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Vitello S, Di Liegro I, Ricciardi MR, Verga C, Amato A, Schiera G, Di Liegro C, Messina G, Proia P. Correlation between polymorphism of TYMS gene and toxicity response to treatment with 5-fluoruracil and capecitabine. Eur J Transl Myol 2020; 30:8970. [PMID: 33117504 PMCID: PMC7582406 DOI: 10.4081/ejtm.2020.8970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 05/13/2020] [Indexed: 11/24/2022] Open
Abstract
Tumorigenesis is a multiphasic process in which genetic alterations guide the progressive transformation in cancer cells1. In order to evaluate the possible correlation between some gene variants and the risk of the toxicity development onset, two of the polymorphisms of the thymidylate synthase (TYMS), rs34743033 (2R/3R) and rs16430 (DEL/INS) were investigated. We enrolled in our study 47 patients from the Hospital of Sicily. Our preliminary findings suggest that there could be a linkage between the genotypes discussed and the development of the toxicity following the chemotherapy treatment. These results need to be confirmed by further studies, however this short paper offers some initial insight into the relationships between genetic background and the better outcome for patients.
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Affiliation(s)
| | - Italia Di Liegro
- Department of Experimental Biomedicine and Clinical Neurosciences (BIONEC), University of Palermo, Palermo, Italy
| | | | | | - Alessandra Amato
- Department of Psychological, Pedagogical and Educational Sciences, Sport and Exercise Sciences Research Unit, University of Palermo, Palermo, Italy
| | - Gabriella Schiera
- Department of Biological Chemical and Pharmaceutical Sciences and Technologies (STEBICEF), University of Palermo, Palermo, Italy
| | - Carlo Di Liegro
- Department of Biological Chemical and Pharmaceutical Sciences and Technologies (STEBICEF), University of Palermo, Palermo, Italy
| | - Giuseppe Messina
- Department of Psychological, Pedagogical and Educational Sciences, Sport and Exercise Sciences Research Unit, University of Palermo, Palermo, Italy
| | - Patrizia Proia
- Department of Psychological, Pedagogical and Educational Sciences, Sport and Exercise Sciences Research Unit, University of Palermo, Palermo, Italy
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Vitello S, Di Liegro I, Ricciardi MR, Verga C, Amato A, Schiera G, Di Liegro C, Messina G, Proia P. Correlation between polymorphism of TYMS gene and toxicity response to treatment with 5-fluoruracil and capecitabine. Eur J Transl Myol 2020. [DOI: 10.4081/ejtm.0.8970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Tumorigenesis is a multiphasic process in which genetic alterations guide the progressive transformation in cancer cells1. In order to evaluate the possible correlation between some gene variants and the risk of the toxicity development onset, two of the polymorphisms of the thymidylate synthase (TYMS), rs34743033 (2R/3R) and rs16430 (DEL/INS) were investigated. We enrolled in our study 47 patients from the Hospital of Sicily. Our preliminary findings suggest that there could be a linkage between the genotypes discussed and the development of the toxicity following the chemotherapy treatment. These results need to be confirmed by further studies, however this short paper offers some initial insight into the relationships between genetic background and the better outcome for patients.
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Blasi L, Bordonaro R, Borsellino N, Butera A, Caruso M, Cordio S, Liborio DC, Ferraù F, Giuffrida D, Parra HS, Spada M, Tralongo P, Valenza R, Verderame F, Vitello S, Zerilli F, Piazza D, Firenze A, Gebbia V. Reactions and countermeasures of medical oncologists towards the incoming COVID-19 pandemic: a WhatsApp messenger-based report from the Italian College of Chief Medical Oncologists. Ecancermedicalscience 2020; 14:1046. [PMID: 32565899 PMCID: PMC7289620 DOI: 10.3332/ecancer.2020.1046] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 04/23/2020] [Indexed: 12/30/2022] Open
Abstract
Background This descriptive, unplanned investigation has been undertaken to report reactions, attitudes and countermeasures which have been put in place and implemented by medical oncology units facing the COVID-19 outbreak in Southern Italy. Materials and methods Data have been retrospectively obtained from the time-related analysis of conversations via a WhatsApp messenger-based group chat between the medical directors belonging to the Italian College of Medical Oncology Directors. Overall number, intensity and time trend of conversations related to reactions during the 4 weeks of observation related to the crucial events which occurred between 24 February and 28 March, 2020 2020 are included. A sentiment analysis of conversations was also carried out. Results We report 956 conversations among 19 medical oncology units related to reactions to the crucial events, such as epidemic spread, Government ordinances and guidelines during the 4 weeks of observation. Data show significant awareness of problems linked to the COVID-19 spread among oncologists and rapid diffusion of countermeasures. Actions taken were correlated time wise to crucial events. A correlation between conversations and the volume of activity of oncology units was found. By analysing the sentiment analysis of raw data, positive emotions were reduced in percentage over the weeks. A significant increase in negative emotions was observed as the outbreak impacted on the healthcare system. Conclusion In our experience, the WhatsApp instant-messaging system seems to be a useful tool to share news and reactions between medical oncologists to rapidly implement necessary health measures and answers to most cancer patients' needs and queries in the COVID-19 pandemic scenario.
