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Fedele D, Moroso S, Turoldo A, Bazzocchi G, Conforti C, Zalaudek I, Guglielmi A. A Dramatic Response to Second-Line Nivolumab and Ipilimumab in BRAF-V600-Mutated Metastatic Melanoma. Case Rep Oncol 2024; 17:161-168. [PMID: 38288458 PMCID: PMC10824524 DOI: 10.1159/000535902] [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: 08/30/2023] [Accepted: 12/13/2023] [Indexed: 02/01/2024] Open
Abstract
Introduction Current treatment options for BRAF V600-mutated unresectable stage III/IV melanoma include anti-PD-1 monotherapy or combination with anti-CTLA-4 or anti-LAG-3 agents, BRAF/MEK inhibitors, and clinical trials. The strategy of combination immunotherapy with nivolumab and ipilimumab has shown promising results, achieving higher response rates, longer duration of response, improved progression-free survival, and enhanced overall survival. The optimal sequence of treatments remains a topic of interest, with preliminary data suggesting a greater effectiveness of immunotherapy as the first-line approach. Preclinical trials have indicated that the efficacy of this sequence may be due to the modification of the immune environment by BRAF kinase inhibitors, leading to immune escape by tumor cells and resistance to immune checkpoint inhibitors. Case Presentation We present a case of a 72-year-old woman with high-burden metastatic melanoma who failed to respond to prior targeted therapy with BRAF/MEK inhibitors and exhibited a successful response to the second-line treatment with ipilimumab and nivolumab. We discuss the potential reasons for this positive outcome contributing to the current debate concerning treatment sequences, resistance mechanisms, and biomarkers predictive of response to immune checkpoint inhibitors in metastatic melanoma. Conclusion We believe that in few years the therapeutic algorithms in BRAF V600-mutated unresectable stage III/IV melanoma will be more complex since they will define clearly the correct therapeutic sequences with the inclusion of new immune checkpoint inhibitor drugs and multiple predictive biomarkers of response to better select patients eligible to immunotherapy.
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Affiliation(s)
- Dahlia Fedele
- Department of Medical Oncology, ASUGI, Maggiore Hospital, Trieste, Italy
| | - Stefano Moroso
- Department of Medical Oncology, ASUGI, Maggiore Hospital, Trieste, Italy
| | - Angelo Turoldo
- University Department of Clinical Surgery, ASUGI, Cattinara Hospital, Trieste, Italy
| | - Gabriele Bazzocchi
- Department of Diagnostic Imaging, ASUGI, Maggiore Hospital, Trieste, Italy
| | | | - Iris Zalaudek
- University Department of Clinical Dermatology, ASUGI, Maggiore Hospital, Trieste, Italy
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Conforti C, Toffoli L, Agozzino M, Fedele D, Moroso S, di Meo N, Zalaudek I. Maintenance of clinical response after short treatment with cemiplimab for advanced squamous cell carcinoma. J Eur Acad Dermatol Venereol 2022; 36:e443-e445. [PMID: 35037322 DOI: 10.1111/jdv.17939] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 12/04/2021] [Accepted: 01/07/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Claudio Conforti
- Skin Cancer Unit, Department of Dermatology, Maggiore Hospital, University of Trieste, Trieste, Italy
| | - Ludovica Toffoli
- Skin Cancer Unit, Department of Dermatology, Maggiore Hospital, University of Trieste, Trieste, Italy
| | - Marina Agozzino
- Skin Cancer Unit, Department of Dermatology, Maggiore Hospital, University of Trieste, Trieste, Italy
| | - Dahlia Fedele
- Skin Cancer Unit, Department of Medical Oncology, Maggiore Hospital, Trieste, Italy
| | - Stefano Moroso
- Skin Cancer Unit, Department of Medical Oncology, Maggiore Hospital, Trieste, Italy
| | - Nicola di Meo
- Skin Cancer Unit, Department of Dermatology, Maggiore Hospital, University of Trieste, Trieste, Italy
| | - Iris Zalaudek
- Skin Cancer Unit, Department of Dermatology, Maggiore Hospital, University of Trieste, Trieste, Italy
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Pantano F, Manca P, Armento G, Zeppola T, Onorato A, Iuliani M, Simonetti S, Vincenzi B, Santini D, Mercadante S, Marchetti P, Cuomo A, Caraceni A, Mediati RD, Vellucci R, Mammucari M, Natoli S, Lazzari M, Dauri M, Adile C, Airoldi M, Azzarello G, Blasi L, Chiurazzi B, Degiovanni D, Fusco F, Guardamagna V, Liguori S, Palermo L, Mameli S, Masedu F, Mazzei T, Melotti RM, Menardo V, Miotti D, Moroso S, Pascoletti G, De Santis S, Orsetti R, Papa A, Ricci S, Scelzi E, Sofia M, Aielli F, Valle A, Tonini G. Breakthrough Cancer Pain Clinical Features and Differential Opioids Response: A Machine Learning Approach in Patients With Cancer From the IOPS-MS Study. JCO Precis Oncol 2020; 4:2000158. [PMID: 33283139 PMCID: PMC7713587 DOI: 10.1200/po.20.00158] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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] [Accepted: 10/02/2020] [Indexed: 11/20/2022] Open
Abstract
