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Gemelli M, Carbone M, Abbate MI, Mancin M, Zucchini N, Colonese F, Invernizzi P, Bidoli P, Cortinovis D. Vanishing bile duct syndrome following pembrolizumab infusion: case report and review of the literature. Immunotherapy 2021; 14:175-181. [PMID: 34873918 DOI: 10.2217/imt-2021-0078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
PD-1/PD-L1 inhibitors demonstrate high efficacy in non-small-cell lung cancer and are now routinely used in clinical practice. Severe immune-related adverse events are reported in about 5% of patients, requiring hospitalization and possibly leading to death. We present a rare case of vanishing bile duct syndrome that arose a few days after the first pembrolizumab infusion. Laboratory tests and radiological imaging studies were performed to orient diagnosis and monitor the disease, while the evidence of ductal loss on the histological sample was pathognomonic for vanishing bile duct syndrome. High-dose steroid therapy and immunosuppressors were administered, resulting in scarce efficacy. Prompt recognition and management of similar conditions is crucial to avoid fatal events. Further studies are needed to investigate new drugs for steroid-refractory conditions.
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Affiliation(s)
- Maria Gemelli
- Oncology Unit, ASST Monza San Gerardo Hospital, Monza, 20900, Italy.,Oncology Unit, IRCCS MultiMedica, Sesto San Giovanni, Milan, 20099, Italy
| | - Marco Carbone
- Division of Gastroenterology & Center for Autoimmune Liver Diseases, Department of Medicine & Surgery, University of Milan-Bicocca, Monza, 20900, Italy.,European Reference Network on Hepatological Diseases (ERN RARE-LIVER), San Gerardo Hospital, Monza, 20900, Italy
| | - Maria I Abbate
- Oncology Unit, ASST Monza San Gerardo Hospital, Monza, 20900, Italy
| | - Maddalena Mancin
- Oncology Unit, ASST Monza San Gerardo Hospital, Monza, 20900, Italy
| | - Nicola Zucchini
- Pathology Department, ASST Monza San Gerardo Hospital, Monza, 20900, Italy
| | | | - Pietro Invernizzi
- Division of Gastroenterology & Center for Autoimmune Liver Diseases, Department of Medicine & Surgery, University of Milan-Bicocca, Monza, 20900, Italy.,European Reference Network on Hepatological Diseases (ERN RARE-LIVER), San Gerardo Hospital, Monza, 20900, Italy
| | - Paolo Bidoli
- Oncology Unit, ASST Monza San Gerardo Hospital, Monza, 20900, Italy
| | - Diego Cortinovis
- Oncology Unit, ASST Monza San Gerardo Hospital, Monza, 20900, Italy
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2
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Gemelli M, Bidoli P, Colonese F, Canova S, Cortinovis D. Anti PD-L1 antibody: is there a histologic-oriented efficacy? Focus on atezolizumab in squamous cell non-small cell lung cancer. Front Biosci (Schol Ed) 2021; 13:190-201. [PMID: 34879471 DOI: 10.52586/s562] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 05/15/2021] [Accepted: 05/17/2021] [Indexed: 11/09/2022]
Abstract
Squamous cell lung cancer (SqCLC) is the second most common histotype of non-small cell lung cancer (NSCLC) and is characterized by severe prognosis and lack of specific target agents. Atezolizumab is the first anti Programmed Death Ligand-1 (PDL-1) inhibitor approved for NSCLC patients of both histology in case of disease progression after first or further lines of therapy. Numerous studies are investigating the potential role of atezolizumab in different therapeutic setting, including SqCLC subtype. We searched for published clinical trials in Pubmed database, using the terms "atezolizumab", "squamous cell lung cancer", "NSCLC" and "non-small cell lung cancer". We also searched for recently concluded and not yet published or ongoing trials in clinicaltrials.gov and in data from the latest international congresses. The aim of this review is to summarize current evidence on atezolizumab in SqCLC, from first line setting to novel potential indications from ongoing trials. Strengths and weaknesses of atezolizumab treatment were highlighted to speculate the role of this immune checkpoint inhibitor in novel future clinical scenarios.
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Affiliation(s)
- Maria Gemelli
- Oncology Unit, IRCCS MultiMedica, Sesto San Giovanni, 20099 Milan, Italy.,Oncology Unit, ASST-Monza, San Gerardo Hospital, Monza, 20900 Monza-Brianza, Italy
| | - Paolo Bidoli
- Oncology Unit, ASST-Monza, San Gerardo Hospital, Monza, 20900 Monza-Brianza, Italy
| | - Francesca Colonese
- Oncology Unit, ASST-Monza, San Gerardo Hospital, Monza, 20900 Monza-Brianza, Italy
| | - Stefania Canova
- Oncology Unit, ASST-Monza, San Gerardo Hospital, Monza, 20900 Monza-Brianza, Italy
| | - Diego Cortinovis
- Oncology Unit, ASST-Monza, San Gerardo Hospital, Monza, 20900 Monza-Brianza, Italy
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3
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Pilla L, Alberti A, Di Mauro P, Gemelli M, Cogliati V, Cazzaniga ME, Bidoli P, Maccalli C. Molecular and Immune Biomarkers for Cutaneous Melanoma: Current Status and Future Prospects. Cancers (Basel) 2020; 12:E3456. [PMID: 33233603 PMCID: PMC7699774 DOI: 10.3390/cancers12113456] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 11/11/2020] [Accepted: 11/11/2020] [Indexed: 12/18/2022] Open
Abstract
Advances in the genomic, molecular and immunological make-up of melanoma allowed the development of novel targeted therapy and of immunotherapy, leading to changes in the paradigm of therapeutic interventions and improvement of patients' overall survival. Nevertheless, the mechanisms regulating either the responsiveness or the resistance of melanoma patients to therapies are still mostly unknown. The development of either the combinations or of the sequential treatment of different agents has been investigated but without a strongly molecularly motivated rationale. The need for robust biomarkers to predict patients' responsiveness to defined therapies and for their stratification is still unmet. Progress in immunological assays and genomic techniques as long as improvement in designing and performing studies monitoring the expression of these markers along with the evolution of the disease allowed to identify candidate biomarkers. However, none of them achieved a definitive role in predicting patients' clinical outcomes. Along this line, the cross-talk of melanoma cells with tumor microenvironment plays an important role in the evolution of the disease and needs to be considered in light of the role of predictive biomarkers. The overview of the relationship between the molecular basis of melanoma and targeted therapies is provided in this review, highlighting the benefit for clinical responses and the limitations. Moreover, the role of different candidate biomarkers is described together with the technical approaches for their identification. The provided evidence shows that progress has been achieved in understanding the molecular basis of melanoma and in designing advanced therapeutic strategies. Nevertheless, the molecular determinants of melanoma and their role as biomarkers predicting patients' responsiveness to therapies warrant further investigation with the vision of developing more effective precision medicine.
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Affiliation(s)
- Lorenzo Pilla
- Division of Medical Oncology, San Gerardo Hospital, University of Milano-Bicocca School of Medicine, 20900 Monza, Italy; (P.D.M.); (M.G.); (V.C.); (M.E.C.); (P.B.)
| | - Andrea Alberti
- Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Health Science and Public Health, University of Brescia, ASST Ospedali Civili, 25123 Brescia, Italy;
| | - Pierluigi Di Mauro
- Division of Medical Oncology, San Gerardo Hospital, University of Milano-Bicocca School of Medicine, 20900 Monza, Italy; (P.D.M.); (M.G.); (V.C.); (M.E.C.); (P.B.)
| | - Maria Gemelli
- Division of Medical Oncology, San Gerardo Hospital, University of Milano-Bicocca School of Medicine, 20900 Monza, Italy; (P.D.M.); (M.G.); (V.C.); (M.E.C.); (P.B.)
| | - Viola Cogliati
- Division of Medical Oncology, San Gerardo Hospital, University of Milano-Bicocca School of Medicine, 20900 Monza, Italy; (P.D.M.); (M.G.); (V.C.); (M.E.C.); (P.B.)
| | - Marina Elena Cazzaniga
- Division of Medical Oncology, San Gerardo Hospital, University of Milano-Bicocca School of Medicine, 20900 Monza, Italy; (P.D.M.); (M.G.); (V.C.); (M.E.C.); (P.B.)
| | - Paolo Bidoli
- Division of Medical Oncology, San Gerardo Hospital, University of Milano-Bicocca School of Medicine, 20900 Monza, Italy; (P.D.M.); (M.G.); (V.C.); (M.E.C.); (P.B.)
| | - Cristina Maccalli
- Laboratory of Immune and Biological Therapy, Research Department, Sidra Medicine, Doha 26999, Qatar;
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Laganà M, Gurizzan C, Roca E, Cortinovis D, Signorelli D, Pagani F, Bettini A, Bonomi L, Rinaldi S, Berardi R, Filetti M, Giusti R, Pilotto S, Milella M, Intagliata S, Baggi A, Cortellini A, Soto Parra H, Brighenti M, Petrelli F, Bennati C, Bidoli P, Garassino MC, Berruti A. High Prevalence and Early Occurrence of Skeletal Complications in EGFR Mutated NSCLC Patients With Bone Metastases. Front Oncol 2020; 10:588862. [PMID: 33282740 PMCID: PMC7689017 DOI: 10.3389/fonc.2020.588862] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 10/19/2020] [Indexed: 11/13/2022] Open
Abstract
Objectives The prevalence of Skeletal Related Adverse Events (SREs) in EGFR mutated non-small cell lung cancer (NSCLC) patients with bone metastases, treated with modern tyrosine kinase inhibitors (TKIs), has been scarcely investigated. Materials and Methods We retrospectively evaluated the data of EGFR mutated NSCLC patients with bone metastases treated with TKIs in 12 Italian centers from 2014 to 2019, with the primary aim to explore type and frequency of SREs. Results Seventy-seven out of 274 patients enrolled (28%) developed at least one major SRE: 55/274 (20%) bone fractures, 30/274 (11%) spinal cord compression, 5/274 (2%) hypercalcemia. Median time to the onset of SRE was 3.63 months. Nine patients (3%) underwent bone surgery and 150 (55%) radiation therapy on bone. SREs were more frequently observed within the 12 months from TKI start than afterwards (71 vs 29%, p 0.000). Patient Performance Status and liver metastases where independently associated with the risk of developing SREs. Median TKI exposure and overall survival were 11 and 28 months, respectively. Bone resorption inhibitors were associated with a lower risk of death (HR 0.722, 95% CI: 0.504–1.033, p = 0.075) although not statistically significant at multivariate analysis. Conclusion Bone metastatic NSCLC patients with EGFR mutated disease, treated with EGFR TKIs, have a relatively long survival expectancy and are at high risk to develop SREs. The early SRE occurrence after the TKI start provides the rationale to administer bone resorption inhibitors.
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Affiliation(s)
- Marta Laganà
- Medical Oncology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health University of Brescia, ASST-Spedali Civili, Brescia, Italy
| | - Cristina Gurizzan
- Medical Oncology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health University of Brescia, ASST-Spedali Civili, Brescia, Italy
| | - Elisa Roca
- Medical Oncology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health University of Brescia, ASST-Spedali Civili, Brescia, Italy
| | | | - Diego Signorelli
- Medical Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - Filippo Pagani
- Medical Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - Anna Bettini
- Medical Oncology, ASST Papa Giovanni XXIII di Bergamo, Bergamo, Italy
| | - Lucia Bonomi
- Medical Oncology, ASST Papa Giovanni XXIII di Bergamo, Bergamo, Italy
| | - Silvia Rinaldi
- Medical Oncology, Ospedali Riuniti di Ancona, Ancona, Italy
| | | | - Marco Filetti
- Medical Oncology, Azienda Ospedaliero Universitaria S. Andrea di Roma, Roma, Italy
| | - Raffaele Giusti
- Medical Oncology, Azienda Ospedaliero Universitaria S. Andrea di Roma, Roma, Italy
| | - Sara Pilotto
- Medical Oncology, Università degli studi di Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Michele Milella
- Medical Oncology, Università degli studi di Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Salvatore Intagliata
- Medical Oncology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health University of Brescia, ASST-Spedali Civili, Brescia, Italy
| | - Alice Baggi
- Medical Oncology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health University of Brescia, ASST-Spedali Civili, Brescia, Italy
| | | | - Hector Soto Parra
- Medical Oncology, Policlinico Vittorio Emanuele di Catania, Catania, Italy
| | | | | | - Chiara Bennati
- Ospedale Santa Maria delle Croci di Ravenna, Ravenna, Italy
| | - Paolo Bidoli
- Medical Oncology, Ospedale S. Gerardo di Monza, Monza, Italy
| | | | - Alfredo Berruti
- Medical Oncology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health University of Brescia, ASST-Spedali Civili, Brescia, Italy
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Bani M, Rossi E, Cortinovis D, Russo S, Gallina F, Hillen MA, Canova S, Cicchiello F, Longarini R, Cazzaniga ME, Bidoli P, Valsecchi MG, Strepparava MG. Validation of the Italian version of the full and abbreviated Trust in Oncologist Scale. Eur J Cancer Care (Engl) 2020; 30:e13334. [PMID: 33015898 DOI: 10.1111/ecc.13334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 05/29/2020] [Accepted: 08/07/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The Trust in Oncologist Scale (TiOS) is an 18-item questionnaire aimed to assess the cancer patients' trust in their oncologist and has been validated in Dutch and English language. This study aims to validate the Italian version of the TiOS (IT-TiOS) and the TiOS-Short Form (IT-TiOS-SF). METHODS The IT-TiOS was administered to 194 patients recruited in an Italian oncology department from April to December 2018. Data collected included socio-demographic data, health and clinical information, satisfaction with the most recent oncology visit and trust in the regional healthcare system. Internal consistency, test-retest reliability, convergent and the structural validity of both the full and short form were tested. RESULTS Factor analyses indicated that neither four-factor nor one-factor models of the full scale were acceptable. However, confirmatory factor analysis supported the one-dimensionality of the IT-TiOS-SF, and internal consistency assessed with Cronbach's alpha was 0.88. Mean scores on the IT-TiOS-SF correlated with satisfaction with the oncologist (rs = 0.64) and willingness to recommend the oncologist to others (rs = 0.67), confirming good construct validity. CONCLUSION The IT-TiOS-SF demonstrates good psychometric properties and can be used to assess trust for both clinical and research purposes.
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Affiliation(s)
- Marco Bani
- School of Medicine and Surgery, University of Milano - Bicocca, Milano, Italy
| | - Emanuela Rossi
- School of Medicine and Surgery, University of Milano - Bicocca, Milano, Italy
| | - Diego Cortinovis
- School of Medicine and Surgery, University of Milano - Bicocca, Milano, Italy.,Department of Medical Oncology, ASST Monza, Monza, Italy
| | - Selena Russo
- School of Medicine and Surgery, University of Milano - Bicocca, Milano, Italy
| | | | - Marij A Hillen
- Department of Medical Psychology, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | | | | | | | - Marina Elena Cazzaniga
- School of Medicine and Surgery, University of Milano - Bicocca, Milano, Italy.,Department of Medical Oncology, ASST Monza, Monza, Italy.,Department of Mental Health, ASST Monza, Monza, Italy
| | - Paolo Bidoli
- School of Medicine and Surgery, University of Milano - Bicocca, Milano, Italy.,Department of Medical Oncology, ASST Monza, Monza, Italy
| | | | - Maria Grazia Strepparava
- School of Medicine and Surgery, University of Milano - Bicocca, Milano, Italy.,Phase 1 Research Unit, ASST Monza, Monza, Italy
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Cortinovis D, Grosso F, Carlucci L, Zucali PA, Pasello G, Tiseo M, Sperandi F, Hollander L, Galli F, Torri V, Rulli E, Canova S, Maconi A, Bidoli P, Ceresoli GL, D'Incalci M. Trabectedin in Malignant Pleural Mesothelioma: Results From the Multicentre, Single Arm, Phase II ATREUS Study. Clin Lung Cancer 2020; 22:361-370.e3. [PMID: 32732073 DOI: 10.1016/j.cllc.2020.06.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 06/15/2020] [Accepted: 06/29/2020] [Indexed: 12/14/2022]
Abstract
INTRODUCTION New therapeutic approaches in unresectable malignant pleural mesothelioma (MPM) are eagerly awaited. Trabectedin is an antitumor agent with an effect on cancer cell proliferation and a modulating action on tumor microenvironment. The ATREUS study explored the activity and safety of trabectedin in patients with unresectable MPM. METHODS Epithelioid patients with MPM received trabectedin as second-line while biphasic/sarcomatoid patients with MPM as first- or second-line therapy. Treatment was given intravenously at an initially planned dose of 1.3 mg/m2 every 3 weeks, until progression or unacceptable toxicity. The primary endpoint was progression-free survival rate at 12 weeks (PFS12wks). RESULTS Overall, 78 patients (54%) had epithelioid and 67 (46%) nonepithelioid MPM. PFS12wks in 62 evaluable patients with epithelioid MPM was 43.5% (80% confidence interval 34.9%-52.5%); median progression-free and overall survival were 2.4 and 9.0 months, respectively. PFS12wks in 52 evaluable patients with nonepithelioid MPM was 30.8% (90% confidence interval 20.3%-42.9%); median progression-free and overall survival were 1.7 and 5.4 months. Trabectedin starting dose was amended due to excess of liver toxicity. Eighty-four (64%) and 48 (36%) patients received 1.3 mg/m2 and 1.1. mg/m2, respectively. The most common grade 3-4 toxicities were hepatotoxicity, leukopenia/neutropenia, and fatigue. Grade 3-4 hepatotoxicity was reported in 59 (70%) patients treated at 1.3 mg/m2, and in 19 (40%) treated at 1.1 mg/m2. CONCLUSIONS Trabectedin showed modest clinical activity, at the expense of relevant liver toxicity. Further development of this drug in MPM at full doses is not warranted.
