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Dalla Volta A, Valcamonico F, Zivi A, Procopio G, Sepe P, Del Conte G, Di Meo N, Foti S, Zamboni S, Messina C, Lucchini E, Rizzi A, Ravanelli M, Calza S, Zacchi F, Ciccone G, Suardi N, Maroldi R, Farina D, Berruti A. Whole-body Diffusion-weighted Magnetic Resonance Imaging for Assessment of the Bone Response Rate in Patients with Metastatic Hormone-sensitive Prostate Cancer Receiving Enzalutamide. Eur Urol 2024:S0302-2838(24)02347-9. [PMID: 38772788 DOI: 10.1016/j.eururo.2024.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 04/15/2024] [Accepted: 05/01/2024] [Indexed: 05/23/2024]
Affiliation(s)
- Alberto Dalla Volta
- Unit of Medical Oncology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, ASST Spedali Civili di Brescia, University of Brescia, Brescia, Italy.
| | - Francesca Valcamonico
- Unit of Medical Oncology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, ASST Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - Andrea Zivi
- Division of Oncology, Verona University and Hospital Trust, Verona, Italy; Oncology Area, Section of Innovation Biomedicine, Department of Engineering for Innovation Medicine, University of Verona, Verona, Italy
| | - Giuseppe Procopio
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Pierangela Sepe
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Gianluca Del Conte
- Department of Oncology, Fondazione IRCCS San Raffaele Hospital, Milan, Italy
| | - Nunzia Di Meo
- Unit of Radiology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, ASST Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - Silvia Foti
- Department of Oncology, Fondazione IRCCS San Raffaele Hospital, Milan, Italy
| | - Stefania Zamboni
- Unit of Urology, Department of Medical and Surgical Specialties, Radiological Science and Public Health, ASST Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - Caterina Messina
- Unit of Medical Oncology, ASST Papa Giovanni XXIII, Bergamo, Italy
| | | | - Anna Rizzi
- Unit of Medical Oncology, ASST Garda, Manerbio, Italy
| | - Marco Ravanelli
- Unit of Radiology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, ASST Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - Stefano Calza
- Unit of Biostatistics and Bioinformatics, Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Francesca Zacchi
- Division of Oncology, Verona University and Hospital Trust, Verona, Italy; Oncology Area, Section of Innovation Biomedicine, Department of Engineering for Innovation Medicine, University of Verona, Verona, Italy
| | - Giovannino Ciccone
- Unit of Clinical Epidemiology, AOU Città della Salute e della Scienza di Torino and CPO Piemonte, Turin, Italy
| | - Nazareno Suardi
- Unit of Urology, Department of Medical and Surgical Specialties, Radiological Science and Public Health, ASST Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - Roberto Maroldi
- Unit of Radiology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, ASST Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - Davide Farina
- Unit of Radiology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, ASST Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - Alfredo Berruti
- Unit of Medical Oncology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, ASST Spedali Civili di Brescia, University of Brescia, Brescia, Italy
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Simbolo M, Centonze G, Gkountakos A, Monti V, Maisonneuve P, Golovco S, Sabella G, Del Gobbo A, Gobbo S, Ferrero S, Fabbri A, Pardo C, Garzone G, Prinzi N, Pusceddu S, Testi A, Rolli L, Mangogna A, Bercich L, Benvenuti MR, Bria E, Pilotto S, Berruti A, Pastorino U, Capella C, Infante M, Milella M, Scarpa A, Milione M. Characterization of two transcriptomic subtypes of marker-null large cell carcinoma of the lung suggests different origin and potential new therapeutic perspectives. Virchows Arch 2024; 484:777-788. [PMID: 38168015 PMCID: PMC11106141 DOI: 10.1007/s00428-023-03721-4] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 11/13/2023] [Accepted: 12/05/2023] [Indexed: 01/05/2024]
Abstract
Pulmonary large cell carcinoma (LCC) is an undifferentiated neoplasm lacking morphological, histochemical, and immunohistochemical features of small cell lung cancer, adenocarcinoma (ADC), or squamous cell carcinoma (SCC). The available molecular information on this rare disease is limited. This study aimed to provide an integrated molecular overview of 16 cases evaluating the mutational asset of 409 genes and the transcriptomic profiles of 20,815 genes. Our data showed that TP53 was the most frequently inactivated gene (15/16; 93.7%) followed by RB1 (5/16; 31.3%) and KEAP1 (4/16; 25%), while CRKL and MYB genes were each amplified in 4/16 (25%) cases and MYC in 3/16 (18.8%) cases; transcriptomic analysis identified two molecular subtypes including a Pure-LCC and an adenocarcinoma like-LCC (ADLike-LCC) characterized by different activated pathways and cell of origin. In the Pure-LCC group, POU2F3 and FOXI1 were distinctive overexpressed markers. A tuft cell-like profile and the enrichment of a replication stress signature, particularly involving ATR, was related to this profile. Differently, the ADLike-LCC were characterized by an alveolar-cell transcriptomic profile and association with AIM2 inflammasome complex signature. In conclusion, our study split the histological marker-null LCC into two different transcriptomic entities, with POU2F3, FOXI1, and AIM2 genes as differential expression markers that might be probed by immunohistochemistry for the differential diagnosis between Pure-LCC and ADLike-LCC. Finally, the identification of several signatures linked to replication stress in Pure-LCC and inflammasome complex in ADLike-LCC could be useful for designing new potential therapeutic approaches for these subtypes.
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Affiliation(s)
- Michele Simbolo
- Section of Pathology, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Giovanni Centonze
- 1st Pathology Division, Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Anastasios Gkountakos
- Section of Pathology, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Valentina Monti
- 1st Pathology Division, Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Patrick Maisonneuve
- Division of Epidemiology and Biostatistics, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Stela Golovco
- Section of Pathology, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Giovanna Sabella
- 1st Pathology Division, Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Alessandro Del Gobbo
- Division of Pathology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Stefano Gobbo
- Department of Traslational Medicine, University of Ferrara, Ferrara, Italy
| | - Stefano Ferrero
- Division of Pathology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alessandra Fabbri
- 2nd Pathology Division, Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Carlotta Pardo
- 1st Pathology Division, Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Giovanna Garzone
- 1st Pathology Division, Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Natalie Prinzi
- Division of Pathology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Sara Pusceddu
- Medical Oncology Department, Fondazione IRCCS, Istituto Nazionale Dei Tumori, Milan, Italy
| | - Adele Testi
- 2nd Pathology Division, Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Luigi Rolli
- Thoracic Surgery Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Alessandro Mangogna
- Institute for Maternal and Child Health, IRCCS Burlo Garofalo, Trieste, Italy
| | - Luisa Bercich
- Department of Pathology, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Mauro Roberto Benvenuti
- Thoracic Surgery Unit, Department of Medical and Surgical Specialties Radiological Sciences and Public Health, Medical Oncology, University of Brescia, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Emilio Bria
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Sara Pilotto
- Section of Oncology, Department of Medicine, University of Verona, Verona, Italy
| | - Alfredo Berruti
- Medical Oncology Unit, ASST Spedali Civili of Brescia, Department of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia, Brescia, Italy
| | - Ugo Pastorino
- Thoracic Surgery Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Carlo Capella
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | | | - Michele Milella
- Section of Oncology, Department of Medicine, University of Verona, Verona, Italy
| | - Aldo Scarpa
- Section of Pathology, Department of Diagnostics and Public Health, University of Verona, Verona, Italy.
- ARC-NET Research Centre for Applied Research On Cancer, University and Hospital Trust of Verona, Piazzale Scuro, 10, 37134, Verona (VR), Italy.
| | - Massimo Milione
- 1st Pathology Division, Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
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Scatolini M, Grisanti S, Tomaiuolo P, Grosso E, Basile V, Cosentini D, Puglisi S, Laganà M, Perotti P, Saba L, Rossini E, Palermo F, Sigala S, Volante M, Berruti A, Terzolo M. Germline NGS targeted analysis in adult patients with sporadic adrenocortical carcinoma. Eur J Cancer 2024; 205:114088. [PMID: 38714106 DOI: 10.1016/j.ejca.2024.114088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 04/11/2024] [Accepted: 04/21/2024] [Indexed: 05/09/2024]
Abstract
BACKGROUND Adrenocortical carcinoma (ACC) is a rare cancer that arises sporadically or due to hereditary syndromes. Data on germline variants (GVs) in sporadic ACC are limited. Our aim was to characterize GVs of genes potentially related to adrenal diseases in 150 adult patients with sporadic ACC. METHODS This was a retrospective analysis of stage I-IV ACC patients with sporadic ACC from two reference centers for ACC in Italy. Patients were included in the analysis if they had confirmed diagnosis of ACC, a frozen peripheral blood sample and complete clinical and follow-up data. Next generation sequencing technology was used to analyze the prevalence of GVs in a custom panel of 17 genes belonging to either cancer-predisposition genes or adrenocortical-differentiation genes categories. RESULTS We identified 18 GVs based on their frequency, enrichment and predicted functional characteristics. We found six pathogenic (P) or likely pathogenic (LP) variants in ARMC5, CTNNB1, MSH2, PDE11A and TP53 genes; and twelve variants lacking evidence of pathogenicity. New unique P/LP variants were identified in TP53 (p.G105D) and, for the first time, in ARMC5 (p.P731R). The presence of P/LP GVs was associated with reduced survival outcomes and had a significant and independent impact on both progression-free survival and overall survival. CONCLUSIONS GVs were present in 6.7 % of patients with sporadic ACC, and we identified novel variants of ARMC5 and TP53. These findings may improve understanding of ACC pathogenesis and enable genetic counseling of patients and their families.
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Affiliation(s)
- Maria Scatolini
- Molecular Oncology Laboratory, Fondazione Edo ed Elvo Tempia, 13875 Ponderano, BI, Italy
| | - Salvatore Grisanti
- Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, ASST Spedali Civili, 25123 Brescia, Italy
| | - Pasquale Tomaiuolo
- Molecular Oncology Laboratory, Fondazione Edo ed Elvo Tempia, 13875 Ponderano, BI, Italy; Internal Medicine, Department of Clinical and Biological Sciences, S. Luigi Gonzaga Hospital, University of Turin, 10043 Orbassano, Italy
| | - Enrico Grosso
- Molecular Oncology Laboratory, Fondazione Edo ed Elvo Tempia, 13875 Ponderano, BI, Italy
| | - Vittoria Basile
- Internal Medicine, Department of Clinical and Biological Sciences, S. Luigi Gonzaga Hospital, University of Turin, 10043 Orbassano, Italy
| | - Deborah Cosentini
- Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, ASST Spedali Civili, 25123 Brescia, Italy
| | - Soraya Puglisi
- Internal Medicine, Department of Clinical and Biological Sciences, S. Luigi Gonzaga Hospital, University of Turin, 10043 Orbassano, Italy.
| | - Marta Laganà
- Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, ASST Spedali Civili, 25123 Brescia, Italy
| | - Paola Perotti
- Internal Medicine, Department of Clinical and Biological Sciences, S. Luigi Gonzaga Hospital, University of Turin, 10043 Orbassano, Italy
| | - Laura Saba
- Internal Medicine, Department of Clinical and Biological Sciences, S. Luigi Gonzaga Hospital, University of Turin, 10043 Orbassano, Italy
| | - Elisa Rossini
- Department of Molecular & Translational Medicine, Section of Pharmacology, University of Brescia, 25123 Brescia, Italy
| | - Flavia Palermo
- Molecular Oncology Laboratory, Fondazione Edo ed Elvo Tempia, 13875 Ponderano, BI, Italy
| | - Sandra Sigala
- Department of Molecular & Translational Medicine, Section of Pharmacology, University of Brescia, 25123 Brescia, Italy
| | - Marco Volante
- Pathology Unit, Oncology department, University of Turin, San Luigi Gonzaga University Hospital, Regione Gonzole 10, 10043 Orbassano, Turin, Italy
| | - Alfredo Berruti
- Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, ASST Spedali Civili, 25123 Brescia, Italy
| | - Massimo Terzolo
- Internal Medicine, Department of Clinical and Biological Sciences, S. Luigi Gonzaga Hospital, University of Turin, 10043 Orbassano, Italy
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Bergamini M, Dalla Volta A, Palumbo C, Zamboni S, Triggiani L, Zamparini M, Laganà M, Rinaudo L, Di Meo N, Caramella I, Bresciani R, Valcamonico F, Borghetti P, Guerini A, Farina D, Antonelli A, Simeone C, Mazziotti G, Berruti A. Relationship between circulating FSH levels and body composition and bone health in patients with prostate cancer who undergo androgen deprivation therapy: The BLADE study. eLife 2024; 13:e92655. [PMID: 38656229 PMCID: PMC11042799 DOI: 10.7554/elife.92655] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 04/03/2024] [Indexed: 04/26/2024] Open
Abstract
Background Among its extragonadal effects, follicle-stimulating hormone (FSH) has an impact on body composition and bone metabolism. Since androgen deprivation therapy (ADT) has a profound impact on circulating FSH concentrations, this hormone could potentially be implicated in the changes of fat body mass (FBM), lean body mass (LBM), and bone fragility induced by ADT. The objective of this study is to correlate FSH serum levels with body composition parameters, bone mineral density (BMD), and bone turnover markers at baseline conditions and after 12 months of ADT. Methods Twenty-nine consecutive non-metastatic prostate cancer (PC) patients were enrolled from 2017 to 2019 in a phase IV study. All patients underwent administration of the luteinizing hormone-releasing hormone antagonist degarelix. FBM, LBM, and BMD were evaluated by dual-energy x-ray absorptiometry at baseline and after 12 months of ADT. FSH, alkaline phosphatase, and C-terminal telopeptide of type I collagen were assessed at baseline and after 6 and 12 months. For outcome measurements and statistical analysis, t-test or sign test and Pearson or Spearman tests for continuous variables were used when indicated. Results At baseline conditions, a weak, non-significant, direct relationship was found between FSH serum levels and FBM at arms (r = 0.36) and legs (r = 0.33). Conversely, a stronger correlation was observed between FSH and total FBM (r = 0.52, p = 0.006), fat mass at arms (r = 0.54, p = 0.004), and fat mass at trunk (r = 0.45, p = 0.018) assessed after 12 months. On the other hand, an inverse relationship between serum FSH and appendicular lean mass index/FBM ratio was observed (r = -0.64, p = 0.001). This is an ancillary study of a prospective trial and this is the main limitation. Conclusions FSH serum levels after ADT could have an impact on body composition, in particular on FBM. Therefore, FSH could be a promising marker to monitor the risk of sarcopenic obesity and to guide the clinicians in the tailored evaluation of body composition in PC patients undergoing ADT. Funding This research was partially funded by Ferring Pharmaceuticals. The funder had no role in design and conduct of the study, collection, management, analysis, and interpretation of the data and in preparation, review, or approval of the manuscript. Clinical trial number clinicalTrials.gov NCT03202381, EudraCT Number 2016-004210-10.
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Affiliation(s)
- Marco Bergamini
- Medical Oncology Unit, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of BresciaBresciaItaly
| | - Alberto Dalla Volta
- Medical Oncology Unit, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of BresciaBresciaItaly
| | - Carlotta Palumbo
- Division of Urology, Department of Translational Medicine, University of Eastern Piedmont, Maggiore Della Carità HospitalNovaraItaly
| | - Stefania Zamboni
- Urology Unit, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of BresciaBresciaItaly
| | - Luca Triggiani
- Radiation Oncology Unit, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of BresciaBresciaItaly
| | - Manuel Zamparini
- Medical Oncology Unit, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of BresciaBresciaItaly
| | - Marta Laganà
- Medical Oncology Unit, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of BresciaBresciaItaly
| | | | - Nunzia Di Meo
- Radiology Unit, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of BresciaBresciaItaly
| | - Irene Caramella
- Medical Oncology Unit, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of BresciaBresciaItaly
| | - Roberto Bresciani
- Division of Biotechnology, Department of Molecular and Translational Medicine (DMTM), University of BresciaBresciaItaly
| | - Francesca Valcamonico
- Medical Oncology Unit, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of BresciaBresciaItaly
| | - Paolo Borghetti
- Radiation Oncology Unit, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of BresciaBresciaItaly
| | - Andrea Guerini
- Radiation Oncology Unit, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of BresciaBresciaItaly
| | - Davide Farina
- Radiology Unit, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of BresciaBresciaItaly
| | - Alessandro Antonelli
- Urology Unit, AOUI Verona, Department of Surgery, Dentistry, Pediatrics and Gynecology, University of VeronaVeronaItaly
| | - Claudio Simeone
- Urology Unit, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of BresciaBresciaItaly
| | - Gherardo Mazziotti
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-MilanMilanItaly
- Endocrinology, Diabetology and Medical Andrology Unit, Metabolic Bone Diseases and Osteoporosis Section, IRCCS Humanitas Research Hospital,MilanItaly
| | - Alfredo Berruti
- Medical Oncology Unit, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of BresciaBresciaItaly
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Pedersini R, Buffoni M, Petrelli F, Ghidini A, di Mauro P, Amoroso V, Parati MC, Laini L, Cosentini D, Schivardi G, Ippolito G, Berruti A, Laganà M. Gastrointestinal Toxicity of Antibody Drug Conjugates (ADCs) in Metastatic Breast Cancer: A Pooled Analysis. Clin Breast Cancer 2024:S1526-8209(24)00103-4. [PMID: 38734491 DOI: 10.1016/j.clbc.2024.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 02/22/2024] [Accepted: 04/05/2024] [Indexed: 05/13/2024]
Abstract
Trastuzumab emtansine (T-DM1), sacituzumab govitecan (SG), and trastuzumab deruxtecan (T-DXd) are three ADCs approved for the treatment of metastatic breast cancer (MBC). Since gastrointestinal toxicities have been commonly observed with these drugs in clinical trials, a pooled analysis evaluating gastrointestinal adverse events (AEs) in patients with MBC treated with ADCs in clinical trials was performed. PubMed, Embase, and the Cochrane Library were searched from inception until May 2023 for phase II and III clinical trials reporting frequency and severity of gastrointestinal AEs during treatment with ADCs. Data were retrieved for nausea, vomiting, diarrhea, constipation, and abdominal pain: overall and grade 3-4 toxicity rates according to NCI-CTCAE were collected and expressed as proportions. A pre-specified subgroup analysis according to the agent was also carried out. Fourteen studies, comprising 5608 patients, were included in the analysis. Gastrointestinal AEs were frequently registered with SG and T-DXd. A significantly higher frequency of nausea (65.6% with SG, 75% with T-DXd), vomiting (43.7% with SG, 45% with T-DXd), and diarrhea (59.7% with SG, 29% with T-DXd) was noticed with these ADCs compared to TDM-1. Furthermore, diarrhea was more frequently associated with SG (grade 3 in 7.5% of patients), while constipation and abdominal pain were less common. Gastrointestinal AEs, notably nausea and diarrhea, were frequently reported by MBC patients treated with SG and T-DXd in clinical trials. Since these ADCs are administered continuously until disease progression or occurrence of unbearable AEs, gastrointestinal toxicity may have a negative impact on patient quality of life. Therefore, appropriate management of gastrointestinal AEs is mandatory to ensure treatment efficacy and adherence.
