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Dipasquale A, Barigazzi C, Losurdo A, Persico P, Di Muzio A, Navarria P, Pessina F, van den Bent M, Santoro A, Simonelli M. Brain metastases and next-generation anticancer therapies: a survival guide for clinicians. Crit Rev Oncol Hematol 2024; 194:104239. [PMID: 38128629 DOI: 10.1016/j.critrevonc.2023.104239] [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: 09/04/2023] [Revised: 12/13/2023] [Accepted: 12/14/2023] [Indexed: 12/23/2023] Open
Abstract
Historically, patients with brain metastases (BMs) have been characterized by few systemic treatment options and poor prognosis. The recent introduction of next-generation anticancer therapies such as molecular targeted agents and immunotherapy have revolutionized the clinical decision-making process of this sub-population, posing new challenges to physicians. In this review, current evidence for the use of checkpoint inhibitors and targeted therapies in patients with BMs are discussed, with a focus on lung cancer, breast cancer, melanoma and renal cell carcinoma, providing suggestions and potential workflows for daily clinical practice. Several other on-going and future challenges, such as clinical trials design, ways to improve CNS penetration of novel drugs and unique molecular characteristics of BMs, are also discussed. The aim is producing an updated and easy-to-read guide for physicians, to improve decision-making in clinical practice.
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Affiliation(s)
- Angelo Dipasquale
- Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Chiara Barigazzi
- Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Agnese Losurdo
- Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Pasquale Persico
- Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Antonio Di Muzio
- Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Piera Navarria
- Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Federico Pessina
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; Department of Neurosurgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | | | - Armando Santoro
- Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Matteo Simonelli
- Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.
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Losurdo A, Di Muzio A, Cianciotti BC, Dipasquale A, Persico P, Barigazzi C, Bono B, Feno S, Pessina F, Santoro A, Simonelli M. T Cell Features in Glioblastoma May Guide Therapeutic Strategies to Overcome Microenvironment Immunosuppression. Cancers (Basel) 2024; 16:603. [PMID: 38339353 PMCID: PMC10854506 DOI: 10.3390/cancers16030603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 01/23/2024] [Accepted: 01/25/2024] [Indexed: 02/12/2024] Open
Abstract
Glioblastoma (GBM) is the most aggressive and lethal primary brain tumor, bearing a survival estimate below 10% at five years, despite standard chemoradiation treatment. At recurrence, systemic treatment options are limited and the standard of care is not well defined, with inclusion in clinical trials being highly encouraged. So far, the use of immunotherapeutic strategies in GBM has not proved to significantly improve patients' prognosis in the treatment of newly diagnosed GBM, nor in the recurrent setting. Probably this has to do with the unique immune environment of the central nervous system, which harbors several immunosuppressive/pro-tumorigenic factors, both soluble (e.g., TGF-β, IL-10, STAT3, prostaglandin E2, and VEGF) and cellular (e.g., Tregs, M2 phenotype TAMs, and MDSC). Here we review the immune composition of the GBMs microenvironment, specifically focusing on the phenotype and function of the T cell compartment. Moreover, we give hints on the therapeutic strategies, such as immune checkpoint blockade, vaccinations, and adoptive cell therapy, that, interacting with tumor-infiltrating lymphocytes, might both target in different ways the tumor microenvironment and potentiate the activity of standard therapies. The path to be followed in advancing clinical research on immunotherapy for GBM treatment relies on a twofold strategy: testing combinatorial treatments, aiming to restore active immune anti-tumor responses, tackling immunosuppression, and additionally, designing more phase 0 and window opportunity trials with solid translational analyses to gain deeper insight into the on-treatment shaping of the GBM microenvironment.
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Affiliation(s)
- Agnese Losurdo
- Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy; (A.L.); (A.D.M.); (A.D.); (P.P.); (C.B.); (A.S.)
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milan, Italy;
| | - Antonio Di Muzio
- Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy; (A.L.); (A.D.M.); (A.D.); (P.P.); (C.B.); (A.S.)
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milan, Italy;
| | - Beatrice Claudia Cianciotti
- Laboratory of Translational Immunology, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy; (B.C.C.); (S.F.)
| | - Angelo Dipasquale
- Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy; (A.L.); (A.D.M.); (A.D.); (P.P.); (C.B.); (A.S.)
| | - Pasquale Persico
- Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy; (A.L.); (A.D.M.); (A.D.); (P.P.); (C.B.); (A.S.)
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milan, Italy;
| | - Chiara Barigazzi
- Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy; (A.L.); (A.D.M.); (A.D.); (P.P.); (C.B.); (A.S.)
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milan, Italy;
| | - Beatrice Bono
- Department of Neurosurgery, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy;
| | - Simona Feno
- Laboratory of Translational Immunology, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy; (B.C.C.); (S.F.)
| | - Federico Pessina
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milan, Italy;
- Department of Neurosurgery, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy;
| | - Armando Santoro
- Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy; (A.L.); (A.D.M.); (A.D.); (P.P.); (C.B.); (A.S.)
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milan, Italy;
| | - Matteo Simonelli
- Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy; (A.L.); (A.D.M.); (A.D.); (P.P.); (C.B.); (A.S.)
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milan, Italy;
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3
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Losurdo A, Dipasquale A, Giordano L, Persico P, Lorenzi E, Di Muzio A, Barigazzi C, Korolewicz J, Mehan A, Mohammed O, Scheiner B, Pinato DJ, Santoro A, Simonelli M. Refining patient selection for next-generation immunotherapeutic early-phase clinical trials with a novel and externally validated prognostic nomogram. Front Immunol 2024; 15:1323151. [PMID: 38298193 PMCID: PMC10828843 DOI: 10.3389/fimmu.2024.1323151] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 01/02/2024] [Indexed: 02/02/2024] Open
Abstract
Introduction Identifying which patient may benefit from immunotherapeutic early-phase clinical trials is an unmet need in drug development. Among several proposed prognostic scores, none has been validated in patients receiving immunomodulating agents (IMAs)-based combinations. Patients and methods We retrospectively collected data of 208 patients enrolled in early-phase clinical trials investigating IMAs at our Institution, correlating clinical and blood-based variables with overall survival (OS). A retrospective cohort of 50 patients treated with IMAs at Imperial College (Hammersmith Hospital, London, UK) was used for validation. Results A total of 173 subjects were selected for analyses. Most frequent cancers included non-small cell lung cancer (26%), hepatocellular carcinoma (21.5%) and glioblastoma (13%). Multivariate analysis (MVA) revealed 3 factors to be independently associated with OS: line of treatment (second and third vs subsequent, HR 0.61, 95% CI 0.40-0.93, p 0.02), serum albumin as continuous variable (HR 0.57, 95% CI 0.36-0.91, p 0.02) and number of metastatic sites (<3 vs ≥3, HR 0.68, 95% CI 0.48-0.98, p 0.04). After splitting albumin value at the median (3.84 g/dL), a score system was capable of stratifying patients in 3 groups with significantly different OS (p<0.0001). Relationship with OS reproduced in the external cohort (p=0.008). Then, from these factors we built a nomogram. Conclusions Prior treatment, serum albumin and number of metastatic sites are readily available prognostic traits in patients with advanced malignancies participating into immunotherapy early-phase trials. Combination of these factors can optimize patient selection at study enrollment, maximizing therapeutic intent.
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Affiliation(s)
- Agnese Losurdo
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, Humanitas Cancer Center, Milan, Italy
| | - Angelo Dipasquale
- Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, Humanitas Cancer Center, Milan, Italy
| | - Laura Giordano
- Biostatistic Unit, IRCCS Humanitas Research Hospital, Humanitas Cancer Center, Milan, Italy
| | - Pasquale Persico
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, Humanitas Cancer Center, Milan, Italy
| | - Elena Lorenzi
- Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, Humanitas Cancer Center, Milan, Italy
| | - Antonio Di Muzio
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, Humanitas Cancer Center, Milan, Italy
| | - Chiara Barigazzi
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, Humanitas Cancer Center, Milan, Italy
| | - James Korolewicz
- Division of Cancer, Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, London, United Kingdom
| | - Aman Mehan
- Division of Cancer, Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, London, United Kingdom
| | - Oreoluwa Mohammed
- Division of Cancer, Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, London, United Kingdom
| | - Benhard Scheiner
- Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - David J. Pinato
- Division of Cancer, Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, London, United Kingdom
- Division of Oncology, Department of Translational Medicine (DIMET), Università del Piemonte Orientale A. Avogadro, Novara, Italy
| | - Armando Santoro
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, Humanitas Cancer Center, Milan, Italy
| | - Matteo Simonelli
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, Humanitas Cancer Center, Milan, Italy
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4
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Orzan F, De Bacco F, Lazzarini E, Crisafulli G, Gasparini A, Dipasquale A, Barault L, Macagno M, Persico P, Pessina F, Bono B, Giordano L, Zeppa P, Melcarne A, Cassoni P, Garbossa D, Santoro A, Comoglio PM, Indraccolo S, Simonelli M, Boccaccio C. Liquid biopsy of cerebrospinal fluid enables selective profiling of glioma molecular subtypes at first clinical presentation. Clin Cancer Res 2023; 29:1252-1266. [PMID: 36648487 PMCID: PMC10068436 DOI: 10.1158/1078-0432.ccr-22-2903] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 11/16/2022] [Accepted: 01/12/2023] [Indexed: 01/18/2023]
Abstract
PURPOSE Current glioma diagnostic guidelines call for molecular profiling to stratify patients into prognostic and treatment subgroups. In case the tumor tissue is inaccessible, cerebrospinal fluid (CSF) has been proposed as a reliable tumor DNA source for liquid biopsy. We prospectively investigated the use of CSF for molecular characterization of newly diagnosed gliomas. EXPERIMENTAL DESIGN We recruited two cohorts of newly diagnosed glioma patients, one (n=45) providing CSF collected in proximity of the tumor, the other (n=39) CSF collected by lumbar puncture. Both cohorts provided tumor tissues by surgery concomitant with CSF sampling. DNA samples retrieved from CSF and matched tumors were systematically characterized and compared by comprehensive (NGS) or targeted (ddPCR) methodologies. Conventional and molecular diagnosis outcomes were compared. RESULTS We report that tumor DNA is abundant in CSF close to the tumor, but scanty and mostly below NGS sensitivity threshold in CSF from lumbar puncture. Indeed, tumor DNA is 15 mostly released by cells invading liquoral spaces, generating a gradient that attenuates by departing from the tumor. Nevertheless, in >60% of lumbar puncture CSF samples, tumor DNA is sufficient to assess a selected panel of genetic alterations (IDH and TERT promoter mutations, EGFR amplification, CDKN2A/B deletion: ITEC protocol) and MGMT methylation that, combined with imaging, enable tissue-agnostic identification of main glioma molecular subtypes. CONCLUSIONS This study shows potentialities and limitations of CSF liquid biopsy in achieving molecular characterization of gliomas at first clinical presentation and proposes a protocol to maximize diagnostic information retrievable from CSF DNA.
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Affiliation(s)
| | - Francesca De Bacco
- Istituto di Candiolo, FPO-IRCCS, University of Torino, Candiolo, TO, Italy
| | | | | | | | | | | | - Marco Macagno
- Candiolo Cancer Institute, FPO - IRCCS, Candiolo, -- select state --, Italy
| | | | | | - Beatrice Bono
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Laura Giordano
- Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Pietro Zeppa
- University of Turin Medical School, Turin, Italy
| | | | | | | | | | | | | | - Matteo Simonelli
- Humanitas University, Pieve Emanuele; and Humanitas Cancer Center, Humanitas Clinical and Research Center, IRCCS, Rozzano, Pieve Emanuele, Milan, Italy
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5
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Carenza C, Franzese S, Castagna A, Terzoli S, Simonelli M, Persico P, Bello L, Nibali MC, Pessina F, Kunderfranco P, Peano C, Balin S, Mikulak J, Calcaterra F, Bonecchi R, Savino B, Locati M, Della Bella S, Mavilio D. Perioperative corticosteroid treatment impairs tumor-infiltrating dendritic cells in patients with newly diagnosed adult-type diffuse gliomas. Front Immunol 2023; 13:1074762. [PMID: 36703985 PMCID: PMC9872516 DOI: 10.3389/fimmu.2022.1074762] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 12/22/2022] [Indexed: 01/11/2023] Open
Abstract
Introduction Adult-type diffuse gliomas are malignant primary brain tumors characterized by very poor prognosis. Dendritic cells (DCs) are key in priming antitumor effector functions in cancer, but their role in gliomas remains poorly understood. Methods In this study, we characterized tumor-infiltrating DCs (TIDCs) in adult patients with newly diagnosed diffuse gliomas by using multi-parametric flow cytometry and single-cell RNA sequencing. Results We demonstrated that different subsets of DCs are present in the glioma microenvironment, whereas they are absent in cancer-free brain parenchyma. The largest cluster of TIDCs was characterized by a transcriptomic profile suggestive of severe functional impairment. Patients undergoing perioperative corticosteroid treatment showed a significant reduction of conventional DC1s, the DC subset with key functions in antitumor immunity. They also showed phenotypic and transcriptional evidence of a more severe functional impairment of TIDCs. Discussion Overall, the results of this study indicate that functionally impaired DCs are recruited in the glioma microenvironment. They are severely affected by dexamethasone administration, suggesting that the detrimental effects of corticosteroids on DCs may represent one of the mechanisms contributing to the already reported negative prognostic impact of steroids on glioma patient survival.
