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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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2
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Abstract
The incidence of secondary malignancies following chemotherapy is progressively increasing, mostly due to prolonged survival of patients treated for primary cancer. So far, only 3 cases of solid cancer following busulphan administration have been reported. We describe the case of a patient who developed a renal cancer after 4 years of busulphan treatment for chronic myeloid leukemia. Immunosuppression rather than mutagenesis seems to be responsible for the emergence of second solid cancers in patients receiving busulphan.
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Affiliation(s)
- A Iurlo
- Istituto di Scienze Mediche, Padiglione Granelli, Università degli Studi, Milan, Italy
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3
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4
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Abstract
In a series of 59 patients with chronic or acute myelogenous leukemia (CML, AML) we investigated whether circulating immunoreactive human calcitonin (i-hCT) levels correlate with diagnosis, response to therapy and clinical course. I-hCT was detectable in plasma samples of 88% of patients with CML in the chronic phase and in 100% of patients with CML in blastic transformation. In the AML patients, a significant relation was observed between the cytological subtype and i-hCT levels at diagnosis. In sequentially studied patients the i-hCT plasma concentration was related to the overall mass of leukemic cells, being lower when complete remission was achieved than at diagnosis and increasing at time of recurrence. These data suggest that circulating i-hCT levels can serve as a “tumor marker” in human myelogenous leukemias.
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MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Biomarkers, Tumor/blood
- Calcitonin/blood
- Female
- Humans
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/blood
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/diagnosis
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/therapy
- Leukemia, Myeloid, Acute/blood
- Leukemia, Myeloid, Acute/diagnosis
- Leukemia, Myeloid, Acute/therapy
- Male
- Middle Aged
- Prognosis
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Affiliation(s)
- P Foa
- Institute of Medical Sciences, University of Milano, Italy
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5
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Foa P, Fornier M, Miceli R, Seregni E, Santambrogio L, Nosotti M, Massaron S, Cataldo I, Oldani S, Iurlo A, Caldiera S, Bombardieri E. Preoperative CEA, NSE, SCC, TPA and CYFRA 21.1 Serum Levels as Prognostic Indicators in Resected Non-Small Cell Lung Cancer. Int J Biol Markers 2018; 14:92-8. [PMID: 10399628 DOI: 10.1177/172460089901400206] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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
In 62 patients affected by resectable non-small cell lung cancer (NSCLC) submitted to radical surgery we evaluated the prognostic significance of CEA, NSE, SCC, TPA and CYFRA 21.1 serum levels at diagnosis, as well as the predictive ability of these tumor markers with respect to histological type and pathological stage. The group was composed of 56 male and 6 female patients; the median age was 62 years (range 29–73 years). Thirty-four patients had a histological diagnosis of adenocarcinoma and 28 of squamous cell carcinoma; with regard to pathological stage, 32 patients had stage I, 4 patients stage II and 23 patients stage IIIA disease. A good predictive ability with respect to histological type was obtained with SCC serum levels; as for pathological stage, TPA and CYFRA 21.1 were found to have moderate predictive ability. In this series of patients, at a median follow-up of 55 months after surgery, we found that both TPA and CYFRA 21.1 serum levels at diagnosis were reliable predictors of overall survival, high values of these markers being associated with a worse prognosis.
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Affiliation(s)
- P Foa
- Istituto di Scienze Mediche, Università degli Studi, Milano, Italy
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6
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Ferrari D, Codecà C, Viale G, Bocci B, Broggio F, Crepaldi F, Violati M, Luciani A, Bauer D, Moneghini L, Bulfamante G, Foa P. An unusual case of tracheo-pleural fistula and cardiac metastases in oropharyngeal carcinoma: a case report and review of the literature. Cancers Head Neck 2016; 1:16. [PMID: 31093345 PMCID: PMC6460740 DOI: 10.1186/s41199-016-0018-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 11/21/2016] [Indexed: 01/03/2023]
Abstract
Background Oropharyngeal cancer is frequently associated with human papilloma virus, that also represents a strong prognostic factor. Local relaps and treatment-related complications are frequent, whereas distant metastases occur in about 25% of patients. Case presentation A 49 years-old male presented with a loco-regionally advanced oropharyngeal squamous cell carcinoma and was treated with concomitant chemoradiation. A complete clinical and pathological response was achieved, but the occurrence of necrotising tracheo-esophagitis, with tracheo-mediastino-pleural fistula formation, further complicated the subsequent clinical course. The patient died suddenly. Autopsy revealed multiple myocardial and epicardial metastases from oropharyngeal squamous cell carcinoma. Conclusions Even in case of a transient complete local response, the potential occurrence of severe complications and distant metastases, although infrequent, should be considered. Cardiac metastases are frequently underestimated, as they are often asymptomatic, but may lead to sudden death. Further efforts are needed to improve diagnosis and therapy in this setting.
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Affiliation(s)
- Daris Ferrari
- 1Medical Oncology, San Paolo Hospital, Milan, Italy.,5San Paolo Hospital, via Di Rudinì 8, 20142 Milan, Italy
| | - Carla Codecà
- 1Medical Oncology, San Paolo Hospital, Milan, Italy
| | - Giulia Viale
- 1Medical Oncology, San Paolo Hospital, Milan, Italy
| | | | | | | | | | | | - Dario Bauer
- 2Division of Pathology, San Paolo Hospital, University of Milan Medical School, Milan, Italy
| | - Laura Moneghini
- 2Division of Pathology, San Paolo Hospital, University of Milan Medical School, Milan, Italy
| | - Gaetano Bulfamante
- 3Department of Medicine, Surgery and Dentistry, Division of Pathology, San Paolo Hospital, University of Milan Medical School, Milan, Italy
| | - Paolo Foa
- 4Department of Oncology, Medical Oncology, San Paolo Hospital, University of Milan Medical School, Milan, Italy
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7
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Crepaldi F, Bocci B, Blasi M, Careri C, Patanè D, Viale G, Violati M, Bordin V, Codecà C, Moro A, Foa P, Santambrogio R, Ferrari D. Primary hepatic lymphoma: a monoinstitutional experience. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw345.49] [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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8
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Ferrari D, Codecà C, Bocci B, Crepaldi F, Careri C, Blasi M, Patanè D, Viale G, Violati M, Bordin V, Caldiera S, Luciani A, Zonato S, Foa P. Radiotherapy and cetuximab for elderly patients affected by loco-regionally advanced head and neck cancer. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw340.12] [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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9
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Broggio F, Crepaldi F, Bocci B, Violati M, Battisti N, Careri C, Caldiera S, Codecà C, Bordin V, Luciani A, Zonato S, Cassinelli G, Foa P, Ferrari D. Role of PET/TC in the pre-surgery staging of oral cavity cancers. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv342.07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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10
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Ferrari D, Bossi E, Carta T, Cecco L, Coraci G, Marino S, Ressa A, Rocchetti D, Zamparelli G, Ceresa M, Lovati R, Foa P. Taking care for the patients from hospital discharge to home assistance: 5-year experience from a single Institution. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv346.08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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11
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Bocci B, Broggio F, Crepaldi F, Violati M, Battisti N, Careri C, Bordin V, Caldiera S, Codecà C, Luciani A, Zonato S, Cassinelli G, Foa P, Ferrari D. Intensity-modulated radiotherapy and cetuximab for frail patients with loco-regionally advanced head and neck cancer. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv342.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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12
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Crepaldi F, Broggio F, Bocci B, Careri C, Battisti N, Violati M, Bordin V, Caldiera S, Codecà C, Luciani A, Zonato S, Cassinelli G, Foa P, Ferrari D. Concordance of PET/CT and bone marrow biopsy in lymphoma staging. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv348.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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13
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Luciani A, Biganzoli L, Colloca G, Falci C, Castagneto B, Floriani I, Battisti N, Dottorini L, Ferrari D, Fiduccia P, Zafarana E, Del Monte F, Galli F, Monfardini S, Foa P. Estimating the risk of chemotherapy toxicity in older patients with cancer: The role of the Vulnerable Elders Survey-13 (VES-13). J Geriatr Oncol 2015; 6:272-9. [PMID: 26088748 DOI: 10.1016/j.jgo.2015.02.005] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2014] [Revised: 02/17/2015] [Accepted: 02/20/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Some parameters of the Comprehensive Geriatric Assessment (CGA) are predictive of chemotherapy toxicity. The Vulnerable Elders Survey-13 (VES-13) is a short instrument that has been tested as a means of identifying patients who need a full CGA, but its ability to predict chemotherapy toxicity is still unclear. We performed a pooled analysis of four published clinical trials studying VES-13 as a means of diagnosing vulnerability, in order to evaluate its accuracy in predicting the risk of grade 3/4 toxicity in older patients undergoing chemotherapy. MATERIALS AND METHODS The study involved patients aged ≥ 66 years with a diagnosis of solid or hematological cancer, all of whom were administered VES-13. The number of medications taken by each patient, their comorbidities, their Cumulative Illness Rating Scale for Geriatrics (CIRS-G) score and index, the type of chemotherapy and treatment line, and their Mini Mental State Evaluation (MMSE), and Mini Nutritional Assessment (MNA) scores were recorded. Information was available concerning the grades 3-4 hematological and non-hematological toxicities experienced by each patient. RESULTS The study involved 648 patients aged ≥ 66 years (mean age 76.2±4.5, range 66-90) of whom 336 (51.9%) were female. VES-13 identified 287 patients (44.3%) as vulnerable. Grades 3-4 hematological and non-hematological toxicities were more prevalent in the vulnerable subjects (35.2% vs 20.8%, p<0.0001, and 18.5% vs 10.8%, p=0.0055), who were also at higher risk of both (adjusted ORs 2.15, 95% CI 1.46-3.17, p<0.001); and 1.66 (95% CI 1.02-2.72, p=0.043). CONCLUSIONS VES-13 could be considered to be a good candidate for future prospective studies to assess older patients with cancer at risk of toxicity.
