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Cucciniello L, Garufi G, Di Rienzo R, Martinelli C, Pavone G, Giuliano M, Arpino G, Montemurro F, Del Mastro L, De Laurentiis M, Puglisi F. Estrogen deprivation effects of endocrine therapy in breast cancer patients: Incidence, management and outcome. Cancer Treat Rev 2023; 120:102624. [PMID: 37751658 DOI: 10.1016/j.ctrv.2023.102624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 09/04/2023] [Accepted: 09/06/2023] [Indexed: 09/28/2023]
Abstract
Endocrine therapy is one of the standard adjuvant treatments to reduce the risk of recurrence and mortality in patients with hormone receptor positive early breast cancer. Despite its proven efficacy, ET side effects, which persist over time even if low grade, may deteriorate quality of life. During follow-up visits, emphasis is generally placed on the risk of disease recurrence, while the topic of ET side effects is commonly neglected and discussed only briefly. This could lead to poor adherence to therapy and early treatment discontinuation, resulting in worse survival outcomes. The aim of this review is to provide an overview of the available evidence on the incidence and reporting of ET-related side effects (including vasomotor symptoms, musculoskeletal disorders and genitourinary syndrome of menopause, as well as fatigue, psychological and ocular disorders, dysmetabolic effects and loss of bone density) and of the pharmacological and non-pharmacological strategies available to mitigate symptom burden.
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Affiliation(s)
- Linda Cucciniello
- Department of Medicine, University of Udine, Udine, Italy; Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, Aviano, Italy.
| | - Giovanna Garufi
- Department of Medical Oncology, Università Cattolica del Sacro Cuore, Rome, Italy; Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy.
| | - Rossana Di Rienzo
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | - Claudia Martinelli
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | - Giuliana Pavone
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy; Center of Experimental Oncology and Hematology, A.O.U. Policlinico "G. Rodolico - San Marco", Catania, Italy
| | - Mario Giuliano
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy.
| | - Grazia Arpino
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | | | - Lucia Del Mastro
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy; Breast Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy.
| | | | - Fabio Puglisi
- Department of Medicine, University of Udine, Udine, Italy; Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, Aviano, Italy.
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Mastrantoni L, Garufi G, Di Monte E, Maliziola N, Pasqualoni M, Pontolillo L, Pannunzio S, Cannizzaro MC, Di Bello A, Fabi A, Palazzo A, Tortora G, Bria E, Orlandi A. Adjuvant denosumab in early breast cancer: a systematic review and meta-analysis of randomized controlled clinical trials. Ther Adv Med Oncol 2023; 15:17588359231173180. [PMID: 37284523 PMCID: PMC10240867 DOI: 10.1177/17588359231173180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 04/13/2023] [Indexed: 06/08/2023] Open
Abstract
Background In early breast cancer (BC) the impact of denosumab on survival outcomes is still unclear. We undertook a systematic review and meta-analysis to assess efficacy and safety of adjuvant denosumab in addition to standard anticancer therapy. Methods PubMed, CENTRAL, Scopus, Embase, and oncological meetings websites were screened to identify potentially eligible randomized controlled trials (RCTs). Survival outcomes were disease-free survival (DFS), bone-metastasis-free survival (BMFS), and overall survival (OS). Fracture incidence and time to first fracture were bone-health outcomes. Osteonecrosis of the jaw (ONJ), atypical femur fractures (AFF), and other adverse events were also evaluated. Pooled hazard ratios (HRs) and risk ratios (RR) with respective 95% confidence interval (95% CI) were computed using a random-effects model. Exploratory subgroup analyses were performed. Results Two phase III RCTs were included, the Austrian Breast & Colorectal Cancer Study Group-18 (ABCSG-18) and the D-CARE trials, for a total of 7929 patients. In the ABCSG-18 trial, denosumab was administered every 6 months during endocrine therapy (for a median of seven cycles) while the D-CARE trial used an intensive schedule for a total treatment duration of 5 years. Adjuvant denosumab showed no difference in DFS (HR: 0.932; 95% CI: 0.748-1.162), BMFS (HR: 0.9896; 95% CI: 0.751-1.070), and OS (HR: 0.917; 95% CI: 0.718-1.171) compared to placebo in the overall population. In hormone receptor positive/human epidermal growth factor receptor 2 (HER2) negative BC patients, a DFS (HR: 0.883; 95% CI: 0.782-0.996) and BMFS (HR: 0.832; 95% CI: 0.714-0.970) benefit was observed and BMFS was prolonged in all hormone receptor positive patients (HR: 0.850; 95% CI: 0.735-0.983). Fracture incidence (RR: 0.787; 95% CI: 0.696-0.890) and time to first fracture (HR: 0.760; 95% CI: 0.665-0.869) were also improved. No increase in overall toxicity was seen with denosumab and no differences were observed for ONJ and AFF between the 60-mg every 6-month schedule and placebo. Conclusion Denosumab addition to anticancer treatment does not improve DFS, BMFS, or OS in the overall population, although a DFS improvement was observed in hormone receptor positive/HER2 negative BC patients and a BMFS improvement in all hormone receptor positive patients. Bone-health outcomes were improved with no added toxicity with the 60-mg schedule. Registration PROSPERO identifier: CRD42022332787.
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Affiliation(s)
| | | | | | | | | | - Letizia Pontolillo
- Department of Medical Oncology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Sergio Pannunzio
- Department of Medical Oncology, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Armando Di Bello
- Department of Medical Oncology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alessandra Fabi
- Precision Medicine Breast Unit, Scientific Directorate, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Antonella Palazzo
- Department of Medical Oncology, Università Cattolica del Sacro Cuore, Rome, Italy
- Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Giampaolo Tortora
- Department of Medical Oncology, Università Cattolica del Sacro Cuore, Rome, Italy
- Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
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Mastrantoni L, Garufi G, Monte ED, Maliziola N, Pasqualoni M, Pontolillo L, Pannunzio S, Cannizzaro MC, Bello AD, Fabi A, Palazzo A, Bria E, Tortora G, Orlandi A. Abstract P2-02-06: Adjuvant Denosumab treatment in early breast cancer: a systematic review and meta-analysis of randomized controlled clinical trials. Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-p2-02-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Abstract
Background. Adjuvant denosumab treatment improved bone-health related outcomes in early breast cancer (BC) patients with discordant survival results. We undertook a systematic review and meta-analysis of randomized controlled trials (RCTs) to assess efficacy and safety of adjuvant denosumab in addition to standard anticancer therapy. Methods. PubMed, CENTRAL, Scopus, Embase, clinicaltrials.gov and key oncological meetings websites were screened to identify potentially eligible RCTs based on the PICOs model: P) Participant: pre and postmenopausal early BC patients; I) Intervention: adjuvant denosumab; C) Comparator: placebo; O) Outcomes: Disease-free survival (DFS), Bone Metastasis-free survival (BMFS), Overall Survival (OS), fracture incidence and time to first fracture were adopted as survival endpoints, and Adverse Events, Serious Adverse Events, Osteonecrosis of the Jaw (ONJ) and Atypical Femur Fractures (AFF) as safety endpoints; S) Study design: phase III RCTs. Risk of bias was assessed with Cochrane Collaboration Risk of Bias Tool. Pooled hazard ratios (HR), risk ratios (RR), risk differences (RD) and respective confidence intervals (CI) were computed using both a fixed and a random effect model. Subgroup analyses based on menopausal status, hormone receptor and HER2 status and immunophenotype were performed. Results. Two phase III RCTs were included (ABCSG-18, D-CARE), for an overall population of 7929 early BC patients receiving denosumab or placebo. Denosumab addition to standard of care anticancer treatment showed no difference in DFS (HR 0.93; 95% CI 0.75-1.16, p=0.53), BMFS (HR 0.90; 95% CI 0.75-1.07, p=0.23) and OS (HR 0.92; 95% CI 0.72-1.17, p=0.49). In hormone receptor-positive/HER2 negative patients, denosumab significantly prolonged both DFS (HR 0.88; 95% CI 0.78-0.99, p=0.04) and BMFS (HR 0.83; 95% CI 0.71-0.97, p=0.02). No interaction was found between denosumab addition and menopausal status. Fracture incidence (RR 0.79; 95% CI 0.70-0.89, p< 0.01) and time to first fracture (HR 0.76; 95% CI 0.66-0.87, p< 0.01) were also improved with denosumab. No association between denosumab addition and overall toxicity was seen and no difference was observed in terms of ONJ and AFF between the 60mg every 6 months schedule and placebo (RD 0.001, 95% CI from -0.001 to 0.002, p=0.48) Conclusions. Findings from this meta-analysis validate the role of denosumab as a highly effective anti-resorptive agent. We provide robust evidence that its addition to standard anticancer treatment significantly improves survival outcomes in hormone receptor-positive/HER2 negative early BC patients, suggesting that the implementation of denosumab use in combination with endocrine therapy in this patient population should be reconsidered. Systematic Review Registration: https://www.crd.york.ac.uk/prospero, identifier CRD42022332787.
Citation Format: Luca Mastrantoni, Giovanna Garufi, Elena Di Monte, Noemi Maliziola, Mariangela Pasqualoni, Letizia Pontolillo, Sergio Pannunzio, Maria Chiara Cannizzaro, Armando Di Bello, Alessandra Fabi, Antonella Palazzo, Emilio Bria, Giampaolo Tortora, Armando Orlandi. Adjuvant Denosumab treatment in early breast cancer: a systematic review and meta-analysis of randomized controlled clinical trials. [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P2-02-06.