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Affiliation(s)
- Rebecca Pedersini
- Medical Oncology Department, ASST-Spedali Civili of Brescia, Brescia, Italy; SSVD Breast Unit, ASST-Spedali Civili of Brescia, Brescia, Italy
| | - Martina Buffoni
- Medical Oncology Department, ASST-Spedali Civili of Brescia, Brescia, Italy.
| | | | | | - Pierluigi di Mauro
- Medical Oncology Department, ASST-Spedali Civili of Brescia, Brescia, Italy
| | - Vito Amoroso
- Medical Oncology Department, ASST-Spedali Civili of Brescia, Brescia, Italy
| | | | - Lara Laini
- Medical Oncology Department, ASST-Spedali Civili of Brescia, Brescia, Italy
| | - Deborah Cosentini
- Medical Oncology Department, ASST-Spedali Civili of Brescia, Brescia, Italy
| | - Greta Schivardi
- Medical Oncology Department, ASST-Spedali Civili of Brescia, Brescia, Italy
| | - Giuseppe Ippolito
- Medical Oncology Department, ASST-Spedali Civili of Brescia, Brescia, Italy
| | - Alfredo Berruti
- Medical Oncology Department, ASST-Spedali Civili of Brescia, Brescia, Italy
| | - Marta Laganà
- Medical Oncology Department, ASST-Spedali Civili of Brescia, Brescia, Italy
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Laganà M, Cosentini D, Tiberio GAM, Sigala S, Berruti A. Letter re: Impact of EDP-M on survival of patients with metastatic adrenocortical carcinoma: A population-based study. Eur J Cancer 2024; 201:113602. [PMID: 38364625 DOI: 10.1016/j.ejca.2024.113602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 01/10/2024] [Indexed: 02/18/2024]
Affiliation(s)
- Marta Laganà
- Adrenal Cancer Unit, ASST-Spedali Civili, Brescia, Italy; Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Medical Oncology Unit, University of Brescia at ASST-Spedali Civili, Brescia, Italy
| | - Deborah Cosentini
- Adrenal Cancer Unit, ASST-Spedali Civili, Brescia, Italy; Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Medical Oncology Unit, University of Brescia at ASST-Spedali Civili, Brescia, Italy.
| | - Guido Alberto Massimo Tiberio
- Adrenal Cancer Unit, ASST-Spedali Civili, Brescia, Italy; Radiology Unit, ASST Spedali Civili, Brescia, Italy; Department of Clinical and Experimental Sciences, Surgical Unit, University of Brescia at ASST-Spedali Civili, Brescia, Italy
| | - Sandra Sigala
- Adrenal Cancer Unit, ASST-Spedali Civili, Brescia, Italy; Section of Pharmacology, Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Alfredo Berruti
- Adrenal Cancer Unit, ASST-Spedali Civili, Brescia, Italy; Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Medical Oncology Unit, University of Brescia at ASST-Spedali Civili, Brescia, Italy
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Baudin E, Goichot B, Berruti A, Hadoux J, Moalla S, Laboureau S, Nölting S, de la Fouchardière C, Kienitz T, Deutschbein T, Zovato S, Amar L, Haissaguerre M, Timmers H, Niccoli P, Faggiano A, Angokai M, Lamartina L, Luca F, Cosentini D, Hahner S, Beuschlein F, Attard M, Texier M, Fassnacht M. Sunitinib for metastatic progressive phaeochromocytomas and paragangliomas: results from FIRSTMAPPP, an academic, multicentre, international, randomised, placebo-controlled, double-blind, phase 2 trial. Lancet 2024; 403:1061-1070. [PMID: 38402886 DOI: 10.1016/s0140-6736(23)02554-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 10/04/2023] [Accepted: 11/13/2023] [Indexed: 02/27/2024]
Abstract
BACKGROUND No randomised controlled trial has ever been done in patients with metastatic phaeochromocytomas and paragangliomas. Preclinical and first clinical evidence suggested beneficial effects of sunitinib. We aimed to evaluate the safety and efficacy of sunitinib in patients with metastatic phaeochromocytomas and paragangliomas. METHODS FIRSTMAPPP is a multicentre, international, randomised, placebo-controlled, double-blind, phase 2 trial done at 14 academic centres across four European countries. Eligible participants were adults (aged ≥18 years) with sporadic or inherited progressive metastatic phaeochromocytomas and paragangliomas. Patients were randomly assigned (1:1) to receive either oral sunitinib (37·5 mg per day) or placebo. Randomisation was stratified according to SDHB status (mutation present vs wild type) and number of previous systemic therapies (0 vs ≥1). Primary endpoint was the rate of progression-free survival at 12 months according to real-time central review (Response Evaluation Criteria in Solid Tumours version 1.1). On the basis of a two-step Simon model, we aimed for the accrual of 78 patients, assuming a 20% improvement of the 12-month progression-free survival rate from 20% to 40%, to conclude that sunitinib is effective. Crossover from the placebo group was allowed. This trial is registered with ClinicalTrials.gov, number NCT01371201, and is closed for enrolment. FINDINGS From Dec 1, 2011, to Jan 31, 2019, a total of 78 patients with progressive metastatic phaeochromocytomas and paragangliomas were enrolled (39 patients per group). 25 (32%) of 78 patients had germline SDHx variants and 54 (69%) had used previous therapies. The primary endpoint was met, with a 12-month progression-free survival in 14 of 39 patients (36% [90% CI 23-50]) in the sunitinib group. In the placebo group, the 12-month progression-free survival in seven of 39 patients was 19% (90% CI 11-31), validating the hypotheses of our study design. The most frequent grade 3 or 4 adverse events were asthenia (seven [18%] of 39 and one [3%] of 39), hypertension (five [13%] and four [10%]), and back or bone pain (one [3%] and three [8%]) in the sunitinib and placebo groups, respectively. Three deaths occurred in the sunitinib group: these deaths were due to respiratory insufficiency, amyotrophic lateral sclerosis, and rectal bleeding. Only the latter event was considered drug related. Two deaths occurred in the placebo group due to aspiration pneumonia and septic shock. INTERPRETATION This first randomised trial supports the use of sunitinib as the medical option with the highest level of evidence for anti-tumour efficacy in progressive metastatic phaeochromocytomas and paragangliomas. FUNDING French Ministry of Health, through the National Institute for Cancer, German Ministry of Education and Research, and the German Research Foundation within the CRC/Transregio 205/2, EU Seventh Framework Programme, and a private donator grant.
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Affiliation(s)
- Eric Baudin
- Department of Imaging, Endocrine Oncology Unit, Gustave Roussy, University Paris Saclay, Villejuif, France.
| | - Bernard Goichot
- Department of Endocrinology, Hopital de Hautepierre-Hopitaux Universitaires de Strasbourg, Strasbourg, France
| | - Alfredo Berruti
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, Azienda Ospedaliera Spedali Civili di Brescia, Brescia, Italy
| | - Julien Hadoux
- Department of Imaging, Endocrine Oncology Unit, Gustave Roussy, University Paris Saclay, Villejuif, France
| | - Salma Moalla
- Department of Imaging, Endocrine Oncology Unit, Gustave Roussy, University Paris Saclay, Villejuif, France
| | - Sandrine Laboureau
- Department of Endocrinology Diabetology Nutrition, Hopitaux Universitaires d'Angers, Angers, France
| | - Svenja Nölting
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, Germany
| | | | - Tina Kienitz
- Department of Endocrinology and Metabolism, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Timo Deutschbein
- Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital, University of Würzburg, Würzburg, Germany
| | - Stefania Zovato
- Familial Cancer Clinics, Istituto Oncologico Veneto, IRCCS, Padova, Italy
| | - Laurence Amar
- Department of Hypertension PARIS, Hopital Europeen Georges-Pompidou, Université Paris Cité, Paris, France
| | | | - Henri Timmers
- Internal Medicine, Radboud University Medical Center, Nijmegen, Netherlands
| | - Patricia Niccoli
- Department of Medical Oncology, Institut Paoli Calmette, Marseille, France
| | - Antongiulio Faggiano
- Department of Clinical Medicine and Surgery, Endocrinology, Diabetology and Andrology Unit, Federico II University of Naples, Naples, Italy
| | - Moussa Angokai
- Office of Biostatistics and Epidemiology, Gustave Roussy, Université Paris-Saclay, Villejuif, France; Inserm, Université Paris-Saclay, CESP U1018, Oncostat, labeled Ligue Contre le Cancer, Villejuif, France
| | - Livia Lamartina
- Department of Imaging, Endocrine Oncology Unit, Gustave Roussy, University Paris Saclay, Villejuif, France
| | - Florina Luca
- Department of Endocrinology, Hopital de Hautepierre-Hopitaux Universitaires de Strasbourg, Strasbourg, France
| | - Deborah Cosentini
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, Azienda Ospedaliera Spedali Civili di Brescia, Brescia, Italy
| | - Stefanie Hahner
- Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital, University of Würzburg, Würzburg, Germany
| | - Felix Beuschlein
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, Germany
| | - Marie Attard
- Department of Imaging, Endocrine Oncology Unit, Gustave Roussy, University Paris Saclay, Villejuif, France
| | - Matthieu Texier
- Office of Biostatistics and Epidemiology, Gustave Roussy, Université Paris-Saclay, Villejuif, France; Inserm, Université Paris-Saclay, CESP U1018, Oncostat, labeled Ligue Contre le Cancer, Villejuif, France
| | - Martin Fassnacht
- Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital, University of Würzburg, Würzburg, Germany; Comprehensive Cancer Center Mainfranken, University of Würzburg, Würzburg, Germany
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Antonini S, Pedersini R, Birtolo MF, Baruch NL, Carrone F, Jaafar S, Ciafardini A, Cosentini D, Laganà M, Torrisi R, Farina D, Leonardi L, Balzarini L, Vena W, Bossi AC, Zambelli A, Lania AG, Berruti A, Mazziotti G. Correction: Denosumab improves trabecular bone score in relationship with decrease in fracture risk of women exposed to aromatase inhibitors. J Endocrinol Invest 2024; 47:759. [PMID: 37814065 DOI: 10.1007/s40618-023-02208-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/11/2023]
Affiliation(s)
- S Antonini
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, MI, Italy
- Endocrinology, Diabetology and Andrology Unit, IRCCS Humanitas Research Hospital, Rozzano, MI, Italy
| | - R Pedersini
- Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, ASST Spedali Civili of Brescia, Brescia, Italy
| | - M F Birtolo
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, MI, Italy
- Endocrinology, Diabetology and Andrology Unit, IRCCS Humanitas Research Hospital, Rozzano, MI, Italy
| | - N L Baruch
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, MI, Italy
| | - F Carrone
- Endocrinology, Diabetology and Andrology Unit, IRCCS Humanitas Research Hospital, Rozzano, MI, Italy
| | - S Jaafar
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, MI, Italy
- Endocrinology, Diabetology and Andrology Unit, IRCCS Humanitas Research Hospital, Rozzano, MI, Italy
| | - A Ciafardini
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, MI, Italy
- Endocrinology, Diabetology and Andrology Unit, IRCCS Humanitas Research Hospital, Rozzano, MI, Italy
| | - D Cosentini
- Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, ASST Spedali Civili of Brescia, Brescia, Italy
| | - M Laganà
- Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, ASST Spedali Civili of Brescia, Brescia, Italy
| | - R Torrisi
- Cancer Center, IRCCS Humanitas Research Hospital, Rozzano, MI, Italy
| | - D Farina
- Radiology Unit 2, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, ASST Spedali Civili of Brescia, Brescia, Italy
| | - L Leonardi
- Department of Radiology, IRCCS Humanitas Research Hospital, Rozzano, MI, Italy
| | - L Balzarini
- Department of Radiology, IRCCS Humanitas Research Hospital, Rozzano, MI, Italy
| | - W Vena
- Endocrinology, Humanitas Gavazzeni-Castelli, Bergamo, Italy
| | - A C Bossi
- Endocrinology, Humanitas Gavazzeni-Castelli, Bergamo, Italy
| | - A Zambelli
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, MI, Italy
- Cancer Center, IRCCS Humanitas Research Hospital, Rozzano, MI, Italy
| | - A G Lania
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, MI, Italy.
- Endocrinology, Diabetology and Andrology Unit, IRCCS Humanitas Research Hospital, Rozzano, MI, Italy.
| | - A Berruti
- Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, ASST Spedali Civili of Brescia, Brescia, Italy
| | - G Mazziotti
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, MI, Italy.
- Endocrinology, Diabetology and Andrology Unit, IRCCS Humanitas Research Hospital, Rozzano, MI, Italy.
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Mazziotti G, Lania AG, Laganà M, Berruti A. Prediction of fragility fractures in men with prostate cancer under androgen deprivation therapy: the importance of a multidisciplinary approach using a mini-invasive diagnostic tool. Endocrine 2024; 83:594-596. [PMID: 38112923 DOI: 10.1007/s12020-023-03613-2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 11/11/2023] [Indexed: 12/21/2023]
Abstract
Bone fragility in men who are treated with androgen deprivation therapy (ADT) has a complex pathophysiology that differs from that of primary and post-menopausal osteoporosis. Fracture risk assessment based on bone mineral density (BMD) and Fracture Risk Assessment Tool (FRAX) score might not be effective in this patient setting, since high frequency of fragility fractures has been reported even in subjects with low FRAX risk and normal BMD. In this paper we want to emphasize the importance in the individual assessment of bone fragility and prediction of fractures by measuring parameters of bone quality, assessing morphometric vertebral fractures and evaluating body composition that in subjects under hormone-deprivation therapies can play a crucial role. Noteworthy, a single mini-invasive diagnostic tool, i.e., the dual energy x-ray absorptiometry (DXA) scan, offers the opportunity to evaluate reliably parameters of bone quality (e.g., trabecular bone score) and body composition, besides measurement of BMD and assessment of vertebral fractures by a morphometric approach. This article highlights the values and cost-effectiveness of this mini-invasive tool in the context of multidisciplinary approach to subjects with prostate cancer under ADTs.
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Affiliation(s)
- G Mazziotti
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072, Milan, Italy
- Endocrinology, Diabetology and Andrology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089, Milan, Italy
| | - A G Lania
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072, Milan, Italy
- Endocrinology, Diabetology and Andrology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Marta Laganà
- Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, ASST Spedali Civili of Brescia, Brescia, Italy.
| | - Alfredo Berruti
- Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, ASST Spedali Civili of Brescia, Brescia, Italy
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Rossini E, Tamburello M, Abate A, Zini S, Ribaudo G, Gianoncelli A, Calza S, Valcamonico F, Suardi NR, Mirabella G, Berruti A, Sigala S. The CDK Inhibitor Dinaciclib Improves Cisplatin Response in Nonseminomatous Testicular Cancer: A Preclinical Study. Cells 2024; 13:368. [PMID: 38474332 DOI: 10.3390/cells13050368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 02/08/2024] [Accepted: 02/17/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Most patients with testicular germ cell tumors (GCTs) are treated with cisplatin (CP)-based chemotherapy. However, some of them may develop CP resistance and therefore represent a clinical challenge. Cyclin-dependent kinase 5 (CDK5) is involved in chemotherapy resistance in different types of cancer. Here, we investigated the possible role of CDK5 and other CDKs targeted by dinaciclib in nonseminoma cell models (both CP-sensitive and CP-resistant), evaluating the potential of the CDK inhibitor dinaciclib as a single/combined agent for the treatment of advanced/metastatic testicular cancer (TC). METHODS The effects of dinaciclib and CP on sensitive and resistant NT2/D1 and NCCIT cell viability and proliferation were evaluated using MTT assays and direct count methods. Flow cytometry cell-cycle analysis was performed. The protein expression was assessed via Western blotting. The in vivo experiments were conducted in zebrafish embryos xenografted with TC cells. RESULTS Among all the CDKs analyzed, CDK5 protein expression was significantly higher in CP-resistant models. Dinaciclib reduced the cell viability and proliferation in each cell model, inducing changes in cell-cycle distribution. In drug combination experiments, dinaciclib enhances the CP effect both in vitro and in the zebrafish model. CONCLUSIONS Dinaciclib, when combined with CP, could be useful for improving nonseminoma TC response to CP.
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Affiliation(s)
- Elisa Rossini
- Section of Pharmacology, Department of Molecular and Translational Medicine, University of Brescia, 25123 Brescia, Italy
| | - Mariangela Tamburello
- Section of Pharmacology, Department of Molecular and Translational Medicine, University of Brescia, 25123 Brescia, Italy
| | - Andrea Abate
- Section of Pharmacology, Department of Molecular and Translational Medicine, University of Brescia, 25123 Brescia, Italy
| | - Silvia Zini
- Section of Pharmacology, Department of Molecular and Translational Medicine, University of Brescia, 25123 Brescia, Italy
| | - Giovanni Ribaudo
- Section of Pharmacology, Department of Molecular and Translational Medicine, University of Brescia, 25123 Brescia, Italy
| | - Alessandra Gianoncelli
- Section of Pharmacology, Department of Molecular and Translational Medicine, University of Brescia, 25123 Brescia, Italy
| | - Stefano Calza
- Unit of Biostatistics and Bioinformatics, Department of Molecular and Translational Medicine, University of Brescia, 25123 Brescia, Italy
| | - Francesca Valcamonico
- Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia at ASST Spedali Civili di Brescia, 25123 Brescia, Italy
| | - Nazareno R Suardi
- Urology Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia at ASST Spedali Civili di Brescia, 25123 Brescia, Italy
| | - Giuseppe Mirabella
- Urology Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia at ASST Spedali Civili di Brescia, 25123 Brescia, Italy
| | - Alfredo Berruti
- Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia at ASST Spedali Civili di Brescia, 25123 Brescia, Italy
| | - Sandra Sigala
- Section of Pharmacology, Department of Molecular and Translational Medicine, University of Brescia, 25123 Brescia, Italy
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11
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Dalla Volta A, Palumbo C, Zamboni S, Mazziotti G, Triggiani L, Zamparini M, Maffezzoni F, Rinaudo L, Bergamini M, Di Meo N, Caramella I, Valcamonico F, Borghetti P, Guerini A, Farina D, Antonelli A, Simeone C, Berruti A. Heterogeneity in regional changes in body composition induced by androgen deprivation therapy in prostate cancer patients: potential impact on bone health-the BLADE study. J Endocrinol Invest 2024; 47:335-343. [PMID: 37458931 PMCID: PMC10859344 DOI: 10.1007/s40618-023-02150-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 06/29/2023] [Indexed: 02/13/2024]
Abstract
BACKGROUND It is not clear whether changes in body composition induced by androgen deprivation therapy (ADT) in prostate cancer (PC) patients are uniform or vary in the different body districts and whether regional lean body mass (LBM) and fat body mass (FBM) could have an impact on bone health. OBJECTIVE To prospectively evaluate the regional changes in LBM and FBM in PC patients submitted to degarelix; to explore the relationship of regional body composition and bone mineral density (BMD) and bone turnover markers. DESIGN, SETTING, AND PARTICIPANTS 29 consecutive non metastatic PC patients enrolled from 2017 to 2019. FBM, LBM and bone mineral density (BMD) evaluated by dual-energy x-ray absorptiometry (DXA) at baseline and after 12-month of ADT. Alkaline phosphate (ALP) and C-terminal telopeptide of type I collagen (CTX) assessed at baseline, 6 and 12 months. INTERVENTION All patients underwent degarelix administration. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS T-test or sign test and Pearson or Spearman test for continuous variables were used when indicated. RESULTS AND LIMITATIONS Median percent increase in FBM ranged from + 14.5% in trunk to + 25.4% in the left leg after degarelix. LBM changes varied from + 2% in the trunk to - 4.9% in the right arm. LBM in both arms and legs and their variations after degarelix directly correlated with ALP and inversely correlated with CTX. Lean mass of limbs, trunk and legs significantly correlated with BMD of the hip, lean mass of the trunk significantly correlated with spine BMD. These are post-hoc analysis of a prospective study and this is the main limitation. CONCLUSIONS an heterogeneous change in body composition among body district is observed after ADT and bone turnover is influenced by lean mass and its variation. A supervised physical activity is crucial to maintain general physical performance and preserving bone health.
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Affiliation(s)
- A Dalla Volta
- Medical Oncology Unit, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - C Palumbo
- Division of Urology, Department of Translational Medicine, University of Eastern Piedmont, Maggiore Della Carità Hospital, Novara, Italy
- Urology Unit, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - S Zamboni
- Urology Unit, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - G Mazziotti
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
- Endocrinology, Diabetology and Medical Andrology Unit, Metabolic Bone Diseases and Osteoporosis Section, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - L Triggiani
- Radiation Oncology Unit, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - M Zamparini
- Medical Oncology Unit, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - F Maffezzoni
- Endocrinology, Manerbio-Leno, ASST Garda, Montichiari, Italy
| | - L Rinaudo
- Tecnologie Avanzate S.r.l., Turin, Italy
| | - M Bergamini
- Medical Oncology Unit, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - N Di Meo
- Radiology Unit, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - I Caramella
- Medical Oncology Unit, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - F Valcamonico
- Medical Oncology Unit, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - P Borghetti
- Radiation Oncology Unit, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - A Guerini
- Radiation Oncology Unit, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - D Farina
- Radiology Unit, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - A Antonelli
- Division of Urology, Department of Translational Medicine, University of Eastern Piedmont, Maggiore Della Carità Hospital, Novara, Italy
- Urology Unit, AOUI Verona, Department of Surgery, Dentistry, Pediatrics and Gynecology, University of Verona, Verona, Italy
| | - C Simeone
- Division of Urology, Department of Translational Medicine, University of Eastern Piedmont, Maggiore Della Carità Hospital, Novara, Italy
| | - A Berruti
- Medical Oncology Unit, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy.
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12
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Antonini S, Pedersini R, Birtolo MF, Baruch NL, Carrone F, Jaafar S, Ciafardini A, Cosentini D, Laganà M, Torrisi R, Farina D, Leonardi L, Balzarini L, Vena W, Bossi AC, Zambelli A, Lania AG, Berruti A, Mazziotti G. Denosumab improves trabecular bone score in relationship with decrease in fracture risk of women exposed to aromatase inhibitors. J Endocrinol Invest 2024; 47:433-442. [PMID: 37592052 DOI: 10.1007/s40618-023-02174-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 08/03/2023] [Indexed: 08/19/2023]
Abstract
PURPOSE Trabecular bone score (TBS) is a gray-level textural metric that has shown to correlate with risk of fractures in several forms of osteoporosis. The value of TBS in predicting fractures and the effects of bone-active drugs on TBS in aromatase inhibitors (AIs)-induced osteoporosis are still largely unknown. The primary objective of this retrospective study was to assess the effects of denosumab and bisphosphonates (BPs) on TBS and vertebral fractures (VFs) in women exposed to AIs. METHODS 241 consecutive women (median age 58 years) with early breast cancer undergoing treatment with AIs were evaluated for TBS, bone mineral density (BMD) and morphometric VFs at baseline and after 18-24 months of follow-up. During the study period, 139 women (57.7%) received denosumab 60 mg every 6 months, 53 (22.0%) BPs, whereas 49 women (20.3%) were not treated with bone-active drugs. RESULTS Denosumab significantly increased TBS values (from 1.270 to 1.323; P < 0.001) accompanied by a significant decrease in risk of VFs (odds ratio 0.282; P = 0.021). During treatment with BPs, TBS did not significantly change (P = 0.849) and incidence of VFs was not significantly different from women untreated with bone-active drugs (P = 0.427). In the whole population, women with incident VFs showed higher decrease in TBS vs. non-fractured women (P = 0.003), without significant differences in changes of BMD at any skeletal site. CONCLUSIONS TBS variation predicts fracture risk in AIs treated women. Denosumab is effective to induce early increase of TBS and reduction in risk of VFs.
