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Vallerio P, Orenti A, Tosi F, Maistrello M, Palazzini M, Cingarlini S, Colombo P, Bertuzzi M, Spina F, Amatu A, Lombardo R, Prata I, Scaglione F, Vighi GD, Severgnini B, Siena S, Giannattasio C, Boracchi P, Sartore-Bianchi A. Major adverse cardiovascular events associated with VEGF-targeted anticancer tyrosine kinase inhibitors: a real-life study and proposed algorithm for proactive management. ESMO Open 2021; 7:100338. [PMID: 34920290 PMCID: PMC8685997 DOI: 10.1016/j.esmoop.2021.100338] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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: 07/30/2021] [Revised: 11/06/2021] [Accepted: 11/10/2021] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Vascular endothelial growth factor receptor (VEGFR)-targeted tyrosine kinase inhibitors (TKIs) are widely used in cancer treatment and burdened by cardiovascular toxicity. The majority of data come from clinical trials, thus in selected populations. The aim of our study is to evaluate the cardiotoxicity profile of VEGFR-targeted TKIs and the impact of cardiovascular risk factors in a real-life population. PATIENTS AND METHODS In this cohort, population-based study, patients treated with VEGFR-targeted TKIs, bevacizumab and trastuzumab between 2009 and 2014 were analyzed. A multi-source strategy for data retrieval through hospital, pharmaceutical and administrative databases of the Lombardy region, Italy, has been adopted. The primary endpoint was to determine the incidence and type of major adverse cardiovascular events (MACEs) along with their temporal trend. The secondary endpoint was to define the impact of cardiovascular risk factors in the occurrence of MACEs. RESULTS A total of 829 patients were treated with VEGFR-targeted TKIs. Eighty-one MACEs occurred in the first year of follow-up [crude cumulative incidence (CCI): 9.79%] mainly consisting of arterial thrombotic events (ATEs, 31 events, CCI: 3.99%), followed by rhythm disorders (22 events, CCI: 2.66%), pulmonary embolisms and heart failures (13 events each, CCI: 1.57%). While the incidence of most MACEs showed a plateau after 6 months, ATEs kept increasing along the year of follow-up. Hypertension and dyslipidemia were associated with an increase in risk of ATEs [relative risk difference (RRD) +209.8% and +156.2%, respectively], while the presence of previous MACEs correlated with a higher risk of all MACEs in multivariate analysis (RRD 151.1%, 95% confidence interval 53.6% to 310.3%, P < 0.001). CONCLUSIONS MACEs occur in a clinically significant proportion of patients treated with VEGFR-targeted TKIs, with ATEs being predominant, mainly associated with hypertension and dyslipidemia. A clinical algorithm for effective proactive management of these patients is warranted.
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Affiliation(s)
- P Vallerio
- De Gasperis Cardio Center, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - A Orenti
- Department of Clinical Sciences and Community Health, Laboratory of Medical Statistics, Biometry and Epidemiology "G. A. Maccacaro", University of Milan, Milan, Italy
| | - F Tosi
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - M Maistrello
- Quality Unit, ASST Melegnano e Martesana, Milan, Italy
| | - M Palazzini
- School of Medicine and Surgery Department, Milano-Bicocca University, Milan, Italy
| | - S Cingarlini
- Department of Oncology, Verona Comprehensive Cancer Network, G.B. Rossi Hospital, University of Verona, Verona, Italy
| | - P Colombo
- Division of Quality and Clinical Risk, Department of Clinical Governance and Quality, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - M Bertuzzi
- Division of Quality and Clinical Risk, Department of Clinical Governance and Quality, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - F Spina
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - A Amatu
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - R Lombardo
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - I Prata
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - F Scaglione
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - G D Vighi
- Department of Internal Medicine, ASST Vimercate, Vimercate, Italy
| | - B Severgnini
- Cardiology Unit, ASST Vimercate, Vimercate, Italy
| | - S Siena
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - C Giannattasio
- De Gasperis Cardio Center, Grande Ospedale Metropolitano Niguarda, Milan, Italy; School of Medicine and Surgery Department, Milano-Bicocca University, Milan, Italy
| | - P Boracchi
- Department of Clinical Sciences and Community Health, Laboratory of Medical Statistics, Biometry and Epidemiology "G. A. Maccacaro", University of Milan, Milan, Italy.
| | - A Sartore-Bianchi
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.
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Penitenti F, Landoni L, Scardoni M, Piredda ML, Cingarlini S, Scarpa A, D'Onofrio M, Girelli D, Davi MV. Clinical presentation, genotype-phenotype correlations, and outcome of pancreatic neuroendocrine tumors in Von Hippel-Lindau syndrome. Endocrine 2021; 74:180-187. [PMID: 34036514 PMCID: PMC8440302 DOI: 10.1007/s12020-021-02752-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 05/04/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE Data regarding the clinical management and follow-up of pancreatic neuroendocrine tumors (PanNETs) associated with Von Hippel-Lindau (VHL) syndrome are limited. This study aimed to assess clinical presentation, genotype-phenotype correlations, treatment and prognosis of PanNETs in a series of VHL syndrome patients. METHODS Retrospective analysis of data of patients observed between 2005 and 2020. RESULTS Seventeen patients, including 12 probands and 5 relatives (mean age 30.8 ± 18.4; 7 males), were recruited. PanNETs were found in 13/17 patients (77.5%) at a median age of 37 years: 4/13 (30.7%) at the time of VHL diagnosis and 9 (69.3%) during follow up. Six (46.1%) PanNET patients underwent surgery, whereas seven were conservatively treated (mean tumor diameter: 40 ± 10.9 vs. 15 ± 5.3 mm respectively). Four patients (30.7%) had lymph node metastases and a mean tumor diameter significantly larger than the nonmetastatic PanNETs (44.2 ± 9.3 vs. 17.4 ± 7 mm, p = 0.00049, respectively). Five (83.3%) operated patients had stable disease after a median follow up of 3 years whereas one patient showed liver metastases. Six (85.7%) non-resected PanNETs were stable after a median follow-up of 2 years, whereas one patient developed a new small PanNET and a slight increase in diameter of a pre-existing PanNET. No correlation was found between the type of germline mutation and malignant behavior of PanNETs. CONCLUSIONS PanNETs are a common disease of the VHL syndrome and can be the presenting feature. Tumor size rather than genetic mutation is a prognostic factor of malignancy.