PURPOSE A large proportion of patients with cancer suffer from breakthrough cancer pain (BTcP). Several unmet clinical needs concerning BTcP treatment, such as optimal opioid dosages, are being investigated. In this analysis the hypothesis, we explore with an unsupervised learning algorithm whether distinct subtypes of BTcP exist and whether they can provide new insights into clinical practice. METHODS Partitioning around a k-medoids algorithm on a large data set of patients with BTcP, previously collected by the Italian Oncologic Pain Survey group, was used to identify possible subgroups of BTcP. Resulting clusters were analyzed in terms of BTcP therapy satisfaction, clinical features, and use of basal pain and rapid-onset opioids. Opioid dosages were converted to a unique scale and the BTcP opioids-to-basal pain opioids ratio was calculated for each patient. We used polynomial logistic regression to catch nonlinear relationships between therapy satisfaction and opioid use. RESULTS Our algorithm identified 12 distinct BTcP clusters. Optimal BTcP opioids-to-basal pain opioids ratios differed across the clusters, ranging from 15% to 50%. The majority of clusters were linked to a peculiar association of certain drugs with therapy satisfaction or dissatisfaction. A free online tool was created for new patients’ cluster computation to validate these clusters in future studies and provide handy indications for personalized BTcP therapy. CONCLUSION This work proposes a classification for BTcP and identifies subgroups of patients with unique efficacy of different pain medications. This work supports the theory that the optimal dose of BTcP opioids depends on the dose of basal opioids and identifies novel values that are possibly useful for future trials. These results will allow us to target BTcP therapy on the basis of patient characteristics and to define a precision medicine strategy also for supportive care.
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Affiliation(s)
- Francesco Pantano
- Medical Oncology Department, Campus Bio-Medico University of Rome, Rome, Italy
| | - Paolo Manca
- Medical Oncology Department, Campus Bio-Medico University of Rome, Rome, Italy.,IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Grazia Armento
- Medical Oncology Department, Campus Bio-Medico University of Rome, Rome, Italy
| | - Tea Zeppola
- Medical Oncology Department, Campus Bio-Medico University of Rome, Rome, Italy
| | - Angelo Onorato
- Medical Oncology Department, Campus Bio-Medico University of Rome, Rome, Italy
| | - Michele Iuliani
- Medical Oncology Department, Campus Bio-Medico University of Rome, Rome, Italy
| | - Sonia Simonetti
- Medical Oncology Department, Campus Bio-Medico University of Rome, Rome, Italy
| | - Bruno Vincenzi
- Medical Oncology Department, Campus Bio-Medico University of Rome, Rome, Italy
| | - Daniele Santini
- Medical Oncology Department, Campus Bio-Medico University of Rome, Rome, Italy
| | - Sebastiano Mercadante
- Anesthesia and Intensive Care and Pain Relief and Supportive Care, La Maddalena, Palermo, Italy
| | - Paolo Marchetti
- Molecular and Clinical Medicine Medical Oncology, La Sapienza University of Rome, Rome, Italy
| | - Arturo Cuomo
- Anesthesiology, Resuscitation, and Pain Therapy Department, National Cancer Institute, IRCCS Foundation Pascale, Naples, Italy
| | - Augusto Caraceni
- Palliative Care, Pain Therapy, and Rehabilitation, National Cancer Institute, IRCCS Foundation, Milan, Italy
| | | | - Renato Vellucci
- Palliative Care and Pain Therapy Unit, Careggi Hospital, Florence, Italy
| | | | - Silvia Natoli
- Department of Clinical Science and Translational Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Marzia Lazzari
- Department of Clinical Science and Translational Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Mario Dauri
- Department of Clinical Science and Translational Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Claudio Adile
- Anesthesia and Intensive Care and Pain Relief and Supportive Care, La Maddalena, Palermo, Italy
| | - Mario Airoldi
- Second Medical Oncology Division, Città della Salute e della Scienza Hospital of Turin, Turin, Italy
| | - Giuseppe Azzarello
- Medical Specialties Department, Oncology and Oncologic Hematology, ASL 13 Mirano, Venice, Italy
| | - Livio Blasi
- Medical Oncology Unit, ARNAS Ospedale Civico Di Cristina Benfratelli, Palermo, Italy
| | | | | | - Flavio Fusco
- Palliative Care Unit, Department of Primary and Community Care, ASL 3 Genovese, Genoa, Italy
| | - Vittorio Guardamagna
- Palliative Care and Pain Therapy Unit, European Oncology Institute IRCCS, Milan, Italy
| | - Simeone Liguori
- Palliative Care and Pain Therapy Unit, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Loredana Palermo
- Medical Oncology Unit, National Cancer Research Center "Giovanni Paolo II", Bari, Italy
| | - Sergio Mameli
- Pain Therapy Unit, "A. Businco" Hospital, ASL 8, Cagliari, Italy
| | - Francesco Masedu
- Department of Biotechnological and Applied Clinical Sciences, Section of Clinical Epidemiology and Environmental Medicine, University of L'Aquila, L'Aquila, Italy
| | - Teresita Mazzei
- Section of Clinical Pharmacology and Oncology, Department of Health Sciences, University of Florence, Florence, Italy
| | - Rita Maria Melotti
