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Ilari A, Cogliati V, Sherif N, Grassilli E, Ramazzotti D, Cordani N, Cazzaniga G, Di Bella C, Lavitrano M, Cazzaniga ME, Cerrito MG. Differential Expression of NOTCH-1 and Its Molecular Targets in Response to Metronomic Followed by Conventional Therapy in a Patient with Advanced Triple-Negative Breast Cancer. Biomedicines 2024; 12:272. [PMID: 38397874 PMCID: PMC10886740 DOI: 10.3390/biomedicines12020272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 01/19/2024] [Accepted: 01/23/2024] [Indexed: 02/25/2024] Open
Abstract
A group of 27 patients diagnosed with metastatic triple-negative breast cancer (mTNBC) was randomly distributed into two groups and underwent different lines of metronomic treatment (mCHT). The former group (N 14) received first-line mCHT and showed a higher overall survival rate than the second group (N 13), which underwent second-line mCHT. Analysis of one patient still alive from the first group, diagnosed with mTNBC in 2019, showed a complete metabolic response (CMR) after a composite approach implicating first-line mCHT followed by second-line epirubicin and third-line nab-paclitaxel, and was chosen for subsequent molecular characterization. We found altered expression in the cancer stemness-associated gene NOTCH-1 and its corresponding protein. Additionally, we found changes in the expression of oncogenes, such as MYC and AKT, along with their respective proteins. Overall, our data suggest that a first-line treatment with mCHT followed by MTD might be effective by negatively regulating stemness traits usually associated with the emergence of drug resistance.
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Affiliation(s)
- Alice Ilari
- School of Medicine and Surgery, Milano-Bicocca University, 20900 Monza, Italy; (A.I.); (N.S.); (E.G.); (D.R.); (N.C.); (M.L.); (M.E.C.)
| | - Viola Cogliati
- Phase 1 Research Centre, Fondazione IRCCS San Gerardo dei Tintori, Via Pergolesi 33, 20900 Monza, Italy;
| | - Noorhan Sherif
- School of Medicine and Surgery, Milano-Bicocca University, 20900 Monza, Italy; (A.I.); (N.S.); (E.G.); (D.R.); (N.C.); (M.L.); (M.E.C.)
| | - Emanuela Grassilli
- School of Medicine and Surgery, Milano-Bicocca University, 20900 Monza, Italy; (A.I.); (N.S.); (E.G.); (D.R.); (N.C.); (M.L.); (M.E.C.)
| | - Daniele Ramazzotti
- School of Medicine and Surgery, Milano-Bicocca University, 20900 Monza, Italy; (A.I.); (N.S.); (E.G.); (D.R.); (N.C.); (M.L.); (M.E.C.)
| | - Nicoletta Cordani
- School of Medicine and Surgery, Milano-Bicocca University, 20900 Monza, Italy; (A.I.); (N.S.); (E.G.); (D.R.); (N.C.); (M.L.); (M.E.C.)
| | - Giorgio Cazzaniga
- Department of Pathology, Fondazione IRCCS San Gerardo dei Tintori, Via Pergolesi 33, 20900 Monza, Italy; (G.C.); (C.D.B.)
| | - Camillo Di Bella
- Department of Pathology, Fondazione IRCCS San Gerardo dei Tintori, Via Pergolesi 33, 20900 Monza, Italy; (G.C.); (C.D.B.)
| | - Marialuisa Lavitrano
- School of Medicine and Surgery, Milano-Bicocca University, 20900 Monza, Italy; (A.I.); (N.S.); (E.G.); (D.R.); (N.C.); (M.L.); (M.E.C.)
| | - Marina Elena Cazzaniga
- School of Medicine and Surgery, Milano-Bicocca University, 20900 Monza, Italy; (A.I.); (N.S.); (E.G.); (D.R.); (N.C.); (M.L.); (M.E.C.)
- Phase 1 Research Centre, Fondazione IRCCS San Gerardo dei Tintori, Via Pergolesi 33, 20900 Monza, Italy;
| | - Maria Grazia Cerrito
- School of Medicine and Surgery, Milano-Bicocca University, 20900 Monza, Italy; (A.I.); (N.S.); (E.G.); (D.R.); (N.C.); (M.L.); (M.E.C.)
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Cazzaniga ME, Ademuyiwa F, Petit T, Tio J, Generali D, Ciruelos EM, Califaretti N, Poirier B, Ardizzoia A, Hoenig A, Lex B, Mouret-Reynier MA, Giesecke D, Isambert N, Masetti R, Pitre L, Wrobel D, Augereau P, Milani M, Rask S, Solbach C, Pritzker L, Noubir S, Parissenti A, Trudeau ME. Low RNA disruption during neoadjuvant chemotherapy predicts pathologic complete response absence in patients with breast cancer. JNCI Cancer Spectr 2024; 8:pkad107. [PMID: 38113421 PMCID: PMC10765091 DOI: 10.1093/jncics/pkad107] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 11/20/2023] [Accepted: 12/11/2023] [Indexed: 12/21/2023] Open
Abstract
In previously reported retrospective studies, high tumor RNA disruption during neoadjuvant chemotherapy predicted for post-treatment pathologic complete response (pCR) and improved disease-free survival at definitive surgery for primary early breast cancer. The BREVITY (Breast Cancer Response Evaluation for Individualized Therapy) prospective clinical trial (NCT03524430) seeks to validate these prior findings. Here we report training set (Phase I) findings, including determination of RNA disruption index (RDI) cut points for outcome prediction in the subsequent validation set (Phase II; 454 patients). In 80 patients of the training set, maximum tumor RDI values for biopsies obtained during neoadjuvant chemotherapy were significantly higher in pCR responders than in patients without pCR post-treatment (P = .008). Moreover, maximum tumor RDI values ≤3.7 during treatment predicted for a lack of pCR at surgery (negative predictive value = 93.3%). These findings support the prospect that on-treatment tumor RNA disruption assessments may effectively predict post-surgery outcome, possibly permitting treatment optimization.
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Affiliation(s)
- Marina Elena Cazzaniga
- Phase 1 Research Unit, IRCCS San Gerardo dei Tintori, Monza, MB, Italy
- School of Medicine and Surgery, Milano Bicocca University, Monza, MB, Italy
| | - Foluso Ademuyiwa
- Division of Medical Oncology, Washington University, Saint Louis, MO, USA
| | - Thierry Petit
- Institut Cancérologie Strasbourg Europe, Strasbourg, France
| | - Joke Tio
- Department of Gynecology and Obstetrics, Universitätsklinikum Münster, Münster, Germany
| | - Daniele Generali
- Breast Cancer Unit, ASST of Cremona and Department of Life Sciences, University of Trieste, Trieste, Italy
| | - Eva M Ciruelos
- Medical Oncology Department, Breast Cancer Unit, University Hospital, 12 de Octubre, Madrid, Spain
| | | | | | | | - Arnd Hoenig
- Breast Center, Women's Hospital, Marienhaus Hospital, Mainz, Germany
| | - Benno Lex
- Klinikum Kulmbach—Frauenheilkunde und Geburtshilfe, Kulmbach, Germany
| | | | - Dagmar Giesecke
- Hochtaunus-Kliniken Bad Homburg, Women’s Hospital, Bad Homburg, Germany
| | - Nicolas Isambert
- Pôle Régional de Cancérologie, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | | | | | - Denise Wrobel
- Sozialstiftung Bamberg Klinikum Frauenklinik, Bamberg, Germany
| | | | - Manuela Milani
- Department of Gynecology and Obstetrics, Universitätsklinikum Münster, Münster, Germany
| | - Sara Rask
- Royal Victoria Regional Health Centre, Barrie, ON, Canada
| | - Christine Solbach
- Department of Gynecology and Obstetrics, University Hospital Frankfurt, Germany
| | | | | | - Amadeo Parissenti
- Policlinico Gemelli, Rome, Italy
- Rna Diagnostics, Inc, Toronto, ON, Canada
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Cazzaniga ME, Pronzato P, Amoroso D, Bernardo A, Biganzoli L, Bisagni G, Blasi L, Bria E, Cognetti F, Crinò L, De Laurentiis M, Del Mastro L, De Placido S, Beano A, Ferraù F, Foladore S, Forcignanò R, Gamucci T, Garrone O, Gennari A, Giordano M, Giotta F, Giovanardi F, Latini L, Livi L, Marchetti P, Mattioli R, Michelotti A, Montemurro F, Putzu C, Riccardi F, Ricciardi G, Romagnoli E, Sarobba G, Spazzapan S, Tagliaferri P, Tinari N, Tonini G, Turletti A, Verusio C, Zambelli A, Mustacchi G. Clinical Outcomes of HER2-Negative Metastatic Breast Cancer Patients in Italy in the Last Decade: Results of the GIM 13-AMBRA Study. Cancers (Basel) 2023; 16:117. [PMID: 38201545 PMCID: PMC10777910 DOI: 10.3390/cancers16010117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 11/14/2023] [Accepted: 12/08/2023] [Indexed: 01/12/2024] Open
Abstract
GIM 13-AMBRA is a longitudinal cohort study aimed at describing therapeutic strategies and the relative outcome parameters in 939 HER2-ve MBC patients. Taxanes-based regimens, or taxanes + targeted agents, mainly Bevacizumab, were the preferred first choice in both Luminal (30.2%) and TNBC (33.3%) patients. The median PFS1 was 12.5 months (95% CI 16.79-19.64), without any significant difference according to subtypes, while the median Time to first Treatment Change (TTC1) was significantly lower in TNBC patients (7.7 months-95% CI 5.7-9.2) in comparison to Luminal A (13.2 months, 95% CI 11.7-15.1) and Luminal B patients (11.8 months, 95% CI 10.3-12.8). PFS2 was significantly shorter in TNBC patients (5.5 months, 95% CI 4.3-6.5 vs. Luminal A-9.4, 95% CI 8.1-10.7, and Luminal B-7.7 95% CI 6.8-8.2, F-Ratio 4.30, p = 0.014). TTC2 was significantly lower in patients with TNBC than in those with the other two subtypes. The median OS1 was 35.2 months (95% CI 30.8-37.4) for Luminal A patients, which was significantly higher than that for both Luminal B (28.9 months, 95% CI 26.2-31.2) and TNBC (18.5 months, 95% CI 16-20.1, F-ratio 7.44, p = 0.0006). The GIM 13-AMBRA study is one of the largest collections ever published in Italy and provides useful results in terms of time outcomes for first, second, and further lines of treatment in HER2- MBC patients.
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Affiliation(s)
- Marina Elena Cazzaniga
- Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
- School of Medicine and Surgery, Università Milano Bicocca, 20900 Monza, Italy
| | - Paolo Pronzato
- Oncologia Medica IRCCS IRST San Martino, 16100 Genova, Italy; (P.P.); (L.D.M.)
| | - Domenico Amoroso
- Oncologia Medica, Ospedale Versilia USL Nord Ovest Toscana, 55041 Lido di Camaiore, Italy;
| | - Antonio Bernardo
- Oncologia Istituti Clinici Scientifici Maugeri Spa Società Benefit, 27100 Pavia, Italy;
| | - Laura Biganzoli
- U.O. Oncologia Medica, Ospedale Santo Stefano, 59100 Prato, Italy;
| | - Giancarlo Bisagni
- Oncologia Medica, IRCCS Arcispedale S. Maria Nuova, 42121 Reggio Emilia, Italy;
| | - Livio Blasi
- Oncologia Medica, ARNAS Civico–Di Cristina-Benfratelli, Presidio Ospedaliero ‘Civico e Benfratelli’, 20121 Palermo, Italy;
| | - Emilio Bria
- Oncologia Medica, A.O.U. Integrata Verona, Ospedale Borgo Roma, 37100 Verona, Italy;
| | - Francesco Cognetti
- Oncologia Medica 1, Istituto Nazionale Tumori “Regina Elena”, 00042 Roma, Italy
| | - Lucio Crinò
- Oncologia, Ospedale S. Maria della Misericordia, 06121 Perugia, Italy;
| | | | - Lucia Del Mastro
- Oncologia Medica IRCCS IRST San Martino, 16100 Genova, Italy; (P.P.); (L.D.M.)
| | - Sabino De Placido
- Oncologia Medica, Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi Federico II, 80013 Napoli, Italy;
| | - Alessandra Beano
- Oncologia Medica, Città della Salute e della Scienza, ASL “Città di Torino”, 10024 Torino, Italy;
| | | | - Silva Foladore
- SSD Oncologica e dell’apparato Riproduttivo Femminile, Azienda Sanitaria Universitaria “Giuliano Isontina, 34121 Trieste, Italy;
| | | | | | - Ornella Garrone
- Oncologia Medica, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, 20100 Milano, Italy;
| | - Alessandra Gennari
- Oncologia Medica, Azienda Ospedaliero-Universitaria Maggiore della Carità di Novara, Dipartimento di Medicina e Chirurgia, Università degli Studi del Piemonte Orientale, 28100 Novara, Italy;
| | | | - Francesco Giotta
- Oncologia, IRCCS Istituto Tumori ‘Giovanni Paolo II’, 70100 Bari, Italy;
| | - Filippo Giovanardi
- UOS Day Hospital Oncologico, AUSL Reggio Emilia, Presidio Ospedaliero di Guastalla, 42016 Guastalla, Italy;
| | | | - Lorenzo Livi
- Dipartimento di Scienze Biomediche, Sperimentali e Cliniche ‘Mario Serio’, Università degli Studi di Firenze, UOC Radioterapia, A.O.U. Careggi, 50100 Firenze, Italy;
| | | | - Rodolfo Mattioli
- Oncologia Medica, A.O. Ospedali Riuniti Marche Nord-Ospedale Santa Croce, 61032 Fano, Italy
| | | | - Filippo Montemurro
- Fondazione del Piemonte per l’Oncologia-Istituto di Ricovero e Cura a Carattere Scientifico (I.R.C.C.S.), 10024 Torino, Italy;
| | - Carlo Putzu
- Oncologia Medica, AOU Sassari, 07100 Sassari, Italy
| | - Ferdinando Riccardi
- Oncologia Medica, Azienda Ospedaliera ‘A. Cardarelli’ (AORN), 80013 Napoli, Italy
| | | | | | - Giuseppina Sarobba
- Oncologia Medica, Ospedale ‘San Francesco’, Azienda Sanitaria Locale 3 Nuoro, 08100 Nuoro, Italy
| | - Simon Spazzapan
- Centro di Riferimento Oncologico, IRCCS, 33081 Aviano, Italy;
| | | | - Nicola Tinari
- Oncologia Medica, Policlinico ‘SS. Annunziata’, 66100 Chieti, Italy;
| | - Giuseppe Tonini
- Policlinico Universitario Campus Biomedico, 00042 Roma, Italy;
| | - Anna Turletti
- Presidio Ospedaliero Martini, ASL TO1, 10024 Torino, Italy
| | - Claudio Verusio
- Oncologia Medica, ASST della Valle Olona, Ospedale di Saronno, 21047 Saronno, Italy;
| | - Alberto Zambelli
- Oncologia Medica, ASST Papa Giovanni XXIII, Ospedale Papa Giovanni XXIII, 24100 Bergamo, Italy;
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Cordani N, Mologni L, Piazza R, Tettamanti P, Cogliati V, Mauri M, Villa M, Malighetti F, Di Bella C, Jaconi M, Cerrito MG, Cavaletti G, Lavitrano M, Cazzaniga ME. TWIST1 Upregulation Is a Potential Target for Reversing Resistance to the CDK4/6 Inhibitor in Metastatic Luminal Breast Cancer Cells. Int J Mol Sci 2023; 24:16294. [PMID: 38003483 PMCID: PMC10671583 DOI: 10.3390/ijms242216294] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 11/08/2023] [Accepted: 11/10/2023] [Indexed: 11/26/2023] Open
Abstract
Cyclin-dependent kinase (CDK) 4/6 inhibitors have significantly improved progression-free survival in hormone-receptor-positive (HR+), human-epidermal-growth-factor-receptor-type-2-negative (HER2-) metastatic luminal breast cancer (mLBC). Several studies have shown that in patients with endocrine-sensitive or endocrine-resistant LBC, the addition of CDK4/6 inhibitors to endocrine therapy significantly prolongs progression-free survival. However, the percentage of patients who are unresponsive or refractory to these therapies is as high as 40%, and no reliable and reproducible biomarkers have been validated to select a priori responders or refractory patients. The selection of mutant clones in the target oncoprotein is the main cause of resistance. Other mechanisms such as oncogene amplification/overexpression or mutations in other pathways have been described in several models. In this study, we focused on palbociclib, a selective CDK4/6 inhibitor. We generated a human MCF-7 luminal breast cancer cell line that was able to survive and proliferate at different concentrations of palbociclib and also showed cross-resistance to abemaciclib. The resistant cell line was characterized via RNA sequencing and was found to strongly activate the epithelial-to-mesenchymal transition. Among the top deregulated genes, we found a dramatic downregulation of the CDK4 inhibitor CDKN2B and an upregulation of the TWIST1 transcription factor. TWIST1 was further validated as a target for the reversal of palbociclib resistance. This study provides new relevant information about the mechanisms of resistance to CDK4/6 inhibitors and suggests potential new markers for patients' follow-up care during treatment.
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Affiliation(s)
- Nicoletta Cordani
- School of Medicine and Surgery, Milano-Bicocca University, 20900 Monza, Italy; (L.M.); (R.P.); (P.T.); (M.M.); (M.V.); (F.M.); (M.G.C.); (G.C.); (M.L.); (M.E.C.)
| | - Luca Mologni
- School of Medicine and Surgery, Milano-Bicocca University, 20900 Monza, Italy; (L.M.); (R.P.); (P.T.); (M.M.); (M.V.); (F.M.); (M.G.C.); (G.C.); (M.L.); (M.E.C.)
| | - Rocco Piazza
- School of Medicine and Surgery, Milano-Bicocca University, 20900 Monza, Italy; (L.M.); (R.P.); (P.T.); (M.M.); (M.V.); (F.M.); (M.G.C.); (G.C.); (M.L.); (M.E.C.)
| | - Pietro Tettamanti
- School of Medicine and Surgery, Milano-Bicocca University, 20900 Monza, Italy; (L.M.); (R.P.); (P.T.); (M.M.); (M.V.); (F.M.); (M.G.C.); (G.C.); (M.L.); (M.E.C.)
| | - Viola Cogliati
- Phase 1 Research Centre, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy (C.D.B.); (M.J.)
| | - Mario Mauri
- School of Medicine and Surgery, Milano-Bicocca University, 20900 Monza, Italy; (L.M.); (R.P.); (P.T.); (M.M.); (M.V.); (F.M.); (M.G.C.); (G.C.); (M.L.); (M.E.C.)
| | - Matteo Villa
- School of Medicine and Surgery, Milano-Bicocca University, 20900 Monza, Italy; (L.M.); (R.P.); (P.T.); (M.M.); (M.V.); (F.M.); (M.G.C.); (G.C.); (M.L.); (M.E.C.)
| | - Federica Malighetti
- School of Medicine and Surgery, Milano-Bicocca University, 20900 Monza, Italy; (L.M.); (R.P.); (P.T.); (M.M.); (M.V.); (F.M.); (M.G.C.); (G.C.); (M.L.); (M.E.C.)
| | - Camillo Di Bella
- Phase 1 Research Centre, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy (C.D.B.); (M.J.)
| | - Marta Jaconi
- Phase 1 Research Centre, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy (C.D.B.); (M.J.)
| | - Maria Grazia Cerrito
- School of Medicine and Surgery, Milano-Bicocca University, 20900 Monza, Italy; (L.M.); (R.P.); (P.T.); (M.M.); (M.V.); (F.M.); (M.G.C.); (G.C.); (M.L.); (M.E.C.)
| | - Guido Cavaletti
- School of Medicine and Surgery, Milano-Bicocca University, 20900 Monza, Italy; (L.M.); (R.P.); (P.T.); (M.M.); (M.V.); (F.M.); (M.G.C.); (G.C.); (M.L.); (M.E.C.)
| | - Marialuisa Lavitrano
- School of Medicine and Surgery, Milano-Bicocca University, 20900 Monza, Italy; (L.M.); (R.P.); (P.T.); (M.M.); (M.V.); (F.M.); (M.G.C.); (G.C.); (M.L.); (M.E.C.)
| | - Marina Elena Cazzaniga
- School of Medicine and Surgery, Milano-Bicocca University, 20900 Monza, Italy; (L.M.); (R.P.); (P.T.); (M.M.); (M.V.); (F.M.); (M.G.C.); (G.C.); (M.L.); (M.E.C.)
- Phase 1 Research Centre, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy (C.D.B.); (M.J.)
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Zambelli A, Gallerani E, Garrone O, Pedersini R, Rota Caremoli E, Sagrada P, Sala E, Cazzaniga ME. Working tables on Hormone Receptor positive (HR+), Human Epidermal growth factor Receptor 2 negative (HER2-) early stage breast cancer: Defining high risk of recurrence. Crit Rev Oncol Hematol 2023; 191:104104. [PMID: 37659765 DOI: 10.1016/j.critrevonc.2023.104104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 08/10/2023] [Accepted: 08/15/2023] [Indexed: 09/04/2023] Open
Abstract
Hormone-receptor positive (HR+), Human-Epidermal-growth Factor negative (HER2-) breast cancer, including the Luminal A and the Luminal B subtypes, is the most common in women diagnosed with early-stage BC. Despite the advances in screening, surgery and therapies, recurrence still occurs. Therefore, it is important to identify early those factors that significantly impact the recurrence risk. Based on current evidence and their professional expertise, a Panel of oncologists discussed the definition of high risk of recurrence in early breast cancer. Histological grade, nodal involvement, genomic score, histological grade, tumor size, and Ki-67 proliferation index were rated as the most important factors to define the high risk in patients with early breast cancer. All these factors should be considered comprehensively to tailor the choice of treatment to the peculiar characteristics of each patient.
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Affiliation(s)
- A Zambelli
- Department of Biomedical Sciences, Humanitas University and IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy
| | - E Gallerani
- Ospedale di Circolo di Varese, Varese, Italy
| | - O Garrone
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico Milano, Milan, Italy
| | | | | | - P Sagrada
- Onco-Hematology Unit, ASST Lodi, Lodi, Italy
| | - E Sala
- Oncology Unit, ASST Monza Ospedale San Gerardo, Monza, Italy
| | - M E Cazzaniga
- School of Medicine and Surgery, University of Milano Bicocca, Milan, Italy; Phase 1 Research Unit, Fondazione IRCCS san Gerardo dei Tintori, Monza, Italy.
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6
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Cazzaniga ME, Ciaccio A, Danesi R, Duhoux FP, Girmenia C, Zaman K, Lindman H, Luppi F, Mavroudis D, Paris I, Olubukola A, Samreen A, Schem C, Singer C, Snegovoy A. Late onset toxicities associated with the use of CDK 4/6 inhibitors in hormone receptor positive (HR+), human epidermal growth factor receptor-2 negative (HER2-) metastatic breast cancer patients: a multidisciplinary, pan-EU position paper regarding their optimal management. The GIOCONDA project. Front Oncol 2023; 13:1247270. [PMID: 37954071 PMCID: PMC10639170 DOI: 10.3389/fonc.2023.1247270] [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: 06/25/2023] [Accepted: 09/26/2023] [Indexed: 11/14/2023] Open
Abstract
The personalization of therapies in breast cancer has favoured the introduction of new molecular-targeted therapies into clinical practice. Among them, cyclin-dependent kinases 4 and 6 (CDK4/6) inhibitors have acquired increasing importance, with the approval in recent years of palbociclib, ribociclib, and abemaciclib in combination with endocrine therapy. Currently, no guidelines are available to monitor and manage potential long-term toxicities associated with the use of these drugs. A multidisciplinary panel of European oncologists, was supported by a pharmacologist, a hematologist, a hepatologist and a pulmonologist to discuss the management of long-term toxicities, based on the literature review and their clinical experience. The panel provided detailed roadmaps to manage long-term toxicities associated with the use of CDK4/6 inhibitors in clinical practice. Knowing the frequency and characteristics of the toxicity profile associated with each CDK4/6 inhibitor is important in the decision-making process to match the right drug to the right patient.
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Affiliation(s)
- Marina Elena Cazzaniga
- Phase 1 Research Unit, IRCCS San Gerardo dei Tintori, Monza (MB), Italy
- School of Medicine and Surgery, Milano Bicocca University, Monza (MB), Italy
| | - Antonio Ciaccio
- School of Medicine and Surgery, Milano Bicocca University, Monza (MB), Italy
- Gastroenterologic Unit, IRCCS San Gerardo dei Tintori, Monza (MB), Italy
| | - Romano Danesi
- Department Experimental and Clinical Medicine, University of Pisa, Pisa, Italy
| | | | - Corrado Girmenia
- Department of Hematology, Oncology and Dermatology, Azienda Ospedaliero-Universitaria Policlinico Umberto I, Roma, Italy
| | - Kalhil Zaman
- Breast Center, Department Of Oncology, Lausanne University Hospital CHUV, Lausanne, Switzerland
| | - Henrik Lindman
- Department Of Immunology, Genetics And Pathology, Uppsala University, Uppsala, Sweden
| | - Fabrizio Luppi
- School of Medicine and Surgery, Milano Bicocca University, Monza (MB), Italy
- Division Of Respiratory Diseases, Fondazione IRCCS San Gerardo Dei Tintori, Monza (MB), Italy
| | - Dimitrios Mavroudis
- Department Of Medical Oncology, University Hospital Of Heraklion, Crete, Greece
| | - Ida Paris
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Ayodele Olubukola
- University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Ahmed Samreen
- University Hospitals Of Leicester Osborne Building, Leicester Royal Infirmary, Leicester, United Kingdom
| | | | - Christian Singer
- Department Of Obstetrics & Gynecology Head, Center For Breast Health, Medical University of Vienna, Vienna, Austria
| | - Anton Snegovoy
- Department Of Oncology, University Of Medicine & Dentistry, Moscow, Russia
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Trevisan B, Pepe FF, Vallini I, Montagna E, Amoroso D, Berardi R, Butera A, Cagossi K, Cavanna L, Ciccarese M, Cinieri S, Cretella E, De Conciliis E, Febbraro A, Ferraù F, Ferzi A, Baldelli A, Fontana A, Gambaro AR, Garrone O, Gebbia V, Generali D, Gianni L, Giovanardi F, Grassadonia A, Leonardi V, Sarti S, Musolino A, Nicolini M, Putzu C, Riccardi F, Santini D, Sarobba MG, Schintu MG, Scognamiglio G, Spadaro P, Taverniti C, Toniolo D, Tralongo P, Turletti A, Valenza R, Valerio MR, Vici P, Clivio L, Torri V, Cazzaniga ME. Final results of the real-life observational VICTOR-6 study on metronomic chemotherapy in elderly metastatic breast cancer (MBC) patients. Sci Rep 2023; 13:12255. [PMID: 37507480 PMCID: PMC10382472 DOI: 10.1038/s41598-023-39386-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 07/25/2023] [Indexed: 07/30/2023] Open
Abstract
Nowadays, treatment of metastatic breast cancer (MBC) has been enriched with novel therapeutical strategies. Metronomic chemotherapy (mCHT) is a continuous and frequent administration of chemotherapy at a lower dose and so whit less toxicity. Thus, this strategy could be attractive for elderly MBC patients. Aim of this analysis is to provide insights into mCHT's activity in a real-life setting of elderly MBC patients. Data of patients ≥ 75 years old included in VICTOR-6 study were analyzed. VICTOR-6 is a multicentre, Italian, retrospective study, which collected data on mCHT in MBC patients treated between 2011 and 2016. A total of 112 patients were included. At the beginning of mCHT, median age was 81 years (75-98) and in 33% of the patients mCHT was the first line choice. Overall Response Rate (ORR) and Disease Control Rate (DCR) were 27.9% and 79.3%, respectively. Median PFS ranged between 7.6 and 9.1 months, OS between 14.1 and 18.5 months. The most relevant toxicity was the hematological one (24.1%); severe toxicity (grade 3-4) ranged from 0.9% for skin toxicity up to 8% for hematologic one. This is a large study about mCHT in elderly MBC patients, providing insights to be further investigated in this subgroup of frail patients.
