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Caccese M, Desideri I, Villani V, Simonelli M, Buglione M, Chiesa S, Franceschi E, Gaviani P, Stasi I, Caserta C, Brugnara S, Lolli I, Bennicelli E, Bini P, Cuccu AS, Scoccianti S, Padovan M, Gori S, Bonetti A, Giordano P, Pellerino A, Gregucci F, Riva N, Cinieri S, Internò V, Santoni M, Pernice G, Dealis C, Stievano L, Paiar F, Magni G, De Salvo GL, Zagonel V, Lombardi G. REGOMA-OSS: a large, Italian, multicenter, prospective, observational study evaluating the efficacy and safety of regorafenib in patients with recurrent glioblastoma. ESMO Open 2024; 9:102943. [PMID: 38492275 PMCID: PMC10959650 DOI: 10.1016/j.esmoop.2024.102943] [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: 01/11/2024] [Revised: 02/02/2024] [Accepted: 02/16/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND In the randomized phase II REGOMA trial, regorafenib showed promising activity in patients with recurrent glioblastoma. We conducted a large, multicenter, prospective, observational study to confirm the REGOMA data in a real-world setting. PATIENTS AND METHODS The major inclusion criteria were histologically confirmed diagnosis of glioblastoma according to the World Health Organization (WHO) 2016 classification and relapse after radiotherapy with concurrent/adjuvant temozolomide treatment, good performance status [Eastern Cooperative Oncology Group performance status (ECOG PS 0-1)] and good liver function. Regorafenib was administered at the standard dose of 160 mg/day for 3 weeks on/1 week off. Brain magnetic resonance imaging was carried out within 14 days before starting regorafenib and every 8-12 weeks. The primary endpoint was overall survival (OS). The secondary endpoints were progression-free survival (PFS), objective response rate, disease control rate (DCR), safety and health-related quality of life. The Response Assessment in Neuro-Oncology (RANO) criteria were used for response evaluation and Common Terminology Criteria for Adverse Events (CTCAE) version 5 for assessment of adverse events (AEs). RESULTS From September 2020 to October 2022, 190 patients with recurrent glioblastoma were enrolled from 30 cancer centers in Italy: their median age was 58.5 years [interquartile range (IQR) 53-67 years], 68% were male and 85 (44.7%) were in optimal clinical condition (ECOG PS 0). The number of patients taking steroids at baseline was 113 (60%); the second surgery was carried out in 39 (20.5%). O6-methylguanine-DNA methyltransferase (MGMT) was methylated in 80 patients (50.3%) and 147 (92.4%) of the patients analyzed had isocitrate dehydrogenase (IDH) wild type. The median follow-up period was 20 months (IQR 15.6-25.5 months). The median OS was 7.9 months ([95% confidence interval (CI) 6.5-9.2 months] and the median PFS was 2.6 months (95% CI 2.3-2.9 months). Radiological response was partial response and stable disease in 13 (7.3%) and 26 (14.6%) patients, respectively, with a DCR of 21.9%. The median number of regorafenib cycles per patient was 3 (IQR 2.0-4.0). Grade 3-4 drug-related adverse events were reported in 22.6% of patients. A dose reduction due to AEs was required in 36% of patients. No deaths were considered as treatment-related AEs. CONCLUSIONS This large, real-world observational study showed similar OS with better tolerability of regorafenib in patients with relapsed glioblastoma compared with the REGOMA study.
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Affiliation(s)
- M Caccese
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Padua.
| | - I Desideri
- Department of Experimental and Clinical Biomedical Sciences, Radiation Oncology Unit, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Florence
| | - V Villani
- Neuro-Oncology Unit, IRCCS Regina Elena National Cancer Institute, Rome
| | - M Simonelli
- Department of Biomedical Sciences, Humanitas University, Milan; Humanitas Clinical and Research Center-IRCCS, Humanitas Cancer Center, Milan
| | - M Buglione
- Radiation Oncology Unit, ASST Spedali Civili of Brescia, Brescia
| | - S Chiesa
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, U.O.C. Radioterapia Oncologica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome
| | - E Franceschi
- Nervous System Medical Oncology Department, IRCCS Istituto Delle Scienze Neurologiche di Bologna, Bologna
| | - P Gaviani
- Neuro-Oncological Unit, Istituto Neurologico Carlo Besta, Milan
| | - I Stasi
- Division of Medical Oncology, Civil Hospital, Livorno
| | - C Caserta
- Medical Oncology Department, Santa Maria Hospital, Terni
| | - S Brugnara
- Department of Medical Oncology, Santa Chiara Hospital, Trento
| | - I Lolli
- Oncology Unit of National Institute of Gastroenterology 'S. De Bellis', Research Hospital, Castellana Grotte, Bari
| | - E Bennicelli
- Ospedale Policlinico San Martino, Oncologia Medica 2, Genoa
| | - P Bini
- Neuroncology Unit, IRCCS 'C. Mondino Foundation', University of Pavia, Pavia
| | - A S Cuccu
- Medical Oncology, Sassari Hospital, Sassari
| | - S Scoccianti
- Radioterapia Oncologica, Ospedale Santa Maria Annunziata, Bagno a Ripoli, Florence
| | - M Padovan
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Padua
| | - S Gori
- Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella
| | - A Bonetti
- Department of Oncology, Mater Salutis Hospital, Legnago
| | - P Giordano
- Oncology Unit, Ospedale del Mare, Naples
| | - A Pellerino
- Division of Neuro-Oncology, Department of Neuroscience, City of Health and Science and University of Turin, Turin
| | - F Gregucci
- Department of Radiation Oncology, Miulli General Regional Hospital, Acquaviva delle Fonti
| | - N Riva
- IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) 'Dino Amadori', Meldola
| | - S Cinieri
- Oncology Unit, Ospedale Perrino, Brindisi
| | - V Internò
- Division of Oncology, Department of Biomedical Sciences and Human Oncology, University of Bari, Bari
| | - M Santoni
- Oncology Unit, Macerata Hospital, Macerata
| | - G Pernice
- Oncology Unit, Fondazione Istituto G. Giglio, Cefalù
| | - C Dealis
- Health Directorate, Azienda Sanitaria dell'Alto Adige, Bolzano
| | - L Stievano
- Department of Oncology, Ospedale Civile, Rovigo
| | - F Paiar
- Department of Radiation Oncology, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa
| | - G Magni
- Clinical Research Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - G L De Salvo
- Clinical Research Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - V Zagonel
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Padua
| | - G Lombardi
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Padua
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Bianchini E, Rinaldi D, Alborghetti M, Simonelli M, D’Audino F, Onelli C, Pegolo E, Pontieri FE. The Story behind the Mask: A Narrative Review on Hypomimia in Parkinson's Disease. Brain Sci 2024; 14:109. [PMID: 38275529 PMCID: PMC10814039 DOI: 10.3390/brainsci14010109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 01/18/2024] [Accepted: 01/19/2024] [Indexed: 01/27/2024] Open
Abstract
Facial movements are crucial for social and emotional interaction and well-being. Reduced facial expressions (i.e., hypomimia) is a common feature in patients with Parkinson's disease (PD) and previous studies linked this manifestation to both motor symptoms of the disease and altered emotion recognition and processing. Nevertheless, research on facial motor impairment in PD has been rather scarce and only a limited number of clinical evaluation tools are available, often suffering from poor validation processes and high inter- and intra-rater variability. In recent years, the availability of technology-enhanced quantification methods of facial movements, such as automated video analysis and machine learning application, led to increasing interest in studying hypomimia in PD. In this narrative review, we summarize the current knowledge on pathophysiological hypotheses at the basis of hypomimia in PD, with particular focus on the association between reduced facial expressions and emotional processing and analyze the current evaluation tools and management strategies for this symptom, as well as future research perspectives.
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Affiliation(s)
- Edoardo Bianchini
- Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, 00189 Rome, Italy; (E.B.); (D.R.); (M.A.); (M.S.)
- AGEIS, Université Grenoble Alpes, 38000 Grenoble, France
- Sant’Andrea University Hospital, 00189 Rome, Italy;
| | - Domiziana Rinaldi
- Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, 00189 Rome, Italy; (E.B.); (D.R.); (M.A.); (M.S.)
- Sant’Andrea University Hospital, 00189 Rome, Italy;
| | - Marika Alborghetti
- Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, 00189 Rome, Italy; (E.B.); (D.R.); (M.A.); (M.S.)
- Sant’Andrea University Hospital, 00189 Rome, Italy;
| | - Marta Simonelli
- Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, 00189 Rome, Italy; (E.B.); (D.R.); (M.A.); (M.S.)
- Ospedale dei Castelli, ASL Rome 6, 00040 Ariccia, Italy
| | | | - Camilla Onelli
- Department of Molecular Medicine, University of Padova, 35121 Padova, Italy;
| | - Elena Pegolo
- Department of Information Engineering, University of Padova, 35131 Padova, Italy;
| | - Francesco E. Pontieri
- Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, 00189 Rome, Italy; (E.B.); (D.R.); (M.A.); (M.S.)
