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Vasta FM, Cormio G, Cassani C, Bergamini A, Scarfone G, Ferrandina G, De Vivo R, Marinaccio M, Danese S, Raspagliesi F, Pignata S, Mangili G. Reproductive outcomes after conservative treatment in early and advanced stage MOGCTs. Gynecol Oncol 2024; 181:28-32. [PMID: 38104526 DOI: 10.1016/j.ygyno.2023.11.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 11/05/2023] [Accepted: 11/22/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Malignant ovarian germ cell tumors usually occur in young women. The standard of care is fertility sparing surgery and comprehensive surgical staging followed by adjuvant chemotherapy with BEP (bleomycin, etoposide, cisplatin) if needed. The aim of this study was to analyze the reproductive outcomes after conservative treatment in patients diagnosed, treated and followed up in MITO (Multicenter Italian Trials in Ovarian Cancer) centers. METHODS A questionnaire concerning gynecological symptoms, reproductive outcomes and fertility treatment was administered to 164 MOGCTs survivors. Data regarding patients deceased were collected from MITO-9 database. There were 114 patients diagnosed at reproductive age between 1983 and 2019 included. RESULTS 109 patients answered the questionnaire and 5 patients decesased were included (median age 24.9 years). 78.1% were stage I,4.4% stage II, 14.9% stage III and 2.6% stage IV. 57.9% received chemotherapy, the mean number of cycles was 4.1. Median time to menstrual recovery after BEP was of 5.6 months range, only 1 case of premature ovarian failure was reported. Among the 114 patients 38 (33.3%) attempted to become pregnant, 29/38 (76.3%) got pregnant with a total of 44 conceptions. 40.9% received chemotherapy and 22.9% did not (p 0.048). Pregnancy desire was the only predictive factor associated with live births among women who attempted pregnancy after treatment. CONCLUSIONS As MOGCTs affect women of child-bearing age, fertility preservation represents a major treatment issue. Our results are consistent with the available evidence, confirming that adjuvant chemotherapy for MOGCT does not impact the reproductive function and fertility.
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Affiliation(s)
- Francesca M Vasta
- Department of Obstetrics and Gynecology, IRCCS San Raffaele, Milan, Italy
| | - Gennaro Cormio
- Gynecologic Oncology Unit, IRCCS Istituto Tumori di Bari, Italy; Department of Interdisciplinary Medicine, University of Bari, Italy
| | - Chiara Cassani
- Department of Obstetrics and Gynaecology, Fondazione IRCCS Policlinico San Matteo-University of Pavia, Pavia, Italy
| | - Alice Bergamini
- Department of Obstetrics and Gynecology, IRCCS San Raffaele, Milan, Italy; Università Vita Salute San Raffaele, Milan, Italy.
| | | | - Gabriella Ferrandina
- Dipartimento per la Salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy; Università Cattolica del Sacro Cuore, Istituto di Ginecologia e Ostetricia, Roma, Italy
| | - Rocco De Vivo
- Department of Oncology, Ospedale san Bartolo, Vicenza, Italy
| | - Marco Marinaccio
- Unit of Obstetrics and Gynecology, Department of Biomedical and Human Oncologic Science, University of Bari, Italy
| | - Saverio Danese
- Deparment of Obstetrics and Gynecology, A.O.U. Città della Salute e della Scienza, Torino, Italy
| | | | - Sandro Pignata
- Department of Urology and Gynecology, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale Napoli, Italy
| | - Giorgia Mangili
- Department of Obstetrics and Gynecology, IRCCS San Raffaele, Milan, Italy
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Calvetti L, Tealdo M, Simionato F, Pagiusco G, Cimenton R, Gasparin B, Corà F, De Vivo R, Merlini L, Aprile G. Home-Based Management of Patients With Cancer Experiencing Treatment-Induced Toxicities With a Nurse-Led Telephone Triage (the NTT Study). JCO Oncol Pract 2021; 18:e20-e27. [PMID: 34242052 DOI: 10.1200/op.21.00192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Novel organization models ensure early management of treatment-related adverse events (TRAEs) of new anticancer drugs. The aim of this prospective observational study was to evaluate the impact of the introduction of a nurse-led telephone triage (NTT) in reducing hospitalization of patients with cancer (CPs). PATIENTS AND METHODS CPs on active medical treatment were educated to call the NTT in case of symptoms or TRAEs. Assessment of TRAEs was performed by trained oncology nurses according to the Common Terminology Criteria for Adverse Events grading scales and subsequent actions were taken according to the severity of the events. The primary end point of the study was to compare the rate of hospitalization of CPs on anticancer treatment after the introduction of NTT with that of the 2017-2018 period. RESULTS From September 2018 to September 2019, a total of 1,075 patients received systemic anticancer treatment (v 936 patients in the same 2017-2018 period). Total consultations at NTT were 429 and 581 TRAEs were reported. Notably, 117 patients reported more than one TRAE. Common Terminology Criteria for Adverse Events were graded as G1 (237, 40.8%), G2 (231, 39.8%), or G3-4 (113, 19.4%). In the observation period, 109 CPs on treatment were hospitalized versus 138 in the 2017-2018 period with a normalized hospitalization rate of 10.1% versus 14.7% (P = .002 chi-square) with a reduction in normalized number of hospitalization of 44 and an estimated cost savings of 345,246 euros. CONCLUSION The implementation of the NTT system in the clinical practice may help reducing the rates of hospitalization through the emergency room of CPs receiving modern medical treatments.
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Affiliation(s)
- Lorenzo Calvetti
- Department of Oncology, San Bortolo General Hospital, Vicenza, Italy
| | - Marta Tealdo
- Department of Oncology, San Bortolo General Hospital, Vicenza, Italy
| | | | - Gaetana Pagiusco
- Department of Oncology, San Bortolo General Hospital, Vicenza, Italy
| | - Roberta Cimenton
- Department of Oncology, San Bortolo General Hospital, Vicenza, Italy
| | - Barbara Gasparin
- Department of Oncology, San Bortolo General Hospital, Vicenza, Italy
| | - Francesco Corà
- Department of Emergency, San Bortolo General Hospital, Vicenza, Italy
| | - Rocco De Vivo
- Department of Oncology, San Bortolo General Hospital, Vicenza, Italy
| | - Laura Merlini
- Department of Oncology, San Bortolo General Hospital, Vicenza, Italy
| | - Giuseppe Aprile
- Department of Oncology, San Bortolo General Hospital, Vicenza, Italy
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Stellato M, Santini D, Verzoni E, De Giorgi U, Pantano F, Casadei C, Fornarini G, Maruzzo M, Sbrana A, Di Lorenzo G, Soraru M, Naglieri E, Buti S, De Vivo R, Napolitano A, Vignani F, Mucciarini C, Grillone F, Roviello G, Di Napoli M, Procopio G. Impact of Previous Nephrectomy on Clinical Outcome of Metastatic Renal Carcinoma Treated With Immune-Oncology: A Real-World Study on Behalf of Meet-URO Group (MeetUro-7b). Front Oncol 2021; 11:682449. [PMID: 34168997 PMCID: PMC8217989 DOI: 10.3389/fonc.2021.682449] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 05/11/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Immune-Oncology (IO) improves Overall Survival (OS) in metastatic Renal Cell Carcinoma (mRCC). The prognostic impact of previous Cytoreductive Nephrectomy (CN) and radical nephrectomy (RN), with curative intent, in patients treated with IO is not well defined. The aim of our paper is to evaluate the impact of previous nephrectomy on outcome of mRCC patients treated with IO. METHODS 287 eligible patients were retrospectively collected from 16 Italian referral centers adhering to the MeetUro association. Patients treated with IO as second and third line were included, whereas patients treated with IO as first line were excluded. Kaplan-Meier method and log-rank test were performed to compare Progression Free Survival (PFS) and OS between groups. In our analysis, both CN and RN were included. The association between nephrectomy and other variables was analyzed in univariate and multivariate setting using the Cox proportional hazard model. RESULTS 246/287 (85.7%) patients had nephrectomy before IO treatment. Median PFS in patients who underwent nephrectomy (246/287) was 4.8 months (95%CI 3.9-5.7) vs 3.7 months (95%CI 1.9-5.5) in patients who did not it (HR log rank 0.78; 95%CI 0.53 to 1.15; p = 0.186). Median OS in patients who had previous nephrectomy (246/287) was 20.9 months (95%CI 17.6-24.1) vs 13 months (95%CI 7.7-18.2) in patients who did not it (HR log rank 0.504; 95%CI 0.337 to 0.755; p = 0.001). In the multivariate model, nephrectomy showed a significant association with OS (HR log rank 0.638; 95%CI 0.416 to 0.980), whereas gland metastases were still associated with better outcome in terms of both OS (HR log rank 0.487; 95%CI 0.279 to 0.852) and PFS (HR log rank 0.646; 95%CI 0.435 to 0.958). CONCLUSIONS IO treatment, in patients who had previously undergone nephrectomy, was associated with a better outcome in terms of OS. Further prospective trials would assess this issue in order to guide clinicians in real word practice.
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Affiliation(s)
- Marco Stellato
- Department of Medical Oncology, Campus Bio-Medico University of Rome, Rome, Italy
| | - Daniele Santini
- Department of Medical Oncology, Campus Bio-Medico University of Rome, Rome, Italy
| | - Elena Verzoni
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Ugo De Giorgi
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Italy
| | - Francesco Pantano
- Department of Medical Oncology, Campus Bio-Medico University of Rome, Rome, Italy
| | - Chiara Casadei
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Italy
| | - Giuseppe Fornarini
- Onco-ematological Department, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Marco Maruzzo
- Medical Oncology Unit 1, Department of Oncology, Istituto Oncologico Veneto IOV IRCCS, Padua, Italy
| | - Andrea Sbrana
- Department of Surgical, Medical and Molecular Pathology and Critical Area Medicine, University of Pisa, Pisa, Italy
| | | | - Mariella Soraru
- Oncology Unit, Camposampiero General Hospital, Padova, Italy
| | - Emanuele Naglieri
- Division of Medical Oncology, Istituto Tumori Bari Giovanni Paolo II—IRCCS, Bari, Italy
| | - Sebastiano Buti
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Rocco De Vivo
- Department of Oncology, San Bortolo General Hospital, Vicenza, Italy
| | - Andrea Napolitano
- Department of Medical Oncology, Campus Bio-Medico University of Rome, Rome, Italy
| | | | - Claudia Mucciarini
- U.O. Medicina Oncologica, Ospedale Ramazzini, Carpi-AUSL Modena, Carpi, Italy
| | - Francesco Grillone
- Azienda Ospedaliero-Universitario “Mater Domini”, Policlinico of Catanzaro, Catanzaro, Italy
| | | | - Marilena Di Napoli
- Department of Urology and Gynecology, Istituto Nazionale Tumori IRCCS Fondazione “G. Pascale”, Napoli, Italy
| | - Giuseppe Procopio
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Maruzzo M, Bortolami A, Palleschi D, Zivi A, Nicodemo M, Sartori D, De Vivo R, Zustovich F, Bimbatti D, Pastorelli D, Vultaggio GD, Soraru' M, Ballestrin M, Zanchetta G, Modonesi C, Randisi P, Barile C, Perri G, Basso U, Zagonel V. Use of nivolumab (N) and cabozantinib (C) for treatment of the metastatic renal cell carcinoma (mRCC) in the Veneto region: Results of AMOUR study. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.6_suppl.290] [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
290 Background: Second (2L) or third-line (3L) treatment options for mRCC have dramatically changed in the last years. The standard of care as per Italian Regulatory Agencies approvals is N or C. To date, there are no criteria for the choice between N and C, which both demonstrated OS gain in the pivotal trials. Methods: We planned a retrospective, real world analysis of the use of N and C as 2L and 3L treatment in 17 Oncology Units of Veneto Region. All consecutive patients (pts) with mRCC treated in advanced setting in 2017-2018 were included. Results: We identified 170 pts, 73% males, median age 68.4 years. All pts started a 2L treatment while only 59% received a 3L treatment. In our cohort, patients with NLR > 3 at treatment start had a shorter OS (43 vs 90 months (mos), p < 0.0001); IMDC classification maintained its prognostic role. In 2L, N was administrated in 108 pts (63%), C in 29 pts (17%); in 3L N was administrated in 42 pts (25%), C in 49 pts (29%). Reported oncologists’ reasons for 2L choice were: change of mechanism of action compared to first line (28%), response to previous TKI (21.2%), intolerance to TKI (17.6%), previous toxicity (12.9%), tumor burden (11.2%), age of the patient (4.1%). Median OS and PFS in 2L were 28.4 and 6.6 mos for N, 16.8 and 6.6 mos for 2L C. Median OS and PFS in 3L were 27 and 5.2 mos for N, 16.6 and 7.5 mos for C. 46 pts received the sequence of drugs N > C, 12 the opposite sequence C > N. Median OS for N > C vs C > N were 96.6 vs 36 mos (p > 0.0001); median PFS for both the sequences were similar at 5.7 mos (p = ns). The cost per patient of the sequence N > C is 51.606 € while for the sequence C > N is 31.480,00 €. Between the two sequences a cost effectiveness per month of survival analysis was performed: the cost per month of OS for the sequence N > C was 534,18 € while for the sequence C > N was 874,46 €, heavily higher. Conclusions: In our real-world setting cohort, most of the pts received N as 2L treatment and a minority received C. Outcome of single drug are superimposable to published literature. With the limits of the retrospective nature of the study, with a cost per month of OS lower a much longer OS, the sequence N > C appear to be a better treatment strategy.