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Affiliation(s)
- F Penitenti
- Department of Medicine, Section of Endocrinology, ENETS Center of Excellence, University and Hospital Trust of Verona, Verona, Italy
| | - L Landoni
- Department of Surgery, The Pancreas Institute, ENETS Center of Excellence, University and Hospital Trust of Verona, Verona, Italy
| | - M Scardoni
- Department of Diagnostics and Public Health, Section of Pathology, ENETS Center of Excellence, University and Hospital Trust of Verona, Verona, Italy
| | - M L Piredda
- ARC-Net Research Center, University and Hospital Trust of Verona, Verona, Italy
| | - S Cingarlini
- Department of Medicine, Section of Oncology, ENETS Center of Excellence, University and Hospital Trust of Verona, Verona, Italy
| | - A Scarpa
- Department of Diagnostics and Public Health, Section of Pathology, ENETS Center of Excellence, University and Hospital Trust of Verona, Verona, Italy
- ARC-Net Research Center, University and Hospital Trust of Verona, Verona, Italy
| | - M D'Onofrio
- Department of Radiology, ENETS Center of Excellence, University and Hospital Trust of Verona, Verona, Italy
| | - D Girelli
- Department of Medicine, Section of Internal Medicine, ENETS Center of Excellence, University and Hospital Trust of Verona, Verona, Italy
| | - M V Davi
- Department of Medicine, Section of Endocrinology, ENETS Center of Excellence, University and Hospital Trust of Verona, Verona, Italy.
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Panzuto F, Maccauro M, Campana D, Faggiano A, Massironi S, Pusceddu S, Spada F, Ferone D, Modica R, Grana CM, Ferolla P, Rinzivillo M, Badalamenti G, Zatelli MC, Gelsomino F, De Carlo E, Bartolomei M, Brizzi MP, Cingarlini S, Versari A, Fanciulli G, Arvat E, Merola E, Cives M, Tafuto S, Baldari S, Falconi M. Impact of the SARS-CoV2 pandemic dissemination on the management of neuroendocrine neoplasia in Italy: a report from the Italian Association for Neuroendocrine Tumors (Itanet). J Endocrinol Invest 2021; 44:989-994. [PMID: 32803662 PMCID: PMC7429140 DOI: 10.1007/s40618-020-01393-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 08/09/2020] [Indexed: 02/08/2023]
Abstract
INTRODUCTION The organization of the healthcare system has significantly changed after the recent COVID-19 outbreak, with a negative impact on the management of oncological patients. The present survey reports data collected by the Italian Association for Neuroendocrine Tumors on the management of patients with neuroendocrine neoplasia (NEN) during the pandemic dissemination. METHODS A survey with 57 questions was sent to NEN-dedicated Italian centers regarding the management of patients in the period March 9, 2020, to May 9, 2020 RESULTS: The main modification in the centers' activity consisted of decreases in newly diagnosed NEN patients (- 76.8%), decreases in performed surgical procedures (- 58%), delays to starting peptide receptor radionuclide therapy (45.5%), postponed/canceled follow-up examinations (26%), and canceled multidisciplinary teams' activity (20.8%). A low proportion of centers (< 10%) reported having to withdraw systemic anti-tumor medical treatment due to concerns about the pandemic situation, whereas PRRT was withdrawn from no patients. CONCLUSION Although the COVID-19 outbreak induced the centers to reduce some important activities in the management of NEN patients, the Italian network was able to provide continuity in care without withdrawing anti-tumor treatment for the majority of patients.
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Affiliation(s)
- F Panzuto
- Digestive Disease Unit, ENETS Center of Excellence, Sant'Andrea University Hospital, Via di Grottarossa 1035, 00189, Rome, Italy.
