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Reni M, Giommoni E, Bergamo F, Milella M, Cavanna L, Di Marco MC, Spada M, Cordio S, Aprile G, Cardellino GG, Maiello E, Bernardini I, Ghidini M, Bozzarelli S, Macchini M, Orsi G, De Simone I, Rulli E, Porcu L, Torri V, Pinto C. Guideline Application in Real world: multi-Institutional Based survey of Adjuvant and first-Line pancreatic Ductal adenocarcinoma treatment in Italy. Primary analysis of the GARIBALDI survey. ESMO Open 2023; 8:100777. [PMID: 36731325 PMCID: PMC10024128 DOI: 10.1016/j.esmoop.2022.100777] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/04/2022] [Accepted: 12/19/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Information about the adherence to scientific societies guidelines in the 'real-world' therapeutic management of oncological patients are lacking. This multicenter, prospective survey was aimed to improve the knowledge relative to 2017-2018 recommendations of the Italian Association of Medical Oncology (AIOM). PATIENTS AND METHODS Treatment-naive adult patients with pancreatic adenocarcinoma were enrolled. Group A received adjuvant therapy, group B received primary chemotherapy, and group C had metastatic disease. The results on patients accrued until 31 October 2019 with a mature follow-up were presented. RESULTS Since July 2017, 833 eligible patients of 923 (90%) were enrolled in 44 Italian centers. The median age was 69 years (range 36-89 years; 24% >75 years); 48% were female; 93% had Eastern Cooperative Oncology Group (ECOG) performance status (PS) score of 0 or 1; group A: 16%, group B: 30%; group C: 54%; 72% Nord, 13% Center, 15% South. In group A, guidelines adherence was 68% [95% confidence interval (CI) 59% to 76%]; 53% of patients received gemcitabine and 15% gemcitabine + capecitabine; median CA19.9 was 29 (range 0-7300; not reported 15%); median survival was 36.4 months (95% CI 27.5-47.3 months). In group B, guidelines adherence was 96% (95% CI 92% to 98%); 55% of patients received nab-paclitaxel + gemcitabine, 27% FOLFIRINOX, 12% gemcitabine, and 3% clinical trial; median CA19.9 was 337 (range 0-20220; not reported 9%); median survival was 18.1 months (95% CI 15.6-19.9 months). In group C, guidelines adherence was 96% (95% CI 94% to 98%); 71% of patients received nab-paclitaxel + gemcitabine, 16% gemcitabine, 8% FOLFIRINOX, and 4% clinical trial; liver and lung metastases were reported in 76% and 23% of patients, respectively; median CA19.9 value was 760 (range 0-1374500; not reported 9%); median survival was 10.0 months (95% CI 9.1-11.1 months). CONCLUSIONS The GARIBALDI survey shows a very high rate of adherence to guidelines and survival outcome in line with the literature. CA19.9 testing should be enhanced; nutritional and psychological counseling represent an unmet need. Enrollment to assess adherence to updated AIOM guidelines is ongoing.
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Affiliation(s)
- M Reni
- Department of Medical Oncology, Vita e Salute University, IRCCS San Raffaele Scientific Institute, Milan, Italy.
| | - E Giommoni
- Medical Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - F Bergamo
- Unit of Medical Oncology 1, Department of Clinical and Experimental Oncology, Istituto Oncologico Veneto, IRCCS, Padua, Italy
| | - M Milella
- Oncology Verona, Policlinico Universitario G.B. Rossi Borgo Roma, Verona, Italy
| | - L Cavanna
- Oncology and Hematology Department, Oncology Unit, Piacenza General Hospital, Piacenza, Italy
| | | | - M Spada
- Unit of Oncology, San Raffaele G. Giglio Institute, Contrada Pietrapollastra - Pisciotto, Cefalù, Italy
| | - S Cordio
- ARNAS Garibaldi Nesima - Catania, Italy
| | - G Aprile
- San Bortolo General Hospital, ULSS8 Berica Est District - Vicenza, Italy
| | - G G Cardellino
- Department of Oncology, University & General Hospital, Udine Pz.le S. Maria della Misericordia 15, Udine, Italy
| | - E Maiello
- Medical Oncology, Hospital Casa Sollievo Della Sofferenza-San Giovanni Rotondo, Foggia, Italy
| | - I Bernardini
- Department of Oncology, Carpi and Mirandola Hospitals, Carpi e Mirandola, Italy
| | | | - S Bozzarelli
- Clinical Institute Humanitas - Rozzano (Milan), Milan, Italy
| | - M Macchini
- Department of Medical Oncology, Vita e Salute University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - G Orsi
- Department of Medical Oncology, Vita e Salute University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - I De Simone
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Er Rulli
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - L Porcu
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - V Torri
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - C Pinto
- AUSL-IRCCS Clinical Cancer Center of Reggio Emilia - Reggio Emilia, Italy
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Hammel P, Golan T, Reni M, Van Cutsem E, Macarulla Mercade T, Hall M, Park J, Hochhauser D, Arnold D, Oh DY, Reinacher-Schick A, Tortora G, Algül H, O'Reilly E, Sharan K, Ou X, Cui K, Locker G, Kindler H. 1298P Extended overall survival results from the POLO study of active maintenance olaparib in patients with metastatic pancreatic cancer and a germline BRCA mutation. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1430] [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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Milella M, Orsi G, Palloni A, Salvatore L, Procaccio L, Noventa S, Bozzarelli S, Garajova I, Vasile E, Giordano G, Macchini M, Cavaliere A, Gaule M, Lonardi S, Di Marco M, Tortora G, Sperduti I, Reni M. 1307P Real-world impact of olaparib use in advanced pancreatic cancer (PC) patients (pts) harboring germline BRCA1/2 (gBRCA) mutations. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1439] [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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Redegalli M, Schiavo Lena M, Cangi MG, Smart CE, Mori M, Fiorino C, Arcidiacono PG, Balzano G, Falconi M, Reni M, Doglioni C. Proposal for a New Pathologic Prognostic Index After Neoadjuvant Chemotherapy in Pancreatic Ductal Adenocarcinoma (PINC). Ann Surg Oncol 2022; 29:3492-3502. [PMID: 35230580 PMCID: PMC9072515 DOI: 10.1245/s10434-022-11413-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 01/16/2022] [Indexed: 01/03/2023]
Abstract
BACKGROUND Limited information is available on the relevant prognostic variables after surgery for patients with pancreatic ductal adenocarcinoma (PDAC) subjected to neoadjuvant chemotherapy (NACT). NACT is known to induce a spectrum of histological changes in PDAC. Different grading regression systems are currently available; unfortunately, they lack precision and accuracy. We aimed to identify a new quantitative prognostic index based on tumor morphology. PATIENTS AND METHODS The study population was composed of 69 patients with resectable or borderline resectable PDAC treated with preoperative NACT (neoadjuvant group) and 36 patients submitted to upfront surgery (upfront-surgery group). A comprehensive histological assessment on hematoxylin and eosin (H&E) stained sections evaluated 20 morphological parameters. The association between patient survival and morphological variables was evaluated to generate a prognostic index. RESULTS The distribution of morphological parameters evaluated was significantly different between upfront-surgery and neoadjuvant groups, demonstrating the effect of NACT on tumor morphology. On multivariate analysis for patients that received NACT, the predictors of shorter overall survival (OS) and disease-free survival (DFS) were perineural invasion and lymph node ratio. Conversely, high stroma to neoplasia ratio predicted longer OS and DFS. These variables were combined to generate a semiquantitative prognostic index based on both OS and DFS, which significantly distinguished patients with poor outcomes from those with a good outcome. Bootstrap analysis confirmed the reproducibility of the model. CONCLUSIONS The pathologic prognostic index proposed is mostly quantitative in nature, easy to use, and may represent a reliable tumor regression grading system to predict patient outcomes after NACT followed by surgery for PDAC.
