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Musacchio L, Palluzzi E, Di Napoli M, Lauria R, Ferrandina G, Angioli R, Bergamini A, Corrado G, Perniola G, Cassani C, Savarese A, Gori S, Greco F, De Angelis C, Zafarana E, Giannarelli D, Cinieri S, Mosconi AM, Raspagliesi F, Pignata S, Scambia G, Lorusso D. Real world data of niraparib in platinum sensitive relapsed ovarian cancer: A multicenter experience of the MITO group. Gynecol Oncol 2024; 184:24-30. [PMID: 38277918 DOI: 10.1016/j.ygyno.2024.01.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 12/13/2023] [Accepted: 01/12/2024] [Indexed: 01/28/2024]
Abstract
OBJECTIVE PARP (poly adenosine diphosphate [ADP]-ribose polymerase) inhibitors are approved as maintenance therapy in platinum sensitive ovarian cancer (OC), in first line and in the recurrent setting, regardless of BRCA mutational status. Real-world data after the introduction of these agents are needed to evaluate whether the benefit observed in phase III randomized clinical trials can be translated into clinical practice. The aim of our study was to provide real-life data on efficacy and safety of niraparib administered as maintenance in platinum sensitive relapsed OC patients (PSROC). METHODS This retrospective/prospective observational study included relapsed OC patients that received niraparib as maintenance, at the time of platinum sensitive recurrence within the Italian expanded-access program. Clinical data at the time of diagnosis and at the time of recurrence were collected and analyzed. Median progression free survival (PFS) and overall survival (OS) were calculated as the time from start of niraparib treatment to subsequent radiologically confirmed relapse and death or last contact, respectively. RESULTS Among 304 eligible patients, 260 (85%) had BRCA wild-type tumor and 36. (11.9%) were BRCA mutated. Median PFS was 9.1 months (95% CI: 6.9-11.2) and 10.3 months (95% CI: 7.0-13.5) in the BRCAwt and BRCAmut cohorts, respectively. Furthermore, median OS was 41.7 months (95% CI: 31.6-41.9) and 34.6 months (95% CI: N.E.) in the BRCAwt and BRCAmut cohorts, respectively. CONCLUSION Data from this large real-life dataset suggested that maintenance with niraparib in the real-life setting of platinum sensitive OC recurrence is effective and well tolerated.
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Affiliation(s)
- Lucia Musacchio
- Department of Women and Child Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Eleonora Palluzzi
- Department of Women and Child Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Marilena Di Napoli
- Dipartimento di Uro-Ginecologia, Istituto Nazionale per lo Studio e la Cura dei Tumori IRCCS Fondazione Pascale, Naples, Italy
| | - Rossella Lauria
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Gabriella Ferrandina
- Department of Women and Child Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Roberto Angioli
- Department of Obstetrics and Gynaecology, Campus Bio-Medico, University of Rome, Rome, Italy
| | - Alice Bergamini
- Department of Obstetrics and Gynecology, IRCCS Ospedale San Raffaele, Milano, Italy
| | - Giacomo Corrado
- Department of Women and Child Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giorgia Perniola
- Department of Obstetrics and Gynecology, Sapienza University, Rome, Italy
| | - Chiara Cassani
- Department of Obstetrics and Gynaecology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Antonella Savarese
- Medical Oncology 1, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Stefania Gori
- Medical Oncology, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar di Valpolicella (Verona), Italy
| | - Filippo Greco
- Department of Oncology; "Mater Salutis" Hospital, ULSS9, Verona, Italy
| | - Carmine De Angelis
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Elena Zafarana
- Dipartimento Oncologico, SOC Oncologia Medica-Prato, Nuovo Ospedale di Prato Santo Stefano, Azienda USL Toscana Centro, Prato, Italy
| | - Diana Giannarelli
- Facility of Epidemiology and Biostatistics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Saverio Cinieri
- Department of Medical Oncology, Perrino Hospital, ASL Brindisi, Brindisi, Italy
| | - Anna Maria Mosconi
- Medical Oncology Division, S. Maria della Misericordia Hospital, Perugia, Italy
| | | | - Sandro Pignata
- Dipartimento di Uro-Ginecologia, Istituto Nazionale per lo Studio e la Cura dei Tumori IRCCS Fondazione Pascale, Naples, Italy
| | - Giovanni Scambia
- Department of Women and Child Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Department of Life Science and Public Health, Catholic University of Sacred Heart Largo Agostino Gemelli, Rome, Italy
| | - Domenica Lorusso
- Department of Women and Child Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Department of Life Science and Public Health, Catholic University of Sacred Heart Largo Agostino Gemelli, Rome, Italy.
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Musacchio L, Palluzzi E, Lauria R, Di Napoli M, Corrado G, Bergamini A, Salutari V, Marchetti C, Angioli R, Cassani C, Gori S, Palaia I, Savarese A, Raspagliesi F, Mosconi A, Zafarana E, De Angelis C, Ferrandina G, Scambia G, Lorusso D. 52P Real-world data of niraparib in platinum sensitive relapsed ovarian cancer: A multicenter experience of the MITO group. ESMO Open 2023. [DOI: 10.1016/j.esmoop.2023.100832] [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: 02/27/2023] Open
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Crispo A, Rivieccio G, Cataldo L, Coluccia S, Luongo A, Coppola E, Grimaldi M, Montagnese C, Nocerino F, Celentano E, Saviano R, Bastone A, Baglio G, De Angelis C, Ciardiello F, Avallone A, Cassata A, Costanzo R, Morabito A, Maione P, Gridelli C, Cigolari S, Borrelli A, De Placido S, Schiavone F, Bianchi AAM, Pignata S, Aquino A, Bonito C, Buonerba C, Caccavallo F, Carlomagno C, Cavaliere M, Centonze S, Damiano S, De Divitiis C, De Nardo R, Del Deo Vito A, D'Errico D, Esposito G, Esposito L, Famiglietti V, Formisano L, Formisano L, Franzese E, Gaeta V, Gragnano E, Grimaldi R, Iovane G, Lauria R, Migliore G, Mirto M, Napoletano A, Napoli D, Vitale P, Pepe S, Rambaldo MP, Renato M, Rescigno M, Rossi E, Santabarbara G, Stanzione C. New approach to implement cancer patient care: The valutazione percorso rete oncologica campana (ValPeROC)‐experience from an Italian oncology network. Eur J Cancer Care (Engl) 2022; 31:e13736. [PMID: 37039607 DOI: 10.1111/ecc.13736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 09/12/2022] [Accepted: 09/27/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The primary goal of the Campania Oncology Network (ROC) was to reduce cancer delay and care fragmentation through the establishment of cancer-specific multidisciplinary oncologic groups (GOMs) and diagnostic and therapeutic assistance paths (PDTAs). METHODS Five cancer centres of the ROC, with their own cancer specific GOM, were selected. In our analysis, we have focused on four neoplasms: lung, colon, ovarian and prostate cancers. The median time for pre-GOM and GOM Times was calculated for each tumour site. Univariate and multivariate logistic regressions were performed to individuate risk factors for pre-GOM and GOM Time. RESULTS Significant differences were observed for prostate cancer compared to other patients either for pre-GOM or GOM Times. Significant risks were found for ovarian and prostate cancers in pre-GOM time and for prostate cancer in GOM-Time. CONCLUSIONS This experience will produce knowledge and data to guide decision-making and to manage more effectively the challenges of fighting cancer in Campania region. The Valutazione Percorso Rete Oncologica Campana (ValPeROC) study evaluates, for the first time, the ROC activity, through the analysis of key performance indices. Pre-GOM and GOM Time represent the quality of the entire regional health system and are useful to define models, which can evaluate the performance of the ROC over time.
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Affiliation(s)
- Anna Crispo
- Epidemiology and Biostatistics Unit Istituto Nazionale Tumori IRCCS 'Fondazione G. Pascale', Naples, Italy Naples Italy
| | - Giorgia Rivieccio
- Department of Managerial Studies and Quantitative Methods University of Naples Parthenope Faculty of Economics Naples Italy
| | - Luca Cataldo
- Department of Managerial Studies and Quantitative Methods University of Naples Parthenope Faculty of Economics Naples Italy
| | - Sergio Coluccia
- Epidemiology and Biostatistics Unit Istituto Nazionale Tumori IRCCS 'Fondazione G. Pascale', Naples, Italy Naples Italy
| | - Assunta Luongo
- Epidemiology and Biostatistics Unit Istituto Nazionale Tumori IRCCS 'Fondazione G. Pascale', Naples, Italy Naples Italy
| | - Elisabetta Coppola
- Department of Urology and Gynecology Istituto Nazionale Tumori IRCCS ‘Fondazione G. Pascale’ Naples Italy
| | - Maria Grimaldi
- Epidemiology and Biostatistics Unit Istituto Nazionale Tumori IRCCS 'Fondazione G. Pascale', Naples, Italy Naples Italy
| | - Concetta Montagnese
- Epidemiology and Biostatistics Unit Istituto Nazionale Tumori IRCCS 'Fondazione G. Pascale', Naples, Italy Naples Italy
| | - Flavia Nocerino
- Epidemiology and Biostatistics Unit Istituto Nazionale Tumori IRCCS 'Fondazione G. Pascale', Naples, Italy Naples Italy
| | - Egidio Celentano
- Epidemiology and Biostatistics Unit Istituto Nazionale Tumori IRCCS 'Fondazione G. Pascale', Naples, Italy Naples Italy
| | - Rocco Saviano
- National Cancer Institute IRCCS Pascale Foundation Naples Italy
| | - Anna Bastone
- Department of Managerial Studies and Quantitative Methods University of Naples Parthenope Faculty of Economics Naples Italy
| | - Giovanni Baglio
- AGENAS ‐ Italian National Agency for Regional Healthcare Services Rome Italy
| | - Carmine De Angelis
- Department of Clinical Medicine and Surgery University of Naples Federico II Naples Italy
| | - Fortunato Ciardiello
- Oncologia Medica, Dipartimento di Medicina di Precisione Università degli Studi della Campania ‘L. Vanvitelli’ Naples Italy
| | - Antonio Avallone
- Experimental Clinical Abdominal Oncology Unit Istituto Nazionale Tumori 'Fondazione G. Pascale', Naples, Italy Naples Italy
| | - Antonino Cassata
- Medical Oncology Unit Istituto Nazionale Tumori 'Fondazione G. Pascale', Naples, Italy Naples Italy
| | - Raffaele Costanzo
- Thoracic Department Istituto Nazionale Tumori 'Fondazione G. Pascale', Naples, Italy Naples Italy
| | - Alessandro Morabito
- Thoracic Department Istituto Nazionale Tumori 'Fondazione G. Pascale', Naples, Italy Naples Italy
| | - Paolo Maione
- Division of Medical Oncology S.G. Moscati Hospital Avellino Italy
| | - Cesare Gridelli
- Division of Medical Oncology S.G. Moscati Hospital Avellino Italy
| | - Silvio Cigolari
- Hospital Health Direction Azienda Ospedaliera Universitaria ‘San Giovanni di Dio e Ruggi d'Aragona’ Salerno Italy
| | - Anna Borrelli
- Hospital Health Direction Azienda Ospedaliera Universitaria ‘San Giovanni di Dio e Ruggi d'Aragona’ Salerno Italy
| | - Sabino De Placido
- Department of Clinical Medicine and Surgery University of Naples Federico II Naples Italy
| | - Francesco Schiavone
- Department of Managerial Studies and Quantitative Methods University of Naples Parthenope Faculty of Economics Naples Italy
| | - Attilio A. M. Bianchi
- Directorate‐General for Management Istituto Nazionale Tumori 'Fondazione G. Pascale', Naples, Italy Naples Italy
| | - Sandro Pignata
- Department of Urology and Gynecology Istituto Nazionale Tumori IRCCS ‘Fondazione G. Pascale’ Naples Italy
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Di Liello R, Arenare L, Raspagliesi F, Scambia G, Pisano C, Colombo N, Frezzini S, Tognon G, Artioli G, Gadducci A, Lauria R, Ferrero A, Cinieri S, De Censi A, Breda E, Scollo P, De Giorgi U, Lissoni AA, Katsaros D, Lorusso D, Salutari V, Cecere SC, Lapresa M, Nardin M, Bogani G, Distefano M, Greggi S, Gargiulo P, Schettino C, Gallo C, Daniele G, Califano D, Perrone F, Pignata S, Piccirillo MC. Thromboembolic events and antithrombotic prophylaxis in advanced ovarian cancer patients treated with bevacizumab: secondary analysis of the phase IV MITO-16A/MaNGO-OV2A trial. Int J Gynecol Cancer 2021; 31:1348-1355. [PMID: 34462317 DOI: 10.1136/ijgc-2021-002786] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 08/16/2021] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION The use of routine antithrombotic prophylaxis is not recommended for advanced cancer patients receiving chemotherapy. The effect of bevacizumab-containing therapy on the risk of thromboembolic events remains controversial in ovarian cancer patients. We report on the incidence of thromboembolic events and the prevalence of antithrombotic therapy in patients enrolled in the single arm, phase IV, MITO-16A/MaNGO-OV2A trial. METHODS In this trial, potential prognostic factors for patients with previously untreated ovarian cancer receiving a combination of platinum-based chemotherapy and bevacizumab were explored and the final analysis has already been reported. In this secondary analysis, the occurrence of thromboembolic events and the use of antithrombotic therapy were described according to the clinical characteristics of the patients. The prognostic role of thromboembolic events for progression-free and overall survival were also evaluated. RESULTS From October 2012 to November 2014, 398 eligible patients were enrolled. 76 patients (19.1%) were receiving some type of anticoagulant or anti-aggregant treatment at baseline. Overall, 24 thromboembolic events were reported (cumulative incidence of 6.0%). The occurrence of thromboembolic events was not associated with baseline patient characteristics and was not modified by the use of antithrombotic prophylaxis (HR 0.60, 95% CI 0.18 to 2.0). Occurrence of thromboembolic events was not associated with progression-free survival (HR 1.34, 95% CI 0.83 to 2.15) or overall survival (HR 0.78, 95% CI 0.37 to 1.61). CONCLUSIONS In our study, a 6.0% rate of thromboembolic events was reported during treatment with bevacizumab plus chemotherapy. Thromboembolic events were not associated with the clinical characteristics of the patients or with the use of antithrombotic prophylaxis, nor did they significantly affect the long-term prognosis. TRIAL REGISTRATION NUMBER NCT01706120.
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Affiliation(s)
- Raimondo Di Liello
- Unità Sperimentazioni Cliniche, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Napoli, Italy
| | - Laura Arenare
- Unità Sperimentazioni Cliniche, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Napoli, Italy
| | - Francesco Raspagliesi
- Dipartimento di Chirurgia, SC Chirurgia Ginecologica, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - Giovanni Scambia
- Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Ginecologia Oncologica, Fondazione Policlinico Universitario Gemelli IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Carmela Pisano
- Oncologia Clinica Sperimentale Uro-Ginecologica, Istituto Nazionale Tumori IRCCS Fondazione G Pascale, Napoli, Italy
| | - Nicoletta Colombo
- Istituto Europeo di Oncologia IRCCS, and Dipartimento di Medicina e Chirurgia, Università degli Studi di Milano-Bicocca, Milano, Italy
| | - Simona Frezzini
- Oncologia Medica II e Radiologia, Istituto Oncologico Veneto IRCCS, and Università di Padova, Padova, Italy
| | - Germana Tognon
- Divisione di Ostetricia e Ginecologia, ASST Spedali Civili di Brescia, Università di Brescia, Brescia, Italy
| | - Grazia Artioli
- Oncologia Medica, ULSS2 Marca Trevigiana, Treviso, Italy
| | - Angiolo Gadducci
- Dipartimento di Medicina Clinica e Sperimentale, UO Ginecologia e Ostetricia, Università di Pisa, Pisa, Italy
| | - Rossella Lauria
- Oncologia Medica, Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli Federico II, Napoli, Italy
| | - Annamaria Ferrero
- Divisione Universitaria di Ginecologia e Ostetricia, AO Ordine Mauriziano, Torino, Italy
| | - Saverio Cinieri
- Oncologia Medica, Ospedale Senatore Antonio Perrino, Brindisi, Italy
| | | | - Enrico Breda
- Dipartimento di Oncologia, Ospedale S. Giovanni Calibita Fatebenefratelli, Roma, Italy
| | - Paolo Scollo
- UO Ostetricia e Ginecologia, Dipartimento Materno-Infantile, Ospedale Cannizzaro, Catania, Italy
| | - Ugo De Giorgi
- IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Italy
| | | | - Dionyssios Katsaros
- AOU Città della Salute, Dipartimento di Scienze Chirurgiche, Ginecologia Oncologica, Ospedale Ostetrico Ginecologico S Anna, Torino, Italy
| | - Domenica Lorusso
- Divisione di Ginecologia Medica, Istituto Europeo di Oncologia IRCCS, Milano, Italy
| | - Vanda Salutari
- Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Ginecologia Oncologica, Fondazione Policlinico Universitario Gemelli IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Sabrina Chiara Cecere
- Oncologia Clinica Sperimentale Uro-Ginecologica, Istituto Nazionale Tumori IRCCS Fondazione G Pascale, Napoli, Italy
| | - Mariateresa Lapresa
- Divisione di Ginecologia Medica, Istituto Europeo di Oncologia IRCCS, Milano, Italy
| | - Margherita Nardin
- Oncologia Medica II e Radiologia, Istituto Oncologico Veneto IRCCS, and Università di Padova, Padova, Italy
| | - Giorgio Bogani
- Dipartimento di Chirurgia, SC Chirurgia Ginecologica, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - Mariagrazia Distefano
- Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Ginecologia Oncologica, Fondazione Policlinico Universitario Gemelli IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Stefano Greggi
- SC Ginecologia Oncologica, Istituto Nazionale Tumori IRCCS Fondazione G Pascale, Napoli, Campania, Italy
| | - Piera Gargiulo
- Unità Sperimentazioni Cliniche, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Napoli, Italy
| | - Clorinda Schettino
- Unità Sperimentazioni Cliniche, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Napoli, Italy
| | - Ciro Gallo
- Dipartimento di Salute Mentale e Fisica e Medicina Preventiva, Università degli Studi della Campania Luigi Vanvitelli, Napoli, Italy
| | - Gennaro Daniele
- Direzione Scientifica, Fondazione Policlinico Universitario A Gemelli IRCCS, Roma, Italy
| | - Daniela Califano
- Bersagli Molecolari del Microambiente, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Italy
| | - Francesco Perrone
- Unità Sperimentazioni Cliniche, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Napoli, Italy
| | - Sandro Pignata
- Oncologia Clinica Sperimentale Uro-Ginecologica, Istituto Nazionale Tumori IRCCS Fondazione G Pascale, Napoli, Italy
| | - Maria Carmela Piccirillo
- Unità Sperimentazioni Cliniche, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Napoli, Italy
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Cecere SC, Musacchio L, Bartoletti M, Salutari V, Arenare L, Lorusso D, Ronzino G, Lauria R, Cormio G, Naglieri E, Scollo P, Marchetti C, Raspagliesi F, Greggi S, Cinieri S, Bergamini A, Orditura M, Valabrega G, Scambia G, Martinelli F, De Matteis E, Cardalesi C, Loizzi V, Perniola G, Carella C, Scandurra G, Giannone G, Pignata S. Cytoreductive surgery followed by chemotherapy and olaparib maintenance in BRCA 1/2 mutated recurrent ovarian cancer: a retrospective MITO group study. Int J Gynecol Cancer 2021; 31:1031-1036. [PMID: 33990353 DOI: 10.1136/ijgc-2020-002343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 04/06/2021] [Accepted: 04/08/2021] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION The role of cytoreductive surgery in the poly-ADP ribose polymerase inhibitors era is not fully investigated. We evaluated the impact of surgery performed prior to platinum-based chemotherapy followed by olaparib maintenance in platinum-sensitive BRCA-mutated recurrent ovarian cancer. METHODS This retrospective study included platinum-sensitive recurrent ovarian cancer BRCA-mutated patients from 13 Multicenter Italian Trials in Ovarian cancer and gynecological malignancies centers treated between September 2015 and May 2019. The primary outcomes were progression-free survival and overall survival. Data on post-progression treatment was also assessed. RESULTS Among 209 patients, 72 patients (34.5%) underwent cytoreductive surgery followed by platinum-based chemotherapy and olaparib maintenance, while 137 patients (65.5%) underwent chemotherapy treatment alone. After a median follow-up of 37.3 months (95% CI: 33.4 to 40.8), median progression-free survival in the surgery group was not reached, compared with 11 months in patients receiving chemotherapy alone (P<0.001). Median overall survival was nearly double in patients undergoing surgery before chemotherapy (55 vs 28 months, P<0.001). Post-progression therapy was assessed in 127 patients: response rate to chemotherapy was 29.2%, 8.8%, and 9.0% in patients with platinum-free interval >12 months, between 6 and 12 months, and <6 months, respectively. CONCLUSION Cytoreductive surgery performed before platinum therapy and olaparib maintenance was associated with longer progression-free survival and overall survival in BRCA-mutated platinum-sensitive relapsed ovarian cancer patients. In accordance with our preliminary results, the response rate to chemotherapy given after progression during olaparib was associated with platinum-free interval.