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Affiliation(s)
- Luca Mastrantoni
- 1Fondazione Policlinico Universitario Agostino Gemelli IRCCS - Università Cattolica del Sacro Cuore
| | - Giovanna Garufi
- 2Fondazione Policlinico Universitario Agostino Gemelli IRCCS - Università Cattolica del Sacro Cuore
| | - Elena Di Monte
- 3Fondazione Policlinico Universitario Agostino Gemelli IRCCS - Università Cattolica del Sacro Cuore
| | - Noemi Maliziola
- 4Fondazione Policlinico Universitario Agostino Gemelli IRCCS - Università Cattolica del Sacro Cuore
| | - Mariangela Pasqualoni
- 5Fondazione Policlinico Universitario Agostino Gemelli IRCCS - Università Cattolica del Sacro Cuore
| | - Letizia Pontolillo
- 6Fondazione Policlinico Universitario Agostino Gemelli IRCCS - Università Cattolica del Sacro Cuore
| | - Sergio Pannunzio
- 7Fondazione Policlinico Universitario Agostino Gemelli IRCCS - Università Cattolica del Sacro Cuore
| | - Maria Chiara Cannizzaro
- 8Fondazione Policlinico Universitario Agostino Gemelli IRCCS - Università Cattolica del Sacro Cuore
| | - Armando Di Bello
- 9Fondazione Policlinico Universitario Agostino Gemelli IRCCS - Università Cattolica del Sacro Cuore
| | - Alessandra Fabi
- 10Precision Medicine in Breast Cancer, Fondazione Policlinico Universitario A. Gemelli, IRCCS Rome - Italy
| | - Antonella Palazzo
- 11Fondazione Policlinico Universitario A. Gemelli IRCCS Rome - Italy
| | - Emilio Bria
- 12Università Cattolica Sacro Cuore Rome - Italy
| | - Giampaolo Tortora
- 13Fondazione Policlinico Universitario Agostino Gemelli IRCCS - Università Cattolica del Sacro Cuore
| | - Armando Orlandi
- 14Fondazione Policlinico Universitario Agostino Gemelli IRCCS - Università Cattolica del Sacro Cuore
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Mastrantoni L, Orlandi A, Palazzo A, Garufi G, Fabi A, Daniele G, Giannarelli D, Tortora G, Bria E. The likelihood of being helped or harmed as a patient-centred tool to assess cyclin dependent kinase 4/6 inhibitors clinical impact and safety in metastatic breast cancer: a systematic review and sensitivity-analysis. EClinicalMedicine 2023; 56:101824. [PMID: 36713467 PMCID: PMC9874016 DOI: 10.1016/j.eclinm.2023.101824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 12/29/2022] [Accepted: 12/30/2022] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND In hormone-receptor positive/HER2-negative metastatic breast cancer (mBC) no randomized comparisons are available between CDK4/6 inhibitors. We undertook this systematic review and meta-analysis to assess the reliability of the likelihood of being helped or harmed (LHH). METHODS PubMed, CENTRAL, Embase and oncological meetings websites were searched to September 13th, 2022. We included phase III randomized controlled trials (RCTs) investigating palbociclib, ribociclib and abemaciclib in addition to endocrine therapy (ET) compared to placebo in hormone-receptor positive/HER2-negative advanced or mBC. Outcomes were progression-free survival (PFS), overall survival (OS), adverse events (AEs), dose reductions and discontinuations. Hazard ratios (HRs) and risk differences were computed with a random effect model to estimate the number needed to treat/harm (NNT/NNH). LHH was computed as (1/NNT)/(1/NNH). PROSPERO registration number: CRD42022362417. FINDINGS 2204 records were screened and seven RCTs (4415 patients) were included. A significant PFS benefit was observed in patients treated with a CDK4/6 inhibitor compared to placebo (HR 0.549; 0.508-0.594, I 2 = 0). Palbociclib, ribociclib and abemaciclib had similar NNTs (4.4, 5.0 and 4.4). Palbociclib and ribociclib showed lower LHHs for grade 3-4 neutropenia (0.33 and 0.35) and febrile neutropenia ([FN], 14.27 and 15.52), while abemaciclib the lowest LHH for any grade diarrhea (0.42). Abemaciclib had a lower LHH for grade 3-4 fatigue (9.92) and the highest LHH for all grade 3-4 AEs (0.62), while ribociclib the lowest LHH (1.75) for grade 3-4 hepatotoxicity. Palbociclib had the highest LHH for dose reductions and discontinuations (0.65 and 6.17). Considering OS, an overall benefit was observed (HR 0.788, 0.727-0.856, I 2 = 0%); ribociclib and abemaciclib had lower NNTs (9.7 and 10.0). Ribociclib showed the highest LHH for diarrhea (1.29), fatigue (7.37), dose reductions (0.28) and discontinuations (2.40), while abemaciclib the highest LHHs for neutropenia (0.40), FN (12.53) and hepatotoxicity (2.23). INTERPRETATION Palbociclib and ribociclib showed lower LHHs for haematological toxicities and abemaciclib for diarrhea. Palbociclib confirmed to be a manageable drug. The LHH appears to be a reliable synthesis tool for balancing risks and benefits of experimental drugs when head-to-head comparisons are missing. FUNDING None.
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Affiliation(s)
- Luca Mastrantoni
- Medical Oncology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Armando Orlandi
- Medical Oncology, Università Cattolica del Sacro Cuore, Rome, Italy
- Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Antonella Palazzo
- Medical Oncology, Università Cattolica del Sacro Cuore, Rome, Italy
- Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Giovanna Garufi
- Medical Oncology, Università Cattolica del Sacro Cuore, Rome, Italy
- Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Alessandra Fabi
- Precision Medicine Breast Unit, Scientific Directorate, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Gennaro Daniele
- UOC Phase I, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Diana Giannarelli
- Biostatistic, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Giampaolo Tortora
- Medical Oncology, Università Cattolica del Sacro Cuore, Rome, Italy
- Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Emilio Bria
- Medical Oncology, Università Cattolica del Sacro Cuore, Rome, Italy
- Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
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Garufi G, Carbognin L, Sperduti I, Miglietta F, Dieci MV, Mazzeo R, Orlandi A, Gerratana L, Palazzo A, Fabi A, Paris I, Franco A, Franceschini G, Fiorio E, Pilotto S, Guarneri V, Puglisi F, Conte P, Milella M, Scambia G, Tortora G, Bria E. Development of a nomogram for predicting pathological complete response in luminal breast cancer patients following neoadjuvant chemotherapy. Ther Adv Med Oncol 2023; 15:17588359221138657. [PMID: 36936199 PMCID: PMC10017935 DOI: 10.1177/17588359221138657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 10/27/2022] [Indexed: 03/17/2023] Open
Abstract
Background Given the low chance of response to neoadjuvant chemotherapy (NACT) in luminal breast cancer (LBC), the identification of predictive factors of pathological complete response (pCR) represents a challenge. A multicenter retrospective analysis was performed to develop and validate a predictive nomogram for pCR, based on pre-treatment clinicopathological features. Methods Clinicopathological data from stage I-III LBC patients undergone NACT and surgery were retrospectively collected. Descriptive statistics was adopted. A multivariate model was used to identify independent predictors of pCR. The obtained log-odds ratios (ORs) were adopted to derive weighting factors for the predictive nomogram. The receiver operating characteristic analysis was applied to determine the nomogram accuracy. The model was internally and externally validated. Results In the training set, data from 539 patients were gathered: pCR rate was 11.3% [95% confidence interval (CI): 8.6-13.9] (luminal A-like: 5.3%, 95% CI: 1.5-9.1, and luminal B-like: 13.1%, 95% CI: 9.8-13.4). The optimal Ki67 cutoff to predict pCR was 44% (area under the curve (AUC): 0.69; p < 0.001). Clinical stage I-II (OR: 3.67, 95% CI: 1.75-7.71, p = 0.001), Ki67 ⩾44% (OR: 3.00, 95% CI: 1.59-5.65, p = 0.001), and progesterone receptor (PR) <1% (OR: 2.49, 95% CI: 1.15-5.38, p = 0.019) were independent predictors of pCR, with high replication rates at internal validation (100%, 98%, and 87%, respectively). According to the nomogram, the probability of pCR ranged from 3.4% for clinical stage III, PR > 1%, and Ki67 <44% to 53.3% for clinical stage I-II, PR < 1%, and Ki67 ⩾44% (accuracy: AUC, 0.73; p < 0.0001). In the validation set (248 patients), the predictive performance of the model was confirmed (AUC: 0.7; p < 0.0001). Conclusion The combination of commonly available clinicopathological pre-NACT factors allows to develop a nomogram which appears to reliably predict pCR in LBC.
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Affiliation(s)
| | | | | | - Federica Miglietta
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
- Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy
| | - Maria Vittoria Dieci
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
- Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy
| | - Roberta Mazzeo
- Oncologia Medica, Centro di Riferimento Oncologico (CRO), IRCCS, Aviano (PN), Italy University of Udine, Italy
| | - Armando Orlandi
- Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Lorenzo Gerratana
- Oncologia Medica, Centro di Riferimento Oncologico (CRO), IRCCS, Aviano (PN), Italy University of Udine, Italy
| | - Antonella Palazzo
- Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Alessandra Fabi
- Unit of Precision Medicine in Senology, Scientific Directorate, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Ida Paris
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Antonio Franco
- Breast Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gianluca Franceschini
- Breast Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Elena Fiorio
- Medical Oncology, Department of Medicine, University of Verona Hospital Trust, Verona, Italy
| | - Sara Pilotto
- Medical Oncology, Department of Medicine, University of Verona Hospital Trust, Verona, Italy
| | - Valentina Guarneri
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
- Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy
| | - Fabio Puglisi
- Oncologia Medica, Centro di Riferimento Oncologico (CRO), IRCCS, Aviano (PN), Italy University of Udine, Italy
| | - Pierfranco Conte
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
- Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy
| | - Michele Milella
- Medical Oncology, Department of Medicine, University of Verona Hospital Trust, Verona, Italy
| | - Giovanni Scambia
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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Pasqualoni M, Orlandi A, Palazzo A, Garufi G, Cannizzaro MC, Pontolillo L, Pannunzio S, Cutigni C, Sollena P, Federico F, Bria E, Tortora G. Case report: Vitiligo-like toxicity due to ribociclib during first-line treatment of metastatic breast cancer: two cases of premature interruption of therapy and exceptional response. Front Oncol 2023; 13:1067264. [PMID: 36969030 PMCID: PMC10034067 DOI: 10.3389/fonc.2023.1067264] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 02/17/2023] [Indexed: 03/29/2023] Open
Abstract
Cancer treatment-related adverse events (AEs) are sometimes associated with outcomes for cancer patients, especially with the newest therapies such as target therapy and immunotherapy. A few years ago, the first-line therapy for hormone-receptor-positive metastatic breast cancer (mBC) patients has been deeply changed by the introduction of cyclin-dependent kinase (CDK) 4/6 inhibitors, and now, we are improving our knowledge about their AEs and significance in clinical practice. Here, we report our experience with two cases of vitiligo-like lesions that occur early during treatment with ribociclib. We tried to change the CDK4/6 inhibitor for one patient, but the skin reaction persisted. Both patients retained only the endocrine therapy alone and had an unexpected durable progression-free survival (PFS). Some data on skin toxicities, including vitiligo-like lesions by CDK4/6 inhibitors, have recently been reported in the literature, but for the first time, we highlight a possible correlation with improved survival outcomes of patients. Uncovering the etiology of this toxicity, verifying the involvement of the immune system, and demonstrating a possible positive impact in survival represent an intriguing research objective for the near future.