- Sant’Andrea University Hospital, 00189 Rome, Italy;
- Fondazione Santa Lucia IRCCS, 00179 Rome, Italy
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Di Giacomo A, Mason P, Snijder R, Abdul-Ahad A, Lahn M, Van der Veen L, Hammett T, Zorrilla R, Pickering C, Durini M, Simonelli M, Carlo-Stella C, Santoro A, Spiliopoulou P, Evans T, Maio M. 119P Long-term safety evaluation of roginolisib (formerly IOA-244), a highly selective phosphoinositide 3-kinase inhibitor delta (PI3Kδ), in a phase I first-in-human (FIH) study. ESMO Open 2023. [DOI: 10.1016/j.esmoop.2023.101065] [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: 04/05/2023] Open
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Simonelli M, Calvo E, Davar D, Richards D, Gutierrez M, Moreno Garcia V, Marron T, Rottey S, Orcurto A, Renouf D, Joerger M, Barriga Falcon S, Fan J, Gibson E, Chakraborty D, Arora V, Melero I. 200MO Anti–IL-8 BMS-986253 + nivolumab (NIVO) ± ipilimumab (IPI) in patients (pts) with advanced cancer: Update of initial phase I results. Immuno-Oncology and Technology 2022. [DOI: 10.1016/j.iotech.2022.100311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Di Giacomo A, Santangelo F, Amato G, E. Simonetti, Graham J, Lahn M, van der Veen L, Hammett T, Pickering C, Durini M, Ziyang T, Lakshmikanth T, Brodin P, Occhipinti M, Simonelli M, Carlo-Stella C, Santoro A, Spiliopoulou P, Evans T, Maio M. 192P Safety and clinical activity of IOA-244: A highly selective phosphoinositide 3-kinase inhibitor delta (PI3Kδ), in a phase I first-in-human (FIH) study. Immuno-Oncology and Technology 2022. [DOI: 10.1016/j.iotech.2022.100304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Mazaccara A, Privitera G, Di Pucchio A, Barbina D, Bertinato L, Mistretta A, Simonelli M, Caminada S, Arzilli G, Brusaferro S. Need for a competency-based approach for the Public Health Workforce training: the ISS proposal. Eur J Public Health 2022. [PMCID: PMC9594438 DOI: 10.1093/eurpub/ckac131.028] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Issue The COVID-19 pandemic acted as a catalyst for a reconsidering health care professional workforce (HCPW) competency needed to face future public health challenges, in line with the recent WHO “Global Competency and Outcomes Framework for UHC” document. In this context, in the Italian G20 Presidency framework, the Italian National Institute of Health (ISS), launched a program named “Laboratorium” - recognised in the G20 Declarations of Ministers of Health and Leaders - aimed to the development of training tools suitable for distance learning in whatever context they are placed. Description of the problem Common competencies and needs of the HCPW have to be fulfilled through cross-sectional and multilevel training, to overcome the current emergency and be able to face future challenges. The aim is to provide a modular educational approach that is finalized to actively involve the participant: health professionals step in their training pathway according to their knowledge gaps, identify their specific learning objectives and, through a problem-based learning approach, acquire the proper skills for their function and tasks. Results We propose a two-tiered approach to training: the development of competence based courses oriented to active learning. A pilot course on Epidemic Intelligence design according to this model is ready to be released. At the same time, a repository of everything available on the web systematically selected from authorised sources by a scientific committee was created to support the training objective. It is characterised by a detailed multilevel tagging that allows an effective modularisation to reach only the content useful for its user. Lessons Accessibility to health-related training materials is a required necessity at every level of HCPW. Profiles within healthcare are increasingly heterogeneous and there is a need to focus on disseminating tools that can provide knowledge to address different healthcare scenarios and common purposes. Key messages • Future public health challenges underline a need for a competencies-based learning approach in Healthcare Workforce training. • Italian National Institute of Health propose two methods within the ‘Laboratorium’ project to enable this type of learning: specifically designed courses and a structured document repository.
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Affiliation(s)
- A Mazaccara
- Training Office, National Institute of Health , Rome, Italy
| | - G Privitera
- Training Office, National Institute of Health , Rome, Italy
| | - A Di Pucchio
- Training Office, National Institute of Health , Rome, Italy
| | - D Barbina
- Training Office, National Institute of Health , Rome, Italy
| | - L Bertinato
- Scientific Secretariat to the President Head, National Institute of Health , Rome, Italy
| | - A Mistretta
- National Institute of Health Scientific Communication Unit, , Rome, Italy
| | - M Simonelli
- National Center for Global Health, National Institute of Health , Rome, Italy
| | - S Caminada
- Department of Public Health and Infectious Diseases, Sapienza University of Rome , Rome, Italy
| | - G Arzilli
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa , Pisa, Italy
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7
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Simonelli M, Garralda E, Eskens F, Gil-Martin M, Yen CJ, Obermannova R, Chao Y, Lonardi S, Melichar B, Moreno V, Yu ML, Bongiovanni A, Calvo E, Rottey S, Machiels JP, Gonzalez-Martin A, Paz-Ares L, Chang CL, Mason W, Lin CC, Reardon DA, Vieito M, Santoro A, Meng R, Abbadessa G, Menas F, Lee H, Liu Q, Combeau C, Ternes N, Ziti-Ljajic S, Massard C. Isatuximab plus atezolizumab in patients with advanced solid tumors: results from a phase I/II, open-label, multicenter study. ESMO Open 2022; 7:100562. [PMID: 35987165 PMCID: PMC9588873 DOI: 10.1016/j.esmoop.2022.100562] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 07/08/2022] [Accepted: 07/11/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND The anti-CD38 antibody isatuximab is approved for the treatment of relapsed/refractory multiple myeloma, but there are no data on its efficacy in solid tumors. This phase I/II study (NCT03637764) assessed the safety and activity of isatuximab plus atezolizumab (Isa + Atezo), an anti-programmed death-ligand 1 (PD-L1) antibody, in patients with immunotherapy-naive solid tumors: epithelial ovarian cancer (EOC), glioblastoma (GBM), hepatocellular carcinoma (HCC), and squamous cell carcinoma of the head and neck (SCCHN). PATIENTS AND METHODS Phase I assessed safety, tolerability, pharmacokinetics, pharmacodynamics, and the recommended phase II dose (RP2D) of isatuximab 10 mg/kg intravenously (i.v.) every week for 3 weeks followed by once every 3 weeks + atezolizumab 1200 mg i.v. every 3 weeks. Phase II used a Simon's two-stage design to assess the overall response rate or progression-free survival rate at 6 months (GBM cohort). Interim analysis was carried out at 6 months following first dose of the last enrolled patient in each cohort. Pharmacodynamic biomarkers were tested for CD38, PD-L1, tumor-infiltrating immune cells, and FOXP3+ regulatory T cells (Tregs) in the tumor microenvironment (TME). RESULTS Overall, 107 patients were treated (EOC, n = 18; GBM, n = 33; HCC, n = 27; SCCHN, n = 29). In phase I, Isa + Atezo showed an acceptable safety profile, no dose-limiting toxicities were observed, and RP2D was confirmed. Most patients experienced ≥1 treatment-emergent adverse event (TEAE), with ≤48.5% being grade ≥3. The most frequent TEAE was infusion reactions. The study did not continue to stage 2 based on prespecified targets. Tumor-infiltrating CD38+ immune cells were reduced and almost cleared after treatment. Isa + Atezo did not significantly modulate Tregs or PD-L1 expression in the TME. CONCLUSIONS Isa + Atezo had acceptable safety and tolerability. Clinical pharmacodynamic evaluation revealed efficient target engagement of isatuximab via treatment-mediated reduction of CD38+ immune cells in the TME. Based on clinical data, CD38 inhibition does not improve responsiveness to PD-L1 blockade in these patients.
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Affiliation(s)
- M Simonelli
- IRCCS Humanitas Research Hospital, Rozzano, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy.
| | - E Garralda
- Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - F Eskens
- Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - M Gil-Martin
- Institut Català d'Oncologia-IDIBELL, L'Hospitalet, Barcelona, Spain
| | - C-J Yen
- National Cheng Kung University, Tainan, Taiwan
| | - R Obermannova
- Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - Y Chao
- Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - S Lonardi
- Veneto Institute of Oncology IOV, IRCCS, Padova, Italy
| | - B Melichar
- Department of Oncology, Palacky University, Olomouc, Czech Republic
| | - V Moreno
- START Madrid-FJD, Hospital Fundación Jiménez Díaz, Madrid, Spain
| | - M-L Yu
- Hepatobiliary Division, Department of Internal Medicine and Hepatitis Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - A Bongiovanni
- IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - E Calvo
- START Madrid-CIOCC, Centro Integral Oncológico Clara Campal, Madrid, Spain
| | | | - J-P Machiels
- Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - A Gonzalez-Martin
- Clínica Universidad de Navarra, Madrid, and Program in Solid Tumors, Center for Applied Medical Research (CIMA), Pamplona
| | - L Paz-Ares
- Hospital Universitario 12 de Octubre, Madrid, Spain
| | - C-L Chang
- Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei, Taiwan
| | - W Mason
- Princess Margaret Cancer Centre, Toronto, Canada
| | - C-C Lin
- National Taiwan University Hospital, Taipei, Taiwan
| | - D A Reardon
- Dana-Farber Cancer Institute, Harvard University, Boston
| | - M Vieito
- Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - A Santoro
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy; Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | | | | | - F Menas
- Sanofi, Chilly-Mazarin, France
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Gay L, Rossi M, Sciortino T, Conti Nibali M, Simonelli M, Navarria P, Rudà R, Soffietti R, Bello L. P07.08.B Surgical management of recurrent lower-grade gliomas: analysis of oncological and functional outcomes and associated factors. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac174.140] [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: 11/13/2022] Open
Abstract
Abstract
Background
Presently, there are no clear evidence-based recommendations for the surgical management of progressive or recurrent lower-grade gliomas (LGGs). In our work, we evaluated the oncological (PFS, OS) and functional (neurological, neuropsychological, quality of life evaluation) outcomes of a series of LGGs treated in a 5-year period. The aim was to identify clinical, imaging, and molecular factors, associated with better outcomes, to be implemented in the treatment decision making process.
Material and Methods
In our retrospective analysis, 738 recurrent LGGs were included (follow-up 7.9 years; IQR:6-9); 550 were surgically treated, 495 with open resection (with brain mapping techniques), and 55 with tumor biopsy (with frameless stereotactic technique).
