CHE COSA È L'OSTEONCOLOGIA IN ITALIA ? - TONI IBRAHIM BSC,MD, PHD HEAD OF OSTEONCOLOGY AND RARE TUMORS CENTER CANCER INSTITUTE OF ...
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
Che cosa è
l’Osteoncologia in Italia ?
Toni Ibrahim BSc,MD, PhD
Head of Osteoncology and Rare Tumors Center
Cancer Institute of Romagna,IRST-IRCCS
Meldola, Italy
Dichiarazione conflitto di interessi
Relationship Company/Organization
Honoraria Consultant EISAI
Grant to Institution Novartis
Partecipation expenses to congress Novartis, Pharmamar, Ipsen
Toni Ibrahim, 19/06/2019
Outline: 1- Hot topic in Oncology 2- Osteoncology = Evolution and Revolution 3- Conclusions
Hot topic in Oncology
Cancer
Cells
Microenvironment
Cross
talk
TO DOMINATE CANCER….
We need to join forces and speak the same language…
Lab
Researchers
Clinical
Researchers
Research
Support
Figures
Better understand
CANCER BIOLOGY and
PATIENT NEEDS
NATIONAL PROJECT: MULTIDISCIPLINARY APPROACH TO PATIENTS WITH
BONE METASTASES
Prof Dino Amadori
2000 2019
National training courses
2002 Bologna, Rome 2003 Naples, Bologna 2004 Naples, Florence
This strategy could be one of the oncology
Publications: 3 books
experiences, the recent discipline:
2003 - 2018
National training and practical courses in Osteoncology
Course
in Osteoncology
THE OSTEONCOLOGY
(Modena – Forlì- Meldola- Roma- Verona- others)
2003 - 2005
II level University Masters in Osteoncology
(Modena/Bologna/Forlì) Masters/PhD
2009-2019 in Osteoncology
PhD in Osteoncology (Campus Roma)
2008
2014 2016
National Multidisciplinary
Establishment of Establishment of
Osteoncology Osteoncology Bone
Osteoncology
field Center Metastases
Data Base School (MOS)
Osteoncology = Evolution and Revolution in Oncology
Outline: 1- Hot topic in Oncology 2- Osteoncology = Evolution and Revolution 3- Conclusions
New Bone- Cancer relationship
EVOLUTION
Primitive tumors 1- Bone metastases
2- Cancer Treatment Induced Bone Loss
(CTIBL)
REVOLUTION
- Foundation of a new field in Oncology: OSTEONCOLOGY
- Care: mono and multidisciplinary approach
- Research: thanks to new Knowledge in the pathogenesis of bone
metastases, on 2018 the aim of treatments is not only to prevent SREs, but
also to have an impact in the natural history of cancer.
Ibrahim T et al. Oncol Lett. 2013
Danno osseo indotto dai trattamenti antitumorali
Rate of BMD Loss
Normal men 0.5%
Late menop. women 1%
Early menop women 2%
Aromatase Inhibitor 2.6%
Bone Marrow transpl 3.3%
Androgen deprivation 4.6%
AI + GNrh agonist 7.0%
Ovarian failure due 7.6%
chemiother
0 2 4 6 8
Lumbar spine BMD (% /year Bone Loss)Impact of bone metastases
Osteoporosis/
Skeletal Related
CTIBL
Events
QoL Outcome CostsNew Bone- Cancer relationship
EVOLUTION
Primitive tumors 1- Bone metastases
2- Cancer Treatment Induced Bone Loss
(CTIBL)
REVOLUTION
- Foundation of a new field in Oncology: OSTEONCOLOGY
- Care: mono and multidisciplinary approach
- Research: thanks to new Knowledge in the pathogenesis of bone
metastases, on 2019 the aim of treatments is not only to prevent SREs, but
also to have an impact in the natural history of cancer.
