Daniele Santini

Pharmacogenetic Profiling for Cetuximab Plus Irinotecan Therapy in Patients With Refractory Advanced Colorectal Cancer

PURPOSEnRegulation of epidermal growth factor receptor (EGFR) signaling pathways may play a relevant role in determining the activity of cetuximab therapy in patients with metastatic colorectal cancer (MCRC). We investigated possible associations between genetic variants and clinical outcomes of MCRC patients treated with cetuximab-irinotecan salvage therapy.nnnPATIENTS AND METHODSnPatients who underwent cetuximab-irinotecan salvage therapy after disease progression during or after first-line bolus/infusional fluorouracil, leucovorin, and oxaliplatin chemotherapy and a second-line irinotecan-based regimen were considered eligible for analysis of polymorphisms with putative influence on cetuximab-related pathways. Epidermal growth factor (EGF) 61A>G, EGF receptor (EGFR) 216G>T, EGFR 497G>A, EGFR intron-1 (CA)(n) dinucleotide short (S)/long (L) variant, cyclin-D1 870A>G, immunoglobulin-G fragment-C receptors RIIIa 158G>T, and RIIa 131G>A were studied for a possible association with overall survival (OS) as the primary end point. Additional analyses were addressed at possible associations among polymorphisms and EGFR expression, toxicity, and response.nnnRESULTSnIn 110 assessable patients, significant association with favorable OS was observed for EGFR intron-1 S/S and EGF 61 G/G genotypes. In the multivariate model, EGFR intron-1 S/S and EGF 61 G/G genotypes showed a hazard ratio of 0.41 (95% CI, 0.21 to 0.78; P = .006) and 0.44 (95% CI, 0.23 to 0.84; P = .01), respectively. EGFR intron-1 S/S carriers showed more frequent G2-G3 skin toxicity (chi(2) test = 12.7; P = .001) and treatment response (chi(2) test = 9.45; P = .008) than EGFR intron-1 L/L carriers.nnnCONCLUSIONnAlthough additional studies are required for confirmation, our findings could optimize the use of cetuximab in MCRC patients.

Genetic modulation of the Let-7 microRNA binding to KRAS 3′-untranslated region and survival of metastatic colorectal cancer patients treated with salvage cetuximab–irinotecan

There is increasing evidence that the Let-7 microRNA (miRNA) exerts an effect as a tumor suppressor by targeting the KRAS mRNA. The Let-7 complementary site (LCS6) T>G variant in the KRAS 3′-untranslated region weakens Let-7 binding. We analyzed whether the LCS6 variant may be clinically relevant to patients with metastatic colorectal cancer (MCRC) treated with anti-epidermal growth factor receptor (EGFR) therapy. LCS6 genotypes and KRAS/BRAF mutations were determined in the tumor DNA of 134 patients with MCRC who underwent salvage cetuximab–irinotecan therapy. There were 34 G-allele (T/G+G/G) carriers (25%) and 100 T/T genotype carriers (75%). G-allele carriers were significantly more frequent in the KRAS mutation group than in patients with KRAS wild type (P=0.004). In the 121 patients without BRAF V600E mutation, overall survival (OS) and progression-free survival (PFS) times were compared between carriers of the LCS6 G-allele genotypes and carriers of the wild-type T/T genotype. LCS6 G-allele carriers showed worse OS (P=0.001) and PFS (P=0.004) than T/T genotype carriers (confirmed in the multivariate model including the KRAS status). In the exploratory analysis of the 55 unresponsive patients with KRAS mutation, LCS6 G-allele carriers showed adverse OS and PFS times. These findings deserve additional investigations as they may open novel perspectives for the treatment of patients with MCRC.

Pharmacogenetic profiling in patients with advanced colorectal cancer treated with first-line FOLFIRI chemotherapy

The primary end point of the study was the analysis of associations between polymorphisms with putative influence on 5-fluorouracil/irinotecan activity and progression-free survival (PFS) of patients with advanced colorectal cancer treated with first-line FOLFIRI chemotherapy. Peripheral blood samples from 146 prospectively enrolled patients were used for genotyping polymorphisms in thymidylate synthase (TS), methylenetetrahydrofolate reductase (MTHFR), excision repair cross-complementation group-1 (ERCC 1) xeroderma pigmentosum group-D (XPD), X-ray cross-complementing-1 (XRCC 1), X-ray cross-complementing-3 (XRCC 3) and uridine diphosphate-glucuronosyltransferases-A1 (UGT1 A1). TS 3′-UTR 6+/6+ and XRCC3-241 C/C genotypes were associated with adverse PFS. Hazard ratio for PFS achieved 2.89 (95% confidence interval=1.56–5.80; P=0.002) in 30 patients (20%) with both risk genotypes. Risk for Grade III–IV neutropenia was significantly associated with UGT1A1*28 7/7 genotype. These promising findings deserve further investigations and their validation in independent prospective studies.

