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Fadaly WAA, Nemr MTM, Abd El-Hameed AM, Mohamed FEA, Zidan TH. Design and Synthesis of New pyrazole Hybrids Linked to Oxime and Nitrate Moieties as COX-2, EGFR L858R/T790M Inhibitors and Nitric Oxide Donors with dual Anti-inflammatory/Anti-proliferative Activities. Bioorg Chem 2025; 161:108563. [PMID: 40349531 DOI: 10.1016/j.bioorg.2025.108563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2025] [Revised: 05/01/2025] [Accepted: 05/05/2025] [Indexed: 05/14/2025]
Abstract
Two new series of pyrazole derivatives 14a-l and 17a-c with oxime/nitrate moieties as EGFRWT, mutant (EGFRL858R/T790M) and COX-2 inhibitors were synthesized and evaluated for anti-proliferative and anti-inflammatory activities. Compounds 14c, 14e, 14 g, 14i-l, 17b and 17c exhibited COX-2 selectivity in the range of (S.I. = 17-42) when compared to celecoxib (S.I. = 20.43). Concerning anti-neoplastic activity, screening was carried out against 60 human cancer cell lines by (NCI); Nine compounds (14c, 14e, 14 g, 14i-l, 17b and 17c) showed excellent inhibitory activity against all cancer cell lines especially non-small cell lung cancer (NSCLC). Further cytotoxicity testing of compounds 14c, 14e, 14 g, 14i-l, 17b and 17c was conducted on established EGFRT790M/L858R-resistant NSCLC (H1975), all tested compounds except 14 l exhibited potent activity (IC50 = 3.02-27.32 μM) which is higher than that of osimertinib (IC50 = 37.29 μM). It was noted that compound 17c, showed cell cycle arrest at G0/G1 phase of NSCLC (H1975) cells. In addition, compounds 14c, 14e, 14 g, 14i-l, 17b and 17c induced improved selective inhibitory activity against double mutant EGFRL858R/T790M tyrosine kinases with IC50 in the range of (0.031-0.076 μM, with selectivity index range S.I. of 2.5-14.58) which was comparable to that of osimertinib (IC50 = 0.037 μM, with S.I. of 1.89). The most potent anti-cancer compounds 14c, 14e, 14 g, 14i-l, 17b and 17c released NO in a slow rate of (1.45-3.37 %). Finally, applying covalent docking, we identified the covalent binding of 14 g, 14 k, and 17c with Cys797, providing insights into their potential as irreversible inhibitors targeting EGFRL858R/T790M protein.
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Affiliation(s)
- Wael A A Fadaly
- Pharmaceutical Organic Chemistry Department, Faculty of Pharmacy, Beni-Suef University, Beni-Suef 62514, Egypt
| | - Mohamed T M Nemr
- Pharmaceutical Organic Chemistry Department, Faculty of Pharmacy, Cairo University, Kasr El-Eini Street, 11562 Cairo, Egypt.
| | - Abeer M Abd El-Hameed
- Chemistry Department, Faculty of Science, Taibah University, P.O. BOX 30002, Al-Madinah, Al-Munawarah 14177, Saudi Arabia
| | - Fatma E A Mohamed
- Pharmaceutical Organic Chemistry Department, Faculty of Pharmacy, Beni-Suef University, Beni-Suef 62514, Egypt
| | - Taha H Zidan
- Pharmaceutical Organic Chemistry Department, Faculty of Pharmacy, Beni-Suef University, Beni-Suef 62514, Egypt
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2
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Shiono A, Imai H, Endo S, Okazaki S, Abe T, Mouri A, Kaira K, Masubuchi K, Kobayashi K, Minato K, Kato S, Kagamu H. Clinical significance of post‑progression survival after chemoradiotherapy on overall survival in limited‑disease small cell lung cancer. Mol Clin Oncol 2025; 22:58. [PMID: 40322546 PMCID: PMC12046617 DOI: 10.3892/mco.2025.2853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2024] [Accepted: 03/19/2025] [Indexed: 05/08/2025] Open
Abstract
Overall survival (OS) among patients with limited-disease small-cell lung cancer (LD-SCLC) receiving chemoradiotherapy can be significantly influenced by subsequent treatments. Thus, the present study aimed to examine the interplay between progression-free survival (PFS), post-progression survival (PPS) and OS in patients with LD-SCLC undergoing chemoradiotherapy. This study retrospectively analyzed 84 patients with relapsed LD-SCLC who received chemoradiotherapy between April 2007 and June 2021. The correlations between PFS and OS as well as PPS and OS post-chemoradiotherapy were analyzed at the individual patient level. Spearman's rank correlation and linear regression analyses revealed a robust correlation between PPS and OS (r=0.76; P<0.05; R2=0.85). PFS was moderately correlated with OS (r=0.57; P<0.05; R2=0.25). Furthermore, the presence of liver metastases upon relapse and the administration of platinum re-challenge chemotherapy were significantly associated with PPS (P<0.05). The analysis of relationships between OS and PFS as well as OS and PPS in this patient cohort revealed that OS was more strongly correlated with PPS than PFS. These findings suggest that factors such as liver metastases at relapse and the administration of platinum re-challenge chemotherapy may influence PPS.
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Affiliation(s)
- Ayako Shiono
- Department of Respiratory Medicine, Comprehensive Cancer Center, International Medical Center, Saitama Medical University, Hidaka, Saitama 350-1298, Japan
| | - Hisao Imai
- Department of Respiratory Medicine, Comprehensive Cancer Center, International Medical Center, Saitama Medical University, Hidaka, Saitama 350-1298, Japan
- Division of Respiratory Medicine, Gunma Prefectural Cancer Center, Ota, Gunma 373-8550, Japan
| | - Satoshi Endo
- Division of Respiratory Medicine, Gunma Prefectural Cancer Center, Ota, Gunma 373-8550, Japan
| | - Shohei Okazaki
- Division of Radiation Oncology, Gunma Prefectural Cancer Center, Ota, Gunma 373-8550, Japan
| | - Takanori Abe
- Department of Radiation Oncology, International Medical Center, Saitama Medical University, Hidaka, Saitama 350-1298, Japan
| | - Atsuto Mouri
- Department of Respiratory Medicine, Comprehensive Cancer Center, International Medical Center, Saitama Medical University, Hidaka, Saitama 350-1298, Japan
| | - Kyoichi Kaira
- Department of Respiratory Medicine, Comprehensive Cancer Center, International Medical Center, Saitama Medical University, Hidaka, Saitama 350-1298, Japan
| | - Ken Masubuchi
- Division of Respiratory Medicine, Gunma Prefectural Cancer Center, Ota, Gunma 373-8550, Japan
| | - Kunihiko Kobayashi
- Department of Respiratory Medicine, Comprehensive Cancer Center, International Medical Center, Saitama Medical University, Hidaka, Saitama 350-1298, Japan
| | - Koichi Minato
- Division of Respiratory Medicine, Gunma Prefectural Cancer Center, Ota, Gunma 373-8550, Japan
- Division of Health Evaluation and Promotion, SUBARU Health Insurance Society, Ota Memorial Hospital, Ota, Gunma 373-0055, Japan
| | - Shingo Kato
- Department of Radiation Oncology, International Medical Center, Saitama Medical University, Hidaka, Saitama 350-1298, Japan
| | - Hiroshi Kagamu
- Department of Respiratory Medicine, Comprehensive Cancer Center, International Medical Center, Saitama Medical University, Hidaka, Saitama 350-1298, Japan
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Kulkarni R, Zeine E, Potugari B, Gadgeel S, Montecalvo J, Rous FA. Small Cell Lung Cancer With de novo BRAF V600E Mutation and Durable Response to Targeted Therapy: A Case Report. Clin Lung Cancer 2025; 26:e306-e310. [PMID: 40133188 DOI: 10.1016/j.cllc.2025.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2024] [Revised: 02/14/2025] [Accepted: 02/17/2025] [Indexed: 03/27/2025]
Affiliation(s)
- Radhika Kulkarni
- Division of Hematology/Oncology, Department of Internal Medicine, Henry Ford Cancer Institute/Henry Ford Health, Detroit, MI
| | - Elias Zeine
- Division of Hematology/Oncology, Karmanos Cancer Institute at McLaren Central Michigan, Morey Cancer Center, Mount Pleasant, MI
| | - Bindu Potugari
- Division of Hematology/Oncology, Department of Internal Medicine, Henry Ford Cancer Institute/Henry Ford Health, Detroit, MI
| | - Shirish Gadgeel
- Division of Hematology/Oncology, Department of Internal Medicine, Henry Ford Cancer Institute/Henry Ford Health, Detroit, MI
| | | | - Fawzi Abu Rous
- Division of Hematology/Oncology, Department of Internal Medicine, Henry Ford Cancer Institute/Henry Ford Health, Detroit, MI.
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Simpson KL, Rothwell DG, Blackhall F, Dive C. Challenges of small cell lung cancer heterogeneity and phenotypic plasticity. Nat Rev Cancer 2025; 25:447-462. [PMID: 40211072 DOI: 10.1038/s41568-025-00803-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/19/2025] [Indexed: 04/12/2025]
Abstract
Small cell lung cancer (SCLC) is an aggressive neuroendocrine malignancy with ~7% 5-year overall survival reflecting early metastasis and rapid acquired chemoresistance. Immunotherapy briefly extends overall survival in ~15% cases, yet predictive biomarkers are lacking. Targeted therapies are beginning to show promise, with a recently approved delta-like ligand 3 (DLL3)-targeted therapy impacting the treatment landscape. The increased availability of patient-faithful models, accumulating human tumour biobanks and numerous comprehensive molecular profiling studies have collectively facilitated the mapping and understanding of substantial intertumoural and intratumoural heterogeneity. Beyond the almost ubiquitous loss of wild-type p53 and RB1, SCLC is characterized by heterogeneously mis-regulated expression of MYC family members, yes-associated protein 1 (YAP1), NOTCH pathway signalling, anti-apoptotic BCL2 and epigenetic regulators. Molecular subtypes are based on the neurogenic transcription factors achaete-scute homologue 1 (ASCL1) and neurogenic differentiation factor 1 (NEUROD1), the rarer non-neuroendocrine transcription factor POU class 2 homeobox 3 (POU2F3), and immune- and inflammation-related signatures. Furthermore, SCLC shows phenotypic plasticity, including neuroendocrine-to-non-neuroendocrine transition driven by NOTCH signalling, which is associated with disease progression, chemoresistance and immune modulation and, in mouse models, with metastasis. Although these features pose substantial challenges, understanding the molecular vulnerabilities of transcription factor subtypes, the functional relevance of plasticity and cell cooperation offer opportunities for personalized therapies informed by liquid and tissue biomarkers.
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Affiliation(s)
- Kathryn L Simpson
- SCLC Biology Group, Cancer Research UK Manchester Institute, Manchester, UK
- CRUK National Biomarker Centre, University of Manchester, Manchester, UK
- CRUK Lung Cancer Centre of Excellence, Manchester, UK
| | - Dominic G Rothwell
- CRUK National Biomarker Centre, University of Manchester, Manchester, UK
- CRUK Lung Cancer Centre of Excellence, Manchester, UK
| | - Fiona Blackhall
- CRUK Lung Cancer Centre of Excellence, Manchester, UK
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Medical Oncology, Christie Hospital National Health Service, Foundation Trust, Manchester, UK
| | - Caroline Dive
- SCLC Biology Group, Cancer Research UK Manchester Institute, Manchester, UK.
- CRUK National Biomarker Centre, University of Manchester, Manchester, UK.
- CRUK Lung Cancer Centre of Excellence, Manchester, UK.
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5
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Liu H, Chen F, Xu Q, Zhai X, Tian Y, Sun Z, Lu S, Niu J, Zhao J, Jin Y, Zhu H. Construction of a nomogram to guide prophylactic cranial irradiation in extensive‑stage small cell lung cancer. Oncol Lett 2025; 29:265. [PMID: 40230428 PMCID: PMC11995680 DOI: 10.3892/ol.2025.15011] [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: 11/20/2024] [Accepted: 03/05/2025] [Indexed: 04/16/2025] Open
Abstract
Patients with extensive-stage small cell lung cancer (ES-SCLC) have a high risk of brain metastasis (BM). However, to the best of our knowledge, the risk factors for BM remain unclear. The present study aimed to investigate the risk factors and establish a prediction model for BM in patients with ES-SCLC. A total of 156 patients with ES-SCLC who had no BM and achieved a partial or complete response between January 2020 and March 2023 were included. Patients were randomly divided into training (n=109) and validation (n=47) cohorts. Factors associated with BM were assessed in the training cohort. Univariate and Cox multivariate analyses were performed to evaluate patients with ES-SCLC. Cox multivariate analysis identified oligometastasis [hazard ratio (HR), 0.35; 95% CI, 0.14-0.85; P=0.021], sex (HR, 2.48; 95% CI, 1.05-5.85; P=0.038) and baseline adrenal metastasis (HR, 2.85; 95% CI, 1.54-5.21; P<0.001) as independent risk factors for BM. A nomogram model was constructed to predict intracranial progression-free survival (iPFS). The areas under the receiver operating characteristic curves for the 9-, 12- and 18-month iPFS in the training cohort were 0.77, 0.74 and 0.75, respectively. The nomogram prediction and actual validation cohorts demonstrated good agreement. Among the high-risk factors for BM, the overall survival analysis demonstrated that non-oligometastasis and baseline adrenal metastasis were unfavorable prognostic factors. The present nomogram may aid risk assessment for BM in patients with ES-SCLC and guide prophylactic cranial irradiation.
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Affiliation(s)
- Haoyu Liu
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong 250117, P.R. China
| | - Feihu Chen
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong 250117, P.R. China
| | - Qinhao Xu
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong 250117, P.R. China
| | - Xiaoyang Zhai
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong 250117, P.R. China
| | - Yaru Tian
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong 250117, P.R. China
| | - Zhuoran Sun
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong 250117, P.R. China
| | - Shuangqing Lu
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong 250117, P.R. China
| | - Jiling Niu
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong 250117, P.R. China
| | - Junfeng Zhao
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong 250117, P.R. China
| | - Yuqin Jin
- Department of Imageology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong 250117, P.R. China
| | - Hui Zhu
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong 250117, P.R. China
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Ibáñez-Juliá MJ, Bataller L, Cabello-Murgui FJ, Nguyen-Them L, Alentorn A, Torres-Martínez A, Mazón-Momparler M, Gironés-Sarrió R. Clinical and radiological features of pseudoprogression in brain tumors treated with immune checkpoint inhibitors. J Neurooncol 2025:10.1007/s11060-025-05091-0. [PMID: 40426008 DOI: 10.1007/s11060-025-05091-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2025] [Accepted: 05/17/2025] [Indexed: 05/29/2025]
Abstract
PURPOSE Immune checkpoint inhibitors (ICIs) are increasingly used in cancer treatment, resulting in the emergence of various immune-related adverse effects, including pseudoprogression (PsP). We sought to evaluate the characteristics of pseudoprogression in adults treated with ICIs for brain tumors (either primary or secondary), and to compare it with a non- PsP group. METHODS We retrospectively identified adults with brain tumors treated with ICIs at our institution between 2015 and 2023. Eligibility required one brain magnetic resonance imaging scan prior to treatment and another obtained within 6 months after treatment initiation. PsP was defined as radiological worsening within 6 months of ICI initiation, followed by stabilization or improvement without therapy modification. Demographic, clinical, and radiological characteristics were analyzed and compared between the PsP and the non-PsP groups. RESULTS Among 102 eligible patients, 10 (9.8%) developed PsP. Clinical symptoms occurred in 4 (40%) cases, all of which showed favorable outcomes with corticosteroid therapy. The PsP group had higher baseline tumor burden (p = 1.29 × 10⁻¹³) and higher PD-L1 expression (p < 0.001) than the non-PsP group. Median progression-free survival and overall survival were numerically longer in the PsP group with no significant difference. CONCLUSIONS PsP is a frequent complication of ICIs. We describe 4 symptomatic patients with pseudoprogression, challenging the iRANO criteria that recommend excluding this diagnosis in symptomatic cases. Clinical impairment should not automatically rule out pseudoprogression, and each case requires thorough evaluation. High PD-L1 expression and greater tumor burden may be associated with PsP, but further studies are needed to confirm these findings.
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Affiliation(s)
| | - Luis Bataller
- Department of Neurology, Hospital Universitari i Politècnic La Fe, Valencia, Spain.
- Department of Neurology, Instituto Valenciano de Oncología, Valencia, Spain.
| | | | - Ludovic Nguyen-Them
- Department of Neurology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Agusti Alentorn
- Sorbonne Universités, CNRS, UMR S 1127, Institut du Cerveau et de la Moelle épinière, Inserm, Paris, HP, France
- Department of Neurology Mazarin, Hôpitaux universitaires Pitié-Salpêtrière Charles Foix.Assistance Publique Hôpitaux de Paris (APHP), Paris, France
| | - Alba Torres-Martínez
- Medical Oncology Department, Hospital Universitari i Politècnic la Fe, Valencia, Spain
| | | | - Regina Gironés-Sarrió
- Medical Oncology Department, Hospital Universitari i Politècnic la Fe, Valencia, Spain
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7
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Ganti AK, D'Agostino RB, Allan V, Prince P, Estrin A, Gautam N, Boccuti A, Rengarajan B, Li W, Cao Y, Fan X, Poole EM. Real-world use, effectiveness, and safety of second-line lurbinectedin monotherapy in small cell lung cancer. Future Oncol 2025:1-11. [PMID: 40420490 DOI: 10.1080/14796694.2025.2499441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2025] [Accepted: 04/25/2025] [Indexed: 05/28/2025] Open
Abstract
AIM Assess real-world outcomes of lurbinectedin and other second-line treatments (OST) in adults with small cell lung cancer that progressed on/after chemotherapy. PATIENTS & METHODS US-based electronic medical data from Flatiron Health (01/01/2013-03/31/2022) were used. Baseline characteristics, including chemotherapy-free interval (CTFI), in patients receiving lurbinectedin or OST were balanced using propensity score (PS) overlap weighting. RESULTS Before PS-weighting, median (95% confidence interval [CI]) real-world progression-free survival (rwPFS) was 2.46 months (2.07-2.73), and real-world response rate (rwRR) was 27.5% (23.1-32.4) in 374 eligible lurbinectedin-treated patients. After PS-weighting, median rwPFS was 2.73 months (2.33-3.32) and 2.53 months (2.23-2.99) in 291 lurbinectedin-treated patients and 261 OST-treated patients, respectively; rwRR was 30.9% and 31.8% (relative risk, 0.97). Lurbinectedin demonstrated numerically improved median rwPFS (3.61 versus 3.02 months) and rwRR (38.7% versus 36.1%) versus OST in patients with CTFI ≥90 days but not in patients with CTFI <90 days (2.00 months both; 20.5% versus 26.1%). Lurbinectedin-treated patients reported less grade ≥3 thrombocytopenia (11.7%) and anemia (6.5%) versus OST (27.2% and 20.3%, respectively); prevalence by CTFI status were similar. CONCLUSION Lurbinectedin demonstrated comparable real-world effectiveness with OST with a favorable safety profile; however, these findings are limited by small sample size.
