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Cazzaniga ME, Pronzato P, Amoroso D, Bernardo A, Biganzoli L, Bisagni G, Blasi L, Bria E, Cognetti F, Crinò L, De Laurentiis M, Del Mastro L, De Placido S, Beano A, Ferraù F, Foladore S, Forcignanò R, Gamucci T, Garrone O, Gennari A, Giordano M, Giotta F, Giovanardi F, Latini L, Livi L, Marchetti P, Mattioli R, Michelotti A, Montemurro F, Putzu C, Riccardi F, Ricciardi G, Romagnoli E, Sarobba G, Spazzapan S, Tagliaferri P, Tinari N, Tonini G, Turletti A, Verusio C, Zambelli A, Mustacchi G. Clinical Outcomes of HER2-Negative Metastatic Breast Cancer Patients in Italy in the Last Decade: Results of the GIM 13-AMBRA Study. Cancers (Basel) 2023; 16:117. [PMID: 38201545 PMCID: PMC10777910 DOI: 10.3390/cancers16010117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 11/14/2023] [Accepted: 12/08/2023] [Indexed: 01/12/2024] Open
Abstract
GIM 13-AMBRA is a longitudinal cohort study aimed at describing therapeutic strategies and the relative outcome parameters in 939 HER2-ve MBC patients. Taxanes-based regimens, or taxanes + targeted agents, mainly Bevacizumab, were the preferred first choice in both Luminal (30.2%) and TNBC (33.3%) patients. The median PFS1 was 12.5 months (95% CI 16.79-19.64), without any significant difference according to subtypes, while the median Time to first Treatment Change (TTC1) was significantly lower in TNBC patients (7.7 months-95% CI 5.7-9.2) in comparison to Luminal A (13.2 months, 95% CI 11.7-15.1) and Luminal B patients (11.8 months, 95% CI 10.3-12.8). PFS2 was significantly shorter in TNBC patients (5.5 months, 95% CI 4.3-6.5 vs. Luminal A-9.4, 95% CI 8.1-10.7, and Luminal B-7.7 95% CI 6.8-8.2, F-Ratio 4.30, p = 0.014). TTC2 was significantly lower in patients with TNBC than in those with the other two subtypes. The median OS1 was 35.2 months (95% CI 30.8-37.4) for Luminal A patients, which was significantly higher than that for both Luminal B (28.9 months, 95% CI 26.2-31.2) and TNBC (18.5 months, 95% CI 16-20.1, F-ratio 7.44, p = 0.0006). The GIM 13-AMBRA study is one of the largest collections ever published in Italy and provides useful results in terms of time outcomes for first, second, and further lines of treatment in HER2- MBC patients.
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Affiliation(s)
- Marina Elena Cazzaniga
- Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
- School of Medicine and Surgery, Università Milano Bicocca, 20900 Monza, Italy
| | - Paolo Pronzato
- Oncologia Medica IRCCS IRST San Martino, 16100 Genova, Italy; (P.P.); (L.D.M.)
| | - Domenico Amoroso
- Oncologia Medica, Ospedale Versilia USL Nord Ovest Toscana, 55041 Lido di Camaiore, Italy;
| | - Antonio Bernardo
- Oncologia Istituti Clinici Scientifici Maugeri Spa Società Benefit, 27100 Pavia, Italy;
| | - Laura Biganzoli
- U.O. Oncologia Medica, Ospedale Santo Stefano, 59100 Prato, Italy;
| | - Giancarlo Bisagni
- Oncologia Medica, IRCCS Arcispedale S. Maria Nuova, 42121 Reggio Emilia, Italy;
| | - Livio Blasi
- Oncologia Medica, ARNAS Civico–Di Cristina-Benfratelli, Presidio Ospedaliero ‘Civico e Benfratelli’, 20121 Palermo, Italy;
| | - Emilio Bria
- Oncologia Medica, A.O.U. Integrata Verona, Ospedale Borgo Roma, 37100 Verona, Italy;
| | - Francesco Cognetti
- Oncologia Medica 1, Istituto Nazionale Tumori “Regina Elena”, 00042 Roma, Italy
| | - Lucio Crinò
- Oncologia, Ospedale S. Maria della Misericordia, 06121 Perugia, Italy;
| | | | - Lucia Del Mastro
- Oncologia Medica IRCCS IRST San Martino, 16100 Genova, Italy; (P.P.); (L.D.M.)
| | - Sabino De Placido
- Oncologia Medica, Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi Federico II, 80013 Napoli, Italy;
| | - Alessandra Beano
- Oncologia Medica, Città della Salute e della Scienza, ASL “Città di Torino”, 10024 Torino, Italy;
| | | | - Silva Foladore
- SSD Oncologica e dell’apparato Riproduttivo Femminile, Azienda Sanitaria Universitaria “Giuliano Isontina, 34121 Trieste, Italy;
| | | | | | - Ornella Garrone
- Oncologia Medica, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, 20100 Milano, Italy;
| | - Alessandra Gennari
- Oncologia Medica, Azienda Ospedaliero-Universitaria Maggiore della Carità di Novara, Dipartimento di Medicina e Chirurgia, Università degli Studi del Piemonte Orientale, 28100 Novara, Italy;
| | | | - Francesco Giotta
- Oncologia, IRCCS Istituto Tumori ‘Giovanni Paolo II’, 70100 Bari, Italy;
| | - Filippo Giovanardi
- UOS Day Hospital Oncologico, AUSL Reggio Emilia, Presidio Ospedaliero di Guastalla, 42016 Guastalla, Italy;
| | | | - Lorenzo Livi
- Dipartimento di Scienze Biomediche, Sperimentali e Cliniche ‘Mario Serio’, Università degli Studi di Firenze, UOC Radioterapia, A.O.U. Careggi, 50100 Firenze, Italy;
| | | | - Rodolfo Mattioli
- Oncologia Medica, A.O. Ospedali Riuniti Marche Nord-Ospedale Santa Croce, 61032 Fano, Italy
| | | | - Filippo Montemurro
- Fondazione del Piemonte per l’Oncologia-Istituto di Ricovero e Cura a Carattere Scientifico (I.R.C.C.S.), 10024 Torino, Italy;
| | - Carlo Putzu
- Oncologia Medica, AOU Sassari, 07100 Sassari, Italy
| | - Ferdinando Riccardi
- Oncologia Medica, Azienda Ospedaliera ‘A. Cardarelli’ (AORN), 80013 Napoli, Italy
| | | | | | - Giuseppina Sarobba
- Oncologia Medica, Ospedale ‘San Francesco’, Azienda Sanitaria Locale 3 Nuoro, 08100 Nuoro, Italy
| | - Simon Spazzapan
- Centro di Riferimento Oncologico, IRCCS, 33081 Aviano, Italy;
| | | | - Nicola Tinari
- Oncologia Medica, Policlinico ‘SS. Annunziata’, 66100 Chieti, Italy;
| | - Giuseppe Tonini
- Policlinico Universitario Campus Biomedico, 00042 Roma, Italy;
| | - Anna Turletti
- Presidio Ospedaliero Martini, ASL TO1, 10024 Torino, Italy
| | - Claudio Verusio
- Oncologia Medica, ASST della Valle Olona, Ospedale di Saronno, 21047 Saronno, Italy;
| | - Alberto Zambelli
- Oncologia Medica, ASST Papa Giovanni XXIII, Ospedale Papa Giovanni XXIII, 24100 Bergamo, Italy;
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Caminiti C, Annunziata MA, Di Giulio P, Isa L, Mosconi P, Nanni MG, Piredda M, Verusio C, Diodati F, Maglietta G, Passalacqua R. Psychosocial Impact of Virtual Cancer Care through Technology: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Cancers (Basel) 2023; 15:cancers15072090. [PMID: 37046750 PMCID: PMC10093026 DOI: 10.3390/cancers15072090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 03/10/2023] [Accepted: 03/28/2023] [Indexed: 04/03/2023] Open
Abstract
This meta-analysis of RCTs aimed to determine whether replacing face-to-face hospital care with telemedicine deteriorates psychosocial outcomes of adult cancer patients, in terms of quality of life (QoL), anxiety, distress, and depression. RCTs on interventions aimed at improving patient psychosocial outcomes were excluded. MEDLINE, EmBASE, and PsycInfo were searched on 13 May 2022 without language or date restrictions. In total, 1400 records were identified and 8 RCTs included (4434 subjects). Study methodological quality was moderate. Statistically significant improvements were observed in favor of the intervention for QoL (SMD = 0.22, 95% CI 0.01 to 0.43, p = 0.04), anxiety (SMD = −0.17, 95% CI −0.30 to −0.04, p < 0.01), and global distress (SMD = −0.38, 95% CI −0.51 to −0.25, p < 0.01). A meta-analysis on depression could not be performed. In subgroup analyses, the intervention appeared to be more beneficial for patients receiving active treatment vs. follow-up, for “other cancer types” vs. breast cancer, and for “other modes of administration” vs. telephone. Given the many potential advantages of being assisted at home, telemedicine appears to be a viable option in oncology. However, more research is necessary to determine the types of patients who may benefit the most from these alternative care modalities.
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Affiliation(s)
- Caterina Caminiti
- Clinical and Epidemiological Research Unit, University Hospital of Parma, 43126 Parma, Italy
| | | | - Paola Di Giulio
- Department of Public Health and Pediatrics, University of Turin, 10124 Torino, Italy
| | - Luciano Isa
- Division of Oncology, Hospital of Melegnano, 20064 Gorgonzola, Italy
| | - Paola Mosconi
- Laboratory for Medical Research and Consumer Involvement, Department of Public Health, Istituto Di Ricerche Farmacologiche Mario Negri IRCCS, 20156 Milan, Italy
| | - Maria Giulia Nanni
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, 44121 Ferrara, Italy
| | - Michela Piredda
- Research Unit of Nursing Sciences, Campus Bio-Medico University of Rome, 00128 Rome, Italy
| | - Claudio Verusio
- Department of Medical Oncology, Presidio Ospedaliero di Saronno, ASST Valle Olona, 21047 Saronno, Italy
| | - Francesca Diodati
- Clinical and Epidemiological Research Unit, University Hospital of Parma, 43126 Parma, Italy
| | - Giuseppe Maglietta
- Clinical and Epidemiological Research Unit, University Hospital of Parma, 43126 Parma, Italy
| | - Rodolfo Passalacqua
- Medical Oncology Division, Department of Oncology, ASST of Cremona, 26100 Cremona, Italy
- Correspondence: ; Tel.: +39-0372-405237
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DE Cicco L, Marzoli L, Lorusso R, Mancuso RM, Petazzi E, Lanceni AG, Della Bosca E, Buttignol S, Starace A, Verusio C, Bortolato B. CBCT-based Prostate IGRT With and Without Implanted Markers: Assessment of Geometric Corrections and Time for Completion. Anticancer Res 2023; 43:405-408. [PMID: 36585214 DOI: 10.21873/anticanres.16175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 11/30/2022] [Accepted: 12/05/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND/AIM Cone-beam computed tomography (CBCT) is the most commonly used system in modern radiotherapy of prostate cancer for daily positioning verification. The use of intraprostatic radiopaque fiducials (FMs) may be added to CBCT. We wanted to investigate the possible advantage of using FMs in daily CBCT repositioning. MATERIALS AND METHODS We selected three CBCTs for each treatment course for 13 patients (seven with and six without use of FMs) treated at our centre. Seven experienced Radiation Oncologists retrospectively reviewed the CBCTs, recording couch movements for correct patient positioning, and time spent to do it. Analysis of variance and t-test were carried out for comparison of different groups and for differences in mean values of the movements recorded (with p<0.05 as significance level). RESULTS No statistically significant difference was found between operators in the analysis of images with FMs nor of images without them. A difference was only found in the mean corrections in couch rotation and pitch angle, which were higher in the FM group, and in the mean time for image analysis, which was shorter in this group. Using the van Herk formula, we found a possible reduction of clinical target volume and planning target volume margins for the FM group. CONCLUSION According to our study, the use of intraprostatic FMs in daily CBCT seems useful for better detection of and correction for non-negligible rotational errors. Furthermore, FMs reduced the time to treatment start, which is very important in reducing the risk of intrafraction organ motion. These results need to be confirmed by further studies.
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Affiliation(s)
- Luigi DE Cicco
- Division of Radiotherapy, ASST Valle Olona, Busto Arsizio, Italy;
| | - Luca Marzoli
- Division of Medical Physics, ASST Valle Olona, Busto Arsizio, Italy
| | - Rita Lorusso
- Division of Medical Physics, ASST Valle Olona, Busto Arsizio, Italy
| | | | - Elena Petazzi
- Division of Radiotherapy, ASST Valle Olona, Busto Arsizio, Italy
| | | | | | - Sandra Buttignol
- Division of Radiotherapy, ASST Valle Olona, Busto Arsizio, Italy
| | - Antonio Starace
- Division of Radiotherapy, ASST Valle Olona, Busto Arsizio, Italy
| | - Claudio Verusio
- Division of Oncological, Hospital Unit of Saronno, ASST Valle Olona, Busto Arsizio, Italy
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Landi L, Tiseo M, Heukamp L, Menon R, de Marinis F, Minuti G, Cortinovis D, Delmonte A, Galetta D, Bertrand M, Zacher A, Gridelli C, Jacobs F, Chiari R, Verusio C, Giannarelli D, Crinò L, Cappuzzo F. P2.14-02 TP53 Mutations Affect Sensitivity to Lorlatinib in ROS1 Positive NSCLC: Final Results of the PFROST Trial. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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D'Aveni A, Stella S, Dallari B, Barile R, Rugarli S, Zellino C, Cerchiaro E, Riboldi L, Verusio C, Consonni D, Ceresoli G, Mensi C. EP07.01-005 Second Primary Cancers in a Population-Based Mesothelioma Registry. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.537] [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: 11/16/2022]
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Rossi A, Marconi M, Taccini F, Mannarini S, Verusio C. The COVID-19 in oncological settings: The buffering role of the physician’s empathic communication protects from the impact of fear on hopelessness. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e24126] [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
e24126 Background: During the lockdown related to the recent COVID-19 pandemic, many oncological patients, in addition to the fear of the COVID-19, have also experienced a sense of hopelessness related to the difficult management of their medical and oncological care. However, several studies showed that the physician’s empathic communication about medical care management may act as a buffer against this negative relationship. Thus, the study aimed to test a model in which the physician’s empathic communication mediates the relationship between fear of COVID-19 and hopelessness related to aforementioned difficulties. Methods: A sample of 70 oncological outpatients [36 females (51.4%), aged from 40 to 81 years ( mean = 65.94, SD = 11.13)] were recruited at the Department of Medical Oncology, Presidio Ospedaliero di Saronno, ASST Valle Olona. An ad hoc structured interview was developed to assess: (A) fear of COVID-19 (KR20: 0.86); (B) feelings of hopelessness related to the COVID-19 (KR20: 0.80); and (C) the patient's perception of empathy shown by the physician in communicating care management during the pandemic (KR20: 0.71). The factor score of each dimension was used as the total score. A mediation analysis (10,000 bootstrap resampling) was performed. Results: The mediation model showed statistical significance: F = 31.852, p < 0.001; R2 = 0.487. The relationship between ‘fear of COVID-19’ and ‘hopelessness’ was partially mediated by physician’s empathic communication ( path c’: β = 0.369, se = 0.096, 95%CI[0.177; 0.561], p < 0.001) – revealing its buffering role; path a: β = -0.488, se = 0.073, 95%CI[-0.634; -0.342], p < 0.001; path b: β = -0.375, se = 0.124, 95%CI[-0.623; -0.128], p = 0.003. Conclusions: These results highlight the protective role (buffer) of the physician’s empathic communication in the process that leads to hopelessness from the fear of COVID-19. Results suggest how physicians as well as psycho-oncologists should structure stronger interventions – based on the improvement of communication strategies – that may lead to an improvement of patients’ quality of life.
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Affiliation(s)
- Alessandro Rossi
- Department of Philosophy, Sociology, Education, and Applied Psychology, Section of Applied Psychology, University of Padova, Padova, Italy
| | - Maria Marconi
- Department of Medical Oncology, ASST Valle Olona, Presidio Ospedaliero di Saronno, Saronno, Italy
| | | | - Stefania Mannarini
- Department of MedicaDepartment of Philosophy, Sociology, Education, and Applied Psychology, Section of Applied Psychology, University of Padova, Padova, Italy
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Cappuzzo F, Pasello G, Delmonte A, Landi L, Benetti B, Metro G, D'Andrea MR, Gori S, Borra G, Mazzoni F, Verusio C, Pagano M, Giannarelli D, Bonetti AV, Maio M, Scimone A, Adamo V. Combi-TED: A multicenter, phase II, open-label, randomized trial evaluating efficacy of OSE2021 plus docetaxel or OSE2021 plus nivolumab as second-line therapy in metastatic NSCLC progressing after first-line chemo-immunotherapy. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.tps9140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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
TPS9140 Background: First line combination of chemotherapy and immune checkpoint inhibitors (ICIs) improves overall survival (OS) compared with chemotherapy alone in non-small cell lung cancer (NSCLC) patients. However, only few options are available at chemoimmunotherapy failure, with docetaxel representing the standard of care. Tedopi is a cancer vaccine which stimulates killer T cells, currently under development for the therapy of HLA-A2+ lung cancer. In the ATALANTE-1 Phase III trial (EudraCT no. 2015-003183-36), Tedopi provided clinical benefits in patients with advanced NSCLC who failed to respond to checkpoint inhibitors. Given the need for new therapeutic options in patients failing first-line chemo-immunotherapy and the encouraging preliminary data with Tedopi, there is a strong rationale for investigating the activity of Tedopi plus nivolumab or Tedopi plus docetaxel in patients with metastatic NSCLC failing standard first-line therapy. Methods: This is a phase II, non-comparative, randomized multicenter study assessing the combination of Tedopi with docetaxel or nivolumab in NSCLC patients failing after first-line chemoimmunotherapy (EudraCT no. 2020-005170-10). All NSCLC patient candidates for second-line therapy are considered eligible for the study if they are HLA-A2+, with no evidence of EGFR mutations or ALK/ROS1 rearrangement and if they progressed after at least 4 cycles of previous first-line chemo-immunotherapy. Patients are randomly assigned to Tedopi plus docetaxel, Tedopi plus nivolumab (treatment arms) or docetaxel monotherapy (standard arm). The primary endpoint is 1-year OS rate. Secondary endpoints include OS, 2-year OS rate, progression-free survival (PFS), objective response rate (ORR), and safety. An explorative analysis of the correlation of efficacy with several tumor or blood biomarkers (PD-L1 expression, tumor mutational burden, Tedopi neoantigen expression, T cell infiltration), is also performed. Sample size was calculated assuming a 1-year OS rate in the standard arm of 20%. According to the single-stage design, in both treatment arms a 1-year OS rate of 20% would imply that treatment does not warrant further investigation and a 1-year OS rate of 40%, would imply that treatment has a sufficient activity. With a one-sided significance level of 5% and a power of 80%, a total number of 105 patients (35 per treatment arm) need to be enrolled. At the drafting of this abstract, 7 patients have already been enrolled. Total follow-up will be 24 months from last enrolment, for an approximate duration of 48 months. Clinical trial information: NCT04884282.
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Affiliation(s)
| | - Giulia Pasello
- Istituto Oncologico Veneto IRCCS & Università di Padova, Padova, Italy
| | - Angelo Delmonte
- Istituto Romagnolo per lo Studio dei Tumori Dino Amadori-RCCS, Meldola, Italy
| | | | | | | | | | - Stefania Gori
- IRCCS Ospedale Sacro Cuore Don Calabria, Negrar (VR), Italy
| | - Gloria Borra
- Azienda Ospedaliero-Universitaria Maggiore della Carità, Novara, Italy
| | - Francesca Mazzoni
- Medical Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy
| | | | - Maria Pagano
- Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | | | - Michele Maio
- Azienda Ospedaliero Universitaria Senese, Siena, Italy
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Rossi AA, Marconi M, Taccini F, Verusio C, Mannarini S. Screening for Distress in Oncological Patients: The Revised Version of the Psychological Distress Inventory (PDI-R). Front Psychol 2022; 13:859478. [PMID: 35602698 PMCID: PMC9121122 DOI: 10.3389/fpsyg.2022.859478] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 01/21/2022] [Accepted: 03/17/2022] [Indexed: 12/17/2022] Open
Abstract
Background Psychological research in oncological settings is steadily increasing and the construct of psychological distress has rapidly gained popularity-leading to the development of questionnaires aimed at its measurement. The Psychological Distress Inventory (PDI) is one of the most used instruments, but its psychometric properties were not yet deeply evaluated. The present studies aimed at investigating the psychometric properties of the PDI (Study 1) and providing a revised version of the tool (Study 2). Methods Oncological outpatients were enrolled at the Department of Medical Oncology of the Presidio Ospedaliero of Saronno, ASST Valle Olona, Italy. For the first study (N = 251), an Exploratory Graph Analysis was used to explore the item structure of the PDI. In the second study (N = 902), the psychometric properties of the revised PDI (PDI-R) were deeply assessed. Results Study 1 showed that the PDI has a not clear structure and it should be reconsidered. On the opposite, Study 2 showed that the revised version (PDI-R) has a solid factorial structure, it is invariant across gender and age, and it has good psychometric properties. Conclusion Results suggest that the PDI-R is a reliable measure of psychological distress in different samples of oncological patients, with stronger psychometric properties than the original version. Its use in the clinical and research field is therefore recommended to improve the quality of both assessment and treatment of psychological distress in patients with oncological problems.