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Affiliation(s)
- Marco Maruzzo
- Medical Oncology Unit 1, Department of Oncology, Istituto Oncologico Veneto IOV IRCCS, Padua, Italy
| | | | - Dario Palleschi
- Oncology Unit, Azienda ULSS 2 Marca Trevigiana, Treviso, Italy
| | - Andrea Zivi
- Oncology Unit, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | | | - Donata Sartori
- Oncology Unit, Azienda ULSS 3 Serenissima, Mirano, Italy
| | - Rocco De Vivo
- Oncology Unit, Azienda ULSS 8 Berica, Vicenza, Italy
| | | | - Davide Bimbatti
- Medical Oncology Unit 1, Department of Oncology, Istituto Oncologico Veneto IOV IRCCS, Padua, Italy
| | | | | | - Mariella Soraru'
- Medical Oncology, Camposampiero Hospital, Camposampiero (Padua), Italy
| | | | | | - Caterina Modonesi
- Azienda Ulss6-Ospedali Riuniti Padova SUD Uoc Oncologia, Monselice (PD), Italy
| | - Paola Randisi
- Oncology Unit, Azienda ULSS 6 Euganea, Schiavonia, Italy
| | - Carmen Barile
- Oncology Unit, Azienda ULSS 5 Polesana, Rovigo, Italy
| | - Gino Perri
- Oncology Unit, Azienda ULSS 2 Marca Trevigiana, Vittorio Veneto, Italy
| | - Umberto Basso
- Medical Oncology Unit 1, Department of Oncology, Istituto Oncologico Veneto IOV IRCCS, Padua, Italy
| | - Vittorina Zagonel
- Medical Oncology Unit 1, Department of Oncology, Istituto Oncologico Veneto IOV IRCCS, Padua, Italy
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Bartoletti M, Mazzeo R, De Scordilli M, Del Fabro A, Vitale MG, Bortot L, Nicoloso MS, Corsetti S, Bonotto M, Scalone S, Giorda G, Sorio R, Andreetta C, Meacci ML, De Vivo R, Fasola G, Sopracordevole F, Puglisi F. Human epidermal growth factor receptor-2 (HER2) is a potential therapeutic target in extramammary Paget’s disease of the vulva. Int J Gynecol Cancer 2020; 30:1672-1677. [DOI: 10.1136/ijgc-2020-001771] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 09/01/2020] [Accepted: 09/03/2020] [Indexed: 12/15/2022] Open
Abstract
BackgroundInvasive vulvar Paget’s disease with over-expression of the human epidermal growth factor receptor 2 (HER2) protein is potentially suitable for targeted therapy, especially in a metastatic setting where no effective treatments are available.MethodsFour consecutive patients with HER2 positive advanced vulvar Paget’s disease, treated with weekly trastuzumab (loading dose 4 mg/kg, then 2 mg/kg) and paclitaxel (80 mg/m2) followed by 3-weekly trastuzumab maintenance (6 mg/kg), are reported.ResultsMedian age and follow-up of patients were 62.5 years (45–74) and 16 months (6-54), respectively. Complete or partial responses were observed in all patients. Median time to response was 3 months (range 2–4), while median duration of response was 10 months (range 2–34). Case 1 presented with pulmonary and lymph nodes involvement. She experienced a radiological complete response after 24 treatment administrations, and a progression-free survival of 36 months. At disease progression, treatment re-challenge achieved partial response. She is currently receiving treatment with trastuzumab–emtansine. Case 2 was a 74-year-old woman who developed pulmonary metastasis after first-line cisplatin treatment. She had a partial response and a progression-free survival of 10 months. Case 3 had inguinal and para-aortic lymphadenopathy in complete response after 18 treatment administrations. She developed brain metastasis while receiving trastuzumab maintenance. Case 4 was treated for locally advanced disease and experienced a subjective benefit with relief in perineal pain and itching. No unexpected treatment-related side effects were reported.ConclusionsAdvanced vulvar Paget’s disease is a rare disorder and no standard treatment is available. In the sub-group of HER2 positive disease, weekly paclitaxel–trastuzumab appears to be active and safe, and may be considered a therapeutic option in these patients.
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Calvetti L, Tealdo M, Cimenton R, Gentile A, Pretto R, Pavan M, Gasparin B, Pagiusco G, De Vivo R, Merlini L, Aprile G. Home-based management of cancer patients (CPs) experiencing toxicities while on anticancer treatment: The impact of a nurse-led telephone triage (NTT). J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.2002] [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
2002 Background: Novel organization models are needed to ensure early management of new treatment-related toxicity of anticancer treatments. Aim of this prospective observational study was to evaluate the impact of the introduction of NTT in reducing hospitalization of CPs. Methods: CPs on active medical treatment at the Department of Oncology of San Bortolo Hospital (Vicenza, Italy) were given instructions to refer to NTT in case of treatment-related adverse events (TRAEs). The service was opened Mon to Fri from 8am to 8pm. Assessment of TRAEs was performed by trained oncology nurses according to the CTCAE scale and subsequent actions were taken according to the severity of the events. The assessment was made under supervision of a medical oncologist in charge of the service while on duty. Primary endpoint of the study was to compare the rate of hospitalization of CPs on anticancer treatment after the introduction of NTT compared to 2017-2018 period. Results: From September 2018 to September 2019 1,075 patients received systemic anticancer treatment (versus 936 patients in the equivalent 2017 – 2018 period). Total consultations at NTT were 429; 581 TRAEs were reported. 117 patients reported more than one TRAE. CTCAE were graded as G1 237 (40.8%), G2 231 (39.8%) or G3-G4 113 (19.4%). The most common grade ≥ 3 TRAE was fever (38 events (33.6%) that resulted a febrile neutropenia in 7 cases) followed by cancer pain (15 (13.3%)) and fatigue (9 (8%)). In the observation period, 109 CPs on treatment were hospitalized versus 138 in the 2017-2018 period with a normalized hospitalization rate of 10.1% versus 14.7 % (p = 0.002, chi-square) with a reduction of normalized number of hospitalizations of 44 (estimated cost savings of 380.160 euros). Conclusions: Our results provided evidence of successful implementation of the NTT system in reducing rates of hospitalization through emergency room in cancer patients receiving modern medical treatments.
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Affiliation(s)
- Lorenzo Calvetti
- Department of Oncology, San Bortolo General Hospital, Vicenza, Italy
| | - Marta Tealdo
- Department of Oncology, San Bortolo General Hospital, Vicenza, Italy
| | - Roberta Cimenton
- Department of Oncology, San Bortolo General Hospital, Vicenza, Italy
| | - Angela Gentile
- Department of Oncology, San Bortolo General Hospital, Vicenza, Italy
| | - Rachele Pretto
- Department of Oncology, San Bortolo General Hospital, Vicenza, Italy
| | - Monica Pavan
- Department of Oncology, San Bortolo General Hospital, Vicenza, Italy
| | - Barbara Gasparin
- Department of Oncology, San Bortolo General Hospital, Vicenza, Italy
| | - Gaetana Pagiusco
- Department of Oncology, San Bortolo General Hospital, Vicenza, Italy
| | - Rocco De Vivo
- Department of Oncology, San Bortolo General Hospital, Vicenza, Italy
| | - Laura Merlini
- Department of Oncology, San Bortolo General Hospital, Vicenza, Italy
| | - Giuseppe Aprile
- Department of Oncology, San Bortolo General Hospital, Vicenza, Italy
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7
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Stellato M, Santini D, De Giorgi U, Verzoni E, Casadei C, Fornarini G, Maruzzo M, Napolitano A, Sbrana A, Di Lorenzo G, Soraru' M, Naglieri E, Buti S, De Vivo R, Vignani F, Mucciarini C, Grillone F, Roviello G, Pignata S, Procopio G. Impact of previous nephrectomy on clinical outcome of metastatic renal carcinoma treated with immune-oncology (I-O):A real-world study on behalf of Meet-URO group (MeetUro-7b). J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e17088] [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
e17088 Background: Immuno-oncology (IO) treatment demonstrated to improve Overall Survival (OS) in metastatic renal cell carcinoma (mRCC). The prognostic impact of previous citoreductive nephrectomy (CN) and radical nephrectomy with curative intent in patients (pts) treated with IO is not well defined. Methods: 229 eligible pts, with a least one radiological assessment of response according to the RECIST 1:1 criteria, were retrospectively collected from 16 Italian referral centers. Baseline characteristics, outcome data including progression-free survival (PFS) and OS were collected. Kaplan-Meier method and log-rank test were performed to compare PFS and OS between groups. Results: 153(66.8%) pts received IO as second line, 61(26.6%) as third line and 15(6.6%) pts as further line. 54 pts (23.6%) were good risk, 144(62.9%) were intermediate and 31(13.5%) were poor risk according to IMDC score. 189(82.5%) pts underwent nephrectomy (of them 72(32.4%) pts had synchronous metastatic disease and underwent CN), while 40(17.4%) pts did not. Nephrectomy was performed before IO treatment. ECOG PS, at the beginning of IO, was 0 for 167 pts (72.9%), the other 62 (27.1%) had ECOG PS 1 or 2. At a median follow up time of 17.5 months (mo), 13 (5.7%) pts are still in treatment while 216 (94.3%) experienced progression. 81 (35.3%) pts were treated after IO progression with mTOR and VEGFR inhibitors. 63 (27.5%) pts continued IO beyond progression. G3-G4 iAE were reported in 46 pts (20%). Median IO-PFS was 4.5 months in pts who did not undergo nephrectomy and 2.9 mo in pts who did (HR log rank 0.713, 95%CI 0.4788 to 1.063; p= 0.0582). Median IO-OS was 18.4 mo in pts who underwent nephrectomy and 10.3 mo in pts who did not (HR log rank 1.915, 95%CI 1.118 to 3.281; p= 0.0024). The difference in OS was irrespective of the IMDC criteria and the lines of treatment. Conclusions: In our real world experience, in mRCC pts treated with IO, previous nephrectomy was associated with a better outcome in terms of OS with all the limitations of a retrospective collection.