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Affiliation(s)
- M Redegalli
- Pathology Unit, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - M Schiavo Lena
- Pathology Unit, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - M G Cangi
- Pathology Unit, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - C E Smart
- Pathology Unit, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - M Mori
- Medical Physics, San Raffaele Scientific Institute, Milan, Italy
| | - C Fiorino
- Medical Physics, San Raffaele Scientific Institute, Milan, Italy
| | - P G Arcidiacono
- Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational and Clinical Research Centre, San Raffaele Scientific Institute, Vita Salute San Raffaele University, Milan, Italy
| | - G Balzano
- Pancreatic Surgery Unit, Pancreas Translational and Clinical Research Centre, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - M Falconi
- Pancreatic Surgery Unit, Pancreas Translational and Clinical Research Centre, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - M Reni
- Department of Medical Oncology, IRCCS San Raffaele Scientific Institute, Pancreas Translational and Clinical Research Centre, Milan, Italy.
| | - C Doglioni
- Pathology Unit, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
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Orsi G, Di Marco M, Cavaliere A, Niger M, Bozzarelli S, Giordano G, Noventa S, Rapposelli IG, Garajova I, Tortora G, Rodriquenz MG, Bittoni A, Penzo E, De Lorenzo S, Peretti U, Paratore C, Bernardini I, Mosconi S, Spallanzani A, Macchini M, Tamburini E, Bencardino K, Giommoni E, Scartozzi M, Forti L, Valente MM, Militello AM, Cascinu S, Milella M, Reni M. Chemotherapy toxicity and activity in patients with pancreatic ductal adenocarcinoma and germline BRCA1-2 pathogenic variants (gBRCA1-2pv): a multicenter survey. ESMO Open 2021; 6:100238. [PMID: 34392104 PMCID: PMC8371213 DOI: 10.1016/j.esmoop.2021.100238] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 07/15/2021] [Accepted: 07/20/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Germline BRCA1-2 pathogenic variants (gBRCA1-2pv)-related pancreatic ductal adenocarcinoma (PDAC) showed increased sensitivity to DNA cross-linking agents. This study aimed at exploring safety profile, dose intensity, and activity of different chemotherapy regimens in this setting. PATIENTS AND METHODS gBRCA1-2pv PDAC patients of any age and clinical tumor stage who completed a first course of chemotherapy were eligible. A descriptive analysis of chemotherapy toxicity, dose intensity, response, and survival outcomes was performed. RESULTS A total of 85 gBRCA1-2pv PDAC patients treated in 21 Italian centers between December 2008 and March 2021were enrolled. Seventy-four patients were assessable for toxicity and dose intensity, 83 for outcome. Dose intensity was as follows: nab-paclitaxel 72%, gemcitabine 76% (AG); cisplatin 75%, nab-paclitaxel 73%, capecitabine 73%, and gemcitabine 65% (PAXG); fluorouracil 35%, irinotecan 58%, and oxaliplatin 64% (FOLFIRINOX). When compared with the literature, grade 3-4 neutropenia, thrombocytopenia, and diarrhea were increased with PAXG, and unmodified with AG and FOLFIRINOX. RECIST responses were numerically higher with the three- (81%) or four-drug (73%) platinum-containing regimens that outperformed AG (41%) and oxaliplatin-based doublets (56%). Carbohydrate antigen 19.9 (CA19.9) reduction >89% at nadir was reported in two-third of metastatic patients treated with triplets and quadruplets, as opposed to 33% and 45% of patients receiving oxaliplatin-based doublets or AG, respectively. All patients receiving AG experienced disease progression, with a median progression-free survival (mPFS) of 6.4 months, while patients treated with platinum-containing triplets or quadruplets had an mPFS >10.8 months. Albeit still immature, data on overall survival seemed to parallel those on PFS. CONCLUSIONS Our data, as opposed to figures expected from the literature, highlighted that platinum-based regimens provoked an increased toxicity on proliferating cells, when dose intensity was maintained, or an as-expected toxicity, when dose intensity was reduced, while no change in toxicity and dose intensity was evident with AG. Furthermore, an apparently improved outcome of platinum-based triplets or quadruplets over other regimens was observed.
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Affiliation(s)
- G Orsi
- Medical Oncology Department, IRCCS San Raffaele Scientific Institute, Milan, Italy; Pancreas Translational and Clinical Research Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - M Di Marco
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola - Malpighi University Hospital, Bologna, Italy
| | - A Cavaliere
- Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy
| | - M Niger
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - S Bozzarelli
- Department of Medical Oncology and Hematology, Humanitas Cancer Center, Humanitas Clinical and Research Center - IRCCS, Rozzano (Milan), Italy
| | - G Giordano
- Unit of Medical Oncology and Biomolecular Therapy, Policlinico Riuniti, Foggia, Italy; Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - S Noventa
- Department of Medical Oncology, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - I G Rapposelli
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori "Dino Amadori" - IRST, Meldola, Italy
| | - I Garajova
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - G Tortora
- Unit of Medical Oncology, Comprehensive Cancer Center, Fondazione Policlinico Universitario, Agostino Gemelli IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy
| | - M G Rodriquenz
- Oncology Unit, Ospedale IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo (FG), Italy
| | - A Bittoni
- Oncology Unit, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I, GM Lancisi, G Salesi di Ancona, Ancona, Italy
| | - E Penzo
- Medical Oncology Department, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - S De Lorenzo
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - U Peretti
- Medical Oncology Department, IRCCS San Raffaele Scientific Institute, Milan, Italy; Pancreas Translational and Clinical Research Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - C Paratore
- Department of Oncology, University of Turin, Ordine Mauriziano Hospital, Turin, Italy
| | - I Bernardini
- Medical Oncology Unit, Ospedale Ramazzini, Carpi (MO), Italy
| | - S Mosconi
- Oncology Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - A Spallanzani
- Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
| | - M Macchini
- Medical Oncology Department, IRCCS San Raffaele Scientific Institute, Milan, Italy; Pancreas Translational and Clinical Research Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - E Tamburini
- Medical Oncology and Palliative Care Department, Azienda Ospedaliera Cardinale G. Panico, Tricase-Lecce, Italy
| | - K Bencardino
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - E Giommoni
- Medical Oncology Division, Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy
| | - M Scartozzi
- Medical Oncology, University and University Hospital, Cagliari, Italy
| | - L Forti
- Medical Oncology Division, Azienda Ospedaliero-Universitaria Maggiore della Carità, Novara, Italy
| | - M M Valente
- Medical Oncology Department, IRCCS San Raffaele Scientific Institute, Milan, Italy; Pancreas Translational and Clinical Research Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - A M Militello
- Medical Oncology Department, IRCCS San Raffaele Scientific Institute, Milan, Italy; Pancreas Translational and Clinical Research Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - S Cascinu
- Medical Oncology Department, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - M Milella
- Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy
| | - M Reni
- Medical Oncology Department, IRCCS San Raffaele Scientific Institute, Milan, Italy; Pancreas Translational and Clinical Research Center, IRCCS San Raffaele Scientific Institute, Milan, Italy.
