Stefano Cascinu

Szent László Hospital, Budapest, Budapeŝto, Budapest, Hungary

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Publications (433)1941.93 Total impact

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    ABSTRACT: Evidences have shown that neutrophil-to-lymphocyte ratio (NLR) has a prognostic value in patients with cancer. We wanted to test the prognostic significance of NLR in prostatic cancer of patients who are candidate to radical prostatectomy. We have considered 731 patients. Complete demographic data including age, tumor stage, Gleason score, complete blood count and serum biochemical profile were collected. Pre-treatment percentage of neutrophils and NLR were considered, and correlated with patients data and recurrence free survival. 389 patients were evaluated, mean age 65 years, mean follow-up 51.5 months, mean recurrence free survival 51.3 months. Total neutrophil count does not correlate with biochemical recurrence and disease free survival. Patients with a value higher of 60% of neutrophils are more likely to have a recurrence. Patients with a total lymphocyte count <1,500 have a higher rate of relapse. NLR was not correlated with baseline total PSA, with Gleason score and with pathological stage; patients with a NLR >3 has a higher incidence of recurrence. In multivariate analysis including age, total PSA and NLR, NLR is the most important factor able to predict recurrence. There are some limitations to this study; first, this is a retrospective study, and the total number of patients analyzed is relatively small. Our study suggests that pre-treatment NLR may be associated with disease free survival in patients with prostate cancer, and could be introduced in clinical practice. NLR has the advantage of low economic cost and wide availability.
    SpringerPlus 12/2015; 4(1):255. DOI:10.1186/s40064-015-1036-1
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    ABSTRACT: Several novel recurrent mutations of histone modifying and chromatin remodeling genes have been identified in renal cell carcinoma. These mutations cause loss of function of several genes located in close proximity to VHL and include PBRM1, BAP1 and SETD2. PBRM1 encodes for BAF180, a component of the SWI/SNF chromatin remodeling complex, and is inactivated in, on average, 36% of clear cell renal cell carcinoma (ccRCC). Mutations of BAP1 encode for the histone deubiquitinase BRCA1 associated protein-1, and are present in 10% of ccRCCs. They are largely mutually exclusive with PBRM1 mutations. Mutations to SETD2, a histone methyltransferase, occur in 10% of ccRCC. BAP1- or SETD2-mutated ccRCCs have been associated with poor overall survival, while PBRM1 mutations seem to identify a favorable group of ccRCC tumors. This review describes the roles of PBRM1, BAP1 and SETD2 in the development and progression of ccRCC and their potential for future personalized approaches.
    Expert Review of Molecular Diagnostics 07/2015; DOI:10.1586/14737159.2015.1068122 · 4.27 Impact Factor
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    ABSTRACT: Renal cell carcinoma (RCC) is a metabolic disease, being characterized by the dysregulation of metabolic pathways involved in oxygen sensing (VHL/HIF pathway alterations and the subsequent up-regulation of HIF-responsive genes such as VEGF, PDGF, EGF, and glucose transporters GLUT1 and GLUT4, which justify the RCC reliance on aerobic glycolysis), energy sensing (fumarate hydratase-deficient, succinate dehydrogenase-deficient RCC, mutations of HGF/MET pathway resulting in the metabolic Warburg shift marked by RCC increased dependence on aerobic glycolysis and the pentose phosphate shunt, augmented lipogenesis, and reduced AMPK and Krebs cycle activity) and/or nutrient sensing cascade (deregulation of AMPK-TSC1/2-mTOR and PI3K-Akt-mTOR pathways). We analyzed the key metabolic abnormalities underlying RCC carcinogenesis, highlighting those altered pathways that may represent potential targets for the development of more effective therapeutic strategies. Copyright © 2015 Elsevier Ltd. All rights reserved.
    Cancer Treatment Reviews 07/2015; DOI:10.1016/j.ctrv.2015.07.002 · 6.47 Impact Factor
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    ABSTRACT: ABSTRACT Aims: To evaluate potential differences at a molecular level between KRAS mutant tumors (MT) and KRAS wild-type (WT) pancreatic tumors and the biological and prognostic significance of different KRAS mutations. Expression of a panel of 29 genes was analyzed in KRAS WT and MT tumors. Effects of KRAS mutation and gene expression levels were assessed on patients' survival. MUC6 (p = 0.009), HGF (p = 0.011), VEGFR-2 (p = 0.020) and VEGFB (p = 0.026) were significantly more expressed and SMAD4 was less suppressed (p = 0.003) in WT KRAS. Contrariwise, SHH (p = 0.012) and IHH (p = 0.031) were more expressed in MT KRAS patients. No OS difference was found between WT and MT KRAS tumors. KRAS mutation status seems to identify two different subtypes of pancreatic ductal adenocarcinoma with similar outcome but distinct molecular features and probably different therapeutic targets.