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Affiliation(s)
- Marco Stellato
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Daniele Santini
- Department of Medical Oncology, Campus Bio-Medico of Rome University, Rome, Italy
| | - Ugo De Giorgi
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Elena Verzoni
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Chiara Casadei
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Giuseppe Fornarini
- Medical Oncology Unit, IRCCS Azienda Ospedaliera Universitaria San Martino–IST Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy
| | - Marco Maruzzo
- Medical Oncology Unit 1, Department of Oncology, Istituto Oncologico Veneto IOV IRCCS, Padua, Italy
| | - Andrea Napolitano
- Department of Medical Oncology, Campus Bio-Medico of Rome University, Rome, Italy
| | - Andrea Sbrana
- Department of Translational Research and New Technologies in Medicine and Surgery, Unit of Medical Oncology 2, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | | | - Mariella Soraru'
- Oncology Unit, Camposampiero General Hospital, Camposampiero (Padua), Italy
| | - Emanuele Naglieri
- Division of Medical Oncology, Istituto Tumori Bari Giovanni Paolo II - IRCCS, Bari, Italy
| | - Sebastiano Buti
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Rocco De Vivo
- Department of Oncology, San Bortolo General Hospital, Vicenza, Italy
| | | | - Claudia Mucciarini
- U.O. Medicina Oncologica, Ospedale Ramazzini, Carpi-AUSL Modena, Carpi, Italy
| | - Francesco Grillone
- Azienda Ospedaliero-Universitario "Mater Domini", Policlinico of Catanzaro, Catanzaro, Italy
| | | | - Sandro Pignata
- Department of Urology and Gynecology, Istituto Nazionale Tumori IRCCS Fondazione “G. Pascale”, Naples, Italy
| | - Giuseppe Procopio
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Santini D, Stellato M, De Giorgi U, Pignata S, Pantano F, De Lisi D, Casadei C, Maruzzo M, Naglieri E, Buti S, De Vivo R, Di Lorenzo G, Sbrana A, Soraru' M, Fornarini G, Mucciarini C, Grillone F, Roviello G, Vignani F, Procopio G. Clinical outcomes of metastatic renal carcinoma following disease progression to programmed death (PD)-1 or PD-L1 inhibitors (I-O): A Meet-URO group real-world study (Meet-Uro 7). J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.6_suppl.691] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
691 Background: In metastatic renal cell carcinoma (mRCC), immune-oncology (IO), alone or in combination, (IO-IO or IO-TKI) has changed the therapeutic scenario. Few real-world data are available about safety and outcome after IO progression. Methods: Baseline characteristics, outcome data including progression-free survival (PFS) and toxicities were retrospectively collected from 162 eligible pts treated in 16 Italian referral centers adhering to the Meet-Uro group and progressing to IO. Results: 111 pts (68,5%) were treated after progression to IO. 142 (87.6%) pts received IO as second line, 5 pts as first line and 16 pts as further line. Subsequent therapy included cabozantinib (n = 79, 48.0%), everolimus (n = 11, 6.7%), sunitinib (n = 6, 3.7%) and others (n = 15, 9.25%). Median IO-PFS was 4 months (95%CI 3.1-4.8) with no difference in pts pretreated with pazopanib or sunitinib (4 months (95%CI 2.4-5.5) vs 3,9 months (95%CI 2.9-4.9) p = 0.5). PFS tends to be longer in pts reporting adverse events of any grade (5.03 (95%CI 3.8-6.1) vs 2,99 (95%CI 2.4-3.5) months p = 0.004) or without nephrectomy (4.1 vs 2.9 months p = 0.071). Median PFS, in pts treated post-IO, was 6.5 months (95%CI 5.1-7.8). In term of best response, 55 pts (49%) had stability of disease/partial response and 29 pts (26%) had progressive disease, for the other pts treatment is still ongoing. Pts with ECOG PS 0 at progression to IO, had longer PFS, 11 months (95%CI 5.7-17.5) as well as those treated with cabozantinib (7.6 months, 95%CI 5.2-10.1) compared to everolimus, (3.2 months, 95%CI 1.8-4.5) or other drugs (4.3 months, 95%CI 1.3-7.4) p = 0.001. All grade adverse events were reported in 83 pts (74%) with G3-G4 adverse events in 39 pts (35%). Median overall survival, from first line, was 41,1 months (95%CI 30.4-51.8). Conclusions: In our real world experience after progression to IO, most pts received VEGF-TKI and mTOR inhibitors that showed to be active and safe choices. Cabozantinib was associated with a longer mPFS.
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Affiliation(s)
- Daniele Santini
- Department of Medical Oncology, Campus Bio-Medico University of Rome, Rome, Italy
| | - Marco Stellato
- Department of Medical Oncology, Campus Bio-Medico University of Rome, Rome, Italy
| | - Ugo De Giorgi
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Sandro Pignata
- Uro-Gynecological Department, Istituto Nazionale per lo Studio e la Cura dei Tumori, Fondazione “G. Pascale”, Naples, Italy
| | - Francesco Pantano
- Department of Medical Oncology, Campus Bio-Medico University of Rome, Rome, Italy
| | - Delia De Lisi
- Department of Medical Oncology, Santa Chiara Hospital, Trento, Italy
| | - Chiara Casadei
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Marco Maruzzo
- Medical Oncology Unit 1, Department of Oncology, Istituto Oncologico Veneto IOV IRCCS, Padua, Italy
| | - Emanuele Naglieri
- Division of Medical Oncology, Istituto Tumori Bari Giovanni Paolo II - IRCCS, Bari, Italy
| | - Sebastiano Buti
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Rocco De Vivo
- Department of Oncology, San Bortolo General Hospital, Vicenza, Italy
| | | | - Andrea Sbrana
- Department of Translational Research and New Technologies in Medicine and Surgery, Unit of Medical Oncology 2, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Mariella Soraru'
- Oncology Unit, Camposampietro Hospital, Camposampiero (Padua), Italy
| | - Giuseppe Fornarini
- Medical Oncology Unit, IRCCS Azienda Ospedaliera Universitaria San Martino–IST Istituto Nazionale per la Ricerca sul Cancro, Genova, Italy
| | - Claudia Mucciarini
- U.O. Medicina Oncologica, Ospedale Ramazzini, Carpi-AUSL Modena, Carpi, Italy
| | - Francesco Grillone
- Azienda Ospedaliero-Universitario "Mater Domini", Policlinico of Catanzaro, Catanzaro, Italy
| | | | | | - Giuseppe Procopio
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Staehler MD, Hamberg P, Bigot P, Suárez C, Barthelemy P, Eymard JC, Laramas M, Taguieva Pioger N, Gross-Goupil M, Rink M, Masini C, De Vivo R, Gajate P, Azzabi A, Procopio G. CASSIOPE: A real-world study assessing the use of cabozantinib for the treatment of advanced renal cell carcinoma (aRCC) after vascular endothelial growth factor (VEGF)-targeted therapy in Europe. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.6_suppl.tps770] [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
TPS770 Background: Cabozantinib, an inhibitor of multiple receptor tyrosine kinases including VEGF receptor 2, and MET and AXL receptors, is approved for the treatment of aRCC in the USA and, in Europe, in treatment-naïve patients with intermediate or poor risk, as well as following VEGF-targeted therapy. The METEOR trial investigated cabozantinib as second-line (2L) or later-line therapy and showed improved progression-free survival (PFS), objective response rate and overall survival vs everolimus. Adverse events (AEs) associated with cabozantinib were generally manageable in METEOR; dose interruptions and reductions occurred in 70% and 60% of patients, respectively. Here we present the design of the CASSIOPE study which aims to assess the real-life use of cabozantinib as 2L or third- or later-line (≥ 3L) therapy for aRCC. Methods: CASSIOPE is an ongoing, European, prospective, non-interventional study in adults with aRCC who have received ≥ 1 prior VEGF-targeted therapy and are initiating cabozantinib as 2L or ≥ 3L therapy according to Summary of Product Characteristics. The primary endpoint is the proportion of patients with dose modifications (interruption, reduction or discontinuation) due to AEs. Secondary endpoints include additional drug utilization parameters, effectiveness (overall best response, PFS), and healthcare resource utilization associated with managing treatment-related AEs. Overall, 680 patients (340 on 2L therapy; 340 on ≥ 3L therapy) will be enrolled to assess the 2-sided 95% confidence interval of the primary endpoint with a precision of ± 5%, assuming a 75% dose modification rate and ≤15% of starting doses lower than 60 mg. Visits will be based on the site's clinical practice, with a maximum follow-up of 12 months after treatment initiation, even if treatment is continued. Data collection started in April 2018. As of 9 October 2019, 336 patients have been enrolled. The overall study duration is expected to be 36 months. An interim analysis is planned when ≥ 340 patients have completed ≥ 3 months follow-up from treatment initiation. The study is funded by Ipsen Pharma. Clinical trial information: NCT03419572; EUPAS19464.
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Affiliation(s)
- Michael D. Staehler
- University Hospital Munich-Grosshadern, Ludwig Maximilian University, Munich, Germany
| | - Paul Hamberg
- Department of Internal Medicine, Franciscus Gasthuis & Vlietland, Rotterdam, Netherlands
| | - Pierre Bigot
- Service d’Urologie CHU Angers, Université d’Angers, Angers, France
| | - Cristina Suárez
- Vall d'Hebron University Hospital and Institute of Oncology, Barcelona, Spain
| | | | | | | | | | - Marine Gross-Goupil
- Oncology Department, Centre Hospitalier Universitaire, Bordeaux, Aquitaine, France
| | - Michael Rink
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Cristina Masini
- Medical Oncology Unit, Clinical Cancer Centre,AUSL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Rocco De Vivo
- Department of Oncology, San Bortolo General Hospital, Vicenza, Italy
| | - Pablo Gajate
- Medical Oncology Department, Ramón y Cajal University Hospital, Madrid, Spain
| | - Ashraf Azzabi
- Northern Centre for Cancer Care, Newcastle upon Tyne, United Kingdom
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10
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Iacovelli R, Buti S, Buttigliero C, De Vivo R, Caserta C, Ferraú F, Galli L, Martelli V, Masini C, Mattioli R, Merler S, Milesi L, Naglieri E, Ricotta R, Rizzo M, Sacco C, Santini D, Tambaro R, Verri E, Santoni M. Avelumab as single agent for patients with metastatic or locally advanced urothelial cancer PD-L1+ unfit for cisplatin: The ARIES study. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.6_suppl.tps596] [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
TPS596 Background: Urothelial cancer (UC) is the ninth most common cancer worldwide, this tumour has a poor prognosis when in advanced stage. Cisplatin-based chemotherapy is considered the most effective treatment but more than 50% of patients are considered not eligible ( cis-unfit) for this regimen and have a median survival of only 6-9 months. In the past years, the most used chemotherapy regimen for cis-unfit patients was the combination of carboplatin and gemcitabine. Two single arm studies tested the anti-PD-L1/PD1 monoclonal antibodies atezolizumab and pembrolizumab and reported a response rate of 25% with good safety profile in an unselected population for PD-L1 expression. Recently, atezolizumab alone showed longer OS compared to carboplatin-gemcitabine regimen. Avelumab is another fully human anti-PD-L1 IgG1 antibody already tested in urothelial and in other cancers with a promising safety and efficacy profile. Methods: The single arm, phase II ARIES trial (NCT03891238), aims to evaluate the activity and efficacy of avelumab in patients with metastatic or locally advanced UC considered cis-unfit with PD-L1 expression ≥5%. Overall survival is the primary endpoint. Cis-unfit definition includes at least one of the following characteristics (i) ECOG-Performance status=2; (ii) creatinine clearance <60 ml/min; (iii) grade ≥2 peripheral neuropathy or hearing loss; (iv) disease progression within six months after a previous adjuvant/neoadjuvant treatment with cisplatin-based therapy. Avelumab will be administered at standard dose of 10 mg/kg in 1-hour intravenous infusion every 2 weeks (Q2W). Sixty-seven patients will be enrolled, and supportive care is allowed during the study. Avelumab may be continued after radiological progression of disease at physician’s discretion if an improvement of symptoms or not new symptoms will be reported. The study is currently ongoing in twenty centres in Italy. Clinical trial information: NCT03891238.
