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Boccaccino A, Rossini D, Raimondi A, Carullo M, Lonardi S, Morano F, Santini D, Tomasello G, Niger M, Zaniboni A, Daniel F, Bustreo S, Procaccio L, Clavarezza M, Cupini S, Libertini M, Palermo F, Pietrantonio F, Cremolini C. Adverse events during first-line treatments for mCRC: The Toxicity over Time (ToxT) analysis of three randomised trials. Eur J Cancer 2023; 189:112910. [PMID: 37301718 DOI: 10.1016/j.ejca.2023.05.001] [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: 02/22/2023] [Revised: 04/25/2023] [Accepted: 05/01/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND In clinical trials, the assessment of safety is traditionally focused on the overall rate of high-grade and serious adverse events (AEs). A new approach to AEs evaluation, taking into account chronic low-grade AEs, single patient's perspective, and time-related information, such as ToxT analysis, should be considered especially for less intense but potentially long-lasting treatments, such as maintenance strategies in metastatic colorectal cancer (mCRC). PATIENTS AND METHODS We applied ToxT (Toxicity over Time) evaluation to a large cohort of mCRC patients enroled in randomised TRIBE, TRIBE2, and VALENTINO studies, in order to longitudinally describe AEs throughout the whole treatment duration and to compare AEs evolution over cycles between induction and maintenance strategies, providing numerical and graphical results overall and per single patient. After 4-6 months of combination therapy, 5-fluorouracil/leucovorin (5-FU/LV) + bevacizumab or panitumumab was recommended in all studies except for the 50% of patients in the VALENTINO trial who received panitumumab alone. RESULTS Out of 1400 patients included, 42% received FOLFOXIRI (5-FU/LV, oxaliplatin, and irinotecan)/bevacizumab, 18% FOLFIRI/bevacizumab, 24% FOLFOX/bevacizumab, 16% FOLFOX/panitumumab. Mean grade of general and haematological AEs was higher in the first cycles, then progressively decreasing after the end of induction (p < 0.001), and always remaining at the highest levels with FOLFOXIRI/bevacizumab (p < 0.001). Neurotoxicity became more frequent over the cycles with late high-grade episodes (p < 0.001), while the incidence but not the grade of hand-and-foot syndrome gradually increased (p = 0.91). Anti-VEGF-related AEs were more severe in the first cycles, then setting over at low levels (p = 0.03), while anti-EGFR-related AEs still affected patients during maintenance. CONCLUSIONS Most of chemotherapy-related AEs (except for HFS and neuropathy) reach the highest level in the first cycles, then decrease, probably due to their active clinical management. Transition to maintenance allows relief from most AEs, especially with bevacizumab-based regimens, while anti-EGFR-related AEs may persist.
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Affiliation(s)
- Alessandra Boccaccino
- Unit of Oncology, University Hospital of Pisa, Pisa, Italy and Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Roma 67, 56126, Pisa, Italy
| | - Daniele Rossini
- Unit of Oncology, University Hospital of Pisa, Pisa, Italy and Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Roma 67, 56126, Pisa, Italy
| | - Alessandra Raimondi
- Medical Oncology Department, Fondazione IRCCS, Istituto Nazionale dei Tumori, Via Giacomo Venezian 1, 20133 Milan, Italy
| | - Martina Carullo
- Unit of Oncology, University Hospital of Pisa, Pisa, Italy and Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Roma 67, 56126, Pisa, Italy
| | - Sara Lonardi
- Medical Oncology 3, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - Federica Morano
- Medical Oncology Department, Fondazione IRCCS, Istituto Nazionale dei Tumori, Via Giacomo Venezian 1, 20133 Milan, Italy
| | - Daniele Santini
- Oncologia Medica Università Campus Biomedico, Rome, Italy and UOC Oncologia Universitaria, Sapienza University of Rome, Polo Pontino, Italy
| | - Gianluca Tomasello
- Oncologia Medica, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 28, 20122 Milano, Italy
| | - Monica Niger
- Medical Oncology Department, Fondazione IRCCS, Istituto Nazionale dei Tumori, Via Giacomo Venezian 1, 20133 Milan, Italy
| | | | - Francesca Daniel
- Medical Oncology 3, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - Sara Bustreo
- S.C. Oncologia 1 U, A.O.U. Città della Salute e della Scienza di Torino, Presidio Molinette, Italy
| | - Letizia Procaccio
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy and Medical Oncology 1, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | | | - Samanta Cupini
- Department of Oncology, Division of Medical Oncology, Azienda Toscana Nord Ovest, Livorno, Italy
| | | | - Federica Palermo
- Medical Oncology Department, Fondazione IRCCS, Istituto Nazionale dei Tumori, Via Giacomo Venezian 1, 20133 Milan, Italy
| | - Filippo Pietrantonio
- Medical Oncology Department, Fondazione IRCCS, Istituto Nazionale dei Tumori, Via Giacomo Venezian 1, 20133 Milan, Italy
| | - Chiara Cremolini
- Unit of Oncology, University Hospital of Pisa, Pisa, Italy and Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Roma 67, 56126, Pisa, Italy.
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Salvatore L, Bensi M, Corallo S, Bergamo F, Pellegrini I, Rasola C, Borelli B, Tamburini E, Randon G, Galuppo S, Boccaccino A, Viola M, Auriemma A, Fea E, Barbara C, Corvari B, Bustreo S, Smiroldo V, Barbaro B, Tortora G. O-12 Phase II study of preoperative chemoradiotherapy plus avelumab in patients with locally advanced rectal cancer: The AVANA study. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Salvatore L, Bensi M, Corallo S, Bergamo F, Pellegrini I, Rasola C, Borelli B, Tamburini E, Randon G, Galuppo S, Boccaccino A, Viola MG, Auriemma A, Fea E, Barbara C, Bustreo S, Smiroldo V, Barbaro B, Gambacorta MA, Tortora G. Phase II study of preoperative (PREOP) chemoradiotherapy (CTRT) plus avelumab (AVE) in patients (PTS) with locally advanced rectal cancer (LARC): The AVANA study. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.3511] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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
3511 Background: Preop CTRT is considered the standard of care in the management of LARC. RT can induce antigen release from a low neoantigen-burden tumor (such as a mismatch repair proficient colorectal cancer) and activate dendritic cells leading to a CD8+ T lymphocyte-mediated anticancer immune response. In LARC patients, neoadjuvant CTRT increases PD-L1 expression in tumor cells, strongly suggesting a neoadjuvant combinatory strategy with RT and PD-1/PD-L1 pathway blockade. Based on such considerations, we have designed the AVANA study to investigate the role of Ave in combination with preop CTRT in LARC. Methods: This is an Italian multi-center, phase II study. Pts with resectable LARC, defined by the presence of at least one of the following features: cN+, cT4, high risk cT3, received standard preop CTRT (capecitabine 825 mg/sqm/bid 5 days/week+ 50.4 Gy in 28 fractions over 5.5 weeks) plus 6 cycles of Ave 10 mg/Kg every 2 weeks. Surgery with total mesorectal excision was performed at 8-10 weeks after the end of CTRT. The primary end-point was the pCR rate, defined as complete histological regression with no available tumor cells ypT0N0. Secondary end-points were R0 resection rate, tumor downstaging, local recurrence, sphincter preservation rate, progression-free survival, overall survival, safety profile, and the evaluation of exploratory predictive and/or prognostic biomarkers. Assuming as null hypothesis p0 a pCR rate of 15%, a significance level of 5% (one-side), and a power of 80%, a sample size of 101 pts was needed to detect an absolute increment of 10% in pCR rate (from 15% to 25%). The experimental regimen is considered for further studies if, in at least 22 pts, we observe a pCR. Results: From April 2019 to November 2020, a total of 101 resectable LARC pts were enrolled in 10 Italian Centers. The median age was 63 years (23-82), 62 (61.4%) pts were male, 93 (92%) had ECOG PS 0. At baseline, 94 (93%) and 16 (16%) pts had cN+ and cT4 LARC, respectively. All pts completed the induction phase. Out of 96 pts evaluable for pathological response, 22 (23%) pts achieved a pCR and 59 (61.5%) pts a major pathological response (a central review is ongoing). At this time, microsatellite status is available only in 39 pts, of which only one was instable. The rate of grade 3-4 non-immune and immune-related adverse events was 8% and 4%, respectively. Avelumab was early interrupted in 9 pts out 101, mainly due to toxicity. Conclusions: The combination of preop CTRT plus Ave showed a promising activity and a feasible safety profile. According to our statistical considerations, the experimental regimen will be considered for further studies. Updated results will be presented during the Congress. Sponsored by GONO and partially supported by Merck. EUDRACT 2017-003582-10. Clinical trial information: NCT03854799.
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Affiliation(s)
- Lisa Salvatore
- Oncologia Medica, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli–IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maria Bensi
- Oncologia Medica, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli–IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Salvatore Corallo
- Dipartimento di Oncologia Medica Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Francesca Bergamo
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Ilaria Pellegrini
- Dipartimento di Oncologia Medica Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Cosimo Rasola
- Unit of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Beatrice Borelli
- Department of Translational Research and New Technologies in Medicine and Surgery, Unit of Medical Oncology 2, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | | | - Giovanni Randon
- Dipartimento di Oncologia Medica Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Sara Galuppo
- Radiation Oncology Dept-IOV-IRCCS Padova, Padua, Italy
| | - Alessandra Boccaccino
- Department of Translational Research and New Technologies in Medicine and Surgery, Unit of Medical Oncology 2, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | | | | | - Elena Fea
- S.Croce & Carle Teaching Hospital, Cuneo, Italy
| | - Cecilia Barbara
- Department of Oncology; Division of Medical Oncology, Livorno Hospital, Azienda USL Toscana Nord Ovest, Livorno, Italy
| | - Sara Bustreo
- SSD ColoRectal Cancer Unit Dipartimento di Oncologia AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Valeria Smiroldo
- Medical Oncology Unit IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Brunella Barbaro
- Department of Bioimaging and Radiological Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS; Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maria Antonietta Gambacorta
- Diagnostic Imaging, Oncological Radiotherapy and Hematology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS; Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giampaolo Tortora
- Oncologia Medica, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli–IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
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Testa S, Di Cuonzo D, Ritorto G, Fanchini L, Bustreo S, Racca P, Rosato R. Response shift in health-related quality of life measures in the presence of formative indicators. Health Qual Life Outcomes 2021; 19:9. [PMID: 33407569 PMCID: PMC7789337 DOI: 10.1186/s12955-020-01663-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 12/25/2020] [Indexed: 02/01/2023] Open
Abstract
Background Response shift (RS) has been defined as a change in the meaning of an individual’s self-evaluation that needs to be accounted for when assessing longitudinal changes in health-related quality of life (HRQoL). RS detection through structural equation modeling is accomplished by adopting Oort’s procedure based on a measurement model in which the observed variables are defined as reflective indicators of the HRQoL latent variable; that is, the latent variable causes the variation in the reflective indicators. This study aims to propose a procedure that assesses RS when formative indicators are used in measuring HRQoL; in this last case, the latent variable is considered to be a function of some formative indicators. A secondary aim is to compare the new procedure with Oort’s procedure to highlight similarities and differences. Methods The data were retrieved from a consecutive series of 258 patients newly diagnosed with colorectal cancer and undergoing chemotherapy and/or surgery. The European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QOL-C30) was administered twice, once before and once six months after treatment. Structural equation modeling was used to evaluate RS and true change with the newly proposed method (in which fatigue and pain were defined as formative indicators) and with Oort’s procedure (in which fatigue and pain were defined as reflective indicators).
