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Rimini M, Masi G, Lonardi S, Nichetti F, Pressiani T, Lavacchi D, Jessica L, Giordano G, Scartozzi M, Tamburini E, Pastorino A, Rapposelli IG, Daniele B, Martinelli E, Garajova I, Aprile G, Schirripa M, Formica V, Salani F, Winchler C, Bergamo F, Balsano R, Gusmaroli E, Lorenzo A, Landriscina M, Pretta A, Toma I, Pirrone C, Diana A, Leone F, Brunetti O, Brandi G, Garattini SK, Satolli MA, Rossari F, Fornaro L, Niger M, Zanuso V, De Rosa A, Ratti F, Aldrighetti L, De Braud F, Foti S, Rizzato MD, Vivaldi C, Stefano C, Rimassa L, Antonuzzo L, Casadei-Gardini A. Durvalumab Plus Gemcitabine and Cisplatin Versus Gemcitabine and Cisplatin in Biliary Tract Cancer: a Real-World Retrospective, Multicenter Study. Target Oncol 2024:10.1007/s11523-024-01060-1. [PMID: 38691295 DOI: 10.1007/s11523-024-01060-1] [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] [Accepted: 04/02/2024] [Indexed: 05/03/2024]
Abstract
BACKGROUND The TOPAZ-1 phase III trial reported a survival benefit with the anti-programmed cell death ligand 1 (anti-PD-L1) durvalumab in combination with gemcitabine and cisplatin in patients with advanced biliary tract cancer (BTC). OBJECTIVE The present study investigated for the first time the impact on survival of adding durvalumab to cisplatin/gemcitabine compared with cisplatin/gemcitabine in a real-world setting. PATIENTS AND METHODS The analyzed population included patients with unresectable, locally advanced, or metastatic BTC treated with durvalumab in combination with cisplatin/gemcitabine or with cisplatin/gemcitabine alone. The impact of adding durvalumab to chemotherapy in terms of overall survival (OS) and progression free survival (PFS) was investigated with univariate and multivariate analysis. RESULTS Overall, 563 patients were included in the analysis: 213 received cisplatin/gemcitabine alone, 350 received cisplatin/gemcitabine plus durvalumab. At the univariate analysis, the addition of durvalumab was found to have an impact on survival, with a median OS of 14.8 months versus 11.2 months [hazard ratio (HR) 0.63, 95% confidence interval (CI) 0.50-0.80, p = 0.0002] in patients who received cisplatin/gemcitabine plus durvalumab compared to those who received cisplatin/gemcitabine alone. At the univariate analysis for PFS, the addition of durvalumab to cisplatin/gemcitabine demonstrated a survival impact, with a median PFS of 8.3 months and 6.0 months (HR 0.57, 95% CI 0.47-0.70, p < 0.0001) in patients who received cisplatin/gemcitabine plus durvalumab and cisplatin/gemcitabine alone, respectively. The multivariate analysis confirmed that adding durvalumab to cisplatin/gemcitabine is an independent prognostic factor for OS and PFS, with patients > 70 years old and those affected by locally advanced disease experiencing the highest survival benefit. Finally, an exploratory analysis of prognostic factors was performed in the cohort of patients who received durvalumab: neutrophil-lymphocyte ratio (NLR) and disease stage were to be independent prognostic factors in terms of OS. The interaction test highlighted NLR ≤ 3, Eastern Cooperative Oncology Group Performance Status (ECOG PS) = 0, and locally advanced disease as positive predictive factors for OS on cisplatin/gemcitabine plus durvalumab. CONCLUSION In line with the results of the TOPAZ-1 trial, adding durvalumab to cisplatin/gemcitabine has been confirmed to confer a survival benefit in terms of OS and PFS in a real-world setting of patients with advanced BTC.
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Affiliation(s)
- Margherita Rimini
- Department of Oncology, IRCCS San Raffaele Scientific Institute Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Gianluca Masi
- Division of Medical Oncology, Department of Translational Research and New Technologies in Medicine and Surgery, Pisa University Hospital, Pisa, Italy
| | - Sara Lonardi
- Dept of Oncology, Veneto Institute of Oncology IOV-IRCCS, Padova, Italy
| | - Federico Nichetti
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, ENETS Center of Excellence, Via Venezian 1, 20133, Milan, Italy
- Computational Oncology, Molecular Diagnostics Program, National Center for Tumor Diseases (NCT) and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Tiziana Pressiani
- Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Daniele Lavacchi
- Clinical Oncology Unit, Careggi University Hospital, 50134, Florence, Italy
| | - Lucchetti Jessica
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Roma, Italy
| | - Guido Giordano
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Mario Scartozzi
- Medical Oncology, University and University Hospital, Cagliari, Italy
| | - Emiliano Tamburini
- Department of Oncology and Palliative Care, Cardinale G Panico, Tricase City Hospital, Tricase, Italy
| | | | - Ilario Giovanni Rapposelli
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Bruno Daniele
- Medical Oncology Unit, Ospedale del Mare, Napoli, Italy
| | - Erika Martinelli
- Medical Oncology Unit, Department of Precision Medicine, Università Degli Studi Della Campania "Luigi Vanvitelli", Naples, Italy
| | - Ingrid Garajova
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Giuseppe Aprile
- Department of Oncology, San Bortolo General Hospital, Vicenza, Italy
| | - Marta Schirripa
- Medical Oncology Unit, Department of Oncology and Hematology, Belcolle Hospital, Viterbo, Italy
| | - Vincenzo Formica
- Medical Oncology Unit, Department of Systems Medicine, Tor Vergata University Hospital, Rome, Italy
| | - Francesca Salani
- Division of Medical Oncology, Department of Translational Research and New Technologies in Medicine and Surgery, Pisa University Hospital, Pisa, Italy
| | - Costanza Winchler
- Clinical Oncology Unit, Careggi University Hospital, 50134, Florence, Italy
| | - Francesca Bergamo
- Dept of Oncology, Veneto Institute of Oncology IOV-IRCCS, Padova, Italy
| | - Rita Balsano
- Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Medical Oncology Unit, Department of Systems Medicine, Tor Vergata University Hospital, Rome, Italy
| | - Eleonora Gusmaroli
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, ENETS Center of Excellence, Via Venezian 1, 20133, Milan, Italy
| | - Angotti Lorenzo
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Roma, Italy
| | - Matteo Landriscina
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Andrea Pretta
- Medical Oncology, University and University Hospital, Cagliari, Italy
| | - Ilaria Toma
- Department of Oncology and Palliative Care, Cardinale G Panico, Tricase City Hospital, Tricase, Italy
| | - Chiara Pirrone
- Medical Oncology Unit 1, Ospedale Policlinico San Martino, IRCCS, Genoa, Italy
| | - Anna Diana
- Medical Oncology Unit, Ospedale del Mare, Napoli, Italy
| | - Francesco Leone
- Division of Medical Oncology, ASL BI, Nuovo Ospedale degli Infermi, Ponderano, BI, Italy
| | - Oronzo Brunetti
- Istituto Tumori "Giovanni Paolo II" of Bari, IRCCS, Bari, Italy
| | - Giovanni Brandi
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138, Bologna, Italy
| | - Silvio Ken Garattini
- Department of Oncology, Academic Hospital of Udine ASUFC, Piazzale Santa Maria della Misericordia 15, 33100, Udine, UD, Italy
| | - Maria Antonietta Satolli
- Division of Medical Oncology 1, Centro Oncologico Ematologico Subalpino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Federico Rossari
- Department of Oncology, IRCCS San Raffaele Scientific Institute Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Lorenzo Fornaro
- Division of Medical Oncology, Department of Translational Research and New Technologies in Medicine and Surgery, Pisa University Hospital, Pisa, Italy
| | - Monica Niger
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, ENETS Center of Excellence, Via Venezian 1, 20133, Milan, Italy
| | - Valentina Zanuso
- Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Antonio De Rosa
- Dept of Oncology, Veneto Institute of Oncology IOV-IRCCS, Padova, Italy
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, ENETS Center of Excellence, Via Venezian 1, 20133, Milan, Italy
- Computational Oncology, Molecular Diagnostics Program, National Center for Tumor Diseases (NCT) and German Cancer Research Center (DKFZ), Heidelberg, Germany
- Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Clinical Oncology Unit, Careggi University Hospital, 50134, Florence, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Roma, Italy
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
- Medical Oncology, University and University Hospital, Cagliari, Italy
- Department of Oncology and Palliative Care, Cardinale G Panico, Tricase City Hospital, Tricase, Italy
- Medical Oncology Unit 1, Ospedale Policlinico San Martino, IRCCS, Genoa, Italy
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
- Medical Oncology Unit, Ospedale del Mare, Napoli, Italy
- Medical Oncology Unit, Department of Precision Medicine, Università Degli Studi Della Campania "Luigi Vanvitelli", Naples, Italy
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
- Department of Oncology, San Bortolo General Hospital, Vicenza, Italy
- Medical Oncology Unit, Department of Oncology and Hematology, Belcolle Hospital, Viterbo, Italy
- Medical Oncology Unit, Department of Systems Medicine, Tor Vergata University Hospital, Rome, Italy
- Division of Medical Oncology, ASL BI, Nuovo Ospedale degli Infermi, Ponderano, BI, Italy
- Istituto Tumori "Giovanni Paolo II" of Bari, IRCCS, Bari, Italy
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138, Bologna, Italy
- Department of Oncology, Academic Hospital of Udine ASUFC, Piazzale Santa Maria della Misericordia 15, 33100, Udine, UD, Italy
- Division of Medical Oncology 1, Centro Oncologico Ematologico Subalpino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Department of Surgery, oncology and gastroenterology of Padua, Padua, Italy
| | - Francesca Ratti
- Hepatobiliary Surgery Division, IRCCS Ospedale San Raffaele, Milan, Italy
| | | | - Filippo De Braud
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, ENETS Center of Excellence, Via Venezian 1, 20133, Milan, Italy
- Clinical Oncology Unit, Careggi University Hospital, 50134, Florence, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Roma, Italy
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
- Medical Oncology, University and University Hospital, Cagliari, Italy
- Department of Oncology and Palliative Care, Cardinale G Panico, Tricase City Hospital, Tricase, Italy
- Medical Oncology Unit 1, Ospedale Policlinico San Martino, IRCCS, Genoa, Italy
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
- Medical Oncology Unit, Ospedale del Mare, Napoli, Italy
- Medical Oncology Unit, Department of Precision Medicine, Università Degli Studi Della Campania "Luigi Vanvitelli", Naples, Italy
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
- Department of Oncology, San Bortolo General Hospital, Vicenza, Italy
- Medical Oncology Unit, Department of Oncology and Hematology, Belcolle Hospital, Viterbo, Italy
- Medical Oncology Unit, Department of Systems Medicine, Tor Vergata University Hospital, Rome, Italy
- Division of Medical Oncology, ASL BI, Nuovo Ospedale degli Infermi, Ponderano, BI, Italy
- Istituto Tumori "Giovanni Paolo II" of Bari, IRCCS, Bari, Italy
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138, Bologna, Italy
- Department of Oncology, Academic Hospital of Udine ASUFC, Piazzale Santa Maria della Misericordia 15, 33100, Udine, UD, Italy
- Division of Medical Oncology 1, Centro Oncologico Ematologico Subalpino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Department of Surgery, oncology and gastroenterology of Padua, Padua, Italy
- Hepatobiliary Surgery Division, IRCCS Ospedale San Raffaele, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Silvia Foti
- Department of Oncology, IRCCS San Raffaele Scientific Institute Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | | | - Caterina Vivaldi
- Division of Medical Oncology, Department of Translational Research and New Technologies in Medicine and Surgery, Pisa University Hospital, Pisa, Italy
| | - Cascinu Stefano
- Department of Oncology, IRCCS San Raffaele Scientific Institute Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Lorenza Rimassa
- Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Lorenzo Antonuzzo
- Clinical Oncology Unit, Careggi University Hospital, 50134, Florence, Italy
| | - Andrea Casadei-Gardini
- Department of Oncology, IRCCS San Raffaele Scientific Institute Hospital, Vita-Salute San Raffaele University, Milan, Italy.
- Department of Medical Oncology, IRCCS San Raffaele Hospital, Via Olgettina n. 60, Milan, Italy.
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Curcio C, Rosso T, Brugiapaglia S, Guadagnin G, Giordano D, Castellino B, Satolli MA, Spadi R, Campra D, Moro F, Papotti MG, Bertero L, Cassoni P, De Angelis C, Langella S, Ferrero A, Armentano S, Bellotti G, Fenocchio E, Nuzzo A, Ciccone G, Novelli F. Circulating autoantibodies to alpha-enolase (ENO1) and far upstream element-binding protein 1 (FUBP1) are negative prognostic factors for pancreatic cancer patient survival. Clin Exp Med 2023; 23:5089-5100. [PMID: 37910256 PMCID: PMC10725354 DOI: 10.1007/s10238-023-01236-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 10/24/2023] [Indexed: 11/03/2023]
Abstract
Pancreatic ductal adenocarcinoma (PDA) has a dismal prognosis due to a lack of early diagnostic markers and effective therapy. In PDA patients, the glycolytic enzyme and plasminogen receptor alpha-enolase (ENO1) and the transcription factor far upstream element-binding protein 1 (FUBP1) are upregulated and elicit the production of autoantibodies (aAb) that discriminate healthy subjects from PDA patients, with the latter mostly directed to post-translational phosphorylated isoforms. Here, the correlation of prognosis with circulating ENO1 and FUBP1aAb, and their protein tissue expression was analyzed in PDA patients. Circulating ENO1 and FUBP1 aAb was analyzed in two cohorts of PDA patients by ELISA (n = 470), while tissues expression was observed by immunohistochemistry (n = 45). Overall survival (OS) was estimated using the Kaplan-Meier method, while the Cox model was used to estimate the hazard ratios (HR) adjusted for the main prognostic factors. Logistic models were applied to assess associations between death and its risk indicators. All statistical analyses were performed with Stata version 15. Unlike ENO1 aAb, there was a significant correlation between FUBP1 aAb and FUBP1 expression in tumors (p = 0.0268). In addition, we found that high ENO1 (p = 0.016) and intermediate FUBP1 aAb levels (p = 0.013) were unfavorable prognostic factors. Notably, it was found that high anti-FUBP1 aAb level is a good prognostic marker for tail-body PDA (p = 0.016). Our results suggest that different levels of circulating aAb to ENO1 and FUBP1 predict a poor outcome in PDA patients and can be used to improve therapeutic strategies.
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Affiliation(s)
- Claudia Curcio
- Laboratory of Tumor Immunology, Department of Molecular Biotechnology and Health Sciences, University of Torino, Turin, Italy
- ENOAPA Biobank, SSD Banche Tessuti E Bioconservatorio, AOU Città Della Salute E Della Scienza Di Torino, Turin, Italy
| | - Tiziana Rosso
- Unit of Clinical Epidemiology, AOU Città Della Salute E Della Scienza Di Torino and CPO Piemonte, Turin, Italy
| | - Silvia Brugiapaglia
- Laboratory of Tumor Immunology, Department of Molecular Biotechnology and Health Sciences, University of Torino, Turin, Italy
- ENOAPA Biobank, SSD Banche Tessuti E Bioconservatorio, AOU Città Della Salute E Della Scienza Di Torino, Turin, Italy
| | - Giorgia Guadagnin
- Laboratory of Tumor Immunology, Department of Molecular Biotechnology and Health Sciences, University of Torino, Turin, Italy
- ENOAPA Biobank, SSD Banche Tessuti E Bioconservatorio, AOU Città Della Salute E Della Scienza Di Torino, Turin, Italy
| | - Daniele Giordano
- Laboratory of Tumor Immunology, Department of Molecular Biotechnology and Health Sciences, University of Torino, Turin, Italy
- ENOAPA Biobank, SSD Banche Tessuti E Bioconservatorio, AOU Città Della Salute E Della Scienza Di Torino, Turin, Italy
| | - Bruno Castellino
- Centro Oncologico Ematologico Subalpino, AOU Città Della Salute E Della Scienza Di Torino, Turin, Italy
| | - Maria Antonietta Satolli
- Centro Oncologico Ematologico Subalpino, AOU Città Della Salute E Della Scienza Di Torino, Turin, Italy
| | - Rosella Spadi
- Centro Oncologico Ematologico Subalpino, AOU Città Della Salute E Della Scienza Di Torino, Turin, Italy
| | - Donata Campra
- SC Chirurgia Generale d'urgenza E Pronto Soccorso, AOU Città Della Salute E Della Scienza Di Torino, Turin, Italy
| | - Francesco Moro
- SC Chirurgia Generale U2, AOU Città Della Salute E Della Scienza Di Torino, Turin, Italy
| | - Mauro Giulio Papotti
- Pathology Unit, Department of Medical Sciences, University of Torino, AOU Città Della Salute E Della Scienza Di Torino, Turin, Italy
| | - Luca Bertero
- Pathology Unit, Department of Medical Sciences, University of Torino, AOU Città Della Salute E Della Scienza Di Torino, Turin, Italy
| | - Paola Cassoni
- Pathology Unit, Department of Medical Sciences, University of Torino, AOU Città Della Salute E Della Scienza Di Torino, Turin, Italy
| | - Claudio De Angelis
- SCDU Gastroenterology U, AOU Città Della Salute E Della Scienza Di Torino, Turin, Italy
| | - Serena Langella
- General Surgery and Oncology, Ordine Mauriziano Di Torino, Turin, Italy
| | | | - Serena Armentano
- General Surgery and Oncology, Ordine Mauriziano Di Torino, Turin, Italy
| | - Giovanna Bellotti
- Oncology Department, SS. Antonio E Biagio C. Arrigo Di Alessandria, Alessandria, Italy
| | | | - Annamaria Nuzzo
- Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Turin, Italy
| | - Giovannino Ciccone
- Unit of Clinical Epidemiology, AOU Città Della Salute E Della Scienza Di Torino and CPO Piemonte, Turin, Italy
| | - Francesco Novelli
- Laboratory of Tumor Immunology, Department of Molecular Biotechnology and Health Sciences, University of Torino, Turin, Italy.
- ENOAPA Biobank, SSD Banche Tessuti E Bioconservatorio, AOU Città Della Salute E Della Scienza Di Torino, Turin, Italy.
- Department of Molecular Biotechnology and Health Sciences, Molecular Biotechnology Center, Piazza Nizza 44B, Turin, Italy.
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3
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Procaccio L, Merz V, Fasano M, Vaccaro V, Giommoni E, Pretta A, Noventa S, Satolli MA, Giordano G, Zichi C, Pinto C, Zecchetto C, Barsotti G, De Vita F, Milella M, Antonuzzo L, Scartozzi M, Zaniboni A, Spadi R, Casalino S, Bergamo F, De Toni C, Melisi D, Lonardi S. The role of nanoliposomal irinotecan plus fluorouracil/leucovorin in the continuum of care of patients with metastatic pancreatic ductal adenocarcinoma. Cancer Med 2023. [PMID: 37278395 DOI: 10.1002/cam4.6111] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 05/01/2023] [Accepted: 05/07/2023] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND The NAPOLI-I trial showed better outcome of nanoliposomal irinotecan (nal-IRI) plus 5-fluorouracil/leucovorin (5-FU/LV) compared to 5-FU/LV in patients with advanced pancreatic ductal adenocarcinoma cancer (advPDAC) progressed to gemcitabine-based therapy. This study aims to explore the real-world efficacy and safety of 5-FU/LV-nal-IRI. METHODS This is a retrospective multicenter analysis including advPDAC patients receiving 5-FU/LV-nal-IRI after failure of gemcitabine-based therapy. Survival analyses were performed using Kaplan-Meier method, univariate and multivariate analyses by Cox regression. RESULTS A total of 296 patients (median age 64.4 years, ECOG PS ≥1 in 56% of cases) were treated at 11 Italian institutions between 2016 and 2018. 34% of them underwent primary tumor resection, and 79% received gemcitabine-nabpaclitaxel as first line. 5-FU/LV-nal-IRI was administered as second-line in 73% of cases. Objective response and disease control rate were 12% and 41%, respectively. Treatment was well tolerated with dose reductions in 50% of patients but no one permanent discontinuation; the commonest grade ≥3 toxicities were neutropenia (14%) and diarrhea (12%). Median PFS and OS from 5-FU/LV-nal-IRI initiation was 3.2 and 7.1 months, respectively. CONCLUSIONS These real-world data confirm the 5-FU/LV-nal-IRI efficacy and safety in advPDAC patients progressed to gemcitabine-based therapy, with outcomes comparable to NAPOLI-1, even in a less-selected population and with more modern therapeutic algorithm.