Results
Overall, 521 patients (70.6%) recurred. Of those treated with open resection 63.5% relapsed. Tumor progression was histologically confirmed in 72.5% of cases, no valuable tumor (effect of treatment) in 27.5% of cases (particularly in cases previously treated with RT and CHT), histo-molecular conversion (astrocytoma instead of oligodendroglioma diagnosis) in 7.5% of cases, malignant transformation in 38.7% of cases. Among the clinical (patient functional status, previous PFS, previous EOR, previous CHT and duration of CHT, previous RT), imaging (type of recurrence, i.e. typical versus atypical, speed of growth, contrast enhancement), and molecular (IDH, codeletion, ATRX, MGMT, tumor grade, CDNK status) factors analyzed, longest PFS of recurrent tumors was associated with patient functional status, previous PFS, previous EOR, speed of growth (>6 mm/year), atypical type of recurrence, tumor grade, presence of codeletion, and CDNK status. Best functional outcome associated with surgical resection, EOR, and tumor grade; worst functional outcome with RT and malignant transformation. Longest OS associated with previous EOR, surgical resection, tumor grade, presence of co-deletion. Malignant transformation was associated to previous EOR. Among patients submitted solely to tumor biopsy, changes in MGMT methylation status and in IDH status were observed in 65.3% and 5% of cases, respectively. Modification in IDH status was associated with atypical (distant) type of recurrence. New histo-molecular profile helped in the treatment decision making process.
Conclusion
Surgical resection of recurrent LGGs is associated with longer PFS and OS. Tumor biopsy should be considered, when surgery considered unfeasible, to tailor adjuvant treatment.
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Affiliation(s)
- L Gay
- Neurosurgical Oncological Unit, Dept of Oncology and Hemato-oncology, Università degli Studi di Milano , Milano , Italy
| | - M Rossi
- Neurosurgical Oncological Unit, Dept of Oncology and Hemato-oncology, Università degli Studi di Milano , Milano , Italy
| | - T Sciortino
- Neurosurgical Oncological Unit, Dept of Oncology and Hemato-oncology, Università degli Studi di Milano , Milano , Italy
| | - M Conti Nibali
- Neurosurgical Oncological Unit, Dept of Oncology and Hemato-oncology, Università degli Studi di Milano , Milano , Italy
| | - M Simonelli
- Humanitas Cancer Center, Humanitas Research Hospital, IRCCS , Milano , Italy
| | - P Navarria
- Humanitas Cancer Center, Humanitas Research Hospital, IRCCS , Milano , Italy
| | - R Rudà
- Department of Neurology, Castelfranco Veneto Hospital , Castelfranco Veneto , Italy
| | - R Soffietti
- Neuro-Oncologia, Città della Salute e della Scienza, Università di Torino , Torino , Italy
| | - L Bello
- Neurosurgical Oncological Unit, Dept of Oncology and Hemato-oncology, Università degli Studi di Milano , Milano , Italy
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Clerici E, Navarria P, Bellu L, Pessina F, Simonelli M, Marini B, Bianchi S, Scorsetti M. JS09.7.A Reirradiation for recurrent high grade glioma (HGG) patients: results of a single arm prospective phase 2 study. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac174.029] [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: 11/14/2022] Open
Abstract
Abstract
Background
Standard of care for recurrent high grade glioma (HGG) is missing. Several treatment options have been investigated including re-irradiation (re-RT). Results are promising but provided by retrospective studies. We designed a single arm prospective phase II study aiming to evaluate efficacy, and toxicity of re-irradiation.
Material and Methods
Adults patients with good performance status, HGG diagnosis reclassified according to the new 2021 fifth edition WHO CNS classification, an interval time (IT) from previous RT ≥ 6 months were included. Outcome was evaluated by MRI imaging at 1 month, and every 3 months thereafter. Toxicities were evaluated in terms of radionecrosis occurrence, and neurocognitive status.
Results
Ninety recurrent HGG patients were treated, 11 oligodendroglioma grade 3, 18 astrocytoma grade 3 and 4, and 61 glioblastoma grade 4. The median age was 54 years, and majority had KPS 90-100. The median IT between first-RT and re-RT was 24 months. Re-surgery has been performed in 56.6%, and chemotherapy in 53.3%. The median follow up time was 64 months; median overall survival (OS) time,1,2,3-year OS rates were 17 months (95%CI 14-19), 66.7%±4.9, 32.6%±5.0, and 22.2 ± 4.7. Prognostic factors impacting on survival were age (p = 0.0154), IT between first RT and re-RT (p = 0.0051), glioma grade (p = 0.0090), and IDH status (p = 0.0001). Radionecrosis grade 2-3 occurred in 9 (10%) patients; neurocognitive functions remained stable until disease progression.
Conclusion
Re-RT proved to be a safe and feasible treatment option with low toxicity. Younger patients with grade 3 IDH mutated gliomas, and a longer IT had the better outcome.
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Affiliation(s)
- E Clerici
- IRCCS Humanitas Research Hospital , Rozzano , Italy
| | - P Navarria
- IRCCS Humanitas Research Hospital , Rozzano , Italy
| | - L Bellu
- IRCCS Humanitas Research Hospital , Rozzano , Italy
| | - F Pessina
- IRCCS Humanitas Research Hospital , Rozzano , Italy
| | - M Simonelli
- IRCCS Humanitas Research Hospital , Rozzano , Italy
| | - B Marini
- IRCCS Humanitas Research Hospital , Rozzano , Italy
| | - S Bianchi
- IRCCS Humanitas Research Hospital , Rozzano , Italy
| | - M Scorsetti
- IRCCS Humanitas Research Hospital , Rozzano , Italy
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10
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Piccart M, Ruiz Borrego M, Arkenau HT, Escrivá-de-Romaní S, Howell S, Hennequin A, Jimenez-Rodriguez B, Del Conte G, Simonelli M, Palleschi M, Duhoux F, Doger De Speville Uribe B, Curigliano G, Waters S, Aftimos P, Wildiers H, Tosi D, Amair-Pinedo F, Pellacani A, Laurent D. 266P MEN1611, a PI3K inhibitor, combined with trastuzumab (T) ± fulvestrant (F) for HER2+/PIK3CA mutant (mut) advanced or metastatic (a/m) breast cancer (BC): Safety and efficacy results from the ongoing phase Ib study (B-PRECISE-01). Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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11
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Abstract
Abstract
Background
The Universal Health Coverage (UHC) proposes that an ideal health system must be able to extend the health coverage to the whole population (universality), to guarantee all the necessary services (globality) and to do it without additional direct costs for the people (free of charge). The achievement of the UHC represents the target 3.8 of the Sustainable Developed Goals. The World Health Organization and the World Bank have developed an index to monitor the UHC (an algorithm that contains 16 indicators of essential health services), while for financial protection they rely on the incidence of catastrophic expenditure on health (percentage of families in which the living expenses for health without reimbursement exceed the10% of consumption).
Objectives
To strengthen the Italian operators' knowledge about the accessibility to health services in Italy and in countries around the world utilizing the UHC index and the incidence of catastrophic expenditure.
Results
The National Center for Global Health of the Italian National Institute of Health (ISS) collected the documents and the data already produced and validated by the international scientific community. ISS in collaboration with the Department of Public Health and Infectious Disease of Sapienza University of Rome developed a workshop training program to bring the UHC concepts at national level in a simplified manner. This was developed in order to encourage a reflection and to strengthen the understanding of the complexity of the UHC. The framework and the program of the workshop will be presented during the conference.
Conclusions
Studying the UHC means focusing on the inequalities in health care. To increase the sensibility of professionals may be a resource to promote the health coverage for all in the national territory.
Key messages
Encouraging the discussion between professionals is possible to understand the complexity of the UHC. The achievement of the UHC may happen only through the improving of the knowledge about it.
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Affiliation(s)
- G Marchetti
- National Center for Global Health, Italian National Institute of Health, Rome, Italy
- Public Health and Infectious Disease Department, Sapienza University of Rome, Rome, Italy
| | - M Simonelli
- National Center for Global Health, Italian National Institute of Health, Rome, Italy
| | - M G Dente
- National Center for Global Health, Italian National Institute of Health, Rome, Italy
| | - M Marceca
- Public Health and Infectious Disease Department, Sapienza University of Rome, Rome, Italy
| | - S Declich
- National Center for Global Health, Italian National Institute of Health, Rome, Italy
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12
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Caccese M, Simonelli M, Bellu L, Villani V, Rizzato S, Ius T, Pasqualetti F, Russo M, Franchino F, Amoroso R, Bertorelle R, Cavallin F, Dipasquale A, Carosi M, Pizzolitto S, Cesselli D, Gardiman M, Padovan M, Zagonel V, Lombardi G. 361O Defining the prognostic role of MGMT methylation value by pyrosequencing assay in glioblastoma patients: A large Italian multicenter study. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.470] [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: 10/23/2022] Open
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13
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Padovan M, Eoli M, Pellerino A, Rizzato S, Caserta C, Simonelli M, Michiara M, Caccese M, Anghileri E, Finocchiaro G, Zagonel V, Rudà R, Lombardi G. 369MO Final results of depatuxizumab mafodotin plus temozolomide in recurrent glioblastoma patients: Real-world experience from a multicenter study of Italian Association of Neuro-Oncology (AINO). Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.478] [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: 10/23/2022] Open
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14
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Abstract
Respiratory rehabilitation in patients with chronic obstructive pulmonary disease (COPD) is recognized as a cornerstone for the therapeutic path. Physiotherapy involves physical activity with aerobic and anaerobic exercises, which can improve the patient's symptomatic picture, such as motor function, emotional status (depression and anxiety), and improve the pain perception. The training of proprioception is not included in the structure of the exercises proposed by the Global Initiative for Chronic Obstructive Lung Disease (GOLD). The training of proprioception is a very useful strategy for stimulating the cerebellum, a neurological suffering area in patients with COPD. The cerebellum sorts information about pain and emotions, as well as motor stimuli. The article discusses the need to introduce proprioception in respiratory rehabilitation protocols, highlighting the neurological relationships with the management of comorbidities.