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Affiliation(s)
- Livio Blasi
- Medical Oncology Unit, Arnas, Ospedale Civico, Palermo, 90100, and National President of CIPOMO, Italy
| | - Roberto Bordonaro
- Medical Oncology Unit, Arnas, Ospedale Garibaldi, Catania, 95100, Italy
| | - Nicolò Borsellino
- Medical Oncology Unit, Ospedale Buccheri La Ferla, Palermo, 90100, Italy
| | - Alfredo Butera
- Medical Oncology Unit, Ospedale San Giovanni di Dio, Agrigento, 92100, Italy
| | - Michele Caruso
- Medical Oncology Unit, Istituto Clinico Humanitas, Catania, 95100, Italy
| | - Stefano Cordio
- Medical Oncology Unit, Ospedale Paterno Arezzo, Ragusa, 97100, Italy
| | - Di Cristina Liborio
- Medical Oncology Unit, Ospedale Vittorio Emanuele, Castelvetrano, 91022, Italy
| | - Francesco Ferraù
- Medical Oncology Unit, Ospedale San Vincenzo, Taormina, 98039, Italy
| | - Dario Giuffrida
- Medical Oncology Unit, Istituto Oncologico Mediterraneo, Viagrande, 95029, Italy
| | | | | | - Paolo Tralongo
- Medical Oncology Unit, Ospedale Umberto I, Siracusa, 96100, Italy
| | - Roberto Valenza
- Medical Oncology Unit, Ospedale Vittorio Emanuele, Gela, 93012, Italy
| | | | - Stefano Vitello
- Medical Oncology Unit, Ospedale Sant'Elia, Caltanissetta, 93100, Italy
| | - Filippo Zerilli
- Medical Oncology Unit, Ospedale San Antonio Abate, Trapani, 91100, Italy
| | | | | | - Vittorio Gebbia
- Medical Oncology Unit, Ospedale La Maddalena, University of Palermo, Palermo, 90100, Italy
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Cremolini C, Antoniotti C, Rossini D, Lonardi S, Loupakis F, Pietrantonio F, Bordonaro R, Latiano TP, Tamburini E, Santini D, Passardi A, Marmorino F, Grande R, Aprile G, Zaniboni A, Murgioni S, Granetto C, Buonadonna A, Moretto R, Corallo S, Cordio S, Antonuzzo L, Tomasello G, Masi G, Ronzoni M, Di Donato S, Carlomagno C, Clavarezza M, Ritorto G, Mambrini A, Roselli M, Cupini S, Mammoliti S, Fenocchio E, Corgna E, Zagonel V, Fontanini G, Ugolini C, Boni L, Falcone A, Falcone A, Lonardi S, De Braud FGM, Bordonaro R, Maiello E, Tamburini E, Santini D, Frassineti GL, Gamucci T, Aprile G, Zaniboni A, Granetto C, Buonadonna A, Di Costanzo F, Tomasello G, Gianni L, Di Donato S, Carlomagno C, Clavarezza M, Racca P, Mambrini A, Roselli M, Allegrini G, Sobrero A, Aglietta M, Corgna E, Cortesi E, Corsi DC, Ballestrero A, Bonetti A, Di Clemente F, Ruggeri E, Ciardiello F, Benasso M, Vitello S, Cinieri S, Mosconi S, Silvestris N, Frassoldati A, Cupini S, Bertolini A, Tortora G, Bengala C, Ferrari D, Ardizzoia A, Milandri C, Chiara S, Romano G, Miraglia S, Scaltriti L, Pucci F, Blasi L, Brugnatelli S, Fioretto L, Ribecco AS, Longarini R, Frisinghelli M, Banzi M. Upfront FOLFOXIRI plus bevacizumab and reintroduction after progression versus mFOLFOX6 plus bevacizumab followed by FOLFIRI plus bevacizumab in the treatment of patients with metastatic colorectal cancer (TRIBE2): a multicentre, open-label, phase 3, randomised, controlled trial. Lancet Oncol 2020; 21:497-507. [DOI: 10.1016/s1470-2045(19)30862-9] [Citation(s) in RCA: 98] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 12/18/2019] [Accepted: 12/19/2019] [Indexed: 01/07/2023]
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Borelli B, Moretto R, Lonardi S, Bonetti A, Antoniotti C, Pietrantonio F, Masi G, Burgio V, Marmorino F, Salvatore L, Rossini D, Zaniboni A, Zucchelli G, Martignetti A, Di Battista M, Pella N, Passardi A, Boccaccino A, Leone F, Colombo C, Granetto C, Vannini F, Marsico VA, Martinelli E, Antonuzzo L, Vitello S, Delliponti L, Boni L, Cremolini C, Falcone A. TRIPLETE: a randomised phase III study of modified FOLFOXIRI plus panitumumab versus mFOLFOX6 plus panitumumab as initial therapy for patients with unresectable RAS and BRAF wild-type metastatic colorectal cancer. ESMO Open 2018; 3:e000403. [PMID: 30018814 PMCID: PMC6045747 DOI: 10.1136/esmoopen-2018-000403] [Citation(s) in RCA: 16] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Accepted: 05/21/2018] [Indexed: 12/22/2022] Open
Abstract
Background FOLFOXIRI plus bevacizumab is considered a standard option in the upfront treatment of clinically selected patients with metastatic colorectal cancer irrespective of RAS and BRAF molecular status. The randomised MACBETH and VOLFI studies showed that a modified FOLFOXIRI regimen in combination with cetuximab or panitumumab, respectively, achieved high therapeutic activity in RAS and BRAF wild-type patients with an acceptable toxicity profile. Drawing from these considerations, we designed TRIPLETE study aiming at comparing two different chemotherapy backbones (mFOLFOXIRI or mFOLFOX6) in combination with panitumumab in the first-line treatment of patients with RAS and BRAF wild-type metastatic colorectal cancer. Methods This is a prospective, open-label, multicentre phase III trial in which initially unresectable and previously untreated RAS and BRAF wild-type metastatic colorectal cancer patients are randomised to receive a standard treatment with mFOLFOX6 plus panitumumab or an experimental regimen with modified FOLFOXIRI (irinotecan 150 mg/m2, oxaliplatin 85 mg/m2, L-leucovorin 200 mg/m2, 5-fluoruracil 2400 mg/m2 48-hour continuous infusion) plus panitumumab up to 12 cycles, followed by panitumumab plus 5-fluorouracil and L-leucovorin until disease progression. The primary endpoint is overall response rate according to RECIST 1.1 criteria. Discussion The relative benefit of chemotherapy intensification when using an anti-EGFR-based regimen in molecularly selected patients is unknown; TRIPLETE study aims at filling this gap of knowledge. The study is sponsored by the Gruppo Oncologico Nord Ovest Cooperative Group and is currently ongoing at 42 Italian centres. Clinical trial information NCT03231722.
