/274 (20%) bone fractures, 30/274 (11%) spinal cord compression, 5/274 (2%) hypercalcemia. Median time to the onset of SRE was 3.63 months. Nine patients (3%) underwent bone surgery and 150 (55%) radiation therapy on bone. SREs were more frequently observed within the 12 months from TKI start than afterwards (71 vs 29%, p 0.000). Patient Performance Status and liver metastases where independently associated with the risk of developing SREs. Median TKI exposure and overall survival were 11 and 28 months, respectively. Bone resorption inhibitors were associated with a lower risk of death (HR 0.722, 95% CI: 0.504–1.033, p = 0.075) although not statistically significant at multivariate analysis. Conclusion Bone metastatic NSCLC patients with EGFR mutated disease, treated with EGFR TKIs, have a relatively long survival expectancy and are at high risk to develop SREs. The early SRE occurrence after the TKI start provides the rationale to administer bone resorption inhibitors.
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Affiliation(s)
- Marta Laganà
- Medical Oncology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health University of Brescia, ASST-Spedali Civili, Brescia, Italy
| | - Cristina Gurizzan
- Medical Oncology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health University of Brescia, ASST-Spedali Civili, Brescia, Italy
| | - Elisa Roca
- Medical Oncology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health University of Brescia, ASST-Spedali Civili, Brescia, Italy
| | | | - Diego Signorelli
- Medical Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - Filippo Pagani
- Medical Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - Anna Bettini
- Medical Oncology, ASST Papa Giovanni XXIII di Bergamo, Bergamo, Italy
| | - Lucia Bonomi
- Medical Oncology, ASST Papa Giovanni XXIII di Bergamo, Bergamo, Italy
| | - Silvia Rinaldi
- Medical Oncology, Ospedali Riuniti di Ancona, Ancona, Italy
| | | | - Marco Filetti
- Medical Oncology, Azienda Ospedaliero Universitaria S. Andrea di Roma, Roma, Italy
| | - Raffaele Giusti
- Medical Oncology, Azienda Ospedaliero Universitaria S. Andrea di Roma, Roma, Italy
| | - Sara Pilotto
- Medical Oncology, Università degli studi di Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Michele Milella
- Medical Oncology, Università degli studi di Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Salvatore Intagliata
- Medical Oncology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health University of Brescia, ASST-Spedali Civili, Brescia, Italy
| | - Alice Baggi
- Medical Oncology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health University of Brescia, ASST-Spedali Civili, Brescia, Italy
| | | | - Hector Soto Parra
- Medical Oncology, Policlinico Vittorio Emanuele di Catania, Catania, Italy
| | | | | | - Chiara Bennati
- Ospedale Santa Maria delle Croci di Ravenna, Ravenna, Italy
| | - Paolo Bidoli
- Medical Oncology, Ospedale S. Gerardo di Monza, Monza, Italy
| | | | - Alfredo Berruti
- Medical Oncology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health University of Brescia, ASST-Spedali Civili, Brescia, Italy
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Bonomi L, Ghilardi L, Arnoldi E, Tondini CA, Bettini AC. A Rapid Fatal Evolution of Coronavirus Disease-19 in a Patient With Advanced Lung Cancer With a Long-Time Response to Nivolumab. J Thorac Oncol 2020; 15:e83-e85. [PMID: 32243919 PMCID: PMC7270552 DOI: 10.1016/j.jtho.2020.03.021] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 03/27/2020] [Indexed: 12/16/2022]
Affiliation(s)
- Lucia Bonomi
- Oncology Unit, Azienda Socia Sanitaria Territoriale Ospedale Papa Giovanni XXIII, Bergamo, Lombardia, Italy.
| | - Laura Ghilardi
- Oncology Unit, Azienda Socia Sanitaria Territoriale Ospedale Papa Giovanni XXIII, Bergamo, Lombardia, Italy
| | - Ermenegildo Arnoldi
- Oncology Unit, Azienda Socia Sanitaria Territoriale Ospedale Papa Giovanni XXIII, Bergamo, Lombardia, Italy
| | - Carlo Alberto Tondini
- Oncology Unit, Azienda Socia Sanitaria Territoriale Ospedale Papa Giovanni XXIII, Bergamo, Lombardia, Italy
| | - Anna Cecilia Bettini
- Oncology Unit, Azienda Socia Sanitaria Territoriale Ospedale Papa Giovanni XXIII, Bergamo, Lombardia, Italy
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de Marinis F, Giaccone G, Herbst RS, Oprean CM, Szczesna A, Boukovinas I, Bonomi L, Kim YC, Summers YJ, Kurata T, Komatsubara KM, Chen M, Deng Y, Kuriki H, Mocci S, Phan S, Jassem J, Spigel DR. Patient-reported outcomes (PROs) in the randomized, phase III IMpower110 study of atezolizumab (atezo) vs chemotherapy in 1L metastatic NSCLC. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.9594] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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
9594 Background: IMpower110 (NCT02409342) evaluated atezo (anti–PD-L1) monotherapy as 1L treatment in PD-L1–selected patients (pts) with metastatic NSCLC and met its primary endpoint with statistically significant and clinically meaningful OS benefit in TC3 or IC3 wild-type (WT; EGFR/ALK-negative) pts. PROs were prespecified endpoints to assess pt perspectives on overall clinical benefit. Methods: Pts were randomized 1:1 to receive atezo 1200 mg IV q3w (Arm A) or platinum-based chemo (Arm B; 4 or 6 21-day cycles). Arm B non-squamous pts received cisplatin (cis) 75 mg/m2 or carboplatin (carbo) AUC 6 + pemetrexed 500 mg/m2 IV q3w; Arm B squamous pts received cis 75 mg/m2 + gemcitabine (gem) 1250 mg/m2 or carbo AUC 5 + gem 1000 mg/m2 IV q3w. PROs were assessed by the EORTC Quality of Life Questionnaire Core 30 (QLQ-C30) and lung cancer module QLQ-LC13. Time to confirmed deterioration (TTD) in QLQ-LC13 lung cancer symptoms (secondary endpoint) and change from baseline (BL) in global health status (GHS), functioning and lung cancer symptoms (exploratory endpoints) were analyzed in TC3 or IC3-WT pts. Clinically meaningful change was defined as a ≥10-point deterioration from BL. Results: Completion rates at BL (atezo, n = 107; chemo, n = 98) were high in both arms for the QLC-C30 (90% atezo, 86% chemo) and the QLC-LC13 (89% atezo, 85% chemo), and remained > 80% at most visits. Mean BL scores for GHS, physical functioning, and role functioning were moderate, symptom burden was low, and all were similar in both arms. No differences in TTD were seen between arms for cough (HR, 0.98; 95% CI: 0.48, 2.03), chest pain (HR, 1.02; 95% CI: 0.47, 2.22), dyspnea (HR, 0.96, 95% CI: 0.57, 1.60), and 3-symptom composite score (HR, 0.92; 95% CI: 0.59, 1.44). Mean change in physical function from BL to wk 42 was modestly improved with atezo and greater than or similar to chemo. No clinically meaningful worsening in dyspnea, cough or chest pain was seen with atezo vs chemo. Mean change in cough and chest pain from BL numerically improved immediately after start of treatment and was maintained to wk 48 with atezo. Fatigue and nausea/vomiting scores numerically improved immediately with atezo and were maintained to wk 48. Conclusions: QLQ-C30 and QLQ-LC13 completion rates were high at BL and most study visits. TTD of lung cancer-related symptoms was similar in both arms, indicating pts’ low BL symptom burden was maintained for a similar duration. Pts receiving atezo vs chemo sustained numerical improvements in physical function and no worsening in lung cancer-related symptoms. Clinical trial information: NCT02409342 .