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Affiliation(s)
- Letizia Procaccio
- Medical Oncology 1 Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Valeria Merz
- Digestive Molecular Clinical Oncology Research Unit, Università degli Studi di Verona, Verona, Italy
| | - Morena Fasano
- Medical Oncology Unit, Department of Precision Medicine, School of Medicine, University of study of Campania "L. Vanvitelli", Naples, Italy
| | | | - Elisa Giommoni
- Clinical Oncology Unit, Careggi University Hospital, Florence, Italy
| | - Andrea Pretta
- Medical Oncology Department, University Hospital, University of Cagliari, Cagliari, Italy
| | - Silvia Noventa
- Medical Oncology Unit, Casa di Cura Poliambulanza, Brescia, Italy
| | - Maria Antonietta Satolli
- Department of Oncology, University of Turin, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza, Turin, Italy
| | - Guido Giordano
- UO di Oncologia Medica, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Clizia Zichi
- Department of Oncology, University of Turin, Ordine Mauriziano Hospital, Turin, Italy
| | - Carmine Pinto
- High-Complexity Oncology Unit, Clinical Cancer Center, IRCCS Reggio Emilia, Reggio Emilia, Italy
| | - Camilla Zecchetto
- Digestive Molecular Clinical Oncology Research Unit, Università degli Studi di Verona, Verona, Italy
| | - Giulia Barsotti
- Medical Oncology 1 Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Ferdinando De Vita
- Medical Oncology Unit, Department of Precision Medicine, School of Medicine, University of study of Campania "L. Vanvitelli", Naples, Italy
| | | | - Lorenzo Antonuzzo
- Clinical Oncology Unit, Careggi University Hospital, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Mario Scartozzi
- Medical Oncology Department, University Hospital, University of Cagliari, Cagliari, Italy
| | - Alberto Zaniboni
- Medical Oncology Unit, Casa di Cura Poliambulanza, Brescia, Italy
| | - Rosella Spadi
- Medical Oncology 1, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza, Turin, Italy
| | - Simona Casalino
- Digestive Molecular Clinical Oncology Research Unit, Università degli Studi di Verona, Verona, Italy
| | - Francesca Bergamo
- Medical Oncology 1 Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Chiara De Toni
- Medical Oncology 1 Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Davide Melisi
- Digestive Molecular Clinical Oncology Research Unit, Università degli Studi di Verona, Verona, Italy
- Investigational Cancer Therapeutics Clinical Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Sara Lonardi
- Medical Oncology 3 Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
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4
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Casadei-Gardini A, Leone F, Brandi G, Scartozzi M, Silvestris N, Santini D, Faloppi L, Aglietta M, Satolli MA, Rizzo A, Lonardi S, Aprile G, Fornaro L. Survival trends over 20 years in patients with advanced cholangiocarcinoma: Results from a national retrospective analysis of 922 cases in Italy. Front Oncol 2023; 13:1128930. [PMID: 37091141 PMCID: PMC10113474 DOI: 10.3389/fonc.2023.1128930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 03/13/2023] [Indexed: 04/25/2023] Open
Abstract
Cholangiocarcinoma is a rare group of tumors that involve the hepatic biliary tree. Prognosis for patients with cholangiocarcinoma remains dismal. Herein, we present survival trends over a long time period spanning almost 20 years in patients with advanced cholangiocarcinoma receiving systemic chemotherapy. We retrospectively analyzed a large multicenter dataset of cholangiocarcinoma outpatients evaluated in 14 centers within the Cholangiocarcinoma Italian Group Onlus (Gruppo Italiano Colangiocarcinoma Onlus, G.I.C.O.) between 2000 and 2017 (first-line), and 2002 and 2017 (second-line). Three time periods were considered: 2000-2009, 2010-2013, and 2014-2017. A total of 922 patients (51.19% male) with cholangiocarcinoma undergoing first-line therapy were evaluated. The median durations of follow-up for progression-free survival (PFS) and overall survival (OS) were 37 and 57 months, respectively. PFS at 12 months in the three periods of starting first-line therapy was similar, ranging from 11.71% to 15.25%. OS at 12 months progressively improved (38.30%, 44.61% and 49.52%, respectively), although the differences were not statistically significant after adjusting for age, disease status, and primary tumor site. A total of 410 patients (48.5% male) underwent second-line chemotherapy. The median durations of follow-up for PFS and OS were 47.6 and 41.90 months, respectively. An OS of 24.3%, 32.3%, and 33.1% was observed in 2002-2009, 2010-2013, and 2014-2017, respectively. Despite incremental benefits across years, our clinical experience confirms that modest overall advances have been achieved with first- and second-line chemotherapy in advanced cholangiocarcinoma. Efforts should focus on the identification of patients who derive the greatest benefit from treatment.
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Affiliation(s)
- Andrea Casadei-Gardini
- Department of Oncology, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute Hospital, Milan, Italy
| | - Francesco Leone
- Division of Medical Oncology, ASL BI, Nuovo Ospedale degli Infermi, Ponderano, BI, Italy
| | - Giovanni Brandi
- Oncology Unit, Department of Experimental, Diagnostic and Specialty Medicine, Sant’Orsola-Malpighi Hospital, Bologna, Italy
| | - Mario Scartozzi
- Medical Oncology, University Hospital and University of Cagliari, Cagliari, Italy
| | - Nicola Silvestris
- Medical Oncology Unit, Department of Human Pathology “G. Barresi”, University of Messina, Messina, Italy
| | - Daniele Santini
- UOC Oncologia Medica, “Sapienza University”, Polo Pontino, Rome, Italy
| | - Luca Faloppi
- Macerata General Hospital, Medical Oncology Unit, Macerata, Italy
| | - Massimo Aglietta
- Division of Medical Oncology, Candiolo Cancer Institute, FPO - IRCCS, Candiolo, Italy
| | - Maria Antonietta Satolli
- Division of Medical Oncology 1, Centro Oncologico Ematologico Subalpino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Alessandro Rizzo
- Struttura Semplice Dipartimentale di Oncologia Medica per la Presa in Carico Globale del Paziente Oncologico “Don Tonino Bello”, I.R.C.C.S. Istituto Tumori “Giovanni Paolo II”, Bari, Italy
| | - Sara Lonardi
- Oncology Unit 3, Department of Oncology, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - Giuseppe Aprile
- Department of Oncology, San Bortolo General Hospital, Vicenza, Italy
| | - Lorenzo Fornaro
- U.O. Medical Oncology 2 University, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
- *Correspondence: Lorenzo Fornaro,
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5
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Parisi A, Giampieri R, Mammarella A, Felicetti C, Salvatore L, Bensi M, Maratta MG, Strippoli A, Filippi R, Satolli MA, Petrillo A, Daniele B, De Tursi M, Di Marino P, Giordano G, Landriscina M, Vitale P, Zurlo IV, Dell’Aquila E, Tomao S, Depetris I, Di Pietro FR, Zoratto F, Ciardiello D, Pensieri MV, Garrone O, Galassi B, Ferri C, Berardi R, Ghidini M. Primary versus secondary antiemetic prophylaxis with NK1 receptor antagonists in patients affected by gastrointestinal malignancies and treated with a doublet or triplet combination regimen including oxaliplatin and/or irinotecan plus fluoropyrimidines: A propensity score matched analysis. Front Oncol 2022; 12:935826. [PMID: 36033477 PMCID: PMC9413268 DOI: 10.3389/fonc.2022.935826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 06/28/2022] [Indexed: 11/18/2022] Open
Abstract
Aim The aim of the current study is to investigate the impact of primary compared to secondary chemotherapy-induced nausea and vomiting (CINV) prophylaxis with NK1 receptor antagonists (NK1-RA) in patients affected by gastrointestinal malignancies and treated with oxaliplatin- and/or irinotecan-based doublet or triplet regimens. Study design and methods Clinical data of patients affected by gastrointestinal malignancies, treated with an oxaliplatin and/or irinotecan-based doublet or triplet regimen as neo/adjuvant or advanced-line treatment, and who received NK1-RA as primary (from the first cycle of treatment) or secondary (after the onset of CINV with a previous regimen with 5HT3-RA and dexamethasone) prophylaxis for CINV, were retrospectively collected in an observational study involving 16 Italian centers. A propensity score matching was performed by taking into account the following stratification factors: sex (male vs. female), age (< vs. ≥70 years old), overweight (body mass index, BMI < vs. ≥25), underweight (BMI < vs. ≥19), disease spread (early vs. advanced/metastatic), tumor type (esophagogastric cancer vs. the rest, hepatobiliary tumor vs. the rest, colorectal cancer vs. the rest), type of NK1-RA used as primary/secondary prophylaxis (netupitant-palonosetron vs. fosaprepitant/aprepitant), concomitant use of opioids (yes vs. no), concomitant use of antidepressant/antipsychotic drugs (yes vs. no), Eastern Cooperative Oncology Group (ECOG) performance status at the start of NK1-RA treatment (0 vs. 1–2), and intensity of chemotherapy regimen (doublet vs. triplet). Results Among 409 patients included from January 2015 to January 2022 and eligible for analysis, 284 (69%) and 125 (31%) were treated with NK1-RA as primary and secondary antiemetic prophylaxis, respectively. After matching, primary NK1-RA use was not associated with higher rates of protection from emesis regardless the emesis phase (acute phase, p = 0.34; delayed phase, p = 0.14; overall phase, p = 0.80). On the other hand, a lower rate of relevant nausea (p = 0.02) and need for rescue antiemetic therapy (p = 0.000007) in the overall phase was found in primary NK1-RA users. Furthermore, a higher rate of both complete antiemetic response (p = 0.00001) and complete antiemetic protection (p = 0.00007) in the overall phase was more frequently observed in primary NK1-RA users. Finally, chemotherapy delays (p = 0.000009) and chemotherapy dose reductions (p = 0.0000006) were less frequently observed in primary NK1-RA users. Conclusion In patients affected by gastrointestinal malignancies, a primary CINV prophylaxis with NK1-RA, 5HT3-RA, and dexamethasone might be appropriate, particularly in those situations at higher risk of emesis and in which it is important to avoid dose delays and/or dose reductions, keeping a proper dose intensity of chemotherapy drugs.
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Affiliation(s)
- Alessandro Parisi
- Clinica Oncologica e Centro Regionale di Genetica Oncologica, Università Politecnica delle Marche, AOU Ospedali Riuniti-Ancona, Ancona, Italy
- Department of Life, Health and Environmental Sciences, University of L’Aquila, L’Aquila, Italy
- *Correspondence: Alessandro Parisi,
| | - Riccardo Giampieri
- Clinica Oncologica e Centro Regionale di Genetica Oncologica, Università Politecnica delle Marche, AOU Ospedali Riuniti-Ancona, Ancona, Italy
| | - Alex Mammarella
- Clinica Oncologica e Centro Regionale di Genetica Oncologica, Università Politecnica delle Marche, AOU Ospedali Riuniti-Ancona, Ancona, Italy
| | - Cristiano Felicetti
- Clinica Oncologica e Centro Regionale di Genetica Oncologica, Università Politecnica delle Marche, AOU Ospedali Riuniti-Ancona, Ancona, Italy
| | - Lisa Salvatore
- Università Cattolica del Sacro Cuore, Rome, Italy
- Medical Oncology, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Maria Bensi
- Università Cattolica del Sacro Cuore, Rome, Italy
- Medical Oncology, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Maria Grazia Maratta
- Università Cattolica del Sacro Cuore, Rome, Italy
- Medical Oncology, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Antonia Strippoli
- Medical Oncology, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Roberto Filippi
- Department of Oncology, University of Turin, Torino, Italy
- S.C Oncologia Medica 1, Centro Oncologico Ematologico Subalpino (COES), Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Maria Antonietta Satolli
- Department of Oncology, University of Turin, Torino, Italy
- S.C Oncologia Medica 1, Centro Oncologico Ematologico Subalpino (COES), Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | | | - Bruno Daniele
- Medical Oncology Unit, Ospedale del Mare, Naples, Italy
| | - Michele De Tursi
- Department of Medical, Oral and Biotechnological Sciences and Center for Advance Studies and Technology (CAST), G. D’Annunzio University, Chieti, Italy
- Clinical Oncology Unit, S.S. Annunziata Hospital, Chieti, Italy
| | - Pietro Di Marino
- Department of Medical, Oral and Biotechnological Sciences and Center for Advance Studies and Technology (CAST), G. D’Annunzio University, Chieti, Italy
- Clinical Oncology Unit, S.S. Annunziata Hospital, Chieti, Italy
| | - Guido Giordano
- Medical Oncology Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Matteo Landriscina
- Medical Oncology Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | | | | | | | - Silverio Tomao
- Department of Radiological, Oncological and Anatomo-Pathological Sciences, Medical Oncology Unit A, Policlinico Umberto I, ‘Sapienza’ University of Rome, Rome, Italy
| | - Ilaria Depetris
- Medical Oncology, ASL TO4, Ospedale Civile di Ivrea, Turin, Italy
| | | | | | - Davide Ciardiello
- Oncology Unit, Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo, Italy
- Oncology Unit, Department of Precision Medicine, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, Italy
| | | | - Ornella Garrone
- Medical Oncology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Barbara Galassi
- Medical Oncology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Claudio Ferri
- Department of Life, Health and Environmental Sciences, University of L’Aquila, L’Aquila, Italy
| | - Rossana Berardi
- Clinica Oncologica e Centro Regionale di Genetica Oncologica, Università Politecnica delle Marche, AOU Ospedali Riuniti-Ancona, Ancona, Italy
| | - Michele Ghidini
- Medical Oncology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milano, Italy
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6
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Rimini M, Casadei-Gardini A, Brandi G, Leone F, Fornaro L, Pella N, Silvestris N, Montagnani F, Lonardi S, Lai E, Galizia E, Santini D, Palloni A, Filippi R, Masi G, Aprile G, Aglietta M, Frega G, Fenocchio E, Vivaldi C, Satolli MA, Salani F, Scartozzi M, Faloppi L, Pellino A, Sperti E, Burgio V, Ratti F, Aldrighetti L, Cascinu S, Cucchetti A. Risk-adjusted analysis of survival variability among hospitals treating biliary malignancy. J Chemother 2022; 34:543-549. [PMID: 35156913 DOI: 10.1080/1120009x.2022.2036557] [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] [Indexed: 10/19/2022]
Abstract
Biliary tract cancer's (BTC) treatment main stone for advanced stages is constituted by chemotherapy. Surgical centralization and physicians' confidence in the use of new technologies and molecular analysis turned out to be of interest and potentially influencing survival. After applying a random-effect model, the relationship between each clinical variable on the main outcome was investigated through multilevel mixed-effects logistic regression. The risk-standardized outcomes were calculated for each centre involved. In the unadjusted cohort the median survival was 8.6 months (95%C.I.: 7.8-9.3) with a 9-month survival rate of 48.3% (95%C.I.: 45.0-51.5). A substantial heterogeneity across hospitals was found (I2: 70.3%). In multilevel mixed effect logistic regression, male, being treated for gallbladder cancer, higher ECOG, increased NLR, CEA and Ca 19.9 and low value of haemoglobin showed to increase the odds for 9-month mortality. The model estimated that the residual variance observed in 9-month mortality was attributable for the 2.6% to the treating hospital. Through a multilevel mixed effect model, average risk-standardized mortality within 9 months was 50.1%. As noticeable, all hospital's risk-standardized mortality falls within 95%C.I., thus all participating centres provided similar outcomes when adjusted for patient case-mix. Heterogenicity between hospital did not affect the outcome in term of overall survival.
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Affiliation(s)
- Margherita Rimini
- Department of Oncology, IRCCS San Raffaele Scientific Institute Hospital, Milan, Italy
| | - Andrea Casadei-Gardini
- Department of Oncology, IRCCS San Raffaele Scientific Institute Hospital, Milan, Italy.,Department of Oncology, Vita-Salute San Raffaele University, Milan, Italy
| | - Giovanni Brandi
- Oncology Unit, Department of Experimental, Diagnostic and Specialty Medicine, Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - Francesco Leone
- Division of Medical Oncology, ASL BI, Nuovo Ospedale degli Infermi, Ponderano, BI, Italy
| | - Lorenzo Fornaro
- U.O. Oncologia Medica 2 Universitaria, Azienda Ospedaliero-Universitaria Pisana, Pisa, IT, Italy
| | | | - Nicola Silvestris
- Department of Molecular Medicine, Faculty of Advanced Medical Sciences, Tabriz University of Medical Sciences, Tabriz, Iran.,Department of Oncology, IRCCS Istituto Tumori "Giovanni Paolo II" of Bari, Bari, Italy
| | - Francesco Montagnani
- Division of Medical Oncology, ASL BI, Nuovo Ospedale degli Infermi, Ponderano, BI, Italy
| | - Sara Lonardi
- Oncology Unit 3, Department of Oncology, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - Eleonora Lai
- Medical Oncology, University Hospital and University of Cagliari, Cagliari, Italy
| | - Eva Galizia
- Macerata General Hospital, Medical Oncology Unit, Macerata, Italy
| | - Daniele Santini
- Department of Medical Oncology, Campus Bio-Medico University of Rome, Rome, Italy
| | - Andrea Palloni
- Oncology Unit, Department of Experimental, Diagnostic and Specialty Medicine, Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - Roberto Filippi
- Division of Medical Oncology, Candiolo Cancer Institute, FPO - IRCCS, Candiolo, TO, Italy.,Department of Oncology, University of Turin, Torino, Italy.,Centro Oncologico Ematologico Subalpino, Azienda Universitaria Ospedaliera Città della Salute e della Scienza di Torino, Torino, Italy
| | - Gianluca Masi
- U.O. Oncologia Medica 2 Universitaria, Azienda Ospedaliero-Universitaria Pisana, Pisa, IT, Italy
| | | | - Massimo Aglietta
- Division of Medical Oncology, Candiolo Cancer Institute, FPO - IRCCS, Candiolo, TO, Italy.,Department of Oncology, University of Turin, Torino, Italy
| | - Giorgio Frega
- Oncology Unit, Department of Experimental, Diagnostic and Specialty Medicine, Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - Elisabetta Fenocchio
- Multidisciplinary Outpatient Oncology Clinic, Candiolo Cancer Institute, FPO - IRCCS, Candiolo, TO, Italy
| | - Caterina Vivaldi
- U.O. Oncologia Medica 2 Universitaria, Azienda Ospedaliero-Universitaria Pisana, Pisa, IT, Italy
| | - Maria Antonietta Satolli
- Department of Oncology, University of Turin, Torino, Italy.,Centro Oncologico Ematologico Subalpino, Azienda Universitaria Ospedaliera Città della Salute e della Scienza di Torino, Torino, Italy
| | - Francesca Salani
- U.O. Oncologia Medica 2 Universitaria, Azienda Ospedaliero-Universitaria Pisana, Pisa, IT, Italy
| | - Mario Scartozzi
- Medical Oncology, University Hospital and University of Cagliari, Cagliari, Italy
| | - Luca Faloppi
- Macerata General Hospital, Medical Oncology Unit, Macerata, Italy
| | - Antonio Pellino
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy.,Oncology Unit 1, Department of Oncology, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - Elisa Sperti
- Division of Medical Oncology, Ordine Mauriziano Hospital, Torino, Italy
| | - Valentina Burgio
- Department of Oncology, IRCCS San Raffaele Scientific Institute Hospital, Milan, Italy
| | | | | | - Stefano Cascinu
- Department of Oncology, IRCCS San Raffaele Scientific Institute Hospital, Milan, Italy.,Department of Oncology, Vita-Salute San Raffaele University, Milan, Italy
| | - Alessandro Cucchetti
- Department of Medical and Surgical Sciences, DIMEC, Alma Mater Studiorum, University of Bologna, Bologna, Italy.,Oncology Unit, Morgagni-Pierantoni Hospital, Forlì, Italy
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7
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Giommoni E, Lavacchi D, Tirino G, Fornaro L, Iachetta F, Pozzo C, Satolli MA, Spallanzani A, Puzzoni M, Stragliotto S, Sisani M, Formica V, Giovanardi F, Strippoli A, Prisciandaro M, Di Donato S, Pompella L, Pecora I, Romagnani A, Fancelli S, Brugia M, Pillozzi S, De Vita F, Antonuzzo L. Results of the observational prospective RealFLOT study. BMC Cancer 2021; 21:1086. [PMID: 34625033 PMCID: PMC8499559 DOI: 10.1186/s12885-021-08768-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 07/26/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Perioperative FLOT (5-fluorouracil, oxaliplatin and docetaxel) has recently become the gold standard treatment for fit patients with operable gastric (GC) or gastroesophageal (GEJ) adenocarcinoma, getting a 5-year overall survival (OS) of 45%, over 23% with surgery alone. METHODS RealFLOT is an Italian, multicentric, observational trial, collecting data from patients with resectable GC or GEJ adenocarcinoma treated with perioperative FLOT. Aim of the study was to describe feasibility and safety of FLOT, pathological complete response rate (pCR), surgical outcomes and overall response rate (ORR) in an unselected real-world population. Additional analyses evaluated the correlation between pCR and survival and the prognostic role of microsatellite instability (MSI) status. RESULTS Of 206 patients enrolled that received perioperative FLOT at 15 Italian centers, 124 (60.2%) received at least 4 full-dose cycles, 190 (92.2%) underwent surgery, and 142 (68.9%) started the postoperative phase. Among patients who started the postoperative phase, 105 (51.0%) received FLOT, while 37 (18%) received de-intensified regimens, depending on clinical condition or previous toxicities. pCR was achieved in 7.3% of cases. Safety profile was consistent with literature. Neutropenia was the most common G 3-4 adverse event (AE): 19.9% in the preoperative phase and 16.9% in the postoperative phase. No toxic death was observed and 30-day postoperative mortality rate was 1.0%. ORR was 45.6% and disease control rate (DCR) was 94.2%. Disease-free survival (DFS) and OS were significantly longer in case of pCR (p = 0.009 and p = 0.023, respectively). A trend towards better DFS was observed among MSI-H patients. CONCLUSIONS These real-world data confirm the feasibility of FLOT in an unselected population, representative of the clinical practice. pCR rate was lower than expected, nevertheless we confirm pCR as a predictive parameter of survival. In addition, MSI-H status seems to be a positive prognostic marker also in patients treated with taxane-containing triplets.