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Golan T, Hammel P, Reni M, Van Cutsem E, Macarulla Mercade T, Hall M, Park J, Hochhauser D, Arnold D, Oh DY, Reinacher-Schick A, Tortora G, Algül H, O'Reilly E, Bordia S, McGuinness D, Cui K, Locker G, Kindler H. 1468P POLO: Subsequent therapy after maintenance olaparib in patients with a germline BRCA mutation and metastatic pancreatic cancer. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Arnold D, Golan T, Hammel P, Reni M, Van Cutsem E, Macarulla Mercade T, Hall M, Park J, Hochhauser D, Oh DY, Reinacher-Schick A, Tortora G, Algül H, O'Reilly E, Bordia S, McGuinness D, Cui K, Locker G, Kindler H. 1467P POLO: Long-term safety and tolerability of olaparib for patients with a germline BRCA mutation and metastatic pancreatic cancer. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Orsi G, Milella M, Nappo F, Di Marco M, Niger M, Bozzarelli S, Rodriquenz M, Noventa S, Giordano G, Rapposelli I, Bernardini I, Vasile E, Macchini M, Peretti U, Valente M, Paratore C, Spallanzani A, Scartozzi M, Cascinu S, Reni M. 1479P Exploring second-line therapy outcome in pancreatic ductal adenocarcinoma (PDAC) patients with germlineBRCA1-2 pathogenic variants (gBRCA1-2pv). Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Bekaii-Saab T, Okusaka T, Goldstein D, Oh DY, Ueno M, Ioka T, Fang W, Anderson E, Noel M, Reni M, Choi H, Goldberg J, Oh S, Li CP, Tabernero J, Li J, Foos E, Oh C, Van Cutsem E. 1466P Napabucasin + nab-paclitaxel with gemcitabine in patients (pts) with metastatic pancreatic adenocarcinoma (mPDAC): Results from the phase III CanStem111P study. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.794] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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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Tempero M, O'Reilly E, Van Cutsem E, Berlin J, Philip P, Goldstein D, Tabernero J, Borad M, Bachet J, Parner V, Tebbutt N, Chua Y, Corrie P, Harris M, Taieb J, Burge M, Kunzmann V, Zhang G, McGovern D, Marks H, Biankin A, Reni M. LBA-1 Phase 3 APACT trial of adjuvant nab-paclitaxel plus gemcitabine (nab-P + Gem) vs gemcitabine (Gem) alone in patients with resected pancreatic cancer (PC): Updated 5-year overall survival. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.06.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Taieb J, Hammel P, Reni M, Palmer D, Bridgewater J, Cubillo A, Prager G, Bayle S, Hédouin-Biville F, Teng Z, Seufferlein T, Macarulla T. SO-3 Treatment sequences and prognostic factors in metastatic pancreatic ductal adenocarcinoma: Univariate and multivariate analyses of a real-world study in Europe. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.05.027] [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: 11/26/2022] Open
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Tempero M, Oh DY, Tabernero J, Reni M, Van Cutsem E, Hendifar A, Waldschmidt DT, Starling N, Bachet JB, Chang HM, Maurel J, Garcia-Carbonero R, Lonardi S, Coussens LM, Fong L, Tsao LC, Cole G, James D, Macarulla T. Ibrutinib in combination with nab-paclitaxel and gemcitabine for first-line treatment of patients with metastatic pancreatic adenocarcinoma: phase III RESOLVE study. Ann Oncol 2021; 32:600-608. [PMID: 33539945 DOI: 10.1016/j.annonc.2021.01.070] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 01/16/2021] [Accepted: 01/20/2021] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND First-line treatment of metastatic pancreatic ductal adenocarcinoma (PDAC) includes nab-paclitaxel/gemcitabine. Ibrutinib, a Bruton's tyrosine kinase inhibitor, exhibits antitumor activity through tumor microenvironment modulation. The safety and efficacy of first-line ibrutinib plus nab-paclitaxel/gemcitabine treatment in patients with PDAC were evaluated. PATIENTS AND METHODS RESOLVE (NCT02436668) was a phase III, randomized, double-blind, placebo-controlled study. Patients (histologically-confirmed PDAC; stage IV diagnosis ≥6 weeks of randomization; Karnofsky performance score ≥70) were randomized to once-daily oral ibrutinib (560 mg) or placebo plus nab-paclitaxel (125 mg/m2) and gemcitabine (1000 mg/m2). Primary endpoints were overall survival (OS) and investigator-assessed progression-free survival (PFS); overall response rate and safety were assessed. RESULTS In total, 424 patients were randomized (ibrutinib arm, n = 211; placebo arm, n = 213). Baseline characteristics were balanced across arms. After a median follow-up of 25 months, there was no significant difference in OS between ibrutinib plus nab-paclitaxel/gemcitabine versus placebo plus nab-paclitaxel/gemcitabine (median of 9.7 versus 10.8 months; P = 0.3225). PFS was shorter for ibrutinib plus nab-paclitaxel/gemcitabine compared with placebo plus nab-paclitaxel/gemcitabine (median 5.3 versus 6.0 months; P < 0.0001). Overall response rates were 29% and 42%, respectively (P = 0.0058). Patients in the ibrutinib arm had less time on treatment and received lower cumulative doses for all agents compared with the placebo arm. The most common grade ≥3 adverse events for ibrutinib versus placebo arms included neutropenia (24% versus 35%), peripheral sensory neuropathy (17% versus 8%), and anemia (16% versus 17%). Primary reasons for any treatment discontinuation were disease progression and adverse events. CONCLUSIONS Ibrutinib plus nab-paclitaxel/gemcitabine did not improve OS or PFS for patients with PDAC. Safety was consistent with known profiles for these agents.
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Affiliation(s)
- M Tempero
- Department of Medicine, University of California San Francisco, San Francisco, USA.
| | - D-Y Oh
- Department of Internal Medicine, Cancer Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - J Tabernero
- Department of Medical Oncology, Vall d'Hebron University Hospital and Institute of Oncology (VHIO), IOB-Quiron, UVic-UICC, CIBERONC, Barcelona, Spain
| | - M Reni
- Department of Radiochemotherapy, San Raffaele Hospital Scientific Institute, Milan, Italy
| | - E Van Cutsem
- Department of Digestive Oncology, University Hospitals Gasthuisberg/Leuven & KU Leuven, Leuven, Belgium
| | - A Hendifar
- Department of Medical Oncology, Cedars-Sinai Medical Center, Los Angeles, USA
| | - D-T Waldschmidt
- Department of General, Visceral and Cancer Surgery, University of Cologne, Köln, Germany
| | - N Starling
- Section of GI and Lymphoma Units, Department of Medicine, The Royal Marsden, London, UK
| | - J-B Bachet
- Department of Hepatogastroenterology, UPMC, Sorbonne University, Pitié Salpêtrière Hospital, APHP, Paris, France
| | - H-M Chang
- Division of Oncology, Department of Internal Medicine, University of Ulsan College of Medicine, Seoul, South Korea
| | - J Maurel
- Department of Medical Oncology, Translational Genomics and Targeted Therapeutics in Solid Tumors Group, IDIBAPS, Hospital Clinic Barcelona, University of Barcelona, Barcelona, Spain
| | - R Garcia-Carbonero
- Department of Medical Oncology, Hospital Universitario Doce de Octubre, Imas12, UCM, CNIO, CIBERONC, Madrid, Spain
| | - S Lonardi
- Dipartimento di Oncologia Clinical e Sperimentale, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - L M Coussens
- Department of Cell, Developmental & Cancer Biology, Knight Cancer Institute, Oregon Health & Science University, Portland, USA
| | - L Fong
- Department of Medicine, University of California San Francisco, San Francisco, USA
| | - L C Tsao
- Department of Statistics, Pharmacyclics LLC, an AbbVie Company, Sunnyvale, USA
| | - G Cole
- Department of Oncology Development, Pharmacyclics LLC, an AbbVie Company, Sunnyvale, USA
| | - D James
- Department of Clinical Science, Pharmacyclics LLC, an AbbVie Company, Sunnyvale, USA
| | - T Macarulla
- Department of Medical Oncology, Vall d'Hebron University Hospital and Institute of Oncology (VHIO), IOB-Quiron, UVic-UICC, CIBERONC, Barcelona, Spain
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Peretti U, Cavaliere A, Niger M, Tortora G, Di Marco MC, Rodriquenz MG, Centonze F, Rapposelli IG, Giordano G, De Vita F, Stuppia L, Avallone A, Ratti M, Paratore C, Forti LG, Orsi G, Valente MM, Gaule M, Macchini M, Carrera P, Calzavara S, Simbolo M, Melisi D, De Braud F, Salvatore L, De Lorenzo S, Chiarazzo C, Falconi M, Cascinu S, Milella M, Reni M. Germinal BRCA1-2 pathogenic variants (gBRCA1-2pv) and pancreatic cancer: epidemiology of an Italian patient cohort. ESMO Open 2021; 6:100032. [PMID: 33399070 PMCID: PMC7807989 DOI: 10.1016/j.esmoop.2020.100032] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 11/26/2020] [Accepted: 11/27/2020] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVE Germline BRCA1-2 pathogenic variants (gBRCApv) increase the risk of pancreatic cancer and predict for response to platinating agents and poly(ADP-ribose) polymerase inhibitors. Data on worldwide gBRCApv incidence among pancreatic ductal adenocarcinoma (PDAC) patients are sparse and describe a remarkable geographic heterogeneity. The aim of this study is to analyze the epidemiology of gBRCApv in Italian patients. MATERIALS AND METHODS Patients of any age with pancreatic adenocarcinoma, screened within 3 months from diagnosis for gBRCApv in Italian oncologic centers systematically performing tests without any selection. For the purposes of our analysis, breast, ovarian, pancreas, and prostate cancer in a patient's family history was considered as potentially BRCA-associated. Patients or disease characteristics were examined using the χ2 test or Fisher's exact test for qualitative variables and the Student's t-test or Mann-Whitney test for continuous variables, as appropriate. RESULTS Between June 2015 and May 2020, 939 patients were tested by 14 Italian centers; 492 (52%) males, median age 62 years (range 28-87), 569 (61%) metastatic, 273 (29%) with a family history of potentially BRCA-associated cancers. gBRCA1-2pv were found in 76 patients (8.1%; 9.1% in metastatic; 6.4% in non-metastatic). The gBRCA2/gBRCA1 ratio was 5.4 : 1. Patients with gBRCApv were younger compared with wild-type (59 versus 62 years, P = 0.01). The gBRCApv rate was 17.1% among patients <40 years old, 10.4% among patients 41-50 years old, 9.2% among patients 51-60 years old, 6.7% among patients aged 61-70 years, and 6.2% among patients >70 years old (none out of 94 patients >73 years old). gBRCApv frequency in 845 patients <74 years old was 9%. Patients with/without a family history of potentially BRCA-associated tumors had 14%/6% mutations. CONCLUSION Based on our findings of a gBRCApv incidence higher than expected in a real-life series of Italian patients with incident PDAC, we recommend screening all PDAC patients <74 years old, regardless of family history and stage, due to the therapeutic implications and cancer risk prevention in patients' relatives.
