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Staropoli N, Ciliberto D, Luciano F, Napoli C, Costa M, Rossini G, Arbitrio M, Labanca C, Riillo C, Del Giudice T, Crispino A, Salvino A, Galvano A, Russo A, Tassone P, Tagliaferri P. The impact of PARP inhibitors in the whole scenario of ovarian cancer management: A systematic review and network meta-analysis. Crit Rev Oncol Hematol 2024; 193:104229. [PMID: 38065404 DOI: 10.1016/j.critrevonc.2023.104229] [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: 06/20/2023] [Accepted: 12/04/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Carboplatin is still the cornerstone of the first-line treatment in advanced Epithelial Ovarian Cancer (aEOC) management and the clinical response to platinum-derived agents remains the major predictor of long-term outcomes. PATIENT AND METHODS We aimed to identify the best treatment of the aEOC in terms of efficacy and safety, considering all treatment phases. A systematic literature search has been done to compare all treatments in aEOC population. Randomized trials with available survival and safety data published in the 2011-2022 timeframe were enclosed. Only trials reporting the BRCA or HRD (Homologous Recombination Deficiency) status were considered. DATA EXTRACTION AND SYNTHESIS A ranking of treatment schedules on the progression-free survival (PFS) endpoint was performed. The random-effect model was used to elaborate and extract data. The Network Meta-Analysis (NMA) by Bayesian model was performed by STATA v17. Data on PFS were extracted in terms of Hazard ratio with relative confidence intervals. RESULTS This NMA involved 18 trials for a total of 9105 patients. Within 12 treatment groups, we performed 3 different sensitivity analyses including "all comers" Intention to Treat (ITT) population, BRCA-mutated (BRCAm), and HRD subgroups, respectively. Considering the SUCRA-reported cumulative PFS probabilities, we showed that in the ITT population, the inferred best treatment was niraparib plus bevacizumab with a SUCRA of 96.7. In the BRCAm subgroup, the best SUCRA was for olaparib plus chemotherapy (96,9). The HRD population showed an inferred best treatment for niraparib plus bevacizumab (SUCRA 98,4). Moreover, we reported a cumulative summary of PARPi toxicity, in which different 3-4 grade toxicity profiles were observed, despite the PARPi "class effect" in terms of efficacy. CONCLUSIONS Considering all aEOC subgroups, the best therapeutical option was identified as PARPi plus chemotherapy and/or antiangiogenetic agents, suggesting the relevance of combinatory approaches based on molecular profile. This work underlines the potential value of "chemo-free" regimens to prolong the platinum-free interval (PFI).
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Affiliation(s)
- Nicoletta Staropoli
- Department of Experimental and Clinical Medicine, Magna Græcia University, Catanzaro, Italy; Medical and Translational Oncology Unit, AOU Renato Dulbecco, Catanzaro, Italy
| | - Domenico Ciliberto
- Medical and Translational Oncology Unit, AOU Renato Dulbecco, Catanzaro, Italy
| | - Francesco Luciano
- Department of Experimental and Clinical Medicine, Magna Græcia University, Catanzaro, Italy
| | - Cristina Napoli
- Department of Experimental and Clinical Medicine, Magna Græcia University, Catanzaro, Italy
| | - Martina Costa
- Department of Experimental and Clinical Medicine, Magna Græcia University, Catanzaro, Italy
| | - Giacomo Rossini
- Department of Experimental and Clinical Medicine, Magna Græcia University, Catanzaro, Italy
| | - Mariamena Arbitrio
- Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy (CNR), Catanzaro, Italy
| | - Caterina Labanca
- Department of Experimental and Clinical Medicine, Magna Græcia University, Catanzaro, Italy
| | - Caterina Riillo
- Department of Experimental and Clinical Medicine, Magna Græcia University, Catanzaro, Italy
| | - Teresa Del Giudice
- Oncology Unit, "De Lellis" Facility, AOU Renato Dulbecco, Catanzaro, Italy
| | - Antonella Crispino
- Department of Experimental and Clinical Medicine, Magna Græcia University, Catanzaro, Italy
| | - Angela Salvino
- Medical and Translational Oncology Unit, AOU Renato Dulbecco, Catanzaro, Italy
| | - Antonio Galvano
- Department of Surgical, Oncological and Oral Sciences, Section of Medical Oncology, University of Palermo, 90127 Palermo, Italy
| | - Antonio Russo
- Department of Surgical, Oncological and Oral Sciences, Section of Medical Oncology, University of Palermo, 90127 Palermo, Italy; S.H.R.O., Center for Biotechnology, College of Science and Technology, Temple University, Philadelphia, PA, USA
| | - Pierfrancesco Tassone
- Department of Experimental and Clinical Medicine, Magna Græcia University, Catanzaro, Italy; Medical and Translational Oncology Unit, AOU Renato Dulbecco, Catanzaro, Italy; S.H.R.O., Center for Biotechnology, College of Science and Technology, Temple University, Philadelphia, PA, USA
| | - Pierosandro Tagliaferri
- Department of Experimental and Clinical Medicine, Magna Græcia University, Catanzaro, Italy; Medical and Translational Oncology Unit, AOU Renato Dulbecco, Catanzaro, Italy.