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Affiliation(s)
- Bruno Bordoni
- Physical Medicine and Rehabilitation, Foundation Don Carlo Gnocchi, Milan, ITA
| | - Marta Simonelli
- Integrative/Complimentary Medicine, French-Italian School of Osteopathy, Pisa, ITA
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15
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Abstract
The diaphragm muscle is the most important contractile district used for breathing. Like other muscles in the human body, it is subject to ageing and sarcopenia. Sarcopenia can be classified as primary (or age-related) when there are no local or systemic pathologies that cause a functional and morphological detriment of skeletal musculature. Secondary sarcopenia occurs when there is a cause or more pathological causes (illness, malnutrition, immobility) related or unrelated to ageing. In the elderly population, transdiaphragmatic pressure (Pdi) decreases by 20-41%, with a decline in the overall strength of 30% (the strength of the expiratory muscles also decreases). The article discusses the adaptation of the diaphragm muscle to ageing and some other ailments and co-morbidities, such as back pain, emotional alterations, motor incoordination, and cognitive disorders, which are related to breathing.
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Affiliation(s)
- Bruno Bordoni
- Physical Medicine and Rehabilitation, Foundation Don Carlo Gnocchi, Milan, ITA
| | - Bruno Morabito
- Physical Medicine and Rehabilitation, School of Osteopathic Centre for Research and Studies, Milan, ITA
| | - Marta Simonelli
- Integrative/Complimentary Medicine, French-Italian School of Osteopathy, Pisa, ITA
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16
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Simonelli M, Lorenzi E, Dipasquale A, Persico P, Ninatti G, Giordano L, Bertossi M, Santoro A. Patient (pt) selection for immunotherapeutic early-phase clinical trials (ieCTs): A single phase I unit experience. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz244.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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17
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Simonelli M, Persico P, Dipasquale A, Lorenzi E, Giordano L, Pessina F, Navarria P, Scorsetti M, Bello L, Santoro A. Outcome of high-grade gliomas (HGGs) treated into immunotherapeutic early-phase clinical trials (ieCTs): A single-center experience. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz243.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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18
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Caccese M, Simonelli M, Fassan M, Padovan M, Persico P, Bellu L, Dipasquale A, Gardiman M, Indraccolo S, Zagonel V, Lombardi G. Pembrolizumab (Pem) in recurrent high-grade glioma (HGG) patients with mismatch repair deficiency (MMRd): An observational study. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz243.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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19
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Abstract
The tentorium cerebelli is a meningeal portion in relation to the skull, the nervous system, and the cervical tract. In this second part, the article discusses the systematic tentorial relationships, such as the central and cervical neurological connections, the venous circulation and highlights possible clinical alterations that could cause pain. To understand the function of anatomy, we should always remember that every area of the human body is never a segment, but a functional continuum.
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20
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Abstract
The tentorium cerebelli is an integral part of the reciprocal tension membranes that divide some brain areas: the falx cerebri, the falx cerebelli, and the diaphragma sellae. The article is divided into two parts. The first part reviews the anatomy of the tentorium cerebelli, the dura mater, and the ligaments and cervical muscles connected to the tentorium. The tentorial area may be subject to trauma or surgery and knowledge of anatomy and existing relationships is essential to better understand the clinical picture. The second part reviews the systemic relationships of the tentorium cerebelli. The neurological anatomical information, which links the tentorium to the central and peripheral nervous systems, venous brain drainage. The tentorium is not just a body segment, but a systemic communication tool.
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Affiliation(s)
- Bruno Bordoni
- Cardiology, Foundation Don Carlo Gnocchi, Milan, ITA
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21
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Caccese M, Simonelli M, Fassan M, Padovan M, Persico P, Bellu L, Dipasquale A, Gardiman M, Indraccolo S, Zagonel V, Lombardi G. PL2.2 Pembrolizumab (PEM) in recurrent high-grade glioma (HGG)patients with mismatch repair deficiency (dMMR): an observational study. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz126.003] [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: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
Pem, an immune checkpoint inhibitor, demonstrated to be activein various neoplasms with MMRd. No data exists about its efficacy in MMRdglioma patients.
MATERIAL AND METHODS
MMRd HGG relapsed after receiving RT and CT weretreated with Pem. MMR status was analyzed by immunohistochemistry,including the MLH1, MSH2, MSH6, and PMS2 markers. MMR deficiency wasdefined as presence of a weak (wMMRd) or absent (aMMRd) signal atimmunohistochemistry for at least one MMR protein. Other inclusion criteriawere: ECOG PS 0–2, histologically confirmed gliomas, dexamethasone ≤4 mg.Pem was administrated at 200 mg every 3 weeks until progression disease orunacceptable toxicity. Tumor response was evaluated by brain MRI every 10 weeksaccording to the RANO criteria. OS and PFS were evaluated by Kaplan-Meiercurves. CTCAE v4.0 was used for toxicity.
RESULTS
among 167 glioma patients, we found 22 MMRd gliomas. 12 PTS were treated with Pem: 8 wMMRd and 4 aMMRd. According to Bethesda criteria, allPTS had microsatellite stability. Tumor histologies included 5 anaplasticastrocytoma, 1 anaplastic oligodendroglioma, 6 glioblastoma (GBM). MSH2deficiency was found in 6 cases, MSH6 deficiency in 9 cases, PMS2 and MLH1deficiency in 2 cases. Median number of prior line of chemotherapy was 1 (range 1–5). Stable disease (SD) was reported in 4 PTS (33%); 8 PTS showedprogressive disease (PD). PTS with anaplastic gliomas showed a statisticallysignificant association with SD (p=0.03, OR=3); all GBM PTS reported PD; status of MMRd (weak/absent), IDH (mutated/wild-type), MSH2 and MLH6(deficient/proficient) were not associated with SD. Median follow up was 14.7 ms. OS was 5.6 ms (95% CI 0.1–13.8), PFS 2.4 ms (95% CI 1.8–2.9). OS was 2.8 ms and 5.6 ms (p=0.9), PFS was 1.8 ms and 3.1 ms (p=0.5) in PTS with wMMRd and aMMRd. PTS reporting SD and PD had PFS of 7.4 ms (95% CI 4.6–10.2) and 1.8 ms (95% CI 0.2–3.4), p=0.002; OS was “not reached” and 2.8 ms in PTS having SD vs PD (p=0.04). Grade ≥3 adverse eventswere reported in 8% of PTS.
CONCLUSION
a subgroup of recurrent MMRd HGG might benefit from Pem,especially anaplastic gliomas. There was a trend for a longer PFS and OS in PTS with aMMRd. Analyses for identifying additional molecular predictive factors is ongoing.
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Affiliation(s)
- M Caccese
- Department of Oncology, Oncology 1, Veneto Institute of Oncology, IOV – IRCCS, Padova, Italy
| | - M Simonelli
- Humanitas University, Humanitas Clinical and Research Hospital - IRCCS, Milan, Italy
| | - M Fassan
- Department of Medicine and Surgical Pathology and Cytopathology Unit, University Hospital of Padua, Padova, Italy
| | - M Padovan
- Department of Oncology, Oncology 1, Veneto Institute of Oncology, IOV – IRCCS, Padova, Italy
| | - P Persico
- Humanitas University, Humanitas Clinical and Research Hospital - IRCCS, Milan, Italy
| | - L Bellu
- Department of Oncology, Radiotherapy Unit, Veneto Institute of Oncology, IOV – IRCCS, Padova, Italy
| | - A Dipasquale
- Humanitas University, Humanitas Clinical and Research Hospital - IRCCS, Milan, Italy
| | - M Gardiman
- Department of Medicine and Surgical Pathology and Cytopathology Unit, University Hospital of Padua, Padova, Italy
| | - S Indraccolo
- Immunology and Molecular Oncology Unit, Veneto Institute of Oncology, IOV - IRCCS, Padova, Italy
| | - V Zagonel
- Department of Oncology, Oncology 1, Veneto Institute of Oncology, IOV – IRCCS, Padova, Italy
| | - G Lombardi
- Department of Oncology, Oncology 1, Veneto Institute of Oncology, IOV – IRCCS, Padova, Italy
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22
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Simonelli M, Persico P, Dipasquale A, Lorenzi E, Giordano L, Pessina F, Navarria P, Scorsetti M, Bello L, Santoro A. P05.08 High-grade gliomas and immunotherapeutic early phase clinical trials: a single-center experience. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz126.122] [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: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
Patients with high-grade gliomas (HGGs) have historically been excluded from immunotherapeutic early-phase clinical trials (ieCTs) due to unavailability of serial bioptic sampling, the frequent need of corticosteroids, concerns regarding activity of immunotherapy in central nervous system, and rapid clinical deterioration.
MATERIAL AND METHODS
We retrospectively reviewed data of all recurrent HGG patients enrolled in ieCTs at Humanitas Cancer Center Phase I Unit between 2014 and 2019. Disease control rate (DCR) according to RANO criteria, six-months progression-free and overall survival (PFS-6; OS-6), and treatment-related adverse events (TRAEs), were evaluated. A control-cohort (CC) of patients treated with standard treatments (temozolomide, fotemustine, lomustine and procarbazine, bevacizumab) matched (1:1) for sex, age, line of treatment, MGMT methylation status, and IDH mutational status, was selected for comparison. A series of clinical parameters with an established prognostic value for patients with solid tumors treated into ieCTs were correlated with survivals through an univariate analysis. These include: use of steroids, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, lactate dehydrogenase, albumin, total protein.