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Affiliation(s)
- Sabrina Chiara Cecere
- Department of Urology and Gynecology, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Naples, Italy
| | - Lucia Musacchio
- Department of Women and Child Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy.,Department of Maternal and Child Health and Urological Sciences, Policlinico Umberto I, Sapienza, University of Rome, Rome, Italy
| | - Michele Bartoletti
- Unit of Medical Oncology and Cancer Prevention, Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano, CRO, Aviano, Italy.,Department of Medicine, University of Udine, Udine, Italy
| | - Vanda Salutari
- Department of Women and Child Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Laura Arenare
- Clinical Trial Unit, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Campania, Italy
| | - Domenica Lorusso
- Department of Women and Child Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy.,Department of Life Science and Public Health, Catholic University of Sacred Heart, Largo Agostino Gemelli, Rome, Italy.,Gynecologic Oncology Unit, Fondazione Istituto Nazionale Tumori IRCCS, Milan, Italy
| | | | - Rossella Lauria
- Division of Medical Oncology, Azienda Ospedaliera Universitaria Federico II, Napoli, Campania, Italy
| | - Gennaro Cormio
- Gynecologic Oncology Unit, Department of Biomedical Sciences and Human Oncology, University of Bari, Bari, Italy
| | - Emanuele Naglieri
- Medical Oncology Unit, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Paolo Scollo
- Medical Oncology Unit, Cannizzaro Hospital, Catania, Italy
| | - Claudia Marchetti
- Department of Women and Child Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | | | - Stefano Greggi
- Gynecologic Oncology, National Cancer Institute, Institute for Hospitalization and Care Scientific Foundation Pascale, Napoli, Campania, Italy
| | - Saverio Cinieri
- Division of Medical Oncology, Ospedale "Senatore Antonio Perrino", Brindisi, Brindisi, Italy
| | - Alice Bergamini
- Department of Obstetrics and Gynecology, IRCCS, San Raffaele Hospital, Milan, Italy.,Università Vita Salute San Raffaele, Milan, Italy
| | - Michele Orditura
- Università degli Studi della Campania Luigi Vanvitelli, Napoli, Campania, Italy
| | - Giorgio Valabrega
- Candiolo Cancer Institute, FPO- IRCCS, Candiolo (TO), Italy.,Department of Oncology, University of Turin, Torino, Piemonte, Italy
| | - Giovanni Scambia
- Department of Women and Child Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy.,Department of Life Science and Public Health, Catholic University of Sacred Heart, Largo Agostino Gemelli, Rome, Italy
| | - Fabio Martinelli
- Gynecologic Oncology Unit, Fondazione Istituto Nazionale Tumori IRCCS, Milan, Italy
| | | | - Cinzia Cardalesi
- Division of Medical Oncology, Azienda Ospedaliera Universitaria Federico II, Napoli, Campania, Italy
| | - Vera Loizzi
- Gynecologic Oncology Unit, Department of Biomedical Sciences and Human Oncology, University of Bari, Bari, Italy
| | - Giorgia Perniola
- Department of Maternal and Child Health and Urological Sciences, Policlinico Umberto I, Sapienza, University of Rome, Rome, Italy
| | - Claudia Carella
- Interventional Oncology Unit with Integrated Section of Translational Medical Oncology, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | | | - Gaia Giannone
- Candiolo Cancer Institute, FPO- IRCCS, Candiolo (TO), Italy.,Department of Oncology, University of Turin, Torino, Piemonte, Italy
| | - Sandro Pignata
- Department of Urology and Gynecology, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Naples, Italy
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Daniele G, Raspagliesi F, Scambia G, Pisano C, Colombo N, Frezzini S, Tognon G, Artioli G, Gadducci A, Lauria R, Ferrero A, Cinieri S, De Censi A, Breda E, Scollo P, De Giorgi U, Lissoni AA, Katsaros D, Lorusso D, Salutari V, Cecere SC, Zaccarelli E, Nardin M, Bogani G, Distefano M, Greggi S, Piccirillo MC, Fossati R, Giannone G, Arenare L, Gallo C, Perrone F, Pignata S. Bevacizumab, carboplatin, and paclitaxel in the first line treatment of advanced ovarian cancer patients: the phase IV MITO-16A/MaNGO-OV2A study. Int J Gynecol Cancer 2021; 31:875-882. [PMID: 33931498 DOI: 10.1136/ijgc-2021-002434] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/30/2021] [Accepted: 03/31/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To explore the clinical and biological prognostic factors for advanced ovarian cancer patients receiving first-line treatment with carboplatin, paclitaxel, and bevacizumab. METHODS A multicenter, phase IV, single arm trial was performed. Patients with advanced (FIGO (International Federation of Gynecology and Obstetrics) stage IIIB-IV) or recurrent, previously untreated, ovarian cancer received carboplatin (AUC (area under the curve) 5), paclitaxel (175 mg/m2) plus bevacizumab (15 mg/kg) on day 1 for six 3-weekly cycles followed by bevacizumab single agent (15 mg/kg) until progression or unacceptable toxicity up to a maximum of 22 total cycles. Here we report the final analysis on the role of clinical prognostic factors. The study had 80% power with a two-tailed 0.01 α error to detect a 0.60 hazard ratio with a factor expressed in at least 20% of the population. Both progression-free and overall survival were used as endpoints. RESULTS From October 2012 to November 2014, 398 eligible patients were treated. After a median follow-up of 32.3 months (IQR 24.1-40.4), median progression-free survival was 20.8 months (95% CI 19.1 to 22.0) and median overall survival was 41.1 months (95% CI 39.1 to 43.5). Clinical factors significantly predicting progression-free and overall survival were performance status, stage, and residual disease after primary surgery. Neither baseline blood pressure/antihypertensive treatment nor the development of hypertension during bevacizumab were prognostic. There were two deaths possibly related to treatment, but no unexpected safety signal was reported. CONCLUSIONS Efficacy and safety of bevacizumab in combination with carboplatin and paclitaxel and as maintenance were comparable to previous data. Hypertension, either at baseline or developed during treatment, was not prognostic. Performance status, stage, and residual disease after primary surgery remain the most important clinical prognostic factors. TRIAL REGISTRATION NUMBER EudraCT 2012-003043-29; NCT01706120.
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Affiliation(s)
- Gennaro Daniele
- Unità Sperimentazioni Cliniche, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Italy.,Direzione Scientifica, Policlinico Universitario Agostino Gemelli, Roma, Italy
| | | | - Giovanni Scambia
- Dipartimento Scienze della Salute della Donna e del Bambino, Policlinico Universitario Agostino Gemelli, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Carmela Pisano
- Oncologia Clinica Sperimentale Uro-Ginecologica, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Italy
| | - Nicoletta Colombo
- Istituto Europeo di Oncologia IRCCS, and Dipartimento di Medicina e Chirurgia, Università degli Studi di Milano-Bicocca, Milano, Italy
| | - Simona Frezzini
- Oncologia Medica 2, Istituto Oncologico Veneto IRCCS, Padova, Italy
| | - Germana Tognon
- Divisione di Ostetricia e Ginecologia, ASST Spedali Civili di Brescia, Università degli Studi di Brescia, Brescia, Italy
| | - Grazia Artioli
- Oncologia ed Ematologia, U.L.S.S. 13, Mirano (VE), Italy.,Oncologia Medica, ULSS2 Marca Trevigiana, Treviso, Italy
| | - Angiolo Gadducci
- Dipartimento di Medicina Clinica e Sperimentale, UO Ginecologia e Ostetricia, Università degli Studi di Pisa Facolta di Medicina e Chirurgia, Pisa, Italy
| | - Rossella Lauria
- Oncologia Medica, Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli Federico II Scuola di Medicina e Chirurgia, Napoli, Italy
| | - Annamaria Ferrero
- Divisione Universitaria di Ginecologia e Ostetricia, Azienda Ospedaliera Ordine Mauriziano di Torino, Torino, Italy
| | - Saverio Cinieri
- Divisione di Oncologia Medica, Ospedale Antonio Perrino, Brindisi, Italy
| | | | - Enrico Breda
- Dipartimento di oncologia, Ospedale San Giovanni Calibita Fatebenefratelli, Roma, Italy
| | - Paolo Scollo
- Divisione di Ostetricia e Ginecologia, Azienda Ospedaliera Cannizzaro, Catania, Italy
| | - Ugo De Giorgi
- Oncologia Medica, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola (FC), Italy
| | | | - Dionyssios Katsaros
- Dipartimento di Scienze Chirurgiche, Ginecologia Oncologica, Ospedale Sant'Anna, Università di Torino, Torino, Italy
| | - Domenica Lorusso
- Chirurgia Ginecologica, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy.,Dipartimento Scienze della Salute della Donna e del Bambino, Policlinico Universitario Agostino Gemelli, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Vanda Salutari
- Dipartimento Scienze della Salute della Donna e del Bambino, Policlinico Universitario Agostino Gemelli, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Sabrina Chiara Cecere
- Oncologia Clinica Sperimentale Uro-Ginecologica, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Italy
| | - Eleonora Zaccarelli
- Istituto Europeo di Oncologia IRCCS, and Dipartimento di Medicina e Chirurgia, Università degli Studi di Milano-Bicocca, Milano, Italy
| | - Margherita Nardin
- Radiologia, Istituto Oncologico Veneto IRCCS, Università di Padova, Padova, Italy
| | - Giorgio Bogani
- Chirurgia Ginecologica, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - Mariagrazia Distefano
- Dipartimento Scienze della Salute della Donna e del Bambino, Policlinico Universitario Agostino Gemelli, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Stefano Greggi
- Ginecologia Oncologica, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Italy
| | - Maria Carmela Piccirillo
- Unità Sperimentazioni Cliniche, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Italy
| | - Roldano Fossati
- Istituto di Ricerche Farmacologiche Mario Negri, Milano, Italy
| | - Gaia Giannone
- Dipartimento di Oncologia, Università degli Studi di Torino e Istituto di Candiolo, FPO - IRCCS, Torino, Italy
| | - Laura Arenare
- Unità Sperimentazioni Cliniche, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Italy
| | - Ciro Gallo
- Dipartimento di Salute Mentale e Fisica e Medicina Preventiva, Università degli Studi della Campania Luigi Vanvitelli, Napoli, Italy
| | - Francesco Perrone
- Unità Sperimentazioni Cliniche, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Italy
| | - Sandro Pignata
- Oncologia Clinica Sperimentale Uro-Ginecologica, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Italy
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7
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De Angelis C, Bruzzese D, Bernardo A, Baldini E, Leo L, Fabi A, Gamucci T, De Placido P, Poggio F, Russo S, Forestieri V, Lauria R, De Santo I, Caputo R, Cianniello D, Michelotti A, Del Mastro L, De Laurentiis M, Giuliano M, De Placido S, Arpino G. Corrigendum to 'Eribulin in combination with bevacizumab as second-line treatment for HER2-negative metastatic breast cancer progressing after first-line therapy with paclitaxel and bevacizumab: a multicenter, phase II, single arm trial (GIM11-BERGI)': [ESMO Open Volume 6, Issue 2, April 2021, 100054]. ESMO Open 2021; 6:100097. [PMID: 33926709 PMCID: PMC8103531 DOI: 10.1016/j.esmoop.2021.100097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Affiliation(s)
- C De Angelis
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | - D Bruzzese
- Department of Public Health, University of Naples "Federico II", Naples, Italy
| | - A Bernardo
- Oncologia Medica, Fondazione S. Maugeri IRCCS, Pavia, Italy
| | - E Baldini
- Department of Oncology, S. Luca Hospital, Lucca, Italy
| | - L Leo
- Unit of Oncology, A.O.R.N. dei Colli, Napoli, Naples, Italy
| | - A Fabi
- Medical Oncology 1, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - T Gamucci
- Medical Oncology Unit, ASL Frosinone, Frosinone, Italy
| | - P De Placido
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | - F Poggio
- UO Breast Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - S Russo
- Department of Oncology, Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | - V Forestieri
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | - R Lauria
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | - I De Santo
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | - R Caputo
- Breast Oncology Department, Istituto Nazionale Tumori Fondazione G. Pascale, Naples, Italy
| | - D Cianniello
- Breast Oncology Department, Istituto Nazionale Tumori Fondazione G. Pascale, Naples, Italy
| | - A Michelotti
- Azienda Ospedaliera Universitaria Pisana, Ospedale Santa Chiara, Pisa, Italy
| | - L Del Mastro
- UO Breast Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy; University of Genova, Dipartimento di Medicina Interna e Specialità Mediche (DIMI), Genova, Italy
| | - M De Laurentiis
- Breast Oncology Department, Istituto Nazionale Tumori Fondazione G. Pascale, Naples, Italy
| | - M Giuliano
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy.
| | - S De Placido
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | - G Arpino
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
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8
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De Angelis C, Bruzzese D, Bernardo A, Baldini E, Leo L, Fabi A, Gamucci T, De Placido P, Poggio F, Russo S, Forestieri V, Lauria R, De Santo I, Michelotti A, Del Mastro L, De Laurentiis M, Giuliano M, De Placido S, Arpino G. Eribulin in combination with bevacizumab as second-line treatment for HER2-negative metastatic breast cancer progressing after first-line therapy with paclitaxel and bevacizumab: a multicenter, phase II, single arm trial (GIM11-BERGI). ESMO Open 2021; 6:100054. [PMID: 33601296 PMCID: PMC7900694 DOI: 10.1016/j.esmoop.2021.100054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 01/03/2021] [Accepted: 01/12/2021] [Indexed: 12/12/2022] Open
Abstract
Background We evaluated the efficacy and safety of the nontaxane microtubule dynamics inhibitor eribulin plus the humanized anti-VEGF monoclonal antibody bevacizumab in a novel second-line chemotherapy scheme in HER2-negative metastatic breast cancer (MBC) patients progressing after first-line paclitaxel and bevacizumab. Patients and methods This is a multicenter, single-arm, Simon's two-stage, phase II study. The primary endpoint was the overall response rate, considered as the sum of partial and complete response based on the best overall response rate (BORR). The secondary endpoints were progression-free survival (PFS), overall survival (OS), and clinical benefit rate. Results A total of 58 of the 61 patients enrolled in the study were evaluable for efficacy. The BORR was 24.6% (95% CI 14.5-37.3). The clinical benefit rate was 32.8% (95% CI 21.3-46.0). The median PFS was 6.2 months (95% CI 4.0-7.8), and median OS was 14.8 months (95% CI 12.6-22.8). Overall, adverse events (AEs) were clinically manageable and the most common AEs were fatigue, paresthesia, and neutropenia. Quality of life was well preserved in most patients. Conclusions The results of this study suggest that second-line therapy with bevacizumab in combination with eribulin has a meaningful clinical activity and may represent a potential therapeutic option for patients with HER2-negative MBC. Bevacizumab + chemotherapy improved progression-free survival in HER2-negative metastatic breast cancer (MBC) patients. Eribulin monotherapy improved overall survival in patients with anthracycline- and taxane-pretreated MBC. The GIM11-BERGI trial assessed the efficacy and safety of eribulin + bevacizumab as second-line treatment for HER2-MBC. Eribulin + bevacizumab showed to be a safe and active treatment after progression to first-line paclitaxel + bevacizumab.
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Affiliation(s)
- C De Angelis
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | - D Bruzzese
- Department of Public Health, University of Naples "Federico II", Naples, Italy
| | - A Bernardo
- Oncologia Medica, Fondazione S. Maugeri IRCCS, Pavia, Italy
| | - E Baldini
- Department of Oncology, S. Luca Hospital, Lucca, Italy
| | - L Leo
- Unit of Oncology, A.O.R.N. dei Colli, Napoli, Naples, Italy
| | - A Fabi
- Medical Oncology 1, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - T Gamucci
- Medical Oncology Unit, ASL Frosinone, Frosinone, Italy
| | - P De Placido
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | - F Poggio
- UO Breast Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - S Russo
- Department of Oncology, Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | - V Forestieri
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | - R Lauria
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | - I De Santo
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | - A Michelotti
- Azienda Ospedaliera Universitaria Pisana, Ospedale Santa Chiara, Pisa, Italy
| | - L Del Mastro
- UO Breast Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy; University of Genova, Dipartimento di Medicina Interna e Specialità Mediche (DIMI), Genova, Italy
| | - M De Laurentiis
- Breast Oncology Department, Istituto Nazionale Tumori Fondazione G. Pascale, Naples, Italy
| | - M Giuliano
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy.
| | - S De Placido
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | - G Arpino
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
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9
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Arpino G, De Angelis C, De Placido P, Pietroluongo E, Formisano L, Bianco R, Fiore G, Montella E, Forestieri V, Lauria R, Cardalesi C, Vozzella EA, Iervolino A, Giuliano M, De Placido S. Optimising triage procedures for patients with cancer needing active anticancer treatment in the COVID-19 era. ESMO Open 2020; 5:e000885. [PMID: 32958531 PMCID: PMC7507249 DOI: 10.1136/esmoopen-2020-000885] [Citation(s) in RCA: 7] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/11/2020] [Accepted: 08/12/2020] [Indexed: 01/24/2023] Open
Abstract
Background Immunosuppression induced by anticancer therapy in a COVID-19-positive asymptomatic patient with cancer may have a devastating effect and, eventually, be lethal. To identify asymptomatic cases among patients receiving active cancer treatment, the Federico II University Hospital in Naples performs rapid serological tests in addition to hospital standard clinical triage for COVID-19 infection. Methods From 6 to 17 April 2020, all candidates for chemotherapy, radiotherapy or target/immunotherapy, if negative at the standard clinical triage on the day scheduled for anticancer treatment, received a rapid serological test on peripheral blood for COVID-19 IgM and IgG detection. In case of COVID-19 IgM and/or IgG positivity, patients underwent a real-time PCR (RT-PCR) SARS-CoV-2 test to confirm infection, and active cancer treatment was delayed. Results Overall 466 patients, negative for COVID-19 symptoms, underwent serological testing in addition to standard clinical triage. The average age was 61 years (range 25–88 years). Most patients (190, 40.8%) had breast cancer, and chemotherapy with or without immunotherapy was administered in 323 (69.3%) patients. Overall 433 (92.9%) patients were IgG-negative and IgM-negative, and 33 (7.1%) were IgM-positive and/or IgG-positive. Among the latter patients, 18 (3.9%), 11 (2.4%) and 4 (0.9%) were IgM-negative/IgG-positive, IgM-positive/IgG-negative and IgM-positive/IgG-positive, respectively. All 33 patients with a positive serological test, tested negative for RT-PCR SARS-CoV-2 test. No patient in our cohort developed symptoms suggestive of active COVID-19 infection. Conclusion Rapid serological testing at hospital admission failed to detect active asymptomatic COVID-19 infection. Moreover, it entailed additional economic and human resources, delayed therapy administrationand increased hospital accesses.
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Affiliation(s)
- Grazia Arpino
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Campania, Italy
| | - Carmine De Angelis
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Campania, Italy
| | - Pietro De Placido
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Campania, Italy
| | - Erica Pietroluongo
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Campania, Italy
| | - Luigi Formisano
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Campania, Italy
| | - Roberto Bianco
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Campania, Italy
| | - Giovanni Fiore
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Campania, Italy
| | - Emma Montella
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Valeria Forestieri
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Campania, Italy
| | - Rossella Lauria
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Campania, Italy
| | - Cinzia Cardalesi
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Campania, Italy
| | - Emilia Anna Vozzella
- Direzione Sanitaria, Azienda Ospedaliera Universitaria Federico II, Naples, Italy
| | - Anna Iervolino
- Direzione Generale, Azienda Ospedaliera Universitaria Federico II, Naples, Italy
| | - Mario Giuliano
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Campania, Italy.
| | - Sabino De Placido
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Campania, Italy
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10
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Schettini F, Santo ID, Rea CG, Viggiani M, Buono G, Angelis CD, Cardalesi C, Lauria R, Giuliano M, Forestieri V, Thomas G, Maione P, Limite G, Accurso A, Malorni L, Placido SD, Arpino G. Palbociclib added to ongoing endocrine therapy for hormone receptor-positive HER2-negative metastatic breast cancer: A case report series. Mol Clin Oncol 2020; 12:456-460. [PMID: 32257203 PMCID: PMC7087462 DOI: 10.3892/mco.2020.2016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 02/03/2020] [Indexed: 12/02/2022] Open
Abstract
Palbociclib is a potent cyclin-dependent kinase (CDK)4/6 inhibitor that disrupts cell cycle progression and has been recently approved in combination with an aromatase inhibitor or fulvestrant as first- and second-line treatment in hormone receptor (HR)+, human epidermal growth factor receptor (HER)2- metastatic breast cancer. There is evidence that palbociclib may reverse endocrine therapy resistance and that it may also be added to ongoing endocrine therapy beyond progression to obtain clinical benefit. The aim of the present study was to explore this possibility in 5 patients who received palbociclib + fulvestrant following disease progression while under treatment with fulvestrant alone. The median progression-free survival was not reached during a median follow-up of 25 months, and the most frequent best response was stable disease. Three patients remained under treatment on the last re-evaluation. All patients had highly endocrine-sensitive disease and had previously received fulvestrant for ≥12 months. The hypothesis that a selected subpopulation of patients with HR+/HER2- metastatic breast cancer may benefit from the addition of palbociclib to ongoing endocrine therapy beyond disease progression merits further investigation.