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Affiliation(s)
| | | | | | | | | | | | - Lucia Bonomi
- Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | - Young-Chul Kim
- Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun-Gun, South Korea
| | - Yvonne J. Summers
- The Christie Hospital NHS Foundation Trust, Manchester, United Kingdom
| | | | | | - Megan Chen
- Genentech, Inc., South San Francisco, CA
| | - Yu Deng
- Genentech, Inc, South San Francisco, CA
| | | | | | - See Phan
- Genentech, Inc, South San Francisco, CA
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Iacovelli R, Atzori F, Basso U, Bersanelli M, Bonomi L, Bracarda S, Buttigliero C, Fantinel E, Calabro F, Chiuri VE, Di Lorenzo G, Fornarini G, Massari F, Naglieri E, Ortega C, Procopio G, Milella M, Santoni M, Vitale MG, Zucali PA. Phase II study of avelumab plus intermittent axitinib in previously untreated patients with metastatic renal cell carcinoma (Tide-A study). J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.6_suppl.tps762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
TPS762 Background: The combination of avelumab plus axitinib has been recently reported to be superior than sunitinib alone for treatment of previously untreated mRCC patients (Motzer, NEJM 2019). The study reported a median PFS of 13.8 for the combination of avelumab plus axitinib compared to 8.4 months for sunitinib (p<0.001) with an ORR of 48% vs 24%, respectively. To improve treatment efficacy and safety, TKI discontinuation has been considered in patients treated with sunitinib leading to a longer definitive progression free survival (22.4 months) and overall survival (34.8 months) with a better safety profile (Ornstein, JCO 2017). Despite a new tumor response at TKI reintroduction, many patients progressed after the first months of treatment discontinuation suggesting the necessity to maintain the previous response. This study aims to test if patients achieving a tumor response with the combination of avelumab plus axitinib, can discontinue the TKI in order to delay the resistance and decrease the toxicity related to the combination of therapies. Methods: The single arm, phase II TIDE-A trial, aims to evaluate the activity of avelumab as maintenance therapy in patients with mRCC who achieved a tumor response after the induction phase of therapy with the combination of avelumab and axitinib. Eligible patients have clear cell carcinoma, ECOG performance status 0 or 1, measurable, no bulky disease without tumor-related symptoms or hepatic metastases. Eligible patient will receive the combination of avelumab plus axitinib for 36 weeks. Patients achieving RECIST 1.1 partial response discontinue the axitinib and continue avelumab. At tumor progression, the axitinib will be restarted for at least six months. If a new tumor response is achieved, axitinib will be discontinued again until tumor progression. Patients with RECIST 1.1 stable disease continue the combination of avelumab and axitinib until progression of disease. The primary endpoint is to evaluate the rate of patients free of progression after 8 weeks from axitinib discontinuation. The study is currently ongoing in twenty centres in Italy.
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Affiliation(s)
| | - Francesco Atzori
- Medical Oncology Unit, University Hospital of Cagliari, Cagliari, Italy
| | - Umberto Basso
- Medical Oncology Unit 1, Department of Oncology, Istituto Oncologico Veneto IOV IRCCS, Padua, Italy
| | | | - Lucia Bonomi
- Medical Oncology Unit, PIazza OMS, 1, Pope John Paul XXIII Hospital, Bergamo, Italy
| | | | - Consuelo Buttigliero
- Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy
| | - Emanuela Fantinel
- Medical Oncology Unit, Clinical Cancer Centre, IRCCS-AUSL di Reggio Emilia, Reggio Emilia, Italy
| | | | | | | | - Giuseppe Fornarini
- Medical Oncology Unit 1, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale Policlinico San Martino, Genova, Italy
| | | | - Emanuele Naglieri
- Division of Medical Oncology, Istituto Tumori Bari Giovanni Paolo II - IRCCS, Bari, Italy
| | | | - Giuseppe Procopio
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Michele Milella
- Medical Oncology, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Matteo Santoni
- Medical Oncology Unit, Macerata General Hospital, Macerata, Italy
| | | | - Paolo Andrea Zucali
- Humanitas Cancer Center, Humanitas Clinical and Research Center, Rozzano, Italy
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Bonomi L, Bettini AC, Arnoldi E, Chirco A, Ghilardi L, Manara O, Roscigno M, Da Pozzo LF, Tondini CA. Nivolumab efficacy in leptomeningeal metastasis of renal cell carcinoma: a case report. Tumori 2020; 106:NP76-NP78. [PMID: 32041500 DOI: 10.1177/0300891620904411] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Meningeal carcinomatosis is rare in patients with kidney cancer and treatment options are limited. Few patients treated with systemic approaches have been reported. We describe a case of complete remission of leptomeningeal metastasis in a patient with renal cell carcinoma treated with nivolumab. To our knowledge, this is the first report of nivolumab safety and efficacy in this particular site of metastasis. CASE PRESENTATION Our patient was a 60-year-old Caucasian man with bone and lung metastases from renal cell carcinoma. He developed leptomeningeal metastasis and progression of bone and lung lesions after only 2 months of his first-line treatment. He was then treated with nivolumab in second-line setting and experienced a rapid improvement of cancer-related symptoms, complete remission of leptomeningeal and lung lesions, and increased bone mineral density in bone metastasis. The patient did not experience any drug-related toxicity. CONCLUSIONS Meningeal carcinomatosis metastasis from renal cancer is a rare condition. Diagnosis is often challenging: the onset of nonspecific presenting symptoms could be initially attributed to bone involvement, side effects of oncologic therapy, or paraneoplastic syndromes. Our case suggests that nivolumab could be an effective and safe treatment option in patients with pretreated renal cancer with leptomeningeal metastasis.
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Affiliation(s)
- Lucia Bonomi
- Division of Oncology, ASST-Ospedale Papa Giovanni XXIII Bergamo, Italy
| | | | | | - Alessandra Chirco
- Division of Oncology, ASST-Ospedale Papa Giovanni XXIII Bergamo, Italy
| | - Laura Ghilardi
- Division of Oncology, ASST-Ospedale Papa Giovanni XXIII Bergamo, Italy
| | - Ornella Manara
- Department of Neuroradiology, ASST-Ospedale Papa Giovanni XXIII Bergamo, Italy
| | - Marco Roscigno
- Division of Urology, ASST-Ospedale Papa Giovanni XXIII Bergamo, Italy
| | - Luigi Filippo Da Pozzo
- Division of Urology, ASST-Ospedale Papa Giovanni XXIII Bergamo, Italy.,Università degli Studi di Milano Bicocca, School of Medicine and Surgery, Italy
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Negrini G, Ghilardi L, Bonomi L, Arnoldi E, Tondini C, Sansi C, Bettini A. Evaluation of the correlation between diverticulosis and the onset of diarrhea in patients with lung cancer treated with immune checkpoint inhibitors. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz449.026] [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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Facchini G, Rossetti S, Berretta M, Cavaliere C, Scagliarini S, Vitale MG, Ciccarese C, Di Lorenzo G, Palesandro E, Conteduca V, Basso U, Naglieri E, Farnesi A, Aieta M, Borsellino N, La Torre L, Iovane G, Bonomi L, Gasparro D, Ricevuto E, De Tursi M, De Vivo R, Lo Re G, Grillone F, Marchetti P, De Vita F, Scavelli C, Sini C, Pisconti S, Crispo A, Gebbia V, Maestri A, Galli L, De Giorgi U, Iacovelli R, Buonerba C, Cartenì G, D'Aniello C. Second line therapy with axitinib after only prior sunitinib in metastatic renal cell cancer: Italian multicenter real world SAX study final results. J Transl Med 2019; 17:296. [PMID: 31464635 PMCID: PMC6716812 DOI: 10.1186/s12967-019-2047-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 08/22/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND This multi-institutional retrospective real life study was conducted in 22 Italian Oncology Centers and evaluated the role of Axitinib in second line treatment in not selected mRCC patients. METHODS 148 mRCC patients were evaluated. According to Heng score 15.5%, 60.1% and 24.4% of patients were at poor risk, intermediate and favorable risk, respectively. RESULTS PFS, OS, DCR and ORR were 7.14 months, 15.5 months, 70.6% and 16.6%, respectively. The duration of prior sunitinib treatment correlated with a longer significant mPFS, 8.8 vs 6.3 months, respectively. Axitinib therapy was safe, without grade 4 adverse events. The most frequent toxicities of all grades were: fatigue (50%), hypertension (26%), and hypothyroidism (18%). G3 blood pressure elevation significantly correlated with longer mPFS and mOS compared to G1-G2 or no toxicity. Dose titration (DT) to 7 mg and 10 mg bid was feasible in 24% with no statistically significant differences in mPFS and mOS. The sunitinib-axitinib sequence was safe and effective, the mOS was 41.15 months. At multivariate analysis, gender, DCR to axitinib and to previous sunitinib correlated significantly with PFS; whereas DCR to axitinib, nephrectomy and Heng score independently affected overall survival. CONCLUSIONS Axitinib was effective and safe in a not selected real life mRCC population. Trial registration INT - Napoli - 11/16 oss. Registered 20 April 2016. http://www.istitutotumori.na.it.
