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Conte C, Della Corte L, Pelligra S, Bifulco G, Abate B, Riemma G, Palumbo M, Cianci S, Ercoli A. Assessment of Salvage Surgery in Persistent Cervical Cancer after Definitive Radiochemotherapy: A Systematic Review. Medicina (Kaunas) 2023; 59:medicina59020192. [PMID: 36837394 PMCID: PMC9967015 DOI: 10.3390/medicina59020192] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 01/15/2023] [Accepted: 01/16/2023] [Indexed: 01/21/2023]
Abstract
Background and Objectives: The standard treatment approach in locally advanced cervical cancer (LACC) is exclusive concurrent chemoradiation therapy (RTCT). The risk of local residual disease after six months from RTCT is about 20-30%. It is directly related to relapse risk and poor survival, such as in patients with recurrent cervical cancer. This systematic review aims to describe studies investigating salvage surgery's role in persistent/recurrent disease in LACC patients who underwent definitive RTCT. Materials and Methods: Studies were eligible for inclusion when patients had LACC with radiologically suspected or histologically confirmed residual disease after definitive RTCT, diagnosed with post-treatment radiological workup or biopsy. Information on complications after salvage surgery and survival outcomes had to be reported. The methodological quality of the articles was independently assessed by two researchers with the Newcastle-Ottawa scale. Following the recommendations in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, we systematically searched the PubMed, Scopus, Cochrane, Medline, and Medscape databases in May 2022. We applied no language or geographical restrictions but considered only English studies. We included studies containing data about postoperative complications and survival outcomes. Results: Eleven studies fulfilled the inclusion criteria and all were retrospective observational studies. A total of 601 patients were analyzed concerning the salvage surgery in LACC patients for persistent/recurrent disease after RTCT treatment. Overall, 369 (61.4%) and 232 (38.6%) patients underwent a salvage hysterectomy (extrafascial or radical) and pelvic exenteration (anterior, posterior, or total), respectively. Four hundred and thirty-nine (73%) patients had histologically confirmed the residual disease in the salvage surgical specimen, and 109 patients had positive margins (overall range 0-43% of the patients). The risk of severe (grade ≥ 3) postoperative complications after salvage surgery is 29.8% (range 5-57.5%). After a median follow-up of 38 months, the overall RR was about 32% with an overall death rate of 40% after hysterectomy or pelvic exenteration with or without lymphadenectomy. Conclusions: There is heterogeneity between the studies both in their design and results, therefore the effect of salvage surgery on survival and recurrence cannot be adequately estimated. Future homogeneous studies with an appropriately selected population are needed to analyze the safety and efficacy of salvage hysterectomy or pelvic exenteration in patients with residual tumors after definitive RTCT.
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Affiliation(s)
- Carmine Conte
- Department of General Surgery and Medical-Surgical Specialties, Institute of Obstetrics and Ginecology, A.O.U. Policlinico Rodolico—San Marco, University of Catania, 95125 Catania, Italy
- Correspondence: ; Tel.: +39-3290-275-147
| | - Luigi Della Corte
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, 80131 Naples, Italy
| | - Silvia Pelligra
- Department of Woman and Child Health and Public Health, Catholic University of the Sacred Heart, 00168 Rome, Italy
| | - Giuseppe Bifulco
- Department of Public Health, University of Naples Federico II, 80131 Naples, Italy
| | - Biagio Abate
- Department of General Surgery and Medical-Surgical Specialties, Institute of Obstetrics and Ginecology, A.O.U. Policlinico Rodolico—San Marco, University of Catania, 95125 Catania, Italy
| | - Gaetano Riemma
- Department of Woman, Child and General and Specialized Surgery, Luigi Vanvitelli University of Campania, 81100 Naples, Italy
| | - Marco Palumbo
- Department of General Surgery and Medical-Surgical Specialties, Institute of Obstetrics and Ginecology, A.O.U. Policlinico Rodolico—San Marco, University of Catania, 95125 Catania, Italy
| | - Stefano Cianci
- Unit of Gynecology and Obstetrics, Department of Human Pathology of Adult and Childhood “G. Barresi”, University of Messina, 98121 Messina, Italy
| | - Alfredo Ercoli
- Unit of Gynecology and Obstetrics, Department of Human Pathology of Adult and Childhood “G. Barresi”, University of Messina, 98121 Messina, Italy
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Restaino S, Bizzarri N, Tarantino V, Pelligra S, Moroni R, Palmieri E, Monterossi G, Costantini B, Scambia G, Fanfani F. Comparison of Different Near-Infrared Technologies to Detect Sentinel Lymph Node in Uterine Cancer: A Prospective Comparative Cohort Study. Int J Environ Res Public Health 2022; 19:ijerph19127377. [PMID: 35742629 PMCID: PMC9224254 DOI: 10.3390/ijerph19127377] [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] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 06/14/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Sentinel lymph node biopsy is considered a crucial step in endometrial cancer staging. Cervical injection has become the most favored technique and indocyanine green has been demonstrated to be more accurate than other tracers. Different near-infrared camera systems are currently being used to detect indocyanine green in sentinel lymph nodes and have been compared in different patients. The present study aimed to determine the number and site of sentinel lymph nodes detected in the same patients with two different near-infrared technologies. METHODS This is a prospective, single-center, observational, non-sponsored study. Patients with presumed uterine-confined endometrial cancer were prospectively enrolled. After cervical injection, two different near-infrared cameras were used to detect sentinel lymph nodes at the same time: Olympus, Tokyo, Japan-considered the standard (SNIR); and Medtronic, Minneapolis, MN, USA with VISION SENSE® which is a new laser near-infrared (LNIR) fluorescence laparoscope. The two cameras were alternatively switched on to detect sentinel lymph nodes in the same patients. RESULTS Seventy-four consecutive patients were included in the study. Most of the patients were diagnosed with endometrioid histology (62, 83.8%), FIGO stage IA (48, 64.9%), grade 2 (43, 58.1%), and underwent surgery with laparoscopic approach (70, 94.0%). The bilateral detection rate was 56/74 (75.7%) with SNIR and 63/74 (85.1%) with LNIR (p = 0.214). The total number of sentinel lymph nodes identified in the left hemipelvis was 65 and 70 with SNIR and LNIR, respectively; while in the right hemipelvis, there were 74 and 76, respectively. The median number of sentinel lymph nodes identified with SNIR and LNIR was 2 (range, 0-4) and 2 (range, 0-4), respectively (p = 0.370). No difference in site of sentinel lymph node detection was evident between the two technologies (p = 0.994). Twelve patients (16.2%) had sentinel lymph node metastasis: in all cases metastatic sentinel lymph nodes were detected both with Olympus and LNIR. CONCLUSIONS No difference in bilateral detection rate and number or site of sentinel lymph node detection was evident comparing two different technologies of near-infrared camera for ICG detection in endometrial cancer patients. No difference in sentinel lymph node metastases identification was detected between the two technologies.