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Affiliation(s)
- Francesco Schettini
- Department of Clinical Medicine and Surgery, University of Naples 'Federico II', I-80131 Naples, Italy.,Translational Genomics and Targeted Therapeutics in Solid Tumors, IDIBAPS, 08036 Barcelona, Spain
| | - Irene De Santo
- Department of Clinical Medicine and Surgery, University of Naples 'Federico II', I-80131 Naples, Italy.,'Sandro Pitigliani' Medical Oncology Department, Hospital of Prato, I-59100 Prato, Italy
| | - Carmen G Rea
- Department of Clinical Medicine and Surgery, University of Naples 'Federico II', I-80131 Naples, Italy
| | - Martina Viggiani
- Department of Clinical Medicine and Surgery, University of Naples 'Federico II', I-80131 Naples, Italy
| | - Giuseppe Buono
- Department of Clinical Medicine and Surgery, University of Naples 'Federico II', I-80131 Naples, Italy
| | - Carmine De Angelis
- Department of Clinical Medicine and Surgery, University of Naples 'Federico II', I-80131 Naples, Italy
| | - Cinzia Cardalesi
- Department of Clinical Medicine and Surgery, University of Naples 'Federico II', I-80131 Naples, Italy
| | - Rossella Lauria
- Department of Clinical Medicine and Surgery, University of Naples 'Federico II', I-80131 Naples, Italy
| | - Mario Giuliano
- Department of Clinical Medicine and Surgery, University of Naples 'Federico II', I-80131 Naples, Italy
| | - Valeria Forestieri
- Department of Clinical Medicine and Surgery, University of Naples 'Federico II', I-80131 Naples, Italy
| | - Guglielmo Thomas
- Clinica Mediterranea, I-80100 Naples, Italy, Senology Unit, Villa Betania Hospital, I-80100 Naples, Italy
| | | | - Gennaro Limite
- Department of General and Specialist Surgery, University of Naples 'Federico II', I-80131 Naples, Italy
| | - Antonello Accurso
- Department of General and Specialist Surgery, University of Naples 'Federico II', I-80131 Naples, Italy
| | - Luca Malorni
- 'Sandro Pitigliani' Medical Oncology Department, Hospital of Prato, I-59100 Prato, Italy
| | - Sabino De Placido
- Department of Clinical Medicine and Surgery, University of Naples 'Federico II', I-80131 Naples, Italy
| | - Grazia Arpino
- Department of Clinical Medicine and Surgery, University of Naples 'Federico II', I-80131 Naples, Italy
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11
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Lorusso D, Bologna A, Cecere SC, De Matteis E, Scandurra G, Zamagni C, Arcangeli V, Artioli F, Bella M, Blanco G, Cardalesi C, Casartelli C, De Vivo R, Di Napoli M, Gisone EB, Lauria R, Lissoni AA, Loizzi V, Maccaroni E, Mangili G, Marchetti C, Martella F, Naglieri E, Parolin V, Ricciardi G, Ronzino G, Salutari V, Scarfone G, Secondino S, Spagnoletti I, Tasca G, Tognon G, Guarneri V. Sharing real-world experiences to optimize the management of olaparib toxicities: a practical guidance from an Italian expert panel. Support Care Cancer 2020; 28:2435-2442. [PMID: 32048043 DOI: 10.1007/s00520-020-05320-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 01/17/2020] [Indexed: 11/28/2022]
Abstract
Olaparib is the first poly(ADP-ribose) polymerase inhibitor approved as maintenance therapy of recurrent ovarian cancer (OC) patients with a BRCA mutation. To achieve the maximum clinical benefit, adherence to olaparib must be persistent. However, in clinical practice, this is challenged by the frequent suboptimal management of toxicities. In view of the expanding use of olaparib also in Italy, physicians must learn how to adequately and promptly manage drug toxicities not to unnecessarily interrupt or reduce the dose. The experts agreed that nausea,vomiting, anemia, and fatigue are the most frequent events experienced by OC patients on olaparib, and that these toxicities usually develop early during treatment, are mainly of grade 1-2 and transient and can be managed with simple non-pharmacological interventions. By sharing their real-world experiences, the panel prepared, for each toxicity, an algorithm organized by grade and besides the procedures indicated in the local label, included supportive care interventions based also on nutritional and lifestyle modifications and psycho-oncology consultation. Moreover, in view of the tablet entry into the Italian market, the full and reduced dosages of capsules and tablets were compared. This practical guidance is intended to be a tool to support especially less-experienced physicians in the management of these complex patients, with the aim to help preventing the worsening of patients' conditions and the unnecessary interruption/reduction of olaparib dosage, which may jeopardize treatment efficacy.
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Affiliation(s)
- Domenica Lorusso
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy.
| | - Alessandra Bologna
- Oncologia Medica, IRCCS Arcispedale S. Maria Nuova, Viale Risorgimento, 80, 42123, Reggio Emilia, Italy
| | - Sabrina Chiara Cecere
- Oncologia Clinica Sperimentale Uro-Ginecologica, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, Via Mariano Semmola, 53, 80131, Naples, Italy
| | | | - Giusy Scandurra
- Multidisciplinary Breast Unit, Azienda Ospedaliera Cannizzaro, Via Messina, 829, 95126, Catania, Italy
| | - Claudio Zamagni
- Medical Oncology Unit, S.Orsola-Malpighi Hospital, Viale Ercolani 4/2, Bologna, Italy
| | - Valentina Arcangeli
- U.O. Oncologia, Ospedale Infermi Rimini, AUSL Romagna, viale Settembrini 2, 47923, Rimini, Italy
| | - Fabrizio Artioli
- Oncology Dept., Carpi and Mirandola Hospitals, Via G. Molinari 2, 41012, Carpi, Italy
| | - Mariangela Bella
- Medical Oncology Unit, University Hospital of Parma, Viale Antonio Gramsci, 14, 43126, Parma, Italy
| | - Giusi Blanco
- Oncology Unit, Ist. Oncologico del Mediterraneo, Via Penninazzo, 7, Viagrande, 95029, Catania, Italy
| | - Cinzia Cardalesi
- Dept. of Clinical and Surgical Medicine, Federico II University Hospital, Via Pansini 5, 80131, Naples, Italy
| | - Clelia Casartelli
- Medical Oncology Unit, Ospedale Valduce, Via Dante Alighieri, 11, 22100, Como, Italy
| | - Rocco De Vivo
- Medical Oncology Unit, AULSS 8 Vicenza, viale Rodolfi, 37, 36100, Vicenza, Italy
| | - Marilena Di Napoli
- Oncologia Clinica Sperimentale Uro-Ginecologica, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, Via Mariano Semmola, 53, 80131, Naples, Italy
| | - Emanuele Baldo Gisone
- Dept of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Via del Ponte, 19, 21100, Varese, Italy
| | - Rossella Lauria
- Dept. of Clinical and Surgical Medicine, Federico II University Hospital, Via Pansini 5, 80131, Naples, Italy
| | - Alberto Andrea Lissoni
- Dept of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, 20900, Monza, Italy.,Clinic of Obstetrics and Gynecology, San Gerardo Hospital, Via Pergolesi 33, 20900, Monza, Italy
| | - Vera Loizzi
- Dept of Biomedical Sciences and Medical Oncology, University of Bari "Aldo Moro", Piazza Umberto I 1, 70124, Bari, Italy
| | - Elena Maccaroni
- Clinica Oncologica, AOU Ospedali Riuniti Ancona, via Conca 71, , 60020, Ancona, AN, Italy
| | - Giorgia Mangili
- Obstetrics and Gynecology, San Raffaele Hospital, Via Olgettina Milano, 60, 20132, Milan, Italy
| | - Claudia Marchetti
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Francesca Martella
- Breast Unit, Ospedale S.M. Annunziata, USL Toscana Centro, Via dell'Antella, 58, Bagno a Ripoli, 50012, Florence, Italy
| | - Emanuele Naglieri
- Division of Medical Oncology, IRCCS Istituto Oncologico Giovanni Paolo II, Viale Orazio Flacco, 65, 70124, Bari, Italy
| | - Veronica Parolin
- Breast Uni, Azienda Ospedaliera Universitaria Integrata, Piazzale Aristide Stefani, 1, 37126, Verona, Italy
| | - Giusy Ricciardi
- Medical Oncology, AO Papardo, Contrada Papardo, 98158, Messina, Italy
| | - Graziana Ronzino
- Dept. of Oncology, Vito Fazzi Hospital, Piazzetta Muratore, 73100, Lecce, Italy
| | - Vanda Salutari
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Giovanna Scarfone
- Dept of Obstetrics, Gynecology and Neonatology, IRCCS Fondazione Cà Granda, Ospedale Maggiore Policlinico, via F. Sforza 28, Milan, Italy
| | - Simona Secondino
- Fondazione IRCCS Policlinico San Matteo, Viale Camillo Golgi, 19, 27100, Pavia, Italy
| | - Ilaria Spagnoletti
- Medical Oncology Unit, Ospedale Sacro Cuore di Gesù, Fatebenefratelli, Viale Principe di Napoli, 14/A, 82100, Benevento, Italy
| | - Giulia Tasca
- Division of Medical Oncology 2, Istituto Oncologico Veneto, Via Gattamelata, 64, 35128, Padua, Italy
| | - Germana Tognon
- UO Ostetricia e Ginecologia-ASST degli Spedali Civili di Brescia, Università degli Studi, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - Valentina Guarneri
- Division of Medical Oncology 2, Istituto Oncologico Veneto, Via Gattamelata, 64, 35128, Padua, Italy
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Cecere SC, Giannone G, Salutari V, Arenare L, Lorusso D, Ronzino G, Lauria R, Cormio G, Carella C, Scollo P, Ghizzoni V, Raspagliesi F, Di Napoli M, Mazzoni E, Marchetti C, Bergamini A, Orditura M, Valabrega G, Scambia G, Maltese G, De Matteis E, Cardalesi C, Loizzi V, Boccia S, Naglieri E, Scandurra G, Pignata S. Olaparib as maintenance therapy in patients with BRCA 1–2 mutated recurrent platinum sensitive ovarian cancer: Real world data and post progression outcome. Gynecol Oncol 2020; 156:38-44. [DOI: 10.1016/j.ygyno.2019.10.023] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 10/17/2019] [Accepted: 10/19/2019] [Indexed: 11/25/2022]
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Frassoldati A, Biganzoli L, Bordonaro R, Cinieri S, Conte P, Laurentis MD, Mastro LD, Gori S, Lauria R, Marchetti P, Michelotti A, Montemurro F, Naso G, Pronzato P, Puglisi F, Tondini CA. Endocrine therapy for hormone receptor-positive, HER2-negative metastatic breast cancer: extending endocrine sensitivity. Future Oncol 2019; 16:129-145. [PMID: 31849236 DOI: 10.2217/fon-2018-0942] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Targeted agents have significantly prolonged survival and improved response rates in first- and second-line settings of hormone receptor-positive/HER2-negative metastatic breast cancer. Optimal sequencing of the available options may prolong endocrine sensitivity, slow disease progression and delay the need for chemotherapy. However, the optimal treatment sequence remains unclear and therapeutic decisions are complex. We review the latest recommendations and supporting evidence for endocrine therapy in women with hormone receptor-positive/HER2-negative metastatic breast cancer and discuss strategies for the optimal sequential therapy in scenarios of response to endocrine therapy. Although more data are needed to define the best sequence of endocrine treatments, more personalized sequential strategies, which take into account response to previous treatments as well as disease symptoms and safety issues, will be increasingly feasible.
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Affiliation(s)
- Antonio Frassoldati
- Department of Oncology, Azienda Ospedaliero Universitaria di Ferrara-Arcispedale Sant'Anna, Ferrara, Italy
| | - Laura Biganzoli
- Breast Centre, Department of Oncology, AUSL Toscana Centro-Prato, Italy
| | - Roberto Bordonaro
- Department of Oncology, Medical Oncology Unit, ARNAS Garibaldi, Catania, Italy
| | - Saverio Cinieri
- Depertment of Oncology, Medical Oncology & Breast Unit, "Antonio Perrino" Hospital, Brindisi, Italy
| | - Pierfranco Conte
- University of Padua & Istituto Oncologico Veneto, Department of Oncology, Medical Oncology 2, IRCCS, Padua, Italy
| | - Michelino De Laurentis
- Department of Breast and Thoracic Oncology, National Cancer Institute Fondazione "G.Pascale", Naples, Italy
| | - Lucia Del Mastro
- Department of Oncology & Hematology, Medical Oncology 2, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Stefania Gori
- Department of Oncology, IRCCS Sacro Cuore-Don Calabria Hospital, Negrar, Verona, Italy
| | - Rossella Lauria
- Department of Clinical Medicine & Surgery, University of Naples "Federico II", Naples, Italy
| | - Paolo Marchetti
- Medical Oncology Unit, Sant'Andrea Hospital of Rome & IDI-IRCCS, Rome, Italy
| | | | - Filippo Montemurro
- Direzione Day Hospital Oncologico Multidisciplinare, Istituto di Candiolo, FPO-IRCCS, Candiolo, Italy
| | - Giuseppe Naso
- Oncology B Unit, Sapienza University of Rome, Rome, Italy
| | - Paolo Pronzato
- Department of Oncology & Hematology, Medical Oncology 2, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Fabio Puglisi
- Department of Medicine, University of Udine, Italy; Department of Medical Oncology, IRCCS, CRO Aviano, National Cancer Institute, Aviano (PN), Italy
| | - Carlo Alberto Tondini
- Department of Medical Oncology, Azienda Socio-Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy
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14
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Conforti A, Schettini F, Vallone R, Di Rella F, De Rosa P, De Santo I, Giuliano M, Arpino G, Lauria R, De Placido S, Caputo R, De Laurentiis M, Nazzaro G, De Placido G, Locci M, Alviggi C. Unexpected ovarian activity in premenopausal breast cancer survivors treated with exemestane and GnRH analogues. Breast J 2019; 25:1310-1311. [DOI: 10.1111/tbj.13474] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 02/25/2019] [Accepted: 02/26/2019] [Indexed: 12/01/2022]
Affiliation(s)
- Alessandro Conforti
- Department of Neuroscience, Reproductive Science and Odontostomatology University of Naples Federico II Naples Italy
| | - Francesco Schettini
- Department of Clinical Medicine and Surgery University of Naples Federico II Naples Italy
- Translational genomics and targeted therapeutics in solid tumors August Pi I Sunyer Biomedical Research Institute (IDIBAPS) Barcelona Spain
- SOLTI Breast Cancer Research Group Barcelona Spain
| | - Roberta Vallone
- Department of Neuroscience, Reproductive Science and Odontostomatology University of Naples Federico II Naples Italy
| | | | - Pasquale De Rosa
- Department of Neuroscience, Reproductive Science and Odontostomatology University of Naples Federico II Naples Italy
| | - Irene De Santo
- Department of Clinical Medicine and Surgery University of Naples Federico II Naples Italy
| | - Mario Giuliano
- Department of Clinical Medicine and Surgery University of Naples Federico II Naples Italy
| | - Grazia Arpino
- Department of Clinical Medicine and Surgery University of Naples Federico II Naples Italy
| | - Rossella Lauria
- Department of Clinical Medicine and Surgery University of Naples Federico II Naples Italy
| | - Sabino De Placido
- Department of Clinical Medicine and Surgery University of Naples Federico II Naples Italy
| | - Roberta Caputo
- Department of Senology IRCCS “Fondazione G. Pascale” Naples Italy
| | | | - Giovanni Nazzaro
- Department of Neuroscience, Reproductive Science and Odontostomatology University of Naples Federico II Naples Italy
| | - Giuseppe De Placido
- Department of Neuroscience, Reproductive Science and Odontostomatology University of Naples Federico II Naples Italy
| | - Mariavittoria Locci
- Department of Neuroscience, Reproductive Science and Odontostomatology University of Naples Federico II Naples Italy
| | - Carlo Alviggi
- Department of Neuroscience, Reproductive Science and Odontostomatology University of Naples Federico II Naples Italy
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15
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Perrone F, De Laurentiis M, De Placido S, Orditura M, Cinieri S, Riccardi F, Ribecco AS, Putzu C, Del Mastro L, Rossi E, Tinessa V, Mosconi AM, Nuzzo F, Di Rella F, Gravina A, Iodice G, Landi G, Pacilio C, Forestieri V, Lauria R, Fabbri A, Ibrahim T, De Maio E, Barni S, Gori S, Simeon V, Arenare L, Daniele G, Piccirillo MC, Normanno N, de Matteis A, Gallo C. Adjuvant zoledronic acid and letrozole plus ovarian function suppression in premenopausal breast cancer: HOBOE phase 3 randomised trial. Eur J Cancer 2019; 118:178-186. [PMID: 31164265 DOI: 10.1016/j.ejca.2019.05.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [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: 02/28/2019] [Revised: 04/15/2019] [Accepted: 05/02/2019] [Indexed: 11/13/2022]
Abstract
AIM The aim of the study is to analyse whether letrozole (L) and zoledronic acid plus L (ZL) are more effective than tamoxifen (T) as adjuvant endocrine treatment of premenopausal patients with breast cancer with hormone receptor-positive (HR+) tumours. PATIENTS AND METHODS In a phase 3 trial, 1065 premenopausal patients with HR + early breast cancer received triptorelin to suppress ovarian function and were randomly assigned (1:1:1) to adjuvant T, L or ZL for 5 years. Cancer recurrence, second breast or non-breast cancer and death were considered events for the intention-to-treat disease-free survival (DFS) analysis. RESULTS With a 64-month median follow-up and 134 reported events, the disease-free rate at 5 years was 85.4%, 93.2% and 93.3% with T, L and ZL, respectively (overall P = 0.008). The hazard ratio for a DFS event was 0.52 (95% confidence interval [CI], 0.34 to 0.80; P = 0.003) with ZL vs T, 0.72 (95% CI, 0.48 to 1.07; P = 0.06) with L vs T and 0.70 (95% CI, 0.44 to 1.12; P = 0.22) with ZL vs L. With 36 deaths, there was no significant difference in overall survival (P = 0.14). Treatment was stopped for toxicity or refusal in 7.3%, 7.3% and 16.6% patients, and in the safety population, grade 3-4 side-effects were reported in 4.2%, 6.9% and 9.1% patients treated with T, L or ZL, respectively. CONCLUSION HOBOE study shows that in premenopausal patients with early breast cancer undergoing ovarian function suppression with triptorelin, ZL significantly improves DFS, while worsening compliance and toxicity, as compared with T. (NCT00412022).
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Affiliation(s)
- Francesco Perrone
- Clinical Trial Unit, Istituto Nazionale Tumori, IRCCS, Fondazione G.Pascale, Napoli, Italy.
| | - Michelino De Laurentiis
- Clinical and Experimental Senology, Istituto Nazionale Tumori, IRCCS, Fondazione G.Pascale, Napoli, Italy
| | - Sabino De Placido
- Department of Medical and Surgical Clinics, Università Federico II, Napoli, Italy
| | - Michele Orditura
- Oncoematology Unit, Università Degli Studi Della Campania "Luigi Vanvitelli", Napoli, Italy
| | | | | | | | - Carlo Putzu
- Medical Oncology, Azienda Ospedaliera Universitaria, Sassari, Italy
| | - Lucia Del Mastro
- IRCCS Ospedale Policlinico San Martino, Genova, Italy; Department of Internal Medicine (DIMI), Università di Genova, Italy
| | - Emanuela Rossi
- Medical Oncology, A.O. San Giuseppe Moscati, Avellino, Italy
| | | | - Anna Maria Mosconi
- Medical Oncology, Ospedale Santa Maria Della Misericordia, S.Andrea Delle Fratte, Perugia, Italy
| | - Francesco Nuzzo
- Clinical and Experimental Senology, Istituto Nazionale Tumori, IRCCS, Fondazione G.Pascale, Napoli, Italy
| | - Francesca Di Rella
- Clinical and Experimental Senology, Istituto Nazionale Tumori, IRCCS, Fondazione G.Pascale, Napoli, Italy
| | - Adriano Gravina
- Clinical and Experimental Senology, Istituto Nazionale Tumori, IRCCS, Fondazione G.Pascale, Napoli, Italy
| | - Giovanni Iodice
- Clinical and Experimental Senology, Istituto Nazionale Tumori, IRCCS, Fondazione G.Pascale, Napoli, Italy
| | - Gabriella Landi
- Clinical and Experimental Senology, Istituto Nazionale Tumori, IRCCS, Fondazione G.Pascale, Napoli, Italy
| | - Carmen Pacilio
- Clinical and Experimental Senology, Istituto Nazionale Tumori, IRCCS, Fondazione G.Pascale, Napoli, Italy
| | - Valeria Forestieri
- Department of Medical and Surgical Clinics, Università Federico II, Napoli, Italy
| | - Rossella Lauria
- Department of Medical and Surgical Clinics, Università Federico II, Napoli, Italy
| | - Agnese Fabbri
- Department of Medical Oncology, Ospedale Belcolle, Viterbo, Italy
| | - Toni Ibrahim
- Osteoncology and Rare Tumors Center, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola FC, Italy
| | | | - Sandro Barni
- Medical Oncology - Ospedale di Treviglio Caravaggio BG, Italy
| | - Stefania Gori
- Medical Oncology, IRCCS, Ospedale Sacro Cuore Don Calabria, Negrar VR, Italy
| | - Vittorio Simeon
- Medical Statistics, Università Degli Studi Della Campania "Luigi Vanvitelli", Napoli, Italy
| | - Laura Arenare
- Clinical Trial Unit, Istituto Nazionale Tumori, IRCCS, Fondazione G.Pascale, Napoli, Italy
| | - Gennaro Daniele
- Clinical Trial Unit, Istituto Nazionale Tumori, IRCCS, Fondazione G.Pascale, Napoli, Italy
| | | | - Nicola Normanno
- Cellular Biology and Biotherapies, Istituto Nazionale Tumori, IRCCS, Fondazione G.Pascale, Napoli, Italy
| | - Andrea de Matteis
- Clinical and Experimental Senology, Istituto Nazionale Tumori, IRCCS, Fondazione G.Pascale, Napoli, Italy
| | - Ciro Gallo
- Medical Statistics, Università Degli Studi Della Campania "Luigi Vanvitelli", Napoli, Italy
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16
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Buono G, Crispo A, Giuliano M, Rea CG, Forestieri V, Lauria R, De Placido P, De Laurentiis M, Pacilio C, Grimaldi M, Nocerino F, Montella M, De Placido S, Arpino G. Abstract P2-08-15: Metabolic syndrome and early-stage breast cancer outcome: Results from a prospective observational study. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p2-08-15] [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:Previous studies suggested a link between obesity, insulin-resistance and breast cancer outcome. The aim of the present prospective observational study was to investigate the role of metabolic syndrome (MetS) and its components on early breast cancer (EBC) patients' outcome.