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Affiliation(s)
- Apar Kishor Ganti
- Division of Oncology-Hematology, VA Nebraska Western Iowa Health Care System/University of Nebraska Medical Center, Omaha, NE, USA
| | | | - Victoria Allan
- Department of Medical Affairs and Value Statistics, Jazz Pharmaceuticals, Oxford, UK
| | | | - Adina Estrin
- Department of Science, Aetion Inc., New York, NY, USA
| | | | - Anne Boccuti
- Data Science Operations, Jazz Pharmaceuticals, Philadelphia, PA, USA
| | - Badri Rengarajan
- Department of Medical Affairs, Jazz Pharmaceuticals, Palo Alto, CA, USA
| | - Wenyan Li
- Data Science Operations, Jazz Pharmaceuticals, Philadelphia, PA, USA
- Department of Clinical Science, Jazz Pharmaceuticals, Philadelphia, PA, USA
| | - Yanyan Cao
- Data Science Operations, Jazz Pharmaceuticals, Philadelphia, PA, USA
- Department of Epidemiology, Jazz Pharmaceuticals, Philadelphia, PA, USA
| | - Xiaozhou Fan
- Data Science Operations, Jazz Pharmaceuticals, Philadelphia, PA, USA
- Real-world Evidence, Jazz Pharmaceuticals, Philadelphia, PA, USA
| | - Elizabeth M Poole
- Department of Medical Affairs, Jazz Pharmaceuticals, Palo Alto, CA, USA
- Department of Evidence and Value Generation, Jazz Pharmaceuticals, Palo Alto, CA, USA
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Linde S, Møller DS, Linaa MB, Appelt A, Almhagen E, Hofland KF, Knap MM, Kristiansen C, Land LH, Larsen C, Levin N, Lindberg K, Lund MD, Merring-Mikkelsen L, Nielsen TB, Ottosson W, Persson GF, Sand HMB, Suppli MH, Villegas F, Schmidt HH, Szejniuk WM, Hoffmann L. Design and pre-trial dose planning quality assurance of the Nordic trial of inhomogeneous dose escalated radiotherapy for patients with limited disease small cell lung cancer: NIELS. Radiother Oncol 2025; 209:110946. [PMID: 40409366 DOI: 10.1016/j.radonc.2025.110946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2025] [Revised: 04/22/2025] [Accepted: 05/16/2025] [Indexed: 05/25/2025]
Abstract
BACKGROUND AND PURPOSE The NIELS trial will examine if inhomogeneous dose-escalated radiotherapy up to a mean dose of 80 Gy in 40 fractions (fx), twice-daily delivered (BID), for patients with limited disease small cell lung cancer can improve overall survival. Because of the inherent risks of dose-escalation, pre-trial QA is particularly important. This study aims to examine the feasibility of the NIELS trial planning approach in a multicenter setting. MATERIALS AND METHODS The NIELS trial will randomize patients between standard dose radiotherapy (60 Gy/40fx BID) and inhomogeneous dose-escalated radiotherapy (up to 80 Gy/40fx BID). Five representative patient cases were distributed to seven Nordic centers for pre-trial QA planning of a standard and an escalated dose plan. Targets for escalation were primary tumor (GTVp) and involved lymph nodes (GTVn). We evaluated inter-center variation in achievable dose-escalation and doses to organs at risk (OAR). RESULTS All targets could be escalated beyond the standard dose, with a median mean dose of 79.6 Gy [76.9-81.0] and 75.8 Gy [68.3-81.1] for GTVp and GTVn. Some targets could not be fully escalated due to OAR proximity. Three separate breaches of mandatory OAR constraints were observed in 35 escalated dose plans. There was a statistical difference in mean lung dose between standard and escalated plans, though clinically small, with a median inter-patient difference of 0.3 Gy. There were no differences in mean doses to the heart and esophagus. CONCLUSION Inhomogeneous dose-escalation as planned in the NIELS trial is feasible, and the dose-escalation can be performed respecting the OAR constraints in a multi-center setting.
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Affiliation(s)
- Sara Linde
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | - Ditte S Møller
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Mai-Britt Linaa
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Ane Appelt
- Leeds Institute of Medical Research, University of Leeds, Leeds, UK
| | - Erik Almhagen
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden; Nuclear Medicine and Medical Physics, Karolinska University Hospital, Stockholm, Sweden
| | - Kenneth F Hofland
- Department of Oncology, Zealand University Hospital, Næstved, Denmark
| | - Marianne M Knap
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Charlotte Kristiansen
- Department of Oncology, Vejle Hospital, University Hospital of Southern Denmark, Vejle, Denmark
| | - Lotte H Land
- Department of Oncology, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Christina Larsen
- Department of Oncology & Radiotherapy Research Unit, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
| | - Nina Levin
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, NTNU, Trondheim, Norway; Department of Oncology, St. Olavs Hospital, Trondheim, Norway
| | - Karin Lindberg
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden; Centre of Pulmonary Oncology, HHLH-section, Karolinska University Hospital, Stockholm, Sweden
| | - Mikkel D Lund
- Department of Oncology, Vejle Hospital, University Hospital of Southern Denmark, Vejle, Denmark
| | | | - Tine B Nielsen
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - Wiviann Ottosson
- Department of Oncology & Radiotherapy Research Unit, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
| | - Gitte F Persson
- Department of Oncology, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark; Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark
| | - Hella M B Sand
- Department of Oncology, Aalborg University Hospital, Aalborg, Denmark
| | - Morten H Suppli
- Department of Oncology, Zealand University Hospital, Næstved, Denmark
| | - Fernanda Villegas
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden; Nuclear Medicine and Medical Physics, Karolinska University Hospital, Stockholm, Sweden
| | | | - Weronika M Szejniuk
- Department of Oncology & Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Lone Hoffmann
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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9
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Yin X, Liang HW, Liu Y, Huang W, Pan XB. Lobectomy versus sublobar resection on survival in patients with stage T1-2N0M0 small cell lung cancer. PLoS One 2025; 20:e0324315. [PMID: 40367065 PMCID: PMC12077667 DOI: 10.1371/journal.pone.0324315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2025] [Accepted: 04/24/2025] [Indexed: 05/16/2025] Open
Abstract
PURPOSE To compare survival outcomes of lobectomy versus sublobar resection in patients diagnosed with stage T1-2N0M0 small cell lung cancer (SCLC). MATERIALS AND METHODS A comprehensive retrospective analysis was conducted using data from the Surveillance, Epidemiology, and End Results database. The Kaplan-Meier method was utilized to estimate cancer-specific survival (CSS) and overall survival (OS) between stage T1-2N0M0 SCLC patients undergoing sublobar resection and those receiving lobectomy. RESULTS A total of 185 patients were included in the analysis, with 64 undergoing sublobar resection and 121 receiving lobectomy. Before propensity score matching, lobectomy was associated with significantly better CSS (hazard ratio [HR] =, 95% confidence interval [CI]: 0.32, P = 0.006) and OS (HR =, 95% CI: 0.39, P = 0.005) compared to sublobar resection. Multivariable Cox regression analysis confirmed that lobectomy was an independent predictor of improved CSS (HR =, 95% CI: 0.24, P = 0.003) and OS (HR =, 95% CI: 0.36, P = 0.013). After propensity score matching, the differences in CSS (HR =, 95% CI: 0.36, P = 0.177) and OS (HR =, 95% CI: 0.46, P = 0.234) between the two surgical approaches were not statistically significant. CONCLUSION Lobectomy may offer improved survival outcomes compared to sublobar resection in patients with stage T1-2N0M0 SCLC.
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Affiliation(s)
- Xue Yin
- Department of Oncology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, P.R. China
| | - Huan-Wei Liang
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, P.R. China
| | - Yang Liu
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, P.R. China
| | - Wei Huang
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, P.R. China
| | - Xin-Bin Pan
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, P.R. China
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Guan T, Liu X, Zhang L, Ren C, Feng Y, Yang Z, Xiao L. Soybean-Derived Bioactive Components in Prevention and Intervention of Lung Cancer. Mol Nutr Food Res 2025:e70105. [PMID: 40344500 DOI: 10.1002/mnfr.70105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2024] [Revised: 03/24/2025] [Accepted: 04/22/2025] [Indexed: 05/11/2025]
Abstract
Soybean (Glycine max) is one of Asia's most valuable oil crops, offering a rich source of dietary protein and bioactive compounds with diverse clinical applications. Key bioactive phytochemicals in soybean, including isoflavones, flavonoids, carotenoids, phytosterols, soyasaponins, fatty acids, and protein isolates, are known for their potential health benefits. These compounds exert functional properties by modulating critical metabolic pathways, such as the mitogen-activated protein kinase (MAPK), estrogen receptor (ER), and nuclear factor kappa-B (NF-κB) pathways. With a growing body of epidemiological and clinical evidence supporting the anticancer potential of soybean, this review systematically examines the role of soybean-derived bioactive components in the prevention and treatment of lung cancer. To our knowledge, this is the first review to focus specifically on the impact of soy-derived bioactive components on lung cancer progression and modulation, offering insights into their mechanisms and potential as dietary interventions.
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Affiliation(s)
- Tianzhu Guan
- College of Chemistry and Environmental Science, Laboratory of Xinjiang Native Medicinal and Edible Plant Resources Chemistry, Kashi University, Kashi, China
- School of Food Science and Engineering, Yangzhou University, Yangzhou, China
| | - Xiaoxiao Liu
- School of Food Science and Engineering, Yangzhou University, Yangzhou, China
| | - Longfei Zhang
- School of Food Science and Engineering, Yangzhou University, Yangzhou, China
| | - Chenxi Ren
- School of Food Science and Engineering, Yangzhou University, Yangzhou, China
| | - Yining Feng
- School of Food Science and Engineering, Yangzhou University, Yangzhou, China
| | - Zhenquan Yang
- School of Food Science and Engineering, Yangzhou University, Yangzhou, China
| | - Lixia Xiao
- School of Food Science and Engineering, Yangzhou University, Yangzhou, China
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11
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Lamberti G, Rihawi K, Mazzoni F, Riccardi F, Follador A, Tiseo M, Frassoldati A, Colantonio I, Bonetti A, Genova C, Giardina D, Bertolini F, Cinieri S, Pasello G, Brighenti M, Andrini E, Tognetto M, Boni L, Ardizzoni A. Carboplatin, etoposide, atezolizumab, and bevacizumab in the first-line treatment of patients with extensive stage small-cell lung cancer: the GOIRC-01-2019 CeLEBrATE study. J Immunother Cancer 2025; 13:e010694. [PMID: 40341031 PMCID: PMC12067786 DOI: 10.1136/jitc-2024-010694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2024] [Accepted: 04/18/2025] [Indexed: 05/10/2025] Open
Abstract
BACKGROUND The addition of a programmed death-ligand 1 (PD-L1) inhibitor, either atezolizumab or durvalumab, to platinum-etoposide prolonged survival in a limited subset of patients with extensive-stage small-cell lung cancer (ES-SCLC). Preclinical studies demonstrated synergistic antitumor activity of combined vascular endothelial growth factor receptor and PD-L1 inhibition in SCLC. Since bevacizumab added to platinum-etoposide was safe and active in ES-SCLC, we investigated the efficacy of atezolizumab, bevacizumab, carboplatin, and etoposide as first-line treatment of ES-SCLC. METHODS The CeLEBrATE study is an Italian multicentric single-arm phase II trial of carboplatin (area under the curve 5 ml/min), etoposide (100 mg/sqm), bevacizumab (7.5 mg/kg), and atezolizumab (1,200 mg) every 3 weeks (q3w) for four to six courses, followed by bevacizumab and atezolizumab maintenance q3w in patients with ES-SCLC and no contraindications to immunotherapy or antiangiogenic therapy. Patients with asymptomatic brain metastases were eligible. Prophylactic cranial irradiation and consolidation thoracic external radiotherapy were not permitted while on study treatment. Primary endpoint was overall survival (OS) rate at 1 year. RESULTS 53 patients were enrolled (45.3% women, median age 65 years) and received at least one dose of study treatment. At a median follow-up time of 23.4 months (95% CI: 21.1 to 26.0), the 1-year OS rate was 61.8% (90% CI: 50.7% to 72.8%; p=0.04), with a median OS of 12.9 months (95% CI: 11.6 to 17.5). Median progression-free survival was 6.2 months (95% CI: 5.4 to 6.6) and objective response rate was 83.3% (95% CI: 69.8% to 92.5%). Grade 3-4 adverse events were reported in 34 patients (64.2%) leading to dose reductions in 24 (45.3%), and dose delays in 39 (73.9%) and 32 (69.6%) during the induction and maintenance phase, respectively. 19 (35.8%) treatment-related serious adverse events were reported. CONCLUSION The CeLEBrATE study met its primary objective demonstrating a signal of efficacy of bevacizumab, atezolizumab, carboplatin, and etoposide in the first-line treatment of patients with ES-SCLC. TRIAL REGISTRATION NUMBER GOIRC-01-2019 ML41241, Eudract Number: 2019-003798-2.
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Affiliation(s)
- Giuseppe Lamberti
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, Bologna, Italy
- Medical Oncology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Gruppo Oncologico Italiano di Ricerca Clinica (GOIRC), Parma, Italy
| | - Karim Rihawi
- Medical Oncology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Gruppo Oncologico Italiano di Ricerca Clinica (GOIRC), Parma, Italy
| | - Francesca Mazzoni
- Gruppo Oncologico Italiano di Ricerca Clinica (GOIRC), Parma, Italy
- Medical Oncology Unit, Department of Oncology, Careggi University Hospital, Firenze, Italy
| | - Ferdinando Riccardi
- Gruppo Oncologico Italiano di Ricerca Clinica (GOIRC), Parma, Italy
- Medical Oncology Unit, Azienda Ospedaliera Cardarelli, Napoli, Italy
| | - Alessandro Follador
- Gruppo Oncologico Italiano di Ricerca Clinica (GOIRC), Parma, Italy
- Department of Oncology, University Hospital Santa Maria Della Misericordia, Udine, Italy
| | - Marcello Tiseo
- Gruppo Oncologico Italiano di Ricerca Clinica (GOIRC), Parma, Italy
- Department of Medicine and Surgery, University of Parma and Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Antonio Frassoldati
- Gruppo Oncologico Italiano di Ricerca Clinica (GOIRC), Parma, Italy
- Department of Oncology, Azienda Ospedaliero Universitaria di Ferrara-Arcispedale Sant'Anna, Ferrara, Italy
| | - Ida Colantonio
- Gruppo Oncologico Italiano di Ricerca Clinica (GOIRC), Parma, Italy
- Medical Oncology Unit, S. Croce e Carle General Hospital, Cuneo, Italy
| | - Andrea Bonetti
- Gruppo Oncologico Italiano di Ricerca Clinica (GOIRC), Parma, Italy
- Department of Oncology, "Mater Salutis" Hospital, Legnago, Italy
| | - Carlo Genova
- Gruppo Oncologico Italiano di Ricerca Clinica (GOIRC), Parma, Italy
- AcademicOncology Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Internal Medicine and Medical Specialties (DiMI), Università degli Studi di Genova, Genova, Italy
| | - Donatella Giardina
- Gruppo Oncologico Italiano di Ricerca Clinica (GOIRC), Parma, Italy
- Medical Oncology, Ospedale Ramazzini di Carpi and Ospedale di Mirandola, Azienda Usl Modena, Carpi, Italy
| | - Federica Bertolini
- Gruppo Oncologico Italiano di Ricerca Clinica (GOIRC), Parma, Italy
- Division of Medical Oncology, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy
| | - Saverio Cinieri
- Gruppo Oncologico Italiano di Ricerca Clinica (GOIRC), Parma, Italy
- Medical Oncology Unit, Hospital of Brindisi, Brindisi, Italy
| | - Giulia Pasello
- Gruppo Oncologico Italiano di Ricerca Clinica (GOIRC), Parma, Italy
- Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova, Italy
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Matteo Brighenti
- Gruppo Oncologico Italiano di Ricerca Clinica (GOIRC), Parma, Italy
- Medical Oncology Department, ASST Cremona, Cremona, Italy
| | - Elisa Andrini
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Michele Tognetto
- Gruppo Oncologico Italiano di Ricerca Clinica (GOIRC), Parma, Italy
| | - Luca Boni
- Gruppo Oncologico Italiano di Ricerca Clinica (GOIRC), Parma, Italy
- Clinical Epidemiology Unit, IRCSS Ospedale Policlinico San Martino, Genova, Italy
| | - Andrea Ardizzoni
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, Bologna, Italy
- Medical Oncology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Gruppo Oncologico Italiano di Ricerca Clinica (GOIRC), Parma, Italy
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Yang N, Ma ZX, Wang X, Xiao L, Jin L, Li M. Development and validation of a CT-based radiomics nomogram for predicting progression-free survival in patients with small cell lung cancer. BMC Med Imaging 2025; 25:154. [PMID: 40329257 PMCID: PMC12057258 DOI: 10.1186/s12880-025-01691-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2024] [Accepted: 04/25/2025] [Indexed: 05/08/2025] Open
Abstract
PURPOSE Small cell lung cancer (SCLC) is a highly aggressive form of lung cancer, representing about 15% of cases worldwide. Despite advances in imaging, such as low-dose CT, which have increased diagnostic rates, survival outcomes for SCLC patients have remained stagnant. Recent studies have only focused on radiomics, which extracts detailed quantitative features from imaging, with clinical risk factors to improve prognostic models. Therefore, this study aimed to develop a clinical-radiomics fusion nomogram based on computed tomography (CT) to estimate progression-free survival (PFS) in patients diagnosed with SCLC. By integrating radiomics features extracted from CT with clinical data, this model provides personalized prognostic assessment for clinicians. Its clinical utility lies in aiding treatment decision-making by offering more accurate prognostic evaluation, optimizing therapeutic strategies, and identifying high-risk patients at an early stage, ultimately improving overall survival and quality of life. METHODS To develop the nomogram model, 95 patients diagnosed with pathologically confirmed SCLC between January 1, 2013, and December 31, 2023, were included in the study cohort. Participants were randomly divided into training and validation cohorts in a 7:3 ratio. Radiomics features associated with PFS were generated using the least absolute shrinkage and selection operator (LASSO) along with univariate and multivariate analyses. Additionally, in the training cohort, both univariate and multivariate analyses using Cox regression were conducted to identify the significant clinical risk factors influencing PFS. The predictive performance of the clinical and clinical-radiomics fusion nomogram were evaluated using the concordance index, calibration plots, and decision curve analysis (DCA). RESULTS Five radiomics features were selected and used to calculate the radiomics score (Rad-score). The radiomics features were significantly associated with PFS (hazard ratio: 0.5765, 95% confidence interval: 0.3641-0.9128, p < 0.05). Three clinical risk factors significantly associated with PFS were identified: neuron-specific enolase (NSE), carbohydrate antigen 125 levels (CA125), and treatment type, such as surgery. The clinical-radiomics fusion nomogram model (C-index:0.744) demonstrated superior performance compared to the clinical nomogram model (C-index: 0.718) in the training cohort. DCA indicated that the clinical-radiomics fusion nomogram outperformed the clinical nomogram in terms of clinical usefulness. CONCLUSIONS A CT-based clinical-radiomics fusion nomogram was developed to predict PFS in patients with SCLC, which is useful in providing individualized information. ADVANCES IN KNOWLEDGE A clinical-radiomics fusion nomogram was constructed to estimate the probability of PFS based on clinical risk factors and the rad-score.
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Affiliation(s)
- Nan Yang
- Department of Radiology, Huadong Hospital, Fudan University, Shanghai, 200040, China
- Zhang Guozhen Small Pulmonary Nodules Diagnosis and Treatment Center, Shanghai, 200040, China
| | - Zhuang Xuan Ma
- Department of Radiology, Huadong Hospital, Fudan University, Shanghai, 200040, China
- Zhang Guozhen Small Pulmonary Nodules Diagnosis and Treatment Center, Shanghai, 200040, China
| | - Xin Wang
- Department of Pathology, Huadong Hospital, Fudan University, Shanghai, 200040, China
| | - Li Xiao
- Department of Pathology, Huadong Hospital, Fudan University, Shanghai, 200040, China
| | - Liang Jin
- Department of Radiology, Huadong Hospital, Fudan University, Shanghai, 200040, China.
- Zhang Guozhen Small Pulmonary Nodules Diagnosis and Treatment Center, Shanghai, 200040, China.
| | - Ming Li
- Department of Radiology, Huadong Hospital, Fudan University, Shanghai, 200040, China.
- Zhang Guozhen Small Pulmonary Nodules Diagnosis and Treatment Center, Shanghai, 200040, China.