Results According to the new procedure, there was no measurement bias, and on average, patients’ quality of life improved by 3.53 points (on a scale ranging from 0 to 100) at the 6-month follow-up. With Oort’s procedure, the loading of the pain indicator was not invariant across the two time points, suggesting the presence of reprioritization, whereas the estimation of true change was very similar to the previous one: 3.87. Conclusions RS and true change in HRQoL can be evaluated in the presence of formative indicators. Defining a measurement model by formative or reflective indicators can lead to different results.
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Affiliation(s)
- Silvia Testa
- Department of Human and Social Sciences, University of Aosta Valley, Aosta, Italy
| | - Daniela Di Cuonzo
- Department of Psychology, University of Turin, Turin, Italy.,Unit of Cancer Epidemiology, "Città Della Salute E Della Scienza" Hospital, University of Turin, CPO Piemonte, Turin, Italy
| | - Giuliana Ritorto
- SSD Colorectal Cancer Unit, Dipartimento Di Oncologia, "Città Della Salute E Della Scienza Di Torino" Hospital, Turin, Italy
| | - Laura Fanchini
- SSD Colorectal Cancer Unit, Dipartimento Di Oncologia, "Città Della Salute E Della Scienza Di Torino" Hospital, Turin, Italy
| | - Sara Bustreo
- SSD Colorectal Cancer Unit, Dipartimento Di Oncologia, "Città Della Salute E Della Scienza Di Torino" Hospital, Turin, Italy
| | - Patrizia Racca
- SSD Colorectal Cancer Unit, Dipartimento Di Oncologia, "Città Della Salute E Della Scienza Di Torino" Hospital, Turin, Italy
| | - Rosalba Rosato
- Department of Psychology, University of Turin, Turin, Italy. .,Unit of Cancer Epidemiology, "Città Della Salute E Della Scienza" Hospital, University of Turin, CPO Piemonte, Turin, Italy.
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5
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Fucà G, Guarini V, Antoniotti C, Morano F, Moretto R, Corallo S, Marmorino F, Lonardi S, Rimassa L, Sartore-Bianchi A, Borelli B, Tampellini M, Bustreo S, Claravezza M, Boccaccino A, Murialdo R, Zaniboni A, Tomasello G, Loupakis F, Adamo V, Tonini G, Cortesi E, de Braud F, Cremolini C, Pietrantonio F. The Pan-Immune-Inflammation Value is a new prognostic biomarker in metastatic colorectal cancer: results from a pooled-analysis of the Valentino and TRIBE first-line trials. Br J Cancer 2020; 123:403-409. [PMID: 32424148 PMCID: PMC7403416 DOI: 10.1038/s41416-020-0894-7] [Citation(s) in RCA: 84] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 04/03/2020] [Accepted: 04/22/2020] [Indexed: 11/25/2022] Open
Abstract
Background Immune-inflammatory biomarkers (IIBs) showed a prognostic relevance in patients with metastatic CRC (mCRC). We aimed at evaluating the prognostic power of a new comprehensive biomarker, the Pan-Immune-Inflammation Value (PIV), in patients with mCRC receiving first-line therapy. Methods In the present pooled-analysis, we included patients enrolled in the Valentino and TRIBE trials. PIV was calculated as: (neutrophil count × platelet count × monocyte count)/lymphocyte count. A cut-off was determined using the maximally selected rank statistics method. Generalised boosted regression (GBR), the Kaplan–Meier method and Cox hazards regression models were used for survival analyses. Results A total of 438 patients were included. Overall, 208 patients (47%) had a low-baseline PIV and 230 (53%) had a high-baseline PIV. Patients with high PIV experienced a worse PFS (HR, 1.66; 95% CI, 1.36–2.03, P < 0.001) and worse OS (HR, 2.01; 95% CI, 1.57–2.57; P < 0.001) compared to patients with low PIV. PIV outperformed the other IIBs in the GBR model and in the multivariable models. Conclusion PIV is a strong predictor of survival outcomes with better performance than other well-known IIBs in patients with mCRC treated with first-line therapy. PIV should be prospectively validated to better stratify mCRC patients undergoing first-line therapy.
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Affiliation(s)
- Giovanni Fucà
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Vincenzo Guarini
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Carlotta Antoniotti
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy.,Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Federica Morano
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Roberto Moretto
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Salvatore Corallo
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Federica Marmorino
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy.,Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Sara Lonardi
- Unit of Medical Oncology 1, Department of Clinical and Experimental Oncology, Istituto Oncologico Veneto, IRCCS, Padua, Italy
| | - Lorenza Rimassa
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, Humanitas Clinical and Research Center-IRCCS, Rozzano, Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Andrea Sartore-Bianchi
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milan, Italy.,Oncology and Hemato-oncology Department, University of Milan, Milan, Italy
| | - Beatrice Borelli
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy.,Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Marco Tampellini
- Department of Oncology, AOU San Luigi di Orbassano, University of Torino, Orbassano, Italy
| | - Sara Bustreo
- Colorectal Cancer Unit, Medical Oncology Division 1, AOU Città della Salute e della Scienza, Torino, Italy
| | - Matteo Claravezza
- Medical Oncology Unit, Ente Ospedaliero Ospedali Galliera, Genoa, Italy
| | - Alessandra Boccaccino
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy.,Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Roberto Murialdo
- Department of Internal Medicine, University of Genoa and IRCCS AOU San Martino-IST, Genoa, Italy
| | | | - Gianluca Tomasello
- Medical Oncology Unit, Azienda Socio-Sanitaria Territoriale (ASST) Ospedale di Cremona, Cremona, Italy
| | - Fotios Loupakis
- Unit of Medical Oncology 1, Department of Clinical and Experimental Oncology, Istituto Oncologico Veneto, IRCCS, Padua, Italy
| | - Vincenzo Adamo
- Medical Oncology Unit, A.O. Papardo, Messina, Italy.,Department of Human Pathology, University of Messina, Messina, Italy
| | - Giuseppe Tonini
- Oncology Department, Policlinico Campus Bio-Medico di Roma, Rome, Italy
| | | | - Filippo de Braud
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy.,Oncology and Hemato-oncology Department, University of Milan, Milan, Italy
| | - Chiara Cremolini
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy.,Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Filippo Pietrantonio
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy. .,Oncology and Hemato-oncology Department, University of Milan, Milan, Italy.
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Rosato R, Di Cuonzo D, Ritorto G, Fanchini L, Bustreo S, Racca P, Pagano E. Tailoring chemotherapy supply according to patients' preferences: a quantitative method in colorectal cancer care. Curr Med Res Opin 2020; 36:73-81. [PMID: 31535573 DOI: 10.1080/03007995.2019.1670475] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Objectives: The aim of this study was to conduct a discrete choice experiment with patients affected by colorectal cancer to understand their preferences for different attributes of the chemotherapy supply. Our overall goal is to provide evidence on the relative importance of each attribute in order to tailor chemotherapy supply according to patients' priorities in the design or reorganization processes of cancer services.Methods: Focus groups were used to identify the attributes and levels for the discrete choice experiment. The attributes were: continuity of care, understanding, information, treatment choice, and time for therapy. Respondents were asked to choose between two mutually exclusive hypothetical alternatives of chemotherapy supply. Patients completed the discrete choice experiment along with the health-related quality of life and patients' satisfaction questions. Conditional and mixed logistic models were used to analyses the data.Results: Patients with colorectal cancer treated with chemotherapy (n = 76) completed the survey. The most important aspects of chemotherapy supply were: "Providing detailed and complete information" and "High ability in understanding" patients. Preferences were also influenced by the availability of a trusted doctor. Except for one attribute (waiting time for therapy), all other characteristics significantly influenced respondents' preferences.Conclusions: Results should support a policy of strengthening medical doctors' capabilities to communicate with patients, providing them complete information and involving them in the clinical decisions. Specifically, the findings should be used to improve the current provision of cancer care by identifying areas of preferred intervention from the perspectives of patients in order to tailor the service supply accordingly.