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Affiliation(s)
| | | | - Giuseppe Tirino
- Division of Medical Oncology, Department of Precision Medicine, University of Study of Campania "L. Vanvitelli", Naples, Italy
| | - Lorenzo Fornaro
- Medical Oncology, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Francesco Iachetta
- Medical Oncology Unit, Clinical Cancer Center, AUSL-IRCCS, Reggio Emilia, Italy
| | - Carmelo Pozzo
- Medical Oncology, Fondazione Policlinico Universitario "A. Gemelli", IRCCS, Rome, Italy
| | | | | | - Marco Puzzoni
- Medical Oncology Department, University Hospital, University of Cagliari, Cagliari, Italy
| | - Silvia Stragliotto
- Oncology Unit - Dipartimento di Oncologia Clinica e Sperimentale Istituto Oncologico Veneto IOV-IRCCS, Padua, Italy
| | | | - Vincenzo Formica
- Internal Medicine Department "Tor Vergata" University Hospital, Rome, Italy
| | - Filippo Giovanardi
- Medical Oncology, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Antonia Strippoli
- Medical Oncology, Fondazione Policlinico Universitario "A. Gemelli", IRCCS, Rome, Italy
| | - Michele Prisciandaro
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Samantha Di Donato
- Medical Oncology, Department Nuovo Ospedale-Santo Stefano Istituto Toscano Tumori, Prato, Italy
| | - Luca Pompella
- Division of Medical Oncology, Department of Precision Medicine, University of Study of Campania "L. Vanvitelli", Naples, Italy
| | - Irene Pecora
- Medical Oncology, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | | | | | - Marco Brugia
- Medical Oncology Unit, AOU Careggi, Florence, Italy
| | | | - Ferdinando De Vita
- Division of Medical Oncology, Department of Precision Medicine, University of Study of Campania "L. Vanvitelli", Naples, Italy
| | - Lorenzo Antonuzzo
- Medical Oncology Unit, AOU Careggi, Florence, Italy. .,Department of Experimental and Clinical Medicine, University of Firenze, Florence, Italy. .,Clinical Oncology Unit, AOU Careggi, Largo Brambilla 3, 50134, Florence, Italy.
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8
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Filippi R, Montagnani F, Lombardi P, Fornaro L, Aprile G, Casadei-Gardini A, Faloppi L, Palloni A, Satolli MA, Scartozzi M, Citarella F, Lutrino SE, Vivaldi C, Silvestris N, Rovesti G, Rimini M, Aglietta M, Brandi G, Leone F. A prognostic model in patients with advanced biliary tract cancer receiving first-line chemotherapy. Acta Oncol 2021; 60:1317-1324. [PMID: 34282710 DOI: 10.1080/0284186x.2021.1953704] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Standard treatment of advanced biliary tract cancer (aBTC) is represented by first-line chemotherapy (CT1). However, some patients do not gain any benefit from CT1, contributing to the overall dismal prognosis of aBTC. The present study aimed to devise a prognostic model in aBTC patients receiving CT1. METHODS A large panel of clinical, laboratory, and pathology variables, available before the start of CT1, were retrospectively assessed in a multi-centric cohort to determine their prognostic value on univariate and multivariate regression analysis. The variables that showed a significant correlation with overall survival (OS) were computed in a three-tier prognostic score. External validation of the prognostication performance was carried out. RESULTS Clinical histories of 935 patients (median OS 10.3 months), with diagnosis dates ranging from 2001 to 2017, were retrieved from 14 institutions. According to multivariate analysis, Eastern Cooperative Oncology Group performance status, carbohydrate antigen 19.9, albumin levels, and neutrophil/lymphocyte ratio were strongly associated with OS (p <0.01). The prognostic score could generate a highly significant stratification (all between-group p values ≤0.001) into groups of favorable (comprising 51.5% of the sample), intermediate (39.2%), and poor prognosis (9.3%): median OS was 12.7 (CI95% 11.0-14.4), 7.1 (CI95% 5.8-8.4), and 3.2 months (CI95% 1.7-4.7), respectively. This OS gradient was replicated in the validation set (129 patients), with median OS of 12.7 (CI95% 11.0-14.3), 7.5 (CI95% 6.1-8.9), and 1.4 months (CI95% 0.1-2.7), respectively (all between-group p values ≤0.05). CONCLUSION A prognostic score, derived from a limited set of easily-retrievable variables, efficiently stratified a large population of unselected aBTC patients undergoing CT1. This tool could be useful to clinicians, to ascertain the potential benefit from CT1 at the start of treatment.
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Affiliation(s)
- Roberto Filippi
- Department of Oncology, University of Turin, Torino, Italy
- Division of Medical Oncology, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Italy
- Centro Oncologico Ematologico Subalpino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Francesco Montagnani
- Division of Medical Oncology, ASL BI, Nuovo Ospedale degli Infermi, Ponderano, Italy
| | - Pasquale Lombardi
- Department of Oncology, University of Turin, Torino, Italy
- Division of Medical Oncology, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Italy
| | - Lorenzo Fornaro
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Giuseppe Aprile
- Department of Oncology, University Hospital of Udine, Udine, Italy
- Department of Oncology, San Bortolo General Hospital, AULSS8, Vicenza, Italy
| | - Andrea Casadei-Gardini
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Meldola, Italy
- Department of Oncology and Haematology, University Hospital of Modena, Italy
| | - Luca Faloppi
- Medical Oncology Unit, Macerata General Hospital, Macerata, Italy
| | - Andrea Palloni
- Department of Experimental, Diagnostic and Specialty Medicine, University Hospital S. Orsola-Malpighi, Bologna, Italy
| | - Maria Antonietta Satolli
- Department of Oncology, University of Turin, Torino, Italy
- Centro Oncologico Ematologico Subalpino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Mario Scartozzi
- Department of Medical Oncology, University Hospital, Cagliari, Italy
| | - Fabrizio Citarella
- Department of Medical Oncology, Campus Bio-Medico University, Roma, Italy
| | | | - Caterina Vivaldi
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Italy
| | - Nicola Silvestris
- Medical Oncology Unit, IRCCS Cancer Institute “Giovanni Paolo II”, Bari, Italy
- Department of Biomedical Sciences and Human Oncology (DIMO), University of Bari, Italy
| | - Giulia Rovesti
- Department of Oncology and Haematology, University Hospital of Modena, Italy
| | - Margherita Rimini
- Department of Oncology and Haematology, University Hospital of Modena, Italy
| | - Massimo Aglietta
- Department of Oncology, University of Turin, Torino, Italy
- Division of Medical Oncology, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Italy
| | - Giovanni Brandi
- Department of Experimental, Diagnostic and Specialty Medicine, University Hospital S. Orsola-Malpighi, Bologna, Italy
| | - Francesco Leone
- Division of Medical Oncology, ASL BI, Nuovo Ospedale degli Infermi, Ponderano, Italy
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9
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Filippi R, Leone F, Fornaro L, Aprile G, Casadei-Gardini A, Silvestris N, Palloni A, Satolli MA, Scartozzi M, Russano M, Lutrino SE, Lombardi P, Frega G, Garattini SK, Vivaldi C, Spadi R, Giulia O, Fenocchio E, Brunetti O, Aglietta M, Brandi G. Clinical insights and prognostic factors from an advanced biliary tract cancer case series: a real-world analysis. J Chemother 2021; 34:123-132. [PMID: 34313188 DOI: 10.1080/1120009x.2021.1953887] [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] [Indexed: 10/20/2022]
Abstract
Advanced biliary tract cancer (aBTC) comprises a heterogeneous group of rare malignancies with dismal prognosis. Given the scarcity of prospective evidence, the aim of this study was to derive clinically useful insights and prognostic factors from a large, real-world series of aBTC. Clinicopathologic variables and treatment outcomes were retrospectively collected involving 940 patients diagnosed with aBTC between 2001 and 2017, and treated with first-line chemotherapy (CT1) at 14 Italian medical oncology institutions. Median overall survival (OS) was 10.3 months (CI95% 9.5-11.1). CT1 with gemcitabine-Platinum salts doublets achieved OS of 11.7 months vs 7.5 with gemcitabine alone (HR 0.67, p < 0.001). However, a clear temporal trend towards improved OS could not be demonstrated. Radical surgery of recurrent disease achieved a relapse-free survival of 5.9 months. A substantial minority (44.5%) of patients were able to receive a second-line chemotherapy, which achieved a response rate of 7.6%, and disease control in 30% of patients with no significant differences between combination regimens and monotherapies. In a large retrospective series of real-world aBTC, outcomes of standard CT1 closely resembled those of the registrational trials. A limited set of easily retrievable independent prognostic factors was defined. Further research is needed on second-line regimens.
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Affiliation(s)
- Roberto Filippi
- Department of Oncology, University of Turin, Torino, Italy.,Division of Medical Oncology, Candiolo Cancer Institute, FPO - IRCCS, Candiolo, Italy.,Division of Medical Oncology 1, Centro Oncologico Ematologico Subalpino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Francesco Leone
- Division of Medical Oncology, ASL BI, Nuovo Ospedale degli Infermi, Ponderano, Italy
| | - Lorenzo Fornaro
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Giuseppe Aprile
- Department of Oncology, University Hospital of Udine, Udine, Italy.,Department of Oncology, San Bortolo General Hospital, Vicenza, Italy
| | - Andrea Casadei-Gardini
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Meldola, Italy.,Department of Oncology and Haematology, University Hospital of Modena, Italy
| | - Nicola Silvestris
- Medical Oncology Unit, IRCCS Cancer Institute "Giovanni Paolo II", Bari, Italy
| | - Andrea Palloni
- Department of Experimental, Diagnostic and Speciality Medicine, University Hospital S. Orsola-Malpighi, Bologna, Italy
| | - Maria Antonietta Satolli
- Department of Oncology, University of Turin, Torino, Italy.,Division of Medical Oncology 1, Centro Oncologico Ematologico Subalpino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Mario Scartozzi
- Department of Medical Oncology, University Hospital, Cagliari, Italy
| | - Marco Russano
- Department of Medical Oncology, Campus Bio-Medico University, Roma, Italy
| | | | - Pasquale Lombardi
- Department of Oncology, University of Turin, Torino, Italy.,Division of Medical Oncology, Candiolo Cancer Institute, FPO - IRCCS, Candiolo, Italy
| | - Giorgio Frega
- Department of Experimental, Diagnostic and Speciality Medicine, University Hospital S. Orsola-Malpighi, Bologna, Italy
| | | | - Caterina Vivaldi
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy.,Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Italy
| | - Rosella Spadi
- Division of Medical Oncology 1, Centro Oncologico Ematologico Subalpino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Orsi Giulia
- Department of Oncology and Haematology, University Hospital of Modena, Italy
| | - Elisabetta Fenocchio
- Multidisciplinary Outpatient Oncology Clinic, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Italy
| | - Oronzo Brunetti
- Medical Oncology Unit, IRCCS Cancer Institute "Giovanni Paolo II", Bari, Italy
| | - Massimo Aglietta
- Department of Oncology, University of Turin, Torino, Italy.,Division of Medical Oncology, Candiolo Cancer Institute, FPO - IRCCS, Candiolo, Italy
| | - Giovanni Brandi
- Department of Experimental, Diagnostic and Speciality Medicine, University Hospital S. Orsola-Malpighi, Bologna, Italy
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10
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Abstract
Introduction: Characteristic of some rare pediatric and adult malignancies, addiction to the NTRK oncogene family is also observed in a small fraction of common cancers. Inhibition of their protein products, the Trk kinases, proved a successful treatment strategy for these tumors.Areas covered: The current paper reviews the clinical development of larotrectinib, a selective inhibitor of the Trk kinase family, for the treatment of NTRK fusion-positive cancers. The manuscript includes an overview of the efficacy, safety, pharmacokinetics and pharmacodynamics. The authors sum up by providing the reader with their expert opinion on larotrectinib and its potential future use.Expert opinion: Larotrectinib showed tolerability and high efficacy, regardless of the primary site. In 2018, larotrectinib was granted by the Food and Drug Administration a tissue-agnostic approval for the treatment of solid tumors harboring an NTRK fusion. The major challenges will be the implementation of the screening for NTRK fusions in the general oncologic population, and the incorporation of larotrectinib into the therapeutic algorithms.
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Affiliation(s)
- Roberto Filippi
- Medical Oncology 1 - AOU Città Della Salute E Della Scienza Di Torino; Candiolo Cancer Institute, FPO - IRCCS Candiolo; Department of Oncology, University of Turin, Turin, Italy
| | - Ilaria Depetris
- Medical Oncology, Ospedale Civile Di Ivrea, Ivrea, Turin, Italy
| | - Maria Antonietta Satolli
- Medical Oncology 1 - AOU Città Della Salute E Della Scienza Di Torino; Department of Oncology, University of Turin, Turin, Italy
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11
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Mandili G, Curcio C, Bulfamante S, Follia L, Ferrero G, Mazza E, Principe M, Cordero F, Satolli MA, Spadi R, Evangelista A, Giordano D, Viet D, Cappello P, Novelli F. In pancreatic cancer, chemotherapy increases antitumor responses to tumor-associated antigens and potentiates DNA vaccination. J Immunother Cancer 2020; 8:jitc-2020-001071. [PMID: 33115943 PMCID: PMC7594541 DOI: 10.1136/jitc-2020-001071] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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] [Accepted: 09/10/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Pancreatic ductal adenocarcinoma (PDA) is an almost incurable tumor that is mostly resistant to chemotherapy (CT). Adaptive immune responses to tumor-associated antigens (TAA) have been reported, but immunotherapy (IT) clinical trials have not yet achieved any significant increase in survival, confirming the suppressive environment of PDA. As CT has immune-modulating properties, we investigated the effect of gemcitabine (GEM) in antitumor effector responses to TAA in patients with PDA. METHODS The IgG antibody repertoire in patients with PDA before and after CT was profiled by serological proteome analysis and ELISA and their ability to activate complement-dependent cytotoxicity (CDC) was measured. Peripheral T cells were stimulated in vitro with recombinant TAA, and specific proliferation, IFN-γ/IL-10 and CD8+/Treg ratios were measured. Mice that spontaneously developed PDA were treated with GEM and inoculated with an ENO1 (α-Enolase) DNA vaccine. In some experimental groups, the effect of depleting CD4, CD8 and B cells by specific antibodies was also evaluated. RESULTS CT increased the number of TAA recognized by IgG and their ability to activate CDC. Evaluation of the IFN-γ/IL-10 ratio and CD8+/Treg ratios revealed that CT treatment shifted T cell responses to ENO1, G3P (glyceraldheyde-3-phosphate dehydrogenase), K2C8 (keratin, type II cytoskeletal 8) and FUBP1 (far upstream binding protein 1), four of the most recognized TAA, from regulatory to effector. In PDA mice models, treatment with GEM prior to ENO1 DNA vaccination unleashed CD4 antitumor activity and strongly impaired tumor progression compared with mice that were vaccinated or GEM-treated alone. CONCLUSIONS Overall, these data indicate that, in PDA, CT enhances immune responses to TAA and renders them suitable targets for IT.
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Affiliation(s)
- Giorgia Mandili
- Department of Molecular Biotechnology and Health Sciences, University of Turin, Turin, Italy.,Centro Ricerche Medicina Sperimentale, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Claudia Curcio
- Department of Molecular Biotechnology and Health Sciences, University of Turin, Turin, Italy.,Centro Ricerche Medicina Sperimentale, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Sara Bulfamante
- Department of Molecular Biotechnology and Health Sciences, University of Turin, Turin, Italy.,Centro Ricerche Medicina Sperimentale, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Laura Follia
- Department of Molecular Biotechnology and Health Sciences, University of Turin, Turin, Italy.,Computer Science Department, University of Turin, Turin, Italy
| | - Giulio Ferrero
- Computer Science Department, University of Turin, Turin, Italy
| | - Emanuela Mazza
- Department of Molecular Biotechnology and Health Sciences, University of Turin, Turin, Italy.,Centro Ricerche Medicina Sperimentale, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Moitza Principe
- Department of Molecular Biotechnology and Health Sciences, University of Turin, Turin, Italy.,Centro Ricerche Medicina Sperimentale, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | | | - Maria Antonietta Satolli
- Department of Surgical Sciences, University of Turin, Torino, Italy.,Centro Oncologico Ematologico Subalpino, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Rosella Spadi
- Centro Oncologico Ematologico Subalpino, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Andrea Evangelista
- Servizio di Epidemiologia Clinica, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Daniele Giordano
- Department of Molecular Biotechnology and Health Sciences, University of Turin, Turin, Italy.,Centro Ricerche Medicina Sperimentale, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Duy Viet
- Department of Molecular Biotechnology and Health Sciences, University of Turin, Turin, Italy.,Centro Ricerche Medicina Sperimentale, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Paola Cappello
- Department of Molecular Biotechnology and Health Sciences, University of Turin, Turin, Italy.,Centro Ricerche Medicina Sperimentale, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Francesco Novelli
- Department of Molecular Biotechnology and Health Sciences, University of Turin, Turin, Italy .,Centro Ricerche Medicina Sperimentale, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
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12
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Giommoni E, De Vita F, Pecora I, Iachetta F, Strippoli A, Satolli MA, Spallanzani A, Puzzoni M, Nappo F, Sisani M, Formica V, Giovanardi F, Pozzo C, Prisciandaro M, Di Donato S, Pompella L, Salani F, Tirino G, Lavacchi D, Antonuzzo L. Perioperative FLOT in elderly patients with resectable gastric cancer: Subgroup analysis from the observational RealFLOT study. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.4548] [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
4548 Background: The treatment strategy for patients with resectable gastric cancer changed in the last few years with perioperative treatments. FLOT regimen (fluorouracil, oxaliplatin, docetaxel) turned out to be feasible and effective, offering significant improvement in survival outcomes. However, the safety profile of triplet therapies for elderly patients deserves a special attention and, consequently, the best treatment strategy for these patients is still debated. Methods: Focusing on the elderly patient population (age ≥65 years), real-world data from patients with resectable gastric or gastro-oesophageal junction (GEJ) adenocarcinoma (T≥2 and/or N+) enrolled in the observational RealFLOT study were collected. Results: A total of 206 patients with resectable gastric or GEJ adenocarcinoma received perioperative FLOT at 15 Italian centers in routine clinical practice, between September 2016 and September 2019. The median age was 63 years (range 36-77) and 43% of patients enrolled (n = 89) were ≥65 years. Among elderly patients, 46 (52%) received FLOT for at least 4 full-dose cycles in the preoperative phase, 82 (92%) underwent surgery, and 56 (62%) started the postoperative phase. The primary end point of the study, pathological complete response (pCR) rate, was similar among patients aged ≥65 and < 65 (6.7% vs 7.7%, respectively). The distribution of pathological stages did not differ according to age (p = 0.473), and disease-free survival (DFS) is unrelated to the age of patients (log-rank 0.57; p = 0.89). The incidence of grade (G) 3-4 adverse events (AEs) was similar in the two age groups (Table) and the 30-day mortality rates after surgery did not differ according to age. Conclusions: FLOT regimen demonstrated to be feasible and safe in elderly patients since no differences were observed in terms of pCR, DFS and safety profile according to age. [Table: see text]
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Affiliation(s)
- Elisa Giommoni
- Medical Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Ferdinando De Vita
- Division of Medical Oncology, Department of Precision Medicine, University of Study of Campania "L. Vanvitelli", Naples, Italy
| | - Irene Pecora
- Medical Oncology, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Francesco Iachetta
- Medical Oncology Unit, Clinical Cancer Center, AUSL-IRCCS, Reggio Emilia, Italy
| | - Antonia Strippoli
- Medical Oncology, Fondazione Policlinico Universitario “A. Gemelli”, IRCCS, Rome, Italy
| | | | | | - Marco Puzzoni
- Medical Oncology Department, University Hospital, University of Cagliari, Cagliari, Italy
| | - Floriana Nappo
- Department of Clinical and Experimental Oncology, Medical Oncology 1 Unit, Istituto Oncologico Veneto IOV-IRCCS, Padua, Italy
| | | | | | - Filippo Giovanardi
- Medical Oncology, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Carmelo Pozzo
- Oncologia Medica, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli–IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Michele Prisciandaro
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Samantha Di Donato
- Medical Oncology Department, Nuovo Ospedale-Santo Stefano, Istituto Toscano Tumori, Prato, Italy
| | - Luca Pompella
- Division of Medical Oncology, Department of Precision Medicine, University of Study of Campania "L. Vanvitelli", Naples, Italy
| | - Francesca Salani
- Medical Oncology, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Giuseppe Tirino
- Division of Medical Oncology, Department of Precision Medicine, University of Study of Campania "L. Vanvitelli", Naples, Italy
| | - Daniele Lavacchi
- Medical Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Lorenzo Antonuzzo
- Medical Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
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13
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Mandili G, Follia L, Ferrero G, Katayama H, Hong W, Momin AA, Capello M, Giordano D, Spadi R, Satolli MA, Evangelista A, Hanash SM, Cordero F, Novelli F. Immune-Complexome Analysis Identifies Immunoglobulin-Bound Biomarkers That Predict the Response to Chemotherapy of Pancreatic Cancer Patients. Cancers (Basel) 2020; 12:E746. [PMID: 32245227 PMCID: PMC7140049 DOI: 10.3390/cancers12030746] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 03/14/2020] [Accepted: 03/18/2020] [Indexed: 12/12/2022] Open
Abstract
Pancreatic Ductal Adenocarcinoma (PDA) is an aggressive malignancy with a very poor outcome. Although chemotherapy (CT) treatment has poor efficacy, it can enhance tumor immunogenicity. Tumor-Associated Antigens (TAA) are self-proteins that are overexpressed in tumors that may induce antibody production and can be PDA theranostic targets. However, the prognostic value of TAA-antibody association as Circulating Immune Complexes (CIC) has not yet been elucidated, mainly due to the lack of techniques that lead to their identification. In this study, we show a novel method to separate IgG, IgM, and IgA CIC from sera to use them as prognostic biomarkers of CT response. The PDA Immune-Complexome (IC) was identified using a LTQ-Orbitrap mass spectrometer followed by computational analysis. The analysis of the IC of 37 PDA patients before and after CT revealed differential associated antigens (DAA) for each immunoglobulin class. Our method identified different PDA-specific CIC in patients that were associated with poor prognosis patients. Finally, CIC levels were significantly modified by CT suggesting that they can be used as effective prognostic biomarkers to follow CT response in PDA patients.
