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Trevisan B, Pepe FF, Vallini I, Montagna E, Amoroso D, Berardi R, Butera A, Cagossi K, Cavanna L, Ciccarese M, Cinieri S, Cretella E, De Conciliis E, Febbraro A, Ferraù F, Ferzi A, Baldelli A, Fontana A, Gambaro AR, Garrone O, Gebbia V, Generali D, Gianni L, Giovanardi F, Grassadonia A, Leonardi V, Sarti S, Musolino A, Nicolini M, Putzu C, Riccardi F, Santini D, Sarobba MG, Schintu MG, Scognamiglio G, Spadaro P, Taverniti C, Toniolo D, Tralongo P, Turletti A, Valenza R, Valerio MR, Vici P, Clivio L, Torri V, Cazzaniga ME. Final results of the real-life observational VICTOR-6 study on metronomic chemotherapy in elderly metastatic breast cancer (MBC) patients. Sci Rep 2023; 13:12255. [PMID: 37507480 PMCID: PMC10382472 DOI: 10.1038/s41598-023-39386-x] [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] [Received: 04/06/2023] [Accepted: 07/25/2023] [Indexed: 07/30/2023] Open
Abstract
Nowadays, treatment of metastatic breast cancer (MBC) has been enriched with novel therapeutical strategies. Metronomic chemotherapy (mCHT) is a continuous and frequent administration of chemotherapy at a lower dose and so whit less toxicity. Thus, this strategy could be attractive for elderly MBC patients. Aim of this analysis is to provide insights into mCHT's activity in a real-life setting of elderly MBC patients. Data of patients ≥ 75 years old included in VICTOR-6 study were analyzed. VICTOR-6 is a multicentre, Italian, retrospective study, which collected data on mCHT in MBC patients treated between 2011 and 2016. A total of 112 patients were included. At the beginning of mCHT, median age was 81 years (75-98) and in 33% of the patients mCHT was the first line choice. Overall Response Rate (ORR) and Disease Control Rate (DCR) were 27.9% and 79.3%, respectively. Median PFS ranged between 7.6 and 9.1 months, OS between 14.1 and 18.5 months. The most relevant toxicity was the hematological one (24.1%); severe toxicity (grade 3-4) ranged from 0.9% for skin toxicity up to 8% for hematologic one. This is a large study about mCHT in elderly MBC patients, providing insights to be further investigated in this subgroup of frail patients.
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Affiliation(s)
- B Trevisan
- Azienda Ospedaliera San Gerardo, Monza, Italy
| | - F F Pepe
- Azienda Ospedaliera San Gerardo, Monza, Italy
| | - I Vallini
- Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - E Montagna
- European Institute of Oncology, Milan, Italy
| | | | - R Berardi
- Azienda Ospedaliera Universitaria Ospedali Riuniti, Torrette, Italy
| | - A Butera
- Nuovo Ospedale San Giovanni Di Dio, Florence, Italy
| | | | - L Cavanna
- Azienda Ospedaliera Piacenza, Piacenza, Italy
| | | | - S Cinieri
- Ospedale A. Perrino, Brindisi, Italy
| | | | | | - A Febbraro
- Ospedale S. Cuore di Gesù Fatebenefratelli, Benevento, Italy
| | - F Ferraù
- Ospedale San Vincenzo, Taormina, Italy
| | - A Ferzi
- Azienda Ospedaliera Ospedale Civile Di Legnano, Magenta, Italy
| | | | - A Fontana
- Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | | | - O Garrone
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - V Gebbia
- Ospedale La Maddalena, Palermo, Italy
| | - D Generali
- Istituti Ospitalieri Cremona, Cremona, Italy
| | | | | | | | | | - S Sarti
- IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Meldola, Italy
| | | | | | - C Putzu
- Azienda Ospedaliera-Universitaria, Sassari, Italy
| | - F Riccardi
- Ospedale Antonio Cardarelli, Naples, Italy
| | - D Santini
- Università Campus Bio-Medico, RomE, Italy
| | | | | | | | - P Spadaro
- Casa di Cura Villa Salus-Messina, Messina, Italy
| | | | | | | | | | | | - M R Valerio
- A.O.U. Policlinico Paolo Giaccone, Palermo, Italy
| | - P Vici
- INT Regina Elena, Rome, Italy
| | - L Clivio
- IRCCS Mario Negri Institute of Pharmacological Research, Milan, Italy
| | - V Torri
- IRCCS Mario Negri Institute of Pharmacological Research, Milan, Italy
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Cardone C, De Stefano A, Rosati G, Cassata A, Silvestro L, Borrelli M, Di Gennaro E, Romano C, Nappi A, Zanaletti N, Foschini F, Casaretti R, Tatangelo F, Lastoria S, Raddi M, Bilancia D, Granata V, Setola S, Petrillo A, Vitagliano C, Gargiulo P, Arenare L, Febbraro A, Martinelli E, Ciardiello F, Delrio P, Budillon A, Piccirillo MC, Avallone A. Regorafenib monotherapy as second-line treatment of patients with RAS-mutant advanced colorectal cancer (STREAM): an academic, multicenter, single-arm, two-stage, phase II study. ESMO Open 2023; 8:100748. [PMID: 36603521 PMCID: PMC10024144 DOI: 10.1016/j.esmoop.2022.100748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/18/2022] [Accepted: 11/23/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Maintaining angiogenesis inhibition and switching the chemotherapy backbone represent the current second-line therapy in patients with RAS-mutant metastatic colorectal cancer (mCRC). Regorafenib, an oral multikinase inhibitor, prolonged overall survival (OS) in the chemorefractory setting. MATERIALS AND METHODS STREAM was an academic, multicenter, single-arm phase II trial, evaluating the activity of regorafenib in RAS-mutant mCRC, in terms of the rate of patients who were progression-free after 6 months from study entry (6mo-PF). Patients were pretreated with fluoropyrimidine, oxaliplatin, and bevacizumab. According to Simon's two-stage design, ≥18 patients 6mo-PF were needed in the overall population (N = 46). Secondary endpoints were safety, objective response rate (ORR), progression-free survival (PFS), and OS. Early metabolic response by [18F]2-fluoro-2-deoxy-D-glucose-positron emission tomography/computed tomography ([18F]-FDG PET/CT) scan was an exploratory endpoint. EudraCT Number: 2015-001105-13. RESULTS The number of patients 6mo-PF was 8/22 at the first stage and 14/46 in the overall population. The ORR was 10.9%, disease control rate was 54.6%, median (m)PFS was 3.6 months [95% confidence interval (CI) 1.9-6.7 months], mOS was 18.9 months (95% CI 10.3-35.3 months), and mPFS2 (from study entry to subsequent-line progression) was 13.3 months (95% CI 8.4-19.7 months). Long benefiter patients (>6mo-PF) significantly more often had a single metastatic site and lung-limited disease. No unexpected toxicity was reported. Grade ≥3 events occurred in 39.1% of patients, with hand-foot syndrome (13%), fatigue, and hyperbilirubinemia (6.5%) occurring mostly. Baseline metabolic assessment was associated with OS in the multivariate analysis, while early metabolic response was not associated with clinical outcomes. CONCLUSIONS The study did not meet its primary endpoint. However, regorafenib was well tolerated and did not preclude subsequent treatments. Patients with good prognostic features (single metastatic site and lung-limited disease) reported clinical benefit with regorafenib. The exploratory metabolic analysis suggests that baseline [18F]-FDG PET/CT might be useful to select patients with a favorable outcome. A chemotherapy-free interval with regorafenib was associated with durable disease control in a selected group of patients with favorable clinical characteristics.
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Affiliation(s)
- C Cardone
- Experimental Clinical Abdominal Oncology Unit, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Naples, Italy. https://twitter.com/clacardone
| | - A De Stefano
- Experimental Clinical Abdominal Oncology Unit, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Naples, Italy. https://twitter.com/alfdestefano
| | - G Rosati
- Medical Oncology Unit, S. Carlo Hospital, Potenza, Italy
| | - A Cassata
- Experimental Clinical Abdominal Oncology Unit, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Naples, Italy
| | - L Silvestro
- Experimental Clinical Abdominal Oncology Unit, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Naples, Italy
| | - M Borrelli
- Experimental Clinical Abdominal Oncology Unit, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Naples, Italy
| | - E Di Gennaro
- Experimental Pharmacology Unit, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Naples, Italy
| | - C Romano
- Experimental Clinical Abdominal Oncology Unit, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Naples, Italy
| | - A Nappi
- Experimental Clinical Abdominal Oncology Unit, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Naples, Italy
| | - N Zanaletti
- Experimental Clinical Abdominal Oncology Unit, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Naples, Italy
| | - F Foschini
- Experimental Clinical Abdominal Oncology Unit, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Naples, Italy
| | - R Casaretti
- Experimental Clinical Abdominal Oncology Unit, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Naples, Italy
| | - F Tatangelo
- Pathology Unit, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Naples, Italy
| | - S Lastoria
- Nuclear Medicine Unit, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Naples, Italy
| | - M Raddi
- Nuclear Medicine Unit, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Naples, Italy
| | - D Bilancia
- Medical Oncology Unit, S. Carlo Hospital, Potenza, Italy
| | - V Granata
- Radiology Unit, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Naples, Italy
| | - S Setola
- Radiology Unit, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Naples, Italy
| | - A Petrillo
- Radiology Unit, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Naples, Italy
| | - C Vitagliano
- Experimental Pharmacology Unit, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Naples, Italy
| | - P Gargiulo
- Clinical Trial Unit, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Naples, Italy
| | - L Arenare
- Clinical Trial Unit, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Naples, Italy
| | - A Febbraro
- Hospital Sacro Cuore di Gesu, Fatebenefratelli, Benevento, Italy
| | - E Martinelli
- Medical Oncology, Precision Medicine Department, University of Campania Luigi Vanvitelli, Naples, Italy. https://twitter.com/grikamartinelli
| | - F Ciardiello
- Medical Oncology, Precision Medicine Department, University of Campania Luigi Vanvitelli, Naples, Italy
| | - P Delrio
- Colorectal Oncological Surgery, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Naples, Italy
| | - A Budillon
- Experimental Pharmacology Unit, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Naples, Italy. https://twitter.com/AlfredoBudillon
| | - M C Piccirillo
- Clinical Trial Unit, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Naples, Italy
| | - A Avallone
- Experimental Clinical Abdominal Oncology Unit, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Naples, Italy.
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Cardone C, Piccirillo M, Rosati G, De Stefano A, Romano C, Nappi A, Zanaletti N, Foschini F, Cassata A, Casaretti R, Silvestro L, Tatangelo F, Lastoria S, Raddi M, Bilancia D, Febbraro A, Martinelli E, Ciardiello F, Delrio P, Perrone F, Budillon A, Avallone A. P-68 Regorafenib monotherapy as second-line treatment of patients with RAS-mutant advanced colorectal cancer (STREAM): An academic, multicenter, single-arm, two-stage, phase 2 study. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.04.158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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4
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Cazzaniga ME, Vallini I, Montagna E, Amoroso D, Berardi R, Butera A, Cagossi K, Cavanna L, Ciccarese M, Cinieri S, Cretella E, De Conciliis E, Febbraro A, Ferraù F, Ferzi A, Baldelli A, Fontana A, Gambaro AR, Garrone O, Gebbia V, Generali D, Gianni L, Giovanardi F, Grassadonia A, Leonardi V, Marchetti P, Sarti S, Musolino A, Nicolini M, Putzu C, Riccardi F, Santini D, Saracchini S, Sarobba MG, Schintu MG, Scognamiglio G, Spadaro P, Taverniti C, Toniolo D, Tralongo P, Turletti A, Valenza R, Valerio MR, Vici P, Di Mauro P, Cogliati V, Capici S, Clivio L, Torri V. Metronomic chemotherapy (mCHT) in metastatic triple-negative breast cancer (TNBC) patients: results of the VICTOR-6 study. Breast Cancer Res Treat 2021; 190:415-424. [PMID: 34546500 PMCID: PMC8558172 DOI: 10.1007/s10549-021-06375-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 08/13/2021] [Accepted: 08/26/2021] [Indexed: 11/30/2022]
Abstract
Purpose Triple-negative breast cancer (TNBC) represents a subtype of breast cancer which lacks the expression of oestrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor-2 (HER2): TNBC accounts for approximately 20% of newly diagnosed breast cancers and is associated with younger age at diagnosis, greater recurrence risk and shorter survival time. Therapeutic options are very scarce. Aim of the present analysis is to provide further insights into the clinical activity of metronomic chemotherapy (mCHT), in a real-life setting. Methods We used data included in the VICTOR-6 study for the present analysis. VICTOR-6 is an Italian multicentre retrospective cohort study, which collected data of metastatic breast cancer (MBC) patients who have received mCHT between 2011 and 2016. Amongst the 584 patients included in the study, 97 were triple negative. In 40.2% of the TNBC patients, mCHT was the first chemotherapy treatment, whereas 32.9% had received 2 or more lines of treatment for the metastatic disease. 45.4% out of 97 TNBC patients received a vinorelbine (VRL)-based regimen, which resulted in the most used type of mCHT, followed by cyclophosphamide (CTX)-based regimens (30.9%) and capecitabine (CAPE)-based combinations (22.7%). Results Overall response rate (ORR) and disease control rate (DCR) were 17.5% and 64.9%, respectively. Median progression free survival (PFS) and overall survival (OS) were 6.0 months (95% CI: 4.9–7.2) and 12.1 months (95% CI: 9.6–16.7). Median PFS was 6.9 months for CAPE-based regimens (95% CI: 5.0–18.4), 6.1 months (95% CI: 4.0–8.9) for CTX-based and 5.3 months (95% CI: 4.1–9.5) for VRL-based ones. Median OS was 18.2 months (95% CI: 9.1-NE) for CAPE-based regimens and 11.8 months for VRL- (95% CI: 9.3–16.7 and CTX-based ones (95%CI: 8.7–52.8). Tumour response, PFS and OS decreased proportionally in later lines. Conclusion This analysis represents the largest series of TNBC patients treated with mCHT in a real-life setting and provides further insights into the advantages of using this strategy even in this poor prognosis subpopulation.