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Affiliation(s)
- Rosalba Rosato
- Department of Psychology, University of Turin, Torino, Italy
- Unit of Clinical Epidemiology, Città Della Salute e Della Scienza di Torino Hospital-CPO Piemonte, Turin, Italy
| | - Daniela Di Cuonzo
- Department of Psychology, University of Turin, Torino, Italy
- Unit of Clinical Epidemiology, Città Della Salute e Della Scienza di Torino Hospital-CPO Piemonte, Turin, Italy
| | - Giuliana Ritorto
- Dipartimento di Oncologia, SSD Colorectal Cancer Unit, Città Della Salute e Della Scienza di Torino Hospital, Torino, Italy
| | - Laura Fanchini
- Dipartimento di Oncologia, SSD Colorectal Cancer Unit, Città Della Salute e Della Scienza di Torino Hospital, Torino, Italy
| | - Sara Bustreo
- Dipartimento di Oncologia, SSD Colorectal Cancer Unit, Città Della Salute e Della Scienza di Torino Hospital, Torino, Italy
| | - Patrizia Racca
- Dipartimento di Oncologia, SSD Colorectal Cancer Unit, Città Della Salute e Della Scienza di Torino Hospital, Torino, Italy
| | - Eva Pagano
- Unit of Clinical Epidemiology, Città Della Salute e Della Scienza di Torino Hospital-CPO Piemonte, Turin, Italy
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Salvatore L, Bensi M, Pietrantonio F, Boccaccino A, Barbara C, Auriemma A, Ratti M, Tamburini E, Bordonaro R, Clavarezza M, Avallone A, Bergamo F, Granetto C, Bustreo S, Fabio FD, Smiroldo V, Corvari B, Tortora G. Phase II study of preoperative (PREOP) chemoradiotherapy (CTRT) plus avelumab (AVE) in patients (PTS) with locally advanced rectal cancer (LARC): The AVANA Study. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz246.139] [Citation(s) in RCA: 2] [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: 11/14/2022] Open
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Zucchelli G, Moretto R, Schirripa M, Intini R, Rossini D, Santini D, Pizzo C, Antoniotti C, Borelli B, Marmorino F, Urbano F, Burgio V, Libertini M, Prisciandaro M, Buonadonna A, Bustreo S, Allegrini G, Ricci V, Cremolini C, Falcone A. Impact of gender on the safety profile of chemotherapy plus bevacizumab in mCRC: A pooled analysis of TRIBE and TRIBE2 studies. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.3534] [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
3534 Background: Based on retrospective experiences, gender seems to affect the safety profile of chemotherapy (CT), with a higher incidence of CT-related adverse events (AEs) among females than males. Here we focus on the impact of gender on the toxicity of FOLFOXIRI/bevacizumab (bev) as compared with doublets (FOLFOX or FOLFIRI)/bev in two randomized phase III studies by GONO: TRIBE and TRIBE2. Methods: The risk of experiencing CT-related AEs in males and females was estimated in univariable analysis in the overall safety population and according to treatment arms (doublets/bev and FOLFOXIRI/bev). In order to assess the independent weight of gender on the risk of developing AEs, multivariable logistic regression models were built. Results: Among 1187 patients enrolled in TRIBE and TRIBE2 studies, 1176 (684 males, 58%, and 492 females, 42%) were included in the safety population. Overall, women had a significantly higher risk of CT-related AEs, in particular gastrointestinal and hematologic AEs, asthenia and alopecia, independently of the treatment arm. The risk of CT-related AEs was increased with FOLFOXIRI/bev vs doublets/bev independently of gender (p for interaction: 0.329). Notably, among women treated with FOLFOXIRI/bev 50% and 68% experienced any grade of vomiting and nausea, respectively. Conclusions: Female mCRC patients have a higher risk to develop CT-related AEs. In women treated with FOLFOXIRI/bev the high incidence of nausea and vomiting may suggest the need for an intensification of the antiemetic prophylaxis. [Table: see text]
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Affiliation(s)
- Gemma Zucchelli
- Department of Translational Research and New Technologies in Medicine and Surgery, Unit of Medical Oncology 2, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Roberto Moretto
- Department of Translational Research and New Technologies in Medicine and Surgery, Unit of Medical Oncology 2, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Marta Schirripa
- Unit of Medical Oncology 1, Department of Clinical and Experimental Oncology, Veneto Institute of Oncology IOV – IRCCS, Padua, Italy
| | - Rossana Intini
- Unit of Medical Oncology 1, Department of Clinical and Experimental Oncology, Veneto Institute of Oncology IOV – IRCCS, Padua, Italy
| | - Daniele Rossini
- Department of Translational Research and New Technologies in Medicine and Surgery, Unit of Medical Oncology 2, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Daniele Santini
- Department of Medical Oncology, Campus Bio-Medico - University of Rome, Rome, Italy
| | - Claudio Pizzo
- Oncology Unit, Oncology Department, ASST of Cremona, Cremona, Italy
| | - Carlotta Antoniotti
- Department of Translational Research and New Technologies in Medicine and Surgery, Unit of Medical Oncology 2, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Beatrice Borelli
- Department of Translational Research and New Technologies in Medicine and Surgery, Unit of Medical Oncology 2, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Federica Marmorino
- Department of Translational Research and New Technologies in Medicine and Surgery, Unit of Medical Oncology 2, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Federica Urbano
- Department of Radiological Science, Oncology and Patology, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Valentina Burgio
- Division of Experimental Medicine, IRCCS San Raffaele, Department of Oncology, Milan, Italy
| | | | - Michele Prisciandaro
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Angela Buonadonna
- Medical Oncology Dept. RCCS CRO Aviano-National Cancer Institute, Aviano, Italy
| | - Sara Bustreo
- SSD ColoRectal Cancer Unit Dipartimento di Oncologia AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Giacomo Allegrini
- Unit of Medical Oncology, Livorno Hospital, Azienda Toscana Nord Ovest, Livorno, Italy
| | - Vincenzo Ricci
- Unit of Medical Oncology, Azienda Sanitaria Ospedaliera Santa Croce e Carle, Cuneo, Italy
| | - Chiara Cremolini
- Department of Translational Research and New Technologies in Medicine and Surgery, Unit of Medical Oncology 2, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Alfredo Falcone
- Department of Translational Research and New Technologies in Medicine and Surgery, Unit of Medical Oncology 2, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
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9
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Barault L, Amatu A, Siravegna G, Ponzetti A, Moran S, Cassingena A, Mussolin B, Falcomatà C, Binder A, Cristiano C, Oddo D, Cancelliere C, Bustreo S, Bencardino K, Maden S, Vanzati A, Zavattari P, Truini M, Grady WM, Racca P, Michels KB, Siena S, Esteller M, Bardelli A, Sartore-Bianchi A, Di Nicolantonio F, Sartore-Bianchi A, Di Nicolantonio F. Discovery of methylated circulating DNA biomarkers for comprehensive non-invasive monitoring of treatment response in metastatic colorectal cancer. Gut 2018; 67:1995-2005. [PMID: 28982739 PMCID: PMC5897187 DOI: 10.1136/gutjnl-2016-313372] [Citation(s) in RCA: 146] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 08/18/2017] [Accepted: 08/21/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Mutations in cell-free circulating DNA (cfDNA) have been studied for tracking disease relapse in colorectal cancer (CRC). This approach requires personalised assay design due to the lack of universally mutated genes. In contrast, early methylation alterations are restricted to defined genomic loci allowing comprehensive assay design for population studies. Our objective was to identify cancer-specific methylated biomarkers which could be measured longitudinally in cfDNA (liquid biopsy) to monitor therapeutic outcome in patients with metastatic CRC (mCRC). DESIGN Genome-wide methylation microarrays of CRC cell lines (n=149) identified five cancer-specific methylated loci (EYA4, GRIA4, ITGA4, MAP3K14-AS1, MSC). Digital PCR assays were employed to measure methylation of these genes in tumour tissue DNA (n=82) and cfDNA from patients with mCRC (n=182). Plasma longitudinal assessment was performed in a patient subset treated with chemotherapy or targeted therapy. RESULTS Methylation in at least one marker was detected in all tumour tissue samples and in 156 mCRC patient cfDNA samples (85.7%). Plasma marker prevalence was 71.4% for EYA4, 68.5% for GRIA4, 69.7% for ITGA4, 69.1% for MAP3K14-AS1% and 65.1% for MSC. Dynamics of methylation markers was not affected by treatment type and correlated with objective tumour response and progression-free survival. CONCLUSION This five-gene methylation panel can be used to circumvent the absence of patient-specific mutations for monitoring tumour burden dynamics in liquid biopsy under different therapeutic regimens. This method might be proposed for assessing pharmacodynamics in clinical trials or when conventional imaging has limitations.
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Affiliation(s)
- Ludovic Barault
- Department of Oncology, University of Torino, SP 142 km 3.95, 10060 Candiolo (TO), Italy,Candiolo Cancer Institute-FPO, IRCCS, SP 142 km 3.95, 10060 Candiolo (TO), Italy,Corresponding authors: Ludovic Barault, PhD or Dr Federica Di Nicolantonio, PhD, Department of Oncology, University of Torino, Candiolo Cancer Institute – FPO, IRCCS, Strada Provinciale 142, Km 3.95, 10060 Candiolo, Torino, Italy, Phone: +39-011-9933523, Fax: +39-011-9933225, (; )
| | - Alessio Amatu
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Giulia Siravegna
- Department of Oncology, University of Torino, SP 142 km 3.95, 10060 Candiolo (TO), Italy,Candiolo Cancer Institute-FPO, IRCCS, SP 142 km 3.95, 10060 Candiolo (TO), Italy,FIRC Institute of Molecular Oncology (IFOM), Milano, Italy
| | - Agostino Ponzetti
- Colorectal Cancer Unit, Medical Oncology Division 1, AOU Città della Salute e della Scienza, San Giovanni Battista Hospital, Turin, Italy
| | - Sebastian Moran
- Cancer Epigenetics and Biology Program, Bellvitge Biomedical Research Institute, L’Hospitalet, Barcelona, Catalonia, Spain
| | - Andrea Cassingena
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Benedetta Mussolin
- Candiolo Cancer Institute-FPO, IRCCS, SP 142 km 3.95, 10060 Candiolo (TO), Italy
| | - Chiara Falcomatà
- Department of Oncology, University of Torino, SP 142 km 3.95, 10060 Candiolo (TO), Italy,Candiolo Cancer Institute-FPO, IRCCS, SP 142 km 3.95, 10060 Candiolo (TO), Italy
| | - Alexandra Binder
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, California, USA
| | - Carmen Cristiano
- Colorectal Cancer Unit, Medical Oncology Division 1, AOU Città della Salute e della Scienza, San Giovanni Battista Hospital, Turin, Italy
| | - Daniele Oddo
- Department of Oncology, University of Torino, SP 142 km 3.95, 10060 Candiolo (TO), Italy,Candiolo Cancer Institute-FPO, IRCCS, SP 142 km 3.95, 10060 Candiolo (TO), Italy
| | - Carlotta Cancelliere
- Department of Oncology, University of Torino, SP 142 km 3.95, 10060 Candiolo (TO), Italy,Candiolo Cancer Institute-FPO, IRCCS, SP 142 km 3.95, 10060 Candiolo (TO), Italy
| | - Sara Bustreo
- Colorectal Cancer Unit, Medical Oncology Division 1, AOU Città della Salute e della Scienza, San Giovanni Battista Hospital, Turin, Italy
| | - Katia Bencardino
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Sean Maden
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Alice Vanzati
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Patrizia Zavattari
- Unit of Biology and Genetics, Dept. Biomedical Sciences, University of Cagliari, Italy