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Affiliation(s)
- Mariangela Pasqualoni
- Comprehensive Cancer Center, Medical Oncology Unit, Fondazione Policlinico Universitario ‘A. Gemelli’ – IRCCS, Rome, Italy
- Catholic University of Sacred Heart, Rome, Italy
| | - Armando Orlandi
- Comprehensive Cancer Center, Medical Oncology Unit, Fondazione Policlinico Universitario ‘A. Gemelli’ – IRCCS, Rome, Italy
- *Correspondence: Armando Orlandi,
| | - Antonella Palazzo
- Comprehensive Cancer Center, Medical Oncology Unit, Fondazione Policlinico Universitario ‘A. Gemelli’ – IRCCS, Rome, Italy
| | - Giovanna Garufi
- Comprehensive Cancer Center, Medical Oncology Unit, Fondazione Policlinico Universitario ‘A. Gemelli’ – IRCCS, Rome, Italy
- Catholic University of Sacred Heart, Rome, Italy
| | - Maria Chiara Cannizzaro
- Comprehensive Cancer Center, Medical Oncology Unit, Fondazione Policlinico Universitario ‘A. Gemelli’ – IRCCS, Rome, Italy
- Catholic University of Sacred Heart, Rome, Italy
| | - Letizia Pontolillo
- Comprehensive Cancer Center, Medical Oncology Unit, Fondazione Policlinico Universitario ‘A. Gemelli’ – IRCCS, Rome, Italy
- Catholic University of Sacred Heart, Rome, Italy
| | - Sergio Pannunzio
- Comprehensive Cancer Center, Medical Oncology Unit, Fondazione Policlinico Universitario ‘A. Gemelli’ – IRCCS, Rome, Italy
- Catholic University of Sacred Heart, Rome, Italy
| | - Claudia Cutigni
- Comprehensive Cancer Center, Medical Oncology Unit, Fondazione Policlinico Universitario ‘A. Gemelli’ – IRCCS, Rome, Italy
- Catholic University of Sacred Heart, Rome, Italy
| | - Pietro Sollena
- Department of Dermatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Francesco Federico
- Department of Pathology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Emilio Bria
- Comprehensive Cancer Center, Medical Oncology Unit, Fondazione Policlinico Universitario ‘A. Gemelli’ – IRCCS, Rome, Italy
- Catholic University of Sacred Heart, Rome, Italy
| | - Giampaolo Tortora
- Comprehensive Cancer Center, Medical Oncology Unit, Fondazione Policlinico Universitario ‘A. Gemelli’ – IRCCS, Rome, Italy
- Catholic University of Sacred Heart, Rome, Italy
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Garufi G, Carbognin L, Schettini F, Seguí E, Di Leone A, Franco A, Paris I, Scambia G, Tortora G, Fabi A. Updated Neoadjuvant Treatment Landscape for Early Triple Negative Breast Cancer: Immunotherapy, Potential Predictive Biomarkers, and Novel Agents. Cancers (Basel) 2022; 14:cancers14174064. [PMID: 36077601 PMCID: PMC9454536 DOI: 10.3390/cancers14174064] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 08/09/2022] [Accepted: 08/16/2022] [Indexed: 11/21/2022] Open
Abstract
Simple Summary In recent years, several agents have been tested in randomized clinical trials in addition to anthracycline and taxane-based neoadjuvant chemotherapy (NACT) in early-stage triple-negative breast cancer (TNBC) to improve pathological complete response rate and, ultimately, survival outcome. Platinum agents, immune checkpoint inhibitors (ICIs), and PARP-inhibitors are the most extensively studied, while established predictors of their efficacy are lacking. Based on the biological features of TNBC, the purpose of this review is to provide an overview of the role of platinum agents, immunotherapy, and novel target therapies in the neoadjuvant setting. Moreover, based on safety issues and financial costs, we provide an overview of potential biomarkers associated with increased likelihood of benefit from the addition of platinum, ICIs, and novel target therapies to NACT. Abstract Triple-negative breast cancer (TNBC) is characterized by the absence of hormone receptor and HER2 expression, and therefore a lack of therapeutic targets. Anthracyclines and taxane-based neoadjuvant chemotherapy have historically been the cornerstone of treatment of early TNBC. However, genomic and transcriptomic analyses have suggested that TNBCs include various subtypes, characterized by peculiar genomic drivers and potential therapeutic targets. Therefore, several efforts have been made to expand the therapeutic landscape of early TNBC, leading to the introduction of platinum and immunomodulatory agents into the neoadjuvant setting. This review provides a comprehensive overview of the currently available evidence regarding platinum agents and immune-checkpoint-inhibitors for the neoadjuvant treatment of TNBC, as well as the novel target therapies that are currently being evaluated in this setting. Taking into account the economic issues and the side effects of the expanding therapeutic options, we focus on the potential efficacy biomarkers of the emerging therapies, in order to select the best therapeutic strategy for each specific patient.
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Affiliation(s)
- Giovanna Garufi
- Oncologia Medica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Roma, Italy
- Oncologia Medica, Università Cattolica Del Sacro Cuore, 00168 Roma, Italy
- Correspondence: (G.G.); (A.F.)
| | - Luisa Carbognin
- Department of Woman and Child Health and Public Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Roma, Italy
| | - Francesco Schettini
- Medical Oncology Department, Hospital Clinic of Barcelona, 08036 Barcelona, Spain
- Translational Genomics and Targeted Therapies in Solid Tumors, August Pi i Sunyer Biomedical Research Institute, 08036 Barcelona, Spain
- Faculty of Medicine, University of Barcelona, 08036 Barcelona, Spain
| | - Elia Seguí
- Medical Oncology Department, Hospital Clinic of Barcelona, 08036 Barcelona, Spain
- Translational Genomics and Targeted Therapies in Solid Tumors, August Pi i Sunyer Biomedical Research Institute, 08036 Barcelona, Spain
| | - Alba Di Leone
- Breast Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Roma, Italy
| | - Antonio Franco
- Breast Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Roma, Italy
| | - Ida Paris
- Department of Woman and Child Health and Public Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Roma, Italy
| | - Giovanni Scambia
- Oncologia Medica, Università Cattolica Del Sacro Cuore, 00168 Roma, Italy
- Department of Woman and Child Health and Public Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Roma, Italy
| | - Giampaolo Tortora
- Oncologia Medica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Roma, Italy
- Oncologia Medica, Università Cattolica Del Sacro Cuore, 00168 Roma, Italy
| | - Alessandra Fabi
- Unit of Precision Medicine in Senology, Department of Woman and Child Health and Public Health, Scientific Directorate, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, 00168 Roma, Italy
- Correspondence: (G.G.); (A.F.)
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Marazzi F, Orlandi A, Masiello V, Zinicola T, Moschella F, Palazzo A, Chiesa S, Garufi G, Frascino V, Tagliaferri L, Franceschini G, Fabi A, Gambacorta M, Bria E, Masetti R, Tortora G, Valentini V. 191P Radiotherapy (RT) in oligoprogressive metastatic breast cancer (mBC): A retrospective analysis. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.03.210] [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: 11/01/2022] Open
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Garufi G, Carbognin L, Orlandi A, Palazzo A, Tortora G, Bria E. The Therapeutic Challenge of Disseminated Bone Marrow Metastasis From HR-Positive HER2-Negative Breast Cancer: Case Report and Review of the Literature. Front Oncol 2021; 11:651723. [PMID: 34692469 PMCID: PMC8529000 DOI: 10.3389/fonc.2021.651723] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 01/14/2021] [Accepted: 09/10/2021] [Indexed: 01/15/2023] Open
Abstract
The efficacy and safety of the combination of endocrine therapy (ET) and CDK4/6 inhibitors for patients with hormone receptor (HR)-positive HER2-negative metastatic breast cancer (BC) presenting with visceral crisis or life-threatening conditions represent a challenge for daily clinical practice. Indeed, the peculiarity of this clinical presentation (signs and symptoms of rapidly progressive disease) does not allow to include such patients in a trial aiming for drug approval. On the basis of the scientific evidence available so far, chemotherapy represents the standard of care according to guidelines, on the basis of the more rapid activity in comparison with ET alone. Besides, the combination of ET and CDK4/6 inhibitors have demonstrated in clinical trials to have clinically impactful activity in a short time, thus suggesting a potential role in advanced tumors that require rapid response. Herein, we report the clinical history of a young woman with HR-positive HER2-negative metastatic BC and a pancytopenia due to carcinomatosis of the bone marrow receiving letrozole and leuprorelin plus the CDK4/6 inhibitor palbociclib, who significantly derived clinical benefit from treatment. Considering that these peculiar cases are excluded from clinical trials, the estimation of the magnitude of the benefit of the newer ET combination may potentially represent a practical question for large case series and real-world studies.
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Affiliation(s)
- Giovanna Garufi
- Oncologia Medica, Fondazione Policlinico Universitario Agostino Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Roma, Italy.,Università Cattolica Del Sacro Cuore, Roma, Italy
| | - Luisa Carbognin
- Division of Gynecologic Oncology, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Armando Orlandi
- Oncologia Medica, Fondazione Policlinico Universitario Agostino Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Roma, Italy
| | - Antonella Palazzo
- Oncologia Medica, Fondazione Policlinico Universitario Agostino Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Roma, Italy
| | - Giampaolo Tortora
- Oncologia Medica, Fondazione Policlinico Universitario Agostino Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Roma, Italy.,Università Cattolica Del Sacro Cuore, Roma, Italy
| | - Emilio Bria
- Oncologia Medica, Fondazione Policlinico Universitario Agostino Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Roma, Italy.,Università Cattolica Del Sacro Cuore, Roma, Italy
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Orlandi A, D'Archi S, Garufi G, Franco A, Carnassale B, Palazzo A, Bria E, Sanchez M, DI Leone A, Terribile D, Fabi A, Tortora G, Masetti R, Franceschini G. Impact on survival of primary tumor resection in patients with metastatic breast cancer: preliminary results of a retrospective analisys. Minerva Surg 2021; 76:506-511. [PMID: 34338469 DOI: 10.23736/s2724-5691.21.09007-9] [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: 11/08/2022]
Abstract
BACKGROUND Treatment of de novo metastatic breast cancer is usually centered around systemic therapy, with local therapy (surgery and radiation therapy) largely reserved for palliation in patients with significant symptoms from primary tumour. The efficacy of locoregional treatment like surgery and/or radiotherapy is still controversial and the debate about surgical resection of primary tumor (PT) in de novo metastatic breast cancer (MBC) patients persists. METHODS All patients with de novo MBC undergone surgical treatment between January 2015 and January 2020 at the Multidisciplinary Breast Center of the Fondazione Policlinico Universitario A. Gemelli IRCCS in Rome were included in this study. The primary endpoint was overall survival (OS) after PT resection, the secondary endpoint was progression free survival (PFS). The survival analyses were done using Kaplan-Meier method. Patients and tumour characteristics were analyzed in an exploratory modality in order to identify prognostic factor. RESULTS 45 patients received resection of the primary breast cancer (26 mastectomy and 19 breast conserving surgery). Median age of diagnosis was 53 years old (range 25-75 years old). Median follow-up was 25.67 months. The median OS was not reached with 75% of patients alive over 2 years from PT resection. The median PFS was not reached with 64% of patients alive over 2 years from PT resection. For both PFS and OS only the triple negative (TN) immunophenotype appears to be a prognostically unfavorable factor in multivariate analysis. CONCLUSIONS In view of the low number of disease progression events and deaths, although our results are preliminary, surgical treatment of primary breast cancer in metastatic setting seems to be an option after systemic therapies in luminal and HER2 positive breast cancer. Randomized prospective trials in for each immunophenotype are necessary order to confirm this evidence.