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Affiliation(s)
- Andrea Luciani
- Department of Oncology, San Paolo Hospital, Milan, Italy.
| | - Laura Biganzoli
- Sandro Pitigliani Medical Oncology Unit, Hospital of Prato, Prato, Italy
| | - Giuseppe Colloca
- Aging and Medicine Centre, Università Cattolica Sacro Cuore, Rome, Italy
| | - Cristina Falci
- Department of Oncology, Istituto Oncologico, Veneto, Padua, Italy
| | | | - Irene Floriani
- Department of Oncology, IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy
| | | | | | - Daris Ferrari
- Department of Oncology, San Paolo Hospital, Milan, Italy
| | | | - Elena Zafarana
- Sandro Pitigliani Medical Oncology Unit, Hospital of Prato, Prato, Italy
| | | | - Francesca Galli
- Department of Oncology, IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy
| | | | - Paolo Foa
- Department of Oncology, San Paolo Hospital, Milan, Italy
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14
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Luciani A, Brunello A, Battisti N, Romanato G, Caldiera S, Bergamo F, Roma A, Zagonel V, Foa P. The assessment of chemotherapy risk in elderly cancer patients: Validation of the CRASH score in an Italian cohort. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.e20521] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Antonella Brunello
- Medical Oncology 1, Istituto Oncologico Veneto IOV - IRCCS, Padova, Italy
| | | | - Giovanna Romanato
- Department of Medical and Surgical Sciences, University of Padova, Padova, Italy
| | | | - Francesca Bergamo
- Oncologia Medica I, Istituto Oncologico Veneto, IRCCS, Padova, Italy
| | - Anna Roma
- U.O. Oncologia Medica 1, Istituto Oncologico Veneto - IRCCS, Padova, Italy
| | - Vittorina Zagonel
- Department of Clinical and Experimental Oncology, Medical Oncology 1, Veneto Institute of Oncology-IRCCS, Padua, Italy
| | - Paolo Foa
- Azienda Ospedaliera San Paolo, Milan, Italy
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15
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Ghi CM, Paccagnella A, Ferrari D, Foa P, Cossu Rocca M, Verri E, Morelli F, Azzarello G, D'Ambrosio C, Casanova C, Guaraldi M, Massa E, Rossetto C, Bonetti A, Siena S, Frattegiani A, Koussis H, Pieri G, Gava A, Floriani I. OC-006: Concomitant treatment (CRT or cetuximab/RT) with or without induction TPF in Locally Advanced head and neck. Radiother Oncol 2015. [DOI: 10.1016/s0167-8140(15)34766-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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16
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Santoro A, Gebbia V, Pressiani T, Testa A, Personeni N, Arrivas Bajardi E, Foa P, Buonadonna A, Bencardino K, Barone C, Ferrari D, Zaniboni A, Tronconi MC, Cartenì G, Milella M, Comandone A, Ferrari S, Rimassa L. A randomized, multicenter, phase II study of vandetanib monotherapy versus vandetanib in combination with gemcitabine versus gemcitabine plus placebo in subjects with advanced biliary tract cancer: the VanGogh study. Ann Oncol 2014; 26:542-7. [PMID: 25538178 DOI: 10.1093/annonc/mdu576] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND The management of biliary tract cancers (BTCs) is complex due to limited data on the optimal therapeutic approach. This phase II multicenter study evaluated the efficacy and tolerability of vandetanib monotherapy compared with vandetanib plus gemcitabine or gemcitabine plus placebo in patients with advanced BTC. PATIENTS AND METHODS Patients were randomized in a 1 : 1 : 1 ratio to three treatment groups: vandetanib 300 mg monotherapy (V), vandetanib 100 mg plus gemcitabine (V/G), gemcitabine plus placebo (G/P). Vandetanib (300 mg or 100 mg) or placebo was given in single oral daily doses. Gemcitabine 1000 mg/m(2) was i.v. infused on day 1 and day 8 of each 21-day cycle. The primary end point was progression-free survival (PFS). Secondary end points were: objective response rate (ORR), disease control rate, overall survival, duration of response, performance status and safety outcomes. RESULTS A total of 173 patients (mean age 63.6 years) were recruited at 19 centers across Italy. Median (95% confidence intervals) PFS (days) were 105 (72-155), 114 (91-193) and 148 (71-225), respectively, for the V, V/G and G/P treatment groups, with no statistical difference among them (P = 0.18). No statistical difference between treatments was observed for secondary end points, except ORR, which slightly favored the V/G combination over other treatments. The proportion of patients reporting adverse events (AEs) was similar for the three groups (96.6% in V arm, 91.4% in the V/G arm and 89.3% in the G/P arm). CONCLUSIONS Vandetanib treatment did not improve PFS in patients with advanced BTC. The safety profile of vandetanib did not show any additional AEs or worsening of already known AEs. CLINICAL TRIAL NUMBER NCT00753675.
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Affiliation(s)
- A Santoro
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, Humanitas Clinical and Research Center, Milan
| | - V Gebbia
- Department of Medical Oncology, Nursing Home 'La Maddalena', Palermo
| | - T Pressiani
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, Humanitas Clinical and Research Center, Milan
| | - A Testa
- Department of Medical Oncology, Nursing Home 'La Maddalena', Palermo
| | - N Personeni
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, Humanitas Clinical and Research Center, Milan
| | - E Arrivas Bajardi
- Department of Medical Oncology, Nursing Home 'La Maddalena', Palermo
| | - P Foa
- Department of Medical Oncology, 'San Paolo' University Hospital, Milan
| | | | - K Bencardino
- Niguarda Cancer Center, Ospedale Niguarda Ca' Granda, Milan
| | - C Barone
- Department of Medical Oncology, Università Cattolica del S. Cuore, Rome
| | - D Ferrari
- Department of Medical Oncology, 'San Paolo' University Hospital, Milan
| | - A Zaniboni
- Department of Oncology, 'Poliambulanza' Foundation, Brescia
| | - M C Tronconi
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, Humanitas Clinical and Research Center, Milan
| | - G Cartenì
- Department of Oncology, Cardarelli Hospital, Naples
| | - M Milella
- Medical Oncology A, Regina Elena National Cancer Institute, Rome
| | - A Comandone
- Department of Oncology, Gradenigo Hospital, Turin
| | - S Ferrari
- Oncology Unit, AstraZeneca, Basiglio, Italy
| | - L Rimassa
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, Humanitas Clinical and Research Center, Milan
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17
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Carreca IU, D'alia P, Bronte G, Bazan V, Cova D, Foa P, Russo A. Eribulin (E) and capecitabine (C), a combined treatment schedule in elderly metastatic breast cancer (EMBC): Efficacy and safety evaluation (E&S). J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.e20513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Ignazio Ugo Carreca
- Section of Oncology, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | | | - Giuseppe Bronte
- Section of Oncology, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Viviana Bazan
- Section of Oncology, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Dario Cova
- Medical Oncology Unit - Pio Albergo Trivulzio, Milan, Italy
| | - Paolo Foa
- Medical Oncology, San Paolo Hospital, Milano, Italy
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Rimassa L, Bozzarelli S, Zaniboni A, Foa P, Carnaghi C, Passalacqua R, Ramello M, Di Tommaso L, Giordano L, Santoro A. ONC-2012-001: A single-arm phase II study of tivantinib (ARQ 197) plus cetuximab in EGFR inhibitor-resistant MET high patients (pts) with locally advanced or metastatic colorectal cancer (CRC) with wild-type KRAS. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.tps3661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Lorenza Rimassa
- Humanitas Cancer Center, Humanitas Clinical and Research Hospital, Rozzano, Italy
| | - Silvia Bozzarelli
- Humanitas Cancer Center, Humanitas Clinical and Research Hospital, Rozzano, Italy
| | - Alberto Zaniboni
- U.O. Oncologia Medica, Casa di Cura Poliambulanza, Brescia, Italy
| | - Paolo Foa
- Medical Oncology, San Paolo Hospital, Milano, Italy
| | | | | | | | - Luca Di Tommaso
- Department of Pathology, IRCCS Humanitas Clinical Institute and University of Milan School of Medicine, Rozzano, Italy
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Ghi MG, Paccagnella A, Ferrari D, Foa P, Cossu Rocca M, Verri E, Morelli F, Azzarello G, D'Ambrosio C, Cruciani G, Guaraldi M, Massa E, Rossetto C, Bonetti A, Siena S, Minotti V, Koussis H, Pieri G, Baggio V, Floriani I. Concomitant chemoradiation (CRT) or cetuximab/RT (CET/RT) versus induction Docetaxel/ Cisplatin/5-Fluorouracil (TPF) followed by CRT or CET/RT in patients with Locally Advanced Squamous Cell Carcinoma of Head and Neck (LASCCHN). A randomized phase III factorial study (NCT01086826). J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.6004] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | - Daris Ferrari
- Medical Oncology Unit, San Paolo Hospital, Milan, Italy
| | - Paolo Foa
- Medical Oncology, San Paolo Hospital, Milano, Italy
| | - Maria Cossu Rocca
- Medical Oncology Unit of Urogenital and Head and Neck Tumors- European Institute of Oncology, Milano, Italy
| | - Elena Verri
- Medical Oncology Unit of Urogenital and Head and Neck Tumors- European Institute of Oncology, Milano, Italy
| | - Franco Morelli
- U.O.C. Oncologia, IRCCS Caa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Giuseppe Azzarello
- Department of Internal Medical Sciences,Oncology Unit ASL 13, Mirano, Italy
| | | | | | - Monica Guaraldi
- Medical Oncology Department, Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | - Elena Massa
- Dipartimento di Scienze Mediche Internistiche, Cagliari, Italy
| | - Ciro Rossetto
- Department of Oncology University Hospital - Udine, Udine, Italy
| | - Andrea Bonetti
- Department of Oncology, Mater Salutis Hospital-AULSS 21 della Regione Veneto, Legnago, Italy
| | | | - Vincenzo Minotti