    Future Oncology 07/2015; 11(13):1905-1917. DOI:10.2217/fon.15.98 · 2.61 Impact Factor
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    ABSTRACT: The American Society of Clinical Oncology (ASCO) Genitourinary Cancers Symposium, Rosen Shingle Creek, Orlando, FL, USA, 26-28 February 2015 The American Society of Clinical Oncology (ASCO) Genitourinary Cancers Symposium was held in Orlando (FL, USA), from 26 to 28 February 2015. This meeting was focused on 'Integrating Biology into patient-centric care' and represented an attractive opportunity for oncology professionals with a special interest in the diagnosis and treatment of genitourinary tumors. The identification and validation of biomarkers for tumor response had been the focus of several researchers at the symposium, together with the development of novel targeted agents. This report is a summary of the highlights on kidney and prostate tumors presented at the 2015 ASCO Genitourinary Cancers Symposium by various investigators.
    Future Oncology 07/2015; 11(13):1859-1862. DOI:10.2217/fon.15.103 · 2.61 Impact Factor
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    ABSTRACT: Cancer is a disease that has far-reaching consequences for patients and their families. The present study targets unmet caregiver needs so that better support can be provided and planned for. The first phase of the study was to conduct a survey designed to explore basic needs (medical and nursing information, psychological support, social welfare). The survey also investigated the caregiver's personal details (age, sex, degree of kinship). The survey was distributed to caregivers coming to the day hospitals of the 4 oncology departments involved in the study. A total of 137 relatives of cancer patients completed the survey. Among the explored needs, the most recurrent was the availability of a doctor who provides full information on the treatment choices. A further important request was for consistency between the information provided by doctors and that provided by other health-care workers, with specific reference to a patient-centered approach that can be easily and fully understood, available therapeutic options especially at home, and prognosis. The study showed that the need for exhaustive and simple information provided by a referral physician is still an unmet need in the Internet age.
    06/2015; DOI:10.5301/tj.5000362
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    ABSTRACT: HER family receptors play a key role in tumor progression in several malignancies, such as colorectal, lung or breast cancer. The aims of this study were to investigate expression of HER-1, HER-2 and HER-3 in pancreatic cancer (PC) samples and evaluate the association between HER-family receptor expression and patients' clinical outcomes. Tissue samples from 91 PC patients were subjected to immunohistochemical staining to assess the expression of HER-1, HER-2 and HER-3. Semiquantitative scores of zero (no staining or staining in less than 10% of cancer cells), 1+, 2+ or 3+ were assigned to each sample based on the intensity of staining for HER receptors. Scores of 2+ or 3+ were defined as positive staining. HER-1 overexpression was observed in 41 out of 91 samples (45.1%), while HER-2 was not overexpressed in any of the analyzed samples. HER-3 was overexpressed in 37 samples (40.7%) and was found to be associated with advanced TNM stage. In particular, HER-3 was overexpressed in 12 out of 16 stage IV patients (75%) compared with only 33.3% of stage I-III patients (p = 0.02). Among 79 patients with available survival data, the 6 patients with strong HER-3 expression (score 3+) had a shorter survival compared with remaining patients (median overall survival 6.9 months vs. 12.3 months, respectively). HER-1 and HER-3 were found to be expressed in a significant proportion of PC patients. Strong HER-3 expression represents an indicator of poor prognosis in PC patients, being associated with advanced stage and shorter survival.