RESULTS
Five among the 23 ieCTs conducted at our Phase I Unit allowed inclusion of HGG patients. 25 patients were enrolled in the experimental cohort (EC): 22 (88%) glioblastoma, 3 (12%) anaplastic astrocytoma. Median age was 50 years (range 25–71); 16 patients (64%) were men, 9 (36%) women; 17 pts (68%) required steroid therapy, with a median baseline dexamethasone dose of 2 mg (range 1–6). The median number of prior systemic therapies was 1 (range 1–2). Twelve patients (48%) received monotherapies (anti PD-1, anti CSFR-1, anti TGF-ß, anti cereblon), 13 (52%) combination regimens (anti PD-L1 + anti CD38, anti PD-1 + anti CSFR-1). DCR was 40% (1 CR + 2 PR + 7 SD) and 37% (9 SD), in EC and CC, respectively. Four patients (16%) in EC had grade ≥3 TRAEs (1 neutropenia, 1 pneumonia, 2 hepatitis). With a median follow-up of 14 months PFS-6 were 35% and 16% (p=0.075), in EC and CC respectively, while OS-6 was significantly improved in the EC (82% vs 44%, p=0.004). In our small series, none of clinical factors resulted prognostic.
CONCLUSION
Survival outcomes of ourHGG patients treated into ieCTs compared very favorably with a matched CC. Inclusion of HGGs patients into ieCTs should be strongly encouraged. Identification of clinical factors to select who may benefit from ieCTs still remains crucial.
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Affiliation(s)
- M Simonelli
- Humanitas Clinical and Research Center; Humanitas University, Rozzano (Milan), Italy
| | - P Persico
- Humanitas Clinical and Research Center, Rozzano (Milan), Italy
| | - A Dipasquale
- Humanitas Clinical and Research Center, Rozzano (Milan), Italy
| | - E Lorenzi
- Humanitas Clinical and Research Center, Rozzano (Milan), Italy
| | - L Giordano
- Humanitas Clinical and Research Center, Rozzano (Milan), Italy
| | - F Pessina
- Humanitas Clinical and Research Center; Humanitas University, Rozzano (Milan), Italy
| | - P Navarria
- Humanitas Clinical and Research Center, Rozzano (Milan), Italy
| | - M Scorsetti
- Humanitas Clinical and Research Center; Humanitas University, Rozzano (Milan), Italy
| | - L Bello
- Humanitas Clinical and Research Center; University of Milan, Rozzano (Milan), Italy
| | - A Santoro
- Humanitas Clinical and Research Center; Humanitas University, Rozzano (Milan), Italy
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23
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Bordoni B, Morabito B, Simonelli M, Nicoletti L, Rinaldi R, Tobbi F, Caiazzo P. Osteopathic approach with a patient undergoing cardiac transplantation: the five diaphragms. Int Med Case Rep J 2019; 12:303-308. [PMID: 31564994 PMCID: PMC6733248 DOI: 10.2147/imcrj.s204829] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 08/09/2019] [Indexed: 01/11/2023] Open
Abstract
The case report presents a patient with a possible neuropathic sternal pain associated with a recent heart transplant procedure. The patient could not breathe deeply and move the upper limbs, with a trunk torsion, feeling a sharp pain under and around the left breastbone. A fascial osteopathic approach in the treatment of the pelvic floor, the respiratory diaphragm, the thoracic outlet, the tongue and the tentorium cerebelli allowed the patient to access to a cardiovascular rehabilitation program. In osteopathic medicine, these anatomical parts of the body are called the five diaphragms. To our best knowledge, this is the first case report that uses osteopathic treatment in a patient with sternal pain associated with an undergoing cardiac transplantation. The clinical importance of the case report is added to other osteopathic research with patients undergoing cardiac surgery (coronary artery bypass graft) and with multiple benefits, without side effects. One of the main goals of osteopathic treatment is to provide the patient with well-being, from many clinical points of view, allowing the person to be discharged from the hospital more quickly and/or with less pain.
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Affiliation(s)
- Bruno Bordoni
- Foundation Don Carlo Gnocchi IRCCS, Department of Cardiology, Institute of Hospitalization and Care with Scientific Address, Milan 20100, Italy
| | - Bruno Morabito
- Foundation Polyclinic University A. Gemelli University Cattolica Del Sacro Cuore, Rome, Italy.,Department of Osteopathy, CRESO School, Gorla Minore, Piazza XXV Aprile 421055, Italy
| | | | - Luigi Nicoletti
- Department of Osteopathy, Accademia Italiana Terapia Osteopatica Posturale (AITOP), Massa-Carrara, Italy
| | - Riccardo Rinaldi
- Department of Osteopathy, Accademia Italiana Terapia Osteopatica Posturale (AITOP), Massa-Carrara, Italy
| | - Filippo Tobbi
- Poliambulatorio Medico E Odontoiatrico, Busto Arsizio, Varese, Italy
| | - Philippe Caiazzo
- Department of Osteopathy, Accademia Italiana Terapia Osteopatica Posturale (AITOP), Massa-Carrara, Italy
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24
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Abstract
The word diaphragm comes from the Greek (διάϕραγμα), which meant something that divides, but also expressed a concept related to emotions and intellect. Breath is part of a concept of symmorphosis, that is the maximum ability to adapt to multiple functional questions in a defined biological context. The act of breathing determines and defines our holobiont: how we react and who we are. The article reviews the fascial structure that involves and forms the diaphragm muscle with the aim of changing the vision of this complex muscle: from an anatomical and mechanistic form to a fractal and asynchronous form. Another step forward for understanding the diaphragm muscle is that it is not only covered, penetrated and made up of connective tissue, but the contractile tissue itself is a fascial tissue with the same embryological derivation. All the diaphragm muscle is fascia.
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Affiliation(s)
- Bruno Bordoni
- Cardiology, Foundation Don Carlo Gnocchi, Milan, ITA
| | | | - Bruno Morabito
- Osteopathy, School of Osteopathic Centre for Research and Studies, Milan, ITA
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25
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Abstract
The biotensegrity view of the living is a theoretical model and there is no mathematical study in vitro or in vivo that demonstrates its validity, taking into account the presence of liquids (blood, lymph, water), the tension produced by nerves and blood vessels, just as the displacement of the viscera and their resistances and contractions are not taken into consideration. The concept of cellular transduction is reviewed as it is the key to understanding if the passage of different mechanical information occurs only through solid structures, such as the cytoskeleton, or even liquid and viscous. The article focuses on reviewing the weaknesses of the biotensegrity model in the light of new scientific information, trying to coin another term that better reflects the dynamics of living: fascintegrity.
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Affiliation(s)
- Bruno Bordoni
- Cardiology, Foundation Don Carlo Gnocchi, Milan, ITA
| | - Matthew A Varacallo
- Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, USA
| | - Bruno Morabito
- Osteopathy, School of Osteopathic Centre for Research and Studies, Milan, ITA
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26
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Abstract
The application of cranial osteopathic manipulative medicine (OMM) is always controversial in the literature. Primary respiration related to the movement of spheno-basilar synchondrosis in the adult goes against the knowledge of complete ossification that occurs at this articulation after the pubertal phase. The idea that the operator's hands can communicate with the meninges is difficult to accept. The anatomy shows us that the fascial system involves the meninges and that from the microcellular point of view there are no layers that divide one tissue from another. The backing of new sciences, such as quantum physics, suggest that cranial palpation allows the osteopath to come into contact with the meninges. Recent scientific evidence shows that meningeal afferents can affect extracranial areas and that the pericranial musculature itself is able to influence these afferents. The article highlights some reflections in support of cranial osteopathy, based on scientific information that could help the osteopath to improve clinical work.
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Affiliation(s)
- Bruno Bordoni
- Cardiology, Foundation Don Carlo Gnocchi, Milan, ITA
| | - Bruno Morabito
- Osteopathy, School of Osteopathic Centre for Research and Studies, Milan, ITA
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27
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Abstract
According to current scientific standards, the fascia is a connective tissue derived from two separate germ layers, the mesoderm (trunk and limbs, part of the neck) and the ectoderm (cervical tract and skull). The fascia has the property of maintaining the shape and function of its anatomical district, but it also can adapt to mechanical-metabolic stimuli. Smooth muscle and non-voluntary striated musculature originated from the mesoderm have never been properly considered as a type of fascia. They are some of the viscera present in the mediastinum, in the abdomen and in the pelvic floor. This text represents the first article in the international scientific field that discusses the inclusion of some viscera in the context of what is considered fascia, thanks to the efforts of our committee for the definition and nomenclature of the fascial tissue of the Foundation of Osteopathic Research and Clinical Endorsement (FORCE).
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Affiliation(s)
- Bruno Bordoni
- Cardiology, Foundation Don Carlo Gnocchi, Milan, ITA
| | | | - Bruno Morabito
- Osteopathy, School of Osteopathic Centre for Research and Studies, Milan, ITA
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28
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Abstract
In osteopathic clinical practice and in the teaching of osteopathic medicine, the visceral manipulation approach is included. The knowledge that some viscera satisfy the definition of fascial tissue will allow the osteopath to improve its practice. In the second part of the article, we will give a conclusive definition of fascia, and we will explain the embryological development of the heart and how the fascial tissue can be subject to manual treatment. This text is the first in the international scientific field that discusses the inclusion of some viscera in the context of what is considered fascia, through our committee for the definition and nomenclature of the fascial tissue of the Foundation of Osteopathic Research and Clinical Endorsement (FORCE).
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Affiliation(s)
- Bruno Bordoni
- Cardiology, Foundation Don Carlo Gnocchi, Milan, ITA
| | | | - Bruno Morabito
- Osteopathy, School of Osteopathic Centre for Research and Studies, Milan, ITA
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29
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30
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Abstract
The tongue plays a fundamental role in several body functions such as swallowing, breathing, speaking, and chewing. Its action is not confined to the oral cavity, but it affects lower limb muscle strength and posture. The tongue is an organ that has an autocrine/paracrine mechanism of action to synthesize different substances to interact with the whole body; according to a line of thought, it is also an extension of the enteric system. The aim of this study was to review the functions of the tongue and its anatomical association with the body system. According to the authors' knowledge, this is the first scientific article focusing on the tongue in a systemic context. In a clinical evaluation, connections with the tongue should be considered to optimize the clinical examination of the tongue and therefore enhance rehabilitation programs and therapeutic results.