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Affiliation(s)
- Claudia Carenza
- Department of Medical Biotechnologies and Translational Medicine, University of Milan, Milan, Italy,Laboratory of Clinical and Experimental Immunology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Sara Franzese
- Department of Medical Biotechnologies and Translational Medicine, University of Milan, Milan, Italy,Laboratory of Clinical and Experimental Immunology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Alessandra Castagna
- Laboratory of Leukocyte Biology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Sara Terzoli
- Laboratory of Clinical and Experimental Immunology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Matteo Simonelli
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy,Department of Medical Oncology and Hematology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Pasquale Persico
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy,Department of Medical Oncology and Hematology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Lorenzo Bello
- Unit of Oncological Neurosurgery, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Marco Conti Nibali
- Unit of Oncological Neurosurgery, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Federico Pessina
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy,Department of Neurosurgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Paolo Kunderfranco
- Bioinformatics Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Clelia Peano
- Institute of Genetic and Biomedical Research, UoS Milan, National Research Council, Rozzano, Milan, Italy
| | - Simone Balin
- Department of Medical Biotechnologies and Translational Medicine, University of Milan, Milan, Italy,Laboratory of Clinical and Experimental Immunology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Joanna Mikulak
- Laboratory of Clinical and Experimental Immunology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Francesca Calcaterra
- Department of Medical Biotechnologies and Translational Medicine, University of Milan, Milan, Italy,Laboratory of Clinical and Experimental Immunology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Raffaella Bonecchi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy,Laboratory of Chemokine Biology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Benedetta Savino
- Department of Medical Biotechnologies and Translational Medicine, University of Milan, Milan, Italy,Laboratory of Leukocyte Biology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Massimo Locati
- Department of Medical Biotechnologies and Translational Medicine, University of Milan, Milan, Italy,Laboratory of Leukocyte Biology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Silvia Della Bella
- Department of Medical Biotechnologies and Translational Medicine, University of Milan, Milan, Italy,Laboratory of Clinical and Experimental Immunology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy,*Correspondence: Silvia Della Bella, ; Domenico Mavilio,
| | - Domenico Mavilio
- Department of Medical Biotechnologies and Translational Medicine, University of Milan, Milan, Italy,Laboratory of Clinical and Experimental Immunology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy,*Correspondence: Silvia Della Bella, ; Domenico Mavilio,
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6
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Caccese M, Simonelli M, Villani V, Rizzato S, Ius T, Pasqualetti F, Russo M, Rudà R, Amoroso R, Bellu L, Bertorelle R, Cavallin F, Dipasquale A, Carosi M, Pizzolitto S, Cesselli D, Persico P, Casini B, Fassan M, Zagonel V, Lombardi G. Definition of the Prognostic Role of MGMT Promoter Methylation Value by Pyrosequencing in Newly Diagnosed IDH Wild-Type Glioblastoma Patients Treated with Radiochemotherapy: A Large Multicenter Study. Cancers (Basel) 2022; 14:cancers14102425. [PMID: 35626029 PMCID: PMC9139569 DOI: 10.3390/cancers14102425] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 05/09/2022] [Accepted: 05/11/2022] [Indexed: 11/16/2022] Open
Abstract
Background. O6-methylguanine (O6-MeG)-DNA methyltransferase (MGMT) methylation status is a predictive factor for alkylating treatment efficacy in glioblastoma patients, but its prognostic role is still unclear. We performed a large, multicenter study to evaluate the association between MGMT methylation value and survival. Methods. We evaluated glioblastoma patients with an assessment of MGMT methylation status by pyrosequencing from nine Italian centers. The inclusion criteria were histological diagnosis of IDH wild-type glioblastoma, Eastern Cooperative Oncology Group Performance Status (ECOG-PS) ≤2, and radio-chemotherapy treatment with temozolomide. The relationship between OS and MGMT was investigated with a time-dependent Receiver Operating Characteristics (ROC) curve and Cox regression models. Results. In total, 591 newly diagnosed glioblastoma patients were analyzed. The median OS was 16.2 months. The ROC analysis suggested a cut-off of 15% for MGMT methylation. The 2-year Overall Survival (OS) was 18.3% and 51.8% for MGMT methylation <15% and ≥15% (p < 0.0001). In the multivariable analysis, MGMT methylation <15% was associated with impaired survival (p < 0.00001). However, we also found a non-linear association between MGMT methylation and OS (p = 0.002): median OS was 14.8 months for MGMT in 0−4%, 18.9 months for MGMT in 4−40%, and 29.9 months for MGMT in 40−100%. Conclusions. Our findings suggested a non-linear relationship between OS and MGMT promoter methylation, which implies a varying magnitude of prognostic effect across values of MGMT promoter methylation by pyrosequencing in newly diagnosed IDH wild-type glioblastoma patients treated with chemoradiotherapy.
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Affiliation(s)
- Mario Caccese
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV-IRCCS, 35128 Padua, Italy; (V.Z.); (G.L.)
- Correspondence: ; Tel.: +39-(0)4-9821-5888
| | - Matteo Simonelli
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20090 Milan, Italy; (M.S.); (A.D.); (P.P.)
- IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
| | - Veronica Villani
- Neuro-Oncology Unit, Regina Elena National Cancer Institute, 00161 Rome, Italy;
| | - Simona Rizzato
- Department of Oncology, Central Friuli University Health Authority, 33100 Udine, Italy;
| | - Tamara Ius
- Neurosurgery Unit, Department of Neurosciences, Santa Maria della Misericordia University Hospital, 33100 Udine, Italy;
| | - Francesco Pasqualetti
- Radiation Oncology Unit, Pisa University Hospital, 56121 Pisa, Italy;
- Department of Oncology, University of Oxford, Oxford OX1 4BH, UK
| | - Marco Russo
- Neurology Unit, Neuromotor Department, Azienda USL-IRCCS Reggio Emilia, 42121 Emilia, Italy;
| | - Roberta Rudà
- Department of Neuro-Oncology, University of Turin and City of Health and Science Hospital, 10094 Torino, Italy;
- Neurology Unit, Hospital of Castelfranco Veneto, 31033 Castelfranco Veneto, Italy
| | - Rosina Amoroso
- Neurosurgery Unit, Department of Surgery, Hospital of Livorno, Azienda Asl Toscana Nord Ovest, 57100 Livorno, Italy;
| | - Luisa Bellu
- Radiotherapy and Radiosurgery Department, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy;
| | - Roberta Bertorelle
- Immunology and Molecular Oncology Unit, Department of Oncology, Veneto Institute of Oncology IOV IRCCS, 35128 Padua, Italy;
| | | | - Angelo Dipasquale
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20090 Milan, Italy; (M.S.); (A.D.); (P.P.)
- IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
| | - Mariantonia Carosi
- Pathology Unit, Regina Elena National Cancer Institute, 00161 Rome, Italy; (M.C.); (B.C.)
| | - Stefano Pizzolitto
- Department of Surgical Pathology, Central Friuli University Health Authority, 33100 Udine, Italy;
| | - Daniela Cesselli
- Department of Laboratory Medicine, Institute of Pathology, Santa Maria della Misericordia University Hospital, 33100 Udine, Italy;
- Department of Medicine, University of Udine, 33100 Udine, Italy
| | - Pasquale Persico
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20090 Milan, Italy; (M.S.); (A.D.); (P.P.)
- IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
| | - Beatrice Casini
- Pathology Unit, Regina Elena National Cancer Institute, 00161 Rome, Italy; (M.C.); (B.C.)
| | - Matteo Fassan
- Department of Oncology, Veneto Institute of Oncology, IOV-IRCCS, 35128 Padua, Italy;
- Cytopathology Unit, Department of Medicine (DIMED), Surgical Pathology & AMP, University of Padua, 35128 Padua, Italy
| | - Vittorina Zagonel
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV-IRCCS, 35128 Padua, Italy; (V.Z.); (G.L.)
| | - Giuseppe Lombardi
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV-IRCCS, 35128 Padua, Italy; (V.Z.); (G.L.)
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7
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Persico P, Lorenzi E, Losurdo A, Dipasquale A, Di Muzio A, Navarria P, Pessina F, Politi LS, Lombardi G, Santoro A, Simonelli M. Precision Oncology in Lower-Grade Gliomas: Promises and Pitfalls of Therapeutic Strategies Targeting IDH-Mutations. Cancers (Basel) 2022; 14:cancers14051125. [PMID: 35267433 PMCID: PMC8909346 DOI: 10.3390/cancers14051125] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 02/18/2022] [Accepted: 02/18/2022] [Indexed: 12/18/2022] Open
Abstract
Mutations in isocitrate dehydrogenase (IDH)1 and its homolog IDH2 are considered an earliest "driver" genetic event during gliomagenesis, representing now the molecular hallmark of lower-grade gliomas (LGGs). IDH-mutated genes encode for a neomorphic enzyme that converts α-ketoglutarate to the oncometabolite D-2-hydroxyglutarate (2-HG), which accumulates to high concentrations and alters cellular epigenetics and metabolism. Targeting IDH mutations is the first attempt to apply "precision oncology" in LGGs. Two distinct strategies have been proposed so far and are under intense clinical investigation: (i) reducing the amount of intratumoral 2-HG by directly blocking the function of mutant IDH enzyme; (ii) exploiting the selective epigenetic and metabolic cellular vulnerabilities as a consequence of 2-HG accumulation. The present review describes the physiopathological mechanisms by which IDH mutations lead to tumorigenesis, discussing their prognostic significance and pivotal role in the gliomas diagnostic classification system. We critically review preclinical evidence and available clinical data of first-generation mutant-selective IDH inhibitors and novel IDH-targeted vaccines. Finally, as an alternative and attractive approach, we present the rationale to take advantage of selective 2-HG related epigenetic and metabolic weaknesses. The results of ongoing clinical trials will help us clarify the complex scenario of IDH-targeted therapeutic approaches in gliomas.
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Affiliation(s)
- Pasquale Persico
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Milan, Italy; (P.P.); (A.D.M.); (A.D.M.); (F.P.); (L.S.P.); (A.S.)
- Oncology Department, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Milan, Italy; (E.L.); (A.L.)
| | - Elena Lorenzi
- Oncology Department, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Milan, Italy; (E.L.); (A.L.)
| | - Agnese Losurdo
- Oncology Department, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Milan, Italy; (E.L.); (A.L.)
| | - Angelo Dipasquale
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Milan, Italy; (P.P.); (A.D.M.); (A.D.M.); (F.P.); (L.S.P.); (A.S.)
- Oncology Department, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Milan, Italy; (E.L.); (A.L.)
| | - Antonio Di Muzio
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Milan, Italy; (P.P.); (A.D.M.); (A.D.M.); (F.P.); (L.S.P.); (A.S.)
- Oncology Department, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Milan, Italy; (E.L.); (A.L.)
| | - Pierina Navarria
- Radiotherapy Department, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Milan, Italy;
| | - Federico Pessina
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Milan, Italy; (P.P.); (A.D.M.); (A.D.M.); (F.P.); (L.S.P.); (A.S.)
- Neurosurgery Department, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Milan, Italy
| | - Letterio Salvatore Politi
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Milan, Italy; (P.P.); (A.D.M.); (A.D.M.); (F.P.); (L.S.P.); (A.S.)
- Neuroradiology Department, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Milan, Italy
| | - Giuseppe Lombardi
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Via Gattamelata 64, 35128 Padua, Italy;
| | - Armando Santoro
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Milan, Italy; (P.P.); (A.D.M.); (A.D.M.); (F.P.); (L.S.P.); (A.S.)
- Oncology Department, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Milan, Italy; (E.L.); (A.L.)
| | - Matteo Simonelli
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Milan, Italy; (P.P.); (A.D.M.); (A.D.M.); (F.P.); (L.S.P.); (A.S.)
- Oncology Department, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Milan, Italy; (E.L.); (A.L.)