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Staropoli N, Salvino A, Falcone F, Farenza V, Costa M, Rossini G, Manti F, Crispino A, Riillo C, Ciliberto D, Arbitrio M, Tassone P, Tagliaferri P. Pembrolizumab plus lenvatinib in advanced endometrial cancer: case report and systematic review of lung toxicity. Front Oncol 2023; 13:1145986. [PMID: 37492471 PMCID: PMC10363977 DOI: 10.3389/fonc.2023.1145986] [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: 03/15/2023] [Accepted: 06/07/2023] [Indexed: 07/27/2023] Open
Abstract
Background The optimal strategy for the treatment of recurrent and/or advanced endometrial cancer is still undefined. Recently, despite the lack of any predictive biomarker, the combination of pembrolizumab with lenvatinib has improved survival outcomes. We here report the long-term management of lung toxicity in a patient with endometrial cancer, and we critically review the current therapeutic options for this disease. Results A patient with heavily pretreated endometrial cancer took pembrolizumab plus lenvatinib for 1 year, achieving a persistent partial response with a time to treatment failure of 18 months, despite relevant lung toxicity that did not affect the remarkable overall clinical benefit. A systematic review of this combination underlines the efficacy outcome despite toxicity. Interestingly, the literature review on lung toxicity suggested the role of anti-angiogenetic agents in the pathogenesis of lung cavitation, probably related to direct treatment activity, and disclosed a potential radiological sign predictive of the activity of anti-angiogenetic agents. Conclusion We underline the efficacy of pembrolizumab plus lenvatinib in the current treatment landscape of endometrial cancer, underscoring the relevance of a correct management of toxicity.
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Affiliation(s)
- Nicoletta Staropoli
- Medical and Translational Oncology Unit, AOU Renato Dulbecco, Catanzaro, Italy
- Department of Experimental and Clinical Medicine, Magna Græcia University, Catanzaro, Italy
| | - Angela Salvino
- Medical and Translational Oncology Unit, AOU Renato Dulbecco, Catanzaro, Italy
| | - Federica Falcone
- Department of Experimental and Clinical Medicine, Magna Græcia University, Catanzaro, Italy
| | - Valentina Farenza
- Department of Experimental and Clinical Medicine, Magna Græcia University, Catanzaro, Italy
| | - Martina Costa
- Department of Experimental and Clinical Medicine, Magna Græcia University, Catanzaro, Italy
| | - Giacomo Rossini
- Department of Experimental and Clinical Medicine, Magna Græcia University, Catanzaro, Italy
| | | | - Antonella Crispino
- Department of Experimental and Clinical Medicine, Magna Græcia University, Catanzaro, Italy
| | - Caterina Riillo
- Department of Experimental and Clinical Medicine, Magna Græcia University, Catanzaro, Italy
| | - Domenico Ciliberto
- Medical and Translational Oncology Unit, AOU Renato Dulbecco, Catanzaro, Italy
| | - Mariamena Arbitrio
- Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy (CNR), Catanzaro, Italy
| | - Pierfrancesco Tassone
- Medical and Translational Oncology Unit, AOU Renato Dulbecco, Catanzaro, Italy
- Department of Experimental and Clinical Medicine, Magna Græcia University, Catanzaro, Italy
| | - Pierosandro Tagliaferri
- Medical and Translational Oncology Unit, AOU Renato Dulbecco, Catanzaro, Italy
- Department of Experimental and Clinical Medicine, Magna Græcia University, Catanzaro, Italy
