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Arenare L, Di Liello R, De Placido P, Gridelli C, Morabito A, Pignata S, Nuzzo F, Avallone A, Maiello E, Gargiulo P, Schettino C, Gravina A, Gallo C, Chiodini P, Di Maio M, Perrone F, Piccirillo MC. Under-reporting of subjective symptoms and its prognostic value: a pooled analysis of 12 cancer clinical trials. ESMO Open 2024; 9:102941. [PMID: 38452437 PMCID: PMC10937229 DOI: 10.1016/j.esmoop.2024.102941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 02/14/2024] [Accepted: 02/16/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND Oncologists tend to under-report subjective symptoms during cancer treatment. This study describes the under-reporting rate of selected symptoms and explores its association with overall survival (OS). A secondary aim is to test the association of patient-reported symptoms with OS. PATIENTS AND METHODS This is a post hoc analysis on data pooled from 12 randomized trials, promoted by the National Cancer Institute of Naples (Italy), enrolling patients between 2002 and 2019, with published primary analyses. Occurrence and grade of six side-effects (anorexia, nausea, vomiting, constipation, diarrhea and fatigue) reported by physicians were compared with corresponding symptoms reported by patients in quality-of-life (QoL) questionnaires. Under-reporting was defined as the rate of cases reported grade 0 by the physician while grade ≥1 by the patient. Prognostic value was tested in a multivariable model stratified by trial, including age, sex and performance status as confounders. A landmark threshold was defined for OS analyses. RESULTS 3792 patients with advanced lung, ovarian, pancreatic, breast or colorectal cancer were pooled; 2603 (68.6%) were eligible having at least one toxicity assessment and one QoL questionnaire, before the first planned disease restaging. Concordance between physicians' and patients' reporting was low with Cohen's k coefficients ranging from 0.03 (fatigue) to 0.33 (vomiting). Under-reporting ranged from 52.7% (nausea) to 80.5% (anorexia), and was not associated with OS. Patient-reported anorexia, vomiting and fatigue ('a little' or more) were significantly associated with shorter OS. CONCLUSIONS Under-reporting of treatment side-effects is frequent, but it does not affect OS. Patients' reported symptoms should be used for prognostic evaluation.
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Affiliation(s)
- L Arenare
- Unità Sperimentazioni Cliniche, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Naples
| | - R Di Liello
- Oncologia Medica, P.O. Ospedale del Mare-ASL Napoli 1 Centro, Naples
| | - P De Placido
- Department of Clinical Medicine and Surgery, Università Federico II, Naples
| | - C Gridelli
- Divisione di Oncologia Medica, A.O.R.N. San Giuseppe Moscati, Contrada Amoretta, Avellino
| | - A Morabito
- Oncologia Clinica Sperimentale Toraco-Polmonare, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Naples
| | - S Pignata
- Oncologia Clinica Sperimentale Uroginecologica Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Naples
| | - F Nuzzo
- Oncologia Clinica Sperimentale Di Senologia, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Naples
| | - A Avallone
- Oncologia Clinica Sperimentale Addominale, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Naples
| | - E Maiello
- Oncologia, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo
| | - P Gargiulo
- Unità Sperimentazioni Cliniche, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Naples
| | - C Schettino
- Unità Sperimentazioni Cliniche, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Naples
| | - A Gravina
- Unità Sperimentazioni Cliniche, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Naples
| | - C Gallo
- Statistica Medica, Università della Campania 'Luigi Vanvitelli', Naples
| | - P Chiodini
- Statistica Medica, Università della Campania 'Luigi Vanvitelli', Naples
| | - M Di Maio
- Department of Oncology, Università di Torino, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - F Perrone
- Unità Sperimentazioni Cliniche, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Naples
| | - M C Piccirillo
- Unità Sperimentazioni Cliniche, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Naples.
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Schettini F, Conte B, Buono G, De Placido P, Parola S, Griguolo G, Fabi A, Bighin C, Riccardi F, Cianniello D, De Laurentiis M, Puglisi F, Pelizzari G, Bonotto M, Russo S, Frassoldati A, Pazzola A, Montemurro F, Lambertini M, Guarneri V, Cognetti F, Locci M, Generali D, Conte P, De Placido S, Giuliano M, Arpino G, Del Mastro L. T-DM1 versus pertuzumab, trastuzumab and a taxane as first-line therapy of early-relapsed HER2-positive metastatic breast cancer: an Italian multicenter observational study. ESMO Open 2021; 6:100099. [PMID: 33819752 PMCID: PMC8047485 DOI: 10.1016/j.esmoop.2021.100099] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 02/06/2021] [Accepted: 02/27/2021] [Indexed: 02/06/2023] Open
Abstract
Background The current standard first-line treatment of human epidermal growth factor receptor 2 (HER2)-positive (+) metastatic breast cancer is the combination of pertuzumab, trastuzumab and a taxane (P + T + taxane), while standard second-line is ado-trastuzumab-emtansine (T-DM1). The registration trial of pertuzumab, however, did not include early-relapsing patients, defined as patients experiencing tumor relapse ≤12 months from the end of (neo)adjuvant anti-HER2 therapy. Conversely, the pivotal trial of T-DM1 included some patients relapsing ≤6 months after the end of (neo)adjuvant trastuzumab. Thus, a proportion of early-relapsing patients are currently eligible to receive T-DM1 as first-line treatment. Nevertheless, no direct comparison exists between the two regimens in this clinical setting. Patients and methods We retrospectively compared T-DM1 versus P + T + taxane as first-line treatment in two cohorts of early-relapsing patients in an Italian ‘real-world’ setting, involving 14 public health care institutions. The primary endpoint was progression-free survival. Secondary endpoints included patients' characterization, overall survival and post-progression survival. Univariate and multivariate analyses were carried out. All tests were two-sided and a P ≤ 0.05 was considered statistically significant. Results Among 1252 screened patients, 75 met the inclusion criteria. Forty-four (58.7%) received P + T + taxane and 31 (41.3%) received T-DM1. The two cohorts showed similar characteristics of aggressiveness and no significant differences in treatment history. T-DM1, compared with P + T + taxane was associated with worse progression-free survival (adjusted hazard ratio: 2.26, 95% confidence interval: 1.13-4.52, P = 0.021) and overall survival (adjusted hazard ratio: 3.95, 95% confidence interval: 1.38-11.32, P = 0.010), irrespective of previous (neo)adjuvant treatment, age, hormone receptors status, time-to-relapse (≤6 months or within 6-12 months) and presence of visceral/brain metastases. No differences were observed in post-progression survival (P = 0.095). Conclusions Our study suggests superiority for P + T + taxane over T-DM1 as up-front treatment of early-relapsing HER2+ metastatic breast cancer, which merits further assessment in larger and prospective trials. This is the first study comparing pertuzumab + trastuzumab + taxane (P + T + taxane) with T-DM1 in early-relapsing HER2+ MBC. The majority of early-relapsing HER2+ MBC have high-grade, node-positive, large primary tumors. First-line T-DM1 compared with P + T + taxane is associated with worse progression-free survival. First-line T-DM1 compared with P + T + taxane is associated with worse overall survival. Post-progression survival does not differ between the two treatments cohorts.