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Affiliation(s)
- B Trevisan
- Azienda Ospedaliera San Gerardo, Monza, Italy
| | - F F Pepe
- Azienda Ospedaliera San Gerardo, Monza, Italy
| | - I Vallini
- Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - E Montagna
- European Institute of Oncology, Milan, Italy
| | | | - R Berardi
- Azienda Ospedaliera Universitaria Ospedali Riuniti, Torrette, Italy
| | - A Butera
- Nuovo Ospedale San Giovanni Di Dio, Florence, Italy
| | | | - L Cavanna
- Azienda Ospedaliera Piacenza, Piacenza, Italy
| | | | - S Cinieri
- Ospedale A. Perrino, Brindisi, Italy
| | | | | | - A Febbraro
- Ospedale S. Cuore di Gesù Fatebenefratelli, Benevento, Italy
| | - F Ferraù
- Ospedale San Vincenzo, Taormina, Italy
| | - A Ferzi
- Azienda Ospedaliera Ospedale Civile Di Legnano, Magenta, Italy
| | | | - A Fontana
- Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | | | - O Garrone
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - V Gebbia
- Ospedale La Maddalena, Palermo, Italy
| | - D Generali
- Istituti Ospitalieri Cremona, Cremona, Italy
| | | | | | | | | | - S Sarti
- IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Meldola, Italy
| | | | | | - C Putzu
- Azienda Ospedaliera-Universitaria, Sassari, Italy
| | - F Riccardi
- Ospedale Antonio Cardarelli, Naples, Italy
| | - D Santini
- Università Campus Bio-Medico, RomE, Italy
| | | | | | | | - P Spadaro
- Casa di Cura Villa Salus-Messina, Messina, Italy
| | | | | | | | | | | | - M R Valerio
- A.O.U. Policlinico Paolo Giaccone, Palermo, Italy
| | - P Vici
- INT Regina Elena, Rome, Italy
| | - L Clivio
- IRCCS Mario Negri Institute of Pharmacological Research, Milan, Italy
| | - V Torri
- IRCCS Mario Negri Institute of Pharmacological Research, Milan, Italy
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Cordani N, Bianchi T, Ammoni LC, Cortinovis DL, Cazzaniga ME, Lissoni AA, Landoni F, Canova S. An Overview of PARP Resistance in Ovarian Cancer from a Molecular and Clinical Perspective. Int J Mol Sci 2023; 24:11890. [PMID: 37569269 PMCID: PMC10418869 DOI: 10.3390/ijms241511890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 07/18/2023] [Accepted: 07/23/2023] [Indexed: 08/13/2023] Open
Abstract
Epithelial ovarian cancer (EOC), a primarily high-grade serous carcinoma (HGSOC), is one of the major causes of high death-to-incidence ratios of all gynecological cancers. Cytoreductive surgery and platinum-based chemotherapy represent the main treatments for this aggressive disease. Molecular characterization of HGSOC has revealed that up to 50% of cases have a deficiency in the homologous recombination repair (HRR) system, which makes these tumors sensitive to poly ADP-ribose inhibitors (PARP-is). However, drug resistance often occurs and overcoming it represents a big challenge. A number of strategies are under investigation, with the most promising being combinations of PARP-is with antiangiogenetic agents and immune checkpoint inhibitors. Moreover, new drugs targeting different pathways, including the ATR-CHK1-WEE1, the PI3K-AKT and the RAS/RAF/MEK, are under development both in phase I and II-III clinical trials. Nevertheless, there is still a long way to go, and the next few years promise to be exciting.
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Affiliation(s)
- Nicoletta Cordani
- School of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy; (T.B.); (L.C.A.); (M.E.C.); (A.A.L.); (F.L.)
| | - Tommaso Bianchi
- School of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy; (T.B.); (L.C.A.); (M.E.C.); (A.A.L.); (F.L.)
- Clinic of Obstetrics and Gynecology, Fondazione IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, 20900 Monza, Italy
| | - Luca Carlofrancesco Ammoni
- School of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy; (T.B.); (L.C.A.); (M.E.C.); (A.A.L.); (F.L.)
| | | | - Marina Elena Cazzaniga
- School of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy; (T.B.); (L.C.A.); (M.E.C.); (A.A.L.); (F.L.)
- Phase 1 Research Centre, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
| | - Andrea Alberto Lissoni
- School of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy; (T.B.); (L.C.A.); (M.E.C.); (A.A.L.); (F.L.)
- Clinic of Obstetrics and Gynecology, Fondazione IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, 20900 Monza, Italy
| | - Fabio Landoni
- School of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy; (T.B.); (L.C.A.); (M.E.C.); (A.A.L.); (F.L.)
- Clinic of Obstetrics and Gynecology, Fondazione IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, 20900 Monza, Italy
| | - Stefania Canova
- Medical Oncology Unit, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy;
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9
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Di Lisa FS, Krasniqi E, Pizzuti L, Barba M, Cannita K, De Giorgi U, Borella F, Foglietta J, Cariello A, Ferro A, Picardo E, Mitidieri M, Sini V, Stani S, Tonini G, Santini D, La Verde N, Gambaro AR, Grassadonia A, Tinari N, Garrone O, Sarobba G, Livi L, Meattini I, D’Auria G, Vergati M, Gamucci T, Pistelli M, Berardi R, Risi E, Giotta F, Lorusso V, Rinaldi L, Artale S, Cazzaniga ME, Zustovich F, Cappuzzo F, Landi L, Torrisi R, Scagnoli S, Botticelli A, Michelotti A, Fratini B, Saltarelli R, Paris I, Muratore M, Cassano A, Gianni L, Gaspari V, Veltri EM, Zoratto F, Fiorio E, Fabbri MA, Mazzotta M, Ruggeri EM, Pedersini R, Valerio MR, Filomeno L, Minelli M, Scavina P, Raffaele M, Astone A, De Vita R, Pozzi M, Riccardi F, Greco F, Moscetti L, Giordano M, Maugeri-Saccà M, Zennaro A, Botti C, Pelle F, Cappelli S, Cavicchi F, Vizza E, Sanguineti G, Tomao F, Cortesi E, Marchetti P, Tomao S, Speranza I, Sperduti I, Ciliberto G, Vici P. Adjuvant capecitabine in triple negative breast cancer patients with residual disease after neoadjuvant treatment: real-world evidence from CaRe, a multicentric, observational study. Front Oncol 2023; 13:1152123. [PMID: 37260975 PMCID: PMC10227592 DOI: 10.3389/fonc.2023.1152123] [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: 01/27/2023] [Accepted: 04/26/2023] [Indexed: 06/02/2023] Open
Abstract
Background In triple negative breast cancer patients treated with neoadjuvant chemotherapy, residual disease at surgery is the most relevant unfavorable prognostic factor. Current guidelines consider the use of adjuvant capecitabine, based on the results of the randomized CREATE-X study, carried out in Asian patients and including a small subset of triple negative tumors. Thus far, evidence on Caucasian patients is limited, and no real-world data are available. Methods We carried out a multicenter, observational study, involving 44 oncologic centres. Triple negative breast cancer patients with residual disease, treated with adjuvant capecitabine from January 2017 through June 2021, were recruited. We primarily focused on treatment tolerability, with toxicity being reported as potential cause of treatment discontinuation. Secondarily, we assessed effectiveness in the overall study population and in a subset having a minimum follow-up of 2 years. Results Overall, 270 patients were retrospectively identified. The 50.4% of the patients had residual node positive disease, 7.8% and 81.9% had large or G3 residual tumor, respectively, and 80.4% a Ki-67 >20%. Toxicity-related treatment discontinuation was observed only in 10.4% of the patients. In the whole population, at a median follow-up of 15 months, 2-year disease-free survival was 62%, 2 and 3-year overall survival 84.0% and 76.2%, respectively. In 129 patients with a median follow-up of 25 months, 2-year disease-free survival was 43.4%, 2 and 3-year overall survival 78.0% and 70.8%, respectively. Six or more cycles of capecitabine were associated with more favourable outcomes compared with less than six cycles. Conclusion The CaRe study shows an unexpectedly good tolerance of adjuvant capecitabine in a real-world setting, although effectiveness appears to be lower than that observed in the CREATE-X study. Methodological differences between the two studies impose significant limits to comparability concerning effectiveness, and strongly invite further research.
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Affiliation(s)
| | - Eriseld Krasniqi
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Laura Pizzuti
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Maddalena Barba
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Katia Cannita
- Oncology Division, Mazzini Hospital, ASL Teramo, Teramo, Italy
| | - Ugo De Giorgi
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, Meldola, Italy
| | - Fulvio Borella
- Gynecology and Obstetrics 1, Department of Surgical Sciences, City of Health and Science, Sant' Anna Hospital, University of Turin, Turin, Italy
| | | | | | | | - Elisa Picardo
- Gynecology and Obstetrics 4, Department of Surgical Sciences, City of Health and Science, Sant' Anna Hospital, University of Turin, Turin, Italy
| | - Marco Mitidieri
- Gynecology and Obstetrics 4, Department of Surgical Sciences, City of Health and Science, Sant' Anna Hospital, University of Turin, Turin, Italy
| | | | | | - Giuseppe Tonini
- Department of Medical Oncology, Fondazione Policlinico Universitario Campus Biomedico, Rome, Italy
| | - Daniele Santini
- Medical Oncology A, Policlinico Umberto I, Department of Radiological, Oncological and Anatomo-Pathological Sciences, “Sapienza” University of Rome, Rome, Italy
| | - Nicla La Verde
- Department of Oncology, Ospedale Luigi Sacco, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Anna Rita Gambaro
- Department of Oncology, Ospedale Luigi Sacco, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Antonino Grassadonia
- Department of Innovative Technologies in Medicine and Dentistry and Centre for Advanced Studies and Technology (CAST), G. D’Annunzio University, Chieti, Italy
| | - Nicola Tinari
- Department of Medical, Oral and Biotechnological Sciences and Center for Advanced Studies and Technology (CAST), G. D’Annunzio University, Chieti, Italy
| | - Ornella Garrone
- Medical Oncology, Fondazione IRCCS Ca’Granda Ospedale Maggiore Policlinico Milano, Milan, Italy
| | | | - Lorenzo Livi
- Department of Biomedical, Experimental and Clinical Sciences “M. Serio”, University of Florence, Florence, Italy
- Radiotherapy Unit, Oncology Department, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Icro Meattini
- Department of Biomedical, Experimental and Clinical Sciences “M. Serio”, University of Florence, Florence, Italy
- Radiotherapy Unit, Oncology Department, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | | | - Matteo Vergati
- UOC of Medical Oncology, Sandro Pertini Hospital, Rome, Italy
| | - Teresa Gamucci
- UOC of Medical Oncology, Sandro Pertini Hospital, Rome, Italy
| | - Mirco Pistelli
- Oncology Clinic, Università Politecnica delle Marche, Ospedali Riuniti Hospital, Ancona, Italy
| | - Rossana Berardi
- Oncology Clinic, Università Politecnica delle Marche, Ospedali Riuniti Hospital, Ancona, Italy
| | - Emanuela Risi
- Sandro Pitigliani Medical Oncology Department, Hospital of Prato, Prato, Italy
| | - Francesco Giotta
- Department of Medical Oncology, IRCCS Giovanni Paolo II Institute, Bari, Italy
| | - Vito Lorusso
- Department of Medical Oncology, IRCCS Giovanni Paolo II Institute, Bari, Italy
| | - Lucia Rinaldi
- “Don Tonino Bello” Oncology Unit, IRCCS Istituto Tumori “Giovanni Paolo II”, Bari, Italy
| | - Salvatore Artale
- Oncology Department, Ospedale di Gallarate, ASST Valle Olona, Gallarate, Italy
| | - Marina Elena Cazzaniga
- Phase 1 Research Centre and Oncology Unit, Department of Medicine and Surgery, University of Milano-Bicocca, ASST Monza, Monza, Italy
- Oncology Unit, ASST Monza, Monza, Italy
| | - Fable Zustovich
- Oncology Division, AULSS 1 Dolomiti, San Martino Medical Hospital, Belluno, Italy
| | - Federico Cappuzzo
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Lorenza Landi
- Phase I Clinical Studies Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Rosalba Torrisi
- Department of Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Simone Scagnoli
- Department of Medical and Surgical Sciences and Translational Medicine, “Sapienza” University of Rome, Rome, Italy
| | - Andrea Botticelli
- Medical Oncology A, Policlinico Umberto I, Department of Radiological, Oncological and Anatomo-Pathological Sciences, “Sapienza” University of Rome, Rome, Italy
| | - Andrea Michelotti
- UO Medical Oncology I, S. Chiara Hospital, Pisa University Hospital, Pisa, Italy
| | - Beatrice Fratini
- UO Medical Oncology I, S. Chiara Hospital, Pisa University Hospital, Pisa, Italy
| | - Rosa Saltarelli
- Oncology Division, San Giovanni Evangelista Hospital, ASL RM5, Rome, Italy
| | - Ida Paris
- Division of Gynecologic Oncology, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Margherita Muratore
- Division of Gynecologic Oncology, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Alessandra Cassano
- Medical Oncology, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Lorenzo Gianni
- Oncology Unit Rimini, Azienda USL Romagna, Rimini, Italy
| | | | | | - Federica Zoratto
- Medical Oncology Unit, Santa Maria Goretti Hospital, Latina, Italy
| | - Elena Fiorio
- Pathology Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | | | - Marco Mazzotta
- Medical Oncology Unit, Belcolle Hospital, Viterbo, Italy
| | | | | | - Maria Rosaria Valerio
- Medical Oncology, Azienda Ospedaliera Universitaria Policlinico Paolo Giaccone, Palermo, Italy
| | - Lorena Filomeno
- Phase IV Clinical Studies Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Mauro Minelli
- Division of Oncology, San Giovanni Hospital, Rome, Italy
| | - Paola Scavina
- Division of Oncology, San Giovanni Hospital, Rome, Italy
| | - Mimma Raffaele
- Presidio Oncologico Cassia – S. Andrea, ASL Roma 1, Rome, Italy
| | - Antonio Astone
- Oncology Division, San Pietro Fatebenefratelli Hospital, Rome, Italy
| | - Roy De Vita
- Department of Plastic and Reconstructive Surgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Marcello Pozzi
- Department of Plastic and Reconstructive Surgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | | | - Filippo Greco
- Medical Oncology Unit, AULSS 9 Regione Veneto, Scaligera - Ospedale Generale Mater Salutis, Legnago, Italy
| | - Luca Moscetti
- Division of Medical Oncology, Department of Oncology-Hematology, University Hospital of Modena, Modena, Italy
| | | | - Marcello Maugeri-Saccà
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
- Clinical Trial Center, Biostatistics and Bioinformatics, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Alessandro Zennaro
- Clinical Trial Center, Biostatistics and Bioinformatics, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Claudio Botti
- Department of Surgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Fabio Pelle
- Department of Surgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Sonia Cappelli
- Department of Surgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Flavia Cavicchi
- Department of Surgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Enrico Vizza
- Gynecologic Oncology Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Giuseppe Sanguineti
- Department of Radiation Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Federica Tomao
- Department of Maternal and Child Health and Urological Sciences, “Sapienza” University of Rome, Policlinico Umberto I, Rome, Italy
| | - Enrico Cortesi
- Medical Oncology B, Policlinico Umberto I, Department of Radiological, Oncological and Pathological Sciences, “Sapienza” University of Rome, Rome, Italy
| | - Paolo Marchetti
- Scientific Direction, IRCCS IDI, Istituto Dermopatico dell'Immacolata, Rome, Italy
| | - Silverio Tomao
- Department of Radiological, Oncological and Pathological Sciences, “Sapienza” University of Rome, Rome, Italy
| | - Iolanda Speranza
- Medical Oncology A, Policlinico Umberto I, Department of Radiological, Oncological and Anatomo-Pathological Sciences, “Sapienza” University of Rome, Rome, Italy
| | - Isabella Sperduti
- Clinical Trial Center, Biostatistics and Bioinformatics, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Gennaro Ciliberto
- Scientific Direction, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Patrizia Vici
- Phase IV Clinical Studies Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
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10
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Cordani N, Lisini D, Coccè V, Paglia G, Meanti R, Cerrito MG, Tettamanti P, Bonaffini L, Paino F, Alessandri G, Marcianti A, Giannì A, Villa C, Mauri M, Mologni L, Torsello A, Pessina A, Cazzaniga ME. Conditioned Medium of Mesenchymal Stromal Cells Loaded with Paclitaxel Is Effective in Preclinical Models of Triple-Negative Breast Cancer (TNBC). Int J Mol Sci 2023; 24:ijms24065864. [PMID: 36982938 PMCID: PMC10058623 DOI: 10.3390/ijms24065864] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 03/13/2023] [Accepted: 03/14/2023] [Indexed: 03/30/2023] Open
Abstract
Triple-negative breast cancer (TNBC) is a very aggressive disease even in its early stages and is characterized by a severe prognosis. Neoadjuvant chemotherapy is one of the milestones of treatment, and paclitaxel (PTX) is among the most active drugs used in this setting. However, despite its efficacy, peripheral neuropathy occurs in approximately 20-25% of cases and represents the dose-limiting toxicity of this drug. New deliverable strategies to ameliorate drug delivery and reduce side effects are keenly awaited to improve patients' outcomes. Mesenchymal stromal cells (MSCs) have recently been demonstrated as promising drug delivery vectors for cancer treatment. The aim of the present preclinical study is to explore the possibility of a cell therapy approach based on the use of MSCs loaded with PTX to treat TNBC-affected patients. For this purpose, we in vitro evaluated the viability, migration and colony formation of two TNBC cell lines, namely, MDA-MB-231 and BT549, treated with MSC-PTX conditioned medium (MSC-CM PTX) in comparison with both CM of MSCs not loaded with PTX (CTRL) and free PTX. We observed stronger inhibitory effects on survival, migration and tumorigenicity for MSC-CM PTX than for CTRL and free PTX in TNBC cell lines. Further studies will provide more information about activity and potentially open the possibility of using this new drug delivery vector in the context of a clinical study.
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Affiliation(s)
- Nicoletta Cordani
- School of Medicine and Surgery, Milano-Bicocca University, 20900 Monza, Italy
| | - Daniela Lisini
- Cell Therapy Production Unit-UPTC, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Valentina Coccè
- CRC StaMeTec, Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20122 Milan, Italy
| | - Giuseppe Paglia
- School of Medicine and Surgery, Milano-Bicocca University, 20900 Monza, Italy
| | - Ramona Meanti
- School of Medicine and Surgery, Milano-Bicocca University, 20900 Monza, Italy
| | | | - Pietro Tettamanti
- School of Medicine and Surgery, Milano-Bicocca University, 20900 Monza, Italy
- Department of Molecular Medicine, University of Pavia, 27100 Pavia, Italy
| | - Luca Bonaffini
- School of Medicine and Surgery, Milano-Bicocca University, 20900 Monza, Italy
| | - Francesca Paino
- CRC StaMeTec, Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20122 Milan, Italy
| | - Giulio Alessandri
- CRC StaMeTec, Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20122 Milan, Italy
| | - Angela Marcianti
- Cell Therapy Production Unit-UPTC, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Aldo Giannì
- CRC StaMeTec, Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20122 Milan, Italy
- Maxillo-Facial and Dental Unit, Fondazione Ca' Granda IRCCS Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Chiara Villa
- School of Medicine and Surgery, Milano-Bicocca University, 20900 Monza, Italy
| | - Mario Mauri
- School of Medicine and Surgery, Milano-Bicocca University, 20900 Monza, Italy
| | - Luca Mologni
- School of Medicine and Surgery, Milano-Bicocca University, 20900 Monza, Italy
| | - Antonio Torsello
- School of Medicine and Surgery, Milano-Bicocca University, 20900 Monza, Italy
| | - Augusto Pessina
- CRC StaMeTec, Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20122 Milan, Italy
| | - Marina Elena Cazzaniga
- School of Medicine and Surgery, Milano-Bicocca University, 20900 Monza, Italy
- Phase 1 Research Centre, Fondazione IRCCS San Gerardo dei Tintori, Via Pergolesi 33, 20900 Monza, Italy
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11
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Zambelli A, Cazzaniga ME, La Verde N, Munzone E, Antonazzo IC, Mantovani LG, Mancuso A, Generali DG, Cortesi PA. Abstract P6-08-01: A cost-consequence analysis of pertuzumab in the neoadjuvant treatment of high-risk HER2+ Early-Stage Breast Cancer (EBC): health-economic considerations for drug availability in Italy. Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-p6-08-01] [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: 03/06/2023]
Abstract
Abstract
Introduction: Neoadjuvant pertuzumab+trastuzumab+chemotherapy (TPC) combo is a well established treatment for HER2+ high-risk (EBC) as recommended by International and National guidelines. However, notwithstanding EMA approval, in some European countries (i.e Italy and France) pertuzumab drug-access is prevented by the NHS decision not to reimburse the drug in a value-driven sustainability balance. This study aims to estimate the cost and consequences of TPC vs. the same combo w/o pertuzumab (TC) in the neaodjuvant treatment of high-risk HER2+ eBC to better understand the value of TPC regimen.
Methods: With a Markov model, we simulated the costs and consequences associated to TPC or TC neoadjuvant treatments, using 5 years time horizon and Italian Lombardy region Health System point of view. The model includes nine health states: Neoadjuvant treatment; Surgery; Invasive disease-free Survival (IDFS) with pathological complete response (pCR), IDFS with residual disease (RD), non-metastatic recurrence, remission, first-line treatment and subsequent-lines for metastatic cancer, and death. Transition probabilities and utilities were derived from relevant clinical trials and literature. For each neoadjuvant treatment, the model estimates: direct (drug, administration, hospitalization, disease management), indirect (patients’ loss of productivity), total costs and different outcomes, as cumulative incidence of metastatic recurrence, days of work lost, days with activity impairment, IDFS life years, and quality adjusted life years (QALY). Costs and outcomes were estimated per 100-treated patients. An alternative scenario analysis with a 10-year time horizon and a deterministic sensitivity analysis was performed to assess the impact of model time horizon and parameters value.
Results: The estimated costs and outcomes for TPC and TC are reported in Table 1. TPC produces a total direct cost reduction of €75,630 per 100-treated patients, a small increase of TPC neoadjuvant treatment costs (+4.8%) is offset by the lower cost of metastatic treatment and management (-20.4%). Considering also the indirect costs, TPC is associated to a cost reduction of €124,956 per 100-treated patients. The cost saving is associated to a reduction of 5-year cumulative incidence metastatic recurrence (8.32% vs 10.42%, -20.14%), a reduction of days of work loss (-548 days) and days with activity impairment (-283 days) and a 10.5 QALY gained per 100-treated patients. Using a 10-year time horizon, the value of TPC compared to TC increases. Probabilities of pCR with TPC and TC were the parameter with the higher impact on model results.
Conclusion: Use of TC instead of TPC in high-risk HER2+ EBC derives a marginal savings (4.8%) according to the first year of our cost-consequence analysis. However, this negligible savings comes with the need for a heavily and long-lasting adjuvant cytotoxic therapy escalation because of a lower clinical activity of TC vs TPC. Moreover, according to medium-term cost-consequence analysis (5 years) the early negligible savings is overwhelmed by the subsequent increase in costs for the patients’ management, because of the lower clinical efficacy of TC vs. TPC. In Italy, the lack of pertuzumab in the neoadjuvant setting of high-risk HER2+ eBC is questionable; our results support the opportunity to reconsider the pertuzumab availability in Italy and reduce inequalities within Europe.
Cost and consequences of neoadjuvant treatments for high-risk HER2-Positive Early-Stage Breast Cancer: trastuzuamb+pertuzumab+chemotheraphy (TPC) vs trastuzumab+chemotheraphy (TC) IDFS, Invasive disease-free Survival; QALY, quality adjusted life years.
Citation Format: Alberto Zambelli, Marina Elena Cazzaniga, Nicla La Verde, Elisabetta Munzone, Ippazio Cosimo Antonazzo, Lorenzo Giovanni Mantovani, Anna Mancuso, Daniele G. Generali, Paolo Angelo Cortesi. A cost-consequence analysis of pertuzumab in the neoadjuvant treatment of high-risk HER2+ Early-Stage Breast Cancer (EBC): health-economic considerations for drug availability in Italy [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P6-08-01.
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Affiliation(s)
- Alberto Zambelli
- 1IRCCS Humanitas Research Hospital and Humanitas University, Milan, Italy
| | | | - Nicla La Verde
- 3Ospedale Luigi Sacco, ASST Fatebenefratelli Sacco, Milano
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Prina MM, Gotuzzo I, Cazzaniga ME, De Bernardi E, Cafaro P, Capici S, Cogliati V, Pepe FF, Cicchiello F, Riva F, Cordani N, Cerrito MG, Turolla EA, Landoni C, Elisei F, Crivellaro C, Virdone L, Monaco L, Guidi A, Guerra L. Abstract P6-01-42: BASELINE 18FDG-PET METABOLIC TUMOUR VOLUME (MTV) AS A POTENTIAL PREDICTIVE FACTOR OF RESPONSE TO METRONOMIC CHEMOTHERAPY (mCHT) IN HR+/HER2- METASTATIC BREAST CANCER (MBC) PATIENTS (pts). PRELIMINARY RESULTS OF THE METRO-PET STUDY. Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-p6-01-42] [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: 03/06/2023]
Abstract
Abstract
Background: MBC is an incurable disease and chemotherapy (CHT) represents one option of treatment upfront, in TNBC pts, or at failure of an endocrine therapy + targeted agents in HR+ ones. mCHT was extensively studied in different types of ABC pts and is largely used in clinical practice. 18FDG-PET is often used as a tool for disease staging at baseline and for disease restaging during treatment. Different quantitative and semi-quantitative 18FDG-PET parameters have been investigated as predictive and prognostic biomarkers in NSCLC and other tumours. Aim of the present study is to evaluate the role of baseline SUVmax , global SUVmean, SUVpeak, Metabolic Tumour Volume (MTV) and Total Lesion Glycolysis (TLG) as predictive factors of response to mCHT.
