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58 result(s) for "Ruggieri, Lorenzo"
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Hospital-Based Influenza and Pneumococcal Vaccination for Cancer Patients on Active Treatment and Their Family Members during the COVID-19 Pandemic in Italy: A Single-Center Experience
In patients with cancer, tumor- and treatment-induced immunosuppression are responsible for a four-fold increase in morbidity and mortality caused by influenza and invasive Streptococcus pneumoniae infections compared to the general population. The main oncology societies strongly recommend vaccination in patients with cancer to prevent these infections. However, vaccine hesitancy is a main concern in this population. The aim of this study was to assess the feasibility of in-hospital vaccination for patients under anticancer treatment and their family members (FMs) against influenza and pneumococcal infections during the COVID-19 pandemic in order to increase vaccine coverage. This was a single-center, prospective, observational study conducted at the Department of Oncology of Luigi Sacco University Hospital (Milan, Italy) between October 2020 and April 2021. The main primary outcome was the incidence of influenza-like illness (ILI) and pneumococcal infections. The main secondary outcome was safety. A total of 341 subjects were enrolled, including 194 patients with cancer and 147 FMs. The incidence of ILI was higher among patients than among FMs (9% vs. 2.7%, OR 3.92, p = 0.02). Moreover, two subjects were diagnosed with pneumococcal pneumonia. The most frequent vaccine-related AEs were pain in the injection site (31%) and fatigue (8.7%). In conclusion, this hospital-based vaccination strategy was feasible during the COVID-19 pandemic, representing a potential model to maximize vaccine coverage during a public health emergency.
Clinical efficacy of the first two doses of anti‐SARS‐CoV‐2 mRNA vaccines in solid cancer patients
Introduction Cancer patients are frail individuals, thus the prevention of SARS‐CoV‐2 infection is essential. To date, vaccination is the most effective tool to prevent COVID‐19. In a previous study, we evaluated the immunogenicity of two doses of mRNA‐based vaccines (BNT162b2 or mRNA‐1273) in solid cancer patients. We found that seroconversion rate in cancer patients without a previous exposure to SARS‐CoV‐2 was lower than in healthy controls (66.7% vs. 95%, p = 0.0020). The present study aimed to evaluate the clinical efficacy of the vaccination in the same population. Methods This is a single‐institution, prospective observational study. Data were collected through a predefined questionnaire through phone call in the period between the second and third vaccine dose. The primary objective was to describe the clinical efficacy of the vaccination, defined as the percentage of vaccinated subjects who did not develop symptomatic COVID‐19 within 6 months after the second dose. The secondary objective was to describe the clinical features of patients who developed COVID‐19. Results From January to June 2021, 195 cancer patients were enrolled. Considering that 7 (3.59%) patients tested positive for SARS‐CoV‐2 and 5 developed symptomatic disease, the clinical efficacy of the vaccination was 97.4%. COVID‐19 disease in most patients was mild and managed at home; only one hospitalization was recorded and no patient required hospitalization in the intensive care unit. Discussion Our study suggests that increasing vaccination coverage, including booster doses, could improve the prevention of infection, hospitalization, serious illness, and death in the frail population of cancer patients. Prevention of SARS‐CoV‐2 infection is crucial for cancer patients given their frailty and vaccination is the most effective method to achieve this goal. The present study aimed to evaluate the clinical efficacy of the first two doses of anti‐SARS‐CoV‐2 vaccines in treated solid cancer patients. The clinical efficacy was 97.4%. COVID‐19 disease in most patients was mild and managed at home; only one hospitalization was recorded and no patient required hospitalization in the intensive care unit.
Association of Steroids Use with Survival in Patients Treated with Immune Checkpoint Inhibitors: A Systematic Review and Meta-Analysis
Immune checkpoint inhibitors (ICIs) can elicit toxicities by inhibiting negative regulators of adaptive immunity. Sometimes, management of toxicities may require systemic glucocorticoids. We performed a systematic review and meta-analysis of published studies to evaluate the correlation between steroids use, overall survival (OS), and progression-free survival (PFS) in cancer patients treated with ICIs. Publications that compared steroids with non-steroid users in cancer patients treated with ICIs from inception to June 2019 were identified by searching the EMBASE, PubMed, SCOPUS, Web of Science, and Cochrane Library databases. The pooled hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using a random-effects model. Patients (studies, n = 16; patients, n = 4045) taking steroids were at increased risk of death and progression compared to those not taking steroids (HR = 1.54, 95% CI: 1.24–1.91; p = 0.01 and HR = 1.34, 95% CI: 1.02–1.76; p = 0.03, respectively). The main negative effect on OS was associated with patients taking steroids for supportive care (HR = 2.5, 95% CI 1.41–4.43; p < 0.01) or brain metastases (HR = 1.51, 95% CI 1.22–1.87; p < 0.01). In contrast, steroids used to mitigate adverse events did not negatively affect OS. In conclusion, caution is needed when steroids are used for symptom control. In these patients, a negative impact of steroid use was observed for both OS and PFS.