- Department of Medicine and Surgery Sciences, University of Bologna, Bologna, Italy
| | | | - Danilo Miotti
- Pain Therapy ICS Maugeri, IRCCS Foundation, Pavia, Italy
| | - Stefano Moroso
- Medical Oncology, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
| | - Gaetano Pascoletti
- Medical Oncology, Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | - Stefano De Santis
- Palliative Care and Oncologic Pain Service, S. Camillo-Forlanini Hospital, Rome, Italy
| | - Remo Orsetti
- Pain Medicine Unit, S. Camillo-Forlanini Hospital, Rome, Italy
| | - Alfonso Papa
- Pain Relief, A.O. Dei Colli, Monaldi Hospital, Naples, Italy
| | - Sergio Ricci
- Division of Medical Oncology, Department of Oncology, S. Chiara University Hospital, Pisa, Italy
| | - Elvira Scelzi
- Medical Oncology, Castelfranco Veneto Hospital, Treviso, Italy
| | - Michele Sofia
- Department of Palliative Care, Hospice and Pain Therapy Unit, "G. Salvini" Hospital, Milan, Italy
| | - Federica Aielli
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | | | - Giuseppe Tonini
- Medical Oncology Department, Campus Bio-Medico University of Rome, Rome, Italy
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Gori S, Puglisi F, Moroso S, Fabi A, La Verde N, Frassoldati A, Tarenzi E, Garrone O, Vici P, Laudadio L, Cretella E, Turazza M, Foglietta J, Leonardi V, Cavanna L, Barni S, Galanti D, Russo A, Marchetti F, Valerio M, Lunardi G, Alongi F, Inno A. The HERBA Study: A Retrospective Multi-Institutional Italian Study on Patients With Brain Metastases From HER2-Positive Breast Cancer. Clin Breast Cancer 2019; 19:e501-e510. [DOI: 10.1016/j.clbc.2019.05.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 03/28/2019] [Accepted: 05/07/2019] [Indexed: 10/26/2022]
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Gurrieri L, Giudici F, Fedele D, Dicorato A, Malagoli M, Moroso S, Del Conte G, Zanconati F, Guglielmi A. Does second-line therapy affect the outcome of the patients with cholangiocarcinoma? A single institution experience. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx425.028] [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
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Gori S, Turazza M, Inno A, Lunardi G, Moroso S, La Verde N, Frassoldai A, Tarenzi E, Garrone O, Vici P, Laudadio L, Cretella E, Foglietta J, Leonardi V, Cavanna L, Barni S, Marchetti F, Valerio M, Carbognin G, Alongi F, Fabi A. The HERBA trial: a retrospective study on patients (pts) with HER2-positive (HER2+ve) breast cancer (BC) and brain metastases (BMs). Ann Oncol 2017. [DOI: 10.1093/annonc/mdx424.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Mercadante S, Marchetti P, Cuomo A, Caraceni A, Mediati RD, Mammucari M, Natoli S, Lazzari M, Dauri M, Airoldi M, Azzarello G, Bandera M, Blasi L, Cartenì G, Chiurazzi B, Costanzo BVP, Degiovanni D, Fusco F, Guardamagna V, Iaffaioli V, Liguori S, Lorusso V, Mameli S, Mattioli R, Mazzei T, Melotti RM, Menardo V, Miotti D, Moroso S, De Santis S, Orsetti R, Papa A, Ricci S, Sabato AF, Scelzi E, Sofia M, Tonini G, Aielli F, Valle A. Breakthrough Cancer Pain: Preliminary Data of The Italian Oncologic Pain Multisetting Multicentric Survey (IOPS-MS). Adv Ther 2017; 34:120-135. [PMID: 27873235 PMCID: PMC5216057 DOI: 10.1007/s12325-016-0440-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Indexed: 11/29/2022]
Abstract
Introduction An ongoing national multicenter survey [Italian Oncologic Pain multiSetting Multicentric Survey (IOPS-MS)] is evaluating the characteristics of breakthrough cancer pain (BTP) in different clinical settings. Preliminary data from the first 1500 cancer patients with BTP enrolled in this study are presented here. Methods Thirty-two clinical centers are involved in the survey. A diagnosis of BTP was performed by a standard algorithm. Epidemiological data, Karnofsky index, stage of disease, presence and sites of metastases, ongoing oncologic treatment, and characteristics of background pain and BTP and their treatments were recorded. Background pain and BTP intensity were measured. Patients were also questioned about BTP predictability, BTP onset (≤10 or >10 min), BTP duration, background and BTP medications and their doses, time to meaningful pain relief after BTP medication, and satisfaction with BTP medication. The occurrence of adverse reactions was also assessed, as well as mucosal toxicity. Results Background pain was well controlled with opioid treatment (numerical rating scale 3.0 ± 1.1). Patients reported 2.5 ± 1.6 BTP episodes/day with a mean intensity of 7.5 ± 1.4 and duration of 43 ± 40 min; 977 patients (65.1%) reported non-predictable BTP, and 1076 patients (71.7%) reported a rapid onset of BTP (≤10 min). Higher patient satisfaction was reported by patients treated with fast onset opioids. Conclusions These preliminary data underline that the standard algorithm used is a valid tool for a proper diagnosis of BTP in cancer patients. Moreover, rapid relief of pain is crucial for patients’ satisfaction. The final IOPS-MS data are necessary to understand relationships between BTP characteristics and other clinical variables in oncologic patients. Funding Molteni Farmaceutici, Italy.