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Affiliation(s)
- F Schettini
- Department of Clinical Medicine and Surgery, University of Naples 'Federico II', Naples, Italy; Translational Genomics and Targeted Therapies in Solid Tumors Group, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain.
| | - B Conte
- SOLTI Breast Cancer Research Group, Barcelona, Spain; Medical Oncology Unit 2, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - G Buono
- Oncology Unit, San Rocco Hospital, Sessa Aurunca, Italy
| | - P De Placido
- Department of Clinical Medicine and Surgery, University of Naples 'Federico II', Naples, Italy
| | - S Parola
- Department of Clinical Medicine and Surgery, University of Naples 'Federico II', Naples, Italy
| | - G Griguolo
- Division of Oncology 2, Istituto Oncologico Veneto IRCCS, Padua, Italy; Department of Surgery, Oncology and Gastroenterology, University of Padova, Padua, Italy
| | - A Fabi
- Division of Medical Oncology 1, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - C Bighin
- Medical Oncology Unit 2, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - F Riccardi
- Medical Oncology, 'A. Cardarelli' Hospital, Naples, Italy
| | - D Cianniello
- National Cancer Institute Fondazione 'G. Pascale', Naples, Italy
| | - M De Laurentiis
- National Cancer Institute Fondazione 'G. Pascale', Naples, Italy
| | - F Puglisi
- Department of Medicine (DAME), University of Udine, Udine, Italy; Department of Clinical Oncology, CRO Aviano National Cancer Institute, Aviano, Italy
| | - G Pelizzari
- Department of Clinical Oncology, CRO Aviano National Cancer Institute, Aviano, Italy
| | - M Bonotto
- Department of Oncology, ASUFC University Hospital, Udine, Italy
| | - S Russo
- Department of Oncology, ASUFC University Hospital, Udine, Italy
| | - A Frassoldati
- Oncology Unit, University Hospital St. Anna, Ferrara, Italy
| | - A Pazzola
- Division of Medical Oncology, AOU Sassari, Sassari, Italy
| | - F Montemurro
- Depertment of Medical Oncology, Candiolo Cancer Institute, Candiolo, Italy
| | - M Lambertini
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genoa, Italy; Department of Medical Oncology, U.O.C. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - V Guarneri
- Division of Oncology 2, Istituto Oncologico Veneto IRCCS, Padua, Italy; Department of Surgery, Oncology and Gastroenterology, University of Padova, Padua, Italy
| | - F Cognetti
- Department of Clinic and Molecular Medicine, 'La Sapienza' University of Rome, Rome, Italy
| | - M Locci
- Department of Neuroscience, Reproductive Medicine, Odontostomatology, University of Naples 'Federico II', Naples, Italy
| | - D Generali
- Breast Cancer Unit, Azienda Socio Sanitaria Territoriale di Cremona, Cremona, Italy; Department of Medical, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - P Conte
- Division of Oncology 2, Istituto Oncologico Veneto IRCCS, Padua, Italy; Department of Surgery, Oncology and Gastroenterology, University of Padova, Padua, Italy
| | - S De Placido
- Department of Clinical Medicine and Surgery, University of Naples 'Federico II', Naples, Italy
| | - M Giuliano
- Department of Clinical Medicine and Surgery, University of Naples 'Federico II', Naples, Italy
| | - G Arpino
- Department of Clinical Medicine and Surgery, University of Naples 'Federico II', Naples, Italy
| | - L Del Mastro
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genoa, Italy; U.O.S.D. Breast Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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De Angelis C, Bruzzese D, Bernardo A, Baldini E, Leo L, Fabi A, Gamucci T, De Placido P, Poggio F, Russo S, Forestieri V, Lauria R, De Santo I, Caputo R, Cianniello D, Michelotti A, Del Mastro L, De Laurentiis M, Giuliano M, De Placido S, Arpino G. Corrigendum to 'Eribulin in combination with bevacizumab as second-line treatment for HER2-negative metastatic breast cancer progressing after first-line therapy with paclitaxel and bevacizumab: a multicenter, phase II, single arm trial (GIM11-BERGI)': [ESMO Open Volume 6, Issue 2, April 2021, 100054]. ESMO Open 2021; 6:100097. [PMID: 33926709 PMCID: PMC8103531 DOI: 10.1016/j.esmoop.2021.100097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Affiliation(s)
- C De Angelis
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | - D Bruzzese
- Department of Public Health, University of Naples "Federico II", Naples, Italy
| | - A Bernardo
- Oncologia Medica, Fondazione S. Maugeri IRCCS, Pavia, Italy
| | - E Baldini
- Department of Oncology, S. Luca Hospital, Lucca, Italy
| | - L Leo
- Unit of Oncology, A.O.R.N. dei Colli, Napoli, Naples, Italy
| | - A Fabi
- Medical Oncology 1, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - T Gamucci
- Medical Oncology Unit, ASL Frosinone, Frosinone, Italy
| | - P De Placido
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | - F Poggio
- UO Breast Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - S Russo
- Department of Oncology, Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | - V Forestieri
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | - R Lauria
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | - I De Santo
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | - R Caputo
- Breast Oncology Department, Istituto Nazionale Tumori Fondazione G. Pascale, Naples, Italy
| | - D Cianniello
- Breast Oncology Department, Istituto Nazionale Tumori Fondazione G. Pascale, Naples, Italy
| | - A Michelotti
- Azienda Ospedaliera Universitaria Pisana, Ospedale Santa Chiara, Pisa, Italy
| | - L Del Mastro
- UO Breast Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy; University of Genova, Dipartimento di Medicina Interna e Specialità Mediche (DIMI), Genova, Italy
| | - M De Laurentiis
- Breast Oncology Department, Istituto Nazionale Tumori Fondazione G. Pascale, Naples, Italy
| | - M Giuliano
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy.
