1
|
Wong T, Fuld AD, Feller-Kopman DJ. Malignant Pleural Effusions in the Era of Immunotherapy and Antiangiogenic Therapy. Semin Respir Crit Care Med 2023. [PMID: 37308114 DOI: 10.1055/s-0043-1769092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Malignant pleural effusions (MPE) have historically been associated with a poor prognosis, and patients often require a series of invasive procedures and hospitalizations that significantly reduce quality of life at the terminus of life. However, advances in the management of MPE have coincided with the era of immunotherapies, and to a lesser extent, antiangiogenic therapies for the treatment of lung cancer. Landmark studies have shown these drugs to improve overall survival and progression-free survival in patients with lung cancer, but a paucity of phase III trial data exists for the impact of immune checkpoint inhibitors (ICI) on lung cancers associated with MPE. This review will focus on the leading studies investigating the impact of ICI and antiangiogenic therapies in patients with lung cancer and MPE. The diagnostic and prognostic values of vascular endothelial growth factor and endostatin expression levels in malignancy will also be discussed. These advancements are changing the paradigm of MPE management from palliation to treatment for the first time since 1767 when MPE was first reported. The future holds the promise of durable response and extended survival in patients with MPE.
Collapse
Affiliation(s)
- Terrence Wong
- Department of Medicine, Geisel School of Medicine, Dartmouth, Hanover, New Hampshire
- Division of Pulmonary and Critical Care Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Alexander D Fuld
- Department of Medicine and Medical Education, Geisel School of Medicine, Dartmouth, Hanover, New Hampshire
- Department of Medical Oncology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - David J Feller-Kopman
- Department of Medicine, Geisel School of Medicine, Dartmouth, Hanover, New Hampshire
- Division of Pulmonary and Critical Care Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| |
Collapse
|
2
|
Kashima A, Fukuda Y, Shimamura M, Ijichi M, Sagara H. Successful treatment of extensive-stage small cell lung cancer with concurrent pleural and pericardial effusions: Case report. Front Oncol 2022; 12:1040452. [PMID: 36620539 PMCID: PMC9816567 DOI: 10.3389/fonc.2022.1040452] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 12/05/2022] [Indexed: 12/25/2022] Open
Abstract
It is unclear whether pleural/pericardial drainage and pleurodesis/pericardiodesis should be performed before or after initiating chemotherapy in patients with chemotherapy-sensitive small-cell lung cancer. A 76-year-old woman presented to the emergency department with progressive dyspnea on exertion for a week. Chest computed tomography showed a mass shadow anterior to the left upper lobe, bilateral pleural effusions, and a circumferential pericardial effusion surrounding the heart. We diagnosed extensive-stage small-cell lung cancer based on the clinical course and pathological findings. We first performed pleurodesis and pericardial drainage and successfully initiated immune checkpoint inhibitor combined chemotherapy, with improved performance status. This case highlights the importance of aggressive drainage and pleurodesis/pericardiodesis, and suggests that drainage and pleurodesis/pericardiodesis should be considered before systemic chemotherapy in patients with concurrent pericardial or pleural effusions, even in patients with small-cell lung cancer that is sensitive to chemotherapy.
Collapse
|
3
|
Nakagawa N, Kawakami M. Choosing the optimal immunotherapeutic strategies for non-small cell lung cancer based on clinical factors. Front Oncol 2022; 12:952393. [PMID: 36033471 PMCID: PMC9414869 DOI: 10.3389/fonc.2022.952393] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 07/04/2022] [Indexed: 11/24/2022] Open
Abstract
The treatment landscape of advanced non-small cell lung cancer (NSCLC) has changed dramatically since the emergence of immune checkpoint inhibitors (ICIs). Although some patients achieve long survival with relatively mild toxicities, not all patients experience such benefits from ICI treatment. There are several ways to use ICIs in NSCLC patients, including monotherapy, combination immunotherapy, and combination chemoimmunotherapy. Decision-making in the selection of an ICI treatment regimen for NSCLC is complicated partly because of the absence of head-to-head prospective comparisons. Programmed death-ligand 1 (PD-L1) expression is currently considered a standard biomarker for predicting the efficacy of ICIs, although some limitations exist. In addition to the PD-L1 tumor proportion score, many other clinical factors should also be considered to determine the optimal treatment strategy for each patient, including age, performance status, histological subtypes, comorbidities, status of oncogenic driver mutation, and metastatic sites. Nevertheless, evidence of the efficacy and safety of ICIs with some specific conditions of these factors is insufficient. Indeed, patients with poor performance status, oncogenic driver mutations, or interstitial lung disease have frequently been set as ineligible in randomized clinical trials of NSCLC. ICI use in these patients is controversial and remains to be discussed. It is important to select patients for whom ICIs can benefit the most from these populations. In this article, we review previous reports of clinical trials or experience in using ICIs in NSCLC, focusing on several clinical factors that are associated with treatment outcomes, and then discuss the optimal ICI treatment strategies for NSCLC.
Collapse
|
4
|
Albumin Paclitaxel Combined with Intrapleural Infusion of Bevacizumab + Lobaplatin for the Second-Line Treatment of Patients with Non-Squamous Non-Small Cell Lung Cancer. JOURNAL OF ONCOLOGY 2022; 2022:5901450. [PMID: 35794989 PMCID: PMC9251141 DOI: 10.1155/2022/5901450] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 05/26/2022] [Indexed: 12/26/2022]
Abstract
Objective To investigate the clinical efficacy and safety of albumin paclitaxel combined with intrapleural bevacizumab + lobaplatin for patients with non-squamous non-small cell lung cancer (NS-NSCLC) with malignant pleural effusion (MPE) and analyze prognostic factors. Methods A total of 126 NS-NSCLC patients were included in the study. Control group with 64 cases received intrapleural infusion of lobaplatin + intravenous albumin paclitaxel, and treatment group with 62 cases received additional intrapleural bevacizumab perfusion. Analysis was performed by collecting data about MPE, progression-free survival (PFS), overall survival (OS), and scores of quality of life. Results In the treatment and control groups, objective response rate (ORR) was 51.6% and 31.3% (χ2 = 5.39, P=0.02), and disease control rate (DCR) was 91.9% and 71.9% (χ2 = 8.49, P=0.004), respectively. The main adverse reactions (≥grade 3) in the treatment group were thrombocytopenia, peripheral neurotoxicity, proteinuria, neutropenia, and nausea/vomiting, and in the control group, they were weakness, nausea/vomiting, anemia, and peripheral neurotoxicity. In the control and treatment groups, the median PFS was 6.2 (95% confidence interval (CI): 5.86–6.56) and 5.1 (95% CI: 4.956–5.191), and the median OS was 14.4 (95% CI: 12.681–16.113) and 10.6 months (95% CI: 8.759–12.391). The score of quality of life for treated patients was significantly higher than those before treatment and the control group, and the parameters included general health status (GH), role physical (RP), body pain (BP), social function (SF), and vitality (VT); pH, CD4+/CD8+ values, and vascular endothelial growth factor (VEGF) in the pleural effusion significantly affected the PFS and OS (P < 0.05). Bevacizumab administration in patients with bloody pleural effusion did not increase the risk of pleural hemorrhage. Conclusion The combination of albumin paclitaxel and intrapleural bevacizumab + lobaplatin is effective and may reverse the adverse events in patients with NS-NSCLC and MPE. The change of CD4+/CD8+ ratio before and after treatment is an independent and prognostic factor for patients with NS-NSCLC and MPE.
Collapse
|
5
|
Kawachi H, Tamiya M, Taniguchi Y, Yokoyama T, Yokoe S, Oya Y, Imaji M, Okabe F, Kanazu M, Sakata Y, Uematsu S, Tanaka S, Arai D, Saito G, Kobe H, Miyauchi E, Okada A, Hara S, Kumagai T. Efficacy of Immune Checkpoint Inhibitor With or Without Chemotherapy for Non–Squamous Non-Small Cell Lung Cancer with Malignant Pleural Effusion: A Retrospective Multicenter Cohort Study. JTO Clin Res Rep 2022; 3:100355. [PMID: 35769388 PMCID: PMC9234704 DOI: 10.1016/j.jtocrr.2022.100355] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 05/30/2022] [Accepted: 05/31/2022] [Indexed: 11/04/2022] Open
Abstract
Introduction Malignant pleural effusion (MPE) is associated with poor treatment outcome in patients with NSCLC receiving immune checkpoint inhibitors (ICIs). ICIs and chemotherapy (ICI/Chemo) combination therapy is currently the standard therapy for NSCLC, and some ICI/Chemo regimens for nonsquamous (non-Sq) NSCLC contain bevacizumab (BEV), which is effective for controlling MPE and may enhance immune response. This study aimed to determine the optimal first-line treatment for this clinical population. Methods We retrospectively enrolled consecutive patients with non-Sq NSCLC with MPE who received ICI/Chemo or pembrolizumab monotherapy. Treatment outcomes were analyzed in patients with programmed death-ligand 1 (PD-L1) tumor proportion score more than or equal to 50% who were administered ICI/Chemo or pembrolizumab monotherapy (PD-L1 high cohort) and in patients with any PD-L1 status, treated with ICI/Chemo with or without BEV (ICI/Chemo cohort). We used propensity score matching (PSM) to reduce bias. Results PD-L1 high and ICI/Chemo cohorts included 143 and 139 patients, respectively. In PD-L1 high cohort, 37 patients received ICI/Chemo. With PSM, the median progression-free survival was significantly longer in the ICI/Chemo group than in the pembrolizumab group (11.1 versus 3.9 mo, respectively, p = 0.0409). In the ICI/Chemo cohort, 23 patients received BEV. With PSM, no significant difference occurred in median progression-free survival between BEV and non-BEV groups (6.1 versus 7.4 mo, p = 0.9610). Conclusion ICI/Chemo seemed more effective than pembrolizumab monotherapy for patients with non-Sq NSCLC with MPE. Nevertheless, the synergistic effect of BEV with ICI/Chemo may be limited. Further studies are needed to clarify the key factor in the tumor-induced immunosuppression environment in these patients.
Collapse
|
6
|
Yanagihara T, Matsumoto K, Yoneda R, Egashira A, Mannoji H, Watanabe H, Hanaoka K, Nakayama Y, Ogo N, Inutsuka Y, Asoh T, Kohashi K, Kinoshita I, Oda Y, Maeyama T. Lenvatinib for poorly differentiated carcinoma of the anterior mediastinum. Respir Med Case Rep 2021; 33:101477. [PMID: 34401310 PMCID: PMC8349103 DOI: 10.1016/j.rmcr.2021.101477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 07/02/2021] [Accepted: 07/08/2021] [Indexed: 11/22/2022] Open
Abstract
We describe a Case of a 74-year-old Japanese man with poorly differentiated carcinoma of the anterior mediastinum. The patient underwent anterior mediastinal tumor resection through median sternotomy. The tumor, 7.0 × 5.0 cm, had invaded surrounding tissues (pericardium, right lung, right and left brachiocephalic veins, and superior vena cava). Complete resection of the tumor was not performed. One month after the operation, the patient developed multiple pulmonary metastases, right pleural dissemination, and carcinomatous pleurisy. He was treated with lenvatinib, a novel multi-kinase inhibitor, to which the metastasis responded favorably. This case reports for the first time the clinical usefulness of lenvatinib for poorly differentiated carcinoma of the anterior mediastinum. Management of side effects by several methods, including suspending use of medication on weekends (called a weekends-off strategy), is another strong argument to continue lenvatinib administration.
