Lodovico Balducci

University of South Florida, Tampa, Florida, United States

Are you Lodovico Balducci?

Claim your profile

Publications (232)983.61 Total impact

  • Lodovico Balducci

    No preview · Article · Nov 2015 · Cancer control: journal of the Moffitt Cancer Center
  • Lodovico Balducci · Dawn Dolan
    [Show abstract] [Hide abstract]
    ABSTRACT: Background: Chronic lymphocytic leukemia (CLL) occurs primarily in the elderly, and the majority of deaths attributable to CLL occur in persons 65 years of age or older. The greater number of comorbidities and reduced functionality associated with aging have also made successful treatment of CLL in the elderly more difficult. Methods: The authors reviewed current epidemiology and guidelines for treatment of CLL, as well as recently approved therapies and studies of physiological aging. Results: Determination of physiological age and performance of a thorough geriatric assessment play critical roles in the selection of optimal therapeutic approaches for older patients diagnosed with CLL. Conclusion: Older age, expressed via a frailty index, is a prognostic factor for poorer outcome in patients with CLL. However, several novel treatment options may result in reduced mortality and lessened treatmentrelated toxicity in older CLL patients.
    No preview · Article · Nov 2015 · Cancer control: journal of the Moffitt Cancer Center
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Objective: To determine outcomes of patients ≥70 years with resected pancreatic cancer. Methods: A study was conducted to identify pancreatic cancer patients ≥70 years who underwent surgery for pancreatic carcinoma from 2000 to 2012. Patients were excluded if they had neoadjuvant therapy. The primary endpoint was overall survival (OS). Results: We identified 112 patients with a median follow-up of surviving patients of 36 months. The median patient age was 77 years. The median and 5 year OS was 20.5 months and 19%, respectively. Univariate analysis (UVA) showed a significant correlation for increased mortality with N1 (P=0.03) as well as post-op CA19-9 >90 (P<0.001), with a trend towards decreased mortality with adjuvant chemoradiation (P=0.08). Multivariate analysis (MVA) showed a statistically significant increased mortality associated with N1 (P=0.008), post-op CA19-9 >90 (P=0.002), while adjuvant chemoradiation (P=0.04) was associated with decreased mortality. Conclusions: These data show that in patients ≥70, nodal status, post-op CA19-9, and adjuvant chemoradiation, were associated with OS. The data suggests that outcomes of patients ≥70 years who undergo upfront surgical resection are not inferior to younger patients.
    Full-text · Article · Oct 2015 · Journal of gastrointestinal oncology
  • L. Balducci · D. Dolan · S.E. Hoffe
    [Show abstract] [Hide abstract]
    ABSTRACT: Background: In general, cancer is a disease of aging, and palliative care is an essential step in the management of cancer in patients who are older. The goal of this article is to review common symptoms of cancer and oncology treatment and their management. Methods: The pertinent medical literature was reviewed. Results: The scope of palliative care includes personalized cancer treatment. This involves choosing treatment options that best fit the needs of each individual patient. Balancing treatment benefits and risks may be challenging in older patients, many of whom have limited life expectancies and decreased functional reserves. The benefits of treatment may diminish, and the risks of such treatment options increase with age. Thus, the first step toward personalized treatment includes determining physiological age, which is best estimated with a comprehensive geriatric assessment. Prevention of common complications, which include neutropenia and mucositis, allows the administration of treatment in full and effective doses. Fatigue is a chronic symptom related to cancer and its treatment and may lead to functional dependence and an increased risk of death. Fatigue might be prevented by daily exercise even during treatment. Other symptoms include pain and feelings of memory loss. Conclusions: The scope of palliative care encompasses more issues that symptom management and, for this reason, palliative care should be provided once the diagnosis of cancer is established. Determining treatment goals is essential to improve the treatment experience. Symptom management is similar in older and young patients, but symptoms in the older population may be associated with more frequent and severe complications. Many options exist to prevent and ameliorate the complications of oncology treatment in the aged. However, more studies should be conducted on the long-term care of older patients who have survived cancer. © 2015, H. Lee Moffitt Cancer Center and Research Institute. All rights reserved.
    No preview · Article · Oct 2015
  • Source
    Lodovico Balducci

