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Schütte W, Gütz S, Nehls W, Blum TG, Brückl W, Buttmann-Schweiger N, Büttner R, Christopoulos P, Delis S, Deppermann KM, Dickgreber N, Eberhardt W, Eggeling S, Fleckenstein J, Flentje M, Frost N, Griesinger F, Grohé C, Gröschel A, Guckenberger M, Hecker E, Hoffmann H, Huber RM, Junker K, Kauczor HU, Kollmeier J, Kraywinkel K, Krüger M, Kugler C, Möller M, Nestle U, Passlick B, Pfannschmidt J, Reck M, Reinmuth N, Rübe C, Scheubel R, Schumann C, Sebastian M, Serke M, Stoelben E, Stuschke M, Thomas M, Tufman A, Vordermark D, Waller C, Wolf J, Wolf M, Wormanns D. [Prevention, Diagnosis, Therapy, and Follow-up of Lung Cancer - Interdisciplinary Guideline of the German Respiratory Society and the German Cancer Society - Abridged Version]. Pneumologie 2023; 77:671-813. [PMID: 37884003 DOI: 10.1055/a-2029-0134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
The current S3 Lung Cancer Guidelines are edited with fundamental changes to the previous edition based on the dynamic influx of information to this field:The recommendations include de novo a mandatory case presentation for all patients with lung cancer in a multidisciplinary tumor board before initiation of treatment, furthermore CT-Screening for asymptomatic patients at risk (after federal approval), recommendations for incidental lung nodule management , molecular testing of all NSCLC independent of subtypes, EGFR-mutations in resectable early stage lung cancer in relapsed or recurrent disease, adjuvant TKI-therapy in the presence of common EGFR-mutations, adjuvant consolidation treatment with checkpoint inhibitors in resected lung cancer with PD-L1 ≥ 50%, obligatory evaluation of PD-L1-status, consolidation treatment with checkpoint inhibition after radiochemotherapy in patients with PD-L1-pos. tumor, adjuvant consolidation treatment with checkpoint inhibition in patients withPD-L1 ≥ 50% stage IIIA and treatment options in PD-L1 ≥ 50% tumors independent of PD-L1status and targeted therapy and treatment option immune chemotherapy in first line SCLC patients.Based on the current dynamic status of information in this field and the turnaround time required to implement new options, a transformation to a "living guideline" was proposed.
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Affiliation(s)
- Wolfgang Schütte
- Klinik für Innere Medizin II, Krankenhaus Martha Maria Halle-Dölau, Halle (Saale)
| | - Sylvia Gütz
- St. Elisabeth-Krankenhaus Leipzig, Abteilung für Innere Medizin I, Leipzig
| | - Wiebke Nehls
- Klinik für Palliativmedizin und Geriatrie, Helios Klinikum Emil von Behring
| | - Torsten Gerriet Blum
- Helios Klinikum Emil von Behring, Klinik für Pneumologie, Lungenklinik Heckeshorn, Berlin
| | - Wolfgang Brückl
- Klinik für Innere Medizin 3, Schwerpunkt Pneumologie, Klinikum Nürnberg Nord
| | | | - Reinhard Büttner
- Institut für Allgemeine Pathologie und Pathologische Anatomie, Uniklinik Köln, Berlin
| | | | - Sandra Delis
- Helios Klinikum Emil von Behring, Klinik für Pneumologie, Lungenklinik Heckeshorn, Berlin
| | | | - Nikolas Dickgreber
- Klinik für Pneumologie, Thoraxonkologie und Beatmungsmedizin, Klinikum Rheine
| | | | - Stephan Eggeling
- Vivantes Netzwerk für Gesundheit, Klinikum Neukölln, Klinik für Thoraxchirurgie, Berlin
| | - Jochen Fleckenstein
- Klinik für Strahlentherapie und Radioonkologie, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Homburg
| | - Michael Flentje
- Klinik und Poliklinik für Strahlentherapie, Universitätsklinikum Würzburg, Würzburg
| | - Nikolaj Frost
- Medizinische Klinik mit Schwerpunkt Infektiologie/Pneumologie, Charite Universitätsmedizin Berlin, Berlin
| | - Frank Griesinger
- Klinik für Hämatologie und Onkologie, Pius-Hospital Oldenburg, Oldenburg
| | | | - Andreas Gröschel
- Klinik für Pneumologie und Beatmungsmedizin, Clemenshospital, Münster
| | | | | | - Hans Hoffmann