Collapse
Affiliation(s)
- Toyoshi Yanagihara
- Department of Respiratory Medicine, Hamanomachi Hospital, Fukuoka, Japan
| | | | - Reiko Yoneda
- Department of Pathology, Hamanomachi Hospital, Fukuoka, Japan
| | - Ayaka Egashira
- Department of Respiratory Medicine, Hamanomachi Hospital, Fukuoka, Japan
| | - Hiroshi Mannoji
- Department of Cardiovascular Medicine, Hamanomachi Hospital, Fukuoka, Japan
| | - Hiroko Watanabe
- Department of Endocrinology, Hamanomachi Hospital, Fukuoka, Japan
| | - Katsuzo Hanaoka
- Department of Respiratory Medicine, Hamanomachi Hospital, Fukuoka, Japan
| | - Yuuka Nakayama
- Department of Respiratory Medicine, Hamanomachi Hospital, Fukuoka, Japan
| | - Naruhiko Ogo
- Department of Respiratory Medicine, Hamanomachi Hospital, Fukuoka, Japan
| | - Yu Inutsuka
- Department of Respiratory Medicine, Hamanomachi Hospital, Fukuoka, Japan
| | - Tatsuma Asoh
- Department of Respiratory Medicine, Hamanomachi Hospital, Fukuoka, Japan
| | - Kenichi Kohashi
- Department of Anatomic Pathology, Pathological Sciences, Graduate School of Medical Sciences, Kyushu University, Japan
| | - Izumi Kinoshita
- Department of Anatomic Pathology, Pathological Sciences, Graduate School of Medical Sciences, Kyushu University, Japan
| | - Yoshinao Oda
- Department of Anatomic Pathology, Pathological Sciences, Graduate School of Medical Sciences, Kyushu University, Japan
| | - Takashige Maeyama
- Department of Respiratory Medicine, Hamanomachi Hospital, Fukuoka, Japan
| |
Collapse
|
7
|
Matsumoto K, Tamiya A, Matsuda Y, Taniguchi Y, Atagi S, Kawachi H, Tamiya M, Tanizaki S, Uchida J, Ueno K, Yanase T, Suzuki H, Hirashima T. Impact of docetaxel plus ramucirumab on metastatic site in previously treated patients with non-small cell lung cancer: a multicenter retrospective study. Transl Lung Cancer Res 2021; 10:1642-1652. [PMID: 34012781 PMCID: PMC8107751 DOI: 10.21037/tlcr-20-1263] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background Docetaxel (DOC) plus ramucirumab (RAM) has been recommended as an optimal therapy for previously treated patients with non-small cell lung cancer (NSCLC). In a clinical setting, there are few reports about DOC plus RAM, therefore its effect on factors such as Eastern Cooperative Oncology Group (ECOG) performance status (PS) and metastatic sites is still unknown. Methods We recruited NSCLC patients who received DOC plus RAM in four medical facilities in Japan from June 2016 to March 2020. We retrospectively investigated the overall response rate (ORR), disease control rate (DCR), and progression-free survival (PFS) of DOC plus RAM and conducted univariate and multivariate analyses using PFS as a dependent factor. Patients were followed up until June 30, 2020. Results A total of 237 patients were consecutively enrolled. For all patients, the ORR, DCR, and median PFS were 25.2%, 63.9%, and 4.5 months, respectively. The ORR and DCR for malignant pleural effusion (MPE), lung metastasis, and liver metastasis were 7.7% and 53.8%, 30.3% and 77.5%, and 48.6% and 71.4%, respectively. In the multivariate analysis, MPE, lung metastasis, and liver metastasis were not prognostic factors for poor PFS. However, ECOG-PS 2 or more [hazard ratio (HR): 1.66, 95% confidence interval (CI): 1.14–2.40, P=0.008] and brain metastasis (HR: 1.71, 95% CI: 1.23–2.37, P=0.001) were significant and independent factors associated with shorter PFS. Conclusions DOC plus RAM could be an optimal therapy for previous treated NSCLC patients with lung and liver metastasis, and furthermore, should be used carefully for patients with poor ECOG-PS or brain metastasis. Keywords Docetaxel and ramucirumab; non-small cell lung cancer (NSCLC); metastatic site; poor performance status
Collapse
Affiliation(s)
- Kinnosuke Matsumoto
- Department of Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka, Japan
| | - Akihiro Tamiya
- Department of Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka, Japan
| | - Yoshinobu Matsuda
- Department of Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka, Japan
| | - Yoshihiko Taniguchi
- Department of Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka, Japan
| | - Shinji Atagi
- Clinical Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka, Japan
| | - Hayato Kawachi
- Department of Respiratory Medicine, Osaka International Cancer Institute, Osaka, Japan
| | - Motohiro Tamiya
- Department of Respiratory Medicine, Osaka International Cancer Institute, Osaka, Japan
| | - Satoshi Tanizaki
- Department of Respiratory Medicine, Osaka General Medical Center, Osaka, Japan
| | - Junji Uchida
- Department of Respiratory Medicine, Osaka General Medical Center, Osaka, Japan
| | - Kiyonobu Ueno
- Department of Respiratory Medicine, Osaka General Medical Center, Osaka, Japan
| | - Takafumi Yanase
- Department of Respiratory Medicine, Osaka Prefectural Medical Center for Respiratory and Allergic Disease, Osaka, Japan
| | - Hidekazu Suzuki
- Department of Respiratory Medicine, Osaka Prefectural Medical Center for Respiratory and Allergic Disease, Osaka, Japan
| | - Tomonori Hirashima
- Department of Respiratory Medicine, Osaka Prefectural Medical Center for Respiratory and Allergic Disease, Osaka, Japan
| |
Collapse
|
8
|
Nakamoto S, Watanabe J, Ohtani S, Morita S, Ikeda M. Bevacizumab as First-line Treatment for HER2-negative Advanced Breast Cancer: Paclitaxel plus Bevacizumab Versus Other Chemotherapy. In Vivo 2021; 34:1377-1386. [PMID: 32354934 DOI: 10.21873/invivo.11917] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 03/06/2020] [Accepted: 03/09/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND The efficacy of paclitaxel and bevacizumab (PB) compared with other chemotherapies in patients with human epidermal growth factor receptor 2-negative (HER2-) advanced breast cancer is unclear. PATIENTS AND METHODS We retrospectively investigated 301 patients with HER2- ABC who received first-line chemotherapy from January 2011 to December 2016. RESULTS We included 114 patients who received PB and 187 patients who received other chemotherapies. After propensity score matching, the PB group showed a significantly superior overall response rate (77.8% vs. 38.9%, p<0.0001) and median time to treatment failure (7.3 vs. 5.9 months, p=0.035). In subgroup analyses, PB improved the median overall survival of patients with pleural lesions or pulmonary lymphangiopathy (not reached vs. 18.9 months, p=0.037), and of patients with three or more metastatic sites without liver metastases, (48.0 vs. 27.3 months, p=0.015). CONCLUSION Compared with conventional chemotherapy, PB improved the overall response rate and time to treatment failure in patients with HER2- advanced breast cancer and improved overall survival in some patient subgroups.
Collapse
Affiliation(s)
- Shogo Nakamoto
- Department of Breast Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | | | - Shoichiro Ohtani
- Department of Breast Surgery, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Satoshi Morita
- Department of Biomedical Statistics and Bioinformatics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Masahiko Ikeda
- Department of Breast and Thyroid Gland Surgery, Fukuyama City Hospital, Fukuyama, Japan
| |
Collapse
|
9
|
Tamiya M, Tamiya A, Suzuki H, Taniguchi Y, Katayama K, Minomo S, Nakao K, Takeuchi N, Matsuda Y, Naito Y, Shiroyama T, Okamoto N, Okishio K, Kumagai T, Atagi S, Imamura F, Hirashima T. Phase 2 study of bevacizumab plus carboplatin/nab-paclitaxel followed by bevacizumab plus nab-paclitaxel for non-squamous non-small cell lung cancer with malignant pleural effusion. Invest New Drugs 2021; 39:1106-1112. [PMID: 33544282 DOI: 10.1007/s10637-021-01076-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 01/25/2021] [Indexed: 01/01/2023]
Abstract
Objectives Vascular endothelial growth factor plays an important role in the pathogenesis of malignant pleural effusion (MPE). We previously showed the efficacy of bevacizumab (Bev) plus carboplatin (CBDCA)/paclitaxel (PTX) in the treatment of non-small lung cell cancer (NSCLC) with MPE. However, the toxicities were a little severe, and the efficacy was not satisfied sufficiently. Therefore, we conducted a phase II study for NSCLC with MPE to evaluate the efficacy and safety of Bev plus CBDCA/nab-PTX, which is a new combination therapy. Methods Chemotherapy-naive non-squamous (SQ) NSCLC patients with MPE participated in the study. A single aspiration (not allowing chest tube drainage) was allowed before chemotherapy. Patients received a maximum of six cycles of Bev (15 mg/kg, day1) plus CBDCA (AUC 6, day1)/nab-PTX (100 mg/m2, day1, 8) every 3 weeks followed by Bev (15 mg/kg, day1) plus nab-PTX (100 mg/m2, day1, 8) every 3 weeks without disease progression or unacceptable severe toxicities. The primary endpoint was objective response rate (ORR). Results The study enrollment was ceased because of suspension of the registration period (as scheduled) after 12 of 20 planned patients were treated successfully between March 2014 and February 2018. The ORR was 58.3 % (95 % CI, 27.7-84.8 %), and the disease control rate was 100 % (95 % CI, 73.5-100 %). Eight patients received maintenance therapy. Median progression-free and overall survival times were 14.4 and 26.9 months, respectively. Most patients experienced hematological toxicities, including ≥ grade 3 neutropenia and anemia; none experienced severe bleeding events and grade 5 toxicities. Conclusion The combination of Bev plus CBDCA/nab-PTX, a novel combination, might have efficacy with acceptable toxicities in chemotherapy-naïve non-SQ NSCLC patients with MPE.Trial Registration University Hospital Medical Information Network in Japan (UMIN) Clinical Trials Registry (No. UMIN000013329) registered on 4th March 2014.
Collapse
Affiliation(s)
- Motohiro Tamiya
- Department of Thoracic Oncology, Osaka International Cancer Institute, Chuo-ku Otemae 3-1- 69, Osaka City, Osaka, 541-8567, Japan.
| | - Akihiro Tamiya
- Department of Thoracic Oncology, Kinki-Chuo Chest Medical Center, Kitaku Nagasone-cho 1180, Sakai City, Osaka, 591-8555, Japan
| | - Hidekazu Suzuki
- Department of Thoracic Malignancy, Osaka Habikino Medical Center, Habikino 3-7-1, 583-8588, Habikino City, Osaka, Japan
| | - Yoshihiko Taniguchi
- Department of Thoracic Oncology, Kinki-Chuo Chest Medical Center, Kitaku Nagasone-cho 1180, Sakai City, Osaka, 591-8555, Japan
| | - Kanako Katayama
- Department of Thoracic Oncology, Kinki-Chuo Chest Medical Center, Kitaku Nagasone-cho 1180, Sakai City, Osaka, 591-8555, Japan
| | - Shojiro Minomo
- Department of Thoracic Oncology, Kinki-Chuo Chest Medical Center, Kitaku Nagasone-cho 1180, Sakai City, Osaka, 591-8555, Japan
| | - Keiko Nakao
- Department of Thoracic Oncology, Kinki-Chuo Chest Medical Center, Kitaku Nagasone-cho 1180, Sakai City, Osaka, 591-8555, Japan
| | - Naoko Takeuchi
- Department of Thoracic Oncology, Kinki-Chuo Chest Medical Center, Kitaku Nagasone-cho 1180, Sakai City, Osaka, 591-8555, Japan
| | - Yoshinobu Matsuda
- Department of Thoracic Oncology, Kinki-Chuo Chest Medical Center, Kitaku Nagasone-cho 1180, Sakai City, Osaka, 591-8555, Japan
| | - Yujiro Naito
- Department of Respiratory Medicine and Clinical Immunology, Osaka University, Yamadaoka 2-15, 565-0871, Suita City, Osaka, Japan
| | - Takayuki Shiroyama
- Department of Respiratory Medicine and Clinical Immunology, Osaka University, Yamadaoka 2-15, 565-0871, Suita City, Osaka, Japan
| | - Norio Okamoto
- Department of Thoracic Malignancy, Osaka Habikino Medical Center, Habikino 3-7-1, 583-8588, Habikino City, Osaka, Japan
| | - Kyoichi Okishio
- Department of Clinical Research Center, Kinki-Chuo Chest Medical Center, Kitaku Nagasone- cho 1180, Sakai City, Osaka, 591-8555, Japan
| | - Toru Kumagai
- Department of Thoracic Oncology, Osaka International Cancer Institute, Chuo-ku Otemae 3-1- 69, Osaka City, Osaka, 541-8567, Japan
| | - Shinji Atagi
- Department of Clinical Research Center, Kinki-Chuo Chest Medical Center, Kitaku Nagasone- cho 1180, Sakai City, Osaka, 591-8555, Japan
| | - Fumio Imamura
- Department of Thoracic Oncology, Osaka International Cancer Institute, Chuo-ku Otemae 3-1- 69, Osaka City, Osaka, 541-8567, Japan
| | - Tomonori Hirashima
- Department of Thoracic Malignancy, Osaka Habikino Medical Center, Habikino 3-7-1, 583-8588, Habikino City, Osaka, Japan
| |
Collapse
|
10
|
Brueckl WM, Ficker JH, Zeitler G. Clinically relevant prognostic and predictive markers for immune-checkpoint-inhibitor (ICI) therapy in non-small cell lung cancer (NSCLC). BMC Cancer 2020; 20:1185. [PMID: 33272262 PMCID: PMC7713034 DOI: 10.1186/s12885-020-07690-8] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 11/25/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Immune checkpoint inhibitors (ICI) either alone or in combination with chemotherapy have expanded our choice of agents for the palliative treatment of non-small cell lung cancer (NSCLC) patients. Unfortunately, not all patients will experience favorable response to treatment with ICI and may even suffer from severe side effects. Therefore, prognostic and predictive markers, beyond programmed death ligand 1 (PD-L1) expression status, are of utmost importance for decision making in the palliative treatment. This review focuses on clinical, laboratory and genetic markers, most of them easily to obtain in the daily clinical practice. RESULTS Recently, a number of prognostic and predictive factors in association to palliative ICI therapy have been described in NSCLC. Besides biometric parameters and clinical characteristics of the tumor, there are useful markers from routine blood sampling as well as innovative soluble genetic markers which can be determined before and during ICI treatment. Additionally, the level of evidence is noted. CONCLUSIONS These factors can be helpful to predict patients' outcome and tumor response to ICI. They should be implemented prospectively in ICI based clinical trials to develop reliable algorithms for palliative NSCLC treatment.