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Affiliation(s)
- Beatrice Borelli
- Unit of Medical Oncology, Azienda Ospedaliero-Universitaria Pisana, Department of Translational Research and New Technologies in Medicine, University of Pisa, Pisa, Italy
| | - Roberto Moretto
- Unit of Medical Oncology, Azienda Ospedaliero-Universitaria Pisana, Department of Translational Research and New Technologies in Medicine, University of Pisa, Pisa, Italy
| | - Sara Lonardi
- Department of Clinical and Experimental Oncology, SC Medical Oncology Unit 1, Istituto Oncologico Veneto - IRCCS, Padua, Italy
| | - Andrea Bonetti
- Department of Oncology, "Mater Salutis" Hospital, Legnago, Italy
| | - Carlotta Antoniotti
- Unit of Medical Oncology, Azienda Ospedaliero-Universitaria Pisana, Department of Translational Research and New Technologies in Medicine, University of Pisa, Pisa, Italy
| | - Filippo Pietrantonio
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Gianluca Masi
- Unit of Medical Oncology, Azienda Ospedaliero-Universitaria Pisana, Department of Translational Research and New Technologies in Medicine, University of Pisa, Pisa, Italy
| | - Valentina Burgio
- Department of Oncology, Division of Experimental Medicine, IRCCS San Raffaele, Milan, Italy
| | - Federica Marmorino
- Unit of Medical Oncology, Azienda Ospedaliero-Universitaria Pisana, Department of Translational Research and New Technologies in Medicine, University of Pisa, Pisa, Italy
| | - Lisa Salvatore
- Medical Oncology Unit, Department of Medicine, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Daniele Rossini
- Unit of Medical Oncology, Azienda Ospedaliero-Universitaria Pisana, Department of Translational Research and New Technologies in Medicine, University of Pisa, Pisa, Italy
| | | | - Gemma Zucchelli
- Unit of Medical Oncology, Azienda Ospedaliero-Universitaria Pisana, Department of Translational Research and New Technologies in Medicine, University of Pisa, Pisa, Italy
| | | | | | - Nicoletta Pella
- Department of Medical Oncology, Azienda Sanitaria Universitaria Integrata, Udine, Italy
| | - Alessandro Passardi
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Alessandra Boccaccino
- Unit of Medical Oncology, Azienda Ospedaliero-Universitaria Pisana, Department of Translational Research and New Technologies in Medicine, University of Pisa, Pisa, Italy
| | - Francesco Leone
- Department of Medical Oncology, Candiolo Cancer Institute, FPO, IRCCS, Candiolo, Italy.,Department of Oncology, University of Turin, Turin, Italy
| | - Camilla Colombo
- Unit of Medical Oncology, Azienda Ospedaliero-Universitaria Pisana, Department of Translational Research and New Technologies in Medicine, University of Pisa, Pisa, Italy
| | - Cristina Granetto
- Department of Medical Oncology, A.O. S. Croce and Carle Teaching Hospital, Cuneo, Italy
| | - Francesca Vannini
- Unit of Medical Oncology, Azienda Ospedaliero-Universitaria Pisana, Department of Translational Research and New Technologies in Medicine, University of Pisa, Pisa, Italy
| | | | - Erika Martinelli
- Department of Internal and Experimental Medicine "F. Magrassi e A. Lanzara", Institute of Medical Oncology, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Lorenzo Antonuzzo
- S.C. Oncologia Medica 1, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.,Medical Genetics, University of Siena, Siena, Italy
| | - Stefano Vitello
- Department of Medical Oncology, Sant'Elia Hospital, Caltanissetta, Italy
| | - Laura Delliponti
- Unit of Medical Oncology, Azienda Ospedaliero-Universitaria Pisana, Department of Translational Research and New Technologies in Medicine, University of Pisa, Pisa, Italy
| | - Luca Boni
- Clinical Trial Center, AOU Careggi, Firenze, Italy
| | - Chiara Cremolini
- Unit of Medical Oncology, Azienda Ospedaliero-Universitaria Pisana, Department of Translational Research and New Technologies in Medicine, University of Pisa, Pisa, Italy
| | - Alfredo Falcone
- Unit of Medical Oncology, Azienda Ospedaliero-Universitaria Pisana, Department of Translational Research and New Technologies in Medicine, University of Pisa, Pisa, Italy
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Vitello S, Raimondi C, Sollami R, Signorelli C, Triglia E. Treatment in advanced malignant pleural mesothelioma after chemotherapy standard. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw332.40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Cremolini C, Loupakis F, Masi G, Lonardi S, Granetto C, Mancini ML, Chiara S, Moretto R, Rossini D, Vitello S, Allegrini G, Tonini G, Bergamo F, Tomasello G, Ronzoni M, Buonadonna A, Bustreo S, Barbara C, Boni L, Falcone A. FOLFOXIRI or FOLFOXIRI plus bevacizumab as first-line treatment of metastatic colorectal cancer: a propensity score-adjusted analysis from two randomized clinical trials. Ann Oncol 2016; 27:843-9. [PMID: 26861604 DOI: 10.1093/annonc/mdw052] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 02/03/2016] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND FOLFOXIRI plus bevacizumab is a valid option as upfront treatment for metastatic colorectal cancer (mCRC) patients. While several trials investigated the effect of combining bevacizumab with different chemotherapy regimens, including fluoropyrimidines monotherapy and oxaliplatin- or irinotecan-containing doublets, no randomized comparison assessing the impact of the addition of bevacizumab to FOLFOXIRI is available. PATIENTS AND METHODS A total of 122 mCRC patients received first-line FOLFOXIRI in the phase III trial by the GONO (FOLFOXIRI group) and 252 patients received first-line FOLFOXIRI plus bevacizumab in the TRIBE trial (FOLFOXIRI plus bevacizumab group). A propensity score-adjusted method was adopted to provide an estimation of the benefit from the addition of bevacizumab to FOLFOXIRI in terms of survival and activity parameters. RESULTS Patients in the FOLFOXIRI group had more frequently Eastern Cooperative Oncology Group performance status of one or two, high Köhne score, metachronous and liver-limited disease, had previously received adjuvant treatments and had their primary tumors resected. The median progression-free survival (PFS) was 12.3 months in the FOLFOXIRI plus bevacizumab group compared with 10.0 months in the FOLFOXIRI group {propensity score-adjusted hazard ratio (HR) 0.74 [95% confidence interval (CI) 0.59-0.94], P = 0.013}. This association was significant also in the multivariable model (P = 0.024). The median OS was 29.8 months in the FOLFOXIRI plus bevacizumab group compared with 23.6 months in the FOLFOXIRI group [propensity score-adjusted HR: 0.72 (95% CI 0.56-0.93), P = 0.014]. At the multivariable model, the addition of bevacizumab was still associated with significantly longer OS (P = 0.030). No significant differences in RECIST response rate (RR) [65.1% versus 55.7%; propensity score-adjusted odds ratio (OR): 1.29 (95% CI 0.81-2.05), P = 0.280], early RR [62.7% versus 57.8%; OR: 1.14 (95% CI 0.68-1.93), P = 0.619] and median depth of response (42.2% versus 53.8%, P = 0.259) were reported. CONCLUSIONS Though in the absence of a randomized comparison, the addition of bevacizumab to FOLFOXIRI provides significant benefit in PFS and OS, thus supporting the use of FOLFOXIRI plus bevacizumab as upfront treatment for mCRC patients. TRIALS' NUMBERS NCT01219920 and NCT00719797.