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Affiliation(s)
- Alessandro Alberto Rossi
- Section of Applied Psychology, Department of Philosophy, Sociology, Education, and Applied Psychology, University of Padova, Padua, Italy
- Interdepartmental Center for Family Research, University of Padova, Padua, Italy
| | - Maria Marconi
- Department of Medical Oncology, Presidio Ospedaliero di Saronno, ASST Valle Olona, Saronno, Italy
| | - Federica Taccini
- Interdepartmental Center for Family Research, University of Padova, Padua, Italy
| | - Claudio Verusio
- Department of Medical Oncology, Presidio Ospedaliero di Saronno, ASST Valle Olona, Saronno, Italy
| | - Stefania Mannarini
- Section of Applied Psychology, Department of Philosophy, Sociology, Education, and Applied Psychology, University of Padova, Padua, Italy
- Interdepartmental Center for Family Research, University of Padova, Padua, Italy
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Caminiti C, Annunziata MA, Verusio C, Pinto C, Airoldi M, Aragona M, Caputo F, Cinieri S, Giordani P, Gori S, Mattioli R, Novello S, Pazzola A, Procopio G, Russo A, Sarobba G, Zerilli F, Diodati F, Iezzi E, Maglietta G, Passalacqua R. Effectiveness of a Psychosocial Care Quality Improvement Strategy to Address Quality of Life in Patients With Cancer: The HuCare2 Stepped-Wedge Cluster Randomized Trial. JAMA Netw Open 2021; 4:e2128667. [PMID: 34648011 PMCID: PMC8517739 DOI: 10.1001/jamanetworkopen.2021.28667] [Citation(s) in RCA: 1] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
IMPORTANCE Many patients with cancer who would benefit from psychosocial care do not receive it. Implementation strategies may favor the integration of psychosocial care into practice and improve patient outcomes. OBJECTIVE To evaluate the effectiveness of the Humanization in Cancer Care (HuCare) Quality Improvement Strategy vs standard care as improvement of at least 1 of 2 domains (emotional or social function) of patient health-related quality of life at baseline and 3 months. A key secondary aim included investigation of the long-term effect. DESIGN, SETTING, AND PARTICIPANTS HuCare2 was a multicenter, incomplete, stepped-wedge cluster randomized clinical trial, conducted from May 30, 2016, to August 28, 2019, in three 5-center clusters of cancer centers representative of hospital size and geographic location in Italy. The study was divided into 5 equally spaced epochs. Implementation sequence was defined by a blinded statistician; the nature of the intervention precluded blinding for clinical staff. Participants included consecutive adult outpatients with newly diagnosed cancer of any type and stage starting medical cancer treatment. INTERVENTIONS The HuCare Quality Improvement Strategy comprised (1) clinician communication training, (2) on-site visits for context analysis and problem-solving, and (3) implementation of 6 evidence-based recommendations. MAIN OUTCOMES AND MEASURES The primary outcome was the difference between the means of changes of individual scores in emotional or social functions of health-related quality of life detected at baseline and 3-month follow-up (within each group) and during the postintervention epoch compared with control periods (between groups). Long-term effect of the intervention (at 12 months) was assessed as a secondary outcome. Intention-to-treat analysis was used. RESULTS A total of 762 patients (475 [62.3%] women) were enrolled (400 HuCare Quality Improvement Strategy and 362 usual care); mean (SD) age was 61.4 (13.1) years. The HuCare Quality Improvement Strategy significantly improved emotional function during treatment (odds ratio [OR], 1.13; 95% CI, 1.04-1.22; P = .008) but not social function (OR, 0.99; 95% CI, 0.89-1.09; P = .80). Effect on emotional function persisted at 12 months (OR, 1.05; 95% CI, 1.00-1.10; P = .04). CONCLUSIONS AND RELEVANCE In this trial, the HuCare Quality Improvement Strategy significantly improved the emotional function aspect of health-related quality of life during cancer treatment and at 12 months, indicating a change in clinician behavior and in ward organization. These findings support the need for strategies to introduce psychosocial care; however, more research is needed on factors that may maximize the effects. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03008993.
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Affiliation(s)
- Caterina Caminiti
- Research and Innovation Unit, University Hospital of Parma, Parma, Italy
| | | | - Claudio Verusio
- Department of Oncology, ASST Valle Olona, Busto Arsizio, Varese, Italy
| | - Carmine Pinto
- Medical Oncology Unit, Clinical Cancer Center, AUSL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - Mario Airoldi
- Second Medical Oncology Division, AOU Città della Salute e della Scienza of Turin, Turin, Italy
| | - Marcello Aragona
- Medical Oncology Unit, Department of Human Pathology of Adult and Evolutive Age, University of Messina, Messina, Italy
| | | | - Saverio Cinieri
- Oncology Unit, San Antonio Perrino Hospital, Brindisi, Italy
| | - Paolo Giordani
- Medical Oncology Unit, Ospedali Riuniti Marche Nord, Pesaro and Fano, Italy
| | - Stefania Gori
- Medical Oncology Division, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
| | - Rodolfo Mattioli
- Medical Oncology Unit, Ospedali Riuniti Marche Nord, Pesaro and Fano, Italy
| | - Silvia Novello
- Department of Oncology, University of Turin, AOU San Luigi Orbassano, Italy
| | - Antonio Pazzola
- Medical Oncology Unit, University-Hospital of Sassari, Sassari, Italy
| | - Giuseppe Procopio
- Department of Medical Oncology, National Cancer Institute of Milan, Milan, Italy
| | - Antonio Russo
- Medical Oncology Unit, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Giuseppina Sarobba
- Oncology Unit, San Francesco Hospital, ATS Sardegna ASSL Nuoro, Nuoro, Italy
| | | | - Francesca Diodati
- Research and Innovation Unit, University Hospital of Parma, Parma, Italy
| | - Elisa Iezzi
- Research and Innovation Unit, University Hospital of Parma, Parma, Italy
| | - Giuseppe Maglietta
- Research and Innovation Unit, University Hospital of Parma, Parma, Italy
| | - Rodolfo Passalacqua
- Medical Oncology Division, Department of Oncology, ASST of Cremona, Cremona, Italy
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Rossi AA, Marconi M, Taccini F, Verusio C, Mannarini S. From Fear to Hopelessness: The Buffering Effect of Patient-Centered Communication in a Sample of Oncological Patients during COVID-19. Behav Sci (Basel) 2021; 11:bs11060087. [PMID: 34198572 PMCID: PMC8231896 DOI: 10.3390/bs11060087] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [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: 04/16/2021] [Revised: 06/09/2021] [Accepted: 06/10/2021] [Indexed: 02/06/2023] Open
Abstract
Background: COVID-19 represents a threat both for the physical and psychological health of oncological patients experiencing heightened distress levels to which the fear of the virus is also added. Moreover, fear of COVID-19 could lead oncological patients to experience feelings of hopelessness related to their medical care. Patient-centered communication may act as a buffer against the aforementioned variables. This study aimed to test the role of doctor–patient communication in the relationship between fear of COVID-19 and hopelessness. Methods: During the COVID-19 pandemic, a sample of 90 oncological outpatients was recruited (40 males (44.4%) and 50 females (55.6%), mean age = 66.08 (SD = 12.12)). A structured interview was developed and used during the pandemic to measure the patients’ perceived (A) fear of COVID-19, and (B) feelings of hopelessness, and (C) physicians’ use of empathetic and (D) clear language during the consultation. A multiple mediation model was tested, and the effects between males and females were also compared. Results: Empathetic and clear doctor–patient communication buffered the adverse effect of the fear of COVID-19 on hopelessness through a full-mediation model. The effects did not differ between males and females in the overall model but its indirect effects. Discussions: Patient-centered communication using empathy and clear language can buffer the adverse effect of the fear of COVID-19 and protect oncological patients from hopelessness during the pandemic. These findings might help to improve clinical oncological practice.
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Affiliation(s)
- Alessandro Alberto Rossi
- Department of Philosophy, Sociology, Education, and Applied Psychology, Section of Applied Psychology, University of Padova, 35131 Padova, Italy; (F.T.); (S.M.)
- Interdepartmental Center for Family Research, University of Padova, 35131 Padova, Italy
- Correspondence:
| | - Maria Marconi
- Department of Medical Oncology, Presidio Ospedaliero di Saronno, ASST Valle Olona, 21047 Saronno, Italy; (M.M.); (C.V.)
| | - Federica Taccini
- Department of Philosophy, Sociology, Education, and Applied Psychology, Section of Applied Psychology, University of Padova, 35131 Padova, Italy; (F.T.); (S.M.)
- Interdepartmental Center for Family Research, University of Padova, 35131 Padova, Italy
| | - Claudio Verusio
- Department of Medical Oncology, Presidio Ospedaliero di Saronno, ASST Valle Olona, 21047 Saronno, Italy; (M.M.); (C.V.)
| | - Stefania Mannarini
- Department of Philosophy, Sociology, Education, and Applied Psychology, Section of Applied Psychology, University of Padova, 35131 Padova, Italy; (F.T.); (S.M.)
- Interdepartmental Center for Family Research, University of Padova, 35131 Padova, Italy
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11
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Abstract
e24128 Background: In recent years, an ever greater importance is given to the needs of cancer patients which could impact medical treatments, adherence and compliance, and patients’ quality of life (Teo et al. 2019; NCCN, 2015). However, recognizing and addressing the needs of patients may not be enough. Indeed, on one hand, needs that clinicians might consider as 'important' could play a marginal role, and – on the other hand – needs that clinicians may perceive as 'unimportant' may be central for patients. An innovative approach – psychometric network analysis (PNA; Epskamp, 2017) – was used to assess the network among needs ( nodes). Notably, the more a central node (need) is modified (addressed), the more a cascade change will occur in all the other nodes (needs). This study aimed to evaluate: (A) the structure of relationships among needs ( edges) of cancer patients, (B) which needs ( nodes) are the most relevant ( central), and (C) play a key role in the network. Methods: Patients ( n = 511; mean age = 65.95, SD = 12.72; 280 males) were enrolled at the Oncology Day Hospital at the “Presidio Ospedaliero” of Saronno, ASST Valle Olona, Italy. Patients were tested with the Need Evaluation Questionnaire (NEQ) which is composed of 23 items that investigate as many needs – divided into 4 areas: (1) information about diagnosis/prognosis, (2) information about exams and treatment, (3) communicative, and (4) relational needs. Results: Preliminary analysis revealed that all of the items were informative (SDitem < 2.5SDall_itemsSD) and there was no redundancy between items (redundancy index < 0.25). An Ising model (5,000 nonparametric bootstraps) with LASSO regularized nodewise logistic regression was performed. PNA showed a high accuracy: CS-coefficient = 0.56. On one hand, PNA showed that item#2 ( “I need more information about my future condition”; z = 2.039), item#17 ( “I need to speak with a psychologist”; z = 1.209), and item#13 ( “I need to be reassured more by the doctors”; z = 1.201) were the strongest (central) nodes. On the other hand, item#14 ( “ I need the hospital to provide better services”; z = -2.261) was the weakest node in the network. Conclusions: These findings show useful implications for clinical practice. Clinical interventions should address the needs showing the strongest connections in the network. These central nodes can influence all the other connected needs, thus representing important needs to be targeted by clinicians – allowing to tailoring more targeted and efficient therapeutic approaches to meet patients’ needs, with beneficial effects for medical treatments and quality of life.
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Affiliation(s)
- Alessandro Rossi
- Department of Philosophy, Sociology, Education, and Applied Psychology, Section of Applied Psychology, University of Padova, Padova, Italy
| | - Maria Marconi
- Department of Medical Oncology, ASST Valle Olona, Presidio Ospedaliero di Saronno, Saronno, Italy
| | - Stefania Mannarini
- Department of MedicaDepartment of Philosophy, Sociology, Education, and Applied Psychology, Section of Applied Psychology, University of Padova, Padova, Italy
| | - India Minelli
- Department of Medical Oncology, Presidio Ospedaliero di Saronno, ASST Valle Olona, Saronno, Italy
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12
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Bersanelli M, Giannarelli D, De Giorgi U, Pignata S, Di Maio M, Verzoni E, Clemente A, Guadalupi V, Signorelli D, Tiseo M, Giusti R, Filetti M, Di Napoli M, Calvetti L, Cappetta A, Ermacora P, Zara D, Barbieri F, Baldessari C, Scotti V, Mazzoni F, Veccia A, Guglielmini PF, Maruzzo M, Rossi E, Grossi F, Casadei C, Cortellini A, Verderame F, Montesarchio V, Rizzo M, Mencoboni M, Zustovich F, Fratino L, Cinieri S, Negrini G, Banzi M, Sorarù M, Zucali PA, Lacidogna G, Russo A, Battelli N, Fornarini G, Mucciarini C, Bracarda S, Bonetti A, Pezzuolo D, Longo L, Sartori D, Iannopollo M, Cavanna L, Meriggi F, Tassinari D, Corbo C, Gernone A, Prati V, Carnio S, Giordano P, Dicorato AM, Verusio C, Atzori F, Carrozza F, Gori S, Castro A, Pilotto S, Vaccaro V, Garzoli E, Di Costanzo F, Maiello E, Labianca R, Pinto C, Tognetto M, Buti S. Symptomatic COVID-19 in advanced-cancer patients treated with immune-checkpoint inhibitors: prospective analysis from a multicentre observational trial by FICOG. Ther Adv Med Oncol 2020; 12:1758835920968463. [PMID: 33224275 PMCID: PMC7649863 DOI: 10.1177/1758835920968463] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 08/05/2020] [Accepted: 10/02/2020] [Indexed: 12/30/2022] Open
Abstract
Background This prospective, multicentre, observational INVIDIa-2 study is investigating the clinical efficacy of influenza vaccination in advanced-cancer patients receiving immune-checkpoint inhibitors (ICIs), enrolled in 82 Italian centres, from October 2019 to January 2020. The primary endpoint was the incidence of influenza-like illness (ILI) until 30 April 2020. All the ILI episodes, laboratory tests, complications, hospitalizations and pneumonitis were recorded. Therefore, the study prospectively recorded all the COVID-19 ILI events. Patients and methods Patients were included in this non-prespecified COVID-19 analysis, if alive on 31 January 2020, when the Italian government declared the national emergency. The prevalence of confirmed COVID-19 cases was detected as ILI episode with laboratory confirmation of SARS-CoV-2. Cases with clinical-radiological diagnosis of COVID-19 (COVID-like ILIs), were also reported. Results Out of 1257 enrolled patients, 955 matched the inclusion criteria for this unplanned analysis. From 31 January to 30 April 2020, 66 patients had ILI: 9 of 955 cases were confirmed COVID-19 ILIs, with prevalence of 0.9% [95% confidence interval (CI): 0.3-2.4], a hospitalization rate of 100% and a mortality rate of 77.8%. Including 5 COVID-like ILIs, the overall COVID-19 prevalence was 1.5% (95% CI: 0.5-3.1), with 100% hospitalization and 64% mortality. The presence of elderly, males and comorbidities was significantly higher among patients vaccinated against influenza versus unvaccinated (p = 0.009, p < 0.0001, p < 0.0001). Overall COVID-19 prevalence was 1.2% for vaccinated (six of 482 cases, all confirmed) and 1.7% for unvaccinated (8 of 473, 3 confirmed COVID-19 and 5 COVID-like), p = 0.52. The difference remained non-significant, considering confirmed COVID-19 only (p = 0.33). Conclusion COVID-19 has a meaningful clinical impact on the cancer-patient population receiving ICIs, with high prevalence, hospitalization and an alarming mortality rate among symptomatic cases. Influenza vaccination does not protect from SARS-CoV-2 infection.
