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Cazzaniga ME, Airoldi M, Arcangeli V, Artale S, Atzori F, Ballerio A, Bianchi GV, Blasi L, Campidoglio S, Ciccarese M, Cursano MC, Piezzo M, Fabi A, Ferrari L, Ferzi A, Ficorella C, Frassoldati A, Fumagalli A, Garrone O, Gebbia V, Generali D, La Verde N, Maur M, Michelotti A, Moretti G, Musolino A, Palumbo R, Pistelli M, Porpiglia M, Sartori D, Scavelli C, Schirone A, Turletti A, Valerio MR, Vici P, Zambelli A, Clivio L, Torri V. Efficacy and safety of Everolimus and Exemestane in hormone-receptor positive (HR+) human-epidermal-growth-factor negative (HER2-) advanced breast cancer patients: New insights beyond clinical trials. The EVA study. Breast 2017; 35:115-121. [PMID: 28711793 DOI: 10.1016/j.breast.2017.06.043] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 06/12/2017] [Accepted: 06/29/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The BOLERO-2 trial reported efficacy and safety of Everolimus (EVE) and Exemestane (EXE) combination in HR+ advanced breast cancer (ABC) patients. The BALLET trial further evaluated the safety of EVE-EXE in HR+ ABC patients, without reporting efficacy data. Aim of the EVA real-life study was to collect data of efficacy and safety of EVE-EXE combination in the clinical setting, as well as exploring efficacy according to EVE Dose-Intensity (DI) and to previous treatment with Fulvestrant. PATIENTS AND METHODS This study aimed to describe the outcome of ABC pts treated with EVE-EXE combination in terms of median duration of EVE treatment and ORR in a real-life setting. RESULTS From July 2013 to December 2015, the EVA study enrolled 404 pts. Median age was 61 years (33-83). Main metastatic sites were: bone (69.1%), soft tissue (34.7%) and viscera (33.2%). Median number of previous treatments was 2 (1-7). 43.3% of the pts had received Fulvestrant. Median exposure to EVE was 31.0 weeks (15.4-58.3) in the whole population. No difference was observed in terms of EVE exposure duration according to DI (p for trend = 0.27) or type of previous treatments (p = 0.33). ORR and Disease Control Rate (DCR) were observed in 31.6% and 60.7% of the patients, respectively, with the lowest ORRs confined in CHT pre-treated patients or in those who received the lowest DI of EVE. Grade 3-4 adverse events (AEs) were reported in 37.9% of the patients. Main AEs were: stomatitis (11.2%), non-infectious pneumonitis - NIP (3.8%), anaemia (3.8%) and fatigue (3.2%). CONCLUSIONS The EVA study provided new insights in the use of EVE-EVE combination in HR+ ABC pts many years after the publication of the pivotal trial. The combination is safe and the best response could be obtained in patients receiving the full dose of EVE and/or after hormone-therapy as Fulvestrant in ABC.
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Affiliation(s)
- M E Cazzaniga
- Research Unit Phase I Trials, ASST Monza, Monza, Italy; Oncology Unit, ASST Monza, Monza, Italy.