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Affiliation(s)
- Armando Orlandi
- Comprehensive Cancer Center, UOC di Oncologia Medica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy -
| | - Sabatino D'Archi
- Breast Center Unit, Dipartimento Scienze della Salute della donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giovanna Garufi
- Comprehensive Cancer Center, UOC di Oncologia Medica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Antonio Franco
- Breast Center Unit, Dipartimento Scienze della Salute della donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Beatrice Carnassale
- Breast Center Unit, Dipartimento Scienze della Salute della donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Antonella Palazzo
- Comprehensive Cancer Center, UOC di Oncologia Medica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Emilio Bria
- Comprehensive Cancer Center, UOC di Oncologia Medica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Martin Sanchez
- Breast Center Unit, Dipartimento Scienze della Salute della donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Alba DI Leone
- Breast Center Unit, Dipartimento Scienze della Salute della donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Daniela Terribile
- Breast Center Unit, Dipartimento Scienze della Salute della donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Alessandra Fabi
- Breast Center Unit, Dipartimento Scienze della Salute della donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giampaolo Tortora
- Comprehensive Cancer Center, UOC di Oncologia Medica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Riccardo Masetti
- Breast Center Unit, Dipartimento Scienze della Salute della donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Gianluca Franceschini
- Breast Center Unit, Dipartimento Scienze della Salute della donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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Orlandi A, Pontolillo L, Mele C, Pasqualoni M, Pannunzio S, Cannizzaro MC, Cutigni C, Palazzo A, Garufi G, Vellone M, Ardito F, Franceschini G, Sanchez AM, Cassano A, Giuliante F, Bria E, Tortora G. Liver Metastasectomy for Metastatic Breast Cancer Patients: A Single Institution Retrospective Analysis. J Pers Med 2021; 11:jpm11030187. [PMID: 33800160 PMCID: PMC7998479 DOI: 10.3390/jpm11030187] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 02/22/2021] [Accepted: 03/04/2021] [Indexed: 12/11/2022] Open
Abstract
The liver represents the first metastatic site in 5–12% of metastatic breast cancer (MBC) cases. In absence of reliable evidence, liver metastasectomy (LM) could represent a possible therapeutic option for selected MBC patients (patients) in clinical practice. A retrospective analysis including MBC patients who had undergone an LM after a multidisciplinary Tumor Board discussion at the Hepatobiliary Surgery Unit of Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS in Rome, between January 1994 and December 2019 was conducted. The primary endpoint was overall survival (OS) after a MBC-LM; the secondary endpoint was the disease-free interval (DFI) after surgery. Forty-nine MBC patients underwent LM, but clinical data were only available for 22 patients. After a median follow-up of 71 months, median OS and DFI were 67 months (95% CI 45–103) and 15 months (95% CI 11–46), respectively. At univariate analysis, the presence of a negative resection margin (R0) was the only factor that statistically significantly influenced OS (78 months versus 16 months; HR 0.083, p < 0.0001) and DFI (16 months versus 5 months; HR 0.17, p = 0.0058). A LM for MBC might represent a therapeutic option for selected patients. The radical nature of the surgical procedure performed in a high-flow center and after a multidisciplinary discussion appears essential for this therapeutic option.
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Affiliation(s)
- Armando Orlandi
- Comprehensive Cancer Center, UOC di Oncologia Medica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (L.P.); (M.P.); (S.P.); (M.C.C.); (C.C.); (A.P.); (G.G.); (A.C.); (E.B.); (G.T.)
- Correspondence: ; Tel.: +39-0630-156-318
| | - Letizia Pontolillo
- Comprehensive Cancer Center, UOC di Oncologia Medica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (L.P.); (M.P.); (S.P.); (M.C.C.); (C.C.); (A.P.); (G.G.); (A.C.); (E.B.); (G.T.)
- Catholic University of Sacred Heart, 00168 Rome, Italy; (M.V.); (F.A.); (G.F.); (F.G.)
| | - Caterina Mele
- Comprehensive Cancer Center, Hepatobiliary Surgery Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy;
| | - Mariangela Pasqualoni
- Comprehensive Cancer Center, UOC di Oncologia Medica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (L.P.); (M.P.); (S.P.); (M.C.C.); (C.C.); (A.P.); (G.G.); (A.C.); (E.B.); (G.T.)
- Catholic University of Sacred Heart, 00168 Rome, Italy; (M.V.); (F.A.); (G.F.); (F.G.)
| | - Sergio Pannunzio
- Comprehensive Cancer Center, UOC di Oncologia Medica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (L.P.); (M.P.); (S.P.); (M.C.C.); (C.C.); (A.P.); (G.G.); (A.C.); (E.B.); (G.T.)
- Catholic University of Sacred Heart, 00168 Rome, Italy; (M.V.); (F.A.); (G.F.); (F.G.)
| | - Maria Chiara Cannizzaro
- Comprehensive Cancer Center, UOC di Oncologia Medica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (L.P.); (M.P.); (S.P.); (M.C.C.); (C.C.); (A.P.); (G.G.); (A.C.); (E.B.); (G.T.)
- Catholic University of Sacred Heart, 00168 Rome, Italy; (M.V.); (F.A.); (G.F.); (F.G.)
| | - Claudia Cutigni
- Comprehensive Cancer Center, UOC di Oncologia Medica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (L.P.); (M.P.); (S.P.); (M.C.C.); (C.C.); (A.P.); (G.G.); (A.C.); (E.B.); (G.T.)
- Catholic University of Sacred Heart, 00168 Rome, Italy; (M.V.); (F.A.); (G.F.); (F.G.)
| | - Antonella Palazzo
- Comprehensive Cancer Center, UOC di Oncologia Medica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (L.P.); (M.P.); (S.P.); (M.C.C.); (C.C.); (A.P.); (G.G.); (A.C.); (E.B.); (G.T.)
| | - Giovanna Garufi
- Comprehensive Cancer Center, UOC di Oncologia Medica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (L.P.); (M.P.); (S.P.); (M.C.C.); (C.C.); (A.P.); (G.G.); (A.C.); (E.B.); (G.T.)
- Catholic University of Sacred Heart, 00168 Rome, Italy; (M.V.); (F.A.); (G.F.); (F.G.)
| | - Maria Vellone
- Catholic University of Sacred Heart, 00168 Rome, Italy; (M.V.); (F.A.); (G.F.); (F.G.)
- Comprehensive Cancer Center, Hepatobiliary Surgery Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy;
| | - Francesco Ardito
- Catholic University of Sacred Heart, 00168 Rome, Italy; (M.V.); (F.A.); (G.F.); (F.G.)
- Comprehensive Cancer Center, Hepatobiliary Surgery Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy;
| | - Gianluca Franceschini
- Catholic University of Sacred Heart, 00168 Rome, Italy; (M.V.); (F.A.); (G.F.); (F.G.)
- Multidisciplinary Breast Center, Dipartimento Scienze della Salute della donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy;
| | - Alejandro Martin Sanchez
- Multidisciplinary Breast Center, Dipartimento Scienze della Salute della donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy;
| | - Alessandra Cassano
- Comprehensive Cancer Center, UOC di Oncologia Medica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (L.P.); (M.P.); (S.P.); (M.C.C.); (C.C.); (A.P.); (G.G.); (A.C.); (E.B.); (G.T.)
- Catholic University of Sacred Heart, 00168 Rome, Italy; (M.V.); (F.A.); (G.F.); (F.G.)
| | - Felice Giuliante
- Catholic University of Sacred Heart, 00168 Rome, Italy; (M.V.); (F.A.); (G.F.); (F.G.)
- Comprehensive Cancer Center, Hepatobiliary Surgery Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy;
| | - Emilio Bria
- Comprehensive Cancer Center, UOC di Oncologia Medica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (L.P.); (M.P.); (S.P.); (M.C.C.); (C.C.); (A.P.); (G.G.); (A.C.); (E.B.); (G.T.)
- Catholic University of Sacred Heart, 00168 Rome, Italy; (M.V.); (F.A.); (G.F.); (F.G.)
| | - Giampaolo Tortora
- Comprehensive Cancer Center, UOC di Oncologia Medica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (L.P.); (M.P.); (S.P.); (M.C.C.); (C.C.); (A.P.); (G.G.); (A.C.); (E.B.); (G.T.)
- Catholic University of Sacred Heart, 00168 Rome, Italy; (M.V.); (F.A.); (G.F.); (F.G.)