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Affiliation(s)
- C Cremolini
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa Department of Translational Research and New Technologies in Medicine, University of Pisa, Pisa
| | - F Loupakis
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa Department of Translational Research and New Technologies in Medicine, University of Pisa, Pisa
| | - G Masi
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa Department of Translational Research and New Technologies in Medicine, University of Pisa, Pisa
| | - S Lonardi
- Unit of Medical Oncology 1, Istituto Oncologico Veneto, IRCSS, Padua
| | - C Granetto
- Unit of Medical Oncology, Azienda Sanitaria Ospedaliera Santa Croce e Carle, Cuneo
| | - M L Mancini
- Department of Medical Oncology, University of Rome La Sapienza, Rome
| | - S Chiara
- Department of Medical Oncology 2, IRCCS Azienda Ospedaliera Universitaria San Martino-IST Istituto Nazionale per la Ricerca sul Cancro, Genoa
| | - R Moretto
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa Department of Translational Research and New Technologies in Medicine, University of Pisa, Pisa
| | - D Rossini
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa Department of Translational Research and New Technologies in Medicine, University of Pisa, Pisa
| | - S Vitello
- Unit of Oncology, Sant'Elia Hospital, Caltanissetta
| | - G Allegrini
- Unit of Medical Oncology, 'Felice Lotti' Hospital, Pontedera
| | - G Tonini
- Department of Medical Oncology, University Campus Biomedico, Rome
| | - F Bergamo
- Unit of Medical Oncology 1, Istituto Oncologico Veneto, IRCSS, Padua
| | - G Tomasello
- Division of Medicine and Medical Oncology, Azienda Istituti Ospitalieri, Cremona
| | - M Ronzoni
- Department of Oncology, 'San Raffaele' Hospital IRCSS, Milan
| | - A Buonadonna
- Division of Oncology, Centro di Riferimento Oncologico, Aviano
| | - S Bustreo
- ColoRectal Cancer Unit, Unit of Oncology 1, 'Molinette' Hospital, Città della Salute e della Scienza, Turin
| | - C Barbara
- Unit of Medical Oncology, Spedali Riuniti di Livorno, Livorno
| | - L Boni
- Clinical Trials Coordinating Center, Istituto Toscano Tumori, Florence, Italy
| | - A Falcone
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa Department of Translational Research and New Technologies in Medicine, University of Pisa, Pisa
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Cremolini C, Del Re M, Loupakis F, Marmorino F, Citi V, Palombi M, Bergamo F, Schirripa M, Rossini D, Cortesi E, Tomasello G, Spadi R, Buonadonna A, Amoroso D, Vitello S, Di Donato S, Granetto C, D'Amico M, Falcone A, Danesi R. DPYD c.1905 + 1G > A and c.2846A > T and UGT1A1*28 allelic variants as predictors of toxicity: Pharmacogenetic translational analysis from the phase III TRIBE study in metastatic colorectal cancer. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv340.07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Cremolini C, Loupakis F, Antoniotti C, Lonardi S, Masi G, Salvatore L, Cortesi E, Tomasello G, Spadi R, Zaniboni A, Tonini G, Barone C, Vitello S, Longarini R, Bonetti A, D'Amico M, Di Donato S, Granetto C, Boni L, Falcone A. Early tumor shrinkage and depth of response predict long-term outcome in metastatic colorectal cancer patients treated with first-line chemotherapy plus bevacizumab: results from phase III TRIBE trial by the Gruppo Oncologico del Nord Ovest. Ann Oncol 2015; 26:1188-1194. [PMID: 25712456 DOI: 10.1093/annonc/mdv112] [Citation(s) in RCA: 142] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 02/17/2015] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Early tumor shrinkage (ETS) and depth of response (DoR) predict overall survival (OS) in first-line trials of chemotherapy ± anti-EGFR monoclonal antibodies in metastatic colorectal cancer (mCRC). These associations and the predictive accuracy of response measurements for survival parameters were investigated in the phase III TRIBE trial of FOLFOXIRI plus bevacizumab (bev) versus FOLFIRI plus bev. PATIENTS AND METHODS A landmark approach was adopted to define the assessable population. The distribution of RECIST response rate, ETS and DoR was compared in the two arms. Associations between response measurements and progression-free survival (PFS), post-progression survival (PPS) and OS were tested by univariate and multivariate Cox models. Prediction performance of each factor was estimated by C-index. RESULTS A significantly higher percentage of patients in the FOLFOXIRI plus bev arm achieved ETS ≥20%, when compared with the control arm (62.7% versus 51.9%, P = 0.025). Also the DoR was significantly higher in the triplet plus bev arm (43.4% versus 37.8%, P = 0.003). Both ETS and DoR were associated with PFS, PPS and OS at the univariate analyses and in the multivariate models stratified for other prognostic variables. Both ETS and DoR were able to predict survival as accurately as RECIST response. CONCLUSION FOLFOXIRI plus bev improves ETS and DoR when compared with FOLFIRI plus bev. Achieving rapid and deep tumor shrinkage consistently delays tumor progression and prolongs survival in patients treated with first-line chemotherapy plus bev. ETS is a promising and valuable end point for clinical trials' design deserving further investigation.
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Affiliation(s)
- C Cremolini
- Unit of Medical Oncology 2, Polo Oncologico, Azienda Ospedaliero-Universitaria Pisana, Istituto Toscano Tumori, Pisa; Unit of Medical Oncology 2, University of Pisa, Pisa
| | - F Loupakis
- Unit of Medical Oncology 2, Polo Oncologico, Azienda Ospedaliero-Universitaria Pisana, Istituto Toscano Tumori, Pisa; Unit of Medical Oncology 2, University of Pisa, Pisa
| | - C Antoniotti
- Unit of Medical Oncology 2, Polo Oncologico, Azienda Ospedaliero-Universitaria Pisana, Istituto Toscano Tumori, Pisa; Unit of Medical Oncology 2, University of Pisa, Pisa
| | - S Lonardi
- Unit of Medical Oncology 1, Istituto Oncologico Veneto, IRCSS, Padova
| | - G Masi
- Unit of Medical Oncology 2, Polo Oncologico, Azienda Ospedaliero-Universitaria Pisana, Istituto Toscano Tumori, Pisa; Unit of Medical Oncology 2, University of Pisa, Pisa
| | - L Salvatore
- Unit of Medical Oncology 2, Polo Oncologico, Azienda Ospedaliero-Universitaria Pisana, Istituto Toscano Tumori, Pisa; Unit of Medical Oncology 2, University of Pisa, Pisa
| | - E Cortesi
- Department of Medical Oncology, University of Rome La Sapienza, Rome
| | - G Tomasello
- Division of Medicine and Medical Oncology, Azienda Istituti Ospitalieri, Cremona
| | - R Spadi
- Azienda Ospedaliero-Universitaria Città Della Salute e Della Scienza, Turin
| | - A Zaniboni
- Department of Medical Oncology, Fondazione Poliambulanza, Brescia
| | - G Tonini
- Department of Medical Oncology, University Campus Biomedico, Rome
| | - C Barone
- Unit of Medical Oncology, Università Cattolica del Sacro Cuore, Rome
| | - S Vitello
- Unit of Oncology, Sant'Elia Hospital, Caltanissetta
| | - R Longarini
- Unit of Medical Oncology, San Gerardo Hospital, Monza
| | - A Bonetti
- Unit of Medical Oncology, Mater Salutis Hospital, Legnago
| | - M D'Amico
- Unit of Medical Oncology, Galliera Hospital, Genoa
| | - S Di Donato
- Department of Medical Oncology Sandro Pitigliani, Prato Hospital, Istituto Toscano Tumori, Prato
| | - C Granetto
- Unit of Medical Oncology, Azienda Sanitaria Ospedaliera Santa Croce e Carle, Cuneo
| | - L Boni
- Clinical Trials Coordinating Center, Istituto Toscano Tumori, Firenze
| | - A Falcone
- Unit of Medical Oncology 2, Polo Oncologico, Azienda Ospedaliero-Universitaria Pisana, Istituto Toscano Tumori, Pisa; Unit of Medical Oncology 2, University of Pisa, Pisa.