| | - M Airoldi
- Oncology Unit 2 - Città della Salute e della Scienza di Torino, Torino, Italy
| | - V Arcangeli
- Oncology Unit Rimini Azienda USL Romagna, Rimini, Italy
| | - S Artale
- Oncology Department, Ospedale di Gallarate ASST Valle Olona, Gallarate, Italy
| | - F Atzori
- Oncology Unit, Azienda Ospedaliero Universitaria di Cagliari, Cagliari, Italy
| | - A Ballerio
- Oncology Unit, ASST della Valle Olona - Presidio Ospedaliero di Saronno, Saronno, Italy
| | - G V Bianchi
- Oncology Unit 1, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - L Blasi
- Oncology Unit, ARNAS Civico Palermo, Palermo, Italy
| | - S Campidoglio
- Oncology Unit, Ospedale Sacro Cuore di Gesù, Fatebenefratelli, Benevento, Italy
| | - M Ciccarese
- Oncology Unit, Ospedale "Vito Fazzi" di Lecce, Lecce, Italy
| | - M C Cursano
- Oncology Unit, Università Campus Bio-Medico, Roma, Italy
| | - M Piezzo
- National Cancer Institute "Fondazione Giovanni Pascale", Napoli, Italy
| | - A Fabi
- Oncology Unit 1, Istituto Regina Elena - IFO, Roma, Italy
| | - L Ferrari
- Oncology Unit, ASL di Frosinone Osp. "SS. Trinità", Italy
| | - A Ferzi
- Oncology Unit, ASST OVEST Milanese - Presidio di Legnano, Legnano, Italy
| | - C Ficorella
- Dipartimento di Scienze Cliniche Applicate e Biotecnologiche (DISCAB) - Università Degli Studi Dell'Aquila, L'Aquila, Italy
| | - A Frassoldati
- Oncology Unit, Az Ospedaliero Universitaria di Ferrara, Ferrara, Italy
| | - A Fumagalli
- Oncology Unit, Ospedale Moriggia Pelascini, Gravedona, Italy
| | - O Garrone
- Oncology Unit, A.O. S. Croce e Carle Ospedale di Insegnamento, Cuneo, Italy
| | - V Gebbia
- Oncology Unit, Osp. La Maddalena, Palermo, Italy
| | | | - N La Verde
- Oncology Unit, ASST Fatebenefratelli Sacco, Milano, Italy
| | - M Maur
- Oncology and Haematology Department, A.O.U Policlinico di Modena, Modena, Italy
| | - A Michelotti
- Oncology Unit I, Ospedale S. Chiara, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - G Moretti
- Oncology Unit, IRCCS Arcispedale S. Maria Nuova, Reggio Emilia, Italy
| | - A Musolino
- Oncology Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - R Palumbo
- Oncology Unit, IRCCS ICS Maugeri, Pavia, Italy
| | - M Pistelli
- Oncology Unit, AOU Ospedali Riuniti Umberto I-G.M. Lancisi-G. Salesi, Ancona, Italy
| | - M Porpiglia
- Oncology Unit, Presidio Ospedaliero S. Anna, Torino, Italy
| | - D Sartori
- Oncology Unit, AULSS 3, Mirano, Italy
| | - C Scavelli
- Oncology Unit, Ospedale "S. Cuore di Gesù", Gallipoli, Italy
| | - A Schirone
- Oncology Department, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - A Turletti
- Oncology Unit, Ospedale Martini della ASL "Città di Torino", Torino, Italy
| | - M R Valerio
- Oncology Department, Policlinico di Palermo Paolo Giaccone, Palermo, Italy
| | - P Vici
- Oncology Unit, Istituto Nazionale Tumori Regina Elena - IFO, Roma, Italy
| | - A Zambelli
- Oncology Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - L Clivio
- IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milano, Italy
| | - V Torri
- IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milano, Italy
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Forcignanò R, Petrucelli L, Cazzaniga ME, Lupo LI, Chiuri VE, Cairo G, De Matteis E, Febbraro A, Giordano G, Campidoglio S, Fabi A, Giampaglia M, Bilancia D, La Verde N, Maiello E, Morritti M, Giotta F, Lorusso V, Scavelli C, Romito S, Cusmai A, Palmiotti G, Tornesello A, Ciccarese M. Abstract P4-13-15: Dose intensity and efficacy of the combination of everolimus and exemestane (EVE/EXE) in a real world population of hormone receptor positive advanced breast cancer: A multicenter Italian experience. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p4-13-15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
BACKGROUND: Everolimus, an mTOR inhibitor, in combination with exemestane is approved for hormone receptor (HR) positive advanced breast cancer (ABC), after failure of treatment with non-steroidal aromatase inhibitor (NSAI). We assessed the toxicity of the combination and the correlation between dose intensity and response to therapy, in a real world population of ABC from 11 Italian centers. Moreover, we evaluated OS of the whole population, RR and PFS according to line of treatment (from 1rd to 3th and from 4th on).