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Affiliation(s)
| | - Sebastiano Buti
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Consuelo Buttigliero
- Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy
| | | | | | - Francesco Ferraú
- Medical Oncology Department, Ospedale S Vincenzo, Taormina, Italy
| | - Luca Galli
- Azienda Ospedaliero-Universitaria Pisana, Istituto Toscano Tumori, Pisa, Italy
| | - Valentino Martelli
- Medical Oncology Unit 1, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale Policlinico San Martino, Genova, Italy
| | - Cristina Masini
- Medical Oncology Unit, IRCCS-Arcispedale S. Maria Nuova, Reggio Emilia, Italy
| | | | - Sara Merler
- Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Laura Milesi
- Oncologia Medica Asst Papa Giovanni XXIII, Bergamo, Italy
| | - Emanuele Naglieri
- Division of Medical Oncology, Istituto Tumori Bari Giovanni Paolo II - IRCCS, Bari, Italy
| | | | - Mimma Rizzo
- Division of Translational Oncology, IRCCS Istituti Clinici Scientifici Maugeri, Pavia, Italy
| | - Cosimo Sacco
- Dipartimento di Oncologia, Azienda Ospedaliero-Universitaria S. M. della Misericordia, Udine, Italy
| | - Daniele Santini
- Department of Medical Oncology, Campus Bio-Medico-University of Rome, Rome, Italy
| | - Rosa Tambaro
- Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Naples, Italy
| | - Elena Verri
- Medical Oncology Division of Urogenital and Head and Neck Tumors. European Institute of Oncology, Milan, Italy
| | - Matteo Santoni
- Medical Oncology Unit, Macerata General Hospital, Macerata, Italy
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11
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Lorusso D, Bologna A, Cecere SC, De Matteis E, Scandurra G, Zamagni C, Arcangeli V, Artioli F, Bella M, Blanco G, Cardalesi C, Casartelli C, De Vivo R, Di Napoli M, Gisone EB, Lauria R, Lissoni AA, Loizzi V, Maccaroni E, Mangili G, Marchetti C, Martella F, Naglieri E, Parolin V, Ricciardi G, Ronzino G, Salutari V, Scarfone G, Secondino S, Spagnoletti I, Tasca G, Tognon G, Guarneri V. Sharing real-world experiences to optimize the management of olaparib toxicities: a practical guidance from an Italian expert panel. Support Care Cancer 2020; 28:2435-2442. [PMID: 32048043 DOI: 10.1007/s00520-020-05320-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 01/17/2020] [Indexed: 11/28/2022]
Abstract
Olaparib is the first poly(ADP-ribose) polymerase inhibitor approved as maintenance therapy of recurrent ovarian cancer (OC) patients with a BRCA mutation. To achieve the maximum clinical benefit, adherence to olaparib must be persistent. However, in clinical practice, this is challenged by the frequent suboptimal management of toxicities. In view of the expanding use of olaparib also in Italy, physicians must learn how to adequately and promptly manage drug toxicities not to unnecessarily interrupt or reduce the dose. The experts agreed that nausea,vomiting, anemia, and fatigue are the most frequent events experienced by OC patients on olaparib, and that these toxicities usually develop early during treatment, are mainly of grade 1-2 and transient and can be managed with simple non-pharmacological interventions. By sharing their real-world experiences, the panel prepared, for each toxicity, an algorithm organized by grade and besides the procedures indicated in the local label, included supportive care interventions based also on nutritional and lifestyle modifications and psycho-oncology consultation. Moreover, in view of the tablet entry into the Italian market, the full and reduced dosages of capsules and tablets were compared. This practical guidance is intended to be a tool to support especially less-experienced physicians in the management of these complex patients, with the aim to help preventing the worsening of patients' conditions and the unnecessary interruption/reduction of olaparib dosage, which may jeopardize treatment efficacy.
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Affiliation(s)
- Domenica Lorusso
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy.
| | - Alessandra Bologna
- Oncologia Medica, IRCCS Arcispedale S. Maria Nuova, Viale Risorgimento, 80, 42123, Reggio Emilia, Italy
| | - Sabrina Chiara Cecere
- Oncologia Clinica Sperimentale Uro-Ginecologica, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, Via Mariano Semmola, 53, 80131, Naples, Italy
| | | | - Giusy Scandurra
- Multidisciplinary Breast Unit, Azienda Ospedaliera Cannizzaro, Via Messina, 829, 95126, Catania, Italy
| | - Claudio Zamagni
- Medical Oncology Unit, S.Orsola-Malpighi Hospital, Viale Ercolani 4/2, Bologna, Italy
| | - Valentina Arcangeli
- U.O. Oncologia, Ospedale Infermi Rimini, AUSL Romagna, viale Settembrini 2, 47923, Rimini, Italy
| | - Fabrizio Artioli
- Oncology Dept., Carpi and Mirandola Hospitals, Via G. Molinari 2, 41012, Carpi, Italy
| | - Mariangela Bella
- Medical Oncology Unit, University Hospital of Parma, Viale Antonio Gramsci, 14, 43126, Parma, Italy
| | - Giusi Blanco
- Oncology Unit, Ist. Oncologico del Mediterraneo, Via Penninazzo, 7, Viagrande, 95029, Catania, Italy
| | - Cinzia Cardalesi
- Dept. of Clinical and Surgical Medicine, Federico II University Hospital, Via Pansini 5, 80131, Naples, Italy
| | - Clelia Casartelli
- Medical Oncology Unit, Ospedale Valduce, Via Dante Alighieri, 11, 22100, Como, Italy
| | - Rocco De Vivo
- Medical Oncology Unit, AULSS 8 Vicenza, viale Rodolfi, 37, 36100, Vicenza, Italy
| | - Marilena Di Napoli
- Oncologia Clinica Sperimentale Uro-Ginecologica, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, Via Mariano Semmola, 53, 80131, Naples, Italy
| | - Emanuele Baldo Gisone
- Dept of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Via del Ponte, 19, 21100, Varese, Italy
| | - Rossella Lauria
- Dept. of Clinical and Surgical Medicine, Federico II University Hospital, Via Pansini 5, 80131, Naples, Italy
| | - Alberto Andrea Lissoni
- Dept of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, 20900, Monza, Italy.,Clinic of Obstetrics and Gynecology, San Gerardo Hospital, Via Pergolesi 33, 20900, Monza, Italy
| | - Vera Loizzi
- Dept of Biomedical Sciences and Medical Oncology, University of Bari "Aldo Moro", Piazza Umberto I 1, 70124, Bari, Italy
| | - Elena Maccaroni
- Clinica Oncologica, AOU Ospedali Riuniti Ancona, via Conca 71, , 60020, Ancona, AN, Italy
| | - Giorgia Mangili
- Obstetrics and Gynecology, San Raffaele Hospital, Via Olgettina Milano, 60, 20132, Milan, Italy
| | - Claudia Marchetti
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Francesca Martella
- Breast Unit, Ospedale S.M. Annunziata, USL Toscana Centro, Via dell'Antella, 58, Bagno a Ripoli, 50012, Florence, Italy
| | - Emanuele Naglieri
- Division of Medical Oncology, IRCCS Istituto Oncologico Giovanni Paolo II, Viale Orazio Flacco, 65, 70124, Bari, Italy
| | - Veronica Parolin
- Breast Uni, Azienda Ospedaliera Universitaria Integrata, Piazzale Aristide Stefani, 1, 37126, Verona, Italy
| | - Giusy Ricciardi
- Medical Oncology, AO Papardo, Contrada Papardo, 98158, Messina, Italy
| | - Graziana Ronzino
- Dept. of Oncology, Vito Fazzi Hospital, Piazzetta Muratore, 73100, Lecce, Italy
| | - Vanda Salutari
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Giovanna Scarfone
- Dept of Obstetrics, Gynecology and Neonatology, IRCCS Fondazione Cà Granda, Ospedale Maggiore Policlinico, via F. Sforza 28, Milan, Italy
| | - Simona Secondino
- Fondazione IRCCS Policlinico San Matteo, Viale Camillo Golgi, 19, 27100, Pavia, Italy
| | - Ilaria Spagnoletti
- Medical Oncology Unit, Ospedale Sacro Cuore di Gesù, Fatebenefratelli, Viale Principe di Napoli, 14/A, 82100, Benevento, Italy
| | - Giulia Tasca
- Division of Medical Oncology 2, Istituto Oncologico Veneto, Via Gattamelata, 64, 35128, Padua, Italy
| | - Germana Tognon
- UO Ostetricia e Ginecologia-ASST degli Spedali Civili di Brescia, Università degli Studi, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - Valentina Guarneri
- Division of Medical Oncology 2, Istituto Oncologico Veneto, Via Gattamelata, 64, 35128, Padua, Italy
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12
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Facchini G, Rossetti S, Berretta M, Cavaliere C, Scagliarini S, Vitale MG, Ciccarese C, Di Lorenzo G, Palesandro E, Conteduca V, Basso U, Naglieri E, Farnesi A, Aieta M, Borsellino N, La Torre L, Iovane G, Bonomi L, Gasparro D, Ricevuto E, De Tursi M, De Vivo R, Lo Re G, Grillone F, Marchetti P, De Vita F, Scavelli C, Sini C, Pisconti S, Crispo A, Gebbia V, Maestri A, Galli L, De Giorgi U, Iacovelli R, Buonerba C, Cartenì G, D'Aniello C. Second line therapy with axitinib after only prior sunitinib in metastatic renal cell cancer: Italian multicenter real world SAX study final results. J Transl Med 2019; 17:296. [PMID: 31464635 PMCID: PMC6716812 DOI: 10.1186/s12967-019-2047-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 08/22/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND This multi-institutional retrospective real life study was conducted in 22 Italian Oncology Centers and evaluated the role of Axitinib in second line treatment in not selected mRCC patients. METHODS 148 mRCC patients were evaluated. According to Heng score 15.5%, 60.1% and 24.4% of patients were at poor risk, intermediate and favorable risk, respectively. RESULTS PFS, OS, DCR and ORR were 7.14 months, 15.5 months, 70.6% and 16.6%, respectively. The duration of prior sunitinib treatment correlated with a longer significant mPFS, 8.8 vs 6.3 months, respectively. Axitinib therapy was safe, without grade 4 adverse events. The most frequent toxicities of all grades were: fatigue (50%), hypertension (26%), and hypothyroidism (18%). G3 blood pressure elevation significantly correlated with longer mPFS and mOS compared to G1-G2 or no toxicity. Dose titration (DT) to 7 mg and 10 mg bid was feasible in 24% with no statistically significant differences in mPFS and mOS. The sunitinib-axitinib sequence was safe and effective, the mOS was 41.15 months. At multivariate analysis, gender, DCR to axitinib and to previous sunitinib correlated significantly with PFS; whereas DCR to axitinib, nephrectomy and Heng score independently affected overall survival. CONCLUSIONS Axitinib was effective and safe in a not selected real life mRCC population. Trial registration INT - Napoli - 11/16 oss. Registered 20 April 2016. http://www.istitutotumori.na.it.