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Affiliation(s)
- Bruno Bordoni
- Cardiology, Foundation Don Carlo Gnocchi / Institute of Hospitalization and Care, Milan, ITA
| | - Bruno Morabito
- Osteopathy, School of Osteopathic Centre for Research and Studies, Milan, ITA
| | - Roberto Mitrano
- Cardiology, Foundation Don Carlo Gnocchi/institute of Hospitalization and Care, Milan, ITA
| | | | - Anastasia Toccafondi
- Cardiology, Foundation Don Carlo Gnocchi/institute of Hospitalization and Care, Milan, ITA
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31
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Lombardi G, Caccese M, Simonelli M, Fassan M, Persico P, Lorenzi E, Bertorelle R, Gardiman M, Bellu L, Pambuku A, Santoro A, Zagonel V. Mismatch repair deficiency (MMRd) in glioma patients (PTS): Frequency and correlation with clinical, histological and molecular characteristics. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy273.362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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32
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Santoro A, Su WC, Navarro A, Simonelli M, Yang JH, Ardizzoni A, Barlesi F, Kang J, Didominick S, Abdelhady A, Goswami B, Crystal A, Felip E. Dose-determination results from a phase Ib/II study of ceritinib (CER) + ribociclib (RIB) in ALK-positive (ALK+) non-small cell lung cancer (NSCLC). Ann Oncol 2018. [DOI: 10.1093/annonc/mdy292.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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33
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Abstract
Fascia is a cacophony of functions and information, a completely adaptable entropy complex. The fascial system has a solid and a liquid component, acting in a perfect symbiotic synchrony. Each cell communicates with the other cells by sending and receiving signals; this concept is a part of quantum physics and it is known as quantum entanglement: a physical system cannot be described individually, but only as a juxtaposition of multiple systems, where the measurement of a quantity determines the value for other systems. Fascial continuum serves as a target for different manual approaches, such as physiotherapy, osteopathy and chiropractic. Cellular behaviour and the inclusion of quantum physics background are hardly being considered to find out what happens between the operator and the patient during a manual physical contact. The article examines these topics. According to the authors' knowledge, this is the first scientific text to offer manual operators’ new perspectives to understand what happens during palpatory contact. A fascial cell has not only memory but also the awareness of the mechanometabolic information it feels, and it has the anticipatory predisposition in preparing itself for alteration of its natural environment.
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Affiliation(s)
- Bruno Bordoni
- Cardiology, Foundation Don Carlo Gnocchi / (IRCCS) Institute of Hospitalization and Care, Milano, ITA
| | - Marta Simonelli
- Osteopathy, (SOFI) School of French-Italian Osteopathy, Pisa, ITA
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Simonelli M, Massara M, Persico P, Capucetti A, Lorenzi E, Lugli E, Dipasquale A, Nibali M, Rossi M, Bello L, Locati M, Bonecchi R. P04.86 Correlation between activated infiltrating neutrophils and MGMT methylation in patients with diffuse malignant gliomas (MGs). Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy139.320] [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: 11/13/2022] Open
Affiliation(s)
- M Simonelli
- Humanitas Clinical and Research Center, Rozzano (MI), Italy
- Humanitas University, Pieve Emanuele (MI), Italy
| | - M Massara
- Humanitas Clinical and Research Center, Rozzano (MI), Italy
- Università degli Studi di Milano, Milano, Italy
| | - P Persico
- Humanitas Clinical and Research Center, Rozzano (MI), Italy
| | - A Capucetti
- Humanitas Clinical and Research Center, Rozzano (MI), Italy
| | - E Lorenzi
- Humanitas Clinical and Research Center, Rozzano (MI), Italy
| | - E Lugli
- Humanitas Clinical and Research Center, Rozzano (MI), Italy
| | - A Dipasquale
- Humanitas Clinical and Research Center, Rozzano (MI), Italy
| | - M Nibali
- Humanitas Clinical and Research Center, Rozzano (MI), Italy
| | - M Rossi
- Humanitas Clinical and Research Center, Rozzano (MI), Italy
| | - L Bello
- Humanitas Clinical and Research Center, Rozzano (MI), Italy
| | - M Locati
- Humanitas Clinical and Research Center, Rozzano (MI), Italy
- Università degli Studi di Milano, Milano, Italy
| | - R Bonecchi
- Humanitas Clinical and Research Center, Rozzano (MI), Italy
- Humanitas University, Pieve Emanuele (MI), Italy
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Navarria P, Clerici E, Pessina F, Franzese C, Bello L, Simonelli M, Tomatis S, Leonetti A, Scorsetti M. P01.073 Hypofractionated radiation therapy (over 3 weeks) can replace conventional radiation therapy schedule (over 6 weeks) in newly diagnosed glioblastoma patients? The times are ripe. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy139.115] [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: 11/13/2022] Open
Affiliation(s)
| | - E Clerici
- Humanitas Cancer Center, Rozzano, Italy
| | - F Pessina
- Humanitas Cancer Center, Rozzano, Italy
| | | | - L Bello
- Humanitas Cancer Center, Rozzano, Italy
| | | | - S Tomatis
- Humanitas Cancer Center, Rozzano, Italy
| | | | - M Scorsetti
- Humanitas Cancer Center, Rozzano, Italy
- Humanitas University, Rozzano,Milan, Italy
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Pessina F, Navarria P, Conti Nibali M, Riva M, Carta G, Clerici E, Simonelli M, Rudà R, Scorsetti M, Bello L. P01.043 Is surgical resection useful in elderly newly diagnosed glioblastoma patients? Outcome evaluation and prognostic factors assesment. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy139.085] [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: 11/14/2022] Open
Affiliation(s)
- F Pessina
- Humanitas Research Hospital, Rozzano, Italy
| | - P Navarria
- Humanitas Research Hospital, Rozzano, Italy
| | | | - M Riva
- Humanitas Research Hospital, Rozzano, Italy
| | - G Carta
- Humanitas Research Hospital, Rozzano, Italy
| | - E Clerici
- Humanitas Research Hospital, Rozzano, Italy
| | | | - R Rudà
- Humanitas Research Hospital, Rozzano, Italy
| | | | - L Bello
- Humanitas Research Hospital, Rozzano, Italy
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Lombardi G, Caccese M, Simonelli M, Fassan M, Persico P, Lorenzi E, Bertorelle R, Gardiman M, Bellu L, Pambuku A, Santoro A, Zagonel V. P01.018 Mismatch repair deficiency (MMRd) in glioma patients (PTS): frequency and correlation with clinical, histological and molecular characteristics. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy139.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- G Lombardi
- Department of Clinical and Experimental Oncology, Veneto Institute of Oncology, IOV – IRCCS, Padova, Italy
| | - M Caccese
- Department of Clinical and Experimental Oncology, Veneto Institute of Oncology, IOV – IRCCS, Padova, Italy
| | - M Simonelli
- Department of Biomedical Sciences, Humanitas University, Rozzano, Italy
- Humanitas Cancer Center, Humanitas Clinical and Research Hospital, Rozzano, Italy
| | - M Fassan
- Surgical Pathology Unit, Department of Medicine (DIMED), University-Hospital of Padua, Padova, Italy
| | - P Persico
- Humanitas Cancer Center, Humanitas Clinical and Research Hospital, Rozzano, Italy
| | - E Lorenzi
- Humanitas Cancer Center, Humanitas Clinical and Research Hospital, Rozzano, Italy
| | - R Bertorelle
- Immunology and Molecular Oncology Unit, Veneto Institute of Oncology, IOV - IRCCS, Padova, Italy
| | - M Gardiman
- Surgical Pathology Unit, Department of Medicine (DIMED), University-Hospital of Padua, Padova, Italy
| | - L Bellu
- Radiation Therapy and Nuclear Medicine Unit, Veneto Institute of Oncology IOV - IRCCS, Padova, Italy
| | - A Pambuku
- Department of Clinical and Experimental Oncology, Veneto Institute of Oncology, IOV – IRCCS, Padova, Italy
| | - A Santoro
- Department of Biomedical Sciences, Humanitas University, Rozzano, Italy
- Humanitas Cancer Center, Humanitas Clinical and Research Hospital, Rozzano, Italy
| | - V Zagonel
- Department of Clinical and Experimental Oncology, Veneto Institute of Oncology, IOV – IRCCS, Padova, Italy
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Ott PA, Piha-Paul SA, Munster P, Pishvaian MJ, van Brummelen EMJ, Cohen RB, Gomez-Roca C, Ejadi S, Stein M, Chan E, Simonelli M, Morosky A, Saraf S, Emancipator K, Koshiji M, Bennouna J. Safety and antitumor activity of the anti-PD-1 antibody pembrolizumab in patients with recurrent carcinoma of the anal canal. Ann Oncol 2017; 28:1036-1041. [PMID: 28453692 PMCID: PMC5406758 DOI: 10.1093/annonc/mdx029] [Citation(s) in RCA: 171] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background Safety and efficacy of pembrolizumab, a humanized programmed death 1 monoclonal antibody, was assessed in KEYNOTE-028, a multicohort, phase Ib trial for patients with programmed death ligand 1 (PD-L1)-positive advanced solid tumors. We report results for the cohort of patients with advanced anal carcinoma. Patients and methods Patients with PD-L1-positive tumors (≥1%) received intravenous pembrolizumab 10 mg/kg once every 2 weeks for up to 2 years or until confirmed progression or unacceptable toxicity. Response was assessed every 8 weeks for the first 6 months and every 12 weeks thereafter per Response Evaluation Criteria In Solid Tumors, version 1.1. Primary endpoints were safety and overall response rate per investigator review. Secondary endpoints included progression-free survival, overall survival, and response duration. Data cutoff date was 1 July 2015. Results Of the 43 patients with advanced anal carcinoma evaluable for PD-L1 expression, 32 (74%) had PD-L1-positive tumors as assessed with the 22C3 prototype assay, of whom 25 were enrolled between April and September 2014. Sixteen patients (64%) experienced treatment-related adverse events; the most common ones were diarrhea and fatigue in four patients (16%) each and nausea in three patients (12%). There were no treatment-related deaths or discontinuations as of the data cutoff date. Among the 24 patients with squamous cell carcinoma histology, four had confirmed partial response, for an overall response rate of 17% [95% confidence interval (CI), 5%-37%) and 10 (42%) had confirmed stable disease, for a disease control rate of 58%. One additional patient with non-squamous histology had confirmed stable disease. Conclusion In this population of patients with PD-L1-positive advanced squamous cell anal carcinoma, pembrolizumab demonstrated a manageable safety profile and encouraging antitumor activity. These data support further study of pembrolizumab for this patient population. ClinicalTrials.gov NCT02054806.