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Affiliation(s)
- Sebastiano Mercadante
- Anesthesia and Intensive Care and Pain Relief and Supportive Care, La Maddalena Cancer Center, Via San Lorenzo 312, 90146, Palermo, Italy.
| | - Paolo Marchetti
- Molecular and Clinical Medicine, Medical Oncology, La Sapienza University of Rome, Rome, Italy
| | - Arturo Cuomo
- Anesthesiology, Resuscitation, and Pain Therapy Department, National Cancer Institute, IRCCS Foundation Pascale, Naples, Italy
| | - Augusto Caraceni
- Palliative Care, Pain Therapy and Rehabilitation, National Cancer Institute IRCCS Foundation, Milan, Italy
| | | | | | - Silvia Natoli
- Department of Clinical Science and Translational Medicine, University of Rome Tor Vergata, Rome, Italy
- Department of Emergency, Admission and Critical Area, Policlinic of Tor Vergata, Rome, Italy
| | - Marzia Lazzari
- Department of Clinical Science and Translational Medicine, University of Rome Tor Vergata, Rome, Italy
- Department of Emergency, Admission and Critical Area, Policlinic of Tor Vergata, Rome, Italy
| | - Mario Dauri
- Department of Clinical Science and Translational Medicine, University of Rome Tor Vergata, Rome, Italy
- Department of Emergency, Admission and Critical Area, Policlinic of Tor Vergata, Rome, Italy
| | - Mario Airoldi
- 2nd Medical Oncology Division, Città della Salute e della Scienza Hospital of Turin, Turin, Italy
| | - Giuseppe Azzarello
- Medical Specialties Department, Oncology and Oncologic Hematology, ASL 13 Mirano, Venice, Italy
| | - Mauro Bandera
- Medical Oncology Unit, Ospedale di Circolo e Fondazione Macchi Hospital, Varese, Italy
| | - Livio Blasi
- Medical Oncology Unit, ARNAS Ospedale Civico, Di Cristina, Benfratelli, Palermo, Italy
| | | | | | | | | | - Flavio Fusco
- Palliative Care Unit, Department of Primary and Community Care, ASL3 Genovese, Genoa, Italy
| | - Vittorio Guardamagna
- Palliative Care and Pain Therapy Unit, European Oncology Institute IRCCS, Milan, Italy
| | - Vincenzo Iaffaioli
- Abdominal Medical Oncology, National Cancer Institute, IRCCS Foundation Pascale, Naples, Italy
| | - Simeone Liguori
- Palliative Care and Pain Therapy Unit, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Vito Lorusso
- Medical Oncology Unit, National Cancer Research Centre "Giovanni Paolo II", Bari, Italy
| | - Sergio Mameli
- Pain Therapy Unit, "A. Businco" Hospital, ASL 8, Cagliari, Italy
| | | | - Teresita Mazzei
- Section of Clinical Pharmacology and Oncology, Department of Health Sciences, University of Florence, Florence, Italy
| | - Rita Maria Melotti
- Department of Medicine and Surgery Sciences, University of Bologna, Bologna, Italy
| | | | - Danilo Miotti
- Palliative Care Unit, Salvatore Maugeri-IRCCS Foundation, Pavia, Italy
| | - Stefano Moroso
- Medical Oncology, Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | - Stefano De Santis
- Palliative Care and Oncologic Pain Service, S. Camillo-Forlanini Hospital, Rome, Italy
| | - Remo Orsetti
- Pain Medicine Unit, S. Camillo-Forlanini Hospital, Rome, Italy
| | - Alfonso Papa
- Pain Relief, A.O. Dei Colli, Monaldi Hospital, Naples, Italy
| | - Sergio Ricci
- Division of Medical Oncology, Department of Oncology, S. Chiara University Hospital, Pisa, Italy
| | - Alessandro Fabrizio Sabato
- Department of Clinical Science and Translational Medicine, University of Rome Tor Vergata, Rome, Italy
- Department of Emergency, Admission and Critical Area, Policlinic of Tor Vergata, Rome, Italy
| | - Elvira Scelzi
- Medical Oncology, Castelfranco Veneto Hospital, Treviso, Italy
| | - Michele Sofia
- Department of Palliative Care with Hospice and Pain Therapy Unit, "G.Salvini" Hospital, Garbagnate Milanese, Milan, Italy