Collapse
Affiliation(s)
- Wolfgang M Brueckl
- Department of Respiratory Medicine, Allergology and Sleep Medicine / Nuremberg Lung Cancer Center, Paracelsus Medical University, General Hospital Nuremberg, Prof.-Ernst-Nathan-Str. 1, 90419, Nuremberg, Germany.
- Paracelsus Medical Private University Nuremberg, Prof.-Ernst-Nathan-Str. 1, 90419, Nuremberg, Germany.
| | - Joachim H Ficker
- Department of Respiratory Medicine, Allergology and Sleep Medicine / Nuremberg Lung Cancer Center, Paracelsus Medical University, General Hospital Nuremberg, Prof.-Ernst-Nathan-Str. 1, 90419, Nuremberg, Germany
- Paracelsus Medical Private University Nuremberg, Prof.-Ernst-Nathan-Str. 1, 90419, Nuremberg, Germany
| | - Gloria Zeitler
- Paracelsus Medical Private University Nuremberg, Prof.-Ernst-Nathan-Str. 1, 90419, Nuremberg, Germany
| |
Collapse
|
11
|
Noro R, Kobayashi K, Usuki J, Yomota M, Nishitsuji M, Shimokawa T, Ando M, Hino M, Hagiwara K, Miyanaga A, Seike M, Kubota K, Gemma A. Bevacizumab plus chemotherapy in nonsquamous non-small cell lung cancer patients with malignant pleural effusion uncontrolled by tube drainage or pleurodesis: A phase II study North East Japan Study group trial NEJ013B. Thorac Cancer 2020; 11:1876-1884. [PMID: 32421226 PMCID: PMC7327672 DOI: 10.1111/1759-7714.13472] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 04/18/2020] [Accepted: 04/19/2020] [Indexed: 12/26/2022] Open
Abstract
Background Pleurodesis is the standard of care for non‐small cell lung cancer (NSCLC) patients with symptomatic malignant pleural effusion (MPE). However, there is no standard management for MPE uncontrolled by pleurodesis. Most patients with unsuccessful MPE control are unable to receive effective chemotherapy. Vascular endothelial growth factor (VEGF) plays an important role in the pathogenesis of MPE. This multicenter, phase II study investigated the effects of bevacizumab plus chemotherapy in nonsquamous NSCLC patients with unsuccessful management of MPE. Methods Nonsquamous NSCLC patients with MPE following unsuccessful tube drainage or pleurodesis received bevacizumab (15 mg/kg) plus chemotherapy every three weeks. The primary endpoint was pleural effusion control rate (PECR), defined as the percentage of patients without reaccumulation of MPE at eight weeks. Secondary endpoints included pleural progression‐free survival (PPFS), safety, and quality of life (QoL). Results A total of 20 patients (median age: 69 years; 14 males; 20 adenocarcinomas; six epidermal growth factor receptor mutations) were enrolled in nine centers. The PECR was 80% and the primary end point was met. The PPFS and the overall survival (OS) were 16.6 months and 19.6 months, respectively. Patients with high levels of VEGF in the MPE had shorter PPFS (P = 0.010) and OS (P = 0.002). Toxicities of grade ≥ 3 included neutropenia (50%), thrombocytopenia (10%), proteinuria (10%), and hypertension (2%). The cognitive QoL score improved after treatment. Conclusions Bevacizumab plus chemotherapy is highly effective with acceptable toxicities in nonsquamous NSCLC patients with uncontrolled MPE, and should be considered as a standard therapy in this setting. Key points Significant findings of the study Bevacizumab plus chemotherapy is highly effective with acceptable toxicities in nonsquamous NSCLC patients with uncontrolled MPE. What this study adds Bevacizumab plus chemotherapy should be considered as a standard treatment option for patients with uncontrolled MPE. Clinical trial registration UMIN000006868 was a phase II study of efficacy of bevacizumab plus chemotherapy for the management of malignant pleural effusion (MPE) in nonsquamous non‐small cell lung cancer patients with MPE unsuccessfully controlled by tube drainage or pleurodesis (North East Japan Study Group Trial NEJ‐013B) (http://umin.sc.jp/ctr/).
Collapse
Affiliation(s)
- Rintaro Noro
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Kunihiko Kobayashi
- Department of Respiratory medicine, Saitama Medical University International Medical Center, Saitama, Japan
| | - Jiro Usuki
- Department of Pulmonary Medicine, Nippon Medical School Musashikosugi Hospital, Kawasaki, Japan
| | - Makiko Yomota
- Department of Thoracic Oncology and Respiratory Medicine, Tokyo Metropolitan Cancer and Infectious disease Center Komagome Hospital, Tokyo, Japan
| | - Masaru Nishitsuji
- Department of Respiratory Medicine, Ishikawa Prefectural Central Hospital, Kanazawa, Japan
| | - Tsuneo Shimokawa
- Department of Respiratory Medicine and Medical Oncology, Yokohama Municipal Citizen's Hospital, Yokohama, Japan
| | - Masahiro Ando
- Department of Internal Medicine, Jizankai Medical Foundation Tsuboi Cancer Center Hospital, Fukushima, Japan
| | - Mitsunori Hino
- Department of Pulmonary Medicine, Nippon Medical School Chiba Hokuso Hospital, Chiba, Japan
| | - Koichi Hagiwara
- Division of Pulmonary Medicine, Jichi Medical University, Tochigi, Japan
| | - Akihiko Miyanaga
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Masahiro Seike
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Kaoru Kubota
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Akihiko Gemma
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | | |
Collapse
|
12
|
Abrão FC, de Abreu IRLB, de Oliveira MC, Viana GG, Pompa Filho JFS, Younes RN, Negri EM. Prognostic factors of recurrence of malignant pleural effusion: what is the role of neoplasia progression? J Thorac Dis 2020; 12:813-822. [PMID: 32274148 PMCID: PMC7139099 DOI: 10.21037/jtd.2020.01.13] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 11/19/2019] [Indexed: 01/04/2023]
Abstract
BACKGROUND It is known that malignant pleural effusion (MPE) recurs rapidly, in a considerable number of patients. However, some patients do not have MPE recurrence. Since MPE is associated with an average survival of 4-7 months, accurate prediction of prognosis may help recognize patients at higher risk of pleural recurrence, aiming to individualize more intensive treatment strategies. METHODS A prospectively assembled database of cases with pleural effusion treated at a single institution analyzed a subset of patients with symptomatic MPE. Prognostic factors for pleural recurrence were identified by univariable analysis using Kaplan-Meier method and the log-rank test was used for the comparison between the curves. Univariate and multiple Cox regression models were used to evaluate the risk (HR) of recurrence. Receiver operating characteristics (ROC) analysis determined the cutoff points for continuous variables. RESULTS A total of 288 patients were included in the analysis. Recurrence-free survival was of 76.6% at 6 months and 73.3% at 12 months. Univariable analysis regarding factors affecting postoperative recurrence was: lymphocytes, platelets, pleural procedure, chemotherapy lines and number of metastases. The independent factors for recurrence-free survival were pleural procedure and chemotherapy lines. Patients who were submitted to pleurodesis had a protective factor for recurrence, with an HR =0.34 (95% CI, 0.15-0.74, P=0.007). On the other hand, patients submitted to the 1st and 2nd line of palliative CT had, respectively, an HR risk = 2.81 (95% CI, 1.10-7.28, P=0.034) and HR =3.23 (95% CI, 1.33-7.84, P=0.010). CONCLUSIONS patients receiving the first or second line of systemic treatment have a higher risk of MPE recurrence when compared to patients who underwent MPE treatment before starting the systemic treatment. The definitive treatment of MPE, such as pleurodesis, was associated with a lower risk of MPE recurrence.
Collapse
Affiliation(s)
- Fernando Conrado Abrão
- Department of Thoracic Surgery, Oswaldo Cruz Germany Hospital, Sao Paulo, Brazil
- Department of Thoracic Surgery, Santa Marcelina Hospital, São Paulo, SP, Brazil
| | - Igor Renato Louro B. de Abreu
- Department of Thoracic Surgery, Oswaldo Cruz Germany Hospital, Sao Paulo, Brazil
- Department of Thoracic Surgery, Santa Marcelina Hospital, São Paulo, SP, Brazil
| | | | - Geisa Garcia Viana
- Department of Thoracic Surgery, Oswaldo Cruz Germany Hospital, Sao Paulo, Brazil
| | | | - Riad Naim Younes
- Department of Thoracic Surgery, Oswaldo Cruz Germany Hospital, Sao Paulo, Brazil
| | | |
Collapse
|
13
|
Takemoto S, Fukuda M, Yamaguchi H, Ikeda T, Akagi K, Tomono H, Umeyama Y, Dotsu Y, Taniguchi H, Gyotoku H, Senju H, Kitazaki T, Nakatomi K, Nagashima S, Fukuda M, Kinoshita A, Soda H, Mukae H. Phase II study of ramucirumab and docetaxel for previously treated non-small cell lung cancer patients with malignant pleural effusion: Protocol of PLEURAM study. Thorac Cancer 2020; 11:389-393. [PMID: 31851428 PMCID: PMC6996979 DOI: 10.1111/1759-7714.13279] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 11/26/2019] [Accepted: 11/29/2019] [Indexed: 01/06/2023] Open
Abstract
INTRODUCTION Anti-vascular endothelial growth factor therapy has been shown to be effective in non-small cell lung cancer (NSCLC) patients with malignant pleural effusion (MPE); however, there are no data to suggest that ramucirumab has the same effects. METHODS We therefore decided to conduct a phase II study of ramucirumab plus docetaxel for NSCLC patients with MPE. The MPE control rate at eight weeks after the start of treatment will be the primary endpoint, and the objective response rate, progression-free survival, one-year survival rate, overall survival, and toxicity profile will be secondary endpoints. DISCUSSION A previous study indicated that administering chemotherapy in combination with bevacizumab was effective at controlling pleural effusion in patients with NSCLC with carcinomatous pleurisy. It is expected that ramucirumab will have a similar effect to the same group.