METHODS: 154 pts were treated with combination of everolimus 10 mg and exemestane 25 mg daily from 05/2011 today. Median age was 62 (47-82). Median time to metastatic disease was 49 months (0-269). Median number of metastatic sites was 2 (55.2% of pts visceral versus 44.8% non visceral disease). N=117 (75.9%) pretreated with HT as adjuvant; N=126 pts (81.8%) treated with HT for advanced disease prior to EVE/EXE, with a median of one line (0-5). N=102 pts (66.2%) treated with chemotherapy for metastatic disease, with a median of one line (0-6) before everolimus treatment.
RESULTS: Sixteen pts received EVE/EXE as 1st line (10.4%), 39 as 2nd (25.3%), 37 as 3rd (24%), 62 as 4th or more (40,3%). Response was evaluable in 127 out of 154 pts; CR/PR/SD respectively 5/27/56 pts. RR according to line (from 1st to 3rd vs ≥ 4th) was respectively 22.8% vs 26.4% (p=0,864). The median PFS for all population (150 pts) was 38 weeks (95% CI: 33-42). The PFS according to line (1st- 3rd vs ≥ 4th) was 38 wks in both subgroups, p=0.73. OS (126/154 pts) was 28 mths (95% CI: 31-38). The most frequent adverse events were collected in the table.
Adverse eventsOverall %Grade 3-4 %Stomatitis55.810.4Hypercholesterolemia47.40.0Asthenia42.95.2Hyperglycemia36.45.8Hypertriglyceridemia29.20.6Anemia28.63.9Peripheral edema24.71.3Rash23.40.6Increased ALT/AST/GGT21.46.5Thrombocytopenia19.53.9Diarrhea18.81.9Weight loss18.21.3Dysgeusia17.50.6Pneumonitis15.61.9Cutaneous toxicity14.90.6Infection14.33.2Neutropenia11.71.9Nausea11.70.0Anorexia (without stomatitis)10.41.3Electrolyte alterations9.71.3Urea/creatinine increase6.51.3Vomiting6.50.0Uric acid increase4.50.0
Median duration of treatment with everolimus 10 mg and 5 mg was respectively 180 (9-854) and 129 days (3-738). Fifty-eight pts (37,6%) never stopped treatment with everolimus 10 mg; 16 pts (10,4%) definitively stopped everolimus for toxicity; 80 pts (52,0%) temporarily interrupted the treatment, resuming at dose level 10 mg (31 pts) or reducing at 5 mg (49 pts). Main reason for discontinuation/interruption was stomatitis G2-G3. RR and PFS evaluated according to dose intensity, 10 mg vs 5 mg, were respectively 25.9% vs 30% p=0.779, 38 wks (27-44) vs 40 wks (31-48) P=0.614
CONCLUSIONS: efficacy in terms of RR and PFS of the combination EVE/EXE is not related to dose intensity (10 mg vs 5 mg), the discontinuation of the treatment is high with the starting dose of 10 mg, the toxicity is consistent with previous phase II-III studies although we collected some different toxicities.
Citation Format: Forcignanò R, Petrucelli L, Cazzaniga ME, Lupo LI, Chiuri VE, Cairo G, De Matteis E, Febbraro A, Giordano G, Campidoglio S, Fabi A, Giampaglia M, Bilancia D, La Verde N, Maiello E, Morritti M, Giotta F, Lorusso V, Scavelli C, Romito S, Cusmai A, Palmiotti G, Tornesello A, Ciccarese M. Dose intensity and efficacy of the combination of everolimus and exemestane (EVE/EXE) in a real world population of hormone receptor positive advanced breast cancer: A multicenter Italian experience. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P4-13-15.
