1
|
Militello AM, Orsi G, Cavaliere A, Niger M, Avallone A, Salvatore L, Tortora G, Rapposelli IG, Giordano G, Noventa S, Giommoni E, Bozzarelli S, Macchini M, Peretti U, Procaccio L, Puccini A, Cascinu S, Montagna C, Milella M, Reni M. Clinical outcomes and response to chemotherapy in a cohort of pancreatic cancer patients with germline variants of unknown significance (VUS) in BRCA1 and BRCA2 genes. Cancer Chemother Pharmacol 2023; 92:501-510. [PMID: 37725113 DOI: 10.1007/s00280-023-04585-w] [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: 02/05/2023] [Accepted: 08/22/2023] [Indexed: 09/21/2023]
Abstract
PURPOSE The clinical outcome and the efficacy of chemotherapy in pancreatic cancer patients with BRCA1/2 Variants of Unknown Significance (VUS) is unknown. We explored the effects of chemotherapy with or without Platinum in non metastatic and metastatic pancreatic cancer patients with BRCA1/2 VUS. METHODS A retrospective analysis of non-metastatic or metastatic pancreatic cancer patients with gBRCA1/2 VUS treated in 13 Italian centers between November 2015 and December 2020 was performed. All patients were assessed for toxicity and RECIST 1.1 response. Metastatic patients were evaluated for survival outcome. RESULTS 30 pancreatic cancer patients with gBRCA1/2 VUS were considered: 20 were M+ and 10 were non-M+. Pl-CT was recommended to 16 patients: 10 M+ (6 FOLFIRINOX and 4 PAXG) and 6 non-M+ (3 FOLFIRINOX and 3 PAXG); 11 patients received Nabpaclitaxel-Gemcitabine (AG; 8 M+) and 3 patients (2 M+) were treated with Gemcitabine (G). The RECIST 1.1 response rate was 27% for AG and 44% for Pl-CT (22% for (m) FOLFIRINOX and 71% PAXG). 1 year Progression-Free Survival was 37.5% for patients treated with AG and 33% in the Pl-CT subgroup. Median Overall Survival (OS) was 23.5 months for patients treated with AG and 14 months for the Pl-CT subgroup. 1 Year and 2 Year OS were numerically better for AG (1 Year OS: 75% vs 60% and 2 Year OS: 50% and 20% in AG and Pl-CT subgroups, respectively) as well. CONCLUSIONS Pl-CT does not seem to be associated with a better outcome compared to AG chemotherapy in PDAC patients with BRCA 1/2 VUS.
Collapse
Affiliation(s)
- Anna Maria Militello
- Department of Medical Oncology, IRCCS San Raffaele Scientific Institute, Vita-Salute University, Via Olgettina 60, 20123, Milan, Italy
- Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute, Milan, Italy
| | - Giulia Orsi
- Department of Medical Oncology, IRCCS San Raffaele Scientific Institute, Vita-Salute University, Via Olgettina 60, 20123, Milan, Italy
- Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute, Milan, Italy
| | - Alessandro Cavaliere
- Department of Oncology, University of Torino, Candiolo, Italy
- Candiolo Cancer Institute, FPO - IRCCS Candiolo, Candiolo, Italy
| | - Monica Niger
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Dei Tumori Di Milano, Milan, Italy
| | - Antonio Avallone
- Biologia Cellulare e Bioterapie, Istituto Nazionale per lo Studio e la Cura dei Tumori ''Fondazione Giovanni Pascale'' - IRCCS, Naples, Italy
| | - Lisa Salvatore
- Unit of Medical Oncology, Comprehensive Cancer Center, Fondazione Policlinico Universitario, Agostino Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giampaolo Tortora
- Unit of Medical Oncology, Comprehensive Cancer Center, Fondazione Policlinico Universitario, Agostino Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Ilario Giovanni Rapposelli
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) ''Dino Amadori'', Meldola, Italy
| | - Guido Giordano
- Unit of Medical Oncology and Biomolecular Therapy, Policlinico Riuniti, Foggia, Italy
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Silvia Noventa
- Department of Medical Oncology, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - Elisa Giommoni
- Medical Oncology Division, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Silvia Bozzarelli
- Department of Medical Oncology and Hematology, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Marina Macchini
- Department of Medical Oncology, IRCCS San Raffaele Scientific Institute, Vita-Salute University, Via Olgettina 60, 20123, Milan, Italy
- Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute, Milan, Italy
| | - Umberto Peretti
- Department of Medical Oncology, IRCCS San Raffaele Scientific Institute, Vita-Salute University, Via Olgettina 60, 20123, Milan, Italy
- Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute, Milan, Italy
| | - Letizia Procaccio
- Medical Oncology 1 Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padua, Italy
| | - Alberto Puccini
- University of Genoa, Ospedale Policlinico San Martino IRCCS, Genoa, Italy
| | - Stefano Cascinu
- Department of Medical Oncology, IRCCS San Raffaele Scientific Institute, Vita-Salute University, Via Olgettina 60, 20123, Milan, Italy
- Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute, Milan, Italy
| | - Cristina Montagna
- Department of Radiation Oncology and Genomic Instability and Cancer Genetics, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Michele Milella
- Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy
| | - Michele Reni
- Department of Medical Oncology, IRCCS San Raffaele Scientific Institute, Vita-Salute University, Via Olgettina 60, 20123, Milan, Italy.
- Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute, Milan, Italy.
| |
Collapse
|
2
|
Procaccio L, Merz V, Fasano M, Vaccaro V, Giommoni E, Pretta A, Noventa S, Satolli MA, Giordano G, Zichi C, Pinto C, Zecchetto C, Barsotti G, De Vita F, Milella M, Antonuzzo L, Scartozzi M, Zaniboni A, Spadi R, Casalino S, Bergamo F, De Toni C, Melisi D, Lonardi S. The role of nanoliposomal irinotecan plus fluorouracil/leucovorin in the continuum of care of patients with metastatic pancreatic ductal adenocarcinoma. Cancer Med 2023. [PMID: 37278395 DOI: 10.1002/cam4.6111] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 05/01/2023] [Accepted: 05/07/2023] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND The NAPOLI-I trial showed better outcome of nanoliposomal irinotecan (nal-IRI) plus 5-fluorouracil/leucovorin (5-FU/LV) compared to 5-FU/LV in patients with advanced pancreatic ductal adenocarcinoma cancer (advPDAC) progressed to gemcitabine-based therapy. This study aims to explore the real-world efficacy and safety of 5-FU/LV-nal-IRI. METHODS This is a retrospective multicenter analysis including advPDAC patients receiving 5-FU/LV-nal-IRI after failure of gemcitabine-based therapy. Survival analyses were performed using Kaplan-Meier method, univariate and multivariate analyses by Cox regression. RESULTS A total of 296 patients (median age 64.4 years, ECOG PS ≥1 in 56% of cases) were treated at 11 Italian institutions between 2016 and 2018. 34% of them underwent primary tumor resection, and 79% received gemcitabine-nabpaclitaxel as first line. 5-FU/LV-nal-IRI was administered as second-line in 73% of cases. Objective response and disease control rate were 12% and 41%, respectively. Treatment was well tolerated with dose reductions in 50% of patients but no one permanent discontinuation; the commonest grade ≥3 toxicities were neutropenia (14%) and diarrhea (12%). Median PFS and OS from 5-FU/LV-nal-IRI initiation was 3.2 and 7.1 months, respectively. CONCLUSIONS These real-world data confirm the 5-FU/LV-nal-IRI efficacy and safety in advPDAC patients progressed to gemcitabine-based therapy, with outcomes comparable to NAPOLI-1, even in a less-selected population and with more modern therapeutic algorithm.