Methods: MetS was defined by the presence of 3 to 5 of the following components: waist circumference (WC) > 88 cm, blood pressure ≥ 130/≥85 mmHg, serum levels of triglycerides (TG) ≥ 150 mg/dL, high-density lipoprotein (HDL) < 50 mg/dL and fasting glucose (FG) ≥ 110 mg/ dL (National Cholesterol Education Program Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults - NCEP-ATPIII criteria). Overall, 955 EBC patients were prospectively enrolled between January 2009 and December 2013 at University Hospital Federico II and National Cancer Institute G.Pascale, Naples, Italy. Clinical and tumor characteristics were collected for all the patients. A total of 494 patients (51.7%) had complete data on all the components of MetS at first diagnosis and thus were included in the current analysis. Study population was divided into 2 main groups: (1) patients with less than 3 components (No MetS); (2) patients with 3-5 components (MetS). Categorical variables were analyzed by the chi-square test and survival data by the log-rank test and Cox proportional hazards regression model.
Results: Overall 366 (74.1%) and 128 (25.9%) women were categorized as No MetS and MetS, respectively. MetS patients were more likely to be older and postmenopausal compared to No MetS patients. In detail, 46% vs 38% were older than 55 yrs (p<0.0001) and 87% vs 54% were postmenopausal (p<0.0001) in MetS vs No MetS groups, respectively. No statistically significant differences in tumor stage, type of adjuvant therapy or tumor subtypes defined by immunohistochemistry (IHC) were identified among the two groups. At univariate analysis, stage, tumor subtypes, TG and FG values, number of components of MetS, and presence of MetS were significantly associated to both disease free survival (DFS) and overall survival (OS). Age, BMI, WC, and HDL levels were correlated to OS only. At the multivariate Cox proportional hazards model (adjusted for age, menopausal status, stage, IHC subtypes and adjuvant therapy) MetS patients had numerically higher risk of relapse and significantly higher risk of death compared to No MetS patients [DFS hazard ratio (HR): 1.64 95% confidence interval (CI): 0.94-2.86, p=0.07 and OS HR: 3.83, 95% CI 1.7-6.77 p=0.001]. Additionally, of the 366 No MetS patients included in the analysis, 122 (33.3%) had 0 and 244 (66.7%) had “1 to 2” components of MetS. Interestingly, patients with “1 to 2” components of MetS had increased risk of dying compared to patients with 0 components (OS HR: 4.39, 95% CI:1.26-15.36, p=0.02) . No significant difference among these two groups was observed in terms of DFS.
Conclusions: MetS is correlated with poor outcome in EBC patients. Among patients without full criteria for MetS diagnosis, the presence of 1 or 2 components of the syndrome may predict for worse survival. Testing for components of MetS in BC patients is recomended to predict outcome and to eventually suggest lifestyle changes, exercise and diet.
Citation Format: Buono G, Crispo A, Giuliano M, Rea CG, Forestieri V, Lauria R, De Placido P, De Laurentiis M, Pacilio C, Grimaldi M, Nocerino F, Montella M, De Placido S, Arpino G. Metabolic syndrome and early-stage breast cancer outcome: Results from a prospective observational study [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P2-08-15.
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Affiliation(s)
- G Buono
- University of Naples Federico II, Naples, Italy; Unit of Epidemiology, National Cancer Institute, G. Pascale Foundation, Naples, Italy; Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX; Breast Unit, National Cancer Institute, G. Pascale Foundation, Naples, Italy
| | - A Crispo
- University of Naples Federico II, Naples, Italy; Unit of Epidemiology, National Cancer Institute, G. Pascale Foundation, Naples, Italy; Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX; Breast Unit, National Cancer Institute, G. Pascale Foundation, Naples, Italy
| | - M Giuliano
- University of Naples Federico II, Naples, Italy; Unit of Epidemiology, National Cancer Institute, G. Pascale Foundation, Naples, Italy; Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX; Breast Unit, National Cancer Institute, G. Pascale Foundation, Naples, Italy
| | - CG Rea
- University of Naples Federico II, Naples, Italy; Unit of Epidemiology, National Cancer Institute, G. Pascale Foundation, Naples, Italy; Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX; Breast Unit, National Cancer Institute, G. Pascale Foundation, Naples, Italy
| | - V Forestieri
- University of Naples Federico II, Naples, Italy; Unit of Epidemiology, National Cancer Institute, G. Pascale Foundation, Naples, Italy; Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX; Breast Unit, National Cancer Institute, G. Pascale Foundation, Naples, Italy
| | - R Lauria
- University of Naples Federico II, Naples, Italy; Unit of Epidemiology, National Cancer Institute, G. Pascale Foundation, Naples, Italy; Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX; Breast Unit, National Cancer Institute, G. Pascale Foundation, Naples, Italy
| | - P De Placido
- University of Naples Federico II, Naples, Italy; Unit of Epidemiology, National Cancer Institute, G. Pascale Foundation, Naples, Italy; Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX; Breast Unit, National Cancer Institute, G. Pascale Foundation, Naples, Italy
| | - M De Laurentiis
- University of Naples Federico II, Naples, Italy; Unit of Epidemiology, National Cancer Institute, G. Pascale Foundation, Naples, Italy; Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX; Breast Unit, National Cancer Institute, G. Pascale Foundation, Naples, Italy
| | - C Pacilio
- University of Naples Federico II, Naples, Italy; Unit of Epidemiology, National Cancer Institute, G. Pascale Foundation, Naples, Italy; Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX; Breast Unit, National Cancer Institute, G. Pascale Foundation, Naples, Italy
| | - M Grimaldi
- University of Naples Federico II, Naples, Italy; Unit of Epidemiology, National Cancer Institute, G. Pascale Foundation, Naples, Italy; Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX; Breast Unit, National Cancer Institute, G. Pascale Foundation, Naples, Italy
| | - F Nocerino
- University of Naples Federico II, Naples, Italy; Unit of Epidemiology, National Cancer Institute, G. Pascale Foundation, Naples, Italy; Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX; Breast Unit, National Cancer Institute, G. Pascale Foundation, Naples, Italy
| | - M Montella
- University of Naples Federico II, Naples, Italy; Unit of Epidemiology, National Cancer Institute, G. Pascale Foundation, Naples, Italy; Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX; Breast Unit, National Cancer Institute, G. Pascale Foundation, Naples, Italy
| | - S De Placido
- University of Naples Federico II, Naples, Italy; Unit of Epidemiology, National Cancer Institute, G. Pascale Foundation, Naples, Italy; Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX; Breast Unit, National Cancer Institute, G. Pascale Foundation, Naples, Italy
| | - G Arpino
- University of Naples Federico II, Naples, Italy; Unit of Epidemiology, National Cancer Institute, G. Pascale Foundation, Naples, Italy; Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX; Breast Unit, National Cancer Institute, G. Pascale Foundation, Naples, Italy
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17
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De Placido S, De Laurentiis M, Bruzzese D, Bernardo A, Baldini EE, Montesarchio V, Fabi A, Gamucci T, De Placido P, Russo S, Lauria R, De Santo I, De Angelis C, Del Mastro L, Giuliano M, Arpino G. Abstract P6-21-13: A phase II single arm trial evaluating the efficacy and safety of eribulin in combination with bevacizumab for second-line treatment of human epidermal growth factor receptor 2 (HER2)–negative metastatic breast cancer (MBC) progressing after first-line therapy with bevacizumab and paclitaxel. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p6-21-13] [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: At present, there is no standard second-line chemotherapy-based treatment in patients with HER2-negative MBC. Continued VEGF inhibition with bevacizumab is a new potential option in patients progressing to first line bevacizumab and chemotherapy. Eribulin is a non-taxane microtubule dynamics inhibitor, with a unique mechanism of action and suggested beneficial effects on tumor microenvironment and neoangiogenesis. This study evaluated efficacy and safety of eribulin plus bevacizumab as a novel second-line chemotherapy scheme, in patients progressing after first line paclitaxel and bevacizumab.
Methods: This is a multicenter, single-arm, Simon's two-stage, Phase II study. Patients with HER2-negative MBC progressing to paclitaxel and bevacizumab received eribulin (1.23 mg/m2 intravenously on Days 1 and 8 of every 21-day cycle) plus bevacizumab (10 mg/kg every 2 weeks or 15 mg/kg every 3 weeks intravenously), as second-line chemotherapy. The primary endpoint was the overall response rate (ORR), considered as sum of partial (PR) and complete response (CR), basing on the best overall response. The present safety and efficacy analyses, as planned per study design, refer to six cycles of treatment (18 weeks).
Results: Among the 61 patients enrolled in the study, 55 (90,2% ) were evaluable for efficacy. ORR (PR/CR) was 9.1% [95% confidence intervals (C.I.) 3.0 to 19.9]; stable disease (SD) rate was 63.6% [95% C.I. 49.6 to 76.2]; clinical benefit rate (CR/PR/SD) at 24 weeks was 35% [95% C.I. 22.0 to 49.1]. The median progression free survival was 6.3 months [95% C.I. 4.1 to 7.8 months]. Drugs-related adverse events (AEs) were: 49.5% related to eribulin, 7.7% related to bevacizumab, and 11.8% related to both the study drugs. The most common AEs were fatigue (9.9% of all AEs), paresthesia (6.5% of all AEs) and neutropenia (6.2% of all AEs). Quality of life was well preserved among the majority of patients.
Conclusions: The results of our trial suggest that continuing bevacizumab in combination with eribulin, beyond first line treatment with bevacizumab and paclitaxel, offers a reasonable therapeutic option for patients with HER2-negative MBC, without detrimentally affecting quality of life.
Citation Format: De Placido S, De Laurentiis M, Bruzzese D, Bernardo A, Baldini EE, Montesarchio V, Fabi A, Gamucci T, De Placido P, Russo S, Lauria R, De Santo I, De Angelis C, Del Mastro L, Giuliano M, Arpino G. A phase II single arm trial evaluating the efficacy and safety of eribulin in combination with bevacizumab for second-line treatment of human epidermal growth factor receptor 2 (HER2)–negative metastatic breast cancer (MBC) progressing after first-line therapy with bevacizumab and paclitaxel [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P6-21-13.
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Affiliation(s)
- S De Placido
- Università degli Studi di Napoli "Federico II", Napoli, NA, Italy; Istituto Nazionale Tumori - IRCCS "Fondazione G.Pascale", Napoli, NA, Italy; Istituti Clinici Scientifici Maugeri SpA SB, Pavia, PV, Italy; Ospedale San Luca, Lucca, LU, Italy; Azienda Ospedaliera dei Colli Monaldi, Napoli, NA, Italy; IFO - Istituto Nazionale Tumori Regina Elena, Roma, RM, Italy; Ospedale 'SS. Trinità', Sora, FR, Italy; A.O.U. Santa Maria della Misericordia di Udine, Udine, UD, Italy; Azienda Ospedaliera Universitaria Pisana - Ospedale S. Chiara, Pisa, PI, Italy; I.R.C.C.S. A.O.U. San Martino - I.S.T., Genova, GE, Italy
| | - M De Laurentiis
- Università degli Studi di Napoli "Federico II", Napoli, NA, Italy; Istituto Nazionale Tumori - IRCCS "Fondazione G.Pascale", Napoli, NA, Italy; Istituti Clinici Scientifici Maugeri SpA SB, Pavia, PV, Italy; Ospedale San Luca, Lucca, LU, Italy; Azienda Ospedaliera dei Colli Monaldi, Napoli, NA, Italy; IFO - Istituto Nazionale Tumori Regina Elena, Roma, RM, Italy; Ospedale 'SS. Trinità', Sora, FR, Italy; A.O.U. Santa Maria della Misericordia di Udine, Udine, UD, Italy; Azienda Ospedaliera Universitaria Pisana - Ospedale S. Chiara, Pisa, PI, Italy; I.R.C.C.S. A.O.U. San Martino - I.S.T., Genova, GE, Italy
| | - D Bruzzese
- Università degli Studi di Napoli "Federico II", Napoli, NA, Italy; Istituto Nazionale Tumori - IRCCS "Fondazione G.Pascale", Napoli, NA, Italy; Istituti Clinici Scientifici Maugeri SpA SB, Pavia, PV, Italy; Ospedale San Luca, Lucca, LU, Italy; Azienda Ospedaliera dei Colli Monaldi, Napoli, NA, Italy; IFO - Istituto Nazionale Tumori Regina Elena, Roma, RM, Italy; Ospedale 'SS. Trinità', Sora, FR, Italy; A.O.U. Santa Maria della Misericordia di Udine, Udine, UD, Italy; Azienda Ospedaliera Universitaria Pisana - Ospedale S. Chiara, Pisa, PI, Italy; I.R.C.C.S. A.O.U. San Martino - I.S.T., Genova, GE, Italy
| | - A Bernardo
- Università degli Studi di Napoli "Federico II", Napoli, NA, Italy; Istituto Nazionale Tumori - IRCCS "Fondazione G.Pascale", Napoli, NA, Italy; Istituti Clinici Scientifici Maugeri SpA SB, Pavia, PV, Italy; Ospedale San Luca, Lucca, LU, Italy; Azienda Ospedaliera dei Colli Monaldi, Napoli, NA, Italy; IFO - Istituto Nazionale Tumori Regina Elena, Roma, RM, Italy; Ospedale 'SS. Trinità', Sora, FR, Italy; A.O.U. Santa Maria della Misericordia di Udine, Udine, UD, Italy; Azienda Ospedaliera Universitaria Pisana - Ospedale S. Chiara, Pisa, PI, Italy; I.R.C.C.S. A.O.U. San Martino - I.S.T., Genova, GE, Italy
| | - EE Baldini
- Università degli Studi di Napoli "Federico II", Napoli, NA, Italy; Istituto Nazionale Tumori - IRCCS "Fondazione G.Pascale", Napoli, NA, Italy; Istituti Clinici Scientifici Maugeri SpA SB, Pavia, PV, Italy; Ospedale San Luca, Lucca, LU, Italy; Azienda Ospedaliera dei Colli Monaldi, Napoli, NA, Italy; IFO - Istituto Nazionale Tumori Regina Elena, Roma, RM, Italy; Ospedale 'SS. Trinità', Sora, FR, Italy; A.O.U. Santa Maria della Misericordia di Udine, Udine, UD, Italy; Azienda Ospedaliera Universitaria Pisana - Ospedale S. Chiara, Pisa, PI, Italy; I.R.C.C.S. A.O.U. San Martino - I.S.T., Genova, GE, Italy
| | - V Montesarchio
- Università degli Studi di Napoli "Federico II", Napoli, NA, Italy; Istituto Nazionale Tumori - IRCCS "Fondazione G.Pascale", Napoli, NA, Italy; Istituti Clinici Scientifici Maugeri SpA SB, Pavia, PV, Italy; Ospedale San Luca, Lucca, LU, Italy; Azienda Ospedaliera dei Colli Monaldi, Napoli, NA, Italy; IFO - Istituto Nazionale Tumori Regina Elena, Roma, RM, Italy; Ospedale 'SS. Trinità', Sora, FR, Italy; A.O.U. Santa Maria della Misericordia di Udine, Udine, UD, Italy; Azienda Ospedaliera Universitaria Pisana - Ospedale S. Chiara, Pisa, PI, Italy; I.R.C.C.S. A.O.U. San Martino - I.S.T., Genova, GE, Italy
| | - A Fabi
- Università degli Studi di Napoli "Federico II", Napoli, NA, Italy; Istituto Nazionale Tumori - IRCCS "Fondazione G.Pascale", Napoli, NA, Italy; Istituti Clinici Scientifici Maugeri SpA SB, Pavia, PV, Italy; Ospedale San Luca, Lucca, LU, Italy; Azienda Ospedaliera dei Colli Monaldi, Napoli, NA, Italy; IFO - Istituto Nazionale Tumori Regina Elena, Roma, RM, Italy; Ospedale 'SS. Trinità', Sora, FR, Italy; A.O.U. Santa Maria della Misericordia di Udine, Udine, UD, Italy; Azienda Ospedaliera Universitaria Pisana - Ospedale S. Chiara, Pisa, PI, Italy; I.R.C.C.S. A.O.U. San Martino - I.S.T., Genova, GE, Italy
| | - T Gamucci
- Università degli Studi di Napoli "Federico II", Napoli, NA, Italy; Istituto Nazionale Tumori - IRCCS "Fondazione G.Pascale", Napoli, NA, Italy; Istituti Clinici Scientifici Maugeri SpA SB, Pavia, PV, Italy; Ospedale San Luca, Lucca, LU, Italy; Azienda Ospedaliera dei Colli Monaldi, Napoli, NA, Italy; IFO - Istituto Nazionale Tumori Regina Elena, Roma, RM, Italy; Ospedale 'SS. Trinità', Sora, FR, Italy; A.O.U. Santa Maria della Misericordia di Udine, Udine, UD, Italy; Azienda Ospedaliera Universitaria Pisana - Ospedale S. Chiara, Pisa, PI, Italy; I.R.C.C.S. A.O.U. San Martino - I.S.T., Genova, GE, Italy
| | - P De Placido
- Università degli Studi di Napoli "Federico II", Napoli, NA, Italy; Istituto Nazionale Tumori - IRCCS "Fondazione G.Pascale", Napoli, NA, Italy; Istituti Clinici Scientifici Maugeri SpA SB, Pavia, PV, Italy; Ospedale San Luca, Lucca, LU, Italy; Azienda Ospedaliera dei Colli Monaldi, Napoli, NA, Italy; IFO - Istituto Nazionale Tumori Regina Elena, Roma, RM, Italy; Ospedale 'SS. Trinità', Sora, FR, Italy; A.O.U. Santa Maria della Misericordia di Udine, Udine, UD, Italy; Azienda Ospedaliera Universitaria Pisana - Ospedale S. Chiara, Pisa, PI, Italy; I.R.C.C.S. A.O.U. San Martino - I.S.T., Genova, GE, Italy
| | - S Russo
- Università degli Studi di Napoli "Federico II", Napoli, NA, Italy; Istituto Nazionale Tumori - IRCCS "Fondazione G.Pascale", Napoli, NA, Italy; Istituti Clinici Scientifici Maugeri SpA SB, Pavia, PV, Italy; Ospedale San Luca, Lucca, LU, Italy; Azienda Ospedaliera dei Colli Monaldi, Napoli, NA, Italy; IFO - Istituto Nazionale Tumori Regina Elena, Roma, RM, Italy; Ospedale 'SS. Trinità', Sora, FR, Italy; A.O.U. Santa Maria della Misericordia di Udine, Udine, UD, Italy; Azienda Ospedaliera Universitaria Pisana - Ospedale S. Chiara, Pisa, PI, Italy; I.R.C.C.S. A.O.U. San Martino - I.S.T., Genova, GE, Italy
| | - R Lauria
- Università degli Studi di Napoli "Federico II", Napoli, NA, Italy; Istituto Nazionale Tumori - IRCCS "Fondazione G.Pascale", Napoli, NA, Italy; Istituti Clinici Scientifici Maugeri SpA SB, Pavia, PV, Italy; Ospedale San Luca, Lucca, LU, Italy; Azienda Ospedaliera dei Colli Monaldi, Napoli, NA, Italy; IFO - Istituto Nazionale Tumori Regina Elena, Roma, RM, Italy; Ospedale 'SS. Trinità', Sora, FR, Italy; A.O.U. Santa Maria della Misericordia di Udine, Udine, UD, Italy; Azienda Ospedaliera Universitaria Pisana - Ospedale S. Chiara, Pisa, PI, Italy; I.R.C.C.S. A.O.U. San Martino - I.S.T., Genova, GE, Italy
| | - I De Santo
- Università degli Studi di Napoli "Federico II", Napoli, NA, Italy; Istituto Nazionale Tumori - IRCCS "Fondazione G.Pascale", Napoli, NA, Italy; Istituti Clinici Scientifici Maugeri SpA SB, Pavia, PV, Italy; Ospedale San Luca, Lucca, LU, Italy; Azienda Ospedaliera dei Colli Monaldi, Napoli, NA, Italy; IFO - Istituto Nazionale Tumori Regina Elena, Roma, RM, Italy; Ospedale 'SS. Trinità', Sora, FR, Italy; A.O.U. Santa Maria della Misericordia di Udine, Udine, UD, Italy; Azienda Ospedaliera Universitaria Pisana - Ospedale S. Chiara, Pisa, PI, Italy; I.R.C.C.S. A.O.U. San Martino - I.S.T., Genova, GE, Italy
| | - C De Angelis
- Università degli Studi di Napoli "Federico II", Napoli, NA, Italy; Istituto Nazionale Tumori - IRCCS "Fondazione G.Pascale", Napoli, NA, Italy; Istituti Clinici Scientifici Maugeri SpA SB, Pavia, PV, Italy; Ospedale San Luca, Lucca, LU, Italy; Azienda Ospedaliera dei Colli Monaldi, Napoli, NA, Italy; IFO - Istituto Nazionale Tumori Regina Elena, Roma, RM, Italy; Ospedale 'SS. Trinità', Sora, FR, Italy; A.O.U. Santa Maria della Misericordia di Udine, Udine, UD, Italy; Azienda Ospedaliera Universitaria Pisana - Ospedale S. Chiara, Pisa, PI, Italy; I.R.C.C.S. A.O.U. San Martino - I.S.T., Genova, GE, Italy
| | - L Del Mastro
- Università degli Studi di Napoli "Federico II", Napoli, NA, Italy; Istituto Nazionale Tumori - IRCCS "Fondazione G.Pascale", Napoli, NA, Italy; Istituti Clinici Scientifici Maugeri SpA SB, Pavia, PV, Italy; Ospedale San Luca, Lucca, LU, Italy; Azienda Ospedaliera dei Colli Monaldi, Napoli, NA, Italy; IFO - Istituto Nazionale Tumori Regina Elena, Roma, RM, Italy; Ospedale 'SS. Trinità', Sora, FR, Italy; A.O.U. Santa Maria della Misericordia di Udine, Udine, UD, Italy; Azienda Ospedaliera Universitaria Pisana - Ospedale S. Chiara, Pisa, PI, Italy; I.R.C.C.S. A.O.U. San Martino - I.S.T., Genova, GE, Italy
| | - M Giuliano
- Università degli Studi di Napoli "Federico II", Napoli, NA, Italy; Istituto Nazionale Tumori - IRCCS "Fondazione G.Pascale", Napoli, NA, Italy; Istituti Clinici Scientifici Maugeri SpA SB, Pavia, PV, Italy; Ospedale San Luca, Lucca, LU, Italy; Azienda Ospedaliera dei Colli Monaldi, Napoli, NA, Italy; IFO - Istituto Nazionale Tumori Regina Elena, Roma, RM, Italy; Ospedale 'SS. Trinità', Sora, FR, Italy; A.O.U. Santa Maria della Misericordia di Udine, Udine, UD, Italy; Azienda Ospedaliera Universitaria Pisana - Ospedale S. Chiara, Pisa, PI, Italy; I.R.C.C.S. A.O.U. San Martino - I.S.T., Genova, GE, Italy
| | - G Arpino
- Università degli Studi di Napoli "Federico II", Napoli, NA, Italy; Istituto Nazionale Tumori - IRCCS "Fondazione G.Pascale", Napoli, NA, Italy; Istituti Clinici Scientifici Maugeri SpA SB, Pavia, PV, Italy; Ospedale San Luca, Lucca, LU, Italy; Azienda Ospedaliera dei Colli Monaldi, Napoli, NA, Italy; IFO - Istituto Nazionale Tumori Regina Elena, Roma, RM, Italy; Ospedale 'SS. Trinità', Sora, FR, Italy; A.O.U. Santa Maria della Misericordia di Udine, Udine, UD, Italy; Azienda Ospedaliera Universitaria Pisana - Ospedale S. Chiara, Pisa, PI, Italy; I.R.C.C.S. A.O.U. San Martino - I.S.T., Genova, GE, Italy
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Perrone F, De Laurentiis M, de Placido S, Orditura M, Cinieri S, Riccardi F, Ribecco A, Putzu C, Del Mastro L, Rossi E, Daniele B, Mosconi A, Di Rella F, Landi G, Nuzzo F, Pacilio C, Lauria R, Arenare L, Piccirillo M, Gallo C. The HOBOE-2 multicenter randomized phase III trial in premenopausal patients with hormone-receptor positive early breast cancer comparing triptorelin plus either tamoxifen or letrozole or letrozole + zoledronic acid. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy424.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Riccardi F, Colantuoni G, Diana A, Mocerino C, Cartenì G, Lauria R, Febbraro A, Nuzzo F, Addeo R, Marano O, Incoronato P, De Placido S, Ciardiello F, Orditura M. Exemestane and Everolimus combination treatment of hormone receptor positive, HER2 negative metastatic breast cancer: A retrospective study of 9 cancer centers in the Campania Region (Southern Italy) focused on activity, efficacy and safety. Mol Clin Oncol 2018; 9:255-263. [PMID: 30155246 PMCID: PMC6109668 DOI: 10.3892/mco.2018.1672] [Citation(s) in RCA: 6] [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: 01/29/2018] [Accepted: 06/05/2018] [Indexed: 01/19/2023] Open
Abstract
Exemestane (Exe) in combination with Everolimus (Eve) represents an important treatment option for patients diagnosed with hormone receptor positive (HR+), human epidermal growth factor receptor 2 negative (HER2-) metastatic breast cancer (MBC), which was previously treated with non-steroidal aromatase inhibitors (NSAI). Data from unselected populations may be useful for defining the optimal therapeutic algorithm within a clinical setting. Data from 264 HR+, HER2-MBC patients who received Exe-Eve treatment in combination, following the failure of NSAIs was retrospectively analyzed. Different lines of endocrine treatment (ET) were investigated to evaluate the efficacy and toxicity of the treatment within the ‘everyday clinical practice’ population. The disease control rate (DCR) was 73.1%, with no statistically significant difference among the different settings. At a median follow-up of 42 months, the median progression free survival (PFS) was 11.6, 9.7 and 7.5 months for patients treated with Exe-Eve as first, second or third line therapy, respectively. There was a statistically significant correlation with younger age, no previous adjuvant chemotherapy (CT), no previous adjuvant endocrine therapy (ET), HT duration ≥36 months, involvement of liver and/or lung, no prior CT for metastatic disease and PS=0 at the start of treatment. The median overall survival (OS) was 33.0 months; at a median follow-up of 67 months, the median OS was 43.1, 31.7 and 27.9 months in patients treated with Exe-Eve in first, second or third line therapy, respectively. On multivariate analysis, diabetes and previous CT for metastatic disease were revealed to correlate with a worse outcome. Conversely, the presence of mucositis was significantly associated with long-term survival. Overall, Exe-Eve was typically well tolerated and the majority toxicities were G1 or 2, while treatment discontinuation due to unacceptable toxicity was only required in 5.7% of patients. Despite the limitations due to the observational nature of this study, the findings suggest that treatment with Exe-Eve is an active and safe therapeutic option for endocrine-sensitive MBC patients in a real-world clinical setting, regardless of treatment lines.