- Correspondence:
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8
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Simonelli M, Persico P, Capucetti A, Carenza C, Franzese S, Lorenzi E, Dipasquale A, Losurdo A, Giordano L, Pessina F, Navarria P, Politi LS, Mavilio D, Locati M, Della Bella S, Santoro A, Bonecchi R. Immunotherapeutic early-phase clinical trials and malignant gliomas: A single-center experience and comprehensive immunophenotyping of circulating leukocytes. Neurooncol Adv 2021; 3:vdab160. [PMID: 34901858 PMCID: PMC8661084 DOI: 10.1093/noajnl/vdab160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Background Immunotherapeutic early-phase clinical trials (ieCTs) increasingly adopt large expansion cohorts exploring novel agents across different tumor types. High-grade glioma (HGG) patients are usually excluded from these trials. Methods Data of patients with recurrent HGGs treated within multicohort ieCTs between February 2014 and August 2019 (experimental group, EG) at our Phase I Unit were retrospectively reviewed and compared to a matched control group (CG) of patients treated with standard therapies. We retrospectively evaluated clinical, laboratory, and molecular parameters through univariate and multivariate analysis. A prospective characterization of circulating leukocyte subpopulations was performed in the latest twenty patients enrolled in the EG, with a statistical significance cutoff of P < .1. Results Thirty HGG patients were treated into six ieCTs. Fifteen patients received monotherapies (anti-PD-1, anti-CSF-1R, anti-TGFβ, anti-cereblon), fifteen patients combination regimens (anti-PD-L1 + anti-CD38, anti-PD-1 + anti-CSF-1R). In the EG, median progression-free survival and overall survival (OS) from treatment initiation were 1.8 and 8.6 months; twelve patients survived more than 12 months, and two of them more than 6 years. Univariate analysis identified O6-methylguanine DNA methyltransferase (MGMT) promoter methylation and total protein value at six weeks as significantly correlated with a better outcome. Decreased circulating neutrophils and increased conventional dendritic cells levels lead to significantly better OS. Conclusions A subgroup of EG patients achieved remarkably durable disease control. MGMT promoter methylation identifies patients who benefit more from immunotherapy. Monitoring dynamic changes of innate immune cell populations may help to predict clinical outcomes.
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Affiliation(s)
- Matteo Simonelli
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.,IRCCS Humanitas Research Hospital, Milan, Rozzano, Milan, Italy
| | - Pasquale Persico
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.,IRCCS Humanitas Research Hospital, Milan, Rozzano, Milan, Italy
| | - Arianna Capucetti
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.,IRCCS Humanitas Research Hospital, Milan, Rozzano, Milan, Italy
| | - Claudia Carenza
- Unit of Clinical and Experimental Immunology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.,Department of Medical Biotechnologies and Translational Medicine, University of Milan, Milan, Italy
| | - Sara Franzese
- Unit of Clinical and Experimental Immunology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.,Department of Medical Biotechnologies and Translational Medicine, University of Milan, Milan, Italy
| | - Elena Lorenzi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.,IRCCS Humanitas Research Hospital, Milan, Rozzano, Milan, Italy
| | - Angelo Dipasquale
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.,IRCCS Humanitas Research Hospital, Milan, Rozzano, Milan, Italy
| | - Agnese Losurdo
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.,IRCCS Humanitas Research Hospital, Milan, Rozzano, Milan, Italy
| | - Laura Giordano
- IRCCS Humanitas Research Hospital, Milan, Rozzano, Milan, Italy
| | - Federico Pessina
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.,IRCCS Humanitas Research Hospital, Milan, Rozzano, Milan, Italy
| | | | - Letterio S Politi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.,IRCCS Humanitas Research Hospital, Milan, Rozzano, Milan, Italy
| | - Domenico Mavilio
- Unit of Clinical and Experimental Immunology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.,Department of Medical Biotechnologies and Translational Medicine, University of Milan, Milan, Italy
| | - Massimo Locati
- Unit of Leukocyte Biology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.,Department of Medical Biotechnologies and Translational Medicine, University of Milan, Milan, Italy
| | - Silvia Della Bella
- Unit of Clinical and Experimental Immunology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.,Department of Medical Biotechnologies and Translational Medicine, University of Milan, Milan, Italy
| | - Armando Santoro
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.,IRCCS Humanitas Research Hospital, Milan, Rozzano, Milan, Italy
| | - Raffaella Bonecchi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.,IRCCS Humanitas Research Hospital, Milan, Rozzano, Milan, Italy
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9
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Pessina F, Navarria P, Clerici E, Bellu L, Franzini A, Milani D, Simonelli M, Persico P, Politi LS, Casarotti A, Fernandes B, Olei S, Sollini M, Chiti A, Scorsetti M. Role of 11C Methionine Positron Emission Tomography (11CMETPET) for Surgery and Radiation Therapy Planning in Newly Diagnosed Glioblastoma Patients Enrolled into a Phase II Clinical Study. J Clin Med 2021; 10:jcm10112313. [PMID: 34070698 PMCID: PMC8198980 DOI: 10.3390/jcm10112313] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/20/2021] [Accepted: 05/21/2021] [Indexed: 11/16/2022] Open
Abstract
(1) Background: We investigated the role of [11C]-methionine PET in a cohort of newly diagnosed glioblastoma multiforme (GBM) patients to evaluate whether it could modify the extent of surgical resection and improve radiation therapy volume delineation. (2) Methods: Newly diagnosed GBM patients, ages 18-70, with a Karnofsky performance scale (KPS) ≥ 70 with available MRI and [11C]-methionine PET were included. Patients were treated with different amounts of surgical resection followed by radio-chemotherapy. The role of [11C]-methionine PET in surgical and RT planning was analyzed. A threshold of SUVmax was searched. (3) Results: From August 2013 to April 2016, 93 patients were treated and included in this analysis. Residual tumor volume was detected in 63 cases on MRI and in 78 on [11C]-methionine PET, including 15 receiving gross total resection. The location of uptake was mainly observed in FLAIR abnormalities. [11C]-methionine uptake changed RT volume in 11% of patients. The presence of [11C]-methionine uptake in patients receiving GTR proved to influence survival (p = 0.029). The threshold of the SUVmax conditioning outcome was five. (4) Conclusions: [11C]-methionine PET allowed to detect areas at higher risk of recurrence located in FLAIR abnormalities in patients affected by GBM. A challenging issue is represented by integrating morphological and functional imaging to better define the extent of surgical resection to perform.
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Affiliation(s)
- Federico Pessina
- Neurosurgery Department, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy; (F.P.); (A.F.); (D.M.); (A.C.); (S.O.); (M.S.)
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20090 Milan, Italy; (M.S.); (L.S.P.); (A.C.)
| | - Pierina Navarria
- Radiotherapy and Radiosurgery Department, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy; (E.C.); (L.B.)
- Correspondence: ; Tel.: +390-282-247-458
| | - Elena Clerici
- Radiotherapy and Radiosurgery Department, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy; (E.C.); (L.B.)
| | - Luisa Bellu
- Radiotherapy and Radiosurgery Department, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy; (E.C.); (L.B.)
| | - Andrea Franzini
- Neurosurgery Department, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy; (F.P.); (A.F.); (D.M.); (A.C.); (S.O.); (M.S.)
| | - Davide Milani
- Neurosurgery Department, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy; (F.P.); (A.F.); (D.M.); (A.C.); (S.O.); (M.S.)
| | - Matteo Simonelli
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20090 Milan, Italy; (M.S.); (L.S.P.); (A.C.)
- Oncology and Hematology Department, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy;
| | - Pasquale Persico
- Oncology and Hematology Department, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy;
| | - Letterio S. Politi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20090 Milan, Italy; (M.S.); (L.S.P.); (A.C.)
- Neuroradiology Department, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy
| | - Alessandra Casarotti
- Neurosurgery Department, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy; (F.P.); (A.F.); (D.M.); (A.C.); (S.O.); (M.S.)
| | - Bethania Fernandes
- Pathology Department, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy;
| | - Simone Olei
- Neurosurgery Department, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy; (F.P.); (A.F.); (D.M.); (A.C.); (S.O.); (M.S.)
| | - Martina Sollini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20090 Milan, Italy; (M.S.); (L.S.P.); (A.C.)
- Diagnostic Imaging Department, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy
| | - Arturo Chiti
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20090 Milan, Italy; (M.S.); (L.S.P.); (A.C.)
- Pathology Department, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy;
| | - Marta Scorsetti
- Neurosurgery Department, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy; (F.P.); (A.F.); (D.M.); (A.C.); (S.O.); (M.S.)
- Radiotherapy and Radiosurgery Department, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy; (E.C.); (L.B.)
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Lorenzi E, Simonelli M, Persico P, Dipasquale A, Santoro A. Risks of molecular targeted therapies to fertility and safety during pregnancy: a review of current knowledge and future needs. Expert Opin Drug Saf 2021; 20:503-521. [PMID: 33600273 DOI: 10.1080/14740338.2021.1893299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION As the population of young cancer survivors is increasing and a trend toward postponing pregnancy later in life is reported, more efforts are focused toward understanding treatment-induced sequelae, in particular, the effects of cancer and/or treatment on fertility. AREA COVERED Whereas the fertility risk of cytotoxic agents for both men and women is well recognized, the impact of molecular-targeted therapy (MTT) on fertility parameters, their teratogenic potential and pregnancy outcome/management in case of an accidental exposure are not established. We update available clinical data on the impact of new MTTs on fertility in both sexes, their potential teratogenic effects and the outcome of pregnancy during accidental exposure. Agents are categorized by class and the potential relevance of their target signaling pathways to gonadal maturation. EXPERT OPINION The majority of MTTs have worrying preclinical data discouraging their use during pregnancy and reinforcing the idea that they can induce impairment in gonadal function. However, it does not mean that all MTTs result in permanent infertility and that they should be completely avoided during pregnancy. The current review provides a critical evaluation on the most commonly used MTTs, offering a possible guide for clinicians.
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Affiliation(s)
- Elena Lorenzi
- Department of Oncology, IRCCS Humanitas Cancer Center, Rozzano, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Pieve Emanuele, Italy
| | - Matteo Simonelli
- Department of Oncology, IRCCS Humanitas Cancer Center, Rozzano, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Pieve Emanuele, Italy
| | - Pasquale Persico
- Department of Oncology, IRCCS Humanitas Cancer Center, Rozzano, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Pieve Emanuele, Italy
| | - Angelo Dipasquale
- Department of Oncology, IRCCS Humanitas Cancer Center, Rozzano, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Pieve Emanuele, Italy
| | - Armando Santoro
- Department of Oncology, IRCCS Humanitas Cancer Center, Rozzano, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Pieve Emanuele, Italy
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Dipasquale A, Persico P, Lorenzi E, Rahal D, Santoro A, Simonelli M. COVID-19 lung injury as a primer for immune checkpoint inhibitors (ICIs)-related pneumonia in a patient affected by squamous head and neck carcinoma treated with PD-L1 blockade: a case report. J Immunother Cancer 2021; 9:e001870. [PMID: 33574054 PMCID: PMC7880093 DOI: 10.1136/jitc-2020-001870] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2020] [Indexed: 12/30/2022] Open
Abstract
By the beginning of the global pandemic, SARS-CoV-2 infection has dramatically impacted on oncology daily practice. In the current oncological landscape, where immunotherapy has revolutionized the treatment of several malignancies, distinguishing between COVID-19 and immune-mediated pneumonitis can be hard because of shared clinical, radiological and pathological features. Indeed, their common mechanism of aberrant inflammation could lead to a mutual and amplifying interaction.We describe the case of a 65-year-old patient affected by metastatic squamous head and neck cancer and candidate to an experimental therapy including an anti-PD-L1 agent. COVID-19 ground-glass opacities under resolution were an incidental finding during screening procedures and worsened after starting immunotherapy. The diagnostic work-up was consistent with ICIs-related pneumonia and it is conceivable that lung injury by SARS-CoV-2 has acted as an inflammatory primer for the development of the immune-related adverse event.Patients recovered from COVID-19 starting ICIs could be at greater risk of recall immune-mediated pneumonitis. Nasopharyngeal swab and chest CT scan are recommended before starting immunotherapy. The awareness of the phenomenon could allow an easier interpretation of radiological changes under treatment and a faster diagnostic work-up to resume ICIs. In the presence of clinical benefit, for asymptomatic ICIs-related pneumonia a watchful-waiting approach and immunotherapy prosecution are suggested.