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Affiliation(s)
- U Peretti
- Department of Medical Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy; Pancreas Translational & Clinical Research Center, 'Vita-Salute' University, San Raffaele Scientific Institute, Milan, Italy
| | - A Cavaliere
- Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy
| | - M Niger
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - G Tortora
- Department of Medicine, Section of Medical Oncology, Fondazione Policlinico Universitario Gemelli IRCCS, Rome, Italy
| | - M C Di Marco
- Medical Oncology Division, Department of Experimental, Diagnostic and Specialty Medicine - DIMES, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy; Medical Oncology Division, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - M G Rodriquenz
- Oncology Unit, foundation IRCCS Casa Sollievo della sofferenza, San Giovanni Rotondo, Foggia, Italy
| | - F Centonze
- Department of Medical Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy; Pancreas Translational & Clinical Research Center, 'Vita-Salute' University, San Raffaele Scientific Institute, Milan, Italy
| | - I G Rapposelli
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - G Giordano
- Department of Medical Oncology, Policlinico Riuniti, Azienda Ospedaliero Universitarià, Foggia, Italy
| | - F De Vita
- Division of Medical Oncology, Department of Precision Medicine, School of Medicine, 'Luigi Vanvitelli' University of Campania, Naples, Italy
| | - L Stuppia
- Medical Genetics, Department of Psychological, Health and Territorial Sciences Center for Advanced Sciences and Technology G. d'Annunzio University Chieti-Pescara Italy, Chieti, Italy
| | - A Avallone
- Experimental Clinical Abdominal Oncology Unit, Istituto Nazionale Tumori- IRCCS-Fondazione G. Pascale, Naples, Italy
| | - M Ratti
- Department of Oncology, Medical Department, ASST di Cremona, Ospedale di Cremona, Cremona, Italy
| | - C Paratore
- Chiara Paratore, University of Turin, Ordine Mauriziano Hospital, Largo Filippo Turati, Turin, Italy
| | - L G Forti
- SCDU Oncologia, AOU Maggiore della Carità, Novara, Italy
| | - G Orsi
- Department of Medical Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy; Pancreas Translational & Clinical Research Center, 'Vita-Salute' University, San Raffaele Scientific Institute, Milan, Italy
| | - M M Valente
- Department of Medical Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy; Pancreas Translational & Clinical Research Center, 'Vita-Salute' University, San Raffaele Scientific Institute, Milan, Italy
| | - M Gaule
- Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy
| | - M Macchini
- Department of Medical Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy; Pancreas Translational & Clinical Research Center, 'Vita-Salute' University, San Raffaele Scientific Institute, Milan, Italy
| | - P Carrera
- Clinical Genomics - Molecular Genetics Service, Genomics for Diagnosis of Human Diseases, San Raffaele Hospital, Milan, Italy
| | - S Calzavara
- Clinical Genomics - Molecular Genetics Service, Genomics for Diagnosis of Human Diseases, San Raffaele Hospital, Milan, Italy
| | - M Simbolo
- Section of Pathology, Department of Diagnostics and Public Health, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy
| | - D Melisi
- Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy
| | - F De Braud
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - L Salvatore
- Department of Medicine, Section of Medical Oncology, Fondazione Policlinico Universitario Gemelli IRCCS, Rome, Italy
| | - S De Lorenzo
- Medical Oncology Division, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - C Chiarazzo
- Oncology Unit, foundation IRCCS Casa Sollievo della sofferenza, San Giovanni Rotondo, Foggia, Italy
| | - M Falconi
- Pancreas Translational & Clinical Research Center, 'Vita-Salute' University, San Raffaele Scientific Institute, Milan, Italy; Department of Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - S Cascinu
- Department of Medical Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy; Pancreas Translational & Clinical Research Center, 'Vita-Salute' University, San Raffaele Scientific Institute, Milan, Italy
| | - M Milella
- Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy
| | - M Reni
- Department of Medical Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy; Pancreas Translational & Clinical Research Center, 'Vita-Salute' University, San Raffaele Scientific Institute, Milan, Italy.
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Pecorelli N, Pagnanelli M, Belfiori G, Delpini R, Cinelli L, Tamburrino D, Crippa S, Partelli S, Castoldi R, Reni M, Falconi M, Balzano G. Postoperative outcomes and functional recovery after neoadjuvant chemotherapy for pancreatic cancer: A propensity score-matched study. European Journal of Surgical Oncology 2020. [DOI: 10.1016/j.ejso.2020.06.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Mori M, Passoni P, Incerti E, Broggi S, Cattaneo G, Reni M, Spezi E, Slim N, Vanoli E, Bettinardi V, Gianolli L, Picchio M, Di Muzio N, Fiorino C. PH-0717: Locally Advanced Pancreatic Cancer: Robust Radiomic based model of outcome after radiochemotherapy. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00739-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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16
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Reni M, Bergamo F, Giommoni E, Milella M, Cavanna L, Di Marco M, Artioli F, Silvestris N, Spada M, Ghidini M, Maiello E, Cardellino G, Macchini M, Orsi G, Manai C, Valente M, Torri V, Porcu L, Giugliano V, Beretta G. 1562P Observational prospective study of Italian guidelines application for patients with pancreatic ductal adenocarcinoma. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.2045] [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: 11/25/2022] Open
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17
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Peretti U, Trestini I, Carbognin L, Sperduti I, Caldart A, Melisi D, Auriemma A, Soldà C, Tregnago D, Avancini A, Pilotto S, Bria E, Tortora G, Reni M, Milella M. 1856P Clinical relevance of pancreatic enzyme replacement therapy (PERT) in patients affected by advanced pancreatic ductal adenocarcinoma (PDAC) undergoing first-line chemotherapy. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.1503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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18
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Hochhauser D, Kindler H, Hammel P, Reni M, Van Cutsem E, Macarulla T, Hall M, Park J, Arnold D, Oh DY, Reinacher-Schick A, Tortora G, Algül H, O'Reilly E, McGuinness D, Cui K, Schlienger K, Locker G, Golan T. 1527P Assessing clinical benefit of olaparib maintenance treatment in subgroups of patients with germline BRCA mutation (gBRCAm) and metastatic pancreatic cancer: Phase III POLO trial. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.2010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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19
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Hammel P, Kindler HL, Reni M, Van Cutsem E, Macarulla T, Hall MJ, Park JO, Hochhauser D, Arnold D, Oh DY, Reinacher-Schick A, Tortora G, Algül H, O'Reilly EM, McGuinness D, Cui KY, Joo S, Yoo HK, Patel N, Golan T. Health-related quality of life in patients with a germline BRCA mutation and metastatic pancreatic cancer receiving maintenance olaparib. Ann Oncol 2019; 30:1959-1968. [PMID: 31562758 PMCID: PMC6938600 DOI: 10.1093/annonc/mdz406] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Patients with metastatic pancreatic cancer often have a detriment in health-related quality of life (HRQoL). In the randomized, double-blind, phase III POLO trial progression-free survival was significantly longer with maintenance olaparib, a poly(ADP-ribose) polymerase inhibitor, than placebo in patients with a germline BRCA1 and/or BRCA2 mutation (gBRCAm) and metastatic pancreatic cancer whose disease had not progressed during first-line platinum-based chemotherapy. The prespecified HRQoL evaluation is reported here. PATIENTS AND METHODS Patients were randomized to receive maintenance olaparib (300 mg b.i.d.; tablets) or placebo. HRQoL was assessed using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30-item module at baseline, every 4 weeks until disease progression, at discontinuation, and 30 days after last dose. Scores ranged from 0 to 100; a ≥10-point change or difference between arms was considered clinically meaningful. Adjusted mean change from baseline was analysed using a mixed model for repeated measures. Time to sustained clinically meaningful deterioration (TSCMD) was analysed using a log-rank test. RESULTS Of 154 randomized patients, 89 of 92 olaparib-arm and 58 of 62 placebo-arm patients were included in HRQoL analyses. The adjusted mean change in Global Health Status (GHS) score from baseline was <10 points in both arms and there was no significant between-group difference [-2.47; 95% confidence interval (CI) -7.27, 2.33; P = 0.31]. Analysis of physical functioning scores showed a significant between-group difference (-4.45 points; 95% CI -8.75, -0.16; P = 0.04). There was no difference in TSCMD for olaparib versus placebo for GHS [P = 0.25; hazard ratio (HR) 0.72; 95% CI 0.41, 1.27] or physical functioning (P = 0.32; HR 1.38; 95% CI 0.73, 2.63). CONCLUSIONS HRQoL was preserved with maintenance olaparib treatment with no clinically meaningful difference compared with placebo. These results support the observed efficacy benefit of maintenance olaparib in patients with a gBRCAm and metastatic pancreatic cancer. CLINCALTRIALS.GOV NUMBER NCT02184195.