Collapse
Affiliation(s)
- Letizia Procaccio
- Medical Oncology 1 Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Valeria Merz
- Digestive Molecular Clinical Oncology Research Unit, Università degli Studi di Verona, Verona, Italy
| | - Morena Fasano
- Medical Oncology Unit, Department of Precision Medicine, School of Medicine, University of study of Campania "L. Vanvitelli", Naples, Italy
| | | | - Elisa Giommoni
- Clinical Oncology Unit, Careggi University Hospital, Florence, Italy
| | - Andrea Pretta
- Medical Oncology Department, University Hospital, University of Cagliari, Cagliari, Italy
| | - Silvia Noventa
- Medical Oncology Unit, Casa di Cura Poliambulanza, Brescia, Italy
| | - Maria Antonietta Satolli
- Department of Oncology, University of Turin, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza, Turin, Italy
| | - Guido Giordano
- UO di Oncologia Medica, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Clizia Zichi
- Department of Oncology, University of Turin, Ordine Mauriziano Hospital, Turin, Italy
| | - Carmine Pinto
- High-Complexity Oncology Unit, Clinical Cancer Center, IRCCS Reggio Emilia, Reggio Emilia, Italy
| | - Camilla Zecchetto
- Digestive Molecular Clinical Oncology Research Unit, Università degli Studi di Verona, Verona, Italy
| | - Giulia Barsotti
- Medical Oncology 1 Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Ferdinando De Vita
- Medical Oncology Unit, Department of Precision Medicine, School of Medicine, University of study of Campania "L. Vanvitelli", Naples, Italy
| | | | - Lorenzo Antonuzzo
- Clinical Oncology Unit, Careggi University Hospital, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Mario Scartozzi
- Medical Oncology Department, University Hospital, University of Cagliari, Cagliari, Italy
| | - Alberto Zaniboni
- Medical Oncology Unit, Casa di Cura Poliambulanza, Brescia, Italy
| | - Rosella Spadi
- Medical Oncology 1, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza, Turin, Italy
| | - Simona Casalino
- Digestive Molecular Clinical Oncology Research Unit, Università degli Studi di Verona, Verona, Italy
| | - Francesca Bergamo
- Medical Oncology 1 Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Chiara De Toni
- Medical Oncology 1 Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Davide Melisi
- Digestive Molecular Clinical Oncology Research Unit, Università degli Studi di Verona, Verona, Italy
- Investigational Cancer Therapeutics Clinical Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Sara Lonardi
- Medical Oncology 3 Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| |
Collapse
|
3
|
Milella M, Orsi G, Palloni A, Salvatore L, Procaccio L, Noventa S, Bozzarelli S, Garajova I, Vasile E, Giordano G, Macchini M, Cavaliere A, Gaule M, Lonardi S, Di Marco M, Tortora G, Sperduti I, Reni M. 1307P Real-world impact of olaparib use in advanced pancreatic cancer (PC) patients (pts) harboring germline BRCA1/2 (gBRCA) mutations. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1439] [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: 11/01/2022] Open
|
4
|
Cherri S, Oneda E, Noventa S, Melocchi L, Zaniboni A. Microsatellite instability and chemosensitivity in solid tumours. Ther Adv Med Oncol 2022; 14:17588359221099347. [PMID: 35620236 PMCID: PMC9127927 DOI: 10.1177/17588359221099347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 02/13/2022] [Accepted: 04/21/2022] [Indexed: 01/01/2023] Open
Abstract
The use of biomarkers that influence a targeted choice in cancer treatments is the future of medical oncology. Within this scenario, in recent years, an important role has been played by knowledge of microsatellite instability (MSI), a molecular fingerprint that identifies defects in the mismatch repair system. This knowledge has changed clinical practice in the adjuvant setting of colon cancer, and its role in the neoadjuvant setting in gastric tumours is becoming increasingly interesting, as well as in endometrial cancers in both early and advanced diseases. Furthermore, it has undoubtedly conditioned the first lines of treatment in the metastatic setting in different types of cancers. The incidence of MSI is different in different cancer types, as well as in early cancers versus metastatic disease. Knowing the incidence of MSI in the various histologies can provide insight into the potential use of this biomarker considering its prognostic value, especially in the early stages, and its predictive role with respect to treatment response. In particular, MSI can guide the choice of chemotherapy treatments in the adjuvant setting of colon and perioperative setting in gastric tumours, which could lead to immunotherapy treatments in these patients in both the early stages of the disease and the metastatic setting where the response to immunotherapy drugs in diseases with MSI is now well established. In this review, we focus on colon, gastric and endometrial cancers, and we briefly discuss other cancer types where MSI could have a potential role in oncological treatment decisions.
Collapse
Affiliation(s)
- Sara Cherri
- Department of Clinical Oncology, Fondazione Poliambulanza, Via bissolati 57, 25124, Brescia, Italy
| | - Ester Oneda
- Department of Clinical Oncology, Fondazione Poliambulanza, Brescia, Italy
| | - Silvia Noventa
- Department of Clinical Oncology, Fondazione Poliambulanza, Brescia, Italy
| | - Laura Melocchi
- Department of Anatomical Pathology, Fondazione Poliambulanza, Brescia, Italy
| | - Alberto Zaniboni
- Department of Clinical Oncology, Fondazione Poliambulanza, Brescia, Italy
| |
Collapse
|
5
|
Orsi G, Di Marco M, Cavaliere A, Niger M, Bozzarelli S, Giordano G, Noventa S, Rapposelli IG, Garajova I, Tortora G, Rodriquenz MG, Bittoni A, Penzo E, De Lorenzo S, Peretti U, Paratore C, Bernardini I, Mosconi S, Spallanzani A, Macchini M, Tamburini E, Bencardino K, Giommoni E, Scartozzi M, Forti L, Valente MM, Militello AM, Cascinu S, Milella M, Reni M. Chemotherapy toxicity and activity in patients with pancreatic ductal adenocarcinoma and germline BRCA1-2 pathogenic variants (gBRCA1-2pv): a multicenter survey. ESMO Open 2021; 6:100238. [PMID: 34392104 PMCID: PMC8371213 DOI: 10.1016/j.esmoop.2021.100238] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 07/15/2021] [Accepted: 07/20/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Germline BRCA1-2 pathogenic variants (gBRCA1-2pv)-related pancreatic ductal adenocarcinoma (PDAC) showed increased sensitivity to DNA cross-linking agents. This study aimed at exploring safety profile, dose intensity, and activity of different chemotherapy regimens in this setting. PATIENTS AND METHODS gBRCA1-2pv PDAC patients of any age and clinical tumor stage who completed a first course of chemotherapy were eligible. A descriptive analysis of chemotherapy toxicity, dose intensity, response, and survival outcomes was performed. RESULTS A total of 85 gBRCA1-2pv PDAC patients treated in 21 Italian centers between December 2008 and March 2021were enrolled. Seventy-four patients were assessable for toxicity and dose intensity, 83 for outcome. Dose intensity was as follows: nab-paclitaxel 72%, gemcitabine 76% (AG); cisplatin 75%, nab-paclitaxel 73%, capecitabine 73%, and gemcitabine 65% (PAXG); fluorouracil 35%, irinotecan 58%, and oxaliplatin 64% (FOLFIRINOX). When compared with the literature, grade 3-4 neutropenia, thrombocytopenia, and diarrhea were increased with PAXG, and unmodified with AG and FOLFIRINOX. RECIST responses were numerically higher with the three- (81%) or four-drug (73%) platinum-containing regimens that outperformed AG (41%) and oxaliplatin-based doublets (56%). Carbohydrate antigen 19.9 (CA19.9) reduction >89% at nadir was reported in two-third of metastatic patients treated with triplets and quadruplets, as opposed to 33% and 45% of patients receiving oxaliplatin-based doublets or AG, respectively. All patients receiving AG experienced disease progression, with a median progression-free survival (mPFS) of 6.4 months, while patients treated with platinum-containing triplets or quadruplets had an mPFS >10.8 months. Albeit still immature, data on overall survival seemed to parallel those on PFS. CONCLUSIONS Our data, as opposed to figures expected from the literature, highlighted that platinum-based regimens provoked an increased toxicity on proliferating cells, when dose intensity was maintained, or an as-expected toxicity, when dose intensity was reduced, while no change in toxicity and dose intensity was evident with AG. Furthermore, an apparently improved outcome of platinum-based triplets or quadruplets over other regimens was observed.
Collapse
Affiliation(s)
- G Orsi
- Medical Oncology Department, IRCCS San Raffaele Scientific Institute, Milan, Italy; Pancreas Translational and Clinical Research Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - M Di Marco
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola - Malpighi University Hospital, Bologna, Italy
| | - A Cavaliere
- Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy
| | - M Niger
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - S Bozzarelli
- Department of Medical Oncology and Hematology, Humanitas Cancer Center, Humanitas Clinical and Research Center - IRCCS, Rozzano (Milan), Italy
| | - G Giordano
- Unit of Medical Oncology and Biomolecular Therapy, Policlinico Riuniti, Foggia, Italy; Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - S Noventa
- Department of Medical Oncology, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - I G Rapposelli
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori "Dino Amadori" - IRST, Meldola, Italy
| | - I Garajova
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - G Tortora
- Unit of Medical Oncology, Comprehensive Cancer Center, Fondazione Policlinico Universitario, Agostino Gemelli IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy
| | - M G Rodriquenz
- Oncology Unit, Ospedale IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo (FG), Italy
| | - A Bittoni
- Oncology Unit, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I, GM Lancisi, G Salesi di Ancona, Ancona, Italy
| | - E Penzo
- Medical Oncology Department, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - S De Lorenzo
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - U Peretti
- Medical Oncology Department, IRCCS San Raffaele Scientific Institute, Milan, Italy; Pancreas Translational and Clinical Research Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - C Paratore
- Department of Oncology, University of Turin, Ordine Mauriziano Hospital, Turin, Italy
| | - I Bernardini
- Medical Oncology Unit, Ospedale Ramazzini, Carpi (MO), Italy
| | - S Mosconi
- Oncology Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - A Spallanzani
- Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
| | - M Macchini
- Medical Oncology Department, IRCCS San Raffaele Scientific Institute, Milan, Italy; Pancreas Translational and Clinical Research Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - E Tamburini
- Medical Oncology and Palliative Care Department, Azienda Ospedaliera Cardinale G. Panico, Tricase-Lecce, Italy
| | - K Bencardino
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - E Giommoni
- Medical Oncology Division, Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy
| | - M Scartozzi
- Medical Oncology, University and University Hospital, Cagliari, Italy
| | - L Forti
- Medical Oncology Division, Azienda Ospedaliero-Universitaria Maggiore della Carità, Novara, Italy
| | - M M Valente
- Medical Oncology Department, IRCCS San Raffaele Scientific Institute, Milan, Italy; Pancreas Translational and Clinical Research Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - A M Militello
- Medical Oncology Department, IRCCS San Raffaele Scientific Institute, Milan, Italy; Pancreas Translational and Clinical Research Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - S Cascinu
- Medical Oncology Department, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - M Milella
- Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy
| | - M Reni
- Medical Oncology Department, IRCCS San Raffaele Scientific Institute, Milan, Italy; Pancreas Translational and Clinical Research Center, IRCCS San Raffaele Scientific Institute, Milan, Italy.
