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Roila F, Ruggeri B, Ballatori E, Patoia L, Palazzo S, Colucci G, Di Costanzo F, Cascinu S, Labianca R, Sobrero A, Cortesi E, Bressi C, Ferraldeschi R, Mazzoli M, Evangelista M, Di Fonzo C, Cigolari S, Angelini V, Cioffi A, Guardasole V, Zarra E, Tonato M, Betti M, Marrocolo F, Bon-ciarelli V, Cetto G, Silingardi V, Cognetti F, Beretta G, Pessi A, Mosconi S, Milesi L, Bertetto O, Malacarne P, Marzola M, Margutti G, Modenesi C, Manente P, Comandone A, Oliva C, Berniolo P, Cutin SC, Luporini G, Colucci G, Recaldin E, Nicodemo M, Picece V, Turaz-za M, Ferrazzi E, Solina G, Rosati G, Rossi A, Manzione L, Sozzi P, Fornarini G, Lavarello A, Catalano G, Giordani P, Alessandroni P, Troccoli G, Ramus GV, Tonda L, Sirgiovanni M, Iannello GP, Tinessa V, Ruggiero A, Palazzo S, Barni S, Mandalà M, Cremonesi M, Porcile G, Destefanis M, Testore F, Carteni G, Daniele B, Volta C, Ferraù F, Zaniboni A, Marchetti P, Citone G, Cefaro GA, Iacono C, Musi M, Mozzicafreddo A, Imperiale FN, Filippelli G, Sciacca V, D'Aprile M, Isa L, Recchia F, Spada S, Cascinu S, Carroccio R, Mustacchi G, Ceccherini R, Chetrì M, Rizzo P, Botturi M, Marchei P, Bretti S, Montalbetti L, Reguzzoni G, Massidda B, Ionta M, Cruciani G, Prosperi A, Mantovani G, Sidoti V, Peta A, Greco E, Cicero G, Sobrero A, Marsilio P, Vigevani E, Rimondi G, Gebbia V, Nuzzo A, Biondi E, Caroti C, D'Amico M, Tuveri G, Pieri G, Enrici RM, Tonini G, Santini D, Iannone T, Pizza C, Belli M, Del Prete S, Pizza C, Trevisonne R, Serlenga M, Laricchiuta R, Lacava V, Bumma C, Roselli M, Verderame F, Mascia V, Perrone D, Prantera T, Venuta S, Nastasi G, Bortolussi V, Lembo A. Adjuvant Systemic Therapies in Patients with Colorectal Cancer: An Audit on Clinical Practice in Italy. Tumori 2019; 91:472-6. [PMID: 16457144 DOI: 10.1177/030089160509100605] [Citation(s) in RCA: 5] [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] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims and Background Rarely are conclusions from clinical trials summarized in international consensus conferences and promptly transferred to patient care. The adjuvant therapy for colorectal cancer used in daily clinical practice in Italy is described and compared with the recommendations of the 1990 NIH Consensus Conference. Patients and Methods We audited prescriptions of adjuvant systemic therapies for Italian colorectal cancer patients in 82 centers during a fixed one-week period. Results Among 434 patients receiving adjuvant chemotherapy there were 139 (42.5%) colon cancer patients with N- and 169 (51.7%) with N+ regional nodal involvement. Treatment at academic centers, a young age, T4 and a low total number of lymph nodes removed at surgery were the factors potentially justifying the decision for adjuvant chemotherapy in stage II colon cancer patients. The most common chemotherapy used was a bolus of 5-fluorouracil/folinic acid for 6 months (75.8%). Adjuvant radiotherapy was not administered to 37 (38.5%) of 96 patients with stage II and III rectal cancer. Conclusions The study shows that a substantial proportion of patients on adjuvant treatment at a certain time point in a large enough sample of Italian centers are stage II (potential over-treatment) and that an under-treatment of stage II and III rectal cancer patients (lack of radiotherapy) occurs too often in daily clinical practice in this country.
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Affiliation(s)
| | - Fausto Roila
- Divisione Oncologia Medica, Ospedale Policlinico, Perugia
| | | | - Enzo Ballatori
- Unità di Statistica Medica, Dip. Medicina Interna e Sanità Pubblica, Università, L'Aquila
| | - Lucio Patoia
- Dip. Medicina Interna e Scienze Oncologiche, Università, Perugia
| | | | - Giuseppe Colucci
- Oncologia Medica e Sperimentale, Istituto Nazionale Tumori, Bari
| | | | | | | | | | - E. Cortesi
- D.H. Oncologico Policlinico Umberto I, Roma
| | - C. Bressi
- D.H. Oncologico Policlinico Umberto I, Roma
| | | | - M. Mazzoli
- D.H. Oncologico Policlinico Umberto I, Roma
| | | | | | - S. Cigolari
- III Medicina Interna, Università Federico II, Napoli
| | - V. Angelini
- III Medicina Interna, Università Federico II, Napoli
| | - A. Cioffi
- III Medicina Interna, Università Federico II, Napoli
| | - V. Guardasole
- III Medicina Interna, Università Federico II, Napoli
| | - E. Zarra
- III Medicina Interna, Università Federico II, Napoli
| | - M. Tonato
- Divisione Oncologia Medica, Policlinico, Perugia
| | - M. Betti
- Divisione Oncologia Medica, Policlinico, Perugia
| | - F. Marrocolo
- Divisione Oncologia Medica, Policlinico, Perugia
| | | | - G. Cetto
- Divisione Clinicizzata Oncologia Medica, Ospedale Maggiore, Verona
| | | | - F. Cognetti
- Divisione Oncologia Medica, Istituto Nazionale dei Tumori, Roma
| | - G. Beretta
- Divisione Oncologia Medica, Ospedali Riuniti, Bergamo
| | - A. Pessi
- Divisione Oncologia Medica, Ospedali Riuniti, Bergamo
| | - S. Mosconi
- Divisione Oncologia Medica, Ospedali Riuniti, Bergamo
| | - L. Milesi
- Divisione Oncologia Medica, Ospedali Riuniti, Bergamo
| | - O. Bertetto
- Divisione Oncologia Medica, Ospedale S. Giovanni Molinette, Torino
| | - P. Malacarne
- Divisione Oncologia Clinica, Ospedale S. Anna, Ferrara
| | - M. Marzola
- Divisione Oncologia Clinica, Ospedale S. Anna, Ferrara
| | - G. Margutti
- Divisione Oncologia Clinica, Ospedale S. Anna, Ferrara
| | - C. Modenesi
- Divisione Oncologia Clinica, Ospedale S. Anna, Ferrara
| | - P. Manente
- Divisione Oncologia Medica, Ospedale Civile, Castelfranco Veneto
| | - A. Comandone
- Divisione Oncologia Medica, Ospedale Gradenigo, Torino
| | - C. Oliva
- Divisione Oncologia Medica, Ospedale Gradenigo, Torino
| | - P. Berniolo
- Divisione Oncologia Medica, Ospedale Gradenigo, Torino
| | | | - G. Luporini
- Divisione Oncologia Medica, Ospedale S. Carlo Borromeo, Milano
| | - G. Colucci
- Divisione Oncologia Medica e Sperimentale, Istituto Nazionale Tumori, Bari
| | - E. Recaldin
- Divisione Oncologia Medica, Ospedale S. Cuore, Negrar, Verona
| | - M. Nicodemo
- Divisione Oncologia Medica, Ospedale S. Cuore, Negrar, Verona
