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Cesare Gridelli

Publications and source records attributed to Cesare Gridelli.

At least 55 records · Page 3Linked to original sources
PubMed2002

Meeting the chemotherapy needs of elderly and poor performance status patients with NSCLC.

Increasing interest in designing chemotherapy suitable for use in the elderly and in poor performance status (PS) patients has led to clinical trials in advanced non-small cell lung cancer (NSCLC) which have demonstrated a number of important points. First, the randomized Elderly Lung Cancer Vinorelbine Study Group (ELVIS) trial makes clear that elderly patients treated with vinorelbine plus best supportive care (BSC) have significantly improved survival and quality of life when compared with patients treated with BSC alone. Secondly, the Multicenter Italian Lung Cancer in the Elderly Study (MILES) trial demonstrates that the combination of gemcitabine plus vinorelbine in this patient population does not further improve survival or quality of life as compared to single chemotherapy with vinorelbine or gemcitabine. Weekly docetaxel has considerable potential among patients judged likely to tolerate poorly cisplatin-based chemotherapy. In a trial among 39 previously untreated elderly, poor PS or medically compromised patients, weekly 36 mg/m(2) docetaxel produced a 19% response rate and 28% 1-year survival. These data compare favorably with results achieved with other single agents. Weekly, docetaxel is better tolerated than the q 3-week schedule, and myelosuppression is not severe. Weekly docetaxel is also active as second-line therapy. The combination of gemcitabine and docetaxel, both administered weekly, is well tolerated by elderly and/or poor PS patients, is active (median survival 7 months, 1-year survival 29%) and merits further study.

Aged↗
PubMed2002

Chemotherapy of non-small cell lung cancer in the elderly.

Around one-third of all patients with non-small cell lung cancer (NSCLC) are over the age of 70. Elderly patients tolerate chemotherapy poorly because of impaired organ function and co-morbidities. For this reason, these patients are often not considered eligible for aggressive cisplatin-based chemotherapy. A multidimensional geriatric evaluation is important to plan appropriate treatments. At present, there are no indications for adjuvant and neoadjuvant chemotherapy. Combined chemo-radiotherapy in locally advanced disease increases toxicity and seems determine no survival advantage as compared to radiation therapy alone. In advanced disease, single agent vinorelbine proves to be active and well-tolerated, and compared to best supportive care, improves survival and perhaps quality of life. Gemcitabine is active and well tolerated as well. Taxanes are in advanced phase of evaluation. A phase III randomized trial showed that polychemotherapy with gemcitabine + vinorelbine does not improve any outcome as compared to single agent chemotherapy with vinorelbine or gemcitabine. In clinical practice, single agent chemotherapy should remain the standard treatment. The choice of the drug should be based on the toxicity profile of each drug and type of co-morbid conditions. In the near future, new therapeutic strategies and biological agents could improve present results.

Aged↗
PubMed2002

Does chemotherapy have a role as palliative therapy for unfit or elderly patients with non-small-cell lung cancer?

Elderly patients and younger "unfit" patients with poor Eastern Cooperative Oncology Group (ECOG) performance status (PS) (> or = 2) suffering from advanced non-small-cell lung cancer (NSCLC) are two different populations--both of which require palliative treatments. Elderly patients frequently experience progressive decline of organ function and multiple comorbidities, which need to be considered when choosing therapy. ECOG 1594 showed that advanced NSCLC patients with an ECOG PS of 2 did not tolerate platinum-based chemotherapy (cisplatin/paclitaxel, carboplatin/paclitaxel, cisplatin/docetaxel, carboplatin/paclitaxel). These data confirm that treatments designed specifically for this patient subset are needed. Single-agent chemotherapy seems to be a reasonable approach, and non-platinum-based combination chemotherapy should also be investigated. The oncology community has become increasingly aware of the magnitude of the problem of cancer in the elderly. More than 30% of lung cancers arise in patients > or = 70 years old. Elderly patients tolerate chemotherapy poorly, according to the few published papers, and are not considered eligible for aggressive cisplatin-based chemotherapy in clinical practice. A phase III randomized trial (ELVIS [Elderly Lung Cancer Vinorelbine Italian Study]) demonstrated survival and quality-of-life benefits with single-agent vinorelbine versus best supportive care. Among the newer drugs, gemcitabine has demonstrated activity and low toxicity in phase II studies. With this background, we performed a randomized, multicenter phase III trial (MILES [Multicenter Italian Lung Cancer in the Elderly Study]) in 707 advanced NSCLC elderly patients. The MILES study compared single-agent chemotherapy with vinorelbine or gemcitabine versus polychemotherapy with gemcitabine plus vinorelbine. Results showed no benefit in response rate, time to progression, survival, and quality of life for the combination. Single-agent chemotherapy remains the standard treatment approach for elderly NSCLC patients with advanced disease.

