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Rimini M, Masi G, Lonardi S, Nichetti F, Pressiani T, Lavacchi D, Jessica L, Giordano G, Scartozzi M, Tamburini E, Pastorino A, Rapposelli IG, Daniele B, Martinelli E, Garajova I, Aprile G, Schirripa M, Formica V, Salani F, Winchler C, Bergamo F, Balsano R, Gusmaroli E, Lorenzo A, Landriscina M, Pretta A, Toma I, Pirrone C, Diana A, Leone F, Brunetti O, Brandi G, Garattini SK, Satolli MA, Rossari F, Fornaro L, Niger M, Zanuso V, De Rosa A, Ratti F, Aldrighetti L, De Braud F, Foti S, Rizzato MD, Vivaldi C, Stefano C, Rimassa L, Antonuzzo L, Casadei-Gardini A. Durvalumab Plus Gemcitabine and Cisplatin Versus Gemcitabine and Cisplatin in Biliary Tract Cancer: a Real-World Retrospective, Multicenter Study. Target Oncol 2024; 19:359-370. [PMID: 38691295 DOI: 10.1007/s11523-024-01060-1] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2024] [Indexed: 05/03/2024]
Abstract
BACKGROUND The TOPAZ-1 phase III trial reported a survival benefit with the anti-programmed cell death ligand 1 (anti-PD-L1) durvalumab in combination with gemcitabine and cisplatin in patients with advanced biliary tract cancer (BTC). OBJECTIVE The present study investigated for the first time the impact on survival of adding durvalumab to cisplatin/gemcitabine compared with cisplatin/gemcitabine in a real-world setting. PATIENTS AND METHODS The analyzed population included patients with unresectable, locally advanced, or metastatic BTC treated with durvalumab in combination with cisplatin/gemcitabine or with cisplatin/gemcitabine alone. The impact of adding durvalumab to chemotherapy in terms of overall survival (OS) and progression free survival (PFS) was investigated with univariate and multivariate analysis. RESULTS Overall, 563 patients were included in the analysis: 213 received cisplatin/gemcitabine alone, 350 received cisplatin/gemcitabine plus durvalumab. At the univariate analysis, the addition of durvalumab was found to have an impact on survival, with a median OS of 14.8 months versus 11.2 months [hazard ratio (HR) 0.63, 95% confidence interval (CI) 0.50-0.80, p = 0.0002] in patients who received cisplatin/gemcitabine plus durvalumab compared to those who received cisplatin/gemcitabine alone. At the univariate analysis for PFS, the addition of durvalumab to cisplatin/gemcitabine demonstrated a survival impact, with a median PFS of 8.3 months and 6.0 months (HR 0.57, 95% CI 0.47-0.70, p < 0.0001) in patients who received cisplatin/gemcitabine plus durvalumab and cisplatin/gemcitabine alone, respectively. The multivariate analysis confirmed that adding durvalumab to cisplatin/gemcitabine is an independent prognostic factor for OS and PFS, with patients > 70 years old and those affected by locally advanced disease experiencing the highest survival benefit. Finally, an exploratory analysis of prognostic factors was performed in the cohort of patients who received durvalumab: neutrophil-lymphocyte ratio (NLR) and disease stage were to be independent prognostic factors in terms of OS. The interaction test highlighted NLR ≤ 3, Eastern Cooperative Oncology Group Performance Status (ECOG PS) = 0, and locally advanced disease as positive predictive factors for OS on cisplatin/gemcitabine plus durvalumab. CONCLUSION In line with the results of the TOPAZ-1 trial, adding durvalumab to cisplatin/gemcitabine has been confirmed to confer a survival benefit in terms of OS and PFS in a real-world setting of patients with advanced BTC.
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Affiliation(s)
- Margherita Rimini
- Department of Oncology, IRCCS San Raffaele Scientific Institute Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Gianluca Masi
- Division of Medical Oncology, Department of Translational Research and New Technologies in Medicine and Surgery, Pisa University Hospital, Pisa, Italy
| | - Sara Lonardi
- Dept of Oncology, Veneto Institute of Oncology IOV-IRCCS, Padova, Italy
| | - Federico Nichetti
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, ENETS Center of Excellence, Via Venezian 1, 20133, Milan, Italy
- Computational Oncology, Molecular Diagnostics Program, National Center for Tumor Diseases (NCT) and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Tiziana Pressiani
- Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Daniele Lavacchi
- Clinical Oncology Unit, Careggi University Hospital, 50134, Florence, Italy
| | - Lucchetti Jessica
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Roma, Italy
| | - Guido Giordano
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Mario Scartozzi
- Medical Oncology, University and University Hospital, Cagliari, Italy
| | - Emiliano Tamburini
- Department of Oncology and Palliative Care, Cardinale G Panico, Tricase City Hospital, Tricase, Italy
| | | | - Ilario Giovanni Rapposelli
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Bruno Daniele
- Medical Oncology Unit, Ospedale del Mare, Napoli, Italy
| | - Erika Martinelli
- Medical Oncology Unit, Department of Precision Medicine, Università Degli Studi Della Campania "Luigi Vanvitelli", Naples, Italy
| | - Ingrid Garajova
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Giuseppe Aprile
- Department of Oncology, San Bortolo General Hospital, Vicenza, Italy
| | - Marta Schirripa
- Medical Oncology Unit, Department of Oncology and Hematology, Belcolle Hospital, Viterbo, Italy
| | - Vincenzo Formica
- Medical Oncology Unit, Department of Systems Medicine, Tor Vergata University Hospital, Rome, Italy
| | - Francesca Salani
- Division of Medical Oncology, Department of Translational Research and New Technologies in Medicine and Surgery, Pisa University Hospital, Pisa, Italy
| | - Costanza Winchler
- Clinical Oncology Unit, Careggi University Hospital, 50134, Florence, Italy
| | - Francesca Bergamo
- Dept of Oncology, Veneto Institute of Oncology IOV-IRCCS, Padova, Italy
| | - Rita Balsano
- Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Medical Oncology Unit, Department of Systems Medicine, Tor Vergata University Hospital, Rome, Italy
| | - Eleonora Gusmaroli
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, ENETS Center of Excellence, Via Venezian 1, 20133, Milan, Italy
| | - Angotti Lorenzo
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Roma, Italy
| | - Matteo Landriscina
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Andrea Pretta
- Medical Oncology, University and University Hospital, Cagliari, Italy
| | - Ilaria Toma
- Department of Oncology and Palliative Care, Cardinale G Panico, Tricase City Hospital, Tricase, Italy
| | - Chiara Pirrone
- Medical Oncology Unit 1, Ospedale Policlinico San Martino, IRCCS, Genoa, Italy
| | - Anna Diana
- Medical Oncology Unit, Ospedale del Mare, Napoli, Italy
| | - Francesco Leone
- Division of Medical Oncology, ASL BI, Nuovo Ospedale degli Infermi, Ponderano, BI, Italy
| | - Oronzo Brunetti
- Istituto Tumori "Giovanni Paolo II" of Bari, IRCCS, Bari, Italy
| | - Giovanni Brandi
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138, Bologna, Italy
| | - Silvio Ken Garattini
- Department of Oncology, Academic Hospital of Udine ASUFC, Piazzale Santa Maria della Misericordia 15, 33100, Udine, UD, Italy
| | - Maria Antonietta Satolli
- Division of Medical Oncology 1, Centro Oncologico Ematologico Subalpino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Federico Rossari
- Department of Oncology, IRCCS San Raffaele Scientific Institute Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Lorenzo Fornaro
- Division of Medical Oncology, Department of Translational Research and New Technologies in Medicine and Surgery, Pisa University Hospital, Pisa, Italy
| | - Monica Niger
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, ENETS Center of Excellence, Via Venezian 1, 20133, Milan, Italy
| | - Valentina Zanuso
- Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Antonio De Rosa
- Dept of Oncology, Veneto Institute of Oncology IOV-IRCCS, Padova, Italy
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, ENETS Center of Excellence, Via Venezian 1, 20133, Milan, Italy
- Computational Oncology, Molecular Diagnostics Program, National Center for Tumor Diseases (NCT) and German Cancer Research Center (DKFZ), Heidelberg, Germany
- Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Clinical Oncology Unit, Careggi University Hospital, 50134, Florence, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Roma, Italy
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
- Medical Oncology, University and University Hospital, Cagliari, Italy
- Department of Oncology and Palliative Care, Cardinale G Panico, Tricase City Hospital, Tricase, Italy
- Medical Oncology Unit 1, Ospedale Policlinico San Martino, IRCCS, Genoa, Italy
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
- Medical Oncology Unit, Ospedale del Mare, Napoli, Italy
- Medical Oncology Unit, Department of Precision Medicine, Università Degli Studi Della Campania "Luigi Vanvitelli", Naples, Italy
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
- Department of Oncology, San Bortolo General Hospital, Vicenza, Italy
- Medical Oncology Unit, Department of Oncology and Hematology, Belcolle Hospital, Viterbo, Italy
- Medical Oncology Unit, Department of Systems Medicine, Tor Vergata University Hospital, Rome, Italy
- Division of Medical Oncology, ASL BI, Nuovo Ospedale degli Infermi, Ponderano, BI, Italy
- Istituto Tumori "Giovanni Paolo II" of Bari, IRCCS, Bari, Italy
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138, Bologna, Italy
- Department of Oncology, Academic Hospital of Udine ASUFC, Piazzale Santa Maria della Misericordia 15, 33100, Udine, UD, Italy
- Division of Medical Oncology 1, Centro Oncologico Ematologico Subalpino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Department of Surgery, oncology and gastroenterology of Padua, Padua, Italy
| | - Francesca Ratti
- Hepatobiliary Surgery Division, IRCCS Ospedale San Raffaele, Milan, Italy
| | | | - Filippo De Braud
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, ENETS Center of Excellence, Via Venezian 1, 20133, Milan, Italy
- Clinical Oncology Unit, Careggi University Hospital, 50134, Florence, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Roma, Italy
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
- Medical Oncology, University and University Hospital, Cagliari, Italy
- Department of Oncology and Palliative Care, Cardinale G Panico, Tricase City Hospital, Tricase, Italy
- Medical Oncology Unit 1, Ospedale Policlinico San Martino, IRCCS, Genoa, Italy
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
- Medical Oncology Unit, Ospedale del Mare, Napoli, Italy
- Medical Oncology Unit, Department of Precision Medicine, Università Degli Studi Della Campania "Luigi Vanvitelli", Naples, Italy
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
- Department of Oncology, San Bortolo General Hospital, Vicenza, Italy
- Medical Oncology Unit, Department of Oncology and Hematology, Belcolle Hospital, Viterbo, Italy
- Medical Oncology Unit, Department of Systems Medicine, Tor Vergata University Hospital, Rome, Italy
- Division of Medical Oncology, ASL BI, Nuovo Ospedale degli Infermi, Ponderano, BI, Italy
- Istituto Tumori "Giovanni Paolo II" of Bari, IRCCS, Bari, Italy
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138, Bologna, Italy
- Department of Oncology, Academic Hospital of Udine ASUFC, Piazzale Santa Maria della Misericordia 15, 33100, Udine, UD, Italy
- Division of Medical Oncology 1, Centro Oncologico Ematologico Subalpino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Department of Surgery, oncology and gastroenterology of Padua, Padua, Italy
- Hepatobiliary Surgery Division, IRCCS Ospedale San Raffaele, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Silvia Foti
- Department of Oncology, IRCCS San Raffaele Scientific Institute Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | | | - Caterina Vivaldi
- Division of Medical Oncology, Department of Translational Research and New Technologies in Medicine and Surgery, Pisa University Hospital, Pisa, Italy
| | - Cascinu Stefano
- Department of Oncology, IRCCS San Raffaele Scientific Institute Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Lorenza Rimassa
- Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Lorenzo Antonuzzo
- Clinical Oncology Unit, Careggi University Hospital, 50134, Florence, Italy
| | - Andrea Casadei-Gardini
- Department of Oncology, IRCCS San Raffaele Scientific Institute Hospital, Vita-Salute San Raffaele University, Milan, Italy.
- Department of Medical Oncology, IRCCS San Raffaele Hospital, Via Olgettina n. 60, Milan, Italy.
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Mokbel S, Baciarello G, Lavaud P, Omlin A, Calabrò F, Cathomas R, Aeppli S, Parent P, Giannatempo P, Koster KL, Appel N, Gonnet P, Angius G, Tsantoulis P, Arkenau HT, Cattrini C, Messina C, Zeghondy J, Morelli C, Loriot Y, Formica V, Patrikidou A. Development and Validation of an Inflammatory Prognostic Index to Predict Outcomes in Advanced/Metastatic Urothelial Cancer Patients Receiving Immune Checkpoint Inhibitors. Cancers (Basel) 2024; 16:1465. [PMID: 38672547 PMCID: PMC11048042 DOI: 10.3390/cancers16081465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 04/02/2024] [Accepted: 04/08/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Immune checkpoint inhibitors (ICIs) improve overall survival (OS) in advanced/metastatic urothelial cancer (a/mUC) patients. Preliminary evidence suggests a prognostic role of inflammatory biomarkers in this setting. We aimed to develop a disease-specific prognostic inflammatory index for a/mUC patients on ICIs. METHODS Fifteen variables were retrospectively correlated with OS and progression-free survival (PFS) in a development (D, n = 264) and a validation (V, n = 132) cohort of platinum-pretreated a/mUC pts receiving ICIs at L2 or further line. A nomogram and inflammatory prognostic index (U-IPI) were developed. The index was also tested in a control cohort of patients treated with chemotherapy only (C, n = 114). RESULTS The strongest predictors of OS were baseline platelet/lymphocyte (PLR) and neutrophil/lymphocyte (NLR) ratios, and lactate dehydrogenase (LDH), NLR, and albumin changes at 4 weeks. These were used to build the U-IPI, which can distinctly classify patients into good or poor response groups. The nomogram scoring is significant for PFS and OS (p < 0.001 in the D, V, and combined cohorts) for the immunotherapy (IO) cohort, but not for the control cohort. CONCLUSIONS The lack of a baseline systemic inflammatory profile and the absence of early serum inflammatory biomarker changes are associated with significantly better outcomes on ICIs in a/mUC pts. The U-IPI is an easily applicable dynamic prognostic tool for PFS and OS, allowing for the early identification of a sub-group with dismal outcomes that would not benefit from ICIs, while distinguishing another that draws an important benefit.
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Affiliation(s)
- Sara Mokbel
- Faculty of Medicine, UCL—University College London, London WC1H 0AP, UK;
| | - Giuilia Baciarello
- Medical Oncology Department, Azienda Ospedaliera San Camillo Forlanini, 00152 Roma, Italy; (G.B.); (G.A.)
| | - Pernelle Lavaud
- Medical Oncology Department, Gustave Roussy Cancer Campus, 94805 Villejuif, France; (P.L.); (J.Z.); (Y.L.)
| | - Aurelius Omlin
- Medical Oncology and Haematology Department, OnkoZentrum Zürich, 8038 Zurich, Switzerland;
| | - Fabio Calabrò
- Medical Oncology 1, IRCCS National Cancer Institute Regina Elena, 00144 Rome, Italy; (F.C.)
| | - Richard Cathomas
- Medical Oncology 1, IRCCS National Cancer Institute Regina Elena, 00144 Rome, Italy; (F.C.)
| | - Stefanie Aeppli
- Department of Medical Oncology and Haematology, Cantonal Hospital St.Gallen, 9000 St. Gallen, Switzerland; (S.A.); (K.-L.K.)
| | - Pauline Parent
- Medical Oncology Departement, CHU Lille—Centre Hospitalier Régional Universitaire de Lille, 59000 Lille, France;
| | - Patrizia Giannatempo
- Medical Oncology Department, Fondazione IRCCS—Istituto Nazionale dei Tumori, 20133 Milan, Italy;
| | - Kira-Lee Koster
- Department of Medical Oncology and Haematology, Cantonal Hospital St.Gallen, 9000 St. Gallen, Switzerland; (S.A.); (K.-L.K.)
| | - Naara Appel
- Medical Oncology Departement, HUG—Hopitaux Universitaires Geneve, 1205 Geneva, Switzerland; (N.A.); (P.G.)
| | - Philippe Gonnet
- Medical Oncology Departement, HUG—Hopitaux Universitaires Geneve, 1205 Geneva, Switzerland; (N.A.); (P.G.)
| | - Gesuino Angius
- Medical Oncology Department, Azienda Ospedaliera San Camillo Forlanini, 00152 Roma, Italy; (G.B.); (G.A.)
| | - Petros Tsantoulis
- Medical Oncology Departement, HUG—Hopitaux Universitaires Geneve, 1205 Geneva, Switzerland; (N.A.); (P.G.)
| | | | - Carlo Cattrini
- Maggiore della Carità University Hospital, 28100 Novara, Italy;
| | | | - Jean Zeghondy
- Medical Oncology Department, Gustave Roussy Cancer Campus, 94805 Villejuif, France; (P.L.); (J.Z.); (Y.L.)
| | - Cristina Morelli
- Medical Oncology Unit, Policlinico Tor Vergata, 00133 Rome, Italy; (C.M.); (V.F.)
| | - Yohann Loriot
- Medical Oncology Department, Gustave Roussy Cancer Campus, 94805 Villejuif, France; (P.L.); (J.Z.); (Y.L.)
| | - Vincenzo Formica
- Medical Oncology Unit, Policlinico Tor Vergata, 00133 Rome, Italy; (C.M.); (V.F.)
| | - Anna Patrikidou
- Medical Oncology Department, Gustave Roussy Cancer Campus, 94805 Villejuif, France; (P.L.); (J.Z.); (Y.L.)
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Riondino S, Rosenfeld R, Formica V, Morelli C, Parisi G, Torino F, Mariotti S, Roselli M. Effectiveness of Immunotherapy in Non-Small Cell Lung Cancer Patients with a Diagnosis of COPD: Is This a Hidden Prognosticator for Survival and a Risk Factor for Immune-Related Adverse Events? Cancers (Basel) 2024; 16:1251. [PMID: 38610929 PMCID: PMC11011072 DOI: 10.3390/cancers16071251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 03/18/2024] [Accepted: 03/21/2024] [Indexed: 04/14/2024] Open
Abstract
The interplay between the immune system and chronic obstructive pulmonary disease (COPD) and non-small cell lung cancer (NSCLC) is complex and multifaceted. In COPD, chronic inflammation and oxidative stress can lead to immune dysfunction that can exacerbate lung damage, further worsening the respiratory symptoms. In NSCLC, immune cells can recognise and attack the cancer cells, which, however, can evade or suppress the immune response by various mechanisms, such as expressing immune checkpoint proteins or secreting immunosuppressive cytokines, thus creating an immunosuppressive tumour microenvironment that promotes cancer progression and metastasis. The interaction between COPD and NSCLC further complicates the immune response. In patients with both diseases, COPD can impair the immune response against cancer cells by reducing or suppressing the activity of immune cells, or altering their cytokine profile. Moreover, anti-cancer treatments can also affect the immune system and worsen COPD symptoms by causing lung inflammation and fibrosis. Immunotherapy itself can also cause immune-related adverse events that could worsen the respiratory symptoms in patients with COPD-compromised lungs. In the present review, we tried to understand the interplay between the two pathologies and how the efficacy of immunotherapy in NSCLC patients with COPD is affected in these patients.
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Pietrantonio F, Bergamo F, Rossini D, Ghelardi F, De Grandis MC, Germani MM, Barsotti G, Formica V, Frassineti GL, Boscolo G, Cinieri S, Di Donato S, Antonuzzo L, Antoniotti C, Ambrosini M, Piva VM, Nichetti F, Fassan M, Cremolini C, Lonardi S. Negative hyperselection of elderly patients with RAS and BRAF wild-type metastatic colorectal cancer receiving initial panitumumab plus FOLFOX or 5-FU/LV. Eur J Cancer 2023; 195:113396. [PMID: 37924647 DOI: 10.1016/j.ejca.2023.113396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 10/06/2023] [Accepted: 10/13/2023] [Indexed: 11/06/2023]
Abstract
BACKGROUND Upfront anti-EGFR therapy represents the standard of care for patients with left-sided, MSS/pMMR, RAS and BRAF wild-type mCRC. Molecular 'hyperselection' may optimize EGFR inhibition by detecting additional resistance alterations. MATERIALS AND METHODS We used comprehensive genomic profiling on archival samples of elderly patients enrolled in the PANDA trial to detect: HER2 amplification/mutations; MET amplification; NTRK/ROS1/ALK/RET rearrangements; PIK3CA exon 20 mutations; PTEN alterations; AKT1 mutations; MAP2K1 mutations. We defined 'Gene Altered' (GA) patients whose tumour harboured at least one alteration, and 'Hyperselected' (HS) those without. Survival and tumour response outcomes were correlated to hyperselection status alone or combined with primary tumour sidedness or treatment arm. RESULTS Genomic alterations were detected in 41/147 patients (27.9%). PFS, OS and ORR were inferior in GA versus HS (median PFS: 7.6 versus 12.8 months, HR = 2.08, 95% CI: 1.43-3.03, p < 0.001; median OS: 20.0 versus 29.5 months, HR = 1.82, 95% CI:1.23-2.69, p = 0.002; ORR: 51% versus 71%; OR = 0.43, 95% CI: 0.21-0.91, p = 0.02). In the multivariable models, the impact of hyperselection on PFS and OS was confirmed. Lower ORR was observed with 5-FU/LV/panitumumab in GA (40% versus 62%), but not in HS (70% versus 72%). GA was associated with worse survival and response regardless of primary tumour sidedness, whereas in the HS subgroup, right-and left sided tumours had similar outcomes. CONCLUSIONS Molecular hyperselection and comprehensive genomic profiling have a potential usefulness in elderly patients with RAS/BRAF wild-type, pMMR/MSS mCRC, eligible for upfront EGFR inhibition.
