Gamondi C.,Oncology Institute of Southern Switzerland |
Pott M.,Clinical Research Unit |
Payne S.,Lancaster University
Annals of Oncology | Year: 2013
Background: In Switzerland, if certain conditions are met, assisted suicide is not prosecuted. International debate suggests that requests for hasten death are often altered by the provision of palliative care. Aims of the study were to explore patients' reasons for choice of assisted suicide and family perceptions of the interactions with health care professionals. Patients and methods: This is a qualitative study upon 11 relatives of 8 patients cared for by a palliative care team, deceased of assisted suicide. Results: Pain and symptom burden were not regarded by patients as key reasons to seek assisted suicide: existential distress and fear of loss of control were the determinants. Most patients had made pre-illness decisions to use assisted suicide. A general need for perceived control and fear of dependency were reported as a common characteristic of these patients. Patients held misunderstandings about the nature and purpose of palliative care, and the interviewed indicated that patients did not regard provision of palliative care services as influential in preventing their decision. Conclusions: Assisted suicide was preferred despite provision of palliative care. Better understanding of the importance placed on perceived control and anticipated dependency is needed. Further research is needed to develop appropriate support for patients contemplating assisted suicide. © The Author 2013. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved.
Brugger W.,Albert Ludwigs University of Freiburg |
Ghielmini M.,Oncology Institute of Southern Switzerland
Oncologist | Year: 2013
For patients with advanced indolent non-Hodgkin's lymphoma (NHL) or elderly patients with mantle cell lymphoma (MCL), the recently reported results of the German StiL NHL-1 2003 and the international BRIGHT phase III trials showed that, as first-line treatment, the combination of bendamustine and rituximab is at least as effective as rituximab/cyclophosphamide/doxorubicin/vincristine/prednisone or rituximab/cyclophosphamide/vincristine/prednisone, possibly with a better therapeutic index. Bendamustine is therefore increasingly used in clinical practice. Because bendamustine has been used for many years in Germany and in Switzerland, our institutions have had extensive experience with bendamustine, both as a single agent and in combination with rituximab. In this comprehensive review, we summarize the most important clinical data from phase II/III trials with bendamustine in patients with indolent NHL and MCL, both in the relapsed/refractory setting and in the first-line setting. In addition, this review provides practical advice on how to optimally manage bendamustine therapy in patients with NHL. © AlphaMed Press 2013.
Stathis A.,Oncology Institute of Southern Switzerland |
Younes A.,Memorial Sloan Kettering Cancer Center
Annals of Oncology | Year: 2015
Hodgkin lymphoma (HL) remains one of the most curable human cancers, as modern combination chemotherapy and radiation therapy cure ~80% of patients. Over the last two decades, the major efforts were focused on the development of more intensive front-line regimens for patients with advanced stage HL, decreasing the number of chemotherapy cycles and radiation therapy field and doses for patients with early-stage HL and incorporating positron emission tomography imaging in diagnostic, prognostic, and treatment planning. More recently, the improved knowledge of the molecular biology of the disease led to the development of highly active new agents, including the antibody-drug conjugate brentuximab vedotin and immune checkpoint inhibitors. Accordingly, the current efforts are focusing on incorporating these new agents into standard of care regimens, aiming at further improving cure rates, while reducing treatment-related toxicity. In this review, we will focus on the current status of HL therapy and how the development of new agents is re-shaping standard of care regimens. © The Author 2015. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved.
Fehr T.,University of Zürich |
Stussi G.,Oncology Institute of Southern Switzerland
Current Opinion in Organ Transplantation | Year: 2012
PURPOSE OF REVIEW: A dramatic shortage of available organs around the world encouraged attempts to cross previously forbidden immunological boundaries in kidney transplantation. This review focuses on the recent results of ABO-incompatible kidney transplantation. RECENT FINDINGS: The outcome of ABO-incompatible kidney transplantation in terms of patient and graft survival is comparable to ABO-compatible transplantation for adult and pediatric recipients. Splenectomy has been replaced by the B-cell-depleting agent rituximab to avoid isoagglutinin titer rebound, prevent antibody-mediated rejection, and improve graft survival. However, the risk for infections may be increased and warrants caution. Corticosteroids remain a necessary component of any ABO-incompatible protocol; early as well as late steroid withdrawal may bear an enhanced risk for acute rejection and should only be performed with careful follow-up including protocol biopsies. The few studies that have long-term outcomes using protocol biopsies have characterized a state of accommodation by up-regulation of complement inhibitors, down-regulation of A/B antigens, and establishment of endothelial chimerism over time. SUMMARY: The experience accumulated around the world indicates that ABO-incompatible kidney transplantation is well tolerated and effective in adults and in children, and it represents an important step forward in expanding the living donor pool. Further understanding of ABO-incompatible graft accommodation may have broader implication also for human leukocyte antigen-sensitized allograft recipients. © 2012 Wolters Kluwer Health | Lippincott Williams &. Wilkins.
Fasolo A.,Instituto Nazionale Dei Tumori |
Sessa C.,Oncology Institute of Southern Switzerland
Expert Opinion on Investigational Drugs | Year: 2011
Introduction: The mammalian target of the rapamycin (mTOR) signalling pathway has a central role in the regulation of cell growth, survival and angiogenesis and the frequent dysregulation of this pathway in tumor cells makes it a crucial target in the treatment of cancer. Temsirolimus and everolimus are approved for use in metastatic renal cell carcinoma and temsirolimus is also approved for mantle cell lymphoma. All three rapalogs, temsirolimus, everolimus and deforolimus, are currently being evaluated in Phase III studies in several tumors. Areas covered: This paper provides a review of the published literature on the mTOR pathway and related pathway signaling, analogs and novel mTOR inhibitors. The most recent and important data on the mTOR pathway, the role of mTOR inhibitors in cancer treatment and the current status of development of second-generation highly potent and selective mTOR inhibitors are overviewed. Expert opinion: The published data on new mTOR inhibitors are still limited, but the available preclinical results indicate that they have a potent antiproliferative activity against a broad panel of tumor cell lines, have a favorable safety profile, can obtain disease stabilization or even tumor regression and, in some cases, enhance the efficacy of other targeted or standard-of-care anticancer drugs when used in vivo in preclinical studies. © 2011 Informa UK, Ltd.