| | - V. Picece
- Divisione Oncologia Medica, Ospedale S. Cuore, Negrar, Verona
| | - M. Turaz-za
- Divisione Oncologia Medica, Ospedale S. Cuore, Negrar, Verona
| | - E. Ferrazzi
- Divisione Oncologia Medica, Ospedale Civile, Rovigo
| | - G. Solina
- Divisione Chirurgia Oncologica, Ospedale Cervello, Palermo
| | - G. Rosati
- Divisione Oncologia Medica, Ospedale Civile, Potenza
| | - A. Rossi
- Divisione Oncologia Medica, Ospedale Civile, Potenza
| | - L. Manzione
- Divisione Oncologia Medica, Ospedale Civile, Potenza
| | - P. Sozzi
- Divisione Oncologia Medica, Ospedale degli Infermi, Biella
| | - G. Fornarini
- Divisione Oncologia Medica, Ospedale degli Infermi, Biella
| | - A. Lavarello
- Divisione Oncologia Medica, Ospedale Civile, Sestri Levante
| | - G. Catalano
- Divisione Oncologia Medica, Ospedale S. Salvatore, Pesaro
| | - P. Giordani
- Divisione Oncologia Medica, Ospedale S. Salvatore, Pesaro
| | | | - G. Troccoli
- Divisione Oncologia Medica, Policlinico Universitario, Bari
| | - G. Vietti Ramus
- UO di Oncologia, Ospedale S. Giovanni Bosco, ASL Torino 4, Torino
| | - L. Tonda
- UO di Oncologia, Ospedale S. Giovanni Bosco, ASL Torino 4, Torino
| | - M.P. Sirgiovanni
- UO di Oncologia, Ospedale S. Giovanni Bosco, ASL Torino 4, Torino
| | | | - V. Tinessa
- Divisione Oncologia Medica, Ospedale Civile, Benevento
| | - A Ruggiero
- Divisione Oncologia Medica, Ospedale Civile, Benevento
| | - S. Palazzo
- Divisione Oncologia Medica, Ospedale Mariano Santo, Cosenza
| | - S. Barni
- UO di Oncologia Medica, Azienda Ospedaliera, Treviglio
| | - M. Mandalà
- UO di Oncologia Medica, Azienda Ospedaliera, Treviglio
| | - M. Cremonesi
- UO di Oncologia Medica, Azienda Ospedaliera, Treviglio
| | - G. Porcile
- Divisione Oncologia Medica, Ospedale Civile, Alba
| | | | - F. Testore
- Divisione Oncologia Medica, Ospedale Civile, Asti
| | - G. Carteni
- Divisione Oncologia Medica, Ospedale Cardarelli, Napoli
| | - B. Daniele
- Divisione Oncologia Medica, Istituto Nazionale Tumori, Napoli
| | - C. Volta
- Divisione Oncologia Medica, Ospedale Maggiore della Carità, Novara
| | - F. Ferraù
- Divisione Oncologia Medica, Ospedale Civile, Taormina
| | - A. Zaniboni
- Divisione Oncologia Medica, C. Cura Poliambulanza, Brescia
| | - P. Marchetti
- Divisione Oncologia Medica, Ospedale S. Salvatore, L'Aquila
| | - G. Citone
- Divisione Oncologia Medica, Ospedale S. Salvatore, L'Aquila
| | | | - C. Iacono
- Divisione Oncologia Medica, Ospedale Civile, Ragusa
| | - M. Musi
- Divisione Oncologia Medica, Ospedale Generale, Aosta
| | | | | | | | - V. Sciacca
- Divisione Oncologia Medica, Ospedale S. Maria Goretti, Latina
| | - M. D'Aprile
- Divisione Oncologia Medica, Ospedale S. Maria Goretti, Latina
| | - L. Isa
- Divisione Oncologia Medica, Ospedale Civile, Gorgonzola
| | - F. Recchia
- Divisione Oncologia Medica, Ospedale Civile, Avezzano
| | - S. Spada
- D.H. Oncologico, Ospedale Umberto I, Siracusa
| | - S. Cascinu
- Divisione Oncologia Medica, Ospedale Civile, Parma
| | - R. Carroccio
- Unità Operativa Complessa di Oncologia Medica, Ospedale Umberto I, Enna
| | | | | | - M. Chetrì
- D.H. Oncologico, Ospedale di Summa, Brindisi
| | - P. Rizzo
- D.H. Oncologico, Ospedale di Summa, Brindisi
| | - M. Botturi
- UO Radioterapia, Ospedale Niguarda, Milano
| | - P. Marchei
- Divisione Oncologia Medica, Università La Sapienza, Roma
| | - S. Bretti
- Divisione Oncologia Medica, Ospedale Civile, Ivrea
| | | | - G. Reguzzoni
- D. H. Oncologico, Ospedale Civile, Busto Arsizio
| | - B. Massidda
- Oncologia Medica, Policlinico Universitario, Monserrato, Cagliari
| | - M.T. Ionta
- Oncologia Medica, Policlinico Universitario, Monserrato, Cagliari
| | - G. Cruciani
- Divisione Oncologia Medica, Ospedale Civile, Lugo
| | | | - G. Mantovani
- Divisione Oncologia Medica, Università, Cagliari
| | - V. Sidoti
- Divisione Oncologia Medica, Ospedale Civile, Pinerolo
| | - A. Peta
- Divisione Ematologia Oncologica, Ospedale Pugliese, Catanzaro
| | - E. Greco
- Divisione Oncologia Medica, Ospedale Civile, Lamezia Terme
| | - G. Cicero
- Divisione Oncologia Medica, Ospedale Civile, Castrovillari
| | - A. Sobrero
- Divisione Oncologia Medica, Policlinico Universitario, Udine
| | - P. Marsilio
- Divisione Oncologia Medica, Ospedale Civile, Udine
| | - E. Vigevani
- Divisione Oncologia Medica, Ospedale Civile, Tolmezzo
| | - G. Rimondi
- Divisione Oncologia Medica, Ospedale Civile, Tolmezzo
| | - V. Gebbia
- Divisione Oncologia Medica, Policlinico Universitario, Palermo
| | - A. Nuzzo
- UO di Oncologia Medica, Ospedale Renzetti, Lanciano
| | - E. Biondi
- UO di Oncologia Medica, Ospedale Renzetti, Lanciano
| | - C. Caroti
- Divisione Oncologia Medica, Ospedale Galliera, Genova
| | - M. D'Amico
- Divisione Oncologia Medica, Ospedale Galliera, Genova
| | - G. Tuveri
- Divisione Oncologia Medica, Ospedale della Pietà, Trieste
| | - G. Pieri
- Divisione Oncologia Medica, Ospedale della Pietà, Trieste
| | | | - G. Tonini
- Oncologia Medica, Università Campus Biomedico, Roma
| | - D. Santini
- Oncologia Medica, Università Campus Biomedico, Roma
| | - T. Iannone
- Unità di Radioterapia Oncologica, Ospedale civile, Belluno
| | - C. Pizza
- Divisione Oncologia Medica, Ospedale S. Maria della Pietà, Nola
| | | | - S. Del Prete
- Divisione Oncologia Medica, Ospedale Civile, Frattamaggiore
| | - C. Pizza
- Divisione Oncologia Medica, Ospedale S. Maria della Pietà, Nola
| | - R. Trevisonne
- Divisione Oncologia Medica e Radioterapia, Ospedale Civile, Ascoli Piceno
| | - M. Serlenga
- Oncologia Radioterapica, Ospedale Civile, Barletta
| | | | - V. Lacava
- D.H. Oncologia, Università La Sapienza, Roma
| | - C. Bumma
- Divisione Oncologia Medica, Ospedale S. Giovanni Vecchio, Torino
| | - M. Roselli
- Oncologia Medica, Università di Roma “Tor Vergata”, Roma
| | | | - V. Mascia
- Divisione Oncologia Medica, Policlinico Universitario, Cagliari
| | - D. Perrone
- Divisione Oncologia Medica, Ospedale Civile, Saluzzo, Cuneo
| | - T. Prantera
- Divisione Oncologia Medica, Ospedale S. Giovanni di Dio, Crotone
| | - S. Venuta