Ibrahim T et al. Oncol Lett. 2013Oncologist
Dedicated Radiotherapist
Nurse
Palliative Care
Lab Reasearchers Expert
Orthopedic
Data Manager Specialist
Neurological
Pathologist
Patient with bone surgeon
Clinical Cancer disease General and
Pathologist Endocrine surgeon
Endocrinologist Radiologist
Nuclear Medicine
Psicologist Physician
Physiatrist OtolaryngologistNATIONAL PROJECT: MULTIDISCIPLINARY APPROACH TO PATIENTS WITH
BONE METASTASES
Prof Dino Amadori
2000 2019
National training courses
2002 Bologna, Rome 2003 Naples, Bologna 2004 Naples, Florence
Publications: 3 books
2003 - 2018
Course
National training and practical courses in Osteoncology
in Osteoncology
(Modena – Forlì- Meldola- Roma- Verona- others)
2003 - 2005
II level University Masters in Osteoncology
(Modena/Bologna/Forlì) Masters/PhD
2009-2019 in Osteoncology
PhD in Osteoncology (Campus Roma)
2008
2014 2016
National Multidisciplinary
Establishment of Establishment of
Osteoncology Osteoncology Bone
Osteoncology
field Center Metastases
Data Base School (MOS)Società Italiana di Osteoncologia
Mission
ASSISTENZA
Promuovere la formazione di gruppi multidisciplinari per la cura dei pazienti con
patologia oncologica ossea e favorire la nascita di nuovi centri specializzati
RICERCA
Promuovere e sostenere la ricerca di base, traslazionale e clinica, con particolare
riferimento agli studi multidisciplinari
DIDATTICA
Favorire la formazione dei professionisti delle discipline connesse all’osteoncologia
attraverso l’organizzazione di eventi formativi, convegni e la realizzazione di
pubblicazioni scientifiche dedicateSocietà Italiana di Osteoncologia
Governance
Consiglio Direttivo 2017/2020
Presidente: Gaetano Lanzetta
Segretario: Stefano Severi
Tesoriere: Vittorio Fusco
Consiglieri :
- Asssistenza: Alfredo Berruti
- Ricerca preclinica: Francesco Pantano
- Ricerca clinica: Toni Ibrahim
- Formazione: Roberto Casadei
Collegio dei Sindaci : Stefania Zoveto (Presidente), Tiziana Falbo, Laura Mercatali
Sede legale: Via Pietro Marroncelli, 40 . 47014 Meldola (FC)
C.F. 92068610408 P.I. 04113560405Rete Osteoncologia Nazionale
www.osteoncology.it
Centri accreditati di eccellenza:
- Centro di Osteoncologia presso l’istituto Scientifico Romagnolo per lo Studio e la
Cura dei Tumori IRCCS di Meldola
- Centro di Osteoncologia presso l’istituto Oncologico Veneto IOV
- Centro di Osteoncologia presso l’istituto Tumori Regina Elena, Roma
- Centro di Osteoncologia presso l’Università Campus Biomedico, Roma
Centri che rispettano i requisiti minimi:
- Centro di Osteoncologia presso l’istituto Neurotraumatologico Italiano,
Grottaferrata (RM)
- Centro di Osteoncologia presso Ospedale Gradenigo (TO)Multidisciplinary Osteoncology School (MOS)
IRST,IRCCS, Meldola
Aims: Promote training in Osteoncology (bone metastases/bone health):
- Mono- and multidisciplinary care
- Basic, translational and clinical research
- Integration between assistance and research
Target: All professionals interested in Osteoncology from lab to the clinic assistance
Methodology: Theorical and practical coursesNational Bone Metastases Data Base
Materials and Methods
BM Data Base is a multicenter prospective observational study, which has as Coordinating Center
(CC), IRCCS IRST of Meldola. The database will allow to gather information on the medical history of
patients with BM using an online software tailored for these data.
•The platform of the database consists of 4 files containing information regarding patient
demographics, characteristics of the primary tumors and BM, as well as their evolution, in particular
the onset and the types of SRE.
The data are updated every 6 months by the participating centers and reviewed by CC.National Bone Metastases Data Base For information about project, please contact: Alberto Bongiovanni: alberto.bongiovanni@irst.emr.it Flavia Foca: flavia.foca@irst.emr.it
National Bone Metastases data Base : Currently Projects …..
