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Silvestris N, Franchina T, Gallo M, Argentiero A, Avogaro A, Cirino G, Colao A, Danesi R, Di Cianni G, D'Oronzo S, Faggiano A, Fogli S, Giuffrida D, Gori S, Marrano N, Mazzilli R, Monami M, Montagnani M, Morviducci L, Natalicchio A, Ragni A, Renzelli V, Russo A, Sciacca L, Tuveri E, Zatelli MC, Giorgino F, Cinieri S. Diabetes management in cancer patients. An Italian Association of Medical Oncology, Italian Association of Medical Diabetologists, Italian Society of Diabetology, Italian Society of Endocrinology and Italian Society of Pharmacology multidisciplinary consensus position paper. ESMO Open 2023; 8:102062. [PMID: 38070434 PMCID: PMC10714217 DOI: 10.1016/j.esmoop.2023.102062] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 10/07/2023] [Accepted: 10/11/2023] [Indexed: 12/31/2023] Open
Abstract
Cancer management has significantly evolved in recent years, focusing on a multidisciplinary team approach to provide the best possible patient care and address the various comorbidities, toxicities, and complications that may arise during the patient's treatment journey. The co-occurrence of diabetes and cancer presents a significant challenge for health care professionals worldwide. Management of these conditions requires a holistic approach to improve patients' overall health, treatment outcomes, and quality of life, preventing diabetes complications and cancer treatment side-effects. In this article, a multidisciplinary panel of experts from different Italian scientific societies provide a critical overview of the co-management of cancer and diabetes, with an increasing focus on identifying a novel specialty field, 'diabeto-oncology', and suggest new co-management models of cancer patients with diabetes to improve their care. To better support cancer patients with diabetes and ensure high levels of coordinated care between oncologists and diabetologists, 'diabeto-oncology' could represent a new specialized field that combines specific expertise, skills, and training.
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Affiliation(s)
- N Silvestris
- Medical Oncology Unit, Department of Human Pathology "G. Barresi", University of Messina, Messina.
| | - T Franchina
- Medical Oncology Unit, Department of Human Pathology "G. Barresi", University of Messina, Messina
| | - M Gallo
- Endocrinology and Metabolic Diseases Unit, AO SS Antonio e Biagio e Cesare Arrigo of Alessandria, Alessandria
| | - A Argentiero
- Medical Oncology Unit, IRCCS Istituto Tumori "Giovanni Paolo II", Bari
| | - A Avogaro
- Department of Medicine, University of Padova, Padua
| | - G Cirino
- Department of Pharmacy, School of Medicine and Surgery, University of Naples Federico II, Naples
| | - A Colao
- Endocrinology, Diabetology and Andrology Unit, Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples; UNESCO Chair, Education for Health and Sustainable Development, Federico II University, Naples
| | - R Danesi
- Unit of Clinical Pharmacology and Pharmacogenetics, Department of Clinical and Experimental Medicine, University of Pisa, Pisa
| | | | - S D'Oronzo
- Interdisciplinary Department of Medicine, University of Bari Aldo Moro, Bari
| | - A Faggiano
- Endocrinology Unit, Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, ENETS Center of Excellence, Sapienza University of Rome, Rome
| | - S Fogli
- Unit of Clinical Pharmacology and Pharmacogenetics, Department of Clinical and Experimental Medicine, University of Pisa, Pisa
| | - D Giuffrida
- Department of Oncology, Istituto Oncologico del Mediterraneo, Viagrande, Catania
| | - S Gori
- Oncologia Medica, IRCCS Ospedale Don Calabria-Sacro Cuore di Negrar, Verona
| | - N Marrano
- Department of Precision and Regenerative Medicine and Ionian Area, Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, University of Bari Aldo Moro, Bari
| | - R Mazzilli
- Endocrinology Unit, Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, ENETS Center of Excellence, Sapienza University of Rome, Rome
| | - M Monami
- Diabetology, Careggi Hospital and University of Florence, Firenze
| | - M Montagnani
- Department of Precision and Regenerative Medicine and Ionian Area, Section of Pharmacology, Medical School, University of Bari Aldo Moro, Bari
| | - L Morviducci
- Diabetology and Nutrition Unit, Department of Medical Specialties, ASL Roma 1 - S, Spirito Hospital, Rome
| | - A Natalicchio
- Department of Precision and Regenerative Medicine and Ionian Area, Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, University of Bari Aldo Moro, Bari
| | - A Ragni
- Endocrinology and Metabolic Diseases Unit, AO SS Antonio e Biagio e Cesare Arrigo of Alessandria, Alessandria
| | - V Renzelli
- Diabetologist and Endocrinologist, Italian Association of Medical Diabetologists, Rome
| | - A Russo
- Department of Surgical, Oncological and Oral Sciences, Section of Medical Oncology, University of Palermo, Palermo
| | - L Sciacca
- Department of Clinical and Experimental Medicine, Endocrinology Section, University of Catania, Catania
| | - E Tuveri
- Diabetology, Endocrinology and Metabolic Diseases Service, ASL-Sulcis, Carbonia
| | - M C Zatelli
- Section of Endocrinology, Geriatrics, and Internal Medicine, Department of Medical Sciences, University of Ferrara, Ferrara
| | - F Giorgino
- Department of Precision and Regenerative Medicine and Ionian Area, Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, University of Bari Aldo Moro, Bari
| | - S Cinieri
- Medical Oncology Division and Breast Unit, Senatore Antonio Perrino Hospital, ASL Brindisi, Brindisi, Italy
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Natalicchio A, Montagnani M, Gallo M, Marrano N, Faggiano A, Zatelli MC, Mazzilli R, Argentiero A, Danesi R, D'Oronzo S, Fogli S, Giuffrida D, Gori S, Ragni A, Renzelli V, Russo A, Franchina T, Tuveri E, Sciacca L, Monami M, Cirino G, Di Cianni G, Colao A, Avogaro A, Cinieri S, Silvestris N, Giorgino F. MiRNA dysregulation underlying common pathways in type 2 diabetes and cancer development: an Italian Association of Medical Oncology (AIOM)/Italian Association of Medical Diabetologists (AMD)/Italian Society of Diabetology (SID)/Italian Society of Endocrinology (SIE)/Italian Society of Pharmacology (SIF) multidisciplinary critical view. ESMO Open 2023; 8:101573. [PMID: 37263082 PMCID: PMC10245125 DOI: 10.1016/j.esmoop.2023.101573] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 03/27/2023] [Accepted: 04/26/2023] [Indexed: 06/03/2023] Open
Abstract
Increasing evidence suggests that patients with diabetes, particularly type 2 diabetes (T2D), are characterized by an increased risk of developing different types of cancer, so cancer could be proposed as a new T2D-related complication. On the other hand, cancer may also increase the risk of developing new-onset diabetes, mainly caused by anticancer therapies. Hyperinsulinemia, hyperglycemia, and chronic inflammation typical of T2D could represent possible mechanisms involved in cancer development in diabetic patients. MicroRNAs (miRNAs) are a subset of non-coding RNAs, ⁓22 nucleotides in length, which control the post-transcriptional regulation of gene expression through both translational repression and messenger RNA degradation. Of note, miRNAs have multiple target genes and alteration of their expression has been reported in multiple diseases, including T2D and cancer. Accordingly, specific miRNA-regulated pathways are involved in the pathogenesis of both conditions. In this review, a panel of experts from the Italian Association of Medical Oncology (AIOM), Italian Association of Medical Diabetologists (AMD), Italian Society of Diabetology (SID), Italian Society of Endocrinology (SIE), and Italian Society of Pharmacology (SIF) provide a critical view of the evidence about the involvement of miRNAs in the pathophysiology of both T2D and cancer, trying to identify the shared miRNA signature and pathways able to explain the strong correlation between the two conditions, as well as to envision new common pharmacological approaches.
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Affiliation(s)
- A Natalicchio
- Department of Precision and Regenerative Medicine and Ionian Area, Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, University of Bari Aldo Moro, Bari, Italy
| | - M Montagnani
- Department of Precision and Regenerative Medicine and Ionian Area, Section of Pharmacology, Medical School, University of Bari Aldo Moro, Bari, Italy
| | - M Gallo
- Endocrinology and Metabolic Diseases Unit, AO SS Antonio e Biagio e Cesare Arrigo of Alessandria, Alessandria, Italy
| | - N Marrano
- Department of Precision and Regenerative Medicine and Ionian Area, Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, University of Bari Aldo Moro, Bari, Italy
| | - A Faggiano
- Endocrinology Unit, Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, ENETS Center of Excellence, Sapienza University of Rome, Rome, Italy
| | - M C Zatelli
- Section of Endocrinology, Geriatrics, and Internal Medicine, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - R Mazzilli
- Endocrinology Unit, Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, ENETS Center of Excellence, Sapienza University of Rome, Rome, Italy
| | - A Argentiero
- Medical Oncology Unit, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - R Danesi
- Unit of Clinical Pharmacology and Pharmacogenetics, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - S D'Oronzo
- Interdisciplinary Department of Medicine, University of Bari Aldo Moro, Bari, Italy
| | - S Fogli
- Unit of Clinical Pharmacology and Pharmacogenetics, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - D Giuffrida
- Department of Oncology, Istituto Oncologico del Mediterraneo, Viagrande, Catania, Italy
| | - S Gori
- Oncologia Medica, IRCCS Ospedale Don Calabria-Sacro Cuore di Negrar, Verona, Italy
| | - A Ragni
- Endocrinology and Metabolic Diseases Unit, AO SS Antonio e Biagio e Cesare Arrigo of Alessandria, Alessandria, Italy
| | - V Renzelli
- Diabetologist and Endocrinologist, Italian Association of Clinical Diabetologists, Rome, Italy
| | - A Russo
- Department of Surgical, Oncological and Oral Sciences, Section of Medical Oncology, University of Palermo, Palermo, Italy
| | - T Franchina
- Medical Oncology Unit, Department of Human Pathology "G. Barresi", University of Messina, Messina, Italy
| | - E Tuveri
- Diabetology, Endocrinology and Metabolic Diseases Service, ASL-Sulcis, Carbonia, Sardinia, Italy
| | - L Sciacca
- Department of Clinical and Experimental Medicine, Endocrinology Section, University of Catania, Catania, Italy
| | - M Monami
- Diabetology, Careggi Hospital and University of Florence, Firenze, Italy
| | - G Cirino
- Department of Pharmacy, School of Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - G Di Cianni
- Diabetes Unit, Livorno Hospital, Livorno, Italy
| | - A Colao
- Endocrinology, Diabetology and Andrology Unit, Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy; UNESCO Chair, Education for Health and Sustainable Development, Federico II University, Naples, Italy
| | - A Avogaro
- Department of Medicine, University of Padova, Padua, Italy
| | - S Cinieri
- Medical Oncology Division and Breast Unit, Senatore Antonio Perrino Hospital, ASL Brindisi, Brindisi, Italy
| | - N Silvestris
- Medical Oncology Unit, Department of Human Pathology "G. Barresi", University of Messina, Messina, Italy
| | - F Giorgino
- Department of Precision and Regenerative Medicine and Ionian Area, Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, University of Bari Aldo Moro, Bari, Italy.