Collapse
Affiliation(s)
- Shinnosuke Takemoto
- Department of Respiratory MedicineNagasaki University Graduate School of Biomedical SciencesNagasakiJapan
| | - Minoru Fukuda
- Department of Respiratory MedicineNagasaki University Graduate School of Biomedical SciencesNagasakiJapan
- Clinical Oncology CenterNagasaki University HospitalNagasakiJapan
| | - Hiroyuki Yamaguchi
- Department of Respiratory MedicineNagasaki University Graduate School of Biomedical SciencesNagasakiJapan
| | - Takaya Ikeda
- Department of Thoracic OncologyNational Cancer Center Hospital EastKashiwaJapan
| | - Kazumasa Akagi
- Department of Respiratory MedicineNagasaki Prefecture Shimabara HospitalShimabaraJapan
| | - Hiromi Tomono
- Department of Respiratory MedicineSasebo City General HospitalSaseboJapan
| | - Yasuhiro Umeyama
- Department of Respiratory MedicineNagasaki University Graduate School of Biomedical SciencesNagasakiJapan
| | - Yosuke Dotsu
- Department of Respiratory MedicineNagasaki University Graduate School of Biomedical SciencesNagasakiJapan
| | - Hirokazu Taniguchi
- Department of Respiratory MedicineNagasaki University Graduate School of Biomedical SciencesNagasakiJapan
| | - Hiroshi Gyotoku
- Department of Respiratory MedicineNational Hospital Organization Nagasaki Medical CenterOhmuraJapan
| | - Hiroaki Senju
- Department of Respiratory MedicineNagasaki University Graduate School of Biomedical SciencesNagasakiJapan
| | - Takeshi Kitazaki
- Division of Respiratory Diseases, Department of Internal MedicineJapanese Red Cross Nagasaki Genbaku HospitalNagasakiJapan
| | - Katsumi Nakatomi
- Department of Respiratory MedicineNational Hospital Organization Ureshino Medical CenterUreshinoJapan
| | - Seiji Nagashima
- Department of Respiratory MedicineNational Hospital Organization Nagasaki Medical CenterOhmuraJapan
| | - Masaaki Fukuda
- Division of Respiratory Diseases, Department of Internal MedicineJapanese Red Cross Nagasaki Genbaku HospitalNagasakiJapan
| | - Akitoshi Kinoshita
- Department of Respiratory MedicineNagasaki Prefecture Shimabara HospitalShimabaraJapan
| | - Hiroshi Soda
- Department of Respiratory MedicineSasebo City General HospitalSaseboJapan
| | - Hiroshi Mukae
- Department of Respiratory MedicineNagasaki University Graduate School of Biomedical SciencesNagasakiJapan
| |
Collapse
|
14
|
Association between metastatic sites and first-line pembrolizumab treatment outcome for advanced non-small cell lung cancer with high PD-L1 expression: a retrospective multicenter cohort study. Invest New Drugs 2019; 38:211-218. [PMID: 31784866 DOI: 10.1007/s10637-019-00882-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 11/20/2019] [Indexed: 12/26/2022]
Abstract
Associations between treatment outcomes of immune checkpoint inhibitors and metastatic sites in advanced non-small cell lung cancer (NSCLC) are not well known. Therefore, this multicenter retrospective study aimed to investigate the predictive factors of metastatic sites after first-line pembrolizumab treatment for advanced NSCLC with a PD-L1 tumor proportion score (TPS) ≥50%. We retrospectively analyzed advanced NSCLC patients with a PD-L1 TPS ≥50% who underwent first-line pembrolizumab therapy at 11 institutions between February 2017 and April 2018. Clinical data collected from medical records included metastatic sites at the time of pembrolizumab treatment. Treatment outcomes of pembrolizumab were assessed according to the Response Evaluation Criteria in Solid Tumors, version 1.1. In total, 213 patients were included in the study. The median age was 71 years (range 39-91 years). Of the 213 patients, 176 (83%) were men and 172 (81%) had an Eastern Cooperative Oncology Group performance status (ECOG-PS) score of 0-1. The most common metastases were thoracic lymph node metastasis (77%), intrapulmonary metastasis (31%), bone metastasis (28%), and malignant pleural effusion (26%). On multivariate analysis, a poor ECOG-PS score (hazard ratio: 1.95, 95.0% confidence interval: 1.25-3.04; P = 0.003) and malignant pleural effusion (hazard ratio: 1.52, 95.0% confidence interval: 1.01-2.29; P = 0.043) were independent predictors of shorter progression-free survival in patients treated with pembrolizumab. For NSCLC patients with malignant pleural effusion, pembrolizumab monotherapy is not a suitable first-line treatment because of its insufficient effectiveness, even though their PD-L1 TPS was high.
Collapse
|
15
|
Bibby AC, Dorn P, Psallidas I, Porcel JM, Janssen J, Froudarakis M, Subotic D, Astoul P, Licht P, Schmid R, Scherpereel A, Rahman NM, Maskell NA, Cardillo G. ERS/EACTS statement on the management of malignant pleural effusions. Eur J Cardiothorac Surg 2019; 55:116-132. [PMID: 30060030 DOI: 10.1093/ejcts/ezy258] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Accepted: 03/28/2018] [Indexed: 12/26/2022] Open
Abstract
Malignant pleural effusions (MPE) are a common pathology, treated by respiratory physicians and thoracic surgeons alike. In recent years, several well-designed randomized clinical trials have been published that have changed the landscape of MPE management. The European Respiratory Society (ERS) and the European Association for Cardio-Thoracic Surgery (EACTS) established a multidisciplinary collaboration of clinicians with expertise in the management of MPE with the aim of producing a comprehensive review of the scientific literature. Six areas of interest were identified, including the optimum management of symptomatic MPE, management of trapped lung in MPE, management of loculated MPE, prognostic factors in MPE, whether there is a role for oncological therapies prior to intervention for MPE and whether a histological diagnosis is always required in MPE. The literature revealed that talc pleurodesis and indwelling pleural catheters effectively manage the symptoms of MPE. There was limited evidence regarding the management of trapped lung or loculated MPE. The LENT score was identified as a validated tool for predicting survival in MPE, with Brims' prognostic score demonstrating utility in mesothelioma prognostication. There was no evidence to support the use of oncological therapies as an alternative to MPE drainage, and the literature supported the use of tissue biopsy as the gold standard for diagnosis and treatment planning.Management options for malignant pleural effusions have advanced over the past decade, with high-quality randomized trial evidence informing practice in many areas. However, uncertainties remain and further research is required http://ow.ly/rNt730jOxOS.
Collapse
Affiliation(s)
- Anna C Bibby
- Academic Respiratory Unit, University of Bristol Medical School Translational Health Sciences, Bristol, UK
- North Bristol Lung Centre, North Bristol NHS Trust, Bristol, UK
| | - Patrick Dorn
- Division of Thoracic Surgery, University Hospital Bern, Bern, Switzerland
| | | | - Jose M Porcel
- Pleural Medicine Unit, Arnau de Vilanova University Hospital, IRB Lleida, Lleida, Spain
| | - Julius Janssen
- Department of Pulmonary Diseases, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Marios Froudarakis
- Department of Respiratory Medicine, Medical School of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece
| | - Dragan Subotic
- Clinic for Thoracic Surgery, Clinical Center of Serbia, Belgrade, Serbia
| | - Phillippe Astoul
- Department of Thoracic Oncology, Pleural Diseases and Interventional Pulmonology, Hospital North Aix-Marseille University, Marseille, France
| | - Peter Licht
- Department of Cardiothoracic Surgery, Odense University Hospital, Odense, Denmark
| | - Ralph Schmid
- Division of Thoracic Surgery, University Hospital Bern, Bern, Switzerland
| | - Arnaud Scherpereel
- Pulmonary and Thoracic Oncology Department, Hospital of the University (CHU) of Lille, Lille, France
| | - Najib M Rahman
- Oxford Respiratory Trials Unit, University of Oxford, Oxford, UK
- Oxford Centre for Respiratory Medicine, University Hospitals, NHS Foundation Trust, Oxford, UK
| | - Nick A Maskell
- Academic Respiratory Unit, University of Bristol Medical School Translational Health Sciences, Bristol, UK
- North Bristol Lung Centre, North Bristol NHS Trust, Bristol, UK
- Task force chairperson
| | - Giuseppe Cardillo
- Task force chairperson
- Department of Thoracic Surgery, Carlo Forlanini Hospital, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy
| |
Collapse
|
16
|
Saito H, Fukuhara T, Furuya N, Watanabe K, Sugawara S, Iwasawa S, Tsunezuka Y, Yamaguchi O, Okada M, Yoshimori K, Nakachi I, Gemma A, Azuma K, Kurimoto F, Tsubata Y, Fujita Y, Nagashima H, Asai G, Watanabe S, Miyazaki M, Hagiwara K, Nukiwa T, Morita S, Kobayashi K, Maemondo M. Erlotinib plus bevacizumab versus erlotinib alone in patients with EGFR-positive advanced non-squamous non-small-cell lung cancer (NEJ026): interim analysis of an open-label, randomised, multicentre, phase 3 trial. Lancet Oncol 2019; 20:625-635. [PMID: 30975627 DOI: 10.1016/s1470-2045(19)30035-x] [Citation(s) in RCA: 410] [Impact Index Per Article: 82.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 12/25/2018] [Accepted: 01/04/2019] [Indexed: 01/16/2023]
Abstract
BACKGROUND Resistance to first-generation or second-generation EGFR tyrosine kinase inhibitor (TKI) monotherapy develops in almost half of patients with EGFR-positive non-small-cell lung cancer (NSCLC) after 1 year of treatment. The JO25567 phase 2 trial comparing erlotinib plus bevacizumab combination therapy with erlotinib monotherapy established the activity and manageable toxicity of erlotinib plus bevacizumab in patients with NSCLC. We did a phase 3 trial to validate the results of the JO25567 study and report here the results from the preplanned interim analysis. METHODS In this prespecified interim analysis of the randomised, open-label, phase 3 NEJ026 trial, we recruited patients with stage IIIB-IV disease or recurrent, cytologically or histologically confirmed non-squamous NSCLC with activating EGFR genomic aberrations from 69 centres across Japan. Eligible patients were at least 20 years old, and had an Eastern Cooperative Oncology Group performance status of 2 or lower, no previous chemotherapy for advanced disease, and one or more measurable lesions based on Response Evaluation Criteria in Solid Tumours (1.1). Patients were randomly assigned (1:1) to receive oral erlotinib 150 mg per day plus intravenous bevacizumab 15 mg/kg once every 21 days, or erlotinib 150 mg per day monotherapy. Randomisation was done by minimisation, stratified by sex, smoking status, clinical stage, and EGFR mutation subtype. The primary endpoint was progression-free survival. This study is ongoing; the data cutoff for this prespecified interim analysis was Sept 21, 2017. Efficacy was analysed in the modified intention-to-treat population, which included all randomly assigned patients who received at least one dose of treatment and had at least one response evaluation. Safety was analysed in all patients who received at least one dose of study drug. The trial is registered with the University Hospital Medical Information Network Clinical Trials Registry, number UMIN000017069. FINDINGS Between June 3, 2015, and Aug 31, 2016, 228 patients were randomly assigned to receive erlotinib plus bevacizumab (n=114) or erlotinib alone (n=114). 112 patients in each group were evaluable for efficacy, and safety was evaluated in 112 patients in the combination therapy group and 114 in the monotherapy group. Median follow-up was 12·4 months (IQR 7·0-15·7). At the time of interim analysis, median progression-free survival for patients in the erlotinib plus bevacizumab group was 16·9 months (95% CI 14·2-21·0) compared with 13·3 months (11·1-15·3) for patients in the erlotinib group (hazard ratio 0·605, 95% CI 0·417-0·877; p=0·016). 98 (88%) of 112 patients in the erlotinib plus bevacizumab group and 53 (46%) of 114 patients in the erlotinib alone group had grade 3 or worse adverse events. The most common grade 3-4 adverse event was rash (23 [21%] of 112 patients in the erlotinib plus bevacizumab group vs 24 [21%] of 114 patients in the erlotinib alone group). Nine (8%) of 112 patients in the erlotinib plus bevacizumab group and five (4%) of 114 patients in the erlotinib alone group had serious adverse events. The most common serious adverse events were grade 4 neutropenia (two [2%] of 112 patients in the erlotinib plus bevacizumab group) and grade 4 hepatic dysfunction (one [1%] of 112 patients in the erlotinib plus bevacizumab group and one [1%] of 114 patients in the erlotinib alone group). No treatment-related deaths occurred. INTERPRETATION The results of this interim analysis showed that bevacizumab plus erlotinib combination therapy improves progression-free survival compared with erlotinib alone in patients with EGFR-positive NSCLC. Future studies with longer follow-up, and overall survival and quality-of-life data will be required to further assess the efficacy of this combination in this setting. FUNDING Chugai Pharmaceutical.