Patients and Methods: We identified 36 MBC pts treated with mCHT between 2014 and 2021, with at least two separate 18FDG-PET evaluations. Patients and biological tumour characteristics, previous treatments, site of relapse as well as quantitative pre-treatment 18FDG-PET parameters have been collected. Tumour response was assessed using PERCIST Criteria. Median and mean ± SD 18FDG-PET parameters have been reported according to the type of response. Complete and Partial responses have been grouped together with Stable Disease.
Results: Median age was 69 (33-82). Luminal pts were 25 (67.6%), TNBC pts were 16.2%); most were heavily pre-treated for their metastatic disease (≥ 3 lines: 14, 37.8%) and presented ≥ 3 metastatic sites (14, 37.8%). All pts received mCHT, 26 (70.3%) as combination therapy (VRL+CAPE or VRL+CAPE+CTX), or single agent (VRL, 11). Bone was the commonest metastatic site (62.2%). ORR was 43.2%; 7 pts had SD (18.9%), the remaining developed PD (37.8%). Similar values have been observed between the 2 groups in terms of SUVmax , global SUVmean and SUVpeak,. Mean MTV was higher in responder (n=22) vs non responder (n=14) pts, as TLG. Details are reported in Table 1.
Conclusions: High mean baseline MTV and TLG seem to be related to response to mCHT in MBC pts. Our observation is in contrast to what is described for other cancer types, especially NSCLC, and for standard neoadjuvant treatment of BC. Considering the peculiar mechanisms of action of mCHT, our preliminary findings warrant further exploration in a larger series of BC pts.
Table 1 Baseline 18FDG-PET uptake values in responder and non responder patients
Citation Format: Marco Meazza Prina, Irene Gotuzzo, Marina Elena Cazzaniga, Elisabetta De Bernardi, Pietro Cafaro, Serena Capici, Viola Cogliati, Francesca Fulvia Pepe, Federica Cicchiello, Francesca Riva, Nicoletta Cordani, Maria Grazia Cerrito, Elia Anna Turolla, Claudio Landoni, Federica Elisei, Cinzia Crivellaro, Leonardo Virdone, Lavinia Monaco, Alessandro Guidi, Luca Guerra. BASELINE 18FDG-PET METABOLIC TUMOUR VOLUME (MTV) AS A POTENTIAL PREDICTIVE FACTOR OF RESPONSE TO METRONOMIC CHEMOTHERAPY (mCHT) IN HR+/HER2- METASTATIC BREAST CANCER (MBC) PATIENTS (pts). PRELIMINARY RESULTS OF THE METRO-PET STUDY [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P6-01-42.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Luca Guerra
- 20University of Milano Bicocca, Monza, Italy
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Cordani N, Mologni L, Piazza R, Cogliati V, Pepe F, Capici S, Bella CD, Jaconi M, Cerrito MG, Villa M, Tettamanti P, Cavaletti G, Lavitrano M, Cazzaniga ME. Abstract P1-13-21: Loss of CDKN2B expression as a potential marker of resistance to CDK4/6 inhibitor in Luminal Breast Cancer cells. Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-p1-13-21] [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: 03/06/2023]
Abstract
Abstract
Background Cyclin-Dependent Kinase (CDK) 4/6 inhibitors have significantly improved progression-free survival of Hormone Receptor positive (HR+), Human Epidermal Growth Factor Receptor type 2 negative (HER2-) luminal breast cancers (LBC). Several studies demonstrated that the addition of CDK4/6 inhibitors to endocrine therapy results in a significant prolongation of progression-free survival in patients with endocrine-sensitive or endocrine-resistant LBCs. However, the percentage of patients unresponsive or refractory to these therapies is as high as 40%, and no reliable and reproducible biomarkers able to select a priori responder or resistant patients have been validated till now. The main cause of resistance is the selection of mutant clones in the target oncoprotein. Other mechanisms, like oncogene amplification/overexpression or mutations in other pathways, have been described in several models. Here, we focused on palbociclib, a selective inhibitor of CDK4/6. Methods: We generated and characterized human luminal breast cancer MCF-7 and T47D derived cell lines, able to survive and proliferate at different palbociclib concentrations, which also shows cross-resistance to abemaciclib. The resistant MCF7 cell line was characterized by RNA sequencing. Results: To confirm resistance, we performed cell viability assays in MCF-7 and T47D palbociclib sensitive cells (MCF-7pS and T47pS) versus MCF-7 and T47D palbociclib resistant cells (MCF-7pR5), showing a 10-fold increase of IC50 in MCF-7pR5 compared to parental MCF-7pS cells (16.7 vs 1.8 µM) and a 3-fold increase of IC50 in T47DpR5 vs parental T47DpS. We also confirmed a significant cross resistance using abemaciclib in MCF-7pR5 with an IC50 equal to 6.8 vs 0.35 µM and in T47DpR with an IC50 of 10.72 vs 0.5 µM. RNA sequencing, qRT-qPCR and Western blot results demonstrated a dramatic downregulation of the CDK4 inhibitor CDKN2B in both cell lines and we found upregulation of an miR-31, a putative regulator of CDKN2B. This finding was further validated in a biopsy from a patient progressing on CDK4/6 inhibitor therapy. Conclusions: This study provides new relevant information regarding the mechanism of resistance to CDK4/6 inhibitors and suggests potential new markers to follow up patients during the treatment.
Citation Format: Nicoletta Cordani, Luca Mologni, Rocco Piazza, Viola Cogliati, Francesca Pepe, Serena Capici, Camillo Di Bella, Marta Jaconi, Maria Grazia Cerrito, Matteo Villa, Pietro Tettamanti, Guido Cavaletti, Marialuisa Lavitrano, Marina Elena Cazzaniga. Loss of CDKN2B expression as a potential marker of resistance to CDK4/6 inhibitor in Luminal Breast Cancer cells [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P1-13-21.
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Bardia A, Bidard FC, Neven P, Streich G, Montero AJ, Forget F, Mouret-Reynier MA, Sohn JH, Taylor D, Harnden KK, Khong H, Kocsis J, Dalenc F, Dillon P, Babu S, Waters S, Deleu I, García-Sáenz JA, Bria E, Cazzaniga ME, Aftimos P, Cortés J, Tonini G, Sahmoud T, Habboubi N, Grzegorzewski K, Kaklamani V. Abstract GS3-01: GS3-01 EMERALD phase 3 trial of elacestrant versus standard of care endocrine therapy in patients with ER+/HER2- metastatic breast cancer: Updated results by duration of prior CDK4/6i in metastatic setting. Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-gs3-01] [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: 03/06/2023]
Abstract
Abstract
Background: In patients (pts) with ER+/HER2− metastatic breast cancer (MBC) following progression on prior endocrine and CDK4/6i therapy, the EMERALD trial demonstrated significantly prolonged progression-free survival (PFS) and a manageable safety profile for elacestrant versus standard of care endocrine therapy (SoC). Benefit was observed in all pts and in pts with ESR1 mutant MBC (ESR1-mut). EMERALD is the only oral SERD monotherapy pivotal trial where all pts were pretreated with CDK4/6 inhibitor (CDK 4/6i). Here, we examine the impact of duration of prior CDK4/6i on PFS.
Methods: EMERALD (NCT03778931) is a randomized, open-label, phase 3 trial that enrolled pts with ER+/HER2- MBC who previously had 1-2 lines of endocrine therapy, mandatory CDK4/6i, and ≤1 chemotherapy; prior treatment with fulvestrant was allowed. Patients were randomized 1:1 to elacestrant (400 mg orally daily) or SoC (investigator’s choice of aromatase inhibitor or fulvestrant). If randomized to the control arm, patients who received prior fulvestrant were to receive an aromatase inhibitor, and vice versa. If two CDK4/6i were used in the metastatic setting (n=40), the cumulative duration was calculated.
Results: A total of 478 pts were randomized (228 with ESR1-mut) between Feb 2019 – Oct 2020 (n=239, elacestrant; n=239, SoC). Overall survival was not yet mature, as of September 2nd 2022. Updated PFS results show statistically significant results in favor of elacestrant, both in all pts and in pts with ESR1-mut. The duration of prior CDK4/6i in the metastatic setting was positively associated with PFS, the longer the duration of prior CDK4/6i in the metastatic setting (n=465), the longer the PFS on elacestrant versus SoC (Table 1).
Updated safety data were consistent with previously reported results. Most of the adverse events (AEs), including nausea, were grade 1 and 2, and only 3.4% and 0.9% of the pts discontinued trial therapy because of an AE on elacestrant and SoC, respectively. A low percentage of pts received an antiemetic; 8.0%, 3.7%, and 10.3%, on elacestrant, fulvestrant, and AI, respectively. No hematological safety signal was observed and none of the patients in either of the two treatment arms had sinus bradycardia.
Conclusions: EMERALD is the first phase 3 trial to demonstrate a significant PFS improvement versus SoC in all pts and in the subgroup with ESR1 mutations in pts with ER-positive/HER2-negative MBC with 1-2 prior lines of endocrine treatment ± one line of chemotherapy. Elacestrant demonstrated longer PFS versus SOC that was positively associated with the duration of prior treatment with CDK4/6i, which was more pronounced in pts with ESR1-mut MBC. In this 2nd and 3rd line setting, elacestrant was well tolerated with significantly longer PFS versus SoC, highlighting its potential role as a therapeutic option for pts with ER+/HER2- MBC.
Table 1: PFS estimates in the elacestrant and SoC arms based on different cut-off points for the duration of prior CDK4/6i.
Citation Format: Aditya Bardia, Francois-Clement Bidard, Patrick Neven, Guillermo Streich, Alberto J. Montero, Frederic Forget, Marie-Ange Mouret-Reynier, Joo Hyuk Sohn, Donatienne Taylor, Kathleen K. Harnden, Hung Khong, Judit Kocsis, Florence Dalenc, Patrick Dillon, Sunil Babu, Simon Waters, Ines Deleu, Jose Angel García-Sáenz, Emilio Bria, Marina Elena Cazzaniga, Philippe Aftimos, Javier Cortés, Giulia Tonini, Tarek Sahmoud, Nassir Habboubi, Krzysztof Grzegorzewski, Virginia Kaklamani. GS3-01 EMERALD phase 3 trial of elacestrant versus standard of care endocrine therapy in patients with ER+/HER2- metastatic breast cancer: Updated results by duration of prior CDK4/6i in metastatic setting [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr GS3-01.
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Affiliation(s)
- Aditya Bardia
- 1Massachusetts General Hospital Cancer Center, Boston, Massachusetts
| | | | - Patrick Neven
- 3Universitair Ziekenhuis Leuven, Leuven, Vlaams-Brabant, Belgium
| | | | - Alberto J. Montero
- 5UH/Seidman Cancer Center and Case Western Reserve University, Cleveland, OH, USA
| | | | | | - Joo Hyuk Sohn
- 8Yonsei Cancer Center, Seoul, Republic of Korea, Republic of Korea
| | - Donatienne Taylor
- 9Universite catholique de Louvain, CHU UCL Namur—Site Sainte-Elisabeth, Namur, Belgium
| | | | - Hung Khong
- 11Moffit Cancer Center & Research Institute
| | | | - Florence Dalenc
- 13Institut Claudius Régaud, Toulouse, France, Toulouse, France
| | - Patrick Dillon
- 14University of Virginia Health System, Charlottesville, VA, USA
| | - Sunil Babu
- 15Fort Wayne Medical Oncology and Hematology
| | - Simon Waters
- 16Clinical Trials Unit, Velindre Cancer Centre, Cardiff, United Kingdom
| | | | | | - Emilio Bria
- 19Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore
| | | | | | - Javier Cortés
- 22International Breast Cancer Center (IBCC), Pangaea Oncology, Quironsalud Group, Madrid and Barcelona, Spain & Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid, Madrid, Spain
| | | | - Tarek Sahmoud
- 24Stemline Therapeutics/Menarini Group, New Hope, Pennsylvania
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Scagliotti A, Capizzi L, Cazzaniga ME, Ilari A, De Giorgi M, Cordani N, Gallazzi M, Bruno A, Pelosi G, Albini A, Lavitrano M, Grassilli E, Cerrito MG. Co-targeting triple-negative breast cancer cells and endothelial cells by metronomic chemotherapy inhibits cell regrowth and migration via downregulation of the FAK/VEGFR2/VEGF axis and autophagy/apoptosis activation. Front Oncol 2022; 12:998274. [PMID: 36531071 PMCID: PMC9749857 DOI: 10.3389/fonc.2022.998274] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 11/14/2022] [Indexed: 12/07/2023] Open
Abstract
High-dose standard-of-care chemotherapy is the only option for triple-negative breast cancer (TNBC) patients, which eventually die due to metastatic tumors. Recently, metronomic chemotherapy (mCHT) showed advantages in treating TNBCs leading us to investigate the anti-metastatic and anti-angiogenic potential of metronomic 5-Fluorouracil plus Vinorelbine (5-FU+VNR) on endothelial cells (ECs) and TNBCs in comparison to standard treatment (STD). We found that 10-fold lower doses of 5-FU+VNR given mCHT vs. STD inhibits cell proliferation and survival of ECs and TNBC cells. Both schedules strongly affect ECs migration and invasion, but in TNBC cells mCHT is significantly more effective than STD in impairing cell migration and invasion. The two treatments disrupt FAK/VEGFR/VEGF signaling in both ECs and TNBC cells. mCHT, and to a much lesser extent STD treatment, induces apoptosis in ECs, whereas it switches the route of cell death from apoptosis (as induced by STD) to autophagy in TNBC cells. mCHT-treated TNBCs-derived conditioned medium also strongly affects ECs' migration, modulates different angiogenesis-associated proteins, and hampers angiogenesis in matrix sponge in vivo. In conclusion, mCHT administration of 5-FU+VNR is more effective than STD schedule in controlling cell proliferation/survival and migration/invasion of both ECs and TNBC cells and has a strong anti-angiogenic effect. Our data suggest that the stabilization of tumor growth observed in TNBC patients treated with mCHT therapy schedule is likely due not only to direct cytotoxic effects but also to anti-metastatic and anti-angiogenic effects.
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Affiliation(s)
- Arianna Scagliotti
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Laura Capizzi
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Marina Elena Cazzaniga
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Phase 1 Research Center, Azienda Socio Sanitaria Territoriale (ASST) di Monza, Monza, Italy
| | - Alice Ilari
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Marco De Giorgi
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Nicoletta Cordani
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Matteo Gallazzi
- Laboratory of Immunology and General Pathology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Antonino Bruno
- Laboratory of Immunology and General Pathology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
- Laboratory of Innate Immunity, Unit of Molecular Pathology, Biochemistry and Immunology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) MultiMedica, Milan, Italy
| | - Giuseppe Pelosi
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) MultiMedica, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Adriana Albini
- IRCCS European Institute of Oncology (IEO), Milan, Italy
| | | | - Emanuela Grassilli
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
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Terraneo M, Quaglia V, Nuvolati G, Bani M, Russo S, Strepparava MG, Capici S, Cavaliere R, Cazzaniga ME. Social capital and willingness to participate in COVID-19 vaccine trials: an Italian case-control study. BMC Public Health 2022; 22:2137. [PMID: 36411406 PMCID: PMC9677898 DOI: 10.1186/s12889-022-14562-2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 11/07/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND What leads healthy people to enter in a volunteer register for clinical trials? This study aimed to investigate the relationship between the decision to volunteer in clinical trials for a COVID-19 vaccine and social capital, in a sample of healthy volunteers in Italy. Since social capital is characterized by trust, reciprocity, and social and political participation, we claim that it is key in leading individuals to actively take action to protect public health, and to take a risk for the (potential) benefit not only of themselves but for the entire community. METHODS This study was conducted through the administration of a questionnaire to healthy volunteers registered for a phase 1 clinical trial for a COVID-19 vaccine in the Unit Research Centre of ASST-Monza, in September 2020. The primary purpose of a phase 1 study is to evaluate the safety of a new drug candidate before it proceeds to further clinical studies. To approximate a case-control study, we randomly matched the 318 respondents to healthy volunteers (cases) with 318 people randomly selected by Round 9 of the European Social Survey (controls), using three variables, which we considered to be associated with the decision to volunteer: gender, age, and education level. To execute this matching procedure, we used the "ccmatch" module in STATA. RESULTS The findings highlight the positive impact of social capital in the choice of healthy individuals to volunteer in COVID-19 vaccine clinical trials. Controlling for possible confounding factors, some exemplary results show that people with a high level of general trust have a greater likelihood of volunteering compared to people with low trust (OR = 2.75, CI = 1.58-4.77); we also found that it is more probable that volunteers are people who have actively taken action to improve things compared with people who have not (for individuals who did three or more actions: OR = 7.54, CI = 4.10-13.86). People who reported voting (OR = 3.91, CI = 1.70-8.99) and participating in social activities more than other people of their age (OR = 2.89, CI = 1.82-4.60) showed a higher probability to volunteer. CONCLUSIONS Together with the adoption of urgent health measures in response to COVID-19, government policymakers should also promote social capital initiatives to encourage individuals to actively engage in actions aimed at protecting collective health. Our findings make an empirical contribution to the research on vaccines and its intersection with social behaviour, and they provide useful insights for policymakers to manage current and future disease outbreaks and to enhance the enrolment in vaccine trials.
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Affiliation(s)
- Marco Terraneo
- grid.7563.70000 0001 2174 1754Department of Sociology and Social Research, University of Milano-Bicocca, Milan, Italy
| | - Valeria Quaglia
- grid.8042.e0000 0001 2188 0260Department of Political Science, Communication and International Relations, University of Macerata, Macerata, Italy
| | - Giampaolo Nuvolati
- grid.7563.70000 0001 2174 1754Department of Sociology and Social Research, University of Milano-Bicocca, Milan, Italy
| | - Marco Bani
- grid.7563.70000 0001 2174 1754School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Selena Russo
- grid.7563.70000 0001 2174 1754School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Maria Grazia Strepparava
- grid.7563.70000 0001 2174 1754School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy ,grid.7563.70000 0001 2174 1754Clinical Psychology Unit, ASST Monza, University of Milano-Bicocca, Monza, Italy
| | - Serena Capici
- Phase 1 Research Centre, ASST Monza, via Cadore 48, 20900 Monza, Italy
| | - Rebecca Cavaliere
- grid.4912.e0000 0004 0488 7120Royal College of Surgeons, University of Medicine and Health Sciences, Dublin, Ireland
| | - Marina Elena Cazzaniga
- grid.7563.70000 0001 2174 1754School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy ,Phase 1 Research Centre, ASST Monza, via Cadore 48, 20900 Monza, Italy
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Russo S, Bani M, Terraneo M, Quaglia V, Nuvolati G, Cavaliere R, Capici S, Cazzaniga ME, Strepparava MG. Why not? Motivations for entering a volunteer register for clinical trials during the COVID-19 pandemic. Eur J Clin Pharmacol 2022; 78:1791-1800. [PMID: 36102931 PMCID: PMC9471028 DOI: 10.1007/s00228-022-03385-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 09/05/2022] [Indexed: 11/03/2022]
Abstract
Abstract
Backgrounds
Healthy volunteers play a key role in clinical trials and it is crucial to develop recruitment strategies that capitalise on their motivations and maximise their participation. The COVID-19 pandemic has shown the importance of finding motivated healthy volunteers for the development of new vaccines. Public registers represent a promising way to promote the participation of healthy volunteers in the research field, but their adoption is still limited. The current study aimed to explore the motivations of healthy volunteers to enrol in an Italian public register for clinical trials during the COVID-19 pandemic and their attitude toward participating in a phase 1 COVID-19 vaccine clinical trial. The impacts of different enrolling interview modalities (in person, by phone, by mail) on motivation, understanding of information and trust in researchers were also investigated.
Methods
An online survey investigating experience with COVID-19, motivations to enrol, trust in researchers, political and healthcare authorities and pharmacological companies was presented to people applying as healthy volunteers in the public register for clinical trials at Phase 1 Unit Research Centre of ASST Monza, Italy, and considering to participate in a COVID-19 vaccine clinical trial. Data were collected in June 2021.
Results
Altruistic motivations were the main driver for enrolling in the public register, while self-interested motivations were secondary. No gender differences were found. As for enrolling modalities, no differences emerged between in-person and interviews for motivation to enrol, understanding of information and trust in researchers. Email modality led to significantly lower volunteers’ satisfaction and understanding of information but similar trust in research.
Conclusions
This study supports the validity of different interview modalities (in person and by phone) for the enrolment of healthy volunteers for clinical trials and highlights the positive role of public registers for the recruitment procedures.
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Pepe FF, Cazzaniga ME, Baroni S, Riva F, Cicchiello F, Capici S, Cogliati V, Maggioni C, Cordani N, Cerrito MG, Malandrin S. Immunomodulatory effects of metronomic vinorelbine (mVRL), with or without metronomic capecitabine (mCAPE), in hormone receptor positive (HR+)/HER2-negative metastatic breast cancer (MBC) patients: final results of the exploratory phase 2 Victor-5 study. BMC Cancer 2022; 22:956. [PMID: 36068484 PMCID: PMC9446532 DOI: 10.1186/s12885-022-10031-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 04/29/2022] [Accepted: 08/09/2022] [Indexed: 11/10/2022] Open
Abstract
Tregs are able of suppressing tumor-specific effector cells, such as lymphocytes CD8+, CD4+ and Natural Killer cells. Different drugs, especially different schedules of administration, like metronomic chemotherapy (mCHT), seem to be able to increase anticancer immunity, by acting on downregulation of Tregs. Most of the data available regarding the immunomodulating effect of mCHT have been obtained with Cyclophosphamide (CTX). Aim of the present study was to explore the effects of mVRL and mCAPE administration, alone or in combination, on T cells. Observation of 13 metastatic breast cancer patients lasted controlling for 56 days, where Treg frequencies and function, spontaneous anti-tumor T-cell responses were monitored, as well as the clinical outcome. No depletion in Treg absolute numbers, or percentage of T lymphocytes, was observed. Only in 5 patients, a modest and transient depletion of Tregs was observed during the first 14 days of treatment. To better describe the effect on Tregs, we subsequently looked at the variations in Memory, Naïve and Activated Treg subpopulations: we observed a trend in reduction for memory Treg (Treg MEM) and an increase for Treg Naïve (Treg NAIVE) and Treg Activated (Treg ACT) components. We finally analyzed the average trend of Treg in the Treg depleted patients and non-depleted ones, without fiding any significant differences. The trend of the Treg MEM appeared different, showing a reduction during the first 14 days, followed by an increase at the levels before treatment at Day 56 in the group of depleted patients and a progressive substantial reduction in the group of non-depleted patients along the entire course of treatment. Opposed to the data known, treatment with mVRL w/o mCAPE did not show any effect on Tregs.
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Affiliation(s)
- F F Pepe
- Phase 1 Research Centre, ASST Monza, Monza, Italy
| | - M E Cazzaniga
- Phase 1 Research Centre, ASST Monza, Monza, Italy. .,School of Medicine and Surgery, University of Milano Bicocca, Monza, Italy.
| | - S Baroni
- School of Medicine and Surgery, University of Milano Bicocca, Monza, Italy
| | - F Riva
- Oncology Unit, ASST Monza, Monza, Italy
| | | | - S Capici
- Phase 1 Research Centre, ASST Monza, Monza, Italy
| | - V Cogliati
- Phase 1 Research Centre, ASST Monza, Monza, Italy
| | | | - N Cordani
- School of Medicine and Surgery, University of Milano Bicocca, Monza, Italy
| | - M G Cerrito
- School of Medicine and Surgery, University of Milano Bicocca, Monza, Italy
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Cazzaniga ME, Capici S, Cordani N, Cogliati V, Pepe FF, Riva F, Cerrito MG. Metronomic Chemotherapy for Metastatic Breast Cancer Treatment: Clinical and Preclinical Data between Lights and Shadows. J Clin Med 2022; 11:jcm11164710. [PMID: 36012949 PMCID: PMC9410269 DOI: 10.3390/jcm11164710] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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: 07/11/2022] [Revised: 08/08/2022] [Accepted: 08/09/2022] [Indexed: 11/26/2022] Open
Abstract
Metronomic chemotherapy (mCHT), defined as continuous administration of low-dose chemotherapeutic agents with no or short regular treatment-free intervals, was first introduced to the clinic in international guidelines in 2017, and, since then, has become one of the available strategies for the treatment of advanced breast cancer (ABC). Despite recent successes, many unsolved practical and theoretical issues remain to be addressed. The present review aims to identify the “lights and shadows” of mCHT in preclinical and clinical settings. In the preclinical setting, several findings indicate that one of the most noticeable effects of mCHT is on the tumor microenvironment, which, over the last twenty years, has been demonstrated to be pivotal in supporting tumor cell survival and proliferation. On the other hand, the direct effects on tumor cells have been less well-defined. In addition, critical items to be addressed are the lack of definition of an optimal biological dose (OBD), the method of administration of metronomic schedules, and the recognition and validation of predictive biomarkers. In the clinical context—where mCHT has mainly been used in a metastatic setting—low toxicity is the most well-recognised light of mCHT, whereas the type of study design, the absence of randomised trials and uncertainty in terms of doses and drugs remain among the shadows. In conclusion, growing evidence indicates that mCHT is a suitable treatment option for selected metastatic breast cancer (MBC) patients. Moreover, given its multimodal mechanisms of action, its addition to immunological and targeted therapies might represent a promising new approach to the treatment of MBC. More preclinical data are needed in this regard, which can only be obtained through support for translational research as the key link between basic science and patient care.