- Klinikum Rechts der Isar, TU München, Sektion für Thoraxchirurgie, München
| | - Rudolf M Huber
- Medizinische Klinik und Poliklinik V, Thorakale Onkologie, LMU Klinikum Munchen
| | - Klaus Junker
- Klinikum Oststadt Bremen, Institut für Pathologie, Bremen
| | - Hans-Ulrich Kauczor
- Klinikum der Universität Heidelberg, Abteilung Diagnostische Radiologie, Heidelberg
| | - Jens Kollmeier
- Helios Klinikum Emil von Behring, Klinik für Pneumologie, Lungenklinik Heckeshorn, Berlin
| | | | - Marcus Krüger
- Klinik für Thoraxchirurgie, Krankenhaus Martha-Maria Halle-Dölau, Halle-Dölau
| | | | - Miriam Möller
- Krankenhaus Martha-Maria Halle-Dölau, Klinik für Innere Medizin II, Halle-Dölau
| | - Ursula Nestle
- Kliniken Maria Hilf, Klinik für Strahlentherapie, Mönchengladbach
| | | | - Joachim Pfannschmidt
- Klinik für Thoraxchirurgie, Lungenklinik Heckeshorn, Helios Klinikum Emil von Behring, Berlin
| | - Martin Reck
- Lungeclinic Grosshansdorf, Pneumologisch-onkologische Abteilung, Grosshansdorf
| | - Niels Reinmuth
- Klinik für Pneumologie, Thorakale Onkologie, Asklepios Lungenklinik Gauting, Gauting
| | - Christian Rübe
- Klinik für Strahlentherapie und Radioonkologie, Universitätsklinikum des Saarlandes, Homburg/Saar, Homburg
| | | | | | - Martin Sebastian
- Medizinische Klinik II, Universitätsklinikum Frankfurt, Frankfurt
| | - Monika Serke
- Zentrum für Pneumologie und Thoraxchirurgie, Lungenklinik Hemer, Hemer
| | | | - Martin Stuschke
- Klinik und Poliklinik für Strahlentherapie, Universitätsklinikum Essen, Essen
| | - Michael Thomas
- Thoraxklinik am Univ.-Klinikum Heidelberg, Thorakale Onkologie, Heidelberg
| | - Amanda Tufman
- Medizinische Klinik und Poliklinik V, Thorakale Onkologie, LMU Klinikum München
| | - Dirk Vordermark
- Universitätsklinik und Poliklinik für Strahlentherapie, Universitätsklinikum Halle, Halle
| | - Cornelius Waller
- Klinik für Innere Medizin I, Universitätsklinikum Freiburg, Freiburg
| | | | - Martin Wolf
- Klinikum Kassel, Klinik für Onkologie und Hämatologie, Kassel
| | - Dag Wormanns
- Evangelische Lungenklinik, Radiologisches Institut, Berlin
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Petrella F, Rizzo S, Attili I, Passaro A, Zilli T, Martucci F, Bonomo L, Del Grande F, Casiraghi M, De Marinis F, Spaggiari L. Stage III Non-Small-Cell Lung Cancer: An Overview of Treatment Options. Curr Oncol 2023; 30:3160-3175. [PMID: 36975452 PMCID: PMC10047909 DOI: 10.3390/curroncol30030239] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 02/27/2023] [Accepted: 03/06/2023] [Indexed: 03/12/2023] Open
Abstract
Lung cancer is the second-most commonly diagnosed cancer and the leading cause of cancer death worldwide. The most common histological type is non-small-cell lung cancer, accounting for 85% of all lung cancer cases. About one out of three new cases of non-small-cell lung cancer are diagnosed at a locally advanced stage—mainly stage III—consisting of a widely heterogeneous group of patients presenting significant differences in terms of tumor volume, local diffusion, and lymph nodal involvement. Stage III NSCLC therapy is based on the pivotal role of multimodal treatment, including surgery, radiotherapy, and a wide-ranging option of systemic treatments. Radical surgery is indicated in the case of hilar lymphnodal involvement or single station mediastinal ipsilateral involvement, possibly after neoadjuvant chemotherapy; the best appropriate treatment for multistation mediastinal lymph node involvement still represents a matter of debate. Although the main scope of treatments in this setting is potentially curative, the overall survival rates are still poor, ranging from 36% to 26% and 13% in stages IIIA, IIIB, and IIIC, respectively. The aim of this article is to provide an up-to-date, comprehensive overview of the state-of-the-art treatments for stage III non-small-cell lung cancer.