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Affiliation(s)
- Filippo Pietrantonio
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori,, Milano, Italy
| | - Francesca Bergamo
- Department of Oncology, Veneto Institute of Oncology IOV - IRCCS, Padova, Italy
| | - Daniele Rossini
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy; Unit of Medical Oncology 2, University Hospital of Pisa, Pisa, Italy
| | - Filippo Ghelardi
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori,, Milano, Italy
| | - Maria Caterina De Grandis
- Department of Oncology, Veneto Institute of Oncology IOV - IRCCS, Padova, Italy; Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Marco Maria Germani
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy; Unit of Medical Oncology 2, University Hospital of Pisa, Pisa, Italy
| | - Giulia Barsotti
- Department of Oncology, Veneto Institute of Oncology IOV - IRCCS, Padova, Italy
| | | | - Giovanni Luca Frassineti
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori "Dino Amadori" (IRST), Meldola, Italy
| | - Giorgia Boscolo
- Medical Specialties Department, Oncology and Oncological Haematology, ULSS 3 Serenissima, Venice, Italy
| | - Saverio Cinieri
- Medical Oncology Unit, Ospedale Antonio Perrino, Brindisi, Italy
| | - Samantha Di Donato
- Department of Medical Oncology, Nuovo Ospedale di Prato Santo Stefano, Prato, Italy
| | - Lorenzo Antonuzzo
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Clinical Oncology Unit, Careggi University Hospital, Florence, Italy
| | - Carlotta Antoniotti
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy; Unit of Medical Oncology 2, University Hospital of Pisa, Pisa, Italy
| | - Margherita Ambrosini
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori,, Milano, Italy
| | | | - Federico Nichetti
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori,, Milano, Italy
| | - Matteo Fassan
- Department of Medicine (DIMED), University of Padua, Padua, Italy; Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - Chiara Cremolini
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy; Unit of Medical Oncology 2, University Hospital of Pisa, Pisa, Italy
| | - Sara Lonardi
- Department of Oncology, Veneto Institute of Oncology IOV - IRCCS, Padova, Italy.
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Lonardi S, Rasola C, Lobefaro R, Rossini D, Formica V, Scartozzi M, Frassineti GL, Boscolo G, Cinieri S, Di Donato S, Pella N, Bergamo F, Raimondi A, Arnoldi E, Antonuzzo L, Granetto C, Zustovich F, Ronzoni M, Leo S, Morano F, Loupakis F, Buggin F, Zagonel V, Fassan M, Cremolini C, Boni L, Pietrantonio F. Initial Panitumumab Plus Fluorouracil, Leucovorin, and Oxaliplatin or Plus Fluorouracil and Leucovorin in Elderly Patients With RAS and BRAF Wild-Type Metastatic Colorectal Cancer: The PANDA Trial by the GONO Foundation. J Clin Oncol 2023; 41:5263-5273. [PMID: 37535876 DOI: 10.1200/jco.23.00506] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 04/25/2023] [Accepted: 06/21/2023] [Indexed: 08/05/2023] Open
Abstract
PURPOSE To verify whether both doublet chemotherapy with a modified schedule of fluorouracil, leucovorin, and oxaliplatin (mFOLFOX) and monochemotherapy with fluorouracil plus leucovorin (5-FU + LV) achieve satisfactory efficacy when both regimens are combined with panitumumab (PAN) as initial treatment of elderly patients with RAS/BRAF wild-type metastatic colorectal cancer (mCRC). PATIENTS AND METHODS PANDA (ClinicalTrials.gov identifier: NCT02904031) was an open-label, randomized phase II noncomparative trial in previously untreated patients age 70 years and older with unresectable RAS/BRAF wild-type mCRC. Patients were randomly assigned 1:1 to mFOLFOX + PAN (arm A) or 5-FU + LV + PAN (arm B) for up to 12 cycles, followed by PAN maintenance. The primary end point was progression-free survival (PFS). In each arm, assuming a null hypothesis of median PFS time ≤6 months and target PFS ≥9.65, 90 patients per arm were needed to achieve 90% power and 5% type I error (one-sided Brookmeyer-Crowley test). RESULTS Between July 2016 and April 2019, 91 patients were randomly assigned to arm A and 92 to arm B. At a median follow-up of 50.0 months (IQR, 45.6-56.4), median PFS was 9.6 and 9.0 months for arm A and B, respectively (P < .001 in each arm). Overall response rate was 69% and 52%, whereas median overall survival was 23.5 and 22.0 months in arm A and B, respectively. The overall rate of grade >2 chemotherapy-related adverse events was 60% and 37%, respectively. Baseline G8 and Chemotherapy Risk Assessment Scale for High-Age Patients scores were prognostic, but they were not associated with efficacy and safety of the two arms. CONCLUSION Both mFOLFOX and 5-FU + LV + PAN are reasonable options as initial therapy of elderly patients with RAS/BRAF wild-type mCRC. 5-FU + LV + PAN is associated with a better safety profile.
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Affiliation(s)
- Sara Lonardi
- Medical Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Padova, Italy
| | - Cosimo Rasola
- Medical Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Padova, Italy
| | - Riccardo Lobefaro
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Daniele Rossini
- Unit of Medical Oncology 2, University Hospital of Pisa, Pisa, Italy
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | | | - Mario Scartozzi
- Department of Medical Sciences and Public Health, Medical Oncology Unit, "Azienda Ospedaliero Universitaria" of Cagliari, University of Cagliari, Cagliari, Italy
| | - Giovanni Luca Frassineti
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori "Dino Amadori" (IRST), Meldola, Italy
| | - Giorgia Boscolo
- Medical Specialties Department, Oncology and Oncological Haematology, ULSS 3 Serenissima, Mirano, Italy
| | - Saverio Cinieri
- Department of Medical Oncology, Hospital "Senatore Perrino", Brindisi, Italy
| | | | - Nicoletta Pella
- Department of Oncology, ASUFC University Hospital, Udine, Italy
| | - Francesca Bergamo
- Medical Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Padova, Italy
| | - Alessandra Raimondi
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Ermenegildo Arnoldi
- Department of Oncology, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | - Lorenzo Antonuzzo
- Clinical Oncology Unit, Careggi University Hospital, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | | | - Fable Zustovich
- Dipartimento di Oncologia Clinica, UOC Oncologia di Belluno, AULSS 1 Dolomiti, Ospedale S. Martino, Belluno, Italy
| | - Monica Ronzoni
- Oncologia Medica, IRCCS Ospedale San Raffaele, Milano, Italy
| | - Silvana Leo
- Medical Oncology Unit, Vito Fazzi Hospital, Lecce, Italy
| | - Federica Morano
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Fotios Loupakis
- Medical Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Padova, Italy
| | - Federica Buggin
- Medical Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Padova, Italy
| | - Vittorina Zagonel
- Medical Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Padova, Italy
| | - Matteo Fassan
- Department of Medicine (DIMED), Surgical Pathology & Cytopathology Unit, University of Padova, Padova, Italy
- Veneto Institute of Oncology IOV-IRCCS, Padova, Italy
| | - Chiara Cremolini
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Luca Boni
- IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Filippo Pietrantonio
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
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6
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Morelli C, Formica V, Bossi P, Rofei M, Guerriero S, Riondino S, Argirò R, Pucci N, Cenci T, Savino L, Rinaldi CG, Garaci F, Orlandi A, D’Angelillo RM, Arkenau HT, Roselli M. Untailored vs. Gender- and Body-Mass-Index-Tailored Skeletal Muscle Mass Index (SMI) to Assess Sarcopenia in Advanced Head and Neck Squamous Cell Carcinoma (HNSCC). Cancers (Basel) 2023; 15:4716. [PMID: 37835410 PMCID: PMC10571960 DOI: 10.3390/cancers15194716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 09/13/2023] [Accepted: 09/19/2023] [Indexed: 10/15/2023] Open
Abstract
(1) Background: Sarcopenia lasting >1 year might be considered a chronic condition in many HNSCC patients. CT-scan-derived Skeletal Muscle Mass Index (SMI) is an established surrogate of sarcopenia; yet, the cut-off reported in the literature (literature-based, lb-SMI < 43.2) is mainly based on the risk of chemoradiotherapy-induced toxicity, and the optimal value to discriminate OS is under-investigated. (2) Methods: The effect on OS of the lb-SMI cutoff was compared with an untailored OS-oriented SMI cutoff obtained in a cohort of consecutive advanced HNSCC patients treated with primary chemoradiotherapy, bio-chemotherapy or chemo-immunotherapy (cohort-specific, cs-SMI cutoff). Gender- and BMI-tailored (gt-SMI and bt-SMI) cut-offs were also evaluated. Cutoff values were identified by using the maximally selected rank statistics for OS. (3) Results: In 115 HNSCC patients, the cs-SMI cutoff was 31.50, which was lower compared to the lb-SMI reported cut-off. The optimal cut-off separately determined in females, males, overweight and non-overweight patients were 46.02, 34.37, 27.32 and 34.73, respectively. gt-SMI categorization had the highest effect on survival (p < 0.0001); its prognostic value was independent of the treatment setting or the primary location and was retained in a multivariate cox-regression analysis for OS including other HNSCC-specific prognostic factors (p = 0.0004). (4) Conclusions: A tailored SMI assessment would improve clinical management of sarcopenia in chemoradiotherapy-, bio-chemotherapy- or chemo-immunotherapy-treated HNSCC patients. Gender-based SMI could be used for prognostication in HNSCC patients.
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Affiliation(s)
- Cristina Morelli
- Medical Oncology Unit, Department of Systems Medicine, Tor Vergata University Hospital, 00133 Rome, Italy; (C.M.); (M.R.); (S.G.); (S.R.); (M.R.)
| | - Vincenzo Formica
- Medical Oncology Unit, Department of Systems Medicine, Tor Vergata University Hospital, 00133 Rome, Italy; (C.M.); (M.R.); (S.G.); (S.R.); (M.R.)
| | - Paolo Bossi
- Medical Oncology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, “ASST Spedali Civili di Brescia”, University of Brescia, 25123 Brescia, Italy;
| | - Michela Rofei
- Medical Oncology Unit, Department of Systems Medicine, Tor Vergata University Hospital, 00133 Rome, Italy; (C.M.); (M.R.); (S.G.); (S.R.); (M.R.)
| | - Simona Guerriero
- Medical Oncology Unit, Department of Systems Medicine, Tor Vergata University Hospital, 00133 Rome, Italy; (C.M.); (M.R.); (S.G.); (S.R.); (M.R.)
| | - Silvia Riondino
- Medical Oncology Unit, Department of Systems Medicine, Tor Vergata University Hospital, 00133 Rome, Italy; (C.M.); (M.R.); (S.G.); (S.R.); (M.R.)
| | - Renato Argirò
- Interventional Radiology Unit, Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, 00133 Rome, Italy;
| | - Noemi Pucci
- Neuroradiology Unit, Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, 00133 Rome, Italy; (N.P.); (F.G.)
| | - Tonia Cenci
- Anatomic Pathology, Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, 00133 Rome, Italy; (T.C.); (L.S.); (A.O.)
| | - Luca Savino
- Anatomic Pathology, Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, 00133 Rome, Italy; (T.C.); (L.S.); (A.O.)
| | - Carla G. Rinaldi
- Radiation Oncology, Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, 00152 Rome, Italy; (C.G.R.); (R.M.D.)
| | - Francesco Garaci
- Neuroradiology Unit, Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, 00133 Rome, Italy; (N.P.); (F.G.)
| | - Augusto Orlandi
- Anatomic Pathology, Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, 00133 Rome, Italy; (T.C.); (L.S.); (A.O.)
| | - Rolando M. D’Angelillo
- Radiation Oncology, Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, 00152 Rome, Italy; (C.G.R.); (R.M.D.)
| | | | - Mario Roselli
- Medical Oncology Unit, Department of Systems Medicine, Tor Vergata University Hospital, 00133 Rome, Italy; (C.M.); (M.R.); (S.G.); (S.R.); (M.R.)
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7
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Vivaldi C, Genovesi V, Ugolini C, Bernardini L, Casadei-Gardini A, Formica V, Salani F, Orsi G, Massa V, Cacciato-Insilla A, Caccese M, Cesario S, Andrikou K, Graziani J, Campani D, Vasile E, Fontanini G, Fornaro L, Masi G. Mismatch Repair Deficiency in Biliary Tract Cancer: Prognostic Implications and Correlation with Histology. Oncology 2023; 102:157-167. [PMID: 37699372 DOI: 10.1159/000533406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 07/25/2023] [Indexed: 09/14/2023]
Abstract
INTRODUCTION Mismatch repair (MMR) deficiency represents a biomarker and therapeutic target in various neoplasms, but its role in biliary tract cancers (BTCs) remains misunderstood. METHODS MMR status was retrospectively assessed using immunohistochemistry in 163-BTCs patients. We identified MMR proficiency (pMMR)/deficiency (dMMR) according to the loss of MMR proteins (MLH1, PMS2, MSH2, MSH6). The primary objective of the study was to assess the incidence of dMMR in BTCs; the secondary purpose was to explore its association with prognosis and clinical features. RESULTS dMMR was recorded in 9 patients, and it was strongly associated with mucinous histology (p < 0.01). Regarding the prognostic effect, in 122-radically resected patients, disease-free survival (DFS) resulted significantly shorter in dMMR patients compared to pMMR patients (10.7 vs. 31.3 months, p = 0.025) and so did nodal status (48.2 vs. 15.3 months in N0 vs. N+) (p < 0.01). Moreover, dMMR confirmed its prognostic role in terms of DFS at multivariate analysis (p = 0.03), together with nodal status (p = 0.01), and resection margin (p = 0.03). In 103 M+ patients (encompassing 41 metastatic de novo and 62 recurred after surgery patients) there were not differences between dMMR and pMMR regarding survival analyses. CONCLUSIONS dMMR status is strongly correlated with mucinous histology and represents an independent prognostic factor in terms of disease relapse in patients with resected BTC. IMPLICATIONS FOR PRACTICE MMR may play an independent role in promoting an aggressive behaviour in patients with radically resected BTC. These results could be useful in improving the selection of patients after resection and, above all, should justify the evaluation of MMR status as a therapeutic target in BTC, especially in patients with atypical histology.
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Affiliation(s)
- Caterina Vivaldi
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Virginia Genovesi
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Clara Ugolini
- Department of Surgical, Medical, Molecular Pathology and Critical Area, Division of Pathology, University of Pisa, Pisa, Italy
| | - Laura Bernardini
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | | | - Vincenzo Formica
- Medical Oncology Unit, Tor Vergata University Hospital, Rome, Italy
| | - Francesca Salani
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
- Interdisciplinary Research Center "Health Science", Scuola Superiore Sant'Anna, Pisa, Italy
| | - Giulia Orsi
- Department of Medical Oncology, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy
| | - Valentina Massa
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | | | - Miriam Caccese
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Silvia Cesario
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Kalliopi Andrikou
- IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Jessica Graziani
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Daniela Campani
- Department of Surgical, Medical, Molecular Pathology and Critical Area, Division of Pathology, University of Pisa, Pisa, Italy
| | - Enrico Vasile
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Gabriella Fontanini
- Department of Surgical, Medical, Molecular Pathology and Critical Area, Division of Pathology, University of Pisa, Pisa, Italy
| | - Lorenzo Fornaro
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Gianluca Masi
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
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8
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Rimini M, Fornaro L, Lonardi S, Niger M, Lavacchi D, Pressiani T, Lucchetti J, Giordano G, Pretta A, Tamburini E, Pirrone C, Rapposelli IG, Diana A, Martinelli E, Garajová I, Simionato F, Schirripa M, Formica V, Vivaldi C, Caliman E, Rizzato MD, Zanuso V, Nichetti F, Angotti L, Landriscina M, Scartozzi M, Ramundo M, Pastorino A, Daniele B, Cornara N, Persano M, Gusmaroli E, Cerantola R, Salani F, Ratti F, Aldrighetti L, Cascinu S, Rimassa L, Antonuzzo L, Casadei-Gardini A. Durvalumab plus gemcitabine and cisplatin in advanced biliary tract cancer: An early exploratory analysis of real-world data. Liver Int 2023; 43:1803-1812. [PMID: 37452505 DOI: 10.1111/liv.15641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 05/15/2023] [Accepted: 05/27/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND The TOPAZ-1 phase III trial reported a survival benefit with the anti-programmed death cell ligand 1 (anti-PD-L1) durvalumab in combination with gemcitabine and cisplatin in patients with advanced biliary tract cancer. The present study investigated the efficacy and safety of this new standard treatment in a real-world setting. METHODS The analysed population included patients with unresectable, locally advanced or metastatic adenocarcinoma of the biliary tract treated with durvalumab in combination with gemcitabine and cisplatin at 17 Italian centres. The primary endpoint of the study was progression-free survival (PFS), whereas secondary endpoints included overall survival (OS), overall response rate (ORR) and safety. Unadjusted and adjusted hazard ratios (HRs) by baseline characteristics were calculated using the Cox proportional hazards model. RESULTS From February 2022 to November 2022, 145 patients were enrolled. After a median follow-up of 8.5 months (95% CI: 7.9-13.6), the median PFS was 8.9 months (95% CI: 7.4-11.7). Median OS was 12.9 months (95% CI: 10.9-12.9). The investigator-assessed confirmed ORR was 34.5%, and the disease control rate was 87.6%. Any grade adverse events (AEs) occurred in 137 patients (94.5%). Grades 3-4 AEs occurred in 51 patients (35.2%). The rate of immune-mediated AEs (imAEs) was 22.7%. Grades 3-4 imAEs occurred in 2.1% of the patients. In univariate analysis, non-viral aetiology, ECOG PS >0 and NLR ≥3 correlated with shorter PFS. CONCLUSION The results reported in this first real-world analysis mostly confirmed the results achieved in the TOPAZ-1 trial in terms of PFS, ORR and safety.
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Affiliation(s)
- Margherita Rimini
- Medical Oncology Department, IRCSS San Raffaele Scientific Institute, Milan, Italy
- Department of Oncology, Vita-Salute San Raffaele University, Milan, Italy
| | | | - Sara Lonardi
- Medical Oncology 3, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - Monica Niger
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Daniele Lavacchi
- Clinical Oncology Unit, Careggi University Hospital, Florence, Italy
| | - Tiziana Pressiani
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Rozzano (Milan), Italy
| | - Jessica Lucchetti
- Division of Medical Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Guido Giordano
- Unit of Medical Oncology and Biomolecular Therapy, Policlinico Riuniti, Foggia, Italy
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Andrea Pretta
- Medical Oncology, University and University Hospital, Cagliari, Italy
| | - Emiliano Tamburini
- Department of Oncology and Palliative Care, Cardinale G Panico, Tricase City Hospital, Tricase, Italy
| | - Chiara Pirrone
- Medical Oncology Unit 1, Ospedale Policlinico San Martino - IRCCS, Genoa, Italy
| | - Ilario Giovanni Rapposelli
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Anna Diana
- Medical Oncology Unit, Ospedale del Mare, Napoli, Italy
| | - Erika Martinelli
- Medical Oncology Unit, Department of Precision Medicine, Università Degli Studi Della Campania "Luigi Vanvitelli", Naples, Italy
| | - Ingrid Garajová
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Francesca Simionato
- Department of Oncology, San Bortolo General Hospital, Azienda ULSS8 Berica, Vicenza, Italy
| | - Marta Schirripa
- Medical Oncology Unit, Department of Oncology and Hematology, Belcolle Hospital, Viterbo, Italy
| | - Vincenzo Formica
- Medical Oncology Unit, Department of Systems Medicine, Tor Vergata University Hospital, Rome, Italy
| | - Caterina Vivaldi
- Medical Oncology, University Hospital of Pisa, Pisa, Italy
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Enrico Caliman
- Clinical Oncology Unit, Careggi University Hospital, Florence, Italy
| | - Mario Domenico Rizzato
- Medical Oncology 1, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Valentina Zanuso
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Rozzano (Milan), Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (Milan), Italy
| | - Federico Nichetti
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
- Computational Oncology, Molecular Precision Oncology Program, National Center for Tumor Diseases (NCT) and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Lorenzo Angotti
- Division of Medical Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Matteo Landriscina
- Unit of Medical Oncology and Biomolecular Therapy, Policlinico Riuniti, Foggia, Italy
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Mario Scartozzi
- Medical Oncology, University and University Hospital, Cagliari, Italy
| | - Matteo Ramundo
- Department of Oncology and Palliative Care, Cardinale G Panico, Tricase City Hospital, Tricase, Italy
| | | | - Bruno Daniele
- Medical Oncology Unit, Ospedale del Mare, Napoli, Italy
| | - Noemi Cornara
- Medical Oncology Department, IRCSS San Raffaele Scientific Institute, Milan, Italy
- Department of Oncology, Vita-Salute San Raffaele University, Milan, Italy
| | - Mara Persano
- Oncology Unit, San Martino Hospital, Oristano, Italy
| | - Eleonora Gusmaroli
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Riccardo Cerantola
- Medical Oncology 1, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Francesca Salani
- Medical Oncology, University Hospital of Pisa, Pisa, Italy
- Institute of Interdisciplinary Research "Health Science", Scuola Superiore Sant'Anna, Pisa, Italy
| | - Francesca Ratti
- Hepatobiliary Surgery Division, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Luca Aldrighetti
- Hepatobiliary Surgery Division, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Stefano Cascinu
- Medical Oncology Department, IRCSS San Raffaele Scientific Institute, Milan, Italy
- Department of Oncology, Vita-Salute San Raffaele University, Milan, Italy
| | - Lorenza Rimassa
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Rozzano (Milan), Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (Milan), Italy
| | - Lorenzo Antonuzzo
- Clinical Oncology Unit, Careggi University Hospital, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Andrea Casadei-Gardini
- Medical Oncology Department, IRCSS San Raffaele Scientific Institute, Milan, Italy
- Department of Oncology, Vita-Salute San Raffaele University, Milan, Italy
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9
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Formica V, Riondino S, Morelli C, Guerriero S, D'Amore F, Di Grazia A, Del Vecchio Blanco G, Sica G, Arkenau HT, Monteleone G, Roselli M. HIF2α, Hepcidin and their crosstalk as tumour-promoting signalling. Br J Cancer 2023; 129:222-236. [PMID: 37081189 PMCID: PMC10338631 DOI: 10.1038/s41416-023-02266-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 03/25/2023] [Accepted: 03/30/2023] [Indexed: 04/22/2023] Open
Abstract
Not all aspects of the disruption of iron homeostasis in cancer have been fully elucidated. Iron accumulation in cancer cells is frequent for many solid tumours, and this is often accompanied by the contemporary rise of two key iron regulators, HIF2α and Hepcidin. This scenario is different from what happens under physiological conditions, where Hepcidin parallels systemic iron concentrations while HIF2α levels are inversely associated to Hepcidin. The present review highlights the increasing body of evidence for the pro-tumoral effect of HIF2α and Hepcidin, discusses the possible imbalance in HIF2α, Hepcidin and iron homeostasis during cancer, and explores therapeutic options relying on these pathways as anticancer strategies.