| | - S De Placido
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | - G Arpino
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
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Ottaviano M, Giuliano M, Tortora M, La Civita E, Liotti A, Longo M, Bruzzese D, Cennamo M, Riccio V, De Placido P, Picozzi F, Parola S, Daniele B, Botti G, Formisano P, Beguinot F, De Placido S, Terracciano D, Palmieri G. MA06.10 A New Horizon of Liquid Biopsy in Thymic Epithelial Tumors: The Potential Utility of Circulating Cell-Free DNA. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.180] [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: 11/28/2022]
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De Angelis C, Bruzzese D, Bernardo A, Baldini E, Leo L, Fabi A, Gamucci T, De Placido P, Poggio F, Russo S, Forestieri V, Lauria R, De Santo I, Michelotti A, Del Mastro L, De Laurentiis M, Giuliano M, De Placido S, Arpino G. Eribulin in combination with bevacizumab as second-line treatment for HER2-negative metastatic breast cancer progressing after first-line therapy with paclitaxel and bevacizumab: a multicenter, phase II, single arm trial (GIM11-BERGI). ESMO Open 2021; 6:100054. [PMID: 33601296 PMCID: PMC7900694 DOI: 10.1016/j.esmoop.2021.100054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 01/03/2021] [Accepted: 01/12/2021] [Indexed: 12/12/2022] Open
Abstract
Background We evaluated the efficacy and safety of the nontaxane microtubule dynamics inhibitor eribulin plus the humanized anti-VEGF monoclonal antibody bevacizumab in a novel second-line chemotherapy scheme in HER2-negative metastatic breast cancer (MBC) patients progressing after first-line paclitaxel and bevacizumab. Patients and methods This is a multicenter, single-arm, Simon's two-stage, phase II study. The primary endpoint was the overall response rate, considered as the sum of partial and complete response based on the best overall response rate (BORR). The secondary endpoints were progression-free survival (PFS), overall survival (OS), and clinical benefit rate. Results A total of 58 of the 61 patients enrolled in the study were evaluable for efficacy. The BORR was 24.6% (95% CI 14.5-37.3). The clinical benefit rate was 32.8% (95% CI 21.3-46.0). The median PFS was 6.2 months (95% CI 4.0-7.8), and median OS was 14.8 months (95% CI 12.6-22.8). Overall, adverse events (AEs) were clinically manageable and the most common AEs were fatigue, paresthesia, and neutropenia. Quality of life was well preserved in most patients. Conclusions The results of this study suggest that second-line therapy with bevacizumab in combination with eribulin has a meaningful clinical activity and may represent a potential therapeutic option for patients with HER2-negative MBC. Bevacizumab + chemotherapy improved progression-free survival in HER2-negative metastatic breast cancer (MBC) patients. Eribulin monotherapy improved overall survival in patients with anthracycline- and taxane-pretreated MBC. The GIM11-BERGI trial assessed the efficacy and safety of eribulin + bevacizumab as second-line treatment for HER2-MBC. Eribulin + bevacizumab showed to be a safe and active treatment after progression to first-line paclitaxel + bevacizumab.
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Affiliation(s)
- C De Angelis
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | - D Bruzzese
- Department of Public Health, University of Naples "Federico II", Naples, Italy
| | - A Bernardo
- Oncologia Medica, Fondazione S. Maugeri IRCCS, Pavia, Italy
| | - E Baldini
- Department of Oncology, S. Luca Hospital, Lucca, Italy
| | - L Leo
- Unit of Oncology, A.O.R.N. dei Colli, Napoli, Naples, Italy
| | - A Fabi
- Medical Oncology 1, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - T Gamucci
- Medical Oncology Unit, ASL Frosinone, Frosinone, Italy
| | - P De Placido
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | - F Poggio
- UO Breast Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - S Russo
- Department of Oncology, Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | - V Forestieri
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | - R Lauria
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | - I De Santo
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | - A Michelotti
- Azienda Ospedaliera Universitaria Pisana, Ospedale Santa Chiara, Pisa, Italy
| | - L Del Mastro
- UO Breast Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy; University of Genova, Dipartimento di Medicina Interna e Specialità Mediche (DIMI), Genova, Italy
| | - M De Laurentiis
- Breast Oncology Department, Istituto Nazionale Tumori Fondazione G. Pascale, Naples, Italy
| | - M Giuliano
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy.
