Publications by authors named "Bruno Chiurazzi"

8 Publications

  • Page 1 of 1

Folinic acid in colorectal cancer: esquire or fellow knight? Real-world results from a mono institutional, retrospective study.

Oncotarget 2021 Feb 2;12(3):221-229. Epub 2021 Feb 2.

Antonio Cardarelli Hospital, Oncology Unit, Naples, Italy.

The stock of therapeutic weapons available in metastatic colorectal cancer (mCRC) has been progressively grown over the years, with improving both survival and patients' clinical outcome: notwithstanding advances in the knowledge of mCRC biology, as well as advances in treatment, fluoropyrimidine antimetabolite drugs have been for 30 years the mainstay of chemotherapy protocols for this malignancy. 5-Fluorouracil (5FU) seems to act differently depending on administration method: elastomer-mediated continuous infusion better inhibits Thymidylate Synthase (TS), an enzyme playing a pivotal role in DNA synthetic pathway. TS overexpression is an acknowledged poor prognosis predicting factor. The simultaneous combination of 5FU and folinate salt synergistically strengthens fluorouracil cytotoxic effect. In our experience, levofolinate and 5FU together in continuous infusion prolong progression free survival of patients suffering from mCRC, moreover decreasing death risk and showing a clear clinical benefit for patients, irrespective of RAS mutational status, primitive tumor side and metastases surgery.
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February 2021

Sarcomatoid larynx carcinoma differential clinical evolution, on field statistical considerations.

Am J Otolaryngol 2021 May-Jun;42(3):102934. Epub 2021 Jan 27.

Department of Otolaryngology, Pellegrini Hospital, ASL Napoli 1 Centro, Naples, Italy.

Spindle cell larynx carcinoma (SpCC) represents around 3% of laryngeal cancers. It is originated by a single cancer stem cell undergoing epithelial to mesenchymal transition. This explains the aggressiveness, the peculiar resistance to conventional therapy and the frequent relapses. We focused on this particular cancer subset characteristics in patients, in early and advanced stages primarily aiming to define and highlight the differences with Laryngeal Squamous Cell Carcinoma (LSCC) focusing on clinical features, treatments, follow-up and survival in a patient's cohort composed by comparable cases from two subgroups.
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October 2021

Breakthrough Cancer Pain Clinical Features and Differential Opioids Response: A Machine Learning Approach in Patients With Cancer From the IOPS-MS Study.

JCO Precis Oncol 2020 4;4. Epub 2020 Nov 4.

Pain Therapy Unit, "A. Businco" Hospital, ASL 8, Cagliari, Italy.

Purpose: A large proportion of patients with cancer suffer from breakthrough cancer pain (BTcP). Several unmet clinical needs concerning BTcP treatment, such as optimal opioid dosages, are being investigated. In this analysis the hypothesis, we explore with an unsupervised learning algorithm whether distinct subtypes of BTcP exist and whether they can provide new insights into clinical practice.

Methods: Partitioning around a k-medoids algorithm on a large data set of patients with BTcP, previously collected by the Italian Oncologic Pain Survey group, was used to identify possible subgroups of BTcP. Resulting clusters were analyzed in terms of BTcP therapy satisfaction, clinical features, and use of basal pain and rapid-onset opioids. Opioid dosages were converted to a unique scale and the BTcP opioids-to-basal pain opioids ratio was calculated for each patient. We used polynomial logistic regression to catch nonlinear relationships between therapy satisfaction and opioid use.

Results: Our algorithm identified 12 distinct BTcP clusters. Optimal BTcP opioids-to-basal pain opioids ratios differed across the clusters, ranging from 15% to 50%. The majority of clusters were linked to a peculiar association of certain drugs with therapy satisfaction or dissatisfaction. A free online tool was created for new patients' cluster computation to validate these clusters in future studies and provide handy indications for personalized BTcP therapy.

Conclusion: This work proposes a classification for BTcP and identifies subgroups of patients with unique efficacy of different pain medications. This work supports the theory that the optimal dose of BTcP opioids depends on the dose of basal opioids and identifies novel values that are possibly useful for future trials. These results will allow us to target BTcP therapy on the basis of patient characteristics and to define a precision medicine strategy also for supportive care.
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November 2020

Factors Influencing the Clinical Presentation of Breakthrough Pain in Cancer Patients.

Cancers (Basel) 2018 Jun 1;10(6). Epub 2018 Jun 1.

