|
1
|
Liang HW, Liu Y, Pan XB. Treatment patterns and survival analysis in patients with unresectable stage III EGFR-mutated non-small cell lung cancer. Aging (Albany NY) 2024; 16:857-871. [PMID: 38214678 PMCID: PMC10817403 DOI: 10.18632/aging.205425] [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: 08/31/2023] [Accepted: 12/04/2023] [Indexed: 01/13/2024]
Abstract
PURPOSE To investigate the treatment patterns and survival outcomes in patients with unresectable Stage III EGFR-mutated non-small cell lung cancer (NSCLC). MATERIALS AND METHODS A retrospective analysis was conducted on patients with unresectable Stage III EGFR-mutated NSCLC spanning from 2012 to 2022. Treatment patterns were outlined, and survival comparisons between different treatment groups were performed using Kaplan-Meier methods. RESULTS A total of 88 patients were included: 62.5% received TKI alone, 26.1% received TKI+chemotherapy, 4.5% received radiotherapy, 4.5% participated in clinical trials, and 2.4% received TKI+antiangiogenic drugs. Prior to propensity score matching, TKI+chemotherapy and TKI alone groups demonstrated similar progression-free survival (hazard ratio [HR] = 1.56, 95% confidence interval [CI]: 0.87-2.80; P = 0.134), overall survival (HR = 1.12, 95% CI: 0.59-2.13; P = 0.733), and locoregional-free survival (HR = 1.46; 95% CI: 0.75-2.81; P = 0.267). However, TKI+chemotherapy showed reduced distant metastasis-free survival compared to TKI alone (HR = 2.39, 95% CI: 1.11-5.18; P = 0.022). After propensity score matching, no significant differences were observed in progression-free survival (P = 0.435), overall survival (P = 0.205), locoregional-free survival (P = 0.706), and distant metastasis-free survival (P = 0.171) between the TKI+chemotherapy and TKI alone groups. CONCLUSIONS The addition of chemotherapy to TKI did not enhance survival outcomes compared to TKI monotherapy in patients with unresectable Stage III EGFR-mutated NSCLC.
Collapse
Affiliation(s)
- Huan-Wei Liang
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning 530021, Guangxi, P.R. China
| | - Yang Liu
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning 530021, Guangxi, P.R. China
| | - Xin-Bin Pan
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning 530021, Guangxi, P.R. China
| |
Collapse
|
|
2
|
Alt NJ, Muster J, Ziegler DA, Bendrich S, Donath S, Hille A, Anczykowski MZ, Zwerenz CM, Braulke F, von Hammerstein-Equord A, Overbeck TR, Treiber H, Guhlich M, El Shafie R, Rieken S, Leu M, Dröge LH. Outcomes of Multimodal Treatment in Elderly Patients with Localized Non-Small Lung Cancer from a Radiation Oncology Point of View: Special Focus on Low-Dose Cisplatin. Cancers (Basel) 2024; 16:327. [PMID: 38254817 PMCID: PMC10814481 DOI: 10.3390/cancers16020327] [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: 12/07/2023] [Revised: 01/04/2024] [Accepted: 01/09/2024] [Indexed: 01/24/2024] Open
Abstract
Identification of the optimal treatment strategy is challenging in elderly with localized non-small cell lung cancer (NSCLC). Concurrent chemotherapy with low-dose cisplatin represents an option for elderly. Outcomes (1) in elderly (≥70 years, n = 158) vs. younger patients (n = 188) and (2), independently of age, in definitive radiochemotherapy, with low-dose cisplatin (n = 125) vs. cisplatin/vinorelbine (n = 76) were studied. Elderly included more males, had a lower Karnofsky index, more comorbidities, and lower stages. Low-dose cisplatin patients (vs. cisplatin/vinorelbine) had higher age, more comorbidities, and lower stages. We observed reduced dermatitis and dysphagia and increased anemia and thrombocytopenia in elderly vs. younger patients, without increased ≥grade 3 toxicities. Low-dose cisplatin was less toxic than cisplatin/vinorelbine. Survival outcomes were lower in elderly vs. younger and comparable between low-dose cisplatin and cisplatin/vinorelbine. In elderly, gender, Karnofsky index, stage, and multimodal treatment (including additional surgery/systemic therapy) were identified as prognostic factors. In conclusion, we found evidence for an acceptable toxicity profile and the need for improvement of outcomes in elderly with localized NSCLC. Multimodal strategies (including additional surgery/systemic treatment) showed favorable outcomes and should be reasonably considered in elderly who are deemed fit enough. Low-dose cisplatin should be discussed on an individual basis due to favorable toxicity and outcomes.
Collapse
Affiliation(s)
- Niklas Josua Alt
- Department of Radiotherapy and Radiation Oncology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany; (N.J.A.); (D.A.Z.); (S.B.); (S.D.); (A.H.); (M.Z.A.); (C.M.Z.); (M.G.); (R.E.S.); (S.R.); (M.L.)
- Göttingen Comprehensive Cancer Center (G-CCC), University Medical Center Göttingen, Von-Bar-Str. 2/4, 37075 Göttingen, Germany; (F.B.); (A.v.H.-E.); (T.R.O.); (H.T.)
| | - Julian Muster
- Department of Radiotherapy and Radiation Oncology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany; (N.J.A.); (D.A.Z.); (S.B.); (S.D.); (A.H.); (M.Z.A.); (C.M.Z.); (M.G.); (R.E.S.); (S.R.); (M.L.)
- Göttingen Comprehensive Cancer Center (G-CCC), University Medical Center Göttingen, Von-Bar-Str. 2/4, 37075 Göttingen, Germany; (F.B.); (A.v.H.-E.); (T.R.O.); (H.T.)
| | - David Alexander Ziegler
- Department of Radiotherapy and Radiation Oncology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany; (N.J.A.); (D.A.Z.); (S.B.); (S.D.); (A.H.); (M.Z.A.); (C.M.Z.); (M.G.); (R.E.S.); (S.R.); (M.L.)
- Göttingen Comprehensive Cancer Center (G-CCC), University Medical Center Göttingen, Von-Bar-Str. 2/4, 37075 Göttingen, Germany; (F.B.); (A.v.H.-E.); (T.R.O.); (H.T.)
| | - Stephanie Bendrich
- Department of Radiotherapy and Radiation Oncology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany; (N.J.A.); (D.A.Z.); (S.B.); (S.D.); (A.H.); (M.Z.A.); (C.M.Z.); (M.G.); (R.E.S.); (S.R.); (M.L.)
- Göttingen Comprehensive Cancer Center (G-CCC), University Medical Center Göttingen, Von-Bar-Str. 2/4, 37075 Göttingen, Germany; (F.B.); (A.v.H.-E.); (T.R.O.); (H.T.)
| | - Sandra Donath
- Department of Radiotherapy and Radiation Oncology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany; (N.J.A.); (D.A.Z.); (S.B.); (S.D.); (A.H.); (M.Z.A.); (C.M.Z.); (M.G.); (R.E.S.); (S.R.); (M.L.)
- Göttingen Comprehensive Cancer Center (G-CCC), University Medical Center Göttingen, Von-Bar-Str. 2/4, 37075 Göttingen, Germany; (F.B.); (A.v.H.-E.); (T.R.O.); (H.T.)
| | - Andrea Hille
- Department of Radiotherapy and Radiation Oncology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany; (N.J.A.); (D.A.Z.); (S.B.); (S.D.); (A.H.); (M.Z.A.); (C.M.Z.); (M.G.); (R.E.S.); (S.R.); (M.L.)
- Göttingen Comprehensive Cancer Center (G-CCC), University Medical Center Göttingen, Von-Bar-Str. 2/4, 37075 Göttingen, Germany; (F.B.); (A.v.H.-E.); (T.R.O.); (H.T.)
| | - Mahalia Zoe Anczykowski
- Department of Radiotherapy and Radiation Oncology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany; (N.J.A.); (D.A.Z.); (S.B.); (S.D.); (A.H.); (M.Z.A.); (C.M.Z.); (M.G.); (R.E.S.); (S.R.); (M.L.)
- Göttingen Comprehensive Cancer Center (G-CCC), University Medical Center Göttingen, Von-Bar-Str. 2/4, 37075 Göttingen, Germany; (F.B.); (A.v.H.-E.); (T.R.O.); (H.T.)
| | - Carla Marie Zwerenz
- Department of Radiotherapy and Radiation Oncology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany; (N.J.A.); (D.A.Z.); (S.B.); (S.D.); (A.H.); (M.Z.A.); (C.M.Z.); (M.G.); (R.E.S.); (S.R.); (M.L.)
- Göttingen Comprehensive Cancer Center (G-CCC), University Medical Center Göttingen, Von-Bar-Str. 2/4, 37075 Göttingen, Germany; (F.B.); (A.v.H.-E.); (T.R.O.); (H.T.)
| | - Friederike Braulke
- Göttingen Comprehensive Cancer Center (G-CCC), University Medical Center Göttingen, Von-Bar-Str. 2/4, 37075 Göttingen, Germany; (F.B.); (A.v.H.-E.); (T.R.O.); (H.T.)
| | - Alexander von Hammerstein-Equord
- Göttingen Comprehensive Cancer Center (G-CCC), University Medical Center Göttingen, Von-Bar-Str. 2/4, 37075 Göttingen, Germany; (F.B.); (A.v.H.-E.); (T.R.O.); (H.T.)
- Department of Cardio-Thoracic and Vascular Surgery, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany
| | - Tobias Raphael Overbeck
- Göttingen Comprehensive Cancer Center (G-CCC), University Medical Center Göttingen, Von-Bar-Str. 2/4, 37075 Göttingen, Germany; (F.B.); (A.v.H.-E.); (T.R.O.); (H.T.)
- Department of Hematology and Medical Oncology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany
| | - Hannes Treiber
- Göttingen Comprehensive Cancer Center (G-CCC), University Medical Center Göttingen, Von-Bar-Str. 2/4, 37075 Göttingen, Germany; (F.B.); (A.v.H.-E.); (T.R.O.); (H.T.)
- Department of Hematology and Medical Oncology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany
| | - Manuel Guhlich
- Department of Radiotherapy and Radiation Oncology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany; (N.J.A.); (D.A.Z.); (S.B.); (S.D.); (A.H.); (M.Z.A.); (C.M.Z.); (M.G.); (R.E.S.); (S.R.); (M.L.)
- Göttingen Comprehensive Cancer Center (G-CCC), University Medical Center Göttingen, Von-Bar-Str. 2/4, 37075 Göttingen, Germany; (F.B.); (A.v.H.-E.); (T.R.O.); (H.T.)
| | - Rami El Shafie
- Department of Radiotherapy and Radiation Oncology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany; (N.J.A.); (D.A.Z.); (S.B.); (S.D.); (A.H.); (M.Z.A.); (C.M.Z.); (M.G.); (R.E.S.); (S.R.); (M.L.)
- Göttingen Comprehensive Cancer Center (G-CCC), University Medical Center Göttingen, Von-Bar-Str. 2/4, 37075 Göttingen, Germany; (F.B.); (A.v.H.-E.); (T.R.O.); (H.T.)
| | - Stefan Rieken
- Department of Radiotherapy and Radiation Oncology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany; (N.J.A.); (D.A.Z.); (S.B.); (S.D.); (A.H.); (M.Z.A.); (C.M.Z.); (M.G.); (R.E.S.); (S.R.); (M.L.)
- Göttingen Comprehensive Cancer Center (G-CCC), University Medical Center Göttingen, Von-Bar-Str. 2/4, 37075 Göttingen, Germany; (F.B.); (A.v.H.-E.); (T.R.O.); (H.T.)
| | - Martin Leu
- Department of Radiotherapy and Radiation Oncology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany; (N.J.A.); (D.A.Z.); (S.B.); (S.D.); (A.H.); (M.Z.A.); (C.M.Z.); (M.G.); (R.E.S.); (S.R.); (M.L.)
- Göttingen Comprehensive Cancer Center (G-CCC), University Medical Center Göttingen, Von-Bar-Str. 2/4, 37075 Göttingen, Germany; (F.B.); (A.v.H.-E.); (T.R.O.); (H.T.)
| | - Leif Hendrik Dröge
- Department of Radiotherapy and Radiation Oncology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany; (N.J.A.); (D.A.Z.); (S.B.); (S.D.); (A.H.); (M.Z.A.); (C.M.Z.); (M.G.); (R.E.S.); (S.R.); (M.L.)
- Göttingen Comprehensive Cancer Center (G-CCC), University Medical Center Göttingen, Von-Bar-Str. 2/4, 37075 Göttingen, Germany; (F.B.); (A.v.H.-E.); (T.R.O.); (H.T.)
| |
Collapse
|
|
3
|
Liu Y, Liang HW, Pan XB. Efficacy of first-line tyrosine kinase inhibitor between unresectable stage III and stage IV EGFR-mutated non-small cell lung cancer patients. Aging (Albany NY) 2023; 15:204781. [PMID: 37294545 PMCID: PMC10292882 DOI: 10.18632/aging.204781] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 05/27/2023] [Indexed: 06/10/2023]
Abstract
PURPOSE To compare survivals between unresectable stage III and stage IV EGFR-mutated non-small cell lung cancer (NSCLC) patients receiving first-line EGFR-TKI. MATERIALS AND METHODS Unresectable stage III and stage IV EGFR-mutated NSCLC patients were investigated from September 2012 to May 2022. Patients received EGFR-TKI as the first-line treatment. Progression-free survival (PFS) and overall survival (OS) were assessed using the Kaplan-Meier method and propensity score matching (PSM) analyses. RESULTS A total of 558 patients were included: 478 (85.66%) patients were stage IV and 80 (14.34%) patients were stage III. Before PSM, stage III patients showed a better median PFS (15 vs. 13 months; P=0.026) and a similar median OS (29 vs. 30 months; P=0.820) compared to stage IV patients. Stage IV was an independent prognostic factor for PFS [hazard ratio (HR)=1.47, 95% confidence interval (CI): 1.06-2.04; P=0.021], but not for OS (HR=1.11, 95% CI: 0.77-1.60; P=0.560). After PSM, a better median PFS (15 vs. 12 months; P=0.016) and a similar median OS (29 vs. 30 months; P=0.960) were found between stage III and stage IV patients. CONCLUSIONS OS was similar between unresectable stage III and stage IV EGFR-mutated NSCLC patients receiving EGFR-TKI as the first-line treatment.