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Affiliation(s)
| | - Federica Grosso
- Mesothelioma Unit, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Luciano Carlucci
- Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Paolo Andrea Zucali
- Department of Medical Oncology and Hematology, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Giulia Pasello
- Department of Oncology 2, Istituto Oncologico Veneto IRCCS, Padova, Italy
| | - Marcello Tiseo
- Department of Medicine and Surgery, University of Parma and Medical Oncology Unit, Azienda Ospedaliero-Universitaria, Parma, Italy
| | | | - Lital Hollander
- Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Francesca Galli
- Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Valter Torri
- Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Eliana Rulli
- Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy.
| | - Stefania Canova
- Medical Oncology Unit, ASST Ospedale San Gerardo, Monza, Italy
| | - Antonio Maconi
- Scientific Research and Development Department, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Paolo Bidoli
- Medical Oncology Unit, ASST Ospedale San Gerardo, Monza, Italy
| | | | - Maurizio D'Incalci
- Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
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Alberti A, Mancin M, Cortinovis D, Bidoli P, Sala L. Disseminated intravascular coagulation in advanced lung adenocarcinoma during first-line pembrolizumab. Immunotherapy 2020; 12:629-633. [DOI: 10.2217/imt-2020-0018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Aim: Every year 1.6 million people worldwide die from lung cancer, making it one of the most frequent and deadly tumors. Pembrolizumab is a humanized monoclonal antibody against PD-1 that has antitumor activity in advanced non-small-cell lung cancer, with increased activity in tumors that express programmed death ligand 1. Methods & results: We report the first case of pembrolizumab-related disseminated intravascular coagulation (DIC). After excluding other causes of DIC, a diagnosis of pembrolizumab-related DIC was performed and the patient was treated with corticosteroid therapy until signs resolution. Conclusion: Disorders of coagulation–fibrinolysis system related to immunotherapy are rare, but often clinically serious and life threatening, so it is necessary to pay close attention to the various symptoms and signs during immunotherapy.
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Affiliation(s)
- Andrea Alberti
- Department of Oncology, San Gerardo Hospital, Asst-Monza, via Pergolesi 33 Monza, Italy
| | - Maddalena Mancin
- Department of Oncology, San Gerardo Hospital, Asst-Monza, via Pergolesi 33 Monza, Italy
| | - Diego Cortinovis
- Department of Oncology, San Gerardo Hospital, Asst-Monza, via Pergolesi 33 Monza, Italy
| | - Paolo Bidoli
- Department of Oncology, San Gerardo Hospital, Asst-Monza, via Pergolesi 33 Monza, Italy
| | - Luca Sala
- Department of Oncology, San Gerardo Hospital, Asst-Monza, via Pergolesi 33 Monza, Italy
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8
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Massironi S, Pilla L, Elvevi A, Longarini R, Rossi RE, Bidoli P, Invernizzi P. New and Emerging Systemic Therapeutic Options for Advanced Cholangiocarcinoma. Cells 2020; 9:cells9030688. [PMID: 32168869 PMCID: PMC7140695 DOI: 10.3390/cells9030688] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [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: 02/01/2020] [Revised: 02/28/2020] [Accepted: 02/28/2020] [Indexed: 02/05/2023] Open
Abstract
Cholangiocarcinoma (CCA) represents a disease entity that comprises a heterogeneous group of biliary malignant neoplasms, with variable clinical presentation and severity. It may be classified according to its anatomical location and distinguished in intrahepatic (iCCA), perihilar (pCCA), or distal (dCCA), each subtype implying distinct epidemiology, biology, prognosis, and strategy for clinical management. Its incidence has increased globally over the past few decades, and its mortality rate remains high due to both its biological aggressiveness and resistance to medical therapy. Surgery is the only potentially curative treatment and is the standard approach for resectable CCA; however, more than half of the patients have locally advanced or metastatic disease at presentation. For patients with unresectable CCA, the available systemic therapies are of limited effectiveness. However, the advances of the comprehension of the complex molecular landscape of CCA and its tumor microenvironment could provide new keys to better understand the pathogenesis, the mechanisms of resistance and ultimately to identify promising new therapeutic targets. Recently, clinical trials targeting isocitrate dehydrogenase (IDH)-1 mutations and fibroblast growth factor receptor (FGFR)-2 fusions, as well as immunotherapy showed promising results. All these new and emerging therapeutic options are herein discussed.
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Affiliation(s)
- Sara Massironi
- Division of Gastroenterology, San Gerardo Hospital, University of Milano-Bicocca School of Medicine, 20900 Monza, Italy; (A.E.); (P.I.)
- Correspondence: ; Tel.: +39-335-6269995
| | - Lorenzo Pilla
- Division of Medical Oncology, San Gerardo Hospital, University of Milano-Bicocca School of Medicine, 20900 Monza, Italy; (L.P.); (R.L.); (P.B.)
| | - Alessandra Elvevi
- Division of Gastroenterology, San Gerardo Hospital, University of Milano-Bicocca School of Medicine, 20900 Monza, Italy; (A.E.); (P.I.)
| | - Raffaella Longarini
- Division of Medical Oncology, San Gerardo Hospital, University of Milano-Bicocca School of Medicine, 20900 Monza, Italy; (L.P.); (R.L.); (P.B.)
| | - Roberta Elisa Rossi
- Gastrointestinal and Hepato-Pancreatic Surgery and Liver Transplantation Unit, Fondazione IRCCS Istituto Nazionale Tumori (INT, National Cancer Institute) - Università degli Studi di Milano, 20100 Milan, Italy;
| | - Paolo Bidoli
- Division of Medical Oncology, San Gerardo Hospital, University of Milano-Bicocca School of Medicine, 20900 Monza, Italy; (L.P.); (R.L.); (P.B.)
| | - Pietro Invernizzi
- Division of Gastroenterology, San Gerardo Hospital, University of Milano-Bicocca School of Medicine, 20900 Monza, Italy; (A.E.); (P.I.)
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9
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Molina-Vila MA, Stahel RA, Dafni U, Jordana-Ariza N, Balada-Bel A, Garzón-Ibáñez M, García-Peláez B, Mayo-de-las-Casas C, Felip E, Curioni Fontecedro A, Gautschi O, Peters S, Massutí B, Palmero R, Ponce Aix S, Carcereny E, Früh M, Pless M, Popat S, Cuffe S, Bidoli P, Kammler R, Roschitzki-Voser H, Tsourti Z, Karachaliou N, Rosell R. Evolution and Clinical Impact of EGFR Mutations in Circulating Free DNA in the BELIEF Trial. J Thorac Oncol 2020; 15:416-425. [DOI: 10.1016/j.jtho.2019.11.023] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 11/12/2019] [Accepted: 11/19/2019] [Indexed: 01/05/2023]
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10
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Barni S, Rosati G, Lonardi S, Pella N, Banzi M, Zampino MG, Dotti KF, Rimassa L, Marchetti P, Maiello E, Artioli F, Ferrari D, Labianca R, Bidoli P, Zaniboni A, Sobrero A, Iaffaioli V, De Placido S, Frassineti GL, Ciarlo A, Buonadonna A, Silvestris N, Piazza E, Pavesi L, Moroni M, Clerico M, Aglietta M, Giordani P, Galli F, Galli F, Petrelli F. Khorana score and thromboembolic risk in stage II-III colorectal cancer patients: a post hoc analysis from the adjuvant TOSCA trial. Ther Adv Med Oncol 2020; 12:1758835919899850. [PMID: 32010236 PMCID: PMC6974756 DOI: 10.1177/1758835919899850] [Citation(s) in RCA: 5] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Accepted: 12/09/2019] [Indexed: 11/16/2022] Open
Abstract
Background: The risk of venous thromboembolic events (VTE) during adjuvant chemotherapy
for colorectal cancer (CRC) is unknown. We aim to evaluate if the Khorana
score (KS) can predict this risk, and if it represents a prognostic factor
for overall survival (OS) through a post hoc analysis of
the phase III TOSCA trial of different durations (3- versus
6-months) of adjuvant chemotherapy. Methods: A logistic regression model was used to test the associations between the
risk of VTE and the KS. The results are expressed as odds ratios (OR) with
95% confidence intervals (95% CI). To assess the effect of the KS on OS,
multivariable analyses using Cox regression models were performed. The
results are expressed as hazard ratios (HR) with 95% CI. Results: Among 1380 CRC patients with available data, the VTE risk
(n = 72 events: 5.2%) was similar in the two duration arms
(5.5% versus 4.9%), with 0.2% of patients belonging to the
high-risk KS group. Rates of VTE were similar in the low- and
intermediate-risk groups (4.8% versus 6.4%). KS did not
represent an independent predictive factor for VTE occurrence. Chemotherapy
duration was not associated with VTE risk. In addition, KS was not
prognostic for OS in multivariate analysis (HR: 0.92, 95% CI, 0.63–1.36;
p = 0.6835). Conclusions: The use of the KS did not predict VTEs in a low–moderate thromboembolic risk
population as CRC. These data did not support the use of KS to predict VTE
during adjuvant chemotherapy, and suggest that other risk assessment models
should be researched.
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Affiliation(s)
- Sandro Barni
- Oncology Unit, Medical Science Department, ASST Bergamo Ovest, Treviglio (BG), Italy
| | - Gerardo Rosati
- Medical Oncology Unit, Ospedale San Carlo, Potenza, Italy
| | - Sara Lonardi
- Medical Oncology Unit 1, Istituto Oncologico Veneto-IRCCS, Padova, Italy
| | - Nicoletta Pella
- Medical Oncology Unit, Azienda Ospedaliero Universitaria Santa Maria della Misericordia, Udine, Italy
| | - Maria Banzi
- Medical Oncology Unit, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy
| | - Maria G Zampino
- Gastrointestinal Medical Oncology Unit and Neuroendocrine Tumors, Istituto Europeo di Oncologia-IRCCS, Milano, Italy
| | - Katia F Dotti
- Medical Oncology Unit, Fondazione Istituto Nazionale Tumori-IRCCS, Milano, Italy
| | - Lorenza Rimassa
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, Humanitas Clinical and Research Center, Rozzano (MI), Italy
| | - Paolo Marchetti
- Medical Oncology Unit, Sant'Andrea Hospital, Sapienza University of Rome and IDI-IRCCS, Roma, Italy
| | - Evaristo Maiello
- Medical Oncology Unit, Hospital Casa Sollievo della Sofferenza-IRCCS, San Giovanni Rotondo, Italy
| | | | - Daris Ferrari
- Medical Oncology Unit, Azienda Ospedaliera San Paolo, Milano, Italy
| | | | - Paolo Bidoli
- Medical Oncology Unit San Gerardo dei Tintori Hospital, Monza, Italy
| | | | | | - Vincenzo Iaffaioli
- Abdominal Medical Oncology, National Cancer Institute, IRCCS Foundation Pascale, Napoli, Italy
| | - Sabino De Placido
- Department of Clinical Medicine and Surgery, Federico II University, Napoli, Italy
| | - Gian Luca Frassineti
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori IRST, IRCCS, Meldola, Italy
| | | | - Angela Buonadonna
- Medical Oncology Unit Centro di Riferimento Oncologico Aviano-IRCCS, Aviano, Italy
| | - Nicola Silvestris
- Medical Oncology Unit Ospedale Oncologico 'Giovanni Paolo II' and Scientific Directorate-IRCCS, Bari, Italy
| | - Elena Piazza
- Medical Oncology Unit AOU Sacco Hospital, Milano, Italy
| | - Lorenzo Pavesi
- Medical Oncology Unit Fondazione Maugeri-IRCCS, Pavia, Italy
| | - Mauro Moroni
- Medical Oncology Unit AO San Carlo Borromeo, Milano, Italy
| | - Mario Clerico
- Medical Oncology Department ASL Biella, Biella, Italy
| | - Massimo Aglietta
- Candiolo Cancer Institute FPO-IRCCS, Candiolo, Italy, Department of Oncology, University of Torino, Torino, Italy
| | - Paolo Giordani
- Medical Oncology Unit AO Ospedali Riuniti Marche Nord, Pesaro, Italy
| | - Francesca Galli
- Laboratory of Methodology for Clinical Research, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Fabio Galli
- Laboratory of Methodology for Clinical Research, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Fausto Petrelli
- Oncology Unit, Medical Science Department, ASST Bergamo Ovest, Piazzale Ospedale 1, Treviglio (BG), 24047, Italy
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11
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Landi L, D'Incà F, Gelibter A, Chiari R, Grossi F, Delmonte A, Passaro A, Signorelli D, Gelsomino F, Galetta D, Giannarelli D, Soto Parra H, Minuti G, Tiseo M, Migliorino MR, Cognetti F, Toschi L, Bidoli P, Piantedosi F, Calabro' L, Cappuzzo F. Bone metastases and immunotherapy in patients with advanced non-small-cell lung cancer. J Immunother Cancer 2019; 7:316. [PMID: 31752994 PMCID: PMC6868703 DOI: 10.1186/s40425-019-0793-8] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 10/30/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Bone metastases (BoM) are a negative prognostic factor in non-small-cell lung cancer (NSCLC). Beyond its supportive role, bone is a hematopoietic organ actively regulating immune system. We hypothesized that BoM may influence sensitivity to immunotherapy. METHODS Pretreated non-squamous (cohort A) and squamous (cohort B) NSCLCs included in the Italian Expanded Access Program were evaluated for nivolumab efficacy according to BoM. RESULTS Cohort A accounted for 1588 patients with non-squamous NSCLC, including 626 (39%) with (BoM+) and 962 (61%) without BoM (BoM-). Cohort B accounted for 371 patients with squamous histology including 120 BoM+ (32%) and 251 (68%) BoM- cases. BoM+ had lower overall response rate (ORR; Cohort A: 12% versus 23%, p < 0.0001; Cohort B: 13% versus 22%, p = 0.04), shorter progression free survival (PFS; Cohort A: 3.0 versus 4.0 months, p < 0.0001; Cohort B: 2.7 versus 5.2 months, p < 0.0001) and overall survival (OS; Cohort A: 7.4 versus 15.3 months, p < 0.0001; Cohort B: 5.0 versus 10.9 months, p < 0.0001). Moreover, BoM negatively affected outcome irrespective of performance status (PS; OS in both cohorts: p < 0.0001) and liver metastases (OS cohort A: p < 0.0001; OS Cohort B: p = 0.48). At multivariate analysis, BoM independently associated with higher risk of death (cohort A: HR 1.50; cohort B: HR 1.78). CONCLUSIONS BoM impairs immunotherapy efficacy. Accurate bone staging should be included in clinical trials with immunotherapy.
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Affiliation(s)
- Lorenza Landi
- Department of Oncology and Hematology, AUSL Romagna, Ravenna, Italy
| | | | | | - Rita Chiari
- Medical Oncology, Santa Maria della Misericordia Hospital, Perugia, Italy
| | - Francesco Grossi
- Division of Medical Oncology, IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Angelo Delmonte
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Antonio Passaro
- Division of Thoracic Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | | | | | - Domenico Galetta
- Oncologia Medica Toracica, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | | | | | - Gabriele Minuti
- UO Oncologia Medica, Azienda Usl Toscana Nord Ovest, Livorno, Italy
| | - Marcello Tiseo
- Medical Oncology Unit, University Hospital, Parma, Italy
| | | | | | - Luca Toschi
- Humanitas Cancer Center, Rozzano, Milan, Italy
| | - Paolo Bidoli
- Oncology Unit, ASST, Ospedale S. Gerardo, Monza, Italy
| | | | - Luana Calabro'
- Medical Oncology and Immunotherapy, Center for Immuno-Oncology, University Hospital of Siena, Siena, Italy
| | - Federico Cappuzzo
- Department of Oncology and Hematology, AUSL Romagna, Ravenna, Italy.
