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Leone AG, Miceli R, Trapani D, Massagrande M, Morano F, Marsoni S, La Verde N, Berardi R, Casolino R, Lambertini M, Dalu D, Di Maio M, Beretta GD, Perrone F, Cinieri S, Pietrantonio F. Cancer care in transgender and gender-diverse persons: results from two national surveys among providers and health service users by the Italian Association of Medical Oncology. ESMO Open 2023; 8:101578. [PMID: 37270870 DOI: 10.1016/j.esmoop.2023.101578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 04/23/2023] [Accepted: 04/29/2023] [Indexed: 06/06/2023] Open
Abstract
BACKGROUND Transgender and gender-diverse (TGD) population represents an underserved group across the cancer care continuum. To assess the perspective of both oncology health care providers (OHPs) and TGD individuals in Italy, we conducted two national surveys: one among 2407 OHPs about their attitudes, knowledge and behavior toward TGD patients, and one among TGD persons about their health needs, experiences and barriers encountered in the use of health services across the cancer continuum. MATERIALS AND METHODS The surveys were self-compiled web-based computer-aided web interview, conducted in Italy within the 'OncoGender-Promoting Inclusion in Oncology' project, led by the Italian national cancer society [Associazione Italiana di Oncologia Medica (AIOM)]-associated researchers. All members of AIOM were invited by e-mail to participate in the OHP survey. TGD persons were reached through advocacy groups and consumers' panel. The recruitment was completed on a voluntary basis. Survey data were collected and managed using an online platform managed by ELMA Research, an independent pharmaceutical marketing agency. RESULTS A total of 305 OHPs (13% of AIOM members) and 190 TGD individuals participated in the surveys. Only 19% of OHPs felt competent in providing care to TGD patients and 21% declared not to feel comfortable in treating TGD patients. Seventy-one percent of TGD persons reported that they had never joined any cancer screening program; 32% reported one or more acts of discrimination by health care providers. Seventy-two percent of OHPs recognized the lack of specific education on cancer care for TGD patients and deemed it necessary to receive adequate training. CONCLUSIONS A general lack of knowledge among OHPs about TGD health issues seems to be the main driver of difficulties in providing assistance and of discriminatory attitudes against TGD individuals. Ultimately, this whole issue generates access barriers and contributes to lack of trust in health care services. Educational interventions and an implementation of person-centric cancer policies are urgently needed.
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Affiliation(s)
- A G Leone
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - R Miceli
- Department of Biostatistics for Clinical Research, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - D Trapani
- European Institute of Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy; Department of Oncology and Hematology (DIPO), University of Milan, Milan, Italy
| | | | - F Morano
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - S Marsoni
- IFOM-The FIRC Institute of Molecular Oncology, Milan, Italy
| | - N La Verde
- Department of Oncology, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, Milan, Italy
| | - R Berardi
- Oncology Clinic, Università Politecnica delle Marche, AOU delle Marche, Ancona, Italy
| | - R Casolino
- Wolfson Wohl Cancer Research Centre, Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - M Lambertini
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy; Department of Medical Oncology, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - D Dalu
- Department of Oncology, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, Milan, Italy
| | - M Di Maio
- Department of Oncology, University of Turin, A.O. Ordine Mauriziano, Turin, Italy
| | - G D Beretta
- UOC Oncologia Medica, ASL Pescara P.O., Pescara, Italy
| | - F Perrone
- Clinical Trial Unit, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italy
| | - S Cinieri
- Medical Oncology Unit, Ospedale di Summa A. Perrino, Brindisi, Italy
| | - F Pietrantonio
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
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Cantini L, Mentrasti G, Lo Russo G, Signorelli D, Pasello G, Rijavec E, Russano M, Antonuzzo L, Rocco D, Giusti R, Adamo V, Genova C, Tuzi A, Morabito A, Gori S, La Verde N, Chiari R, Cortellini A, Cognigni V, Pecci F, Indini A, De Toma A, Zattarin E, Oresti S, Pizzutilo E, Frega S, Erbetta E, Galletti A, Citarella F, Fancelli S, Caliman E, Della Gravara L, Malapelle U, Filetti M, Piras M, Toscano G, Zullo L, De Tursi M, Di Marino P, D’Emilio V, Cona M, Guida A, Caglio A, Salerno F, Spinelli G, Bennati C, Morgillo F, Russo A, Dellepiane C, Vallini I, Sforza V, Inno A, Rastelli F, Tassi V, Nicolardi L, Pensieri M, Emili R, Roca E, Migliore A, Galassi T, Rocchi M, Berardi R. Erratum to ‘Evaluation of COVID-19 impact on DELAYing diagnostic-therapeutic pathways of lung cancer patients in Italy (COVID-DELAY study): fewer cases and higher stages from a real-world scenario’. ESMO Open 2022; 7:100471. [PMID: 35378403 PMCID: PMC8973259 DOI: 10.1016/j.esmoop.2022.100471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Cantini L, Mentrasti G, Russo GL, Signorelli D, Pasello G, Rijavec E, Russano M, Antonuzzo L, Rocco D, Giusti R, Adamo V, Genova C, Tuzi A, Morabito A, Gori S, Verde NL, Chiari R, Cortellini A, Cognigni V, Pecci F, Indini A, De Toma A, Zattarin E, Oresti S, Pizzutilo EG, Frega S, Erbetta E, Galletti A, Citarella F, Fancelli S, Caliman E, Della Gravara L, Malapelle U, Filetti M, Piras M, Toscano G, Zullo L, De Tursi M, Di Marino P, D'Emilio V, Cona MS, Guida A, Caglio A, Salerno F, Spinelli G, Bennati C, Morgillo F, Russo A, Dellepiane C, Vallini I, Sforza V, Inno A, Rastelli F, Tassi V, Nicolardi L, Pensieri V, Emili R, Roca E, Migliore A, Galassi T, Rocchi MLB, Berardi R. Evaluation of COVID-19 impact on DELAYing diagnostic-therapeutic pathways of lung cancer patients in Italy (COVID-DELAY study): fewer cases and higher stages from a real-world scenario. ESMO Open 2022; 7:100406. [PMID: 35219245 PMCID: PMC8810307 DOI: 10.1016/j.esmoop.2022.100406] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 01/19/2022] [Accepted: 01/23/2022] [Indexed: 12/18/2022] Open
Abstract
Introduction COVID-19 has disrupted the global health care system since March 2020. Lung cancer (LC) patients (pts) represent a vulnerable population highly affected by the pandemic. This multicenter Italian study aimed to evaluate whether the COVID-19 outbreak had an impact on access to cancer diagnosis and treatment of LC pts compared with pre-pandemic time. Methods Consecutive newly diagnosed LC pts referred to 25 Italian Oncology Departments between March and December 2020 were included. Access rate and temporal intervals between date of symptoms onset and diagnostic and therapeutic services were compared with the same period in 2019. Differences between the 2 years were analyzed using the chi-square test for categorical variables and the Mann–Whitney U test for continuous variables. Results A slight reduction (−6.9%) in newly diagnosed LC cases was observed in 2020 compared with 2019 (1523 versus 1637, P = 0.09). Newly diagnosed LC pts in 2020 were more likely to be diagnosed with stage IV disease (P < 0.01) and to be current smokers (someone who has smoked more than 100 cigarettes, including hand-rolled cigarettes, cigars, cigarillos, in their lifetime and has smoked in the last 28 days) (P < 0.01). The drop in terms of new diagnoses was greater in the lockdown period (percentage drop −12% versus −3.2%) compared with the other months included. More LC pts were referred to a low/medium volume hospital in 2020 compared with 2019 (P = 0.01). No differences emerged in terms of interval between symptoms onset and radiological diagnosis (P = 0.94), symptoms onset and cytohistological diagnosis (P = 0.92), symptoms onset and treatment start (P = 0.40), and treatment start and first radiological revaluation (P = 0.36). Conclusions Our study pointed out a reduction of new diagnoses with a shift towards higher stage at diagnosis for LC pts in 2020. Despite this, the measures adopted by Italian Oncology Departments ensured the maintenance of the diagnostic-therapeutic pathways of LC pts. The COVID-19 outbreak had an impact on access to lung cancer (LC) diagnosis and treatment. A slight reduction (−6.9%) in newly diagnosed LC cases was observed in 2020 compared with 2019. Newly diagnosed LC pts in 2020 were more likely to be diagnosed with stage IV disease. The Italian Oncology Departments ensured the maintenance of the diagnostic-therapeutic pathways of LC pts. A reverse migration from high-volume to low-volume cancer centers was noted during the pandemic.
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Affiliation(s)
- L Cantini
- Department of Medical Oncology, Università Politecnica delle Marche, AOU Ospedali Riuniti di Ancona, Ancona, Italy. https://twitter.com/LucaCantiniMD
| | - G Mentrasti
- Department of Medical Oncology, Università Politecnica delle Marche, AOU Ospedali Riuniti di Ancona, Ancona, Italy
| | - G L Russo
- Oncologia Medica 1, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - D Signorelli
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - G Pasello
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padua, Italy; Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padua, Italy
| | - E Rijavec
- Medical Oncology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - M Russano
- Department of Medical Oncology, Campus Bio-Medico University, Rome, Italy
| | - L Antonuzzo
- Medical Oncology Unit, Careggi University Hospital, Florence, Italy
| | - D Rocco
- Department of Pulmonology and Oncology, AORN dei Colli Monaldi, Naples, Italy
| | - R Giusti
- UOC Oncologia Medica, Azienda Ospedaliero Universitaria Sant'Andrea, Università La Sapienza, Rome, Italy
| | - V Adamo
- Oncologia Medica, A.O.Papardo & Università di Messina, Messina, Italy
| | - C Genova
- UOC Clinica di Oncologia Medica, IRCCS Ospedale San Martino, Department of Internal Medicine and Medical Specialties (DIMI), Università degli Studi di Genova, Genoa, Italy
| | - A Tuzi
- Oncologia Medica, ASST Sette Laghi, Varese, Italy
| | - A Morabito
- Thoracic Medical Oncology, Istituto Nazionale Tumori "Fondazione G Pascale", IRCCS, Naples, Italy
| | - S Gori
- UOC Oncologia Medica, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar di Valpolicella, Verona, Italy
| | - N La Verde
- Department of Oncology, Ospedale Luigi Sacco, ASST Fatebenefratelli Sacco, Milan, Italy
| | - R Chiari
- Medical Oncology, Ospedali Riuniti Padova Sud, Monselice, Italy
| | - A Cortellini
- Medical Oncology, St Salvatore Hospital, L'Aquila, Italy
| | - V Cognigni
- Department of Medical Oncology, Università Politecnica delle Marche, AOU Ospedali Riuniti di Ancona, Ancona, Italy
| | - F Pecci
- Department of Medical Oncology, Università Politecnica delle Marche, AOU Ospedali Riuniti di Ancona, Ancona, Italy
| | - A Indini
- Medical Oncology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - A De Toma
- Oncologia Medica 1, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - E Zattarin
- Oncologia Medica 1, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - S Oresti
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milan, Italy; Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milan, Italy
| | - E G Pizzutilo
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milan, Italy; Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milan, Italy
| | - S Frega
- Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padua, Italy
| | - E Erbetta
- Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padua, Italy
| | - A Galletti
- Department of Medical Oncology, Campus Bio-Medico University, Rome, Italy
| | - F Citarella
- Department of Medical Oncology, Campus Bio-Medico University, Rome, Italy
| | - S Fancelli
- Medical Oncology Unit, Careggi University Hospital, Florence, Italy
| | - E Caliman
- Medical Oncology Unit, Careggi University Hospital, Florence, Italy
| | - L Della Gravara
- Dipartment of Experimental Medicine, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - U Malapelle
- Department of Public Health, Università degli Studi di Napoli "Federico II", Naples, Italy
| | - M Filetti
- UOC Oncologia Medica, Azienda Ospedaliero Universitaria Sant'Andrea, Università La Sapienza, Rome, Italy
| | - M Piras
- UOC Oncologia Medica, Azienda Ospedaliero Universitaria Sant'Andrea, Università La Sapienza, Rome, Italy
| | - G Toscano
- Oncologia Medica, A.O.Papardo, Messina, Italy
| | - L Zullo
- UOC Oncologia Medica 2, IRCCS Ospedale San Martino, Genoa, Italy
| | - M De Tursi
- Department of Innovative Technologies in Medicine & Dentistry, Università G. D'Annunzio, Chieti-Pescara, Chieti, Italy
| | - P Di Marino
- Department of Innovative Technologies in Medicine & Dentistry, Università G. D'Annunzio, Chieti-Pescara, Chieti, Italy
| | - V D'Emilio
- UOC Pneumologia, Ospedale Mazzoni, Ascoli Piceno, Italy
| | - M S Cona
- Department of Oncology, Ospedale Luigi Sacco, ASST Fatebenefratelli Sacco, Milan, Italy
| | - A Guida
- Oncologia Medica e Traslazionale, AO Santa Maria, Terni, Italy
| | - A Caglio
- Department of Oncology, University of Turin, Ordine Mauriziano Hospital, Turin, Italy
| | - F Salerno
- Department of Oncology, University of Turin, Ordine Mauriziano Hospital, Turin, Italy
| | - G Spinelli
- UOC Territorial Oncology, University "Sapienza", AUSL Latina, Cds Aprilia, Aprilia, Italy
| | - C Bennati
- Department of Onco-Hematology, AUSL della Romagna, Ravenna, Italy
| | - F Morgillo
- UOC Oncologia ed Ematologia, Department of Precision Medicine, Università degli studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - A Russo
- Oncologia Medica, A.O.Papardo, Messina, Italy
| | - C Dellepiane
- UOC Oncologia Medica 2, IRCCS Ospedale San Martino, Genoa, Italy
| | - I Vallini
- Oncologia Medica, ASST Sette Laghi, Varese, Italy
| | - V Sforza
- Thoracic Medical Oncology, Istituto Nazionale Tumori "Fondazione G Pascale", IRCCS, Naples, Italy
| | - A Inno
- UOC Oncologia Medica, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar di Valpolicella, Verona, Italy
| | - F Rastelli
- UOC Oncologia, Ospedale Mazzoni, Ascoli Piceno, Italy
| | - V Tassi
- Chirurgia Toracica, AO Santa Maria, Terni, Italy
| | - L Nicolardi
- Medical Oncology, Ospedali Riuniti Padova Sud, Monselice, Italy
| | - V Pensieri
- Medical Oncology, St Salvatore Hospital, L'Aquila, Italy
| | - R Emili
- Operative Oncology Unit, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro, Italy
| | - E Roca
- Thoracic Oncology - Lung Unit, Pederzoli Hospital, Peschiera Del Garda, Italy
| | - A Migliore
- Department of Medical Oncology, Università Politecnica delle Marche, AOU Ospedali Riuniti di Ancona, Ancona, Italy
| | - T Galassi
- Department of Medical Oncology, Università Politecnica delle Marche, AOU Ospedali Riuniti di Ancona, Ancona, Italy
| | - M L Bruno Rocchi
- Biomolecular Sciences Department, University of Urbino, Urbino, Italy
| | - R Berardi
- Department of Medical Oncology, Università Politecnica delle Marche, AOU Ospedali Riuniti di Ancona, Ancona, Italy.
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Cagnazzo C, Nanni O, Di Costanzo A, Cenna R, Marchetti F, La Verde N, Frazzetto A. 1856P Electronic informed consent: The need to redesign the consent process for the digital era. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.743] [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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Berardi R, Mentrasti G, Crocetti S, La Verde N, Chiari R, Cona M, Nicolardi L, De Filippis C, Oldani S, Pecci F, Venanzi F, Rocchi M, Savini A, Cantini L, Pistelli M. 1609P COVID-19 outbreak repercussions on breast cancer diagnoses and access to treatment: Preliminary data from the COVID-DELAY study. Ann Oncol 2021. [PMCID: PMC8454380 DOI: 10.1016/j.annonc.2021.08.1602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Cantini L, Mentrasti G, La Verde N, Cona M, Chiari R, Martinelli E, Morgillo F, Nicolardi L, Cortellini A, Pensieri V, Cognigni V, Pinterpe G, Galassi T, Pecci F, Mazzanti P, Di Pietro Paolo M, Giampieri R, Berardi R. 35P Lung cancer diagnosis and continuum of care: How did the COVID-19 outbreak impact? Data from an Italian multicenter study. J Thorac Oncol 2021. [PMCID: PMC8970659 DOI: 10.1016/s1556-0864(21)01877-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Silvestris N, Di Maio M, Russo A, Chiari R, De Giorgi U, Del Mastro L, Giuffrida D, La Verde N, Perrone F, Tucci M, Beretta GD, Cinieri S. COVID-19 infection in cancer patients: what has been the contribution of Associazione Italiana Oncologia Medica (AIOM) to oncological care since the beginning of the first pandemic wave? ESMO Open 2021; 6:100100. [PMID: 33819751 PMCID: PMC7973080 DOI: 10.1016/j.esmoop.2021.100100] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 02/25/2021] [Accepted: 03/01/2021] [Indexed: 11/30/2022] Open
Abstract
High mortality rates in elderly patients or in those with underlying chronic illnesses and/or a compromised immune system is a peculiar feature of COVID-19 infection. The possible coexistence of a cancer and COVID-19 infection in the same individual prompted concerns regarding their synergistic effect on prognosis. In order to balance patients’ needs with the risks related to the infection, the question oncologists have asked from the beginning of the first wave of the pandemic has been: ‘how can we deal with COVID-19 infection in cancer patients?’ In pursuing its mission, the Associazione Italiana Oncologia Medica (AIOM) has made every possible effort to support cancer patients, health care professionals and institutions in the decision-making processes the pandemic has engendered within this scenario. The relevant documents as well as the educational and institutional initiatives the AIOM has taken are reported in this article. AIOM made all efforts to support cancer patients, health care professionals and institutions during the COVID-19 pandemic. ConFederazione degli Oncologi, Cardiologi e Ematologi is the first technical round table in the world bringing together oncologists, cardiologists and hematologists. In November 2020, AIOM, COMU and CIPOMO updated specific COVID-19 recommendations for medical oncology. AIOM has recommended that authorities include cancer patients receiving therapy in the high priority group for vaccination.
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Affiliation(s)
- N Silvestris
- IRCCS Istituto Tumori 'Giovanni Paolo II' of Bari, Bari, Italy; DIMO Università degli Studi di Bari, Bari, Italy
| | - M Di Maio
- Department of Oncology, University of Turin, at Ordine Mauriziano Hospital, Turin, Italy
| | - A Russo
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - R Chiari
- UOC Oncologia Padova Sud, Azienda ULSS 6 Euganea, Padua, Italy
| | - U De Giorgi
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori 'Dino Amadori' (IRST) IRCCS, Meldola, Italy
| | - L Del Mastro
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genoa, Italy
| | - D Giuffrida
- Department of Experimental Oncology, Istituto Oncologico del Mediterraneo, Viagrande, Italy
| | - N La Verde
- Department of Oncology, PO Sacco, ASST Fatebenefratelli Sacco, Milan, Italy
| | - F Perrone
- Clinical Trials Unit, Istituto Nazionale Tumori 'Fondazione G. Pascale', IRCCS, Naples, Italy
| | - M Tucci
- Medical Oncology, Cardinal Massaia Hospital, Asti, Italy
| | - G D Beretta
- Medical Oncology Department, Humanitas Gavazzeni, Bergamo, Italy
| | - S Cinieri
- Medical Oncology Unit, Antonio Perrino Hospital, Brindisi, Italy.
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Berardi R, Torniai M, Cona MS, Cecere FL, Chiari R, Guarneri V, La Verde N, Locati L, Lorusso D, Martinelli E, Giannarelli D, Garassino MC. Social distress among medical oncologists and other healthcare professionals during the first wave of COVID-19 pandemic in Italy. ESMO Open 2021; 6:100053. [PMID: 33601297 PMCID: PMC7900700 DOI: 10.1016/j.esmoop.2021.100053] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 01/03/2021] [Indexed: 11/30/2022] Open
Abstract
Background Coronavirus disease 2019 (COVID-19) has rapidly spread to every country around the world taking on pandemic proportions. Since 8 March 2020, the Italian government ordered a nationwide lockdown with unavoidable social isolation. Healthcare professionals (HCPs) represent the most physically and emotionally involved category. The aim of this study is to assess the social distress among HCPs in Italy. Patients and methods In this online, totally anonymous survey, 24 multiple choice questions were posed to medical staff employed in the Italian Healthcare System during the COVID-19 pandemic. Data collection was performed from 30 March to 24 April 2020. Results A total of 600 HCPs completed the questionnaire. The majority of respondents expressed the fear of being at higher risk of contagion than the general population (83.3%) and the weighty concern of infecting their families (72.5%). An insufficient supply of personal protective equipment (PPE; P = 0.0003) and inadequate training about procedures to follow (P = 0.0092) were seen to significantly coincide with these worries. More than two-thirds declared a change in family organisation, which showed a significant correlation with the concern of infecting their relatives (P < 0.0001). Conclusions This is the first Italian survey on social distress among HCPs during the COVID-19 pandemic. The unavailability of PPE, screening procedures and adequate training strongly affected HCPs' emotional status. Although there was a predominance of oncologists (especially from the North of Italy), which impairs the generalisation of our findings, this survey underlined the social impact that this health emergency has had on HCPs. This is the first Italian survey on healthcare professionals’ (HCPs) social distress during the coronavirus disease 2019 (COVID-19) pandemic. The majority expressed the fear of being at high risk of contagion and the weighty concern of infecting their families. Insufficient supply of personal protective equipment and inadequate training about procedures correlate with these worries. Reducing workers’ psychological distress will certainly yield significant positive benefits for HCPs and health system.