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Affiliation(s)
- Angelo Dipasquale
- Department of Medical Oncology and Hematology, IRCCS Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Pasquale Persico
- Department of Medical Oncology and Hematology, IRCCS Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Elena Lorenzi
- Department of Medical Oncology and Hematology, IRCCS Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Daoud Rahal
- Department of Pathology, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Armando Santoro
- Department of Medical Oncology and Hematology, IRCCS Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Matteo Simonelli
- Department of Medical Oncology and Hematology, IRCCS Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
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12
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Muglia R, Simonelli M, Pessina F, Morenghi E, Navarria P, Persico P, Lorenzi E, Dipasquale A, Grimaldi M, Scorsetti M, Santoro A, Politi LS. Prognostic relevance of temporal muscle thickness as a marker of sarcopenia in patients with glioblastoma at diagnosis. Eur Radiol 2020; 31:4079-4086. [PMID: 33201284 DOI: 10.1007/s00330-020-07471-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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: 06/17/2020] [Revised: 10/16/2020] [Accepted: 11/04/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Temporal muscle thickness (TMT) is a surrogate marker of sarcopenia, correlated with survival expectancy in patients suffering from brain metastases and recurrent or treated glioblastoma. We evaluated the prognostic relevance of TMT measured on brain MRIs acquired at diagnosis in patients affected by glioblastoma. METHODS We retrospectively enrolled 51 patients in our Institution affected by methylated MGMT promoter, IDH1-2 wild-type glioblastoma, who underwent complete surgical resection and subsequent radiotherapy with concomitant and maintenance temozolomide, from January 1, 2015, to April 30, 2017. The last clinical/radiological follow-up date was set to September 3, 2019. TMT was measured bilaterally on reformatted post-contrast 3D MPRAGE images, acquired on our 3-T scanner no more than 2 days before surgery. The median, 25th, and 75th percentile TMT values were identified and population was subdivided accordingly; afterwards, statistical analyses were performed to verify the association among overall survival (OS) and TMT, sex, age, and ECOG performance status. RESULTS In our cohort, the median OS was 20 months (range 3-51). Patients with a TMT ≥ 8.4 mm (median value) did not show a statistically significant increase in OS (Cox regression model: HR 1.34, 95% CI 0.68-2.63, p = 0.403). Similarly, patients with a TMT ≥ 9.85 mm (fourth quartile) did not differ in OS compared to those with TMT ≤ 7 mm (first quartile). The statistical analyses confirmed a significant association among TMT and sex (p = 0.0186), but none for age (p = 0.642) and performance status (p = 0.3982). CONCLUSIONS In our homogeneous cohort of patients with glioblastoma at diagnosis, TMT was not associated with prognosis, age, or ECOG performance status. KEY POINTS • Temporal muscle thickness (TMT) is a surrogate marker of sarcopenia and has been correlated with survival expectancy in patients suffering from brain metastases and recurrent or treated glioblastoma. • We appraised the correlation among TMT and survival, sex, age at surgery, and performance status, measured on brain MRIs of patients affected by glioblastoma at diagnosis. • TMT did not show any significant correlation with prognosis, age at surgery, or performance status, and its usefulness might be restricted only to patients with brain metastases and recurrent or treated glioblastoma.
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Affiliation(s)
- Riccardo Muglia
- Training School in Radiology, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090, Milan, Italy
| | - Matteo Simonelli
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090, Milan, Italy
- Oncology and Hematology Unit, Humanitas Clinical and Research Center - IRCCS, Via A. Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Federico Pessina
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090, Milan, Italy
- Department of Neurosurgery, Humanitas Clinical and Research Center - IRCCS, Via A. Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Emanuela Morenghi
- Biostatistic Unit, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090, Milan, Italy
| | - Pierina Navarria
- Department of Radiotherapy, Humanitas Clinical and Research Center - IRCCS, Via A. Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Pasquale Persico
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090, Milan, Italy
- Oncology and Hematology Unit, Humanitas Clinical and Research Center - IRCCS, Via A. Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Elena Lorenzi
- Oncology and Hematology Unit, Humanitas Clinical and Research Center - IRCCS, Via A. Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Angelo Dipasquale
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090, Milan, Italy
- Oncology and Hematology Unit, Humanitas Clinical and Research Center - IRCCS, Via A. Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Marco Grimaldi
- Department of Neuroradiology, Humanitas Clinical and Research Center - IRCCS, Via A. Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Marta Scorsetti
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090, Milan, Italy
- Department of Radiotherapy, Humanitas Clinical and Research Center - IRCCS, Via A. Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Armando Santoro
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090, Milan, Italy
- Oncology and Hematology Unit, Humanitas Clinical and Research Center - IRCCS, Via A. Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Letterio S Politi
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090, Milan, Italy.
- Department of Neuroradiology, Humanitas Clinical and Research Center - IRCCS, Via A. Manzoni 56, Rozzano, 20089, Milan, Italy.
- Hematology & Oncology Division and Radiology Department, Boston Children's Hospital and Harvard Medical School, 300 Longwood Ave, Boston, MA, 02115, USA.
- Radiology Department and Advanced MRI Center, University of Massachusetts Medical School and Medical Center, 55 Lake Avenue N, Worcester, MA, 01655, USA.
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Navarria P, Pessina F, Clerici E, Rossini Z, Franceschini D, D'Agostino G, Franzese C, Comito T, Loi M, Simonelli M, Lorenzi E, Persico P, Politi LS, Grimaldi M, Bello L, Santoro A, Fornari M, Servadei F, Scorsetti M. Is IDH status the only factor predicting prognosis in newly diagnosed anaplastic glioma patients? Outcome evaluation and prognostic factor analysis in a single-institution large series. J Neurosurg 2020; 135:64-77. [PMID: 32886916 DOI: 10.3171/2020.5.jns201116] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 05/21/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Anaplastic gliomas (AGs) are an extremely heterogeneous group of primary brain tumors. More recently, new discoveries have indicated that isocitrate dehydrogenase (IDH) mutation status is the most important parameter predicting survival. The primary aim of the present analysis was to identify prognostic factors, other than IDH status, that eventually impact survival. METHODS Patients with available clinical, imaging, and molecular profile data who were amenable to resection were evaluated. The extent of resection (EOR) was defined as gross-total resection (GTR), near-total resection (NTR), subtotal resection (STR), or partial resection (PR). Residual tumor volume (RTV) was quantified. Following surgery, patients received adjuvant chemotherapy alone, radiation therapy plus concomitant and adjuvant temozolomide (TMZ), or sequential radio-chemotherapy. Clinical outcome was evaluated by neurological examination and MRI 1 month after treatment and every 4 months thereafter. Tumor progression was defined according to the Response Assessment in Neuro-Oncology (RANO) working group. RESULTS Among 402 patients referred to the authors' institution for AG, 142 were included in the present analysis. Eighty-eight (62%) were male and 54 (38%) were female, with a median age of 43 years (range 19-70 years). At admission, most patients had a Karnofsky Performance Scale score of 90-100 (84.5%) and were symptomatic (93.7%). Forty-eight (33.8%) patients had newly diagnosed anaplastic oligodendrogliomas (AOs), and 94 (66.2%) had anaplastic astrocytomas (AAs). Most of them had mutant IDH tumors (67.6%) and methylated O 6-methylguanine-DNA-methyltransferase (MGMT) promoter status (71.8%). GTR was performed in more than half of the patients (56.3%). RTV was detected in 83 (58.5%) patients. Following surgery, 72 (50.7%) patients received radiotherapy with concomitant and adjuvant TMZ, 48 (33.8%) received sequential radio-chemotherapy, and 22 (15.5%) received adjuvant chemotherapy alone. The median follow-up time was 40 months (range 16-146 months). The median PFS time and the 1-, 3-, and 5-year PFS rates were 35 months (95% CI 27-76) and 78.9% ± 3.4%, 49.7% ± 4.6%, and 42.7% ± 5.4%, respectively. The median OS time and the 1-, 3-, and 5-year OS rates were 91 months (95% CI 66-95) and 90.1% ± 2.5%, 70.9% ± 4.2%, and 61.8% ± 4.9%, respectively. Prognostic factors predicting survival other than molecular profile were the EOR and the RTV (p < 0.0001). Sequential radio-chemotherapy was the more effective treatment administered. CONCLUSIONS In addition to IDH status, EOR and the RTV have proved to statistically impact survival. The pivotal role of adjuvant radiotherapy has been recorded in all AG patients, regardless of tumor features.
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Affiliation(s)
| | - Federico Pessina
- 2Neurosurgery
- 5Department of Biomedical Sciences, Humanitas University, Rozzano; and
| | | | | | | | | | - Ciro Franzese
- Departments of1Radiotherapy and Radiosurgery
- 5Department of Biomedical Sciences, Humanitas University, Rozzano; and
| | | | - Mauro Loi
- Departments of1Radiotherapy and Radiosurgery
| | - Matteo Simonelli
- 3Oncology and Hematology, and
- 5Department of Biomedical Sciences, Humanitas University, Rozzano; and
| | | | | | - Letterio Salvatore Politi
- 4Neuroradiology, Humanitas Cancer Center and Research Hospital, Rozzano
- 5Department of Biomedical Sciences, Humanitas University, Rozzano; and
| | - Marco Grimaldi
- 4Neuroradiology, Humanitas Cancer Center and Research Hospital, Rozzano
| | - Lorenzo Bello
- 6Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Italy
| | - Armando Santoro
- 3Oncology and Hematology, and
- 5Department of Biomedical Sciences, Humanitas University, Rozzano; and
| | | | - Franco Servadei
- 2Neurosurgery
- 5Department of Biomedical Sciences, Humanitas University, Rozzano; and
| | - Marta Scorsetti
- Departments of1Radiotherapy and Radiosurgery
- 5Department of Biomedical Sciences, Humanitas University, Rozzano; and
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Dipasquale A, Persico P, Lorenzi E, Bertossi M, Santoro A, Simonelli M. Conducting Phase I Trials During the SARS-Coronavirus-2 Outbreak: About Science and Care. Front Oncol 2020; 10:926. [PMID: 32574280 PMCID: PMC7256652 DOI: 10.3389/fonc.2020.00926] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 05/11/2020] [Indexed: 01/15/2023] Open
Affiliation(s)
- Angelo Dipasquale
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy.,Humanitas Cancer Center, Humanitas Clinical and Research Center-IRCCS, Rozzano, Italy
| | - Pasquale Persico
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy.,Humanitas Cancer Center, Humanitas Clinical and Research Center-IRCCS, Rozzano, Italy
| | - Elena Lorenzi
- Humanitas Cancer Center, Humanitas Clinical and Research Center-IRCCS, Rozzano, Italy
| | - Monica Bertossi
- Humanitas Cancer Center, Humanitas Clinical and Research Center-IRCCS, Rozzano, Italy
| | - Armando Santoro
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy.,Humanitas Cancer Center, Humanitas Clinical and Research Center-IRCCS, Rozzano, Italy
| | - Matteo Simonelli
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy.,Humanitas Cancer Center, Humanitas Clinical and Research Center-IRCCS, Rozzano, Italy
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Simonelli M, Dipasquale A, Orzan F, Lorenzi E, Persico P, Navarria P, Pessina F, Nibali MC, Bello L, Santoro A, Boccaccio C. Cerebrospinal fluid tumor DNA for liquid biopsy in glioma patients' management: Close to the clinic? Crit Rev Oncol Hematol 2020; 146:102879. [PMID: 32005411 DOI: 10.1016/j.critrevonc.2020.102879] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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: 08/09/2019] [Revised: 12/20/2019] [Accepted: 01/17/2020] [Indexed: 01/24/2023] Open
Abstract
Cell-free circulating tumor DNA (ct-DNA) reflecting the whole tumor spatial and temporal heterogeneity currently represents the most promising candidate for liquid biopsy strategy in glioma. Unlike other solid tumors, it is now widely accepted that the best source of ct-DNA for glioma patients is the cerebrospinal fluid, since blood levels are usually low and detectable only in few cases. A cerebrospinal fluid ct-DNA liquid biopsy approach may virtually support all the stages of glioma management, from facilitating molecular diagnosis when surgery is not feasible, to monitoring tumor response, identifying early recurrence, tracking longitudinal genomic evolution, providing a new molecular characterization at recurrence and allowing patient selection for targeted therapies. This review traces the history of ct-DNA liquid biopsy in the field of diffuse malignant gliomas, describes its current status and analyzes what are the future perspectives and pitfalls of this potentially revolutionary molecular tool.