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Affiliation(s)
- R Forcignanò
- "Vito Fazzi" Hospital, Lecce, Italy; "AO San Gerardo", Monza, Italy; "Sacro Cuore di Gesù Fatebenefratelli" Hospital, Benevento, Italy; "Regina Elena" National Cancer Institute, Roma, Italy; "San Carlo" Hospital, Potenza, Italy; "AO Fatebenefratelli e Oftalmico", Milano, Italy; "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo (Foggia), Italy; "Giovanni Paolo II" Institute, Bari, Italy; "S. Cuore di Gesù" Hospital, Gallipoli (Lecce), Italy; "Ospedali Riuniti" Hospital, Foggia, Italy; "Di Venere" Hospital, Bari, Italy
| | - L Petrucelli
- "Vito Fazzi" Hospital, Lecce, Italy; "AO San Gerardo", Monza, Italy; "Sacro Cuore di Gesù Fatebenefratelli" Hospital, Benevento, Italy; "Regina Elena" National Cancer Institute, Roma, Italy; "San Carlo" Hospital, Potenza, Italy; "AO Fatebenefratelli e Oftalmico", Milano, Italy; "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo (Foggia), Italy; "Giovanni Paolo II" Institute, Bari, Italy; "S. Cuore di Gesù" Hospital, Gallipoli (Lecce), Italy; "Ospedali Riuniti" Hospital, Foggia, Italy; "Di Venere" Hospital, Bari, Italy
| | - ME Cazzaniga
- "Vito Fazzi" Hospital, Lecce, Italy; "AO San Gerardo", Monza, Italy; "Sacro Cuore di Gesù Fatebenefratelli" Hospital, Benevento, Italy; "Regina Elena" National Cancer Institute, Roma, Italy; "San Carlo" Hospital, Potenza, Italy; "AO Fatebenefratelli e Oftalmico", Milano, Italy; "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo (Foggia), Italy; "Giovanni Paolo II" Institute, Bari, Italy; "S. Cuore di Gesù" Hospital, Gallipoli (Lecce), Italy; "Ospedali Riuniti" Hospital, Foggia, Italy; "Di Venere" Hospital, Bari, Italy
| | - LI Lupo
- "Vito Fazzi" Hospital, Lecce, Italy; "AO San Gerardo", Monza, Italy; "Sacro Cuore di Gesù Fatebenefratelli" Hospital, Benevento, Italy; "Regina Elena" National Cancer Institute, Roma, Italy; "San Carlo" Hospital, Potenza, Italy; "AO Fatebenefratelli e Oftalmico", Milano, Italy; "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo (Foggia), Italy; "Giovanni Paolo II" Institute, Bari, Italy; "S. Cuore di Gesù" Hospital, Gallipoli (Lecce), Italy; "Ospedali Riuniti" Hospital, Foggia, Italy; "Di Venere" Hospital, Bari, Italy
| | - VE Chiuri
- "Vito Fazzi" Hospital, Lecce, Italy; "AO San Gerardo", Monza, Italy; "Sacro Cuore di Gesù Fatebenefratelli" Hospital, Benevento, Italy; "Regina Elena" National Cancer Institute, Roma, Italy; "San Carlo" Hospital, Potenza, Italy; "AO Fatebenefratelli e Oftalmico", Milano, Italy; "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo (Foggia), Italy; "Giovanni Paolo II" Institute, Bari, Italy; "S. Cuore di Gesù" Hospital, Gallipoli (Lecce), Italy; "Ospedali Riuniti" Hospital, Foggia, Italy; "Di Venere" Hospital, Bari, Italy
| | - G Cairo
- "Vito Fazzi" Hospital, Lecce, Italy; "AO San Gerardo", Monza, Italy; "Sacro Cuore di Gesù Fatebenefratelli" Hospital, Benevento, Italy; "Regina Elena" National Cancer Institute, Roma, Italy; "San Carlo" Hospital, Potenza, Italy; "AO Fatebenefratelli e Oftalmico", Milano, Italy; "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo (Foggia), Italy; "Giovanni Paolo II" Institute, Bari, Italy; "S. Cuore di Gesù" Hospital, Gallipoli (Lecce), Italy; "Ospedali Riuniti" Hospital, Foggia, Italy; "Di Venere" Hospital, Bari, Italy
