Andrea Sbrana

A case of a patient with severe renal failure on hemodialysis treated with vismodegib for relapsing basal cell carcinoma

Introduction: Basal cell carcinoma (BCC) is the most common skin cancer. Treatment options for metastatic or locally advanced BCC inappropriate for surgery or radiotherapy were poor until vismodegib was approved for use in this setting. This drug can be safely used in patients with mild to moderate renal impairment, but limited data are available for its use in case of severe kidney failure. We present the case of a patient with severe renal failure on hemodialysis treated with vismodegib. Case description: An 83-year-old patient with relapsing BCC of both auricles and severe renal failure on hemodialysis was treated with vismodegib for 7 months. The treatment proved to be effective with a striking reduction of the tumor masses. The patient was on therapy with vismodegib for 7 months and no severe adverse event was observed. Conclusion: Vismodegib could be used in patients with severe renal impairment, but these patients must be attentively followed and strict cooperation among healthcare professionals, such as nephrologists, dermatologists, and medical oncologists, is required.

The role of automated cytometry in the new era of cancer immunotherapy (Review)

The introduction in the clinical practice of several new approaches to cancer immunotherapy has greatly increased the interest in analytical methodologies that can define the immunological profile of patients in the clinical setting. This requires huge effort to obtain reliable monitoring tools that could be used to improve the patients clinical outcome. The clinical applications of flow cytometry (FCM) in oncology started with the measurement of DNA content for the evaluation of both ploidy and cell cycle profile as potential prognostic parameters in the majority of human solid cancer types. The availability of monoclonal antibodies widely broadened the spectrum of clinical applications of this technique, which rapidly became a fundamental tool for the diagnosis and prognosis of malignant hematological diseases. Among the emerging clinical applications of FCM, the study of minimal residual disease in hematological malignancies, the quantification of blood dendritic cells in various types of tumors, the study of metastatic spread in solid tumors throughout both the analysis of circulating endothelial progenitor cells and the identification and characterization of circulating tumor cells, all appear very promising. More recently, an advanced single cell analysis technique has been developed that combines the precision of mass spectrometry with the unique advantages of FCM. This approach, termed mass cytometry, utilizes antibodies conjugated to heavy metal ions for the analysis of cellular proteins by a mass spectrometer. It provides measurement of over 100 simultaneous cellular parameters in a single sample and has evolved from a promising technology to a high recognized platform for multi-dimensional single-cell analysis. Should a careful standardization of the analytical procedures be reached, both FCM and mass cytometry could effectively become ideal tools for the optimization of new immunotherapeutic approaches in cancer patients.

Pharmacogenetics of androgen signaling in prostate cancer: Focus on castration resistance and predictive biomarkers of response to treatment

Tumor heterogeneity strongly affects the molecular mechanisms driving resistance to hormonal therapies in castration-resistant prostate cancer. Since the current use of available treatments can be optimized on the basis of the molecular profile of tumor, the present review focuses on genetic biomarkers in prostate cancer and their application to a personalized treatment.

Long-term response to first-line pazopanib therapy in mRCC patients: A multicenter Italian experience

Background/Aim: The specific characteristics of patients who are most likely to benefit from pazopanib therapy are still uncertain. We report on the results of an Italian multicenter, retrospective analysis investigating the factors associated with longer response to first-line pazopanib in patients with metastatic renal cell carcinoma. Patients and Methods: Adult patients were considered if they had received treatment with pazopanib (800 mg/day) for >12 months in the first-line setting. Results: In total, 112 patients were evaluated. Median duration of pazopanib treatment was 22.6 months (IQR 17.8 months). Median PFS was 22.6 months (95%CI= 20.2-25.0). Eighty-three patients (74.1%) had a PFS ≥18 months. Median OS was 32.9 months (95%CI=30.2-35.6). At statistical analysis, only PS score (1+ vs. 0) was significantly associated with PFS (HR=1.76; 95%CI=1.02-3.05; p=0.04). Conclusion: Pazopanib therapy may be suitable for all patients with mRCC, and especially in those with PS 0.