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12
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Gerber DE, Horn L, Boyer M, Sanborn R, Natale R, Palmero R, Bidoli P, Bondarenko I, Germonpre P, Ghizdavescu D, Kotsakis A, Lena H, Losonczy G, Park K, Su WC, Tang M, Lai J, Kallinteris NL, Shan JS, Reck M, Spigel DR. Randomized phase III study of docetaxel plus bavituximab in previously treated advanced non-squamous non-small-cell lung cancer. Ann Oncol 2019; 29:1548-1553. [PMID: 29767677 DOI: 10.1093/annonc/mdy177] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [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 Bavituximab is a monoclonal antibody that targets phosphatidylserine in the presence of β2 glycoprotein 1 (β2GP1) to exert an antitumor immune response. This phase III trial determined the efficacy of bavituximab combined with docetaxel in patients with previously treated advanced non-small-cell lung cancer (NSCLC). Patients and methods Key eligibility criteria included advanced non-squamous NSCLC with disease progression after treatment with platinum-based doublet chemotherapy, evidence of disease control after at least two cycles of first-line therapy, presence of measurable disease, ECOG performance status 0 or 1, adequate bone marrow and organ function, and no recent history of clinically significant bleeding. Eligible patients were randomized 1 : 1 to receive up to six 21-day cycles of docetaxel plus either weekly bavituximab 3 mg/kg or placebo until progression or toxicity. The primary end point was overall survival (OS). Results A total of 597 patients were enrolled. Median OS was 10.5 months in the docetaxel + bavituximab arm and was 10.9 months in the docetaxel + placebo arm (HR 1.06; 95% CI 0.88-1.29; P = 0.533). There was no difference in progression-free survival (HR 1.00; 95% CI 0.82-1.22; P = 0.990). Toxicities were manageable and similar between arms. In subset analysis, among patients with high baseline serum β2GP1 levels ≥200 µg/ml, a nonsignificant OS trend favored the bavituximab arm (HR 0.82; 95% CI 0.63-1.06; P = 0.134). Among patients who received post-study immune checkpoint inhibitor therapy, OS favored the bavituximab arm (HR 0.46; 95% CI 0.26-0.81; P = 0.006). Conclusions The combination of bavituximab plus docetaxel is not superior to docetaxel in patients with previously treated advanced NSCLC. The addition of bavituximab to docetaxel does not meaningfully increase toxicity. The potential benefit of bavituximab observed in patients with high β2GP1 levels and in patients subsequently treated with immune checkpoint inhibitors requires further investigation. Clinical trial number NCT01999673.
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Affiliation(s)
- D E Gerber
- Division of Hematology-Oncology, Department of Internal Medicine, Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, USA.
| | - L Horn
- Division of Hematology and Oncology, Department of Internal Medicine, Vanderbilt-Ingram Cancer Center, Nashville, USA
| | - M Boyer
- Department of Medical Oncology, Chris O'Brien Lifehouse, Camperdown, NSW, Australia
| | - R Sanborn
- Robert W. Franz Cancer Research Center, Earle A. Chiles Research Institute, Providence Cancer Center, Portland; USA
| | - R Natale
- Department of Internal Medicine (Hematology-Oncology), Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, USA
| | - R Palmero
- Medical Oncology Service, Institut Català d'Oncologia -L'Hospitalet, Barcelona, Spain
| | - P Bidoli
- Department of Oncology, ASST di Monza - Azienda Ospedaliera San Gerardo, Monza, Italy
| | - I Bondarenko
- State Institution Dnipropetrovsk Medical, Academy of the Ministry of Health of Ukraine, Communal Institution Dnipropetrovsk City Multifield Clinical Hospital No. 4 of Dnipropetrovsk Regional Council, Dnipropetrovsk, Ukraine
| | - P Germonpre
- Department of Pneumology, AZ Maria Middelares, Gent, Belgium
| | - D Ghizdavescu
- Department of Oncology, Ploiesti Municipal Hospital, Ploiesti, Romania
| | - A Kotsakis
- Department of Medical Oncology, University General Hospital of Heraklion, Heraklion, Greece
| | - H Lena
- Pneumology Service, Hôspital Pontchaillou, Rennes, France
| | - G Losonczy
- Pulmonology Clinic, Semmelweis Egyetem, Budapest, Hungary
| | - K Park
- Division of Hematology-Oncology, Samsung Medical Center, Seoul, Korea
| | - W-C Su
- Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
| | - M Tang
- Peregrine Pharmaceuticals, Inc., Tustin, USA
| | - J Lai
- Peregrine Pharmaceuticals, Inc., Tustin, USA
| | | | - J S Shan
- Peregrine Pharmaceuticals, Inc., Tustin, USA
| | - M Reck
- Department of Thoracic Oncology, German Center for Lung research (DZL), Lungen Clinic Grosshansdorf, Grosshansdorf, Germany
| | - D R Spigel
- Lung Cancer Clinical Research Program, Sarah Canon Research Institute, Nashville, USA
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13
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Sharma GG, Cortinovis D, Agustoni F, Arosio G, Villa M, Cordani N, Bidoli P, Bisson WH, Pagni F, Piazza R, Gambacorti-Passerini C, Mologni L. A Compound L1196M/G1202R ALK Mutation in a Patient with ALK-Positive Lung Cancer with Acquired Resistance to Brigatinib Also Confers Primary Resistance to Lorlatinib. J Thorac Oncol 2019; 14:e257-e259. [DOI: 10.1016/j.jtho.2019.06.028] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 06/20/2019] [Accepted: 06/21/2019] [Indexed: 11/26/2022]
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14
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Rosell R, Poltoratskiy A, Hochmair M, Laktionov K, Ramlau R, Garcìa MA, Skrickova J, Piovano P, Rizzato S, Bidoli P, Kowalski D, Clementi L, Cseh A, De Marinis F. A phase IIIb, open-label study of afatinib in EGFR TKI-naïve patients with EGFR mutation-positive NSCLC: A biomarker analysis. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz437.009] [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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15
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Passiglia F, Capelletto E, Grossi F, Bidoli P, Galetta D, Follador A, Valmadre G, Defferrari C, Caffo O, Bearz A, Colantonio I, Gregorc V, Scotti V, Cognetti F, Cordero L, Arizio F, Novello S, Torri V, Scagliotti G. The elderly patient individualized chemotherapy (EPIC) trial, a study for an aged population of non-small cell lung cancer. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz260.110] [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: 11/13/2022] Open
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16
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De Giorgi U, Procopio G, Sabbatini R, Caserta C, Mitterer M, Ortega C, Scoppola A, Fornarini G, Ferraú F, Marchetti P, Verusio C, Mini E, Bidoli P, Buti S, Crino L, Basso U, Frassoldati A, Bearz A, Carteni G, Sternberg CN. Association of body mass index and systemic inflammation index with survival in patients with renal cell cancer treated with nivolumab. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e16077] [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
e16077 Background: Body mass index (BMI) and inflammation indexes are easily evaluated, predict survival in many tumors, and are potentially modifiable. The "obesity paradox" of longer survival in cancer patients with high BMI has been explained by altered fatty acid pathways, which could have an impact in immune-inflammatory function, and leptin-driven increase in T cell aging resulting in higher PD-1 expression and dysfunction, which leaves tumors notably more sensitive to checkpoint blockade. We evaluated the potential association of inflammatory indexes and BMI with the clinical outcome of metastatic renal cell carcinoma (mRCC) undergoing immune checkpoint inhibitor therapy. Methods: A prospective cohort of patients with mRCC treated with nivolumab enrolled in the Italian Expanded Access Program (EAP) from July 2015 through April 2016 was examined. Reference measures of inflammation were identified for neutrophil to lymphocyte ratio (NLR) < /≥3, systemic immune-inflammation index (SII) < /≥3 and platelet to lymphocyte ratio (PLR) < /≥232. Patients were classified as high BMI (≥25 kg/m2) versus normal BMI ( < 25 kg/m2). Results: Among 313 evaluable patients, 289 (75.1%) were male, median age was 65 years (range, 40 to 84), with 105 (24.9%) ≥70 years. In univariate analysis, age ≥70 years, performance status, BMI, SII, NLR and PLR were able to predict outcome. In multivariate analyses, SII ≥1375, BMI < 25 and age ≥70 years independently predicted OS (HR, 2.96; 95% CI, 2.05-4.27; HR, 1.59; 95% CI, 1.10-2.30 and HR, 1.65; 95% CI, 1.07-2.55, respectively). Under the model of independent effects, a patient with both SII ≥1375 and BMI < 25 was estimated to have much worse OS (HR, 3.37; 95% CI, 2.29-4.95, p < 0.0001) than a patient with neither or only one risk factor. SII changes at 3 months predicted OS (P < 0.0001). Conclusions: BMI combined with inflammation tripled the risk of death, suggesting that these biomarkers are critical prognostic factors for OS in patients with mRCC treated with nivolumab.
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Affiliation(s)
- Ugo De Giorgi
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Giuseppe Procopio
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | | | | | | | | | | | | | - Francesco Ferraú
- Medical Oncology Department, Ospedale S Vincenzo, Taormina, Italy
| | - Paolo Marchetti
- Department of Medical Oncology Sant’Andrea University Hospital, Rome, Italy
| | - Claudio Verusio
- Department of Oncology, ASST Valle Olona, Busto Arsizio, Italy
| | - Enrico Mini
- Section of Clinical Pharmacology and Oncology, Department of Health Sciences, University of Florence, Florence, Italy
| | - Paolo Bidoli
- Azienda Socio Sanitaria Territoriale-ASST di Monza, Monza, Italy
| | - Sebastiano Buti
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Lucio Crino
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Umberto Basso
- Oncologia 1 - Istituto Oncologico Veneto IOV - IRCCS, Padova, Italy
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17
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Crinò L, Bidoli P, Delmonte A, Grossi F, De Marinis F, Ardizzoni A, Vitiello F, Lo Russo G, Parra HS, Cortesi E, Cappuzzo F, Calabrò L, Tiseo M, Turci D, Gamucci T, Antonelli P, Morabito A, Chella A, Giannarelli D, Galetta D. Italian Cohort of Nivolumab Expanded Access Program in Squamous Non-Small Cell Lung Cancer: Results from a Real-World Population. Oncologist 2019; 24:e1165-e1171. [PMID: 30996007 DOI: 10.1634/theoncologist.2018-0737] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 03/06/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Nivolumab has shown a survival benefit compared with docetaxel as second-line treatment for patients with previously treated advanced squamous non-small cell lung cancer (NSCLC) in a randomized phase III trial. The experiences of patients and physicians in routine clinical practice are often different from those in a controlled clinical trial setting. We present data from the entire Italian cohort of patients with squamous NSCLC enrolled in a worldwide nivolumab NSCLC expanded access program. PATIENTS AND METHODS Patients with pretreated advanced squamous NSCLC received nivolumab 3 mg/kg every 2 weeks for up to 24 months. Safety was monitored throughout; efficacy data collected included objective tumor response, date of progression, and survival information. RESULTS The Italian cohort comprised 371 patients who received at least one dose of nivolumab. In the overall population, the objective response rate (ORR) was 18%, the disease control rate (DCR) was 47%, and median overall survival (OS) was 7.9 months (95% confidence interval 6.2-9.6). In subgroup analyses, ORR, DCR, and median OS were, respectively, 17%, 48%, and 9.1 months in patients previously treated with two or more lines of therapy (n = 209) and 8%, 40%, and 10.0 months in patients treated beyond disease progression (n = 65). In the overall population, the rate of any-grade and grade 3-4 adverse events was 29% and 6%, respectively. Treatment-related adverse events led to treatment discontinuation in 14 patients (5%). There were no treatment-related deaths. CONCLUSION To date, this report represents the most extensive clinical experience with nivolumab in advanced squamous NSCLC in current practice outside the controlled clinical trial setting. These data suggest that the efficacy and safety profiles of nivolumab in a broad, real-world setting are consistent with those obtained in clinical trials. IMPLICATIONS FOR PRACTICE Nivolumab is approved in the U.S. and Europe for the treatment of advanced non-small cell lung cancer (NSCLC) after failure of prior platinum-based chemotherapy. In this cohort of Italian patients with previously treated, advanced squamous NSCLC treated in a real-world setting as part of the nivolumab expanded access program, the efficacy and safety of nivolumab was consistent with that previously reported in nivolumab clinical trials.
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Affiliation(s)
- Lucio Crinò
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Paolo Bidoli
- Department of Oncology, Azienda Socio Sanitaria Territoriale (ASST) Monza, Presidio San Gerardo, Monza, Italy
| | - Angelo Delmonte
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Francesco Grossi
- Division of Medical Oncology, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Andrea Ardizzoni
- Medical Oncology, Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | - Fabiana Vitiello
- Department of Oncology, Azienda Ospedaliera (AO) dei Colli-Monaldi-Cotugno-Centro Traumatrico Ortopedico (CTO), Napoli, Italy
| | | | - Hector Soto Parra
- Department of Oncology, Azienda Ospedaliero-Universitaria (AOU) Policlinico Vittorio Emanuele, Catania, Italy
| | - Enrico Cortesi
- Department of Oncology, Policlinico Umberto I, Roma, Italy
| | - Federico Cappuzzo
- Department Azienda Unità Sanitaria Locale (AUSL), Romagna Viale Randi, Ravenna, Italy
| | - Luana Calabrò
- Medical Oncology and Immunotherapy, Center for Immuno-Oncology, University Hospital of Siena, Siena, Italy
| | - Marcello Tiseo
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Daniele Turci
- Department Azienda Unità Sanitaria Locale (AUSL), Romagna Viale Randi, Ravenna, Italy
| | - Teresa Gamucci
- Medical Oncology Unit, Azienda Sanitaria Locale (ASL) Frosinone, Presidio Ospedaliero Servizi Sanitari (SS) Trinità, Sora (Frosinone), Italy
| | - Paola Antonelli
- Department of Oncology, Presidio Ospedaliero di Busto Arsizio, Busto Arsizio, Italy
| | - Alessandro Morabito
- Thoracic Medical Oncology, Istituto Nazionale Tumori, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Fondazione G. Pascale, Napoli, Italy
| | | | - Diana Giannarelli
- Department of Oncology, Istituto Nazionale Tumori Regina Elena, Roma, Italy
| | - Domenico Galetta
- Medical Thoracic Oncology Unit, IRCCS Istituto Tumori Giovanni Paolo II, Bari, Italy
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18
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De Giorgi U, Procopio G, Giannarelli D, Sabbatini R, Bearz A, Buti S, Basso U, Mitterer M, Ortega C, Bidoli P, Ferraù F, Crinò L, Frassoldati A, Marchetti P, Mini E, Scoppola A, Verusio C, Fornarini G, Cartenì G, Caserta C, Sternberg CN. Association of Systemic Inflammation Index and Body Mass Index with Survival in Patients with Renal Cell Cancer Treated with Nivolumab. Clin Cancer Res 2019; 25:3839-3846. [PMID: 30967420 DOI: 10.1158/1078-0432.ccr-18-3661] [Citation(s) in RCA: 132] [Impact Index Per Article: 26.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 02/06/2019] [Accepted: 04/03/2019] [Indexed: 12/26/2022]
Abstract
PURPOSE Inflammation indexes and body mass index (BMI) are easily evaluated, predict survival, and are potentially modifiable. We evaluated the potential association of inflammatory indexes and BMI with the clinical outcome of patients with renal cell carcinoma (RCC) undergoing immune checkpoint inhibitor therapy. EXPERIMENTAL DESIGN A prospective cohort of patients with metastatic RCC treated with nivolumab enrolled in the Italian Expanded Access Program from July 2015 through April 2016 was examined. Reference measures of inflammation were identified for neutrophil-to-lymphocyte ratio (NLR) </≥ 3, systemic immune inflammation index (SII) </≥ 1,375, and platelet-to-lymphocyte ratio (PLR) </≥ 232. Patients were classified as high BMI (≥25 kg/m2) versus normal BMI (<25 kg/m2). RESULTS Among 313 evaluable patients, 235 (75.1%) were male, and median age was 65 years (range, 40-84 years), with 105 (33.69%) ≥70 years. In univariate analysis, age, performance status, BMI, SII, NLR, and PLR were able to predict outcome. In multivariate analyses, SII ≥1,375, BMI <25 kg/m2, and age ≥70 years independently predicted overall survival [OS; HR = 2.96, 95% confidence interval (CI), 2.05-4.27; HR = 1.59, 95% CI, 1.10-2.30; and HR = 1.65, 95% CI, 1.07-2.55, respectively). A patient with both SII ≥1,375 and BMI <25 kg/m2 was estimated to have much worse OS (HR, 3.37; 95% CI, 2.29-4.95; P <0.0001) than a patient with neither or only one risk factor. SII changes at 3 months predicted OS (P <0.0001). CONCLUSIONS Normal BMI combined with inflammation tripled the risk of death, suggesting that these biomarkers are critical prognostic factors for OS in patients with RCC treated with nivolumab.