| | - E De Matteis
- "Vito Fazzi" Hospital, Lecce, Italy; "AO San Gerardo", Monza, Italy; "Sacro Cuore di Gesù Fatebenefratelli" Hospital, Benevento, Italy; "Regina Elena" National Cancer Institute, Roma, Italy; "San Carlo" Hospital, Potenza, Italy; "AO Fatebenefratelli e Oftalmico", Milano, Italy; "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo (Foggia), Italy; "Giovanni Paolo II" Institute, Bari, Italy; "S. Cuore di Gesù" Hospital, Gallipoli (Lecce), Italy; "Ospedali Riuniti" Hospital, Foggia, Italy; "Di Venere" Hospital, Bari, Italy
| | - A Febbraro
- "Vito Fazzi" Hospital, Lecce, Italy; "AO San Gerardo", Monza, Italy; "Sacro Cuore di Gesù Fatebenefratelli" Hospital, Benevento, Italy; "Regina Elena" National Cancer Institute, Roma, Italy; "San Carlo" Hospital, Potenza, Italy; "AO Fatebenefratelli e Oftalmico", Milano, Italy; "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo (Foggia), Italy; "Giovanni Paolo II" Institute, Bari, Italy; "S. Cuore di Gesù" Hospital, Gallipoli (Lecce), Italy; "Ospedali Riuniti" Hospital, Foggia, Italy; "Di Venere" Hospital, Bari, Italy
| | - G Giordano
- "Vito Fazzi" Hospital, Lecce, Italy; "AO San Gerardo", Monza, Italy; "Sacro Cuore di Gesù Fatebenefratelli" Hospital, Benevento, Italy; "Regina Elena" National Cancer Institute, Roma, Italy; "San Carlo" Hospital, Potenza, Italy; "AO Fatebenefratelli e Oftalmico", Milano, Italy; "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo (Foggia), Italy; "Giovanni Paolo II" Institute, Bari, Italy; "S. Cuore di Gesù" Hospital, Gallipoli (Lecce), Italy; "Ospedali Riuniti" Hospital, Foggia, Italy; "Di Venere" Hospital, Bari, Italy
| | - S Campidoglio
- "Vito Fazzi" Hospital, Lecce, Italy; "AO San Gerardo", Monza, Italy; "Sacro Cuore di Gesù Fatebenefratelli" Hospital, Benevento, Italy; "Regina Elena" National Cancer Institute, Roma, Italy; "San Carlo" Hospital, Potenza, Italy; "AO Fatebenefratelli e Oftalmico", Milano, Italy; "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo (Foggia), Italy; "Giovanni Paolo II" Institute, Bari, Italy; "S. Cuore di Gesù" Hospital, Gallipoli (Lecce), Italy; "Ospedali Riuniti" Hospital, Foggia, Italy; "Di Venere" Hospital, Bari, Italy
| | - A Fabi
- "Vito Fazzi" Hospital, Lecce, Italy; "AO San Gerardo", Monza, Italy; "Sacro Cuore di Gesù Fatebenefratelli" Hospital, Benevento, Italy; "Regina Elena" National Cancer Institute, Roma, Italy; "San Carlo" Hospital, Potenza, Italy; "AO Fatebenefratelli e Oftalmico", Milano, Italy; "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo (Foggia), Italy; "Giovanni Paolo II" Institute, Bari, Italy; "S. Cuore di Gesù" Hospital, Gallipoli (Lecce), Italy; "Ospedali Riuniti" Hospital, Foggia, Italy; "Di Venere" Hospital, Bari, Italy
| | - M Giampaglia
- "Vito Fazzi" Hospital, Lecce, Italy; "AO San Gerardo", Monza, Italy; "Sacro Cuore di Gesù Fatebenefratelli" Hospital, Benevento, Italy; "Regina Elena" National Cancer Institute, Roma, Italy; "San Carlo" Hospital, Potenza, Italy; "AO Fatebenefratelli e Oftalmico", Milano, Italy; "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo (Foggia), Italy; "Giovanni Paolo II" Institute, Bari, Italy; "S. Cuore di Gesù" Hospital, Gallipoli (Lecce), Italy; "Ospedali Riuniti" Hospital, Foggia, Italy; "Di Venere" Hospital, Bari, Italy
