Oncology, Infectious Diseases, Immunology and Microbiology, Microbiology
20
Scopus Publications
Scopus Publications
HIV and Cancer: Insights into Viral-Mediated Oncogenesis and Immunosuppression Angioletta Lasagna, Giacomo Pozza, Maddalena Matone, Cinzia Fasola, Lorenzo Ruggieri, Nicla La Verde, Paolo Pedrazzoli, Davide Dalu Pathogens, 2026 Background: People living with HIV (PLWH) have a substantially increased risk of both AIDS-defining cancers (ADCs) and non-AIDS-defining cancers (NADCs), which remain a major cause of morbidity despite effective antiretroviral therapy (ART); this review aims to integrate current epidemiological, molecular, and clinical evidence on HIV-associated oncogenesis. Methods: A structured literature search was conducted in PubMed (2000–2026) using predefined keywords, including “HIV”, “cancer”, “oncogenesis”, and “immune dysregulation”, with inclusion of original studies, systematic reviews, and meta-analyses meeting predefined quality criteria. Results: Available evidence indicates that HIV contributes to cancer development through both direct and indirect mechanisms: viral proteins such as Tat, Nef, and Vpr disrupt apoptosis, DNA repair, and cell cycle regulation, while chronic immune activation, persistent inflammation, and immunosuppression impair tumor immune surveillance and facilitate oncogenic viral co-infections, including Epstein–Barr virus, human papillomavirus, and human herpesvirus 8. Emerging pathways, such as epigenetic alterations, microRNA dysregulation, metabolic reprogramming, and the contribution of HIV reservoirs to pro-tumorigenic microenvironments, further modulate cancer risk. Conclusions: HIV may function as a cofactor that enhances the effects of oncogenic viruses by promoting viral persistence and immune dysregulation; while biologically plausible, direct evidence linking HIV to amplification of tumorigenesis in humans remains limited.
The impact of bio-psycho-social factors on mental health outcomes in patients with solid tumors Raffaela D.G. Sartori, Davide Dalu, Davide De Francesco, Valentina Biscaldi, Maria Silvia Cona, Anna Gambaro, Sabrina Ferrario, Lorenzo Ruggieri, Virginio Filipazzi, Cinzia Fasola, Cristina Marrazzo, Nicla La Verde Tumori, 2026 Introduction: The old oncology approach, which considered the clinical and performance status as the most relevant diseases course and well-being indexes, has been recently replaced by a care system also focusing on a person’s characteristics and needs. This study analyzed the role of physical symptoms, illness awareness, individual activities and social contexts on anxious/depressive symptoms and mental health in localized (LP) and advanced/metastatic (AMP) cancer patients. Methods: Socio-demographic and medical information was gathered. The Revised Illness Perception Questionnaire, Hospital and Depression Anxiety Scale, and Mental Health Continuum Short-Form were administered. Results: One hundred and thirteen patients, 75 LP and 38 AMP, aged 27-82, were enrolled. Unique patterns of difficulties and resources emerged at different stages of cancer. AMP reported a worse quality of life in perceived illness persistence and treatments control, anxious/depressive symptoms, and psychological well-being. In LP, higher levels of anxious/depressive symptoms were associated with lack of hobbies, and higher perceived illness control was linked to higher mental health. LP did not report higher well-being than AMP. No significant differences in flourishing persons distributions were detected among groups. A multivariable model showed that the independent presence of pain and partner influenced higher levels of mental health more in AMP than in LP. Conclusion: Tailored intervention should enhance individuals’ mental health and active resources mobilization.
Turning lessons into action: Building an inclusive oncology care for transgender and gender-diverse people- Pavia & Milano framework Amelia Barcellini, Chiara Cassani, Anna Maria Mancuso, Giuseppe Antonelli, Claudio Baggini, Laura Beduschi, Elisabetta Bettega, Fabiola Bologna, Daniele Calzavara, Cristina Campiglio, Francesco Celestina, Maria Grazia Colombo, Claudia Roberta Combei, Simone D’Alpaos, Silvia Deandrea, Silvia Desigis, Alessandra Dell’Era, Francesca Dionigi, Cinzia Fasola, Silvia Illari, Bianca Iula, Nicla La Verde, Manuela Nebuloni, Gianmarco Negri, Mara Ravasi, Lorenzo Ruggieri, Raffaela Sartori, Simona Secondino, Maria Silvia Spinelli, Barbara Tagliaferri, Davide Dalu, Laura Deborah Locati Journal of Cancer Policy, 2025 Italy remains one of the lowest-ranking Western European countries in terms of rights and protections for transgender and gender-diverse (TGD) individuals, with serious consequences for equitable healthcare access. In response to these disparities, and thanks to the initiative and support of the advocacy group Salute Donna Odv Salute Uomo, a multidisciplinary team organised a series of public conferences in Pavia and Milan in 2024. These events brought together healthcare professionals, researchers, LGBTQIA+ organisations, and patient advocates to define practical strategies for more inclusive cancer care. The outcome is a shared framework presented in this manuscript, aimed at enhancing cultural competence and institutional responsiveness in oncology services for TGD patients.