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Affiliation(s)
- S Antonini
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, MI, Italy
- Endocrinology, Diabetology and Andrology Unit, IRCCS Humanitas Research Hospital, Rozzano, MI, Italy
| | - R Pedersini
- Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, ASST Spedali Civili of Brescia, Brescia, Italy
| | - M F Birtolo
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, MI, Italy
- Endocrinology, Diabetology and Andrology Unit, IRCCS Humanitas Research Hospital, Rozzano, MI, Italy
| | - N L Baruch
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, MI, Italy
| | - F Carrone
- Endocrinology, Diabetology and Andrology Unit, IRCCS Humanitas Research Hospital, Rozzano, MI, Italy
| | - S Jaafar
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, MI, Italy
- Endocrinology, Diabetology and Andrology Unit, IRCCS Humanitas Research Hospital, Rozzano, MI, Italy
| | - A Ciafardini
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, MI, Italy
- Endocrinology, Diabetology and Andrology Unit, IRCCS Humanitas Research Hospital, Rozzano, MI, Italy
| | - D Cosentini
- Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, ASST Spedali Civili of Brescia, Brescia, Italy
| | - M Laganà
- Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, ASST Spedali Civili of Brescia, Brescia, Italy
| | - R Torrisi
- Cancer Center, IRCCS Humanitas Research Hospital, Rozzano, MI, Italy
| | - D Farina
- Radiology Unit 2, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, ASST Spedali Civili of Brescia, Brescia, Italy
| | - L Leonardi
- Department of Radiology, IRCCS Humanitas Research Hospital, Rozzano, MI, Italy
| | - L Balzarini
- Department of Radiology, IRCCS Humanitas Research Hospital, Rozzano, MI, Italy
| | - W Vena
- Endocrinology, Humanitas Gavazzeni-Castelli, Bergamo, Italy
| | - A C Bossi
- Endocrinology, Humanitas Gavazzeni-Castelli, Bergamo, Italy
| | - A Zambelli
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, MI, Italy
- Cancer Center, IRCCS Humanitas Research Hospital, Rozzano, MI, Italy
| | - A G Lania
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, MI, Italy.
- Endocrinology, Diabetology and Andrology Unit, IRCCS Humanitas Research Hospital, Rozzano, MI, Italy.
| | - A Berruti
- Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, ASST Spedali Civili of Brescia, Brescia, Italy
| | - G Mazziotti
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, MI, Italy.
- Endocrinology, Diabetology and Andrology Unit, IRCCS Humanitas Research Hospital, Rozzano, MI, Italy.
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13
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Gurizzan C, Esposito A, Lorini L, Smussi D, Turla A, Baggi A, Laganà M, Zamparini M, Bianchi S, Volta AD, Grisanti S, Giacomelli L, Berruti A, Bossi P. Oncological treatment administration at end of life: a retrospective study. Future Oncol 2024; 20:329-334. [PMID: 38420932 DOI: 10.2217/fon-2023-0092] [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] [Indexed: 03/02/2024] Open
Abstract
Background: This work evaluated the proportion of patients who continue therapy until their last month of life or initiate a new therapy in the last 3 months of life (end of life [EOL]). Methods: Data for 486 patients were retrospectively collected. Results: In EOL, 205 (42.3%) received systemic therapy. Better performance status (last month overall response [OR]: 0.39; 95% CI: 0.25-0.60; p < 0.001; last 3 months OR: 0.47; 95% CI: 0.34-0.65; p < 0.001) and lack of activation of palliative care (last month OR: 0.26; 95% CI: 0.13-0.54; p < 0.001; last 3 months OR: 0.18; 95% CI: 0.10-0.32; p < 0.001) were associated with higher probability of EOL therapy. Conclusion: A non-negligible proportion of patients in real-life settings continue to receive systemic treatment in EOL.
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Affiliation(s)
- Cristina Gurizzan
- Medical Oncology, Department of Medical & Surgical Specialties, Radiological Sciences & Public Health, University of Brescia, ASST-Spedali Civili, Piazzale Spedali Civili 1, 25125, Brescia, Italy
| | - Andrea Esposito
- Medical Oncology, Department of Medical & Surgical Specialties, Radiological Sciences & Public Health, University of Brescia, ASST-Spedali Civili, Piazzale Spedali Civili 1, 25125, Brescia, Italy
| | - Luigi Lorini
- Medical Oncology, Department of Medical & Surgical Specialties, Radiological Sciences & Public Health, University of Brescia, ASST-Spedali Civili, Piazzale Spedali Civili 1, 25125, Brescia, Italy
| | - Davide Smussi
- Medical Oncology, Department of Medical & Surgical Specialties, Radiological Sciences & Public Health, University of Brescia, ASST-Spedali Civili, Piazzale Spedali Civili 1, 25125, Brescia, Italy
| | - Antonella Turla
- Medical Oncology, Department of Medical & Surgical Specialties, Radiological Sciences & Public Health, University of Brescia, ASST-Spedali Civili, Piazzale Spedali Civili 1, 25125, Brescia, Italy
| | - Alice Baggi
- Medical Oncology, Department of Medical & Surgical Specialties, Radiological Sciences & Public Health, University of Brescia, ASST-Spedali Civili, Piazzale Spedali Civili 1, 25125, Brescia, Italy
| | - Marta Laganà
- Medical Oncology, Department of Medical & Surgical Specialties, Radiological Sciences & Public Health, University of Brescia, ASST-Spedali Civili, Piazzale Spedali Civili 1, 25125, Brescia, Italy
| | - Manuel Zamparini
- Medical Oncology, Department of Medical & Surgical Specialties, Radiological Sciences & Public Health, University of Brescia, ASST-Spedali Civili, Piazzale Spedali Civili 1, 25125, Brescia, Italy
| | - Susanna Bianchi
- Medical Oncology, Department of Medical & Surgical Specialties, Radiological Sciences & Public Health, University of Brescia, ASST-Spedali Civili, Piazzale Spedali Civili 1, 25125, Brescia, Italy
| | - Alberto Dalla Volta
- Medical Oncology, Department of Medical & Surgical Specialties, Radiological Sciences & Public Health, University of Brescia, ASST-Spedali Civili, Piazzale Spedali Civili 1, 25125, Brescia, Italy
| | - Salvatore Grisanti
- Medical Oncology, Department of Medical & Surgical Specialties, Radiological Sciences & Public Health, University of Brescia, ASST-Spedali Civili, Piazzale Spedali Civili 1, 25125, Brescia, Italy
| | | | - Alfredo Berruti
- Medical Oncology, Department of Medical & Surgical Specialties, Radiological Sciences & Public Health, University of Brescia, ASST-Spedali Civili, Piazzale Spedali Civili 1, 25125, Brescia, Italy
| | - Paolo Bossi
- Medical Oncology, Department of Medical & Surgical Specialties, Radiological Sciences & Public Health, University of Brescia, ASST-Spedali Civili, Piazzale Spedali Civili 1, 25125, Brescia, Italy
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14
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Cosentini D, Pedersini R, Di Mauro P, Zamparini M, Schivardi G, Rinaudo L, Di Meo N, Del Barba A, Cappelli C, Laganà M, Alberti A, Baronchelli M, Guerci G, Laini L, Grisanti S, Simoncini EL, Farina D, Mazziotti G, Berruti A. Fat Body Mass and Vertebral Fracture Progression in Women With Breast Cancer. JAMA Netw Open 2024; 7:e2350950. [PMID: 38198137 PMCID: PMC10782249 DOI: 10.1001/jamanetworkopen.2023.50950] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 11/20/2023] [Indexed: 01/11/2024] Open
Abstract
Importance Women with early breast cancer (EBC) exposed to aromatase inhibitors (AIs) may experience fragility fractures despite treatment with bone-active drugs. Risk factors for fractures in patients receiving AIs and denosumab have not been explored to date. Objectives To evaluate whether an association exists between dual x-ray absorptiometry (DXA)-measured fat body mass (FBM) and vertebral fracture (VF) progression in postmenopausal women with EBC undergoing adjuvant therapy with AIs in combination with denosumab and to examine whether VF was associated with common risk factors for bone fracture and parameters of body composition other than FBM. Design, Setting, and Participants For this prospective, single-center, cohort study, 237 patients with EBC who were undergoing adjuvant treatment with AIs and denosumab (60 mg every 6 months) were enrolled at the Breast Unit of the ASST Spedali Civili of Brescia from September 2014 to June 2018. Data analysis was conducted in June 2022. Exposure Body composition parameters, bone mineral density, and morphometric VFs were assessed by DXA at study entry and after 18 months of therapy. Main Outcomes and Measures VF progression, defined as either new or worsening of preexisting VFs, between the 2 time points. Results Of the 237 patients enrolled (median [range] age, 61 [28-84] years), 17 (4.4%) reported VF progression. Univariable analysis found an association between VF progression and a history of clinical fractures (odds ratio [OR], 3.22; 95% CI, 1.19-8.74; P = .02), Fracture Risk Assessment Tool (FRAX) score for major fractures (OR, 4.42; 95% CI, 1.23-13.79; P = .04), percentage of FBM (OR, 6.04; 95% CI, 1.69-21.63; P = .006), and android fat (OR, 9.58; 95% CI, 1.17-78.21; P = .04) and an inverse association with appendicular lean mass index-FBM ratio (OR, 0.25, 95% CI, 0.08-0.82; P = .02). Multivariable analysis revealed percentage of FBM (OR, 5.41; 95% CI, 1.49-19.59; P = .01) and FRAX score (OR, 3.95; 95% CI, 1.09-14.39; P = .04) as independent variables associated with VF progression. Conclusions and Relevance The findings of this study suggest that baseline FBM is an independent factor for VF progression in patients with EBC treated with adjuvant AIs and denosumab. This observation is new and indicates that diet and exercise may synergize with denosumab in the management of bone health in this patient setting.
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Affiliation(s)
- Deborah Cosentini
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Medical Oncology, University of Brescia, ASST Spedali Civili, Brescia, Italy
| | - Rebecca Pedersini
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Medical Oncology, University of Brescia, ASST Spedali Civili, Brescia, Italy
- SSVD Breast Unit, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Pierluigi Di Mauro
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Medical Oncology, University of Brescia, ASST Spedali Civili, Brescia, Italy
| | - Manuel Zamparini
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Medical Oncology, University of Brescia, ASST Spedali Civili, Brescia, Italy
| | - Greta Schivardi
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Medical Oncology, University of Brescia, ASST Spedali Civili, Brescia, Italy
| | | | - Nunzia Di Meo
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Radiology, University of Brescia, ASST Spedali Civili, Brescia, Italy
| | - Andrea Del Barba
- Department of Experimental Sciences, Unit of Endocrinology and Metabolism, University of Brescia, ASST Spedali Civili, Brescia, Italy
| | - Carlo Cappelli
- Department of Experimental Sciences, Unit of Endocrinology and Metabolism, University of Brescia, ASST Spedali Civili, Brescia, Italy
| | - Marta Laganà
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Medical Oncology, University of Brescia, ASST Spedali Civili, Brescia, Italy
| | - Andrea Alberti
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Medical Oncology, University of Brescia, ASST Spedali Civili, Brescia, Italy
| | - Maria Baronchelli
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Medical Oncology, University of Brescia, ASST Spedali Civili, Brescia, Italy
| | - Greta Guerci
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Medical Oncology, University of Brescia, ASST Spedali Civili, Brescia, Italy
| | - Lara Laini
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Medical Oncology, University of Brescia, ASST Spedali Civili, Brescia, Italy
| | - Salvatore Grisanti
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Medical Oncology, University of Brescia, ASST Spedali Civili, Brescia, Italy
| | | | - Davide Farina
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Radiology, University of Brescia, ASST Spedali Civili, Brescia, Italy
| | - Gherardo Mazziotti
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Endocrinology, Diabetology and Medical Andrology Unit, Metabolic Bone Diseases and Osteoporosis Section, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Alfredo Berruti
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Medical Oncology, University of Brescia, ASST Spedali Civili, Brescia, Italy
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15
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Fazio N, Falconi M, Foglia E, Bartolomei M, Berruti A, D'Onofrio M, Ferone D, Giordano A, Grimaldi F, Milione M, Panzuto F, Santimaria M, Schillaci O, Seregni E, Stasi M, Volante M, Lastoria S. Optimising Radioligand Therapy for Patients with Gastro-Entero-Pancreatic Neuroendocrine Tumours: Expert Opinion from an Italian Multidisciplinary Group. Adv Ther 2024; 41:113-129. [PMID: 37987917 PMCID: PMC10796590 DOI: 10.1007/s12325-023-02714-8] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 10/17/2023] [Indexed: 11/22/2023]
Abstract
Radioligand therapy (RLT) with lutetium (177Lu) oxodotreotide is an approved therapy in combination with somatostatin analogues (SSAs) for patients with advanced, well-differentiated G1-G2, gastro-entero-pancreatic neuroendocrine tumours (GEP-NETs) that progress on SSAs. We conducted a series of round table meetings throughout Italy to identify issues related to RLT delivery to patients with GEP-NETs. Four key issues were identified: (1) the proper definition of tumour progression prior to RLT initiation; (2) the impact of RLT in patients with bone metastases and/or high hepatic tumour burden; (3) the optimal follow-up protocol after RLT; and (4) organisational issues related to RLT use and managerial implications. This article reviews the literature relating to the aforementioned issues and makes recommendations based on available evidence and Italian NET experts' opinions. In particular, the group recommends the development of a diagnostic-therapeutic care pathway (DTCP) for patients undergoing RLT which provides systematic guidance but can still be individualised for each patient's clinical and psychosocial needs. A DTCP may clarify the diagnostic, therapeutic and post-treatment monitoring process, and improve communication and the coordination of care between hub and spoke centres. The DTCP may also contribute to changes in the care process related to the 2013/59/EURATOM Directive and to the definition of costs when planning for future or updated reimbursement of RLT in Italy.
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Affiliation(s)
- Nicola Fazio
- Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, Istituto Europeo di Oncologia (IEO) IRCCS, Milan, Italy
| | - Massimo Falconi
- Pancreatic Surgery Unit, Pancreas Translational & Clinical Research Center, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Emanuela Foglia
- School of Industrial Engineering and HD LAB-Carlo Cattaneo-LIUC University, Castellanza, Italy
| | - Mirco Bartolomei
- Nuclear Medicine Unit, Azienda Ospedaliero-Universitaria di Ferrara, Ferrara, Italy
| | - Alfredo Berruti
- Medical Oncology Unit, ASST Spedali Civili, Brescia, Italy
- Department of Medical & Surgical Specialties, Radiological Sciences & Public Health, University of Brescia, Brescia, Italy
| | - Mirko D'Onofrio
- Radiology, GB Rossi University Hospital, University of Verona, Verona, Italy
| | - Diego Ferone
- Endocrinology, Department of Internal Medicine and Medical Specialties (DiMI), University of Genova and Endocrinology Clinic, IRCCS, Ospedale Policlinico San Martino, Genoa, Italy
| | - Alessandro Giordano
- Nuclear Medicine Unit, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Section of Nuclear Medicine, Dipartimento Universitario di Scienze Radiologiche ed Ematologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Franco Grimaldi
- Endocrinology and Diseases of Metabolism Unit, University Hospital Santa Maria Misericordia, Udine, Italy
| | - Massimo Milione
- Anatomia Patologica 1, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Francesco Panzuto
- Department of Medical-Surgical Sciences and Translational Medicine, Sapienza University and Digestive Disease Unit, Sant'Andrea University Hospital, ENETS Center of Excellence, Rome, Italy
| | - Monica Santimaria
- Nuclear Medicine Unit, S. Bortolo Hospital, AULSS 8 Berica, Vicenza, Italy
| | - Orazio Schillaci
- Department of Biomedicine and Prevention, University Tor Vergata, Rome, Italy
| | - Ettore Seregni
- Nuclear Medicine Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Michele Stasi
- Medical Physics Department, A.O. Ordine Mauriziano di Torino, Turin, Italy
| | - Marco Volante
- Department of Oncology, University of Turin, and Pathology Unit, San Luigi Hospital, Turin, Orbassano, Italy
| | - Secondo Lastoria
- Nuclear Medicine and Therapy with Radionuclides, Cyclotron and Radiopharmacy Units, IRCCS National Cancer Institute, Fondazione Senatore G. Pascale, Via M. Semmola, 80131, Naples, Italy.
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16
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Turla A, Laganà M, Cremaschi V, Zamparini M, De Maria L, Consoli F, Abate A, Tamburello M, Alberti A, Sigala S, Grisanti S, Fontanella MM, Cosentini D, Berruti A. Outcome of brain metastases from adrenocortical carcinoma: a pooled analysis. J Endocrinol Invest 2024; 47:223-234. [PMID: 37354248 PMCID: PMC10776734 DOI: 10.1007/s40618-023-02140-1] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 06/15/2023] [Indexed: 06/26/2023]
Abstract
PURPOSE Brain metastases rarely complicate the natural history of patients with adrenocortical carcinoma (ACC). No information is available regarding the life expectancy and efficacy of treatments in ACC patients with brain involvement. METHODS A pooled analysis was performed by searching on PubMed and using the keywords: "brain metastases in adrenocortical carcinoma", and "leptomeningeal metastases in adrenocortical carcinoma". Four patients diagnosed at Spedali Civili Hospital in Brescia were added to the analysis. Data concerning demographic, disease characteristics, adopted treatments and patient prognosis were collected. RESULTS A total of 27 patients (18 adults and 9 children) were included in this study, 22 of them had an adequate follow-up. Brain metastases occurred late in the natural history of adult patients but not in that of children. Surgery plus/minus radiation therapy was the treatment of choice. Adult patients with brain metastases had a poor prognosis with a median progression-free survival (PFS) and overall survival (OS) of 2 and 7 months, respectively. Median PFS and OS were not attained in children. CONCLUSION Brain metastases in ACC patients are rare and are associated with poor prognosis, particularly in adults. Surgery plus/minus radiotherapy is the only therapeutic approach that can offer patients a chance to obtain durable local disease control.
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Affiliation(s)
- A Turla
- Medical Oncology Unit, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - M Laganà
- Medical Oncology Unit, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - V Cremaschi
- Medical Oncology Unit, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - M Zamparini
- Medical Oncology Unit, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - L De Maria
- Neurosurgery Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - F Consoli
- Medical Oncology Unit, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - A Abate
- Section of Pharmacology, Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - M Tamburello
- Section of Pharmacology, Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - A Alberti
- Medical Oncology Unit, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - S Sigala
- Section of Pharmacology, Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - S Grisanti
- Medical Oncology Unit, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - M M Fontanella
- Neurosurgery Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - D Cosentini
- Medical Oncology Unit, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - A Berruti
- Medical Oncology Unit, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy.
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17
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Bergamini M, Dalla Volta A, Valcamonico F, Caramella I, Buffoni M, Munari E, Fisogni S, Zanotelli T, Suardi NR, Berruti A. Pathological Complete Response to Pembrolizumab plus Axitinib Combination following Serious Immune-Related Adverse Events in an Advanced Renal Cell Carcinoma Patient with a History of Rheumatoid Arthritis. Case Rep Oncol 2024; 17:56-68. [PMID: 38188482 PMCID: PMC10769506 DOI: 10.1159/000535460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 11/08/2023] [Indexed: 01/09/2024] Open
Abstract
Immune checkpoint inhibitors (ICIs)-based combinations have improved survival outcomes of advanced renal cell carcinoma (RCC) patients and are currently recommended as first-line treatment options. Rheumatoid arthritis (RA) is a systemic autoimmune disease (AD) of unknown etiology characterized by a chronic inflammatory process involving joints and extra-articular organs. Patients with AD are usually excluded from large randomized clinical trials investigating immunotherapeutic drugs. Therefore, little is known about clinical outcomes of patients with a history of RA treated with ICIs in real-world practice. In the present study, we report the clinical outcome of an advanced RCC patient with a history of RA treated with pembrolizumab in combination with axitinib. The patient experienced serious immune-related adverse events (irAEs) and achieved pathological complete response following only one ICI administration. Our case report shows that ICI-based combinations can be administered efficaciously in advanced RCC patients with a history of AD. However, a close monitoring of these patients is required, given the risk of irAEs and clinical exacerbations of symptoms associated with the preexisting AD. Moreover, prospective clinical data are needed to assess the hypothesis of a correlation between the onset of irAEs and AD flares and responses and survival outcomes to ICIs.
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Affiliation(s)
- Marco Bergamini
- Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Alberto Dalla Volta
- Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Francesca Valcamonico
- Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Irene Caramella
- Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Martina Buffoni
- Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Enrico Munari
- Department of Molecular and Translational Medicine, Pathology Unit, University of Brescia and ASST Spedali Civili Brescia, Brescia, Italy
| | - Simona Fisogni
- Department of Molecular and Translational Medicine, Pathology Unit, University of Brescia and ASST Spedali Civili Brescia, Brescia, Italy
| | - Tiziano Zanotelli
- Urology Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Nazareno Roberto Suardi
- Urology Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Alfredo Berruti
- Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, ASST Spedali Civili di Brescia, Brescia, Italy
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18
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Pedersini R, Laganà M, Bosio S, Zanini B, Cosentini D, di Mauro P, Alberti A, Schivardi G, Laini L, Ippolito G, Amoroso V, Vassalli L, Simoncini EL, Berruti A, Donato F. Is weight gain preventable in women with early breast cancer undergoing chemotherapy? A real-world study on dietary pattern, physical activity, and body weight before and after chemotherapy. Breast Cancer Res Treat 2023; 202:461-471. [PMID: 37695400 PMCID: PMC10564810 DOI: 10.1007/s10549-023-07095-8] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 08/13/2023] [Indexed: 09/12/2023]
Abstract
PURPOSE We aimed to investigate the role of a lifestyle intervention and clinical and therapeutic factors for preventing weight gain in early breast cancer (BC) patients from one week before to 12 months after chemotherapy. METHODS Dietary assessments were conducted by a trained dietician using a food-frequency questionnaire at each clinical assessment. Total energy, macronutrients intakes, and physical activity were estimated and the Mediterranean Diet Score (MDS) for adherence to Mediterranean diet was calculated. At each follow-up visit, patients were provided with dietary advices according to Mediterranean and Italian guidelines by a registered dietician, after evaluation of their food records. The associations of clinical characteristics, dietary pattern, and physical activity with weight gain were evaluated by multiple logistic regression, with weight gain ≥5% from baseline value as a dichotomous dependent variable. RESULTS 169 early BC patients who met all follow-up visits and provided complete data were included in the analysis. From baseline to last assessment, weight loss (≥5% decrease from baseline value), stable weight, and weight gain were observed in 23.1%, 58%, and 18.9% women, respectively. Overall, a 0.68 kg mean decrease in women's weight (-1.1% from baseline) was observed. The risk of gaining weight increased for having normal weight/underweight at baseline, receiving hormone therapy, MDS worsening, and physical activity decreasing from baseline to last assessment. CONCLUSION Providing simple suggestions on Mediterranean diet principles was effective for preventing weight gain in normal weight women and favoring weight loss in overweight and obese women.