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Affiliation(s)
- Stefano Restaino
- Department of Obstetrics, Gynecology, and Pediatrics, Obstetrics and Gynecology Unit, Udine University Hospital, DAME, 33100 Udine, Italy;
| | - Nicolò Bizzarri
- UOC Ginecologia Oncologica, Dipartimento per la Salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (N.B.); (S.P.); (G.M.); (B.C.); (G.S.)
| | | | - Silvia Pelligra
- UOC Ginecologia Oncologica, Dipartimento per la Salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (N.B.); (S.P.); (G.M.); (B.C.); (G.S.)
| | - Rossana Moroni
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Direzione Scientifica IRCCS, L.go Agostino Gemelli 8, 00168 Rome, Italy;
| | - Emilia Palmieri
- Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (V.T.); (E.P.)
| | - Giorgia Monterossi
- UOC Ginecologia Oncologica, Dipartimento per la Salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (N.B.); (S.P.); (G.M.); (B.C.); (G.S.)
| | - Barbara Costantini
- UOC Ginecologia Oncologica, Dipartimento per la Salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (N.B.); (S.P.); (G.M.); (B.C.); (G.S.)
| | - Giovanni Scambia
- UOC Ginecologia Oncologica, Dipartimento per la Salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (N.B.); (S.P.); (G.M.); (B.C.); (G.S.)
- Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (V.T.); (E.P.)
| | - Francesco Fanfani
- UOC Ginecologia Oncologica, Dipartimento per la Salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (N.B.); (S.P.); (G.M.); (B.C.); (G.S.)
- Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (V.T.); (E.P.)
- Correspondence: ; Tel.: +39-06-30154979
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Nero C, Pasciuto T, Cappuccio S, Corrado G, Pelligra S, Zannoni GF, Santoro A, Piermattei A, Minucci A, Lorusso D, Fanfani F, Scambia G. Further refining 2020 ESGO/ESTRO/ESP molecular risk classes in patients with early-stage endometrial cancer: A propensity score-matched analysis. Cancer 2022; 128:2898-2907. [PMID: 35617463 PMCID: PMC9541547 DOI: 10.1002/cncr.34331] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 02/24/2022] [Accepted: 02/28/2022] [Indexed: 11/12/2022]
Abstract
Background The integration of molecular features with clinicopathological findings in endometrial cancer classification seems to be able to significantly refine risk assessment. Nevertheless, clinical management remains challenging, and different therapeutic options are available for each class. Further prognostic characterization of the subgroups within each risk class could be helpful in the decision‐making process. Methods This study evaluated the role of the 2020 European Society of Gynaecological Oncology (ESGO)/European Society for Radiotherapy and Oncology (ESTRO)/European Society of Pathology (ESP) risk assessment system and the three prognostic profiles adopted in the PORTEC‐4a trial in predicting disease‐free and overall survival in a retrospective study cohort of patients with early‐stage endometrial cancer. Patients were selected according to a 1:2 propensity score matching analysis. Moreover, the sequencing of 29 genes was undertaken for tumor samples. Results The study included 137 patients. No differences in disease‐free or overall survival at 5 years were observed among the 2020 ESGO/ESTRO/ESP risk classes without molecular features (p = .766 and p = .176, respectively). Once molecular features were integrated, the probability of overall survival was significantly different (p = .011). When the three prognostic profiles were applied, the probability of recurrence had a p value of .097, and significant differences were observed in overall survival (p = .004). Among patients experiencing recurrence, 17.6% showed mutations in BRCA1/2, RAD50, BRIP1, and XRCC2, whereas 22.5% had PD‐L1–positive expression and an MUTYH mutation. Conclusions Further stratification within each risk class according to the most relevant prognostic features could better define the prognosis of patients with early‐stage endometrial cancer. Nearly half of the patients who experienced recurrence showed a targetable molecular alteration for which dedicated trials should be encouraged. The 2020 molecular integrated risk assessment is of crucial importance for better defining the prognosis of patients with early‐stage endometrial cancer. Nevertheless, further stratification within each risk class according to the most relevant prognostic features could better define the biological behavior of the disease and thus allow better tailoring of adjuvant treatment.
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Affiliation(s)
- Camilla Nero
- Gynecologic Oncology Unit, Dipartimento per le Scienze della Salute della Donna del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Tina Pasciuto
- Research Core Facility Data Collection- Gemelli Science and Technology Park (G-STeP), Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Serena Cappuccio
- Gynecologic Oncology Unit, Dipartimento per le Scienze della Salute della Donna del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Giacomo Corrado
- Gynecologic Oncology Unit, Dipartimento per le Scienze della Salute della Donna del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Silvia Pelligra
- Gynecologic Oncology Unit, Dipartimento per le Scienze della Salute della Donna del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Gian Franco Zannoni
- Università Cattolica del Sacro Cuore, Rome, Italy.,Gineco-Patologia e Patologia Mammaria unit, Dipartimento per le Scienze della Salute della Donna del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Angela Santoro
- Gineco-Patologia e Patologia Mammaria unit, Dipartimento per le Scienze della Salute della Donna del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Alessia Piermattei
- Gineco-Patologia e Patologia Mammaria unit, Dipartimento per le Scienze della Salute della Donna del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Angelo Minucci
- Diagnostica Molecolare e Genomica unit, Dipartimento per le Scienze della Salute della Donna del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Domenica Lorusso
- Gynecologic Oncology Unit, Dipartimento per le Scienze della Salute della Donna del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Fanfani
- Gynecologic Oncology Unit, Dipartimento per le Scienze della Salute della Donna del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giovanni Scambia
- Gynecologic Oncology Unit, Dipartimento per le Scienze della Salute della Donna del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