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Affiliation(s)
- Gaetano Facchini
- Departmental Unit of Clinical and Experimental Uro-Andrologic Oncology, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Via M. Semmola, 80131, Napoli, Italy.
| | - Sabrina Rossetti
- Departmental Unit of Clinical and Experimental Uro-Andrologic Oncology, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Via M. Semmola, 80131, Napoli, Italy
| | - Massimiliano Berretta
- Department of Medical Oncology, Centro di Riferimento Oncologico, Istituto Nazionale Tumori CRO, Aviano, PN, Italy
| | - Carla Cavaliere
- UOC of Medical Oncology ASL NA 3 SUD Ospedali Riuniti Area Nolana, Naples, Italy
| | - Sarah Scagliarini
- Division of Oncology, Azienda Ospedaliera di Rilievo Nazionale A. Cardarelli, Naples, Italy
| | - Maria Giuseppa Vitale
- Division of Medical Oncology, Azienda Ospedaliera Universitaria Policlinico di Modena, Modena, Italy
| | - Chiara Ciccarese
- Medical Oncology, Azienda Ospedaliera Universitaria Integrata, University of Verona, Verona, Italy
| | - Giuseppe Di Lorenzo
- Department of Clinical Medicine and Surgery, Università degli Studi di Napoli Federico II, Naples, Italy
| | - Erica Palesandro
- Division of Medical Oncology, Candiolo Cancer Institute-FPO, IRCCS, Candiolo, Italy
| | - Vincenza Conteduca
- Department of Oncology, IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (I.R.S.T.), Meldola, Italy
| | - Umberto Basso
- Medical Oncology Unit 1, Istituto Oncologico Veneto IOV IRCCS, Padua, Italy
| | - Emanuele Naglieri
- Division of Medical Oncology, Istituto Oncologico Giovanni Paolo II, Bari, Italy
| | - Azzurra Farnesi
- University Hospital of Pisa, Oncology Unit 2, Pisa, Pisa, Italy
| | - Michele Aieta
- Medical Oncology Department, National Institute of Cancer, Rionero in Vulture, Italy
| | | | - Leonardo La Torre
- Medical Oncology Department, "Santa Maria della Scaletta" Hospital AUSL, Imola, Italy
| | - Gelsomina Iovane
- Departmental Unit of Clinical and Experimental Uro-Andrologic Oncology, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Via M. Semmola, 80131, Napoli, Italy
| | - Lucia Bonomi
- Oncology Department, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | | | - Enrico Ricevuto
- S. Salvatore Hospital, ASL1 Abruzzo, University of L'Aquila, L'Aquila, Italy
| | - Michele De Tursi
- Oncology and Experimental Medicine, "G. D'Annunzio" University, Chieti, Italy
| | | | | | - Francesco Grillone
- Medical Oncology Unit Azienda Ospedaliera "Mater Domini", Catanzaro, Italy
| | | | - Ferdinando De Vita
- Division of Medical Oncology, University of Campania "L. Vanvitelli", Napoli, Italy
| | - Claudio Scavelli
- Medical Oncology Unit, "S. Cuore di Gesù" Hospital, Gallipoli, Italy
| | | | | | - Anna Crispo
- Departmental Unit of Clinical and Experimental Uro-Andrologic Oncology, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Via M. Semmola, 80131, Napoli, Italy
| | - Vittorio Gebbia
- Medical Oncology Unit, La Maddalena Clinic for Cancer, University of Palermo, Palermo, Italy
| | - Antonio Maestri
- Medical Oncology Department, "Santa Maria della Scaletta" Hospital AUSL, Imola, Italy
| | - Luca Galli
- University Hospital of Pisa, Oncology Unit 2, Pisa, Pisa, Italy
| | - Ugo De Giorgi
- Department of Oncology, IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (I.R.S.T.), Meldola, Italy
| | - Roberto Iacovelli
- Medical Oncology, Azienda Ospedaliera Universitaria Integrata, University of Verona, Verona, Italy
| | - Carlo Buonerba
- Department of Clinical Medicine and Surgery, Università degli Studi di Napoli Federico II, Naples, Italy
| | - Giacomo Cartenì
- Division of Oncology, Azienda Ospedaliera di Rilievo Nazionale A. Cardarelli, Naples, Italy
| | - Carmine D'Aniello
- Division of Medical Oncology, AORN Dei Colli "Ospedali Monaldi-Cotugno-CTO", Napoli, Italy
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Flammer J, Kitazawa Y, Bonomi L, Mills B, Fsadni M, Dorigo MT, Shirato S, Journel B, Chavy B, Chevallier B. Influence of Carteolol and Timolol on IOP and Visual Fields in Glaucoma: A Multi-Center, Double-Masked, Prospective Study. Eur J Ophthalmol 2018; 2:169-74. [PMID: 1490088 DOI: 10.1177/112067219200200402] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The influences of Carteolol and Timolol eye drops on intraocular pressure (IOP) and visual fields were compared in a multi-center, double-masked, prospective study. Two-hundred and forty eyes of 120 patients were initially included in the study, and 142 eyes of 72 patients fulfilled all the criteria for final statistical analysis. Both drugs significantly reduced IOP. The visual fields in both treatment groups did not change during one year of treatment. In both groups some patients improved slightly, and others deteriorated slightly. This indicates that locally applied beta-blockers may efficiently stop further progression of visual field defects in cases with increased IOP and early visual field damage. There was no difference between Carteolol and Timolol in this regard. The side effects were minimal, and there were no differences in their frequency or intensity in the two treatment groups.