| |
Collapse
|
6
|
Lemmers DHL, Cherri S, van Etten-Jamaludin FS, Noventa S, Zaniboni A, Wilmink JW, Besselink MG, Abu Hilal M. Adjuvant chemotherapy following curative-intent resection for ampullary adenocarcinoma. Hippokratia 2021. [DOI: 10.1002/14651858.cd014749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Daniel HL Lemmers
- Department of Surgery, Hepato-Biliary and Pancreatic Unit; Instituto Fondazione Poliambulanza; Brescia Italy
- Department of Surgery; Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam; Amsterdam Netherlands
| | - Sara Cherri
- Department of Medical Oncology; Instituto Fondazione Poliambulanza; Brescia Italy
| | | | - Silvia Noventa
- Department of Medical Oncology; Instituto Fondazione Poliambulanza; Brescia Italy
| | - Alberto Zaniboni
- Department of Medical Oncology; Instituto Fondazione Poliambulanza; Brescia Italy
| | - Johanna W Wilmink
- Department of Medical Oncology; Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam; Amsterdam Netherlands
| | - Marc G Besselink
- Department of Surgery; Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam; Amsterdam Netherlands
| | - Mohammed Abu Hilal
- Department of Surgery, Hepato-Biliary and Pancreatic Unit; Instituto Fondazione Poliambulanza; Brescia Italy
| |
Collapse
|
7
|
Orsi G, Milella M, Nappo F, Di Marco M, Niger M, Bozzarelli S, Rodriquenz M, Noventa S, Giordano G, Rapposelli I, Bernardini I, Vasile E, Macchini M, Peretti U, Valente M, Paratore C, Spallanzani A, Scartozzi M, Cascinu S, Reni M. 1479P Exploring second-line therapy outcome in pancreatic ductal adenocarcinoma (PDAC) patients with germlineBRCA1-2 pathogenic variants (gBRCA1-2pv). Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
8
|
Abstract
Pancreatic cancer is considered one of the most aggressive cancers, with an increasing incidence in recent years. To date, chemotherapy is still the standard of care for advanced metastatic disease, unfortunately providing only a slight advantage in terms of survival. The molecular and cellular characteristics of pancreatic cancer cells, as well as the cells that characterize the pancreatic tumour microenvironment, are the basis of the mechanisms of resistance to treatment. After progression during first-line treatment, few patients are eligible for second-line treatment due to the loss of performance status. To date, a clear survival advantage has not yet been demonstrated for second-line chemotherapy. Precision medicine could be the key to increasing responses to cancer treatment and finally impacting survival in this difficult-to-treat disease. In this review, we analyze current recommendations in the second-line setting and potential future prospects.
Collapse
Affiliation(s)
- Sara Cherri
- Department of Oncology, Fondazione Poliambulanza, Brescia 25124, Italy
| | - Silvia Noventa
- Department of Oncology, Fondazione Poliambulanza, Brescia 25124, Italy
| | - Alberto Zaniboni
- Department of Oncology, Fondazione Poliambulanza, Brescia 25124, Italy
| |
Collapse
|
9
|
Cascinu S, Berardi R, Bianco R, Bilancia D, Zaniboni A, Ferrari D, Mosconi S, Spallanzani A, Cavanna L, Leo S, Negri F, Beretta GD, Sobrero A, Banzi M, Morabito A, Bittoni A, Marciano R, Ferrara D, Noventa S, Piccirillo MC, Labianca R, Mosconi C, Casadei Gardini A, Gallo C, Perrone F. Nab-paclitaxel/gemcitabine combination is more effective than gemcitabine alone in locally advanced, unresectable pancreatic cancer - A GISCAD phase II randomized trial. Eur J Cancer 2021; 148:422-429. [PMID: 33812334 DOI: 10.1016/j.ejca.2021.02.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 02/10/2021] [Accepted: 02/15/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND The role of combination chemotherapy has not yet been established in unresectable locally advanced pancreatic cancer (LAPC) lacking dedicated randomized trials. METHODS This phase II trial tested the efficacy of Nab-paclitaxel (NAB-P)/Gemcitabine (G) versus G alone. Patients were randomized, 1:1 to G 1000 mg/m2 on days 1, 8 and 15 every 28 days versus NAB-P 125 mg/m2 on days 1, 8 and 15 every 28 days plus G 1000 mg/m2 on days 1, 8 and 15 every 28 days. Disease progression rate after three cycles of chemotherapy was the primary end-point. Progression-free survival (PFS), overall survival (OS) and response rate were secondary end-points. FINDINGS A total of124 patients were enrolled. The study showed a reduction of a progressive disease from 45.6% with G to 25.4% with NAB-P/G (P = 0.01) at 3 months. Noteworthy, at 6 months in the G arm, 35.6% of patients present a metastatic spread versus 20.8% in the NAB/G arm. The response rate was 5.3% in the G arm and 27% in the NAB/G arm. Median PFS was 4 months for the G arm and 7 months for the NAB-P/G arm. Median OS was 10.6 in the G arm and 12.7 months in the NAB-P/G arm. One patient died during treatment with G due to a stroke. INTERPRETATION NAB-P/G reduced the rate of LAPC patients progressing after three cycles of chemotherapy compared with G, especially in terms of distant relapses. It positively affects PFS. To the best of our knowledge, this is the first randomized trial providing evidence that combination chemotherapy is superior to gemcitabine alone in this setting. CLINICALTRIALS. GOV IDENTIFIER NCT02043730.
Collapse
Affiliation(s)
- Stefano Cascinu
- Medical Oncology Department, Università Vita-Salute, IRCCS-Ospedale San Raffaele, Milano, Italy.
| | - Rossana Berardi
- Medical Oncology Unit, Università Politecnica delle Marche, Azienda Ospedaliera Umberto I, Salesi, Lancisi, Ancona, Italy
| | | | | | | | - Daris Ferrari
- Medical Oncology Unit, Azienda Ospedaliera San Paolo, Milano, Italy
| | | | - Andrea Spallanzani
- Medical Oncology Unit, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | | | - Silvana Leo
- Medical Oncology Unit, Ospedale di Lecce, Italy
| | - Francesca Negri
- Medical Oncology Unit, Azienda Ospedaliero-Universitaria di Parma, Italy
| | | | | | - Maria Banzi
- Medical Oncology Unit, Ospedale-IRCCS di Reggio Emilia, Italy
| | | | - Alessandro Bittoni
- Medical Oncology Unit, Università Politecnica delle Marche, Azienda Ospedaliera Umberto I, Salesi, Lancisi, Ancona, Italy
| | | | | | - Silvia Noventa
- Medical Oncology Unit, Fondazione Poliambulanza, Brescia, Italy
| | | | | | - Cristina Mosconi
- Istituto di Radiologia, Policlinico S. Orsola, Università di Bologna, Italy
| | - Andrea Casadei Gardini
- Medical Oncology Department, Università Vita-Salute, IRCCS-Ospedale San Raffaele, Milano, Italy
| | - Ciro Gallo
- Statistica Medica Università degli Studi della Campania Luigi Vanvitelli, Italy
| | - Francesco Perrone
- Fondazione Istituto Nazionale Tumori-IRCCS G. Pascale, Napoli, Italy
| |
Collapse
|
10
|
Cherri S, Lemmers DHL, Noventa S, Abu Hilal M, Zaniboni A. Outcome of oncological patients admitted with COVID-19: experience of a hospital center in northern Italy. Ther Adv Med Oncol 2020; 12:1758835920962370. [PMID: 33062065 PMCID: PMC7533930 DOI: 10.1177/1758835920962370] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 09/04/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Recent literature regarding the outcome of cancer patients infected with COVID-19 are not encouraging. Nevertheless, current evidence on the risk and benefits of continuing oncological treatment of cancer patients during the pandemic remains insufficient. We provide our experience in a center with high access for patients with COVID-19-associated pneumonia in Lombardy, Italy. We conducted a retrospective study using a prospectively maintained database of patients admitted to our hospital between 25 February 2020 and 9 April 2020 with a confirmed diagnosis of COVID-19 pneumonia. RESULTS A total of 53 patients with a history or current oncological disease were included in this study. Sixteen oncological patients (30.2%) died during hospitalization. Multivariable logistic regression analysis found that age (Odds ratio [OR]: 1.17, p = 0.009), diabetes (OR: 15.05, p = 0.028) and active oncological disease (OR 13.60, p = 0.015) were independently associated with in-hospital mortality. The mortality rate of the total number of cancer patients is about twice as high as that of non-oncological patients admitted to our hospital with a diagnosis of COVID-19. CONCLUSION The presence of active oncological disease is independently related to mortality as well as age and diabetes. The majority of patients who died were frail. Careful evaluation of the risks and benefits of treatment in frail patients is needed, considering that difficult access to intensive care may have affected the mortality rate.