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Affiliation(s)
- Ugo De Giorgi
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy.
| | - Giuseppe Procopio
- Department of Medical Oncology, Istituto Nazionale dei Tumori IRCCS, Milan, Italy
| | - Diana Giannarelli
- Department of Statistics, Regina Elena National Cancer Institute IRCCS, Rome, Italy
| | | | - Alessandra Bearz
- Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | | | - Umberto Basso
- Department of Medical Oncology, Istituto Oncologico Veneto (IOV) IRCCS, Padua, Italy
| | - Manfred Mitterer
- Department of Medical Oncology, Ospedale "Franz Tappeiner," Merano, Italy
| | - Cinzia Ortega
- Department of Medical Oncology, Ospedale S. Lazzaro ASL CN2 Alba-Bra, Cuneo, Italy
| | - Paolo Bidoli
- Department of Medical Oncology, Ospedale San Gerardo, Monza, Italy
| | - Francesco Ferraù
- Department of Medical Oncology, Ospedale "S. Vincenzo," Taormina, Italy
| | - Lucio Crinò
- Department of Medical Oncology, AO Perugia, Perugia, Italy
| | | | - Paolo Marchetti
- Department of Medical Oncology, Ospedale Sant'Andrea, Rome, Italy
| | - Enrico Mini
- Department of Oncology, Careggi University Hospital, Florence, Italy
| | - Alessandro Scoppola
- Department of Medical Oncology, Istituto Dermopatico dell'Immacolata, Rome, Italy
| | - Claudio Verusio
- Department of Medical Oncology, P.O. di Saronno, Varese, Italy
| | | | - Giacomo Cartenì
- Department of Medical Oncology, AO "A. Cardarelli," Naples, Italy
| | - Claudia Caserta
- Department of Medical Oncology, AOU Santa Maria, Terni, Italy
| | - Cora N Sternberg
- Englander Institute for Precision Medicine, Weill Cornell Medicine, New York, New York
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Garon EB, Reinmuth N, Falchero L, Garcia Garcia Y, Hureaux J, Gore I, Harris RP, Bidoli P, Baldini E, Ros S, Laack E, Mitchell P, Wolf M, O'Byrne KJ, Zibdawi L, Jao K, Spigel D, Li A, Rabindran SK, Pichon E. CheckMate 384: Phase IIIb/IV trial of nivolumab (nivo) 480 mg Q4W versus 240 mg Q2W after ≤ 12 months of nivo in previously treated advanced NSCLC. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.8_suppl.100] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
100 Background: Nivo is approved as 240 mg Q2W in the EU and Japan and 240 mg Q2W or 480 mg Q4W in the US and Canada for second-line treatment (tx) of advanced NSCLC. Pharmacokinetic modeling in various tumors predicts that exposure, efficacy and safety can be maintained with less frequent Q4W dosing, which may provide a more convenient tx option. We present an interim analysis of efficacy and safety from CheckMate 384 (NCT02713867), an international, open-label, randomized phase 3b/4 trial evaluating less frequent nivo dosing (480 mg Q4W vs 240 mg Q2W) in patients (pts) with advanced NSCLC and prior Q2W nivo tx. Methods: Pts (N = 329) with previously treated histologically confirmed stage IIIB/IV or recurrent NSCLC, ECOG performance status 0–2, and prior tx with nivo 3 mg/kg or 240 mg Q2W for ≤12 mo, with ≥2 consecutive assessments of complete / partial response or stable disease, were randomized 1:1 to nivo 480 mg Q4W or 240 mg Q2W over a 30-min infusion. Co-primary endpoints: post-randomization (RND) progression-free survival rates (PFS) at 6 mo and 1 y. Secondary endpoints included safety. Due to tx landscape changes in NSCLC, statistical analyses were amended for a reduced sample size. One-sided 95% CIs were generated to compare PFS rates; presented data analyses are descriptive. Results: Of 166 and 163 pts randomized to 480 mg Q4W and 240 mg Q2W, 164 and 161 pts were treated, respectively. Median follow-up was 9.5 mo (480 mg Q4W) and 10.2 mo (240 mg Q2W). Baseline characteristics were balanced between tx arms. Stratified PFS rates post-RND were comparable between tx arms at 6 mo and 1 y (Table). Safety profiles were similar; any grade tx-related adverse events (TRAEs) and TRAEs leading to discontinuation were reported in 48% vs 61% and 6% vs 9% of pts with 480 mg Q4W vs 240 mg Q2W. No tx-related deaths were reported. Conclusions: Nivo 480 mg Q4W showed similar efficacy and safety to 240 mg Q2W in pts with disease control on nivo, supporting the potential use of 480 mg Q4W as a more convenient dosing option for second-line NSCLC tx. Clinical trial information: NCT02713867. [Table: see text]
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Affiliation(s)
| | | | | | | | | | - Ira Gore
- Alabama Oncology, Birmingham, AL
| | | | - Paolo Bidoli
- Azienda Socio Sanitaria Territoriale-ASST di Monza, Monza, Italy
| | - Editta Baldini
- Oncology Department, Medical Oncology Division, San Luca Hospital, Lucca, Italy
| | - Silverio Ros
- Department of Internal Medicine, University of Murcia, Murcia, Spain
| | | | | | | | | | - Labib Zibdawi
- Southlake Regional Health Centre, Newmarket, ON, Canada
| | - Kevin Jao
- Hôpital du Sacré-Coeur de Montréal, Montreal, QC, Canada
| | - David Spigel
- Sarah Cannon Research Institute/Tennessee Oncology Nashville, PLLC, Nashville, TN
| | - Ang Li
- Bristol-Myers Squibb, Princeton, NJ
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20
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Crinò L, Bronte G, Bidoli P, Cravero P, Minenza E, Cortesi E, Garassino MC, Proto C, Cappuzzo F, Grossi F, Tonini G, Sarobba MG, Pinotti G, Numico G, Samaritani R, Ciuffreda L, Frassoldati A, Bregni M, Santo A, Piantedosi F, Illiano A, De Marinis F, Tamberi S, Giannarelli D, Delmonte A. Nivolumab and brain metastases in patients with advanced non-squamous non-small cell lung cancer. Lung Cancer 2019; 129:35-40. [DOI: 10.1016/j.lungcan.2018.12.025] [Citation(s) in RCA: 88] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 12/19/2018] [Accepted: 12/25/2018] [Indexed: 12/01/2022]
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21
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Abbate MI, Cortinovis DL, Tiseo M, Vavalà T, Cerea G, Toschi L, Canova S, Colonese F, Bidoli P. Peritoneal carcinomatosis in non-small-cell lung cancer: retrospective multicentric analysis and literature review. Future Oncol 2019; 15:989-994. [DOI: 10.2217/fon-2018-0469] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: We investigated outcomes in patients with advanced non-small-cell lung cancer (NSCLC) and peritoneal involvement. Patients & methods: NSCLC patients with peritoneal carcinomatosis (PC) were included. We evaluated mOS1 (overall survival [OS] from NSCLC diagnosis) and mOS2 (OS from diagnosis of PC). Results: In total, 60 NSCLC patients were diagnosed with PC, 12 (20%) patients had a diagnosis of NSCLC and synchronous PC with a median OS of 9 months. Smokers had a shorter mOS1 and mOS2 compared with never-smokers; EGFR-mutated patients on tyrosine kinase inhibitors had longer mOS1 and mOS2 than EGFR wild-type patients. Conclusion: Metachronous PC is correlated to a short survival, irrespective of treatment line. Never-smokers and EGFR-mutated patients had improved mOS1 and mOS2 when compared with smokers and EGFR wild-type population.
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Affiliation(s)
| | | | - Marcello Tiseo
- Azienda Ospedaliero-Sanitaria San Luigi Gonzaga, Regione Gonzole 10, Orbassano, TO, Italy
| | - Tiziana Vavalà
- Azienda Ospedaliero-Sanitaria San Luigi Gonzaga, Regione Gonzole 10, Orbassano, TO, Italy
- Presidio Ospedaliero Saluzzo-Savigliano, Via Ospedali, 14, Savigliano, CN, Italy
| | - Giulio Cerea
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Piazza dell’Ospedale Maggiore 3, Milano, Italy
| | - Luca Toschi
- Istituto Clinico Humanitas, Via Alessandro Manzoni 56, Milano, Italy
| | - Stefania Canova
- Ospedale San Gerardo, Via GB Pergolesi 33, 20052 Monza, Italy
| | | | - Paolo Bidoli
- Ospedale San Gerardo, Via GB Pergolesi 33, 20052 Monza, Italy
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22
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Cavaletti G, Cornblath DR, Merkies IS, Postma TJ, Rossi E, Alberti P, Bruna J, Argyriou AA, Briani C, Velasco R, Kalofonos HP, Psimaras D, Ricard D, Pace A, Faber CG, Lalisang RI, Brandsma D, Koeppen S, Kerrigan S, Schenone A, Grisold W, Mazzeo A, Padua L, Dorsey SG, Penas‐Prado M, Valsecchi MG, Cavaletti G, Cornblath DR, Merkies IS, Postma TJ, Rossi E, Alberti P, Bruna J, Argyriou AA, Briani C, Velasco R, Kalofonos HP, Psimaras D, Ricard D, Pace A, Faber CG, Lalisang RI, Brandsma D, Koeppen S, Kerrigan S, Schenone A, Grisold W, Mazzeo A, Padua L, Dorsey SG, Penas‐Prado M, Valsecchi MG, Frigeni B, Lanzani F, Mattavelli L, Piatti ML, Binda D, Bidoli P, Cazzaniga M, Cortinovis D, Galiè E, Campagnolo M, Salvalaggio A, Ruiz M, Vanhoutte EK, Boogerd W, Hense J, Grant R, Storey D, Reni L, Demichelis C, Pessino A, Granata G, Leandri M, Ghigliotti I, Plasmati R, Pastorelli F, Heimans J, Eurelings M, Meijer RJ, Pozza EL, Toscano A, Gentile L, Santarpia M, Gonzalez CD. Patients' and physicians' interpretation of chemotherapy‐induced peripheral neurotoxicity. J Peripher Nerv Syst 2019; 24:111-119. [DOI: 10.1111/jns.12306] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 12/13/2018] [Accepted: 01/15/2019] [Indexed: 12/14/2022]
Affiliation(s)
- Guido Cavaletti
- Experimental Neurology Unit, School of Medicine and SurgeryUniversity of Milano‐Bicocca Monza Italy
| | - David R. Cornblath
- Department of NeurologyJohns Hopkins University School of Medicine Baltimore Maryland USA
| | - Ingemar S.J. Merkies
- Department of Neurology, Spaarne HospitalHoofddorp/Maastricht University Medical Center Maastricht The Netherlands
- Department of NeurologySt. Elisabeth Hospital Willemstad Curaçao
| | - Tjeerd J. Postma
- Department of Neurology, Amsterdam UMCVrije Universiteit Amsterdam Amsterdam The Netherlands
| | - Emanela Rossi
- Center of Biostatistics for Clinical Epidemiology, School of Medicine and SurgeryUniversity of Milano‐Bicocca Monza Italy
| | - Paola Alberti
- Experimental Neurology Unit, School of Medicine and SurgeryUniversity of Milano‐Bicocca Monza Italy
| | - Jordi Bruna
- Unit of Neuro‐Oncology, Department of NeurologyUniversity Hospital of Bellvitge‐IDIBELL (Bellvitge Biomedical Research Institute) Hospitalet, Spain
| | - Andreas A. Argyriou
- Division of Clinical Oncology‐Department of MedicineUniversity Hospital of Patras Patras Greece
| | - Chiara Briani
- Department of NeurosciencesUniversity of Padova Padova Italy
| | - Roser Velasco
- Unit of Neuro‐Oncology, Department of NeurologyUniversity Hospital of Bellvitge‐IDIBELL (Bellvitge Biomedical Research Institute) Hospitalet, Spain
| | - Haralabos P. Kalofonos
- Division of Clinical Oncology‐Department of MedicineUniversity Hospital of Patras Patras Greece
| | - Dimitri Psimaras
- Hôpital de la Pitié‐Salpêtrière, AP‐HPService de Neurologie Mazarin Paris France
| | - Damien Ricard
- Service de Neurologie de l'HIE PercyService de Santé des Armées Clamart France
| | - Andrea Pace
- Neuroncology UnitIRCCS Regina Elena National Cancer Institute Rome Italy
| | - Catharina G. Faber
- Department of Neurology, Spaarne HospitalHoofddorp/Maastricht University Medical Center Maastricht The Netherlands
| | - Roy I. Lalisang
- Division of Medical Oncology, Department of Internal MedicineGROW‐School of Oncology and Developmental Biology, Maastricht University Medical Center Maastricht The Netherlands
| | - Dieta Brandsma
- Department of Neuro‐oncologyNetherlands Cancer Institute Amsterdam The Netherlands
| | - Susanne Koeppen
- Department of Neurology and West German Cancer CenterUniversity of Essen Essen Germany
| | - Simon Kerrigan
- Edinburgh Centre for Neuro‐Oncology and Edinburgh Cancer Research CentreWestern General Hospital Edinburgh UK
| | - Angelo Schenone
- Department of Neurosciences, Rehabilitation, OphthalmologyGenetic and Maternal Infantile Sciences, University of Genova and Ospedale Policlinico San Martino Genoa Italy
- Dipartimento di NeuroscienzeIRCCS Ospedale Policlinico San Martino Genoa Italy
| | - Wolfgang Grisold
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology Vienna Austria
| | - Anna Mazzeo
- Department of Clinical and Experimental MedicineUniversity of Messina Messina Italy
| | - Luca Padua
- Department of Neurosciences Cattolica UniversityRome and IRCCS Don Carlo Gnocchi Milan Italy
| | - Susan G. Dorsey
- Department of Pain & Translational Symptom ScienceUniversity of Maryland School of Nursing and the Marlene and Stewart Greenebaum Cancer Center Baltimore Maryland USA
| | - Marta Penas‐Prado
- Department of Neuro‐OncologyThe UT MD Anderson Cancer Center Houston Texas USA
| | - Maria G. Valsecchi
- Center of Biostatistics for Clinical Epidemiology, School of Medicine and SurgeryUniversity of Milano‐Bicocca Monza Italy
| | | | | | | | | | | | | | - Jordi Bruna
- University Hospital of Bellvitge‐IDIBELL (Bellvitge Biomedical Research Institute) Hospitalet
| | | | | | | | | | | | | | | | | | | | | | | | | | - Angelo Schenone
- University of Genova and Ospedale Policlinico San Martino Genoa
| | - Wolfgang Grisold
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology Vienna
| | | | | | - Susan G. Dorsey
- University of Maryland School of Nursing and the Marlene and Stewart Greenebaum Cancer Center Baltimore
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23
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Reck M, Horn L, Novello S, Barlesi F, Albert I, Juhász E, Kowalski D, Robinet G, Cadranel J, Bidoli P, Chung J, Fritsch A, Drews U, Wagner A, Govindan R. Phase II Study of Roniciclib in Combination with Cisplatin/Etoposide or Carboplatin/Etoposide as First-Line Therapy in Patients with Extensive-Disease Small Cell Lung Cancer. J Thorac Oncol 2019; 14:701-711. [PMID: 30677506 DOI: 10.1016/j.jtho.2019.01.010] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [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: 08/29/2018] [Revised: 12/21/2018] [Accepted: 01/09/2019] [Indexed: 12/21/2022]
Abstract
INTRODUCTION This phase II study evaluated the efficacy and safety of the pan-cyclin-dependent kinase inhibitor roniciclib with platinum-based chemotherapy in patients with extensive-disease SCLC. METHODS In this randomized, double-blind study, unselected patients with previously untreated extensive-disease SCLC received roniciclib, 5 mg, or placebo twice daily according to a 3 days-on, 4 days-off schedule in 21-day cycles, with concomitant cisplatin or carboplatin on day 1 and etoposide on days 1 to 3. The primary end point was progression-free survival. Other end points included overall survival, objective response rate, and safety. RESULTS A total of 140 patients received treatment: 70 with roniciclib plus chemotherapy and 70 with placebo plus chemotherapy. Median progression-free survival times was 4.9 months (95% confidence interval [CI]: 4.2-5.5) with roniciclib plus chemotherapy and 5.5 months (95% CI: 4.6-5.6) with placebo plus chemotherapy (hazard ratio [HR] = 1.242, 95% CI: 0.820-1.881, p = 0.8653). Median overall survival times was 9.7 months (95% CI: 7.9-11.1) with roniciclib plus chemotherapy and 10.3 months (95% CI: 8.7-11.9) with placebo plus chemotherapy (HR = 1.281, 95% CI: 0.776-1.912, p = 0.7858). The objective response rates were 60.6% with roniciclib plus chemotherapy and 74.6% with placebo plus chemotherapy. Common treatment-emergent adverse events in both groups included nausea, vomiting, and fatigue. Serious treatment-emergent adverse events were more common with roniciclib plus chemotherapy (57.1%) than with placebo plus chemotherapy (38.6%). CONCLUSIONS Roniciclib combined with chemotherapy demonstrated an unfavorable risk-benefit profile in patients with extensive-disease SCLC, and the study was prematurely terminated.