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Affiliation(s)
- Francesco Petrella
- Department of Thoracic Surgery, European Institute of Oncology IRCCS, 20141 Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, 20141 Milan, Italy
- Correspondence: ; Tel.: +0039-0257489362
| | - Stefania Rizzo
- Service of Radiology, Imaging Institute of Southern Switzerland (IIMSI), EOC, Via Tesserete 46, 6900 Lugano, Switzerland
- Faculty of Biomedical Sciences, University of Italian Switzerland, Via Buffi 13, 6900 Lugano, Switzerland
| | - Ilaria Attili
- Division of Thoracic Oncology, European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Antonio Passaro
- Division of Thoracic Oncology, European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Thomas Zilli
- Faculty of Biomedical Sciences, University of Italian Switzerland, Via Buffi 13, 6900 Lugano, Switzerland
- Radiation Oncology, Oncological Institute of Southern Switzerland, EOC, 6500 Bellinzona, Switzerland
- Faculty of Medicine, University of Geneva, 1211 Geneva, Switzerland
| | - Francesco Martucci
- Radiation Oncology, Oncological Institute of Southern Switzerland, EOC, 6500 Bellinzona, Switzerland
| | - Luca Bonomo
- Service of Radiology, Imaging Institute of Southern Switzerland (IIMSI), EOC, Via Tesserete 46, 6900 Lugano, Switzerland
| | - Filippo Del Grande
- Service of Radiology, Imaging Institute of Southern Switzerland (IIMSI), EOC, Via Tesserete 46, 6900 Lugano, Switzerland
- Faculty of Biomedical Sciences, University of Italian Switzerland, Via Buffi 13, 6900 Lugano, Switzerland
| | - Monica Casiraghi
- Department of Thoracic Surgery, European Institute of Oncology IRCCS, 20141 Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, 20141 Milan, Italy
| | - Filippo De Marinis
- Division of Thoracic Oncology, European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Lorenzo Spaggiari
- Department of Thoracic Surgery, European Institute of Oncology IRCCS, 20141 Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, 20141 Milan, Italy
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3
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König D, Schär S, Vuong D, Guckenberger M, Furrer K, Opitz I, Weder W, Rothschild SI, Ochsenbein A, Zippelius A, Addeo A, Mark M, Eboulet EI, Hayoz S, Thierstein S, Betticher DC, Ris HB, Stupp R, Curioni-Fontecedro A, Peters S, Pless M, Früh M. Long-term outcomes of operable stage III NSCLC in the pre-immunotherapy era: results from a pooled analysis of the SAKK 16/96, SAKK 16/00, SAKK 16/01, and SAKK 16/08 trials. ESMO Open 2022; 7:100455. [PMID: 35398718 PMCID: PMC9011017 DOI: 10.1016/j.esmoop.2022.100455] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 02/20/2022] [Accepted: 02/28/2022] [Indexed: 12/25/2022] Open
Abstract
Background Chemoradiotherapy with durvalumab consolidation has yielded excellent results in stage III non-small-cell lung cancer (NSCLC). Therefore, it is essential to identify patients who might benefit from a surgical approach. Material and methods Data from 437 patients with operable stage III NSCLC enrolled in four consecutive Swiss Group for Clinical Cancer Research (SAKK) trials (16/96, 16/00, 16/01, 16/08) were pooled and outcomes were analyzed in 431 eligible patients. All patients were treated with three cycles of induction chemotherapy (cisplatin/docetaxel), followed in some patients by neoadjuvant radiotherapy (44 Gy, 22 fractions) (16/00, 16/01, 16/08) and cetuximab (16/08). Results With a median follow-up time of 9.3 years (range 8.5-10.3 years), 5- and 10-year overall survival (OS) rates were 37% and 25%, respectively. Overall, 342 patients (79%) underwent tumor resection, with