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Bruno W, Dalmasso B, Barile M, Andreotti V, Elefanti L, Colombino M, Vanni I, Allavena E, Barbero F, Passoni E, Merelli B, Pellegrini S, Morgese F, Danesi R, Calò V, Bazan V, D'Elia AV, Molica C, Gensini F, Sala E, Uliana V, Soma PF, Genuardi M, Ballestrero A, Spagnolo F, Tanda E, Queirolo P, Mandalà M, Stanganelli I, Palmieri G, Menin C, Pastorino L, Ghiorzo P. Predictors of germline status for hereditary melanoma: 5 years of multi-gene panel testing within the Italian Melanoma Intergroup. ESMO Open 2022; 7:100525. [PMID: 35777164 PMCID: PMC9434136 DOI: 10.1016/j.esmoop.2022.100525] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 05/26/2022] [Accepted: 05/29/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND The incidence of cutaneous melanoma is increasing in Italy, in parallel with the implementation of gene panels. Therefore, a revision of national genetic assessment criteria for hereditary melanoma may be needed. The aim of this study was to identify predictors of susceptibility variants in the largest prospective cohort of Italian high-risk melanoma cases studied to date. MATERIALS AND METHODS From 25 Italian centers, we recruited 1044 family members and germline sequenced 940 cutaneous melanoma index cases through a shared gene panel, which included the following genes: CDKN2A, CDK4, BAP1, POT1, ACD, TERF2IP, MITF and ATM. We assessed detection rate according to familial status, region of origin, number of melanomas and presence and type of non-melanoma tumors. RESULTS The overall detection rate was 9.47% (5.53% analyzing CDKN2A alone), ranging from 5.14% in sporadic multiple melanoma cases (spoMPM) with two cutaneous melanomas to 13.9% in familial cases with at least three affected members. Three or more cutaneous melanomas in spoMPM cases, pancreatic cancer and region of origin predicted germline status [odds ratio (OR) = 3.23, 3.15, 2.43, P < 0.05]. Conversely, age > 60 years was a negative independent predictor (OR = 0.13, P = 0.008), and was the age category with the lowest detection rate, especially for CDKN2A. Detection rate was 19% when cutaneous melanoma and pancreatic cancer clustered together. CONCLUSIONS Gene panel doubled the detection rate given by CDKN2A alone. National genetic testing criteria may need a revision, especially regarding age cut-off (60) in the absence of strong family history, pancreatic cancer and/or a high number of cutaneous melanomas.
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Affiliation(s)
- W Bruno
- IRCCS Ospedale Policlinico San Martino, Genetics of Rare Cancers, Genoa, Italy; University of Genoa, Department of Internal Medicine and Medical Specialties (DiMI), Genoa, Italy.
| | - B Dalmasso
- IRCCS Ospedale Policlinico San Martino, Genetics of Rare Cancers, Genoa, Italy
| | - M Barile
- IRCCS Ospedale Policlinico San Martino, Genetics of Rare Cancers, Genoa, Italy
| | - V Andreotti
- IRCCS Ospedale Policlinico San Martino, Genetics of Rare Cancers, Genoa, Italy
| | - L Elefanti
- Immunology and Diagnostic Molecular Oncology Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - M Colombino
- Unit of Cancer Genetics, Institute of Genetics and Biomedical Research of the National Research Council (IRGB-CNR), Sassari, Italy
| | - I Vanni
- IRCCS Ospedale Policlinico San Martino, Genetics of Rare Cancers, Genoa, Italy; University of Genoa, Department of Internal Medicine and Medical Specialties (DiMI), Genoa, Italy
| | - E Allavena
- University of Genoa, Department of Internal Medicine and Medical Specialties (DiMI), Genoa, Italy
| | - F Barbero
- IRCCS Ospedale Policlinico San Martino, Genetics of Rare Cancers, Genoa, Italy
| | - E Passoni
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - B Merelli
- Oncology Unit, ASST Papa Giovanni XXIIII, Bergamo, Italy
| | - S Pellegrini
- Immunology and Diagnostic Molecular Oncology Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy; Department of Surgery, Oncology and Gastroenterology (DISCOG), University of Padua, Padua, Italy
| | - F Morgese
- Oncology Unit, AOU Ospedali Riuniti di Ancona, Ancona, Italy
| | - R Danesi
- Romagna Cancer Registry, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) 'Dino Amadori', Meldola, Italy
| | - V Calò
- Department of Surgical, Oncological and Oral Sciences, Section of Medical Oncology, University of Palermo, Palermo, Italy
| | - V Bazan
- Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, Palermo, Italy
| | - A V D'Elia
- Institute of Medical Genetics, ASUFC University Hospital of Udine, Udine, Italy
| | - C Molica
- Medical Oncology Unit, S. Maria della Misericordia Hospital, Perugia, Italy
| | - F Gensini
- Department of Experimental and Clinical Biomedical Sciences 'Mario Serio', University of Florence, Florence, Italy
| | - E Sala
- Cytogenetics and Medical Genetics Unit, H San Gerardo ASST Monza, Monza, Italy
| | - V Uliana
- Medical Genetics Unit, AOU di Parma, Parma, Italy
| | - P F Soma
- Casa di Cura Gibiino, Catania, Italy
| | - M Genuardi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Medical Genetics Unit, Rome, Italy; Università Cattolica del Sacro Cuore, Department of Life Sciences and Public Health, Rome, Italy
| | - A Ballestrero
- IRCCS Ospedale Policlinico San Martino, Genetics of Rare Cancers, Genoa, Italy; University of Genoa, Department of Internal Medicine and Medical Specialties (DiMI), Genoa, Italy
| | - F Spagnolo
- IRCCS Ospedale Policlinico San Martino, Medical Oncology 2, Genoa, Italy
| | - E Tanda
- IRCCS Ospedale Policlinico San Martino, Medical Oncology 2, Genoa, Italy
| | - P Queirolo
- Division of Medical Oncology for Melanoma, Sarcoma, and Rare Tumors, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - M Mandalà
- Medical Oncology Unit, S. Maria della Misericordia Hospital, Perugia, Italy; Department of Surgery and Medicine, University of Perugia, Perugia, Italy
| | - I Stanganelli
- Skin Cancer Unit, IRCCS IRST Istituto Scientifico Romagnolo per lo Studio dei Tumori 'Dino Amadori' (IRST) IRCCS, Meldola, Italy; Dermatologic Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - G Palmieri
- Unit of Cancer Genetics, Institute of Genetics and Biomedical Research of the National Research Council (IRGB-CNR), Sassari, Italy
| | - C Menin
- Immunology and Diagnostic Molecular Oncology Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - L Pastorino
- IRCCS Ospedale Policlinico San Martino, Genetics of Rare Cancers, Genoa, Italy; University of Genoa, Department of Internal Medicine and Medical Specialties (DiMI), Genoa, Italy
| | - P Ghiorzo
- IRCCS Ospedale Policlinico San Martino, Genetics of Rare Cancers, Genoa, Italy; University of Genoa, Department of Internal Medicine and Medical Specialties (DiMI), Genoa, Italy
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Conte P, Ascierto PA, Patelli G, Danesi R, Vanzulli A, Sandomenico F, Tarsia P, Cattelan A, Comes A, De Laurentiis M, Falcone A, Regge D, Richeldi L, Siena S. Drug-induced interstitial lung disease during cancer therapies: expert opinion on diagnosis and treatment. ESMO Open 2022; 7:100404. [PMID: 35219244 PMCID: PMC8881716 DOI: 10.1016/j.esmoop.2022.100404] [Citation(s) in RCA: 55] [Impact Index Per Article: 27.5] [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: 10/21/2021] [Revised: 01/16/2022] [Accepted: 01/18/2022] [Indexed: 01/05/2023] Open
Abstract
Background Drug-induced interstitial lung disease (DIILD) is a form of interstitial lung disease resulting from exposure to drugs causing inflammation and possibly interstitial fibrosis. Antineoplastic drugs are the primary cause of DIILD, accounting for 23%-51% of cases, with bleomycin, everolimus, erlotinib, trastuzumab-deruxtecan and immune checkpoint inhibitors being the most common causative agents. DIILD can be difficult to identify and manage, and there are currently no specific guidelines on the diagnosis and treatment of DIILD caused by anticancer drugs. Objective To develop recommendations for the diagnosis and management of DIILD in cancer patients. Methods Based on the published literature and their clinical expertise, a multidisciplinary group of experts in Italy developed recommendations stratified by DIILD severity, based on the Common Terminology Criteria for Adverse Events. Results The recommendations highlight the importance of multidisciplinary interaction in the diagnosis and management of DIILD. Important components of the diagnostic process are physical examination and careful patient history-taking, measurement of vital signs (particularly respiratory rate and arterial oxygen saturation), relevant laboratory tests, respiratory function testing with spirometry and diffusing capacity of the lung for carbon monoxide and computed tomography/imaging. Because the clinical and radiological signs of DIILD are often similar to those of pneumonias or interstitial lung diseases, differential diagnosis is important, including microbial and serological testing to exclude or confirm infectious causes. In most cases, management of DIILD requires the discontinuation of the antineoplastic agent and the administration of short-term steroids. Steroid tapering must be undertaken slowly to prevent reactivation of DIILD. Patients with severe and very severe (grade 3 and 4) DIILD will require hospitalisation and often need oxygen and non-invasive ventilation. Decisions about invasive ventilation should take into account the patient’s cancer prognosis. Conclusions These recommendations provide a structured step-by-step diagnostic and therapeutic approach for each grade of suspected cancer-related DIILD. There is a lack of guidance for the management of DIILD in cancer patients. A multidisciplinary team in Italy developed step-by-step diagnostic and therapeutic guidelines for DIILD in cancer patients. Differential diagnosis of DIILD is critical to exclude other forms of interstitial lung disease or infectious causes. Usually the antineoplastic agent is discontinued, steroids started and further management dictated by DIILD severity.
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Affiliation(s)
- P Conte
- DiSCOG, University of Padova and Medical Oncology 2, IOV-Istituto Oncologico Veneto IRCCS, Padua, Italy
| | - P A Ascierto
- Department of Melanoma, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Naples, Italy
| | - G Patelli
- Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milan, Italy; Department of Hematology, Oncology and Molecular Medicine, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - R Danesi
- Unit of Clinical Pharmacology and Pharmacogenetics, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - A Vanzulli
- Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milan, Italy; Radiology Department, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - F Sandomenico
- Radiology Unit, Buon Consiglio Fatebenefratelli Hospital, Naples, Italy
| | - P Tarsia
- Pneumology Unit, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - A Cattelan
- Tropical and Infectious Diseases Unit, Padua University Hospital, Padua, Italy
| | - A Comes
- Unità Operativa Complessa di Pneumologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - M De Laurentiis
- Department of Breast and Thoracic Oncology, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Naples, Italy
| | - A Falcone
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - D Regge
- Department of Radiology, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Turin, Italy; Department of Surgical Sciences, University of Turin, Turin, Italy
| | - L Richeldi
- Unità Operativa Complessa di Pneumologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - S Siena
- Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milan, Italy; Department of Hematology, Oncology and Molecular Medicine, Grande Ospedale Metropolitano Niguarda, Milan, Italy.