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Affiliation(s)
- Rebecca Pedersini
- Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, ASST Spedali Civili of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy
- SSVD Breast Unit, ASST Spedali Civili of Brescia, 25123, Brescia, Italy
| | - Marta Laganà
- Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, ASST Spedali Civili of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy
- SSVD Breast Unit, ASST Spedali Civili of Brescia, 25123, Brescia, Italy
| | - Sara Bosio
- SSVD Breast Unit, ASST Spedali Civili of Brescia, 25123, Brescia, Italy
| | - Barbara Zanini
- Clinical and Experimental Sciences Department, University of Brescia, 25123, Brescia, Italy
| | - Deborah Cosentini
- Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, ASST Spedali Civili of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - Pierluigi di Mauro
- Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, ASST Spedali Civili of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - Andrea Alberti
- Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, ASST Spedali Civili of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - Greta Schivardi
- Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, ASST Spedali Civili of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - Lara Laini
- Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, ASST Spedali Civili of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - Giuseppe Ippolito
- Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, ASST Spedali Civili of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - Vito Amoroso
- Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, ASST Spedali Civili of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - Lucia Vassalli
- Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, ASST Spedali Civili of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy
- SSVD Breast Unit, ASST Spedali Civili of Brescia, 25123, Brescia, Italy
| | | | - Alfredo Berruti
- Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, ASST Spedali Civili of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy.
| | - Francesco Donato
- Unit of Hygiene, Epidemiology, and Public Health, Department of Medical and Surgical Specialties Radiological Sciences and Public Health, University of Brescia, 25123, Brescia, Italy
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Laganà M, Cremaschi V, Alberti A, Vodopivec Kuri DM, Cosentini D, Berruti A. The Evolving Treatment Landscape of Medullary Thyroid Cancer. Curr Treat Options Oncol 2023; 24:1815-1832. [PMID: 37979019 PMCID: PMC10781862 DOI: 10.1007/s11864-023-01145-5] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2023] [Indexed: 11/19/2023]
Abstract
OPINION STATEMENT Genetic assessment is crucial to address the correct treatment for advanced medullary thyroid cancer (MTC). Multi tyrosine kinase inhibitors (mTKIs) cabozantinib and vandetanib are good first line options, even vandetanib prescription is currently limited to RET mutated patients. Selective RET inhibitors such as pralsetinib could be a preferred upfront treatment in case of RET mutated MTC presenting common or gatekeeper RET mutations (e.g. M918T; V804L/M). Selpercatinib, otherwise, can be prescribed as the second line after disease progression to mTKIs. The best option for subsequent lines is to consider inclusion in clinical trials or alternatively other mTKIs such as sunitinib, sorafenib, lenvatinib, or pazopanib could be evaluated. New perspectives include next-generation RET inhibitors able to overcome resistance mechanisms responsible for disease progression to standard mTKIs and RET inhibitors, and immunotherapy for MTC presenting with high tumor mutational burden.
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Affiliation(s)
- Marta Laganà
- Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia at ASST Spedali Civili, 25123, Brescia, Italy
| | - Valentina Cremaschi
- Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia at ASST Spedali Civili, 25123, Brescia, Italy
| | - Andrea Alberti
- Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia at ASST Spedali Civili, 25123, Brescia, Italy.
| | - Danica M Vodopivec Kuri
- Department of Endocrinology, Diabetes, and Metabolism, University Of Alabama, 619 19Th St S, Birmingham, AL, 35249, USA
| | - Deborah Cosentini
- Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia at ASST Spedali Civili, 25123, Brescia, Italy
| | - Alfredo Berruti
- Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia at ASST Spedali Civili, 25123, Brescia, Italy
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Alberti A, Stocker G, Lordick F, Hacker UT, Kobitzsch B, Haffner I, Baiocchi GL, Zamparini M, Tiberio GAM, Baronchelli C, Caruso A, Bossi P, Berruti A. Plasma EBV DNA as a prognostic factor in EBV associated gastric cancer: a multicenter, prospective study (EBV PRESAGE study). Front Oncol 2023; 13:1276138. [PMID: 37941551 PMCID: PMC10629611 DOI: 10.3389/fonc.2023.1276138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 10/05/2023] [Indexed: 11/10/2023] Open
Abstract
Purpose The Cancer Genome Atlas Research Network identified Epstein-Barr-Virus (EBV)-positive gastric cancer as a distinct molecular subtype. The prevalence is 8-9% and the histological examination shows pronounced lymphocytic infiltration, elevated levels of IFN-γ and consequently overexpression of PD-L1. The role of plasma EBV DNA load as a prognostic factor in patients with this cancer subtype is still to be defined. Methods and analysis The present multicenter prospective observational study "EBV PRESAGE", involving German and Italian cancer centers, aims to evaluate the prognostic role of plasma EBV DNA in EBV-related gastric cancer (GC). The objective is to study the association between plasma EBV DNA load at different consecutive time points and the patient's prognosis. Every patient with a new diagnosis of gastric cancer (including gastroesophageal junction adenocarcinoma) will be screened for Epstein-Barr encoded small Region (EBER) on tissue biopsies using in situ hybridization (ISH). If EBER ISH is positive, blood analysis for plasma EBV DNA will be conducted. The plasma EBV quantitative analysis will be centralized, and extraction, detection, and quantification of EBV DNA in plasma samples will be performed using real-time PCR. Discussion We hypothesized that plasma EBV DNA represents a non-invasive tool for monitoring EBV-related GC and might be valuable as a prognostic marker.
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Affiliation(s)
- Andrea Alberti
- Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia at the Azienda Socio Sanitaria Territoriale (ASST)-Spedali Civili, Brescia, Italy
| | - Gertraud Stocker
- Department of Medicine II (Oncology, Gastroenterology, Hepatology and Pulmonology), University Cancer Center Leipzig (UCCL), University of Leipzig Medical Center, Leipzig, Germany
| | - Florian Lordick
- Department of Medicine II (Oncology, Gastroenterology, Hepatology and Pulmonology), University Cancer Center Leipzig (UCCL), University of Leipzig Medical Center, Leipzig, Germany
| | - Ulrich T. Hacker
- Department of Medicine II (Oncology, Gastroenterology, Hepatology and Pulmonology), University Cancer Center Leipzig (UCCL), University of Leipzig Medical Center, Leipzig, Germany
| | - Benjamin Kobitzsch
- Department of Medicine II (Oncology, Gastroenterology, Hepatology and Pulmonology), University Cancer Center Leipzig (UCCL), University of Leipzig Medical Center, Leipzig, Germany
| | - Ivonne Haffner
- Department of Medicine II (Oncology, Gastroenterology, Hepatology and Pulmonology), University Cancer Center Leipzig (UCCL), University of Leipzig Medical Center, Leipzig, Germany
| | - Gian Luca Baiocchi
- Surgical Unit, Department of Clinical and Experimental Sciences, University of Brescia at the Azienda Socio Sanitaria Territoriale (ASST), Cremona, Italy
| | - Manuel Zamparini
- Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia at the Azienda Socio Sanitaria Territoriale (ASST)-Spedali Civili, Brescia, Italy
| | - Guido A. M. Tiberio
- Surgical Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia at the Azienda Socio Sanitaria Territoriale (ASST)-Spedali Civili, Brescia, Italy
| | - Carla Baronchelli
- Pathology Unit, Azienda Socio Sanitaria Territoriale (ASST)-Spedali Civili, Brescia, Italy
| | - Arnaldo Caruso
- Microbiology Unit, Department of Molecular and Translational Medicine, University of Brescia-Spedali Civili at the Azienda Socio Sanitaria Territoriale (ASST) – Spedali Civili, Brescia, Italy
| | - Paolo Bossi
- Medical Oncology and Hematology Unit, Humanitas University, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Alfredo Berruti
- Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia at the Azienda Socio Sanitaria Territoriale (ASST)-Spedali Civili, Brescia, Italy
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21
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Terzolo M, Fassnacht M, Perotti P, Libé R, Kastelan D, Lacroix A, Arlt W, Haak HR, Loli P, Decoudier B, Lasolle H, Quinkler M, Haissaguerre M, Chabre O, Caron P, Stigliano A, Giordano R, Zatelli MC, Bancos I, Fragoso MCBV, Canu L, Luconi M, Puglisi S, Basile V, Reimondo G, Kroiss M, Megerle F, Hahner S, Kimpel O, Dusek T, Nölting S, Bourdeau I, Chortis V, Ettaieb MH, Cosentini D, Grisanti S, Baudin E, Berchialla P, Bovis F, Sormani MP, Bruzzi P, Beuschlein F, Bertherat J, Berruti A. Adjuvant mitotane versus surveillance in low-grade, localised adrenocortical carcinoma (ADIUVO): an international, multicentre, open-label, randomised, phase 3 trial and observational study. Lancet Diabetes Endocrinol 2023; 11:720-730. [PMID: 37619579 PMCID: PMC10522778 DOI: 10.1016/s2213-8587(23)00193-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/31/2023] [Accepted: 06/26/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND Adjuvant treatment with mitotane is commonly used after resection of adrenocortical carcinoma; however, treatment remains controversial, particularly if risk of recurrence is not high. We aimed to assess the efficacy and safety of adjuvant mitotane compared with surveillance alone following complete tumour resection in patients with adrenocortical carcinoma considered to be at low to intermediate risk of recurrence. METHODS ADIUVO was a multicentre, open-label, parallel, randomised, phase 3 trial done in 23 centres across seven countries. Patients aged 18 years or older with adrenocortical carcinoma and low to intermediate risk of recurrence (R0, stage I-III, and Ki67 ≤10%) were randomly assigned to adjuvant oral mitotane two or three times daily (the dose was adjusted by the local investigator with the target of reaching and maintaining plasma mitotane concentrations of 14-20 mg/L) for 2 years or surveillance alone. All consecutive patients at 14 study centres fulfilling the eligibility criteria of the ADIUVO trial who refused randomisation and agreed on data collection via the European Network for the Study of Adrenal Tumors adrenocortical carcinoma registry were included prospectively in the ADIUVO Observational study. The primary endpoint was recurrence-free survival, defined as the time from randomisation to the first radiological evidence of recurrence or death from any cause (whichever occurred first), assessed in all randomly assigned patients by intention to treat. Overall survival, defined as time from the date of randomisation to the date of death from any cause, was a secondary endpoint analysed by intention to treat in all randomly assigned patients. Safety was assessed in all patients who adhered to the assigned regimen, which was defined by taking at least one tablet of mitotane in the mitotane group and no mitotane at all in the surveillance group. The ADIUVO trial is registered with ClinicalTrials.gov, NCT00777244, and is now complete. FINDINGS Between Oct 23, 2008, and Dec 27, 2018, 45 patients were randomly assigned to mitotane and 46 to surveillance alone. Because the study was discontinued prematurely, 5-year recurrence-free and overall survival are reported instead of recurrence-free and overall survival as defined in the protocol. 5-year recurrence-free survival was 79% (95% CI 67-94) in the mitotane group and 75% (63-90) in the surveillance group (hazard ratio 0·74 [95% CI 0·30-1·85]). Two people in the mitotane group and five people in the surveillance group died, and 5-year overall survival was not significantly different (95% [95% CI 89-100] in the mitotane group and 86% [74-100] in the surveillance group). All 42 patients who received mitotane had adverse events, and eight (19%) discontinued treatment. There were no grade 4 adverse events or treatment-related deaths. INTERPRETATION Adjuvant mitotane might not be indicated in patients with low-grade, localised adrenocortical carcinoma considering the relatively good prognosis of these patients, and no significant improvement in recurrence-free survival and treatment-associated toxicity in the mitotane group. However, the study was discontinued prematurely due to slow recruitment and cannot rule out an efficacy of treatment. FUNDING AIFA, ENSAT Cancer Health F2-2010-259735 programme, Deutsche Forschungsgemeinschaft, Cancer Research UK, and the French Ministry of Health.
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Affiliation(s)
- Massimo Terzolo
- Internal Medicine, Department of Clinical and Biological Sciences, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | - Martin Fassnacht
- Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital, University of Würzburg, Würzburg, Germany; Comprehensive Cancer Center Mainfranken, University of Würzburg, Würzburg, Germany
| | - Paola Perotti
- Internal Medicine, Department of Clinical and Biological Sciences, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | - Rossella Libé
- Rare Cancer Network COMETE Cancer, Hôpital Cochin, Paris, France
| | - Darko Kastelan
- Department of Endocrinology University Hospital Zagreb, Zagreb, Croatia
| | - André Lacroix
- Service d'Endocrinologie, Département de Médecine, Centre Hospitalier de l'Universite de Montréal, Montreal, QC, Canada
| | - Wiebke Arlt
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK; MRC London Institute of Medical Sciences and Faculty of Medicine, Imperial College London, London, UK
| | - Harm Reinout Haak
- Department of Internal Medicine, Maxima Medisch Centrum, Eindhoven, Netherlands; CAPHRI School for Public Health and Primary Care, Ageing and Long-Term Care, Maastricht University, and Department of Internal Medicine, Division of General Internal Medicine, Maastricht University Medical Centre+, Maastricht, Netherlands
| | - Paola Loli
- Division of Endocrinology, Niguarda Cà Granda Hospital, Milan, Italy
| | - Bénédicte Decoudier
- Centre Hospitalier Universitaire de Reims, Service d'Endocrinologie-Diabètologie-Nutrition, Reims, France
| | - Helene Lasolle
- Federation d'Endocrinologie, Hospices Civils de Lyon and University de Lyon, Lyon, France
| | | | - Magalie Haissaguerre
- Department of Endocrinology and Endocrine Oncology, Haut Leveque Hospital, University Hospital of Bordeaux, France
| | - Olivier Chabre
- University Grenoble Alpes, Service d'Endocrinologie CHU Grenoble Alpes, Unité Mixte de Recherche INSERM-CEA-UGA UMR1036 38000 Grenoble Alpes, France
| | - Philippe Caron
- Department of Endocrinology and Metabolic Diseases, Cardiovascular and Metabolic Unit, CHU Larrey, Toulouse, France
| | - Antonio Stigliano
- Endocrinology, Department of Clinical and Molecular Medicine, Sant'Andrea University Hospital, Sapienza University of Rome, Rome, Italy
| | - Roberta Giordano
- Division of Endocrinology, Diabetology and Metabolism, Department of Biological and Clinical Sciences, University of Turin, Turin, Italy
| | - Maria Chiara Zatelli
- Section of Endocrinology and Internal Medicine, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Irina Bancos
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN, USA
| | - Maria Candida Barisson Villares Fragoso
- Unidade de Suprarrenal, Disciplina de Endocrinologia e Metabologia do Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, Instituto do Cancer do Estado de São Paulo-ICESP, São Paulo, Brazil
| | - Letizia Canu
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Michaela Luconi
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Soraya Puglisi
- Internal Medicine, Department of Clinical and Biological Sciences, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy.
| | - Vittoria Basile
- Internal Medicine, Department of Clinical and Biological Sciences, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | - Giuseppe Reimondo
- Internal Medicine, Department of Clinical and Biological Sciences, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | - Matthias Kroiss
- Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital, University of Würzburg, Würzburg, Germany
| | - Felix Megerle
- Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital, University of Würzburg, Würzburg, Germany
| | - Stefanie Hahner
- Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital, University of Würzburg, Würzburg, Germany
| | - Otilia Kimpel
- Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital, University of Würzburg, Würzburg, Germany
| | - Tina Dusek
- Department of Endocrinology University Hospital Zagreb, Zagreb, Croatia
| | - Svenja Nölting
- Department of Endocrinology, Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, Germany; Department of Endocrinology, Diabetology and Clinical Nutrition, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Isabelle Bourdeau
- Service d'Endocrinologie, Département de Médecine, Centre Hospitalier de l'Universite de Montréal, Montreal, QC, Canada
| | - Vasileios Chortis
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | | | - Deborah Cosentini
- Oncology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health Medical, ASST-Spedali Civili, University of Brescia, Brescia, Italy
| | - Salvatore Grisanti
- Oncology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health Medical, ASST-Spedali Civili, University of Brescia, Brescia, Italy
| | - Eric Baudin
- Endocrine Oncology Gustave Roussy, Villejuif, France
| | - Paola Berchialla
- Statistical Unit, Department of Clinical and Biological Sciences, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | - Francesca Bovis
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | | | - Paolo Bruzzi
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Felix Beuschlein
- Department of Endocrinology, Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, Germany; Department of Endocrinology, Diabetology and Clinical Nutrition, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Jerome Bertherat
- Université Paris Cité, Institut Cochin, Inserm U1016, CNRS UMR8104, Service d'Endocrinologie, Hopital Cochin, APHP, Paris, France
| | - Alfredo Berruti
- Oncology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health Medical, ASST-Spedali Civili, University of Brescia, Brescia, Italy
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Dalla Volta A, Caramella I, Di Mauro P, Bergamini M, Cosentini D, Valcamonico F, Cappelli C, Laganà M, Di Meo N, Farina D, Pedersini R, Mazziotti G, Berruti A. Role of Body Composition in the Prediction of Skeletal Fragility Induced by Hormone Deprivation Therapies in Cancer Patients. Curr Oncol Rep 2023; 25:1141-1152. [PMID: 37624550 PMCID: PMC10556180 DOI: 10.1007/s11912-023-01447-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2023] [Indexed: 08/26/2023]
Abstract
PURPOSE OF REVIEW This review paper is intended to show that changes in body composition are key in the pathogenesis of bone fragility amongst patients with breast and prostate cancer receiving hormone deprivation therapies (HDTs) and that the mechanism is based on the development of alterations in bone quality rather than in bone quantity. RECENT FINDINGS Preclinical and clinical data suggest a tight connection amongst bone, adipose and muscular tissues by means of several soluble mediators, potentially leading to (1) bone resorption and bone quality deterioration in sarcopenic obese subjects, (2) bone mineral deposition in healthy trained subjects. Cancer patients treated with HDTs frequently fall into the first condition, named osteosarcopenic obesity. Current clinical guidelines for the prevention of treatment-induced osteoporosis focus on bone mineral density (BMD) as a main predictive factor for fracture risk; however, the pathophysiology underlying HDT-induced bone fragility differs from that of primary and postmenopausal osteoporosis, suggesting a prevalent role for bone quality alterations. Focusing on available data from clinical trials, in our review we suggest osteosarcopenic obesity as a common target for the prevention and treatment of HDTs-related metabolic and skeletal complications, beyond a BMD-centred approach.