| | - S De Placido
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | - G Arpino
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
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Ottaviano M, Giuliano M, Tortora M, Picozzi F, Mucci B, Parola S, Riccio V, Pietroluongo E, De Placido P, Vaia A, D'Esposito V, Malfitano A, Di Somma S, Campione S, Staibano S, Botti G, Formisano P, Daniele B, De Placido S, Palmieri G. 1901P Immunomodulatory role of multi-agent therapy in thymic epithelial tumours and severe immunological dysregulation. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.1444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Foschini F, Formisano L, Marciano R, Mozzillo E, Carratù A, Napolitano F, Santaniello A, De Placido P, Cascetta P, Servetto A, Bianco R. FOLFIRINOX after first-line gemcitabine-based chemotherapy in metastatic pancreatic cancer: a mono-institutional experience. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz155.192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Ferro M, Di Lorenzo G, Vartolomei MD, Bruzzese D, Cantiello F, Lucarelli G, Musi G, Di Stasi S, Hurle R, Guazzoni G, Busetto GM, Gabriele A, Del Giudice F, Damiano R, Perri F, Perdona S, Verze P, Borghesi M, Schiavina R, Almeida GL, Bove P, Lima E, Autorino R, Crisan N, Farhan ARA, Battaglia M, Russo GI, Ieluzzi V, Morgia G, De Placido P, Terracciano D, Cimmino A, Scafuri L, Mirone V, De Cobelli O, Shariat S, Sonpavde G, Buonerba C. Absolute basophil count is associated with time to recurrence in patients with high-grade T1 bladder cancer receiving bacillus Calmette-Guérin after transurethral resection of the bladder tumor. World J Urol 2019; 38:143-150. [PMID: 30993426 DOI: 10.1007/s00345-019-02754-2] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 04/01/2019] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Basophils, eosinophils and monocytes may be involved in BCG-induced immune responses and be associated with outcomes of bladder cancer patients receiving intravesical BCG. Our objective was to explore the association of baseline counts of basophils, eosinophils and monocytes with outcomes of patients with high-grade T1 bladder cancer receiving a standard course of intravesical BCG. METHODS We retrospectively reviewed medical records of patients with primary T1 HG/G3 bladder cancer. After re-TURBT, patients were treated with a 6-week course of intravesical BCG induction followed by intravesical BCG every week for 3 weeks given at 3, 6, 12, 18, 24, 30 and 36 months from initiation of therapy The analysis of potential risk factors for recurrence, muscle invasion and cancer-specific and overall survival was performed using univariable Cox regression models. Those factors that presented, at univariate analysis, an association with the event at a liberal p < 0.1, have been selected for the development of a multivariable model. RESULTS A total of 1045 patients with primary T1 HG/G3 were included. A total of 678 (64.9%) recurrences, 303 (29.0%) progressions and 150 (14.3%) deaths were observed during follow-up. Multivariate analysis showed that logarithmic transformation of basophils count was associated with a 30% increment in the hazard of recurrence per unit increase of logarithmic basophils count (HR 1.30; 95% confidence interval 1.09-1.54; p = 0.0026). Basophil count modeled by quartiles was also significantly associated with time to recurrence [second vs. lower quartile HR 1.42 (1.12-1.79); p = 0.003, third vs. lower quartile HR 1.26 (1.01-1.57); p = 0.041; upper vs. lower quartile HR 1.36 (1.1-1.68); p = 0.005]. The limitations of a retrospective study are applicable. CONCLUSION Baseline basophil count may predict recurrence in BCG-treated HG/G3 T1 bladder cancer patients. External validation is warranted.
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Affiliation(s)
- M Ferro
- Division of Urology, European Institute of Oncology, via Ripamonti 435, Milan, Italy.
| | - G Di Lorenzo
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy.,Department of Medicine, Università degli Studi del Molise, Campobasso, Italy
| | - M D Vartolomei
- Division of Urology, European Institute of Oncology, via Ripamonti 435, Milan, Italy.,Department of Cell and Molecular Biology, University of Medicine and Pharmacy, Tirgu Mures, Romania
| | - D Bruzzese
- Department of Public Health, Federico II University of Naples, Naples, Italy
| | - F Cantiello
- Department of Urology, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - G Lucarelli
- Department of Emergency and Organ Transplantation, Urology, Andrology and Kidney Transplantation Unit, University of Bari, Bari, Italy
| | - G Musi
- Division of Urology, European Institute of Oncology, via Ripamonti 435, Milan, Italy
| | - S Di Stasi
- Department of Experimental Medicine and Surgery, Tor Vegata University, Rome, Italy
| | - R Hurle
- Department of Urology, Istituto Clinico Humanitas Istituto di Ricovero e Cura a Carattere Scientifico-Clinical and Research Hospital, Milan, Italy
| | - G Guazzoni
- Department of Biomedical Science, Humanitas University, Milan, Rozzano, Italy
| | - G M Busetto
- Department of Urology, Sapienza University of Rome, Rome, Italy
| | - A Gabriele
- Department of Urology, Sapienza University of Rome, Rome, Italy
| | - F Del Giudice
- Department of Urology, Sapienza University of Rome, Rome, Italy
| | - R Damiano
- Department of Urology, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - F Perri
- Uro-Gynecological Department, Istituto Nazionale per lo Studio e la Cura dei Tumori, Fondazione "G. Pascale" IRCCS, Naples, Italy
| | - S Perdona
- Uro-Gynecological Department, Istituto Nazionale per lo Studio e la Cura dei Tumori, Fondazione "G. Pascale" IRCCS, Naples, Italy
| | - P Verze
- Department of Neurosciences, Sciences of Reproduction and Odontostomatology, Urology Unit, University of Naples "Federico II", Naples, Italy
| | - M Borghesi
- Department of Urology, University of Bologna, Bologna, Italy
| | - R Schiavina
- Department of Urology, University of Bologna, Bologna, Italy
| | - G L Almeida
- Departamento de Urologia, University of Vale do Itajaí, Itajaí, Brazil
| | - P Bove
- Division of Urology, Department of Experimental Medicine and Surgery, Urology Unit, Tor Vergata University of Rome, Rome, Italy
| | - E Lima
- Life and Health Sciences Research Institute, University of Minho, Braga, Portugal
| | - R Autorino
- Division of Urology, Virginia Commonwealth University, Richmond, VA, USA
| | - N Crisan
- Department of Urology, University of Medicine and Pharmacy "Iuliu Haţeganu,", Cluj-Napoca, Romania
| | - A R Abu Farhan
- Department of Urology, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - M Battaglia
- Department of Emergency and Organ Transplantation, Urology, Andrology and Kidney Transplantation Unit, University of Bari, Bari, Italy
| | - G I Russo
- Department of Urology, University of Catania, Catania, Italy
| | - Vincenzo Ieluzzi
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
| | - G Morgia
- Department of Urology, University of Catania, Catania, Italy
| | - P De Placido
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
| | - D Terracciano
- Department of Translational Medical Sciences, University of Naples "Federico II", Naples, Italy
| | - A Cimmino
- Institute of Genetics and Biophysics "A. Buzzati-Traverso", CNR, Naples, Italy
| | - L Scafuri
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
| | - V Mirone
- Department of Neurosciences, Sciences of Reproduction and Odontostomatology, Urology Unit, University of Naples "Federico II", Naples, Italy
| | - O De Cobelli
- Division of Urology, European Institute of Oncology, via Ripamonti 435, Milan, Italy
| | - S Shariat
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Guru Sonpavde
- Dana-Farber Cancer Institute, GU Oncology Division, Harvard Medical School, Boston, MA, USA
| | - C Buonerba
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy.,Zoo-prophylactic Institute of Southern Italy, Portici, Italy
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Buono G, Crispo A, Giuliano M, Rea CG, Forestieri V, Lauria R, De Placido P, De Laurentiis M, Pacilio C, Grimaldi M, Nocerino F, Montella M, De Placido S, Arpino G. Abstract P2-08-15: Metabolic syndrome and early-stage breast cancer outcome: Results from a prospective observational study. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p2-08-15] [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:Previous studies suggested a link between obesity, insulin-resistance and breast cancer outcome. The aim of the present prospective observational study was to investigate the role of metabolic syndrome (MetS) and its components on early breast cancer (EBC) patients' outcome.