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Del Re M, Omarini C, Diodati L, Palleschi M, Meattini I, Crucitta S, Lorenzini G, Isca C, Fontana A, Livi L, Piacentini F, Fogli S, De Giorgi U, Danesi R. Reply to comments on: Drug-drug interactions between palbociclib and proton pump inhibitors may significantly affect clinical outcome of metastatic breast cancer patients. ESMO Open 2022; 7:100381. [PMID: 35131649 PMCID: PMC8897157 DOI: 10.1016/j.esmoop.2022.100381] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 01/06/2022] [Indexed: 11/30/2022] Open
Affiliation(s)
- M Del Re
- Unit of Clinical Pharmacology and Pharmacogenetics, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
| | - C Omarini
- Division of Medical Oncology, University Hospital of Modena, Modena, Italy
| | - L Diodati
- Unit of Medical Oncology, Department of Translational Research and New Technologies in Medicine, University of Pisa, Pisa, Italy
| | - M Palleschi
- Unit of Medical Oncology, IRCCS-Istituto Romagnolo per lo Studio dei Tumori (IRST) 'Dino Amadori', Meldola, Italy
| | - I Meattini
- Department of Experimental and Clinical Biomedical Sciences 'M. Serio', University of Florence, Florence, Italy; Radiation Oncology Unit - Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - S Crucitta
- Unit of Clinical Pharmacology and Pharmacogenetics, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - G Lorenzini
- Unit of Medical Oncology, Department of Translational Research and New Technologies in Medicine, University of Pisa, Pisa, Italy
| | - C Isca
- Division of Medical Oncology, University Hospital of Modena, Modena, Italy
| | - A Fontana
- Unit of Medical Oncology, Department of Translational Research and New Technologies in Medicine, University of Pisa, Pisa, Italy
| | - L Livi
- Department of Experimental and Clinical Biomedical Sciences 'M. Serio', University of Florence, Florence, Italy; Radiation Oncology Unit - Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - F Piacentini
- Division of Medical Oncology, University Hospital of Modena, Modena, Italy
| | - S Fogli
- Unit of Clinical Pharmacology and Pharmacogenetics, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - U De Giorgi
- Unit of Medical Oncology, IRCCS-Istituto Romagnolo per lo Studio dei Tumori (IRST) 'Dino Amadori', Meldola, Italy
| | - R Danesi
- Unit of Clinical Pharmacology and Pharmacogenetics, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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Del Re M, Brighi N, Rizzo M, Paolieri F, Rebuzzi S, Beninato T, Crucitta S, Mercinelli C, Gri N, Puglisi S, Verzoni E, Bleve S, Cucchiara F, Procopio G, Fornarini G, Galli L, Porta C, De Giorgi U, Danesi R. 695P Drug-drug interactions between pazopanib and proton pump inhibitors may significantly affect clinical outcome of patients affected by metastatic renal cell carcinoma. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Del Re M, Omarini C, Diodati L, Palleschi M, Meattini I, Crucitta S, Isca C, Fogli S, Bleve S, Lorenzini G, Fontana A, Livi L, Piacentini F, De Giorgi U, Danesi R. 239P Drug-drug interactions between palbociclib and proton pump inhibitors may significantly affect clinical outcome of metastatic breast cancer patients. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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8
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Russo A, Incorvaia L, Del Re M, Malapelle U, Capoluongo E, Gristina V, Castiglia M, Danesi R, Fassan M, Giuffrè G, Gori S, Marchetti A, Normanno N, Pinto C, Rossi G, Santini D, Sartore-Bianchi A, Silvestris N, Tagliaferri P, Troncone G, Cinieri S, Beretta GD. The molecular profiling of solid tumors by liquid biopsy: a position paper of the AIOM-SIAPEC-IAP-SIBioC-SIC-SIF Italian Scientific Societies. ESMO Open 2021; 6:100164. [PMID: 34091263 PMCID: PMC8182269 DOI: 10.1016/j.esmoop.2021.100164] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [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] [Received: 03/29/2021] [Revised: 05/02/2021] [Accepted: 05/05/2021] [Indexed: 02/08/2023] Open
Abstract
The term liquid biopsy (LB) refers to the use of various biological fluids as a surrogate for neoplastic tissue to achieve information for diagnostic, prognostic and predictive purposes. In the current clinical practice, LB is used for the identification of driver mutations in circulating tumor DNA derived from both tumor tissue and circulating neoplastic cells. As suggested by a growing body of evidence, however, there are several clinical settings where biological samples other than tissue could be used in the routine practice to identify potentially predictive biomarkers of either response or resistance to targeted treatments. New applications are emerging as useful clinical tools, and other blood derivatives, such as circulating tumor cells, circulating tumor RNA, microRNAs, platelets, extracellular vesicles, as well as other biofluids such as urine and cerebrospinal fluid, may be adopted in the near future. Despite the evident advantages compared with tissue biopsy, LB still presents some limitations due to both biological and technological issues. In this context, the absence of harmonized procedures corresponds to an unmet clinical need, ultimately affecting the rapid implementation of LB in clinical practice. In this position paper, based on experts’ opinions, the AIOM–SIAPEC-IAP–SIBIOC–SIF Italian Scientific Societies critically discuss the most relevant technical issues of LB, the current and emerging evidences, with the aim to optimizing the applications of LB in the clinical setting. In the current clinical practice LB is used for the identification of driver mutations in circulating tumor DNA (ctDNA). New applications in tumors other than non-small-cell lung cancer (NSCLC) are emerging as useful clinical tools. Other blood derivatives, together with other biofluids, are an active field of research and may be adopted in the near future. Despite the evident advantages, liquid biopsy still presents limitations due to both biological and technological issues. Standardization of the procedures needs to be addressed to ensure widespread implementation in clinical practice.
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Affiliation(s)
- A Russo
- Department of Surgical, Oncological and Oral Sciences, Section of Medical Oncology, University of Palermo, Palermo, Italy.
| | - L Incorvaia
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (Bi.N.D.), Section of Medical Oncology, University of Palermo, Palermo, Italy
| | - M Del Re
- Unit of Clinical Pharmacology and Pharmacogenetics, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa, Italy
| | - U Malapelle
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - E Capoluongo
- Department of Molecular Medicine and Medical Biotechnology, University of Naples Federico II, Naples, Italy; CEINGE, Biotecnologie Avanzate, Naples, Italy
| | - V Gristina
- Department of Surgical, Oncological and Oral Sciences, Section of Medical Oncology, University of Palermo, Palermo, Italy
| | - M Castiglia
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (Bi.N.D.), Section of Medical Oncology, University of Palermo, Palermo, Italy
| | - R Danesi
- Unit of Clinical Pharmacology and Pharmacogenetics, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa, Italy
| | - M Fassan
- Department of Medicine (DIMED), Surgical Pathology Unit, University of Padua, Padua, Italy; Veneto Institute of Oncology (IOV-IRCCS), Padua, Italy
| | - G Giuffrè
- Department of Human Pathology in Adult and Developmental Age 'Gaetano Barresi', Section of Pathology, University of Messina, Messina, Italy
| | - S Gori
- Department of Oncology, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar di Valpolicella, Italy
| | - A Marchetti
- Center of Predictive Molecular Medicine, University-Foundation, CeSI Biotech Chieti, Chieti, Italy
| | - N Normanno
- Cell Biology and Biotherapy Unit, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Naples, Italy
| | - C Pinto
- Medical Oncology Unit, Clinical Cancer Centre, IRCCS-AUSL di Reggio Emilia, Reggio Emilia, Italy
| | - G Rossi
- Pathology Unit, Ospedale Santa Maria Delle Croci, Ravenna, Italy
| | - D Santini
- Department of Medical Oncology, University Campus Biomedico, Rome, Italy
| | - A Sartore-Bianchi
- Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milan, Italy
| | - N Silvestris
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Tumori 'Giovanni Paolo II' of Bari, Bari, Italy; Department of Biomedical Sciences and Human Oncology, Aldo Moro University of Bari, Bari, Italy
| | - P Tagliaferri
- Medical and Translational Oncology Unit, Department of Experimental and Clinical Medicine, Magna Graecia University, Catanzaro, Italy
| | - G Troncone
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - S Cinieri
- Medical Oncology Division and Breast Unit, Senatore Antonio Perrino Hospital, ASL Brindisi, Brindisi, Italy
| | - G D Beretta
- Department of Oncology, Humanitas Gavazzeni, Bergamo, Italy
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9
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Del Re M, Conteduca V, Crucitta S, Gurioli G, Casadei C, Restante G, Schepisi G, Lolli C, Cucchiara F, Danesi R, De Giorgi U. Androgen receptor gain in circulating free DNA and splicing variant 7 in exosomes predict clinical outcome in CRPC patients treated with abiraterone and enzalutamide. Prostate Cancer Prostatic Dis 2021; 24:524-531. [PMID: 33500577 PMCID: PMC8134038 DOI: 10.1038/s41391-020-00309-w] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [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] [Received: 08/18/2020] [Revised: 11/06/2020] [Accepted: 12/04/2020] [Indexed: 12/04/2022]
Abstract
BACKGROUND Androgen receptor (AR) signaling inhibitors represent the standard treatment in metastatic castration resistance prostate cancer (mCRPC) patients. However, some patients display a primary resistance, and several studies investigated the role of the AR as a predictive biomarker of response to treatment. This study is aimed to evaluate the role of AR in liquid biopsy to predict clinical outcome to AR signaling inhibitors in mCRPC patients. METHODS Six milliliters of plasma samples were collected before first-line treatment with abiraterone or enzalutamide. Circulating free DNA (cfDNA) and exosome-RNA were isolated for analysis of AR gain and AR splice variant 7 (AR-V7), respectively, by digital droplet PCR. RESULTS Eighty-four mCRPC patients received abiraterone (n = 40) or enzalutamide (n = 44) as first-line therapy. Twelve patients (14.3%) presented AR gain and 30 (35.7%) AR-V7+ at baseline. Median progression-free survival (PFS) and overall survival (OS) were significantly longer in AR-V7- vs AR-V7+ patients (24.3 vs 5.4 months, p < 0.0001; not reached vs 16.2 months, p = 0.0001, respectively). Patients carrying the AR gain had a median PFS of 4.8 vs 24.3 months for AR normal patients (p < 0.0001). Median OS was significantly longer in AR normal vs patients with AR gain (not reached vs 8.17 months, p < 0.0001). A significant correlation between AR-V7 and AR gain was observed (r = 0.28; p = 0.01). The AR gain/AR-V7 combined analysis confirmed a strong predictive effect for biomarkers combination vs patients without any AR aberration (PFS 3.8 vs 28 month, respectively; OS 6.1 vs not reached, respectively; p < 0.0001). CONCLUSIONS The present study demonstrates that cfDNA and exosome-RNA are both a reliable source of AR variants and their combined detection in liquid biopsy predicts resistance to AR signaling inhibitors.
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MESH Headings
- Aged
- Aged, 80 and over
- Alternative Splicing
- Androstenes/therapeutic use
- Benzamides/therapeutic use
- Biomarkers, Tumor/blood
- Biomarkers, Tumor/genetics
- Cell-Free Nucleic Acids/genetics
- Drug Resistance, Neoplasm
- Exosomes/genetics
- Follow-Up Studies
- Humans
- Male
- Middle Aged
- Nitriles/therapeutic use
- Phenylthiohydantoin/therapeutic use
- Prognosis
- Prostatic Neoplasms, Castration-Resistant/blood
- Prostatic Neoplasms, Castration-Resistant/drug therapy
- Prostatic Neoplasms, Castration-Resistant/genetics
- Prostatic Neoplasms, Castration-Resistant/pathology
- Receptors, Androgen/blood
- Receptors, Androgen/genetics
- Retrospective Studies
- Survival Rate
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Affiliation(s)
- M Del Re
- Unit of Clinical Pharmacology and Pharmacogenetics, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa, Italy
| | - V Conteduca
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - S Crucitta
- Unit of Clinical Pharmacology and Pharmacogenetics, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa, Italy
| | - G Gurioli
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - C Casadei
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - G Restante
- Unit of Clinical Pharmacology and Pharmacogenetics, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa, Italy
| | - G Schepisi
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - C Lolli
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - F Cucchiara
- Unit of Clinical Pharmacology and Pharmacogenetics, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa, Italy
| | - R Danesi
- Unit of Clinical Pharmacology and Pharmacogenetics, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa, Italy.
| | - U De Giorgi
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
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10
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Danesi R, Lo YMD, Oellerich M, Beck J, Galbiati S, Re MD, Lianidou E, Neumaier M, van Schaik RHN. What do we need to obtain high quality circulating tumor DNA (ctDNA) for routine diagnostic test in oncology? - Considerations on pre-analytical aspects by the IFCC workgroup cfDNA. Clin Chim Acta 2021; 520:168-171. [PMID: 34081934 DOI: 10.1016/j.cca.2021.05.033] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [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: 10/21/2020] [Revised: 05/28/2021] [Accepted: 05/28/2021] [Indexed: 12/17/2022]
Abstract
The analysis of circulating cell free DNA is an important tool for the analysis of tumor resistance, tumor heterogeneity, detection of minimal residual disease and detection of allograft rejection in kidney or heart transplant patients. The proper use of this technique is important, and starts with considering pre-analytic aspects. The current paper addresses some important technical considerations to ensure the proper and harmonized use of cfDNA techniques.