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Affiliation(s)
- Martin Reck
- LungenClinic Grosshansdorf, Airway Research Center North, German Center for Lung Research, Grosshansdorf, Germany.
| | - Leora Horn
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Silvia Novello
- Department of Oncology, University of Turin, Orbassano, Turin, Italy
| | - Fabrice Barlesi
- Aix-Marseille University, Marseille, France; Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - István Albert
- Pulmonary Department, Mátraháza Hospital, Mátraháza, Hungary
| | - Erzsébet Juhász
- Korányi National Institute for Pulmonology, Budapest, Hungary
| | | | | | | | | | - John Chung
- Bayer HealthCare Pharmaceuticals, Inc., Whippany, New Jersey
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Vernieri C, Galli F, Ferrari L, Marchetti P, Lonardi S, Maiello E, Iaffaioli RV, Zampino MG, Zaniboni A, De Placido S, Banzi M, Damiani A, Ferrari D, Rosati G, Labianca RF, Bidoli P, Frassineti GL, Nicolini M, Pavesi L, Tronconi MC, Buonadonna A, Ferrario S, Re GL, Adamo V, Tamburini E, Clerico M, Giordani P, Leonardi F, Barni S, Ciarlo A, Cavanna L, Gori S, Cinieri S, Faedi M, Aglietta M, Antista M, Dotti KF, Galli F, Di Bartolomeo M. Impact of Metformin Use and Diabetic Status During Adjuvant Fluoropyrimidine-Oxaliplatin Chemotherapy on the Outcome of Patients with Resected Colon Cancer: A TOSCA Study Subanalysis. Oncologist 2019; 24:385-393. [PMID: 30606884 DOI: 10.1634/theoncologist.2018-0442] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 10/19/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) is associated with increased risk of colon cancer (CC), whereas metformin use seems to be protective. However, the impact of metformin use on the risk of death or disease recurrence after radical surgery for CC remains uncertain. MATERIALS AND METHODS This is a substudy conducted in patients with high-risk stage II or stage III CC randomized in the TOSCA trial, which compared 3 versus 6 months of fluoropyrimidine-oxaliplatin adjuvant chemotherapy. Objective of the study was to investigate the impact of metformin exposure during adjuvant chemotherapy on overall survival (OS) and relapse-free survival (RFS). We also evaluated the impact of T2DM or metformin dosage on clinical outcomes. RESULTS Out of 3,759 patients enrolled in the TOSCA trial, 133 patients with diabetes (9.2%) and 1,319 without diabetes (90.8%) were recruited in this study. After excluding 13 patients with diabetes without information on metformin exposure, 76 patients with T2DM (63.3%) were defined as metformin users and 44 (36.7%) as metformin nonusers. After a median follow-up of 60.4 months, 26 (21.7%) patients relapsed and 16 (13.3%) died. Metformin use was neither associated with OS (adjusted hazard ratio [HR], 1.51; 95% confidence interval [CI], 0.48-4.77; p = .4781) nor with RFS (HR, 1.56; 95% CI, 0.69-3.54; p = .2881). Similarly, we found no association between T2DM or metformin dosage and OS or RFS. CONCLUSIONS Metformin use and T2DM did not impact on OS or RFS in patients with resected CC treated with adjuvant fluoropyrimidine-oxaliplatin chemotherapy. Larger studies and longer follow-up are required to clarify the potential efficacy of metformin in improving the prognosis of patients with CC. IMPLICATIONS FOR PRACTICE The role of the antidiabetic drug metformin in colon cancer prevention and treatment is highly debated. While low-dose metformin reduced the incidence of colorectal adenomas in two prospective studies, its effect in patients with already established colon cancer remains unclear. In this study, the potential impact of metformin on the survival of resected colon cancer patients who received adjuvant chemotherapy was investigated in the context of the TOSCA study. We did not find any association between metformin use or dosages and patient survival. Prospective studies are required to draw definitive conclusions about metformin impact on colon cancer recurrence and survival.
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Affiliation(s)
- Claudio Vernieri
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
- The Italian Foundation for Cancer Research Institute of Molecular Oncology, Milan, Italy
| | - Fabio Galli
- IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Laura Ferrari
- Azienda Ospedaliero Universitaria Santa Maria della Misericordia, Udine, Italy
| | - Paolo Marchetti
- Sant'Andrea Hospital, Sapienza University of Rome and IRCCS Istituto Dermopatico dell'Immacolata, Rome, Italy
| | | | - Evaristo Maiello
- Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | | | | | | | | | - Maria Banzi
- IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | | | | | | | | | | | - Giovanni L Frassineti
- IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Meldola, Italy
| | | | | | | | | | | | - Giovanni Lo Re
- Azienda Ospedaliera S. Maria degli Angeli Pordenone, Pordenone, Italy
| | - Vincenzo Adamo
- Dipartimento Universitario di Patologia Umana & Azienda Ospedaliera Papardo, Messina, Italy
| | | | | | | | | | - Sandro Barni
- Ospedale Treviglio Caravaggio Treviglio, Bergamo, Italy
| | | | | | | | | | | | | | - Maria Antista
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Katia F Dotti
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Francesca Galli
- IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
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Passiglia F, Cappuzzo F, Alabiso O, Bettini AC, Bidoli P, Chiari R, Defferrari C, Delmonte A, Finocchiaro G, Francini G, Gelsomino F, Giannarelli D, Giordano M, Illiano A, Livi L, Martelli O, Natoli C, Puppo G, Ricevuto E, Roca E, Turci D, Galetta D. Efficacy of nivolumab in pre-treated non-small-cell lung cancer patients harbouring KRAS mutations. Br J Cancer 2019; 120:57-62. [PMID: 30377342 PMCID: PMC6325128 DOI: 10.1038/s41416-018-0234-3] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Revised: 07/12/2018] [Accepted: 07/26/2018] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The present study investigated the efficacy and safety of nivolumab in pre-treated patients with advanced NSCLC harbouring KRAS mutations. METHODS Clinical data and KRAS mutational status were analysed in patients treated with nivolumab within the Italian Expanded Access Program. Objective response rate, progression-free survival and overall survival were evaluated. Patients were monitored for adverse events using the National Cancer Institute Common Terminology Criteria for Adverse Events. RESULTS Among 530 patients evaluated for KRAS mutations, 206 (39%) were positive while 324 (61%) were KRAS wild-type mutations. KRAS status did not influence nivolumab efficacy in terms of ORR (20% vs 17%, P = 0.39) and DCR (47% vs 41%, P = 0.23). The median PFS and OS were 4 vs 3 months (P = 0.5) and 11.2 vs 10 months (P = 0.8) in the KRAS-positive vs the KRAS-negative group. The 3-months PFS rate was significantly higher in the KRAS-positive group as compared to the KRAS-negative group (53% vs 42%, P = 0.01). The percentage of any grade and grade 3-4 AEs were 45% vs 33% (P = 0.003) and 11% vs 6% (P = 0.03) in KRAS-positive and KRAS-negative groups, respectively. CONCLUSIONS Nivolumab is an effective and safe treatment option for patients with previously treated, advanced non-squamous NSCLC regardless of KRAS mutations.
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Affiliation(s)
- Francesco Passiglia
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Palermo, Italy
| | - Federico Cappuzzo
- Department of Oncology and Hematology, AUSL Romagna, Ravenna, Italy.
| | - Oscar Alabiso
- University Hospital "Maggiore della Carità", Novara, Italy
| | | | | | - Rita Chiari
- Department of Medical Oncology, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | | | - Angelo Delmonte
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumouri (IRST), Meldola, Italy
| | | | | | | | - Diana Giannarelli
- Biostatistics Unit, Scientific Direction, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | | | | | | | | | - Clara Natoli
- Department of Medical, Oral and Biotechnological Sciencesl, CeSI-MeT University G. D'Annunzio, Chieti-Pescara, Italy
| | | | - Enrico Ricevuto
- Assistenza Oncologica Territoriale, Ospedale San Salvatore, Rete Oncologica ASL1 Abruzzo, Università di L'Aquila, Aquila, Italy
| | - Elisa Roca
- ASST Spedali Civili di Brescia, Brescia, Italy
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Landi L, D'Incà F, Cortesi E, Chiari R, Grossi F, Delmonte A, De Marinis F, Signorelli D, Dazzi C, Sperandi F, Catino A, Giannarelli D, Soto Parra H, Minuti G, Bordi P, Migliorino M, Palla A, Tonini G, Cognetti F, Santoro A, Tassinari D, Scoppola A, Bidoli P, Piantedosi F, Maio M, Crinò L, Cappuzzo F. P1.01-53 Bone Metastases and Efficacy of Immunotherapy in Patients with Pretreated Advanced Non-Small-Cell Lung Cancer (NSCLC). J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.609] [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: 11/30/2022]
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Barni S, Rosati G, Zagonel V, Pella N, Banzi M, Zampino M, Di Bartolomeo M, Rimassa L, Marchetti P, Maiello E, Artioli F, Ferrari D, Labianca R, Bidoli P, Zaniboni A, Sobrero A, Iaffaioli V, de Placido S, Frassineti L, Galli F, Petrelli F. Thromboembolic risk and survival with Khorana score in resected colorectal cancer patients: Subgroup analysis from the adjuvant TOSCA trial. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy281.129] [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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Agustoni F, Yu H, Ellison K, Smith D, Mitchell P, Rivalland G, Dziadziuszko R, Gao D, Suda K, Ren S, Rivard C, Caldwell C, Rozeboom L, Brovsky K, Cortinovis D, Bidoli P, Hirsch F. MA11.05 Indoleamine 2,3-Dioxygenase Expression in Non-Small-Cell Lung Cancer: Analyses of Prevalence, Clinical Correlations and Prognostic Impact. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.406] [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: 11/16/2022]
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Petrelli F, Rosati G, Banzi M, Zampino M, Pella N, Di Bartolomeo M, Maiello E, Bidoli P, Ferrari D, Rimassa L, Labianca R, Scartozzi M, Lonardi S, de Placido S, Zaniboni A, Sobrero A, Frassineti L, Silvestris N, Corsi D, Galli F, Barni S. Prognostic value of neutrophil-lymphocite ratio in resected high risk colorectal cancer: An analysis of adjuvant TOSCA trial. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy281.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Luciani A, Toschi L, Fava S, Cortinovis D, Filipazzi V, Tuzi A, Marra A, Rossi S, Rossi A, Blasi M, Violati M, Sala L, Agustoni F, Bidoli P, Zonato S, Ferrari D. Immunotherapy in elderly patients (≥ 75 yrs) with advanced non-small cell lung cancer (NSCLC): A multicenter Italian experience. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy292.094] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [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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31
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Cortinovis D, Canova S, Abbate MI, Colonese F, Cogliati V, Bidoli P. Challenges in ALK inhibition of ALK-positive non-small-cell lung cancer: from ALK positivity detection to treatment strategies after relapse. Future Oncol 2018; 14:2303-2317. [PMID: 30088419 DOI: 10.2217/fon-2018-0066] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ALK positivity, despite representing only in a small proportion of patients with non-small-cell lung cancer, is worth researching at diagnosis given the possibility to treat these patients with some targeted ALK inhibitors, which are more potent than chemotherapy. Thanks to understanding the resistance mechanisms, newer and more selective inhibitors are now available in clinical practice. Hence, this disease represents, after EGFR inhibition, a largely effective precision medicine approach. However, there are still some clinical situations in which the targeted drug seems to be ineffective. This review discusses some uncertainty about such a 'precision medicine application', focusing on some weaknesses and giving perspectives and suggestions to improve the management of this specific population.
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Affiliation(s)
| | | | | | | | | | - Paolo Bidoli
- Medical Oncology Unit, ASST San Gerardo, Monza, Italy
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Smit EF, Garon EB, Reck M, Cappuzzo F, Bidoli P, Cohen RB, Gao L, O'Brien LM, Lee P, Zimmermann A, Ferry DR, Melemed AS, Pérol M. Exposure-response relationship for ramucirumab from the randomized, double-blind, phase 3 REVEL trial (docetaxel versus docetaxel plus ramucirumab) in second-line treatment of metastatic non-small cell lung cancer. Cancer Chemother Pharmacol 2018; 82:77-86. [PMID: 29721850 DOI: 10.1007/s00280-018-3560-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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: 09/01/2017] [Accepted: 03/03/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE Ramucirumab plus docetaxel improved survival in REVEL, a randomized phase 3 trial for patients with Stage IV non-small cell lung cancer after standard platinum-based chemotherapy. This exploratory analysis evaluated the exposure-response relationship of ramucirumab from REVEL. METHODS Patients received ramucirumab (10 mg/kg) or placebo plus docetaxel (75 mg/m2) every 3 weeks. Pharmacokinetic samples were collected. A population pharmacokinetic analysis predicted ramucirumab minimum concentration after first-dose administration (Cmin,1) and average concentration at steady state (Cave,ss). Predicted Cmin,1 and Cave,ss were used to evaluate the relationship between ramucirumab exposure and efficacy and safety, respectively. Exposure-efficacy was assessed by Kaplan-Meier and Cox regression analyses; exposure-safety was assessed by ordered categorical analyses. RESULTS Analyses included 376 patients treated with ramucirumab plus docetaxel and 366 patients treated with placebo plus docetaxel (364 for safety population). After adjusting for corresponding prognostic factors, the association between overall survival (OS) and Cmin,1 was statistically significant (p = 0.0110), although progression-free survival (PFS) showed a marginal association (p = 0.0515). At high ramucirumab exposures (Cmin,1), greater improvements (smaller hazard ratios) were seen for OS and PFS when stratified by Cmin,1 exposure quartiles. A statistically significant correlation was observed between ramucirumab Cave,ss and grade ≥ 3 febrile neutropenia and hypertension. CONCLUSIONS An association was observed between ramucirumab exposure and efficacy. Higher ramucirumab exposure was associated with improved clinical outcomes and increased toxicity in this analysis. Two exposure-response prospective randomized trials are being conducted to address causation (NCT02443883 and NCT02514551), with encouraging preliminary results (Ajani et al. in Ann Oncol 28:abstr 698P, 2017).
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Affiliation(s)
- Egbert F Smit
- Department of Thoracic Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands.