| | - Giuseppe Tonini
- Department of Medical Oncology, Campus Bio-Medico University of Rome, Rome, Italy
| | - Federica Aielli
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
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Cinausero M, Gerratana L, Bonotto M, Iacono D, Bozza C, Basile D, Pelizzari G, Vitale M, Fontanella C, Fanotto V, Andreetta C, Minisini A, Moroso S, Poletto E, Russo S, Mansutti M, Fasola G, Puglisi F. Last-line treatment of luminal metastatic breast cancer: which factors influence the therapeutic choice? Ann Oncol 2016. [DOI: 10.1093/annonc/mdw337.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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9
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Fontanella C, Fanotto V, Gerratana L, Bonotto M, Cinausero M, Bozza C, Iacono D, Russo S, Andreetta C, Minisini AM, Moroso S, Mansutti M, Fasola G, Puglisi F. Abstract P2-08-06: Usefulness of the pre-treatment neutrophil-to-lymphocyte ratio in predicting first-line progression free-survival in triple-negative breast cancer patients. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p2-08-06] [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
Background: The neutrophil-to-lymphocyte ratio (NLR) is an independent predictor of poor prognosis inunselected breast cancer patients with NLR >3.3. Moreover, pre-treatment NLR has been associated with disease-free and overal survival (OS) in patients with early triple-negative breast cancer (TNBC). We aimed to determine whether the NLR is predictive of progression-free survival (PFS) in metastatic TNBC.
Methods: We reviewed the records of 48 TNBC patients who received at least one administration of first-line (1°L) chemotherapy for advanced disease from October 2004 to April 2014. The NLR (absolute neutrophil count/absolute lymphocyte count) was calculated from the full blood count routinely performed immediately before the initiation of first-line treatment. The association between categorical variables was calculated by X2 test. PFS (from start of 1°L treatment to disease progression or death) and OS (from start of 1°L treatment to death) were estimated using Kaplan Meier method. Multivariable Cox regression was used to determine the independent prognostic significances of the NLR (co-variables stage at diagnosis, histology, and tumor grade).
Results: NLR was not associated with stage at diagnosis (p=0.214), histology (p=0.597), or tumor grade (p=0.775). After a median follow-up of 10.9 months (range 1.3-54.9), 88.6% of TNBC patients with NLR≤3.3 versus 0.0% of patients with NLR>3.3 had a 1°L PFS>3 months (p<0.001). Similarly, 62.9% of TNBC patients with NLR≤3.3 versus 30.8% of patients with NLR>3.3 had an OS>10 months (p=0.047). Metastatic TNBC patients with NLR≤3.3 had a longer median 1°L PFS (5.2 months) and median OS (13.5 months) compared with patients with NLR>3.3 (1°L PFS 2.1 months, p<0.001; OS 7.7 months, p=0.018). In multivariable analysis, NLR>3.3 is associated with a shorter PFS (hazard ratio [HR] 22.4; 95% confidence interval [CI] 6.7-75.1, p<0.001) and higher risk of death (HR 3.2, 95%CI 1.4-7.4, p=0.005).
Conclusion: Our study showed that pre-treatment NLR is associated with 1°L PFS and OS in patients with metastatic TNBC. However, further investigation in larger series of metastatic TNBC is warranted.
Citation Format: Fontanella C, Fanotto V, Gerratana L, Bonotto M, Cinausero M, Bozza C, Iacono D, Russo S, Andreetta C, Minisini AM, Moroso S, Mansutti M, Fasola G, Puglisi F. Usefulness of the pre-treatment neutrophil-to-lymphocyte ratio in predicting first-line progression free-survival in triple-negative breast cancer patients. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P2-08-06.