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Affiliation(s)
- R Danesi
- Clinical Pharmacology and Pharmacogenetics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Y M D Lo
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China
| | - M Oellerich
- Dept. Clinical Pharmacology, George-August University, University Medical Center Goettingen, Goettingen, Germany
| | - J Beck
- Chronix BioMedical GmbH, Goettingen, Germany
| | - S Galbiati
- Unit of Genomic for the Diagnosis of Human Pathologies, Division of Genetics and Cell Biology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - M Del Re
- Clinical Pharmacology and Pharmacogenetics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - E Lianidou
- Dept. Chemistry, University of Athens, Athens, Greece
| | - M Neumaier
- Institute for Clinical Chemistry, Mannheim, Germany
| | - R H N van Schaik
- Dept. Clinical Chemistry, Erasmus University Medical Center, Rotterdam, The Netherlands.
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11
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Gallo M, Adinolfi V, Morviducci L, Acquati S, Tuveri E, Ferrari P, Zatelli MC, Faggiano A, Argentiero A, Natalicchio A, D'Oronzo S, Danesi R, Gori S, Russo A, Montagnani M, Beretta GD, Di Bartolo P, Silvestris N, Giorgino F. Early prediction of pancreatic cancer from new-onset diabetes: an Associazione Italiana Oncologia Medica (AIOM)/Associazione Medici Diabetologi (AMD)/Società Italiana Endocrinologia (SIE)/Società Italiana Farmacologia (SIF) multidisciplinary consensus position paper. ESMO Open 2021; 6:100155. [PMID: 34020401 PMCID: PMC8144346 DOI: 10.1016/j.esmoop.2021.100155] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 04/19/2021] [Indexed: 02/07/2023] Open
Abstract
Pancreatic cancer (PC) is a common cause of cancer-related death, due to difficulties in detecting early-stage disease, to its aggressive behaviour, and to poor response to systemic therapy. Therefore, developing strategies for early diagnosis of resectable PC is critical for improving survival. Diabetes mellitus is another major public health problem worldwide. Furthermore, diabetes can represent both a risk factor and a consequence of PC: nowadays, the relationship between these two diseases is considered a high priority for research. New-onset diabetes can be an early manifestation of PC, especially in a thin adult without a family history of diabetes. However, even if targeted screening for patients at higher risk of PC could be a promising approach, this is not recommended in asymptomatic adults with new-onset diabetes, due to the much higher incidence of hyperglycaemia than PC and to the lack of a safe and affordable PC screening test. Prompted by a well-established and productive multidisciplinary cooperation, the Italian Association of Medical Oncology (AIOM), the Italian Medical Diabetologists Association (AMD), the Italian Society of Endocrinology (SIE), and the Italian Society of Pharmacology (SIF) here review available evidence on the mechanisms linking diabetes and PC, addressing the feasibility of screening for early PC in patients with diabetes, and sharing a set of update statements with the aim of providing a state-of-the-art overview and a decision aid tool for daily clinical practice. The incidence of PC is increasing and its prognosis is very poor; therefore, early detection is fundamental. New-onset diabetes may be an early manifestation of PC, often disappearing after its resection. Screening for PC is not currently recommended among people with new-onset diabetes, due to its high incidence. Thin subjects >50 years old at the time of diabetes onset, with sudden weight loss and severe hyperglycaemia are at higher risk. Currently some clinical models are promising for stratifying cancer risk in people with new-onset diabetes.
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Affiliation(s)
- M Gallo
- Endocrinology and Metabolic Diseases Unit of AO SS Antonio e Biagio e Cesare Arrigo of Alessandria, Alessandria, Italy.
| | - V Adinolfi
- Endocrinology and Diabetology Unit, ASL Verbano Cusio Ossola, Domodossola, Italy
| | - L Morviducci
- Diabetology and Nutrition Unit, Department of Medical Specialities, ASL Roma 1 - S. Spirito Hospital, Rome, Italy
| | - S Acquati
- Endocrinology Unit, Ospedale Pierantoni-Morgagni, Forlì, Italy
| | - E Tuveri
- Diabetology, Endocrinology and Metabolic Diseases Service, ATS Sardegna - ASSL Carbonia-Iglesias, Italy
| | - P Ferrari
- Palliative Care Unit, Istituti Clinici Scientifici Maugeri SPA SB, IRCCS, Pavia, Italy
| | - M C Zatelli
- Section of Endocrinology & Internal Medicine, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - A Faggiano
- Endocrinology Unit, Department of Clinical & Molecular Medicine, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - A Argentiero
- Medical Oncology Unit, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - A Natalicchio
- Department of Emergency and Organ Transplantation, Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, University of Bari Aldo Moro, Bari, Italy
| | - S D'Oronzo
- Department of Biomedical Sciences and Human Oncology, University of Bari Aldo Moro, Bari, Italy
| | - R Danesi
- Unit of Clinical Pharmacology and Pharmacogenetics, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - S Gori
- Oncologia Medica, IRCCS Ospedale Don Calabria-Sacro Cuore di Negrar, Verona, Italy
| | - A Russo
- Department of Surgical, Oncological and Oral Sciences, Section of Medical Oncology, University of Palermo, Palermo, Italy
| | - M Montagnani
- Department of Biomedical Sciences and Human Oncology, University of Bari Aldo Moro, Bari, Italy
| | - G D Beretta
- Medical Oncology Department, Humanitas Gavazzeni, Bergamo, Italy
| | - P Di Bartolo
- Ravenna Diabetes Center, Romagna Diabetes Managed Clinical Network - Romagna Local Health Authority, Ravenna, Italy
| | - N Silvestris
- Medical Oncology Unit, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy; Department of Biomedical Sciences and Human Oncology, University of Bari Aldo Moro, Bari, Italy
| | - F Giorgino
- Department of Emergency and Organ Transplantation, Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, University of Bari Aldo Moro, Bari, Italy
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12
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Silvestris N, Argentiero A, Natalicchio A, D'Oronzo S, Beretta GD, Acquati S, Adinolfi V, Di Bartolo P, Danesi R, Faggiano A, Ferrari P, Gallo M, Gori S, Morviducci L, Russo A, Tuveri E, Zatelli MC, Montagnani M, Giorgino F. Antineoplastic dosing in overweight and obese cancer patients: an Associazione Italiana Oncologia Medica (AIOM)/Associazione Medici Diabetologi (AMD)/Società Italiana Endocrinologia (SIE)/Società Italiana Farmacologia (SIF) multidisciplinary consensus position paper. ESMO Open 2021; 6:100153. [PMID: 33984679 PMCID: PMC8134762 DOI: 10.1016/j.esmoop.2021.100153] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 03/23/2021] [Accepted: 04/14/2021] [Indexed: 01/22/2023] Open
Abstract
Most anticancer molecules are administered in body-size-based dosing schedules, bringing up unsolved issues regarding pharmacokinetic data in heavy patients. The worldwide spread of obesity has not been matched by improved methods and strategies for tailored drug dosage in this population. The weight or body surface area (BSA)-based approaches may fail to fully reflect the complexity of the anthropometric features besides obesity in cancer patients suffering from sarcopenia. Likewise, there is a lack of pharmacokinetic data on obese patients for the majority of chemotherapeutic agents as well as for new target drugs and immunotherapy. Therefore, although the available findings point to the role of dose intensity in cancer treatment, and support full weight-based dosing, empirical dose capping often occurs in clinical practice in order to avoid toxicity. Thus a panel of experts of the Associazione Italiana Oncologia Medica (AIOM), Associazione Medici Diabetologi (AMD), Società Italiana Endocrinologia (SIE), and Società Italiana Farmacologia (SIF), provides here a consensus statement for appropriate cytotoxic chemotherapy and new biological cancer drug dosing in obese patients. The worldwide spread of obesity is an emerging challenge also in cancer patients Weight or BSA-based approaches do not adequately address the critical issue of optimal dosing for cancer drugs under obesity Empirical dose capping is often employed in clinical practice to avoid toxicities among overweight and obese patients There is a lack of clinical and pharmacokinetic studies in this population Clinical practice recommendations should guide suitable dosing of cytotoxic and biological cancer drugs in obese patients
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Affiliation(s)
- N Silvestris
- Medical Oncology Unit, IRCCS Istituto Tumori 'Giovanni Paolo II', Bari, Italy; Department of Biomedical Sciences and Human Oncology, Division of Medical Oncology, University of Bari Aldo Moro, Bari, Italy.
| | - A Argentiero
- Medical Oncology Unit, IRCCS Istituto Tumori 'Giovanni Paolo II', Bari, Italy
| | - A Natalicchio
- Department of Emergency and Organ Transplantation, Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, University of Bari Aldo Moro, Bari, Italy
| | - S D'Oronzo
- Department of Biomedical Sciences and Human Oncology, Division of Medical Oncology, University of Bari Aldo Moro, Bari, Italy; Faculty of Medicine, Dentistry and Health, University of Sheffield, Sheffield, UK
| | - G D Beretta
- Medical Oncology Department, Humanitas Gavazzeni, Bergamo, Italy
| | - S Acquati
- Endocrinology Unit, Ospedale Pierantoni-Morgagni, Forlì, Italy
| | - V Adinolfi
- Endocrinology and Diabetology Unit, ASL Verbano Cusio Ossola, Domodossola, Italy
| | - P Di Bartolo
- Diabetology Clinic, Rete Clinica di Diabetologia Aziendale - Dipartimento, Internistico di Ravenna - AUSL Romagna, Ravenna, Italy
| | - R Danesi
- Unit of Clinical Pharmacology and Pharmacogenetics, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - A Faggiano
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - P Ferrari
- Palliative Care Unit, Istituti Clinici Scientifici Maugeri SPA SB, IRCCS (PV), Pavia PV, Italy
| | - M Gallo
- Endocrinology and Metabolic Diseases Unit of AO SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - S Gori
- Oncologia Medica, IRCCS Ospedale Don Calabria-Sacro Cuore di Negrar, Verona, Italy
| | - L Morviducci
- Diabetology and Nutrition Unit, Department of Medical Specialities, ASL Roma 1 - S. Spirito Hospital, Rome, Italy
| | - A Russo
- Department of Surgical, Oncological and Oral Sciences, Section of Medical Oncology, University of Palermo, Palermo, Italy
| | - E Tuveri
- Diabetology, Endocrinology and Metabolic Diseases Service, ATS Sardegna - ASSL Carbonia-Iglesias, Italy
| | - M C Zatelli
- Section of Endocrinology and Internal Medicine, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - M Montagnani
- Department of Biomedical Sciences and Human Oncology, Division of Medical Oncology, University of Bari Aldo Moro, Bari, Italy
| | - F Giorgino
- Department of Emergency and Organ Transplantation, Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, University of Bari Aldo Moro, Bari, Italy
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13
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Danesi R, Fogli S, Indraccolo S, Del Re M, Dei Tos AP, Leoncini L, Antonuzzo L, Bonanno L, Guarneri V, Pierini A, Amunni G, Conte P. Druggable targets meet oncogenic drivers: opportunities and limitations of target-based classification of tumors and the role of Molecular Tumor Boards. ESMO Open 2021; 6:100040. [PMID: 33540286 PMCID: PMC7859305 DOI: 10.1016/j.esmoop.2020.100040] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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: 08/17/2020] [Revised: 11/15/2020] [Accepted: 12/16/2020] [Indexed: 02/06/2023] Open
Abstract
The therapeutic landscape of cancer is changing rapidly due to the growing number of approved drugs capable of targeting specific genetic alterations. This aspect, together with the development of noninvasive methods for the assessment of somatic mutations in the peripheral blood of patients, generated a growing interest toward a new tumor-agnostic classification system based on ‘predictive’ biomarkers. The current review article discusses this emerging alternative approach to the classification of cancer and its implications for the selection of treatments. It is suggested that different types of cancers sharing the same molecular profiles could benefit from the same targeted drugs. Although recent clinical trials have demonstrated that this approach cannot be generalized, there are also specific examples that demonstrate the clinical utility of this alternative vision. In this rapidly evolving scenario, a multidisciplinary approach managed by institutional Molecular Tumor Boards is fundamental to interpret the biological and clinical relevance of genetic alterations and the complexity of their relationship with treatment response. The identification of oncogenic drivers offers the opportunity to develop target-specific drugs. The inhibition of crucial pathways realizes the principle of druggable target to exploit cancer vulnerability. The approval of new anticancer agents based on target-based concept represents a paradigm shift in cancer therapy. However, only few drugs have been approved so far on an agnostic basis and the concept of biomarker cannot be generalized. Tumor Molecular Boards will have an increasing role in the identification of new therapeutic options in selected patients.