Collapse
Affiliation(s)
- Sara Cherri
- Department of Clinical Oncology, Fondazione Poliambulanza, Brescia, Italy
| | - Daniel H. L. Lemmers
- Department of Surgery, Fondazione Poliambulanza, Brescia, Italy
- Department of Surgery, Amsterdam UMC, Cancer Center Amsterdam, University of Amsterdam, Amsterdam, The Netherlands
| | - Silvia Noventa
- Department of Oncology, Fondazione Poliambulanza, Brescia, Italy
| | | | - Alberto Zaniboni
- Department of Oncology, Fondazione Poliambulanza, Brescia, Italy
| |
Collapse
|
11
|
Pellino A, Manai C, Merz V, Scartozzi M, Milella M, De Vita F, Antonuzzo L, Zichi C, Satolli MA, Panebianco M, Noventa S, Giordano G, Nappo F, Zecchetto C, Puzzoni M, Vaccaro V, Pappalardo A, Giommoni E, Melisi D, Lonardi S. Observational retrospective evaluation of treatment with liposomal irinotecan plus fluorouracil/leucovorin for metastatic pancreatic cancer patients: An Italian large real-world analysis. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.4_suppl.660] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
660 Background: In the NAPOLI I phase III trial, Nanoliposomal irinotecan (nal-IRI) plus 5-fluorouracil/leucovorin (5-FU/LV) showed better outcome compared to 5FU/LV in patients with metastatic Pancreatic Cancer (MPC) progressed to 1st- line gemcitabine-based therapy. Aim of this study is to explore the real-world efficacy and safety of 5FU/LV-nal-IRI by a compassionate use programme and to identify potential prognostic factors that could affect survival in this setting. Methods: This is a retrospective multi-center analysis including patients with MPC who received 5FU/LV-nal-IRI after failure of a gemcitabine-based therapy. Survival analyses were carried out by the Kaplan-Meier method. Univariate and multivariate analyses were performed by using the log-rank test and the Cox regression. Results: A total of 296 pts (median age, 69 years, range 30-82; 50% male; ECOG PS 0, 44%) were treated at 11 Italian institutions from June 2016 and November 2018. 34% of the pts have been previously resected on their primary tumor, and 76% received gemcitabine-nabpaclitaxel as 1st - line treatment. 5FU/LV-nal-IRI has been administered as 2nd - line in 72% of the pts, while in 23% of the cases as 3rd - line or more. The median OS was 7.1 months [95% confidence interval (CI) 6.1 - 8.1] and the median PFS was 3.3 months (95% CI 2.9 - 3.6). At six months, OS and PFS rate were 53.4% and 31.4% respectively. ORR was 12% and DCR was 40%. 52% of pts received more than 4 cycle with dose reduction in 148 pts (50%). Most common grade 3 toxicities were neutropenia (14%), diarrhea (11%), anemia (3%), nausea (3%), fatigue (3%), mucositis (2%) and vomiting (1%). Baseline characteristics associated with better OS were ECOG PS 0, normal CEA, neutrophil-to-lymphocyte ratio ≤5 and haemoglobin ≥11 g/dL. Conclusions: These real-world data confirm the efficacy and safety of 5FU/LV-nal-IRI in patients with MPC progressed to a gemcitabine-based therapy, with outcome comparable to NAPOLI-1 even in a less selected population and with more active 1st - line combination therapy. In this cohort, well known prognostic markers has been confirmed, as expected.
Collapse
Affiliation(s)
- Antonio Pellino
- Department of Clinical and Experimental Oncology, Medical Oncology 1 Unit, Istituto Oncologico Veneto IOV-IRCCS, Padua, Italy
| | - Chiara Manai
- Department of Clinical and Experimental Oncology, Medical Oncology 1 Unit, Istituto Oncologico Veneto IOV-IRCCS, Padua, Italy
| | - Valeria Merz
- Unit of Medical Oncology, University of Verona Hospital Trust, Verona, TN, Italy
| | - Mario Scartozzi
- Medical Oncology Department, University Hospital, University of Cagliari, Cagliari, Italy
| | - Michele Milella
- Medical Oncology, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Ferdinando De Vita
- Division of Medical Oncology, Department of Precision Medicine, University of Study of Campania "L. Vanvitelli", Naples, Italy
| | - Lorenzo Antonuzzo
- Medical Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Clizia Zichi
- Department of Oncology, University of Turin, Ordine Mauriziano Hospital, Turin, Italy
| | | | - Michele Panebianco
- Medical Oncology Unit, Clinical Cancer Center, IRCCS-AUSL di Reggio Emilia, Reggio Emilia, Italy
| | - Silvia Noventa
- Medical Oncology Unit, Casa di Cura Poliambulanza, Brescia, Italy
| | - Guido Giordano
- Fondazione IRCCS Casa Sollievo della Sofferenza, UO di Oncologia Medica, San Giovanni Rotondo, Italy
| | - Floriana Nappo
- Department of Clinical and Experimental Oncology, Medical Oncology 1 Unit, Istituto Oncologico Veneto IOV-IRCCS, Padua, Italy
| | - Camilla Zecchetto
- Unit of Medical Oncology, University of Verona Hospital Trust, Verona, Italy
| | - Marco Puzzoni
- Medical Oncology Department, University Hospital, University of Cagliari, Cagliari, Italy
| | - Vanja Vaccaro
- Medical Oncology 1, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Annalisa Pappalardo
- Division of Medical Oncology, Department of Precision Medicine, University of Study of Campania "L. Vanvitelli", Naples, Italy
| | - Elisa Giommoni
- Medical Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Davide Melisi
- Medicine - Digestive Molecular Clinical Oncology Research Unit, University of Verona, Verona, Italy
| | - Sara Lonardi
- Department of Clinical and Experimental Oncology, Medical Oncology 1 Unit, Istituto Oncologico Veneto IOV-IRCCS, Padua, Italy
| |
Collapse
|
12
|
Cascinu S, Berardi R, Bianco R, Bilancia D, Zaniboni A, Ferrari D, Mosconi S, Spallanzani A, Cavanna L, Leo S, Negri F, Beretta G, Sobrero A, Banzi M, Morabito A, Bittoni A, Marciano R, Ferrara D, Noventa S, Piccirillo M. Nab-paclitaxel (Nab) plus gemcitabine (G) is more effective than G alone in locally advanced, unresectable pancreatic cancer (LAUPC): The GAP trial, a GISCAD phase II comparative randomized trial. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz247.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
|
13
|
Mirandola M, Sabogal Rueda MD, Andreis F, Meriggi F, Codignola C, Gadaldi E, Prochilo T, Libertini M, Di Biasi B, Abeni C, Noventa S, Rota L, Ogliosi C, Zaniboni A. Yoga Protocol for Cancer Patients: A Systematic Exploration of Psychophysiological Benefits. Rev Recent Clin Trials 2019; 14:261-268. [PMID: 31362680 DOI: 10.2174/1574887114666190729143742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 04/24/2019] [Accepted: 07/19/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Several studies report that practicing Yoga may lead to numerous psychophysiological benefits in patients undergoing treatment for cancer. Moreover, it may result in an effective alternative for coping with sleep disturbances, anxiety, depression and fatigue symptoms. A study based on the "Yoga in Oncology" project of the Foundation Poliambulanza was carried out, and it was designed to explore the benefits of Yoga, therefore corroborating Yoga as a therapeutic activity that can have a beneficial impact on patients diagnosed with cancer. METHODS Seventy patients were recruited, of whom 20% were males and 80% were females 18 years of age and older. All patients were being treated at the oncology department for gastrointestinal, mammary or genital carcinoma, and the disease was metastatic in 80% of patients. Data were collected between April 2013 and May 2017. The protocol consisted of a weekly 90-minute Yoga lesson for 8 consecutive weeks, and the data collection was carried out in 2 phases: (T0) preprotocol assessment and (T1) postprotocol assessment. Psychophysiological assessment was carried out with the following scales: the (BFI) Brief Fatigue Inventory, (HADS) Hospital Anxiety and Depression Scale and (PSQI) Pittsburgh Sleep Quality Index. RESULTS Data analysis showed a significant difference between the (T0) and (T1) HADS (Hospital Anxiety and Depression Scale) scores. The constructs of this scale consist of psychological variables for the assessment of anxiety and depression. In contrast, scores from the (BFI) Brief Fatigue Inventory and (PSQI) Pittsburgh Sleep Quality Index did not show significant differences between (T0) and (T1): such scales are relative to psychophysiological variables for an assessment of the perception of fatigue and quality of sleep. CONCLUSION It is noteworthy that the data, once analyzed, showed a significant difference between preprotocol and postprotocol levels of anxiety and depression but not for the perception of fatigue or the quality of sleep. In accordance with the scientific literature, data from this study highlight that practicing Yoga may promote changes in the levels of perceived anxiety and depression in patients undergoing treatment for cancer, thus positively affecting their (QoL). It is clear that the difference in significance between the psychological and physiological variables considered here and the statistical significance found only in levels of anxiety and depression encourage further studies to account for the nature of fatigue and sleep disturbances and how to address these symptoms in oncological patients. Moreover, other points of interest for future clinical research regard the evaluation of the reason for the possible denial to participate to this kind of study, as well as the social-cultural differences in patients' behavior.