Rising Concern About the Carcinogenetic Role of Micro-Nanoplastics
In recent years, awareness regarding micro-nanoplastics’ (MNPs) potential effects on human health has progressively increased. Despite a large body of evidence regarding the origin and distribution of MNPs in the environment, their impact on human health remains to be determined. In this context, there is a major need to address their potential carcinogenic risks, since MNPs could hypothetically mediate direct and indirect carcinogenic effects, the latter mediated by particle-linked chemical carcinogens. Currently, evidence in this field is scarce and heterogeneous, but the reported increased incidence of malignant tumors among younger populations, together with the ubiquitous environmental abundance of MNPs, are rising a global concern regarding the possible role of MNPs in the development and progression of cancer. In this review, we provide an overview of the currently available evidence in eco-toxicology, as well as methods for the identification and characterization of environmental MNP particulates and their health-associated risks, with a focus on cancer. In addition, we suggest possible routes for future research in order to unravel the carcinogenetic potential of MNP exposure and to understand prognostic and preventive implications of intratumoral MNPs.
Host-Related Factors in the Interplay among Inflammation, Immunity and Dormancy in Breast Cancer Recurrence and Prognosis: An Overview for Clinicians
A significant proportion of patients treated for early breast cancer develop medium-term and late distant recurrence. The delayed manifestation of metastatic disease is defined as “dormancy”. This model describes the aspects of the clinical latency of isolated metastatic cancer cells. Dormancy is regulated by extremely complex interactions between disseminated cancer cells and the microenvironment where they reside, the latter in turn influenced directly by the host. Among these entangled mechanisms, inflammation and immunity may play leading roles. This review is divided into two parts: the first describes the biological underpinnings of cancer dormancy and the role of the immune response, in particular, for breast cancer; the second provides an overview of the host-related factors that may influence systemic inflammation and immune response, subsequently impacting the dynamics of breast cancer dormancy. The aim of this review is to provide physicians and medical oncologists a useful tool to understand the clinical implications of this relevant topic.
Efficacy of Retreatment with Oxaliplatin-Based Regimens in Metastatic Colorectal Cancer Patients: The RETROX-CRC Retrospective Study
Background: oxaliplatin with fluoropyrimidine is a “mainstay” regarding the upfront treatment of metastatic colorectal cancer (mCRC). In contrast, the efficacy and safety of oxaliplatin-based regimens in late-care settings have been poorly reported. Methods: we identified a real-world mCRC patient cohort who were re-treated with oxaliplatin, and in which clinicopathological features were retrospectively analyzed to identify efficacy–predictive determinants (RETROX-CRC study). Results: of 2606 patients, 119 fulfilled the eligibility criteria. Oxaliplatin retreatment response rate (RR) and disease control rate (DCR) were 21.6% (CI 14.4–31.0%), and 57.8% (CI 47.7–67.4). A trend towards better RR and DCR was observed among patients who had first oxaliplatin in an adjuvant setting; a poorer outcome was observed if two or more intervening treatments were delivered. Median progression-free survival (PFS) was 5.1 months (95%CI 4.3–6.1), reducing to 4.0 months (95%CI 3.07–5.13) if oxaliplatin was readministered beyond third-line (HR 2.02; 1.25–3.25; p = 0.004). Safety data were retrieved in 65 patients (54.6%); 18.5% (12/65) and 7.7% (5/65) had G3–4 toxicities. Toxicities led to discontinuation in 34/119 (28.6%). Conclusions: oxaliplatin retreatment produced further RR in around one-fifth of patients and DCR 57.8%. Efficacy decreased in more pre-treated patients and around one-third of patients discontinued treatment due to adverse events. Translational studies improving patient selection are warranted.
Cancer Awareness Among People Living with HIV (PLWH): Insights from an Italian Survey of Oncologists and Infectious Disease Specialists
Since the mid-1990s, the adoption of combined antiretroviral therapy (cART) has significantly reduced HIV-related mortality and morbidity. Nevertheless, cancer continues to be the leading cause of death in people living with HIV (PLWH). We conducted a survey to assess the knowledge and inter-disciplinarity among the Italian oncologists and infectious disease specialists in the cancer prevention and treatment of PLWH. All the members of AIOM, SIMIT and SITA who are oncologists and infectious disease specialists were invited via email. A survey with 24 queries was administered using a web-based platform. Data were analysed with the chi-square or Fisher exact tests to explore any significant difference between the two specialist subgroups. From April to June 2023, 182 participants filled in the questionnaires. A low rate of respondents from each scientific society was reported (3% for AIOM, 8% from SIMIT and 2% from SITA). All interviewees agreed that HIV infection was a relevant risk factor for cancer (95.1%) and that PLWH had limited access to clinical trials (73.1%). More than a third of oncologists worked in a hospital without an infectious diseases department, using a remote method of communication for interdisciplinary discussion (telephone and Email were used in 64.5% of cases). Eighty-four percent of the oncologists vs 51.4% of the infectious disease specialists had in charge less than 5 patients with HIV during the previous year. The results of this survey underscore the opportunity for education, interdisciplinary collaboration, and organizational support to optimize cancer care for PLWH. A Hub&Spoke model could represent a potential facilitation to build-up in the near future through inter-societal collaboration.