| | - M Maccauro
- Nuclear Medicine Unit, ENETS Center of Excellence, IRRCS National Cancer Institute (INT), Milan, Italy
| | - D Campana
- Division of Oncology, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - A Faggiano
- Endocrinology Unit, Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - S Massironi
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), San Gerardo Hospital, Monza, Italy
| | - S Pusceddu
- Oncology Unit, ENETS Center of Excellence, IRRCS National Cancer Institute (INT), Milan, Italy
| | - F Spada
- Oncology Unit, ENETS Center of Excellence, European Cancer Institute (IEO), Milan, Italy
| | - D Ferone
- Endocrinology Unit, IRCCS Ospedale Policlinico San Martino; Endocrinology, Department of Internal Medicine and Medical Specialties (DIMI), University of Genoa, Genoa, Italy
| | - R Modica
- Department of Clinical Medicine and Surgery, University "Federico II", Naples, Italy
| | - C M Grana
- Nuclear Medicine Division, IRCCS European Institute of Oncology, Milan, Italy
| | - P Ferolla
- Multidisciplinary Group for Diagnosis and Treatment of Neuroendocrine Tumors Umbria Regional Cancer Network, Perugia, Italy
| | - M Rinzivillo
- Digestive Disease Unit, ENETS Center of Excellence, Sant'Andrea University Hospital, Via di Grottarossa 1035, 00189, Rome, Italy
| | - G Badalamenti
- Department of Surgical, Oncological and Oral Sciences, Section of Medical Oncology, University of Palermo, Palermo, Italy
| | - M C Zatelli
- Section of Endocrinology and Internal Medicine,, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - F Gelsomino
- Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
| | - E De Carlo
- Department of Medicine, Internal Medicine III, University of Padova, Padua, Italy
| | - M Bartolomei
- Nuclear Medicine Department, Sant'Anna Hospital, Ferrara, Italy
| | - M P Brizzi
- Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Italy
| | - S Cingarlini
- Oncology Unit, ENETS Center of Excellence, University Hospital of Verona, Verona, Italy
| | - A Versari
- Nuclear Medicine Unit, Azienda Unità Sanitaria Locale-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - G Fanciulli
- NET Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari - Endocrine Unit, AOU Sassari, Sassari, Italy
| | - E Arvat
- Oncological Endocrinology Unit, Department of Medical Sciences, University of Turin, Turin, Italy
| | - E Merola
- Department of Gastroenterology, Azienda Provinciale per i Servizi Sanitari di Trento (APSS), Trento, Italy
| | - M Cives
- Department of Biomedical Sciences and Human Oncology, University of Bari, Bari, Italy
| | - S Tafuto
- S.C. Sarcomi e Tumori Rari, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, Napoli, Italy
| | - S Baldari
- Nuclear Medicine Unit, Department of Biomedical and Dental Sciences and of Morpho-Functional Imaging, University of Messina, Messina, Italy
| | - M Falconi
- Pancreatic Surgery, ENETS Center of Excellence, Pancreas Translational and Clinical Research Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Veltroni A, Cosaro E, Spada F, Fazio N, Faggiano A, Colao A, Pusceddu S, Zatelli MC, Campana D, Piovesan A, Pia A, Grossrubatscher EM, Filice A, Bianchi A, Razzore P, Toaiari M, Cingarlini S, Landoni L, Micciolo R, Davì MV. Clinico-pathological features, treatments and survival of malignant insulinomas: a multicenter study. Eur J Endocrinol 2020; 182:439-446. [PMID: 32061159 DOI: 10.1530/eje-19-0989] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 02/12/2020] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Management of malignant insulinomas is challenging due to the need to control both hypoglycaemic syndrome and tumor growth. Literature data is limited to small series. AIM OF THE STUDY To analyze clinico-pathological characteristics, treatments and prognosis of patients with malignant insulinoma. MATERIALS AND METHODS Multicenter retrospective study on 31 patients (male: 61.3%) diagnosed between 1988 and 2017. RESULTS The mean age at diagnosis was 48 years. The mean NET diameter was 41 ± 31 mm, and 70.8% of NETs were G2. Metastases were widespread in 38.7%, hepatic in 41.9% and only lymph nodal in 19.4%. In 16.1% of the cases, the hypoglycaemic syndrome occurred after 46 ± 35 months from the diagnosis of originally non-functioning NET, whereas in 83.9% of the cases it led to the diagnosis of NET, of which 42.3% with a mean diagnostic delay of 32.7 ± 39.8 months. Surgical treatment was performed in 67.7% of the cases. The 5-year survival rate was 62%. Overall survival was significantly higher in patients with Ki-67 ≤10% (P = 0.03), insulin level <60 µU/mL (P = 0.015) and in patients who underwent surgery (P = 0.006). Peptide Receptor Radionuclide Therapy (PRRT) was performed in 45.1%, with syndrome control in 93% of patients. CONCLUSIONS Our study includes the largest series of patients with malignant insulinoma reported to date. The hypoglycaemic syndrome may occur after years in initially non-functioning NETs or be misunderstood with delayed diagnosis of NETs. Surgical treatment and Ki67 ≤10% are prognostic factors associated with better survival. PPRT proved to be effective in the control of hypoglycaemia in majority of cases.