- Division of Medical Oncology, Azienda Ospedaliera, Perugia, Italy
| | | | - Gabriella Pieri
- Oncology Department, Oncology Unit, Ospedali Riuniti di Trieste, Trieste, Italy
| | - Vittorio Baggio
- Division of Medical Oncology, Ospedale Cà Foncello, Treviso, Italy
| | - Irene Floriani
- Laboratory of Clinical Trials, Oncology Department, Istituto di Ricerche Farmacologiche, Milano, Italy
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Ghi MG, Paccagnella A, Ferrari D, Foa P, Cossu Rocca M, Verri E, Maiello E, Azzarello G, D'Ambrosio C, Casanova C, Guaraldi M, Mantovani G, Rossetto C, Bonetti A, Cipani T, Crino L, Koussis H, Pieri G, Gava A, Floriani I. A phase II-III study comparing concomitant chemoradiotherapy (CRT) versus cetuximab/RT (CET/RT) with or without induction docetaxel/cisplatin/5-fluorouracil (TPF) in locally advanced head and neck squamous cell carcinoma (LASCCHN): Efficacy results (NCT01086826). J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.6003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [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
6003 Background: This is the first phase III study directly comparing CRT vs CET/RT in LASCCHN. Primary endpoints of this study were to compare: 1) overall survival (OS) of induction vs. no induction arms; 2) Grade 3-4 in-field toxicity of CRT vs. CET/RT. Preliminary toxicity results of concomitant treatments (primary endpoint for this comparison) were reported at the 2012 ASCO meeting. Here we present response rate and survival data for the two concomitant treatments (CRT vs. CET/RT), irrespective of induction chemotherapy. Methods: Untreated patients with unresectable LASCCHN, stage III-IV, ECOG PS 0–1 were randomized to a 2x2 factorial design: Arm A1: CRT (2 cycles of cisplatin/5fluorouracil concomitant to RT); Arm A2: CET/RT; Arm B1: 3 cycles of TPF followed by the same CRT; Arm B2:3 cycles of TPF followed by CET/RT. Results: A total of421 patients were randomized: 261 received CRT (131 Arm A1+ 130 Arm B1) and 160 received CET/RT (80 Arm A2+ 80 Arm B2). 82% were male; median age was 60y; PS of 0 (79%) or 1 (21%). Stage was III (32%) or IV (68%). Sites of disease were: oral cavity 20%, oropharynx 57%, hypopharynx: 23%. No significant differences were observed in patients’ characteristics distribution. At a median follow-up of 32.9 months, a total of 174 deaths occurred (204 required for final OS analysis). Data on activity and efficacy of CRT and CET/RT are shown in the Table. Conclusions: No significant differences were observed in response rate, progression free survival and OS between CRT and CET/RT. Pts are still being followed-up to assess OS of induction vs. no induction arms. Clinical trial information: NCT01086826. [Table: see text]
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Affiliation(s)
| | | | | | - Paolo Foa
- Medical Oncology, San Paolo Hospital, Milano, Italy
| | | | - Elena Verri
- European Institute of Oncology, Milano, Italy
| | - Evaristo Maiello
- IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Giuseppe Azzarello
- Department of Internal Medical Sciences,Oncology Unit ASL 13, Mirano, Italy
| | | | | | - Monica Guaraldi
- Medical Oncology Department, Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | | | - Ciro Rossetto
- Department of Oncology University Hospital, Udine, Italy
| | - Andrea Bonetti
- Department of Oncology, Mater Salutis Hospital-AULSS 21 della Regione Veneto, Legnago, Italy
| | - Tiziana Cipani
- Department of Oncology, Ospedale Niguarda Ca' Granda, Milano, Italy
| | - Lucio Crino
- Medical Oncology, S. Maria della Misericordia Hospital, Perugia, Italy
| | | | - Gabriella Pieri
- Oncology Department, Oncology Unit, Ospedali Riuniti di Trieste, Trieste, Italy
| | - Alessandro Gava
- Radiotherapy Department, Ospedale Ca' Foncello, Treviso, Italy
| | - Irene Floriani
- Laboratory of Clinical Trials, Oncology Department, Istituto di Ricerche Farmacologiche, Milano, Italy
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21
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Rimassa L, Pressiani T, Boni C, Carnaghi C, Rota Caremoli E, Fagiuoli S, Foa P, Salvagni S, Cortesi E, Chiara Tronconi M, Personeni N, Bozzarelli S, Chiara Banzi M, Fanello S, Romano Lutman F, Giordano L, Santoro A. A phase II randomized dose escalation trial of sorafenib in patients with advanced hepatocellular carcinoma. Oncologist 2013. [PMID: 23580239 DOI: 10.1634/theoncologist] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Sorafenib has proven survival benefits in patients with advanced hepatocellular carcinoma (HCC). The viability of continuing sorafenib at a higher dosage in patients who experienced radiologic disease progression was investigated. METHODS Patients who experienced disease progression while on sorafenib 400 mg twice daily were randomized to sorafenib 600 mg twice daily (n = 49) or best supportive care (n = 52). The primary end point was progression-free survival (PFS). Time to progression, overall survival, and safety were also evaluated. RESULTS The study did not meet its primary end point. The difference in PFS between the sorafenib arm (3.91 months) and the best supportive care arm (2.69 months) did not reach statistical significance (p = 0.086). Adverse events were mainly grade 1-2 and similar across both groups. In the sorafenib arm, the most frequent events were diarrhea (80%), weight loss (75%), fatigue (67%), hand-foot-skin reaction (49%), abdominal pain (37%), and stomatitis (26%). CONCLUSIONS Escalated-dose sorafenib in patients with advanced HCC who progressed while on sorafenib, failed to provide any clinical benefit. Second-line treatment still remains an open issue to be explored in appropriate clinical trials.
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Affiliation(s)
- Lorenza Rimassa
- Medical Oncology and Hematology Unit, Cancer Center, Humanitas Clinical and Research Center, Rozzano, Milan, Italy.
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22
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Rimassa L, Pressiani T, Boni C, Carnaghi C, Rota Caremoli E, Fagiuoli S, Foa P, Salvagni S, Cortesi E, Chiara Tronconi M, Personeni N, Bozzarelli S, Chiara Banzi M, Fanello S, Romano Lutman F, Giordano L, Santoro A. A phase II randomized dose escalation trial of sorafenib in patients with advanced hepatocellular carcinoma. Oncologist 2013; 18:379-80. [PMID: 23580239 DOI: 10.1634/theoncologist.2012-0221] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Sorafenib has proven survival benefits in patients with advanced hepatocellular carcinoma (HCC). The viability of continuing sorafenib at a higher dosage in patients who experienced radiologic disease progression was investigated. METHODS Patients who experienced disease progression while on sorafenib 400 mg twice daily were randomized to sorafenib 600 mg twice daily (n = 49) or best supportive care (n = 52). The primary end point was progression-free survival (PFS). Time to progression, overall survival, and safety were also evaluated. RESULTS The study did not meet its primary end point. The difference in PFS between the sorafenib arm (3.91 months) and the best supportive care arm (2.69 months) did not reach statistical significance (p = 0.086). Adverse events were mainly grade 1-2 and similar across both groups. In the sorafenib arm, the most frequent events were diarrhea (80%), weight loss (75%), fatigue (67%), hand-foot-skin reaction (49%), abdominal pain (37%), and stomatitis (26%). CONCLUSIONS Escalated-dose sorafenib in patients with advanced HCC who progressed while on sorafenib, failed to provide any clinical benefit. Second-line treatment still remains an open issue to be explored in appropriate clinical trials.
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Affiliation(s)
- Lorenza Rimassa
- Medical Oncology and Hematology Unit, Cancer Center, Humanitas Clinical and Research Center, Rozzano, Milan, Italy.
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23
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Luciani A, Dottorini L, Battisti N, Bertuzzi C, Caldiera S, Floriani I, Zonato S, Ferrari D, Foa P. Screening elderly cancer patients for disabilities: evaluation of study of osteoporotic fractures (SOF) index and comprehensive geriatric assessment (CGA). Ann Oncol 2013; 24:469-474. [PMID: 23041592 DOI: 10.1093/annonc/mds471] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [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: 10/07/2023] Open
Abstract
BACKGROUND Comprehensive geriatric assessment (CGA) is a multidimensional tool aimed at detecting multiple age-related problems; the study of osteoporotic fractures (SOF) index is a 3-item instrument designed to measure frailty and pre-frailty status. The aim of this prospective cohort study was to evaluate the accuracy of the SOF index and CGA in predicting the disability status in elderly cancer patients. PATIENTS AND METHODS Patients aged ≥ 70 years with a confirmed diagnosis of a solid or hematologic tumor underwent both CGA and SOF assessment. The sensitivity and specificity of SOF in determining the presence of frailty were analyzed using the CGA as the reference standard. The diagnostic accuracy of SOF < 80% was considered not acceptable. RESULTS The study involved 400 patients aged ≥ 70 years (median age 77.2, range 70-97).The SOF and CGA classified, respectively, 33.2% and 31.8% of patients as fit, 67.8% and 68.2% as unfit. The SOF showed a sensibility and a specificity of 89.0 [95% confidence interval (CI) 84.7-92.5] and 81.1 (73.2-87.5) with an accuracy of 86.5 (82.8-89.7). The negative predictive value (NPV) was 103/133, i.e. 77.4% (95% CI 69.4-84.2). CONCLUSIONS As the SOF proved to reach the end-point of our study, we support its use as a means of screening elderly cancer patients in everyday clinical practice.
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Affiliation(s)
- A Luciani
- Department of Oncology, San Paolo Hospital, Milan; Department of Medicine, Surgery and Dentistry, University of Milan, Milan.