Collapse
Affiliation(s)
- Yang Liu
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning 530021, Guangxi, P.R. China
| | - Huan-Wei Liang
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning 530021, Guangxi, P.R. China
| | - Xin-Bin Pan
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning 530021, Guangxi, P.R. China
| |
Collapse
|
|
4
|
Yacouba MBM, Feng M, Thokerunga E, Bongolo CC, Gado AF, He F, Ke J, Zhang Z, Wang Y. Optimum cycles of induction chemotherapy in concurrent chemo-radiotherapy management of unresectable stage III non-small cell lung cancer: Results from a single institutional database. Medicine (Baltimore) 2023; 102:e33760. [PMID: 37171312 PMCID: PMC10174407 DOI: 10.1097/md.0000000000033760] [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: 05/13/2023] Open
Abstract
Induction chemotherapy (IC) prior to concurrent chemo-radiotherapy is the recommended treatment for unresectable stage III non-small cell lung cancer (NSCLC). However, the optimum number of IC cycles for improved survival outcomes is still not known. Here, we assessed the efficacy of 2 or more cycles of IC for unresectable stage III NSCLC patients from our hospital. Data on unresectable stage III NSCLC patients treated with IC + concurrent chemo-radiotherapy at our hospital between 2018 and 2022 were retrieved and analyzed, and survival outcomes compared between IC = 2 and IC > 2 patients. Univariate and multivariate Cox regression, and Chi-square or Fisher exact test were used to assess prognosis and acute toxicity profiles. One hundred twenty-six patients were recruited; 90 for IC = 2 and 36 for IC > 2. Median follow-up time was 26 months [IQR 16-38]. Three-year overall survival was not statistically significant between the 2 groups (77.8% vs 75.0%, P = .453). Distant metastasis free survival, loco-regional recurrence free survival and progression free survival were also not significant, (90.0% vs 86.1%, P = .068), 97.8% vs 97.2%, P = .056), and (73.3% vs 66.7%, P = .446) respectively. Univariate and multivariate Cox regression analysis revealed smoking, T_stage, N_stage, and IC_regimen as independent prognostic factor for overall survival, while drinking and T_stage were risk factors for progression free survival. In summary, 2 cycles of platinum-based IC was effective for stage III unresectable NSCLC and adding more than 2 cycles did not offer extra survival benefits.
Collapse
Affiliation(s)
| | - Maohui Feng
- Department of Gastrointestinal Surgery, Zhongnan Hospital of Wuhan University, and Clinical Cancer Study Center of Hubei Province, China
| | - Erick Thokerunga
- Program and Department of Clinical Laboratory Medicine, Center for Gene Diagnosis, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Christian Cedric Bongolo
- Program and Department of Clinical Laboratory Medicine, Center for Gene Diagnosis, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Adamou Foumakoye Gado
- Department of Anesthesia and Intensive Care, Hôpital Général DE Référence Niamey, Republic of Niger
| | - Feng He
- Department of Anesthesiology, Zhongnan Hospital of Wuhan University, Wuhan China
| | - Jianjuan Ke
- Department of Anesthesiology, Zhongnan Hospital of Wuhan University, Wuhan China
| | - Zongze Zhang
- Department of Anesthesiology, Zhongnan Hospital of Wuhan University, Wuhan China
| | - Yanlin Wang
- Department of Anesthesiology, Zhongnan Hospital of Wuhan University, Wuhan China
| |
Collapse
|
|
5
|
Dieleman E, van der Woude L, van Os R, van Bockel L, Coremans I, van Es C, De Jaeger K, Knol HP, Kolff W, Koppe F, Pomp J, Reymen B, Schinagl D, Spoelstra F, Tissing-Tan C, van der Voort van Zyp N, van der Wel A, Wijsman R, Dielwart M, Wiegman E, Damhuis R, Belderbos J. The Dutch Lung Cancer Audit-Radiotherapy (DLCA-R): Real-World Data on Stage III Non-Small Cell Lung Cancer Patients Treated With Curative Chemoradiation. Clin Lung Cancer 2023; 24:130-136. [PMID: 36572596 DOI: 10.1016/j.cllc.2022.11.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 10/23/2022] [Accepted: 11/16/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Chemoradiotherapy (CRT) is the standard of care in inoperable non-small-cell lung cancer (NSCLC) patients, favoring concurrent (cCRT) over sequential CRT (seqCRT), with adjuvant immunotherapy in responders. Elderly and frail NSCLC patients have generally been excluded from trials in the past. In elderly patients however, the higher treatment related morbidity of cCRT, may outweigh the possible lower tumor control of seqCRT. For elderly patients with locally advanced NSCLC real-world data is essential to be able to balance treatment toxicity and treatment outcome. The aim of this study is to analyze acute toxicity and 3-month mortality of curative chemoradiation (CRT) in patients with stage III NSCLC and to analyze whether cCRT for elderly stage III NSCLC patients is safe. METHODS The Dutch Lung Cancer Audit-Radiotherapy (DLCA-R) is a national lung cancer audit that started in 2013 for patients treated with curative intent radiotherapy. All Dutch patients treated for stage III NSCLC between 2015 and 2018 with seqCRT or cCRT for (primary or recurrent) stage III lung cancer are included in this population-based study. Information was collected on patient, tumor- and treatment characteristics and the incidence and severity of acute non-hematological toxicity (CTCAE-4 version 4.03) and mortality within 3 months after the end of radiotherapy. To evaluate the association between prognostic factors and outcome (acute toxicity and mortality within 3 months), an univariable and multivariable analysis was performed. The definition of cCRT was:radiotherapy started within 30 days after the start of chemotherapy. RESULTS Out of all 20 Dutch departments of radiation oncology, 19 centers participated in the registry. A total of 2942 NSCLC stage III patients were treated with CRT. Of these 67.2% (n = 1977) were treated with cCRT (median age 66 years) and 32.8% (n = 965) were treated with seqCRT (median age 69 years). Good performance status (WHO 0-1) was scored in 88.6% for patients treated with cCRT and in 71.0% in the patients treated with seqCRT. Acute nonhematological 3-month toxicity (CTCAE grade ≥3 or radiation pneumonitis grade ≥2) was scored in 21.9% of the patients treated with cCRT and in 17.7% of the patients treated with seqCRT. The univariable analysis for acute toxicity showed significantly increased toxicity for cCRT (P = .008), WHO ≥2 (P = .006), and TNM IIIC (P = .031). The multivariable analysis for acute toxicity was significant for cCRT (P = .015), WHO ≥2 (P = .001) and TNM IIIC (P = .016). The univariable analysis for 3-month mortality showed significance for seqCRT (P = .025), WHO ≥2 (P < .001), higher cumulative radiotherapy dose (P < .001), higher gross tumor volume total (P = .020) and male patients (p < .001). None of these variables reached significance in the multivariable analysis for 3-month mortality. CONCLUSION In this national lung cancer audit of inoperable NSCLC patients, 3-month toxicity was significantly higher in patients treated with cCRT (21.9% vs. 17.7% for seqCRT) higher TNM stage IIIC, and poor performance (WHO≥2) patients.The 3-months mortality was not significantly different for tested parameters. Age was not a risk factor for acute toxicity, nor 3 months mortality.
Collapse
Affiliation(s)
- Edith Dieleman
- Amsterdam UMC location AMC, Radiation Oncology, Amsterdam, The Netherlands
| | - Lisa van der Woude
- RadboudUMC, Cardiothoracic surgery, Nijmegen, The Netherlands; Dutch Institute for Clinical Auditing, Leiden, The Netherlands
| | - Rob van Os
- Amsterdam UMC location AMC, Radiation Oncology, Amsterdam, The Netherlands
| | | | - Ida Coremans
- LUMC, Radiation Oncology, Leiden, The Netherlands
| | | | - Katrien De Jaeger
- Catharina Ziekenhuis, Radiation Oncology, Eindhoven, The Netherlands
| | - Hans Peter Knol
- Noordwest Ziekenhuis groep, Radiation Oncology, Alkmaar, The Netherlands
| | - Willemijn Kolff
- Amsterdam UMC location AMC, Radiation Oncology, Amsterdam, The Netherlands
| | - Frederike Koppe
- Instituut Verbeeten, Radiation Oncology, Tilburg, The Netherlands
| | - Jacqueline Pomp
- Medisch Spectrum Twente, Radiation Oncology, Enschede, The Netherlands
| | - Bart Reymen
- Maastro, Radiation Oncology, Maastricht, The Netherlands
| | | | - Femke Spoelstra
- Amsterdam UMC location VUMC, Radiation Oncology, Amsterdam, The Netherlands
| | | | | | - Antoinet van der Wel
- Radiotherapeutisch Instituut Friesland, Radiation Oncology, Leeuwarden, The Netherlands
| | - Robin Wijsman
- UMCG, Radiation Oncology, Groningen, The Netherlands
| | | | | | - Ronald Damhuis
- Department of Research, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
| | - Jose Belderbos
- Netherlands Cancer Institute, Radiation Oncology, Amsterdam, The Netherlands
| |
Collapse
|
|
6
|
Beta Blockers with Statins May Decrease All-Cause Mortality in Patients with Cardiovascular Diseases and Locally Advanced Unresectable Non-Small-Cell Lung Cancer after Chemoradiotherapy. Cancers (Basel) 2023; 15:cancers15041277. [PMID: 36831618 PMCID: PMC9954027 DOI: 10.3390/cancers15041277] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 02/05/2023] [Accepted: 02/14/2023] [Indexed: 02/19/2023] Open
Abstract
The study was conducted in the era when maintenance immunotherapy with durvalumab was not available in clinical practice after chemoradiotherapy (CRT) in unresectable non-small-cell lung cancer (NSCLC). The main aim of the study was to check whether the presence of cardiovascular diseases (CVD) and their pharmacotherapy affects the overall survival (OS) in such NSCLC patients undergoing sequential CRT. The group of 196 patients were analyzed: 101 patients with CVD (51.53%) and 95 patients with other reasons of qualification for sequential CRT (decreased performance status, older age, and other non-cardiovascular co-morbidities). Although patients with CVD were more often in older age, and they more often experienced cardiac and nephrological complications (p < 0.05 for all), there was a statistically nonsignificant trend for lower all-cause mortality in patients with CVD. The lowest all-cause mortality was observed in patients treated with beta-blockers and statins after two (HR = 0.31; 95%CI: 0.1-0.98; p = 0.047), three (HR = 0.33; 95%CI: 0.13-0.81; p = 0.015) and even four (HR = 0.45; 95%CI: 0.22-0.97; p = 0.027) years of follow-up. The benefit in OS remained significant in 101 patients with CVD treated with beta-blockers (HR = 0.65; 95%CI: 0.43-0.99; p = 0.045), and eventually statin, throughout the whole follow-up (log-rank p < 0.05). Further prospective studies are necessary to confirm the role of beta-blockers and statins in reduction of mortality in NSCLC patients undergoing radical CRT.
Collapse
|
|
7
|
Li J, Zou Q, Gu R, Wang F, Li X. Development and validation of nomograms to predict early death for elderly lung cancer patients. Front Surg 2023; 10:1113863. [PMID: 36860947 PMCID: PMC9968844 DOI: 10.3389/fsurg.2023.1113863] [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: 12/01/2022] [Accepted: 01/18/2023] [Indexed: 02/15/2023] Open
Abstract
Background Due to the aging of society, the average age of LC (lung cancer) patients has increased in recent years. The purpose of this study was to determine the risk factors and develop nomograms to predict the probability of early death (dead in three months) for elderly (≥ 75 years old) LC patients. Methods Data of elderly LC patients were obtained from the SEER database by using the SEER stat software. All patients were randomly divided into a training cohort and a validation cohort in a ratio of 7:3. The risk factors of all-cause early and cancer-specific early death were identified by univariate logistic regression and backward stepwise multivariable logistic regression in the training cohort. Then, risk factors were used to construct nomograms. The performance of nomograms was validated by receiver operating curves (ROC), calibration curves, and decision curve analysis (DCA) in the training cohort and validation cohort. Results A total of 15,057 elderly LC patients in the SEER database were included in this research and randomly divided into a training cohort (n = 10,541) and a validation cohort (n = 4516). The multivariable logistic regression models found that there were 12 independent risk factors for the all-cause early death and 11 independent risk factors for the cancer-specific early death of the elderly LC patients, which were then integrated into the nomograms. The ROC indicated that the nomograms exhibited high discriminative ability in predicting all-cause early (AUC in training cohort = 0.817, AUC in validation cohort = 0.821) and cancer-specific early death (AUC in training cohort = 0.824, AUC in validation cohort = 0.827). The calibration plots of the nomograms were close to the diagonal line revealing that there was good concordance between the predicted and practical early death probability in the training and validation cohort. Moreover, the results of DCA analysis indicated that the nomograms had good clinical utility in predicting early death probability. Conclusion The nomograms were constructed and validated to predict the early death probability of elderly LC patients based on the SEER database. The nomograms were expected to have high predictive ability and good clinical utility, which may help oncologists develop better treatment strategies.