- Divisione Oncologia Medica, Policlinico Universitario, Catanzaro
| | - G. Nastasi
- Divisione Medicina Oncologica, Ospedale Civile, Alzano Lombardo
| | | | - A. Lembo
- Servizio Oncologia Medica, Casa di Cura M. Polo, Roma
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Santini D, Tampellini M, Vincenzi B, Ibrahim T, Ortega C, Virzi V, Silvestris N, Berardi R, Masini C, Calipari N, Ottaviani D, Catalano V, Badalamenti G, Giannicola R, Fabbri F, Venditti O, Fratto ME, Mazzara C, Latiano TP, Bertolini F, Petrelli F, Ottone A, Caroti C, Salvatore L, Falcone A, Giordani P, Addeo R, Aglietta M, Cascinu S, Barni S, Maiello E, Tonini G. Natural history of bone metastasis in colorectal cancer: final results of a large Italian bone metastases study. Ann Oncol 2012; 23:2072-2077. [PMID: 22219016 DOI: 10.1093/annonc/mdr572] [Citation(s) in RCA: 88] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Data are limited regarding bone metastases from colorectal cancer (CRC). The objective of this study was to survey the natural history of bone metastasis in CRC. PATIENTS AND METHODS This retrospective, multicenter, observational study of 264 patients with CRC involving bone examined cancer treatments, bone metastases characteristics, skeletal-related event (SRE) type and frequency, zoledronic acid therapy, and disease outcomes. RESULTS Most patients with bone metastases had pathologic T3/4 disease at CRC diagnosis. The spine was the most common site involved (65%), followed by hip/pelvis (34%), long bones (26%), and other sites (17%). Median time from CRC diagnosis to bone metastases was 11.00 months; median time to first SRE thereafter was 2.00 months. Radiation and pathologic fractures affected 45% and 10% of patients, respectively; 32% of patients had no reported SREs. Patients survived for a median of 7.00 months after bone metastases diagnosis; SREs did not significantly affect survival. Subgroup analyses revealed that zoledronic acid significantly prolonged median time to first SRE (2.00 months versus 1.00 month, respectively, P=0.009) and produced a trend toward improved overall survival versus no zoledronic acid. CONCLUSION This study illustrates the burden of bone metastases from CRC and supports the use of zoledronic acid in this setting.
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Affiliation(s)
- D Santini
- Department of Medical Oncology, University Campus Bio-Medico, Rome.
| | - M Tampellini
- Department of Medical Oncology, University of Torino, San Luigi Hospital, Orbassano, Torino
| | - B Vincenzi
- Department of Medical Oncology, University Campus Bio-Medico, Rome
| | - T Ibrahim
- Osteo-oncology Center, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Meldola, Forlì-Cesena
| | - C Ortega
- Oncological Department, Medical Oncology, Institute for Cancer Research and Treatment (IRCC), Candiolo, Torino
| | - V Virzi
- Department of Medical Oncology, University Campus Bio-Medico, Rome
| | - N Silvestris
- Medical and Experimental Oncology Unit, Oncology Institute Giovanni Paolo II, Bari
| | - R Berardi
- Department of Medical Oncology, Universita Politecnica delle Marche, Ancona
| | - C Masini
- Department of Medical Oncology, University Hospital, Modena
| | - N Calipari
- Department of Radiotherapy, Ospedali Riuniti, Reggio Calabria
| | - D Ottaviani
- Department of Medical Oncology, Presidio Sanitario Gradenigo, Turin
| | - V Catalano
- Department of Medical Oncology, A.O. Ospedali Riuniti Marche Nord, Pesaro
| | - G Badalamenti
- Department of Surgery and Oncology, Policlinico Universitario 'P. Giaccone', Palermo
| | - R Giannicola
- Department of Medical Oncology, Ospedali Riuniti, Reggio Calabria
| | - F Fabbri
- Osteo-oncology Center, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Meldola, Forlì-Cesena
| | - O Venditti
- Department of Medical Oncology, University Campus Bio-Medico, Rome
| | - M E Fratto
- Department of Medical Oncology, University Campus Bio-Medico, Rome
| | - C Mazzara
- Department of Medical Oncology, University Campus Bio-Medico, Rome
| | - T P Latiano
- Department of Onco-Hematology, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo
| | - F Bertolini
- Department of Medical Oncology, University Hospital, Modena
| | - F Petrelli
- Department of Medical Oncology, Azienda Ospedaliera Treviglio-Caravaggio, Treviglio, Bergamo
| | - A Ottone
- Department of Medical Oncology, University of Torino, San Luigi Hospital, Orbassano, Torino
| | - C Caroti
- S.C. Medical Oncology, Galliera Hospital, Genoa
| | - L Salvatore
- Division of Medical Oncology, Department of Oncology, University Hospital S. Chiara, Pisa
| | - A Falcone
- Division of Medical Oncology, Department of Oncology, University Hospital S. Chiara, Pisa
| | - P Giordani
- Department of Medical Oncology, A.O. Ospedali Riuniti Marche Nord, Pesaro
| | - R Addeo
- Department of Medical Oncology, Ospedale San Giovanni di Dio di Frattamaggiore, Naples
| | - M Aglietta
- Oncological Department, Medical Oncology, Institute for Cancer Research and Treatment (IRCC), Candiolo, Torino; Department of Clinical Oncology, University of Torino Medical School - Institute for Cancer Research and Treatment, Candiolo, Torino, Italy
| | - S Cascinu
- Department of Medical Oncology, Universita Politecnica delle Marche, Ancona
| | - S Barni
- Department of Medical Oncology, Azienda Ospedaliera Treviglio-Caravaggio, Treviglio, Bergamo
| | - E Maiello
- Department of Onco-Hematology, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo
| | - G Tonini
- Department of Medical Oncology, University Campus Bio-Medico, Rome