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Affiliation(s)
- M E Cazzaniga
- Phase 1 Research Centre and Oncology Unit, Department of Medicine and Surgery, University of Milano-Bicocca, ASST Monza, Via Pergolesi 33, 20900, Monza, MB, Italy.
- Oncology Unit, ASST Monza, Monza, MB, Italy.
| | - I Vallini
- Medical Oncology, ASST Sette Laghi Ospedale Di Circolo E Fondazione Macchi, Varese, VA, Italy
| | - E Montagna
- Medical Senology Division, IEO, Milan, Italy
| | - D Amoroso
- Medical Oncology, Ospedale Versilia, ATNO, Lido Di Camaiore, LU, Italy
| | - R Berardi
- Medical Oncology, Università Politecnica Delle Marche, AOU Ospedali Riuniti, Ancona, Italy
| | - A Butera
- Medical Oncology, Ospedale San Giovanni Di Dio, Agrigento, Italy
| | - K Cagossi
- Medical Oncology, Ospedale Ramazzini, Carpi, Italy
| | - L Cavanna
- Medical Oncology, Azienda Ospedaliera Piacenza, Piacenza, Italy
| | - M Ciccarese
- Medical Oncology, Ospedale Vito Fazzi, Lecce, Italy
| | - S Cinieri
- Medical Oncology, ASL Brindisi, Brindisi, Italy
| | - E Cretella
- Medical Oncology, Ospedale Bolzano, Bolzano, Italy
| | | | - A Febbraro
- Medical Oncology, Ospedale S. Cuore di Gesù Fatebenefratelli, Benevento, Italy
| | - F Ferraù
- Medical Oncology, Osp Taormina, Taormina, Italy
| | - A Ferzi
- Medical Oncology, A.S.S.T. Ovest Milanese Legnano, Legnano, Italy
| | - A Baldelli
- Medical Oncology, Ospedale San Salvatore, Pesaro, Italy
| | - A Fontana
- Medical Oncology 2, Az. Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - A R Gambaro
- Medical Oncology, ASST Fatebenefratelli Sacco, Milano, Italy
| | - O Garrone
- Breast Unit Medical Oncology, A.O. S. Croce e Carle, Cuneo, Italy
| | - V Gebbia
- Medical Oncology, Ospedale La Maddalena, Palermo, Italy
| | - D Generali
- Medical Oncology, Istituti Ospitalieri Cremona, Cremona, Italy
| | - L Gianni
- Medical Oncology, Azienda USL Romagna, U.O. di Oncologia Rimini, Cattolica, Italy
| | - F Giovanardi
- AUSL IRCCS Reggio Emilia Provincial Oncology Unit, Reggio Emilia, Italy
| | - A Grassadonia
- Medical Oncology, P.O. SS Annunziata -ASL2 Lanciano-Vasto, Chieti, Italy
| | - V Leonardi
- Medical Oncology, Ospedale Civico, Palermo, Italy
| | - P Marchetti
- Medical Oncology, A.O. Sant'Andrea, Roma, Italy
| | - S Sarti
- IRCCS Istituto Romagnolo per lo studio dei Tumori (IRST) "Dino Amadori", 47014, Meldola, Italy
| | - A Musolino
- Department of Medicine and Surgery, Medical Oncology and Breast Unit, University of Parma and University Hospital of Parma, Parma, Italy
| | - M Nicolini
- Medical Oncology, Azienda USL Romagna, U.O. di Oncologia Rimini, Cattolica, Italy
| | - C Putzu
- Medical Oncology, A. Ospedaliera-Universitaria, Sassari, Italy
| | - F Riccardi
- Medical Oncology, A. Ospedaliera Antonio Cardarelli, Napoli, Italy
| | - D Santini
- Medical Oncology, Università Campus Bio-Medico, Roma, Italy
| | - S Saracchini
- Medical Oncology, Az. Osp. Santa Maria degli Angeli, Pordenone, Italy
| | - M G Sarobba
- Medical Oncology, Ospedale San Francesco, Nuoro, Italy
| | - M G Schintu
- Medical Oncology, Osp Giovanni Paolo II, Olbia, Italy
| | | | - P Spadaro
- Medical Oncology, Casa di Cura Villa Salus-Messina, Messina, Italy
| | - C Taverniti
- Medical Oncology, A.O.U. Città della Salute e della Scienza, Osp. Molinette, Torino, Italy
| | - D Toniolo
- Medical Oncology, ASST Rhodense, Ospedale di Circolo Rho, Rho, Italy
| | - P Tralongo
- Medical Oncology, Osp. Umberto I, Siracusa, Italy
| | - A Turletti
- Medical Oncology, P.O. Martini, Torino, Italy
| | - R Valenza
- Medical Oncology, P.O. Vittorio Emanuele, Gela, Italy
| | - M R Valerio
- Department of Discipline Chirurgiche, Oncologiche e Stomatologiche (DICHIRONS), Medical Oncology, A.O.U. Policlinico Paolo Giaccone, Palermo, Italy
| | - P Vici
- Phase IV trials, IRCCS, INT Regina Elena, Rome, Italy
| | - P Di Mauro
- Oncology Unit, ASST Monza, Monza, MB, Italy
| | - V Cogliati
- Phase 1 Research Centre and Oncology Unit, Department of Medicine and Surgery, University of Milano-Bicocca, ASST Monza, Via Pergolesi 33, 20900, Monza, MB, Italy
| | - S Capici
- Phase 1 Research Centre and Oncology Unit, Department of Medicine and Surgery, University of Milano-Bicocca, ASST Monza, Via Pergolesi 33, 20900, Monza, MB, Italy
| | - L Clivio
- Oncology Department, IRCCS Mario Negri Institute, Milan, Italy
| | - V Torri
- Oncology Department, IRCCS Mario Negri Institute, Milan, Italy
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5
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Cazzaniga ME, Pinotti G, Montagna E, Amoroso D, Berardi R, Butera A, Cagossi K, Cavanna L, Ciccarese M, Cinieri S, Cretella E, De Conciliis E, Febbraro A, Ferraù F, Ferzi A, Fiorentini G, Fontana A, Gambaro AR, Garrone O, Gebbia V, Generali D, Gianni L, Giovanardi F, Grassadonia A, Leonardi V, Marchetti P, Melegari E, Musolino A, Nicolini M, Putzu C, Riccardi F, Santini D, Saracchini S, Sarobba MG, Schintu MG, Scognamiglio G, Spadaro P, Taverniti C, Toniolo D, Tralongo P, Turletti A, Valenza R, Valerio MR, Vici P, Clivio L, Torri V. Metronomic chemotherapy for advanced breast cancer patients in the real world practice: Final results of the VICTOR-6 study. Breast 2019; 48:7-16. [PMID: 31470257 DOI: 10.1016/j.breast.2019.07.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 07/24/2019] [Accepted: 07/29/2019] [Indexed: 12/21/2022] Open
Abstract
Metronomic chemotherapy (mCHT) refers to the minimum biologically effective dose of a chemotherapy agent given as a continuous dosing regimen, with no prolonged drug-free breaks, that leads to antitumor activity. Aim of the present study is to describe the use of mCHT in a retrospective cohort of metastatic breast cancer (MBC) patients in order to collect data regarding the different types and regimens of drugs employed, their efficacy and safety. Between January 2011 and December 2016, data of 584 metastatic breast cancer patients treated with mCHT were collected. The use of VRL-based regimens increased during the time of observation (2011: 16.8% - 2016: 29.8%), as well as CTX-based ones (2011: 17.1% - 2016: 25.6%), whereas CAPE-based and MTX-based regimens remained stable. In the 1st-line setting, the highest ORR and DCR were observed for VRL-based regimens (single agent: 44% and 88%; combination: 36.7% and 82.4%, respectively). Assuming VRL-single agent as the referee treatment (median PFS: 7.2 months, 95% CI: 5.3-10.3), the longest median PFS were observed in VRL-combination regimens (9.5, 95%CI 88.8-11.3, HR = 0.72) and in CAPE-single agent (10.7, 95%CI 8.3-15.8, HR = 0.70). The VICTOR-6 study provides new data coming from the real-life setting, by adding new information regarding the use of mCHT as an option of treatment for MBC patients.
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Affiliation(s)
- M E Cazzaniga
- Research Unit Phase I Trials, ASST Monza, Monza, Italy; Oncology Unit, ASST Monza, Italy.
| | - G Pinotti
- Medical Oncology, ASST Sette Laghi "Ospedale di Circolo e Fondazione Macchi, Varese, VA, Italy
| | - E Montagna
- Medical Senology Division, IEO, Milan, Italy
| | - D Amoroso
- Medical Oncology, Ospedale Della Versilia, Lido di Camaiore, IT, Italy
| | - R Berardi
- Medical Oncology, A. Ospedaliero-universitaria Ospedali Riuniti, Ancona, IT, Italy
| | - A Butera
- Medical Oncology, Ospedale San Giovanni di Dio, Agrigento, IT, Italy
| | - K Cagossi
- Medical Oncology, Ospedale Ramazzini, Carpi, IT, Italy
| | - L Cavanna
- Medical Oncology, Azienda Ospedaliera Piacenza, Piacenza, IT, Italy
| | - M Ciccarese
- Medical Oncology, Ospedale Vito Fazzi, Lecce, IT, Italy
| | - S Cinieri
- Medical Oncology, ASL Brindisi, Brindisi, Italy
| | - E Cretella
- Medical Oncology, Ospedale Bolzano, IT, Italy
| | | | - A Febbraro
- Medical Oncology, Ospedale S. Cuore di Gesù Fatebenefratelli, Benevento, Italy
| | - F Ferraù
- Medical Oncology, Osp Taormina, Taormina, IT, Italy
| | - A Ferzi
- Medical Oncology, A.S.S.T. Ovest Milanese, Legnano, IT, Italy
| | - G Fiorentini
- Medical Oncology, Ospedale San Salvatore, Pesaro, Italy
| | - A Fontana
- Medical Oncology, Az. Ospedaliero-Universitaria, Pisana, IT, Italy
| | - A R Gambaro
- Medical Oncology, ASST Fatebenefratelli, Sacco, IT, Italy
| | - O Garrone
- Medical Oncology, A.O. S. Croce e Carle, Cuneo, Italy
| | - V Gebbia
- Medical Oncology, Ospedale La Maddalena, Palermo, IT, Italy
| | - D Generali
- Medical Oncology, Istituti Ospitalieri Cremona, Cremona, IT, Italy
| | - L Gianni
- Medical Oncology, Azienda USL Romagna, U.O. di Oncologia Rimini, Cattolica, IT, Italy
| | - F Giovanardi
- Medical Oncology, Ospedale Civile, Guastalla, IT, Italy
| | - A Grassadonia
- Medical Oncology, P.O. SS Annunziata -ASL2 Lanciano-Vasto, Chieti, IT, Italy
| | - V Leonardi
- Medical Oncology, Ospedale Civico, Palermo, IT, Italy
| | - P Marchetti
- Medical Oncology, A.O. Sant'Andrea, Roma, IT, Italy
| | - E Melegari
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - A Musolino
- Medical Oncology, Azienda Ospedaliero-Universitaria di Parma, IT, Italy
| | - M Nicolini
- Medical Oncology, Azienda USL Romagna, U.O. di Oncologia Rimini, Cattolica, IT, Italy
| | - C Putzu
- Medical Oncology, A. Ospedaliera-Universitaria, Sassari, IT, Italy
| | - F Riccardi
- Medical Oncology, A. Ospedaliera Antonio Cardarelli, Napoli, IT, Italy
| | - D Santini
- Medical Oncology Università Campus Bio-Medico, Roma, IT, Italy
| | - S Saracchini
- Medical Oncology, Az. Osp. Santa Maria Degli Angeli, Pordenone, IT, Italy
| | - M G Sarobba
- Medical Oncology, Ospedale San Francesco, Nuoro, IT, Italy
| | - M G Schintu
- Medical Oncology, Osp Giovanni Paolo II, Olbia, IT, Italy
| | | | - P Spadaro
- Medical Oncology, Casa di Cura Villa Salus, Messina, IT, Italy
| | - C Taverniti
- Medical Oncology, A.O.U. Città Della Salute e Della Scienza, Osp. Molinette, Torino, IT, Italy
| | - D Toniolo
- Medical Oncology, ASST Rhodense 3 Ospedale di Circolo Rho, IT, Italy
| | - P Tralongo
- Medical Oncology, Osp. Umberto I, Siracusa, IT, Italy
| | - A Turletti
- Medical Oncology, P.O. Martini, Torino, IT, Italy
| | - R Valenza
- Medical Oncology, P.O. Vittorio Emanuele, Gela, IT, Italy
| | - M R Valerio
- Medical Oncology, A.O.U. Policlinico Paolo Giaccone, Palermo, IT, Italy
| | - P Vici
- Medical Oncology, B, INT Regina Elena, Roma, IT, Italy
| | - L Clivio
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Italy
| | - V Torri
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Italy