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Tassone P, Di Martino MT, Arbitrio M, Fiorillo L, Staropoli N, Ciliberto D, Cordua A, Scionti F, Bertucci B, Salvino A, Lopreiato M, Thunarf F, Cuomo O, Zito MC, De Fina MR, Brescia A, Gualtieri S, Riillo C, Manti F, Caracciolo D, Barbieri V, Di Paola ED, Di Francesco AE, Tagliaferri P. Safety and activity of the first-in-class locked nucleic acid (LNA) miR-221 selective inhibitor in refractory advanced cancer patients: a first-in-human, phase 1, open-label, dose-escalation study. J Hematol Oncol 2023; 16:68. [PMID: 37365583 DOI: 10.1186/s13045-023-01468-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [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: 12/25/2022] [Accepted: 06/16/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND We developed a 13-mer locked nucleic acid (LNA) inhibitor of miR-221 (LNA-i-miR-221) with a full phosphorothioate (PS)-modified backbone. This agent downregulated miR-221, demonstrated anti-tumor activity against human xenografts in mice, and favorable toxicokinetics in rats and monkeys. Allometric interspecies scaling allowed us to define the first-in-class LNA-i-miR-221 safe starting dose for the clinical translation. METHODS In this first-in-human, open-label, dose-escalation phase 1 trial, we enrolled progressive cancer patients (aged ≥ 18 years) with ECOG 0-2 into 5 cohorts. The treatment cycle was based on a 30-min IV infusion of LNA-i-miR-221 on 4 consecutive days. Three patients within the first cohort were treated with 2 cycles (8 infusions), while 14 patients were treated with a single course (4 infusions); all patients were evaluated for phase 1 primary endpoint. The study was approved by the Ethics Committee and Regulatory Authorities (EudraCT 2017-002615-33). RESULTS Seventeen patients received the investigational treatment, and 16 were evaluable for response. LNA-i-miR-221 was well tolerated, with no grade 3-4 toxicity, and the MTD was not reached. We recorded stable disease (SD) in 8 (50.0%) patients and partial response (PR) in 1 (6.3%) colorectal cancer case (total SD + PR: 56.3%). Pharmacokinetics indicated non-linear drug concentration increase across the dose range. Pharmacodynamics demonstrated concentration-dependent downregulation of miR-221 and upregulation of its CDKN1B/p27 and PTEN canonical targets. Five mg/kg was defined as the recommended phase II dose. CONCLUSIONS The excellent safety profile, the promising bio-modulator, and the anti-tumor activity offer the rationale for further clinical investigation of LNA-i-miR-221 (ClinTrials.Gov: NCT04811898).
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Affiliation(s)
- Pierfrancesco Tassone
- Department of Experimental and Clinical Medicine (DMSC), Magna Graecia University, Catanzaro, Italy.
- Phase 1 and Translational Medical Oncology Unit, AOU Renato Dulbecco, Catanzaro, Italy.
| | - Maria Teresa Di Martino
- Department of Experimental and Clinical Medicine (DMSC), Magna Graecia University, Catanzaro, Italy
- Phase 1 and Translational Medical Oncology Unit, AOU Renato Dulbecco, Catanzaro, Italy
- Medical Oncology Unit, AOU Renato Dulbecco, Catanzaro, Italy
| | - Mariamena Arbitrio
- Phase 1 and Translational Medical Oncology Unit, AOU Renato Dulbecco, Catanzaro, Italy
- Institute of Research and Biomedical Innovation (IRIB), Italian National Council (CNR), Catanzaro, Italy
| | - Lucia Fiorillo
- Phase 1 and Translational Medical Oncology Unit, AOU Renato Dulbecco, Catanzaro, Italy
- Medical Oncology Unit, AOU Renato Dulbecco, Catanzaro, Italy
| | - Nicoletta Staropoli
- Phase 1 and Translational Medical Oncology Unit, AOU Renato Dulbecco, Catanzaro, Italy
- Medical Oncology Unit, AOU Renato Dulbecco, Catanzaro, Italy
| | - Domenico Ciliberto
- Phase 1 and Translational Medical Oncology Unit, AOU Renato Dulbecco, Catanzaro, Italy
- Medical Oncology Unit, AOU Renato Dulbecco, Catanzaro, Italy
| | - Alessia Cordua
- Department of Experimental and Clinical Medicine (DMSC), Magna Graecia University, Catanzaro, Italy
| | - Francesca Scionti
- Department of Experimental and Clinical Medicine (DMSC), Magna Graecia University, Catanzaro, Italy
| | | | - Angela Salvino
- Phase 1 and Translational Medical Oncology Unit, AOU Renato Dulbecco, Catanzaro, Italy
- Medical Oncology Unit, AOU Renato Dulbecco, Catanzaro, Italy
| | - Mariangela Lopreiato
- Department of Experimental and Clinical Medicine (DMSC), Magna Graecia University, Catanzaro, Italy
| | - Fredrik Thunarf