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Affiliation(s)
| | | | - Anna Diana
- Division of Medical Oncology, Department of Precision Medicine, University of Campania 'Luigi Vanvitelli', I-80131 Naples, Italy
| | | | | | - Rossella Lauria
- Medical Oncology, Department of Clinical Medicine and Surgery, University of Naples Federico II, I-80131 Naples, Italy
| | - Antonio Febbraro
- Medical Oncology, Sacro Cuore di Gesù Fatebenefratelli Hospital, I-82100 Benevento, Italy
| | - Francesco Nuzzo
- Breast Cancer Unit, Cancer Institute G. Pascale Foundation, I-80131 Naples, Italy
| | - Raffaele Addeo
- Medical Oncology, Frattamaggiore Hospital, I-80027 Frattamaggiore, Italy
| | - Ombretta Marano
- Medical Oncology, Santa Maria della Pietà Hospital, I-80035 Nola, Italy
| | | | - Sabino De Placido
- Medical Oncology, Department of Clinical Medicine and Surgery, University of Naples Federico II, I-80131 Naples, Italy
| | - Fortunato Ciardiello
- Division of Medical Oncology, Department of Precision Medicine, University of Campania 'Luigi Vanvitelli', I-80131 Naples, Italy
| | - Michele Orditura
- Division of Medical Oncology, Department of Precision Medicine, University of Campania 'Luigi Vanvitelli', I-80131 Naples, Italy
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Cianniello D, Prudente A, Caputo R, Piezzo M, Riemma M, Savastano B, Cocco S, Cerillo I, Lauria R, Giuliano M, Cardalesi C, Buono G, Arpino G, Iodice G, Di Rella F, Pacilio C, Del Prete S, De Placido S, De Laurentiis M. PerTe: Pertuzumab for the neoadjuvant treatment of HER2-positive breast cancer patients—Efficacy and safety of pertuzumab in “real life" setting. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e12654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Daniela Cianniello
- IRCCS INT Fondazione Giovanni Pascale - Breast Oncology Unit, Naples, Italy
| | | | - Roberta Caputo
- IRCCS INT Fondazione Giovanni Pascale - Breast Oncology Unit, Naples, Italy
| | - Michela Piezzo
- IRCCS INT Fondazione Giovanni Pascale - Breast Oncology Unit, Naples, Italy
| | - Maria Riemma
- IRCCS INT Fondazione Giovanni Pascale - Breast Oncology Unit, Naples, Italy
| | - Beatrice Savastano
- IRCCS INT Fondazione Giovanni Pascale - Breast Oncology Unit, Naples, Italy
| | - Stefania Cocco
- IRCCS INT Fondazione Giovanni Pascale - Breast Oncology Unit, Naples, Italy
| | - Ivana Cerillo
- IRCCS INT Fondazione Giovanni Pascale - Breast Oncology Unit, Naples, Italy
| | | | | | | | | | | | - Giovanni Iodice
- IRCCS INT Fondazione Giovanni Pascale - Breast Oncology Unit, Naples, Italy
| | - Francesca Di Rella
- IRCCS INT Fondazione Giovanni Pascale - Breast Oncology Unit, Naples, Italy
| | - Carmen Pacilio
- IRCCS INT Fondazione Giovanni Pascale - Breast Oncology Unit, Naples, Italy
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Di Lorenzo G, Autorino R, De Laurentiis M, Bianco R, Lauria R, Giordano A, De Sio M, D'Armiento M, Bianco AR, De Placido S. Is There a Standard Chemotherapeutic Regimen for Hormone-Refractory Prostate Cancer? Present and Future Approaches in the Management of the Disease. Tumori 2018; 89:349-60. [PMID: 14606635 DOI: 10.1177/030089160308900402] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 11/17/2022]
Abstract
Prostate cancer that no longer responds to hormonal manipulation can be defined as hormone-refractory prostate cancer. Until recently, there has been no standard chemotherapeutic approach for hormone-refractory prostate cancer. The major benefits of chemotherapy in the treatment of the disease are palliative in nature, in terms of reduction of pain and use of analgesics and improvement of performance status, as followed in the most recent trials. Phase III studies are necessary to better evaluate the efficacy of the different regimens, because several old studies suffer for methodological deficits. There is a promising activity of new drug combinations, such as vinca alkaloids and taxanes. Phase I and II trial are testing combinations of classic chemotherapeutic agents and biologic drugs, and the first results appear interesting. In this article, recent advances in the treatment of hormone-refractory prostate cancer using chemotherapeutic regimens are critically reviewed.
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Bianco AR, Stefani S, Gridelli C, Gentile M, Contegiacomo A, Giampaglia F, Lauria R, Conte A, Ferrante G. Intensive Alternating Combination Chemotherapy and High Dose Chest Radiotherapy in Small Cell Lung Cancer. Tumori 2018; 77:437-41. [PMID: 1664155 DOI: 10.1177/030089169107700513] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Sixty-nine patients, 32 with limited and 37 with extensive small cell lung cancer (SCLC), were admitted to the present study. Patients with limited disease underwent alternating combination chemotherapy consisting of CAV (cyclophosphamide, adriamycin, vincristine) and PE (cisplatin and etoposide) regimens and concurrent high dose thoracic radiotherapy (6,000 cGy); prophylactic brain irradiation (3,000 cGy) was administered to complete responders. Patients with extensive disease received the same alternating chemotherapy but not radiotherapy. In the 25 evaluable patients with limited disease we obtained an objective response (OR) in 80% with a complete response (CR) in 54% and partial response (PR) in 24%, stable disease (SD) in 4% and progressive disease (PD) in 16%. Median duration of response was 9.5 months for CR and 8.5 months for PR. Median survival was 14 months for all patients with 12% long-term survivors. Toxicity was acceptable. In the 32 evaluable patients with extensive disease we observed 65.6% OR with 18.7% CR and 46.8% PR, 9.3% minimal response and 25% PD. Median duration of response was 7 months for CR and 8 months for PR. Median survival was 10 months for all patients. The treatment was well tolerated. Our study did not show a therapeutic advantage for alternating combination chemotherapy in SCLC and failed to show the use of high dose chest radiotherapy in combined modality for limited disease.
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Affiliation(s)
- A R Bianco
- Cattedra di Oncologia Medica, 2a Facoltà di Medicina, Università di Napoli, Italy
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Gridelli C, Contegiacomo A, Lauria R, Gentile M, Airoma G, De Placido S, Perrone F, Ferrante G, Bianco AR. Salvage Chemotherapy with Ccnu and Methotrexate for Small Cell Lung Cancer Resistant to Cav/Pe Alternating Chemotherapy. Tumori 2018. [DOI: 10.1177/030089169107700611] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
CCNU and methotrexate were employed as salvage treatment in 34 small cell lung cancer patients resistant to CAV/PE alternating Induction chemotherapy. In the 33 evaluable patients we observed an objective response rate of 21.2 % and 3 % complete response; median survival was 4 months with 2 patients alive 18 months from starting salvage chemotherapy. The treatment was well tolerated. CCNU and methotrexate has shown to be a moderately active and tolerable salvage treatment for small cell lung cancer after CAV/PE alternating first-line chemotherapy.
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Affiliation(s)
- Cesare Gridelli
- Cattedra di Oncologia Medica, II Facoltà di Medicina, Università di Napoli
| | - Alma Contegiacomo
- Cattedra di Oncologia Medica, II Facoltà di Medicina, Università di Napoli
| | - Rossella Lauria
- Cattedra di Oncologia Medica, II Facoltà di Medicina, Università di Napoli
| | - Maria Gentile
- Cattedra di Chirurgia Toracica, II Facoltà di Medicina, Università di Napoli
| | - Giuseppe Airoma
- Cattedra di Oncologia Medica, II Facoltà di Medicina, Università di Napoli
| | - Sabino De Placido
- Cattedra di Oncologia Medica, II Facoltà di Medicina, Università di Napoli
| | - Francesco Perrone
- Cattedra di Oncologia Medica, II Facoltà di Medicina, Università di Napoli
| | - Giovanni Ferrante
- Cattedra di Chirurgia Toracica, II Facoltà di Medicina, Università di Napoli
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24
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Bergamini A, Ferrandina G, Candiani M, Cormio G, Giorda G, Lauria R, Perrone AM, Scarfone G, Breda E, Savarese A, Frigerio L, Gadducci A, Mascilini F, Maneschi F, Cassani C, Marchetti C, Cecere SC, Biglia N, De Giorgi U, Raspagliesi F, Lorusso D, Mangili G. Laparoscopic surgery in the treatment of stage I adult granulosa cells tumors of the ovary: Results from the MITO-9 study. Eur J Surg Oncol 2018; 44:766-770. [PMID: 29576462 DOI: 10.1016/j.ejso.2018.03.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 02/16/2018] [Accepted: 03/05/2018] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE Surgery represents the mainstay of treatment of stage I adult type granulosa cell tumors of the ovary (AGCTs). Because of the rarity and indolent course of the disease, no prospective trials are available. Open surgery has long been considered the traditional approach; oncological safety of laparoscopy is only supported by small series or case reports. The aim of this study was to compare the oncological outcomes between laparoscopic and open surgery in stage I AGCTs treated within the MITO (Multicenter Italian Trials in Ovarian cancer) Group. METHODS Data from patients with stage I AGCTs were retrospectively collected. Clinicopathological features were evaluated for association with relapse and death. Survival curves were calculated using the Kaplan-Meier method and compared with the log-rank test. The role of clinicopathological variables as prognostic factors for survival was evaluated using Cox's regression model. RESULTS 223 patients were identified. Stage 1A, 1B and 1C were 61.5%, 1.3% and 29.6% respectively. 7.6% were apparently stage I. Surgical approach was laparoscopic for 93 patients (41.7%) and open for 130 (58.3%). 5-years DFS was 84% and 82%, 10-years DFS was 68% and 64% for the laparoscopic and open-group (p = 0.6).5-years OS was 100% and 99%, 10 years OS was 98% and 97% for the laparoscopic and open-surgery group (p = 0.8). At multivariate analyses stage IC, incomplete staging, site of primary surgery retained significant prognostic value. CONCLUSION The present study suggests that surgical route does not affect the oncological safety of patients with stage I AGCTs, with comparable outcomes between laparoscopic and open approach.
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Affiliation(s)
- A Bergamini
- Department of Obstetrics and Gynecology, IRCCS San Raffaele Hospital, Milan, Italy.
| | - G Ferrandina
- Department of Obstetrics and Gynecology, Gynecology Oncology Unit, Catholic University of Sacred Heart of Rome, Italy
| | - M Candiani
- Department of Obstetrics and Gynecology, IRCCS San Raffaele Hospital, Milan, Italy
| | - G Cormio
- Department of Biomedical Science and Human Oncology, University of Bari, Bari I, Bari, Italy; Gynecologic Oncology Unit, IRCCS National Cancer Institute "Giovanni Paolo II" Bari, Italy
| | - G Giorda
- Gynecological Oncology Unit, Centro di Riferimento Oncologico - National Cancer Institute, Aviano, Italy
| | - R Lauria
- Dipartimento di Medicina Clinica e Chirurgia, Università di Napoli Federico II, Napoli, Italy
| | - A M Perrone
- Department of Gynecology Oncology, Institute of Obstetrics and Gynecology, S. Orsola Hospital, Bologna, Italy
| | - G Scarfone
- Department of Obstetrics, Gynecology and Neonatology, IRCCS Fondazione Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - E Breda
- Medical Oncology Unit Ospedale S Giovanni Calibita Fatebenefratelli, Rome, Italy
| | - A Savarese
- Division of Medical Oncology 1, Regina Elena Cancer Institute, Rome, Italy
| | - L Frigerio
- Department of Obstetrics & Gynaecology, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - A Gadducci
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - F Mascilini
- Department of Obstetrics and Gynecology, Gynecology Oncology Unit, Catholic University of Sacred Heart of Rome, Italy
| | - F Maneschi
- Gynecology and Obstetric Unit, AO San Giovanni Addolorata, Rome, Italy
| | - C Cassani
- Department of Obstetrics and Gynaecology Fondazione IRCCS Policlinico San Matteo-University of Pavia, Pavia, Italy
| | - C Marchetti
- Department of Gynecological-Obstetrical and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - S C Cecere
- Division of Medical Oncology, Department of Uro-Gynaecological Oncology, Istituto Nazionale Tumori IRCCS "Fondazione G. Pascale", Naples, Italy
| | - N Biglia
- Obstetrics and Gynaecology Unit, Umberto I Hospital, Department of Surgical Sciences, School of Medicine, University of Turin, Turin, Italy
| | - U De Giorgi
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola (FC), Italy
| | - F Raspagliesi
- Gynecologic Oncology Unit, IRCCS National Cancer Institute Foundation, Milan, Italy
| | - D Lorusso
- Gynecologic Oncology Unit, IRCCS National Cancer Institute Foundation, Milan, Italy
| | - G Mangili
- Department of Obstetrics and Gynecology, IRCCS San Raffaele Hospital, Milan, Italy
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25
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De Placido S, Gallo C, De Laurentiis M, Bisagni G, Arpino G, Sarobba MG, Riccardi F, Russo A, Del Mastro L, Cogoni AA, Cognetti F, Gori S, Foglietta J, Frassoldati A, Amoroso D, Laudadio L, Moscetti L, Montemurro F, Verusio C, Bernardo A, Lorusso V, Gravina A, Moretti G, Lauria R, Lai A, Mocerino C, Rizzo S, Nuzzo F, Carlini P, Perrone F, Agostara B, Aieta M, Alabiso O, Alicicco MG, Amadori D, Amaducci L, Amiconi G, Antuzzi G, Ardine M, Ardizzoia A, Aversa C, Badalamenti G, Barni S, Basurto C, Berardi R, Bergamasco C, Bidoli P, Bighin C, Biondi E, Bisagni G, Boni C, Borgonovo K, Botta M, Bravi S, Bruzzi P, Buono G, Butera A, Caldara A, Candeloro G, Cappelletti C, Cardalesi C, Carfora E, Cariello A, Carrozza F, Cartenì G, Caruso M, Casadei V, Casanova C, Castori L, Cavanna L, Cavazzini G, Cazzaniga M, Chilelli M, Chiodini P, Chiorrini S, Ciardiello F, Ciccarese M, Cinieri S, Clerico M, Coccaro M, Comande M, Corbo C, Cortino G, Cusenza S, Daniele G, D'arco AM, D'auria G, Dazzi C, De Angelis C, de Braud F, De Feo G, De Matteis A, De Tursi M, Di Blasio A, di Lucca G, Di Lullo L, Di Rella F, Di Renzo G, Di Stefano P, Di Stefano A, Diana A, Donati S, Fabbri A, Fabi A, Faedi M, Farina G, Farris A, Febbraro A, Fedele P, Federico P, Ferraù F, Ferretti G, Ferro A, Floriani I, Forcignanò R, Forciniti S, Forestieri V, Fornari G, Frisinghelli M, Fusco V, Gallizzi G, Galvano A, Gambardella A, Gambi A, Gebbia V, Gervasi E, Ghilardi M, Giacobino A, Giardina G, Giotta F, Giraudi S, Giuliano M, Grassadonia A, Grasso D, Grosso F, Guizzaro L, Incoronato P, Incorvaia L, Iodice G, La Verde N, Labonia V, Landi G, Latorre A, Leonardi V, Levaggi A, Limite G, Lina Bascialla L, Livi L, Maiello E, Mandelli D, Marcon I, Menon D, Montedoro M, Moraca L, Moretti A, Morritti MG, Morselli P, Mura A, Mura S, Musacchio M, Muzio A, Natale D, Natoli C, Nigro C, Nisticò C, Nuzzo A, Orditura M, Orlando L, Pacilio C, Palumbo G, Palumbo R, Pasini F, Paterno E, Pazzola A, Pelliccioni S, Pensabene M, Perroni D, Pesenti Gritti A, Petrelli F, Piccirillo MC, Pinotti G, Pogliani C, Poli D, Prader S, Recchia F, Rizzi D, Romano C, Rossello R, Rossini C, Salvucci G, Sanna V, Santini A, Saracchini S, Savastano C, Scambia G, Schettini F, Schiavone P, Schirone A, Seles E, Signoriello S, Signoriello G, Silva RR, Silvestri A, Simeon V, Spagnoletti I, Tamberi S, Teragni C, Thalmann V, Thomas R, Thomas G, Tienghi A, Tinari N, Tinessa V, Tomei F, Tonini G, Torri V, Traficante D, Tudini M, Turazza M, Vignoli R, Vitale MG, Zacchia A, Zagarese P, Zanni A, Zavallone L, Zavettieri M, Zoboli A. Adjuvant anastrozole versus exemestane versus letrozole, upfront or after 2 years of tamoxifen, in endocrine-sensitive breast cancer (FATA-GIM3): a randomised, phase 3 trial. Lancet Oncol 2018; 19:474-485. [PMID: 29482983 DOI: 10.1016/s1470-2045(18)30116-5] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 01/04/2018] [Accepted: 01/08/2018] [Indexed: 01/04/2023]
Abstract
BACKGROUND Uncertainty exists about the optimal schedule of adjuvant treatment of breast cancer with aromatase inhibitors and, to our knowledge, no trial has directly compared the three aromatase inhibitors anastrozole, exemestane, and letrozole. We investigated the schedule and type of aromatase inhibitors to be used as adjuvant treatment for hormone receptor-positive early breast cancer. METHODS FATA-GIM3 is a multicentre, open-label, randomised, phase 3 trial of six different treatments in postmenopausal women with hormone receptor-positive early breast cancer. Eligible patients had histologically confirmed invasive hormone receptor-positive breast cancer that had been completely removed by surgery, any pathological tumour size, and axillary nodal status. Key exclusion criteria were hormone replacement therapy, recurrent or metastatic disease, previous treatment with tamoxifen, and another malignancy in the previous 10 years. Patients were randomly assigned in an equal ratio to one of six treatment groups: oral anastrozole (1 mg per day), exemestane (25 mg per day), or letrozole (2·5 mg per day) tablets upfront for 5 years (upfront strategy) or oral tamoxifen (20 mg per day) for 2 years followed by oral administration of one of the three aromatase inhibitors for 3 years (switch strategy). Randomisation was done by a computerised minimisation procedure stratified for oestrogen receptor, progesterone receptor, and HER2 status; previous chemotherapy; and pathological nodal status. Neither the patients nor the physicians were masked to treatment allocation. The primary endpoint was disease-free survival. The minimum cutoff to declare superiority of the upfront strategy over the switch strategy was assumed to be a 2% difference in disease-free survival at 5 years. Primary efficacy analyses were done by intention to treat; safety analyses included all patients for whom at least one safety case report form had been completed. Follow-up is ongoing. This trial is registered with the European Clinical Trials Database, number 2006-004018-42, and ClinicalTrials.gov, number NCT00541086. FINDINGS Between March 9, 2007, and July 31, 2012, 3697 patients were enrolled into the study. After a median follow-up of 60 months (IQR 46-72), 401 disease-free survival events were reported, including 211 (11%) of 1850 patients allocated to the switch strategy and 190 (10%) of 1847 patients allocated to upfront treatment. 5-year disease-free survival was 88·5% (95% CI 86·7-90·0) with the switch strategy and 89·8% (88·2-91·2) with upfront treatment (hazard ratio 0·89, 95% CI 0·73-1·08; p=0·23). 5-year disease-free survival was 90·0% (95% CI 87·9-91·7) with anastrozole (124 events), 88·0% (85·8-89·9) with exemestane (148 events), and 89·4% (87·3 to 91·1) with letrozole (129 events; p=0·24). No unexpected serious adverse reactions or treatment-related deaths occurred. Musculoskeletal side-effects were the most frequent grade 3-4 events, reported in 130 (7%) of 1761 patients who received the switch strategy and 128 (7%) of 1766 patients who received upfront treatment. Grade 1 musculoskeletal events were more frequent with the upfront schedule than with the switch schedule (924 [52%] of 1766 patients vs 745 [42%] of 1761 patients). All other grade 3-4 adverse events occurred in less than 2% of patients in either group. INTERPRETATION 5 years of treatment with aromatase inhibitors was not superior to 2 years of tamoxifen followed by 3 years of aromatase inhibitors. None of the three aromatase inhibitors was superior to the others in terms of efficacy. Therefore, patient preference, tolerability, and financial constraints should be considered when deciding the optimal treatment approach in this setting. FUNDING Italian Drug Agency.