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Tymon-Rosario J, Bonazzoli E, Bellone S, Manzano A, Pelligra S, Guglielmi A, Gnutti B, Nagarkatti N, Zeybek B, Manara P, Zammataro L, Harold J, Mauricio D, Buza N, Hui P, Altwerger G, Menderes G, Ratner E, Clark M, Andikyan V, Huang GS, Silasi DA, Azodi M, Schwartz PE, Santin AD. DHES0815A, a novel antibody-drug conjugate targeting HER2/neu, is highly active against uterine serous carcinomas in vitro and in vivo. Gynecol Oncol 2021; 163:334-341. [PMID: 34452746 PMCID: PMC8722447 DOI: 10.1016/j.ygyno.2021.08.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 08/01/2021] [Accepted: 08/17/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Uterine serous carcinoma (USC) is an aggressive histologic variant of endometrial cancer which portends a poor prognosis. DHES0815A is a novel antibody-drug-conjugate (ADC) which binds specifically to HER2 overexpressing tumors at a distinct epitope from that bound by trastuzumab and pertuzumab after which it delivers the toxic payload, PBD-MA, a DNA mono-alkylating agent. The objective of this study was to evaluate the preclinical activity of DHES0815A against primary USC cell lines and xenografts. METHODS Twelve primary USC cell lines were assessed by immunohistochemistry (IHC) for HER2 protein expression and for C-erbB2 gene amplification using fluorescent in situ hybridization (FISH) analysis. Cell viability and bystander killing in USC cell lines after exposure to DHES0815A, the non-targeted ADC, and the unconjugated antibody (i.e. MHES0488A) were evaluated using flow cytometry-based-assays. In vivo activity of DHES0815A was tested against HER2/neu overexpressing USC xenografts. RESULTS High HER2/neu protein expression was seen in 25% (3/12) of the primary USC cell lines. USC cell lines overexpressing HER2/neu were significantly more sensitive to DHES0815A when compared to the non-targeted control ADC (p < 0.001). DHES0815A did not induce significant bystander killing of HER2/neu negative tumors when admixed with HER2/neu positive tumors. DHES0815A caused growth-inhibition and increased survival in USC HER2/neu overexpressing xenografts when compared to controls (p < 0.01). CONCLUSIONS DHES0815A is both highly selective and toxic to USC tumors overexpressing HER2/neu both in vitro and in vivo. HER2-directed ADCs, alone or in combination with other HER2/neu targeted agents may represent a novel treatment option for patients with tumors harboring HER2/neu overexpression refractory to trastuzumab and traditional chemotherapy.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Antibodies, Monoclonal, Humanized/pharmacology
- Antibodies, Monoclonal, Humanized/therapeutic use
- Benzodiazepines/pharmacology
- Benzodiazepines/therapeutic use
- Bystander Effect/drug effects
- Cell Line, Tumor
- Cystadenocarcinoma, Serous/drug therapy
- Cystadenocarcinoma, Serous/pathology
- Drug Resistance, Neoplasm
- Female
- Humans
- Immunoconjugates/pharmacology
- Immunoconjugates/therapeutic use
- Middle Aged
- Primary Cell Culture
- Receptor, ErbB-2/antagonists & inhibitors
- Trastuzumab/pharmacology
- Trastuzumab/therapeutic use
- Uterine Neoplasms/drug therapy
- Uterine Neoplasms/pathology
- Xenograft Model Antitumor Assays
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Affiliation(s)
- Joan Tymon-Rosario
- Department of Obstetrics, Gynecology, Reproductive Sciences Yale University School of Medicine, CT 06520, USA
| | - Elena Bonazzoli
- Department of Obstetrics, Gynecology, Reproductive Sciences Yale University School of Medicine, CT 06520, USA
| | - Stefania Bellone
- Department of Obstetrics, Gynecology, Reproductive Sciences Yale University School of Medicine, CT 06520, USA
| | - Aranzazu Manzano
- Department of Obstetrics, Gynecology, Reproductive Sciences Yale University School of Medicine, CT 06520, USA
| | - Silvia Pelligra
- Department of Obstetrics, Gynecology, Reproductive Sciences Yale University School of Medicine, CT 06520, USA; Gynecologic Oncology Unit, Women Wealth Area, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Adele Guglielmi
- Department of Obstetrics, Gynecology, Reproductive Sciences Yale University School of Medicine, CT 06520, USA
| | - Barbara Gnutti
- Department of Obstetrics, Gynecology, Reproductive Sciences Yale University School of Medicine, CT 06520, USA
| | - Nupur Nagarkatti
- Department of Obstetrics, Gynecology, Reproductive Sciences Yale University School of Medicine, CT 06520, USA
| | - Burak Zeybek
- Department of Obstetrics, Gynecology, Reproductive Sciences Yale University School of Medicine, CT 06520, USA
| | - Paola Manara
- Department of Obstetrics, Gynecology, Reproductive Sciences Yale University School of Medicine, CT 06520, USA
| | - Luca Zammataro
- Department of Obstetrics, Gynecology, Reproductive Sciences Yale University School of Medicine, CT 06520, USA
| | - Justin Harold
- Department of Obstetrics, Gynecology, Reproductive Sciences Yale University School of Medicine, CT 06520, USA
| | - Dennis Mauricio
- Department of Obstetrics, Gynecology, Reproductive Sciences Yale University School of Medicine, CT 06520, USA
| | - Natalia Buza
- Department of Pathology, Yale University School of Medicine, CT 06520, USA
| | - Pei Hui
- Department of Pathology, Yale University School of Medicine, CT 06520, USA
| | - Gary Altwerger
- Department of Obstetrics, Gynecology, Reproductive Sciences Yale University School of Medicine, CT 06520, USA
| | - Gulden Menderes
- Department of Obstetrics, Gynecology, Reproductive Sciences Yale University School of Medicine, CT 06520, USA
| | - Elena Ratner
- Department of Obstetrics, Gynecology, Reproductive Sciences Yale University School of Medicine, CT 06520, USA
| | - Mitchell Clark
- Department of Obstetrics, Gynecology, Reproductive Sciences Yale University School of Medicine, CT 06520, USA
| | - Vaagn Andikyan
- Department of Obstetrics, Gynecology, Reproductive Sciences Yale University School of Medicine, CT 06520, USA
| | - Gloria S Huang
- Department of Obstetrics, Gynecology, Reproductive Sciences Yale University School of Medicine, CT 06520, USA
| | - Dan-Arin Silasi
- Gynecologic Oncology, Obstetrics and Gynecology, Mercy Hospital St. Louis, MO 63141, USA
| | - Masoud Azodi
- Department of Obstetrics, Gynecology, Reproductive Sciences Yale University School of Medicine, CT 06520, USA
| | - Peter E Schwartz
- Department of Obstetrics, Gynecology, Reproductive Sciences Yale University School of Medicine, CT 06520, USA
| | - Alessandro D Santin
- Department of Obstetrics, Gynecology, Reproductive Sciences Yale University School of Medicine, CT 06520, USA.
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5
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Tymon-Rosario JTR, Bonazzoli E, Bellone S, Manzano A, Manara P, Zammataro L, Pelligra S, Guglielmi A, Gnutti B, Zeybek B, Harold J, Mauricio D, Ratner E, Schwartz P, Santin AD. Abstract 911: In vitro and in vivo activity of DHES0815A, an antibody-drug conjugate targeting HER2/neu in uterine serous carcinoma. Cancer Res 2021. [DOI: 10.1158/1538-7445.am2021-911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Objective: Uterine serous carcinoma (USC) is an aggressive histologic variant of endometrial cancer which portends a poor prognosis. DHES0815A is a novel antibody-drug-conjugate (ADC) which binds specifically to HER2 overexpressing tumors at a distinct epitope from that bound by trastuzumab and pertuzumab after which it delivers the toxic payload, PBD-MA, a DNA mono-alkylating agent. The objective of this study was to evaluate the preclinical activity of DHES0815A against primary USC cell lines and xenografts.