    The International journal of biological markers 06/2015; DOI:10.5301/jbm.5000157 · 1.36 Impact Factor
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    ABSTRACT: Pruritus has been described with targeted therapies in cancer patients. We performed an up-to-date meta-analysis to determine the incidence and RR in patients with cancer treated with these agents. PubMed databases were searched for articles published till October 2014. Eligible studies were selected according to PRISMA statement. Summary incidence, RR, and 95% CIs were calculated using random-effects or fixed-effects models based on the heterogeneity of selected studies. A total of 4803 potentially relevant trials were identified; of them, 33 randomized phase III studies were included in this meta-analysis; 20,151 patients treated with 14 distinct targeted agents were available for this analysis; 8816 (44%) had Non-small cell lung cancer (NSCLC) and 12,257 had other malignancies. The highest incidences of all-grade pruritus were observed with panitumumab (56.8) and gefitinib (49.4), while the lowest incidences were reported by erlotinib (3.6) and sunitinib (5.8). In addition, the highest incidence of high-grade pruritus was reported by gefitinib (5.9). The summary RR of developing all-grade and high-grade pruritus with targeted agents vs. controls were 2.2 and 2.6, respectively. The highest RRs of all-grade pruritus were associated with panitumumab (25.6) and ipilimumab (4.5). Grouping by drug category, the RR of all-grade pruritus with anti-EGFR mAbs was 2.84 (95% CI 2.39 to 3.37) compared to anti-EGFR/HER2 TKIs and 1.24 (95% CI 1.03 to 1.49) to immunotherapy. Treatment with biological therapy in cancer patients is associated with a significant increase in the risk of pruritus, and frequent clinical monitoring of pruritus should be emphasized when managing these and newer targeted agents. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
    Critical reviews in oncology/hematology 06/2015; DOI:10.1016/j.critrevonc.2015.05.007 · 4.05 Impact Factor
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    ABSTRACT: Data on TMPRSS2-ERG and AR-V7 may pave the way for personalised therapy for prostate cancer (PCa) patients. Comprehensive molecular profiling can help identify multiple PCa subtypes and driving alterations. Translating these findings into clinical practice is still challenging. Copyright © 2015 European Association of Urology. Published by Elsevier B.V. All rights reserved.
    European Urology 06/2015; DOI:10.1016/j.eururo.2015.05.041 · 12.48 Impact Factor
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    ABSTRACT: Although epidermal growth factor receptor (EGFR) inhibitors have progressively become a relevant therapeutic arm in the treatment of patients with advanced colorectal cancer, the responses achieved are not durable and resistance invariably occurs. The advances in sequencing technology have allowed not only a more profound molecular tumor characterization but also the identification of the different molecular pathways involved in drug resistance and disease progression. These biological improvements have encouraged researchers to design clinical studies testing novel target therapies. Areas covered: After discussing the results of key Phase III randomized trials and providing commentary on the most promising novel agents (Sym004, MM-151, GA201 and MEHD7945A), the authors present the future steps ahead toward a real tailored treatment. Expert opinion: EGFR inhibitors are highly effective in the advanced disease setting. Although the negative predictive role of RAS and possibly BRAF mutations has already been established, more comprehensive efforts are needed to optimize the use of these drugs. At the same time, understanding the underlying biology will help basic scientists to develop new compounds able to overcome both primary and acquired resistance and help clinical researchers to test novel drugs within adequately designed trials whose results eventually are expected to reshape the overall treatment strategy.
    Expert Opinion on Investigational Drugs 06/2015; DOI:10.1517/13543784.2015.1054479 · 5.43 Impact Factor
  • Pancreatology 06/2015; 15(3):S89. DOI:10.1016/j.pan.2015.05.327 · 2.50 Impact Factor
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    ABSTRACT: Previous studies suggested that the incidental use of β-blockers might influence clinical outcome in solid tumors. We assessed the correlation between the incidental use of β-blockers and clinical outcome in colorectal cancer patients treated with first-line chemotherapy alone or in combination with bevacizumab in metastatic colorectal cancer patients.We collected data from 235 metastatic colorectal cancer patients treated with first-line chemotherapy alone (128 patients) or with bevacizumab (107 patients). Patients were stratified for clinical factors such as β-blockers use, age, sex, and site of metastases, previous adjuvant chemotherapy and ECOG performance status.In the chemotherapy alone group patients receiving β-blockers showed an improved overall survival (median OS 41.3 vs 25.7 months, P = 0.03, HR: 2.26, 95% CI: 1.05-3.24). A significant relationship with improved response rate was also evident for B-blocker users (P = 0.044).On the contrary in the β-blockers users group treated with chemotherapy in combination with bevacizumab we observed a trend toward a worse overall survival although nonstatistically significant (median OS 18.5 vs 23.6 months, HR: 0. 89, 95% CI: 0.38-2.03, P = 0.77).Our analysis confirmed a potential prognostic role for the use of β-blockers in colorectal cancer patients treated with chemotherapy. Our findings also suggest a potential worse outcome for patients on β-blockers receiving bevacizumab. Future prospective studies should include the incidental use of β-blockers as stratification factor for clinical outcome.