Rising Concern About the Carcinogenetic Role of Micro-Nanoplastics Lorenzo Ruggieri, Ottavia Amato, Cristina Marrazzo, Manuela Nebuloni, Davide Dalu, Maria Silvia Cona, Anna Gambaro, Eliana Rulli, Nicla La Verde International Journal of Molecular Sciences, 2025 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.
Management of polypharmacy and potential drug-drug interactions in people with HIV and cancer: insights from a 4-year multidisciplinary clinic experience Dario Cattaneo, Anna Lisa Ridolfo, Davide Dalu, Chiara Pruneri, Andrea Giacomelli, Maria Vittoria Cossu, Lorenzo Ruggieri, Cinzia Fasola, Aurora Civati, Alberto Dolci, Nicla La Verde, Spinello Antinori, Andrea Gori, Cristina Gervasoni Expert Opinion on Drug Metabolism and Toxicology, 2025 BACKGROUND People with HIV and cancer (PWHC) are often treated with different combinations of antiretroviral and oncology drugs, frequently associated with other co-medications; this significantly increases the risk of potential drug-drug interactions (DDIs). RESEARCH DESIGN AND METHODS A prospective observational study has been carried out from May 2020 to May 2024 to describe the management of therapies in PWHC in an outpatient clinic. RESULTS 140 PWHC treated with 42 different antiretroviral and 59 oncology regimens were enrolled, resulting in the identification of 410 DDIs. Of these, 8% were scored as red-flag DDIs). Among antiretroviral medications, 77% of red-flag DDIs involved ritonavir or cobicistat. Paclitaxel was the oncology drug most frequently associated with red-flag-DDIs (77%). Proton pump inhibitors (PPIs) were involved in 19% of red-flag and 32 of orange-flag DDIs. The most frequent recommendations included performing an electrocardiogram (38%), conducting therapeutic drug monitoring (31%), discontinuing PPIs (29%) and/or adjusting the timing of drug intake (28%). CONCLUSIONS A high prevalence of polypharmacy and clinically relevant DDIs was observed in our cohort of PWHC. A multidisciplinary team could play a pivotal role in optimizing pharmacological therapies in this clinical setting, for example, by reducing the use of PPIs and booster-based antiretroviral regimens.
Cancer Awareness Among People Living with HIV (PLWH): Insights from an Italian Survey of Oncologists and Infectious Disease Specialists Davide Dalu, Rosaria Iardino, Emanuela Vaccher, Angioletta Lasagna, Margherita Digaetano, Alberto Leone, Lorenzo Ruggieri, Eva Massari, Eva Blondeaux, Andrea Gori, Cristina Mussini, Giuliano Rizzardini, Matteo Bassetti, Antonio Di Biagio, Claudio Mastroianni, Luisa Brogonzoli, Mario Cascio, Francesco Perrone, Saverio Cinieri, Giordano Beretta, Nicla La Verde HIV AIDS Research and Palliative Care, 2025 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.
Ralstonia insidiosa Bacteremia in Patients with Solid Cancer Treated by Means of a Central Venous Catheter Lorenzo Ruggieri, Anna Lisa Ridolfo, Sara Giordana Rimoldi, Maria Silvia Cona, Davide Dalu, Pietro Olivieri, Giuliano Rizzardini, Spinello Antinori, Anna Gambaro, Sabrina Ferrario, Cinzia Fasola, Maria Antista, Carmen Giusy Rea, Nicla La Verde Hygiene, 2024 Ralstonia spp. are low-virulent environmental Gram-negative bacteria that can cause serious nosocomial infections in immunocompromised patients. We report the characteristics of a cluster of R. insidiosa bacteremia cases occurring in our oncology day ward in Milan, Italy, between January and March 2022. A case was defined as a cancer patient attending our day ward and whose blood culture (performed because of bacteremia symptoms) led to the isolation of Ralstonia insidiosa. An epidemiological investigation was conducted in order to seek the possible source of infection. Seven adult patients received curative or palliative treatment via infusion through a Port-a-Cath (PAC). All developed symptoms within 24 h of the infusion (three during the infusion itself). Ralstonia insidiosa was isolated in the blood drawn from the PAC in all patients. All of the isolates were susceptible to carbapenems, fluoroquinolones, and piperacillin/tazobactam but resistant to aminoglycosides and cephalosporins. Systemic and/or lock antibiotic therapy led to stable symptom resolution and negative blood cultures in five patients, whereas bacteremia recurred in two patients. An epidemiological investigation suggested that extrinsic contamination of antiseptic solutions was the possible cause of the R. insidiosa infections. Although R. insidiosa is not considered a virulent pathogen, clinicians, microbiologists, and infection control teams should be aware about its potential to cause outbreaks of nosocomial bloodstream infections, especially in immunocompromised patients bearing central venous catheters.