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Affiliation(s)
- Vincenzo Formica
- Medical Oncology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Viale Oxford, 81, 00133, Rome, Italy.
| | - Silvia Riondino
- Medical Oncology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Viale Oxford, 81, 00133, Rome, Italy
| | - Cristina Morelli
- Medical Oncology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Viale Oxford, 81, 00133, Rome, Italy
- PhD Program in Systems and Experimental Medicine (XXXV cycle), University of Rome Tor Vergata, Via Montpellier 1, 00133, Rome, Italy
| | - Simona Guerriero
- Medical Oncology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Viale Oxford, 81, 00133, Rome, Italy
| | - Federica D'Amore
- Medical Oncology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Viale Oxford, 81, 00133, Rome, Italy
| | - Antonio Di Grazia
- Gastroenterology Unit, Department of Systems Medicine, University of Rome Tor Vergata, 00133, Rome, Italy
| | | | - Giuseppe Sica
- Department of Surgery, University of Rome Tor Vergata, Rome, Italy
| | | | - Giovanni Monteleone
- Gastroenterology Unit, Department of Systems Medicine, University of Rome Tor Vergata, 00133, Rome, Italy
| | - Mario Roselli
- Medical Oncology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Viale Oxford, 81, 00133, Rome, Italy
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10
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Neri B, Mancone R, Savino L, Schiavone S, Formica V, Pizzi F, Salvatori S, Mossa M, Migliozzi S, Fiorillo M, Morelli C, Moscardelli A, Lolli E, Calabrese E, Sica GS, Monteleone G, Biancone L. Mucinous and Signet-Ring Cell Colonic Adenocarcinoma in Inflammatory Bowel Disease: A Case-Control Study. Cancers (Basel) 2023; 15:3803. [PMID: 37568619 PMCID: PMC10417294 DOI: 10.3390/cancers15153803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 07/18/2023] [Accepted: 07/25/2023] [Indexed: 08/13/2023] Open
Abstract
A higher frequency of mucinous and signet-ring cell colonic adenocarcinoma has been reported in inflammatory bowel disease (IBD). The primary aim was to investigate the frequency of mucinous and signet-ring cell colorectal adenocarcinoma in patients with IBD (Cases) versus age-matched non-IBD Controls. The secondary aims were to compare the characteristics of these two histotypes of colorectal cancer (CRC) in IBD patients vs. Controls and to search for specific risk factors in IBD. In a case-control study, all IBD patients with CRC diagnosed from 2000 to 2022 were enrolled and matched for age (1:2) with non-IBD Controls with CRC. The study population included 120 CRC patients (40 IBD, 80 Controls). In IBD, CRC included standard adenocarcinoma in 23 (57.5%) patients mucinous/signet-ring cell adenocarcinoma in 17 (42.5%) patients. The proportion of mucinous/signet-ring cell adenocarcinoma was higher in IBD than in Controls (17 [42.5%] vs. 18 [22.5%]; p = 0.03). In rectal CRC, the proportion of mucinous/signet-ring cell adenocarcinoma was higher than standard adenocarcinoma in IBD (8 [47.1%] vs. 4 [17.4%]; p = 0.04) but not in Controls (4 [22.2%] vs. 20 [32.2%]; p = 0.59). In rectal CRC, the proportion of these two histotypes was higher in Cases than in Controls (8/12 [66.6%] vs. 4/24 [16.6%]; p = 0.008), with no risk factors identified in IBD. CRC was more frequently represented by mucinous/signet-ring cell adenocarcinoma in IBD than in age-matched non-IBD Controls. In IBD, these two CRC histotypes were more frequent in the rectum.
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Affiliation(s)
- Benedetto Neri
- Gastroenterology Unit, Department of Systems Medicine, University “Tor Vergata” of Rome, 00133 Roma, Italy; (B.N.); (R.M.); (S.S.); (F.P.); (S.S.); (M.M.); (S.M.); (M.F.); (A.M.); (E.L.); (E.C.); (G.M.)
| | - Roberto Mancone
- Gastroenterology Unit, Department of Systems Medicine, University “Tor Vergata” of Rome, 00133 Roma, Italy; (B.N.); (R.M.); (S.S.); (F.P.); (S.S.); (M.M.); (S.M.); (M.F.); (A.M.); (E.L.); (E.C.); (G.M.)
| | - Luca Savino
- Pathology Unit, Department of Biomedicine and Prevention, University “Tor Vergata” of Rome, 00133 Roma, Italy;
| | - Sara Schiavone
- Gastroenterology Unit, Department of Systems Medicine, University “Tor Vergata” of Rome, 00133 Roma, Italy; (B.N.); (R.M.); (S.S.); (F.P.); (S.S.); (M.M.); (S.M.); (M.F.); (A.M.); (E.L.); (E.C.); (G.M.)
| | - Vincenzo Formica
- Medical Oncology Unit, Department of Systems Medicine, University “Tor Vergata” of Rome, 00133 Roma, Italy; (V.F.); (C.M.)
| | - Francesca Pizzi
- Gastroenterology Unit, Department of Systems Medicine, University “Tor Vergata” of Rome, 00133 Roma, Italy; (B.N.); (R.M.); (S.S.); (F.P.); (S.S.); (M.M.); (S.M.); (M.F.); (A.M.); (E.L.); (E.C.); (G.M.)
| | - Silvia Salvatori
- Gastroenterology Unit, Department of Systems Medicine, University “Tor Vergata” of Rome, 00133 Roma, Italy; (B.N.); (R.M.); (S.S.); (F.P.); (S.S.); (M.M.); (S.M.); (M.F.); (A.M.); (E.L.); (E.C.); (G.M.)
| | - Michelangela Mossa
- Gastroenterology Unit, Department of Systems Medicine, University “Tor Vergata” of Rome, 00133 Roma, Italy; (B.N.); (R.M.); (S.S.); (F.P.); (S.S.); (M.M.); (S.M.); (M.F.); (A.M.); (E.L.); (E.C.); (G.M.)
| | - Stefano Migliozzi
- Gastroenterology Unit, Department of Systems Medicine, University “Tor Vergata” of Rome, 00133 Roma, Italy; (B.N.); (R.M.); (S.S.); (F.P.); (S.S.); (M.M.); (S.M.); (M.F.); (A.M.); (E.L.); (E.C.); (G.M.)
| | - Mariasofia Fiorillo
- Gastroenterology Unit, Department of Systems Medicine, University “Tor Vergata” of Rome, 00133 Roma, Italy; (B.N.); (R.M.); (S.S.); (F.P.); (S.S.); (M.M.); (S.M.); (M.F.); (A.M.); (E.L.); (E.C.); (G.M.)
| | - Cristina Morelli
- Medical Oncology Unit, Department of Systems Medicine, University “Tor Vergata” of Rome, 00133 Roma, Italy; (V.F.); (C.M.)
| | - Alessandro Moscardelli
- Gastroenterology Unit, Department of Systems Medicine, University “Tor Vergata” of Rome, 00133 Roma, Italy; (B.N.); (R.M.); (S.S.); (F.P.); (S.S.); (M.M.); (S.M.); (M.F.); (A.M.); (E.L.); (E.C.); (G.M.)
| | - Elisabetta Lolli
- Gastroenterology Unit, Department of Systems Medicine, University “Tor Vergata” of Rome, 00133 Roma, Italy; (B.N.); (R.M.); (S.S.); (F.P.); (S.S.); (M.M.); (S.M.); (M.F.); (A.M.); (E.L.); (E.C.); (G.M.)
| | - Emma Calabrese
- Gastroenterology Unit, Department of Systems Medicine, University “Tor Vergata” of Rome, 00133 Roma, Italy; (B.N.); (R.M.); (S.S.); (F.P.); (S.S.); (M.M.); (S.M.); (M.F.); (A.M.); (E.L.); (E.C.); (G.M.)
| | - Giuseppe S. Sica
- Department of Surgery, University “Tor Vergata” of Rome, 00133 Roma, Italy;
| | - Giovanni Monteleone
- Gastroenterology Unit, Department of Systems Medicine, University “Tor Vergata” of Rome, 00133 Roma, Italy; (B.N.); (R.M.); (S.S.); (F.P.); (S.S.); (M.M.); (S.M.); (M.F.); (A.M.); (E.L.); (E.C.); (G.M.)
| | - Livia Biancone
- Gastroenterology Unit, Department of Systems Medicine, University “Tor Vergata” of Rome, 00133 Roma, Italy; (B.N.); (R.M.); (S.S.); (F.P.); (S.S.); (M.M.); (S.M.); (M.F.); (A.M.); (E.L.); (E.C.); (G.M.)
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11
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Formica V, Morelli C, Conca V, Calegari MA, Lucchetti J, Dell'Aquila E, Schirripa M, Messina M, Salvatore L, Lo Prinzi F, Dima G, Trovato G, Riondino S, Roselli M, Skoulidis F, Arkenau HT, Cremolini C. Irinotecan- vs. Oxaliplatin-Based Doublets in KRAS G12C-Mutated Metastatic Colorectal Cancer-A Multicentre Propensity-Score-Matched Retrospective Analysis. Cancers (Basel) 2023; 15:cancers15113064. [PMID: 37297026 DOI: 10.3390/cancers15113064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 05/22/2023] [Accepted: 05/30/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND KRASG12C-mutated metastatic colorectal cancer (mCRC) has recently been recognized as a distinct druggable molecular entity; however, there are limited data on its sensitivity to standard chemotherapy. In the near future, the combination of chemotherapy plus a KRASG12C-inhibitor might become the standard of care; however, the optimal chemotherapy backbone is unknown. METHODS A multicentre retrospective analysis was conducted including KRASG12C-mutated mCRC patients treated with first-line FOLFIRI or FOLFOX +/- bevacizumab. Both unmatched and propensity-score-matched analysis (PSMA) were conducted, with PSMA controlling for: previous adjuvant chemotherapy, ECOG PS, use of bevacizumab in first line, timing of metastasis appearance, time from diagnosis to first-line start, number of metastatic sites, presence of mucinous component, gender, and age. Subgroup analyses were also performed to investigate subgroup treatment-effect interactions. KRASG12D-mutated patients were analysed as control. RESULTS One hundred and four patients treated with irinotecan-(N = 47) or oxaliplatin-based (N = 57) chemotherapy were included. In the unmatched population, objective response rate (ORR) and median (m) progression-free and overall survival (mPFS and mOS) were comparable between the treatment arms. However, a late (>12 months) PFS advantage was observed with irinotecan (HR 0.62, p = 0.02). In the PSMA-derived cohort, a significant improvement with irinotecan vs. oxaliplatin was observed for both PFS and OS: 12- and 24-month PFS rates of 55% vs. 31% and 40% vs. 0% (HR 0.40, p = 0.01) and mOS 37.9 vs. 21.7 months (HR 0.45, p = 0.045), respectively. According to the subgroup analysis, interaction effects between the presence of lung metastases and treatment groups were found in terms of PFS (p for interaction = 0.08) and OS (p for interaction = 0.03), with a higher benefit from irinotecan in patients without lung metastases. No difference between treatment groups was observed in the KRASG12D-mutated cohort (N = 153). CONCLUSIONS First-line irinotecan-based regimens provided better survival results in KRASG12C-mutated mCRC patients and should be preferred over oxaliplatin. These findings should also be considered when investigating chemotherapy plus targeted agent combinations.
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Affiliation(s)
- Vincenzo Formica
- Medical Oncology Unit, Department of Medicine of the Systems, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Cristina Morelli
- Medical Oncology Unit, Department of Medicine of the Systems, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Veronica Conca
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy
| | - Maria Alessandra Calegari
- Oncologia Medica, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Jessica Lucchetti
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Rome, Italy
| | | | - Marta Schirripa
- Department of Oncology and Hematology, Belcolle Hospital, Azienda Sanitaria Locale Viterbo, 01100 Viterbo, Italy
| | - Marco Messina
- UOC Oncologia Medica, ARNAS Ospedali Civico Di Cristina Benefratelli, 90127 Palermo, Italy
| | - Lisa Salvatore
- Oncologia Medica, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Oncologia Medica, Università Cattolica del Sacro Cuore, 00186 Rome, Italy
| | - Federica Lo Prinzi
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Rome, Italy
| | - Giovanni Dima
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy
| | - Giovanni Trovato
- Oncologia Medica, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Oncologia Medica, Università Cattolica del Sacro Cuore, 00186 Rome, Italy
| | - Silvia Riondino
- Medical Oncology Unit, Department of Medicine of the Systems, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Mario Roselli
- Medical Oncology Unit, Department of Medicine of the Systems, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Ferdinandos Skoulidis
- Department of Thoracic-Head & Neck Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | | | - Chiara Cremolini
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy
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12
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Prete AA, Manca P, Messina M, Formica V, Frassineti GL, Zampino MG, Corsi DC, Orciuolo C, Prisciandaro M, Bergamo F, Angerilli V, Scartozzi M, Casagrande M, Masi G, Ronzoni M, Morano F, Vettore V, Salmaso R, Rasola C, Maddalena G, Del Bianco P, Milione M, Cremolini C, Fassan M, Pietrantonio F, Lonardi S. Extensive molecular profiling of squamous cell anal carcinoma in a phase 2 trial population: Translational analyses of the "CARACAS" study. Eur J Cancer 2023; 182:87-97. [PMID: 36753836 DOI: 10.1016/j.ejca.2022.12.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 12/02/2022] [Accepted: 12/23/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Molecular characteristics of squamous cell anal carcinoma (SCAC) are poorly explored. Immune checkpoint inhibitors showed limited activity in phase I/II trials, but predictive and prognostic biomarkers are lacking. PATIENTS AND METHODS In the phase II randomised trial CARACAS (NCT03944252), avelumab alone (Arm A) or with cetuximab (Arm B) was tested in pre-treated advanced SCAC , with overall response rate being the primary end-point. On pre-treatment tumour tissue samples, we assessed Human papillomavirus status, programmed-death ligand 1 (PD-L1) expression, mismatch repair proteins expression, tumour mutational burden (TMB) and comprehensive genomic profiling by FoundationOne CDx. Tumour-infiltrating lymphocytes were characterised on haematoxylin-eosine-stained samples. Primary objective was to describe response to immunotherapy in the CARACAS trial population according to molecular and histological characteristics. Secondary objectives were to assess progression-free survival (PFS) and overall survival (OS) according to molecular biomarkers. RESULTS High PD-L1 (>40 with combined positive score) was significantly more frequent in patients with disease control (p = 0.0109). High TMB (>10 mutations per megabase) was related to better OS (hazard ratio (HR) = 0.09; 95%confidence interval (CI) 0.01-0.68; p = 0.019) and PFS (HR = 0.44; 95%CI = 0.15-1.27; p = 0.129). High expression of PD-L1 conferred longer OS (HR = 0.46; 95%CI = 0.19-1.08; p = 0.075) and PFS (HR = 0.42; 95%CI = 0.20-0.92; p = 0.03). Neither OS (HR = 1.30; 95%CI = 0.72-2.36; p = 0.39) or PFS (HR = 1.31; 95%CI = 0.74-2.31; p = 0.357) was affected by high (>1.2) Tumour-infiltrating lymphocytes count. High TMB and PD-L1identified patients were with significantly better OS (HR = 0.33; 95%CI = 0.13-0.81; p = 0.015) and PFS (HR = 0.48; 95%CI = 0.23-1.00; p = 0.015). CONCLUSIONS To our knowledge, TranslaCARACAS is the first study to document prognostic role of TMB and PD-L1 in advanced SCAC patients treated with immune checkpoint inhibitors.
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Affiliation(s)
- Alessandra A Prete
- Medical Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Paolo Manca
- Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumouri, Milan, Italy
| | - Marco Messina
- Oncologia, Fondazione Istituto G. Giglio, Cefalù, Italy
| | | | - Giovanni L Frassineti
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumouri "Dino Amadori" (IRST), Meldola, Italy
| | - Maria G Zampino
- Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumours, European Institute of Oncology - IRCCS, Milan, Italy
| | - Domenico C Corsi
- Medical Oncology Unit Ospedale San Giovanni Calibita Fatebenefratelli, Rome, Italy
| | - Corrado Orciuolo
- Oncology Unit, Department of Radiology, Oncology and Human Pathology, Sapienza University of Rome, Italy
| | | | - Francesca Bergamo
- Medical Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Valentina Angerilli
- Department of Medicine (DIMED), Surgical Pathology & Cytopathology Unit, University of Padua Padua, Italy
| | | | | | - Gianluca Masi
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy; Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Italy
| | - Monica Ronzoni
- Oncologia Medica, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Federica Morano
- Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumouri, Milan, Italy
| | - Valentina Vettore
- Medical Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Roberta Salmaso
- Department of Medicine (DIMED), Surgical Pathology & Cytopathology Unit, University of Padua Padua, Italy
| | - Cosimo Rasola
- Medical Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy; Department of Surgery, Oncology and Gastroenterology, University of Padua, 35128 Padua, Italy
| | - Giulia Maddalena
- Medical Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy; Department of Surgery, Oncology and Gastroenterology, University of Padua, 35128 Padua, Italy
| | - Paola Del Bianco
- Clinical Research Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Massimo Milione
- Department of the Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumouri, Milan, Italy
| | - Chiara Cremolini
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy; Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Italy.
| | - Matteo Fassan
- Department of Medicine (DIMED), Surgical Pathology & Cytopathology Unit, University of Padua Padua, Italy; Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | | | - Sara Lonardi
- Medical Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
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13
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Pirozzi BM, Siragusa L, Baldini G, Pellicciaro M, Grande M, Efrati C, Finizio R, Formica V, Del Vecchio Blanco G, Sica GS. Influence of COVID-19 Pandemic on Colorectal Cancer Presentation, Management and Outcome during the COVID-19 Pandemic. J Clin Med 2023; 12:jcm12041425. [PMID: 36835958 PMCID: PMC9962694 DOI: 10.3390/jcm12041425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 01/30/2023] [Accepted: 02/06/2023] [Indexed: 02/17/2023] Open
Abstract
The aim of the study was to investigate whether the COVID-19 pandemic and related measures had an influence on colorectal cancer (CRC) presentation, management, and outcomes; it was a retrospective monocentric study. CRC patients undergoing surgery during the COVID-19 pandemic (1 March 2020-28 February 2022) (group B) were compared with patients operated on in the previous two years (1 March 2018-29 February 2020) in the same unit (group A). The primary outcome was to investigate whether there were differences in concern regarding the stage at presentation, as a whole and after dividing groups based on cancer location (right colon cancer, left colon cancer, rectal cancer). Secondary outcomes included differences in the number of patients admitted from emergency departments and emergency surgeries between periods, and differences in the postoperative outcomes. A subanalysis within the pandemic group was conducted on the same outcomes, dividing the aforementioned group based on pandemic trends. Two hundred and eighty (280) were operated on during the study period: 147 in group A and 133 in group B. Stage at presentation was similar between groups; however, the subgroups analysis showed that in the pandemic group, the number of early-stage left colon cancer occurrences almost halves, yet not significantly. Emergency department referral was more common in group B (p-value: 0.003); in group B, they also had longer operations and there was a more frequent use of ostomy. No differences in the number of postoperative complications nor in the postoperative outcomes were found. Patients with CRC were more frequently referred through the emergency department during the COVID-19 pandemic and left-sided cancers appear to be generally diagnosed at a more advanced stage. Postoperative outcomes showed that high specialized colorectal units can deliver standard high-level treatment under high-pressure external conditions.