Collapse
Affiliation(s)
- Jiafei Li
- Department of Respiratory and Critical Care, Medicine, Chuzhou Hospital of Anhui Medical University, Anhui, China
| | - Qian Zou
- Department of Respiratory and Critical Care, Medicine, Chuzhou Hospital of Anhui Medical University, Anhui, China
| | - Rubing Gu
- Department of Respiratory and Critical Care, Medicine, Chuzhou Hospital of Anhui Medical University, Anhui, China
| | - Fang Wang
- Department of Respiratory and Critical Care, Medicine, Chuzhou Hospital of Anhui Medical University, Anhui, China
| | | |
Collapse
|
|
8
|
Woodford K, Koo K, Reynolds J, Stirling RG, Harden SV, Brand M, Senthi S. Persisting Gaps in Optimal Care of Stage III Non-small Cell Lung Cancer: An Australian Patterns of Care Analysis. Oncologist 2022; 28:e92-e102. [PMID: 36541690 PMCID: PMC9907057 DOI: 10.1093/oncolo/oyac246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 10/20/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Wide variation exists globally in the treatment and outcomes of stage III patients with non-small cell lung cancer (NSCLC). We conducted an up-to-date patterns of care analysis in the state of Victoria, Australia, with a particular focus on the proportion of patients receiving treatment with radical intent, treatment trends over time, and survival. MATERIALS AND METHODS Stage III patients with NSCLC were identified in the Victorian Lung Cancer Registry and categorized by treatment received and treatment intent. Logistic regression was used to explore factors predictive of receipt of radical treatment and the treatment trends over time. Cox regression was used to explore variables associated with overall survival (OS). Covariates evaluated included age, sex, ECOG performance status, smoking status, year of diagnosis, Australian born, Aboriginal or Torres Strait Islander status, socioeconomic status, rurality, public/private status of notifying institution, and multidisciplinary meeting discussion. RESULTS A total of 1396 patients were diagnosed between 2012 and 2019 and received treatment with radical intent 67%, palliative intent 23%, unknown intent 5% and no treatment 5%. Radical intent treatment was less likely if patients were >75 years, ECOG ≥1, had T3-4 or N3 disease or resided rurally. Surgery use decreased over time, while concurrent chemoradiotherapy and immunotherapy use increased. Median OS was 38.0, 11.1, and 4.4 months following radical treatment, palliative treatment or no treatment, respectively. CONCLUSION Almost a third of stage III patients with NSCLC still do not receive radical treatment. Strategies to facilitate radical treatment and better support decision making between increasing multimodality options are required.
Collapse
Affiliation(s)
- Katrina Woodford
- Corresponding author: Katrina Woodford, PhD, Department of Radiation Oncology, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, VIC 3000, Australia. Tel: +61 3 8559 6067; Fax: +61 3 85596009; E-mail:
| | - Kendrick Koo
- Alfred Health Radiation Oncology, The Alfred Hospital, Melbourne, VIC, Australia,Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia,Department of Epidemiology & Preventative Medicine, School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC, Australia
| | - John Reynolds
- Department of Epidemiology & Preventative Medicine, School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC, Australia
| | - Robert G Stirling
- Department of Medicine, Monash University, Clayton, VIC, Australia,Department of Respiratory Medicine, The Alfred Hospital, Melbourne, VIC, Australia
| | - Susan V Harden
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia,Department of Epidemiology & Preventative Medicine, School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC, Australia
| | - Margaret Brand
- Department of Epidemiology & Preventative Medicine, School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC, Australia
| | - Sashendra Senthi
- Alfred Health Radiation Oncology, The Alfred Hospital, Melbourne, VIC, Australia,Department of Surgery, Central Clinical School, Monash University, Melbourne, VIC, Australia
| |
Collapse
|
|
9
|
Yu G, Liu X, Li Y, Zhang Y, Yan R, Zhu L, Wang Z. The nomograms for predicting overall and cancer-specific survival in elderly patients with early-stage lung cancer: A population-based study using SEER database. Front Public Health 2022; 10:946299. [PMID: 36159305 PMCID: PMC9493218 DOI: 10.3389/fpubh.2022.946299] [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: 05/17/2022] [Accepted: 08/19/2022] [Indexed: 01/21/2023] Open
Abstract
Purpose Lung cancer is the leading cause of death from cancer and the number of operable elderly lung cancer patients is increasing, with advanced age being associated with a poorer prognosis. However, there is no easy and comprehensive prognostic assessment method for these patients. Methods Clinicopathological data of patients aged 65 years or older with TNM stage I-II lung cancer from 2004 to 2018 were downloaded from the SEER database. Patients from 2004 to 2015 were randomized into a training group (n = 16,457) and a validation group (n = 7,048). Data from 2016 to 2018 (n = 6,231) were used for external validation. Two nomogram prognostic models were created after independent prognostic factors connected to both overall survival (OS) and cancer-specific survival (CSS) in the training set by using univariate and multivariate Cox proportional hazards regression analysis. In turn, overall survival (OS) and cancer-specific survival (CSS) were predicted for patients at 1, 3, and 5 years. Based on the concordance index (C-index), calibration curves, area under the receiver operating characteristics (ROC) curve (AUC), the time-dependent area under the ROC curve, the validity, accuracy, discrimination, predictive ability, and clinical utility of the models were evaluated. Decision curve analysis (DCA) was used to assess the clinical value of the models. Results A total of 29,736 patients were included. Univariate and multivariate analyses suggested that age, race, gender, marriage, disease grade, AJCC stage, T-stage, surgery, radiotherapy, chemotherapy, and tumor size were independent risk factors for patient prognosis. These 11 variables were included in nomogram to predict OS and CSS of patients. C-indexes of OS for the training, validation and external validation sets were 0.730 (95% CI, 0.709-0.751), 0.734 (95% CI, 0.722-0.746), and 0.750 (95% CI, 0.734-0.766), respectively. The AUC results for the training and validation sets indicated good accuracy for this nomogram. The calibration curves demonstrated a high degree of concordance between actual and anticipated values, and the DCA demonstrated that the nomograms had better clinical application than the traditional TNM staging approach. Conclusion This study identified risk factors for survival in operable elderly lung cancer patients and established a new column line graph for predicting OS and CSS in these patients. The model has good clinical application and can be a good clinical decision-making tool for physicians and patients.
Collapse
Affiliation(s)
- Gen Yu
- Department of Oncology, Ganxi Cancer Hospital, Pingxiang, Jiangxi, China
| | - Xiaozhu Liu
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yunhe Li
- Department of Cardiothoracic Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yang Zhang
- College of Medical Informatics, Chongqing Medical University, Chongqing, China,Medical Data Science Academy, Chongqing Medical University, Chongqing, China
| | - Ruxin Yan
- Department of Oncology, The First Affiliated Hospital of Army Medical University, Chongqing, China
| | - Lingfeng Zhu
- Artificial Intelligence Laboratory, Pharnexcloud Digital Technology (Chengdu) Co., Ltd., Chengdu, China
| | - Zhongjian Wang
- Artificial Intelligence Laboratory, Pharnexcloud Digital Technology (Chengdu) Co., Ltd., Chengdu, China,*Correspondence: Zhongjian Wang
| |
Collapse
|
|
10
|
Khilafath HRAS, Ganesan B, Sekar N, Mohapatra D, Mahadevan P, Vellingiri J, Prakasarao A, Singaravelu G. Evaluation of photoneutron dose equivalent in 10 MV and 15 MV beams for wedge and open fields in the Elekta Versa HD linac. Appl Radiat Isot 2022; 188:110363. [PMID: 35863145 DOI: 10.1016/j.apradiso.2022.110363] [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: 12/05/2021] [Revised: 05/08/2022] [Accepted: 07/05/2022] [Indexed: 11/16/2022]
Abstract
In a high-energy medical linear accelerator (linac), if the interaction of photon energy is higher than the neutron binding energy of high atomic material, it emits a neutron field through a photonuclear reaction. The objective of this current study is to measure the photoneutron dose equivalent produces in a motorized wedge field and open field of 10 MV and 15 MV photon beams in Elekta Versa HD™ linac. The PNDE values were recorded at various positions along the patient plane using the Bubble Detector-Personal Neutron Dosimeter (BD-PND). The results revealed that the PNDE values are higher in 20 × 20 cm2 than 10 × 10 cm2 field sizes for both the 60° wedge and open fields of 10 MV and 15 MV beams. In addition, the 60° wedge fields generate higher photoneutron contamination when compared with the 45°, 30° wedge fields and open field sizes. Hence, on average PNDE values produced by the 15 MV beam were higher by a factor of 1.98 and 2.11 times for open and 60° wedge fields than the 10 MV beam, respectively.
Collapse
Affiliation(s)
| | - Bharanidharan Ganesan
- Department of Medical Physics, College of Engineering, Anna University, Chennai, 600025, Tamilnadu, India.
| | - Nandakumar Sekar
- Department of Medical Physics, College of Engineering, Anna University, Chennai, 600025, Tamilnadu, India
| | - Dinakrushna Mohapatra
- Reactor and Radiological Safety Section, Safety Research Institute-Atomic Energy Regulatory Board (SRI-AERB), Kalpakkam, 603102, Tamilnadu, India
| | - Pramod Mahadevan
- Department of Radiation Oncology, VPS Lakeshore Hospital, Kochi, 682040, Kerala, India
| | | | - Aruna Prakasarao
- Department of Medical Physics, College of Engineering, Anna University, Chennai, 600025, Tamilnadu, India
| | - Ganesan Singaravelu
- Department of Medical Physics, College of Engineering, Anna University, Chennai, 600025, Tamilnadu, India
| |
Collapse
|
|
11
|
Van Dao T, Diep TB, Le Phuong T, Huggenberger R, Kumar A. Real-World Treatment Patterns and Clinical Outcomes in Patients With Stage III Non-Small-Cell Lung Cancer: Results of KINDLE-Vietnam Cohort. Front Oncol 2022; 12:842296. [PMID: 35677172 PMCID: PMC9169691 DOI: 10.3389/fonc.2022.842296] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 04/13/2022] [Indexed: 12/24/2022] Open
Abstract
Objective KINDLE-Vietnam was a part of a real-world KINDLE study with an aim to characterise treatment patterns and clinical outcomes of patients with stage III non-small cell lung cancer (NSCLC). Materials and Methods Retrospective data from patients diagnosed with stage III NSCLC (American Joint Committee on Cancer, 7th edition) between January 2013 and December 2017 with at least 9 months of follow-up were collected from 2 centres in Vietnam. Descriptive statistics were used to summarise demographics, disease characteristics and treatment modalities. Kaplan-Meier methodology evaluated survival estimates; 2-sided 95% confidence intervals (CIs) were computed. Inferential statistics were used to correlate clinical and treatment variables with median progression-free survival (mPFS) and median overall survival (mOS). Results A total of 150 patients (median age: 60 years [range 26-82]) were enrolled; 75.3% were male, 62.0% had smoking history, 56.4% had stage IIIB disease and 62.5% had adenocarcinoma. The majority of the cases (97.3%) were not discussed at a multidisciplinary team meeting. Overall, chemotherapy alone (43.3%), radiotherapy alone (17.0%), sequential chemoradiation (13.5%) and concurrent chemoradiation (12.8%) were preferred as initial therapy. Surgery-based treatment was administered in limited patients (stage IIIA, 10%; stage IIIB, 1.3%). Palliative therapy was the most commonly administered treatment upon relapse in the second-and third-line setting. The mPFS and mOS for the Vietnam cohort were 8.7 months (95% CI, 7.59-9.72) and 25.7 months (95% CI, 19.98-42.61), respectively. The mPFS and mOS for stage IIIA were 11.9 months (95% CI, 8.64-14.95) and 28.2 months (95% CI, 24.15-not-calculable) and for stage IIIB were 7.8 months (95% CI, 6.64-8.71) and 20.0 months (95% CI, 13.01-42.61). Conclusions KINDLE-Vietnam offers insights into the clinical findings of stage III NSCLC. There is a high unmet need for identifying patients in the early stages of NSCLC. Strategies for improving clinical outcomes in this patient population include physician education, multidisciplinary management and catering to increased access to novel agents like immunotherapy and targeted therapy.
Collapse
Affiliation(s)
- Tu Van Dao
- Cancer Research and Clinical Trials Center, Vietnam National Cancer Hospital, Hanoi, Vietnam.,Oncology Department, Hanoi Medical University, Hanoi, Vietnam
| | - Tuan Bao Diep
- Ho Chi Minh City Oncology Hospital, Ho Chi Minh City, Vietnam
| | - Tri Le Phuong
- Medical Affairs, AstraZeneca Vietnam, Ho Chi Minh, Vietnam
| | | | - Amit Kumar
- Medical Affairs, AstraZeneca India, Bangalore, India
| |
Collapse
|
|
12
|
Parisi S, Lillo S, Cacciola A, Ferini G, Valenti V, Viola A, Santacaterina A, Platania A, Brogna A, Tamburella C, Pergolizzi S. Non-stereotactic radiotherapy in older cancer patients. Heliyon 2022; 8:e09593. [PMID: 35706953 PMCID: PMC9189877 DOI: 10.1016/j.heliyon.2022.e09593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 01/19/2022] [Accepted: 05/25/2022] [Indexed: 11/28/2022] Open
Abstract
Old or very old oncological patients represent a heterogeneous and frail population due to concomitant comorbidities. Whether radiotherapy alone or in combination with novel cancer drugs may provide a clear benefit in this setting of patients is still a matter of debate. The aim of our review is to analyze the evaluation process and the different therapeutic possibilities in older cancer patients, focusing on the different and most disparate applications of radiotherapy. We reviewed the most recent literature on radiotherapy in older patients providing clinical evidence of treatment related toxicity, tolerance and outcomes using standard fractionated and/or hypofractionated irradiation alone or in combination with chemotherapy, targeted and immunotherapy. In older cancer patients unfit for systemic therapy or surgery, radiotherapy represents a valid therapeutic approach, both with curative and palliative intents, ensuring excellent patient compliance in terms of local toxicity and adherence to therapy.