| | - L Dottorini
- Department of Oncology, San Paolo Hospital, Milan; Department of Medicine, Surgery and Dentistry, University of Milan, Milan
| | - N Battisti
- Department of Oncology, San Paolo Hospital, Milan; Department of Medicine, Surgery and Dentistry, University of Milan, Milan
| | - C Bertuzzi
- Department of Oncology, San Paolo Hospital, Milan; Department of Medicine, Surgery and Dentistry, University of Milan, Milan
| | - S Caldiera
- Department of Oncology, San Paolo Hospital, Milan; Department of Medicine, Surgery and Dentistry, University of Milan, Milan
| | - I Floriani
- Laboratory of Clinical Trial, Istituto di Ricerche Farmacologiche 'Mario Negri', Milan, Italy
| | - S Zonato
- Department of Oncology, San Paolo Hospital, Milan; Department of Medicine, Surgery and Dentistry, University of Milan, Milan
| | - D Ferrari
- Department of Oncology, San Paolo Hospital, Milan; Department of Medicine, Surgery and Dentistry, University of Milan, Milan
| | - P Foa
- Department of Oncology, San Paolo Hospital, Milan; Department of Medicine, Surgery and Dentistry, University of Milan, Milan
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Seregni E, Foa P, Bogni A, Botti C, Cataldo I, Sala M, Mezzetti M, Gasparini M, Santambrogio L, Legnani D, Bombardieri E. Evaluation of the soluble fragments of cytokeratin 19 (CK19) in non-small cell lung cancer (NSCLC). Oncol Rep 2012; 3:95-101. [PMID: 21594322 DOI: 10.3892/or.3.1.95] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
This study compared the diagnostic efficacy of serum CK19 determination (Cyfra 21-1) with other tumour markers, such as CEA, SCC, NSE, TPA, in patients with resected non-small lung cancer. Tumour marker levels were tested in 90 patients with benign lung disease and at diagnosis in 72 patients with proven NSCLC, 39 squamous cell carcinoma and 33 adenocarcinoma. At presentation baseline levels of all tumor markers were significantly higher (p<0.05) in lung cancer patients than in control subjects, except for NSE. A significant increase (p<0.05) in serum concentrations was observed from stage I to stage IIIb only for Cyfra 21-1 (stage I/II, median=2.7 ng/ml; stage IIIb, median=6.3 ng/ml) and TPA (stage I/II, median=89.8 IU/ml; stage IIIb, median=170.7 IU/ml). Receiver operating characteristic (ROC) analysis was performed to evaluate the best threshold values and the global accuracy of each marker. The highest global sensitivity for NSCLC was reached by TPA (70.8%), whereas that of Cyfra 21-1 was 50%. According to tumour histology, significant difference (p<0.05) in serum levels were found only for CEA (adenocarcinomas, median=5.6 ng/ml; squamous cell carcinoma, median=3.2 ng/ml) and SCC (adenocarcinomas, median=1.0 ng/ml; squamous cell carcinoma, median=1.5 ng/ml). As regards squamous cell carcinoma histotype, the highest sensitivity was obtained by TPA (74.4% at a specificity of 62.2%) and for adenocarcinomas by CEA (78.8% at a specificity of 85.6%). Tumour marker levels were also determined during the follow-up of 10 patients. The best sensitivity in detecting relapses was shown by CEA (90%), followed by TPA (70%), SCC (50%), Cyfra 21-1 (40%) and NSE (10%), even though the CEA test displayed a high percentage of false positive results (98.1%) in patients with no evidence of disease (NED).
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Affiliation(s)
- E Seregni
- IST NAZL STUDIO & CURA TUMORI,DIV NUCL MED,MILAN,ITALY. UNIV MILAN,IST SCI MED,MILAN,ITALY. IST NAZL STUDIO & CURA TUMORI,DIV ONCOL CHIRURG TORACICA,MILAN,ITALY. ICP,CTR TRANSFUS CLIN MANGIAGALLI,MILAN,ITALY. UNIV MILAN,CATTEDRA CHIRURG GEN & TORACICA,MILAN,ITALY. UNIV MILAN,IST MALATTIE RESP,MILAN,ITALY
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Carreca I, Castagneto B, Condemi G, Foa P, Gambardella A, Cova D. Sorafenib (SFB) flat dose (FD) in frail elderly patients (FEPts) with Child–Pugh Advanced Hepatocellular Carcinoma (AHCC): Two year. J Geriatr Oncol 2012. [DOI: 10.1016/j.jgo.2012.10.075] [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: 11/24/2022]
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Ferrari D, Codecà C, Bertuzzi C, Broggio F, Crepaldi F, Luciani A, Floriani I, Ansarin M, Chiesa F, Alterio D, Foa P. Role of plasma EBV DNA levels in predicting recurrence of nasopharyngeal carcinoma in a Western population. BMC Cancer 2012; 12:208. [PMID: 22646734 PMCID: PMC3443044 DOI: 10.1186/1471-2407-12-208] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2011] [Accepted: 05/16/2012] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Loco-regionally advanced nasopharyngeal carcinomas can be cured by the combination of chemotherapy and radiotherapy. In Eastern countries, plasma levels of viral Epstein-Barr deoxyribonucleic acid (DNA) are accurate in predicting recurrence, but few data are available in Western populations. The aim of this prospective study was to evaluate the relationship between viral Epstein-Barr DNA copy numbers in plasma and the response rate, progression-free survival and overall survival in a cohort of Western patients with stage IIb-IVb nasopharyngeal cancer. METHODS We evaluated plasma samples from 36 consecutive patients treated with induction chemotherapy followed by chemoradiation. EBV copy numbers were determined after DNA extraction using real-time quantitative polymerase chain reaction. Survival curves were estimated using the Kaplan-Meier method. RESULTS Circulating Epstein-Barr virus DNA levels were measured before treatment, at the end of concomitant chemo- and radiotherapy, and during the follow-up period. Pre-treatment levels significantly correlated with the initial stage and probability of relapse. Their increase was 100% specific and 71.3% sensitive in detecting loco-regional or metastatic recurrence (an overall accuracy of 94.4%). Three-year progression-free and overall survival were respectively 78.2% and 97.1%. CONCLUSIONS The results of this study confirm that patients from a Western country affected by loco-regionally advanced nasopharyngeal carcinoma have high plasma Epstein-Barr virus DNA levels at diagnosis. The monitoring of plasma levels is sensitive and highly specific in detecting disease recurrence and metastases.
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Affiliation(s)
- Daris Ferrari
- Division of Medical Oncology and Department of Medicine, Surgery and Dentistry, San Paolo Hospital and University of Milan, Via Di Rudinì 8, Milan, Italy.
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Carreca IU, Piazza D, Castagneto B, Condemi G, Cova D, Gambardella A, Foa P. Sorafenib (SFB) treated elderly patients (E) with hepatocellular carcinoma (HCC): Chromogranine A (CGA) plus vascular endothelial growth factor (VEGF) as predicting factors (PF) of treatment outcome. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.e14676] [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
e14676 Background: HCC accounts for approximately 90% of all primary liver cancers, and is the fifth most common cancer in the world and prognosis is so far very poor,particularly in E patients.Between all tentative of treatment till know SFB seems to be the most promising drug in patients with advanced or metastatic HCC.Aim of the study is to investigate if SFB is efficient and safe also in E HCC patients despite the comorbidities and other problems. Objectives: To investigate if CgA and VEGF work as predicting factors of Sorafenib treatment outcomes. Methods: 51 patients, mean age 68,9 (65-85) with HCC were enrolled . Serum CgA, VEGF and αFP were evaluated at baseline and after end of treatment (SFB 400mg p.o. bid), until disease progression. Clinical response (RECIST), Comprehensive Geriatric Assessment and PFS were considered as well. Results: CgA mean value (baseline: 77.9 – after treatment: 26.25 UI/L) and VEGF levels (baseline: 67.3 – after treatment 47.2 pg/ml) seems to have a predictive role in clinical benefit. A correlation between lower values of CgA and VEGF was noted in pts with longer PFS. Furthermore 3-4 toxicity was not observed in these pts. OS median was 11 months. Conclusions: The most relevant data in this study refer to the role of serum CgA and VEGF levels, for prediction of tumor response. If these findings were confirmed in future largest studies, it could be sufficient to measure these markers levels for identification of those HCC patients who have more probability of obtaining clinical benefit from a sorafenib treatment.
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Affiliation(s)
- Ignazio Ugo Carreca
- Chair of Oncology and Oncogeriatric Unit-University of Palermo, Palermo, Italy
| | - Dario Piazza
- Medical Oncology Unit - University of Palermo, Italy, Palermo, Italy
| | | | | | - Dario Cova
- Medical Oncology Unit - Pio Albergo Trivulzio, Milan, Italy
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Stoehlmacher-Williams J, Villanueva C, Foa P, Rottey S, Winquist E, Licitra LF, Davidenko I, Skladowski KA, Tahara M, Faivre SJ, Oliner KS, Pan Z, Bach BA, Vermorken JB. Safety and efficacy of panitumumab (pmab) in HPV-positive (+) and HPV-negative (-) recurrent/metastatic squamous cell carcinoma of the head and neck (R/M SCCHN): Analysis of the global phase III SPECTRUM trial. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.5504] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [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
5504^ Background: SPECTRUM evaluated the safety and efficacy of pmab, a fully human monoclonal antibody against the epidermal growth factor receptor, with platinum‑based chemotherapy (CT) vs CT alone in patients (pts) with R/M SCCHN. This predefined analysis presents outcomes by tumor HPV status. Methods: All tumor samples were centrally reviewed. HPV status was determined using a validated immunohistochemistry assay to p16INK4A by an independent lab blinded to treatment assignments. Tumor samples were scored positive or negative according to prespecified criteria. Results: Of 657 enrolled pts (ITT), 443 (67%) had samples evaluable for HPV testing. Ninety‑nine (22%) tumors were HPV+ and 344 (78%) were HPV-. HPV+ rates varied by site (37% oropharynx, 19% larynx, 15% oral cavity, and 13% hypopharynx) and geographic region (44% N America, 22% W Europe, 21% Asia Pacific, 19% S America, and 18% E Europe). Demographics were generally balanced except pts with HPV+ vs HPV- tumors were more often non‑smokers (31% vs 14%), had oropharyngeal tumors (47% vs 23%), and had poorly differentiated tumors (30% vs 13%). Efficacy results are shown (Table). Adverse events were generally balanced between HPV+ and HPV- pts. Conclusions: Pts with HPV- R/M SCCHN administered pmab + CT had improved overall survival (OS) and progression‑free survival (PFS), whereas no improvement in OS or PFS was observed in pts with HPV+ tumors. [Table: see text]
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Affiliation(s)
| | | | - Paolo Foa
- San Paolo University Hospital, Milan, Italy
| | | | | | | | | | | | - Makoto Tahara
- National Cancer Center Hospital East, Kashiwa, Japan
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Gridelli C, Novello S, Zilembo N, Foa P, Favaretto AG, De Marinis F, Genestreti G, Crinò L, Grossi F, Caffo O, Ferraù F, Cruciani G, Brandes AA, Galetta D, Barni S, Fasola G, Siena S, Mari E, Iannacone C, Ciardiello F. Final results of a randomized, double-blind, phase II study of gemcitabine plus vandetanib or plus placebo in the treatment of advanced (stage IIIB/IV) non-small cell lung cancer (NSCLC) elderly patients (ZELIG study NCT00753714). J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.7550] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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
7550 Background: Vandetanib (V) is a once-daily oral inhibitor of VEGFR, EGFR and RET signaling. Single-agent gemcitabine (G) is a standard of care option for unselected patients (pts) unfit for doublet platinum based chemotherapy. This study assessed the progression-free survival (PFS) benefit of G+V compared to G plus placebo (P) in pts with advanced NSCLC aged ≥ 70 years. Methods: Eligible pts (stage IIIB/IV NSCLC; WHO PS 0-2; all histologies; chemonaïve, aged ≥70) were randomized 1:1 to receive G 1200 mg/m2 i.v. day 1 and 8 of each 21-day cycle, up to 6 cycles plus V 100 mg/day or plus P until progression/toxicity. The primary objective was PFS (80% power to detect a hazard ratio [HR] ≤ 0.667). Secondary endpoints included overall survival (OS), objective response rate (ORR), disease control rate (DCR), and safety. Results: Between Oct 2008-May 2010, 124 pts (median age 75 yrs (70-84); 72.6% male; 57.2% WHO PS 0-1; 74.2% past/never-smoker; 58.1% adenocarcinoma; 89.5% stage IV) were randomized to G+V (n = 61) or G+P (n = 63). Baseline characteristics were similar in both arms. At data cut-off (Apr11), 87.9% pts progressed and 73.4% pts had died. PFS was significantly prolonged for G+V (HR=0.729; 95% CI 0.484-1.096; p=0.0417), median PFS G+V=6.0 months, G+P=5.5 months. No differences were seen in ORR (14.8% and 12.7%; p = 0.74), DCR (72.1% and 66.7%; p =0.51), OS (HR=1.024 [95% CI 0.667-1.571] p=0.8960), proportion of pts alive at 1-year G+V=31.1% and G+P=30.2% (p=0.90). Adverse events (AEs) observed for V 100 mg were generally consistent with previous NSCLC studies of V 100 mg. Common AEs (any grade) occurring with a greater frequency in the G+V arm included skin toxicity (34.4% vs 15.9%) and hypertension (9.8% vs 3.2%). Diarrhea and neutropenia were similar in both arms (14.8% and 14.3%; 19.7% and 19.0%). Conclusions: Despite a marginally statistically significant improvement in PFS the study did not met the primary and secondary end points. The combination G+V was well tolerated in this clinical setting.