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Affiliation(s)
- Matteo Simonelli
- Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, MI, Italy; Oncology and Hematology Unit, Humanitas Cancer Center, Humanitas Clinical and Research Center - IRCCS, Rozzano, MI, Italy.
| | - Angelo Dipasquale
- Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, MI, Italy; Oncology and Hematology Unit, Humanitas Cancer Center, Humanitas Clinical and Research Center - IRCCS, Rozzano, MI, Italy
| | - Francesca Orzan
- Laboratory of Cancer Stem Cell Research, Candiolo Cancer Institute - FPO-IRCCS, Candiolo, TO, Italy
| | - Elena Lorenzi
- Oncology and Hematology Unit, Humanitas Cancer Center, Humanitas Clinical and Research Center - IRCCS, Rozzano, MI, Italy
| | - Pasquale Persico
- Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, MI, Italy; Oncology and Hematology Unit, Humanitas Cancer Center, Humanitas Clinical and Research Center - IRCCS, Rozzano, MI, Italy
| | - Pierina Navarria
- Radiotherapy and Radiosurgery Unit, Humanitas Cancer Center, Humanitas Clinical and Research Center - IRCCS, Rozzano, MI, Italy
| | - Federico Pessina
- Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, MI, Italy; Department of Neurosurgery, Humanitas Clinical and Research Center - IRCCS, Rozzano, MI, Italy
| | - Marco Conti Nibali
- University of Milan, Department of Oncology and Hematology, Milan, Italy
| | - Lorenzo Bello
- University of Milan, Department of Oncology and Hematology, Milan, Italy
| | - Armando Santoro
- Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, MI, Italy; Oncology and Hematology Unit, Humanitas Cancer Center, Humanitas Clinical and Research Center - IRCCS, Rozzano, MI, Italy
| | - Carla Boccaccio
- Laboratory of Cancer Stem Cell Research, Candiolo Cancer Institute - FPO-IRCCS, Candiolo, TO, Italy
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Simonelli M, Lorenzi E, Dipasquale A, Persico P, Ninatti G, Giordano L, Bertossi M, Santoro A. Patient (pt) selection for immunotherapeutic early-phase clinical trials (ieCTs): A single phase I unit experience. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz244.054] [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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Simonelli M, Persico P, Dipasquale A, Lorenzi E, Giordano L, Pessina F, Navarria P, Scorsetti M, Bello L, Santoro A. Outcome of high-grade gliomas (HGGs) treated into immunotherapeutic early-phase clinical trials (ieCTs): A single-center experience. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz243.039] [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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18
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Caccese M, Simonelli M, Fassan M, Padovan M, Persico P, Bellu L, Dipasquale A, Gardiman M, Indraccolo S, Zagonel V, Lombardi G. Pembrolizumab (Pem) in recurrent high-grade glioma (HGG) patients with mismatch repair deficiency (MMRd): An observational study. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz243.038] [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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19
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Caccese M, Simonelli M, Fassan M, Padovan M, Persico P, Bellu L, Dipasquale A, Gardiman M, Indraccolo S, Zagonel V, Lombardi G. PL2.2 Pembrolizumab (PEM) in recurrent high-grade glioma (HGG)patients with mismatch repair deficiency (dMMR): an observational study. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz126.003] [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: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
Pem, an immune checkpoint inhibitor, demonstrated to be activein various neoplasms with MMRd. No data exists about its efficacy in MMRdglioma patients.
MATERIAL AND METHODS
MMRd HGG relapsed after receiving RT and CT weretreated with Pem. MMR status was analyzed by immunohistochemistry,including the MLH1, MSH2, MSH6, and PMS2 markers. MMR deficiency wasdefined as presence of a weak (wMMRd) or absent (aMMRd) signal atimmunohistochemistry for at least one MMR protein. Other inclusion criteriawere: ECOG PS 0–2, histologically confirmed gliomas, dexamethasone ≤4 mg.Pem was administrated at 200 mg every 3 weeks until progression disease orunacceptable toxicity. Tumor response was evaluated by brain MRI every 10 weeksaccording to the RANO criteria. OS and PFS were evaluated by Kaplan-Meiercurves. CTCAE v4.0 was used for toxicity.
RESULTS
among 167 glioma patients, we found 22 MMRd gliomas. 12 PTS were treated with Pem: 8 wMMRd and 4 aMMRd. According to Bethesda criteria, allPTS had microsatellite stability. Tumor histologies included 5 anaplasticastrocytoma, 1 anaplastic oligodendroglioma, 6 glioblastoma (GBM). MSH2deficiency was found in 6 cases, MSH6 deficiency in 9 cases, PMS2 and MLH1deficiency in 2 cases. Median number of prior line of chemotherapy was 1 (range 1–5). Stable disease (SD) was reported in 4 PTS (33%); 8 PTS showedprogressive disease (PD). PTS with anaplastic gliomas showed a statisticallysignificant association with SD (p=0.03, OR=3); all GBM PTS reported PD; status of MMRd (weak/absent), IDH (mutated/wild-type), MSH2 and MLH6(deficient/proficient) were not associated with SD. Median follow up was 14.7 ms. OS was 5.6 ms (95% CI 0.1–13.8), PFS 2.4 ms (95% CI 1.8–2.9). OS was 2.8 ms and 5.6 ms (p=0.9), PFS was 1.8 ms and 3.1 ms (p=0.5) in PTS with wMMRd and aMMRd. PTS reporting SD and PD had PFS of 7.4 ms (95% CI 4.6–10.2) and 1.8 ms (95% CI 0.2–3.4), p=0.002; OS was “not reached” and 2.8 ms in PTS having SD vs PD (p=0.04). Grade ≥3 adverse eventswere reported in 8% of PTS.
CONCLUSION
a subgroup of recurrent MMRd HGG might benefit from Pem,especially anaplastic gliomas. There was a trend for a longer PFS and OS in PTS with aMMRd. Analyses for identifying additional molecular predictive factors is ongoing.
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Affiliation(s)
- M Caccese
- Department of Oncology, Oncology 1, Veneto Institute of Oncology, IOV – IRCCS, Padova, Italy
| | - M Simonelli
- Humanitas University, Humanitas Clinical and Research Hospital - IRCCS, Milan, Italy
| | - M Fassan
- Department of Medicine and Surgical Pathology and Cytopathology Unit, University Hospital of Padua, Padova, Italy
| | - M Padovan
- Department of Oncology, Oncology 1, Veneto Institute of Oncology, IOV – IRCCS, Padova, Italy
| | - P Persico
- Humanitas University, Humanitas Clinical and Research Hospital - IRCCS, Milan, Italy
| | - L Bellu
- Department of Oncology, Radiotherapy Unit, Veneto Institute of Oncology, IOV – IRCCS, Padova, Italy
| | - A Dipasquale
- Humanitas University, Humanitas Clinical and Research Hospital - IRCCS, Milan, Italy
| | - M Gardiman
- Department of Medicine and Surgical Pathology and Cytopathology Unit, University Hospital of Padua, Padova, Italy
| | - S Indraccolo
- Immunology and Molecular Oncology Unit, Veneto Institute of Oncology, IOV - IRCCS, Padova, Italy
| | - V Zagonel
- Department of Oncology, Oncology 1, Veneto Institute of Oncology, IOV – IRCCS, Padova, Italy
| | - G Lombardi
- Department of Oncology, Oncology 1, Veneto Institute of Oncology, IOV – IRCCS, Padova, Italy
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20
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Simonelli M, Persico P, Dipasquale A, Lorenzi E, Giordano L, Pessina F, Navarria P, Scorsetti M, Bello L, Santoro A. P05.08 High-grade gliomas and immunotherapeutic early phase clinical trials: a single-center experience. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz126.122] [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: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
Patients with high-grade gliomas (HGGs) have historically been excluded from immunotherapeutic early-phase clinical trials (ieCTs) due to unavailability of serial bioptic sampling, the frequent need of corticosteroids, concerns regarding activity of immunotherapy in central nervous system, and rapid clinical deterioration.
MATERIAL AND METHODS
We retrospectively reviewed data of all recurrent HGG patients enrolled in ieCTs at Humanitas Cancer Center Phase I Unit between 2014 and 2019. Disease control rate (DCR) according to RANO criteria, six-months progression-free and overall survival (PFS-6; OS-6), and treatment-related adverse events (TRAEs), were evaluated. A control-cohort (CC) of patients treated with standard treatments (temozolomide, fotemustine, lomustine and procarbazine, bevacizumab) matched (1:1) for sex, age, line of treatment, MGMT methylation status, and IDH mutational status, was selected for comparison. A series of clinical parameters with an established prognostic value for patients with solid tumors treated into ieCTs were correlated with survivals through an univariate analysis. These include: use of steroids, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, lactate dehydrogenase, albumin, total protein.
RESULTS
Five among the 23 ieCTs conducted at our Phase I Unit allowed inclusion of HGG patients. 25 patients were enrolled in the experimental cohort (EC): 22 (88%) glioblastoma, 3 (12%) anaplastic astrocytoma. Median age was 50 years (range 25–71); 16 patients (64%) were men, 9 (36%) women; 17 pts (68%) required steroid therapy, with a median baseline dexamethasone dose of 2 mg (range 1–6). The median number of prior systemic therapies was 1 (range 1–2). Twelve patients (48%) received monotherapies (anti PD-1, anti CSFR-1, anti TGF-ß, anti cereblon), 13 (52%) combination regimens (anti PD-L1 + anti CD38, anti PD-1 + anti CSFR-1). DCR was 40% (1 CR + 2 PR + 7 SD) and 37% (9 SD), in EC and CC, respectively. Four patients (16%) in EC had grade ≥3 TRAEs (1 neutropenia, 1 pneumonia, 2 hepatitis). With a median follow-up of 14 months PFS-6 were 35% and 16% (p=0.075), in EC and CC respectively, while OS-6 was significantly improved in the EC (82% vs 44%, p=0.004). In our small series, none of clinical factors resulted prognostic.
CONCLUSION
Survival outcomes of ourHGG patients treated into ieCTs compared very favorably with a matched CC. Inclusion of HGGs patients into ieCTs should be strongly encouraged. Identification of clinical factors to select who may benefit from ieCTs still remains crucial.
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Affiliation(s)
- M Simonelli
- Humanitas Clinical and Research Center; Humanitas University, Rozzano (Milan), Italy
| | - P Persico
- Humanitas Clinical and Research Center, Rozzano (Milan), Italy
| | - A Dipasquale
- Humanitas Clinical and Research Center, Rozzano (Milan), Italy
| | - E Lorenzi
- Humanitas Clinical and Research Center, Rozzano (Milan), Italy
| | - L Giordano
- Humanitas Clinical and Research Center, Rozzano (Milan), Italy
| | - F Pessina
- Humanitas Clinical and Research Center; Humanitas University, Rozzano (Milan), Italy
| | - P Navarria
- Humanitas Clinical and Research Center, Rozzano (Milan), Italy
| | - M Scorsetti
- Humanitas Clinical and Research Center; Humanitas University, Rozzano (Milan), Italy
| | - L Bello
- Humanitas Clinical and Research Center; University of Milan, Rozzano (Milan), Italy
| | - A Santoro
- Humanitas Clinical and Research Center; Humanitas University, Rozzano (Milan), Italy
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Lombardi G, Caccese M, Simonelli M, Fassan M, Padovan M, Persico P, Bellu L, Dipasquale A, Gardiman MP, Indraccolo S, Zagonel V. Pembrolizumab (Pem) in recurrent high-grade glioma (HGG) patients (PTS) with mismatch repair deficiency (MMRd): An observational study. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.2043] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
2043 Background: Pem, an immune checkpoint inhibitor, demonstrated to be active in various neoplasms with MMRd. No data exists about its efficacy in MMRd glioma PTS. Methods: MMRd HGG relapsed after receiving RT and CT were treated with Pem. MMR status was analyzed by immunohistochemistry, including the MLH1, MSH2, MSH6, and PMS2 markers. MMRd was defined as presence of a weak (wMMRd) or absent (aMMRd) signal for at least one MMR protein. Other inclusion criteria were: ECOG PS 0-2, histologically confirmed glioma, dexamethasone ≤4 mg. Pem was administrated at 200 mg every 3 weeks until disease progression or unacceptable toxicity. Tumor response was evaluated by brain MRI every 10 weeks according to the RANO criteria. OS and PFS were evaluated by Kaplan-Meier curves. Results: among 167 glioma PTS, we found 22 MMRd gliomas. 12 PTS were treated with Pem: 8 wMMRd and 4 aMMRd. According to Bethesda criteria, all PTS had microsatellite stability. Tumor histologies included 5 anaplastic astrocytoma, 1 anaplastic oligodendroglioma, 6 glioblastoma (GBM). MSH2 deficiency was found in 6 cases , MSH6 deficiency in 9 cases, PMS2 and MLH1 deficiency in 2 cases. Median number of prior lines of chemotherapy was 1 (range 1-5). Stable disease (SD) was reported in 4 PTS (33%); 8 PTS showed progressive disease (PD). PTS with anaplastic gliomas showed a statistically significant association with SD (p=0.03, OR=3); all GBM PTS reported PD; status of MMRd (weak/absent), IDH (mutated/wild-type), MSH2 and MLH6 (deficient/proficient) were not associated with SD. Median follow up was 14.7 ms. OS was 5.6 ms (95% CI 0.1-13.8), PFS 2.4 ms (95% CI 1.8-2.9). OS was 2.8 ms and 5.6 ms (p=0.9), PFS was 1.8 ms and 3.1 ms (p=0.5) in PTS with wMMRd and aMMRd, respectively. PTS reporting SD and PD had PFS of 7.4 ms (95% CI 4.6-10.2) and 1.8 ms (95% CI 0.2-3.4), p=0.002; OS was “not reached” and 2.8 ms in PTS having SD vs PD (p=0.04), respectively. Grade ≥3 adverse events were reported in 8% of PTS. Conclusions: a subgroup of recurrent MMRd HGG might benefit from Pem, especially anaplastic gliomas. There was a trend for a longer PFS and OS in PTS with aMMRd. The enrollment and analyses for identifying additional molecular predictive factors are ongoing.