Aged↗
PubMed2002

Individualized chemotherapy for elderly patients with nonsmall cell lung cancer.

Approximately one third of all patients with nonsmall cell lung cancer (NSCLC) are over the age of seventy. Elderly patients tolerate chemotherapy poorly because of impaired organ function and comorbidities. For this reason, these patients are often not considered eligible for aggressive cisplatin-based chemotherapy. A multidimensional geriatric evaluation is important to plan appropriate treatments. At present, there are no indications for adjuvant and neoadjuvant chemotherapy. Combined chemoradiotherapy in locally advanced disease increases toxicity and seems determine no survival advantage as compared with radiation therapy alone. In advanced disease, single-agent vinorelbine proves to be active and well-tolerated, and compared with best supportive care, improves survival and perhaps quality of life. Gemcitabine is active and also well tolerated. Taxanes are in advanced phase of evaluation. A phase III randomized trial showed that polychemotherapy with gemcitabine and vinorelbine does not improve any outcome as compared with single-agent chemotherapy with vinorelbine or gemcitabine. In clinical practice, single-agent chemotherapy should remain the standard treatment. The choice of the drug should be based on the toxicity profile of each drug and type of comorbid conditions. In the near future, new therapeutic strategies and biologic agents could improve present results.

Age Factors↗
PubMed2002

Vinorelbine in the treatment of non-small cell lung cancer.

Non-small cell lung cancer (NSCLC) remains a fatal disease: the majority of patients are diagnosed as having metastases or advanced inoperable tumors. The activity of chemotherapy in NSCLC patients is low with objective response rarely complete and sustained. Cisplatin-based combinations are considered as the standard chemotherapy treatment. Recently., the introduction of new and less toxic chemotherapeutic agents., such as vinorelbine., has led investigators to research for active non-cisplatin-containing combinations to treat patients with advanced disease having as primary needs symptom relief and an acceptable quality of life. This review will focus on the pharmacological properties of vinorelbine and its role in adjuvant chemotherapy., in combined chemo-radiotherapy., in advanced disease and in the particular setting of the elderly. The oral use of vinorelbine will be among the future developments of this drug.

Aged↗
PubMedDate not supplied

CD40 activation as potential tool in malignant neoplasms.

BACKGROUND: CD40, a cell surface molecule, is expressed on B-cell malignancies and many different solid tumors. It is capable of mediating diverse biological phenomena such as the induction of apoptosis in tumors and stimulation of the immune response. It has thus been studied as a possible target for antitumor therapy. The general aim of this review is to focus the attention of clinical oncologists on the involvement of CD40 in tumors and the rationale of CD40-activation-based therapies in new, biologically oriented antitumor protocols. METHODS: A Medline review of published papers about the role of CD40 activation in cancer therapy. RESULTS: Many authors have shown that CD40 activation promotes apoptotic death of tumor cells and that the presence of the molecule on the surface of carcinoma lines is an important factor in the generation of tumor-specific T-cell responses that contribute to tumor cell elimination. The CD40 ligand (CD40L) is the natural ligand for CD40; it is expressed primarily on the surface of activated T lymphocytes. Preclinical studies suggest that CD40-CD40L interaction could be useful for cytotoxicity against CD40-expressing tumors and for immune stimulation. Tumor inhibition was observed when tumor cells were treated with agonistic anti-CD40 monoclonal antibodies or with the soluble form of CD40L. The results of the first phase I clinical trial to treat cancer patients with subcutaneous injection of recombinant human CD40L have been recently reported. Immunohistochemical studies have revealed that detection of CD40 in primary cutaneous malignant melanoma and lung cancer may have a negative prognostic value. Interestingly, up-regulation of CD40 was observed in the tumor vessels of renal carcinomas and Kaposi's sarcoma, suggesting possible involvement of CD40 in tumor angiogenesis. Recently, it has also been shown that CD40 engagement on endothelial cells induces in vitro tubule formation and expression of matrix metalloproteinases, two processes involved in the neovascularization and progression of tumors. CONCLUSIONS: CD40 activation represents an exciting target for hematological malignancies and solid tumors expressing the molecule, but its functional role in cancer development still remains unclear and controversial.