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Affiliation(s)
- Gaetano Facchini
- Departmental Unit of Clinical and Experimental Uro-Andrologic Oncology, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Via M. Semmola, 80131, Napoli, Italy.
| | - Sabrina Rossetti
- Departmental Unit of Clinical and Experimental Uro-Andrologic Oncology, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Via M. Semmola, 80131, Napoli, Italy
| | - Massimiliano Berretta
- Department of Medical Oncology, Centro di Riferimento Oncologico, Istituto Nazionale Tumori CRO, Aviano, PN, Italy
| | - Carla Cavaliere
- UOC of Medical Oncology ASL NA 3 SUD Ospedali Riuniti Area Nolana, Naples, Italy
| | - Sarah Scagliarini
- Division of Oncology, Azienda Ospedaliera di Rilievo Nazionale A. Cardarelli, Naples, Italy
| | - Maria Giuseppa Vitale
- Division of Medical Oncology, Azienda Ospedaliera Universitaria Policlinico di Modena, Modena, Italy
| | - Chiara Ciccarese
- Medical Oncology, Azienda Ospedaliera Universitaria Integrata, University of Verona, Verona, Italy
| | - Giuseppe Di Lorenzo
- Department of Clinical Medicine and Surgery, Università degli Studi di Napoli Federico II, Naples, Italy
| | - Erica Palesandro
- Division of Medical Oncology, Candiolo Cancer Institute-FPO, IRCCS, Candiolo, Italy
| | - Vincenza Conteduca
- Department of Oncology, IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (I.R.S.T.), Meldola, Italy
| | - Umberto Basso
- Medical Oncology Unit 1, Istituto Oncologico Veneto IOV IRCCS, Padua, Italy
| | - Emanuele Naglieri
- Division of Medical Oncology, Istituto Oncologico Giovanni Paolo II, Bari, Italy
| | - Azzurra Farnesi
- University Hospital of Pisa, Oncology Unit 2, Pisa, Pisa, Italy
| | - Michele Aieta
- Medical Oncology Department, National Institute of Cancer, Rionero in Vulture, Italy
| | | | - Leonardo La Torre
- Medical Oncology Department, "Santa Maria della Scaletta" Hospital AUSL, Imola, Italy
| | - Gelsomina Iovane
- Departmental Unit of Clinical and Experimental Uro-Andrologic Oncology, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Via M. Semmola, 80131, Napoli, Italy
| | - Lucia Bonomi
- Oncology Department, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | | | - Enrico Ricevuto
- S. Salvatore Hospital, ASL1 Abruzzo, University of L'Aquila, L'Aquila, Italy
| | - Michele De Tursi
- Oncology and Experimental Medicine, "G. D'Annunzio" University, Chieti, Italy
| | | | | | - Francesco Grillone
- Medical Oncology Unit Azienda Ospedaliera "Mater Domini", Catanzaro, Italy
| | | | - Ferdinando De Vita
- Division of Medical Oncology, University of Campania "L. Vanvitelli", Napoli, Italy
| | - Claudio Scavelli
- Medical Oncology Unit, "S. Cuore di Gesù" Hospital, Gallipoli, Italy
| | | | | | - Anna Crispo
- Departmental Unit of Clinical and Experimental Uro-Andrologic Oncology, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Via M. Semmola, 80131, Napoli, Italy
| | - Vittorio Gebbia
- Medical Oncology Unit, La Maddalena Clinic for Cancer, University of Palermo, Palermo, Italy
| | - Antonio Maestri
- Medical Oncology Department, "Santa Maria della Scaletta" Hospital AUSL, Imola, Italy
| | - Luca Galli
- University Hospital of Pisa, Oncology Unit 2, Pisa, Pisa, Italy
| | - Ugo De Giorgi
- Department of Oncology, IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (I.R.S.T.), Meldola, Italy
| | - Roberto Iacovelli
- Medical Oncology, Azienda Ospedaliera Universitaria Integrata, University of Verona, Verona, Italy
| | - Carlo Buonerba
- Department of Clinical Medicine and Surgery, Università degli Studi di Napoli Federico II, Naples, Italy
| | - Giacomo Cartenì
- Division of Oncology, Azienda Ospedaliera di Rilievo Nazionale A. Cardarelli, Naples, Italy
| | - Carmine D'Aniello
- Division of Medical Oncology, AORN Dei Colli "Ospedali Monaldi-Cotugno-CTO", Napoli, Italy
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13
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Maruzzo M, Basso U, Borsatti E, Evangelista L, Alongi F, Caffo O, Maines F, Galuppo S, De Vivo R, Zustovich F, Palleschi D, Zivi A, Sava T, Sorarù M, Iacovelli R, Nicodemo M, Baier S, Fratino L, Zagonel V. Results From a Large, Multicenter, Retrospective Analysis On Radium223 Use in Metastatic Castration-resistant Prostate Cancer (mCRPC) in the Triveneto Italian Region. Clin Genitourin Cancer 2019; 17:e187-e194. [DOI: 10.1016/j.clgc.2018.10.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Revised: 10/08/2018] [Accepted: 10/21/2018] [Indexed: 10/28/2022]
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14
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Montagnani F, Crivelli F, Aprile G, Vivaldi C, Pecora I, De Vivo R, Clerico MA, Fornaro L. Long-term survival after liver metastasectomy in gastric cancer: Systematic review and meta-analysis of prognostic factors. Cancer Treat Rev 2018; 69:11-20. [PMID: 29860024 DOI: 10.1016/j.ctrv.2018.05.010] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 05/15/2018] [Accepted: 05/16/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND Despite the amelioration of systemic therapy, overall survival (OS) of metastatic gastric cancer (GC) patients remains poor. Liver is a common metastatic site and retrospective series suggest a potential OS benefit from hepatectomy, with interesting 5-year (5 y) and 10-year (10 y) OS rates in selected patients. We aim to evaluate the impact of liver resection and related prognostic factors on long-term outcome in this setting. METHODS We searched Pubmed, EMBASE, and Abstracts/posters from international meetings since 1990. Data were extracted from publish papers. Random effects models meta-analyses and meta-regression models were built to assess 5yOS and the impact of different prognostic factor. Heterogeneity was assessed using between study variance, I2 and Cochran's Q. Funnel plot were used to assess small study bias. RESULTS Thirty-three observational studies (for a total of 1304 patients) were included. Our analysis demonstrates a 5yOS rate of 22% (95%CI: 18-26%) and 10yOS rate of 11% (95%CI: 7-18%) among patients undergoing radical hepatectomy. A favorable effect on OS was shown by several factors linked to primary cancer (lower T and N stage, no lympho-vascular or serosal invasion) and burden of hepatic disease (≤3 metastases, unilobar involvement, greatest lesion < 5 cm, negative resection margins). Moreover, lower CEA and CA19.9 levels and post-resection chemotherapy were associated with improved OS. CONCLUSIONS Surgical resection of liver metastases from GC seems associated with a significant chance of 5yOS and 10yOS and compares favourably with results of medical treatment alone. Prospective evaluation of this approach and validation of adequate selection criteria are needed.
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Affiliation(s)
- Francesco Montagnani
- Department of Oncology, Azienda Sanitaria locale di Biella, Ponderano (BI), Italy.
| | | | - Giuseppe Aprile
- Department of Oncology, Ospedale San Bortolo, Azienda ULSS8 Berica - Distretto Est, Vicenza, Italy
| | - Caterina Vivaldi
- Unit of Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Irene Pecora
- Unit of Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Rocco De Vivo
- Department of Oncology, Ospedale San Bortolo, Azienda ULSS8 Berica - Distretto Est, Vicenza, Italy
| | | | - Lorenzo Fornaro
- Unit of Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
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15
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Verzoni E, De Giorgi U, Derosa L, Caffo O, Boccardo F, Facchini G, Porcu L, De Vincenzo F, Zaniboni A, Chiuri VE, Fratino L, Santini D, Adamo V, De Vivo R, Dinota A, Messina C, Ricotta R, Caserta C, Scavelli C, Susi M, Tartarone A, Surace G, Mosca A, Bruno M, Barni S, Grassi P, Procopio G. Predictors of long-term response to abiraterone in patients with metastastic castration-resistant prostate cancer: a retrospective cohort study. Oncotarget 2018; 7:40085-40094. [PMID: 27223078 PMCID: PMC5129994 DOI: 10.18632/oncotarget.9485] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Accepted: 04/10/2016] [Indexed: 12/19/2022] Open
Abstract
We aimed to identify clinical predictors of long-term response to abiraterone (defined as >12 months drug exposure) in a retrospective cohort of metastatic castration-resistant prostate cancer patients treated in post-docetaxel setting at 24 Italian centers. The Cox proportional hazards model was used to analyze the association between clinical features and the duration of drug exposure. Results were expressed as hazard ratios (HR) with associated 95% confidence intervals (CI). A total of 143 patients met the inclusion criteria. Their median age was 73 years, median Gleason score 8 and median abiraterone exposure 20 months. At the univariate analysis, a significant correlation with the duration of abiraterone exposure was found for Gleason score (HR 0.82, 95% CI 0.71-0.96; p=0.012), PSA (HR 1.10, 95% CI 1.03-1.18; p=0.08) and lactic dehydrogenase levels (HR 1.22, 95% CI 1.02-1.46; p=0.027), while the association between lower alkaline phosphatase levels and treatment duration was marginally significant (HR 1.07, 95% CI 0.99-1.16; p=0.074). Only PSA and Gleason score were predictive of long-term treatment duration in the multivariate analysis. No other clinical factors resulted to be predictive of sustained response to abiraterone, including metastatic disease at diagnosis and visceral disease, suggesting that all subgroups of patients may derive a substantial clinical benefit from abiraterone treatment. These findings need to be validated in prospective, larger studies.