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Affiliation(s)
- Giorgia Mandili
- Department of Molecular Biotechnology and Health Sciences, University of Turin, 10126 Torino, Italy; (G.M.); (L.F.)
- Center for Experimental Research and Medical Studies (CeRMS), University of Turin, 10126 Torino, Italy
| | - Laura Follia
- Department of Molecular Biotechnology and Health Sciences, University of Turin, 10126 Torino, Italy; (G.M.); (L.F.)
- Center for Experimental Research and Medical Studies (CeRMS), University of Turin, 10126 Torino, Italy
- Department of Computer Science, University of Turin, 10149 Torino, Italy; (G.F.); (F.C.)
| | - Giulio Ferrero
- Department of Computer Science, University of Turin, 10149 Torino, Italy; (G.F.); (F.C.)
- Department of Clinical and Biological Sciences, San Luigi Hospital, University of Turin, 10043 Orbassano, Turin, Italy
| | - Hiroyuki Katayama
- MD Anderson Cancer Center, University of Texas, Houston, TX 77030, USA
| | - Wang Hong
- MD Anderson Cancer Center, University of Texas, Houston, TX 77030, USA
| | - Amin A. Momin
- MD Anderson Cancer Center, University of Texas, Houston, TX 77030, USA
| | - Michela Capello
- MD Anderson Cancer Center, University of Texas, Houston, TX 77030, USA
| | - Daniele Giordano
- Center for Experimental Research and Medical Studies (CeRMS), University of Turin, 10126 Torino, Italy
| | - Rosella Spadi
- Centro Oncologico Ematologico Subalpino (COES), University of Turin, 10126 Torino, Italy
| | | | - Andrea Evangelista
- Cittá della salute e della scienza University Hospital of Turin, University of Turin, 10126 Torino, Italy
| | - Samir M. Hanash
- MD Anderson Cancer Center, University of Texas, Houston, TX 77030, USA
| | - Francesca Cordero
- Department of Computer Science, University of Turin, 10149 Torino, Italy; (G.F.); (F.C.)
| | - Francesco Novelli
- Department of Molecular Biotechnology and Health Sciences, University of Turin, 10126 Torino, Italy; (G.M.); (L.F.)
- Center for Experimental Research and Medical Studies (CeRMS), University of Turin, 10126 Torino, Italy
- Cittá della salute e della scienza University Hospital of Turin, University of Turin, 10126 Torino, Italy
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14
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Giommoni E, De Vita F, Pecora I, Iachetta F, Strippoli A, Satolli MA, Spallanzani A, Puzzoni M, Stragliotto S, Sisani M, Formica V, Giovanardi F, Pozzo C, Prisciandaro M, Di Donato S, Petrillo A, Catanese S, Tirino G, Lavacchi D, Antonuzzo L. Perioperative FLOT in resectable gastric cancer: Italian real-world data from the RealFLOT study. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.4_suppl.300] [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
300 Background: Perioperative treatments have significantly improved survival in patients with resectable gastric cancer, increasing 5-year overall survival from 23% with surgery alone to 45% with FLOT (fluorouracil, oxaliplatin, docetaxel). Pathological regression is a prognostic marker of better survival. Methods: In this observational, retro- and prospective study we collected data from patients with resectable gastric or gastro-oesophageal junction (GEJ) adenocarcinoma treated, as clinical practice, with perioperative FLOT. All patients had clinical T2 or higher and/or nodal involvement, according to FLOT4-AIO trial. Results: A total of 206 patients received perioperative chemotherapy with FLOT at 15 Italian centres, between September 2016 and September 2019. Overall, 186 (90.3%) patients completed the preoperative phase, 190 (92%) underwent surgery, and 142 (68.9%) started the postoperative phase. Among patients who started the postoperative phase, 105 (51.0%) received FLOT, while 37 (18%) received less intensive regimens (e.g. FOLFOX or De Gramont), depending on performance status after surgery or toxicity in the preoperative phase. Pathological complete response (pCR) was obtained in 7.3% of cases. In the preoperative phase, grade (G) 3-4 hematological and gastrointestinal adverse events (AEs) were reported in 42 (20.4%) and 13 (6.3%) patients, respectively. Conclusions: These real data confirmed the feasibility of perioperative FLOT in a less-selected population, representative of the clinical practice. The pCR rate was lower than in the FLOT4-AIO trial. The survival outcomes, potential predictive or prognostic factors and comprehensive safety data will be included in the final analysis. [Table: see text]
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Affiliation(s)
- Elisa Giommoni
- Medical Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Ferdinando De Vita
- Division of Medical Oncology, Department of Precision Medicine, University of Study of Campania "L. Vanvitelli", Naples, Italy
| | - Irene Pecora
- Medical Oncology, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Francesco Iachetta
- Medical Oncology Unit, Clinical Cancer Center, AUSL-IRCCS, Reggio Emilia, Italy
| | - Antonia Strippoli
- Medical Oncology, Fondazione Policlinico Universitario “A. Gemelli”, IRCCS, Rome, Italy
| | | | | | - Marco Puzzoni
- Medical Oncology Department, University Hospital, University of Cagliari, Cagliari, Italy
| | - Silvia Stragliotto
- Oncology Unit - Dipartimento di Oncologia Clinica e Sperimentale Istituto Oncologico Veneto IOV-IRCCS, Padua, Italy
| | | | - Vincenzo Formica
- Internal Medicine Department "Tor Vergata" University Hospital, Rome, Italy
| | - Filippo Giovanardi
- Medical Oncology, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Carmelo Pozzo
- Medical Oncology, Fondazione Policlinico Universitario “A. Gemelli”, IRCCS, Rome, Italy
| | - Michele Prisciandaro
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Samantha Di Donato
- Medical Oncology, Department Nuovo Ospedale-Santo Stefano Instituto Toscano Tumori, Prato, Italy
| | - Angelica Petrillo
- Division of Medical Oncology, Department of Precision Medicine, University of Study of Campania “L. Vanvitelli”, Naples, Italy
| | - Silvia Catanese
- Medical Oncology, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Giuseppe Tirino
- Division of Medical Oncology, Department of Precision Medicine, University of Study of Campania “L. Vanvitelli”, Naples, Italy
| | - Daniele Lavacchi
- Medical Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Lorenzo Antonuzzo
- Medical Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
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15
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Pellino A, Manai C, Merz V, Scartozzi M, Milella M, De Vita F, Antonuzzo L, Zichi C, Satolli MA, Panebianco M, Noventa S, Giordano G, Nappo F, Zecchetto C, Puzzoni M, Vaccaro V, Pappalardo A, Giommoni E, Melisi D, Lonardi S. Observational retrospective evaluation of treatment with liposomal irinotecan plus fluorouracil/leucovorin for metastatic pancreatic cancer patients: An Italian large real-world analysis. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.4_suppl.660] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
660 Background: In the NAPOLI I phase III trial, Nanoliposomal irinotecan (nal-IRI) plus 5-fluorouracil/leucovorin (5-FU/LV) showed better outcome compared to 5FU/LV in patients with metastatic Pancreatic Cancer (MPC) progressed to 1st- line gemcitabine-based therapy. Aim of this study is to explore the real-world efficacy and safety of 5FU/LV-nal-IRI by a compassionate use programme and to identify potential prognostic factors that could affect survival in this setting. Methods: This is a retrospective multi-center analysis including patients with MPC who received 5FU/LV-nal-IRI after failure of a gemcitabine-based therapy. Survival analyses were carried out by the Kaplan-Meier method. Univariate and multivariate analyses were performed by using the log-rank test and the Cox regression. Results: A total of 296 pts (median age, 69 years, range 30-82; 50% male; ECOG PS 0, 44%) were treated at 11 Italian institutions from June 2016 and November 2018. 34% of the pts have been previously resected on their primary tumor, and 76% received gemcitabine-nabpaclitaxel as 1st - line treatment. 5FU/LV-nal-IRI has been administered as 2nd - line in 72% of the pts, while in 23% of the cases as 3rd - line or more. The median OS was 7.1 months [95% confidence interval (CI) 6.1 - 8.1] and the median PFS was 3.3 months (95% CI 2.9 - 3.6). At six months, OS and PFS rate were 53.4% and 31.4% respectively. ORR was 12% and DCR was 40%. 52% of pts received more than 4 cycle with dose reduction in 148 pts (50%). Most common grade 3 toxicities were neutropenia (14%), diarrhea (11%), anemia (3%), nausea (3%), fatigue (3%), mucositis (2%) and vomiting (1%). Baseline characteristics associated with better OS were ECOG PS 0, normal CEA, neutrophil-to-lymphocyte ratio ≤5 and haemoglobin ≥11 g/dL. Conclusions: These real-world data confirm the efficacy and safety of 5FU/LV-nal-IRI in patients with MPC progressed to a gemcitabine-based therapy, with outcome comparable to NAPOLI-1 even in a less selected population and with more active 1st - line combination therapy. In this cohort, well known prognostic markers has been confirmed, as expected.
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Affiliation(s)
- Antonio Pellino
- Department of Clinical and Experimental Oncology, Medical Oncology 1 Unit, Istituto Oncologico Veneto IOV-IRCCS, Padua, Italy
| | - Chiara Manai
- Department of Clinical and Experimental Oncology, Medical Oncology 1 Unit, Istituto Oncologico Veneto IOV-IRCCS, Padua, Italy
| | - Valeria Merz
- Unit of Medical Oncology, University of Verona Hospital Trust, Verona, TN, Italy
| | - Mario Scartozzi
- Medical Oncology Department, University Hospital, University of Cagliari, Cagliari, Italy
| | - Michele Milella
- Medical Oncology, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Ferdinando De Vita
- Division of Medical Oncology, Department of Precision Medicine, University of Study of Campania "L. Vanvitelli", Naples, Italy
| | - Lorenzo Antonuzzo
- Medical Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Clizia Zichi
- Department of Oncology, University of Turin, Ordine Mauriziano Hospital, Turin, Italy
| | | | - Michele Panebianco
- Medical Oncology Unit, Clinical Cancer Center, IRCCS-AUSL di Reggio Emilia, Reggio Emilia, Italy
| | - Silvia Noventa
- Medical Oncology Unit, Casa di Cura Poliambulanza, Brescia, Italy
| | - Guido Giordano
- Fondazione IRCCS Casa Sollievo della Sofferenza, UO di Oncologia Medica, San Giovanni Rotondo, Italy
| | - Floriana Nappo
- Department of Clinical and Experimental Oncology, Medical Oncology 1 Unit, Istituto Oncologico Veneto IOV-IRCCS, Padua, Italy
| | - Camilla Zecchetto
- Unit of Medical Oncology, University of Verona Hospital Trust, Verona, Italy
| | - Marco Puzzoni
- Medical Oncology Department, University Hospital, University of Cagliari, Cagliari, Italy
| | - Vanja Vaccaro
- Medical Oncology 1, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Annalisa Pappalardo
- Division of Medical Oncology, Department of Precision Medicine, University of Study of Campania "L. Vanvitelli", Naples, Italy
| | - Elisa Giommoni
- Medical Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Davide Melisi
- Medicine - Digestive Molecular Clinical Oncology Research Unit, University of Verona, Verona, Italy
| | - Sara Lonardi
- Department of Clinical and Experimental Oncology, Medical Oncology 1 Unit, Istituto Oncologico Veneto IOV-IRCCS, Padua, Italy
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Fornaro L, Leone F, Vienot A, Casadei-Gardini A, Vivaldi C, Lièvre A, Lombardi P, De Luca E, Vernerey D, Sperti E, Musettini G, Satolli MA, Edeline J, Spadi R, Neuzillet C, Falcone A, Pasquini G, Clerico M, Passardi A, Buscaglia P, Meurisse A, Aglietta M, Brac C, Vasile E, Montagnani F. Validated Nomogram Predicting 6-Month Survival in Pancreatic Cancer Patients Receiving First-Line 5-Fluorouracil, Oxaliplatin, and Irinotecan. Clin Colorectal Cancer 2019; 18:e394-e401. [PMID: 31564556 DOI: 10.1016/j.clcc.2019.08.004] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 06/22/2019] [Accepted: 08/27/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND FOLFIRINOX (leucovorin, 5-fluorouracil, irinotecan, and oxaliplatin) is an option for fit patients with metastatic (MPC) and locally advanced unresectable (LAPC) pancreatic cancer. However, no criteria reliably identify patients with better outcomes. PATIENTS AND METHODS We investigated putative prognostic factors among 137 MPC/LAPC patients treated with triplet chemotherapy. Association with 6-month survival status (primary endpoint) was assessed by multivariate logistic regression models. A nomogram predicting the risk of death at 6 months was built by assigning a numeric score to each identified variable, weighted on its level of association with survival. External validation was performed in an independent data set of 206 patients. The study was registered at ClinicalTrials.gov (NCT03590275). RESULTS Four variables (performance status, liver metastases, baseline carbohydrate antigen 19-9 level, and neutrophil-to-lymphocyte ratio) were found to be associated with 6-month survival by multivariate analysis or had sufficient clinical plausibility to be included in the nomogram. Accuracy was confirmed in the validation cohort (C index = 0.762; 95% confidence interval, 0.713-0.825). After grouping all cases, 4 subsets with different outcomes were identified by 0, 1, 2, or > 2 poor prognostic features (P < .0001). CONCLUSION The nomogram we constructed accurately predicts the risk of death in the first 6 months after initiation of FOLFIRINOX in MPC/LAPC patients. This tool could be useful to guide communication about prognosis, and to inform the design and interpretation of clinical trials.
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Affiliation(s)
- Lorenzo Fornaro
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy.
| | - Francesco Leone
- Department of Medical Oncology, University of Turin, Turin, Italy; Medical Oncology, Candiolo Cancer Institute, FPO, IRCCS, Candiolo, Italy
| | - Angélique Vienot
- Department of Medical Oncology, Besancon University Hospital, Besançon, France
| | | | - Caterina Vivaldi
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Astrid Lièvre
- Department of Gastroenterology, Rennes University Hospital, Rennes 1 University, COSS (Chemistry Oncogenesis Stress Signaling), UMR_S 1242, Rennes, France
| | - Pasquale Lombardi
- Department of Medical Oncology, University of Turin, Turin, Italy; Medical Oncology, Candiolo Cancer Institute, FPO, IRCCS, Candiolo, Italy
| | - Emmanuele De Luca
- Department of Medical Oncology, University of Turin, Turin, Italy; S.C.D.U. Oncologia, A.O. Ordine Mauriziano, Ospedale Umberto I, Turin, Italy
| | - Dewi Vernerey
- Methodological and Quality of Life in Oncology Unit, EA 3181, Besançon University Hospital, Besançon, France
| | - Elisa Sperti
- S.C.D.U. Oncologia, A.O. Ordine Mauriziano, Ospedale Umberto I, Turin, Italy
| | - Gianna Musettini
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Maria Antonietta Satolli
- Department of Medical Oncology, University of Turin, Turin, Italy; Medical Oncology 1 Division, Città della Salute e della Scienza, Turin, Italy
| | - Julien Edeline
- Oncology Department, Cancer Institute Eugène Marquis, Rennes 1 University, INSERM, INRA, Rennes 1 University, Nutrition Metabolism and Cancer (NuMeCan), Rennes, France
| | - Rosella Spadi
- Medical Oncology 1 Division, Città della Salute e della Scienza, Turin, Italy
| | - Cindy Neuzillet
- Department of Medical Oncology, Curie Institute, Saint Cloud, France
| | - Alfredo Falcone
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy; Department of Translational Research and New Technologies in Medicine, University of Pisa, Pisa, Italy
| | - Giulia Pasquini
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Mario Clerico
- S.C. Oncologia, Department of Oncology, ASL BI, Biella, Italy
| | - Alessandro Passardi
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | | | - Aurélia Meurisse
- Methodological and Quality of Life in Oncology Unit, EA 3181, Besançon University Hospital, Besançon, France
| | - Massimo Aglietta
- Department of Medical Oncology, University of Turin, Turin, Italy; Medical Oncology, Candiolo Cancer Institute, FPO, IRCCS, Candiolo, Italy
| | - Clémence Brac
- Oncology Department, Cancer Institute Eugène Marquis, Rennes, France
| | - Enrico Vasile
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
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Follia L, Ferrero G, Mandili G, Beccuti M, Giordano D, Spadi R, Satolli MA, Evangelista A, Katayama H, Hong W, Momin AA, Capello M, Hanash SM, Novelli F, Cordero F. Integrative Analysis of Novel Metabolic Subtypes in Pancreatic Cancer Fosters New Prognostic Biomarkers. Front Oncol 2019; 9:115. [PMID: 30873387 PMCID: PMC6400843 DOI: 10.3389/fonc.2019.00115] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [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: 09/10/2018] [Accepted: 02/07/2019] [Indexed: 12/25/2022] Open
Abstract
Background: Most of the patients with Pancreatic Ductal Adenocarcinoma (PDA) are not eligible for a curative surgical resection. For this reason there is an urgent need for personalized therapies. PDA is the result of complex interactions between tumor molecular profile and metabolites produced by its microenvironment. Despite recent studies identified PDA molecular subtypes, its metabolic classification is still lacking. Methods: We applied an integrative analysis on transcriptomic and genomic data of glycolytic genes in PDA. Data were collected from public datasets and molecular glycolytic subtypes were defined using hierarchical clustering. The grade of purity of the cancer samples was assessed estimating the different amount of stromal and immunological infiltrate among the identified PDA subtypes. Analyses of metabolomic data from a subset of PDA cell lines allowed us to identify the different metabolites produced by the metabolic subtypes. Sera of a cohort of 31 PDA patients were analyzed using Q-TOF mass spectrometer to measure the amount of metabolic circulating proteins present before and after chemotherapy. Results: Our integrative analysis of glycolytic genes identified two glycolytic and two non-glycolytic metabolic PDA subtypes. Glycolytic patients develop disease earlier, have poor prognosis, low immune-infiltrated tumors, and are characterized by a gain in chr12p13 genomic region. This gain results in the over-expression of GAPDH, TPI1, and FOXM1. PDA cell lines with the gain of chr12p13 are characterized by an higher lipid uptake and sensitivity to drug targeting the fatty acid metabolism. Our sera proteomic analysis confirms that TPI1 serum levels increase in poor prognosis gemcitabine-treated patients. Conclusions: We identify four metabolic PDA subtypes with different prognosis outcomes which may have pivotal role in setting personalized treatments. Moreover, our data suggest TPI1 as putative prognostic PDA biomarker.