Animals↗
PubMedDate not supplied

Pancreatic involvement from heavily pretreated small cell lung cancer successfully treated with transcatheter intra-arterial chemotherapy: a case report with local and systemic disease control.

This is a case report on pancreatic metastases from small cell lung cancer successfully treated by transcatheter arterial infusion of chemotherapy. The patient showed partial regression of pancreatic and thoracic disease. To our knowledge this is the first reported case of small cell lung cancer with pancreatic involvement treated with the transcatheter arterial infusion procedure; it represents an example of integrated treatments that may be considered for patients with pancreatic involvement from small cell lung cancer even if heavily pretreated.

Aged↗
PubMedDate not supplied

Synchronous bilateral retinal metastases from lung adenocarcinoma.

Hematogenous retinal metastases from non-small cell lung cancer are rare, and are even more uncommonly observed bilaterally. Non-small cell lung cancer usually metastasizes to the liver, adrenal glands, lung, bone, central nervous system, and kidney. We report the case of a 41-year-old male patient with advanced lung adenocarcinoma heavily pretreated with polychemotherapy and palliative radiotherapy up to June 2003, when synchronous bilateral retinal metastases were diagnosed. The patient's prognosis was worsened by the onset of the retinal metastases and he died three months later.

Adenocarcinoma↗
PubMedDate not supplied

Treatment of small cell lung cancer in the elderly.

Small cell lung cancer (SCLC) accounts for approximately 20% of lung carcinomas. Chemotherapy is the cornerstone of treatment for SCLC. In limited disease, the median survival time is about 12-16 months, with a 4%-5% long-term survival rate; in extensive disease the median survival time is 7-11 months. More than 50% of lung cancer patients are diagnosed when they are over the age of 65, and about 30% are over 70. Elderly patients tolerate chemotherapy poorly compared with their younger counterparts, because of age-related progressive reductions in organ function and comorbidities. The standard therapy for limited disease is combined chemoradiotherapy, followed by prophylactic brain irradiation for patients achieving complete responses. In the elderly, the addition of radiotherapy to chemotherapy must be carefully evaluated, considering the slight survival benefit and potential for substantial toxicity incurred with this treatment. The best approach is to design clinical trials that specifically include geriatric assessment to develop active and well-tolerated chemotherapy regimens for elderly SCLC patients. Survival improvement for SCLC patients requires a better understanding of tumor biology and the subsequent development of novel therapeutic strategies. Several targeted agents have been introduced into clinical trials in SCLC, but a minority of these new agents offers a promise of improved outcomes, and negative results are reported more commonly than positive ones. This review focuses on the main issues in the treatment of elderly SCLC patients.

Aged↗
PubMedDate not supplied

Has lung cancer in the elderly different characteristics at presentation?

Lung cancer is the first cause of cancer death for males aged > or =35 years, and the second for females aged between 35 and 70 years. Elderly patients seem to have the worst performance status (PS) and earlier stage of disease at diagnosis. We analyzed data concerning 1,035 patients with lung cancer referred to the National Cancer Institute of Naples. The variables considered in the analysis were: gender; type of cancer [small cell lung cancer (SCLC), non-small cell lung cancer (NSCLC)]; ECOG (Eastern Cooperative Oncology Group) PS, the stage of disease at diagnosis, the histological type, age at diagnosis. In order to better assess the relevance of age at diagnosis in lung cancer patients we categorized the age into two groups (young < or =70; old >70 years). The statistical analyses were performed using chi2 trend test with corresponding p-value and odds ratios (OR) for the examined variables, with a corresponding 95% confidence interval. These were derived using multiple logistic regression, fitted by the maximum likelihood method. For all the 1035 patients the risk between the age at diagnosis and the performance status was not statistically significant (OR=1.1, 95%CI 0.8-1.5). We repeated the same risk distinguishing the histological type and we analyzed the performance status for the SCLC (OR=1.0, 95%CI 0.4-2.5) and the stage at diagnosis (OR=1.0, 95%CI 0.4-3.0), without any significant difference. Our study showed that elderly patients with lung cancer do not seem to have different characteristics at presentation, particularly related to stage of disease, PS and histology, as compared to their younger counterpart. Other characteristics such as type and number of co-morbidities and organ function differ in the two groups of populations.

Adult↗
PubMedDate not supplied

Oral cytotoxic drugs.

Explore the source record for details and available documents.

Administration, Oral↗
PubMedDate not supplied

Single agent vinorelbine as first-line chemotherapy in elderly patients with advanced breast cancer.