- Department of Pulmonary Diseases, VU University Medical Centre, PO Box 7057, 1007 MB, Amsterdam, The Netherlands.
| | - Edward B Garon
- David Geffen School of Medicine at UCLA/Translational Research in Oncology-US Network, Los Angeles, CA, USA
| | - Martin Reck
- Lungen Clinic Grosshansdorf, Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Grosshansdorf, Germany
| | | | - Paolo Bidoli
- Nuovo Ospedale San Gerardo, Via Pergolesi, Milano, Italy
| | | | - Ling Gao
- Eli Lilly and Company, Bridgewater, NJ, USA
| | | | - Pablo Lee
- Eli Lilly and Company, Bridgewater, NJ, USA
| | | | | | | | - Maurice Pérol
- Département de Cancérologie Médicale Centre Léon-Bérard, Lyon, France
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33
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Colonese F, La Rosa VL, Laganà AS, Vitale SG, Cortinovis D, Bidoli P. Comment on: "Is there a role for vitamin D in human reproduction?". Horm Mol Biol Clin Investig 2018; 29:37-38. [PMID: 27740917 DOI: 10.1515/hmbci-2016-0040] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Accepted: 09/14/2016] [Indexed: 11/15/2022]
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34
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Cerrito MG, De Giorgi M, Pelizzoni D, Bonomo SM, Digiacomo N, Scagliotti A, Bugarin C, Gaipa G, Grassilli E, Lavitrano M, Giovannoni R, Bidoli P, Cazzaniga ME. Metronomic combination of Vinorelbine and 5Fluorouracil is able to inhibit triple-negative breast cancer cells. Results from the proof-of-concept VICTOR-0 study. Oncotarget 2018; 9:27448-27459. [PMID: 29937997 PMCID: PMC6007943 DOI: 10.18632/oncotarget.25422] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Accepted: 05/01/2018] [Indexed: 12/26/2022] Open
Abstract
Triple Negative Breast Cancer (TNBC) is an aggressive neoplasia with median Overall Survival (OS) less than two years. Despite the availability of new drugs, the chance of survival of these patients did not increase. The combination of low doses of drugs in a metronomic schedule showed efficacy in clinical trials, exhibiting an anti-proliferative and anti-tumour activity. In Victor-2 study we recently evaluated a new metronomic combination (mCHT) of Capecitabine (CAPE) and Vinorelbine (VNR) in breast cancer patients showing a disease control rate with a median Progression-Free Survival (PFS) of 4.7 months in 28 TNBC patients. Here in Victor-0 study, we examined the effect of mCHT vs standard (STD) schedule of administration of different combinations of 5-Fluorouracil (5FU), the active metabolite of CAPE, and VNR in TNBC cell lines MDA-MB-231 and BT-549. A significant anti-proliferative activity was observed in cells treated with metronomic vs STD administration of 5FU or VNR alone. Combination of the two drugs showed an additive inhibitor effect on cell growth in both cell lines. Moreover, after exposure of cells to 5FU and VNR under mCHT or conventional schedule of administration we also observed a downregulation of chemoresistance factor Bcl-2, changes in pro-apoptotic protein Bax and in cleaved effector caspase-3 and increased expression of LC3A/B autophagy protein. Our results therefore suggest that molecular mechanisms implicated in apoptosis and autophagy as well as the cross-talk between these two forms of cell death in MDA-MB-231 and BT-549 cells treated with 5FU and VNR is dose- and schedule-dependent and provide some insights about the roles of autophagy and senescence in 5FU/VNR-induced cell death.
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Affiliation(s)
- Maria Grazia Cerrito
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza 20900, Italy
| | - Marco De Giorgi
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza 20900, Italy
| | - Davide Pelizzoni
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza 20900, Italy.,Oncology Unit, ASST Monza, Monza 20900, Italy
| | - Sara Maria Bonomo
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza 20900, Italy
| | - Nunzio Digiacomo
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza 20900, Italy.,Oncology Unit, ASST Monza, Monza 20900, Italy
| | - Arianna Scagliotti
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza 20900, Italy
| | - Cristina Bugarin
- M.Tettamanti Research Center, Pediatric Clinic, University of Milano Bicocca, Monza 20900, Italy
| | - Giuseppe Gaipa
- M.Tettamanti Research Center, Pediatric Clinic, University of Milano Bicocca, Monza 20900, Italy
| | - Emanuela Grassilli
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza 20900, Italy
| | - Marialuisa Lavitrano
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza 20900, Italy
| | - Roberto Giovannoni
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza 20900, Italy
| | - Paolo Bidoli
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza 20900, Italy.,Oncology Unit, ASST Monza, Monza 20900, Italy
| | - Marina Elena Cazzaniga
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza 20900, Italy.,Oncology Unit, ASST Monza, Monza 20900, Italy.,Phase 1 Research Centre, Monza 20900, Italy
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35
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Ghi MG, Paccagnella A, Ferrari D, Foa P, Alterio D, Codecà C, Nolè F, Verri E, Orecchia R, Morelli F, Parisi S, Mastromauro C, Mione CA, Rossetto C, Polsinelli M, Koussis H, Loreggian L, Bonetti A, Campostrini F, Azzarello G, D'Ambrosio C, Bertoni F, Casanova C, Emiliani E, Guaraldi M, Bunkheila F, Bidoli P, Niespolo RM, Gava A, Massa E, Frattegiani A, Valduga F, Pieri G, Cipani T, Da Corte D, Chiappa F, Rulli E. Induction TPF followed by concomitant treatment versus concomitant treatment alone in locally advanced head and neck cancer. A phase II-III trial. Ann Oncol 2018; 28:2206-2212. [PMID: 28911070 DOI: 10.1093/annonc/mdx299] [Citation(s) in RCA: 101] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background Platinum-based chemoradiation (CCRT) is the standard treatment for Locally Advanced Head and Neck Squamous-Cell Carcinoma (LAHNSCC). Cetuximab/RT (CET/RT) is an alternative treatment option to CCRT. The efficacy of induction chemotherapy (IC) followed by chemoradiation compared to chemoradiation alone has not been demonstrated in randomized clinical trials. The goals of this phase II-III trial were to assess: (i) the overall survival (OS) of IC versus no-induction (no-IC) and (ii) the Grade 3-4 in-field mucosal toxicity of CCRT versus CET/RT. The present paper focuses on the analysis of efficacy. Materials and methods Patients with LAHNSCC were randomized to receive concomitant treatment alone [CCRT (Arm A1) or CET/RT (Arm A2)], or three cycles of induction docetaxel/cisplatin/5 fluorouracil (TPF) followed by CCRT (Arm B1) or followed by CET/RT (Arm B2). The superiority hypothesis of OS comparison of IC versus no-IC (Arms B1 + B2 versus A1 + A2) required 204 deaths to detect an absolute 3-year OS difference of 12% (HR 0.675, with 80% power at two-sided 5% significance level). Results 414 out of 421 patients were finally analyzed: 206 in the IC and 208 in the no-IC arm. Six patients were excluded because of major violation and one because of metastatic disease at diagnosis. With a median follow-up of 44.8 months, OS was significantly higher in the IC arm (HR 0.74; 95% CI 0.56-0.97; P = 0.031). Complete Responses (P = 0.0028), Progression Free Survival (P = 0.013) and the Loco-regional Control (P = 0.036) were also significantly higher in the IC arm. Compliance to concomitant treatments was not affected by induction TPF. Conclusions IC followed by concomitant treatment improved the outcome of patients with LAHNSCC without compromising compliance to the concomitant treatments. The degree of the benefit of IC could be different according to the type of the subsequent concomitant strategy. Clinical Trial Number NCT01086826, www.clinicaltrials.gov.
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Affiliation(s)
- M G Ghi
- Medical Oncology Department, Ospedale dell'Angelo, Venezia
| | - A Paccagnella
- Medical Oncology Department, Ospedale dell'Angelo, Venezia
| | - D Ferrari
- Medical Oncology Unit, Ospedale San Paolo, Milano
| | - P Foa
- Medical Oncology Unit, Ospedale San Paolo, Milano
| | | | - C Codecà
- Medical Oncology Unit, Ospedale San Paolo, Milano
| | - F Nolè
- Unit of Urogenital and Head and Neck Oncology, Istituto Europeo di Oncologia, Milano
| | - E Verri
- Unit of Urogenital and Head and Neck Oncology, Istituto Europeo di Oncologia, Milano
| | | | | | - S Parisi
- U.O.C. Radiation Oncology, IRCCS Casa Sollievo della Sofferenza, San Giovanni, Rotondo
| | - C Mastromauro
- Medical Oncology Department, Ospedale dell'Angelo, Venezia
| | - C A Mione
- Radiotherapy Department, Ospedale SS Giovanni e Paolo, Venezia
| | | | - M Polsinelli
- S.O.C. Radiation Oncology, Azienda Ospedaliero-Universitaria S.Maria della Misericordia, Udine
| | - H Koussis
- Medical Oncology Department 2, Istituto Oncologico Veneto- IRCCS, Padova
| | - L Loreggian
- Radiotherapy Department, Istituto Oncologico Veneto - IRCCS, Padova
| | - A Bonetti
- Medical Oncology Department, Ospedale Mater Salutis, Legnago
| | - F Campostrini
- Radiotherapy Department, Ospedale Mater Salutis, Legnago
| | - G Azzarello
- Oncology Unit, Department of Internal Medical Sciences, Mirano
| | | | - F Bertoni
- Radiotherapy Department, Azienda Ospedaliero Universitaria, Modena
| | | | - E Emiliani
- Radiotherapy Department, Azienda USL, Ravenna
| | - M Guaraldi
- Medical Oncology Department, Policlinico Sant'Orsola-Malpighi, Bologna
| | - F Bunkheila
- Radiotherapy Department, Policlinico Sant'Orsola-Malpighi, Bologna
| | - P Bidoli
- Medical Oncology Department, Ospedale San Gerardo, Monza
| | - R M Niespolo
- Radiotherapy Department, Ospedale San Gerardo, Monza, Ospedale San Gerardo, Monza
| | - A Gava
- Radiotherapy Department, Ospedale Ca' Foncello, Treviso
| | - E Massa
- Department of Medical Science, Università degli Studi di Cagliari, Cagliari
| | - A Frattegiani
- Radiation Oncology Department, Ospedale S. Maria della Misericordia, Perugia
| | - F Valduga
- Medical Oncology Department, Ospedale S. Chiara, Trento
| | - G Pieri
- Medical Oncology Department, AO Triestina, Trieste
| | - T Cipani
- Niguarda Cancer Center, Ospedale Niguarda Cà Granda, Milano
| | - D Da Corte
- Oncology Department, Ospedale S. Martino, Belluno
| | - F Chiappa
- Laboratory of Clinical Research, Istituto di Ricerche Farmacologiche "Mario Negri," Milano, Italy
| | - E Rulli
- Laboratory of Clinical Research, Istituto di Ricerche Farmacologiche "Mario Negri," Milano, Italy
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Gregorc V, Gaafar RM, Favaretto A, Grossi F, Jassem J, Polychronis A, Bidoli P, Tiseo M, Shah R, Taylor P, Novello S, Muzio A, Bearz A, Greillier L, Fontana F, Salini G, Lambiase A, O'Brien M. NGR-hTNF in combination with best investigator choice in previously treated malignant pleural mesothelioma (NGR015): a randomised, double-blind, placebo-controlled phase 3 trial. Lancet Oncol 2018; 19:799-811. [PMID: 29753703 DOI: 10.1016/s1470-2045(18)30193-1] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 02/19/2018] [Accepted: 02/26/2018] [Indexed: 01/17/2023]
Abstract
BACKGROUND Malignant pleural mesothelioma is an aggressive cancer with highly vascularised tumours. It has poor prognosis and few treatment options after failure of first-line chemotherapy. NGR-hTNF is a vascular-targeting drug that increases penetration of intratumoral chemotherapy and T-cell infiltration by modifying the tumour microenvironment. In this trial, we aimed to investigate the efficacy and safety of NGR-hTNF in patients with malignant pleural mesothelioma who had progressed during or after a first-line treatment. METHODS NGR015 was a randomised, double-blind, placebo-controlled phase 3 trial done in 41 centres in 12 countries. Eligible participants had malignant pleural mesothelioma of any histological subtype (epithelial, sarcomatoid, or mixed), were aged 18 years or older, and had an Eastern Cooperative Oncology Group performance status of 0-2 and radiologically documented progressive disease after one pemetrexed-based chemotherapy regimen. Participants were randomly assigned to receive weekly NGR-hTNF 0·8 μg/m2 intravenously plus best investigator choice (n=200), or placebo plus best investigator choice (n=200). Best investigator choice was decided before random assignment and could be single-agent gemcitabine (1000-1250 mg/m2 intravenously), vinorelbine (25 mg/m2 intravenously or 60 mg/m2 orally), doxorubicin (60-75 mg/m2 intravenously), or best supportive care only. Patients were randomised (1:1) with a block size of four after stratification for performance status and best investigator choice. The primary study endpoint was overall survival in the intention-to-treat population. The trial is closed to new participants and is registered with ClinicalTrials.gov (NCT01098266). FINDINGS Between April 12, 2010 and Jan 21, 2013, we enrolled 400 eligible participants. 381 (95%) of 400 patients were selected to receive chemotherapy before all participants were randomly assigned to receive NGF-hTNF plus best investigator choice (n=200) or placebo plus best investigator choice (n=200). At the cutoff date (April 29, 2014), the median follow-up was 18·7 months (IQR 15·1-24·4), and overall survival did not differ between the two treatment groups (median 8·5 months [95% CI 7·2-9·9] in the NGR-hTNF group vs 8·0 months [6·6-8·9] in the placebo group; hazard ratio 0·94, 95% CI 0·75-1·18; p=0·58). Grade 3 or worse study-emergent adverse events occurred in 136 (70%) of patients receiving NGR-hTNF versus 118 (61%) of patients receiving placebo, with the most common being neutropenia (35 [18%] of 193 patients vs 36 [19%] of 193 patients), pain (11 [6%] vs 16 [8%]), dyspnoea (nine [5%] vs seven [4%]), and chills (nine [5%] vs none). 50 (26%) patients in the NGR-hTNF group had a serious adverse event, compared with 47 (24%) in the placebo group. Treatment-related serious adverse events occurred in 17 (9%) patients in the NGR-hTNF group and 20 patients (10%) in the placebo group. There were 12 deaths in the NGR-hTNF group and 13 deaths in the placebo group, but none were treatment related. INTERPRETATION The study did not meet its primary endpoint. The hypothesis-generating findings from the subgroup analyses deserve a confirmatory randomised trial because patients who rapidly progress after first-line treatment have a poor prognosis. FUNDING MolMed.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Silvia Novello
- University of Turin, AOU San Luigi, Orbassano, Turin, Italy
| | | | | | - Laurent Greillier
- Assistance Publique Hôpitaux de Marseille, Aix Marseille University, Marseille, France
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Abstract
Twenty-one patients with limited (12 cases) or extensive (9 cases) small cell lung cancer entered a pilot study with adriamycin (ADM) plus ifosfamide (IFX) as first line treatment for six planned cycles. ADM was administered at the dose of 60 mg/m2 iv push on day 1 and IFX at 3 g/m2/iv in 1-hour infusion on days 1 and 2. To prevent IFX-induced hemorrhagic cystitis, mercaptoethane sulfonate sodium (Mesna) was given after the admnistration of IFX at the dose of 500 mg/m2 by iv push four times (hour 0, 4, 8, 12) on days 1 and 2. In the absence of disease progression, chemotherapy was repeated every 3 weeks for 6 cycles. All patients were evaluable for analysis of response, toxicity and survival. The overall response rate clinically and radiologically assessed after four treatment cycles was 95.3% (CR 28.6%, PR 66.7%). However, by continuing the same drug treatment up to the sixth cycle, 7 of 14 partial responders showed tumor progression within the intrathoracic region. Therefore, at the end of the planned chemotherapy program the partial remission rate fell to 33.3%, for a total remission rate of 61.9% and a median total survival of 9 months (range 5 to 36+). The regimen was well tolerated with only one case presenting hemorrhagic cystitis. The results achieved with this drug combination appear comparable to those obtained with other conventional regimens. However, the high response rate achieved after four cycles and the low incidence of marrow toxicity suggest the use of this regimen for a short period with increased dose levels.
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Affiliation(s)
- P Bidoli
- Division of Medical Oncology, Istituto Nazionale Tumori, Milano, Italy
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Spinazzé S, Viviani S, Bidoli P, Rovelli F, Palmer P, Franks CR, Arienti F, Rivoltini L, Parmiani G. Effect of Prolonged Subcutaneous Administration of Interleukin-2 on the Orcadian Rhythms of Cortisol and Beta-Endorphin in Advanced Small Cell Lung Cancer Patients. Tumori 2018; 77:496-9. [PMID: 1666467 DOI: 10.1177/030089169107700609] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Interleukin-2 has been shown to stimulate Cortisol secretion in man. Owing to its Immunosuppressive properties, an increase in Cortisol levels during interleukin-2 cancer immunotherapy could potentially counteract induced activation of the antitumor immune response. Few data are available about Cortisol secretion secondary to prolonged interleukin-2 administration. To Investigate the problem, we evaluated Cortisol circadian rhythms in 7 consecutive metastatic small cell lung cancer patients who received interleukin-2 subcutaneously for 4 weeks (daily dose: 6 × 106 × IU/m2). Venous blood samples were drawn at 8.00 a.m., 4.00 p.m. and 12.00 p.m., before Interleukin-2, and after each week until the end of the cycle. Beta-endorphin levels were also measured on the same samples. Four patients were evaluated during a second interleukin-2 cycle. Mean Cortisol levels increased during Interleukin-2 therapy, but were significantly higher than those seen in basal conditions after the first week of treatment. Moreover, Cortisol peaks observed during the second cycle of therapy were not significantly different from those seen during the first cycle. Mean beta-endorphin levels increased in response to interleukin-2 administration, but the increase did not reach statistical significance. The early Cortisol rise progressively decreased as treatment continued. This suggests that the interleukin-2-induced Cortisol rise has no relevant clinical importance in antagonizing the activation of an effective antitumor immune response during cancer immunotherapy with interleukin-2.