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Garufi G, Carbognin L, Orlandi A, Tortora G, Bria E. Smoking habit and hospitalization for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-related pneumonia: The unsolved paradox behind the evidence. Eur J Intern Med 2020; 77:121-122. [PMID: 32345527 PMCID: PMC7177104 DOI: 10.1016/j.ejim.2020.04.042] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 04/20/2020] [Indexed: 01/08/2023]
Affiliation(s)
- Giovanna Garufi
- Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy; Medical Oncology, Università Cattolica del Sacro Cuore, Roma, Italy.
| | - Luisa Carbognin
- Division of Gynecologic Oncology, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Armando Orlandi
- Medical Oncology, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Giampaolo Tortora
- Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy; Medical Oncology, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Emilio Bria
- Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy; Medical Oncology, Università Cattolica del Sacro Cuore, Roma, Italy
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Orlandi A, Iattoni E, Pizzuti L, Fabbri A, Botticelli A, Dio CD, Palazzo A, Garufi G, Indellicati G, Alesini D, Carbognin L, Paris I, Vaccaro A, Moscetti L, Cassano A, Vici P, Magri V, Naso G, Giannarelli D, Marchetti P, Bria E, Tortora G. Abstract P1-19-43: Palbociclib-fulvestrant (PALBO-FUL) and everolimus -exemestane (EVE-EXE) for second line hormonal treatment (HT) of metastatic breast cancer (MBC) with lobular histology: A propensity score matched analysis. Cancer Res 2020. [DOI: 10.1158/1538-7445.sabcs19-p1-19-43] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Recently, CDK4/6i proved to improve the efficacy of HT of pts affected by luminal MBC. However, the best sequence of HT is still unclear and it is still uncertain if pts with lobular histology derive the same benefit of ductal when receiving second line CDK4/6i. Particularly in lobular MBC, the dysregulation of the AKTpathway with the overexpression of cyclin E potentially represents an important mechanism of acquired resistance to HT, finally providing an intrinsic resistance to subsequent CDK4/6i. Thus, a multicentric retrospective study was conducted to determine the efficacy of PALBO-FUL versus EVE-EXE as second line HT of MBC with Lobular histology.Methods: Pts affected by Lobular MBC receiving PALBO-FUL or EVE-EXE for second line HT from 2013 to 2018 in 6 Italian centers were considered eligible. The primary endpoint was progression free survival (PFS). A propensity score (PS) adjustment for baseline characteristics was further accomplished for survival analysis. Results: Seventy-four of 376 screened pts were diagnosed for Lobular MBC; 46pts received PALBO-FUL, whereas 28 were treated with EVE-EXE, without imbalance in clinical characteristics. PFS resulted to be significantly longer for pts receiving EVE-EXE in comparison with PALBO-FUL (6.1 vs. 4.5 months, HR 0.58, 95% CI 0.35-0.96; p=0.025). Previous chemotherapy exposure resulted to be significantly associated with PFS at the multivariate analysis (HR 0.41, 95% CI 0.24-0.72, p=0.002). At the PS analysis, adjusted for previous chemotherapy exposure and synchronous/metachronous metastatic status, PFS was confirmed to be significantly longer for pts receiving EVE-EXE in comparison with PALBO-FUL (6.0 vs. 4.6 months, p=0.04)Conclusion: This retrospective real-world analysis generates the hypothesis of a potential benefit of EVE-EXE in comparison with PALBO-FUL for second line HT of MBC with Lobular histology. Nevertheless, the small pts’ sample calls for a larger and adequately sized prospective validation. However, these data allow to speculate on the best hormonal therapeutic sequence in MLBC. Indeed, in this setting a late exposure to CDK4/6i might not allow to exploit its efficacy, while once hormonal resistance is acquired the inhibition of AKT/m-TOR pathway may represent the best option.
Citation Format: Armando Orlandi, Elena Iattoni, Laura Pizzuti, Agnese Fabbri, Andrea Botticelli, Carmela Di Dio, Antonella Palazzo, Giovanna Garufi, Giulia Indellicati, Daniele Alesini, Luisa Carbognin, Ida Paris, Angela Vaccaro, Luca Moscetti, Alessandra Cassano, Patrizia Vici, Valentina Magri, Giuseppe Naso, Diana Giannarelli, Paolo Marchetti, Emilio Bria, Giampaolo Tortora. Palbociclib-fulvestrant (PALBO-FUL) and everolimus -exemestane (EVE-EXE) for second line hormonal treatment (HT) of metastatic breast cancer (MBC) with lobular histology: A propensity score matched analysis [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P1-19-43.
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Affiliation(s)
- Armando Orlandi
- 1Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Elena Iattoni
- 1Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | | | | | | | - Carmela Di Dio
- 1Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | | | - Giovanna Garufi
- 1Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | | | | | - Luisa Carbognin
- 1Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Ida Paris
- 1Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | | | | | | | | | | | | | | | | | - Emilio Bria
- 1Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
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Garufi G, Palazzo A, Paris I, Orlandi A, Cassano A, Tortora G, Scambia G, Bria E, Carbognin L. Neoadjuvant therapy for triple-negative breast cancer: potential predictive biomarkers of activity and efficacy of platinum chemotherapy, PARP- and immune-checkpoint-inhibitors. Expert Opin Pharmacother 2020; 21:687-699. [PMID: 32052646 DOI: 10.1080/14656566.2020.1724957] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Despite recent advances in the molecular characterization of triple-negative breast cancer (TNBC), the standard treatment for early-stage TNBC is represented by the historically used anthracycline and taxane-based chemotherapy. In this modern era of precision medicine, several new therapeutic strategies and novel agents have been investigated in the neoadjuvant setting of TNBC, in order to individualize treatment. AREAS COVERED This review provides a comprehensive overview of the currently available evidence regarding the activity and efficacy of platinum agents, PARP- and immune-checkpoint-inhibitors for the neoadjuvant treatment of TNBC, highlighting the available data on potential predictive biomarkers of response or resistance to such treatments. EXPERT OPINION The genomic and immune landscape of TNBC has encouraged the exploration of drugs that interfere with the DNA repair mechanism and that modulate immune response. Overall, these drugs seem to improve the pCR rate in TNBC, despite preliminary and heterogeneous results. Taking into account the economic issues and the side effects of these drugs, it is crucial to further explore the potential predictive role of BRCA mutational status and homologous recombination deficiency score, for platinum agents and PARP-inhibitors, and tumor infiltrating lymphocytes and other immune biomarkers for checkpoint inhibitors, respectively.
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Affiliation(s)
- Giovanna Garufi
- Oncologia Medica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS , Roma, Italy.,Università Cattolica Del Sacro Cuore , Roma, Italy
| | - Antonella Palazzo
- Oncologia Medica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS , Roma, Italy
| | - Ida Paris
- Division of Gynecologic Oncology, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS , Roma, Italy
| | - Armando Orlandi
- Oncologia Medica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS , Roma, Italy
| | - Alessandra Cassano
- Oncologia Medica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS , Roma, Italy.,Università Cattolica Del Sacro Cuore , Roma, Italy
| | - Giampaolo Tortora
- Oncologia Medica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS , Roma, Italy.,Università Cattolica Del Sacro Cuore , Roma, Italy
| | - Giovanni Scambia
- Università Cattolica Del Sacro Cuore , Roma, Italy.,Division of Gynecologic Oncology, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS , Roma, Italy
| | - Emilio Bria
- Oncologia Medica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS , Roma, Italy.,Università Cattolica Del Sacro Cuore , Roma, Italy
| | - Luisa Carbognin
- Division of Gynecologic Oncology, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS , Roma, Italy
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Orlandi A, Aroldi F, Garutti M, Di Dio C, Garufi G, Iattoni E, Palazzo A, Indellicati G, Franceschini G, Cassano A, Bria E, Tortora G. Poor efficacy of palbociclib in second-line treatment of metastatic lobular breast cancer in a case series: Use before or never more? Breast J 2019; 26:1458-1460. [PMID: 31891985 DOI: 10.1111/tbj.13740] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 12/11/2019] [Accepted: 12/12/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Armando Orlandi
- Unit of Clinical Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Francesca Aroldi
- Unit of Clinical Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Mattia Garutti
- Unit of Clinical Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Carmela Di Dio
- Unit of Clinical Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Giovanna Garufi
- Unit of Clinical Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Elena Iattoni
- Unit of Clinical Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Antonella Palazzo
- Unit of Clinical Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Giulia Indellicati
- Unit of Clinical Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | | | - Alessandra Cassano
- Unit of Clinical Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Emilio Bria
- Unit of Clinical Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Giampaolo Tortora
- Unit of Clinical Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
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16
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Orlandi A, Iattoni E, Pizzuti L, Fabbri M, Botticelli A, Di Dio C, Palazzo A, Garufi G, Indellicati G, Alesini D, Carbognin L, Paris I, vaccaro A, Moscetti L, Cassano A, Vici P, Giannarelli D, Marchetti P, Bria E, Tortora G. Palbociclib-fulvestrant (PALBO-FUL) and everolimus -exemestane (EVE-EXE) for second line hormonal treatment (HT) of metastatic breast cancer (MBC) with lobular histology: A propensity score matched analysis of a multicenter ‘real-world’ patients (pts) series. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz242.034] [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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17
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Zurlo IV, Strippoli A, Calegari MA, Martini M, Cocomazzi A, Orlandi A, Cassano A, Vita E, Garufi G, Di Stefano B, Bagala C, Bria E, Pozzo C, Basso M. Histology could predict a “hot” or a “cold” gastric tumor? J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.8_suppl.44] [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
44 Background: The emerging role of immunotherapy (IT) in cancer treatments has increased the research about tumor microenvironment (TME), tumor infiltrating lymphocytes (TILs) function and their TME regulation. Nowadays ongoing trial are showing conflicting preliminary data about the efficacy of IT in advanced gastric cancer (GC). Therefore, we performed this exploratory analysis to evaluate the correlation between histology, TILs density (reported as CD4/CD8 tissue ratio), neutrophil-lymphocytes ratio (NLR) and response outcome in GC patients who underwent cytotoxic neoadjuvant treatment (NAD). Methods: CD4+ and CD8+ expression was assessed by immunohistochemistry (IHC) in pre-NAD biopsies. NLR was calculated on baseline complete blood count. A cut-off value to define low or high NLR has been selected on 3.0, based on literature data. X2 test was used to explore the correlation between histology, CD4/CD8 ratio, NLR and response. Results: We analyzed 10 diffuse and 10 intestinal GC histotypes. In the intestinal-type CD4/CD8 ratio was lower (ratio range 1:15 - 1:20) with a predominant count of CD8+ suggesting a hot and inflamed TME compared to the diffuse cohort (ratio range 1:3 -1:5) where both CD8+ and CD4+ density was lower (p=0.03). Baseline NLR was calculated in 18 out of 20 pts. All intestinal GCs showed a low NLR (<3) while all diffuse GCs displayed a high cutoff (p=0.03). CD4/CD8 ratio resulted associated to histology (p=0.025) and response outcome (p=0.0003). NLR was statistically related to histology (p=0.03) and CD4/CD8 tissue ratio (p=0.03), confirming a different systemic inflammatory status and TME according to histology. Conclusions: Despite the small sample size, our exploratory analysis shows a possible correlation between histology, systemic inflammation and TME behavior (“hot” vs“cold”) described by NLR and TILs concentration (CD4/CD8 ratio) respectively and response to NAD. Intestinal-type seems to be a “hot” tumor whereas diffuse-type appears “cold”. Future clinical trial should analyze the impact of histology and TME features on IT efficacy and the appropriate strategy to convert “cold” tumor increasing TILs density.