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Santini D, Vincenzi B, Russo A, Ortega C, Porta C, Galluzzo S, La Verde NM, Caroti C, Addeo R, Tonini G. Association of receptor activator of NF-kb (RANK) expression with bone metastasis in breast carcinomas. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.1053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Ardizzzoni A, Boni L, Scolaro T, Selvaggi G, De Marinis F, Buffoni L, Grossi F, D'Alessandro V, Barbera S, Caroti C. Induction chemotherapy followed by thoracic irradiation with or without concurrent chemotherapy in locally advanced inoperable NSCLC: A randomized phase III trial. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.7520] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Ferrero G, Testore F, Milanese S, Porcile G, Caroti C, D’Amico M, Folco U, Gozza A. Four years trial in elderly people of appraisal and comparison by geriatric assessment instruments: Use of high potency opioids for cancer pain control and quality of life. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.18610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
18610 Background: Pain is probably under-recognized and under-treated in the Elderly with advanced cancer disease but the effect of a therapy with high potency opioids is not studied so much in geriatric age people. To evaluate efficacy and tollerability of escalating doses of Transdermal Fentanyl (TTS-F) or equipollent doses of oral morphine long acting with Immediate Release Oral Morphine (IROM) as rescue medication for treatment of moderate-severe cancer pain, we have started a Multicentric Observational Analysis in four cancer centres of north-western Italy. Studies of oncological palliation using valid measures of quality of life show that patients may be willing to accept some side effects of treatment as long as they gain relief from tumor-related symptoms Methods: -TIQ (Therapy Impact Questionnaire) -VAS (Visual Analogic Scale): 0 to 10 -Toxicity (WHO criteria) -Geriatric Assessment for pts aged >70 yrs (only at time 0): CIRS (Comorbility Index) IADL/ADL (Instrumental Activities Daily Living/Activities Daily Living). Patients characteristics -159 pts -Total Median Age: 66 yrs (range 38–86) -Median ECOG PS: 1 (range 0–2) -Elderly (>70 yrs): 75. Pain Starting situation -Median starting VAS: 5.5 (range 3–9) -TIQ: depression 70 pts, cachexia 55 pts, dispnoea 40 pts -CIRS (Comorbidity index): comorbidity were present among 66 pts. TTS-Fentanyl starting dose: 25 mcg/h every 72 h (range 25–50 mcg) or oral morphine long acting 60–90 mg plus IROM 10 mg every 4–6 hours for breakthrough pain present in 38 pts Results: -Quickly pain VAS downloading during first two weeks of treatment (median VAS 1) -Analgesic doses were not significantly increased after two months and not exceeded WHO grade 2 -IROM rescue was similar to that observed for the overall population -TIQ, ADL and IADL were not influenced by therapy. Conclusions: High potency opioids (TTS-F or long acting morphine equipollent doses, plus Rescue-IROM) offers durable long term maintenance pain relief wild acceptable toxicity also in elderly people, is particularly useful for cancer pts with compliance problems and may be considered as first-line treatment for moderate/severe cancer pain. No significant financial relationships to disclose.
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Affiliation(s)
- G. Ferrero
- ASL19 Asti, Asti, Italy; ASL18 Alba, Alba, Italy; Galliera Hospital, Genova, Italy; Santa Corona Hospital, Pietra Ligure (SV), Italy
| | - F. Testore
- ASL19 Asti, Asti, Italy; ASL18 Alba, Alba, Italy; Galliera Hospital, Genova, Italy; Santa Corona Hospital, Pietra Ligure (SV), Italy
| | - S. Milanese
- ASL19 Asti, Asti, Italy; ASL18 Alba, Alba, Italy; Galliera Hospital, Genova, Italy; Santa Corona Hospital, Pietra Ligure (SV), Italy
| | - G. Porcile
- ASL19 Asti, Asti, Italy; ASL18 Alba, Alba, Italy; Galliera Hospital, Genova, Italy; Santa Corona Hospital, Pietra Ligure (SV), Italy
| | - C. Caroti
- ASL19 Asti, Asti, Italy; ASL18 Alba, Alba, Italy; Galliera Hospital, Genova, Italy; Santa Corona Hospital, Pietra Ligure (SV), Italy
| | - M. D’Amico
- ASL19 Asti, Asti, Italy; ASL18 Alba, Alba, Italy; Galliera Hospital, Genova, Italy; Santa Corona Hospital, Pietra Ligure (SV), Italy
| | - U. Folco
- ASL19 Asti, Asti, Italy; ASL18 Alba, Alba, Italy; Galliera Hospital, Genova, Italy; Santa Corona Hospital, Pietra Ligure (SV), Italy
| | - A. Gozza
- ASL19 Asti, Asti, Italy; ASL18 Alba, Alba, Italy; Galliera Hospital, Genova, Italy; Santa Corona Hospital, Pietra Ligure (SV), Italy
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Ferrero G, Porcile G, Pronzato P, Naso C, Gozza A, Galliano M, Folco U, Caroti C. Italian observational trial of appraisal and comparison by geriatric assessment instruments. Use of high potency opioids for cancer pain control and quality of life in elderly people. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.8164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- G. Ferrero
- Asl18 Alba-Bra, Alba, Italy; S. Andrea Felettino, La Spezia, Italy; Corona Hosp, Pietra Ligure (Sv), Italy; EO Galliera, Genova, Italy
| | - G. Porcile
- Asl18 Alba-Bra, Alba, Italy; S. Andrea Felettino, La Spezia, Italy; Corona Hosp, Pietra Ligure (Sv), Italy; EO Galliera, Genova, Italy
| | - P. Pronzato
- Asl18 Alba-Bra, Alba, Italy; S. Andrea Felettino, La Spezia, Italy; Corona Hosp, Pietra Ligure (Sv), Italy; EO Galliera, Genova, Italy
| | - C. Naso
- Asl18 Alba-Bra, Alba, Italy; S. Andrea Felettino, La Spezia, Italy; Corona Hosp, Pietra Ligure (Sv), Italy; EO Galliera, Genova, Italy
| | - A. Gozza
- Asl18 Alba-Bra, Alba, Italy; S. Andrea Felettino, La Spezia, Italy; Corona Hosp, Pietra Ligure (Sv), Italy; EO Galliera, Genova, Italy
| | - M. Galliano
- Asl18 Alba-Bra, Alba, Italy; S. Andrea Felettino, La Spezia, Italy; Corona Hosp, Pietra Ligure (Sv), Italy; EO Galliera, Genova, Italy
| | - U. Folco
- Asl18 Alba-Bra, Alba, Italy; S. Andrea Felettino, La Spezia, Italy; Corona Hosp, Pietra Ligure (Sv), Italy; EO Galliera, Genova, Italy
| | - C. Caroti
- Asl18 Alba-Bra, Alba, Italy; S. Andrea Felettino, La Spezia, Italy; Corona Hosp, Pietra Ligure (Sv), Italy; EO Galliera, Genova, Italy
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7
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Aschele C, Vitali ML, Binda GA, Decian F, Battistini G, Caroti C, D' Amico M, Ricci P, Siragusa A, Gallo L. A phase I study of uracil/tegafur (UFT) and oral leucovorin (LV) + weekly oxaliplatin (OXA) and preoperative radiotherapy (RT) in locally advanced rectal cancer (LARC). J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.3637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- C. Aschele