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Affiliation(s)
- A Veltroni
- Section of Endocrinology, Department of Medicine, ENETS Center of Excellence, Verona University, Verona, Italy
| | - E Cosaro
- Section of Endocrinology, Department of Medicine, ENETS Center of Excellence, Verona University, Verona, Italy
| | - F Spada
- Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, ENETS Center of Excellence, European Institute of Oncology, IEO, IRCCS, Milan, Italy
| | - N Fazio
- Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, ENETS Center of Excellence, European Institute of Oncology, IEO, IRCCS, Milan, Italy
| | - A Faggiano
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - A Colao
- Endocrinology Division, Department of Clinical Medicine and Surgery, ENETS Center of Excellence, University of Naples Federico II, Naples, Italy
| | - S Pusceddu
- Fondazione IRCCS Istituto Nazionale Tumori, ENETS Center of Excellence, Milan, Italy
| | - M C Zatelli
- Section of Endocrinology and Internal Medicine, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - D Campana
- Department of Medical and Surgical Sciences, ENETS Center of Excellence, University of Bologna, Bologna, Italy
| | - A Piovesan
- Oncological Endocrinology Unit, Department of Medical Sciences, University of Turin, Turin, Italy
| | - A Pia
- Internal Medicine, Department of Clinical and Biological Sciences, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy
| | - E M Grossrubatscher
- S.C. Endocrinologia ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - A Filice
- Nuclear Medicine Azienda USL-IRCCS Reggio Emilia, Reggio Emilia, Italy
| | - A Bianchi
- Pituitary Unit, Fondazione Policlinico A. Gemelli IRCCS, Catholic University, ENETS Center of Excellence, School of Medicine, Rome, Italy
| | | | - M Toaiari
- Pederzoli Hospital, Peschiera del Garda, Italy
| | - S Cingarlini
- Oncology, ENETS Center of Excellence, University of Verona, Verona, Italy
| | - L Landoni
- Pancreatic Surgery, ENETS Center of Excellence, University of Verona, Verona, Italy
| | - R Micciolo
- Department of Psychology and Cognitive Sciences, University of Trento, Trento, Italy
| | - M V Davì
- Section of Endocrinology, Department of Medicine, ENETS Center of Excellence, Verona University, Verona, Italy
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Veltroni A, Zambon G, Cingarlini S, Davì MV. Autoimmune hypoglycaemia caused by alpha-lipoic acid: a rare condition in Caucasian patients. Endocrinol Diabetes Metab Case Rep 2018; 2018:EDM180011. [PMID: 30532998 PMCID: PMC6300856 DOI: 10.1530/edm-18-0011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Accepted: 11/22/2018] [Indexed: 11/08/2022] Open
Abstract
Insulin autoimmune syndrome (IAS), a rare cause of autoimmune hyperinsulinaemic hypoglycaemia, is relatively well known in Japan. The incidence in Caucasians is less than one-fifth of that reported in Japanese people, but it is becoming increasingly recognised worldwide in non-Asians as well. Drugs containing sulphydryl groups are known to be associated with the disease in genetically predisposed individuals. Moreover, several recent reports showed a direct association between the onset of IAS and the consumption of dietary supplements containing alpha-lipoic acid (LA). Insulinoma remains the most prevalent cause of hypersulinaemic hypoglycaemia in Caucasians. Consequently, primary investigation in these patients is generally focused on localisation of the pancreatic tumour, often with invasive procedures followed by surgery. We described a case of an Italian woman presenting to us with severe recurrent hypoglycaemia associated with high insulin and C-peptide levels and no evidence of pancreatic lesions at imaging diagnostic procedures. She had taken LA until 2 weeks before hospitalisation. After an evaluation of her drug history, an autoimmune form of hypoglycaemia was suspected and the titre of insulin autoantibodies was found to be markedly elevated. This allowed us to diagnose LA-related IAS, thus preventing any unnecessary surgery and avoiding invasive diagnostic interventions. Learning points: IAS is a rare cause of hyperinsulinaemic hypoglycaemia that typically affects Asian population, but it has been increasingly recognised in Caucasian patients. It should be considered among the differential diagnosis of hyperinsulinaemic hypoglycaemia to avoid unnecessary diagnostic investigations and surgery. It should be suspected in the presence of very high serum insulin levels (100-10 000 μU/mL) associated with high C-peptide levels. There is a strong association with administration of drugs containing sulphydryl groups included LA, a dietary supplement commonly used in Western countries to treat peripheral neuropathy.
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Affiliation(s)
- A Veltroni
- ENETS Center of Excellence, Department of Medicine, University of Verona, Verona, Italy
| | - G Zambon
- ENETS Center of Excellence, Department of Medicine, University of Verona, Verona, Italy
| | - S Cingarlini
- ENETS Center of Excellence, Department of Oncology, University of Verona, Verona, Italy
| | - M V Davì
- ENETS Center of Excellence, Department of Medicine, University of Verona, Verona, Italy
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Nottegar A, Luchini C, Cingarlini S, Beccari S, Grego E, Gilioli E, Manfrin E, Bonetti F. Pathological complete response in a patient affected by multiple synchronous, breast and lung primary malignancies: a case report and review of the literature. Pathologica 2016; 108:164-168. [PMID: 28195257] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
Abstract
A pathological complete response in a patient affected by multiple synchronous, breast and lung primary malignancies is reported. A 63-year-old woman presented with an invasive ductal carcinoma of the breast and a lung adenocarcinoma. After multidisciplinary discussion, the patient underwent pulmonary left lower lobectomy followed by radio-chemotherapy with cisplatin and vinorelbine and started hormone therapy with letrozole. Ten months later, a left mastectomy with axillary lymph nodes dissection was performed. Histologically, a pathological complete response (pCR) was documented. With a review of the Literature, we discuss the issue of multiple primary malignancies, with its diagnostic and therapeutic implications. In cases of multiple synchronous malignancies it has been highlighted the importance of the choice of the best therapeutic approach for both the malignancies, reducing collateral individual effects.