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Affiliation(s)
- Giuseppe Lombardi
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Mario Caccese
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Matteo Simonelli
- Humanitas University, Humanitas Clinical and Research Hospital-IRCCS, Pieve Emanuele, Italy
| | - Matteo Fassan
- Department of Medicine (DIMED), Pathology Unit, University of Padua, Padova, Italy, Padova, Italy
| | - Marta Padovan
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | | | - Luisa Bellu
- Radiotherapy Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | | | | | - Stefano Indraccolo
- Immunology and Molecular Oncology Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
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Simonelli M, Persico P, Dipasquale A, Lorenzi E, Giordano L, Pessina F, Navarria P, Scorsetti M, Bello L, Santoro A. High-grade gliomas (HGGs) and immunotherapeutic early-phase clinical trials (ieCTs): A single-center experience. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e13512] [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
e13512 Background: Patients with HGGs have historically been excluded from ieCTs due to unavailability of serial bioptic sampling, frequent need of corticosteroids, concerns on activity of immunotherapy in central nervous system, and rapid clinical deterioration. Methods: We retrospectively reviewed data of all recurrent HGG patients enrolled in ieCTs at Humanitas Cancer Center Phase I Unit between 2014 and 2018. Disease control rate (DCR) according to RANO criteria, six-months progression-free and overall survival (PFS-6; OS-6), and treatment-related adverse events (TRAEs), were evaluated. A control-cohort (CC) of patients treated with standard treatments (temozolomide, fotemustine, lomustine and procarbazine, bevacizumab) matched (1:1) for age, line of treatment, MGMT methylation and IDH mutational status, was selected for comparison. Clinical parameters including use of steroids, neutrophil-to-lymphocyte ratio, lactate dehydrogenase, albumin, total protein, were correlated with survival through an univariate analysis. Results: 5 among 21 ieCTs allowed inclusion of HGG patients. 20 patients were enrolled in our experimental cohort (EC); 17 (85%) glioblastoma, 3 (15%) anaplastic astrocytoma. Median age was 53 years (range 30-71); 12 patients (60%) were men, 8 (40%) women; 13 pts (65%) required steroid therapy, with a median dexamethasone dose of 2 mg (range 1-6). The median number of prior systemic therapies was 1 (range 1-2). 11 patients (55%) received monotherapies (anti PD-1, anti CSFR-1, anti TGF-ß, anti cereblon), 9 (45%) combination regimens (anti PD-L1 + anti CD38, anti PD-1 + anti CSFR-1). DCR was 45% (1 CR + 2 PR + 6 SD) and 30% (1 RP +5 SD), in EC and CC, respectively. 4 patients (20%) in EC had grade ≥3 TRAEs (1 neutropenia, 1 pneumonia, 2 hepatitis). With a median follow-up of 22 months PFS-6 and OS-6 were 53% and 11% (p < .0001), 80% and 42% (p < 0.0001) in EC and CC, respectively. In our small series, none of clinical factors resulted prognostic. Conclusions: Survival outcomes of our HGG patients treated into ieCTs compared very favorably with a matched CC. Inclusion of HGGs patients into ieCTs should be strongly encouraged. Identification of clinical selection factors remains crucial.
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Affiliation(s)
- Matteo Simonelli
- Humanitas University, Humanitas Clinical and Research Hospital-IRCCS, Pieve Emanuele, Italy
| | | | | | - Elena Lorenzi
- Humanitas Clinical and Research Hospital-IRCCS, Rozzano, Italy
| | - Laura Giordano
- Humanitas Clinical and Research Center - IRCCS, Rozzano, Italy
| | - Federico Pessina
- Humanitas University, Humanitas Clinical and Research Hospital-IRCCS, Pieve Emanuele, Italy
| | | | - Marta Scorsetti
- Humanitas University, Humanitas Clinical and Research Hospital-IRCCS, Pieve Emanuele, Italy
| | - Lorenzo Bello
- University of Milan; Humanitas Clinical and Research Hospital - IRCCS, Rozzano, Italy
| | - Armando Santoro
- Medical Oncology and Hematology Unit. Humanitas Cancer Center. Humanitas Clinical and Research Center - IRCCS.Department of Biomedical Sciences. Humanitas University, Rozzano, Milan, Italy
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Lombardi G, Caccese M, Simonelli M, Fassan M, Persico P, Lorenzi E, Bertorelle R, Gardiman M, Bellu L, Pambuku A, Santoro A, Zagonel V. Mismatch repair deficiency (MMRd) in glioma patients (PTS): Frequency and correlation with clinical, histological and molecular characteristics. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy273.362] [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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Simonelli M, Massara M, Persico P, Capucetti A, Lorenzi E, Lugli E, Dipasquale A, Nibali M, Rossi M, Bello L, Locati M, Bonecchi R. P04.86 Correlation between activated infiltrating neutrophils and MGMT methylation in patients with diffuse malignant gliomas (MGs). Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy139.320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- M Simonelli
- Humanitas Clinical and Research Center, Rozzano (MI), Italy
- Humanitas University, Pieve Emanuele (MI), Italy
| | - M Massara
- Humanitas Clinical and Research Center, Rozzano (MI), Italy
- Università degli Studi di Milano, Milano, Italy
| | - P Persico
- Humanitas Clinical and Research Center, Rozzano (MI), Italy
| | - A Capucetti
- Humanitas Clinical and Research Center, Rozzano (MI), Italy
| | - E Lorenzi
- Humanitas Clinical and Research Center, Rozzano (MI), Italy
| | - E Lugli
- Humanitas Clinical and Research Center, Rozzano (MI), Italy
| | - A Dipasquale
- Humanitas Clinical and Research Center, Rozzano (MI), Italy
| | - M Nibali
- Humanitas Clinical and Research Center, Rozzano (MI), Italy
| | - M Rossi
- Humanitas Clinical and Research Center, Rozzano (MI), Italy
| | - L Bello
- Humanitas Clinical and Research Center, Rozzano (MI), Italy
| | - M Locati
- Humanitas Clinical and Research Center, Rozzano (MI), Italy
- Università degli Studi di Milano, Milano, Italy
| | - R Bonecchi
- Humanitas Clinical and Research Center, Rozzano (MI), Italy
- Humanitas University, Pieve Emanuele (MI), Italy
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25
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Lombardi G, Caccese M, Simonelli M, Fassan M, Persico P, Lorenzi E, Bertorelle R, Gardiman M, Bellu L, Pambuku A, Santoro A, Zagonel V. P01.018 Mismatch repair deficiency (MMRd) in glioma patients (PTS): frequency and correlation with clinical, histological and molecular characteristics. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy139.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- G Lombardi
- Department of Clinical and Experimental Oncology, Veneto Institute of Oncology, IOV – IRCCS, Padova, Italy
| | - M Caccese
- Department of Clinical and Experimental Oncology, Veneto Institute of Oncology, IOV – IRCCS, Padova, Italy
| | - M Simonelli
- Department of Biomedical Sciences, Humanitas University, Rozzano, Italy
- Humanitas Cancer Center, Humanitas Clinical and Research Hospital, Rozzano, Italy
| | - M Fassan
- Surgical Pathology Unit, Department of Medicine (DIMED), University-Hospital of Padua, Padova, Italy
| | - P Persico
- Humanitas Cancer Center, Humanitas Clinical and Research Hospital, Rozzano, Italy
| | - E Lorenzi
- Humanitas Cancer Center, Humanitas Clinical and Research Hospital, Rozzano, Italy
| | - R Bertorelle
- Immunology and Molecular Oncology Unit, Veneto Institute of Oncology, IOV - IRCCS, Padova, Italy
| | - M Gardiman
- Surgical Pathology Unit, Department of Medicine (DIMED), University-Hospital of Padua, Padova, Italy
| | - L Bellu
- Radiation Therapy and Nuclear Medicine Unit, Veneto Institute of Oncology IOV - IRCCS, Padova, Italy
| | - A Pambuku
- Department of Clinical and Experimental Oncology, Veneto Institute of Oncology, IOV – IRCCS, Padova, Italy
| | - A Santoro
- Department of Biomedical Sciences, Humanitas University, Rozzano, Italy
- Humanitas Cancer Center, Humanitas Clinical and Research Hospital, Rozzano, Italy
| | - V Zagonel
- Department of Clinical and Experimental Oncology, Veneto Institute of Oncology, IOV – IRCCS, Padova, Italy
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26
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Perrino M, Bozzarelli S, Zucali PA, De Pas TM, Simonelli M, De Vincenzo F, Conforti F, Persico P, Miggiano C, Cordua N, Cioffi A, Sala S, Mrakic Sposta F, Giordano L, Santoro A. A phase II study of regorafenib in patients with thymic epithelial tumours previously treated with chemotherapy. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.8579] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Matteo Perrino
- Department of Oncology, Humanitas Research Hospital - Humanitas Cancer Center, Rozzano, Italy
| | | | - Paolo Andrea Zucali
- Humanitas Cancer Center, Humanitas Clinical and Research Center, Rozzano, Italy
| | | | | | | | | | | | - Chiara Miggiano
- Department of Oncology, Humanitas Research Hospital - Humanitas Cancer Center, Rozzano, Italy
| | | | | | | | | | - Laura Giordano
- Humanitas Clinical and Research Center, Rozzano (MI), Italy
| | - Armando Santoro
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, Rozzano (Milano), Italy
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Abstract
Neutrophils are the most abundant white blood cells and are the first recruited to inflammatory sites. Neutrophils are an important component of the tumor stroma and can exert both anti-tumoral and pro-tumoral activities, depending on their maturation and activation state. In human gliomas, the number of circulating and infiltrating neutrophils correlates with the severity of the disease, indicating a prognostic and possible pro-tumoral role for these leukocytes. In glioma preclinical models, neutrophils promote tumor growth and orchestrate the resistance to anti-angiogenic therapies. Nevertheless, recent data indicate that neutrophils can be activated to directly kill tumor cells or to orchestrate the anti-tumoral response. Here, we review current knowledge about the role of neutrophils in glioma and their possible involvement in new strategies to improve current cancer therapies.