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De Stefano A, Nasti G, Febbraro A, Rosati G, Giuliani F, Santini D, Aprile G, Scartozzi M, Silvestris F, Luppi G, Lolli I, Mastroianni C, Leo S, Montesarchio V, Gridelli C, Pozzo C, Sperti E, Giannarelli D, Budillon A, Avallone A. Intermittent or continuous panitumumab (PAN) plus FOLFIRI for first-line treatment of patients (pts) with RAS/BRAF wild-type (WT) metastatic colorectal cancer (mCRC): A randomized phase II trial (IMPROVE). Ann Oncol 2018. [DOI: 10.1093/annonc/mdy281.154] [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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Ciardiello F, Martinelli E, Cardone C, Troiani T, Normanno N, Pisconti S, Bordonaro R, Nappi A, Giuliani F, Biglietto M, Barone C, Rachiglio A, Montesarchio V, Cinieri S, Rizzi D, Febbraro A, Latiano T, Modoni G, Colucci G, Maiello E. Survival analysis of KRAS, NRAS, BRAF, PIK3CA wild type (wt) metastatic colorectal cancer (mCRC) patients (pts) treated with FOLFIRI plus cetuximab in the CAPRI- GOIM trial. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx422.006] [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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8
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Martinelli E, Cardone C, Troiani T, Normanno N, Pisconti S, Sforza V, Bordonaro AR, Rachiglio AM, Lambiase M, Latiano TP, Modoni G, Cordio S, Giuliani F, Biglietto M, Montesarchio V, Barone C, Tonini G, Cinieri S, Febbraro A, Rizzi D, De Vita F, Orditura M, Colucci G, Maiello E, Ciardiello F, Iaffaioli V, Nasti G, Nappi A, Botti G, Tatangelo F, Chicchinelli N, Montrone M, Sebastio A, Guarino T, Simone G, Graziano P, Chiarazzo C, Maggio G, Longhitano L, Manusia M, Cartenì G, Nappi O, Micheli P, Leo L, Rossi S, Cassano A, Tommaselli E, Giordano G, Sponziello F, Marino A, Rinaldi A, Romito S, Muda AO, Lorusso V, Leo S, Barni S, Grimaldi G, Aieta M. Clinical activity and tolerability of FOLFIRI and cetuximab in elderly patients with metastatic colorectal cancer in the CAPRI-GOIM first-line trial. ESMO Open 2017; 1:e000086. [PMID: 28848656 PMCID: PMC5548975 DOI: 10.1136/esmoopen-2016-000086] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 07/13/2016] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND In the cetuximab after progression in KRAS wild-type colorectal cancer patients (CAPRI) trial patients with metastatic colorectal cancer (mCRC) received 5-fluorouracil, folinic acid and irinotecan (FOLFIRI) and cetuximab in first line followed by 5-Fluorouracil, folinic acid, oxaliplatin (FOLFOX) with or without cetuximab until progression. Limited data are available on the efficacy and safety of anti-epidermal growth factor receptor (anti-EGFR) agents on elderly patients with mCRC. In the current study we evaluated the efficacy and safety of FOLFIRI plus cetuximab in age-defined subgroups. METHODS A post-hoc analysis was performed in CAPRI trial patients; outcomes (progression-free survival (PFS), overall response rate (ORR), safety) were analysed by age-groups and stratified according to molecular characterisation. 3 age cut-offs were used to define the elderly population (≥65; ≥70 and ≥75 years). RESULTS 340 patients with mCRC were treated in first line with FOLFIRI plus cetuximab. Among those, 154 patients were >65 years, 86 >70 years and 35 >75 years. Next-generation sequencing (NGS) was performed in 182 patients. Among them, 87 patients were >65 years, 46 >70 and 17 >75. 104 of 182 patients were wild type (WT) for KRAS, NRAS, BRAF, PIK3CA genes. In the quadruple WT group, 51 patients were ≥65 years; 29 were ≥70; 9 were ≥75. Median PFS was similar within the age-subgroups in the intention-to-treat population, NGS cohort and quadruple WT patients, respectively. Likewise, ORR was not significantly different among age-subgroups in the 3 populations. Safety profile was acceptable and similarly reported among all age-groups, with the exception of grade ≥3 diarrhoea (55% vs 25%, p=0.04) and neutropaenia (75% vs 37%, p=0.03) in patients ≥75 years and grade ≥3 fatigue (31% vs 20%, p=0.01) in patients <75 years. CONCLUSIONS Tolerability of cetuximab plus FOLFIRI was acceptable in elderly patients. Similar ORR and PFS were observed according to age-groups. No differences in adverse events were reported among the defined subgroups with the exception of higher incidence of grade ≥3 diarrhoea and neutropaenia in patients ≥75 years and grade ≥3 fatigue in patients <75 years. TRIAL REGISTRATION NUMBER 2009-014041-81.
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Affiliation(s)
- E Martinelli
- Medical Oncology, Department of Clinical and Experimental Medicine "F. Magrassi", Universitá degli Studi della Campania "Luigi Vanvitelli" , Naples, Italy.
| | - C Cardone
- Medical Oncology, Department of Clinical and Experimental Medicine "F. Magrassi", Universitá degli Studi della Campania "Luigi Vanvitelli" , Naples, Italy
| | - T Troiani
- Medical Oncology, Department of Clinical and Experimental Medicine "F. Magrassi", Universitá degli Studi della Campania "Luigi Vanvitelli" , Naples, Italy
| | - N Normanno
- Cell Biology and Biotherapy Unit, National Cancer Institute "Fondazione Giovanni Pascale", Naples, Italy
| | - S Pisconti
- Department of Medical Oncology, Hospital SS. Annunziata, Taranto, Italy
| | - V Sforza
- Medical Oncology, Department of Clinical and Experimental Medicine "F. Magrassi", Universitá degli Studi della Campania "Luigi Vanvitelli" , Naples, Italy
| | - A R Bordonaro
- Department of Medical Oncology, Hospital Garibaldi, Nesima, Catania, Italy
| | - A M Rachiglio
- Cell Biology and Biotherapy Unit, National Cancer Institute "Fondazione Giovanni Pascale", Naples, Italy; Laboratory of Pharmacogenomics, Centro di Ricerche Oncologiche di Mercogliano (CROM)-National Cancer Institute "Fondazione Giovanni Pascale", Naples, Italy
| | - M Lambiase
- Cell Biology and Biotherapy Unit, National Cancer Institute "Fondazione Giovanni Pascale", Naples, Italy; Laboratory of Pharmacogenomics, Centro di Ricerche Oncologiche di Mercogliano (CROM)-National Cancer Institute "Fondazione Giovanni Pascale", Naples, Italy
| | - T P Latiano
- Department of Medical Oncology, Hospital Casa Sollievo della Sofferenza, San Giovanni Rotondo (Foggia), Italy
| | - G Modoni
- Department of Medical Oncology, Hospital SS. Annunziata, Taranto, Italy
| | - S Cordio
- Department of Medical Oncology, Hospital Garibaldi, Nesima, Catania, Italy
| | - F Giuliani
- Department of Medical Oncology, National Cancer Institute Giovanni Paolo II, Bari,Italy
| | - M Biglietto
- Department of Medical Oncology, Hospital "A. Cardarelli", Naples, Italy
| | - V Montesarchio
- Department of Medical Oncology, Hospital Monaldi- Azienda Ospedaliera dei Colli, Naples,Italy
| | - C Barone
- Department of Medical Oncology, University Hospital A. Gemelli ,Rome, Italy
| | - G Tonini
- Department of Medical Oncology, Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - S Cinieri
- Department of Medical Oncology, Hospital A. Perrino, Brindisi, Italy
| | - A Febbraro
- Department of Medical Oncology, Hospital Sacro Cuore di Gesù, Fatebenefratelli, Benevento, Italy
| | | | - F De Vita
- Medical Oncology, Department of Clinical and Experimental Medicine "F. Magrassi", Universitá degli Studi della Campania "Luigi Vanvitelli" , Naples, Italy
| | - M Orditura
- Medical Oncology, Department of Clinical and Experimental Medicine "F. Magrassi", Universitá degli Studi della Campania "Luigi Vanvitelli" , Naples, Italy
| | - G Colucci
- Department of Medical Oncology, National Cancer Institute Giovanni Paolo II, Bari,Italy
| | - E Maiello
- Department of Medical Oncology, Hospital Casa Sollievo della Sofferenza, San Giovanni Rotondo (Foggia), Italy
| | - F Ciardiello
- Medical Oncology, Department of Clinical and Experimental Medicine "F. Magrassi", Universitá degli Studi della Campania "Luigi Vanvitelli" , Naples, Italy
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Generali D, Bordonaro R, Febbraro A, Madoffa A, Romito S, Michelotti A, Savastano C, Mariani G, Tondini C, Piovano P, Iona MT, Bighin C, Roviello G, Ascione G, Goffredo F, Sartori D, Frassoldati A, Simoncini E. Abstract P4-22-17: Safety of the combination of everolimus plus exemestane in the Italian cohort of patients enrolled in the expanded access “BALLET” study. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p4-22-17] [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 expanded access “BALLET” study has been designed toevaluate the safety of EVE plus EXE combination in hormone receptor-positive (HR+), human epidermal growth factor-receptor-2-negative (HER2-) metastatic Breast Cancer (mBC). The Italian population was predominantly enrolled in trial.
Patients and methods: Patients has been included according to the inclusion and exclusion criteria provided previously in the BALLET study. The aim of our analysis was the safety everolimus and exemestane analysed in two sets of population: a subpopulation including only patients who never received chemotherapy in metastatic setting (416 patients – 36.1% of the safety population) and a subpopulation including only patients who received at least one chemotherapy in metastatic setting, whatever the line of treatment (735 patients – 63.9%).
Results:One thousand two hundred seventy nine (1279) Italian female patients were screened, 1153 (90.1% of the screened set) out of these were included in the analysis and 1151 (90.0% of the screened set) were included in the safety population. 1116 (97.0% of the safety population) prematurely discontinued the study drug and the main reasons reported were disease progression (39.1%), local reimbursement of everolimus (31.1%) and adverse event(s) (16.1%). The mean duration of study treatment exposure was 158.3±106.79 days (median 139.5) for exemestane and 153.9±108.48 days (median 135.0) for everolimus with a treatment compliance (higher than 90%) of 94.4% and 58.6% and (lower than 60%) of 0.1% and 15.1% for exemestane and everolimus, respectively. 92.5% of patients of the safety population (91.1% and . 93.3% patients without and with chemotherapy respectively) experienced at least one adverse event: gastrointestinal disorders” (67.3% vs. 64.6% in without and with chemo group); general disorders (48.6% vs. 48.3%); metabolism and nutrition disorders (35.6% vs. 37.4%) and skin and subcutaneous tissue disorders (32.2% vs. 27.5%). The incidence of everolimus related adverse events was higher (83.9%) when compared to those which occurred with exemestane. The most commonly reported adverse event was stomatitis (51.3% of patients) with 22.5% Grade 1; 18.2% Grade 2; 10.5% Grade 3; 0.2% Grade 4. The 49.7% of the patients experienced at least one stomatitis related to everolimus. No relevant difference was observed between the two groups of patients without and with chemo in metastatic setting.
Conclusions: The administration of chemotherapy before starting EVE plus EXE combination did not affect the safety profile of EXE/EVE in the treatment of mBC. The stomatitis is the most frequent and relevant adverse event to be clinically focused on.
Citation Format: Generali D, Bordonaro R, Febbraro A, Madoffa A, Romito S, Michelotti A, Savastano C, Mariani G, Tondini C, Piovano P, Iona MT, Bighin C, Roviello G, Ascione G, Goffredo F, Sartori D, Frassoldati A, Simoncini E. Safety of the combination of everolimus plus exemestane in the Italian cohort of patients enrolled in the expanded access “BALLET” study [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P4-22-17.