Variations in the interleukin-1 receptor antagonist gene impact on survival of patients with advanced colorectal cancer

The interleukin-1 receptor antagonist (IL-1RA) cytokine is thought to counteract tumor angiogenesis/metastasis. Two single nucleotide polymorphisms in the IL-1RA gene (rs4251961 T/C and rs579543 C/T) influence IL-1RA circulating levels with highest production in carriers of the homozygous rs4251961 T/T and rs579543 T/T genotypes. A total of 180 patients with metastatic colorectal cancer were categorized as high IL-1RA producers if they were carriers of at least one of the rs4251961 T/T or rs579543 T/T genotypes (T/T carriers). Median survival times were 35.8 months (95% confidence interval: 29.7–43.7 months) and 28.6 months (95% confidence interval: 25.6–30 months) in 56 T/T carriers and in 124 non-T/T carriers, respectively. The favorable association between T/T carriers’ status and survival was significant in the multivariate analysis (P=0.018). Also, T/T carriers and non-T/T carriers were prevalent among patients with Karnofsky performance status 90–100 and 70–80, respectively (P=0.002). These findings encourage additional studies in this field and the evaluation of a recombinant-IL-1RA for anticancer activity.

Heterogeneity of Breast Cancer: Gene Signatures and Beyond

The initial steps into a better understanding of the heterogeneity and biology of breast cancer were made at the onset of 2000, with the first identification of distinct molecular subtypes of human breast tumors possessing different outcome. Gene expression profiling and microarray analysis opened a road leading to the new molecular classification of breast cancer, recognizing at least five reproducible subtypes: luminal A, luminal B, ERBB2, basal, and normal-like. This revolutionary concept was triggered from an intense research driven by the evidence that 60–70% of all breast cancers are classified as “not otherwise specified” infiltrating ductal carcinomas (IDC NOS).

Complications in Surgical Management of Cervical Spinal Metastases

Bone is the third most frequent metastatic site. The vertebral column is the most common site for bone metastases, with an incidence of 30–70% in patients with stage IV cancer [1] . Among patients with cancer, in 12–20%, the initial clinical presentation is spinal column metastases [2] . Furthermore, metastases are the most frequent spinal column cancer in the United States, with approximately 18,000 new cases diagnosed annually. Multiple lesions at noncontiguous levels occur in 10–40% of the cases. Breast, lung, and prostate cancers have been the most common malignancies with secondary spine involvement [3] . These are followed by renal cancer, gastrointestinal cancer, thyroid cancer, sarcoma, and the lympophoreticular malignances: lymphoma and multiple myeloma. Metastases from prostate cancer, breast cancer, melanoma, and lung cancer commonly cause spinal metastases in 90.5, 74.3, 54.5, and 44.9% of patients, respectively.

Bone Metastases in Metastatic Renal Cell Carcinoma: Now We Know That Cabozantinib Targets Bone Microenvironment

The multiple tyrosine kinases inhibitor cabozantinib has shown improvements in progression-free survival (PFS), overall survival (OS) and objective response rate (ORR) in comparison to everolimus in patients with metastatic renal cell carcinoma (mRCC) in the METEOR trial, a phase III, randomized, open-label trial [1,2], leading to its approval in mRCC patients previously treated with antiangiogenic agents.

Cytokines Behavior in Multiple Myeloma Patients during Zoledronic Acid Treatment

Objective: Multiple Myeloma (MM) is characterized by uncoupling of bone resorption from bone formation which leads to the predominance of resorption. Bisphosphonates are chemical compounds that selectively concentrate at the interface of the active osteoclasts and the bone resorption surface where they inhibit osteoclast activity. Aim of this study was to describe cytokines behaviour in MM and to evaluate whether zoledronic acid could have an in vivo anti-angiogenic property in MM as observed in solid tumours.Methods: Serum samples from 29 (16 males and 13 females) consecutive MM patients with lytic bone lesions treated with 4 mg of zoledronic acid were tested for platelet derived growth factor (PDGF), vascular endothelial growth factor (VEGF), interleukin-6 (IL-6), tumor necrosis factor (TNF α) and insulin growth factor (IGF-I). Basal cytokine levels were compared with the values observed after 1, 2, 7 and 21 days of treatment, using the Wilcoxon’s test for nonparametric-dependent continuous variables.Results: A significant increase in IL-6 and TNF α was observed on days 1 and 2. As for VEGF, the levels of this cytokine did not change significantly from basal values during the entire period of observation except for a significant increase day 7 (P=0.0005). Moreover, PDGF significantly decreased (P=0.005) after 2 days from zoledronic acid infusion.Conclusions: From this study appears that in MM, treatment with zoledronic acid induces a transient reduction in PDGF according with previous studies in solid cancer, while the increase of IL-6 and VEGF could be related through a paracrine mechanism. The anti-myeloma effect of this drug could be driven through this mechanism.

Targeted Therapies for Bone Metastases

Cancer metastasis to the bone develops commonly in patients with various malignancies, and is a major cause of morbidity and diminished quality of life in many affected patients. Emerging treatments for metastatic bone disease have arisen from advances in our understanding of the unique cellular and molecular mechanisms that contribute to the bone metastases.

Systemic Therapy for Rare Tumours of the Skin and Soft Tissue Tumour

The role of systemic therapy in the management of soft tissue sarcoma and rare tumours of the skin is still extremely important. Even if the principal therapeutic approach in the localised disease is represented by surgery, in the metastatic setting, the role of surgery is still poorly defined, and a systemic approach becomes mandatory. Furthermore, the possible use of systemic therapies both in the adjuvant setting, with the aim of consolidating the results obtained through surgery, and in the neoadjuvant setting, in order to optimise the local control of the disease, has been recently assessed.