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Del Re M, Cremolini C, Loupakis F, Marmorino F, Citi V, Palombi M, Bergamo F, Schirripa M, Rossini D, Cortesi E, Tomasello G, Spadi R, Buonadonna A, Amoroso D, Vitello S, Di Donato S, Granetto C, D'Amico M, Danesi R, Falcone A. DPYD c.1905+1G>A and c.2846A>T and UGT1A1*28 allelic variants as predictors of toxicity: Pharmacogenetic translational analysis from the phase III TRIBE study in metastatic colorectal cancer. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.3532] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Marzia Del Re
- University of Pisa Department of Clinical and Experimental Medicine, Ghezzano, Italy
| | - Chiara Cremolini
- Azienda Ospedaliero-Universitaria Pisana, Istituto Toscano Tumori, Pisa, Italy
| | - Fotios Loupakis
- Azienda Ospedaliero-Universitaria Pisana, Istituto Toscano Tumori, Pisa, Italy
| | - Federica Marmorino
- U.O. Oncologia Medica 2, Azienda Ospedaliero-Universitaria Pisana, Istituto Toscano Tumori, Pisa, Italy
| | - Valentina Citi
- Clinical Pharmacology Unit, Department of Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Francesca Bergamo
- U.O. Oncologia Medica 1, Istituto Oncologico Veneto - IRCCS, Padova, Italy
| | | | | | - Enrico Cortesi
- Dipartimento di Oncologia Medica, Università di Roma La Sapienza, Rome, Italy
| | | | - Rosella Spadi
- Medical Oncology Unit, Molinette Hospital, Torino, Italy
| | - Angela Buonadonna
- Dipartimento di Oncologia Medica, Istituto Nazionale Tumori, Aviano, Italy
| | | | | | - Samantha Di Donato
- Sandro Pitigliani Medical Oncology Department, Hospital of Prato, Istituto Toscano Tumori, Prato, Italy
| | - Cristina Granetto
- U.O. Oncologia Medica, Azienda Sanitaria Ospedaliera S. Croce e Carle, Cuneo, Italy
| | | | - Romano Danesi
- Clinical Pharmacology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Alfredo Falcone
- Azienda Ospedaliero-Universitaria Pisana, Istituto Toscano Tumori, Pisa, Italy
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Cremolini C, Loupakis F, Rossini D, Masi G, Salvatore L, Barbara C, Brunetti I, Antoniotti C, Granetto C, Cortesi E, Chiara S, Vitello S, Lonardi S, Ciuffreda L, Tomasello G, Ronzoni M, Buonadonna A, Tomcikova D, Boni L, Falcone A. Folfoxiri with or Without Bevacizumab (Bev) As First-Line Treatment of Metastatic Colorectal Cancer (Mcrc): a Propensity Score-Based Analysis. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu333.21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Cremolini C, Loupakis F, Lonardi S, Tomasello G, Ronzoni M, Zaniboni A, Tonini G, Valsuani C, Chiara S, Boni C, Marcucci L, Negri F, Barone C, Vitello S, D'Amico M, Granetto C, Antoniotti C, Salvatore L, Fontanini G, Tomcikova D, Boni L, Falcone A. Subgroup Analyses in RAS Mutant, BRAF Mutant and “ALL WT” Metastatic Colorectal Cancer Patients Treated with Folfoxiri Plus Bevacizumab (BEV) or Folfiri Plus BEV in the Tribe Study. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu193.7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
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Loupakis F, Cremolini C, Lonardi S, Tomasello G, Ronzoni M, Zaniboni A, Tonini G, Valsuani C, Chiara S, Boni C, Marcucci L, Negri F, Barone C, Vitello S, D'Amico M, Granetto C, Fontanini G, Tomcikova D, Boni L, Falcone A. Subgroup analyses in RAS mutant, BRAF mutant and all-wt mCRC pts treated with FOLFOXIRI plus bevacizumab (bev) or FOLFIRI plus bev in the TRIBE study. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.3519] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [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)
- Fotios Loupakis
- U.O. Oncologia Medica 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Chiara Cremolini
- U.O. Oncologia Medica 2, Azienda Ospedaliero-Universitaria Pisana, Istituto Toscano Tumori, Pisa, Italy
| | - Sara Lonardi
- Medical Oncology 1, Istituto Oncologico Veneto IOV - IRCCS, Padova, Italy
| | | | - Monica Ronzoni
- Dipartimento di Oncologia Medica, Istituto Scientifico San Raffaele, Milano, Italy
| | - Alberto Zaniboni
- Department of Medical Oncology, Casa di Cura Poliambulanza, Brescia, Italy
| | - Giuseppe Tonini
- Department of Medical Oncology, Campus Bio-Medico University of Rome, Rome, Italy
| | | | - Silvana Chiara
- Medical Oncology Unit, National Cancer Institute, Genoa, Italy
| | | | | | - Francesca Negri
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | | | | | | | - Cristina Granetto
- U.O. Oncologia Medica, Azienda Sanitaria Ospedaliera S. Croce e Carle, Cuneo, Italy
| | | | | | - Luca Boni
- Clinical Trial Coordinating Center, AOU Careggi, Istituto Toscano Tumori (ITT), Firenze, Italy
| | - Alfredo Falcone
- U.O. Oncologia Medica 2, Azienda Ospedaliero-Universitaria Pisana, Istituto Toscano Tumori, Pisa, Italy
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Cremolini C, Loupakis F, Lonardi S, Trenta P, Antoniotti C, Masi G, Tomasello G, Ronzoni M, Ciuffreda L, Zaniboni A, Carlomagno C, Boni C, Negri F, Barone C, Vitello S, Giuntini N, Bonetti A, D'Amico M, Boni L, Falcone A. Early tumor shrinkage (ETS) and deepness of response (DoR) to predict progression-free, postprogression, and overall survival: Results from the phase III TRIBE trial. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.3_suppl.521] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