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Affiliation(s)
- Ina Valeria Zurlo
- Fondazione Policlinico Universitario A. Gemelli - IRCCS - UOC Oncologia Medica, Rome, Italy
| | - Antonia Strippoli
- Istituto di Oncologia Medica, Oncological Area, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Maurizio Martini
- Fondazione Policlinico Universitario Agostino Gemelli - Istituto di Anatomia Patologica, Rome, Italy
| | - Alessandra Cocomazzi
- Istituto di Anatomia Patologica, Oncological Area, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Armando Orlandi
- Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
| | - Alessandra Cassano
- Fondazione Policlinico Universitario A. Gemelli - IRCCS - UOC Oncologia Medica, Rome, Italy
| | | | | | - Brunella Di Stefano
- Fondazione Policlinico Universitario A. Gemelli - IRCCS - UOC Oncologia Medica, Rome, Italy
| | | | - Emilio Bria
- Medical Oncology Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Carmelo Pozzo
- Fondazione Policlinico Universitario A. Gemelli - IRCCS - UOC Oncologia Medica, Rome, Italy
| | - Michele Basso
- Fondazione Policlinico Universitario A. Gemelli - IRCCS - UOC Oncologia Medica, Rome, Italy
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Corallo S, Calegari MA, Zurlo IV, Marchesani S, Orlandi A, Dadduzio V, Di Stefano B, Camarda F, Di Dio C, Garufi G, Barbaro B, Vellone M, Ardito F, Giuliante F, Pozzo C, Cassano A, Barone CA, Bria E, Basso M. The impact of multidisciplinary team (MDT) management on outcome of hepatic resection in liver-limited colorectal metastases. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.4_suppl.671] [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
671 Background: Hepatic resection is the gold standard treatment for pts with liver-limited mCRC with 5- and 10-yrs survival rates reaching up to 60% and 20%. Although multidisciplinary team (MDT) management might ensure a more accurate assessment of pts and a faster referral to surgeons, reports discussing the impact of MDTs on survival are controversial and to date there are no strong evidences supporting routinely MDT discussion. The aim of this study was to evaluate the benefit of MDT management in pts with liver-limited mCRC in our single institution experience. Methods: Clinical records of pts with liver-limited mCRC who underwent radical surgery at Fondazione Policlinico “A. Gemelli” - IRCCS from Jan-2006 to Dec-2016 were retrospectively analyzed. The objective of the analysis was to compare survivals of pts managed within our MDT (MDT cohort) to those of pts referred to surgery from other hospitals without MDT discussion (non-MDT cohort). Primary endpoints were DFS and OS. Differences in baseline characteristics and in post-operative morbidity were evaluated. Results: Of the 619 pts analyzed, 230 were included in the MDT cohort and 389 in the non-MDT cohort. No significant difference between the two groups was found in terms of DFS (12vs11 m; p 0.09) and OS (55vs51 m; p 0.68). Concerning baseline characteristics, in the MDT cohort compared to non-MDT cohort there was a statistically higher number of median metastases (4.5vs2.6; p < 0.0001) and a higher rate of synchronous metastases (61.7vs39.3%; p < 0.001). Despite pre-operative CT rate was higher in the MDT group (75.8vs70.7%), the median duration of CT before surgery was significantly lower in MDT pts (7 vs 8 cycle; p < 0.001). Moreover, post-operative morbidity was significantly lower in the MDT cohort (6.2vs19.2%; p < 0.00001). Conclusions: Our study does not demonstrate a survival benefit from MDT management of pts with liver limited mCRC. However, the analysis shows that MDT assessment allows to consider eligible for surgery pts with a more advanced disease. Moreover, MDT discussion seems to reduce the median duration of pre-operative CT with a consequent lower rate of post-operative morbidities. Our data warrant prospective validation.
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Affiliation(s)
| | | | - Ina Valeria Zurlo
- Fondazione Policlinico Universitario A. Gemelli - IRCCS - UOC Oncologia Medica, Roma, Italy
| | - Silvio Marchesani
- Fondazione Policlinico Universitario A. Gemelli - IRCCS - UOC Oncologia Medica, Roma, Italy
| | - Armando Orlandi
- Fondazione Policlinico Universitario A. Gemelli - IRCCS - UOC Oncologia Medica, Roma, Italy
| | | | - Brunella Di Stefano
- Fondazione Policlinico Universitario A. Gemelli - IRCCS - UOC Oncologia Medica, Roma, Italy
| | - Floriana Camarda
- Fondazione Policlinico Universitario A. Gemelli - IRCCS - UOC Oncologia Medica, Rome, Italy
| | - Carmela Di Dio
- Fondazione Policlinico Universitario A. Gemelli - IRCCS - UOC Oncologia Medica, Roma, Italy
| | - Giovanna Garufi
- Fondazione Policlinico Universitario A. Gemelli - IRCCS - UOC Oncologia Medica, Roma, Italy
| | - Brunella Barbaro
- Fondazione Policlinico Universitario A. Gemelli - IRCCS - Istituto di Radiologia, Rome, Italy
| | - Maria Vellone
- Fondazione Policlinico Universitario A. Gemelli - IRCCS - UOC Chirugia Epato-biliare, Rome, Italy
| | - Francesco Ardito
- Fondazione Policlinico Universitario A. Gemelli - IRCCS - UOC Chirurgia Epato-biliare, Roma, Italy
| | - Felice Giuliante
- Fondazione Policlinico Universitario A. Gemelli - IRCCS - UOC Chirurgia Epato-biliare, Roma, Italy
| | - Carmelo Pozzo
- Fondazione Policlinico Universitario A. Gemelli - IRCCS - UOC Oncologia Medica, Rome, Italy
| | - Alessandra Cassano
- Fondazione Policlinico Universitario A. Gemelli - IRCCS - UOC Oncologia Medica, Rome, Italy
| | - Carlo Antonio Barone
- Fondazione Policlinico Universitario A. Gemelli - IRCCS - UOC Oncologia Medica, Rome, Italy
| | - Emilio Bria
- Medical Oncology Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Michele Basso
- Fondazione Policlinico Universitario A. Gemelli - IRCCS - UOC Oncologia Medica, Roma, Italy
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Calegari MA, Zurlo IV, Di Stefano B, Camarda F, Di Dio C, Garufi G, Cassano A, Barone CA, Bria E, Basso M, Orlandi A. FOLFOX rechallenge versus regorafenib in patients with metastatic colorectal cancer refractory to standard chemotherapy: A retrospective analysis. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.4_suppl.669] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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
669 Background: Nowadays the optimal treatment for mCRC beyond second line is still questioned. During last years, regorafenib and TAS-102 showed to improve survival compared to best supportive care in pts with refractory mCRC. Recently, some retrospective analyses compared the efficacy and safety of regorafenib and TAS-102 reporting no significant differences in survival and response outcomes. In real-world clinical practice, chemotherapy (CT) rechallenge is often considered for refractory mCRC. However, evidences regarding CT rechallenge is limited and no study has previously compared such approach with the recently approved antineoplastic agents in late lines. The aim of this study was to compare the efficacy between CT rechallenge and regorafenib in pts with refractory mCRC. Methods: This is a mono-institutional retrospective study. We compared the efficacy of FOLFOX rechallenge and regorafenib in pts with mCRC refractory to at least 2 lines of standard CT, treated at Fondazione Policlinico Universitario “A. Gemelli”-IRCCS between Jan-10 and Jan-18. The primary endpoint was OS. Secondary endpoints were RR and PFS. Results: One hundred thirty-one pts received regorafenib and 43 FOLFOX rechallenge. OS was significantly higher with FOLFOX rechallenge than it was with regorafenib (13 vs. 6 months; HR 0.67, 95% CI 0.33-0.66; p = 0.0002). PFS was significantly higher in the FOLFOX rechallenge group compared to the regorafenib group (5 vs. 3 months; HR 0.64, 95% CI 0.46-0.89; p = 0.0073). Accordingly, RR was better in pts receiving FOLFOX rechallenge compared to regorafenib (25 vs. 3%; Chi-square p < 0.0001). Conclusions: Our study, although retrospective and small-sized, compared for the first time to our knowledge the efficacy of CT rechallenge to regorafenib in refractory mCRC. In our analysis, CT rechallenge with FOLFOX proved to be superior compared to regorafenib, with a survival and response benefit in pretreated mCRC. The survival benefit observed for rechallenge might be explained by the significantly higher tumor shrinkage achieved with CT rechallenge compared to regorafenib. Our results warrant further confirmation in wider and/or prospective analyses.