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Affiliation(s)
- Alberto Dalla Volta
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, Medical Oncology Unit, University of Brescia, Azienda Socio Sanitaria Territoriale (ASST) Spedali Civili, 25123, Brescia, Italy
| | - Irene Caramella
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, Medical Oncology Unit, University of Brescia, Azienda Socio Sanitaria Territoriale (ASST) Spedali Civili, 25123, Brescia, Italy.
| | - Pierluigi Di Mauro
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, Medical Oncology Unit, University of Brescia, Azienda Socio Sanitaria Territoriale (ASST) Spedali Civili, 25123, Brescia, Italy
| | - Marco Bergamini
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, Medical Oncology Unit, University of Brescia, Azienda Socio Sanitaria Territoriale (ASST) Spedali Civili, 25123, Brescia, Italy
| | - Deborah Cosentini
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, Medical Oncology Unit, University of Brescia, Azienda Socio Sanitaria Territoriale (ASST) Spedali Civili, 25123, Brescia, Italy
| | - Francesca Valcamonico
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, Medical Oncology Unit, University of Brescia, Azienda Socio Sanitaria Territoriale (ASST) Spedali Civili, 25123, Brescia, Italy
| | - Carlo Cappelli
- Department of Experimental Sciences, Unit of Endocrinology and Metabolism, University of Brescia, Azienda Socio Sanitaria Territoriale (ASST) Spedali Civili, Brescia, Italy
| | - Marta Laganà
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, Medical Oncology Unit, University of Brescia, Azienda Socio Sanitaria Territoriale (ASST) Spedali Civili, 25123, Brescia, Italy
| | - Nunzia Di Meo
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, Radiology Unit, University of Brescia, Azienda Socio Sanitaria Territoriale (ASST) Spedali Civili, Brescia, Italy
| | - Davide Farina
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, Radiology Unit, University of Brescia, Azienda Socio Sanitaria Territoriale (ASST) Spedali Civili, Brescia, Italy
| | - Rebecca Pedersini
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, Medical Oncology Unit, University of Brescia, Azienda Socio Sanitaria Territoriale (ASST) Spedali Civili, 25123, Brescia, Italy
- Breast Unit, Azienda Socio Sanitaria Territoriale (ASST) Spedali Civili, Brescia, Italy
| | - Gherardo Mazziotti
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Endocrinology, Diabetology and Andrology Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Alfredo Berruti
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, Medical Oncology Unit, University of Brescia, Azienda Socio Sanitaria Territoriale (ASST) Spedali Civili, 25123, Brescia, Italy
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23
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Puglisi S, Calabrese A, Ferraù F, Violi MA, Laganà M, Grisanti S, Ceccato F, Scaroni C, Di Dalmazi G, Stigliano A, Altieri B, Canu L, Loli P, Pivonello R, Arvat E, Morelli V, Perotti P, Basile V, Berchialla P, Urru S, Fiori C, Porpiglia F, Berruti A, Pia A, Reimondo G, Cannavò S, Terzolo M. New Findings on Presentation and Outcome of Patients With Adrenocortical Cancer: Results From a National Cohort Study. J Clin Endocrinol Metab 2023; 108:2517-2525. [PMID: 37022947 DOI: 10.1210/clinem/dgad199] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 03/24/2023] [Accepted: 03/31/2023] [Indexed: 04/07/2023]
Abstract
CONTEXT Because of the rarity of adrenocortical cancer (ACC), only a few population-based studies are available, and they reported limited details in the characterization of patients and their treatment. OBJECTIVE To describe in a nationwide cohort the presentation of patients with ACC, treatment strategies, and potential prognostic factors. METHODS Retrospective analysis of 512 patients with ACC, diagnosed in 12 referral centers in Italy from January 1990 to June 2018. RESULTS ACC diagnosed as incidentalomas accounted for overall 38.1% of cases, with a frequency that increases with age and with less aggressive pathological features than symptomatic tumors. Women (60.2%) were younger than men and had smaller tumors, which more frequently secreted hormones. Surgery was mainly done with an open approach (72%), and after surgical resection, 62.7% of patients started adjuvant mitotane therapy. Recurrence after tumor resection occurred in 56.2% of patients. In patients with localized disease, cortisol secretion, ENSAT stage III, Ki67%, and Weiss score were associated with an increased risk of recurrence, whereas margin-free resection, open surgery, and adjuvant mitotane treatment were associated with reduced risk. Death occurred in 38.1% of patients and recurrence-free survival (RFS) predicted overall survival (OS). In localized disease, age, cortisol secretion, Ki67%, ENSAT stage III, and recurrence were associated with increased risk of mortality. ACCs presenting as adrenal incidentalomas showed prolonged RFS and OS. CONCLUSION Our study shows that ACC is a sex-related disease and demonstrates that an incidental presentation is associated with a better outcome. Given the correlation between RFS and OS, RFS may be used as a surrogate endpoint in clinical studies.
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Affiliation(s)
- Soraya Puglisi
- Internal Medicine, Department of Clinical and Biological Sciences, S. Luigi Hospital, University of Turin, 10043 Turin, Italy
| | - Anna Calabrese
- Internal Medicine, Department of Clinical and Biological Sciences, S. Luigi Hospital, University of Turin, 10043 Turin, Italy
| | - Francesco Ferraù
- Endocrine Unit of University Hospital of Messina, University of Messina, 98124 Messina, Italy
| | - Maria Antonia Violi
- Endocrine Unit of University Hospital of Messina, University of Messina, 98124 Messina, Italy
| | - Marta Laganà
- Oncology Unit, University of Brescia, 25123 Brescia, Italy
| | | | - Filippo Ceccato
- Endocrinology Unit, Department of Medicine DIMED, University-Hospital of Padua, 35128 Padua, Italy
| | - Carla Scaroni
- Endocrinology Unit, Department of Medicine DIMED, University-Hospital of Padua, 35128 Padua, Italy
| | - Guido Di Dalmazi
- Division of Endocrinology and Diabetes Prevention and Care Unit, IRCCS, University Hospital of Bologna, 40138 Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum-University of Bologna, 40126 Bologna, Italy
| | - Antonio Stigliano
- Endocrinology, Department of Clinical and Molecular Medicine, Sant'Andrea University Hospital, Sapienza University of Rome, 00189 Rome, Italy
| | - Barbara Altieri
- Division of Endocrinology and Metabolic Diseases, University-Hospital Gemelli, IRCCS, Catholic University of the Sacred Heart, 00168 Rome, Italy
| | - Letizia Canu
- Endocrinology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, 50134 Florence, Italy
| | - Paola Loli
- Endocrinology, Clinica Polispecialistica San Carlo, 20037 Milan, Italy
| | - Rosario Pivonello
- Endocrinology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, 80131 Naples, Italy
| | - Emanuela Arvat
- Oncological Endocrinology Unit, Department of Medical Sciences, University of Turin, 10043 Turin, Italy
| | - Valentina Morelli
- Department of Endocrine and Metabolic Disease, Istituto Auxologico Italiano, IRCSS, 20145 Milan, Italy
| | - Paola Perotti
- Internal Medicine, Department of Clinical and Biological Sciences, S. Luigi Hospital, University of Turin, 10043 Turin, Italy
| | - Vittoria Basile
- Internal Medicine, Department of Clinical and Biological Sciences, S. Luigi Hospital, University of Turin, 10043 Turin, Italy
| | - Paola Berchialla
- Statistical Unit, Department of Clinical and Biological Sciences, University of Turin, 10043 Turin, Italy
| | - Sara Urru
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35121 Padua, Italy
| | - Cristian Fiori
- Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, 10043 Turin, Italy
| | - Francesco Porpiglia
- Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, 10043 Turin, Italy
| | | | - Anna Pia
- Internal Medicine, Department of Clinical and Biological Sciences, S. Luigi Hospital, University of Turin, 10043 Turin, Italy
| | - Giuseppe Reimondo
- Internal Medicine, Department of Clinical and Biological Sciences, S. Luigi Hospital, University of Turin, 10043 Turin, Italy
| | - Salvatore Cannavò
- Endocrine Unit of University Hospital of Messina, University of Messina, 98124 Messina, Italy
| | - Massimo Terzolo
- Internal Medicine, Department of Clinical and Biological Sciences, S. Luigi Hospital, University of Turin, 10043 Turin, Italy
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Sigala S, Bothou C, Penton D, Abate A, Peitzsch M, Cosentini D, Tiberio GAM, Bornstein SR, Berruti A, Hantel C. Correction: Sigala et al. A Comprehensive Investigation of Steroidogenic Signaling in Classical and New Experimental Cell Models of Adrenocortical Carcinoma. Cells 2022, 11, 1439. Cells 2023; 12:2274. [PMID: 37759554 PMCID: PMC10526947 DOI: 10.3390/cells12182274] [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: 04/20/2023] [Accepted: 08/16/2023] [Indexed: 09/29/2023] Open
Abstract
The authors made the following changes to their paper [...].
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Affiliation(s)
- Sandra Sigala
- Section of Pharmacology, Department of Molecular and Translational Medicine, University of Brescia, 25124 Brescia, Italy; (S.S.); (A.A.)
| | - Christina Bothou
- Department of Endocrinology, Diabetology and Clinical Nutrition, University Hospital Zurich (USZ) and University of Zurich (UZH), 8091 Zürich, Switzerland; (C.B.); (S.R.B.)
| | - David Penton
- Electrophysiology Facility (e-phac), Department of Molecular Life Sciences, University of Zurich (UZH), 8057 Zürich, Switzerland;
| | - Andrea Abate
- Section of Pharmacology, Department of Molecular and Translational Medicine, University of Brescia, 25124 Brescia, Italy; (S.S.); (A.A.)
| | - Mirko Peitzsch
- Medizinische Klinik und Poliklinik III, University Hospital Carl Gustav Carus Dresden, 01307 Dresden, Germany;
| | - Deborah Cosentini
- Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia at ASST Spedali Civili di Brescia, 25124 Brescia, Italy; (D.C.); (A.B.)
| | - Guido A. M. Tiberio
- Surgical Clinic, Department of Clinical and Experimental Sciences, University of Brescia at ASST Spedali Civili di Brescia, 25124 Brescia, Italy;
| | - Stefan R. Bornstein
- Department of Endocrinology, Diabetology and Clinical Nutrition, University Hospital Zurich (USZ) and University of Zurich (UZH), 8091 Zürich, Switzerland; (C.B.); (S.R.B.)
- Medizinische Klinik und Poliklinik III, University Hospital Carl Gustav Carus Dresden, 01307 Dresden, Germany;
- Diabetes and Nutritional Sciences, King’s College London, London WC2R 2LS, UK
- Center for Regenerative Therapies, Technische Universität Dresden, 01307 Dresden, Germany
- Paul-Langerhans-Institute Dresden, Helmholtz Center Munich, University Hospital Carl Gustav Carus, Faculty of Medicine, Technische Universität Dresden, 01307 Dresden, Germany
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 636921, Singapore
| | - Alfredo Berruti
- Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia at ASST Spedali Civili di Brescia, 25124 Brescia, Italy; (D.C.); (A.B.)
| | - Constanze Hantel
- Department of Endocrinology, Diabetology and Clinical Nutrition, University Hospital Zurich (USZ) and University of Zurich (UZH), 8091 Zürich, Switzerland; (C.B.); (S.R.B.)
- Medizinische Klinik und Poliklinik III, University Hospital Carl Gustav Carus Dresden, 01307 Dresden, Germany;
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Turla A, Laganà M, Abate A, Cremaschi V, Zamparini M, Chittò M, Consoli F, Alberti A, Ambrosini R, Tamburello M, Grisanti S, Tiberio GAM, Sigala S, Cosentini D, Berruti A. Feasibility and Activity of Megestrol Acetate in Addition to Etoposide, Doxorubicin, Cisplatin, and Mitotane as First-Line Therapy in Patients with Metastatic/Unresectable Adrenocortical Carcinoma with Low Performance Status. Cancers (Basel) 2023; 15:4491. [PMID: 37760461 PMCID: PMC10527072 DOI: 10.3390/cancers15184491] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 08/23/2023] [Accepted: 09/07/2023] [Indexed: 09/29/2023] Open
Abstract
(1) Background: The standard first-line therapy for advanced adrenocortical carcinoma (ACC) is represented by EDP-M (etoposide, doxorubicin, cisplatin + mitotane). Progestins have shown cytotoxic activity both in vitro and in vivo on ACC; better EDP-M tolerability and efficacy have been hypnotized due to the association with progestins. (2) Methods: The feasibility and tolerability of EDP-M combined with oral megestrol acetate (EDP-MM) were tested in 24 patients (pts) affected by metastatic ACC with a low performance status (PS); the case group was compared with a 48 pts control group according to the propensity score. The secondary objectives were clinical benefit rate (CBR), progression-free survival (PFS), and overall survival (OS). (3) Results: Thirteen pts (54.2%) in the EDP-MM population experienced progestin-related toxicities; in particular, five pts experienced vaginal bleeding (20.8%); four pts experienced weight gain (16.7%); and thromboembolic events, worsening of hypertension, skin rashes, and hyperglycemia were registered in one patient each (4.2%). This led to the discontinuation of megestrol acetate in four pts (16.7%). EDP-M-related toxicities were similar in both groups. No differences in PFS and OS curves were observed; the CBR was 75.0% and 60.4%, respectively. (4) Conclusions: The association of EDP-M + megestrol acetate in ACC pts with a low PS is feasible and well tolerated; its efficacy appeared to be non-inferior to EDP-M administered to pts with a good PS.
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Affiliation(s)
- Antonella Turla
- Medical Oncology Unit, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Piazzale Spedali Civili 1, 25123 Brescia, Italy; (A.T.); (V.C.); (M.Z.); (M.C.); (F.C.); (A.A.); (S.G.); (D.C.); (A.B.)
| | - Marta Laganà
- Medical Oncology Unit, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Piazzale Spedali Civili 1, 25123 Brescia, Italy; (A.T.); (V.C.); (M.Z.); (M.C.); (F.C.); (A.A.); (S.G.); (D.C.); (A.B.)
| | - Andrea Abate
- Section of Pharmacology, Department of Molecular and Translational Medicine, University of Brescia, Viale Europa 11, 25123 Brescia, Italy; (A.A.); (M.T.); (S.S.)
| | - Valentina Cremaschi
- Medical Oncology Unit, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Piazzale Spedali Civili 1, 25123 Brescia, Italy; (A.T.); (V.C.); (M.Z.); (M.C.); (F.C.); (A.A.); (S.G.); (D.C.); (A.B.)
| | - Manuel Zamparini
- Medical Oncology Unit, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Piazzale Spedali Civili 1, 25123 Brescia, Italy; (A.T.); (V.C.); (M.Z.); (M.C.); (F.C.); (A.A.); (S.G.); (D.C.); (A.B.)
| | - Matteo Chittò
- Medical Oncology Unit, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Piazzale Spedali Civili 1, 25123 Brescia, Italy; (A.T.); (V.C.); (M.Z.); (M.C.); (F.C.); (A.A.); (S.G.); (D.C.); (A.B.)
| | - Francesca Consoli
- Medical Oncology Unit, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Piazzale Spedali Civili 1, 25123 Brescia, Italy; (A.T.); (V.C.); (M.Z.); (M.C.); (F.C.); (A.A.); (S.G.); (D.C.); (A.B.)
| | - Andrea Alberti
- Medical Oncology Unit, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Piazzale Spedali Civili 1, 25123 Brescia, Italy; (A.T.); (V.C.); (M.Z.); (M.C.); (F.C.); (A.A.); (S.G.); (D.C.); (A.B.)
| | - Roberta Ambrosini
- Radiology Unit, ASST Spedali Civili, Piazzale Spedali Civili 1, 25123 Brescia, Italy;
| | - Mariangela Tamburello
- Section of Pharmacology, Department of Molecular and Translational Medicine, University of Brescia, Viale Europa 11, 25123 Brescia, Italy; (A.A.); (M.T.); (S.S.)
| | - Salvatore Grisanti
- Medical Oncology Unit, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Piazzale Spedali Civili 1, 25123 Brescia, Italy; (A.T.); (V.C.); (M.Z.); (M.C.); (F.C.); (A.A.); (S.G.); (D.C.); (A.B.)
| | - Guido Alberto Massimo Tiberio
- Surgical Unit, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Piazzale Spedali Civili 1, 25123 Brescia, Italy;
| | - Sandra Sigala
- Section of Pharmacology, Department of Molecular and Translational Medicine, University of Brescia, Viale Europa 11, 25123 Brescia, Italy; (A.A.); (M.T.); (S.S.)
| | - Deborah Cosentini
- Medical Oncology Unit, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Piazzale Spedali Civili 1, 25123 Brescia, Italy; (A.T.); (V.C.); (M.Z.); (M.C.); (F.C.); (A.A.); (S.G.); (D.C.); (A.B.)
| | - Alfredo Berruti
- Medical Oncology Unit, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Piazzale Spedali Civili 1, 25123 Brescia, Italy; (A.T.); (V.C.); (M.Z.); (M.C.); (F.C.); (A.A.); (S.G.); (D.C.); (A.B.)
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Ruggiero C, Tamburello M, Rossini E, Zini S, Durand N, Cantini G, Cioppi F, Hantel C, Kiseljak-Vassiliades K, Wierman ME, Landwehr LS, Weigand I, Kurlbaum M, Zizioli D, Turtoi A, Yang S, Berruti A, Luconi M, Sigala S, Lalli E. FSCN1 as a new druggable target in adrenocortical carcinoma. Int J Cancer 2023; 153:210-223. [PMID: 36971100 DOI: 10.1002/ijc.34526] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 03/02/2023] [Accepted: 03/15/2023] [Indexed: 03/29/2023]
Abstract
Adrenocortical carcinoma (ACC) is a rare endocrine malignancy with a high risk of relapse and metastatic spread. The actin-bundling protein fascin (FSCN1) is overexpressed in aggressive ACC and represents a reliable prognostic indicator. FSCN1 has been shown to synergize with VAV2, a guanine nucleotide exchange factor for the Rho/Rac GTPase family, to enhance the invasion properties of ACC cancer cells. Based on those results, we investigated the effects of FSCN1 inactivation by CRISPR/Cas9 or pharmacological blockade on the invasive properties of ACC cells, both in vitro and in an in vivo metastatic ACC zebrafish model. Here, we showed that FSCN1 is a transcriptional target for β-catenin in H295R ACC cells and that its inactivation resulted in defects in cell attachment and proliferation. FSCN1 knock-out modulated the expression of genes involved in cytoskeleton dynamics and cell adhesion. When Steroidogenic Factor-1 (SF-1) dosage was upregulated in H295R cells, activating their invasive capacities, FSCN1 knock-out reduced the number of filopodia, lamellipodia/ruffles and focal adhesions, while decreasing cell invasion in Matrigel. Similar effects were produced by the FSCN1 inhibitor G2-044, which also diminished the invasion of other ACC cell lines expressing lower levels of FSCN1 than H295R. In the zebrafish model, metastases formation was significantly reduced in FSCN1 knock-out cells and G2-044 significantly reduced the number of metastases formed by ACC cells. Our results indicate that FSCN1 is a new druggable target for ACC and provide the rationale for future clinical trials with FSCN1 inhibitors in patients with ACC.
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Affiliation(s)
- Carmen Ruggiero
- Institut de Pharmacologie Moléculaire et Cellulaire CNRS UMR 7275, 06560, Valbonne, France
- Université Côte d'Azur, 06560, Valbonne, France
| | - Mariangela Tamburello
- Section of Pharmacology, Department of Molecular and Translational Medicine, University of Brescia, 25124, Brescia, Italy
| | - Elisa Rossini
- Section of Pharmacology, Department of Molecular and Translational Medicine, University of Brescia, 25124, Brescia, Italy
| | - Silvia Zini
- Section of Pharmacology, Department of Molecular and Translational Medicine, University of Brescia, 25124, Brescia, Italy
| | - Nelly Durand
- Institut de Pharmacologie Moléculaire et Cellulaire CNRS UMR 7275, 06560, Valbonne, France
- Université Côte d'Azur, 06560, Valbonne, France
| | - Giulia Cantini
- Endocrinology Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, 50134, Florence, Italy
- Centro di Ricerca e Innovazione sulle Patologie Surrenaliche, AOU Careggi, 50134, Florence, Italy
| | - Francesca Cioppi
- Centro di Ricerca e Innovazione sulle Patologie Surrenaliche, AOU Careggi, 50134, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, 50134, Florence, Italy
| | - Constanze Hantel
- Department of Endocrinology, Diabetology and Clinical Nutrition, University Hospital Zurich (USZ) and University of Zurich (UZH), 8091, Zürich, Switzerland
- Medizinische Klinik und Poliklinik III, University Hospital Carl Gustav Carus Dresden, 01307, Dresden, Germany
| | - Katja Kiseljak-Vassiliades
- Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, 80045, Aurora, Colorado, USA
- Rocky Mountain Regional Veterans Affairs Medical Center, 80045, Aurora, Colorado, USA
| | - Margaret E Wierman
- Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, 80045, Aurora, Colorado, USA
- Rocky Mountain Regional Veterans Affairs Medical Center, 80045, Aurora, Colorado, USA
| | - Laura-Sophie Landwehr
- Division of Endocrinology and Diabetology-Department of Internal Medicine I, University Hospital, University of Würzburg, 97080, Würzburg, Germany
| | - Isabel Weigand
- Division of Endocrinology and Diabetology-Department of Internal Medicine I, University Hospital, University of Würzburg, 97080, Würzburg, Germany
- Department of Medicine IV, University Hospital Munich, Ludwig-Maximilians-Universität München, 81377, Munich, Germany
| | - Max Kurlbaum
- Division of Endocrinology and Diabetology-Department of Internal Medicine I, University Hospital, University of Würzburg, 97080, Würzburg, Germany
| | - Daniela Zizioli
- Section of Biotechnology, Department of Molecular and Translational Medicine, University of Brescia, 25124, Brescia, Italy
| | - Andrei Turtoi
- Tumor Microenvironment and Resistance to Therapy Laboratory, Institut de Recherche en Cancérologie de Montpellier, Université de Montpellier-INSERM U1194, 34090, Montpellier, France
- Platform for Translational Oncometabolomics, Biocampus, CNRS-INSERM-Université de Montpellier, 34090, Montpellier, France
| | - Shengyu Yang
- Department of Cellular and Molecular Physiology, Penn State University College of Medicine, 17033, Hershey, Pennsylvania, USA
| | - Alfredo Berruti
- Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia and ASST Spedali Civili di Brescia, 25123, Brescia, Italy
| | - Michaela Luconi
- Endocrinology Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, 50134, Florence, Italy
- Centro di Ricerca e Innovazione sulle Patologie Surrenaliche, AOU Careggi, 50134, Florence, Italy
| | - Sandra Sigala
- Section of Pharmacology, Department of Molecular and Translational Medicine, University of Brescia, 25124, Brescia, Italy
| | - Enzo Lalli
- Institut de Pharmacologie Moléculaire et Cellulaire CNRS UMR 7275, 06560, Valbonne, France
- Université Côte d'Azur, 06560, Valbonne, France
- Inserm, 06560, Valbonne, France
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Albano D, Dondi F, Bauckneht M, Albertelli M, Durmo R, Filice A, Versari A, Morbelli S, Berruti A, Bertagna F. The diagnostic and prognostic role of combined [ 18F]FDG and [ 68Ga]-DOTA-peptides PET/CT in primary pulmonary carcinoids: a multicentric experience. Eur Radiol 2023; 33:4167-4177. [PMID: 36482218 DOI: 10.1007/s00330-022-09326-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 10/26/2022] [Accepted: 11/09/2022] [Indexed: 12/13/2022]
Abstract
OBJECTIVES In the present retrospective multicentric study, we combined [68Ga]-DOTA-peptides and [18F]FDG-PET/CT findings aiming to investigate their capability to differentiate typical (TC) and atypical pulmonary carcinoids (AC) and their prognostic role. METHODS From three centers, 61 patients were retrospectively included. Based on a dual tracer combination we classified PET scans as score 1, [18F]FDG- and [68Ga]-DOTA-peptides negative; score 2, [68Ga]-DOTA-peptides positive and [18F]FDG-negative; score 3, [68Ga]-DOTA-peptides negative and [18F]FDG-positive; score 4, both tracers positive. Moreover, for each patient, the ratios of SUVmax on [68Ga]-DOTA-PET to that on [18F]FDG-PET were calculated (SUVr). RESULTS Thirty-five patients had a final diagnosis of TC. Twenty-two TC (57%) had positive [68Ga]-DOTA-peptides PET; instead, 21/26 (81%) AC had positive [18F]FDG-PET/CT. On dual-tracer analysis, scores 1, 2, 3 and 4 were 13%, 20%, 43% and 24% for all populations; 17%, 26%, 20% and 37% for TC; 8%, 11%, 73% and 8% for AC. Median SUVr was significantly higher in TC than AC (6.4 vs. 0.4, p = 0.011). The best value of SUVr to predict the final diagnosis was 1.05 (AUC 0.889). Relapse or progression of disease happened in 17 patients (11 affected by AC) and death in 10 cases (7 AC). AC diagnosis, positive [18F]FDG-PET, negative DOTA-PET and dual tracer score were significantly correlated with PFS (p = 0.013, p = 0.033, p = 0.029 and p = 0.019), while only AC diagnosis with OS (p = 0.022). CONCLUSION PET/CT findings had also a prognostic role in predicting PFS. Dual-tracer PET behavior may be used to predict the nature of pulmonary carcinoids and select the most appropriate management. KEY POINTS • Combination of [18F]FDG and [68Ga]-DOTA-peptides PET/CT results may help to differentiate between atypical and typical lung carcinoids. • The SUVmax ratio between [18F]FDG and [68Ga]-DOTA-peptides PET may help to differentiate between atypical and typical lung carcinoids. • Histotype and PET/CT features have a prognostic impact on PFS.