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Affiliation(s)
- A Nottegar
- Department of Pathology and Diagnostics, University of Verona, Italy
| | - C Luchini
- Department of Pathology and Diagnostics, University of Verona, Italy
| | - S Cingarlini
- Medical Oncology, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - S Beccari
- Department of Pathology and Diagnostics, University of Verona, Italy
| | - E Grego
- Medical Oncology, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - E Gilioli
- Department of Pathology and Diagnostics, University of Verona, Italy
| | - E Manfrin
- Department of Pathology and Diagnostics, University of Verona, Italy
| | - F Bonetti
- Department of Pathology and Diagnostics, University of Verona, Italy
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Pusceddu S, Marconcini R, Spada F, Massironi S, Bongiovanni A, Brizzi M, Brighi N, Colao A, Giuffrida D, De Fave G, Cingarlini S, Aroldi F, Antonuzzo L, Berardi R, Catena L, de divitis C, Ermacora P, Di Maio M, Buzzoni R, de Braud F. Metformin impact on progression-free survival in diabetic patients with advanced pancreatic neuroendocrine tumors (pNET) receiving everolimus and/or somatostatin analogues. The PRIME-NET (Pancreatic multicentric, Retrospective, Italian MEtformin) study. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw369.02] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Genestreti G, Giovannini N, Frizziero M, Maglie M, Sanna S, Cingarlini S, Molino A, Piciucchi S, Cetto G, Santo A. Carboplatin and Gemcitabine in First-Line Treatment of Elderly Patients with Advanced Non-Small Cell Lung Cancer: Data from a Retrospective Study. J Chemother 2013; 23:232-7. [DOI: 10.1179/joc.2011.23.4.232] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Remo A, Zanella C, Pancione M, Astati L, Piacentini P, Cingarlini S, Bonetti A, Micheletto C, Talamini A, Chilosi M, Vendraminelli R, Manfrin E. Lung metastasis from TTF-1 positive sigmoid adenocarcinoma. pitfalls and management. Pathologica 2013; 105:69-72. [PMID: 23946985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Abstract
The lung is a frequent site of metastatic involvement, and in many cases the differential diagnosis between a metastasis and a primary carcinoma is a substantial question. TTF-1 is considered as a reliable marker for differential diagnosis in distinguishing primary lung carcinoma and metastasis, especially when dealing with an adenocarcinoma or a large-cell carcinoma. It was generally thought that adenocarcinomas arising in the gastrointestinal tract do not express TTF-1. Recently, it has been reported that a small percentage (1.8%-5.8%) of intestinal adenocarcinoma TTF-1 positive show differences in sensitivity/specificity depending on the antibody clones. We report a case of lung localization of a TTF-1 positive adenocarcinoma in a patient with a history of colon adenocarcinoma. Based on the current results and previous reports, we propose the following criteria for diagnosing lung metastasis from TTF-1 positive intestinal adenocarcinoma. 1) Clinical features and anamnestic history are diagnostic milestones, and provide very important information as a prognostic parameter of primary carcinoma and the time interval between the two localizations (primary and metastasis). 2) The histologic features are compatible with an enteric differentiation. 3) TTF-1 must be tested in the primary carcinoma. 4) In lung lesions, in association with TTF-1, it could be useful to test other immunohistochemical markers such as CDX-2 and NapsinA. 5) Testing other immunohistochemical or molecular markers in either lesion is not very useful. Heterogeneity between primary and metastatic lesions has been reported in the literature. Application of the above-mentioned criteria would simplify diagnosis of lung metastases from TTF-1 positive intestinal adenocarcinoma.
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Affiliation(s)
- A Remo
- Mater Salutis Hospital, ULSS21 Legnago, Verona, Italy.
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Frigerio B, Fracasso G, Luison E, Cingarlini S, Mortarino M, Coliva A, Seregni E, Bombardieri E, Zuccolotto G, Rosato A, Colombatti M, Canevari S, Figini M. A single-chain fragment against prostate specific membrane antigen as a tool to build theranostic reagents for prostate cancer. Eur J Cancer 2013; 49:2223-32. [PMID: 23433847 DOI: 10.1016/j.ejca.2013.01.024] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Revised: 01/24/2013] [Accepted: 01/26/2013] [Indexed: 10/27/2022]
Abstract
Prostate carcinoma is the most common non-cutaneous cancer in developed countries and represents the second leading cause of death. Early stage androgen dependent prostate carcinoma responds well to conventional therapies, but relatively few treatment options exist for patients with hormone-refractory prostate cancer. One of the most suitable targets for antibody-mediated approaches is prostate specific membrane antigen (PSMA) which is a well known tumour associated antigen. PSMA is a type II integral cell-surface membrane protein that is not secreted, and its expression density and enzymatic activity are increased progressively in prostate cancer compared to normal prostate epithelium, thereby making PSMA an ideal target for monoclonal antibody imaging and therapy. To obtain a small protein that can better penetrate tissue, we have engineered a single-chain variable fragment (scFv) starting from the variable heavy and light domains of the murine anti-PSMA monoclonal antibody D2B. scFvD2B was analysed in vitro for activity, stability, internalisation ability and in vivo for targeting specificity. Maintenance of function and immunoreactivity as well as extremely high radiolabelling efficiency and radiochemical purity were demonstrated by in vitro assays and under different experimental conditions. Despite its monovalent binding, scFvD2B retained a good strength of binding and was able to internalise around 40% of bound antigen. In vivo we showed its ability to specifically target only PSMA expressing prostate cancer xenografts. Due to these advantageous properties, scFvD2B has the potential to become a good theranostic reagent for early detection and therapy of prostate cancers.
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Affiliation(s)
- B Frigerio
- Molecular Therapies Unit, Department of Experimental Oncology and Molecular Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - G Fracasso
- Department of Pathology and Diagnostics, Section of Immunology, University of Verona, Verona, Italy
| | - E Luison
- Molecular Therapies Unit, Department of Experimental Oncology and Molecular Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - S Cingarlini
- Medical Oncology, Azienda Ospedaliera Universitaria Integrata (AOUI), Verona, Italy
| | - M Mortarino
- Molecular Therapies Unit, Department of Experimental Oncology and Molecular Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - A Coliva
- Department of Diagnostic Imaging and Radiotherapy, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - E Seregni
- Department of Diagnostic Imaging and Radiotherapy, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - E Bombardieri
- Department of Diagnostic Imaging and Radiotherapy, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | | | - A Rosato
- Istituto Oncologico Veneto IRCCS, Padova, Italy; Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - M Colombatti
- Department of Pathology and Diagnostics, Section of Immunology, University of Verona, Verona, Italy
| | - S Canevari
- Molecular Therapies Unit, Department of Experimental Oncology and Molecular Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - M Figini
- Molecular Therapies Unit, Department of Experimental Oncology and Molecular Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy.