• Italian Bone Metastases Database: Breast Cancer Prospective Data
- Abstract ASCO 2016 e AIOM 2016
- Abstract AIOM 2019 ( submitted)
- In corso Analisi dei dati e stesura Paper per pubblicazione nel 2019
• Italian Bone Metastases Database NSCLC: Cancer Prospective Data
• Bone Metastases NSCLC: ICI + DENOSUMAB vs ICI + Zoledronate
• Prospective Study on BM management in elderly patient’s
• Prospective Study Sarcoma Bone MetastasesOsteoncology Center Osteoncology Center: Pathway Indicators 1- Effect on Quality of life and pain 2- Patient Satisfaction 3- Patient adherence 4- Attraction Index 5- Cost of service
Results: MDOT interventions
Results: BPI analysis A significant improvement in the worst (p
Results: Patient’s Satisfaction
Patient adherence 236 visits (1° semester 2018) only one patient did not attend the appointment at the Clinic
Attraction Index
(2014-2018)
6961 patients (percorso metastasi ossee e CTIBL)
2509 (37 %) Area Vasta Romagna
4452 (63 %) Ext. Area Vasta Romagna
1016 (23 %) Ext. Emilia RomagnaIl percorso assistenziale in osteoncologia : l’esperienza del
gruppo integrato di cure dell’Azienda Ospedaliera
S. Giovanni battista di Torino
The cost analysis of the GIC group confirms this change:
(120 patients GIC vs 35 patients pre-GIC):
• A mean cost reduction of 225 euro per patient;
• Diagnosis more expensive;
• Lower cost of hospital admission (surgery);
• Surgery definitive, not palliative kind (preventive fracture);
• Fifty percent reduction in waiting time from hospitalisation
to surgery
Colangelo I, Mecosan 2006New Bone- Cancer relationship
EVOLUTION
Primitive tumors 1- Bone metastases
2- Cancer Treatment Induced Bone Loss
(CTIBL)
REVOLUTION
- Foundation of a new field in Oncology: OSTEONCOLOGY
- Care: mono and multidisciplinary approach
- Research: thanks to new Knowledge in the pathogenesis of bone
metastases, on 2019 the aim of treatments is not only to prevent SREs, but
also to have an impact in the natural history of cancer.
Ibrahim T et al. Oncol Lett. 2013Bone Metastases Are a Mixture of
Osteoblastic and Osteoclastic Lesions
Osteoblastic Mixed Osteolytic
Myeloma
Breast
Prostate
Adapted from: Halvorson K et al. Clin J Pain. 2006;22:587.
At
http://www.meddean.luc.edu/lumen/MedEd/Radio/curriculum/Surgery/Met_bone_list1.htmOSTEOLYTIC MODEL: a vicious cycle
RANK
Buijs, The prostate,2009OSTEOBLASTIC MODEL: a vicious cycle
(A) Prostate cancer cells secrete osteogenic growth factors, activating osteoblasts to deposit new bone matrix.
(B) Osteoblasts secrete a range of additional factors such as insulin-like growth factor (IGF), fibroblast growth factor
(FGF), and transforming growth factor-b (TGFb).
(C) These factors attract prostate cancer cells, further enhancing their proliferation and growth.
Ibrahim T, Cancer 2010Treatment of Bone Metastases
Medical treatment of bone
metastases has become
progressively complex and currently
includes:
well known antitumor agents
bone targeted molecules
Ibrahim T, Tumori 2013The Metastatic Process: hypothesis
CTIBL
2
1 MSC, HSC STRESSING
Peripheral Bone Bone FACTORS Primitive
tissues (HSC, MSC) (MSC, MF, (cytokines,
tumor
Neut) exosomes…)
physiologica HSC MSC, TAM,
lHSC niche in patrolling TAN
tissue
HSC, 3
Mac
Peripheral
tissues
Pre-metastatic
(bone, liver, niche
lung…)
Death
4
CTC, DTC
Dormancy Metastatic from primary
tumor/bone
niche
(bone, liver, lung…)
Metastatic
growth
Ibrahim T, not pubblishedThe metastatic process/pre-metastatic Niche
Osteoblast cells regulate HSC cells and are
Tumour cell
closely linked with vascular remodeling and
arriving in bone
osteoclast activity
Perivascular
Osteoblastic
Niche Osteoclast
Niche
Tumour cell
Hematopoietic
Osteoblast
stem cell niche
HSCBone Microenvironment
CTIBL
Shiozawa Y, Clinical Cancer Research, 2011Summary
Bone Targeted Therapy
-The use of adjuvant BTT has now been demonstrated to
reduce the development of bone metastasis, distant
recurrence, and breast cancer mortality among
Advanced setting
postmenopausal women and in premenopausal women
undergoing ovarian suppression.