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13
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Vitale E, Rizzo A, Maistrello L, Guven DC, Cauli O, Galetta D, Longo V. Treatment-Related Adverse Events in Extended Stage Small Cell Lung Cancer Patients Receiving First-Line Chemoimmunotherapy Versus Chemotherapy Alone: A Systematic Review and Meta-Analysis. Cancers (Basel) 2025; 17:1571. [PMID: 40361497 PMCID: PMC12072015 DOI: 10.3390/cancers17091571] [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: 03/06/2025] [Revised: 04/28/2025] [Accepted: 05/03/2025] [Indexed: 05/15/2025] Open
Abstract
Introduction: Nowadays the prognosis of extended stage (ES) small cell lung cancer (SCLC) patients is poor. However, a high response rate to first-line chemotherapy (CT) and the addition of immune checkpoint inhibitors (ICIs) have notably ameliorated the outcome of these patients. The aim of our study is to compare treatment-related adverse events (TRAEs) between ES- SCLC patients receiving first-line ICIs adding CT and those receiving only CT. Methods: All phase III clinical trials published between 15 June 2008, and 30 June 2024, likenessing ICIs adding systemic CT and only CT in treatment-naïve ES-SCLC patients were retrieved. Results: Twenty-six types of adverse events were included, grouped into ten categories, for a total of 43,391 observations (observations in immune group n = 22,643 and in placebo group n = 20,748) and 9831 events. Our analysis suggested a statistically significant increase in hematological events in patients receiving ICIs plus CT compared with CT alone. Conversely, blood pressure alterations such as hypertension were more frequent in patients treated with CT alone. Conclusions: Despite our analysis confirming the manageable safety profile of chemoimmunotherapy, this remains an issue to be further investigated.
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Affiliation(s)
- Elsa Vitale
- Medical Thoracic Oncology Unit, IRCCS Istituto Tumori “Giovanni Paolo II”, 70124 Bari, Italy; (E.V.); (D.G.)
| | - Alessandro Rizzo
- Struttura S.S.D.C.O.r.O., Bed Management Presa in Carico, TDM, IRCCS Istituto Tumori “Giovanni Paolo II”, 70124 Bari, Italy;
| | | | - Deniz Can Guven
- Medical Oncology Clinic, Health Sciences University, Elazig City Hospital, Elazig 23280, Turkey;
| | - Omar Cauli
- Nursing Department, Faculty of Nursing and Podiatrics, Universitat de València, 46010 Valencia, Spain;
| | - Domenico Galetta
- Medical Thoracic Oncology Unit, IRCCS Istituto Tumori “Giovanni Paolo II”, 70124 Bari, Italy; (E.V.); (D.G.)
| | - Vito Longo
- Medical Thoracic Oncology Unit, IRCCS Istituto Tumori “Giovanni Paolo II”, 70124 Bari, Italy; (E.V.); (D.G.)
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14
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Ai Y, Liu J, Li Y, Wang F, Du X, Jain RK, Lin L, Chen YW. SAMA: A Self-and-Mutual Attention Network for Accurate Recurrence Prediction of Non-Small Cell Lung Cancer Using Genetic and CT Data. IEEE J Biomed Health Inform 2025; 29:3220-3233. [PMID: 39348246 DOI: 10.1109/jbhi.2024.3471194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/02/2024]
Abstract
Accurate preoperative recurrence prediction for non-small cell lung cancer (NSCLC) is a challenging issue in the medical field. Existing studies primarily conduct image and molecular analyses independently or directly fuse multimodal information through radiomics and genomics, which fail to fully exploit and effectively utilize the highly heterogeneous cross-modal information at different levels and model the complex relationships between modalities, resulting in poor fusion performance and becoming the bottleneck of precise recurrence prediction. To address these limitations, we propose a novel unified framework, the Self-and-Mutual Attention (SAMA) Network, designed to efficiently fuse and utilize macroscopic CT images and microscopic gene data for precise NSCLC recurrence prediction, integrating handcrafted features, deep features, and gene features. Specifically, we design a Self-and-Mutual Attention Module that performs three-stage fusion: the self-enhancement stage enhances modality-specific features; the gene-guided and CT-guided cross-modality fusion stages perform bidirectional cross-guidance on the self-enhanced features, complementing and refining each modality, enhancing heterogeneous feature expression; and the optimized feature aggregation stage ensures the refined interactive features for precise prediction. Extensive experiments on both publicly available datasets from The Cancer Imaging Archive (TCIA) and The Cancer Genome Atlas (TCGA) demonstrate that our method achieves state-of-the-art performance and exhibits broad applicability to various cancers.
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15
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Steindl A, Zach C, Berchtold L, Grisold A, Gatterbauer B, Eckert F, Bago-Horvath Z, Hainfellner JA, Exner R, Fitzal F, Pfeiler G, Singer CF, Widhalm G, Bartsch R, Preusser M, Berghoff AS. Prognostic relevance of the neurological symptom burden in brain metastases from breast cancer. Br J Cancer 2025; 132:733-743. [PMID: 40025253 PMCID: PMC11997164 DOI: 10.1038/s41416-025-02967-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 12/18/2024] [Accepted: 02/20/2025] [Indexed: 03/04/2025] Open
Abstract
BACKGROUND Existing prognostic models for breast cancer (BC) brain metastases (BM) overlook neurological symptoms. Thus, we explored the incidence and prognostic relevance of neurological symptoms in a real-world cohort of BC patients with BM. METHODS The Vienna Brain Metastasis Registry identified BC patients with BM between 1992 and 2020, categorised by subtype: hormone receptor-positive/human epidermal growth factor receptor 2-negative (HR+/HER2-), HER2 overexpressing (HER2+), and triple-negative (TN). RESULTS A total of 716 patients with BM from BC were included. In total, 80% (573/716) of the patients presented with neurological symptoms at BM diagnosis. Across all BC subtypes, asymptomatic patients presented with a significantly longer median OS from diagnosis of BM compared to symptomatic patients (p < 0.05; log-rank test; HR+ BC 29 vs. 9 months; HER2+ BC 24 vs. 12 months; TN 12 vs. 6 months). In multivariate analysis with the BC-specific Graded Prognostic Assessment (Breast-GPA: HR:1.4; 95% CI:1.3-1.5; p < 0.001), the presence of neurological symptoms at diagnosis (HR:1.6; 95% CI: 1.4-1.9; p < 0.001) presented as independently associated with OS from time of BM diagnosis, respectively. CONCLUSIONS Neurological burden at BM diagnosis independently predicts survival in BC patients. Our findings emphasise incorporating the symptom status in the prognostic evaluation and reassessing BM screening in high-risk patients during prospective clinical trials.
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Affiliation(s)
- Ariane Steindl
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
- Christian Doppler Laboratory for Personalized Immunotherapy, Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Clara Zach
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Luzia Berchtold
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
- Institute of Medical Statistics, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Anna Grisold
- Department of Neurology, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | | | - Franziska Eckert
- Department of Radiation Oncology, Medical University of Vienna, Vienna, Austria
| | | | - Johannes A Hainfellner
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Ruth Exner
- Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Florian Fitzal
- Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Georg Pfeiler
- Department of Obstetrics and Gynecology, and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Christian F Singer
- Department of Obstetrics and Gynecology, and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Georg Widhalm
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Rupert Bartsch
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Matthias Preusser
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
- Christian Doppler Laboratory for Personalized Immunotherapy, Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Anna S Berghoff
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria.
- Christian Doppler Laboratory for Personalized Immunotherapy, Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria.
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Paz-Ares L, Gupta B, Baena J, Liu SV. Unmet Needs in Maintenance Therapy for Extensive Stage Small Cell Lung Cancer. Clin Lung Cancer 2025; 26:168-178. [PMID: 40155220 DOI: 10.1016/j.cllc.2025.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 11/19/2024] [Accepted: 02/27/2025] [Indexed: 04/01/2025]
Abstract
Small cell lung cancer (SCLC) is a highly aggressive malignancy and an exceptionally lethal disease; most patients present with extensive stage (ES) disease at diagnosis. Very little had changed in the treatment of ES-SCLC for decades until immune checkpoint inhibitor (ICI) therapy combined with chemotherapy followed by ICI maintenance monotherapy was added to standard treatment paradigms in 2019. Despite this important advance, high rates of relapse are still observed in patients with ES-SCLC and long-term survival rates remain low, with approximately 40% of patients proceeding to receive second-line treatment. There is an urgent need for novel treatment strategies to improve patient outcomes. In this review, we describe the rationale for maintenance therapy approaches in ES-SCLC and summarize the existing data on chemotherapy, ICIs, and other agents in the first-line maintenance setting. Predictive biomarkers, SCLC subtypes, and new therapeutics in development are discussed including lurbinectedin, antibody-drug conjugates, and T-cell engager molecules.
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Affiliation(s)
- Luis Paz-Ares
- Hospital Universitario 12 de Octubre, H120H120-CNIO Lung Cancer Clinical Research Unit, Universidad Complutense & Ciberonc, Madrid, Spain
| | - Brinda Gupta
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
| | - Javier Baena
- Hospital Universitario 12 de Octubre, H120H120-CNIO Lung Cancer Clinical Research Unit, Universidad Complutense & Ciberonc, Madrid, Spain
| | - Stephen V Liu
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC.
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Galvani L, Zappi A, Pusceddu S, Gelsomino F, La Salvia A, Oldani S, Panzuto F, Andrini E, Lamberti G, Campana D. Capecitabine and temozolomide or temozolomide alone in patients with atypical carcinoids. Endocrine 2025; 88:660-667. [PMID: 39853630 PMCID: PMC12069480 DOI: 10.1007/s12020-025-04171-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2024] [Accepted: 01/14/2025] [Indexed: 01/26/2025]
Abstract
BACKGROUND Lung neuroendocrine neoplasms (NENs) represent about 20% of all lung cancers. Few therapeutic options are available for atypical carcinoids (ACs). Single-agent temozolomide (TEM) is active in lung NENs, but whether the addition of capecitabine (CAPTEM) is associated with improved outcomes, is unknown. We sought to investigate the TEM-based therapies (TEM or CAPTEM) in patients with advanced AC. MATERIAL AND METHODS This was a retrospective analysis of prospectively collected data from patients with AC of the lung referred to our institution from January 2003 to January 2023 who have received chemotherapy with either TEM or CAPTEM as any line treatment. Primary endpoint was progression free survival (PFS), secondary endpoints included overall response rate (ORR) and overall survival (OS). RESULTS In this study we included 31 patients with advanced AC. Median Ki-67 was 14.4% (3-30). CAPTEM in 17 patients (54.8%), while TEM was administered in 14 patients (45.2%). Overall, ORR was 39% (N = 12/31, all partial responses), while median PFS and OS were 57.4 months (95%CI: 43.2-71.7) and 24.4 months (95% confidence interval [95%CI]: 14.7-34.1). Median PFS was 33.9 months (15.6-52.1) in the CAPTEM group, while it was 15.5 (7.3-23.8) in the TEM group (p = 0.047). When adjusting for potential confounding factors, treatment with TEM vs CAPTEM retained its independent association with an increased risk of progression (HR: 4.01 [95%CI: 1.18-13.68]; p = 0.027). CONCLUSIONS Treatment with CAPTEM is associated with longer PFS than TEM alone in patients with AC. Prospective studies with larger sample size are needed to validate this finding.
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Affiliation(s)
- Linda Galvani
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum - Università di Bologna, Bologna, Italy
| | - Arianna Zappi
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum - Università di Bologna, Bologna, Italy
| | - Sara Pusceddu
- Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Fabio Gelsomino
- Division of Oncology, Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
| | - Anna La Salvia
- Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
- National Center for Drug Research and Evaluation, National Institute of Health (ISS), Rome, Italy
| | - Simone Oldani
- Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Francesco Panzuto
- Department of Medical-Surgical Sciences and Translational Medicine, Sapienza University of Rome, Rome, Italy
- Digestive Disease Unit, Sant'Andrea University Hospital, ENETS Center of Excellence, Rome, Italy
| | - Elisa Andrini
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum - Università di Bologna, Bologna, Italy
| | - Giuseppe Lamberti
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum - Università di Bologna, Bologna, Italy.
| | - Davide Campana
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum - Università di Bologna, Bologna, Italy
- Medical Oncology Department, IRCCS Azienda Ospedaliero-Universitaria Sant'Orsola-Malpighi di Bologna, Bologna, Italy
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18
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Dhaeyer S, Missault E, Surmont V, Vermaelen K, Stevens D. Outcome of temozolomide in relapsed small cell lung cancer: A retrospective single center analysis. Lung Cancer 2025; 203:108539. [PMID: 40279759 DOI: 10.1016/j.lungcan.2025.108539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2024] [Revised: 03/17/2025] [Accepted: 04/11/2025] [Indexed: 04/29/2025]
Abstract
OBJECTIVES Extensive-stage small cell lung cancer (SCLC) has a dismal prognosis. Despite initial responsiveness to first-line platinum-etoposide chemotherapy, most patients relapse within six months. Managing disease progression, particularly in platinum-resistant or refractory cases, remains challenging. Topotecan is the only drug approved in the European Union for the second-line treatment of SCLC but is associated with modest clinical activity and high rates of hematological toxicities. Temozolomide, an oral alkylating agent, has been investigated as a viable alternative for treating relapsed SCLC. This study presents the largest real-world cohort of SCLC-patients treated with temozolomide. METHODS We performed a retrospective analysis of patients with relapsed SCLC treated with temozolomide at a single academic hospital in Belgium. Temozolomide was administered at a fixed dose of 250 mg orally once daily on days 1-5 of each 28-day cycle. Data on activity (overall response rate (ORR), disease control rate (DCR), median progression-free survival (mPFS) and median overall survival (mOS)) and safety (treatment related adverse events (TRAE)) were collected. RESULTS Between February 2011 and May 2023, a total of 48 patients with relapsed SCLC were treated with temozolomide of which 47 patients, median age 61 years, were included in this real-world analysis. The majority of the patients were heavily pretreated with 57.4 % having received two or more prior systemic therapies. An objective response was observed in 14.9 % and the DCR was 23.4 %. The median PFS was 1.7 months (95 % CI 1.5-1.9) and the median OS was 3.2 months (95 % CI 2.3-4.1). Grade 3-4 TRAEs occurred in 34 % of the patients. CONCLUSIONS Temozolomide demonstrated modest clinical activity in this real-world effectiveness analysis of patients with relapsed SCLC. Nevertheless, given its comparable response rate and milder toxicity profile compared to topotecan, temozolomide should be considered as a viable alternative to topotecan for treating relapsed SCLC.
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Affiliation(s)
- Sofie Dhaeyer
- Department of Internal Medicine, Ghent University Hospital, Ghent, Belgium
| | - Elise Missault
- Department of Internal Medicine, Ghent University Hospital, Ghent, Belgium
| | - Veerle Surmont
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - Karim Vermaelen
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - Dieter Stevens
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium.
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19
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Fukushima T, Togasaki K, Hamamoto J, Emoto K, Ebisudani T, Mitsuishi A, Sugihara K, Shinozaki T, Okada M, Saito A, Takaoka H, Ito F, Shigematsu L, Ohta Y, Takahashi S, Matano M, Kurebayashi Y, Ohgino K, Sato T, Kawada I, Asakura K, Hishida T, Asamura H, Ikemura S, Terai H, Soejima K, Oda M, Fujii M, Fukunaga K, Yasuda H, Sato T. An organoid library unveils subtype-specific IGF-1 dependency via a YAP-AP1 axis in human small cell lung cancer. NATURE CANCER 2025:10.1038/s43018-025-00945-y. [PMID: 40307487 DOI: 10.1038/s43018-025-00945-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 03/07/2025] [Indexed: 05/02/2025]
Abstract
Small cell lung cancer (SCLC) is a devastating disease with limited therapeutic advancements. Although SCLC has recently been classified into four molecular subtypes, subtype-specific therapies are still lacking. Here, we established 40 patient-derived SCLC organoid lines with predominant TP53 and RB1 alterations and rare targetable genetic lesions. Transcriptome profiling divided the SCLC organoids into neuroendocrine (NE)-type SCLC and non-NE-type SCLC, with the latter characterized by YAP1 or POU2F3 expression. NE-type SCLC organoids grew independent of alveolar niche factors, whereas non-NE-type SCLC organoids relied on insulin-like growth factor (IGF)-1-driven YAP1 and AP1 activation. Therapeutic targeting of IGF-1, YAP1 and AP1 effectively suppressed the growth of non-NE-type organoids. Co-knockout of TP53 and RB1 in human alveolar cells altered their lineage toward the airway epithelium-like fate and conferred IGF-1 dependency, validating the subtype-phenotype connection. Our SCLC organoid library represents a valuable resource for developing biology-based therapies and has the potential to reshape the drug discovery landscape.
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Affiliation(s)
- Takahiro Fukushima
- Division of Pulmonary Medicine, Department of Medicine, Keio University, School of Medicine, Tokyo, Japan
| | - Kazuhiro Togasaki
- Department of Organoid Medicine, Keio University School of Medicine, Tokyo, Japan
- Department of Integrative Medicine and Biochemistry, Keio University School of Medicine, Tokyo, Japan
- Division of Gastroenterology Medicine, Department of Medicine, Keio University, School of Medicine, Tokyo, Japan
| | - Junko Hamamoto
- Division of Pulmonary Medicine, Department of Medicine, Keio University, School of Medicine, Tokyo, Japan
| | - Katsura Emoto
- Department of Pathology, Keio University School of Medicine, Tokyo, Japan
| | - Toshiki Ebisudani
- Division of Pulmonary Medicine, Department of Medicine, Keio University, School of Medicine, Tokyo, Japan
- Department of Organoid Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Akifumi Mitsuishi
- Division of Pulmonary Medicine, Department of Medicine, Keio University, School of Medicine, Tokyo, Japan
| | - Kai Sugihara
- Division of Pulmonary Medicine, Department of Medicine, Keio University, School of Medicine, Tokyo, Japan
| | - Taro Shinozaki
- Division of Pulmonary Medicine, Department of Medicine, Keio University, School of Medicine, Tokyo, Japan
| | - Masahiko Okada
- Division of Pulmonary Medicine, Department of Medicine, Keio University, School of Medicine, Tokyo, Japan
| | - Ayaka Saito
- Division of Pulmonary Medicine, Department of Medicine, Keio University, School of Medicine, Tokyo, Japan
| | - Hatsuyo Takaoka
- Division of Pulmonary Medicine, Department of Medicine, Keio University, School of Medicine, Tokyo, Japan
| | - Fumimaro Ito
- Division of Pulmonary Medicine, Department of Medicine, Keio University, School of Medicine, Tokyo, Japan
| | - Lisa Shigematsu
- Division of Pulmonary Medicine, Department of Medicine, Keio University, School of Medicine, Tokyo, Japan
| | - Yuki Ohta
- Department of Organoid Medicine, Keio University School of Medicine, Tokyo, Japan
- Department of Integrative Medicine and Biochemistry, Keio University School of Medicine, Tokyo, Japan
| | - Sirirat Takahashi
- Department of Organoid Medicine, Keio University School of Medicine, Tokyo, Japan
- Department of Integrative Medicine and Biochemistry, Keio University School of Medicine, Tokyo, Japan
| | - Mami Matano
- Department of Organoid Medicine, Keio University School of Medicine, Tokyo, Japan
- Department of Integrative Medicine and Biochemistry, Keio University School of Medicine, Tokyo, Japan
| | - Yutaka Kurebayashi
- Department of Pathology, Keio University School of Medicine, Tokyo, Japan
| | - Keiko Ohgino
- Division of Pulmonary Medicine, Department of Medicine, Keio University, School of Medicine, Tokyo, Japan
| | - Takashi Sato
- Department of Respiratory Medicine, Kitasato University School of Medicine, Kanagawa, Japan
| | - Ichiro Kawada
- Division of Pulmonary Medicine, Department of Medicine, Keio University, School of Medicine, Tokyo, Japan
| | - Keisuke Asakura
- Division of Thoracic Surgery, Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Tomoyuki Hishida
- Division of Thoracic Surgery, Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Hisao Asamura
- Division of Thoracic Surgery, Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Shinnosuke Ikemura
- Department of Pulmonary Medicine, Faculty of Medicine University of Yamanashi, Yamanashi, Japan
| | - Hideki Terai
- Division of Pulmonary Medicine, Department of Medicine, Keio University, School of Medicine, Tokyo, Japan
| | - Kenzo Soejima
- Department of Pulmonary Medicine, Faculty of Medicine University of Yamanashi, Yamanashi, Japan
| | - Mayumi Oda
- Department of Organoid Medicine, Keio University School of Medicine, Tokyo, Japan
- Department of Integrative Medicine and Biochemistry, Keio University School of Medicine, Tokyo, Japan
| | - Masayuki Fujii
- Department of Organoid Medicine, Keio University School of Medicine, Tokyo, Japan
- Department of Integrative Medicine and Biochemistry, Keio University School of Medicine, Tokyo, Japan
| | - Koichi Fukunaga
- Division of Pulmonary Medicine, Department of Medicine, Keio University, School of Medicine, Tokyo, Japan
| | - Hiroyuki Yasuda
- Division of Pulmonary Medicine, Department of Medicine, Keio University, School of Medicine, Tokyo, Japan.
| | - Toshiro Sato
- Department of Organoid Medicine, Keio University School of Medicine, Tokyo, Japan.