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Abstract
The serine/threonine kinase mammalian target of rapamycin (mTOR) plays a central role in regulating critical cellular processes such as growth, proliferation, and protein synthesis. The study of cancer predisposing syndromes within which neuroendocrine tumors (NETs) may arise has furnished clues on the involvement of mTOR pathway in sporadic diseases so far. Recent comprehensive analyses have definitely shown activation of mTOR pathway in both experimental and human sporadic NETs. Upstream regulators of mTOR (PTEN and TSC2) have been found mutated in sporadic pNETs. Activation of mTOR pathways in NETs is already demonstrated by expression profiles analysis that revealed downregulation of TSC2 gene and alterations of TSC2 and PTEN protein expression in the vast majority of well-differentiated tumors. Moreover, a global microRNA expression analysis revealed the overexpression, in highly aggressive tumors, of a microRNA (miR-21) that targets PTEN reducing its expression and therefore leading to mTOR activation as well. Overall, these clues have furnished the rationale for the use of mTOR inhibitors the treatment of pNETs. With the recent approval of Everolimus (mTOR-targeted drug) for the treatment of advanced pNETs, this paradigm has been effectively translated into the clinical setting. In this review, we discuss mTOR pathway involvement in NETs, the clinical evidence supporting the use of mTOR inhibitors in cancer treatment, and the current clinical issues that remain to be elucidated to improve patient management.
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Affiliation(s)
- S Cingarlini
- Section of Medical Oncology, Department of Medicine, Azienda Ospedaliera Universitaria Integrata (AOUI), Verona, Italy.
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Bria E, Bonomi M, Pilotto S, Massari F, Sperduti I, Cingarlini S, Auriemma A, Giannarelli D, Tortora G. 1309 POSTER How Much is the Likelihood of Being Helped or Harmed (LHH) When Adopting Oral Targeted Agents (OTA) in the Treatment of Advanced Solid Tumours (AST) – Comprehensive Assessment of Their Clinical Overall Impact According to FDA/EMEa Regulatory Approvals. Eur J Cancer 2011. [DOI: 10.1016/s0959-8049(11)70883-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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13
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Cartei G, Binato S, Sacco C, Bearz A, Scalone S, Ceravolo R, Cingarlini S, Fantoni U, Palamidese A, Iop A, Colombrino E. Simplified gemcitabine and platin regimen in patients with advanced or metastatic non-small cell lung cancer (NSCLC) to be proposed as neoadjuvant therapy. Ann Oncol 2008; 17 Suppl 5:v47-51. [PMID: 16807462 DOI: 10.1093/annonc/mdj949] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Chemotherapy of non-small-cell lung cancer (NSCLC) has been improved by the use of cis-platin (P) and the pyrimidine antimetabolite gemcitabine (G) (2',2'-difluorodeoxycytidine). GP regimens currently used in Italy for NSCLC were and are mainly based on G day 1, 8 and 15; P on day 2, every 28 days (4 Day-Hospital admissions per cycle). However, the third G dose is frequently omitted because of myelo-toxicity, with a consistent dose decrease of both G and P in comparison with the intended dose. The 24-h lag time from 1(st) G and P has not reasonable clinical pharmacology base. AIM OF THE STUDY To have a simplified GP regimen based on two Day-Hospital admissions per cycle, with G on day 1 and 8, P after G on day 8; every 21 days, with the goal to use it in the neoadjuvant setting. MATERIAL AND METHODS The study was designed as a controlled, prospective, multicentre investigation, based on G (1500 mg/m(2)) on day 1 and 8, and P (100 mg/m(2)) on day 8 immediately following G, administered on a 3-week cycle. Quality of life (EORTC) was valuated in 46 patients out of 95 valuable patients. Restaging procedures were repeated after the 3rd and the 6th cycle. RESULTS Enrolled patients were 105 (stage IV: 63: IIIB: 29; IIIA: 13). GP cycles were 488 (1 to 6 per patient) 95 patients had at least 3 cycles and 59 of them had further 3 cycles. Myelotoxicity >or= g3 was mainly neutropenia, easily amenable with symptomatic and GCSF therapies (12.6% neutropenic fever); PNS toxicity occurred in 17.9% of patients. QoL was ameliorated (P < 0.05). Therapy was tolerable and gave a Response Rate (RR) of 52.3% after 3 cycles (Intention-to-treat analysis) and of 57.9% in 95 valuable patients who received at least 3 therapy cycles. CONCLUSION Present results confirm a good efficacy and/or synergism of G to P, with G on day 1 and 8 and P on day 8. This two day-hospital admissions regimen is at least as good as more complex GP regimens, and may be proposed in the neoadjuvant setting.
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Affiliation(s)
- G Cartei
- Medical Oncology, 1st floor IOV-IRCCS, Padova, Italy.