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Affiliation(s)
| | - Ina Valeria Zurlo
- Fondazione Policlinico Universitario A. Gemelli - IRCCS - UOC Oncologia Medica, Roma, Italy
| | - Brunella Di Stefano
- Fondazione Policlinico Universitario A. Gemelli - IRCCS - UOC Oncologia Medica, Roma, Italy
| | - Floriana Camarda
- Fondazione Policlinico Universitario A. Gemelli - IRCCS - UOC Oncologia Medica, Rome, Italy
| | - Carmela Di Dio
- Fondazione Policlinico Universitario A. Gemelli - IRCCS - UOC Oncologia Medica, Roma, Italy
| | - Giovanna Garufi
- Fondazione Policlinico Universitario A. Gemelli - IRCCS - UOC Oncologia Medica, Roma, Italy
| | - Alessandra Cassano
- Fondazione Policlinico Universitario A. Gemelli - IRCCS - UOC Oncologia Medica, Rome, Italy
| | - Carlo Antonio Barone
- Fondazione Policlinico Universitario A. Gemelli - IRCCS - UOC Oncologia Medica, Rome, Italy
| | - Emilio Bria
- Medical Oncology Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Michele Basso
- Fondazione Policlinico Universitario A. Gemelli - IRCCS - UOC Oncologia Medica, Roma, Italy
| | - Armando Orlandi
- Fondazione Policlinico Universitario A. Gemelli - IRCCS - UOC Oncologia Medica, Roma, Italy
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Zurlo IV, Calegari MA, Orlandi A, Strippoli A, Pozzo C, Bagalà C, Garufi G, Di Dio C, Barone C, Bria E, Basso M. Locally advanced gastric cancer (LAGC): Does histology suggest strategy in PAN-cancer Era? J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.4_suppl.97] [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
97 Background: Surgery is the only potentially curative treatment for LAGC. Evidences suggest that perioperative CT (pCT) plus surgery is superior to surgery alone, whereas studies on adjuvant CT (aCT) are controversial. Guidelines recommend a pCT approach in pts with stage II/III, nevertheless in real-life many pts receive immediate surgery followed by aCT. Histology influences both survival and pathological response with worse prognosis among diffuse LAGC. No trial has compared pCT and aCT or investigated the impact of histology on the outcome of these different approaches. We hypothesized that histology may predict a different benefit from CT administered in the two settings, allowing to define the optimal strategy. We performed a study comparing the two approaches according to histology. Methods: We retrospectively analyzed pts with stage II/III LAGCs treated at our Institution between Jan-09 and Jan-17. The objective of the study was to evaluate the impact of histology (intestinal and diffuse) on survival according to strategy approach (pCT vs aCT). Primary endpoints were DFS and OS. Results: 81 pts had diffuse LAGC (29 received pCT, 52 aCT) and 60 had intestinal LAGC (32 received pCT, 29 aCT). In the intestinal cohort both DFS and OS were significantly higher in pts treated with pCT compared to aCT (DFS: HR 0.3, p = 0.02; OS: HR 0.3, p = 0.03). On the contrary in the diffuse cohort both DFS and OS were significantly lower in pts receiving pCT compared to those receiving aCT (DFS: HR 2.4, p = 0.0014; OS: HR 2.6, p = 0.0012). Conclusions: Our study, although retrospective and small-sized, shows that the survival benefit of pCT is limited to intestinal LAGC, whereas in diffuse LAGC the administration of pCT appears detrimental. Indeed, diffuse LAGC is known to be chemoresistant and pCT might delay surgery allowing metastasization. Despite the arising of recent molecular classification, still far from modifying clinical practice, histotype might represent an easy factor to discriminate pts benefitting from pCT (intestinal) to those in whom upfront surgery might be recommended (diffuse). Our hypothesis needs to be confirmed in prospective trials.
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Affiliation(s)
- Ina Valeria Zurlo
- Fondazione Policlinico Universitario A. Gemelli - IRCCS - UOC Oncologia Medica, Roma, Italy
| | | | - Armando Orlandi
- Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
| | - Antonia Strippoli
- Medical Oncology, Catholic University of the Sacred Heart, Rome, Italy
| | - Carmelo Pozzo
- Fondazione Policlinico Universitario A. Gemelli - IRCCS - UOC Oncologia Medica, Rome, Italy
| | - Cinzia Bagalà
- Policlinico Universitario A. Gemelli, U.O.C. Oncologia Medica, Rome, Italy
| | | | - Carmela Di Dio
- Fondazione Policlinico Universitario A. Gemelli - IRCCS - UOC Oncologia Medica, Roma, Italy
| | - Carlo Barone
- Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
| | - Emilio Bria
- Medical Oncology Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Michele Basso
- Fondazione Policlinico Universitario Agostino Gemelli - UOC Oncologia Medica, Roma, Italy
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21
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Schinzari G, Rossi E, Pierconti F, Garufi G, Monterisi S, Strippoli A, D’Argento E, Cassano A, Barone C. Monoinstitutional real world experience in management of Vinflunine as second line therapy for transitional cell carcinoma of the urothelium. Oncotarget 2018; 9:8765-8771. [PMID: 29492236 PMCID: PMC5823567 DOI: 10.18632/oncotarget.24162] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 12/03/2017] [Indexed: 11/25/2022] Open
Abstract
Vinflunine is the only cytotoxic agent tested as a second line therapy in transitional cell carcinoma of the urothelium in a phase III trial. It is not largely employed in clinical practice because of the high incidence of grade 3-4 toxicity. We evaluated efficacy and safety of Vinflunine at the dose of 280 mg/m2 every 3 weeks associated with primary prophylaxis with granulocyte growth factors and laxatives for patients progressed after platinum + Gemcitabine. Overall survival was 8.5 months, progression-free survival 4.33 months and response rate 25%, with disease control rate 57.2%. Grade III-IV neutropenia occurred in 10.7% of the patients, grade III-IV anemia and grade III thrombocytopenia in 10.7% and 7.2%, respectively. Among non haematological toxicity, grade I-II constipation was reported in 14.2% of the patients, without grade III-IV adverse events. No discontinuation for toxicity was observed. This study underlines that Vinfluinine at a dose of 280 mg/m2 associated with primary prophylaxis for neutropenia and constipation is effective and with a favorable toxicity profile.
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Affiliation(s)
- Giovanni Schinzari
- Department of Medical Oncology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Ernesto Rossi
- Department of Medical Oncology, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Giovanna Garufi
- Department of Medical Oncology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Santa Monterisi
- Department of Medical Oncology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Antonia Strippoli
- Department of Medical Oncology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Ettore D’Argento
- Department of Medical Oncology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alessandra Cassano
- Department of Medical Oncology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Carlo Barone
- Department of Medical Oncology, Università Cattolica del Sacro Cuore, Rome, Italy
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22
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Mazzei MM, Sindoni A, Santacaterina A, Platania A, Marino L, Umina V, Girlando A, Ricottone N, D'Agostino A, Marletta F, Tamburo M, Acquaviva G, Spatola C, Privitera G, Frosina P, Garufi G, Bonanno S, Rosso A, Barone V, Corallo A, Sansotta G, Delia P, Donato V, Lopes S, Pisana M, Runco R, Risoleti E, Arcudi A, Rifatto C, Arena G, Potami A, Messina G, Parisi S, Marletta D, Pontoriero A, Iatì G, Pergolizzi S. Radiation therapy utilisation in patients with bone metastases secondary to prostate cancer: A multicenter study. Eur J Cancer Care (Engl) 2017; 26. [PMID: 28657212 DOI: 10.1111/ecc.12681] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2017] [Indexed: 11/28/2022]
Affiliation(s)
- M M Mazzei
- Department of Biomedical and Dental Sciences and Morphological and Functional Images, University of Messina, Messina, Italy
| | - A Sindoni
- Department of Biomedical and Dental Sciences and Morphological and Functional Images, University of Messina, Messina, Italy
| | | | - A Platania
- Radiotherapy Unit, AOOR Papardo, Piemonte, Messina, Italy
| | - L Marino
- Radiotherapy Unit, REM Center, Catania, Italy
| | - V Umina
- Radiotherapy Unit, REM Center, Catania, Italy
| | - A Girlando
- Radiotherapy Unit, Humanitas, Catania, Italy
| | - N Ricottone
- Radiotherapy Unit, Humanitas, Catania, Italy
| | | | | | | | - G Acquaviva
- Radiotherapy Unit, AOOR Papardo, Piemonte, Messina, Italy
| | - C Spatola
- Radiotherapy Unit, University Hospital of Catania, Catania, Italy
| | - G Privitera
- Radiotherapy Unit, University Hospital of Catania, Catania, Italy
| | - P Frosina
- Radiotherapy Unit, "San Vincenzo" Hospital, Taormina, Italy
| | - G Garufi
- Radiotherapy Unit, "San Vincenzo" Hospital, Taormina, Italy
| | - S Bonanno
- Garibaldi-Nesima Hospital, Catania, Italy
| | - A Rosso
- Garibaldi-Nesima Hospital, Catania, Italy
| | - V Barone
- Paternò Arezzo Hospital, Ragusa, Italy
| | - A Corallo
- Paternò Arezzo Hospital, Ragusa, Italy
| | - G Sansotta
- Radiotherapy Unit, University Hospital of Messina, Messina, Italy
| | - P Delia
- Radiotherapy Unit, University Hospital of Messina, Messina, Italy
| | - V Donato
- Radiotherapy Unit, University Hospital of Messina, Messina, Italy
| | - S Lopes
- Radiotherapy Unit, University Hospital of Messina, Messina, Italy
| | - M Pisana
- Radiotherapy Unit, University Hospital of Messina, Messina, Italy
| | - R Runco
- University of Messina, Messina, Italy
| | - E Risoleti
- Department of Biomedical and Dental Sciences and Morphological and Functional Images, University of Messina, Messina, Italy
| | - A Arcudi
- Department of Biomedical and Dental Sciences and Morphological and Functional Images, University of Messina, Messina, Italy
| | - C Rifatto
- Department of Biomedical and Dental Sciences and Morphological and Functional Images, University of Messina, Messina, Italy
| | - G Arena
- Radiotherapy Unit, University Hospital of Messina, Messina, Italy
| | - A Potami
- Radiotherapy Unit, University Hospital of Messina, Messina, Italy
| | - G Messina
- Radiotherapy Unit, University Hospital of Messina, Messina, Italy
| | - S Parisi
- University of Messina, Messina, Italy
| | | | - A Pontoriero
- Radiotherapy Unit, University Hospital of Messina, Messina, Italy
| | - G Iatì
- Radiotherapy Unit, University Hospital of Messina, Messina, Italy
| | - S Pergolizzi
- Department of Biomedical and Dental Sciences and Morphological and Functional Images, University of Messina, Messina, Italy
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23
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Catalano D, Trovato GM, Spadaro D, Martines GF, Garufi G, Tonzuso A, Grasso D, Sciacchitano SG. Insulin resistance in postmenopausal women: concurrent effects of hormone replacement therapy and coffee. Climacteric 2009; 11:373-82. [DOI: 10.1080/13697130802348728] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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24
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Trovato GM, Catalano D, Martines GF, Spadaro D, Di Corrado D, Crispi V, Garufi G, Di Nuovo S. Psychological stress measure in type 2 diabetes. Eur Rev Med Pharmacol Sci 2006; 10:69-74. [PMID: 16705951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Psychological stress has been implicated as a cause of several psychosomatic disorders, but also as a factor that can unfavourably influence many diseases including diabetes mellitus. Measure of psychological stress in diabetes was performed by Psychological Stress Measure (PSM), a validated instrument, designed using 49 items drawn from descriptors generated by focus groups on stress. Clinical and psychological framework was assessed in a cohort of 100 type 2 diabetic patients (30 m, 70 f), aged 66.99 +/- 13.68 years considering disease grade, complications and level of instruction. Three other questionnaires were administered concurrently to all patients: Sickness Impact Profile (SIP), Functional Living Index (FLI) and SF-36 QOL. ANOVA statistical testing and Spearman correlation matrix were used also vs socio-cultural and clinical profile. Gender, obesity, diet compliance, smoking do not affect PSM response. Hypertensive patients and those with family history of diabetes show lower PSM scores, according to a sort of moderator effect on stress of concurrent and/or previous experience with chronic disease. Neuromuscular ailments are more prevalent in women; men vs women experience severe limitations of their working capacities and relational possibilities, with severe discomfort. In the whole, higher scores of PSM (greater stress p < 0.01) and lower scores of FLI (fair well-being perception; p < 0.01) are reciprocally related inside any school instruction level. Despite the great reciprocal association of the PSM vs FLI and SIP, no significant correlation is found between PSM vs SF-36 QOL. Socio-cultural elements interfere, and particularly instruction level quantified as school grades achieved, with the manner of living their disease. Interventions on psychological distress of type 2 diabetes mellitus patients is warranted, specially in the groups with lower levels of instruction which may need an attentive strategy for achieving a satisfactory coping with this disease.