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Affiliation(s)
- R Berardi
- Clinica Oncologica, Università Politecnica Marche - Ospedali Riuniti, Ancona, Italy.
| | - M Torniai
- Clinica Oncologica, Università Politecnica Marche - Ospedali Riuniti, Ancona, Italy
| | - M S Cona
- Department of Oncology, Ospedale Luigi Sacco - ASST Fatebenefratelli Sacco, Milan, Italy
| | - F L Cecere
- IRCCS Regina Elena, National Cancer Institute, Rome, Italy
| | - R Chiari
- UOC Oncologia Padova Sud-AULSS 6 Euganea, Padova, Italy
| | - V Guarneri
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy; Medical Oncology 2, Istituto Oncologico Veneto IOV IRCCS, Padova, Italy
| | - N La Verde
- Department of Oncology, Ospedale Luigi Sacco - ASST Fatebenefratelli Sacco, Milan, Italy
| | - L Locati
- Head and Neck Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - D Lorusso
- Gynecologic Oncology Unit and Scientific Directorate, Fondazione Policlinico Universitario Gemelli IRCCS, Catholic University of Sacred Heart, Rome, Italy
| | - E Martinelli
- Oncologia Medica, Dipartimento di Medicina di Precisione, Università degli Studi della Campania 'L. Vanvitelli', Napoli, Italy
| | - D Giannarelli
- Biostatistical Unit, Regina Elena National Cancer Institute, IRCCS, Rome, Italy
| | - M C Garassino
- Thoracic Oncology Unit, Medical Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
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Moretti A, Bianchi F, Abbate IV, Gherardi G, Bonavita M, Passoni E, Nazzaro G, Bramati A, Dazzani MC, Piva S, Paternò E, Frungillo N, Farina G, La Verde N. Localized morphea after breast implant for breast cancer: A case report. Tumori 2018; 104:NP25-NP28. [PMID: 29714655 DOI: 10.1177/0300891618763209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE Early breast cancer follow-up guidelines for patients who underwent surgery suggest a regular and accurate clinical examination of the breast area, for an early identification of cutaneous or subcutaneous breast cancer relapse. Nonetheless, breast skin lesions arising in patients treated with mastectomy for breast cancer can be caused by several diseases. A series of diagnostic hypotheses should be considered, not only focusing on cutaneous metastasis, but also on dermatologic and systemic diseases. CASE REPORT In February 2015, a 37-year-old patient underwent a right subcutaneous mastectomy for stage IIA breast cancer. Five months after beginning adjuvant chemotherapy, she noted hyperpigmentation and thickening of the skin on the right breast. Differential diagnosis included local relapse, skin infection, lymphoma, or primary cutaneous disease, and a skin biopsy was performed. The histopathologic specimen showed full-thickness sclerosis, with features of localized morphea. Therapy with clobetasol was prescribed, with progressive resolution of the thickness. The collaboration between many professionals in a multidisciplinary team (oncologist, dermatologist, plastic surgeon, and pathologist) was crucial to achieving the diagnosis. CONCLUSION In the literature, some articles describe correlation between connective tissue diseases and silicone breast implants, but the pathogenetic mechanisms are unknown. We report a rare case of breast morphea after positioning a silicone implant in a patient who had undergone mastectomy. This clinical report represents an interesting model of multidisciplinary management of a patient with breast cancer who developed an uncommon dermatologic disease. Further studies are needed to clarify the association between silicone implants and breast morphea.
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Affiliation(s)
- A Moretti
- 1 Department of Oncology Fatebenefratelli, ASST Fatebenefratelli Sacco, Milan, Italy
| | - F Bianchi
- 2 Department of Pathology, ASST Fatebenefratelli & Sacco, Milan, Italy
| | - I V Abbate
- 3 Department of Dermatology, Umberto I Hospital Lugo, (Ravenna), Italy
| | - G Gherardi
- 2 Department of Pathology, ASST Fatebenefratelli & Sacco, Milan, Italy
| | - M Bonavita
- 4 Department of Plastic Surgery, Fatebenefratelli, ASST Fatebenefratelli & Sacco, Milan, Italy
| | - E Passoni
- 5 Department of Dermatology, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - G Nazzaro
- 6 Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Italy
| | - A Bramati
- 1 Department of Oncology Fatebenefratelli, ASST Fatebenefratelli Sacco, Milan, Italy
| | - M C Dazzani
- 1 Department of Oncology Fatebenefratelli, ASST Fatebenefratelli Sacco, Milan, Italy
| | - S Piva
- 1 Department of Oncology Fatebenefratelli, ASST Fatebenefratelli Sacco, Milan, Italy
| | - E Paternò
- 1 Department of Oncology Fatebenefratelli, ASST Fatebenefratelli Sacco, Milan, Italy
| | - N Frungillo
- 1 Department of Oncology Fatebenefratelli, ASST Fatebenefratelli Sacco, Milan, Italy
| | - G Farina
- 1 Department of Oncology Fatebenefratelli, ASST Fatebenefratelli Sacco, Milan, Italy
| | - N La Verde
- 1 Department of Oncology Fatebenefratelli, ASST Fatebenefratelli Sacco, Milan, Italy
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La Verde N, Collovà E, Blasi L, Pinotti G, Bernardo A, Bonotto M, Garrone O, Brunello A, Cavazzini MG, Bareggi C, Prochilo T, Porcu L, Moretti A, Barni S. Abstract P1-14-04: Overall survival in metastatic breast cancer patients in the third millennium: Results of an Italian study. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p1-14-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
BACKGROUND - Metastatic breast cancer (MBC) is a life-threatening disease. It is important to provide data about real-life MBC patients (pts) to understand the current prognostic factors. The aim of the present observational study, named COSMO (Checking Overall Survival in a MBC Observational study) is to describe the overall survival (OS) in a large cohort of MBC pts, assessing its correlation with specific prognostic factors (demographic, clinic, pathologic and biological).
PATIENTS AND METHODS - The COSMO study is a multicenter, retrospective, cohort study, developed throughout the collaboration of 31 Italian oncological centers. Data about pts diagnosed as metastatic from 01/01/2000 to 31/12/2008, were collected. The association between molecular subtypes, metastatic sites, disease free interval (DFI) and OS were assessed. Pts were classified in three subgroups, based on the biological characteristics of their tumor: luminal, HER2-positive (regardless of hormone receptor) and triple negative (TN). Metastatic sites were categorized as visceral versus non-visceral disease, only bone and central nervous system (CNS) metastases. DFI was calculated from diagnosis to first relapse only for M0 pts.
RESULTS - Of 3931 MBC pts enrolled in the study, 3720 were evaluable, with a median age of 61 years (interquartile range, IQR, 51-71). 1804 (62,1%) pts had a luminal disease, 691 (23,8%) HER2-positive, 410 (14.1%) TN. Median DFI was 3.2 years (IQR 1.7- 6.0). Regarding metastatic sites, pts with visceral disease were 2332 (63%); 826 (22,2%) pts had bone isolated metastases; in 306 (8,3%) pts, CNS metastases were reported. With a median follow up of 9 years (IQR 5.7-11.0) and 3098 (83.3%) recorded events, we founded a median OS of 2.8 years (95%CI: 2.7-2.9) years. OS was strictly depending from molecular subtypes with a better prognosis for HER2-positive versus luminal and TN MBC pts, median OS of 3.1 (95%CI 2.8-3.4), 3.0 (95%CI: 2.9-3.1) and 1.5 (95%CI: 1.3-1.7) years respectively (p-value<0.001). 525 (14,1%) pts received trastuzumab. Metastatic sites affect prognosis, with a better OS for bone disease (3.4 years, 95%CI: 3.1-3.6) versus visceral disease (2.2 years 95%CI: 2.0- 2.3). Brain metastasis correlate with the worst prognosis: OS of 1.5 years (95% CI: 0.8 – 1.7). Even DFI shows a correlation with prognosis: pts with DFI>2 years show a median OS of 3 years (95% CI: 2.9 – 3.2), while those with DFI<2 years have a median OS of 2.4 years (95% CI: 2.3-2.6); HR was 0.69 (95%CI: 0,62-0,76) for every five years of increase in DFI (p-value<0.001).
CONCLUSIONS - Molecular subtype is crucial for prognosis: HER2-positive subtype has the best prognosis, while TN subtype has the shorter OS. Having a longer DFI from diagnosis (>2 years) correlate with a better prognosis. Our study confirm that sites of metastasis affects outcome: visceral involvement correlates with poor prognosis and, particularly, pts with brain metastasis represent the worst subgroup, while pts with solely bone disease have the best prognosis. The COSMO study provides a view on the Italian landscape of MBC between 2000 and 2008, adding new insights about pts prognosis.
Citation Format: La Verde N, Collovà E, Blasi L, Pinotti G, Bernardo A, Bonotto M, Garrone O, Brunello A, Cavazzini MG, Bareggi C, Prochilo T, Porcu L, Moretti A, Barni S, On Behalf of COSMO Study Group. Overall survival in metastatic breast cancer patients in the third millennium: Results of an Italian study [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P1-14-04.
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Affiliation(s)
- N La Verde
- ASST Fatebenefratelli Sacco PO Fatebenefratelli, Milan, MI, Italy; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, MI, Italy; ASST Ovest Milanese, Legnano, MI, Italy; Istituti Clinici Scientifici Maugeri, Pavia, PV, Italy; ASST Bergamo Ovest Ospedale di Treviglio, Treviglio, BG, Italy; Fondazione Poliambulanza di Brescia, Brescia, BS, Italy; ASST-Settelaghi Varese, Varese, VA, Italy; Università degli Studi di Udine, Scuola di Specializzazione in Oncologia Medica, Udine, UD, Italy; S. Croce & Carle Teaching Hospital, Oncology, Cuneo, CN, Italy; IRCCS Istituto Oncologico Veneto, Padova, PD, Italy; ASST Mantova, AO Carlo Poma, Mantova, MN, Italy; ARNAS AO Ospedale Civico Cristina Benfratelli, Palermo, PA, Italy; IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Milan, MI, Italy
| | - E Collovà
- ASST Fatebenefratelli Sacco PO Fatebenefratelli, Milan, MI, Italy; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, MI, Italy; ASST Ovest Milanese, Legnano, MI, Italy; Istituti Clinici Scientifici Maugeri, Pavia, PV, Italy; ASST Bergamo Ovest Ospedale di Treviglio, Treviglio, BG, Italy; Fondazione Poliambulanza di Brescia, Brescia, BS, Italy; ASST-Settelaghi Varese, Varese, VA, Italy; Università degli Studi di Udine, Scuola di Specializzazione in Oncologia Medica, Udine, UD, Italy; S. Croce & Carle Teaching Hospital, Oncology, Cuneo, CN, Italy; IRCCS Istituto Oncologico Veneto, Padova, PD, Italy; ASST Mantova, AO Carlo Poma, Mantova, MN, Italy; ARNAS AO Ospedale Civico Cristina Benfratelli, Palermo, PA, Italy; IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Milan, MI, Italy
| | - L Blasi
- ASST Fatebenefratelli Sacco PO Fatebenefratelli, Milan, MI, Italy; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, MI, Italy; ASST Ovest Milanese, Legnano, MI, Italy; Istituti Clinici Scientifici Maugeri, Pavia, PV, Italy; ASST Bergamo Ovest Ospedale di Treviglio, Treviglio, BG, Italy; Fondazione Poliambulanza di Brescia, Brescia, BS, Italy; ASST-Settelaghi Varese, Varese, VA, Italy; Università degli Studi di Udine, Scuola di Specializzazione in Oncologia Medica, Udine, UD, Italy; S. Croce & Carle Teaching Hospital, Oncology, Cuneo, CN, Italy; IRCCS Istituto Oncologico Veneto, Padova, PD, Italy; ASST Mantova, AO Carlo Poma, Mantova, MN, Italy; ARNAS AO Ospedale Civico Cristina Benfratelli, Palermo, PA, Italy; IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Milan, MI, Italy
| | - G Pinotti
- ASST Fatebenefratelli Sacco PO Fatebenefratelli, Milan, MI, Italy; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, MI, Italy; ASST Ovest Milanese, Legnano, MI, Italy; Istituti Clinici Scientifici Maugeri, Pavia, PV, Italy; ASST Bergamo Ovest Ospedale di Treviglio, Treviglio, BG, Italy; Fondazione Poliambulanza di Brescia, Brescia, BS, Italy; ASST-Settelaghi Varese, Varese, VA, Italy; Università degli Studi di Udine, Scuola di Specializzazione in Oncologia Medica, Udine, UD, Italy; S. Croce & Carle Teaching Hospital, Oncology, Cuneo, CN, Italy; IRCCS Istituto Oncologico Veneto, Padova, PD, Italy; ASST Mantova, AO Carlo Poma, Mantova, MN, Italy; ARNAS AO Ospedale Civico Cristina Benfratelli, Palermo, PA, Italy; IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Milan, MI, Italy
| | - A Bernardo
- ASST Fatebenefratelli Sacco PO Fatebenefratelli, Milan, MI, Italy; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, MI, Italy; ASST Ovest Milanese, Legnano, MI, Italy; Istituti Clinici Scientifici Maugeri, Pavia, PV, Italy; ASST Bergamo Ovest Ospedale di Treviglio, Treviglio, BG, Italy; Fondazione Poliambulanza di Brescia, Brescia, BS, Italy; ASST-Settelaghi Varese, Varese, VA, Italy; Università degli Studi di Udine, Scuola di Specializzazione in Oncologia Medica, Udine, UD, Italy; S. Croce & Carle Teaching Hospital, Oncology, Cuneo, CN, Italy; IRCCS Istituto Oncologico Veneto, Padova, PD, Italy; ASST Mantova, AO Carlo Poma, Mantova, MN, Italy; ARNAS AO Ospedale Civico Cristina Benfratelli, Palermo, PA, Italy; IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Milan, MI, Italy
| | - M Bonotto
- ASST Fatebenefratelli Sacco PO Fatebenefratelli, Milan, MI, Italy; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, MI, Italy; ASST Ovest Milanese, Legnano, MI, Italy; Istituti Clinici Scientifici Maugeri, Pavia, PV, Italy; ASST Bergamo Ovest Ospedale di Treviglio, Treviglio, BG, Italy; Fondazione Poliambulanza di Brescia, Brescia, BS, Italy; ASST-Settelaghi Varese, Varese, VA, Italy; Università degli Studi di Udine, Scuola di Specializzazione in Oncologia Medica, Udine, UD, Italy; S. Croce & Carle Teaching Hospital, Oncology, Cuneo, CN, Italy; IRCCS Istituto Oncologico Veneto, Padova, PD, Italy; ASST Mantova, AO Carlo Poma, Mantova, MN, Italy; ARNAS AO Ospedale Civico Cristina Benfratelli, Palermo, PA, Italy; IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Milan, MI, Italy
| | - O Garrone
- ASST Fatebenefratelli Sacco PO Fatebenefratelli, Milan, MI, Italy; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, MI, Italy; ASST Ovest Milanese, Legnano, MI, Italy; Istituti Clinici Scientifici Maugeri, Pavia, PV, Italy; ASST Bergamo Ovest Ospedale di Treviglio, Treviglio, BG, Italy; Fondazione Poliambulanza di Brescia, Brescia, BS, Italy; ASST-Settelaghi Varese, Varese, VA, Italy; Università degli Studi di Udine, Scuola di Specializzazione in Oncologia Medica, Udine, UD, Italy; S. Croce & Carle Teaching Hospital, Oncology, Cuneo, CN, Italy; IRCCS Istituto Oncologico Veneto, Padova, PD, Italy; ASST Mantova, AO Carlo Poma, Mantova, MN, Italy; ARNAS AO Ospedale Civico Cristina Benfratelli, Palermo, PA, Italy; IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Milan, MI, Italy
| | - A Brunello
- ASST Fatebenefratelli Sacco PO Fatebenefratelli, Milan, MI, Italy; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, MI, Italy; ASST Ovest Milanese, Legnano, MI, Italy; Istituti Clinici Scientifici Maugeri, Pavia, PV, Italy; ASST Bergamo Ovest Ospedale di Treviglio, Treviglio, BG, Italy; Fondazione Poliambulanza di Brescia, Brescia, BS, Italy; ASST-Settelaghi Varese, Varese, VA, Italy; Università degli Studi di Udine, Scuola di Specializzazione in Oncologia Medica, Udine, UD, Italy; S. Croce & Carle Teaching Hospital, Oncology, Cuneo, CN, Italy; IRCCS Istituto Oncologico Veneto, Padova, PD, Italy; ASST Mantova, AO Carlo Poma, Mantova, MN, Italy; ARNAS AO Ospedale Civico Cristina Benfratelli, Palermo, PA, Italy; IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Milan, MI, Italy
| | - MG Cavazzini
- ASST Fatebenefratelli Sacco PO Fatebenefratelli, Milan, MI, Italy; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, MI, Italy; ASST Ovest Milanese, Legnano, MI, Italy; Istituti Clinici Scientifici Maugeri, Pavia, PV, Italy; ASST Bergamo Ovest Ospedale di Treviglio, Treviglio, BG, Italy; Fondazione Poliambulanza di Brescia, Brescia, BS, Italy; ASST-Settelaghi Varese, Varese, VA, Italy; Università degli Studi di Udine, Scuola di Specializzazione in Oncologia Medica, Udine, UD, Italy; S. Croce & Carle Teaching Hospital, Oncology, Cuneo, CN, Italy; IRCCS Istituto Oncologico Veneto, Padova, PD, Italy; ASST Mantova, AO Carlo Poma, Mantova, MN, Italy; ARNAS AO Ospedale Civico Cristina Benfratelli, Palermo, PA, Italy; IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Milan, MI, Italy
| | - C Bareggi
- ASST Fatebenefratelli Sacco PO Fatebenefratelli, Milan, MI, Italy; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, MI, Italy; ASST Ovest Milanese, Legnano, MI, Italy; Istituti Clinici Scientifici Maugeri, Pavia, PV, Italy; ASST Bergamo Ovest Ospedale di Treviglio, Treviglio, BG, Italy; Fondazione Poliambulanza di Brescia, Brescia, BS, Italy; ASST-Settelaghi Varese, Varese, VA, Italy; Università degli Studi di Udine, Scuola di Specializzazione in Oncologia Medica, Udine, UD, Italy; S. Croce & Carle Teaching Hospital, Oncology, Cuneo, CN, Italy; IRCCS Istituto Oncologico Veneto, Padova, PD, Italy; ASST Mantova, AO Carlo Poma, Mantova, MN, Italy; ARNAS AO Ospedale Civico Cristina Benfratelli, Palermo, PA, Italy; IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Milan, MI, Italy
| | - T Prochilo
- ASST Fatebenefratelli Sacco PO Fatebenefratelli, Milan, MI, Italy; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, MI, Italy; ASST Ovest Milanese, Legnano, MI, Italy; Istituti Clinici Scientifici Maugeri, Pavia, PV, Italy; ASST Bergamo Ovest Ospedale di Treviglio, Treviglio, BG, Italy; Fondazione Poliambulanza di Brescia, Brescia, BS, Italy; ASST-Settelaghi Varese, Varese, VA, Italy; Università degli Studi di Udine, Scuola di Specializzazione in Oncologia Medica, Udine, UD, Italy; S. Croce & Carle Teaching Hospital, Oncology, Cuneo, CN, Italy; IRCCS Istituto Oncologico Veneto, Padova, PD, Italy; ASST Mantova, AO Carlo Poma, Mantova, MN, Italy; ARNAS AO Ospedale Civico Cristina Benfratelli, Palermo, PA, Italy; IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Milan, MI, Italy
| | - L Porcu
- ASST Fatebenefratelli Sacco PO Fatebenefratelli, Milan, MI, Italy; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, MI, Italy; ASST Ovest Milanese, Legnano, MI, Italy; Istituti Clinici Scientifici Maugeri, Pavia, PV, Italy; ASST Bergamo Ovest Ospedale di Treviglio, Treviglio, BG, Italy; Fondazione Poliambulanza di Brescia, Brescia, BS, Italy; ASST-Settelaghi Varese, Varese, VA, Italy; Università degli Studi di Udine, Scuola di Specializzazione in Oncologia Medica, Udine, UD, Italy; S. Croce & Carle Teaching Hospital, Oncology, Cuneo, CN, Italy; IRCCS Istituto Oncologico Veneto, Padova, PD, Italy; ASST Mantova, AO Carlo Poma, Mantova, MN, Italy; ARNAS AO Ospedale Civico Cristina Benfratelli, Palermo, PA, Italy; IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Milan, MI, Italy
| | - A Moretti
- ASST Fatebenefratelli Sacco PO Fatebenefratelli, Milan, MI, Italy; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, MI, Italy; ASST Ovest Milanese, Legnano, MI, Italy; Istituti Clinici Scientifici Maugeri, Pavia, PV, Italy; ASST Bergamo Ovest Ospedale di Treviglio, Treviglio, BG, Italy; Fondazione Poliambulanza di Brescia, Brescia, BS, Italy; ASST-Settelaghi Varese, Varese, VA, Italy; Università degli Studi di Udine, Scuola di Specializzazione in Oncologia Medica, Udine, UD, Italy; S. Croce & Carle Teaching Hospital, Oncology, Cuneo, CN, Italy; IRCCS Istituto Oncologico Veneto, Padova, PD, Italy; ASST Mantova, AO Carlo Poma, Mantova, MN, Italy; ARNAS AO Ospedale Civico Cristina Benfratelli, Palermo, PA, Italy; IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Milan, MI, Italy
| | - S Barni
- ASST Fatebenefratelli Sacco PO Fatebenefratelli, Milan, MI, Italy; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, MI, Italy; ASST Ovest Milanese, Legnano, MI, Italy; Istituti Clinici Scientifici Maugeri, Pavia, PV, Italy; ASST Bergamo Ovest Ospedale di Treviglio, Treviglio, BG, Italy; Fondazione Poliambulanza di Brescia, Brescia, BS, Italy; ASST-Settelaghi Varese, Varese, VA, Italy; Università degli Studi di Udine, Scuola di Specializzazione in Oncologia Medica, Udine, UD, Italy; S. Croce & Carle Teaching Hospital, Oncology, Cuneo, CN, Italy; IRCCS Istituto Oncologico Veneto, Padova, PD, Italy; ASST Mantova, AO Carlo Poma, Mantova, MN, Italy; ARNAS AO Ospedale Civico Cristina Benfratelli, Palermo, PA, Italy; IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Milan, MI, Italy
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Fabi A, Alesini D, Valle E, Carbognin L, Arpino G, Montemurro F, Ciccarese M, Cannita K, Paris I, Cursano MC, Moscetti L, Ferretti G, De Laurentiis M, Zambelli A, La Verde N, Nisticò C, Gasparro S, Giannarelli D, Cognetti F. Abstract P1-17-02: Ado-trastuzumab emtansine (TDM-1) treatment and brain metastases in HER2 positive metastatic breast cancer patients: Final analysis of an italian multicenter study. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p1-17-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Ado-trastuzumab emtansine (T-DM1) is a drug-antibody conjugate whose activity has been confirmed in HER2+ advanced breast cancer (BC) patients by the phase 3 EMILIA trial (Verma et al, NEJM 2012). Within the 991 patients enrolled in this trial, about 10% were affected with brain metastases (BM); in this subgroup, safety and efficacy of T-DM1 were confirmed although without any PFS improvement.