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Affiliation(s)
- B. M. Pirozzi
- Department of Surgery, University of Rome “Tor Vergata”, 00133 Rome, Italy
- Correspondence:
| | - L. Siragusa
- Department of Surgery, University of Rome “Tor Vergata”, 00133 Rome, Italy
| | - G. Baldini
- Department of Surgery, University of Rome “Tor Vergata”, 00133 Rome, Italy
| | - M. Pellicciaro
- Department of Surgery, University of Rome “Tor Vergata”, 00133 Rome, Italy
| | - M. Grande
- Department of Emergency, University of Rome “Tor Vergata”, 00133 Rome, Italy
| | - C. Efrati
- Department of Medicine, Israelitic Hospital of Rome, 00148 Rome, Italy
| | - R. Finizio
- Department of Medicine, Israelitic Hospital of Rome, 00148 Rome, Italy
| | - V. Formica
- Department of Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy
| | | | - G. S. Sica
- Department of Surgery, University of Rome “Tor Vergata”, 00133 Rome, Italy
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14
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Riondino S, Formica V, Valenzi E, Morelli C, Flaminio V, Portarena I, Torino F, Roselli M. Obesity and Breast Cancer: Interaction or Interference with the Response to Therapy? Curr Oncol 2023; 30:1220-1231. [PMID: 36661743 PMCID: PMC9857850 DOI: 10.3390/curroncol30010094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 01/12/2023] [Accepted: 01/13/2023] [Indexed: 01/19/2023] Open
Abstract
Background: Aromatase inhibitors (AI) are widely used for treating hormone-sensitive breast cancer (BC). Obesity, however, due to aromatase-mediated androgen conversion into estradiol in the peripheral adipose tissue, might impair AI inhibitory capacity. We aimed at identifying a cut-off of body mass index (BMI) with significant prognostic impact, in a cohort of stage I-II BC patients on systemic adjuvant therapy with AI. Methods: we retrospectively evaluated routinely collected baseline parameters. The optimal BMI cut-off affecting disease-free survival (DFS) in AI-treated BC patients was identified through maximally selected rank statistics; non-linear association between BMI and DFS in the AI cohort was assessed by hazard-ratio-smoothed curve analysis using BMI as continuous variable. The impact of the BMI cut-off on survival outcomes was estimated through Kaplan−Meier plots, with log-rank test and hazard ratio estimation comparing patient subgroups. Results: A total of 319 BC patients under adjuvant endocrine therapy and/or adjuvant chemotherapy were included. Curve-fitting analysis showed that for a BMI cut-off >29 in AI-treated BC patients (n = 172), DFS was increasingly deteriorating and that the impact of BMI on 2-year DFS identified a cut-off specific only for the cohort of postmenopausal BC patients under adjuvant therapy with AI. Conclusion: in radically resected hormone-sensitive BC patients undergoing neoadjuvant or adjuvant chemotherapy and treated with AI, obesity represents a risk factor for recurrence, with a significantly reduced 2-year DFS.
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Affiliation(s)
- Silvia Riondino
- Department of Systems Medicine, University of Rome Tor Vergata, Via Montpellier, 1, 00152 Rome, Italy
| | - Vincenzo Formica
- Department of Systems Medicine, University of Rome Tor Vergata, Via Montpellier, 1, 00152 Rome, Italy
| | - Elena Valenzi
- Department of Systems Medicine, University of Rome Tor Vergata, Via Montpellier, 1, 00152 Rome, Italy
| | - Cristina Morelli
- Medical Oncology Unit, University Hospital Tor Vergata, Viale Oxford, 81, 00133 Rome, Italy
| | - Valeria Flaminio
- Department of Systems Medicine, University of Rome Tor Vergata, Via Montpellier, 1, 00152 Rome, Italy
| | - Ilaria Portarena
- Medical Oncology Unit, University Hospital Tor Vergata, Viale Oxford, 81, 00133 Rome, Italy
| | - Francesco Torino
- Department of Systems Medicine, University of Rome Tor Vergata, Via Montpellier, 1, 00152 Rome, Italy
| | - Mario Roselli
- Department of Systems Medicine, University of Rome Tor Vergata, Via Montpellier, 1, 00152 Rome, Italy
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15
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Di Grazia A, Di Fusco D, Franzè E, Colella M, Strimpakos G, Salvatori S, Formica V, Laudisi F, Maresca C, Colantoni A, Ortenzi A, Stolfi C, Monteleone I, Monteleone G. Hepcidin Upregulation in Colorectal Cancer Associates with Accumulation of Regulatory Macrophages and Epithelial-Mesenchymal Transition and Correlates with Progression of the Disease. Cancers (Basel) 2022; 14:5294. [PMID: 36358713 PMCID: PMC9658525 DOI: 10.3390/cancers14215294] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 10/24/2022] [Accepted: 10/26/2022] [Indexed: 08/30/2023] Open
Abstract
Advanced, metastatic colorectal cancer (CRC) is associated with high rate of mortality because of its poor responsiveness to chemotherapy/immunotherapy. Recent studies have shown that hepcidin, a peptide hormone produced mainly by hepatocytes, is expressed by and enhances the growth of tumor cells. We here assessed whether hepcidin expression helps identify subsets of CRC with advanced and aggressive course. By integrating results of in vitro/ex vivo studies with data of bioinformatics databases, we initially showed that hepcidin RNA and protein expression was more pronounced in tissue samples taken from the tumor area, as compared to the macroscopically unaffected, adjacent, colonic mucosa of CRC patients. The induction of hepcidin in the colonic epithelial cell line HCEC-1ct by interleukin (IL)-6, IL-21 and IL-23 occurred via a Stat3-dependent mechanism and, in primary CRC cells, hepcidin co-localized with active Stat3. In CRC tissue, hepcidin content correlated mainly with macrophage accumulation and IL-10 and CD206 expression, two markers of regulatory macrophages. Consistently, both IL-10 and CD206 were up-regulated by hepcidin in blood mononuclear cells. The highest levels of hepcidin were found in metastatic CRC and survival analysis showed that high expression of hepcidin associated with poor prognosis. Moreover, hepcidin expression correlated with markers of epithelial-to-mesenchymal transition and the silencing of hepcidin in CRC cells reduced epithelial-to-mesenchymal transition markers. These findings indicate that hepcidin is markedly induced in the advanced stages of CRC and suggest that it could serve as a prognostic biomarker in CRC.
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Affiliation(s)
- Antonio Di Grazia
- Department of Systems Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy
| | - Davide Di Fusco
- Department of Systems Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy
| | - Eleonora Franzè
- Department of Systems Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy
| | - Marco Colella
- Department of Systems Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy
| | - Georgios Strimpakos
- Institute of Biochemistry and Cell Biology (IBBC), National Council of Research (CNR), 00146 Rome, Italy
| | - Silvia Salvatori
- Gastroenterology Unit, Fondazione Policlinico “Tor Vergata”, 00133 Rome, Italy
| | - Vincenzo Formica
- Medical Oncology Unit, Fondazione Policlinico “Tor Vergata”, 00133 Rome, Italy
| | - Federica Laudisi
- Department of Systems Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy
| | - Claudia Maresca
- Department of Systems Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy
| | - Alfredo Colantoni
- Department of Systems Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy
| | - Angela Ortenzi
- Department of Systems Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy
| | - Carmine Stolfi
- Department of Systems Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy
| | - Ivan Monteleone
- Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, 00133 Rome, Italy
| | - Giovanni Monteleone
- Department of Systems Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy
- Gastroenterology Unit, Fondazione Policlinico “Tor Vergata”, 00133 Rome, Italy
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16
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Morelli C, Formica V, Patrikidou A, Rofei M, Shiu KK, Riondino S, Argirò R, Floris R, Ferlosio A, Orlandi A, Roselli M, Arkenau HT. Nutritional index for immune-checkpoint inhibitor in patients with metastatic gastro-esophageal junction/gastric cancer. J Gastrointest Oncol 2022; 13:2072-2081. [PMID: 36388663 PMCID: PMC9660047 DOI: 10.21037/jgo-22-217] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 08/02/2022] [Indexed: 08/08/2023] Open
Abstract
BACKGROUND Nutritional status is strongly associated to prognosis in metastatic gastrooesophageal junction (mGOJ)/gastric cancer (GC) patients. The aim of the present study was to develop an immune-checkpoint inhibitor (ICI)-specific nutritional index (NI). METHODS Ten serum and anthropometric nutritional markers derived from blood tests or CT scans were analyzed at baseline in patients treated with second-line ICI and correlated with overall survival (OS). An ICI-specific NI (the NUTRIICI) was developed with its specificity assessed in an independent group of patients treated with standard second-line chemotherapy. RESULTS From June 2014 to December 2018, 57 mGOJ/GC patients (14 females, 43 males) with a median(m) age of 61 years (range 29-85) received ICI as second-line therapy (Pembrolizumab n=26, Nivolumab n=16, Avelumab n=15). Among the 10 analyzed variables, Onodera's prognostic NI (PNI) ≤33 and waist-to-hip (WHR) <1 were independent predictors of OS and used to build the NUTRIICI. Patients with both favorable factors (i.e., PNI >33 and WHR ≥1, comparator group) had a mOS of 18.0 vs. 6.7 months of patients with one unfavorable factor (either PNI ≤33 or WHR <1, Hazard Ratio, HR 3.06), vs. 1.3 months of patients with both unfavorable factors (HR 17.56), overall P<0.0001. In the independent group of patients treated with standard chemotherapy NUTRIICI was not associated with prognosis (P=0.57). CONCLUSIONS NUTRIICI is the first ICI-specific NI for mOGJ/GC patients receiving second-line ICI. A validation in larger cohorts is strongly encouraged.
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Affiliation(s)
- Cristina Morelli
- Medical Oncology Unit and PhD program in Systems and Experimental Medicine (XXXV cycle), Tor Vergata University Hospital, Rome, Italy
| | - Vincenzo Formica
- Medical Oncology Unit and PhD program in Systems and Experimental Medicine (XXXV cycle), Tor Vergata University Hospital, Rome, Italy
| | - Anna Patrikidou
- Department of Cancer Medicine, Gustave Roussy Cancer Campus, Villejuif, France
| | - Michela Rofei
- Medical Oncology Unit and PhD program in Systems and Experimental Medicine (XXXV cycle), Tor Vergata University Hospital, Rome, Italy
| | - Kai Keen Shiu
- Department of Oncology, University College Hospital, London, UK
| | - Silvia Riondino
- Medical Oncology Unit and PhD program in Systems and Experimental Medicine (XXXV cycle), Tor Vergata University Hospital, Rome, Italy
| | - Renato Argirò
- Diagnostic Imaging and Interventional Radiology, University Hospital of Rome Tor Vergata, Rome, Italy
| | - Roberto Floris
- Diagnostic Imaging and Interventional Radiology, University Hospital of Rome Tor Vergata, Rome, Italy
| | - Amedeo Ferlosio
- Anatomic Pathology, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Augusto Orlandi
- Anatomic Pathology, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Mario Roselli
- Medical Oncology Unit and PhD program in Systems and Experimental Medicine (XXXV cycle), Tor Vergata University Hospital, Rome, Italy
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17
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Guida AM, Sensi B, Formica V, D'Angelillo RM, Roselli M, Del Vecchio Blanco G, Rossi P, Capolupo GT, Caricato M, Sica GS. Total neoadjuvant therapy for the treatment of locally advanced rectal cancer: a systematic minireview. Biol Direct 2022; 17:16. [PMID: 35698084 PMCID: PMC9195214 DOI: 10.1186/s13062-022-00329-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 05/30/2022] [Indexed: 12/13/2022] Open
Abstract
Colorectal carcinoma is the second leading cause of cancer-related deaths, and indeed, rectal cancer accounting for approximately one third of newly diagnosed patients. Gold standard in the treatment of rectal cancer is a multimodality approach, aiming at a good control of the local disease. Distant recurrences are the major cause of mortality. Currently, Locally Advanced Rectal Cancer (LARC) patients undergo a combined treatment of chemotherapy and radiotherapy, followed by surgery. Eventually, more chemotherapy, namely adjuvant chemotherapy (aCT), may be necessary. Total Neoadjuvant Therapy (TNT) is an emerging approach aimed to reduce distant metastases and improve local control. Several ongoing studies are analyzing whether this new approach could improve oncological outcomes. Published results were encouraging, but the heterogeneity of protocols in use, makes the comparison and interpretation of data rather complex. One of the major concerns regarding TNT administration is related to its effect on larger and more advanced cancers that might not undergo similar down-staging as smaller, early-stage tumors. This minireview, based on a systematic literature search of randomized clinical trials and meta-analysis, summarizes current knowledge on TNT. The aim was to confirm or refute whether or not current practice of TNT is based on relevant evidence, to establish the quality of that evidence, and to address any uncertainty or variation in practice that may be occurring. A tentative grouping of general study characteristics, clinical features and treatments characteristics has been undertaken to evaluate if the reported studies are sufficiently homogeneous in terms of subjects involved, interventions, and outcomes to provide a meaningful idea of which patients are more likely to gain from this treatment.
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Affiliation(s)
- Andrea M Guida
- Department of Surgery, Minimally Invasive Unit, University of Rome Tor Vergata, 00133, Rome, Italy
| | - Bruno Sensi
- Department of Surgery, Minimally Invasive Unit, University of Rome Tor Vergata, 00133, Rome, Italy
| | - Vincenzo Formica
- Department of Systems Medicine, Medical Oncology Unit, Policlinico Tor Vergata, Rome, Italy
| | - Rolando M D'Angelillo
- Department of Biomedicine and Prevention, Radiation Oncology, University of Rome Tor Vergata, 00133, Rome, Italy
| | - Mario Roselli
- Department of Systems Medicine, Medical Oncology Unit, Policlinico Tor Vergata, Rome, Italy
| | | | - Piero Rossi
- Department of Surgery, Minimally Invasive Unit, University of Rome Tor Vergata, 00133, Rome, Italy
| | - Gabriella T Capolupo
- Department of Colorectal Surgery, Colorectal Surgery Unit, Campus Bio-Medico University, 00128, Rome, Italy
| | - Marco Caricato
- Department of Colorectal Surgery, Colorectal Surgery Unit, Campus Bio-Medico University, 00128, Rome, Italy
| | - Giuseppe S Sica
- Department of Surgery, Minimally Invasive Unit, University of Rome Tor Vergata, 00133, Rome, Italy. .,Department of Surgery, Policlinico Tor Vergata, University of Rome, Tor Vergata, Viale Oxford 81, 00133, Rome, Italy.
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18
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Cremolini C, Rossini D, Lonardi S, Antoniotti C, Pietrantonio F, Marmorino F, Antonuzzo L, Boccaccino A, Randon G, Giommoni E, Pozzo C, Moretto R, De Grandis MC, Viola MG, Passardi A, Buonadonna A, Formica V, Aprile G, Boni L, Masi G. Modified FOLFOXIRI plus panitumumab (mFOLFOXIRI/PAN) versus mFOLFOX6/PAN as initial treatment of patients with unresectable RAS and BRAF wild-type metastatic colorectal cancer (mCRC): Results of the phase III randomized TRIPLETE study by GONO. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.17_suppl.lba3505] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
LBA3505 Background: The association of a chemotherapy doublet (FOLFOX/FOLFIRI) with an anti-EGFR monoclonal antibody (cetuximab or panitumumab) is an upfront option for the treatment of RAS and BRAF wt mCRC patients. Phase II studies investigating the combination of the triplet FOLFOXIRI with an anti-EGFR reported promising activity results and an acceptable safety profile when lower doses of 5FU and irinotecan were adopted. The added value of intensifying the upfront chemotherapy when combined with a targeted agent in a molecularly selected population is not established. Methods: TRIPLETE is a prospective, open label, phase III trial in which previously untreated patients with unresectable RAS and BRAF wt mCRC were randomized to receive mFOLFOX6/pan (arm A) or mFOLFOXIRI (irinotecan 150 mg/sqm, oxaliplatin 85 mg/sqm, L-leucovorin 200 mg/sqm, 5-fluoruracil 2400 mg/sqm 48 h infusion)/pan (arm B) up to 12 cycles, followed by 5FU/LV/pan until disease progression. The primary endpoint is overall response rate (ORR) according to RECIST 1.1 criteria. Secondary endpoints include safety profile, R0 resection rate, PFS and OS. Under the assumption of an ORR of 60% in arm A, to detect an increase of at least 15% in arm B, a sample size of 432 cases provided approximately 90% power to a two-sided chi square test for heterogeneity at the 0.05 significance level. Results: From September 2017 to September 2021, 435 pts were enrolled (arm A/B: 217/218) in 67 Italian sites. Main pts’ characteristics were (arm A/B): median age 59/59, ECOG PS 0 80%/84%, left-sided 88%/88%, synchronous metastases 88%/87%, prior adjuvant 2%/6%, resected primary 43%/51%, liver-only 37%/39%. Main grade > 2 adverse events were diarrhoea 7%/23%, stomatitis 7%/7%, neutropenia 20%/32%, febrile neutropenia 3%/6%, fatigue 2%/7%, skin rash 29%/19%. 160 (73%) out of 218 patients in arm B and 165 (76%) out of 217 patients in arm A achieved RECIST response (OR 0.87, 95%CI 0.56-1.34, p=0.526). No interaction effect between treatment arm and disease spread (liver-limited vs not-liver limited) was evident. No differences in early tumor shrinkage (arm A/B 58%/57%, p=0.878) and deepness of response (median arm A/B: 47%/48%, p=0.845) were reported, nor in R0 resection rate (arm A/B 29%/25%, p=0.317). At a median follow up of 26.5 mos, 305 (arm A/B: 157/148) PFS events were collected, with no significant difference between arms (median PFS: 12.7 vs 12.3 months, HR: 0.88, 95%CI 0.70-1.11, p=0.277). Conclusions: The intensification of the upfront chemotherapy backbone in combination with panitumumab in molecularly selected and mostly (88%) left-sided mCRC patients does not provide any benefit in terms of treatment activity at the price of a non-negligible increase in gastrointestinal toxicity. Clinical trial information: NCT03231722.
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Affiliation(s)
- Chiara Cremolini
- Department of Translational Research and New Technologies in Medicine and Surgery-Unit of Medical Oncology 2, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Daniele Rossini
- Department of Translational Research and New Technologies in Medicine and Surgery-Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Sara Lonardi
- Medical Oncology 3, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - Carlotta Antoniotti
- Department of Translational Research and New Technologies in Medicine and Surgery-Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Filippo Pietrantonio
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Federica Marmorino
- Department of Translational Research and New Technologies in Medicine and Surgery-Unit of Medical Oncology 2, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Lorenzo Antonuzzo
- Clinical Oncology Unit, Careggi University Hospital - Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Alessandra Boccaccino
- Department of Translational Research and New Technologies in Medicine and Surgery-Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Giovanni Randon
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Elisa Giommoni
- Clinical Oncology Unit, Careggi University Hospital, Florence, Italy
| | - Carmelo Pozzo
- Oncologia Medica, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Roberto Moretto
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | | | | | - Alessandro Passardi
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, Meldola, Italy
| | - Angela Buonadonna
- Medical Oncology Unit, Centro di Riferimento Oncologico di Aviano, Istituto di Ricovero e Cura a Carattere Scientifico, Aviano, Italy
| | - Vincenzo Formica
- Medical Oncology Unit, Tor Vergata University Hospital, Rome, Italy
| | - Giuseppe Aprile
- Department of Oncology, San Bortolo General Hospital, Azienda ULSS8 Berica, Vicenza, Italy
| | - Luca Boni
- Clinical Epidemiology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Gianluca Masi
- Department of Translational Research and New Technologies in Medicine and Surgery-Unit of Medical Oncology 2, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
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19
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Rossini D, Antoniotti C, Lonardi S, Pietrantonio F, Moretto R, Antonuzzo L, Boccaccino A, Morano F, Brugia M, Pozzo C, Marmorino F, Bergamo F, Tamburini E, Passardi A, Randon G, Murgioni S, Borelli B, Buonadonna A, Giordano M, Fontanini G, Conca V, Formica V, Aglietta M, Bordonaro R, Aprile G, Masi G, Boni L, Cremolini C. Upfront Modified Fluorouracil, Leucovorin, Oxaliplatin, and Irinotecan Plus Panitumumab Versus Fluorouracil, Leucovorin, and Oxaliplatin Plus Panitumumab for Patients With RAS/BRAF Wild-Type Metastatic Colorectal Cancer: The Phase III TRIPLETE Study by GONO. J Clin Oncol 2022; 40:2878-2888. [PMID: 35666229 PMCID: PMC9426812 DOI: 10.1200/jco.22.00839] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
To verify whether the intensification of the upfront chemotherapy backbone with a modified schedule of modified fluorouracil, leucovorin, oxaliplatin, and irinotecan (mFOLFOXIRI) increases the activity of fluorouracil, leucovorin, and oxaliplatin when both regimens are combined with panitumumab as initial treatment for RAS and BRAF wild-type (wt) metastatic colorectal cancer (mCRC).