- Department of Integrative Medicine and Biochemistry, Keio University School of Medicine, Tokyo, Japan.
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20
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Cognigni V, Toscani I, D’Agnelli S, Pecci F, Righi L, Berardi R, Tiseo M. Molecular heterogeneity of small cell lung cancer and new therapeutic possibilities: a narrative review of the literature. Transl Lung Cancer Res 2025; 14:1441-1455. [PMID: 40386726 PMCID: PMC12082233 DOI: 10.21037/tlcr-24-755] [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: 09/14/2024] [Accepted: 01/08/2025] [Indexed: 05/20/2025]
Abstract
Background and Objective Small cell lung cancer (SCLC) is an aggressive disease commonly occurring in individuals with a history of heavy smoking. Despite recent approvals of chemotherapy and immunotherapy in the first-line treatment of extensive-stage SCLC, it maintains a poor prognosis. Moreover, only a small percentage of patients benefits from the addition of immunotherapy to platinum-based chemotherapy. The lack of significant progress in therapeutic options unrevealed the urgent need for a deeper understanding of tumor biology and easy-to-use predictive biomarkers, aiming to better tailor the treatment strategy. The aim of this review is to summarize recent evidence about the biology, molecular heterogeneity, as well as tumor microenvironment (TME) of SCLC and their forefront therapeutic implications. Methods A literature search was conducted using PubMed, focusing on articles published in English from 1981 to October 2024. Studies on SCLC biology and subclassification were selected for further analysis and integrated in the current narrative review. Key Content and Findings SCLC entity implies four distinct molecular subtypes based on transcription factors expression, specifically achaete-scute homolog 1 (ASCL1), neurogenic differentiation 1 (NEUROD1), POU class 2 homeobox 3 (POU2F3), and yes-associated protein 1 (YAP1), reflecting the tumor heterogeneity in terms of gene expression, transcriptional profiles, immune infiltration, and treatment sensitivity. Recently, a new subgroup, "SCLC-I", has been proposed to replace the YAP1 subtype, showing higher responsiveness to immunotherapy. The TME, implying immune cell infiltration and their interactions with cancer cells, plays a crucial role in determining SCLC's sensitivity to immunotherapy. Conclusions Advances in SCLC molecular characterization and the development of targeted therapies against specific molecular pathways might improve patients' clinical outcome, supporting a more personalized approach to this complex disease.
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Affiliation(s)
- Valeria Cognigni
- Department of Medical Oncology, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria delle Marche, Ancona, Italy
| | - Ilaria Toscani
- Medical Oncology Unit, Hospital of Piacenza, Piacenza, Italy
| | - Simona D’Agnelli
- Department of Medicine and Surgery, University of Parma, Parma, Italy
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Federica Pecci
- Department of Medicine and Surgery, University of Parma, Parma, Italy
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Luisella Righi
- Pathology Unit, Department of Oncology, University of Torino at San Luigi Hospital, Orbassano, Italy
| | - Rossana Berardi
- Department of Medical Oncology, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria delle Marche, Ancona, Italy
| | - Marcello Tiseo
- Department of Medicine and Surgery, University of Parma, Parma, Italy
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
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21
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Barba A, López-Vilaró L, Ferre M, Martinez-Recio S, Majem M, Sullivan I, Salazar J. CD274 ( PD-L1) Polymorphisms as Predictors of Efficacy in First-Line Platinum-Based Chemotherapy for Extensive-Stage Small Cell Lung Cancer. Int J Mol Sci 2025; 26:4245. [PMID: 40362483 PMCID: PMC12072405 DOI: 10.3390/ijms26094245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2025] [Revised: 04/22/2025] [Accepted: 04/28/2025] [Indexed: 05/15/2025] Open
Abstract
The cornerstone of first-line treatment in extensive-stage small cell lung cancer (ES-SCLC) is platinum- and etoposide-based chemotherapy. Platinum compounds could immunomodulate the tumor microenvironment in addition to their cytotoxic effect. Genetic variation in immune checkpoint (IC) pathways may predict chemotherapy efficacy. Polymorphisms in the IC genes were determined, and their association with survival was analyzed in 78 patients with ES-SCLC treated with chemotherapy. PD-L1 protein expression in tumor tissue was determined. Three variants in CD274 were associated with better median progression-free survival (mPFS): rs2297136 (hazard ratio [HR] 0.52, 95% CI 0.29-0.93; p = 0.03), rs2282055 (HR 0.23, 95% CI 0.09-0.64; p = 0.005), and rs822336 (HR 0.41, 95% CI 0.23-0.73; p = 0.002). CTLA4 rs231775 was also associated with mPFS (HR 0.30, 95% CI 0.14-0.63; p = 0.002). The variants CD274 rs2297136 and CD274 rs822336 were associated with platinum sensitivity (odds ratio [OR] 0.13, 95% CI 0.02-0.70; p = 0.02, and OR 0.08, 95% CI 0.01-0.46; p = 0.005, respectively). CD274 rs2297136 was also associated with better overall survival (p = 0.02), but not after adjustment for covariates. No association was found between CD274 germline variants and PD-L1 tumor expression. Our results suggest that CD274 and CTLA4 variants may be predictive biomarkers for platinum plus etoposide treatment in ES-SCLC.
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Affiliation(s)
- Andrés Barba
- Department of Medical Oncology, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain; (A.B.); (S.M.-R.); (M.M.); (I.S.)
- Department of Medicine, Faculty of Medicine, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain
- Translational Medical Oncology Laboratory, Institut de Recerca Sant Pau (IR Sant Pau), 08041 Barcelona, Spain
| | - Laura López-Vilaró
- Department of Pathology, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain; (L.L.-V.); (M.F.)
| | - Malena Ferre
- Department of Pathology, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain; (L.L.-V.); (M.F.)
| | - Sergio Martinez-Recio
- Department of Medical Oncology, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain; (A.B.); (S.M.-R.); (M.M.); (I.S.)
- Translational Medical Oncology Laboratory, Institut de Recerca Sant Pau (IR Sant Pau), 08041 Barcelona, Spain
| | - Margarita Majem
- Department of Medical Oncology, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain; (A.B.); (S.M.-R.); (M.M.); (I.S.)
- Translational Medical Oncology Laboratory, Institut de Recerca Sant Pau (IR Sant Pau), 08041 Barcelona, Spain
| | - Ivana Sullivan
- Department of Medical Oncology, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain; (A.B.); (S.M.-R.); (M.M.); (I.S.)
- Translational Medical Oncology Laboratory, Institut de Recerca Sant Pau (IR Sant Pau), 08041 Barcelona, Spain
| | - Juliana Salazar
- Translational Medical Oncology Laboratory, Institut de Recerca Sant Pau (IR Sant Pau), 08041 Barcelona, Spain
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22
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Ramos R, Vale N. Emerging Immunotherapies in Lung Cancer: The Latest Advances and the Future of mRNA Vaccines. Vaccines (Basel) 2025; 13:476. [PMID: 40432088 PMCID: PMC12115764 DOI: 10.3390/vaccines13050476] [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: 03/11/2025] [Revised: 04/25/2025] [Accepted: 04/28/2025] [Indexed: 05/29/2025] Open
Abstract
Lung cancer is the most lethal malignancy worldwide, having the highest incidence rate. This is a heterogeneous disease classified according to its histological and molecular characteristics. Depending on these, different therapeutic approaches have already been approved for lung cancer treatment targeting genetic alterations or even the immune system. Nonetheless, other therapies are being studied to continuously improve the care and survival of lung cancer patients. Among them, immunotherapies are one of the main targets of investigation to try and combat the ability of some malignant cells to evade anti-tumor responses mediated by the immune system. Cancer vaccine development has emerged as a promising approach to strengthen the patient's immune system and combat the disease, especially mRNA vaccines. Currently, there are several ongoing studies investigating the therapeutic efficacy of mRNA vaccines in lung cancer treatment alone or combined with other therapeutic drugs. This review aims to highlight the importance of immunotherapy in lung cancer treatment, presenting the most recent advances particularly in mRNA-based vaccines as well as the challenges and future perspectives.
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Affiliation(s)
- Raquel Ramos
- PerMed Research Group, RISE-Health, Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal;
- RISE-Health, Department of Community Medicine, Health Information and Decision (MEDCIDS), Faculty of Medicine, University of Porto, Rua Doutor Plácido da Costa, 4200-450 Porto, Portugal
| | - Nuno Vale
- PerMed Research Group, RISE-Health, Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal;
- RISE-Health, Department of Community Medicine, Health Information and Decision (MEDCIDS), Faculty of Medicine, University of Porto, Rua Doutor Plácido da Costa, 4200-450 Porto, Portugal
- Laboratory of Personalized Medicine, Department of Community Medicine, Health Information and Decision (MEDCIDS), Faculty of Medicine, University of Porto, Rua Doutor Plácido da Costa, 4200-450 Porto, Portugal
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23
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Zhou JX, Sun YC, Xiao L, Lu HL, Yin XM, Fan K, Zhou YN. Efficacy analysis and prognostic factors of first-line chemotherapy combined with immunotherapy in extensive-stage small cell lung cancer: a real-world study. Sci Rep 2025; 15:13063. [PMID: 40240495 PMCID: PMC12003727 DOI: 10.1038/s41598-025-98018-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2024] [Accepted: 04/08/2025] [Indexed: 04/18/2025] Open
Abstract
Extensive-stage small cell lung cancer (ES-SCLC) is a highly aggressive subtype of lung cancer with limited treatment options and poor prognosis. In recent years, immune checkpoint inhibitors (ICIs) combined with chemotherapy have demonstrated significant efficacy in several clinical trials. This study aims to evaluate the efficacy of first-line chemotherapy combined with immunotherapy in patients with ES-SCLC and identify prognostic factors based on real-world data. This retrospective study analyzed the clinical data of 349 patients with ES-SCLC treated at Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine from January 2018 to August 2023. The patients were divided into a combination group (chemotherapy plus immunotherapy, n = 173) and a chemotherapy group (chemotherapy alone, n = 176) based on their treatment regimens. The primary endpoints were overall survival (OS) and progression-free survival (PFS), and the secondary endpoint was treatment-related adverse events. Kaplan-Meier survival analysis was performed, and Cox regression models were used to analyze the factors influencing OS and PFS. The median OS in the combination group was 14.9 months, significantly longer than 11.9 months in the chemotherapy group (P < 0.001). After applying Propensity Score Matching (PSM) to minimize selection bias, the survival advantage remained statistically significant. The 1-, 2-, and 3-year OS rates in the combination group were 62.4%, 42.8%, and 19.5%, respectively, compared to 50.2%, 20.8%, and 9.6% in the chemotherapy group. The median PFS in the combination group was 5.4 months, also significantly longer than the 3.8 months observed in the chemotherapy group (P < 0.001). Multivariate analysis identified chemotherapy alone, ECOG performance status, and number of metastatic sites as independent risk factors for poorer OS and PFS (P < 0.001). A separate analysis was conducted to evaluate the association between tumor response (CR/PR/SD/PD) and survival outcomes, which showed that patients with CR/PR had significantly better OS and PFS compared to those with SD/PD (P < 0.001). These findings reinforce the clinical importance of achieving tumor response. There were no significant differences in the incidence of adverse events between the two groups, with most adverse events being grade 1-2, and no grade 5 adverse events were reported. This study demonstrates that chemotherapy combined with immunotherapy significantly prolongs OS and PFS in patients with ES-SCLC without substantially increasing treatment-related adverse events. This combination therapy shows promising clinical value for improving long-term prognosis in ES-SCLC patients. Future studies should explore potential biomarkers to optimize individualized treatment strategies.
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Affiliation(s)
- Jian-Xi Zhou
- Department of Radiation Oncology, Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine-Hebei Province, Cangzhou, 061000, Hebei, China
| | - Yun-Chuan Sun
- Department of Radiation Oncology, Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine-Hebei Province, Cangzhou, 061000, Hebei, China
| | - Li Xiao
- Department of Radiation Oncology, Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine-Hebei Province, Cangzhou, 061000, Hebei, China
| | - Hong-Ling Lu
- Department of Radiation Oncology, Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine-Hebei Province, Cangzhou, 061000, Hebei, China
| | - Xiao-Ming Yin
- Department of Radiation Oncology, Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine-Hebei Province, Cangzhou, 061000, Hebei, China
| | - Kui Fan
- Department of Radiation Oncology, Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine-Hebei Province, Cangzhou, 061000, Hebei, China
| | - Ying-Nan Zhou
- Department of Radiotherapy and Chemotherapy, Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine East Ward, Cangzhou, 061000, Hebei, China.
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24
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Torchia A, Ciappina G, Giammaruco M, Monteferrante I, Landi L, Cappuzzo F. Antibody-Based Therapeutics in Small Cell Lung Cancer: A Narrative Review. Biologics 2025; 19:189-199. [PMID: 40260055 PMCID: PMC12009746 DOI: 10.2147/btt.s500460] [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: 02/01/2025] [Accepted: 04/05/2025] [Indexed: 04/23/2025]
Abstract
Small-cell lung cancer (SCLC) is the most aggressive lung cancer, mostly diagnosed at advanced stage, and with few therapeutic options for patients failing the first-line treatment. Antibody-based therapies, such as antibody-drug conjugates and T-cell engagers, are emerging as a promising option in the treatment of various solid tumors, including SCLC. T-cell engagers are molecules able to trigger the T-cell-mediated tumor cell death binding, at the same time, a T-cell and a tumor cell target. Tarlatamab is a DLL3-directed bi-specific T-cell engager (BiTE) whose efficacy was evaluated in a Phase 2 study. Antibody-drug conjugates (ADC) consist of a tumor-directed monoclonal antibody conjugated to a cytotoxic payload able to selectively kill tumor cells through different mechanisms. Ifinatamab-deruxtecan is an anti-B7-H3 ADC showing efficacy in pretreated SCLC patients in a phase 2 clinical trial. Sacituzumab govitecan is a Trop-2-directed ADC already used in other tumor types and evaluated in SCLC in the phase 2 TROPiCS-03 trial, with positive results. Bispecific antibodies targeting VEGF and PD-(L)1 showed antitumor activity in phase 1 and 2 clinical trials. Other antibody-based agents are currently at an earlier phase of their clinical development and showed a promising activity. Novel antibody-based agents could potentially acquire a prominent role in the treatment of SCLC, a field with few therapeutic options. Direct comparisons with the current standard of care still lack, however Phase 3 trials are currently ongoing.
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Affiliation(s)
- Andrea Torchia
- Clinical and Molecular Medicine, Sapienza - Università di Roma, Rome, Italy
- Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Giuliana Ciappina
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | | | - Ilaria Monteferrante
- Department of Anesthesiology, Intensive Care and Pain Therapy, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Lorenza Landi
- Clinical Trials Unit: Phase 1 and Precision Medicine, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Federico Cappuzzo
- Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
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Čakš M, Janžič U, Rutar T, Unk M, Demšar A, Mohorčič K, Turnšek N, Matos E, But-Hadžić J. Benefit of Consolidation Thoracic Radiotherapy in Extensive-Stage Small-Cell Lung Cancer Patients Treated with Immunotherapy: Data from Slovenian Cohort. Int J Mol Sci 2025; 26:3631. [PMID: 40332154 PMCID: PMC12027371 DOI: 10.3390/ijms26083631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2025] [Revised: 03/29/2025] [Accepted: 04/10/2025] [Indexed: 05/08/2025] Open
Abstract
Chemoimmunotherapy (CT/IO) with immune checkpoint inhibitors has recently become the standard of care for extensive-stage small cell lung cancer (ES-SCLC). Given the uncertain role of consolidation thoracic radiotherapy (cTRT) in this setting, we conducted a real-world study to evaluate the efficacy and safety of cTRT in ES-SCLC patients receiving first-line CT/IO. We performed a retrospective analysis of ES-SCLC patients treated with first-line CT/IO in Slovenia from December 2019 to June 2024. Patient characteristics, treatment patterns, survival outcomes, and adverse events were analyzed, with subgroup comparisons based on cTRT administration. Among 208 patients (median age: 66 years), median overall survival was 12.1 months (95% CI: 10.6-13.7). cTRT was administered to 46 patients (22.1%), who had fewer metastases. cTRT was associated with improved OS (17.0 vs. 10.8 months; p < 0.001) and was an independent OS predictor (HR = 0.58, p = 0.035). Grade ≥ 3 adverse events were similar (26.1% vs. 21.3%), though pneumonitis occurred more frequently with cTRT (6.5% vs. 0%, p = 0.001). cTRT may improve survival in ES-SCLC patients treated with CT/IO, with no significant increase in toxicity apart from pneumonitis. Further prospective studies are needed.
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Affiliation(s)
- Marina Čakš
- Department of Oncology, University Medical Centre Maribor, 2000 Maribor, Slovenia; (M.Č.); (T.R.); (A.D.)
| | - Urška Janžič
- Medical Oncology Unit, University Clinic Golnik, 4204 Golnik, Slovenia; (U.J.); (K.M.)
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia; (M.U.); (N.T.); (E.M.)
| | - Tjaša Rutar
- Department of Oncology, University Medical Centre Maribor, 2000 Maribor, Slovenia; (M.Č.); (T.R.); (A.D.)
| | - Mojca Unk
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia; (M.U.); (N.T.); (E.M.)
- Department of Medical Oncology, Institute of Oncology Ljubljana, 1000 Ljubljana, Slovenia
| | - Ana Demšar
- Department of Oncology, University Medical Centre Maribor, 2000 Maribor, Slovenia; (M.Č.); (T.R.); (A.D.)
| | - Katja Mohorčič
- Medical Oncology Unit, University Clinic Golnik, 4204 Golnik, Slovenia; (U.J.); (K.M.)
| | - Nina Turnšek
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia; (M.U.); (N.T.); (E.M.)
- Department of Medical Oncology, Institute of Oncology Ljubljana, 1000 Ljubljana, Slovenia
| | - Erika Matos
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia; (M.U.); (N.T.); (E.M.)
- Department of Medical Oncology, Institute of Oncology Ljubljana, 1000 Ljubljana, Slovenia
| | - Jasna But-Hadžić
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia; (M.U.); (N.T.); (E.M.)