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Affiliation(s)
- Matteo Massara
- Humanitas Clinical and Research Center, Rozzano, Italy.,Department of Medical Biotechnologies and Translational Medicine, Università degli Studi di Milano, Milan, Italy
| | | | - Ornella Bonavita
- Humanitas Clinical and Research Center, Rozzano, Italy.,Department of Medical Biotechnologies and Translational Medicine, Università degli Studi di Milano, Milan, Italy
| | - Valeria Mollica Poeta
- Humanitas Clinical and Research Center, Rozzano, Italy.,Humanitas University, Rozzano, Italy
| | - Massimo Locati
- Humanitas Clinical and Research Center, Rozzano, Italy.,Department of Medical Biotechnologies and Translational Medicine, Università degli Studi di Milano, Milan, Italy
| | - Matteo Simonelli
- Humanitas Clinical and Research Center, Rozzano, Italy.,Humanitas University, Rozzano, Italy
| | - Raffaella Bonecchi
- Humanitas Clinical and Research Center, Rozzano, Italy.,Humanitas University, Rozzano, Italy
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28
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Tan CW, Lee YH, Choolani M, Tan HH, Griffith L, Chan J, Chuang PC, Wu MH, Lin YJ, Tsai SJ, Rahmati M, Petitbarat M, Dubanchet S, Bensussan A, Chaouat G, Ledee N, Bissonnette L, Haouzi D, Monzo C, Traver S, Bringer S, Faidherbe J, Perrochia H, Ait-Ahmed O, Dechaud H, Hamamah S, Ibrahim MG, de Arellano MLB, Sachtleben M, Chiantera V, Frangini S, Younes S, Schneider A, Plendl J, Mechsner S, Ono M, Hamai H, Chikawa A, Teramura S, Takata R, Sugimoto T, Iwahashi K, Ohhama N, Nakahira R, Shigeta M, Park IH, Lee KH, Sun HG, Kim SG, Lee JH, Kim YY, Kim HJ, Jeon GH, Kim CM, Bocca S, Wang H, Anderson S, Yu L, Horcajadas J, Oehninger S, Bastu E, Mutlu MF, Celik C, Yasa C, Dural O, Buyru F, Quintana F, Cobo A, Remohi J, Ferrando M, Matorras R, Bermejo A, Iglesias C, Cerrillo M, Ruiz M, Blesa D, Simon C, Garcia-Velasco JA, Chamie L, Ribeiro DMF, Riboldi M, Pereira R, Rosa MB, Gomes C, de Mello PH, Fettback P, Domingues T, Cambiaghi A, Soares ACP, Kimati C, Motta ELA, Serafini P, Hapangama DK, Valentijn AJ, Al-Lamee H, Palial K, Drury JA, von Zglinicki T, Saretzki G, Gargett CE, Liao CY, Lee KH, Sung YJ, Li HY, Morotti M, Remorgida V, Venturini PL, Ferrero S, Nabeta M, Iki A, Hashimoto H, Koizumi M, Matsubara Y, Hamada K, Fujioka T, Matsubara K, Kusanagi Y, Nawa A, Zanatta A, Riboldi M, da Rocha AM, Guerra JL, Cogliati B, Pereira R, Motta ELA, Serafini P, Bianchi PDM, Zanatta A, Riboldi M, da Rocha AM, Cogliati B, Guerra JL, Pereira R, Motta ELA, Serafini P, Prieto B, Exposito A, Mendoza R, Rabanal A, Matorras R, Bedaiwy M, Yi L, Dahoud W, Liu J, Hurd W, Falcone T, Biscotti C, Mesiano S, Sugiyama R, Nakagawa K, Nishi Y, Kuribayashi Y, Akira S, Germeyer A, Rosner S, Jauckus J, Strowitzki T, von Wolff M, Khan KN, Kitajima M, Fujishita A, Nakashima M, Masuzaki H, Kajihara T, Ishihara O, Brosens J, Ledee N, Petitbarat M, Rahmati M, Vezmar K, Savournin V, Dubanchet S, Chaouat G, Balet R, Bensussan A, Chaouat G, Lee YH, Loh SF, Tannenbaum SR, Chan JKY, Scarella A, Chamy V, Devoto L, Abrao M, Sovino H, Krasnopolskaya K, Popov A, Kabanova D, Beketova A, Ivakhnenko V, Shohayeb A, Wahba A, Abousetta A, al-inany H, Wahba A, El Daly A, Zayed M, Kvaskoff M, Han J, Missmer SA, Navarro P, Meola J, Ribas CP, Paz CP, Ferriani RA, Donabela FC, Tafi E, Maggiore ULR, Scala C, Remorgida V, Venturini PL, Ferrero S, Hackl J, Strehl J, Wachter D, Dittrich R, Cupisti S, Hildebrandt T, Lotz L, Attig M, Hoffmann I, Renner S, Hartmann A, Beckmann MW, Urquiza F, Ferrer C, Incera E, Azpiroz A, Junovich G, Pappalardo C, Guerrero G, Pasqualini S, Gutierrez G, Corti L, Sanchez AM, Bordignon PP, Santambrogio P, Levi S, Persico P, Vigano P, Papaleo E, Ferrari S, Candiani M, van der Houwen LEE, Schreurs AMF, Lambalk CB, Schats R, Hompes PGA, Mijatovic V, Xu SY, Li J, Chen XY, Chen SQ, Guo LY, Mathew D, Nunes Q, Lane B, Fernig D, Hapangama D, Lind T, Hammarstrom M, Golmann D, Rodriguez-Wallberg K, Hestiantoro A, Cakra A, Aulia A, Al-Inany H, Houston B, Farquhar C, Abousetta A, Tagliaferri V, Gagliano D, Immediata V, Tartaglia C, Zumpano A, Campagna G, Lanzone A, Guido M, Matsuzaki S, Darcha C, Botchorishvili R, Pouly JL, Mage G, Canis M, Shivhare SB, Bulmer JN, Innes BA, Hapangama DK, Lash GE, de Graaff AA, Zandstra H, Smits LJ, Van Beek JJ, Dunselman GAJ, Bozdag G, Calis PT, Demiralp DO, Ayhan B, Igci N, Yarali H, Acar N, Er H, Ozmen A, Ustunel I, Korgun ET, Kuroda K, Kuroda M, Arakawa A, Kitade M, Brosens AI, Brosens JJ, Takeda S, Yao T. Endometriosis, endometrium, implantation and fallopian tube. Hum Reprod 2013. [DOI: 10.1093/humrep/det211] [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: 10/26/2022] Open
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29
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De Simone R, Ranieri A, Montella S, Marchese M, Persico P, Bonavita V. Sinus venous stenosis, intracranial hypertension and progression of primary headaches. Neurol Sci 2012; 33 Suppl 1:S21-5. [PMID: 22644164 DOI: 10.1007/s10072-012-1037-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The recently advanced hypothesis that idiopathic intracranial hypertension without papilledema (IIHWOP) is a powerful risk factor for the progression of pain in individuals prone to episodic primary headache implies that IIHWOP is much more prevalent than it is believed to be in the general population and that it can run almost asymptomatic in most of the affected individuals. In this review, we discuss the evidence available supporting that: (a) sinus venous stenosis-associated IIHWOP is much more prevalent than believed in the general population and can run without symptoms or signs of raised intracranial pressure in most of individuals affected, (b) sinus venous stenosis is a very sensitive and specific predictor of intermittent or continuous idiopathic intracranial hypertension with or without papilledema, even in asymptomatic individuals, (c) in primary headache prone individuals, a comorbidity with a hidden stenosis-associated IIHWOP represents a very common, although largely underestimated, modifiable risk factor for the progression and refractoriness of headache.
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Affiliation(s)
- Roberto De Simone
- Headache Centre, Department of Neurological Sciences, University of Naples Federico II, via Pansini 5, 80131 Naples, Italy.
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31
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Cerruti P, Santagata G, Gomez d’Ayala G, Ambrogi V, Carfagna C, Malinconico M, Persico P. Effect of a natural polyphenolic extract on the properties of a biodegradable starch-based polymer. Polym Degrad Stab 2011. [DOI: 10.1016/j.polymdegradstab.2011.02.003] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Ferrari S, Persico P, Di Puppo F, Giardina P, Ferrari A. Laparoscopic lateral ovarian transposition: a fertility sparing procedure. Minerva Ginecol 2009; 61:465-468. [PMID: 19749679] [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: 05/28/2023]
Abstract
This article reports the case of a 30-year-old woman who, in 2003, had diffuse large B-cell lymphoma of the left vaginal fornix, associated with sclerosis. After six chemoimmunotherapy cycles the patient underwent a laparoscopic procedure for lateral ovarian transposition to spare ovarian function before radiotherapy. Six months after the transposition the evaluation of ovarian function was performed. The hypothalamic-pituitary-ovary axis was normal. Three years after radiation therapy (2006) the patient spontaneously conceived. Her pregnancy proceeded regularly. She had an uneventful vaginal delivery. Lateral ovarian transposition with tubal anatomy preservation, which is an underused technique, can be successfully used to spare ovarian function in women who undergo pelvic radiotherapy and to let them achieve spontaneous pregnancy.
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MESH Headings
- Adult
- Antibodies, Monoclonal/administration & dosage
- Antibodies, Monoclonal, Murine-Derived
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Combined Modality Therapy
- Cyclophosphamide/administration & dosage
- Doxorubicin/administration & dosage
- Female
- Humans
- Hypothalamo-Hypophyseal System/physiology
- Infant, Newborn
- Infertility, Female/etiology
- Infertility, Female/prevention & control
- Laparoscopy/methods
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, Large B-Cell, Diffuse/radiotherapy
- Ovary/transplantation
- Pregnancy
- Radiotherapy/adverse effects
- Rituximab
- Transplantation, Heterotopic
- Vaginal Neoplasms/drug therapy
- Vaginal Neoplasms/radiotherapy
- Vincristine/administration & dosage
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Affiliation(s)
- S Ferrari
- Obstetrics and Gynecology Department, Vita-Salute University, San Raffaele Hospital, Milan, Italy. stefano.ferrari@ fastwebnet.it
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Abstract
Jojoba oil containing polyamide microcapsules having diameter of approximately 5 microm were prepared by inter-facial polycondensation by direct method (oil-in-water). Qualitative effects of both the formulation and the process parameters on microcapsules characteristics were investigated by SEM observations. Morphological analysis showed the dependence of the external membrane compactness on the chemical nature of the water-soluble polyamine and the oil-soluble acid polychloride: 1,6-hexamethylenediamine (HMDA) and terephthaloyl dichloride (TDC) were found to favour the production of smooth and dense surfaces. The use of ultrasonic irradiations during the dispersion step to get a further reduction of microcapsules size was also evaluated.
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Affiliation(s)
- P Persico
- Dipartimento di Ingegneria dei Materiali e della Produzione, Universitá di Napoli Frederico II, Italy.
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34
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Toma S, Colombo S, Cornegliani L, Persico P, Galzerano M, Gianino MM, Noli C. Efficacy and tolerability of once-daily cephalexin in canine superficial pyoderma: an open controlled study. J Small Anim Pract 2008; 49:384-91. [PMID: 18631220 DOI: 10.1111/j.1748-5827.2008.00585.x] [Citation(s) in RCA: 9] [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: 11/28/2022]
Abstract
OBJECTIVES The aims of this study were to evaluate the efficacy and tolerability of oral cephalexin given at 30 mg/kg once daily in dogs with superficial pyoderma and to compare them with those of oral cephalexin given at 15 mg/kg twice daily. METHODS Twenty dogs with superficial pyoderma were treated with cephalexin at 30 to 60 mg/kg orally once daily (group A) and compared with 20 dogs treated at a dose of 15 to 30 mg/kg orally twice daily (group B). Dogs were treated until 14 days after clinical remission. Type and distribution of lesions, pruritus and general health status were assessed every 14 days using a numerical scale until 14 days after treatment discontinuation. Total scores for each evaluation day were compared between the two groups as well as time to obtain resolution and percentage of relapses. RESULTS Resolution of superficial pyoderma was obtained in all dogs in 14 to 42 days (median 28 days for both groups), with no difference between groups. Six dogs experienced vomiting or diarrhoea but did not require discontinuation of the treatment. Only one dog (in group A) relapsed nine days after treatment discontinuation. CLINICAL SIGNIFICANCE Once-daily cephalexin is as effective as twice-daily cephalexin in the treatment of canine superficial pyoderma.
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Affiliation(s)
- S Toma
- Ospedale Veterinario Cuneese, Via Cuneo 52/N, 12011 Borgo San Dalmazzo CN, Italy
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35
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Doldi N, Persico P, De Santis L, Rabellotti E, Papaleo E, Ferrari A. Serum progesterone at human chorionic gonadotropin injection significantly correlate with female age. Minerva Ginecol 2005; 57:477-82. [PMID: 16170294] [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: 05/04/2023]
Abstract
AIM In in vitro fertilization-embryo transfer (IVF-ET) higher age and low responses are associated with accelerated luteinization of mature follicles rather than diminished responsiveness. The aim of this study was to determine whether an elevated serum progesterone (P) on the day of human chorionic gonadotropin (hCG) administration during gonadotropin stimulation for IVF-ET is associated with age. METHODS E2 (17beta estradiol) and P concentrations on the day of hCG administration, number and quality of oocytes and embryos, and clinical pregnancies were retrospectively analyzed in 460 women undergoing IVF-ET. We evaluated patients according to age; the 25-30 age group (n=140), the 31-35 age group (n=100), the 36-40 (n=90), and the 41-45 age group (n=130). RESULTS In the 25-30 age group (n=140) P was 0.67+/-0.3 ng/mL, in the 31-35 age group (n=100) P was 0.87+/-0.2 ng/mL, in the 36-40 age group (n=90) P was 0.95+/-0.2 ng/mL, in the 41-45 age group (n=130) P was 1+/-0.2 ng/mL. The difference between the 25-30 age group and the 41-45 age group was statistically significant (P<0.05). CONCLUSIONS Periovulatory levels of serum P vary according to ovarian response to controlled ovarian hyperstimulation. Periovulatory P may reflect inadequate steroidogenesis. In women stimulated with recombinant follicle stimulating hormone for IVF, the serum P on the day of hCG administration increases with age.
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Affiliation(s)
- N Doldi
- Department of Obstetrics and Gynecology, Vita-Salute University, San Raffaele Hospital, Milan, Italy.