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Affiliation(s)
- Laura Follia
- Center for Experimental Research and Medical Studies, Azienda Universitaria Ospedaliera Città della Salute e della Scienza di Torino, Turin, Italy.,Department of Molecular Biotechnology and Health Sciences, University of Turin, Turin, Italy.,Department of Computer Sciences, University of Turin, Turin, Italy
| | - Giulio Ferrero
- Department of Computer Sciences, University of Turin, Turin, Italy
| | - Giorgia Mandili
- Center for Experimental Research and Medical Studies, Azienda Universitaria Ospedaliera Città della Salute e della Scienza di Torino, Turin, Italy.,Department of Molecular Biotechnology and Health Sciences, University of Turin, Turin, Italy
| | - Marco Beccuti
- Department of Computer Sciences, University of Turin, Turin, Italy
| | - Daniele Giordano
- Center for Experimental Research and Medical Studies, Azienda Universitaria Ospedaliera Città della Salute e della Scienza di Torino, Turin, Italy
| | - Rosella Spadi
- Centro Oncologico Ematologico Subalpino, Azienda Universitaria Ospedaliera Città della Salute e della Scienza di Torino, Turin, Italy
| | - Maria Antonietta Satolli
- Centro Oncologico Ematologico Subalpino, Azienda Universitaria Ospedaliera Città della Salute e della Scienza di Torino, Turin, Italy
| | - Andrea Evangelista
- Servizio di Epidemiologia dei Tumori, Azienda Universitaria Ospedaliera Città della Salute e della Scienza di Torino, Turin, Italy
| | - Hiroyuki Katayama
- Department of Clinical Cancer Prevention Research, MD Anderson Cancer Center, Houston, TX, United States
| | - Wang Hong
- Department of Clinical Cancer Prevention Research, MD Anderson Cancer Center, Houston, TX, United States
| | - Amin A Momin
- Department of Clinical Cancer Prevention Research, MD Anderson Cancer Center, Houston, TX, United States
| | - Michela Capello
- Department of Clinical Cancer Prevention Research, MD Anderson Cancer Center, Houston, TX, United States
| | - Samir M Hanash
- Department of Clinical Cancer Prevention Research, MD Anderson Cancer Center, Houston, TX, United States
| | - Francesco Novelli
- Center for Experimental Research and Medical Studies, Azienda Universitaria Ospedaliera Città della Salute e della Scienza di Torino, Turin, Italy.,Department of Molecular Biotechnology and Health Sciences, University of Turin, Turin, Italy.,Molecular Biotechnology Center, University of Turin, Turin, Italy
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18
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Martini S, Arcadipane F, Strignano P, Spadi R, Contu V, Fiandra C, Ragona R, Catalano G, Satolli MA, Camandona M, Romagnoli R, Ricardi U, Franco P. Volumetric modulated arc therapy (VMAT) in the treatment of esophageal cancer patients. Med Oncol 2018; 35:150. [PMID: 30284647 DOI: 10.1007/s12032-018-1211-7] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 09/27/2018] [Indexed: 02/08/2023]
Abstract
The aim of the study is to evaluate feasibility, safety, toxicity profile, and dosimetric results of volumetric modulated arc therapy (VMAT) to deliver definitive or pre-operative radiation in locally advanced esophageal cancer patients. A total of 68 patients were treated with VMAT between March 2014 and March 2018 (44% vs 56% for definitive and neoadjuvant settings, respectively). Dose prescription differed depending on the clinical scenario (54-60 Gy in 30 fractions for definitive treatments; 41.4/45 Gy in 23-25 fractions in the pre-operative setting). Most of the patients were given concurrent chemotherapy. Two coplanar and one non-coplanar arcs were employed for VMAT delivery. Treatment was generally well tolerated. Acute toxicity was generally mild. In patients treated with definitive intent, ≥ G3 toxicities were observed for esophagitis (30%), anorexia (26.7%), fatigue (26.7%), nausea (6.7%), and vomiting (3.3%). In patients treated within a neoadjuvant approach, ≥ G3 anorexia (21%), esophagitis (15.8%), fatigue (13.3%), nausea (5.3%), and vomiting (2.6%) were observed. Dosimetric results were consistent in term of both target coverage and normal tissue sparing. In conclusion, VMAT proved to be a feasible, safe, and effective strategy to deliver definitive or pre-operative radiation in locally advanced esophageal cancer patients.
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Affiliation(s)
- Stefania Martini
- Department of Oncology, Radiation Oncology, University of Turin, Turin, Italy
| | | | - Paolo Strignano
- Department of Surgery, General Surgery 2U and Liver Transplantation Center, University of Turin, AOU Citta' della Salute e della Scienza, Turin, Italy
| | - Rosella Spadi
- Department of Oncology, Medical Oncology 1, AOU Citta' della Salute e della Scienza, Turin, Italy
| | - Viviana Contu
- Department of Oncology, Medical Oncology 2, AOU Citta' della Salute e della Scienza, Turin, Italy
| | - Christian Fiandra
- Department of Oncology, Radiation Oncology, University of Turin, Turin, Italy
| | - Riccardo Ragona
- Department of Oncology, Radiation Oncology, University of Turin, Turin, Italy
| | - Giorgia Catalano
- Department of Surgery, General Surgery 2U and Liver Transplantation Center, University of Turin, AOU Citta' della Salute e della Scienza, Turin, Italy
| | | | | | - Renato Romagnoli
- Department of Surgery, General Surgery 2U and Liver Transplantation Center, University of Turin, AOU Citta' della Salute e della Scienza, Turin, Italy
| | - Umberto Ricardi
- Department of Oncology, Radiation Oncology, University of Turin, Turin, Italy
| | - Pierfrancesco Franco
- Department of Oncology, Radiation Oncology, University of Turin, Turin, Italy. .,Department of Oncology - Radiation Oncology, University of Turin School of Medicine, Via Genova 3, 10126, Turin, Italy.
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Bulfamante S, Mandili G, Principe M, Giordano D, Mazza E, Curcio C, Follia L, Ferrero G, Evangelista A, Satolli MA, Cappello P, Novelli F. Abstract 2761: Antibody and T cell response profiling in pancreatic cancer patients before and after chemotherapy identify tumor associated antigens suitable for immunotherapy. Cancer Res 2018. [DOI: 10.1158/1538-7445.am2018-2761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Pancreatic ductal adenocarcinoma (PDA) is one of the most lethal cancer, both for lack of effective screening method and for resistance to chemotherapy (CTX) and radiotherapy. However, some chemotherapeutic agents, such as gemcitabine, have immune modulatory effects. We started from the hypothesis that more immunogenic antigens can be induced by CTX and targeted by passive or active immunotherapy. To discover TAAs that might be selected for immunotherapy, antibody response in PDA patients' sera was analyzed before and after CTX. TAAs mostly recognized after CTX were selected and used to evaluate whether PDA patients' T cells have an increased TAA-specific response after CTX and if the immune checkpoint blockade (ICB) could enhance T cells activation.
Material and methods: Antibody response in sera of PDA patients, before and after CTX treatments, was analyzed by Serological Proteome Analysis (SERPA) and the antigens recognized were identified by mass spectrometry. T cell proliferation and IFNγ and IL10 production were evaluated on patients' PBMCs (peripheral blood mononuclear cells) stimulated with TAAs in presence or not of ICB.
Results: After CTX the level of antibody recognition increased, both in term of intensity and number of recognized TAAs. For some of these TAAs the increased antibody recognition showed a positive correlation with patients' survival. Of note, after CTX an increased complement dependent cytotoxicity against PDA cell lines was demonstrated in 48% of PDA patients' sera. In most cases after CTX PDA patients' T cells stimulated in vitro with recombinant selected TAAs proliferated more. Moreover, about 50% of TAA-specific T cell responses switched from a protumor regulatory to an antitumor effector phenotype after CTX. Interestingly, this shift was better elicited by ICB after CTX than before.
Conclusions: These data indicate that in PDA patients CTX induces an increase of TAAs-specific antibodies. Furthermore, CTX can switch several TAA-specific T cell responses from regulatory to effector phenotype and ICB could potentiate this polarization. Based on these results the combination of DNA vaccination against TAA and CTX is currently investigated in a PDA mouse model.
Citation Format: Sara Bulfamante, Giorgia Mandili, Moitza Principe, Daniele Giordano, Emanuela Mazza, Claudia Curcio, Laura Follia, Giulio Ferrero, Andrea Evangelista, Maria Antonietta Satolli, Paola Cappello, Francesco Novelli. Antibody and T cell response profiling in pancreatic cancer patients before and after chemotherapy identify tumor associated antigens suitable for immunotherapy [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 2761.
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Fornaro L, Leone F, Vienot A, Casadei Gardini A, Vivaldi C, Lombardi P, Meurisse A, Passardi A, Vasile E, De Luca E, Edeline J, Musettini G, Satolli MA, Neuzillet C, Spadi R, Vernerey D, Falcone A, Clerico M, Lievre A, Montagnani F. An easy-to-use nomogram to predict overall survival (OS) at 6 months after initiation of FOLFIRINOX first-line chemotherapy in patients (pts) with metastatic pancreatic cancer (mPC). J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.4_suppl.394] [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
394 Background: FOLFIRINOX achieved a significant step forward in the treatment of mPC. However, patient prognosis remains dismal, and better discrimination of outcomes could be useful to guide clinical decision-making and patient stratification. We aimed at developing and validating a prognostic model and nomogram able to predict the risk of early death (within 6 months post-treatment initiation) in mPC pts treated with first-line FOLFIRINOX. Methods: Data from 137 mPC treated with the GONO FOLFOXIRI schedule at a single institution were used as developing set. Univariate associations with death in the first 6 months after treatment initiation were investigated. Based on the multivariate model, a nomogram was developed assigning points equal to its weighted relevance to each significant variable. The nomogram was externally validated on an independent, parallel cohort of 206 mPC pts treated with FOLFIRINOX at different Italian and French centers. Predictive ability was assessed with the concordance index (C-index) and visual inspection of the calibration plot. Results: 4 out of the 27 considered variables were retained in the multivariable model: ECOG performance status (PS), neutrophils-to-lymphocytes ratio (NLR), liver metastases, and basal serum CA19.9. The nomogram demonstrated adequate discriminative ability in the validation set with a C-index of 0.754. When grouped in different prognostic categories (according to none, 1, 2, or > 2 risk factors), pts included in our study showed significantly different outcomes with median OS ranging from 6.2 ( > 2 risk factors) to 19.5 months (no risk factors, P < 0.05). Conclusions: PS, NLR, liver metastasis, and CA19.9 were the major determinants of 6-month OS. Our nomogram may help clinicians in discussing with pts the benefits and risks of therapy, and in designing future clinical trials. A visual format of the nomogram will be presented. [Table: see text]
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Affiliation(s)
| | - Francesco Leone
- Istituto di Candiolo, Fondazione del Piemonte per l'Oncologia, IRCCS, Candiolo, Italy
| | | | | | | | | | | | - Alessandro Passardi
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori IRCCS, Meldola, Italy
| | - Enrico Vasile
- Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | | | | | - Gianna Musettini
- Azienda Ospedaliero-Universitaria Pisana/ Istituto Toscano Tumori, Pisa, Italy
| | | | | | | | | | | | | | - Astrid Lievre
- CHU Pontchaillou Université Rennes 1, Rennes, France
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Franco P, Arcadipane F, Strignano P, Spadi R, Trino E, Martini S, Iorio GC, Satolli MA, Airoldi M, Romagnoli R, Camandona M, Ricardi U. Pre-operative treatments for adenocarcinoma of the lower oesophagus and gastro-oesophageal junction: a review of the current evidence from randomized trials. Med Oncol 2017; 34:40. [PMID: 28176241 DOI: 10.1007/s12032-017-0898-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Accepted: 01/31/2017] [Indexed: 01/03/2023]
Abstract
Adenocarcinomas of the lower oesophagus and gastro-oesophageal junction are a complex clinico-pathological setting. Multimodality therapy is considered mandatory in most disease presentations. Nevertheless, the most appropriate treatment package has yet to be established. We herein summarize the evidence derived from randomized phase III trials on pre-operative treatments in this oncological scenario.
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Affiliation(s)
- Pierfrancesco Franco
- Department of Oncology, Radiation Oncology, University of Turin, Via Genova 3, 10126, Turin, Italy.
| | - Francesca Arcadipane
- Department of Oncology, Radiation Oncology, University of Turin, Via Genova 3, 10126, Turin, Italy
| | - Paolo Strignano
- Department of Surgical Sciences, General Surgery 2U and Liver Transplantation Center, University of Turin, Turin, Italy
| | - Rosella Spadi
- Department of Oncology, Medical Oncology 1, AOU Citta' della Salute e della Scienza, Turin, Italy
| | - Elisabetta Trino
- Department of Oncology, Radiation Oncology, University of Turin, Via Genova 3, 10126, Turin, Italy
| | - Stefania Martini
- Department of Oncology, Radiation Oncology, University of Turin, Via Genova 3, 10126, Turin, Italy
| | - Giuseppe Carlo Iorio
- Department of Oncology, Radiation Oncology, University of Turin, Via Genova 3, 10126, Turin, Italy
| | | | - Mario Airoldi
- Department of Oncology, Medical Oncology 2, AOU Citta' della Salute e della Scienza, Turin, Italy
| | - Renato Romagnoli
- Department of Surgical Sciences, General Surgery 2U and Liver Transplantation Center, University of Turin, Turin, Italy
| | - Michele Camandona
- Department of Surgical Sciences, General Surgery 1U, University of Turin, Turin, Italy
| | - Umberto Ricardi
- Department of Oncology, Radiation Oncology, University of Turin, Via Genova 3, 10126, Turin, Italy
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Santini D, Barni S, Intagliata S, Falcone A, Ferraù F, Galetta D, Moscetti L, La Verde N, Ibrahim T, Petrelli F, Vasile E, Ginocchi L, Ottaviani D, Longo F, Ortega C, Russo A, Badalamenti G, Collovà E, Lanzetta G, Mansueto G, Adamo V, De Marinis F, Satolli MA, Cantile F, Mancuso A, Tanca FM, Addeo R, Russano M, Sterpi M, Pantano F, Vincenzi B, Tonini G. Corrigendum: Natural History of Non-Small-Cell Lung Cancer with Bone Metastases. Sci Rep 2016; 6:22205. [PMID: 27079142 PMCID: PMC4832177 DOI: 10.1038/srep22205] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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23
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Spadi R, Brusa F, Ponzetti A, Chiappino I, Birocco N, Ciuffreda L, Satolli MA. Current therapeutic strategies for advanced pancreatic cancer: A review for clinicians. World J Clin Oncol 2016; 7:27-43. [PMID: 26862489 PMCID: PMC4734936 DOI: 10.5306/wjco.v7.i1.27] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 09/22/2015] [Accepted: 11/23/2015] [Indexed: 02/06/2023] Open
Abstract
Pancreatic cancer (PC) would become the second leading cause of cancer death in the near future, despite representing only 3% of new cancer diagnosis. Survival improvement will come from a better knowledge of risk factors, earlier diagnosis, better integration of locoregional and systemic therapies, as well as the development of more efficacious drugs rising from a deeper understanding of disease biology. For patients with unresectable, non-metastatic disease, combined strategies encompassing primary chemotherapy and radiation seems to be promising. In fit patients, new polychemotherapy regimens can lead to better outcomes in terms of slight but significant survival improvement associated with a positive impact on quality of life. The upfront use of these regimes can also increase the rate of radical resections in borderline resectable and locally advanced PC. Second line treatments showed to positively affect both overall survival and quality of life in fit patients affected by metastatic disease. At present, oxaliplatin-based regimens are the most extensively studied. Nonetheless, other promising drugs are currently under evaluation. Presently, in addition to surgery and conventional radiation therapy, new locoregional treatment techniques are emerging as alternative options in the multimodal approach to patients or diseases not suitable for radical surgery. As of today, in contrast with other types of cancer, targeted therapies failed to show relevant activity either alone or in combination with chemotherapy and, thus, current clinical practice does not include them. Up to now, despite the fact of extremely promising results in different tumors, also immunotherapy is not in the actual therapeutic armamentarium for PC. In the present paper, we provide a comprehensive review of the current state of the art of clinical practice and research in PC aiming to offer a guide for clinicians on the most relevant topics in the management of this disease.