    Medicine 06/2015; 94(24):e719. DOI:10.1097/MD.0000000000000719 · 4.87 Impact Factor
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    ABSTRACT: Background: ASPECCT met its primary endpoint of non-inferiority of overall survival (OS) of pmab vs cmab. We evaluate outcomes by hypomag, an on-treatment, anti-EGFR related adverse event that develops due to the inhibition of EGFR function. Conflicting reports have suggested hypomag is associated with survival. Methods: Patients (pts) with previously treated WT KRAS exon 2 mCRC were randomized 1:1 to receive pmab or cmab. The primary endpoint was non-inferiority of OS. Progression-free survival (PFS) and objective response rate (ORR) were secondary endpoints. Pts were categorized ± any grade hypomag during the study and data from the primary analysis was evaluated by treatment arm. Analysis of Mg supplementation during hypomag was not conducted. Results: 999 pts were randomized and treated: 499 pmab, 500 cmab. Any grade hypomag was 28.8% and grade ≥3 was 7.3% in the pmab arm vs 18.9% and 2.6% in the cmab arm, respectively. Median time to first hypomag onset was 82 days in the pmab arm and 57 days in the cmab arm. In the pmab arm, 1.0% of pts discontinued treatment and 5% of pts had dose modifications due to hypomag vs <0.5% and 3% in the cmab arm, respectively. Results are shown (Table). Conclusions: In ASPECCT, rates of hypomag were higher in the pmab vs the cmab arm. Pts who developed any grade hypomag with pmab or cmab had higher ORR, PFS, and OS compared with those pts who did not. Clinical trial information: NCT01001377 Pmab Arm Hypomag – Yes (n = 143) Hypomag – No (n = 353) HR (95% CI) Median OS - mos (95% CI) 13.8 (11.6 – 15.5) 8.7 (8.1 – 9.8) 0.61 (0.48 – 0.77) Median PFS - mos (95% CI) 6.7 (5.2 – 6.8) 3.0 (2.8 – 3.1) 0.46 (0.37 – 0.56) ORRa - % (95% CI) 34.5 (26.7 – 42.9) 16.9 (13.1 – 21.2) Odds Ratio (95% CI) 2.71 (1.67 – 4.34) Median duration of treatment - wks (range) 28.0 (6.3 – 88.0) 11.7 (2.0 – 130.0) Cmab Arm Hypomag – Yes (n = 95) Hypomag – No (n = 408) HR(95% CI) Median OS - mos (95% CI) 12.5 (10.0 – 14.8) 9.4 (8.3 – 10.5) 0.70 (0.55 – 0.91) Median PFS - mos (95% CI) 6.6 (5.0 – 6.8) 3.2 (3.0 – 4.0) 0.53 (0.42 – 0.68) ORRa - % (95% CI) 28.0 (19.1 – 38.2) 17.9 (14.2 – 22.0) Odds Ratio (95% CI) 1.81 (1.02 – 3.15) Median duration of treatment - wks (range) 27.0 (4.0 – 94.3) 14.0 (1.0 – 69.9) aEvaluable pts per modified RECIST.
    ASCO 2015, Chicago; 05/2015
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    ABSTRACT: The combination chemotherapies with methotrexate plus vinblastine, doxorubicin and cisplatin (MVAC or CMV regimens) or gemcitabine plus cisplatin represent the standard as first-line therapy for patients with metastatic urothelial cancer. In Europe, vinflunine is an option for second-line therapy for patients progressed during first-line or perioperative platinum-containing regimen. Alternative regimens containing taxanes and/or gemcitabine may be valuated case by case. Furthermore, carboplatin should be considered in patients unfit for cisplatin both in the first and second-line setting. Based on these findings, a better comprehension of the mechanisms underlying the development of drug resistance in patients with bladder cancer will represent a major step forward in optimizing patients' outcome. This article reviews the current knowledge of the mechanisms and emerging strategies to overcome resistance in patients with advanced urothelial cancer. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
    Critical Reviews in Oncology/Hematology 05/2015; DOI:10.1016/j.critrevonc.2015.05.005 · 4.05 Impact Factor
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    ABSTRACT: Several clinical series have demonstrated a notably low overall survival for colorectal cancer patients diagnosed with a BRAF-mutant tumor. A potentially interesting predictive role has also been suggested for BRAF-mutant colorectal cancer receiving anti-EGFR monoclonal antibodies. Although a global consensus exists in indicating BRAF as a prognostic factor with a possible predictive activity, the clinical use of BRAF mutational status in colorectal tumors is still controversial. This article reviews the current knowledge on the use and implications of BRAF mutational status in colorectal tumors, in order to define its present role in the clinical practice. Also suggested are possible treatment strategies in this prognostically challenging group of patients. Finally, a comprehensive outlook on future developments for specifically directed anti-BRAF therapy is illustrated.