521 Background: The TRIBE trial demonstrated that first-line FOLFOXIRI plus bevacizumab (bev) improves PFS, response rate (RECIST), and OS in comparison to FOLFIRI plus bev (ASCO Annual Meeting 2013). Recent experiences evidenced that both ETS and DoR may implement the assessment of response and correlate with survival in metastatic colorectal cancer (mCRC). Methods: ETS was defined as the relative change in the sum of longest diameters of RECIST target lesions at week 8 compared to baseline. A 20% decrease was adopted as cut-off value to discriminate early responders and non-responders. DoR was defined as the relative change in the sum of longest diameters of RECIST target lesions at the nadir in the absence of new lesions or progression of non-target lesions compared to baseline. The median value was used as cut-off. Results: Out of 508 randomized patients, 443 and 484 patients were evaluable for ETS and DoR, respectively. Early responders achieved longer PFS (median PFS: 12.7 vs 10.0 mos, HR: 0.66 [0.52-0.79], p<0.0001), post-progression survival (median PPS: 17.1 vs 10.7 mos, HR: 0.64 [0.47-0.81], p=0.0005) and OS (median OS: 35.8 vs 22.4 mos, HR: 0.54 [0.39-0.67], p<0.0001). Patients achieving a DoR higher than the median reported longer PFS (median PFS: 13.1 vs 9.3 mos, HR: 0.61 [0.49-0.73], p<0.0001), PPS (median PPS: 18.4 vs 10.5 mos, HR: 0.58 [0.44-0.73], p<0.0001) and OS (median OS: 36.8 vs 21.3 mos, HR: 0.47 [0.35-0.58], p<0.0001). A significant correlation of DoR as a continuous variable with PFS (HR: 0.983 [0.979-0.986], p<0.0001), PPS (HR: 0.987 [0.984-0.991], p<0.0001) and OS (HR: 0.979 [0.975-0.983], p<0.0001) was observed. No differences across arms were reported. Conclusions: ETS and DoR predict PFS, PPS and OS. These findings support the hypothesis that the adoption of active upfront regimens, able to induce a rapid and deep tumor shrinkage, may positively affect the subsequent disease history, thus translating into an advantage in survival. Clinical trial information: NCT00719797.
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Affiliation(s)
- Chiara Cremolini
- U.O. Oncologia Medica 2, Azienda Ospedaliero-Universitaria Pisana, Istituto Toscano Tumori, Pisa, Italy
| | - Fotios Loupakis
- U.O. Oncologia Medica 2, Azienda Ospedaliero-Universitaria Pisana, Istituto Toscano Tumori, Pisa, Italy
| | - Sara Lonardi
- Oncologia Medica 1, Istituto Oncologico Veneto - IRCCS, Padova, Italy
| | | | - Carlotta Antoniotti
- U.O. Oncologia Medica 2, Azienda Ospedaliero-Universitaria Pisana, Istituto Toscano Tumori, Pisa, Italy
| | - Gianluca Masi
- U.O. Oncologia Medica 2, Azienda Ospedaliero-Universitaria Pisana, Istituto Toscano Tumori, Pisa, Italy
| | | | - Monica Ronzoni
- Dipartimento di Oncologia Medica, Istituto Scientifico San Raffaele, Milano, Italy
| | | | | | - Chiara Carlomagno
- Department of Molecular and Clinical Endocrinology and Oncology, University of Naples Federico II, Naples, Italy
| | - Corrado Boni
- Division of Oncology, Arcispedale S. Maria Nuova, Reggio Emilia, Italy
| | - Francesca Negri
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | | | | | | | - Andrea Bonetti
- Department of Oncology, Mater Salutis Hospital-AULSS 21 della Regione Veneto, Legnago, Italy
| | | | - Luca Boni
- Clinical Trial Coordinating Center, AOU Careggi, Istituto Toscano Tumori (ITT), Firenze, Italy
| | - Alfredo Falcone
- U.O. Oncologia Medica 2, Azienda Ospedaliero-Universitaria Pisana, Istituto Toscano Tumori, Pisa, Italy
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Cremolini C, Loupakis F, Masi G, Lonardi S, Zagonel V, Salvatore L, Trenta P, Tomasello G, Ronzoni M, Ciuffreda L, Zaniboni A, Tonini G, Buonadonna A, Barbara C, Negri FV, Barone C, Vitello S, Giuntini N, Bonetti A, D'Amico M, Boni L, Falcone A. FOLFOXIRI/Bevacizumab Versus FOLFIRI/Bevacizumab as First-Line Treatment in Unresectable Metastatic Colorectal Cancer: Results of Phase III Tribe Trial by Gono Group. Ann Oncol 2013. [DOI: 10.1093/annonc/mdt201.26] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Vitello S, Vacirca F, Triglia E, Giarratano G. Treatment in metastatic prostate cancer with hormone refractory. EJC Suppl 2008. [DOI: 10.1016/j.ejcsup.2008.06.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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17
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Vitello S, Giarratano G, Maiorana SO, Di Cristina. Malignant pleural mesothelioma: Scheme therapeutic after standard treatment (study of phase II). EJC Suppl 2008. [DOI: 10.1016/j.ejcsup.2008.06.094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Vitello S, Triglia E, Scuderi G, Mangione M. Integrated regimen therapeutic (polybiologic-chemotherapy) for melanoma advanced. EJC Suppl 2008. [DOI: 10.1016/j.ejcsup.2008.06.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Falcone A, Ricci S, Brunetti I, Pfanner E, Allegrini G, Barbara C, Crinò L, Benedetti G, Evangelista W, Fanchini L, Cortesi E, Picone V, Vitello S, Chiara S, Granetto C, Porcile G, Fioretto L, Orlandini C, Andreuccetti M, Masi G. Phase III trial of infusional fluorouracil, leucovorin, oxaliplatin, and irinotecan (FOLFOXIRI) compared with infusional fluorouracil, leucovorin, and irinotecan (FOLFIRI) as first-line treatment for metastatic colorectal cancer: the Gruppo Oncologico Nord Ovest. J Clin Oncol 2007; 25:1670-6. [PMID: 17470860 DOI: 10.1200/jco.2006.09.0928] [Citation(s) in RCA: 838] [Impact Index Per Article: 49.