Collapse
Affiliation(s)
- Silvana Parisi
- Radiation Oncology Unit - Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Sara Lillo
- Radiation Oncology Unit - Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Alberto Cacciola
- Radiation Oncology Unit - Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Gianluca Ferini
- Radiation Oncology Unit - REM Radioterapia, Viagrande, Italy
| | - Vito Valenti
- Radiation Oncology Unit - REM Radioterapia, Viagrande, Italy
| | - Anna Viola
- Radiation Oncology Unit - REM Radioterapia, Viagrande, Italy
| | | | | | - Anna Brogna
- Medical Physics Unit, A.O.U. "G. Martino", Messina, Italy
| | - Consuelo Tamburella
- Radiation Oncology Unit - Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Stefano Pergolizzi
- Radiation Oncology Unit - Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina, Italy
| |
Collapse
|
|
13
|
Mayne NR, Bajaj SS, Powell J, Elser HC, Civiello BS, Fintelmann FJ, Li X, Yang CFJ. Extended Delay to Treatment for Stage III-IV Non-Small-Cell Lung Cancer and Survival: Balancing Risks During the COVID-19 Pandemic. Clin Lung Cancer 2022; 23:e362-e376. [PMID: 35660355 PMCID: PMC9068243 DOI: 10.1016/j.cllc.2022.05.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 04/28/2022] [Accepted: 05/01/2022] [Indexed: 12/17/2022]
Affiliation(s)
| | - Simar S Bajaj
- Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - Joseph Powell
- Case Western Reserve University School of Medicine, Cleveland, OH
| | - Holly C Elser
- Stanford University School of Medicine, Stanford, CA; Division of Epidemiology and Biostatistics, UC Berkeley School of Public Health, Berkeley, CA
| | | | | | - Xiao Li
- Case Western Reserve University School of Medicine, Cleveland, OH
| | - Chi-Fu Jeffrey Yang
- Department of Surgery, Massachusetts General Hospital, Boston, MA; Seacoast Cancer Center at Wentworth Douglass Hospital, Dover, NH.
| |
Collapse
|
|
14
|
Borghetti P, Guerini AE, Sangalli C, Piperno G, Franceschini D, La Mattina S, Arcangeli S, Filippi AR. Unmet needs in the management of unresectable stage III non-small cell lung cancer: a review after the 'Radio Talk' webinars. Expert Rev Anticancer Ther 2022; 22:549-559. [PMID: 35450510 DOI: 10.1080/14737140.2022.2069098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Stage III non-small cell lung cancer (NSCLC) is a variable entity, encompassing bulky primary tumors, nodal involvement or both. Multidisciplinary evaluation is essential to discuss multiple treatment options, to outline optimal management and to examine the main debated topics and critical issues not addressed by current trials and guidelines that influence daily clinical practice. AREAS COVERED From March to May 2021, 5 meetings were scheduled in a webinar format titled 'Radio Talk' due to the COVID-19 pandemic; the faculty was composed of 6 radiation oncologists from 6 different Institutions of Italy, all of them were the referring radiation oncologist for lung cancer treatment at their respective departments and were or had been members of AIRO (Italian Association of Radiation Oncology) Thoracic Oncology Study Group. The topics covered included: pulmonary toxicity, cardiac toxicity, radiotherapy dose, fractionation and volumes, unfit/elderly patients, multidisciplinary management. EXPERT OPINION The debate was focused on the unmet needs triggered by case reports, personal experiences and questions; the answers were often not univocal, however, the exchange of opinion and the contribution of different centers confirmed the role of multidisciplinary management and the necessity that the most critical issues should be investigated in clinical trials.
Collapse
Affiliation(s)
- Paolo Borghetti
- Department of Radiation Oncology, University and Spedali Civili Hospital, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - Andrea Emanuele Guerini
- Department of Radiation Oncology, University and Spedali Civili Hospital, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - Claudia Sangalli
- Department of Radiation Oncology 1, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Gaia Piperno
- Division of Radiotherapy, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Davide Franceschini
- Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Salvatore La Mattina
- Department of Radiation Oncology, University and Spedali Civili Hospital, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - Stefano Arcangeli
- Department of Radiation Oncology, School of Medicine and Surgery, University of Milan Bicocca, Milan, Italy
| | - Andrea Riccardo Filippi
- Department of Radiation Oncology, Fondazione IRCCS Policlinico San Matteo and University of Pavia, Pavia, Italy
| |
Collapse
|
|
15
|
Yang Y, Chen M, Xie J, Ji Y, Sheng L, Qiu G, Du X, Wei Q. Treatment Patterns and Outcomes of Elderly Patients With Potentially Curable Esophageal Cancer. Front Oncol 2022; 12:778898. [PMID: 35237508 PMCID: PMC8882918 DOI: 10.3389/fonc.2022.778898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 01/24/2022] [Indexed: 11/16/2022] Open
Abstract
Objectives The proportion of elderly patients with esophageal cancer (EC) is increasing due to prolonged life expectancy and aging process. The aim of the study is to explore the optimal treatment strategy for elderly patients (aged ≥70 years) with locally advanced EC. Methods Eligible patients with cT2-4aNxM0 EC were identified in the Surveillance, Epidemiology, and End Results database from 2010 to 2016. Treatment patterns were divided into six groups: surgical resection (S), chemoradiotherapy (CRT), trimodality therapy (CRT+S), radiotherapy (RT), chemotherapy (CT), or observation with no treatment (Obs). Survival between groups was compared using the log-rank test, and the Cox proportional hazards model was used to identify factors associated with overall survival (OS). Results A total of 2917 patients with potentially curable EC were identified. Of all the patients included, 6.7%, 51.8%, 18.0%, 9.4% and 3.6%received S, CRT, CRT+S, RT, and CT, respectively, whereas 10.6% underwent Obs. The 3-year OS estimates were 30.2% (95% confidence interval [CI]: 23.5–38.9%), 25.4% (95% CI: 22.8–28.3%),44.3% (95% CI: 39.3–49.9%), 11.4% (95% CI: 7.7–17.0%), 16.1% (95% CI: 9.1–28.3%), and 5.6% (95% CI: 3.2–9.8%) for S, CRT, CRT+S RT, CT, and Obs (p<0.001), respectively. Overall, patents underwent CRT+S had the longest OS, compared to other treatment patterns, and the survival difference was not significant between patients receiving CRT and S (p=0.12) in the elderly population. However, the survival benefits of trimodality therapy over CRT gradually weakened with the increase in age, and became statistically non-significant for EC patients aged ≥80 years (p=0.35). Multivariate analysis showed that treatment patterns, age, sex, tumor grade, T stage, N stage, and marital status were significantly associated with OS. Conclusion Generally, the use of trimodality therapy was associated with the longest OS, the survival benefits were comparable between CRT and S alone, and CRT was superior to RT or CT alone in elderly patients with curable EC. For patients intolerable to surgery or aged ≥80 years, definitive CRT should be considered as a preferable option.
Collapse
Affiliation(s)
- Yang Yang
- Department of Radiation Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Department of Thoracic Radiotherapy, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, China
- Zhejiang Key Laboratory of Radiation Oncology, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, China
| | - Mengyuan Chen
- Department of Thoracic Radiotherapy, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, China
- Zhejiang Key Laboratory of Radiation Oncology, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, China
| | - Jiping Xie
- Department of Radiation Oncology, Yuyao People’s Hospital, Ningbo, China
| | - Yongling Ji
- Department of Thoracic Radiotherapy, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, China
- Zhejiang Key Laboratory of Radiation Oncology, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, China
| | - Liming Sheng
- Department of Thoracic Radiotherapy, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, China
- Zhejiang Key Laboratory of Radiation Oncology, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, China
| | - Guoqin Qiu
- Department of Thoracic Radiotherapy, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, China
- Zhejiang Key Laboratory of Radiation Oncology, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, China
| | - Xianghui Du
- Department of Thoracic Radiotherapy, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, China
- Zhejiang Key Laboratory of Radiation Oncology, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, China
| | - Qichun Wei
- Department of Radiation Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- *Correspondence: Qichun Wei,
| |
Collapse
|
|
16
|
Yang Y, Zhang T, Zhou Z, Liang J, Chen D, Feng Q, Xiao Z, Hui Z, Lv J, Deng L, Wang X, Wang W, Wang J, Liu W, Zhai Y, Wang J, Bi N, Wang L. Development and validation of a prediction model using molecular marker for long-term survival in unresectable stage III non-small cell lung cancer treated with chemoradiotherapy. Thorac Cancer 2021; 13:296-307. [PMID: 34927371 PMCID: PMC8807329 DOI: 10.1111/1759-7714.14218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 10/18/2021] [Accepted: 10/19/2021] [Indexed: 12/28/2022] Open
Abstract
Background This study aimed to establish a predictive nomogram integrating epidermal growth factor receptor (EGFR) mutation status for 3‐ and 5‐year overall survival (OS) in unresectable/inoperable stage III non‐small cell lung cancer (NSCLC) treated with definitive chemoradiotherapy. Methods A total of 533 stage III NSCLC patients receiving chemoradiotherapy from 2013 to 2017 in our institution were included and divided into training and testing sets (2:1). Significant factors impacting OS were identified in the training set and integrated into the nomogram based on Cox proportional hazards regression. The model was subject to bootstrap internal validation and external validation within the testing set and an independent cohort from a phase III trial. The accuracy and discriminative capacity of the model were examined by calibration plots, C‐indexes and risk stratifications. Results The final multivariate model incorporated sex, smoking history, histology (including EGFR mutation status), TNM stage, planning target volume, chemotherapy sequence and radiation pneumonitis grade. The bootstrapped C‐indexes in the training set were 0.688, 0.710 for the 3‐ and 5‐year OS. For external validation, C‐indexes for 3‐ and 5‐year OS were 0.717, 0.720 in the testing set and 0.744, 0.699 in the external testing cohort, respectively. The calibration plots presented satisfying accuracy. The derivative risk stratification strategy classified patients into distinct survival subgroups successfully and performed better than the traditional TNM staging. Conclusions The nomogram incorporating EGFR mutation status could facilitate survival prediction and risk stratification for individual stage III NSCLC, providing information for enhanced immunotherapy decision and future trial design.
Collapse
Affiliation(s)
- Yufan Yang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Tao Zhang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zongmei Zhou
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jun Liang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Dongfu Chen
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qinfu Feng
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zefen Xiao
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhouguang Hui
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jima Lv
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lei Deng
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xin Wang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wenqing Wang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jianyang Wang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wenyang Liu
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yirui Zhai
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jie Wang
- State Key Laboratory of Molecular Oncology, Department of Medical Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Nan Bi
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Luhua Wang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,Department of Radiation Oncology, National Cancer Center/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China
| |
Collapse
|
|
17
|
Concurrent Chemoradiation With or Without Durvalumab in Elderly Patients With Unresectable Stage III NSCLC: Safety and Efficacy. JTO Clin Res Rep 2021; 2:100251. [PMID: 34917991 PMCID: PMC8665356 DOI: 10.1016/j.jtocrr.2021.100251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 10/04/2021] [Accepted: 10/26/2021] [Indexed: 12/02/2022] Open
Abstract
Introduction The addition of durvalumab after chemoradiation therapy (CRT) in unresectable stage III NSCLC significantly improves survival. The benefit of this approach in elderly patients is controversial given the toxicity associated with CRT and, thus, may be underutilized. We sought to investigate the outcomes of elderly patients treated with CRT without or without durvalumab at our center. Methods We reviewed all stage III patients with NSCLC treated with CRT between 2018 and 2020. Patients were analyzed on the basis of age: less than 70 years and 70 years and older. The end points evaluated were treatment patterns, toxicity, progression-free survival, and overall survival. Results The baseline characteristics including Eastern Cooperative Oncology Group performance status and comorbidities were similar among the 115 patients (44 elderly, 71 young). Completion rates of CRT (100%, 97%) and chemotherapy dose intensity (97%, 97%) were high in elderly and young patients, respectively. There was a trend toward increased hospitalizations in elderly patients because of infections (27% versus 13%, p = 0.08). Of those who did not have primary progression after CRT, 78% of eldery and 81% of young patients received durvalumab. The incidence of grade 3 or higher immune-related adverse events was 9% in elderly and 6% in young patients (p = 0.67). The median progression-free survival was similar (15.6 versus 10.5 mo, p = 0.10), even after adjusting for comorbidities (hazard ratio = 0.6, p = 0.09). The 12-month overall survival rates were 78% in the elderly and 76% in young patients (p = 0.98). Conclusions Well-selected elderly patients can be treated safely with CRT followed by durvalumab with similar survival benefits compared with their younger counterparts. We would advocate for the referral of all elderly patients for oncologic assessment to avoid undertreatment.
Collapse
|
|
18
|
Zaborowska-Szmit M, Olszyna-Serementa M, Kowalski DM, Szmit S, Krzakowski M. Elderly Patients with Locally Advanced and Unresectable Non-Small-Cell Lung Cancer May Benefit from Sequential Chemoradiotherapy. Cancers (Basel) 2021; 13:cancers13184534. [PMID: 34572760 PMCID: PMC8466795 DOI: 10.3390/cancers13184534] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 09/01/2021] [Accepted: 09/06/2021] [Indexed: 12/25/2022] Open
Abstract
Simple Summary The combination of chemotherapy and radiotherapy, compared with radiotherapy alone, reduces the risk of local disease recurrence and the risk of distant metastases in patients with locally advanced unresectable non-small-cell lung cancer. Concurrent chemoradiotherapy is the most effective but also has the highest risk of toxicity. Older patients often have comorbidities and a reduced cardio-pulmonary capacity; therefore, they are less often qualified for concurrent chemoradiotherapy due to the predicted too high toxicity. The study documents the sense of considering sequential chemoradiotherapy in the elderly, regardless of whether they are in a good performance status and how many concomitant diseases were recognized earlier in their history. Compared to younger patients, the elderly benefit more from sequential chemoradiotherapy, because with the same toxicity, complete response is achieved more often and distant metastases are less frequently observed, which translates into a significantly longer survival. Abstract Concurrent chemoradiotherapy is recommended for locally advanced and unresectable non-small-cell lung cancer (NSCLC), but radiotherapy alone may be used in patients that are ineligible for combined-modality therapy due to poor performance status or comorbidities, which may concern elderly patients in particular. The best candidates for sequential chemoradiotherapy remain undefined. The purpose of the study was to determine the importance of a patients’ age during qualification for sequential chemoradiotherapy. The study enrolled 196 patients. Older patients (age > 65years) more often had above the median Charlson Comorbidity Index CCI > 4 (p < 0.01) and Simplified Charlson Comorbidity Index SCCI > 8 (p = 0.03), and less frequently the optimal Karnofsky Performance Score KPS = 100 (p < 0.01). There were no significant differences in histological diagnoses, frequency of stage IIIA/IIIB, weight loss, or severity of smoking between older and younger patients. Older patients experienced complete response more often (p = 0.01) and distant metastases less frequently (p = 0.03). Univariable analysis revealed as significant for overall survival: age > 65years (HR = 0.66; p = 0.02), stage IIIA (HR = 0.68; p = 0.01), weight loss > 10% (HR = 1.61; p = 0.04). Multivariable analysis confirmed age > 65years as a uniquely favorable prognostic factor (HR = 0.54; p < 0.01) independent of lung cancer disease characteristics, KPS = 100, CCI > 4, SCCI > 8. Sequential chemoradiotherapy may be considered as favorable in elderly populations.