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Affiliation(s)
- Marina Elena Cazzaniga
- School of Medicine and Surgery, Milano-Bicocca University, 20900 Monza, Italy
- Phase 1 Research Centre, ASST Monza, 20900 Monza, Italy
| | - Serena Capici
- Phase 1 Research Centre, ASST Monza, 20900 Monza, Italy
| | - Nicoletta Cordani
- School of Medicine and Surgery, Milano-Bicocca University, 20900 Monza, Italy
| | | | | | | | - Maria Grazia Cerrito
- School of Medicine and Surgery, Milano-Bicocca University, 20900 Monza, Italy
- Correspondence: ; Tel.: +39-039-2339037
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Capici S, Ammoni LC, Meli N, Cogliati V, Pepe FF, Piazza F, Cazzaniga ME. Personalised Therapies for Metastatic Triple-Negative Breast Cancer: When Target Is Not Everything. Cancers (Basel) 2022; 14:cancers14153729. [PMID: 35954393 PMCID: PMC9367432 DOI: 10.3390/cancers14153729] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 06/20/2022] [Revised: 07/14/2022] [Accepted: 07/22/2022] [Indexed: 02/04/2023] Open
Abstract
Simple Summary The purpose of the present review is to shed light on new molecular biomarkers in triple-negative breast cancer (TNBC), showing emerging therapeutic approaches related to specific molecular signatures and their mechanisms of action. A general overview of ongoing clinical trials, future perspectives and differences in approval by American and European regulatory authorities is provided. Abstract Triple-negative breast cancer—defined by the absence of oestrogen/progesterone receptors and human epidermal growth factor receptor 2 expression—is a complex and heterogeneous type of tumour characterised by poor prognosis, aggressive behaviour and lack of effective therapeutic strategies. The identification of new biomarkers and molecular signatures is leading to development of new therapeutic strategies including immunotherapy, targeted therapy and antibody-drug conjugates (ADCs). Against a background where chemotherapy has always been considered the standard of care, evolution towards a precision medicine approach could improve TNBC clinical practice in a complex scenario, with many therapeutic options and new drugs. The aim of this review was to focus on emerging therapeutic targets and their related specific therapy, discussing available and emerging drugs, underlining differences in approval by American and European regulatory authorities and showing the future perspective in the large number of ongoing clinical trials.
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Affiliation(s)
- Serena Capici
- Phase 1 Research Centre, ASST-Monza (MB), 20900 Monza, Italy; (S.C.); (V.C.); (F.F.P.); (M.E.C.)
| | - Luca Carlofrancesco Ammoni
- School of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy; (N.M.); (F.P.)
- Correspondence:
| | - Nicole Meli
- School of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy; (N.M.); (F.P.)
| | - Viola Cogliati
- Phase 1 Research Centre, ASST-Monza (MB), 20900 Monza, Italy; (S.C.); (V.C.); (F.F.P.); (M.E.C.)
| | - Francesca Fulvia Pepe
- Phase 1 Research Centre, ASST-Monza (MB), 20900 Monza, Italy; (S.C.); (V.C.); (F.F.P.); (M.E.C.)
| | - Francesca Piazza
- School of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy; (N.M.); (F.P.)
| | - Marina Elena Cazzaniga
- Phase 1 Research Centre, ASST-Monza (MB), 20900 Monza, Italy; (S.C.); (V.C.); (F.F.P.); (M.E.C.)
- School of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy; (N.M.); (F.P.)
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Arpino G, Bianchini G, Malorni L, Zambelli A, Puglisi F, Del Mastro L, Colleoni M, Montemurro F, Bianchi GV, Paris I, Allegrini G, Tamberi S, Cazzaniga ME, Orditura M, Zamagni C, Grasso D, Benelli M, Callari M, Benfante A, De Laurentiis M. Circulating tumor DNA (ctDNA) and serum thymidine kinase 1 activity (TKa) matched dynamics in patients (pts) with hormone receptor–positive (HR+), human epidermal growth factor 2–negative (HER2-) advanced breast cancer (ABC) treated in first-line (1L) with ribociclib (RIB) and letrozole (LET) in the BioItaLEE trial. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.1012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
1012 Background: Independent early dynamic assessment (baseline [D0] and day 15 of first cycle [D15]) of both TKa and ctDNA was prognostic and predictive in pts with HR+, HER2− ABC treated with RIB+LET enrolled in the BioItaLEE trial (NCT03439046). Here we performed a combined analysis of these two biomarkers. Methods: 287 pts were enrolled in the study. Overall, early dynamics were assessable for both biomarkers in 241/287 pts (84.0%). Methods applied for ctDNA and TKa evaluation were previously reported. For ctDNA, samples were defined as wild type (WT) if no mutations were observed at D0 and D15, ctDNA positive (+) if with or negative (-) if without a primary target mutation at D15. Samples were TKa+ or TKa- if TKa levels were above or below the limit of detection at D15. According to ctDNA and TKa pts were classified as: WT/TKa-, WT/TKa+, ctDNA-/TKa-, ctDNA-/TKa+, ctDNA+/TKa- and ctDNA+/TKa+ and then divided into 3 main study groups (GRs) WT/TKa- (GR1, n = 126), WT/TKa+, ctDNA-/TKa-, ctDNA-/TKa+, ctDNA+/TKa- (GR2, n = 96) and ctDNA+/TKa+ (GR3, n = 19). The association between biomarkers and PFS (progression-free survival) was estimated using Kaplan-Meier analysis and multivariate Cox models with 95% confidence intervals (CIs) adjusted for clinical variables. Results: Median follow-up was 26.9 months. In multivariate Cox models both TKa dynamics and mutational tumor burden at D15 were independently predictive of PFS. Hazard ratios (HRs) were 0.37 (95% CI: 0.23-0.60; p < 0.0001) for WT vs ctDNA+ and 0.56 (95% CI: 0.32-1.00; p = 0.0506) for ctDNA- vs ctDNA+. For TKa, HR was 0.49 (95% CI: 0.30-0.80; p = 0.0040) in TKa- vs TKa+. Interestingly combining the two variables further improve prediction of outcome. HRs for TKa- vs TKa+ were 0.17 (95% CI: 0.09-0.32; p < 0.0001), 0.28 (95% CI: 0.13-0.59; p = 0.0009) and 0.44 (95% CI: 0.23-0.86; p = 0.0169) in WT, ctDNA- and ctDNA+ pts, respectively. Considering the 3 study GRs, median PFSs (95% CI) were not reached (27.89, NE), 19.58 (13.83, 23.39) and 6.65 (2.83, 12.16) months in GR1, GR2 and GR3, respectively, p < 0.001. At multivariate Cox models, HRs of GR1 and GR2 compared with GR3 were 0.17 (95% CI: 0.09-0.32; p < 0.0001) and 0.37 (95% CI: 0.20-0.67; p = 0.001) respectively. Conclusions: These findings suggest that combining the early dynamic assessment of both ctDNA and TKa may improve outcome prediction in pts treated with RIB+LET. Pts with ctDNA+/TKa+ are strongly enriched for non-responders. TKa and ctDNA capture different features of tumor biological activity and their combination warrants further evaluation in relation to other treatments, settings, and diseases. Clinical trial information: NCT03439046.
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Affiliation(s)
- Grazia Arpino
- Department of Medical Clinics and Surgery, Università Federico II, Napoli, Italy
| | | | - Luca Malorni
- Department of Oncology and Translational Research Unit "Sandro Pitigliani", Ospedale di Prato, Azienda USL Toscana Centro, Prato, Italy
| | - Alberto Zambelli
- U.S.C. Oncologia, Presidio Ospedaliero Papa Giovanni XXIII, Bergamo, Italy
| | - Fabio Puglisi
- S.O.C. Oncologia Medica e Prevenzione Oncologica, IRCCS, Centro di Riferimento Oncologico, Aviano, Italy
| | - Lucia Del Mastro
- U.O.S.D. Breast Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Marco Colleoni
- Senologia Medica, IEO, Istituto Europeo di Oncologia, IRCCS, Milano, Italy
| | | | | | - Ida Paris
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Giacomo Allegrini
- U.O.C. Oncologia Medica, Presidio Ospedaliero Livorno, Livorno, Italy
| | - Stefano Tamberi
- U.O. Oncologia, P.O. Ospedale degli Infermi – AUSL, Ravenna, Italy
| | - Marina Elena Cazzaniga
- Phase 1 Research Unit & Oncology Unit, Azienda Socio Sanitaria Territoriale Monza & Milano Bicocca School of Medicine and Surgery, Monza, Italy
| | - Michele Orditura
- U.O.C. Oncologia Medica e Ematologia, A.O.U. Università Degli Studi L. Vanvitelli, Napoli, Italy
| | - Claudio Zamagni
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | | | - Matteo Benelli
- Department of Oncology and Bioinformatics Unit, Ospedale di Prato, Azienda USL Toscana Centro, Prato, Italy
| | - Maurizio Callari
- CRUK Cambridge Institute, University of Cambridge Li Ka Shing Centre, Cambridge, United Kingdom
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Mauro PD, Capici S, Cogliati V, Pepe FF, Maggioni C, Riva F, Cicchiello F, Cazzaniga ME. Exceptional disease control with neratinib monotherapy in HER2-positive advanced breast cancer: a case report. Current Problems in Cancer: Case Reports 2022. [DOI: 10.1016/j.cpccr.2022.100167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Cogliati V, Capici S, Pepe FF, di Mauro P, Riva F, Cicchiello F, Maggioni C, Cordani N, Cerrito MG, Cazzaniga ME. How to Treat HR+/HER2- Metastatic Breast Cancer Patients after CDK4/6 Inhibitors: An Unfinished Story. Life (Basel) 2022; 12:378. [PMID: 35330128 PMCID: PMC8954717 DOI: 10.3390/life12030378] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 02/26/2022] [Accepted: 03/03/2022] [Indexed: 12/19/2022] Open
Abstract
CDK4/6 inhibitors in association with endocrine therapy represent the best therapeutic choice for either endocrine-sensitive or resistant hormone-receptor-positive advanced breast cancer patients. On the contrary, the optimal therapeutic strategy after the failure of CDK4/6 inhibitors-based treatment still remains an open question worldwide. In this review, we analyze the most studied mechanisms of resistance to CDK4/6 inhibitors treatment, as well as the most significant results of retrospective and prospective trials in the setting of progression after CDK4/6 inhibitors, to provide the reader a comprehensive overview from both a preclinical and especially a clinical perspective. In our opinion, an approach based on a deeper knowledge of resistance mechanisms to CDK4/6 inhibitors, but also on a careful analysis of what is done in clinical practice, can lead to a better definition of prospective randomized trials, to implement a personalized sequence approach, based on molecular analyses.
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Affiliation(s)
- Viola Cogliati
- Phase 1 Research Centre, ASST Monza, 20900 Monza, MB, Italy; (S.C.); (F.F.P.); (M.E.C.)
| | - Serena Capici
- Phase 1 Research Centre, ASST Monza, 20900 Monza, MB, Italy; (S.C.); (F.F.P.); (M.E.C.)
| | - Francesca Fulvia Pepe
- Phase 1 Research Centre, ASST Monza, 20900 Monza, MB, Italy; (S.C.); (F.F.P.); (M.E.C.)
| | - Pierluigi di Mauro
- Oncology Unit, ASST Monza, 20900 Monza, MB, Italy; (P.d.M.); (F.R.); (F.C.); (C.M.)
| | - Francesca Riva
- Oncology Unit, ASST Monza, 20900 Monza, MB, Italy; (P.d.M.); (F.R.); (F.C.); (C.M.)
| | - Federica Cicchiello
- Oncology Unit, ASST Monza, 20900 Monza, MB, Italy; (P.d.M.); (F.R.); (F.C.); (C.M.)
| | - Claudia Maggioni
- Oncology Unit, ASST Monza, 20900 Monza, MB, Italy; (P.d.M.); (F.R.); (F.C.); (C.M.)
| | - Nicoletta Cordani
- School of Medicine and Surgery, University of Milano Bicocca, 20900 Monza, MB, Italy; (N.C.); (M.G.C.)
| | - Maria Grazia Cerrito
- School of Medicine and Surgery, University of Milano Bicocca, 20900 Monza, MB, Italy; (N.C.); (M.G.C.)
| | - Marina Elena Cazzaniga
- Phase 1 Research Centre, ASST Monza, 20900 Monza, MB, Italy; (S.C.); (F.F.P.); (M.E.C.)
- School of Medicine and Surgery, University of Milano Bicocca, 20900 Monza, MB, Italy; (N.C.); (M.G.C.)
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24
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Bianchini G, Malorni L, Arpino G, Zambelli A, Puglisi F, Mastro LD, Colleoni M, Montemurro F, Bianchi G, Paris I, Allegrini G, Cazzaniga ME, Orditura M, Zamagni C, Tamberi S, Castelletti D, Benelli M, Callari M, Santoro A, De Laurentiis M. Abstract GS3-07: Circulating tumor DNA (ctDNA) dynamics in patients with hormone receptor positive (HR+)/HER2 negative (HER2-) advanced breast cancer (aBC) treated in first line with ribociclib (R) and letrozole (L) in the BioItaLEE trial. Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-gs3-07] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: ctDNA analysis is emerging as an attractive non-invasive approach to characterize tumor biology, describe its evolution over time, and predict treatment benefit. Here, we assessed the prognostic and predictive role of baseline and dynamic ctDNA analysis in HR+/HER2- aBC patients (pts) treated with R+L. Methods: 287 postmenopausal pts were enrolled in the BioItaLEE trial (NCT03439046). Liquid biopsies were collected at baseline (D0; n=263), day 15 of cycle 1 (D15; n=238), day 1 of cycle 2 (C2D1; n=241) and at first imaging (FI, at approximately 12 weeks; n=206). ctDNA analysis was carried out using a 533-amplicon Custom AmpliSeq HD Panel, with amplicons covering the coding exons of 39 BC-related genes (limit of detection: 0.1%). Target mutations were defined as single-nucleotide variant (SNV) or Insertion/Deletion detected at D0. When multiple target mutations were detected, the one with the highest variant allele frequency (VAF) was considered. The association between pre-treatment and on-treatment ctDNA dynamics with progression-free survival (PFS) was assessed using Multivariate Cox models. VAF clearance was defined as 100% decrease in a target mutation. Results: Median follow-up was 26.9 months and median PFS was 23.39 (20.8-NE) months. At baseline, target mutations were detected in 113 pts (43.0%), whereas 150 pts were wild-type (wt). Mean (SD) pre-treatment VAF at D0 was 11.3% (14.4). The absence of a target mutation at D0 was associated with good prognosis (HR: 0.41, 95% CI: 0.27–0.61; p<0.0001). Considering early ctDNA dynamics, a significant VAF reduction was observed at D15 and C2D1 with a mean (SD) change of -64.3% (55.9) and -68.6% (52.2), respectively. In pts with a target mutation detected at baseline, early VAF clearance was observed in 47.1% of pts at D15 and in 52.4% of pts at C2D1. Clearance at D15 or C2D1 was associated with improved PFS (D15, HR: 0.51, 95% CI: 0.28-0.91, p=0.0228; C2D1, HR: 0.44, 95% CI: 0.25-0.78, p=0.0052). Pts achieving clearance at D15, which was maintained at C2D1 (39.4%) had the lowest risk of progression compared to those who had no clearance at any or both timepoints (HR: 0.40, 95% CI: 0.20-0.79; p=0.084). Monitoring of the 150 pts without a detectable target mutation at baseline revealed a new, detectable mutation at later timepoints (D15, C2D1 and FI) in 34 pts (22.7%). The absence of new mutations was associated with a lower risk of progression (HR: 0.45, 95% CI: 0.24-0.85; p=0.0143). Considering all time points individually, D15 was the most informative of patient outcome. Indeed, pts without mutation at D15 (42.9%) had an extremely favorable outcome, either because they achieved early treatment-related clearance or maintained baseline absence of a target mutation (HR: 0.32, 95% CI: 0.20-0.51; p<0.0001). Notably, in pts with detectable target mutation at D15, a VAF below the median showed a trend for better prognosis versus high VAF (HR: 0.56, 95% CI: 0.30-1.04; p=0.065). Conclusions: The presence of a detectable mutation in baseline liquid biopsies appears to be a negative prognostic factor. Within this high-risk group, early VAF clearance during the first R+L cycle was informative of treatment benefit and associated with a lower risk of progression. Monitoring of ctDNA in patients without baseline mutations demonstrated that the detection of new mutations by FI assessment was associated with worse outcome. Overall, pre-treatment and early dynamics of ctDNA (assessed by NGS) represent promising prognostic and predictive biomarkers in patients with HR+/HER2- aBC treated with ribociclib/letrozole in the first-line. Further studies are warranted to validate the clinical utility of these biomarkers.
Citation Format: Giampaolo Bianchini, Luca Malorni, Grazia Arpino, Alberto Zambelli, Fabio Puglisi, Lucia Del Mastro, Marco Colleoni, Filippo Montemurro, Giulia Bianchi, Ida Paris, Giacomo Allegrini, Marina Elena Cazzaniga, Michele Orditura, Claudio Zamagni, Stefano Tamberi, Daniela Castelletti, Matteo Benelli, Maurizio Callari, Angela Santoro, Michelino De Laurentiis. Circulating tumor DNA (ctDNA) dynamics in patients with hormone receptor positive (HR+)/HER2 negative (HER2-) advanced breast cancer (aBC) treated in first line with ribociclib (R) and letrozole (L) in the BioItaLEE trial [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr GS3-07.
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Affiliation(s)
| | - Luca Malorni
- Department of Oncology and Translational Research Unit "Sandro Pitigliani", Ospedale di Prato, Azienda USL Toscana Centro, Prato, Italy
| | - Grazia Arpino
- Department of Medical Clinics and Surgery, Università Federico II, Napoli, Italy
| | - Alberto Zambelli
- U.S.C. Oncologia, Presidio Ospedaliero Papa Giovanni XXIII, Bergamo, Italy
| | - Fabio Puglisi
- S.O.C. Oncologia Medica e Prevenzione Oncologica, IRCCS, Centro di Riferimento Oncologico, Aviano, Italy
| | - Lucia Del Mastro
- U.O.S.D. Breast Unit, I.R.C.C.S. Ospedale Policlinico San Martino, Genoa, Italy
| | - Marco Colleoni
- Senologia Medica, IEO, Istituto Europeo di Oncologia, IRCCS,, Milano, Italy
| | | | - Giulia Bianchi
- SC Oncologia Medica 1, Fondazione IRCCS Istituto Nazionale Tumori Milano, Milan, Italy
| | - Ida Paris
- Department of Woman and Child Sciences, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Giacomo Allegrini
- U.O.C. Oncologia Medica, Presidio Ospedaliero Livorno, Livorno, Italy
| | - Marina Elena Cazzaniga
- Phase 1 Research Unit & Oncology Unit, Azienda Socio Sanitaria Territoriale Monza & Milano Bicocca School of Medicine and Surgery, Monza, Italy
| | - Michele Orditura
- U.O.C. Oncologia Medica e Ematologia, A.O.U. Università Degli Studi L. Vanvitelli, Napoli, Italy
| | - Claudio Zamagni
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Stefano Tamberi
- U.O. Oncologia, P.O. Ospedale degli Infermi – AUSL, Ravenna, Italy
| | | | - Matteo Benelli
- Department of Oncology and Bioinformatics Unit, Ospedale di Prato, Azienda USL Toscana Centro, Prato, Italy
| | - Maurizio Callari
- CRUK Cambridge Institute, University of Cambridge Li Ka Shing Centre, Cambridge, United Kingdom
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Llombart-Cussac A, Gligorov J, Di Cosimo S, Albacar C, Cortez P, Martinez-De Dueñas E, López A, Carañana V, Medioni J, Cavanna L, Cazzaniga ME, Braga S, Coelho P, Sampayo-Cordero M, Malfettone A, Pérez-García JM, Cortes J. Abstract OT2-19-06: Phase 2 study of abemaciclib in combination with endocrine therapy with or without paclitaxel induction in patients with hormone receptor-positive, HER2-negative advanced breast cancer and aggressive disease criteria: ABIGAIL. Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-ot2-19-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Endocrine therapy (ET) is the preferred therapy option for patients (pts) with hormone receptor-positive (HR[+]) advanced breast cancer (ABC), except for pts with visceral crisis who often receive chemotherapy to achieve rapid symptom control. Cyclin-dependent kinases 4/6 inhibitors have improved the effectiveness of ET across all subgroups of pts with ABC by targeting potential mechanisms of resistance. An exploratory analysis revealed that the addition of abemaciclib to ET conferred the largest benefit in pts with poor prognostic characteristics (liver metastases, high grade tumors, or progesterone receptor-negative status) [Di Leo, NPJ Breast Cancer 2018; 4: 41]. ABIGAIL aims to provide consistent evidence that abemaciclib plus ET is superior or non-inferior to paclitaxel in terms of early overall response as first-line regimen in HR[+], HER2-negative ABC pts with poor prognosis. Trial Design: This is a multicenter, randomized, open-label, phase 2 trial. Eligible participants are men and women of any menopausal status aged ≥18 years with HR[+], HER2-negative ABC who had no prior systemic therapy in the advanced setting and at least one of the following aggressive disease criteria: (i) Visceral disease; (ii) High histological grade and/or progesterone receptor-negative status; (iii) Lactate dehydrogenase >1.5 × the upper limit of normal; (iv) Relapse while on or within 36 months of completing adjuvant ET. Eastern Cooperative Oncology Group performance status of 0 or 1, measurable disease as per RECIST 1.1, and adequate organ function are also required. A total of 160 pts will be randomly assigned (1:1) to receive abemaciclib (300 mg/day orally during each 28-day cycle) plus ET as per investigator’s criteria (either letrozole [2.5 mg/day orally] or fulvestrant [500 mg intramuscularly on days 1, 15 of cycle 1, and on day 1 thereafter], or paclitaxel (90 mg/m² intravenously on days 1, 8, 15). Men and pre-/peri-menopausal women will receive a gonadotropin-releasing hormone agonist if randomized to abemaciclib plus ET. At investigator’s discretion, pts in the paclitaxel arm could receive abemaciclib plus ET at any point after the first 12 weeks or extend chemotherapy for a total of 6 cycles. Randomization will be stratified according to the presence of visceral disease and endocrine therapy. The primary endpoint is 12-week overall response rate (ORR) as per RECIST 1.1. Key secondary endpoints include ORR, clinical benefit rate, 12-week progression-free survival, progression-free survival, time to response, duration of response, overall survival, time to first subsequent therapy, time to second subsequent therapy, and time to first chemotherapy for pts in abemaciclib plus ET arm, patient-reported outcomes, and safety as per NCI-CTCAE 5.0. The sample size assumes the comparison of two proportions in an asymptotical normal test. We expect that 12-week ORR will be higher in the abemaciclib plus ET arm than paclitaxel arm (30% vs. 15%), with the assumption of a 5% non-inferiority margin. Based on a 10% dropout rate, a sample size of 160 pts is necessary to attain 80% power at nominal level of two-sided alpha of 0.05. We will test the superiority of abemaciclib plus ET as compared with paclitaxel if the non-inferiority is achieved. Both analyses, will be conducted with the Newcombe hybrid score method for confidence intervals. This trial was opened to accrual in May 2021.
Citation Format: Antonio Llombart-Cussac, Joseph Gligorov, Serena Di Cosimo, Cinta Albacar, Patricia Cortez, Eduardo Martinez-De Dueñas, Ana López, Vicente Carañana, Jacques Medioni, Luigi Cavanna, Marina Elena Cazzaniga, Sofia Braga, Passos Coelho, Miguel Sampayo-Cordero, Andrea Malfettone, José Manuel Pérez-García, Javier Cortes. Phase 2 study of abemaciclib in combination with endocrine therapy with or without paclitaxel induction in patients with hormone receptor-positive, HER2-negative advanced breast cancer and aggressive disease criteria: ABIGAIL [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr OT2-19-06.
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Affiliation(s)
- Antonio Llombart-Cussac
- Hospital Arnau de Vilanova; FISABIO; Universidad Católica de Valencia; Medica Scientia Innovation Research (MEDSIR), Barcelona, Spain
| | - Joseph Gligorov
- Institut Universitaire de Cancérologie AP-HP. Sorbonne Université, Paris, France
| | - Serena Di Cosimo
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; Medica Scientia Innovation Research (MEDSIR), Barcelona, Spain
| | | | - Patricia Cortez
- IOB Institute of Oncology, Hospital Ruber Internacional, Quiron Group, Madrid, Spain
| | | | - Ana López
- Hospital Universitario de León, León, Spain
| | | | | | | | | | - Sofia Braga
- Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal
| | | | | | | | - José Manuel Pérez-García
- International Breast Cancer Center (IBCC), Quironsalud Group; Medica Scientia Innovation Research (MEDSIR), Barcelona, Spain
| | - Javier Cortes
- International Breast Cancer Center (IBCC), Quironsalud Group, Barcelona; Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; Medica Scientia Innovation Research (MEDSIR); Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
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26
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Montagna E, Pagan E, Cancello G, Sangalli C, Bagnardi V, Munzone E, Salè EO, Malengo D, Cazzaniga ME, Negri M, Peruzzotti G, Veronesi P, Viale G, Colleoni M. The prolonged clinical benefit with metronomic chemotherapy (VEX regimen) in metastatic breast cancer patients. Anticancer Drugs 2022; 33:e628-e634. [PMID: 34407044 DOI: 10.1097/cad.0000000000001209] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Metronomic chemotherapy is a treatment option for metastatic breast cancer (MBC) patients who require prolonged disease control without cumulative toxicity. Data available on the efficacy and tolerability of prolonged usage of metronomic therapy are limited. We analyzed patients with MBC, enrolled in a clinical trial, who obtained a prolonged clinical benefit for a duration of at least 12 months with vinorelbine 30 or 40 mg orally three times a week, cyclophosphamide 50 mg daily and capecitabine 500 mg three times a day (VEX regimen). The patients were treated at the European Institute of Oncology, Milan. We identified 67 MBC patients. The median age before starting the VEX regimen was 53 years. There were 59 patients (88%) who had hormone-receptors positive and HER2 negative BC. We had 37 patients who received VEX as the first-line treatment for MBC, while 30 patients were pretreated. The objective response rate was 49% (95% CI, 37-62). The median duration of VEX treatment after the first year was 14 months (min-max range 0.3-81.3 months). The progression-free survival at 3 years was 25.4% (95% CI, 15.7-36.2) and at 4 years was 18.5% (95% CI, 10.1-28.8 time 0 corresponds to 1 year after starting VEX). A total of 25 patients required a dose reduction, 7% of patients experienced G3 hand and foot syndrome. Metronomic VEX regimen can induce prolonged clinical benefit in MBC. On the basis of this long-term safety evaluation, there is no evidence of specific cumulative or delayed toxicities with metronomic chemotherapy.