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24
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Niccolai E, Taddei A, Ricci F, Rolla S, D'Elios MM, Benagiano M, Bechi P, Bencini L, Ringressi MN, Pini A, Castiglione F, Giordano D, Satolli MA, Coratti A, Cianchi F, Bani D, Prisco D, Novelli F, Amedei A. Intra-tumoral IFN-γ-producing Th22 cells correlate with TNM staging and the worst outcomes in pancreatic cancer. Clin Sci (Lond) 2016; 130:247-58. [PMID: 26590104 DOI: 10.1042/cs20150437] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 11/20/2015] [Indexed: 12/11/2022]
Abstract
PDAC (pancreatic ductal adenocarcinoma) is the fifth leading cause of cancer-related death. The causes of this cancer remain unknown, but increasing evidence indicates a key role of the host immune response and cytokines in human carcinogenesis. Intra-tumoral IL (interleukin)-22 levels have been shown to be elevated in PDAC patients. However, little is known regarding the expression and clinical relevance of Th22 cells in human PDAC and, furthermore, which TILs (tumour-infiltrating lymphocytes) are the main producers of IL-22 is unknown. In the present study, we characterized the functional proprieties of the different subsets of IL-22-producing TILs and analysed their relationship with the TNM staging system and patient survival. We have demonstrated for the first time that, in PDAC patients, the T-cells co-producing IFN-γ (interferon γ) and exerting perforin-mediated cytotoxicity are the major intra-tumoral source of IL-22. In addition, isolated Th22 cells were able to induce apoptosis, which was antagonized by IL-22. Finally, we observed that the IL-22-producing T-cells were significantly increased in tumour tissue and that this increase was positively correlated with TNM staging of PDAC and poorer patient survival. These novel findings support the dual role of the anti-tumour immune system and that IL-22-producing cells may participate in PDAC pathogenesis. Therefore monitoring Th22 levels could be a good diagnostic parameter, and blocking IL-22 signalling may represent a viable method for anti-PDAC therapies.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Apoptosis
- Carcinoma, Pancreatic Ductal/immunology
- Carcinoma, Pancreatic Ductal/metabolism
- Carcinoma, Pancreatic Ductal/mortality
- Carcinoma, Pancreatic Ductal/pathology
- Cell Line, Tumor
- Coculture Techniques
- Cytotoxicity, Immunologic
- Female
- Granzymes/metabolism
- Humans
- Interferon-gamma/immunology
- Interferon-gamma/metabolism
- Interleukins/immunology
- Interleukins/metabolism
- Lymphocyte Activation
- Lymphocytes, Tumor-Infiltrating/immunology
- Lymphocytes, Tumor-Infiltrating/metabolism
- Lymphocytes, Tumor-Infiltrating/pathology
- Male
- Middle Aged
- Neoplasm Staging
- Pancreatic Neoplasms/immunology
- Pancreatic Neoplasms/metabolism
- Pancreatic Neoplasms/mortality
- Pancreatic Neoplasms/pathology
- Paracrine Communication
- Perforin/metabolism
- Phenotype
- Signal Transduction
- T-Lymphocytes, Helper-Inducer/immunology
- T-Lymphocytes, Helper-Inducer/metabolism
- T-Lymphocytes, Helper-Inducer/pathology
- Interleukin-22
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Affiliation(s)
- Elena Niccolai
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, 50134 Florence, Italy
| | - Antonio Taddei
- Immunogenetics and Transplant Biology Service, Azienda Ospedaliera Città della Salute e della Scienza di Torino, via Santena 19, 10126 Turin, Italy
| | - Federica Ricci
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, 50134 Florence, Italy
| | - Simona Rolla
- Centre for Experimental Research and Medical Studies (CERMS), Azienda Ospedaliera Città della Salute e della Scienza di Torino, via Cherasco 15, 10126 Turin, Italy Molecular Biology Center and Department of Molecular Biotechnology and Health Sciences, University of Turin, via Nizza 52, 10126 Turin, Italy
| | - Mario Milco D'Elios
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, 50134 Florence, Italy Department of Neuro-Skeletal Muscle and Sensory Organs, Interdisciplinary Internal Medicine Unit, Azienda Ospedaliero Universitaria Careggi, 50134 Florence, Italy
| | - Marisa Benagiano
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, 50134 Florence, Italy
| | - Paolo Bechi
- Department of Surgery and Translational Medicine, University of Florence, Viale Michelangiolo 41, 50125 Florence, Italy Department of Biomedicine, Azienda Ospedaliera Universitaria Careggi (AOUC), Largo Brambilla 3, 50134 Florence, Italy
| | - Lapo Bencini
- Department of Oncology, Division of General and Oncologic Surgery, Azienda Ospedaliera Universitaria Careggi (AOUC), Largo Brambilla 3, 50134 Florence, Italy
| | - Maria Novella Ringressi
- Department of Surgery and Translational Medicine, University of Florence, Viale Michelangiolo 41, 50125 Florence, Italy Department of Biomedicine, Azienda Ospedaliera Universitaria Careggi (AOUC), Largo Brambilla 3, 50134 Florence, Italy
| | - Alessandro Pini
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, 50134 Florence, Italy
| | - Francesca Castiglione
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, 50134 Florence, Italy
| | - Daniele Giordano
- Centre for Experimental Research and Medical Studies (CERMS), Azienda Ospedaliera Città della Salute e della Scienza di Torino, via Cherasco 15, 10126 Turin, Italy Molecular Biology Center and Department of Molecular Biotechnology and Health Sciences, University of Turin, via Nizza 52, 10126 Turin, Italy
| | - Maria Antonietta Satolli
- Centro Oncologico Ematologico Subalpino (COES), AOU Città della Salute e della Scienza di Torino, 10126 Turin, Italy
| | - Andrea Coratti
- Department of Oncology, Division of General and Oncologic Surgery, Azienda Ospedaliera Universitaria Careggi (AOUC), Largo Brambilla 3, 50134 Florence, Italy
| | - Fabio Cianchi
- Department of Surgery and Translational Medicine, University of Florence, Viale Michelangiolo 41, 50125 Florence, Italy Department of Biomedicine, Azienda Ospedaliera Universitaria Careggi (AOUC), Largo Brambilla 3, 50134 Florence, Italy
| | - Daniele Bani
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, 50134 Florence, Italy
| | - Domenico Prisco
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, 50134 Florence, Italy Department of Neuro-Skeletal Muscle and Sensory Organs, Interdisciplinary Internal Medicine Unit, Azienda Ospedaliero Universitaria Careggi, 50134 Florence, Italy
| | - Francesco Novelli
- Immunogenetics and Transplant Biology Service, Azienda Ospedaliera Città della Salute e della Scienza di Torino, via Santena 19, 10126 Turin, Italy Centre for Experimental Research and Medical Studies (CERMS), Azienda Ospedaliera Città della Salute e della Scienza di Torino, via Cherasco 15, 10126 Turin, Italy Molecular Biology Center and Department of Molecular Biotechnology and Health Sciences, University of Turin, via Nizza 52, 10126 Turin, Italy
| | - Amedeo Amedei
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, 50134 Florence, Italy Department of Neuro-Skeletal Muscle and Sensory Organs, Interdisciplinary Internal Medicine Unit, Azienda Ospedaliero Universitaria Careggi, 50134 Florence, Italy
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Santini D, Daniele S, Barni S, Sandro B, Intagliata S, Salvatore I, Falcone A, Alfredo F, Ferraù F, Francesco F, Galetta D, Domenico G, Moscetti L, Luca M, La Verde N, Nicla LV, Ibrahim T, Toni I, Petrelli F, Fausto P, Vasile E, Enrico V, Ginocchi L, Laura G, Ottaviani D, Davide O, Longo F, Flavia L, Ortega C, Cinzia O, Russo A, Antonio R, Badalamenti G, Giuseppe B, Collovà E, Elena C, Lanzetta G, Gaetano L, Mansueto G, Giovanni M, Adamo V, Vincenzo A, De Marinis F, Filippo DM, Satolli MA, Cantile F, Flavia C, Mancuso A, Andrea M, Tanca FM, Addeo R, Raffaele A, Russano M, Marco R, Sterpi M, Sterpi M, Pantano F, Francesco P, Vincenzi B, Bruno V, Tonini G, Giuseppe T. Natural History of Non-Small-Cell Lung Cancer with Bone Metastases. Sci Rep 2015; 5:18670. [PMID: 26690845 PMCID: PMC4687045 DOI: 10.1038/srep18670] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 11/18/2015] [Indexed: 11/09/2022] Open
Abstract
We conducted a large, multicenter, retrospective survey aimed to explore the impact of tumor bone involvement in Non-Small Cell Lung Cancer.Data on clinical-pathology, skeletal outcomes and bone-directed therapies for 661 deceased patients with evidence of bone metastasis were collected and statistically analyzed. Bone metastases were evident at diagnosis in 57.5% of patients. In the remaining cases median time to bone metastases appearance was 9 months. Biphosphonates were administered in 59.6% of patients. Skeletal-related events were experienced by 57.7% of patients; the most common was the need for radiotherapy. Median time to first skeletal-related event was 6 months. Median survival after bone metastases diagnosis was 9.5 months and after the first skeletal-related event was 7 months. We created a score based on four factors used to predict the overall survival from the diagnosis of bone metastases: age >65 years, non-adenocarcinoma histology, ECOG Performance Status >2, concomitant presence of visceral metastases at the bone metastases diagnosis. The presence of more than two of these factors is associated with a worse prognosis.This study demonstrates that patients affected by Non-Small Cell Lung Cancer with bone metastases represent a heterogeneous population in terms of risk of skeletal events and survival.
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Affiliation(s)
| | - Santini Daniele
- Department of Medical Oncology, University Campus Bio-Medico, Rome, Italy
| | | | - Barni Sandro
- Division of Medical Oncology, Department of Oncology, Azienda Ospedaliera Treviglio, Piazzale Ospedale 1, 24047, Treviglio, BG, Italy
| | | | | | | | - Falcone Alfredo
- Unit of Medical Oncology 2, Department of Translational Research and New Technologies in Medicine and Surgery, Azienda Ospedaliero-Universitaria Pisana and University of Pisa, Via Roma 67, 56126 Pisa, Italy
| | | | - Ferraù Francesco
- Division of Medical Oncology, S.Vincenzo Hospital, Taormina, Italy
| | | | - Galetta Domenico
- Medical Oncology Unit, Clinical Cancer Center, Istituto Tumori "Giovanni Paolo II", Viale Orazio Flacco 65, 70124 Bari, Italy
| | | | - Moscetti Luca
- Department of Oncology and Hematology, 'Belcolle' Hospital, Viterbo, Italy
| | | | - La Verde Nicla
- Department of Oncology, A.O. Fatebenefratelli e Oftalmico, Corso di Porta Nuova 23, 20121, Milan, Italy
| | | | - Ibrahim Toni
- Osteoncology and Rare Tumors Center, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola (FC), Italy
| | | | - Petrelli Fausto
- Division of Medical Oncology, Department of Oncology, Azienda Ospedaliera Treviglio, Piazzale Ospedale 1, 24047, Treviglio, BG, Italy
| | | | - Vasile Enrico
- Unit of Medical Oncology 2, Department of Translational Research and New Technologies in Medicine and Surgery, Azienda Ospedaliero-Universitaria Pisana and University of Pisa, Via Roma 67, 56126 Pisa, Italy
| | | | - Ginocchi Laura
- Unit of Medical Oncology 2, Department of Translational Research and New Technologies in Medicine and Surgery, Azienda Ospedaliero-Universitaria Pisana and University of Pisa, Via Roma 67, 56126 Pisa, Italy
| | | | - Ottaviani Davide
- Department of Medical Oncology, Presidio Sanitario Gradenigo, Turin, Italy
| | | | - Longo Flavia
- Department of Molecular Medicine, University Sapienza, Rome, Italy
| | | | - Ortega Cinzia
- Department of Medical Oncology, Institute for Cancer Research &Treatment (IRCC), Candiolo, Torino, Italy
| | | | - Russo Antonio
- Department of Surgery and Oncology, Section of Medical Oncology, University of Palermo, Palermo, Italy
| | | | - Badalamenti Giuseppe
- Department of Surgery and Oncology, Section of Medical Oncology, University of Palermo, Palermo, Italy
| | | | - Collovà Elena
- Medical Oncology, AO Ospedale Civile di Legnano, Italy
| | | | - Lanzetta Gaetano
- Istituto Neurotraumatologico Italiano, Unità Funzionale di Oncologia, Grottaferrata, Italy
| | | | | | | | - Adamo Vincenzo
- Department of Human Pathology, University of Messina, Messina, Italy ; Medical Oncology Unit, Azienda Ospedaliera Ospedali Riuniti Papardo-Piemonte, Messina, Italy
| | | | - De Marinis Filippo
- Division of Thoracic Oncology, European Institute of Oncology (IEO), Milan, Italy
| | | | | | | | | | - Mancuso Andrea
- Department of Medical Oncology, San Camillo and Forlanini Hospitals Rome, Italy
| | | | | | | | | | - Russano Marco
- Department of Medical Oncology, University Campus Bio-Medico, Rome, Italy
| | | | - M Sterpi
- Department of Medical Oncology, University Campus Bio-Medico, Rome, Italy
| | | | - Pantano Francesco
- Department of Medical Oncology, University Campus Bio-Medico, Rome, Italy
| | | | - Vincenzi Bruno
- Department of Medical Oncology, University Campus Bio-Medico, Rome, Italy
| | - Giuseppe Tonini
- Department of Medical Oncology, University Campus Bio-Medico, Rome, Italy
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Satolli MA, Buffoni L, Spadi R, Roato I. Gastric cancer: The times they are a-changin'. World J Gastrointest Oncol 2015; 7:303-16. [PMID: 26600930 PMCID: PMC4644853 DOI: 10.4251/wjgo.v7.i11.303] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 07/15/2015] [Accepted: 08/13/2015] [Indexed: 02/05/2023] Open
Abstract
Gastric cancer is the third leading cause of cancer death worldwide. Even though during these last decades gastric cancer incidence decreased in Western countries, it remains endemic and with a high incidence in Eastern countries. The survival in advanced and metastatic stage of gastric cancer is still very poor. Recently the Cancer Genoma Atlas Research Network identified four subtypes with different molecular profiles to classify gastric cancer in order to offer the optimal targeted therapies for pre-selected patients. Indeed, the key point is still the selection of patients for the right treatment, on basis of molecular tumor characterization. Since chemotherapy reached a plateau of efficacy for gastric cancer, the combination between cytotoxic therapy and biological agents gets a better prognosis and decreases chemotherapeutic toxicity. Currently, Trastuzumab in combination with platinum and fluorouracil is the only approved targeted therapy in the first line for c-erbB2 positive patients, whereas Ramucirumab is the only approved targeted agent for patients with metastatic gastric cancer. New perspectives for an effective treatment derived from the immunotherapeutic strategies. Here, we report an overview on gastric cancer treatments, with particular attention to recent advances in targeted therapies and in immunotherapeutic approach.
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Buffoni L, Consito L, Filippi AR, Ruffini E, Solidoro P, Bironzo P, Satolli MA, Schena M, Ciuffreda L. Advanced non-small cell lung cancer in elderly patients: A review. World J Respirol 2015; 5:102-111. [DOI: 10.5320/wjr.v5.i2.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Revised: 01/15/2015] [Accepted: 04/07/2015] [Indexed: 02/06/2023] Open
Abstract
Over 50% of patients diagnosed with non-small-cell lung cancer (NSCLC) are 65 years old while 30% exceed 70 years old. Comparing elderly patients to their younger counterpart they poorly tolerate chemotherapy due to progressive reduction of organ function and age-related co-existing pathologies. Due to this reason elderly are usually excluded from platinum-based chemotherapy, which still represent the standard of care for advanced NSCLC. In every-day practice, single-agent schedule with a third-generation drug is the recommended option for elderly patients with advanced NSCLC. A modest increase in toxicity for elderly patients has been demonstrated by subgroup analyses concluding for platinum-based combination chemotherapy being similar in young patients and fit elderly. Even though the cited evidence, feasibility of chemotherapy based on platinum remains an open question. Prospective randomised trials are warranted in order to change guide lines and give the clinicians a new therapeutic option. Recent emerging role of molecular target in selecting patients for new targeted therapies suggest dedicated trials for elderly patients. The same is for more accurate evaluation of elderly patients with increasing evidence for a comprehensive geriatric assessment as a valid tool for customized treatment in NSCLC elderly patients. Suitable evidences for the treatment of elderly patients affected by advanced NSCLC together with more appropriate and validated tools for patients selection are reviewed along the manuscript.
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28
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Santoni M, Conti A, Procopio G, Porta C, Ibrahim T, Barni S, Guida FM, Fontana A, Berruti A, Berardi R, Massari F, Vincenzi B, Ortega C, Ottaviani D, Carteni G, Lanzetta G, De Lisi D, Silvestris N, Satolli MA, Collovà E, Russo A, Badalamenti G, Luzi Fedeli S, Tanca FM, Adamo V, Maiello E, Sabbatini R, Felici A, Cinieri S, Montironi R, Bracarda S, Tonini G, Cascinu S, Santini D. Bone metastases in patients with metastatic renal cell carcinoma: are they always associated with poor prognosis? J Exp Clin Cancer Res 2015; 34:10. [PMID: 25651794 PMCID: PMC4328067 DOI: 10.1186/s13046-015-0122-0] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2014] [Accepted: 01/03/2015] [Indexed: 01/21/2023]
Abstract
Purpose Aim of this study was to investigate for the presence of existing prognostic factors in patients with bone metastases (BMs) from RCC since bone represents an unfavorable site of metastasis for renal cell carcinoma (mRCC). Materials and methods Data of patients with BMs from RCC were retrospectively collected. Age, sex, ECOG-Performance Status (PS), MSKCC group, tumor histology, presence of concomitant metastases to other sites, time from nephrectomy to bone metastases (TTBM, classified into three groups: <1 year, between 1 and 5 years and >5 years) and time from BMs to skeletal-related event (SRE) were included in the Cox analysis to investigate their prognostic relevance. Results 470 patients were enrolled in this analysis. In 19 patients (4%),bone was the only metastatic site; 277 patients had concomitant metastases in other sites. Median time to BMs was 16 months (range 0 − 44y) with Median OS of 17 months. Number of metastatic sites (including bone, p = 0.01), concomitant metastases, high Fuhrman grade (p < 0.001) and non-clear cell histology (p = 0.013) were significantly associated with poor prognosis. Patients with TTBM >5 years had longer OS (22 months) compared to patients with TTBM <1 year (13 months) or between 1 and 5 years (19 months) from nephrectomy (p < 0.001), no difference was found between these two last groups (p = 0.18). At multivariate analysis, ECOG-PS, MSKCC group and concomitant lung or lymph node metastases were independent predictors of OS in patients with BMs. Conclusions Our study suggest that age, ECOG-PS, histology, MSKCC score, TTBM and the presence of concomitant metastases should be considered in order to optimize the management of RCC patients with BMs.
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Affiliation(s)
- Matteo Santoni
- Department of Medical Oncology, AOU Ospedali Riuniti, Università Politecnica delle, Marche, Ancona, Italy.
| | - Alessandro Conti
- Department of Clinical and Specialist Sciences, Urology, Università Politecnica delle Marche, Ancona, Italy.
| | - Giuseppe Procopio
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
| | - Camillo Porta
- Division of Medical Oncology, I.R.C.C.S. San Matteo University Hospital Foundation, Pavia, Italy.
| | - Toni Ibrahim
- Osteoncology and Rare Tumors Center, IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), Meldola, FC, Italy.
| | - Sandro Barni
- Medical Oncology Department, Azienda Ospedaliera Treviglio-Caravaggio, Treviglio, Italy.
| | | | - Andrea Fontana
- Unit of Medical Oncology 2, Istituto Toscano Tumori, Azienda-Ospedaliero-Universitaria Pisana, Pisa, Italy.
| | - Alfredo Berruti
- Dipartimento di Specialità Medico-Chirurgiche, Medical Oncology, Scienze Radiologiche e Sanità Pubblica, Università degli Studi di Brescia, Azienda Ospedaliera Spedali Civili, Brescia, Italy.
| | - Rossana Berardi
- Department of Medical Oncology, AOU Ospedali Riuniti, Università Politecnica delle, Marche, Ancona, Italy.
| | - Francesco Massari
- Department of Medical Oncology, "G.B. Rossi" Academic Hospital, Azienda Ospedaliera Universitaria Integrata, University of Verona, Verona, Italy.
| | - Bruno Vincenzi
- Department of Medical Oncology, Campus Bio-Medico University of Rome, Rome, Italy.
| | - Cinzia Ortega
- Department of Medical Oncology, Institute for Cancer Research & Treatment (IRCC), Candiolo, Torino, Italy.
| | - Davide Ottaviani
- Department of Medical Oncology, Presidio Sanitario Gradenigo, Turin, Italy.
| | - Giacomo Carteni
- Department of Medical Oncology, Cardarelli Hospital, Naples, Italy.
| | - Gaetano Lanzetta
- Department of Neurological Sciences, Neuromed Institute, IRCSS, Pozzilli, IS, Italy. .,Istituto Neurotraumatologico Italiano, Unità Funzionale di Oncologia, Grottaferrata, Italy.
| | - Delia De Lisi
- Department of Medical Oncology, Campus Bio-Medico University of Rome, Rome, Italy.
| | - Nicola Silvestris
- Medical Oncology Unit, National Cancer Research Centre "Giovanni Paolo II", Bari, Italy.
| | - Maria Antonietta Satolli
- Department of Oncology, University of Turin, Medical Oncology 1, AOU Città della Salute e della Scienza, Turin, Italy.
| | - Elena Collovà
- Division of Medical Oncology, Hospital of Legnano, Milan, Italy.
| | - Antonio Russo
- Department of Surgery and Oncology, Section of Medical Oncology, University of Palermo, Palermo, Italy.
| | - Giuseppe Badalamenti
- Department of Surgery and Oncology, Section of Medical Oncology, University of Palermo, Palermo, Italy.
| | - Stefano Luzi Fedeli
- Department of Medical Oncology, AOU Ospedali Riuniti, Università Politecnica delle Marche, Presidio San Salvatore, Pesaro, Italy.
| | | | - Vincenzo Adamo
- Department of Human Pathology, Medical Oncology Unit AOOR Papardo-Piemonte, University of Messina, Messina, Italy.
| | - Evaristo Maiello
- Oncology Unit, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, FG, Italy.
| | - Roberto Sabbatini
- Dipartimento Integrato di Oncologia ed Ematologia, Medical Oncology Division, Università degli Studi di Modena e Reggio Emilia, Modena, Italy.
| | - Alessandra Felici
- Department of Medical Oncology, Regina Elena National Cancer Institute, Rome, Italy.
| | - Saverio Cinieri
- Medical Oncology Department & Breast Unit - Hospital of Brindisi and Medical Oncology Department - European Institute of Oncology, Milan, Italy.
| | - Rodolfo Montironi
- Section of Pathological Anatomy, Polytechnic University of the Marche Region, School of Medicine, United Hospitals, Ancona, Italy.
| | - Sergio Bracarda
- Department of Oncology, USL-8, Ospedale San Donato, Arezzo, Italy.
| | - Giuseppe Tonini
- Department of Medical Oncology, Campus Bio-Medico University of Rome, Rome, Italy.
| | - Stefano Cascinu
- Department of Medical Oncology, AOU Ospedali Riuniti, Università Politecnica delle, Marche, Ancona, Italy.
| | - Daniele Santini
- Department of Medical Oncology, Campus Bio-Medico University of Rome, Rome, Italy.