- E.O. Ospedali Galliera, Depts of Medical Oncology, Radiotherapy & Colorectal Surgery, Genova, Italy; E.O. Ospedali Galliera, Depts of Medical Oncology, Radiotherapy& Colorectal Surgery, Genova, Italy; Clinica Chirurgica - Università di Genova, Genova, Italy; Osp Evangelico Internazionale, Genova, Italy
| | - M. L. Vitali
- E.O. Ospedali Galliera, Depts of Medical Oncology, Radiotherapy & Colorectal Surgery, Genova, Italy; E.O. Ospedali Galliera, Depts of Medical Oncology, Radiotherapy& Colorectal Surgery, Genova, Italy; Clinica Chirurgica - Università di Genova, Genova, Italy; Osp Evangelico Internazionale, Genova, Italy
| | - G. A. Binda
- E.O. Ospedali Galliera, Depts of Medical Oncology, Radiotherapy & Colorectal Surgery, Genova, Italy; E.O. Ospedali Galliera, Depts of Medical Oncology, Radiotherapy& Colorectal Surgery, Genova, Italy; Clinica Chirurgica - Università di Genova, Genova, Italy; Osp Evangelico Internazionale, Genova, Italy
| | - F. Decian
- E.O. Ospedali Galliera, Depts of Medical Oncology, Radiotherapy & Colorectal Surgery, Genova, Italy; E.O. Ospedali Galliera, Depts of Medical Oncology, Radiotherapy& Colorectal Surgery, Genova, Italy; Clinica Chirurgica - Università di Genova, Genova, Italy; Osp Evangelico Internazionale, Genova, Italy
| | - G. Battistini
- E.O. Ospedali Galliera, Depts of Medical Oncology, Radiotherapy & Colorectal Surgery, Genova, Italy; E.O. Ospedali Galliera, Depts of Medical Oncology, Radiotherapy& Colorectal Surgery, Genova, Italy; Clinica Chirurgica - Università di Genova, Genova, Italy; Osp Evangelico Internazionale, Genova, Italy
| | - C. Caroti
- E.O. Ospedali Galliera, Depts of Medical Oncology, Radiotherapy & Colorectal Surgery, Genova, Italy; E.O. Ospedali Galliera, Depts of Medical Oncology, Radiotherapy& Colorectal Surgery, Genova, Italy; Clinica Chirurgica - Università di Genova, Genova, Italy; Osp Evangelico Internazionale, Genova, Italy
| | - M. D' Amico
- E.O. Ospedali Galliera, Depts of Medical Oncology, Radiotherapy & Colorectal Surgery, Genova, Italy; E.O. Ospedali Galliera, Depts of Medical Oncology, Radiotherapy& Colorectal Surgery, Genova, Italy; Clinica Chirurgica - Università di Genova, Genova, Italy; Osp Evangelico Internazionale, Genova, Italy
| | - P. Ricci
- E.O. Ospedali Galliera, Depts of Medical Oncology, Radiotherapy & Colorectal Surgery, Genova, Italy; E.O. Ospedali Galliera, Depts of Medical Oncology, Radiotherapy& Colorectal Surgery, Genova, Italy; Clinica Chirurgica - Università di Genova, Genova, Italy; Osp Evangelico Internazionale, Genova, Italy
| | - A. Siragusa
- E.O. Ospedali Galliera, Depts of Medical Oncology, Radiotherapy & Colorectal Surgery, Genova, Italy; E.O. Ospedali Galliera, Depts of Medical Oncology, Radiotherapy& Colorectal Surgery, Genova, Italy; Clinica Chirurgica - Università di Genova, Genova, Italy; Osp Evangelico Internazionale, Genova, Italy
| | - L. Gallo
- E.O. Ospedali Galliera, Depts of Medical Oncology, Radiotherapy & Colorectal Surgery, Genova, Italy; E.O. Ospedali Galliera, Depts of Medical Oncology, Radiotherapy& Colorectal Surgery, Genova, Italy; Clinica Chirurgica - Università di Genova, Genova, Italy; Osp Evangelico Internazionale, Genova, Italy
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8
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Caroti C, Aschele C, Gozza A, D'Amico M, Naso C, Gallo L, Folco U, Pronzato P. Cancer pain management: Safety and efficacy of transdermal fentanyl (TDF). J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.8234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- C. Caroti
- E.O. Ospedali Galliera, Genova, Italy; Azienda Ospedaliera Ospedale Santa Corona, Pietra Ligure (SV), Italy; Ospedale S. Andrea, La Spezia, Italy
| | - C. Aschele
- E.O. Ospedali Galliera, Genova, Italy; Azienda Ospedaliera Ospedale Santa Corona, Pietra Ligure (SV), Italy; Ospedale S. Andrea, La Spezia, Italy
| | - A. Gozza
- E.O. Ospedali Galliera, Genova, Italy; Azienda Ospedaliera Ospedale Santa Corona, Pietra Ligure (SV), Italy; Ospedale S. Andrea, La Spezia, Italy
| | - M. D'Amico
- E.O. Ospedali Galliera, Genova, Italy; Azienda Ospedaliera Ospedale Santa Corona, Pietra Ligure (SV), Italy; Ospedale S. Andrea, La Spezia, Italy
| | - C. Naso
- E.O. Ospedali Galliera, Genova, Italy; Azienda Ospedaliera Ospedale Santa Corona, Pietra Ligure (SV), Italy; Ospedale S. Andrea, La Spezia, Italy
| | - L. Gallo
- E.O. Ospedali Galliera, Genova, Italy; Azienda Ospedaliera Ospedale Santa Corona, Pietra Ligure (SV), Italy; Ospedale S. Andrea, La Spezia, Italy
| | - U. Folco
- E.O. Ospedali Galliera, Genova, Italy; Azienda Ospedaliera Ospedale Santa Corona, Pietra Ligure (SV), Italy; Ospedale S. Andrea, La Spezia, Italy
| | - P. Pronzato
- E.O. Ospedali Galliera, Genova, Italy; Azienda Ospedaliera Ospedale Santa Corona, Pietra Ligure (SV), Italy; Ospedale S. Andrea, La Spezia, Italy
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Lonardi S, Paris MK, Stefani M, Caroti C, D'Amico M, Jirillo A, Pronzato P, Gallo L, Monfardini S, Aschele C. Gemcitabine (GEM) as salvage therapy in patients (pts) with advanced colorectal cancer (CRC) refractory to 5-fluorouracil (FU), irinotecan (IRI) and oxaliplatin (OXA). J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.3577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- S. Lonardi
- Padova University Hospital, Padova, Italy; E.O. Ospedali Galliera, Genova, Italy; Ospedale Sant'Andrea, La Spezia, Italy
| | - M. K. Paris
- Padova University Hospital, Padova, Italy; E.O. Ospedali Galliera, Genova, Italy; Ospedale Sant'Andrea, La Spezia, Italy
| | - M. Stefani
- Padova University Hospital, Padova, Italy; E.O. Ospedali Galliera, Genova, Italy; Ospedale Sant'Andrea, La Spezia, Italy
| | - C. Caroti
- Padova University Hospital, Padova, Italy; E.O. Ospedali Galliera, Genova, Italy; Ospedale Sant'Andrea, La Spezia, Italy
| | - M. D'Amico
- Padova University Hospital, Padova, Italy; E.O. Ospedali Galliera, Genova, Italy; Ospedale Sant'Andrea, La Spezia, Italy