Collapse
Affiliation(s)
| | | | - Naoki Furuya
- St Marianna University School of Medicine, Kawasaki, Japan
| | | | | | | | | | | | | | | | | | | | | | | | | | - Yuka Fujita
- National Hospital Organization Asahikawa Medical Center, Asahikawa, Japan
| | | | - Gyo Asai
- Aichi Cancer Center Aichi Hospital, Okazaki, Japan
| | | | | | | | | | | | | | - Makoto Maemondo
- Iwate Medical University School of Medicine, Morioka, Japan.
| |
Collapse
|
17
|
刘 玉, 田 攀. [Progress of Bevacizumab in Malignant Pleural Effusion Caused by Non-small Cell Lung Cancer]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2019; 22:118-124. [PMID: 30827329 PMCID: PMC6397943 DOI: 10.3779/j.issn.1009-3419.2019.02.07] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Revised: 10/08/2018] [Accepted: 11/04/2018] [Indexed: 02/05/2023]
Abstract
Lung cancer is the most commonly diagnosed cancer worldwide. Malignant pleural effusion (MPE) caused by advanced lung cancer seriously affect the patients' quality of life and prognosis. The management of MPE includes thoracentesis, pleurodesis, indwelling pleural catheters and drug perfusion in pleural cavity. Vascular endothelial growth factor (VEGF) and its receptor are a group of important ligands and receptors that affect angiogenesis. They are the main factors controlling angiogenesis, and they play an important role in the formation of MPE. Bevacizumab is a recombinant humanized VEGF monoclonal antibody, competitively binding to endogenous VEGF receptor. Bevacizumab can inhibit new blood vessel formation, reduce vascular permeability, prevent pleural effusion accumulation and slow the growth of cancers. This review aims to discuss the progress of bevacizumab in the treatment of MPE caused by non-small cell lung cancer (NSCLC), and explore the clinical application, efficacy, safety and future direction of bevacizumab.
.
Collapse
Affiliation(s)
- 玉杰 刘
- />610041 成都,四川大学华西医院呼吸与危重症医学科Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu 610041, China
| | - 攀文 田
- />610041 成都,四川大学华西医院呼吸与危重症医学科Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu 610041, China
| |
Collapse
|
18
|
Song X, Chen D, Guo J, Kong L, Wang H, Wang Z. Better efficacy of intrapleural infusion of bevacizumab with pemetrexed for malignant pleural effusion mediated from nonsquamous non-small cell lung cancer. Onco Targets Ther 2018; 11:8421-8426. [PMID: 30568464 PMCID: PMC6267356 DOI: 10.2147/ott.s184030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background and objective Several clinical trials have reported that intrapleural infusion of bevacizumab with or without cisplatin exhibits encouraging efficacy in nonsquamous non-small cell lung cancer (NS-NSCLC) patients with malignant serous cavity effusion. However, most of the studies included a number of different types of cancers or different hydrops types rather than focusing on one. In addition, no study reported the efficacy and toxicity of intrapleural infusion of bevacizumab and pemetrexed for advanced NS-NSCLC patients with malignant pleural effusion (MPE). Patients and methods We retrospectively collected patients with MPE mediated from NS-NSCLC who underwent intrapleural infusion of bevacizumab between August 2012 and February 2017. According to the different combined agents with bevacizumab, we divide patients into two groups: Group 1 (BP Group) intrapleural infusion of bevacizumab combined with pemetrexed and Group 2 (BD group) intrapleural infusion of bevacizumab combined with cisplatin. Results A total of 45 patients were enrolled in this study. Twenty-two of them received intrapleuralinfusion of bevacizumab and pemetrexed every 2 weeks, 23 received bevacizumab and cisplatin after draining effusion as much as possible. The progression-free survival for patients in BP group was significantly higher than BD group (P < 0.05) while the overall survival between the two groups was not significantly different (P > 0.05). In addition, there was no statistical difference in adverse effects between two groups. Conclusion Intrapleural infusion of bevacizumab and pemetrexed is effective and tolerable for patients with MPE mediated from NSCLC.
Collapse
Affiliation(s)
- Xinyu Song
- Department of Medical Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, Shandong, People's Republic of China, ; .,School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences, Jinan, Shandong, People's Republic of China
| | - Dawei Chen
- Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, Shandong, People's Republic of China
| | - Jun Guo
- Department of Medical Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, Shandong, People's Republic of China, ;
| | - Li Kong
- Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, Shandong, People's Republic of China
| | - Haiyong Wang
- Department of Medical Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, Shandong, People's Republic of China, ;
| | - Zhehai Wang
- Department of Medical Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, Shandong, People's Republic of China, ;
| |
Collapse
|
19
|
Bibby AC, Dorn P, Psallidas I, Porcel JM, Janssen J, Froudarakis M, Subotic D, Astoul P, Licht P, Schmid R, Scherpereel A, Rahman NM, Cardillo G, Maskell NA. ERS/EACTS statement on the management of malignant pleural effusions. Eur Respir J 2018; 52:13993003.00349-2018. [DOI: 10.1183/13993003.00349-2018] [Citation(s) in RCA: 116] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Accepted: 03/28/2018] [Indexed: 02/07/2023]
Abstract
Malignant pleural effusions (MPE) are a common pathology, treated by respiratory physicians and thoracic surgeons alike. In recent years, several well-designed randomised clinical trials have been published that have changed the landscape of MPE management. The European Respiratory Society (ERS) and the European Association for Cardio-Thoracic Surgery (EACTS) established a multidisciplinary collaboration of clinicians with expertise in the management of MPE with the aim of producing a comprehensive review of the scientific literature.Six areas of interest were identified, including the optimum management of symptomatic MPE, management of trapped lung in MPE, management of loculated MPE, prognostic factors in MPE, whether there is a role for oncological therapies prior to intervention for MPE and whether a histological diagnosis is always required in MPE.The literature revealed that talc pleurodesis and indwelling pleural catheters effectively manage the symptoms of MPE. There was limited evidence regarding the management of trapped lung or loculated MPE. The LENT score was identified as a validated tool for predicting survival in MPE, with Brims' prognostic score demonstrating utility in mesothelioma prognostication. There was no evidence to support the use of oncological therapies as an alternative to MPE drainage, and the literature supported the use of tissue biopsy as the gold standard for diagnosis and treatment planning.
Collapse
|
20
|
Chen Y, Mathy NW, Lu H. The role of VEGF in the diagnosis and treatment of malignant pleural effusion in patients with non‑small cell lung cancer (Review). Mol Med Rep 2018; 17:8019-8030. [PMID: 29693703 PMCID: PMC5983970 DOI: 10.3892/mmr.2018.8922] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 02/15/2018] [Indexed: 12/21/2022] Open
Abstract
Malignant pleural effusion (MPE) is a severe medical condition, which can result in breathlessness, pain, cachexia and reduced physical activity. It can occur in almost all types of malignant tumors; however, lung cancer is the most common cause of MPE, accounting for ~1/3 of clinical cases. Although there are numerous therapeutic approaches currently available for the treatment of MPE, none are fully effective and the majority can only alleviate the symptoms of the patients. Vascular endothelial growth factor (VEGF) has now been recognized as one of the most important regulatory factors in tumor angiogenesis, which participates in the entire process of tumor growth through its function to stimulate tumor angiogenesis, activate host vascular endothelial cells and promote malignant proliferation. Novel drugs targeting VEGF, including endostar and bevacizumab, have been developed and approved for the treatment of various tumors. Data from recent clinical studies have demonstrated that drugs targeting VEGF are effective and safe for the clinical management of MPE. Therefore, VEGF‑targeting represents a promising novel strategy for the diagnosis and treatment of MPE. The present review summarized recent advances in the role of VEGF in the pathogenesis, diagnosis and clinical management of MPE in patients with non‑small cell lung cancer.
Collapse
Affiliation(s)
- Yao Chen
- Department of Oncology, Jianghan University School of Medicine, Wuhan, Hubei 430056, P.R. China
| | | | - Hongda Lu
- Department of Oncology, Wuhan Central Hospital, Wuhan, Hubei 430014, P.R. China
| |
Collapse
|
21
|
Abrao FC, de Abreu IRLB, Viana GG, de Oliveira MC, Negri EM, Younes RN. Wet M1a non-small cell lung cancer: is it possible to predict recurrence of pleural effusion? J Thorac Dis 2018; 10:808-815. [PMID: 29607152 DOI: 10.21037/jtd.2018.01.53] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Background The propose was to recognize risk factors of malignant pleural effusion (MPE) recurrence in patients with symptomatic M1a non-small cell lung cancer (NSCLC). Methods All patients with NSCLC and MPE submitted to pleural palliative procedures were enrolled in a prospective study. Group I contained patients who had pleural recurrence, and Group II with no pleural recurrence. Prognostic factors for pleural recurrence were identified by univariable analysis, using Fisher's exact test for categorical variables and Student's t test for quantitative variables. Afterwards the significant variables were entered into a multivariable logistic regression analysis (with P<0.05 considered significant). Receiver operating characteristics (ROC) analysis determined the cutoff points for continuous variables. Results A total of 82 patients were included in the analysis. There were 15 patients (18.3%) in Group I and 67 patients (81.7%) in Group II. Univariable analysis regarding factors affecting postoperative recurrence was: adenosine deaminase concentration in pleural fluid <16 mg/dL (P=0.04), albumin concentration in pleural fluid <2.4 mg/dL (P=0.03), administration of second-line palliative chemotherapy (P=0.018) and type of procedure [therapeutic pleural aspiration (TPA)] (P=0.023). At the multivariable analysis, only the type of procedure (TPA) (P=0.031) was identified as independent predictor of recurrence. Conclusions The identification of this factor may assist the choice of the optimal palliative technique; at the first episode of MPE in NSCLC patients and definitive procedure as pleurodesis or indwelling pleural catheter are recommended.
Collapse
Affiliation(s)
- Fernando Conrado Abrao
- Oncology Center Hospital Alemão Oswaldo Cruz, Faculdade de Medicina Universidade, São Paulo, Brazil
| | | | - Geisa Garcia Viana
- Department of Thoracic Surgery, Hospital Santa Marcelina, São Paulo, Brazil
| | | | - Elnara Marcia Negri
- Oncology Center Hospital Alemão Oswaldo Cruz, Faculdade de Medicina Universidade, São Paulo, Brazil
| | - Riad Naim Younes
- Oncology Center Hospital Alemão Oswaldo Cruz, Faculdade de Medicina Universidade, São Paulo, Brazil
| |
Collapse
|
22
|
Guo S, Martin MG, Tian C, Cui J, Wang L, Wu S, Gu W. Evaluation of Detection Methods and Values of Circulating Vascular Endothelial Growth Factor in Lung Cancer. J Cancer 2018; 9:1287-1300. [PMID: 29675110 PMCID: PMC5907677 DOI: 10.7150/jca.22020] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 01/19/2018] [Indexed: 01/08/2023] Open
Abstract
Lung cancer is the deadliest cancer in the world. Angiogenesis plays a crucial role of the incidence, progression, and metastasis in lung cancer. Angiogenesis inhibitors are used to treat non-small cell lung cancer (NSCLC) patients, and the molecular biomarkers are also being assessed to predict treatment response/therapeutic response and patients' prognosis. Vascular endothelial growth factor (VEGF) is a signal protein produced by cells that stimulates angiogenesis. Due to its predictive values of prognosis on NSCLC, a large number of methods have been developed and evaluated to detect VEGF levels in a variety of studies. In this article, we review the detection methods designed to measure the VEGF levels in different body fluids and prognosticate the value of VEGF in treatment, diagnosis and survival in lung cancer.