| | - D Bilancia
- "Vito Fazzi" Hospital, Lecce, Italy; "AO San Gerardo", Monza, Italy; "Sacro Cuore di Gesù Fatebenefratelli" Hospital, Benevento, Italy; "Regina Elena" National Cancer Institute, Roma, Italy; "San Carlo" Hospital, Potenza, Italy; "AO Fatebenefratelli e Oftalmico", Milano, Italy; "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo (Foggia), Italy; "Giovanni Paolo II" Institute, Bari, Italy; "S. Cuore di Gesù" Hospital, Gallipoli (Lecce), Italy; "Ospedali Riuniti" Hospital, Foggia, Italy; "Di Venere" Hospital, Bari, Italy
| | - N La Verde
- "Vito Fazzi" Hospital, Lecce, Italy; "AO San Gerardo", Monza, Italy; "Sacro Cuore di Gesù Fatebenefratelli" Hospital, Benevento, Italy; "Regina Elena" National Cancer Institute, Roma, Italy; "San Carlo" Hospital, Potenza, Italy; "AO Fatebenefratelli e Oftalmico", Milano, Italy; "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo (Foggia), Italy; "Giovanni Paolo II" Institute, Bari, Italy; "S. Cuore di Gesù" Hospital, Gallipoli (Lecce), Italy; "Ospedali Riuniti" Hospital, Foggia, Italy; "Di Venere" Hospital, Bari, Italy
| | - E Maiello
- "Vito Fazzi" Hospital, Lecce, Italy; "AO San Gerardo", Monza, Italy; "Sacro Cuore di Gesù Fatebenefratelli" Hospital, Benevento, Italy; "Regina Elena" National Cancer Institute, Roma, Italy; "San Carlo" Hospital, Potenza, Italy; "AO Fatebenefratelli e Oftalmico", Milano, Italy; "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo (Foggia), Italy; "Giovanni Paolo II" Institute, Bari, Italy; "S. Cuore di Gesù" Hospital, Gallipoli (Lecce), Italy; "Ospedali Riuniti" Hospital, Foggia, Italy; "Di Venere" Hospital, Bari, Italy
| | - M Morritti
- "Vito Fazzi" Hospital, Lecce, Italy; "AO San Gerardo", Monza, Italy; "Sacro Cuore di Gesù Fatebenefratelli" Hospital, Benevento, Italy; "Regina Elena" National Cancer Institute, Roma, Italy; "San Carlo" Hospital, Potenza, Italy; "AO Fatebenefratelli e Oftalmico", Milano, Italy; "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo (Foggia), Italy; "Giovanni Paolo II" Institute, Bari, Italy; "S. Cuore di Gesù" Hospital, Gallipoli (Lecce), Italy; "Ospedali Riuniti" Hospital, Foggia, Italy; "Di Venere" Hospital, Bari, Italy
| | - F Giotta
- "Vito Fazzi" Hospital, Lecce, Italy; "AO San Gerardo", Monza, Italy; "Sacro Cuore di Gesù Fatebenefratelli" Hospital, Benevento, Italy; "Regina Elena" National Cancer Institute, Roma, Italy; "San Carlo" Hospital, Potenza, Italy; "AO Fatebenefratelli e Oftalmico", Milano, Italy; "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo (Foggia), Italy; "Giovanni Paolo II" Institute, Bari, Italy; "S. Cuore di Gesù" Hospital, Gallipoli (Lecce), Italy; "Ospedali Riuniti" Hospital, Foggia, Italy; "Di Venere" Hospital, Bari, Italy
| | - V Lorusso
- "Vito Fazzi" Hospital, Lecce, Italy; "AO San Gerardo", Monza, Italy; "Sacro Cuore di Gesù Fatebenefratelli" Hospital, Benevento, Italy; "Regina Elena" National Cancer Institute, Roma, Italy; "San Carlo" Hospital, Potenza, Italy; "AO Fatebenefratelli e Oftalmico", Milano, Italy; "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo (Foggia), Italy; "Giovanni Paolo II" Institute, Bari, Italy; "S. Cuore di Gesù" Hospital, Gallipoli (Lecce), Italy; "Ospedali Riuniti" Hospital, Foggia, Italy; "Di Venere" Hospital, Bari, Italy
| | - C Scavelli