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 Davide Dalu, Anna Lisa Ridolfo, Lorenzo Ruggieri, Maria Silvia Cona, Agostino Riva, Davide De Francesco, Chiara Tricella, Cinzia Fasola, Sabrina Ferrario, Anna Gambaro, Benedetta Lombardi Stocchetti, Valeria Smiroldo, Gaia Rebecchi, Sheila Piva, Giorgia Carrozzo, Spinello Antinori, Nicla La Verde Vaccines, 2024 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.
Activity of osimeRTInib in non-small-cell lung Cancer with UNcommon epidermal growth factor receptor mutations: retrospective Observational multicenter study (ARTICUNO) E.G. Pizzutilo, A.G. Agostara, S. Oresti, D. Signorelli, S. Stabile, C. Lauricella, V. Motta, A. Amatu, L. Ruggieri, M. Brambilla, M. Occhipinti, C. Proto, R. Giusti, M. Filetti, C. Genova, G. Barletta, F. Gelsomino, C. Bennati, M. Siringo, G.R. Di Fazio, M. Russano, M. Montrone, E. Gariazzo, E. Roca, P. Bordi, A. Delmonte, A. Scimone, L. Belluomini, F. Mazzoni, A. Carta, G. Pelizzari, G. Viscardi, F. Morgillo, A. Gelibter, S. Gori, R. Berardi, D. Cortinovis, A. Ardizzoni, S.M. Veronese, A. Sartore-Bianchi, L.G. Giannetta, G. Cerea, S. Siena ESMO Open, 2024 •Largest dataset of NSCLC with uncommon EGFR alterations treated with osimertinib.•Best outcomes with compound uncommon–common EGFR mutations and with G719X, L861X, or S768I.•Heterogeneous activity with rarer mutations; no response with alterations at E709 residue.•Confirmed activity in the central nervous system, with intracranial ORR of 58%.•Amplification of EGFR or MET, TP53 mutations, and EGFR E709K are putative mechanisms of resistance. BackgroundOsimertinib represents the standard of care for the treatment of advanced non-small-cell lung cancer (NSCLC) harboring classical epidermal growth factor receptor (EGFR) mutations, constituting 80%-90% of all EGFR alterations. In the remaining cases, an assorted group of uncommon alterations of EGFR (uEGFR) can be detected, which confer variable sensitivity to previous generations of EGFR inhibitors, overall with lower therapeutic activity. Data on osimertinib in this setting are limited and strongly warranted.Patients and methodsThe ARTICUNO study retrospectively evaluated data on osimertinib activity from patients with advanced NSCLC harboring uEGFR treated in 21 clinical centers between August 2017 and March 2023. Data analysis was carried out with a descriptive aim. Investigators collected response data according to RECIST version 1.1 criteria. The median duration of response, progression-free survival (mPFS), and overall survival were estimated by the Kaplan–Meier method.ResultsEighty-six patients harboring uEGFR and treated with osimertinib were identified. Patients with ‘major’ uEGFR, that is, G719X, L861X, and S768I mutations (n = 51), had an overall response rate (ORR) and mPFS of 50% and 9 months, respectively. Variable outcomes were registered in cases with rarer ‘minor’ mutations (n = 27), with ORR and mPFS of 31% and 4 months, respectively. Among seven patients with exon 20 insertions, ORR was 14%, while the best outcome was registered among patients with compound mutations including at least one classical EGFR mutation (n = 13). Thirty patients presented brain metastases (BMs) and intracranial ORR and mPFS were 58% and 9 months, respectively. Amplification of EGFR or MET, TP53 mutations, and EGFR E709K emerged after osimertinib failure in a dataset of 18 patients with available rebiopsy.ConclusionThe ARTICUNO study confirms the activity of osimertinib in patients with uEGFR, especially in those with compound uncommon–common mutations, or major uEGFR, even in the presence of BMs. Alterations at the E709 residue of EGFR are associated with resistance to osimertinib. Osimertinib represents the standard of care for the treatment of advanced non-small-cell lung cancer (NSCLC) harboring classical epidermal growth factor receptor (EGFR) mutations, constituting 80%-90% of all EGFR alterations. In the remaining cases, an assorted group of uncommon alterations of EGFR (uEGFR) can be detected, which confer variable sensitivity to previous generations of EGFR inhibitors, overall with lower therapeutic activity. Data on osimertinib in this setting are limited and strongly warranted. The ARTICUNO study retrospectively evaluated data on osimertinib activity from patients with advanced NSCLC harboring uEGFR treated in 21 clinical centers between August 2017 