Methods: Twelve primary USC cell lines were assessed by immunohistochemistry (IHC) for HER2 protein expression and for C-erbB2 gene amplification using fluorescent in situ hybridization (FISH) analysis. Cell viability and bystander killing in USC cell lines after exposure to DHES0815A, the non-targeted ADC, and the unconjugated antibody (i.e. MHES0488A) were evaluated using flow cytometry-based-assays. In vivo activity of DHES0815A was tested against HER2/neu overexpressing USC xenografts.
Results: High HER2/neu protein expression was seen in 25% (3/12) of the primary USC cell lines. USC cell lines overexpressing HER2/neu were significantly more sensitive to DHES0815A when compared to the non-targeted control ADC (p<0.001). DHES0815A did not induce significant bystander killing of HER2/neu negative tumors when admixed with HER2/neu positive tumors. DHES0815A caused growth-inhibition and increased survival in USC HER2/neu overexpressing xenografts when compared to controls (p<0.01).
Conclusions: DHES0815A is both highly selective and toxic to USC tumors overexpressing HER2/neu both in vitro and in vivo. HER2-directed ADCs, alone or in combination with other HER2/neu targeted agents may represent a novel treatment option for patients with tumors harboring HER2/neu overexpression refractory to trastuzumab and traditional chemotherapy.
Citation Format: Joan Tymon R. Tymon-Rosario, Elena Bonazzoli, Stefania Bellone, Arancha Manzano, Paola Manara, Luca Zammataro, Silvia Pelligra, Adele Guglielmi, Barbara Gnutti, Burak Zeybek, Justin Harold, Dennis Mauricio, Elena Ratner, Peter Schwartz, Alessandro D. Santin. In vitro and in vivo activity of DHES0815A, an antibody-drug conjugate targeting HER2/neu in uterine serous carcinoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 911.
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Affiliation(s)
| | | | | | | | - Paola Manara
- Yale University School of Medicine, New Haven, CT
| | | | | | | | | | - Burak Zeybek
- Yale University School of Medicine, New Haven, CT
| | | | | | - Elena Ratner
- Yale University School of Medicine, New Haven, CT
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6
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Conte C, Fagotti A, Avesani G, Trombadori C, Federico A, D'Indinosante M, Giudice MT, Pelligra S, Lodoli C, Marchetti C, Ferrandina G, Scambia G, Gallotta V. Update on the secondary cytoreduction in platinum-sensitive recurrent ovarian cancer: a narrative review. Ann Transl Med 2021; 9:510. [PMID: 33850907 PMCID: PMC8039681 DOI: 10.21037/atm-20-4690] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
The ovarian cancer recurrence occurs in 75% of patients with advanced FIGO stage, and its treatment is a challenge for the oncologist in gynecology. The standard treatment of recurrent ovarian cancer (ROC) usually includes intravenous chemotherapy according to platinum sensitivity. Furthermore, maintenance treatment with target therapies [e.g., anti-angiogenic drug or PARP inhibitors (PARPi)], should be provided if not precedently administrated. In this scenario, secondary cytoreductive surgery (SCS) remains a practical but controversial option for platinum-sensitive ROC (PSROC). So far, several retrospective series and a Cochrane meta-analysis had concluded that SCS could determine better survival outcomes in ROC with favorable prognostic characteristics, such as the presence of a single anatomical site of recurrence, or when patients are accurately selected for surgery based on complete resection’s predictive models. Recently, three randomized clinical trials (RCTs) investigated the role of SCS in PSROC patients selected with different criteria. All the three RCTs showed a significant statistical advantage in progression-free survival (PFS) in the SCS group, with an even more significant difference in patients with complete cytoreduction (about 7-month PFS increased). Data on overall survival (OS) are different in the two completed trials. The GOG213 study has documented a longer OS of PSROC patients who received chemotherapy alone compared to surgery plus chemotherapy. Contrarily, the DESKTOP III trial showed 7.7 months of increased OS in the surgery group vs. chemotherapy alone, with a more difference in the complete tumor cytoreduction (CTC) group (12 months). These RCTs thereby suggest that undergoing complete cytoreduction may not be the only key and that the disease biology may also matter. Few recent retrospective series investigated the role of SCS according to BRCA mutation status and the effect of SCS in patients receiving emerging PARPi. A consequence of the developments in SCS and knowledge of different molecular pathways influencing the recurrent disease is that the future research objective should be to individualize and personalize the surgical approach.
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Affiliation(s)
- Carmine Conte
- Department of Woman, Child and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Institute of Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Anna Fagotti
- Department of Woman, Child and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Institute of Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giacomo Avesani
- Department of Diagnostic Imaging, Radiation Therapy and Haematology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Charlotte Trombadori
- Department of Diagnostic Imaging, Radiation Therapy and Haematology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Alex Federico
- Department of Woman, Child and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Marco D'Indinosante
- Institute of Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maria Teresa Giudice
- Institute of Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Silvia Pelligra
- Institute of Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Claudio Lodoli
- Department of General Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Claudia Marchetti
- Department of Woman, Child and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Gabriella Ferrandina
- Department of Woman, Child and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Institute of Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giovanni Scambia
- Department of Woman, Child and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Institute of Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Valerio Gallotta
- Department of Woman, Child and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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Pelligra S, Scaletta G, Cianci S, Gueli Alletti S, Restaino S, Fagotti A, Scambia G, Fanfani F. Update on new imaging technologies in sentinel node detection. ACTA ACUST UNITED AC 2020; 72:404-412. [PMID: 33306284 DOI: 10.23736/s0026-4784.20.04707-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
In most cancers, lymph node status is the most critical factor impacting the evolution of the disease and the overall survival. Identifying potential nodal metastasis allows the oncologist to adjust the stage and, consequently, the patient's treatment. For this reason, a precise evaluation of the regional nodes is mandatory. In gynecological cancers, pelvic, paraaortic, and inguinal nodes are the region most frequently interested by metastasis. In the past years, comprehensive lymphadenectomy was the standard of care for endometrial, cervical, ovarian, and vulvar cancers. However, after introducing the sentinel lymph node (SNL) biopsy in breast cancers, this technique has gained much more interest in gynecology oncology. Several studies have shown that SLN allows an evaluation of the node status without the complications related to the lymphadenectomy that impacts the patient's quality of life. In this review, we discuss the role of SNL biopsy in gynecological cancers and the technique's evolution over the years. Moreover, we debate the OSNA method for SLN analysis that is recently introduced for uterine cancer.