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Martinelli E, Cardone C, Troiani T, Normanno N, Pisconti S, Bordonaro R, Francesco G, Biglietto M, Barone C, Rachiglio A, Montesarchio V, Tonini G, Cinieri S, Rizzi D, Febbraro A, Latiano T, Modoni G, Giuseppe C, Maiello E, Ciardiello F. Clinical activity of FOLFIRI plus cetuximab in elderly patients (pts) according to extended gene mutation status by next generation sequencing (NGS) in the CAPRI- GOIM trial. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw370.96] [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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Ventriglia J, Petrillo A, Huerta M, Laterza M, Savastano B, Gambardella V, Tirino G, Pompella L, Diana A, Febbraro A, Troiani T, Orditura M, Cervantes A, Ciardiello F, De Vita F. Neutrophil to lymphocyte ratio is a predictor of outcome in metastatic pancreatic cancer patients (MPC) treated with nab-paclitaxel and gemcitabine. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw371.83] [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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Lutrino E, Orlando L, Giordano G, Zamagni C, Caliolo C, Febbraro A, Giampaglia M, Dima G, Quaranta A, Scavelli C, Bilancia D, Filippelli G, Fontanella C, Schiavone P, Fedele P, Enrica M, Rubino D, Cinieri S. Safety and efficacy of eribulin plus trastuzumab in pretreated HER2-positive advanced breast cancer (ABC) patients. An Italian multicenter experience. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw365.26] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Orlando L, Lutrino E, Giordano G, Zamagni C, Caliolo C, Febbraro A, Giampaglia M, Dima G, Rubino D, Scavelli C, Schiavone P, Bilancia D, Filippelli G, Quaranta A, Fedele P, Mazzoni E, Fontanella C, Cinieri S. Safety of Eribulin plus Trastuzumab in pre-treated HER2-positive advanced breast cancer (ABC) patients: results from an Italian observational study. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw337.39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Maiello E, Martinelli E, Cardone C, Troiani T, Normanno N, Pisconti S, Bordonaro R, Giuliani F, Biglietto M, Barone C, Rachiglio A, Montesarchio V, Tonini G, Cinieri S, Rizzi D, Febbraro A, Latiano T, Modoni G, Colucci G, Ciardiello F. Clinical activity of FOLFIRI plus cetuximab in elderly patients (pts) according to extended gene mutation status by Next Generation Sequencing (NGS) in the CAPRI- GOIM trial. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw335.02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Ciardiello F, Normanno N, Martinelli E, Troiani T, Pisconti S, Cardone C, Nappi A, Bordonaro AR, Rachiglio M, Lambiase M, Latiano TP, Modoni G, Cordio S, Giuliani F, Biglietto M, Montesarchio V, Barone C, Tonini G, Cinieri S, Febbraro A, Rizzi D, De Vita F, Orditura M, Colucci G, Maiello E. Cetuximab continuation after first progression in metastatic colorectal cancer (CAPRI-GOIM): a randomized phase II trial of FOLFOX plus cetuximab versus FOLFOX. Ann Oncol 2016; 27:1055-1061. [PMID: 27002107 DOI: 10.1093/annonc/mdw136] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Accepted: 03/04/2016] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Cetuximab plus chemotherapy is a first-line treatment option in metastatic KRAS and NRAS wild-type colorectal cancer (CRC) patients. No data are currently available on continuing anti-epidermal growth factor receptor (EGFR) therapy beyond progression. PATIENTS AND METHODS We did this open-label, 1:1 randomized phase II trial at 25 hospitals in Italy to evaluate the efficacy of cetuximab plus 5-fluorouracil, folinic acid and oxaliplatin (FOLFOX) as second-line treatment of KRAS exon 2 wild-type metastatic CRC patients treated in first line with 5-fluorouracil, folinic acid and irinotecan (FOLFIRI) plus cetuximab. Patients received FOLFOX plus cetuximab (arm A) or FOLFOX (arm B). Primary end point was progression-free survival (PFS). Tumour tissues were assessed by next-generation sequencing (NGS). This report is the final analysis. RESULTS Between 1 February 2010 and 28 September 2014, 153 patients were randomized (74 in arm A and 79 in arm B). Median PFS was 6.4 [95% confidence interval (CI) 4.7-8.0] versus 4.5 months (95% CI 3.3-5.7); [hazard ratio (HR), 0.81; 95% CI 0.58-1.12; P = 0.19], respectively. NGS was performed in 117/153 (76.5%) cases; 66/117 patients (34 in arm A and 32 in arm B) had KRAS, NRAS, BRAF and PIK3CA wild-type tumours. For these patients, PFS was longer in the FOLFOX plus cetuximab arm [median 6.9 (95% CI 5.5-8.2) versus 5.3 months (95% CI 3.7-6.9); HR, 0.56 (95% CI 0.33-0.94); P = 0.025]. There was a trend in better overall survival: median 23.7 [(95% CI 19.4-28.0) versus 19.8 months (95% CI 14.9-24.7); HR, 0.57 (95% CI 0.32-1.02); P = 0.056]. CONCLUSIONS Continuing cetuximab treatment in combination with chemotherapy is of potential therapeutic efficacy in molecularly selected patients and should be validated in randomized phase III trials.
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Affiliation(s)
- F Ciardiello
- Medical Oncology, Department of Clinical and Experimental Medicine 'F. Magrassi', Second University of Naples, Naples.
| | - N Normanno
- Cell Biology and Biotherapy Unit, National Cancer Institute 'Fondazione Giovanni Pascale', Naples
| | - E Martinelli
- Medical Oncology, Department of Clinical and Experimental Medicine 'F. Magrassi', Second University of Naples, Naples
| | - T Troiani
- Medical Oncology, Department of Clinical and Experimental Medicine 'F. Magrassi', Second University of Naples, Naples
| | - S Pisconti
- Medical Oncology, Hospital SS. Annunziata, Taranto
| | - C Cardone
- Medical Oncology, Department of Clinical and Experimental Medicine 'F. Magrassi', Second University of Naples, Naples
| | - A Nappi
- Medical Oncology, Department of Clinical and Experimental Medicine 'F. Magrassi', Second University of Naples, Naples
| | - A R Bordonaro
- Medical Oncology, Hospital Garibaldi, Nesima, Catania
| | - M Rachiglio
- Cell Biology and Biotherapy Unit, National Cancer Institute 'Fondazione Giovanni Pascale', Naples; Laboratory of Pharmacogenomics, Centro di Ricerche Oncologiche di Mercogliano (CROM)-National Cancer Institute 'Fondazione Giovanni Pascale', Naples
| | - M Lambiase
- Cell Biology and Biotherapy Unit, National Cancer Institute 'Fondazione Giovanni Pascale', Naples; Laboratory of Pharmacogenomics, Centro di Ricerche Oncologiche di Mercogliano (CROM)-National Cancer Institute 'Fondazione Giovanni Pascale', Naples
| | - T P Latiano
- Medical Oncology, Hospital Casa Sollievo della Sofferenza, San Giovanni Rotondo (Foggia)
| | - G Modoni
- Medical Oncology, Hospital SS. Annunziata, Taranto
| | - S Cordio
- Medical Oncology, Hospital Garibaldi, Nesima, Catania
| | - F Giuliani
- Medical Oncology, National Cancer Institute Giovanni Paolo II, Bari
| | - M Biglietto
- Medical Oncology, Hospital 'A. Cardarelli', Naples
| | - V Montesarchio
- Medical Oncology, Hospital Monaldi- Azienda Ospedaliera dei Colli, Naples
| | - C Barone
- Medical Oncology, University Hospital A. Gemelli, Rome
| | - G Tonini
- Policlinico Universitario Campus Bio-Medico, Rome
| | - S Cinieri
- Medical Oncology, Hospital A. Perrino, Brindisi
| | - A Febbraro
- Medical Oncology, Hospital Sacro Cuore di Gesù, Fatebenefratelli, Benevento
| | - D Rizzi
- GOIM Trial Office, Bari, Italy
| | - F De Vita
- Medical Oncology, Department of Clinical and Experimental Medicine 'F. Magrassi', Second University of Naples, Naples
| | - M Orditura
- Medical Oncology, Department of Clinical and Experimental Medicine 'F. Magrassi', Second University of Naples, Naples
| | - G Colucci
- Medical Oncology, National Cancer Institute Giovanni Paolo II, Bari
| | - E Maiello
- Medical Oncology, Hospital Casa Sollievo della Sofferenza, San Giovanni Rotondo (Foggia)
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Forcignanò R, Petrucelli L, Cazzaniga ME, Lupo LI, Chiuri VE, Cairo G, De Matteis E, Febbraro A, Giordano G, Campidoglio S, Fabi A, Giampaglia M, Bilancia D, La Verde N, Maiello E, Morritti M, Giotta F, Lorusso V, Scavelli C, Romito S, Cusmai A, Palmiotti G, Tornesello A, Ciccarese M. Abstract P4-13-15: Dose intensity and efficacy of the combination of everolimus and exemestane (EVE/EXE) in a real world population of hormone receptor positive advanced breast cancer: A multicenter Italian experience. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p4-13-15] [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: Everolimus, an mTOR inhibitor, in combination with exemestane is approved for hormone receptor (HR) positive advanced breast cancer (ABC), after failure of treatment with non-steroidal aromatase inhibitor (NSAI). We assessed the toxicity of the combination and the correlation between dose intensity and response to therapy, in a real world population of ABC from 11 Italian centers. Moreover, we evaluated OS of the whole population, RR and PFS according to line of treatment (from 1rd to 3th and from 4th on).
METHODS: 154 pts were treated with combination of everolimus 10 mg and exemestane 25 mg daily from 05/2011 today. Median age was 62 (47-82). Median time to metastatic disease was 49 months (0-269). Median number of metastatic sites was 2 (55.2% of pts visceral versus 44.8% non visceral disease). N=117 (75.9%) pretreated with HT as adjuvant; N=126 pts (81.8%) treated with HT for advanced disease prior to EVE/EXE, with a median of one line (0-5). N=102 pts (66.2%) treated with chemotherapy for metastatic disease, with a median of one line (0-6) before everolimus treatment.
RESULTS: Sixteen pts received EVE/EXE as 1st line (10.4%), 39 as 2nd (25.3%), 37 as 3rd (24%), 62 as 4th or more (40,3%). Response was evaluable in 127 out of 154 pts; CR/PR/SD respectively 5/27/56 pts. RR according to line (from 1st to 3rd vs ≥ 4th) was respectively 22.8% vs 26.4% (p=0,864). The median PFS for all population (150 pts) was 38 weeks (95% CI: 33-42). The PFS according to line (1st- 3rd vs ≥ 4th) was 38 wks in both subgroups, p=0.73. OS (126/154 pts) was 28 mths (95% CI: 31-38). The most frequent adverse events were collected in the table.
Adverse eventsOverall %Grade 3-4 %Stomatitis55.810.4Hypercholesterolemia47.40.0Asthenia42.95.2Hyperglycemia36.45.8Hypertriglyceridemia29.20.6Anemia28.63.9Peripheral edema24.71.3Rash23.40.6Increased ALT/AST/GGT21.46.5Thrombocytopenia19.53.9Diarrhea18.81.9Weight loss18.21.3Dysgeusia17.50.6Pneumonitis15.61.9Cutaneous toxicity14.90.6Infection14.33.2Neutropenia11.71.9Nausea11.70.0Anorexia (without stomatitis)10.41.3Electrolyte alterations9.71.3Urea/creatinine increase6.51.3Vomiting6.50.0Uric acid increase4.50.0
Median duration of treatment with everolimus 10 mg and 5 mg was respectively 180 (9-854) and 129 days (3-738). Fifty-eight pts (37,6%) never stopped treatment with everolimus 10 mg; 16 pts (10,4%) definitively stopped everolimus for toxicity; 80 pts (52,0%) temporarily interrupted the treatment, resuming at dose level 10 mg (31 pts) or reducing at 5 mg (49 pts). Main reason for discontinuation/interruption was stomatitis G2-G3. RR and PFS evaluated according to dose intensity, 10 mg vs 5 mg, were respectively 25.9% vs 30% p=0.779, 38 wks (27-44) vs 40 wks (31-48) P=0.614
CONCLUSIONS: efficacy in terms of RR and PFS of the combination EVE/EXE is not related to dose intensity (10 mg vs 5 mg), the discontinuation of the treatment is high with the starting dose of 10 mg, the toxicity is consistent with previous phase II-III studies although we collected some different toxicities.
Citation Format: Forcignanò R, Petrucelli L, Cazzaniga ME, Lupo LI, Chiuri VE, Cairo G, De Matteis E, Febbraro A, Giordano G, Campidoglio S, Fabi A, Giampaglia M, Bilancia D, La Verde N, Maiello E, Morritti M, Giotta F, Lorusso V, Scavelli C, Romito S, Cusmai A, Palmiotti G, Tornesello A, Ciccarese M. Dose intensity and efficacy of the combination of everolimus and exemestane (EVE/EXE) in a real world population of hormone receptor positive advanced breast cancer: A multicenter Italian experience. [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 P4-13-15.