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Zustovich F, Cartei G, Dal Bianco M, De Zorzi L, Ceravolo R, Zovato S, Salmaso F, Binato S, Artioli G, Cingarlini S, Pastorelli D. A phase II study of gemcitabine and immunotherapy in renal cancer: preliminary results and review of the literature. Ann Oncol 2008; 17 Suppl 5:v133-6. [PMID: 16807442 DOI: 10.1093/annonc/mdj968] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Affiliation(s)
- F Zustovich
- O.U.C. Medical Oncology, Busonera Hospital 1 floor, National Oncology Institute of Veneto (IOV - IRCCS ) Padua, Italy.
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Zustovich F, Cartei G, Ceravolo R, Salmaso F, Zovato S, Artioli G, Cingarlini S, Binato S, Pastorelli D. Fixed infusion rate (FIR) gemcitabine (G) based treatment for advanced renal cell carcinoma (ARCC): Efficacy and toxicity data from a phase II study. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.14632] [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
14632 Background: ARCC is still an untreatable disease because high dose IL2 therapy is feasible and effective only in a small percentage of patients (pts). Standard dose IL2 is palliative as well as every other treatment. G is a well tolerated agent, even in aged pts and is moderately effective in ARCC. FIR of 10 mg/m2/min increases intracellular G active metabolites and may enhance therapeutic and toxic effect. Aim of study was to evaluate the FIR-G effectiveness in ARCC. Methods: G was administered IV at 10 mg/m2/min FIR for 50 to 1250 min according to age and PS on day 1,8,15 every 28. Immunotherapy (IT) was IL2 3MU subcutaneously daily for 5 days a week or Alfa-INF 3MU three days a week, chronically given. Results: We enrolled 23 pts; 5 female; median age 59 years (29–75), all stage IV disease, all nephrectomized with histologically confirmed clear cell carcinoma; median Fhurman’s grade was 3 (1–4); median PS was 2 (0–3); 9 pts had bone mets; prior treatments: IT, mostly low doses IL2, in 12 pts; chemotherapy in 7 pts and palliative radiotherapy in 9 pts. 125 cycles (median of 5, range 1–35) were administered with a median G dose of 1050 mg/m2 over 105’. 13 Pts received IT (11 pts were IT naïve and received IL2 and 2 pts previously treated with IL2 received Alfa-INF). In the 22 pts valuable for toxicity grade 1–2/#pts was: granulocytopenia/5, anemia/2, nausea/5, vomiting/2, constipation/1, mucositis/1, fever/1, infection/1, fatigue/2, cutaneous/5, peripheral edema/4; grade 3–4 was: anemia/3, nausea/1, fatigue/3, cutaneous/1, vascular venous/1, peripheral edema/1. 26 cycles had to be delayed due to side effects. In the 22 valuable pts we reported 3 PR with a RR of 14% and 11 pts (50%) had SD. All pts were valuable for TTP with a median of 5.6 months (1–35). Data on OS are still immature with a median of 15+ (3–55+). Conclusions: FIR-G ± IT is safe and moderately effective against ARCC. Due to the small number of pts no separate analysis is possible between G ± IT or prognostic factors groups. Nevertheless our TTP and OS data are promising considering the detrimental prognostic factors in the treated population. Present work was part of studies program of, and partly supported by, AOI (Associazione Oncologia Italiana), Padova, Italy. No significant financial relationships to disclose.
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Affiliation(s)
- F. Zustovich
- Medical Oncology 1st floor IOV- IRCCS, Padova, Italy
| | - G. Cartei
- Medical Oncology 1st floor IOV- IRCCS, Padova, Italy
| | - R. Ceravolo
- Medical Oncology 1st floor IOV- IRCCS, Padova, Italy
| | - F. Salmaso
- Medical Oncology 1st floor IOV- IRCCS, Padova, Italy
| | - S. Zovato
- Medical Oncology 1st floor IOV- IRCCS, Padova, Italy
| | - G. Artioli
- Medical Oncology 1st floor IOV- IRCCS, Padova, Italy
| | - S. Cingarlini
- Medical Oncology 1st floor IOV- IRCCS, Padova, Italy
| | - S. Binato
- Medical Oncology 1st floor IOV- IRCCS, Padova, Italy
| | - D. Pastorelli
- Medical Oncology 1st floor IOV- IRCCS, Padova, Italy
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Cartei G, Binato S, Sacco C, Scalone S, Ceravolo R, Fantoni U, Cingarlini S, Palamidese A, Iop A, Colombrino E. Simplified gemcitabine and platin regimen for NSCLC to be used in the neoadjuvant setting. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.17155] [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
17155 Background: Platin (P) salts and Gemcitabine (G) are used for NSCLC. GP regimens frequently included G on day 1, 8 and 15; P on day 2; every 28 days. However, the third G dose often is omitted because of myelo-toxicity, with a consistent no respect of the intended drugs’ doses. We devised a simplified regimen, based on two Day-Hospital admissions per cycle (c), with G on day 1 and 8; P after G on day 8; every 21 days. Aim of study: a high RR within the first 3 c.s for a GP regimen for neoadjuvant therapy. Methods: This prospective, multi-centre investigation included G (1500 mg/m2) on day 1 and 8, and P (100 mg/m2) on day 8 immediately following G, on a 3-weeks-c. Eligible criteria: age 18 to 75 years, NSCLC histologically, no previous chemotherapy, KPS 50%, WBC ≥ 4.0 × 109/L, platelet ≥100 × 109/L and normal kidney-liver function. QoL evaluation: 46 out of 95 valuable patients. Restaging procedures: repeated 3 and 6 c.s. Results: Out of 105 patients, 95 had at least 3 c.s and 59 of them had further 3 c.s. Myelo-toxicity ≥ G3 was mainly neuthropoenia, easily amenable with symptomatic and GCSF therapies; PNS toxicity occurred in 17.9% of patients. QoL was ameliorated (p < 0.05). Therapy was tolerable; gave RR was 52.3% after 3 c.s (Intention-to-treat analysis) and 57.9% in 95 valuable patients after at least 3 therapy c.s. In the 95 valuable patients over the first 42 days, i.e. after 2 c.s and just before the third c., 10 c.s out of 190 were delayed by one week, with a dose intensity reduction of 5.29%. Conclusions: This two Day-Hospital admissions regimen is at least as good as more complex GP regimens, with an appreciable RR after 3c.s; it may be proponed in the neoadjuvant setting. Acknowledgments: Present work was part of studies program of, and partly supported by, AOI (Associazione Oncologia Italiana, Padova, Italy). No significant financial relationships to disclose.