- Biometrics Department, LINK Medical Research AB, Uppsala, Sweden
| | - Onofrio Cuomo
- Department of Experimental and Clinical Medicine (DMSC), Magna Graecia University, Catanzaro, Italy
| | | | | | | | - Simona Gualtieri
- Phase 1 and Translational Medical Oncology Unit, AOU Renato Dulbecco, Catanzaro, Italy
- Medical Oncology Unit, AOU Renato Dulbecco, Catanzaro, Italy
| | - Caterina Riillo
- Department of Experimental and Clinical Medicine (DMSC), Magna Graecia University, Catanzaro, Italy
| | | | - Daniele Caracciolo
- Department of Experimental and Clinical Medicine (DMSC), Magna Graecia University, Catanzaro, Italy
| | - Vito Barbieri
- Medical Oncology Unit, AOU Renato Dulbecco, Catanzaro, Italy
| | - Eugenio Donato Di Paola
- Pharmacology Unit, Department of Science of Health, Magna Graecia University, Catanzaro, Italy
| | | | - Pierosandro Tagliaferri
- Department of Experimental and Clinical Medicine (DMSC), Magna Graecia University, Catanzaro, Italy
- Medical Oncology Unit, AOU Renato Dulbecco, Catanzaro, Italy
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Staropoli N, Arbitrio M, Salvino A, Scionti F, Ciliberto D, Ingargiola R, Labanca C, Agapito G, Iuliano E, Barbieri V, Cucè M, Zuccalà V, Cannataro M, Tassone P, Tagliaferri P. A Prognostic and Carboplatin Response Predictive Model in Ovarian Cancer: A Mono-Institutional Retrospective Study Based on Clinics and Pharmacogenomics. Biomedicines 2022; 10:1210. [PMID: 35625946 PMCID: PMC9138265 DOI: 10.3390/biomedicines10051210] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 05/20/2022] [Accepted: 05/20/2022] [Indexed: 11/17/2022] Open
Abstract
Carboplatin is the cornerstone of ovarian cancer (OC) treatment, while platinum-response, dependent on interindividual variability, is the major prognostic factor for long-term outcomes. This retrospective study was focused on explorative search of genetic polymorphisms in the Absorption, Distribution, Metabolism, Excretion (ADME) genes for the identification of biomarkers prognostic/predictive of platinum-response in OC patients. Ninety-two advanced OC patients treated with carboplatin-based therapy were enrolled at our institution. Of these, we showed that 72% of patients were platinum-sensitive, with a significant benefit in terms of OS (p = 0.001). We identified an inflammatory-score with a longer OS in patients with lower scores as compared to patients with the maximum score (p = 0.001). Thirty-two patients were genotyped for 1931 single nucleotide polymorphisms (SNPs) and five copy number variations (CNVs) by the DMET Plus array platform. Among prognostic polymorphisms, we found a potential role of UGT2A1 both as a predictor of platinum-response (p = 0.01) and as prognostic of survival (p = 0.05). Finally, we identified 24 SNPs related to OS. UGT2A1 correlates to an "inflammatory-score" and retains a potential prognostic role in advanced OC. These data provide a proof of concept that warrants further validation in follow-up studies for the definition of novel biomarkers in this aggressive disease.
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Affiliation(s)
- Nicoletta Staropoli
- Medical Oncology Unit, AOU Mater Domini, 88100 Catanzaro, Italy; (A.S.); (D.C.); (M.C.); (P.T.)
| | - Mariamena Arbitrio
- Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy (CNR), 88100 Catanzaro, Italy
| | - Angela Salvino
- Medical Oncology Unit, AOU Mater Domini, 88100 Catanzaro, Italy; (A.S.); (D.C.); (M.C.); (P.T.)
| | - Francesca Scionti
- Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy (CNR), 98125 Messina, Italy;
| | - Domenico Ciliberto
- Medical Oncology Unit, AOU Mater Domini, 88100 Catanzaro, Italy; (A.S.); (D.C.); (M.C.); (P.T.)
| | - Rossana Ingargiola
- Department of Experimental and Clinical Medicine, Magna Græcia University, 88100 Catanzaro, Italy; (R.I.); (C.L.); (E.I.)
| | - Caterina Labanca
- Department of Experimental and Clinical Medicine, Magna Græcia University, 88100 Catanzaro, Italy; (R.I.); (C.L.); (E.I.)