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Affiliation(s)
- R Forcignanò
- "Vito Fazzi" Hospital, Lecce, Italy; "AO San Gerardo", Monza, Italy; "Sacro Cuore di Gesù Fatebenefratelli" Hospital, Benevento, Italy; "Regina Elena" National Cancer Institute, Roma, Italy; "San Carlo" Hospital, Potenza, Italy; "AO Fatebenefratelli e Oftalmico", Milano, Italy; "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo (Foggia), Italy; "Giovanni Paolo II" Institute, Bari, Italy; "S. Cuore di Gesù" Hospital, Gallipoli (Lecce), Italy; "Ospedali Riuniti" Hospital, Foggia, Italy; "Di Venere" Hospital, Bari, Italy
| | - L Petrucelli
- "Vito Fazzi" Hospital, Lecce, Italy; "AO San Gerardo", Monza, Italy; "Sacro Cuore di Gesù Fatebenefratelli" Hospital, Benevento, Italy; "Regina Elena" National Cancer Institute, Roma, Italy; "San Carlo" Hospital, Potenza, Italy; "AO Fatebenefratelli e Oftalmico", Milano, Italy; "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo (Foggia), Italy; "Giovanni Paolo II" Institute, Bari, Italy; "S. Cuore di Gesù" Hospital, Gallipoli (Lecce), Italy; "Ospedali Riuniti" Hospital, Foggia, Italy; "Di Venere" Hospital, Bari, Italy
| | - ME Cazzaniga
- "Vito Fazzi" Hospital, Lecce, Italy; "AO San Gerardo", Monza, Italy; "Sacro Cuore di Gesù Fatebenefratelli" Hospital, Benevento, Italy; "Regina Elena" National Cancer Institute, Roma, Italy; "San Carlo" Hospital, Potenza, Italy; "AO Fatebenefratelli e Oftalmico", Milano, Italy; "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo (Foggia), Italy; "Giovanni Paolo II" Institute, Bari, Italy; "S. Cuore di Gesù" Hospital, Gallipoli (Lecce), Italy; "Ospedali Riuniti" Hospital, Foggia, Italy; "Di Venere" Hospital, Bari, Italy
| | - LI Lupo
- "Vito Fazzi" Hospital, Lecce, Italy; "AO San Gerardo", Monza, Italy; "Sacro Cuore di Gesù Fatebenefratelli" Hospital, Benevento, Italy; "Regina Elena" National Cancer Institute, Roma, Italy; "San Carlo" Hospital, Potenza, Italy; "AO Fatebenefratelli e Oftalmico", Milano, Italy; "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo (Foggia), Italy; "Giovanni Paolo II" Institute, Bari, Italy; "S. Cuore di Gesù" Hospital, Gallipoli (Lecce), Italy; "Ospedali Riuniti" Hospital, Foggia, Italy; "Di Venere" Hospital, Bari, Italy
| | - VE Chiuri
- "Vito Fazzi" Hospital, Lecce, Italy; "AO San Gerardo", Monza, Italy; "Sacro Cuore di Gesù Fatebenefratelli" Hospital, Benevento, Italy; "Regina Elena" National Cancer Institute, Roma, Italy; "San Carlo" Hospital, Potenza, Italy; "AO Fatebenefratelli e Oftalmico", Milano, Italy; "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo (Foggia), Italy; "Giovanni Paolo II" Institute, Bari, Italy; "S. Cuore di Gesù" Hospital, Gallipoli (Lecce), Italy; "Ospedali Riuniti" Hospital, Foggia, Italy; "Di Venere" Hospital, Bari, Italy
| | - G Cairo
- "Vito Fazzi" Hospital, Lecce, Italy; "AO San Gerardo", Monza, Italy; "Sacro Cuore di Gesù Fatebenefratelli" Hospital, Benevento, Italy; "Regina Elena" National Cancer Institute, Roma, Italy; "San Carlo" Hospital, Potenza, Italy; "AO Fatebenefratelli e Oftalmico", Milano, Italy; "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo (Foggia), Italy; "Giovanni Paolo II" Institute, Bari, Italy; "S. Cuore di Gesù" Hospital, Gallipoli (Lecce), Italy; "Ospedali Riuniti" Hospital, Foggia, Italy; "Di Venere" Hospital, Bari, Italy
| | - E De Matteis
- "Vito Fazzi" Hospital, Lecce, Italy; "AO San Gerardo", Monza, Italy; "Sacro Cuore di Gesù Fatebenefratelli" Hospital, Benevento, Italy; "Regina Elena" National Cancer Institute, Roma, Italy; "San Carlo" Hospital, Potenza, Italy; "AO Fatebenefratelli e Oftalmico", Milano, Italy; "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo (Foggia), Italy; "Giovanni Paolo II" Institute, Bari, Italy; "S. Cuore di Gesù" Hospital, Gallipoli (Lecce), Italy; "Ospedali Riuniti" Hospital, Foggia, Italy; "Di Venere" Hospital, Bari, Italy
| | - A Febbraro
- "Vito Fazzi" Hospital, Lecce, Italy; "AO San Gerardo", Monza, Italy; "Sacro Cuore di Gesù Fatebenefratelli" Hospital, Benevento, Italy; "Regina Elena" National Cancer Institute, Roma, Italy; "San Carlo" Hospital, Potenza, Italy; "AO Fatebenefratelli e Oftalmico", Milano, Italy; "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo (Foggia), Italy; "Giovanni Paolo II" Institute, Bari, Italy; "S. Cuore di Gesù" Hospital, Gallipoli (Lecce), Italy; "Ospedali Riuniti" Hospital, Foggia, Italy; "Di Venere" Hospital, Bari, Italy
| | - G Giordano
- "Vito Fazzi" Hospital, Lecce, Italy; "AO San Gerardo", Monza, Italy; "Sacro Cuore di Gesù Fatebenefratelli" Hospital, Benevento, Italy; "Regina Elena" National Cancer Institute, Roma, Italy; "San Carlo" Hospital, Potenza, Italy; "AO Fatebenefratelli e Oftalmico", Milano, Italy; "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo (Foggia), Italy; "Giovanni Paolo II" Institute, Bari, Italy; "S. Cuore di Gesù" Hospital, Gallipoli (Lecce), Italy; "Ospedali Riuniti" Hospital, Foggia, Italy; "Di Venere" Hospital, Bari, Italy
| | - S Campidoglio
- "Vito Fazzi" Hospital, Lecce, Italy; "AO San Gerardo", Monza, Italy; "Sacro Cuore di Gesù Fatebenefratelli" Hospital, Benevento, Italy; "Regina Elena" National Cancer Institute, Roma, Italy; "San Carlo" Hospital, Potenza, Italy; "AO Fatebenefratelli e Oftalmico", Milano, Italy; "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo (Foggia), Italy; "Giovanni Paolo II" Institute, Bari, Italy; "S. Cuore di Gesù" Hospital, Gallipoli (Lecce), Italy; "Ospedali Riuniti" Hospital, Foggia, Italy; "Di Venere" Hospital, Bari, Italy
| | - A Fabi
- "Vito Fazzi" Hospital, Lecce, Italy; "AO San Gerardo", Monza, Italy; "Sacro Cuore di Gesù Fatebenefratelli" Hospital, Benevento, Italy; "Regina Elena" National Cancer Institute, Roma, Italy; "San Carlo" Hospital, Potenza, Italy; "AO Fatebenefratelli e Oftalmico", Milano, Italy; "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo (Foggia), Italy; "Giovanni Paolo II" Institute, Bari, Italy; "S. Cuore di Gesù" Hospital, Gallipoli (Lecce), Italy; "Ospedali Riuniti" Hospital, Foggia, Italy; "Di Venere" Hospital, Bari, Italy
| | - M Giampaglia
- "Vito Fazzi" Hospital, Lecce, Italy; "AO San Gerardo", Monza, Italy; "Sacro Cuore di Gesù Fatebenefratelli" Hospital, Benevento, Italy; "Regina Elena" National Cancer Institute, Roma, Italy; "San Carlo" Hospital, Potenza, Italy; "AO Fatebenefratelli e Oftalmico", Milano, Italy; "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo (Foggia), Italy; "Giovanni Paolo II" Institute, Bari, Italy; "S. Cuore di Gesù" Hospital, Gallipoli (Lecce), Italy; "Ospedali Riuniti" Hospital, Foggia, Italy; "Di Venere" Hospital, Bari, Italy
| | - D Bilancia
- "Vito Fazzi" Hospital, Lecce, Italy; "AO San Gerardo", Monza, Italy; "Sacro Cuore di Gesù Fatebenefratelli" Hospital, Benevento, Italy; "Regina Elena" National Cancer Institute, Roma, Italy; "San Carlo" Hospital, Potenza, Italy; "AO Fatebenefratelli e Oftalmico", Milano, Italy; "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo (Foggia), Italy; "Giovanni Paolo II" Institute, Bari, Italy; "S. Cuore di Gesù" Hospital, Gallipoli (Lecce), Italy; "Ospedali Riuniti" Hospital, Foggia, Italy; "Di Venere" Hospital, Bari, Italy
| | - N La Verde
- "Vito Fazzi" Hospital, Lecce, Italy; "AO San Gerardo", Monza, Italy; "Sacro Cuore di Gesù Fatebenefratelli" Hospital, Benevento, Italy; "Regina Elena" National Cancer Institute, Roma, Italy; "San Carlo" Hospital, Potenza, Italy; "AO Fatebenefratelli e Oftalmico", Milano, Italy; "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo (Foggia), Italy; "Giovanni Paolo II" Institute, Bari, Italy; "S. Cuore di Gesù" Hospital, Gallipoli (Lecce), Italy; "Ospedali Riuniti" Hospital, Foggia, Italy; "Di Venere" Hospital, Bari, Italy
| | - E Maiello
- "Vito Fazzi" Hospital, Lecce, Italy; "AO San Gerardo", Monza, Italy; "Sacro Cuore di Gesù Fatebenefratelli" Hospital, Benevento, Italy; "Regina Elena" National Cancer Institute, Roma, Italy; "San Carlo" Hospital, Potenza, Italy; "AO Fatebenefratelli e Oftalmico", Milano, Italy; "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo (Foggia), Italy; "Giovanni Paolo II" Institute, Bari, Italy; "S. Cuore di Gesù" Hospital, Gallipoli (Lecce), Italy; "Ospedali Riuniti" Hospital, Foggia, Italy; "Di Venere" Hospital, Bari, Italy
| | - M Morritti
- "Vito Fazzi" Hospital, Lecce, Italy; "AO San Gerardo", Monza, Italy; "Sacro Cuore di Gesù Fatebenefratelli" Hospital, Benevento, Italy; "Regina Elena" National Cancer Institute, Roma, Italy; "San Carlo" Hospital, Potenza, Italy; "AO Fatebenefratelli e Oftalmico", Milano, Italy; "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo (Foggia), Italy; "Giovanni Paolo II" Institute, Bari, Italy; "S. Cuore di Gesù" Hospital, Gallipoli (Lecce), Italy; "Ospedali Riuniti" Hospital, Foggia, Italy; "Di Venere" Hospital, Bari, Italy
| | - F Giotta
- "Vito Fazzi" Hospital, Lecce, Italy; "AO San Gerardo", Monza, Italy; "Sacro Cuore di Gesù Fatebenefratelli" Hospital, Benevento, Italy; "Regina Elena" National Cancer Institute, Roma, Italy; "San Carlo" Hospital, Potenza, Italy; "AO Fatebenefratelli e Oftalmico", Milano, Italy; "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo (Foggia), Italy; "Giovanni Paolo II" Institute, Bari, Italy; "S. Cuore di Gesù" Hospital, Gallipoli (Lecce), Italy; "Ospedali Riuniti" Hospital, Foggia, Italy; "Di Venere" Hospital, Bari, Italy
| | - V Lorusso
- "Vito Fazzi" Hospital, Lecce, Italy; "AO San Gerardo", Monza, Italy; "Sacro Cuore di Gesù Fatebenefratelli" Hospital, Benevento, Italy; "Regina Elena" National Cancer Institute, Roma, Italy; "San Carlo" Hospital, Potenza, Italy; "AO Fatebenefratelli e Oftalmico", Milano, Italy; "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo (Foggia), Italy; "Giovanni Paolo II" Institute, Bari, Italy; "S. Cuore di Gesù" Hospital, Gallipoli (Lecce), Italy; "Ospedali Riuniti" Hospital, Foggia, Italy; "Di Venere" Hospital, Bari, Italy
| | - C Scavelli
- "Vito Fazzi" Hospital, Lecce, Italy; "AO San Gerardo", Monza, Italy; "Sacro Cuore di Gesù Fatebenefratelli" Hospital, Benevento, Italy; "Regina Elena" National Cancer Institute, Roma, Italy; "San Carlo" Hospital, Potenza, Italy; "AO Fatebenefratelli e Oftalmico", Milano, Italy; "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo (Foggia), Italy; "Giovanni Paolo II" Institute, Bari, Italy; "S. Cuore di Gesù" Hospital, Gallipoli (Lecce), Italy; "Ospedali Riuniti" Hospital, Foggia, Italy; "Di Venere" Hospital, Bari, Italy
| | - S Romito
- "Vito Fazzi" Hospital, Lecce, Italy; "AO San Gerardo", Monza, Italy; "Sacro Cuore di Gesù Fatebenefratelli" Hospital, Benevento, Italy; "Regina Elena" National Cancer Institute, Roma, Italy; "San Carlo" Hospital, Potenza, Italy; "AO Fatebenefratelli e Oftalmico", Milano, Italy; "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo (Foggia), Italy; "Giovanni Paolo II" Institute, Bari, Italy; "S. Cuore di Gesù" Hospital, Gallipoli (Lecce), Italy; "Ospedali Riuniti" Hospital, Foggia, Italy; "Di Venere" Hospital, Bari, Italy
| | - A Cusmai
- "Vito Fazzi" Hospital, Lecce, Italy; "AO San Gerardo", Monza, Italy; "Sacro Cuore di Gesù Fatebenefratelli" Hospital, Benevento, Italy; "Regina Elena" National Cancer Institute, Roma, Italy; "San Carlo" Hospital, Potenza, Italy; "AO Fatebenefratelli e Oftalmico", Milano, Italy; "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo (Foggia), Italy; "Giovanni Paolo II" Institute, Bari, Italy; "S. Cuore di Gesù" Hospital, Gallipoli (Lecce), Italy; "Ospedali Riuniti" Hospital, Foggia, Italy; "Di Venere" Hospital, Bari, Italy
| | - G Palmiotti
- "Vito Fazzi" Hospital, Lecce, Italy; "AO San Gerardo", Monza, Italy; "Sacro Cuore di Gesù Fatebenefratelli" Hospital, Benevento, Italy; "Regina Elena" National Cancer Institute, Roma, Italy; "San Carlo" Hospital, Potenza, Italy; "AO Fatebenefratelli e Oftalmico", Milano, Italy; "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo (Foggia), Italy; "Giovanni Paolo II" Institute, Bari, Italy; "S. Cuore di Gesù" Hospital, Gallipoli (Lecce), Italy; "Ospedali Riuniti" Hospital, Foggia, Italy; "Di Venere" Hospital, Bari, Italy
| | - A Tornesello
- "Vito Fazzi" Hospital, Lecce, Italy; "AO San Gerardo", Monza, Italy; "Sacro Cuore di Gesù Fatebenefratelli" Hospital, Benevento, Italy; "Regina Elena" National Cancer Institute, Roma, Italy; "San Carlo" Hospital, Potenza, Italy; "AO Fatebenefratelli e Oftalmico", Milano, Italy; "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo (Foggia), Italy; "Giovanni Paolo II" Institute, Bari, Italy; "S. Cuore di Gesù" Hospital, Gallipoli (Lecce), Italy; "Ospedali Riuniti" Hospital, Foggia, Italy; "Di Venere" Hospital, Bari, Italy
| | - M Ciccarese
- "Vito Fazzi" Hospital, Lecce, Italy; "AO San Gerardo", Monza, Italy; "Sacro Cuore di Gesù Fatebenefratelli" Hospital, Benevento, Italy; "Regina Elena" National Cancer Institute, Roma, Italy; "San Carlo" Hospital, Potenza, Italy; "AO Fatebenefratelli e Oftalmico", Milano, Italy; "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo (Foggia), Italy; "Giovanni Paolo II" Institute, Bari, Italy; "S. Cuore di Gesù" Hospital, Gallipoli (Lecce), Italy; "Ospedali Riuniti" Hospital, Foggia, Italy; "Di Venere" Hospital, Bari, Italy