Patients and methods: In an Italian, multicenter, retrospective analysis involving 303 patients with advanced BC treated with T-DM1 (Fabi et al, Oncotarget 2017), we analyzed 87 patients with BM (BM-group). The study wanted to evaluate the efficacy of T-DM1 on BM; furthermore we compared BM-group with the remaining 216 patients without BM (nBM-group) in order to study outcome of disease. MRI was used as assessment imaging.
The number of extracranial metastatic sites in the BM-group and in the nBM-group was 1 for 10 (11.5%) and for 74 patients (34.3%), 2 for 23 (26.4%) and 93 (43%) patients, 3 for 25 (28.7% and 38 (17.6%) and 4 or more for 29 (33%) and 11 (5%), respectively.
In the BM-group, 5 patients (5.7%) had received surgery alone as local treatment for brain metastases, 13 (14.9%) surgery plus stereotactic radio-surgery (SRS), 4 (4.7%) surgery plus whole-brain radiotherapy (WBRT), 23 (26.5%) SRS alone, 40 (45.9%)WBRT alone and 2 (2.3%) WBRT followed by SRS. Twenty-eight patients (32.9%) and 89 (42.4%) in the BM-group and nBM-group, respectively, received T-DM1 as second line, 24 (28.2%) and 49 (23.3%) as third line and 33 (38.8%) and 72 (34.3%) as fourth line. Mean number of cycles was 6 in both groups.
Results:Among BM-group, 53 patients (60.9%) were evaluable for response. Two (3.8%) obtained brain complete response, 14 (26.4%) partial response and 13 (24.5%) stable disease [brain disease control rate: 54.7%); 24 (45.3%) progressed during T-DM1.
Regarding extracranial metastases, overall response rate was 35.1% in the BM-group and 38.3% in the nBM-group; 6 months-clinical benefit was 50.6% and 52.3%, respectively. Median PFS was 7 months in the BM-group and 8 months in the nBM-group; when T-DM1 was given as second line, median PFS was 5 months in the BM-group and 11 months in nBM-group (p=0.01) while as third, line in which 76% of patients received lapatinib/capacitabine before TDM1, median PFS was 12 and 13 months (p=NS), respectively.
Conclusions: T-DM1 showed a good activity on BM in BC patients. A better outcome was shown in patients previously treated with lapatinib. The identification of clinical and biological prognostic factors could be needed to better select more responder patients with BM to T-DM1.
Citation Format: Fabi A, Alesini D, Valle E, Carbognin L, Arpino G, Montemurro F, Ciccarese M, Cannita K, Paris I, Cursano MC, Moscetti L, Ferretti G, De Laurentiis M, Zambelli A, La Verde N, Nisticò C, Gasparro S, Giannarelli D, Cognetti F. Ado-trastuzumab emtansine (TDM-1) treatment and brain metastases in HER2 positive metastatic breast cancer patients: Final analysis of an italian multicenter study [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P1-17-02.
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Affiliation(s)
- A Fabi
- Regina Elena National Cancer Institute, Roma, RM, Italy; Oncologia Medica, Ospedale Businco, Cagliari, RM, Italy; University Verona, Italy, Italy; University Federico II Napoli, Italy; Ospedale Vito Fazi, Lecce, Italy; Istituto Piemontese A Carattere Scientifico, Italy; Ospedale Civile, L'Aquila, Italy; Ospedale G. Gemelli, Roma, Italy; Università Campus Biomedico, Rome, Italy; Ospedale Modena, Modena, Italy; Regina Elena National Cancer Institute, Rome, Italy; Pascale Institute, Napoli, Italy; Ospedale Riuniti, Bergamo, Italy; Ospedale San Raffele, Milano, Italy
| | - D Alesini
- Regina Elena National Cancer Institute, Roma, RM, Italy; Oncologia Medica, Ospedale Businco, Cagliari, RM, Italy; University Verona, Italy, Italy; University Federico II Napoli, Italy; Ospedale Vito Fazi, Lecce, Italy; Istituto Piemontese A Carattere Scientifico, Italy; Ospedale Civile, L'Aquila, Italy; Ospedale G. Gemelli, Roma, Italy; Università Campus Biomedico, Rome, Italy; Ospedale Modena, Modena, Italy; Regina Elena National Cancer Institute, Rome, Italy; Pascale Institute, Napoli, Italy; Ospedale Riuniti, Bergamo, Italy; Ospedale San Raffele, Milano, Italy
| | - E Valle
- Regina Elena National Cancer Institute, Roma, RM, Italy; Oncologia Medica, Ospedale Businco, Cagliari, RM, Italy; University Verona, Italy, Italy; University Federico II Napoli, Italy; Ospedale Vito Fazi, Lecce, Italy; Istituto Piemontese A Carattere Scientifico, Italy; Ospedale Civile, L'Aquila, Italy; Ospedale G. Gemelli, Roma, Italy; Università Campus Biomedico, Rome, Italy; Ospedale Modena, Modena, Italy; Regina Elena National Cancer Institute, Rome, Italy; Pascale Institute, Napoli, Italy; Ospedale Riuniti, Bergamo, Italy; Ospedale San Raffele, Milano, Italy
| | - L Carbognin
- Regina Elena National Cancer Institute, Roma, RM, Italy; Oncologia Medica, Ospedale Businco, Cagliari, RM, Italy; University Verona, Italy, Italy; University Federico II Napoli, Italy; Ospedale Vito Fazi, Lecce, Italy; Istituto Piemontese A Carattere Scientifico, Italy; Ospedale Civile, L'Aquila, Italy; Ospedale G. Gemelli, Roma, Italy; Università Campus Biomedico, Rome, Italy; Ospedale Modena, Modena, Italy; Regina Elena National Cancer Institute, Rome, Italy; Pascale Institute, Napoli, Italy; Ospedale Riuniti, Bergamo, Italy; Ospedale San Raffele, Milano, Italy
| | - G Arpino
- Regina Elena National Cancer Institute, Roma, RM, Italy; Oncologia Medica, Ospedale Businco, Cagliari, RM, Italy; University Verona, Italy, Italy; University Federico II Napoli, Italy; Ospedale Vito Fazi, Lecce, Italy; Istituto Piemontese A Carattere Scientifico, Italy; Ospedale Civile, L'Aquila, Italy; Ospedale G. Gemelli, Roma, Italy; Università Campus Biomedico, Rome, Italy; Ospedale Modena, Modena, Italy; Regina Elena National Cancer Institute, Rome, Italy; Pascale Institute, Napoli, Italy; Ospedale Riuniti, Bergamo, Italy; Ospedale San Raffele, Milano, Italy
| | - F Montemurro
- Regina Elena National Cancer Institute, Roma, RM, Italy; Oncologia Medica, Ospedale Businco, Cagliari, RM, Italy; University Verona, Italy, Italy; University Federico II Napoli, Italy; Ospedale Vito Fazi, Lecce, Italy; Istituto Piemontese A Carattere Scientifico, Italy; Ospedale Civile, L'Aquila, Italy; Ospedale G. Gemelli, Roma, Italy; Università Campus Biomedico, Rome, Italy; Ospedale Modena, Modena, Italy; Regina Elena National Cancer Institute, Rome, Italy; Pascale Institute, Napoli, Italy; Ospedale Riuniti, Bergamo, Italy; Ospedale San Raffele, Milano, Italy
| | - M Ciccarese
- Regina Elena National Cancer Institute, Roma, RM, Italy; Oncologia Medica, Ospedale Businco, Cagliari, RM, Italy; University Verona, Italy, Italy; University Federico II Napoli, Italy; Ospedale Vito Fazi, Lecce, Italy; Istituto Piemontese A Carattere Scientifico, Italy; Ospedale Civile, L'Aquila, Italy; Ospedale G. Gemelli, Roma, Italy; Università Campus Biomedico, Rome, Italy; Ospedale Modena, Modena, Italy; Regina Elena National Cancer Institute, Rome, Italy; Pascale Institute, Napoli, Italy; Ospedale Riuniti, Bergamo, Italy; Ospedale San Raffele, Milano, Italy
| | - K Cannita
- Regina Elena National Cancer Institute, Roma, RM, Italy; Oncologia Medica, Ospedale Businco, Cagliari, RM, Italy; University Verona, Italy, Italy; University Federico II Napoli, Italy; Ospedale Vito Fazi, Lecce, Italy; Istituto Piemontese A Carattere Scientifico, Italy; Ospedale Civile, L'Aquila, Italy; Ospedale G. Gemelli, Roma, Italy; Università Campus Biomedico, Rome, Italy; Ospedale Modena, Modena, Italy; Regina Elena National Cancer Institute, Rome, Italy; Pascale Institute, Napoli, Italy; Ospedale Riuniti, Bergamo, Italy; Ospedale San Raffele, Milano, Italy
| | - I Paris
- Regina Elena National Cancer Institute, Roma, RM, Italy; Oncologia Medica, Ospedale Businco, Cagliari, RM, Italy; University Verona, Italy, Italy; University Federico II Napoli, Italy; Ospedale Vito Fazi, Lecce, Italy; Istituto Piemontese A Carattere Scientifico, Italy; Ospedale Civile, L'Aquila, Italy; Ospedale G. Gemelli, Roma, Italy; Università Campus Biomedico, Rome, Italy; Ospedale Modena, Modena, Italy; Regina Elena National Cancer Institute, Rome, Italy; Pascale Institute, Napoli, Italy; Ospedale Riuniti, Bergamo, Italy; Ospedale San Raffele, Milano, Italy
| | - MC Cursano
- Regina Elena National Cancer Institute, Roma, RM, Italy; Oncologia Medica, Ospedale Businco, Cagliari, RM, Italy; University Verona, Italy, Italy; University Federico II Napoli, Italy; Ospedale Vito Fazi, Lecce, Italy; Istituto Piemontese A Carattere Scientifico, Italy; Ospedale Civile, L'Aquila, Italy; Ospedale G. Gemelli, Roma, Italy; Università Campus Biomedico, Rome, Italy; Ospedale Modena, Modena, Italy; Regina Elena National Cancer Institute, Rome, Italy; Pascale Institute, Napoli, Italy; Ospedale Riuniti, Bergamo, Italy; Ospedale San Raffele, Milano, Italy
| | - L Moscetti
- Regina Elena National Cancer Institute, Roma, RM, Italy; Oncologia Medica, Ospedale Businco, Cagliari, RM, Italy; University Verona, Italy, Italy; University Federico II Napoli, Italy; Ospedale Vito Fazi, Lecce, Italy; Istituto Piemontese A Carattere Scientifico, Italy; Ospedale Civile, L'Aquila, Italy; Ospedale G. Gemelli, Roma, Italy; Università Campus Biomedico, Rome, Italy; Ospedale Modena, Modena, Italy; Regina Elena National Cancer Institute, Rome, Italy; Pascale Institute, Napoli, Italy; Ospedale Riuniti, Bergamo, Italy; Ospedale San Raffele, Milano, Italy
| | - G Ferretti
- Regina Elena National Cancer Institute, Roma, RM, Italy; Oncologia Medica, Ospedale Businco, Cagliari, RM, Italy; University Verona, Italy, Italy; University Federico II Napoli, Italy; Ospedale Vito Fazi, Lecce, Italy; Istituto Piemontese A Carattere Scientifico, Italy; Ospedale Civile, L'Aquila, Italy; Ospedale G. Gemelli, Roma, Italy; Università Campus Biomedico, Rome, Italy; Ospedale Modena, Modena, Italy; Regina Elena National Cancer Institute, Rome, Italy; Pascale Institute, Napoli, Italy; Ospedale Riuniti, Bergamo, Italy; Ospedale San Raffele, Milano, Italy
| | - M De Laurentiis
- Regina Elena National Cancer Institute, Roma, RM, Italy; Oncologia Medica, Ospedale Businco, Cagliari, RM, Italy; University Verona, Italy, Italy; University Federico II Napoli, Italy; Ospedale Vito Fazi, Lecce, Italy; Istituto Piemontese A Carattere Scientifico, Italy; Ospedale Civile, L'Aquila, Italy; Ospedale G. Gemelli, Roma, Italy; Università Campus Biomedico, Rome, Italy; Ospedale Modena, Modena, Italy; Regina Elena National Cancer Institute, Rome, Italy; Pascale Institute, Napoli, Italy; Ospedale Riuniti, Bergamo, Italy; Ospedale San Raffele, Milano, Italy
| | - A Zambelli
- Regina Elena National Cancer Institute, Roma, RM, Italy; Oncologia Medica, Ospedale Businco, Cagliari, RM, Italy; University Verona, Italy, Italy; University Federico II Napoli, Italy; Ospedale Vito Fazi, Lecce, Italy; Istituto Piemontese A Carattere Scientifico, Italy; Ospedale Civile, L'Aquila, Italy; Ospedale G. Gemelli, Roma, Italy; Università Campus Biomedico, Rome, Italy; Ospedale Modena, Modena, Italy; Regina Elena National Cancer Institute, Rome, Italy; Pascale Institute, Napoli, Italy; Ospedale Riuniti, Bergamo, Italy; Ospedale San Raffele, Milano, Italy
| | - N La Verde
- Regina Elena National Cancer Institute, Roma, RM, Italy; Oncologia Medica, Ospedale Businco, Cagliari, RM, Italy; University Verona, Italy, Italy; University Federico II Napoli, Italy; Ospedale Vito Fazi, Lecce, Italy; Istituto Piemontese A Carattere Scientifico, Italy; Ospedale Civile, L'Aquila, Italy; Ospedale G. Gemelli, Roma, Italy; Università Campus Biomedico, Rome, Italy; Ospedale Modena, Modena, Italy; Regina Elena National Cancer Institute, Rome, Italy; Pascale Institute, Napoli, Italy; Ospedale Riuniti, Bergamo, Italy; Ospedale San Raffele, Milano, Italy
| | - C Nisticò
- Regina Elena National Cancer Institute, Roma, RM, Italy; Oncologia Medica, Ospedale Businco, Cagliari, RM, Italy; University Verona, Italy, Italy; University Federico II Napoli, Italy; Ospedale Vito Fazi, Lecce, Italy; Istituto Piemontese A Carattere Scientifico, Italy; Ospedale Civile, L'Aquila, Italy; Ospedale G. Gemelli, Roma, Italy; Università Campus Biomedico, Rome, Italy; Ospedale Modena, Modena, Italy; Regina Elena National Cancer Institute, Rome, Italy; Pascale Institute, Napoli, Italy; Ospedale Riuniti, Bergamo, Italy; Ospedale San Raffele, Milano, Italy
| | - S Gasparro
- Regina Elena National Cancer Institute, Roma, RM, Italy; Oncologia Medica, Ospedale Businco, Cagliari, RM, Italy; University Verona, Italy, Italy; University Federico II Napoli, Italy; Ospedale Vito Fazi, Lecce, Italy; Istituto Piemontese A Carattere Scientifico, Italy; Ospedale Civile, L'Aquila, Italy; Ospedale G. Gemelli, Roma, Italy; Università Campus Biomedico, Rome, Italy; Ospedale Modena, Modena, Italy; Regina Elena National Cancer Institute, Rome, Italy; Pascale Institute, Napoli, Italy; Ospedale Riuniti, Bergamo, Italy; Ospedale San Raffele, Milano, Italy
| | - D Giannarelli
- Regina Elena National Cancer Institute, Roma, RM, Italy; Oncologia Medica, Ospedale Businco, Cagliari, RM, Italy; University Verona, Italy, Italy; University Federico II Napoli, Italy; Ospedale Vito Fazi, Lecce, Italy; Istituto Piemontese A Carattere Scientifico, Italy; Ospedale Civile, L'Aquila, Italy; Ospedale G. Gemelli, Roma, Italy; Università Campus Biomedico, Rome, Italy; Ospedale Modena, Modena, Italy; Regina Elena National Cancer Institute, Rome, Italy; Pascale Institute, Napoli, Italy; Ospedale Riuniti, Bergamo, Italy; Ospedale San Raffele, Milano, Italy
| | - F Cognetti
- Regina Elena National Cancer Institute, Roma, RM, Italy; Oncologia Medica, Ospedale Businco, Cagliari, RM, Italy; University Verona, Italy, Italy; University Federico II Napoli, Italy; Ospedale Vito Fazi, Lecce, Italy; Istituto Piemontese A Carattere Scientifico, Italy; Ospedale Civile, L'Aquila, Italy; Ospedale G. Gemelli, Roma, Italy; Università Campus Biomedico, Rome, Italy; Ospedale Modena, Modena, Italy; Regina Elena National Cancer Institute, Rome, Italy; Pascale Institute, Napoli, Italy; Ospedale Riuniti, Bergamo, Italy; Ospedale San Raffele, Milano, Italy
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Abstract
Cetuximab is a chimeric immunoglobulin G1 monoclonal antibody that targets the extracellular domain of the epidermal growth factor receptor (EGFR) with high specificity and affinity. It competitively inhibits endogenous ligand binding and thereby inhibits subsequent EGFR activation. The EGFR signaling pathways regulate cell differentiation, proliferation, migration, angiogenesis and apoptosis, all of which become deregulated in cancer cells. EGFR is an important target for cancer therapy and many studies have demonstrated that cetuximab is active in several types of cancer, particularly colorectal and head and neck cancer. Cetuximab enhances the effects of many standard cytotoxic agents, including irinotecan, and in combination with chemotherapy it can elicit antitumor responses in tumors that previously failed to respond to that chemotherapy. Cetuximab also enhances radiation-induced apoptosis. On the basis of a pivotal European randomized study (the BOND study) and of 2 clinical studies conducted in the USA, cetuximab has been approved in combination with irinotecan for patients affected by EGFR-expressing metastatic colon cancer after failure with irinotecan. There have only been a few small phase II trials on first-line treatment in metastatic colorectal cancer, but the results suggest promising activity of cetuximab together with irinotecan or oxaliplatin. There is some evidence that additive efficacy can be achieved using EGFR inhibitors in combination with vascular endothelial growth factor receptor inhibitors such as bevacizumab. A correlation between response and the main toxicity (acne-like skin reaction) has been observed but is unclear. EGFR status as a specific marker for EGFR inhibitors is controversial. At the moment, EGFR expression does not appear to be a predictive factor for response to EGFR inhibitors.
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Affiliation(s)
- R. Labianca
- Oncology Department, Ospedali Riuniti, Bergamo
| | - N. La Verde
- Oncology Department, Ospedale Fatebenefratelli e Oftalmico, Milan - Italy
| | - M.C. Garassino
- Oncology Department, Ospedale Fatebenefratelli e Oftalmico, Milan - Italy
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13
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Garrone O, Cursano M, De Angelis C, Giarratano T, Saggia C, Beano A, Cazzaniga M, La Verde N, Milani A, Collovà E, Coltelli L, de Conciliis E, Vandone A, Airoldi M, D'Onofrio L, Bertolini I, Guarneri V, Donadio M, Riva F, Merlano M. From the CLEOPATRA study to real life: preliminary results from the G.O.N.O. SUPER trial. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx424.013] [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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14
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Gori S, Turazza M, Inno A, Lunardi G, Moroso S, La Verde N, Frassoldai A, Tarenzi E, Garrone O, Vici P, Laudadio L, Cretella E, Foglietta J, Leonardi V, Cavanna L, Barni S, Marchetti F, Valerio M, Carbognin G, Alongi F, Fabi A. The HERBA trial: a retrospective study on patients (pts) with HER2-positive (HER2+ve) breast cancer (BC) and brain metastases (BMs). Ann Oncol 2017. [DOI: 10.1093/annonc/mdx424.016] [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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15
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Cazzaniga ME, Airoldi M, Arcangeli V, Artale S, Atzori F, Ballerio A, Bianchi GV, Blasi L, Campidoglio S, Ciccarese M, Cursano MC, Piezzo M, Fabi A, Ferrari L, Ferzi A, Ficorella C, Frassoldati A, Fumagalli A, Garrone O, Gebbia V, Generali D, La Verde N, Maur M, Michelotti A, Moretti G, Musolino A, Palumbo R, Pistelli M, Porpiglia M, Sartori D, Scavelli C, Schirone A, Turletti A, Valerio MR, Vici P, Zambelli A, Clivio L, Torri V. Efficacy and safety of Everolimus and Exemestane in hormone-receptor positive (HR+) human-epidermal-growth-factor negative (HER2-) advanced breast cancer patients: New insights beyond clinical trials. The EVA study. Breast 2017; 35:115-121. [PMID: 28711793 DOI: 10.1016/j.breast.2017.06.043] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [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: 04/10/2017] [Revised: 06/12/2017] [Accepted: 06/29/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The BOLERO-2 trial reported efficacy and safety of Everolimus (EVE) and Exemestane (EXE) combination in HR+ advanced breast cancer (ABC) patients. The BALLET trial further evaluated the safety of EVE-EXE in HR+ ABC patients, without reporting efficacy data. Aim of the EVA real-life study was to collect data of efficacy and safety of EVE-EXE combination in the clinical setting, as well as exploring efficacy according to EVE Dose-Intensity (DI) and to previous treatment with Fulvestrant. PATIENTS AND METHODS This study aimed to describe the outcome of ABC pts treated with EVE-EXE combination in terms of median duration of EVE treatment and ORR in a real-life setting. RESULTS From July 2013 to December 2015, the EVA study enrolled 404 pts. Median age was 61 years (33-83). Main metastatic sites were: bone (69.1%), soft tissue (34.7%) and viscera (33.2%). Median number of previous treatments was 2 (1-7). 43.3% of the pts had received Fulvestrant. Median exposure to EVE was 31.0 weeks (15.4-58.3) in the whole population. No difference was observed in terms of EVE exposure duration according to DI (p for trend = 0.27) or type of previous treatments (p = 0.33). ORR and Disease Control Rate (DCR) were observed in 31.6% and 60.7% of the patients, respectively, with the lowest ORRs confined in CHT pre-treated patients or in those who received the lowest DI of EVE. Grade 3-4 adverse events (AEs) were reported in 37.9% of the patients. Main AEs were: stomatitis (11.2%), non-infectious pneumonitis - NIP (3.8%), anaemia (3.8%) and fatigue (3.2%). CONCLUSIONS The EVA study provided new insights in the use of EVE-EVE combination in HR+ ABC pts many years after the publication of the pivotal trial. The combination is safe and the best response could be obtained in patients receiving the full dose of EVE and/or after hormone-therapy as Fulvestrant in ABC.