- Department of Radiotherapy, Institute of Oncology Ljubljana, 1000 Ljubljana, Slovenia
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26
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Chiang CL, Liao YT, Sun RL, Huang HC, Shen CI, Tseng YH, Luo YH, Chen YM. Treatment patterns and survival outcomes in patients with small-cell lung cancer following failure of first-line platinum-based chemotherapy. Clin Transl Oncol 2025:10.1007/s12094-025-03918-w. [PMID: 40208517 DOI: 10.1007/s12094-025-03918-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2024] [Accepted: 03/30/2025] [Indexed: 04/11/2025]
Abstract
PURPOSE Small-cell lung cancer (SCLC) is an aggressive malignancy with limited treatment options, especially after the failure of first-line (1L) platinum-based chemotherapy. This study evaluated the treatment patterns and survival outcomes of Taiwanese patients with SCLC following 1L treatment failure, focusing on the effects of treatment-free interval (TFI). METHODS This retrospective study enrolled 287 patients with SCLC from 2012 to 2021. Data on clinical characteristics, systemic treatments after 1L failure, and survival status were collected. Progression-free survival (PFS) and overall survival (OS) were examined in analyses stratified by TFI. TFI < 90 days and ≥ 90 days denoted resistant relapse and sensitive relapse, respectively. RESULTS Second-line (2L) and third-line (3L) chemotherapy was administered to 76% and 54.1% of patients, respectively. Topotecan was administered to 25.4% of patients, primarily those with TFI 90-179 days. Platinum rechallenge was administered to 8.4% of patients, primarily those with TFI ≥ 180 days. The median PFS of patients with 2L treatment was 2.3 months (95% CI 2.2-2.6), and the median OS was 5.1 months (95% CI 4.3-6.2). Patients with TFI ≥ 90 days had significantly longer PFS (2.6 vs 2.2 months, P = 0.011) and OS (9.6 vs 4.0 months, P < 0.0001) than did those with TFI < 90 days. Platinum rechallenge showed similar efficacy to topotecan in patients with sensitive relapse (3.0 vs 2.7 months, P = 0.61). CONCLUSIONS Survival outcomes in patients with relapsed SCLC remain poor, particularly in those with platinum-resistant relapse. Our findings highlight the importance of optimizing 1L treatment for delaying disease progression. More effective 2L therapies should be developed to improve survival outcomes in patients with relapsed SCLC.
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Affiliation(s)
- Chi-Lu Chiang
- Department of Chest Medicine, Taipei Veterans General Hospital, 201, Section 2, Shih-Pai Road, Taipei, 112, Taiwan.
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
| | - Ying-Ting Liao
- Department of Chest Medicine, Taipei Veterans General Hospital, 201, Section 2, Shih-Pai Road, Taipei, 112, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ruei-Lin Sun
- Department of Chest Medicine, Taipei Veterans General Hospital, 201, Section 2, Shih-Pai Road, Taipei, 112, Taiwan
| | - Hsu-Ching Huang
- Department of Chest Medicine, Taipei Veterans General Hospital, 201, Section 2, Shih-Pai Road, Taipei, 112, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chia-I Shen
- Department of Chest Medicine, Taipei Veterans General Hospital, 201, Section 2, Shih-Pai Road, Taipei, 112, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yen-Han Tseng
- Department of Chest Medicine, Taipei Veterans General Hospital, 201, Section 2, Shih-Pai Road, Taipei, 112, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yung-Hung Luo
- Department of Chest Medicine, Taipei Veterans General Hospital, 201, Section 2, Shih-Pai Road, Taipei, 112, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yuh-Min Chen
- Department of Chest Medicine, Taipei Veterans General Hospital, 201, Section 2, Shih-Pai Road, Taipei, 112, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
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Horinouchi H, Chang CHS, Shaw J, Archangelidi O, Balasubramanian A, Pundole X. Real-world treatment patterns and survival in extensive stage small-cell lung cancer in Japan. Jpn J Clin Oncol 2025; 55:383-390. [PMID: 39703179 PMCID: PMC11973631 DOI: 10.1093/jjco/hyae175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2024] [Accepted: 12/03/2024] [Indexed: 12/21/2024] Open
Abstract
OBJECTIVE To describe standard of care and inform the evolving unmet need among extensive stage small-cell lung cancer (ES-SCLC) patients in Japan since approval of first-line anti-PD-L1 therapies, we describe treatment patterns and overall survival by line of therapy. METHODS We conducted a descriptive analysis of adult ES-SCLC patients in Japan using de-identified patient data within the MDV database (hospital-based claims) to describe treatment patterns and DeSC database (payer-based claims linked to mortality of municipality records) to describe both treatment patterns and real-world overall survival (rwOS). RESULTS The study population of MDV and DeSC cohorts included 6302 and 903 patients, respectively. First-line anti-PD-L1 therapy-based regimens grew since their approval in 2019 and were used in ~35% and ~59% of patients in 2022, in the MDV and DeSC cohorts, respectively. Amrubicin monotherapy was the most common second-line (2 L) regimen before and after 1 L anti-PD-L1 approvals. No clear standard of care was identified in third-line (3 L) and fourth-line (4 L). Median rwOS following 1 L therapy was 10.6 months (95% CI: 9.0, 11.8) and 9.3 months (95% CI: 8.3, 10.3) in patients who did and did not receive anti-PD-L1 therapy, respectively. Following 2 L, 3 L, and 4 L therapy, median rwOS was 6.7 months (95% CI: 5.9, 7.4), 5.5 months (95% CI: 4.4, 6.4), and 4.7 months (95% CI: 3.4, 6.9), respectively. CONCLUSIONS Anti-PD-L1 therapies have become part of first-line standard of care but survival in treated Japanese ES-SCLC patients remains poor, highlighting the unmet medical need in the post anti-PD-L1 era.
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Affiliation(s)
- Hidehito Horinouchi
- Department of Thoracic Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan
| | - Chia-Hsien Suzu Chang
- Center for Observational Research, Amgen K.K., 9-7-1 Akasaka, Minato-ku, Tokyo 107-6239, Japan
| | - Jaime Shaw
- Center for Observational Research, Amgen Inc., One Amgen Center Drive, Thousand Oaks, CA 91320, United States
| | - Olga Archangelidi
- Center for Observational Research, Amgen Ltd., 4 Uxbridge Business Park, Sanderson Road, Uxbridge UB8 1DH, United Kingdom
| | - Akhila Balasubramanian
- Center for Observational Research, Amgen Inc., One Amgen Center Drive, Thousand Oaks, CA 91320, United States
| | - Xerxes Pundole
- Center for Observational Research, Amgen Inc., One Amgen Center Drive, Thousand Oaks, CA 91320, United States
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28
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Dal Maso A, Ferrarini F, Esposito G, Minuzzo SA, Puggia AM, Pezzuto F, Zulato E, Bao LC, De Nuzzo M, Ferro A, Frega S, Pasello G, Calabrese F, Fassan M, Rea F, Guarneri V, Indraccolo S, Bonanno L. Liver kinase B1 expression is associated with improved prognosis and tumor immune microenvironment features in small cell lung cancer. Front Oncol 2025; 15:1552506. [PMID: 40255421 PMCID: PMC12006004 DOI: 10.3389/fonc.2025.1552506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2024] [Accepted: 03/17/2025] [Indexed: 04/22/2025] Open
Abstract
Background Small cell lung cancer (SCLC) is characterized by early metastatic potential and poor prognosis. Liver kinase B1 (LKB1) is a tumor suppressor and a cell metabolism regulator. LKB1 downregulation has been associated with a cold tumor immune microenvironment (TIME). We aimed to analyze the role of LKB1 in SCLC in relation to its association with overall survival (OS) and TIME components. Methods We retrospectively evaluated SCLC patients consecutively treated at our institution from 1996 to 2020 with available tissue. LKB1, PD-L1 on tumor cells and on tumor immune-infiltrating cells, CD8, and FOXP3 were evaluated by immunohistochemistry (IHC), categorized according to predefined cutoffs. The primary endpoint was the description of LKB1 expression, and the secondary endpoints were the association with prognosis and TIME features. Results Tissue samples of 138 out of 481 SCLCs were adequate for molecular analyses. Eighty patients had limited stage (LS) at diagnosis and 58 had extended stage (ES). The median LKB1 IHC score was 4. Patients with IHC score >4 (n = 67) were classified as LKB1-positive. The probability of LKB1 positivity was higher in LS [odds ratio 2.78, 95% confidence interval (95% CI) 1.18-7.14]. At the data cutoff (2 January 2024), 123 patients died. The median OS (mOS) was 14.0 months (95% CI 11.5-19.4). mOS was significantly longer in patients with LKB1-positive expression [32.4 months (95% CI 13.6-62.4) vs. 11.2 months (95% CI 8.7-14.7); p < 0.001]. At multivariate analysis, positive LKB1 expression, LS, and no weight loss at diagnosis were confirmed as independent positive prognostic factors. TIME features were evaluated in 70 patients. Unexpectedly, LKB1-negative samples were more likely to show CD8+ tumor-infiltrating lymphocytes (TILs; p = 0.013). No association with PD-L1 expression nor the presence of FOXP3+ TILs was found. Conclusion LKB1 expression is a potential positive prognostic marker in SCLC. In this series, LKB1 expression was negatively associated with the presence of CD8+ TILs.
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Affiliation(s)
| | - Federica Ferrarini
- Basic and Translational Oncology, Veneto Institute of Oncology IOV - IRCCS, Padova, Italy
| | - Giovanni Esposito
- Immunology and Molecular Oncology Diagnostics, Veneto Institute of Oncology IOV - IRCCS, Padova, Italy
| | - Sonia Anna Minuzzo
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Anna Maria Puggia
- Anatomy and Pathological Histology, Veneto Institute of Oncology IOV - IRCCS, Castelfranco Veneto, Italy
| | - Federica Pezzuto
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Elisabetta Zulato
- Basic and Translational Oncology, Veneto Institute of Oncology IOV - IRCCS, Padova, Italy
| | - Loc Carlo Bao
- Medical Oncology 2, Veneto Institute of Oncology IOV - IRCCS, Padova, Italy
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Mattia De Nuzzo
- Medical Oncology 2, Veneto Institute of Oncology IOV - IRCCS, Padova, Italy
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Alessandra Ferro
- Medical Oncology 2, Veneto Institute of Oncology IOV - IRCCS, Padova, Italy
| | - Stefano Frega
- Medical Oncology 2, Veneto Institute of Oncology IOV - IRCCS, Padova, Italy
| | - Giulia Pasello
- Medical Oncology 2, Veneto Institute of Oncology IOV - IRCCS, Padova, Italy
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Fiorella Calabrese
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Matteo Fassan
- Department of Medicine, University of Padua, Padua, Italy
- Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - Federico Rea
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
- Thoracic Surgery Unit, Padova University Hospital, Padova, Italy
| | - Valentina Guarneri
- Medical Oncology 2, Veneto Institute of Oncology IOV - IRCCS, Padova, Italy
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Stefano Indraccolo
- Basic and Translational Oncology, Veneto Institute of Oncology IOV - IRCCS, Padova, Italy
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Laura Bonanno
- Medical Oncology 2, Veneto Institute of Oncology IOV - IRCCS, Padova, Italy
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
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29
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Brink GJ, Hami N, Mertens S, Nijman HW, van Lonkhuijzen LRCW, Roes EM, Lok CAR, de Kroon CD, Piek JMJ, Hofhuis W, Snippert HJG, Groeneweg JW, Witteveen PO, Zweemer RP. Response to Systemic Therapies in Patient-Derived Cell Lines from Primary and Recurrent Adult Granulosa Cell Tumors. Mol Cancer Ther 2025; 24:628-638. [PMID: 39600124 DOI: 10.1158/1535-7163.mct-24-0223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 08/08/2024] [Accepted: 11/21/2024] [Indexed: 11/29/2024]
Abstract
In patients with the rare adult-type granulosa cell tumor (aGCT), surgery is the primary treatment for both primary and recurrent disease. In cases of inoperable disease, systematic therapy is administered, but variable response rates and drug resistance complicate predicting the most effective therapy. Drug screen testing on patient-derived cell lines may offer a solution. In a national prospective study on aGCT, fresh tissue was cultured into 2D cell lines, testing 27 clinical and experimental drugs. Dose-response curves and synergy were calculated using GraphPad Prism and CompuSyn software. We established 34 patient-derived cell lines from tissue of 20 patients with aGCT. Of these, seven patients had a primary diagnosis of aGCT and 13 patients had recurrent disease. In eight patients, multiple tumor locations were cultured. On each cell line, 10 monotherapies and 17 combinations of drugs were tested. Carboplatin/gemcitabine showed efficacy and synergy in almost all patient-derived cell lines. Synergy could not be detected in the regular carboplatin/paclitaxel and carboplatin/etoposide combinations. Experimental combinations alpelisib/fulvestrant and alpelisib/gemcitabine showed efficacy of more than 75%. Drug screens on patient-derived tumor cell lines reflect the reality of the variable response of systemic therapy in patients with aGCT. In future research, this technique may be used to personalize the systemic treatment of patients with aGCT in a clinical study. The good response to carboplatin/gemcitabine in our patient-derived cell lines can then be confirmed in a clinical setting.
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Affiliation(s)
- Geertruid J Brink
- Department of Gynecologic Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Nizar Hami
- Department of Molecular Cancer Research, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Sander Mertens
- Department of Molecular Cancer Research, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Hans W Nijman
- Department of Obstetrics and Gynecology, University Medical Center Groningen, Groningen, the Netherlands
| | - Luc R C W van Lonkhuijzen
- Department of Gynecological Oncology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Eva Maria Roes
- Department of Gynecologic Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Christine A R Lok
- Department of Gynecological Oncology, Center Gynaecologic Oncology Amsterdam, Amsterdam, the Netherlands
| | - Cornelis D de Kroon
- Department of Gynecology, Leiden University Medical Center, Leiden, the Netherlands
| | - Jurgen M J Piek
- Department of Obstetrics and Gynecology, Catharina Hospital, Eindhoven, the Netherlands
| | - Ward Hofhuis
- Department of Obstetrics and Gynecology, Franciscus Gasthuis en Vlietland, Rotterdam, the Netherlands
| | - Hugo J G Snippert
- Department of Molecular Cancer Research, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Jolijn W Groeneweg
- Department of Gynecologic Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Petronella O Witteveen
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Ronald P Zweemer
- Department of Gynecologic Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
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30
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Cooper WA, Webster F, Butnor KJ, Calabrese F, Chou TY, Hwang DM, Kern I, Popat S, Sholl L, Yatabe Y, Nicholson AG. Data set for the reporting of lung cancer: recommendations from the International Collaboration on Cancer Reporting (ICCR). Histopathology 2025; 86:665-680. [PMID: 39438780 DOI: 10.1111/his.15313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2024]
Abstract
Lung cancer is the leading cause of cancer related deaths worldwide, although some patients with early-stage disease can be cured with surgical resection. Standardised reporting of all clinically relevant pathological parameters is essential for best patient care and is also important for ongoing data collection and refinement of important pathological features that impact patient prognosis, staging and clinical care. Using the established International Collaboration on Cancer Reporting (ICCR) procedure, a representative international expert panel of nine lung pathologists as well as an oncologist was convened. Essential core elements and suggested non-core elements were identified for inclusion in the resected lung cancer pathology data set based on predetermined levels of evidence as well as consensus expert opinion. A lung cancer histopathology reporting guide was developed that includes relevant clinical, macroscopic, microscopic and ancillary testing. Critical review and discussion of current evidence was incorporated into the new data set including changes from the 2021 World Health Organisation (WHO) Classification of Thoracic Tumours, fifth edition, new requirements for grading invasive non-mucinous adenocarcinomas, assessment of response to neoadjuvant therapy and requirements for molecular testing in early-stage resected lung carcinomas. This ICCR data set represents incorporation of all relevant parameters for histology reporting of lung cancer resection specimens. Routine use of this data set is recommended for all pathology reporting of resected lung cancer and it is freely available worldwide on the ICCR website (https://www.iccr-cancer.org/datasets/published-datasets/). Widespread implementation will help to ensure consistent and comprehensive pathology reporting and data collection essential for lung cancer patient care, clinical trials and other research.
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Affiliation(s)
- Wendy A Cooper
- Royal Prince Alfred Hospital, NSW Health Pathology, Camperdown, NSW, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- School of Medicine, Western Sydney University, Sydney, NSW, Australia
| | - Fleur Webster
- International Collaboration on Cancer Reporting, Surry Hills, NSW, Australia
| | - Kelly J Butnor
- Department of Pathology and Laboratory Medicine, The University of Vermont Medical Center, Burlington, Vermont, USA
| | - Fiorella Calabrese
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova Medical School, Padova, Italy
| | | | - David M Hwang
- Department of Laboratory Medicine and Pathobiology, University of Toronto and Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Izidor Kern
- Cytology and Pathology Laboratory, University Clinic of Respiratory and Allergic Diseases, Golnik, Slovenia
| | | | - Lynette Sholl
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Yasushi Yatabe
- Department of Diagnostic Pathology, National Cancer Center Hospital, Tokyo, Japan
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31
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Kuhtić I, Mandić Paulić T, Kovačević L, Badovinac S, Jakopović M, Dobrenić M, Hrabak-Paar M. Clinical TNM Lung Cancer Staging: A Diagnostic Algorithm with a Pictorial Review. Diagnostics (Basel) 2025; 15:908. [PMID: 40218258 PMCID: PMC11988785 DOI: 10.3390/diagnostics15070908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2025] [Revised: 03/13/2025] [Accepted: 03/29/2025] [Indexed: 04/14/2025] Open
Abstract
Lung cancer is a prevalent malignant disease with the highest mortality rate among oncological conditions. The assessment of its clinical TNM staging primarily relies on contrast-enhanced computed tomography (CT) of the thorax and proximal abdomen, sometimes with the addition of positron emission tomography/CT scans, mainly for better evaluation of mediastinal lymph node involvement and detection of distant metastases. The purpose of TNM staging is to establish a universal nomenclature for the anatomical extent of lung cancer, facilitating interdisciplinary communication for treatment decisions and research advancements. Recent studies utilizing a large international database and multidisciplinary insights indicate a need to update the TNM classification to enhance the anatomical categorization of lung cancer, ultimately optimizing treatment strategies. The eighth edition of the TNM classification, issued by the International Association for the Study of Lung Cancer (IASLC), transitioned to the ninth edition on 1 January 2025. Key changes include a more detailed classification of the N and M descriptor categories, whereas the T descriptor remains unchanged. Notably, the N2 category will be split into N2a and N2b based on the single-station or multi-station involvement of ipsilateral mediastinal and/or subcarinal lymph nodes, respectively. The M1c category will differentiate between single (M1c1) and multiple (M1c2) organ system involvement for extrathoracic metastases. This review article emphasizes the role of radiologists in implementing the updated TNM classification through CT imaging for correct clinical lung cancer staging and optimal patient management.
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Affiliation(s)
- Ivana Kuhtić
- Department of Diagnostic and Interventional Radiology, University Hospital Centre Zagreb, 10000 Zagreb, Croatia
| | - Tinamarel Mandić Paulić
- Department of Diagnostic and Interventional Radiology, University Hospital Centre Zagreb, 10000 Zagreb, Croatia
| | - Lucija Kovačević
- Department of Diagnostic and Interventional Radiology, University Hospital Centre Zagreb, 10000 Zagreb, Croatia
| | - Sonja Badovinac
- Department of Pulmonology, University Hospital Centre Zagreb, 10000 Zagreb, Croatia
| | - Marko Jakopović
- Department of Pulmonology, University Hospital Centre Zagreb, 10000 Zagreb, Croatia
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Margareta Dobrenić
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
- Department of Nuclear Medicine and Radiation Protection, University Hospital Centre Zagreb, 10000 Zagreb, Croatia
| | - Maja Hrabak-Paar
- Department of Diagnostic and Interventional Radiology, University Hospital Centre Zagreb, 10000 Zagreb, Croatia
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
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32
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Takahashi Y, Horikawa Y, Matsuyama Y, Asai K, Endo J, Yabe D. A Novel Multiple Endocrine Neoplasia Type 1 Gene Variant Found in Scalp Pulmonary Neuroendocrine Tumor Metastasis. JCEM CASE REPORTS 2025; 3:luaf047. [PMID: 40115415 PMCID: PMC11924372 DOI: 10.1210/jcemcr/luaf047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2024] [Indexed: 03/23/2025]
Abstract
Multiple endocrine neoplasia type 1 (MEN1) is a genetic disorder usually diagnosed following hyperparathyroidism or pancreatic and gastrointestinal neuroendocrine neoplasm (NEN). We report here a case of MEN1 that was diagnosed following cancer multigene panel testing of a scalp metastasis of small cell lung carcinoma (SCLC). A 45-year-old male had noticed weight loss 20 months before admission to our department. He was identified with multiple nodules in the lungs, and bronchoscopy permitted diagnosis of SCLC at another hospital. He was then relocated to our hospital, where he began receiving chemotherapy and radiation therapy. A metastatic lesion had appeared on his scalp 3 months before admission, which had been diagnosed as a neuroendocrine tumor (NET, corresponding to grade 2) based on histopathological examination. Cancer multigene panel testing was performed and a MEN1 variant (c.266T > G; p.Leu89Arg) was discovered; the patient was then referred to our department. Germline genetic testing revealed the same, novel germline variant in MEN1, leading to his diagnosis of MEN1 and lung NEN metastases. In this case, the stage of NENs can vary between the primary tumor (SCLC) and its metastases (NET), potentially involving second-hit mutations or tumor suppressor genes.