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Giordano G, De Vita F, Melisi D, Vaccaro V, Zaniboni A, Zagonel V, Vasile E, Passardi A, Leo L, Ventriglia J, Marciano R, Russano M, Conca R, Andreozzi F, Lucchini E, Musettini G, Bertocchi P, Bergamo F, Milella M, Febbraro A. 2335 Analysis of activity, efficacy and safety of first line Nab Paclitaxel (Nab-P) and Gemcitabine (G) in advanced pancreatic cancer (APDAC) frail and elderly patients (pts). Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)31251-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Giordano G, Febbraro A, Vaccaro V, Zagonel V, De Giorgi U, Melisi D, Vasile E, Bianco R, Lo Re G, Valente M, Formica V, Montesarchio V, Maiorino L, Sanna G, Bittoni A, Ricci V, Santini D, Zaniboni A, Milella M, De Vita F. 2334 Nab Paclitaxel (Nab-P) and Gemcitabine (G) as first line chemotherapy (CT) in advanced pancreatic cancer (APDAC) patients (pts): An Italian “real life” study. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)31250-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Ciardiello F, Normanno N, Martinelli E, Troiani T, Cardone C, Nappi A, Rachiglio A, Lambiase M, Pisconti S, Giuliani F, Barone C, Biglietto M, Montesarchio V, Tonini G, Rizzi D, Cinieri S, Bordonaro R, Febbraro A, De Vita F, Orditura M, Colucci G, Maiello E. LBA-09 Cetuximab beyond progression in RAS wild type (WT) metastatic colorectal cancer (mCRC): the CAPRI-GOIM randomized phase II study of FOLFOX versus FOLFOX plus cetuximab. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv262.09] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [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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Sciascia V, Febbraro A, Benincasa G, Di Gaeta E, Perillo G, Marra D, Festa L, Pascale L, Ambrosino G. Microwave ablation with AMICA® probe for unresectable locally advanced pancreatic cancer. Quality of life and performance status. Eur J Surg Oncol 2015. [DOI: 10.1016/j.ejso.2014.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Giordano G, Melisi D, Milella M, Zaniboni A, Vasile E, Zagonel V, Giommoni E, Maiorino L, Santoni M, Vaccaro V, Bertocchi P, Bergamo F, Musettini G, Lucchini E, Cascinu S, Febbraro A. Activity, Efficacy and Safety of Nab-Paclitaxel (Nab-P) and Gemcitabine (G) in Advanced Pancreatic Cancer (Apdac) Elderly Patients. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu334.98] [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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Vaccaro V, Sperduti I, Melisi D, Bria E, Vasile E, Santoni M, Giordano G, Bertocchi P, Lucchini E, Pino M, Gelibter A, Garufi C, Zeuli M, Zaniboni A, Febbraro A, Cascinu S, Falcone A, Tortora G, Cognetti F, Milella M. Clinical Impact of Folfirinox Dose/Schedule Modifications (Mfolforinox) and Additional Supportive Measures in the Management of Pancreatic Cancer (Pdac) Patients (Pts). Ann Oncol 2014. [DOI: 10.1093/annonc/mdu334.75] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Ciccarese M, Orlando L, Fedele P, Schiavone P, Maiello E, Cilenti P, Aieta M, Bozza G, Forcignanò M, Febbraro A, Bordonaro R, Romito S, Rinaldi A, Borsellino N, Riccardi F, Pisconti S, Lorusso V, Colucci G, Cinieri S. A Multicenter Phase Ii Trial of Nab-Paclitaxel in Combination with Capecitabine in Patients (Pts) with Her-2 Negative and Triple Negative Advanced Breast Cancer (Abc): an Interim Analysis. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu329.20] [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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Ciardiello F, Normanno N, Maiello E, Martinelli E, Troiani T, Pisconti S, Giuliani F, Barone C, Cartenì G, Rachiglio AM, Montesarchio V, Tonini G, Rizzi D, Cinieri S, Bordonaro R, Febbraro A, De Vita F, Orditura M, Fenizia F, Lambiase M, Rinaldi A, Tatangelo F, Botti G, Colucci G. Clinical activity of FOLFIRI plus cetuximab according to extended gene mutation status by next-generation sequencing: findings from the CAPRI-GOIM trial. Ann Oncol 2014; 25:1756-1761. [PMID: 24942275 DOI: 10.1093/annonc/mdu230] [Citation(s) in RCA: 94] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023] Open
Abstract
BACKGROUND Treatment with antiepidermal growth factor receptor (anti-EGFR) monoclonal antibodies has been restricted to metastatic colorectal cancer (mCRC) patients with RAS wild-type tumors. Next-generation sequencing (NGS) allows the assessment in a single analysis of a large number of gene alterations and might provide important predictive and prognostic information. PATIENTS AND METHODS In the CAPRI-GOIM trial, 340 KRAS exon 2 wild-type mCRC patients received first-line FOLFIRI plus cetuximab. Tumor samples (182/340, 53.5%) were assessed by NGS to search for mutations in 22 genes involved in colon cancer. RESULTS Objective responses in the NGS cohort were observed in 104/182 patients [overall response rate (ORR) 57.1%; 95% confidence interval (95% CI) 52% to 66.4%] with a median progression-free survival (mPFS) of 9.8 (95% CI 8.7-11.5) months. NGS analysis was successfully completed in all 182 samples. One or more gene mutations (up to five) were detected in 124/182 (68.1%) tumors within 14/22 genes for a total of 206 mutations. KRAS exon 2 mutations were identified in 29/182 (15.9%) samples, defined as wild type by local laboratory assessment. Frequently mutated genes were: TP53 (39.6%), KRAS exons 3/4 (8.8%), NRAS exons 2/3 (7.1%), PIK3CA exons 9/20 (13.2%), BRAF (8.2%). FOLFIRI plus cetuximab treatment determined ORR of 62.0% (95% CI 55.5% to 74.6%) with mPFS of 11.1 (95% CI 9.2-12.8) months in patients with KRAS and NRAS wild-type tumors. Conversely, ORR was 46.6% (95% CI 39.9-57.5%) with mPFS of 8.9 (95% CI 7.4-9.6) months in patients with KRAS or NRAS mutations. Similarly, the subgroup of patients carrying KRAS, NRAS, BRAF, or PIK3CA mutations showed a worse outcome, although this might be due to a prognostic effect. CONCLUSIONS This study demonstrates that NGS analysis in mCRC is feasible, reveals high level of intra and intertumor heterogeneity, and identifies patients that might benefit of FOLFIRI plus cetuximab treatment.
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Affiliation(s)
- F Ciardiello
- Department of Clinical and Experimental Medicine 'F. Magrassi', Medical Oncology, Second University of Naples, Naples.
| | - N Normanno
- Cell Biology and Biotherapy Unit, National Cancer Institute 'Fondazione Giovanni Pascale', Naples
| | - E Maiello
- Medical Oncology, Hospital Casa Sollievo Della Sofferenza-San Giovanni Rotondo (Foggia), San Giovanni Rotondo
| | - E Martinelli
- Department of Clinical and Experimental Medicine 'F. Magrassi', Medical Oncology, Second University of Naples, Naples
| | - T Troiani
- Department of Clinical and Experimental Medicine 'F. Magrassi', Medical Oncology, Second University of Naples, Naples
| | - S Pisconti
- Department of Medical Oncology, Hospital SS. Annunziata, Taranto
| | - F Giuliani
- Department of Medical Oncology, National Cancer Institute Giovanni Paolo II, Bari
| | - C Barone
- Department of Medical Oncology, University Hospital A. Gemelli, Rome
| | - G Cartenì
- Department of Medical Oncology, Hospital 'A. Cardarelli', Naples
| | - A M Rachiglio
- Cell Biology and Biotherapy Unit, National Cancer Institute 'Fondazione Giovanni Pascale', Naples
| | - V Montesarchio
- Department of Medical Oncology, Hospital Monaldi- Azienda Ospedaliera dei Colli, Napoles
| | - G Tonini
- Department of Medical Oncology, Univeristy Hospital Campus Bio-Medico di Rome, Rome
| | - D Rizzi
- Department of Medical Oncology, National Cancer Institute Giovanni Paolo II, Bari
| | - S Cinieri
- Department of Medical Oncology, Hospital A. Perrino, Brindisi
| | - R Bordonaro
- Department of Medical Oncology, Hospital Garibaldi, Nesima, Catania
| | - A Febbraro
- Department of Medical Oncology, Hospital Sacro Cuore di Gesù, Fatebenefratelli, Benevento
| | - F De Vita
- Department of Clinical and Experimental Medicine 'F. Magrassi', Medical Oncology, Second University of Naples, Naples
| | - M Orditura
- Department of Clinical and Experimental Medicine 'F. Magrassi', Medical Oncology, Second University of Naples, Naples
| | - F Fenizia
- Cell Biology and Biotherapy Unit, National Cancer Institute 'Fondazione Giovanni Pascale', Naples
| | - M Lambiase
- Cell Biology and Biotherapy Unit, National Cancer Institute 'Fondazione Giovanni Pascale', Naples
| | - A Rinaldi
- Department of Medical Oncology, Hospital Polo Occidentale, Castellaneta, Bari
| | - F Tatangelo
- Cell Biology and Biotherapy Unit, National Cancer Institute 'Fondazione Giovanni Pascale', Naples
| | - G Botti
- Department of Pathology, National Cancer Institute 'Fondazione Giovanni Pascale', Naples, Italy
| | - G Colucci
- Department of Medical Oncology, National Cancer Institute Giovanni Paolo II, Bari
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Giordano G, Milella M, Melisi D, Zaniboni A, Caponi S, Zagonel V, Giommoni E, Santoni M, Vaccaro V, Bertocchi P, Bergamo F, Molinara E, Musettini G, Lucchini E, Febbraro A. Nab-Paclitaxel (Nab-P) and Gemcitabine (G) in Pretreated Advanced Pancreatic Cancer (Apdac) Patients (Pts): a Multicentre Retrospective Analysis. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu334.103] [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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Addeo R, Vincenzi B, Riccardi F, Febbraro A, Maiorino L, Incoronato P, Mabilia R, Bianco M, Russo E, Pisano A, Del Prete S. Multicenter observational study on adherence and acceptance of lapatinib treatment in patients with HER2+ metastatic breast cancer. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e11102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Del Prete S, Piantedosi F, Rocco D, Riccardi F, Vincenzi B, Bianco M, Savastano C, Montesarchio V, Matarese M, Sabia A, Illiano A, Pisano A, Biglietto M, Pistolese G, Leo L, Maiorino L, Febbraro A, Addeo R. Anemia management with epoetin beta in anemic patients with cancer receiving chemotherapy: Pananemia observational study on clinical practice. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e19630] [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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Garassino MC, Bianchi A, Febbraro A, Spagnoletti I, Iorno V, Bramati A, Carbone C, Isa L, Breda E, Magarotto R, Torri V, Farina G. Final results of a randomized phase II trial (NCT00637975) evaluating activity and toxicity of fixed-dose oxycodone and increasing dose of pregabalin versus increasing dose of oxycodone and fixed-dose pregabalin for the treatment of oncologic neuropathic pain (NEUROPAIN-01). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.9028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Addeo R, Montella L, Cennamo G, Maione P, Guerra G, Bianco M, Febbraro A, Capasso E, Russo E, del Prete S. P273 Non-pegylated liposomal doxorubicin in combination with cyclophosphamide and docetaxel as adjuvant therapy for women with high-risk breast cancer. Safety, quality of life, and efficacy analysis of TMC protocol. Breast 2011. [DOI: 10.1016/s0960-9776(11)70215-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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30
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Giuliani F, Febbraro A, Addeo R, Rizzi D, Maiello E, Del Prete S, Pisconti S, Colucci G. Sorafenib plus cisplatin and gemcitabine in the treatment of advanced hepatocellular carcinoma (HCC): A phase II study by the Gruppo Oncologico dell'Italia Meridionale (prot. GOIM 2705). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.4_suppl.225] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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
225 Background: Sorafenib is the standard treatment in advanced HCC. The combination of cisplatin and gemcitabine demonstrated to be active and well tolerated in tumors with a similar poor outcome such as pancreatic and biliary-tract cancers. Considering these data, the GOIM started a phase II trial aiming to evaluate the activity and safety of the combination of sorafenib, gemcitabine and cisplatin in advanced HCC. Methods: Patients affected by advanced HCC, not suitable for surgery or locoregional procedures, with measurable disease (Recist criteria), age ≥ 18 years, clip-score ≤3, ECOG performance status ≥ 60 (K.fsky), adequate bone marrow reserve and renal and hepatic function and who signed written informed consent, were enrolled and received cisplatin 40 mg/mq iv plus gemcitabine 800 mg/mq iv bi-weekly, while sorafenib was orally administrated at the dosage of 400 mg bid continuously. A maximum of 6 cycles of chemotherapy was planned; a maintenance with sorafenib was permitted for not progressing patients. The evaluation of activity was performed every three cycles. A Simon's two stage, two steps study design was applied: at the first step, at least 3 OR had to be observed among the first 28 patients to continue the enrollment. Up to now, 23 patients have been enrolled. Their main characteristics were: sex (male/female) 19/4, median age: 70 yrs, median PS 80,main sites of disease liver 22, lymph nodes 4, lung 2, others 3. Results: Up to now 18 patients are evaluable for activity while 5 are too early. One CR, 3 PR, 6 SD and 8 PRO for an ORR of 4/18 (22%) and a tumor control of 10/18 (55%). Twenty-one patients are evaluable for safety. The main observed side effects (%G1-2/G3-4) (NCI criteria) were: hand-foot skin reaction (HFSR) 9/14, mucositis 9/4, diarrhea 23/4, nausea/vomiting 23/0, leucopenia 23/0, anemia 9/0, thrombocytopenia 19/4, asthenia 14/14, cardiovascular 0/4, others 9/4. Conclusions: Our preliminary data seems to demonstrate that the combination of cisplatin, gemcitabine, and sorafenib is active and well tolerated in advanced HCC patients. The accrual is ongoing. No significant financial relationships to disclose.