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Affiliation(s)
- R Danesi
- Clinical Pharmacology and Pharmacogenetics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - S Fogli
- Clinical Pharmacology and Pharmacogenetics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - S Indraccolo
- Molecular Oncology Unit, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - M Del Re
- Clinical Pharmacology and Pharmacogenetics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - A P Dei Tos
- Department of Medicine, School of Medicine, University of Padua, Padua, Italy
| | - L Leoncini
- Department of Medical Biotechnology, Anatomic Pathology Division, University of Siena, Siena, Italy
| | - L Antonuzzo
- Medical Oncology Unit, Careggi University Hospital, Florence, Italy
| | - L Bonanno
- Medical Oncology 2, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - V Guarneri
- Medical Oncology 2, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy; Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - A Pierini
- Integrated Access, Roche, Monza, Italy
| | - G Amunni
- Institute for the Study, Prevention and Oncology Network (ISPRO), Florence, Italy.
| | - P Conte
- Medical Oncology 2, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy; Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
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14
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Ciccolini J, Del Re M, Danesi R, Milano G, Schellens JHM, Raymond E. Predicting fluoropyrimidine-related toxicity: turning wish to will, the PAMM-EORTC position. Ann Oncol 2019; 29:1893-1894. [PMID: 30032203 DOI: 10.1093/annonc/mdy258] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- J Ciccolini
- PAMM Group, European Organisation for Research and Treatment of Cancer (EORTC), Brussels, Belgium.
| | - M Del Re
- PAMM Group, European Organisation for Research and Treatment of Cancer (EORTC), Brussels, Belgium
| | - R Danesi
- PAMM Group, European Organisation for Research and Treatment of Cancer (EORTC), Brussels, Belgium
| | - G Milano
- PAMM Group, European Organisation for Research and Treatment of Cancer (EORTC), Brussels, Belgium
| | - J H M Schellens
- PAMM Group, European Organisation for Research and Treatment of Cancer (EORTC), Brussels, Belgium
| | - E Raymond
- PAMM Group, European Organisation for Research and Treatment of Cancer (EORTC), Brussels, Belgium
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Del Re M, Conteduca V, Crucitta S, Gurioli G, Casadei C, Restante G, Schepisi G, Lolli C, Morganti R, Danesi R, De Giorgi U. Analysis of the androgen receptor status in liquid biopsy to predict the outcome to abiraterone and enzalutamide in CRPC patients. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz239.004] [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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Danesi R, Petrini I, Mazzoni F, Valleggi S, Gianfilippo G, Pozzessere D, Crucitta S, Restante G, Chella A, Garassino M, Miccoli M, De Re M. Incidence of T790M in NSCLC patients progressed to gefitinib, erlotinib, and afatinib: A study on circulating tumour DNA. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz260.083] [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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Del Re M, Crucitta S, Sbrana A, Rofi E, Paolieri F, Galli L, Falcone A, van Schaik R, Jenster G, Morganti R, Pignata S, Danesi R. Role of AR-V7 and AR-FL in resistance to hormonal therapy in mCRPC: Independent actors or reciprocal drivers? A translational study by Meet-Uro group. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy269.086] [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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18
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Crucitta S, Del Re M, Fontana A, Bertolini I, Rofi E, De Angelis C, Diodati L, Cavallero D, Salvadori B, Falcone A, Morganti R, Danesi R. Expression of TK1 and CDK9 in plasma-derived exosomes is associated with clinical response to CDK4/6 inhibitors in breast cancer. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy269.143] [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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19
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Rofi E, Del Re M, Vivaldi C, Crucitta S, Arrigoni E, Pasquini G, Catanese S, Pecora I, Musettini G, Vasile E, Falcone A, Danesi R. Selective induction of PD-L1 expression in plasma-derived exosomes by gemcitabine-nab-paclitaxel vs. FOLFIRINOX in pancreas cancer. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy269.167] [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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20
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Rossini D, Cremolini C, Conca E, Del Re M, Busico A, Pietrantonio F, Bergamo F, Danesi R, Cardellino G, Tamburini E, Dell'Aquila E, Strippoli A, Masi G, Tonini G, Negri F, Corsi D, Pella N, Intini R, Falcone A, Santini D. Liquid biopsy allows predicting benefit from rechallenge with cetuximab(cet)+irinotecan(iri) in RAS/BRAF wild-type mCRC patients(pts) with resistance to 1st-line cet+iri: Final results and translational analyses of the CRICKET study by GONO. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy149.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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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21
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Falcone A, Pfanner E, Brunetti I, Allegrini G, Lencioni M, Galli C, Masi G, Danesi R, Antonuzzo A, Del Tacca M, Conte PF. Suramin in Combination with 5-Fluorouracil (5-FU) and Leucovorin (LV) in Metastatic Colorectal Cancer Patients Resistant to 5-FU+LV-Based Chemotherapy. Tumori 2018; 84:666-8. [PMID: 10080673 DOI: 10.1177/030089169808400610] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIMS AND BACKGROUND Suramin has been shown to be of interest as a potential new anticancer agent because of its capacity to inhibit the binding of several growth factors to their receptors and to inhibit the growth of cancer cells in vitro. Since multi-autocrine loops involving growth factors which are antagonized by suramin have been demonstrated in colorectal cancer, we previously evaluated the activity of suramin in patients with advanced colorectal cancer. Interestingly, in this study three patients who had received 5-FU+LV after suramin, although heavily pretreated with fluoropyrimidines, obtained an objective response. This observation was intriguing as it might have been that suramin had changed the biology of the tumor, making it sensitive to 5-FU+LV. We therefore conducted the present study to investigate the possibility that suramin might overcome the resistance to 5-FU+LV. METHODS AND STUDY DESIGN Only colorectal cancer patients with metastatic and progressive disease during 5-FU+LV-based chemotherapy were eligible for this study. Suramin was administered for eight weeks at doses determined by means of a computer-assisted dosing algorithm that used Bayesian pharmacokinetics to maintain suramin plasma concentrations of 200-250 microg/ml. 5-FU was administered weekly at a dosis of 450 mg/m2 halfway through a two-hour infusion of I-LV 250 mg/m2 starting one week after the initiation of suramin for a maximum of 26 weeks. RESULTS Treatment was relatively well tolerated, but no objective responses were observed after the accrual of 13 patients in the first stage of the trial. Consequently, the trial was interrupted according to the initial two-stage sampling design. CONCLUSIONS The present study does not support the hypothesis that suramin might overcome resistance to 5-FU+LV and its use in colorectal cancer is not recommended.
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Affiliation(s)
- A Falcone
- U.O. Oncologia Medica, Dipartimento di Oncologia, Ospedale S. Chiara, Pisa, Italy
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Danesi R, Del Re M, Ciccolini J, Schellens JHM, Schwab M, van Schaik RHN, van Kuilenburg ABP. Prevention of fluoropyrimidine toxicity: do we still have to try our patient's luck? Ann Oncol 2018; 28:183. [PMID: 27687313 DOI: 10.1093/annonc/mdw448] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- R Danesi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - M Del Re
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - J Ciccolini
- Clinical Pharmacokinetics, La Timone University Hospital, Marseille, and GPCO-Unicancer, Paris, France
| | - J H M Schellens
- Department of Clinical Pharmacology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - M Schwab
- Dr Margarete Fischer-Bosch-Institute of Clinical Pharmacology, Stuttgart and Department of Clinical Pharmacology, University Hospital, Tuebingen, Germany
| | - R H N van Schaik
- IFCC Reference center - Pharmacogenetics, Department of Clinical Chemistry, Erasmus University, Rotterdam
| | - A B P van Kuilenburg
- Department of Clinical Chemistry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Minari R, Bordi P, Del Re M, Facchinetti F, Mazzoni F, Barbieri F, Camerini A, Comin CE, Gnetti L, Azzoni C, Nizzoli R, Bortesi B, Rofi E, Petreni P, Campanini N, Rossi G, Danesi R, Tiseo M. Primary resistance to osimertinib due to SCLC transformation: Issue of T790M determination on liquid re-biopsy. Lung Cancer 2017; 115:21-27. [PMID: 29290257 DOI: 10.1016/j.lungcan.2017.11.011] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [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: 07/30/2017] [Revised: 11/01/2017] [Accepted: 11/13/2017] [Indexed: 12/22/2022]
Abstract
OBJECTIVES EGFR T790M mutation is the most common mechanism of resistance to first-/second-generation EGFR tyrosine kinase inhibitors (TKIs) in non-small cell lung cancer (NSCLC) and could be overcome by third-generation EGFR-TKIs, such as osimertinib. Liquid biopsy, a non-invasive technique used to test the presence of the resistant mutation, may help avoiding tissue re-biopsy. However, analysing only circulating-free DNA, information about other less frequent and coexisting resistance mechanisms may remain unrevealed. MATERIALS AND METHODS All patients reported in this series participated in the ASTRIS trial, a real world treatment study testing the efficacy of osimertinib (80mg os die) in advanced T790M-positive NSCLC progressed to prior EGFR-TKI. Patients were considered eligible to osimertinib if T790M positive on tissue or plasma samples. In our patients, EGFR molecular testing on blood sample was conducted with digital droplet PCR (ddPCR). RESULTS We report our experience of five patients treated with osimertinib after T790M detection on liquid biopsy that presented a disease progression at first tumor assessment mediated by SCLC transformation, as evidenced at tissue re-biopsies. All patients showed low ratio T790M/activating mutation in the blood before osimertinib (lower than 0.03). For three patients, EGFR mutational analysis was T790M-negative when re-assessed by using a less sensitive method (therascreen®) on the same liquid biopsy sample analysed by ddPCR before osimertinib therapy. CONCLUSION Although liquid biopsy is a relevant tool to diagnose T790M presence in NSCLC patients resistant to EGFR-TKI, in case of a low ratio T790M/activating mutation, tissue biopsy should be considered to exclude the presence of SCLC transformation and/or other concomitant resistance mechanisms.
