G. Fasola
Misericordia University
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Featured researches published by G. Fasola.
British Journal of Cancer | 2015
Marta Schirripa; Francesca Bergamo; Chiara Cremolini; Mariaelena Casagrande; Sara Lonardi; Giuseppe Aprile; Dongyun Yang; Federica Marmorino; Giulia Pasquini; Elisa Sensi; Cristiana Lupi; G. De Maglio; Nicla Borrelli; Stefano Pizzolitto; G. Fasola; Roberta Bertorelle; Massimo Rugge; Gabriella Fontanini; Vittorina Zagonel; Fotios Loupakis; Alfredo Falcone
Background:Despite major advances in the management of metastatic colorectal cancer (mCRC) with liver-only involvement, relapse rates are high and reliable prognostic markers are needed.Methods:To assess the prognostic impact of BRAF and RAS mutations in a large series of liver-resected patients, medical records of 3024 mCRC patients were reviewed. Eligible cases undergoing potentially curative liver resection were selected. BRAF and RAS mutational status was tested on primary and/or metastases by means of pyrosequencing and mass spectrometry genotyping assay. Primary endpoint was relapse-free survival (RFS).Results:In the final study population (N=309) BRAF mutant, RAS mutant and all wild-type (wt) patients were 12(4%), 160(52%) and 137(44%), respectively. Median RFS was 5.7, 11.0 and 14.4 months respectively and differed significantly (Log-rank, P=0.043). At multivariate analyses, BRAF mutant had a higher risk of relapse in comparison to all wt (multivariate hazard ratio (HR)=2.31; 95% CI, 1.09–4.87; P=0.029) and to RAS mutant (multivariate HR=2.06; 95% CI, 1.02–4.14; P=0.044). Similar results were obtained in terms of overall survival. Compared with all wt patients, RAS mutant showed a higher risk of death (HR=1.47; 95% CI, 1.05–2.07; P=0.025), but such effect was lost at multivariate analyses.Conclusions:BRAF mutation is associated with an extremely poor median RFS after liver resection and with higher probability of relapse and death. Knowledge of BRAF mutational status may optimise clinical decision making in mCRC patients potentially candidate to hepatic surgery. RAS status as useful marker in this setting might require further studies.
Supportive Care in Cancer | 2013
Giuseppe Aprile; Federica Edith Pisa; A. Follador; Luisa Foltran; F. De Pauli; Micol Mazzer; Stefania Eufemia Lutrino; C. Sacco; Mauro Mansutti; G. Fasola
PurposeAs a result of the growing cancer incidence and the increasing trend towards chemotherapy treatment, a higher number of cancer outpatients ask for unplanned visits. This study aimed to describe the nature and magnitude of this phenomenon and to identify risk factors for repeated unplanned presentations and hospital admission.MethodsUnplanned consultations (2,811) of 1,431 cancer patients who accessed our acute oncology clinic over a 2-year period were reviewed. Demographics, clinical variables and reason(s) for presentation were all recorded. Recurrent event survival analysis was used to evaluate the relation of potential predictors to the two outcome events repeated presentations and hospitalization. A stratified Cox proportional hazard model was used.ResultsOf 1,431 patients, 625 (43xa0%) received chemotherapy during the 90xa0days before the unplanned visit. Pain (27.7xa0%), fatigue (17.6xa0%), dyspnoea (13.8xa0%), fever (11.5xa0%) and gastrointestinal problems (31xa0%) were reported frequently. The time interval since the last chemotherapy was significantly related to the rate of repeated presentation. Two hundred and nine patients (7xa0%) were hospitalized after an unplanned presentation. Number of symptoms and selected toxicities, along with distance from the hospital, were all predictors for hospitalization.ConclusionsThe management of unscheduled presentations of cancer outpatients is becoming crucial to avoid inappropriate selection for hospital admission and interferences with the ordinary work plan, improving quality of oncology services.