PainTherapy, S. Croce e Carle Hospital, 12100 Cuneo, Italy,

The aim of this study was to identify potential variables influencing the clinical presentation of breakthrough cancer pain (BTP). Cancer patients with a diagnosis of BTP were enrolled. Demographic and clinical characteristics, as well as background pain and BTP characteristics were collected. Multivariate analyses were conducted to assess the correlation between BTP characteristics and the variables examined. Data of 4016 patients were analysed. Average daily number of BTP episodes was 2.4, mean intensity was 7.5, and a mean duration was 43.3 min. A short onset BTP was observed in 68.9% of patients. In 30.5% of patients BTP was predictable. There were 86.0% of participants who reported a marked interference of BTP with their daily activities. Furthermore, 86.8% of patients were receiving opioids for the management of BTP. The average time to meaningful pain relief was 16.5 min and 70.9% of patients were satisfied with their BTP medications. Age, head and neck cancer, Karnofsky, background pain intensity, predictable and fast onset BTP were independently associated with the number of BTP episodes. BTP pain intensity was independently associated with background pain intensity, fast onset BTP, and Karnofsky. Neuropathic pain mechanism was independently associated with unpredictable BTP. Variables independently associated with a longer duration of BTP were age, place of visit, cancer diagnosis, disease-oriented therapy, background pain intensity and mechanism, and unpredictable BTP. Age, Karnofsky, background pain intensity, fast onset, and long duration of BTP were independently associated with interference with daily activity. BTP has a variable presentation depending on interdependent relationships among its different characteristics.
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June 2018

Prevalence of malnutrition in patients at first medical oncology visit: the PreMiO study.

Oncotarget 2017 Oct 10;8(45):79884-79896. Epub 2017 Aug 10.

Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology Sapienza, St. Andrea Hospital, Rome, Italy.

Background: In cancer patients, malnutrition is associated with treatment toxicity, complications, reduced physical functioning, and decreased survival. The Prevalence of Malnutrition in Oncology (PreMiO) study identified malnutrition or its risk among cancer patients making their first medical oncology visit. Innovatively, oncologists, not nutritionists, evaluated the nutritional status of the patients in this study.

Methods: PreMiO was a prospective, observational study conducted at 22 medical oncology centers across Italy. For inclusion, adult patients (>18 years) had a solid tumor diagnosis, were treatment-naive, and had a life expectancy >3 months. Malnutrition was identified by the Mini Nutritional Assessment (MNA), appetite status with a visual analog scale (VAS), and appetite loss with a modified version of Anorexia-Cachexia Subscale (AC/S-12) of the Functional Assessment of Anorexia-Cachexia Therapy (FAACT).

Findings: Of patients enrolled (1,952), 51% had nutritional impairment; 9% were overtly malnourished, and 43% were at risk for malnutrition. Severity of malnutrition was positively correlated with the stage of cancer. Over 40% of patients were experiencing anorexia, as reported in the VAS and FAACT questionnaire. During the prior six months, 64% of patients lost weight (1-10 kg).

Interpretation: Malnutrition, anorexia, and weight loss are common in cancer patients, even at their first visit to a medical oncology center.
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October 2017

Breakthrough Cancer Pain: Preliminary Data of The Italian Oncologic Pain Multisetting Multicentric Survey (IOPS-MS).

Adv Ther 2017 01 21;34(1):120-135. Epub 2016 Nov 21.

Palliative Care and Oncologic Pain Service, S. Camillo-Forlanini Hospital, Rome, Italy.

Introduction: An ongoing national multicenter survey [Italian Oncologic Pain multiSetting Multicentric Survey (IOPS-MS)] is evaluating the characteristics of breakthrough cancer pain (BTP) in different clinical settings. Preliminary data from the first 1500 cancer patients with BTP enrolled in this study are presented here.

Methods: Thirty-two clinical centers are involved in the survey. A diagnosis of BTP was performed by a standard algorithm. Epidemiological data, Karnofsky index, stage of disease, presence and sites of metastases, ongoing oncologic treatment, and characteristics of background pain and BTP and their treatments were recorded. Background pain and BTP intensity were measured. Patients were also questioned about BTP predictability, BTP onset (≤10 or >10 min), BTP duration, background and BTP medications and their doses, time to meaningful pain relief after BTP medication, and satisfaction with BTP medication. The occurrence of adverse reactions was also assessed, as well as mucosal toxicity.

Results: Background pain was well controlled with opioid treatment (numerical rating scale 3.0 ± 1.1). Patients reported 2.5 ± 1.6 BTP episodes/day with a mean intensity of 7.5 ± 1.4 and duration of 43 ± 40 min; 977 patients (65.1%) reported non-predictable BTP, and 1076 patients (71.7%) reported a rapid onset of BTP (≤10 min). Higher patient satisfaction was reported by patients treated with fast onset opioids.

Conclusions: These preliminary data underline that the standard algorithm used is a valid tool for a proper diagnosis of BTP in cancer patients. Moreover, rapid relief of pain is crucial for patients' satisfaction. The final IOPS-MS data are necessary to understand relationships between BTP characteristics and other clinical variables in oncologic patients.