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Affiliation(s)
- Melissa Bersanelli
- Medicine and Surgery Department, University of Parma, and Medical Oncology Unit, University Hospital of Parma, Via Gramsci 14, Parma 43126, Italy
| | - Diana Giannarelli
- Biostatistical Unit, Regina Elena National Cancer Institute, IRCCS, Rome, Lazio, Italy
| | - Ugo De Giorgi
- Istituto Scientifico Romagnolo per lo Studio e la Cura de Tumori (IRST) IRCCS, Meldola, Italy
| | - Sandro Pignata
- Dipartimento Corp-S Assistenziale dei Percorsi Oncologici Uro-Genitale, SSD Oncologia Clinica Sperimentale Uro-Andrologica, Istituto Nazionale Tumori 'Fondazione G. Pascale', IRCCS, Napoli, Italy
| | - Massimo Di Maio
- Department of Oncology, University of Turin and Medical Oncology, AO Ordine Mauriziano, Turin, Italy
| | - Elena Verzoni
- SS Oncologia Genitourinaria, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Alberto Clemente
- Biostatistics and Clinical Research Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Valentina Guadalupi
- SS Oncologia Genitourinaria, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Diego Signorelli
- Thoracic Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori of Milan, Milano, Italy
| | - Marcello Tiseo
- Medicine and Surgery Department, University of Parma, Parma, Italy
| | - Raffaele Giusti
- Medical Oncology Unit, Azienda Ospedaliero-Universitaria Sant'Andrea, Roma, Italy
| | - Marco Filetti
- Medical Oncology Unit, Azienda Ospedaliero-Universitaria Sant'Andrea - Sapienza Facoltà di Medicina e Psicologia, Roma, Italy
| | - Marilena Di Napoli
- Dipartimento Corp-S Assistenziale dei Percorsi Oncologici Uro-Genitale, SSD Oncologia Clinica Sperimentale Uro-Andrologica, Istituto Nazionale Tumori 'Fondazione G. Pascale', IRCCS, Napoli, Italy
| | - Lorenzo Calvetti
- Department of Oncology, San Bortolo General Hospital, Unità Locale Socio-Sanitaria (ULSS) 8 Berica-East District, Vicenza, Italy
| | - Alessandro Cappetta
- Department of Oncology, San Bortolo General Hospital, Unità Locale Socio-Sanitaria (ULSS) 8 Berica-East District, Vicenza, Italy
| | - Paola Ermacora
- Dipartimento di Oncologia, Presidio Ospedaliero Universitario Santa Maria della Misericordia, Azienda sanitaria universitaria integrata Friuli Centrale, Udine, Italy
| | - Diego Zara
- Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Fausto Barbieri
- Medical Oncology Unit, University Hospital of Modena, Modena, Italy
| | | | - Vieri Scotti
- Oncology Department, Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy
| | | | | | | | - Marco Maruzzo
- Oncologia Medica 1, Istituto Oncologico Veneto IOV-IRCCS, Padova
| | - Ernesto Rossi
- Medical Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Francesco Grossi
- Department of Medical Oncology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Chiara Casadei
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Alessio Cortellini
- Department of Biotechnological and Applied Clinical Sciences, St. Salvatore Hospital, University of L'Aquila, L'Aquila, Italy
| | | | - Vincenzo Montesarchio
- UOC Oncologia, Ospedale Monaldi, Azienda Ospedaliera Specialistica dei Colli, Napoli, Italy
| | - Mimma Rizzo
- Oncologia Traslazionale, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | | | - Fable Zustovich
- UOC Oncologia di Belluno, Dipartimento di Oncologia Clinica, AULSS 1 Dolomiti, Ospedale S. Martino, Belluno, Italy
| | - Lucia Fratino
- Dipartimento di Oncologia Medica, Centro di Riferimento Oncologico di Aviano, Pordenone, Italy
| | - Saverio Cinieri
- Medical Oncology Division and Breast Unit, Senatore Antonio Perrino Hospital, ASL Brindisi, Brindisi, Italy
| | - Giorgia Negrini
- Oncologia Medica, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - Maria Banzi
- Medical Oncology Unit, AUSL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - Mariella Sorarù
- Medical Oncology, Camposampiero Hospital, USSL15 Alta Padovana, Padova, Italy
| | - Paolo Andrea Zucali
- Department of Oncology, Humanitas Clinical and Research Centre, IRCCS, Rozzano, Milan, Italy, and Humanitas University, Department of Biomedical Sciences, Milan, Italy
| | | | - Antonio Russo
- Dipartimento di Discipline Chirurgiche, Oncologiche e Stomatologiche, Università degli Studi di Palermo, Palermo, Italy
| | - Nicola Battelli
- UOC Oncologia, Ospedale Generale Provinciale di Macerata, ASUR Marche Area Vasta 3, Macerata, Italy
| | - Giuseppe Fornarini
- Medical Oncology Unit 1, IRCCS Policlinico San Martino Hospital, Genova, Italy
| | | | - Sergio Bracarda
- Struttura Complessa di Oncologia Medica e Traslazionale, Azienda Ospedaliera Santa Maria di Terni, Italy
| | - Andrea Bonetti
- Department of Oncology, Mater Salutis Hospital, Legnago, Verona
| | - Debora Pezzuolo
- Medicina oncologica, Ospedale di Guastalla e Correggio, Area Nord, Reggio Emilia, Italy
| | - Lucia Longo
- Unità operativa di Oncologia, Ospedale di Sassuolo, Area Sud dell'Azienda USL di Modena, Sassuolo, Modena, Italy
| | - Donata Sartori
- Oncologia Dolo-Mirano, AULSS3 Serenissima, Mestre, Venezia, Italy
| | - Mauro Iannopollo
- Medical Oncology Unit, Dip. Oncology, St Jacopo Hospital, Azienda USL Toscana Centro, Pistoia, Italy
| | | | - Fausto Meriggi
- Oncologia Medica, Fondazione Poliambulanza, Istituto Ospedaliero, Brescia, Italy
| | | | - Claudia Corbo
- UO di Oncologia, Ospedale Sacro Cuore di Gesù, Fatebenefratelli, Benevento, Italy
| | - Angela Gernone
- UO Oncologia Medica Universitaria, Azienda Ospedaliera Policlinico di Bari, Bari, Italy
| | | | - Simona Carnio
- Department of Oncology, University of Turin, San Luigi Hospital, Orbassano, Italy
| | | | | | - Claudio Verusio
- Oncologia Medica, Presidio Ospedaliero di Saronno, Saronno, Italy
| | - Francesco Atzori
- Medical Oncology, Department of Medical Sciences 'M. Aresu', University Hospital and University of Cagliari, Cagliari, Italy
| | - Francesco Carrozza
- Unità Operativa di Oncologia di Faenza, AUSL Romagna, Faenza, Ravenna, Italy
| | - Stefania Gori
- Medical Oncology Unit, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
| | - Antonino Castro
- Struttura semplice dipartimentale di Oncologia, ASST Franciacorta, Chiari, Brescia, Italy
| | - Sara Pilotto
- Section of Oncology, Department of Medicine, University of Verona and Verona University Hospital Trust, Verona, Italy
| | - Vanja Vaccaro
- Oncology Unit 1, Regina Elena National Cancer Institute, IRCCS, Rome, Italy
| | | | | | - Evaristo Maiello
- Medical Oncology, Foundation IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| | | | - Carmine Pinto
- Medical Oncology Unit, AUSL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | | | - Sebastiano Buti
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
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13
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Rossi A, Marconi M, Mannarini S, Minelli I, Bianchi S, Verusio C. Effectiveness of brief-focused cognitive behavioral therapy in the reduction of cancer-related distress and emotive problems: A comparative study. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e24169] [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
e24169 Background: In recent years, there was an increase of cognitive-behavioral therapy (CBT) oriented brief-focused psychological intervention protocols for the reduction of cancer-related emotive difficulties that oncological patients have to face almost every day and that could have a negative impact on medical treatment (Di Matteo, Lepper & Croghan, 2006; NCCN, 2015). Thus, this study aimed to determine the effectiveness of a 10-session brief CBT (B-CBT-P) compared with a control group (CG). Methods: Participants ( n = 67; mean age = 63.11, SD = 12.1, 35 female) enrolled at the Oncology Day Hospital at the “Presidio Ospedaliero” of Saronno, ASST Valle Olona, Italy who undertook (B-CBT-P: n = 34) or non-undertook (CG: n = 33) a psychotherapy intervention – with one of two different psychologists (authors MM and MI) to avoid potential biases. Participants were tested with the Distress Thermometer and the Problem List (DT&PL) at the baseline (T1; overall McDonald’s omega = .90), at the end of the 10-sessions B-CBT-P (T2; overall McDonald’s omega = .89). Results: A multilevel-multivariate repeated measure regression analysis was performed – controlling for age, type and localization of tumor, and therapist. In line with psychotherapy protocol, results showed no statistical significant changes for ‘practical problems’ ( p = 0.0497 ns), ‘spiritual problems’ ( p = 0.321 ns), and ‘physical problems’ ( p = 0.206). Results revealed a statistical significance reduction of ‘relationships problems’ ( p = 0.015; pooled Cohen’s d = 0.341), ‘emotive problems’ ( p = 0.012; pooled Cohen’s d = 0.349), and the distress thermometer ( p = 0.008; pooled Cohen’s d = 0.373). Conclusions: Considering that emotive and relational problems, as well as distress, occurs frequently among oncological patients, this study is into an important area. Results suggest that B-CBT-P is statistically and clinically effective to improve the emotive and relational sphere of oncological patients. However, the small effect sizes found suggest that these short protocols may not be sufficient to bring important changes in the patient's life. This study opens up to the idea of improving these protocols so that the cancer patient can improve his quality of life – even with a few psychotherapy sessions.
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Affiliation(s)
- Alessandro Rossi
- Department of Philosophy, Sociology, Education, and Applied Psychology, Section of Applied Psychology, University of Padova, Padova, Italy
| | - Maria Marconi
- Department of Medical Oncology, ASST Valle Olona, Presidio Ospedaliero di Saronno, Saronno, Italy
| | - Stefania Mannarini
- Department of MedicaDepartment of Philosophy, Sociology, Education, and Applied Psychology, Section of Applied Psychology, University of Padova, Padova, Italy
| | - India Minelli
- Department of Medical Oncology, Presidio Ospedaliero di Saronno, ASST Valle Olona, Saronno, Italy
| | - Silvia Bianchi
- Department of Medical Oncology, ASST Valle Olona, Presidio Ospedaliero di Saronno, Saronno, Italy
| | - Claudio Verusio
- Department of Oncology, ASST Valle Olona, Busto Arsizio, Italy
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14
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Meessen JMTA, Cardinale D, Ciceri F, Sandri MT, Civelli M, Bottazzi B, Cucchi G, Menatti E, Mangiavacchi M, Condorelli G, Barbieri E, Gori S, Colombo A, Curigliano G, Salvatici M, Pastori P, Ghisoni F, Bianchi A, Falci C, Cortesi P, Farolfi A, Monopoli A, Milandri C, Bregni M, Malossi A, Nassiacos D, Verusio C, Staszewsky L, Leone R, Novelli D, Balconi G, Nicolis EB, Franzosi MG, Masson S, Garlanda C, Mantovani A, Cipolla CM, Latini R. Circulating biomarkers and cardiac function over 3 years after chemotherapy with anthracyclines: the ICOS-ONE trial. ESC Heart Fail 2020; 7:1452-1466. [PMID: 32358917 PMCID: PMC7373944 DOI: 10.1002/ehf2.12695] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 01/10/2020] [Accepted: 03/12/2020] [Indexed: 12/21/2022] Open
Abstract
AIMS A multicentre trial, ICOS-ONE, showed increases above the upper limit of normality of cardiac troponin (cTn) in 27% of patients within 12 months after the end of cancer chemotherapy (CT) with anthracyclines, whether cardiac protection with enalapril was started at study entry in all (prevention arm) or only upon first occurrence on supra-normal cTn (troponin-triggered arm). The aims of the present post hoc analysis were (i) to assess whether anthracycline-based treatment could induce cardiotoxicity over 36 month follow-up and (ii) to describe the time course of three cardiovascular biomarkers (i.e. troponin I cTnI-Ultra, B-type natriuretic peptide BNP, and pentraxin 3 PTX3) and of left ventricular (LV) function up to 36 months. METHODS AND RESULTS Eligible patients were those prescribed first-in-life CT, without evidence of cardiovascular disease, normal cTn, LV ejection fraction (EF) >50%, not on renin-angiotensin aldosterone system antagonists. Patients underwent echocardiography and blood sampling at 24 and 36 months. No differences were observed in biomarker concentration between the two study arms, 'prevention' vs. 'troponin-triggered'. During additional follow-up 13 more deaths occurred, leading to a total of 23 (9.5%), all due to a non-cardiovascular cause. No new occurrences of LV-dysfunction were reported. Two additional patients were admitted to the hospital for cardiovascular causes, both for acute pulmonary embolism. No first onset of raised cTnI-Ultra was reported in the extended follow-up. BNP remained within normal range: at 36 months was 23.4 ng/L, higher (N.S.) than at baseline, 17.6 ng/L. PTX3 peaked at 5.2 ng/mL 1 month after CT and returned to baseline values thereafter. cTnI-Ultra peaked at 26 ng/L 1 month after CT and returned to 3 ng/L until the last measurement at 36 months. All echocardiographic variables remained stable during follow-up with a median LVEF of 63% and left atrial volume index about 24 mL/m2 . CONCLUSIONS First-in-life CT with median cumulative dose of anthracyclines of 180 mg/m2 does not seem to cause clinically significant cardiac injury, as assessed by circulating biomarkers and echocardiography, in patients aged 51 years (median), without pre-existing cardiac disease. This may suggest either a 100% efficacy of enalapril (given as preventive or troponin-triggered) or a reassuringly low absolute cardiovascular risk in this cohort of patients, which may not require intensive cardiologic follow-up.
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Affiliation(s)
- Jennifer M T A Meessen
- Department of Cardiovascular Medicine, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | | | - Fabio Ciceri
- Haematology/Transplant Unit, IRCCS Ospedale San Raffaele, Università Vita-Salute, Milan, Italy
| | - Maria Teresa Sandri
- Laboratory Medicine, Humanitas Clinical and Reseach Center - IRCCS - Rozzano, Milan, Italy
| | - Maurizio Civelli
- Department of Cardiology, European Institute of Oncology, Milan, Italy
| | - Barbara Bottazzi
- Department of Immunology, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy
| | | | | | - Maurizio Mangiavacchi
- Department of Cardiology, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy
| | - Gianluigi Condorelli
- Department of Cardiology, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy
| | - Enrico Barbieri
- Department of Cardiology, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar, Italy
| | - Stefania Gori
- Department of Oncology, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar, Italy
| | | | - Giuseppe Curigliano
- Division of Early Drug Development for Innovative Therapy, Department of Oncology and Hemato-Oncology, University of Milano, European Institute of Oncology, Milan, Italy
| | - Michela Salvatici
- Laboratory Medicine, Humanitas Clinical and Reseach Center - IRCCS - Rozzano, Milan, Italy
| | - Paolo Pastori
- Department of Cardiology, Ospedale di Vaio, Fidenza, Italy
| | - Francesco Ghisoni
- Unità Operativa Complessa Cure Palliative, Ospedale di Vaio, Fidenza, Italy
| | - Alessandra Bianchi
- Department of Cardiology, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy
| | - Cristina Falci
- Department of Oncology, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy
| | - Pietro Cortesi
- Department of Cardiology, IRCCS - Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, IRST, Meldola, Italy
| | - Alberto Farolfi
- Department of Oncology, IRCCS - Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, IRST, Meldola, Italy
| | - Anna Monopoli
- Department of Cardiology, Nuovo Ospedale San Giuseppe, Empoli, Italy
| | - Carlo Milandri
- Department of Oncology, Nuovo Ospedale San Giuseppe, Empoli, Italy
| | - Marco Bregni
- Department of Oncology, Presidio Ospedaliero di Busto Arsizio, Busto Arsizio, Italy
| | | | - Daniele Nassiacos
- Department of Cardiology, Presidio Ospedaliero di Saronno, Saronno, Italy
| | - Claudio Verusio
- Department of Oncology, Presidio Ospedaliero di Saronno, Saronno, Italy
| | - Lidia Staszewsky
- Department of Cardiovascular Medicine, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Roberto Leone
- Department of Immunology, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy
| | - Deborah Novelli
- Department of Cardiovascular Medicine, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Giovanna Balconi
- Department of Cardiovascular Medicine, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Enrico B Nicolis
- Department of Cardiovascular Medicine, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Maria Grazia Franzosi
- Department of Cardiovascular Medicine, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Serge Masson
- Department of Cardiovascular Medicine, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Cecilia Garlanda
- Department of Immunology, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy.,Humanitas University, Milan, Italy
| | - Alberto Mantovani
- Department of Immunology, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy.,Humanitas University, Milan, Italy.,The William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Carlo M Cipolla
- Department of Cardiology, European Institute of Oncology, Milan, Italy
| | - Roberto Latini
- Department of Cardiovascular Medicine, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
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15
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Cazzaniga ME, Verusio C, Ciccarese M, Fumagalli A, Sartori D, Valerio MR, Airoldi M, Moretti G, Ficorella C, Gianni L, Michelotti A, Zambelli A, Febbraro A, Generali D, Pistelli M, Garrone O, Musolino A, Vici P, Maur M, Mentuccia L, La Verde N, Bianchi GV, Artale S, Blasi L, De Laurentiis M, Atzori F, Turletti A, Porpiglia M, Santini D, Fabi A, Gebbia V, Schirone A, Palumbo R, Ferzi A, Frassoldati A, Scavelli C, Clivio L, Giordano M, Donadio M, Biganzoli L, Del Mastro L, Bisagni G, Livi L, Natoli C, Montemurro F, Riccardi F, Romagnoli E, Marchetti P, Torri V, Pronzato P, Mustacchi G. Is There Still a Role for Endocrine Therapy Alone in HR+/HER2- Advanced Breast Cancer Patients? Results from the Analysis of Two Data Sets of Patients Treated with High-Dose Fulvestrant as First-Line Therapy in the Real-World Setting: The EVA and GIM-13 AMBRA Studies. Breast Care (Basel) 2020; 15:30-37. [PMID: 32231495 DOI: 10.1159/000495469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 11/15/2018] [Indexed: 11/19/2022] Open
Abstract
Background Different studies suggest that fulvestrant 500 mg every 28 days (HD-FUL) could be an active treatment in HR+ advanced breast cancer (ABC) patients even treated with aromatase inhibitors in the adjuvant setting. The aim of this analysis is to describe the outcome of ABC patients treated with HD-FUL as first-line treatment in terms of median duration of treatment and the overall response rate in a real-world setting. Methods For the purpose of the present analysis, we considered two data sets of HR+ ABC patients collected in Italy between 2012 and 2015 (EVA and GIM-13 AMBRA studies). Results Eighty-one and 91 patients have been identified from the two data sets. The median age was 63 years (range 35-82) for the EVA and 57.8 years (range 35.0-82.3) for the AMBRA patients. ORRs were 23.5 and 24.3% in the whole population, 26.9% in the patients with bone only, and 21.8 and 21.4% in those with visceral metastases. The median duration of HD-FUL was 11.6 months (range 1-48) and 12.4 months (range 2.9-70.0) in the two data sets, respectively. Conclusion These data suggest that HD-FUL should still continue to play a significant role as first-line therapy in HR+ ABC patients.
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Affiliation(s)
- Marina Elena Cazzaniga
- Research Unit Phase I Trials, ASST Monza, Monza, Italy.,Oncology Unit, ASST Monza, Monza, Italy
| | - Claudio Verusio
- Oncology Unit, ASST della Valle Olona - Presidio Ospedaliero di Saronno, Saronno, Italy
| | | | | | | | | | - Mario Airoldi
- Oncology Unit 2 - Città della Salute e della Scienza di Torino, Turin, Italy
| | - Gabriella Moretti
- Oncology Unit, IRCCS Arcispedale S. Maria Nuova, Reggio Emilia, Italy
| | - Corrado Ficorella
- Dipartimento di Scienze Cliniche Applicate e Biotecnologiche (DISCAB) - Università Degli Studi Dell'Aquila, L'Aquila, Italy
| | - Lorenzo Gianni
- Oncology Unit Rimini, Azienda USL Romagna, Rimini, Italy
| | - Andrea Michelotti
- Oncology Unit 2, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | | | - Antonio Febbraro
- Oncology Unit, Ospedale Sacro Cuore di Gesù, Fatebenefratelli, Benevento, Italy
| | | | - Mirco Pistelli
- Oncology Unit, AOU Ospedali Riuniti Ancona, Ancona, Italy
| | - Ornella Garrone
- Oncology Unit, A.O.S. Croce e Carle Ospedale di Insegnamento, Cuneo, Italy
| | - Antonino Musolino
- Oncology Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Patrizia Vici
- Oncology Unit 2, Istituto Nazionale Tumori Regina Elena - IFO, Rome, Italy
| | - Michela Maur
- Oncology Unit, Policlinico University Hospital of Modena, Modena, Italy
| | - Lucia Mentuccia
- Oncology Unit, ASL di Frosinone, Osp. "SS. Trinità", Sora, Italy
| | - Nicla La Verde
- Oncology Unit, ASST Fatebenefratelli Sacco Presidio Ospedaliero Fatebenefratelli, Milan, Italy
| | | | - Salvatore Artale
- Oncology Departement, Ospedale di Gallarate, ASST Valle Olona, Gallarate, Italy
| | - Livio Blasi
- Oncology Unit, ARNAS Civico Palermo, Palermo, Italy
| | | | | | | | - Mauro Porpiglia
- Oncology Unit, ASST della Valle Olona - Presidio Ospedaliero di Saronno, Saronno, Italy
| | | | - Alessandra Fabi
- Oncology Unit, Ospedale Moriggia Pelascini, Gravedona, Italy
| | | | - Alessio Schirone
- Oncology Department, Policlinico "Paolo Giaccone", Palermo, Italy
| | - Raffaella Palumbo
- Oncology Unit 2 - Città della Salute e della Scienza di Torino, Turin, Italy
| | - Antonella Ferzi
- Oncology Unit, IRCCS Arcispedale S. Maria Nuova, Reggio Emilia, Italy
| | - Antonio Frassoldati
- Dipartimento di Scienze Cliniche Applicate e Biotecnologiche (DISCAB) - Università Degli Studi Dell'Aquila, L'Aquila, Italy
| | | | - Luca Clivio
- Oncology Unit 2, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | | | - Michela Donadio
- Oncology Unit, Ospedale Sacro Cuore di Gesù, Fatebenefratelli, Benevento, Italy
| | | | | | - Giancarlo Bisagni
- Oncology Unit, A.O.S. Croce e Carle Ospedale di Insegnamento, Cuneo, Italy
| | - Lorenzo Livi
- Oncology Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Clara Natoli
- Oncology Unit 2, Istituto Nazionale Tumori Regina Elena - IFO, Rome, Italy
| | | | | | - Emanuela Romagnoli
- Oncology Unit, ASST Fatebenefratelli Sacco Presidio Ospedaliero Fatebenefratelli, Milan, Italy
| | - Paolo Marchetti
- Oncology Unit 1, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Valter Torri
- Oncology Unit 2, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Paolo Pronzato
- Oncology Departement, Ospedale di Gallarate, ASST Valle Olona, Gallarate, Italy
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16
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Ruzzo A, Graziano F, Galli F, Galli F, Rulli E, Lonardi S, Ronzoni M, Massidda B, Zagonel V, Pella N, Mucciarini C, Labianca R, Ionta MT, Bagaloni I, Veltri E, Sozzi P, Barni S, Ricci V, Foltran L, Nicolini M, Biondi E, Bramati A, Turci D, Lazzarelli S, Verusio C, Bergamo F, Sobrero A, Frontini L, Magnani M. Author Correction: Sex-Related Differences in Impact on Safety of Pharmacogenetic Profile for Colon Cancer Patients Treated with FOLFOX-4 or XELOX Adjuvant Chemotherapy. Sci Rep 2020; 10:1918. [PMID: 32005869 PMCID: PMC6994718 DOI: 10.1038/s41598-020-58486-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Annamaria Ruzzo
- Department of Biomolecular Sciences, Università degli Studi di Urbino "Carlo Bo", Urbino, Italy.