| | - Giuseppe Agapito
- Department of Law, Economics and Sociology, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy;
- Data Analytics Research Center, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy;
| | - Eleonora Iuliano
- Department of Experimental and Clinical Medicine, Magna Græcia University, 88100 Catanzaro, Italy; (R.I.); (C.L.); (E.I.)
| | - Vito Barbieri
- Medical Oncology Unit, “Pugliese-Ciaccio” Hospital, 88100 Catanzaro, Italy;
| | - Maria Cucè
- Medical Oncology Unit, AOU Mater Domini, 88100 Catanzaro, Italy; (A.S.); (D.C.); (M.C.); (P.T.)
| | - Valeria Zuccalà
- Pathology Unit, “Pugliese-Ciaccio” Hospital, 88100 Catanzaro, Italy;
| | - Mario Cannataro
- Data Analytics Research Center, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy;
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy
| | - Pierfrancesco Tassone
- Medical Oncology Unit, AOU Mater Domini, 88100 Catanzaro, Italy; (A.S.); (D.C.); (M.C.); (P.T.)
- Department of Experimental and Clinical Medicine, Magna Græcia University, 88100 Catanzaro, Italy; (R.I.); (C.L.); (E.I.)
| | - Pierosandro Tagliaferri
- Medical Oncology Unit, AOU Mater Domini, 88100 Catanzaro, Italy; (A.S.); (D.C.); (M.C.); (P.T.)
- Department of Experimental and Clinical Medicine, Magna Græcia University, 88100 Catanzaro, Italy; (R.I.); (C.L.); (E.I.)
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Staropoli N, Ciliberto D, Del Giudice T, Iuliano E, Cucè M, Grillone F, Salvino A, Barbieri V, Russo A, Tassone P, Tagliaferri P. The Era of PARP inhibitors in ovarian cancer: “Class Action” or not? A systematic review and meta-analysis. Crit Rev Oncol Hematol 2018; 131:83-89. [DOI: 10.1016/j.critrevonc.2018.08.011] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Revised: 08/10/2018] [Accepted: 08/22/2018] [Indexed: 02/08/2023] Open
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Staropoli N, Ciliberto D, Chiellino S, Caglioti F, Del Giudice T, Gualtieri S, Salvino A, Strangio A, Botta C, Pignata S, Tassone P, Tagliaferri P. Is ovarian cancer a targetable disease? A systematic review and meta-analysis and genomic data investigation. Oncotarget 2016; 7:82741-82756. [PMID: 27764790 PMCID: PMC5347729 DOI: 10.18632/oncotarget.12633] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Accepted: 09/25/2016] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES The current gold-standard for the first-line treatment in IIIb/IV stages of epithelial ovarian cancer (EOC) is the combination of carboplatin and paclitaxel plus bevacizumab in some countries. In the era of personalized medicine, there is still uncertainty on the impact of several molecularly targeted agents, which have been investigated for the management of this disease. To shed light on the actual role of targeted therapy in EOC, a systematic review and meta-analysis was performed. METHODS Clinical trials were selected by searching "Pubmed" database and abstracts from major cancer meetings within the time-frame of January 2004-June 2015. The endpoints were survival outcome and response rate (RR). Hazard ratios (HRs) of survival outcomes, with confidence intervals and odds-ratios (ORs) of RR, were extracted from retrieved studies and used for current analysis. Meta-analysis was carried out by random effect model. RESULTS 30 randomized trials for a total of 10,530 patients were selected and included in the final analysis. A benefit in terms of OS (pooled HR 0.915; 95%CI 0.840-0.997; p=0.043), particularly for anti-angiogenetic agents (HR 0.872; 95%CI 0.761-1.000; p=0.049), has been demonstrated for targeted therapy. Moreover, a significant advantage in platinum-resistant subgroup in term of PFS (HR 0.755; 95%CI 0.624-0.912; p=0.004) was found. CONCLUSIONS This systematic review and meta-analysis provide the first evidence that targeted therapy is potentially able to translate into improved survival of EOC patients, with a major role played by anti-angiogenetic drugs. The role of target therapy is underlined in the platinum-resistant setting that represents the "pain in the neck" in EOC management.