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Affiliation(s)
- Emilia Montagna
- Division of Medical Senology, Istituto Europeo di Oncologia, IRCCS
| | - Eleonora Pagan
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca
| | | | | | - Vincenzo Bagnardi
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca
| | | | | | - Daniela Malengo
- Division of pharmacy, Istituto Europeo di Oncologia, IRCCS Milan
| | | | | | | | - Paolo Veronesi
- Division of Senology
- Division of Pathology, Istituto Europeo di Oncologia, IRCCS
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Giuseppe Viale
- Division of Pathology, Istituto Europeo di Oncologia, IRCCS
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Marco Colleoni
- Division of Medical Senology, Istituto Europeo di Oncologia, IRCCS
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27
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Cazzaniga ME, Vallini I, Montagna E, Amoroso D, Berardi R, Butera A, Cagossi K, Cavanna L, Ciccarese M, Cinieri S, Cretella E, De Conciliis E, Febbraro A, Ferraù F, Ferzi A, Baldelli A, Fontana A, Gambaro AR, Garrone O, Gebbia V, Generali D, Gianni L, Giovanardi F, Grassadonia A, Leonardi V, Marchetti P, Sarti S, Musolino A, Nicolini M, Putzu C, Riccardi F, Santini D, Saracchini S, Sarobba MG, Schintu MG, Scognamiglio G, Spadaro P, Taverniti C, Toniolo D, Tralongo P, Turletti A, Valenza R, Valerio MR, Vici P, Di Mauro P, Cogliati V, Capici S, Clivio L, Torri V. Metronomic chemotherapy (mCHT) in metastatic triple-negative breast cancer (TNBC) patients: results of the VICTOR-6 study. Breast Cancer Res Treat 2021; 190:415-424. [PMID: 34546500 PMCID: PMC8558172 DOI: 10.1007/s10549-021-06375-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 08/26/2021] [Indexed: 11/30/2022]
Abstract
Purpose Triple-negative breast cancer (TNBC) represents a subtype of breast cancer which lacks the expression of oestrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor-2 (HER2): TNBC accounts for approximately 20% of newly diagnosed breast cancers and is associated with younger age at diagnosis, greater recurrence risk and shorter survival time. Therapeutic options are very scarce. Aim of the present analysis is to provide further insights into the clinical activity of metronomic chemotherapy (mCHT), in a real-life setting. Methods We used data included in the VICTOR-6 study for the present analysis. VICTOR-6 is an Italian multicentre retrospective cohort study, which collected data of metastatic breast cancer (MBC) patients who have received mCHT between 2011 and 2016. Amongst the 584 patients included in the study, 97 were triple negative. In 40.2% of the TNBC patients, mCHT was the first chemotherapy treatment, whereas 32.9% had received 2 or more lines of treatment for the metastatic disease. 45.4% out of 97 TNBC patients received a vinorelbine (VRL)-based regimen, which resulted in the most used type of mCHT, followed by cyclophosphamide (CTX)-based regimens (30.9%) and capecitabine (CAPE)-based combinations (22.7%). Results Overall response rate (ORR) and disease control rate (DCR) were 17.5% and 64.9%, respectively. Median progression free survival (PFS) and overall survival (OS) were 6.0 months (95% CI: 4.9–7.2) and 12.1 months (95% CI: 9.6–16.7). Median PFS was 6.9 months for CAPE-based regimens (95% CI: 5.0–18.4), 6.1 months (95% CI: 4.0–8.9) for CTX-based and 5.3 months (95% CI: 4.1–9.5) for VRL-based ones. Median OS was 18.2 months (95% CI: 9.1-NE) for CAPE-based regimens and 11.8 months for VRL- (95% CI: 9.3–16.7 and CTX-based ones (95%CI: 8.7–52.8). Tumour response, PFS and OS decreased proportionally in later lines. Conclusion This analysis represents the largest series of TNBC patients treated with mCHT in a real-life setting and provides further insights into the advantages of using this strategy even in this poor prognosis subpopulation.
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Affiliation(s)
- M E Cazzaniga
- Phase 1 Research Centre and Oncology Unit, Department of Medicine and Surgery, University of Milano-Bicocca, ASST Monza, Via Pergolesi 33, 20900, Monza, MB, Italy.
- Oncology Unit, ASST Monza, Monza, MB, Italy.
| | - I Vallini
- Medical Oncology, ASST Sette Laghi Ospedale Di Circolo E Fondazione Macchi, Varese, VA, Italy
| | - E Montagna
- Medical Senology Division, IEO, Milan, Italy
| | - D Amoroso
- Medical Oncology, Ospedale Versilia, ATNO, Lido Di Camaiore, LU, Italy
| | - R Berardi
- Medical Oncology, Università Politecnica Delle Marche, AOU Ospedali Riuniti, Ancona, Italy
| | - A Butera
- Medical Oncology, Ospedale San Giovanni Di Dio, Agrigento, Italy
| | - K Cagossi
- Medical Oncology, Ospedale Ramazzini, Carpi, Italy
| | - L Cavanna
- Medical Oncology, Azienda Ospedaliera Piacenza, Piacenza, Italy
| | - M Ciccarese
- Medical Oncology, Ospedale Vito Fazzi, Lecce, Italy
| | - S Cinieri
- Medical Oncology, ASL Brindisi, Brindisi, Italy
| | - E Cretella
- Medical Oncology, Ospedale Bolzano, Bolzano, Italy
| | | | - A Febbraro
- Medical Oncology, Ospedale S. Cuore di Gesù Fatebenefratelli, Benevento, Italy
| | - F Ferraù
- Medical Oncology, Osp Taormina, Taormina, Italy
| | - A Ferzi
- Medical Oncology, A.S.S.T. Ovest Milanese Legnano, Legnano, Italy
| | - A Baldelli
- Medical Oncology, Ospedale San Salvatore, Pesaro, Italy
| | - A Fontana
- Medical Oncology 2, Az. Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - A R Gambaro
- Medical Oncology, ASST Fatebenefratelli Sacco, Milano, Italy
| | - O Garrone
- Breast Unit Medical Oncology, A.O. S. Croce e Carle, Cuneo, Italy
| | - V Gebbia
- Medical Oncology, Ospedale La Maddalena, Palermo, Italy
| | - D Generali
- Medical Oncology, Istituti Ospitalieri Cremona, Cremona, Italy
| | - L Gianni
- Medical Oncology, Azienda USL Romagna, U.O. di Oncologia Rimini, Cattolica, Italy
| | - F Giovanardi
- AUSL IRCCS Reggio Emilia Provincial Oncology Unit, Reggio Emilia, Italy
| | - A Grassadonia
- Medical Oncology, P.O. SS Annunziata -ASL2 Lanciano-Vasto, Chieti, Italy
| | - V Leonardi
- Medical Oncology, Ospedale Civico, Palermo, Italy
| | - P Marchetti
- Medical Oncology, A.O. Sant'Andrea, Roma, Italy
| | - S Sarti
- IRCCS Istituto Romagnolo per lo studio dei Tumori (IRST) "Dino Amadori", 47014, Meldola, Italy
| | - A Musolino
- Department of Medicine and Surgery, Medical Oncology and Breast Unit, University of Parma and University Hospital of Parma, Parma, Italy
| | - M Nicolini
- Medical Oncology, Azienda USL Romagna, U.O. di Oncologia Rimini, Cattolica, Italy
| | - C Putzu
- Medical Oncology, A. Ospedaliera-Universitaria, Sassari, Italy
| | - F Riccardi
- Medical Oncology, A. Ospedaliera Antonio Cardarelli, Napoli, Italy
| | - D Santini
- Medical Oncology, Università Campus Bio-Medico, Roma, Italy
| | - S Saracchini
- Medical Oncology, Az. Osp. Santa Maria degli Angeli, Pordenone, Italy
| | - M G Sarobba
- Medical Oncology, Ospedale San Francesco, Nuoro, Italy
| | - M G Schintu
- Medical Oncology, Osp Giovanni Paolo II, Olbia, Italy
| | | | - P Spadaro
- Medical Oncology, Casa di Cura Villa Salus-Messina, Messina, Italy
| | - C Taverniti
- Medical Oncology, A.O.U. Città della Salute e della Scienza, Osp. Molinette, Torino, Italy
| | - D Toniolo
- Medical Oncology, ASST Rhodense, Ospedale di Circolo Rho, Rho, Italy
| | - P Tralongo
- Medical Oncology, Osp. Umberto I, Siracusa, Italy
| | - A Turletti
- Medical Oncology, P.O. Martini, Torino, Italy
| | - R Valenza
- Medical Oncology, P.O. Vittorio Emanuele, Gela, Italy
| | - M R Valerio
- Department of Discipline Chirurgiche, Oncologiche e Stomatologiche (DICHIRONS), Medical Oncology, A.O.U. Policlinico Paolo Giaccone, Palermo, Italy
| | - P Vici
- Phase IV trials, IRCCS, INT Regina Elena, Rome, Italy
| | - P Di Mauro
- Oncology Unit, ASST Monza, Monza, MB, Italy
| | - V Cogliati
- Phase 1 Research Centre and Oncology Unit, Department of Medicine and Surgery, University of Milano-Bicocca, ASST Monza, Via Pergolesi 33, 20900, Monza, MB, Italy
| | - S Capici
- Phase 1 Research Centre and Oncology Unit, Department of Medicine and Surgery, University of Milano-Bicocca, ASST Monza, Via Pergolesi 33, 20900, Monza, MB, Italy
| | - L Clivio
- Oncology Department, IRCCS Mario Negri Institute, Milan, Italy
| | - V Torri
- Oncology Department, IRCCS Mario Negri Institute, Milan, Italy
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Torrisi R, Palumbo R, De Sanctis R, Vici P, Bianchi GV, Cortesi L, Leonardi V, Gueli R, Fabi A, Valerio MR, Gambaro AR, Tagliaferri B, Pizzuti L, Cazzaniga ME, Santoro A. Fulvestrant and trastuzumab in patients with luminal HER2-positive advanced breast cancer (ABC): an Italian real-world experience (HERMIONE 9). Breast Cancer Res Treat 2021; 190:103-109. [PMID: 34453206 DOI: 10.1007/s10549-021-06371-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 08/20/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE The most appropriate therapy for HR + /HER2-positive (HER2 +) advanced breast cancer (ABC) is a matter of debate. Co-targeting of both receptors represents an attractive strategy to overcome the cross-talk between them. METHODS The HERMIONE 9 is an observational retrospective multicentric study which aimed to describe the clinical outcome of patients with HR + /HER2 + ABC who received the combination of Fulvestrant (F) and Trastuzumab (T) as part of their routine treatment at 10 Italian Institutions. RESULTS Eighty-seven patients were included. Median age was 63 (range, 35-87) years. The median number of previous treatments was 3 (range, 0-10) and F and T were administered as ≥ 3rd line in 67 patients. Among the 86 evaluable patients, 6 (6.9%) achieved CR, 18 (20.7%) PR, and 44 (50.6%) had SD ≥ 24 weeks with an overall CBR of 78.2%. At a median follow-up of 33.6 months, mPFS of the entire cohort was 12.9 months (range, 2.47-128.67). No difference was observed in mPFS between patients treated after progression or as maintenance therapy (mPFS 12.9 and 13.9 months in 64 and 23 patients, respectively), neither considering the number of previous treatment lines (≤ 3 or < 3). CONCLUSION The combination of F and T was active in this cohort at poor prognosis and deserves further investigations possibly in combination with pertuzumab in patients with high ER expression.
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Affiliation(s)
- Rosalba Torrisi
- Department of Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, via A. Manzoni 56 20089, Rozzano, Milano, Italy.
| | | | - Rita De Sanctis
- Department of Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, via A. Manzoni 56 20089, Rozzano, Milano, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Patrizia Vici
- UOC OM2 IRCCS Regina Elena National Cancer Institute, Roma, Italy
| | | | - Laura Cortesi
- Department of Oncology and Haematology, Modena Hospital University, Modena, Italy
| | - Vita Leonardi
- Department of Medical Oncology, ARNAS Civico, Palermo, Italy
| | | | - Alessandra Fabi
- Precision Medicine in Breast Cancer Unit, Scientific Directorate, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Maria Rosaria Valerio
- Medical Oncology Unit, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Anna Rita Gambaro
- Medical Oncology, ASST Fatebenefratelli Sacco PO Sacco, Milano, Italy
| | | | - Laura Pizzuti
- UOC OM2 IRCCS Regina Elena National Cancer Institute, Roma, Italy
| | - Marina Elena Cazzaniga
- Centro Ricerca Fase 1 ASST Monza and Università Degli Studi Milano Bicocca, Milano, Italy
| | - Armando Santoro
- Department of Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, via A. Manzoni 56 20089, Rozzano, Milano, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
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Cazzaniga ME, Cordani N, Capici S, Cogliati V, Riva F, Cerrito MG. Metronomic Chemotherapy. Cancers (Basel) 2021; 13:cancers13092236. [PMID: 34066606 PMCID: PMC8125766 DOI: 10.3390/cancers13092236] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [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: 03/15/2021] [Revised: 04/20/2021] [Accepted: 04/28/2021] [Indexed: 12/15/2022] Open
Abstract
Simple Summary The present article reviews the state of the art of metronomic chemotherapy use to treat the principal types of cancers, namely breast, non-small cell lung cancer and colorectal ones, and of the most recent progresses in understanding the underlying mechanisms of action. Areas of novelty, in terms of new regimens, new types of cancer suitable for Metronomic chemotherapy (mCHT) and the overview of current ongoing trials, along with a critical review of them, are also provided. Abstract Metronomic chemotherapy treatment (mCHT) refers to the chronic administration of low doses chemotherapy that can sustain prolonged, and active plasma levels of drugs, producing favorable tolerability and it is a new promising therapeutic approach in solid and in hematologic tumors. mCHT has not only a direct effect on tumor cells, but also an action on cell microenvironment, by inhibiting tumor angiogenesis, or promoting immune response and for these reasons can be considered a multi-target therapy itself. Here we review the state of the art of mCHT use in some classical tumour types, such as breast and no small cell lung cancer (NSCLC), see what is new regarding most recent data in different cancer types, such as glioblastoma (GBL) and acute myeloid leukemia (AML), and new drugs with potential metronomic administration. Finally, a look at the strategic use of mCHT in the context of health emergencies, or in low –and middle-income countries (LMICs), where access to adequate healthcare is often not easy, is mandatory, as we always need to bear in in mind that equity in care must be a compulsory part of our medical work and research.
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Affiliation(s)
- Marina Elena Cazzaniga
- School of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza (MB), Italy;
- Phase 1 Research Centre, ASST-Monza (MB), 20900 Monza, Italy; (S.C.); (V.C.)
- Correspondence: (M.E.C.); (M.G.C.); Tel.: +39-0392-339-037 (M.E.C.)
| | - Nicoletta Cordani
- School of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza (MB), Italy;
| | - Serena Capici
- Phase 1 Research Centre, ASST-Monza (MB), 20900 Monza, Italy; (S.C.); (V.C.)
| | - Viola Cogliati
- Phase 1 Research Centre, ASST-Monza (MB), 20900 Monza, Italy; (S.C.); (V.C.)
| | - Francesca Riva
- Unit of Clinic Oncology, ASST-Monza (MB), 20900 Monza, Italy;
| | - Maria Grazia Cerrito
- School of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza (MB), Italy;
- Correspondence: (M.E.C.); (M.G.C.); Tel.: +39-0392-339-037 (M.E.C.)
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Capici S, Sala L, Galimberti S, Valsecchi MG, Squillace N, Gustinetti G, Cazzaniga ME, Bonfanti P. The Role for Tocilizumab in COVID-19 Patients: Reflections on Monza Cohort Data. Infect Drug Resist 2021; 14:1389-1392. [PMID: 33880043 PMCID: PMC8053531 DOI: 10.2147/idr.s304414] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 03/31/2021] [Indexed: 11/23/2022] Open
Abstract
The severe acute respiratory syndrome coronavirus 2 pandemic has dominated the global health scenario from the beginning of 2020 and still represents a major health emergency. Cytokine inhibitors as tocilizumab have been used to treat COVID-19 severe pneumonia with conflicting results. We performed a retrospective study whose results can contribute to the general overview regarding the role of these agents in severe COVID-19 pneumonia, suggesting an interesting, even not statistically significant evidence of the effectiveness of tocilizumab treatment in this disease and sow a seed of reflection about their use in future waves of pandemic. We compared two cohorts of patients treated with local standard of care and with tocilizumab in the experimental one. With a median follow-up of 92 days, deaths were 6 and 16 in the tocilizumab and the standard of care group, respectively. With a longer follow-up than previous studies, a trend in difference with regards to mortality of the groups was observed.
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Affiliation(s)
| | - Luca Sala
- Phase 1 Research Unit, ASST Monza, Monza, Italy
| | - Stefania Galimberti
- Bicocca Bioinformatics Biostatistics and Bioimaging B4 Center, School of Medicine and Surgery, University of Milano - Bicocca, Monza, Italy
| | - Maria Grazia Valsecchi
- Bicocca Bioinformatics Biostatistics and Bioimaging B4 Center, School of Medicine and Surgery, University of Milano - Bicocca, Monza, Italy
| | | | | | - Marina Elena Cazzaniga
- Phase 1 Research Unit, ASST Monza, Monza, Italy.,School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Paolo Bonfanti
- Infectious Disease Unit, ASST Monza, Monza, Italy.,School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
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31
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Zeppellini A, Galimberti S, Leone BE, Pacifico C, Riva F, Cicchiello F, Capici S, Maggioni C, Sala L, Cazzaniga ME. Comparison of tumor microenvironment in primary and paired metastatic ER+/HER2- breast cancers: results of a pilot study. BMC Cancer 2021; 21:260. [PMID: 33691674 PMCID: PMC7944604 DOI: 10.1186/s12885-021-07960-z] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 12/02/2020] [Indexed: 12/17/2022] Open
Abstract
Background Tumor microenvironment (TME) is a dynamic setting and changes in TILs and their subpopulations are potential candidates to influence the metastatic process. Aim of this pilot study is to describe the changes occurring between primary breast cancers and their paired metastases in terms of TILs composition. To assess if these changes influence the process of metastasis development, we used a control group of patients. Methods We retrospectively identified 18 Luminal patients, for whom primary and metastatic tissue were available (cases) and 18 paired-matched patients (controls), not relapsed after at least 9 years of follow-up, and we quantified TILs and their composition (i.e. T CD8+ and CD4+/FOXP3+). The presence of TILs was defined as ≥10%. Results Our results showed that the microenvironment composition of relapsed patients was poor of TILs (median = 5%, I-III quartiles = 0.6–5%), CD8+ (2.5%, 0–5%) and CD4+/FOXP3 + (0%, 0–0.6%) in the primary tumor. Comparable results were observed in their related metastases (TILs 3.8%, 0.6–5%; CD8+ 0%, 0–1.3%; CD4+/FOXP3+ 0%,0–1.9%). On the contrary, the microenvironment in the control group was richer of TILs (5%, 5–17.5%) in comparison to cases, both in primary tumor (p = 0.035) and related metastases (p = 0.018). Although CD8+ in controls were similar to cases at primary tumor (p = 0.6498), but not at metastasis (p = 0.0223), they expressed only one part on the TILs subpopulations (p = 0.0060), while TILs in the cases at primary tumor were almost completely CD8+ (p = 0.5034). Conclusions These findings suggest that the lack of activation of immune system in the primary tumor might influence the multifactor process of cancer progression.
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Affiliation(s)
| | - Stefania Galimberti
- School of Medicine and Surgery, Bicocca Bioinformatics Biostatistics and Bioimaging B4 Center, University of Milano - Bicocca, via Cadore, Monza, Italy.
| | - Biagio Eugenio Leone
- School of Medicine and Surgery, University of Milano - Bicocca, via Cadore, Monza, Italy.,Department of Medical Pathology, ASST Monza, via Pergolesi, Monza, Italy
| | - Claudia Pacifico
- School of Medicine and Surgery, Bicocca Bioinformatics Biostatistics and Bioimaging B4 Center, University of Milano - Bicocca, via Cadore, Monza, Italy
| | - Francesca Riva
- Department of Medical Oncology, ASST Monza, via Pergolesi, Monza, Italy
| | | | - Serena Capici
- Phase 1 Research Centre - ASST Monza, via Pergolesi, Monza, Italy
| | - Claudia Maggioni
- Department of Medical Oncology, ASST Monza, via Pergolesi, Monza, Italy
| | - Luca Sala
- Department of Medical Oncology, ASST Monza, via Pergolesi, Monza, Italy
| | - Marina Elena Cazzaniga
- School of Medicine and Surgery, University of Milano - Bicocca, via Cadore, Monza, Italy.,Phase 1 Research Centre - ASST Monza, via Pergolesi, Monza, Italy
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Cazzaniga ME, Giordano M, Bandera M, Cassani C, Bounous V, Lania A, Biasi G, Destro M, Ricci S, Lucini D, Biglia N, Pagani O. Managing Menopausal Symptoms in Young Women With Breast Cancer: When Medicine Is Not All. The Take Care Project. Clin Breast Cancer 2021; 21:e547-e560. [PMID: 33685833 DOI: 10.1016/j.clbc.2021.01.010] [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] [Received: 07/26/2020] [Revised: 09/29/2020] [Accepted: 01/17/2021] [Indexed: 10/22/2022]
Abstract
In the last decade, endocrine therapy strategies in perimenopausal women with hormone-responsive early breast cancer (BC) have changed and now ovarian function suppression (OFS) is recommended for the majority of patients. Side effects of OFS mimic menopausal symptoms, including hot flushes, sweats, weight gain, and sexual dysfunction, which may negatively impact quality of life (QoL). Aims of the Take Care Project are the education of physicians and patients to have all the information (medical and nonmedical) they need to manage menopausal symptoms by distributing educational materials useful to face menopause. Four different areas have been identified by surveys conducted among physicians and young patients: for each area, interventions and tools have been elaborated by a doctor and nonphysician professionals of these identified areas, to offer the widest information available. Clinical and practical suggestions have been provided. Based on the evidence given, we strongly suggest setting up a multidisciplinary team for the treatment planning of young patients with BC, which could help patients to face and manage their new menopause condition. The reduction of side effects and the improvement in QoL should be the best ally to treat young patients with BC.
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Affiliation(s)
- Marina Elena Cazzaniga
- Phase 1 Research Unit & Oncology Unit, Azienda Socio Sanitaria Territoriale Monza & Milano Bicocca School of Medicine and Surgery, Monza, Italy.
| | - Monica Giordano
- Oncology Unit, Azienda Socio Sanitaria Territoriale Lariana, Como, Italy
| | - Mirko Bandera
- Farmacie Sant'Agata, Pharmacy Group, Bulgarograsso (Como), Italy
| | - Chiara Cassani
- Department of Obstetrics and Gynecology, Istituto di Ricovero e Cura a Carattere Scientifico, Policlinico San Matteo, Pavia, Italy
| | - Valentina Bounous
- Department of Obstetrics and Gynecology, Mauriziano "Umberto I" Hospital, University of Turin, Turin, Italy
| | - Andrea Lania
- Endocrinology, Diabetology and Andrology Unit, Biomedicine Department, Humanitas University, Milan, Italy
| | - Giovanna Biasi
- Prevention Department, Unità Operativa Complessa Medicine and Sport and Exercise, Treviso, Italy
| | - Maurizio Destro
- Medical Unit, Azienda Socio Sanitaria Territoriale Bergamo Ovest, Treviglio (BG) Italy
| | - Sauro Ricci
- Executive Chef, Joja Restaurant, Milan, Italy
| | - Daniela Lucini
- Exercise Medicine Unit, University of Milan BIOMETRA Department, Humanitas Clinical and Research Center, Milan, Italy
| | - Nicoletta Biglia
- Department of Obstetrics and Gynecology, Mauriziano "Umberto I" Hospital, University of Turin, Turin, Italy
| | - Olivia Pagani
- EOC Istituto Oncologico della Svizzera Italiana Ospedale Regionale Bellinzona e Valli 6500, Bellinzona, Switzerland
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Pilla L, Alberti A, Di Mauro P, Gemelli M, Cogliati V, Cazzaniga ME, Bidoli P, Maccalli C. Molecular and Immune Biomarkers for Cutaneous Melanoma: Current Status and Future Prospects. Cancers (Basel) 2020; 12:E3456. [PMID: 33233603 PMCID: PMC7699774 DOI: 10.3390/cancers12113456] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 09/28/2020] [Revised: 11/11/2020] [Accepted: 11/11/2020] [Indexed: 12/18/2022] Open
Abstract
Advances in the genomic, molecular and immunological make-up of melanoma allowed the development of novel targeted therapy and of immunotherapy, leading to changes in the paradigm of therapeutic interventions and improvement of patients' overall survival. Nevertheless, the mechanisms regulating either the responsiveness or the resistance of melanoma patients to therapies are still mostly unknown. The development of either the combinations or of the sequential treatment of different agents has been investigated but without a strongly molecularly motivated rationale. The need for robust biomarkers to predict patients' responsiveness to defined therapies and for their stratification is still unmet. Progress in immunological assays and genomic techniques as long as improvement in designing and performing studies monitoring the expression of these markers along with the evolution of the disease allowed to identify candidate biomarkers. However, none of them achieved a definitive role in predicting patients' clinical outcomes. Along this line, the cross-talk of melanoma cells with tumor microenvironment plays an important role in the evolution of the disease and needs to be considered in light of the role of predictive biomarkers. The overview of the relationship between the molecular basis of melanoma and targeted therapies is provided in this review, highlighting the benefit for clinical responses and the limitations. Moreover, the role of different candidate biomarkers is described together with the technical approaches for their identification. The provided evidence shows that progress has been achieved in understanding the molecular basis of melanoma and in designing advanced therapeutic strategies. Nevertheless, the molecular determinants of melanoma and their role as biomarkers predicting patients' responsiveness to therapies warrant further investigation with the vision of developing more effective precision medicine.