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Affiliation(s)
- R Minari
- Medical Oncology Unit, University Hospital of Parma, Italy
| | - P Bordi
- Medical Oncology Unit, University Hospital of Parma, Italy
| | - M Del Re
- Clinical Pharmacology and Pharmacogenetic Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - F Facchinetti
- Medical Oncology Unit, University Hospital of Parma, Italy
| | - F Mazzoni
- Department of Medical Oncology, Careggi Hospital of Firenze, Firenze, Italy
| | - F Barbieri
- Department of Oncology, University Hospital Policlinico of Modena, Modena, Italy
| | - A Camerini
- Medical Oncology, Versilia Hospital, Lido di Camaiore, Italy
| | - C E Comin
- Department of Experimental and Clinical Medicine, Section of Surgery, Histopathology and Molecular Pathology, University of Florence, Italy
| | - L Gnetti
- Pathology Unit, Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy
| | - C Azzoni
- Pathology Unit, Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy
| | - R Nizzoli
- Medical Oncology Unit, University Hospital of Parma, Italy
| | - B Bortesi
- Medical Oncology Unit, University Hospital of Parma, Italy
| | - E Rofi
- Clinical Pharmacology and Pharmacogenetic Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - P Petreni
- Department of Medical Oncology, Careggi Hospital of Firenze, Firenze, Italy
| | - N Campanini
- Pathology Unit, Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy
| | - G Rossi
- Pathology Unit, Azienda USL Valle d'Aosta, Regional Hospital "Parini", Aosta, Italy
| | - R Danesi
- Clinical Pharmacology and Pharmacogenetic Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - M Tiseo
- Medical Oncology Unit, University Hospital of Parma, Italy.
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Del Re M, Vivaldi C, Rofi E, Vasile E, Miccoli M, Caparello C, d'Arienzo P, Fornaro L, Falcone A, Danesi R. Early changes in plasma levels of mutant KRAS DNA as a sensitive marker of response to chemotherapy in pancreatic cancer. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx425.010] [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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Adua D, Del Re M, Rojas Limpe F, Casolari L, Danesi R, Di Fabio F, Ardizzoni A. Dihydropyrimidine dehydrogenase (DPD) deficiency: how to translate it in clinical practice? Ann Oncol 2017. [DOI: 10.1093/annonc/mdx422.032] [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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26
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Vivaldi C, Arrigoni E, Morganti R, Pecora I, Fidilio L, Catanese S, Restante G, Fornaro L, Crucitta S, Lencioni M, Rofi E, Vasile E, Falcone A, Danesi R, Del Re M. Analysis of DPYD and UGT1A1 genotype in patients with advanced pancreatic cancer treated with modified FOLFIRINOX. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx425.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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27
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Vivaldi C, Arrigoni E, Morganti R, Catanese S, Fidilio L, Pecora I, Restante G, Fornaro L, Crucitta S, Lencioni M, Rofi E, Vasile E, Falcone A, Danesi R, Del Re M. Analysis of DPYD and UGT1A1 genotype in patients with advanced pancreatic cancer treated with modified FOLFIRINOX. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx390.062] [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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28
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Fogli S, Polini B, Carrozzi L, Pistelli F, Puppo G, Palla A, Saba A, Zucchi R, Re MD, Danesi R. Nicotine Metabolite Ratio in Smokers: A Real World Experience. Clin Ther 2017. [DOI: 10.1016/j.clinthera.2017.05.271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Antonuzzo L, Del Re M, Barucca V, Spada F, Meoni G, Restante G, Danesi R, Di Costanzo F, Fazio N. Critical focus on mechanisms of resistance and toxicity of m-TOR inhibitors in pancreatic neuroendocrine tumors. Cancer Treat Rev 2017; 57:28-35. [PMID: 28535439 DOI: 10.1016/j.ctrv.2017.05.001] [Citation(s) in RCA: 14] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 05/01/2017] [Accepted: 05/03/2017] [Indexed: 10/19/2022]
Abstract
Pancreatic neuroendocrine tumors (pNETs) are rare neoplasms representing less than 2% of all pancreatic malignancies. The PI3K-AKT-mTOR pathway is often deregulated in pNETs and seems to play a key role in tumorigenesis. Everolimus, an inhibitor of the mTOR pathway, has demonstrated efficacy in the treatment of pNETs. Nevertheless de novo or acquired drug resistance is responsible for disease progression and represents a major obstacle to overcome by clinicians. Blocking the PI3K/AKT/mTOR pathway may cover the supposed main mechanisms of resistance to everolimus. Therefore, BEZ-235, a potent oral dual PI3K/mTOR inhibitor was investigated in clinical trials. Globally more than 250 patients with different types of solid tumors were treated. Two studies were conducted in pNETs with BEZ-235 as single agent. The former was a phase 2 trial conducted in pNETs resistant to everolimus while the latter a randomized trial comparing everolimus and BEZ-235. Unfortunately, both the studies disappointed the expectations and were prematurely halted mainly due to severe toxicity. On this basis we reviewed m-TOR inhibitors in pNETs, focusing on their mechanisms of resistance and toxicity.
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Affiliation(s)
- L Antonuzzo
- S.C. Oncologia Medica 1, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy; Medical Genetics, University of Siena, Siena, Italy.
| | - M Del Re
- Clinical Pharmacology and Pharmacogenetic Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - V Barucca
- Division of Medical Oncology, Misericordia General Hospital, Grosseto, Italy
| | - F Spada
- Unit of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, European Institute of Oncology, Milan, Italy
| | - G Meoni
- S.C. Oncologia Medica 1, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - G Restante
- Clinical Pharmacology and Pharmacogenetic Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - R Danesi
- Clinical Pharmacology and Pharmacogenetic Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - F Di Costanzo
- S.C. Oncologia Medica 1, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - N Fazio
- Unit of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, European Institute of Oncology, Milan, Italy
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Cantarella M, Pasqualetti F, Gonnelli A, Orlandi P, Giuliani D, Delishaj D, Montrone S, Coraggio G, Lombardo E, Simeon V, Di Desiderio T, Fioravanti A, Fabrini M, Danesi R, Guarini S, Paiar F, Bocci G. PO-0630: The role of mc4r gene polymorphisms in gbm patients treated with concomitant radio-chemotherapy. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)31067-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Di Paolo A, Orlandi P, Di Desidero T, Danesi R, Bocci G. Simultaneous, but not consecutive combination with folinate salts potentiates 5-fluorouracil antitumor activity in vitro. Eur J Cancer 2017. [DOI: 10.1016/s0959-8049(17)30301-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Del Re M, Biasco E, Crucitta S, Derosa L, Rofi E, Farnesi A, Sbrana A, Restante G, Galli L, Falcone A, Jenster G, van Schaik R, Danesi R. AR-V7 detection in plasma-derived exosomal RNA strongly predicts resistance to hormonal therapy in metastatic prostate cancer. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw372.13] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Del Re M, Biasco E, Crucitta S, Derosa L, Rofi E, Sbrana A, Farnesi A, Restante G, Galli L, Falcone A, Jenster G, van Schaik R, Danesi R. The detection of AR-V7 in plasma-derived exosomal RNA strongly predicts resistance to hormonal therapy in metastatic prostate cancer patients. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw334.01] [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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Del Re M, Citi V, Crucitta S, Rofi E, Belcari F, van Schaik RH, Danesi R. Pharmacogenetics of CYP2D6 and tamoxifen therapy: Light at the end of the tunnel? Pharmacol Res 2016; 107:398-406. [PMID: 27060675 DOI: 10.1016/j.phrs.2016.03.025] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Revised: 03/06/2016] [Accepted: 03/21/2016] [Indexed: 01/08/2023]
Abstract
The clinical usefulness of assessing the enzymatic activity of CYPD6 in patients taking tamoxifen had been longly debated. In favour of preemptive evaluation of phenotypic profile of patients is the strong pharmacologic rationale, being that the formation of endoxifen, the major and clinically most important metabolite of tamoxifen, is largely dependent on the activity of CYP2D6. This enzyme is highly polymorphic for which the activity is largely depending on genetics, but that can also be inhibited by a number of drugs, i.e. antidepressants, which are frequently used in patients with cancer. Unfortunately, the clinical trials that have been published in the last years are contradicting each other on the association between CYP2D6 and significant clinical endpoints, and for this reason CYP2D6 genotyping is at present not generally recommended. Despite this, the CYP2D6 genotyping test for tamoxifen is available in many laboratories and it may still be an appropriate test to use it in specific cases.
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Affiliation(s)
- M Del Re
- Clinical Pharmacology and Pharmacogenetics Unit, Department of Laboratory Medicine, University Hospital, Pisa, Italy.
| | - V Citi
- Clinical Pharmacology and Pharmacogenetics Unit, Department of Laboratory Medicine, University Hospital, Pisa, Italy
| | - S Crucitta
- Clinical Pharmacology and Pharmacogenetics Unit, Department of Laboratory Medicine, University Hospital, Pisa, Italy
| | - E Rofi
- Clinical Pharmacology and Pharmacogenetics Unit, Department of Laboratory Medicine, University Hospital, Pisa, Italy
| | - F Belcari
- Clinical Pharmacology and Pharmacogenetics Unit, Department of Laboratory Medicine, University Hospital, Pisa, Italy
| | - R H van Schaik
- Department of Clinical Chemistry, Erasmus MC, Rotterdam, The Netherlands
| | - R Danesi
- Clinical Pharmacology and Pharmacogenetics Unit, Department of Laboratory Medicine, University Hospital, Pisa, Italy
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Bordi P, Del Re M, Danesi R, Tiseo M. 2PD Monitoring of secondary drug resistance mutations in circulating tumor DNA of patients with advanced ALK positive NSCLC. J Thorac Oncol 2016. [DOI: 10.1016/s1556-0864(16)30117-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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36
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Cremolini C, Del Re M, Loupakis F, Marmorino F, Citi V, Palombi M, Bergamo F, Schirripa M, Rossini D, Cortesi E, Tomasello G, Spadi R, Buonadonna A, Amoroso D, Vitello S, Di Donato S, Granetto C, D'Amico M, Falcone A, Danesi R. DPYD c.1905 + 1G > A and c.2846A > T and UGT1A1*28 allelic variants as predictors of toxicity: Pharmacogenetic translational analysis from the phase III TRIBE study in metastatic colorectal cancer. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv340.07] [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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37
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Del Re M, Tiseo M, D'Incecco A, Camerini A, Petrini I, Lucchesi M, Inno A, Spada D, Bordi P, Vasile E, Citi V, Malpeli G, Testa E, Gori S, Falcone A, Amoroso D, Chella A, Cappuzzo F, Ardizzoni A, Scarpa A, Danesi R. KRAS has a role in acquired resistance to EGFR-TKIs in NSCLC: an analysis on circulating tumor DNA. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv343.34] [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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38
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Fontanelli G, Baratè C, Ciabatti E, Guerrini F, Grassi S, Del Re M, Morganti R, Petrini I, Arici R, Barsotti S, Metelli MR, Danesi R, Galimberti S. Real-Time PCR and Droplet Digital PCR: two techniques for detection of the JAK2(V617F) mutation in Philadelphia-negative chronic myeloproliferative neoplasms. Int J Lab Hematol 2015; 37:766-73. [PMID: 26189968 DOI: 10.1111/ijlh.12404] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [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: 04/19/2015] [Accepted: 06/19/2015] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Philadelphia-negative chronic myeloproliferative neoplasms (MPNs) are clonal disorders that present JAK2(V617F) mutation in 50-95% of cases. The main objective of this study was the comparison of two PCR methods, real-time (qPCR) and droplet digital PCR (DD-PCR) for detection of the JAK2(V617F) mutation, to assess analytic sensitivity, specificity, and feasibility of the two methods. METHODS Ninety-nine patients with MPN of 225 presenting the JAK2(V617F) mutation by qPCR have been evaluated by DD-PCR also. RESULTS We demonstrated an absolute concordance in terms of specificity between the two methods, DD-PCR showing a higher sensitivity (half a log higher than qPCR). As expected, a progressive increase of mutant allele burden was observed from essential thrombocythemia (ET) to polycythemia vera (PV) and primary myelofibrosis (PMF) to secondary myelofibrosis (SMF). CONCLUSION In conclusion, our study showed that DD-PCR could represent a new and promising technological evolution for detection of JAK2 mutation in MPNs.