    Expert Review of Molecular Diagnostics 05/2015; DOI:10.1586/14737159.2015.1047346 · 4.27 Impact Factor
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    ABSTRACT: Non-clear cell renal cell carcinomas (nccRCCs) are a heterogeneous group of tumors, characterized by different histological features, molecular alterations, clinical outcomes, and responses to treatment. According to the 2004 WHO classification, 50 different histotypes were recognized. In 2013, five new distinct epithelial tumors and three provisional entities have been added to this classification, relying on morphology, immunohistochemistry, cytogenetics, and molecular pathology advances. Targeted therapies against VEGF and mTOR pathways have become the cornerstones of the treatment for clear cell RCC, dramatically revolutionizing the patients' prognosis. Interestingly, other than mTOR and VEGF pathways, tumor proliferation of some nccRCC histotypes seems to depend on alternative signaling pathways, as demonstrated by the close correlation between papillary RCC and activation of the HGF/MET axis. Currently, several strategies are under evaluation in patients with nccRCC. These approaches include TKIs and mTOR inhibitors, MET-pathway antagonists and immunotherapy. The aim of this review is to analyze the rationale for the use of TKIs and mTOR inhibitors as treatment options for nccRCC and to describe the future therapeutic perspectives for these patients. Copyright © 2015 Elsevier Ltd. All rights reserved.
    Cancer Treatment Reviews 05/2015; DOI:10.1016/j.ctrv.2015.05.006 · 6.47 Impact Factor
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    ABSTRACT: Background: The primary analysis of ASPECCT demonstrated that pmab was non-inferior to cmab for overall survival (OS) in chemorefractory WT KRASmCRC. Here, we report the final analysis of ASPECCT. Methods: In ASPECCT, patients (pts) had WT KRASmCRC, ECOG performance status (PS) ≤2, prior irinotecan, oxaliplatin, and fluorouracil treatment, and no prior anti-EGFR therapy. Pts were stratified by geographic region (North America/Western Europe/Australia vs rest of world) and ECOG PS (0-1 vs 2) and randomized 1:1 to receive pmab 6 mg/kg q2w or cmab 400 mg/m2 followed by 250 mg/m2 qw. The primary endpoint was OS assessed for non-inferiority (retention of ≥50% of the cmab effect vs best supportive care [BSC]; HR=0.55 [95% CI: 0.41 - 0.74] based on NCIC CTG C0.17). Secondary endpoints included progression-free survival (PFS), objective response rate (ORR), and safety. All pts were followed for survival for up to 2 years after the last pt was randomized and a final analysis of efficacy and safety was conducted. No formal hypothesis testing was performed. Results: 999 pts were randomized and treated: 499 pmab and 500 cmab. 90% of pts had died at the time of this analysis (78% in the previously reported primary analysis). Baseline demographics and disease characteristics were similar between arms. Non-inferiority results for OS are shown (Table). Overall, any grade and grade 3-4 adverse events (AEs) were similar between arms. AEs of interest were (pmab vs cmab): grade 3-4 skin toxicity 13% vs 10%, grade 3-4 infusion reactions 0.5% vs 2%, and grade 3-4 hypomagnesemia 7% vs 3%. Conclusions: Consistent with the primary analysis, the final analysis of ASPECCT showed that pmab was non-inferior to cmab for OS in chemorefractory WT KRASmCRC. Safety profiles were as expected for pmab and cmab. Clinical trial information: NCT01001377
    American Society of Clinical Oncology, Chicago; 05/2015
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    ABSTRACT: Small renal masses (SRMs) represent a heterogeneous group showing a variety of clinical and biological behaviors. The best treatment for SRMs has been the focus of much debate over the past decades. Present strategies include surgery (partial or radical nephrectomy), local treatments (radiofrequency and cryoablation), or active surveillance. The choice among these therapeutic options is based on patient clinical features such as age or comorbidities rather than on tumor characteristics. Several studies have recently focused on the molecular behavior of SRMs. They showed that SRMs present histotype and nuclear grading heterogeneity, together with not unvarying growth kinetics and risk of recurrence or metastasis, suggesting that personalized approaches should be designed to optimize the management of these patients. At present, several studies are in course to identify predictive biomarkers to guide the decision-making process in this subpopulation. In this review, we summarized the data on growth kinetics, tumor heterogeneity, and risk of metastasis in patients with SRMs, with focus on the current role of biopsies and imaging in the management of these patients. Copyright © 2015 Elsevier Inc. All rights reserved.