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Affiliation(s)
- Daniele Rossini
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy.,Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Carlotta Antoniotti
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy.,Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Sara Lonardi
- Medical Oncology 3, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Filippo Pietrantonio
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Roberto Moretto
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Lorenzo Antonuzzo
- Clinical Oncology Unit, Careggi University Hospital-Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Alessandra Boccaccino
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy.,Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Federica Morano
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Marco Brugia
- Medical Oncology Unit, Careggi University Hospital, Florence, Italy
| | - Carmelo Pozzo
- Medical Oncology, Comprehensive Cancer Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Federica Marmorino
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy.,Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Francesca Bergamo
- Medical Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Emiliano Tamburini
- Oncology and Palliative Care Department, Cardinale G. Panico Tricase City Hospital, Tricase, Italy
| | - Alessandro Passardi
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori," Meldola, Italy
| | - Giovanni Randon
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Sabina Murgioni
- Medical Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Beatrice Borelli
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy.,Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Angela Buonadonna
- Department of Medical Oncology, CRO Aviano, National Cancer Institute, IRCCS, Aviano, Italy
| | - Mirella Giordano
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy.,Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Gabriella Fontanini
- Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
| | - Veronica Conca
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy.,Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Vincenzo Formica
- Medical Oncology Unit, Tor Vergata University Hospital, Rome, Italy
| | - Massimo Aglietta
- Medical Oncology, Candiolo Cancer Institute, Fondazione del Piemonte per l'Oncologia (FPO)-Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Torino, Italy
| | - Roberto Bordonaro
- Medical Oncology Unit, Azienda Ospedaliera di Rilievo Nazionale e Alta Specializzazione (ARNAS), Ospedale Garibaldi, Catania, Italy
| | - Giuseppe Aprile
- Department of Oncology, San Bortolo General Hospital, Azienda ULSS8 Berica, Vicenza, Italy
| | - Gianluca Masi
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy.,Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Luca Boni
- Clinical Epidemiology Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Chiara Cremolini
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy.,Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
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20
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Morelli C, Rofei M, Riondino S, Fraboni D, Torino F, Orlandi A, Tesauro M, Del Vecchio Blanco G, Federici M, Arkenau HT, Formica V, Roselli M. Immune Response in Vitamin D Deficient Metastatic Colorectal Cancer Patients: A Player That Should Be Considered for Targeted Vitamin D Supplementation. Cancers (Basel) 2022; 14:2594. [PMID: 35681576 PMCID: PMC9179512 DOI: 10.3390/cancers14112594] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 05/22/2022] [Accepted: 05/23/2022] [Indexed: 01/05/2023] Open
Abstract
Background: Vitamin D deficiency is a poor prognostic factor in metastatic colorectal cancer (mCRC); however, targeted supplementation trials have so far yielded limited results. We investigated clinical-laboratory parameters influencing vitamin D deficiency, with a particular focus on immune response, and the effect on survival. These parameters could help optimize targeted supplementation therapy. Methods: Association of plasma 25-hydroxyvitamin D (25(OH])D) with overall survival (OS) was assessed with the Hazard Ratio Smoothed Curve with Restricted Cubic Splines (HRSC-RCS) and maximally selected rank statistics (MSRS) in mCRC patients who underwent first-line chemotherapy. Several hematobiochemical variables were evaluated as predictors of vitamin D deficiency by means of Least Absolute Shrinkage and Selection Operator (LASSO) analysis. In a patient subset, peripheral lymphocyte subpopulations were also analyzed. Results: One hundred thirty-three mCRC patients were included. The median(m) baseline 25(OH)D was 10.8 ng/mL (range 3−53.4). HRSC-RCS revealed a linear association between 25(OH)D and OS. MSRS found 10 ng/mL as the optimal 25(OH)D cut-off. The median OS for 25(OH)D < 10 (n = 60) vs. > 10 ng/mL (n = 73) was 12.3 and 24.5 months, respectively (p = 0.002). The LASSO analysis identified high neutrophil-to-lymphocyte ratio (NLR > 3.5) as the strongest predictor of vitamin D deficiency (Odds Ratio 3.35, p 0.0009). Moreover, patients with low 25(OH)D levels (< 10 ng/mL) and high NLR (>3.5) had the shortest survival and patients with 25(OH)D >10 ng/mL and NLR <3.5 had the longest: mOS 8.1 and 28.1 months, respectively, HR 3.40 (1.76−6.59), p 0.0004. Besides the significant difference in NLR between 25(OH)D < and > 10 ng/mL patients (mNLR 3.6 vs. 2.9, p 0.03), the lymphocyte subpopulation analysis revealed that vitamin D deficiency was associated with high T- CD4+ (p = 0.04) and low B (p = 0.03) lymphocyte frequency. Conclusions: NLR is a powerful predictor of Vitamin D deficiency and can further help in stratifying prognosis. Vitamin D deficiency was associated with significant variations in peripheral immune cells. We hypothesize that integrated targeted interventions to both vitamin D and immune system would improve the prognosis of mCRC patients.
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Affiliation(s)
- Cristina Morelli
- Medical Oncology Unit, Department of Systems Medicine, Tor Vergata University Hospital, 00133 Rome, Italy; (C.M.); (M.R.); (S.R.); (F.T.); (M.R.)
| | - Michela Rofei
- Medical Oncology Unit, Department of Systems Medicine, Tor Vergata University Hospital, 00133 Rome, Italy; (C.M.); (M.R.); (S.R.); (F.T.); (M.R.)
| | - Silvia Riondino
- Medical Oncology Unit, Department of Systems Medicine, Tor Vergata University Hospital, 00133 Rome, Italy; (C.M.); (M.R.); (S.R.); (F.T.); (M.R.)
| | - Daniela Fraboni
- Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, 00133 Rome, Italy;
| | - Francesco Torino
- Medical Oncology Unit, Department of Systems Medicine, Tor Vergata University Hospital, 00133 Rome, Italy; (C.M.); (M.R.); (S.R.); (F.T.); (M.R.)
| | - Augusto Orlandi
- Anatomic Pathology, Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, 00133 Rome, Italy;
| | - Manfredi Tesauro
- Department of Internal Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy;
| | | | - Massimo Federici
- Department of Systems Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy;
| | - Hendrik-Tobias Arkenau
- Sarah Cannon Research Institute, Cancer Institute, University College London, London W1G 6AD, UK;
| | - Vincenzo Formica
- Medical Oncology Unit, Department of Systems Medicine, Tor Vergata University Hospital, 00133 Rome, Italy; (C.M.); (M.R.); (S.R.); (F.T.); (M.R.)
| | - Mario Roselli
- Medical Oncology Unit, Department of Systems Medicine, Tor Vergata University Hospital, 00133 Rome, Italy; (C.M.); (M.R.); (S.R.); (F.T.); (M.R.)
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21
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Prete AA, Manca P, Morano F, Rasola C, Messina M, Formica V, Corsi DC, Cortesi E, Frassineti GL, Zampino MG, Casagrande M, Masi G, Ronzoni M, Scartozzi M, Prisciandaro M, Bergamo F, Vettore V, Pietrantonio F, Fassan M, Lonardi S. Extensive molecular profiling of squamous cell anal carcinoma in a phase 2 trial population: Translational analyses of the “CARACAS” study. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.4_suppl.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
5 Background: Advanced squamous cell anal cancer (aSCAC) is a rare and aggressive disease, accounting for poor prognosis and high morbidity. No targeted therapies are currently available and, after the first line, no standard treatments are approved. Immune checkpoint inhibitors (ICI) showed signs of activity in previous phase I/II trials, but predictive and prognostic biomarkers are lacking. Anti-EGFR have been tested given the rarity of KRAS mutations in aSCAC, with encouraging results. Earlier preclinical evidence suggests possible synergism between cetuximab (cet) and ICI. Methods: In the phase II randomized trial CARACAS (NCT03944252), we tested avelumab (ave) alone (Arm A) or with cet (Arm B) in pretreated aSCAC; overall response rate (ORR) was the primary endpoint. With one-sided a error set at 0.05 and power of 80%, at least 4 responses out of 27 patients (pts) per arm had to be observed to declare the study positive. On pre-treatment tumor tissue samples, we assessed HPV status, PD-L1 expression, microsatellite status, tumor mutational burden (TMB) and performed next generation sequencing (NGS) via FoundationOne CDx. Primary objective was to describe the clinical outcomes of ICI in SCAC in the CARACAS trial population according to molecular analyses. Secondary objectives were to assess progression-free survival (PFS) and overall survival (OS) according to molecular characteristics to individuate new prognostic biomarkers in SCAC. Cox regression was used to investigate the effect of the main variables analysed on survival. Translational analyses were performed on the 100% of the study population since all the pts received ICI. Results: In the clinical trial, the Arm B reached the primary endpoint (ORR 17%, 95% CI 5·6-34·7). High TMB (≥10 mutations per megabase) was related with longer OS (HR=0.09; 95% CI 0.01-0.68; p=0.019), showing the same trend in PFS (HR=0.44; 95%CI=0.15-1.27; p=0.129). As well, tumors with high expression of PD-L1 (>40 measured with combined positive score, CPS) showed significantly longer OS (HR=2.19; 95% CI=0.92-5.19; p=0.075) and PFS (HR=2.35; 95%CI=1.09-5.1; p=0.03). High TILs (>1.2) did not affect significantly OS (HR=0.77; 95% CI=0.42-1.4; p=0.39) nor PFS (HR=1.19; 95%CI=0.57-2.48; p=0.645). When combined together and with high TILs, high TMB and PD-L1identified pts with significantly better prognosis in OS (HR=0.43; 95% CI=0.21-0.87; p=0.019) and PFS (HR=0.48; 95%CI=0.23-1.00; p=0.051). Remarkable responses were also observed in pts with high PD-L1 expression and TMB. Conclusions: TranslaCARACAS study documented prognostic role of high TMB and PD-L1 in mSCAC treated with ICI with or without anti-EGFR. Stratifying per high TMB, PD-L1 and TILs, a subgroup of pts with particularly favorable prognosis and deep responses were detected. Further investigation in larger cohorts is warranted to confirm our findings.
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Affiliation(s)
- Alessandra Anna Prete
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | | | - Federica Morano
- Medical Oncology Department, ENETS Center of Excellence, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Cosimo Rasola
- Unit of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Marco Messina
- UOC Oncologia Fondazione Istituto G. Giglio, Cefalù (Pa), Palermo, Italy
| | | | | | | | - Giovanni Luca Frassineti
- Medical Oncology Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - M. Giulia Zampino
- Divisione di Oncologia Medica Gastrointestinale e Tumori Neuroendocrini Istituto Europeo di Oncologia-IRCCS, Milan, Italy
| | - Mariaelena Casagrande
- Department of Oncology, Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | - Gianluca Masi
- Azienda Ospedaliera-Universitaria Pisana, Pisa, Italy
| | - Monica Ronzoni
- Department of Oncology, Istituto Scientifico San Raffaele IRCSS, Milan, Italy
| | - Mario Scartozzi
- Medical Oncology Unit, University Hospital and University of Cagliari, Cagliari, Italy
| | - Michele Prisciandaro
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Francesca Bergamo
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Valentina Vettore
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Filippo Pietrantonio
- Medical Oncology Department, Fondazione IRCSS-Istituto Nazionale dei Tumori, Milan, Italy
| | - Matteo Fassan
- Department of Pathology, University Hospital of Padua, Padua, Italy
| | - Sara Lonardi
- Veneto Institute of Oncology (IOV)-IRCCS, Padua, Italy
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Morelli C, Formica V, Doldo E, Riondino S, Rofei M, Vergilii L, Palmieri G, Arkenau HT, Roselli M, Orlandi A. OUP accepted manuscript. Oncologist 2022; 27:e420-e421. [PMID: 35325223 PMCID: PMC9075005 DOI: 10.1093/oncolo/oyac057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 01/20/2022] [Indexed: 11/17/2022] Open
Affiliation(s)
- Cristina Morelli
- Medical Oncology Unit, Department of Systems Medicine, Tor Vergata University Hospital, Rome, Italy
| | - Vincenzo Formica
- Medical Oncology Unit, Department of Systems Medicine, Tor Vergata University Hospital, Rome, Italy
| | - Elena Doldo
- Anatomic Pathology, Department of Biomedicine and Prevention, Tor Vergata University Hospital, Rome, Italy
| | - Silvia Riondino
- Medical Oncology Unit, Department of Systems Medicine, Tor Vergata University Hospital, Rome, Italy
| | - Michela Rofei
- Medical Oncology Unit, Department of Systems Medicine, Tor Vergata University Hospital, Rome, Italy
| | - Lorena Vergilii
- Anatomic Pathology, Department of Biomedicine and Prevention, Tor Vergata University Hospital, Rome, Italy
| | - Giampiero Palmieri
- Anatomic Pathology, Department of Biomedicine and Prevention, Tor Vergata University Hospital, Rome, Italy
| | - Hendrik-Tobias Arkenau
- Sarah Cannon Research Institute, Cancer Institute, University College London, London, UK
| | - Mario Roselli
- Medical Oncology Unit, Department of Systems Medicine, Tor Vergata University Hospital, Rome, Italy
| | - Augusto Orlandi
- Anatomic Pathology, Department of Biomedicine and Prevention, Tor Vergata University Hospital, Rome, Italy
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23
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Lonardi S, Prete AA, Morano F, Messina M, Formica V, Corsi DC, Orciuolo C, Frassineti GL, Zampino MG, Casagrande M, Masi G, Ronzoni M, Scartozzi M, Buonadonna A, Mosconi S, Ratti M, Sartore-Bianchi A, Tamburini E, Prisciandaro M, Bergamo F, Spada M, Corallo S, Vettore V, Loupakis F, Fassan M, Del Bianco P, Zagonel V, Pietrantonio F. Randomized phase II trial of avelumab alone or in combination with cetuximab for patients with previously treated, locally advanced, or metastatic squamous cell anal carcinoma: the CARACAS study. J Immunother Cancer 2021; 9:e002996. [PMID: 34815354 PMCID: PMC8611452 DOI: 10.1136/jitc-2021-002996] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND No standard therapies beyond first line are established for advanced squamous cell anal carcinoma (aSCAC). Earlier preliminary data suggest activity of epidermal growth factor receptor (EGFR) inhibition and programmed cell death ligand (PD-(L))1 blockade in patients with previously treated disease. Aim of this study was to explore activity and safety of avelumab with/without cetuximab in patients with aSCAC. METHODS In this open-label, non-comparative, 'pick the winner', multicenter randomized phase II trial (NCT03944252), patients with aSCAC progressing after one or more lines of treatment were randomized 1:1 to the anti-PD-L1 agent avelumab alone (arm A) or combined with cetuximab (arm B). Overall response rate (ORR) was the primary endpoint. With one-sided α error set at 0.05 and power of 80%, at least 4 responses out of 27 patients per arm had to be observed to declare the study positive. Secondary endpoints were progression free survival (PFS), overall survival (OS), and safety. RESULTS Thirty patients per arm were enrolled. Three patients in arm A and five in arm B achieved partial response: primary endpoint was reached in combination arm. ORR was 10% (95% CI 2.1 to 26.5) and 17% (95% CI 5.6 to 34.7) in arms A and B; disease control rate was 50% (95% CI 31.3 to 68.7) in arm A and 57 (95% CI 37.4-74.5) in arm B. At a median follow-up of 26.7 months (IQR 26.5-26.9), median PFS was 2.0 months (95% CI 1.8 to 4.0) in arm A and 3.9 (95% CI 2.1 to 5.6) in arm B. Median OS was 13.9 months (95% CI 7.7 to 19.4) in arm A and 7.8 (95% CI 6.2 to 11.2) in arm B. Acceptable safety profile was observed in both arms. CONCLUSIONS CARACAS study met its primary endpoint in arm B, documenting promising activity of dual EGFR and PD-L1 blockade in aSCAC.
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Affiliation(s)
- Sara Lonardi
- Istituto Oncologico Veneto Istituto di Ricovero e Cura a Carattere Scientifico, Department of Oncology 1, veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Alessandra Anna Prete
- Istituto Oncologico Veneto Istituto di Ricovero e Cura a Carattere Scientifico, Department of Oncology 1, veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Federica Morano
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Marco Messina
- Department of Oncology, Fondazione Istituto G. Giglio, Cefalù, Italy
| | | | | | - Corrado Orciuolo
- Oncology Unit, Department of Radiology, Oncology and Human Pathology, Sapienza University of Roma, Rome, Italy
| | - Giovanni Luca Frassineti
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori Dino Amadori (IRST), Meldola, Italy
| | - Maria Giulia Zampino
- Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, European Institute of Oncology-IRCCS, Milan, Italy
| | - Mariaelena Casagrande
- Department of Oncology, Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | - Gianluca Masi
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
- Division of Medical Oncology, Pisa University Hospital, Pisa, Italy
| | - Monica Ronzoni
- Oncologia Medica, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Mario Scartozzi
- Department of Medical Oncology, University of Cagliari, Cagliari, Italy
| | - Angela Buonadonna
- Unit of Medical Oncology and Cancer Prevention, Centro di Riferimento Oncologico di Aviano IRCCS, Aviano, Italy
| | - Stefania Mosconi
- Department of Medical Oncology, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | | | | | - Emiliano Tamburini
- Department of Oncology and Palliative Care, Cardinale G Panico, Tricase City Hospital, Tricase, Italy
| | - Michele Prisciandaro
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Francesca Bergamo
- Istituto Oncologico Veneto Istituto di Ricovero e Cura a Carattere Scientifico, Department of Oncology 1, veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | | | - Salvatore Corallo
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Valentina Vettore
- Istituto Oncologico Veneto Istituto di Ricovero e Cura a Carattere Scientifico, Department of Oncology 1, veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Fotios Loupakis
- Istituto Oncologico Veneto Istituto di Ricovero e Cura a Carattere Scientifico, Department of Oncology 1, veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Matteo Fassan
- Department of Medicine (DIMED), Pathology Unit, University of Padua, Padua, Veneto, Italy, University of Padova, Padova, Veneto, Italy
- Veneto Institute of Oncology, IOV-IRCCS, Padua, Veneto, Italy
| | - Paola Del Bianco
- Clinical Research Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Vittorina Zagonel
- Istituto Oncologico Veneto Istituto di Ricovero e Cura a Carattere Scientifico, Department of Oncology 1, veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Filippo Pietrantonio
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
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Giommoni E, Lavacchi D, Tirino G, Fornaro L, Iachetta F, Pozzo C, Satolli MA, Spallanzani A, Puzzoni M, Stragliotto S, Sisani M, Formica V, Giovanardi F, Strippoli A, Prisciandaro M, Di Donato S, Pompella L, Pecora I, Romagnani A, Fancelli S, Brugia M, Pillozzi S, De Vita F, Antonuzzo L. Results of the observational prospective RealFLOT study. BMC Cancer 2021; 21:1086. [PMID: 34625033 PMCID: PMC8499559 DOI: 10.1186/s12885-021-08768-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 07/26/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Perioperative FLOT (5-fluorouracil, oxaliplatin and docetaxel) has recently become the gold standard treatment for fit patients with operable gastric (GC) or gastroesophageal (GEJ) adenocarcinoma, getting a 5-year overall survival (OS) of 45%, over 23% with surgery alone. METHODS RealFLOT is an Italian, multicentric, observational trial, collecting data from patients with resectable GC or GEJ adenocarcinoma treated with perioperative FLOT. Aim of the study was to describe feasibility and safety of FLOT, pathological complete response rate (pCR), surgical outcomes and overall response rate (ORR) in an unselected real-world population. Additional analyses evaluated the correlation between pCR and survival and the prognostic role of microsatellite instability (MSI) status. RESULTS Of 206 patients enrolled that received perioperative FLOT at 15 Italian centers, 124 (60.2%) received at least 4 full-dose cycles, 190 (92.2%) underwent surgery, and 142 (68.9%) started the postoperative phase. Among patients who started the postoperative phase, 105 (51.0%) received FLOT, while 37 (18%) received de-intensified regimens, depending on clinical condition or previous toxicities. pCR was achieved in 7.3% of cases. Safety profile was consistent with literature. Neutropenia was the most common G 3-4 adverse event (AE): 19.9% in the preoperative phase and 16.9% in the postoperative phase. No toxic death was observed and 30-day postoperative mortality rate was 1.0%. ORR was 45.6% and disease control rate (DCR) was 94.2%. Disease-free survival (DFS) and OS were significantly longer in case of pCR (p = 0.009 and p = 0.023, respectively). A trend towards better DFS was observed among MSI-H patients. CONCLUSIONS These real-world data confirm the feasibility of FLOT in an unselected population, representative of the clinical practice. pCR rate was lower than expected, nevertheless we confirm pCR as a predictive parameter of survival. In addition, MSI-H status seems to be a positive prognostic marker also in patients treated with taxane-containing triplets.