Collapse
Affiliation(s)
- Sumin Guo
- Department of Oncology, Hebei Chest Hospital, Lung Cancer Control and Prevention Center of Hebei Province, Shijiazhuang, Hebei, 050041, China.,Department of Orthopaedic Surgery- Campbell Clinic and Pathology, University of Tennessee Health Science Center, Memphis, TN, 38163, USA
| | - Michael G Martin
- West Cancer Center, University of Tennessee Health Science Center, Memphis, Tennessee, 38163, USA
| | - Cheng Tian
- Department of Orthopaedic Surgery- Campbell Clinic and Pathology, University of Tennessee Health Science Center, Memphis, TN, 38163, USA
| | - Jinglin Cui
- Department of Orthopaedic Surgery- Campbell Clinic and Pathology, University of Tennessee Health Science Center, Memphis, TN, 38163, USA.,Center of Integrative Research, The First Hospital of Qiqihaer City, Qiqihaer, Heilongjiang, 161005, PR China
| | - Lishi Wang
- Department of Basic Medicine (Basic Medical Research), Inner Mongolia Medical University, Inner Mongolia, 010110, PR China
| | - Shucai Wu
- Department of Oncology, Hebei Chest Hospital, Lung Cancer Control and Prevention Center of Hebei Province, Shijiazhuang, Hebei, 050041, China
| | - Weikuan Gu
- Department of Orthopaedic Surgery- Campbell Clinic and Pathology, University of Tennessee Health Science Center, Memphis, TN, 38163, USA.,Research Service, Veterans Affairs Medical Center, 1030 Jefferson Avenue, Memphis TN 38104, USA
| |
Collapse
|
23
|
Clinical predictors of bevacizumab-associated intestinal perforation in non-small cell lung cancer. Invest New Drugs 2018. [PMID: 29536229 DOI: 10.1007/s10637-018-0581-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Background Bevacizumab (Bev) is generally well-tolerated, and Bev-associated intestinal perforation (BAP) is a rare albeit serious side effect in cases of non-small cell lung cancer (NSCLC). Therefore, the present study aimed to identify clinical predictors of BAP to help predict and manage the development of life-threatening intestinal complications among patients receiving Bev. Methods This retrospective study evaluated demographic, clinical, and treatment factors for patients with NSCLC who were treated with Bev between February 2010 and August 2015 at our center. Results We identified 314 regimens (208 patients; median age: 65 years; 115 women) for analysis, which included 119 first-line regimens, 74 s-line regimens, and 121 third-line or later regimens. BAP occurred in 7 cases (2.23% among all regimens and 3.37% among all patients), which generally occurred during first- or second-line treatment and was caused by ulcerative colitis (1 case), colon diverticulitis (1 case), and idiopathic perforations (5 cases). Univariate analyses revealed that BAP was significantly associated with deteriorating PS during the first cycle of chemotherapy (odd ratio [OR]: 11.07, 95% confidence interval [CI]: 2.37-51.63, p = 0.0022), grade ≥ 3 diarrhea (OR: 11.37, 95% CI: 2.37-54.50, p = 0.0024), febrile neutropenia (OR: 9.16, 95% CI: 1.98-42.49, p = 0.0047), and stomatitis (OR: 4.60, 95% CI: 1.01-21.04, p = 0.0492). Conclusions Among patients with NSCLC, BAP was associated with deteriorating PS during the first cycle of chemotherapy, grade ≥ 3 diarrhea, febrile neutropenia, and stomatitis. Therefore, careful observation is needed for patients with NSCLC who receive Bev in any line of treatment, especially if they develop serious side effects that affect their PS or mucous membrane.
Collapse
|
24
|
Chen D, Song X, Shi F, Zhu H, Wang H, Zhang N, Zhang Y, Kong L, Yu J. Greater efficacy of intracavitary infusion of bevacizumab compared to traditional local treatments for patients with malignant cavity serous effusion. Oncotarget 2018; 8:35262-35271. [PMID: 27823984 PMCID: PMC5471052 DOI: 10.18632/oncotarget.13064] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 10/28/2016] [Indexed: 11/25/2022] Open
Abstract
Intracavitary infusion of bevacizumab is one effective treatment for malignant serous cavity effusion (MSCE). In this study, we retrospectively evaluated the efficacy of local treatments in 996 advanced cancer patients with MSCE who received paracentesis and intracavitary bevacizumab, or chemotherapy, biological response modifiers, or simple puncture to drain the effusion. The median progression-free survival (PFS) time in patients treated with bevacizumab was 189 days (range, 13-522 days), which was longer than in patients who received one of the other three treatments (p < 0.05). Subgroup analysis revealed that intracavitary infusion of bevacizumab was advantageous for patients with malignant pleural, pericardial, or peritoneal effusions. The median PFS in patients receiving intracavitary bevacizumab did not significantly differ from that of patients receiving a combination of intracavitary and intravenous bevacizumab. Thus the efficacy did not depend on whether patients received intravenous bevacizumab. Only mild related adverse events were observed in all cases, and they did not differ between groups. Proteinuria (severity grade < 3) was most likely to occur in patients who received a combination of intracavitary and intravenous bevacizumab, but no obvious symptoms were observed. Thus, intracavitary infusion of bevacizumab was effective for controlling MSCE without apparent toxicity.
Collapse
Affiliation(s)
- Dawei Chen
- Weifang Medical University, Weifang, China.,Department of Radiotherapy, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, China
| | - Xinyu Song
- Department of Radiotherapy, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, China.,School of Medicine and Life Sciences, University of Jinan - Shandong Academy of Medical Sciences, Jinan, China
| | - Fang Shi
- Department of Radiotherapy, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, China.,School of Medicine and Life Sciences, University of Jinan - Shandong Academy of Medical Sciences, Jinan, China
| | - Hui Zhu
- Department of Radiotherapy, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, China.,School of Medicine and Life Sciences, University of Jinan - Shandong Academy of Medical Sciences, Jinan, China
| | - Haiyong Wang
- Department of Radiotherapy, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, China
| | - Nasha Zhang
- Department of Radiotherapy, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, China
| | - Yan Zhang
- Department of Radiotherapy, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, China.,School of Medicine and Life Sciences, University of Jinan - Shandong Academy of Medical Sciences, Jinan, China
| | - Li Kong
- Department of Radiotherapy, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, China.,School of Medicine and Life Sciences, University of Jinan - Shandong Academy of Medical Sciences, Jinan, China
| | - Jinming Yu
- Department of Radiotherapy, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, China.,School of Medicine and Life Sciences, University of Jinan - Shandong Academy of Medical Sciences, Jinan, China
| |
Collapse
|
25
|
Tamiya M, Tamiya A, Inoue T, Kimura M, Kunimasa K, Nakahama K, Taniguchi Y, Shiroyama T, Isa SI, Nishino K, Kumagai T, Suzuki H, Hirashima T, Atagi S, Imamura F. Metastatic site as a predictor of nivolumab efficacy in patients with advanced non-small cell lung cancer: A retrospective multicenter trial. PLoS One 2018; 13:e0192227. [PMID: 29470536 PMCID: PMC5823394 DOI: 10.1371/journal.pone.0192227] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Accepted: 01/18/2018] [Indexed: 12/13/2022] Open
Abstract
Purpose To conduct a retrospective multicenter trial to determine the significance of metastatic site as a predictor of nivolumab efficacy in patients with advanced non-small cell lung cancer. Methods This study was conducted across three medical centers in Japan. We retrospectively reviewed all patients who commenced nivolumab treatment at these centers between December 17, 2015 and July 31, 2016. Clinical data were collected, including age, sex, smoking status, Eastern Cooperative Oncology Group performance status, and metastatic site (lymph nodes, liver, brain, bone, lungs [intrapulmonary metastasis], and malignant pleural effusion) at the time of commencing nivolumab treatment. Patients were followed-up until March 31, 2017. Results Two hundred and one patients were enrolled. The median age at the time of commencing nivolumab treatment was 68 (range, 27–87) years. One hundred and thirty-five patients were male, 157 patients had a history of smoking, 153 patients had a performance status of 0–1, and 42 patients had squamous cell carcinoma. The median progression-free survival of all patients was 2.5 months. In the univariate analysis, a performance status of ≥2 (hazard ratio [HR]: 1.89, 95.0% confidence interval [CI]: 1.33–2.69; p < 0.001) and liver (HR: 2.09, 95.0% CI: 1.35–3.25; p < 0.001) and lung (HR: 1.57, 95.0% CI: 1.14–2.16; p < 0.01) metastases correlated with a significantly shorter progression-free survival in nivolumab-treated patients. In the multivariate analysis, a performance status of ≥2 (HR: 1.54, 95.0% CI: 1.05–2.25; p < 0.05) and liver (HR: 1.90, 95.0% CI: 1.21–2.98; p < 0.01) and lung (HR: 1.41, 95.0% CI: 1.00–1.99; p < 0.05) metastases were independently correlated with a significantly shorter progression-free survival in nivolumab-treated patients. Conclusion Liver and lung metastases and a poor performance status are independent predictors of nivolumab efficacy in patients with advanced non-small cell lung cancer.
Collapse
Affiliation(s)
| | - Akihiro Tamiya
- National Hospital Organization Kinki-chuo Chest Medical Center, Osaka, Japan
| | - Takako Inoue
- Osaka International Cancer Institute, Osaka, Japan
| | | | - Kei Kunimasa
- Osaka International Cancer Institute, Osaka, Japan
| | - Kenji Nakahama
- National Hospital Organization Kinki-chuo Chest Medical Center, Osaka, Japan
| | - Yoshihiko Taniguchi
- National Hospital Organization Kinki-chuo Chest Medical Center, Osaka, Japan
| | - Takayuki Shiroyama
- Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Osaka, Japan
| | - Shun-ichi Isa
- National Hospital Organization Kinki-chuo Chest Medical Center, Osaka, Japan
| | | | - Toru Kumagai
- Osaka International Cancer Institute, Osaka, Japan
| | - Hidekazu Suzuki
- Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Osaka, Japan
| | - Tomonori Hirashima
- Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Osaka, Japan
| | - Shinji Atagi
- National Hospital Organization Kinki-chuo Chest Medical Center, Osaka, Japan
| | - Fumio Imamura
- Osaka International Cancer Institute, Osaka, Japan
- * E-mail:
| |
Collapse
|
26
|
Tao H, Meng Q, Li M, Shi L, Tang J, Liu Z. Outcomes of bevacizumab combined with chemotherapy in lung adenocarcinoma-induced malignant pleural effusion. Thorac Cancer 2018; 9:298-304. [PMID: 29297985 PMCID: PMC5792722 DOI: 10.1111/1759-7714.12582] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 11/27/2017] [Accepted: 11/28/2017] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND VEGF is critical in the pathogenesis of malignant pleural effusion (MPE). To understand the clinical benefits of antiangiogenic agents, the efficacy of chemotherapy containing bevacizmab was investigated in patients with lung adenocarcinoma-induced MPE. METHODS The data of lung adenocarcinoma patients with MPE treated with bevacizumab plus chemotherapy on day 1, every three weeks, for ≤ 6 cycles was retrospectively collected. Patients who achieved a response or stable disease were administered bevacizumab as maintenance therapy until progression. The primary outcomes of the study were MPE response rate (RR), MPE control rate, and pleural progression-free survival (PPFS), while the secondary outcomes were PFS, overall survival (OS), changes to the lung volume and thoracic cage, and safety profiles. RESULTS A total of 21 cases were collected, and all were evaluable for response, including 15 chemotherapy-naïve patients and 6 who experienced relapse. The median cycle of treatments was 7 (1-42) and 5 (2-6) for bevacizumab and chemotherapy, respectively. The MPE RR reached 81.0%. The MPE control rate at 6, 12, 24, 48, and 96 weeks were 95.2%, 90.0%, 89.5%, 73.7%, and 43.8%, respectively. Median PPFS was significantly longer than PFS (22.2 vs. 7.8 months; P = 0.044), and median OS was 25.8 months. Nineteen (90.5%) patients experienced lung re-expansion after treatment. Only one (4.8%) patient suffered thoracic volume decrease during treatment and the follow-up period. No unexpected adverse events were observed. CONCLUSIONS Bevacizumab combined with chemotherapy demonstrated efficacious, persistence, and safety in controlling lung cancer-induced MPE, indicating a potential superior therapeutic option.