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Affiliation(s)
- Silvia Pelligra
- Department of Women's and Children's Health Sciences and Public Health, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Giuseppe Scaletta
- Department of Women's and Children's Health Sciences and Public Health, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy -
| | - Stefano Cianci
- Department of Woman, Child and General and Specialized Surgery, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Salvatore Gueli Alletti
- Department of Women's and Children's Health Sciences and Public Health, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Stefano Restaino
- Department of Women's and Children's Health Sciences and Public Health, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Anna Fagotti
- Department of Women's and Children's Health Sciences and Public Health, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy.,Department of Women's and Children's Health Sciences and Public Health, Sacred Heart Catholic University, Rome, Italy
| | - Giovanni Scambia
- Department of Women's and Children's Health Sciences and Public Health, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy.,Department of Women's and Children's Health Sciences and Public Health, Sacred Heart Catholic University, Rome, Italy
| | - Francesco Fanfani
- Department of Women's and Children's Health Sciences and Public Health, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy.,Department of Women's and Children's Health Sciences and Public Health, Sacred Heart Catholic University, Rome, Italy
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Novelli AA, Puppo A, Ceccaroni M, Olearo E, Monterossi G, Mantovani G, Pelligra S, Olearo PL, Fanfani F, Scambia G. Diagnostic accuracy and economic impact of three work-up strategies identifying risk groups in endometrial cancer, fully incorporating sentinel lymph node algorithm. Facts Views Vis Obgyn 2020; 12:169-177. [PMID: 33123692 PMCID: PMC7580266] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND According to the European Society for Medical Oncology/ European Society of Gynaecological Oncology/European Society for Radiotherapy and Oncology (ESMO/ESGO/ESTRO) Consensus Conference, the role of preoperative risk groups (RGs) in endometrial cancer (EC) is to direct surgical nodal staging. We compared diagnostic accuracy and economic impact of three work-up strategies to identify RGs. METHODS A retrospective multicentre study including patients with early-stage EC. The three different work-up strategies were as follows:-Mondovì Hospital: transvaginal ultrasonography, pelvic magnetic resonance imaging (MRI); frozen section examination of the uterus in case of imaging discordance. High-risk patients underwent abdominal computed tomography.-Gemelli Hospital: transvaginal ultrasonography, MRI, One-Step Nucleic Acid Amplification (OSNA) of sentinel lymph node (SLN); frozen section examination of the uterus in case of imaging discordance.-Negrar Hospital: positron emission tomography (PET), frozen section examination of the uterus and of SLN. For statistical purposes patients were assigned, preoperatively and postoperatively, to two groups: group A (high-risk) and group B (not high-risk). RESULTS Three hundred eighty-five patients were included (93 Mondovì, 215 Gemelli, 77 Negrar). Endometrial biopsy errors led to 47.3% misclassifications. Test accuracy of Mondovì, Gemelli and Negrar strategies was 0.83 (95%CI 0.734-0.901), 0.95 (95%CI 0.909-0.975) and 0.94 (95%CI 0.866-0.985), respectively. Preoperative work-up mean cost per patient in group A was €514.5 at Mondovì, €868.5 at Gemelli, and €1212.8 at Negrar hospital (p-value < 0.001), while in group B was €378.8 at Mondovì, €941.2 at Gemelli, and €1848.4 at Negrar hospital (p-value < 0.001). CONCLUSIONS In our study, work-up strategies with more relevant economic impact showed a better diagnostic accuracy. Upcoming guidelines should specify recommendations about the gold standard work-up strategy, including the role of SLN.
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Affiliation(s)
- AA Novelli
- Department of Obstetrics and Gynaecology, “Regina Montis Regalis” Hospital, Mondovì (Cuneo), Italy,Università Cattolica del Sacro Cuore, Rome, Italy
| | - A Puppo
- Department of Obstetrics and Gynaecology, “Regina Montis Regalis” Hospital, Mondovì (Cuneo), Italy,Department of Obstetrics and Gynaecology, Santa Croce e Carle Hospital, Cuneo, Italy
| | - M Ceccaroni
- Department of Obstetrics and Gynaecology, Gynaecologic Oncology and Minimally-Invasive Pelvic
Surgery, International School of Surgical Anatomy, IRCCS Sacro Cuore-Don Calabria Hospital, Negrar (Verona), Italy
| | - E Olearo
- Department of Obstetrics and Gynaecology, “Regina Montis Regalis” Hospital, Mondovì (Cuneo), Italy
| | - G Monterossi
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - G Mantovani
- Department of Obstetrics and Gynaecology, Gynaecologic Oncology and Minimally-Invasive Pelvic
Surgery, International School of Surgical Anatomy, IRCCS Sacro Cuore-Don Calabria Hospital, Negrar (Verona), Italy
| | - S Pelligra
- Università Cattolica del Sacro Cuore, Rome, Italy,Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - PL Olearo
- Department of Obstetrics and Gynaecology, “Regina Montis Regalis” Hospital, Mondovì (Cuneo), Italy
| | - F Fanfani
- Università Cattolica del Sacro Cuore, Rome, Italy,Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - G Scambia
- Università Cattolica del Sacro Cuore, Rome, Italy,Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
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Bonazzoli E, Bellone S, Zammataro L, Gnutti B, Guglielmi A, Pelligra S, Manara P, Tymon-Rosario J, Zeybek B, Han C, Santin AD. Abstract 5341: Derangements in HUWE1/c-MYC pathway confer sensitivity to the BET bromodomain inhibitor GS-626510 in uterine cervical carcinoma. Cancer Res 2020. [DOI: 10.1158/1538-7445.am2020-5341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Purpose: The prognosis for women with advanced or recurrent cervical cancer (CC) no longer responsive to radiation and/or chemotherapy remains poor. Whole-exome-sequencing (WES) studies have recently reported c-MYC gene amplification and HUWE1 gene mutations in a significant number of CC suggesting the HUWE1/c-MYC pathway as potential therapeutic target. We investigated HUWE1 and c-MYC expression in fresh-frozen CC and the potential activity of the novel BET bromodomain inhibitor GS-626510 (Gilead-Science-Inc.) against primary WES CC-cultures and CC-xenografts.
Experimental Design: HUWE1 and c-MYC expression were evaluated by qRT-PCR in a total of 23 CC including 12 fresh frozen tumor tissues and 11 primary cell lines. c-MYC expression was also evaluated by Western-Blot (WB) and fluorescence in situ hybridization (FISH) experiments in all 11 fully sequenced primary CC cell lines. Primary tumors were evaluated for sensitivity to GS-626510 in-vitro using proliferation and viability-assays. siRNA experiments were used to evaluate the effect of HUWE1 silencing on primary CC cell line growth and sensitivity to GS-626510. Finally, the in-vivo activity of GS-626510 was studied in CC-CVX8 mouse-xenografts.