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Affiliation(s)
- G Fontanelli
- U.O. Hematology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - C Baratè
- U.O. Hematology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - E Ciabatti
- U.O. Hematology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.,GenOMEC, University of Siena, Siena, Italy
| | - F Guerrini
- U.O. Hematology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - S Grassi
- U.O. Hematology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - M Del Re
- U.O. Pharmacology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - R Morganti
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - I Petrini
- Department of Translational Research and New Technologies in Medicine, University of Pisa, Pisa, Italy
| | - R Arici
- U.O. Hematology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - S Barsotti
- U.O. Hematology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - M R Metelli
- U.O. Hematology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - R Danesi
- U.O. Pharmacology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - S Galimberti
- U.O. Hematology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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Del Re M, Pietrantonio F, Palombi M, Sameen S, Loupakis F, Barbara C, Latiano T, Ulivi P, Zafarana E, Passardi A, Maiello E, Brandes A, Cappuzzo F, Siena S, De Braud F, Falcone A, Labianca R, Zamagni C, Pinto C, Danesi R. Pattern of Dihydropyrimidine Dehydrogenase Genetic Variants in Patients with Various Degrees of Tolerability of Fluoropyrimidine Treatment. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu326.62] [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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40
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Spada D, Del Re M, Citi V, Guarino S, Ficarelli R, Testa E, Danesi R. Liquid Biopsy to Monitor the Evolution of Nsclc Egfr+During Treatment with Gefintinib. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu358.47] [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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41
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Di Paolo A, Polillo M, Tascini C, Lewis R, Menichetti F, Danesi R. Different Recommendations for Daptomycin Dosing Over Time in Patients With Severe Infections. Clin Infect Dis 2014; 58:1788-9. [DOI: 10.1093/cid/ciu230] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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42
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Di Paolo A, Polillo M, Capecchi M, Cervetti G, Baratè C, Angelini S, Guerrini F, Fontanelli G, Arici R, Ciabatti E, Grassi S, Bocci G, Hrelia P, Danesi R, Petrini M, Galimberti S. The c.480C>G polymorphism of hOCT1 influences imatinib clearance in patients affected by chronic myeloid leukemia. Pharmacogenomics J 2014; 14:328-35. [PMID: 24589908 DOI: 10.1038/tpj.2014.7] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2013] [Revised: 01/17/2014] [Accepted: 01/31/2014] [Indexed: 12/30/2022]
Abstract
The aim of the study was to investigate any possible influence of polymorphisms of transmembrane transporters human organic cation transporter 1 (hOCT1), ABCB1, ABCG2 on imatinib pharmacokinetics in 33 men and 27 women (median age and range, 56 and 27-79 years, respectively) affected by chronic myeloid leukemia. A population pharmacokinetic analysis was performed to investigate imatinib disposition in every patient and the role of transporter polymorphisms. Results showed that the α1-acid glycoprotein and the c.480C>G genotype of hOCT1 had a significant effect on apparent drug clearance (CL/F) being responsible, respectively, for a 20% and 10% decrease in interindividual variability (IIV) of CL/F (from 50.1 up to 19.6%). Interestingly, 25 patients carrying at least one polymorphic c.480 G allele had a significant lower CL/F value with respect to the 35 c.480CC individuals (mean±s.d., 9.6±1.6 vs 12.1±2.3 l h(-1), respectively; P<0.001). In conclusion, the hOCT1 c.480C>G SNP may significantly influence imatinib pharmacokinetics, supporting further analyses in larger groups of patients.
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Affiliation(s)
- A Di Paolo
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 55, Pisa, Italy
| | - M Polillo
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 55, Pisa, Italy
| | - M Capecchi
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 55, Pisa, Italy
| | - G Cervetti
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 55, Pisa, Italy
| | - C Baratè
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 55, Pisa, Italy
| | - S Angelini
- Department of Pharmacy and Biotechnology, University of Bologna, Via Irnerio 48, Bologna, Italy
| | - F Guerrini
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 55, Pisa, Italy
| | - G Fontanelli
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 55, Pisa, Italy
| | - R Arici
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 55, Pisa, Italy
| | - E Ciabatti
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 55, Pisa, Italy
| | - S Grassi
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 55, Pisa, Italy
| | - G Bocci
- 1] Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 55, Pisa, Italy [2] Istituto Toscano Tumori, Via Alderotti 86/N, Florence, Italy
| | - P Hrelia
- Department of Pharmacy and Biotechnology, University of Bologna, Via Irnerio 48, Bologna, Italy
| | - R Danesi
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 55, Pisa, Italy
| | - M Petrini
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 55, Pisa, Italy
| | - S Galimberti
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 55, Pisa, Italy
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Fogli S, Stefanelli F, Picchianti L, Del Re M, Mey V, Bardelli C, Danesi R, Breschi MC. Synergistic interaction between PPAR ligands and salbutamol on human bronchial smooth muscle cell proliferation. Br J Pharmacol 2014; 168:266-75. [PMID: 22924744 DOI: 10.1111/j.1476-5381.2012.02180.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2012] [Revised: 07/05/2012] [Accepted: 08/13/2012] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND PURPOSE An important objective in asthma therapy is to prevent the accelerated growth of airway smooth muscle cells which leads to hyperplasia and bronchial hyperreactivity. We investigated the effect of combination of salbutamol and PPARγ agonists on growth factor-stimulated human bronchial smooth muscle cell (BSMC) proliferation. EXPERIMENTAL APPROACH Synergism was quantified by the combination index-isobologram method. Assays used here included analyses of growth inhibition, cell viability, DNA fragmentation, gene transcription, cell cycle and protein expression. KEY RESULTS The PPARγ gene was highly expressed in BSMC and the protein was identified in cell nuclei. Single-agent salbutamol or PPARγ agonists prevented growth factor-induced human BSMC proliferation within a micromolar range of concentrations through their specific receptor subtypes. Sub-micromolar levels of combined salbutamol-PPARγ agonist inhibited growth by 50% at concentrations from ∼2 to 12-fold lower than those required for each drug alone, without induction of apoptosis or necrosis. Combination treatments also promoted cell cycle arrest at the G1/S transition phase and inhibition of ERK phosphorylation. CONCLUSIONS AND IMPLICATIONS The synergistic interaction between PPARγ agonists and β(2) -adrenoceptor agonists on airway smooth muscle cell proliferation highlights the anti-remodelling potential of this combination in chronic lung diseases.
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Affiliation(s)
- S Fogli
- Department of Psychiatry, Neurobiology, Pharmacology and Biotechnologies, University of Pisa, Italy.
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Del Re M, Fontana A, Del Re I, Bona E, Salvadori B, Ferrarini I, Landucci E, Fancelli S, Bertolini I, Michelotti A, Falcone A, Danesi R. Abstract P1-08-31: Putative role of genetic variants of eNOS in survival and toxicity of patients given antiangiogenic therapy. Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-p1-08-31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: The development of tumor angiogensis is mainly driven by vascular endothelial growth factor (VEGF), which is strongly overexpressed in many cancers. VEGF induces the expression of the endothelial nitric oxide (NO) synthase (eNOS) and the resultant overproduction of NO may be associated with recruitment of inflammatory cells, disruption of endothelial barrier, edema and impaired drug delivery within tumors (1). Functional polymorphisms in the eNOS gene, including -786C>T and 894G>T, have been associated with impaired production of NO and higher incidence of hypertension (HT) (2), diabetic nephropathy (3) and glaucoma (4). Since suppression of VEGF-eNOS signal transduction by antiangiogenic drugs may normalize tumor vasculature by restoring interstitial fluid pressure and drug distribution in tumors, but may induce HT in patients, the purpose of this study was to examine the association between the major eNOS variants -786C>T and 894G>T with treatment outcome and risk of HT in metastatic breast cancer (MBC) patients given bevacizumab. Methods: Sixty-five MBC patients given bevacizumab as per approved indication were enrolled. Main characteristics were: mean age 49.5 years (range 29-73) at first diagnosis, 53 years (range 34-74) at metastatic progression and PS 0-1. Four subjects with HT and 1 patient with compensated cardiovascular disease were also included. First-line chemotherapy for metastatic disease was taxol plus bevacizumab. Germline DNA was extracted from peripheral blood with the Qiamp Mini Kit (Qiagen, Milano, Italy) and examined for eNOS -786C>T and 894G>T variants by Real Time PCR (Life Sciences 7900HT platform) and automatic sequencing (Life Sciences 3100 Avant). The study was approved by the local Ethics Committee. Results: Genotype frequencies are reported below (Table 1). The presence of -786TT genotype was associated with longer PFS compared with the other genotypes (median PFS 95%CI, CC/CT = 9 vs TT = 12 months, Log-rank [Mantel Cox] test p = 0.0066), but not with any grade of HT. Also the 894GT/TT was associated with longer PFS compaed with the GG homozygous wild-type genotype (median PFS 95%CI, GG = 7,5 vs GT/TT = 10 months, Log-rank [Mantel-Cox] test p = 0,0497). The incidence and severity of HT did not vary among genotypes. Conclusion: Patients bearing deficient eNOS variant did not experience higher risk or severity of HT with respect to the wild-type allele but enjoied a longer PFS.
Table 1. Genotype frequenciesSNPFrequencies%Frequencies%Frequencies%-786C>TCCCTTT 37%33.8%26.2%894G>TGGGTTT 41.5%53.8%4.6%
References
1. Goel S et al. Physiol Rev 2011;91:1071
2. Niu W, Qi Y. PLoS One 2011;6:e24266
3. Rahimi Z et al. Dis Markers 2013;34:437
4. Awadalla MS et al. Invest Ophtalmol Vis Sci 2013;54:2108.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P1-08-31.