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Affiliation(s)
- Sabino De Placido
- Dipartimento di Clinica Medica e Chirurgia, Università Federico II, Naples, Italy
| | - Ciro Gallo
- Statistica Medica, Università degli Studi della Campania Luigi Vanvitelli, Naples, Italy
| | - Michelino De Laurentiis
- Istituto Nazionale per lo Studio e la Cura dei Tumori, Fondazione Pascale, Istituto di Ricovero e Cura a Carattere Scientifico, Naples, Italy
| | - Giancarlo Bisagni
- Dipartimento di Oncologia, Arcispedale S Maria Nuova-IRCCS, Reggio Emilia, Italy
| | - Grazia Arpino
- Dipartimento di Clinica Medica e Chirurgia, Università Federico II, Naples, Italy
| | | | | | - Antonio Russo
- Dipartimento di Scienze Chirurgiche, Oncologiche e Stomatologiche, Sezione di Oncologia Medica, Università di Palermo, Palermo, Italy
| | - Lucia Del Mastro
- Dipartimento di Medicina Interna e Specialità Mediche, Università degli Studi di Genova-Oncologia Medica, Ospedale Policlinico San Martino, Genoa, Italy
| | | | - Francesco Cognetti
- Divisione Oncologia Medica 1, Istituto Nazionale Tumori Regina Elena, Rome, Italy
| | - Stefania Gori
- Oncologia Medica, Ospedale Sacro Cuore Don Calabria, Negrar, Italy
| | | | | | - Domenico Amoroso
- Oncologia Medica, Ospedale della Versilia, Lido di Camaiore (LU), Istituto Toscano Tumori, Florence, Italy
| | | | - Luca Moscetti
- Dipartimento di Oncologia Medica, Ospedale Belcolle, Viterbo, Italy
| | - Filippo Montemurro
- Divisione di Oncologia Clinica Investigativa dell'Istituto di Candiolo-IRCCS, Candiolo, Italy
| | | | | | - Vito Lorusso
- Polo Oncologico, Ospedale Vito Fazzi, Lecce, Italy
| | - Adriano Gravina
- Istituto Nazionale per lo Studio e la Cura dei Tumori, Fondazione Pascale, Istituto di Ricovero e Cura a Carattere Scientifico, Naples, Italy
| | - Gabriella Moretti
- Dipartimento di Oncologia, Arcispedale S Maria Nuova-IRCCS, Reggio Emilia, Italy
| | - Rossella Lauria
- Dipartimento di Clinica Medica e Chirurgia, Università Federico II, Naples, Italy
| | - Antonella Lai
- Oncologia Medica, Azienda Ospedaliera Universitaria, Sassari, Italy
| | | | - Sergio Rizzo
- Dipartimento di Scienze Chirurgiche, Oncologiche e Stomatologiche, Sezione di Oncologia Medica, Università di Palermo, Palermo, Italy
| | - Francesco Nuzzo
- Istituto Nazionale per lo Studio e la Cura dei Tumori, Fondazione Pascale, Istituto di Ricovero e Cura a Carattere Scientifico, Naples, Italy
| | - Paolo Carlini
- Divisione Oncologia Medica 1, Istituto Nazionale Tumori Regina Elena, Rome, Italy
| | - Francesco Perrone
- Istituto Nazionale per lo Studio e la Cura dei Tumori, Fondazione Pascale, Istituto di Ricovero e Cura a Carattere Scientifico, Naples, Italy.
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Pensabene M, Stanzione B, Cerillo I, Ciancia G, Cozzolino I, Ruocco R, Condello C, Di Lorenzo G, Giuliano M, Forestieri V, Arpino G, De Placido S, Lauria R. It is no longer the time to disregard thyroid metastases from breast cancer: a case report and review of the literature. BMC Cancer 2018; 18:146. [PMID: 29409458 PMCID: PMC5801832 DOI: 10.1186/s12885-018-4054-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 01/25/2018] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Metastases to the thyroid gland are more frequent than previously thought, although most of them are occult or not clinically relevant. Overall, only 42 cases of metastases to thyroid from breast cancer have been reported thus far. Here we report the case of a patient with breast cancer metastatic to the thyroid. We also review the 42 previously reported cases (published between 1962 and 2012). This is the first review about metastases to thyroid gland from breast cancer. CASE PRESENTATION A 64-year-old woman of Caucasian origin was diagnosed with a lobular invasive carcinoma of the breast (luminal A, stage II). She received adjuvant chemotherapy, followed by endocrine therapy. During follow-up, fine-needle cytology of a thyroid nodule revealed malignant cells that were estrogen-positive, which suggested a diagnosis of metastases to the thyroid. Imaging did not reveal any other metastatic site and showed only enlargement of the left thyroid lobe and an inhomogeneous pattern of colloid and cystic degeneration and calcifications. The patient underwent left hemithyroidectomy. Histology of thyroid tissue showed a colloid goitre containing dispersed small atypical neoplastic cells with eccentric nuclei. Immunohistochemistry showed cytokeratin-19 and oestrogen receptor, but not tireoglobulin, e-cadherin or cytokeratin-7, thereby confirming metastases from a lobular breast carcinoma. Hormonal treatment is ongoing. CONCLUSION This case report and first review of the literature on metastases to thyroid from breast cancer highlight the importance of a correct early diagnostic work-up in such cases. Indeed, a primary lesion should be distinguished from metastases given the different treatment protocol related to primary cancer and the clinical impact on prognosis.
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Affiliation(s)
- Matilde Pensabene
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", via Sergio Pansini, 80131, Naples, Italy.
| | - Brigida Stanzione
- Department of Medical Oncology, National Cancer Institute, Aviano, PN, Italy
| | - Ivana Cerillo
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", via Sergio Pansini, 80131, Naples, Italy
| | - Giuseppe Ciancia
- Department of Advanced Biomedical Sciences, Pathology Unit, University of Naples "Federico II", via Sergio Pansini, 80131, Naples, Italy
| | - Immacolata Cozzolino
- Department of Advanced Biomedical Sciences, Pathology Unit, University of Naples "Federico II", via Sergio Pansini, 80131, Naples, Italy
| | - Raffaella Ruocco
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", via Sergio Pansini, 80131, Naples, Italy
| | - Caterina Condello
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", via Sergio Pansini, 80131, Naples, Italy
| | - Giuseppe Di Lorenzo
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", via Sergio Pansini, 80131, Naples, Italy
| | - Mario Giuliano
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", via Sergio Pansini, 80131, Naples, Italy
| | - Valeria Forestieri
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", via Sergio Pansini, 80131, Naples, Italy
| | - Grazia Arpino
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", via Sergio Pansini, 80131, Naples, Italy
| | - Sabino De Placido
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", via Sergio Pansini, 80131, Naples, Italy
| | - Rossella Lauria
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", via Sergio Pansini, 80131, Naples, Italy
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Buono G, Crispo A, Giuliano M, De Angelis C, Schettini F, Forestieri V, Lauria R, Pensabene M, De Laurentiis M, Augustin LSA, Amore A, D'Aiuto M, Tortoriello R, Accurso A, Cavalcanti E, Botti G, Montella M, De Placido S, Arpino G. Combined effect of obesity and diabetes on early breast cancer outcome: a prospective observational study. Oncotarget 2017; 8:115709-115717. [PMID: 29383194 PMCID: PMC5777806 DOI: 10.18632/oncotarget.22977] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2017] [Accepted: 11/16/2017] [Indexed: 12/27/2022] Open
Abstract
Background Previous studies suggested that obesity and diabetes were correlated with breast cancer outcome. The aim of the present study was to investigate the prognostic effect of obesity and diabetes on the outcome of early breast cancer patients. Materials and Methods Overall, 841 early breast cancer patients were prospectively enrolled between January 2009 and December 2013. Study population was divided into four groups: (1) patients without obesity or diabetes; (2) patients with only diabetes; (3) patients with only obesity; and (4) patients with both diabetes and obesity. Categorical variables were analyzed by the chi-square test and survival data by the log-rank test. Results At diagnosis, obese and diabetic patients were more likely to be older (p < 0.0001) and post-menopausal (p < 0.0001) and to have a tumor larger than 2 cm (p < 0.0001) than patients in groups 1–3. At univariate analyses, obese and diabetic patients had a worse disease-free survival (p = 0.01) and overall survival (p = 0.001) than did patients without obesity and diabetes. At multivariate analyses, the co-presence of obesity and diabetes was an independent prognostic factor for disease-free survival (hazard ratio=2.62, 95% CI 1.23–5.60) but not for overall survival. Conclusions At diagnosis, patients with obesity and diabetes were older, had larger tumors and a worse outcome compared to patients without obesity or diabetes. These data suggest that metabolic health influences the prognosis of patients affected by early breast cancer.
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Affiliation(s)
- Giuseppe Buono
- Department of Clinical Medicine and Surgery, Oncology Division, University of Naples Federico II, Naples, Italy
| | - Anna Crispo
- Unit of Epidemiology, National Cancer Institute, G. Pascale Foundation, Naples, Italy
| | - Mario Giuliano
- Department of Clinical Medicine and Surgery, Oncology Division, University of Naples Federico II, Naples, Italy.,Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX, USA
| | - Carmine De Angelis
- Department of Clinical Medicine and Surgery, Oncology Division, University of Naples Federico II, Naples, Italy
| | - Francesco Schettini
- Department of Clinical Medicine and Surgery, Oncology Division, University of Naples Federico II, Naples, Italy
| | - Valeria Forestieri
- Department of Clinical Medicine and Surgery, Oncology Division, University of Naples Federico II, Naples, Italy
| | - Rossella Lauria
- Department of Clinical Medicine and Surgery, Oncology Division, University of Naples Federico II, Naples, Italy
| | - Matilde Pensabene
- Department of Clinical Medicine and Surgery, Oncology Division, University of Naples Federico II, Naples, Italy
| | | | - Livia Silvia Adriana Augustin
- Unit of Epidemiology, National Cancer Institute, G. Pascale Foundation, Naples, Italy.,Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Canada
| | - Alfonso Amore
- Breast Unit, National Cancer Institute, G. Pascale Foundation, Naples, Italy
| | | | | | - Antonello Accurso
- Department of Gastroenterology, Endocrinology and Surgery, University of Naples Federico II, Naples, Italy
| | - Ernesta Cavalcanti
- Unit of Epidemiology, National Cancer Institute, G. Pascale Foundation, Naples, Italy
| | - Gerardo Botti
- Unit of Epidemiology, National Cancer Institute, G. Pascale Foundation, Naples, Italy
| | - Maurizio Montella
- Unit of Epidemiology, National Cancer Institute, G. Pascale Foundation, Naples, Italy
| | - Sabino De Placido
- Department of Clinical Medicine and Surgery, Oncology Division, University of Naples Federico II, Naples, Italy
| | - Grazia Arpino
- Department of Clinical Medicine and Surgery, Oncology Division, University of Naples Federico II, Naples, Italy
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28
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Arpino G, Pensabene M, Condello C, Ruocco R, Cerillo I, Lauria R, Forestieri V, Giuliano M, De Angelis C, Montella M, Crispo A, De Placido S. Tumor characteristics and prognosis in familial breast cancer. BMC Cancer 2016; 16:924. [PMID: 27899083 PMCID: PMC5129604 DOI: 10.1186/s12885-016-2962-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 11/22/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Approximately 5-10% of breast cancers are hereditary and their biology and prognosis appear to differ from those of sporadic breast cancers. In this study we compared the biological features and clinical characteristics of non metastatic breast cancer in patients with BRCA mutations versus patients with a family history suggesting hereditary breast cancer but without BRCA mutations (BRCA wild type) versus patients with sporadic disease, and correlated these findings with clinical outcome. METHODS We retrieved the clinical and biological data of 33 BRCA-positive, 66 BRCA-wild type and 1826 sporadic breast cancer patients contained in a single institution clinical database between 1980 and 2012. Specifically, we recorded age, tumor size, nodal status, treatment type, pattern of relapse, second primary incidence, outcome (disease-free survival and overall survival), and biological features (estrogen receptor [ER], progesterone receptor [PgR], tumor grade, proliferation and c-erbB2 status). Median follow-up was 70 months. RESULTS BRCA-positive patients were significantly younger than sporadic breast cancer patients, and less likely to be ER-, PgR- or c-erbB2-positive than women with BRCA-wild type or sporadic breast cancer. Tumor size and grade, nodal status and proliferation did not differ among the three groups. Rates of radical mastectomy were 58, 42 and 37%, and those of conservative surgery were 42, 58 and 63% in women with BRCA-positive, BRCA-wild type and sporadic breast cancer (p = 0.03), respectively. The incidence of contralateral breast cancer was 12, 14 and 0% (p <0.0001) and the incidence of second primary tumors (non breast) was 9, 1 and 2% (p <0.0001) in BRCA-positive, BRCA-wild type and sporadic breast cancer, respectively. Median disease-free survival in years was 29 in BRCA-wild type, 19 in BRCA-positive and 14 in sporadic breast cancer patients (log-rank = 0.007). Median overall survival in years was not reached for BRCA-wild type, 19 for BRCA-positive and 13 for sporadic breast cancer patients (log-rank <0.0001). At multivariate analyses only BRCA-wild type status was related to a significant improvement in overall survival versus the sporadic breast cancer group (HR = 0,51; 95% CI (0,28-0,93) p = 0.028). CONCLUSIONS The biology and outcome of breast cancer differ between patients with BRCA mutations, patients with a family history but no BRCA mutations and patients with sporadic breast cancer.
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Affiliation(s)
- G Arpino
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy.
| | - M Pensabene
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - C Condello
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - R Ruocco
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - I Cerillo
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - R Lauria
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - V Forestieri
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - M Giuliano
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - C De Angelis
- The Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, Texas, USA
| | - M Montella
- Department of Epidemiology, Istituto Nazionale Tumori Pascale, Naples, Italy
| | - A Crispo
- Department of Epidemiology, Istituto Nazionale Tumori Pascale, Naples, Italy
| | - S De Placido
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
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Gargiulo P, Pensabene M, Milano M, Arpino G, Giuliano M, Forestieri V, Condello C, Lauria R, De Placido S. Long-term survival and BRCA status in male breast cancer: a retrospective single-center analysis. BMC Cancer 2016; 16:375. [PMID: 27377827 PMCID: PMC4932666 DOI: 10.1186/s12885-016-2414-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Accepted: 06/28/2016] [Indexed: 11/17/2022] Open
Abstract
Background Male breast cancer (MBC) is rare. Given the paucity of randomized trials, treatment is generally extrapolated from female breast cancer guidelines. Methods This is a retrospective analysis of all male patients presenting with MBC at the Department of Oncology at University Federico II of Naples between January 1989 and January 2014. We recorded the following data: baseline characteristics (age, height, weight, body mass index, risk factors, family history), tumor characteristics (side affected, stage, histotype, hormonal and HER2 status, and Ki-67 expression), treatment (type of surgery, chemotherapy, endocrine therapy, and/or radiotherapy), BRCA1/2 mutation status (if available), other tumors, and long-term survival. Results Forty-seven patients were analyzed. Median age was 62.0 [55.0–72.0]. Among risk factors, obesity and family history of breast cancer were associated with 21 % and 30 % of MBC cases, respectively. The majority of tumors were diagnosed at an early stage: stage I (34.0 %) and stage II (44.7 %). Infiltrating ductal carcinoma was the most frequent histologic subtype (95.8 %). Hormone receptors were generally positive (88.4 % of cases were Estrogen receptor [ER] positive and 81.4 % Progesteron receptor [PgR] positive). Human epidermal growth factor receptor 2 (HER2) was positive in 26.8 % of cases; 7.0 % of MBCs were triple negative. The tumor had high proliferation index (Ki67 ≥ 20 %) in 64.7 %. Surgery was predominantly mastectomy (85.1 %), whereas quadrantectomy was performed in 14.9 % of patients. Adjuvant chemotherapy was administered to 70.7 % of patients, endocrine therapy to 90.2 %, trastuzumab to 16.7 % and radiotherapy to 32.6 %. BRCA status was available for 17 patients: 10 wild-type, 1 BRCA1 carrier, 5 BRCA2 carriers, 1 unknown variant sequence. The overall estimated long-term survival was about 90 % at 5 years, 80 % at 10 years and 70 % at 20 years. Patients carrying a BRCA mutation had a significantly lower survival than patients with wild-type BRCA (p = 0.04). Conclusions Long-term survival was high in MBC patients referred to our clinical unit. Survival was poorer in BRCA-mutated patients than in patients with wild-type BRCA.