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29
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Occhipinti S, Sponton L, Rolla S, Caorsi C, Novarino A, Donadio M, Bustreo S, Satolli MA, Pecchioni C, Marchini C, Amici A, Cavallo F, Cappello P, Pierobon D, Novelli F, Giovarelli M. Chimeric rat/human HER2 efficiently circumvents HER2 tolerance in cancer patients. Clin Cancer Res 2014; 20:2910-21. [PMID: 24668647 DOI: 10.1158/1078-0432.ccr-13-2663] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Despite the great success of HER2 vaccine strategies in animal models, effective clinical results have not yet been obtained. We studied the feasibility of using DNA coding for chimeric rat/human HER2 as a tool to break the unresponsiveness of T cells from patients with HER2-overexpressing tumors (HER2-CP). EXPERIMENTAL DESIGN Dendritic cells (DCs) generated from patients with HER2-overexpressing breast (n = 28) and pancreatic (n = 16) cancer were transfected with DNA plasmids that express human HER2 or heterologous rat sequences in separate plasmids or as chimeric constructs encoding rat/human HER2 fusion proteins and used to activate autologous T cells. Activation was evaluated by IFN-γ ELISPOT assay, perforin expression, and ability to halt HER2+ tumor growth in vivo. RESULTS Specific sustained proliferation and IFN-γ production by CD4 and CD8 T cells from HER2-CP was observed after stimulation with autologous DCs transfected with chimeric rat/human HER2 plasmids. Instead, T cells from healthy donors (n = 22) could be easily stimulated with autologous DCs transfected with any human, rat, or chimeric rat/human HER2 plasmid. Chimeric HER2-transfected DCs from HER2-CP were also able to induce a sustained T-cell response that significantly hindered the in vivo growth of HER2(+) tumors. The efficacy of chimeric plasmids in overcoming tumor-induced T-cell dysfunction relies on their ability to circumvent suppressor effects exerted by regulatory T cells (Treg) and/or interleukin (IL)-10 and TGF-β1. CONCLUSIONS These results provide the proof of concept that chimeric rat/human HER2 plasmids can be used as effective vaccines for any HER2-CP with the advantage of being not limited to specific MHC. Clin Cancer Res; 20(11); 2910-21. ©2014 AACR.
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Affiliation(s)
- Sergio Occhipinti
- Authors' Affiliations: Departments of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy; Center for Experimental Research and Medical Studies (CERMS), AO Città della Salute e della Scienza di Torino, Torino, Italy; Immunogenetic and Transplant Biology Service, AO Città della Salute e della Scienza Torino, Italy; Division of Oncology, Subalpine OncoHematology Cancer Center (COES), AO Città della Salute e della Scienza di Torino, Torino, Italy; Department of Oncology, University of Turin, Orbassano, Italy; Department of Medical Sciences, University of Torino, Torino, Italy, Department of Molecular Cellular and Animal Biology, University of Camerino, Camerino, ItalyAuthors' Affiliations: Departments of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy; Center for Experimental Research and Medical Studies (CERMS), AO Città della Salute e della Scienza di Torino, Torino, Italy; Immunogenetic and Transplant Biology Service, AO Città della Salute e della Scienza Torino, Italy; Division of Oncology, Subalpine OncoHematology Cancer Center (COES), AO Città della Salute e della Scienza di Torino, Torino, Italy; Department of Oncology, University of Turin, Orbassano, Italy; Department of Medical Sciences, University of Torino, Torino, Italy, Department of Molecular Cellular and Animal Biology, University of Camerino, Camerino, Italy
| | - Laura Sponton
- Authors' Affiliations: Departments of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy; Center for Experimental Research and Medical Studies (CERMS), AO Città della Salute e della Scienza di Torino, Torino, Italy; Immunogenetic and Transplant Biology Service, AO Città della Salute e della Scienza Torino, Italy; Division of Oncology, Subalpine OncoHematology Cancer Center (COES), AO Città della Salute e della Scienza di Torino, Torino, Italy; Department of Oncology, University of Turin, Orbassano, Italy; Department of Medical Sciences, University of Torino, Torino, Italy, Department of Molecular Cellular and Animal Biology, University of Camerino, Camerino, ItalyAuthors' Affiliations: Departments of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy; Center for Experimental Research and Medical Studies (CERMS), AO Città della Salute e della Scienza di Torino, Torino, Italy; Immunogenetic and Transplant Biology Service, AO Città della Salute e della Scienza Torino, Italy; Division of Oncology, Subalpine OncoHematology Cancer Center (COES), AO Città della Salute e della Scienza di Torino, Torino, Italy; Department of Oncology, University of Turin, Orbassano, Italy; Department of Medical Sciences, University of Torino, Torino, Italy, Department of Molecular Cellular and Animal Biology, University of Camerino, Camerino, Italy
| | - Simona Rolla
- Authors' Affiliations: Departments of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy; Center for Experimental Research and Medical Studies (CERMS), AO Città della Salute e della Scienza di Torino, Torino, Italy; Immunogenetic and Transplant Biology Service, AO Città della Salute e della Scienza Torino, Italy; Division of Oncology, Subalpine OncoHematology Cancer Center (COES), AO Città della Salute e della Scienza di Torino, Torino, Italy; Department of Oncology, University of Turin, Orbassano, Italy; Department of Medical Sciences, University of Torino, Torino, Italy, Department of Molecular Cellular and Animal Biology, University of Camerino, Camerino, ItalyAuthors' Affiliations: Departments of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy; Center for Experimental Research and Medical Studies (CERMS), AO Città della Salute e della Scienza di Torino, Torino, Italy; Immunogenetic and Transplant Biology Service, AO Città della Salute e della Scienza Torino, Italy; Division of Oncology, Subalpine OncoHematology Cancer Center (COES), AO Città della Salute e della Scienza di Torino, Torino, Italy; Department of Oncology, University of Turin, Orbassano, Italy; Department of Medical Sciences, University of Torino, Torino, Italy, Department of Molecular Cellular and Animal Biology, University of Camerino, Camerino, Italy
| | - Cristiana Caorsi
- Authors' Affiliations: Departments of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy; Center for Experimental Research and Medical Studies (CERMS), AO Città della Salute e della Scienza di Torino, Torino, Italy; Immunogenetic and Transplant Biology Service, AO Città della Salute e della Scienza Torino, Italy; Division of Oncology, Subalpine OncoHematology Cancer Center (COES), AO Città della Salute e della Scienza di Torino, Torino, Italy; Department of Oncology, University of Turin, Orbassano, Italy; Department of Medical Sciences, University of Torino, Torino, Italy, Department of Molecular Cellular and Animal Biology, University of Camerino, Camerino, Italy
| | - Anna Novarino
- Authors' Affiliations: Departments of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy; Center for Experimental Research and Medical Studies (CERMS), AO Città della Salute e della Scienza di Torino, Torino, Italy; Immunogenetic and Transplant Biology Service, AO Città della Salute e della Scienza Torino, Italy; Division of Oncology, Subalpine OncoHematology Cancer Center (COES), AO Città della Salute e della Scienza di Torino, Torino, Italy; Department of Oncology, University of Turin, Orbassano, Italy; Department of Medical Sciences, University of Torino, Torino, Italy, Department of Molecular Cellular and Animal Biology, University of Camerino, Camerino, Italy
| | - Michela Donadio
- Authors' Affiliations: Departments of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy; Center for Experimental Research and Medical Studies (CERMS), AO Città della Salute e della Scienza di Torino, Torino, Italy; Immunogenetic and Transplant Biology Service, AO Città della Salute e della Scienza Torino, Italy; Division of Oncology, Subalpine OncoHematology Cancer Center (COES), AO Città della Salute e della Scienza di Torino, Torino, Italy; Department of Oncology, University of Turin, Orbassano, Italy; Department of Medical Sciences, University of Torino, Torino, Italy, Department of Molecular Cellular and Animal Biology, University of Camerino, Camerino, Italy
| | - Sara Bustreo
- Authors' Affiliations: Departments of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy; Center for Experimental Research and Medical Studies (CERMS), AO Città della Salute e della Scienza di Torino, Torino, Italy; Immunogenetic and Transplant Biology Service, AO Città della Salute e della Scienza Torino, Italy; Division of Oncology, Subalpine OncoHematology Cancer Center (COES), AO Città della Salute e della Scienza di Torino, Torino, Italy; Department of Oncology, University of Turin, Orbassano, Italy; Department of Medical Sciences, University of Torino, Torino, Italy, Department of Molecular Cellular and Animal Biology, University of Camerino, Camerino, Italy
| | - Maria Antonietta Satolli
- Authors' Affiliations: Departments of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy; Center for Experimental Research and Medical Studies (CERMS), AO Città della Salute e della Scienza di Torino, Torino, Italy; Immunogenetic and Transplant Biology Service, AO Città della Salute e della Scienza Torino, Italy; Division of Oncology, Subalpine OncoHematology Cancer Center (COES), AO Città della Salute e della Scienza di Torino, Torino, Italy; Department of Oncology, University of Turin, Orbassano, Italy; Department of Medical Sciences, University of Torino, Torino, Italy, Department of Molecular Cellular and Animal Biology, University of Camerino, Camerino, Italy
| | - Carla Pecchioni
- Authors' Affiliations: Departments of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy; Center for Experimental Research and Medical Studies (CERMS), AO Città della Salute e della Scienza di Torino, Torino, Italy; Immunogenetic and Transplant Biology Service, AO Città della Salute e della Scienza Torino, Italy; Division of Oncology, Subalpine OncoHematology Cancer Center (COES), AO Città della Salute e della Scienza di Torino, Torino, Italy; Department of Oncology, University of Turin, Orbassano, Italy; Department of Medical Sciences, University of Torino, Torino, Italy, Department of Molecular Cellular and Animal Biology, University of Camerino, Camerino, Italy
| | - Cristina Marchini
- Authors' Affiliations: Departments of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy; Center for Experimental Research and Medical Studies (CERMS), AO Città della Salute e della Scienza di Torino, Torino, Italy; Immunogenetic and Transplant Biology Service, AO Città della Salute e della Scienza Torino, Italy; Division of Oncology, Subalpine OncoHematology Cancer Center (COES), AO Città della Salute e della Scienza di Torino, Torino, Italy; Department of Oncology, University of Turin, Orbassano, Italy; Department of Medical Sciences, University of Torino, Torino, Italy, Department of Molecular Cellular and Animal Biology, University of Camerino, Camerino, Italy
| | - Augusto Amici
- Authors' Affiliations: Departments of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy; Center for Experimental Research and Medical Studies (CERMS), AO Città della Salute e della Scienza di Torino, Torino, Italy; Immunogenetic and Transplant Biology Service, AO Città della Salute e della Scienza Torino, Italy; Division of Oncology, Subalpine OncoHematology Cancer Center (COES), AO Città della Salute e della Scienza di Torino, Torino, Italy; Department of Oncology, University of Turin, Orbassano, Italy; Department of Medical Sciences, University of Torino, Torino, Italy, Department of Molecular Cellular and Animal Biology, University of Camerino, Camerino, Italy
| | - Federica Cavallo
- Authors' Affiliations: Departments of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy; Center for Experimental Research and Medical Studies (CERMS), AO Città della Salute e della Scienza di Torino, Torino, Italy; Immunogenetic and Transplant Biology Service, AO Città della Salute e della Scienza Torino, Italy; Division of Oncology, Subalpine OncoHematology Cancer Center (COES), AO Città della Salute e della Scienza di Torino, Torino, Italy; Department of Oncology, University of Turin, Orbassano, Italy; Department of Medical Sciences, University of Torino, Torino, Italy, Department of Molecular Cellular and Animal Biology, University of Camerino, Camerino, Italy
| | - Paola Cappello
- Authors' Affiliations: Departments of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy; Center for Experimental Research and Medical Studies (CERMS), AO Città della Salute e della Scienza di Torino, Torino, Italy; Immunogenetic and Transplant Biology Service, AO Città della Salute e della Scienza Torino, Italy; Division of Oncology, Subalpine OncoHematology Cancer Center (COES), AO Città della Salute e della Scienza di Torino, Torino, Italy; Department of Oncology, University of Turin, Orbassano, Italy; Department of Medical Sciences, University of Torino, Torino, Italy, Department of Molecular Cellular and Animal Biology, University of Camerino, Camerino, ItalyAuthors' Affiliations: Departments of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy; Center for Experimental Research and Medical Studies (CERMS), AO Città della Salute e della Scienza di Torino, Torino, Italy; Immunogenetic and Transplant Biology Service, AO Città della Salute e della Scienza Torino, Italy; Division of Oncology, Subalpine OncoHematology Cancer Center (COES), AO Città della Salute e della Scienza di Torino, Torino, Italy; Department of Oncology, University of Turin, Orbassano, Italy; Department of Medical Sciences, University of Torino, Torino, Italy, Department of Molecular Cellular and Animal Biology, University of Camerino, Camerino, Italy
| | - Daniele Pierobon
- Authors' Affiliations: Departments of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy; Center for Experimental Research and Medical Studies (CERMS), AO Città della Salute e della Scienza di Torino, Torino, Italy; Immunogenetic and Transplant Biology Service, AO Città della Salute e della Scienza Torino, Italy; Division of Oncology, Subalpine OncoHematology Cancer Center (COES), AO Città della Salute e della Scienza di Torino, Torino, Italy; Department of Oncology, University of Turin, Orbassano, Italy; Department of Medical Sciences, University of Torino, Torino, Italy, Department of Molecular Cellular and Animal Biology, University of Camerino, Camerino, ItalyAuthors' Affiliations: Departments of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy; Center for Experimental Research and Medical Studies (CERMS), AO Città della Salute e della Scienza di Torino, Torino, Italy; Immunogenetic and Transplant Biology Service, AO Città della Salute e della Scienza Torino, Italy; Division of Oncology, Subalpine OncoHematology Cancer Center (COES), AO Città della Salute e della Scienza di Torino, Torino, Italy; Department of Oncology, University of Turin, Orbassano, Italy; Department of Medical Sciences, University of Torino, Torino, Italy, Department of Molecular Cellular and Animal Biology, University of Camerino, Camerino, Italy
| | - Francesco Novelli
- Authors' Affiliations: Departments of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy; Center for Experimental Research and Medical Studies (CERMS), AO Città della Salute e della Scienza di Torino, Torino, Italy; Immunogenetic and Transplant Biology Service, AO Città della Salute e della Scienza Torino, Italy; Division of Oncology, Subalpine OncoHematology Cancer Center (COES), AO Città della Salute e della Scienza di Torino, Torino, Italy; Department of Oncology, University of Turin, Orbassano, Italy; Department of Medical Sciences, University of Torino, Torino, Italy, Department of Molecular Cellular and Animal Biology, University of Camerino, Camerino, ItalyAuthors' Affiliations: Departments of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy; Center for Experimental Research and Medical Studies (CERMS), AO Città della Salute e della Scienza di Torino, Torino, Italy; Immunogenetic and Transplant Biology Service, AO Città della Salute e della Scienza Torino, Italy; Division of Oncology, Subalpine OncoHematology Cancer Center (COES), AO Città della Salute e della Scienza di Torino, Torino, Italy; Department of Oncology, University of Turin, Orbassano, Italy; Department of Medical Sciences, University of Torino, Torino, Italy, Department of Molecular Cellular and Animal Biology, University of Camerino, Camerino, Italy
| | - Mirella Giovarelli
- Authors' Affiliations: Departments of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy; Center for Experimental Research and Medical Studies (CERMS), AO Città della Salute e della Scienza di Torino, Torino, Italy; Immunogenetic and Transplant Biology Service, AO Città della Salute e della Scienza Torino, Italy; Division of Oncology, Subalpine OncoHematology Cancer Center (COES), AO Città della Salute e della Scienza di Torino, Torino, Italy; Department of Oncology, University of Turin, Orbassano, Italy; Department of Medical Sciences, University of Torino, Torino, Italy, Department of Molecular Cellular and Animal Biology, University of Camerino, Camerino, ItalyAuthors' Affiliations: Departments of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy; Center for Experimental Research and Medical Studies (CERMS), AO Città della Salute e della Scienza di Torino, Torino, Italy; Immunogenetic and Transplant Biology Service, AO Città della Salute e della Scienza Torino, Italy; Division of Oncology, Subalpine OncoHematology Cancer Center (COES), AO Città della Salute e della Scienza di Torino, Torino, Italy; Department of Oncology, University of Turin, Orbassano, Italy; Department of Medical Sciences, University of Torino, Torino, Italy, Department of Molecular Cellular and Animal Biology, University of Camerino, Camerino, Italy
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Silvestris N, Pantano F, Ibrahim T, Gamucci T, De Vita F, Di Palma T, Pedrazzoli P, Barni S, Bernardo A, Febbraro A, Satolli MA, Bertocchi P, Catalano V, Giommoni E, Comandone A, Maiello E, Riccardi F, Ferrara R, Trogu A, Berardi R, Leo S, Bertolini A, Angelini F, Cinieri S, Russo A, Pisconti S, Brunetti AE, Azzariti A, Santini D. Natural history of malignant bone disease in gastric cancer: final results of a multicenter bone metastasis survey. PLoS One 2013; 8:e74402. [PMID: 24204569 PMCID: PMC3810275 DOI: 10.1371/journal.pone.0074402] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Accepted: 08/01/2013] [Indexed: 02/06/2023] Open
Abstract
Background Bone metastasis represents an increasing clinical problem in advanced gastric cancer (GC) as disease-related survival improves. In literature, few data on the natural history of bone disease in GC are available. Patients and Methods Data on clinicopathology, skeletal outcomes, skeletal-related events (SREs), and bone-directed therapies for 208 deceased GC patients with evidence of bone metastasis were statistically analyzed. Results Median time to bone metastasis was 8 months (CI 95%, 6.125–9.875 months) considering all included patients. Median number of SREs/patient was one. Less than half of the patients (31%) experienced at least one and only 4 and 2% experienced at least two and three events, respectively. Median times to first and second SRE were 2 and 4 months, respectively. Median survival was 6 months after bone metastasis diagnosis and 3 months after first SRE. Median survival in patients who did not experience SREs was 5 months. Among patients who received zoledronic acid before the first SRE, the median time to appearance of first SRE was significantly prolonged compared to control (7 months vs 4 months for control; P: 0.0005). Conclusions To our knowledge, this retrospective analysis is the largest multicenter study to demonstrate that bone metastases from GC are not so rare, are commonly aggressive and result in relatively early onset of SREs in the majority of patients. Indeed, our large study, which included 90 patients treated with ZOL, showed, for the first time in literature, a significant extension of time to first SRE and increase in the median survival time after diagnosis of bone metastasis. Taken together, these data may support the beneficial effects of ZOL in GC patients.