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Affiliation(s)
- J Flammer
- University Eye Clinic Basel, Switzerland
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14
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Ardizzoni A, Bidoli P, Chiari R, Bonomi L, Turci D, Landi L, Toschi L, De Tursi M, Francini G, Giordano M, Alabiso O, De Censi A, Livi L, Berruti A, Minelli M, Ricevuto E, Illiano A, Puppo G, Delmonte A, Galetta D. MA 02.05 Nivolumab in Advanced Non-Squamous NSCLC Patients with KRAS Mutations: Results from the Italian Expanded Access Program (EAP). J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.454] [Citation(s) in RCA: 2] [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: 11/30/2022]
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Arnoldi E, Bettini A, Bonomi L, Tasca C, Livraghi L, Chirco A, Tondini C. Elderly patients with lung cancer: does clinical practice reflect evidence-based medicine? our four-year experience (2013-2016). Ann Oncol 2017. [DOI: 10.1093/annonc/mdx426.036] [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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Bidoli P, Chiari R, Catino A, Grossi F, Noberasco C, Gelsomino F, Gilli M, Proto C, Parra HS, Migliorino M, Bonomi L, Tassinari D, Frassoldati A, Albanese V, Fadda G, Cognetti F, de galitiis F, Finocchiaro G, Delmonte A. Efficacy and safety data from patients with advanced squamous NSCLC and brain metastases participating in the nivolumab Expanded Access Programme (EAP) in Italy. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw383.28] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [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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Bonomi M, Bonomi L, Sauta M, Bettini A, Squadroni M, Brena F, Cerchiaro E, Ripa C, Salvini P, Beretta G, Tondini C, Ceresoli G. Uncommon epidermal growth factor receptor (EGFR) mutations in non-small cell lung cancer and sensitivity to EGFR tyrosine kinase inhibitors, a two centers experience. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw332.20] [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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Marabese M, Ganzinelli M, Garassino MC, Shepherd FA, Piva S, Caiola E, Macerelli M, Bettini A, Lauricella C, Floriani I, Farina G, Longo F, Bonomi L, Fabbri MA, Veronese S, Marsoni S, Broggini M, Rulli E. KRAS mutations affect prognosis of non-small-cell lung cancer patients treated with first-line platinum containing chemotherapy. Oncotarget 2016; 6:34014-22. [PMID: 26416458 PMCID: PMC4741822 DOI: 10.18632/oncotarget.5607] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [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: 05/04/2015] [Accepted: 08/26/2015] [Indexed: 11/25/2022] Open
Abstract
KRAS mutations seem to indicate a poor outcome in Non-Small-Cell Lung Cancer (NSCLC) but such evidence is still debated. The aim of this planned ancillary study within the TAILOR trial was to assess the prognostic value of KRAS mutations in advanced NSCLC patients treated with platinum-based first-line chemotherapy. Patients (N = 540), enrolled in the study in 52 Italian hospitals, were centrally genotyped twice in two independent laboratories for EGFR and KRAS mutational status. Of these, 247 patients were eligible and included in the present study. The primary endpoint was overall survival (OS) according to KRAS mutational status in patients harboring EGFR wild-type. Sixty (24.3%) out of 247 patients harbored KRAS mutations. Median OS was 14.3 months and 10.6 months in wild-type and mutated KRAS patients, respectively (unadjusted Hazard Ratio [HR]=1.41, 95%Confidence Interval [CI]: 1.03-1.94 P = 0.032; adjusted HR=1.39, 95%CI: 1.00-1.94 P = 0.050). This study, with all consecutive patients genotyped, indicates that the presence of KRAS mutations has a mild negative impact on OS in advanced NSCLC patient treated with a first-line platinum-containing regimen. Trial Registration: clinicaltrials.gov identifier NCT00637910
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Affiliation(s)
- Mirko Marabese
- Oncology Department, IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Monica Ganzinelli
- Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Marina C Garassino
- Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Sheila Piva
- Oncology Department, Ospedale Fatebenefratelli e Oftalmico, Milan, Italy
| | - Elisa Caiola
- Oncology Department, IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Marianna Macerelli
- Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Anna Bettini
- Oncology Department, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - Calogero Lauricella
- Molecular Pathology Unit, Niguarda Cancer Center, Ospedale Niguarda Ca' Granda, Milan, Italy
| | - Irene Floriani
- Oncology Department, IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Gabriella Farina
- Oncology Department, Ospedale Fatebenefratelli e Oftalmico, Milan, Italy
| | - Flavia Longo
- Medical Oncology, Policlinico Umberto I, Rome, Italy
| | - Lucia Bonomi
- Oncology Department, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | | | - Silvio Veronese
- Molecular Pathology Unit, Niguarda Cancer Center, Ospedale Niguarda Ca' Granda, Milan, Italy
| | - Silvia Marsoni
- Clinical Trials Coordination Unit, Institute for Cancer Research and Treatment, IRCCS, Candiolo, Italy
| | - Massimo Broggini
- Oncology Department, IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Eliana Rulli
- Oncology Department, IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
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Benecchi G, Bonomi L, Palleri F, Calabri E, Rossi R, Ceccon G, Ghetti C. Development of an adaptive radiotherapy method using portal imaging and CBCT. Phys Med 2016. [DOI: 10.1016/j.ejmp.2016.01.014] [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: 11/25/2022] Open
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Ghilardi L, Massazza G, Bonomi L, Ciaravino G, Michetti G, Oprandi B, Lucianetti A, Candiago E, Bertuletti C, Gianatti A, Tondini C, Labianca R, Bettini A. Effectiveness of direct egfr mutations research at time of diagnostic biopsy for lung cancer: a single institution outcome research. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv343.49] [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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Bonomi L. Cataracts induced by topical ocular medications. Dev Ophthalmol 2015; 17:196-8. [PMID: 2792523 DOI: 10.1159/000417029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- L Bonomi
- Institute of Ophthalmology, University of Verona, Italy
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Affiliation(s)
- L Bonomi
- Institute of Ophthalmology, University of Verona, Italy
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Carenini BB, Brogliatti B, Spinelli D, Orzatesi N, Gandolfo E, Bonomi L, Brusini P, Guerra R, Salvi G, Fiore P, Balestrazzi E, Boccassini S, Bucci M, Montrone F, Esposito G, Gelso P, Ferreri G. Latanoprost in monotherapy compared with Timolol and Dorzolamide in association as hypotensive agents in primary open-angle glaucoma and ocular hypertension. An open, randomized, multicentric, Italian study. ACTA ACUST UNITED AC 2014. [DOI: 10.1111/j.1600-0420.1999.tb01151.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Bonomi L, Bettini A, Bonacina R, Villa F, Mariani U, Caremoli ER, Tondini C. 3082 Efficacy of a survaillance dental programm on prevention of osteonecrosis of the jaw in cancer patients with bone metastases: a single institution preliminary experience. EJC Suppl 2009. [DOI: 10.1016/s1359-6349(09)70681-0] [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: 11/25/2022] Open
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Mandalà M, Imberti GL, Piazzalunga D, Belfiglio M, Labianca R, Barberis M, Marchesi L, Poletti P, Bonomi L, Novellino L, Di Biagio K, Milesi A, Guerra U, Tondini C. Clinical and histopathological risk factors to predict sentinel lymph node positivity, disease-free and overall survival in clinical stages I-II AJCC skin melanoma: outcome analysis from a single-institution prospectively collected database. Eur J Cancer 2009; 45:2537-45. [PMID: 19553103 DOI: 10.1016/j.ejca.2009.05.034] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2009] [Revised: 05/24/2009] [Accepted: 05/27/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND To investigate if the tumour infiltrating lymphocytes (TILs) are able to predict the sentinel lymph node (SLN) positivity, the disease-free survival (DFS) and overall survival (OS) in clinical stages I-II AJCC primary cutaneous melanoma (PCM). METHODS The study included consecutive patients with PCM, all diagnosed, treated and followed up prospectively. Logistic regression was used to investigate the association between DFS, OS, SLN positivity and Breslow thickness, Clark level, TIL, ulceration, lesion site, gender, regression and age. RESULTS From November 1998 to October 2008, 1251 consecutive patients with PCM were evaluated. Median age was 51 (range 15-96) with 32.2% (N=393) of them older than 60; 44.8% of them were males. Of the whole series, a total of 404 patients with primary vertical growth phase (VGP) melanoma and no clinical evidence of metastatic disease underwent SLN biopsy. Of these, 74 (18.8%) had a positive SLN. In a multivariate analysis, primary melanoma on the extremities versus that on the axial locations (truncal and head/neck) (OR 0.49, 95% CI 0.25-0.98, p 0.04) and TILs (TILs versus no TILs) (OR 0.47, 95%CI 0.25-0.90, p 0.02) were predictive for lower probability of SLN involvement, while thickness (>4mm versus 0-1mm) (OR 24, 19, 95% CI 4.91-119.13, p<.001) was predictive for higher risk of SLN positivity. A multivariate stepwise analysis confirmed these results. The histological status of the SLN was the most significant predictor of DFS and OS. Patients with a negative SLN had a 5-year DFS of 75.9%, compared with 35.2% in patients with a positive SLN (p<.0001) and a 5-year OS of 88.7% versus 42.9%, respectively (p<.0001). CONCLUSIONS Our study demonstrates that the absence of TILs predicts SLN metastasis, in multivariate analysis the SLN positivity predicts DFS and OS.
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Affiliation(s)
- M Mandalà
- Unit of Medical Oncology, Ospedali Riuniti Bergamo, Largo Barozzi 1, Bergamo 24126, Italy.