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Affiliation(s)
| | | | - Giuseppe Tirino
- Division of Medical Oncology, Department of Precision Medicine, University of Study of Campania "L. Vanvitelli", Naples, Italy
| | - Lorenzo Fornaro
- Medical Oncology, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Francesco Iachetta
- Medical Oncology Unit, Clinical Cancer Center, AUSL-IRCCS, Reggio Emilia, Italy
| | - Carmelo Pozzo
- Medical Oncology, Fondazione Policlinico Universitario "A. Gemelli", IRCCS, Rome, Italy
| | | | | | - Marco Puzzoni
- Medical Oncology Department, University Hospital, University of Cagliari, Cagliari, Italy
| | - Silvia Stragliotto
- Oncology Unit - Dipartimento di Oncologia Clinica e Sperimentale Istituto Oncologico Veneto IOV-IRCCS, Padua, Italy
| | | | - Vincenzo Formica
- Internal Medicine Department "Tor Vergata" University Hospital, Rome, Italy
| | - Filippo Giovanardi
- Medical Oncology, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Antonia Strippoli
- Medical Oncology, Fondazione Policlinico Universitario "A. Gemelli", IRCCS, Rome, Italy
| | - Michele Prisciandaro
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Samantha Di Donato
- Medical Oncology, Department Nuovo Ospedale-Santo Stefano Istituto Toscano Tumori, Prato, Italy
| | - Luca Pompella
- Division of Medical Oncology, Department of Precision Medicine, University of Study of Campania "L. Vanvitelli", Naples, Italy
| | - Irene Pecora
- Medical Oncology, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | | | | | - Marco Brugia
- Medical Oncology Unit, AOU Careggi, Florence, Italy
| | | | - Ferdinando De Vita
- Division of Medical Oncology, Department of Precision Medicine, University of Study of Campania "L. Vanvitelli", Naples, Italy
| | - Lorenzo Antonuzzo
- Medical Oncology Unit, AOU Careggi, Florence, Italy. .,Department of Experimental and Clinical Medicine, University of Firenze, Florence, Italy. .,Clinical Oncology Unit, AOU Careggi, Largo Brambilla 3, 50134, Florence, Italy.
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25
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Formica V, Sera F, Cremolini C, Riondino S, Morelli C, Arkenau HT, Roselli M. KRAS and BRAF Mutations in Stage II/III Colon Cancer: A Systematic Review and Meta-Analysis. J Natl Cancer Inst 2021; 114:517-527. [PMID: 34542636 DOI: 10.1093/jnci/djab190] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 08/09/2021] [Accepted: 09/15/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND KRAS and BRAF mutations are well-established predictive and prognostic factors in metastatic colorectal cancer, however their impact in the adjuvant setting has not yet been established. METHODS We performed a meta-analysis of adjuvant phase III trials in patients with stage II and III colon cancer with available data on the impact of KRAS/BRAF mutations on both disease-free survival (DFS) and overall survival (OS). Trials were subgrouped based on whether adjustment for microsatellite instability (MSI) was performed and the subgroup effect was analyzed through a meta-regression. To increase the precision of the estimates, a joint DFS/OS (so-called 'multivariate') meta-analysis was performed. All statistical tests were 2-sided. RESULTS Nine trials were selected (QUASAR 2, PETACC-8, N0147, CALGB-89803, NSABP-C07, NSABP-C08, PETACC-3, QUASAR, MOSAIC) including a total of 10893 patients. In the primary meta-analysis, KRAS mutation was associated with poor DFS (pooled HR = 1.36, 95% CI = 1.15-1.61, P < .001) and OS (pooled HR = 1.27, 95% CI = 1.03-1.55, P = .03) and BRAF mutation was also associated with poor DFS (pooled HR = 1.33, 95% CI = 1.00-1.78, P = .05) and OS (pooled HR = 1.49, 95% CI = 1.31-1.70, P < .001). MSI adjustment enhanced the effect of the mutations on outcome in the MSI-adjusted subgroup for both the KRAS mutation (pooled HR for DFS = 1.43, 95% CI = 1.15-1.79, P = .001; and pooled HR for OS = 1.33, 95% CI = 1.03-1.71, P = .03) and the BRAF mutation (pooled HR for DFS = 1.59, 95% CI = 1.22-2.07, P = .001; and pooled HR for OS = 1.67, 95% CI = 1.37-2.04, P < .001). The interaction between BRAF and MSI adjustment was statistically significant for DFS (P interaction = 0.02). This interaction was even more pronounced in the DFS/OS multivariate meta-analysis. CONCLUSIONS Both KRAS and BRAF mutations were statistically significantly associated with both DFS and OS, with the mutation effect being enhanced by MSI adjustment. Effective adjuvant treatment for microsatellite stable BRAF or KRAS-mutated colon cancer represents an unmet clinical need and exploring the use of recently available BRAF and KRAS inhibitors in this setting would be highly desirable.
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Affiliation(s)
- Vincenzo Formica
- Medical Oncology Unit, Department of Systems Medicine, Tor Vergata University Hospital, Rome, Italy
| | - Francesco Sera
- Department of Statistics, Computer Science and Applications "G Parenti, " University of Florence, Florence, Italy
| | - Chiara Cremolini
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy.,Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Silvia Riondino
- Medical Oncology Unit, Department of Systems Medicine, Tor Vergata University Hospital, Rome, Italy
| | - Cristina Morelli
- Medical Oncology Unit, Department of Systems Medicine, Tor Vergata University Hospital, Rome, Italy
| | - Hendrik-Tobias Arkenau
- Sarah Cannon Research Institute, Cancer Institute, University College London, London, UK
| | - Mario Roselli
- Medical Oncology Unit, Department of Systems Medicine, Tor Vergata University Hospital, Rome, Italy
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Guerriero S, Morelli C, Rofei M, Riondino S, Argirò R, Morosetti D, Gasparrini F, Nitti D, Benassi M, Di Girolamo S, D'Angelillo R, Formica V, Roselli M. 920P The sarcopenia skeletal muscle mass index (SMI) has a three-tier survival effect in HNSCC, which can be predicted by hemoglobin (Hb), lymphocytes (Ly) and creatinine (Cre). Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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27
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Rofei M, Morelli C, Riondino S, Guerriero S, Parisi G, Braudo S, Nitti D, Ferroni P, Guadagni F, Fraboni D, Orlandi A, Formica V, Roselli M. 492P Vitamin D deficiency in metastatic colorectal cancer (mCRC) worsens survival and correlates with significant peripheral inflammatory/immune cell changes. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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28
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Syeed Z, Forster M, Boukovinas I, Nutting C, Carnell D, Guerrero Urbano T, Sibtain A, Kalavrezos N, Patel G, Al Bakir M, Arkenau HT, Levva S, Gonnet P, Morelli C, Guerriero S, Rofei M, Formica V, Patrikidou A. 889P Development of a head and neck immune prognostic index (HN-IPI) classification for patients with recurrent/metastatic head and neck squamous cell carcinoma (R/M HNSCC) who received immune checkpoint inhibitors (ICIs). Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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29
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Del Vecchio Blanco G, Dwairi R, Giannelli M, Palmieri G, Formica V, Portarena I, Grasso E, Di Iorio L, Benassi M, Giudice EA, Nardecchia A, Rossi P, Roselli M, Sica G, Monteleone G, Paoluzi OA. Clinical care pathway program versus open-access system: a study on appropriateness, quality, and efficiency in the delivery of colonoscopy in the colorectal cancer. Intern Emerg Med 2021; 16:1197-1206. [PMID: 33555540 PMCID: PMC8310505 DOI: 10.1007/s11739-020-02565-z] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 11/06/2020] [Indexed: 12/15/2022]
Abstract
Open-access colonoscopy (OAC), whereby the colonoscopy is performed without a prior office visit with a gastroenterologist, is affected by inappropriateness which leads to overprescription and reduced availability of the procedure in case of alarming symptoms. The clinical care pathway (CCP) is a healthcare management tool promoted by national health systems to organize work-up of various morbidities. Recently, we started a CCP dedicated to colorectal cancer (CRC), including a colonoscopy session for CRC diagnosis and prevention. We aimed to evaluate the appropriateness, the quality, and the efficiency in the delivery of colonoscopy with the open-access system and a CCP program in the CRC. Quality indicators for colonoscopy in subjects in the CCP were compared to referrals by general practitioners (OAC) or by non-gastroenterologist physicians (non-gastroenterologist physician colonoscopy, NGPC). Attendance rate to colonoscopy was greater in the CCP group and NGPC group than in the OAC group (99%, 99%, and 86%, respectively). Waiting time in the CCP group was shorter than in the OAC group (3.88 ± 2.27 vs. 32 ± 22.31 weeks, respectively). Appropriateness of colonoscopy prescription was better in the CCP group than in the OAC group (92 vs. 50%, respectively). OAC is affected by the lack of timeliness and low appropriateness of prescription. A CCP reduces the number of inappropriate colonoscopies, especially for post-polypectomy surveillance, and improves the delivery of colonoscopy in patients requiring a fast-track examination. The high rate of inappropriate OAC suggests that this modality of healthcare should be widely reviewed.
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Affiliation(s)
| | - Rami Dwairi
- Department of Internal Medicine, University of Mutah, Karak, Jordan
| | - Mario Giannelli
- Department of Systems Medicine, Gastroenterology Unit, University of Rome "Tor Vergata", Rome, Italy
| | - Giampiero Palmieri
- Department of Biomedicine and Prevention, Anatomic Pathology Unit, University "Tor Vergata", Rome, Italy
| | - Vincenzo Formica
- Department of Oncohematology, Oncology Unit, University Tor Vergata, Rome, Italy
| | - Ilaria Portarena
- Department of Oncohematology, Oncology Unit, University Tor Vergata, Rome, Italy
| | - Enrico Grasso
- Department of Systems Medicine, Gastroenterology Unit, University of Rome "Tor Vergata", Rome, Italy
| | - Laura Di Iorio
- Department of Systems Medicine, Gastroenterology Unit, University of Rome "Tor Vergata", Rome, Italy
| | - Michela Benassi
- Department of Diagnostic Imaging, Interventional Radiology and Radiotherapy, University "Tor Vergata", Rome, Italy
| | - Emilia Anna Giudice
- Department of Diagnostic Imaging, Interventional Radiology and Radiotherapy, University "Tor Vergata", Rome, Italy
| | - Antonella Nardecchia
- Department of Diagnostic Imaging, Interventional Radiology and Radiotherapy, University "Tor Vergata", Rome, Italy
| | - Piero Rossi
- Department of Surgery, University Tor Vergata, Rome, Italy
| | - Mario Roselli
- Department of Oncohematology, Oncology Unit, University Tor Vergata, Rome, Italy
| | - Giuseppe Sica
- Department of Surgery, University Tor Vergata, Rome, Italy
| | - Giovanni Monteleone
- Department of Systems Medicine, Gastroenterology Unit, University of Rome "Tor Vergata", Rome, Italy
| | - Omero Alessandro Paoluzi
- Department of Systems Medicine, Gastroenterology Unit, University of Rome "Tor Vergata", Rome, Italy
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Rofei M, Morelli C, Riondino S, Guerriero S, Parisi G, Argiró R, Nitti D, Guadagni F, Formica V, Roselli M. P-162 Universally adopted vitamin D deficiency cutoff of 10 ng/mL is optimal for metastatic colorectal cancer prognostication and correlated with neutrophil/lymphocyte ratio. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.05.217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Morelli C, Formica V, Riondino S, Russo A, Ferroni P, Guadagni F, Roselli M. Irinotecan or Oxaliplatin: Which is the First Move for the Mate? Curr Med Chem 2021; 28:3158-3172. [PMID: 33069191 DOI: 10.2174/0929867327666201016124950] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 09/02/2020] [Accepted: 09/06/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVES The aim of the present review is to discuss the potential link between RAS, BRAF and microsatellite instability (MSI) mutational patterns and chemotherapeutic agent efficacy [Irinotecan (IRI) vs. Oxaliplatin (OXA)], and how this can potentially influence the choice of the chemotherapy backbone. METHODS Following a review of the research literature, all pertinent articles published in the core journals were selected for the study. The inclusion criteria regarded relevant clinical and pre-clinical studies on the topic of interest (Relationship of OXA and IRI to KRAS/BRAF mutations and MSI). RESULTS Excision repair cross complementation group 1 (ERCC1) expression is inhibited by KRAS mutation, making tumor cells more sensitive to OXA. Results from OPUS, COIN and PRIME trials support that no conclusive data are available for BRAF mutant population because of the small number of patients. Enhanced IRI cytotoxicity to MSI cell lines is due to the participation of some of the mismatch repair (MMR) components in various DNA repair processes and their role in the maintenance of the pro-apoptotic effect of IRI and G2/M cell arrest. CONCLUSION OXA and IRI are indispensable drugs for mCRC treatment and their selection must be as careful as that of targeted agents. We suggest taking into consideration the interaction between known genomic alterations and OXA and IRI activity to personalize chemotherapy in mCRC patients.
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Affiliation(s)
- Cristina Morelli
- Department of Systems Medicine, Medical Oncology Unit, Tor Vergata Clinical Center, Tor Vergata University of Rome, Viale Oxford 81, 00133, Rome, Italy
| | - Vincenzo Formica
- Department of Systems Medicine, Medical Oncology Unit, Tor Vergata Clinical Center, Tor Vergata University of Rome, Viale Oxford 81, 00133, Rome, Italy
| | - Silvia Riondino
- Department of Systems Medicine, Medical Oncology Unit, Tor Vergata Clinical Center, Tor Vergata University of Rome, Viale Oxford 81, 00133, Rome, Italy
| | - Antonio Russo
- Department of Surgical, Oncological and Stomatological Sciences, University of Palermo, Via del Vespro 129, 90127 Palermo, Italy
| | - Patrizia Ferroni
- BioBIM (InterInstitutional Multidisciplinary Biobank), IRCCS San Raffaele Pisana, Via di Val Cannuta 247, 00166 Rome, Italy
| | - Fiorella Guadagni
- BioBIM (InterInstitutional Multidisciplinary Biobank), IRCCS San Raffaele Pisana, Via di Val Cannuta 247, 00166 Rome, Italy
| | - Mario Roselli
- Department of Systems Medicine, Medical Oncology Unit, Tor Vergata Clinical Center, Tor Vergata University of Rome, Viale Oxford 81, 00133, Rome, Italy
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Formica V, Nardecchia A, Morelli C, Lucchetti J, Giuliano G, Renzi N, Gallo C, Pellegrino R, Massimiliani V, Serci C, Russo A, Patrikidou A, Arkenau HT, Maiorino L, Tesauro M, Roselli M. Health-related quality of life in patients with advanced colorectal cancer: a predictive nomogram including BMI, sex and age. Ann Palliat Med 2021; 10:4252-4261. [PMID: 33832305 DOI: 10.21037/apm-20-2194] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 02/05/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Health-related quality of life (HRQoL) is not universally assessed in metastatic colorectal cancer (mCRC) patients. We tried to identify patient subgroups for whom HRQoL assessment should be strongly encouraged. METHODS Consecutive mCRC patients who had been deemed candidates for first-line chemotherapy were enrolled in a prospective study (NCT03873064) and asked to complete the HRQoL questionnaire EORTC QLQ-C30. Primary endpoint was the Global Health Status (GHS) of EORTC QLQ-C30. A nomogram was built for prediction of low GHS (i.e., <67%). RESULTS Among recruited patients (n=173), a univariable logistic regression analysis (LRA) found that body mass index (BMI <23), age (>65 years) and sex (female) were significantly associated with low GHS. The multivariable LRA confirmed they were independently associated with the outcome (P values of 0.04-0.004). BMI, age and sex were included in a final predictive model (C-statistics, 67%; P=0.001) and used to build a nomogram. A total nomogram score ≥72 was associated with a risk of 28% or higher of having a low GHS. The 28% risk cut-off had a sensitivity of 90% and a specificity of 34% for identifying low GHS. A decision curve analysis revealed that a risk threshold of 28% of the model was associated to an added net benefit of ≥4% when using the nomogram. Low GHS was recorded in 58% vs. 23% of patients with >28% vs. <28% risk according to the nomogram, respectively (odds ratio 3.54, P=0.0004). CONCLUSIONS High BMI together with young age and male sex were protective against HRQoL deterioration. In centers where HRQoL is not routinely assessed, such an assessment should be at least made for mCRC patients at risk according to the proposed nomogram (i.e., over 65-year-old females with BMI <23).
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Affiliation(s)
- Vincenzo Formica
- Medical Oncology Unit, Department of Systems Medicine, Tor Vergata University Hospital, Rome, Italy
| | - Antonella Nardecchia
- Medical Oncology Unit, Department of Systems Medicine, Tor Vergata University Hospital, Rome, Italy
| | - Cristina Morelli
- Medical Oncology Unit, Department of Systems Medicine, Tor Vergata University Hospital, Rome, Italy
| | - Jessica Lucchetti
- Medical Oncology Unit, Department of Systems Medicine, Tor Vergata University Hospital, Rome, Italy
| | - Greta Giuliano
- Medical Oncology Unit, Department of Systems Medicine, Tor Vergata University Hospital, Rome, Italy
| | - Nicola Renzi
- Medical Oncology Unit, Department of Systems Medicine, Tor Vergata University Hospital, Rome, Italy
| | - Chiara Gallo
- Medical Oncology Unit, Department of Systems Medicine, Tor Vergata University Hospital, Rome, Italy
| | - Rachela Pellegrino
- Medical Oncology Unit, Department of Systems Medicine, Tor Vergata University Hospital, Rome, Italy
| | - Valentina Massimiliani
- Medical Oncology Unit, Department of Systems Medicine, Tor Vergata University Hospital, Rome, Italy
| | - Cristiano Serci
- Medical Oncology Unit, Department of Systems Medicine, Tor Vergata University Hospital, Rome, Italy
| | - Anna Russo
- Medical Oncology Unit, "Paolo Giaccone" University Hospital, Palermo, Italy
| | - Anna Patrikidou
- Medical Oncology, Sarah Cannon Research Institute UK, London, UK;
| | | | - Luigi Maiorino
- Medical Oncology Unit, San Gennaro Hospital, Naple, Italy
| | - Manfredi Tesauro
- Internal Medicine Department, Department of Systems Medicine, Tor Vergata University Hospital, Rome, Italy
| | - Mario Roselli
- Medical Oncology Unit, Department of Systems Medicine, Tor Vergata University Hospital, Rome, Italy
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Del Vecchio Blanco G, Palmieri G, Giannarelli D, Formica V, Portarena I, Nardecchia A, Troncone E, Benassi M, Giudice E, Anselmo A, Tisone G, Roselli M, Monteleone G, Paoluzi OA. Factors influencing diagnostic accuracy of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) in pancreatic and biliary tumors. Scand J Gastroenterol 2021; 56:498-504. [PMID: 33539716 DOI: 10.1080/00365521.2021.1880628] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIM Diagnostic accuracy of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is influenced by several factors, primarily operator expertise. Formal training in EUS-FNA, as suggested by the European Society of Gastrointestinal Endoscopy and the American Society for Gastrointestinal Endoscopy guidelines, is not always available and is often expensive and time-consuming. In this study we evaluate factors influencing the diagnostic accuracy of pancreatic EUS-FNA. METHODS In a retrospective study, 557 consecutive EUS-FNAs were evaluated. Several variables relating to the procedures were considered to calculate the EUS-FNA performance over eight years. RESULTS A total of 308 out of 557 EUS-FNAs were selected. Overall sensitivity of EUS-FNA was 66% (95% CI: 60.8-71.8), specificity 100%, and diagnostic accuracy 69% (95% CI: 64.0-74.4). An increase in diagnostic accuracy was observed to >90% using a new fine-needle biopsy (FNB) needle and in the case of simultaneous sampling of primary and metastatic lesions. Diagnostic accuracy >80% was observed after 250 procedures, in the absence of rapid on-site cytopathological examination (ROSE). Multivariate logistic regression analysis confirmed that the FNB needle, operator skill, and double EUS-FNA sampling are associated with high diagnostic accuracy. CONCLUSIONS The learning curve for EUS-FNA may be longer and a considerable number of procedures are needed to achieve high diagnostic accuracy in the absence of ROSE. However, the use of FNB needles and the simultaneous sampling of primary and metastatic lesions can rapidly improve the diagnostic accuracy of the procedure.