| | - A. Jirillo
- Padova University Hospital, Padova, Italy; E.O. Ospedali Galliera, Genova, Italy; Ospedale Sant'Andrea, La Spezia, Italy
| | - P. Pronzato
- Padova University Hospital, Padova, Italy; E.O. Ospedali Galliera, Genova, Italy; Ospedale Sant'Andrea, La Spezia, Italy
| | - L. Gallo
- Padova University Hospital, Padova, Italy; E.O. Ospedali Galliera, Genova, Italy; Ospedale Sant'Andrea, La Spezia, Italy
| | - S. Monfardini
- Padova University Hospital, Padova, Italy; E.O. Ospedali Galliera, Genova, Italy; Ospedale Sant'Andrea, La Spezia, Italy
| | - C. Aschele
- Padova University Hospital, Padova, Italy; E.O. Ospedali Galliera, Genova, Italy; Ospedale Sant'Andrea, La Spezia, Italy
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Pasetto LM, Lonardi S, Sartor L, Brandes AA, Chiarion Sileni V, Caroti C, D'Amico M, Gallo L, Monfardini S, Aschele C. Phase I study of weekly oxaliplatin (OXA) + 5-fluorouracil continuous infusion (FU CI) in patients (pts) with advanced colorectal cancer (CRC). J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.3770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- L. M. Pasetto
- Padova University Hospital, Padova, Italy; Ospedale Civile, Castelfranco Veneto, Italy; E.O. Ospedali Galliera, Genova, Italy
| | - S. Lonardi
- Padova University Hospital, Padova, Italy; Ospedale Civile, Castelfranco Veneto, Italy; E.O. Ospedali Galliera, Genova, Italy
| | - L. Sartor
- Padova University Hospital, Padova, Italy; Ospedale Civile, Castelfranco Veneto, Italy; E.O. Ospedali Galliera, Genova, Italy
| | - A. A. Brandes
- Padova University Hospital, Padova, Italy; Ospedale Civile, Castelfranco Veneto, Italy; E.O. Ospedali Galliera, Genova, Italy
| | - V. Chiarion Sileni
- Padova University Hospital, Padova, Italy; Ospedale Civile, Castelfranco Veneto, Italy; E.O. Ospedali Galliera, Genova, Italy
| | - C. Caroti
- Padova University Hospital, Padova, Italy; Ospedale Civile, Castelfranco Veneto, Italy; E.O. Ospedali Galliera, Genova, Italy
| | - M. D'Amico
- Padova University Hospital, Padova, Italy; Ospedale Civile, Castelfranco Veneto, Italy; E.O. Ospedali Galliera, Genova, Italy
| | - L. Gallo
- Padova University Hospital, Padova, Italy; Ospedale Civile, Castelfranco Veneto, Italy; E.O. Ospedali Galliera, Genova, Italy
| | - S. Monfardini
- Padova University Hospital, Padova, Italy; Ospedale Civile, Castelfranco Veneto, Italy; E.O. Ospedali Galliera, Genova, Italy
| | - C. Aschele
- Padova University Hospital, Padova, Italy; Ospedale Civile, Castelfranco Veneto, Italy; E.O. Ospedali Galliera, Genova, Italy
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Guglielmi A, Cirillo M, Mammoliti S, Fornarini G, Caroti C, Sobrero A. Prospective evaluation of patients' preferences of three different regimens in a phase II study of FU, oxaliplatin, mitomycin C and CPT-11 in advanced colorectal cancer. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.3757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- A. Guglielmi
- S. Martino Hospital, Genova, Italy; Negrar Hospital, Verona, Italy; Galliera Hospital, Genova, Italy
| | - M. Cirillo
- S. Martino Hospital, Genova, Italy; Negrar Hospital, Verona, Italy; Galliera Hospital, Genova, Italy
| | - S. Mammoliti
- S. Martino Hospital, Genova, Italy; Negrar Hospital, Verona, Italy; Galliera Hospital, Genova, Italy
| | - G. Fornarini
- S. Martino Hospital, Genova, Italy; Negrar Hospital, Verona, Italy; Galliera Hospital, Genova, Italy
| | - C. Caroti
- S. Martino Hospital, Genova, Italy; Negrar Hospital, Verona, Italy; Galliera Hospital, Genova, Italy
| | - A. Sobrero
- S. Martino Hospital, Genova, Italy; Negrar Hospital, Verona, Italy; Galliera Hospital, Genova, Italy
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12
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Boccardo F, Rubagotti A, Amoroso D, Mesiti M, Romeo D, Caroti C, Farris A, Cruciani G, Villa E, Schieppati G, Mustacchi G. Sequential tamoxifen and aminoglutethimide versus tamoxifen alone in the adjuvant treatment of postmenopausal breast cancer patients: results of an Italian cooperative study. J Clin Oncol 2001; 19:4209-15. [PMID: 11709564 DOI: 10.1200/jco.2001.19.22.4209] [Citation(s) in RCA: 65] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To determine whether switching patients from tamoxifen to antiaromatase treatment would prevent some of the relapses or deaths that we assume would occur if tamoxifen were continued. PATIENTS AND METHODS Three hundred eighty postmenopausal breast cancer patients receiving adjuvant tamoxifen treatment for 3 years were randomized to either continue tamoxifen for 2 more years or to switch to low-dose aminoglutethimide (250 mg daily) for 2 years. RESULTS At a median follow-up of 61 months (range, 5 to 94 months), 59 events occurred in the tamoxifen group, and 55 occurred in the aminoglutethimide group. More treatment failures at distant sites, such as viscera (P =.02), were observed in the tamoxifen group. Although no differences in disease-free survival between the two groups have emerged so far, a significant trend favors aminoglutethimide in overall survival (P =.005) and breast cancer-specific survival (P =.06). Even if more patients in the antiaromatase group complained of drug-related side effects and more of them discontinued treatment (P =.0001), the number of cardiovascular events and, in general, of life-threatening adverse events was higher in the tamoxifen arm. CONCLUSION Switching patients from tamoxifen to aminoglutethimide treatment resulted in comparable event-free survival, but longer overall survival was achieved in patients who were switched to aminoglutethimide as compared with those who continued to receive tamoxifen. Should these preliminary results be confirmed by larger studies with a similar design, which are now testing the effectiveness of the new, more active, and tolerable aromatase inhibitors, sequencing tamoxifen with an aromatase inhibitor could become a preferable alternative to tamoxifen alone in early breast cancer patients.
