Attitude of Italian medical oncologists toward palliative care for patients with advanced cancer: results of the SIO project.

The aim of this survey was to describe the attitude of Italian oncologists towards palliative care. A survey on palliative care was carried out among 400 Italian oncologists. Seventy-two percent indicated that the management of patients with advanced stage cancer represents the majority of their practice. They are often involved in the management of pain (78%) and complications of chemotherapy (61%), and frequently, in the treatment of terminal patients (60%). Only 8.5% reported having frequent collaboration with psychiatrists in support of emotional and psychological patients' disturbances. About 40% are often directly involved in the management of existential or spiritual distress. Discussions on euthanasia and assisted suicide, which are illegal in Italy, took place never (68%) or occasionally (27%). Respondents agreed that all oncology centres should have access to palliative care service. These results are in line with those of the European Society of Medical Oncology survey and may be usefully employed to improve the organisation of palliative care

“Oxaliplatin plus high dose folinic acid and 5-fluoruracil i.v. bolus (OXAFAFU) versus irinotecan plus high dose folinic acid and 5-fluoruracil i.v. bolus (IRIFAFU) in patients with metastatic colorectal carcinoma: Southern Italy Cooperative Oncology Group trial 0103”

PURPOSE: The primary end point of this phase III trial was to compare the response rate (RR) of oxaliplatin (OXA) plus levo-folinic acid (l-FA) and 5-fluorouracil (5-FU) bolus with that of irinotecan (IRI) plus l-FA and 5-FU bolus in advanced colorectal carcinoma. PATIENTS AND METHODS: Patients with measurable metastatic colorectal carcinoma were randomly allocated to receive: IRI 200 mg/m(2) on day 1, l-FA 250 mg/m(2) intravenously plus 5-FU 850 mg/m(2) on day 2 (IRIFAFU); or OXA 100 mg/m(2) on day 1, l-FA 250 mg/m(2) plus 5-FU 1050 mg/m(2) on day 2 [OXAFAFU high dose (hd)]. Cycles were given every 2 weeks. After a planned interim analysis, OXA was reduced to 85 mg/m(2) and 5-FU to 850 mg/m(2) [OXAFAFU low dose (ld)]. RESULTS: Two hundred and seventy-four patients (IRIFAFU, 135; OXAFAFUhd, 71; OXAFAFUld, 68) were treated. Forty-two confirmed responses were achieved with IRIFAFU, 29 with OXAFAFUhd and 32 with OXAFAFUld. The response rate with OXAFAFU [44%; 95% confidence interval (CI) 35% to 52%] was significantly higher (P=0.029) than that of IRIFAFU (31%; 95% CI 23% to 40%). Occurrence of grade > or =3 neutropenia with OXAFAFUld was similar to that for IRIFAFU (29% versus 31%), while severe diarrhoea was significantly lower (12% versus 24%). Median failure-free survival (7 versus 5.8 months; P=0.046) and overall survival of patients (18.9 versus 15.6 months; P=0.032) were significantly prolonged with OXAFAFU. CONCLUSIONS: OXAFAFU was more active and less toxic than IRIFAFU, and it should be preferred in the first-line treatment of advanced colorectal cancer patients

Residual neurotoxicity in ovarian cancer patients in clinical remission after first-line chemotherapy with carboplatin and paclitaxel: The Multicenter Italian Trial in Ovarian cancer (MITO-4) retrospective study