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Affiliation(s)
- Nicoletta Staropoli
- Department of Experimental and Clinical Medicine, Magna Græcia University, Catanzaro, Italy
| | - Domenico Ciliberto
- Department of Experimental and Clinical Medicine, Magna Græcia University, Catanzaro, Italy
| | - Silvia Chiellino
- Department of Experimental and Clinical Medicine, Magna Græcia University, Catanzaro, Italy
| | - Francesca Caglioti
- Department of Experimental and Clinical Medicine, Magna Græcia University, Catanzaro, Italy
| | - Teresa Del Giudice
- Department of Experimental and Clinical Medicine, Magna Græcia University, Catanzaro, Italy
| | - Simona Gualtieri
- Department of Experimental and Clinical Medicine, Magna Græcia University, Catanzaro, Italy
| | - Angela Salvino
- Department of Experimental and Clinical Medicine, Magna Græcia University, Catanzaro, Italy
| | - Alessandra Strangio
- Department of Experimental and Clinical Medicine, Magna Græcia University, Catanzaro, Italy
| | - Cirino Botta
- Department of Experimental and Clinical Medicine, Magna Græcia University, Catanzaro, Italy
| | - Sandro Pignata
- Department of Gynecologic and Urologic Oncology, Fondazione Pascale, National Cancer Institute of Naples, Naples, Italy
| | - Pierfrancesco Tassone
- Department of Experimental and Clinical Medicine, Magna Græcia University, Catanzaro, Italy
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Mignogna C, Staropoli N, Botta C, De Marco C, Rizzuto A, Morelli M, Di Cello A, Franco R, Camastra C, Presta I, Malara N, Salvino A, Tassone P, Tagliaferri P, Barni T, Donato G, Di Vito A. Aurora Kinase A expression predicts platinum-resistance and adverse outcome in high-grade serous ovarian carcinoma patients. J Ovarian Res 2016; 9:31. [PMID: 27209210 PMCID: PMC4875597 DOI: 10.1186/s13048-016-0238-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 05/05/2016] [Indexed: 12/22/2022] Open
Abstract
High-Grade Serous Ovarian Carcinoma (HGSOC) is the predominant histotype of epithelial ovarian cancer (EOC), characterized by advanced stage at diagnosis, frequent TP53 mutation, rapid progression, and high responsiveness to platinum-based-chemotherapy. To date, standard first-line-chemotherapy in advanced EOC includes platinum salts and paclitaxel with or without bevacizumab. The major prognostic factor is the response duration from the end of the platinum-based treatment (platinum-free interval) and about 10–0 % of EOC patients bear a platinum-refractory disease or develop early resistance (platinum-free interval shorter than 6 months). On these bases, a careful selection of patients who could benefit from chemotherapy is recommended to avoid unnecessary side effects and for a better disease outcome. In this retrospective study, an immunohistochemical evaluation of Aurora Kinase A (AURKA) was performed on 41 cases of HGSOC according to platinum-status. Taking into account the number and intensity of AURKA positive cells we built a predictive score able to discriminate with high accuracy platinum-sensitive patients from platinum-resistant patients (p < 0.001). Furthermore, we observed that AURKA overexpression correlates to worse overall survival (p = 0.001; HR 0.14). We here suggest AURKA as new effective tool to predict the biological behavior of HGSOC. Particularly, our results indicate that AURKA has a role both as predictor of platinum-resistance and as prognostic factor, that deserves further investigation in prospective clinical trials. Indeed, in the era of personalized medicine, AURKA could assist the clinicians in selecting the best treatment and represent, at the same time, a promising new therapeutic target in EOC treatment.
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Affiliation(s)
- Chiara Mignogna
- Department of Health Science, Pathology Unit, Magna Græcia University of Catanzaro, Medical School, Viale Europa, 88100, Catanzaro, Italy.
| | - Nicoletta Staropoli
- Department of Experimental and Clinical Medicine, Medical Oncology, Magna Græcia University of Catanzaro, Medical School, Viale Europa, 88100, Catanzaro, Italy.