Collapse
Affiliation(s)
- Hong Tao
- Department of Medical Oncology, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, China
| | - Qiyi Meng
- Department of Medical Oncology, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, China
| | - Mingzhi Li
- Department of Medical Oncology, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, China
| | - Liang Shi
- Department of Medical Oncology, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, China
| | - Junfang Tang
- Department of Medical Oncology, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, China
| | - Zhe Liu
- Department of Medical Oncology, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, China
| |
Collapse
|
27
|
Sabang RL, Gandhiraj D, Fanucchi M, Epelbaum O. Role of bevacizumab in the management of the patient with malignant pleural effusion: more questions than answers. Expert Rev Respir Med 2017; 12:87-94. [PMID: 29235400 DOI: 10.1080/17476348.2018.1417042] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Malignant pleural effusion (MPE) is a feature of metastatic cancer associated with significant morbidity and cost. The typical management of MPE is systemic chemotherapy and mechanical intervention. Vascular endothelial growth factor (VEGF), an inducer of vascular permeability, has been shown to mediate fluid formation. Therefore, bevacizumab, an inhibitor of VEGF, offers theoretical promise for abolishing fluid formation in MPE. Areas covered: This review begins with a summary of VEGF physiology and evidence of its role in MPE pathogenesis. This is followed by an overview of bevacizumab and major trials that put it on the map of non-small cell lung cancer (NSCLC). The majority of the article is devoted to a review of the current evidence base for the use of bevacizumab for MPE control in metastatic pleural malignancy. The review concludes with considerations of patient selection and toxicity. Expert commentary: Evidence in support of bevacizumab administration for MPE management remains flawed. Small studies suggest efficacy of both intravenous and intrapleural routes, but their design raises bias concerns. Bevacizumab appears to be safe in properly selected cases. The future of MPE management may de-emphasize VEGF inhibition in favor of precise molecular therapeutics that could address the root cause of tumorigenesis.
Collapse
Affiliation(s)
- Ralph Llewel Sabang
- a Department of Internal Medicine , Westchester Medical Center , Valhalla , NY , USA
| | - Deepthi Gandhiraj
- b Division of Pulmonary, Critical Care, and Sleep Medicine , Saint Louis University , St Louis , MO , USA
| | - Michael Fanucchi
- c Division of Hematology and Oncology , Westchester Medical Center , Valhalla , NY , USA
| | - Oleg Epelbaum
- d Division of Pulmonary, Critical Care, and Sleep Medicine , Westchester Medical Center , Valhalla , NY , USA
| |
Collapse
|
28
|
Natsume M, Honda T, Haruyama T, Ishihara M, Fukasawa Y, Sakamoto T, Tanzawa S, Usui R, Ota S, Ichikawa Y, Watanabe K, Seki N. A Case of Lung Adenocarcinoma with Marked Improvement of Pulmonary Lymphangitic Carcinomatosis by Adding Bevacizumab to Cisplatin and Pemetrexed. Case Rep Oncol 2017. [PMID: 29515397 PMCID: PMC5836232 DOI: 10.1159/000484662] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
A 40-year-old man with a diagnosis of lung adenocarcinoma (cT4N3M1c, stage IVB) experienced worsening of lymphangitic carcinomatosis in the right lung and right pleural effusion after receiving 1 cycle of first-line chemotherapy consisting of cisplatin and pemetrexed. Bevacizumab was thus added from the second cycle of the cisplatin-pemetrexed regimen, leading to a marked improvement in pulmonary lymphangitic carcinomatosis and a decrease in pleural effusion. Subsequently, maintenance therapy consisting of pemetrexed and bevacizumab was continued, successfully leading to long-term progression-free survival. Generally, pulmonary lymphangitic carcinomatosis shows poor prognosis because of poor response to chemotherapy. However, recent studies have been elucidating the role of the vascular endothelial growth factor A (VEGF-A)/VEGF receptor-2 pathway in pulmonary lymphangitic carcinomatosis. Therefore, bevacizumab is expected to be beneficial in the treatment of this pathological condition.
Collapse
Affiliation(s)
- Maika Natsume
- Division of Medical Oncology, Department of Internal Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Takeshi Honda
- Division of Medical Oncology, Department of Internal Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Terunobu Haruyama
- Division of Medical Oncology, Department of Internal Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Masashi Ishihara
- Division of Medical Oncology, Department of Internal Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Yoko Fukasawa
- Division of Medical Oncology, Department of Internal Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Takahiko Sakamoto
- Division of Medical Oncology, Department of Internal Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Shigeru Tanzawa
- Division of Medical Oncology, Department of Internal Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Ryo Usui
- Division of Medical Oncology, Department of Internal Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Shuji Ota
- Division of Medical Oncology, Department of Internal Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Yasuko Ichikawa
- Division of Medical Oncology, Department of Internal Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Kiyotaka Watanabe
- Division of Medical Oncology, Department of Internal Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Nobuhiko Seki
- Division of Medical Oncology, Department of Internal Medicine, Teikyo University School of Medicine, Tokyo, Japan
| |
Collapse
|
29
|
Jiang T, Li A, Su C, Li X, Zhao C, Ren S, Zhou C, Zhang J. Addition of bevacizumab for malignant pleural effusion as the manifestation of acquired EGFR-TKI resistance in NSCLC patients. Oncotarget 2017; 8:62648-62657. [PMID: 28977977 PMCID: PMC5617537 DOI: 10.18632/oncotarget.16061] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 02/22/2017] [Indexed: 01/15/2023] Open
Abstract
This study aimed to investigate the role of bevacizumab in patients with advanced non-small cell lung cancer (NSCLC) who had developed acquired resistance to EGFR-TKIs therapy that manifested as malignant pleural effusion (MPE). In total, 86 patients were included. 47 patients received bevacizumab plus continued EGFR-TKIs and 39 patients received bevacizumab plus chemotherapy. The curative efficacy rate for MPE in bevacizumab plus EGFR-TKIs group was significantly higher than that in bevacizumab plus chemotherapy group (89.4% vs. 64.1%, respectively; P = 0.005). Patients in bevacizumab plus EGFR-TKIs group had longer progression-free survival (PFS) than those in bevacizumab plus chemotherapy group (median PFS 6.3 vs. 4.8 months, P = 0.042). While patients with acquired T790M mutation in bevacizumab plus EGFR-TKIs group had a significantly longer PFS than those in bevacizumab plus chemotherapy group (median PFS 6.9 vs. 4.6 months, P = 0.022), patients with negative T790M had similar PFS (median PFS 6.1 vs. 5.5 months, P = 0.588). Overall survival (OS) was similar between two groups (P = 0.480). In multivariate analysis, curative efficacy was an independent prognostic factor (HR 0.275, P = 0.047). In conclusion bevacizumab plus EGFR-TKIs could be a valuable treatment for NSCLC patients presenting with MPE upon resistant to EGFR-TKIs therapy, especially for those with acquired T790M mutation.
Collapse
Affiliation(s)
- Tao Jiang
- Department of Medical Oncology, Shanghai Pulmonary Hospital, Thoracic Cancer Institute, Tongji University School of Medicine, Shanghai, P.R. China
| | - Aiwu Li
- Department of Medical Oncology, Shanghai Pulmonary Hospital, Thoracic Cancer Institute, Tongji University School of Medicine, Shanghai, P.R. China
| | - Chunxia Su
- Department of Medical Oncology, Shanghai Pulmonary Hospital, Thoracic Cancer Institute, Tongji University School of Medicine, Shanghai, P.R. China
| | - Xuefei Li
- Department of Lung Cancer and Immunology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, P.R. China
| | - Chao Zhao
- Department of Lung Cancer and Immunology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, P.R. China
| | - Shengxiang Ren
- Department of Medical Oncology, Shanghai Pulmonary Hospital, Thoracic Cancer Institute, Tongji University School of Medicine, Shanghai, P.R. China
| | - Caicun Zhou
- Department of Medical Oncology, Shanghai Pulmonary Hospital, Thoracic Cancer Institute, Tongji University School of Medicine, Shanghai, P.R. China
| | - Jun Zhang
- Department of Internal Medicine, Division of Hematology, Oncology and Blood & Marrow Transplantation, Holden Comprehensive Cancer Center, University of Iowa, Carver College of Medicine, Iowa, IA, USA
| |
Collapse
|
30
|
Mori R, Fujimoto D, Ito M, Tomii K. Bevacizumab for ramucirumab refractory malignant pleural effusion in non-small cell lung cancer: a case report and review of the literature. Oncotarget 2017; 8:48521-48524. [PMID: 28591698 PMCID: PMC5564666 DOI: 10.18632/oncotarget.17952] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 05/01/2017] [Indexed: 01/30/2023] Open
Abstract
Malignant pleural effusion (MPE) is a major problem associated with advanced non-small cell lung cancer for which an optimum treatment strategy has yet to be determined. Notably, vascular endothelial growth factor (VEGF) signaling has been found to influence MPE, and bevacizumab, a VEGF ligand inhibitor, can effectively control MPE. Ramucirumab, a human monoclonal antibody specific for VEGF receptor-2, has recently been approved for advanced non-small cell lung cancer. However, it remains unclear which of these agents more effectively control MPE.We describe a case of a 68-year-old man with advanced non-small cell lung cancer in whom ramucirumab plus docetaxel-refractory MPE was responsive to bevacizumab plus docetaxel combination therapy. The patient's MPE progressed after two cycles of ramucirumab plus docetaxel second-line chemotherapy. After switching to bevacizumab plus docetaxel, a computed tomography scan revealed a decreased MPE after two cycles of treatment.Bevacizumab may be more effective for treating MPE. However, further investigations are still warranted to determine the optimal VEGF-targeted agent for this condition.
Collapse
MESH Headings
- Aged
- Antibodies, Monoclonal/pharmacology
- Antibodies, Monoclonal/therapeutic use
- Antibodies, Monoclonal, Humanized
- Antineoplastic Agents/pharmacology
- Antineoplastic Agents/therapeutic use
- Antineoplastic Agents, Immunological/therapeutic use
- Bevacizumab/therapeutic use
- Carcinoma, Non-Small-Cell Lung/diagnostic imaging
- Carcinoma, Non-Small-Cell Lung/drug therapy
- Carcinoma, Non-Small-Cell Lung/pathology
- Drug Resistance, Neoplasm
- Humans
- Lung Neoplasms/diagnostic imaging
- Lung Neoplasms/drug therapy
- Lung Neoplasms/pathology
- Male
- Pleural Effusion, Malignant/pathology
- Tomography, X-Ray Computed
- Treatment Outcome
- Ramucirumab
Collapse
Affiliation(s)
- Ryobu Mori
- Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Hyogo, Japan
| | - Daichi Fujimoto
- Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Hyogo, Japan
| | - Munehiro Ito
- Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Hyogo, Japan
| | - Keisuke Tomii
- Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Hyogo, Japan
| |
Collapse
|
31
|
Nohara K, Takada K, Kojima E, Ninomiya K, Miyamatsu S, Shimizu T, Sakurai T, Mizuno T, Yamashita Y. A propensity score-matched comparison of the efficacies of OK-432 and talc slurry for pleurodesis for malignant pleural effusion induced by lung adenocarcinoma. Respir Investig 2016; 54:341-346. [PMID: 27566382 DOI: 10.1016/j.resinv.2016.04.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 04/05/2016] [Accepted: 04/27/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND The choice of an optimal sclerosant for pleurodesis for malignant pleural effusion remains controversial. This retrospective clinical study compared the efficacy and safety of two sclerosants; talc slurry (talc-s) and OK-432. METHODS We compared the characteristics, 30/90-day success rates, and adverse events in patients with lung adenocarcinoma who underwent pleurodesis by using either OK-432 or talc-s. Propensity score matching was used to compare the two scelrosants. RESULTS Ninety-four patients (mean age=71.6±9.6 years) were included in this retrospective study, of whom 64 received OK-432 and 30 received talc-s. Seventy-three patients (77.6%) were initially diagnosed with clinical stage IV lung cancer, with a 28.7% epidermal growth factor receptor mutation frequency. The propensity score-matched cohort included 26 patients from each group. The 30-day success rates for OK-432 and talc-s were 80.7% and 76.9%, respectively (odds ratio: 1.26, 95% confidence interval: 0.33-4.77, p=0.73). Neither the overall incidence of adverse events nor the 90-day success rates differed significantly. Multivariate logistic regression revealed that the predictors of 30-day success were lower drainage volume on the previous day, particularly <250mL/day, the presence of full lung expansion, and pre-therapy with an epidermal growth factor receptor-tyrosine kinase inhibitor. The median post-pleurodesis survival time was 6.9 months, which was not significantly different between the study groups. CONCLUSIONS Propensity score-matched analyses showed that pleurodesis using OK-432 and talc-s demonstrated comparable efficacy and safety profiles in patients with lung adenocarcinoma. This indicated that OK-432 could be a viable alternative to talc-s in this procedure.