- "Vito Fazzi" Hospital, Lecce, Italy; "AO San Gerardo", Monza, Italy; "Sacro Cuore di Gesù Fatebenefratelli" Hospital, Benevento, Italy; "Regina Elena" National Cancer Institute, Roma, Italy; "San Carlo" Hospital, Potenza, Italy; "AO Fatebenefratelli e Oftalmico", Milano, Italy; "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo (Foggia), Italy; "Giovanni Paolo II" Institute, Bari, Italy; "S. Cuore di Gesù" Hospital, Gallipoli (Lecce), Italy; "Ospedali Riuniti" Hospital, Foggia, Italy; "Di Venere" Hospital, Bari, Italy
| | - S Romito
- "Vito Fazzi" Hospital, Lecce, Italy; "AO San Gerardo", Monza, Italy; "Sacro Cuore di Gesù Fatebenefratelli" Hospital, Benevento, Italy; "Regina Elena" National Cancer Institute, Roma, Italy; "San Carlo" Hospital, Potenza, Italy; "AO Fatebenefratelli e Oftalmico", Milano, Italy; "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo (Foggia), Italy; "Giovanni Paolo II" Institute, Bari, Italy; "S. Cuore di Gesù" Hospital, Gallipoli (Lecce), Italy; "Ospedali Riuniti" Hospital, Foggia, Italy; "Di Venere" Hospital, Bari, Italy
| | - A Cusmai
- "Vito Fazzi" Hospital, Lecce, Italy; "AO San Gerardo", Monza, Italy; "Sacro Cuore di Gesù Fatebenefratelli" Hospital, Benevento, Italy; "Regina Elena" National Cancer Institute, Roma, Italy; "San Carlo" Hospital, Potenza, Italy; "AO Fatebenefratelli e Oftalmico", Milano, Italy; "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo (Foggia), Italy; "Giovanni Paolo II" Institute, Bari, Italy; "S. Cuore di Gesù" Hospital, Gallipoli (Lecce), Italy; "Ospedali Riuniti" Hospital, Foggia, Italy; "Di Venere" Hospital, Bari, Italy
| | - G Palmiotti
- "Vito Fazzi" Hospital, Lecce, Italy; "AO San Gerardo", Monza, Italy; "Sacro Cuore di Gesù Fatebenefratelli" Hospital, Benevento, Italy; "Regina Elena" National Cancer Institute, Roma, Italy; "San Carlo" Hospital, Potenza, Italy; "AO Fatebenefratelli e Oftalmico", Milano, Italy; "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo (Foggia), Italy; "Giovanni Paolo II" Institute, Bari, Italy; "S. Cuore di Gesù" Hospital, Gallipoli (Lecce), Italy; "Ospedali Riuniti" Hospital, Foggia, Italy; "Di Venere" Hospital, Bari, Italy
| | - A Tornesello
- "Vito Fazzi" Hospital, Lecce, Italy; "AO San Gerardo", Monza, Italy; "Sacro Cuore di Gesù Fatebenefratelli" Hospital, Benevento, Italy; "Regina Elena" National Cancer Institute, Roma, Italy; "San Carlo" Hospital, Potenza, Italy; "AO Fatebenefratelli e Oftalmico", Milano, Italy; "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo (Foggia), Italy; "Giovanni Paolo II" Institute, Bari, Italy; "S. Cuore di Gesù" Hospital, Gallipoli (Lecce), Italy; "Ospedali Riuniti" Hospital, Foggia, Italy; "Di Venere" Hospital, Bari, Italy
| | - M Ciccarese
- "Vito Fazzi" Hospital, Lecce, Italy; "AO San Gerardo", Monza, Italy; "Sacro Cuore di Gesù Fatebenefratelli" Hospital, Benevento, Italy; "Regina Elena" National Cancer Institute, Roma, Italy; "San Carlo" Hospital, Potenza, Italy; "AO Fatebenefratelli e Oftalmico", Milano, Italy; "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo (Foggia), Italy; "Giovanni Paolo II" Institute, Bari, Italy; "S. Cuore di Gesù" Hospital, Gallipoli (Lecce), Italy; "Ospedali Riuniti" Hospital, Foggia, Italy; "Di Venere" Hospital, Bari, Italy
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