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Affiliation(s)
- Yoshihiro Takahashi
- Department of Diabetes, Endocrinology and Metabolism and Department of Rheumatology and Clinical Immunology, Gifu University Graduate School of Medicine, Gifu 501-1194, Japan
- Department of Clinical Genetics Center, Gifu University Hospital, Gifu 501-1194, Japan
| | - Yukio Horikawa
- Department of Diabetes, Endocrinology and Metabolism and Department of Rheumatology and Clinical Immunology, Gifu University Graduate School of Medicine, Gifu 501-1194, Japan
- Department of Clinical Genetics Center, Gifu University Hospital, Gifu 501-1194, Japan
| | - Yumi Matsuyama
- Department of Clinical Genetics Center, Gifu University Hospital, Gifu 501-1194, Japan
| | - Kimiko Asai
- Department of Clinical Genetics Center, Gifu University Hospital, Gifu 501-1194, Japan
| | - Junki Endo
- Department of Cardiology and Respiratory Medicine, Gifu University Graduate School of Medicine, Gifu 501-1194, Japan
| | - Daisuke Yabe
- Department of Diabetes, Endocrinology and Metabolism and Department of Rheumatology and Clinical Immunology, Gifu University Graduate School of Medicine, Gifu 501-1194, Japan
- Yutaka Seino Distinguished Center for Diabetes Research, Kansai Electric Power Medical Research Institute, Osaka 553-0003, Japan
- Center for One Medicine Innovative Translational Research, Gifu University, Gifu 501-1194, Japan
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Browne C, Ayoub T, Samarasinghe N, Hussaini S, Warner A, Black M, Palma DA, Raphael J, Kuruvilla S, Blanchette PS. Impact of an Etoposide Chemotherapy Shortage on Patients With Extensive-Stage Small-Cell Lung Cancer: Results of a Natural Experiment. JCO Oncol Pract 2025; 21:485-493. [PMID: 39226485 DOI: 10.1200/op.24.00394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Revised: 06/28/2024] [Accepted: 07/29/2024] [Indexed: 09/05/2024] Open
Abstract
PURPOSE A shortage of essential intravenous (IV) etoposide lasted from 2018 until 2020 in Ontario, Canada, allowing for a natural experiment in which external factors (IV etoposide availability) dictated patients' treatment assignment. The purpose of this study was to evaluate the impact of this IV etoposide shortage (IVES) on patient care outcomes. METHODS Individuals with extensive-stage small-cell lung cancer (ES-SCLC) treated during a pre-IVES (November 2017-October 2018) and IVES (November 2018-October 2019) time intervals were retrospectively reviewed at the Verspeeten Family Cancer Centre. We investigated the association of the shortage on health care utilization and survival using a time-to-event analysis, Cox proportional hazards and logistic regression modeling. RESULTS A total of 119 patients with ES-SCLC were assessed, 49 in the pre-IVES interval and 70 in the IVES interval. The median age was 68 (IQR, 62-74) years, 48% (n = 57) were male, 33% (n = 39) had CNS metastases, and 69% (n = 82) received first-line systemic therapy. Alternate regimens used for IVES cohort included IV platinum-oral (PO) etoposide, IV platinum-IV irinotecan, and PO etoposide monotherapy. An adjusted multivariable model demonstrated a significant increase in hospitalization (odds ratio, 2.30 [95% CI, 1.01 to 5.24]; P = .047) and shorter progression-free survival (PFS; hazard ratio, 1.79 [95% CI, 1.19 to 2.68]; P = .005) during the IVES. CONCLUSION This study demonstrated increased hospitalization, and decreased PFS, among patients with ES-SCLC treated with alternate chemotherapy regimens during an IVES. The impact of cancer drug shortages can be harmful, and optimizing a more secure drug supply with mitigation strategies is warranted.
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Affiliation(s)
- Claire Browne
- Division of Medical Oncology, Department of Oncology, Verspeeten Family Cancer Centre, London Health Sciences Centre, Western University, London, ON, Canada
| | - Toufic Ayoub
- Department of Science, Western University, London, ON, Canada
| | - Nadeesha Samarasinghe
- Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
- Division of General Surgery, Department of Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Syed Hussaini
- Division of Medical Oncology, Department of Oncology, Verspeeten Family Cancer Centre, London Health Sciences Centre, Western University, London, ON, Canada
- Department of Oncology, Oakville Trafalgar Memorial Hospital, Oakville, ON, Canada
| | - Andrew Warner
- Division of Radiation Oncology, Department of Oncology, Verspeeten Family Cancer Centre, London Health Sciences Centre, Western University, London, ON, Canada
| | - Morgan Black
- Division of Medical Oncology, Department of Oncology, Verspeeten Family Cancer Centre, London Health Sciences Centre, Western University, London, ON, Canada
| | - David A Palma
- Division of Radiation Oncology, Department of Oncology, Verspeeten Family Cancer Centre, London Health Sciences Centre, Western University, London, ON, Canada
| | - Jacques Raphael
- Division of Medical Oncology, Department of Oncology, Verspeeten Family Cancer Centre, London Health Sciences Centre, Western University, London, ON, Canada
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
| | - Sara Kuruvilla
- Division of Medical Oncology, Department of Oncology, Verspeeten Family Cancer Centre, London Health Sciences Centre, Western University, London, ON, Canada
| | - Phillip S Blanchette
- Division of Medical Oncology, Department of Oncology, Verspeeten Family Cancer Centre, London Health Sciences Centre, Western University, London, ON, Canada
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
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Kim SY, Park HS, Chiang AC. Small Cell Lung Cancer: A Review. JAMA 2025:2832148. [PMID: 40163214 DOI: 10.1001/jama.2025.0560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/02/2025]
Abstract
Importance Small cell lung cancer (SCLC) is a high-grade neuroendocrine carcinoma with an incidence of 4.7 cases per 100 000 individuals in 2021 in the US and a 5-year overall survival of 12% to 30%. Observations Cigarette smoking is the primary risk factor for development of SCLC, as 95% of patients diagnosed with SCLC have a history of tobacco use. Patients with SCLC may present with respiratory symptoms such as cough (40%), shortness of breath (34%), hemoptysis (10%), or metastases with corresponding local symptoms (30%) such as pleuritis or bone pain; approximately 60% of patients with SCLC may be asymptomatic at diagnosis. Chest imaging may demonstrate central hilar (85%) or mediastinal lymphadenopathy (75%). At diagnosis, approximately 15% of patients have brain metastases, which may present as headache or focal weakness. Diagnosis is confirmed by biopsy of a primary lung mass, thoracic lymph node, or metastatic lesion. Small cell lung cancer is classified into limited stage (LS-SCLC; 30%) vs extensive stage (ES-SCLC; 70%) based on whether the disease can be treated within a radiation field that is typically confined to 1 hemithorax but may include contralateral mediastinal and supraclavicular nodes. For patients with LS-SCLC, surgery or concurrent chemotherapy with platinum-etoposide and radiotherapy is potentially curative in 30% of patients. More recently, median survival for LS-SCLC has reached up to 55.9 months with the addition of durvalumab, an immunotherapy. First-line treatment for ES-SCLC is combined treatment with platinum-etoposide chemotherapy and immunotherapy with the programmed cell death 1 ligand 1 (PD-L1) inhibitors durvalumab or atezolizumab followed by maintenance immunotherapy until disease progression or toxicity. Although initial rates of tumor shrinkage are 60% to 70% with platinum-etoposide and immunotherapy treatment, the median overall survival of patients treated for ES-SCLC is approximately 12 to 13 months, with 60% of patients relapsing within 3 months. Second-line therapy for patients with ES-SCLC includes the DNA-alkylating agent lurbinectedin (35% overall response rate; median progression-free survival, 3.7 months) and a bispecific T-cell engager against delta-like ligand 3, tarlatamab (40% overall response rate; median progression-free survival, 4.9 months). Conclusions and Relevance Small cell lung cancer is a smoking-related malignancy that presents at an advanced stage in 70% of patients. Three-year overall survival is approximately 56.5% for LS-SCLC and 17.6% for ES-SCLC. First-line treatment for LS-SCLC is radiation targeting the tumor given concurrently with chemotherapy and followed by consolidation immunotherapy. For ES-SCLC, first-line treatment is chemotherapy and immunotherapy followed by maintenance immunotherapy.
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Affiliation(s)
- So Yeon Kim
- Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Henry S Park
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut
| | - Anne C Chiang
- Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
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Zhao S, Kang S. Comprehensive economic value evaluation of adding tislelizumab to first-line chemotherapy for patients with extensive-stage small cell lung cancer in China. Expert Rev Pharmacoecon Outcomes Res 2025:1-7. [PMID: 40134070 DOI: 10.1080/14737167.2025.2483423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2024] [Revised: 03/09/2025] [Accepted: 03/11/2025] [Indexed: 03/27/2025]
Abstract
BACKGROUND The cost-effectiveness of tislelizumab plus chemotherapy for patients with extensive-stage small cell lung cancer (ES-SCLC) was uncleared yet. The current analysis aimed to evaluate the cost-effective of adding tislelizumab to the first-line chemotherapy for patients with untreated ES-SCLC from the Chinese health-care system perspective. RESEARCH DESIGN AND METHODS A partitioned survival model that simulated 3-week patients transition in 10-year time horizon was established to evaluate the economic value. The clinical benefit and safety data were gathered from the RATIONALE-312 trial, model parameters were gathered from the local charges and previously published studies. Sensitivity analyses and subgroup analyses were conducted to examine the robustness of the model outcomes. RESULTS Tislelizumab plus chemotherapy could bring additional 0.61 LYs and 0.30 QALYs with the marginal cost of $5,849.40, resulting in the incremental cost-effectiveness ratio (ICER) of $19,592.08 per additional quality-adjusted life-years (QALYs) gained. Sensitivity analyses and subgroup analyses confirmed the robustness of the model results for both intention-to-treat patients and all subgroup patients. CONCLUSIONS Tislelizumab plus chemotherapy could be considered cost-effective first-line therapy for patients with untreated ES-SCLC patients compared with chemotherapy alone from the perspective of Chinese health-care system.
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Affiliation(s)
- Shan Zhao
- Department of Oncology, The Second Hospital of Hebei Medical University, Shijiazhuang, PR China
| | - Shuo Kang
- Medical Insurance Office, The Second Hospital of Hebei Medical University, Shijiazhuang, PR China
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Xu J, Zhang W, Xie F, Wang C, Cheng F, Rao R, Chen Y, Zhang L, Wen W, Zhao Z, Yuan J, Zheng Y, Yu Z. Prognostic significance of ALK high expression in SCLC: a 9-year cohort analysis. Front Oncol 2025; 15:1530339. [PMID: 40201354 PMCID: PMC11975910 DOI: 10.3389/fonc.2025.1530339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2024] [Accepted: 03/04/2025] [Indexed: 04/10/2025] Open
Abstract
Purpose The aim of this study was to investigate the prognostic value of the abnormal expression of anaplastic lymphoma kinase (ALK) protein in patients with small cell lung cancer (SCLC) based on 9-year data from our center. Methods A retrospective cohort study was conducted to assess the clinical outcomes of patients with ALK-positive SCLC diagnosed in our hospital over the past 9 years. We used public databases to analyze the expression of ALK in pan-cancer and its prognostic value and analyzed the correlation between ALK and SCLC prognosis-related genes. Results A total of 685 patients diagnosed with SCLC underwent ALK testing, and 59 patients were identified to have abnormal expression of the ALK protein, with 10 cases showing strong expression, 14 cases displaying moderate expression, and 35 cases exhibiting weak expression. The median age of the ALK-positive cohort was 64 years (range: 58-70 years), 91.5% (54/59) were male, 61.0% (36/59) were smokers, and the median overall survival (mOS) was 7.0 months (95% CI: 4.5-9.5 months). Within this cohort, the mOS for the ALK (+) subgroup was 4.0 months (95% CI: 2.9-5.1 months), the mOS for the ALK (++) subgroup was 10.0 months (95% CI: 4.9-15.1 months), and the mOS for the ALK (+++) subgroup was 12.0 months (95% CI: 7.4-16.6 months). Kaplan-Meier revealed that the mOS of the ALKLow group was significantly worse than that of the ALKHigh group [mOS: 4.0 months (95% CI: 2.9-5.1 months) versus 11.0 months (95% CI: 8.3-13.7 months), p = 0.009]. Following covariate adjustment using a Cox regression model, it was indicated that the level of abnormal expression of the ALK protein was an independent prognostic factor for patients with SCLC (HR: 0.486, 95% CI: 0.271-0.871, p = 0.015). Conclusion The prognosis for patients with SCLC with strong abnormal expression of the ALK protein was significantly better than those with weak expression.
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Affiliation(s)
- Jinhe Xu
- Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Wenting Zhang
- Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Feilai Xie
- Pathology Department, Dongfang Hospital of Xiamen University, Fuzhou General Hospital of Fujian Medical University, The 900th Hospital of the Joint Logistic Support Force, PLA, Fuzhou, China
| | - Chenxi Wang
- Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Feng Cheng
- Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Ruiying Rao
- Department of Respiratory and Critical Care Medicine, Fuzong Teaching Hospital, Fujian University of Traditional Chinese Medicine (900 Hospital), Fuzhou, China
| | - Ying Chen
- Department of Pulmonary and Critical Care Medicine, Fuzhou General Hospital of Fujian Medical University, Dongfang Hospital of Xiamen University, The 900th Hospital of the Joint Logistic Support Force, PLA, Fuzhou, China
| | - Lei Zhang
- Department of Pulmonary and Critical Care Medicine, Fuzhou General Hospital of Fujian Medical University, Dongfang Hospital of Xiamen University, The 900th Hospital of the Joint Logistic Support Force, PLA, Fuzhou, China
| | - Wen Wen
- Department of Pulmonary and Critical Care Medicine, Fuzhou General Hospital of Fujian Medical University, Dongfang Hospital of Xiamen University, The 900th Hospital of the Joint Logistic Support Force, PLA, Fuzhou, China
| | - Zhongquan Zhao
- Department of Pulmonary and Critical Care Medicine, Fuzhou General Hospital of Fujian Medical University, Dongfang Hospital of Xiamen University, The 900th Hospital of the Joint Logistic Support Force, PLA, Fuzhou, China
| | - Jialing Yuan
- Department of Pulmonary and Critical Care Medicine, Fuzhou General Hospital of Fujian Medical University, Dongfang Hospital of Xiamen University, The 900th Hospital of the Joint Logistic Support Force, PLA, Fuzhou, China
| | - Yuqin Zheng
- Department of Pulmonary and Critical Care Medicine, Fuzhou General Hospital of Fujian Medical University, Dongfang Hospital of Xiamen University, The 900th Hospital of the Joint Logistic Support Force, PLA, Fuzhou, China
| | - Zongyang Yu
- Department of Pulmonary and Critical Care Medicine, Fuzhou General Hospital of Fujian Medical University, Dongfang Hospital of Xiamen University, The 900th Hospital of the Joint Logistic Support Force, PLA, Fuzhou, China
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Zheng Z, Zhu H, Fang L. Tislelizumab plus chemotherapy versus chemotherapy as first-line treatment for extensive-stage small cell lung cancer: A cost-effectiveness analysis. PLoS One 2025; 20:e0320189. [PMID: 40131983 PMCID: PMC11936185 DOI: 10.1371/journal.pone.0320189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2024] [Accepted: 02/15/2025] [Indexed: 03/27/2025] Open
Abstract
OBJECTIVE This study aims to conduct a cost-effectiveness analysis of tislelizumab in combination with platinum and etoposide compared to the standard treatment of etoposide and platinum as first-line therapy for extensive-stage small cell lung cancer(ES-SCLC) from the Chinese medical system perspective. METHODS A partitioned survival model was developed utilizing data from the RATIONALE-312 trial to accurately simulate the clinical and economic outcomes of both treatment arms. This model incorporates three distinct health states, namely progression-free survival, disease progression, and death. These states are exclusive of each other, and patients can transition between them as their disease progresses.The model accounted for various cost components such as drug therapy, management of adverse events, disease progression, and overall survival. To evaluate the cost-effectiveness of the interventions, quality-adjusted life-year (QALY) and incremental cost-effectiveness ratio (ICER) were chosen as the metrics. The analysis employed a willingness to pay (WTP) threshold of $39,855.79 per QALY. Additionally, sensitivity analyses were conducted to assess the robustness and reliability of the model. RESULTS The tislelizumab group had a total cost of $52,749.69, whereas the chemotherapy group's total expenses amounted to $8,811.62. Additionally, the tislelizumab group experienced a gain of 2.21 QALY compared to the chemotherapy group, albeit incurring an additional cost of $43,938.07. Consequently, this led to an ICER of $19,881.48, which falls below the Chinese WTP threshold of $39,855.79. Sensitivity analyses confirmed the robustness of the findings across a range of scenarios. CONCLUSION This cost-effectiveness analysis based on the RATIONALE-312 trial demonstrates that tislelizumab plus platinum and etoposide is a cost-effective treatment option for ES-SCLC compared to the standard chemotherapy from the Chinese medical system perspective.
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Affiliation(s)
- Zhiwei Zheng
- Department of Pharmacy, Cancer Hospital of Shantou University Medical College, Shantou, China
| | - Huide Zhu
- Department of Pharmacy, Cancer Hospital of Shantou University Medical College, Shantou, China
| | - Ling Fang
- Department of Pharmacy, Cancer Hospital of Shantou University Medical College, Shantou, China
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He Y, Tang X, Yang F, Jiang Q, Deng L, Lang W. Exploring resistance to initial chemotherapy in small cell lung cancer: The role of bone metastasis and other clinicopathologic characteristics. Medicine (Baltimore) 2025; 104:e41953. [PMID: 40128052 PMCID: PMC11936556 DOI: 10.1097/md.0000000000041953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Accepted: 03/06/2025] [Indexed: 03/26/2025] Open
Abstract
Clinically, approximately 10% to 20% of small cell lung cancer (SCLC) patients do not respond well to initial platinum-based first-line chemotherapy. Knowledge about the clinicopathologic characteristics of these primary drug-resistant populations is limited. This study aimed to explore the clinicopathologic characteristics in SCLC populations insensitive to initial chemotherapy. This study enrolled SCLC patients with insensitivity to initial chemotherapy and analyzed their clinicopathological characteristics. Binary logistic regression analysis was used to determine the independent factors that influence chemosensitivity. The study evaluated 142 cases to determine the clinicopathologic characteristics of SCLC populations with insensitivity to initial chemotherapy. Between the chemotherapy-insensitive group (n = 32) and the chemotherapy-sensitive group (n = 110), no significant differences were observed in sex, age, smoking status, tumor size, lymph-node metastasis, vascular invasion, carcinomatous lymphangitis, mediastinal invasion, superior vena cava syndrome, tumor stage, brain metastases, pleural metastasis, lung metastasis, adrenal metastasis, or the immunohistochemical markers cytokeratin, synaptophysin, chromogranin A, thyroid transcription factor-1, and Ki-67 (all P > .05). However, significant differences in liver metastasis (P = .005), bone metastasis (P < .001), and neural cell adhesion molecule expression (P = .027) were identified. Binary logistic regression analysis revealed that bone metastasis (P = .008) was an independent high-risk factor for insensitivity to initial first-line chemotherapy. Bone metastasis is an independent high-risk factor for insensitivity to initial chemotherapy in SCLC. Enhancing our understanding of SCLC biology and osteoimmuno-oncology could identify new vulnerabilities and better define patient populations that may benefit from tailored clinical treatments to overcome drug resistance.