a complete resection (R0) rate of 80%. Patients (n = 272, 63%) with R0 had significantly longer OS compared to patients who had surgery but incomplete resection (64.8 versus 19.2 months, P < 0.001). OS for patients who achieved pathological complete remission (pCR) (n = 66, 15%) was significantly better compared to resected patients without pCR (86.5 versus 37.0 months, P = 0.003). For patients with pCR, the 5- and 10-year event-free survival and OS rates were 45.7% [95% confidence interval (CI) 32.8% to 57.7%] and 28.1% (95% CI 15.2% to 42.6%), and 58.2% (95% CI 45.2% to 69.2%) and 45.0% (95% CI 31.5% to 57.6%), respectively. Conclusion We report favorable long-term outcomes in patients with operable stage III NSCLC treated with neoadjuvant chemotherapy with cisplatin and docetaxel ± neoadjuvant sequential radiotherapy from four prospective SAKK trials. Almost two-third of the patients underwent complete resection after neoadjuvant therapy. We confirm R0 resection and pCR as important predictors of outcome. Combined modality treatment in operable stage III NSCLC results in 5- and 10-year survival rates of 37% and 25%. Long-term survival for patients with incomplete resection is poor. Complete resection and pCR are important predictors for outcome.
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Affiliation(s)
- D König
- Department of Medical Oncology, University Hospital of Basel, Basel, Switzerland.
| | - S Schär
- Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland
| | - D Vuong
- Department of Radiation Oncology, University Hospital of Zurich, Zurich, Switzerland
| | - M Guckenberger
- Department of Radiation Oncology, University Hospital of Zurich, Zurich, Switzerland
| | - K Furrer
- Department of Thoracic Surgery, University Hospital of Zurich, Zurich, Switzerland
| | - I Opitz
- Department of Thoracic Surgery, University Hospital of Zurich, Zurich, Switzerland
| | - W Weder
- Clinics for Thoracic Surgery, Bethanien, Zurich, Switzerland
| | - S I Rothschild
- Department of Medical Oncology, University Hospital of Basel, Basel, Switzerland
| | - A Ochsenbein
- Department of Medical Oncology, University Hospital of Bern (Inselspital), Bern, Switzerland
| | - A Zippelius
- Department of Medical Oncology, University Hospital of Basel, Basel, Switzerland
| | - A Addeo
- Department of Oncology, University Hospital of Geneva, Geneva, Switzerland
| | - M Mark
- Department of Oncology, Cantonal Hospital of Graubünden, Chur, Switzerland
| | - E I Eboulet
- Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland
| | - S Hayoz
- Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland
| | - S Thierstein
- Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland
| | - D C Betticher
- Clinics of Medical Oncology, Cantonal Hospital of Fribourg (HFR), Fribourg, Switzerland
| | - H-B Ris
- Clinics for Thoracic Surgery, Hôpital du Valais, Sion, Switzerland
| | - R Stupp
- Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - A Curioni-Fontecedro
- Department of Medical Oncology, University Hospital of Zurich, Zurich, Switzerland
| | - S Peters
- Department of Medical Oncology, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - M Pless
- Department of Medical Oncology, Cantonal Hospital of Winterthur, Winterthur, Switzerland
| | - M Früh
- Department of Medical Oncology/Hematology, Cantonal Hospital of St. Gallen, St. Gallen, Switzerland
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4