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Affiliation(s)
- Piera Gargiulo
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Matilde Pensabene
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Monica Milano
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Grazia Arpino
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Mario Giuliano
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Pansini 5, 80131, Naples, Italy.,Lester and Sue Smith Breast Center at Baylor College of Medicine, Houston, Tx, USA
| | - Valeria Forestieri
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Caterina Condello
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Rossella Lauria
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Pansini 5, 80131, Naples, Italy.
| | - Sabino De Placido
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Pansini 5, 80131, Naples, Italy
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Piccirillo M, Scambia G, Lorusso D, De Giorgi U, Nicoletto M, Lauria R, Mosconi A, Sacco C, Omarini C, Tagliaferri P, Ferrandina G, Cinieri S, Pisano C, Cecere S, Di Napoli M, Salutari V, Daniele G, Gallo C, Perrone F, Pignata S. MITO (Multicentre Italian Trials in Ovarian cancer) - CERV 2 trial: a randomized phase II study of carboplatin and paclitaxel +/- cetuximab, in advanced and/or recurrent cervical cancer. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv339.01] [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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Pignata S, Scambia G, Lorusso D, De Giorgi U, Nicoletto MO, Lauria R, Mosconi AM, Sacco C, Omarini C, Tagliaferri P, Ferrandina G, Cinieri S, Pisano C, Cecere SC, Di Napoli M, Salutari V, Piccirillo MC, Daniele G, Gallo C, Perrone F. MITO (Multicentre Italian Trials in Ovarian cancer): CERV 2 trial—A randomized phase II study of carboplatin and paclitaxel +/- cetuximab, in advanced and/or recurrent cervical cancer. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.5520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Sandro Pignata
- MITO and Istituto Nazionale Tumori di Napoli, Napoli, Italy
| | - Giovanni Scambia
- Universita Cattolica del Sacro Cuore Policlinico Agostino Gemelli, Rome, Italy
| | - Domenica Lorusso
- MITO and Fondazione IRCCS National Cancer Institute, Milan, Italy
| | - Ugo De Giorgi
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) - IRCCS, Meldola, Italy
| | | | | | | | - Cosimo Sacco
- Dipartimento di Oncologia, Azienda Ospedaliero-Universitaria, Udine, Italy
| | - Claudia Omarini
- Department of Oncology, Hematology and Respiratory Diseases, Modena University Hospital, Modena, Italy
| | | | | | | | | | | | | | | | | | | | - Ciro Gallo
- Medical Statistics, Department of Medicine and Public Health, Second University, Napoli, Italy
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Perrone F, Nuzzo F, Di Rella F, Gravina A, Iodice G, Labonia V, Landi G, Pacilio C, Rossi E, De Laurentiis M, D'Aiuto M, Botti G, Forestieri V, Lauria R, De Placido S, Tinessa V, Daniele B, Gori S, Colantuoni G, Barni S, Riccardi F, De Maio E, Montanino A, Morabito A, Daniele G, Di Maio M, Piccirillo M, Signoriello S, Gallo C, de Matteis A. Weekly docetaxel versus CMF as adjuvant chemotherapy for older women with early breast cancer: final results of the randomized phase III ELDA trial. Ann Oncol 2015; 26:675-682. [DOI: 10.1093/annonc/mdu564] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [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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Crisci V, Mainenti PP, Corvino F, Lauria R, Maurea S. Bone involvement by adenocarcinoma of the uterine cervix: a rare entity. Pol J Radiol 2015; 80:81-4. [PMID: 25745521 PMCID: PMC4332296 DOI: 10.12659/pjr.892369] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 09/01/2014] [Accepted: 11/11/2014] [Indexed: 11/09/2022] Open
Abstract
Background Adenocarcinoma is the second most frequent cancer of the uterine cervix after squamous carcinoma, and the most frequent histotype is the mucinous one. Endo-cervical adenocarcinoma accounts for about 10–30% of all cervical cancers and clinically the lesion can be asymptomatic or, more frequently, presenting with anomalous bleeding and/or vaginal discharge. Case Report A 41-year-old woman with a diagnosis of adenocarcinoma of the uterine cervix was subjected to chemotherapy after radical surgery. During the follow-up, the patient underwent a Positron Emission Tomography integrated with Computed Tomography and pelvic Magnetic Resonance, which showed rapid and diffuse disease progression from the site of the lesion to the pelvic bones. Conclusions Bone involvement in patients with cervical cancer, being a rare event, is significant since it greatly reduces life expectancy. The majority of metastatic bone lesions in cervical cancer seem to be of osteolytic nature. In our patient, Positron Emission Tomography integrated with Computed Tomography and Magnetic Resonance were the imaging methods used during the follow-up and both techniques clearly showed diffuse and rapid tumour spread to the bones.
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Affiliation(s)
- Vincenzina Crisci
- Department of Diagnostic Imaging, University of Naples "Federico II", Naples, Italy ; Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Pier Paolo Mainenti
- Department of Diagnostic Imaging, Institute of Biostructure and Bioimaging CNR Foundation, Naples, Italy
| | - Fabio Corvino
- Department of Diagnostic Imaging, University of Naples "Federico II", Naples, Italy ; Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Rossella Lauria
- Department of Integrated Activities of Clinical Medicine, University of Naples "Federico II", Naples, Italy
| | - Simone Maurea
- Department of Radiology and Institute of Biostructures, University of Naples "Federico II", Naples, Italy
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Pignata S, Scambia G, Katsaros D, Gallo C, Pujade-Lauraine E, De Placido S, Bologna A, Weber B, Raspagliesi F, Panici PB, Cormio G, Sorio R, Cavazzini MG, Ferrandina G, Breda E, Murgia V, Sacco C, Cinieri S, Salutari V, Ricci C, Pisano C, Greggi S, Lauria R, Lorusso D, Marchetti C, Selvaggi L, Signoriello S, Piccirillo MC, Di Maio M, Perrone F. Carboplatin plus paclitaxel once a week versus every 3 weeks in patients with advanced ovarian cancer (MITO-7): a randomised, multicentre, open-label, phase 3 trial. Lancet Oncol 2014; 15:396-405. [PMID: 24582486 DOI: 10.1016/s1470-2045(14)70049-x] [Citation(s) in RCA: 261] [Impact Index Per Article: 26.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Carboplatin plus paclitaxel administered every 3 weeks is standard first-line chemotherapy for patients with advanced ovarian cancer. A weekly paclitaxel schedule combined with carboplatin every 3 weeks prolonged progression-free survival and overall survival in a Japanese phase 3 trial. The aim of our study was to assess whether a weekly schedule of carboplatin plus paclitaxel is more effective than the same drugs given every 3 weeks. METHODS We did a multicentre, randomised, phase 3 study at 67 institutions in Italy and France. Women with FIGO stage IC-IV ovarian cancer, an ECOG performance status of 2 or lower, and who had never received chemotherapy were randomly allocated in a 1:1 ratio to receive either carboplatin (AUC 6 mg/mL per min) plus paclitaxel (175 mg/m(2)) every 3 weeks for six cycles or carboplatin (AUC 2 mg/mL per min) plus paclitaxel (60 mg/m(2)) every week for 18 weeks. Randomisation was done by computer-based minimisation, stratified by centre, residual disease after surgery, and ECOG performance status. The study was not blinded. Coprimary endpoints were progression-free survival and quality of life (assessed by the Functional Assessment of Cancer Therapy Ovarian Trial Outcome Index [FACT-O/TOI] score), and analysis was by modified intention to treat. This report presents the final analysis. The study is registered with ClinicalTrials.gov, number NCT00660842. FINDINGS 822 patients were enrolled into the study between Nov 20, 2008, and March 1, 2012; 12 withdrew their consent immediately after randomisation and were excluded, and 810 were eligible for analysis. 404 women were allocated treatment every 3 weeks and 406 were assigned to the weekly schedule. After median follow-up of 22·3 months (IQR 16·2-30·9), 449 progression-free survival events were recorded. Median progression-free survival was 17·3 months (95% CI 15·2-20·2) in patients assigned to treatment every 3 weeks, versus 18·3 months (16·8-20·9) in women allocated to the weekly schedule (hazard ratio 0·96, 95% CI 0·80-1·16; p=0·66). FACT-O/TOI scores differed significantly between the two schedules (treatment-by-time interaction p<0·0001); with treatment every 3 weeks, FACT-O/TOI scores worsened at every cycle (weeks 1, 4, and 7), whereas for the weekly schedule, after transient worsening at week 1, FACT-O/TOI scores remained stable. Fewer patients assigned to the weekly group than those allocated treatment every 3 weeks had grade 3-4 neutropenia (167 [42%] of 399 patients vs 200 [50%] of 400 patients), febrile neutropenia (two [0·5%] vs 11 [3%]), grade 3-4 thrombocytopenia (four [1%] vs 27 [7%]), and grade 2 or worse neuropathy (24 [6%] vs 68 [17%]). Three deaths during the study were attributed to chemotherapy; two women died who were allocated treatment every 3 weeks and one death was recorded in the group assigned the weekly regimen. INTERPRETATION A weekly regimen of carboplatin and paclitaxel might be a reasonable option for first-line treatment of women with advanced ovarian cancer. FUNDING None.
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Affiliation(s)
- Sandro Pignata
- Dipartimento di Oncologia Uroginecologica, Istituto Nazionale per lo Studio e la Cura dei Tumori, Fondazione G Pascale, IRCCS, Napoli, Italy.
| | - Giovanni Scambia
- Dipartimento per la Tutela della Salute della Donna, della Vita Nascente, del Bambino e dell' Adolescente, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Dionyssios Katsaros
- Ginecologia Oncologica, Azienda Ospedaliera Città della Salute e della Scienza, Presidio S Anna e Università, Torino, Italy
| | - Ciro Gallo
- Statistica Medica, Seconda Università di Napoli, Napoli, Italy
| | | | - Sabino De Placido
- Dipartimento di Medicina Clinica e Chirurgia, Università di Napoli Federico II, Napoli, Italy
| | | | | | - Francesco Raspagliesi
- Unità di Ginecologia Oncologica, Istituto Nazionale per lo Studio e la Cura dei Tumori, IRCCS, Milano, Italy
| | - Pierluigi Benedetti Panici
- Dipartimento di Scienze Ginecologico-Ostetriche e Scienze Urologiche, Università La Sapienza, Roma, Italy
| | | | - Roberto Sorio
- Oncologia Medica C, Centro di Riferimento Oncologico, Aviano-PN, Italy
| | | | - Gabriella Ferrandina
- Ginecologia Oncologica, Centro di Ricerca e Formazione ad Alta Tecnologia nelle Scienze Biomediche, Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Enrico Breda
- Oncologia Medica Ospedale S Giovanni Calibita Fatebenefratelli, Roma, Italy
| | | | - Cosimo Sacco
- Dipartimento di Oncologia AO S Maria della Misericordia, Udine, Italy
| | - Saverio Cinieri
- Oncologia Medica, Ospedale Antonio Perrino, Brindisi, and Istituto Europeo di Oncologia, Milano, Italy
| | - Vanda Salutari
- Dipartimento per la Tutela della Salute della Donna, della Vita Nascente, del Bambino e dell' Adolescente, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Caterina Ricci
- Dipartimento per la Tutela della Salute della Donna, della Vita Nascente, del Bambino e dell' Adolescente, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Carmela Pisano
- Dipartimento di Oncologia Uroginecologica, Istituto Nazionale per lo Studio e la Cura dei Tumori, Fondazione G Pascale, IRCCS, Napoli, Italy
| | - Stefano Greggi
- Dipartimento di Oncologia Uroginecologica, Istituto Nazionale per lo Studio e la Cura dei Tumori, Fondazione G Pascale, IRCCS, Napoli, Italy
| | - Rossella Lauria
- Dipartimento di Medicina Clinica e Chirurgia, Università di Napoli Federico II, Napoli, Italy
| | - Domenica Lorusso
- Unità di Ginecologia Oncologica, Istituto Nazionale per lo Studio e la Cura dei Tumori, IRCCS, Milano, Italy
| | - Claudia Marchetti
- Dipartimento di Scienze Ginecologico-Ostetriche e Scienze Urologiche, Università La Sapienza, Roma, Italy
| | | | | | - Maria Carmela Piccirillo
- Unità Sperimentazioni Cliniche, Istituto Nazionale per lo Studio e la Cura dei Tumori, Fondazione G Pascale, IRCCS, Napoli, Italy
| | - Massimo Di Maio
- Unità Sperimentazioni Cliniche, Istituto Nazionale per lo Studio e la Cura dei Tumori, Fondazione G Pascale, IRCCS, Napoli, Italy
| | - Francesco Perrone
- Unità Sperimentazioni Cliniche, Istituto Nazionale per lo Studio e la Cura dei Tumori, Fondazione G Pascale, IRCCS, Napoli, Italy
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Arpino G, Galderisi M, De Angelis C, Milano M, Gargiulo P, Santoro A, De Stefano F, Muscariello R, De Santo I, Lauria R, De Simone G, De Placido S. Abstract P4-01-21: Head to head comparison of standard echo doppler versus 3D speckle tracking echocardiography for early subclinical cardiotoxicity detection in breast cancer patients treated with anthracycline adjuvant chemotherapy. Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-p4-01-21] [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. Anthracycline (ANT)-containing regimens represent the prevalent choice for adjuvant therapy in early breast cancer (EBC) patients. However, cardio toxicity is a major limitation, strongly affecting the quality of life and the overall survival of cancer patients, regardless of the oncologic prognosis.
Aims: To assess the diagnostic power of real-time 3D Speckle Tracking Echocardiography (STE) in comparison with standard echo Doppler (SED) in detection of early subclinical ANT related cardio toxicity in breast cancer patients.
Methods: Fifty-five consecutive patients (F/M = 54/1, mean age = 48 years) with EBC were prospectively enrolled in the study. All patients received three cycles of epirubicin (EPI) based chemo regimen followed by taxanes. Overall, average EPI cumulative dose per patient was 505 ± 68 mg/m2 (range = 360-720 mg/m2). Complete SED exam including determination of 2D ejection fraction (EF) and pulsed Tissue Doppler of the mitral annulus were measured at baseline and at the end of the three cycles of EPI. Three-D determination of left ventricular volumes and EF as well as 3D STE-derived global longitudinal strain (GLS), global circumferential strain (GCS), global area strain (GAS) and global radial strain (GRS) were assessed, whenever feasible, at the same time points.
Results: All the patients completed the three cycles of EPI as per protocol. No overt clinical manifestation of heart failure was observed. Standard echo doppler was performed in all the patients. Two-D EF did not significantly change with EPI treatment. However, the E/e’ ratio measured by SED, was significantly increased after EPI administration (6.7±1.7 vs. 7.25±1.8 before and after treatment, respectively; p<0.05). Overall, 3D ventricular volumetric assessment was feasible in the 63.6% (35/55) of patients and 3D STE in the 60% (33/55) of patients due to anatomical or technical problems. Among parameters measured by 3D STE, a reduction of EF (58.8±8% vs. 61.7±7.1%, before and after treatment, respectively; p<0.02) and a significant increase of the left ventricular end-systolic volume (p<0.01) was observed. Importantly, a significant decrease of the following 3D STE parameters: GLS (p<0.01), GRS (p<0.001), GCS (p<0.0001) and GAS (p<0.0001) were observed after EPI therapy.
Conclusions: Results from the present study confirm the increased sensitivity of real time 3D STE technique in detecting early subclinical signs of cardio toxicity in patients with EBC treated with EPI adjuvant chemotherapy. However, due to technical problems, STE was not feasible in the entire patient population included in the study. Among parameters measured by SED, the E/e’ ratio identifies early signs of cardiac dysfunction more accurately compared to the standard 2D EF determination.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P4-01-21.
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Affiliation(s)
- G Arpino
- University of Naples “Federico II”, Naples, Italy; Cardiology, University of Naples “Federico II”, Naples, Italy
| | - M Galderisi
- University of Naples “Federico II”, Naples, Italy; Cardiology, University of Naples “Federico II”, Naples, Italy
| | - C De Angelis
- University of Naples “Federico II”, Naples, Italy; Cardiology, University of Naples “Federico II”, Naples, Italy
| | - M Milano
- University of Naples “Federico II”, Naples, Italy; Cardiology, University of Naples “Federico II”, Naples, Italy
| | - P Gargiulo
- University of Naples “Federico II”, Naples, Italy; Cardiology, University of Naples “Federico II”, Naples, Italy
| | - A Santoro
- University of Naples “Federico II”, Naples, Italy; Cardiology, University of Naples “Federico II”, Naples, Italy
| | - F De Stefano
- University of Naples “Federico II”, Naples, Italy; Cardiology, University of Naples “Federico II”, Naples, Italy
| | - R Muscariello
- University of Naples “Federico II”, Naples, Italy; Cardiology, University of Naples “Federico II”, Naples, Italy
| | - I De Santo
- University of Naples “Federico II”, Naples, Italy; Cardiology, University of Naples “Federico II”, Naples, Italy
| | - R Lauria
- University of Naples “Federico II”, Naples, Italy; Cardiology, University of Naples “Federico II”, Naples, Italy
| | - G De Simone
- University of Naples “Federico II”, Naples, Italy; Cardiology, University of Naples “Federico II”, Naples, Italy
| | - S De Placido
- University of Naples “Federico II”, Naples, Italy; Cardiology, University of Naples “Federico II”, Naples, Italy
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Muraru D, Mihaila S, Piasentini E, Casablanca S, Naso P, Puma L, Ermacora D, Zoppellaro G, Iliceto S, Badano L, Farsalinos K, Daraban A, Unlu S, Pellikka P, Lancellotti P, Thomas J, Badano L, Voigt JU, Antoine C, Dadfarin-Bejou A, Gallet R, Bremont C, Dubois-Rande J, Lim P, Acosta Martinez J, Lopez-Haldon J, Rodriguez-Rodriguez J, Lopez-Pardo F, Martinez-Martinez A, Nylander E, Hard L, Andersson J, Lindqvist P, Remmets J, Winter R, Andersson B, Roijer A, Gao S, Maret E, Esposito R, Santoro C, Raia R, Schiano-Lomoriello V, Lauria R, Arpino G, De Simone G, Galderisi M, El Ghannudi S, Samet H, Germain P, Jeung MY, Gangi A, Roy C, Marta L, Placido R, Ramalho A, Cortez-Dias N, Nobre Menezes M, Santos L, Infante Oliveira E, Martins S, Almeida A, Nunes Diogo A, Bech-Hanssen O, Pergola V, Fadel B, Di Salvo G, Buccheri S, Mangiafico S, Lavanco V, Bottari V, Arcidiacono A, Tamburino C, Monte IP. Moderated Posters session * The emerging role of 2-dimensional strain in clinical practice: 13/12/2013, 14:00-18:00 * Location: Moderated Poster area. Eur Heart J Cardiovasc Imaging 2013. [DOI: 10.1093/ehjci/jet211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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De Angelis C, Milano M, Gargiulo P, Stanzione B, Forestieri V, Lauria R, Pensabene M, D'Arco F, De Placido S, Arpino G. Long-term disease control with lapatinib and capecitabine in a patient with HER2-positive metastatic breast cancer pretreated with trastuzumab and trastuzumab-emtansine. Tumori 2013. [PMID: 24158083 DOI: 10.1700/1334.14822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
We describe the case of a woman who has been undergoing treatment for HER2-positive metastatic breast cancer since 2002. She presented liver metastasis at diagnosis in February 2002. Combination therapy with docetaxel and trastuzumab was administered as first-line treatment, and a complete response of the hepatic lesion and a partial response at the breast primary cancer site were achieved. After 6 cycles of therapy, the patient underwent surgical excision of the breast and then received trastuzumab alone until progression, which occurred in March 2010 with the development of a right chest wall lesion. The patient progressed after therapy with trastuzumab emtansine (T-DM1) received as second-line treatment. Subsequently, a combination of lapatinib and capecitabine was started in April 2011. At this writing, the patient is still receiving treatment (24 months) and is showing a long-lasting response with a favorable safety profile.
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Grimaldi L, Danzi M, Reggio S, Pannullo M, Danzi R, Lauria R. Decision making in borderline ovarian tumors: report of a rare case of mesosigma psammocarcinoma. Ann Ital Chir 2013; 84:S2239253X13021609. [PMID: 23995281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Psammocarcinoma is a rare variant of serous carcinoma arising either from ovary or peritoneum, characterized by massive psammoma body formation, low-grade of cytologic differentiation and invasiveness. Its clinical behavior is similar to the serous borderline tumors, whose prognosis is significantly better compared to invasive forms, with a 5-year survival in stage I greater than 95%. A typical feature of borderline ovary tumors is the presence, in more than 30% of cases, of borderline peritoneal implants similar to primary ovarian cancer or of invasive forms. We report a case of a 44-years-old woman who referred to our clinic for mesosigmoid mass , accidentally discovered by ultrasonography. Sigmoidectomy with fertility sparing surgery was performed in september 2010. The mass was hystologically characterized by many psammoma bodies and low grade cytological features with diagnosis of psammocarcinoma of mesosigma. One year after the primary surgery, the patient showed with left adnexial mass; optimal debulking surgery was performed including omentectomy, total abdominal hysterectomy, bilateral adnexectomy and appendicectomy. The patient did not receive any adjuvant chemotherapy and to date she is alive and with no evidence of disease. The conclusion is that psammocarcinoma is a very rare tumor that behaves less aggressively than typical serous carcinoma, the mainstay of treatment is surgical debulking , with fertility sparing surgery as possible option in young patients with ovaries macroscopically free of disease.