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Affiliation(s)
- S Spinazzé
- Division of Medical Oncology A, Istituto Nazionale Tumori, Milan, Italy
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Cataldo I, Bedini AV, Muscolino G, Valente M, Pastorino U, Bidoli P, Pilotti S, Ravasi G. Surgical Resection in the Treatment of Stages I-II of Small Cell Lung Carcinoma (SCLC). Tumori 2018; 75:28-30. [PMID: 2540577 DOI: 10.1177/030089168907500108] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
From 1981 to 1986, 17 patients with resected small cell lung carcinoma (SCLC) staged as I or II according to the new TNM classification were recruited for a prospective study to evaluate the effctiveness of surgery and postoperative chemotherapy (plus locoregional radiotherapy only when a nonradical resection was accomplished) in the treatment of early stages of the disease. Six patients received full protocol chemotherapy (6 courses) and 8 a mean of 79.1% of the planned courses. Three patients received non adjuvant treatment. Locoregional radiotherapy for residual disease was administered in 2 cases. One patient died for myelosuppression due to chemotherapy and 10 for recurrences of cancer, all within the 20th postoperative month. Metastases accounted 80% of overall recurrences. Six patients were alive and tumor-free at 18, 22, 39, 44, 47 and 51 months from resection. Actuarial observed 3-year survival was 32%.
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Affiliation(s)
- I Cataldo
- Divisione di Oncologia Chirurgica Toracica, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milano, Italy
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Abstract
A prospective randomized study was conducted to compare the antiemetic efficacy of metoclopramide (MCP) versus its recent derivative alizapride (ALZ) in patients undergoing cancer chemotherapy. Both drugs were given at a dose of 2 mg/kg i.v. push for 5 doses. A positive response was defined as absence of nausea or emesis, or moderate nausea with one or two emeses per day. Eighty-two patients were evaluable. Forty-two received MCP and 40 received ALZ. A positive response was observed in 54% MCP-treated and 41% ALZ-treated patients. Neurologic toxicity, mainly extrapyramidal disturbances, was the most remarkable adverse side effect; it occurred more frequently in the MCP-treated group (31%) than in the ALZ-treated group (17%). Both drugs were found to be more effective in previously untreated patients and when employed together with steroids. MCP was more effective (52% positive response) than ALZ (41% positive response) in cisplatin-treated patients. To better control drug-induced vomiting, we believe that future trials should evaluate slow i.v. infusion of antiemetic agents and their combination with dexamethasone.
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Bidoli P, Stani SC, De Candis D, Cortinovis D, Parra HS, Bajetta E. Single-Agent Chemotherapy with Vinorelbine for Pretreated or Metastatic Squamous Cell Carcinoma of the Esophagus. Tumori 2018; 87:299-302. [PMID: 11765177 DOI: 10.1177/030089160108700504] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aims and Background At least half of the patients with squamous cell carcinoma of the esophagus (SCCE) present at diagnosis with metastatic disease, and most patients in a locally advanced phase will develop metastases despite potentially curative local therapy. Thus, the majority of patients with SCCE will become candidate for palliative chemotherapy. Only a few drugs have demonstrated moderate activity (>15%) against SCCE. The main purpose of this phase II trial was to assess the activity of vinorelbine, a semisynthetic vinca alkaloid with a wide spectrum of action, in advanced or relapsed SCCE. Methods Seventeen patients were included in the trial. Eleven of them had already received chemotherapy (cisplatin and fluorouracil) and/or radiotherapy at the time of the first diagnosis All patients were treated with vinorelbine at the dose of 30 mg/m2 every two weeks. Results Sixteen of the 17 patients enrolled in the trial were assessable for activity: partial responses were observed in 4 of the 16 (25%), and 3 of them were pretreated patients. A significant improvement of dysphagia was obtained in 4 of 11 symptomatic patients. Toxicity was mild, with only one episode of grade 4 neutropenia and constipation. Conclusions In our experience, single-agent vinorelbine is active against SCCE. It was also active in patients previously treated with cisplatin and fluorouracil. The good tolerability and the possibility of relieving symptoms such as dysphagia strongly suggest the addition of vinorelbine to combination regimens with cisplatin as front-line chemotherapy for SCCE.
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Affiliation(s)
- P Bidoli
- Medical Oncology Unit B, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan, Italy
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Bozzetti F, Cozzaglio L, Gavazzi C, Bidoli P, Bonfanti G, Montalto F, Soto Parra H, Valente M, Zucali R. Nutritional Support in Patients with Cancer of the Esophagus: Impact on Nutritional Status, Patient Compliance to Therapy, and Survival. Tumori 2018; 84:681-6. [PMID: 10080677 DOI: 10.1177/030089169808400614] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIMS AND BACKGROUND The multimodal approach to patients with esophageal squamous cell carcinoma often includes polychemotherapy combined with radiation therapy. Cancer dysphagia and drug-related anorexia, mucositis and vomiting can all lead to malnutrition. The aim of this study was to analyze the impact of the administration of enteral nutrition (EN) on the patient's nutritional status, tolerance of chemotherapy and radiotherapy, and final oncological outcome. METHODS Fifty esophageal cancer patients who were to be submitted to chemotherapy (days 1-4 5-fluorouracil (FU) 1 g/m2/day and cisplatin (CDDP) 100 mg/m2/day 1) for two cycles plus radiotherapy (31 Gy) were referred to the Nutrition Support Unit prior to any therapy due to their malnourished status. Twenty-nine dysphagic patients received nutrition via tube (37 kcal/kg/day + 2.0 g proteins/kg/day for 34 days), while 21 others who were not dysphagic were given a standard oral diet (SD). The patients who received EN had a more severe weight loss than the SD patients (16.8% vs 12.8%, P <0.02). RESULTS The dose of administered EN represented 86% of the planned support, and 70% of the nutritional therapy was administered in the home setting. Administration of EN support resulted in stable body weight and unchanged levels of visceral proteins, while SD patients had a decrease in body weight, total proteins and serum albumin (P <0.01). There was no difference between the two groups in terms of tolerance and response to cancer therapy, suitability for radical resection and median survival (9.5 months). CONCLUSIONS EN in patients with cancer of the esophagus undergoing chemotherapy and radiotherapy is well tolerated, feasible even in the home setting, prevents further nutritional deterioration and achieves the same oncological results in dysphagic patients as those achieved in non-dysphagic patients.
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Affiliation(s)
- F Bozzetti
- Department of Surgery of the Gastrointestinal Tract, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan, Italy
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Garassino MC, Cho BC, Kim JH, Mazières J, Vansteenkiste J, Lena H, Corral Jaime J, Gray JE, Powderly J, Chouaid C, Bidoli P, Wheatley-Price P, Park K, Soo RA, Huang Y, Wadsworth C, Dennis PA, Rizvi NA. Durvalumab as third-line or later treatment for advanced non-small-cell lung cancer (ATLANTIC): an open-label, single-arm, phase 2 study. Lancet Oncol 2018; 19:521-536. [PMID: 29545095 DOI: 10.1016/s1470-2045(18)30144-x] [Citation(s) in RCA: 417] [Impact Index Per Article: 69.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 01/23/2018] [Accepted: 01/25/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Immune checkpoint inhibitors are a new standard of care for patients with advanced non-small-cell lung cancer (NSCLC) without EGFR tyrosine kinase or anaplastic lymphoma kinase (ALK) genetic aberrations (EGFR-/ALK-), but clinical benefit in patients with EGFR mutations or ALK rearrangements (EGFR+/ALK+) has not been shown. We assessed the effect of durvalumab (anti-PD-L1) treatment in three cohorts of patients with NSCLC defined by EGFR/ALK status and tumour expression of PD-L1. METHODS ATLANTIC is a phase 2, open-label, single-arm trial at 139 study centres in Asia, Europe, and North America. Eligible patients had advanced NSCLC with disease progression following at least two previous systemic regimens, including platinum-based chemotherapy (and tyrosine kinase inhibitor therapy if indicated); were aged 18 years or older; had a WHO performance status score of 0 or 1; and measurable disease per Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1. Key exclusion criteria included mixed small-cell lung cancer and NSCLC histology; previous exposure to any anti-PD-1 or anti-PD-L1 antibody; and any previous grade 3 or worse immune-related adverse event while receiving any immunotherapy agent. Patients in cohort 1 had EGFR+/ALK+ NSCLC with at least 25%, or less than 25%, of tumour cells with PD-L1 expression. Patients in cohorts 2 and 3 had EGFR-/ALK- NSCLC; cohort 2 included patients with at least 25%, or less than 25%, of tumour cells with PD-L1 expression, and cohort 3 included patients with at least 90% of tumour cells with PD-L1 expression. Patients received durvalumab (10 mg/kg) every 2 weeks, via intravenous infusion, for up to 12 months. Retreatment was allowed for patients who benefited but then progressed after completing 12 months. The primary endpoint was the proportion of patients with increased tumour expression of PD-L1 (defined as ≥25% of tumour cells in cohorts 1 and 2, and ≥90% of tumour cells in cohort 3) who achieved an objective response, assessed in patients who were evaluable for response per independent central review according to RECIST version 1.1. Safety was assessed in all patients who received at least one dose of durvalumab and for whom any post-dose data were available. The trial is ongoing, but is no longer open to accrual, and is registered with ClinicalTrials.gov, number NCT02087423. FINDINGS Between Feb 25, 2014, and Dec 28, 2015, 444 patients were enrolled and received durvalumab: 111 in cohort 1, 265 in cohort 2, and 68 in cohort 3. Among patients with at least 25% of tumour cells expressing PD-L1 who were evaluable for objective response per independent central review, an objective response was achieved in 9 (12·2%, 95% CI 5·7-21·8) of 74 patients in cohort 1 and 24 (16·4%, 10·8-23·5) of 146 patients in cohort 2. In cohort 3, 21 (30·9%, 20·2-43·3) of 68 patients achieved an objective response. Grade 3 or 4 treatment-related adverse events occurred in 40 (9%) of 444 patients overall: six (5%) of 111 patients in cohort 1, 22 (8%) of 265 in cohort 2, and 12 (18%) of 68 in cohort 3. The most common treatment-related grade 3 or 4 adverse events were pneumonitis (four patients [1%]), elevated gamma-glutamyltransferase (four [1%]), diarrhoea (three [1%]), infusion-related reaction (three [1%]), elevated aspartate aminotransferase (two [<1%]), elevated transaminases (two [<1%]), vomiting (two [<1%]), and fatigue (two [<1%]). Treatment-related serious adverse events occurred in 27 (6%) of 444 patients overall: five (5%) of 111 patients in cohort 1, 14 (5%) of 265 in cohort 2, and eight (12%) of 68 in cohort 3. The most common serious adverse events overall were pneumonitis (five patients [1%]), fatigue (three [1%]), and infusion-related reaction (three [1%]). Immune-mediated events were manageable with standard treatment guidelines. INTERPRETATION In patients with advanced and heavily pretreated NSCLC, the clinical activity and safety profile of durvalumab was consistent with that of other anti-PD-1 and anti-PD-L1 agents. Responses were recorded in all cohorts; the proportion of patients with EGFR-/ALK- NSCLC (cohorts 2 and 3) achieving a response was higher than the proportion with EGFR+/ALK+ NSCLC (cohort 1) achieving a response. The clinical activity of durvalumab in patients with EGFR+ NSCLC with ≥25% of tumour cells expressing PD-L1 was encouraging, and further investigation of durvalumab in patients with EGFR+/ALK+ NSCLC is warranted. FUNDING AstraZeneca.
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Affiliation(s)
| | - Byoung-Chul Cho
- Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Joo-Hang Kim
- CHA Bundang Medical Center, CHA University, Gyeonggi-do, South Korea
| | - Julien Mazières
- Toulouse University Hospital, Université Paul Sabatier, Toulouse, France
| | | | - Hervé Lena
- CHU Rennes-Hôpital Pontchaillou, Rennes University, Rennes, France
| | | | - Jhanelle E Gray
- H Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - John Powderly
- Carolina BioOncology Institute, Huntersville, NC, USA
| | | | | | - Paul Wheatley-Price
- The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Keunchil Park
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Ross A Soo
- National University Hospital and National University Cancer Institute, Singapore
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De Placido S, Gallo C, De Laurentiis M, Bisagni G, Arpino G, Sarobba MG, Riccardi F, Russo A, Del Mastro L, Cogoni AA, Cognetti F, Gori S, Foglietta J, Frassoldati A, Amoroso D, Laudadio L, Moscetti L, Montemurro F, Verusio C, Bernardo A, Lorusso V, Gravina A, Moretti G, Lauria R, Lai A, Mocerino C, Rizzo S, Nuzzo F, Carlini P, Perrone F, Agostara B, Aieta M, Alabiso O, Alicicco MG, Amadori D, Amaducci L, Amiconi G, Antuzzi G, Ardine M, Ardizzoia A, Aversa C, Badalamenti G, Barni S, Basurto C, Berardi R, Bergamasco C, Bidoli P, Bighin C, Biondi E, Bisagni G, Boni C, Borgonovo K, Botta M, Bravi S, Bruzzi P, Buono G, Butera A, Caldara A, Candeloro G, Cappelletti C, Cardalesi C, Carfora E, Cariello A, Carrozza F, Cartenì G, Caruso M, Casadei V, Casanova C, Castori L, Cavanna L, Cavazzini G, Cazzaniga M, Chilelli M, Chiodini P, Chiorrini S, Ciardiello F, Ciccarese M, Cinieri S, Clerico M, Coccaro M, Comande M, Corbo C, Cortino G, Cusenza S, Daniele G, D'arco AM, D'auria G, Dazzi C, De Angelis C, de Braud F, De Feo G, De Matteis A, De Tursi M, Di Blasio A, di Lucca G, Di Lullo L, Di Rella F, Di Renzo G, Di Stefano P, Di Stefano A, Diana A, Donati S, Fabbri A, Fabi A, Faedi M, Farina G, Farris A, Febbraro A, Fedele P, Federico P, Ferraù F, Ferretti G, Ferro A, Floriani I, Forcignanò R, Forciniti S, Forestieri V, Fornari G, Frisinghelli M, Fusco V, Gallizzi G, Galvano A, Gambardella A, Gambi A, Gebbia V, Gervasi E, Ghilardi M, Giacobino A, Giardina G, Giotta F, Giraudi S, Giuliano M, Grassadonia A, Grasso D, Grosso F, Guizzaro L, Incoronato P, Incorvaia L, Iodice G, La Verde N, Labonia V, Landi G, Latorre A, Leonardi V, Levaggi A, Limite G, Lina Bascialla L, Livi L, Maiello E, Mandelli D, Marcon I, Menon D, Montedoro M, Moraca L, Moretti A, Morritti MG, Morselli P, Mura A, Mura S, Musacchio M, Muzio A, Natale D, Natoli C, Nigro C, Nisticò C, Nuzzo A, Orditura M, Orlando L, Pacilio C, Palumbo G, Palumbo R, Pasini F, Paterno E, Pazzola A, Pelliccioni S, Pensabene M, Perroni D, Pesenti Gritti A, Petrelli F, Piccirillo MC, Pinotti G, Pogliani C, Poli D, Prader S, Recchia F, Rizzi D, Romano C, Rossello R, Rossini C, Salvucci G, Sanna V, Santini A, Saracchini S, Savastano C, Scambia G, Schettini F, Schiavone P, Schirone A, Seles E, Signoriello S, Signoriello G, Silva RR, Silvestri A, Simeon V, Spagnoletti I, Tamberi S, Teragni C, Thalmann V, Thomas R, Thomas G, Tienghi A, Tinari N, Tinessa V, Tomei F, Tonini G, Torri V, Traficante D, Tudini M, Turazza M, Vignoli R, Vitale MG, Zacchia A, Zagarese P, Zanni A, Zavallone L, Zavettieri M, Zoboli A. Adjuvant anastrozole versus exemestane versus letrozole, upfront or after 2 years of tamoxifen, in endocrine-sensitive breast cancer (FATA-GIM3): a randomised, phase 3 trial. Lancet Oncol 2018; 19:474-485. [PMID: 29482983 DOI: 10.1016/s1470-2045(18)30116-5] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 01/04/2018] [Accepted: 01/08/2018] [Indexed: 01/04/2023]
Abstract
BACKGROUND Uncertainty exists about the optimal schedule of adjuvant treatment of breast cancer with aromatase inhibitors and, to our knowledge, no trial has directly compared the three aromatase inhibitors anastrozole, exemestane, and letrozole. We investigated the schedule and type of aromatase inhibitors to be used as adjuvant treatment for hormone receptor-positive early breast cancer. METHODS FATA-GIM3 is a multicentre, open-label, randomised, phase 3 trial of six different treatments in postmenopausal women with hormone receptor-positive early breast cancer. Eligible patients had histologically confirmed invasive hormone receptor-positive breast cancer that had been completely removed by surgery, any pathological tumour size, and axillary nodal status. Key exclusion criteria were hormone replacement therapy, recurrent or metastatic disease, previous treatment with tamoxifen, and another malignancy in the previous 10 years. Patients were randomly assigned in an equal ratio to one of six treatment groups: oral anastrozole (1 mg per day), exemestane (25 mg per day), or letrozole (2·5 mg per day) tablets upfront for 5 years (upfront strategy) or oral tamoxifen (20 mg per day) for 2 years followed by oral administration of one of the three aromatase inhibitors for 3 years (switch strategy). Randomisation was done by a computerised minimisation procedure stratified for oestrogen receptor, progesterone receptor, and HER2 status; previous chemotherapy; and pathological nodal status. Neither the patients nor the physicians were masked to treatment allocation. The primary endpoint was disease-free survival. The minimum cutoff to declare superiority of the upfront strategy over the switch strategy was assumed to be a 2% difference in disease-free survival at 5 years. Primary efficacy analyses were done by intention to treat; safety analyses included all patients for whom at least one safety case report form had been completed. Follow-up is ongoing. This trial is registered with the European Clinical Trials Database, number 2006-004018-42, and ClinicalTrials.gov, number NCT00541086. FINDINGS Between March 9, 2007, and July 31, 2012, 3697 patients were enrolled into the study. After a median follow-up of 60 months (IQR 46-72), 401 disease-free survival events were reported, including 211 (11%) of 1850 patients allocated to the switch strategy and 190 (10%) of 1847 patients allocated to upfront treatment. 5-year disease-free survival was 88·5% (95% CI 86·7-90·0) with the switch strategy and 89·8% (88·2-91·2) with upfront treatment (hazard ratio 0·89, 95% CI 0·73-1·08; p=0·23). 5-year disease-free survival was 90·0% (95% CI 87·9-91·7) with anastrozole (124 events), 88·0% (85·8-89·9) with exemestane (148 events), and 89·4% (87·3 to 91·1) with letrozole (129 events; p=0·24). No unexpected serious adverse reactions or treatment-related deaths occurred. Musculoskeletal side-effects were the most frequent grade 3-4 events, reported in 130 (7%) of 1761 patients who received the switch strategy and 128 (7%) of 1766 patients who received upfront treatment. Grade 1 musculoskeletal events were more frequent with the upfront schedule than with the switch schedule (924 [52%] of 1766 patients vs 745 [42%] of 1761 patients). All other grade 3-4 adverse events occurred in less than 2% of patients in either group. INTERPRETATION 5 years of treatment with aromatase inhibitors was not superior to 2 years of tamoxifen followed by 3 years of aromatase inhibitors. None of the three aromatase inhibitors was superior to the others in terms of efficacy. Therefore, patient preference, tolerability, and financial constraints should be considered when deciding the optimal treatment approach in this setting. FUNDING Italian Drug Agency.
