Alice Lunghi

Sunitinib-induced hyperparathyroidism: a possible mechanism to altered bone homeostasis.

Sunitinib malate is an orally bioavailable tyrosine kinase inhibitor that is active against many tyrosine kinase receptors involving crucial pathways in both healthy tissues and malignant tissues. Because its use in clinical practice is quite recent, many of its possible side effects remain unknown. In this report, the authors describe the incidence of new‐onset hyperparathyroidism in a cohort of patients with metastatic renal cell carcinoma who received treatment with sunitinib.

Osteonecrosis of the jaw and angiogenesis inhibitors: a revival of a rare but serous side effect

Osteonecrosis of the jaw (ONJ) is a rare treatment related side effect that was firstly described in 2002 through a case report in metastatic bone cancer patient treated with bisphosphonates (BPs) therapy. ONJ is defined as an eight weeks or longer clinical finding of exposed bone in the oral cavity without response to appropriate therapy. The diagnosis is mainly clinical but often requires a radiological confirmation with an orthopantomography. So it must be made by a dental specialist with sufficient experience on ONJ and requires a detailed anamnestic exploration of comorbidities and treatments history. In particular, ONJ affects a wide number of oncologic patients treated with BPs for bone metastatic cancers and, more recently, with anti-angiogenic drugs. The aim of this this paper is to describe diagnosis and classification of this rare but serious side effect and its pathophysiology. In particular, we provide a detailed description of clinical evidences upon the relationship between anti-angiogenic drugs and ONJ. Considering the evolving of cancer epidemiology with a greater number of cancer surviving patients, this side effect always deserves more attention. We conclude that ONJ must be always carefully investigated and prevented with a multidisciplinary approach involving oncologist, radiation oncologist and skilled dental practitioner when a cancer patient must begin a BP or an antiangiogenic treatment.

First-line treatment of NSCLC with bevacizumab: real world data from an Italian regional based survey

Background: We aimed to explore the use of platinum plus bevacizumab in a real world NSCLC population. Patients and methods: We retrospectively collected data from patients affected by NS-NSCLC treated with platinum plus bevacizumab across Tuscany. Results: We evaluated 62 (median age: 63.5 [30–77] years) pts. All but one presented with adenocarcinoma and the majority had ECOG PS of 0/1. 17.7% presented with central lesion, 11.3% with brain metastasis, 38.7% with hypertension and 4.8% with mild haemoptysis. We observed a median time to progression (TTP) of 6.5 [2–37] and a median overall survival (OS) of 10.5 [2–39] months. Overall response rate (ORR) was 59.6% with a disease control rate (DCR) of 80.6%. Safety profile was acceptable. We observed five cardiovascular events and two major bleedings with no toxic deaths. Conclusion: Safety and efficacy real world data are consistent with those from clinical trials even in a less selected population.

A new proteomic test could guide treatment decision in second-line therapy for patients with EGFR unselected non-small cell lung cancer?

Nowadays non-small cell lung cancer (NSCLC) is the first cause of death for tumor worldwide. In the second line setting there are few results upon survival parameters from the various treatment options. European Society of Medical Oncology (ESMO) guidelines say that patients clinically or radiologically progressing after first-line chemotherapy, irrespective of administration of maintenance chemotherapy, and with an Eastern Cooperative Oncology Group (ECOG) Performance Status (PS) 0-2, should be offered second-line chemotherapy (1). In this setting, single agents chemotherapy improve disease-related symptoms and overall survival (OS) to nearly 6.7-8.3 months, with 30% of patients alive at 1 year (2,3). Comparable options in the second-line therapy consist of pemetrexed—for non-squamous histology only—or docetaxel. Erlotinib is an additional potential option in patients with PS 0-2 (1). Epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) are the standard treatment option for advanced NSCLC patients harboring EGFR-activating mutations.