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Affiliation(s)
| | - Giampiero Palmieri
- Anatomic Pathology Unit, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Diana Giannarelli
- Biostatistical Unit, Regina Elena Institute-Hospital Physiotherapy Institutes, Rome, Italy
| | | | | | | | - Edoardo Troncone
- Gastroenterology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Michela Benassi
- Radiotherapy Unit, Department of Oncohematology, University of Rome Tor Vergata, Rome, Italy
| | - Emilia Giudice
- Radiotherapy Unit, Department of Oncohematology, University of Rome Tor Vergata, Rome, Italy
| | - Alessandro Anselmo
- Transplant Surgery Unit, Department of Surgery, University of Rome Tor Vergata, Rome, Italy
| | - Giuseppe Tisone
- Transplant Surgery Unit, Department of Surgery, University of Rome Tor Vergata, Rome, Italy
| | - Mario Roselli
- Oncology Unit, University of Rome Tor Vergata, Rome, Italy
| | - Giovanni Monteleone
- Gastroenterology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Omero Alessandro Paoluzi
- Gastroenterology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
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Bavetta M, Silvaggio D, Campione E, Sollena P, Formica V, Coletta D, Graziani G, Romano MCP, Roselli M, Peris K, Bianchi L. The Effects of Association of Topical Polydatin Improves the Preemptive Systemic Treatment on EGFR Inhibitors Cutaneous Adverse Reactions. J Clin Med 2021; 10:jcm10030466. [PMID: 33530427 PMCID: PMC7866016 DOI: 10.3390/jcm10030466] [Citation(s) in RCA: 4] [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: 11/26/2020] [Revised: 01/19/2021] [Accepted: 01/22/2021] [Indexed: 12/20/2022] Open
Abstract
Epidermal Growth Factor Receptor inhibitors (EGFRi) are approved as therapeutic options in several solid tumors. Cutaneous papulopustular eruption is the most frequent cutaneous adverse-event (AE), usually treated with emollient or corticosteroids according to toxicity grade. Our study evaluated the efficacy and safety of a topical product containing polydatin, a glycosylated polyphenol, natural precursor of resveratrol showing anti-inflammatory and anti-oxidative activities, for the prevention and treatment of skin papulopustular rash in EGFRi-treated patients. Forty oncologic patients treated with EGFRi were enrolled in two groups: group-A, 20 patients with papulopustular AE, and group-B, 20 patients without cutaneous manifestations. The study consisted of twice-daily application of polydatin cream 1.5% (group-A) and 0.8% (group-B) for 6 months. In group-A patients, we observed at week 4 a remarkable improvement of skin manifestation and quality of life evaluated with National-Cancer-Institute-Common-Terminology-Criteria for Adverse-Events (NCI-CTCAE), Dermatology-Life-Quality-Index (DLQI) score and Visual-Analogue-Scale (VAS) pruritus, with a statistical significance of p < 0.05. None of the patients of group-B developed skin AEs to EGFRi. No cutaneous AEs related to the polydatin product were reported in both groups. Polydatin can be a good topical aid for the prevention and management of papulopustular rash in cancer patients receiving EGFRi, also capable of improving cancer patients’ quality of life.
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Affiliation(s)
- Mauro Bavetta
- Dermatology Unit, Department of Systems Medicine, Tor Vergata University Hospital Foundation, 00133 Rome, Italy; (E.C.); (L.B.)
- Correspondence: (M.B.); (D.S.)
| | - Dionisio Silvaggio
- Dermatology Unit, Department of Systems Medicine, Tor Vergata University Hospital Foundation, 00133 Rome, Italy; (E.C.); (L.B.)
- Correspondence: (M.B.); (D.S.)
| | - Elena Campione
- Dermatology Unit, Department of Systems Medicine, Tor Vergata University Hospital Foundation, 00133 Rome, Italy; (E.C.); (L.B.)
| | - Pietro Sollena
- Dermatology Unit, Department of Medical and Surgical Sciences, Fondazione Agostino Gemelli University Hospital IRCCS, 00168 Rome, Italy; (P.S.); (K.P.)
| | - Vincenzo Formica
- Oncology Unit, Department of Systems Medicine, Tor Vergata University Hospital Foundation, 00133 Rome, Italy; (V.F.); (D.C.); (M.R.)
| | - Deborah Coletta
- Oncology Unit, Department of Systems Medicine, Tor Vergata University Hospital Foundation, 00133 Rome, Italy; (V.F.); (D.C.); (M.R.)
| | - Grazia Graziani
- Department of Systems Medicine, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy;
| | | | - Mario Roselli
- Oncology Unit, Department of Systems Medicine, Tor Vergata University Hospital Foundation, 00133 Rome, Italy; (V.F.); (D.C.); (M.R.)
| | - Ketty Peris
- Dermatology Unit, Department of Medical and Surgical Sciences, Fondazione Agostino Gemelli University Hospital IRCCS, 00168 Rome, Italy; (P.S.); (K.P.)
- Institute of Dermatology, Cattolica del Sacro Cuore University, 00168 Rome, Italy
| | - Luca Bianchi
- Dermatology Unit, Department of Systems Medicine, Tor Vergata University Hospital Foundation, 00133 Rome, Italy; (E.C.); (L.B.)
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Formica V, Morelli C, Patrikidou A, Shiu KK, Nardecchia A, Lucchetti J, Roselli M, Arkenau HT. A systematic review and meta-analysis of PD-1/PD-L1 inhibitors in specific patient subgroups with advanced gastro-oesophageal junction and gastric adenocarcinoma. Crit Rev Oncol Hematol 2021; 157:103173. [PMID: 33278677 DOI: 10.1016/j.critrevonc.2020.103173] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 08/27/2020] [Accepted: 11/05/2020] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND immune checkpoint inhibitors(ICIs) have shown contradictory results in patients with advanced gastro-oesophageal junction/gastric cancer(GOJ/GC). AIM to identify specific patient subgroups that would derive survival benefit from ICIs. METHODS a subgroup meta-analysis of randomised clinical trials(RCTs) was carried out. RESULTS four phase-III-RCTs were identified with data on the following variables: primary location(Gastric vs GOJ); age(≤ 65 vs >65); gender(male vs female); ECOG PS(0 vs 1); ethnicity (Asian vs non-Asian), histology(intestinal vs diffuse), PD-L1 expression(≥ 1% vs < 1%). PD-L1 positivity was significantly associated with survival benefit from ICIs (HR: 0.82, p 0.047), with a significant interaction between PD-L1 expression and ICI efficacy (interaction HR: 1.41, p 0.02). Numerically, the second most relevant interaction was ICI efficacy and gender, with ICI being more effective in males. CONCLUSION The PD-L1 positive patient subgroup derives significant survival benefit from ICI in GOJ/GC, however other predictors are eagerly needed to further refine patient selection.
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Affiliation(s)
- V Formica
- Medical Oncology Unit, Tor Vergata University Hospital, Viale Oxford 81, Rome, Italy.
| | - C Morelli
- Medical Oncology Unit, Tor Vergata University Hospital, Viale Oxford 81, Rome, Italy
| | - A Patrikidou
- Medical Oncology, Sarah Cannon Research Institute UK, London, UK
| | - K K Shiu
- Department of Oncology, University College Hospital, 235 Euston Road, London, NW1 2BU, UK
| | - A Nardecchia
- Medical Oncology Unit, Tor Vergata University Hospital, Viale Oxford 81, Rome, Italy
| | - J Lucchetti
- Medical Oncology Unit, Tor Vergata University Hospital, Viale Oxford 81, Rome, Italy
| | - M Roselli
- Medical Oncology Unit, Tor Vergata University Hospital, Viale Oxford 81, Rome, Italy
| | - H T Arkenau
- Medical Oncology, Sarah Cannon Research Institute UK, London, UK
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Formica V, Morelli C, Patrikidou A, Shiu KK, Roselli M, Arkenau HT. Lymph node-only metastatic gastric/gastroesophageal junction cancer and efficacy of immunotherapy. Gastric Cancer 2020; 23:1107-1108. [PMID: 32424650 DOI: 10.1007/s10120-020-01084-2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 05/06/2020] [Indexed: 02/07/2023]
Affiliation(s)
- V Formica
- Medical Oncology Unit and PhD program in Systems and Experimental Medicine (XXXV cycle), Tor Vergata University Hospital, Viale Oxford, 81, 00133, Rome, Italy.
| | - C Morelli
- Medical Oncology Unit and PhD program in Systems and Experimental Medicine (XXXV cycle), Tor Vergata University Hospital, Viale Oxford, 81, 00133, Rome, Italy
| | - A Patrikidou
- Drug Development Unit, Sarah Cannon Research Institute UK, London, UK.,Department of Oncology, University College Hospital, 235 Euston Road, London, NW1 2BU, UK
| | - K K Shiu
- Department of Oncology, University College Hospital, 235 Euston Road, London, NW1 2BU, UK
| | - M Roselli
- Medical Oncology Unit and PhD program in Systems and Experimental Medicine (XXXV cycle), Tor Vergata University Hospital, Viale Oxford, 81, 00133, Rome, Italy
| | - H T Arkenau
- Drug Development Unit, Sarah Cannon Research Institute UK, London, UK.,Department of Oncology, University College Hospital, 235 Euston Road, London, NW1 2BU, UK
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Formica V, Morelli C, Riondino S, Renzi N, Nitti D, Roselli M. Artificial intelligence for the study of colorectal cancer tissue slides. Artif Intell Gastroenterol 2020; 1:51-59. [DOI: 10.35712/aig.v1.i3.51] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 09/25/2020] [Accepted: 09/27/2020] [Indexed: 02/06/2023] Open
Abstract
Artificial intelligence (AI) is gaining incredible momentum as a companion diagnostic in a number of fields in oncology. In the present mini-review, we summarize the main uses and findings of AI applied to the analysis of digital histopathological images of slides from colorectal cancer (CRC) patients. Machine learning tools have been developed to automatically and objectively recognize specific CRC subtypes, such as those with microsatellite instability and high lymphocyte infiltration that would optimally respond to specific therapies. Also, AI-based classification in distinct prognostic groups with no studies of the basic biological features of the tumor have been attempted in a methodological approach that we called “biology-agnostic”.
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Affiliation(s)
- Vincenzo Formica
- Department of Systems Medicine, Medical Oncology Unit, Tor Vergata University Hospital, Rome 00133, Italy
| | - Cristina Morelli
- Department of Systems Medicine, Medical Oncology Unit, Tor Vergata University Hospital, Rome 00133, Italy
| | - Silvia Riondino
- Department of Systems Medicine, Medical Oncology Unit, Tor Vergata University Hospital, Rome 00133, Italy
| | - Nicola Renzi
- Department of Systems Medicine, Medical Oncology Unit, Tor Vergata University Hospital, Rome 00133, Italy
| | - Daniele Nitti
- Department of Systems Medicine, Medical Oncology Unit, Tor Vergata University Hospital, Rome 00133, Italy
| | - Mario Roselli
- Department of Systems Medicine, Medical Oncology Unit, Tor Vergata University Hospital, Rome 00133, Italy
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Lonardi S, Pietrantonio F, Prete A, Messina M, Formica V, Corsi D, Cortesi E, Frassineti L, Zampino M, Ronzoni M, Scartozzi M, Casagrande M, Conca V, Bergamo F, Prisciandaro M, Intini R, Antista M, Paola D, Vettore V, Zagonel V. 402MO Final results of the CARACAS study: Randomized phase II trial of avelumab alone or with cetuximab for unresectable, locally advanced or metastatic squamous cell anal carcinoma progressed to at least one line of treatment. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.513] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Morelli C, Formica V, Patrikidou A, Murias C, Butt SUR, Lucchetti J, Renzi N, Nitti D, Shiu KK, Roselli M, Arkenau T. 1476P NUTRitional Index for immune-checkpoint inhibitors (ICI) (NUTRICI) for patients (pts) with metastatic gastro-oesophageal junction (GOJ)/gastric cancer (GC). Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.1982] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Vivaldi C, Salani F, Rovesti G, Pecora I, Catanese S, Casadei-Gardini A, Massa V, Bernardini L, Riggi L, Andrikou K, Rapposelli GI, Formica V, Lencioni M, Falcone A, Vasile E, Fornaro L. First-line gemcitabine plus nab-paclitaxel for elderly patients with metastatic pancreatic cancer: Crossing the frontier of age? Eur J Cancer 2020; 137:108-116. [PMID: 32750500 DOI: 10.1016/j.ejca.2020.06.031] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 06/12/2020] [Accepted: 06/26/2020] [Indexed: 01/05/2023]
Abstract
BACKGROUND Gemcitabine plus nab-paclitaxel (Gem-Nab) represents a standard first-line treatment for metastatic pancreatic cancer (mPC), but few data are available for elderly patients. We aimed to add evidence about safety and efficacy of Gem-Nab in this population. METHODS We collected data of 156 patients with mPC aged ≥65 years receiving Gem-Nab. Patients were stratified according to age: <70 (group 1: 65 patients) and ≥70 years (group 2: 91 patients). RESULTS The median age was 71 years (range: 65-87 years). The toxicity profile was similar between group 1 and 2, except for all-grade anaemia (92.1% vs. 78.7%, respectively; p = 0.04) and neurotoxicity (61.9% vs. 40.4%, respectively; p = 0.02), also as a result of a lower dose intensity of nab-paclitaxel (83.3% vs. 90.5%, respectively; p = 0.04) administered to oldest patients. The response rate was 25.6% (group 1 vs. 2: 20.0% vs. 29.7%; p = 0.12). After a median follow-up of 26.5 months, median overall survival (OS) and progression-free survival (PFS) were similar between the groups (p > 0.05). The starting dose of Gem-Nab did not affect PFS and OS (p > 0.05). CONCLUSION Gem-Nab is active and effective in older patients with mPC, with the results in line with the general mPC population enrolled in clinical trials. Mild dose modifications for elderly patients might be considered to improve safety without impairing efficacy.
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Affiliation(s)
- Caterina Vivaldi
- Unit of Medical Oncology, Azienda Ospedaliero-Universitaria Pisana, Via Roma 67, Pisa, 56126, Italy; Department of Translational Research and New Surgical and Medical Technologies, University of Pisa, Via Savi 6, Pisa, 56126, Italy
| | - Francesca Salani
- Unit of Medical Oncology, Azienda Ospedaliero-Universitaria Pisana, Via Roma 67, Pisa, 56126, Italy
| | - Giulia Rovesti
- Department of Oncology and Hematology, Division of Oncology, University of Modena and Reggio Emilia, Via del Pozzo 71, Modena, 41100, Italy
| | - Irene Pecora
- Unit of Medical Oncology, Azienda Ospedaliero-Universitaria Pisana, Via Roma 67, Pisa, 56126, Italy
| | - Silvia Catanese
- Unit of Medical Oncology, Azienda Ospedaliero-Universitaria Pisana, Via Roma 67, Pisa, 56126, Italy
| | - Andrea Casadei-Gardini
- Department of Medical Oncology, Istituto Scientifico Romagnolo per Lo Studio e La Cura Dei Tumori (IRST) IRCCS, Via P. Maroncelli N. 40, Meldola, 47014, Italy
| | - Valentina Massa
- Unit of Medical Oncology, Azienda Ospedaliero-Universitaria Pisana, Via Roma 67, Pisa, 56126, Italy
| | - Laura Bernardini
- Unit of Medical Oncology, Azienda Ospedaliero-Universitaria Pisana, Via Roma 67, Pisa, 56126, Italy
| | - Laura Riggi
- Department of Oncology and Hematology, Division of Oncology, University of Modena and Reggio Emilia, Via del Pozzo 71, Modena, 41100, Italy
| | - Kalliopi Andrikou
- Department of Oncology and Hematology, Division of Oncology, University of Modena and Reggio Emilia, Via del Pozzo 71, Modena, 41100, Italy
| | - Giovanni I Rapposelli
- Department of Medical Oncology, Istituto Scientifico Romagnolo per Lo Studio e La Cura Dei Tumori (IRST) IRCCS, Via P. Maroncelli N. 40, Meldola, 47014, Italy
| | - Vincenzo Formica
- Medical Oncology Unit, Tor Vergata University, Viale Oxford 81, Rome, 00133, Italy
| | - Monica Lencioni
- Unit of Medical Oncology, Azienda Ospedaliero-Universitaria Pisana, Via Roma 67, Pisa, 56126, Italy
| | - Alfredo Falcone
- Unit of Medical Oncology, Azienda Ospedaliero-Universitaria Pisana, Via Roma 67, Pisa, 56126, Italy; Department of Translational Research and New Surgical and Medical Technologies, University of Pisa, Via Savi 6, Pisa, 56126, Italy
| | - Enrico Vasile
- Unit of Medical Oncology, Azienda Ospedaliero-Universitaria Pisana, Via Roma 67, Pisa, 56126, Italy
| | - Lorenzo Fornaro
- Unit of Medical Oncology, Azienda Ospedaliero-Universitaria Pisana, Via Roma 67, Pisa, 56126, Italy.
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Formica V, Minieri M, Bernardini S, Ciotti M, D'Agostini C, Roselli M, Andreoni M, Morelli C, Parisi G, Federici M, Paganelli C, Legramante JM. Complete blood count might help to identify subjects with high probability of testing positive to SARS-CoV-2. Clin Med (Lond) 2020; 20:e114-e119. [PMID: 32620590 DOI: 10.7861/clinmed.2020-0373] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The SARS-CoV-2 pandemic has dramatically increased the workload for health systems and a consequent need to optimise resources has arisen, including the selection of patients for swab tests. We retrospectively reviewed consecutive patients presenting to the emergency department with symptoms suggestive of COVID-19 and undergoing swab tests for SARS-CoV-2. Complete blood counts (CBCs) were analysed looking for predictors of test positivity. Eight significant predictors were identified and used to build a 'complete' CBC score with a discriminatory power for COVID-19 diagnosis of AUC 92% (p<0.0001). When looking at the weight of individual variables, mean corpuscular volume (MCV), age, platelets and eosinophils (MAPE: MCV ≤90 fL, 65 points; age ≥45 years, 100 points; platelets ≤180×103/μL, 73 points; eosinophils <0.01/μL, 94 points) gave the highest contribution and were used to build a 'simplified' MAPE score with a discriminatory power of AUC 88%. By setting the cut-off MAPE score at ≥173 points, sensitivity and specificity for COVID-19 diagnosis were 83% and 82%, respectively, and the actual test positivity rate was 60% as compared to 6% of patients with MAPE score <173 points (odds ratio 23.04, 95% confidence interval [CI] 9.1-58.3, p-value <0.0001). In conclusion, CBC-based scores have potential for optimising the SARS-CoV-2 testing process: if these findings are confirmed in the future, swab tests may be waived for subjects with low score and uncertain symptoms, while they may be considered for asymptomatic or oligosymptomatic patients with high scores.
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Affiliation(s)
- Vincenzo Formica
- Medical Oncology Unit, Tor Vergata University Hospital, Rome, Italy
| | - Marilena Minieri
- Department of Experimental Medicine, Tor Vergata University Hospital, Rome, Italy
| | - Sergio Bernardini
- Department of Experimental Medicine, Tor Vergata University Hospital, Rome, Italy
| | - Marco Ciotti
- Virology Unit, Tor Vergata University Hospital, Rome, Italy
| | | | - Mario Roselli
- Medical Oncology Unit, Tor Vergata University Hospital, Rome, Italy
| | - Massimo Andreoni
- Infectious Disease Unit, Tor Vergata University Hospital, Rome, Italy
| | - Cristina Morelli
- Medical Oncology Unit, Tor Vergata University Hospital, Rome, Italy
| | - Giusy Parisi
- Medical Oncology Unit, Tor Vergata University Hospital, Rome, Italy
| | - Massimo Federici
- Department of Systems medicine, Tor Vergata University Hospital, Rome, Italy
| | - Carla Paganelli
- Emergency Department, Tor Vergata University Hospital, Rome, Italy
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42
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Buccafusca G, Cappuccio F, Cordio S, Mare M, Bruera G, Colombo A, Formica V, Montesarchio V, Tonini G, Leo S, Antonuzzo L, Gemma D, Biglietto M, Giuseppina B, Carlomagno C, Tralongo P. P-66 Treatment with FOLFIRI-aflibercept in an elderly population (over 75 and octogenarians) with metastatic colorectal cancer after failure of an oxaliplatin-based regimen: Experience in a real-life population. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.04.148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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43
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Pecora I, Vivaldi C, Rovesti G, Catanese S, Salani F, Gardini AC, Massa V, Bernardini L, Riggi M, Andrikou K, Rapposelli I, Formica V, Cesario S, Caccese M, Lencioni M, Vasile E, Falcone A, Fornaro L. P-188 Safety and efficacy of first-line gemcitabine plus nab-paclitaxel for elderly metastatic pancreatic cancer patients. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.04.270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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44
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Lonardi S, Schirripa M, Buggin F, Antonuzzo L, Merelli B, Boscolo G, Cinieri S, Di Donato S, Lobefaro R, Moretto R, Formica V, Passardi A, Ricci V, Pella N, Scartozzi M, Zustovich F, Zagonel V, Fassan M, Boni L, Loupakis F. First-line FOLFOX plus panitumumab versus 5FU plus panitumumab in RAS-BRAF wild-type metastatic colorectal cancer elderly patients: The PANDA study. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.4002] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [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
4002 Background: Data on first-line treatment efficacy in elderly patients are limited. Many analyses adopt a questionable cut-off of 65 years and specific evidence with anti-EGFRs is low. FOLFOX-panitumumab (pan) is an option for RAS wild-type (wt) untreated mCRC patients. Guidelines recommend considering fluoropyrimidine monotherapy as an option for elderly patients, but no randomized studies have ever explored the role of the combination with an anti-EGFR. Methods: This is a prospective, open-label, multicenter phase II randomized trial. Unresectable and previously untreated RAS- BRAF wt mCRC patients aged ≥70 were randomized to receive FOLFOX-pan (arm A), or 5FU/LV-pan (arm B) for up to 12 cycles followed by pan maintenance until PD. The primary EP was PFS in both arms. Stratification criteria were age (≤75 vs > 75 years), ECOG PS (0–1 vs 2) and geriatric assessment with G8 Score (≤14 vs > 14). In each treatment arm, the null hypothesis for median PFS was set at ≤6 months. Assuming an expected median PFS time ≥9.5 months with both experimental regimens, a sample size of 90 patients in each arm granted to the study a power of 90%, with a type I error rate equal to 5% (1-sided Brookmeyer-Crowley test) for rejecting the null hypothesis. No formal comparison between the two arms was planned. Results: From Jul 2016 to Apr 2019 a total of 394 patients were screened, 211 were deemed eligible for inclusion and 185 were randomized (92 arm A and 93 arm B). Main pts’ characteristics were (arm A/B): males 66%/61%; median age 77/77y; PS≥1 49%/55%; right colon 23%/21%; G8 > 14 31%/30%. At a median follow up of 20.5 mos, 135 (arm A/B: 64/71) PD events were collected. Median PFS was 9.6 (95% CI 8.8-10.9) in arm A with FOLFOX-pan and 9.1 (95% CI 7.7-9.9) in arm B with 5FU/LV-pan. Response rates were (arm A/B): 65%/57%. Grade 3-4 toxicities were (arm A/B): neutropenia 9.8%/1.1%; diarrhea 16.3%/1.1%; stomatitis 9.8%/4.4%; neurotoxicity 3.3%/0%; fatigue 6.5%/4.4%; skin rash 25%/24.2%, hypomagnesemia 3.3%/7.7%. Conclusions: Large prospective randomized studies in molecularly selected elderly mCRC are feasible with multicenter collaborative efforts. Primary EP was met in both treatment arms. 5FU/LV plus panitumumab for up to 12 cycles followed by panitumumab maintenance until PD might be a reasonable option in elderly mCRC patients with RAS/BRAF wt tumors deserving further investigations in phase III trials. Clinical trial information: NCT02904031 .