Collapse
Affiliation(s)
- Mara Mirandola
- Oncology Department, Poliambulanza Foundation, via Leonida Bissolati 57, 25124 Brescia, Italy
| | | | - Federica Andreis
- Oncology Department, Poliambulanza Foundation, via Leonida Bissolati 57, 25124 Brescia, Italy
| | - Fausto Meriggi
- Oncology Department, Poliambulanza Foundation, via Leonida Bissolati 57, 25124 Brescia, Italy
| | - Claudio Codignola
- General Surgery Department, Poliambulanza Foundation, via Leonida Bissolati 57, 25124 Brescia, Italy
| | - Elena Gadaldi
- Oncology Department, Poliambulanza Foundation, via Leonida Bissolati 57, 25124 Brescia, Italy
| | - Tiziana Prochilo
- Oncology Department, Poliambulanza Foundation, via Leonida Bissolati 57, 25124 Brescia, Italy
| | - Michela Libertini
- Oncology Department, Poliambulanza Foundation, via Leonida Bissolati 57, 25124 Brescia, Italy
| | - Brunella Di Biasi
- Oncology Department, Poliambulanza Foundation, via Leonida Bissolati 57, 25124 Brescia, Italy
| | - Chiara Abeni
- Oncology Department, Poliambulanza Foundation, via Leonida Bissolati 57, 25124 Brescia, Italy
| | - Silvia Noventa
- Oncology Department, Poliambulanza Foundation, via Leonida Bissolati 57, 25124 Brescia, Italy
| | - Luigina Rota
- Oncology Department, Poliambulanza Foundation, via Leonida Bissolati 57, 25124 Brescia, Italy
| | - Chiara Ogliosi
- Oncology Department, Poliambulanza Foundation, via Leonida Bissolati 57, 25124 Brescia, Italy
| | - Alberto Zaniboni
- Oncology Department, Poliambulanza Foundation, via Leonida Bissolati 57, 25124 Brescia, Italy
| |
Collapse
|
14
|
Rossini D, Sbrana A, Bergamo F, Manai C, Santini D, Ghidini M, Antoniotti C, Moretto R, Marmorino F, Urbano F, Ronzoni M, Noventa S, Randon G, Carlomagno C, Latiano T, Cordio S, Granetto C, Cremolini C, Falcone A, Antonuzzo A. Clinical impact of neutropenia and febrile neutropenia in metastatic colorectal cancer patients treated with FOLFOXIRI/bevacizumab: a pooled analysis of TRIBE and TRIBE2 studies. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz156.014] [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
|
15
|
Raimondi A, Di Maio M, Peverelli G, Morano F, Corallo S, Bergamo F, Cremolini C, Smiroldo V, Amatu A, Tampellini M, Fanchini L, Murialdo R, Clavarezza M, Noventa S, Adamo V, Ratti M, Petrelli F, Antonuzzo L, Palermo M, de Braud F, Di Bartolomeo M, Pietrantonio F. Health-related quality of life in RAS wild-type metastatic colorectal cancer patients treated with panitumumab plus FOLFOX followed by panitumumab or panitumumab plus 5-FU/LV maintenance: the secondary endpoint of the Valentino study. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz156.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
16
|
Rossini D, Sbrana A, Bergamo F, Manai C, Santini D, Ghidini M, Antoniotti C, Moretto R, Marmorino F, Urbano F, Ronzoni M, Noventa S, Randon G, Carlomagno C, Latiano TP, Cordio SS, Granetto C, Cremolini C, Falcone A, Antonuzzo A. Clinical impact of neutropenia and febrile neutropenia in mCRC pts treated with FOLFOXIRI/bevacizumab (bev): A pooled analysis of TRIBE and TRIBE2 studies. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.11591] [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
11591 Background: FOLFOXIRI/bev is a valid option as first-line therapy for unresectable mCRC. TRIBE and TRIBE2 trials reported better activity and efficacy of the triplet/bev when compared with doublets/bev at the price of a higher incidence of chemo-related toxicities, including neutropenia (N). Here we aim at providing a detailed description of this adverse event, including the occurrence of febrile neutropenia (FN) and the use of granulocyte-colony stimulating factors (G-CSFs), in order to estimate the clinical relevance of N during FOLFOXIRI/bev. Methods: Safety data of 1175 pts enrolled in the TRIBE and TRIBE2 studies were reviewed. The incidence of N, the incidence and severity of FN, and the use of G-CSF in the triplet/bev and in the doublets/bev arms were compared using the Chi-square or the Fisher exact test as appropriate. Results: Out of 1175 pts included in the final analysis, 586 (49.8%) were treated with FOLFOXIRI/bev. Five pts (0.8%) in the doublets/bev arms and 29 (4.9%) in the triplet/bev arms received a primary prophylaxis with G-CSF. Among other pts, 118 (20.2%) in the doublets/bev arms and 276 (49.9%) in the triplet/bev arms experienced ≥ G3 N (p < 0.001). FN occurred in 25 (4.3%) and 41 (7.4%) cases respectively (p=0.041). Out of 78 FN episodes, 4 (13.3%) out of 30 in the doublets/bev arms and 13 out of 48 (27.1%) in the triplet/bev arms were associated with a poor MASCC score (<21) (p=0.17). G-CSF was used in 1069 (10.8%) cycles, 270 (5.3%) in doublets/bev and 799 (16.6%) in triplet/bev arms. In both arms, the majority of N and FN episodes were observed in the first two months (318 ≥ G3 N episodes out of 675 (47.1%), and 54 FN episodes out of 78 (69.2%)). Conclusions: FOLFOXIRI/bev was associated with a higher risk of N and FN than doublets/bev. However, the risk of FN was lower than 10%, thus not requiring a systematic use of primary G-CSF prophylaxis. The majority of FN episodes was associated with a good MASCC score, thus having a limited clinical impact. The vast majority of FN episodes occurred in the first two months of treatment, suggesting a closer monitoring of this adverse event during the first courses of therapy.