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Porta C, Bonomi L, Lillaz B, Klersy C, Imarisio I, Paglino C, Rovati B, Danova M, Ferraris E, Mensi M, Rovereto B. Immunological stress in kidney cancer patients undergoing either open nephrectomy or nephron-sparing surgery: an immunophenotypic study of lymphocyte subpopulations and circulating dendritic cells. Oncol Rep 2008; 20:1511-1519. [PMID: 19020735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
Immunosuppression is a characteristic hallmark of renal cell carcinoma (RCC), with several complex immune defects, almost solely at the level of cell-mediated immune function, well evident even in patients at first diagnosis. The main circulating lymphocyte subsets and the total number of circulating dendritic cells were quantified in 47 RCC patients at diagnosis (T0), 12 h (T1), 24 h (T2) and 8 days following either radical nephrectomy or nephron-sparing surgery using flow cytometry. RCC patients presented, at baseline, (T0) a profound state of immunosuppression involving naïve T-cells, memory T-cells, CD16+ NK and total circulating dendritic cells, that worsened after 12 (T1) and 24 h (T2) from surgery, involving the majority of the analysed subsets; after 8 days (T3) from surgical removal of tumor, however, there was a return of all the analyzed parameters to the basal state. In conclusion, surgery causes transient but relevant immune suppression in RCC patients; even though, by day +8, this tends to return to baseline, immunostimulatory therapies could be considered in the peri-operative setting with the aim of reducing immunosuppression and, hopefully, also disease recurrence.
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Affiliation(s)
- Camillo Porta
- Medical Oncology, I.R.C.C.S. San Matteo University Hospital Foundation, I-27100 Pavia, Italy.
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Porta C, Paglino C, Imarisio I, Bonomi L. Uncovering Pandora's vase: the growing problem of new toxicities from novel anticancer agents. The case of sorafenib and sunitinib. Clin Exp Med 2008; 7:127-34. [PMID: 18188524 DOI: 10.1007/s10238-007-0145-8] [Citation(s) in RCA: 123] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2007] [Accepted: 10/31/2007] [Indexed: 01/11/2023]
Abstract
As newer, molecularly targeted, anticancer drugs are entering clinical practice, a wide array of previously unrecognised and ill defined side effects of these drugs are increasingly observed. Sorafenib and sunitinib are two of these novel agents, acting on tumour angiogenesis as well as on other key proliferative pathways; recently approved for the treatment of advanced kidney cancer, they may cause peculiar cutaneous, vascular and mucosal toxicities, including hand-foot skin reaction, skin rash, hypertension and GERD-like oesophagitis/gastritis. In this review, we shall deal with these poorly recognised, but sometimes extremely distressing, toxicities; pathophysiologic mechanisms will be discussed and suggestions for treatment of each toxicity will be proposed, based on the few pieces of evidence available and, especially, on our empirical experience.
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Affiliation(s)
- C Porta
- Medical Oncology, IRCCS San Matteo University Hospital Foundation, Piazzale C. Golgi, I-27100, Pavia, Italy.
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Porta C, Paglino C, Imarisio I, Bonomi L. Cytokine-based immunotherapy for advanced kidney cancer: past results and future perspectives in the era of molecularly targeted agents. ScientificWorldJournal 2007; 7:837-49. [PMID: 17619768 PMCID: PMC5901142 DOI: 10.1100/tsw.2007.154] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Until recently, immunotherapy has been the only therapeutic option available for patients with advanced kidney cancer, even though different choices were often made on the two sides of the Atlantic Ocean. The absence of alternatives made different immunotherapeutic approaches common practice, even with few adequate randomized studies that addressed key questions, such as the best treatment and schedule, and so on. The recent registration of the first two, molecularly targeted, agents Sorafenib and Sunitinib could (and will) render many therapeutic approaches, e.g., single-agent Interferon, obsolete. In this review, we shall cover the past achievements obtained so far with cytokine-based immunotherapy and discuss the present role of immunotherapy in the era of molecularly targeted agents. In particular, specific indications for immunotherapy are emerging (e.g., the use of Interleukin-2 in patients with high CAIX expression), while new trials are ongoing to test immunotherapy in combination with molecularly targeted agents, such as Sorafenib, Sunitinib, or Bevacizumab.
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Affiliation(s)
- Camillo Porta
- Medical Oncology, I.R.C.C.S. San Matteo University Hospital Foundation, Pavia, Italy.
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Porta C, Bonomi L, Lillaz B, Paglino C, Rovati B, Imarisio I, Morbini P, Villa C, Danova M, Mensi M, Rovereto B. Renal cell carcinoma-induced immunosuppression: an immunophenotypic study of lymphocyte subpopulations and circulating dendritic cells. Anticancer Res 2007; 27:165-73. [PMID: 17352228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
BACKGROUND Renal cell carcinoma (RCC)-induced immune dysfunction in patients at first diagnosis was investigated. PATIENTS AND METHODS The main circulating lymphocyte subsets, the total number of circulating and intratumor dendritic cells and the titers of circulating VEGF were quantified in 47 RCC patients, using flow cytometric, immunohistochemical and ELISA assays. RESULTS Despite a significant activation of CD3/HLA-DR+ lymphocytes and of the CD56+ NK subset, RCC patients presented a marked immunosuppression of CD4/CD45RA naïve T-cells, CD4/CD45RO memory T-cells, CD16+ NK-cells, and total circulating dendritic cells, as well as a significant increase of lymphocytes co-expressing the CD4 and CD8 antigens. Finally, CD16+/CD56+ NK and DCs were poorly represented in tumor specimens. CONCLUSION The complex immunological dysfunctions demonstrated involve different levels of immunocompetence and indicate a pattern of major disturbance of the immune system.
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Affiliation(s)
- Camillo Porta
- A. Ferrata" Institute of Internal Medicine and Medical Oncology, I.R.C.C.S. San Matteo University Hospital, Piazzale C. Golgi, I-27100 Pavia, Italy.
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Porta C, Zimatore M, Bonomi L, Imarisio I, Paglino C, Sartore-Bianchi A, Mutti L. Raltitrexed–Oxaliplatin combination chemotherapy is inactive as second-line treatment for malignant pleural mesothelioma patients. Lung Cancer 2005; 48:429-34. [DOI: 10.1016/j.lungcan.2004.11.015] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2004] [Revised: 11/16/2004] [Accepted: 11/23/2004] [Indexed: 01/16/2023]
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Porta C, Imarisio I, De Amici M, Bonomi L, Paglino C, Biscaldi E, Zimatore M, Sartore-Bianchi A, Danova M, Moratti R, Riccardi A. Pro-neoangiogenic cytokines (VEGF and bFGF) and anemia in solid tumor patients. Oncol Rep 2005. [DOI: 10.3892/or.13.4.689] [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: 11/05/2022] Open
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Porta C, Imarisio I, De Amici M, Bonomi L, Paglino C, Biscaldi E, Zimatore M, Sartore-Bianchi A, Danova M, Moratti R, Riccardi A. Pro-neoangiogenic cytokines (VEGF and bFGF) and anemia in solid tumor patients. Oncol Rep 2005; 13:689-95. [PMID: 15756443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023] Open
Abstract
Using a commercial ELISA assay, we evaluated circulating VEGF and bFGF levels in 203 consecutive patients with solid tumors, and sought a correlation between them and with the grade of anemia. Serum VEGF values were within the normal range in 128 patients (63.05%), with a mean value of 675.04 pg/ml (median, 571.00; range, 0-2796.54). The analysis of VEGF values per tumor group did not provide any statistically significant difference. Regarding bFGF, 143 patients (70.44%) had measurable, and thus abnormal, bFGF values. Overall, mean bFGF serum value was 57.14 pg/ml (median, 8.30; range, 0-4334.71), with the highest bFGF levels found in breast carcinoma patients. As expected, a large number of our patients was fairly anemic, mean hemoglobin level being 11.47 g/dl (median, 11.30; range, 7.1-19.20), the lowest titers being observed in prostate carcinoma patients. No statistically significant correlation was found between serum VEGF and hemoglobin values (r=0.004) but a significant negative correlation was seen between serum bFGF and hemoglobin (r=-0.22, p<0.05). Considering the different tumor groups, a statistically significant negative correlation between bFGF and hemoglobin becomes even more apparent in the subgroup of renal carcinoma patients (r=-0.55, p<0.05). In conclusion, our results demonstrate that there is a statistically significant correlation between systemic hypoxia (evaluated in terms of hemoglobin levels) and circulating bFGF values, but not VEGF; this correlation may lead to therapeutic interventions.
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Affiliation(s)
- Camillo Porta
- Medical Oncology, I.R.C.C.S. San Matteo University Hospital, Piazzale C. Golgi, I-27100 Pavia, Italy.