Results: Fresh-frozen CC and primary CC cell lines overexpressed c-MYC when compared to normal control tissues (mean ± SEM mRNA values = 7.06 ± 1.17 vs a mean ± SEM = 2.96 ± 0.97, p = 0.01). FISH experiments demonstrated amplification of c-MYC in 9 out of 11 (82%) of the primary CC cell lines. Primary CC cell lines with derangements in the HUWE1/c-MYC pathway were highly sensitive to GS-626510, with a dose-response decrease in cell proliferation and IC50 values ranging from 3 to 57 nM. Silencing of HUWE1 by siRNA significantly increased c-MYC expression as well as CC cell proliferation and enhanced the in vitro sensitivity to GS-626510. Twice daily oral doses of GS-626510 (10 mg/kg) were well tolerated in vivo in animals and highly effective in decreasing tumor-growth (p = 0.004) and increasing survival (p value = 0.004) of mice harboring CC-CVX8 xenografts.
Conclusions: Downregulation/inactivation of HUWE1 may increase c-MYC expression and proliferation in primary CC cell lines. GS-626510 may represent a novel, potentially highly effective therapeutic agent against CC overexpressing c-MYC and/or harboring HUWE1 mutations. Clinical studies with BET inhibitor in CC-patients harboring radiation/chemotherapy-resistant disease are warranted.
Citation Format: Elena Bonazzoli, Stefania Bellone, Luca Zammataro, Barbara Gnutti, Adele Guglielmi, Silvia Pelligra, Paola Manara, Joan Tymon-Rosario, Burak Zeybek, Chanhee Han, Alessandro D. Santin. Derangements in HUWE1/c-MYC pathway confer sensitivity to the BET bromodomain inhibitor GS-626510 in uterine cervical carcinoma [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 5341.
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Bonazzoli E, Bellone S, Zammataro L, Gnutti B, Guglielmi A, Pelligra S, Nagarkatti N, Manara P, Tymon-Rosario J, Zeybek B, Altwerger G, Menderes G, Han C, Ratner E, Silasi DA, Huang GS, Andikyan V, Azodi M, Schwartz PE, Santin AD. Derangements in HUWE1/c-MYC pathway confer sensitivity to the BET bromodomain inhibitor GS-626510 in uterine cervical carcinoma. Gynecol Oncol 2020; 158:769-775. [PMID: 32600791 DOI: 10.1016/j.ygyno.2020.06.484] [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: 04/03/2020] [Accepted: 06/11/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Whole-exome-sequencing (WES) studies reported c-MYC gene-amplification and HUWE1 gene deletion/mutations in a significant number of cervical-cancer-patients (CC) suggesting HUWE1/c-MYC pathway as potential therapeutic target. We investigated HUWE1/c-MYC expression in fresh-frozen-CC and the activity of the novel BET inhibitor GS-626510 (Gilead-Science-Inc) against primary WES CC-cultures and CC-xenografts. METHODS HUWE1 and c-MYC expression were evaluated by qRT-PCR in 23 CC including 12 fresh-frozen-tumor-tissues and 11 primary-cell-lines. c-Myc expression was also evaluated by Western-Blot (WB) and fluorescence-in-situ-hybridization (FISH) in all 11 fully sequenced primary-CC-cell-lines. Primary tumors were evaluated for sensitivity to GS-626510 in-vitro using proliferation and viability-assays. siRNA experiments were used to evaluate the effect of HUWE1 silencing on primary-CC-cell-line growth and sensitivity to GS-626510. Finally, the in-vivo activity of GS-626510 was studied in CC-CVX8-mouse-xenografts. RESULTS Fresh-frozen-CC and primary-CC-cell-lines overexpressed c-MYC when compared to normal tissues (p = .01). FISH demonstrated amplification of c-MYC in 9/11 (82%) of the primary-CC-cell-lines. Cell-lines with derangements in HUWE1/c-MYC pathway were highly sensitive to GS-626510, with a dose-response decrease in cell proliferation and viability. siRNA silencing of HUWE1 significantly increased c-MYC expression and CC cell-proliferation and enhanced the in-vitro sensitivity to GS-626510. Twice-daily oral doses of GS-626510 were well tolerated in-vivo and highly effective in decreasing tumor-growth (p = .004) and increasing survival (p = .004) of CC-CVX8 xenografts. CONCLUSIONS Downregulation/inactivation of HUWE1 may increase c-MYC expression and proliferation in primary-CC-cell-lines. GS-626510 may represent a novel, potentially highly effective therapeutic agent against CC overexpressing c-MYC and/or harboring HUWE1 mutations. Clinical studies with BET inhibitor in CC-patients harboring radiation/chemotherapy-resistant disease are warranted.
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Affiliation(s)
- Elena Bonazzoli
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT 06520, USA
| | - Stefania Bellone
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT 06520, USA
| | - Luca Zammataro
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT 06520, USA
| | - Barbara Gnutti
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT 06520, USA
| | - Adele Guglielmi
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT 06520, USA
| | - Silvia Pelligra
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT 06520, USA
| | - Nupur Nagarkatti
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT 06520, USA
| | - Paola Manara
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT 06520, USA
| | - Joan Tymon-Rosario
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT 06520, USA
| | - Burak Zeybek
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT 06520, USA
| | - Gary Altwerger
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT 06520, USA
| | - Gulden Menderes
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT 06520, USA
| | - Chanhee Han
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT 06520, USA
| | - Elena Ratner
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT 06520, USA
| | - Dan-Arin Silasi
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT 06520, USA
| | - Gloria S Huang
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT 06520, USA
| | - Vaagn Andikyan
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT 06520, USA
| | - Masoud Azodi
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT 06520, USA
| | - Peter E Schwartz
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT 06520, USA
| | - Alessandro D Santin
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT 06520, USA.