BACKGROUND: Breast cancer arises in about 48% of patients (pts) older than 65 years. Chemotherapy is administered to elderly pts with advanced breast cancer (ABC) resistant to hormonal treatment or with visceral metastases. Vinorelbine (VNR), a semisynthetic vinca alkaloid, is active and well-tolerated in ABC reporting, as a single agent, an objective response (OR) rate of 41%-60%. The ELVIS (Elderly Lung cancer Vinorelbine Italian Study) trial demonstrated the tolerability and efficacy of VNR in elderly pts with advanced non-small cell lung cancer (JNCI 91: 66-72, 1999). MATERIALS AND METHODS: From January 1999 to December 2000, we analysed, retrospectively, our data about single-agent VNR as a first-line chemotherapy in elderly pts (> or = 70 years) with ABC. Twenty-four pts were analysed. VNR was administered at the dose of 30 mg/m2, i.v., days 1 and 8, every 3 weeks for a maximum of 6 cycles. RESULTS: The main toxicity was (% of pts): grade (G) 3-4 neutropenia 25%; G 2 thrombocytopenia 4.1%; G 2 asthenia 25%; G 2-3 constipation 16.6%; and G 1 neurotoxicity 25%. No cycles of chemotherapy were omitted or postponed. Granulocyte colony-stimulating factor was administered in 12.5% of a total of 112 cycles. Nine (37.5%) objective responses (2 complete and 7 partial responses) were observed. The median duration of response and survival were 7 and 11 months, respectively. CONCLUSION: These results suggest that single agent VNR is active and well-tolerated in elderly pts with ABC. Further prospective trials are warranted.

Aged↗
PubMedDate not supplied

5-HT3-receptor antagonists in the control of delayed-onset emesis.

Nausea and vomiting are typical side-effects of cancer therapy. The management of acute-onset emesis (< 24 hours post-treatment) has improved markedly in recent years and the 5-HT3-receptor antagonists are widely regarded as the antiemetic 'gold standard' during this period. Delayed-onset emesis (> 24 hours post-treatment), however, still represents a therapeutic challenge. Available data indicates that the 5-HT3-receptor antagonists are at least as good as conventional antiemetics in controlling delayed-onset emesis, and that their efficacy in this setting may be improved by the addition of a corticosteroid. As a result, antiemetic guidelines recommend the addition of a 5-HT3-receptor antagonist for the treatment of delayed emesis, particularly for high-risk patients.

Antiemetics↗
PubMedDate not supplied

Complete response of severe symptomatic bone marrow metastases from heavily pretreated breast cancer with a 3-weekly trastuzumab schedule. A clinical case.

Overexpression of HER-2/neu in breast cancer has been associated with more aggressive disease and poor overall survival. Trastuzumab, a recombinant humanized monoclonal antibody with high affinity for the HER-2 protein, inhibits the growth of breast cancer cells overexpressing HER-2. Trastuzumab showed, as second-line treatment, 15% of objective response in metastatic breast cancer. Bone marrow metastases are detectable in 23% of the patients with advanced breast cancer at first relapse and this rate increases in patients with metastatic disease. We report a case of a complete response of bone marrow metastases from breast cancer using a 3-weekly trastuzumab schedule, in a heavily pretreated patient with severe symptomatic pancytopenia.

Antibodies, Monoclonal↗
PubMedDate not supplied

Gefitinib as salvage therapy in pretreated patients with advanced non-small cell lung cancer. Data from a compassionate use program.

PURPOSE: To evaluate the tolerabiliy and activity of gefitinib, an epidermal growth factor receptor tyrosine kinase inhibitor, in patients with pretreated advanced non-small cell lung cancer (NSCLC). MATERIALS AND METHODS: From July 2001 to August 2003, we analysed, retrospectively, the data of 125 previously treated advanced NSCLC patients receiving gefitinib 250 mg, orally once daily in a compassionate use program. RESULTS: Main toxicity was (% of patients): grade 1-2 skin changes in 7 (5.0%) and 8 (6.4%) patients, respectively. Grade 1 diarrhea in 16 (12.8%) patients. Grade 1 and 2 hypertransaminasemia in 1 (0.8%) patient, respectively. Grade 2 onychopathy in 1 (0.8%) patient and epistaxis in 1 (0.8%) case. There were 1 complete response (0.8%), 6 partial responses (4.8%) and 22 (17.6%) stable disease with an overall control of disease in 23.2% of cases. Median progression-free survival and overall survival were 8.8 and 21.5 weeks, respectively. CONCLUSION: Gefitinib is active, feasible and well-tolerated in pretreated patients affected by advanced NSCLC.

Adult↗