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Affiliation(s)
| | - V Fanotto
- University Hospital of Udine, Udine, Italy
| | | | - M Bonotto
- University Hospital of Udine, Udine, Italy
| | | | - C Bozza
- University Hospital of Udine, Udine, Italy
| | - D Iacono
- University Hospital of Udine, Udine, Italy
| | - S Russo
- University Hospital of Udine, Udine, Italy
| | | | | | - S Moroso
- University Hospital of Udine, Udine, Italy
| | - M Mansutti
- University Hospital of Udine, Udine, Italy
| | - G Fasola
- University Hospital of Udine, Udine, Italy
| | - F Puglisi
- University Hospital of Udine, Udine, Italy
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Moroso S, Bonotto M, Gerratana L, Arpino G, De Angelis C, Iacono D, Cinausero M, Milano M, Gargiulo P, Fontanella C, Bozza C, Fanotto V, De Carlo E, Guardascione M, Russo S, Andreetta C, Minisini A, Mansutti M, Fasola G, De Placido S, Puglisi F. Luminal-like metastatic breast cancer: which is the room of endocrine maintenance therapy after first line chemotherapy? Ann Oncol 2015. [DOI: 10.1093/annonc/mdv336.03] [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
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11
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Bozza C, Fontanella C, Fanotto V, De Carlo E, Iacono D, Bonotto M, Cinausero M, Gerratana L, Guardascione M, Rihawi K, Russo S, Andreetta C, Minisini A, Moroso S, Mansutti M, Aprile G, Fasola G, Puglisi F. Unplanned hospital admission of early breast cancer outpatients treated with adjuvant chemotherapy. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv336.11] [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
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Cinausero M, Gerratana L, Iacono D, Bonotto M, Bozza C, Bolzonello S, Fanotto V, Poletto E, Fontanella C, Guardascione M, Minisini A, Russo S, Andreetta C, Moroso S, Mansutti M, Fasola G, Puglisi F. Last-line treatment of advanced breast cancer: outcome measures and prognostic factors. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv336.07] [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: 11/13/2022] Open
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Iacono D, Cinausero M, Gerratana L, Poletto E, Moroso S, Pella N, Puglisi F, Fasola G, Minisini A. Primary cutaneous melanoma in elderly patients: analyses and considerations from a retrospective observational study. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv337.04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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14
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Fontanella C, Fanotto V, De Carlo E, Iacono D, Bozza C, Bonotto M, Cinausero M, Gerratana L, Guardascione M, Rihawi K, Russo S, Andreetta C, Minisini A, Moroso S, Mansutti M, Sottile R, Aprile G, Fasola G, Puglisi F. Risk of unplanned presentations and hospital admission of metastatic breast cancer outpatients. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv336.10] [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
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Bonotto M, Gerratana L, Arpino G, Di Maio M, De Angelis C, Iacono D, Cinausero M, Milano M, Gargiulo P, Fontanella C, Bozza C, Moroso S, Minisini A, Mansutti M, Fasola G, De Placido S, Puglisi F. First line treatment in patients with luminal-like metastatic breast cancer: a propensity score-matched analysis. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv336.17] [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
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Bonotto M, Gerratana L, Arpino G, Di Maio M, De Angelis C, Iacono D, Cinausero M, Milano M, Gargiulo P, Fontanella C, Bozza C, Moroso S, Minisini A, Mansutti M, Fasola G, De Placido S, Puglisi F. 1864 Chemotherapy versus endocrine therapy as first line treatment in patients with luminal-like metastatic breast cancer. Impact on survival. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)30814-0] [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: 12/01/2022]
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Bonotto M, Gerratana L, Mansutti M, Moroso S, Russo S, Iacono D, Minisini A, Fasola G, Puglisi F. Advanced luminal breast cancer: Who receives chemotherapy as first-line systemic treatment? J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.e11524] [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: 11/20/2022] Open
Affiliation(s)
- Marta Bonotto
- Department of Oncology, University Hospital of Udine, Udine, Italy
| | - Lorenzo Gerratana
- Department of Oncology, University Hospital of Udine - Department of Medical and Biological Sciences, University of Udine, Udine, Italy
| | - Mauro Mansutti
- Department of Oncology, University Hospital of Udine, Udine, Italy
| | - Stefano Moroso
- Department of Oncology, University Hospital of Udine, Udine, Italy
| | - Stefania Russo
- Department of Oncology, University Hospital of Udine, Udine, Italy
| | - Donatella Iacono
- Department of Oncology, University Hospital of Udine, Udine, Italy
| | | | - Gianpiero Fasola
- Department of Oncology, University Hospital of Udine, Udine, Italy