Collapse
Affiliation(s)
- Magdalena Zaborowska-Szmit
- Department of Lung Cancer and Thoracic Tumors, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (M.Z.-S.); (M.O.-S.); (D.M.K.); (M.K.)
| | - Marta Olszyna-Serementa
- Department of Lung Cancer and Thoracic Tumors, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (M.Z.-S.); (M.O.-S.); (D.M.K.); (M.K.)
| | - Dariusz M. Kowalski
- Department of Lung Cancer and Thoracic Tumors, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (M.Z.-S.); (M.O.-S.); (D.M.K.); (M.K.)
| | - Sebastian Szmit
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre, 05-400 Otwock, Poland
- Correspondence:
| | - Maciej Krzakowski
- Department of Lung Cancer and Thoracic Tumors, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (M.Z.-S.); (M.O.-S.); (D.M.K.); (M.K.)
| |
Collapse
|
|
19
|
Stemness-Suppressive Effect of Bibenzyl from Dendrobium ellipsophyllum in Human Lung Cancer Stem-Like Cells. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021; 2021:5516655. [PMID: 34349823 PMCID: PMC8328707 DOI: 10.1155/2021/5516655] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 07/15/2021] [Indexed: 12/17/2022]
Abstract
Cancer stem-like cells (CSCs) are key mediators driving tumor initiation, metastasis, therapeutic failure, and subsequent cancer relapse. Thus, targeting CSCs has recently emerged as a potential strategy to improve chemotherapy. In this study, the anticancer activity and stemness-regulating capacity of 4,5,4'-trihydroxy-3,3'-dimethoxybibenzyl (TDB), a bibenzyl extracted from Dendrobium ellipsophyllum, are revealed in CSCs of various human lung cancer cells. Culture with TDB (5-10 μM) strongly abolished tumor-initiating cells in lung cancer H460, H23, and A549 cells in both anchorage-dependent and anchorage-independent colony formation assays. Through the 3D single-spheroid formation model, attenuation of self-renewal capacity was observed in CSC-enriched populations treated with 1-10 μM TDB for 7 days. Flow cytometry analysis confirmed the attenuation of %cell overexpressing CD133, a CSC biomarker, in TDB-treated lung cancer spheroids. TDB at 5-10 μM remarkably suppressed regulatory signals of p-Akt/Akt, p-GSK3β/GSK3β, and β-catenin corresponding to the downregulated mRNA level of stemness transcription factors including Nanog, Oct4, and Sox2. Moreover, the antiapoptosis Bcl-2 and Mcl-1 proteins, which are downstream molecules of Akt signaling, were evidently decreased in CSC-enriched spheroids after culture with TDB (1-10 μM) for 24 h. Interestingly, the diminution of Akt expression by specific siAkt effectively reversed suppressive activity of TDB targeting on the CSC phenotype in human lung cancer cells. These findings provide promising evidence of the inhibitory effect of TDB against lung CSCs via suppression of Akt/GSK3β/β-catenin cascade and related proteins, which would facilitate the development of this bibenzyl natural compound as a novel CSC-targeted therapeutic approach for lung cancer treatment.
Collapse
|
|
20
|
Ronden MI, Bahce I, Claessens NJ, Barlo N, Dahele MR, Daniels JM, Tissing-Tan C, Hekma E, Hashemi SM, van der Wel A, Spoelstra FO, Verbakel WFR, Tiemessen MA, van Laren M, Becker A, Tarasevych S, Haasbeek CJ, Maassen van den Brink K, Dickhoff C, Senan S. The Impact of the Availability of Immunotherapy on Patterns of Care in Stage III NSCLC: A Dutch Multicenter Analysis. JTO Clin Res Rep 2021; 2:100195. [PMID: 34590040 PMCID: PMC8474425 DOI: 10.1016/j.jtocrr.2021.100195] [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: 02/02/2021] [Revised: 05/02/2021] [Accepted: 05/25/2021] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Treatment patterns in stage III NSCLC can vary considerably between countries. The PACIFIC trial reported improvements in progression-free and overall survival with adjuvant durvalumab after concurrent chemoradiotherapy (CCRT). We studied treatment decision-making by three Dutch regional thoracic multidisciplinary tumor boards between 2015 and 2019, to identify changes in practice when adjuvant durvalumab became available. METHODS Details of patients presenting with stage III NSCLC were retrospectively collected. Both CCRT and multimodality schemes incorporating planned surgery were defined as being radical-intent treatment (RIT). RESULTS Of 855 eligible patients, most (95%) were discussed at a thoracic multidisciplinary tumor board, which recommended a RIT in 63% (n = 510). Only 52% (n = 424) of the patients finally received a RIT. Predictors for not recommending RIT were age greater than or equal to 70 years, WHO performance score greater than or equal to 2, Charlson comorbidity index greater than or equal to 2 (excluding age), forced expiratory volume in 1 second less than 80% of predicted value, N3 disease, and period of diagnosis. Between 2015 to 2017 and 2018 to 2019, the proportion of patients undergoing CCRT increased from 34% to 42% (p = 0.02) and use of sequential chemoradiotherapy declined (21%-16%, p = 0.05). Rates of early toxicity and 1-year mortality were comparable for both periods. After 2018, 57% of the patients who underwent CCRT (90 of 159) received adjuvant durvalumab. CONCLUSIONS After publication of the PACIFIC trial, a significant increase was observed in the use of CCRT for patients with stage III NSCLC with rates of early toxicity and mortality being unchanged. Since 2018, 57% of the patients undergoing CCRT went on to receive adjuvant durvalumab. Nevertheless, approximately half of the patients were still considered unfit for a RIT.
Collapse
Affiliation(s)
- Merle I. Ronden
- Department of Radiation Oncology, Amsterdam UMC, Amsterdam, the Netherlands
- Department of Pulmonology, Amsterdam UMC, Amsterdam, the Netherlands
| | - Idris Bahce
- Department of Pulmonology, Amsterdam UMC, Amsterdam, the Netherlands
| | | | - Nicole Barlo
- Department of Pulmonology, Noordwest Ziekenhuisgroep, Alkmaar, the Netherlands
| | - Max R. Dahele
- Department of Radiation Oncology, Amsterdam UMC, Amsterdam, the Netherlands
| | | | | | - Edo Hekma
- Department of Surgery, Rijnstate Ziekenhuis, Arnhem, the Netherlands
| | | | | | | | | | - Marian A. Tiemessen
- Department of Pulmonology, Dijklander Ziekenhuis, Hoorn & Purmerend, the Netherlands
| | - Marjolein van Laren
- Department of Pulmonology, Dijklander Ziekenhuis, Hoorn & Purmerend, the Netherlands
| | - Annemarie Becker
- Department of Pulmonology, Amsterdam UMC, Amsterdam, the Netherlands
| | | | | | | | - Chris Dickhoff
- Department of Surgery, Amsterdam UMC, Amsterdam, the Netherlands
| | - Suresh Senan
- Department of Radiation Oncology, Amsterdam UMC, Amsterdam, the Netherlands
| |
Collapse
|
|
21
|
Pilleron S, Maringe C, Charvat H, Atkinson J, Morris E, Sarfati D. Age disparities in lung cancer survival in New Zealand: The role of patient and clinical factors. Lung Cancer 2021; 157:92-99. [PMID: 34006378 DOI: 10.1016/j.lungcan.2021.05.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 05/05/2021] [Accepted: 05/10/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Age is an important prognostic factor for lung cancer. However, no studies have investigated the age difference in lung cancer survival per se. We, therefore, described the role of patient-related and clinical factors on the age pattern in lung cancer excess mortality hazard by stage at diagnosis in New Zealand. MATERIALS AND METHODS We extracted 22 487 new lung cancer cases aged 50-99 (median age = 71, 47.1 % females) diagnosed between 1 January 2006 and 31 July 2017 from the New Zealand population-based cancer registry and followed up to December 2019. We modelled the effect of age at diagnosis, sex, ethnicity, deprivation, comorbidity, and emergency presentation on the excess mortality hazard by stage at diagnosis, and we derived corresponding lung cancer net survival. RESULTS The age difference in net survival was particularly marked for localised and regional lung cancers, with a sharp decline in survival from the age of 70. No identified factors influenced age disparities in patients with localised cancer. However, for other stages, females had a greater difference in survival between middle-age and older-age than males. Comorbidity and emergency presentation played a minor role. Ethnicity and deprivation did not influence age disparities in lung cancer survival. CONCLUSION Sex and stage at diagnosis were the most important factors of age disparities in lung cancer survival in New Zealand.
Collapse
Affiliation(s)
- Sophie Pilleron
- Department of Public Health, University of Otago, PO Box 7343, Wellington, New Zealand; Nuffield Department of Population Health, University of Oxford, Big Data Institute, Old Road Campus, Oxford, OX3 7LF, UK.
| | - Camille Maringe
- Inequalities in Cancer Outcomes Network, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | - Hadrien Charvat
- Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan; Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France.
| | - June Atkinson
- Department of Public Health, University of Otago, PO Box 7343, Wellington, New Zealand.
| | - Eva Morris
- Nuffield Department of Population Health, University of Oxford, Big Data Institute, Old Road Campus, Oxford, OX3 7LF, UK. https://www.twitter.com/EJAMorris
| | - Diana Sarfati
- Department of Public Health, University of Otago, PO Box 7343, Wellington, New Zealand. https://www.twitter.com/DiSarfati
| |
Collapse
|
|
22
|
Miller ED, Nalin AP, Diaz Pardo DA, Arnett AL, Huang E, Gasior AC, Malalur P, Chen HZ, Williams TM, Bazan JG. Disparate Use of Chemoradiation in Elderly Patients With Localized Anal Cancer. J Natl Compr Canc Netw 2021; 20:644-652.e2. [PMID: 34111839 DOI: 10.6004/jnccn.2020.7691] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 11/30/2020] [Indexed: 01/20/2023]
Abstract
BACKGROUND The incidence of squamous cell carcinoma of the anus (SCCA) is increasing, particularly among the elderly (age ≥65 years). We sought to compare patterns of care for the treatment of SCCA in elderly versus nonelderly patients. METHODS Data for patients with stages I-III SCCA diagnosed from 2004 through 2015 were obtained from the National Cancer Database. Patients were categorized as having received standard-of-care (SOC) chemoradiation (CRT) with multiagent chemotherapy, non-SOC therapy, palliative therapy, or no treatment. Differences in treatment groups were tested using the chi-square test. We used logistic regression to identify predictors of SOC CRT and multiagent versus single-agent chemotherapy in patients receiving CRT. Propensity score matching was used to compare overall survival (OS) in elderly patients receiving multiagent versus single-agent chemotherapy for those receiving CRT. RESULTS We identified 9,156 elderly and 17,640 nonelderly patients. A lower proportion of elderly versus nonelderly patients (54.5% vs 65.0%; P<.0001) received SOC CRT than other treatments or no treatment. In multivariate analysis, elderly patients were 38% less likely than nonelderly patients to receive SOC CRT (odds ratio, 0.62; 95% CI, 0.58-0.65; P<.0001). A higher proportion of the elderly were treated with single-agent versus multiagent chemotherapy (16.9% vs 11.8%; P<.0001), which resulted in a >1.5-fold increase in the likelihood of elderly patients receiving single-agent chemotherapy (odds ratio, 1.52; 95% CI, 1.39-1.66) in multivariate analysis. After propensity score matching, 3-year OS was higher in elderly patients who received CRT with multiagent versus single-agent chemotherapy (77.1% vs 67.5%; hazard ratio, 0.78; 95% CI, 0.68-0.89; P=.0002). CONCLUSIONS In this comprehensive study of patients with stages I-III SCCA, elderly patients were less likely than nonelderly patients to receive SOC CRT. The low proportion of elderly patients receiving SOC CRT with multiagent chemotherapy for localized anal cancer suggests that the optimal treatment approach for this vulnerable population remains undefined.
Collapse
Affiliation(s)
| | | | | | | | - Emily Huang
- 2Department of Colon and Rectal Surgery, and
| | | | - Pannaga Malalur
- 3Department of Internal Medicine, Division of Medical Oncology, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Hui-Zi Chen
- 3Department of Internal Medicine, Division of Medical Oncology, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | | | | |
Collapse
|
|
23
|
Jazieh AR, Onal HC, Tan DSW, Soo RA, Prabhash K, Kumar A, Huggenberger R, Robb S, Cho BC. Real-World Treatment Patterns and Clinical Outcomes in Patients With Stage III NSCLC: Results of KINDLE, a Multicountry Observational Study. J Thorac Oncol 2021; 16:1733-1744. [PMID: 34051381 DOI: 10.1016/j.jtho.2021.05.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 05/11/2021] [Accepted: 05/12/2021] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Stage III NSCLC is a heterogeneous disease requiring a multimodal management approach. We conducted a real-world, global study to characterize patients, treatment patterns, and their associated clinical outcomes for stage III NSCLC. METHODS KINDLE was a retrospective study in patients with stage III NSCLC (American Joint Committee on Cancer, seventh edition) diagnosed between January 2013 and December 2017, with at least 9 months of documented follow-up since index diagnosis. In addition to descriptive statistics, Kaplan-Meier methodology evaluated survival estimates; two-sided 95% confidence interval was computed. Cox proportional hazards model was used for univariate and multivariate analyses. RESULTS A total of 3151 patients from more than 100 centers across 19 countries from Asia, Middle East, Africa, and Latin America were enrolled. Median age was 63.0 years (range: 21.0-92.0); 76.5% were males, 69.2% had a smoking history, 53.7% had adenocarcinoma, and 21.4% underwent curative resection. Of greater than 25 treatment regimens, concurrent chemoradiotherapy was the most common (29.4%). The overall median progression-free survival (95% confidence interval) and median overall survival (mOS) were 12.5 months (12.06-13.14) and 34.9 months (32.00-38.01), respectively. Significant associations (p < 0.05) were observed for median progression-free survival and mOS with respect to sex, region, smoking status, stage, histology, and Eastern Cooperative Oncology Group status. In univariate and multivariate analyses, younger age, stage IIIA, better Eastern Cooperative Oncology Group status, concurrent chemoradiotherapy, and surgery as initial therapy predicted better mOS. CONCLUSIONS KINDLE reveals the diversity in treatment practices and outcomes in stage III NSCLC in a real-world setting in the preimmuno-oncology era. There is a high unmet medical need, necessitating novel approaches to optimize outcomes.