BACKGROUND: Carboplatin/paclitaxel is the chemotherapy of choice for advanced ovarian cancer, both in first line and in platinum-sensitive recurrence. Although a significant proportion of patients have some neurotoxicity during treatment, the long-term outcome of chemotherapy-induced neuropathy has been scantly studied. We retrospectively assessed the prevalence of residual neuropathy in a cohort of patients in clinical remission after first-line carboplatin/paclitaxel for advanced ovarian cancer. METHODS: 120 patients have been included in this study (101 participating in a multicentre phase III trial evaluating the efficacy of consolidation treatment with topotecan, and 19 treated at the National Cancer Institute of Naples after the end of the trial). All patients received carboplatin (AUC 5) plus paclitaxel (175 mg/m(2)) every 3 weeks for 6 cycles, completing treatment between 1998 and 2003. Data were collected between May and September 2004. Residual sensory and motor neurotoxicity were coded according to the National Cancer Institute – Common Toxicity Criteria. RESULTS: 55 patients (46%) did not experience any grade of neurological toxicity during chemotherapy and of these none had signs of neuropathy during follow-up. The other 65 patients (54%) had chemotherapy-induced neurotoxicity during treatment and follow-up data are available for 60 of them. Fourteen out of 60 patients (23%) referred residual neuropathy at the most recent follow-up visit, after a median follow up of 18 months (range, 7–58 months): 12 patients had grade 1 and 2 patients grade 2 peripheral sensory neuropathy; 3 patients also had grade 1 motor neuropathy. The remaining 46/60 patients (77%) had no residual neuropathy at the moment of interview: recovery from neurotoxicity had occurred in the first 2 months after the end of chemotherapy in 22 (37%), between 2 and 6 months in 15 (25%), or after more than 6 months in 9 patients (15%). Considering all 120 treated patients, there was a 15% probability of persistent neurological toxicity 6 months after the end of chemotherapy. CONCLUSION: A significant proportion of patients with advanced ovarian cancer treated with first-line carboplatin/paclitaxel suffer long-term residual neuropathy. This issue should be carefully taken into account before considering re-treatment with the same agents in sensitive recurrent disease

Prevalence of <i>KRAS</i>, <i>BRAF</i>, and <i>PIK3CA</i> somatic mutations in patients with colorectal carcinoma may vary in the same population: clues from Sardinia

Background Role of KRAS, BRAF and PIK3CA mutations in pathogenesis of colorectal cancer (CRC) has been recently investigated worldwide. In this population-based study, we evaluated the incidence rates and distribution of such somatic mutations in genetically isolated population from Sardinia. Methods From April 2009 to July 2011, formalin-fixed paraffin-embedded tissues (N = 478) were prospectively collected from Sardinian CRC patients at clinics across the entire island. Genomic DNA was isolated from tissue sections and screened for mutations in KRAS, BRAF, and PIK3CA genes by automated DNA sequencing. Results Overall, KRAS tumour mutation rate was 30% (145/478 positive cases). Distribution of mutation carriers was surprisingly different within the island: 87/204 (43%) in North Sardinia vs. 58/274 (21%) in Middle-South Sardinia (p&lt;0.001). Among 384 CRC cases whose DNA was available, only one (0.3%) patient carried a mutation in BRAF gene; PIK3CA was found mutated in 67 (17%) patients. A significant inverse distribution of PIK3CA mutation rates was observed within Sardinian population: 19/183 (10%) cases from northern vs. 48/201 (24%) cases from central-southern island (p&lt;0.001). This heterogeneity in frequencies of KRAS/PIK3CA somatic mutations is consistent with already-reported discrepancies in distribution of germline mutations for other malignancies within Sardinian population. Preliminary clinical evaluation of 118 KRAS wild-type patients undergoing anti-EGFR-based treatment indicated lack of role for PIK3CA in predicting response to therapy. Conclusions Our findings support the hypothesis that differences in patients’ origins and related genetic backgrounds may contribute to even determine the incidence rate of somatic mutations in candidate cancer genes.</br

The MateCat tool

Abstract We present a new web-based CAT tool providing translators with a professional work environment, integrating translation memories, terminology bases, concordancers, and machine translation. The tool is completely developed as open source software and has been already successfully deployed for business, research and education. The MateCat Tool represents today probably the best available open source platform for investigating, integrating, and evaluating under realistic conditions the impact of new machine translation technology on human post-editing

Molecular alterations in key-regulator genes among patients with T4 breast carcinoma

Background: Prognostic factors in patients who are diagnosed with T4 breast carcinomas are widely awaited. We here evaluated the clinical role of some molecular alterations involved in tumorigenesis in a well-characterized cohort of T4 breast cancer patients with a long follow-up period. Methods: A consecutive series of 53 patients with T4 breast carcinoma was enrolled between 1992 and 2001 in Sardinia, and observed up for a median of 125 months. Archival paraffin-embedded tissue sections were used for immunohistochemistry (IHC) and fluorescence in situ hybridization (FISH) analyses, in order to assess alterations in expression levels of survivin, p53, and pERK1-2 proteins as well as in amplification of CyclinD1 and h-prune genes. The Kaplan-Meier and Cox regression methods were used for survival assessment and statistical analysis. Results: Overall, patients carrying increased expression of pERK1-2 (p = 0.027) and survivin (p = 0.008) proteins as well as amplification of h-prune gene (p = 0.045) presented a statistically-significant poorer overall survival in comparison with cases found negative for such alterations. After multivariate analysis, the pathological response to primary chemotherapy and the survivin overexpression in primary carcinoma represented the main parameters with a role as independent prognostic factors in our series. Conclusions: Although retrospective, our study identified some molecular parameters with a significant impact on prediction of the response to therapy or prognosis among T4 breast cancer patients. Further large prospective studies are needed in order to validate the use of such markers for the management of these patients