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Affiliation(s)
- Yulong He
- Department of Oncology, Nanxishan Hospital of the Guangxi Zhuang Autonomous Region, Guilin, Guangxi, China
| | - Xiaorong Tang
- Department of Spine Surgery, Guilin People’s Hospital, Guilin, Guangxi, China
| | - Fang Yang
- Department of Oncology, Nanxishan Hospital of the Guangxi Zhuang Autonomous Region, Guilin, Guangxi, China
| | - Qinling Jiang
- Department of Oncology, Nanxishan Hospital of the Guangxi Zhuang Autonomous Region, Guilin, Guangxi, China
| | - Lin Deng
- Department of Oncology, Nanxishan Hospital of the Guangxi Zhuang Autonomous Region, Guilin, Guangxi, China
| | - Wenwang Lang
- Department of Pharmacy, Nanxishan Hospital of the Guangxi Zhuang Autonomous Region, Guilin, Guangxi, China
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Tronchetti J, Roy P, Laroumagne S, Lovato JB, Legodec J, Fournier C, Cellerin L, Lorut C, Gonin F, Vergnon JM, Egenod T, Bourinet V, Camuset J, Degot T, Mangiapan G, Edme J, Astoul P, Guibert N, Dutau H. Role of Therapeutic Bronchoscopy in Malignant Central Airway Obstruction Due to Small Cell Lung Cancer: Results From the EpiGETIF Registry. Arch Bronconeumol 2025:S0300-2896(25)00086-9. [PMID: 40240278 DOI: 10.1016/j.arbres.2025.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2025] [Revised: 02/28/2025] [Accepted: 03/08/2025] [Indexed: 04/18/2025]
Affiliation(s)
- Julie Tronchetti
- Interventional Pulmonology Department, North University Hospital, Marseille, France
| | - Pascalin Roy
- Pulmonology Department, Quebec Heart and Lung Institute, Quebec City, Canada
| | - Sophie Laroumagne
- Interventional Pulmonology Department, North University Hospital, Marseille, France
| | - Jean-Baptiste Lovato
- Interventional Pulmonology Department, North University Hospital, Marseille, France
| | - Julien Legodec
- Pulmonology Department, Saint Joseph Hospital, Marseille, France
| | - Clément Fournier
- Pulmonology Department, Heart and Lung Institute, CHU Lille, F-59000 Lille, France
| | - Laurent Cellerin
- Pulmonology Department, Nantes University Hospital, Nantes, France
| | - Christine Lorut
- Pulmonology Department, Cochin University Hospital, Paris, France
| | - François Gonin
- Thoracic Surgery Department, Foch-Suresnes University Hospital, Paris, France
| | - Jean-Michel Vergnon
- Pulmonology Department, Saint Etienne University Hospital, Saint Etienne, France
| | - Thomas Egenod
- Pulmonology Department, Limoges University Hospital, Limoges, France
| | - Valerian Bourinet
- Pulmonology Department, Saint Pierre University Hospital, Saint Pierre, France
| | - Juliette Camuset
- Pulmonology Department, Tenon University Hospital, Paris, France
| | - Tristan Degot
- Pulmonology Department, Strasbourg University Hospital, Strasbourg, France
| | - Gilles Mangiapan
- Pulmonology Department, Créteil Intercommunal Hospital, Créteil, France
| | - Juliette Edme
- Pulmonology Department, Toulouse University Hospital, Toulouse, France
| | - Philippe Astoul
- Interventional Pulmonology Department, North University Hospital, Marseille, France
| | - Nicolas Guibert
- Pulmonology Department, Toulouse University Hospital, Toulouse, France.
| | - Hervé Dutau
- Interventional Pulmonology Department, North University Hospital, Marseille, France
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Gerba-Górecka K, Romanowska-Dixon B, Karska-Basta I, Cieplińska-Kechner E, Nowak MS. Clinical Characteristics and Management of Ocular Metastases. Cancers (Basel) 2025; 17:1041. [PMID: 40149375 PMCID: PMC11940828 DOI: 10.3390/cancers17061041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2025] [Revised: 03/09/2025] [Accepted: 03/18/2025] [Indexed: 03/29/2025] Open
Abstract
Intraocular metastases represent the most common type of intraocular tumors in adults. In most cases, the metastases originate from primary breast and lung cancers. Effective management of patients with intraocular metastatic disease requires a multidisciplinary approach involving ophthalmologists, oncologists, and radiation therapists. The primary goals of treatment are disease control, maintenance of optimal quality of life, and preservation of functional vision. This article provides an in-depth overview of intraocular metastases, with special emphasis on the practical aspects of their diagnosis and treatment based on the most recent literature.
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Affiliation(s)
- Karolina Gerba-Górecka
- Clinic of Ophthalmology and Ocular Oncology, University Hospital, 38 Kopernika Str., 31-501 Krakow, Poland; (B.R.-D.); (E.C.-K.)
| | - Bożena Romanowska-Dixon
- Clinic of Ophthalmology and Ocular Oncology, University Hospital, 38 Kopernika Str., 31-501 Krakow, Poland; (B.R.-D.); (E.C.-K.)
- Department of Ophthalmology, Jagiellonian University Medical College, 38 Kopernika Str., 31-501 Krakow, Poland
| | - Izabella Karska-Basta
- Clinic of Ophthalmology and Ocular Oncology, University Hospital, 38 Kopernika Str., 31-501 Krakow, Poland; (B.R.-D.); (E.C.-K.)
- Department of Ophthalmology, Jagiellonian University Medical College, 38 Kopernika Str., 31-501 Krakow, Poland
| | - Ewelina Cieplińska-Kechner
- Clinic of Ophthalmology and Ocular Oncology, University Hospital, 38 Kopernika Str., 31-501 Krakow, Poland; (B.R.-D.); (E.C.-K.)
| | - Michał S. Nowak
- Institute of Optics and Optometry, University of Social Science, 121 Gdanska Str., 90-519 Lodz, Poland;
- Provisus Eye Clinic, 112 Redzinska Str., 42-209 Czestochowa, Poland
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Vo MC, Nguyen VT, Tran VDH, Oh HJ, Jung SH, Bae WK, Lee JJ, Oh IJ. Combination therapy with expanded natural killer cells and atezolizumab exerts potent antitumor immunity in small cell lung cancer. Cancer Immunol Immunother 2025; 74:143. [PMID: 40056167 PMCID: PMC11890499 DOI: 10.1007/s00262-025-03997-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2024] [Accepted: 02/22/2025] [Indexed: 03/10/2025]
Abstract
Despite an initial response to platinum-based chemotherapy, most patients with extensive stage of small cell lung cancer (SCLC) have a poor prognosis due to recurrence. Additionally, the benefit of immune checkpoint inhibitors is more modest than non-small cell lung cancer. Natural killer (NK) cells can directly eliminate cancer cells without prior sensitization; this is largely governed by inflammatory cytokines, which serve as killing signals to cancer cells. Here, we investigated whether the combination of NK cells plus atezolizumab, a fully humanized monoclonal antibody that specifically targets the protein programmed death-ligand 1 (PD-L1), has a synergistic effect against SCLC. NK cells were expanded and activated using irradiated K562 feeder cells in the presence of interleukin (IL)-2/IL-15/IL-21/41BB ligand for 14 days. Expanded and activated NK cells (eNK) were combined with atezolizumab and used to treat SCLC cells in both in vitro and in vivo studies. The results revealed increased PD-L1 expression in SCLC cells after the eNK challenge. eNK cells plus atezolizumab demonstrated increased cytotoxicity toward target SCLC cells, as evidenced by increased interferon-γ and tumor necrosis factor-α production, and higher levels of SCLC stem cell (CD44+CD90+) suppression. Combined treatment with eNK and atezolizumab more effectively inhibited SCLC tumor growth and significantly prolonged the survival of treated mice. Our findings revealed that combining eNK with atezolizumab strongly increased cytotoxicity, significantly inhibited SCLC tumor growth, and prolonged the survival of treated mice. These results provide a framework for developing a more advanced immunotherapeutic modality for future clinical trials for patients with SCLC.
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Affiliation(s)
- Manh-Cuong Vo
- Institute of Research and Development, Duy Tan University, Danang, Vietnam
- VaxCell-Biotherapeutics, Hwasun, South Korea
- Immunotherapy Innovation Center, Chonnam National University Hwasun Hospital, Hwasun, South Korea
| | - Van-Tan Nguyen
- Department of Internal Medicine, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, 322 Seoyang-Ro, Hwasun-Eup, Hwasun-gun, Jeollanam-do, 58128, Republic of Korea
| | - Van-Dinh-Huan Tran
- Department of Internal Medicine, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, 322 Seoyang-Ro, Hwasun-Eup, Hwasun-gun, Jeollanam-do, 58128, Republic of Korea
| | - Hyung-Joo Oh
- Department of Internal Medicine, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, 322 Seoyang-Ro, Hwasun-Eup, Hwasun-gun, Jeollanam-do, 58128, Republic of Korea
| | - Sung-Hoon Jung
- Department of Internal Medicine, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, 322 Seoyang-Ro, Hwasun-Eup, Hwasun-gun, Jeollanam-do, 58128, Republic of Korea
| | - Woo Kyun Bae
- Department of Internal Medicine, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, 322 Seoyang-Ro, Hwasun-Eup, Hwasun-gun, Jeollanam-do, 58128, Republic of Korea
- VaxCell-Biotherapeutics, Hwasun, South Korea
| | - Je-Jung Lee
- Department of Internal Medicine, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, 322 Seoyang-Ro, Hwasun-Eup, Hwasun-gun, Jeollanam-do, 58128, Republic of Korea
- VaxCell-Biotherapeutics, Hwasun, South Korea
- Immunotherapy Innovation Center, Chonnam National University Hwasun Hospital, Hwasun, South Korea
| | - In-Jae Oh
- Department of Internal Medicine, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, 322 Seoyang-Ro, Hwasun-Eup, Hwasun-gun, Jeollanam-do, 58128, Republic of Korea.
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Chen Y, Liu X, Sun Y, Liu K, Ding D, Song S, Tan W. Noninvasive molecular imaging using anti-Trop-2 aptamer for targeted therapy of small cell lung cancer. J Nanobiotechnology 2025; 23:182. [PMID: 40050871 PMCID: PMC11887224 DOI: 10.1186/s12951-025-03184-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2024] [Accepted: 02/01/2025] [Indexed: 03/09/2025] Open
Abstract
Recent advancements in antibody-drug conjugates (ADCs) targeting trophoblast surface cell antigen 2 (Trop-2) have brought important progress in the field of targeted therapy. This progress also holds promise for the treatment of small cell lung cancer (SCLC) as anti-Trop-2 therapy appears to have a safe and effective clinical activity in metastatic SCLC patients. However, effective treatments of anti-Trop-2 ADCs rely on the comprehensive assessment of Trop-2 expression at the tumor sites, SCLC exhibits intratumoral heterogeneity, making the accurate acquisition of histological biopsies a challenge. To address this issue, we herein report the development of an anti-Trop-2 aptamer consisting of 76 bases is specifically bind to Trop-2-overexpressing SCLC cells. Further truncated anti-Trop-2 aptamer with 46 nucleotides also possesses excellent in vitro and in vivo binding affinity with Trop-2 antigens. After radiolabeling with gallium-68 radionuclide, an aptamer-based molecular imaging probe was successfully fabricated named [68Ga]Ga-NOTA-TRP-c. This imaging probe demonstrated effective and precise differentiation of Trop-2-positive tumors in both murine- and human-derived animal models, exhibiting favorable metabolic profiles. Furthermore, Trop-2-positive SCLC tumors recognized by anti-Trop-2 aptamer can be treated with anti-Trop-2 ADC sacituzumab govitecan (SG), either in vitro or in vivo. Importantly, SG induces DNA damage and cell apoptosis without affecting the expression of Trop-2 on the cell surface, which makes it possible to use anti-Trop-2 aptamer to monitor the expression of Trop-2 in SCLC. This study highlights the potential of aptamer-based molecular imaging and imaging-guided SG treatment as a promising option for targeted therapy in SCLC.
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Affiliation(s)
- Yamei Chen
- Institute of Molecular Medicine (IMM), Shanghai Key Laboratory for Nucleic Acid Chemistry and Nanomedicine, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200240, China
| | - Xuwei Liu
- Department of Nuclear Medicine, Fudan University Shanghai Cancer Center, Shanghai, 200032, China
| | - Yang Sun
- Institute of Molecular Medicine (IMM), Shanghai Key Laboratory for Nucleic Acid Chemistry and Nanomedicine, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200240, China
| | - Keying Liu
- Institute of Molecular Medicine (IMM), Shanghai Key Laboratory for Nucleic Acid Chemistry and Nanomedicine, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200240, China
| | - Ding Ding
- Institute of Molecular Medicine (IMM), Shanghai Key Laboratory for Nucleic Acid Chemistry and Nanomedicine, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200240, China.
| | - Shaoli Song
- Department of Nuclear Medicine, Fudan University Shanghai Cancer Center, Shanghai, 200032, China.
| | - Weihong Tan
- Institute of Molecular Medicine (IMM), Shanghai Key Laboratory for Nucleic Acid Chemistry and Nanomedicine, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200240, China.
- The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, Zhejiang, 310022, China.
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Hayashi K, Shiratori T, Ueda K, Okamoto K, Kataoka Y, Kawaguchi Y, Ohshio Y, Hanaoka J. Dynamic chest radiography in post-lobectomy recovery: a novel approach to evaluating pulmonary function and thoracic structures in patients with primary lung cancer. Quant Imaging Med Surg 2025; 15:2232-2245. [PMID: 40160658 PMCID: PMC11948396 DOI: 10.21037/qims-24-1714] [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: 08/17/2024] [Accepted: 01/03/2025] [Indexed: 04/02/2025]
Abstract
Background Lobectomy for lung cancer leads to changes in thoracic structures and reduced pulmonary function, but real-time evaluation of compensatory mechanisms has been challenging. This study employed dynamic chest radiography to examine post-lobectomy changes in the projected lung area and excursion of diaphragm, as evaluated by sequential chest radiography, and determine their correlation with pulmonary function recovery. Methods This single-center and cross-sectional study was conducted at the Shiga University of Medical Science Hospital and included 65 patients who underwent lobectomy between May 2018 and December 2020. Dynamic chest radiography was performed preoperatively and at 1, 3, 6, and 12 months postoperatively alongside standard pulmonary function tests. We evaluated the postoperative trends in pulmonary function, projected lung area, and excursion of diaphragm. The results were analyzed using the Mann-Whitney U test and Fisher's exact test. Additionally, correlations between changes in the pulmonary function and dynamic chest radiography (DCR) parameters were assessed using Spearman's rank correlation coefficients. The utility of DCR in predicting postoperative pulmonary function recovery was further examined using receiver operating characteristic (ROC) curve analysis. Results Significant correlations were observed between the maximum projected lung area and pulmonary function recovery, particularly in upper lobectomy cases (correlation with vital capacity at 1 month postoperatively: r=0.72, P<0.01). This correlation was observed consistently across various surgical procedures, which suggests that early postoperative projected lung area measurements can predict pulmonary function recovery at 12 months. Excursion of diaphragm, especially in upper lobectomy cases, also showed a positive correlation with pulmonary function recovery (correlation with vital capacity at 1 month postoperatively: r=0.55, P<0.01). Receiver operating characteristic curve analysis validated the predictive capability of early postoperative projected lung area for long-term pulmonary function recovery with area under the curve of 0.815 [95% confidence interval (CI): 0.636-0.994] for upper lobectomy and 0.798 (95% CI: 0.564-0.982) for lower lobectomy groups. Conclusions Dynamic chest radiography, which assessed the projected lung area and excursion of diaphragm, emerged as a promising non-invasive tool for monitoring post-lobectomy recovery and guiding rehabilitation efforts. These findings indicate its potential as an early predictor of pulmonary recovery, advocating for its integration into the perioperative care of patients with lung cancer. Future research should expand patient cohorts and refine predictive models using preoperative dynamic chest radiography to enhance post-lobectomy outcomes.
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Affiliation(s)
- Kazuki Hayashi
- Division of General Thoracic Surgery, Department of Surgery, Shiga University of Medical Science, Otsu, Japan
- Department of General Thoracic Surgery, Omi Medical Center, Kusatsu, Japan
| | - Takuya Shiratori
- Division of General Thoracic Surgery, Department of Surgery, Shiga University of Medical Science, Otsu, Japan
| | - Keiko Ueda
- Division of General Thoracic Surgery, Department of Surgery, Shiga University of Medical Science, Otsu, Japan
| | - Keigo Okamoto
- Division of General Thoracic Surgery, Department of Surgery, Shiga University of Medical Science, Otsu, Japan
| | - Yoko Kataoka
- Division of General Thoracic Surgery, Department of Surgery, Shiga University of Medical Science, Otsu, Japan
| | - Yo Kawaguchi
- Division of General Thoracic Surgery, Department of Surgery, Shiga University of Medical Science, Otsu, Japan
| | - Yasuhiko Ohshio
- Division of General Thoracic Surgery, Department of Surgery, Shiga University of Medical Science, Otsu, Japan
| | - Jun Hanaoka
- Division of General Thoracic Surgery, Department of Surgery, Shiga University of Medical Science, Otsu, Japan
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Levy A, Rusthoven CG, Brown PD, Le Péchoux C, Faivre-Finn C. Prophylactic Cranial Irradiation for Patients With SCLC-A New Perspective in the Immunotherapy Era. J Thorac Oncol 2025; 20:395-398. [PMID: 39551470 DOI: 10.1016/j.jtho.2024.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2024] [Revised: 11/08/2024] [Accepted: 11/10/2024] [Indexed: 11/19/2024]
Abstract
Prophylactic cranial irradiation (PCI) has long been used for SCLC to reduce the risk of brain metastases and potentially improve overall survival. Nevertheless, recent immunotherapy trials have provided limited data on its impact, as few patients were treated with PCI. The ADRIATIC trial reported improved outcomes with consolidation immunotherapy in limited-stage SCLC, and PCI was a stratification factor. Notably, patients receiving PCI in both arms had better outcomes than those who did not. Ongoing studies, such as EORTC-1901 PRIMALung (NCT04790253) and SWOG 1827-MAVERICK (NCT04155034), are further investigating PCI's role in the era of immunotherapy, highlighting its potential importance in evolving treatment strategies.
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Affiliation(s)
- Antonin Levy
- Department of Radiation Oncology, Gustave Roussy, Université Paris Saclay, Villejuif, France; Gustave Roussy, Inserm U1030, Radiothérapie Moléculaire et Innovations Thérapeutiques, Université Paris Saclay, Villejuif, France; Faculté de Médecine, Université Paris Saclay, Le Kremlin-Bicêtre, France.
| | - Chad G Rusthoven
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
| | - Paul D Brown
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Cécile Le Péchoux
- Department of Radiation Oncology, Gustave Roussy, Université Paris Saclay, Villejuif, France
| | - Corinne Faivre-Finn
- Division of Cancer Sciences, University of Manchester, The Christie NHS Foundation Trust, Manchester, United Kingdom
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Johnsen SP, Baas P, Sørensen JB, Chouaid C, Griesinger F, Daumont MJ, Rault C, Emanuel G, Penrod JR, Jacobs H, Muwaffak M, Schoemaker MJ, Munro REJ, Baskaran D, Durand-Zaleski I, O’Donnell JC. Advancing real-world research in thoracic malignancies: learnings from the international I-O Optimise initiative. Future Oncol 2025; 21:867-878. [PMID: 39996596 PMCID: PMC11916385 DOI: 10.1080/14796694.2025.2466416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2024] [Accepted: 02/10/2025] [Indexed: 02/26/2025] Open
Abstract
In recent years, the thoracic malignancies treatment landscape has become more complex with the emergence of novel targeted and immunotherapy-based treatments. Although beneficial to patients and physicians, this fast-paced therapeutic evolution has increased the complexity of clinical decision-making and amplified the importance of real-world evidence to support data from randomized controlled trials. The international I-O Optimise initiative was established in 2016 to provide real-world insights into the thoracic malignancies treatment landscape, and has since collaborated with 14 data sources across Europe and Canada, allowing access to data from ~ 500,000 patients with non-small-cell lung cancer, small-cell lung cancer, and malignant pleural mesothelioma. This article reviews pertinent I-O Optimise research, with discussion of the methodological/data-related learnings and expectations for future insights.