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Affiliation(s)
| | | | - Nicoletta Zilembo
- Department of Oncology, IRCCSS Fondazione Istituto Nazionale Tumori, Milan, Italy
| | - Paolo Foa
- Azienda Ospedaliera San Paolo, Milano, Italy
| | | | | | | | - Lucio Crinò
- Division of Medical Oncology, S. Maria della Misericordia Hospital, Perugia, Italy
| | - Francesco Grossi
- Lung Cancer Unit, National Institute for Cancer Research, Genova, Italy
| | | | - Francesco Ferraù
- Medical Oncology Unit, San Vincenzo Hospital, Taormina, Catania, Italy
| | | | - Alba Ariela Brandes
- Medical Oncology Department, Bellaria-Maggiore Hospital, Azienda USL of Bologna, Bologna, Italy
| | | | - Sandro Barni
- Division of Oncology, Treviglio Hospital, Treviglio, Italy
| | - Gianpiero Fasola
- Department of Oncology, University Hospital of Udine, Udine, Italy
| | - Salvatore Siena
- Department of Oncology, Ospedale Niguarda Ca' Granda, Milan, Italy
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Ghi MG, Paccagnella A, Ferrari D, Foa P, Nole F, Morelli F, Azzarello G, D'Ambrosio C, Casanova C, Guaraldi M, Mantovani G, Rossetto C, Bonetti A, Siena S, Crino L, Buffoli A, Koussis H, Pieri G, Gava A, Floriani I. Cetuximab/radiotherapy (CET+RT) versus concomitant chemoradiotherapy (cCHT+RT) with or without induction docetaxel/cisplatin/5-fluorouracil (TPF) in locally advanced head and neck squamous cell carcinoma (LASCCHN): Preliminary results on toxicity of a randomized, 2x2 factorial, phase II-III study (NCT01086826). J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.5513] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [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
5513 Background: The standard treatment options for LASCCHN are cCHT+RT or CET+RT. Strategies to improve the efficacy with the integration of induction chemotherapy are being investigated. Primary endpoints of this study were to compare: 1) the overall survival (OS) of induction vs. no induction arms; 2) the Grade(G)3-4 in-field toxicity of cCHT+RT vs. CET+RT. Methods: Patients (pts) with unresectable LASCCHN, stage III-IV, ECOG PS 0–1 were randomized to a 2x2 factorial design: Arm A1: cCHT+RT (2 cycles of ciplatin/5fluorouracil); Arm A2: CET+RTX; Arm B1: 3 cycles of TPF followed by the same cCHT+RT; Arm B2: 3 cycles of TPF followed by CET+RT. A total of 204 deaths over 420 pts ( including the 101 randomized in the phase II part of the study comparing cCHT+RT with or w/o induction TPF) were required to detect a HR of death of 0.675 (A1+A2 vs. B1+B2; 2-sided a=0.05; b=0.20) and a 10% difference in G3-4 in-field mucosal toxicity (A1+B1 vs. A2+B2). Results: By February 2012, 387 pts over 413 pts were evaluable for toxicity. 82% of pts were male; median age was 60y; PS: 0=77.8% and 1=22.2%. Disease stage was III (31%) or IV (69%). Sites of disease were oral cavity (21.7%), oropharynx (54.8%), hypopharynx (23.5%). At a median follow-up of 21 months, 126 deaths occurred. Data on G3-4 in-field toxicity (primary endpoint) and compliance to cCHT+RT vs CET+RT are shown in the table. Conclusions: No advantage for CET+RT over cCHT+RT was observed regarding G3-4 in-field toxicities and feasibility. Pts are still being followed-up to assess OS. [Table: see text]
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Affiliation(s)
| | | | | | | | - Franco Nole
- Unit for Medical Care, European Institute of Oncology, Milan, Italy
| | - Franco Morelli
- Oncology Unit, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Giuseppe Azzarello
- Department of Internal Medical Sciences,Oncology Unit ASL 13, Mirano, Italy
| | | | | | - Monica Guaraldi
- Medical Oncology Department, Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | | | - Ciro Rossetto
- Department of Oncology University Hospital, Udine, Italy
| | - Andrea Bonetti
- Department of Oncology, Mater Salutis Hospital, Legnago, Italy
| | - Salvatore Siena
- Department of Oncology, Ospedale Niguarda Ca' Granda, Milan, Italy
| | - Lucio Crino
- Medical Oncology, S. Maria della Misericordia Hospital, Perugia, Italy
| | | | | | - Gabriella Pieri
- Oncology Department, Oncology Unit, Ospedali Riuniti di Trieste, Trieste, Italy
| | | | - Irene Floriani
- Laboratory of Clinical Trials, Oncology Department, Istituto di Ricerche Farmacologiche, Milan, Italy
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Milella M, Felici A, Lorenzo GD, Aieta M, Ardito R, Boni C, Rondini E, Aitini E, Villa E, Re GL, Algeri R, Foa P, Amoroso D, Moscetti L, Gallucci M, Giannarelli D, Placido SD, Cognetti F. Abstract LB-226: mTOR inhibition by Temsirolimus as second-line treatment for advanced RCC: The Medical optimization of Torisel® (MoTOR) phase II trial by the Italian Kidney Cancer Group (GIR). Cancer Res 2012. [DOI: 10.1158/1538-7445.am2012-lb-226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: The mammalian target of rapamycin (mTOR) kinase is an essential regulator of growth and response to hypoxic and metabolic stress and a well-established therapeutic target in renal cell carcinoma (RCC). The mTOR inhibitor Temsirolimus (CCI-779, Torisel®) is the first-line treatment of choice for RCC patients with poor-risk features. Preclinical and clinical evidence indicates that mTOR inhibitors may be effective in controlling RCC growth, even after resistance to agents targeting the VEGF/VEGFR axis ensues. Thus we designed a multicenter phase II trial to assess the activity and safety of Temsirolimus as II-line treatment for advanced RCC patients (pts). Methodology: This was an open-label, multicenter, phase II trial of Temsirolimus (25 mg/wk i.v.), administered to advanced RCC pts with documented progression after I-line treatment. Primary endpoint was PFS rate at 6 mos. Tumor response was assessed every 8 wks. Considering a 6-mo PFS rate of 20% unacceptable (p0=20%) and a 6-mo PFS rate of 40% (p1=40%) of interest, a minimum targeted accrual of 47 pts in the sunitinib-pretreated group was to be pursued in order to reach 90% power at a significance level of 5%. Pts who underwent any other I-line treatment were allowed on study until the target accrual in the sunitinib-pretreated group was met. Results: From May 2009 to January 2012, 76 pts were enrolled (median age: 67 yrs, range: 36-86; M/F: 58/18; ECOG PS 0/1/2: 51/19/6); I-line therapy included sunitinib (60 pts), bevacizumab (8), sorafenib (3), cytokines (2), or other (3). With 18/57 evaluable patients free from progression at 6 mos in the sunitinib-pretreated group the primary endpoint was met. Median PFS was 4.0 mos (95% CI: 2.7-5.3) and 4.6 mos (95% CI: 2.8-6.5) in the overall (n=71) and sunitinib-pretreated (n=57) populations, respectively; OS in the same groups was 13.7 mos (95% CI: 9.1-18.3) and 14.6 mos (95% CI: 8.9-20.3), respectively. Six out of 71 pts (8%) had PR and 33/71 (46%) had SD as their best response. Toxicity (n=68) was mild with G3 anemia, neutropenia and thrombocytopenia in 2, 1, and 1 pts, respectively; G3 hyperglycemia and G3 hypertriglyceridemia in 2 and 7 pts, respectively; G4 hypercholesterolemia in 2 pts; G3 stomatitis in 5 pts; G3 asthenia in 3 pts; G3-4 pulmonary toxicity in 2 pts; G3 diarrhea in 2 pts; G3 cutaneous rash in 1 pt. Only 1 hypersensitivity reaction occurred during Temsirolimus infusion. Treatment compliance was good, with <10% of weekly administrations omitted and 15/67 (22%) pts requiring dose reductions (to 20 mg/wk and 15 mg/wk in 11 and 4 pts, respectively). Mean number of weekly administrations received was 15. Conclusions. Temsirolimus is an active and well-tolerated II-line treatment for advanced RCC, particularly in sunitinib-pretreated pts, and may constitute a suitable therapeutic option in this setting.
Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr LB-226. doi:1538-7445.AM2012-LB-226
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Affiliation(s)
| | | | | | - Michele Aieta
- 3Ospedale Oncologico Regionale, Rionero in Vulture, Italy
| | | | - Corrado Boni
- 4Arcispedale S.Maria Nuova, Reggio Emilia, Italy
| | | | | | - Eugenio Villa
- 6Istituto Scientifico S.Raffaele - IRCCS, Milan, Italy
| | - Giovanni Lo Re
- 7Azienda Ospedaliera Santa Maria degli Angeli, Pordenone, Italy
| | | | - Paolo Foa
- 9Azienda Ospedaliera S. Paolo, Polo Universitario, Milan, Italy
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Pressiani T, Boni C, Rimassa L, Labianca R, Fagiuoli S, Ardizzoni A, Foa P, Cortesi E, Giordano L, Santoro A. Sorafenib (S) in patients (pts) with advanced hepatocellular carcinoma (HCC): Safety and efficacy in Child-Pugh (CP) class A and B patients. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.4_suppl.306] [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
306 Background: S is the first systemic agent that has been shown to prolong survival in pts with CP A advanced HCC. However, its safety and efficacy have not been extensively evaluated in pts with CP B cirrhosis. Methods: We performed a descriptive analysis on pts with histologically documented advanced HCC and CP A/B cirrhosis, enrolled in a multicenter phase II randomized, open-label trial (data reported elsewhere), in order to assess the feasibility and efficacy of treatment with S in CP B pts. Written informed consent was obtained from all pts. Results: From April 2007 to July 2008, 297 pts were prospectively treated with S 400 mg bid, 234 (78.8%) CP A, 63 (21.2%) CP B. 232 pts were male (76%), median age was 68.3 yrs (range 19.8-89.2 yrs), 217 pts had no extra hepatic disease (73.1%). The two subgroups, according to CP class A or B, were homogeneous for all considered parameters. Median treatment duration was >3 months (mos) for 59.4% of CP A pts and for 27% of CP B pts (p <0.001). Median PFS for the total population was 3.9 mos, 4.3 mos for CP A pts and 2.1 mos for CP B pts (p<0.001). Median OS was 10 mos for CP A pts and 3.8 mos for CP B pts (p<0.001). Adverse events (all grades) were similar in type and incidence for CP A and B pts, with fatigue, stomatitis, diarrhea and weight loss having the highest incidence (44%, 41%, 38% and 38%, respectively). Specifically, no differences in terms of grade 3-4 events have been documented between the two groups. Conclusions: This study supports the feasibility of S also in advanced HCC pts with CP B status. Tolerability data suggest that pts with CP B status might potentially be treated safely with S for its potential survival benefits. Further prospective trials, specifically designed to investigate S in CP B pts, are eagerly advocated.
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Affiliation(s)
- Tiziana Pressiani
- Humanitas Cancer Center, Rozzano, Italy; Division of Oncolgy, Arcispedale S. Maria Nuova, Reggio Emilia, Italy; Ospedali Riuniti di Bergamo, Bergamo, Italy; Unità di Oncologia Medica, Azienda Ospedaliero-Universitaria, Parma, Italy; Azienda Ospedaliera San Paolo, Milano, Italy; Dipartimento di Oncologia Medica, Università di Roma La Sapienza, Roma, Italy
| | - Corrado Boni
- Humanitas Cancer Center, Rozzano, Italy; Division of Oncolgy, Arcispedale S. Maria Nuova, Reggio Emilia, Italy; Ospedali Riuniti di Bergamo, Bergamo, Italy; Unità di Oncologia Medica, Azienda Ospedaliero-Universitaria, Parma, Italy; Azienda Ospedaliera San Paolo, Milano, Italy; Dipartimento di Oncologia Medica, Università di Roma La Sapienza, Roma, Italy
| | - Lorenza Rimassa
- Humanitas Cancer Center, Rozzano, Italy; Division of Oncolgy, Arcispedale S. Maria Nuova, Reggio Emilia, Italy; Ospedali Riuniti di Bergamo, Bergamo, Italy; Unità di Oncologia Medica, Azienda Ospedaliero-Universitaria, Parma, Italy; Azienda Ospedaliera San Paolo, Milano, Italy; Dipartimento di Oncologia Medica, Università di Roma La Sapienza, Roma, Italy
| | - Roberto Labianca
- Humanitas Cancer Center, Rozzano, Italy; Division of Oncolgy, Arcispedale S. Maria Nuova, Reggio Emilia, Italy; Ospedali Riuniti di Bergamo, Bergamo, Italy; Unità di Oncologia Medica, Azienda Ospedaliero-Universitaria, Parma, Italy; Azienda Ospedaliera San Paolo, Milano, Italy; Dipartimento di Oncologia Medica, Università di Roma La Sapienza, Roma, Italy
| | - Stefano Fagiuoli
- Humanitas Cancer Center, Rozzano, Italy; Division of Oncolgy, Arcispedale S. Maria Nuova, Reggio Emilia, Italy; Ospedali Riuniti di Bergamo, Bergamo, Italy; Unità di Oncologia Medica, Azienda Ospedaliero-Universitaria, Parma, Italy; Azienda Ospedaliera San Paolo, Milano, Italy; Dipartimento di Oncologia Medica, Università di Roma La Sapienza, Roma, Italy
| | - Andrea Ardizzoni
- Humanitas Cancer Center, Rozzano, Italy; Division of Oncolgy, Arcispedale S. Maria Nuova, Reggio Emilia, Italy; Ospedali Riuniti di Bergamo, Bergamo, Italy; Unità di Oncologia Medica, Azienda Ospedaliero-Universitaria, Parma, Italy; Azienda Ospedaliera San Paolo, Milano, Italy; Dipartimento di Oncologia Medica, Università di Roma La Sapienza, Roma, Italy
| | - Paolo Foa
- Humanitas Cancer Center, Rozzano, Italy; Division of Oncolgy, Arcispedale S. Maria Nuova, Reggio Emilia, Italy; Ospedali Riuniti di Bergamo, Bergamo, Italy; Unità di Oncologia Medica, Azienda Ospedaliero-Universitaria, Parma, Italy; Azienda Ospedaliera San Paolo, Milano, Italy; Dipartimento di Oncologia Medica, Università di Roma La Sapienza, Roma, Italy
| | - Enrico Cortesi
- Humanitas Cancer Center, Rozzano, Italy; Division of Oncolgy, Arcispedale S. Maria Nuova, Reggio Emilia, Italy; Ospedali Riuniti di Bergamo, Bergamo, Italy; Unità di Oncologia Medica, Azienda Ospedaliero-Universitaria, Parma, Italy; Azienda Ospedaliera San Paolo, Milano, Italy; Dipartimento di Oncologia Medica, Università di Roma La Sapienza, Roma, Italy
| | - Laura Giordano
- Humanitas Cancer Center, Rozzano, Italy; Division of Oncolgy, Arcispedale S. Maria Nuova, Reggio Emilia, Italy; Ospedali Riuniti di Bergamo, Bergamo, Italy; Unità di Oncologia Medica, Azienda Ospedaliero-Universitaria, Parma, Italy; Azienda Ospedaliera San Paolo, Milano, Italy; Dipartimento di Oncologia Medica, Università di Roma La Sapienza, Roma, Italy
| | - Armando Santoro
- Humanitas Cancer Center, Rozzano, Italy; Division of Oncolgy, Arcispedale S. Maria Nuova, Reggio Emilia, Italy; Ospedali Riuniti di Bergamo, Bergamo, Italy; Unità di Oncologia Medica, Azienda Ospedaliero-Universitaria, Parma, Italy; Azienda Ospedaliera San Paolo, Milano, Italy; Dipartimento di Oncologia Medica, Università di Roma La Sapienza, Roma, Italy
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Joss A, Baenninger C, Foa P, Koepke S, Krauss M, McArdell CS, Rottermann K, Wei Y, Zapata A, Siegrist H. Water reuse: >90% water yield in MBR/RO through concentrate recycling and CO2 addition as scaling control. Water Res 2011; 45:6141-6151. [PMID: 21959090 DOI: 10.1016/j.watres.2011.09.011] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2011] [Revised: 09/04/2011] [Accepted: 09/05/2011] [Indexed: 05/31/2023]
Abstract
Over 1.5 years continuous piloting of a municipal wastewater plant upgraded with a double membrane system (ca. 0.6 m(3) d(-1) of product water produced) have demonstrated the feasibility of achieving high water quality with a water yield of 90% by combining a membrane bioreactor (MBR) with a submerged ultrafiltration membrane followed by a reverse osmosis membrane (RO). The novelty of the proposed treatment scheme consists of the appropriate conditioning of MBR effluent prior to the RO and in recycling the RO concentrates back to the biological unit. All the 15 pharmaceuticals measured in the influent municipal sewage were retained below 100 ng L(-1), a proposed quality parameter, and mostly below detection limits of 10 ng L(-1). The mass balance of the micropollutants shows that these are either degraded or discharged with the excess concentrate, while only minor quantities were found in the excess sludge. The micropollutant load in the concentrate can be significantly reduced by ozonation. A low treated water salinity (<10 mM inorganic salts; 280 ± 70 μS cm(-1)) also confirms that the resulting product has a high water quality. Solids precipitation and inorganic scaling are effectively mitigated by lowering the pH in the RO feed water with CO(2) conditioning, while the concentrate from the RO is recycled to the biological unit where CO(2) is stripped by aeration. This causes precipitation to occur in the bioreactor bulk, where it is much less of a process issue. SiO(2) is the sole exception. Equilibrium modeling of precipitation reactions confirms the effectiveness of this scaling-mitigation approach for CaCO(3) precipitation, calcium phosphate and sulfate minerals.
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Affiliation(s)
- Adriano Joss
- Eawag, Swiss Federal Institute of Aquatic Science and Technology, Ueberlandstr. 133, 8600 Duebendorf, Switzerland.