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Affiliation(s)
- P Hammel
- Department of Digestive Oncology, Hôpital Beaujon (AP-HP), Clichy, and University Paris VII, Paris, France.
| | - H L Kindler
- Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, USA
| | - M Reni
- Department of Oncology, IRCCS Ospedale San Raffaele Scientific Institute, Milan, Italy
| | - E Van Cutsem
- Division of Digestive Oncology, University Hospitals Gasthuisberg and KU Leuven, Leuven, Belgium
| | - T Macarulla
- Department of Medical Oncology, Vall d'Hebron University Hospital and Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - M J Hall
- Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia, USA
| | - J O Park
- Division of Hematology-Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - D Hochhauser
- Department of Oncology, University College London Cancer Institute, London, UK
| | - D Arnold
- Department of Oncology, Asklepios Tumorzentrum Hamburg Asklepios Klinik Altona, Hamburg, Germany
| | - D-Y Oh
- Department of Internal Medicine, Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea
| | - A Reinacher-Schick
- Department of Hematology, Oncology and Palliative Care, St. Josef-Hospital, Ruhr University Bochum, Bochum, Germany
| | - G Tortora
- Department of Medicine, Section of Medical Oncology, Azienda Ospedaliera Universitaria Integrata Verona, Verona and Fondazione Policlinico Universitario Gemelli IRCCS, Rome, Italy
| | - H Algül
- Second Department of Internal Medicine, Klinikum rechts der Isar, Comprehensive Cancer Center Munich-TUM and Department of Internal Medicine II, Technische Universität München, Munich, Germany
| | - E M O'Reilly
- Gastrointestinal Oncology Service, Memorial Sloan Kettering Cancer Center, New York, USA
| | | | - K Y Cui
- AstraZeneca, Gaithersburg, USA
| | - S Joo
- Merck & Co., Inc., Kenilworth, USA
| | | | - N Patel
- AstraZeneca, Gaithersburg, USA
| | - T Golan
- The Oncology Institute, Sheba Medical Center, Tel Aviv, Israel
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20
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Oh DY, Golan T, Hammel P, Reni M, Van Cutsem E, Macarulla T, Hall M, Park J, Hochhauser D, Arnold D, Reinacher-Schick A, Tortora G, Algül H, O'Reilly E, McGuinness D, Cui K, Schlienger K, Locker G, Kindler H. Olaparib as maintenance treatment following first-line platinum-based chemotherapy (PBC) in patients (pts) with a germline BRCA mutation and metastatic pancreatic cancer (mPC): Phase III POLO trial. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz422.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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21
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Reni M, Braverman J, Hendifar A, Li CP, Macarulla Mercade T, Oh DY, Riess H, Tempero M, Lu B, Marcus J, Joshi N, Botterman M, Dueck A. Evaluation of minimal important difference (MID) for the European organisation for research and treatment of cancer (EORTC) pancreatic cancer module (PAN26) in patients with surgically resected pancreatic adenocarcinoma. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz247.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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22
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Hammel P, Kindler H, Reni M, Van Cutsem E, Macarulla Mercade T, Hall M, Park J, Hochhauser D, Arnold D, Oh DY, Reinacher-Schick A, Tortora G, Algül H, O’Reilly E, McGuinness D, Cui K, Joo S, Yoo H, Patel N, Golan T. POLO: Health-related quality of life (HRQoL) of olaparib maintenance treatment versus placebo in patients with a germline BRCA mutation and metastatic pancreatic cancer (mPC). Ann Oncol 2019. [DOI: 10.1093/annonc/mdz247.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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23
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Van Cutsem E, Golan T, Hammel P, Reni M, Macarulla T, Hall M, Park J, Hochhauser D, Arnold D, Oh DY, Reinacher-Schick A, Tortora G, Algül H, O’Reilly E, McGuinness D, Cui K, Schlienger K, Locker G, Kindler H. POLO: Time to treatment discontinuation and subsequent therapies following maintenance olaparib for patients (pts) with a germline BRCA mutation and metastatic pancreatic cancer (mPC). Ann Oncol 2019. [DOI: 10.1093/annonc/mdz247.020] [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: 11/14/2022] Open
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Tempero M, Reni M, Riess H, O’Reilly E, Krishnamurthi S, Österlund P, Ales-Diaz I, Milella M, Siena S, Tabernero J, Van Cutsem E, Philip P, Goldstein D, Berlin J, Li M, Ferrara S, Bruchec YL, McGovern D, Biankin A. Phase III, international, multicenter, randomized, open-label trial of adjuvant nab-paclitaxel plus gemcitabine (nab-P/G) vs gemcitabine (G) alone for surgically resected pancreatic adenocarcinoma (APACT): Subgroup analyses. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz247.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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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Riess H, Braverman J, Reni M, Dueck A, Hendifar A, Oh DY, Li CP, Mercade TM, Shah A, Joshi N, Botterman M, Mantovani E, Lu B, Tempero M. Impact of adjuvant treatment with nab-paclitaxel and gemcitabine (nab-P+GEM) vs gemcitabine alone (GEM) on health-related quality of life (QoL) in patients (pts) with surgically resected pancreatic adenocarcinoma (PA) in the adjuvant pancreatic adenocarcinoma clinical trial (APACT). Ann Oncol 2019. [DOI: 10.1093/annonc/mdz247.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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26
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Golan T, Hammel P, Reni M, Van Cutsem E, Macarulla T, Hall M, Park J, Hochhauser D, Arnold D, Oh D, Reinacher-Schick A, Tortora G, Algül H, O’Reilly E, McGuinness D, Cui K, Schlienger K, Locker G, Kindler H. Olaparib as maintenance treatment following first-line platinum-based chemotherapy in patients with a germline BRCA mutation and metastatic pancreatic cancer: phase III POLO trial. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz183] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Tempero M, Oh D, Macarulla T, Reni M, Van Cutsem E, Hendifar A, Waldschmidt D, Starling N, Bachet J, Chang H, Maurel J, Lonardi S, Coussens L, Fong L, Tsao L, Cole G, James D, Tabernero J. Ibrutinib in combination with nab-paclitaxel and gemcitabine as first-line treatment for patients with metastatic pancreatic adenocarcinoma: results from the phase 3 RESOLVE study. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz154.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Reni M, Riess H, O’Reilly E, Santoro A, Park J, Bekaii-Saab T, Tempero M, Shan Y, Macarulla T, Van Cutsem E, Noel M, Berlin J, Biankin A, Dhani N, Frassineti G, Goldstein D, Romano A, Bruchec YL, Philip P. An international, randomized, open-label, phase III trial of adjuvant nab-paclitaxel plus gemcitabine vs gemcitabine alone for surgically resected pancreatic adenocarcinoma (APACT): primary analysis and quality of life outcomes. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz154] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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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Reni M, Bergamo F, Cavanna L, Spada M, Ghidini M, Giommoni E, Maiello E, Artioli F, Cardellino G, Torri V, Cinquini M, Giugliano V, Pinto C. Real-world guideline application in the management of pancreatic cancer patients: the Italian GARIBALDI study. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz155.133] [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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Peretti U, Reni M, Zanon S, Macchini M, Mazza E, Balzano G, Tamburrino D, Arcidiacono P, Massimo F, Gianni L. Time to CA19.9 nadir: a clue for defining treatment duration of primary chemotherapy in resectable PDAC. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz156.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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31