Breast cancer "tailored follow-up" in Italian oncology units: a web-based survey

urpose: Breast cancer follow-up procedures after primary treatment are still a controversial issue. Aim of this study was to investigate, through a web-based survey, surveillance methodologies selected by Italian oncologists in everyday clinical practice. Methods: Referents of Italian medical oncology units were invited to participate to the study via e-mail through the SurveyMonkey website. Participants were asked how, in their institution, exams of disease staging and follow-up are planned in asymptomatic women and if surveillance continues beyond the 5th year. Results: Between February and May 2013, 125 out of 233 (53.6%) invited referents of Italian medical oncology units agreed to participate in the survey. Ninety-seven (77.6%) referents state that modalities of breast cancer follow-up are planned according to the risk of disease progression at diagnosis and only 12 (9.6%) oncology units apply the minimal follow-up procedures according to international guidelines. Minimal follow-up is never applied in high risk asymptomatic women. Ninety-eight (78.4%) oncology units continue follow-up in all patients beyond 5 years. Conclusions: Our survey shows that 90.4% of participating Italian oncology units declare they do not apply the minimal breast cancer follow-up procedures after primary treatment in asymptomatic women, as suggested by national and international guidelines. Interestingly, about 80.0% of interviewed referents performs the so called "tailored follow-up", high intensity for high risk, low intensity for low risk patients. There is an urgent need of randomized clinical trials able to determine the effectiveness of risk-based follow-up modalities, their ideal frequency and persistence in time

Governare ad arte. Pratiche artistiche in cerca di cittadinanza

Governare ad arte è un programma di ricerca biennale – finanziato dalla Regione Sardegna e avviato alla fine del 2013 – che coinvolge sociologi e architetti delle Università di Sassari, Roma Sapienza e Bologna. La ricerca esplora i modelli di cittadinanza progettuale proposti da un genere di arte pubblica che, dalla metà degli anni ’90, la critica definisce relazionale, partecipativa, dialogica, processuale (Lacy 1995; Jacob et al. 1995; Miles 1997; Know 2004; Detheridge 2010). Si tratta di interventi estetici e politici al tempo stesso, che coinvolgono i cittadini nella trasformazione degli spazi pubblici, proponendo nuove relazioni, rappresentazioni e interpretazioni di questi spazi e dei loro conflitti. La ricerca studia le relazioni tra comunicazione artistica, cultura e partecipazione politica concentrandosi su queste pratiche contemporanee di arte pubblica relazionale, con l’obiettivo di superare alcuni dei limiti individuati negli studi culturali sui movimenti sociali e l’arte (Roth 1983; Eyerman, Jamison 1998; Roy 2010), nelle prospettive istituzionali sulla partecipazione culturale (DiMaggio 1986; Crane 1992) e nelle statistiche culturali (Laaksonen 2010; UNESCO 2012). In questi approcci teorico-metodologici, infatti, l’arte – in particolare la musica – è stata considerata come uno dei repertori di protesta, anziché come un territorio di partecipazione politica in sé, in grado di attivare processi culturali complessi, debolmente spiegati da variabili come la frequenza/soddisfazione dei cittadini che partecipano ad associazioni di volontariato/corsi d’arte o visitano musei/gallerie. In particolare, la ricerca RQ1) confronta le caratteristiche di queste azioni artistiche con alcuni tratti caratterizzanti delle azioni collettive contemporanee (Beck 1986; Giddens 1991; Micheletti 2003; Castells 2012; Bennett 2012); RQ2) esplora i modelli creativi di political engagement che queste pratiche artistiche propongono alle loro audience attive, performative ed empowered (Hall, Jefferson 1976; Abercrombrie, Longhurst 1998; Bolter, Grusin 1999: Jenkins 2006; Castells 2009; Dahlgren 2009); RQ3) analizza le relazioni tra questi modelli artistici di partecipazione politica e i modelli partecipativi di pianificazione territoriale (Arnstein 1969; Healey 2003; Lane 2005). I contesti in cui si concentra la ricerca (l’Italia, con un focus sulla Sardegna) risultano particolarmente interessanti alla luce di due tendenze: la crisi delle forme tradizionali di partecipazione politica (Istat 2014) e la svolta partecipativa delle politiche del territorio (Ciaffi, Mela 2006). La ricerca ha finora individuato (attraverso testimoni privilegiati, database, critica artistica) 85 dei più importanti progetti italiani di arte pubblica relazionale, attivati dal 2000 intorno a temi politici legati al territorio (ecologia, dialogo interculturale, richieste inascoltate delle periferie, etc.). E li ha analizzati attraverso un approccio mixed-method, registrando prima, a livello nazionale, gli attributi di una serie di variabili relative agli artisti (forma organizzativa, rapporto con il territorio dell’azione, etc.) e alle pratiche artistiche (committenti/finanziamenti, agenda, caratteristiche dei pubblici coinvolti, etc.), e intervistando poi, in Sardegna, artisti, amministratori e cittadini, con l’obiettivo di confrontare le diverse riflessività degli attori coinvolti nelle pratiche artistiche e i diversi contesti simbolici in cui vivono (Couldry 2010, 2012). Nel corso del secondo anno, il progetto prevede l’organizzazione di Laboratori di ricerca partecipata, in cui attivare un confronto tra i diversi attori coinvolti nella ricerca