Valli M.C.,Oncology Institute of Southern Switzerland
Critical Reviews in Oncology/Hematology | Year: 2012
Post-mastectomy RT decreases the rate of locoregional recurrences of about 70% in all patients irrespective of age, tumor characteristics or systemic therapy. Post-mastectomy RT has to be proposed, moreover when locoregional lymph nodes are part of the PTV, if an optimal coverage of the PTV and a satisfactory sparing of the OAR could be obtained. Due to the results of meta-analysis, consensus conferences and randomized trials the long-term efficacy of RT in decreasing the risk of LRF is well established and the vast majority of women, treated with mastectomy, will benefit from it. © 2010 Elsevier Ireland Ltd.
Giovanella L.,Oncology Institute of Southern Switzerland
Expert Review of Endocrinology and Metabolism | Year: 2012
Differentiated thyroid cancer (DTC) generally has a favorable prognosis; however, the chance of a recurrence in patients with DTC is 20%, and 8% of patients with recurrence will subsequently die of the disease. After thyroid remnant ablation, detectable serum thyroglobulin levels are a sensitive marker for residual or recurrent disease, while imaging procedures, primarily neck ultrasound and an iodine-131 ( 131I) or iodine-123 diagnostic whole-body scan, are useful to localize recurrent disease. However, ultrasound cannot identify lesions outside the neck, and diagnostic whole-body scan is of limited value if progressive dedifferentiation of thyroid carcinoma cells occurs. In these patients, fluorine-18 ( 18F)-fluorodeoxyglucose PET/computed tomography ( 18FDG-PET/CT) has been shown to improve detection and localization of tumor foci. Additionally, 18FDG-PET/CT is also of value in selecting patients unlikely to benefit from additional 131I therapy and those at highest risk of disease-specific mortality, which may prompt more alternative therapies. Recently, iodine-124 ( 124I)-PET/CT was proved to perform better than low-dose diagnostic 131I scans. Additionally, 124I PET/CT succesfully predicts the results of subsequent high-dose post-treatment 131I scans and allows lesion-based dosimetric calculations. The present article reviews the utility and limitations of PET/CT techniques in DTC management and offers practical recommendations. © 2012 Expert Reviews Ltd.
Ghielmini M.,Oncology Institute of Southern Switzerland
Annals of Oncology | Year: 2010
Follicular lymphoma is an indolent and usually incurable disease. It has been therefore traditionally approached either by watch and wait or with single-agent treatments. The purpose was to maintain a good quality of life for a prolonged time. More aggressive regimens, including polychemotherapy, high-dose chemotherapy with stem-cell rescue and the emergence of new cytotoxic drugs have significantly improved the remission duration but could never demonstrate an impact on overall survival. In the past decade, through the addition of drugs acting on the immune system such as interferon or rituximab, the survival of follicular lymphoma patients could be improved by the range of several years. As a consequence several clinicians believe that we are near to a cure for follicular lymphoma so that the first-line treatment should be more aggressive to reach this goal. Nevertheless, at present, none of the new strategies can be shown to cure. We believe that even in the presence of many possible treatment options, watch and wait remains a good option for many patients with follicular lymphoma. When treatment is needed, chemotherapy with rituximab is the standard even though none of the chemotherapy regimens can be shown to be superior. As quality of life remains an issue, the combination of rituximab and bendamustine, a drug with high efficacy and a favourable toxicity profile, is a good new option for patients. © The Author 2010. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved.
Giovanella L.,Oncology Institute of Southern Switzerland |
Suriano S.,Oncology Institute of Southern Switzerland
Head and Neck | Year: 2011
Background The purpose of our study was to examine the prevalence of significant heterophilic antibody (HAb) interferences in serum calcitonin measurement in a large cohort of patients with thyroid nodules. Methods Enrolled in the study were 378 patients with thyroid nodules shown not to have medullary thyroid carcinoma (MTC) after extensive diagnostic workup. Serum calcitonin measurement was performed before and after incubating each serum sample in heterophilic-blocking tubes (HBTs) and the differences were calculated. Samples showing an absolute percentage difference greater than 3 SD from the mean percentage difference were considered as affected by heterophilic antibody interference. Results Five of 378 patients (1.3%) with HAb interferences were identified, 4 with clinically relevant false-positive calcitonin results. Conclusion A false-positive calcitonin result due to HAb interference occurs more frequently than MTC (1.3% vs 0%) in our patient series. A serum pretreatment in HBTs should be considered when increased serum calcitonin levels are found in a patient with a thyroid nodule to prevent unwarranted investigations or therapies. © 2010 Wiley Periodicals, Inc.
Oncology Institute Of Southern Switzerland | Date: 2012-12-04
The present invention relates to a therapeutic method for the treatment of cancer that comprises the use of a combination of inotuzumab ozogamicin (CMC-544) and temsirolimus. The enhanced antitumor of the combination therapy is particularly useful for patient population that are recalcitrant to inotuzumab ozogamicin or temsirolimus therapy, relapse after treatment with inotuzumab ozogamicin or temsirolimus or where enhanced antitumor effect reduces toxicities associated with treatment using inotuzumab ozogamicin or temsirolimus.