    Preview · Article · Jul 2015
  • [Show abstract] [Hide abstract]
    ABSTRACT: Peptide vaccines are capable of eliciting immune responses targeting tumor-associated antigens (TAA) such as the Wilms' Tumor 1 (WT1) antigen, often overexpressed in myeloid malignancies. Here, we assessed the safety, tolerability, and immunogenicity of a polyvalent WT1 peptide vaccine. Individuals with WT1-positive acute myeloid leukemia (AML) in first (CR1) or second (CR2) remission or with higher-risk myelodysplastic syndrome (MDS) following at least 1 prior line of therapy were vaccinated with a mixture of peptides derived from the WT1 protein, with sargramostim injections before vaccination to amplify immunogenicity. Six vaccinations were delivered bi-weekly, continuing then monthly until patients received 12 vaccinations or showed disease relapse or progression. Therapeutic efficacy was evaluated by progression-free and overall survival. Immune responses were evaluated by delayed-type hypersensitivity testing and T-cell IFNγ ELISPOT at specified intervals. In 16 patients who received at least one vaccination, 10 completed the planned course of six vaccinations and six continued for up to six additional monthly vaccinations. Vaccinations were well tolerated, with no patients discontinuing due to toxicity. One of two patients with high-risk MDS experienced a prolonged decrease in transfusion dependence. Two of 14 AML patients demonstrated relapse-free survival >1 year. Both patients were in CR2 at time of vaccination, with duration of their remission exceeding duration of their first remission, suggesting a potential benefit. Our WT1 vaccine was well-tolerated. The clinical benefit that we observed in several patients suggests engagement of a protective immune response, indicating a need for further trials. This article is protected by copyright. All rights reserved. © 2015 Wiley Periodicals, Inc.
    No preview · Article · Mar 2015 · American Journal of Hematology
  • Lodovico Balducci
    [Show abstract] [Hide abstract]
    ABSTRACT: This article explores the treatment of cancer of the stomach and of the lower esophagus in older individuals. The incidence of both malignancies increases with age and, at present, the biology of the diseases, including sensitivity to chemotherapy, does not seem to change with age. The treatment of these cancers in patients 70 and over includes assessment of life expectancy secondary to physiologic age and evaluation of the individual's tolerance to stress. For this purpose a comprehensive geriatric assessment (CGA) is the best validated instrument. For individuals whose life expectancy without cancer exceeds that with cancer, the estimate of the risk of chemotherapy complications may reveal those patients in need of additional care and those patients in whom the risk of treatment may exceed the potential benefits. All older individuals receiving chemotherapy may need adjustment of the doses to the glomerular filtration rate, support with myelopoietic growth factors, and special care to prevent severe and irreversible neurotoxicity.
    No preview · Article · Feb 2015 · Journal of gastrointestinal oncology
  • [Show abstract] [Hide abstract]
    ABSTRACT: The so-called "silver tsunami" is a metaphor that the individuals 65 and older represent the most rapidly growing segment of the Western world population. Aging is an ongoing process that leads the loss of functional reserve of multiple organ systems, increased susceptibility to stress, it is associated with increased prevalence of chronic disease, and functional dependence. Determined by a combination of genetic and environmental factors, this process is highly individualized and poorly reflected in chronologic age. The heterogeneity and the complexity of the older old population represent the main challenge to the treatment of cancer in those patients. We should discern "fit" elderly in whom standard cancer treatment appears to be comparable to a younger population and "unfit" or "frail" elderly, in which the risks of the treatment may overwhelm potential benefits. There are many aspects that have to be assessed before treating an elderly patient, or before to choose the treatment itself. In our review we will try to explain and describe the meaning and the most important aspects related to the oldest old complex patients, and how to manage those patients.
    No preview · Article · Jan 2015 · Current Pharmaceutical Design
  • [Show abstract] [Hide abstract]