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The Gruppo Oncologico Nord Ovest (GONO) conducted a phase III study comparing fluorouracil, leucovorin, oxaliplatin, and irinotecan (FOLFOXIRI [irinotecan 165 mg/m2 day 1, oxaliplatin 85 mg/m2 day 1, leucovorin 200 mg/m2 day 1, fluorouracil 3,200 mg/m2 48-hour continuous infusion starting on day 1, every 2 weeks]) with infusional fluorouracil, leucovorin, and irinotecan (FOLFIRI). METHODS Selection criteria included unresectable metastatic colorectal cancer, age 18 to 75 years, and no prior chemotherapy for advanced disease. The primary end point was response rate (RR). RESULTS A total of 244 patients were randomly assigned. An increase of grade 2 to 3 peripheral neurotoxicity (0% v 19%; P < .001), and grade 3 to 4 neutropenia (28% v 50%; P < .001) were observed in the FOLFOXIRI arm. The incidence of febrile neutropenia (3% v 5%) and grade 3 to 4 diarrhea (12% v 20%) were not significantly different. Responses, as assessed by investigators, were, for FOLFIRI and FOLFOXIRI, respectively, complete, 6% and 8%; and partial, 35% and 58%, (RR, 41% v 66%; P = .0002). RR confirmed by an external panel was 34% versus 60% (P < .0001). The R0 secondary resection rate of metastases was greater in the FOLFOXIRI arm (6% v 15%; P = .033, among all 244 patients; and 12% v 36%; P = .017 among patients with liver metastases only). Progression-free survival (PFS) and overall survival (OS) were both significantly improved in the FOLFOXIRI arm (median PFS, 6.9 v 9.8 months; hazard ratio [HR], 0.63; P = .0006; median OS, 16.7 v 22.6 months; HR, 0.70; P = .032). CONCLUSION The FOLFOXIRI regimen improves RR, PFS, and OS compared with FOLFIRI, with an increased, but manageable, toxicity in patients with metastatic colorectal cancer with favorable prognostic characteristics. Further studies of FOLFOXIRI in combination with targeted agents and in the neoadjuvant setting are warranted.
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Affiliation(s)
- Alfredo Falcone
- U.O. Oncologia Medica, Istituto Toscano Tumori, Livorno, Italy.
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Falcone A, Masi G, Brunetti I, Benedetti G, Bertetto O, Picone V, Chiara S, Merlano M, Vitello S, Ricci S. The triplet combination of irinotecan, oxaliplatin and 5FU/LV (FOLFOXIRI) vs the doublet of irinotecan and 5FU/LV (FOLFIRI) as first-line treatment of metastatic colorectal cancer (MCRC): Results of a randomized phase III trial by the Gruppo Oncologico Nord Ovest (G.O.N.O.). J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.3513] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [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
3513 Background: We demonstrated interesting activity and manageable toxicities for the FOLFOXIRI regimen in phase I-II studies. Methods: The G.O.N.O. conduced a phase III study comparing FOLFIRI (CPT11 180 mg/sqm d1, l-LV 100 mg/sqm d1+d2, 5FU 400 mg/sqm bolus d1+d2, 5FU 600 mg/sqm 22-h inf. on d1+d2, arm A), to FOLFOXIRI (CPT11 165 mg/sqm d1, LOHP 85 mg/sqm d1, l-LV 200 mg/sqm d1, 5FU 3200 mg/sqm 48-h inf. starting on d1, arm B). Both treatments were repeated every 2 weeks and at progression to FOLFIRI a FOLFOX combination was recommended. Selection criteria included measurable and not resectable MCRC, age 18–75 years, no prior chemotherapy for advanced disease. Primary endpoint was response rate (RR) and planned accrual was 240 pts. Secondary endpoints were PFS, OS, post-CT R0 surgical resections, safety and QoL. Results: A total of 244 pts were randomized. Main toxicities were (arm A/arm B): grade 3–4 diarrhea 12%/20%, grade 3–4 vomiting 2%/7%, grade 3–4 stomatitis 3%/5%, grade 2–3 peripheral neurotoxicity 0%/20%, grade 4 neutropenia 11%/17%, febrile neutropenia 3%/5%. Two pts in each arm died within 60 days, but no toxic deaths occurred. Responses, assessed by investigators, were (arm A/arm B): complete 6%/8%, partial 35%/58%, stable 33%/21%, progression 24%/11%, for an overall RR of 41% vs 66%, p=0.0002. RR confirmed by an external panel was 34%/60%, p<0.0001. This increased activity allowed a radical secondary resection of mts in a greater percentage of patients in the FOLFOXIRI arm (6% vs 14%, p=0.05, among all 244 pts and 12% vs 36%, p=0.02, among 81 patients with liver mts only). At a median follow-up of 15.2 months 112 vs 104 pts have progressed and 81 vs 65 have died with a significant improvement in progression-free and overall survival in favor of the triplet (median PFS 6.9 vs 9.8 mos, HR: 0.63, p=0.0006; median S 16.7 vs 22.6, HR:0.70, p=0.032). Conclusions: The FOLFOXIRI regimen is feasible with manageable toxicities and significantly increases RR, R0 resection of mts, PFS and overall S compared to FOLFIRI. (Partially supported by Fondazione ARCO). [Table: see text]
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Affiliation(s)
- A. Falcone
- Università degli Studi, Pisa, Italy; Ospedale Civile, Livorno, Italy; Ospedale S. Chiara, Pisa, Italy; Ospedale Bellaria, Bologna, Italy; Ospedale S. Giovanni Le Molinette, Torino, Italy; Università La Sapienza, Roma, Italy; IST, Genova, Italy; Azienda Ospedaliera S. Croce e Carle, Cuneo, Italy; Ospedale S. Elia, Caltanissetta, Italy
| | - G. Masi
- Università degli Studi, Pisa, Italy; Ospedale Civile, Livorno, Italy; Ospedale S. Chiara, Pisa, Italy; Ospedale Bellaria, Bologna, Italy; Ospedale S. Giovanni Le Molinette, Torino, Italy; Università La Sapienza, Roma, Italy; IST, Genova, Italy; Azienda Ospedaliera S. Croce e Carle, Cuneo, Italy; Ospedale S. Elia, Caltanissetta, Italy
| | - I. Brunetti
- Università degli Studi, Pisa, Italy; Ospedale Civile, Livorno, Italy; Ospedale S. Chiara, Pisa, Italy; Ospedale Bellaria, Bologna, Italy; Ospedale S. Giovanni Le Molinette, Torino, Italy; Università La Sapienza, Roma, Italy; IST, Genova, Italy; Azienda Ospedaliera S. Croce e Carle, Cuneo, Italy; Ospedale S. Elia, Caltanissetta, Italy
| | - G. Benedetti