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Affiliation(s)
- F Boccardo
- Professorial Unit of Medical Oncology, University and National Cancer Research Institute, Largo R Benzi 10, 16132 Genoa, Italy.
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Sobrero A, Guglielmi A, Cirillo M, Recaldin E, Frassineti GL, Aschele C, Ravaioli A, Testore P, Caroti C, Gallo L, Pessi MA, Cortesi E, Turci D, Grossi F, Labianca R. 5-fluorouracil modulated by leucovorin, methotrexate and mitomycin: highly effective, low-cost chemotherapy for advanced colorectal cancer. Br J Cancer 2001; 84:1023-8. [PMID: 11308248 PMCID: PMC2363863 DOI: 10.1054/bjoc.2001.1732] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [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] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
We have reported that an alternating regimen of bolus and continuous infusion 5-fluorouracil (FU) was superior to bolus FU in terms of response rate and progression-free survival in advanced colorectal cancer. Biochemical modulation was an essential part of this regimen and it was selective for the schedule of FU administration: bolus FU was in fact modulated by methotrexate (MTX) while continuous infusion FU was potentiated by 6-s-leucovorin (LV). Considering the low cost and the favourable report on the activity of mitomycin C (mito) added to CI FU, we have incorporated this agent in the infusional part of our treatment programme. 105 patients with untreated, advanced, measurable colorectal cancer were accrued from 13 Italian centres and treated with the following regimen. 2 biweekly cycles of FU bolus (600 mg/m(2)), modulated by MTX (24 h earlier, 200 mg/m(2)) were alternated with a 3-week continuous infusion of FU (200 mg/m(2)daily), modulated by LV (20 mg/m(2)weekly bolus). Mito, 7 mg/m(2), was given on the first day of the infusional period. After a 1 week rest, the whole cycle (8 weeks) was repeated, if indicated. 5 complete and 34 partial responses were obtained (response rate, 37% on the intention to treat basis; 95% confidence limits, 28-46%). After a median follow-up time of 26 months, 37 patients are still alive. The median progression-free survival is 7.7 months with an overall survival of 18.8 months and a 2-year survival rate of 30%. The regimen was very well tolerated with fewer than 13% of patients experiencing WHO grade III-IV toxicity. These results are consistent with those obtained by our group in 3 previous trials of schedule specific biochemical modulation of FU. They also indicate a highly active, little toxic, inexpensive regimen of old drugs to be used (a) as an alternative to the more expensive combinations including CPT-11 or oxaliplatin or (b) as the basis for combination programmes with these agents.
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Sobrero A, Zaniboni A, Frassineti GL, Aschele C, Guglielmi A, Giuliani R, Ravaioli A, Lanfranco C, Caroti C, Arnoldi E, Barni S, Gallo L, Pessi MA, Turci D, Cortesi E, Grossi F, Frontini L, Piazza E, Bruzzi P, Labianca R. Schedule specific biochemical modulation of 5-fluorouracil in advanced colorectal cancer: a randomized study. GISCAD, IOR and collaborating centers. Ann Oncol 2000; 11:1413-20. [PMID: 11142481 DOI: 10.1023/a:1026527605389] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND We have recently suggested that bolus 5-fluorouracil (5-FU) may work via a RNA directed mechanism while continuous infusion 5-FU may kill cells via a thymidylate synthase related pathway. It may thus be possible to selectively modulate each schedule biochemically. We have compared an alternating regimen of bolus and continuous infusion 5-FU, selectively modulated for the schedule of administration, with modulated bolus 5-FU in advanced colorectal cancer patients. PATIENTS AND METHODS Two hundred fourteen patients from nineteen Italian centers were randomized to the control arm consisting of biweekly cycles of MTX, 200 mg/m2 on day 1, followed by bolus 5-FU 600 mg/m2 on day 2 and 6-S-leucovorin rescue, or to the experimental arm consisting of two biweekly cycles of the same regimen as in the control arm alternated to three weeks of continuous infusion 5-FU (200 mg/m2 day) + weekly bolus 6-S-leucovorin, 20 mg/m2. RESULTS Nine CR and twenty-seven PR were obtained on one hundred eleven evaluable patients treated in experimental arm (RR = 32%, 95% confidence interval (95% CI): 24%-42%), while two CR and eleven PR were observed among one hundred three evaluable patients in control arm (RR = 13%, 95% CI: 7%-21%). WHO grade 3-4 toxicity occurred in 13% of cycles of experimental arm and in 8% of cycles in control arm. The PFS was significantly longer in experimental arm (6.2 vs. 4.3 months, odds ratio 0.66, P = 0.003), while the overall survival was similar in both arms (14.8 months in experimental arm vs. 14.1 months in control arm); quality of life was similar as well. Eighty percent of patients receiving second-line chemotherapy in control arm were treated with continuous infusion 5-FU. CONCLUSIONS Alternating, schedule-specific biochemical modulation of FU is more active than MTX --> 5-FU as first-line treatment of advanced colorectal cancer. However, the overall survival was similar suggesting that alternating bolus and infusional 5-FU upfront may be as effective as giving them in sequence as first- and second-line treatment.