Collapse
Affiliation(s)
- Abdul Rahman Jazieh
- Department of Oncology, King Abdulaziz Medical City, King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia.
| | - Huseyin Cem Onal
- Department of Radiation Oncology, Adana Dr. Turgut Noyan Research and Treatment Centre, Baskent University Faculty of Medicine, Adana, Turkey
| | - Daniel Shao Weng Tan
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Ross A Soo
- Department of Haematology-Oncology, National University Cancer Institute, Singapore, Singapore
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | | | | | | | - Byoung-Chul Cho
- Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea
| |
Collapse
|
|
24
|
Finazzi T, Schneiders FL, Senan S. Developments in radiation techniques for thoracic malignancies. Eur Respir Rev 2021; 30:30/160/200224. [PMID: 33952599 DOI: 10.1183/16000617.0224-2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 10/27/2020] [Indexed: 12/25/2022] Open
Abstract
Radiation therapy is a cornerstone of modern lung cancer treatment alongside surgery, chemotherapy, immunotherapy and targeted therapies. Advances in radiotherapy techniques have enhanced the accuracy of radiation delivery, which has contributed to the evolution of radiation therapy into a guideline-recommended treatment in both early-stage and locally advanced nonsmall cell lung cancer. Furthermore, although radiotherapy has long been used for palliation of disease in advanced lung cancer, it is increasingly having a role as a locally ablative treatment in patients with oligometastatic disease.This review provides an overview of recent developments in radiation techniques, particularly for non-radiation oncologists who are involved in the care of lung cancer patients. Technical advances are discussed, and findings of recent clinical trials are highlighted, all of which have led to a changing perception of the role of radiation therapy in multidisciplinary care.
Collapse
Affiliation(s)
- Tobias Finazzi
- Clinic of Radiotherapy and Radiation Oncology, University Hospital Basel, Basel, Switzerland
| | - Famke L Schneiders
- Dept of Radiation Oncology, Amsterdam University Medical Centers, Location VUmc, Amsterdam, The Netherlands
| | - Suresh Senan
- Dept of Radiation Oncology, Amsterdam University Medical Centers, Location VUmc, Amsterdam, The Netherlands
| |
Collapse
|
|
25
|
Poon DJJ, Tay LM, Ho D, Chua MLK, Chow EKH, Yeo ELL. Improving the therapeutic ratio of radiotherapy against radioresistant cancers: Leveraging on novel artificial intelligence-based approaches for drug combination discovery. Cancer Lett 2021; 511:56-67. [PMID: 33933554 DOI: 10.1016/j.canlet.2021.04.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 04/14/2021] [Accepted: 04/25/2021] [Indexed: 12/15/2022]
Abstract
Despite numerous advances in cancer radiotherapy, tumor radioresistance remain one of the major challenges limiting treatment efficacy of radiotherapy. Conventional strategies to overcome radioresistance involve understanding the underpinning molecular mechanisms, and subsequently using combinatorial treatment strategies involving radiation and targeted drug combinations against these radioresistant tumors. These strategies exploit and target the molecular fingerprint and vulnerability of the radioresistant clones to achieve improved efficacy in tumor eradication. However, conventional drug-screening approaches for the discovery of new drug combinations have been proven to be inefficient, limited and laborious. With the increasing availability of computational resources in recent years, novel approaches such as Quadratic Phenotypic Optimization Platform (QPOP), CURATE.AI and Drug Combination and Prediction and Testing (DCPT) platform have emerged to aid in drug combination discovery and the longitudinally optimized modulation of combination therapy dosing. These platforms could overcome the limitations of conventional screening approaches, thereby facilitating the discovery of more optimal drug combinations to improve the therapeutic ratio of combinatorial treatment. The use of better and more accurate models and methods with rapid turnover can thus facilitate a rapid translation in the clinic, hence, resulting in a better patient outcome. Here, we reviewed the clinical observations, molecular mechanisms and proposed treatment strategies for tumor radioresistance and discussed how novel approaches may be applied to enhance drug combination discovery, with the aim to further improve the therapeutic ratio and treatment efficacy of radiotherapy against radioresistant cancers.
Collapse
Affiliation(s)
- Dennis Jun Jie Poon
- Division of Radiation Oncology, National Cancer Centre Singapore, 11 Hospital Crescent, 169610, Singapore.
| | - Li Min Tay
- Cancer Science Institute, Yong Loo Lin School of Medicine, National University of Singapore, 117599, Singapore.
| | - Dean Ho
- The N.1 Institute of Health (N.1), National University of Singapore, 117456, Singapore; Department of Bioengineering, National University of Singapore, 117583, Singapore; Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, 117597, Singapore; The Institute for Digital Medicine (WisDM), Yong Loo Lin School of Medicine, National University of Singapore, 117456, Singapore.
| | - Melvin Lee Kiang Chua
- Division of Radiation Oncology, National Cancer Centre Singapore, 11 Hospital Crescent, 169610, Singapore; Division of Medical Sciences, National Cancer Centre Singapore, 11 Hospital Crescent, 169610, Singapore; Oncology Academic Clinical Program, Duke-NUS Medical School, 8 College Road, 169857, Singapore.
| | - Edward Kai-Hua Chow
- Cancer Science Institute, Yong Loo Lin School of Medicine, National University of Singapore, 117599, Singapore; The N.1 Institute of Health (N.1), National University of Singapore, 117456, Singapore; Department of Bioengineering, National University of Singapore, 117583, Singapore; Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, 117597, Singapore; The Institute for Digital Medicine (WisDM), Yong Loo Lin School of Medicine, National University of Singapore, 117456, Singapore.
| | - Eugenia Li Ling Yeo
- Division of Medical Sciences, National Cancer Centre Singapore, 11 Hospital Crescent, 169610, Singapore.
| |
Collapse
|
|
26
|
Łazar-Poniatowska M, Bandura A, Dziadziuszko R, Jassem J. Concurrent chemoradiotherapy for stage III non-small-cell lung cancer: recent progress and future perspectives (a narrative review). Transl Lung Cancer Res 2021; 10:2018-2031. [PMID: 34012811 PMCID: PMC8107727 DOI: 10.21037/tlcr-20-704] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Concurrent chemoradiotherapy (CHRT) remains the therapeutic standard for locally advanced inoperable non-small-cell lung cancer (NSCLC). The median overall survival (OS) with this approach is in the range of 20–30 months, with five-year survival of approximately 30%. These outcomes have recently been further improved by supplementing CHRT with maintenance durvalumab, a monoclonal anti-PD-L1 agent. The progress in treatment outcomes of locally advanced NSCLC before the era of immunotherapy has been achieved mainly by virtue of developments in diagnostics and radiotherapy techniques. Routine implementation of endoscopic and endobronchial ultrasonography for mediastinal lymph nodes assessment, positron emission tomography/computed tomography and magnetic resonance imaging of the brain allows for more accurate staging of NSCLC and for optimizing treatment strategy. Thorough staging and respiratory motion control allows for higher conformity of radiotherapy and reduction of radiotherapy related toxicity. Dose escalation with prolonged overall treatment time does not improve treatment outcomes of CHRT. In consequence, 60 Gy in 2 Gy fractions or equivalent biological dose remains the standard dose for definitive CHRT in locally advanced NSCLC. However, owing to increased toxicity of CHRT, this option may not be applicable in a proportion of elderly or frail patients. This article summarizes recent developments in curative CHRT for inoperable stage III NSCLC, and presents perspectives for further improvements of this strategy
Collapse
Affiliation(s)
| | - Artur Bandura
- Department of Oncology and Radiotherapy, Medical University of Gdańsk, Gdańsk, Poland
| | - Rafał Dziadziuszko
- Department of Oncology and Radiotherapy, Medical University of Gdańsk, Gdańsk, Poland
| | - Jacek Jassem
- Department of Oncology and Radiotherapy, Medical University of Gdańsk, Gdańsk, Poland
| |
Collapse
|
|
27
|
Hayashi K, Yamamoto N, Nakajima M, Nomoto A, Ishikawa H, Ogawa K, Tsuji H. Carbon-ion radiotherapy for octogenarians with locally advanced non-small-cell lung cancer. Jpn J Radiol 2021; 39:703-709. [PMID: 33608792 PMCID: PMC8255258 DOI: 10.1007/s11604-021-01101-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 02/03/2021] [Indexed: 01/14/2023]
Abstract
PURPOSE The clinical significance of carbon-ion radiotherapy (CIRT) for octogenarians with locally advanced non-small-cell lung cancer (LA-NSCLC) remains unclear. We aimed to evaluate the clinical outcomes of CIRT alone for octogenarians with LA-NSCLC. MATERIALS AND METHODS We evaluated 32 patients who underwent CIRT alone between 1997 and 2015. The median age was 82.0 years (range, 80-88 years). In terms of clinical stage (UICC 7th edition), 7 (21.9%), 10 (31.3%), 11 (34.4%), and 4 (12.5%) patients had stage IIA, IIB, IIIA, and ΙΙΙB disease, respectively. The median CIRT dose was 72.0 Gy (relative biological effectiveness), and the median follow-up period was 33.1 months. RESULTS All patients successfully completed CIRT. Regarding grade ≥ 2 toxicities, 1 (3.1%), 3 (9.4%), and 4 (0.7%) patients developed grade 3 radiation pneumonitis, grade 2 radiation pneumonitis, and grade 2 dermatitis, respectively. No grade ≥ 4 toxicities were observed. The 2 year LC, PFS, and OS rates were 83.5%, 46.7%, and 68.0%, respectively. CONCLUSION CIRT alone is safe and effective for octogenarians with LA-NSCLC.
Collapse
Affiliation(s)
- Kazuhiko Hayashi
- QST Hospital, National Institutes for Quantum and Radiological Sciences and Technology, 4-9-1 Anagawa, Inage-ku, Chiba, 263-8555, Japan
- Department of Radiation Oncology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, Japan
| | - Naoyoshi Yamamoto
- QST Hospital, National Institutes for Quantum and Radiological Sciences and Technology, 4-9-1 Anagawa, Inage-ku, Chiba, 263-8555, Japan.
| | - Mio Nakajima
- QST Hospital, National Institutes for Quantum and Radiological Sciences and Technology, 4-9-1 Anagawa, Inage-ku, Chiba, 263-8555, Japan
| | - Akihiro Nomoto
- QST Hospital, National Institutes for Quantum and Radiological Sciences and Technology, 4-9-1 Anagawa, Inage-ku, Chiba, 263-8555, Japan
| | - Hitoshi Ishikawa
- QST Hospital, National Institutes for Quantum and Radiological Sciences and Technology, 4-9-1 Anagawa, Inage-ku, Chiba, 263-8555, Japan
| | - Kazuhiko Ogawa
- Department of Radiation Oncology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, Japan
| | - Hiroshi Tsuji
- QST Hospital, National Institutes for Quantum and Radiological Sciences and Technology, 4-9-1 Anagawa, Inage-ku, Chiba, 263-8555, Japan
| |
Collapse
|
|
28
|
Conibear J. Rationale for concurrent chemoradiotherapy for patients with stage III non-small-cell lung cancer. Br J Cancer 2020; 123:10-17. [PMID: 33293671 PMCID: PMC7735212 DOI: 10.1038/s41416-020-01070-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
When treating patients with unresectable stage III non-small-cell lung cancer (NSCLC), those with a good performance status and disease measured within a radical treatment volume should be considered for definitive concurrent chemoradiotherapy (cCRT). This guidance is based on key scientific rationale from two large Phase 3 randomised studies and meta-analyses demonstrating the superiority of cCRT over sequential (sCRT). However, the efficacy of cCRT comes at the cost of increased acute toxicity versus sequential treatment. Currently, there are several documented approaches that are addressing this drawback, which this paper outlines. At the point of diagnosis, a multidisciplinary team (MDT) approach can enable accurate assessment of patients, to determine the optimal treatment strategy to minimise risks. In addition, reviewing the Advisory Committee on Radiation Oncology Practice (ACROP) guidelines can provide clinical oncologists with additional recommendations for outlining target volume and organ-at-risk delineation for standard clinical scenarios in definitive cCRT (and adjuvant radiotherapy). Furthermore, modern advances in radiotherapy treatment planning software and treatment delivery mean that radiation oncologists can safely treat substantially larger lung tumours with higher radiotherapy doses, with greater accuracy, whilst minimising the radiotherapy dose to the surrounding healthy tissues. The combination of these advances in cCRT may assist in creating comprehensive strategies to allow patients to receive potentially curative benefits from treatments such as immunotherapy, as well as minimising treatment-related risks.
Collapse
Affiliation(s)
- John Conibear
- Department of Clinical Oncology, St. Bartholomew's Hospital, London, UK.
| |
Collapse
|
|
29
|
Maggiore RJ, Zahrieh D, McMurray RP, Feliciano JL, Samson P, Mohindra P, Chen H, Wong ML, Lafky JM, Jatoi A, Le-Rademacher JG. Toxicity and survival outcomes in older adults receiving concurrent or sequential chemoradiation for stage III non-small cell lung cancer in Alliance trials (Alliance A151812). J Geriatr Oncol 2020; 12:563-571. [PMID: 32950428 DOI: 10.1016/j.jgo.2020.09.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 06/17/2020] [Accepted: 09/01/2020] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Optimal treatment for older adults with stage III non-small cell lung cancer (NSCLC) remains unclear. Here we hypothesized that sequential chemoradiation therapy (sCRT) is better tolerated than concurrent (cCRT) but confers acceptable efficacy. We evaluated these strategies in older adults utilizing Alliance for Clinical Trials in Oncology data. MATERIALS AND METHODS Pooled analyses from 6 first-line stage III NSCLC CRT trials (Cancer and Leukemia Group B 8433, 8831, 9130, 30106, 30407, 39801) were used to compare toxicity and survival outcomes with cCRT versus sCRT in patients age ≥ 65 years. Grade 3-5 adverse events (AEs), progression-free and overall survival (PFS; OS) are reported with adjustment for covariates. RESULTS Four hundred older adults, of whom 106 (26.5%) had received sCRT and 294 (73.5%) had received cCRT, comprised the cohorts. Virtually all had an Eastern Cooperative Oncology Group performance status (ECOG PS) 0-1 (99%). More grade 3-5 AEs were observed at any time-point with cCRT than sCRT (94.2% versus 86.8%; 95% confidence interval for difference in proportions, 1.3%, 15.5%) and this finding remained after adjusting for length of study treatment (P = 0.018). Comparable PFS and OS were observed with sCRT versus cCRT (median: 8.0 versus 9.2 months; median: 11.9 versus 13.4 months, respectively) even after adjustment for age, sex, ECOG PS, body mass index, pretreatment weight loss, stage, and cisplatin-based therapy (P = 0.604 and P = 0.906, respectively). DISCUSSION These data show that sCRT was associated with less toxicity than cCRT with no associated statistically significant decrease in efficacy outcomes and that sCRT merits further study in this population.