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Affiliation(s)
- Domenico Albano
- Nuclear Medicine, ASST Spedali Civili di Brescia, P.le Spedali Civili 1, 25123, Brescia, Italy.
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health; Nuclear Medicine, University of Brescia, Brescia, Italy.
| | - Francesco Dondi
- Nuclear Medicine, ASST Spedali Civili di Brescia, P.le Spedali Civili 1, 25123, Brescia, Italy
| | - Matteo Bauckneht
- Nuclear Medicine, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Health Sciences (DISSAL), University of Genova, Genova, Italy
| | - Manuela Albertelli
- Endocrinology Unit, IRCCS Ospedale Policlinico San Martino, University of Genova, Genova, Italy
| | - Rexhep Durmo
- Nuclear Medicine, Azienda USL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
- PhD Program in Clinical and Experimental Medicine (CEM), University of Modena and Reggio Emilia, Modena, Italy
| | - Angelina Filice
- Nuclear Medicine, Azienda USL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - Annibale Versari
- Nuclear Medicine, Azienda USL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - Silvia Morbelli
- Nuclear Medicine, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Health Sciences (DISSAL), University of Genova, Genova, Italy
| | - Alfredo Berruti
- Medical Oncology Unit, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Francesco Bertagna
- Nuclear Medicine, ASST Spedali Civili di Brescia, P.le Spedali Civili 1, 25123, Brescia, Italy
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health; Nuclear Medicine, University of Brescia, Brescia, Italy
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Fassi E, Mandruzzato M, Zamparini M, Bianchi S, Petrelli F, Baggi A, Alberti A, Grisanti S, Berruti A. Clinical presentation and outcome of patients with enteric-type adenocarcinoma of the lung: A pooled analysis of published cases. Lung Cancer 2023; 179:107176. [PMID: 37015149 DOI: 10.1016/j.lungcan.2023.107176] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 03/14/2023] [Accepted: 03/17/2023] [Indexed: 04/03/2023]
Abstract
Enteric-type adenocarcinoma of the lung (lung-ETAC, former pulmonary enteric adenocarcinoma, PEAC) is a rare subtype of non-small cell lung cancer (NSCLC), which shares morphological and immunohistochemical features with lung and colorectal adenocarcinoma. Few data are available on patient prognosis, possible prognostic factors and systemic approach to metastatic disease. We performed a pooled analysis and a systematic review of published lung-ETAC, along with an additional case description. Thirty-one eligible publications were identified, providing data from 126 patients. In the 127 patients overall analyzed, median overall survival (OS) was 56.0 (range 36.7-75.3) months in early-stage patients and 14.0 (range 4.5-23.5) months in those with advanced/metastatic disease. Median disease-free survival (DFS) after radical surgery was 24 (range 22.6-35.1) months. Smoking status (HR 4.304, 95% CI: 1.261-14.693, p = 0.020) and node involvement (HR 1.853, 95% CI: 1.179-2.911, p = 0.007) were the negative independent prognostic factors at multivariate analysis. As regards systemic therapies for advanced cases, no firm conclusions were drawn about the efficacy of lung cancer-oriented chemotherapy regimens as opposed to colon cancer-oriented ones. Molecular analysis of lung-ETAC revealed a relatively high mutational rate, with alterations in several druggable molecular pathways, KRAS and NRAS (31%) were the most frequently mutated oncogenes, followed by ROS1 (15%), RET (13%), BRAF (11%), EGFR (8%) and ALK (6%). Moreover, 3 (15%) out of 20 cases showed DNA mismatch repair deficiency (dMMR). In conclusion, advanced lung-ETAC patients appeared to have a better prognosis compared to other subtypes of NSCLC. Moreover, the mutational rate and microsatellite instability found in lung-ETACs suggest that a significant proportion of these patients could benefit from target therapies and immunotherapy.
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Tamburello M, Abate A, Rossini E, Basnet RM, Zizioli D, Cosentini D, Hantel C, Laganà M, Tiberio GAM, Grisanti S, Memo M, Berruti A, Sigala S. Preclinical Evidence of Progesterone as a New Pharmacological Strategy in Human Adrenocortical Carcinoma Cell Lines. Int J Mol Sci 2023; 24:ijms24076829. [PMID: 37047801 PMCID: PMC10095539 DOI: 10.3390/ijms24076829] [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: 02/26/2023] [Revised: 03/30/2023] [Accepted: 04/03/2023] [Indexed: 04/08/2023] Open
Abstract
Background: Adrenocortical cancer (ACC) is a rare malignancy with a dismal prognosis. The treatment includes mitotane and EDP chemotherapy (etoposide, doxorubicin, and cisplatin). However, new therapeutic approaches for advanced ACC are needed, particularly targeting the metastatic process. Here, we deepen the role of progesterone as a new potential drug for ACC, in line with its antitumoral effect in other cancers. Methods: NCI-H295R, MUC-1, and TVBF-7 cell lines were used and xenografted in zebrafish embryos. Migration and invasion were studied using transwell assays, and MMP2 activity was studied using zymography. Apoptosis and cell cycle were analyzed by flow cytometry. Results: Progesterone significantly reduced xenograft tumor area and metastasis formation in embryos injected with metastatic lines, MUC-1 and TVBF-7. These results were confirmed in vitro, where the reduction of invasion was mediated, at least in part, by the decrease in MMP2 levels. Progesterone exerted a long-lasting effect in metastaticcells. Progesterone caused apoptosis in NCI-H295R and MUC-1, inducing changes in the cell-cycle distribution, while autophagy was predominantly activated in TVBF-7 cells. Conclusion: Our results give support to the role of progesterone in ACC. The involvement of its analog (megestrol acetate) in reducing ACC progression in ACC patients undergoing EDP-M therapy is now under investigation in the PESETA phase II clinical study.
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Affiliation(s)
- Mariangela Tamburello
- Section of Pharmacology, Department of Molecular and Translational Medicine, University of Brescia, 25123 Brescia, Italy
| | - Andrea Abate
- Section of Pharmacology, Department of Molecular and Translational Medicine, University of Brescia, 25123 Brescia, Italy
| | - Elisa Rossini
- Section of Pharmacology, Department of Molecular and Translational Medicine, University of Brescia, 25123 Brescia, Italy
| | - Ram Manohar Basnet
- Section of Biotechnology, Department of Molecular and Translational Medicine, University of Brescia, 25123 Brescia, Italy
| | - Daniela Zizioli
- Section of Biotechnology, Department of Molecular and Translational Medicine, University of Brescia, 25123 Brescia, Italy
| | - Deborah Cosentini
- Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia and ASST Spedali Civili di Brescia, 25123 Brescia, Italy
| | - Constanze Hantel
- Department of Endocrinology, Diabetology and Clinical Nutrition, University Hospital Zurich (USZ) and University of Zurich (UZH), 8091 Zürich, Switzerland
- Medizinische Klinik und Poliklinik III, University Hospital Carl Gustav Carus Dresden, 01307 Dresden, Germany
| | - Marta Laganà
- Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia and ASST Spedali Civili di Brescia, 25123 Brescia, Italy
| | - Guido Alberto Massimo Tiberio
- Surgical Clinic, Department of Clinical and Experimental Sciences, University of Brescia at ASST Spedali Civili di Brescia, 25123 Brescia, Italy
| | - Salvatore Grisanti
- Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia and ASST Spedali Civili di Brescia, 25123 Brescia, Italy
| | - Maurizio Memo
- Section of Pharmacology, Department of Molecular and Translational Medicine, University of Brescia, 25123 Brescia, Italy
| | - Alfredo Berruti
- Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia and ASST Spedali Civili di Brescia, 25123 Brescia, Italy
| | - Sandra Sigala
- Section of Pharmacology, Department of Molecular and Translational Medicine, University of Brescia, 25123 Brescia, Italy
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Grisanti S, Borghetti P, Bianchi S, Vultaggio C, Mandruzzato M, Facheris G, Fassi E, Ammoni L, Baggi A, Prina MM, Magrini S, Berruti A. 167P Five-years incidence of SCLC and analysis of PM2.5 air pollution in the province of Brescia: Preliminary results. J Thorac Oncol 2023. [DOI: 10.1016/s1556-0864(23)00421-5] [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: 04/03/2023]
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Cremaschi V, Cosentini D, Abate A, Boglioni M, Laganà M, Tamburello M, Ambrosini R, Dondi F, Giacchè M, Tiberio G, Grisanti S, Sigala S, Berruti A. 40TiP Activity of the addition of progesterone to standard EDP-M scheme in patients with advanced adrenocortical carcinoma: A randomized, placebo-controlled phase II trial (PESETA). ESMO Open 2023. [DOI: 10.1016/j.esmoop.2023.101061] [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: 04/05/2023] Open
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Cosentini D, Grisanti S, Laganà M, Di Meo N, Cremaschi V, Turla A, Cappelli C, Loli P, Farina D, Berruti A. 30P Bone fragility in patients with adrenocortical carcinoma undergoing mitotane therapy. ESMO Open 2023. [DOI: 10.1016/j.esmoop.2023.101051] [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: 04/05/2023] Open
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Laganà M, Cosentini D, Grisanti S, Remde H, Almeida M, Pusceddu S, Deutschbein T, Fagundes G, Pereira A, Grana C, Fazio N, Corssmit E, Bongiovanni A, Canu L, Kim E, Habra M, Jimenez C, Berruti A. 31P Bone metastases and skeletal related events in pheochromocytoma and paraganglioma patients: International, retrospective study. ESMO Open 2023. [DOI: 10.1016/j.esmoop.2023.101052] [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: 04/05/2023] Open
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Grisanti S, Scatolini M, Tomaiuolo P, Grosso E, Basile V, Cosentini D, Puglisi S, Laganà M, Perotti P, Rossini E, Smussi D, Sigala S, Volante M, Berruti A, Terzolo M. 29MO Germline variants NGS characterization in patients with non-syndromic adrenocortical carcinoma. ESMO Open 2023. [DOI: 10.1016/j.esmoop.2023.101050] [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: 04/05/2023] Open
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35
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Turla A, Laganà M, Cosentini D, Zamparini M, Ambrosini R, Cremaschi V, Tiberio G, Abate A, Tamburello M, Sigala S, Grisanti S, Berruti A. 35P Feasibility and activity of megestrol acetate in addition to EDP-M as first-line therapy in patients with metastatic/unresectable adrenocortical carcinoma. ESMO Open 2023. [DOI: 10.1016/j.esmoop.2023.101056] [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: 04/05/2023] Open
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36
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Dalla Volta A, Valcamonico F, Zivi A, Procopio G, Sepe P, Del Conte G, Di Meo N, Foti S, Zamboni S, Messina C, Lucchini E, Rizzi A, Ravanelli M, Milella M, Calza S, Simeone C, Maroldi R, Farina D, Berruti A. Whole-body diffusion-weighted magnetic resonance imaging to assess bone response in patients with hormone-sensitive metastatic prostate cancer randomly assigned to receive androgen deprivation + enzalutamide ± zoledronic acid. J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.6_suppl.46] [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: 03/16/2023] Open
Abstract
46 Background: Bone is frequently involved in metastatic hormone sensitive prostate cancer (mHSPC). Whole-body diffusion-weighted magnetic resonance imaging (WB-DW-MRI) is a promising imaging technique for the assessment of bone response in prostate cancer. It is not known whether the addition of antiresorptive agents can improve disease response in bone in mHSPC patients undergoing next generation hormonal agents. Methods: In this multicenter phase II study patients with de novo or relapsed mHSPC and bone metastases at bone scan were randomly allocated with a 1:1 ratio to receive either androgen deprivation therapy (ADT) plus Enzalutamide (E arm) or the same combination with the addition of Zoledronic Acid (EZ arm). The study was designed to observe a significant increase in bone response rate in the experimental arm after 12 months of treatment, as assessed through WB-DW-MRI. WB-DW-MRI was performed centrally at baseline and after 6 and 12 months and images were evaluated by the same radiologist. Results: From February 2018 to June 2021, 126 mHSPC patients were randomized, 64 in EZ arm and 62 in E arm. A total of 111 patients, 54 from E arm and 57 from EZ arm, were eligible for WB-DW-MRI assessment (15 patients were excluded because of the absence of bone target lesions at MRI or specific contraindications to MRI). Bone response at 6 months was observed in 41 patients (76%) in E arm and 41 patients (72%) in EZ arm; the corresponding bone response at 12 months were 44 (82%) and 44 (77%), respectively (OR 0.77; 95%IC 0.30-1.93; p = 0.6). Complete response was the best overall bone response after 12 months in 9 patients (17%) from E arm and in 11 patients (19%) from EZ arm. In the same period, treatment was interrupted due to disease progression in 7 (13%) and 7 (12%) patients in E and EZ arm, respectively. Conclusions: The addition of Zoledronic Acid to Enzalutamide and ADT did not improve bone disease response in patients with mHSPC. WB-DW-MRI was able to detect bone responses in a great proportion of patients. Clinical trial information: NCT03336983 .
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Affiliation(s)
| | | | - Andrea Zivi
- Oncology Unit, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | | | - Pierangela Sepe
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | | | - Nunzia Di Meo
- Radiology Unit - ASST Spedali Civili, Brescia, Italy
| | | | | | - Caterina Messina
- Medical Oncology Unit - ASST Papa Giovanni XXIII, Bergamo, Italy
| | | | - Anna Rizzi
- Medical Oncology Unit - ASST Garda, Manerbio, Italy
| | | | - Michele Milella
- Medical Oncology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | | | | | - Roberto Maroldi
- Department of Radiology, University of Brescia, ASST Spedali Civili, Brescia, Italy
| | - Davide Farina
- Radiology Unit - ASST Spedali Civili, Brescia, Italy
| | - Alfredo Berruti
- Medical Oncology Unit, Department of Medical & Surgical Specialties, Radiological Sciences & Public Health, University of Brescia, ASST Spedali Civili, Brescia, Italy
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Berruti A, Bracarda S, Caffo O, Cortesi E, D'Angelillo R, Del Re M, Facchini G, Pappagallo G, Procopio G, Sabbatini R, Santini D. nmCRPC, a look in the continuous care of prostate cancer patients: state of art and future perspectives. Cancer Treat Rev 2023; 115:102525. [PMID: 36822009 DOI: 10.1016/j.ctrv.2023.102525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 02/10/2023] [Accepted: 02/12/2023] [Indexed: 02/16/2023]
Abstract
Non-metastatic castration resistant prostate cancer (nmCRPC) is a clinical setting defined as confirmed rising levels of PSA in patients treated with ADT but without detectable metastases on conventional imaging with computerized tomography (CT) and technetium-99 m scintigraphy. Men with nmCRPC and a PSA doubling time (PSADT) ≤ 10 months are considered at high risk of rapidly developing metastases with a consequent possible impact on survival. Three recent phase III trials have demonstrated, in this setting, the efficacy of adding a next-generation androgen receptor targeted agent (ARTA) to ADT in respect to ADT only, in delaying the development of metastases (metastasis-free survival, MFS) and prolong overall survival. The magnitude of clinical benefit of these agents was even more meaningful if considering the low incidence of drug related adverse events. Our review described the latest advances in the management of nmCRPC, deriving from the pivotal clinical trials, SPARTAN, PROSPER and ARAMIS, in order to support clinicians to optimally manage these patients. Of note, the emergence of novel, more accurate, next-generation imaging techniques (including Ga PSMA-PET/CT), as well as eventual future tumor biomarkers, is modifying the entity and definition of the nmCRPC setting, with a consequent impact on patient's diagnosis and management.
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Affiliation(s)
- Alfredo Berruti
- Unit of Medical Oncology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Italy.
| | - Sergio Bracarda
- Medical and Translational Oncology Unit, Department of Oncology, Azienda Ospedaliera Santa Maria, Terni, Italy.
| | - Orazio Caffo
- Department of Medical Oncology, Santa Chiara Hospital, Trento, Italy.
| | - Enrico Cortesi
- Medical Oncology Department, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy.
| | | | - Marzia Del Re
- Unit of Clinical Pharmacology and Pharmacogenetics, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
| | - Gaetano Facchini
- Oncology Complex Unit, "S. Maria delle Grazie" Hospital, ASL NA2 NORD, Pozzuoli, Italy.
| | - Giovanni Pappagallo
- School of Methodology of Clinical Research, IRCCS "Sacro Cuore-Don Calabria" Hospital, 37024 Negrar di Valpolicella, VR, Italy.
| | - Giuseppe Procopio
- Medical Oncology Unit, Programma Prostata, Fondazione Istituto Nazionale Tumori, Milano.
| | - Roberto Sabbatini
- SC Oncologia, Azienda Ospedaliera Universitaria Policlinico di Modena, Modena, Italy.
| | - Daniele Santini
- UOC oncologia medica territoriale, La Sapienza Università, Polo Pontino, Latina, Italy.
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Abate A, Tamburello M, Rossini E, Basnet RM, Ribaudo G, Gianoncelli A, Hantel C, Cosentini D, Laganà M, Grisanti S, Tiberio GAM, Memo M, Berruti A, Sigala S. Trabectedin impairs invasiveness and metastasis in adrenocortical carcinoma preclinical models. Endocr Relat Cancer 2023; 30:e220273. [PMID: 36449565 DOI: 10.1530/erc-22-0273] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 11/29/2022] [Indexed: 12/05/2022]
Abstract
The pharmacological approach to adrenocortical carcinoma (ACC) is based on mitotane with/without etoposide, doxorubicin, and cisplatin, according to the disease stage. Considering the limited efficacy and toxicity of this treatment, new strategies are required. Trabectedin is a marine-derivated antitumoral agent that inhibits oncogenic transcription. We have already demonstrated trabectedin cytotoxic activity at sub-nanomolar concentrations in ACC cells. Here, we expanded the investigation of trabectedin effect on ACC preclinical models, evaluating whether trabectedin could affect ACC cells' invasiveness and metastasis formation. NCI-H295R, MUC-1, and TVBF-7 cell lines were used. Cell tumor xenografts in Danio rerio embryos were performed. The tumor mass areas and the number of embryos with metastasis were evaluated. The in vitro invasiveness of cells was evaluated. Effects of trabectedin of MMP2, TIMP1, and TIMP2 were evaluated at gene level qRT-PCR. MMP2 secreted in the cell medium was evaluated by Western blot and by zymography. Xenograft experiments demonstrated that trabectedin significantly reduced the tumor area in each ACC cell model and metastasis formation in embryos injected with metastasis-derived cell lines. Trabectedin treatment reduced the invasiveness of ACC cells across the matrix, which was greater at baseline for the metastatic models. In metastatic cell models, protein analysis demonstrated a reduction of MMP2 secretion and activity in the culture medium after treatment. Our results indicate that trabectedin interferes with invasiveness and metastasis processes, both dramatic features of ACC. Furthermore, these results support those previously published in providing the rationale for a clinical evaluation of the efficacy of trabectedin in ACC patients.