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Affiliation(s)
- Lorenzo Pilla
- Division of Medical Oncology, San Gerardo Hospital, University of Milano-Bicocca School of Medicine, 20900 Monza, Italy; (P.D.M.); (M.G.); (V.C.); (M.E.C.); (P.B.)
| | - Andrea Alberti
- Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Health Science and Public Health, University of Brescia, ASST Ospedali Civili, 25123 Brescia, Italy;
| | - Pierluigi Di Mauro
- Division of Medical Oncology, San Gerardo Hospital, University of Milano-Bicocca School of Medicine, 20900 Monza, Italy; (P.D.M.); (M.G.); (V.C.); (M.E.C.); (P.B.)
| | - Maria Gemelli
- Division of Medical Oncology, San Gerardo Hospital, University of Milano-Bicocca School of Medicine, 20900 Monza, Italy; (P.D.M.); (M.G.); (V.C.); (M.E.C.); (P.B.)
| | - Viola Cogliati
- Division of Medical Oncology, San Gerardo Hospital, University of Milano-Bicocca School of Medicine, 20900 Monza, Italy; (P.D.M.); (M.G.); (V.C.); (M.E.C.); (P.B.)
| | - Marina Elena Cazzaniga
- Division of Medical Oncology, San Gerardo Hospital, University of Milano-Bicocca School of Medicine, 20900 Monza, Italy; (P.D.M.); (M.G.); (V.C.); (M.E.C.); (P.B.)
| | - Paolo Bidoli
- Division of Medical Oncology, San Gerardo Hospital, University of Milano-Bicocca School of Medicine, 20900 Monza, Italy; (P.D.M.); (M.G.); (V.C.); (M.E.C.); (P.B.)
| | - Cristina Maccalli
- Laboratory of Immune and Biological Therapy, Research Department, Sidra Medicine, Doha 26999, Qatar;
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Bani M, Rossi E, Cortinovis D, Russo S, Gallina F, Hillen MA, Canova S, Cicchiello F, Longarini R, Cazzaniga ME, Bidoli P, Valsecchi MG, Strepparava MG. Validation of the Italian version of the full and abbreviated Trust in Oncologist Scale. Eur J Cancer Care (Engl) 2020; 30:e13334. [PMID: 33015898 DOI: 10.1111/ecc.13334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 05/29/2020] [Accepted: 08/07/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The Trust in Oncologist Scale (TiOS) is an 18-item questionnaire aimed to assess the cancer patients' trust in their oncologist and has been validated in Dutch and English language. This study aims to validate the Italian version of the TiOS (IT-TiOS) and the TiOS-Short Form (IT-TiOS-SF). METHODS The IT-TiOS was administered to 194 patients recruited in an Italian oncology department from April to December 2018. Data collected included socio-demographic data, health and clinical information, satisfaction with the most recent oncology visit and trust in the regional healthcare system. Internal consistency, test-retest reliability, convergent and the structural validity of both the full and short form were tested. RESULTS Factor analyses indicated that neither four-factor nor one-factor models of the full scale were acceptable. However, confirmatory factor analysis supported the one-dimensionality of the IT-TiOS-SF, and internal consistency assessed with Cronbach's alpha was 0.88. Mean scores on the IT-TiOS-SF correlated with satisfaction with the oncologist (rs = 0.64) and willingness to recommend the oncologist to others (rs = 0.67), confirming good construct validity. CONCLUSION The IT-TiOS-SF demonstrates good psychometric properties and can be used to assess trust for both clinical and research purposes.
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Affiliation(s)
- Marco Bani
- School of Medicine and Surgery, University of Milano - Bicocca, Milano, Italy
| | - Emanuela Rossi
- School of Medicine and Surgery, University of Milano - Bicocca, Milano, Italy
| | - Diego Cortinovis
- School of Medicine and Surgery, University of Milano - Bicocca, Milano, Italy.,Department of Medical Oncology, ASST Monza, Monza, Italy
| | - Selena Russo
- School of Medicine and Surgery, University of Milano - Bicocca, Milano, Italy
| | | | - Marij A Hillen
- Department of Medical Psychology, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | | | | | | | - Marina Elena Cazzaniga
- School of Medicine and Surgery, University of Milano - Bicocca, Milano, Italy.,Department of Medical Oncology, ASST Monza, Monza, Italy.,Department of Mental Health, ASST Monza, Monza, Italy
| | - Paolo Bidoli
- School of Medicine and Surgery, University of Milano - Bicocca, Milano, Italy.,Department of Medical Oncology, ASST Monza, Monza, Italy
| | | | - Maria Grazia Strepparava
- School of Medicine and Surgery, University of Milano - Bicocca, Milano, Italy.,Phase 1 Research Unit, ASST Monza, Monza, Italy
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35
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Cazzaniga ME, Verusio C, Ciccarese M, Fumagalli A, Sartori D, Valerio MR, Airoldi M, Moretti G, Ficorella C, Gianni L, Michelotti A, Zambelli A, Febbraro A, Generali D, Pistelli M, Garrone O, Musolino A, Vici P, Maur M, Mentuccia L, La Verde N, Bianchi GV, Artale S, Blasi L, De Laurentiis M, Atzori F, Turletti A, Porpiglia M, Santini D, Fabi A, Gebbia V, Schirone A, Palumbo R, Ferzi A, Frassoldati A, Scavelli C, Clivio L, Giordano M, Donadio M, Biganzoli L, Del Mastro L, Bisagni G, Livi L, Natoli C, Montemurro F, Riccardi F, Romagnoli E, Marchetti P, Torri V, Pronzato P, Mustacchi G. Is There Still a Role for Endocrine Therapy Alone in HR+/HER2- Advanced Breast Cancer Patients? Results from the Analysis of Two Data Sets of Patients Treated with High-Dose Fulvestrant as First-Line Therapy in the Real-World Setting: The EVA and GIM-13 AMBRA Studies. Breast Care (Basel) 2020; 15:30-37. [PMID: 32231495 DOI: 10.1159/000495469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 11/15/2018] [Indexed: 11/19/2022] Open
Abstract
Background Different studies suggest that fulvestrant 500 mg every 28 days (HD-FUL) could be an active treatment in HR+ advanced breast cancer (ABC) patients even treated with aromatase inhibitors in the adjuvant setting. The aim of this analysis is to describe the outcome of ABC patients treated with HD-FUL as first-line treatment in terms of median duration of treatment and the overall response rate in a real-world setting. Methods For the purpose of the present analysis, we considered two data sets of HR+ ABC patients collected in Italy between 2012 and 2015 (EVA and GIM-13 AMBRA studies). Results Eighty-one and 91 patients have been identified from the two data sets. The median age was 63 years (range 35-82) for the EVA and 57.8 years (range 35.0-82.3) for the AMBRA patients. ORRs were 23.5 and 24.3% in the whole population, 26.9% in the patients with bone only, and 21.8 and 21.4% in those with visceral metastases. The median duration of HD-FUL was 11.6 months (range 1-48) and 12.4 months (range 2.9-70.0) in the two data sets, respectively. Conclusion These data suggest that HD-FUL should still continue to play a significant role as first-line therapy in HR+ ABC patients.
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Affiliation(s)
- Marina Elena Cazzaniga
- Research Unit Phase I Trials, ASST Monza, Monza, Italy.,Oncology Unit, ASST Monza, Monza, Italy
| | - Claudio Verusio
- Oncology Unit, ASST della Valle Olona - Presidio Ospedaliero di Saronno, Saronno, Italy
| | | | | | | | | | - Mario Airoldi
- Oncology Unit 2 - Città della Salute e della Scienza di Torino, Turin, Italy
| | - Gabriella Moretti
- Oncology Unit, IRCCS Arcispedale S. Maria Nuova, Reggio Emilia, Italy
| | - Corrado Ficorella
- Dipartimento di Scienze Cliniche Applicate e Biotecnologiche (DISCAB) - Università Degli Studi Dell'Aquila, L'Aquila, Italy
| | - Lorenzo Gianni
- Oncology Unit Rimini, Azienda USL Romagna, Rimini, Italy
| | - Andrea Michelotti
- Oncology Unit 2, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | | | - Antonio Febbraro
- Oncology Unit, Ospedale Sacro Cuore di Gesù, Fatebenefratelli, Benevento, Italy
| | | | - Mirco Pistelli
- Oncology Unit, AOU Ospedali Riuniti Ancona, Ancona, Italy
| | - Ornella Garrone
- Oncology Unit, A.O.S. Croce e Carle Ospedale di Insegnamento, Cuneo, Italy
| | - Antonino Musolino
- Oncology Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Patrizia Vici
- Oncology Unit 2, Istituto Nazionale Tumori Regina Elena - IFO, Rome, Italy
| | - Michela Maur
- Oncology Unit, Policlinico University Hospital of Modena, Modena, Italy
| | - Lucia Mentuccia
- Oncology Unit, ASL di Frosinone, Osp. "SS. Trinità", Sora, Italy
| | - Nicla La Verde
- Oncology Unit, ASST Fatebenefratelli Sacco Presidio Ospedaliero Fatebenefratelli, Milan, Italy
| | | | - Salvatore Artale
- Oncology Departement, Ospedale di Gallarate, ASST Valle Olona, Gallarate, Italy
| | - Livio Blasi
- Oncology Unit, ARNAS Civico Palermo, Palermo, Italy
| | | | | | | | - Mauro Porpiglia
- Oncology Unit, ASST della Valle Olona - Presidio Ospedaliero di Saronno, Saronno, Italy
| | | | - Alessandra Fabi
- Oncology Unit, Ospedale Moriggia Pelascini, Gravedona, Italy
| | | | - Alessio Schirone
- Oncology Department, Policlinico "Paolo Giaccone", Palermo, Italy
| | - Raffaella Palumbo
- Oncology Unit 2 - Città della Salute e della Scienza di Torino, Turin, Italy
| | - Antonella Ferzi
- Oncology Unit, IRCCS Arcispedale S. Maria Nuova, Reggio Emilia, Italy
| | - Antonio Frassoldati
- Dipartimento di Scienze Cliniche Applicate e Biotecnologiche (DISCAB) - Università Degli Studi Dell'Aquila, L'Aquila, Italy
| | | | - Luca Clivio
- Oncology Unit 2, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | | | - Michela Donadio
- Oncology Unit, Ospedale Sacro Cuore di Gesù, Fatebenefratelli, Benevento, Italy
| | | | | | - Giancarlo Bisagni
- Oncology Unit, A.O.S. Croce e Carle Ospedale di Insegnamento, Cuneo, Italy
| | - Lorenzo Livi
- Oncology Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Clara Natoli
- Oncology Unit 2, Istituto Nazionale Tumori Regina Elena - IFO, Rome, Italy
| | | | | | - Emanuela Romagnoli
- Oncology Unit, ASST Fatebenefratelli Sacco Presidio Ospedaliero Fatebenefratelli, Milan, Italy
| | - Paolo Marchetti
- Oncology Unit 1, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Valter Torri
- Oncology Unit 2, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Paolo Pronzato
- Oncology Departement, Ospedale di Gallarate, ASST Valle Olona, Gallarate, Italy
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Caputo R, Cazzaniga ME, Sbrana A, Torrisi R, Paris I, Giordano M, Montesarchio V, Guarneri V, Amaducci L, Bilancia D, Cilenti G, Fabi A, Collovà E, Schirone A, Bonizzoni E, Celio L, De Placido S, De Laurentiis M. Netupitant/palonosetron (NEPA) and dexamethasone for prevention of emesis in breast cancer patients receiving adjuvant anthracycline plus cyclophosphamide: a multi-cycle, phase II study. BMC Cancer 2020; 20:232. [PMID: 32188417 PMCID: PMC7081578 DOI: 10.1186/s12885-020-6707-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 03/03/2020] [Indexed: 02/08/2023] Open
Abstract
Background NEPA is an oral fixed-dose combination of netupitant, a new highly selective neurokinin-1 receptor antagonist, and palonosetron. This study was conducted to evaluate whether the efficacy of NEPA against chemotherapy-induced nausea and vomiting (CINV) in cycle 1 would be maintained over subsequent chemotherapy cycles in breast cancer patients receiving adjuvant anthracycline plus cyclophosphamide (AC). The study also describes the relationship between efficacy on day 1 through 5 (overall period) and control of CINV on day 6 through 21 (very late period) in each cycle. Methods In this multicentre, phase II study, patients received both NEPA and dexamethasone (12 mg intravenously) just before chemotherapy. The primary efficacy endpoint was overall complete response (CR; no emesis and no rescue medication use) in cycle 1. Sustained efficacy was evaluated during the subsequent cycles by calculating the rate of CR in cycles 2–4 and by assessing the probability of sustained CR over multiple cycles. The impact of both overall CR and risk factors for CINV on the control of very late events (vomiting and moderate-to-severe nausea) were also examined. Results Of the 149 patients enrolled in the study, 139 were evaluable for a total of 552 cycles; 97.8% completed all 4 cycles. The proportion of patients with an overall CR was 70.5% (90% CI, 64.1 to 76.9) in cycle 1, and this was maintained in subsequent cycles. The cumulative percentage of patients with a sustained CR over 4 cycles was 53%. NEPA was well tolerated across cycles. In each cycle, patients with CR experienced a significantly better control of very late CINV events than those who experienced no CR. Among the patients with CR, the only predictor for increased likelihood of developing very late CINV was pre-chemotherapy (anticipatory) nausea (adjusted odds ratio = 0.65–0.50 for no CINV events on cycles 3 and 4). Conclusion The high anti-emetic efficacy seen with the NEPA regimen in the first cycle was maintained over multiple cycles of adjuvant AC for breast cancer. Preliminary evidence also suggests that patients achieving a CR during the overall period gain high protection even against very late CINV events in each chemotherapy cycle. Trial registration This trial was retrospectively registered at Clinicaltrials.gov identifier (NCT03862144) on 05/Mar/2019.
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Affiliation(s)
- Roberta Caputo
- Breast Medical Oncology Division, Istituto Nazionale Tumori IRCCS "Fondazione G. Pascale", Naples, Italy
| | | | - Andrea Sbrana
- Medical Oncology Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Rosalba Torrisi
- Department of Medical Oncology and Hematology, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Ida Paris
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | | | - Valentina Guarneri
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy.,Istituto Oncologico Veneto IOV I.R.C.C.S, Padova, Italy
| | - Laura Amaducci
- Oncology Department Area Vasta Romagna, Faenza Hospital, Faenza, Ravenna, Italy
| | | | - Giuseppina Cilenti
- Medical Oncology Division, Fondazione IRCCS Casa Sollievo Della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| | | | - Elena Collovà
- Oncology Unit, ASST Ovest Milanese, Legnano Hospital, Legnano, Milan, Italy
| | - Alessio Schirone
- Clinical Oncology Division, Azienda Ospedaliero-Universitaria, Cona, Ferrara, Italy
| | - Erminio Bonizzoni
- Department of Clinical Science and Community. Section of Medical Statistics, Biometry and Epidemiology "G.A. Maccacaro". Faculty of Medicine and Surgery, University of Milan, Milan, Italy
| | - Luigi Celio
- Medical Oncology Unit 1, Fondazione IRCCS "Istituto Nazionale dei Tumori", Milan, Italy
| | - Sabino De Placido
- Clinical Medicine and Surgery Department, University of Naples Federico II, Naples, Italy
| | - Michelino De Laurentiis
- Breast Medical Oncology Division, Istituto Nazionale Tumori IRCCS "Fondazione G. Pascale", Naples, Italy.
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Cazzaniga ME, De Placido S, D'Alonzo A, Piezzo M, Natoli C, Milani A, Bologna A, Alu M, Turletti A, Pugliese P, Biganzoli L, De Angelis C, Garrone O, Marchetti P, Riccardi F, Bernardo A, Livi L, Fabi A, Taverniti C, Romagnoli E, Pronzato P, Mustacchi G. Abstract P5-07-10: Progression-free survival (PFS) and overall survival (OS) in HER2-ve advanced breast cancer (ABC) patients (pts) according to the molecular subtype in the era of modern agents. Results from the GIM-13 AMBRA study. Cancer Res 2020. [DOI: 10.1158/1538-7445.sabcs19-p5-07-10] [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 Pts with ABC have a diverse clinical course and OS rates vary significantly among pts. New strategies had potentially changed the natural history of these pts, however data from clinical studies are still lacking and Real-World Studies (RWS) are crucial in clinical outcome evaluation.
PATIENTS AND METHODS AMBRA is a longitudinal cohort study, aiming to describe the choice of first and subsequent lines of treatment in HER2-ve ABC pts receiving at least one CHT (SABCS 2016, P5-15-07 & P5-14-09) in the years 2012-2015. The present analysis is focused on the description of Progression-Free Survival (PFS) and OS according to the biologic subtype in the deceased population. So far, 791/1500 pts have been registered into the study and 255 (32.2%) are evaluable. Time to event analysis between subtypes was evaluated by Cox-Mantel Hazard Ratio and Logrank Test. DFS by Wilcoxon Rank-Sum Test
RESULTS Pts distribution according to molecular subtype was: Luminal A (86, 33.7%), Luminal B (107 (42.1%), TNBC (62, 24.3%). Median ages at diagnosis were 55.8, 52.9 and 55.1 years for the 3 subgroups, respectively. Mean DFS was significantly different according to the molecular subtypes: 87.28, 61.37 and 23.9 months. The difference between Luminal B and TNBC is statistically significant as well. Mean PFS of 1st-line therapy was 17.9 11.7 and 7.8 months respectively. Mean OS from 1stprogression was 32.9 24.2 and 15.8 months respectively.
CONCLUSIONS Our data confirm in a RWS the different biological behaviour between Lum A and B. Metastatic life span is quite good for Luminals and disappointing for TNBC. Median time from last CHT and Death is quite short and similar.
Luminal ALuminal BTNBCMean DFS (months)87.28 [95%CI: 72.9-101.7]61.37 [95%CI: 52.3-70.4] p=0003623.9 months [95%CI: 18.5-29.3] p=0.000000Mean PFS (months)17.9 [95%CI: 12.5-23.5]11.7 [95%CI:9.8-13.7]7.8 months [95%CI: 5.9-9.6]Mean OS from 1st progression (months)32.9 [95%CI:25.4-40.4]24.2 [95%CI: 21.3-26.9]15.8 [95%CI: 13.0-18.6]Median time from last CHT and Death (months)2.231.951.53Lum A/Lum B HR (p value)Lum A/TNBC HR (p value)Lum B/TNBC HR (p value)PFS 1st-Line0.73 (0.02)0.49 (0.0000)0.63 (0.003)OS from diagnosis (years)0.59 (0.0003)0.25 (0.0000)0.34 (0.0000)OS from 1st-PD0.72 (0.02)0.47 (0.0000)0.50 (0.0002)
Citation Format: Marina Elena Cazzaniga, Sabino De Placido, Alessia D'Alonzo, Michela Piezzo, Clara Natoli, Andrea Milani, Alessandra Bologna, Massimiliano Alu, Anna Turletti, Palma Pugliese, Laura Biganzoli, Claudia De Angelis, Ornella Garrone, Paolo Marchetti, Ferdinando Riccardi, Antonio Bernardo, Lorenzo Livi, Alessandra Fabi, Cristiana Taverniti, Emanuela Romagnoli, Paolo Pronzato, Giorgio Mustacchi, on behalf of GIM-13 AMBRA Study Group. Progression-free survival (PFS) and overall survival (OS) in HER2-ve advanced breast cancer (ABC) patients (pts) according to the molecular subtype in the era of modern agents. Results from the GIM-13 AMBRA study [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P5-07-10.
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Affiliation(s)
| | | | - Alessia D'Alonzo
- 3Ospedale Policlinico San Martino- Oncologia Medica, Napolio, Italy
| | - Michela Piezzo
- 4INT Fondazione Giovanni Pascale-IRCCS -Breast Oncology Unit, Napoli, Italy
| | - Clara Natoli
- 5Dep. of Medical, Oral and Biotechnological Sciences and CeSI-MeT- University G. D'Annunzio, Chieti, Italy
| | - Andrea Milani
- 6Candiolo Cancer Institute, FPO-IRCCS, Torino, Italy
| | | | | | | | | | - Laura Biganzoli
- 11Ospedale Santo Stefano- U.O. Oncologia Medica, Prato, Italy
| | - Claudia De Angelis
- 12Azienda Ospedaliera Universitaria Pisana- Oncologia Medica, Pisa, Italy
| | - Ornella Garrone
- 13Breast Unit, Medical Oncology S.Croce and Carle Teaching Hospital Cuneo, Cuneo, Italy
| | | | | | - Antonio Bernardo
- 16Istituti Clinici Scientifici Maugeri Spa Società Benefit, Pavia, Italy
| | - Lorenzo Livi
- 17AOU Careggi - Radioterapia Oncologica, Firenze, Italy
| | - Alessandra Fabi
- 18Istituto Nazionale Tumori “Regina Elena”- Oncologia Medica 1, Roma, Italy
| | - Cristiana Taverniti
- 19A.O.U. Città della Salute e della Scienza- SSCVD Oncologia Medica Senologica, Torino, Italy
| | | | - Paolo Pronzato
- 21Ospedale Policlinico San Martino- Oncologia Medica, Genova, Italy
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Cazzaniga ME, Pinotti G, Montagna E, Amoroso D, Berardi R, Butera A, Cagossi K, Cavanna L, Ciccarese M, Cinieri S, Cretella E, De Conciliis E, Febbraro A, Ferraù F, Ferzi A, Fiorentini G, Fontana A, Gambaro AR, Garrone O, Gebbia V, Generali D, Gianni L, Giovanardi F, Grassadonia A, Leonardi V, Marchetti P, Melegari E, Musolino A, Nicolini M, Putzu C, Riccardi F, Santini D, Saracchini S, Sarobba MG, Schintu MG, Scognamiglio G, Spadaro P, Taverniti C, Toniolo D, Tralongo P, Turletti A, Valenza R, Valerio MR, Vici P, Clivio L, Torri V. Metronomic chemotherapy for advanced breast cancer patients in the real world practice: Final results of the VICTOR-6 study. Breast 2019; 48:7-16. [PMID: 31470257 DOI: 10.1016/j.breast.2019.07.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [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: 03/05/2019] [Revised: 07/24/2019] [Accepted: 07/29/2019] [Indexed: 12/21/2022] Open
Abstract
Metronomic chemotherapy (mCHT) refers to the minimum biologically effective dose of a chemotherapy agent given as a continuous dosing regimen, with no prolonged drug-free breaks, that leads to antitumor activity. Aim of the present study is to describe the use of mCHT in a retrospective cohort of metastatic breast cancer (MBC) patients in order to collect data regarding the different types and regimens of drugs employed, their efficacy and safety. Between January 2011 and December 2016, data of 584 metastatic breast cancer patients treated with mCHT were collected. The use of VRL-based regimens increased during the time of observation (2011: 16.8% - 2016: 29.8%), as well as CTX-based ones (2011: 17.1% - 2016: 25.6%), whereas CAPE-based and MTX-based regimens remained stable. In the 1st-line setting, the highest ORR and DCR were observed for VRL-based regimens (single agent: 44% and 88%; combination: 36.7% and 82.4%, respectively). Assuming VRL-single agent as the referee treatment (median PFS: 7.2 months, 95% CI: 5.3-10.3), the longest median PFS were observed in VRL-combination regimens (9.5, 95%CI 88.8-11.3, HR = 0.72) and in CAPE-single agent (10.7, 95%CI 8.3-15.8, HR = 0.70). The VICTOR-6 study provides new data coming from the real-life setting, by adding new information regarding the use of mCHT as an option of treatment for MBC patients.
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Affiliation(s)
- M E Cazzaniga
- Research Unit Phase I Trials, ASST Monza, Monza, Italy; Oncology Unit, ASST Monza, Italy.
| | - G Pinotti
- Medical Oncology, ASST Sette Laghi "Ospedale di Circolo e Fondazione Macchi, Varese, VA, Italy
| | - E Montagna
- Medical Senology Division, IEO, Milan, Italy
| | - D Amoroso
- Medical Oncology, Ospedale Della Versilia, Lido di Camaiore, IT, Italy
| | - R Berardi
- Medical Oncology, A. Ospedaliero-universitaria Ospedali Riuniti, Ancona, IT, Italy
| | - A Butera
- Medical Oncology, Ospedale San Giovanni di Dio, Agrigento, IT, Italy
| | - K Cagossi
- Medical Oncology, Ospedale Ramazzini, Carpi, IT, Italy
| | - L Cavanna
- Medical Oncology, Azienda Ospedaliera Piacenza, Piacenza, IT, Italy
| | - M Ciccarese
- Medical Oncology, Ospedale Vito Fazzi, Lecce, IT, Italy
| | - S Cinieri
- Medical Oncology, ASL Brindisi, Brindisi, Italy
| | - E Cretella
- Medical Oncology, Ospedale Bolzano, IT, Italy
| | | | - A Febbraro
- Medical Oncology, Ospedale S. Cuore di Gesù Fatebenefratelli, Benevento, Italy
| | - F Ferraù
- Medical Oncology, Osp Taormina, Taormina, IT, Italy
| | - A Ferzi
- Medical Oncology, A.S.S.T. Ovest Milanese, Legnano, IT, Italy
| | - G Fiorentini
- Medical Oncology, Ospedale San Salvatore, Pesaro, Italy
| | - A Fontana
- Medical Oncology, Az. Ospedaliero-Universitaria, Pisana, IT, Italy
| | - A R Gambaro
- Medical Oncology, ASST Fatebenefratelli, Sacco, IT, Italy
| | - O Garrone
- Medical Oncology, A.O. S. Croce e Carle, Cuneo, Italy
| | - V Gebbia
- Medical Oncology, Ospedale La Maddalena, Palermo, IT, Italy
| | - D Generali
- Medical Oncology, Istituti Ospitalieri Cremona, Cremona, IT, Italy
| | - L Gianni
- Medical Oncology, Azienda USL Romagna, U.O. di Oncologia Rimini, Cattolica, IT, Italy
| | - F Giovanardi
- Medical Oncology, Ospedale Civile, Guastalla, IT, Italy
| | - A Grassadonia
- Medical Oncology, P.O. SS Annunziata -ASL2 Lanciano-Vasto, Chieti, IT, Italy
| | - V Leonardi
- Medical Oncology, Ospedale Civico, Palermo, IT, Italy
| | - P Marchetti
- Medical Oncology, A.O. Sant'Andrea, Roma, IT, Italy
| | - E Melegari
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - A Musolino
- Medical Oncology, Azienda Ospedaliero-Universitaria di Parma, IT, Italy
| | - M Nicolini
- Medical Oncology, Azienda USL Romagna, U.O. di Oncologia Rimini, Cattolica, IT, Italy
| | - C Putzu
- Medical Oncology, A. Ospedaliera-Universitaria, Sassari, IT, Italy
| | - F Riccardi
- Medical Oncology, A. Ospedaliera Antonio Cardarelli, Napoli, IT, Italy
| | - D Santini
- Medical Oncology Università Campus Bio-Medico, Roma, IT, Italy
| | - S Saracchini
- Medical Oncology, Az. Osp. Santa Maria Degli Angeli, Pordenone, IT, Italy
| | - M G Sarobba
- Medical Oncology, Ospedale San Francesco, Nuoro, IT, Italy
| | - M G Schintu
- Medical Oncology, Osp Giovanni Paolo II, Olbia, IT, Italy
| | | | - P Spadaro
- Medical Oncology, Casa di Cura Villa Salus, Messina, IT, Italy
| | - C Taverniti
- Medical Oncology, A.O.U. Città Della Salute e Della Scienza, Osp. Molinette, Torino, IT, Italy
| | - D Toniolo
- Medical Oncology, ASST Rhodense 3 Ospedale di Circolo Rho, IT, Italy
| | - P Tralongo
- Medical Oncology, Osp. Umberto I, Siracusa, IT, Italy
| | - A Turletti
- Medical Oncology, P.O. Martini, Torino, IT, Italy
| | - R Valenza
- Medical Oncology, P.O. Vittorio Emanuele, Gela, IT, Italy
| | - M R Valerio
- Medical Oncology, A.O.U. Policlinico Paolo Giaccone, Palermo, IT, Italy
| | - P Vici
- Medical Oncology, B, INT Regina Elena, Roma, IT, Italy
| | - L Clivio
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Italy
| | - V Torri
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Italy
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Di Cosimo S, La Verde N, Moretti A, Cazzaniga ME, Generali D, Bianchi GV, Mariani L, Torri V, Crippa F, Paolini B, Scaperrotta G, De Santis MC, Di Nicola M, Apolone G, Gulino A, Tripodo C, Colombo MP, Folli S, de Braud F. Neoadjuvant eribulin mesylate following anthracycline and taxane in triple negative breast cancer: Results from the HOPE study. PLoS One 2019; 14:e0220644. [PMID: 31390375 PMCID: PMC6685628 DOI: 10.1371/journal.pone.0220644] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 03/04/2019] [Accepted: 07/15/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Eribulin mesylate (E) is indicated for metastatic breast cancer patients previously treated with anthracycline and taxane. We argued that E could also benefit patients eligible for neoadjuvant chemotherapy. METHODS Patients with primary triple negative breast cancer ≥2 cm received doxorubicin 60 mg/m2 and paclitaxel 200 mg/m2 x 4 cycles (AT) followed by E 1.4 mg/m2 x 4 cycles. Primary endpoint was pathological complete response (pCR) rate; secondary and explorative endpoints included clinical/metabolic response rates and safety, and biomarker analysis, respectively. Using a two-stage Simon design, 43 patients were to be included provided that 4 of 13 patients had achieved pCR in the first stage of the study. RESULTS In stage I of the study 13 women were enrolled, median age 43 years, tumor size 2-5 cm in 9/13 (69%), positive nodal status in 8/13 (61%). Main grade 3 adverse event was neutropenia (related to AT and E in 4 and 2 cases, respectively). AT followed by E induced clinical complete + partial responses in 11/13 patients (85%), pCR in 3/13 (23%). Median measurements of maximum standardized uptake value (SUVmax) resulted 13, 3, and 1.9 at baseline, after AT and E, respectively. Complete metabolic response (CMR) occurred after AT and after E in 2 and 3 cases, respectively. Notably, 2 of the 5 (40%) patients with CMR achieved pCR at surgery. Immunostaining of paired pre-/post-treatment tumor specimens showed a reduction of β-catenin, CyclinD1, Zeb-1, and c-myc expression, in the absence of N-cadherin modulation. The study was interrupted at stage I due to the lack of the required patients with pCR. CONCLUSIONS Despite the early study closure, preoperative E following AT showed clinical and biological activity in triple negative breast cancer patients. Furthermore, the modulation of β-catenin pathway core proteins, supposedly outside the domain of epithelial-mesenchymal transition, claims for further investigation. TRIAL REGISTRATION EU Clinical Trial Register, EudraCT number 2012-004956-12.