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Reni M, Winter J, Tortora G, Pelzer U, Riess H, Chang H, O’Reilly E, Oh D, Diaz IA, Milella M, Bendell J, Garlipp B, Tempero M, Macarulla T, Van Cutsem E, Berlin J, Goldstein D, Lu B, Jeanes J, Philip P. Analysis of patient screening in the phase III, international, randomized, open-label APACT trial. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz156] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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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Van Cutsem E, Corrie P, Ducreux M, Sigal D, Sahai V, Oh DY, Bullock A, Bang YJ, Baron A, Hendifar A, Li CP, Philip P, Reni M, Zalupski M, Zheng L, Berman C, Chondros D, Tempero M. HALO 109-301: Phase III, randomized, double-blind, placebo-controlled study of pegvorhyaluronidase alfa (PEGPH20) + nab-paclitaxel/gemcitabine (AG) in patients with previously untreated hyaluronan (HA)-high stage IV pancreatic ductal adenocarcinoma (PDA). Ann Oncol 2018. [DOI: 10.1093/annonc/mdy282.172] [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: 11/14/2022] Open
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33
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Dadduzio V, Rizzato M, Ramondo G, Vivaldi C, Milella M, Brandi G, Cereda S, Murgioni S, Cardellino G, Filippi R, Santini D, Pasquini G, Intini R, Vaccaro V, Palloni A, Reni M, Musettini G, Gringeri E, Aliberti C, Zagonel V. Advanced intrahepatic cholangiocarcinoma (iCCA) treated with arterial-directed therapies (ADT): Outcomes and safety from a multicenter Italian experience. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy282.147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Macarulla Mercade T, Hendifar A, Li CP, Reni M, Riess H, Tempero M, Dueck A, Botteman M, Deshpande C, Lucas E, Oh DY. Health-related quality of life (HRQoL) in patients with early-stage pancreatic cancer (ESPC) receiving adjuvant or neoadjuvant chemotherapy (A/NAC): A systematic literature review (SLR). Ann Oncol 2018. [DOI: 10.1093/annonc/mdy282.124] [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: 11/14/2022] Open
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Santini D, Brandi G, Aprile G, Russano M, Cereda S, Leone F, Lonardi S, Fornaro L, Scartozzi M, Silvestris N, Barni S, Pantano F, Vincenzi B, Palloni A, Frega G, Casagrande M, Ferrari L, Dadduzio V, Intini R, Filippi R, Vasile E, Vivaldi C, Faloppi L, Brunetti O, Reni M, Aglietta M, Tonini G. Bone metastases in biliary cancers: A multicenter retrospective survey. J Bone Oncol 2018; 12:33-37. [PMID: 30042924 PMCID: PMC6054714 DOI: 10.1016/j.jbo.2017.11.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2017] [Revised: 11/18/2017] [Accepted: 11/24/2017] [Indexed: 10/24/2022] Open
Abstract
•Natural history of biliary cancers metastatic to bone•The role of skeletal events in patients with biliary cancer•Biliary cancer and bone metastases: role of bisphosphonates.
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Affiliation(s)
- D Santini
- Department of Medical Oncology, University Campus Bio-Medico, Rome, Italy
| | - G Brandi
- Department of Experimental, Diagnostic and Speciality Medicine, Sant'Orsola Malpighi Hospital, University of Bologna, Bologna, Italy
| | - G Aprile
- Department of Oncology, San Bortolo Hospital, ULSS8 Berica–East District, Vicenza, Italy
- Department of Oncology, University and General Hospital, Udine, Italy
| | - M Russano
- Department of Medical Oncology, University Campus Bio-Medico, Rome, Italy
| | - S Cereda
- Department of Medical Oncology, San Raffaele Scientific Institute, Milan, Italy
| | - F Leone
- Department of Oncology, University of Turin Medical School/Piedmont Foundation for Oncology, Candiolo Cancer Institute - FPO, IRCCS, Candiolo, Italy
| | - S Lonardi
- Medical Oncology Unit 1, Department of Clinical and Experimental Oncology, Istituto Oncologico Veneto IOV-IRCCS, Padua, Italy
| | - L Fornaro
- Unit of Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Via Roma 67, 56126, Italy
| | - M Scartozzi
- Medical Oncology, Hospital & University of Cagliari, Italy
| | - N Silvestris
- Medical Oncology Unit, Cancer Institute ``Giovanni Paolo II'', 70124 Bari, Italy
| | - S Barni
- Medical Oncology Unit, ASST Bergamo Ovest, Piazzale Ospedale 1, 24047 Treviglio, Bergamo, Italy
| | - F Pantano
- Department of Medical Oncology, University Campus Bio-Medico, Rome, Italy
| | - B Vincenzi
- Department of Medical Oncology, University Campus Bio-Medico, Rome, Italy
| | - A Palloni
- Department of Experimental, Diagnostic and Speciality Medicine, Sant'Orsola Malpighi Hospital, University of Bologna, Bologna, Italy
| | - G Frega
- Department of Experimental, Diagnostic and Speciality Medicine, Sant'Orsola Malpighi Hospital, University of Bologna, Bologna, Italy
| | - M Casagrande
- Department of Oncology, University and General Hospital, Udine, Italy
| | - L Ferrari
- Department of Oncology, University and General Hospital, Udine, Italy
| | - V Dadduzio
- Medical Oncology Unit 1, Department of Clinical and Experimental Oncology, Istituto Oncologico Veneto IOV-IRCCS, Padua, Italy
| | - R Intini
- Medical Oncology Unit 1, Department of Clinical and Experimental Oncology, Istituto Oncologico Veneto IOV-IRCCS, Padua, Italy
| | - R Filippi
- Department of Oncology, University of Turin Medical School/Piedmont Foundation for Oncology, Candiolo Cancer Institute - FPO, IRCCS, Candiolo, Italy
| | - E Vasile
- Unit of Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Via Roma 67, 56126, Italy
| | - C Vivaldi
- Unit of Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Via Roma 67, 56126, Italy
| | - L Faloppi
- Medical Oncology, Hospital of Macerata, Macerata, Italy & Medical Oncology, University of Cagliari, Italy
| | - O Brunetti
- Medical Oncology Unit, Cancer Institute ``Giovanni Paolo II'', 70124 Bari, Italy
| | - M Reni
- Department of Medical Oncology, San Raffaele Scientific Institute, Milan, Italy
| | - M Aglietta
- Department of Oncology, University of Turin Medical School/Piedmont Foundation for Oncology, Candiolo Cancer Institute - FPO, IRCCS, Candiolo, Italy
| | - G Tonini
- Department of Medical Oncology, University Campus Bio-Medico, Rome, Italy
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Fossati V, Cattaneo GM, Zerbi A, Galli L, Bordogna G, Reni M, Parolini D, Carlucci M, Bissi A, Staudacher C. The Role of Intraoperative Therapy by Electron Beam and Combination of Adjuvant Chemotherapy and External Radiotherapy in Carcinoma of the Pancreas. Tumori 2018; 81:23-31. [PMID: 7754537 DOI: 10.1177/030089169508100106] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims and background In the treatment of pancreatic carcinomas, one modality is intraoperative radiotherapy (IORT). A study was carried out to assess the feasibility of IORT alone or in a multimodality approach with postoperative adjuvant chemotherapy and external radiotherapy and to compare local control and survival of patients. Another objective of this retrospective study was to verify prognostic factors in resected patients treated with IORT. Methods From January 1985 through September 1992, 54 adenocarcinomas of the pancreas (unresectable and resected patients) were treated with IORT by electron beam at the San Raffaele Hospital and then analyzed. Comparison was also carried out between IORT-treated resected patients and a non-randomized control group of resected patients treated without IORT in the same period. Results In unresectable patients treated by laparotomy bypass and IORT, overall median survival was 6 months and 8 months in non-metastatic patients. Relief of severe pain present in 14 patients was observed in 85% within 12 days of IORT. As regards resected patients, the most important finding was that significantly better local control resulted from IORT. In fact, overall, local relapses were 25% in the IORT group and 55.8% in the non-IORT group (control group); instead, survival of the IORT group was not significantly longer than that of the control group. From a statistical analysis of resected patients treated with IORT and performed on prognostic factors on the basis of available data, survival was significantly influenced by tumor pathologic grading and diameter; postoperative adjuvant therapy was not a significant prognosis factor. Conclusions IORT has a role in local control of unresectable pancreatic carcinomas and in control of resultant severe pain. In resected patients, IORT is effective in decreasing local recurrences but has little impact on survival. To obtain more satisfactory results, new and more effective adjuvant therapies and better abdominal prophylaxis should be tested.