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Affiliation(s)
- Sara Lonardi
- Veneto Institute of Oncology (IOV)-IRCCS, Padua, Italy
| | - Marta Schirripa
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Federica Buggin
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Lorenzo Antonuzzo
- Medical Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | | | - Giorgia Boscolo
- Medical Specialties Department, Oncology and Oncologic Hematology, ULSS 3 Serenissima, Milan, Italy
| | - Saverio Cinieri
- Department of Oncology, Medical Oncology, "Antonio Perrino" Hospital, Brindisi, Italy
| | | | - Riccardo Lobefaro
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Roberto Moretto
- Department of Translational Research and New Technologies in Medicine and Surgery, Unit of Medical Oncology 2, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | | | - Alessandro Passardi
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Vincenzo Ricci
- Medical Oncology, A.O. S. Croce and Carle Teaching Hospital, Cuneo, Italy
| | - Nicoletta Pella
- Department of Oncology - ASUI Udine University Hospital, Udine, Italy
| | - Mario Scartozzi
- Medical Oncology Department, University Hospital, University of Cagliari, Cagliari, Italy
| | | | - Vittorina Zagonel
- Oncologia Medica 1, Istituto Oncologico Veneto IRCCS Padova, Padua, Italy
| | - Matteo Fassan
- Department of Medicine (DIMED), Pathology Unit, University of Padua, Padua, Italy
| | - Luca Boni
- Clinical Trial Coordinating Center, AOU Careggi, Florence, Italy
| | - Fotios Loupakis
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
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Giommoni E, De Vita F, Pecora I, Iachetta F, Strippoli A, Satolli MA, Spallanzani A, Puzzoni M, Nappo F, Sisani M, Formica V, Giovanardi F, Pozzo C, Prisciandaro M, Di Donato S, Pompella L, Salani F, Tirino G, Lavacchi D, Antonuzzo L. Perioperative FLOT in elderly patients with resectable gastric cancer: Subgroup analysis from the observational RealFLOT study. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.4548] [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
4548 Background: The treatment strategy for patients with resectable gastric cancer changed in the last few years with perioperative treatments. FLOT regimen (fluorouracil, oxaliplatin, docetaxel) turned out to be feasible and effective, offering significant improvement in survival outcomes. However, the safety profile of triplet therapies for elderly patients deserves a special attention and, consequently, the best treatment strategy for these patients is still debated. Methods: Focusing on the elderly patient population (age ≥65 years), real-world data from patients with resectable gastric or gastro-oesophageal junction (GEJ) adenocarcinoma (T≥2 and/or N+) enrolled in the observational RealFLOT study were collected. Results: A total of 206 patients with resectable gastric or GEJ adenocarcinoma received perioperative FLOT at 15 Italian centers in routine clinical practice, between September 2016 and September 2019. The median age was 63 years (range 36-77) and 43% of patients enrolled (n = 89) were ≥65 years. Among elderly patients, 46 (52%) received FLOT for at least 4 full-dose cycles in the preoperative phase, 82 (92%) underwent surgery, and 56 (62%) started the postoperative phase. The primary end point of the study, pathological complete response (pCR) rate, was similar among patients aged ≥65 and < 65 (6.7% vs 7.7%, respectively). The distribution of pathological stages did not differ according to age (p = 0.473), and disease-free survival (DFS) is unrelated to the age of patients (log-rank 0.57; p = 0.89). The incidence of grade (G) 3-4 adverse events (AEs) was similar in the two age groups (Table) and the 30-day mortality rates after surgery did not differ according to age. Conclusions: FLOT regimen demonstrated to be feasible and safe in elderly patients since no differences were observed in terms of pCR, DFS and safety profile according to age. [Table: see text]
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Affiliation(s)
- Elisa Giommoni
- Medical Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Ferdinando De Vita
- Division of Medical Oncology, Department of Precision Medicine, University of Study of Campania "L. Vanvitelli", Naples, Italy
| | - Irene Pecora
- Medical Oncology, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Francesco Iachetta
- Medical Oncology Unit, Clinical Cancer Center, AUSL-IRCCS, Reggio Emilia, Italy
| | - Antonia Strippoli
- Medical Oncology, Fondazione Policlinico Universitario “A. Gemelli”, IRCCS, Rome, Italy
| | | | | | - Marco Puzzoni
- Medical Oncology Department, University Hospital, University of Cagliari, Cagliari, Italy
| | - Floriana Nappo
- Department of Clinical and Experimental Oncology, Medical Oncology 1 Unit, Istituto Oncologico Veneto IOV-IRCCS, Padua, Italy
| | | | | | - Filippo Giovanardi
- Medical Oncology, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Carmelo Pozzo
- Oncologia Medica, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli–IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Michele Prisciandaro
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Samantha Di Donato
- Medical Oncology Department, Nuovo Ospedale-Santo Stefano, Istituto Toscano Tumori, Prato, Italy
| | - Luca Pompella
- Division of Medical Oncology, Department of Precision Medicine, University of Study of Campania "L. Vanvitelli", Naples, Italy
| | - Francesca Salani
- Medical Oncology, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Giuseppe Tirino
- Division of Medical Oncology, Department of Precision Medicine, University of Study of Campania "L. Vanvitelli", Naples, Italy
| | - Daniele Lavacchi
- Medical Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Lorenzo Antonuzzo
- Medical Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
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Morelli C, Formica V, Patrikidou A, Murias C, Butt SUR, Nardecchia A, Lucchetti J, Renzi N, Shiu KK, Roselli M, Arkenau T. Gastric inflammatory prognostic index (GIPI) to predict efficacy of PD-1/PD-L1 immune checkpoint inhibitors in metastatic gastroesophageal junction (GOJ)/gastric cancer (GC) patients. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.4530] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4530 Background: ICIs demonstrated improved overall survival (OS) in heavily pre-treated mGOJ/GC pts. Pts selection exclusively based on PD-L1 tissue expression appears to be suboptimal, despite data from subgroup analyses of KEYNOTE trials. Strong rationale suggests a potential predictive role of inflammatory biomarkers in ICIs treated mGOJ/GC pts. Methods: Ten systemic inflammatory markers [platelets, monocytes, neutrophil/lymphocyte ratio (NLR), platelets-lymphocyte ratio, lymphocytes, sum of mononuclear cells, albumin, lactate dehydrogenase, c-reactive protein (CRP) and serum globulin] were retrospectively analyzed at baseline in 57 mGOJ/GC pts with unknown PD-L1 status treated in second-line with ICIs, and correlated with OS. Least Absolute Shrinkage and Selection Operator (LASSO) method was used to select variables (preliminarily subject to optimal coding using HR smoothed curves for OS) with the highest prognostic value. Selected variables were then analyzed in a multivariate Cox Regression Model and used to build a GIPI nomogram. Results: NLR and CRP taken as continuous variables and albumin categorized as < vs > 30 g/dL were found as the most meaningful independent predictors of OS and used to build the GIPI nomogram. Nomogram-based lowest (l), mid-low, mid-high and highest (h) risk quartiles were associated with median(m)OS of 14.9, 7.1, 5.6 and 2.1 months (mos), respectively [HR of l vs h 4.94, p 0.0002]. By optimally dichotomizing CRP and NLR, pts with one or more of the following risk factors: NLR >6, CRP >15 mg/L, albumin <30 g/dL (n: 29) had a mOS of 3.9 mos vs 14.2 mos of pts with no risk factor (n: 28) (HR 2.48, p 0.001). Conclusions: GIPI, combining NLR, CRP and Albumin, is the first inflammatory index with a significant prognostic value in mOGJ/GC pts receiving second-line ICIs. Its implementation in correlation with PD-L1 expression in the present cohort is ongoing. GIPI merits validation in independent cohorts and prospective clinical trials.
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Affiliation(s)
| | | | | | | | | | | | | | - Nicola Renzi
- Medical Oncology Unit - Tor Vergata University Hospital of Rome, Rome, Italy
| | - Kai-Keen Shiu
- University College London Hospital NHS Foundation Trust, London, United Kingdom
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Giommoni E, De Vita F, Pecora I, Iachetta F, Strippoli A, Satolli MA, Spallanzani A, Puzzoni M, Stragliotto S, Sisani M, Formica V, Giovanardi F, Pozzo C, Prisciandaro M, Di Donato S, Petrillo A, Catanese S, Tirino G, Lavacchi D, Antonuzzo L. Perioperative FLOT in resectable gastric cancer: Italian real-world data from the RealFLOT study. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.4_suppl.300] [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
300 Background: Perioperative treatments have significantly improved survival in patients with resectable gastric cancer, increasing 5-year overall survival from 23% with surgery alone to 45% with FLOT (fluorouracil, oxaliplatin, docetaxel). Pathological regression is a prognostic marker of better survival. Methods: In this observational, retro- and prospective study we collected data from patients with resectable gastric or gastro-oesophageal junction (GEJ) adenocarcinoma treated, as clinical practice, with perioperative FLOT. All patients had clinical T2 or higher and/or nodal involvement, according to FLOT4-AIO trial. Results: A total of 206 patients received perioperative chemotherapy with FLOT at 15 Italian centres, between September 2016 and September 2019. Overall, 186 (90.3%) patients completed the preoperative phase, 190 (92%) underwent surgery, and 142 (68.9%) started the postoperative phase. Among patients who started the postoperative phase, 105 (51.0%) received FLOT, while 37 (18%) received less intensive regimens (e.g. FOLFOX or De Gramont), depending on performance status after surgery or toxicity in the preoperative phase. Pathological complete response (pCR) was obtained in 7.3% of cases. In the preoperative phase, grade (G) 3-4 hematological and gastrointestinal adverse events (AEs) were reported in 42 (20.4%) and 13 (6.3%) patients, respectively. Conclusions: These real data confirmed the feasibility of perioperative FLOT in a less-selected population, representative of the clinical practice. The pCR rate was lower than in the FLOT4-AIO trial. The survival outcomes, potential predictive or prognostic factors and comprehensive safety data will be included in the final analysis. [Table: see text]
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Affiliation(s)
- Elisa Giommoni
- Medical Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Ferdinando De Vita
- Division of Medical Oncology, Department of Precision Medicine, University of Study of Campania "L. Vanvitelli", Naples, Italy
| | - Irene Pecora
- Medical Oncology, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Francesco Iachetta
- Medical Oncology Unit, Clinical Cancer Center, AUSL-IRCCS, Reggio Emilia, Italy
| | - Antonia Strippoli
- Medical Oncology, Fondazione Policlinico Universitario “A. Gemelli”, IRCCS, Rome, Italy
| | | | | | - Marco Puzzoni
- Medical Oncology Department, University Hospital, University of Cagliari, Cagliari, Italy
| | - Silvia Stragliotto
- Oncology Unit - Dipartimento di Oncologia Clinica e Sperimentale Istituto Oncologico Veneto IOV-IRCCS, Padua, Italy
| | | | - Vincenzo Formica
- Internal Medicine Department "Tor Vergata" University Hospital, Rome, Italy
| | - Filippo Giovanardi
- Medical Oncology, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Carmelo Pozzo
- Medical Oncology, Fondazione Policlinico Universitario “A. Gemelli”, IRCCS, Rome, Italy
| | - Michele Prisciandaro
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Samantha Di Donato
- Medical Oncology, Department Nuovo Ospedale-Santo Stefano Instituto Toscano Tumori, Prato, Italy
| | - Angelica Petrillo
- Division of Medical Oncology, Department of Precision Medicine, University of Study of Campania “L. Vanvitelli”, Naples, Italy
| | - Silvia Catanese
- Medical Oncology, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Giuseppe Tirino
- Division of Medical Oncology, Department of Precision Medicine, University of Study of Campania “L. Vanvitelli”, Naples, Italy
| | - Daniele Lavacchi
- Medical Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Lorenzo Antonuzzo
- Medical Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
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Morelli C, Formica V, Patrikidou A, Murrias C, Butt S, Nardecchia A, Lucchetti J, Renzi N, Iannantuono GM, Roselli M, Shiu KK, Arkenau T. Gastric Immune Prognostic Index (GIPI) in metastatic (m) gastro-oesophageal junction (GOJ)/gastric cancer (GC) patients (pts) treated with PD-1/PD-L1 immune checkpoint inhibitors (ICIs). J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.4_suppl.417] [Citation(s) in RCA: 2] [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: 11/20/2022] Open
Abstract
417 Background: ICIs demonstrated improved overall survival (OS) in heavily pre-treated mGOJ/GC pts. Pts selection exclusively based on PD-L1 tissue expression appears to be suboptimal, despite data from subgroup analyses of KEYNOTE trials. Strong rationale suggests a potential predictive role of inflammatory biomarkers in ICIs treated mGOJ/GC pts. Methods: 11 systemic inflammatory markers [platelets, monocytes, neutrophil/lymphocyte ratio (NLR), platelets-lymphocyte ratio, lymphocytes, sum of mononuclear cells, albumin, lactate dehydrogenase, alkaline phosphatase (ALP), c-reactive protein (CRP) and serum globulin] were retrospectively analyzed at baseline in 57 mGOJ/GC pts with unknown PD-L1 status treated in second-line with ICIs, and correlated with OS. Least Absolute Shrinkage and Selection Operator (LASSO) method was used to select variables (preliminarily subject to optimal coding using HR smoothed curves for OS) with the highest prognostic value.Selected variables were then analysed in a multivariate Cox Regression Model and used to build a GIPI nomogram. Results: NLR and CRP taken as continuous variables and ALP categorized as < vs > 150 IU/L were found as the most meaningful independent predictors of OS [(HR 1.30 (95%CI 1.02-1.65), 2.00 (95%CI 1.09-3.66), 2.82 (95%CI 1.29-6.20) and p values 0.04, 0.01, 0.02, respectively)] and used to build the GIPI nomogram. Nomogram-based lowest(l), mid and highest(h) risk tertiles were associated with median(m)OS of 14.5,10.6 and 2.4 months(mos), respectively [HR of l vs h 0.26 (95%CI 0.12-0.53), p 0.0002]. By optimally dichotomizing CRP and NLR, pts with one or more of the following risk factors: NLR > 6, CRP > 15 mg/L, ALP < 150 IU/L (n: 31) had a mOS of 3.9mos vs 14.5mos of pts with no risk factor (n: 26) (HR 2.72, p 0.0005). Conclusions: GIPI, combining NLR, CRP and ALP, is the first inflammatory index with a significant prognostic value in mOGJ/GC pts receiving second line ICIs. Its implementation with analysis of PD-L1 expression in the present cohort is ongoing. GIPI merits validation in external cohorts and prospective clinical trials.
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Affiliation(s)
| | - Vincenzo Formica
- Internal Medicine Department "Tor Vergata" University Hospital, Rome, Italy
| | | | | | - Sabeeh Butt
- Sarah Cannon Research Institute, London, United Kingdom
| | | | | | | | | | | | - Kai-Keen Shiu
- University College London Hospital NHS Foundation Trust, London, United Kingdom
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Sibio S, Di Giorgio A, D'Ugo S, Palmieri G, Cinelli L, Formica V, Sensi B, Bagaglini G, Di Carlo S, Bellato V, Sica GS. Histotype influences emergency presentation and prognosis in colon cancer surgery. Langenbecks Arch Surg 2019; 404:841-851. [PMID: 31760472 DOI: 10.1007/s00423-019-01826-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 11/27/2018] [Accepted: 09/13/2019] [Indexed: 02/06/2023]
Abstract
AIM To investigate whether differences in histotype in colon cancer correlate with clinical presentation and if they might influence oncological outcomes and survival. METHODS Data regarding colon cancer patients operated both electively or in emergency between 2009 and 2014 were retrospectively collected from a prospectively maintained database and analyzed for the purpose of this study. Rectal cancer was excluded from this analysis. Statistical univariate and multivariate analyses were performed to investigate possible significant variables influencing clinical presentation, as well as oncological outcomes and survival. RESULTS Data from 219 patients undergoing colorectal resection for cancer of the colon only were retrieved. One hundred seventy-four patients had an elective procedure and forty-five had an emergency colectomy. Emergency presentation was more likely to occur in mucinous (p < 0.05) and signet ring cell (p < 0.01) tumors. No definitive differences in 5-year overall (44.7% vs. 60.6%, p = 0.078) and disease-free (51.2% vs. 64.4%, p = 0.09) survival were found between the two groups as a whole, but the T3 emergency patients showed worse prognosis than the elective (p < 0.03). Lymph node invasion, laparoscopy, histology, and blood transfusions were independent variables found to influence survival. Distribution assessed for pTNM stage showed T3 cancers were more common in emergency (p < 0.01). CONCLUSIONS AND DISCUSSION Mucinous and signet ring cell tumors are related to emergency presentation, pT3 stage, poorest outcomes, and survival. Disease-free survival in patients who had emergency surgery for T3 colon cancer seems related to the histotype.
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Affiliation(s)
- Simone Sibio
- Department of Surgery "Pietro Valdoni", Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy. .,Department of Surgery "Pietro Valdoni", Sapienza University of Rome, Via Lancisi 2, 00155, Rome, Italy.
| | - A Di Giorgio
- Department of Surgery, Tor Vergata Hospital, Tor Vergata University of Rome, Viale Oxford 81, 00133, Rome, Italy
| | - S D'Ugo
- Department of Surgery, Tor Vergata Hospital, Tor Vergata University of Rome, Viale Oxford 81, 00133, Rome, Italy
| | - G Palmieri
- Department of Surgery, Tor Vergata Hospital, Tor Vergata University of Rome, Viale Oxford 81, 00133, Rome, Italy
| | - L Cinelli
- Department of Surgery, Tor Vergata Hospital, Tor Vergata University of Rome, Viale Oxford 81, 00133, Rome, Italy
| | - V Formica
- Department of Surgery, Tor Vergata Hospital, Tor Vergata University of Rome, Viale Oxford 81, 00133, Rome, Italy
| | - B Sensi
- Department of Surgery, Tor Vergata Hospital, Tor Vergata University of Rome, Viale Oxford 81, 00133, Rome, Italy
| | - G Bagaglini
- Department of Surgery, Tor Vergata Hospital, Tor Vergata University of Rome, Viale Oxford 81, 00133, Rome, Italy
| | - S Di Carlo
- Department of Surgery, Tor Vergata Hospital, Tor Vergata University of Rome, Viale Oxford 81, 00133, Rome, Italy
| | - V Bellato
- Department of Surgical Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - G S Sica
- Department of Surgery, Tor Vergata Hospital, Tor Vergata University of Rome, Viale Oxford 81, 00133, Rome, Italy
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Vivaldi C, Ugolini C, Orsi G, Formica V, Catanese S, Andrea C, Andrikou K, Doldo E, Pecora I, Campani D, Bonetti LR, Pasquini G, Salani F, Massa V, Niccoli C, Lencioni M, Vasile E, Gardini AC, Fornaro L, Fontanini G, Cascinu S, Falcone A. Characterization of mismatch repair deficiency in biliary tract cancer. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz155.278] [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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