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Affiliation(s)
- M E Cazzaniga
- Research Unit Phase I Trials, ASST Monza, Monza, Italy; Oncology Unit, ASST Monza, Monza, Italy.
| | - M Airoldi
- Oncology Unit 2 - Città della Salute e della Scienza di Torino, Torino, Italy
| | - V Arcangeli
- Oncology Unit Rimini Azienda USL Romagna, Rimini, Italy
| | - S Artale
- Oncology Department, Ospedale di Gallarate ASST Valle Olona, Gallarate, Italy
| | - F Atzori
- Oncology Unit, Azienda Ospedaliero Universitaria di Cagliari, Cagliari, Italy
| | - A Ballerio
- Oncology Unit, ASST della Valle Olona - Presidio Ospedaliero di Saronno, Saronno, Italy
| | - G V Bianchi
- Oncology Unit 1, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - L Blasi
- Oncology Unit, ARNAS Civico Palermo, Palermo, Italy
| | - S Campidoglio
- Oncology Unit, Ospedale Sacro Cuore di Gesù, Fatebenefratelli, Benevento, Italy
| | - M Ciccarese
- Oncology Unit, Ospedale "Vito Fazzi" di Lecce, Lecce, Italy
| | - M C Cursano
- Oncology Unit, Università Campus Bio-Medico, Roma, Italy
| | - M Piezzo
- National Cancer Institute "Fondazione Giovanni Pascale", Napoli, Italy
| | - A Fabi
- Oncology Unit 1, Istituto Regina Elena - IFO, Roma, Italy
| | - L Ferrari
- Oncology Unit, ASL di Frosinone Osp. "SS. Trinità", Italy
| | - A Ferzi
- Oncology Unit, ASST OVEST Milanese - Presidio di Legnano, Legnano, Italy
| | - C Ficorella
- Dipartimento di Scienze Cliniche Applicate e Biotecnologiche (DISCAB) - Università Degli Studi Dell'Aquila, L'Aquila, Italy
| | - A Frassoldati
- Oncology Unit, Az Ospedaliero Universitaria di Ferrara, Ferrara, Italy
| | - A Fumagalli
- Oncology Unit, Ospedale Moriggia Pelascini, Gravedona, Italy
| | - O Garrone
- Oncology Unit, A.O. S. Croce e Carle Ospedale di Insegnamento, Cuneo, Italy
| | - V Gebbia
- Oncology Unit, Osp. La Maddalena, Palermo, Italy
| | | | - N La Verde
- Oncology Unit, ASST Fatebenefratelli Sacco, Milano, Italy
| | - M Maur
- Oncology and Haematology Department, A.O.U Policlinico di Modena, Modena, Italy
| | - A Michelotti
- Oncology Unit I, Ospedale S. Chiara, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - G Moretti
- Oncology Unit, IRCCS Arcispedale S. Maria Nuova, Reggio Emilia, Italy
| | - A Musolino
- Oncology Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - R Palumbo
- Oncology Unit, IRCCS ICS Maugeri, Pavia, Italy
| | - M Pistelli
- Oncology Unit, AOU Ospedali Riuniti Umberto I-G.M. Lancisi-G. Salesi, Ancona, Italy
| | - M Porpiglia
- Oncology Unit, Presidio Ospedaliero S. Anna, Torino, Italy
| | - D Sartori
- Oncology Unit, AULSS 3, Mirano, Italy
| | - C Scavelli
- Oncology Unit, Ospedale "S. Cuore di Gesù", Gallipoli, Italy
| | - A Schirone
- Oncology Department, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - A Turletti
- Oncology Unit, Ospedale Martini della ASL "Città di Torino", Torino, Italy
| | - M R Valerio
- Oncology Department, Policlinico di Palermo Paolo Giaccone, Palermo, Italy
| | - P Vici
- Oncology Unit, Istituto Nazionale Tumori Regina Elena - IFO, Roma, Italy
| | - A Zambelli
- Oncology Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - L Clivio
- IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milano, Italy
| | - V Torri
- IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milano, Italy
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16
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Fabi A, De Laurentiis M, Caruso M, Valle E, Moscetti L, Santini D, Cannita K, Carbognin L, Ciccarese M, Rossello R, Arpino G, Leonardi V, Montemurro F, La Verde N, Generali DG, Zambelli A, Scandurra G, Russillo M, Paris I, D'Ottavio AM, Filippelli G, Giampaglia M, Stani S, Fabbri A, Alesini D, Giannarelli D, Cognetti F. Abstract P4-21-11: T-DM1 in HER2 positive advanced breast cancer patients: Real world practice from a multicenter observational study. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p4-21-11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: T-DM1 showed remarkable activity in metastatic HER-2 positive breast cancer (mBC) and it was recently approved for clinical use in patients (pts) who previously failed Trastuzumab- and Taxanes-based therapies. Currently, little is known on the performance of T-DM1 in a “real life” scenario. Therefore, we investigated effectiveness and safety of T-DM1 in Italian daily practice.
Methods: Pts baseline characteristics and clinical outcome of pts with HER-2 positive mBC treated with T-DM1 between 2013 and 2015 at 20 Italian Institutions were retrospectively collected and analyzed.
Results: 300 pts were included in our analysis. Median age was 51 years (27-78); visceral metastases were present in 204 (68%) pts and brain metastases in 86 (29%). It is noteworthy that 111 (37%) pts received T-DM1 as pure second line, 83 (28%) as third line and 96 (32%) as further lines. Moreover 10 (3%) pts had T-DM1 as first line because disease recurrence occurred during or adjuvant trastuzumab of within 6 months of its completion. The overall response rate (ORR) was 40%, global disease control rate (gDCR) 64%, median progression-free survival (PFS) 7.0 months (C.I.95%: 5.6-8.4) and overall survival (OS) at 2 years 63%. Pts with 1, 2 and 3 or more metastatic site had OS at 2 years of 87%, 67% and 46%, respectively (p<0.0001). When T-DM1 was given as second line the PFS was 8.0 months and beyond second-line was 6.8 months. Interestingly, for 38 (13%) pts who progressed after Pertuzumab-plus trastuzumab and taxanes as first line treatment, ORR and gDCR were similar to pertuzumab-naïve patients (38% and 62%, respectively) However PFS was 5.0 months (C.I.95%: 4.3-5.7) compared to 9.0 (95% C.I. 5.5-12.4) achieved in pts not receiving a previous pertuzumab-based treatment. Most frequent grade ≥3 toxicities were thrombocytopenia (2.6%), alopecia (2.1%), hypertransaminasemia (2.2%), neutropenia (1.3%), asthenia (1.3%) and diarrhea (0.4%).
Conclusions: To our knowledge, this is the first real life, multicenter retrospective analysis evaluating efficacy and safety of T-DM1 in pretreated HER-2 positive mBC pts. We observed remarkable results in terms of PFS and OS, especially when T-DM1 was given early in the course of metastatic disease. Shortened PFS in patients progressing after pertuzumab suggest further analyses to better define possible molecular mechanisms of cross-resistences between two molecules. As a whole there was no evidence of significant or unexpected toxicities. Although these findings should be taken with caution due to the retrospective analysis and the different lines of previous treatment considered, we confirmed the potential therapeutic role of T-DM1 across a heterogeneous population of HER-2 positive mBC patients. The final analysis will be presented to the meeting.
Citation Format: Fabi A, De Laurentiis M, Caruso M, Valle E, Moscetti L, Santini D, Cannita K, Carbognin L, Ciccarese M, Rossello R, Arpino G, Leonardi V, Montemurro F, La Verde N, Generali DG, Zambelli A, Scandurra G, Russillo M, Paris I, D'Ottavio AM, Filippelli G, Giampaglia M, Stani S, Fabbri A, Alesini D, Giannarelli D, Cognetti F. T-DM1 in HER2 positive advanced breast cancer patients: Real world practice from a multicenter observational study [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P4-21-11.
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Affiliation(s)
- A Fabi
- Istituto Nazionale Tumori Regina Elena, Roma; Istituto Nazionale Tumori Fondazione Pascale, Napoli; CCO Humanitas, Catania; Ospedale Oncologico Armando Businco, Cagliari; Azienda Ospedaliero-Universitaria, Modena; Campus Bio Medico, Roma; Presidio Ospedaliero S. Salvatore, L'Aquila; Azienda Universitaria Integrata, Verona; Ospedale Vito Fazzi, Lecce; Ospedale S. Vincenzo, Taormina; Università Federico II, Napoli; ARNAS Civico, Palermo; Fondazione del Piemonte per l'Oncologia, Candiolo; Ospedale S. Raffaele, Milano; Istituti Ospedalieri, Cremona; Azienda Ospedaliera Ospedali Riuniti, Bergamo; Ospedale Oncologico, Catania; Ospedale Oncologico, Lucca; Università Cattolica del Sacro Cuore Agostino Gemelli, Roma; Ospedale S. Giovanni Addolorata, Roma; Ospedale S. Francesco di Paola, Paola; Azienda Ospedaliera S. Carlo, Potenza; Ospedale S. Spirito, Roma; Ospedale Belcolle, Viterbo
| | - M De Laurentiis
- Istituto Nazionale Tumori Regina Elena, Roma; Istituto Nazionale Tumori Fondazione Pascale, Napoli; CCO Humanitas, Catania; Ospedale Oncologico Armando Businco, Cagliari; Azienda Ospedaliero-Universitaria, Modena; Campus Bio Medico, Roma; Presidio Ospedaliero S. Salvatore, L'Aquila; Azienda Universitaria Integrata, Verona; Ospedale Vito Fazzi, Lecce; Ospedale S. Vincenzo, Taormina; Università Federico II, Napoli; ARNAS Civico, Palermo; Fondazione del Piemonte per l'Oncologia, Candiolo; Ospedale S. Raffaele, Milano; Istituti Ospedalieri, Cremona; Azienda Ospedaliera Ospedali Riuniti, Bergamo; Ospedale Oncologico, Catania; Ospedale Oncologico, Lucca; Università Cattolica del Sacro Cuore Agostino Gemelli, Roma; Ospedale S. Giovanni Addolorata, Roma; Ospedale S. Francesco di Paola, Paola; Azienda Ospedaliera S. Carlo, Potenza; Ospedale S. Spirito, Roma; Ospedale Belcolle, Viterbo
| | - M Caruso
- Istituto Nazionale Tumori Regina Elena, Roma; Istituto Nazionale Tumori Fondazione Pascale, Napoli; CCO Humanitas, Catania; Ospedale Oncologico Armando Businco, Cagliari; Azienda Ospedaliero-Universitaria, Modena; Campus Bio Medico, Roma; Presidio Ospedaliero S. Salvatore, L'Aquila; Azienda Universitaria Integrata, Verona; Ospedale Vito Fazzi, Lecce; Ospedale S. Vincenzo, Taormina; Università Federico II, Napoli; ARNAS Civico, Palermo; Fondazione del Piemonte per l'Oncologia, Candiolo; Ospedale S. Raffaele, Milano; Istituti Ospedalieri, Cremona; Azienda Ospedaliera Ospedali Riuniti, Bergamo; Ospedale Oncologico, Catania; Ospedale Oncologico, Lucca; Università Cattolica del Sacro Cuore Agostino Gemelli, Roma; Ospedale S. Giovanni Addolorata, Roma; Ospedale S. Francesco di Paola, Paola; Azienda Ospedaliera S. Carlo, Potenza; Ospedale S. Spirito, Roma; Ospedale Belcolle, Viterbo
| | - E Valle
- Istituto Nazionale Tumori Regina Elena, Roma; Istituto Nazionale Tumori Fondazione Pascale, Napoli; CCO Humanitas, Catania; Ospedale Oncologico Armando Businco, Cagliari; Azienda Ospedaliero-Universitaria, Modena; Campus Bio Medico, Roma; Presidio Ospedaliero S. Salvatore, L'Aquila; Azienda Universitaria Integrata, Verona; Ospedale Vito Fazzi, Lecce; Ospedale S. Vincenzo, Taormina; Università Federico II, Napoli; ARNAS Civico, Palermo; Fondazione del Piemonte per l'Oncologia, Candiolo; Ospedale S. Raffaele, Milano; Istituti Ospedalieri, Cremona; Azienda Ospedaliera Ospedali Riuniti, Bergamo; Ospedale Oncologico, Catania; Ospedale Oncologico, Lucca; Università Cattolica del Sacro Cuore Agostino Gemelli, Roma; Ospedale S. Giovanni Addolorata, Roma; Ospedale S. Francesco di Paola, Paola; Azienda Ospedaliera S. Carlo, Potenza; Ospedale S. Spirito, Roma; Ospedale Belcolle, Viterbo
| | - L Moscetti
- Istituto Nazionale Tumori Regina Elena, Roma; Istituto Nazionale Tumori Fondazione Pascale, Napoli; CCO Humanitas, Catania; Ospedale Oncologico Armando Businco, Cagliari; Azienda Ospedaliero-Universitaria, Modena; Campus Bio Medico, Roma; Presidio Ospedaliero S. Salvatore, L'Aquila; Azienda Universitaria Integrata, Verona; Ospedale Vito Fazzi, Lecce; Ospedale S. Vincenzo, Taormina; Università Federico II, Napoli; ARNAS Civico, Palermo; Fondazione del Piemonte per l'Oncologia, Candiolo; Ospedale S. Raffaele, Milano; Istituti Ospedalieri, Cremona; Azienda Ospedaliera Ospedali Riuniti, Bergamo; Ospedale Oncologico, Catania; Ospedale Oncologico, Lucca; Università Cattolica del Sacro Cuore Agostino Gemelli, Roma; Ospedale S. Giovanni Addolorata, Roma; Ospedale S. Francesco di Paola, Paola; Azienda Ospedaliera S. Carlo, Potenza; Ospedale S. Spirito, Roma; Ospedale Belcolle, Viterbo
| | - D Santini
- Istituto Nazionale Tumori Regina Elena, Roma; Istituto Nazionale Tumori Fondazione Pascale, Napoli; CCO Humanitas, Catania; Ospedale Oncologico Armando Businco, Cagliari; Azienda Ospedaliero-Universitaria, Modena; Campus Bio Medico, Roma; Presidio Ospedaliero S. Salvatore, L'Aquila; Azienda Universitaria Integrata, Verona; Ospedale Vito Fazzi, Lecce; Ospedale S. Vincenzo, Taormina; Università Federico II, Napoli; ARNAS Civico, Palermo; Fondazione del Piemonte per l'Oncologia, Candiolo; Ospedale S. Raffaele, Milano; Istituti Ospedalieri, Cremona; Azienda Ospedaliera Ospedali Riuniti, Bergamo; Ospedale Oncologico, Catania; Ospedale Oncologico, Lucca; Università Cattolica del Sacro Cuore Agostino Gemelli, Roma; Ospedale S. Giovanni Addolorata, Roma; Ospedale S. Francesco di Paola, Paola; Azienda Ospedaliera S. Carlo, Potenza; Ospedale S. Spirito, Roma; Ospedale Belcolle, Viterbo
| | - K Cannita
- Istituto Nazionale Tumori Regina Elena, Roma; Istituto Nazionale Tumori Fondazione Pascale, Napoli; CCO Humanitas, Catania; Ospedale Oncologico Armando Businco, Cagliari; Azienda Ospedaliero-Universitaria, Modena; Campus Bio Medico, Roma; Presidio Ospedaliero S. Salvatore, L'Aquila; Azienda Universitaria Integrata, Verona; Ospedale Vito Fazzi, Lecce; Ospedale S. Vincenzo, Taormina; Università Federico II, Napoli; ARNAS Civico, Palermo; Fondazione del Piemonte per l'Oncologia, Candiolo; Ospedale S. Raffaele, Milano; Istituti Ospedalieri, Cremona; Azienda Ospedaliera Ospedali Riuniti, Bergamo; Ospedale Oncologico, Catania; Ospedale Oncologico, Lucca; Università Cattolica del Sacro Cuore Agostino Gemelli, Roma; Ospedale S. Giovanni Addolorata, Roma; Ospedale S. Francesco di Paola, Paola; Azienda Ospedaliera S. Carlo, Potenza; Ospedale S. Spirito, Roma; Ospedale Belcolle, Viterbo
| | - L Carbognin
- Istituto Nazionale Tumori Regina Elena, Roma; Istituto Nazionale Tumori Fondazione Pascale, Napoli; CCO Humanitas, Catania; Ospedale Oncologico Armando Businco, Cagliari; Azienda Ospedaliero-Universitaria, Modena; Campus Bio Medico, Roma; Presidio Ospedaliero S. Salvatore, L'Aquila; Azienda Universitaria Integrata, Verona; Ospedale Vito Fazzi, Lecce; Ospedale S. Vincenzo, Taormina; Università Federico II, Napoli; ARNAS Civico, Palermo; Fondazione del Piemonte per l'Oncologia, Candiolo; Ospedale S. Raffaele, Milano; Istituti Ospedalieri, Cremona; Azienda Ospedaliera Ospedali Riuniti, Bergamo; Ospedale Oncologico, Catania; Ospedale Oncologico, Lucca; Università Cattolica del Sacro Cuore Agostino Gemelli, Roma; Ospedale S. Giovanni Addolorata, Roma; Ospedale S. Francesco di Paola, Paola; Azienda Ospedaliera S. Carlo, Potenza; Ospedale S. Spirito, Roma; Ospedale Belcolle, Viterbo
| | - M Ciccarese
- Istituto Nazionale Tumori Regina Elena, Roma; Istituto Nazionale Tumori Fondazione Pascale, Napoli; CCO Humanitas, Catania; Ospedale Oncologico Armando Businco, Cagliari; Azienda Ospedaliero-Universitaria, Modena; Campus Bio Medico, Roma; Presidio Ospedaliero S. Salvatore, L'Aquila; Azienda Universitaria Integrata, Verona; Ospedale Vito Fazzi, Lecce; Ospedale S. Vincenzo, Taormina; Università Federico II, Napoli; ARNAS Civico, Palermo; Fondazione del Piemonte per l'Oncologia, Candiolo; Ospedale S. Raffaele, Milano; Istituti Ospedalieri, Cremona; Azienda Ospedaliera Ospedali Riuniti, Bergamo; Ospedale Oncologico, Catania; Ospedale Oncologico, Lucca; Università Cattolica del Sacro Cuore Agostino Gemelli, Roma; Ospedale S. Giovanni Addolorata, Roma; Ospedale S. Francesco di Paola, Paola; Azienda Ospedaliera S. Carlo, Potenza; Ospedale S. Spirito, Roma; Ospedale Belcolle, Viterbo
| | - R Rossello
- Istituto Nazionale Tumori Regina Elena, Roma; Istituto Nazionale Tumori Fondazione Pascale, Napoli; CCO Humanitas, Catania; Ospedale Oncologico Armando Businco, Cagliari; Azienda Ospedaliero-Universitaria, Modena; Campus Bio Medico, Roma; Presidio Ospedaliero S. Salvatore, L'Aquila; Azienda Universitaria Integrata, Verona; Ospedale Vito Fazzi, Lecce; Ospedale S. Vincenzo, Taormina; Università Federico II, Napoli; ARNAS Civico, Palermo; Fondazione del Piemonte per l'Oncologia, Candiolo; Ospedale S. Raffaele, Milano; Istituti Ospedalieri, Cremona; Azienda Ospedaliera Ospedali Riuniti, Bergamo; Ospedale Oncologico, Catania; Ospedale Oncologico, Lucca; Università Cattolica del Sacro Cuore Agostino Gemelli, Roma; Ospedale S. Giovanni Addolorata, Roma; Ospedale S. Francesco di Paola, Paola; Azienda Ospedaliera S. Carlo, Potenza; Ospedale S. Spirito, Roma; Ospedale Belcolle, Viterbo
| | - G Arpino
- Istituto Nazionale Tumori Regina Elena, Roma; Istituto Nazionale Tumori Fondazione Pascale, Napoli; CCO Humanitas, Catania; Ospedale Oncologico Armando Businco, Cagliari; Azienda Ospedaliero-Universitaria, Modena; Campus Bio Medico, Roma; Presidio Ospedaliero S. Salvatore, L'Aquila; Azienda Universitaria Integrata, Verona; Ospedale Vito Fazzi, Lecce; Ospedale S. Vincenzo, Taormina; Università Federico II, Napoli; ARNAS Civico, Palermo; Fondazione del Piemonte per l'Oncologia, Candiolo; Ospedale S. Raffaele, Milano; Istituti Ospedalieri, Cremona; Azienda Ospedaliera Ospedali Riuniti, Bergamo; Ospedale Oncologico, Catania; Ospedale Oncologico, Lucca; Università Cattolica del Sacro Cuore Agostino Gemelli, Roma; Ospedale S. Giovanni Addolorata, Roma; Ospedale S. Francesco di Paola, Paola; Azienda Ospedaliera S. Carlo, Potenza; Ospedale S. Spirito, Roma; Ospedale Belcolle, Viterbo