Collapse
Affiliation(s)
- Kango Nohara
- Division of Respiratory Medicine, Komaki City Hospital, 1-20 Johbuji, Komaki 485-8520, Japan.
| | - Kazuto Takada
- Division of Respiratory Medicine, Komaki City Hospital, 1-20 Johbuji, Komaki 485-8520, Japan.
| | - Eiji Kojima
- Division of Respiratory Medicine, Komaki City Hospital, 1-20 Johbuji, Komaki 485-8520, Japan.
| | - Kiyoko Ninomiya
- Division of Respiratory Medicine, Komaki City Hospital, 1-20 Johbuji, Komaki 485-8520, Japan.
| | - Shoko Miyamatsu
- Division of Respiratory Medicine, Komaki City Hospital, 1-20 Johbuji, Komaki 485-8520, Japan.
| | - Takahiro Shimizu
- Division of Respiratory Medicine, Komaki City Hospital, 1-20 Johbuji, Komaki 485-8520, Japan.
| | - Tsutomu Sakurai
- Division of Respiratory Medicine, Komaki City Hospital, 1-20 Johbuji, Komaki 485-8520, Japan.
| | - Takaaki Mizuno
- Division of Respiratory Medicine, Komaki City Hospital, 1-20 Johbuji, Komaki 485-8520, Japan.
| | - Yuuki Yamashita
- Division of Respiratory Medicine, Komaki City Hospital, 1-20 Johbuji, Komaki 485-8520, Japan.
| |
Collapse
|
32
|
Usui K, Sugawara S, Nishitsuji M, Fujita Y, Inoue A, Mouri A, Watanabe H, Sakai H, Kinoshita I, Ohhara Y, Maemondo M, Kagamu H, Hagiwara K, Kobayashi K. A phase II study of bevacizumab with carboplatin-pemetrexed in non-squamous non-small cell lung carcinoma patients with malignant pleural effusions: North East Japan Study Group Trial NEJ013A. Lung Cancer 2016; 99:131-6. [DOI: 10.1016/j.lungcan.2016.07.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 06/01/2016] [Accepted: 07/03/2016] [Indexed: 10/21/2022]
|
33
|
Kuang Y, Jiang X, Zhang Y, Lu Y, Ma H, Guo Y, Zhang Y, An S, Li J, Liu L, Wu Y, Liang J, Jiang C. Dual Functional Peptide-Driven Nanoparticles for Highly Efficient Glioma-Targeting and Drug Codelivery. Mol Pharm 2016; 13:1599-607. [DOI: 10.1021/acs.molpharmaceut.6b00051] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Yuyang Kuang
- Key Laboratory of Smart Drug Delivery, Ministry of Education,
Department of Pharmaceutics, School of Pharmacy, Fudan University, Shanghai 201203, China
| | - Xutao Jiang
- Key Laboratory of Smart Drug Delivery, Ministry of Education,
Department of Pharmaceutics, School of Pharmacy, Fudan University, Shanghai 201203, China
| | - Yu Zhang
- Key Laboratory of Smart Drug Delivery, Ministry of Education,
Department of Pharmaceutics, School of Pharmacy, Fudan University, Shanghai 201203, China
| | - Yifei Lu
- Key Laboratory of Smart Drug Delivery, Ministry of Education,
Department of Pharmaceutics, School of Pharmacy, Fudan University, Shanghai 201203, China
| | - Haojun Ma
- Key Laboratory of Smart Drug Delivery, Ministry of Education,
Department of Pharmaceutics, School of Pharmacy, Fudan University, Shanghai 201203, China
| | - Yubo Guo
- Key Laboratory of Smart Drug Delivery, Ministry of Education,
Department of Pharmaceutics, School of Pharmacy, Fudan University, Shanghai 201203, China
| | - Yujie Zhang
- Key Laboratory of Smart Drug Delivery, Ministry of Education,
Department of Pharmaceutics, School of Pharmacy, Fudan University, Shanghai 201203, China
| | - Sai An
- Key Laboratory of Smart Drug Delivery, Ministry of Education,
Department of Pharmaceutics, School of Pharmacy, Fudan University, Shanghai 201203, China
| | - Jianfeng Li
- Key Laboratory of Smart Drug Delivery, Ministry of Education,
Department of Pharmaceutics, School of Pharmacy, Fudan University, Shanghai 201203, China
| | - Lisha Liu
- Key Laboratory of Smart Drug Delivery, Ministry of Education,
Department of Pharmaceutics, School of Pharmacy, Fudan University, Shanghai 201203, China
| | - Yinhao Wu
- Key Laboratory of Smart Drug Delivery, Ministry of Education,
Department of Pharmaceutics, School of Pharmacy, Fudan University, Shanghai 201203, China
| | - Jianying Liang
- Department of Pharmaceutical
Analysis, School of Pharmacy, Fudan University, Shanghai 201203, China
| | - Chen Jiang
- Key Laboratory of Smart Drug Delivery, Ministry of Education,
Department of Pharmaceutics, School of Pharmacy, Fudan University, Shanghai 201203, China
- State Key
Laboratory of Medical Neurobiology, Fudan University, Shanghai 201203, China
| |
Collapse
|
34
|
Pagani E, Ruffini F, Antonini Cappellini GC, Scoppola A, Fortes C, Marchetti P, Graziani G, D'Atri S, Lacal PM. Placenta growth factor and neuropilin-1 collaborate in promoting melanoma aggressiveness. Int J Oncol 2016; 48:1581-9. [PMID: 26846845 DOI: 10.3892/ijo.2016.3362] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 10/20/2015] [Indexed: 11/06/2022] Open
Abstract
The placenta growth factor (PlGF) is a member of the vascular endothelial growth factor (VEGF) family, which shares with VEGF-A the tyrosine kinase receptor VEGFR-1 and the co-receptor neuropilin-1 (NRP-1). In melanoma models, PlGF enhances tumour growth and neovessel formation, whereas NRP-1 promotes the metastatic process. Increased secretion of PlGF and expression of NRP-1 have also been involved in intrinsic or acquired resistance to anti‑angiogenic therapies. In this study we investigated whether PlGF and NRP-1 cooperate in promoting melanoma aggressiveness independently of VEGFR-1. For this purpose, the melanoma cell clones M14-N, expressing NRP-1 and lacking VEGFR-1, and M14-C, devoid of both receptors, were used. M14-N cells are characterized by an invasive phenotype and vasculogenic mimicry, whereas M14-C cells possess a negligible invasive capacity. The results indicated that M14-N cells secrete higher levels of PlGF than M14-C cells and that PlGF is involved in the invasion of the extracellular matrix (ECM) and vasculogenic mimicry of M14-N cells. In fact, neutralizing antibodies against PlGF reverted ECM invasion in response to PlGF and markedly reduced the formation of tubule-like structures. Moreover, M14-N cells migrated in response to PlGF and chemotaxis was specifically abrogated by anti-NRP-1 antibodies, demonstrating that PlGF directly activates NRP-1 in the absence of VEGFR-1. We also compared the levels of PlGF in the plasma of patients affected by metastatic melanoma with those of healthy donors and evaluated whether PlGF levels could be affected by a bevacizumab-containing chemotherapy regimen. Melanoma patients showed a 20-fold increase in plasma PlGF and the bevacizumab-containing regimen induced a reduction of VEGF-A and in a further increase of PlGF. In conclusion, our studies suggest that the activation of NRP-1 by PlGF directly contributes to melanoma aggressiveness and represents a potential compensatory pro-angiogenic mechanism that may contribute to the resistance to therapies targeting VEGF-A.
Collapse
Affiliation(s)
- Elena Pagani
- Laboratory of Molecular Oncology, 'Istituto Dermopatico dell'Immacolata'- IRCCS, Rome, Italy
| | - Federica Ruffini
- Laboratory of Molecular Oncology, 'Istituto Dermopatico dell'Immacolata'- IRCCS, Rome, Italy
| | | | - Alessandro Scoppola
- Department of Oncology and Dermatological Oncology, 'Istituto Dermopatico dell'Immacolata'- IRCCS, Rome, Italy
| | - Cristina Fortes
- Epidemiology Unit, 'Istituto Dermopatico dell'Immacolata'- IRCCS, Rome, Italy
| | - Paolo Marchetti
- Department of Oncology, Sant'Andrea Hospital, University of Rome 'La Sapienza', Rome, Italy
| | - Grazia Graziani
- Department of Systems Medicine, University of Rome 'Tor Vergata', Rome, Italy
| | - Stefania D'Atri
- Laboratory of Molecular Oncology, 'Istituto Dermopatico dell'Immacolata'- IRCCS, Rome, Italy
| | - Pedro Miguel Lacal
- Laboratory of Molecular Oncology, 'Istituto Dermopatico dell'Immacolata'- IRCCS, Rome, Italy
| |
Collapse
|
35
|
Marquez-Medina D, Popat S. Closing faucets: the role of anti-angiogenic therapies in malignant pleural diseases. Clin Transl Oncol 2015; 18:760-8. [PMID: 26680633 DOI: 10.1007/s12094-015-1464-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 11/27/2015] [Indexed: 01/31/2023]
Abstract
Malignant pleural effusion (MPE) represents 15-35 % of pleural effusions and markedly worsens the prognosis and quality of life of patients with cancer. Malignant mesothelioma (MM) and lung adenocarcinoma are the most frequent primary and secondary causes, respectively, of MPE. Effective treatments for cancer-related MPE are warranted in order to improve symptoms, reduce the number of invasive pleural procedures, and prolong patient life. Since angiogenesis plays a key role in MPE development, the potential role of bevacizumab and other anti-angiogenic therapies have been explored in this review. No relevant phase III trials have specifically analysed the benefit from adding bevacizumab to platinum-based chemotherapy in lung cancer-related MPE. However, small retrospective series reported 71.4-93.3 % MPE control rate, a reduction in invasive procedures, and a safe profile with this combination. Being approved for the first-line treatment of non-squamous advanced NSCLC, the addition of bevacizumab should be considered for patients presenting with MPE. In addition, further studies in this are recommended. In MM, the addition of bevacizumab to platinum-based chemotherapy did not meet primary endpoints in two phase II trials. However, the beneficial results on OS reported in comparison with historical cohorts and the statistically significant benefit on PFS and OS observed in the phase III MAPS trial foretell an eventual role for the combination of platinum/pemetrexed/bevacizumab as front-line systemic therapy for pleural MM. To date, no other anti-angiogenic drug has showed significant benefit in the treatment of patients with either MPE or MM. However, new promising drugs such as ramucirumab or recombinant human endostar warrant further investigation.
Collapse
Affiliation(s)
- D Marquez-Medina
- Medical Oncology Department, Arnau de Vilanova University Hospital, Avda. Rovira Roure, 80, 25198, Lleida, Spain.
| | - S Popat
- Lung Cancer Unit, Royal Marsden Hospital, London, UK
| |
Collapse
|