Collapse
Affiliation(s)
| | - David Zahrieh
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN, United States of America; Mayo Clinic, Rochester, MN, United States of America.
| | - Ryan P McMurray
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN, United States of America; Mayo Clinic, Rochester, MN, United States of America
| | | | - Pamela Samson
- Washington University School of Medicine, St. Louis, MO, United States of America
| | | | - Hongbin Chen
- Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States of America
| | - Melisa L Wong
- University of California, San Francisco, CA, United States of America
| | | | - Aminah Jatoi
- Mayo Clinic, Rochester, MN, United States of America
| | - Jennifer G Le-Rademacher
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN, United States of America; Mayo Clinic, Rochester, MN, United States of America
| |
Collapse
|
|
30
|
Battisti NML, Liposits G, De Glas NA, Gomes F, Baldini C, Mohile S. Systemic Therapy of Common Tumours in Older Patients: Challenges and Opportunities. A Young International Society of Geriatric Oncology Review Paper. Curr Oncol Rep 2020; 22:98. [PMID: 32725503 DOI: 10.1007/s11912-020-00958-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE OF REVIEW Decision-making for systemic treatments in older patients with cancer is difficult because of concerns for decreased organ function, risk of toxicity, limited life expectancy due to comorbidities and the lack of evidence available to guide its management in this population. Here, we review the data on the role of systemic agents for the treatment of common malignancies in this age group. RECENT FINDINGS Evidence on the use of systemic treatments for older patients with cancer is increasing, especially for newer options including immune checkpoint inhibitors and targeted agents that provide comparable benefit in older and younger patients. Nonetheless, the risks for short- and long-term toxicities need to be considered. More research is warranted and represents a unique opportunity to increase the knowledge on cancer treatment for older adults. Healthy, older individuals should be considered for standard systemic treatment options, whereas those at risk based on geriatric assessments require adjusted plans. Geriatric assessments are key for decision-making.
Collapse
Affiliation(s)
- Nicolò Matteo Luca Battisti
- Department of Medicine, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, London, SM2 5PT, UK. .,Breast Cancer Research Division, The Institute of Cancer Research, 15 Cotswold Road, Sutton, London, SM2 5NG, UK.
| | - Gabor Liposits
- Department of Oncology, Regional Hospital West Jutland, Gl Landevej 61, 7400, Herning, Denmark
| | - Nienke Aafke De Glas
- Department of Medical Oncology, Leiden University Medical Center, Albinusdreef 2, 2333, Leiden, ZA, Netherlands
| | - Fabio Gomes
- Medical Oncology, The Christie NHS Foundation Trust, Wilmslow Road, Manchester, M20 4BX, UK
| | - Capucine Baldini
- Drug Development Department, Institut Gustave Roussy, Gustave Roussy Cancer Campus, 114 Rue Edouard Vaillant, 94800, Villejuif, France
| | - Supriya Mohile
- Division of Hematology/Oncology, James P. Wilmot Cancer Institute, University of Rochester Medical Center, 601 Elmwood Ave # 704, Rochester, NY, 14642, USA
| |
Collapse
|
|
31
|
Shahrokh S, Mansouri V, Razzaghi M. Assessment of the SRC Inhibition Role in the Efficacy of Breast Cancer Radiotherapy. J Lasers Med Sci 2020; 10:S18-S22. [PMID: 32021668 DOI: 10.15171/jlms.2019.s4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Introduction: Radiotherapy (RT) is an effective therapeutic method for preventing the recurrence of breast cancer after surgery. The development and improvement of RT are of interest to scientists. Possible improvement of RT via study of dysregulated proteins of breast cancer cell line MDA-MB-231 which is exposed to 10 Gray (Gy) radiation is aim of this study. Methods: Using protein-protein interaction (PPI) network analysis by means of running Cytoscape software via the STRING database, the up-regulated proteins of MDA-MB-231 breast cancer cells irradiated by a single and fractioned 10 Gy 137Cs γ-radiation were analyzed. The network was analyzed by using the Network analyzer to characterize the central genes. The action map was mapped for the queried genes and the added neighbors via CluePedia-STRING ACTIONS-v10.5- 20.11.2017. Results: The 14 differentially expressed proteins (DEPs) plus 10 neighbors interacted to construct a network. Among the 14 queried DEPs, FN1, CSPG4, LRP1, GSN, RTN4, and CTSD were highlighted as a complex set in the analysis. The analysis revealed that SRC as an added neighbor was activated by the critical DEPs. The activation of other oncogenes like AKT1 was also determined. Conclusion: The results indicate that the inhibition of SRC activity or the inhibition of its activators is a useful function of breast cancer RT.
Collapse
Affiliation(s)
- Shabnam Shahrokh
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Vahid Mansouri
- Proteomics Research Center, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Razzaghi
- Laser Application in Medical Sciences Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| |
Collapse
|
|
32
|
van Loon J, Dingemans AMC. Is Concurrent Chemoradiotherapy Also the Best Treatment for Elderly Patients with Limited-Stage Small Cell Lung Cancer? - What the CONVERT Data Can Tell Us. J Thorac Oncol 2019; 14:13-15. [PMID: 30579544 DOI: 10.1016/j.jtho.2018.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 11/14/2018] [Indexed: 11/19/2022]
Affiliation(s)
- Judith van Loon
- MAASTRO Clinic, Department of Radiation Oncology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands.
| | - Anne-Marie C Dingemans
- Department of Pulmonary Diseases, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| |
Collapse
|
|
33
|
Kim DY, Song C, Kim SH, Kim YJ, Lee JS, Kim JS. Chemoradiotherapy versus radiotherapy alone following induction chemotherapy for elderly patients with stage III lung cancer. Radiat Oncol J 2019; 37:176-184. [PMID: 31591865 PMCID: PMC6790792 DOI: 10.3857/roj.2019.00087] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 06/24/2019] [Indexed: 01/06/2023] Open
Abstract
Purpose It is unclear whether adding concurrent chemotherapy (CT) to definitive radiotherapy (RT) following induction CT is a tolerable and cost effective treatment for non-small-cell lung cancer (NSCLC) patients aged 70 years or older with comorbidities. This study evaluated the actual clinical outcomes between concurrent chemoradiotherapy (CCRT) and RT alone following induction CT or not in patients (≥70 years) in a single institution’s clinical practice. Materials and Methods A total of 82 patients with unresectable stage III NSCLC between 2004 and 2016 were retrospectively analyzed. Their treatment tolerance and clinical outcomes such as overall survival (OS), locoregional recurrence (LRR), treatment toxicities and distant metastasis (DM) were evaluated. Early mortality rates were also evaluated as 4-month mortality after RT. Results Fifty-four patients received CCRT and 28 patients received RT alone. Induction CT before RT was performed for 68.5% and 50.0% in CCRT and RT alone groups. Treatment tolerance was significantly worse in CCRT (p = 0.046). The median survival was 21.1 and 18.1 months for CCRT and RT alone, which was not statistically significant. LRR and DM were also not different. Most early deaths after CCRT were attributed to non-cancer-related mortality. Acute esophagitis of grade ≥2 occurred more following CCRT (p = 0.017). In multivariate analysis, a Charlson Comorbidity Index (CCI) of ≥5 and a weight loss of ≥5% after RT were associated with poor OS. The factors adversely affecting 4-month survival were a CCI of ≥5 and CCRT. Conclusion There were no significant differences in OS, LRR, and DM between CCRT and RT alone treatment in elderly patients. However, there was a poorer tolerance and higher incidence of acute esophagitis in the CCRT group. Specifically, when the patients had a CCI of ≥5, RT alone seems to be reasonable with a low probability of early death.
Collapse
Affiliation(s)
- Dong-Yun Kim
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Korea
| | - Changhoon Song
- Department of Radiation Oncology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Se Hyun Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Yu Jung Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jong Seok Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jae-Sung Kim
- Department of Radiation Oncology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| |
Collapse
|
|
34
|
Jairam V, Park HS. Strengths and limitations of large databases in lung cancer radiation oncology research. Transl Lung Cancer Res 2019; 8:S172-S183. [PMID: 31673522 DOI: 10.21037/tlcr.2019.05.06] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
There has been a substantial rise in the utilization of large databases in radiation oncology research. The advantages of these datasets include a large sample size and inclusion of a diverse population of patients in a real-world setting. Such observational studies hold promise in enhancing our understanding of questions for which evidence is conflicting or absent in lung cancer radiotherapy. However, it is critical that investigators understand the strengths and limitations of large databases in order to avoid the common pitfalls that beset observational analyses. This review begins by outlining the data variables available in major registries that are used most often in observational analyses. This is followed by a discussion of the type of radiotherapy-related questions that can be addressed using such datasets, accompanied by examples from the lung cancer literature. Finally, we describe some limitations of observational research and techniques to mitigate bias and confounding. We hope that clinicians and researchers find this review helpful for designing new research studies and interpreting published analyses in the literature.
Collapse
Affiliation(s)
- Vikram Jairam
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT, USA
| | - Henry S Park
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT, USA.,Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale School of Medicine, New Haven, CT, USA
| |
Collapse
|
|
35
|
Ryan KJ, Skinner KE, Fernandes AW, Punekar RS, Pavilack M, Walker MS, VanderWalde NA. Real-world treatment patterns among patients with unresected stage III non-small-cell lung cancer. Future Oncol 2019; 15:2943-2953. [DOI: 10.2217/fon-2018-0939] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Aim: Little is known about recent treatment patterns among patients with unresected stage III NSCLC in the real world. This retrospective study used medical records from USA community oncology practices to address this knowledge gap. Materials & methods: Eligible patients were stage III NSCLC adults diagnosed between 1 January 2011 and 1 March 2016 without surgical resection. Treatment patterns were assessed across three progression intervals, from stage III diagnosis through third progression. Results: The most common regimen in interval 1 was platinum doublet chemotherapy + radiation therapy, in interval 2 was chemotherapy only, and in interval 3 was non-platinum chemotherapy monotherapy. Conclusion: Most patients were treated following national guidelines, but important unmet needs remain.
Collapse
Affiliation(s)
- Kellie J Ryan
- AstraZeneca, 101 Orchard Ridge Dr. (3233D), Gaithersburg, MD 20878, USA
| | - Karen E Skinner
- Vector Oncology, 6555 Quince, Suite 400, Memphis, TN 38119, USA
| | | | | | - Melissa Pavilack
- AstraZeneca, 101 Orchard Ridge Dr. (3233D), Gaithersburg, MD 20878, USA
| | - Mark S Walker
- Vector Oncology, 6555 Quince, Suite 400, Memphis, TN 38119, USA
| | - Noam A VanderWalde
- West Cancer Center/University of Tennessee Health Science Center, 7945 Wolf River Boulevard, Germantown, TN 38138, USA
| |
Collapse
|
|
36
|
Guo M, Li B, Yu Y, Wang S, Xu Y, Sun X, Wang L, Yu J. Delineating the pattern of treatment for elderly locally advanced NSCLC and predicting outcomes by a validated model: A SEER based analysis. Cancer Med 2019; 8:2587-2598. [PMID: 30945441 PMCID: PMC6537004 DOI: 10.1002/cam4.2127] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Revised: 02/15/2019] [Accepted: 03/11/2019] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Locally advanced nonsmall-cell lung cancer (LA-NSCLC) represented a highly heterogeneous group, with more than half of the patients aged ≥65 years at the time of diagnosis. However, the optimal treatment for elderly LA-NSCLC patients was still not defined. METHODS A total of 33530 elderly patients (≥65 years) diagnosed with LA-NSCLC from 2004 to 2014 were identified from Surveillance, Epidemiology, and End Results (SEER) database. RESULTS Locally advanced nonsmall-cell lung cancer patients aged 65-74 years were more frequently treated with chemoradiotherapy (CRT) (40%), while patients aged ≥75 years received more best supportive care (BSC) (36%). For age group of 65-74 years, patients who had surgery with or without (neo)adjuvant therapy had a median survival of 28 months, CRT 15 months, radiotherapy (RT) alone 6 months, chemotherapy alone 11 months, and BSC 3 months; while for patients aged ≥ 75 years, the median OS was 20, 13, 7, 9, and 2, respectively. Besides, independent clinicopathological factors were integrated into nomograms for OS and CSS prediction, C-indexes achieved 0.692 and 0.698, respectively. Importantly, the discrimination of nomogram was superior to that of the American Joint Committee on Cancer TNM classification (0.742 vs 0.572 for training set and 0.731 vs 0.565 for validation set). CONCLUSION For elderly patients with LA-NSCLC, the curative-intent treatment (surgery or CRT) conferred better survival compared to chemotherapy alone, RT alone and BSC. The proposed nomograms based on independent clinicopathological variables may be practical and helpful for precise evaluation of patient prognosis, and guiding the individualized treatment for elderly LA-NSCLC.