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Scaletta G, Dinoi G, Capozzi V, Cianci S, Pelligra S, Ergasti R, Fagotti A, Scambia G, Fanfani F. Comparison of minimally invasive surgery with laparotomic approach in the treatment of high risk endometrial cancer: A systematic review. Eur J Surg Oncol 2020; 46:782-788. [DOI: 10.1016/j.ejso.2019.11.519] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 11/24/2019] [Accepted: 11/30/2019] [Indexed: 02/04/2023] Open
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Perrone E, Lopez S, Zeybek B, Bellone S, Bonazzoli E, Pelligra S, Zammataro L, Manzano A, Manara P, Bianchi A, Buza N, Tymon-Rosario J, Altwerger G, Han C, Menderes G, Ratner E, Silasi DA, Azodi M, Hui P, Schwartz PE, Scambia G, Santin AD. Preclinical Activity of Sacituzumab Govitecan, an Antibody-Drug Conjugate Targeting Trophoblast Cell-Surface Antigen 2 (Trop-2) Linked to the Active Metabolite of Irinotecan (SN-38), in Ovarian Cancer. Front Oncol 2020; 10:118. [PMID: 32117765 PMCID: PMC7028697 DOI: 10.3389/fonc.2020.00118] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 01/22/2020] [Indexed: 11/26/2022] Open
Abstract
Background: Epithelial ovarian cancer (EOC) is the most lethal gynecologic malignancy. Sacituzumab govitecan (SG) is a novel antibody-drug-conjugate (ADC) targeting trophoblast-antigen-2 (Trop-2), a cell surface glycoprotein highly expressed in many epithelial tumors, to deliver SN-38, the active metabolite of irinotecan. This study aimed to evaluate Trop-2 expression in EOC tissues and the preclinical activity of SG against primary EOC cell lines and xenografts. Methods: Trop-2 expression was assessed in 90 formalin-fixed-paraffin-embedded tumors and nine primary tumor cell lines by immunohistochemistry (IHC) and flow cytometry, respectively. Trop-2 expression and cell viability after exposure to SG in primary tumor cell lines, non-targeting control ADC, and SG-parental antibody hRS7 were evaluated using flow-cytometry-based-assays. Antibody-dependent-cell-cytotoxicity (ADCC) against Trop-2+ and Trop-2- EOC cell lines was tested in vitro using 4 h Chromium-release-assays. In vivo activity of SG was evaluated against Trop-2+ EOC xenografts. Results: Moderate-to-strong staining was seen in 47% (42/90) of ovarian tumors by IHC while 89% (8/9) of the primary EOC cell lines overexpressed Trop-2 by flow cytometry. EOC Trop-2+ were significantly more sensitive to SG compared to control ADC (p < 0.05). Both SG and hRS7 mediated high ADCC activity against Trop-2+ cell lines. SG also induced significant bystander killing of Trop-2- tumor cells admixed with Trop-2+ EOC cells. In in vivo experiments SG treatment demonstrated impressive anti-tumor activity against chemotherapy-resistant EOC xenografts. Conclusion: SG demonstrates remarkable preclinical activity against biologically aggressive and chemotherapy-resistant EOC cell lines and a significant bystander effect against EOC cell lines with heterogenous Trop-2 expression. Clinical trials are warranted.
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Affiliation(s)
- Emanuele Perrone
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, United States
- Department of Woman and Child Health Sciences, Universita' Cattolica del Sacro Cuore, Rome, Italy
| | - Salvatore Lopez
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, United States
- Department of Experimental and Clinical Medicine, Magna Graecia University, Catanzaro, Italy
| | - Burak Zeybek
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, United States
| | - Stefania Bellone
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, United States
| | - Elena Bonazzoli
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, United States
| | - Silvia Pelligra
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, United States
| | - Luca Zammataro
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, United States
| | - Aranzazu Manzano
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, United States
| | - Paola Manara
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, United States
| | - Anna Bianchi
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, United States
| | - Natalia Buza
- Department of Pathology, Yale University School of Medicine, New Haven, CT, United States
| | - Joan Tymon-Rosario
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, United States
| | - Gary Altwerger
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, United States
| | - Chanhee Han
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, United States
| | - Gulden Menderes
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, United States
| | - Elena Ratner
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, United States
| | - Dan-Arin Silasi
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, United States
| | - Masoud Azodi
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, United States
| | - Pei Hui
- Department of Pathology, Yale University School of Medicine, New Haven, CT, United States
| | - Peter E. Schwartz
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, United States
| | - Giovanni Scambia
- Department of Experimental and Clinical Medicine, Magna Graecia University, Catanzaro, Italy
| | - Alessandro D. Santin
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, United States
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Legge F, Restaino S, Leone L, Carone V, Ronsini C, Di Fiore GLM, Pasciuto T, Pelligra S, Ciccarone F, Scambia G, Fanfani F. Clinical outcome of recurrent endometrial cancer: analysis of post-relapse survival by pattern of recurrence and secondary treatment. Int J Gynecol Cancer 2019; 30:193-200. [PMID: 31792085 DOI: 10.1136/ijgc-2019-000822] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 10/04/2019] [Accepted: 10/10/2019] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Recurrence of endometrial cancer is an important clinical challenge, with median survival rarely exceeding 12 months. The aim of this study was to analyze patterns of endometrial cancer recurrence and associations of these patterns with clinical outcome. METHODS The study included patients with endometrial cancer who underwent primary surgical treatment with or without adjuvant treatment between July 2004 and June 2017 at the Gynaecologic Oncology Unit of one of three tertiary hospitals of the Catholic University Network in Italy with complete follow-up data available. Information on the date and pattern of recurrence was retrieved for each relapse. Post-relapse survival was recorded as the time from the date of recurrence to the date of death or last follow-up. Survival probabilities were compared using log rank tests, and associations of clinico-pathological characteristics with post-relapse survival were tested using Cox's regression models. RESULTS A total of 1503 patients were included in the analysis. We identified 210 recurrences (14.0%) and 105 deaths (7.0%) at a median follow-up of 34 months (range 1-162). One hundred and fifty-eight recurrences (78.1%) occurred during the first two years of follow-up. Most recurrences were multifocal (n=121, 57.6%) and involved extrapelvic sites (n=38, 65.7%). Parameters associated with post-relapse survival in the univariate analysis included histotype, grade, time to recurrence, pattern of recurrence, number of relapsing lesions, and secondary radical surgery. Only the pattern of recurrence and secondary radical surgery were independent predictors of post-relapse survival in the multivariate analysis (p=0.025 and p=0.0001, respectively). CONCLUSION Lymph node recurrence and the feasibility of secondary radical surgery were independent predictors of post-relapse survival in patients with recurrent endometrial cancer.