| | | | - Francesca Galli
- Laboratory of Methodology for Clinical research, Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Fabio Galli
- Laboratory of Methodology for Clinical research, Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Eliana Rulli
- Laboratory of Methodology for Clinical research, Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Sara Lonardi
- Istituto Oncologico Veneto IOV - IRCCS, Padova, Italy
| | | | - Bruno Massidda
- Azienda Ospedaliera Universitaria di Cagliari, P.O. Monserrato, Monserrato, Italy
| | | | - Nicoletta Pella
- Azienda Ospedaliera S. Maria della Misericordia, Udine, Italy
| | | | | | - Maria Teresa Ionta
- Azienda Ospedaliera Universitaria di Cagliari, P.O. Monserrato, Monserrato, Italy
| | - Irene Bagaloni
- Department of Biomolecular Sciences, Università degli Studi di Urbino "Carlo Bo", Urbino, Italy
| | | | | | - Sandro Barni
- Ospedale "Treviglio-Caravaggio", Treviglio, Italy
| | | | - Luisa Foltran
- Azienda Ospedaliera Santa Maria degli Angeli, Pordenone, Italy
| | - Mario Nicolini
- Azienda Ospedaliera Ospedale "Cervesi", Cattolica, Italy
| | | | | | | | | | | | | | | | | | - Mauro Magnani
- Department of Biomolecular Sciences, Università degli Studi di Urbino "Carlo Bo", Urbino, Italy
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17
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Bolzacchini E, Pinotti G, Bertù L, Verusio C, Galli L, Mumoli N, Barbara C, Danova M, Bregni M, Artale S, Rossini C, Nigro O, Antonuzzo A, Derosa L, Torchio M, Barzaghi S, Ricci I, Suter M, Ballerio A, Vallini I, Dentali F. On-target Toxicities Predictive of Survival in Metastatic Renal Cell Carcinoma (mRCC) Treated With Sunitinib: A Multicenter Retrospective Study. Clin Genitourin Cancer 2019; 18:e145-e156. [PMID: 31889670 DOI: 10.1016/j.clgc.2019.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 04/24/2019] [Revised: 09/23/2019] [Accepted: 10/06/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Preliminary studies suggested that selected drug-related toxicities of sunitinib may correlate with a better prognosis. PATIENTS AND METHODS From January 2006 through December 2015, we retrospectively analyzed data of 145 patients with metastatic renal cell carcinoma treated with sunitinib as a first-line therapy in 7 different Italian oncology departments. Hypertension, hypothyroidism, thrombocytopenia, neutropenia, and anemia were evaluated. Overall survival (OS) and progression-free survival (PFS) were calculated. OS and PFS were compared in patients who developed and who did not develop a drug-related toxicity. A multivariate analysis using the Cox regression model was performed. RESULTS We evaluated 145 patients (92 males; median age, 70 years); 105 (62.4%) patients experienced at least 1 toxicity: 66 (45.5%) patients developed hypothyroidism, 41 (28.3%) thrombocytopenia, 39 (26.9%) hypertension that required medical therapy, 22 (15.2%) anemia, and 11 (7.6%) neutropenia. The median PFS of patients who developed hypertension was 12 months (95% confidence interval [CI], 9-21 months) versus 9 months (95% CI, 7-12 months) in patients who did not develop toxicity; the median OS was 36 months (95% CI, 22 months to not reached) versus 26 months (95% CI, 18-34 months). For neutropenia, the median PFS was 17.5 months (95% CI, 9-65 months) versus 10 months (95% CI, 8-12 months); the median OS was 23 months (95% CI, 13 months to not reached) versus 28 months (95% CI, 22-35 months). At univariate and multivariate analysis, we observed a protective effect of hypertension and neutropenia on tumor progression (hazard ratio, 0.47; 95% CI, 0.28-0.78 and hazard ratio, 0.26; 95% CI, 0.09-0.76, respectively). CONCLUSIONS Many patients developed toxicities during treatment with sunitinib; hypertension and neutropenia were related to longer PFS in our cohort.
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Affiliation(s)
- Elena Bolzacchini
- U.O. Oncologia, Ospedale Sant'Anna, ASST-LARIANA, Como, Italy; Università degli studi dell'Insubria di Varese, Varese, Italy.
| | | | - Lorenza Bertù
- Dipartimento di Medicina e Chirurgia, Università degli Studi dell'Insubria di Varese, Varese, Italy
| | - Claudio Verusio
- Oncologia Medica, Presidio Ospedaliero di Saronno, Saronno, Italy
| | - Luca Galli
- Oncologia Medica, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Nicola Mumoli
- Medicina Interna, Azienda USL6 Livorno - Presidio Ospedaliero di Livorno, Livorno, Italy
| | | | - Marco Danova
- Medicina Interna ad indirizzo Oncologico, Ospedale di Vigevano, Azienda Socio-Sanitaria Territoriale di Pavia, Pavia, Italy
| | - Marco Bregni
- Oncologia Medica, Ospedale di Busto Arsizio - ASST Valle Olona, Busto Arsizio, Italy
| | - Salvatore Artale
- Oncologia Medica, Azienda Ospedaliera S. Antonio Abate di Gallarate, Gallarate, Italy
| | - Chiara Rossini
- Oncologia Medica, Presidio Ospedaliero di Saronno, Saronno, Italy
| | - Olga Nigro
- Oncologia Medica, Ospedale di Circolo, Varese, Italy
| | - Andrea Antonuzzo
- Oncologia Medica, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Lisa Derosa
- Oncologia Medica, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Martina Torchio
- Medicina Interna ad indirizzo Oncologico, Ospedale di Vigevano, Azienda Socio-Sanitaria Territoriale di Pavia, Pavia, Italy
| | - Sabrina Barzaghi
- Oncologia Medica, Azienda Ospedaliera S. Antonio Abate di Gallarate, Gallarate, Italy
| | - Isabella Ricci
- Oncologia Medica, Azienda Ospedaliera S. Antonio Abate di Gallarate, Gallarate, Italy
| | - Matteo Suter
- Oncologia Medica, Ospedale di Circolo, Varese, Italy
| | - Alice Ballerio
- Oncologia Medica, Presidio Ospedaliero di Saronno, Saronno, Italy
| | | | - Francesco Dentali
- Dipartimento di Medicina e Chirurgia, Università degli Studi dell'Insubria di Varese, Varese, Italy
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18
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Landi L, Tiseo M, Heukamp L, Menon R, Spitaleri G, Cortinovis D, Delmonte A, Galetta D, D’Arcangelo M, D’Incà F, Bertrand M, Jóri B, Zacher A, Gridelli C, Novello S, Chiari R, Verusio C, Crinò L, Cappuzzo F. Secondary ROS1 mutations and lorlatinib sensitivity in crizotinib-refractory ROS1 positive NSCLC: Results of the prospective PFROST trial. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz260.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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19
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Lettig L, Sahnane N, Pepe F, Cerutti R, Albeni C, Franzi F, Veronesi G, Ogliari F, Pastore A, Tuzi A, Pinotti G, Bovio A, Verusio C, Giordano M, Troncone G, Sessa F, Malapelle U, Furlan D. EGFR T790M detection rate in lung adenocarcinomas at baseline using droplet digital PCR and validation by ultra-deep next generation sequencing. Transl Lung Cancer Res 2019; 8:584-592. [PMID: 31737495 DOI: 10.21037/tlcr.2019.09.18] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Routine testing of baseline EGFR T790M mutation may have important clinical impact but many discordant data have been reported regarding the diagnostic, prognostic and predictive role of this marker. In this study we aimed to assess T790M frequency in 164 untreated EGFR-mutated NSCLCs using methods with different sensitivity as well as to analyze the relationship between baseline T790M mutation status, patient's clinicopathologic features and tyrosine kinase inhibitors (TKI) treatment outcomes. Methods We compared the diagnostic performance, sensitivity and specificity of three methods, namely MALDI-TOF mass spectrometry (MS), Allele-Specific Real Time PCR (AS-PCR), droplet digital PCR (ddPCR). Ultra-deep next generation sequencing (NGS) validation of T790M-mutant NSCLCs was performed using SiRe® panel. Results Baseline T790M occurred in 17% of the tumors. Intermediately sensitive techniques such as MALDI-TOF MS (detection limit of T790M ≥5%) allow to detect T790M in 2% of cases exhibiting mutant-allele fractions ranging from 11.5% to 17%. Median overall survival (OS) in these patients was poor (7.3 months) and progression free survival (PFS) was of 3.3 months in patients treated with a 1st generation EGFR TKI. The remaining T790M-positive cases showed very low mutant-allele fractions ranging from 0.07% to 0.38% and required highly sensitive methods such as ddPCR and NGS to be identified. All these cases showed a concurrent sensitizing EGFR mutation (mainly exon 19 deletion), and clinicopathological features similar to those observed in EGFR mutant cancers. Median OS of these patients was 27 months while median PFS after TKI treatment was 20 months. Conclusions Routine test of baseline EGFR T790M may have an important role in the prediction to EGFR TKI therapy response and should be performed using highly sensitive and quantitative methods, such as ddPCR and NGS, in order to reliably distinguish NSCLCs with high or very low T790M mutant-allele fraction.
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Affiliation(s)
- Lucio Lettig
- Unit of Pathology, Department of Medicine and Surgery, ASST Sette Laghi, University of Insubria, Varese, Italy
| | - Nora Sahnane
- Unit of Pathology, Department of Medicine and Surgery, ASST Sette Laghi, University of Insubria, Varese, Italy
| | - Francesco Pepe
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Roberta Cerutti
- Unit of Pathology, Department of Medicine and Surgery, ASST Sette Laghi, University of Insubria, Varese, Italy
| | - Chiara Albeni
- Unit of Pathology, Department of Medicine and Surgery, ASST Sette Laghi, University of Insubria, Varese, Italy
| | - Francesca Franzi
- Unit of Pathology, Department of Medicine and Surgery, ASST Sette Laghi, University of Insubria, Varese, Italy
| | - Giovanni Veronesi
- Research Center in Epidemiology and Preventive Medicine (EPIMED), Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | | | | | | | | | | | | | | | - Giancarlo Troncone
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Fausto Sessa
- Unit of Pathology, Department of Medicine and Surgery, ASST Sette Laghi, University of Insubria, Varese, Italy
| | - Umberto Malapelle
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Daniela Furlan
- Unit of Pathology, Department of Medicine and Surgery, ASST Sette Laghi, University of Insubria, Varese, Italy
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20
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Landi L, Chiari R, Tiseo M, D'Incà F, Dazzi C, Chella A, Delmonte A, Bonanno L, Giannarelli D, Cortinovis DL, de Marinis F, Borra G, Morabito A, Gridelli C, Galetta D, Barbieri F, Grossi F, Capelletto E, Minuti G, Mazzoni F, Verusio C, Bria E, Alì G, Bruno R, Proietti A, Fontanini G, Crinò L, Cappuzzo F. Crizotinib in MET-Deregulated or ROS1-Rearranged Pretreated Non–Small Cell Lung Cancer (METROS): A Phase II, Prospective, Multicenter, Two-Arms Trial. Clin Cancer Res 2019; 25:7312-7319. [DOI: 10.1158/1078-0432.ccr-19-0994] [Citation(s) in RCA: 99] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 06/13/2019] [Accepted: 08/12/2019] [Indexed: 11/16/2022]
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21
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Ruzzo A, Graziano F, Galli F, Galli F, Rulli E, Lonardi S, Ronzoni M, Massidda B, Zagonel V, Pella N, Mucciarini C, Labianca R, Ionta MT, Bagaloni I, Veltri E, Sozzi P, Barni S, Ricci V, Foltran L, Nicolini M, Biondi E, Bramati A, Turci D, Lazzarelli S, Verusio C, Bergamo F, Sobrero A, Frontini L, Magnani M. Sex-Related Differences in Impact on Safety of Pharmacogenetic Profile for Colon Cancer Patients Treated with FOLFOX-4 or XELOX Adjuvant Chemotherapy. Sci Rep 2019; 9:11527. [PMID: 31395900 PMCID: PMC6687727 DOI: 10.1038/s41598-019-47627-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 01/25/2019] [Accepted: 07/12/2019] [Indexed: 01/28/2023] Open
Abstract
Polymorphisms contribute to inter-individual differences and show a promising predictive role for chemotherapy-related toxicity in colon cancer (CC). TOSCA is a multicentre, randomized, non-inferiority, phase III study conducted in high-risk stage II/stage III CC patients treated with 6 vs 3 months of FOLFOX-4 or XELOX adjuvant chemotherapy. During this post-hoc analysis, 218 women and 294 men were genotyped for 17 polymorphisms: TYMS (rs34743033, rs2853542, rs11280056), MTHFR (rs1801133, rs1801131), ERCC1 (rs11615), XRCC1 (rs25487), XRCC3 (rs861539), XPD (rs1799793, rs13181), GSTP1 (rs1695), GSTT1/GSTM1 (deletion +/−), ABCC1 (rs2074087), and ABCC2 (rs3740066, rs1885301, rs4148386). The aim was to assess the interaction between these polymorphisms and sex, on safety in terms of time to grade ≥3 haematological (TTH), grade ≥3 gastrointestinal (TTG) and grade ≥2 neurological (TTN) toxicity. Interactions were detected on TTH for rs1801133 and rs1799793, on TTG for rs13181 and on TTN for rs11615. Rs1799793 GA genotype (p = 0.006) and A allele (p = 0.009) shortened TTH in men. In women, the rs11615 CC genotype worsened TTN (co-dominant model p = 0.008, recessive model p = 0.003) and rs13181 G allele improved the TTG (p = 0.039). Differences between the two sexes in genotype distribution of rs1885301 (p = 0.020) and rs4148386 (p = 0.005) were found. We highlight that polymorphisms could be sex-specific biomarkers. These results, however, need to be confirmed in additional series.
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Affiliation(s)
- Annamaria Ruzzo
- Department of Biomolecular Sciences, Università degli Studi di Urbino "Carlo Bo", Urbino, Italy.
| | | | - Francesca Galli
- Laboratory of Methodology for Clinical research, Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Fabio Galli
- Laboratory of Methodology for Clinical research, Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Eliana Rulli
- Laboratory of Methodology for Clinical research, Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Sara Lonardi
- Istituto Oncologico Veneto IOV - IRCCS, Padova, Italy
| | | | - Bruno Massidda
- Azienda Ospedaliera Universitaria di Cagliari, P.O. Monserrato, Monserrato, Italy
| | | | - Nicoletta Pella
- Azienda Ospedaliera S. Maria della Misericordia, Udine, Italy
| | | | | | - Maria Teresa Ionta
- Azienda Ospedaliera Universitaria di Cagliari, P.O. Monserrato, Monserrato, Italy
| | - Irene Bagaloni
- Department of Biomolecular Sciences, Università degli Studi di Urbino "Carlo Bo", Urbino, Italy
| | | | | | - Sandro Barni
- Ospedale "Treviglio-Caravaggio", Treviglio, Italy
| | | | - Luisa Foltran
- Azienda Ospedaliera Santa Maria degli Angeli, Pordenone, Italy
| | - Mario Nicolini
- Azienda Ospedaliera Ospedale "Cervesi", Cattolica, Italy
| | | | | | | | | | | | | | | | | | - Mauro Magnani
- Department of Biomolecular Sciences, Università degli Studi di Urbino "Carlo Bo", Urbino, Italy
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Rossi A, Marconi M, Mannarini S, Minelli I, Anderboni M, Rossini C, Di Lucca G, Verusio C. Effectiveness of psychological distress reduction with cognitive behavioral therapy for oncological patients: A one-year follow-up study. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.11624] [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
11624 Background: Distress has a negative impact on medical treatment (Di Matteo, Lepper & Croghan, 2006) and it is considered one of the most important indexes of psychological suffering in oncological patients (NCCN, 2015). Thus, the purpose of this study was to determine the long term effectiveness of brief Cognitive Behavioral Therapy for patients with cancer (CBT-C) compared with a control group (CG) of oncological patients without any psychotherapy intervention - at one year after a chemotherapy treatment. Methods: Participants ( n = 80; mean age = 63.3, SD = 13.4; 54 female) enrolled at the Oncology Day Hospital at the “Presidio Ospedaliero” of Saronno, ASST Valle Olona, Italy who undertook (CBT-C: n = 40) or non-undertook (CG: n = 40) a psychotherapy intervention. Individual psychotherapy sessions strictly followed the IPOS guidelines (Watson & Kissane, 2017). Participants were tested with the Psychological distress Inventory (PDI) at the baseline (T1; Cronbach α = .88) at the end of the chemotherapy treatment (T2; Cronbach α = .87), at the end of the psychotherapy intervention (T3; Cronbach α = .88), 6-month follow-up (T4; Cronbach α = .85), and 1-year follow-up (T5; Cronbach α = .84). Results: Multilevel growth curve modeling – controlling for age, number of sessions, type and localization of tumor – showed a sharper reduction of distress for CBT-C participants that continue after posttreatment until 1-year follow-up ( p < .001); whereas for CG participants it reduced more gradually from pretreatment to 1-year follow-up ( p < .001). The results revealed a significant difference between the linear slopes for each treatment condition ( p < .001). The overall Hedges’ g comparing the two groups for distress reduction between pretreatment and 1-year follow-up was 2.14 (p < .001) in favor of CBT-C. Conclusions: Given that psychological distress occurs frequently among oncological patients this study is into an important area of study. Results suggest that CBT-C is statistically and clinically effective in treating psychological distress 1 year after the chemotherapy treatment. These findings revealed a kind of long-term effectiveness psychological intervention able both to reduce psychological suffering and improve a better quality of life in oncological settings.
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Affiliation(s)
- Alessandro Rossi
- Department of Philosophy, Sociology, Education, and Applied Psychology, Section of Applied Psychology, University of Padova, Padova, Italy
| | - Maria Marconi
- Department of Medical Oncology, ASST Valle Olona, Presidio Ospedaliero di Saronno, Saronno, Italy
| | - Stefania Mannarini
- Department of MedicaDepartment of Philosophy, Sociology, Education, and Applied Psychology, Section of Applied Psychology, University of Padova, Padova, Italy
| | - India Minelli
- Department of Medical Oncology, Presidio Ospedaliero di Saronno, ASST Valle Olona, Saronno, Italy
| | - Monica Anderboni
- Department of Medical Oncology, Presidio Ospedaliero di Saronno, ASST Valle Olona, Saronno, Italy
| | - Chiara Rossini
- Department of Medical Oncology, ASST Valle Olona, Presidio Ospedaliero di Saronno, Saronno, Italy
| | | | - Claudio Verusio
- Department of Oncology, ASST Valle Olona, Busto Arsizio, Italy
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Passalacqua R, Iezzi E, Annunziata MA, Verusio C, Pinto C, Airoldi M, Aragona M, Caputo F, Cinieri S, Giordani P, Gori S, Mattioli R, Novello S, Pazzola A, Procopio G, Russo A, Sacco C, Sarobba G, Zerilli F, Caminiti C. Integrating psychosocial care into routine cancer care: A stepped-wedge design cluster randomized controlled trial (SWD-RCT) to evaluate effectiveness of the HuCare Quality Improvement Strategy (HQIS) on health-related quality of life (HRQoL). J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.6515] [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
6515 Background: Cancer patients (pts) often do not receive evidence-based psychosocial care. We evaluate the effects of an implementation strategy we previously demonstrated feasible, which includes communication skill training for all physicians and nurses; four support visits at the centers by an improvement team to assist staff in identifying obstacles, finding solutions, and strengthening motivation; screening for distress and social needs; individualized pts' education with a referring nurse; use of a question prompt list. Methods: Multicenter incomplete SWD-RCT with 3 clusters of 5 centers each. Consecutive outpatients requiring medical treatment and diagnosed in the previous 2 months were eligible. Primary endpoint: difference of at least one of the 2 domains of HRQoL emotional or social functions, at 3 months from baseline, in pts of the centers that implemented the HQIS vs standard of care (SoC). Secondary endpoints include: patient mood, long-term effect, overall HRQoL. Analyses were performed using a beta-binomial regression model. Results: 762 pts were enrolled. At baseline, 41% showed high anxiety (HADS-A>7), and 88% had at least one psychosocial need. 299 health professionals attended 3-day courses (84% of all clinical staff). 647 pts (85%) were available for analysis. The 315 pts who received HQIS exhibited better quality of life for the emotional domain than those assigned to SOC (OR=1.115, p=0.016). Pts who showed the greatest improvement were the older (OR=1.003, p=0.035), had lower anxiety basal levels (OR=0.853, p<0.001), and social needs were met (OR=1.182, p<0.001). The difference was not significant for the social domain (OR=0.955, p=0.353). The HQIS’s long-term effect was confirmed for the emotional domain at 12 months. No effect on mood (HADS-D) and overall HRQoL was observed. Conclusions: To our knowledge this is the first RCT demonstrating the effectiveness of a psychosocial care implementation strategy on cancer patients’ emotional well-being. Clinical trial information: NCT03008993.