| | - V Leonardi
- Istituto Nazionale Tumori Regina Elena, Roma; Istituto Nazionale Tumori Fondazione Pascale, Napoli; CCO Humanitas, Catania; Ospedale Oncologico Armando Businco, Cagliari; Azienda Ospedaliero-Universitaria, Modena; Campus Bio Medico, Roma; Presidio Ospedaliero S. Salvatore, L'Aquila; Azienda Universitaria Integrata, Verona; Ospedale Vito Fazzi, Lecce; Ospedale S. Vincenzo, Taormina; Università Federico II, Napoli; ARNAS Civico, Palermo; Fondazione del Piemonte per l'Oncologia, Candiolo; Ospedale S. Raffaele, Milano; Istituti Ospedalieri, Cremona; Azienda Ospedaliera Ospedali Riuniti, Bergamo; Ospedale Oncologico, Catania; Ospedale Oncologico, Lucca; Università Cattolica del Sacro Cuore Agostino Gemelli, Roma; Ospedale S. Giovanni Addolorata, Roma; Ospedale S. Francesco di Paola, Paola; Azienda Ospedaliera S. Carlo, Potenza; Ospedale S. Spirito, Roma; Ospedale Belcolle, Viterbo
| | - F Montemurro
- Istituto Nazionale Tumori Regina Elena, Roma; Istituto Nazionale Tumori Fondazione Pascale, Napoli; CCO Humanitas, Catania; Ospedale Oncologico Armando Businco, Cagliari; Azienda Ospedaliero-Universitaria, Modena; Campus Bio Medico, Roma; Presidio Ospedaliero S. Salvatore, L'Aquila; Azienda Universitaria Integrata, Verona; Ospedale Vito Fazzi, Lecce; Ospedale S. Vincenzo, Taormina; Università Federico II, Napoli; ARNAS Civico, Palermo; Fondazione del Piemonte per l'Oncologia, Candiolo; Ospedale S. Raffaele, Milano; Istituti Ospedalieri, Cremona; Azienda Ospedaliera Ospedali Riuniti, Bergamo; Ospedale Oncologico, Catania; Ospedale Oncologico, Lucca; Università Cattolica del Sacro Cuore Agostino Gemelli, Roma; Ospedale S. Giovanni Addolorata, Roma; Ospedale S. Francesco di Paola, Paola; Azienda Ospedaliera S. Carlo, Potenza; Ospedale S. Spirito, Roma; Ospedale Belcolle, Viterbo
| | - N La Verde
- Istituto Nazionale Tumori Regina Elena, Roma; Istituto Nazionale Tumori Fondazione Pascale, Napoli; CCO Humanitas, Catania; Ospedale Oncologico Armando Businco, Cagliari; Azienda Ospedaliero-Universitaria, Modena; Campus Bio Medico, Roma; Presidio Ospedaliero S. Salvatore, L'Aquila; Azienda Universitaria Integrata, Verona; Ospedale Vito Fazzi, Lecce; Ospedale S. Vincenzo, Taormina; Università Federico II, Napoli; ARNAS Civico, Palermo; Fondazione del Piemonte per l'Oncologia, Candiolo; Ospedale S. Raffaele, Milano; Istituti Ospedalieri, Cremona; Azienda Ospedaliera Ospedali Riuniti, Bergamo; Ospedale Oncologico, Catania; Ospedale Oncologico, Lucca; Università Cattolica del Sacro Cuore Agostino Gemelli, Roma; Ospedale S. Giovanni Addolorata, Roma; Ospedale S. Francesco di Paola, Paola; Azienda Ospedaliera S. Carlo, Potenza; Ospedale S. Spirito, Roma; Ospedale Belcolle, Viterbo
| | - DG Generali
- Istituto Nazionale Tumori Regina Elena, Roma; Istituto Nazionale Tumori Fondazione Pascale, Napoli; CCO Humanitas, Catania; Ospedale Oncologico Armando Businco, Cagliari; Azienda Ospedaliero-Universitaria, Modena; Campus Bio Medico, Roma; Presidio Ospedaliero S. Salvatore, L'Aquila; Azienda Universitaria Integrata, Verona; Ospedale Vito Fazzi, Lecce; Ospedale S. Vincenzo, Taormina; Università Federico II, Napoli; ARNAS Civico, Palermo; Fondazione del Piemonte per l'Oncologia, Candiolo; Ospedale S. Raffaele, Milano; Istituti Ospedalieri, Cremona; Azienda Ospedaliera Ospedali Riuniti, Bergamo; Ospedale Oncologico, Catania; Ospedale Oncologico, Lucca; Università Cattolica del Sacro Cuore Agostino Gemelli, Roma; Ospedale S. Giovanni Addolorata, Roma; Ospedale S. Francesco di Paola, Paola; Azienda Ospedaliera S. Carlo, Potenza; Ospedale S. Spirito, Roma; Ospedale Belcolle, Viterbo
| | - A Zambelli
- Istituto Nazionale Tumori Regina Elena, Roma; Istituto Nazionale Tumori Fondazione Pascale, Napoli; CCO Humanitas, Catania; Ospedale Oncologico Armando Businco, Cagliari; Azienda Ospedaliero-Universitaria, Modena; Campus Bio Medico, Roma; Presidio Ospedaliero S. Salvatore, L'Aquila; Azienda Universitaria Integrata, Verona; Ospedale Vito Fazzi, Lecce; Ospedale S. Vincenzo, Taormina; Università Federico II, Napoli; ARNAS Civico, Palermo; Fondazione del Piemonte per l'Oncologia, Candiolo; Ospedale S. Raffaele, Milano; Istituti Ospedalieri, Cremona; Azienda Ospedaliera Ospedali Riuniti, Bergamo; Ospedale Oncologico, Catania; Ospedale Oncologico, Lucca; Università Cattolica del Sacro Cuore Agostino Gemelli, Roma; Ospedale S. Giovanni Addolorata, Roma; Ospedale S. Francesco di Paola, Paola; Azienda Ospedaliera S. Carlo, Potenza; Ospedale S. Spirito, Roma; Ospedale Belcolle, Viterbo
| | - G Scandurra
- Istituto Nazionale Tumori Regina Elena, Roma; Istituto Nazionale Tumori Fondazione Pascale, Napoli; CCO Humanitas, Catania; Ospedale Oncologico Armando Businco, Cagliari; Azienda Ospedaliero-Universitaria, Modena; Campus Bio Medico, Roma; Presidio Ospedaliero S. Salvatore, L'Aquila; Azienda Universitaria Integrata, Verona; Ospedale Vito Fazzi, Lecce; Ospedale S. Vincenzo, Taormina; Università Federico II, Napoli; ARNAS Civico, Palermo; Fondazione del Piemonte per l'Oncologia, Candiolo; Ospedale S. Raffaele, Milano; Istituti Ospedalieri, Cremona; Azienda Ospedaliera Ospedali Riuniti, Bergamo; Ospedale Oncologico, Catania; Ospedale Oncologico, Lucca; Università Cattolica del Sacro Cuore Agostino Gemelli, Roma; Ospedale S. Giovanni Addolorata, Roma; Ospedale S. Francesco di Paola, Paola; Azienda Ospedaliera S. Carlo, Potenza; Ospedale S. Spirito, Roma; Ospedale Belcolle, Viterbo
| | - M Russillo
- Istituto Nazionale Tumori Regina Elena, Roma; Istituto Nazionale Tumori Fondazione Pascale, Napoli; CCO Humanitas, Catania; Ospedale Oncologico Armando Businco, Cagliari; Azienda Ospedaliero-Universitaria, Modena; Campus Bio Medico, Roma; Presidio Ospedaliero S. Salvatore, L'Aquila; Azienda Universitaria Integrata, Verona; Ospedale Vito Fazzi, Lecce; Ospedale S. Vincenzo, Taormina; Università Federico II, Napoli; ARNAS Civico, Palermo; Fondazione del Piemonte per l'Oncologia, Candiolo; Ospedale S. Raffaele, Milano; Istituti Ospedalieri, Cremona; Azienda Ospedaliera Ospedali Riuniti, Bergamo; Ospedale Oncologico, Catania; Ospedale Oncologico, Lucca; Università Cattolica del Sacro Cuore Agostino Gemelli, Roma; Ospedale S. Giovanni Addolorata, Roma; Ospedale S. Francesco di Paola, Paola; Azienda Ospedaliera S. Carlo, Potenza; Ospedale S. Spirito, Roma; Ospedale Belcolle, Viterbo
| | - I Paris
- Istituto Nazionale Tumori Regina Elena, Roma; Istituto Nazionale Tumori Fondazione Pascale, Napoli; CCO Humanitas, Catania; Ospedale Oncologico Armando Businco, Cagliari; Azienda Ospedaliero-Universitaria, Modena; Campus Bio Medico, Roma; Presidio Ospedaliero S. Salvatore, L'Aquila; Azienda Universitaria Integrata, Verona; Ospedale Vito Fazzi, Lecce; Ospedale S. Vincenzo, Taormina; Università Federico II, Napoli; ARNAS Civico, Palermo; Fondazione del Piemonte per l'Oncologia, Candiolo; Ospedale S. Raffaele, Milano; Istituti Ospedalieri, Cremona; Azienda Ospedaliera Ospedali Riuniti, Bergamo; Ospedale Oncologico, Catania; Ospedale Oncologico, Lucca; Università Cattolica del Sacro Cuore Agostino Gemelli, Roma; Ospedale S. Giovanni Addolorata, Roma; Ospedale S. Francesco di Paola, Paola; Azienda Ospedaliera S. Carlo, Potenza; Ospedale S. Spirito, Roma; Ospedale Belcolle, Viterbo
| | - AM D'Ottavio
- Istituto Nazionale Tumori Regina Elena, Roma; Istituto Nazionale Tumori Fondazione Pascale, Napoli; CCO Humanitas, Catania; Ospedale Oncologico Armando Businco, Cagliari; Azienda Ospedaliero-Universitaria, Modena; Campus Bio Medico, Roma; Presidio Ospedaliero S. Salvatore, L'Aquila; Azienda Universitaria Integrata, Verona; Ospedale Vito Fazzi, Lecce; Ospedale S. Vincenzo, Taormina; Università Federico II, Napoli; ARNAS Civico, Palermo; Fondazione del Piemonte per l'Oncologia, Candiolo; Ospedale S. Raffaele, Milano; Istituti Ospedalieri, Cremona; Azienda Ospedaliera Ospedali Riuniti, Bergamo; Ospedale Oncologico, Catania; Ospedale Oncologico, Lucca; Università Cattolica del Sacro Cuore Agostino Gemelli, Roma; Ospedale S. Giovanni Addolorata, Roma; Ospedale S. Francesco di Paola, Paola; Azienda Ospedaliera S. Carlo, Potenza; Ospedale S. Spirito, Roma; Ospedale Belcolle, Viterbo
| | - G Filippelli
- Istituto Nazionale Tumori Regina Elena, Roma; Istituto Nazionale Tumori Fondazione Pascale, Napoli; CCO Humanitas, Catania; Ospedale Oncologico Armando Businco, Cagliari; Azienda Ospedaliero-Universitaria, Modena; Campus Bio Medico, Roma; Presidio Ospedaliero S. Salvatore, L'Aquila; Azienda Universitaria Integrata, Verona; Ospedale Vito Fazzi, Lecce; Ospedale S. Vincenzo, Taormina; Università Federico II, Napoli; ARNAS Civico, Palermo; Fondazione del Piemonte per l'Oncologia, Candiolo; Ospedale S. Raffaele, Milano; Istituti Ospedalieri, Cremona; Azienda Ospedaliera Ospedali Riuniti, Bergamo; Ospedale Oncologico, Catania; Ospedale Oncologico, Lucca; Università Cattolica del Sacro Cuore Agostino Gemelli, Roma; Ospedale S. Giovanni Addolorata, Roma; Ospedale S. Francesco di Paola, Paola; Azienda Ospedaliera S. Carlo, Potenza; Ospedale S. Spirito, Roma; Ospedale Belcolle, Viterbo
| | - M Giampaglia
- Istituto Nazionale Tumori Regina Elena, Roma; Istituto Nazionale Tumori Fondazione Pascale, Napoli; CCO Humanitas, Catania; Ospedale Oncologico Armando Businco, Cagliari; Azienda Ospedaliero-Universitaria, Modena; Campus Bio Medico, Roma; Presidio Ospedaliero S. Salvatore, L'Aquila; Azienda Universitaria Integrata, Verona; Ospedale Vito Fazzi, Lecce; Ospedale S. Vincenzo, Taormina; Università Federico II, Napoli; ARNAS Civico, Palermo; Fondazione del Piemonte per l'Oncologia, Candiolo; Ospedale S. Raffaele, Milano; Istituti Ospedalieri, Cremona; Azienda Ospedaliera Ospedali Riuniti, Bergamo; Ospedale Oncologico, Catania; Ospedale Oncologico, Lucca; Università Cattolica del Sacro Cuore Agostino Gemelli, Roma; Ospedale S. Giovanni Addolorata, Roma; Ospedale S. Francesco di Paola, Paola; Azienda Ospedaliera S. Carlo, Potenza; Ospedale S. Spirito, Roma; Ospedale Belcolle, Viterbo
| | - S Stani
- Istituto Nazionale Tumori Regina Elena, Roma; Istituto Nazionale Tumori Fondazione Pascale, Napoli; CCO Humanitas, Catania; Ospedale Oncologico Armando Businco, Cagliari; Azienda Ospedaliero-Universitaria, Modena; Campus Bio Medico, Roma; Presidio Ospedaliero S. Salvatore, L'Aquila; Azienda Universitaria Integrata, Verona; Ospedale Vito Fazzi, Lecce; Ospedale S. Vincenzo, Taormina; Università Federico II, Napoli; ARNAS Civico, Palermo; Fondazione del Piemonte per l'Oncologia, Candiolo; Ospedale S. Raffaele, Milano; Istituti Ospedalieri, Cremona; Azienda Ospedaliera Ospedali Riuniti, Bergamo; Ospedale Oncologico, Catania; Ospedale Oncologico, Lucca; Università Cattolica del Sacro Cuore Agostino Gemelli, Roma; Ospedale S. Giovanni Addolorata, Roma; Ospedale S. Francesco di Paola, Paola; Azienda Ospedaliera S. Carlo, Potenza; Ospedale S. Spirito, Roma; Ospedale Belcolle, Viterbo
| | - A Fabbri
- Istituto Nazionale Tumori Regina Elena, Roma; Istituto Nazionale Tumori Fondazione Pascale, Napoli; CCO Humanitas, Catania; Ospedale Oncologico Armando Businco, Cagliari; Azienda Ospedaliero-Universitaria, Modena; Campus Bio Medico, Roma; Presidio Ospedaliero S. Salvatore, L'Aquila; Azienda Universitaria Integrata, Verona; Ospedale Vito Fazzi, Lecce; Ospedale S. Vincenzo, Taormina; Università Federico II, Napoli; ARNAS Civico, Palermo; Fondazione del Piemonte per l'Oncologia, Candiolo; Ospedale S. Raffaele, Milano; Istituti Ospedalieri, Cremona; Azienda Ospedaliera Ospedali Riuniti, Bergamo; Ospedale Oncologico, Catania; Ospedale Oncologico, Lucca; Università Cattolica del Sacro Cuore Agostino Gemelli, Roma; Ospedale S. Giovanni Addolorata, Roma; Ospedale S. Francesco di Paola, Paola; Azienda Ospedaliera S. Carlo, Potenza; Ospedale S. Spirito, Roma; Ospedale Belcolle, Viterbo
| | - D Alesini
- Istituto Nazionale Tumori Regina Elena, Roma; Istituto Nazionale Tumori Fondazione Pascale, Napoli; CCO Humanitas, Catania; Ospedale Oncologico Armando Businco, Cagliari; Azienda Ospedaliero-Universitaria, Modena; Campus Bio Medico, Roma; Presidio Ospedaliero S. Salvatore, L'Aquila; Azienda Universitaria Integrata, Verona; Ospedale Vito Fazzi, Lecce; Ospedale S. Vincenzo, Taormina; Università Federico II, Napoli; ARNAS Civico, Palermo; Fondazione del Piemonte per l'Oncologia, Candiolo; Ospedale S. Raffaele, Milano; Istituti Ospedalieri, Cremona; Azienda Ospedaliera Ospedali Riuniti, Bergamo; Ospedale Oncologico, Catania; Ospedale Oncologico, Lucca; Università Cattolica del Sacro Cuore Agostino Gemelli, Roma; Ospedale S. Giovanni Addolorata, Roma; Ospedale S. Francesco di Paola, Paola; Azienda Ospedaliera S. Carlo, Potenza; Ospedale S. Spirito, Roma; Ospedale Belcolle, Viterbo
| | - D Giannarelli
- Istituto Nazionale Tumori Regina Elena, Roma; Istituto Nazionale Tumori Fondazione Pascale, Napoli; CCO Humanitas, Catania; Ospedale Oncologico Armando Businco, Cagliari; Azienda Ospedaliero-Universitaria, Modena; Campus Bio Medico, Roma; Presidio Ospedaliero S. Salvatore, L'Aquila; Azienda Universitaria Integrata, Verona; Ospedale Vito Fazzi, Lecce; Ospedale S. Vincenzo, Taormina; Università Federico II, Napoli; ARNAS Civico, Palermo; Fondazione del Piemonte per l'Oncologia, Candiolo; Ospedale S. Raffaele, Milano; Istituti Ospedalieri, Cremona; Azienda Ospedaliera Ospedali Riuniti, Bergamo; Ospedale Oncologico, Catania; Ospedale Oncologico, Lucca; Università Cattolica del Sacro Cuore Agostino Gemelli, Roma; Ospedale S. Giovanni Addolorata, Roma; Ospedale S. Francesco di Paola, Paola; Azienda Ospedaliera S. Carlo, Potenza; Ospedale S. Spirito, Roma; Ospedale Belcolle, Viterbo
| | - F Cognetti
- Istituto Nazionale Tumori Regina Elena, Roma; Istituto Nazionale Tumori Fondazione Pascale, Napoli; CCO Humanitas, Catania; Ospedale Oncologico Armando Businco, Cagliari; Azienda Ospedaliero-Universitaria, Modena; Campus Bio Medico, Roma; Presidio Ospedaliero S. Salvatore, L'Aquila; Azienda Universitaria Integrata, Verona; Ospedale Vito Fazzi, Lecce; Ospedale S. Vincenzo, Taormina; Università Federico II, Napoli; ARNAS Civico, Palermo; Fondazione del Piemonte per l'Oncologia, Candiolo; Ospedale S. Raffaele, Milano; Istituti Ospedalieri, Cremona; Azienda Ospedaliera Ospedali Riuniti, Bergamo; Ospedale Oncologico, Catania; Ospedale Oncologico, Lucca; Università Cattolica del Sacro Cuore Agostino Gemelli, Roma; Ospedale S. Giovanni Addolorata, Roma; Ospedale S. Francesco di Paola, Paola; Azienda Ospedaliera S. Carlo, Potenza; Ospedale S. Spirito, Roma; Ospedale Belcolle, Viterbo
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La Verde N, Moretti A, Damia G, Paternò E, Santini D, Garrone O, Fabi A, Ciccarese M, Cretella E, Torri V, Generali D, Grasso D, Puglisi F, Collovà E, Roila F, Bertolini A, Barni S, Vici P, Luigi C, Scandurra G, Bramati A, Dazzani MC, Farina G. Abstract OT1-01-05: PAINTER: Evaluation of eribulin tolerability and correlation between a set of polymorphisms and neuropathy in patients with metastatic breast cancer. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-ot1-01-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
BACKGROUND Eribulin is a synthetic analogue of halichondrin B which inhibits microtubule dynamics. It has been approved in Europe for the treatment of locally advanced or metastatic breast cancer (mBC) progressed after at least two chemotherapy regimens for advanced disease. The most common adverse events (AEs) were fatigue, neutropenia and peripheral neuropathy, which occurs with an incidence ranging from 13.9% to 35%. It was severe only in a small proportion of patients, suggesting an individual susceptibility. The neurotoxicity mechanisms associated with microtubulin interfering agents have not been fully defined. Few studies reported an association between some SNPs (Single Nucleotide Polymorphisms) and microtubulin interfering agents-induced neuropathy, mainly taxanes. As the use of Eribulin becomes more widespread, a better knowledge of its safety profile, outside of clinical trials, is warranted. Given that Eribulin toxicity can result in treatment discontinuation, the ability to anticipate which patients will experience severe toxicity could allow for either early intervention or even possibly for prophylactic therapy, or for a better selection of patients eligible for treatment.
METHODS This is a multicenter, interventional, single-arm, phase IV study. The primary objective is the evaluation of the safety and tolerability profile of Eribulin in an unselected population of patients with mBC. Secondary objectives are the description of compliance to treatment and efficacy.
ENDPOINTS
•Incidence, time of onset, severity and duration of all AEs experienced during treatment with Eribulin, especially the most common reported in previous studies but also other possible unexpected toxicities.
•Association between a set of selected SNPs and the onset of any grade peripheral neuropathy. Specifically, 15 SNPs located in genes involved in microtubule dynamics or resulted from genome wide association studies, will be analyzed.
•Evaluation of quality of life during treatment using validated questionnaires.
•Assessment of dose intensity and dose schedule maintenance.
•DOT (Duration Of Treatment) and OS (Overall Survival).