| | - Mauro Truini
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - William M. Grady
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA,Department of Medicine, University of Washington School of Medicine, Seattle, WA
| | - Patrizia Racca
- Colorectal Cancer Unit, Medical Oncology Division 1, AOU Città della Salute e della Scienza, San Giovanni Battista Hospital, Turin, Italy
| | - Karin B. Michels
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, California, USA
| | - Salvatore Siena
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milan, Italy,Università degli Studi di Milano, Milan, Italy
| | - Manel Esteller
- Colorectal Cancer Unit, Medical Oncology Division 1, AOU Città della Salute e della Scienza, San Giovanni Battista Hospital, Turin, Italy,Department of Physiological Sciences II, School of Medicine, University of Barcelona, Barcelona, Catalonia, Spain,Institucio Catalana de Recerca i Estudis Avançats, Barcelona, Catalonia, Spain
| | - Alberto Bardelli
- Department of Oncology, University of Torino, SP 142 km 3.95, 10060 Candiolo (TO), Italy,Candiolo Cancer Institute-FPO, IRCCS, SP 142 km 3.95, 10060 Candiolo (TO), Italy
| | | | - Federica Di Nicolantonio
- Department of Oncology, University of Torino, SP 142 km 3.95, 10060 Candiolo (TO), Italy,Candiolo Cancer Institute-FPO, IRCCS, SP 142 km 3.95, 10060 Candiolo (TO), Italy,Corresponding authors: Ludovic Barault, PhD or Dr Federica Di Nicolantonio, PhD, Department of Oncology, University of Torino, Candiolo Cancer Institute – FPO, IRCCS, Strada Provinciale 142, Km 3.95, 10060 Candiolo, Torino, Italy, Phone: +39-011-9933523, Fax: +39-011-9933225, (; )
| | | | - Federica Di Nicolantonio
- Department of Oncology, University of Torino, Torino, Italy.,Candiolo Cancer Institute-FPO, IRCCS, Candiolo, Italy
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10
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Pietrantonio F, Morano F, Corallo S, Raimondi A, Loupakis F, Cremolini C, Smiroldo V, Berenato R, Bianchi AS, Tampellini M, Bustreo S, Clavarezza M, Murialdo R, Zaniboni A, Tomasello G, Peverelli G, Antoniotti C, Procaccio L, Cinieri S, Antonuzzo L, Di Bartolomeo M, de Braud F. First-line FOLFOX plus panitumumab followed by 5-FU/LV plus panitumumab or single-agent panitumumab as maintenance therapy in patients with RAS wild-type metastatic colorectal cancer (mCRC): The VALENTINO study. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy149.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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11
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Pietrantonio F, Morano F, Corallo S, Lonardi S, Cremolini C, Rimassa L, Sartore-Bianchi A, Tampellini M, Bustreo S, Clavarezza M, Murialdo R, Zaniboni A, Adamo V, Tomasello G, Giordano M, Petrelli F, Longarini R, Zagonel V, Di Bartolomeo M, De Braud FG. First-line FOLFOX plus panitumumab (Pan) followed by 5FU/LV plus Pan or single-agent Pan as maintenance therapy in patients with RAS wild-type metastatic colorectal cancer (mCRC): The VALENTINO study. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.3505] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Filippo Pietrantonio
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Federica Morano
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | | | | | | | | | | | - Sara Bustreo
- Dipartimento di Oncologia- SSD ColoRectal Cancer Unit- AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | | | | | | | - Vincenzo Adamo
- Medical Oncology Unit-A.O. Papardo, Messina and Department of Human Pathology University of Messina, Messina, Italy
| | | | | | | | | | - Vittorina Zagonel
- Department of Clinical and Experimental Oncology, Medical Oncology 1, Veneto Institute of Oncology, IOV-IRCCS, Padua, Italy
| | | | - Filippo G. De Braud
- Fondazione IRCCS Istituto Nazionale dei Tumori and University of Milan, Milan, Italy
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12
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Odisio B, Calandri M, Yamashita S, Gazzera C, Fonio P, Veltri A, Bustreo S, Sheth R, Yevich S, Vauthey J. 4:00 PM Abstract No. 396 Ablation of colorectal liver metastasis: interaction of ablation margins and RAS mutation profiling on local tumor progression outcomes. J Vasc Interv Radiol 2018. [DOI: 10.1016/j.jvir.2018.01.439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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13
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Pinto C, Di Bisceglie M, Di Fabio F, Bochicchio A, Latiano T, Cordio S, Rosati G, Aschele C, Marino A, Bergamo F, Bustreo S, Frassineti L, Ciardiello F, Damato A, Giaquinta S, Baldari D, Boni L. Phase II Study of Preoperative Treatment with External Radiotherapy Plus Panitumumab in Low-Risk, Locally Advanced Rectal Cancer (RaP Study/STAR-03). Oncologist 2018. [PMID: 29523646 DOI: 10.1634/theoncologist.2017-0484] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Treatment with fluoropyrimidines and concomitant long-course external radiotherapy (RTE) is the standard of care in locally advanced rectal cancer (LARC) preoperative chemoradiation. A randomized phase II study (RaP/STAR-03) was conducted that aimed to evaluate the activity and safety of the monoclonal antibody anti-epidermal growth factor receptor panitumumab as a single agent in combination with radiotherapy in low-risk LARC preoperative treatment. MATERIALS AND METHODS Patients had adenocarcinoma of the mid-low rectum, cT3N- or cT2-T3N+, KRAS wild-type status, and negative circumferential radial margin. Panitumumab was administered concomitant to RTE. Rectal surgery was performed 6-8 weeks after the end of preoperative treatment. The adjuvant chemotherapy regimen was FOLFOX. The primary endpoint was the pathologic complete response (pCR) rate. The sample size was calculated using Simon's two-stage design. A pCR of 16% was considered to qualify the experimental treatment for further testing. RESULTS Ninety-eight patients were enrolled in 13 Italian centers from October 2012 to October 2015. Three panitumumab infusions were administered in 92 (93.4%) patients. The RTE compliance was median dose 50.4 Gy; ≥28 fractions in 82 (83.7%) patients. Surgical treatment was performed in 92 (93.9%) patients, and no severe intraoperative complications were observed. A pCR was observed in 10 (10.9%) patients (95% confidence interval, 4.72%-17.07%). Pathological downstaging occurred in 45 (45.9%) patients. Grade 3 toxicities were observed in 22 (22.3%) patients, and the common adverse events were skin rash in 16 (16.3%) patients. No grade 4 toxicities were reported. CONCLUSION The pCR rate (our primary endpoint), at only 10.9%, did not reach the specified level considered suitable for further testing. However, the analysis showed a good toxicity profile and compliance to concomitant administration of panitumumab and RTE in preoperative treatment of LARC. The pCR evaluation in all wild-type RAS is ongoing. IMPLICATIONS FOR PRACTICE The aim of the RaP/STAR-03 study was to evaluate the activity and safety of monoclonal antibody anti-epidermal growth factor receptor (EGFR) panitumumab as a single agent without chemotherapy in low-risk, locally advanced rectal cancer (LARC) preoperative treatment. Nevertheless, the use of panitumumab in combination with radiotherapy in preoperative treatment in patients with KRAS wild type and low-risk LARC did not reach the pathologic complete response primary endpoint. This study showed a good toxicity profile and compliance to combination treatment. Further analysis of NRAS and BRAF on tissue and circulating levels of the EGFR ligands and vascular factors (soluble vascular endothelial growth factor, E-selectin) may provide insight on the potential molecular pathways involved in the anti-EGFR response.
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Affiliation(s)
- Carmine Pinto
- Medical Oncology Unit, Clinical Cancer Centre, IRCCS-Arcispedale S. Maria Nuova, Reggio Emilia, Italy
| | | | | | | | - Tiziana Latiano
- Medical Oncology Unit, IRCCS-Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Stefano Cordio
- Medical Oncology Unit, Ospedale Garibaldi, Catania, Italy
| | - Gerardo Rosati
- Medical Oncology Unit, Ospedale San Carlo, Potenza, Italy
| | - Carlo Aschele
- Medical Oncology Unit, Ospedale Civile, La Spezia, Italy
| | | | - Francesca Bergamo
- Medical Oncology Unit 1, Istituto Oncologico Veneto IOV - IRCCS, Padova, Italy
| | - Sara Bustreo
- Medical Oncology Unit, IRST-IRCCS, Meldola, Italy
| | - Luca Frassineti
- Medical Oncology Unit, AOU Città della Salute e della Scienza, Turin, Italy
| | | | - Angela Damato
- Medical Oncology Unit, Clinical Cancer Centre, IRCCS-Arcispedale S. Maria Nuova, Reggio Emilia, Italy
| | | | | | - Luca Boni
- Clinical Trial Center, Policlinico Careggi, Florence, Italy
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14
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Calandri M, Yamashita S, Gazzera C, Fonio P, Veltri A, Bustreo S, Sheth RA, Yevich SM, Vauthey JN, Odisio BC. Ablation of colorectal liver metastasis: Interaction of ablation margins and RAS mutation profiling on local tumour progression-free survival. Eur Radiol 2018; 28:2727-2734. [DOI: 10.1007/s00330-017-5273-2] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 12/18/2017] [Accepted: 12/21/2017] [Indexed: 12/22/2022]
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15
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Schena M, La Rovere E, Solerio D, Bustreo S, Barone C, Daniele L, Buffoni L, Bironzo P, Sapino A, Gasparri G, Ciuffreda L, Ricardi U. Neoadjuvant chemo-radiotherapy for locally advanced esophageal cancer: A monocentric study. Tumori 2018; 98:451-7. [DOI: 10.1177/030089161209800409] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Aims and background Multimodal therapy is a keystone of care in advanced esophageal cancer. Although neoadjuvant chemoradiotherapy is known to provide a survival advantage in selected cases, reliable prognostic and response predictive factors remain elusive. We report the outcome in a series of esophageal cancer patients treated at our center and the results of a retrospective analysis of epidermal growth factor receptor (EGFR) expression and EGFR/HER2 gene copy numbers taken as possible prognostic and predictive factors. Methods and study design Between 2001 and 2009, a total of 40 consecutive patients (34 men and 6 women; median age, 59 years) were treated for esophageal cancer. Treatment: cisplatin, 80 mg/m2 day 1, and 5-fluorouracil, 800 mg/m2/24 h on days 1–5, every 21 days, concomitant with 3D-conformal radiotherapy (54–59.4 in 30–33 fractions) for three up to four cycles. Surgery was performed in eligible patients 6–8 weeks after chemoradiation. EGFR expression and EGFR/HER2 amplification and gene copy number were studied by immunohistochemical analysis and fluorescence in situ hybridization, respectively. Results Acceptable toxicity following chemoradiation was recorded, with G3–G4 hematological toxicity in 20% of patients and G3–G4 dysphagia in less than 10%; 14 (35%) patients achieved complete response and 19 (48%) partial response; 18 underwent surgery after chemoradiation, of which 8 (20%) achieved pathologic complete response. The median survival was 29 months (95% CI, 25.7–32.1): 42 months for the resected and 20 for the unresected patients. EGFR and HER2 analysis in 28 patients showed that 89% had immunohistochemical EGFR expression, with 5 cases of EGFR and 10 of HER2 gene gain without a significant difference in response rate and survival in these patient subgroups. Conclusions Our results suggest a better outcome in patients who underwent surgery after chemoradiation. A larger sample size is necessary to clarify the role of EGFR and HER2 gene gain in predict response and survival.