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Affiliation(s)
- A Sobrero
- University of Udine, Department of Medical Oncology, Italy.
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Aschele C, Guglielmi A, Frassineti GL, Milandri C, Amadori D, Labianca R, Vinci M, Tixi L, Caroti C, Ciferri E, Verdi E, Rosso R, Sobrero A. Schedule-selective biochemical modulation of 5-fluorouracil in advanced colorectal cancer: a multicentric phase II study. Br J Cancer 1998; 77:341-6. [PMID: 9461008 PMCID: PMC2151226 DOI: 10.1038/bjc.1998.53] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
We have recently reported high clinical activity against advanced colorectal cancer of a regimen-alternating bolus FUra, modulated by methotrexate (MTX), and continuous infusion FUra, modulated by 6-s-leucovorin (6-s-LV). Considering the low toxicity of the bolus part of this regimen and our recent in vitro finding of a strong synergism between bolus FUra and natural-beta-IFN (n-beta-IFN), this cytokine was incorporated in the bolus part of our treatment programme. Fifty-six patients with untreated, advanced, measurable colorectal cancer were treated with two biweekly cycles of FUra bolus (600 mg m(-2)), modulated by MTX (24 h earlier, 200 mg m(-2)), and n-beta-IFN (3 x 10(6) IU i.m. every 12 h, starting at the time of FUra administration for four doses), alternating with a 3-week continuous infusion of FUra (200 mg m(-2) daily), modulated by 6-s-LV (20 mg m(-2) weekly bolus). After a 1-week rest, the whole cycle (8 weeks) was repeated if indicated. A total of 5 complete and 17 partial responses were obtained (response rate, 41%; 95% confidence limits, 28-55%) in 54 assessable patients. After a median follow-up time of 36 months, five patients are still alive. Overall, the median time to treatment failure was 6.4 months. The median duration of survival was 15.0 months. There was one treatment-related death after a course of MTX --> bolus FUra/n-beta-IFN and grade III-IV toxicity occurred in 18% of the patients. As the addition of n-beta-IFN results in high toxicity, whereas the efficacy seems to be similar to that of the same regimen without the cytokine, our groups are currently randomizing the original regimen, without IFN, against standard modulated bolus FUra.
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Affiliation(s)
- C Aschele
- Department of Medical Oncology, Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy
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Mammoliti S, Merlini L, Caroti C, Gallo L. Phase II study of mitoxantrone, 5-fluorouracil, and levo-leucovorin (MLF) in elderly advanced breast cancer patients. Breast Cancer Res Treat 1996; 37:93-6. [PMID: 8750532 DOI: 10.1007/bf01806636] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
We have carried out a phase II trial to evaluate the efficacy and toxicity of a combination therapy consisting of mitoxantrone 10 mg/sqm i.v. on day 1, levo-leucovorin 250 mg/sqm administered over 2 hours and 5-fluorouracil 500 mg/sqm i.v. push after the first hour of levo-leucovorin infusion, on days 15-16 (MFL) in patients aged more than 65 years. 24 patients with advanced breast cancer entered the study: 16 aged 65-70 yrs, 4 patients 70-75 yrs, and 4 > 75 yrs. Median PS was 1 (range 0-2); sites of metastases were: bone 14 patients, viscera 14 patients, soft tissue 11 patients, and CNS 1 patient. A median number of 6 cycles (range 3-9) was administered. All patients were evaluable for response and toxicity; partial response was obtained in 12 (50%) patients (95% C.I 30-70), stable disease was observed in 9 patients (37.5%), while 3 patients (12.5%) progressed. Median progression-free survival and survival were 9 months (range 2-14) and 14 months (range 5-36), respectively. Toxicity was generally mild and the most frequently observed side-effects were WHO gr. 1-2 leukopenia in 6/24 (25%) patients and gr. 1-2 emesis in 10/24 (41.6%) pts. 1 patient pretreated with doxorubicin cumulative dose of 240 mg/sqm showed clinical signs of congestive heart failure (NYHA grade 1) after the fifth cycle of treatment. MFL is a well tolerated regimen and could represent a safe and effective treatment in older advanced breast cancer patients.
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Affiliation(s)
- S Mammoliti
- Medical Oncology Dept. E.O., Ospedali Galliera, Genova, Italy
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Mammoliti S, Merlini L, Caroti C, Gallo L. Mitoxantrone, 5-fluorouracil and levo-leucovorin as salvage treatment in advanced breast cancer patients. Eur J Cancer 1994; 30A:248-9. [PMID: 8155400 DOI: 10.1016/0959-8049(94)90103-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Gipponi M, Caroti C, Oliva A, Cafiero F. [Clinical evaluation of the tolerability of imipenem in the treatment of postoperative infections in oncologic surgery]. MINERVA CHIR 1990; 45:91-4. [PMID: 2336161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Fifteen neoplastic patients were examined in a pilot study to evaluate side effects and efficacy of imipenem (three doses of 500 mg/die, e.v.) as monochemotherapy of post-operative septic complications. These infections included: two wound infections, nine lung infections, one case of mixed infection (spread purulent peritonitis associated with lung infection), one case of urinary tract infection, one chronic suppurative malleolar ulcer in a patient with Kaposi's sarcoma, and one case of mediastinitis due to oesophageal perforation during endoscopic dilatation. Antibiotic treatment was successful in 14 patients, apyrexia being reached within 2nd to 13th day of treatment (median: 4th day) with negative microbiologic and radiologic assessment; only in the patient with chronic suppurative malleolar ulcer, notwithstanding apyrexia, microbiologic culture indicated the persistence of a pre-treatment pathogen (P. mirabilis). Side effects included only a slight and transient increase of serum transaminases in one patient.
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Affiliation(s)
- M Gipponi
- Divisione di Oncologia Chirurgica, Istituto Nazionale per la Ricerca sul Cancro, Genova
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Canavese G, Catturich A, Battistini G, Caroti C, Pronzato P, Gardin G, Amoroso D, Bertelli G, Conte PF, Tomao S. The role of surgery in the combined treatment of locally advanced breast cancer. Oncology 1989; 46:353-6. [PMID: 2587002 DOI: 10.1159/000226749] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Sixty patients with stage IIIA and IIIB breast cancer have been treated with a combined modality approach including induction chemotherapy, surgery and adjuvant chemotherapy: 74.5% of patients achieved an objective response after 3 cycles of induction chemotherapy, and 98.3% of patients were rendered disease-free after induction chemotherapy and surgery or radiotherapy; at 4 years, actuarial survival and disease-free survival are 71.5% and 43%, respectively. These results are significantly better than our historical control, and locally advanced breast cancer must now be considered a curable disease when treated with an aggressive multimodal approach.
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Affiliation(s)
- G Canavese
- Divisioni di Oncologia Chirurgica e, Instituto Nazionale par la Ricerca sul Cancro, Genova, Italia
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