- Università degli Studi, Pisa, Italy; Ospedale Civile, Livorno, Italy; Ospedale S. Chiara, Pisa, Italy; Ospedale Bellaria, Bologna, Italy; Ospedale S. Giovanni Le Molinette, Torino, Italy; Università La Sapienza, Roma, Italy; IST, Genova, Italy; Azienda Ospedaliera S. Croce e Carle, Cuneo, Italy; Ospedale S. Elia, Caltanissetta, Italy
| | - O. Bertetto
- Università degli Studi, Pisa, Italy; Ospedale Civile, Livorno, Italy; Ospedale S. Chiara, Pisa, Italy; Ospedale Bellaria, Bologna, Italy; Ospedale S. Giovanni Le Molinette, Torino, Italy; Università La Sapienza, Roma, Italy; IST, Genova, Italy; Azienda Ospedaliera S. Croce e Carle, Cuneo, Italy; Ospedale S. Elia, Caltanissetta, Italy
| | - V. Picone
- Università degli Studi, Pisa, Italy; Ospedale Civile, Livorno, Italy; Ospedale S. Chiara, Pisa, Italy; Ospedale Bellaria, Bologna, Italy; Ospedale S. Giovanni Le Molinette, Torino, Italy; Università La Sapienza, Roma, Italy; IST, Genova, Italy; Azienda Ospedaliera S. Croce e Carle, Cuneo, Italy; Ospedale S. Elia, Caltanissetta, Italy
| | - S. Chiara
- Università degli Studi, Pisa, Italy; Ospedale Civile, Livorno, Italy; Ospedale S. Chiara, Pisa, Italy; Ospedale Bellaria, Bologna, Italy; Ospedale S. Giovanni Le Molinette, Torino, Italy; Università La Sapienza, Roma, Italy; IST, Genova, Italy; Azienda Ospedaliera S. Croce e Carle, Cuneo, Italy; Ospedale S. Elia, Caltanissetta, Italy
| | - M. Merlano
- Università degli Studi, Pisa, Italy; Ospedale Civile, Livorno, Italy; Ospedale S. Chiara, Pisa, Italy; Ospedale Bellaria, Bologna, Italy; Ospedale S. Giovanni Le Molinette, Torino, Italy; Università La Sapienza, Roma, Italy; IST, Genova, Italy; Azienda Ospedaliera S. Croce e Carle, Cuneo, Italy; Ospedale S. Elia, Caltanissetta, Italy
| | - S. Vitello
- Università degli Studi, Pisa, Italy; Ospedale Civile, Livorno, Italy; Ospedale S. Chiara, Pisa, Italy; Ospedale Bellaria, Bologna, Italy; Ospedale S. Giovanni Le Molinette, Torino, Italy; Università La Sapienza, Roma, Italy; IST, Genova, Italy; Azienda Ospedaliera S. Croce e Carle, Cuneo, Italy; Ospedale S. Elia, Caltanissetta, Italy
| | - S. Ricci
- Università degli Studi, Pisa, Italy; Ospedale Civile, Livorno, Italy; Ospedale S. Chiara, Pisa, Italy; Ospedale Bellaria, Bologna, Italy; Ospedale S. Giovanni Le Molinette, Torino, Italy; Università La Sapienza, Roma, Italy; IST, Genova, Italy; Azienda Ospedaliera S. Croce e Carle, Cuneo, Italy; Ospedale S. Elia, Caltanissetta, Italy
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Palmeri S, Leonardi V, Gebbia V, De Bella MT, Ferraù F, Faillú G, Spatafora M, Valenza R, Di Vita G, Vitello S, Carroccio R, Sciortino G, Vaglica M, Accurso V, Agostara B, Licata G. Gemcitabine plus vinorelbine in stage IIIB or IV non-small cell lung cancer (NSCLC): a multicentre phase II clinical trial. Lung Cancer 2001; 34:115-23. [PMID: 11557121 DOI: 10.1016/s0169-5002(01)00206-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [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: 10/27/2022]
Abstract
A phase II study in patients with stage IIIB/IV non-small cell lung cancer (NSCLC) was carried out to evaluate the clinical activity and toxicity of the chemotherapeutic combination of gemcitabine+vinorelbine (GEM/VNR). Forty-five patients (40 male, 5 female) with a median age of 67 years (range 37-73) and a median ECOG performance status of 1 (range 0-2) were enrolled into the trial. Twenty patients had stage IIIB (two positive supraclavicular nodes and 20 cytologically positive pleural effusion), and 25 had stage IV NSCLC. GEM 1000 mg/m(2) diluted in 250 cc(3) of normal saline was administered iv on days 1, 8, and 15, while VNR was given 30 mg/m(2) on days 1 and 8 every 4 weeks. The median number of courses/patient was 4 (range 3-7). According to an intent-to-treat analysis 2 (4%) patients had a complete response and 16 (36%; 95% CL 22-52%) had a partial response for an overall response rate of 40% (95% CL 26-56%). Twelve (27%) patients had stable disease and 15 (33%) were considered as treatment failures. Median overall survival of the whole series was 8+ months with 33% of patients alive at 1 year. Toxicity was generally mild. WHO grade 3-4 neutropenia was recorded in 22% of cases, grade 1-3 liver toxicity in 6% of patients and neutropenia-unrelated fever in 9%. This multicentre phase II study suggests that the GEM/VNR combination regimen is an active and well tolerated regimen in patients with stage IIIB/IV NSCLC. Larger studies comparing cisplatin-based regimens to new schedules without cisplatin are warranted.
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Affiliation(s)
- S Palmeri
- Istituto di Clinica Medica, Universita' di Palermo, Piazza delle Cliniche 2, 90127 Palermo, Italy.
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Adamo V, Aiello R, Altavilla G, Cammarata M, Carreca I, Carroccio R, Di Carlo A, Failla G, Iacono C, Ianniuo E, Leonardi V, Pagliarello F, Palmeri S, Tarantino G, Vitello S. 1225 Ondansetron (OND) vs granisetron (GRA) in the control of chemotherapy-induced acute emesis. Eur J Cancer 1995. [DOI: 10.1016/0959-8049(95)96471-o] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Butera A, Di Girolamo G, Giresi A, Pizza, Scianna G, Vitello S, Di Carlo A. Neoadiuvant chemotherapy with epihin inflammatory breast cancer. Eur J Cancer 1994. [DOI: 10.1016/0959-8049(94)90733-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Goodstein HA, Bessant H, Thibodeau G, Vitello S, Vlahakos I. The effect of three variables on the verbal problem solving of educable mentally handicapped children. Am J Ment Defic 1972; 76:703-9. [PMID: 4113162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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