Collapse
Affiliation(s)
- Daniele Rossini
- Department of Translational Research and New Technologies in Medicine and Surgery, Unit of Medical Oncology 2, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Andrea Sbrana
- Department of Translational Research and New Technologies in Medicine and Surgery, Unit of Medical Oncology 2, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Francesca Bergamo
- Department of Clinical and Experimental Oncology, Medical Oncology 1 Unit, Istituto Oncologico Veneto IOV-IRCCS, Padua, Italy
| | - Chiara Manai
- Department of Clinical and Experimental Oncology, Medical Oncology 1 Unit, Istituto Oncologico Veneto IOV-IRCCS, Padua, Italy
| | - Daniele Santini
- Department of Medical Oncology, Campus Bio-Medico - University of Rome, Rome, 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
| | - Roberto Moretto
- 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
| | - Monica Ronzoni
- Department of Oncology, Istituto Scientifico San Raffaele IRCSS, Milan, Italy
| | - Silvia Noventa
- Medical Oncology Unit, Casa di Cura Poliambulanza, Brescia, Italy
| | - Giovanni Randon
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Chiara Carlomagno
- Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy
| | - Tiziana Pia Latiano
- Oncology Unit, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo (FG), Italy
| | | | - Cristina Granetto
- Oncologia Medica, 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
| | - Andrea Antonuzzo
- Unit of Medical Oncology 1, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| |
Collapse
|
17
|
Usmani S, Orevi M, Stefanelli A, Zaniboni A, Gofrit ON, Bnà C, Illuminati S, Lojacono G, Noventa S, Savelli G. Neuroendocrine differentiation in castration resistant prostate cancer. Nuclear medicine radiopharmaceuticals and imaging techniques: A narrative review. Crit Rev Oncol Hematol 2019; 138:29-37. [PMID: 31092382 DOI: 10.1016/j.critrevonc.2019.03.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 03/12/2019] [Accepted: 03/12/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Androgen Deprivation Therapy (ADT) is the primary treatment for patients suffering from relapsing or advanced prostate cancer (PC). Hormone therapy generally guarantees adequate clinical control of the disease for some years, even in those patients affected by widespread skeletal and soft tissue metastases. Despite ADT, however, most patients treated with hormones eventually progress to castration-resistant prostate cancer (CRPC), for which there are no effective treatments. This clinical reality is an open challenge to the oncologist because of those neoplasms which elaborate neuroendocrine differentiation (NED). METHODS An online search of current and past literature on NED in CRPC was performed. Relevant articles dealing with the biological and pathological basis of NED, with nuclear medicine imaging in CRPC and somatostatin treatment in NED were analyzed. EVIDENCE FROM THE LITERATURE NED may arise in prostate cancer patients in the late stages of ADT. The onset of NED offers prognostic insight because it reflects a dramatic increase in the aggressive nature of the neoplasm. Several genetic, molecular, cytological and immunohistochemical markers are associated with this transformation. Among these, overexpression of somatostatin receptors, seen through Nuclear Medicine testing, is one of the most studied. CONCLUSIONS Preliminary studies show that the overexpression of somatostatin receptors related to NED in CRPC may easily be studied in vivo with PET/CT. This finding offers a potentially useful objective for targeted therapy in CRPC. If the overexpression of SSTRs is shown to afflict a significant segment of patients with CRPC, this will open further study of possible therapeutic options based on this marker.
Collapse
Affiliation(s)
- Sharjeel Usmani
- Department of Nuclear Medicine, Kuwait Cancer Control Center Al Sabah Medical District, 70653, Kuwait
| | - Marina Orevi
- Nuclear Medicine Division, Kiryat Hadassah, POB 12000, Jerusalem 91120, Israel
| | - Antonella Stefanelli
- Nuclear Medicine Division, Fondazione Poliambulanza Istituto Ospedaliero, via L. Bissolati, 57, 25124 Brescia, Italy
| | - Alberto Zaniboni
- Department of Medical Oncology, Fondazione Poliambulanza Istituto Ospedaliero, via L. Bissolati, 57, 25124 Brescia, Italy
| | | | - Claudio Bnà
- Radiology Division, Fondazione Poliambulanza Istituto Ospedaliero, via L. Bissolati, 57, 25124 Brescia, Italy
| | - Sonia Illuminati
- Radiology Division, Fondazione Poliambulanza Istituto Ospedaliero, via L. Bissolati, 57, 25124 Brescia, Italy
| | - Giulia Lojacono
- Nuclear Medicine Division, Fondazione Poliambulanza Istituto Ospedaliero, via L. Bissolati, 57, 25124 Brescia, Italy
| | - Silvia Noventa
- Department of Medical Oncology, Fondazione Poliambulanza Istituto Ospedaliero, via L. Bissolati, 57, 25124 Brescia, Italy
| | - Giordano Savelli
- Nuclear Medicine Division, Fondazione Poliambulanza Istituto Ospedaliero, via L. Bissolati, 57, 25124 Brescia, Italy.
| |
Collapse
|
18
|
Cremolini C, Rossini D, Martinelli E, Pietrantonio F, Lonardi S, Noventa S, Tamburini E, Frassineti GL, Mosconi S, Nichetti F, Murgioni S, Troiani T, Borelli B, Zucchelli G, Dal Maso A, Sforza V, Masi G, Antoniotti C, Di Bartolomeo M, Miceli R, Ciardiello F, Falcone A. Trifluridine/Tipiracil (TAS-102) in Refractory Metastatic Colorectal Cancer: A Multicenter Register in the Frame of the Italian Compassionate Use Program. Oncologist 2018; 23:1178-1187. [PMID: 29739893 PMCID: PMC6263124 DOI: 10.1634/theoncologist.2017-0573] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 03/06/2018] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND TAS-102 is indicated for patients with metastatic colorectal cancer (mCRC) previously treated with, or not considered candidates for, available therapies. Given the complete inefficacy in half of patients, the lack of predictive factors, the palliative setting, and the financial and clinical toxicity, optimizing the cost-benefit ratio is crucial. The "ColonLife" nomogram allows an estimate of the 12-week life expectancy of patients with refractory mCRC. MATERIALS AND METHODS We collected data from patients treated at eight Italian centers in the compassionate use program. Baseline characteristics of patients who were or were not progression free at 6 months were compared. The discriminative ability of the ColonLife nomogram was assessed. Among patients who received both TAS-102 and regorafenib, clinical outcomes of the two sequences were compared. RESULTS This study included 341 patients. Six (2%) and 93 (27%) patients achieved response and disease stabilization, respectively. The median progression-free survival (PFS) was 2.4 months with an estimated 6-month PFS rate of 19%; the median overall survival (OS) was 6.2 months. An Eastern Cooperative Oncology Group performance status (ECOG PS) of 0, normal lactate dehydrogenase (LDH), and a time from the diagnosis of metastatic disease of >18 months were independently associated with higher chances of a patient being progression free at 6 months. The discriminative ability of ColonLife was confirmed. Among 121 patients who received both regorafenib and TAS-102, no differences in first or second PFS or OS were reported between the two sequences. CONCLUSION One out of five patients achieves clinical benefit with TAS-102. ECOG PS, LDH, and time from diagnosis of metastatic disease may help to identify these patients. Excluding patients with very short life expectancy appears a reasonable approach. IMPLICATIONS FOR PRACTICE Improving the cost-efficacy ratio of TAS-102 in metastatic colorectal cancer is needed to spare useless toxicities in a definitely palliative setting. Eastern Cooperative Oncology Group performance status, lactate dehydrogenase levels, and time from the diagnosis of metastatic disease may help to identify patients more likely to achieve benefit. Properly designed prognostic tools (i.e., the "ColonLife" nomogram) may enable excluding from further treatments patients with very limited life expectancy.