and March 2023. Data analysis was carried out with a descriptive aim. Investigators collected response data according to RECIST version 1.1 criteria. The median duration of response, progression-free survival (mPFS), and overall survival were estimated by the Kaplan–Meier method. Eighty-six patients harboring uEGFR and treated with osimertinib were identified. Patients with ‘major’ uEGFR, that is, G719X, L861X, and S768I mutations (n = 51), had an overall response rate (ORR) and mPFS of 50% and 9 months, respectively. Variable outcomes were registered in cases with rarer ‘minor’ mutations (n = 27), with ORR and mPFS of 31% and 4 months, respectively. Among seven patients with exon 20 insertions, ORR was 14%, while the best outcome was registered among patients with compound mutations including at least one classical EGFR mutation (n = 13). Thirty patients presented brain metastases (BMs) and intracranial ORR and mPFS were 58% and 9 months, respectively. Amplification of EGFR or MET, TP53 mutations, and EGFR E709K emerged after osimertinib failure in a dataset of 18 patients with available rebiopsy. The ARTICUNO study confirms the activity of osimertinib in patients with uEGFR, especially in those with compound uncommon–common mutations, or major uEGFR, even in the presence of BMs. Alterations at the E709 residue of EGFR are associated with resistance to osimertinib.
Implications of hormonal carcinogenesis for transgender and gender-diverse people undergoing gender-Affirming hormone therapy: An up-To-date review Alberto Giovanni Leone, Stefania Bonadonna, Chiara Cassani, Amelia Barcellini, Marianna Sirico, Barbara Tagliaferri, Stefano Maccarone, Davide Dalu, Lorenzo Ruggieri, Filippo Ghelardi, Matteo Lambertini, Simone Nardin, Rossana Berardi, Nicla La Verde, Francesco Perrone, Saverio Cinieri, Dario Trapani, Filippo Pietrantonio BMJ Oncology, 2024 Transgender and gender-diverse (TGD) individuals face an elevated risk of cancer in comparison with the general population. This increased risk is primarily attributed to an imbalanced exposure to modifiable risk factors and a limited adherence to cancer screening programmes, stemming from historical social and economic marginalisation. Consequently, these factors contribute to poorer clinical outcomes in terms of cancer diagnosis and mortality. A focal point of interest is the potential carcinogenic effect of gender-affirming hormone therapy (GAHT). It is crucial to recognise that GAHT serves as an essential, life-saving treatment for TGD individuals. Therefore, if a demonstrated direct correlation between GAHT and elevated cancer risk emerges, essential shared decision-making discussions should occur between oncology practitioners and patients. This narrative review aims to collect and discuss evidence regarding potential correlations between GAHT and the most prevalent tumours known to be influenced by sex hormones. The objective is to comprehend how these potential carcinogenic effects impact health and inform health interventions for TGD individuals. Unfortunately, the scarcity of epidemiological data on cancer incidence in the TGD population persists due to the absence of sexual orientation and gender identity data collection in cancer centres. Consequently, in most cases, establishing a positive or negative correlation between GAHT and cancer risk remains speculative. There is an urgent need for concerted efforts from researchers and clinicians worldwide to overcome barriers and enhance cancer prevention and care in this specific population.
Antibody response to three-dose anti-SARS-CoV-2 mRNA-vaccination in treated solid cancer patients Davide Dalu, Maciej Tarkowski, Lorenzo Ruggieri, Maria Silvia Cona, Arianna Gabrieli, Davide De Francesco, Cinzia Fasola, Sabrina Ferrario, Anna Gambaro, Elsa Masedu, Gaia Parma, Eliana Rulli, Claudia De Stradis, Domenico Mavilio, Francesca Calcaterra, Federica Manoni, Agostino Riva, Nicla La Verde International Journal of Cancer, 2024
Clinical efficacy of the first two doses of anti-SARS-CoV-2 mRNA vaccines in solid cancer patients Maria Silvia Cona, Agostino Riva, Davide Dalu, Arianna Gabrieli, Cinzia Fasola, Giuseppe Lipari, Giacomo Pozza, Eliana Rulli, Francesca Galli, Lorenzo Ruggieri, Elsa Masedu, Gaia Parma, Davide Chizzoniti, Anna Gambaro, Sabrina Ferrario, Maria Antista, Matteo De Monte, Maciej S. Tarkowski, Nicla La Verde Cancer Medicine, 2023