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Gerratana L, Fanotto V, Bonotto M, Bolzonello S, Andreetta C, Moroso S, Pascoletti G, Fasola G, Puglisi F. Pattern of metastatic spread and prognosis of breast cancer biologic subtypes. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.e12532] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Lorenzo Gerratana
- Department of Oncology, University Hospital of Udine - Department of Medical and Biological Sciences, University of Udine, Udine, Italy
| | | | - Marta Bonotto
- Department of Oncology, University Hospital of Udine, Udine, Italy
| | | | | | - Stefano Moroso
- Department of Oncology, University Hospital of Udine, Udine, Italy
| | | | - Gianpiero Fasola
- Department of Oncology, University Hospital of Udine, Udine, Italy
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Minisini AM, Moroso S, Gerratana L, Giangreco M, Iacono D, Poletto E, Guardascione M, Fontanella C, Fasola G, Puglisi F. Risk factors and survival outcomes in patients with brain metastases from breast cancer. Clin Exp Metastasis 2013; 30:951-6. [PMID: 23775210 DOI: 10.1007/s10585-013-9594-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Accepted: 06/03/2013] [Indexed: 10/26/2022]
Abstract
Development of central nervous system (CNS) metastases in breast cancer (BC) is associated with poor prognosis. The incidence of CNS metastases in metastatic BC is reported to be about 10-16 %, but different subtypes of BC are associated with different risk of developing CNS metastases. We retrospectively analysed the risk of CNS metastases and the outcome in a cohort of 473 patients with metastatic BC. CNS metastases were diagnosed in 15.6 % of patients and median survival from diagnosis of CNS metastases was 7.53 (25th-75th 2.8-18.9) months. The risk of developing CNS metastases was higher in patients with grade 3, hormone receptor negative, HER2-positive, high Ki-67 BC. When compared to luminal A subtype, only HER2-positive BC was associated with increased risk of CNS metastases. Survival from diagnosis of CNS metastases was longer in patients with HER2-positive BC, while it was shorter in patients that did not receive any locoregional treatment, or with extra-CNS disease, or with more than 3 CNS lesions.
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Affiliation(s)
- A M Minisini
- Department of Oncology, University Hospital of Udine, Piazzale S.M. Misericordia, 33100, Udine, Italy
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Ferro A, Eccher C, Triolo R, Caldara A, Di Pasquale MC, Russo LM, De Carli NL, Cuorvo LV, Barbareschi M, Gasperetti F, Berlanda G, Pellegrini M, Moroso S, Galligioni E. Abstract P5-01-10: Clinical-pathological features and outcomes of Invasive lobular (ILC) vs Invasive ductal (IDC) breast cancer (BC): a mono-institutional series. Cancer Res 2012. [DOI: 10.1158/0008-5472.sabcs12-p5-01-10] [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 aim of our study was to investigate different clinico-biological behavior associated to ILC compared to IDC evaluating implications on survival outcomes
Methods: We analyzed data from 3749 cases of IBC treated from 1995 to 2008 and categorized as having ILC, IDC and mixed/other. Associations between clinical-pathological variables and the ILC/IDC histotype were assessed using a χ2 test. Log-rank test and Cox regression model were performed to evaluate the impact of hystologic types on overall survival (OS), Event Free Survival (EFS) and Post-Progression Survival (PPS).
Results: We identified 445 (12%) ILC, 3021 (80.5%) IDC, 149 mixed (ductal-lobular) BC (3.9%) and 134 other hystotypes (3.6%). Median age was 61 (25–97) years. Compared with IDC, ILC occurred significantly (p < 0.001) more likely in older age, larger in size (T≥2: 46 vs 34%) with frequent axilla involvement (43 vs 37%). It was associated with better differentiated tumors usually presenting low ki67, high level of ER expression and HER2 negative status. Mastectomies were more frequent (45%) in ILC than in IDC (37%). As ILC showed higher ER expression rates, adjuvant hormonal (± previous chemo) therapy was more frequently given to them than IDC (77 vs 64%). At a median follow up of 77 (0–272) months, there were not significant differences in EFS (81.4 vs 82.1%, p = 0.7) and OS (82.8 vs 84.6%; p = 0.19) between ILC vs IDC. Relapses, contralateral and second tumors were 65 (15%), 9 (2%) and 22 (5%) in ILC vs 404 (13%), 84 (2.8%) and 174 (5.7%) in IDC. Local recurences were 16 (3.6%) vs 175 (5.7%) in ILC vs IDC; preferential sites of distant relapses were similar in both histotypes. Median time to first event was 38.3 in ILC vs 35.23 months in IDC. PPS was 16.5 m (0–100) in ILC and 22.2 m (0–187) in IDC. ILC showed worse prognosis than IDC within luminal A (86.9 vs 93.5%; p = 0.003), C (70.4 vs 88.5%; p = 0.028) and in triple negative subtypes (50 vs 73.1%; p = 0.021). No difference in OS was seen for age, size, hormonal and nodal status, except in N >3 ILC pts, in whom a trend of worse prognosis (55.6 vs 60.2%) was observed.
Conclusions: Despite the quite favorable biological pattern, ILC did not show a better outcomes than IDC.
Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P5-01-10.