Methods: MetS was defined by the presence of 3 to 5 of the following components: waist circumference (WC) > 88 cm, blood pressure ≥ 130/≥85 mmHg, serum levels of triglycerides (TG) ≥ 150 mg/dL, high-density lipoprotein (HDL) < 50 mg/dL and fasting glucose (FG) ≥ 110 mg/ dL (National Cholesterol Education Program Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults - NCEP-ATPIII criteria). Overall, 955 EBC patients were prospectively enrolled between January 2009 and December 2013 at University Hospital Federico II and National Cancer Institute G.Pascale, Naples, Italy. Clinical and tumor characteristics were collected for all the patients. A total of 494 patients (51.7%) had complete data on all the components of MetS at first diagnosis and thus were included in the current analysis. Study population was divided into 2 main groups: (1) patients with less than 3 components (No MetS); (2) patients with 3-5 components (MetS). Categorical variables were analyzed by the chi-square test and survival data by the log-rank test and Cox proportional hazards regression model.
Results: Overall 366 (74.1%) and 128 (25.9%) women were categorized as No MetS and MetS, respectively. MetS patients were more likely to be older and postmenopausal compared to No MetS patients. In detail, 46% vs 38% were older than 55 yrs (p<0.0001) and 87% vs 54% were postmenopausal (p<0.0001) in MetS vs No MetS groups, respectively. No statistically significant differences in tumor stage, type of adjuvant therapy or tumor subtypes defined by immunohistochemistry (IHC) were identified among the two groups. At univariate analysis, stage, tumor subtypes, TG and FG values, number of components of MetS, and presence of MetS were significantly associated to both disease free survival (DFS) and overall survival (OS). Age, BMI, WC, and HDL levels were correlated to OS only. At the multivariate Cox proportional hazards model (adjusted for age, menopausal status, stage, IHC subtypes and adjuvant therapy) MetS patients had numerically higher risk of relapse and significantly higher risk of death compared to No MetS patients [DFS hazard ratio (HR): 1.64 95% confidence interval (CI): 0.94-2.86, p=0.07 and OS HR: 3.83, 95% CI 1.7-6.77 p=0.001]. Additionally, of the 366 No MetS patients included in the analysis, 122 (33.3%) had 0 and 244 (66.7%) had “1 to 2” components of MetS. Interestingly, patients with “1 to 2” components of MetS had increased risk of dying compared to patients with 0 components (OS HR: 4.39, 95% CI:1.26-15.36, p=0.02) . No significant difference among these two groups was observed in terms of DFS.
Conclusions: MetS is correlated with poor outcome in EBC patients. Among patients without full criteria for MetS diagnosis, the presence of 1 or 2 components of the syndrome may predict for worse survival. Testing for components of MetS in BC patients is recomended to predict outcome and to eventually suggest lifestyle changes, exercise and diet.
Citation Format: Buono G, Crispo A, Giuliano M, Rea CG, Forestieri V, Lauria R, De Placido P, De Laurentiis M, Pacilio C, Grimaldi M, Nocerino F, Montella M, De Placido S, Arpino G. Metabolic syndrome and early-stage breast cancer outcome: Results from a prospective observational study [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P2-08-15.
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Affiliation(s)
- G Buono
- University of Naples Federico II, Naples, Italy; Unit of Epidemiology, National Cancer Institute, G. Pascale Foundation, Naples, Italy; Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX; Breast Unit, National Cancer Institute, G. Pascale Foundation, Naples, Italy
| | - A Crispo
- University of Naples Federico II, Naples, Italy; Unit of Epidemiology, National Cancer Institute, G. Pascale Foundation, Naples, Italy; Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX; Breast Unit, National Cancer Institute, G. Pascale Foundation, Naples, Italy
| | - M Giuliano
- University of Naples Federico II, Naples, Italy; Unit of Epidemiology, National Cancer Institute, G. Pascale Foundation, Naples, Italy; Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX; Breast Unit, National Cancer Institute, G. Pascale Foundation, Naples, Italy
| | - CG Rea
- University of Naples Federico II, Naples, Italy; Unit of Epidemiology, National Cancer Institute, G. Pascale Foundation, Naples, Italy; Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX; Breast Unit, National Cancer Institute, G. Pascale Foundation, Naples, Italy
| | - V Forestieri
- University of Naples Federico II, Naples, Italy; Unit of Epidemiology, National Cancer Institute, G. Pascale Foundation, Naples, Italy; Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX; Breast Unit, National Cancer Institute, G. Pascale Foundation, Naples, Italy
| | - R Lauria
- University of Naples Federico II, Naples, Italy; Unit of Epidemiology, National Cancer Institute, G. Pascale Foundation, Naples, Italy; Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX; Breast Unit, National Cancer Institute, G. Pascale Foundation, Naples, Italy
| | - P De Placido
- University of Naples Federico II, Naples, Italy; Unit of Epidemiology, National Cancer Institute, G. Pascale Foundation, Naples, Italy; Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX; Breast Unit, National Cancer Institute, G. Pascale Foundation, Naples, Italy
| | - M De Laurentiis