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Pignata S, Scambia G, Lauria R, Raspagliesi F, Benedetti Panici P, Cormio G, Katsaros D, Sorio R, Cavazzini G, Ferrandina G, Breda E, Murgia V, Sacco C, Asensio Sierra NM, Pisano C, Salutari V, Weber BE, Pujade-Lauraine E, Gallo C, Perrone F. A randomized multicenter phase III study comparing weekly versus every 3 weeks carboplatin (C) plus paclitaxel (P) in patients with advanced ovarian cancer (AOC): Multicenter Italian Trials in Ovarian Cancer (MITO-7)—European Network of Gynaecological Oncological Trial Groups (ENGOT-ov-10) and Gynecologic Cancer Intergroup (GCIG) trial. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.18_suppl.lba5501] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
LBA5501 Background: Three-weekly (3w) CP is standard first-line chemotherapy for AOC pts. Weekly (w) P combined with 3w C prolonged PFS and OS in a JGOG phase III trial. MITO-7 is an academic randomized phase III study, comparing 3w vs. w CP. Methods: AOC chemonaive pts, stage IC-IV, age≤75, ECOG PS≤2, were randomized to 3wCP (C AUC6 + P 175mg/m², d1q21) for 6 cycles or to wCP (C AUC2 + P 60mg/m²) for 18 administrations. Coprimary endpoints were PFS and quality of life (QoL), measured by FACT-O and FACT/GOG-Ntx. With 80% power in detecting HR of 0.75, 2-sided α=0.05, 383 events were needed for PFS analysis. The arms were compared with a log-rank test and in a Cox model adjusted by stage, PS, residual disease, age and size of institution, following intention-to-treat. QoL was measured at baseline and weekly for 9 wks. Interaction between arm and QoL time was tested in a linear mixed model. Toxicity was coded by NCI-CTCAE v3.0. Results: 822 pts were enrolled by MITO, MANGO, and GINECO. Median age was 60; stage III (66%) and IV (18%) were prevalent. As of March 18, 2013, with median follow-up 20 months, 410 PFS events were recorded. Median PFS was 18.8 months with wCP and 16.5 months with 3wCP (HR 0.88, 95%CI 0.72-1.06, p=0.18). Lack of significant difference was confirmed (HR 0.87, 95%CI 0.71-1.05) in Cox model. For all scores, QoL course was significantly different between arms (p<0.0001). With 3wCP, QoL scores clearly worsened after each chemotherapy course (weeks 1, 4, 7), whilst with wCP, after a small and transient worsening at week 1, scores remained stable. Considering severe grades (≥3), wCP produced significantly less neutropenia, febrile neutropenia, thrombocytopenia, renal toxicity, and neuropathy. Conclusions: Compared to standard CP every 3 weeks, weekly CP did not demonstrate a significant benefit in PFS, but was associated with better QoL and toxicity. Clinical trial information: NCT00660842.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Eric Pujade-Lauraine
- Université Paris Descartes, AP-HP, Hôpitaux Universitaires Paris Centre, Site Hôtel-Dieu, Paris, France
| | - Ciro Gallo
- Medical Statistics, Department of Medicine and Public Health, Second University, Napoli, Italy
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De Angelis C, Cerillo I, Ruocco R, Bruzzese D, Forestieri V, Lauria R, Stanzione B, Paciolla I, De Laurentiis M, De Placido S, Arpino G. Clinical benefit of fulvestrant in postmenopausal women with advanced breast cancer according to prior therapy. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.e11528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e11528 Background: Hormone therapy (HT) is limited by the onset of resistance. Preclinical studies suggest that complete blockade of the estrogen receptor (ER) with the ER antagonist Fulvestrant (F) can overcome this resistance. The aim of this study was to evaluate the efficacy and tolerability of F in postmenopausal women with hormone-responsive (HR) metastatic breast cancer (MBC) previously treated with Tamoxifen (T) or Aromatase Inhibitors (AI). Methods: From May 2006 to July 2008 83 patients with HR MBC progressing after T or AI for adjuvant or metastatic disease receiving F 250 mg/month were identified. Median time to progression (TTP), overall survival (OS), clinical benefit rate (CBR) defined as the proportion of partial or complete responses (CR, PR) or stable disease (SD) lasting ‡6 months were analyzed. Results: Six, 32, 33 and 12 patients received F as 1st, 2nd, 3rd and 4thline of HT for MBC, respectively. Fulvestrant resulted in an overall CBR of 38.6% (32/83) with 0% CR, 9% PR, 30%SD, 56% PD. Disease was not evaluable in 4.8% of cases. Median TTP to F was 4.9 months (4 - 5.8; 95% C.I.) and OS was 20.1 months (15.8 - 24.4; 95% C.I.). Patients with visceral metastases and with more advanced lines of overall therapy had worse outcome (OR 3.13, 1.17-8.37, 95% C.I.; p 0.023 and OR 0.72, 0.54-0.96, 95% C.I.; p 0.025, respectively). However, Fulvestrant showed activity up to the fourth line of endocrine therapy regardless of number of metastatic sites and previous AI or T therapy. Overall treatment was well tolerated. Arthralgia, swelling, and myalgia were the most common adverse all were grade 1 or 2. No injection-related adverse events were reported. Conclusions: Fulvestrant is an active treatment in HR MBC previously challenged with HT. Safety profile is optimal and it may be a suitable option in extensively pre-treated patients. Further exploration of its use in this patient population is warranted.
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Pignata S, Scambia G, Lauria R, Raspagliesi F, Benedetti Panici P, Cormio G, Katsaros D, Sorio R, Cavazzini G, Ferrandina G, Breda E, Murgia V, Sacco C, Asensio Sierra NM, Pisano C, Salutari V, Weber BE, Pujade-Lauraine E, Gallo C, Perrone F. A randomized multicenter phase III study comparing weekly versus every 3 week carboplatin (C) plus paclitaxel (P) in patients with advanced ovarian cancer (AOC): Multicentre Italian Trials in Ovarian Cancer (MITO-7)– European Network of Gynaecological Oncological Trial Groups (ENGOT-ov-10)–Gynecologic Cancer Intergroup (GCIG ) trial. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.lba5501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
LBA5501 The full, final text of this abstract will be available at abstract.asco.org at 7:30 AM (EDT) on Saturday, June 1, 2013, and in the Annual Meeting Proceedings online supplement to the June 20, 2013, issue of Journal of Clinical Oncology. Onsite at the Meeting, this abstract will be printed in the Saturday edition of ASCO Daily News.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Eric Pujade-Lauraine
- Université Paris Descartes, AP-HP, Hôpitaux Universitaires Paris Centre, Site Hôtel-Dieu, Paris, France
| | - Ciro Gallo
- Medical Statistics, Department of Medicine and Public Health, Second University, Napoli, Italy
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De Angelis C, Milano M, Gargiulo P, Stanzione B, Forestieri V, Lauria R, Pensabene M, D'Arco F, De Placido S, Arpino G. Long-term disease control with lapatinib and capecitabine in a patient with HER2-positive metastatic breast cancer pretreated with trastuzumab and trastuzumab-emtansine. Tumori 2013; 99:e131-3. [DOI: 10.1177/030089161309900333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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
We describe the case of a woman who has been undergoing treatment for HER2-positive metastatic breast cancer since 2002. She presented liver metastasis at diagnosis in February 2002. Combination therapy with docetaxel and trastuzumab was administered as first-line treatment, and a complete response of the hepatic lesion and a partial response at the breast primary cancer site were achieved. After 6 cycles of therapy, the patient underwent surgical excision of the breast and then received trastuzumab alone until progression, which occurred in March 2010 with the development of a right chest wall lesion. The patient progressed after therapy with trastuzumab emtansine (T-DM1) received as second-line treatment. Subsequently, a combination of lapatinib and capecitabine was started in April 2011. At this writing, the patient is still receiving treatment (24 months) and is showing a long-lasting response with a favorable safety profile.
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Affiliation(s)
| | - Monica Milano
- Oncologia Medica, Dipartimento di Medicina Clinica e Chirurgia
| | - Piera Gargiulo
- Oncologia Medica, Dipartimento di Medicina Clinica e Chirurgia
| | | | | | - Rossella Lauria
- Oncologia Medica, Dipartimento di Medicina Clinica e Chirurgia
| | | | - Felice D'Arco
- Dipartimento di Diagnostica per Immagini e Radioterapia, Università degli Studi di Napoli Federico II, Naples, Italy
| | | | - Grazia Arpino
- Oncologia Medica, Dipartimento di Medicina Clinica e Chirurgia
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Mangili G, Sigismondi C, Frigerio L, Candiani M, Savarese A, Giorda G, Lauria R, Tamberi S, Greggi S, Lorusso D. Recurrent granulosa cell tumors (GCTs) of the ovary: a MITO-9 retrospective study. Gynecol Oncol 2013; 130:38-42. [PMID: 23623833 DOI: 10.1016/j.ygyno.2013.04.047] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Revised: 04/16/2013] [Accepted: 04/17/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Optimal treatment of recurrent GCTs is unknown. The aim of this study was to evaluate the characteristics of recurrent GCTs. METHODS Data on 35 recurrent GCTs were reviewed. RESULTS Initial FIGO stages were: 11 IA, 11 IC, 6 Ix, 1 IIB, 5 IIIC and 1 IV. All patients had undergone primary surgical treatment, and in 8 cases adjuvant chemotherapy was given. The median RFS was 53.2 months with differences between patients receiving (72.5 months) and not receiving (48 months) adjuvant chemotherapy and between patients optimally staged (64.5 months) or not staged (47 months). Recurrence sites were: pelvic, 13; abdominal, 6; lymph-nodal, 2; pelvic+abdominal, 7; abdominal+lymph-nodal, 4; and pelvic+lymph-nodal, 3. Twenty-five patients underwent debulking surgery+chemotherapy, 6 surgery, 2 surgery+radiotherapy, 1 chemotherapy and 1 palliation. 69% completed the chemotherapy. No difference was found in OS among patients receiving or not receiving chemotherapy after secondary surgery at recurrence and among the different relapse sites. Eleven patients developed a second relapse after a median time of 38 months. 81.8% had received adjuvant therapy at first recurrence. Four patients underwent surgery, 4 surgery+chemotherapy, 1 surgery+radiotherapy and 2 palliation. Four patients developed a third recurrence after a median time of 41 months. Two patients received chemotherapy and 2 hepatic resection. Nine patients (25.7%) died of disease. 5y-OS from the first recurrence was 55.6% and 87.4% for patients with or without residual tumor at subsequent debulking surgery, respectively. CONCLUSIONS In GCTs surgery remains the cornerstone treatment at relapse. RFS was higher in patients who received adjuvant therapy after initial diagnosis, with no difference in OS.
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Affiliation(s)
- Giorgia Mangili
- Gynecology Department, IRCCS Ospedale San Raffaele, Milan, Italy
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Fabbrocini G, Panariello L, Pensabene M, Lauria R, Matano E, Martellotta D, Bianca D, De Placido S, Ayala F. EMPACT Syndrome Associated with Phenobarbital. Dermatitis 2013; 24:37-9. [PMID: 23340399 DOI: 10.1097/der.0b013e31827ede32] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Arpino G, Pensabene M, Forestieri V, Condello C, Sarno MA, Ruocco R, Cerillo I, De Angelis C, Lauria R, Crispo A, De Placido S. Breast cancer prognosis in BRCA1/2 mutation carriers: A case control study. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.1554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
1554 Background: We evaluated the clinical impact of germ-line BRCA1/2 mutations and variants of unknown clinical significance (VUS) for BRCA1/2 in patients (pts) with early breast cancer (BC). Methods: Twenty-eight BRCA-positive (BRCA+) BC pts with germ-line BRCA1 /2 mutations and 16 VUS BC pts were selected from our database and matched (1:3) with 154 nonhereditary BC controls (sporadic controls, SC, defined by no associated personal history of breast cancer and no family history of breast and ovarian cancer or an uninformative BRCA mutation test) for stage, histologic subtype, age, and year of diagnosis. Clinical characteristics, recurrence (rec) pattern, disease free survival (DFS) and overall survival (OS) were analyzed. Results: Compared with VUS and SC, BRCA+ pts were less likely to express estrogen receptor (64% vs. 89% vs. 54% respectively p<.005) and progesterone receptor (64% vs. 86% vs. 59% respectively p<.005) but more likely to be triple negative (0 vs. 3.4% vs 47.4% respectively p<.005). Compared with VUS and SC, BRCA+ pts were more likely treated by radical mastectomy (37.5% vs. 26.4% vs. 59.3% % respectively p<.005). Pattern of rec was also different. Compared with VUS and SC, BRAC+ pts developed more second tumors (11% vs. 6.3% vs. 1.9% respectively p<.0001) but less local or distant rec (31% vs. 2.6 vs. 0% for local rec and 12% vs. 16% vs. 11% for distant rec respectively p<.0001). Controlateral BC was more frequent in VUS compared to the BRAC+ and SC pts (12% vs. 7% vs. 1% respectively, p<.0001). At a median follow up of 88 months, at univariate analysis, BRAC+ but not VUS pts had worse OS compared to SC (p=.006). No difference in DFS was observed for VUS or BRAC+ when compared to SC pts. After adjustment for age, stage, grade, nodal status, hormone receptors, adjuvant therapy and year of diagnosis, BRCA+ pts continued to have and increased risk of death compared to SC (HR 5.9, 95% CI 1.9-18.1, p<.002). Most of the deaths observed in BRAC+ pts were not cancer related. Conclusions: Despite decrease incidence of local or distant recs, BRAC+ pts seems to be more likely to die compared to SC. Development of second cancers and unknown effects of BRCA1/2 mutations on nonneoplastic diseases that cause death may account for this findings.
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Affiliation(s)
- Grazia Arpino
- Medical Oncology, Endocrinology and Oncology Department, University Federico II of Napoli, Napoli, Italy
| | | | | | - Caterina Condello
- Department of Clinical Oncology and Endocrinology and Rare Tumors Reference Center Campania Region, University Federico II, Naples, Italy
| | | | | | | | | | | | - Anna Crispo
- Struttura Semplice Dipartimentale di Epidemiologia, Istituto Nazionale Tumori Pascale, Naples, Italy
| | - Sabino De Placido
- Medical Oncology, Endocrinology and Oncology Department, University Federico II of Napoli, Naples, Italy
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Carlomagno C, Insabato L, Bifulco G, De Placido S, Lauria R. Ovarian metastasis following gallbladder carcinoma: a case report. EUR J GYNAECOL ONCOL 2010; 31:219-221. [PMID: 20527247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
BACKGROUND Mucinous ovarian cancer raises problems of differential diagnoses because it is often difficult to distinguish the primary from the metastatic form. Most metastatic ovarian tumors originate from the gastrointestinal tract, mainly colorectal, gastric, pancreatic; the gallbladder is a very rare source of ovarian metastases. CASE We report a case of ovarian metastases from a gallbladder cancer, incidentally diagnosed more than 2.5 years earlier during a laparoscopic intervention for biliary lithiasis. CONCLUSION The interest of this case lies in the long progression-free survival, the venous thromboembolism syndrome that preceded by a few months the diagnosis of the ovarian mass and the discrepancy between the radiologic and the laparoscopic stage assessment.
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Affiliation(s)
- C Carlomagno
- Department of Endocrinology and Molecular and Clinical Oncology, Federico II University, Naples, Italy.
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Barba M, Yang L, Schünemann HJ, Sperati F, Grioni S, Stranges S, Westerlind KC, Blandino G, Gallucci M, Lauria R, Malorni L, Muti P. Urinary estrogen metabolites and prostate cancer: a case-control study and meta-analysis. J Exp Clin Cancer Res 2009; 28:135. [PMID: 19814782 PMCID: PMC2766371 DOI: 10.1186/1756-9966-28-135] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2009] [Accepted: 10/08/2009] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To investigate prostate cancer (Pca) risk in relation to estrogen metabolism, expressed as urinary 2-hydroxyestrone (2-OHE1), 16alpha-hydroxyestrone (16alpha-OHE1) and 2-OHE1 to 16alpha-OHE1 ratio. METHODS We conducted a case-control study within the Western New York Health Cohort Study (WNYHCS) from 1996 to 2001. From January 2003 through September 2004, we completed the re-call and follow-up of 1092 cohort participants. Cases (n = 26) and controls (n = 110) were matched on age, race and recruitment period according to a 1:4 ratio. We used the unconditional logistic regression to compute crude and adjusted odds ratios (OR) and 95% confident interval (CI) of Pca in relation to 2-OHE1, 16alphaOHE1 and 2-OHE1 to 16alpha-OHE1 by tertiles of urine concentrations (stored in a biorepository for an average of 4 years). We identified age, race, education and body mass index as covariates. We also conducted a systematic review of the literature which revealed no additional studies, but we pooled the results from this study with those from a previously conducted case-control study using the DerSimonian-Laird random effects method. RESULTS We observed a non-significant risk reduction in the highest tertile of 2-OHE1 (OR 0.72, 95% CI 0.25-2.10). Conversely, the odds in the highest tertile of 16alpha-OHE1 showed a non-significant risk increase (OR 1.76 95% CI 0.62-4.98). There was a suggestion of reduced Pca risk for men in the highest tertile of 2-OHE1 to 16alpha-OHE1 ratio (OR 0.56, 95% CI 0.19-1.68). The pooled estimates confirmed the association between an increased Pca risk and higher urinary levels of 16alpha-OHE1 (third vs. first tertile: OR 1.82, 95% CI 1.09-3.05) and the protective effect of a higher 2-OHE 1 to 16alpha-OHE1 ratio (third vs. first tertile: OR 0.53, 95% CI 0.31-0.90). CONCLUSION Our study and the pooled results provide evidence for a differential role of the estrogen hydroxylation pathway in Pca development and encourage further study.
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Affiliation(s)
- Maddalena Barba
- Department of Epidemiology, National Cancer Institute Regina Elena, Rome, Italy.
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Pignata S, Ferrandina G, Scarfone G, Scollo P, Odicino F, Cormio G, Katsaros D, Villa A, Mereu L, Ghezzi F, Manzione L, Lauria R, Breda E, Alletti DG, Ballardini M, Lombardi AV, Sorio R, Mangili G, Priolo D, Magni G, Morabito A. Activity of chemotherapy in mucinous ovarian cancer with a recurrence free interval of more than 6 months: results from the SOCRATES retrospective study. BMC Cancer 2008; 8:252. [PMID: 18761742 PMCID: PMC2538544 DOI: 10.1186/1471-2407-8-252] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2008] [Accepted: 09/01/2008] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Mucinous ovarian carcinoma have a poorer prognosis compared with other histological subtypes. The aim of this study was to evaluate, retrospectively, the activity of chemotherapy in patients with platinum sensitive recurrent mucinous ovarian cancer. METHODS The SOCRATES study retrospectively assessed the pattern of care of a cohort of patients with recurrent platinum-sensitive ovarian cancer observed in the years 2000-2002 in 37 Italian centres. Data were collected between April and September 2005. Patients with recurrent ovarian cancer with > 6 months of platinum free interval were considered eligible. RESULTS Twenty patients with mucinous histotype and 388 patients with other histotypes were analyzed. At baseline, mucinous tumours differed from the others for an higher number of patients with lower tumor grading (p = 0.0056) and less advanced FIGO stage (p = 0.025). At time of recurrence, a statistically significant difference was found in performance status (worse in mucinous, p = 0.024). About 20% of patients underwent secondary cytoreduction in both groups, but a lower number of patients were optimally debulked in the mucinous group (p = 0.03). Patients with mucinous cancer received more frequently single agent platinum than platinum based-combination therapy or other non-platinum schedules as second line therapy (p = 0.026), with a response rate lower than in non-mucinous group (36.4% vs 62.6%, respectively, p = 0.04). Median time to progression and overall survival were worse for mucinous ovarian cancer. Finally, mucinous cancer received a lower number of chemotherapy lines (p = 0.0023). CONCLUSION This analysis shows that platinum sensitive mucinous ovarian cancer has a poor response to chemotherapy. Studies dedicated to this histological subgroup are needed.
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Affiliation(s)
| | | | - Giovanna Scarfone
- Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, Clinica Ostetrico-Ginecologica, Milano, Italy
| | - Paolo Scollo
- A.O. S. Cannizzaro, Ginecologia ed Ostetricia, Catania, Italy
| | - Franco Odicino
- A.O. Spedali Civili-Università degli Studi di Brescia, II Ginecologia ed Ostetricia, Brescia, Italy
| | - Gennaro Cormio
- Azienda Ospedaliera Policlinico, II Ginecologia e Ostetricia, Bari, Italy
| | - Dionyssios Katsaros
- Azienda Ospedaliera O.I.R.M.-S. Anna, Ginecologica Oncologica, Università di Torino, Italy
| | - Antonella Villa
- Ospedali Riuniti di Bergamo, U.O. di Ginecologia, Bergamo, Italy
| | - Liliana Mereu
- Ospedale Policlinico S. Matteo, Ostetrica e Ginecologica, Pavia, Italy
| | - Fabio Ghezzi
- Università dell'Insubria Clinica Ginecologia e Ostetrica, Varese, Italy
| | - Luigi Manzione
- Azienda Ospedaliera S. Carlo, Oncologia Medica, Potenza, Italy
| | | | - Enrico Breda
- Ospedale S. Giovanni-Fatebene Fratelli-Isola Tiberina, Oncologia Medica, Roma, Italy
| | | | - Michela Ballardini
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori – IRST, Meldola (FC), Italy
| | | | | | - Giorgia Mangili
- Ospedale S. Raffaele, Ginecologia Oncologica Medica, Milano, Italy
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Nuzzo F, Morabito A, De Maio E, Di Rella F, Gravina A, Labonia V, Landi G, Pacilio C, Piccirillo MC, Rossi E, D’Aiuto G, Thomas R, Gori S, Colozza M, De Placido S, Lauria R, Signoriello G, Gallo C, Perrone F, de Matteis A. Weekly docetaxel versus CMF as adjuvant chemotherapy for elderly breast cancer patients: Safety data from the multicentre phase 3 randomised ELDA trial. Crit Rev Oncol Hematol 2008; 66:171-80. [DOI: 10.1016/j.critrevonc.2007.10.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2007] [Revised: 10/25/2007] [Accepted: 10/31/2007] [Indexed: 11/29/2022] Open
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De Laurentiis M, Cancello G, D'Agostino D, Giuliano M, Giordano A, Montagna E, Lauria R, Forestieri V, Esposito A, Silvestro L, Pennacchio R, Criscitiello C, Montanino A, Limite G, Bianco AR, De Placido S. Taxane-based combinations as adjuvant chemotherapy of early breast cancer: a meta-analysis of randomized trials. J Clin Oncol 2008; 26:44-53. [PMID: 18165639 DOI: 10.1200/jco.2007.11.3787] [Citation(s) in RCA: 320] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
PURPOSE We conducted a meta-analysis of randomized trials that evaluated the efficacy of incorporating taxanes into anthracycline-based regimens for early breast cancer (EBC). We aimed to determine whether this approach improves disease-free survival (DFS) and overall survival (OS) and whether benefits are maintained across relevant patient subgroups. METHODS Studies were retrieved by searching the PubMed database and the proceedings of major conferences. We extracted hazard ratios (HR) and 95% CIs for DFS and OS from each trial and obtained pooled estimates using an inverse-variance model. RESULTS Thirteen studies were included in the meta-analysis (N = 22,903 patients). The pooled HR estimate was 0.83 (95% CI, 0.79 to 0.87; P < .00001) for DFS and 0.85 (95% CI, 0.79 to 0.91; P < .00001) for OS. Risk reduction was not influenced by the type of taxane, by estrogen receptor (ER) expression, by the number of axillary metastases (N1 to 3 v N4+), or by the patient's age/menopausal status. Sensitivity analysis showed that taxanes given in combination with anthracyclines, unlike sequential administration, did not significantly improve OS. However, the test for interaction showed that HR did not differ between the two schedules (P = .54). Taxane administration resulted in an absolute 5-year risk reduction of 5% for DFS and 3% for OS. CONCLUSION The addition of a taxane to an anthracycline-based regimen improves the DFS and OS of high-risk EBC patients. The DFS benefit was independent of ER expression, degree of nodal involvement, type of taxane, age/menopausal status of patient, and administration schedule.
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Affiliation(s)
- Michele De Laurentiis
- Dipartimento di Endocrinologia ed Oncologia Molecolare e Clinica, Università di Napoli Federico II, Napoli, Italy.
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