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Affiliation(s)
- Marina Schena
- Department of Onco-Hematology, Oncology Unit, San Giovanni Battista Hospital, Turin
| | - Erika La Rovere
- Department of Onco-Hematology, Oncology Unit, San Giovanni Battista Hospital, Turin
| | - Dino Solerio
- Department of Clinical Physiopathology, Esophageal Surgery Unit, University of Turin, San Giovanni Battista Hospital, Turin, Italy
| | - Sara Bustreo
- Department of Onco-Hematology, Oncology Unit, San Giovanni Battista Hospital, Turin
| | - Carla Barone
- Department of Onco-Hematology, Oncology Unit, San Giovanni Battista Hospital, Turin
| | - Lorenzo Daniele
- Department of Biomedical Sciences and Human Oncology, University of Turin, Turin
| | - Lucio Buffoni
- Department of Onco-Hematology, Oncology Unit, San Giovanni Battista Hospital, Turin
| | - Paolo Bironzo
- Department of Onco-Hematology, Oncology Unit, San Giovanni Battista Hospital, Turin
| | - Anna Sapino
- Department of Biomedical Sciences and Human Oncology, University of Turin, Turin
| | - Guido Gasparri
- Department of Clinical Physiopathology, Esophageal Surgery Unit, University of Turin, San Giovanni Battista Hospital, Turin, Italy
| | - Libero Ciuffreda
- Department of Onco-Hematology, Oncology Unit, San Giovanni Battista Hospital, Turin
| | - Umberto Ricardi
- Department of Medical and Surgical Sciences, Radiation Oncology Unit, University of Turin, San Giovanni Battista Hospital, Turin, Italy
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Ponzetti A, Crsitiano C, Milanesi E, Ritorto G, Bustreo S, Mecca C, Ciuffreda L. Very elderly patients and lung cancer in a tertiary care center: a real life experience. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx426.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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17
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Rossini D, Moretto R, Cremolini C, Zagonel V, Tonini G, Ricci V, Aprile G, Lonardi S, Tomasello G, Dell'Aquila E, Allegrini G, Bergamo F, Mancini M, Antoniotti C, Ronzoni M, Zaniboni A, Marmorino F, Bustreo S, Mori E, Falcone A. Treatments (tx) after progression to first-line FOLFOXIRI plus bevacizumab (bev) in metastatic colorectal cancer (mCRC) patients (pts): A pooled analysis of TRIBE and MOMA studies by GONO group. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.3542] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
3542 Background: FOLFOXIRI plus bev is regarded by international guidelines as a valuable option in the first-line tx of mCRC pts. One of the major concerns for the adoption of this regimen is the potential limitation of subsequent therapeutic options. The aim of the present analysis was to focus on treatments received after progression in TRIBE (NCT00719797) and MOMA (NCTNCT02271464) studies. Methods: We collected data of tx received after progression and their outcome in terms of 2ndPFS (time from 2nd line tx start to disease progression or death) and OS II (time from 2nd line tx start to death). For pts in which the same drugs used in first-line were totally or partially reintroduced, the chemotherapy-free interval (CFI, time from the last administration of irinotecan or oxaliplatin during first-line to disease progression) was calculated. Results: Out of 482 pts treated with upfront FOLFOXIRI plus bev, 429 progressed. 303 (70.6%) pts received a 2nd line tx: 93 FOLFOXIRI +/- bev (Group A), 119 FOLFOX/XELOX or FOLFIRI +/- bev (Group B) and 91 other tx (Group C), including an anti-EGFR moAb in 60 cases. No difference was observed among the three groups in terms of 2ndPFS (median 2nd PFS Group A: 5.6 vs Group B: 4.4 vs Group C: 3.9 mos; p = 0.60) or OS II (median OS II Group A: 14.9 vs Group B: 13.8 vs Group C: 11.7 mos; p = 0.49). In the subgroup of pts with a CFI < 6 mos, Group A (n = 52) reported longer 2ndPFS compared to both Group B (n = 58) (median 2ndPFS 5.3 vs 3.0 mos; HR: 0.61,95%CI 0.41-0.89; p = 0.009) and Group C (n = 58) (5.3 vs 3.2 mos; HR: 0.71, 95%CI 0.48-1.05; p = 0.07). Consistent results were achieved in OS II (Group A vs Group B; median OS 13.6 vs 10.8 mos; HR: 0.65, 95%CI 0.42-1.00; p = 0.053; Group A vs Group C 13.6 vs 8.9 mos; HR: 0.60, 95%CI 0.39-0.93; p = 0.002). In the subgroup of pts with a CFI ≥ 6 mos, no significant difference was shown between Group A (n = 41) and Group B (n = 61) or C (n = 33). Conclusions: Tx after progression to first-line FOLFOXIRI plus bev are feasible and show expected efficacy results. The reintroduction of the triplet plus bev seems more effective than doublets plus bev or other tx when a more aggressive disease biology is suggested (CFI < 6 mos).
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Affiliation(s)
- Daniele Rossini
- Unit of Medical Oncology 2, Azienda Ospedaliera-Universitaria Pisana, the Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Roberto Moretto
- Unit of Medical Oncology 2, Azienda Ospedaliera-Universitaria Pisana, the Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Chiara Cremolini
- Unit of Medical Oncology 2, Azienda Ospedaliera-Universitaria Pisana, the Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Vittorina Zagonel
- Unit of Medical Oncology 1, Department of Clinical and Experimental Oncology, Oncologic Institute of Veneto, IRCCS, Padua, Italy
| | - Giuseppe Tonini
- Medical Oncology Department, University Campus Bio-Medico, Rome, Italy
| | - Vincenzo Ricci
- Unit of Medical Oncology, Azienda Sanitaria Ospedaliera Santa Croce e Carle, Cuneo, Italy
| | - Giuseppe Aprile
- Department of Oncology, University and General Hospital, Udine, Italy
| | - Sara Lonardi
- Department of Clinical and Experimental Oncology, Medical Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | | | | | - Giacomo Allegrini
- U.O. Oncologia Medica, Azienda USL-5, Istituto Toscano Tumori, Pontedera, Italy
| | - Francesca Bergamo
- Department of Clinical and Experimental Oncology, Medical Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Marialaura Mancini
- Department of Radiological, Oncological and Pathological Sciences, Division of Medical Oncology, Sapienza University of Rome, Rome, Italy
| | - Carlotta Antoniotti
- Unit of Medical Oncology 2, Azienda Ospedaliera-Universitaria Pisana, the Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Monica Ronzoni
- Department of Oncology, Istituto Scientifico San Raffaele IRCSS, Milan, Italy
| | | | - Federica Marmorino
- Unit of Medical Oncology 2, Azienda Ospedaliera-Universitaria Pisana, the Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Sara Bustreo
- Dipartimento di Oncologia- SSD ColoRectal Cancer Unit- AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Elena Mori
- Department of Medical Oncology, Hospital of Prato, Prato, Italy
| | - Alfredo Falcone
- Unit of Medical Oncology 2, Azienda Ospedaliera-Universitaria Pisana, the Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
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Pinto C, Di Bisceglie M, Di Fabio F, Bochicchio A, Latiano T, Cordio S, Rosati G, Aschele C, Marino A, Bergamo F, Bustreo S, Frassineti L, Ciardiello F, Giaquinta S, Baldari D, Boni L. Phase II open-label single-arm study of pre-operative panitumumab and external pelvic radiotherapy (RTE) in locally advanced rectal cancer (LARC) patients (pts) (RaP/STAR-03 Study). Ann Oncol 2016. [DOI: 10.1093/annonc/mdw335.07] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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19
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Ponzetti A, Zaccaria G, Bustreo S, Mecca C, Spadi R, Fanchini L, Ritorto G, Zanini M, Ciuffreda L, Racca P. Monocentric survey about the use of Raltitrexed in the daily clinical practice for patients with metastatic colorectal cancer. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw335.50] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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20
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Franco P, Arcadipane F, Ragona R, Lesca A, Gallio E, Mistrangelo M, Cassoni P, Arena V, Bustreo S, Faletti R, Rondi N, Morino M, Ricardi U. Dose to specific subregions of pelvic bone marrow defined with FDG-PET as a predictor of hematologic nadirs during concomitant chemoradiation in anal cancer patients. Med Oncol 2016; 33:72. [PMID: 27277756 DOI: 10.1007/s12032-016-0789-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 06/02/2016] [Indexed: 11/30/2022]
Abstract
To test the hypothesis that irradiated volume of specific subregions of pelvic active bone marrow as detected by (18)FDG-PET may be a predictor of decreased blood cells nadirs in anal cancer patients undergoing concurrent chemoradiation, we analyzed 44 patients submitted to IMRT and concurrent chemotherapy. Several bony structures were defined: pelvic and lumbar-sacral (LSBM), lower pelvis (LPBM) and iliac (IBM) bone marrow. Active BM was characterized employing (18)FDG-PET and characterized in all subregions as the volume having standard uptake values (SUVs) higher than SUVmean. All other regions were defined as inactive BM. On dose-volume histograms, dosimetric parameters were taken. Endpoints included white blood cell count (WBC), absolute neutrophil count (ANC), hemoglobin (Hb) and platelet (Plt) nadirs. Generalized linear modeling was used to find correlations between dosimetric variables and blood cells nadirs. WBC nadir was significantly correlated with LSBM mean dose (β = -1.852; 95 % CI -3.205/-0.500; p = 0.009), V10 (β = -2.153; 95 % CI -4.263/-0.721; p = 0.002), V20 (β = -2.081; 95 % CI -4.880/-0.112; p = 0.003), V30 (β = -1.971; 95 % CI -4.748/-0.090; p = 0.023) and IBM V10 (β = -0.073; 95 % CI -0.106/-0.023; p = 0.016). ANC nadir found to be significantly associated with LSBM V10 (β = -1.878; 95 % CI -4.799/-0.643; p = 0.025), V20 (β = -1.765; 95 % CI -4.050/-0.613; p = 0.030) and IBM V10 (β = -0.039; 95 % CI -0.066/-0.010; p = 0.027). Borderline significance was found for correlation between Plt nadir and LSBM V30 (β = -0.056; 95 % CI -2.748/-0.187; p = 0.060), V40 (β = -0.059; 95 % CI -3.112/-0.150; p = 0.060) and IBM V30 (β = -0.028; 95 % CI -0.074/-0.023; p = 0.056). No inactive BM subsites were found to be correlated with any blood cell nadir. (18)FDG-PET is able to define active bone marrow within pelvic osseous structures. LSBM is the strongest predictor of decreased blood cells nadirs in anal cancer patients undergoing concurrent chemoradiation.
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Affiliation(s)
- Pierfrancesco Franco
- Department of Oncology, Radiation Oncology, University of Turin, Via Genova 3, 10126, Turin, Italy.