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Affiliation(s)
- A Ferro
- S Chiara Hospital, Trento, Italy; FBK, Trento, Italy
| | - C Eccher
- S Chiara Hospital, Trento, Italy; FBK, Trento, Italy
| | - R Triolo
- S Chiara Hospital, Trento, Italy; FBK, Trento, Italy
| | - A Caldara
- S Chiara Hospital, Trento, Italy; FBK, Trento, Italy
| | | | - LM Russo
- S Chiara Hospital, Trento, Italy; FBK, Trento, Italy
| | - NL De Carli
- S Chiara Hospital, Trento, Italy; FBK, Trento, Italy
| | - LV Cuorvo
- S Chiara Hospital, Trento, Italy; FBK, Trento, Italy
| | - M Barbareschi
- S Chiara Hospital, Trento, Italy; FBK, Trento, Italy
| | - F Gasperetti
- S Chiara Hospital, Trento, Italy; FBK, Trento, Italy
| | - G Berlanda
- S Chiara Hospital, Trento, Italy; FBK, Trento, Italy
| | - M Pellegrini
- S Chiara Hospital, Trento, Italy; FBK, Trento, Italy
| | - S Moroso
- S Chiara Hospital, Trento, Italy; FBK, Trento, Italy
| | - E Galligioni
- S Chiara Hospital, Trento, Italy; FBK, Trento, Italy
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Ferro A, Eccher C, Triolo R, Caldara A, Di Pasquale M, Moroso S, Russo L, Barbareschi M, Galligioni E. Clinical Behavior and Prognosis of Different Immunohistochemistry-Detected Subtypes of Invasive Breast Cancer: A Monoinstitutional Series. Ann Oncol 2012. [DOI: 10.1016/s0923-7534(20)32820-9] [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: 11/26/2022] Open
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Andreetta C, Driol P, Bonotto M, Gerratana L, Valent F, Russo S, Minisini A, Pascoletti G, Moroso S, Sottile R, Mansutti M, Fasola G, Puglisi F. Association of body mass index and outcome in advanced breast cancer. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.1044] [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
1044 Background: Obesity represents a well-known risk factor for the development of breast cancer and an adverse prognostic factor in early disease. Overweight is associated with reduced efficacy of aromatase inhibitors in adjuvant setting. Few data have been reported about the potential relationship of overweight and outcome in advanced breast cancer (ABC). Methods: We retrospectively evaluated body mass index (BMI) in a consecutive series of 400 ABC patients treated at our institution. BMI was calculated at baseline of diagnosis of ABC. We evaluated association of BMI and other prognostic and predictive markers with Progression Free Survival (PFS) and Overall Survival (OS). We evaluated PFS at first and subsequent lines of chemotherapy (CT) and endocrine therapy (ET). Overweight patients were defined as having BMI > 25. Results: Overweight patients were 52%. Median age of the population was 58 years. Median OS was 33.7 months. Overall, 76% of patients presented with ER+ and 17.7% with HER2+ ABC.Overweight was associated with increased age at diagnosis, menopausal status and luminal B or triple negative immunophenotype. At multivariate analysis, BMI > 25 was associated with better PFS at first-line ET (HR= 0.68, 95% CI 0.46-0.99). BMI was not associated with OS. Conclusions: BMI at baseline does not seem to be an adverse prognostic factor for ABC patients. Overweight may be associated with better PFS in endocrine responsive ABC treated with ET, especially in first-line setting. The role of BMI in ABC deserves to be further investigated.
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Affiliation(s)
| | - Pamela Driol
- Department of Medical and Biological Sciences, and Department of Oncology, University Hospital of Udine, Udine, Italy
| | - Marta Bonotto
- Department of Medical and Biological Sciences, and Department of Oncology, University Hospital of Udine, Udine, Italy
| | - Lorenzo Gerratana
- Department of Medical and Biological Sciences, and Department of Oncology, University Hospital of Udine, Udine, Italy
| | - Francesca Valent
- Institute of Hygiene and Epidemiology, University Hospital of Udine, Udine, Italy
| | - Stefania Russo
- Department of Oncology, University Hospital of Udine, Udine, Italy
| | | | | | - Stefano Moroso
- Department of Oncology, University Hospital, Udine, Italy
| | - Roberta Sottile
- Department of Medical and Biological Sciences, and Department of Oncology, University Hospital of Udine, Udine, Italy
| | - Mauro Mansutti
- Department of Oncology, University Hospital of Udine, Udine, Italy
| | - Gianpiero Fasola
- Department of Oncology, University Hospital of Udine, Udine, Italy
| | - Fabio Puglisi
- Department of Medical and Biological Sciences, and Department of Oncology, University Hospital of Udine, Udine, Italy
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Puglisi F, Deroma L, Rizzetto I, Driol P, Sottile R, Pascoletti G, Moroso S, Fasola G, Russo S. Patient perceptions of the side effects of anticancer therapy. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e19623] [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: 11/20/2022] Open
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