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Affiliation(s)
- V Fossati
- Radiation-Oncology Department, Istituto Nazionale Tumori, Milan, Italy
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Italia C, Fiorino C, Ciocca M, Cattaneo GM, Montanaro P, Bolognesi A, Lanceni A, Reni M, Bonini A, Modugno A, Calandrino R, Valdagni R. Quality Control by Portal Film Analysis in Radiotherapy for Prostate Cancer: A Comparison between Two Different Institutions and Treatment Techniques. Tumori 2018; 84:640-8. [PMID: 10080668 DOI: 10.1177/030089169808400605] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIMS AND BACKGROUND Accuracy and reproducibility of patient setup during radiotherapy for prostate cancer were investigated in two different Institutions (A and B), within their Quality Assurance programs. The purpose of the study was to evaluate and compare setup accuracy and reproducibility in Institutions A and B, which adopt different patient positioning and treatment techniques for prostate irradiation. MATERIALS AND METHODS A retrospective analysis of portal localization films taken during the treatment course was performed: 30 and 21 patients in Institutes A and B, respectively, entered the study. In Institute A, patients were treated in a prone position, utilizing an individualized immobilization cast (either an alpha cradle or a heat and vacuum-formed cellulose acetate cast) with an open table top and individual abdominal wall compressor to minimize small bowel irradiation; a 5-field conformal technique was used. In Institute B, patients were treated in a supine position without any immobilization device; a 6-field BEV-based technique (conformal only for patients treated with a radical aim) was adopted. A total of 598 portal films (420 from Institute A and 178 from Institute B) were analyzed. The mean number of films per patient was 12 (range, 4-29). Systematic and random setup errors were estimated utilizing the statistical method suggested by Bijhold et al. (1992). RESULTS When patients with a mean (systematic) error larger than 5, 8 and 10 mm in craniocaudal, lateral and posterior-anterior directions, respectively, were compared, no statistically significant difference between the two groups was observed. Similarly, when comparing portal films, a significant difference (P <0.01) appeared only in the craniocaudal direction (errors > 5 mm: Institute A = 24%; Institute B = 11%). In both Institutes, the SD of random and systematic error distribution ranged from 1.8 to 4.2 mm, with a small prevalence of systematic errors. Only for craniocaudal shifts in Institute A was the random error larger than the systematic error, and it was significantly worse than in Institute B (1 SD, 4.2 mm in Institute A vs 1.8 mm in Institute B). CONCLUSIONS Setup errors observed in Institutes A and B were similar and in accord with data reported in the literature. In Institute B, satisfactory geometrical treatment quality was achieved without patient immobilization. In Institute A, the goal of minimizing small bowel irradiation and prostate motion through the aforementioned technique, which makes patient position less comfortable, did not seem to considerably increase daily setup uncertainty.
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Affiliation(s)
- C Italia
- Department of Radiation Oncology, Casa di Cura S. Pio X, Milan, Italy
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Reni M, Cozzarini C, Panucci MG, Ceresoli GL, Ferreri AJ, Fiorino C, Truci G, Falini A, Tartara F, Terreni MR, Verusio C, Villa E. Irradiation Fields and Doses in Glioblastoma Multiforme: Are Current Standards Adequate? Tumori 2018; 87:85-90. [PMID: 11401212 DOI: 10.1177/030089160108700204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims and background The optimum conventional radiotherapy in glioblastoma multiforme patients has not been clearly defined by prospective trials. To better characterize a standard radiotherapy in glioblastoma multiforme, the impact on survival of different fields and doses was analyzed in a retrospective single center series. Methods One hundred and forty-seven patients with glioblastoma multiforme, submitted to biopsy only (n = 15), subtotal (n = 48) or total resection (n = 82) and who completed the planned postsurgical radiotherapy, were considered. The median age was 57 years, the male/female ratio 1.5/1, and the performance status ≥70 in 76%. Whole brain irradiation, followed by a boost to partial brain, was used in 75 cases with a whole brain dose of 44–50 Gy (median, 46) and a partial brain dose of 56–70 Gy (median, 60 Gy). Partial brain irradiation alone was used in 72 patients with a dose of 56–70 Gy (median, 61 Gy). Ninety-eight patients received 56–60 Gy (median, 59 Gy) to partial brain whereas 49 patients received 61–70 Gy (median, 63 Gy). Results There was an almost significantly longer survival in patients irradiated to the partial brain alone with respect to those also receiving whole brain radiotherapy (P = 0.056). Doses <60 Gy significantly prolonged survival (P = 0.006). Multivariate analysis confirmed that the impact on survival of radiation dose was independent of age, performance status, extent of surgery, field of irradiation and the use of chemotherapy. The extent of irradiation field was not independently related to improved survival. Conclusions Our retrospective findings suggest that we reflect on the adequacy of the current standard irradiation parameters. Well-designed prospective trials are necessary to standardize the radiotherapy control group in patients with glioblastoma multiforme to be compared in phase III trials with innovative therapeutic approaches.
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Affiliation(s)
- M Reni
- Department of Radiochemotherapy, San Raffaele Hospital Scientific Institute, Milan, Italy.
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Balzano G, Zanon S, Castoldi R, Aleotti F, Zerbi A, Falconi M, Andreasi V, Gianni L, Nicoletti R, Reni M. A randomized phase II trial on neoadjuvant chemotherapy in resectable pancreatic adenocarcinoma. Eur J Surg Oncol 2018. [DOI: 10.1016/j.ejso.2018.01.069] [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: 11/27/2022] Open
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Slim N, Gumina C, Parise P, Mazza E, Cossu A, Albarello L, Puccetti F, Reni M, Rosati R, Passoni P, Di Muzio N. EP-1449: Neoadjuvant chemoradiotherapy IG-IMRT PET based in esophageal or esophageal gastric junction cancer. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)31758-4] [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: 10/14/2022]
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Taieb J, Pointet AL, Van Laethem JL, Laquente B, Pernot S, Lordick F, Reni M. What treatment in 2017 for inoperable pancreatic cancers? Ann Oncol 2018; 28:1473-1483. [PMID: 28459988 DOI: 10.1093/annonc/mdx174] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Indexed: 02/07/2023] Open
Abstract
Pancreatic adenocarcinoma is a frequent and severe disease, either diagnosed as metastatic pancreatic adenocarcinoma (MPA) or as locally advanced pancreatic carcinoma (LAPC). Though no improvement in patients outcome have been made between 1996 and 2011, since 5 years new treatment options have become available to treat our patients. New standard first line regimens, such as FOLFIRINOX and gemcitabine combined with nab-paclitaxel, have improved overall survivals and second line treatments have been tested and validated. Other first-line treatments have failed, but research remains active and trials are ongoing with promising new anti-cancer agents. These new effective regimens used for MPA have yielded promising results in LAPC patients in open cohorts or phase II trials and a recent trial have failed to demonstrate the added value of classical external radiotherapy in this setting. Here, we review current standards of care in LAPC and MPA, consider the latest challenges and strategic questions, and examine what we may hope for in the future.