| | - Francesca Arcadipane
- Department of Oncology, Radiation Oncology, University of Turin, Via Genova 3, 10126, Turin, Italy
| | - Riccardo Ragona
- Department of Oncology, Radiation Oncology, University of Turin, Via Genova 3, 10126, Turin, Italy
| | - Adriana Lesca
- Department of Radiology. Nuclear Medicine Unit, AOU Città della Salute e della Scienza, Turin, Italy
| | - Elena Gallio
- Department of Radiology, Medical Physics Unit, AOU Città della Salute e della Scienza, Turin, Italy
| | | | - Paola Cassoni
- Department of Medical Sciences, Pathology Unit, University of Torino, Turin, Italy
| | - Vincenzo Arena
- Center for Diagnostic Imaging (IRMET), Nuclear Medicine, Turin, Italy
| | - Sara Bustreo
- Oncological Centre for Gastrointestinal Neoplasm, Medical Oncology 1, AOU Città della Salute e della Scienza, Turin, Italy
| | - Riccardo Faletti
- Department of Surgical Sciences, Radiology Unit, University of Turin, Turin, Italy
| | - Nadia Rondi
- Department of Oncology, Radiation Oncology, AOU Città della Salute e della Scienza, Turin, Italy
| | - Mario Morino
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Umberto Ricardi
- Department of Oncology, Radiation Oncology, University of Turin, Via Genova 3, 10126, Turin, Italy
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21
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Bustreo S, Osella-Abate S, Cassoni P, Donadio M, Airoldi M, Pedani F, Papotti M, Sapino A, Castellano I. Optimal Ki67 cut-off for luminal breast cancer prognostic evaluation: a large case series study with a long-term follow-up. Breast Cancer Res Treat 2016; 157:363-371. [PMID: 27155668 PMCID: PMC4875067 DOI: 10.1007/s10549-016-3817-9] [Citation(s) in RCA: 128] [Impact Index Per Article: 16.0] [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: 03/14/2016] [Accepted: 04/26/2016] [Indexed: 01/10/2023]
Abstract
Although Ki67 index suffers from poor reproducibility, it is one of the most important prognostic markers used by oncologists to select the treatment of estrogen receptor (ER) positive breast cancer patients. In this study, we aim to establish the optimal Ki67 cut-offs for stratifying patient prognosis and to create a comprehensive prognostic index for clinical applications. A mono-institutional cohort of 1.577 human epidermal growth factor receptor 2 negative/ER+ breast cancer patients having complete clinical, histological, and follow-up data was collected. The 14 and 20 % Ki67 cut-offs were correlated to disease-free interval (DFI) and disease-specific survival (DSS). To create a comprehensive prognostic index, we used independent variables selected by uni/multivariate analyses. In terms of DFI and DSS, patients bearing tumors with Ki67 < 14 % proliferation index did not differ from those with Ki67 values between 14 and 20 %. Patients with tumor with Ki67 > 20 % showed the poorest prognosis. Moreover, to tumor size, the number of metastatic lymph nodes and Ki67 > 20 % was given a score value, varying depending on definite cut-offs and used to create a prognostic index, which was applied to the population. Patients with a prognostic index ≥3 were characterized by significant risk of relapse [DFI: Hazard Ratio (HR) = 4.74, p < 0.001] and death (DSS: HR = 5.03, p < 0.001). We confirm that the 20 % Ki67 cut-off is the best to stratify high-risk patients in luminal breast cancers, and we suggest to integrate it with other prognostic factors, to better stratify patients at risk of adverse outcome.
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Affiliation(s)
- Sara Bustreo
- Department of Medical Oncology 1, Città della Salute e della Scienza Hospital, Turin, Italy
| | - Simona Osella-Abate
- Division of Pathology, Department of Medical Sciences, University of Torino, Via Santena 7, 10126, Turin, Italy
| | - Paola Cassoni
- Division of Pathology, Department of Medical Sciences, University of Torino, Via Santena 7, 10126, Turin, Italy
| | - Michela Donadio
- Department of Medical Oncology 1, Città della Salute e della Scienza Hospital, Turin, Italy
| | - Mario Airoldi
- Department of Medical Oncology 2, Città della Salute e della Scienza Hospital, Turin, Italy
| | - Fulvia Pedani
- Department of Medical Oncology 2, Città della Salute e della Scienza Hospital, Turin, Italy
| | - Mauro Papotti
- Department of Oncology, University of Torino, Turin, Italy
| | - Anna Sapino
- Division of Pathology, Department of Medical Sciences, University of Torino, Via Santena 7, 10126, Turin, Italy.,Pathology Unit, Fondazione del Piemonte per l'Oncologia (FPO), Candiolo Cancer Institute (IRCCS), Candiolo, Italy
| | - Isabella Castellano
- Division of Pathology, Department of Medical Sciences, University of Torino, Via Santena 7, 10126, Turin, Italy.
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22
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Cremolini C, Loupakis F, Masi G, Lonardi S, Granetto C, Mancini ML, Chiara S, Moretto R, Rossini D, Vitello S, Allegrini G, Tonini G, Bergamo F, Tomasello G, Ronzoni M, Buonadonna A, Bustreo S, Barbara C, Boni L, Falcone A. FOLFOXIRI or FOLFOXIRI plus bevacizumab as first-line treatment of metastatic colorectal cancer: a propensity score-adjusted analysis from two randomized clinical trials. Ann Oncol 2016; 27:843-9. [PMID: 26861604 DOI: 10.1093/annonc/mdw052] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 02/03/2016] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND FOLFOXIRI plus bevacizumab is a valid option as upfront treatment for metastatic colorectal cancer (mCRC) patients. While several trials investigated the effect of combining bevacizumab with different chemotherapy regimens, including fluoropyrimidines monotherapy and oxaliplatin- or irinotecan-containing doublets, no randomized comparison assessing the impact of the addition of bevacizumab to FOLFOXIRI is available. PATIENTS AND METHODS A total of 122 mCRC patients received first-line FOLFOXIRI in the phase III trial by the GONO (FOLFOXIRI group) and 252 patients received first-line FOLFOXIRI plus bevacizumab in the TRIBE trial (FOLFOXIRI plus bevacizumab group). A propensity score-adjusted method was adopted to provide an estimation of the benefit from the addition of bevacizumab to FOLFOXIRI in terms of survival and activity parameters. RESULTS Patients in the FOLFOXIRI group had more frequently Eastern Cooperative Oncology Group performance status of one or two, high Köhne score, metachronous and liver-limited disease, had previously received adjuvant treatments and had their primary tumors resected. The median progression-free survival (PFS) was 12.3 months in the FOLFOXIRI plus bevacizumab group compared with 10.0 months in the FOLFOXIRI group {propensity score-adjusted hazard ratio (HR) 0.74 [95% confidence interval (CI) 0.59-0.94], P = 0.013}. This association was significant also in the multivariable model (P = 0.024). The median OS was 29.8 months in the FOLFOXIRI plus bevacizumab group compared with 23.6 months in the FOLFOXIRI group [propensity score-adjusted HR: 0.72 (95% CI 0.56-0.93), P = 0.014]. At the multivariable model, the addition of bevacizumab was still associated with significantly longer OS (P = 0.030). No significant differences in RECIST response rate (RR) [65.1% versus 55.7%; propensity score-adjusted odds ratio (OR): 1.29 (95% CI 0.81-2.05), P = 0.280], early RR [62.7% versus 57.8%; OR: 1.14 (95% CI 0.68-1.93), P = 0.619] and median depth of response (42.2% versus 53.8%, P = 0.259) were reported. CONCLUSIONS Though in the absence of a randomized comparison, the addition of bevacizumab to FOLFOXIRI provides significant benefit in PFS and OS, thus supporting the use of FOLFOXIRI plus bevacizumab as upfront treatment for mCRC patients. TRIALS' NUMBERS NCT01219920 and NCT00719797.
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Affiliation(s)
- C Cremolini
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa Department of Translational Research and New Technologies in Medicine, University of Pisa, Pisa
| | - F Loupakis
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa Department of Translational Research and New Technologies in Medicine, University of Pisa, Pisa
| | - G Masi
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa Department of Translational Research and New Technologies in Medicine, University of Pisa, Pisa
| | - S Lonardi
- Unit of Medical Oncology 1, Istituto Oncologico Veneto, IRCSS, Padua
| | - C Granetto
- Unit of Medical Oncology, Azienda Sanitaria Ospedaliera Santa Croce e Carle, Cuneo
| | - M L Mancini
- Department of Medical Oncology, University of Rome La Sapienza, Rome
| | - S Chiara
- Department of Medical Oncology 2, IRCCS Azienda Ospedaliera Universitaria San Martino-IST Istituto Nazionale per la Ricerca sul Cancro, Genoa
| | - R Moretto
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa Department of Translational Research and New Technologies in Medicine, University of Pisa, Pisa
| | - D Rossini
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa Department of Translational Research and New Technologies in Medicine, University of Pisa, Pisa
| | - S Vitello
- Unit of Oncology, Sant'Elia Hospital, Caltanissetta
| | - G Allegrini
- Unit of Medical Oncology, 'Felice Lotti' Hospital, Pontedera
| | - G Tonini
- Department of Medical Oncology, University Campus Biomedico, Rome
| | - F Bergamo
- Unit of Medical Oncology 1, Istituto Oncologico Veneto, IRCSS, Padua
| | - G Tomasello
- Division of Medicine and Medical Oncology, Azienda Istituti Ospitalieri, Cremona
| | - M Ronzoni
- Department of Oncology, 'San Raffaele' Hospital IRCSS, Milan
| | - A Buonadonna
- Division of Oncology, Centro di Riferimento Oncologico, Aviano
| | - S Bustreo
- ColoRectal Cancer Unit, Unit of Oncology 1, 'Molinette' Hospital, Città della Salute e della Scienza, Turin
| | - C Barbara
- Unit of Medical Oncology, Spedali Riuniti di Livorno, Livorno
| | - L Boni
- Clinical Trials Coordinating Center, Istituto Toscano Tumori, Florence, Italy
| | - A Falcone
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa Department of Translational Research and New Technologies in Medicine, University of Pisa, Pisa
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23
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Occhipinti S, Sponton L, Rolla S, Caorsi C, Novarino A, Donadio M, Bustreo S, Satolli MA, Pecchioni C, Marchini C, Amici A, Cavallo F, Cappello P, Pierobon D, Novelli F, Giovarelli M. Chimeric rat/human HER2 efficiently circumvents HER2 tolerance in cancer patients. Clin Cancer Res 2014; 20:2910-21. [PMID: 24668647 DOI: 10.1158/1078-0432.ccr-13-2663] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Despite the great success of HER2 vaccine strategies in animal models, effective clinical results have not yet been obtained. We studied the feasibility of using DNA coding for chimeric rat/human HER2 as a tool to break the unresponsiveness of T cells from patients with HER2-overexpressing tumors (HER2-CP). EXPERIMENTAL DESIGN Dendritic cells (DCs) generated from patients with HER2-overexpressing breast (n = 28) and pancreatic (n = 16) cancer were transfected with DNA plasmids that express human HER2 or heterologous rat sequences in separate plasmids or as chimeric constructs encoding rat/human HER2 fusion proteins and used to activate autologous T cells. Activation was evaluated by IFN-γ ELISPOT assay, perforin expression, and ability to halt HER2+ tumor growth in vivo. RESULTS Specific sustained proliferation and IFN-γ production by CD4 and CD8 T cells from HER2-CP was observed after stimulation with autologous DCs transfected with chimeric rat/human HER2 plasmids. Instead, T cells from healthy donors (n = 22) could be easily stimulated with autologous DCs transfected with any human, rat, or chimeric rat/human HER2 plasmid. Chimeric HER2-transfected DCs from HER2-CP were also able to induce a sustained T-cell response that significantly hindered the in vivo growth of HER2(+) tumors. The efficacy of chimeric plasmids in overcoming tumor-induced T-cell dysfunction relies on their ability to circumvent suppressor effects exerted by regulatory T cells (Treg) and/or interleukin (IL)-10 and TGF-β1. CONCLUSIONS These results provide the proof of concept that chimeric rat/human HER2 plasmids can be used as effective vaccines for any HER2-CP with the advantage of being not limited to specific MHC. Clin Cancer Res; 20(11); 2910-21. ©2014 AACR.