    ABSTRACT: Pain is one of the most frequent reasons for consultations in general practice, presenting either alone or associated at some comorbidity. In all care settings for older and oldest old patients, exists a gap between best-practice recommendations and current clinical practice. Clinical manifestations of persistent pain are often complex and multifactorial in the frail population, so the approach to pain management in older persons differs from that for younger people. The purpose of this review is to describe the best approach to assess and manage the persistent cancer and no-cancer pain in elderly, to explain the principles of pain treatment in this so often frail and complex population, to compare the different drugs that should be used or avoided in older and oldest old patients considering the age-related physiologic changes. Considerable emphasis is placed to conditions more common in elderly such as neuropathic pain or typical subsets of the aging population such as the assessment of pain in people with dementia.
    No preview · Article · Jan 2015 · Current Pharmaceutical Design
  • [Show abstract] [Hide abstract]
    ABSTRACT: To determine if age affects outcome in patients with resected pancreatic head cancer. An IRB-approved pancreatic cancer database was queried for patients with upfront resected pancreatic head cancer treated at our institution between 2000 and 2012. Overall survival (OS) curves were calculated according to the Kaplan-Meier method and log-rank analysis. Multivariate analysis was performed using the Cox proportional hazard model. We identified 193 patients. Patients ≥70years were less likely to receive adjuvant treatment (p=0.002); however there were no other significant differences between age groups. There was a trend towards increased pancreatic leaks in the elderly group (p=0.06), but no difference in post-operative complications or mortality. There was no difference in overall survival based on age. Median and 5-year OS were 23months and 26.7% in patients <70years, 23.4months and 23% in those 70-75, 16.1months and 0% in those 76-80, and 18.7months and 15.4% in those >80years (p=0.62). On univariate analysis, there was increased OS in patients with lower T stage, N0 status, post-operative CA19-9 level <90, and use of chemoradiotherapy (p<0.05). Multivariate analysis revealed that lower tumor stage, N0, post-operative CA19-9 level <90, and use of any adjuvant therapy predicted decreased mortality (p<0.05). Age, gender, tumor site, tumor grade, and positive margins were not prognostic on multivariate analysis. There is no difference in outcomes when comparing elderly patients with resected pancreatic cancer to those patients <70years of age. Copyright © 2014 Elsevier Inc. All rights reserved.
    No preview · Article · Dec 2014 · Journal of Geriatric Oncology
  • Lodovico Balducci
    [Show abstract] [Hide abstract]
    ABSTRACT: The request by a convicted sexual offender to have a penile implant presents an ethical dilemma that is analyzed in this case report. The conclusions include the fact that ethical decisions require a team approach and shared responsibility among practitioners and that there are ethical questions that have not been completely answered. In this case the unanswered question is whether autonomy should trample justice or justice should trample autonomy.
    No preview · Article · Dec 2014
  • Lodovico Balducci · May Mo · Esteban Abella · Alan Saven
    [Show abstract] [Hide abstract]
    ABSTRACT: Objectives: To evaluate primary prophylaxis with pegfilgrastim, a recombinant human granulocyte colony-stimulating factor, on maintaining relative dose intensity (RDI) in patients with non-Hodgkin lymphoma (NHL) receiving cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) or CHOP-rituximab (CHOP-R). Methods: This retrospective analysis pooled data from pegfilgrastim NHL clinical trials. Patients received up to 6 cycles of CHOP/CHOP-R every 2 (Q2W) or 3 (Q3W) weeks. RDI and the patient incidence of dose delay, reduction, discontinuation, and adverse events leading to dose alteration/discontinuation were summarized overall and by age group (below 65, 65 to 75, and above 75 y) and treatment schedule. RDI during treatment exposure and RDI adjusted by the planned 6 cycles of treatment were calculated. The adjusted RDI was also evaluated with multiple regression analysis. Results: Mean RDI during treatment exposure was 93% and 94% in overall patients in the Q2W and Q3W regimens, respectively. Mean adjusted RDI was 88% and 80%, respectively. The incidence of patients with RDI>85% was lower in older patients (65 y and above). In older patients, the incidence of dose reduction and discontinuation were higher regardless of treatment schedule, whereas dose delay was higher in the Q2W regimen. Multiple regression analysis identified age and cancer stage as potential factors associated with RDI. Adverse events leading to dose alteration/discontinuation were spread across hematological and nonhematological toxicities; older patients had a higher incidence of these adverse events. Conclusions: Pegfilgrastim primary prophylaxis maintained RDI in NHL patients receiving CHOP/CHOP-R during treatment. Adjusted RDI was lower in elderly patients because of early termination of chemotherapy.
    No preview · Article · Oct 2014 · American Journal of Clinical Oncology