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Affiliation(s)
- M Del Re
- University of Pisa, Pisa, Italy; Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - A Fontana
- University of Pisa, Pisa, Italy; Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - I Del Re
- University of Pisa, Pisa, Italy; Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - E Bona
- University of Pisa, Pisa, Italy; Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - B Salvadori
- University of Pisa, Pisa, Italy; Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - I Ferrarini
- University of Pisa, Pisa, Italy; Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - E Landucci
- University of Pisa, Pisa, Italy; Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - S Fancelli
- University of Pisa, Pisa, Italy; Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - I Bertolini
- University of Pisa, Pisa, Italy; Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - A Michelotti
- University of Pisa, Pisa, Italy; Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - A Falcone
- University of Pisa, Pisa, Italy; Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - R Danesi
- University of Pisa, Pisa, Italy; Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
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Pasqualetti F, Ferrazza P, Cocuzza P, Crea F, Matteucci F, Fabrini M, Fatigante L, Bocci G, Danesi R, Greco C. EP-0997: Polymorphisms of Akt and EZH2 as predict factor of radiochemotherapy in patients with glioblastoma (GBM). Radiother Oncol 2013. [DOI: 10.1016/s0167-8140(15)33303-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: 10/23/2022]
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46
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Duhagon MA, Crea F, Danesi R, Farrar WL. Embryonic stem cell pathways and chemotherapy response: an unexplored route. Ann Oncol 2013; 24:558-559. [PMID: 23233652 DOI: 10.1093/annonc/mds610] [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] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- M A Duhagon
- Molecular Interactions Laboratory-School of Science/Department of Genetics-School of Medicine, University of the Republic, Montevideo, Uruguay.
| | - F Crea
- Department of Internal Medicine, Division of Pharmacology, University of Pisa, Pisa, Italy
| | - R Danesi
- Department of Internal Medicine, Division of Pharmacology, University of Pisa, Pisa, Italy
| | - W L Farrar
- Laboratory of Cancer Prevention, Cancer Stem Cell Section, NCI-Frederick-NIH, Frederick, USA
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Del Re M, Ferrarini I, Fontana A, Santoro M, Bona E, Del Re I, Stasi I, Bertolini I, Laurà F, Landucci E, Salvadori B, Falcone A, Danesi R. Abstract P5-17-06: The deficient eNOS c.894G>T genotype is not associated with increased severity of hypertension and proteinuria in breast cancer patients receiving bevacizumab. Cancer Res 2012. [DOI: 10.1158/0008-5472.sabcs12-p5-17-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background. Tumor angiogenesis is a complex process involving a wide array of effector molecules and stromal cells. In tumor tissue, vasculature is structurally and functionally abnormal, causing elevated interstitial pressure and irregular perfusion. The expression of vascular endothelial growth factor (VEGF), the most important angiogenic factor, is enhanced in many tumors. VEGF may induce nitric oxide (NO) production via up-regulation of the endothelial NO synthase (eNOS, NOS3) and the resultant overproduction of NO is associated with vasodilation and edema within tumors (Goel S et al. Physiol Rev 2011;91:1071). eNOS plays an important physiologic role in maintaining blood pressure homeostasis and vascular integrity by providing constitutive release of NO in endothelial cells. Functional variants of the eNOS gene, including the single-nucleotide polymorphism rs1799983 (c.894G>T, p. Asp298Glu) at codon 298, have been associated with reduced function of eNOS and higher incidence of hypertension (HT) (Niu W, Qi Y. PLoS One 2011;6:e24266).
Purpose. Since suppression of VEGF-eNOS axis by anti-angiogenic therapies is considered a causative factor of HT in patients, the purpose of this study was to examine whether the major eNOS non-synonymous variant c.894G>T may be associated with increased risk of developing hypertension (HT) and proteinuria (PU) in breast cancer patients treated with bevacizumab.
Patients and methods. Forty-one metastatic breast cancer patients given bevacizumab as per standard of care were enrolled. Main characteristics were: median age 49.5 years (range 29–73) at first diagnosis, 53 years (range 34–74) at metastatic disease; PS 0–1 in all patients; 4 subjects with hypertension and 1 patient with compensated cardiovascular disease at diagnosis. Twenty-six subjects had received neoadjuvant or adjuvant chemotherapy based on anthracycline and taxane; first-line chemotherapy for metastatic disease was paclitaxel plus bevacizumab for all patients; 14 subjects received hormone-therapy for metastatic disease (range 1–5 lines). Germline DNA was extracted from peripheral blood and used to screen patients for eNOS c.894G>T variant by automatic sequencing. The study was approved by the local Ethics Committee.
Results. Three patients (7.3%) were homozygous variant c.894TT, 12 (29.3%) homozygous wild-type c.894GG and the remaining 26 (63.4%) were heterozygous c.894GT. The c.894TT patients had no HT or PU at baseline and developed grade (G) 1, 2, 2 HT, respectively, and in one case PU during treatment. G1, 2 and 3 HT developed in 4, 5 and 2 c.894GG subjects, respectively, while PU was observed in 7/12 (58%) patients. The full range of HT grades and PU were observed in heterozygous subjects. Thirty-seven patients achieved one of the following: partial remission, minimal response or stable disease upon treatment with bevacizumab in combination with chemotherapy; 3 subjects had progressive disease and 1 was not evaluable.
Conclusions. The presence of the mutant T allele of c.894G>T is not associated with increased severity of HT and PU; therefore, bevacizumab can be administered at no increased risk in TT patients with respect to the wild-type GG population.
Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P5-17-06.
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Affiliation(s)
- M Del Re
- University Hospital, Pisa, Italy
| | | | | | | | - E Bona
- University Hospital, Pisa, Italy
| | - I Del Re
- University Hospital, Pisa, Italy
| | - I Stasi
- University Hospital, Pisa, Italy
| | | | - F Laurà
- University Hospital, Pisa, Italy
| | | | | | | | - R Danesi
- University Hospital, Pisa, Italy
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Fornaro L, Crea F, Faviana P, Masi G, Vivaldi C, De Gregorio V, Paolicchi E, Fontanini G, Danesi R, Falcone A. EZH2 Expression in Colorectal (CRC) Cancer: Single Nucleotide Polymorphism (SNP) Characterization and Correlation With Clinico-Pathological and Molecular Parameters. Ann Oncol 2012. [DOI: 10.1016/s0923-7534(20)32774-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Crea F, Fornaro L, Paolicchi E, Masi G, Frumento P, Loupakis F, Salvatore L, Cremolini C, Schirripa M, Graziano F, Ronzoni M, Ricci V, Farrar WL, Falcone A, Danesi R. An EZH2 polymorphism is associated with clinical outcome in metastatic colorectal cancer patients. Ann Oncol 2012; 23:1207-1213. [PMID: 21926398 DOI: 10.1093/annonc/mdr387] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Despite therapeutic innovations, metastatic colorectal cancer (mCRC) is still characterized by poor prognosis and few molecular markers predict the risk of progression. Polycomb group genes (PcGs) are epigenetic modifiers involved in tumor suppressor gene silencing. PcG member EZH2 mediates gene silencing through histone-H3 lysine-27 methylation. In colorectal cancer (CRC), EZH2 overexpression predicts shorter survival. Recently, four EZH2 single-nucleotide polymorphisms (SNPs) have been described. The present study was aimed at evaluating the correlation between EZH2 SNPs and outcome parameters in mCRC patients. PATIENTS AND METHODS DNA was extracted from blood samples of 110 mCRC patients treated with first-line 5-fluorouracil, folinic acid, irinotecan (FOLFIRI) and bevacizumab. Genotyping was carried out by real-time PCR. Genotype was used to predict objective response, progression-free survival (PFS) and overall survival (OS). EZH2 messenger RNA levels were evaluated on lymphocytes of a parallel cohort of 50 CRC patients. RESULTS One allelic variant (rs3757441 C/C versus C/T or T/T) was significantly associated with shorter PFS and OS (P < 0.01 and P < 0.05, respectively). At multivariate analysis, the same variant resulted an independent predictor of PFS and OS (P < 0.05). The C/C variant was associated with significantly higher EZH2 expression (P < 0.05). CONCLUSION An EZH2 SNP may be useful to predict clinical outcome in mCRC patients.
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Affiliation(s)
- F Crea
- Division of Pharmacology, Department of Internal Medicine, University of Pisa, Pisa.
| | - L Fornaro
- Division of Medical Oncology, Department of Oncology, Transplants and New Technologies in Medicine, University of Pisa, Pisa, Italy
| | - E Paolicchi
- Division of Pharmacology, Department of Internal Medicine, University of Pisa, Pisa
| | - G Masi
- Division of Medical Oncology, Department of Oncology, Transplants and New Technologies in Medicine, University of Pisa, Pisa, Italy
| | - P Frumento
- Unit of Biostatistics, Institute of Environmental Health, Karolinska Institutet, Stockholm, Sweden
| | - F Loupakis
- Division of Medical Oncology, Department of Oncology, Transplants and New Technologies in Medicine, University of Pisa, Pisa, Italy
| | - L Salvatore
- Division of Medical Oncology, Department of Oncology, Transplants and New Technologies in Medicine, University of Pisa, Pisa, Italy
| | - C Cremolini
- Division of Medical Oncology, Department of Oncology, Transplants and New Technologies in Medicine, University of Pisa, Pisa, Italy
| | - M Schirripa
- Division of Medical Oncology, Department of Oncology, Transplants and New Technologies in Medicine, University of Pisa, Pisa, Italy
| | - F Graziano
- Medical Oncology Unit, Department of Onco-Hematology, Azienda Ospedaliera S. Salvatore, Pesaro
| | - M Ronzoni
- Division of Medical Oncology, S. Raffaele Scientific Institute, Milano, Italy
| | - V Ricci
- Division of Medical Oncology, S. Raffaele Scientific Institute, Milano, Italy
| | - W L Farrar
- Cancer Stem Cell Section, Laboratory of Cancer Prevention, National Institute of Cancer-Frederick, Frederick, USA
| | - A Falcone
- Division of Medical Oncology, Department of Oncology, Transplants and New Technologies in Medicine, University of Pisa, Pisa, Italy
| | - R Danesi
- Division of Pharmacology, Department of Internal Medicine, University of Pisa, Pisa
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50
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Fornaro L, Crea F, Masi G, Paolicchi E, Loupakis F, Graziano F, Salvatore L, Ronzoni M, Ricci V, Cremolini C, Schirripa M, Danesi R, Falcone A. EZH2 polymorphism and benefit from bevacizumab in colorectal cancer: another piece to the puzzle. Ann Oncol 2012; 23:1370-1371. [PMID: 22383679 DOI: 10.1093/annonc/mds031] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- L Fornaro
- Department of Oncology, Transplants and New Technologies in Medicine, Division of Medical Oncology, University of Pisa, Pisa.
| | - F Crea
- Department of Internal Medicine, Division of Pharmacology, University of Pisa, Pisa
| | - G Masi
- Department of Oncology, Transplants and New Technologies in Medicine, Division of Medical Oncology, University of Pisa, Pisa
| | - E Paolicchi
- Department of Internal Medicine, Division of Pharmacology, University of Pisa, Pisa
| | - F Loupakis
- Department of Oncology, Transplants and New Technologies in Medicine, Division of Medical Oncology, University of Pisa, Pisa
| | - F Graziano
- Medical Oncology Unit, Department of Onco-Hematology, Azienda Ospedaliera S. Salvatore, Pesaro
| | - L Salvatore
- Department of Oncology, Transplants and New Technologies in Medicine, Division of Medical Oncology, University of Pisa, Pisa
| | - M Ronzoni
- Division of Medical Oncology, S. Raffaele Scientific Institute, Milano, Italy
| | - V Ricci
- Division of Medical Oncology, S. Raffaele Scientific Institute, Milano, Italy
| | - C Cremolini
- Department of Oncology, Transplants and New Technologies in Medicine, Division of Medical Oncology, University of Pisa, Pisa
| | - M Schirripa
- Department of Oncology, Transplants and New Technologies in Medicine, Division of Medical Oncology, University of Pisa, Pisa
| | - R Danesi
- Department of Internal Medicine, Division of Pharmacology, University of Pisa, Pisa
| | - A Falcone
- Department of Oncology, Transplants and New Technologies in Medicine, Division of Medical Oncology, University of Pisa, Pisa
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