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Affiliation(s)
- Elena Verzoni
- Unit of Medical Oncology 1, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Ugo De Giorgi
- Department of Medical Oncology, IRST, IRCCS, Meldola, Italy
| | - Lisa Derosa
- Unit of Medical Oncology 2, Istituto Toscano Tumori, Pisa, Italy
| | | | | | - Gaetano Facchini
- Unit of Medical Oncology, Department of Uro-Gynecological Oncology, Istituto Nazionale Tumori, Fondazione G. Pascale IRCCS, Naples, Italy
| | - Luca Porcu
- Department of Oncology, IRCCS- Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | | | | | | | | | | | | | | | | | | | - Riccardo Ricotta
- Niguarda Cancer Center, Ospedale Niguarda Ca' Granda, Milan, Italy
| | | | | | - Marina Susi
- Ospedale Madonna delle Grazie, Matera, Italy
| | - Alfredo Tartarone
- IRCCS Centro di Riferimento Oncologico della Basilicata (CROB), Rionero in Vulture, Italy
| | | | | | | | | | - Paolo Grassi
- Unit of Medical Oncology 1, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Giuseppe Procopio
- Unit of Medical Oncology 1, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
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16
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D'Aniello C, Vitale MG, Farnesi A, Calvetti L, Laterza MM, Cavaliere C, Della Pepa C, Conteduca V, Crispo A, De Vita F, Grillone F, Ricevuto E, De Tursi M, De Vivo R, Di Napoli M, Cecere SC, Iovane G, Amore A, Piscitelli R, Quarto G, Pisconti S, Ciliberto G, Maiolino P, Muto P, Perdonà S, Berretta M, Naglieri E, Galli L, Cartenì G, De Giorgi U, Pignata S, Facchini G, Rossetti S. Axitinib after Sunitinib in Metastatic Renal Cancer: Preliminary Results from Italian "Real-World" SAX Study. Front Pharmacol 2016; 7:331. [PMID: 27733829 PMCID: PMC5039205 DOI: 10.3389/fphar.2016.00331] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 09/07/2016] [Indexed: 12/20/2022] Open
Abstract
Axitinib is an oral angiogenesis inhibitor, currently approved for treatment of metastatic renal cell carcinoma (mRCC) after failure of prior treatment with Sunitinib or cytokine. The present study is an Italian Multi-Institutional Retrospective Analysis that evaluated the outcomes of Axitinib, in second-line treatment of mRCC. The medical records of 62 patients treated with Axitinib, were retrospectively reviewed. The Progression Free Survival (PFS), the Overall Survival (OS), the Objective Response Rate (ORR), the Disease Control Rate (DCR), and the safety profile of axitinib and sunitinib–axitinib sequence, were the primary endpoint. The mPFS was 5.83 months (95% CI 3.93–7.73 months). When patients was stratified by Heng score, mPFS was 5.73, 5.83, 10.03 months according to poor, intermediate, and favorable risk group, respectively. The mOS from the start of axitinib was 13.3 months (95% CI 8.6–17.9 months); the observed ORR and DCR were 25 and 71%, respectively. When stratified patients by subgroups defined by duration of prior therapy with Sunitinib (≤ vs. >median duration), there was a statistically significant difference in mPFS with 8.9 (95% CI 4.39–13.40 months) vs. 5.46 months (95% CI 4.04–6.88 months) for patients with a median duration of Sunitinib >13.2 months. DCR and ORR to previous Sunitinib treatment was associated with longer statistically mPFS, 7.23 (95% CI 3.95–10.51 months, p = 0.01) and 8.67 (95% CI 4.0–13.33 months, p = 0.008) vs. 2.97 (95% CI 0.65–5.27 months, p = 0.01) and 2.97 months (95% CI 0.66–5.28 months, p = 0.01), respectively. Overall Axitinib at standard schedule of 5 mg bid, was well-tolerated. The most common adverse events of all grades were fatig (25.6%), hypertension (22.6%), gastro-intestinal disorders (25.9%), and hypothyroidism (16.1%). The sequence Sunitinib–Axitinib was well-tolerated without worsening in side effects, with a median OS of 34.7 months (95% CI 18.4–51.0 months). Our results are consistent with the available literature; this retrospective analysis confirms that Axitinib is effective and safe in routine clinical practice.
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Affiliation(s)
- Carmine D'Aniello
- Oncology Unit, A.O.R.N. dei COLLI "Ospedali Monaldi-Cotugno-CTO," Naples, Italy
| | | | | | | | - Maria M Laterza
- Division of Medical Oncology, Department of Internal and Experimental Medicine "F. Magrassi," Second University of Naples - School of Medicine Naples, Italy
| | - Carla Cavaliere
- Department of Onco-Hematology Medical Oncology, S.G. Moscati Hospital of Taranto Taranto, Italy
| | - Chiara Della Pepa
- Department of Uro-Gynaecological Oncology, Division of Medical Oncology, Istituto Nazional Tumori IRCCS "Fondazione G. Pascale," Naples, Italy
| | - Vincenza Conteduca
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori IRCCS Meldola, Italy
| | - Anna Crispo
- Unit of Epidemiology, Struttura Complessa di Statistica Medica, Biometria e Bioinformatica, Istituto Nazionale Tumori IRCCS "Fondazione G. Pascale," Naples, Italy
| | - Ferdinando De Vita
- Division of Medical Oncology, Department of Internal and Experimental Medicine "F. Magrassi," Second University of Naples - School of Medicine Naples, Italy
| | - Francesco Grillone
- Medical Oncology Unit, Azienda Ospedaliera "Mater Domini," Catanzaro, Italy
| | - Enrico Ricevuto
- Oncology Network ASL1 Abruzzo, Oncology Territorial Care Unit, Division of Medical Oncology, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila L'Aquila, Italy
| | - Michele De Tursi
- Department of Medical, Oral and Biotechnological Sciences, University "G. D'Annunzio," Chieti, Italy
| | | | - Marilena Di Napoli
- Department of Uro-Gynaecological Oncology, Division of Medical Oncology, Istituto Nazional Tumori IRCCS "Fondazione G. Pascale," Naples, Italy
| | - Sabrina C Cecere
- Department of Uro-Gynaecological Oncology, Division of Medical Oncology, Istituto Nazional Tumori IRCCS "Fondazione G. Pascale," Naples, Italy
| | - Gelsomina Iovane
- Department of Uro-Gynaecological Oncology, Division of Medical Oncology, Istituto Nazional Tumori IRCCS "Fondazione G. Pascale," Naples, Italy
| | - Alfonso Amore
- Hepatobiliary Unit, Division of Abdominal Surgical Oncology, National Cancer Institute "G. Pascale Foundation," IRCCS Naples, Italy
| | - Raffaele Piscitelli
- Pharmacy Unit, Istituto Nazionale Tumori IRCCS "Fondazione G. Pascale," Naples, Italy
| | - Giuseppe Quarto
- Division of Urology, Department of Uro-Gynaecological Oncology, Istituto Nazionale Tumori IRCCS "Fondazione G. Pascale," Naples, Italy
| | - Salvatore Pisconti
- Department of Onco-Hematology Medical Oncology, S.G. Moscati Hospital of Taranto Taranto, Italy
| | - Gennaro Ciliberto
- Scientific Direction, Istituto Nazionale Tumori IRCCS "Fondazione G. Pascale," Naples, Italy
| | - Piera Maiolino
- Pharmacy Unit, Istituto Nazionale Tumori IRCCS "Fondazione G. Pascale," Naples, Italy
| | - Paolo Muto
- Division of Radiation Oncology, Istituto Nazionale Tumori IRCCS "Fondazione G. Pascale," Naples, Italy
| | - Sisto Perdonà
- Division of Urology, Department of Uro-Gynaecological Oncology, Istituto Nazionale Tumori IRCCS "Fondazione G. Pascale," Naples, Italy
| | | | - Emanuele Naglieri
- Division of Medical Oncology, Istituto Oncologico Giovanni Paolo II Bari, Italy
| | - Luca Galli
- Oncology Unit 2, University Hospital of Pisa Pisa, Italy
| | | | - Ugo De Giorgi
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori IRCCS Meldola, Italy
| | - Sandro Pignata
- Department of Uro-Gynaecological Oncology, Division of Medical Oncology, Istituto Nazional Tumori IRCCS "Fondazione G. Pascale," Naples, Italy
| | - Gaetano Facchini
- Department of Uro-Gynaecological Oncology, Division of Medical Oncology, Istituto Nazional Tumori IRCCS "Fondazione G. Pascale," Naples, Italy
| | - Sabrina Rossetti
- Department of Uro-Gynaecological Oncology, Division of Medical Oncology, Istituto Nazional Tumori IRCCS "Fondazione G. Pascale," Naples, Italy
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17
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Caffo O, Lo Re G, Sava T, Buti S, Sacco C, Basso U, Zustovich F, Lodde M, Perin A, Facchini G, Veccia A, Maines F, Barile C, Fratino L, Gernone A, De Vivo R, Pappagallo GL, Galligioni E. Intermittent docetaxel chemotherapy as first-line treatment for metastatic castration-resistant prostate cancer patients. Future Oncol 2015; 11:965-73. [PMID: 25760977 DOI: 10.2217/fon.14.284] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIMS The intermittent administration of chemotherapy is a means of preserving patients' quality of life (QL). The aim of this study was to verify whether the intermittent administration of docetaxel (DOC) improves the patients' QL. PATIENTS & METHODS All patients received DOC 70 mg/m(2) every 3 weeks for eight cycles. The patients were randomized to receive DOC continuously or with a fixed 3-month interval after the first four DOC courses. RESULTS The study involved 148 patients. There was no difference in QL between the groups receiving intermittent or continuous treatment. Intermittence had no detrimental effects on disease control. CONCLUSION Although feasible and not detrimental, our results showed that true intermittent chemotherapy in metastatic castration-resistant prostate cancer patients failed to improve the patients' QL.
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Affiliation(s)
- Orazio Caffo
- Medical Oncology Department, Santa Chiara Hospital, Trento, Italy
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18
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Santoni M, Conti A, Porta C, Procopio G, Sternberg CN, Basso U, De Giorgi U, Bracarda S, Rizzo M, Ortega C, Massari F, Iacovelli R, Derosa L, Masini C, Milella M, Di Lorenzo G, Atzori F, Pagano M, Buti S, De Vivo R, Mosca A, Rossi M, Paglino C, Verzoni E, Cerbone L, Muzzonigro G, Falconi M, Montironi R, Burattini L, Santini D, Cascinu S. Sunitinib, Pazopanib or Sorafenib for the Treatment of Patients with Late Relapsing Metastatic Renal Cell Carcinoma. J Urol 2015; 193:41-7. [DOI: 10.1016/j.juro.2014.07.011] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2014] [Indexed: 01/17/2023]
Affiliation(s)
- Matteo Santoni
- Clinica di Oncologia Medica, AOU Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy
| | - Alessandro Conti
- Dipartimento di Scienze Cliniche Specialistiche ed Odontostomatologiche, Clinica di Urologia, AOU Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy
| | - Camillo Porta
- Medical Oncology, IRCCS San Matteo University Hospital Foundation, Pavia, Italy
| | - Giuseppe Procopio
- Department of Medical Oncology, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milan, Italy
| | - Cora N. Sternberg
- Department of Medical Oncology, San Camillo and Forlanini Hospitals, Rome, Italy
| | - Umberto Basso
- Medical Oncology 1, Istituto Oncologico Veneto, IRCCS, Padova, Italy
| | - Ugo De Giorgi
- IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori-I.R.S.T., Meldola (FC), Italy
| | - Sergio Bracarda
- Department of Oncology, Istituto Toscano Tumori, Ospedale San Donato USL-8, Arezzo, Italy
| | - Mimma Rizzo
- Department of Medical Oncology, Cardarelli Hospital, Napoli, Italy
| | - Cinzia Ortega
- Oncology Foundation of Piedmont, Institute for Cancer Research and Treatment, Laboratory Medicine, Candiolo, Italy
| | - Francesco Massari
- Medical Oncology, ‘G.B. Rossi’ Academic Hospital, University of Verona, Verona, Italy
| | - Roberto Iacovelli
- Department of Medical Oncology, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milan, Italy
| | - Lisa Derosa