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Affiliation(s)
| | - Elisa Iezzi
- Azienda Ospedaliero Universitaria, Parma, Italy
| | | | - Claudio Verusio
- Department of Oncology, ASST Valle Olona, Busto Arsizio, Italy
| | - Carmine Pinto
- Medical Oncology Unit. Clinical Cancer Center. AUSL-IRCCS Reggio Emilia, Reggio Emilia, Italy
| | - Mario Airoldi
- 2nd Medical Oncology Division, A. O. Città della Salute e della Scienza di Torino, Torino, Italy
| | | | | | - Saverio Cinieri
- European Institute of Oncology (IRCCS), Milan, and San Antonio Perrino Hospital, Brindisi, Italy
| | | | - Stefania Gori
- Oncology Unit, Ospedale Sacro Cuore-don Calabria, Negrar, Italy
| | | | - Silvia Novello
- Department of Oncology, University of Turin, Orbassano, Italy
| | - Antonio Pazzola
- Medical Oncology - Ospedale Civile SS. Annunziata, Sassari, Italy
| | - Giuseppe Procopio
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Antonio Russo
- Unit of Medical Oncology - Department of Oncology - AOUP, Palermo, Italy
| | - Cosimo Sacco
- Dipartimento di Oncologia, Azienda Ospedaliero-Universitaria S. M. della Misericordia, Udine, Italy
| | - Giuseppina Sarobba
- "UOC Oncologia Ospedale San Francesco ATS Sardegna ASSL Nuoro", Nuoro, Italy
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Rossi A, Marconi M, Mannarini S, Minelli I, Fusi C, Anderboni M, Rossini C, Di Lucca G, Verusio C. Profiling cancer-related distress and problems: A latent class analysis approach. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e23191] [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
e23191 Background: Psychological distresses, emotional troubles, social difficulties as well as both physical and practical issues are all among oppressive problems that oncological patients have to face almost every day. On one hand, these problems seem to have a strong impact on quality of life; and to the other hand, these issues seem to be related to specific cancer-related variables ( e.g.: type and localization of the tumor). Thus, the aim of the study was to use a Latent Class Analysis (LCA) approach to profile a latent structure accounting for the covariance between psychological distress and everyday problems due to cancer. A one-factor model with three classes was hypothesized, which comprised distress and cancer-related problems as indicators and age, type of medical treatment as well as type and localization of tumor as external variables that moderate the latent structure. Methods: Patients ( N = 264, 62.3% female, mean age = 65.3, SD = 12.4) were enrolled at the Oncology Day Hospital, “Presidio Ospedaliero” of Saronno, ASST Valle Olona, Italy. Using the standardized Distress Thermometer and Problem List (TD&PL; NCCN, 2015) patients were tested for: (A) distress; (B) practical problems (Cronbach’s α = .63); (C) social difficulties (Cronbach’s α = .65); (D) emotional issues (Cronbach’s α = .86) and (E) physical problems (Cronbach’s α = .77). Results: First of all, a CFA was performed to test the original factorial structure of the DT&PL. The original five factor solution was supported by adequate fit indices: RMSEA = .063; CFI = .924. Then, the LCA (10000 bootstrap resampling) shows the goodness-of-model fit [χ2 = 10.01; p = .11; LRχ2 = 9.30; p = .09] and the goodness-of-classification quality [Entropy = .80 ( > .7); Average-Latent-Class-Assignment-Probability: .975, .900, and .902 for Class1, Class2, and Class3, respectively]. The LCA identified a latent variable with three classes (VLMR = 193.38; p < .001; Class1 = .49%; Class2 = .23%, and Class3 = .28%). In addition, interactions with the latent variable were found for age ( β = .12; p = .039), type of medical treatment ( β = .29; p = .009), as well as type and localization of tumor ( β = .20; p = .025). Conclusions: These results provided a better understand of psychological distress and cancer-related issues: each class represents a specific “profile” – moderated by age, type of medical treatment, and type and localization of tumor. These results recommend paying more attention to the specific profile expressed by the patient suggesting new ways to improve their quality of life.
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Affiliation(s)
- Alessandro Rossi
- Department of Philosophy, Sociology, Education, and Applied Psychology, Section of Applied Psychology, University of Padova, Padova, Italy
| | - Maria Marconi
- Department of Medical Oncology, ASST Valle Olona, Presidio Ospedaliero di Saronno, Saronno, Italy
| | - Stefania Mannarini
- Department of MedicaDepartment of Philosophy, Sociology, Education, and Applied Psychology, Section of Applied Psychology, University of Padova, Padova, Italy
| | - India Minelli
- Department of Medical Oncology, Presidio Ospedaliero di Saronno, ASST Valle Olona, Saronno, Italy
| | - Chiara Fusi
- Department of Medical Oncology, Presidio Ospedaliero di Saronno, ASST Valle Olona, Saronno, Italy
| | - Monica Anderboni
- Department of Medical Oncology, Presidio Ospedaliero di Saronno, ASST Valle Olona, Saronno, Italy
| | - Chiara Rossini
- Department of Medical Oncology, ASST Valle Olona, Presidio Ospedaliero di Saronno, Saronno, Italy
| | | | - Claudio Verusio
- Department of Oncology, ASST Valle Olona, Busto Arsizio, Italy
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De Giorgi U, Procopio G, Sabbatini R, Caserta C, Mitterer M, Ortega C, Scoppola A, Fornarini G, Ferraú F, Marchetti P, Verusio C, Mini E, Bidoli P, Buti S, Crino L, Basso U, Frassoldati A, Bearz A, Carteni G, Sternberg CN. Association of body mass index and systemic inflammation index with survival in patients with renal cell cancer treated with nivolumab. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e16077] [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
e16077 Background: Body mass index (BMI) and inflammation indexes are easily evaluated, predict survival in many tumors, and are potentially modifiable. The "obesity paradox" of longer survival in cancer patients with high BMI has been explained by altered fatty acid pathways, which could have an impact in immune-inflammatory function, and leptin-driven increase in T cell aging resulting in higher PD-1 expression and dysfunction, which leaves tumors notably more sensitive to checkpoint blockade. We evaluated the potential association of inflammatory indexes and BMI with the clinical outcome of metastatic renal cell carcinoma (mRCC) undergoing immune checkpoint inhibitor therapy. Methods: A prospective cohort of patients with mRCC treated with nivolumab enrolled in the Italian Expanded Access Program (EAP) from July 2015 through April 2016 was examined. Reference measures of inflammation were identified for neutrophil to lymphocyte ratio (NLR) < /≥3, systemic immune-inflammation index (SII) < /≥3 and platelet to lymphocyte ratio (PLR) < /≥232. Patients were classified as high BMI (≥25 kg/m2) versus normal BMI ( < 25 kg/m2). Results: Among 313 evaluable patients, 289 (75.1%) were male, median age was 65 years (range, 40 to 84), with 105 (24.9%) ≥70 years. In univariate analysis, age ≥70 years, performance status, BMI, SII, NLR and PLR were able to predict outcome. In multivariate analyses, SII ≥1375, BMI < 25 and age ≥70 years independently predicted OS (HR, 2.96; 95% CI, 2.05-4.27; HR, 1.59; 95% CI, 1.10-2.30 and HR, 1.65; 95% CI, 1.07-2.55, respectively). Under the model of independent effects, a patient with both SII ≥1375 and BMI < 25 was estimated to have much worse OS (HR, 3.37; 95% CI, 2.29-4.95, p < 0.0001) than a patient with neither or only one risk factor. SII changes at 3 months predicted OS (P < 0.0001). Conclusions: BMI combined with inflammation tripled the risk of death, suggesting that these biomarkers are critical prognostic factors for OS in patients with mRCC treated with nivolumab.
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Affiliation(s)
- Ugo De Giorgi
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Giuseppe Procopio
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | | | | | | | | | | | | | - Francesco Ferraú
- Medical Oncology Department, Ospedale S Vincenzo, Taormina, Italy
| | - Paolo Marchetti
- Department of Medical Oncology Sant’Andrea University Hospital, Rome, Italy
| | - Claudio Verusio
- Department of Oncology, ASST Valle Olona, Busto Arsizio, Italy
| | - Enrico Mini
- Section of Clinical Pharmacology and Oncology, Department of Health Sciences, University of Florence, Florence, Italy
| | - Paolo Bidoli
- Azienda Socio Sanitaria Territoriale-ASST di Monza, Monza, Italy
| | - Sebastiano Buti
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Lucio Crino
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Umberto Basso
- Oncologia 1 - Istituto Oncologico Veneto IOV - IRCCS, Padova, Italy
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26
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De Giorgi U, Procopio G, Giannarelli D, Sabbatini R, Bearz A, Buti S, Basso U, Mitterer M, Ortega C, Bidoli P, Ferraù F, Crinò L, Frassoldati A, Marchetti P, Mini E, Scoppola A, Verusio C, Fornarini G, Cartenì G, Caserta C, Sternberg CN. Association of Systemic Inflammation Index and Body Mass Index with Survival in Patients with Renal Cell Cancer Treated with Nivolumab. Clin Cancer Res 2019; 25:3839-3846. [PMID: 30967420 DOI: 10.1158/1078-0432.ccr-18-3661] [Citation(s) in RCA: 132] [Impact Index Per Article: 26.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 02/06/2019] [Accepted: 04/03/2019] [Indexed: 12/26/2022]
Abstract
PURPOSE Inflammation indexes and body mass index (BMI) are easily evaluated, predict survival, and are potentially modifiable. We evaluated the potential association of inflammatory indexes and BMI with the clinical outcome of patients with renal cell carcinoma (RCC) undergoing immune checkpoint inhibitor therapy. EXPERIMENTAL DESIGN A prospective cohort of patients with metastatic RCC treated with nivolumab enrolled in the Italian Expanded Access Program from July 2015 through April 2016 was examined. Reference measures of inflammation were identified for neutrophil-to-lymphocyte ratio (NLR) </≥ 3, systemic immune inflammation index (SII) </≥ 1,375, and platelet-to-lymphocyte ratio (PLR) </≥ 232. Patients were classified as high BMI (≥25 kg/m2) versus normal BMI (<25 kg/m2). RESULTS Among 313 evaluable patients, 235 (75.1%) were male, and median age was 65 years (range, 40-84 years), with 105 (33.69%) ≥70 years. In univariate analysis, age, performance status, BMI, SII, NLR, and PLR were able to predict outcome. In multivariate analyses, SII ≥1,375, BMI <25 kg/m2, and age ≥70 years independently predicted overall survival [OS; HR = 2.96, 95% confidence interval (CI), 2.05-4.27; HR = 1.59, 95% CI, 1.10-2.30; and HR = 1.65, 95% CI, 1.07-2.55, respectively). A patient with both SII ≥1,375 and BMI <25 kg/m2 was estimated to have much worse OS (HR, 3.37; 95% CI, 2.29-4.95; P <0.0001) than a patient with neither or only one risk factor. SII changes at 3 months predicted OS (P <0.0001). CONCLUSIONS Normal BMI combined with inflammation tripled the risk of death, suggesting that these biomarkers are critical prognostic factors for OS in patients with RCC treated with nivolumab.
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Affiliation(s)
- Ugo De Giorgi
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy.
| | - Giuseppe Procopio
- Department of Medical Oncology, Istituto Nazionale dei Tumori IRCCS, Milan, Italy
| | - Diana Giannarelli
- Department of Statistics, Regina Elena National Cancer Institute IRCCS, Rome, Italy
| | | | - Alessandra Bearz
- Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | | | - Umberto Basso
- Department of Medical Oncology, Istituto Oncologico Veneto (IOV) IRCCS, Padua, Italy
| | - Manfred Mitterer
- Department of Medical Oncology, Ospedale "Franz Tappeiner," Merano, Italy
| | - Cinzia Ortega
- Department of Medical Oncology, Ospedale S. Lazzaro ASL CN2 Alba-Bra, Cuneo, Italy
| | - Paolo Bidoli
- Department of Medical Oncology, Ospedale San Gerardo, Monza, Italy
| | - Francesco Ferraù
- Department of Medical Oncology, Ospedale "S. Vincenzo," Taormina, Italy
| | - Lucio Crinò
- Department of Medical Oncology, AO Perugia, Perugia, Italy
| | | | - Paolo Marchetti
- Department of Medical Oncology, Ospedale Sant'Andrea, Rome, Italy
| | - Enrico Mini
- Department of Oncology, Careggi University Hospital, Florence, Italy
| | - Alessandro Scoppola
- Department of Medical Oncology, Istituto Dermopatico dell'Immacolata, Rome, Italy
| | - Claudio Verusio
- Department of Medical Oncology, P.O. di Saronno, Varese, Italy
| | | | - Giacomo Cartenì
- Department of Medical Oncology, AO "A. Cardarelli," Naples, Italy
| | - Claudia Caserta
- Department of Medical Oncology, AOU Santa Maria, Terni, Italy
| | - Cora N Sternberg
- Englander Institute for Precision Medicine, Weill Cornell Medicine, New York, New York
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Gelsomino F, Tiseo M, Boni L, Cavanna L, Camerini A, Chiari R, Verusio C, Tognetto M, Ardizzoni A. An open-label, randomized phase III study of early switch maintenance vs delayed second-line nivolumab in advanced stage squamous non-small cell lung cancer (NSCLC) patients after standard first-line platinum-based chemotherapy: EDEN trial. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz063.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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28
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Di Bartolomeo M, Niger M, Morano F, Corallo S, Antista M, Tamberi S, Lonardi S, Di Donato S, Berardi R, Scartozzi M, Cardellino GG, Di Costanzo F, Rimassa L, Luporini AG, Longarini R, Zaniboni A, Bertolini A, Tomasello G, Pinotti G, Scagliotti G, Tortora G, Bonetti A, Spallanzani A, Frassineti GL, Tassinari D, Giuliani F, Cinieri S, Maiello E, Verusio C, Bracarda S, Catalano V, Basso M, Ciuffreda L, De Vita F, Parra HS, Fornaro L, Caporale M, de Braud F, Pietrantonio F. Assessment of Ramucirumab plus paclitaxel as switch maintenance versus continuation of first-line chemotherapy in patients with advanced HER-2 negative gastric or gastroesophageal junction cancers: the ARMANI phase III trial. BMC Cancer 2019; 19:283. [PMID: 30922323 PMCID: PMC6440108 DOI: 10.1186/s12885-019-5498-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 09/24/2018] [Accepted: 03/20/2019] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Platinum/fluoropyrimidine regimens are the backbone of first-line chemotherapy for advanced gastric cancer (AGC). However response rates to first line chemotherapy range from 30 to 50% and disease progression occurs after 4-6 cycles. The optimal duration of first-line therapy is still unknown and its continuation until disease progression represents the standard. However this strategy is often associated with cumulative toxicity and rapid development of drug resistance. Moreover, only about 40% of AGC pts. are eligible for second-line treatment. METHODS This is a randomized, open-label, multicenter phase III trial. It aims at assessing whether switch maintenance to ramucirumab plus paclitaxel will extend the progression-free survival (PFS) of subjects with HER-2 negative AGC who have not progressed after 3 months of a first-line with a platinum/fluoropyrimidine regimen (either FOLFOX4, mFOLFOX6 or XELOX). The primary endpoint is to compare Progression-Free Survival (PFS) of patients in ARM A (switch maintenance to ramucirumab and placlitaxel) versus ARM B (continuation of the same first-line therapy with oxaliplatin/fluoropyrimidine). Secondary endpoints are: overall survival, time-to-treatment failure, overall response rate, duration of response, percentage of patients that will receive a second line therapy according to arm treatment, safety, quality of life. Exploratory studies including Next-Generation Sequencing (NGS) in archival tumor tissues are planned in order to identify potential biomarkers of primary resistance and prognosis. DISCUSSION The ARMANI study estimates if patients treated with early swich with ramucirumab plus paclitaxel received benefit when compared to those treated with continuation of first line therapy. The hypothesis is that the early administration of an active, non-cross resistant second-line regimen such as ramucirumab plus paclitaxel may prolong the time in which patients are progression-free, and consequently have a better quality of life. Moreover, this strategy may rescue all those subjects that become ineligible for second-line therapy due to the rapid deterioration of health status after the first disease progression. TRIAL REGISTRATION ARMANI is registered at ClinicalTrials.gov ( NCT02934464 , October 17, 2016) and EudraCT(2016-001783-12, April 202,016).
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Affiliation(s)
- Maria Di Bartolomeo
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Tumori, via G. Venezian, 1, 20133 Milan, Italy
| | - Monica Niger
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Tumori, via G. Venezian, 1, 20133 Milan, Italy
| | - Federica Morano
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Tumori, via G. Venezian, 1, 20133 Milan, Italy
| | - Salvatore Corallo
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Tumori, via G. Venezian, 1, 20133 Milan, Italy
| | - Maria Antista
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Tumori, via G. Venezian, 1, 20133 Milan, Italy
| | - Stefano Tamberi
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), Ravenna Viale Randi, 5, 48121 Ravenna, Italy
| | - Sara Lonardi
- Department of Medical Oncology, IOV Istituto Oncologico Veneto, Via Gattamelata, 64, 35128 Padova, PD Italy
| | - Samantha Di Donato
- Sandro Pitigliani Medical Oncology Department, Nuovo Ospedale di Prato, Via Suor Niccolina Infermiera, 20, 59100 Prato, Italy
| | - Rossana Berardi
- Department of Medical Oncology, AOU Ospedali Riuniti Di Ancona, via Corridoni, 11, 60123 Ancona, Italy
| | - Mario Scartozzi
- Department of Medical Oncology, AOU Cagliari, Via Ospedale, 54, 09124 Cagliari, Italy
| | - Giovanni Gerardo Cardellino
- Department of Medical Oncology, Azienda Sanitaria Universitaria Integrata di Udine, Via Pozzuolo, 330 – 33100, piazzale Santa Maria della misericordia 15, 33100 Udine, Udine Italy
| | - Francesco Di Costanzo
- Department of Medical Oncology, AOU Careggi di Firenze, Largo Brambilla, 3, 50134 Florence, Italy
| | - Lorenza Rimassa
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, Humanitas Clinical and Research Center, Via Alessandro Manzoni, 56, 20089 Rozzano, Milan Italy
| | - Alberto Gianluigi Luporini
- Department of Medical Oncology, IRCCS Policlinico San Donato, Piazza Edmondo Malan, 2, 20097 San Donato Milanese, MI Italy
| | - Raffaella Longarini
- Department of Medical Oncology, Ospedale San Gerardo, Via G. B. Pergolesi, 33, 20900 Monza, Italy
| | - Alberto Zaniboni
- Department of Medical Oncology, Fondazione Poliambulanza, Via Leonida Bissolati, 57, 25124 Brescia, Italy
| | - Alessandro Bertolini
- Department of Medical Oncology, ASST della Valtellina e dell’Alto Lario, Via Stelvio, 25, 23100 Sondrio, Italy
| | - Gianluca Tomasello
- Department of Medical Oncology, Ospedale di Cremona, Viale Concordia, 1, 26100 Cremona, Italy
| | - Graziella Pinotti
- Department of Medical Oncology, Ospedale di Circolo e Fondazione Macchi, Viale Luigi Borri, 57, 21100 Varese, Italy
| | - Giorgio Scagliotti
- Department of Medical Oncology, AOU San Luigi Gonzaga, Regione Gonzole, 10, 10043 Orbassano, Torino Italy
| | - Giampaolo Tortora
- Department of Medical Oncology, AOUI Verona Ospedale Policlinico ‘Giambattista Rossi’ di Borgo Roma, Piazzale L.A. Scuro, 10, 37134 Verona, VR Italy
| | - Andrea Bonetti
- Department of Medical Oncology, Ospedale Mater Salutis, Via Carlo Gianella, 1, 37045 Legnago, Verona, Italy
| | - Andrea Spallanzani
- Department of Medical Oncology, AOU di Modena, Via Emilia Est, 583-585, 41122 Modena, MO Italy
| | - Giovanni Luca Frassineti
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, via P. Maroncelli, 40, 47014 Meldola, Italy
| | - Davide Tassinari
- Department of Medical Oncology, Ospedale degli infermi di Rimini, Viale L. Settembrini, 2, 47923 Rimini, Italy
| | - Francesco Giuliani
- Department of Medical Oncology, I.R.C.C.S. Istituto Tumori Bari, Viale Orazio Flacco, 65, 70124 Bari, Italy
| | - Saverio Cinieri
- Department of Medical Oncology, Ospedale A. Perrino di Brindisi, Strada Statale 7 per Mesagne, 72100 Brindisi, Italy
| | - Evaristo Maiello
- Department of Medical Oncology, Casa Sollievo della Sofferenza, Viale Cappuccini, 1, 71013 San Giovanni Rotondo, FG Italy
| | - Claudio Verusio
- Department of Medical Oncology, ASST Valle Olona, PO Saronno Piazzale Borella 1, 21047 Saronno, Varese Italy
| | - Sergio Bracarda
- Department of Medical Oncology, Ospedale San Donato, Azienda USL Toscana Sudest Via Pietro Nenni, 20/22, 52100 Arezzo, Italy
| | - Vincenzo Catalano
- Department of Medical Oncology, Azienda Ospedaliera “Ospedali Riuniti Marche Nord”, Piazzale Cinelli, 4, 61121 Pesaro, Italy
| | - Michele Basso
- Department of Medical Oncology, Fondazione Policlinico Universitario “A. Gemelli” - IRCCS, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli, 8, 00168 Rome, Italy
| | - Libero Ciuffreda
- Department of Medical Oncology, A.O.U. Citta della Salute e della Scienza di Torino, H Molinette, corso Bramante, 88, 10126 Torino, Italy
| | - Ferdinando De Vita
- Division of Medical Oncology, Department of Precision Medicine, University of Campania ‘Luigi Vanvitelli’ - School of Medicine, Via S.Pansini, 5, 80131 Naples, Italy
| | - Hector Soto Parra
- Department of Medical Oncology, P.O. G. Rodolico, Via Plebiscito, 628 Catania, Italy
| | - Lorenzo Fornaro
- Department of Medical Oncology, AOU Pisana, Polo Oncologico - Osp. S. Chiara, via Roma 67, 56100 Pisa, Italy
| | - Marta Caporale
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Tumori, via G. Venezian, 1, 20133 Milan, Italy
| | - Filippo de Braud
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Tumori, via G. Venezian, 1, 20133 Milan, Italy
- Department of Hematology-Oncology, University Milan, Milan, Italy
| | - Filippo Pietrantonio
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Tumori, via G. Venezian, 1, 20133 Milan, Italy
- Department of Hematology-Oncology, University Milan, Milan, Italy
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Digiacomo N, Bolzacchini E, Veronesi G, Cerutti R, Sahnane N, Pinotti G, Bregni M, Artale S, Verusio C, Crivelli F, Capella C, Sessa F, Furlan D. Neuroendocrine Differentiation, Microsatellite Instability, and Tumor-infiltrating Lymphocytes in Advanced Colorectal Cancer With BRAF Mutation. Clin Colorectal Cancer 2018; 18:e251-e260. [PMID: 30638691 DOI: 10.1016/j.clcc.2018.12.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 12/10/2018] [Accepted: 12/14/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Approximately 10% of metastatic colorectal cancer (mCRC) cases will harbor the BRAF p.V600E mutation (BRAF-mCRC) and have been associated with a poor prognosis. Although they are usually considered a unique clinical entity, biologic heterogeneity has been described. We performed an extensive clinicopathologic study of a multicenter series of BRAF-mCRC to highlight differences between tumors with microsatellite instability (MSI) and microsatellite stable tumors, focusing on both inflammatory profiles and neuroendocrine differentiation. METHODS We included 59 BRAF-mCRC cases and collected the clinical data (ie, surgery, treatment, and follow-up). We evaluated MSI status, budding, lympho-angioinvasion, neuroinvasion, extent of active stroma, CD3+ and CD8+ intratumoral and peritumoral lymphocytes, programmed cell death ligand 1, p53, Ki-67, synaptophysin, and CDX2 expression. RESULTS The 22 MSI BRAF-mCRC cases were associated with the right side (P < .0001), an expansive grown pattern (P < .01), programmed cell death ligand 1 expression (P < .0001), high CD8 T-cell content (P = .0001), and lymph node metastases (P < .029). The 37 MSS BRAF-mCRC cases were characterized by a greater stromal component (P = .0002), pulmonary metastases (P = .095), and p53 and synaptophysin immunoreactivity (P = .004 and P = .001, respectively). Univariate analysis demonstrated that MSI and a high CD8 T-cell content were associated with a 34% (hazard ratio [HR], 0.66; 95% confidence interval [CI], 0.34-1.28; P = .2) and 33% (HR, 0.67; 95% CI, 0.45-0.99; P = .04) reduction in the risk of death, respectively. The combined presence of MSI and CD8 T-cell content decreased the hazard of mortality ≤ 63% (HR, 0.37; 95% CI, 0.14-0.97; P = .2), which was slightly reduced after multivariate analysis. CONCLUSION A simultaneous evaluation of MSI, CD8 T-cell content, and neuroendocrine markers could allow for the identification of subsets of BRAF-mCRC with a different prognosis and potential eligibility for specific treatments.