  • No preview · Article · Oct 2014 · Journal of Geriatric Oncology

  • No preview · Article · Oct 2014 · Journal of Geriatric Oncology
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Background: Senescence-associated genes (SAGs) are responsible for the senescence-associated secretory phenotype, linked in turn to cellular aging, the aging brain, and the pathogenesis of cancer. Objective: We hypothesized that senescence-associated genes are overexpressed in older patients, in higher grades of glioma, and portend a poor prognosis. Methods: Forty-seven gliomas were arrayed on a custom version of the Affymetrix HG-U133 + 2.0 GeneChip, for expression of fo(u)rteen senescence-associated genes: CCL2, CCL7, CDKN1A, COPG, CSF2RB, CXCL1, ICAM-1, IGFBP-3, IL-6, IL-8, SAA4, TNFRSF-11B, TNFSF-11 and TP53. A combined "senescence score" was generated using principal component analysis to measure the combined effect of the senescence-associated gene signature. Results: An elevated senescence score correlated with older age (r = 0.37; P = .01) as well as a higher degree of malignancy, as determined by WHO, histological grade (r = 0.49; P < .001). There was a mild association with poor prognosis (P = .06). Gliosarcomas showed the highest scores. Six genes independently correlated with either age (IL-6, TNFRSF-11B, IGFBP-3, SAA4, and COPG), prognosis (IL-6, SAA4), or the grade of the glioma (IL-6, IL-8, ICAM-1, IGFBP-3, and COPG). Conclusion: We report: 1) a novel molecular signature in human gliomas, based on cellular senescence, translating the concept of SAG to human cancer, 2) the senescence signature is composed of genes central to the pathogenesis of gliomas, defining a novel, aggressive subtype of glioma; and 3) these genes provide prognostic biomarkers, as well as targets, for drug discovery and immunotherapy.
    Full-text · Article · Sep 2014 · Journal of Geriatric Oncology

  • No preview · Article · Sep 2014 · International journal of radiation oncology, biology, physics

  • No preview · Article · Sep 2014 · International journal of radiation oncology, biology, physics
  • Armando Santoro · Lodovico Balducci
    [Show abstract] [Hide abstract]
    ABSTRACT: This article reviews the Grandangolo conference on cancer survivorship and highlights the major findings. These include the improvement in survivorship, and the emergence of survivorship related syndromes, such as new neoplasms, cardiomyopathy, neutorpathy fatigue and memory loss. Emotional disorders may include the Lazarus’ Syndrome and the post-traumatic stress disorder. An open question is whether we should have specialists of survivorship or primary care physicians or oncologists could fulfill this role.
    No preview · Article · Aug 2014
  • Lodovico Balducci
    [Show abstract] [Hide abstract]
    ABSTRACT: Background: Data relating to cancer treatment in the older patient population are limited because older individuals have been under-represented in clinical trials. The goal of this review was to establish which factors hinder the participation of older individuals to clinical trials and to examine possible solutions. Methods: The literature relating to cancer treatment in the older patient population was reviewed. Results: The benefit of systemic cancer treatment may decrease with age, and risks may be increased due to reduced life expectancy and reduced tolerance of stress in the older population. Therefore, a multipronged approach is recommended for clinical studies in these patients, including phase 2 studies limited to persons 70 years of age and older, stratification by life expectancy and predicted treatment tolerance in phase 3 studies, and registration studies to establish predictive variables for treatment-related toxicity in older individuals. Conclusions: A combination of prospective and registration studies may supply adequate information to study cancer treatments in the older patient population.
    No preview · Article · Jul 2014 · Cancer control: journal of the Moffitt Cancer Center
  • Lodovico Balducci

    No preview · Article · Jun 2014 · Internal and Emergency Medicine

Publication Stats

6k Citations
983.61 Total Impact Points

Institutions

  • 1994-2015
    • University of South Florida
      • • Department of Oncologic Sciences
      • • Morsani College of Medicine
      • • Florida Policy Exchange Center on Aging
      Tampa, Florida, United States
  • 1970-2015
    • Moffitt Cancer Center
      • Department of Cancer Epidemiology
      Tampa, Florida, United States
  • 2013
    • The University of Tampa
      Tampa, Florida, United States
  • 1992-1993
    • James A. Haley Veterans Hospital
      Tampa, Florida, United States
    • United States Department of Veterans Affairs
      Бедфорд, Massachusetts, United States
  • 1978-1987
    • University of Mississippi Medical Center
      • • Department of Medicine
      • • Division of Oncology
      Jackson, Mississippi, United States