| | - Cirino Botta
- Translational Medical Oncology Unit, Department of Experimental and Clinical Medicine, Magna Græcia University, Catanzaro, Italy
| | - Carmela De Marco
- Department of Experimental and Clinical Medicine, Magna Græcia University, Catanzaro, Italy
| | - Antonia Rizzuto
- Department of Medical and Surgical Sciences, Magna Græcia University, Catanzaro, Italy
| | - Michele Morelli
- Department of Experimental and Clinical Medicine, Magna Græcia University, Catanzaro, Italy
| | - Annalisa Di Cello
- Department of Experimental and Clinical Medicine, Magna Græcia University, Catanzaro, Italy
| | - Renato Franco
- Department of Mental and Physical Health and Preventive Medicine, Second University of Naples, Naples, Italy
| | - Caterina Camastra
- Department of Health Science, Pathology Unit, Magna Græcia University of Catanzaro, Medical School, Viale Europa, 88100, Catanzaro, Italy
| | - Ivan Presta
- Department of Health Science, Pathology Unit, Magna Græcia University of Catanzaro, Medical School, Viale Europa, 88100, Catanzaro, Italy
| | - Natalia Malara
- Department of Health Science, Pathology Unit, Magna Græcia University of Catanzaro, Medical School, Viale Europa, 88100, Catanzaro, Italy
| | - Angela Salvino
- Department of Experimental and Clinical Medicine, Medical Oncology, Magna Græcia University of Catanzaro, Medical School, Viale Europa, 88100, Catanzaro, Italy
| | - Pierfrancesco Tassone
- Translational Medical Oncology Unit, Department of Experimental and Clinical Medicine, Magna Græcia University, Catanzaro, Italy
| | - Pierosandro Tagliaferri
- Department of Experimental and Clinical Medicine, Medical Oncology, Magna Græcia University of Catanzaro, Medical School, Viale Europa, 88100, Catanzaro, Italy
| | - Tullio Barni
- Department of Experimental and Clinical Medicine, Magna Græcia University, Catanzaro, Italy
| | - Giuseppe Donato
- Department of Health Science, Pathology Unit, Magna Græcia University of Catanzaro, Medical School, Viale Europa, 88100, Catanzaro, Italy
| | - Anna Di Vito
- Department of Experimental and Clinical Medicine, Magna Græcia University, Catanzaro, Italy
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Staropoli N, Ciliberto D, Chiellino S, Del Giudice T, Caglioti F, Strangio A, Salvino A, Tassone P, Tagliaferri P. Role of targeted therapy in ovarian cancer treatment: a systematic review and meta-analysis of randomized trials. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv339.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Staropoli N, Ciliberto D, Botta C, Fiorillo L, Grimaldi A, Lama S, Caraglia M, Salvino A, Tassone P, Tagliaferri P. Pegylated liposomal doxorubicin in the management of ovarian cancer: a systematic review and metaanalysis of randomized trials. Cancer Biol Ther 2014; 15:707-20. [PMID: 24658024 PMCID: PMC4049787 DOI: 10.4161/cbt.28557] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Revised: 03/09/2014] [Accepted: 03/16/2014] [Indexed: 02/06/2023] Open
Abstract
Ovarian cancer is the leading cause of death among gynecological tumors. Carboplatin/paclitaxel represents the cornerstone of front-line treatment. Instead, there is no consensus for management of recurrent/progressive disease, in which pegylated liposomal doxorubicin (PLD) ± carboplatin is widely used. We performed a systematic review and metaanalysis to evaluate impact of PLD-based compared with no-PLD-based regimens in the ovarian cancer treatment. Data were extracted from randomized trials comparing PLD-based treatment to any other regimens in the January 2000-January 2013 time-frame. Study end-points were overall survival (OS), progression free survival (PFS), response rate (RR), CA125 response, and toxicity. Hazard ratios (HRs) of OS and PFS, with 95% CI, odds ratios (ORs) of RR and risk ratios of CA125 response and grade 3-4 toxicity, were extracted. Data were pooled using fixed and random effect models for selected endpoints. Fourteen randomized trials for a total of 5760 patients were selected and included for the final analysis, which showed no OS differences for PLD-based compared with other regimens (pooled HR: 0.94; 95% CI: 0.88-1.02; P = 0.132) and a significant PFS benefit of PLD-based schedule (HR: 0.91; 95% CI: 0.86-0.96; P = 0.001), particularly in second-line (HR: 0.85; 95% CI: 0.75-0.91) and in platinum-sensitive (HR: 0.83; 95% CI: 0.74-0.94) subgroups. This work confirmed the peculiar tolerability profile of this drug, moreover no difference was observed for common hematological toxicities and for RR, CA125 response. PLD-containing regimens do not improve OS when compared with any other schedule in all phases of disease. A marginal PFS advantage is observed only in platinum-sensitive setting and second-line treatment.