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Affiliation(s)
- Sergio Occhipinti
- Authors' Affiliations: Departments of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy; Center for Experimental Research and Medical Studies (CERMS), AO Città della Salute e della Scienza di Torino, Torino, Italy; Immunogenetic and Transplant Biology Service, AO Città della Salute e della Scienza Torino, Italy; Division of Oncology, Subalpine OncoHematology Cancer Center (COES), AO Città della Salute e della Scienza di Torino, Torino, Italy; Department of Oncology, University of Turin, Orbassano, Italy; Department of Medical Sciences, University of Torino, Torino, Italy, Department of Molecular Cellular and Animal Biology, University of Camerino, Camerino, ItalyAuthors' Affiliations: Departments of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy; Center for Experimental Research and Medical Studies (CERMS), AO Città della Salute e della Scienza di Torino, Torino, Italy; Immunogenetic and Transplant Biology Service, AO Città della Salute e della Scienza Torino, Italy; Division of Oncology, Subalpine OncoHematology Cancer Center (COES), AO Città della Salute e della Scienza di Torino, Torino, Italy; Department of Oncology, University of Turin, Orbassano, Italy; Department of Medical Sciences, University of Torino, Torino, Italy, Department of Molecular Cellular and Animal Biology, University of Camerino, Camerino, Italy
| | - Laura Sponton
- Authors' Affiliations: Departments of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy; Center for Experimental Research and Medical Studies (CERMS), AO Città della Salute e della Scienza di Torino, Torino, Italy; Immunogenetic and Transplant Biology Service, AO Città della Salute e della Scienza Torino, Italy; Division of Oncology, Subalpine OncoHematology Cancer Center (COES), AO Città della Salute e della Scienza di Torino, Torino, Italy; Department of Oncology, University of Turin, Orbassano, Italy; Department of Medical Sciences, University of Torino, Torino, Italy, Department of Molecular Cellular and Animal Biology, University of Camerino, Camerino, ItalyAuthors' Affiliations: Departments of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy; Center for Experimental Research and Medical Studies (CERMS), AO Città della Salute e della Scienza di Torino, Torino, Italy; Immunogenetic and Transplant Biology Service, AO Città della Salute e della Scienza Torino, Italy; Division of Oncology, Subalpine OncoHematology Cancer Center (COES), AO Città della Salute e della Scienza di Torino, Torino, Italy; Department of Oncology, University of Turin, Orbassano, Italy; Department of Medical Sciences, University of Torino, Torino, Italy, Department of Molecular Cellular and Animal Biology, University of Camerino, Camerino, Italy
| | - Simona Rolla
- Authors' Affiliations: Departments of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy; Center for Experimental Research and Medical Studies (CERMS), AO Città della Salute e della Scienza di Torino, Torino, Italy; Immunogenetic and Transplant Biology Service, AO Città della Salute e della Scienza Torino, Italy; Division of Oncology, Subalpine OncoHematology Cancer Center (COES), AO Città della Salute e della Scienza di Torino, Torino, Italy; Department of Oncology, University of Turin, Orbassano, Italy; Department of Medical Sciences, University of Torino, Torino, Italy, Department of Molecular Cellular and Animal Biology, University of Camerino, Camerino, ItalyAuthors' Affiliations: Departments of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy; Center for Experimental Research and Medical Studies (CERMS), AO Città della Salute e della Scienza di Torino, Torino, Italy; Immunogenetic and Transplant Biology Service, AO Città della Salute e della Scienza Torino, Italy; Division of Oncology, Subalpine OncoHematology Cancer Center (COES), AO Città della Salute e della Scienza di Torino, Torino, Italy; Department of Oncology, University of Turin, Orbassano, Italy; Department of Medical Sciences, University of Torino, Torino, Italy, Department of Molecular Cellular and Animal Biology, University of Camerino, Camerino, Italy
| | - Cristiana Caorsi
- Authors' Affiliations: Departments of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy; Center for Experimental Research and Medical Studies (CERMS), AO Città della Salute e della Scienza di Torino, Torino, Italy; Immunogenetic and Transplant Biology Service, AO Città della Salute e della Scienza Torino, Italy; Division of Oncology, Subalpine OncoHematology Cancer Center (COES), AO Città della Salute e della Scienza di Torino, Torino, Italy; Department of Oncology, University of Turin, Orbassano, Italy; Department of Medical Sciences, University of Torino, Torino, Italy, Department of Molecular Cellular and Animal Biology, University of Camerino, Camerino, Italy
| | - Anna Novarino
- Authors' Affiliations: Departments of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy; Center for Experimental Research and Medical Studies (CERMS), AO Città della Salute e della Scienza di Torino, Torino, Italy; Immunogenetic and Transplant Biology Service, AO Città della Salute e della Scienza Torino, Italy; Division of Oncology, Subalpine OncoHematology Cancer Center (COES), AO Città della Salute e della Scienza di Torino, Torino, Italy; Department of Oncology, University of Turin, Orbassano, Italy; Department of Medical Sciences, University of Torino, Torino, Italy, Department of Molecular Cellular and Animal Biology, University of Camerino, Camerino, Italy
| | - Michela Donadio
- Authors' Affiliations: Departments of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy; Center for Experimental Research and Medical Studies (CERMS), AO Città della Salute e della Scienza di Torino, Torino, Italy; Immunogenetic and Transplant Biology Service, AO Città della Salute e della Scienza Torino, Italy; Division of Oncology, Subalpine OncoHematology Cancer Center (COES), AO Città della Salute e della Scienza di Torino, Torino, Italy; Department of Oncology, University of Turin, Orbassano, Italy; Department of Medical Sciences, University of Torino, Torino, Italy, Department of Molecular Cellular and Animal Biology, University of Camerino, Camerino, Italy
| | - Sara Bustreo
- Authors' Affiliations: Departments of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy; Center for Experimental Research and Medical Studies (CERMS), AO Città della Salute e della Scienza di Torino, Torino, Italy; Immunogenetic and Transplant Biology Service, AO Città della Salute e della Scienza Torino, Italy; Division of Oncology, Subalpine OncoHematology Cancer Center (COES), AO Città della Salute e della Scienza di Torino, Torino, Italy; Department of Oncology, University of Turin, Orbassano, Italy; Department of Medical Sciences, University of Torino, Torino, Italy, Department of Molecular Cellular and Animal Biology, University of Camerino, Camerino, Italy
| | - Maria Antonietta Satolli
- Authors' Affiliations: Departments of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy; Center for Experimental Research and Medical Studies (CERMS), AO Città della Salute e della Scienza di Torino, Torino, Italy; Immunogenetic and Transplant Biology Service, AO Città della Salute e della Scienza Torino, Italy; Division of Oncology, Subalpine OncoHematology Cancer Center (COES), AO Città della Salute e della Scienza di Torino, Torino, Italy; Department of Oncology, University of Turin, Orbassano, Italy; Department of Medical Sciences, University of Torino, Torino, Italy, Department of Molecular Cellular and Animal Biology, University of Camerino, Camerino, Italy
| | - Carla Pecchioni
- Authors' Affiliations: Departments of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy; Center for Experimental Research and Medical Studies (CERMS), AO Città della Salute e della Scienza di Torino, Torino, Italy; Immunogenetic and Transplant Biology Service, AO Città della Salute e della Scienza Torino, Italy; Division of Oncology, Subalpine OncoHematology Cancer Center (COES), AO Città della Salute e della Scienza di Torino, Torino, Italy; Department of Oncology, University of Turin, Orbassano, Italy; Department of Medical Sciences, University of Torino, Torino, Italy, Department of Molecular Cellular and Animal Biology, University of Camerino, Camerino, Italy
| | - Cristina Marchini
- Authors' Affiliations: Departments of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy; Center for Experimental Research and Medical Studies (CERMS), AO Città della Salute e della Scienza di Torino, Torino, Italy; Immunogenetic and Transplant Biology Service, AO Città della Salute e della Scienza Torino, Italy; Division of Oncology, Subalpine OncoHematology Cancer Center (COES), AO Città della Salute e della Scienza di Torino, Torino, Italy; Department of Oncology, University of Turin, Orbassano, Italy; Department of Medical Sciences, University of Torino, Torino, Italy, Department of Molecular Cellular and Animal Biology, University of Camerino, Camerino, Italy
| | - Augusto Amici
- Authors' Affiliations: Departments of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy; Center for Experimental Research and Medical Studies (CERMS), AO Città della Salute e della Scienza di Torino, Torino, Italy; Immunogenetic and Transplant Biology Service, AO Città della Salute e della Scienza Torino, Italy; Division of Oncology, Subalpine OncoHematology Cancer Center (COES), AO Città della Salute e della Scienza di Torino, Torino, Italy; Department of Oncology, University of Turin, Orbassano, Italy; Department of Medical Sciences, University of Torino, Torino, Italy, Department of Molecular Cellular and Animal Biology, University of Camerino, Camerino, Italy
| | - Federica Cavallo
- Authors' Affiliations: Departments of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy; Center for Experimental Research and Medical Studies (CERMS), AO Città della Salute e della Scienza di Torino, Torino, Italy; Immunogenetic and Transplant Biology Service, AO Città della Salute e della Scienza Torino, Italy; Division of Oncology, Subalpine OncoHematology Cancer Center (COES), AO Città della Salute e della Scienza di Torino, Torino, Italy; Department of Oncology, University of Turin, Orbassano, Italy; Department of Medical Sciences, University of Torino, Torino, Italy, Department of Molecular Cellular and Animal Biology, University of Camerino, Camerino, Italy
| | - Paola Cappello
- Authors' Affiliations: Departments of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy; Center for Experimental Research and Medical Studies (CERMS), AO Città della Salute e della Scienza di Torino, Torino, Italy; Immunogenetic and Transplant Biology Service, AO Città della Salute e della Scienza Torino, Italy; Division of Oncology, Subalpine OncoHematology Cancer Center (COES), AO Città della Salute e della Scienza di Torino, Torino, Italy; Department of Oncology, University of Turin, Orbassano, Italy; Department of Medical Sciences, University of Torino, Torino, Italy, Department of Molecular Cellular and Animal Biology, University of Camerino, Camerino, ItalyAuthors' Affiliations: Departments of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy; Center for Experimental Research and Medical Studies (CERMS), AO Città della Salute e della Scienza di Torino, Torino, Italy; Immunogenetic and Transplant Biology Service, AO Città della Salute e della Scienza Torino, Italy; Division of Oncology, Subalpine OncoHematology Cancer Center (COES), AO Città della Salute e della Scienza di Torino, Torino, Italy; Department of Oncology, University of Turin, Orbassano, Italy; Department of Medical Sciences, University of Torino, Torino, Italy, Department of Molecular Cellular and Animal Biology, University of Camerino, Camerino, Italy
| | - Daniele Pierobon