Journal of Thoracic Oncology | 2010
Francesco Grossi; Riccardo Spizzo; Domenico Bordo; Veronica Cacitti; Francesca Valent; Ciro Rossetto; A. Follador; Silvia Di Terlizzi; Marianna Aita; Angelo Morelli; G. Fasola; Clara Consiglieri; Tino Ceschia; Carlo A. Beltrami; Ornella Belvedere
Introduction: Stage IIIA non-small cell lung cancer (NSCLC) with ipsilateral mediastinal lymph node metastases (N2) is a heterogeneous disease with differing prognoses. In this study, we retrospectively investigated the prognostic value of the expression of 10 molecular markers in 87 patients with stage IIIA pN2 NSCLC treated with radical surgery. Methods: Primary tumor tissue microarrays (TMAs) were constructed and sections used for immunohistochemical analysis of epidermal growth factor receptor, ErbB-2, c-kit, cyclooxygenase-2, survivin, bcl-2, cyclin D1, cyclin B1, metalloproteinase (MMP)-2, and MMP-9. Univariate and multivariate analyses and unsupervised hierarchical clustering analysis of clinical pathologic and immunostaining data were performed. Results: Bcl-2 (p < 0.0001) and cyclin D1 (p = 0.015) were more highly expressed in squamous cell carcinoma (SCC), whereas MMP-2 (p = 0.009), MMP-9 (p = 0.005), and survivin (p = 0.032) had increased expression in other histologic subtypes. In univariate analysis, SCC histology and cyclin D1 expressions were favorable prognostic factors (p = 0.015 and p < 0.0001, respectively); by contrast, MMP-9 expression was associated with worse prognosis (p = 0.042). In multivariate analysis, cyclin D1 was the only positive prognostic factor (p < 0.0001). Unsupervised hierarchical clustering analysis of TMA immunostaining data identified five distinct clusters. They formed two subsets of patients with better (clusters 1 and 2) and worse (clusters 3, 4, and 5) prognoses, and median survival of 51 and 10 months, respectively (p < 0.0001). The better prognosis subset mainly comprised patients with SCC (80%). Conclusions: Hierarchical clustering of TMA immunostaining data using a limited set of markers identifies patients with stage IIIA pN2 NSCLC at high risk of recurrence, who may benefit from more aggressive treatment.
BMC Health Services Research | 2013
Marianna Aita; Ornella Belvedere; Elisa De Carlo; Laura Deroma; Federica De Pauli; L. Gurrieri; Angela Denaro; Loris Zanier; G. Fasola
BackgroundChemotherapy administration is a high-risk process. Aim of this study was to evaluate the frequency, type, preventability, as well as potential and actual severity of outpatient chemotherapy prescribing errors in an Oncology Department where electronic prescribing is used.MethodsUp to three electronic prescriptions per patient record were selected from the clinical records of consecutive patients who received cytotoxic chemotherapy between January 2007 and December 2008. Wrong prescriptions were classified as incomplete, incorrect or inappropriate. Error preventability was classified using a four-point scale. Severity was defined according to the Healthcare Failure Mode and Effect Analysis Severity Scale.ResultsEight hundred and thirty-five prescriptions were eligible. The overall error rate was 20%. Excluding systematic errors (i.e. errors due to an initially faulty implementation of chemotherapy protocols into computerized dictionaries) from the analysis, the error rate decreased to 8%. Incomplete prescriptions were the majority. Most errors were deemed definitely preventable. According to error presumptive potential for damage, 72% were classified as minor; only 3% had the potential to produce major or catastrophic injury. Sixty-eight percent were classified as near misses; adverse drug events had no or little effect on clinical outcome.ConclusionsChemotherapy prescribing errors may arise even using electronic prescribing. Although periodic audits may be useful to detect common errors and guide corrective actions, it is crucial to get the computerized physician order entry system and set-ups correct before implementation.
Journal of Thoracic Oncology | 2012
G. Fasola; Simona Rizzato; Valentina Merlo; Marianna Aita; Tino Ceschia; Francesco Giacomuzzi; Emilio Lugatti; Stefano Meduri; Angelo Morelli; Maurizio Rocco; Valeria Domenica Tozzi
Introduction: Integrated care pathways (ICPs) have been proposed as effective strategies for quality improvement. To date, limited data are available that detail the methodology to design an optimal care pathway for patients with non–small-cell lung cancer (NSCLC). The main aim of this study was to assess the quality of health care delivered to lung cancer patients referred to a hub university hospital. Methods: All professionals involved with the management of NSCLC patients, in cooperation with health care researchers, identified 11 quality indicators and associated benchmarks. These were used to estimate the quality and efficiency of health care delivered to a cohort of 175 NSCLC patients. Results: The gap between “desired” and “actual” performance has been measured by benchmarking current practice against key quality indicators. Diagnostic workup, multidisciplinary team care and medical treatment of advanced disease have emerged as areas of good performance. Conversely, the management of early-stage disease offers room for improvement, in terms of both accuracy of nodal staging and surgical timeliness. Conclusions: Analyzing the process of caring for NSCLC patients is feasible and offers room for improvement. Acquired knowledge may be shared with hospital administrators, guide the revision of ICPs, and enable the delivery of consistent, high-quality clinical standards.