- University of Naples Federico II, Naples, Italy; Unit of Epidemiology, National Cancer Institute, G. Pascale Foundation, Naples, Italy; Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX; Breast Unit, National Cancer Institute, G. Pascale Foundation, Naples, Italy
| | - C Pacilio
- University of Naples Federico II, Naples, Italy; Unit of Epidemiology, National Cancer Institute, G. Pascale Foundation, Naples, Italy; Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX; Breast Unit, National Cancer Institute, G. Pascale Foundation, Naples, Italy
| | - M Grimaldi
- University of Naples Federico II, Naples, Italy; Unit of Epidemiology, National Cancer Institute, G. Pascale Foundation, Naples, Italy; Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX; Breast Unit, National Cancer Institute, G. Pascale Foundation, Naples, Italy
| | - F Nocerino
- University of Naples Federico II, Naples, Italy; Unit of Epidemiology, National Cancer Institute, G. Pascale Foundation, Naples, Italy; Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX; Breast Unit, National Cancer Institute, G. Pascale Foundation, Naples, Italy
| | - M Montella
- University of Naples Federico II, Naples, Italy; Unit of Epidemiology, National Cancer Institute, G. Pascale Foundation, Naples, Italy; Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX; Breast Unit, National Cancer Institute, G. Pascale Foundation, Naples, Italy
| | - S De Placido
- University of Naples Federico II, Naples, Italy; Unit of Epidemiology, National Cancer Institute, G. Pascale Foundation, Naples, Italy; Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX; Breast Unit, National Cancer Institute, G. Pascale Foundation, Naples, Italy
| | - G Arpino
- University of Naples Federico II, Naples, Italy; Unit of Epidemiology, National Cancer Institute, G. Pascale Foundation, Naples, Italy; Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX; Breast Unit, National Cancer Institute, G. Pascale Foundation, Naples, Italy
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De Placido S, De Laurentiis M, Bruzzese D, Bernardo A, Baldini EE, Montesarchio V, Fabi A, Gamucci T, De Placido P, Russo S, Lauria R, De Santo I, De Angelis C, Del Mastro L, Giuliano M, Arpino G. Abstract P6-21-13: A phase II single arm trial evaluating the efficacy and safety of eribulin in combination with bevacizumab for second-line treatment of human epidermal growth factor receptor 2 (HER2)–negative metastatic breast cancer (MBC) progressing after first-line therapy with bevacizumab and paclitaxel. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p6-21-13] [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: At present, there is no standard second-line chemotherapy-based treatment in patients with HER2-negative MBC. Continued VEGF inhibition with bevacizumab is a new potential option in patients progressing to first line bevacizumab and chemotherapy. Eribulin is a non-taxane microtubule dynamics inhibitor, with a unique mechanism of action and suggested beneficial effects on tumor microenvironment and neoangiogenesis. This study evaluated efficacy and safety of eribulin plus bevacizumab as a novel second-line chemotherapy scheme, in patients progressing after first line paclitaxel and bevacizumab.
Methods: This is a multicenter, single-arm, Simon's two-stage, Phase II study. Patients with HER2-negative MBC progressing to paclitaxel and bevacizumab received eribulin (1.23 mg/m2 intravenously on Days 1 and 8 of every 21-day cycle) plus bevacizumab (10 mg/kg every 2 weeks or 15 mg/kg every 3 weeks intravenously), as second-line chemotherapy. The primary endpoint was the overall response rate (ORR), considered as sum of partial (PR) and complete response (CR), basing on the best overall response. The present safety and efficacy analyses, as planned per study design, refer to six cycles of treatment (18 weeks).
Results: Among the 61 patients enrolled in the study, 55 (90,2% ) were evaluable for efficacy. ORR (PR/CR) was 9.1% [95% confidence intervals (C.I.) 3.0 to 19.9]; stable disease (SD) rate was 63.6% [95% C.I. 49.6 to 76.2]; clinical benefit rate (CR/PR/SD) at 24 weeks was 35% [95% C.I. 22.0 to 49.1]. The median progression free survival was 6.3 months [95% C.I. 4.1 to 7.8 months]. Drugs-related adverse events (AEs) were: 49.5% related to eribulin, 7.7% related to bevacizumab, and 11.8% related to both the study drugs. The most common AEs were fatigue (9.9% of all AEs), paresthesia (6.5% of all AEs) and neutropenia (6.2% of all AEs). Quality of life was well preserved among the majority of patients.
Conclusions: The results of our trial suggest that continuing bevacizumab in combination with eribulin, beyond first line treatment with bevacizumab and paclitaxel, offers a reasonable therapeutic option for patients with HER2-negative MBC, without detrimentally affecting quality of life.
Citation Format: De Placido S, De Laurentiis M, Bruzzese D, Bernardo A, Baldini EE, Montesarchio V, Fabi A, Gamucci T, De Placido P, Russo S, Lauria R, De Santo I, De Angelis C, Del Mastro L, Giuliano M, Arpino G. A phase II single arm trial evaluating the efficacy and safety of eribulin in combination with bevacizumab for second-line treatment of human epidermal growth factor receptor 2 (HER2)–negative metastatic breast cancer (MBC) progressing after first-line therapy with bevacizumab and paclitaxel [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P6-21-13.