- Authors' Affiliations: Departments of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy; Center for Experimental Research and Medical Studies (CERMS), AO Città della Salute e della Scienza di Torino, Torino, Italy; Immunogenetic and Transplant Biology Service, AO Città della Salute e della Scienza Torino, Italy; Division of Oncology, Subalpine OncoHematology Cancer Center (COES), AO Città della Salute e della Scienza di Torino, Torino, Italy; Department of Oncology, University of Turin, Orbassano, Italy; Department of Medical Sciences, University of Torino, Torino, Italy, Department of Molecular Cellular and Animal Biology, University of Camerino, Camerino, ItalyAuthors' Affiliations: Departments of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy; Center for Experimental Research and Medical Studies (CERMS), AO Città della Salute e della Scienza di Torino, Torino, Italy; Immunogenetic and Transplant Biology Service, AO Città della Salute e della Scienza Torino, Italy; Division of Oncology, Subalpine OncoHematology Cancer Center (COES), AO Città della Salute e della Scienza di Torino, Torino, Italy; Department of Oncology, University of Turin, Orbassano, Italy; Department of Medical Sciences, University of Torino, Torino, Italy, Department of Molecular Cellular and Animal Biology, University of Camerino, Camerino, Italy
| | - Francesco Novelli
- Authors' Affiliations: Departments of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy; Center for Experimental Research and Medical Studies (CERMS), AO Città della Salute e della Scienza di Torino, Torino, Italy; Immunogenetic and Transplant Biology Service, AO Città della Salute e della Scienza Torino, Italy; Division of Oncology, Subalpine OncoHematology Cancer Center (COES), AO Città della Salute e della Scienza di Torino, Torino, Italy; Department of Oncology, University of Turin, Orbassano, Italy; Department of Medical Sciences, University of Torino, Torino, Italy, Department of Molecular Cellular and Animal Biology, University of Camerino, Camerino, ItalyAuthors' Affiliations: Departments of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy; Center for Experimental Research and Medical Studies (CERMS), AO Città della Salute e della Scienza di Torino, Torino, Italy; Immunogenetic and Transplant Biology Service, AO Città della Salute e della Scienza Torino, Italy; Division of Oncology, Subalpine OncoHematology Cancer Center (COES), AO Città della Salute e della Scienza di Torino, Torino, Italy; Department of Oncology, University of Turin, Orbassano, Italy; Department of Medical Sciences, University of Torino, Torino, Italy, Department of Molecular Cellular and Animal Biology, University of Camerino, Camerino, Italy
| | - Mirella Giovarelli
- Authors' Affiliations: Departments of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy; Center for Experimental Research and Medical Studies (CERMS), AO Città della Salute e della Scienza di Torino, Torino, Italy; Immunogenetic and Transplant Biology Service, AO Città della Salute e della Scienza Torino, Italy; Division of Oncology, Subalpine OncoHematology Cancer Center (COES), AO Città della Salute e della Scienza di Torino, Torino, Italy; Department of Oncology, University of Turin, Orbassano, Italy; Department of Medical Sciences, University of Torino, Torino, Italy, Department of Molecular Cellular and Animal Biology, University of Camerino, Camerino, ItalyAuthors' Affiliations: Departments of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy; Center for Experimental Research and Medical Studies (CERMS), AO Città della Salute e della Scienza di Torino, Torino, Italy; Immunogenetic and Transplant Biology Service, AO Città della Salute e della Scienza Torino, Italy; Division of Oncology, Subalpine OncoHematology Cancer Center (COES), AO Città della Salute e della Scienza di Torino, Torino, Italy; Department of Oncology, University of Turin, Orbassano, Italy; Department of Medical Sciences, University of Torino, Torino, Italy, Department of Molecular Cellular and Animal Biology, University of Camerino, Camerino, Italy
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Roila F, Ballatori E, Fabi A, Fatigoni S, Chiara S, Ionta MT, Aieta M, Clerico M, Palladino MA, Indelli M, Garrone O, Bustreo S, Ruggeri B. Aprepitant (AP) versus dexamethasone (D) for preventing delayed emesis induced by anthracyclines plus cyclophosphamide (A+C) chemotherapy (CT) in breast cancer patients (pts): A double-blind, multicenter, randomized study. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.9614] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
9614 Background: A combination of AP + a 5-HT3 receptor antagonist + D and AP alone is recommended, respectively, for the prophylaxis of acute and delayed emesis induced by A+C CT in breast cancer pts. In the registrative study the role of AP in delayed emesis was not defined because prophylaxis of acute emesis was different between the two arms, and the superiority of AP on delayed emesis could be the consequence of a dependent effect on the different results achieved in acute phase. Aim of this study was to compare the efficacy of AP versus D in preventing delayed emesis in pts receiving the same prophylaxis of acute emesis. Methods: A randomized double-blind study comparing AP versus D was completed in naive breast cancer pts treated with A+C. Before CT, all pts were treated with intravenous palonosetron 0.25 mg and D 8 mg, and oral AP 125 mg. On days 2 and 3 pts randomly received D 4 mg bid or AP 80 mg qd. Primary endpoint was rate of complete response (no vomiting, no rescue treatment) from days 2 - 5 after CT. Results: From September 2009 to July 2012, 580 pts were enrolled; 551 were fully evaluated, 273 in arm D and 278 in arm AP. Day 1 complete response rates were similar: 239/273 (87.6%) in D arm and 236/278 (84.9%) in AP arm. From day 2-5, complete response was the same with both antiemetic prophylaxes (79.5%), and all secondary endpoints (complete protection, total control, no vomiting, no nausea, score of FLIE) assumed similar values. During the delayed phase, incidence of insomnia (2.9% vs. 0.4%) and heartburn (8.1% vs. 3.6%) was significantly superior in D arm. Conclusions: In breast cancer pts submitted to A+C CT and receiving the same antiemetic prophylaxis for acute emesis, D and AP present similar efficacy and toxicity. Clinical trial information: NCT 00869973.
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Affiliation(s)
| | | | - Alessandra Fabi
- Medical Oncology, Regina Elena National Cancer Institute, Rome, Italy
| | | | - Silvana Chiara
- Medical Oncology Unit, National Cancer Institute, Genoa, Italy
| | | | | | | | | | | | - Ornella Garrone
- Medical Oncology, Santa Croce General Hospital, Cuneo, Italy
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Barilà DA, Bianco A, Bustreo S, Donadio M, Rosso S, Cattel F. CPC-002 A Multicentre Retrospective Study to Evaluate the Economic Impact of the Prescribing Models For Trastuzumab in the Piemonte Region: Abstract CPC-002 Table 1. Eur J Hosp Pharm 2013. [DOI: 10.1136/ejhpharm-2013-000276.459] [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: 11/03/2022] Open
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Schena M, La Rovere E, Solerio D, Bustreo S, Barone C, Daniele L, Buffoni L, Bironzo P, Sapino A, Gasparri G, Ciuffreda L, Ricardi U. Neoadjuvant chemo-radiotherapy for locally advanced esophageal cancer: a monocentric study. Tumori 2012. [PMID: 23052161 DOI: 10.1700/1146.12639] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
AIMS AND BACKGROUND Multimodal therapy is a keystone of care in advanced esophageal cancer. Although neoadjuvant chemoradiotherapy is known to provide a survival advantage in selected cases, reliable prognostic and response predictive factors remain elusive. We report the outcome in a series of esophageal cancer patients treated at our center and the results of a retrospective analysis of epidermal growth factor receptor (EGFR) expression and EGFR/HER2 gene copy numbers taken as possible prognostic and predictive factors. METHODS AND STUDY DESIGN Between 2001 and 2009, a total of 40 consecutive patients (34 men and 6 women; median age, 59 years) were treated for esophageal cancer. TREATMENT cisplatin, 80 mg/m² day 1, and 5-fluorouracil, 800 mg/m²/24 h on days 1-5, every 21 days, concomitant with 3D-conformal radiotherapy (54-59.4 in 30-33 fractions) for three up to four cycles. Surgery was performed in eligible patients 6-8 weeks after chemoradiation. EGFR expression and EGFR/HER2 amplification and gene copy number were studied by immunohistochemical analysis and fluorescence in situ hybridization, respectively. RESULTS Acceptable toxicity following chemoradiation was recorded, with G3-G4 hematological toxicity in 20% of patients and G3-G4 dysphagia in less than 10%; 14 (35%) patients achieved complete response and 19 (48%) partial response; 18 underwent surgery after chemoradiation, of which 8 (20%) achieved pathologic complete response. The median survival was 29 months (95% CI, 25.7-32.1): 42 months for the resected and 20 for the unresected patients. EGFR and HER2 analysis in 28 patients showed that 89% had immunohistochemical EGFR expression, with 5 cases of EGFR and 10 of HER2 gene gain without a significant difference in response rate and survival in these patient subgroups. CONCLUSIONS Our results suggest a better outcome in patients who underwent surgery after chemoradiation. A larger sample size is necessary to clarify the role of EGFR and HER2 gene gain in predict response and survival.
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Affiliation(s)
- Marina Schena
- Department of Onco-Hematology, Oncology Unit, San Giovanni Battista Hospital, Turin, Italy.
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Schena M, Guarrera S, Buffoni L, Salvadori A, Voglino F, Allione A, Pecorari G, Ruffini E, Garzino-Demo P, Bustreo S, Consito L, Bironzo P, Matullo G. DNA repair gene expression level in peripheral blood and tumour tissue from non-small cell lung cancer and head and neck squamous cell cancer patients. DNA Repair (Amst) 2012; 11:374-80. [DOI: 10.1016/j.dnarep.2012.01.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2011] [Revised: 12/28/2011] [Accepted: 01/05/2012] [Indexed: 12/22/2022]
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Rampino M, Bacigalupo A, Russi E, Schena M, Lastrucci L, Iotti C, Reali A, Musu A, Balcet V, Piva C, Bustreo S, Munoz F, Ragona R, Corvò R, Ricardi U. Efficacy and feasibility of induction chemotherapy and radiotherapy plus cetuximab in head and neck cancer. Anticancer Res 2012; 32:195-199. [PMID: 22213307] [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: 05/31/2023]
Abstract
BACKGROUND To determine the potential activity and tolerability of sequential treatment in head and neck cancer, we conducted a phase II trial based on induction chemotherapy of two cycles of taxotere, cisplatin and 5-fluorouracil followed by radiotherapy plus weekly cetuximab. PATIENTS AND METHODS Thirty-six patients with stage III or IV squamous cell carcinoma of the oral cavity, larynx, oropharynx and hypopharynx were treated and evaluated for response and acute toxicity. RESULTS Eighty-one percent of patients had stage IV disease and 42% had hypopharyngeal and oral cavity primaries. The overall response rate was 81.8%, with 60.6% complete response and 33.3% partial response. Severe toxicities were febrile neutropenia (6%) during induction chemotherapy and dermatitis (48%), mucositis (33%) and dysphagia (12%) during the concurrent phase. CONCLUSION Our protocol proved to be feasible, effective and well tolerated. This sequential strategy should be further investigated.
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Affiliation(s)
- M Rampino
- Department of Medical and Surgical Sciences, Radiation Oncology Unit, University of Torino, San Giovanni Battista Hospital, Torino, Italy.
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Bussone R, Bustreo S, Ala A, Cianci R, Bevilacqua S, Grilz G, Castellano I, Mistrangelo M, Ritorto G, Vandone AM, Donadio M. Electrochemotherapy with bleomycin in the treatment of cutaneous metastases from breast cancer and resistant to standard therapies: a case report. Breast 2011. [DOI: 10.1016/j.breast.2011.08.072] [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: 11/29/2022] Open
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