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Affiliation(s)
| | | | - Anna Moretti
- ASST Fatebenefratelli-Sacco, PO Fatebenefratelli, Milano, Italy
| | | | | | | | - Luigi Mariani
- Fondazione IRCCS Istituto Nazionale dei Tumori—Milano, Italy
| | - Valter Torri
- IRCCS—Istituto di Ricerche Farmacologiche “Mario Negri”, Milano, Italy
| | - Flavio Crippa
- Fondazione IRCCS Istituto Nazionale dei Tumori—Milano, Italy
| | - Biagio Paolini
- Fondazione IRCCS Istituto Nazionale dei Tumori—Milano, Italy
| | | | | | | | | | | | | | | | - Secondo Folli
- Fondazione IRCCS Istituto Nazionale dei Tumori—Milano, Italy
| | - Filippo de Braud
- Fondazione IRCCS Istituto Nazionale dei Tumori—Milano, Italy
- University of Milan, School of Medicine, Milano, Italy
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40
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Buono G, Fabi A, Del Mastro L, Cannita K, La Verde NM, Ardito R, Riccardi F, Montemurro F, Cazzaniga ME, Garrone O, Zambelli A, Conte B, Caputo R, Cianniello D, Bonotto M, Bartoletti M, Parola S, De Placido S, Di Maio M, Arpino G. Long-term toxicity profile of trastuzumab emtansine (T-DM1): A multicenter real-life study. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e12507] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e12507 Background: T-DM1 is widely used in HER2 positive metastatic breast cancer (MBC) patients (pts), often for many cycles until progression. However, little is known about its long term toxicity. The aim of this study was to evaluate the safety profile of T-DM1 when delivered for ≥12 cycles. Methods: HER2 positive MBC pts who had received ≥12 cycles of T-DM1 across 18 Italian cancer centers were enrolled from January 2017 to September 2018. The 12 cycles cut-off was chosen based on the EMILIA trial median PFS (9.6 months), to identify a patient population treated with T-DM1 for longer time. Tumor and clinical characteristics were collected. Standard haematological tests, blood chemistries and side effects (nausea, vomiting, diarrhea, stomatitis, asthenia) were recorded cycle by cycle, according CTCAE criteria version 4. Haematological and laboratory toxicities were available for 86 patients, while other toxicities for all 115 patients. Results: Overall, 115 pts were enrolled. Median age was 54.5 (range 29.6–81.9); median time from diagnosis of metastatic disease to first T-DM1 cycle was 32.5 months. T-DM1 was administered as 2nd line and 3rd line of treatment in 45.2% and 27.8% of pts, respectively. Median number of cycles was 18 (range 12-59). Complete response, partial response and stable disease rates were 11.4%, 43% and 45.6%, respectively. Treatment related side effects are shown in table 1. Interestingly, no increased liver toxicity was observed in pts with liver metastases. Analysis of mean CTCAE grade by cycle showed that no relevant incremental toxicity was observed during long term T-DM1 therapy. Conclusions: T-DM1 is safe and well tolerated in these long responding pts. We found no relevant cumulative toxicity. Patients should be treated with T-DM1 as long as their tumor responds, as no safety issues are related to its long term use. [Table: see text]
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Affiliation(s)
- Giuseppe Buono
- Department of Clinical Medicine and Surgery, Oncology Division, University Federico II, Naples, Italy
| | - Alessandra Fabi
- Division of Medical Oncology, “Regina Elena” National Cancer Institute, Rome, Italy
| | - Lucia Del Mastro
- Department of Medical Oncology, IRCCS AOU San Martino–IST, National Cancer Institute, Genova, Italy
| | - Katia Cannita
- S. Salvatore Hospital, University of L'Aquila, L'Aquila, Italy
| | - Nicla Maria La Verde
- Department of Oncology, ASST Fatebenefratelli Sacco, PO Fatebenefratelli, Milan, Italy
| | - Raffaele Ardito
- Oncology Day Hospital Unit, IRCCS CROB, Rionero in Vulture, Italy
| | | | - Filippo Montemurro
- Investigational and Clinical Oncology, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Italy
| | | | - Ornella Garrone
- Breast Unit Medical Oncology S. Croce and Carle Teaching Hospital, Cuneo, Italy
| | | | - Benedetta Conte
- Department of Medical Oncology, IRCCS AOU San Martino–IST, National Cancer Institute, Genova, Italy
| | - Roberta Caputo
- Istituto Nazionale Tumori IRCCS "Fondazione G. Pascale" -Breast Oncology Division, Naples, Italy
| | - Daniela Cianniello
- Istituto Nazionale Tumori IRCCS "Fondazione G. Pascale" -Breast Oncology Unit, Naples, Italy
| | - Marta Bonotto
- Department of Oncology, University Hospital of Udine, Udine, Italy
| | - Michele Bartoletti
- School of Medical Oncology, Department of Medicine, University of Udine, Udine, Italy
| | - Sara Parola
- Department of Clinical Medicine and Surgery, Oncology Division, University Federico II, Naples, Italy
| | - Sabino De Placido
- Oncology Unit, Department of Clinical Medicine and Surgery, University Federico II of Naples, Naples, Italy
| | - Massimo Di Maio
- Medical Oncology, Mauriziano Hospital; Department of Oncology, University of Turin, Torino, Italy
| | - Grazia Arpino
- Department of Clinical Medicine and Surgery, Oncology Division, University Federico II, Naples, Italy
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Cazzaniga ME, Pronzato P, Schettini F, Del Mastro L, Riemma M, Alù M, Turletti A, Giordano M, Pugliese P, De Angelis C, Garrone O, Marchetti P, Riccardi F, Bernardo A, Livi L, Fabi A, Taverniti C, De Placido S, Mustacchi G. Progression-free survival (PFS) and overall survival (OS) in HER2-ve advanced breast cancer (ABC) patients (pts) according to the molecular subtype in the era of modern agents: Results from the GIM-13 AMBRA study. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e12528] [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
e12528 Background: Pts with ABC have a diverse clinical course and OS rates vary significantly among pts. New strategies had potentially changed the natural history of these pts, however data from clinical studies are still lacking and Real-World Studies (RWS) are crucial in clinical outcome evaluation. Methods: AMBRA is a longitudinal cohort study, aiming to describe the choice of first and subsequent lines of treatment in HER2-ve ABC pts receiving at least one CHT (SABCS 2016, P5-15-07 & P5-14-09) in the years 2012-2015. The present analysis is focused on the description of Progression-Free Survival (PFS) and OS according to the biologic subtype in the deceased population. So far, 791/1500 pts have been registered into the study and 255 (32.2%) are evaluable. Time to event analysis between subtypes was evaluated by Cox-Mantel Hazard Ratio and Logrank Test. DFS by Wilcoxon Rank-Sum Test. Results: Pts distribution according to molecular subtype was: Luminal A (86, 33.7%), Luminal B (107 (42.1%), TNBC (62, 24.3%). Median ages at diagnosis were 55.8, 52.9 and 55.1 years for the 3 subgroups, respectively. Mean DFS was significantly different according to the molecular subtypes: 87.28, 61.37 and 23.9 months. The difference between Luminal B and TNBC is statistically significant as well. Mean PFS of first-line therapy was 17.9 11.7 and 7.8 months respectively. Mean OS from first progression was 32.9 24.2 and 15.8 months respectively. Statistical details. Conclusions: Our data confirm in a RWS the different biological behaviour between Lum A and B. Metastatic life span is quite good for Luminal and disappointing for TNBC. Median time from last CHT and Death is quite short and similar.[Table: see text]
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Affiliation(s)
| | - Paolo Pronzato
- San Martino- IST Ist Naz Per La Ricerca Sul Cancro, Genova, Italy
| | | | - Lucia Del Mastro
- Department of Medical Oncology, IRCCS AOU San Martino–IST, National Cancer Institute, Genova, Italy
| | - Maria Riemma
- Istituto Nazionale Tumori IRCCS "Fondazione G. Pascale" -Breast Oncology Unit, Naples, Italy
| | | | - Anna Turletti
- Medical Oncology, ASLTO1 Ospedale Martini, Torino, Italy
| | | | | | | | - Ornella Garrone
- Breast Unit Medical Oncology S. Croce and Carle Teaching Hospital, Cuneo, Italy
| | - Paolo Marchetti
- Department of Medical Oncology Sant’Andrea University Hospital, Rome, Italy
| | | | | | | | - Alessandra Fabi
- Division of Medical Oncology, “Regina Elena” National Cancer Institute, Rome, Italy
| | | | - Sabino De Placido
- Oncology Unit, Department of Clinical Medicine and Surgery, University Federico II of Naples, Naples, Italy
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Mustacchi G, Pronzato P, Arpino G, D'Alonzo A, Piezzo M, Natoli C, Milani A, Bologna A, Blasi L, De Placido S, Diodati L, Beano A, Romagnoli E, Cazzaniga ME. Triple-negative (TNBC) metastatic breast cancer (MBC) patients (pts): Is chemotherapy (CHT) choice influenced by adjuvant (adj) treatments? Results from the GIM-13 AMBRA study. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e12549] [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
e12549 Background: TNBC shows a very bad prognosis: median time to relapse is 18 months and median overall survival (OS) is less than 24 months. Methods: AMBRA is a longitudinal cohort study, describing the choice of 1st- and subsequent treatments in HER2-ve MBC pts in the years 2012-2015. The present analysis is focused on TNBC pts (127 out of 879 evaluable; 14.4%) and CHT strategies, overall and according to adj treatment. Kaplan Meyer probability of survival from primary (DFS), 1st (PFS1) and 2nd (PFS2) progression and Time from last CHT and death were calculated for the whole population and according the main adj regimens. Results: Median age at primary diagnosis was 53 years. The most used regimens in the adj setting were anthra/taxane(tax) 50.7%, anthra 22.1% or others (CMF included) 20.6%). Median time to events was: DFS 23.2, PFS16.5 and PFS2 4.3 months, respectively. CHT choices in the metastatic setting according to adj treatment were: Conclusions: Our results show that taxanes play a crucial role in MBC even if used in 50% of Adj. CAPE/VRL, Platinum regimens and Eribuline are also widely used. Time from last CHT administration and Death is very short in 30% of cases[Table: see text]
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Affiliation(s)
| | - Paolo Pronzato
- San Martino- IST Ist Naz Per La Ricerca Sul Cancro, Genova, Italy
| | - Grazia Arpino
- Department of Clinical Medicine and Surgery, Oncology Division, University Federico II, Naples, Italy
| | - Alessia D'Alonzo
- Ospedale Policlinico San Martino- Oncologia medica, Genova, Italy
| | - Michela Piezzo
- Istituto Nazionale Tumori IRCCS "Fondazione G. Pascale" -Breast Oncology Unit, Naples, Italy
| | - Clara Natoli
- Department of Medical, Oral & Biotechnological Sciences University G. D’Annunzio, Chieti-Pescara, Chieti, Italy
| | - Andrea Milani
- Investigative Clinical Oncology - Candiolo Cancer Institute-FPO IRCCS, Candiolo, Italy
| | | | - Livio Blasi
- Fondazione San Raffaele-Giglio, Palerio, Italy
| | - Sabino De Placido
- Oncology Unit, Department of Clinical Medicine and Surgery, University Federico II of Naples, Naples, Italy
| | | | - Alessandra Beano
- Oncology Department Aou Città Della Salute e Della Scienza, Torino, Italy
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Cazzaniga ME, Danesi R, Girmenia C, Invernizzi P, Elvevi A, Uguccioni M. Management of toxicities associated with targeted therapies for HR-positive metastatic breast cancer: a multidisciplinary approach is the key to success. Breast Cancer Res Treat 2019; 176:483-494. [PMID: 31065872 PMCID: PMC6586706 DOI: 10.1007/s10549-019-05261-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [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: 02/11/2019] [Accepted: 04/26/2019] [Indexed: 02/07/2023]
Abstract
Purpose Agents targeting HR-positive, HER2-negative locally advanced or metastatic breast cancer have improved patient outcomes compared with conventional single-agent endocrine therapy. Currently, approved targeted agents include everolimus and three CDK4/6 inhibitors, palbociclib, ribociclib, and abemaciclib. Unlike the well-characterized and easily manageable safety profile of endocrine therapies, adverse events associated with targeted therapies are complex and potentially severe. Their prompt recognition and treatment, crucial for prolonged endocrine sensitivity and survival, may be challenging and requires a multidisciplinary effort and a good knowledge of drug interactions. Methods We reviewed the current evidence on the drug safety of targeted agents for metastatic breast cancer currently used in clinical practice in Italy, supported by the clinical experience of Italian oncologists with expertise in the field. Results All oncologists had used CDK4/6 inhibitors in clinical practice and/or within a clinical trial. The clinical management of toxicities, including dose adjustments, treatment interruptions, and concerns regarding special populations is discussed, and the management of relevant adverse events, related to individual agents and class-specific, toxicities is reviewed. Hematologic toxicities have the greatest impact on clinical management of the disease and on patients. Although toxicities associated with the new treatments result in more visits to the physician and more time and attention with patients, they are manageable, with no need for the oncologist to consult with specialist physicians. Conclusions Based on the available evidence and current guidelines, we propose a series of practical recommendations for multidisciplinary clinical management of the various toxicities associated with the addition of targeted agents to endocrine therapy.
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Affiliation(s)
- Marina Elena Cazzaniga
- Department of Medical Oncology & Phase 1 Research Centre ASST-Monza, Via Pergolesi 33, 20900, Monza, Italy.
| | - Romano Danesi
- Unit of Clinical Pharmacology and Pharmacogenetics, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Corrado Girmenia
- Department of Hematology, Oncology and Dermatology, Azienda Policlinico Umberto I, Sapienza University, Rome, Italy
| | - Pietro Invernizzi
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milan Bicocca, Monza, Italy
| | - Alessandra Elvevi
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milan Bicocca, Monza, Italy
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Cazzaniga ME, Biganzoli L, Cortesi L, De Placido S, Donadio M, Fabi A, Ferro A, Generali D, Lorusso V, Milani A, Montagna E, Munzone E, Orlando L, Pizzuti L, Simoncini E, Zamagni C, Pappagallo GL. Treating advanced breast cancer with metronomic chemotherapy: what is known, what is new and what is the future? Onco Targets Ther 2019; 12:2989-2997. [PMID: 31114242 PMCID: PMC6485034 DOI: 10.2147/ott.s189163] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The prognosis for patients with locally advanced or metastatic breast cancer (mBC) remains poor, with a median survival of 2–4 years. About 10% of newly diagnosed breast cancer patients present with metastatic disease, and 30%–50% of those diagnosed at earlier stages will subsequently progress to mBC. In terms of ongoing management for advanced/metastatic breast cancer after failure of hormonal therapy, there is a high medical need for new treatment options that prolong the interval to the start of intensive cytotoxic therapy, which is often associated with potentially serious side effects and reduced quality of life. Oral chemotherapeutic agents such as capecitabine and vinorelbine have demonstrated efficacy in patients with mBC, with prolonged disease control and good tolerability. Use of oral chemotherapy reduces the time and cost associated with treatment and is often more acceptable to patients than intravenous drug delivery. Metronomic administration of oral chemotherapy is therefore a promising treatment strategy for some patients with mBC and inhibits tumor progression via multiple mechanisms of action. Ongoing clinical trials are investigating metronomic chemotherapy regimens as a strategy to prolong disease control with favorable tolerability. This article provides an overview of metronomic chemotherapy treatment options in mBC, with perspectives on this therapy from a panel of experts.
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Affiliation(s)
| | - Laura Biganzoli
- Medical Oncology Division, Hospital of Prato, Azienda USL Toscana Centro, Prato, Italy
| | - Laura Cortesi
- Haematology and Oncology Unit, Azienda Ospedaliero-Universitaria Policlinico di Modena, Modena, Italy
| | - Sabino De Placido
- Clinical Medicine and Surgery Department, University of Naples Federico II, Naples, Italy
| | - Michela Donadio
- Medical Oncology Breast Unit, AOU Città della Salute e della Scienza, Turin, Italy
| | - Alessandra Fabi
- Oncology Unit 1, Regina Elena National Cancer Institute, Rome, Italy
| | | | - Daniele Generali
- Department of Medical, Surgery and Health Sciences, University of Trieste, Trieste, Italy.,UO Multidisciplinare di Patologia Mammaria e Ricerca Traslazionale, ASST di Cremona, Cremona, Italy
| | - Vito Lorusso
- Operative Unit of Medical Oncology, Oncology Institute of Bari, Bari, Italy
| | - Andrea Milani
- Division of Investigative Clinical Oncology, Candiolo Cancer Institute - FPO, IRCCS, Candiolo, Italy
| | - Emilia Montagna
- Division of Medical Senology, IEO, European Institute of Oncology, IRCCS, Milan, Italy
| | - Elisabetta Munzone
- Division of Medical Senology, IEO, European Institute of Oncology, IRCCS, Milan, Italy
| | - Laura Orlando
- Medical Oncology & Breast Unit, "Antonio Perrino" Hospital, Brindisi, Italy
| | - Laura Pizzuti
- Oncology Unit 1, Regina Elena National Cancer Institute, Rome, Italy
| | - Edda Simoncini
- Breast Unit, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Claudio Zamagni
- SSD Medical Oncology Addarii, Policlinico Sant'Orsola Malpighi, Bologna, Italy
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Cazzaniga ME, Blasi L, Pronzato P, Giordano M, Garrone O, Donadio M, Del Mastro L, Livi L, Natoli C, Michelotti A, Turletti A, Riccardi F, De Laurentiis M, Marchetti P, Montemurro F, Romagnoli E, De Placido S, Biganzoli L, Bologna A, Bria E, Mustacchi G. Abstract P4-13-04: Not presented. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p4-13-04] [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
This abstract was not presented at the conference.
Citation Format: Cazzaniga ME, Blasi L, Pronzato P, Giordano M, Garrone O, Donadio M, Del Mastro L, Livi L, Natoli C, Michelotti A, Turletti A, Riccardi F, De Laurentiis M, Marchetti P, Montemurro F, Romagnoli E, De Placido S, Biganzoli L, Bologna A, Bria E, Mustacchi G. Not presented [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P4-13-04.