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Affiliation(s)
- Nunzio Digiacomo
- Unit of Pathology, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | | | - Giovanni Veronesi
- Research Center in Epidemiology and Preventive Medicine (EPIMED), Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Roberta Cerutti
- Unit of Pathology, Department of Medicine and Surgery, University of Insubria, Varese, Italy; Research Center for the Study of Hereditary and Familial Tumors, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Nora Sahnane
- Unit of Pathology, Department of Medicine and Surgery, University of Insubria, Varese, Italy; Research Center for the Study of Hereditary and Familial Tumors, Department of Medicine and Surgery, University of Insubria, Varese, Italy.
| | | | - Marco Bregni
- Unit of Oncology, ASST Valle Olona, Varese, Italy
| | | | | | | | - Carlo Capella
- Unit of Pathology, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Fausto Sessa
- Unit of Pathology, Department of Medicine and Surgery, University of Insubria, Varese, Italy; Research Center for the Study of Hereditary and Familial Tumors, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Daniela Furlan
- Unit of Pathology, Department of Medicine and Surgery, University of Insubria, Varese, Italy; Research Center for the Study of Hereditary and Familial Tumors, Department of Medicine and Surgery, University of Insubria, Varese, Italy
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30
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Cazzaniga M, Verusio C, Ciccarese M, Fumagalli A, Sartori D, Valerio MR, Airoldi M, Moretti G, Ficorella C, Arcangeli V, Diodati L, Zambelli A, Febbraro A, Generali D, Pistelli M, Garrone O, Musolino A, Vici P, Maur M, Mentuccia L, La Verde N, Bianchi G, Artale S, Blasi L, Piezzo M, Atzori F, Turletti A, Benedetto C, Cursano MC, Fabi A, Gebbia V, Schirone A, Palumbo R, Ferzi A, Frassoldati A, Scavelli C, Clivio L, Torri V. Correction 2: Everolimus (EVE) and exemestane (EXE) in patients with advanced breast cancer aged ≥ 65 years: new lessons for clinical practice from the EVA study. Oncotarget 2018; 9:36720-36721. [PMID: 30613355 PMCID: PMC6291174 DOI: 10.18632/oncotarget.26431] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Marina Cazzaniga
- Research Unit Phase I trials, ASST Monza, Monza, Italy.,Oncology Unit, ASST Monza, Monza, Italy
| | - Claudio Verusio
- Oncology Unit, ASST della Valle Olona-Presidio Ospedaliero di Saronno, Saronno, Italy
| | | | | | | | | | - Mario Airoldi
- Oncology Unit 2-Città della Salute e della Scienza di Torino, Torino, Italy
| | - Gabriella Moretti
- Oncology Unit, IRCCS Arcispedale S. Maria Nuova, Reggio Emilia, Italy
| | - Corrado Ficorella
- Dipartimento di Scienze Cliniche Applicate e Biotecnologiche (DISCAB)-Università Degli Studi Dell'Aquila, L'Aquila, Italy
| | | | - Lucrezia Diodati
- Oncology Unit 2, Azienda Osp edaliera Universitaria Pisa via Roma 67, Pisa, Italy
| | | | - Antonio Febbraro
- Oncology Unit, Ospedale Sacro Cuore di Gesù, Fatebenefratelli, Benevento, Italy
| | | | - Mirco Pistelli
- Oncology Unit, AOU Ospedali Riuniti Umberto I-GM Lancisi-G Salesi, Ancona, Italy
| | - Ornella Garrone
- Oncology Unit, AOS Croce e Carle Ospedale di Insegnamento, Cuneo, Italy
| | - Antonino Musolino
- Oncology Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Patrizia Vici
- Oncology Unit 2, Istituto Nazionale Tumori Regina Elena-IFO, Roma, Italy
| | - Michela Maur
- Oncology Unit, Policlinico University Hospital of Modena, Modena, Italy
| | - Lucia Mentuccia
- Oncology Unit, ASL di Frosinone Osp. "SS. Trinità", Sora, Italy
| | - Nicla La Verde
- Oncology Unit, ASST Fatebenefratelli Sacco Presidio Ospedaliero Fatebenefratelli, Milano, Italy
| | - Giulia Bianchi
- Oncology Unit 1, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - Salvatore Artale
- Oncology Departement, Ospedale di Gallarate ASST Valle Olona, Gallarate, Italy
| | - Livio Blasi
- Oncology Unit, ARNAS Civico Palermo, Palermo, Italy
| | - Michela Piezzo
- National Cancer Institute "Fondazione Giovanni Pascale", Napoli, Italy
| | - Francesco Atzori
- Struttura Complessa di Oncologia Medica Azienda Ospedaliero-Universitaria Cagliari, Cagliari, Italy
| | - Anna Turletti
- Oncology Unit, Ospedale Martini della ASL Città di Torino, Torino, Italy
| | - Chiara Benedetto
- Dipartimento Universitario Ginecologia e Ostetricia 1, Ospedale S. Anna Torino, Turin, Italy
| | | | | | | | - Alessio Schirone
- Oncolgy Department, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | | | - Antonella Ferzi
- Oncology Unit, ASST OVEST Milanese, Presidio di Legnano, Legnano, Italy
| | | | | | - Luca Clivio
- IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri", Milano, Italy
| | - Valter Torri
- IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri", Milano, Italy
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Cazzaniga M, Verusio C, Ciccarese M, Fumagalli A, Sartori D, Valerio MR, Ancona C, Airoldi M, Moretti G, Ficorella C, Arcangeli V, Diodati L, Zambelli A, Febbraro A, Generali D, Pistelli M, Garrone O, Musolino A, Vici P, Maur M, Mentuccia L, La Verde N, Bianchi G, Artale S, Blasi L, Piezzo M, Atzori F, Turletti A, Benedetto C, Cursano MC, Fabi A, Gebbia V, Schirone A, Palumbo R, Ferzi A, Frassoldati A, Scavelli C, Clivio L, Torri On Behalf Of The Eva Study Group V. Everolimus (EVE) and exemestane (EXE) in patients with advanced breast cancer aged ≥ 65 years: new lessons for clinical practice from the EVA study. Oncotarget 2018; 9:31877-31887. [PMID: 30159129 PMCID: PMC6112755 DOI: 10.18632/oncotarget.25874] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 04/02/2018] [Accepted: 07/12/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The present analysis focuses on real-world data of Everolimus-Exemestane in advanced HR+ve, HER2-ve elderly breast cancer patients (aged 65 years) included in the EVA study, with unique findings in those aged 70 years. METHODS Data are collected from clinical records and analysed according to age cut-off (< 65 years; 65 - 69 years and {greater than or equal to} 70 years). Relationship of analyzed variables with response were tested by mean of a Mantel-Haenszel chi square test. Time to event analysis was described by Kaplan Meier approach and association with baseline characteristics was analysed by stratified log-rank test and proportional hazard model. RESULTS From July 2013 to December 2015, the EVA study enrolled overall 404 pts. 154 patients out of 404 (38,1%) were aged {greater than or equal to} 65 years, of whom 87 were {greater than or equal to} 70 years. Median duration of EVE treatment was 28.5 weeks (95% CI 19.0 - 33.8) in patients aged 65-69 years and 24,4 weeks (95% CI 19,2 - 33,2) in those aged {greater than or equal to} 70 years. Fewer patients aged 65 years received the highest EVE Dose-Intensity (>7.5 mg/day) in comparison to younger patients (49,6% vs. 66,8%). Grade 3–4 toxicities occurred to 55 patients (35,7%), mainly stomatitis (10,9%), rash (5,8%) and non-infectious pneumonitis (NIP) (3,6%). Some toxicities, such as weight loss and anaemia were peculiarly observed in patients aged {greater than or equal to} 70 years. Five treatment-related deaths were collected (3,2%). CONCLUSIONS EVE-EXE combination remains one of the potential treatments in HR+ patients also for elderly ones.
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Affiliation(s)
- Marina Cazzaniga
- Research Unit Phase I trials, ASST Monza, Monza, Italy.,Oncology Unit, ASST Monza, Monza, Italy
| | - Claudio Verusio
- Oncology Unit, ASST della Valle Olona-Presidio Ospedaliero di Saronno, Saronno, Italy
| | | | | | | | | | - Cristina Ancona
- Oncology Department, Policlinico di Palermo Paolo Giaccone, Palermo, Italy
| | - Mario Airoldi
- Oncology Unit 2-Città della Salute e della Scienza di Torino, Torino, Italy
| | - Gabriella Moretti
- Oncology Unit, IRCCS Arcispedale S. Maria Nuova, Reggio Emilia, Italy
| | - Corrado Ficorella
- Dipartimento di Scienze Cliniche Applicate e Biotecnologiche (DISCAB)-Università Degli Studi Dell'Aquila, L'Aquila, Italy
| | | | - Lucrezia Diodati
- Oncology Unit 2, Azienda Osp edaliera Universitaria Pisa via Roma 67, Pisa, Italy
| | | | - Antonio Febbraro
- Oncology Unit, Ospedale Sacro Cuore di Gesù, Fatebenefratelli, Benevento, Italy
| | | | - Mirco Pistelli
- Oncology Unit, AOU Ospedali Riuniti Umberto I-GM Lancisi-G Salesi, Ancona, Italy
| | - Ornella Garrone
- Oncology Unit, AOS Croce e Carle Ospedale di Insegnamento, Cuneo, Italy
| | - Antonino Musolino
- Oncology Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Patrizia Vici
- Oncology Unit 2, Istituto Nazionale Tumori Regina Elena-IFO, Roma, Italy
| | - Michela Maur
- Oncology Unit, Policlinico University Hospital of Modena, Modena, Italy
| | - Lucia Mentuccia
- Oncology Unit, ASL di Frosinone Osp. "SS. Trinità", Sora, Italy
| | - Nicla La Verde
- Oncology Unit, ASST Fatebenefratelli Sacco Presidio Ospedaliero Fatebenefratelli, Milano, Italy
| | - Giulia Bianchi
- Oncology Unit 1, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - Salvatore Artale
- Oncology Departement, Ospedale di Gallarate ASST Valle Olona, Gallarate, Italy
| | - Livio Blasi
- Oncology Unit, ARNAS Civico Palermo, Palermo, Italy
| | - Matilde Piezzo
- National Cancer Institute "Fondazione Giovanni Pascale", Napoli, Italy
| | - Francesco Atzori
- Struttura Complessa di Oncologia Medica Azienda Ospedaliero-Universitaria Cagliari, Italy
| | - Anna Turletti
- Oncology Unit, Ospedale Martini della ASL Città di Torino, Torino, Italy
| | - Chiara Benedetto
- Dipartimento Universitario Ginecologia e Ostetricia 1, Ospedale S. Anna Torino, Turin, Italy
| | | | | | | | - Antonio Schirone
- Oncolgy Department, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | | | - Antonella Ferzi
- Oncology Unit, ASST OVEST Milanese, Presidio di Legnano, Legnano, Italy
| | | | | | - Luca Clivio
- IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri", Milano, Italy
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DeCensi A, Numico G, Ballatori E, Artioli F, Clerico M, Fioretto L, Livellara V, Ruggeri B, Tomirotti M, Verusio C, Roila F. Conflict of interest among Italian medical oncologists: a national survey. BMJ Open 2018; 8:e020912. [PMID: 29961019 PMCID: PMC6042593 DOI: 10.1136/bmjopen-2017-020912] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 04/03/2018] [Accepted: 05/04/2018] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES To assess Italian medical oncologists' opinion on the implications of conflict of interest (COI) on medical education, care and research, and to evaluate their direct financial relationships. DESIGN National cross-sectional survey conducted between March and April 2017 among Italian oncologists. SETTING Online survey sponsored by the Italian College of Medical Oncology Chiefs through its website. PARTICIPANTS Italian oncologists who filled out an anonymous questionnaire including 19 items and individual and working characteristics. MAIN OUTCOME MEASURE The proportion of medical oncologists perceiving COI as an outstanding issue and those receiving direct payments from industry. RESULTS There were 321 respondents, representing 13% of Italian tenured medical oncologists. Overall, 62% declared direct payments from the pharmaceutical industry in the last 3 years. Sixty-eight per cent felt the majority of Italian oncologists have a COI with industry, but 59% suppose this is not greater than that of other specialties. Eighty-two per cent consider that most oncology education is supported by industry. More than 75% believe that current allocation of industry budget on marketing and promotion rather than research and development is unfair, but 75% consider it appropriate to receive travel and lodging hospitality from industry. A median net profit margin of €5000 per patient enrolled in an industry trial was considered appropriate for the employee institution. Sixty per cent agree to receive a personal fee for patients enrolled in industry trials, but 79% state this should be reported in the informed consent. Over 90% believe that scientific societies should publish a financial report of industry support. Finally, 79% disagree to being a coauthor of an article written by a medical writer when no substantial scientific contribution is made. CONCLUSIONS Among Italian oncologists COI is perceived as an important issue influencing costs, education, care and science. A more rigorous policy on COI should be implemented.