Cancer Awareness Among People Living with HIV : Insights from an Italian Survey of Oncologists and Infectious Disease Specialists
Introduction: Since the mid-1990s, the adoption of combined antiretroviral therapy (cART) has significantly reduced HIV- related mortality and morbidity. Nevertheless, cancer continues to be the leading cause of death in people living with HIV (PLWH). We conducted a survey to assess the knowledge and inter-disciplinarity among the Italian oncologists and infectious disease specialists in the cancer prevention and treatment of PLWH. Materials and Methods: All the members of AIOM, SIMIT and SITA who are oncologists and infectious disease specialists were invited via email. A survey with 24 queries was administered using a web-based platform. Data were analysed with the chi-square or Fisher exact tests to explore any significant difference between the two specialist subgroups. Results: From April to June 2023, 182 participants filled in the questionnaires. A low rate of respondents from each scientific society was reported (3% for AIOM, 8% from SIMIT and 2% from SITA). All interviewees agreed that HIV infection was a relevant risk factor for cancer (95.1%) and that PLWH had limited access to clinical trials (73.1%). More than a third of oncologists worked in a hospital without an infectious diseases department, using a remote method of communication for interdisciplinary discussion (telephone and Email were used in 64.5% of cases). Eighty-four percent of the oncologists vs 51.4% of the infectious disease specialists had in charge less than 5 patients with HIV during the previous year. Conclusion: The results of this survey underscore the opportunity for education, interdisciplinary collaboration, and organizational support to optimize cancer care for PLWH. A Hub&Spoke model could represent a potential facilitation to build-up in the near future through inter-societal collaboration. Plain language summary: * In the last years, antiretroviral therapy consistently prolonged the life expectancy of people living with HIV (PLWH). * To date, cancer remains a leading cause of death for PLWH. * We conducted a web-based survey directed to oncologists and infectious disease specialists. * The survey underscored a reduced specialist awareness regarding the main needs of patients with HIV and cancer. Keywords: HIV, cancer, PLWH, survey, Italy, chemotherapy
Cancer Awareness Among People Living with HIV
Introduction: Since the mid-1990s, the adoption of combined antiretroviral therapy (cART) has significantly reduced HIV- related mortality and morbidity. Nevertheless, cancer continues to be the leading cause of death in people living with HIV (PLWH). We conducted a survey to assess the knowledge and inter-disciplinarity among the Italian oncologists and infectious disease specialists in the cancer prevention and treatment of PLWH. Materials and Methods: All the members of AIOM, SIMIT and SITA who are oncologists and infectious disease specialists were invited via email. A survey with 24 queries was administered using a web-based platform. Data were analysed with the chi-square or Fisher exact tests to explore any significant difference between the two specialist subgroups. Results: From April to June 2023, 182 participants filled in the questionnaires. A low rate of respondents from each scientific society was reported (3% for AIOM, 8% from SIMIT and 2% from SITA). All interviewees agreed that HIV infection was a relevant risk factor for cancer (95.1%) and that PLWH had limited access to clinical trials (73.1%). More than a third of oncologists worked in a hospital without an infectious diseases department, using a remote method of communication for interdisciplinary discussion (telephone and Email were used in 64.5% of cases). Eighty-four percent of the oncologists vs 51.4% of the infectious disease specialists had in charge less than 5 patients with HIV during the previous year. Conclusion: The results of this survey underscore the opportunity for education, interdisciplinary collaboration, and organizational support to optimize cancer care for PLWH. A Hub&Spoke model could represent a potential facilitation to build-up in the near future through inter-societal collaboration. Plain language summary: * In the last years, antiretroviral therapy consistently prolonged the life expectancy of people living with HIV (PLWH). * To date, cancer remains a leading cause of death for PLWH. * We conducted a web-based survey directed to oncologists and infectious disease specialists. * The survey underscored a reduced specialist awareness regarding the main needs of patients with HIV and cancer. Keywords: HIV, cancer, PLWH, survey, Italy, chemotherapy