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Affiliation(s)
- Andrea Abate
- Section of Pharmacology, Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Mariangela Tamburello
- Section of Pharmacology, Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Elisa Rossini
- Section of Pharmacology, Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Ram Manohar Basnet
- Section of Pharmacology, Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Giovanni Ribaudo
- Section of Pharmacology, Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Alessandra Gianoncelli
- Section of Pharmacology, Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Constanze Hantel
- Department of Endocrinology, Diabetology and Clinical Nutrition, University Hospital Zurich (USZ) and University of Zurich (UZH), Zurich, Switzerland
- Medizinische Klinik und Poliklinik III, University Hospital Carl Gustav Carus Dresden, Dresden, Germany
| | - Deborah Cosentini
- Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia and ASST Spedali Civili di Brescia, Brescia, Italy
| | - Marta Laganà
- Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia and ASST Spedali Civili di Brescia, Brescia, Italy
| | - Salvatore Grisanti
- Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia and ASST Spedali Civili di Brescia, Brescia, Italy
| | - Guido Alberto Massimo Tiberio
- Surgical Clinic, Department of Clinical and Experimental Sciences, University of Brescia at ASST Spedali Civili di Brescia, Brescia, Italy
| | - Maurizio Memo
- Section of Pharmacology, Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Alfredo Berruti
- Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia and ASST Spedali Civili di Brescia, Brescia, Italy
| | - Sandra Sigala
- Section of Pharmacology, Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
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Sarvestani AL, Gregory SN, Teke ME, Terzolo M, Berruti A, Hernandez JM, Habra MA. Mitotane With or Without Cisplatin and Etoposide for Patients with a High Risk of Recurrence in Stages 1-3 Adrenocortical Cancer After Surgery. Ann Surg Oncol 2023; 30:680-682. [PMID: 36305989 DOI: 10.1245/s10434-022-12725-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 10/13/2022] [Indexed: 01/10/2023]
Affiliation(s)
- Amber Leila Sarvestani
- Surgical Oncology Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Stephanie N Gregory
- Surgical Oncology Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Martha E Teke
- Surgical Oncology Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Massimo Terzolo
- San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | - Alfredo Berruti
- Medical Oncology, Department of Medical and Surgical Specialities, Radiological Sciences and Public Health University of Brescia, ASSAT-Spedali Civili, Brescia, Italy
| | - Jonathan M Hernandez
- Surgical Oncology Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
| | - Mouhammed Amir Habra
- Department of Endocrine Neoplasia and Hormonal Disorders, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Centonze G, Maisonneuve P, Simbolo M, Lagano V, Grillo F, Prinzi N, Pusceddu S, Missiato L, Colantuono M, Sabella G, Bercich L, Mangogna A, Rolli L, Grisanti S, Benvenuti MR, Pastorino U, Roz L, Scarpa A, Berruti A, Capella C, Milione M. Ascl1 and OTP tumour expressions are associated with disease-free survival in lung atypical carcinoids. Histopathology 2023; 82:870-884. [PMID: 36720841 DOI: 10.1111/his.14873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 01/11/2023] [Accepted: 01/28/2023] [Indexed: 02/02/2023]
Abstract
According to World Health Organization guidelines, atypical carcinoids (ACs) are well-differentiated lung neuroendocrine tumours with 2-10 mitoses/2 mm2 and/or foci of necrosis (usually punctate). Besides morphological criteria, no further tools in predicting AC clinical outcomes are proposed. The aim of this work was to identify novel factors able to predict AC disease aggressiveness and progression. METHODS AND RESULTS: Three hundred-seventy lung carcinoids were collected and centrally reviewed by two expert pathologists. Morphology and immunohistochemical markers (Ki-67, TTF-1, CD44, OTP, SSTR2A, Ascl1, p53, and Rb1) were studied and correlated with disease-free survival (DFS) and overall survival (OS). Fifty-eight of 370 tumours were defined as AC. Survival analysis showed that patients with Ascl1 + ACs and those with OTP-ACs had a significantly worse DFS than patients with Ascl1-ACs and OTP + ACs, respectively. Combining Ascl1 and OTP expressions, groups were formed reflecting the aggressiveness of disease (P = 0.0005). Ki-67 ≥10% patients had a significantly worse DFS than patients with Ki-67 <10%. At multivariable analysis, Ascl1 (present versus absent, hazard ratio [HR] = 3.42, 95% confidence interval [CI] 1.35-8.65, P = 0.009) and OTP (present versus absent, HR = 0.26, 95% CI 0.10-0.68, P = 0.006) were independently associated with DFS. The prognosis of patients with Ki-67 ≥10% tended to be worse compared to that with Ki-67 <10%. On the contrary, OTP (present versus absent, HR = 0.28, 95% CI 0.09-0.89, P = 0.03), tumour stage (III-IV versus I-II, HR = 4.25, 95% CI 1.42-12.73, P = 0.01) and increasing age (10-year increase, HR = 1.67, 95% CI 1.04-2.68, P = 0.03) were independently associated with OS. CONCLUSION: This retrospective analysis of lung ACs showed that Ascl1 and OTP could be the main prognostic drivers of postoperative recurrence.
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Affiliation(s)
- Giovanni Centonze
- 1st Pathology Division, Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.,Tumor Genomics Unit, Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Patrick Maisonneuve
- Division of Epidemiology and Biostatistics, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Michele Simbolo
- Department of Diagnostics and Public Health, Section of Pathology, University of Verona, Verona, Italy
| | - Vincenzo Lagano
- 1st Pathology Division, Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Federica Grillo
- Unit of Pathology, Department of Surgical Sciences and Integrated Diagnostics, University of Genoa and Ospedale Policlinico San Martino, Genoa, Italy
| | - Natalie Prinzi
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Sara Pusceddu
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Loretta Missiato
- 1st Pathology Division, Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Marilena Colantuono
- 1st Pathology Division, Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giovanna Sabella
- 1st Pathology Division, Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Luisa Bercich
- Department of Pathology, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Alessandro Mangogna
- Institute for Maternal and Child Health, IRCCS Burlo Garofalo, Trieste, Italy
| | - Luigi Rolli
- Thoracic Surgery Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Salvatore Grisanti
- Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, ASST Spedali Civili, Brescia, Italy
| | - Mauro Roberto Benvenuti
- Thoracic Surgery Unit, Department of Medical and Surgical Specialties Radiological Sciences and Public Health, Medical Oncology, University of Brescia, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Ugo Pastorino
- Thoracic Surgery Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Luca Roz
- Tumor Genomics Unit, Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Aldo Scarpa
- Department of Diagnostics and Public Health, Section of Pathology, University of Verona, Verona, Italy.,ARC-NET Research Center for Applied Research on Cancer, and Department of Diagnostics and Public Health, Section of Pathology, University of Verona, Verona, Italy
| | - Alfredo Berruti
- Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, ASST Spedali Civili, Brescia, Italy
| | - Carlo Capella
- Unit of Pathology, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Massimo Milione
- 1st Pathology Division, Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Pedersini R, Cosentini D, Rinaudo L, Zamparini M, Ulivieri FM, di Mauro P, Maffezzoni F, Monteverdi S, Vena W, Laini L, Amoroso V, Simoncini EL, Farina D, Mazziotti G, Berruti A. Assessment of DXA derived bone quality indexes and bone geometry parameters in early breast cancer patients: A single center cross-sectional study. Bone Rep 2023; 18:101654. [PMID: 36700242 PMCID: PMC9868326 DOI: 10.1016/j.bonr.2023.101654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 01/03/2023] [Accepted: 01/06/2023] [Indexed: 01/12/2023] Open
Abstract
Background Bone mineral density (BMD) lacks sensitivity in individual fracture risk assessment in early breast cancer (EBC) patients treated with aromatase inhibitors (AIs). New dual-energy X-ray absorptiometry (DXA) based risk factors are needed. Methods Trabecular bone score (TBS), bone strain index (BSI) and DXA parameters of bone geometry were evaluated in postmenopausal women diagnosed with EBC. The aim was to explore their association with morphometric vertebral fractures (VFs). Subjects were categorized in 3 groups in order to evaluate the impact of AIs and denosumab on bone geometry: AI-naive, AI-treated minus (AIDen-) or plus (AIDen+) denosumab. Results A total of 610 EBC patients entered the study: 305 were AI-naive, 187 AIDen-, and 118 AIDen+. In the AI-naive group, the presence of VFs was associated with lower total hip BMD and T-score and higher femoral BSI. As regards as bone geometry parameters, AI-naive fractured patients reported a significant increase in femoral narrow neck (NN) endocortical width, femoral NN subperiosteal width, intertrochanteric buckling ratio (BR), intertrochanteric endocortical width, femoral shaft (FS) BR and endocortical width, as compared to non-fractured patients. Intertrochanteric BR and intertrochanteric cortical thickness significantly increased in the presence of VFs in AIDen- patients, not in AIDen+ ones. An increase in cross-sectional area and cross-sectional moment of inertia, both intertrochanteric and at FS, significantly correlated with VFs only in AIDen+. No association with VFs was found for either lumbar BSI or TBS in all groups. Conclusions Bone geometry parameters are variably associated with VFs in EBC patients, either AI-naive or AI treated in combination with denosumab. These data suggest a tailored choice of fracture risk parameters in the 3 subgroups of EBC patients.
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Key Words
- AI, aromatase inhibitor
- AIDen+, aromatase inhibitor with denosumab
- AIDen-, aromatase inhibitor without denosumab
- Aromatase inhibitors
- BMD, bone mineral density
- BMI, body-mass index
- BR, buckling ratio
- BSI, bone strain index
- Bone strain index
- CSA, cross-sectional area
- CSMI, cross-sectional moment of inertia
- DXA, dual-energy X-ray absorptiometry
- Dual-energy X-ray absorptiometry
- EBC, early breast cancer
- FS, femoral shaft
- HAL, hip axis length
- HR, hormone receptor
- HSA, Hip Structure Analysis
- IT, intertrochanteric
- NN, narrow neck
- NSA, neck shaft angle
- PS, propensity score
- ROC, receiver operator characteristic
- TBS, trabecular bone score
- VF, vertebral fracture
- Vertebral fractures
- Z, modulus
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Affiliation(s)
- Rebecca Pedersini
- Medical Oncology, ASST Spedali Civili, Brescia, Italy
- Breast Unit, ASST Spedali Civili, Brescia, Italy
- Corresponding author at: Oncologia Medica, ASST Spedali Civili di Brescia, Piazzale Spedali Civili 1, 20123, Brescia, Italy.
| | - Deborah Cosentini
- Medical Oncology, ASST Spedali Civili, Brescia, Italy
- Breast Unit, ASST Spedali Civili, Brescia, Italy
| | | | | | | | | | | | | | - Walter Vena
- Endocrinology, Diabetology and Medical Andrology Unit, Metabolic Bone Diseases and Osteoporosis Section, IRCCS Humanitas Research Hospital, Rozzano, MI, Italy
| | - Lara Laini
- Medical Oncology, ASST Spedali Civili, Brescia, Italy
| | - Vito Amoroso
- Medical Oncology, ASST Spedali Civili, Brescia, Italy
| | | | - Davide Farina
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Medical Oncology, University of Brescia, ASST Spedali Civili, Brescia, Italy
| | - Gherardo Mazziotti
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy
- Endocrinology, Diabetology and Medical Andrology Unit, Metabolic Bone Diseases and Osteoporosis Section, IRCCS Humanitas Research Hospital, Rozzano, MI, Italy
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Centonze G, Maisonneuve P, Simbolo M, Lagano V, Grillo F, Fabbri A, Prinzi N, Garzone G, Filugelli M, Pardo C, Mietta A, Pusceddu S, Sabella G, Bercich L, Mangogna A, Rolli L, Grisanti S, Benvenuti MR, Pastorino U, Roz L, Scarpa A, Berruti A, Capella C, Milione M. Lung carcinoid tumours: histology and Ki-67, the eternal rivalry. Histopathology 2023; 82:324-339. [PMID: 36239545 PMCID: PMC10092270 DOI: 10.1111/his.14819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 09/12/2022] [Accepted: 10/03/2022] [Indexed: 12/13/2022]
Abstract
WHO classification of Thoracic Tumours defines lung carcinoid tumours (LCTs) as well-differentiated neuroendocrine neoplasms (NENs) classified in low grade typical (TC) and intermediate grade atypical carcinoids (AC). Limited data exist concerning protein expression and morphologic factors able to predict disease aggressiveness. Though Ki-67 has proved to be a powerful diagnostic and prognostic factor for Gastro-entero-pancreatic NENs, its role in lung NENs is still debated. A retrospective series of 370 LCT from two oncology centers was centrally reviewed. Morphology and immunohistochemical markers (Ki-67, TTF-1, CD44, OTP, SSTR-2A, Ascl1, and p53) were studied and correlated with Overall Survival (OS), Cancer-specific survival (CSS) and Disease-free survival (DFS). Carcinoid histology was confirmed in 355 patients: 297 (83.7%) TC and 58 (16.3%) AC. Ki-67 at 3% was the best value in predicting DFS. Ki-67 ≥ 3% tumours were significantly associated with AC histology, stage III-IV, smoking, vascular invasion, tumour spread through air spaces OTP negativity, and TTF-1, Ascl1 and p53 positivity. After adjustment for center and period of diagnosis, both Ki-67 (≥3 versus <3) and histology (AC versus TC) alone significantly added prognostic information to OS and CSS multivariable model with age, stage and OTP; addition of both variables did not provide further prognostic information. Conversely, an improved significance of the DFS prediction model at multivariate analysis was seen by adding Ki-67 (≥3 versus <3, P adj = 0.01) to TC and AC histological distinction, age, lymph node involvement, residual tumour and OTP. Ki-67 ≥ 3% plays a potentially pivotal role in LCT prognosis, irrespective of histological grade.
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Affiliation(s)
- Giovanni Centonze
- 1st Pathology Division, Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.,Tumor Genomics Unit, Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Patrick Maisonneuve
- Division of Epidemiology and Biostatistics, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Michele Simbolo
- Department of Diagnostics and Public Health, Section of Pathology, University of Verona, Verona, Italy
| | - Vincenzo Lagano
- 1st Pathology Division, Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Federica Grillo
- Unit of Pathology, Department of Surgical Sciences and Integrated Diagnostics, University of Genoa and Ospedale Policlinico San Martino, Genoa, Italy
| | - Alessandra Fabbri
- 2nd Pathology Division, Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Natalie Prinzi
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giovanna Garzone
- 1st Pathology Division, Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Martina Filugelli
- 1st Pathology Division, Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Carlotta Pardo
- 1st Pathology Division, Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Alessia Mietta
- 1st Pathology Division, Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Sara Pusceddu
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giovanna Sabella
- 1st Pathology Division, Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Luisa Bercich
- Department of Pathology, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Alessandro Mangogna
- Institute for Maternal and Child Health, IRCCS Burlo Garofalo, Trieste, Italy
| | - Luigi Rolli
- Thoracic Surgery Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Salvatore Grisanti
- Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, ASST Spedali Civili, Brescia, Italy
| | - Mauro Roberto Benvenuti
- Thoracic Surgery Unit, Department of Medical and Surgical Specialties Radiological Sciences and Public Health, Medical Oncology, University of Brescia, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Ugo Pastorino
- Thoracic Surgery Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Luca Roz
- Tumor Genomics Unit, Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Aldo Scarpa
- Department of Diagnostics and Public Health, Section of Pathology, University of Verona, Verona, Italy.,ARC-NET Research Center for Applied Research on Cancer, and Department of Diagnostics and Public Health, Section of Pathology, University of Verona, Verona, Italy
| | - Alfredo Berruti
- Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, ASST Spedali Civili, Brescia, Italy
| | - Carlo Capella
- Unit of Pathology, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Massimo Milione
- 1st Pathology Division, Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Bossi P, Lorini L, Cosentini D, Grisanti S, Battocchio S, Berruti A. Is it time to tailor treatments in androgen receptor positive salivary gland cancers? Oral Oncol 2023; 136:106274. [PMID: 36516663 DOI: 10.1016/j.oraloncology.2022.106274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 11/23/2022] [Accepted: 12/04/2022] [Indexed: 12/14/2022]
Affiliation(s)
- Paolo Bossi
- Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, ASST Spedali Civili di Brescia, Brescia, Italy.
| | - Luigi Lorini
- Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Deborah Cosentini
- Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Salvatore Grisanti
- Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, ASST Spedali Civili di Brescia, Brescia, Italy
| | | | - Alfredo Berruti
- Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, ASST Spedali Civili di Brescia, Brescia, Italy
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di Mauro P, Schivardi G, Pedersini R, Laini L, Esposito A, Amoroso V, Laganà M, Grisanti S, Cosentini D, Berruti A. Sacituzumab govitecan and radiotherapy in metastatic, triple-negative, and BRCA-mutant breast cancer patient with active brain metastases: A case report. Front Oncol 2023; 13:1139372. [PMID: 36890829 PMCID: PMC9987211 DOI: 10.3389/fonc.2023.1139372] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 02/06/2023] [Indexed: 02/22/2023] Open
Abstract
Background Triple-negative breast cancer (TNBC) is an aggressive cancer subtype, owing to its high metastatic potential: Patients who develop brain metastases (BMs) have a poor prognosis due to the lack of effective systemic treatments. Surgery and radiation therapy are valid options, while pharmacotherapy still relies on systemic chemotherapy, which has limited efficacy. Among the new treatment strategies available, the antibody-drug conjugate (ADC) sacituzumab govitecan has shown an encouraging activity in metastatic TNBC, even in the presence of BMs. Case presentation A 59-year-old woman was diagnosed with early TNBC and underwent surgery and subsequent adjuvant chemotherapy. A germline pathogenic variant in BReast CAncer gene 2 (BRCA2) was revealed after genetic testing. After 11 months from the completion of adjuvant treatment, she had pulmonary and hilar nodal relapse and began first-line chemotherapy with carboplatin and paclitaxel. However, after only 3 months from starting the treatment, she experienced relevant disease progression, due to the appearance of numerous and symptomatic BMs. Sacituzumab govitecan (10 mg/kg) was started as second-line treatment as part of the Expanded Access Program (EAP). She reported symptomatic relief after the first cycle and received whole-brain radiotherapy (WBRT) concomitantly to sacituzumab govitecan treatment. The subsequent CT scan showed an extracranial partial response and a near-to-complete intracranial response; no grade 3 adverse events were reported, even if sacituzumab govitecan was reduced to 7.5 mg/kg due to persistent G2 asthenia. After 10 months from starting sacituzumab govitecan, a systemic disease progression was documented, while intracranial response was maintained. Conclusions This case report supports the potential efficacy and safety of sacituzumab govitecan in the treatment of early recurrent and BRCA-mutant TNBC. Despite the presence of active BMs, our patient had a progression-free survival (PFS) of 10 months in the second-line setting and sacituzumab govitecan was safe when administered together with radiation therapy. Further real-world data are warranted to confirm sacituzumab govitecan efficacy in this patient population.
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Affiliation(s)
- Pierluigi di Mauro
- Medical Oncology, Azienda Socio Sanitaria Territoriale Spedali Civili, Brescia, Italy
| | - Greta Schivardi
- Medical Oncology, Azienda Socio Sanitaria Territoriale Spedali Civili, Brescia, Italy
| | - Rebecca Pedersini
- Medical Oncology, Azienda Socio Sanitaria Territoriale Spedali Civili, Brescia, Italy.,Breast Unit, Azienda Socio Sanitaria Territoriale Spedali Civili, Brescia, Italy
| | - Lara Laini
- Medical Oncology, Azienda Socio Sanitaria Territoriale Spedali Civili, Brescia, Italy
| | - Andrea Esposito
- Medical Oncology, Azienda Socio Sanitaria Territoriale Spedali Civili, Brescia, Italy
| | - Vito Amoroso
- Medical Oncology, Azienda Socio Sanitaria Territoriale Spedali Civili, Brescia, Italy
| | - Marta Laganà
- Medical Oncology, Azienda Socio Sanitaria Territoriale Spedali Civili, Brescia, Italy
| | - Salvatore Grisanti
- Medical Oncology, Azienda Socio Sanitaria Territoriale Spedali Civili, Brescia, Italy
| | - Deborah Cosentini
- Medical Oncology, Azienda Socio Sanitaria Territoriale Spedali Civili, Brescia, Italy.,Breast Unit, Azienda Socio Sanitaria Territoriale Spedali Civili, Brescia, Italy
| | - Alfredo Berruti
- Medical Oncology, Azienda Socio Sanitaria Territoriale Spedali Civili, Brescia, Italy
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Ferolla P, Berruti A, Spada F, Brizzi MP, Ibrahim T, Marconcini R, Giuffrida D, Amoroso V, La Salvia A, Vaccaro V, Faggiano A, Colao A, Volante M, Ghizzoni S, Mazzanti P, Houchard A, Fazio N. Efficacy and Safety of Lanreotide Autogel and Temozolomide Combination Therapy in Progressive Thoracic Neuroendocrine Tumors (Carcinoid): Results from the Phase 2 ATLANT Study. Neuroendocrinology 2023; 113:332-342. [PMID: 36044870 DOI: 10.1159/000526811] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 08/22/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Lanreotide autogel (LAN) and temozolomide (TMZ) are guidelines-recommended monotherapies for thoracic neuroendocrine tumors (carcinoids; T-NETs), but prospective data for both combined and monotherapies are lacking. ATLANT (NCT02698410) evaluated efficacy and safety of LAN/TMZ in progressive T-NETs. METHODS ATLANT was a 12-month, Italian, phase 2, single-arm, open-label, multicenter pilot study. Eligible patients had unresectable, locally advanced/metastatic, well-/moderately differentiated T-NETs with radiological progression. Patients received subcutaneous LAN 120 mg every 28 days and oral TMZ 250 mg/day for 5 consecutive days every 28-day cycle. Main endpoints are disease control rate (DCR) at 9 months (primary; investigator-assessed), median progression-free survival (PFS), biomarkers, and safety. RESULTS The number of patients was 40; 60% were male. Primary tumor site was lung (90%) and thymus (10%). Carcinoid type was typical (20.0%) and atypical (52.5%). DCR at 9 months was 35.0% (95% confidence interval (CI) 20.63-51.68; nonacceptability threshold ≤10%, p < 0.0001; not significantly above clinically relevant threshold ≥30%, p = 0.2968). DCR between 7.5 and 10.5 months (sensitivity analysis) was 45.0% (95% CI: 29.26-61.51) and clinically relevant (p = 0.0320 at ≥30% threshold). Median PFS was 37.1 (95% CI: 24.1-52.9) weeks. No association was observed between biomarker variations (chromogranin A, neuron-specific enolase, somatostatin receptor type-2, Ki-67, 6-O-methylguanine-DNA-methyl-transferase) and DCR or PFS. Most patients (97.5%) had treatment-emergent adverse events (TEAEs); 72.5% had treatment-related TEAEs. TEAEs were mainly grade 1/2. No unanticipated TEAEs were reported. CONCLUSIONS This study showed that the LAN/TMZ combination has promising efficacy in progressive T-NETs, and was well tolerated. Larger studies are warranted to support the clinical benefits of LAN/TMZ in patients with T-NETs.