Collapse
Affiliation(s)
- Chiara Cremolini
- Unit of Medical Oncology, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
- Department of Translational Research and New Technologies in Medicine, University of Pisa, Pisa, Italy
| | - Daniele Rossini
- Unit of Medical Oncology, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
- Department of Translational Research and New Technologies in Medicine, University of Pisa, Pisa, Italy
| | - Erika Martinelli
- Department of Internal and Experimental Medicine "F. Magrassi e A. Lanzara,", Institute of Medical Oncology, Università degli studi della Campania Luigi Vanvitelli, Naples, Italy
| | - Filippo Pietrantonio
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Sara Lonardi
- Department of Clinical and Experimental Oncology, SC Medical Oncology Unit 1, Istituto Oncologico Veneto - IRCCS, Padua, Italy
| | - Silvia Noventa
- Medical Oncology, Fondazione Poliambulanza, Brescia, Italy
| | | | - Giovanni Luca Frassineti
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Stefania Mosconi
- Unit of Medical Oncology, Department of Oncology and Hematology, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Federico Nichetti
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Sabina Murgioni
- Department of Clinical and Experimental Oncology, SC Medical Oncology Unit 1, Istituto Oncologico Veneto - IRCCS, Padua, Italy
| | - Teresa Troiani
- Department of Internal and Experimental Medicine "F. Magrassi e A. Lanzara,", Institute of Medical Oncology, Università degli studi della Campania Luigi Vanvitelli, Naples, Italy
| | - Beatrice Borelli
- Unit of Medical Oncology, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
- Department of Translational Research and New Technologies in Medicine, University of Pisa, Pisa, Italy
| | - Gemma Zucchelli
- Unit of Medical Oncology, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
- Department of Translational Research and New Technologies in Medicine, University of Pisa, Pisa, Italy
| | - Alessandro Dal Maso
- Department of Clinical and Experimental Oncology, SC Medical Oncology Unit 1, Istituto Oncologico Veneto - IRCCS, Padua, Italy
- Department of Clinical and Experimental Oncology, SC Medical Oncology Unit 1, Istituto Oncologico Veneto - IRCCS, Scuola di Specializzazione in Oncologia, University of Padua, Padua, Italy
| | - Vincenzo Sforza
- Department of Internal and Experimental Medicine "F. Magrassi e A. Lanzara,", Institute of Medical Oncology, Università degli studi della Campania Luigi Vanvitelli, Naples, Italy
| | - Gianluca Masi
- Unit of Medical Oncology, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
- Department of Translational Research and New Technologies in Medicine, University of Pisa, Pisa, Italy
| | - Carlotta Antoniotti
- Unit of Medical Oncology, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
- Department of Translational Research and New Technologies in Medicine, University of Pisa, Pisa, Italy
| | - Maria Di Bartolomeo
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Rosalba Miceli
- Trial Office and Biomedical Statistics, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Fortunato Ciardiello
- Department of Internal and Experimental Medicine "F. Magrassi e A. Lanzara,", Institute of Medical Oncology, Università degli studi della Campania Luigi Vanvitelli, Naples, Italy
| | - Alfredo Falcone
- Unit of Medical Oncology, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
- Department of Translational Research and New Technologies in Medicine, University of Pisa, Pisa, Italy
| |
Collapse
|
19
|
Pietrantonio F, Barretta F, Fanotto V, Park SH, Morano F, Fucà G, Niger M, Prisciandaro M, Silvestris N, Bergamo F, Fornaro L, Bordonaro R, Rimassa L, Santini D, Tomasello G, Antonuzzo L, Noventa S, Avallone A, Leone F, Faloppi L, Di Donato S, de Braud F, Lee J, De Vita F, Di Bartolomeo M, Miceli R, Aprile G. Estimating Survival Probabilities of Advanced Gastric Cancer Patients in the Second-Line Setting: The Gastric Life Nomogram. Oncology 2018; 95:344-352. [PMID: 30130791 DOI: 10.1159/000491753] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 07/02/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVE We built and externally validated a nomogram for predicting the overall survival (OS) probability of advanced gastric cancer patients receiving second-line treatment. METHODS The nomogram was developed on a set of 320 Italian patients and validated on two independent sets (295 Italian and 172 Korean patients). Putative prognostic variables were selected using a random forest model and included in the multivariable Cox model. The nomogram's performance was evaluated by calibration plot and C index. RESULTS ECOG performance status, neutrophils to lymphocytes ratio, and peritoneal involvement were selected and included into the multivariable model. The C index was 0.72 (95% CI 0.68-0.75) in the development set, 0.69 (95% CI 0.65-0.73) in the Italian validation set, but only 0.57 (95% CI 0.52-0.62) in the Korean set. While Italian calibrations were quite good, the Korean one was poor. Regarding 6-month OS predictions, calibration was best in both Caucasian cohorts and worst the in Asian one. CONCLUSIONS Our nomogram may be a useful tool to predict 3- or 6-month OS in Caucasian gastric cancer patients eligible for second-line therapy. Based on three easy-to-collect variables, the Gastric Life nomogram may help clinicians improve patient selection for second-line treatments and assist in clinical trial enrollment.
Collapse
Affiliation(s)
- Filippo Pietrantonio
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, .,Department of Oncology and Hemato-Oncology, University of Milan, Milan,
| | - Francesco Barretta
- Unit of Clinical Epidemiology and Trial Organization, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Valentina Fanotto
- Department of Oncology, University and General Hospital of Udine, Udine, Italy
| | - Se Hoon Park
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Federica Morano
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giovanni Fucà
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Monica Niger
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Michele Prisciandaro
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Nicola Silvestris
- Medical Oncology Unit, National Cancer Institute IRCCS "Giovanni Paolo II,", Bari, Italy
| | - Francesca Bergamo
- Medical Oncology Unit 1, Istituto Oncologico Veneto - IRCCS, Padova, Italy
| | - Lorenzo Fornaro
- Medical Oncology Unit, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | | | - Lorenza Rimassa
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, Humanitas Clinical and Research Center, Rozzano, Italy
| | | | | | - Lorenzo Antonuzzo
- Medical Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy
| | - Silvia Noventa
- Medical Oncology Unit, Fondazione Poliambulanza, Brescia, Italy
| | - Antonio Avallone
- Department of Abdominal Oncology, Istituto Nazionale, Tumori di Napoli "G. Pascale" IRCCS, Napoli, Italy
| | - Francesco Leone
- Department of Oncology, University of Turin, FPO-IRCCS, Candiolo, Italy
| | - Luca Faloppi
- Medical Oncology Unit, Macerata General Hospital, ASUR Marche AV3, Macerata, Italy
| | - Samantha Di Donato
- Medical Oncology Department, Nuovo Ospedale-Santo Stefano, Istituto Toscano Tumori, Prato, Italy
| | - Filippo de Braud
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Jeeyun Lee
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ferdinando De Vita
- Division of Medical Oncology, "F. Magrassi" Department of Clinical and Experimental Medicine, University of Campania "Luigi Vanvitelli,", Napoli, Italy
| | - Maria Di Bartolomeo
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Rosalba Miceli
- Unit of Clinical Epidemiology and Trial Organization, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giuseppe Aprile
- Department of Oncology, San Bortolo General Hospital, Vicenza, Italy
| |
Collapse
|
20
|
Andreis F, Meriggi F, Codignola C, Frigoli I, Prochilo T, Mutti S, Huscher A, Libertini M, Di Biasi B, Abeni C, Ogliosi C, Noventa S, Rota L, Pedrali C, Zaniboni A. Impact of a Psycho-Educational Team in early Breast Cancer Patients' Coping Strategies: The Venere Project. Rev Recent Clin Trials 2018; 13:274-280. [PMID: 29629664 DOI: 10.2174/1574887113666180409152025] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2017] [Revised: 03/29/2018] [Accepted: 03/30/2018] [Indexed: 06/08/2023]
Abstract
AIMS AND BACKGROUND The main purpose of our psycho-educational groups was to help women with breast cancer, learn how to cope with the physical, emotional, and lifestyle changes associated with cancer as well as with medical treatments that can be painful and traumatic. With this study, we wanted to detect the effects that group action had on the women who participated in it. METHODS We studied a total of 97 patients who participated in 13 psycho-education groups. The whole sample was female patients who had breast cancer with no recurrence or metastases. RESULTS All patients were evaluated with the Hospital Anxiety and Depression Scale (HADS) and the Body Image Scale (BIS). We found no significant effect on anxiety and body image for the brief psycho- educational group for women with breast cancer in this study. It is possible to highlight a statistical difference and hence an improvement between the results of the HADS depression test at T0 (first evaluation at the first meeting) and T1 (retest in the final meeting). CONCLUSION The tests did not show a significant effect on anxiety and body image perception, but the patients reported that the psycho-educational group was an important intervention for their life. Outcome measurement is more complex in psychosocial research because many variables come into play and each phase of treatment is characterized by different types of problems for the patient: physical, relational and psychological aspects are involved.
Collapse
Affiliation(s)
| | - Fausto Meriggi
- Oncology Department, Fondazione Poliambulanza, Brescia, Italy
| | - Claudio Codignola
- General Surgery Department, Fondazione Poliambulanza, Brescia, Italy
| | - Ilaria Frigoli
- Oncology Department, Fondazione Poliambulanza, Brescia, Italy
| | | | - Stefano Mutti
- General Surgery Department, Fondazione Poliambulanza, Brescia, Italy
| | | | | | | | - Chiara Abeni
- Oncology Department, Fondazione Poliambulanza, Brescia, Italy
| | - Chiara Ogliosi
- Oncology Department, Fondazione Poliambulanza, Brescia, Italy
| | - Silvia Noventa
- Oncology Department, Fondazione Poliambulanza, Brescia, Italy
| | - Luigina Rota
- Oncology Department, Fondazione Poliambulanza, Brescia, Italy
| | - Chiara Pedrali
- Oncology Department, Fondazione Poliambulanza, Brescia, Italy
| | | |
Collapse
|
21
|
Morano F, Pietrantonio F, Barretta F, Fanotto V, Niger M, Nichetti F, Bergamo F, Silvestris N, Fornaro L, Bordonaro R, Baretti M, Santini D, Tomasello G, Antonuzzo L, Noventa S, Avallone A, Di Donato S, Maiello E, De Vita F, Aprile G. Estimation of 12-weeks life expectancy in patients (pts) with metastatic gastric cancer (mGC) candidated for second-line treatment: the “Gastric Life” nomogram. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx425.008] [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
|
22
|
Andreis F, Gadaldi E, Meriggi F, Mirandola M, Rota L, Abeni C, Bertocchi P, Aroldi F, Prochilo T, Di Biasi B, Ogliosi C, Libertini M, Noventa S, Zaniboni A. Dignity Therapy: a new psychoterapeutic approach for people facing advanced disease. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx434.016] [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: 11/13/2022] Open
|
23
|
Pietrantonio F, Barretta F, Fanotto V, Niger M, Morano F, Bergamo F, Silvestris N, Fornaro L, Bordonaro R, Baretti M, Santini D, Tomasello G, Antonuzzo L, Noventa S, Avallone A, Di Donato S, Maiello E, De Vita F, Miceli R, Aprile G. Estimating 12-weeks life expectancy in metastatic gastric cancer (mGC) patients (pts) candidates for second-line treatment: The “Gastric Life” nomogram. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx369.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
24
|
Meriggi F, Codignola C, Beretta GD, Ceresoli GL, Caprioli A, Scartozzi M, Fraccon AP, Prochilo T, Ogliosi C, Noventa S, Libertini M, Zaniboni A. Prognostic value of neutrophil-to-lymphocyte ratio in advanced EGFR-mutated non-small cell lung cancer (NSCLC) treated with a tyrosine-kinase inhibitors: A retrospective analysis in a series of western patients. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.e23045] [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
e23045 Background: Several studies demonstrated that an elevated neutrophil-to-lymphocyte ratio (NLR) correlate with a poor prognosis both in early and advanced stage of NSCLC. The aim of this retrospective analysis was to investigate the correlation between NLR and prognosis in caucasian patients diagnosed with advanced EGFR-mutated NSCLC and treated with tyrosine kinase inhibitors (TKIs). Methods: A retrospective database was used to identify consecutive patients diagnosed with advanced EGFR-mutated NSCLC and treated with TKIs. From January 2011 to December 2015, 63 patients from five Institutions were enclosed in our series. NLR was derived from the absolute neutrophil and the absolute lymphocyte counts of a full blood count.Survival curves were calculated with Kaplan-Meier method and data were compared by log-rank test. Prognostic significance of NLR were assessed using a Cox regression analysis. Results: Sixty-three eligible patients were stratified according to the mean pretreatment NLR value (3.57 ± 2.42). The chosen cut-off for NLR was 3.5. Forty patients had NLR < 3.5 while 23 patients had a value of NLR > 3.5.A statistical significant difference, both in PFS and OS, was found in the NLR < 3.5 group compared with the higher NLR group (PFS: p < 0.01, OS: p < 0.05). According to univariate analysis, histological type (adenocarcinoma vs non-adenocarcinoma) and NLR value correlate significantly with PFS and OS. In Cox multivariate analysis, only NLR ³ 3.5 resulted significantly associated as independent prognostic factor for worse PFS (HR 2.275, 95% CI 1.257-4.116, p < 0.01) and OS (HR 2.699, 95% CI 1.187-6.137, p < 0.05). Conclusions: Pre-treatment NLR seems to represent a reliable, simple, and easy to reproduce, laboratory tool to predict survival and outcome to therapies in western caucasian EGFR-mutated NSCLC patients. Further prospective trials are needed to definitively confirm its prognostic and predictive role.