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Affiliation(s)
- F. Giuliani
- NCI, Bari, Italy; Fatebenefratelli Hospital, Benevento, Italy; Frattamaggiore Hospital, Frattamaggiore, Italy; Casa Sollievo Sofferenza, San Giovanni Rotondo, Italy; SS Annunziata Hospital, Taranto, Italy; Istituto Oncologico Bari, Bari, Italy
| | - A. Febbraro
- NCI, Bari, Italy; Fatebenefratelli Hospital, Benevento, Italy; Frattamaggiore Hospital, Frattamaggiore, Italy; Casa Sollievo Sofferenza, San Giovanni Rotondo, Italy; SS Annunziata Hospital, Taranto, Italy; Istituto Oncologico Bari, Bari, Italy
| | - R. Addeo
- NCI, Bari, Italy; Fatebenefratelli Hospital, Benevento, Italy; Frattamaggiore Hospital, Frattamaggiore, Italy; Casa Sollievo Sofferenza, San Giovanni Rotondo, Italy; SS Annunziata Hospital, Taranto, Italy; Istituto Oncologico Bari, Bari, Italy
| | - D. Rizzi
- NCI, Bari, Italy; Fatebenefratelli Hospital, Benevento, Italy; Frattamaggiore Hospital, Frattamaggiore, Italy; Casa Sollievo Sofferenza, San Giovanni Rotondo, Italy; SS Annunziata Hospital, Taranto, Italy; Istituto Oncologico Bari, Bari, Italy
| | - E. Maiello
- NCI, Bari, Italy; Fatebenefratelli Hospital, Benevento, Italy; Frattamaggiore Hospital, Frattamaggiore, Italy; Casa Sollievo Sofferenza, San Giovanni Rotondo, Italy; SS Annunziata Hospital, Taranto, Italy; Istituto Oncologico Bari, Bari, Italy
| | - S. Del Prete
- NCI, Bari, Italy; Fatebenefratelli Hospital, Benevento, Italy; Frattamaggiore Hospital, Frattamaggiore, Italy; Casa Sollievo Sofferenza, San Giovanni Rotondo, Italy; SS Annunziata Hospital, Taranto, Italy; Istituto Oncologico Bari, Bari, Italy
| | - S. Pisconti
- NCI, Bari, Italy; Fatebenefratelli Hospital, Benevento, Italy; Frattamaggiore Hospital, Frattamaggiore, Italy; Casa Sollievo Sofferenza, San Giovanni Rotondo, Italy; SS Annunziata Hospital, Taranto, Italy; Istituto Oncologico Bari, Bari, Italy
| | - G. Colucci
- NCI, Bari, Italy; Fatebenefratelli Hospital, Benevento, Italy; Frattamaggiore Hospital, Frattamaggiore, Italy; Casa Sollievo Sofferenza, San Giovanni Rotondo, Italy; SS Annunziata Hospital, Taranto, Italy; Istituto Oncologico Bari, Bari, Italy
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Arpino G, Cammarota S, Ianniello G, Genua G, Febbraro A, Mastrogiacomo F, Mabilia R, Pisano A, Bianco M, Barbato E, Daniele B, Savastano C, Del Prete S, Malorni L, De Placido S. Abstract P1-09-06: Imaging Tests in Staging and Surveillance of Early Breast Cancer (EBC) — Changes in Routine Clinical Practice and Cost Implications. Cancer Res 2010. [DOI: 10.1158/0008-5472.sabcs10-p1-09-06] [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. New imaging tests such as computed tomography [CT], [18F]fluorodeoxyglucose-positron emission tomography (FDG-PET) scanning and magnetic resonance imaging (MRI) are not recommended for staging or follow up of asymptomatic patients with EBC according to current guidelines. However, frequently these tests are requested even in the absence of a clinical indication. Variations in practice patterns have significant cost implications and no clear impact on cancer outcomes. Aim. In the present study we analyzed how the availability of novel and more expensive imaging technique has changed staging and follow-up modalities in EBC patients and if these changes affect costs. Methods. Two thousand and five patients with EBC diagnosed between January 2005 and December 2008 were identified using clinical computerized medical records from 639 general practitioners assisting 915,689 inhabitants of the Campania, a southern region of Italy. For each year EBC incidence, the mean number of diagnostic tests per patient (N/Pt) done during the first year after the initial diagnosis and the mean costs per each year were evaluated and compared by Anova test. Results. We identified 576, 489, 474 and 497 newly diagnosed cases of EBC in 2005, 2006, 2007 and 2008 respectively.
Table 1
Table 1 describes changes in the mean number of different imaging tests requested per patient in these years. Overall, there was a significant increase of the mean number of imaging tests done per patient from 2005 to 2008 (P<0.0001). No change of the mean number of mammograms, bone scan and chest X ray requested per patient was observed. However, importantly, the mean number of TC scan, PET scan and MRI requested per patient almost doubled from 2005 to 2008. Accordingly, the mean costs for staging and surveillance per patient also significantly increased (355 € in 2005, 378 € in 2006, 391 € in 2007 and 547 € in 2008; <0.0001).
Conclusions. TC scan, PET scan and MRI employment for patient with EBC in daily clinical practice has been steadily growing over the past four years. However, there are no data to support their role in routine breast cancer staging or surveillance in asymptomatic patients. More studies are needed to characterize which subset of patients deserve more intensive staging and follow up procedures as costs related to these imaging test prescriptions are relevant.
Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P1-09-06.
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Affiliation(s)
- G Arpino
- University of Naples Federico II
| | | | | | - G Genua
- University of Naples Federico II
| | | | | | | | - A Pisano
- University of Naples Federico II
| | - M Bianco
- University of Naples Federico II
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Pancione M, Forte N, Campione S, Napolitano A, Parente D, Sabatino L, Febbraro A, Colantuoni V. The high expression of p53 in sporadic colorectal carcinoma is associated with metastasis and decreased survival. Pathologica 2010; 102:51-56. [PMID: 23596757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Abstract
INTRODUCTION Alteration in the p53 tumour suppressor gene is an event that occurs frequently in human cancer, although its role as predictive and/or prognostic marker is still unclear. The aim of this study was to compare the expression profiles of p53 in colorectal carcinoma with clinicopathological features and survival rate at 5 years from diagnosis. METHODS One hundred and twenty cases of primary sporadic colorectal cancers (CRCs) and 80 matched normal mucosas were analyzed by immunohistochemistry on paraffin-embedded specimens. The correlation between protein expression profiles, clinicopathological parameters and survival was investigated. RESULTS In tumour tissues, the expression of p53 was high in 41 cases, low in 38 and negative in 41. A significant correlation was observed between increased p53 expression presence of lymph node (p = 0.002) or liver metastasis (p = 0.008). Moreover, higher levels of p53 were related with advanced tumour stage (III-IV; p = 0.007), poor survival and disease recurrence (p < 0.01). Interestingly, in multivariate analysis p53 expression and distant metastasis were independent prognostic markers. DISCUSSION Our results suggest that nuclear p53 accumulation in sporadic CRC may have prognostic significance and contribute to identification of patients at high risk of mortality. The current findings may be relevant for management of patients with CRC.
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Affiliation(s)
- M Pancione
- Department of Biological and Environmental Sciences, University of Sannio, Benevento, Italy.
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33
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Capaccio D, Ciccodicola A, Sabatino L, Casamassimi A, Pancione M, Fucci A, Febbraro A, Merlino A, Graziano G, Colantuoni V. A novel germline mutation in peroxisome proliferator-activated receptor gamma gene associated with large intestine polyp formation and dyslipidemia. Biochim Biophys Acta Mol Basis Dis 2010; 1802:572-81. [PMID: 20123124 DOI: 10.1016/j.bbadis.2010.01.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2009] [Revised: 01/07/2010] [Accepted: 01/19/2010] [Indexed: 12/31/2022]
Abstract
We report a novel PPARG germline mutation in a patient affected by colorectal cancer that replaces serine 289 with cysteine in the mature protein (S289C). The mutant has impaired transactivation potential and acts as dominant negative to the wild type receptor. In addition, it no longer restrains cell proliferation both in vitro and in vivo. Interestingly, the S289C mutant poorly activates target genes and interferes with the inflammatory pathway in tumor tissues and proximal normal mucosa. Consistently, only mutation carriers exhibit colonic lesions that can evolve to dysplastic polyps. The proband presented also dyslipidemia, hypertension and overweight, not associated to type 2 diabetes; of note, family members tested positive for the mutation and display only a dyslipidemic profile at variable penetrance with other biochemical parameters in the normal range. Finally, superimposing the mutation to the crystal structure of the ligand binding domain, the new Cys289 becomes so closely positioned to Cys285 to form an S-S bridge. This would reduce the depth of the ligand binding pocket and impede agonist positioning, explaining the biological effects and subcellular distribution of the mutant protein. This is the first PPARG germline mutation associated with dyslipidemia and colonic polyp formation that can progress to full-blown adenocarcinoma.
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Affiliation(s)
- D Capaccio
- Department of Biological and Environmental Sciences, University of Sannio, Via Port'Arsa, 11, 82100 Benevento, Italy
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Lumachi F, Ambrosino G, Polistina F, Costantin G, Franceson P, Guglielmi R, Zanco L, Casamassima F, Febbraro A, Gerunda G. 6031 Robotic radiosurgery in the local control of unresectable liver metastases in patients with colorectal cancer – preliminary results. EJC Suppl 2009. [DOI: 10.1016/s1359-6349(09)71126-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Pignata S, Scambia G, Pisano C, Breda E, Di Maio M, Greggi S, Ferrandina G, Lorusso D, Zagonel V, Febbraro A, Riva N, De Rosa V, Gallo C, Perrone F. A multicentre phase II study of carboplatin plus pegylated liposomal doxorubicin as first-line chemotherapy for patients with advanced or recurrent endometrial carcinoma: the END-1 study of the MITO (Multicentre Italian Trials in Ovarian Cancer and Gynecologic Malignancies) group. Br J Cancer 2007; 96:1639-43. [PMID: 17486128 PMCID: PMC2359926 DOI: 10.1038/sj.bjc.6603787] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Anthracyclines and platinum derivates are active drugs for advanced endometrial carcinoma (AEC), but new schedules with higher efficacy and better tolerability are needed. A phase II study was conducted to describe activity and tolerability of carboplatin (C)+pegylated liposomal doxorubicin (PLD) in patients with AEC. Patients with chemonaive AEC, PS ⩽2, aged <75 years, with at least one measurable lesion were eligible. Treatment was C (area under curve 5)+PLD (40 mg m−2) on day 1 every 4 weeks, up to six cycles. Forty-two patients were needed in a single-stage design, with at least 13 objective responses to define the treatment active. Forty-two patients were enrolled. Median age was 64 years (31–74). A total of 64% of patients were recurrent while 36% were advanced. Three complete (7%) and 22 partial responses (52%) were observed, for an overall response rate of 59.5% (95% exact CI: 43.3–74.3). One death potentially related to treatment was recorded (death at home for unknown reasons after 6th cycle). Other relevant toxicities (% of patients) were grade 3/4 neutropaenia 33%/14%, febrile neutropaenia 5%, grade 3/4 thrombocytopaenia 17%/5%, grade 3/4 anaemia 31%/2%. Skin toxicity was mild: grade 1 14%, grade 2 10%, grade 3 5%. Hair loss: complete 5%, partial 12%. The combination of carboplatin and PLD shows good activity and favourable toxicity as first-line chemotherapy of patients with AEC, deserving further studies in this setting.