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Affiliation(s)
- J Taieb
- Hepatogastroenterology and GI Oncology Department, Sorbonne Paris Cité, Paris Descartes University, Georges Pompidou European Hospital, Paris, France
| | - A-L Pointet
- Hepatogastroenterology and GI Oncology Department, Sorbonne Paris Cité, Paris Descartes University, Georges Pompidou European Hospital, Paris, France
| | - J L Van Laethem
- Department of Gastroenterology and Digestive Oncology, Erasme University Hospital, ULB, Brussels, Belgium
| | - B Laquente
- Medical Oncology Department, Catalan Institute of Oncology, L'Hospitalet, Barcelona, Spain
| | - S Pernot
- Hepatogastroenterology and GI Oncology Department, Sorbonne Paris Cité, Paris Descartes University, Georges Pompidou European Hospital, Paris, France
| | - F Lordick
- University Cancer Center Leipzig (UCCL), University Medicine Leipzig, Leipzig, Germany
| | - M Reni
- Department of Medical Oncology, IRCCS Ospedale San Raffaele, Milan, Italy
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Oh DY, Bang YJ, Van Cutsem E, Hendifar A, Reni M, Zheng L, Ducreux M, Harris W, Corrie P, Seery T, Chondros D, Bullock A, Li CP. Phase 3, randomized, double-blind, placebo-controlled study of PEGylated recombinant human hyaluronidase PH20 (PEGPH20)+nab-paclitaxel/gemcitabine in patients with previously untreated, hyaluronan-high, stage IV pancreatic ductal adenocarcinoma (PDA). Ann Oncol 2017. [DOI: 10.1093/annonc/mdx660.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Reni M, Zanon S, Balzano G, Nobile S, Pircher CC, Chiaravalli M, Passoni P, Arcidiacono PG, Nicoletti R, Crippa S, Slim N, Doglioni C, Falconi M, Gianni L. Selecting patients for resection after primary chemotherapy for non-metastatic pancreatic adenocarcinoma. Ann Oncol 2017; 28:2786-2792. [PMID: 28945895 DOI: 10.1093/annonc/mdx495] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [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] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Patients with borderline (BL) or locally advanced (LA) pancreatic adenocarcinoma are usually treated with primary chemotherapy (CT), followed by resection when feasible. Scanty data are available about the criteria to candidate patients to resection after CT. PATIENTS AND METHODS Between 2002 and 2016 overall 223 patients diagnosed with BL or LA pancreatic adenocarcinoma were primarily treated with Gemcitabine combination (4-drugs or nab-paclitaxel-gemcitabine) for 3-6 months followed by surgery and/or chemoradiation. Resection was carried out when radical resection could be predicted by imaging studies and intraoperative findings. The prognostic value of both pre-treatment factors and treatment response was retrospectively evaluated, searching for criteria that could improve the selection of patients for surgery. RESULTS Median survival (MS) for the whole population was 18.3 months. Surgical resection was carried out in 61 patients; MS in resected patients was significantly longer (30.0 months) as compared with 162 non-resected patients (16.5 months) (P < 0.00001). According to response criteria, 48% had a radiological partial response, 47% a stable disease and 5% a disease progression); CA19.9 response (reduction >50%) was obtained in 77.8% of patients. Among resected patients, neither pre-treatment factors, including BL/LA distinction, nor radiological response, were able to prognosticate survival differences. Survival of resected patients having no CA19.9 response was significantly lower as compared with responders (MS 15.0 versus 31.5 months, P = 0.04), and was similar to non-responders patients that did not undergo resection (MS 10.9 months, P= 0.25). Multivariate analysis carried out on the overall population, showed that Karnofsky performance status, T3-T4 status, resection and CA19.9 response were independent prognostic factors, while radiological response, BL/LA distinction and baseline CA19.9 had not significant influence on survival. CONCLUSIONS CA19.9 response may allow a better selection of patients who will benefit from resection after primary CT for BL or LA pancreatic adenocarcinoma.
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Affiliation(s)
| | | | - G Balzano
- Pancreatic Surgery Unit, Pancreas Translational & Clinical Research Center
| | - S Nobile
- Pancreatic Surgery Unit, Pancreas Translational & Clinical Research Center
| | | | | | | | - P G Arcidiacono
- Department of Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute IRCCS
| | | | - S Crippa
- Pancreatic Surgery Unit, Pancreas Translational & Clinical Research Center
| | - N Slim
- Department of Radiotherapy
| | - C Doglioni
- Department of Pathology, Pancreas Translational & Clinical Research Center, IRCCS Ospedale San Raffaele, Milan; Department of Vita-Salute San Raffaele University, Milan, Italy
| | - M Falconi
- Pancreatic Surgery Unit, Pancreas Translational & Clinical Research Center; Department of Vita-Salute San Raffaele University, Milan, Italy
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Reni M, Zanon S, Balzano G, Castoldi R, Zerbi A, Tronconi M, Pinelli D, Mosconi S, Doglioni C, Galli F, Falconi M, Gianni L. Randomized phase 2 trial of peri- or post-operative chemotherapy in resectable pancreatic adenocarcinoma. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx425] [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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Zanon S, Pircher C, Chiaravalle M, Macchini M, Peretti U, Balzano G, Passoni P, Nicoletti R, Arcidiacono P, Pepe G, Doglioni C, Romi S, Gritti E, Falconi M, Gianni L, Reni M. Randomized phase 2 trial of nab-paclitaxel plus gemcitabine, ± capecitabine, cisplatin (paxg regimen) in metastatic pancreatic adenocarcinoma. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx425.002] [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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Reni M, Zanon S, Pircher C, Chiaravalli M, Macchini M, Peretti U, Mazza E, Balzano G, Passoni P, Nicoletti R, Arcidiacono P, Pepe G, Doglioni C, Romi S, Ceraulo D, Falconi M, Gianni L. Randomized phase 2 trial of nab-paclitaxel plus gemcitabine, ± capecitabine, cisplatin (PAXG regimen) in metastatic pancreatic adenocarcinoma. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx369.122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Reni M, Zanon S, Balzano G, Castoldi R, Zerbi A, Tronconi M, Pinelli D, Mosconi S, Doglioni C, Falconi M, Gianni L. Randomized phase 2 trial of peri- or post-operative chemotherapy in resectable pancreatic adenocarcinoma. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx369.119] [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: 11/14/2022] Open
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van Rijssen L, ter Veer E, Besselink M, Mali R, Berlin J, Boeck S, Bonnetain F, Conroy T, Deplanque G, Goldstein D, Glimelius B, Neoptolemos J, Reni M, Scheithauer W, van der Meer J, Wilmink J, van der Poel M, Busch O, van Oijen M, van Laarhoven H. COnsensus statement on mandatory measurements in PAncreatic cancer trials for systemic treatment of unresectable disease (COMM-PACT). Ann Oncol 2017. [DOI: 10.1093/annonc/mdx369.129] [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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Van Cutsem E, Hendifar A, Reni M, Zheng L, Ducreaux M, Harris W, Corrie P, Seery T, Chondros D, Bullock A. Global phase 3, randomized, double-blind, placebo-controlled study evaluating PEGylated recombinant human hyaluronidase PH20 (PEGPH20) plus nab-paclitaxel and gemcitabine in patients with previously untreated, hyaluronan (HA)-high, stage IV pancreatic ductal adenocarcinoma (PDA). Ann Oncol 2017. [DOI: 10.1093/annonc/mdx369.156] [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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Bekaii-Saab T, Goldstein D, Li C, Okusaka T, O’Neil B, Reni M, Tabernero J, Qin S, Van Cutsem E, Borodyansky L, Li C. CanStem111P trial: A phase III study of napabucasin plus nab-paclitaxel (nab-PTX) with gemcitabine (gem) in adult patients with metastatic pancreatic adenocarcinoma (mPDAC). Ann Oncol 2017. [DOI: 10.1093/annonc/mdx261.379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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