STATISTICAL METHODS Summary statistics will be used in order to describe patient characteristics. Safety endpoints will be estimated by means of absolute and relative frequencies and associated 95%CI. The relationship between baseline variables and the risk of severe toxicity, as well as the relationship between SNPs and risk of neuropathy will be described by means of contingency tables and their association with outcome will be assessed by χ2 test of Mantel-Haenzel and a logistic regression model. DOT and OS will be described using Kaplan-Meier curves. A sample size of 200 patients will also allow us to get a good fitting for statistical analysis of the relationship between primary endpoint and not more than 10 factors. Regarding the relationship between SNPs and risk of neuropathy it will be feasible to screen for association about 10-15 SNPs, with known prevalence >15%.
PRESENT ACCRUAL AND TARGET ACCRUAL 98 of 200 patients were enrolled until 18/05/2016. Target accrual is open for 200 patients.
CONTACT INFORMATION Nicla La Verde: nicla.laverde@asst-fbf-sacco.it.
Citation Format: La Verde N, Moretti A, Damia G, Paternò E, Santini D, Garrone O, Fabi A, Ciccarese M, Cretella E, Torri V, Generali D, Grasso D, Puglisi F, Collovà E, Roila F, Bertolini A, Barni S, Vici P, Luigi C, Scandurra G, Bramati A, Dazzani MC, Farina G. PAINTER: Evaluation of eribulin tolerability and correlation between a set of polymorphisms and neuropathy in patients with metastatic breast cancer [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr OT1-01-05.
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Affiliation(s)
- N La Verde
- ASST Fatebenefratelli Sacco, PO Fatebenefratelli, Milan, Italy; Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy; Campus Bio-Medico, University of Rome, Rome, Italy; Unit of Medical Oncology, S. Croce & Carle Teaching Hospital, Cuneo, Italy; Medical Oncology A, INT Regina Elena, Rome, Italy; Vito Fazi Hospital, Lecce, Italy; Medical Oncology, Azienda Sanitaria dell'Alto Adige, Bolzano, Italy; Laboratory of Methodology for Biomedical Research, IRCCS-Mario Negri Institute for Pharmacological Research, Milan, Italy; Unit of Molecular Therapy & Pharmacogenomic, AO Azienda Istituti Ospitalieri di Cremona, Cremona, Italy; Medical Oncology, IRCCS Foundation, San Matteo Hospital, Pavia, Italy; University Hospital of Udine, Udine, Italy; Oncology Unit, AO Ospedale Civile di Legnano, Legnano, Italy; Medical Oncology, Santa Maria Hospital, Terni, Italy; Medical Oncology Unit, A.O. Valtellina e Valchiavenna, Sondrio, Italy; Treviglio-Caravaggio Hospital, Treviglio, Italy; "Regina Elena" National Cancer Inst
| | - A Moretti
- ASST Fatebenefratelli Sacco, PO Fatebenefratelli, Milan, Italy; Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy; Campus Bio-Medico, University of Rome, Rome, Italy; Unit of Medical Oncology, S. Croce & Carle Teaching Hospital, Cuneo, Italy; Medical Oncology A, INT Regina Elena, Rome, Italy; Vito Fazi Hospital, Lecce, Italy; Medical Oncology, Azienda Sanitaria dell'Alto Adige, Bolzano, Italy; Laboratory of Methodology for Biomedical Research, IRCCS-Mario Negri Institute for Pharmacological Research, Milan, Italy; Unit of Molecular Therapy & Pharmacogenomic, AO Azienda Istituti Ospitalieri di Cremona, Cremona, Italy; Medical Oncology, IRCCS Foundation, San Matteo Hospital, Pavia, Italy; University Hospital of Udine, Udine, Italy; Oncology Unit, AO Ospedale Civile di Legnano, Legnano, Italy; Medical Oncology, Santa Maria Hospital, Terni, Italy; Medical Oncology Unit, A.O. Valtellina e Valchiavenna, Sondrio, Italy; Treviglio-Caravaggio Hospital, Treviglio, Italy; "Regina Elena" National Cancer Inst
| | - G Damia
- ASST Fatebenefratelli Sacco, PO Fatebenefratelli, Milan, Italy; Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy; Campus Bio-Medico, University of Rome, Rome, Italy; Unit of Medical Oncology, S. Croce & Carle Teaching Hospital, Cuneo, Italy; Medical Oncology A, INT Regina Elena, Rome, Italy; Vito Fazi Hospital, Lecce, Italy; Medical Oncology, Azienda Sanitaria dell'Alto Adige, Bolzano, Italy; Laboratory of Methodology for Biomedical Research, IRCCS-Mario Negri Institute for Pharmacological Research, Milan, Italy; Unit of Molecular Therapy & Pharmacogenomic, AO Azienda Istituti Ospitalieri di Cremona, Cremona, Italy; Medical Oncology, IRCCS Foundation, San Matteo Hospital, Pavia, Italy; University Hospital of Udine, Udine, Italy; Oncology Unit, AO Ospedale Civile di Legnano, Legnano, Italy; Medical Oncology, Santa Maria Hospital, Terni, Italy; Medical Oncology Unit, A.O. Valtellina e Valchiavenna, Sondrio, Italy; Treviglio-Caravaggio Hospital, Treviglio, Italy; "Regina Elena" National Cancer Inst
| | - E Paternò
- ASST Fatebenefratelli Sacco, PO Fatebenefratelli, Milan, Italy; Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy; Campus Bio-Medico, University of Rome, Rome, Italy; Unit of Medical Oncology, S. Croce & Carle Teaching Hospital, Cuneo, Italy; Medical Oncology A, INT Regina Elena, Rome, Italy; Vito Fazi Hospital, Lecce, Italy; Medical Oncology, Azienda Sanitaria dell'Alto Adige, Bolzano, Italy; Laboratory of Methodology for Biomedical Research, IRCCS-Mario Negri Institute for Pharmacological Research, Milan, Italy; Unit of Molecular Therapy & Pharmacogenomic, AO Azienda Istituti Ospitalieri di Cremona, Cremona, Italy; Medical Oncology, IRCCS Foundation, San Matteo Hospital, Pavia, Italy; University Hospital of Udine, Udine, Italy; Oncology Unit, AO Ospedale Civile di Legnano, Legnano, Italy; Medical Oncology, Santa Maria Hospital, Terni, Italy; Medical Oncology Unit, A.O. Valtellina e Valchiavenna, Sondrio, Italy; Treviglio-Caravaggio Hospital, Treviglio, Italy; "Regina Elena" National Cancer Inst
| | - D Santini
- ASST Fatebenefratelli Sacco, PO Fatebenefratelli, Milan, Italy; Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy; Campus Bio-Medico, University of Rome, Rome, Italy; Unit of Medical Oncology, S. Croce & Carle Teaching Hospital, Cuneo, Italy; Medical Oncology A, INT Regina Elena, Rome, Italy; Vito Fazi Hospital, Lecce, Italy; Medical Oncology, Azienda Sanitaria dell'Alto Adige, Bolzano, Italy; Laboratory of Methodology for Biomedical Research, IRCCS-Mario Negri Institute for Pharmacological Research, Milan, Italy; Unit of Molecular Therapy & Pharmacogenomic, AO Azienda Istituti Ospitalieri di Cremona, Cremona, Italy; Medical Oncology, IRCCS Foundation, San Matteo Hospital, Pavia, Italy; University Hospital of Udine, Udine, Italy; Oncology Unit, AO Ospedale Civile di Legnano, Legnano, Italy; Medical Oncology, Santa Maria Hospital, Terni, Italy; Medical Oncology Unit, A.O. Valtellina e Valchiavenna, Sondrio, Italy; Treviglio-Caravaggio Hospital, Treviglio, Italy; "Regina Elena" National Cancer Inst
| | - O Garrone
- ASST Fatebenefratelli Sacco, PO Fatebenefratelli, Milan, Italy; Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy; Campus Bio-Medico, University of Rome, Rome, Italy; Unit of Medical Oncology, S. Croce & Carle Teaching Hospital, Cuneo, Italy; Medical Oncology A, INT Regina Elena, Rome, Italy; Vito Fazi Hospital, Lecce, Italy; Medical Oncology, Azienda Sanitaria dell'Alto Adige, Bolzano, Italy; Laboratory of Methodology for Biomedical Research, IRCCS-Mario Negri Institute for Pharmacological Research, Milan, Italy; Unit of Molecular Therapy & Pharmacogenomic, AO Azienda Istituti Ospitalieri di Cremona, Cremona, Italy; Medical Oncology, IRCCS Foundation, San Matteo Hospital, Pavia, Italy; University Hospital of Udine, Udine, Italy; Oncology Unit, AO Ospedale Civile di Legnano, Legnano, Italy; Medical Oncology, Santa Maria Hospital, Terni, Italy; Medical Oncology Unit, A.O. Valtellina e Valchiavenna, Sondrio, Italy; Treviglio-Caravaggio Hospital, Treviglio, Italy; "Regina Elena" National Cancer Inst
| | - A Fabi
- ASST Fatebenefratelli Sacco, PO Fatebenefratelli, Milan, Italy; Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy; Campus Bio-Medico, University of Rome, Rome, Italy; Unit of Medical Oncology, S. Croce & Carle Teaching Hospital, Cuneo, Italy; Medical Oncology A, INT Regina Elena, Rome, Italy; Vito Fazi Hospital, Lecce, Italy; Medical Oncology, Azienda Sanitaria dell'Alto Adige, Bolzano, Italy; Laboratory of Methodology for Biomedical Research, IRCCS-Mario Negri Institute for Pharmacological Research, Milan, Italy; Unit of Molecular Therapy & Pharmacogenomic, AO Azienda Istituti Ospitalieri di Cremona, Cremona, Italy; Medical Oncology, IRCCS Foundation, San Matteo Hospital, Pavia, Italy; University Hospital of Udine, Udine, Italy; Oncology Unit, AO Ospedale Civile di Legnano, Legnano, Italy; Medical Oncology, Santa Maria Hospital, Terni, Italy; Medical Oncology Unit, A.O. Valtellina e Valchiavenna, Sondrio, Italy; Treviglio-Caravaggio Hospital, Treviglio, Italy; "Regina Elena" National Cancer Inst
| | - M Ciccarese
- ASST Fatebenefratelli Sacco, PO Fatebenefratelli, Milan, Italy; Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy; Campus Bio-Medico, University of Rome, Rome, Italy; Unit of Medical Oncology, S. Croce & Carle Teaching Hospital, Cuneo, Italy; Medical Oncology A, INT Regina Elena, Rome, Italy; Vito Fazi Hospital, Lecce, Italy; Medical Oncology, Azienda Sanitaria dell'Alto Adige, Bolzano, Italy; Laboratory of Methodology for Biomedical Research, IRCCS-Mario Negri Institute for Pharmacological Research, Milan, Italy; Unit of Molecular Therapy & Pharmacogenomic, AO Azienda Istituti Ospitalieri di Cremona, Cremona, Italy; Medical Oncology, IRCCS Foundation, San Matteo Hospital, Pavia, Italy; University Hospital of Udine, Udine, Italy; Oncology Unit, AO Ospedale Civile di Legnano, Legnano, Italy; Medical Oncology, Santa Maria Hospital, Terni, Italy; Medical Oncology Unit, A.O. Valtellina e Valchiavenna, Sondrio, Italy; Treviglio-Caravaggio Hospital, Treviglio, Italy; "Regina Elena" National Cancer Inst
| | - E Cretella
- ASST Fatebenefratelli Sacco, PO Fatebenefratelli, Milan, Italy; Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy; Campus Bio-Medico, University of Rome, Rome, Italy; Unit of Medical Oncology, S. Croce & Carle Teaching Hospital, Cuneo, Italy; Medical Oncology A, INT Regina Elena, Rome, Italy; Vito Fazi Hospital, Lecce, Italy; Medical Oncology, Azienda Sanitaria dell'Alto Adige, Bolzano, Italy; Laboratory of Methodology for Biomedical Research, IRCCS-Mario Negri Institute for Pharmacological Research, Milan, Italy; Unit of Molecular Therapy & Pharmacogenomic, AO Azienda Istituti Ospitalieri di Cremona, Cremona, Italy; Medical Oncology, IRCCS Foundation, San Matteo Hospital, Pavia, Italy; University Hospital of Udine, Udine, Italy; Oncology Unit, AO Ospedale Civile di Legnano, Legnano, Italy; Medical Oncology, Santa Maria Hospital, Terni, Italy; Medical Oncology Unit, A.O. Valtellina e Valchiavenna, Sondrio, Italy; Treviglio-Caravaggio Hospital, Treviglio, Italy; "Regina Elena" National Cancer Inst
| | - V Torri
- ASST Fatebenefratelli Sacco, PO Fatebenefratelli, Milan, Italy; Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy; Campus Bio-Medico, University of Rome, Rome, Italy; Unit of Medical Oncology, S. Croce & Carle Teaching Hospital, Cuneo, Italy; Medical Oncology A, INT Regina Elena, Rome, Italy; Vito Fazi Hospital, Lecce, Italy; Medical Oncology, Azienda Sanitaria dell'Alto Adige, Bolzano, Italy; Laboratory of Methodology for Biomedical Research, IRCCS-Mario Negri Institute for Pharmacological Research, Milan, Italy; Unit of Molecular Therapy & Pharmacogenomic, AO Azienda Istituti Ospitalieri di Cremona, Cremona, Italy; Medical Oncology, IRCCS Foundation, San Matteo Hospital, Pavia, Italy; University Hospital of Udine, Udine, Italy; Oncology Unit, AO Ospedale Civile di Legnano, Legnano, Italy; Medical Oncology, Santa Maria Hospital, Terni, Italy; Medical Oncology Unit, A.O. Valtellina e Valchiavenna, Sondrio, Italy; Treviglio-Caravaggio Hospital, Treviglio, Italy; "Regina Elena" National Cancer Inst
| | - D Generali
- ASST Fatebenefratelli Sacco, PO Fatebenefratelli, Milan, Italy; Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy; Campus Bio-Medico, University of Rome, Rome, Italy; Unit of Medical Oncology, S. Croce & Carle Teaching Hospital, Cuneo, Italy; Medical Oncology A, INT Regina Elena, Rome, Italy; Vito Fazi Hospital, Lecce, Italy; Medical Oncology, Azienda Sanitaria dell'Alto Adige, Bolzano, Italy; Laboratory of Methodology for Biomedical Research, IRCCS-Mario Negri Institute for Pharmacological Research, Milan, Italy; Unit of Molecular Therapy & Pharmacogenomic, AO Azienda Istituti Ospitalieri di Cremona, Cremona, Italy; Medical Oncology, IRCCS Foundation, San Matteo Hospital, Pavia, Italy; University Hospital of Udine, Udine, Italy; Oncology Unit, AO Ospedale Civile di Legnano, Legnano, Italy; Medical Oncology, Santa Maria Hospital, Terni, Italy; Medical Oncology Unit, A.O. Valtellina e Valchiavenna, Sondrio, Italy; Treviglio-Caravaggio Hospital, Treviglio, Italy; "Regina Elena" National Cancer Inst
| | - D Grasso
- ASST Fatebenefratelli Sacco, PO Fatebenefratelli, Milan, Italy; Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy; Campus Bio-Medico, University of Rome, Rome, Italy; Unit of Medical Oncology, S. Croce & Carle Teaching Hospital, Cuneo, Italy; Medical Oncology A, INT Regina Elena, Rome, Italy; Vito Fazi Hospital, Lecce, Italy; Medical Oncology, Azienda Sanitaria dell'Alto Adige, Bolzano, Italy; Laboratory of Methodology for Biomedical Research, IRCCS-Mario Negri Institute for Pharmacological Research, Milan, Italy; Unit of Molecular Therapy & Pharmacogenomic, AO Azienda Istituti Ospitalieri di Cremona, Cremona, Italy; Medical Oncology, IRCCS Foundation, San Matteo Hospital, Pavia, Italy; University Hospital of Udine, Udine, Italy; Oncology Unit, AO Ospedale Civile di Legnano, Legnano, Italy; Medical Oncology, Santa Maria Hospital, Terni, Italy; Medical Oncology Unit, A.O. Valtellina e Valchiavenna, Sondrio, Italy; Treviglio-Caravaggio Hospital, Treviglio, Italy; "Regina Elena" National Cancer Inst
| | - F Puglisi
- ASST Fatebenefratelli Sacco, PO Fatebenefratelli, Milan, Italy; Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy; Campus Bio-Medico, University of Rome, Rome, Italy; Unit of Medical Oncology, S. Croce & Carle Teaching Hospital, Cuneo, Italy; Medical Oncology A, INT Regina Elena, Rome, Italy; Vito Fazi Hospital, Lecce, Italy; Medical Oncology, Azienda Sanitaria dell'Alto Adige, Bolzano, Italy; Laboratory of Methodology for Biomedical Research, IRCCS-Mario Negri Institute for Pharmacological Research, Milan, Italy; Unit of Molecular Therapy & Pharmacogenomic, AO Azienda Istituti Ospitalieri di Cremona, Cremona, Italy; Medical Oncology, IRCCS Foundation, San Matteo Hospital, Pavia, Italy; University Hospital of Udine, Udine, Italy; Oncology Unit, AO Ospedale Civile di Legnano, Legnano, Italy; Medical Oncology, Santa Maria Hospital, Terni, Italy; Medical Oncology Unit, A.O. Valtellina e Valchiavenna, Sondrio, Italy; Treviglio-Caravaggio Hospital, Treviglio, Italy; "Regina Elena" National Cancer Inst
| | - E Collovà
- ASST Fatebenefratelli Sacco, PO Fatebenefratelli, Milan, Italy; Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy; Campus Bio-Medico, University of Rome, Rome, Italy; Unit of Medical Oncology, S. Croce & Carle Teaching Hospital, Cuneo, Italy; Medical Oncology A, INT Regina Elena, Rome, Italy; Vito Fazi Hospital, Lecce, Italy; Medical Oncology, Azienda Sanitaria dell'Alto Adige, Bolzano, Italy; Laboratory of Methodology for Biomedical Research, IRCCS-Mario Negri Institute for Pharmacological Research, Milan, Italy; Unit of Molecular Therapy & Pharmacogenomic, AO Azienda Istituti Ospitalieri di Cremona, Cremona, Italy; Medical Oncology, IRCCS Foundation, San Matteo Hospital, Pavia, Italy; University Hospital of Udine, Udine, Italy; Oncology Unit, AO Ospedale Civile di Legnano, Legnano, Italy; Medical Oncology, Santa Maria Hospital, Terni, Italy; Medical Oncology Unit, A.O. Valtellina e Valchiavenna, Sondrio, Italy; Treviglio-Caravaggio Hospital, Treviglio, Italy; "Regina Elena" National Cancer Inst
| | - F Roila
- ASST Fatebenefratelli Sacco, PO Fatebenefratelli, Milan, Italy; Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy; Campus Bio-Medico, University of Rome, Rome, Italy; Unit of Medical Oncology, S. Croce & Carle Teaching Hospital, Cuneo, Italy; Medical Oncology A, INT Regina Elena, Rome, Italy; Vito Fazi Hospital, Lecce, Italy; Medical Oncology, Azienda Sanitaria dell'Alto Adige, Bolzano, Italy; Laboratory of Methodology for Biomedical Research, IRCCS-Mario Negri Institute for Pharmacological Research, Milan, Italy; Unit of Molecular Therapy & Pharmacogenomic, AO Azienda Istituti Ospitalieri di Cremona, Cremona, Italy; Medical Oncology, IRCCS Foundation, San Matteo Hospital, Pavia, Italy; University Hospital of Udine, Udine, Italy; Oncology Unit, AO Ospedale Civile di Legnano, Legnano, Italy; Medical Oncology, Santa Maria Hospital, Terni, Italy; Medical Oncology Unit, A.O. Valtellina e Valchiavenna, Sondrio, Italy; Treviglio-Caravaggio Hospital, Treviglio, Italy; "Regina Elena" National Cancer Inst
| | - A Bertolini
- ASST Fatebenefratelli Sacco, PO Fatebenefratelli, Milan, Italy; Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy; Campus Bio-Medico, University of Rome, Rome, Italy; Unit of Medical Oncology, S. Croce & Carle Teaching Hospital, Cuneo, Italy; Medical Oncology A, INT Regina Elena, Rome, Italy; Vito Fazi Hospital, Lecce, Italy; Medical Oncology, Azienda Sanitaria dell'Alto Adige, Bolzano, Italy; Laboratory of Methodology for Biomedical Research, IRCCS-Mario Negri Institute for Pharmacological Research, Milan, Italy; Unit of Molecular Therapy & Pharmacogenomic, AO Azienda Istituti Ospitalieri di Cremona, Cremona, Italy; Medical Oncology, IRCCS Foundation, San Matteo Hospital, Pavia, Italy; University Hospital of Udine, Udine, Italy; Oncology Unit, AO Ospedale Civile di Legnano, Legnano, Italy; Medical Oncology, Santa Maria Hospital, Terni, Italy; Medical Oncology Unit, A.O. Valtellina e Valchiavenna, Sondrio, Italy; Treviglio-Caravaggio Hospital, Treviglio, Italy; "Regina Elena" National Cancer Inst
| | - S Barni
- ASST Fatebenefratelli Sacco, PO Fatebenefratelli, Milan, Italy; Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy; Campus Bio-Medico, University of Rome, Rome, Italy; Unit of Medical Oncology, S. Croce & Carle Teaching Hospital, Cuneo, Italy; Medical Oncology A, INT Regina Elena, Rome, Italy; Vito Fazi Hospital, Lecce, Italy; Medical Oncology, Azienda Sanitaria dell'Alto Adige, Bolzano, Italy; Laboratory of Methodology for Biomedical Research, IRCCS-Mario Negri Institute for Pharmacological Research, Milan, Italy; Unit of Molecular Therapy & Pharmacogenomic, AO Azienda Istituti Ospitalieri di Cremona, Cremona, Italy; Medical Oncology, IRCCS Foundation, San Matteo Hospital, Pavia, Italy; University Hospital of Udine, Udine, Italy; Oncology Unit, AO Ospedale Civile di Legnano, Legnano, Italy; Medical Oncology, Santa Maria Hospital, Terni, Italy; Medical Oncology Unit, A.O. Valtellina e Valchiavenna, Sondrio, Italy; Treviglio-Caravaggio Hospital, Treviglio, Italy; "Regina Elena" National Cancer Inst
| | - P Vici