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Avila RE, Samar ME, Ferraris R, Bonomi L. [Ultrastructural behavior of interstitial cells innervation during the differentiation of the chick embryo ovary cultured with 17-beta-estradiol]. Rev Fac Cien Med Univ Nac Cordoba 2003; 58:49-55. [PMID: 12934260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
In a previous work we demonstrated the relationship between nerve fibers and nerve endings and interstitial cells (estrogen-producing cells) from the atrophic right ovary and the medulla in the left functioning ovary during embryogenesis in the chick, in ovo. Besides, the local production of neurotrophins by steroidogenic cells is probably involved in the control of ovarian innervation. The objective of the present study was to analyze ultrastructurally the innervation during the differentiation of chick ovary cultured with 17-beta-estradiol. Explants of right and left ovaries from seven to nineteen days in ovo development were cultured separately for 4 days in MEM (controls) or in the presence of 17-beta-estradiol (problems). In controls the electron microscopic examination of the innervation explants from chick embryo ovaries revealed that the interstitial cells are well innervated. Nerve fibres and nerve endings were observed in close contact with steroid-producing cells, a similar pattern of innervation that those of the fifteen days ovaries in ovo development. Problems cultured from seven days showed nerve fibres and nerve endings at difference to controls. These results in vitro suggest that innervation of the ovaries is controlled by indirect mechanism via the hypothalamic-pituitary system and local production factors. More experiments are necessary to confirm this results.
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Affiliation(s)
- R E Avila
- Facultad de Ciencias Médicas, U.N.C., IIa. Cátedra de Biología Celular, Histología y Embriología.
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Porta C, Paglino C, Imarisio I, Bonomi L, Biscaldi E, Natalizi A, Zimatore M, Danova M, Riccardi A. 869 Gemcitabine (GEM) and oxaliplatin (I-OHP) to treat immunotherapy-resistant advanced renal cell carcinoma (ARCC) patients (pts.): preliminary results of a single institution phase II study. EJC Suppl 2003. [DOI: 10.1016/s1359-6349(03)90895-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Abstract
BACKGROUND AND OBJECTIVE Patients with glaucoma refractory to medical or surgical treatment are difficult to treat. The aim of this study was to evaluate the effect of contact transscleral diode laser cyclophotocoagulation (DLPC) on these patients' intra-ocular pressure (IOP) and visual acuity. PATIENTS AND METHODS 37 eyes of 36 patients who suffered from refractory glaucoma and who had undergone DLPC, were followed at the Eye Clinic of Verona University for an average of 14 +/- 4 months. The average age was 54 +/- 26 years. IOP, visual acuity and ocular complications were analysed. RESULTS A total of 71 treatments were given. More than 1 treatment was given in 22 eyes (59%). The mean pretreatment IOP was 33.1 +/- 3.3 mm Hg. At the last follow-up, the mean IOP was 21 +/- 1.6 mm Hg. Mean total medications were reduced from 4.4 +/- 0.5 to 2.4 +/- 0.3. No serious complications occurred in 71 treatments. Visual acuity remained stable in 25 eyes (67.5%), improved in 6 eyes (16.2%) and decreased in 6 eyes (16.2%). CONCLUSIONS DLPC is effective in lowering IOP in eyes with refractory glaucoma. It also serves to reduce the number of antiglaucoma medications. This procedure is relatively safe. Nevertheless, multiple DLPC applications may be needed.
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Affiliation(s)
- V Pucci
- Department of Neurologic Science and Vision, Eye Clinic, University of Verona, Italy.
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Marchini G, Babighian S, Tosi R, Perfetti S, Bonomi L. Effects of 2% ibopamine on pupil, refraction, anterior segment anatomy and intraocular pressure. J Ocul Pharmacol Ther 2001; 17:215-23. [PMID: 11436942 DOI: 10.1089/108076801750295254] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The aim of the study was to determine the effects of a dopaminergic drug, 2% ibopamine, on the pupil, intraocular pressure and other ocular and ultrasound biometric variables. Thirty healthy subjects and 15 patients with primary open-angle glaucoma, aged from 40 to 78 years (mean age: 59.2 +/- 11), were included in two prospective open controlled trials. In the first, the mydriatic effect of 2% ibopamine and its inhibition and reversibility were evaluated in 15 healthy subjects using the alpha1-adrenergic drug, 0.5% dapiprazole. In the second, refraction, visual acuity, pupil diameter, intraocular pressure and 5 A-scan ultrasound biometric variables were evaluated in 15 healthy subjects and in 15 glaucoma patients. As early as forty min after administration of 2% ibopamine, a marked mydriatic effect (7.3 vs 3.9 mm; P < 0.0001), which was completely inhibited or reversed by 0.5% dapiprazole, was detected. The drug induced no changes in refraction, visual acuity or A-scan ultrasound biometric variables in any of the subjects examined. In healthy subjects, the intraocular pressure values were not changed to a statistically significant extent (13.8 vs 14.8 mm Hg; P = 0.668), whereas a slight, though significant, hypertensive effect (24 vs 22.2 mm Hg; P = 0.002) was observed in the glaucoma patients. The study confirms the intense mydriatic effect of 2% ibopamine with no changes in refraction, visual acuity or A-scan ultrasound biometric variables. The drug has no effect on intraocular pressure in healthy subjects, but induces a significant hypertensive effect in patients with initial glaucoma. This characteristic could be used for early diagnosis of primary open-angle glaucoma.
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Affiliation(s)
- G Marchini
- Department of Ophthalmology, University of Verona, Italy.
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Bonomi L, Babighian S, Bonadimani M, Perfetti S, Brusini P, Bernardi P, Coser S, De Concini M, Cumer P, Pedrotti M, Totolo G, Carli M. Correlation between glaucoma and vascular factors, and circumstances leading to the diagnosis of glaucoma. Acta Ophthalmol Scand Suppl 2001:34-5. [PMID: 11235524 DOI: 10.1111/j.1600-0420.2000.tb01091.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Marchini G, Marraffa M, Brunelli C, Morbio R, Bonomi L. Ultrasound biomicroscopy and intraocular-pressure-lowering mechanisms of deep sclerectomy with reticulated hyaluronic acid implant. J Cataract Refract Surg 2001; 27:507-17. [PMID: 11311615 DOI: 10.1016/s0886-3350(00)00857-9] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE To evaluate the anatomic characteristics and intraocular pressure (IOP) lowering mechanisms of deep sclerectomy with reticulated hyaluronic acid implant (DS with RHAI) using ultrasound biomicroscopy (UBM). SETTING Eye Clinic, Department of Neurological and Vision Sciences, University of Verona, Verona, Italy. METHODS Thirty patients with primary open-angle glaucoma not controlled by medical therapy had DS with RHAI in 1 eye. A complete ocular examination and UBM study were performed 1, 3, 6, and 12 months postoperatively and thereafter at 6 month intervals. Eleven parameters were evaluated, the most important of which were IOP, surgical success in lowering IOP to 21 mm Hg or less with or without additional medical therapy, UBM appearance of the site of DS with RHAI, size of the decompression space, presence of a filtering bleb and supraciliary hypoechoic area, and scleral reflectivity around the decompression space. RESULTS After a mean follow-up of 11.4 months +/- 4.7 (SD), the mean percentage reduction in IOP compared to preoperatively was 38% (from 26 +/- 4.5 mm Hg to 16.2 +/- 3.8 mm Hg; P =.0001). Twenty-four patients (80%) had an IOP less than 21 mm Hg; however, 7 of these eyes (23%) required additional IOP-lowering medical therapy. The operation failed in 6 patients (20%) despite additional therapy. Ultrasound biomicroscopy revealed a reduction in the size of the decompression space from 6 months postoperatively and its disappearance in 2 cases. The difference in size at the last follow-up and at 1 month postoperatively (maximum length 2.41 +/- 1.02 mm versus 3.53 +/- 0.51 mm) was significant (P =.0001). At the last examination, a filtering bleb was present in 18 patients (60%), a supraciliary hypoechoic area in 18 (60%), and hyporeflectivity of the scleral tissue around the decompression space in 14 (47%). These 3 UBM characteristics were detected singly and in various combinations. The simultaneous presence of all 3 characteristics in the same eye correlated significantly with a higher surgical success rate (P =.004). CONCLUSIONS Ultrasound biomicroscopy showed that filtering bleb formation was frequent in eyes having DS with RHAI but that it was not the only surgically induced IOP-lowering mechanism. Increased uveoscleral and transscleral filtration may be equally important.