    Urologic Oncology 05/2015; 33(7). DOI:10.1016/j.urolonc.2015.04.001 · 3.36 Impact Factor
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    ABSTRACT: The aim of our study was to evaluate whether a panel of biomarkers, prospectively analysed might be able to predict patients' clinical outcome more accurately than RAS status alone. K-RAS (exons 2, 3, 4) wild type colorectal cancer patients, candidates to second/third-line cetuximab with chemotherapy were prospectively allocated into 2 groups on the basis of their profile: favourable (BRAF and PIK3CA exon 20 wild type, EGFR GCN ≥ 2.6, HER-3 Rajkumar score ≤ 8, IGF-1 immunostaining < 2) or unfavourable (any of the previous markers altered or mutated). After the introduction of N-RAS status (exons 2, 3, 4) only RAS wild type patients were considered eligible. Primary aim was response rate (RR). To detect a difference in terms of RR among patients with an unfavourable profile (estimated around 25%) and patients with a favourable profile (estimated around 60%), with a probability alpha of 0.05 and beta of 0.05, required sample size was 46 patients. Secondary endpoints were progression free survival (PFS) and overall survival (OS). Forty-six patients were enrolled. Seventeen patients (37%) were allocated to the favourable and 29 patients (63%) to the unfavourable profile. RR in the favourable and unfavourable group was 11/17 (65%) and 2/29 (7%) (p = 0.007) respectively. The favourable group also showed an improved PFS (8 months vs. 3 months, p < 0.0001) and OS (15 months vs. 6 months, p < 0.0001). Our results suggest that prospective selection of optimal candidates for cetuximab treatment is feasible and may be able to improve clinical outcome.
    Journal of Translational Medicine 05/2015; 13(1):140. DOI:10.1186/s12967-015-0501-5 · 3.99 Impact Factor

Publication Stats

7k Citations
1,941.93 Total Impact Points


  • 2015
    • Szent László Hospital, Budapest
      Budapeŝto, Budapest, Hungary
  • 1970–2015
    • Università Politecnica delle Marche
      • • Chair of Medical Oncology
      • • Clinic of Cardiology
      Ancona, The Marches, Italy
  • 2001–2013
    • University Hospital of Parma
      • Reparto di Oncologia medica
      Parma, Emilia-Romagna, Italy
  • 2012
    • Second University of Naples
      Caserta, Campania, Italy
  • 2007–2012
    • Azienda Ospedaliero - Universitaria "Ospedali Riuniti" Trieste
      Trst, Friuli Venezia Giulia, Italy
    • Università di Pisa
      Pisa, Tuscany, Italy
  • 2011
    • Ludwig Institute for Cancer Research Ltd Belgium
      Bruxelles, Brussels Capital, Belgium
  • 1989–2008
    • Ospedali Riuniti di Bergamo
      Bérgamo, Lombardy, Italy
  • 2006
    • Azienda Ospedaliera Ospedali Riuniti Papardo Piemonte
      Messina, Sicily, Italy
  • 2000–2005
    • Università degli Studi di Urbino "Carlo Bo"
      Urbino, The Marches, Italy
  • 2003
    • University-Hospital of Padova
      Padua, Veneto, Italy
  • 1999–2003
    • Università degli Studi di Messina
      • • Dipartimento di Scienze Radiologiche
      • • Dipartimento di Neuroscienze
      • • Dipartimento di Medicina Clinica e Sperimentale
      Messina, Sicily, Italy
    • Azienda Ospedaliera Bianchi-Melacrino-Morelli di Reggio Calabria
      Reggio di Calabria, Calabria, Italy
  • 1997–2003
    • Università degli Studi di Siena
      Siena, Tuscany, Italy
  • 1993–1997
    • Azienda Ospedaliera San Carlo Borromeo Milano
      • Division of Medical Oncology
      Milano, Lombardy, Italy
  • 1996
    • Ospedale Santissimo Salvatore
      Persiceto, Emilia-Romagna, Italy
  • 1994
    • Azienda Ospedaliera San Gerardo
      Monza, Lombardy, Italy