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Affiliation(s)
- Andrea DeCensi
- Division of Medical Oncology, Galliera Hospital, Genova, Italy
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Gianmauro Numico
- Division of Medical Oncology, SS Antonio e Biagio Hospital, Alessandria, Italy
| | | | - Fabrizio Artioli
- Department of Oncology, Carpi and Mirandola Hospitals, Carpi e Mirandola, Italy
| | - Mario Clerico
- Department of Medical Oncology, Hospital of Biella, Biella, Italy
- CIPOMO, Milan, Italy
| | - Luisa Fioretto
- Department of Oncology, SM Annunziata Hospital, Florence, Italy
| | | | - Benedetta Ruggeri
- Clinical Governance, Area Vasta 5, ASUR Marche, Ascoli Piceno, Italy
| | | | - Claudio Verusio
- Division of Medical Oncology, ASST Valle Olona, Saronno, Italy
| | - Fausto Roila
- Division of Medical Oncology, Ospedale Santa Maria, Terni, Italy
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Rossi A, Marconi M, Mannarini S, Minelli I, Rossini C, Morena R, Di Lucca G, Verusio C. Profiling cancer-related needs and the role of physical, practical and psychological difficulties: A latent class analysis approach. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e22161] [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)
- Alessandro Rossi
- Department of Philosophy, Sociology, Education, and Applied Psychology, Section of Applied Psychology, University of Padova, Padova, Italy
| | - Maria Marconi
- Department of Medical Oncology, ASST Valle Olona, Presidio Ospedaliero di Saronno, Saronno, Italy
| | - Stefania Mannarini
- Department of MedicaDepartment of Philosophy, Sociology, Education, and Applied Psychology, Section of Applied Psychology, University of Padova, Padova, Italy
| | - India Minelli
- Department of Medical Oncology, Presidio Ospedaliero di Saronno, ASST Valle Olona, Saronno, Italy
| | - Chiara Rossini
- Department of Medical Oncology, ASST Valle Olona, Presidio Ospedaliero di Saronno, Saronno, Italy
| | - Raffaella Morena
- Department of Medical Oncology, ASST Valle Olona, Presidio Ospedaliero di Saronno, Saronno, Italy
| | | | - Claudio Verusio
- Department of Oncology, ASST Valle Olona, Busto Arsizio, Italy
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Rossi A, Marconi M, Minelli I, Mannarini S, Ratti MM, Rossini C, Di Lucca G, Verusio C. When the loss of spirituality leads to the loss of the path: The moderating role of spirituality in a multiple-step-mediation process from physical suffering to distress. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e22160] [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)
- Alessandro Rossi
- Department of Philosophy, Sociology, Education, and Applied Psychology, Section of Applied Psychology, University of Padova, Padova, Italy
| | - Maria Marconi
- Department of Medical Oncology, ASST Valle Olona, Presidio Ospedaliero di Saronno, Saronno, Italy
| | - India Minelli
- Department of Medical Oncology, Presidio Ospedaliero di Saronno, ASST Valle Olona, Saronno, Italy
| | - Stefania Mannarini
- Department of MedicaDepartment of Philosophy, Sociology, Education, and Applied Psychology, Section of Applied Psychology, University of Padova, Padova, Italy
| | - Maria Monica Ratti
- Department of Medical Oncology, Presidio Ospedaliero di Saronno, ASST Valle Olona, Saronno, Italy
| | - Chiara Rossini
- Department of Medical Oncology, ASST Valle Olona, Presidio Ospedaliero di Saronno, Saronno, Italy
| | - Giuseppe Di Lucca
- Department of Medical Oncology, Presidio Ospedaliero di Saronno, ASST Valle Olona, Saronno, Italy
| | - Claudio Verusio
- Department of Oncology, ASST Valle Olona, Busto Arsizio, Italy
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Bolzacchini E, Cerutti R, Digiacomo N, Sahnane N, Pinotti G, Bregni M, Artale S, Verusio C, Crivelli F, Capella C, Sessa F, Furlan D. Difference in immune infiltration in MSI and MSS BRAF mutant colorectal cancer. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e15624] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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)
| | - Roberta Cerutti
- Anatomic Pathology Unit, Medicine and Surgery Department, University of Insubria, Varese, Italy
| | - Nunzio Digiacomo
- Anatomic Pathology Unit, Medicine and Surgery Department, University of Insubria, Varese, Italy
| | - Nora Sahnane
- Anatomic Pathology Unit, Medicine and Surgery Department, University of Insubria, Varese, Italy
| | | | - Marco Bregni
- Department of Oncology, ASST Valle Olona, Busto Arsizio, Italy
| | | | - Claudio Verusio
- Department of Oncology, ASST Valle Olona, Busto Arsizio, Italy
| | | | - Carlo Capella
- Anatomic Pathology Unit, Medicine and Surgery Department, University of Insubria, Varese, Italy
| | - Fausto Sessa
- Anatomic Pathology Unit, Medicine and Surgery Department, University of Insubria, Varese, Italy
| | - Daniela Furlan
- Anatomic Pathology Unit, Medicine and Surgery Department, University of Insubria, Varese, Italy
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Frustaci S, Buonadonna A, Romanini A, Comandone A, Dalla Palma M, Gamucci T, Verusio C, Lionetto R, Dani C, Casali P, Santoro A. Increasing dose of Continuous Infusion Ifosfamide and Fixed dose of Bolus Epirubicin in Soft Tissue Sarcomas. A Study of the Italian Group on Rare Tumors. Tumori 2018; 85:229-33. [PMID: 10587022 DOI: 10.1177/030089169908500403] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 11/15/2022]
Abstract
Purpose To evaluate the maximum tolerated doses (MTD) of ifosfamide when given as a continuous infusion and in combination with fixed doses of bolus 4′-epidoxorubicin in advanced previously untreated adult soft tissue sarcoma patients. Methods Treatment consisted of epidoxorubicin, 60 mg/m2 days one and two, and ifosfamide, 1.5 g/m2 every 12 hrs as a 72-hr infusion, at the first level. Further levels of ifosfamide were defined as increments of 12 hrs of the same infusion program. G-CSF 300 μg/die was administered from days +7 to +14. Dose-limiting toxicity (DLT) was defined as: G4 leukopenia or thrombocytopenia of ≥5 days; any G3 neuro or nephrotoxicity; G4 toxicity of any kind. Patients had to complete at least 2 consecutive cycles, and MTD was defined as the level in which 20% of patients developed a DLT; 10-15 patients were entered in each level. Results First level: overall, 13 patients entered, 3 were not assessable for MTD, and only one developed a DLT. Second level: 18 patients entered, 3 were not assessable for MTD. Hematologic DLT was observed in 3/15 assessable patients. Therefore, the MTD was found at the ifosfamide level of 10.5 g/m2 given in 84 hrs. Eight patients of 29 assessable for response achieved an objective response: 1 complete and 7 partial. The overall response rate was 28% (95% CI: 13-47%). Conclusions If we accept 4-day G4 leukopenia as a reliable cutoff for safety, ifosfamide intensification cannot be substantially exploited over already available schedules with the combination of ifosfamide and anthracyclines.
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Affiliation(s)
- S Frustaci
- Divisione di Oncologia Medica, Centro di Riferimento Oncologico, Aviano, Italy.
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Abstract
A prospective randomized study was conducted to compare the antiemetic efficacy of metoclopramide (MCP) versus its recent derivative alizapride (ALZ) in patients undergoing cancer chemotherapy. Both drugs were given at a dose of 2 mg/kg i.v. push for 5 doses. A positive response was defined as absence of nausea or emesis, or moderate nausea with one or two emeses per day. Eighty-two patients were evaluable. Forty-two received MCP and 40 received ALZ. A positive response was observed in 54% MCP-treated and 41% ALZ-treated patients. Neurologic toxicity, mainly extrapyramidal disturbances, was the most remarkable adverse side effect; it occurred more frequently in the MCP-treated group (31%) than in the ALZ-treated group (17%). Both drugs were found to be more effective in previously untreated patients and when employed together with steroids. MCP was more effective (52% positive response) than ALZ (41% positive response) in cisplatin-treated patients. To better control drug-induced vomiting, we believe that future trials should evaluate slow i.v. infusion of antiemetic agents and their combination with dexamethasone.
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Reni M, Cozzarini C, Panucci MG, Ceresoli GL, Ferreri AJ, Fiorino C, Truci G, Falini A, Tartara F, Terreni MR, Verusio C, Villa E. Irradiation Fields and Doses in Glioblastoma Multiforme: Are Current Standards Adequate? Tumori 2018; 87:85-90. [PMID: 11401212 DOI: 10.1177/030089160108700204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims and background The optimum conventional radiotherapy in glioblastoma multiforme patients has not been clearly defined by prospective trials. To better characterize a standard radiotherapy in glioblastoma multiforme, the impact on survival of different fields and doses was analyzed in a retrospective single center series. Methods One hundred and forty-seven patients with glioblastoma multiforme, submitted to biopsy only (n = 15), subtotal (n = 48) or total resection (n = 82) and who completed the planned postsurgical radiotherapy, were considered. The median age was 57 years, the male/female ratio 1.5/1, and the performance status ≥70 in 76%. Whole brain irradiation, followed by a boost to partial brain, was used in 75 cases with a whole brain dose of 44–50 Gy (median, 46) and a partial brain dose of 56–70 Gy (median, 60 Gy). Partial brain irradiation alone was used in 72 patients with a dose of 56–70 Gy (median, 61 Gy). Ninety-eight patients received 56–60 Gy (median, 59 Gy) to partial brain whereas 49 patients received 61–70 Gy (median, 63 Gy). Results There was an almost significantly longer survival in patients irradiated to the partial brain alone with respect to those also receiving whole brain radiotherapy (P = 0.056). Doses <60 Gy significantly prolonged survival (P = 0.006). Multivariate analysis confirmed that the impact on survival of radiation dose was independent of age, performance status, extent of surgery, field of irradiation and the use of chemotherapy. The extent of irradiation field was not independently related to improved survival. Conclusions Our retrospective findings suggest that we reflect on the adequacy of the current standard irradiation parameters. Well-designed prospective trials are necessary to standardize the radiotherapy control group in patients with glioblastoma multiforme to be compared in phase III trials with innovative therapeutic approaches.
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Affiliation(s)
- M Reni
- Department of Radiochemotherapy, San Raffaele Hospital Scientific Institute, Milan, Italy.
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Bretti S, Berruti A, Dogliotti L, Castagneto B, Bertulli R, Spadaro P, Toscano G, Astorre P, Verusio C, Lionetto R, Bruzzi P, Santoro A. Combined Epirubicin and Interleukin-2 Regimen in the Treatment of Malignant Mesothelioma: A Multicenter Phase II Study of the Italian Group on Rare Tumors. Tumori 2018; 84:558-61. [PMID: 9862516 DOI: 10.1177/030089169808400509] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [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
The Italian Group on Rare Tumors undertook a phase II study of a combination of epirubicin and interleukin-2 in 21 chemotherapy-naive patients with malignant mesothelioma. All patients had bidimensionally measurable disease at CT scan. Treatment included intravenous administration of epirubicin at a dose of 110 mg/m2 i.v. on day 1, and interleukin-2 at a dose of 9 MU subcutaneously from day 8 to day 12 and from day 15 to day 19. Cycles were repeated every three weeks, up to six times in the absence of progressive disease. Treatment response was evaluated after two cycles of therapy. Only one patient achieved a partial response, resulting in an overall response rate of 5% (1/21) with a median progression-free and overall survival of 5 and 10 months, respectively. Toxicity was relevant and caused treatment discontinuation in many patients. These results do not support the use of such a combination in the management of malignant mesothelioma.
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Affiliation(s)
- S Bretti
- Divisione di Oncologia Medica, Ospedale Oncologico S. Giovanni A.S., Torino, Italy
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Cardinale D, Ciceri F, Latini R, Franzosi MG, Sandri MT, Civelli M, Cucchi G, Menatti E, Mangiavacchi M, Cavina R, Barbieri E, Gori S, Colombo A, Curigliano G, Salvatici M, Rizzo A, Ghisoni F, Bianchi A, Falci C, Aquilina M, Rocca A, Monopoli A, Milandri C, Rossetti G, Bregni M, Sicuro M, Malossi A, Nassiacos D, Verusio C, Giordano M, Staszewsky L, Barlera S, Nicolis EB, Magnoli M, Masson S, Cipolla CM. Anthracycline-induced cardiotoxicity: A multicenter randomised trial comparing two strategies for guiding prevention with enalapril: The International CardioOncology Society-one trial. Eur J Cancer 2018; 94:126-137. [PMID: 29567630 DOI: 10.1016/j.ejca.2018.02.005] [Citation(s) in RCA: 135] [Impact Index Per Article: 22.5] [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: 02/08/2018] [Accepted: 02/13/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Troponin changes over time have been suggested to allow for an early diagnosis of cardiac injury ensuing cancer chemotherapy; cancer patients with troponin elevation may benefit of therapy with enalapril. It is unknown whether a preventive treatment with enalapril may further increase the benefit. METHODS The International CardioOncology Society-one trial (ICOS-ONE) was a controlled, open-label trial conducted in 21 Italian hospitals. Patients were randomly assigned to two strategies: enalapril in all patients started before chemotherapy (CT; 'prevention' arm), and enalapril started only in patients with an increase in troponin during or after CT ('troponin-triggered' arm). Troponin was assayed locally in 2596 blood samples, before and after each anthracycline-containing CT cycle and at each study visit; electrocardiogram and echocardiogram were done at baseline, and at 1, 3, 6 and 12-month follow-up. Primary outcome was the incidence of troponin elevation above the threshold. FINDINGS Of the 273 patients, 88% were women, mean age 51 ± 12 years. The majority (76%) had breast cancer, 3% had a history of hypertension and 4% were diabetic. Epirubicin and doxorubicin were most commonly prescribed, with median cumulative doses of 360 [270-360] and 240 [240-240] mg/m2, respectively. The incidence of troponin elevation was 23% in the prevention and 26% in the troponin-triggered group (p = 0.50). Three patients (1.1%) -two in the prevention, one in the troponin-triggered group-developed cardiotoxicity, defined as 10% point reduction of LV ejection fraction, with values lower than 50%. INTERPRETATION Low cumulative doses of anthracyclines in adult patients with low cardiovascular risk can raise troponins, without differences between the two strategies of giving enalapril. Considering a benefit of enalapril in the prevention of LV dysfunction, a troponin-triggered strategy may be more convenient.
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Affiliation(s)
| | - Fabio Ciceri
- Haematology/Transplant Unit, Istituto Scientifico H. San Raffaele, Milano, Italy
| | - Roberto Latini
- Department of Cardiovascular Research, IRCCS - Mario Negri Institute for Pharmacological Research, Milano, Italy.
| | - Maria Grazia Franzosi
- Department of Cardiovascular Research, IRCCS - Mario Negri Institute for Pharmacological Research, Milano, Italy
| | | | - Maurizio Civelli
- Cardioncology Division, European Institute of Oncology, Milano, Italy
| | | | | | | | | | | | | | | | - Giuseppe Curigliano
- Division of Early Drug Development for Innovative Therapy, Department of Oncology and Hemato-Oncology, University of Milano, European Institute of Oncology, Milano, Italy
| | - Michela Salvatici
- Laboratory Medicine Division, European Institute of Oncology, Milano, Italy
| | | | - Francesco Ghisoni
- Unità Operativa Complessa Cure Palliative, Ospedale di Vaio, Fidenza, Italy
| | | | | | - Michele Aquilina
- Cardiology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori - IRCCS, Meldola, Italy
| | - Andrea Rocca
- Oncology, IRCCS-Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Meldola, Italy
| | - Anna Monopoli
- Cardiology, Nuovo Ospedale San Giuseppe, Empoli, Italy
| | | | | | - Marco Bregni
- Oncology, Presidio Ospedaliero di Busto Arsizio, Italy
| | - Marco Sicuro
- Cardiology, Ospedale Regionale Umberto Parini, Aosta, Italy
| | | | | | | | - Monica Giordano
- Oncology, Azienda Socio Sanitaria Territoriale Lariana, Como, Italy
| | - Lidia Staszewsky
- Department of Cardiovascular Research, IRCCS - Mario Negri Institute for Pharmacological Research, Milano, Italy
| | - Simona Barlera
- Department of Cardiovascular Research, IRCCS - Mario Negri Institute for Pharmacological Research, Milano, Italy
| | - Enrico B Nicolis
- Department of Cardiovascular Research, IRCCS - Mario Negri Institute for Pharmacological Research, Milano, Italy
| | - Michela Magnoli
- Department of Cardiovascular Research, IRCCS - Mario Negri Institute for Pharmacological Research, Milano, Italy
| | - Serge Masson
- Department of Cardiovascular Research, IRCCS - Mario Negri Institute for Pharmacological Research, Milano, Italy
| | - Carlo M Cipolla
- Cardioncology Division, European Institute of Oncology, Milano, Italy
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De Placido S, Gallo C, De Laurentiis M, Bisagni G, Arpino G, Sarobba MG, Riccardi F, Russo A, Del Mastro L, Cogoni AA, Cognetti F, Gori S, Foglietta J, Frassoldati A, Amoroso D, Laudadio L, Moscetti L, Montemurro F, Verusio C, Bernardo A, Lorusso V, Gravina A, Moretti G, Lauria R, Lai A, Mocerino C, Rizzo S, Nuzzo F, Carlini P, Perrone F, Agostara B, Aieta M, Alabiso O, Alicicco MG, Amadori D, Amaducci L, Amiconi G, Antuzzi G, Ardine M, Ardizzoia A, Aversa C, Badalamenti G, Barni S, Basurto C, Berardi R, Bergamasco C, Bidoli P, Bighin C, Biondi E, Bisagni G, Boni C, Borgonovo K, Botta M, Bravi S, Bruzzi P, Buono G, Butera A, Caldara A, Candeloro G, Cappelletti C, Cardalesi C, Carfora E, Cariello A, Carrozza F, Cartenì G, Caruso M, Casadei V, Casanova C, Castori L, Cavanna L, Cavazzini G, Cazzaniga M, Chilelli M, Chiodini P, Chiorrini S, Ciardiello F, Ciccarese M, Cinieri S, Clerico M, Coccaro M, Comande M, Corbo C, Cortino G, Cusenza S, Daniele G, D'arco AM, D'auria G, Dazzi C, De Angelis C, de Braud F, De Feo G, De Matteis A, De Tursi M, Di Blasio A, di Lucca G, Di Lullo L, Di Rella F, Di Renzo G, Di Stefano P, Di Stefano A, Diana A, Donati S, Fabbri A, Fabi A, Faedi M, Farina G, Farris A, Febbraro A, Fedele P, Federico P, Ferraù F, Ferretti G, Ferro A, Floriani I, Forcignanò R, Forciniti S, Forestieri V, Fornari G, Frisinghelli M, Fusco V, Gallizzi G, Galvano A, Gambardella A, Gambi A, Gebbia V, Gervasi E, Ghilardi M, Giacobino A, Giardina G, Giotta F, Giraudi S, Giuliano M, Grassadonia A, Grasso D, Grosso F, Guizzaro L, Incoronato P, Incorvaia L, Iodice G, La Verde N, Labonia V, Landi G, Latorre A, Leonardi V, Levaggi A, Limite G, Lina Bascialla L, Livi L, Maiello E, Mandelli D, Marcon I, Menon D, Montedoro M, Moraca L, Moretti A, Morritti MG, Morselli P, Mura A, Mura S, Musacchio M, Muzio A, Natale D, Natoli C, Nigro C, Nisticò C, Nuzzo A, Orditura M, Orlando L, Pacilio C, Palumbo G, Palumbo R, Pasini F, Paterno E, Pazzola A, Pelliccioni S, Pensabene M, Perroni D, Pesenti Gritti A, Petrelli F, Piccirillo MC, Pinotti G, Pogliani C, Poli D, Prader S, Recchia F, Rizzi D, Romano C, Rossello R, Rossini C, Salvucci G, Sanna V, Santini A, Saracchini S, Savastano C, Scambia G, Schettini F, Schiavone P, Schirone A, Seles E, Signoriello S, Signoriello G, Silva RR, Silvestri A, Simeon V, Spagnoletti I, Tamberi S, Teragni C, Thalmann V, Thomas R, Thomas G, Tienghi A, Tinari N, Tinessa V, Tomei F, Tonini G, Torri V, Traficante D, Tudini M, Turazza M, Vignoli R, Vitale MG, Zacchia A, Zagarese P, Zanni A, Zavallone L, Zavettieri M, Zoboli A. Adjuvant anastrozole versus exemestane versus letrozole, upfront or after 2 years of tamoxifen, in endocrine-sensitive breast cancer (FATA-GIM3): a randomised, phase 3 trial. Lancet Oncol 2018; 19:474-485. [PMID: 29482983 DOI: 10.1016/s1470-2045(18)30116-5] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 01/04/2018] [Accepted: 01/08/2018] [Indexed: 01/04/2023]
Abstract
BACKGROUND Uncertainty exists about the optimal schedule of adjuvant treatment of breast cancer with aromatase inhibitors and, to our knowledge, no trial has directly compared the three aromatase inhibitors anastrozole, exemestane, and letrozole. We investigated the schedule and type of aromatase inhibitors to be used as adjuvant treatment for hormone receptor-positive early breast cancer. METHODS FATA-GIM3 is a multicentre, open-label, randomised, phase 3 trial of six different treatments in postmenopausal women with hormone receptor-positive early breast cancer. Eligible patients had histologically confirmed invasive hormone receptor-positive breast cancer that had been completely removed by surgery, any pathological tumour size, and axillary nodal status. Key exclusion criteria were hormone replacement therapy, recurrent or metastatic disease, previous treatment with tamoxifen, and another malignancy in the previous 10 years. Patients were randomly assigned in an equal ratio to one of six treatment groups: oral anastrozole (1 mg per day), exemestane (25 mg per day), or letrozole (2·5 mg per day) tablets upfront for 5 years (upfront strategy) or oral tamoxifen (20 mg per day) for 2 years followed by oral administration of one of the three aromatase inhibitors for 3 years (switch strategy). Randomisation was done by a computerised minimisation procedure stratified for oestrogen receptor, progesterone receptor, and HER2 status; previous chemotherapy; and pathological nodal status. Neither the patients nor the physicians were masked to treatment allocation. The primary endpoint was disease-free survival. The minimum cutoff to declare superiority of the upfront strategy over the switch strategy was assumed to be a 2% difference in disease-free survival at 5 years. Primary efficacy analyses were done by intention to treat; safety analyses included all patients for whom at least one safety case report form had been completed. Follow-up is ongoing. This trial is registered with the European Clinical Trials Database, number 2006-004018-42, and ClinicalTrials.gov, number NCT00541086. FINDINGS Between March 9, 2007, and July 31, 2012, 3697 patients were enrolled into the study. After a median follow-up of 60 months (IQR 46-72), 401 disease-free survival events were reported, including 211 (11%) of 1850 patients allocated to the switch strategy and 190 (10%) of 1847 patients allocated to upfront treatment. 5-year disease-free survival was 88·5% (95% CI 86·7-90·0) with the switch strategy and 89·8% (88·2-91·2) with upfront treatment (hazard ratio 0·89, 95% CI 0·73-1·08; p=0·23). 5-year disease-free survival was 90·0% (95% CI 87·9-91·7) with anastrozole (124 events), 88·0% (85·8-89·9) with exemestane (148 events), and 89·4% (87·3 to 91·1) with letrozole (129 events; p=0·24). No unexpected serious adverse reactions or treatment-related deaths occurred. Musculoskeletal side-effects were the most frequent grade 3-4 events, reported in 130 (7%) of 1761 patients who received the switch strategy and 128 (7%) of 1766 patients who received upfront treatment. Grade 1 musculoskeletal events were more frequent with the upfront schedule than with the switch schedule (924 [52%] of 1766 patients vs 745 [42%] of 1761 patients). All other grade 3-4 adverse events occurred in less than 2% of patients in either group. INTERPRETATION 5 years of treatment with aromatase inhibitors was not superior to 2 years of tamoxifen followed by 3 years of aromatase inhibitors. None of the three aromatase inhibitors was superior to the others in terms of efficacy. Therefore, patient preference, tolerability, and financial constraints should be considered when deciding the optimal treatment approach in this setting. FUNDING Italian Drug Agency.