Funding: Molteni Farmaceutici, Italy.
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January 2017

Italian Oncological Pain Survey (IOPS): a multicentre Italian study of breakthrough pain performed in different settings.

Clin J Pain 2015 Mar;31(3):214-21

*Anesthesia and Intensive Care & Pain Relief and Supportive Care, La Maddalena Cancer Center, Palermo †Emergency Care, Critical Care Medicine, Pain Medicine and Anesthesiology Department, Tor Vergata University of Rome ‡Anesthesiology, Resuscitation, and Pain Therapy Department, Umberto I Hospital ¶Molecular and Clinical Medicine Medical Oncology, La Sapienza University of Rome #IDI-IRCCS ‡‡‡‡Primary Care, ASL RM F, Rome §Anesthesiology, Resuscitation, and Pain Therapy Department ¶Abdominal Medical Oncology, National Cancer Institute, IRCCS Foundation Pascale ††Medical Oncology, A.O.R.N "A. Cardarelli" Hospital †††Pain Relief, A.O. Dei Colli, Monaldi Hospital, Naples ∥Palliative Care ASL3, Genoa ##Palliative Care, Gerontology and Physical Education Department, E.O. Galliera Hospitals, Genoa **Pain Relief, Palliative Care, Oncology Department, Careggi Hospital, Florence ‡‡Hematology Oncology Center Subalpine (COES), A.O. City Health and Science, Molinette §§§Palliative Care, FARO Foundation, Turin §§IRCCS Foundation National Cancer Institute of Milan, Milan ***Palliative Care, Pain Relief, ASL 13 Mirano Veneto Region ‡‡‡Palliative Care, Pain Relief, Infermi Hospital, Rimini ∥∥∥Medical Oncology, Humanitas Oncology Center of Catania, Catania ¶¶¶Medical Oncology 1, Careggi Hospital, Florence ###Pain Relief, IRCCS Veneto Oncological Institute, Padua ****Pain Relief, Palliative Care, AV3 Macerata Hospital, Macerata ††††Medical Oncology A.O. Treviglio, Bergamo, Italy ∥∥European Palliative Care Research Center, Norwegian University of Science and Technology, Trondheim, Norway.

Objective: A survey of breakthrough pain (BTP) was performed in five palliative care units (PCU), seven oncology departments (ONC), and nine pain clinics (OPC).

Methods: A standard algorithm was used to confirm the diagnosis of BTP of patients refereed to different settings.

Results: 1,412 evaluable cancer patients were enrolled. 53.9% were males and the mean age was 63.7±13.1 years. The mean intensity of background pain was 2.8±0.73. Patients reported 2.4±1.1 BTP episodes/day with a mean intensity of 7.37±1.28. 80.6% patients reported that the BTP had a significant negative impact in everyday life. The majority of patients reported a fast onset of BTP, which was predictable in 50.7% of cases, while BTP with a gradual onset (>10 min) was less predictable (29%) (P=0.001). PCU patients were older, had lower Karnofsky levels, a lower number of BTP episodes/day, a slow onset of BTP onset, and a less predictable BTP. Cancer diagnosis was performed a mean of 23.5 months (SD±32.8) before the assessment. The mean duration of background pain was 3.5 months (SD±3.5), and the mean duration of any analgesic treatment was 2.5 months (SD±3). BTP started a mean of 2.2 months (SD±1.9) before the assessment. Characteristics of BTP were influenced by the course of disease, as well as the duration of background pain and initiation of BTP. Most patients took rapid onset opioids and were satisfied with the treatment. BTP diagnosis was prevalently made by ONC and OPC physicians, and rarely by GPs.

Conclusion: This survey performed by an Italian observatory expert review group, has confirmed that the BTP represents a clinically relevant condition with a negative impact on the patient's quality of life. BTP was detected in all settings involved. A number of factors are associated with the BTP. Also factors regarding the course of disease and setting of care have been assessed. This information may help in stratifying patients or predicting the risk of development of BTP with specific characteristics.
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March 2015

Gefitinib in non-small cell lung carcinoma: a case report of an unusual side effect and complete response in advanced disease.

Tumori 2013 Jan-Feb;99(1):3e-5e

Department of Medical Oncology Studies, Second University of Naples, Napels, Italy.

Gefitinib is a tyrosine kinase inhibitor, indicated in advanced non-small cell lung cancer in all lines of treatment for patients harboring EGFR mutations. It has a favorable toxicity profile but may induce unexpected adverse effects, such as an infiammatory reaction in the bladder. We report a rare case of hemorrhagic cystitis, an unusual side effect, in a patient with non-small cell lung cancer treated with gefitinib, which did not compromise the clinical response.
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May 2013