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Affiliation(s)
- S De Placido
- Università degli Studi di Napoli "Federico II", Napoli, NA, Italy; Istituto Nazionale Tumori - IRCCS "Fondazione G.Pascale", Napoli, NA, Italy; Istituti Clinici Scientifici Maugeri SpA SB, Pavia, PV, Italy; Ospedale San Luca, Lucca, LU, Italy; Azienda Ospedaliera dei Colli Monaldi, Napoli, NA, Italy; IFO - Istituto Nazionale Tumori Regina Elena, Roma, RM, Italy; Ospedale 'SS. Trinità', Sora, FR, Italy; A.O.U. Santa Maria della Misericordia di Udine, Udine, UD, Italy; Azienda Ospedaliera Universitaria Pisana - Ospedale S. Chiara, Pisa, PI, Italy; I.R.C.C.S. A.O.U. San Martino - I.S.T., Genova, GE, Italy
| | - M De Laurentiis
- Università degli Studi di Napoli "Federico II", Napoli, NA, Italy; Istituto Nazionale Tumori - IRCCS "Fondazione G.Pascale", Napoli, NA, Italy; Istituti Clinici Scientifici Maugeri SpA SB, Pavia, PV, Italy; Ospedale San Luca, Lucca, LU, Italy; Azienda Ospedaliera dei Colli Monaldi, Napoli, NA, Italy; IFO - Istituto Nazionale Tumori Regina Elena, Roma, RM, Italy; Ospedale 'SS. Trinità', Sora, FR, Italy; A.O.U. Santa Maria della Misericordia di Udine, Udine, UD, Italy; Azienda Ospedaliera Universitaria Pisana - Ospedale S. Chiara, Pisa, PI, Italy; I.R.C.C.S. A.O.U. San Martino - I.S.T., Genova, GE, Italy
| | - D Bruzzese
- Università degli Studi di Napoli "Federico II", Napoli, NA, Italy; Istituto Nazionale Tumori - IRCCS "Fondazione G.Pascale", Napoli, NA, Italy; Istituti Clinici Scientifici Maugeri SpA SB, Pavia, PV, Italy; Ospedale San Luca, Lucca, LU, Italy; Azienda Ospedaliera dei Colli Monaldi, Napoli, NA, Italy; IFO - Istituto Nazionale Tumori Regina Elena, Roma, RM, Italy; Ospedale 'SS. Trinità', Sora, FR, Italy; A.O.U. Santa Maria della Misericordia di Udine, Udine, UD, Italy; Azienda Ospedaliera Universitaria Pisana - Ospedale S. Chiara, Pisa, PI, Italy; I.R.C.C.S. A.O.U. San Martino - I.S.T., Genova, GE, Italy
| | - A Bernardo
- Università degli Studi di Napoli "Federico II", Napoli, NA, Italy; Istituto Nazionale Tumori - IRCCS "Fondazione G.Pascale", Napoli, NA, Italy; Istituti Clinici Scientifici Maugeri SpA SB, Pavia, PV, Italy; Ospedale San Luca, Lucca, LU, Italy; Azienda Ospedaliera dei Colli Monaldi, Napoli, NA, Italy; IFO - Istituto Nazionale Tumori Regina Elena, Roma, RM, Italy; Ospedale 'SS. Trinità', Sora, FR, Italy; A.O.U. Santa Maria della Misericordia di Udine, Udine, UD, Italy; Azienda Ospedaliera Universitaria Pisana - Ospedale S. Chiara, Pisa, PI, Italy; I.R.C.C.S. A.O.U. San Martino - I.S.T., Genova, GE, Italy
| | - EE Baldini
- Università degli Studi di Napoli "Federico II", Napoli, NA, Italy; Istituto Nazionale Tumori - IRCCS "Fondazione G.Pascale", Napoli, NA, Italy; Istituti Clinici Scientifici Maugeri SpA SB, Pavia, PV, Italy; Ospedale San Luca, Lucca, LU, Italy; Azienda Ospedaliera dei Colli Monaldi, Napoli, NA, Italy; IFO - Istituto Nazionale Tumori Regina Elena, Roma, RM, Italy; Ospedale 'SS. Trinità', Sora, FR, Italy; A.O.U. Santa Maria della Misericordia di Udine, Udine, UD, Italy; Azienda Ospedaliera Universitaria Pisana - Ospedale S. Chiara, Pisa, PI, Italy; I.R.C.C.S. A.O.U. San Martino - I.S.T., Genova, GE, Italy
| | - V Montesarchio
- Università degli Studi di Napoli "Federico II", Napoli, NA, Italy; Istituto Nazionale Tumori - IRCCS "Fondazione G.Pascale", Napoli, NA, Italy; Istituti Clinici Scientifici Maugeri SpA SB, Pavia, PV, Italy; Ospedale San Luca, Lucca, LU, Italy; Azienda Ospedaliera dei Colli Monaldi, Napoli, NA, Italy; IFO - Istituto Nazionale Tumori Regina Elena, Roma, RM, Italy; Ospedale 'SS. Trinità', Sora, FR, Italy; A.O.U. Santa Maria della Misericordia di Udine, Udine, UD, Italy; Azienda Ospedaliera Universitaria Pisana - Ospedale S. Chiara, Pisa, PI, Italy; I.R.C.C.S. A.O.U. San Martino - I.S.T., Genova, GE, Italy
| | - A Fabi
- Università degli Studi di Napoli "Federico II", Napoli, NA, Italy; Istituto Nazionale Tumori - IRCCS "Fondazione G.Pascale", Napoli, NA, Italy; Istituti Clinici Scientifici Maugeri SpA SB, Pavia, PV, Italy; Ospedale San Luca, Lucca, LU, Italy; Azienda Ospedaliera dei Colli Monaldi, Napoli, NA, Italy; IFO - Istituto Nazionale Tumori Regina Elena, Roma, RM, Italy; Ospedale 'SS. Trinità', Sora, FR, Italy; A.O.U. Santa Maria della Misericordia di Udine, Udine, UD, Italy; Azienda Ospedaliera Universitaria Pisana - Ospedale S. Chiara, Pisa, PI, Italy; I.R.C.C.S. A.O.U. San Martino - I.S.T., Genova, GE, Italy
| | - T Gamucci
- Università degli Studi di Napoli "Federico II", Napoli, NA, Italy; Istituto Nazionale Tumori - IRCCS "Fondazione G.Pascale", Napoli, NA, Italy; Istituti Clinici Scientifici Maugeri SpA SB, Pavia, PV, Italy; Ospedale San Luca, Lucca, LU, Italy; Azienda Ospedaliera dei Colli Monaldi, Napoli, NA, Italy; IFO - Istituto Nazionale Tumori Regina Elena, Roma, RM, Italy; Ospedale 'SS. Trinità', Sora, FR, Italy; A.O.U. Santa Maria della Misericordia di Udine, Udine, UD, Italy; Azienda Ospedaliera Universitaria Pisana - Ospedale S. Chiara, Pisa, PI, Italy; I.R.C.C.S. A.O.U. San Martino - I.S.T., Genova, GE, Italy