- ASST Fatebenefratelli Sacco, PO Fatebenefratelli, Milan, Italy; Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy; Campus Bio-Medico, University of Rome, Rome, Italy; Unit of Medical Oncology, S. Croce & Carle Teaching Hospital, Cuneo, Italy; Medical Oncology A, INT Regina Elena, Rome, Italy; Vito Fazi Hospital, Lecce, Italy; Medical Oncology, Azienda Sanitaria dell'Alto Adige, Bolzano, Italy; Laboratory of Methodology for Biomedical Research, IRCCS-Mario Negri Institute for Pharmacological Research, Milan, Italy; Unit of Molecular Therapy & Pharmacogenomic, AO Azienda Istituti Ospitalieri di Cremona, Cremona, Italy; Medical Oncology, IRCCS Foundation, San Matteo Hospital, Pavia, Italy; University Hospital of Udine, Udine, Italy; Oncology Unit, AO Ospedale Civile di Legnano, Legnano, Italy; Medical Oncology, Santa Maria Hospital, Terni, Italy; Medical Oncology Unit, A.O. Valtellina e Valchiavenna, Sondrio, Italy; Treviglio-Caravaggio Hospital, Treviglio, Italy; "Regina Elena" National Cancer Inst
| | - C Luigi
- ASST Fatebenefratelli Sacco, PO Fatebenefratelli, Milan, Italy; Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy; Campus Bio-Medico, University of Rome, Rome, Italy; Unit of Medical Oncology, S. Croce & Carle Teaching Hospital, Cuneo, Italy; Medical Oncology A, INT Regina Elena, Rome, Italy; Vito Fazi Hospital, Lecce, Italy; Medical Oncology, Azienda Sanitaria dell'Alto Adige, Bolzano, Italy; Laboratory of Methodology for Biomedical Research, IRCCS-Mario Negri Institute for Pharmacological Research, Milan, Italy; Unit of Molecular Therapy & Pharmacogenomic, AO Azienda Istituti Ospitalieri di Cremona, Cremona, Italy; Medical Oncology, IRCCS Foundation, San Matteo Hospital, Pavia, Italy; University Hospital of Udine, Udine, Italy; Oncology Unit, AO Ospedale Civile di Legnano, Legnano, Italy; Medical Oncology, Santa Maria Hospital, Terni, Italy; Medical Oncology Unit, A.O. Valtellina e Valchiavenna, Sondrio, Italy; Treviglio-Caravaggio Hospital, Treviglio, Italy; "Regina Elena" National Cancer Inst
| | - G Scandurra
- ASST Fatebenefratelli Sacco, PO Fatebenefratelli, Milan, Italy; Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy; Campus Bio-Medico, University of Rome, Rome, Italy; Unit of Medical Oncology, S. Croce & Carle Teaching Hospital, Cuneo, Italy; Medical Oncology A, INT Regina Elena, Rome, Italy; Vito Fazi Hospital, Lecce, Italy; Medical Oncology, Azienda Sanitaria dell'Alto Adige, Bolzano, Italy; Laboratory of Methodology for Biomedical Research, IRCCS-Mario Negri Institute for Pharmacological Research, Milan, Italy; Unit of Molecular Therapy & Pharmacogenomic, AO Azienda Istituti Ospitalieri di Cremona, Cremona, Italy; Medical Oncology, IRCCS Foundation, San Matteo Hospital, Pavia, Italy; University Hospital of Udine, Udine, Italy; Oncology Unit, AO Ospedale Civile di Legnano, Legnano, Italy; Medical Oncology, Santa Maria Hospital, Terni, Italy; Medical Oncology Unit, A.O. Valtellina e Valchiavenna, Sondrio, Italy; Treviglio-Caravaggio Hospital, Treviglio, Italy; "Regina Elena" National Cancer Inst
| | - A Bramati
- ASST Fatebenefratelli Sacco, PO Fatebenefratelli, Milan, Italy; Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy; Campus Bio-Medico, University of Rome, Rome, Italy; Unit of Medical Oncology, S. Croce & Carle Teaching Hospital, Cuneo, Italy; Medical Oncology A, INT Regina Elena, Rome, Italy; Vito Fazi Hospital, Lecce, Italy; Medical Oncology, Azienda Sanitaria dell'Alto Adige, Bolzano, Italy; Laboratory of Methodology for Biomedical Research, IRCCS-Mario Negri Institute for Pharmacological Research, Milan, Italy; Unit of Molecular Therapy & Pharmacogenomic, AO Azienda Istituti Ospitalieri di Cremona, Cremona, Italy; Medical Oncology, IRCCS Foundation, San Matteo Hospital, Pavia, Italy; University Hospital of Udine, Udine, Italy; Oncology Unit, AO Ospedale Civile di Legnano, Legnano, Italy; Medical Oncology, Santa Maria Hospital, Terni, Italy; Medical Oncology Unit, A.O. Valtellina e Valchiavenna, Sondrio, Italy; Treviglio-Caravaggio Hospital, Treviglio, Italy; "Regina Elena" National Cancer Inst
| | - MC Dazzani
- ASST Fatebenefratelli Sacco, PO Fatebenefratelli, Milan, Italy; Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy; Campus Bio-Medico, University of Rome, Rome, Italy; Unit of Medical Oncology, S. Croce & Carle Teaching Hospital, Cuneo, Italy; Medical Oncology A, INT Regina Elena, Rome, Italy; Vito Fazi Hospital, Lecce, Italy; Medical Oncology, Azienda Sanitaria dell'Alto Adige, Bolzano, Italy; Laboratory of Methodology for Biomedical Research, IRCCS-Mario Negri Institute for Pharmacological Research, Milan, Italy; Unit of Molecular Therapy & Pharmacogenomic, AO Azienda Istituti Ospitalieri di Cremona, Cremona, Italy; Medical Oncology, IRCCS Foundation, San Matteo Hospital, Pavia, Italy; University Hospital of Udine, Udine, Italy; Oncology Unit, AO Ospedale Civile di Legnano, Legnano, Italy; Medical Oncology, Santa Maria Hospital, Terni, Italy; Medical Oncology Unit, A.O. Valtellina e Valchiavenna, Sondrio, Italy; Treviglio-Caravaggio Hospital, Treviglio, Italy; "Regina Elena" National Cancer Inst
| | - G Farina
- ASST Fatebenefratelli Sacco, PO Fatebenefratelli, Milan, Italy; Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy; Campus Bio-Medico, University of Rome, Rome, Italy; Unit of Medical Oncology, S. Croce & Carle Teaching Hospital, Cuneo, Italy; Medical Oncology A, INT Regina Elena, Rome, Italy; Vito Fazi Hospital, Lecce, Italy; Medical Oncology, Azienda Sanitaria dell'Alto Adige, Bolzano, Italy; Laboratory of Methodology for Biomedical Research, IRCCS-Mario Negri Institute for Pharmacological Research, Milan, Italy; Unit of Molecular Therapy & Pharmacogenomic, AO Azienda Istituti Ospitalieri di Cremona, Cremona, Italy; Medical Oncology, IRCCS Foundation, San Matteo Hospital, Pavia, Italy; University Hospital of Udine, Udine, Italy; Oncology Unit, AO Ospedale Civile di Legnano, Legnano, Italy; Medical Oncology, Santa Maria Hospital, Terni, Italy; Medical Oncology Unit, A.O. Valtellina e Valchiavenna, Sondrio, Italy; Treviglio-Caravaggio Hospital, Treviglio, Italy; "Regina Elena" National Cancer Inst
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Fabi A, Alesini D, De Laurentiis M, Valle E, Santini D, Cannita K, Carbognin L, Ciccarese M, Arpino G, Leonardi V, Montemurro F, La Verde N, Generali D, Scandurra G, Russillo M, Paris I, D'Ottavio A, Filippelli G, Stani S, Giannarelli D, Cognetti F. Italian observational study on T-DM1 in HER2 positive advanced breast cancer patients: real world effectiveness and safety. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw337.07] [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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Forcignanò R, Petrucelli L, Cazzaniga ME, Lupo LI, Chiuri VE, Cairo G, De Matteis E, Febbraro A, Giordano G, Campidoglio S, Fabi A, Giampaglia M, Bilancia D, La Verde N, Maiello E, Morritti M, Giotta F, Lorusso V, Scavelli C, Romito S, Cusmai A, Palmiotti G, Tornesello A, Ciccarese M. Abstract P4-13-15: Dose intensity and efficacy of the combination of everolimus and exemestane (EVE/EXE) in a real world population of hormone receptor positive advanced breast cancer: A multicenter Italian experience. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p4-13-15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
BACKGROUND: Everolimus, an mTOR inhibitor, in combination with exemestane is approved for hormone receptor (HR) positive advanced breast cancer (ABC), after failure of treatment with non-steroidal aromatase inhibitor (NSAI). We assessed the toxicity of the combination and the correlation between dose intensity and response to therapy, in a real world population of ABC from 11 Italian centers. Moreover, we evaluated OS of the whole population, RR and PFS according to line of treatment (from 1rd to 3th and from 4th on).
METHODS: 154 pts were treated with combination of everolimus 10 mg and exemestane 25 mg daily from 05/2011 today. Median age was 62 (47-82). Median time to metastatic disease was 49 months (0-269). Median number of metastatic sites was 2 (55.2% of pts visceral versus 44.8% non visceral disease). N=117 (75.9%) pretreated with HT as adjuvant; N=126 pts (81.8%) treated with HT for advanced disease prior to EVE/EXE, with a median of one line (0-5). N=102 pts (66.2%) treated with chemotherapy for metastatic disease, with a median of one line (0-6) before everolimus treatment.
RESULTS: Sixteen pts received EVE/EXE as 1st line (10.4%), 39 as 2nd (25.3%), 37 as 3rd (24%), 62 as 4th or more (40,3%). Response was evaluable in 127 out of 154 pts; CR/PR/SD respectively 5/27/56 pts. RR according to line (from 1st to 3rd vs ≥ 4th) was respectively 22.8% vs 26.4% (p=0,864). The median PFS for all population (150 pts) was 38 weeks (95% CI: 33-42). The PFS according to line (1st- 3rd vs ≥ 4th) was 38 wks in both subgroups, p=0.73. OS (126/154 pts) was 28 mths (95% CI: 31-38). The most frequent adverse events were collected in the table.
Adverse eventsOverall %Grade 3-4 %Stomatitis55.810.4Hypercholesterolemia47.40.0Asthenia42.95.2Hyperglycemia36.45.8Hypertriglyceridemia29.20.6Anemia28.63.9Peripheral edema24.71.3Rash23.40.6Increased ALT/AST/GGT21.46.5Thrombocytopenia19.53.9Diarrhea18.81.9Weight loss18.21.3Dysgeusia17.50.6Pneumonitis15.61.9Cutaneous toxicity14.90.6Infection14.33.2Neutropenia11.71.9Nausea11.70.0Anorexia (without stomatitis)10.41.3Electrolyte alterations9.71.3Urea/creatinine increase6.51.3Vomiting6.50.0Uric acid increase4.50.0
Median duration of treatment with everolimus 10 mg and 5 mg was respectively 180 (9-854) and 129 days (3-738). Fifty-eight pts (37,6%) never stopped treatment with everolimus 10 mg; 16 pts (10,4%) definitively stopped everolimus for toxicity; 80 pts (52,0%) temporarily interrupted the treatment, resuming at dose level 10 mg (31 pts) or reducing at 5 mg (49 pts). Main reason for discontinuation/interruption was stomatitis G2-G3. RR and PFS evaluated according to dose intensity, 10 mg vs 5 mg, were respectively 25.9% vs 30% p=0.779, 38 wks (27-44) vs 40 wks (31-48) P=0.614
CONCLUSIONS: efficacy in terms of RR and PFS of the combination EVE/EXE is not related to dose intensity (10 mg vs 5 mg), the discontinuation of the treatment is high with the starting dose of 10 mg, the toxicity is consistent with previous phase II-III studies although we collected some different toxicities.
Citation Format: Forcignanò R, Petrucelli L, Cazzaniga ME, Lupo LI, Chiuri VE, Cairo G, De Matteis E, Febbraro A, Giordano G, Campidoglio S, Fabi A, Giampaglia M, Bilancia D, La Verde N, Maiello E, Morritti M, Giotta F, Lorusso V, Scavelli C, Romito S, Cusmai A, Palmiotti G, Tornesello A, Ciccarese M. Dose intensity and efficacy of the combination of everolimus and exemestane (EVE/EXE) in a real world population of hormone receptor positive advanced breast cancer: A multicenter Italian experience. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P4-13-15.
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Affiliation(s)
- R Forcignanò
- "Vito Fazzi" Hospital, Lecce, Italy; "AO San Gerardo", Monza, Italy; "Sacro Cuore di Gesù Fatebenefratelli" Hospital, Benevento, Italy; "Regina Elena" National Cancer Institute, Roma, Italy; "San Carlo" Hospital, Potenza, Italy; "AO Fatebenefratelli e Oftalmico", Milano, Italy; "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo (Foggia), Italy; "Giovanni Paolo II" Institute, Bari, Italy; "S. Cuore di Gesù" Hospital, Gallipoli (Lecce), Italy; "Ospedali Riuniti" Hospital, Foggia, Italy; "Di Venere" Hospital, Bari, Italy
| | - L Petrucelli
- "Vito Fazzi" Hospital, Lecce, Italy; "AO San Gerardo", Monza, Italy; "Sacro Cuore di Gesù Fatebenefratelli" Hospital, Benevento, Italy; "Regina Elena" National Cancer Institute, Roma, Italy; "San Carlo" Hospital, Potenza, Italy; "AO Fatebenefratelli e Oftalmico", Milano, Italy; "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo (Foggia), Italy; "Giovanni Paolo II" Institute, Bari, Italy; "S. Cuore di Gesù" Hospital, Gallipoli (Lecce), Italy; "Ospedali Riuniti" Hospital, Foggia, Italy; "Di Venere" Hospital, Bari, Italy
| | - ME Cazzaniga
- "Vito Fazzi" Hospital, Lecce, Italy; "AO San Gerardo", Monza, Italy; "Sacro Cuore di Gesù Fatebenefratelli" Hospital, Benevento, Italy; "Regina Elena" National Cancer Institute, Roma, Italy; "San Carlo" Hospital, Potenza, Italy; "AO Fatebenefratelli e Oftalmico", Milano, Italy; "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo (Foggia), Italy; "Giovanni Paolo II" Institute, Bari, Italy; "S. Cuore di Gesù" Hospital, Gallipoli (Lecce), Italy; "Ospedali Riuniti" Hospital, Foggia, Italy; "Di Venere" Hospital, Bari, Italy
| | - LI Lupo
- "Vito Fazzi" Hospital, Lecce, Italy; "AO San Gerardo", Monza, Italy; "Sacro Cuore di Gesù Fatebenefratelli" Hospital, Benevento, Italy; "Regina Elena" National Cancer Institute, Roma, Italy; "San Carlo" Hospital, Potenza, Italy; "AO Fatebenefratelli e Oftalmico", Milano, Italy; "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo (Foggia), Italy; "Giovanni Paolo II" Institute, Bari, Italy; "S. Cuore di Gesù" Hospital, Gallipoli (Lecce), Italy; "Ospedali Riuniti" Hospital, Foggia, Italy; "Di Venere" Hospital, Bari, Italy
| | - VE Chiuri
- "Vito Fazzi" Hospital, Lecce, Italy; "AO San Gerardo", Monza, Italy; "Sacro Cuore di Gesù Fatebenefratelli" Hospital, Benevento, Italy; "Regina Elena" National Cancer Institute, Roma, Italy; "San Carlo" Hospital, Potenza, Italy; "AO Fatebenefratelli e Oftalmico", Milano, Italy; "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo (Foggia), Italy; "Giovanni Paolo II" Institute, Bari, Italy; "S. Cuore di Gesù" Hospital, Gallipoli (Lecce), Italy; "Ospedali Riuniti" Hospital, Foggia, Italy; "Di Venere" Hospital, Bari, Italy
| | - G Cairo
- "Vito Fazzi" Hospital, Lecce, Italy; "AO San Gerardo", Monza, Italy; "Sacro Cuore di Gesù Fatebenefratelli" Hospital, Benevento, Italy; "Regina Elena" National Cancer Institute, Roma, Italy; "San Carlo" Hospital, Potenza, Italy; "AO Fatebenefratelli e Oftalmico", Milano, Italy; "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo (Foggia), Italy; "Giovanni Paolo II" Institute, Bari, Italy; "S. Cuore di Gesù" Hospital, Gallipoli (Lecce), Italy; "Ospedali Riuniti" Hospital, Foggia, Italy; "Di Venere" Hospital, Bari, Italy
| | - E De Matteis
- "Vito Fazzi" Hospital, Lecce, Italy; "AO San Gerardo", Monza, Italy; "Sacro Cuore di Gesù Fatebenefratelli" Hospital, Benevento, Italy; "Regina Elena" National Cancer Institute, Roma, Italy; "San Carlo" Hospital, Potenza, Italy; "AO Fatebenefratelli e Oftalmico", Milano, Italy; "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo (Foggia), Italy; "Giovanni Paolo II" Institute, Bari, Italy; "S. Cuore di Gesù" Hospital, Gallipoli (Lecce), Italy; "Ospedali Riuniti" Hospital, Foggia, Italy; "Di Venere" Hospital, Bari, Italy
| | - A Febbraro
- "Vito Fazzi" Hospital, Lecce, Italy; "AO San Gerardo", Monza, Italy; "Sacro Cuore di Gesù Fatebenefratelli" Hospital, Benevento, Italy; "Regina Elena" National Cancer Institute, Roma, Italy; "San Carlo" Hospital, Potenza, Italy; "AO Fatebenefratelli e Oftalmico", Milano, Italy; "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo (Foggia), Italy; "Giovanni Paolo II" Institute, Bari, Italy; "S. Cuore di Gesù" Hospital, Gallipoli (Lecce), Italy; "Ospedali Riuniti" Hospital, Foggia, Italy; "Di Venere" Hospital, Bari, Italy
| | - G Giordano
- "Vito Fazzi" Hospital, Lecce, Italy; "AO San Gerardo", Monza, Italy; "Sacro Cuore di Gesù Fatebenefratelli" Hospital, Benevento, Italy; "Regina Elena" National Cancer Institute, Roma, Italy; "San Carlo" Hospital, Potenza, Italy; "AO Fatebenefratelli e Oftalmico", Milano, Italy; "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo (Foggia), Italy; "Giovanni Paolo II" Institute, Bari, Italy; "S. Cuore di Gesù" Hospital, Gallipoli (Lecce), Italy; "Ospedali Riuniti" Hospital, Foggia, Italy; "Di Venere" Hospital, Bari, Italy
| | - S Campidoglio
- "Vito Fazzi" Hospital, Lecce, Italy; "AO San Gerardo", Monza, Italy; "Sacro Cuore di Gesù Fatebenefratelli" Hospital, Benevento, Italy; "Regina Elena" National Cancer Institute, Roma, Italy; "San Carlo" Hospital, Potenza, Italy; "AO Fatebenefratelli e Oftalmico", Milano, Italy; "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo (Foggia), Italy; "Giovanni Paolo II" Institute, Bari, Italy; "S. Cuore di Gesù" Hospital, Gallipoli (Lecce), Italy; "Ospedali Riuniti" Hospital, Foggia, Italy; "Di Venere" Hospital, Bari, Italy
| | - A Fabi
- "Vito Fazzi" Hospital, Lecce, Italy; "AO San Gerardo", Monza, Italy; "Sacro Cuore di Gesù Fatebenefratelli" Hospital, Benevento, Italy; "Regina Elena" National Cancer Institute, Roma, Italy; "San Carlo" Hospital, Potenza, Italy; "AO Fatebenefratelli e Oftalmico", Milano, Italy; "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo (Foggia), Italy; "Giovanni Paolo II" Institute, Bari, Italy; "S. Cuore di Gesù" Hospital, Gallipoli (Lecce), Italy; "Ospedali Riuniti" Hospital, Foggia, Italy; "Di Venere" Hospital, Bari, Italy
| | - M Giampaglia
- "Vito Fazzi" Hospital, Lecce, Italy; "AO San Gerardo", Monza, Italy; "Sacro Cuore di Gesù Fatebenefratelli" Hospital, Benevento, Italy; "Regina Elena" National Cancer Institute, Roma, Italy; "San Carlo" Hospital, Potenza, Italy; "AO Fatebenefratelli e Oftalmico", Milano, Italy; "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo (Foggia), Italy; "Giovanni Paolo II" Institute, Bari, Italy; "S. Cuore di Gesù" Hospital, Gallipoli (Lecce), Italy; "Ospedali Riuniti" Hospital, Foggia, Italy; "Di Venere" Hospital, Bari, Italy
| | - D Bilancia
- "Vito Fazzi" Hospital, Lecce, Italy; "AO San Gerardo", Monza, Italy; "Sacro Cuore di Gesù Fatebenefratelli" Hospital, Benevento, Italy; "Regina Elena" National Cancer Institute, Roma, Italy; "San Carlo" Hospital, Potenza, Italy; "AO Fatebenefratelli e Oftalmico", Milano, Italy; "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo (Foggia), Italy; "Giovanni Paolo II" Institute, Bari, Italy; "S. Cuore di Gesù" Hospital, Gallipoli (Lecce), Italy; "Ospedali Riuniti" Hospital, Foggia, Italy; "Di Venere" Hospital, Bari, Italy
| | - N La Verde
- "Vito Fazzi" Hospital, Lecce, Italy; "AO San Gerardo", Monza, Italy; "Sacro Cuore di Gesù Fatebenefratelli" Hospital, Benevento, Italy; "Regina Elena" National Cancer Institute, Roma, Italy; "San Carlo" Hospital, Potenza, Italy; "AO Fatebenefratelli e Oftalmico", Milano, Italy; "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo (Foggia), Italy; "Giovanni Paolo II" Institute, Bari, Italy; "S. Cuore di Gesù" Hospital, Gallipoli (Lecce), Italy; "Ospedali Riuniti" Hospital, Foggia, Italy; "Di Venere" Hospital, Bari, Italy
| | - E Maiello
- "Vito Fazzi" Hospital, Lecce, Italy; "AO San Gerardo", Monza, Italy; "Sacro Cuore di Gesù Fatebenefratelli" Hospital, Benevento, Italy; "Regina Elena" National Cancer Institute, Roma, Italy; "San Carlo" Hospital, Potenza, Italy; "AO Fatebenefratelli e Oftalmico", Milano, Italy; "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo (Foggia), Italy; "Giovanni Paolo II" Institute, Bari, Italy; "S. Cuore di Gesù" Hospital, Gallipoli (Lecce), Italy; "Ospedali Riuniti" Hospital, Foggia, Italy; "Di Venere" Hospital, Bari, Italy
| | - M Morritti