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Affiliation(s)
- Andrea Luciani
- San Paolo Hospital; and University of Milan, Milan, Italy
| | - Paolo Foa
- San Paolo Hospital; and University of Milan, Milan, Italy
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Henke M, Alfonsi M, Foa P, Giralt J, Bardet E, Cerezo L, Salzwimmer M, Lizambri R, Emmerson L, Chen MG, Berger D. Palifermin decreases severe oral mucositis of patients undergoing postoperative radiochemotherapy for head and neck cancer: a randomized, placebo-controlled trial. J Clin Oncol 2011; 29:2815-20. [PMID: 21670447 DOI: 10.1200/jco.2010.32.4103] [Citation(s) in RCA: 111] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
PURPOSE Radiochemotherapy of head and neck cancer causes severe mucositis in most patients. We investigated whether palifermin reduces this debilitating sequela. METHODS We conducted a multicenter, double-blind, randomized, placebo-controlled trial in 186 patients with stages II to IVB carcinoma of the oral cavity, oropharynx, hypopharynx, or larynx. Patients received 60 or 66 Gy after complete (R0) or incomplete resection (R1), respectively, at 2 Gy/fraction and five fractions per week. Cisplatin 100 mg/m(2) was administered on days 1 and 22 (and on day 43 with R1). Patients were randomly assigned to receive weekly palifermin 120 μg/kg or placebo from 3 days before and continuing throughout radiochemotherapy. Trained evaluators performed oral assessments twice weekly. The primary end point was the incidence of severe oral mucositis (WHO grades 3 to 4). Overall survival and time to locoregional progression were also assessed. Analysis was by intention to treat. RESULTS Severe oral mucositis was seen in 47 (51%) of 92 patients administered palifermin and 63 (67%) of 94 administered placebo (P = .027). Palifermin decreased the duration (median, 4.5 v 22.0 days) and prolonged the time to develop (median, 45 v 32 days) severe mucositis. Neither patient-reported mouth and throat soreness scores nor treatment breaks differed between treatment arms. After median follow-up of 32.8 months, 23 deaths (25%) had occurred in both treatment arms, and disease had recurred in 25 (27%) and 22 (24%) of palifermin- and placebo-treated patients, respectively. CONCLUSION Palifermin reduced the occurrence of severe oral mucositis in patients with head and neck cancer undergoing postoperative radiochemotherapy. Additional clinical exploration of palifermin with postoperative radiochemotherapy would be useful.
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Pressiani T, Rimassa L, Boni C, Labianca R, Fagiuoli S, Ardizzoni A, Foa P, Cortesi E, Porta C, Artioli F, Latini L, Carnaghi C, Lutman RF, Torzilli G, Tommasini M, Ceriani R, Covini G, Giordano L, Locopo N, Santoro A. Phase II randomized trial on dose-escalated sorafenib (S) versus best supportive care (BSC) in patients with advanced hepatocellular carcinoma (HCC) with disease progression on prior S treatment. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.4115] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Affiliation(s)
| | | | - Paolo Foa
- San Paolo Hospital; and University of Milan, Milan, Italy
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Luciani A, Ascione G, Bertuzzi C, Marussi D, Codecà C, Di Maria G, Caldiera SE, Floriani I, Zonato S, Ferrari D, Foa P. Detecting Disabilities in Older Patients With Cancer: Comparison Between Comprehensive Geriatric Assessment and Vulnerable Elders Survey-13. J Clin Oncol 2010; 28:2046-50. [DOI: 10.1200/jco.2009.25.9978] [Citation(s) in RCA: 155] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PurposeComprehensive geriatric assessment (CGA) is a multidimensional method used by geriatricians and oncologists to detect and evaluate multiple age-related problems and to plan and coordinate interventions. Because its main drawback is the time required, efforts have been made to evaluate screening instruments suitable for preliminarily assessing elderly patients. The main aim of this study was to establish the accuracy of the Vulnerable Elders Survey-13 (VES-13) in predicting the presence of abnormalities revealed by CGA.Patients and MethodsPatients age ≥ 70 years with a histologically or cytologically confirmed diagnosis of a solid or hematologic tumor underwent both CGA and a VES-13 assessment, and the reliability and validity of VES-13 were analyzed.ResultsFifty-three percent of the 419 elderly patients with cancer (mean age, 76.8 years) were vulnerable on VES-13; the rates of disabilities on CGA and activities of daily living (ADLs)/instrumental activities of daily living (IADLs) scales were 30% and 25%, respectively. The sensitivity and specificity of VES-13 were 87% and 62%, respectively, versus CGA and 90% and 70%, respectively, versus ADL/IADL scales.ConclusionsOn the basis of our data, VES-13 is highly predictive of impaired functional status and can thus be considered a useful preliminary means of assessing older patients with cancer before undertaking a full CGA.
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Affiliation(s)
- Andrea Luciani
- From the Division of Medical Oncology, San Paolo Hospital; Department of Medicine, Surgery, and Dentistry, University of Milan; and Istituto Mario Negri, Milan, Italy
| | - Gilda Ascione
- From the Division of Medical Oncology, San Paolo Hospital; Department of Medicine, Surgery, and Dentistry, University of Milan; and Istituto Mario Negri, Milan, Italy
| | - Cecilia Bertuzzi
- From the Division of Medical Oncology, San Paolo Hospital; Department of Medicine, Surgery, and Dentistry, University of Milan; and Istituto Mario Negri, Milan, Italy
| | - Desirè Marussi
- From the Division of Medical Oncology, San Paolo Hospital; Department of Medicine, Surgery, and Dentistry, University of Milan; and Istituto Mario Negri, Milan, Italy
| | - Carla Codecà
- From the Division of Medical Oncology, San Paolo Hospital; Department of Medicine, Surgery, and Dentistry, University of Milan; and Istituto Mario Negri, Milan, Italy
| | - Giuseppe Di Maria
- From the Division of Medical Oncology, San Paolo Hospital; Department of Medicine, Surgery, and Dentistry, University of Milan; and Istituto Mario Negri, Milan, Italy
| | - Sarah Elisabetta Caldiera
- From the Division of Medical Oncology, San Paolo Hospital; Department of Medicine, Surgery, and Dentistry, University of Milan; and Istituto Mario Negri, Milan, Italy
| | - Irene Floriani
- From the Division of Medical Oncology, San Paolo Hospital; Department of Medicine, Surgery, and Dentistry, University of Milan; and Istituto Mario Negri, Milan, Italy
| | - Sabrina Zonato
- From the Division of Medical Oncology, San Paolo Hospital; Department of Medicine, Surgery, and Dentistry, University of Milan; and Istituto Mario Negri, Milan, Italy
| | - Daris Ferrari
- From the Division of Medical Oncology, San Paolo Hospital; Department of Medicine, Surgery, and Dentistry, University of Milan; and Istituto Mario Negri, Milan, Italy
| | - Paolo Foa
- From the Division of Medical Oncology, San Paolo Hospital; Department of Medicine, Surgery, and Dentistry, University of Milan; and Istituto Mario Negri, Milan, Italy
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Abstract
The efficacy of traditional chemotherapy in inducing objective responses and prolonging survival in recurrent or metastatic head and neck cancer has been disappointing. More recent drugs have not proven superior to the classic regimen of cisplatin and 5-fluorouracil. Anti-EGFR monoclonal antibodies, either as single agents or associated to chemotherapy, have been shown to be active and little toxic. Among them, cetuximab has proven to be the most promising. Indeed the Extreme study, which compared the classic couple cisplatin (CDDP) + 5-fluorouracil with the same regimen plus cetuximab, has constituted a remarkable innovation. The results of that trial seem to indicate a third agent added to CDDP and 5-fluorouracil improved both progression-free survival and overall survival in the recurrent or metastatic setting. Unfortunately, the results obtained with the tyrosine kinase inhibitors are less impressive, and additional studies are needed to explore the potentiality of this class of drug. As far as antiangiogenetics are concerned, the research is insufficient for any conclusion to be drawn in terms of efficacy. It is hoped that, in the near future, the most active combination between biological agents and traditional chemotherapy will be found, so that the path successfully taken in other neoplastic diseases may be retraced.
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Affiliation(s)
- Daris Ferrari
- San Paolo Hospital, Department of Oncology, via Di Rudini 8, 20142, Milan, Italy.
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Luciani A, Jacobsen P, Extermann M, Marussi D, Overcash J, Foa P, Balducci L. P95 The impact of fatigue on functional status in elderly cancer patients undergoing chemotherapy. Crit Rev Oncol Hematol 2009. [DOI: 10.1016/s1040-8428(09)70133-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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41
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Luciani A, Ascione G, Bertuzzi C, Di Maria G, Colloca G, Zonato S, Ferrari D, Foa P. P96 The impact of chemotherapy on body composition and functional status in elderly cancer patients. Crit Rev Oncol Hematol 2009. [DOI: 10.1016/s1040-8428(09)70134-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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42
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Luciani A, Bertuzzi C, Ascione G, Di Gennaro E, Bozzoni S, Zonato S, Ferrari D, Foa P. Dose intensity correlate with survival in elderly patients treated with chemotherapy for advanced non-small cell lung cancer. Lung Cancer 2009; 66:94-6. [DOI: 10.1016/j.lungcan.2008.12.019] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2008] [Revised: 12/02/2008] [Accepted: 12/13/2008] [Indexed: 11/15/2022]
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43
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Stöhlmacher J, Davidenko I, Winquist E, Licitra L, Skladowski K, Ciuleanu T, Kumar R, Foa P, Gansert J, Vermorken J. 8514 SPECTRUM, a phase III trial for patients with recurrent and/or metastatic squamous cell carcinoma of the head and neck (SCCHN) receiving chemotherapy with or without panitumumab: interim pooled safety analysis. EJC Suppl 2009. [DOI: 10.1016/s1359-6349(09)71605-2] [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: 11/28/2022] Open
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44
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Nolè F, Crivellari D, Mattioli R, Pinotti G, Foa P, Verri E, Fougeray R, Brandely M, Goldhirsch A. Phase II study of an all-oral combination of vinorelbine with capecitabine in patients with metastatic breast cancer. Cancer Chemother Pharmacol 2009; 64:673-80. [DOI: 10.1007/s00280-008-0915-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2008] [Accepted: 12/19/2008] [Indexed: 10/21/2022]
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45
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Borghi E, La Francesca M, Gazzola L, Marchetti G, Zonato S, Foa P, d'Arminio Monforte A, Morace G. Rhodococcus equi infection in a patient with spinocellular carcinoma of unknown origin. J Med Microbiol 2008; 57:1431-1433. [DOI: 10.1099/jmm.0.2008/002048-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
A Rhodococcus equi pulmonary infection in a 63-year-old man receiving chemotherapy and radiotherapy for spinocellular carcinoma is described. The patient, a knife-grinder, was promptly treated with levofloxacin plus amikacin followed by rifampicin for 2 months, and he is still in good clinical condition after an 8-month follow-up.