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Affiliation(s)
- G M Trovato
- Istituto di Medicina Interna e Terapia Medica, Facoltà di Medicina e Chirurgia, University of Catania, Italy.
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25
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Pergolizzi S, Delia P, Santacaterina A, Frosina P, Frazzetto G, Girlando A, D'Agostino A, Tamburo M, Ferrera G, Garufi G. 312 Combined treatment with radiotherapy and temozolomide in recursive partitioning analysis (RPA) class V–VI glioblastoma patients. Preliminary results of a multicenter prospective study. EJC Suppl 2003. [DOI: 10.1016/s1359-6349(03)90345-4] [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: 11/28/2022] Open
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26
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Pergolizzi S, Settineri N, Santacaterina A, Maisano R, Frosina P, Loria F, Nardella G, Garufi G, Sansotta G, De Renzis C. Prognostic factors in ambulatory patients with inoperable locoregionally recurrent rectal cancer following curative surgery. Anticancer Res 1999; 19:1383-90. [PMID: 10365110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
BACKGROUND The optimal treatment for locoregionally recurrent rectal cancer after curative surgery has not yet been defined. The definition of prognostic factors could lead to the selection of an aggressive therapeutic approach in patients with favourable prognosis alone. PATIENTS AND METHODS The records of thirty-nine ambulatory pts, 15 female and 24 male, with diagnosis of locoregionally recurrent rectal cancer (LRRC) after curative surgery and treated with radiotherapy were retrospectively analyzed. The following factors were analyzed for their ability to predict the clinical response and outcome for LRRC: age, sex, initial tumor grading, primary surgical approach, initial primary tumor stage according to Dukes' classification, disease free survival (time to primary surgery and detection of a LRRC), pelvic-perineal structure affected by recurrence, total radiation dose, chemotherapy with fluorouracil, symptomatic response to the therapy, locoregional symptomatic re-recurrence, systemic progression disease. RESULTS In the univariate analysis, predictive factors for survival, were graded (G1-2 vs G3 p = 0.04), Dukes' stage at first diagnosis (A-B vs C p = 0.01), and site of pelvic-perineal recurrence (Pelvic mass alone yes vs no p = 0.01; Nerve and/or Osseous involvement yes vs no p < 0.001). Following therapy for LRRC, a better survival was observed in pts with a complete symptomatic response (complete remission vs partial remission vs no change p < 0.001), without a further locoregional symptomatic re-recurrence (re-recurrence, yes vs no p = 0.001) and/or appearance of metastatic disease (yes vs no p < 0.001).
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Affiliation(s)
- S Pergolizzi
- IST-Genova, Satellite Unit of Biomedical Technology (Radiobiomedical Area), c/o University of Messina, Italy.
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27
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Santiemma V, Garufi G, Magnanti M, Pastore R, Rossi HF, Guerrini HL, De Meo M, Fabbrini A. Luteinizing hormone pulsatility is altered in essential hypertension. Arch Androl 1997; 38:23-8. [PMID: 9017119 DOI: 10.3109/01485019708988528] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The aim of this investigation was to study the pattern of luteinizing hormone (LH) secretion in men with mild and moderate hypertension. LH pulsatility was evaluated for 8 h in 14 male patients, subdivided into 2 groups; group A, consisting of 8 patients, whose systolic blood pressure ranged between 180 and 160 mm Hg and whose diastolic blood pressure was between 115 and 105 mm Hg; and group B, 6 patients whose systolic blood pressure ranged between 220 and 180 mm Hg and whose diastolic blood pressure was between 104 and 95 mm Hg. Seven healthy males were evaluated as controls (group C). The major changes of LH pulsatility in group A included an increased peak width, increased peak amplitude, and increased peak area. In group B the changes followed the same pattern as in group A, but were more pronounced. The number of LH peaks was reduced, the peak width was increased, and both peak amplitude and peak area were increased as compared to the control group. The pattern of LH pulsatility is altered in essential hypertension and the main feature is represented by the prolonged duration of LH peaks and their greater amplitude. The altered pattern of LH secretion is likely to reflect a primary hypothalamic derangement with the gonadotropin releasing hormone (Gn-RH) secreting neurons remaining synchronized for longer times and secreting larger Gn-RH masses than in normal subjects. Since the nuclei of the brain stem (A1-A6) involved in the control of Gn-RH secretion respond to blood pressure changes, the altered activity of monoaminergic neurons may be the link between hypertension and changes of LH pulsatility.
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Affiliation(s)
- V Santiemma
- Department of Medical Pathophysiology-V Clinica Medica, La Sapienza University, Rome, Italy
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28
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Magnanti M, Malizia S, Garufi G, Lenzi A, Anselmo AP, Beligotti F, Fabbrini A, Santiemma V. Luteinizing hormone pulsatility and computer-assisted analysis of sperm features in patients with Hodgkin's disease. J Cancer Res Clin Oncol 1996; 122:416-20. [PMID: 8690752 DOI: 10.1007/bf01212881] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The aim of this work was to characterize further the impairment of the reproductive function reported in untreated male patients with Hodgkin's disease. We evaluated the pattern of luteinizing hormone pulsatility and unconventional sperm features by computer-assisted sperm analysis (CASA) in 20 adult patients affected by biopsy-proven Hodgkin's disease before they were submitted to any therapeutic approach. Changes of luteinizing hormone pulsatility were documented and consisted mainly in an increase in pulse number in comparison with control subjects (P < 0.05). On CASA, 1/3 of the patients showed a reduction in the sperm number but, when motility, velocity and linearity of progression were evaluated, the number of patients with seminal alterations rose to 2/3. Sperm velocity and linearity were already impaired in stages I and II, whereas sperm number was reduced only in stage III. Symptomatic patients, regardless of the stage, showed a significant deterioration of all parameters. Our study supports the view that in Hodgkin's disease, before any treatment, a disorder of the reproductive system is present, both at hypothalamic/hypophysial and the gonadal level, having a pathogenesis that deserves to be elucidated by further study.
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Affiliation(s)
- M Magnanti
- Dipartimento di Fisiopatologia Medica, Università di Roma La Sapienza, Rome, Italy
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29
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Santiemma V, Garufi G, Magnanti M, Pastore R, Beligotti F, Malizia S, Mariani S, Fabbrini E, De Meo M, Fabbrini A. [Alteration of luteinizing hormone pulsatility in patients with arterial hypertension]. Recenti Prog Med 1996; 87:58-61. [PMID: 8725081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The pattern of luteinizing hormone (LH) secretion in men with mild and moderate hypertension was studied. LH pulsatility was evaluated for eight hours in 14 male patients, who were subdivided into two groups: group A, consisting of 8 patients, whose systolic blood pressure ranged between 180-160 mmHg and the diastolic between 104-95 mmHg; group B, 6 patients whose systolic blood pressure ranged between 220 and 180 mmHg and the diastolic between 115-105 mmHg. Seven healthy adult males were evaluated as a control. The major changes of LH pulsatility in group A included an increased peak width (p < 0.05), increased peak amplitude (p < 0.001) and increased peak area (p < 0.001). In group B the changes followed the same pattern as in group A, but were more pronounced. The number of LH peaks was reduced (p < 0.01), the peak width was increased (p < 0.05), and both peak amplitude and peak area were increased as compared to the control group (p < 0.001). Our study demonstrates that the pattern of LH pulsatility is altered in essential hypertension and the main feature is represented by the prolonged duration of LH peaks and their greater amplitude. The altered pattern of LH secretion is likely to reflect a primary hypothalamic derangement with the gonadotropin releasing hormone (Gn-RH) secreting neurons remaining synchronized for longer times and secreting larger Gn-RH masses than in normal subjects.
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Affiliation(s)
- V Santiemma
- Dipartimento di Fisiopathologia Medica, Università La Sapienza, Roma
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Santiemma V, Rosati P, Guerzoni C, Mariani S, Beligotti F, Magnanti M, Garufi G, Galoni T, Fabbrini A. Human Sertoli cells in vitro: morphological features and androgen-binding protein secretion. J Steroid Biochem Mol Biol 1992; 43:423-9. [PMID: 1327074 DOI: 10.1016/0960-0760(92)90080-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Sertoli cells play a pivotal role in the regulation of spermatogenesis as they provide the anatomical basis of the blood-testis barrier. In the present paper we report some results of our studies on the ultrastructural features, the responsiveness to FSH, and the ability to secrete androgen-binding protein (ABP) of human Sertoli cells in vitro. The nucleus showed the characteristic foldings of the nuclear membrane, scattered chromatin, and a fibrillar nucleolus. In the cytoplasm Charcot-Boettcher crystals were present and active phagocytic activity was documented by the presence of vacuoles containing lipids and cellular debris. Human Sertoli cells in culture responded to FSH with a maximal rise in cAMP that was approx. 3-fold. This response to FSH is comparable to that reported for the adult rat but lower than that of the immature rat, and suggests that human as well as rat Sertoli cells could have a reduced response to FSH since sexual maturation was achieved. As no evidence has been reported on ABP secretion by human Sertoli cells in culture we evaluated the concentration of this protein in the Sertoli cell spent media. Human Sertoli cells in culture produced ABP and the response to FSH was dose-related. The Kd value of human ABP (hABP) was approx. 7.5 nM, being slightly higher than that of the rat ABP and an order of magnitude different from that of sex hormone-binding globulin (SHBG) present in human plasma. We also measured the association and dissociation rates of dihydrotestosterone-hABP complexes and the Kd/Ka ratio was very close to the value of Kd of the Scatchard analysis. The differences between hABP and SHBG may open the way to the selective measurement of ABP in many conditions of male infertility.
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Affiliation(s)
- V Santiemma
- Istituto di Clinica Medica V, La Sapienza University of Rome, Italy
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