- The use of Denosumab has now been demonstrated in
prostate cancer patients at high risk of reccurence, to reduce
the development of bone metastasis. No effect on mortality.
Adjuvant settingOutline: 1- Hot topic in Oncology 2- Osteoncology = Evolution and Revolution 3- Conclusions
Osteoncology
Bone Health/Omeostasis
QoL Costs
Outcome
NATURAL HISTORY OF CANCERNew Bone- Cancer relationship
EVOLUTION
Primitive tumors 1- Bone metastases
2- Cancer Treatment Induced Bone Loss
(CTIBL)
REVOLUTION
- Foundation of a new field in Oncology: OSTEONCOLOGY
- Care: mono and multidisciplinary approach
- Research: thanks to new Knowledge in the pathogenesis of bone
metastases, on 2018 the aim of treatments is not only to prevent SREs, but
also to have an impact in the natural history of cancer.
Ibrahim T et al. Oncol Lett. 2013Normal bone turnover: bone breackdown
and bone formation are in equilibrium
T5
T5
T11
L1
T11
L1
- Progressivo calo del CA 15.3 (10/10: 50, 02/11: 29): Ca duttale inf mammario ER/PgR + in trattamento con Letrozolo
- Stabilità pleurica: eupnoica;
- Dicembre 2010: si reca al PS per dolore acuto rachide con crolli e vertebroplastica T11 e L1;
- Persistenza del dolore che ha necessitato un ulteriore lungo ricovero e inserimento catetere epidurale;
- Gennaio 2011: consulenza CDO, inizia bisfosfonato ev con supplementazione di calcio e vitamina D3
- Aprile 2011: TC visceri e osso stabili, markers negativi e pz con analgesici orali (Oxycontin 30 x 2).CDO-TR strategies for a new tarsversal discipline as
Osteoncology and Rare Tumors
Method: Team
(Lab/Clinic)
Mono/multidisciplinary approach:
assistance and reasearch
2005
Specific expertise
2011
National and International
Network/Collaborations
2019
Pharmaceutical companies
Spontaneous ReasearchNational and International Collaborations
Princeton
Univ. NY
Duke Leiden
(USA)
University Univ Medical
(USA) Y. Kang
Centre (Olanda)
X. Wang G. Van der
Pluijm
Osteoncology National Network
Pathology
Unit TMHRI
AVR
CDO-TR Texas Univ.
Houston,USA
CCCN Romagna
M. Ferrari
Campus Bio-
medico Univ
Rome
Prof Santini Istituti
Rare Tumors Network
Ortopedici
Regina Elena Rizzoli, BO
(Prof Donati)
Institute Modena
Rome University
Prof Biagini Prof CataniL’Osteoncologia ……
Osteoncology and
Rare Tumors Center
CDO-TR
Director: Toni Ibrahim
Oncologists: Lab Researchers:
Alberto Bongiovanni Laura Mercatali
Sebastiano Calpona Chiara Liverani Centro di
Giandomenico Di Menna Alessandro De Vita Eccellenza
Lorena Gurrieri Chiara Spadazzi Member and Collaborations:
Federica Recine Giacomo Miserocchi - CCCN of Romagna
Nada Riva Claudia Cocchi - National Network of Osteoncology
Valentina Fausti (Tr) - National Network of Rare Tumors
Sivia De Bonis (Tr) Specialist Nurse:
- EURACAN (European Reference Network)
Venetia Zavoiu - University of Bologna, Modena, Milan and Ferrara
Data Manager: - Alleanza Contro il Cancro
Pharmacyst:
Benedetta Rossi - Istituto Ortopedico Rizzoli
Valentina Di Iorio
Monia Dall’Agata - Princeton University, USA
Alessandra Affatato - The Methodist Research Institute, Houston,USA
Statistic: - Leiden University, The Netherlends 50
Flavia FocaYou can also read