Collapse
Affiliation(s)
- Fausto Meriggi
- Oncology Department, Poliambulanza Foundation, Brescia, Italy
| | | | | | | | | | - Mario Scartozzi
- Medical Oncology Department, University Hospital, University of Cagliari, Cagliari, Italy
| | - Anna Paola Fraccon
- Medical Oncology, Casa di Cura Pederzoli, Peschiera Del Garda, Peschiera Del Garda (VR), Italy
| | - Tiziana Prochilo
- Department of Medical Oncology, Fondazione Poliambulanza, Brescia, Italy
| | | | | | | | | |
Collapse
|
25
|
Omarini C, Guaitoli G, Noventa S, Andreotti A, Gambini A, Palma E, Papi S, Tazzioli G, Balduzzi S, Dominici M, Cascinu S, Piacentini F. Impact of time to surgery after neoadjuvant chemotherapy in operable breast cancer patients. Eur J Surg Oncol 2016; 43:613-618. [PMID: 27793416 DOI: 10.1016/j.ejso.2016.09.020] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 09/08/2016] [Accepted: 09/26/2016] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The optimal time interval between the end of neoadjuvant systemic therapy (NST) and breast surgery is still unclear. It is not known if a delay in surgery might influence the benefit of primary chemotherapy. The aim of this study is to evaluate the relationship between time to surgery (TTS) and survival outcomes. PATIENTS AND METHODS According to TTS, women with diagnosis of BC treated with NST were divided into two cohorts: group A = 21 days or fewer and group B = longer than 21 days. OS and RFS were estimated and compared according to TTS and known prognostic factors. RESULTS A total of 319 patients were included in the study: 61 in group A and 258 in group B. Median TTS was 34 days. No association between clinical stage, nuclear grade, type of chemotherapy, type of surgery and TTS was detected. OS and RFS were significantly worse for group B compared with group A, with a hazard ratio of 3.1 (95% CI, 1.1-8.6 p = 0.03) and 3.1 (95% CI, 1.3-7.1 p = 0.008) respectively. Multivariate analysis confirmed that TTS was an independent prognostic factor in term of OS (p = 0.03) and RFS (p = 0.01). Even in the subgroup of patients with pCR, TTS continued to be an independent prognostic factor for both OS and RFS (p = 0.05 and p = 0.03). CONCLUSIONS TTS after NST seems to influence survival outcomes. BC patients underwent surgery within 21 days experienced maximal benefit from previous treatment: this advantage is consistent and maintained over time.
Collapse
Affiliation(s)
- C Omarini
- Division of Medical Oncology, Department of Medical and Surgical Sciences for Children & Adults, University Hospital of Modena, Via del Pozzo 71, 41122 Modena, Italy.
| | - G Guaitoli
- Division of Medical Oncology, Department of Medical and Surgical Sciences for Children & Adults, University Hospital of Modena, Via del Pozzo 71, 41122 Modena, Italy
| | - S Noventa
- Division of Medical Oncology, Department of Medical and Surgical Sciences for Children & Adults, University Hospital of Modena, Via del Pozzo 71, 41122 Modena, Italy
| | - A Andreotti
- Breast Oncology Unit, Department of General Surgery and Surgical Specialities, University Hospital of Modena, Via del Pozzo 71, 41122 Modena, Italy
| | - A Gambini
- Breast Oncology Unit, Department of General Surgery and Surgical Specialities, University Hospital of Modena, Via del Pozzo 71, 41122 Modena, Italy
| | - E Palma
- Breast Oncology Unit, Department of General Surgery and Surgical Specialities, University Hospital of Modena, Via del Pozzo 71, 41122 Modena, Italy
| | - S Papi
- Breast Oncology Unit, Department of General Surgery and Surgical Specialities, University Hospital of Modena, Via del Pozzo 71, 41122 Modena, Italy
| | - G Tazzioli
- Breast Oncology Unit, Department of General Surgery and Surgical Specialities, University Hospital of Modena, Via del Pozzo 71, 41122 Modena, Italy
| | - S Balduzzi
- Department of Medicine and Public Health, University Hospital of Modena, Via del Pozzo 71, 41122 Modena, Italy
| | - M Dominici
- Division of Medical Oncology, Department of Medical and Surgical Sciences for Children & Adults, University Hospital of Modena, Via del Pozzo 71, 41122 Modena, Italy
| | - S Cascinu
- Division of Medical Oncology, Department of Medical and Surgical Sciences for Children & Adults, University Hospital of Modena, Via del Pozzo 71, 41122 Modena, Italy
| | - F Piacentini
- Division of Medical Oncology, Department of Medical and Surgical Sciences for Children & Adults, University Hospital of Modena, Via del Pozzo 71, 41122 Modena, Italy
| |
Collapse
|
26
|
Lattoni E, Omarini C, Tamma A, Noventa S, Orsi G, Piacentini F, Moscetti L, Cascinu S. Pre and post anti Her-2 therapy era: a mono-institutional analysis of the outcome in patients with residual disease after neoadjuvant therapy for Her-2 positive locally advanced breast cancer. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw337.48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
27
|
Guida A, Noventa S, Napolitano M, Clo' V, Cascinu S, Sabbatini R. Prognostic role of inflammatory markers in Mestatatic Renal Cell Carcinoma (mRCC): retrospective single-centre Italian experience. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw334.07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
28
|
Spallanzani A, Bertolini F, Barbieri F, Longo L, Tomasello C, Noventa S, Cavazza A, Pelosi G, Carella R, Graziano P, Ascani S, Asioli S, Murer B, Rossi G. Pleuro-pulmonary synovial sarcoma: clinico-pathologic and molecular characteristics from a multi-institutional series of 48 cases. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv338.08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
29
|
Longo L, Barbieri F, Bertolini F, Tiseo M, Migaldi M, Giardina D, Montanari G, Vincenzi G, Tomasello C, Noventa S, Spallanzani A, Sighinolfi P, Sartori G, Bordi P, Rossi G. Mutational analysis of EGFR, c-KIT, PDGFRs, BRAF and KRAS, and expression of ALK and PD-L1 in a series of 103 thymic epithelial tumors with different histology. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv343.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
30
|
Fontana A, Federica B, Reggiani-Bonetti L, Pettorelli E, Noventa S, Meduri B, Gelsomino F, Zironi S, Spallanzani A, Mazzeo E, Maiorana A, Conte P, Luppi G. Everolimus in locally advanced rectal cancer (E-LARC study, Ib): biomarkers evaluation. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv340.39] [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: 11/15/2022] Open
|