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Affiliation(s)
- G Marchini
- The Eye Clinic, Department of Neurological and Vision Sciences, University of Verona, Verona, Italy.
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Bonomi L, Marchini G, Marraffa M, Morbio R. The relationship between intraocular pressure and glaucoma in a defined population. Data from the Egna-Neumarkt Glaucoma Study. Ophthalmologica 2001; 215:34-8. [PMID: 11125267 DOI: 10.1159/000050823] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
PURPOSE To provide data on the prevalence of ocular hypertension and glaucoma and on the diagnostic validity of tonometry. METHODS In this cross-sectional, population-based study, 4,927 subjects over 40 years of age were examined. Each subject underwent a complete ocular examination as part of the Egna-Neumarkt Glaucoma Study. These examinations were carried out by trained, quality-controlled ophthalmologists, according to a predetermined standard protocol that included a medical interview, applanation tonometry, computerized perimetry, optic nerve head examination and other ocular measurements. The following data were recorded: mean IOP, prevalence of ocular hypertension, primary open-angle glaucoma and normal tension glaucoma. Sensitivity, specificity and the predictive value of the tonometric test, as well as the distribution of IOP in the different groups were also determined. RESULTS The overall prevalence of ocular hypertension, hypertensive primary open-angle glaucoma and normal tension glaucoma corresponded to 2.1, 1.4 and 0.6%, respectively. Other types of glaucoma accounted for a further 0.9%. The sensitivity and specificity of the tonometric test in recognizing glaucoma (cut-off between 21 and 22 mm Hg) were, respectively, 80.1 and 97.8%. The predictive values of the positivity and negativity of the test were 52.1 and 99.4%, respectively. CONCLUSIONS The prevalence of ocular hypertension and glaucoma was similar to that found in several recent epidemiological studies. Tonometry alone is obviously not sufficient to ascertain or to exclude the presence of glaucoma; its diagnostic validity however is high and should never be underestimated. An elevated IOP is the main risk factor for glaucoma, with the degree of risk increasing as the level of IOP increases.
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Affiliation(s)
- L Bonomi
- Clinica Oculistica, Università degli studi di Verona, Verona, Italy.
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Abstract
OBJECTIVE To assess the impact of vascular risk factors on the prevalence of primary open angle glaucoma. DESIGN Population-based cross-sectional study. PARTICIPANTS Four thousand two hundred ninety-seven patients more than 40 years of age underwent a complete ocular examination in the context of the Egna-Neumarkt Glaucoma Study. INTERVENTION Ocular examinations were performed by trained, quality-controlled ophthalmologists according to a predefined standardized protocol including medical interview, blood pressure reading, applanation tonometry, computerized perimetry, and optic nerve head examination. MAIN OUTCOME MEASURES Prevalences of ocular hypertension, primary open-angle glaucoma, normal-tension glaucoma, and other types of glaucoma were determined. Correlation coefficients were calculated for the association between systemic blood pressure and age-adjusted intraocular pressure (IOP) and between age and both intraocular and systemic blood pressures. Odds ratios were computed to assess the risk of primary open-angle glaucoma and normal-tension glaucoma in relation to systemic hypertension or antihypertensive medication, blood pressure levels, diastolic perfusion pressure, and a number of other cardiovascular risk factors. RESULTS A positive correlation was found between systemic blood pressure and IOP, and an association was found between diagnosis of primary open-angle glaucoma and systemic hypertension. Lower diastolic perfusion pressure is associated with a marked, progressive increase in the frequency of hypertensive glaucoma. No relationship was found between systemic diseases of vascular origin and glaucoma. CONCLUSIONS Our data are in line with those reported in other recent epidemiologic studies and show that reduced diastolic perfusion pressure is an important risk factor for primary open-angle glaucoma.
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Affiliation(s)
- L Bonomi
- Clinica Oculistica, Universita degli Studi di Verona, Verona, Italy
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De Natale R, Marraffa M, Morbio R, Tomazzoli L, Bonomi L. Visual field defects and normal nerve fiber layer: may they coexist in primary open-angle glaucoma? Ophthalmologica 2000; 214:119-21. [PMID: 10720915 DOI: 10.1159/000027479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The retinal nerve fiber layer (RNFL) is the anatomical structure most sensitive to glaucoma injury. Before a functional loss such as a visual field defect is displayed, a large number of nerve fibers can be damaged. However, there are glaucoma patients in which an apparently normal RNFL coexists with evident visual field defects. A total of 54 eyes affected with primary open-angle glaucoma were studied. Visual field was examined with the Humphrey Field Analyzer (Zeiss) using program 30-2. The Nerve Fiber Analyzer II (Laser Diagnostic Technologies) was used to study the RNFL of these patients. Mean deviation of the visual field ranged from 6 to 31 dB in all eyes that were examined. The average thickness of the RNFL ranged from 20 to 90 microm. According to our previous experience 75 microm was fixed as the cutoff between normal and pathological values of RNFL thickness. We identified 5 eyes with a RNFL thickness over 75 microm and a visual field with a mean deviation over 6 dB; 9% of the studied eyes were found to have a visual field defect with no changes in RNFL. We conclude that not all subjects have the same number of fibers at birth and that it is therefore possible to underestimate the RNFL changes. Our study illustrates that the concept of normal and altered has to be considered as a relative one for all the aspects characterizing the glaucomatous disease.
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Angius A, Spinelli P, Ghilotti G, Casu G, Sole G, Loi A, Totaro A, Zelante L, Gasparini P, Orzalesi N, Pirastu M, Bonomi L. Myocilin Gln368stop mutation and advanced age as risk factors for late-onset primary open-angle glaucoma. Arch Ophthalmol 2000; 118:674-9. [PMID: 10815160 DOI: 10.1001/archopht.118.5.674] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Juvenile open-angle glaucoma has been found to be associated with molecular defects in the myocilin (MYOC) gene. Most of the defects are missense mutations located in the third exon. The Gln368stop mutation has recently been found in several cases of late-onset primary open-angle glaucoma (POAG). OBJECTIVE To study the effect of glaucoma risk in a relatively homogeneous genetic population. METHODS A clinical study was performed in all living members of a 5-generation family. DNA analysis was performed for studying association with genetic markers and identifying the mutation. RESULTS We identified the Gln368stop molecular defect in 19 patients with POAG, 5 patients with ocular hypertension, and 22 healthy carriers. We compared affected and unaffected carriers based on age at onset and last examination, respectively. Besides the presence of 3 young patients with POAG (<40 years old), the number of glaucomatous patients in the advanced age group increased. CONCLUSIONS The penetrance of glaucoma increases with age in Gln368stop carriers, but some remain unaffected at advanced age and others are affected at an early age. This suggests that additional risk factors are operating within this family, which may be identified by a genome-wide linkage search in this large pedigree. CLINICAL RELEVANCE The myocilin Gln368stop mutation shows a good genotype-phenotype correlation and should be investigated in all familiar cases of chronic POAG. This may be important for early diagnosis and periodical checkups of presymptomatic individuals belonging to these families.