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Affiliation(s)
- Francesco Legge
- Gynecologic Oncology Unit, "F. Miulli" General Regional Hospital, Acquaviva delle Fonti, Bari, Italy
| | - Stefano Restaino
- Dipartimento per la Tutela della Salute della Donna e della Vita Nascente, UOC di Ginecologia Oncologica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Luca Leone
- Gynecologic Oncology Unit, "F. Miulli" General Regional Hospital, Acquaviva delle Fonti, Bari, Italy
| | - Vito Carone
- Gynecologic Oncology Unit, "F. Miulli" General Regional Hospital, Acquaviva delle Fonti, Bari, Italy
| | - Carlo Ronsini
- Gynecologic and Obstetrics Unit, Università "G. d'Annunzio, Chieti, Italy
| | - Giacomo Lorenzo Maria Di Fiore
- Dipartimento per la Tutela della Salute della Donna e della Vita Nascente, UOC di Ginecologia Oncologica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Tina Pasciuto
- Statistics Technology Archiving Research (STAR) Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Silvia Pelligra
- Gynecologic Oncology, Catholic University of the Sacred Heart, Rome, Italy
| | - Francesca Ciccarone
- Dipartimento per la Tutela della Salute della Donna e della Vita Nascente, UOC di Ginecologia Oncologica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Giovanni Scambia
- Dipartimento per la Tutela della Salute della Donna e della Vita Nascente, UOC di Ginecologia Oncologica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.,Gynecologic Oncology, Catholic University of the Sacred Heart, Rome, Italy
| | - Francesco Fanfani
- Dipartimento per la Tutela della Salute della Donna e della Vita Nascente, UOC di Ginecologia Oncologica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy .,Gynecologic Oncology, Catholic University of the Sacred Heart, Rome, Italy
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14
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Gallotta V, Conte C, Federico A, Vizzielli G, Gueli Alletti S, Tortorella L, Pedone Anchora L, Cosentino F, Chiantera V, Fagotti A, D'Indinosante M, Pelligra S, Scambia G, Ferrandina G. Robotic versus laparoscopic radical hysterectomy in early cervical cancer: A case matched control study. Eur J Surg Oncol 2018; 44:754-759. [PMID: 29422253 DOI: 10.1016/j.ejso.2018.01.092] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [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: 12/18/2017] [Revised: 01/06/2018] [Accepted: 01/16/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND This study aims at evaluating the feasibility, surgical outcome and oncological results observed after robotic radical hysterectomy (RH) compared to laparoscopy for patients with early stage cervical cancer (ECC) patients. METHODS Between January 2010 and October 2016, 210 patients underwent RH for treatment of ECC: 70 underwent robotic approach (Cases), and 140 underwent laparoscopic approach (Controls). RESULTS There was no statistically significant difference between the two approaches with regard to clinical patient characteristics and in terms of extent of RH and rate of pelvic and aortic lymphadenectomy. Operative time was significantly longer in the robotic versus laparoscopic group (median = 243 min, range 90-612 versus median = 210 min, range 80-660; p value = 0.008). Conversion to laparotomy was necessary in 4 patients (1.9%) in the whole series. No difference was found in terms of intraoperative and postoperative complications between the two groups. Overall, during the observation period, 34 (16.2%) patients experienced any grade postoperative complications, and 21 (10.0%) had >G2 complications. The 3-yr DFS was 88.0% versus 84.0% in robotic and laparoscopic group, respectively (p value = 0.866). Central and/or lateral pelvic disease represented the most common site of relapse. The 3-yr OS was 90.8% in patients underwent robotic RH versus 94.0% in patients underwent laparoscopic RH (p value = 0.924). CONCLUSIONS The present study shows the equivalence of robotic and laparoscopic approaches to radical surgery of ECC patients, in terms of perioperative and postoperative outcomes with equivalent survival figures, and thus the choice of approach can be tailored to the choice of patient and surgeon.
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Affiliation(s)
- Valerio Gallotta
- Division of Gynecologic Oncology, Fondazione "Policlinico Universitario A. Gemelli", Catholic University of the Sacred Heart, Rome, Italy.
| | - Carmine Conte
- Division of Gynecologic Oncology, Fondazione "Policlinico Universitario A. Gemelli", Catholic University of the Sacred Heart, Rome, Italy
| | - Alex Federico
- Division of Gynecologic Oncology, Fondazione "Policlinico Universitario A. Gemelli", Catholic University of the Sacred Heart, Rome, Italy
| | - Giuseppe Vizzielli
- Division of Gynecologic Oncology, Fondazione "Policlinico Universitario A. Gemelli", Catholic University of the Sacred Heart, Rome, Italy
| | - Salvatore Gueli Alletti
- Division of Gynecologic Oncology, Fondazione "Policlinico Universitario A. Gemelli", Catholic University of the Sacred Heart, Rome, Italy
| | - Lucia Tortorella
- Division of Gynecologic Oncology, Fondazione "Policlinico Universitario A. Gemelli", Catholic University of the Sacred Heart, Rome, Italy
| | - Luigi Pedone Anchora
- Division of Gynecologic Oncology, Fondazione "Policlinico Universitario A. Gemelli", Catholic University of the Sacred Heart, Rome, Italy
| | - Francesco Cosentino
- Division of Gynecologic Oncology, Fondazione "Policlinico Universitario A. Gemelli", Catholic University of the Sacred Heart, Rome, Italy
| | - Vito Chiantera
- Division of Gynecologic Oncology, University of Palermo, Palermo, Italy
| | - Anna Fagotti
- Division of Gynecologic Oncology, Fondazione "Policlinico Universitario A. Gemelli", Catholic University of the Sacred Heart, Rome, Italy
| | - Marco D'Indinosante
- Division of Gynecologic Oncology, Fondazione "Policlinico Universitario A. Gemelli", Catholic University of the Sacred Heart, Rome, Italy
| | - Silvia Pelligra
- Division of Gynecologic Oncology, Fondazione "Policlinico Universitario A. Gemelli", Catholic University of the Sacred Heart, Rome, Italy
| | - Giovanni Scambia
- Department of Women's and Children's Health, Catholic University of the Sacred Heart, Rome, Italy
| | - Gabriella Ferrandina
- Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy
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15
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Malaponte G, Arcidiacono C, Mazzarino C, Pelligra S, Volti GL, Bevelacqua V, Volti SL. Cephalosporin-induced Hemolytic Anemia in a Sicilian Child. Hematology 2016; 5:327-34. [DOI: 10.1080/10245332.2000.11746527] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
- G. Malaponte
- Departments of General Pathology, Via Androne 83, 95124 Catania, Italy
| | - C. Arcidiacono
- Departments of Pediatrics, Via S. Sofia 78, 95123 Catania, Italy, University of Catania, Italy
| | - C. Mazzarino
- Departments of General Pathology, Via Androne 83, 95124 Catania, Italy
| | - S. Pelligra
- Departments of General Pathology, Via Androne 83, 95124 Catania, Italy
| | - G. Li Volti
- Departments of Pediatrics, Via S. Sofia 78, 95123 Catania, Italy, University of Catania, Italy
| | - V. Bevelacqua
- Departments of General Pathology, Via Androne 83, 95124 Catania, Italy
| | - S. Li Volti
- Departments of Pediatrics, Via S. Sofia 78, 95123 Catania, Italy, University of Catania, Italy
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16
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Malaponte G, Arcidiacono C, Mazzarino C, Pelligra S, Li Volti G, Bevelacqua V, Li Volti S. Cephalosporin-induced Hemolytic Anemia in a Sicilian Child; Erythropoiesis. Hematology 2001; 5:327-334. [PMID: 11399632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023] Open
Abstract
A 27-month-old child developed acute hemolysis on two occasions after the administration of cephalosporin. On the first occasion, hemolysis was intravascular and was due to the formation of complexes between antibodies and the drug, which bound to red blood cells and caused severe hemolysis. On the second occasion, hemolysis was extravascular and was probably due to antibody-dependent cell-mediated cytotoxicity. Marked increases in levels of CD(19) (+) and CD(57) (+) CD(8) (+) cells were detected among the subpopulations of the patient's lymphocytes but only in the level of CD(19) (+) cells from the patient's father, after incubation of a sample of whole blood with a solution of cephalosporins. These results might explain the differences between the immune response of the patient and those of other members of his family and of an unrelated control.
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Affiliation(s)
- G. Malaponte
- Departments of General Pathology, Via Androne 83, 95124 Catania, Italy
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