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Affiliation(s)
- Sabino De Placido
- Dipartimento di Clinica Medica e Chirurgia, Università Federico II, Naples, Italy
| | - Ciro Gallo
- Statistica Medica, Università degli Studi della Campania Luigi Vanvitelli, Naples, Italy
| | - Michelino De Laurentiis
- Istituto Nazionale per lo Studio e la Cura dei Tumori, Fondazione Pascale, Istituto di Ricovero e Cura a Carattere Scientifico, Naples, Italy
| | - Giancarlo Bisagni
- Dipartimento di Oncologia, Arcispedale S Maria Nuova-IRCCS, Reggio Emilia, Italy
| | - Grazia Arpino
- Dipartimento di Clinica Medica e Chirurgia, Università Federico II, Naples, Italy
| | | | | | - Antonio Russo
- Dipartimento di Scienze Chirurgiche, Oncologiche e Stomatologiche, Sezione di Oncologia Medica, Università di Palermo, Palermo, Italy
| | - Lucia Del Mastro
- Dipartimento di Medicina Interna e Specialità Mediche, Università degli Studi di Genova-Oncologia Medica, Ospedale Policlinico San Martino, Genoa, Italy
| | | | - Francesco Cognetti
- Divisione Oncologia Medica 1, Istituto Nazionale Tumori Regina Elena, Rome, Italy
| | - Stefania Gori
- Oncologia Medica, Ospedale Sacro Cuore Don Calabria, Negrar, Italy
| | | | | | - Domenico Amoroso
- Oncologia Medica, Ospedale della Versilia, Lido di Camaiore (LU), Istituto Toscano Tumori, Florence, Italy
| | | | - Luca Moscetti
- Dipartimento di Oncologia Medica, Ospedale Belcolle, Viterbo, Italy
| | - Filippo Montemurro
- Divisione di Oncologia Clinica Investigativa dell'Istituto di Candiolo-IRCCS, Candiolo, Italy
| | | | | | - Vito Lorusso
- Polo Oncologico, Ospedale Vito Fazzi, Lecce, Italy
| | - Adriano Gravina
- Istituto Nazionale per lo Studio e la Cura dei Tumori, Fondazione Pascale, Istituto di Ricovero e Cura a Carattere Scientifico, Naples, Italy
| | - Gabriella Moretti
- Dipartimento di Oncologia, Arcispedale S Maria Nuova-IRCCS, Reggio Emilia, Italy
| | - Rossella Lauria
- Dipartimento di Clinica Medica e Chirurgia, Università Federico II, Naples, Italy
| | - Antonella Lai
- Oncologia Medica, Azienda Ospedaliera Universitaria, Sassari, Italy
| | | | - Sergio Rizzo
- Dipartimento di Scienze Chirurgiche, Oncologiche e Stomatologiche, Sezione di Oncologia Medica, Università di Palermo, Palermo, Italy
| | - Francesco Nuzzo
- Istituto Nazionale per lo Studio e la Cura dei Tumori, Fondazione Pascale, Istituto di Ricovero e Cura a Carattere Scientifico, Naples, Italy
| | - Paolo Carlini
- Divisione Oncologia Medica 1, Istituto Nazionale Tumori Regina Elena, Rome, Italy
| | - Francesco Perrone
- Istituto Nazionale per lo Studio e la Cura dei Tumori, Fondazione Pascale, Istituto di Ricovero e Cura a Carattere Scientifico, Naples, Italy.
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Verusio C, Ratti M, Bertin F, Portaluppi A, Rossi A, Sarno L, Marconi M. Patient relationship training in an integrated perspective: guidelines for psychological intervention. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx434.023] [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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Sarno L, Ratti M, Soldi E, Derevianko A, Verusio C. Cancer, emotions, and cinema: a preliminary study about the changes experienced by oncological patients. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx434.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Ratti M, Bertin F, Rossi A, Portaluppi A, Marconi M, Sarno L, Verusio C. Evaluation OF psychological aspects of taking care cancer patients: a multicentre study on a sample of caregivers. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx434.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Di Lucca G, Rossini C, Morena R, Banfi L, Pogliani C, Parati M, Sali L, Troisi A, Verusio C. Association between the development of autoimmune hypothyroidism and objective response to nivolumab: report of two cases. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx436.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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De Giorgi U, Procopio G, Guida A, Bearz A, Buti S, Basso U, Mitterer M, Ortega C, Bidoli P, Ferrau F, Crinò L, Frassoldati A, Marchetti P, Mini E, Scoppola A, Verusio C, Fornarini G, Cartenì G, Caserta C, Sternberg C. Inflammatory indexes strongly predict clinical outcome in patients (pts) with metastatic renal cell cancer (mRCC) treated with nivolumab: results from the Italian expanded access program (EAP). Ann Oncol 2017. [DOI: 10.1093/annonc/mdx371.058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Emile JF, Julié C, Le Malicot K, Lepage C, Tabernero J, Mini E, Folprecht G, Van Laethem JL, Dimet S, Boulagnon-Rombi C, Allard MA, Penault-Llorca F, Bennouna J, Laurent-Puig P, Taieb J, Thaler J, Greil R, Gaenzer J, Eisterer W, Tschmelitsch J, Keil F, Samonigg H, Zabernigg A, Schmid F, Steger G, Steinacher R, Andel J, Jagdt B, Lang A, Fridrik M, Függer R, Hofbauer F, Woell E, Geissler D, Lenauer A, Prager M, D'Haens G, Demolin G, Kerger J, Deboever G, Ghillebert G, Polus M, Van Cutsem E, Kalantari HR, Delaunoit T, Goeminne JC, Peeters M, Vergauwe P, Houbiers G, Humblet Y, Janssens J, Schrijvers D, Vanderstraeten E, Van Laethem JL, Vermorken J, Van Daele D, Ferrante M, Forget F, Hendlisz A, Yilmaz M, Nielsen SE, Vestermark L, Larsen J, Zawadi MA, Bouche O, Mineur L, Bennouna-Louridi J, Dourthe LM, Ychou M, Boucher E, Taieb J, Pezet D, Desseigne F, Ducreux M, Texereau P, Miglianico L, Rougier P, Fratte S, Levache CB, Merrouche Y, Ellis S, Locher C, Ramee JF, Garnier C, Viret F, Chauffert B, Cojean-Zelek I, Michel P, Lecaille C, Borel C, Seitz JF, Smith D, Lombard-Bohas C, Andre T, Gornet JM, Fein F, Coulon-Sfairi MA, Kaminsky MC, Lagasse JP, Luet D, Etienne PL, Gasmi M, Vanoli A, Nguyen S, Aparicio T, Perrier H, Stremsdoerfer N, Laplaige P, Arsene D, Auby D, Bedenne L, Coriat R, Denis B, Geoffroy P, Piot G, Becouarn Y, Bordes G, Deplanque G, Dupuis O, Fruge F, Guimbaud R, Lecomte T, Lledo G, Sobhani I, Asnacios A, Azzedine A, Desauw C, Galais MP, Gargot D, Lam YH, Abakar-Mahamat A, Berdah JF, Catteau S, Clavero-Fabri MC, Codoul JF, Legoux JL, Goldfain D, Guichard P, Verge DP, Provencal J, Vedrenne B, Brezault-Bonnet C, Cleau D, Desir JP, Fallik D, Garcia B, Gaspard MH, Genet D, Hartwig J, Krummel Y, Budnik TM, Palascak-Juif V, Randrianarivelo H, Rinaldi Y, Aleba A, Darut-Jouve A, de Gramont A, Hamon H, Wendehenne F, Matzdorff A, Stahl MK, Schepp W, Burk M, Mueller L, Folprecht G, Geissler M, Mantovani-Loeffler L, Hoehler T, Asperger W, Kroening H, von Weikersthal LF, Fuxius S, Groschek M, Meiler J, Trarbach T, Rauh J, Ziegenhagen N, Kretzschmar A, Graeven U, Nusch A, von Wichert G, Hofheinz RD, Kleber G, Schmidt KH, Vehling-Kaiser U, Baum C, Schuette J, Haag GM, Holtkamp W, Potenberg J, Reiber T, Schliesser G, Schmoll HJ, Schneider-Kappus W, Abenhardt W, Denzlinger C, Henning J, Marxsen B, Derigs HG, Lambertz H, Becker-Boost I, Caca K, Constantin C, Decker T, Eschenburg H, Gabius S, Hebart H, Hoffmeister A, Horst HA, Kremers S, Leithaeuser M, Mueller S, Wagner S, Daum S, Schlegel F, Stauch M, Heinemann V, Maiello E, Latini L, Zaniboni A, Amadori D, Aprile G, Barni S, Mattioli R, Martoni A, Passalacqua R, Nicolini M, Pasquini E, Rabbi C, Aitini E, Ravaioli A, Barone C, Biasco G, Tamberi S, Gambi A, Verusio C, Marzola M, Lelli G, Boni C, Cascinu S, Bidoli P, Vaghi M, Cruciani G, Di Costanzo F, Sobrero A, Mini E, Petrioli R, Aglietta M, Alabiso O, Capuzzo F, Falcone A, Corsi DC, Labianca R, Salvagni S, Chiara S, Ciuffreda L, Ferraù F, Giuliani F, Lonardi S, Gebbia N, Mantovani G, Sanches E, Mellidez JC, Santos P, Freire J, Sarmento C, Costa L, Pinto AM, Barroso S, Santo JE, Guedes F, Monteiro A, Sa A, Furtado I, Salazar R, Aguilar EA, Herrero FR, Tabernero J, Valera JS, Ayerbes MV, Batlle JF, Gil S, Esteve AA, Garcia-Giron C, Vivanco GL, Salvia AS, Orduña VA, Garcia RV, Gallego J, Sureda BM, Remon J, Safont Aguilera MJ, Nogueras LC, Merino BQ, Castro CG, de Prado PM, Pericay CP, Figueiras MC, Jordan IG, Gome Reina MJ, Garcia ALL, Garcia-Ramos AA, Cervantes A, Martos CF, Gaspar EM, Montero IC, Emperador PE, Carbonero AL, Castillo MG, Garcia TG, Lopez JG, Flores EG, Morales MG, Muñoz ML, Martín AL, Maurel J, Camara JC, Garcia RD, Salgado M, Busquier IH, Ruiz TC, Muñoa AL, Aliguer MN, de Taranco AVO, Ureña MM, Gaspa FL, Ponce JJ, Roig CB, Jimenez PV, Brotons AG, Rodriguez SA, Martinez JA, Ruiz LC, Ruiz MC, Bridgewater J, Glynne-Jones R, Tahir S, Hickish T, Cassidy J, Samuel L. Prospective validation of a lymphocyte infiltration prognostic test in stage III colon cancer patients treated with adjuvant FOLFOX. Eur J Cancer 2017. [DOI: 10.1016/j.ejca.2017.04.025] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Ratti MM, Portaluppi A, Bertin F, Franchini E, Verusio C. The importance of evaluation and taking care of the patient and caregiver in the oncological disease experience: A multicentre study. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.e21551] [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
e21551 Background: Caregiver and patient are a dyad in which the hardship of one inevitably results in a worsening of the other’s condition. Supporting caregivers so they can deal with their relatives’ cancerous condition is useful to improve both patient care and collaboration with medical teams (Zavagli et al., 2012). Burden of caregivers has psychological and physical negative impact on patients (Gritti et al., 2011). This research matches the effects of the oncological disease on the patients and the caregivers, to find similarities and differences in order to better understand their specific needs and optimizing the support provided to them in hospital setting. Methods: Two different sets of tests are composed of a particular registry paper, SF-36, MAC, BDI-II, STAI-Y, addressed to patients, and SF-36, ZBI, COPE, addressed to caregivers. The samples are made up of 250 patients (M = 107; W = 143) and 143 caregivers (M = 54; W = 89). 34% of the sample had changes in job life due the illness process (C1), while 69% of caregivers had changes in their social, working or familiar life due taking care patients (CC1). 40% of patients in sample of caregivers had received the diagnosis since less than 3 months (CD3), 23% from 3 to 6 months (CD3-6), 14% from 6 to 12 months (CD6-12) and 22% over 12 months (CD12). Results:C1 reported worse levels of “Mental Health Index” (t = 2,016; p = ,045), depression (t = -3,949; p = ,000) and anxiety (t = -3,363; p = ,001) than patients had not changes in job. CC1 had worse levels of “Mental Health Index” (t = 4,276; p = ,045) and burden (t = -6,402; p = ,000) than caregivers without changes in life. Patients who received the diagnosis since less than 3 months reported less “Fighting Spirit” coping style (F(210;8) = 2,76; p = ,006) and worse levels of “Role Limitations due to Emotional Problems” (F(211;8) = 2,346; p = ,020) than in other periods. CD12 reported worse levels of burden than CD3, CD3-6 and CD6-12 (F(136;3) = 3,67; p = ,014). Conclusions:The results suggest that patients and caregivers share a similar suffering related to life changes, but underscore a difference in the adaptation to the disease condition with increasing time from diagnosis.
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Affiliation(s)
| | | | | | - Eleonora Franchini
- Health and Clinical Psychology Service, IRCCS San Raffaele Hospital, Milan, Italy
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Rossi A, Marconi M, Di Lucca G, Morena R, Pogliani C, Parati MC, Rossini C, Verusio C. Exploring the form of change: A latent growth curve model of distress in oncologic patients undergoing specific cancer-related psychological intervention—A preliminary study. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.e21556] [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
e21556 Background: Psychological distress is one of the most important indexes of suffering in oncological patients – due to its severe negative impacts on medical treatments. Thus, the attention to this topic has increased constantly – focusing on the observed outcomes of (psychological) cares. However, very few studies investigated the (latent) pattern ( form) of change in distress within oncological patients receiving psychological intervention. The aim of the study was to test a Latent Growth Curve Model to explore the form of change in distress. Methods: A longitudinal research design was used. Patients ( N= 122, mean age: 68.3, SD= 12.3, 63 female-59 male) were enrolled at the Department of Medical Oncology at Presidio Ospedaliero of Saronno, ASST Valle Olona, Italy, and assessed for the presence of distress with Psychological Distress Inventory (PDI). As clinical routine, all patients received a specific cancer-related psychological intervention (CBT, mainly; mean of sessions: 27.4, SD= 13.5) and were tested at the beginning (T1; α= .88) and at the end of treatment (T2; α= .86) and at timed-balanced follow-up (T3; α= .87). Results: First, longitudinal invariance of measurement was performed to test whether (A) factor structure of PDI and (B) factor loadings of indicators were constant across time. PDI showed metric measurement invariance: Δχ2= 20.4; Δχ2 df= 24; p(Δχ2) = 0.67. Afterward, a LGCM was performed testing different trends of growth (no growth vs. linear vs. free) – controlling for age, number of sessions received, type and localization of tumor. The comparison of growth curves reveal that the linear trends of change had the best model fit to the data: χ2= 4.124, p= .248; RMSEA = .055(.000–.171), p(RMSEA < .05) = .372, CFI = .990, SRMR = .027. Conclusions: These findings highlight that the (latent) linear growth better explain true change of distress – among oncological patients receiving a specific cancer-related psychological intervention. These results outline the possibility to improve the structure of psychological and medical treatments for oncological settings, to reduce psychological suffering and increase quality of life.
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Affiliation(s)
- Alessandro Rossi
- Psychology Research Laboratory, IRCCS Istituto Auxologico Italiano, Ospedale San Giuseppe, Oggebbio, Italy
| | - Maria Marconi
- Department of Medical Oncology, ASST Valle Olona, Presidio Ospedaliero di Saronno, Saronno, Italy
| | | | - Raffaella Morena
- Department of Medical Oncology, ASST Valle Olona, Presidio Ospedaliero di Saronno, Saronno, Italy
| | - Claudia Pogliani
- Department of Medical Oncology, Presidio Ospedaliero di Saronno, ASST Valle Olona, Saronno, Italy
| | - Maria Chiara Parati
- Department of Medical Oncology, Presidio Ospedaliero di Saronno, ASST Valle Olona, Saronno, Italy
| | - Chiara Rossini
- Department of Medical Oncology, ASST Valle Olona, Presidio Ospedaliero di Saronno, Saronno, Italy
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Cazzaniga ME, Cortesi L, Ferzi A, Scaltriti L, Cicchiello F, Ciccarese M, Della Torre S, Villa F, Giordano M, Verusio C, Nicolini M, Gambaro AR, Zanlorenzi L, Biraghi E, Legramandi L, Rulli E. Metronomic chemotherapy with oral vinorelbine (mVNR) and capecitabine (mCAPE) in advanced HER2-negative breast cancer patients: is it a way to optimize disease control? Final results of the VICTOR-2 study. Breast Cancer Res Treat 2016; 160:501-509. [PMID: 27752847 PMCID: PMC5090011 DOI: 10.1007/s10549-016-4009-3] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 10/03/2016] [Indexed: 11/29/2022]
Abstract
Purpose The VICTOR-1 study demonstrated that the all-oral metronomic combination of vinorelbine and capecitabine is highly active and well tolerated in hormone receptor-positive/HER2-negative patients. The VICTOR-2 study was designed to confirm these results. Methods Patients received mVNR 40 mg three times a week and mCAPE 500 mg three times a day, continuously. The primary endpoint was the clinical benefit rate (CBR); secondary endpoints were toxicity, objective response rate (ORR), and progression-free survival (PFS). Results Eighty patients were evaluable for the primary efficacy analysis. Median age was 65.3 years; most patients had HR-positive tumors (65 %). The CBR was 45.7 % (95 % CI 28.8–63.4) and 51.1 % (95 % CI 35.8–66.3) in first- and ≥ second-line therapy, respectively. The ORR was 35.5 % in first-line (95 % CI 19.2–54.6) and 25.6 % in ≥second-line (95 % CI 13.5–41.2). The median duration of response was 11.3 and 6.4 months and PFS rates at 1 year were 24.3 and 22.2 %, respectively. In triple-negative breast cancer patients (N = 28, 35 %) a lower, but clinically relevant CBR (35.7, 95 % CI 18.6–55.9) was observed. The main toxicities per cycle were non-febrile neutropenia (1.1 %), hand-foot syndrome (1.0 %), nausea and vomiting (1.0 %), leucopenia (0.8 %), fatigue (0.7 %), and diarrhea (0.4 %). Conclusion The VICTOR-2 study confirms the clinical activity of mVNR and mCAPE in HER2-negative breast cancer patients, suggesting that the easy schedule of administration, which requires monthly blood tests and limits patients’ dependence on hospitals, and the low cost of the drugs are valuable elements, even for countries with limited access to innovative or expensive drugs.
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Affiliation(s)
- M E Cazzaniga
- Oncology Unit, ASST Monza, Via Pergolesi, 33 20900, Monza, MB, Italy.
| | - L Cortesi
- Haematology and Oncology Unit, Azienda Ospedaliero-Universitaria Policlinico di Modena, Modena, Italy
| | - A Ferzi
- Oncology Unit, ASST Ovest Milanese, Ospedale di Legnano, Legnano, Italy
| | - L Scaltriti
- Oncology Day Hospital Unit, Ospedale Civile di Guastalla, Guastalla, Italy
| | - F Cicchiello
- Oncology Unit, ASST Monza, Via Pergolesi, 33 20900, Monza, MB, Italy
| | - M Ciccarese
- Oncology Unit, Ospedale Vito Fazzi, Lecce, Italy
| | - S Della Torre
- Oncology Unit, ASST Rhodense-Presidio di Garbagnate Milanese e Presidio di Rho, Garbagnate, Italy
| | - F Villa
- Oncology Unit, ASST, Lecco, Italy
| | - M Giordano
- Oncology Unit, ASST Lariana, Como, Italy
| | - C Verusio
- Oncology Unit, ASST della Valle Olona, Saronno, Italy
| | - M Nicolini
- Oncology Day Hospital Unit, Azienda USL Romagna, Cattolica, Italy
| | - A R Gambaro
- Oncology Unit, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - L Zanlorenzi
- Oncology Unit, ASST della Valle Olona, Busto Arsizio, Italy
| | - E Biraghi
- Oncology Unit, ASST Melegnano e Martesana, Gorgonzola, Italy
| | - L Legramandi
- Methodology for Clinical Research Laboratory, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - E Rulli
- Methodology for Clinical Research Laboratory, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
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