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36
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Cornegliani L, Toma S, Persico P, Noli C. FC-47 Comparison of four different types of stain in ear cytology. Vet Dermatol 2004. [DOI: 10.1111/j.1365-3164.2004.411_47.x] [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]
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37
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Persico P, Metafora S, Mancuso F, Calignano A, Venturelli A, Mariniello L, Porta R. Protective effect of SV-IV on platelet-activating factor-induced hypotension, bronchoconstriction and gastric mucosal injury. Eur J Pharmacol 1993; 241:71-4. [PMID: 8223928 DOI: 10.1016/0014-2999(93)90934-a] [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: 01/29/2023]
Abstract
The inhibitory effect of one of the major proteins secreted by the rat seminal vesicles (SV-IV) on platelet-activating factor (PAF)-induced biological activities was investigated in vivo. SV-IV was found to prevent dose dependently both hypotension and acute bronchospasm caused by PAF administration in guinea-pigs. In addition, SV-IV inhibited both PAF- and ethanol-induced gastric mucosal injury in a dose-dependent manner.
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Affiliation(s)
- P Persico
- Department of Experimental Pharmacology, University of Naples Federico II, Italy
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38
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Persico P, Calignano A, Mancuso F, Sorrentino L. Involvement of NK receptors and beta-adrenoceptors in nitric oxide-dependent relaxation of rabbit aorta rings following electrical-field stimulation. Eur J Pharmacol 1993; 238:105-9. [PMID: 7691617 DOI: 10.1016/0014-2999(93)90512-g] [Citation(s) in RCA: 7] [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: 01/26/2023]
Abstract
Electrical-field stimulation caused an endothelium-dependent relaxation in rabbit aorta rings precontracted by phenylephrine. The relaxation was reduced in a dose-dependent manner by morphine, benzalkonium, [D-Pro2,D-Trp7,9]substance P and an beta-adrenoceptor antagonist, propranolol. The vasodilatation was enhanced by superoxide dismutase and abolished by haemoglobin and NG-monomethyl-L-arginine. The inhibitory effect of NG-monomethyl-L-arginine was reversed by L-arginine, the precursor of nitric oxide biosynthesis, but not by its enantiomer, D-arginine. These data show that the electrically induced relaxation is independent on nitric oxide released by NK receptors and beta-receptors. Moreover, morphine, by reducing substance P release, decreased the magnitude of electrically induced relaxation, suggesting an indirect role of opioids in the regulation of the peripheral circulation through the control of nitric oxide release. Furthermore our observations confirm the hypothesis that subtypes of beta-adrenoceptors releasing nitric oxide participate in the regulation of vascular tone.
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Affiliation(s)
- P Persico
- Department of Experimental Pharmacology, University of Naples Federico II, Italy
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39
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Porta R, Metafora S, Esposito C, Mariniello L, Persico P, Mancuso F, Peluso G. Biological activities of a major protein secreted from the rat seminal vesicles after structural modification catalyzed by transglutaminase in vitro. Immunopharmacology 1993; 25:179-88. [PMID: 8099070 DOI: 10.1016/0162-3109(93)90019-m] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The immunosuppressive, anti-inflammatory and anti-thrombotic properties of SV-IV, a major protein secreted from the epithelium of rat seminal vesicles, were investigated after transglutaminase-catalyzed covalent incorporation of two molecules of spermidine (Spd) into the protein at the level of Gln-9 and Gln-86. The modified molecular form of the protein (Spd2-SV-IV) showed a more marked inhibitory activity on Con A-induced lymphocyte blastogenesis in comparison with the native protein, whereas no differences in the ability to inhibit the mixed lymphocyte reaction and to decrease the rat epididymal sperm immunogenicity were found between modified and native SV-IV. Spd2-SV-IV was also less effective than native SV-IV to inhibit platelet aggregation induced in vivo by different thrombogenic agents. In contrast, superimposable inhibitory tracings were observed in the in vitro platelet aggregation experiments performed with the two different molecular forms on the protein. Finally, Spd2-SV-IV was shown to retain unchanged the anti-inflammatory activity of native SV-IV.
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Affiliation(s)
- R Porta
- Department of Biochemistry and Biophysics, University of Naples, Italy
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40
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Abstract
Opioids increase the dopaminergic turnover in nucleus striatum and nucleus accumbens of mice, causing behavioural changes such as increased locomotion and food intake. We have now shown that L-arginine administration increases morphine-induced locomotion and changes in food intake in mice. D-Arginine had no effect, suggesting a stereospecific mechanism. Furthermore NG-nitro-L-arginine methyl ester, a specific inhibitor of nitric oxide synthase, reduced the morphine-induced effects. These results suggest that endogenous nitric oxide could play a role in the modulation of dopaminergic effects elicited by morphine.
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Affiliation(s)
- A Calignano
- Department of Experimental Pharmacology, University of Naples Federico II, Italy
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41
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Calignano A, Capasso A, Persico P, Mancuso F, Sorrentino L. Dexamethasone modifies morphine-, atropine-, verapamil-induced constipation in mice. Gen Pharmacol 1992; 23:753-6. [PMID: 1397982 DOI: 10.1016/0306-3623(92)90161-c] [Citation(s) in RCA: 5] [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] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
1. The effect of dexamethasone in gastrointestinal constipation induced by morphine, verapamil and atropine in mice has been studied. 2. These drugs caused a dose-related inhibition of charcoal meal transit, which was reversed by dexamethasone. 3. Dexamethasone resulted more active in reversing morphine and atropine constipation, than in modifying verapamil effect. 4. The authors concluded that the interaction of dexamethasone on its receptor could release a larger amount of acetylcholine resulting in a reversion of atropine- or morphine-induced constipation. 5. The minor effect of dexamethasone on verapamil-induced constipation suggest a reduced involvement of calcium influx. 6. The above results suggest a role for steroid in gastrointestinal transit and propose a possible mechanism through which dexamethasone could reverse morphine- and atropine-induced constipation.
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Affiliation(s)
- A Calignano
- Department of Experimental Pharmacology, University of Naples Federico II, Italy
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Abstract
1. Following intravenous administration of morphine.HCl a reduction in mean arterial blood pressure (MABP) was produced, quaternary morphine analogue was ineffective. 2. Theophylline and 8-phenyltheophylline administration reduced morphine-induced hypotension. 3. A2 adenosine receptor agonist caused an hypotension while A1 adenosine receptor agonist was ineffective. 4. L-NG-Mono-methylarginine administration reduced the hypotensive effect of exogenous A2 agonist while it was ineffective on morphine-induced hypotension. 5. Morphine-induced hypotension was increased by pretreatment with dipyridamole, whereas tetrabenazine abolished it. 6. The present study is consistent with previous reports on the central hypotensive action of morphine and propose a role for adenosine release in morphine-induced hypotension.
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Affiliation(s)
- A Calignano
- Department of Experimental Pharmacology, University of Naples Federico II, Italy
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Abstract
Gamma(glutamyl5)spermine derivative of substance P (Spm-SP) was synthesized in vitro in the presence of purified guinea pig liver transglutaminase and Ca2+. The spermine adduct of the neuropeptide was purified by HPLC on a reversed-phase column and characterized by fast atom bombardment mass spectrometry. The biological activities of Spm-SP were tested by assaying, in comparison with substance P, its ability to induce both the contractions of smooth muscle in vitro and the edema formation in vivo. Spm-SP was shown not to elicit contractile responses in the isolated rat stomach strip and duodenum and not to antagonize the spasmogenic effect evoked by the native neuropeptide. Furthermore, Spm-SP was unable, when administered into rats by plantar injection, either to provoke an acute inflammatory response in the hind limb or to antagonize the edema formation induced by a concurrent administration of substance P. These results indicate that the introduction of a large size hydrophilic moiety at the glutamine5 level negatively affects the ability of the neuropeptide to bind to its receptor(s), thus supporting the view that the hydrophobic middle portion of substance P plays a key role in receptor recognition.
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Affiliation(s)
- P Persico
- Department of Experimental Pharmacology, University of Naples, Italy
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Persico P, Capasso A, Calignano A, Sorrentino L. Effect of RU-38486 on dexamethasone reversal of morphine-induced constipation in mice. Gen Pharmacol 1991; 22:867-8. [PMID: 1761192 DOI: 10.1016/0306-3623(91)90221-q] [Citation(s) in RCA: 4] [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: 12/28/2022]
Abstract
1. Morphine and dexamethasone significantly reduce gastrointestinal transit in mice. The degree of reduction was greater for morphine. 2. Dexamethasone pretreatment was found, however, to antagonize morphine-induced constipation. 3. Cycloheximide does not modify the dexamethasone effects. 4. RU-38486 reverses both the inhibitory action of dexamethasone on gastrointestinal transit and its reducing effect on morphine-induced constipation. 5. These results suggest that dexamethasone might act through binding to receptors not linked to DNA-responsive elements.
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Affiliation(s)
- P Persico
- Department of Experimental Pharmacology, University of Naples Federico II, Italy
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Persico P, Capasso A, Calignano A, Sorrentino L. The action of dexamethasone on electrically-induced contractions of guinea-pig isolated ileum. Gen Pharmacol 1991; 22:319-22. [PMID: 2055427 DOI: 10.1016/0306-3623(91)90456-g] [Citation(s) in RCA: 7] [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] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
1. The effect of dexamethasone and its interaction with morphine has been studied on transmurally-stimulated guinea-pig ileum preparation. 2. Dexamethasone dose-dependently depressed the contractions of the ileum; this action has a rapid onset. 3. Naloxone did not reverse the inhibitory effect of dexamethasone. 4. When dexamethasone and morphine were given in combination the maximum reduction observed was equal to the sum of the single effect of two drugs given individually and naloxone antagonized only the inhibition induced by morphine. 5. Proteic synthesis inhibitors did not modify the inhibition induced by dexamethasone. 6. RU-38486, a glucocorticoid antagonist receptor, antagonized completely the inhibitory effect of DXM without affecting the inhibition induced by morphine showing that the effect of dexamethasone occurs by glucocorticoid receptor-mediated processes.
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Affiliation(s)
- P Persico
- Department of Experimental Pharmacology, University of Naples, Italy
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Persico P, Mancuso F, Metafora S, Peluso G, Ravagnan G, Esposito C, Porta R. In vivo and in vitro inhibition of platelet aggregation by SV-IV, a major protein secreted from the rat seminal vesicle epithelium. Biochem Pharmacol 1990; 40:1157-61. [PMID: 2390113 DOI: 10.1016/0006-2952(90)90509-j] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
In summary, the present study documents that platelet aggregation triggered by thrombin, ADP, collagen and PAF both in vivo and in vitro, was prevented by SV-IV in a dose-dependent manner. Only platelet aggregation by AA was not affected by the protein, thus suggesting a possible involvement of PLA2 inhibition in the molecular mechanism at the basis of SV-IV anti-thrombotic effect.
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Affiliation(s)
- P Persico
- Department of Experimental Pharmacology, University of Naples, Italy
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Calignano A, Persico P, Capasso A, Mancuso F, Sorrentino L. Adenosine release in the morphine-induced hypotention in urethane anesthetized rat. Pharmacol Res 1990. [DOI: 10.1016/s1043-6618(09)80123-0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Calignano A, Capasso A, Mancuso F, Persico P, Sorrentino L. Substance P pretreatment modifies morphine-induced hypotension in anesthetized rats. Pharmacol Res 1990; 22 Suppl 3:82. [PMID: 1711199 DOI: 10.1016/s1043-6618(09)80041-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- A Calignano
- Department of Experimental Pharmacology, University of Naples Federico II, Italy
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Metafora S, Peluso G, Persico P, Ravagnan G, Esposito C, Porta R. Immunosuppressive and anti-inflammatory properties of a major protein secreted from the epithelium of the rat seminal vesicles. Biochem Pharmacol 1989; 38:121-31. [PMID: 2521290 DOI: 10.1016/0006-2952(89)90158-5] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.2] [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: 01/01/2023]
Abstract
The nonspecies specific immunosuppressive and anti-inflammatory properties of a major protein (SV-IV) secreted from the epithelium of rat seminal vesicles (SV) are described. To detect the immunosuppressive effect, peripheral blood lymphocytes (PBL) were pretreated for 2 hr at 37 degrees with SV-IV, and the protein was maintained in the incubation medium during the whole culture time. We obtained evidence that, during preincubation of PBL and SV-IV the protein was transformed by a transglutaminase (TGase) released from PBL into modified low and high molecular weight forms able to bind to PBL surfaces. It is suggested that T lymphocytes are the possible targets of the immunosuppressive effect. SV-IV seems to inhibit only the early phase of the proliferative response of T lymphocytes to mitogens without having any direct effect on the enzymatic system involved in DNA synthesis. Moreover, the protein SV-IV was also shown to possess an anti-inflammatory property due to a block of the arachidonic acid cascade at the level of the enzyme phospholipase A2 (PLA2). The physiological significance of the immunosuppressive and anti-inflammatory properties of SV-IV are discussed in relation to different aspects of the mammalian reproduction.
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Affiliation(s)
- S Metafora
- CNR Institute of Protein Biochemistry and Enzymology, Arcofelice, Naples, Italy
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