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Affiliation(s)
- A Angius
- Istituto di Genetica Molecolare CNR, Alghero, Italy
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Bonomi L, Marchini G, Marraffa M, Bernardi P, De Franco I, Perfetti S, Varotto A. Epidemiology of angle-closure glaucoma: prevalence, clinical types, and association with peripheral anterior chamber depth in the Egna-Neumarket Glaucoma Study. Ophthalmology 2000; 107:998-1003. [PMID: 10811096 DOI: 10.1016/s0161-6420(00)00022-1] [Citation(s) in RCA: 89] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE To assess the prevalence of primary angle-closure glaucoma (PACG), the frequency of its different clinical presentations, and its association with peripheral anterior chamber depth in a defined population in Northern Italy. DESIGN Cross-sectional epidemiologic study in a defined population. PARTICIPANTS All subjects resident in the Egna-Neumarkt area of the South Tyrol Region (Northern Italy) and more than 40 years of age were invited to undergo an ophthalmologic examination. INTERVENTION After the screening examination, subjects with suspected glaucoma were re-examined at the screening center to confirm the diagnosis. All cases that still proved suspect after the second examination underwent a third phase of investigations and were classified as healthy or as definitely glaucomatous. Each subject was examined according to a standard protocol, including medical history interview, refraction and visual acuity determination, ocular biomicroscopy, evaluation of peripheral anterior chamber depth by means of the Van Herick method, applanation tonometry, optic disc evaluation, and computerized perimetry. Gonioscopy was not performed during initial screening but only in all selected patients in the second and third phases of investigations. The diagnosis of PACG was made on the basis of the concomitant presence of at least two of the following criteria: intraocular pressure > or = 22 mmHg, glaucomatous optic disc abnormalities, glaucomatous visual field defects. In addition, biomicroscopic or gonioscopic evidence of angle closure was also necessary. MAIN OUTCOME MEASURES Percentage distribution of peripheral anterior chamber depths, prevalence of angle-closure glaucoma, and frequency of the different PACG clinical presentations. RESULTS Four thousand two hundred ninety-seven subjects were examined (73.9% overall participation rate). The peripheral depth of the anterior chamber according to the Van Herick method was grade 2 in 14.7%, grade 1 in 2.5%, and grade 0 in 0.3% of the population. The overall prevalence of angle-closure glaucoma was 0.6% (26 cases). Five of these were cases of previous acute attacks resolved by therapy, three were cases of chronic angle-closure after acute attacks, three were intermittent angle-closure glaucomas, and 15 were chronic angle-closure cases. CONCLUSIONS Occludable angles were more frequent than in other white populations previously studied. The prevalence of PACG is not as low as is usually believed; this type of glaucoma accounts for more than a quarter of all glaucomas found in the Egna-Neumarkt population. The most frequent clinical presentation is chronic angle-closure glaucoma.
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Affiliation(s)
- L Bonomi
- Clinica Oculistica, Università degli Studi di Verona, Italy
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Abstract
BACKGROUND This study was carried out to determine the effect of an acute attack of angle-closure glaucoma on the visual field. METHODS A total of 53 eyes were examined 36-48 h after remission of an acute glaucoma attack by means of computerised perimetry (Humphrey 630 perimeter, 30-2 program). Perimetry was repeated after at least 1 month in 22 eyes. RESULTS Perimetric defects, varying greatly in severity and primarily of the generalised type or concerning at least wide sectors of the field, were detected in 45 (85%) of 53 cases. The visual field was normal in the remaining 8 patients (15%). The upper nasal quadrants were the most frequently affected and the degree of eccentricity was most frequently involved within the 9 degrees -21 degrees area. In 7 of the 22 cases in which perimetry was repeated after 1 month, complete normalisation was noted in the visual field. CONCLUSIONS An isolated attack of acute glaucoma produces in most cases a perimetric defect of generalised or mixed type. This may be reversible. The most affected zones were the upper half of the visual field and the 9 degrees -21 degrees area.
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Affiliation(s)
- L Bonomi
- Ospedale di Borgo Trento, Clinica Oculistica, Università degli Studi di Verona, Piazzale Stefani 1, I-37126 Verona, Italy
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Abstract
The aim of the study was to evaluate the effect of an alpha2-adrenergic agonist, 0.2% brimonidine, on a number of echobiometry and ultrasound biomicroscopy ocular parameters. Ten healthy subjects ranging in age from 20 to 40 years (mean age 29+/-3.39) were recruited into this prospective open-label trial. After instillation of 0.2% brimonidine eye drops, the following parameters were assessed: refraction, visual acuity, pupil diameter, intraocular pressure, five A-scan echobiometric parameters and 15 ultrasound biomicroscopy parameters. As early as the first hour after administration of the drug, a marked ocular hypotensive effect was detected associated with a miotic effect, without any refractive or visual acuity alterations. The A-scan echobiometry parameters were unchanged, while, as far as the ultrasound biomicroscopy variables were concerned, we observed an increase in iris-lens contact distance and a reduction in iris root thickness with a resulting increase in posterior chamber depth and in iris-ciliary process distances. No changes were observed in either the anterior chamber or the anterior iris profile. Brimonidine 0.2% proved to be an ocular hypotensive agent which is also endowed with a mild miotic effect, without giving rise to refractive or visual acuity alterations. The drug does not alter the thickness and position of the lens and does not facilitate pupil block; it reduces the iris thickness with an increase in posterior chamber depth and in iris-ciliary process distance but with no changes in anterior chamber depth or chamber angle width.
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Affiliation(s)
- G Marchini
- Department of Ophthalmology, University of Verona, Italy
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Gallenga PE, Lobefalo L, Colangelo L, Della Loggia G, Orzalesi N, Velati P, Bujtar E, Ponte F, Damiani S, Bucci MG, Bonini S, Curatola MR, Palma LA, Bonomi L, Tomazzoli Gerosa L, Pagliarusco A, Milan E, Jauch A. Topical lomefloxacin 0.3% twice daily versus tobramycin 0.3% in acute bacterial conjunctivitis: A multicenter double-blind phase III study. Ophthalmologica 1999; 213:250-7. [PMID: 10420109 DOI: 10.1159/000027430] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
AIMS/BACKGROUND To evaluate in a double-masked comparative, prospective, randomized multicenter trial the efficacy of lomefloxacin 0.3% eye drops twice daily and of tobramycin eye drops 4 times daily in patients with acute bacterial conjunctivitis. METHODS Ninety-nine subjects were enrolled: 50 were treated with lomefloxacin 0.3% eye drops twice daily and 49 with tobramycin 0.3% eye drops 4 times daily. In all patients, conjunctival swabbing and assessment of objective signs and of subjective symptoms were performed. RESULTS There was no statistical difference for any individual sign or symptom or for the sum score of either key or other signs and symptoms at any of the examination days. The sum score of both key and other signs and symptoms decreased in both groups at day 3-4 as compared to baseline values (p < 0.0001). The decrease in both these scores continued significantly from day 3-4 to day 7-8 (p < 0.05) and was similar in the two treatment groups (p > 0.4). The lowest resistance rate was seen in lomefloxacin (3.5%) and in neomycin (7.0%), while tobramycin showed resistance in 10 out of 88 resistance strains (11.4%). CONCLUSION Both lomefloxacin 0.3% twice daily and tobramycin 0.3% administered 4 times daily were well tolerated and showed a high degree of clinical and microbiological efficacy in the treatment of acute bacterial conjunctivitis. Lomefloxacin caused less resistance than other antibiotics evaluated.
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Affiliation(s)
- P E Gallenga
- Institute of Ophthalmology, University 'G. D'Annunzio', Chieti, Italy
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Marraffa M, Perfetti S, Morbio R, Bonomi L. The nerve fibre layer in ocular hypertension. Preliminary results. Acta Ophthalmol Scand Suppl 1999:29-30. [PMID: 9972334 DOI: 10.1111/j.1600-0420.1998.tb00872.x] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
A group of healthy subjects (IOP < 22 mmHg) and a simple ocular hypertension group (IOP > or = 22 mmHg) were examined with a view to checking if there were any differences between their nerve fibre layers. Results indicate thinner fibres in the ocular hypertensives significantly correlative with pressure increase. Among the two groups, some corresponding fibre thicknesses were found.
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Affiliation(s)
- M Marraffa
- Department of Neurological Science and Vision, University of Verona
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Abstract
A questionnaire was prepared and given to 332 subjects who passed through our Institute for Glaucoma with the aim of evaluating their quality of life. The diagnosis of glaucoma is associated with a diminished quality of life in a considerable percentage of the interviewed subjects. The patients are troubled most of all by the inconvenience of the treatments and the fear of visual compromission. Mitotic therapies, polytherapies and systemic therapies are the less agreeable of them. Of the therapy in itself, the most disagreeable aspects are the frequency and timetable of the medications. No quality of life differences were mentioned by surgically treated patients nor those on solely pharmacological treatment.
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