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Affiliation(s)
- Piero Ferolla
- Multidisciplinary NET Center, Umbria Regional Cancer Network, Perugia, Italy
| | - Alfredo Berruti
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, Medical Oncology, University of Brescia at ASST-Spedali Civili, Brescia, Italy
| | - Francesca Spada
- Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, European Institute of Oncology, IRCCS, IEO, Milan, Italy
| | - Maria Pia Brizzi
- Department of Oncology, Medical Oncology, A.O.U. San Luigi Gonzaga, Turin, Italy
| | - Toni Ibrahim
- Osteoncology and Rare Tumors Center, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST), "Dino Amadori", Meldola, Italy
| | | | - Dario Giuffrida
- Department of Oncology, Istituto Oncologico del Mediterraneo, Viagrande (Catania), Italy
| | - Vito Amoroso
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, Medical Oncology, University of Brescia at ASST-Spedali Civili, Brescia, Italy
| | - Anna La Salvia
- Department of Oncology, Medical Oncology, A.O.U. San Luigi Gonzaga, Turin, Italy
| | - Vanja Vaccaro
- Medical Oncology 1, Regina Elena National Cancer Institute, IRCCS, Rome, Italy
| | - Antongiulio Faggiano
- Endocrinology Unit, Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, Università Sapienza di Roma, Rome, Italy
| | - Annamaria Colao
- Department of Clinical Medicine and Surgery and UNESCO Chair for Health Education and Sustainable Development, Università Federico II di Napoli, Naples, Italy
| | - Marco Volante
- Department of Oncology, University of Turin, Turin, Italy
| | | | | | | | - Nicola Fazio
- Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, European Institute of Oncology, IRCCS, IEO, Milan, Italy
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Delbarba A, Cosentini D, Facondo P, Laganà M, Pezzaioli LC, Cremaschi V, Alberti A, Grisanti S, Cappelli C, Ferlin A, Berruti A. Androgen serum levels in male patients with adrenocortical carcinoma given mitotane therapy: A single center retrospective longitudinal study. Front Endocrinol (Lausanne) 2023; 14:1128061. [PMID: 37077359 PMCID: PMC10108714 DOI: 10.3389/fendo.2023.1128061] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 03/22/2023] [Indexed: 04/05/2023] Open
Abstract
OBJECTIVE Hypogonadism is common in male patients with adrenocortical carcinoma (ACC) who are under treatment with mitotane, but the phenomenon is underestimated, and its prevalence has been poorly studied. This single-center retrospective longitudinal study was undertaken to assess the frequency of testosterone deficiency before and after mitotane therapy, the possible mechanism involved, and the relationship between hypogonadism with serum mitotane levels and prognosis. RESEARCH DESIGN AND METHODS Consecutive male ACC patients followed at the Medical Oncology of Spedali Civili Hospital in Brescia underwent hormonal assessment to detect testosterone deficiency at baseline and during mitotane therapy. RESULTS A total of 24 patients entered the study. Of these patients, 10 (41.7%) already had testosterone deficiency at baseline. During follow-up, total testosterone (TT) showed a biphasic evolution over time with an increase in the first 6 months followed by a subsequent progressive decrease until 36 months. Sex hormone binding globulin (SHBG) progressively increased, and calculated free testosterone (cFT) progressively decreased. Based on cFT evaluation, the proportion of hypogonadic patients progressively increased with a cumulative prevalence of 87.5% over the study course. A negative correlation was observed between serum mitotane levels >14 mg/L and TT and cFT. CONCLUSION Testosterone deficiency is common in men with ACC prior to mitotane treatment. In addition, this therapy exposes these patients to further elevated risk of hypogonadism that should be promptly detected and counteracted, since it might have a negative impact on quality of life.
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Affiliation(s)
- Andrea Delbarba
- Department of Experimental Sciences, Unit of Endocrinology and Metabolism, University of Brescia, Azienda Socio Sanitaria Territoriale (ASST) Spedali Civili, Brescia, Italy
| | - Deborah Cosentini
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, Medical Oncology Unit, University of Brescia, ASST Spedali Civili, Brescia, Italy
| | - Paolo Facondo
- Department of Experimental Sciences, Unit of Endocrinology and Metabolism, University of Brescia, Azienda Socio Sanitaria Territoriale (ASST) Spedali Civili, Brescia, Italy
| | - Marta Laganà
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, Medical Oncology Unit, University of Brescia, ASST Spedali Civili, Brescia, Italy
| | - Letizia Chiara Pezzaioli
- Department of Experimental Sciences, Unit of Endocrinology and Metabolism, University of Brescia, Azienda Socio Sanitaria Territoriale (ASST) Spedali Civili, Brescia, Italy
| | - Valentina Cremaschi
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, Medical Oncology Unit, University of Brescia, ASST Spedali Civili, Brescia, Italy
| | - Andrea Alberti
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, Medical Oncology Unit, University of Brescia, ASST Spedali Civili, Brescia, Italy
| | - Salvatore Grisanti
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, Medical Oncology Unit, University of Brescia, ASST Spedali Civili, Brescia, Italy
| | - Carlo Cappelli
- Department of Experimental Sciences, Unit of Endocrinology and Metabolism, University of Brescia, Azienda Socio Sanitaria Territoriale (ASST) Spedali Civili, Brescia, Italy
| | - Alberto Ferlin
- Unit of Andrology and Reproductive Medicine, Department of Medicine, University of Padua, Padua, Italy
| | - Alfredo Berruti
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, Medical Oncology Unit, University of Brescia, ASST Spedali Civili, Brescia, Italy
- *Correspondence: Alfredo Berruti,
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Fassnacht M, Assie G, Baudin E, Eisenhofer G, Fouchardiere CDL, Haak HR, de Krijger R, Porpiglia F, Terzolo M, Berruti A. Corrigendum to "Adrenocortical carcinomas and malignant phaeochromocytomas: ESMO-EURACAN Clinical Practice Guidelines for diagnosis, treatment and follow-up": [Annals of Oncology volume 31 (2020) 1476-1490]. Ann Oncol 2022:S0923-7534(22)04775-5. [PMID: 36564283 DOI: 10.1016/j.annonc.2022.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- M Fassnacht
- Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital, University of Würzburg, Würzburg; Comprehensive Cancer Center Mainfranken, University of Würzburg, Würzburg, Germany
| | - G Assie
- Department of Endocrinology, Reference Centre for Rare Adrenal Diseases, Reference Centre for Rare Adrenal Cancers, Hôpital Cochin, Assistance Publique Hôpitaux de Paris, Paris; Institut Cochin, Institut National de la Santé et de la Recherche Médicale U1016, Centre National de la Recherche Scientifique UMR8104, Université Paris Descartes, Sorbonne Paris Cité, Paris
| | - E Baudin
- Department of Endocrine Oncology and Nuclear Medicine, Gustave Roussy, Villejuif, France
| | - G Eisenhofer
- Department of Medicine III and Institute of Clinical Chemistry and Laboratory Medicine, Technische Universität Dresden, Dresden, Germany
| | - C de la Fouchardiere
- Department of Medical Oncology, Centre Léon Bérard, University Claude Bernard Lyon I, Lyon, France
| | - H R Haak
- Department of Internal Medicine Máxima Medisch Centrum, Eindhoven; Department of Internal Medicine, Division of General Internal Medicine, Maastricht University Medical Centre, Maastricht; Maastricht University, CAPHRI School for Public Health and Primary Care, Ageing and Long-Term Care, Maastricht
| | - R de Krijger
- Department of Pathology, University Medical Center Utrecht, Utrecht; Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - F Porpiglia
- Division of Urology, San Luigi Hospital e Orbassano, Turin; Department of Oncology, University of Turin, Turin
| | - M Terzolo
- Internal Medicine, Department of Clinical and Biological Sciences, San Luigi Hospital, University of Turin, Turin
| | - A Berruti
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Medical Oncology, University of Brescia, ASST-Spedali Civili, Brescia, Italy
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Caramella I, Dalla Volta A, Bergamini M, Cosentini D, Valcamonico F, Berruti A. Maintenance of androgen deprivation therapy or testosterone supplementation in the management of castration-resistant prostate cancer: that is the question. Endocrine 2022; 78:441-445. [PMID: 35986139 PMCID: PMC9637055 DOI: 10.1007/s12020-022-03166-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 08/03/2022] [Indexed: 11/18/2022]
Abstract
PURPOSE Whether or not androgen receptor (AR) axis could still be targetable in castration resistant prostate cancer (CRPC) patients with disease progression to next generation hormonal agents (NGHAs) is a controversial issue. RESULTS Serum testosterone in CRPC patients has a positive prognostic role and increasing testosterone levels after androgen deprivation therapy (ADT) withdrawal or testosterone supplementation, as part of a bipolar androgen therapy (BAT) strategy, has been shown to potentially restore sensitivity to previous lines of NGHAs. CONCLUSION These data suggest that maintenance of ADT in CRPC patients receiving further lines of treatment, as recommended by current international guidelines, could be questionable. Conversely, testosterone supplementation aimed to re-sensitize CRPC to further hormonal manipulation is a strategy worth to be explored in future clinical trials.
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Affiliation(s)
- Irene Caramella
- Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia. ASST Spedali Civili, Brescia, Italy
| | - Alberto Dalla Volta
- Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia. ASST Spedali Civili, Brescia, Italy
| | - Marco Bergamini
- Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia. ASST Spedali Civili, Brescia, Italy
| | - Deborah Cosentini
- Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia. ASST Spedali Civili, Brescia, Italy
| | - Francesca Valcamonico
- Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia. ASST Spedali Civili, Brescia, Italy
| | - Alfredo Berruti
- Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia. ASST Spedali Civili, Brescia, Italy.
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Palumbo C, Dalla Volta A, Zamboni S, Mazziotti G, Zamparini M, Triggiani L, Borghetti P, Maffezzoni F, Bresciani R, Rinaudo L, Valcamonico F, Farina D, Magrini SM, Antonelli A, Simeone C, Berruti A. Effect of Degarelix Administration on Bone Health in Prostate Cancer Patients Without Bone Metastases. The Blade Study. J Clin Endocrinol Metab 2022; 107:3398-3407. [PMID: 35971857 DOI: 10.1210/clinem/dgac489] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Indexed: 11/19/2022]
Abstract
CONTEXT As patients are now living with prostate cancer for longer, the long-term impact of hormonal treatment on bone health is an increasingly debated subject. OBJECTIVE To characterize the changes in bone mineral density (BMD) and bone turnover markers after degarelix administration in prostate cancer patients without bone metastases. To explore the predictive role of body composition on treatment induced bone loss. METHODS BMD and body composition (lean body mass, fat body mass, and appendicular mass index [ALMI]) were assessed by dual X-ray absorptiometry on study entry and after 12 months of degarelix therapy. Alkaline phosphate (ALP) and C-terminal telopeptide of type I collagen (CTX) were assessed at baseline, and 6 and 12 months. RESULTS Twenty-nine patients entered the study. Degarelix administration was associated with a significant decrease in BMD after 12 months (2.4% reduction from baseline at lumbar spine). Serum CTX and ALP increased significantly (median increase from baseline 99% and 19.3%, respectively). An inverse correlation was observed between ALMI and CTX, but not ALP, at both baseline (Pearson r = -0.62, P < .0001) and month 12 (Pearson r = -0.41, P = .032). Moreover, a significant inverse correlation between changes in ALMI and CTX at 12 months (Pearson r = -0.43, P = .019) and a direct relationship between changes of ALMI and ALP (Pearson r = 0.44, P = .016) during degarelix therapy were observed. CONCLUSION Degarelix administration is associated with a significant decrease in BMD and increase in bone turnover markers. ALMI is a promising predictor of bone loss in prostate cancer patients receiving androgen deprivation therapy, and ALMI changes during therapy are associated with bone turnover derangement favoring bone quality alterations.
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Affiliation(s)
- Carlotta Palumbo
- Urology Unit, Ospedale Maggiore della Carità, Novara, Italy
- Urology Unit, ASST Spedali Civili, Department of Medical & Surgical Specialties, Radiological Sciences & Public Health, University of Brescia, Brescia, Italy
| | - Alberto Dalla Volta
- Medical Oncology Unit, ASST Spedali Civili, Department of Medical & Surgical Specialties, Radiological Sciences & Public Health, University of Brescia, Brescia, Italy
| | - Stefania Zamboni
- Urology Unit, ASST Spedali Civili, Department of Medical & Surgical Specialties, Radiological Sciences & Public Health, University of Brescia, Brescia, Italy
| | - Gherardo Mazziotti
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
- Endocrinology, Diabetology and Medical Andrology Unit, Metabolic Bone Diseases and Osteoporosis Section, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Manuel Zamparini
- Medical Oncology Unit, ASST Spedali Civili, Department of Medical & Surgical Specialties, Radiological Sciences & Public Health, University of Brescia, Brescia, Italy
| | - Luca Triggiani
- Radiation Oncology Unit, ASST Spedali Civili, Department of Medical & Surgical Specialties, Radiological Sciences & Public Health, University of Brescia, Brescia, Italy
| | - Paolo Borghetti
- Radiation Oncology Unit, ASST Spedali Civili, Department of Medical & Surgical Specialties, Radiological Sciences & Public Health, University of Brescia, Brescia, Italy
| | - Filippo Maffezzoni
- Radiology Unit, ASST Spedali Civili, Department of Medical & Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
- Diabetologia, Manerbio-Leno, ASST Garda, Italy
| | - Roberto Bresciani
- Division of Biotechnology, Department of Molecular and Translational Medicine (DMTM), University of Brescia, Brescia, Italy
| | | | - Francesca Valcamonico
- Medical Oncology Unit, ASST Spedali Civili, Department of Medical & Surgical Specialties, Radiological Sciences & Public Health, University of Brescia, Brescia, Italy
| | - Davide Farina
- Radiology Unit, ASST Spedali Civili, Department of Medical & Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Stefano Maria Magrini
- Radiation Oncology Unit, ASST Spedali Civili, Department of Medical & Surgical Specialties, Radiological Sciences & Public Health, University of Brescia, Brescia, Italy
| | - Alessandro Antonelli
- Urology Unit, ASST Spedali Civili, Department of Medical & Surgical Specialties, Radiological Sciences & Public Health, University of Brescia, Brescia, Italy
- Urology Unit, AOUI Verona, Department of Surgery, Dentistry, Pediatrics and Gynecology, University of Verona, Verona, Italy
| | - Claudio Simeone
- Urology Unit, ASST Spedali Civili, Department of Medical & Surgical Specialties, Radiological Sciences & Public Health, University of Brescia, Brescia, Italy
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Centonze G, Maisonneuve P, Prinzi N, Pusceddu S, Albarello L, Pisa E, Barberis M, Vanoli A, Spaggiari P, Bossi P, Cattaneo L, Sabella G, Solcia E, La Rosa S, Grillo F, Tagliabue G, Scarpa A, Papotti M, Volante M, Mangogna A, Del Gobbo A, Ferrero S, Rolli L, Roca E, Bercich L, Benvenuti M, Messerini L, Inzani F, Pruneri G, Busico A, Perrone F, Tamborini E, Pellegrinelli A, Kankava K, Berruti A, Pastorino U, Fazio N, Sessa F, Capella C, Rindi G, Milione M. Prognostic Factors across Poorly Differentiated Neuroendocrine Neoplasms: A Pooled Analysis. Neuroendocrinology 2022; 113:457-469. [PMID: 36417840 DOI: 10.1159/000528186] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 10/17/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Poorly differentiated neuroendocrine carcinomas (NECs) are characterized by aggressive clinical course and poor prognosis. No reliable prognostic markers have been validated to date; thus, the definition of a specific NEC prognostic algorithm represents a clinical need. This study aimed to analyze a large NEC case series to validate the specific prognostic factors identified in previous studies on gastro-entero-pancreatic and lung NECs and to assess if further prognostic parameters can be isolated. METHODS A pooled analysis of four NEC retrospective studies was performed to evaluate the prognostic role of Ki-67 cut-off, the overall survival (OS) according to primary cancer site, and further prognostic parameters using multivariable Cox proportional hazards model and machine learning random survival forest (RSF). RESULTS 422 NECs were analyzed. The most represented tumor site was the colorectum (n = 156, 37%), followed by the lungs (n = 111, 26%), gastroesophageal site (n = 83, 20%; 66 gastric, 79%) and pancreas (n = 42, 10%). The Ki-67 index was the most relevant predictor, followed by morphology (pure or mixed/combined NECs), stage, and site. The predicted RSF response for survival at 1, 2, or 3 years showed decreasing survival with increasing Ki-67, pure NEC morphology, stage III-IV, and colorectal NEC disease. Patients with Ki-67 <55% and mixed/combined morphology had better survival than those with pure morphology. Morphology pure or mixed/combined became irrelevant in NEC survival when Ki-67 was ≥55%. The prognosis of metastatic patients who did not receive any treatment tended to be worse compared to that of the treated group. The prognostic impact of Rb1 immunolabeling appears to be limited when multiple risk factors are simultaneously assessed. CONCLUSION The most effective parameters to predict OS for NEC patients could be Ki-67, pure or mixed/combined morphology, stage, and site.
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Affiliation(s)
- Giovanni Centonze
- 1st Pathology Unit, Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Patrick Maisonneuve
- Division of Epidemiology and Biostatistics, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Natalie Prinzi
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Sara Pusceddu
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Luca Albarello
- Pathology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Eleonora Pisa
- Division of Pathology, European Institute of Oncology (IEO), Milan, Italy
| | - Massimo Barberis
- Division of Pathology, European Institute of Oncology (IEO), Milan, Italy
| | - Alessandro Vanoli
- Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Paola Spaggiari
- Department of Pathology, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Paola Bossi
- Department of Pathology, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Laura Cattaneo
- 1st Pathology Unit, Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giovanna Sabella
- 1st Pathology Unit, Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Enrico Solcia
- Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Stefano La Rosa
- Unit of Pathology, Department of Medicine and Surgery and Research Center for the Study of Hereditary and Familial tumors, University of Insubria, Varese, Italy
| | - Federica Grillo
- Unit of Pathology, Department of Surgical Sciences and Integrated Diagnostics, University of Genoa and Ospedale Policlinico San Martino, Genoa, Italy
| | - Giovanna Tagliabue
- Lombardy Cancer Registry, Varese Province Cancer Registry Unit, Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Aldo Scarpa
- ARC-NET Research Center for Applied Research on Cancer, Verona, Italy
- Department of Diagnostics and Public Health, Section of Pathology, University of Verona, Verona, Italy
| | - Mauro Papotti
- Department of Oncology, University of Turin, Turin, Italy
| | - Marco Volante
- Department of Oncology, University of Turin, Turin, Italy
| | - Alessandro Mangogna
- Institute for Maternal and Child Health, IRCCS Burlo Garofalo, Trieste, Italy
| | - Alessandro Del Gobbo
- Division of Pathology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Stefano Ferrero
- Division of Pathology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Biomedical Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Luigi Rolli
- Thoracic Surgery Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Elisa Roca
- Thoracic Oncology - Lung Unit, Pederzoli Hospital, Peschiera del Garda, Verona, Italy
| | - Luisa Bercich
- Department of Pathology, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Mauro Benvenuti
- Thoracic Surgery Unit, Department of Medical and Surgical Specialties Radiological Sciences and Public Health, Medical Oncology, University of Brescia, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Luca Messerini
- Diagnostic and Molecular Pathology, Department of Experimental and Clinical Medicine, University of Florence, Firenze, Italy
| | - Frediano Inzani
- Anatomic Pathology Unit, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
| | - Giancarlo Pruneri
- 2nd Pathology Division, Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Adele Busico
- 2nd Pathology Division, Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Federica Perrone
- 2nd Pathology Division, Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Elena Tamborini
- 2nd Pathology Division, Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Alessio Pellegrinelli
- Department of Pathology, ASST Franciacorta, Mellino Mellini Hospital, Brescia, Italy
| | - Ketevani Kankava
- Scientific and Diagnostic Pathology Laboratory, Tbilisi State Medical University, Tbilisi, Georgia
| | - Alfredo Berruti
- Medical Oncology Unit, ASST Spedali Civili of Brescia, Department of Medical and Surgical Specialties, Radiological Science, Brescia, Italy
- Public Health, University of Brescia, Brescia, Italy
| | - Ugo Pastorino
- Thoracic Surgery Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Nicola Fazio
- Gastrointestinal Medical Oncology and Neuroendocrine Tumors Unit, European Institute of Oncology (IEO), Milan, Italy
| | - Fausto Sessa
- Unit of Pathology, Department of Medicine and Surgery and Research Center for the Study of Hereditary and Familial tumors, University of Insubria, Varese, Italy
| | - Carlo Capella
- Unit of Pathology, Department of Medicine and Surgery and Research Center for the Study of Hereditary and Familial tumors, University of Insubria, Varese, Italy
| | - Guido Rindi
- Section of Anatomic Pathology, Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore/Unit of Anatomic Pathology, Rome, Italy
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS/Roma European Neuroendocrine Tumor Society (ENETS) Center of Excellence, Rome, Italy
| | - Massimo Milione
- 1st Pathology Unit, Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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