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Affiliation(s)
- Nicola Silvestris
- Medical Oncology Unit, National Cancer Research Centre Istituto Tumori “Giovanni Paolo II”, Bari, Italy
- * E-mail:
| | | | - Toni Ibrahim
- Osteoncology and Rare Tumors Center, IRCCS -Romagnolo Scientific Institute for the Study and Treatment of Cancer, Meldola, Italy
| | - Teresa Gamucci
- Medical Oncology Unit, Hospital of Frosinone, Frosinone, Italy
| | | | | | - Paolo Pedrazzoli
- Department of Oncology-Hematology, Hospital of Pavia, Pavia, Italy
| | - Sandro Barni
- Division of Medical Oncology, Treviglio-Caravaggio Hospital, Treviglio, Italy
| | - Antonio Bernardo
- Operative Unit of Oncology - IRCCS Fondazione Maugeri, Pavia, Italy
| | | | | | - Paola Bertocchi
- Department of Medical Oncology, Fondazione Poliambulanza of Brescia, Brescia, Italy
| | | | - Elisa Giommoni
- Medical Oncology Unit, Hospital Careggi, Florence, Italy
| | - Alessandro Comandone
- Department of Oncology, Gradenigo Hospital and Gruppo Piemontese Sarcomi, Turin, Italy
| | - Evaristo Maiello
- Medical Oncology Unit, Hospital “Casa Sollievo della Sofferenza”, San Giovanni Rotondo, Italy
| | | | | | - Antonio Trogu
- Medical Oncology Unit, Hospital of Aosta, Aosta, Italy
| | | | - Silvana Leo
- Medical Oncology Unit, Hospital of Lecce, Lecce, Italy
| | | | - Francesco Angelini
- Medical Oncology Unit, Hospital Regina Apostolorum, Albano Laziale, Italy
| | - Saverio Cinieri
- Medical Oncology Department & Breast Unit – Hospital of Brindisi and Medical Oncology Department – European Institute of Oncology, Milan, Italy
| | - Antonio Russo
- Medical Oncology Unit, University of Palermo, Palermo, Italy
| | | | - Anna Elisabetta Brunetti
- Medical Oncology Unit, National Cancer Research Centre Istituto Tumori “Giovanni Paolo II”, Bari, Italy
| | - Amalia Azzariti
- Clinical and Preclinical Pharmacology Laboratory, National Cancer Research Centre Istituto Tumori “Giovanni Paolo II”, Bari, Italy
| | - Daniele Santini
- Medical Oncology Unit, University Campus Bio-Medico, Roma, Italy
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D'Amico L, Satolli MA, Mecca C, Castiglione A, Ceccarelli M, D'Amelio P, Garino M, De Giuli M, Sandrucci S, Ferracini R, Roato I. Bone metastases in gastric cancer follow a RANKL-independent mechanism. Oncol Rep 2013; 29:1453-8. [PMID: 23404437 DOI: 10.3892/or.2013.2280] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2012] [Accepted: 12/27/2012] [Indexed: 01/06/2023] Open
Abstract
Gastric cancer is one of the most common and lethal malignancies worldwide. Bone metastases in gastric cancer are less common than in other solid tumors, but when they occur the prognosis is generally poor. Increased osteoclastogenesis and osteoclast activity are common features in bone metastases caused by different osteotropic cancer. We investigated osteoclastogenesis and its mechanisms in gastric cancer by enrolling 31 newly diagnosed gastric cancer patients and 45 healthy controls. We studied in vitro osteoclastogenesis in the peripheral blood mononuclear cell cultures of patients and controls, showing spontaneous osteoclastogenesis for half of the patients. This osteoclastogenesis was RANKL- and TNF-α-independent. We analyzed primary tumor and bone metastatic tissues of gastric cancer for the expression of genes involved in osteoclastogenesis. The expression of transforming growth factor-β (TGF-β), osteoprotegerin (OPG), IL-7 and dickkopf-1 (DKK-1) was higher in primary tumors than in bone metastases. RANKL was not detectable in primary tumor or in bone metastatic tissue. The serum RANKL level was significantly higher in healthy controls than in patients, and it was not related to osteoclastogenesis, thereby suggesting that RANKL is not involved in the bone metastatic mechanisms in gastric cancer. We hypothesized a role of RANKL in angiogenesis, thus we compared the serum levels of RANKL to those of VEGF, since VEGF is directly related to angiogenesis. Different from RANKL, the VEGF serum levels were higher in gastric patients than in controls, suggesting a block of the angiogenesis inhibition due to RANKL. RANKL and VEGF serum levels were not predictive of overall survival in our cohort of gastric patients.
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Affiliation(s)
- Lucia D'Amico
- CeRMS (Center for Experimental Research and Medical Studies), Department of Medical Oncology, San Giovanni Battista Hospital, and Department of Surgical and Medical Discplines, University of Turin, Turin, Italy
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Vizio B, Mauri FA, Prati A, Trivedi P, Giacobino A, Novarino A, Satolli MA, Ciuffreda L, Camandona M, Gasparri G, Bellone G. Comparative evaluation of cancer stem cell markers in normal pancreas and pancreatic ductal adenocarcinoma. Oncol Rep 2011; 27:69-76. [PMID: 21922151 DOI: 10.3892/or.2011.1461] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2011] [Accepted: 04/20/2011] [Indexed: 11/06/2022] Open
Abstract
Chemoresistance and self-renewal of cancer stem cells (CSC), found in many tumors including pancreatic ductal adenocarcinoma (PDAC), are believed to underlie tumor mass regrowth. The distribution of cells carrying the putative stem-cell markers CD133, Nestin, Notch1-4, Jagged1 and 2, ABCG2 and aldehyde dehydrogenase (ALDH1) was assessed immunohistochemically using PDAC and normal pancreas tissue microarrays. The immunoreactivity was semi-quantitatively graded against the normal pancreas and was correlated with the differentiation grade and disease stage. No statistical significant differences were found between normal pancreas and PDAC in the expression of Nestin, Notch1, 3 and 4, ABCG2 or ALDH1. Notch2 and Jagged1 and 2 expression were increased in PDAC. CD133-positive cells were above-normal in PDAC, but the difference was not statistically significant. Nestin, Notch1-4, Jagged1, ABCG2 and ALDH1 immunostaining scores were not correlated with tumor grade or disease stage. CD133 and Notch2 expression was significantly inversely correlated with tumor grade, but not disease stage. Notch3 immunostaining positively correlated with tumor stage, but not with differentiation grade. Jagged2 protein expression correlated inversely with disease stage, but not with tumor grade. From the clinical standpoint, improved delineation of the tumor CSC signature, putatively responsible for tumor initiation and recurrence after initial response to chemotherapy, may offer novel therapeutic targets for this highly lethal cancer.
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Affiliation(s)
- Barbara Vizio
- Department of Clinical Physiopathology, University of Turin, and Department of Medical Oncology, Azienda Ospedaliera Universitaria San Giovanni Battista, Turin, Italy
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Santini D, Vincenzi B, Adamo V, Addeo R, Fusco V, Russo A, Montemurro F, Roato I, Redana S, Lanzetta G, Satolli MA, Berruti A, Leoni V, Galluzzo S, Antimi M, Ferraro G, Rossi M, Del Prete S, Valerio MR, Marra M, Caraglia M, Tonini G. Cigarette smoking habit does not reduce the benefit from first line trastuzumab-based treatment in advanced breast cancer patients. Oncol Rep 2011; 25:1545-8. [PMID: 21455582 DOI: 10.3892/or.2011.1235] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2009] [Accepted: 11/27/2009] [Indexed: 11/06/2022] Open
Abstract
Many ErbB2-positive cancers may show intrinsic resistance, and the frequent development of acquired resistance to ErbB-targeted agents represents a substantial clinical problem. The constitutive NF-κB activation in some HER-2/neu positive breast cancer may represent a potential cause of resistance to trastuzumab therapy. Preclinical data revealed that 4-(N-Methyl-N-nitrosamino)-1-(3-pyridyl)-1-butanone (NNK), the tobacco-specific nitrosamine is able to enhance NF-κB DNA binding activity and theoretically to increase the resistance to trastuzumab. Two hundred and forty-eight women with pathologically confirmed, uni- or bidimensionally measurable, HER-2-positive metastatic breast cancer (MBC) treated with trastuzumab-based therapy as first line combination for metastatic disease were considered eligible. For all included patients data on smoking habit were detectable from medical records. We retrospectively analysed the smoking habits of 248 MBC patients and correlated these habits with activity and efficacy of trastuzumab-based therapy. No statistically significant difference in terms of response rate (RR), time to progression (TTP) and overall survival (OS) was identified between smokers (former plus active smokers) and never smokers. Moreover, no statistically significant difference in terms of RR, TTP and OS was identified either comparing active smokers and former smokers. Moreover, we did not observed any significant statistical difference in terms of TTP and OS between smokers ≥10 cigarettes/day and <10 cigarettes/day. This study clearly showed lack of any correlation between cigarette smoking habit and both activity and efficacy of trastuzumab-based first line therapy in metastatic HER2/neu positive breast cancer patients.
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Affiliation(s)
- Daniele Santini
- Department of Medical Oncology, University Campus Bio-Medico, Rome, Italy
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Bussolati B, Satolli MA, Camussi G. [The role of angiogenesis in renal carcinoma]. G Ital Nefrol 2008; 25:297-305. [PMID: 18473301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Renal cell carcinoma is characterized by intense angiogenesis associated with the inactivation of the von Hippel-Lindau oncosuppressor gene with consequent hyperexpression of proangiogenic factors. Functional and molecular characterization of renal tumor endothelial cells has demonstrated an increase in angiogenesis and cell survival. The proangiogenic phenotype was due to hyperactivation of the PI3K/Akt/mTor pathway, which downregulates the synthesis of the antiangiogenic factor thrombospondin-1. Moreover, renal tumor endothelial cells presented an immature and embryonic phenotype with expression of the embryonic kidney-specific gene PAX-2. It is conceivable that the endothelium present in renal carcinoma is heterogeneous, with a possible origin from adjacent vessels, resident or circulating stem cells, or from the tumor cells themselves. The relevance of the angiogenic process in renal carcinoma is underlined by the therapeutic effect of antiangiogenic drugs. Different drugs against VEGF, such as the anti-VEGF monoclonal antibody bevacizumab, and small molecule tyrosine-kinase inhibitors, such as sunitinib and sorafenib, showed a clinical effect in patients with metastatic carcinoma. However, antiangiogenic therapy, although beneficial, is not sufficient per se. These studies suggest a role for the angiogenic program in the growth and dissemination of renal carcinoma and indicate the need for new therapeutic strategies.
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MESH Headings
- Angiogenesis Inhibitors/therapeutic use
- Antibodies, Monoclonal/therapeutic use
- Antibodies, Monoclonal, Humanized
- Benzenesulfonates/therapeutic use
- Bevacizumab
- Carcinoma, Renal Cell/blood supply
- Carcinoma, Renal Cell/drug therapy
- Carcinoma, Renal Cell/genetics
- Carcinoma, Renal Cell/metabolism
- Drug Therapy, Combination
- Endothelial Growth Factors/biosynthesis
- Endothelial Growth Factors/genetics
- Endothelial Growth Factors/metabolism
- Endothelium, Vascular/metabolism
- Endothelium, Vascular/pathology
- Humans
- Indoles/therapeutic use
- Kidney Neoplasms/blood supply
- Kidney Neoplasms/drug therapy
- Kidney Neoplasms/genetics
- Kidney Neoplasms/metabolism
- Neovascularization, Pathologic/drug therapy
- Neovascularization, Pathologic/genetics
- Neovascularization, Pathologic/metabolism
- Niacinamide/analogs & derivatives
- PAX2 Transcription Factor/metabolism
- Phenotype
- Phenylurea Compounds
- Protein Kinase Inhibitors/therapeutic use
- Proto-Oncogene Proteins c-akt/metabolism
- Pyridines/therapeutic use
- Pyrroles/therapeutic use
- Sorafenib
- Sunitinib
- Thrombospondin 1/metabolism
- Vascular Endothelial Growth Factor Receptor-1/metabolism
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Affiliation(s)
- B Bussolati
- Laboratorio di Fisiopatologia Renale e Vascolare, Dipartimento di Medicina Interna e Centro Interdipartimentale di Biotecnologie, Ospedale Molinette, Università degli Studi, Corso Dogliotti 14, Turin, Italy.
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Sandrucci S, Mussa B, Goss M, Mistrangelo M, Satolli MA, Sapino A, Bellò M, Bisi G, Mussa A. Lymphoscintigraphic localization of sentinel node in early colorectal cancer: results of a monocentric study. J Surg Oncol 2007; 96:464-9. [PMID: 17929257 DOI: 10.1002/jso.20848] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND OBJECTIVES Evaluation of the feasibility of the sentinel node technique in early colorectal neoplasms and its overall accuracy in predicting nodal metastases. METHODS Thirty-five patients with colon or rectal lesions or degenerate polyps not radically excised by endoscopy were included. Lymphatic mapping was performed with 99mTc labeled albumin colloid injected submucosally by an endoscopic route the afternoon before the surgical procedure. The day of the intervention, 2.5% patent blue V dye (S.A.L.F: Italy) was injected circumferentially around the tumor. A hand held gamma detecting probe (Scintiprobe m100, Pol-Hi-Tech, Italy) was employed to detect "hot" nodes, in vivo and ex vivo. All sentinel nodes were embedded separately for haematoxylin and eosin staining. No IHC or PCR techniques were employed. RESULTS Sentinel lymph nodes (SLN) were successfully identified in 35 out of 35 patients. Concordance between SLN and nodal status was observed in 32 out of 35 cases (91.4%); four patients (11.4%) were upstaged. Three skip nodal metastases were observed (false-negative rate: 8.5%). CONCLUSIONS The sentinel node technique with blue dye and radiotracer seems valuable in early colorectal cancers detected by screening programs: a good organization and a learning curve are needed, as further multicentric studies.
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Affiliation(s)
- Sergio Sandrucci
- Oncologic Surgery, S. Giovanni Battista Hospital, University of Turin, Turin, Italy.
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Asioli S, Senetta R, Maldi E, D'Ambrosio E, Satolli MA, Bussolati G, Cassoni P. “Benign” metastatic meningioma: clinico-pathological analysis of one case metastasising to the lung and overview on the concepts of either primitive or metastatic meningiomas of the lung. Virchows Arch 2007; 450:591-4. [PMID: 17431673 DOI: 10.1007/s00428-007-0392-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [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: 02/08/2007] [Revised: 02/15/2007] [Accepted: 02/18/2007] [Indexed: 12/29/2022]
Abstract
Lung "metastases" of benign meningiomas are rarely described events of biological and clinical interest. We, here, report of a 70-year-old healthy woman found by CT scan to have multiple lesions, the two largest in the right lung on routine examination. Anamnesis revealed that the patient underwent a surgical resection of cerebral meningioma 12 years before. The larger lung lesion was a 3-cm node located in the right lung and was removed by wedge resection. Macroscopically, it showed well-defined borders, whitish colour and firm consistency; histologically, it was uniformly composed by spindle meningothelial cells arranged in fascicules including psammoma bodies. The morphological and immunohistochemical features of this lesion, together with the similarity with the original cerebral tumour and its indolent evolution, led to a final diagnosis of "benign" meningioma metastatic to the lung. Lung metastatic meningiomas may be a diagnostic challenge because of their unusual site of presentation and the possible confusion with primitive lung meningiomas or primary mesenchymal lung lesions. They represent a typical example of "benign" tumours that may implant to the lung similar to other tumours, definitely considered benign but reported to rarely present unusual secondary localization.
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Affiliation(s)
- Sofia Asioli
- Department of Biomedical Sciences and Human Oncology Molinette Hospital, University of Turin, Via Santena 7, 10100, Turin, Italy.
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Evangelista W, Satolli MA, Malossi A, Mussa B, Sandrucci S. Sentinel lymph node mapping in colorectal cancer: a feasibility study. Tumori 2002; 88:37-40. [PMID: 12004848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
AIMS AND BACKGROUND Sentinel lymph node (SLN) biopsy is currently used and investigated in melanoma and in breast cancer. Its utility in gastrointestinal malignancies is still under debate. The prognosis of colorectal cancer patients is strongly related to the lymphatic involvement. The aim of this study was to evaluate the feasibility of SLN mapping in colorectal cancer and to assess its impact on pathological staging and treatment. METHODS AND STUDY DESIGN We injected blue dye in 11 colorectal cancer patients during surgery. After resection the tumor specimen was examined to identify blue-stained lymph nodes and these lymph nodes were sent separately to the pathologist. Routine hematoxylin-eosin examination was performed on all nodes (including blue ones). No other techniques (eg immunohistochemistry or PCR) were performed. RESULTS Sentinel lymph nodes were successfully identified in 10 of the 11 patients. We observed only one false negative result (10%) and the agreement between SLN and other lymph node status was 80% (8/10). One patient was upstaged: SLN was positive for metastases while the other lymph nodes were negative. CONCLUSIONS Lymphatic mapping using patent blue dye is feasible in colorectal cancer. The identification of lymph nodal metastases by this technique led to upstaging of one patient, who may benefit from adjuvant therapy. These initial results prompt further investigation of this procedure as an accurate, minimally invasive staging approach in early colorectal cancer. We proceed with our study to evaluate the role of SLN mapping in colorectal cancer management.
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Affiliation(s)
- Walter Evangelista
- Department of Oncology, Medical Oncology Service, Azienda Ospedaliera San Giovanni Battista, Turin, Italy. walterev.@tin.it
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38
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Martinotti R, Evangelista W, Goss M, Angelini F, Satolli MA. [New therapeutic options in the treatment of hepatocellular carcinoma]. Minerva Med 2001; 92:341-7. [PMID: 11675578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
Hepatocellular carcinoma (HCC) is the fourth cause of death for cancer, the first in northern Africa and is the eighth tumor for incidence in the world. Risk factors are: liver cirrhosis, HBV, HCV and natural toxins (i.e. aflatoxin). A screening program is feasible and based on serum alpha-fetoprotein dosage and periodic liver ultrasonography. Instrumental diagnosis is based on ultrasonography associated with angiography or spiral TC associated with systemic portography. The best therapy of HCC is based on a multimodal approach: surgery when feasible, associated with or in alternative to intratumoral ethanol injection (PEI), transcatheter arterial chemoembolization (TACE), chemotherapy and radiotherapy. These different therapeutical approaches are related to the liver extent of the disease and liver functioning. Poor results obtained with chemotherapy led to research different therapeutical approaches as hormonal substances, immune modulators or genetic modulators. Most patients present with advanced disease, and their survival rate decreases with the increase of liver cirrhosis concomitant with HCC. Better results should be obtained with the use of different therapeutical approaches as angiogenetic inhibitors, today only for experimental use at present.
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Affiliation(s)
- R Martinotti
- UODU Chirurgia Oncologica, Day Hospital Oncologico, A.O. S. Giovanni Battista, Torino, Italy
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Zanon C, Satolli MA, Alabiso O, Grassi L, Miraglia S. [Two cases of melanoma metastasis. Description and review of the literature]. MINERVA CHIR 1996; 51:979-82. [PMID: 9072728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The metastases of malignant melanoma can appear after many years to primitive diagnosis and can involve many organs. There are reported two cases of metastatic melanoma presenting in a parotid gland and in the small bowel. The rarity of the metastatic melanoma to parotid gland and the difficulty of diagnosing intestinal involvement are discussed together with a review of the literature. The surgical treatment was justified by therapeutic and diagnostic aim, without positive influence on survival.
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Affiliation(s)
- C Zanon
- Servizio Autonomo Universitario di Chirurgia Esofagea ed Oncologia, Ospedale Molinette, Università degli Studi, Torino
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Trombetta F, Sandrucci S, Moscato R, Satolli MA. [Solitary fibrous tumor of the pleura. Clinical case]. MINERVA CHIR 1996; 51:485-8. [PMID: 8992400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Solitary fibrous tumors of the pleura represent a rare clinicopathological entity: 456 cases only have been reported since 1991. A interesting case of solitary fibrous tumor of the pleura is described here, because it turned up in a female patient followed up for a bilateral breast cancer and so with the exact determination of the period of beginning. The complex morphological picture is illustrated in relation to other cases reported in the literature. Immunohistochemical results are stressed, particularly as regards the coexpression of vimentin and desmin without necrosis and the low number of mitosis. As there are no criteria to determine the possible aggressive or malignant behaviour of the tumor, surgical resection of the lesion is indispensable both to resolve the diagnosis and to carry out the only proposable therapy.
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Affiliation(s)
- F Trombetta
- Servizio Autonomo Universitario di Chirurgia Esofagea ed Oncologica, Università degli Studi, Torino
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Abstract
Endothelial hyperplasia has rarely been recognized in the thyroid. Ischaemic events or hemorrhage, sometimes as a result of fine needle aspiration procedures, have been regarded as possible causes. To clarify the morphological pattern and the clinical significance of this lesion, we studied a series of adenomatous goitres and selected 11 cases showing prominent endothelial hyperplasia in an individual nodule. Grossly, the parenchyma of the affected nodule was substituted by greyish, friable tissue surrounded by a fibrous capsule and by a thin rim of residual thyroid parenchyma. Microscopically, fibrinous and haemorrhagic material was crossed by intercommunicating vascular channels or papillary structures. These were lined by plump endothelial cells. In only one case had pre-operative fine needle aspiration biopsy been performed: smears yielded a haemorrhagic background, fibrin and numerous elongated cells; colloid and follicular cells were virtually absent. In both surgical and cytological specimens a differential diagnosis with a vascular neoplasm, a rare occurrence in the thyroid, was taken into consideration. We conclude that intranodular reactive endothelial hyperplasia is a relatively common occurrence (1.6%) in adenomatous goitre and is of diagnostic interest in both surgical and cytological specimens, since it can mimic vascular tumours and may lead to unnecessary treatment if misdiagnosed.
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Affiliation(s)
- A Sapino
- Department of Biomedical Sciences and Oncology, University of Turin, Italy
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