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Affiliation(s)
- Elisa Borghi
- Department of Public Health – Microbiology – Virology, University of Milan, Milan, Italy
| | - Maria La Francesca
- Department of Public Health – Microbiology – Virology, University of Milan, Milan, Italy
| | - Lidia Gazzola
- Department of Medicine, Surgery and Dentistry, Clinic of Infectious Diseases, San Paolo Hospital, University of Milan, Milan, Italy
| | - Giulia Marchetti
- Department of Medicine, Surgery and Dentistry, Clinic of Infectious Diseases, San Paolo Hospital, University of Milan, Milan, Italy
| | - Sabrina Zonato
- Medical Oncology Unit, San Paolo Hospital, University of Milan, Milan, Italy
| | - Paolo Foa
- Medical Oncology Unit, San Paolo Hospital, University of Milan, Milan, Italy
| | - Antonella d'Arminio Monforte
- Department of Medicine, Surgery and Dentistry, Clinic of Infectious Diseases, San Paolo Hospital, University of Milan, Milan, Italy
| | - Giulia Morace
- Department of Public Health – Microbiology – Virology, University of Milan, Milan, Italy
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Luciani A, Ascione G, Bertuzzi C, Caldiera S, Bordin V, Ferrari D, Foa P. CGA based chemotherapy in elderly patients with non small cell lung cancer: an observational prospective study. Crit Rev Oncol Hematol 2008. [DOI: 10.1016/s1040-8428(08)70075-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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47
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Ferrari D, Chiesa F, Codecà C, Calabrese L, Jereczek-Fossa BA, Alterio D, Fiore J, Luciani A, Floriani I, Orecchia R, Foa P. Locoregionally advanced nasopharyngeal carcinoma: induction chemotherapy with cisplatin and 5-fluorouracil followed by radiotherapy and concurrent cisplatin: a phase II study. Oncology 2008; 74:158-66. [PMID: 18714164 DOI: 10.1159/000151363] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2008] [Accepted: 03/25/2008] [Indexed: 12/27/2022]
Abstract
BACKGROUND Chemoradiotherapy is the current standard of care for locoregionally advanced nasopharyngeal carcinoma. The purpose of this study was to assess the feasibility and efficacy of induction chemotherapy (CHT) followed by concomitant chemoradiotherapy in this patient population. PATIENTS AND METHODS In this single-arm, phase II study, patients with locoregionally advanced nasopharyngeal carcinoma were treated with 3 cycles of induction CHT with cisplatin (100 mg/m(2) on day 1) and 5-fluorouracil (1,000 mg/m(2) continuous infusion on days 1-4) followed by 3 cycles of cisplatin (100 mg/m(2) on days 1, 22 and 43) and concurrent radiotherapy up to 70 Gy. The primary endpoint was objective response. RESULTS Thirty-four patients were enrolled, and all completed both induction treatment and subsequent chemoradiotherapy. Objective response rates were 79.4% (95% CI 62.1-91.3) and 85.3% (95% CI 68.9-95.0) after induction CHT and chemoradiation, respectively. Treatment was well tolerated and toxicity was manageable. At a median follow-up of 29 months, 3-year overall survival and progression-free survival rates are 80.0% (95% CI 0.64-0.95) and 54.0% (95% CI 0.36-0.73), respectively. CONCLUSIONS Induction CHT with cisplatin and 5-fluorouracil followed by concomitant chemoradiotherapy is a feasible and active regimen for patients with stage IIB-IVB nasopharyngeal carcinoma. This regimen resulted in excellent locoregional disease control and overall survival.
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Affiliation(s)
- D Ferrari
- Division of Medical Oncology, San Paolo Hospital, Milan, Italy.
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48
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Luciani A, Gilda A, Tagliabue L, Gilardi L, Oldani S, Codecà C, Caldiera S, Lucignani G, Foa P. The impact of chemotherapy on sarcopenia and fatigue in elderly cancer patients: A prospective pilot study. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.9635] [Citation(s) in RCA: 3] [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: 11/20/2022] Open
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49
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Luciani A, Ascione G, Marussi D, Oldani S, Caldiera S, Bozzoni S, Codecà C, Zonato S, Ferrari D, Foa P. Clinical analysis of multiple primary malignancies in the elderly. Med Oncol 2008; 26:27-31. [PMID: 18483884 DOI: 10.1007/s12032-008-9075-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2007] [Accepted: 04/30/2008] [Indexed: 11/29/2022]
Abstract
BACKGROUND Cancer incidence raises progressively during life span; it is estimated that by the year 2030 almost 70% of all neoplasms will occur in people over 65 years old. As carcinogenesis is a multistep, time-requiring process, it is expected that as people live longer they are more likely to develop cancer, and therefore, the prevalence of multiple primary malignancies (MPM) is destined to increase with age. PATIENTS AND METHODS Records of all consecutive cancer patients referred to our center from January 2004 to January 2007 were reviewed. We chose the definition of MPM proposed by Warren and Gates. Multiple malignancies were assessed for elderly (>or=70 years old) and younger patients. t-Test and Mc Nemar test were used; subgroup analysis was also performed according to age stratification. RESULTS A total of 1,503 consecutive patients were considered; 566 were 70 years old or more (mean age 76.5 years, range 70-96 years) and 878 were younger (mean age 57 years, range 18-69 years). The prevalence of multiple malignancies in the elderly people versus younger ones was 15% and 6%, respectively (P = 0.001). As far as the elderly population is concerned, 21% (56/271) of males compared with 14% (42/295) of females had developed MPM; no significant difference was found between the subgroups with MPM or not as far as age (P = 0.16), comorbidities (P = 0.79), medications (P = 0.76), CIRS-G score and index (P = 0.47, P = 0.54), and PS (P = 0.93) are concerned. Most frequent associations among cancer types were prostate with lung (10/87, 11%), prostate with colorectal cancer (10/87, 11%), and smoking-related cancer, namely lung and head and neck cancer (X/Y, 6%). CONCLUSIONS Elderly patients are more likely to develop MPM compared to younger ones. Significant cancer association according to field cancerogenesis concept was the one of smoking-related cancer; other MPM patterns were apparently a random phenomenon.
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Affiliation(s)
- Andrea Luciani
- Medical Oncology Unit, S. Paolo Hospital, Via DI Rudinì 8, 20142 Milan, Italy.
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50
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Di Costanzo F, Gasperoni S, Manzione L, Bisagni G, Labianca R, Bravi S, Cortesi E, Carlini P, Bracci R, Tomao S, Messerini L, Arcangeli A, Torri V, Bilancia D, Floriani I, Tonato M, Dinota A, Strafiuso G, Corgna E, Porrozzi S, Boni C, Rondini E, Giunta A, Monzio Compagnoni B, Biagioni F, Cesari M, Fornarini G, Nelli F, Carboni M, Cognetti F, Enzo MR, Piga A, Romiti A, Olivetti A, Masoni L, De Stefanis M, Dalla Mola A, Camera S, Recchia F, De Filippis S, Scipioni L, Zironi S, Luppi G, Italia M, Banducci S, Pisani Leretti A, Massidda B, Ionta MT, Nicolosi A, Canaletti R, Biscottini B, Grigniani F, Di Costanzo F, Rovei R, Croce E, Carroccio R, Gilli G, Cavalli C, Olgiati A, Pandolfi U, Rossetti R, Natalini G, Foa P, Oldani S, Bruno L, Cascinu S, Catalano G, Catalano V, Lungarotti F, Farris A, Sarobba MG, Trignano M, Muscogiuri A, Francavilla F, Figoli F, Leoni M, Papiani G, Orselli G, Antimi M, Bellini V, Cabassi A, Contu A, Pazzola A, Frignano M, Lastraioli E, Saggese M, Bianchini D, Antonuzzo L, Mela M, Camisa R. Adjuvant chemotherapy in completely resected gastric cancer: a randomized phase III trial conducted by GOIRC. J Natl Cancer Inst 2008; 100:388-98. [PMID: 18334706 DOI: 10.1093/jnci/djn054] [Citation(s) in RCA: 91] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Complete surgical resection of gastric cancer is potentially curative, but long-term survival is poor. METHODS Patients with histologically proven adenocarcinoma of the stomach of stages IB, II, IIIA and B, or IV (T4N2M0) and treated with potentially curative surgery were randomly assigned to follow-up alone or to intravenous treatment with four cycles (repeated every 21 days) of PELF (cisplatin [40 mg/m(2), on days 1 and 5], epirubicin [30 mg/m(2), days 1 and 5], L-leucovorin [100 mg/m(2), days 1-4], and 5-fluorouracil [300 mg/m(2), days 1-4] in a hospital setting. Frequencies and severity of adverse events were determined. Overall survival (OS) and disease-free survival (DFS) were compared between the treatment arms using Kaplan-Meier analysis and a Cox proportional hazards regression model. All statistical tests were two-sided. RESULTS From January 1995 through September 2000, 258 patients were randomly assigned to chemotherapy (n = 130) or surgery alone (n = 128). Patient characteristics were well balanced between the two arms. Among those who received chemotherapy, grade 3 or 4 toxic effects including vomiting, mucositis, and diarrhea were experienced by 21.1%, 8.4%, and 11.8% of patients, respectively. Leucopenia, anemia, and thrombocytopenia of grade 3 or 4 were experienced by 20.3%, 3.3%, and 4.2% of patients, respectively. After a median follow-up of 72.8 months, 128 patients (49.6%) experienced recurrence and 139 (53.9%) deaths were observed, one toxicity-related. Relative to treatment with surgery alone, adjuvant chemotherapy did not increase disease-free survival (hazard ratio [HR] of recurrence = 0.92; 95% confidence interval [CI] = 0.66 to 1.27) or overall survival (HR of death = 0.90; 95% CI = 0.64 to 1.26). CONCLUSIONS Our results failed to provide proof of an effect of adjuvant chemotherapy with PELF on overall survival or disease-free survival. The estimated effect of chemotherapy (10% reduction in the hazard of death or relapse) is modest and consistent with the results of meta-analyses of adjuvant chemotherapy without platinum agents.
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Affiliation(s)
- Francesco Di Costanzo
- Unit of Medical Oncology, Azienda Ospedaliero Universitaria Careggi, Viale Pieraccini 17, 50139 Florence, Italy.
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