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Metzenmacher M, Kopp HG, Griesinger F, Reinmuth N, Sebastian M, Serke M, Waller CF, Thomas M, Eggert J, Schmid-Bindert G, Hoiczyk M, Christoph DC, Kimmich M, Deuß B, Seifert S, Held S, Schuler M, Herold T, Breitenbuecher F, Eberhardt WEE. A randomized, multicenter phase II study comparing efficacy, safety and tolerability of two dosing regimens of cisplatin and pemetrexed in patients with advanced or metastatic non-small-cell lung cancer. Ther Adv Med Oncol 2021; 13:1758835921996506. [PMID: 34104223 PMCID: PMC8164550 DOI: 10.1177/1758835921996506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 01/22/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Pemetrexed and cisplatin is a first-line standard in non-squamous non-small-cell lung cancer without targetable mutations. It became the backbone of checkpoint-inhibitor–chemotherapy combinations. Single high doses of cisplatin pose toxicity risks and require hyperhydration, potentially prolonging outpatient application. The aim of this study was to compare efficacy, safety and tolerability of split-dose cisplatin with the standard schedule. Methods: Patients with metastatic non-squamous non-small-cell lung cancer were randomly assigned to up to six 21-day cycles of pemetrexed 500 mg/m2 and cisplatin 75 mg/m2 on day 1 (arm A), or pemetrexed 500 mg/m2 (day 1) and cisplatin 40 mg/m2 (day 1 + 8, arm B), followed by pemetrexed maintenance. Primary endpoint was objective response rate. Secondary objectives were overall survival, progression-free survival, time to progression, treatment compliance, toxicity profile, and quality of life. Results: We enrolled 130 patients (129 evaluable). Median cycle numbers in A and B were six (1–6) and five (1–6). Dose intensities were comparable between arms. More patients in A received pemetrexed maintenance (24.2% versus 11.1%). With 16 (24.2%) in A and 19 (30.2%) patients in B achieving objective responses [odds ratio 0.74 (0.34–1.62), p = 0.55] the primary endpoint was met. Overall survival was not different between arms (median 14.4 versus 14.9 months); [HR = 1.07; (0.68–1.68), p = 0.78]. Median progression-free survival was 7.0 months in A and 6.2 months in B [HR = 1.63; (1.17–2.38); p = 0.01]. Adverse events of CTCAE grade ⩾3, particularly hematological, were more frequent in B. No difference in grade 4 and 5 infections between arms was noted. Treatment-related asthenia and nausea/vomiting of any grade were more frequent in A. Global health status, fatigue and constipation measured on day 1 of cycle 4 demonstrated superior scores in B. Conclusion: Pemetrexed and split-dose cisplatin is safe and effective. Advantages of split-dose cisplatin with regard to specific toxicities allow personalization of this important chemotherapy backbone. Trial Registration: European Clinical Trials Database (EudraCT) number 2011-001963-37.
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Affiliation(s)
- Martin Metzenmacher
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany
| | - Hans-Georg Kopp
- Department of Medical Oncology, University Medical Center Tuebingen, Tuebingen, Germany
| | - Frank Griesinger
- Department of Hematology and Medical Oncology, Pius-Hospital Oldenburg, University Medicine Oldenburg, Oldenburg, Germany
| | - Niels Reinmuth
- Department of Oncology, Department of Pulmonology, LungenClinic Grosshansdorf, Grosshansdorf, Germany
| | - Martin Sebastian
- Department of Hematology and Medical Oncology, University Hospital Frankfurt, Frankfurt, Germany
| | - Monika Serke
- Department of Pulmonology, Lungenklinik Hemer, Hemer, Germany
| | - Cornelius Florian Waller
- Department of Medicine I, University Medical Center Freiburg, Faculty of Medicine, University Freiburg, Freiburg, Germany
| | - Michael Thomas
- Department of Thoracic Oncology, Thoraxklinik, University Hospital Heidelberg and Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research (DZL), Heidelberg, Germany