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Affiliation(s)
- Nicoletta Staropoli
- Medical Oncology Unit; Department of Experimental and Clinical Medicine; Magna Græcia University and T. Campanella Cancer Center; Catanzaro, Italy
| | - Domenico Ciliberto
- Medical Oncology Unit; Department of Experimental and Clinical Medicine; Magna Græcia University and T. Campanella Cancer Center; Catanzaro, Italy
| | - Cirino Botta
- Medical Oncology Unit; Department of Experimental and Clinical Medicine; Magna Græcia University and T. Campanella Cancer Center; Catanzaro, Italy
| | - Lucia Fiorillo
- Medical Oncology Unit; Department of Experimental and Clinical Medicine; Magna Græcia University and T. Campanella Cancer Center; Catanzaro, Italy
| | - Anna Grimaldi
- Department of Biochemistry; Biophysics and General Pathology; Second University of Naples; Naples, Italy
| | - Stefania Lama
- Department of Biochemistry; Biophysics and General Pathology; Second University of Naples; Naples, Italy
| | - Michele Caraglia
- Department of Biochemistry; Biophysics and General Pathology; Second University of Naples; Naples, Italy
| | - Angela Salvino
- Medical Oncology Unit; Department of Experimental and Clinical Medicine; Magna Græcia University and T. Campanella Cancer Center; Catanzaro, Italy
| | - Pierfrancesco Tassone
- Medical Oncology Unit; Department of Experimental and Clinical Medicine; Magna Græcia University and T. Campanella Cancer Center; Catanzaro, Italy
| | - Pierosandro Tagliaferri
- Medical Oncology Unit; Department of Experimental and Clinical Medicine; Magna Græcia University and T. Campanella Cancer Center; Catanzaro, Italy
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Staropoli N, Ciliberto D, Botta C, Fiorillo L, Gualtieri S, Salvino A, Tassone P, Tagliaferri P. A retrospective analysis of pegylated liposomal doxorubicin in ovarian cancer: do we still need it? J Ovarian Res 2013; 6:10. [PMID: 23388584 PMCID: PMC3599392 DOI: 10.1186/1757-2215-6-10] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2012] [Accepted: 01/25/2013] [Indexed: 12/05/2022] Open
Abstract
Background Ovarian cancer (OC) is the sixth most common cancer in women. Currently, carboplatin/paclitaxel ± bevacizumab is the cornerstone of front-line treatment. Conversely, the therapeutic options for recurrent or progressive disease are not well defined. For platinum-sensitive patients the best therapeutic approach is still a re-challenge with a platinum-based regimen. Pegylated liposomal doxorubicin (PLD), is considered one of the most active therapeutic options for recurrent or progressive OC. In this retrospective mono-institutional analysis, we evaluated the impact of PLD on the outcome of OC patients. Patients and methods We performed the retrospective study on a cohort of 108 patients with histologically confirmed serous papillary OC, followed at our Institution between 2001 and 2011. 80 patients were in stage III/IV and 55 of them received a second-line treatment. Thirty patients were treated with PLD. Both groups (PLD-treated versus PLD-untreated) underwent a median of 3 treatment lines and were prognostically balanced. The median follow-up was 60 months. Survival endpoints, toxicity and correlations between patients’ baseline characteristics and treatment efficacy were evaluated. Results Patients who had undergone PLD treatment (PLD group) showed a median overall survival (OS) of 45 months as compared to 65 months of patients not treated with PLD (PLD-free group) (HR 2.50 [0.95-6.67; p = 0.06]). Moreover, the median progression-free survival was 6 months in the PLD group versus 10 months in the PLD-free group (HR 1.75 [0.94-3.34; p = 0.07]). The overall objective response rate in II line treatment was 43% (13% in PLD group versus 57% in PLD-free group). Furthermore, we investigated survival endpoints in platinum-refractory patients who received PLD at least once during the course of disease. No OS advantage was achieved by PLD administration when compared to other therapeutic options (30 versus 32 months; HR 1.16 [0.31-4.34; p = 0.81]). No difference in term of toxicity was observed among different groups. Conclusions No evidence of superiority if PLD was compared to alternative agents was found in this analysis, particularly in the platinum-refractory setting. Our findings indicate a modest therapeutic activity of PLD in OC. Analysis of cost/benefit of PLD in OC is eagerly awaited.
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Affiliation(s)
- Nicoletta Staropoli
- Medical Oncology Unit, Department of Experimental and Clinical Medicine, Magna Græcia University and Tommaso Campanella Cancer Center, Campus Salvatore Venuta, Catanzaro, Italy.
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Tassone P, Tagliaferri P, Cucinotto I, Lavecchia AM, Leone F, Pietragalla A, Salvino A, Barbieri V, Venuta S. Pegylated liposomal doxorubicin is active in Stewart–Treves syndrome. Ann Oncol 2007; 18:959-60. [PMID: 17488733 DOI: 10.1093/annonc/mdm113] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Salvino A, Lollini MN. [Identification of some of fermentation of phenanthrene by microorganisms belonging to the genus arthrobacter]. Boll Soc Ital Biol Sper 1977; 53:916-21. [PMID: 597413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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