- "Vito Fazzi" Hospital, Lecce, Italy; "AO San Gerardo", Monza, Italy; "Sacro Cuore di Gesù Fatebenefratelli" Hospital, Benevento, Italy; "Regina Elena" National Cancer Institute, Roma, Italy; "San Carlo" Hospital, Potenza, Italy; "AO Fatebenefratelli e Oftalmico", Milano, Italy; "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo (Foggia), Italy; "Giovanni Paolo II" Institute, Bari, Italy; "S. Cuore di Gesù" Hospital, Gallipoli (Lecce), Italy; "Ospedali Riuniti" Hospital, Foggia, Italy; "Di Venere" Hospital, Bari, Italy
| | - F Giotta
- "Vito Fazzi" Hospital, Lecce, Italy; "AO San Gerardo", Monza, Italy; "Sacro Cuore di Gesù Fatebenefratelli" Hospital, Benevento, Italy; "Regina Elena" National Cancer Institute, Roma, Italy; "San Carlo" Hospital, Potenza, Italy; "AO Fatebenefratelli e Oftalmico", Milano, Italy; "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo (Foggia), Italy; "Giovanni Paolo II" Institute, Bari, Italy; "S. Cuore di Gesù" Hospital, Gallipoli (Lecce), Italy; "Ospedali Riuniti" Hospital, Foggia, Italy; "Di Venere" Hospital, Bari, Italy
| | - V Lorusso
- "Vito Fazzi" Hospital, Lecce, Italy; "AO San Gerardo", Monza, Italy; "Sacro Cuore di Gesù Fatebenefratelli" Hospital, Benevento, Italy; "Regina Elena" National Cancer Institute, Roma, Italy; "San Carlo" Hospital, Potenza, Italy; "AO Fatebenefratelli e Oftalmico", Milano, Italy; "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo (Foggia), Italy; "Giovanni Paolo II" Institute, Bari, Italy; "S. Cuore di Gesù" Hospital, Gallipoli (Lecce), Italy; "Ospedali Riuniti" Hospital, Foggia, Italy; "Di Venere" Hospital, Bari, Italy
| | - C Scavelli
- "Vito Fazzi" Hospital, Lecce, Italy; "AO San Gerardo", Monza, Italy; "Sacro Cuore di Gesù Fatebenefratelli" Hospital, Benevento, Italy; "Regina Elena" National Cancer Institute, Roma, Italy; "San Carlo" Hospital, Potenza, Italy; "AO Fatebenefratelli e Oftalmico", Milano, Italy; "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo (Foggia), Italy; "Giovanni Paolo II" Institute, Bari, Italy; "S. Cuore di Gesù" Hospital, Gallipoli (Lecce), Italy; "Ospedali Riuniti" Hospital, Foggia, Italy; "Di Venere" Hospital, Bari, Italy
| | - S Romito
- "Vito Fazzi" Hospital, Lecce, Italy; "AO San Gerardo", Monza, Italy; "Sacro Cuore di Gesù Fatebenefratelli" Hospital, Benevento, Italy; "Regina Elena" National Cancer Institute, Roma, Italy; "San Carlo" Hospital, Potenza, Italy; "AO Fatebenefratelli e Oftalmico", Milano, Italy; "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo (Foggia), Italy; "Giovanni Paolo II" Institute, Bari, Italy; "S. Cuore di Gesù" Hospital, Gallipoli (Lecce), Italy; "Ospedali Riuniti" Hospital, Foggia, Italy; "Di Venere" Hospital, Bari, Italy
| | - A Cusmai
- "Vito Fazzi" Hospital, Lecce, Italy; "AO San Gerardo", Monza, Italy; "Sacro Cuore di Gesù Fatebenefratelli" Hospital, Benevento, Italy; "Regina Elena" National Cancer Institute, Roma, Italy; "San Carlo" Hospital, Potenza, Italy; "AO Fatebenefratelli e Oftalmico", Milano, Italy; "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo (Foggia), Italy; "Giovanni Paolo II" Institute, Bari, Italy; "S. Cuore di Gesù" Hospital, Gallipoli (Lecce), Italy; "Ospedali Riuniti" Hospital, Foggia, Italy; "Di Venere" Hospital, Bari, Italy
| | - G Palmiotti
- "Vito Fazzi" Hospital, Lecce, Italy; "AO San Gerardo", Monza, Italy; "Sacro Cuore di Gesù Fatebenefratelli" Hospital, Benevento, Italy; "Regina Elena" National Cancer Institute, Roma, Italy; "San Carlo" Hospital, Potenza, Italy; "AO Fatebenefratelli e Oftalmico", Milano, Italy; "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo (Foggia), Italy; "Giovanni Paolo II" Institute, Bari, Italy; "S. Cuore di Gesù" Hospital, Gallipoli (Lecce), Italy; "Ospedali Riuniti" Hospital, Foggia, Italy; "Di Venere" Hospital, Bari, Italy
| | - A Tornesello
- "Vito Fazzi" Hospital, Lecce, Italy; "AO San Gerardo", Monza, Italy; "Sacro Cuore di Gesù Fatebenefratelli" Hospital, Benevento, Italy; "Regina Elena" National Cancer Institute, Roma, Italy; "San Carlo" Hospital, Potenza, Italy; "AO Fatebenefratelli e Oftalmico", Milano, Italy; "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo (Foggia), Italy; "Giovanni Paolo II" Institute, Bari, Italy; "S. Cuore di Gesù" Hospital, Gallipoli (Lecce), Italy; "Ospedali Riuniti" Hospital, Foggia, Italy; "Di Venere" Hospital, Bari, Italy
| | - M Ciccarese
- "Vito Fazzi" Hospital, Lecce, Italy; "AO San Gerardo", Monza, Italy; "Sacro Cuore di Gesù Fatebenefratelli" Hospital, Benevento, Italy; "Regina Elena" National Cancer Institute, Roma, Italy; "San Carlo" Hospital, Potenza, Italy; "AO Fatebenefratelli e Oftalmico", Milano, Italy; "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo (Foggia), Italy; "Giovanni Paolo II" Institute, Bari, Italy; "S. Cuore di Gesù" Hospital, Gallipoli (Lecce), Italy; "Ospedali Riuniti" Hospital, Foggia, Italy; "Di Venere" Hospital, Bari, Italy
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Catania C, Zagonel V, Fosser V, La Verde N, Bertetto O, Iacono C, Venturini M, Radice D, Adamoli L, Boccardo F. Opinions concerning euthanasia, life-sustaining treatment and acceleration of death: results of an Italian Association of Medical Oncology (AIOM) survey. Ann Oncol 2008; 19:1947-54. [PMID: 18556665 DOI: 10.1093/annonc/mdn381] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [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
BACKGROUND Advance directives, acceleration of death, euthanasia and 'life-sustaining treatment' have sparked much heated debate among the media, the public, doctors and political leaders. We evaluate the personal opinions of Italian Association of Medical Oncology (AIOM) members. PATIENTS AND METHODS A 30-item questionnaire was developed and delivered to all 1,832 AIOM members. RESULTS Six-hundred and eighty-five (37%) oncologists completed and returned the questionnaires. Sixty-three per cent felt culturally and psychologically prepared to face these issues. Fifty-four per cent believed that what had been decided while the patient enjoyed good health is no longer applicable in an advanced state of terminal illness. Thirty-nine per cent believed that doctors should abide by these directives, while 49% believed that this should be discussed on a case-by-case basis. Fourteen per cent of oncologists were favourable towards euthanasia and 42% only in particular circumstances. Fifty-six per cent had received at least one request for accelerating death: 15% consented, 50% discussed it with the patient and 31% refused. CONCLUSION Advance directives, euthanasia, accelerated death and life-sustaining treatment represent considerable challenges for Italian oncologists. Although prepared to face these issues, AIOM members ask for a debate within the medical world and for a shared judicial regulation.
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Affiliation(s)
- C Catania
- New Drugs Development Unit, Medical Oncology Division, European Institute of Oncology, Milan, Italy.
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La Verde N, Garassino MC, Spinelli G, Scanni A, Sburlati P, Farina G, Labianca R. Reversible palpebral ptosis following oxaliplatin infusion. Dig Liver Dis 2007; 39:1041. [PMID: 17913604 DOI: 10.1016/j.dld.2007.07.162] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2007] [Accepted: 07/27/2007] [Indexed: 12/11/2022]
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Garassino M, Borgonovo K, Cinquini M, Martelli O, Mancuso Petricca A, La Verde N, Sburlati P, Bramati A, Farina G, Torri V. 6535 POSTER Predictive role of biological markers in NSCLC patients (pts) treated with EGFR tyrosine kinase inhibitors (TKIs): a metanalysis of randomized trials. EJC Suppl 2007. [DOI: 10.1016/s1359-6349(07)71363-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Garassino MC, Borgonovo K, La Verde N, Sburlati P, Bianchi C, Cobelli S, Rovej R, Tomirotti M, Torri V, Farina G. Efficacy of FUFOX regimen in the treatment of a selected population with metastatic colorectal cancer (MCC). J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.14596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
14596 Background: FOLFOX is usually employed as first line treatment of MCC. Some patients (pts), for both clinical reasons and poor compliance, are not eligible for CVD insertion. At the moment, it is not clear if FUFOX (with 5-FU bolus) is less active than FOLFOX (with 5-FU infusion). We evaluated the outcome of MCC pts treated, as first line, with FUFOX. Primary end-point is efficacy. Secondary endpoints are time to progression (TTP) and overall survival (OS). Toxicity is also reported. Materials and Methods: We analysed all consecutive MCC patients who referred to our centre, without CVD, treated with the Hochster regimen: Oxaliplatin 85 mg/m2 days 1, 15; Leucovorin 20 mg/m2 and 5-FU 500 mg/m2 bolus days 1, 8, 15 - every 28 days. Response rate was evaluated with RECIST criteria. TTP and OS were analysed with Kaplan-Meier methods. Results: From July 2003 to October 2006 we treated 25 MCC pts. Main characteristics were: median age 71 years (range 46–79), 12 males, 13 females; PS 0–1; metastatic sites: liver 15 pts; lung 6; abdominal 10. 2 pts are early. A total of 128 courses were administered (5,4 median courses/pt, range 3–9). 5/23 pts (21.7% 90%CI: 9.0%-40.4%) had a PR and 2 achieved a secondary complete surgery. 15/23 pts (65.2%: 90%CI: 46.0%-81.4%) had a SD and 3 pts (13.0%: 90%CI: 3.7%- 30.4%) had a PD. At the moment of analysis 14 pts are still alive with a median follow up of 25 months; the median time to progression is 7.2 months. This combination was well tolerated with no grade 3–4 toxicities observed. G1-G2 peripheral neurotoxicity is reported in 15/25 pts (60%). Other common toxicities are: G1–2 haematological in 10 pts (40%); G1–2 gastrointestinal in 7 pts (28%); asthenia 5 pts (20%). Conclusions: We observed a low response rate, but high number of stable disease. Toxicity was acceptable. Although this is a not controlled study, this regimen seems to be less effective than infusional regimens but, due to the high control rate of disease (86.9%) we can consider it an alternative choice for patients that refuse or cannot receive continuous infusion. No significant financial relationships to disclose.
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Affiliation(s)
- M. C. Garassino
- Fatebenefratelli & Ophtalmic Hospital, Milan, Italy; Ospedale Maggiore Policlinico Foundation, Milano, Italy; Mario Negri Institute, Milano, Italy
| | - K. Borgonovo
- Fatebenefratelli & Ophtalmic Hospital, Milan, Italy; Ospedale Maggiore Policlinico Foundation, Milano, Italy; Mario Negri Institute, Milano, Italy
| | - N. La Verde
- Fatebenefratelli & Ophtalmic Hospital, Milan, Italy; Ospedale Maggiore Policlinico Foundation, Milano, Italy; Mario Negri Institute, Milano, Italy
| | - P. Sburlati
- Fatebenefratelli & Ophtalmic Hospital, Milan, Italy; Ospedale Maggiore Policlinico Foundation, Milano, Italy; Mario Negri Institute, Milano, Italy
| | - C. Bianchi
- Fatebenefratelli & Ophtalmic Hospital, Milan, Italy; Ospedale Maggiore Policlinico Foundation, Milano, Italy; Mario Negri Institute, Milano, Italy
| | - S. Cobelli
- Fatebenefratelli & Ophtalmic Hospital, Milan, Italy; Ospedale Maggiore Policlinico Foundation, Milano, Italy; Mario Negri Institute, Milano, Italy
| | - R. Rovej
- Fatebenefratelli & Ophtalmic Hospital, Milan, Italy; Ospedale Maggiore Policlinico Foundation, Milano, Italy; Mario Negri Institute, Milano, Italy
| | - M. Tomirotti
- Fatebenefratelli & Ophtalmic Hospital, Milan, Italy; Ospedale Maggiore Policlinico Foundation, Milano, Italy; Mario Negri Institute, Milano, Italy
| | - V. Torri
- Fatebenefratelli & Ophtalmic Hospital, Milan, Italy; Ospedale Maggiore Policlinico Foundation, Milano, Italy; Mario Negri Institute, Milano, Italy
| | - G. Farina
- Fatebenefratelli & Ophtalmic Hospital, Milan, Italy; Ospedale Maggiore Policlinico Foundation, Milano, Italy; Mario Negri Institute, Milano, Italy
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La Verde N, Borgonovo K, Garassino MC, Sburlati P, Pedretti D, Perrone S, Mihali D, Mantica C, Galassi B, Farina G. Osteonecrosis of the jaw (ONJ) in cancer patients (pts) treated with bisphosphonates (B): Results of a monoinstitutional monitoring program. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.19601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
19601 Background: B reduce bone metastases complications. ONJ is a serious adverse event during B treatment. Therefore, it's necessary to identify some procedures to reduce ONJ injures in a monitoring program. Patients and Methods: We retrospectively reviewed how an active program of prevention based on clinical oral cavity examination, dentists and pts education might improve ONJ outcome in pts receiving pamidronate (P) 90 mg monthly or zoledronate (Z) 4 mg monthly. Results: from October 2003 to October 2006, 154 consecutive pts were treated; 95 females, 59 males; primary tumors: 66 breast, 28 prostate, 26 lung, 9 myeloma, 4 NHL, 21 other. In June 2005 the monitoring program started on all our pts. ONJ was diagnosed in 15/154 (9.7%) pts, 8 before and 7 after June 2005; all pts were treated with Z (total 2,987 courses, range 8–43; median courses/pt 19.4) and 4 pts pretreated also with P (total 124 courses, range 12–43, median courses/pt 31. Tumors: 7 breast, 1 kidney, 2 lung, 1 head-neck, 1 thyroid, 1 NHL, 1 prostate, 1 sarcoma. Concomitant therapies: 14 pts chemotherapy; 7 hormonotherapy; 2 head-neck radiotherapy; 5 steroids. Significant anamnesis: 9 recent dentoalveolar procedures, 4 diabetes. First symptoms: multiple recurrent alveolar abscesses 9, pain 3, dental mobility 1, paresthesia of the lower lip 1, exposed bone 1. Main treatments were: antibiotics and antifungals 11, curettages 3, surgical resections 4 (1 partial maxillectomy, complicated by septic shock and oronasal communication, 2 partial mandibulectomies, 1 segmental mandibular resection). These last 4 pts, that had the worst prognosis, were diagnosed before starting the monitoring program, and they had been treated with aggressive dental procedures at the exordium. 7 new ONJ cases, diagnosed after June 2005 were successfully treated without aggressive dentist interventions, achieving a good control. Conclusions: We remark that ONJ B related is a frequent adverse event (9.7%), especially with Z. A monitoring program based on non- surgical treatment and patients and physicians education may improve its management. No significant financial relationships to disclose.
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Affiliation(s)
- N. La Verde
- Fatebenefratelli & Ophtalmic Hospital, Milan, Italy; Fondazione Ospedale Maggiore Policlinico, Milan, Italy
| | - K. Borgonovo
- Fatebenefratelli & Ophtalmic Hospital, Milan, Italy; Fondazione Ospedale Maggiore Policlinico, Milan, Italy
| | - M. C. Garassino
- Fatebenefratelli & Ophtalmic Hospital, Milan, Italy; Fondazione Ospedale Maggiore Policlinico, Milan, Italy
| | - P. Sburlati
- Fatebenefratelli & Ophtalmic Hospital, Milan, Italy; Fondazione Ospedale Maggiore Policlinico, Milan, Italy
| | - D. Pedretti
- Fatebenefratelli & Ophtalmic Hospital, Milan, Italy; Fondazione Ospedale Maggiore Policlinico, Milan, Italy
| | - S. Perrone
- Fatebenefratelli & Ophtalmic Hospital, Milan, Italy; Fondazione Ospedale Maggiore Policlinico, Milan, Italy
| | - D. Mihali
- Fatebenefratelli & Ophtalmic Hospital, Milan, Italy; Fondazione Ospedale Maggiore Policlinico, Milan, Italy
| | - C. Mantica
- Fatebenefratelli & Ophtalmic Hospital, Milan, Italy; Fondazione Ospedale Maggiore Policlinico, Milan, Italy
| | - B. Galassi
- Fatebenefratelli & Ophtalmic Hospital, Milan, Italy; Fondazione Ospedale Maggiore Policlinico, Milan, Italy
| | - G. Farina
- Fatebenefratelli & Ophtalmic Hospital, Milan, Italy; Fondazione Ospedale Maggiore Policlinico, Milan, Italy
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Labianca R, La Verde N, Garassino MC. Development and clinical indications of cetuximab. Int J Biol Markers 2007; 22:S40-6. [PMID: 17520580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Cetuximab is a chimeric immunoglobulin G1 monoclonal antibody that targets the extracellular domain of the epidermal growth factor receptor (EGFR) with high specificity and affinity. It competitively inhibits endogenous ligand binding and thereby inhibits subsequent EGFR activation. The EGFR signaling pathways regulate cell differentiation, proliferation, migration, angiogenesis and apoptosis, all of which become deregulated in cancer cells. EGFR is an important target for cancer therapy and many studies have demonstrated that cetuximab is active in several types of cancer, particularly colorectal and head and neck cancer. Cetuximab enhances the effects of many standard cytotoxic agents, including irinotecan, and in combination with chemotherapy it can elicit antitumor responses in tumors that previously failed to respond to that chemotherapy. Cetuximab also enhances radiation-induced apoptosis. On the basis of a pivotal European randomized study (the BOND study) and of 2 clinical studies conducted in the USA, cetuximab has been approved in combination with irinotecan for patients affected by EGFR-expressing metastatic colon cancer after failure with irinotecan. There have only been a few small phase II trials on first-line treatment in metastatic colorectal cancer, but the results suggest promising activity of cetuximab together with irinotecan or oxaliplatin. There is some evidence that additive efficacy can be achieved using EGFR inhibitors in combination with vascular endothelial growth factor receptor inhibitors such as bevacizumab. A correlation between response and the main toxicity (acne-like skin reaction) has been observed but is unclear. EGFR status as a specific marker for EGFR inhibitors is controversial. At the moment, EGFR expression does not appear to be a predictive factor for response to EGFR inhibitors.
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Affiliation(s)
- R Labianca
- Oncology Department, Ospedali Riuniti, Bergamo, Italy
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Ratti R, Farina G, Borgonovo K, La Verde N, Pedretti D, Rovej R, Cobelli S, Mantica C, Dimaiuta M, Scanni A. Recurrent alveolar abscesses by bisphosphonates. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.3211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- R. Ratti
- Osp Fatebenefratelli e Oftalmico, Milano, Italy
| | - G. Farina
- Osp Fatebenefratelli e Oftalmico, Milano, Italy
| | | | - N. La Verde
- Osp Fatebenefratelli e Oftalmico, Milano, Italy
| | - D. Pedretti
- Osp Fatebenefratelli e Oftalmico, Milano, Italy
| | - R. Rovej
- Osp Fatebenefratelli e Oftalmico, Milano, Italy
| | - S. Cobelli
- Osp Fatebenefratelli e Oftalmico, Milano, Italy
| | - C. Mantica
- Osp Fatebenefratelli e Oftalmico, Milano, Italy
| | - M. Dimaiuta
- Osp Fatebenefratelli e Oftalmico, Milano, Italy
| | - A. Scanni
- Osp Fatebenefratelli e Oftalmico, Milano, Italy
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Mantica C, La Verde N, Farina G, Cobelli S, Dambrosio M, Perrone S, Tomirotti M, Scanni A. 59 Tamoxifen (TAM) in breast cancer (BC): Toxicity of long term adjuvant treatment. Eur J Cancer 1995. [DOI: 10.1016/0959-8049(95)95311-s] [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: 10/27/2022]
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