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Affiliation(s)
- Søren Paaske Johnsen
- Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University and Aalborg University Hospital, Gistrup, Denmark
| | - Paul Baas
- Department of Thoracic Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
- Department of Pulmonary Disease, Leiden University Medical Hospital, Leiden, The Netherlands
| | | | - Christos Chouaid
- Pneumology Unit, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Frank Griesinger
- Department of Haematology & Oncology, University Department Internal Medicine-Oncology, Pius-Hospital, University Medicine Oldenburg, Oldenburg, Germany
| | - Melinda J Daumont
- Worldwide Health Economics & Outcomes Research, Bristol Myers Squibb, Braine-L’Alleud, Belgium
| | | | - Gabrielle Emanuel
- Real-World Data Analytics Markets, Bristol Myers Squibb, Uxbridge, UK
| | - John R Penrod
- Worldwide Health Economics & Outcomes Research, Bristol Myers Squibb, Princeton, NJ, USA
| | | | | | | | | | | | - Isabelle Durand-Zaleski
- AP-HP Health Economics Research Unit, Hôtel-Dieu Hospital, INSERM UMR 1153 CRESS, UPEC, Paris, France
| | - John C O’Donnell
- Worldwide Health Economics & Outcomes Research, Bristol Myers Squibb, Princeton, NJ, USA
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46
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Damiano P, Stefani A, Avancini A, Belluomini L, Bria E, Pilotto S. Real-world evidence in extensive disease small cell lung cancer: The missing piece of the puzzle. Crit Rev Oncol Hematol 2025; 207:104618. [PMID: 39827977 DOI: 10.1016/j.critrevonc.2025.104618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2024] [Revised: 01/10/2025] [Accepted: 01/11/2025] [Indexed: 01/22/2025] Open
Abstract
Small cell lung cancer (SCLC) is a highly aggressive disease, often diagnosed at an advanced stage and with limited treatment options. In recent years, immunotherapy has been approved in combination with chemotherapy in the first line setting of extensive stage disease (ES-SCLC). However, only 10-15 % of patients with ES-SCLC treated with chemoimmunotherapy (CT-IO) experience a long-term benefit. In addition, patients are often clinically frail due to advanced age, comorbidities, and disease-related symptoms, making SCLC a challenging condition. Real-world evidence (RWE) becomes particularly valuable in this scenario, not only to confirm the results of pivotal trials, but also to evaluate the outcomes of CT-IO in populations that are generally excluded from clinical trials. RWE could also define the role of integrative treatments such as thoracic consolidation radiotherapy and prophylactic cranial irradiation, which are used in selected patients in the clinical practice but were scarcely applied in pivotal trials. In this review, we focused on RWE in ES-SCLC, with the aim of improving clinical decision making. Notably, real-world data have largely confirmed the efficacy and safety of CT-IO observed in pivotal clinical trials, with a possible benefit even in more fragile patients. However, these studies also highlight that a significant proportion of the ES-SCLC population remains untreated due to poor clinical conditions.
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Affiliation(s)
- Paola Damiano
- UOC Oncologia Medica, Isola Tiberina Gemelli Isola, Roma, Italy.
| | - Alessio Stefani
- Medical Oncology, Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Roma, Italy.
| | - Alice Avancini
- Section of Innovation Biomedicine - Oncology Area, Department of Engineering for Innovation Medicine (DIMI), University of Verona, Italy.
| | - Lorenzo Belluomini
- Section of Innovation Biomedicine - Oncology Area, Department of Engineering for Innovation Medicine (DIMI), University of Verona, Italy.
| | - Emilio Bria
- UOC Oncologia Medica, Isola Tiberina Gemelli Isola, Roma, Italy; Medical Oncology, Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Roma, Italy; UOC Oncologia Medica, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy.
| | - Sara Pilotto
- Section of Innovation Biomedicine - Oncology Area, Department of Engineering for Innovation Medicine (DIMI), University of Verona, Italy.
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Njotu FN, Pougoue Ketchemen J, Babeker H, Henning N, Tikum AF, Nwangele E, Monzer A, Hassani N, Gray BD, Pak KY, Torlakovic EE, Uppalapati M, Fonge H. Preclinical safety and effectiveness of a long-acting somatostatin analogue [ 225Ac]Ac-EBTATE against small cell lung cancer and pancreatic neuroendocrine tumors. Eur J Nucl Med Mol Imaging 2025; 52:1305-1320. [PMID: 39627348 DOI: 10.1007/s00259-024-07011-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2024] [Accepted: 11/24/2024] [Indexed: 02/20/2025]
Abstract
PURPOSE We report the preclinical evaluation of potent long-acting [225Ac]Ac-EBTATE against SSTR2-positive small cell lung cancer (SCLC) and pancreatic neuroendocrine tumors (pan-NETs). METHODS The pharmacokinetic, biodistribution, and safety studies were evaluated in healthy female and/or male BALB/c mice after intravenous injections of [225Ac]Ac-EBTATE. Further biodistribution and radioligand therapy were investigated in female athymic BALB/c nude mice bearing high or low SSTR2-expressing subcutaneous SCLC models NCI-H524 or NCI-H727, respectively, and in a pan-NET model QGP1.SSTR2. RESULTS Pharmacokinetics confirmed a prolonged clearance half-life (40.27 ± 9.23 h) while biodistribution in healthy male and female BALB/c mice was similar, with prolonged blood circulation that peaked at 6 h. Biodistribution in subcutaneous xenograft models of NCI-H524 and NCI-H727 showed consistent tumor-uptake with SSTR2-overexpression while the projected human effective doses for males and females were 61.7 and 83.7 millisievert/megabecquerel, respectively. 2 × 34 kBq of [225Ac]Ac-EBTATE administered 10 days (d) apart, was generally tolerated for 28 days in healthy BALB/c mice as revealed by blood biochemistry, complete blood count, and histopathological examination of H&E-stained organs. Targeted alpha therapy at 2 × 30 kBq of [225Ac]Ac-EBTATE, injected 10 days apart, resulted in 100% survivals and 80% and 20% complete remissions for NCI-H524 and QGP1.SSTR2 models, respectively. Additionally, [225Ac]Ac-EBTATE had a dose-dependent response in the NCI-H727 model, with median survivals for 2 × 30 kBq and 2 × 15 kBq groups being 63 d (p < 0.0007), and 47 d (p = 0.0148), respectively. CONCLUSIONS [225Ac]Ac-EBTATE is safe and effective against SCLC and pan-NET and therefore warrants clinical investigation.
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Affiliation(s)
- Fabrice N Njotu
- Department of Medical Imaging, College of Medicine, University of Saskatchewan, Saskatoon, SK, S7N 0W8, Canada
- Department of Pathology and Laboratory Medicine, College of Medicine, University of Saskatchewan, 107 Wiggins Rd, Saskatoon, SK, S7N 5A2, Canada
- Axe Oncologie, Centre de Recherche du CHU de Québec-Université Laval, 2250 Boul. Henri-Bourassa, Québec, QC, G1J 5B3, Canada
- Faculté de Pharmacie, Université Laval, Ferdinand Andry Pavillon, 1050 Av. de la Medicine, Québec, QC, G1V 0A6, Canada
| | - Jessica Pougoue Ketchemen
- Department of Medical Imaging, College of Medicine, University of Saskatchewan, Saskatoon, SK, S7N 0W8, Canada
- Axe Oncologie, Centre de Recherche du CHU de Québec-Université Laval, 2250 Boul. Henri-Bourassa, Québec, QC, G1J 5B3, Canada
- Faculté de Pharmacie, Université Laval, Ferdinand Andry Pavillon, 1050 Av. de la Medicine, Québec, QC, G1V 0A6, Canada
| | - Hanan Babeker
- Department of Medical Imaging, College of Medicine, University of Saskatchewan, Saskatoon, SK, S7N 0W8, Canada
| | - Nikita Henning
- Department of Medical Imaging, College of Medicine, University of Saskatchewan, Saskatoon, SK, S7N 0W8, Canada
| | - Anjong F Tikum
- Department of Medical Imaging, College of Medicine, University of Saskatchewan, Saskatoon, SK, S7N 0W8, Canada
| | - Emmanuel Nwangele
- Department of Medical Imaging, College of Medicine, University of Saskatchewan, Saskatoon, SK, S7N 0W8, Canada
- Department of Pathology and Laboratory Medicine, College of Medicine, University of Saskatchewan, 107 Wiggins Rd, Saskatoon, SK, S7N 5A2, Canada
- Axe Oncologie, Centre de Recherche du CHU de Québec-Université Laval, 2250 Boul. Henri-Bourassa, Québec, QC, G1J 5B3, Canada
- Faculté de Pharmacie, Université Laval, Ferdinand Andry Pavillon, 1050 Av. de la Medicine, Québec, QC, G1V 0A6, Canada
| | - Alissar Monzer
- Department of Medical Imaging, College of Medicine, University of Saskatchewan, Saskatoon, SK, S7N 0W8, Canada
| | - Nava Hassani
- Department of Medical Imaging, College of Medicine, University of Saskatchewan, Saskatoon, SK, S7N 0W8, Canada
- Department of Small Animal Clinical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, SK, S7N 5B4, Canada
| | - Brian D Gray
- Molecular Targeting Technologies, Inc. West Chester, West Chester, PA, 19380, USA
| | - Koon Y Pak
- Molecular Targeting Technologies, Inc. West Chester, West Chester, PA, 19380, USA
| | - Emina E Torlakovic
- Department of Pathology and Laboratory Medicine, College of Medicine, University of Saskatchewan, 107 Wiggins Rd, Saskatoon, SK, S7N 5A2, Canada
- Department of Pathology, Royal University Hospital Saskatoon, Saskatoon, SK, S7N 0W8, Canada
| | - Maruti Uppalapati
- Department of Pathology and Laboratory Medicine, College of Medicine, University of Saskatchewan, 107 Wiggins Rd, Saskatoon, SK, S7N 5A2, Canada.
| | - Humphrey Fonge
- Department of Medical Imaging, College of Medicine, University of Saskatchewan, Saskatoon, SK, S7N 0W8, Canada.
- Axe Oncologie, Centre de Recherche du CHU de Québec-Université Laval, 2250 Boul. Henri-Bourassa, Québec, QC, G1J 5B3, Canada.
- Faculté de Pharmacie, Université Laval, Ferdinand Andry Pavillon, 1050 Av. de la Medicine, Québec, QC, G1V 0A6, Canada.
- Department of Medical Imaging, Royal University Hospital Saskatoon, Saskatoon, SK, S7N 0W8, Canada.
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Richlitzki C, Manapov F, Holzgreve A, Rabe M, Werner RA, Belka C, Unterrainer M, Eze C. Advances of PET/CT in Target Delineation of Lung Cancer Before Radiation Therapy. Semin Nucl Med 2025; 55:190-201. [PMID: 40064578 DOI: 10.1053/j.semnuclmed.2025.02.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2025] [Accepted: 02/28/2025] [Indexed: 03/17/2025]
Abstract
In the clinical management of lung cancer, radiotherapy remains a cornerstone of multimodal treatment strategies, often used alongside surgery or in combination with systemic therapies such as chemotherapy, tyrosine kinase inhibitors, and immune checkpoint inhibitors. While conventional imaging modalities like computed tomography (CT) and magnetic resonance imaging (MRI) continue to play a central role in staging, response assessment, and radiotherapy planning, advanced imaging techniques, particularly [18F]FDG PET/CT, are being increasingly integrated into routine clinical practice. These advanced techniques address the limitations of standard imaging by providing insight into molecular and metabolic tumor characteristics, enabling precise tumor visualization, accurate target volume delineation, and early treatment response assessment. This review examines the role of radiotherapy in the multidisciplinary management of lung cancer, detailing current concepts of morphological and functional imaging for staging and treatment planning. It also highlights the growing importance of PET-based radiotherapy planning, emphasizing its contributions to target volume definition and predictive value for treatment outcomes. Recent methodological advances, including the integration of artificial intelligence (AI), radiomics, technical innovations, and novel PET ligands, are discussed, highlighting their potential to improve the precision, efficacy, and personalization of lung cancer radiotherapy planning.
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Affiliation(s)
- Cedric Richlitzki
- Department of Radiation Oncology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Farkhad Manapov
- Department of Radiation Oncology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Adrien Holzgreve
- Department of Nuclear Medicine, LMU University Hospital, LMU Munich, Munich, Germany; Ahmanson Translational Theranostics Division, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Moritz Rabe
- Department of Radiation Oncology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Rudolf Alexander Werner
- Department of Nuclear Medicine, LMU University Hospital, LMU Munich, Munich, Germany; The Russell H Morgan Department of Radiology and Radiological Science, Division of Nuclear Medicine and Molecular Imaging, Johns Hopkins School of Medicine, Baltimore, MD
| | - Claus Belka
- Department of Radiation Oncology, LMU University Hospital, LMU Munich, Munich, Germany; German Cancer Consortium, German Cancer Research Center, Heidelberg, Germany; Comprehensive Pneumology Center Munich, Member of the German Center for Lung Research, Munich, Germany; Bavarian Cancer Research Center, Munich, Germany
| | - Marcus Unterrainer
- Department of Nuclear Medicine, LMU University Hospital, LMU Munich, Munich, Germany; Die Radiologie, Munich, Germany
| | - Chukwuka Eze
- Department of Radiation Oncology, LMU University Hospital, LMU Munich, Munich, Germany.
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Ayeni A, Evbuomwan O, Vangu MDTW. The Role of [ 18F]FDG PET/CT in Monitoring of Therapy Response in Lung Cancer. Semin Nucl Med 2025; 55:175-189. [PMID: 40021362 DOI: 10.1053/j.semnuclmed.2025.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2025] [Accepted: 02/06/2025] [Indexed: 03/03/2025]
Abstract
Lung cancer remains a leading cause of cancer deaths worldwide, with an all stage 5-year relative survival rate of less than 30%. Multiple treatment strategies are available and continue to evolve, with therapy primarily tailored to the type and stage of the disease. Accurate monitoring of therapy response is crucial for optimizing treatment outcomes. PET/CT imaging with [18F]FDG has become the standard of care across various phases of lung cancer management due to its ability to assess metabolic activity. This review underscores the pivotal role of [18F]FDG PET/CT in evaluating therapy response in lung cancer, particularly in non-small cell lung cancer (NSCLC). It examines conventional response criteria and their adaptations in the era of immunotherapy, highlighting the value of integrating metabolic imaging with established criteria to improve treatment assessment and guide clinical decisions. The potential of non-[18F]FDG PET tracers targeting diverse biological pathways to provide deeper insights into tumor biology, therapy response and predictive outcomes is also explored. Additionally, the emerging role of radiomics in enhancing treatment efficacy assessment and improving patient management is briefly highlighted. Despite the challenges in the routine clinical application of various metabolic response criteria, [18F]FDG PET/CT remains a crucial tool in monitoring therapy response in lung cancer. Ongoing advancements in therapeutic strategies, radiopharmaceuticals, and imaging techniques continue to drive progress in lung cancer management, promising improved patient outcomes.
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Affiliation(s)
- Akinwale Ayeni
- Division of Nuclear Medicine, Department of Radiation Sciences, Faculty of Health Sciences, University of The Witwatersrand, Johannesburg, South Africa; Nuclear Medicine, Klerksdorp/Tshepong Hospital Complex, Klerksdorp, North West Province, South Africa; Division of Nuclear Medicine, Department of Radiation Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
| | - Osayande Evbuomwan
- Department of Nuclear Medicine, Faculty of Health Sciences, University of The Free State, Bloemfontein, South Africa
| | - Mboyo-Di-Tamba Willy Vangu
- Division of Nuclear Medicine, Department of Radiation Sciences, Faculty of Health Sciences, University of The Witwatersrand, Johannesburg, South Africa
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50
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Zheng L, Yang H, Xie T, Huang D, Tian H. Knowledge and attitudes toward [ 18F] fluorodeoxyglucose ( 18F-FDG) positron emission tomography/computed tomography among non-radiologist medical staff. BMC MEDICAL EDUCATION 2025; 25:306. [PMID: 40001203 PMCID: PMC11863951 DOI: 10.1186/s12909-025-06864-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 02/12/2025] [Indexed: 02/27/2025]
Abstract
BACKGROUND To investigate the current knowledge and attitudes towards [18F]fluorodeoxyglucose (18F-FDG) positron emission tomography (PET)/computed tomography (CT) among non-radiologist medical staff in China. METHODS This cross-sectional study was conducted between November 18, 2022, and December 6, 2022, at the First Affiliated Hospital (Southwest Hospital) of the Army Medical University (Third Military Medical University) among non-radiologist staff (medical, nursing, and others). The questionnaire survey (Cronbach's α = 0.887) included 28 items: 10 on demographics, 11 on knowledge (maximum score of 22), and seven on attitudes (maximum score of 35). The factors influencing knowledge and attitudes were identified using multivariable logistic regression analysis. RESULTS This study analyzed 631 valid questionnaires. The mean knowledge score was 7.16 ± 6.48 (32.55%), indicating poor knowledge. The mean attitude score was 22.859 ± 2.36 (65.29%), indicating positive attitudes. Nursing (OR = 0.301, 95%CI: 0.159-0.571), other occupations (OR = 0.426, 95%CI: 0.200-0.905), departments with high volumes of PET/CT prescriptions (OR = 0.419, 95%CI: 0.269-0.652), radioprotection training (OR = 2.520, 95%CI: 1.576-4.030), underwent (or a relative) a PET/CT (OR = 1.713, 95%CI: 1.063-2.761), and contact with 1-10 (OR = 2.429, 95%CI: 1.627-3.627) or > 10 (OR = 3.575, 95%CI: 1.762-7.252) patients per month were independently associated with higher knowledge scores. Only the knowledge scores (OR = 1.063, 95%CI: 1.032-1.094) were independently associated with higher attitude scores. CONCLUSION Non-radiologist medical staff members in China have poor knowledge but positive attitudes toward PET/CT. This study identified knowledge areas worth improving in future training interventions. Radioprotection training appears particularly useful in improving the knowledge of PET/CT, which should translate into more favorable attitudes. TRIAL REGISTRATION Not applicable.
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Affiliation(s)
- Lei Zheng
- Nuclear Medicine Department, The First Affiliated Hospital (Southwest Hospital), Army Medical University (Third Military Medical University), Gao Tan Yan Street, Chongqing, 400038, China
| | - Hang Yang
- Nuclear Medicine Department, The First Affiliated Hospital (Southwest Hospital), Army Medical University (Third Military Medical University), Gao Tan Yan Street, Chongqing, 400038, China
| | - Tianxin Xie
- Nuclear Medicine Department, The First Affiliated Hospital (Southwest Hospital), Army Medical University (Third Military Medical University), Gao Tan Yan Street, Chongqing, 400038, China
| | - Dingde Huang
- Nuclear Medicine Department, The First Affiliated Hospital (Southwest Hospital), Army Medical University (Third Military Medical University), Gao Tan Yan Street, Chongqing, 400038, China.
| | - Haiying Tian
- Oncology Department, The First Affiliated Hospital (Southwest Hospital), Army Medical University (Third Military Medical University), Gao Tan Yan Street, Chongqing, 400038, China.
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