European Journal of Cancer | 2011
Ornella Belvedere; A. Follador; Ciro Rossetto; Valentina Merlo; Carlotta Defferrari; Angela M. Sibau; Marianna Aita; Maria Giovanna Dal Bello; Stefano Meduri; Marica Gaiardo; G. Fasola; Francesco Grossi
INTRODUCTIONnTo date, no combination regimen has proven superior to single agent chemotherapy as a second-line treatment for non-small cell lung cancer (NSCLC).nnnMETHODSnThis multicenter, non-comparative randomised phase II trial evaluated the activity of docetaxel (75 mg/m(2) on day 1) with oxaliplatin (70 mg/m(2) on day 2) every 3 weeks in previously treated NSCLC patients; the reference arm was single-agent docetaxel (75 mg/m(2) on day 1 every 3 weeks). It was designed as a one-stage, three-outcome phase II trial; 21 evaluable patients were required in each arm. The primary end-point was response rate; secondary end-points were toxicity, progression free survival (PFS) and overall survival.nnnRESULTSnFifty patients were enrolled. Patient characteristics included male/female, 76/24%; median age 62 years; ECOG PS 0/1, 36/64%; previous platinum-based chemotherapy, 98%. Partial response was seen in 20% and 8%, stable disease in 52% and 32%, of patients treated with docetaxel/oxaliplatin and docetaxel, respectively. Main grade 3-4 toxicities were neutropenia 56% and 64%; febrile neutropenia 4% and 8%; diarrhoea 12% and 4% for docetaxel/oxaliplatin and docetaxel, respectively. Median PFS was 5.0 and 1.7 months, median survival 11.0 and 7.1 months, and 1-year survival 44% and 32% for docetaxel/oxaliplatin and docetaxel, respectively.nnnCONCLUSIONSnThe study met its pre-defined study end-point; docetaxel/oxaliplatin and more generally platinum-containing doublets warrant further evaluation as second-line therapy for patients with NSCLC.
Journal of Clinical Oncology | 2011
S. Rizzato; V. Merlo; Marianna Aita; A. Sibau; J. Menis; L. Gurrieri; E. Lugatti; M. Gaiardo; Stefano Meduri; F. Giacomuzzi; V. Tozzi; G. Fasola
e16573 Background: ICPs are structured multidisciplinary care plans for a specific clinical condition; they describe the tasks to be carried out together with their timing and sequence and the discipline involved in completing the task. They have been proposed as quality improvement strategies of both clinical and organizational aspects of patient-oriented care. Nowadays few data are available to detail existing ICPs for NSCLC pts and the methodology for designing an optimal care plan. Aim of this project was to review current clinical pathways in the care of NSCLC pts who were referred to the University Hospital of Udine, Italy.nnnMETHODSnA multidisciplinary focus group was established to: 1) map existing local care pathways for NSCLC pts; 2) review the literature and available guidelines to identify quality benchmarks and corresponding, specific indicators; 3) apply these indicators to assess the quality of existing ICPs; 4) recognize key areas for process improvement.nnnRESULTSnEleven quality indicators were identified. They consist in intermediate outputs of the care process and may assess both clinical, organizational and economical aspects of pts care. Indicators were used to survey the ICPs of 175 NSCLC pts who were referred to our Hospital in 2008; data for 6 representative indicators are shown below (Table).nnnCONCLUSIONSnBy means of a limited set of quality indicators, we were able to verify the adherence of routine clinical practice to clinical guidelines and to elicit some critical issues in the care of NSCLC pts. Results need to be shared and discussed with Hospital Managers, with the aim of guiding the redesign of ICPs and improving the clinical, organizational and economic efficiency of the care process. [Table: see text].
Journal of Clinical Oncology | 2010
Erika Rijavec; Ornella Belvedere; Marianna Aita; Ciro Rossetto; A. Follador; C. Sacco; Tino Ceschia; Paolo Pronzato; G. Fasola; Francesco Grossi
ASCO Meeting Abstracts | 2007
E. Zanon; Giuseppe Aprile; Francesco Tuniz; F. De Pauli; E. Iaiza; Nicoletta Pella; M. Saman; Miran Skrap; G. Fasola; Andrea Piga
Journal of Clinical Oncology | 2004
Francesco Grossi; Ornella Belvedere; Ciro Rossetto; A. Sibau; E. Vigevani; L. Recchia; C. Sacco; A. Iop; S. Tumolo; G. Fasola