| | - Jochen Eggert
- Practice of Medical Oncology and Hematology, Onkologische Praxis Moers, Moers, Nordrhein-Westfalen, Germany
| | | | - Mathias Hoiczyk
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Nordrhein-Westfalen, Germany
| | - Daniel Christian Christoph
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Nordrhein-Westfalen, Germany
| | - Martin Kimmich
- Department of Medical Oncology, University Medical Center Tuebingen, Tuebingen, Germany
| | - Burkhard Deuß
- ClinAssess GmbH, Clinical Research Organisation (CRO), Leverkusen, Germany
| | - Stephanie Seifert
- ClinAssess GmbH, Clinical Research Organisation (CRO), Leverkusen, Germany
| | - Swantje Held
- ClinAssess GmbH, Clinical Research Organisation (CRO), Leverkusen, Germany
| | - Martin Schuler
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany
| | - Thomas Herold
- Department of Pathology, West German Cancer Center, University Hospital Essen, Essen, Germany
| | - Frank Breitenbuecher
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Nordrhein-Westfalen, Germany
| | - Wilfried Ernst Erich Eberhardt
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Hufelandstraße 55, Essen, Nordrhein-Westfalen, 45147, Germany
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5
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Früh M, Betticher DC, Stupp R, Xyrafas A, Peters S, Ris HB, Mirimanoff RO, Ochsenbein AF, Schmid R, Matzinger O, Stahel RA, Weder W, Guckenberger M, Rothschild SI, Lardinois D, Mach N, Mark M, Gautschi O, Thierstein S, Biaggi Rudolf C, Pless M. Multimodal Treatment in Operable Stage III NSCLC: A Pooled Analysis on Long-Term Results of Three SAKK trials (SAKK 16/96, 16/00, and 16/01). J Thorac Oncol 2019; 14:115-123. [DOI: 10.1016/j.jtho.2018.09.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 09/05/2018] [Accepted: 09/08/2018] [Indexed: 12/25/2022]
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6
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Current Status and Future Perspectives on Neoadjuvant Therapy in Lung Cancer. J Thorac Oncol 2018; 13:1818-1831. [DOI: 10.1016/j.jtho.2018.09.017] [Citation(s) in RCA: 91] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 09/17/2018] [Accepted: 09/17/2018] [Indexed: 12/25/2022]
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7
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Noronha V, Zanwar S, Joshi A, Patil VM, Mahajan A, Janu A, Agarwal JP, Bhargava P, Kapoor A, Prabhash K. Practice Patterns and Outcomes for Pemetrexed Plus Platinum Doublet as Neoadjuvant Chemotherapy in Adenocarcinomas of Lung: Looking Beyond the Usual Paradigm. Clin Oncol (R Coll Radiol) 2018; 30:23-29. [PMID: 29239731 DOI: 10.1016/j.clon.2017.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Revised: 10/08/2017] [Accepted: 10/16/2017] [Indexed: 02/05/2023]
Affiliation(s)
- V Noronha
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India
| | - S Zanwar
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India
| | - A Joshi
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India
| | - V M Patil
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India
| | - A Mahajan
- Department of Radiodiagnosis, Tata Memorial Hospital, Mumbai, India
| | - A Janu
- Department of Radiodiagnosis, Tata Memorial Hospital, Mumbai, India
| | - J P Agarwal
- Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, India
| | - P Bhargava
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India
| | - A Kapoor
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India
| | - K Prabhash
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India.