| | - P De Placido
- Università degli Studi di Napoli "Federico II", Napoli, NA, Italy; Istituto Nazionale Tumori - IRCCS "Fondazione G.Pascale", Napoli, NA, Italy; Istituti Clinici Scientifici Maugeri SpA SB, Pavia, PV, Italy; Ospedale San Luca, Lucca, LU, Italy; Azienda Ospedaliera dei Colli Monaldi, Napoli, NA, Italy; IFO - Istituto Nazionale Tumori Regina Elena, Roma, RM, Italy; Ospedale 'SS. Trinità', Sora, FR, Italy; A.O.U. Santa Maria della Misericordia di Udine, Udine, UD, Italy; Azienda Ospedaliera Universitaria Pisana - Ospedale S. Chiara, Pisa, PI, Italy; I.R.C.C.S. A.O.U. San Martino - I.S.T., Genova, GE, Italy
| | - S Russo
- Università degli Studi di Napoli "Federico II", Napoli, NA, Italy; Istituto Nazionale Tumori - IRCCS "Fondazione G.Pascale", Napoli, NA, Italy; Istituti Clinici Scientifici Maugeri SpA SB, Pavia, PV, Italy; Ospedale San Luca, Lucca, LU, Italy; Azienda Ospedaliera dei Colli Monaldi, Napoli, NA, Italy; IFO - Istituto Nazionale Tumori Regina Elena, Roma, RM, Italy; Ospedale 'SS. Trinità', Sora, FR, Italy; A.O.U. Santa Maria della Misericordia di Udine, Udine, UD, Italy; Azienda Ospedaliera Universitaria Pisana - Ospedale S. Chiara, Pisa, PI, Italy; I.R.C.C.S. A.O.U. San Martino - I.S.T., Genova, GE, Italy
| | - R Lauria
- Università degli Studi di Napoli "Federico II", Napoli, NA, Italy; Istituto Nazionale Tumori - IRCCS "Fondazione G.Pascale", Napoli, NA, Italy; Istituti Clinici Scientifici Maugeri SpA SB, Pavia, PV, Italy; Ospedale San Luca, Lucca, LU, Italy; Azienda Ospedaliera dei Colli Monaldi, Napoli, NA, Italy; IFO - Istituto Nazionale Tumori Regina Elena, Roma, RM, Italy; Ospedale 'SS. Trinità', Sora, FR, Italy; A.O.U. Santa Maria della Misericordia di Udine, Udine, UD, Italy; Azienda Ospedaliera Universitaria Pisana - Ospedale S. Chiara, Pisa, PI, Italy; I.R.C.C.S. A.O.U. San Martino - I.S.T., Genova, GE, Italy
| | - I De Santo
- Università degli Studi di Napoli "Federico II", Napoli, NA, Italy; Istituto Nazionale Tumori - IRCCS "Fondazione G.Pascale", Napoli, NA, Italy; Istituti Clinici Scientifici Maugeri SpA SB, Pavia, PV, Italy; Ospedale San Luca, Lucca, LU, Italy; Azienda Ospedaliera dei Colli Monaldi, Napoli, NA, Italy; IFO - Istituto Nazionale Tumori Regina Elena, Roma, RM, Italy; Ospedale 'SS. Trinità', Sora, FR, Italy; A.O.U. Santa Maria della Misericordia di Udine, Udine, UD, Italy; Azienda Ospedaliera Universitaria Pisana - Ospedale S. Chiara, Pisa, PI, Italy; I.R.C.C.S. A.O.U. San Martino - I.S.T., Genova, GE, Italy
| | - C De Angelis
- Università degli Studi di Napoli "Federico II", Napoli, NA, Italy; Istituto Nazionale Tumori - IRCCS "Fondazione G.Pascale", Napoli, NA, Italy; Istituti Clinici Scientifici Maugeri SpA SB, Pavia, PV, Italy; Ospedale San Luca, Lucca, LU, Italy; Azienda Ospedaliera dei Colli Monaldi, Napoli, NA, Italy; IFO - Istituto Nazionale Tumori Regina Elena, Roma, RM, Italy; Ospedale 'SS. Trinità', Sora, FR, Italy; A.O.U. Santa Maria della Misericordia di Udine, Udine, UD, Italy; Azienda Ospedaliera Universitaria Pisana - Ospedale S. Chiara, Pisa, PI, Italy; I.R.C.C.S. A.O.U. San Martino - I.S.T., Genova, GE, Italy
| | - L Del Mastro
- Università degli Studi di Napoli "Federico II", Napoli, NA, Italy; Istituto Nazionale Tumori - IRCCS "Fondazione G.Pascale", Napoli, NA, Italy; Istituti Clinici Scientifici Maugeri SpA SB, Pavia, PV, Italy; Ospedale San Luca, Lucca, LU, Italy; Azienda Ospedaliera dei Colli Monaldi, Napoli, NA, Italy; IFO - Istituto Nazionale Tumori Regina Elena, Roma, RM, Italy; Ospedale 'SS. Trinità', Sora, FR, Italy; A.O.U. Santa Maria della Misericordia di Udine, Udine, UD, Italy; Azienda Ospedaliera Universitaria Pisana - Ospedale S. Chiara, Pisa, PI, Italy; I.R.C.C.S. A.O.U. San Martino - I.S.T., Genova, GE, Italy
| | - M Giuliano
- Università degli Studi di Napoli "Federico II", Napoli, NA, Italy; Istituto Nazionale Tumori - IRCCS "Fondazione G.Pascale", Napoli, NA, Italy; Istituti Clinici Scientifici Maugeri SpA SB, Pavia, PV, Italy; Ospedale San Luca, Lucca, LU, Italy; Azienda Ospedaliera dei Colli Monaldi, Napoli, NA, Italy; IFO - Istituto Nazionale Tumori Regina Elena, Roma, RM, Italy; Ospedale 'SS. Trinità', Sora, FR, Italy; A.O.U. Santa Maria della Misericordia di Udine, Udine, UD, Italy; Azienda Ospedaliera Universitaria Pisana - Ospedale S. Chiara, Pisa, PI, Italy; I.R.C.C.S. A.O.U. San Martino - I.S.T., Genova, GE, Italy
| | - G Arpino
- Università degli Studi di Napoli "Federico II", Napoli, NA, Italy; Istituto Nazionale Tumori - IRCCS "Fondazione G.Pascale", Napoli, NA, Italy; Istituti Clinici Scientifici Maugeri SpA SB, Pavia, PV, Italy; Ospedale San Luca, Lucca, LU, Italy; Azienda Ospedaliera dei Colli Monaldi, Napoli, NA, Italy; IFO - Istituto Nazionale Tumori Regina Elena, Roma, RM, Italy; Ospedale 'SS. Trinità', Sora, FR, Italy; A.O.U. Santa Maria della Misericordia di Udine, Udine, UD, Italy; Azienda Ospedaliera Universitaria Pisana - Ospedale S. Chiara, Pisa, PI, Italy; I.R.C.C.S. A.O.U. San Martino - I.S.T., Genova, GE, Italy
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