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Affiliation(s)
- S Pignata
- Instituto Nazionale Tumori, UOC Oncologia Medica B, Napoli, Italy.
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Lorusso D, Pignata S, Scambia G, Zagonel V, Riva N, Febbraro A, Pisano C, Greggi S, Breda E, Morabito A. A multicentre phase 2 study of carboplatin (C) plus pegylated liposomal doxorubicin (PLD) as first-line chemotherapy for patients (pts) with advanced or recurrent endometrial carcinoma (AEC): The END-1 study of the MITO (Multicentre Italian Trials in Ovarian Cancer) Group. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.5041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
5041 Background: Anthracyclines and platinum derivates are active drugs for pts with AEC, but new schedules with higher efficacy and better tolerability are needed. A prospective phase 2 study was conducted to describe tolerability and activity of C + PLD in pts with AEC. Methods: Pts with chemo-naïve AEC, PS ≤2, aged less than 75 years and with at least one measurable lesion were eligible. Treatment was C (AUC 5) + PLD (40 mg/m2) on day 1 every 4 weeks, up to 6 cycles. A single-stage design was applied. With objective response as primary endpoint, type I error = 0.05 and II error = 0.10, p0 = 0.20, p1= 0.40, 42 patients were needed, with at least 13 objective responses to define the treatment active. Response was assessed by RECIST and toxicity was coded with NCI-CTC. Results: From November 2002 to July 2005, 42 pts were enrolled at 5 Institutions. Median age was 64 years (31–74). PS was 0/1/2 in 28/13/1 pts, respectively. 62% of pts were stage IV. Out of 40 pts out of treatment, 3 complete (7.5%) and 20 partial responses (50%) have been already observed, for an overall response rate of 57.5% (95% exact CI: 40.9–73.0). One death potentially related to treatment was recorded (death at home for unknown reasons after 6th cycle). Other relevant toxicities (% of pts) were g3/4 neutropenia 30%/15%, febrile neutropenia 5%, g3/4 thrombocytopenia pts 17.5%/5%, g3/4 anemia 32.5%/5%, g3 heart rhythm 1 pt, g2 liver toxicity 1pt. Skin toxicity was mild: g1 12.5%, g2 7.5%, g3 5%. Hair loss: complete 1 pt, partial 12.5%. Conclusions: The combination of C and PLD shows a good activity and a favourable toxicity profile in first-line chemotherapy of pts with AEC, deserving further studies in this setting. No significant financial relationships to disclose.
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Affiliation(s)
- D. Lorusso
- Catholic University of the Sacred Heart, Rome, Italy; National Cancer Institute, Naples, Italy; San Giovanni Calibita - Fatebenefratelli Hospital, Rome, Italy; Pierantoni Hospital, Forlì, Italy; Fatebenefratelli Hospital, Benevento, Italy
| | - S. Pignata
- Catholic University of the Sacred Heart, Rome, Italy; National Cancer Institute, Naples, Italy; San Giovanni Calibita - Fatebenefratelli Hospital, Rome, Italy; Pierantoni Hospital, Forlì, Italy; Fatebenefratelli Hospital, Benevento, Italy
| | - G. Scambia
- Catholic University of the Sacred Heart, Rome, Italy; National Cancer Institute, Naples, Italy; San Giovanni Calibita - Fatebenefratelli Hospital, Rome, Italy; Pierantoni Hospital, Forlì, Italy; Fatebenefratelli Hospital, Benevento, Italy
| | - V. Zagonel
- Catholic University of the Sacred Heart, Rome, Italy; National Cancer Institute, Naples, Italy; San Giovanni Calibita - Fatebenefratelli Hospital, Rome, Italy; Pierantoni Hospital, Forlì, Italy; Fatebenefratelli Hospital, Benevento, Italy
| | - N. Riva
- Catholic University of the Sacred Heart, Rome, Italy; National Cancer Institute, Naples, Italy; San Giovanni Calibita - Fatebenefratelli Hospital, Rome, Italy; Pierantoni Hospital, Forlì, Italy; Fatebenefratelli Hospital, Benevento, Italy
| | - A. Febbraro
- Catholic University of the Sacred Heart, Rome, Italy; National Cancer Institute, Naples, Italy; San Giovanni Calibita - Fatebenefratelli Hospital, Rome, Italy; Pierantoni Hospital, Forlì, Italy; Fatebenefratelli Hospital, Benevento, Italy
| | - C. Pisano
- Catholic University of the Sacred Heart, Rome, Italy; National Cancer Institute, Naples, Italy; San Giovanni Calibita - Fatebenefratelli Hospital, Rome, Italy; Pierantoni Hospital, Forlì, Italy; Fatebenefratelli Hospital, Benevento, Italy
| | - S. Greggi
- Catholic University of the Sacred Heart, Rome, Italy; National Cancer Institute, Naples, Italy; San Giovanni Calibita - Fatebenefratelli Hospital, Rome, Italy; Pierantoni Hospital, Forlì, Italy; Fatebenefratelli Hospital, Benevento, Italy
| | - E. Breda
- Catholic University of the Sacred Heart, Rome, Italy; National Cancer Institute, Naples, Italy; San Giovanni Calibita - Fatebenefratelli Hospital, Rome, Italy; Pierantoni Hospital, Forlì, Italy; Fatebenefratelli Hospital, Benevento, Italy
| | - A. Morabito
- Catholic University of the Sacred Heart, Rome, Italy; National Cancer Institute, Naples, Italy; San Giovanni Calibita - Fatebenefratelli Hospital, Rome, Italy; Pierantoni Hospital, Forlì, Italy; Fatebenefratelli Hospital, Benevento, Italy
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Di Maio M, Iaffaioli RV, de Placido S, Biamonte R, Scambia G, Di Vagno G, Febbraro A, Colucci G, Pisano C, Pignata S. Residual neurotoxicity in patients with ovarian cancer in clinical remission after first-line chemotherapy with carboplatin and paclitaxel: The Multicenter Italian Trials in Ovarian cancer (MITO-4) retrospective study. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.5015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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)
- M. Di Maio
- National Cancer Institute, Naples, Italy; National Cancer Institute, Naples, Italy; Università Fed II, Naples, Italy; Osp Mariano Santo, Cosenza, Italy; Policlinico Univ Gemelli, Roma, Italy; Casa Sollievo della Sofferenza, San Giovanni Rotondo (FG), Italy; Osp Fatebenefratelli, Benevento, Italy; IRCCS Oncologico, Bari, Italy
| | - R. V. Iaffaioli
- National Cancer Institute, Naples, Italy; National Cancer Institute, Naples, Italy; Università Fed II, Naples, Italy; Osp Mariano Santo, Cosenza, Italy; Policlinico Univ Gemelli, Roma, Italy; Casa Sollievo della Sofferenza, San Giovanni Rotondo (FG), Italy; Osp Fatebenefratelli, Benevento, Italy; IRCCS Oncologico, Bari, Italy
| | - S. de Placido
- National Cancer Institute, Naples, Italy; National Cancer Institute, Naples, Italy; Università Fed II, Naples, Italy; Osp Mariano Santo, Cosenza, Italy; Policlinico Univ Gemelli, Roma, Italy; Casa Sollievo della Sofferenza, San Giovanni Rotondo (FG), Italy; Osp Fatebenefratelli, Benevento, Italy; IRCCS Oncologico, Bari, Italy
| | - R. Biamonte
- National Cancer Institute, Naples, Italy; National Cancer Institute, Naples, Italy; Università Fed II, Naples, Italy; Osp Mariano Santo, Cosenza, Italy; Policlinico Univ Gemelli, Roma, Italy; Casa Sollievo della Sofferenza, San Giovanni Rotondo (FG), Italy; Osp Fatebenefratelli, Benevento, Italy; IRCCS Oncologico, Bari, Italy
| | - G. Scambia
- National Cancer Institute, Naples, Italy; National Cancer Institute, Naples, Italy; Università Fed II, Naples, Italy; Osp Mariano Santo, Cosenza, Italy; Policlinico Univ Gemelli, Roma, Italy; Casa Sollievo della Sofferenza, San Giovanni Rotondo (FG), Italy; Osp Fatebenefratelli, Benevento, Italy; IRCCS Oncologico, Bari, Italy
| | - G. Di Vagno
- National Cancer Institute, Naples, Italy; National Cancer Institute, Naples, Italy; Università Fed II, Naples, Italy; Osp Mariano Santo, Cosenza, Italy; Policlinico Univ Gemelli, Roma, Italy; Casa Sollievo della Sofferenza, San Giovanni Rotondo (FG), Italy; Osp Fatebenefratelli, Benevento, Italy; IRCCS Oncologico, Bari, Italy
| | - A. Febbraro
- National Cancer Institute, Naples, Italy; National Cancer Institute, Naples, Italy; Università Fed II, Naples, Italy; Osp Mariano Santo, Cosenza, Italy; Policlinico Univ Gemelli, Roma, Italy; Casa Sollievo della Sofferenza, San Giovanni Rotondo (FG), Italy; Osp Fatebenefratelli, Benevento, Italy; IRCCS Oncologico, Bari, Italy
| | - G. Colucci
- National Cancer Institute, Naples, Italy; National Cancer Institute, Naples, Italy; Università Fed II, Naples, Italy; Osp Mariano Santo, Cosenza, Italy; Policlinico Univ Gemelli, Roma, Italy; Casa Sollievo della Sofferenza, San Giovanni Rotondo (FG), Italy; Osp Fatebenefratelli, Benevento, Italy; IRCCS Oncologico, Bari, Italy
| | - C. Pisano
- National Cancer Institute, Naples, Italy; National Cancer Institute, Naples, Italy; Università Fed II, Naples, Italy; Osp Mariano Santo, Cosenza, Italy; Policlinico Univ Gemelli, Roma, Italy; Casa Sollievo della Sofferenza, San Giovanni Rotondo (FG), Italy; Osp Fatebenefratelli, Benevento, Italy; IRCCS Oncologico, Bari, Italy
| | - S. Pignata
- National Cancer Institute, Naples, Italy; National Cancer Institute, Naples, Italy; Università Fed II, Naples, Italy; Osp Mariano Santo, Cosenza, Italy; Policlinico Univ Gemelli, Roma, Italy; Casa Sollievo della Sofferenza, San Giovanni Rotondo (FG), Italy; Osp Fatebenefratelli, Benevento, Italy; IRCCS Oncologico, Bari, Italy
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Iaffaioli RV, Formato R, Tortoriello A, Del Prete S, Caraglia M, Pappagallo G, Pisano A, Gebbia V, Fanelli F, Ianniello G, Cigolari S, Pizza C, Marano O, Pezzella G, Pedicini T, Febbraro A, Incoronato P, Manzione L, Ferrari E, Marzano N, Quattrin S, Pisconti S, Nasti G, Giotta G, Colucci G. Phase II study of sequential hormonal therapy with anastrozole/exemestane in advanced and metastatic breast cancer. Br J Cancer 2005; 92:1621-5. [PMID: 15856035 PMCID: PMC2362023 DOI: 10.1038/sj.bjc.6602579] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2004] [Revised: 03/07/2005] [Accepted: 03/07/2005] [Indexed: 11/16/2022] Open
Abstract
Hormonal therapy is the preferred systemic treatment for recurrent or metastatic, post-menopausal hormone-receptor-positive breast cancer. Previous studies have shown that there is no cross-resistance between exemestane and reversible aromatase inhibitors. Exposure to hormonal therapy does not hamper later response to chemotherapy. Patients with locally advanced or metastatic, hormonal receptor positive or unknown, breast cancer were treated with oral anastrozole, until disease progression, followed by oral exemestane until new evidence of disease progression. The primary end point of the study was clinical benefit, defined as the sum of complete responses (CR), partial responses (PR) and > 24 weeks stable disease (SD). In all, 100 patients were enrolled in the study. Anastrozole produced eight CR and 19 PR for an overall response rate of 27% (95% CI: 18.6-36.8%). An additional 46 patients had long-term (> 24 weeks) SD for an overall clinical benefit of 73% (95% CI: 63.2-81.4). Median time to progression (TTP) was 11 months (95% CI: 10-12). A total of 50 patients were evaluated for the second-line treatment: exemestane produced one CR and three PR; 25 patients had SD which lasted > or = 6 months in 18 patients. Median TTP was 5 months. Toxicity of treatment was low. Our study confirms that treatment with sequential hormonal agents can extend the period of time during which endocrine therapy can be used, thereby deferring the decision to use chemotherapy.
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