Capecitabine plus oxaliplatin for the first-line treatment of elderly patients with metastatic colorectal carcinoma

BACKGROUND. In patients with metastatic colorectal carcinoma (MCC), capecitabine has demonstrated a superior response rate (RR), equivalent disease progression- free (PFS) and overall survival (OS), and an improved overall tolerability profile compared with bolus 5-.uorouracil/leucovorin (5-FU/LV). The FOLFOX4 regimen, combining oxaliplatin with LV and bolus plus infusional 5-FU (LV5FU2), has been shown to improve RR and PFS versus LV5FU2, and it was more effective and less toxic than irinotecan plus bolus 5-FU/LV. Capecitabine (an oral .uoropyrimidine) may be an effective, well tolerated, and more convenient alternative to 5-FU/LV in combination with oxaliplatin, especially in older patients. METHODS. Elderly ≥ 70 years) patients with MCC were treated with a 3-weekly regimen of oxaliplatin at an initial dose of 85 mg/m2 intravenously on Day 1 plus capecitabine 1000 mg/m2 orally twice daily from Days 2 to 15 (XELOX regimen). In the absence of Grade &#8805; 2 hematologic toxicity, oxaliplatin was increased to 100 mg/m2 in the second cycle, and in the absence of Grade &#8805; 2 nonhematologic adverse events during Cycle 2, capecitabine was increased to 1250 mg/ m2 twice daily in the third and subsequent cycles. After the first 35 patients (first series), the treatment protocol was amended so that only an oxaliplatin increase to 110 mg/ m2 and 130 mg/m2 during Cycles 2 and 3, respectively, was planned in the remaining 41 patients (second series). RESULTS. Seventy-six patients with a median age of 75 years (range, 70–82 years) entered the current study. In the first series, the oxaliplatin dose was increased in 18 (51%) patients, and the capecitabine dose was increased in 4 (11%) patients. In the second series, the oxaliplatin dose was increased to 110 mg/m2 in 26 (63%) patients, and to 130 mg/ m2 in 19 (46%) patients. In all, 2 complete and 29 partial responses were observed, for an overall RR of 41% (95% confidence interval [CI], 30–53%). The median PFS was 8.5 months (95% CI, 6.7–10.3 months), and the median OS was 14.4 months (95% CI, 11.9 –16.9 months). In a multivariate analysis, the presence of disease symptoms affected both PFS and OS, whereas OS also was independently affected by male gender and disease spread. Age had no independent effect on PFS or OS. Five percent of patients developed Grade &#8805; 3 hematologic toxicity during treatment, Grade 3 peripheral neuropathy occurred in 8% of patients, and severe hand-foot syndrome in 13% of patients. CONCLUSIONS. Fit elderly patients with MCC showed a good RR to XELOX with only mild toxicity observed in most patients. XELOX, should, therefore be considered as an important therapeutic option for elderly patients with MCC