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MESH Headings
- Aged
- Aged, 80 and over
- Anal Canal/pathology
- Antibodies, Monoclonal, Humanized/adverse effects
- Antibodies, Monoclonal, Humanized/therapeutic use
- Antineoplastic Agents, Immunological/adverse effects
- Antineoplastic Agents, Immunological/therapeutic use
- Anus Neoplasms/drug therapy
- Anus Neoplasms/mortality
- Carcinoma, Squamous Cell/drug therapy
- Carcinoma, Squamous Cell/mortality
- Disease-Free Survival
- Female
- Humans
- Male
- Middle Aged
- Neoplasm Recurrence, Local/drug therapy
- Neoplasm Recurrence, Local/mortality
- Treatment Outcome
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Affiliation(s)
- P. A. Ott
- Center for Immuno-Oncology, Dana-Farber Cancer Institute, Boston
| | - S. A. Piha-Paul
- Department of Investigational Cancer Therapeutics, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston
| | - P. Munster
- Department of Medicine (Hematology/Oncology), Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco
| | - M. J. Pishvaian
- Department of Hematology/Oncology, Georgetown University, Washington DC, USA
| | - E. M. J. van Brummelen
- Department of Molecular Pathology & Clinical Pharmacology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - R. B. Cohen
- Department of Medicine, University of Pennsylvania, Philadelphia, USA
| | - C. Gomez-Roca
- Clinical Research Unit, Institut Claudius Regaud and Institut Universitaire du Cancer—Oncopole, Toulouse, France
| | - S. Ejadi
- Department of Medical Oncology, Virginia G. Piper Cancer Center, Scottsdale
| | - M. Stein
- Department of Medical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick
| | - E. Chan
- Department of Medicine (Hematology/Oncology), Vanderbilt-Ingram Cancer Center, Nashville, USA
| | - M. Simonelli
- Department of Medical Oncology and Hematology, Humanitas Cancer Center, Rozzano, Italy
| | - A. Morosky
- Department of Clinical Oncology, Merck & Co, Inc., Kenilworth, USA
| | - S. Saraf
- Department of Clinical Oncology, Merck & Co, Inc., Kenilworth, USA
| | - K. Emancipator
- Department of Clinical Oncology, Merck & Co, Inc., Kenilworth, USA
| | - M. Koshiji
- Department of Clinical Oncology, Merck & Co, Inc., Kenilworth, USA
| | - J. Bennouna
- Department of Medical Oncology, Institut de Cancérologie de l’Ouest, Nantes, France
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Clerici E, Navarria P, Ascolese A, Pessina F, Tomatis S, Cozzi L, Simonelli M, Santoro A, Franzese C, Bello L, Scorsetti M. EP-1409: Prospective study of hypofractionated radiotherapy for elderly patients with High Grade Glioma. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)31844-3] [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: 10/19/2022]
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Navarria P, Pessina F, Tomatis S, Simonelli M, Santoro A, Ascolese A, Clerici E, Rossi M, Bello L, Scorsetti M. P09.36 A new therapeutic strategy for newly diagnosed glioblastoma patients: hypofractionated stereotactic radiation therapy (HSRT) delivered in 15 fractions respect to standard fractionation in 30 fractions, with concomitant temozolomide chemotherapy - A phase II study. Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox036.292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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41
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Pessina F, Navarria P, Ascolese A, Cozzi L, Tomatis S, Riva M, Simonelli M, Scorsetti M, Bello L. P08.28 Role of surgical resection in recurrent glioblastoma: prognostic factors and outcome evaluation. Neuro Oncol 2016. [DOI: 10.1093/neuonc/now188.161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Navarria P, Pessina F, Ascolese A, Tomatis S, Bello L, Simonelli M, Riva M, Lopci E, Santoro A, Scorsetti M. P08.44 Phase II study of hypofractionated radiation therapy with concomitant and adjuvant temozolomide following surgical resection for patients with newly diagnosed glioblastoma: preliminary evaluation. Neuro Oncol 2016. [DOI: 10.1093/neuonc/now188.177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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43
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Simonelli M, Zucali P, Santoro A, Thomas MB, de Braud FG, Borghaei H, Berlin J, Denlinger CS, Noberasco C, Rimassa L, Kim TY, English PA, Abbattista A, Gallo Stampino C, Carpentieri M, Williams JA. Phase I study of PF-03446962, a fully human monoclonal antibody against activin receptor-like kinase-1, in patients with hepatocellular carcinoma. Ann Oncol 2016; 27:1782-7. [PMID: 27329247 DOI: 10.1093/annonc/mdw240] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 06/09/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND This expansion cohort of a multicenter, dose-escalation, phase I study (NCT00557856) evaluated safety, tolerability, antitumor activity, pharmacokinetics, and pharmacodynamic effects of the anti-activin receptor-like kinase-1 (ALK-1) monoclonal antibody PF-03446962 in advanced hepatocellular carcinoma (HCC). PATIENTS AND METHODS Patients with HCC and disease progression after prior antiangiogenic therapy or intolerance to treatment received PF-03446962 7 mg/kg intravenously biweekly, as recommended in the dose-escalation part of the study. RESULTS Twenty-four patients received PF-03446962. The most frequent treatment-related adverse events (AEs) were thrombocytopenia (33.3%), asthenia (29.2), and chills (16.7%). Two patients experienced treatment-related telangiectasia, suggesting an in vivo knockout of ALK-1 function through ALK-1 pathway inhibition. Overall, treatment-related grade 3-4 AEs were reported in eight patients (33.3%). Treatment-related grade 3-4 thrombocytopenia was noted in four patients. No complete or partial responses were reported. Twelve (50%) patients achieved stable disease, which lasted ≥12 weeks in seven (29.2%) patients. The median time to progression was 3 months. Biomarker analyses showed higher mean tumor expression of c-tumor mesenchymal-epithelial transition factor and higher mean serum levels of bone morphogenetic protein-9 in patients with disease control (DC) for ≥12 weeks versus patients with disease progression. Conversely, lower mean serum transforming growth factor-β and vascular endothelial growth factor receptor-3 levels were detected in patients with DC versus patients with progression. CONCLUSIONS The observed safety, tolerability, pharmacokinetic profile, and clinical activity support further evaluation of PF-03446962 in patients with HCC and other solid malignancies, as single agent or in combination with other antiangiogenic, chemotherapeutic, or immunotherapeutic agents. TRIAL REGISTRATION NUMBER NCT00557856.