- UO Oncologia Medica 2 Universitaria Azienda Ospedaliero-Universitaria Pisana Istituto Toscano Tumori, Pisa, Italy
| | - Cristina Masini
- Oncology Division, Department of Oncology and Hematology, University of Modena e Reggio Emilia, Modena, Italy
| | - Michele Milella
- Medical Oncology A, Regina Elena National Cancer Institute, Rome, Italy
| | - Giuseppe Di Lorenzo
- Genitourinary Cancer Section, Medical Oncology Division, Department of Endocrinology and Oncology, University Federico II, Napoli, Italy
| | - Francesco Atzori
- Medical Oncology Unit, Azienda Ospedaliero Universitaria of Cagliari, Cagliari, Italy
| | - Maria Pagano
- Department of Oncology, Oncology Unit, Azienda Ospedaliera AsMN, Istituto di Ricovero e cura a carattere scientifico, Reggio Emilia, Italy
| | - Sebastiano Buti
- Department of Oncology, University Hospital of Parma, Parma, Italy
| | - Rocco De Vivo
- Medical Oncology, S. Bortolo Hospital, Vicenza, Italy
| | - Alessandra Mosca
- Medical Oncology, Maggiore della Carità Hospital, University of Eastern Piedmont “A. Avogadro”, Novara, Italy
| | - Marta Rossi
- S.C. Oncologia Medica, Azienda Ospedaliera di Perugia, Ospedale S. Maria della Misericordia, Perugia, Italy
| | - Chiara Paglino
- Medical Oncology, IRCCS San Matteo University Hospital Foundation, Pavia, Italy
| | - Elena Verzoni
- Department of Medical Oncology, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milan, Italy
| | - Linda Cerbone
- Department of Medical Oncology, San Camillo and Forlanini Hospitals, Rome, Italy
| | - Giovanni Muzzonigro
- Dipartimento di Scienze Cliniche Specialistiche ed Odontostomatologiche, Clinica di Urologia, AOU Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy
| | - Massimo Falconi
- Division of Pancreatic and Digestive Surgery, Università Politecnica delle Marche, Ancona, Italy
| | - Rodolfo Montironi
- Section of Pathological Anatomy, Università Politecnica delle Marche, School of Medicine, AOU Ospedali Riuniti, Ancona, Italy
| | - Luciano Burattini
- Clinica di Oncologia Medica, AOU Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy
| | - Daniele Santini
- Oncologia Medica, University Campus Bio-Medico Roma, Rome, Italy
| | - Stefano Cascinu
- Clinica di Oncologia Medica, AOU Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy
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19
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Santoni M, Porta C, Procopio G, Cerbone L, Basso U, De Giorgi U, Rizzo M, Ortega C, Massari F, Iacovelli R, di Lorenzo G, Milella M, Sabbatini R, Atzori F, De Vivo R, Berardi R, Santini D, Cascinu S. Differences in terms of progression-free survival (PFS) and overall survival (OS) in patients treated with first-line sorafenib, sunitinib, and pazopanib for late relapsing (>5 years) renal cell carcinoma. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.4_suppl.421] [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
421 Background: Aim of this retrospective study was to investigate the clinico-pathological features and the outcome of patients (pts) with late relapsing renal cell carcinoma (LateR-RCC) treated with vascular endothelial growth factor receptor (VEGFR) tyrosine kinase inhibitor (TKI) as first line therapy. Methods: Data were collected from 19 Italian centers involved in the treatment of metastatic RCC. Late relapse was defined as >5 yr after initial radical nephrectomy. MSKCC prognostic categories were assessed before starting first-line treatment with VEGFR-TKI. Overall survival (OS) and progression free-survival (PFS) were estimated with the Kaplan-Meyer method with 95% CI and curves were compared with log-rank test. A Cox-regression model was applied to the data with a univariate and multivariate approach. Variables included in the univariate analysis were gender, age, time from surgery, MSKCC risk-group and targeted therapy employed at first line. Results: A total of 2,490 pts were screened and 269 pts (11%) were identified as LateR-RCC and treated with first-line VEGFR-TKI. Median age was 66 yr (range 29-87). Median time to recurrence was 7.9 yr. MSKCC prognostic category was good in 63% of pts, intermediate in 31% and poor in 6%. First-line therapy consisted of sunitinib in 190 pts (71%), sorafenib in 58 pts (21%) and pazopanib in 21 pts (8%). The median PFS was 20.0 months (95% CI 17.0−25.1) for sunitinib and 14.1 months for both sorafenib (95% CI 11.0−29.0) and pazopanib (95% CI 11.2−NR). At multivariate analysis, only MSKCC prognostic group was an independent prognostic factor for OS (HR: 2.07; 95% CI, 1.52–2.82 p < 0.001) and PFS (HR 2.54; 95% CI, 1.93−3.36 p < 0.001), whereas first line TKI was not significantly associated with OS (HR: 0.94; 95% CI, 0.38–1.82 p = 0.895) and PFS (HR 0.77; 95% CI, 0.43−1.99 p= 0.547). Conclusions: No significant differences were found in terms of OS and PFS in pts with LateR-RCC treated with first-line sorafenib, sunitinib or pazopanib. Our data may be considered in the long-term management of these patients.
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Affiliation(s)
- Matteo Santoni
- Medical Oncology, Polytechnic University of the Marche Region, Azienda Ospedaliero-Universitaria, Ospedali Riuniti Umberto I-GM Lancisi and G Salesi, Ancona, Italy
| | - Camillo Porta
- IRCCS San Matteo University Hospital Foundation, Pavia, Italy
| | | | | | - Umberto Basso
- Medical Oncology 1, Istituto Oncologico Veneto IOV - IRCCS, Padova, Italy
| | - Ugo De Giorgi
- IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (I.R.S.T.), Meldola, Italy
| | - Mimma Rizzo
- Medical Oncology, AORN Cardarelli, Napoli, Italy
| | - Cinzia Ortega
- Fondazione del Piemonte per l'Oncologia-Institute for Cancer Research and Treatment, Candiolo (Turin), Italy
| | - Francesco Massari
- Medical Oncology, Azienda Ospedaliera Universitaria Integrata, University of Verona, Verona, Italy
| | | | | | | | | | - Francesco Atzori
- Struttura Complessa di Oncologia Medica, A.O.U. di Cagliari, Cagliari, Italy
| | | | - Rossana Berardi
- Clinica di Oncologia Medica, A.O. Ospedali Riuniti-Università Politecnica delle Marche, Ancona, Italy
| | - Daniele Santini
- Department of Medical Oncology, Università Campus Bio-Medico, Rome, Rome, Italy
| | - Stefano Cascinu
- Clinica di Oncologia Medica, A.O. Ospedali Riuniti-Università Politecnica delle Marche, Ancona, Italy
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20
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Caffo O, Lo Re G, Sava T, Buti S, Sacco C, Basso U, Zustovich F, Martini T, Perin A, Veccia A, Russo L, Facchini G, Barile C, Gernone A, De Vivo R, Pappagallo GL, Galligioni E. Preliminary results of a factorial phase II randomized trial of continuous (C) or intermittent (I) docetaxel (DOC) with or without estramustine (E) as first-line treatment for castration-resistant prostate cancer (CRPC) (HOPLITE trial). J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.5_suppl.220] [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
220 Background: DOC given for 8 consecutive courses is considered a standard first line treatment for CRPC pts and I administration could reduce its impact on quality of life (QL). E is considered synergistic with DOC. Aim of this study was to evaluate in a 2 × 2 factorial design, if I DOC could improve QL compared to C DOC and whether E added to DOC could improve its activity. Methods: CRPC pts were randomized to: C DOC 70 mg/m2 i.v. q 3 wks for 8 courses, alone (arm A) or with E 280 mg/TID p.o. for 5 days starting on -1 day (arm B), or the same treatments given with a 3-month rest period after the first 4 courses (arm C and D, respectively). The primary end points were QL (EORTC QLQ C30 and BPI) of A+B vs C+D and 1-y PFS (according to PCWG2) of A+C vs B+D. Results: From 11/06 to 10/10, 148 CRPC pts were enrolled and 124 pts are presently evaluable (24 too early). The median age was 69 (range 42–81) and the median baseline PSA was 55.6 (range 0.33–4212). The major hematological toxicities were: anemia G3 (3 pts), neutropenia G3 (4 pts) – G4 (5 pts), febrile neutropenia (5 pts). QL outcomes of C and I groups, were not statistically different in terms of general QL items. 1-y PFS was also superimposable (10% and 13.5%, respectively) for DOC and DOC+E groups. The 2-y overall survival was also evaluated with no differences between I and C groups (42.5% and 53.7% respectively) and between DOC and DOC+E groups (42.8% and 53.5% respectively). Conclusions: These preliminary results seem to indicate that I treatment may not improve QL compared to C treatment. Moreover, the addition of E to DOC did not improve 1-y PFS of CRPC pts. Updated data with the complete sample analysis will be presented.
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Affiliation(s)
- Orazio Caffo
- Santa Chiara Hospital, Trento, Italy; Santa Maria Degli Angeli General Hospital, Pordenone, Italy; Civil Hospital, Verona, Italy; Istituti Ospitaleri di Cremona, Cremona, Italy; University Hospital of Udine, Udine, Italy; Medical Oncology 1, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy; Oncologia Medica 1 - IOV, Padova, Italy; S. Maurizio Hospital, Bolzano, Italy; Civil Hospital, Thiene, Italy; National Cancer Institute, Naples, Italy; Azienda ULSS 18 Rovigo, Rovigo, Italy; Oncology Unit,
| | - Giovanni Lo Re
- Santa Chiara Hospital, Trento, Italy; Santa Maria Degli Angeli General Hospital, Pordenone, Italy; Civil Hospital, Verona, Italy; Istituti Ospitaleri di Cremona, Cremona, Italy; University Hospital of Udine, Udine, Italy; Medical Oncology 1, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy; Oncologia Medica 1 - IOV, Padova, Italy; S. Maurizio Hospital, Bolzano, Italy; Civil Hospital, Thiene, Italy; National Cancer Institute, Naples, Italy; Azienda ULSS 18 Rovigo, Rovigo, Italy; Oncology Unit,
| | - Teodoro Sava
- Santa Chiara Hospital, Trento, Italy; Santa Maria Degli Angeli General Hospital, Pordenone, Italy; Civil Hospital, Verona, Italy; Istituti Ospitaleri di Cremona, Cremona, Italy; University Hospital of Udine, Udine, Italy; Medical Oncology 1, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy; Oncologia Medica 1 - IOV, Padova, Italy; S. Maurizio Hospital, Bolzano, Italy; Civil Hospital, Thiene, Italy; National Cancer Institute, Naples, Italy; Azienda ULSS 18 Rovigo, Rovigo, Italy; Oncology Unit,
| | - Sebastiano Buti
- Santa Chiara Hospital, Trento, Italy; Santa Maria Degli Angeli General Hospital, Pordenone, Italy; Civil Hospital, Verona, Italy; Istituti Ospitaleri di Cremona, Cremona, Italy; University Hospital of Udine, Udine, Italy; Medical Oncology 1, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy; Oncologia Medica 1 - IOV, Padova, Italy; S. Maurizio Hospital, Bolzano, Italy; Civil Hospital, Thiene, Italy; National Cancer Institute, Naples, Italy; Azienda ULSS 18 Rovigo, Rovigo, Italy; Oncology Unit,
| | - Cosimo Sacco
- Santa Chiara Hospital, Trento, Italy; Santa Maria Degli Angeli General Hospital, Pordenone, Italy; Civil Hospital, Verona, Italy; Istituti Ospitaleri di Cremona, Cremona, Italy; University Hospital of Udine, Udine, Italy; Medical Oncology 1, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy; Oncologia Medica 1 - IOV, Padova, Italy; S. Maurizio Hospital, Bolzano, Italy; Civil Hospital, Thiene, Italy; National Cancer Institute, Naples, Italy; Azienda ULSS 18 Rovigo, Rovigo, Italy; Oncology Unit,
| | - Umberto Basso