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Affiliation(s)
- G. Cartei
- Division of Medical Oncology, Padova, Italy; IOV IRCCS, Padua, Italy; S. Maria Misericordia Hospital, Udine, Italy; IOV IRCCS, Udine, Italy; Padua Hospital, Padua, Italy; ASS5 Latisana, Padua, Italy
| | - S. Binato
- Division of Medical Oncology, Padova, Italy; IOV IRCCS, Padua, Italy; S. Maria Misericordia Hospital, Udine, Italy; IOV IRCCS, Udine, Italy; Padua Hospital, Padua, Italy; ASS5 Latisana, Padua, Italy
| | - C. Sacco
- Division of Medical Oncology, Padova, Italy; IOV IRCCS, Padua, Italy; S. Maria Misericordia Hospital, Udine, Italy; IOV IRCCS, Udine, Italy; Padua Hospital, Padua, Italy; ASS5 Latisana, Padua, Italy
| | - S. Scalone
- Division of Medical Oncology, Padova, Italy; IOV IRCCS, Padua, Italy; S. Maria Misericordia Hospital, Udine, Italy; IOV IRCCS, Udine, Italy; Padua Hospital, Padua, Italy; ASS5 Latisana, Padua, Italy
| | - R. Ceravolo
- Division of Medical Oncology, Padova, Italy; IOV IRCCS, Padua, Italy; S. Maria Misericordia Hospital, Udine, Italy; IOV IRCCS, Udine, Italy; Padua Hospital, Padua, Italy; ASS5 Latisana, Padua, Italy
| | - U. Fantoni
- Division of Medical Oncology, Padova, Italy; IOV IRCCS, Padua, Italy; S. Maria Misericordia Hospital, Udine, Italy; IOV IRCCS, Udine, Italy; Padua Hospital, Padua, Italy; ASS5 Latisana, Padua, Italy
| | - S. Cingarlini
- Division of Medical Oncology, Padova, Italy; IOV IRCCS, Padua, Italy; S. Maria Misericordia Hospital, Udine, Italy; IOV IRCCS, Udine, Italy; Padua Hospital, Padua, Italy; ASS5 Latisana, Padua, Italy
| | - A. Palamidese
- Division of Medical Oncology, Padova, Italy; IOV IRCCS, Padua, Italy; S. Maria Misericordia Hospital, Udine, Italy; IOV IRCCS, Udine, Italy; Padua Hospital, Padua, Italy; ASS5 Latisana, Padua, Italy
| | - A. Iop
- Division of Medical Oncology, Padova, Italy; IOV IRCCS, Padua, Italy; S. Maria Misericordia Hospital, Udine, Italy; IOV IRCCS, Udine, Italy; Padua Hospital, Padua, Italy; ASS5 Latisana, Padua, Italy
| | - E. Colombrino
- Division of Medical Oncology, Padova, Italy; IOV IRCCS, Padua, Italy; S. Maria Misericordia Hospital, Udine, Italy; IOV IRCCS, Udine, Italy; Padua Hospital, Padua, Italy; ASS5 Latisana, Padua, Italy
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Pastorelli D, Cartei G, Zustovich F, Marchese F, Artioli G, Zovato S, Binato S, Ceravolo R, Cingarlini S, Salmaso F, Mattiazzi M, Sanavio C, Farinati F, Zanus G, Cillo U. Gemcitabine and liposomal doxorubicin in biliary and hepatic carcinoma (HCC) chemotherapy: preliminary results and review of the literature. Ann Oncol 2006; 17 Suppl 5:v153-7. [PMID: 16807446 DOI: 10.1093/annonc/mdj972] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Advanced biliary tract cancers have a poor prognosis. Gemcitabine (G) as a single agent or in combination represents an active treatment option. Systemic chemotherapy in hepatocellular carcinoma represents a palliative treatment. Gemcitabine in combination with Liposomal Doxorubicin (LD) may represent an active treatment option. PATIENTS AND METHODS Clinical trials for biliary and hepatic carcinoma have been reviewed. RESULTS We obtained RC (1 pt), RP (4 pts), SD (8 pts) and seven pts had PD (RR 25% and SD 40%). Our chemotherapy regimen was Gemcitabine 1000 mg/m(2) d 1 and 8, Liposomal Doxorubicin 30 mg d 1, q 28. Patients were 21 (17 M), aged 44 to 78 (median 63 yrs). Only in 8 pts we observed G 3-4 haematological toxicity, thrombocytopenia and neutropenia (7 G3, 1 G4).
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Affiliation(s)
- D Pastorelli
- O.U.C. Medical Oncology, Busonera Hospital 1 floor, National Oncology Institute of Veneto, IOV - IRCCS, Padua, Italy.
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