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Affiliation(s)
- M Simonelli
- Humanitas Clinical and Research Center, Humanitas Cancer Center, Rozzano, Milano, Italy
| | - P Zucali
- Humanitas Clinical and Research Center, Humanitas Cancer Center, Rozzano, Milano, Italy
| | - A Santoro
- Humanitas Clinical and Research Center, Humanitas Cancer Center, Rozzano, Milano, Italy
| | - M B Thomas
- Division of Hematology/Oncology, Medical University of South Carolina, Charleston, USA
| | - F G de Braud
- Department of Medical Oncology, European Institute of Oncology, Milan, Italy
| | - H Borghaei
- Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia
| | - J Berlin
- Department of Gastrointestinal Oncology, Vanderbilt University, Nashville, USA
| | - C S Denlinger
- Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia
| | - C Noberasco
- Department of Medical Oncology, European Institute of Oncology, Milan, Italy
| | - L Rimassa
- Humanitas Clinical and Research Center, Humanitas Cancer Center, Rozzano, Milano, Italy
| | - T-Y Kim
- Department of Medical Oncology/Hematology, Seoul National Hospital, Seoul, Republic of Korea
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Ceresoli G, Zucali P, Grosso F, Mencoboni M, Sauta M, Soto Parra H, Pasello G, Cortinovis D, Perrino M, Muzio A, Bruzzone A, De Vincenzo F, Degiovanni D, Bonomi M, Simonelli M, Beretta G, Giordano L, Santoro A. Vinorelbine as second or third-line therapy in pemetrexed-pretreated malignant pleural mesothelioma (MPM) patients. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv343.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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45
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Zucali P, Simonelli M, De Vincenzo F, Fatuzzo G, Bertossi M, Perrino M, Miggiano C, Giordano L, Bonifacio C, Mrakic Sposta F, Santoro A. Tivantinib in combination with Carboplatin and Pemetrexed as first line treatment in patients with advanced non-squamous NSCLC or Malignant Pleural Mesothelioma: results of phase I trial. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv343.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Ott P, Piha-Paul S, Munster P, Pishvaian M, Van Brummelen E, Cohen R, Gomez-Roca C, Ejadi S, Stein M, Chan E, Simonelli M, Morosky A, Yuan S, Koshiji M, Bennouna J. 500 Pembrolizumab (MK-3475) for PD-L1-positive squamous cell carcinoma (SCC) of the anal canal: Preliminary safety and efficacy results from KEYNOTE-028. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(15)30008-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
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Simonelli M, Zucali P, Suter M, Rubino L, Santoro A, Carlo-Stella C. 542 Tivantinib in combination with gemcitabine shows strong antitumor activity on mesothelioma cell lines and cytoskeletal effects via inhibition of actin. Eur J Cancer 2014. [DOI: 10.1016/s0959-8049(14)70668-9] [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: 10/24/2022]
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Ceresoli GL, Grosso F, Zucali PA, Mencoboni M, Pasello G, Ripa C, Degiovanni D, Simonelli M, Bruzzone A, Dipietrantonj C, Piccolini E, Beretta GD, Favaretto AG, Giordano L, Santoro A, Botta M. Prognostic factors in elderly patients with malignant pleural mesothelioma: results of a multicenter survey. Br J Cancer 2014; 111:220-6. [PMID: 24918816 PMCID: PMC4102949 DOI: 10.1038/bjc.2014.312] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [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: 01/19/2014] [Revised: 04/29/2014] [Accepted: 05/12/2014] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The incidence of malignant pleural mesothelioma (MPM) in elderly patients is increasing. There are no specific guidelines for their management. METHODS The clinical records of elderly patients (⩾70 years old) with MPM referred from January 2005 to November 2011 to six Italian Centres were reviewed. Age, gender, histology, International Mesothelioma Interest Group (IMIG) stage, Eastern Cooperative Oncology Group Performance Status (ECOG-PS), Charlson Comorbidity Index (CCI) and treatment modalities were analysed and correlated to overall survival (OS). RESULTS In total, 241 patients were identified. Charlson Comorbidity Index was ⩾1 in 92 patients (38%). Treatment was multimodality therapy including surgery in 18, chemotherapy alone in 180 (75%) and best supportive care in 43 cases (18%). Chemotherapy was mainly pemetrexed based. Median OS was 11.4 months. Non-epithelioid histology (HR 2.32; 95% CI 1.66-3.23, P<0.001), age ⩾75 years (HR 1.44; 95% CI 1.08-1.93, P=0.014), advanced (III-IV) stage (HR 1.47; 95% CI 1.09-1.98, P=0.011) and CCI⩾1 (HR 1.38; 95% CI 1.02-1.85, P=0.034) were associated to a shorter OS. Treatment with pemetrexed was associated with improved OS (HR 0.40; 95% CI 0.28-0.56, P<0.001). CONCLUSIONS Non-epithelioid histology, age ⩾75 years, advanced IMIG stage and presence of comorbidities according to CCI were significant prognostic factors in elderly patients with MPM. Treatment with pemetrexed-based chemotherapy was feasible in this setting. Prospective dedicated trials in MPM elderly patients selected according to prognostic factors including comorbidity scales are warranted.
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Affiliation(s)
- G L Ceresoli
- Oncology, Cliniche Humanitas Gavazzeni, Bergamo, Italy
| | - F Grosso
- Oncology, Ospedale SS Antonio e Biagio, Alessandria, Italy
| | - P A Zucali
- Oncology, Humanitas Cancer Center, Rozzano (Milan), Italy
| | - M Mencoboni
- Oncology, Ospedale Villa Scassi, Sampierdarena, Genova, Italy
| | - G Pasello
- Oncology, Istituto Oncologico Veneto, Padova, Italy
| | - C Ripa
- Oncology, Cliniche Humanitas Gavazzeni, Bergamo, Italy
| | - D Degiovanni
- Palliative Care Unit, Ospedale S. Spirito, Casale Monferrato, Italy
| | - M Simonelli
- Oncology, Humanitas Cancer Center, Rozzano (Milan), Italy
| | - A Bruzzone
- Oncology, Ospedale Villa Scassi, Sampierdarena, Genova, Italy
| | | | - E Piccolini
- Pneumology, Ospedale S. Spirito, Casale Monferrato, Italy
| | - G D Beretta
- Oncology, Cliniche Humanitas Gavazzeni, Bergamo, Italy
| | | | - L Giordano
- Biostatistic Unit, Humanitas Cancer Center, Rozzano (Milan), Italy
| | - A Santoro
- Oncology, Humanitas Cancer Center, Rozzano (Milan), Italy
| | - M Botta
- Oncology, Ospedale S. Spirito, Casale Monferrato, Italy
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Zucali PA, Perrino M, Lorenzi E, Ceresoli GL, De Vincenzo F, Simonelli M, Gianoncelli L, De Sanctis R, Giordano L, Santoro A. Vinorelbine in pemetrexed-pretreated patients with malignant pleural mesothelioma. Lung Cancer 2013; 84:265-70. [PMID: 24321581 DOI: 10.1016/j.lungcan.2013.11.011] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [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: 04/28/2013] [Revised: 11/02/2013] [Accepted: 11/11/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND Pemetrexed-platinum chemotherapy is the standard first-line treatment of unresectable malignant pleural mesothelioma (MPM). At progression, patients are generally selected to experimental trials, when available, or, in every-day clinical practice, they are offered second-line chemotherapy. The optimal treatment has not yet been defined. The aim of this retrospective, single-center study was to evaluate the activity and toxicity of vinorelbine administered to a consecutive series of pemetrexed-pretreated MPM patients. METHODS Vinorelbine 25 mg/m(2) was administered intravenously as a single agent on days 1, 8 every three weeks, either as second-line (2L) or further-line (>2L) therapy. Treatment was repeated for a maximum of 6 cycles, until progression, or unacceptable toxicity. RESULTS Fifty-nine patients were included in this analysis. Vinorelbine was given to 34 patients as 2L, and to 25 as > 2L treatment. The median age was 69 years (range 45-80). Forty-two patients (71.2%) had a good EORTC prognostic score. Partial response was observed in 9 (15.2%) cases, stable disease in 20 (33.9%). The overall disease control rate (DCR) was 49.1%. Median progression-free survival (PFS) and overall survival (OS) were 2.3 and 6.2 months, respectively. ECOG performance status (PS) (HR(0 vs. 1-2) 0.50; 95%CI: 0.3-0.8; p = 0.014) and PFS ≥ 6 months following first-line (FL) chemotherapy (HR(FL-PFS>6 ms vs. <6 ms) 0.50; 95%CI: 0.3-0.9; p = 0.031) were significantly associated to OS in multivariate analysis. No difference was observed in terms of DCR, PFS, and OS in relation to age, histology, sex, line of vinorelbine therapy, or response to FL treatment. Hematological toxicity was acceptable, with grade 3/4 neutropenia occurring in 5 (8.4%) patients, and there were no cases of febrile neutropenia. The main non-hematological toxicities were grade 2 fatigue in 17 (28.8%) and constipation in 7 (11.8%) patients. CONCLUSIONS Vinorelbine was moderately active in pemetrexed-pretreated MPM patients, with an acceptable toxicity profile, particularly in patients with ECOG-PS0 and FL-PFS ≥ 6 months.
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Affiliation(s)
- P A Zucali
- Department of Medical Oncology and Hematology, Humanitas Clinical and Research Center, Rozzano, Milan, Italy.
| | - M Perrino
- Department of Medical Oncology and Hematology, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - E Lorenzi
- Department of Medical Oncology and Hematology, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - G L Ceresoli
- Department of Medical Oncology and Hematology, Istituto Humanitas Gavazzeni, Bergamo, Italy
| | - F De Vincenzo
- Department of Medical Oncology and Hematology, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - M Simonelli
- Department of Medical Oncology and Hematology, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - L Gianoncelli
- Department of Medical Oncology and Hematology, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - R De Sanctis
- Department of Medical Oncology and Hematology, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - L Giordano
- Biostatistic Unit, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - A Santoro
- Department of Medical Oncology and Hematology, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
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Santoro A, Simonelli M, Rodriguez-Lope C, Zucali P, Camacho LH, Granito A, Senzer N, Rimassa L, Abbadessa G, Schwartz B, Lamar M, Savage RE, Bruix J. A Phase-1b study of tivantinib (ARQ 197) in adult patients with hepatocellular carcinoma and cirrhosis. Br J Cancer 2013; 108:21-4. [PMID: 23287988 PMCID: PMC3553536 DOI: 10.1038/bjc.2012.556] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [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] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The mesenchymal-epithelial transition factor (MET) receptor is dysregulated in hepatocellular carcinoma (HCC), and tivantinib (ARQ 197) is an oral, selective, MET inhibitor. METHODS This Phase-1b study assessed tivantinib safety as primary objective in patients with previously treated HCC and Child-Pugh A or B liver cirrhosis. Patients received oral tivantinib 360 mg twice daily until disease progression or unacceptable toxicity. RESULTS Among 21 HCC patients, common drug-related adverse events (AEs) were neutropaenia, anaemia, asthenia, leucopaenia, anorexia, diarrhoea, and fatigue. No drug-related worsening of liver function or performance status occurred, but one Child-Pugh B patient experienced drug-related bilirubin increase. Four patients had drug-related serious AEs, including one neutropaenia-related death. Haematologic toxicities were more frequent than in previous tivantinib studies but were manageable with prompt therapy. Best response was stable disease (median, 5.3 months) in 9 of 16 evaluable patients (56%). Median time to progression was 3.3 months. CONCLUSION Tivantinib demonstrated a manageable safety profile and preliminary antitumour activity in patients with HCC and Child-Pugh A or B cirrhosis.
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Affiliation(s)
- A Santoro
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, Istituto Clinico Humanitas IRCCS, Via Manzoni 56, 20089 Rozzano (Milan), Italy
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