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Affiliation(s)
- Sabino De Placido
- Dipartimento di Clinica Medica e Chirurgia, Università Federico II, Naples, Italy
| | - Ciro Gallo
- Statistica Medica, Università degli Studi della Campania Luigi Vanvitelli, Naples, Italy
| | - Michelino De Laurentiis
- Istituto Nazionale per lo Studio e la Cura dei Tumori, Fondazione Pascale, Istituto di Ricovero e Cura a Carattere Scientifico, Naples, Italy
| | - Giancarlo Bisagni
- Dipartimento di Oncologia, Arcispedale S Maria Nuova-IRCCS, Reggio Emilia, Italy
| | - Grazia Arpino
- Dipartimento di Clinica Medica e Chirurgia, Università Federico II, Naples, Italy
| | | | | | - Antonio Russo
- Dipartimento di Scienze Chirurgiche, Oncologiche e Stomatologiche, Sezione di Oncologia Medica, Università di Palermo, Palermo, Italy
| | - Lucia Del Mastro
- Dipartimento di Medicina Interna e Specialità Mediche, Università degli Studi di Genova-Oncologia Medica, Ospedale Policlinico San Martino, Genoa, Italy
| | | | - Francesco Cognetti
- Divisione Oncologia Medica 1, Istituto Nazionale Tumori Regina Elena, Rome, Italy
| | - Stefania Gori
- Oncologia Medica, Ospedale Sacro Cuore Don Calabria, Negrar, Italy
| | | | | | - Domenico Amoroso
- Oncologia Medica, Ospedale della Versilia, Lido di Camaiore (LU), Istituto Toscano Tumori, Florence, Italy
| | | | - Luca Moscetti
- Dipartimento di Oncologia Medica, Ospedale Belcolle, Viterbo, Italy
| | - Filippo Montemurro
- Divisione di Oncologia Clinica Investigativa dell'Istituto di Candiolo-IRCCS, Candiolo, Italy
| | | | | | - Vito Lorusso
- Polo Oncologico, Ospedale Vito Fazzi, Lecce, Italy
| | - Adriano Gravina
- Istituto Nazionale per lo Studio e la Cura dei Tumori, Fondazione Pascale, Istituto di Ricovero e Cura a Carattere Scientifico, Naples, Italy
| | - Gabriella Moretti
- Dipartimento di Oncologia, Arcispedale S Maria Nuova-IRCCS, Reggio Emilia, Italy
| | - Rossella Lauria
- Dipartimento di Clinica Medica e Chirurgia, Università Federico II, Naples, Italy
| | - Antonella Lai
- Oncologia Medica, Azienda Ospedaliera Universitaria, Sassari, Italy
| | | | - Sergio Rizzo
- Dipartimento di Scienze Chirurgiche, Oncologiche e Stomatologiche, Sezione di Oncologia Medica, Università di Palermo, Palermo, Italy
| | - Francesco Nuzzo
- Istituto Nazionale per lo Studio e la Cura dei Tumori, Fondazione Pascale, Istituto di Ricovero e Cura a Carattere Scientifico, Naples, Italy
| | - Paolo Carlini
- Divisione Oncologia Medica 1, Istituto Nazionale Tumori Regina Elena, Rome, Italy
| | - Francesco Perrone
- Istituto Nazionale per lo Studio e la Cura dei Tumori, Fondazione Pascale, Istituto di Ricovero e Cura a Carattere Scientifico, Naples, Italy.
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Scorsetti M, Alongi F, Navarria P, Cortinovis D, Bidoli P. Overall and Disease-Free Survival Greater than 12 Years in Metastatic Non-Small Cell Lung Cancer after Linear Accelerator-Based Stereotactic Radiosurgery for Solitary Brain Metastasis. Tumori 2018. [DOI: 10.1177/030089161209800218] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The best treatment approach for solitary brain metastasis is not well defined and there is no consensus on this issue. It is still being debated whether patients with isolated brain metastasis should undergo surgical resection or stereotactic radiosurgery, and which patients should receive adjuvant whole brain radiotherapy. The median survival in patients with single or multiple metastatic lesions who underwent only stereotactic radiosurgery improved from two-three months to nine months. To the best of our knowledge this is the first report on patients treated with linear accelerator-based stereotactic radiosurgery alone where an overall survival of more than 12 years was obtained, maintaining good quality of life in three cases of solitary brain metastasis from non-small cell lung cancer. In addition to the case reports, we present a brief literature review on this topic.
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Affiliation(s)
- Marta Scorsetti
- Department of Radiotherapy and Radiosurgery, Humanitas Cancer Center, IRCCS Istituto Clinico Humanitas Rozzano
| | - Filippo Alongi
- Department of Radiotherapy and Radiosurgery, Humanitas Cancer Center, IRCCS Istituto Clinico Humanitas Rozzano
| | - Piera Navarria
- Department of Radiotherapy and Radiosurgery, Humanitas Cancer Center, IRCCS Istituto Clinico Humanitas Rozzano
| | | | - Paolo Bidoli
- Medical Oncology Unit, Ospedale San Gerardo, Monza, Italy
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Ardizzoni A, Bidoli P, Chiari R, Bonomi L, Turci D, Landi L, Toschi L, De Tursi M, Francini G, Giordano M, Alabiso O, De Censi A, Livi L, Berruti A, Minelli M, Ricevuto E, Illiano A, Puppo G, Delmonte A, Galetta D. MA 02.05 Nivolumab in Advanced Non-Squamous NSCLC Patients with KRAS Mutations: Results from the Italian Expanded Access Program (EAP). J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.454] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Reck M, Paz-Ares L, Pérol M, Johnson M, Pennell N, Novello S, Cappuzzo F, Bidoli P, Zimmermann A, Lee P, Sashegyi A, Varea Menendez R. Subgroup analysis of patients (Pts) refractory to first-line (1L) chemotherapy from REVEL, a randomized phase 3 study of docetaxel (DOC) with ramucirumab (RAM) or placebo (PBO) for second-line (2L) treatment of stage IV non-small-cell lung cancer (NSCLC). Ann Oncol 2017. [DOI: 10.1093/annonc/mdx426.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Zaniboni A, Lonardi S, Labianca R, Di Bartolomeo M, Rosati G, Ronzoni M, Pella N, Banzi M, Zampino M, Pasini F, Marchetti P, Rimassa L, Maiello E, Bidoli P, Cinieri S, Barni S, Ciuffreda L, Beretta G, Frontini L, Rulli E, Sobrero A. FOLFOX4/XELOX in stage II–III colon cancer: early survival data of the Italian Three Or Six Colon Adjuvant (TOSCA) trial. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx421] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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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Reck M, Paz-Ares L, Bidoli P, Cappuzzo F, Dakhil S, Moro-Sibilot D, Borghaei H, Johnson M, Jotte R, Pennell NA, Shepherd FA, Tsao A, Thomas M, Carter GC, Chan-Diehl F, Alexandris E, Lee P, Zimmermann A, Sashegyi A, Pérol M. Outcomes in patients with aggressive or refractory disease from REVEL: A randomized phase III study of docetaxel with ramucirumab or placebo for second-line treatment of stage IV non-small-cell lung cancer. Lung Cancer 2017; 112:181-187. [PMID: 29191593 DOI: 10.1016/j.lungcan.2017.07.038] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [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: 03/21/2017] [Revised: 07/27/2017] [Accepted: 07/31/2017] [Indexed: 12/22/2022]
Abstract
OBJECTIVES The REVEL study demonstrated improved efficacy for patients with advanced non-small cell lung cancer treated with ramucirumab plus docetaxel, independent of histology. This exploratory analysis characterized the treatment effect in REVEL patients who were refractory to prior first-line treatment. MATERIALS AND METHODS Refractory patients had a best response of progressive disease to first-line treatment. Endpoints included overall survival (OS), progression-free survival (PFS), objective response rate (ORR), quality of life (QoL), and safety. Kaplan-Meier and Cox proportional hazards regression were performed for OS and PFS, and Cochran-Mantel-Haenszel test was used for response. QoL was assessed with the Lung Cancer Symptom Scale. Sensitivity analyses were performed on subgroups of the intent-to-treat population with limited time on first-line therapy. RESULTS Of 1253 randomized patients in REVEL, 360 (29%) were refractory to first-line treatment. Baseline characteristics were largely balanced between treatment arms. In the control arm, median OS for refractory patients was 6.3 versus 10.3 months for patients not meeting this criterion, demonstrating the poor prognosis of refractory patients. Median OS (8.3 vs. 6.3 months; HR, 0.86; 95% CI, 0.68-1.08), median PFS (4.0 vs. 2.5 months; HR, 0.71; 95% CI, 0.57-0.88), and ORR (22.5% vs. 12.6%) were improved in refractory patients treated with ramucirumab compared to placebo, without new safety concerns or further deteriorating patient QoL. CONCLUSIONS The effect of ramucirumab in refractory patients is similar to that in the intent-to-treat population. The benefit/risk profile for refractory patients suggests that ramucirumab plus docetaxel is an appropriate treatment option even in this difficult-to-treat population.
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Affiliation(s)
- Martin Reck
- Department of Thoracic Oncology, Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Lung Clinic Grosshansdorf, Grosshansdorf, Germany.
| | - Luis Paz-Ares
- Virgen del Rocio University Hospital, Seville, Spain
| | | | | | | | | | | | - Melissa Johnson
- Sarah Cannon Research Institute, Nashville, TN, United States
| | - Robert Jotte
- Rocky Mountain Cancer Centers, Denver, CO, United States
| | - Nathan A Pennell
- Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, United States
| | | | - Anne Tsao
- University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Michael Thomas
- Internistische Onkologie der Thoraxtumoren, Thoraxklinik im Universitätsklinikum Heidelberg, Translational Lung Research Center Heidelberg (TLRC-H), German Center for Lung Research (DZL), Heidelberg, Germany
| | | | | | | | - Pablo Lee
- Eli Lilly and Company, Indianapolis, IN, United States
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Bossi P, Cortinovis D, Fatigoni S, Cossu Rocca M, Fabi A, Seminara P, Ripamonti C, Alfieri S, Granata R, Bergamini C, Agustoni F, Bidoli P, Nolè F, Pessi MA, Macchi F, Michellini L, Montanaro F, Roila F. A randomized, double-blind, placebo-controlled, multicenter study of a ginger extract in the management of chemotherapy-induced nausea and vomiting (CINV) in patients receiving high-dose cisplatin. Ann Oncol 2017; 28:2547-2551. [PMID: 28666335 DOI: 10.1093/annonc/mdx315] [Citation(s) in RCA: 30] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The activity of ginger in the management of chemotherapy-induced nausea and vomiting (CINV) has been suggested, but design inadequacies, heterogeneity of the population, small numbers and poor quality of tested products limit the possibility to offer generalizable results. PATIENTS AND METHODS We conducted a randomized, double-blind, placebo-controlled, multicenter study in patients planned to receive ≥2 chemotherapy cycles with high dose (>50 mg/m2) cisplatin. Patients received ginger 160 mg/day (with standardized dose of bioactive compounds) or placebo in addition to the standard antiemetic prophylaxis for CINV, starting from the day after cisplatin administration. CINV was assessed through daily visual-analogue scale and Functional Living Index Emesis questionnaires. The main objective was protection from delayed nausea; secondary end points included intercycle nausea and nausea anticipatory symptoms. RESULTS In total, 121 patients received ginger and 123 placebo. Lung (49%) and head and neck cancer (HNC; 35%) were the most represented tumors. No differences were reported in terms of safety profile or compliance. The incidence of delayed, intercycle and anticipatory nausea did not differ between the two arms in the first cycle and second cycle. A benefit of ginger over placebo in Functional Living Index Emesis nausea score differences (day 6-day 1) was identified for females (P = 0.048) and HNC patients (P = 0.038). CONCLUSIONS In patients treated with high-dose cisplatin, the daily addition of ginger, even if safe, did not result in a protective effect on CINV. The favorable effect observed on nausea in subgroups at particular risk of nausea (females; HNC) deserves specific investigation.
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Affiliation(s)
- P Bossi
- Head and Neck Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Scientific Direction, Latis Cro, Genova, Milano;.
| | | | - S Fatigoni
- Medical Oncology, Ospedale Santa Maria, Terni
| | - M Cossu Rocca
- Medical Oncology, Istituto Europeo di Oncologia, Milano
| | - A Fabi
- Medical Oncology, Istituto Nazionale Regina Elena, Roma
| | - P Seminara
- Medical Oncology, Università Sapienza, Roma
| | | | - S Alfieri
- Head and Neck Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Scientific Direction, Latis Cro, Genova, Milano
| | - R Granata
- Head and Neck Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Scientific Direction, Latis Cro, Genova, Milano
| | - C Bergamini
- Head and Neck Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Scientific Direction, Latis Cro, Genova, Milano
| | - F Agustoni
- Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - P Bidoli
- Medical Oncology, Ospedale San Gerardo, Monza
| | - F Nolè
- Medical Oncology, Istituto Europeo di Oncologia, Milano
| | | | - F Macchi
- Scientific & Clinical Development, Helsinn Integrative Care, Lugano, Switzerland
| | | | - F Montanaro
- Statistical Department, Latis Cro, Genova, Italy
| | - F Roila
- Medical Oncology, Ospedale Santa Maria, Terni
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