- Santa Chiara Hospital, Trento, Italy; Santa Maria Degli Angeli General Hospital, Pordenone, Italy; Civil Hospital, Verona, Italy; Istituti Ospitaleri di Cremona, Cremona, Italy; University Hospital of Udine, Udine, Italy; Medical Oncology 1, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy; Oncologia Medica 1 - IOV, Padova, Italy; S. Maurizio Hospital, Bolzano, Italy; Civil Hospital, Thiene, Italy; National Cancer Institute, Naples, Italy; Azienda ULSS 18 Rovigo, Rovigo, Italy; Oncology Unit,
| | - Fable Zustovich
- Santa Chiara Hospital, Trento, Italy; Santa Maria Degli Angeli General Hospital, Pordenone, Italy; Civil Hospital, Verona, Italy; Istituti Ospitaleri di Cremona, Cremona, Italy; University Hospital of Udine, Udine, Italy; Medical Oncology 1, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy; Oncologia Medica 1 - IOV, Padova, Italy; S. Maurizio Hospital, Bolzano, Italy; Civil Hospital, Thiene, Italy; National Cancer Institute, Naples, Italy; Azienda ULSS 18 Rovigo, Rovigo, Italy; Oncology Unit,
| | - Thomas Martini
- Santa Chiara Hospital, Trento, Italy; Santa Maria Degli Angeli General Hospital, Pordenone, Italy; Civil Hospital, Verona, Italy; Istituti Ospitaleri di Cremona, Cremona, Italy; University Hospital of Udine, Udine, Italy; Medical Oncology 1, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy; Oncologia Medica 1 - IOV, Padova, Italy; S. Maurizio Hospital, Bolzano, Italy; Civil Hospital, Thiene, Italy; National Cancer Institute, Naples, Italy; Azienda ULSS 18 Rovigo, Rovigo, Italy; Oncology Unit,
| | - Alessandra Perin
- Santa Chiara Hospital, Trento, Italy; Santa Maria Degli Angeli General Hospital, Pordenone, Italy; Civil Hospital, Verona, Italy; Istituti Ospitaleri di Cremona, Cremona, Italy; University Hospital of Udine, Udine, Italy; Medical Oncology 1, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy; Oncologia Medica 1 - IOV, Padova, Italy; S. Maurizio Hospital, Bolzano, Italy; Civil Hospital, Thiene, Italy; National Cancer Institute, Naples, Italy; Azienda ULSS 18 Rovigo, Rovigo, Italy; Oncology Unit,
| | - Antonello Veccia
- Santa Chiara Hospital, Trento, Italy; Santa Maria Degli Angeli General Hospital, Pordenone, Italy; Civil Hospital, Verona, Italy; Istituti Ospitaleri di Cremona, Cremona, Italy; University Hospital of Udine, Udine, Italy; Medical Oncology 1, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy; Oncologia Medica 1 - IOV, Padova, Italy; S. Maurizio Hospital, Bolzano, Italy; Civil Hospital, Thiene, Italy; National Cancer Institute, Naples, Italy; Azienda ULSS 18 Rovigo, Rovigo, Italy; Oncology Unit,
| | - Lucianna Russo
- Santa Chiara Hospital, Trento, Italy; Santa Maria Degli Angeli General Hospital, Pordenone, Italy; Civil Hospital, Verona, Italy; Istituti Ospitaleri di Cremona, Cremona, Italy; University Hospital of Udine, Udine, Italy; Medical Oncology 1, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy; Oncologia Medica 1 - IOV, Padova, Italy; S. Maurizio Hospital, Bolzano, Italy; Civil Hospital, Thiene, Italy; National Cancer Institute, Naples, Italy; Azienda ULSS 18 Rovigo, Rovigo, Italy; Oncology Unit,
| | - Gaetano Facchini
- Santa Chiara Hospital, Trento, Italy; Santa Maria Degli Angeli General Hospital, Pordenone, Italy; Civil Hospital, Verona, Italy; Istituti Ospitaleri di Cremona, Cremona, Italy; University Hospital of Udine, Udine, Italy; Medical Oncology 1, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy; Oncologia Medica 1 - IOV, Padova, Italy; S. Maurizio Hospital, Bolzano, Italy; Civil Hospital, Thiene, Italy; National Cancer Institute, Naples, Italy; Azienda ULSS 18 Rovigo, Rovigo, Italy; Oncology Unit,
| | - Carmen Barile
- Santa Chiara Hospital, Trento, Italy; Santa Maria Degli Angeli General Hospital, Pordenone, Italy; Civil Hospital, Verona, Italy; Istituti Ospitaleri di Cremona, Cremona, Italy; University Hospital of Udine, Udine, Italy; Medical Oncology 1, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy; Oncologia Medica 1 - IOV, Padova, Italy; S. Maurizio Hospital, Bolzano, Italy; Civil Hospital, Thiene, Italy; National Cancer Institute, Naples, Italy; Azienda ULSS 18 Rovigo, Rovigo, Italy; Oncology Unit,
| | - Angela Gernone
- Santa Chiara Hospital, Trento, Italy; Santa Maria Degli Angeli General Hospital, Pordenone, Italy; Civil Hospital, Verona, Italy; Istituti Ospitaleri di Cremona, Cremona, Italy; University Hospital of Udine, Udine, Italy; Medical Oncology 1, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy; Oncologia Medica 1 - IOV, Padova, Italy; S. Maurizio Hospital, Bolzano, Italy; Civil Hospital, Thiene, Italy; National Cancer Institute, Naples, Italy; Azienda ULSS 18 Rovigo, Rovigo, Italy; Oncology Unit,
| | - Rocco De Vivo
- Santa Chiara Hospital, Trento, Italy; Santa Maria Degli Angeli General Hospital, Pordenone, Italy; Civil Hospital, Verona, Italy; Istituti Ospitaleri di Cremona, Cremona, Italy; University Hospital of Udine, Udine, Italy; Medical Oncology 1, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy; Oncologia Medica 1 - IOV, Padova, Italy; S. Maurizio Hospital, Bolzano, Italy; Civil Hospital, Thiene, Italy; National Cancer Institute, Naples, Italy; Azienda ULSS 18 Rovigo, Rovigo, Italy; Oncology Unit,
| | - Giovanni L. Pappagallo
- Santa Chiara Hospital, Trento, Italy; Santa Maria Degli Angeli General Hospital, Pordenone, Italy; Civil Hospital, Verona, Italy; Istituti Ospitaleri di Cremona, Cremona, Italy; University Hospital of Udine, Udine, Italy; Medical Oncology 1, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy; Oncologia Medica 1 - IOV, Padova, Italy; S. Maurizio Hospital, Bolzano, Italy; Civil Hospital, Thiene, Italy; National Cancer Institute, Naples, Italy; Azienda ULSS 18 Rovigo, Rovigo, Italy; Oncology Unit,
| | - Enzo Galligioni
- Santa Chiara Hospital, Trento, Italy; Santa Maria Degli Angeli General Hospital, Pordenone, Italy; Civil Hospital, Verona, Italy; Istituti Ospitaleri di Cremona, Cremona, Italy; University Hospital of Udine, Udine, Italy; Medical Oncology 1, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy; Oncologia Medica 1 - IOV, Padova, Italy; S. Maurizio Hospital, Bolzano, Italy; Civil Hospital, Thiene, Italy; National Cancer Institute, Naples, Italy; Azienda ULSS 18 Rovigo, Rovigo, Italy; Oncology Unit,
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Pignata S, Breda E, Scambia G, Pisano C, Zagonel V, Lorusso D, Greggi S, De Vivo R, Ferrandina G, Gallo C, Perrone F. A phase II study of weekly carboplatin and paclitaxel as first-line treatment of elderly patients with advanced ovarian cancer. Crit Rev Oncol Hematol 2008; 66:229-36. [DOI: 10.1016/j.critrevonc.2007.12.005] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2007] [Revised: 12/10/2007] [Accepted: 12/13/2007] [Indexed: 12/27/2022] Open
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Pignata S, Scambia G, Savarese A, Breda E, Scollo P, De Vivo R, Rossi E, Gebbia V, Natale D, Del Gaizo F, Naglieri E, Ferro A, Musso P, D'Arco AM, Sorio R, Pisano C, Di Maio M, Signoriello G, Annunziata A, Perrone F. Safety of a 3-weekly schedule of carboplatin plus pegylated liposomal doxorubicin as first line chemotherapy in patients with ovarian cancer: preliminary results of the MITO-2 randomized trial. BMC Cancer 2006; 6:202. [PMID: 16882344 PMCID: PMC1553473 DOI: 10.1186/1471-2407-6-202] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2006] [Accepted: 08/01/2006] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The MITO-2 (Multicentre Italian Trials in Ovarian cancer) study is a randomized phase III trial comparing carboplatin plus paclitaxel to carboplatin plus pegylated liposomal doxorubicin in first-line chemotherapy of patients with ovarian cancer. Due to the paucity of published phase I data on the 3-weekly experimental schedule used, an early safety analysis was planned. METHODS Patients with ovarian cancer (stage Ic-IV), aged < 75 years, ECOG performance status RESULTS The pre-planned safety analysis was performed in July 2004. Data from the first 50 patients treated with carboplatin plus pegylated liposomal doxorubicin were evaluated. Median age was 60 years (range 34-75). Forty-three patients (86%) completed 6 cycles. Two thirds of the patients had at least one cycle delayed due to toxicity, but 63% of the cycles were administered on time. In most cases the reason for chemotherapy delay was neutropenia or other hematological toxicity. No delay due to palmar-plantar erythrodysesthesia (PPE) was recorded. No toxic death was recorded. Reported hematological toxicities were: grade (G) 3 anemia 16%, G3/G4 neutropenia 36% and 10% respectively, G3/4 thrombocytopenia 22% and 4% respectively. Non-haematological toxicity was infrequent: pulmonary G1 6%, heart rhythm G1 4%, liver toxicity G1 6%, G2 4% and G3 2%. Complete hair loss was reported in 6% of patients, and G1 neuropathy in 2%. PPE was recorded in 14% of the cases (G1 10%, G2 2%, G3 2%). CONCLUSION This safety analysis shows that the adopted schedule of carboplatin plus pegylated liposomal doxorubicin given every 3 weeks is feasible as first line treatment in ovarian cancer patients, although 37% of the cycles were delayed due to haematological toxicity. Toxicities that are common with standard combination of carboplatin plus paclitaxel (neurotoxicity and hair loss) are infrequent with this experimental schedule, and skin toxicity appears manageable.
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Affiliation(s)
- Sandro Pignata
- Medical Oncology B, National Cancer Institute, Naples, Italy
| | - Giovanni Scambia
- Gynecologic Oncology Unit, Catholic University of the Sacred Heart, Rome, Italy
| | | | - Enrico Breda
- Medical Oncology, Fatebenefratelli Hospital, Rome, Italy
| | | | - Rocco De Vivo
- Medical Oncology, S. Bortolo Hospital, Vicenza, Italy
| | - Emanuela Rossi
- Medical Oncology C, National Cancer Institute, Naples, Italy
| | | | - Donato Natale
- Medical Oncology, S. Massimo Hospital, Penne (PE), Italy
| | | | - Emanuele Naglieri
- Medical and Experimental Oncology Unit, Oncology Institute, Bari, Italy
| | | | - Pietro Musso
- Gynecologic Oncology, M. Ascoli Hospital, Palermo, Italy
| | | | - Roberto Sorio
- Medical Oncology C, National Cancer Institute – Centro di Riferimento Oncologico, Aviano (PN), Italy
| | - Carmela Pisano
- Medical Oncology B, National Cancer Institute, Naples, Italy
| | - Massimo Di Maio
- Clinical Trials Unit, National Cancer Institute, Naples, Italy
| | | | - Annalisa Annunziata
- Department of Medicine and Public health, Second University of Naples, Italy
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Abstract
Non-small cell lung cancer (NSCLC) remains a fatal disease: the majority of patients are diagnosed as having metastases or advanced inoperable tumors. The activity of chemotherapy in NSCLC patients is low with objective response rarely complete and sustained. Cisplatin-based combinations are considered as the standard chemotherapy treatment. Recently., the introduction of new and less toxic chemotherapeutic agents., such as vinorelbine., has led investigators to research for active non-cisplatin-containing combinations to treat patients with advanced disease having as primary needs symptom relief and an acceptable quality of life. This review will focus on the pharmacological properties of vinorelbine and its role in adjuvant chemotherapy., in combined chemo-radiotherapy., in advanced disease and in the particular setting of the elderly. The oral use of vinorelbine will be among the future developments of this drug.
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Affiliation(s)
- Cesare Gridelli
- Divisione di Oncologia Medica, Azienda Ospedaliera S.G.Moscati, Avellino, Italy.
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