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Affiliation(s)
- ME Cazzaniga
- ASST Monza, Monza, Italy; University of Trieste, Trieste, Italy; AOU San Martino, Genova, Italy; ASST Lariana, Como, Italy; Osp S. Croce, Cuneo, Italy; Az. Sanitaria Osped. Molinette, Torino, Italy; University of Firenze, Firenze, Italy; University of Chieti, Chieti, Italy; AOU Santa Chiara, Pisa, Italy; Osp. Evangelico Valdese, Torino, Italy; Osp. Cardarelli, Napoli, Italy; Istituto Pascale, Napoli, Italy; La Sapienza Università di Roma, Roma, Italy; Istituto di Candiolo - FPO (IRCCS), Torino, Italy; Oncologia AV3, Macerata, Italy; Università Federico II, Napoli, Italy; Nuovo Ospedale S. Stefano, Prato, Italy; Az. Osp. Reggio Emilia, Reggio Emilia, Italy; Università Cattolica del Sacro Cuore, Fondazione Policlinico 'A. Gemelli', Roma, Italy; Presidio Ospedaliero Civico e Benfratelli, Palermo, Italy
| | - L Blasi
- ASST Monza, Monza, Italy; University of Trieste, Trieste, Italy; AOU San Martino, Genova, Italy; ASST Lariana, Como, Italy; Osp S. Croce, Cuneo, Italy; Az. Sanitaria Osped. Molinette, Torino, Italy; University of Firenze, Firenze, Italy; University of Chieti, Chieti, Italy; AOU Santa Chiara, Pisa, Italy; Osp. Evangelico Valdese, Torino, Italy; Osp. Cardarelli, Napoli, Italy; Istituto Pascale, Napoli, Italy; La Sapienza Università di Roma, Roma, Italy; Istituto di Candiolo - FPO (IRCCS), Torino, Italy; Oncologia AV3, Macerata, Italy; Università Federico II, Napoli, Italy; Nuovo Ospedale S. Stefano, Prato, Italy; Az. Osp. Reggio Emilia, Reggio Emilia, Italy; Università Cattolica del Sacro Cuore, Fondazione Policlinico 'A. Gemelli', Roma, Italy; Presidio Ospedaliero Civico e Benfratelli, Palermo, Italy
| | - P Pronzato
- ASST Monza, Monza, Italy; University of Trieste, Trieste, Italy; AOU San Martino, Genova, Italy; ASST Lariana, Como, Italy; Osp S. Croce, Cuneo, Italy; Az. Sanitaria Osped. Molinette, Torino, Italy; University of Firenze, Firenze, Italy; University of Chieti, Chieti, Italy; AOU Santa Chiara, Pisa, Italy; Osp. Evangelico Valdese, Torino, Italy; Osp. Cardarelli, Napoli, Italy; Istituto Pascale, Napoli, Italy; La Sapienza Università di Roma, Roma, Italy; Istituto di Candiolo - FPO (IRCCS), Torino, Italy; Oncologia AV3, Macerata, Italy; Università Federico II, Napoli, Italy; Nuovo Ospedale S. Stefano, Prato, Italy; Az. Osp. Reggio Emilia, Reggio Emilia, Italy; Università Cattolica del Sacro Cuore, Fondazione Policlinico 'A. Gemelli', Roma, Italy; Presidio Ospedaliero Civico e Benfratelli, Palermo, Italy
| | - M Giordano
- ASST Monza, Monza, Italy; University of Trieste, Trieste, Italy; AOU San Martino, Genova, Italy; ASST Lariana, Como, Italy; Osp S. Croce, Cuneo, Italy; Az. Sanitaria Osped. Molinette, Torino, Italy; University of Firenze, Firenze, Italy; University of Chieti, Chieti, Italy; AOU Santa Chiara, Pisa, Italy; Osp. Evangelico Valdese, Torino, Italy; Osp. Cardarelli, Napoli, Italy; Istituto Pascale, Napoli, Italy; La Sapienza Università di Roma, Roma, Italy; Istituto di Candiolo - FPO (IRCCS), Torino, Italy; Oncologia AV3, Macerata, Italy; Università Federico II, Napoli, Italy; Nuovo Ospedale S. Stefano, Prato, Italy; Az. Osp. Reggio Emilia, Reggio Emilia, Italy; Università Cattolica del Sacro Cuore, Fondazione Policlinico 'A. Gemelli', Roma, Italy; Presidio Ospedaliero Civico e Benfratelli, Palermo, Italy
| | - O Garrone
- ASST Monza, Monza, Italy; University of Trieste, Trieste, Italy; AOU San Martino, Genova, Italy; ASST Lariana, Como, Italy; Osp S. Croce, Cuneo, Italy; Az. Sanitaria Osped. Molinette, Torino, Italy; University of Firenze, Firenze, Italy; University of Chieti, Chieti, Italy; AOU Santa Chiara, Pisa, Italy; Osp. Evangelico Valdese, Torino, Italy; Osp. Cardarelli, Napoli, Italy; Istituto Pascale, Napoli, Italy; La Sapienza Università di Roma, Roma, Italy; Istituto di Candiolo - FPO (IRCCS), Torino, Italy; Oncologia AV3, Macerata, Italy; Università Federico II, Napoli, Italy; Nuovo Ospedale S. Stefano, Prato, Italy; Az. Osp. Reggio Emilia, Reggio Emilia, Italy; Università Cattolica del Sacro Cuore, Fondazione Policlinico 'A. Gemelli', Roma, Italy; Presidio Ospedaliero Civico e Benfratelli, Palermo, Italy
| | - M Donadio
- ASST Monza, Monza, Italy; University of Trieste, Trieste, Italy; AOU San Martino, Genova, Italy; ASST Lariana, Como, Italy; Osp S. Croce, Cuneo, Italy; Az. Sanitaria Osped. Molinette, Torino, Italy; University of Firenze, Firenze, Italy; University of Chieti, Chieti, Italy; AOU Santa Chiara, Pisa, Italy; Osp. Evangelico Valdese, Torino, Italy; Osp. Cardarelli, Napoli, Italy; Istituto Pascale, Napoli, Italy; La Sapienza Università di Roma, Roma, Italy; Istituto di Candiolo - FPO (IRCCS), Torino, Italy; Oncologia AV3, Macerata, Italy; Università Federico II, Napoli, Italy; Nuovo Ospedale S. Stefano, Prato, Italy; Az. Osp. Reggio Emilia, Reggio Emilia, Italy; Università Cattolica del Sacro Cuore, Fondazione Policlinico 'A. Gemelli', Roma, Italy; Presidio Ospedaliero Civico e Benfratelli, Palermo, Italy
| | - L Del Mastro
- ASST Monza, Monza, Italy; University of Trieste, Trieste, Italy; AOU San Martino, Genova, Italy; ASST Lariana, Como, Italy; Osp S. Croce, Cuneo, Italy; Az. Sanitaria Osped. Molinette, Torino, Italy; University of Firenze, Firenze, Italy; University of Chieti, Chieti, Italy; AOU Santa Chiara, Pisa, Italy; Osp. Evangelico Valdese, Torino, Italy; Osp. Cardarelli, Napoli, Italy; Istituto Pascale, Napoli, Italy; La Sapienza Università di Roma, Roma, Italy; Istituto di Candiolo - FPO (IRCCS), Torino, Italy; Oncologia AV3, Macerata, Italy; Università Federico II, Napoli, Italy; Nuovo Ospedale S. Stefano, Prato, Italy; Az. Osp. Reggio Emilia, Reggio Emilia, Italy; Università Cattolica del Sacro Cuore, Fondazione Policlinico 'A. Gemelli', Roma, Italy; Presidio Ospedaliero Civico e Benfratelli, Palermo, Italy
| | - L Livi
- ASST Monza, Monza, Italy; University of Trieste, Trieste, Italy; AOU San Martino, Genova, Italy; ASST Lariana, Como, Italy; Osp S. Croce, Cuneo, Italy; Az. Sanitaria Osped. Molinette, Torino, Italy; University of Firenze, Firenze, Italy; University of Chieti, Chieti, Italy; AOU Santa Chiara, Pisa, Italy; Osp. Evangelico Valdese, Torino, Italy; Osp. Cardarelli, Napoli, Italy; Istituto Pascale, Napoli, Italy; La Sapienza Università di Roma, Roma, Italy; Istituto di Candiolo - FPO (IRCCS), Torino, Italy; Oncologia AV3, Macerata, Italy; Università Federico II, Napoli, Italy; Nuovo Ospedale S. Stefano, Prato, Italy; Az. Osp. Reggio Emilia, Reggio Emilia, Italy; Università Cattolica del Sacro Cuore, Fondazione Policlinico 'A. Gemelli', Roma, Italy; Presidio Ospedaliero Civico e Benfratelli, Palermo, Italy
| | - C Natoli
- ASST Monza, Monza, Italy; University of Trieste, Trieste, Italy; AOU San Martino, Genova, Italy; ASST Lariana, Como, Italy; Osp S. Croce, Cuneo, Italy; Az. Sanitaria Osped. Molinette, Torino, Italy; University of Firenze, Firenze, Italy; University of Chieti, Chieti, Italy; AOU Santa Chiara, Pisa, Italy; Osp. Evangelico Valdese, Torino, Italy; Osp. Cardarelli, Napoli, Italy; Istituto Pascale, Napoli, Italy; La Sapienza Università di Roma, Roma, Italy; Istituto di Candiolo - FPO (IRCCS), Torino, Italy; Oncologia AV3, Macerata, Italy; Università Federico II, Napoli, Italy; Nuovo Ospedale S. Stefano, Prato, Italy; Az. Osp. Reggio Emilia, Reggio Emilia, Italy; Università Cattolica del Sacro Cuore, Fondazione Policlinico 'A. Gemelli', Roma, Italy; Presidio Ospedaliero Civico e Benfratelli, Palermo, Italy
| | - A Michelotti
- ASST Monza, Monza, Italy; University of Trieste, Trieste, Italy; AOU San Martino, Genova, Italy; ASST Lariana, Como, Italy; Osp S. Croce, Cuneo, Italy; Az. Sanitaria Osped. Molinette, Torino, Italy; University of Firenze, Firenze, Italy; University of Chieti, Chieti, Italy; AOU Santa Chiara, Pisa, Italy; Osp. Evangelico Valdese, Torino, Italy; Osp. Cardarelli, Napoli, Italy; Istituto Pascale, Napoli, Italy; La Sapienza Università di Roma, Roma, Italy; Istituto di Candiolo - FPO (IRCCS), Torino, Italy; Oncologia AV3, Macerata, Italy; Università Federico II, Napoli, Italy; Nuovo Ospedale S. Stefano, Prato, Italy; Az. Osp. Reggio Emilia, Reggio Emilia, Italy; Università Cattolica del Sacro Cuore, Fondazione Policlinico 'A. Gemelli', Roma, Italy; Presidio Ospedaliero Civico e Benfratelli, Palermo, Italy
| | - A Turletti
- ASST Monza, Monza, Italy; University of Trieste, Trieste, Italy; AOU San Martino, Genova, Italy; ASST Lariana, Como, Italy; Osp S. Croce, Cuneo, Italy; Az. Sanitaria Osped. Molinette, Torino, Italy; University of Firenze, Firenze, Italy; University of Chieti, Chieti, Italy; AOU Santa Chiara, Pisa, Italy; Osp. Evangelico Valdese, Torino, Italy; Osp. Cardarelli, Napoli, Italy; Istituto Pascale, Napoli, Italy; La Sapienza Università di Roma, Roma, Italy; Istituto di Candiolo - FPO (IRCCS), Torino, Italy; Oncologia AV3, Macerata, Italy; Università Federico II, Napoli, Italy; Nuovo Ospedale S. Stefano, Prato, Italy; Az. Osp. Reggio Emilia, Reggio Emilia, Italy; Università Cattolica del Sacro Cuore, Fondazione Policlinico 'A. Gemelli', Roma, Italy; Presidio Ospedaliero Civico e Benfratelli, Palermo, Italy
| | - F Riccardi
- ASST Monza, Monza, Italy; University of Trieste, Trieste, Italy; AOU San Martino, Genova, Italy; ASST Lariana, Como, Italy; Osp S. Croce, Cuneo, Italy; Az. Sanitaria Osped. Molinette, Torino, Italy; University of Firenze, Firenze, Italy; University of Chieti, Chieti, Italy; AOU Santa Chiara, Pisa, Italy; Osp. Evangelico Valdese, Torino, Italy; Osp. Cardarelli, Napoli, Italy; Istituto Pascale, Napoli, Italy; La Sapienza Università di Roma, Roma, Italy; Istituto di Candiolo - FPO (IRCCS), Torino, Italy; Oncologia AV3, Macerata, Italy; Università Federico II, Napoli, Italy; Nuovo Ospedale S. Stefano, Prato, Italy; Az. Osp. Reggio Emilia, Reggio Emilia, Italy; Università Cattolica del Sacro Cuore, Fondazione Policlinico 'A. Gemelli', Roma, Italy; Presidio Ospedaliero Civico e Benfratelli, Palermo, Italy
| | - M De Laurentiis
- ASST Monza, Monza, Italy; University of Trieste, Trieste, Italy; AOU San Martino, Genova, Italy; ASST Lariana, Como, Italy; Osp S. Croce, Cuneo, Italy; Az. Sanitaria Osped. Molinette, Torino, Italy; University of Firenze, Firenze, Italy; University of Chieti, Chieti, Italy; AOU Santa Chiara, Pisa, Italy; Osp. Evangelico Valdese, Torino, Italy; Osp. Cardarelli, Napoli, Italy; Istituto Pascale, Napoli, Italy; La Sapienza Università di Roma, Roma, Italy; Istituto di Candiolo - FPO (IRCCS), Torino, Italy; Oncologia AV3, Macerata, Italy; Università Federico II, Napoli, Italy; Nuovo Ospedale S. Stefano, Prato, Italy; Az. Osp. Reggio Emilia, Reggio Emilia, Italy; Università Cattolica del Sacro Cuore, Fondazione Policlinico 'A. Gemelli', Roma, Italy; Presidio Ospedaliero Civico e Benfratelli, Palermo, Italy
| | - P Marchetti
- ASST Monza, Monza, Italy; University of Trieste, Trieste, Italy; AOU San Martino, Genova, Italy; ASST Lariana, Como, Italy; Osp S. Croce, Cuneo, Italy; Az. Sanitaria Osped. Molinette, Torino, Italy; University of Firenze, Firenze, Italy; University of Chieti, Chieti, Italy; AOU Santa Chiara, Pisa, Italy; Osp. Evangelico Valdese, Torino, Italy; Osp. Cardarelli, Napoli, Italy; Istituto Pascale, Napoli, Italy; La Sapienza Università di Roma, Roma, Italy; Istituto di Candiolo - FPO (IRCCS), Torino, Italy; Oncologia AV3, Macerata, Italy; Università Federico II, Napoli, Italy; Nuovo Ospedale S. Stefano, Prato, Italy; Az. Osp. Reggio Emilia, Reggio Emilia, Italy; Università Cattolica del Sacro Cuore, Fondazione Policlinico 'A. Gemelli', Roma, Italy; Presidio Ospedaliero Civico e Benfratelli, Palermo, Italy
| | - F Montemurro
- ASST Monza, Monza, Italy; University of Trieste, Trieste, Italy; AOU San Martino, Genova, Italy; ASST Lariana, Como, Italy; Osp S. Croce, Cuneo, Italy; Az. Sanitaria Osped. Molinette, Torino, Italy; University of Firenze, Firenze, Italy; University of Chieti, Chieti, Italy; AOU Santa Chiara, Pisa, Italy; Osp. Evangelico Valdese, Torino, Italy; Osp. Cardarelli, Napoli, Italy; Istituto Pascale, Napoli, Italy; La Sapienza Università di Roma, Roma, Italy; Istituto di Candiolo - FPO (IRCCS), Torino, Italy; Oncologia AV3, Macerata, Italy; Università Federico II, Napoli, Italy; Nuovo Ospedale S. Stefano, Prato, Italy; Az. Osp. Reggio Emilia, Reggio Emilia, Italy; Università Cattolica del Sacro Cuore, Fondazione Policlinico 'A. Gemelli', Roma, Italy; Presidio Ospedaliero Civico e Benfratelli, Palermo, Italy
| | - E Romagnoli
- ASST Monza, Monza, Italy; University of Trieste, Trieste, Italy; AOU San Martino, Genova, Italy; ASST Lariana, Como, Italy; Osp S. Croce, Cuneo, Italy; Az. Sanitaria Osped. Molinette, Torino, Italy; University of Firenze, Firenze, Italy; University of Chieti, Chieti, Italy; AOU Santa Chiara, Pisa, Italy; Osp. Evangelico Valdese, Torino, Italy; Osp. Cardarelli, Napoli, Italy; Istituto Pascale, Napoli, Italy; La Sapienza Università di Roma, Roma, Italy; Istituto di Candiolo - FPO (IRCCS), Torino, Italy; Oncologia AV3, Macerata, Italy; Università Federico II, Napoli, Italy; Nuovo Ospedale S. Stefano, Prato, Italy; Az. Osp. Reggio Emilia, Reggio Emilia, Italy; Università Cattolica del Sacro Cuore, Fondazione Policlinico 'A. Gemelli', Roma, Italy; Presidio Ospedaliero Civico e Benfratelli, Palermo, Italy
| | - S De Placido
- ASST Monza, Monza, Italy; University of Trieste, Trieste, Italy; AOU San Martino, Genova, Italy; ASST Lariana, Como, Italy; Osp S. Croce, Cuneo, Italy; Az. Sanitaria Osped. Molinette, Torino, Italy; University of Firenze, Firenze, Italy; University of Chieti, Chieti, Italy; AOU Santa Chiara, Pisa, Italy; Osp. Evangelico Valdese, Torino, Italy; Osp. Cardarelli, Napoli, Italy; Istituto Pascale, Napoli, Italy; La Sapienza Università di Roma, Roma, Italy; Istituto di Candiolo - FPO (IRCCS), Torino, Italy; Oncologia AV3, Macerata, Italy; Università Federico II, Napoli, Italy; Nuovo Ospedale S. Stefano, Prato, Italy; Az. Osp. Reggio Emilia, Reggio Emilia, Italy; Università Cattolica del Sacro Cuore, Fondazione Policlinico 'A. Gemelli', Roma, Italy; Presidio Ospedaliero Civico e Benfratelli, Palermo, Italy
| | - L Biganzoli
- ASST Monza, Monza, Italy; University of Trieste, Trieste, Italy; AOU San Martino, Genova, Italy; ASST Lariana, Como, Italy; Osp S. Croce, Cuneo, Italy; Az. Sanitaria Osped. Molinette, Torino, Italy; University of Firenze, Firenze, Italy; University of Chieti, Chieti, Italy; AOU Santa Chiara, Pisa, Italy; Osp. Evangelico Valdese, Torino, Italy; Osp. Cardarelli, Napoli, Italy; Istituto Pascale, Napoli, Italy; La Sapienza Università di Roma, Roma, Italy; Istituto di Candiolo - FPO (IRCCS), Torino, Italy; Oncologia AV3, Macerata, Italy; Università Federico II, Napoli, Italy; Nuovo Ospedale S. Stefano, Prato, Italy; Az. Osp. Reggio Emilia, Reggio Emilia, Italy; Università Cattolica del Sacro Cuore, Fondazione Policlinico 'A. Gemelli', Roma, Italy; Presidio Ospedaliero Civico e Benfratelli, Palermo, Italy
| | - A Bologna
- ASST Monza, Monza, Italy; University of Trieste, Trieste, Italy; AOU San Martino, Genova, Italy; ASST Lariana, Como, Italy; Osp S. Croce, Cuneo, Italy; Az. Sanitaria Osped. Molinette, Torino, Italy; University of Firenze, Firenze, Italy; University of Chieti, Chieti, Italy; AOU Santa Chiara, Pisa, Italy; Osp. Evangelico Valdese, Torino, Italy; Osp. Cardarelli, Napoli, Italy; Istituto Pascale, Napoli, Italy; La Sapienza Università di Roma, Roma, Italy; Istituto di Candiolo - FPO (IRCCS), Torino, Italy; Oncologia AV3, Macerata, Italy; Università Federico II, Napoli, Italy; Nuovo Ospedale S. Stefano, Prato, Italy; Az. Osp. Reggio Emilia, Reggio Emilia, Italy; Università Cattolica del Sacro Cuore, Fondazione Policlinico 'A. Gemelli', Roma, Italy; Presidio Ospedaliero Civico e Benfratelli, Palermo, Italy
| | - E Bria
- ASST Monza, Monza, Italy; University of Trieste, Trieste, Italy; AOU San Martino, Genova, Italy; ASST Lariana, Como, Italy; Osp S. Croce, Cuneo, Italy; Az. Sanitaria Osped. Molinette, Torino, Italy; University of Firenze, Firenze, Italy; University of Chieti, Chieti, Italy; AOU Santa Chiara, Pisa, Italy; Osp. Evangelico Valdese, Torino, Italy; Osp. Cardarelli, Napoli, Italy; Istituto Pascale, Napoli, Italy; La Sapienza Università di Roma, Roma, Italy; Istituto di Candiolo - FPO (IRCCS), Torino, Italy; Oncologia AV3, Macerata, Italy; Università Federico II, Napoli, Italy; Nuovo Ospedale S. Stefano, Prato, Italy; Az. Osp. Reggio Emilia, Reggio Emilia, Italy; Università Cattolica del Sacro Cuore, Fondazione Policlinico 'A. Gemelli', Roma, Italy; Presidio Ospedaliero Civico e Benfratelli, Palermo, Italy
| | - G Mustacchi
- ASST Monza, Monza, Italy; University of Trieste, Trieste, Italy; AOU San Martino, Genova, Italy; ASST Lariana, Como, Italy; Osp S. Croce, Cuneo, Italy; Az. Sanitaria Osped. Molinette, Torino, Italy; University of Firenze, Firenze, Italy; University of Chieti, Chieti, Italy; AOU Santa Chiara, Pisa, Italy; Osp. Evangelico Valdese, Torino, Italy; Osp. Cardarelli, Napoli, Italy; Istituto Pascale, Napoli, Italy; La Sapienza Università di Roma, Roma, Italy; Istituto di Candiolo - FPO (IRCCS), Torino, Italy; Oncologia AV3, Macerata, Italy; Università Federico II, Napoli, Italy; Nuovo Ospedale S. Stefano, Prato, Italy; Az. Osp. Reggio Emilia, Reggio Emilia, Italy; Università Cattolica del Sacro Cuore, Fondazione Policlinico 'A. Gemelli', Roma, Italy; Presidio Ospedaliero Civico e Benfratelli, Palermo, Italy
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46
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Cerrito MG, De Giorgi M, Pelizzoni D, Bonomo SM, Digiacomo N, Scagliotti A, Bugarin C, Gaipa G, Grassilli E, Lavitrano M, Giovannoni R, Bidoli P, Cazzaniga ME. Metronomic combination of Vinorelbine and 5Fluorouracil is able to inhibit triple-negative breast cancer cells. Results from the proof-of-concept VICTOR-0 study. Oncotarget 2018; 9:27448-27459. [PMID: 29937997 PMCID: PMC6007943 DOI: 10.18632/oncotarget.25422] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Accepted: 05/01/2018] [Indexed: 12/26/2022] Open
Abstract
Triple Negative Breast Cancer (TNBC) is an aggressive neoplasia with median Overall Survival (OS) less than two years. Despite the availability of new drugs, the chance of survival of these patients did not increase. The combination of low doses of drugs in a metronomic schedule showed efficacy in clinical trials, exhibiting an anti-proliferative and anti-tumour activity. In Victor-2 study we recently evaluated a new metronomic combination (mCHT) of Capecitabine (CAPE) and Vinorelbine (VNR) in breast cancer patients showing a disease control rate with a median Progression-Free Survival (PFS) of 4.7 months in 28 TNBC patients. Here in Victor-0 study, we examined the effect of mCHT vs standard (STD) schedule of administration of different combinations of 5-Fluorouracil (5FU), the active metabolite of CAPE, and VNR in TNBC cell lines MDA-MB-231 and BT-549. A significant anti-proliferative activity was observed in cells treated with metronomic vs STD administration of 5FU or VNR alone. Combination of the two drugs showed an additive inhibitor effect on cell growth in both cell lines. Moreover, after exposure of cells to 5FU and VNR under mCHT or conventional schedule of administration we also observed a downregulation of chemoresistance factor Bcl-2, changes in pro-apoptotic protein Bax and in cleaved effector caspase-3 and increased expression of LC3A/B autophagy protein. Our results therefore suggest that molecular mechanisms implicated in apoptosis and autophagy as well as the cross-talk between these two forms of cell death in MDA-MB-231 and BT-549 cells treated with 5FU and VNR is dose- and schedule-dependent and provide some insights about the roles of autophagy and senescence in 5FU/VNR-induced cell death.
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Affiliation(s)
- Maria Grazia Cerrito
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza 20900, Italy
| | - Marco De Giorgi
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza 20900, Italy
| | - Davide Pelizzoni
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza 20900, Italy.,Oncology Unit, ASST Monza, Monza 20900, Italy
| | - Sara Maria Bonomo
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza 20900, Italy
| | - Nunzio Digiacomo
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza 20900, Italy.,Oncology Unit, ASST Monza, Monza 20900, Italy
| | - Arianna Scagliotti
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza 20900, Italy
| | - Cristina Bugarin
- M.Tettamanti Research Center, Pediatric Clinic, University of Milano Bicocca, Monza 20900, Italy
| | - Giuseppe Gaipa
- M.Tettamanti Research Center, Pediatric Clinic, University of Milano Bicocca, Monza 20900, Italy
| | - Emanuela Grassilli
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza 20900, Italy
| | - Marialuisa Lavitrano
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza 20900, Italy
| | - Roberto Giovannoni
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza 20900, Italy
| | - Paolo Bidoli
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza 20900, Italy.,Oncology Unit, ASST Monza, Monza 20900, Italy
| | - Marina Elena Cazzaniga
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza 20900, Italy.,Oncology Unit, ASST Monza, Monza 20900, Italy.,Phase 1 Research Centre, Monza 20900, Italy
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47
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Cazzaniga ME, Pronzato P, Meattini I, Biganzoli L, Taverniti C, Natoli C, De Placido S, Aversa C, Bordin E, Giordano M, Bologna A, Diodati L, Blasi L, Garrone O, Romagnoli E, Mocerino C, D'Alonzo A, Piezzo M, Mustacchi G. Validation of time to treatment change (TTC) as a surrogate end-point of progression free survival (PFS) for observational trials in metastatic breast cancer patients (MBC): The GIM-13 AMBRA study. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e13081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Paolo Pronzato
- San Martino- IST Ist Naz Per La Ricerca Sul Cancro, Genova, Italy
| | | | - Laura Biganzoli
- Sandro Pitigliani Medical Oncology Department, Hospital of Prato, Prato, Italy
| | | | - Clara Natoli
- Department of Experimental and Clinical Sciences, University, Chieti, Italy
| | | | - Caterina Aversa
- Medical Oncology I Fondazione del Piemonte per l'Oncologia Irccs Candiolo, Candiolo (Turin), Italy
| | - Elio Bordin
- ASL "Città di Torino" Ospedale Martini, Torino, Italy
| | | | | | | | - Livio Blasi
- Fondazione San Raffaele-Giglio, Palerio, Italy
| | - Ornella Garrone
- Medical Oncology, S. Croce and Carle Teaching Hospital, Cuneo, Italy
| | | | | | - Alessia D'Alonzo
- Ospedale Policlinico San Martino- Oncologia medica, Genova, Italy
| | - Michela Piezzo
- IRCCS INT Fondazione Giovanni Pascale - Breast Oncology Unit, Naples, Italy
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48
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Mustacchi G, Pronzato P, D'Alonzo A, Mocerino C, Romagnoli E, Garrone O, Blasi L, De Laurentiis M, Michelotti A, Bologna A, Giordano M, Turletti A, Montemurro F, De Placido S, Natoli C, Taverniti C, Biganzoli L, Meattini I, Marchetti P, Cazzaniga ME. Nab-paclitaxel (Nab-P) in patients (pts) with HER2-ve advanced breast cancer (ABC): A focus on the elderly— Preliminary results of the GIM-13 AMBRA study. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e13078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Paolo Pronzato
- San Martino- IST Ist Naz Per La Ricerca Sul Cancro, Genova, Italy
| | - Alessia D'Alonzo
- Ospedale Policlinico San Martino- Oncologia medica, Genova, Italy
| | | | | | - Ornella Garrone
- Medical Oncology, S. Croce and Carle Teaching Hospital, Cuneo, Italy
| | - Livio Blasi
- Fondazione San Raffaele-Giglio, Palerio, Italy
| | | | - Andrea Michelotti
- Oncology Unit I, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | | | | | - Anna Turletti
- Medical Oncology, ASLTO1 Ospedale Martini, Torino, Italy
| | - Filippo Montemurro
- Investigative Clinical Oncology - Candiolo Cancer Institute-FPO IRCCS, Candiolo, Italy
| | | | - Clara Natoli
- Department of Experimental and Clinical Sciences, University, Chieti, Italy
| | | | - Laura Biganzoli
- Sandro Pitigliani Medical Oncology Department, Hospital of Prato, Prato, Italy
| | | | - Paolo Marchetti
- S. Andrea Hospital, Sapienza University of Rome, Rome, Italy
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49
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Cazzaniga ME, Scognamiglio G, Generali DG, Ferzi A, Vandone AM, Spadaro P, Mocerino C, Montagna E, Cretella E, Gambaro A, Taverniti C, Turletti A, Sarobba G, Iezzi L, Roberto M, Ciccarese M, Tralongo P, Clivio L, Pedroli S, Torri V. Metronomic chemotherapy (mCHT) in HER2-ve advanced breast cancer (ABC) patients (pts): Final results of the VICTOR-6 study. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e13076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | - Antonella Ferzi
- Medicina II - Oncologia Medica, Ospedale Civile di Legnano, Legnano, Italy
| | | | | | | | | | | | | | | | - Anna Turletti
- Medical Oncology, ASLTO1 Ospedale Martini, Torino, Italy
| | - Giuseppina Sarobba
- "UOC Oncologia Ospedale San Francesco ATS Sardegna ASSL Nuoro", Nuoro, Italy
| | - Laura Iezzi
- "CeSi-MeT Università G.D'Annunzio Chieti-Pescara", Chieti, Italy
| | - Michela Roberto
- Sant Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | | | | | - Luca Clivio
- Istituto Ricerche Farmacologiche "Mario Negri", Milan, Italy
| | | | - Valter Torri
- IRCCS Istituto Di Ricerche Farmacologiche Mario Negri, Milan, Italy
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50
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Pronzato P, Mustacchi G, Giordano M, Garrone O, Del Mastro L, Natoli C, Turletti A, Romagnoli E, Bologna A, Mocerino C, Alù M, De Angelis C, Aversa C, Arpino G, Taverniti C, Biganzoli L, Meattini I, Piezzo M, Cazzaniga ME. First-line therapy with fulvestrant (FUL) in HR+ve, HER2-ve advanced pre-treated breast cancer (ABC) patients (pts): Results from the GIM-13 AMBRA Study. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e13032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Paolo Pronzato
- San Martino- IST Ist Naz Per La Ricerca Sul Cancro, Genova, Italy
| | | | | | - Ornella Garrone
- Medical Oncology, S. Croce and Carle Teaching Hospital, Cuneo, Italy
| | | | - Clara Natoli
- Department of Experimental and Clinical Sciences, University, Chieti, Italy
| | - Anna Turletti
- Medical Oncology, ASLTO1 Ospedale Martini, Torino, Italy
| | | | - Alessandra Bologna
- Medical Oncology Unit, IRCCS-Arcispedale S. Maria Nuova, Reggio Emilia, Italy
| | | | | | | | - Caterina Aversa
- Medical Oncology I Fondazione del Piemonte per l'Oncologia Irccs Candiolo, Candiolo (Turin), Italy
| | - Grazia Arpino
- Clinical Medicine and Surgery Department, University of Naples Federico II, Naples, Italy
| | | | - Laura Biganzoli
- Sandro Pitigliani Medical Oncology Department, Hospital of Prato, Prato, Italy
| | | | - Michela Piezzo
- IRCCS INT Fondazione Giovanni Pascale - Breast Oncology Unit, Naples, Italy
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