Collapse
Affiliation(s)
- Meiying Guo
- School of MedicineShandong UniversityJinanChina
- Department of Radiation OncologyShandong Cancer Hospital Affiliated to Shandong UniversityJinanChina
| | - Butuo Li
- Department of Radiation OncologyShandong Cancer Hospital Affiliated to Shandong UniversityJinanChina
- Department of Radiation Oncology and Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and HospitalNational Clinical Research Center for CancerTianjinChina
| | - Yishan Yu
- Department of Radiation OncologyShandong Cancer Hospital Affiliated to Shandong UniversityJinanChina
- Shandong Academy of Medical SciencesJinanChina
| | - Shijiang Wang
- Department of Radiation OncologyShandong Cancer Hospital Affiliated to Shandong UniversityJinanChina
- Shandong Academy of Medical SciencesJinanChina
| | - Yiyue Xu
- School of MedicineShandong UniversityJinanChina
- Department of Radiation OncologyShandong Cancer Hospital Affiliated to Shandong UniversityJinanChina
| | - Xindong Sun
- Department of Radiation OncologyShandong Cancer Hospital Affiliated to Shandong UniversityJinanChina
- Shandong Academy of Medical SciencesJinanChina
| | - Linlin Wang
- Department of Radiation OncologyShandong Cancer Hospital Affiliated to Shandong UniversityJinanChina
- Shandong Academy of Medical SciencesJinanChina
| | - Jinming Yu
- Department of Radiation OncologyShandong Cancer Hospital Affiliated to Shandong UniversityJinanChina
- Shandong Academy of Medical SciencesJinanChina
| |
Collapse
|
|
37
|
Abstract
PURPOSE OF REVIEW We intend to highlight progress made in 2017 to lung cancer molecular nosology and application of new knowledge to treatment. RECENT FINDINGS Studies have shown that agents targeting specific molecular defects in lung cancers such as epidermal growth factor receptor(egfr) mutations, alk or ros1 gene rearrangements, are more effective than conventional combination chemotherapy as primary treatment for various lung cancer subgroups. Identification of mechanisms of drug resistance has guided development of improved agents and effective salvage regimens. Progress in reversing tumor-induced immunosuppression has led to further improvements in response rates (RR) including some patients with prolonged durable remissions. SUMMARY State-of-the-art management of patients with lung cancer requires information derived from tumor molecular analysis, obtained either directly from the tumor or from tumor-derived circulating DNA. Empiric combination chemotherapy is no longer uniformly the best available treatment for all patients. Therapeutic decisions should be guided by an understanding of molecular features of an individual patient's tumor. The future gains will likely emerge from finding optimal ways of combining targeted therapy, immunotherapy, and chemotherapy.
Collapse
|
|
38
|
Real-world outcomes in patients with unresected stage III non-small cell lung cancer. Med Oncol 2019; 36:24. [DOI: 10.1007/s12032-019-1249-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 01/21/2019] [Indexed: 12/17/2022]
|
|
39
|
Hatton MQF, Lawless CA, Faivre-Finn C, Landau D, Lester JF, Fenwick J, Simões R, McCartney E, Boyd KA, Haswell T, Shaw A, Paul J. Accelerated, Dose escalated, Sequential Chemoradiotherapy in Non-small-cell lung cancer (ADSCaN): a protocol for a randomised phase II study. BMJ Open 2019; 9:e019903. [PMID: 30700475 PMCID: PMC6352760 DOI: 10.1136/bmjopen-2017-019903] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 07/23/2018] [Accepted: 11/05/2018] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Lung cancer is the most common cause of cancer mortality in the UK, and non-small-cell lung cancer (NSCLC) accounts for approximately 85% of all lung cancers. Most patients present with inoperable disease; therefore, radiotherapy plays a major role in treatment. However, the majority of patients are not suitable for the gold standard treatment (concurrent chemoradiotherapy) due to performance status and comorbidities. Novel strategies integrating radiotherapy advances and radiobiological knowledge need to be evaluated in patients treated with sequential chemoradiotherapy. Four separate dose escalation accelerated radiotherapy schedules have been completed in UK (CHART-ED, IDEAL-CRT, I-START and Isotoxic IMRT). This study will compare these schedules with a UK standard sequential chemoradiotherapy schedule of 55 Gy in 20 fractions over 4 weeks. As it would be impossible to test all schedules in a phase III study, the aim is to use a combined randomised phase II screening/'pick the winner' approach to identify the best schedule to take into a randomised phase III study against conventionally fractionated radiotherapy. METHODS AND ANALYSIS Suitable patients will have histologically/cytologically confirmed, stage III NSCLC and are able to undergo chemoradiotherapy treatment. The study will recruit 360 patients; 120 on the standard arm and 60 on each experimental arm. Patients will complete 2-4 cycles of platinum-based chemotherapy before being randomised to one of the radiotherapy schedules. The primary endpoint is progression-free survival, with overall survival, time to local-regional failure, toxicity and cost-effectiveness as secondary objectives. ETHICS AND DISSEMINATION The study has received ethical approval (research ethics committee (REC) reference: 16/WS/0165) from the West of Scotland REC 1. The trial is conducted in accordance with the Declaration of Helsinki and Good Clinical Practice. Trial results will be published in a peer-reviewed journal and presented internationally. TRIAL REGISTRATION NUMBER ISRCTN47674500.
Collapse
Affiliation(s)
| | - Claire Anne Lawless
- Cancer Research UK Clinical Trials Unit, Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | | | - David Landau
- Guy's & St. Thomas' NHS Trust, Guy's Hospital, London, UK
| | | | - John Fenwick
- Department of Physics, Clatterbridge Cancer Centre, Bebington, UK
| | - Rita Simões
- National Radiotherapy Trials Quality Assurance (RTTQA) Group, Mount Vernon Hospital, Middlesex, UK
| | - Elaine McCartney
- Cancer Research UK Clinical Trials Unit, Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Kathleen Anne Boyd
- Health Economics and Health Technology Assessment, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Tom Haswell
- National Cancer Research Institute Consumer Liaison Group, London, UK
| | - Ann Shaw
- Cancer Research UK Clinical Trials Unit, Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - James Paul
- Cancer Research UK Clinical Trials Unit, Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| |
Collapse
|
|
40
|
Arulananda S, Mitchell P. Elderly patients with stage III NSCLC survive longer when chemotherapy is added to radiotherapy-fortune favours the bold. Transl Lung Cancer Res 2018; 7:S388-S392. [PMID: 30705864 DOI: 10.21037/tlcr.2018.08.12] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Surein Arulananda
- Cancer Immuno-Biology Laboratory, Olivia Newton-John Cancer Research Institute, Heidelberg, Australia.,School of Cancer Medicine, La Trobe University, Heidelberg, Australia.,Department of Medical Oncology, Austin Health, Heidelberg, Australia
| | - Paul Mitchell
- Cancer Immuno-Biology Laboratory, Olivia Newton-John Cancer Research Institute, Heidelberg, Australia.,Department of Medical Oncology, Austin Health, Heidelberg, Australia.,Department of Medicine, University of Melbourne, Parkville, Australia
| |
Collapse
|
|
41
|
Miller ED, Fisher JL, Haglund KE, Grecula JC, Xu-Welliver M, Bertino EM, He K, Shields PG, Carbone DP, Williams TM, Otterson GA, Bazan JG. Identifying patterns of care for elderly patients with non-surgically treated stage III non-small cell lung cancer: an analysis of the national cancer database. Radiat Oncol 2018; 13:196. [PMID: 30290823 PMCID: PMC6173899 DOI: 10.1186/s13014-018-1142-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 09/26/2018] [Indexed: 12/21/2022] Open
Abstract
Background To compare patterns of care for elderly patients versus non-elderly patients with non-surgically treated stage III non-small cell lung cancer (NSCLC) using the National Cancer Database (NCDB). We hypothesize that elderly patients are less likely to receive curative treatments, including concurrent chemoradiation (CCRT), compared to non-elderly patients. Methods We identified patients from the NCDB between 2003 and 2014 with non-surgically treated stage III NSCLC. We defined elderly as ≥70 years old and non-elderly <70 years old. Treatment categories included: no treatment, palliative treatment (chemotherapy alone, radiation (RT) alone <59.4 Gy or chemoradiation (CRT) <59.4 Gy), or definitive treatment (RT alone ≥59.4 Gy or CRT ≥59.4 Gy). Differences in treatment between elderly and non-elderly were tested using the χ2 test. Results We identified 57,602 elderly and 55,928 non-elderly patients. More elderly patients received no treatment (24.5% vs. 13.2%, P < 0.0001) and the elderly were less likely to receive definitive treatment (48.5% vs. 56.3%, P < 0.0001). CCRT was delivered in a significantly smaller proportion of elderly vs. non-elderly patients (66.0% vs. 78.9%, P < 0.0001 in patients treated with definitive intent; 32.0% vs. 44.5%, P < 0.0001 in patients receiving any treatment; and 24.2% vs. 38.6%, P < 0.0001 amongst all patients). Conclusions In this large study of patients with non-surgically treated stage III NSCLC, elderly patients were less likely to receive any treatment or treatment with definitive intent compared to the non-elderly. The lack of use of concurrent or sequential chemotherapy in the elderly with stage III NSCLC suggests that the optimal treatment approach for this vulnerable population remains undefined. Electronic supplementary material The online version of this article (10.1186/s13014-018-1142-7) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Eric D Miller
- Department of Radiation Oncology, at the Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University, 460 W. 10th Avenue, Columbus, OH, 43210, USA
| | - James L Fisher
- College of Public Health, at the Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Karl E Haglund
- Department of Radiation Oncology, at the Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University, 460 W. 10th Avenue, Columbus, OH, 43210, USA
| | - John C Grecula
- Department of Radiation Oncology, at the Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University, 460 W. 10th Avenue, Columbus, OH, 43210, USA
| | - Meng Xu-Welliver
- Department of Radiation Oncology, at the Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University, 460 W. 10th Avenue, Columbus, OH, 43210, USA
| | - Erin M Bertino
- Department of Internal Medicine, Division of Medical Oncology, at the Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Kai He
- Department of Internal Medicine, Division of Medical Oncology, at the Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Peter G Shields
- Department of Internal Medicine, Division of Medical Oncology, at the Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - David P Carbone
- Department of Internal Medicine, Division of Medical Oncology, at the Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Terence M Williams
- Department of Radiation Oncology, at the Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University, 460 W. 10th Avenue, Columbus, OH, 43210, USA
| | - Gregory A Otterson
- Department of Internal Medicine, Division of Medical Oncology, at the Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Jose G Bazan
- Department of Radiation Oncology, at the Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University, 460 W. 10th Avenue, Columbus, OH, 43210, USA.
| |
Collapse
|
|
42
|
Radovic M, Kanesvaran R, Rittmeyer A, Früh M, Minervini F, Glatzer M, Putora PM. Multidisciplinary treatment of lung cancer in older patients: A review. J Geriatr Oncol 2018; 10:405-410. [PMID: 30292418 DOI: 10.1016/j.jgo.2018.09.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 08/09/2018] [Accepted: 09/10/2018] [Indexed: 12/25/2022]
Abstract
Lung cancer is the leading cause of cancer death worldwide. Older patients represent approximately half of the patient population and optimal management of these patients is challenging. In early-stagenon-small cell lung cancer (NSCLC), lobectomy should be considered in fit older patients. For unfit patients, stereotactic body radiotherapy (SBRT) represents a good alternative. While data on the benefit and risk of concurrent chemo-radiotherapy (cCRT) in older patients with locally advanced NSCLC is conflicting, age alone should not preclude cCRT. Multidisciplinary collaboration is essential for appropriate patient selection. In limited disease small cell lung cancer (SCLC), older patients appear to benefit similarly from standard treatment compared to their younger counterparts, however, with a higher risk of toxicity. Appropriately selected older patients with lung cancer seem to derive as much benefit from active oncological treatment as their younger counterparts. Geriatric screening tests and comprehensive geriatric assessments (CGA) can be helpful when choosing between treatment strategies. Older patients are at risk for under-treatment; this should be avoided by proper selection and multidisciplinary management. This review outlines the management of lung cancer in older patients.
Collapse
Affiliation(s)
- Marco Radovic
- Dept of Radiation Oncology, Kantonsspital St Gallen, St Gallen, Switzerland
| | | | - Achim Rittmeyer
- Dept of Thoracic Oncology, Lungenfachklinik Immenhausen, Immenhausen, Germany
| | - Martin Früh
- Dept of Radiation Oncology, Kantonsspital St Gallen, St Gallen, Switzerland; Dept of Oncology, Haematology, Kantonsspital St Gallen, St Gallen, Switzerland
| | - Fabrizio Minervini
- Dept of Radiation Oncology, Kantonsspital St Gallen, St Gallen, Switzerland; Dept of Thoracic Surgery, Kantonsspital St Gallen, St Gallen, Switzerland
| | - Markus Glatzer
- Dept of Radiation Oncology, Kantonsspital St Gallen, St Gallen, Switzerland
| | - Paul Martin Putora
- Dept of Radiation Oncology, Kantonsspital St Gallen, St Gallen, Switzerland.
| |
Collapse
|
|
43
|
Jia L, Lv D, Zhang S, Wang Z, Zhou B. Astragaloside IV Inhibits the Progression of Non-Small Cell Lung Cancer Through the Akt/GSK-3β/β-Catenin Pathway. Oncol Res 2018; 27:503-508. [PMID: 30131090 PMCID: PMC7848426 DOI: 10.3727/096504018x15344989701565] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Astragaloside IV (AS-IV) is an active ingredient in Astragalus membranaceus and is involved in various biological processes, such as regulating the immune system, and counteracting inflammation and malignancy. The aim of this study was to explore the effect of AS-IV on non-small cell lung cancer (NSCLC) cells. Cell counting kit (CCK)-8 assay and flow cytometry were performed to investigate cell survival and cell death, and Western blotting was performed to assess protein expression. We found that AS-IV inhibited the migration and proliferation of NSCLC cells and caused a noticeable increase in cell death. Furthermore, the expression of Bax, a marker of cell death, was increased, whereas the expression of Bcl-2, an antiapoptotic protein, was reduced. AS-IV also promoted cleavage of caspase-3, another indication of apoptosis. Finally, the Akt/GSK-3β/β-catenin axis was suppressed in response to AS-IV. Taken together, these findings provide evidence that AS-IV inhibits NSCLC development via inhibition of the Akt/GSK-3β/β-catenin signaling axis. We therefore propose that AS-IV represents a promising novel agent for the treatment of NSCLC.
Collapse
Affiliation(s)
- Liwei Jia
- School of Pharmacy, Heilongjiang University of Chinese Medicine, Harbin, Heilongjiang Province, P.R. China
| | - Dongying Lv
- Heilongjiang Environmental Monitoring Central Station, Harbin, Heilongjiang Province, P.R. China
| | - Shuang Zhang
- School of Pharmacy, Heilongjiang University of Chinese Medicine, Harbin, Heilongjiang Province, P.R. China
| | - Zhenyue Wang
- School of Pharmacy, Heilongjiang University of Chinese Medicine, Harbin, Heilongjiang Province, P.R. China
| | - Bo Zhou
- School of Pharmacy, Heilongjiang University of Chinese Medicine, Harbin, Heilongjiang Province, P.R. China
| |
Collapse
|