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8
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Früh M, Ris HB, Xyrafas A, Peters S, Mirimanoff RO, Gautschi O, Pless M, Stupp R. Preoperative chemoradiotherapy with cisplatin and docetaxel for stage IIIB non-small-cell lung cancer: 10-year follow-up of the SAKK 16/01 trial. Ann Oncol 2016; 27:1971-3. [PMID: 27358380 DOI: 10.1093/annonc/mdw251] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- M Früh
- Department of Medical Oncology, Cantonal Hospital of St Gallen, St Gallen
| | - H B Ris
- Department of Thoracic Surgery, University Hospital of Lausanne (CHUV), Lausanne
| | | | | | - R O Mirimanoff
- Radiation Oncology, University Hospital of Lausanne (CHUV), Lausanne
| | - O Gautschi
- Department of Medical Oncology, University Hospital of Bern (Inselspital), Bern Cantonal Hospital of Lucerne, Lucerne
| | - M Pless
- Department of Medical Oncology, University Hospital of Basel, Basel Cantonal Hospital of Winterthur, Winterthur
| | - R Stupp
- Departments of Medical Oncology Department of Oncology, University Hospital of Zurich, Zurich, Switzerland
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9
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[The role of surgery for the management of resectable stage III non-small cell lung cancer]. Strahlenther Onkol 2016; 192:592-4. [PMID: 27334274 DOI: 10.1007/s00066-016-1001-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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10
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Bonanno L, Zago G, Marulli G, Del Bianco P, Schiavon M, Pasello G, Polo V, Canova F, Tonetto F, Loreggian L, Rea F, Conte P, Favaretto A. Radiological response and survival in locally advanced non-small-cell lung cancer patients treated with three-drug induction chemotherapy followed by radical local treatment. Onco Targets Ther 2016; 9:3671-81. [PMID: 27382305 PMCID: PMC4922786 DOI: 10.2147/ott.s98435] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES If concurrent chemoradiotherapy cannot be performed, induction chemotherapy followed by radical-intent surgical treatment is an acceptable option for non primarily resectable non-small-cell lung cancers (NSCLCs). No markers are available to predict which patients may benefit from local treatment after induction. This exploratory study aims to assess the feasibility and the activity of multimodality treatment, including triple-agent chemotherapy followed by radical surgery and/or radiotherapy in locally advanced NSCLCs. METHODS We retrospectively collected data from locally advanced NSCLCs treated with induction chemotherapy with carboplatin (area under the curve 6, d [day]1), paclitaxel (200 mg/m(2), d1), and gemcitabine (1,000 mg/m(2) d1, 8) for three to four courses, followed by radical surgery and/or radiotherapy. We analyzed radiological response and toxicity. Estimated progression-free survival (PFS) and overall survival (OS) were correlated to response, surgery, and clinical features. RESULTS In all, 58 NSCLCs were included in the study: 40 staged as IIIA, 18 as IIIB (according to TNM Classification of Malignant Tumors-7th edition staging system). A total of 36 (62%) patients achieved partial response (PR), and six (10%) progressions were recorded. Grade 3-4 hematological toxicity was observed in 36 (62%) cases. After chemotherapy, 37 (64%) patients underwent surgery followed by adjuvant radiotherapy, and two patients received radical-intent radiotherapy. The median PFS and OS were 11 months and 23 months, respectively. Both PFS and OS were significantly correlated to objective response (P<0.0001) and surgery (P<0.0001 and P=0.002). Patients obtaining PR and receiving local treatment achieved a median PFS and OS of 35 and 48 months, respectively. Median PFS and OS of patients not achieving PR or not receiving local treatment were 5-7 and 11-15 months, respectively. The extension of surgery did not affect the outcome. CONCLUSION The multimodality treatment was feasible, and triple-agent induction was associated with a considerable rate of PR. Patients achieving PR and receiving radical surgery or radiotherapy (53%) achieved a median OS of 4 years.
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Affiliation(s)
- Laura Bonanno
- Medical Oncology Unit 2, Veneto Institute of Oncology IOV-IRCCS
| | - Giulia Zago
- Medical Oncology Unit 2, Veneto Institute of Oncology IOV-IRCCS
| | | | - Paola Del Bianco
- Clinical Trials and Biostatistics Unit, Veneto Institute of Oncology IOV-IRCCS
| | | | - Giulia Pasello
- Medical Oncology Unit 2, Veneto Institute of Oncology IOV-IRCCS
| | - Valentina Polo
- Medical Oncology Unit 2, Veneto Institute of Oncology IOV-IRCCS
- Department of Surgery, Oncology and Gastroenterology, University of Padova
| | - Fabio Canova
- Medical Oncology Unit 2, Veneto Institute of Oncology IOV-IRCCS
| | - Fabrizio Tonetto
- Radiotherapy Unit, Veneto Institute of Oncology IOV-IRCCS, Padova, Italy
| | - Lucio Loreggian
- Radiotherapy Unit, Veneto Institute of Oncology IOV-IRCCS, Padova, Italy
| | - Federico Rea
- Thoracic Surgery Department, University of Padova
| | - PierFranco Conte
- Medical Oncology Unit 2, Veneto Institute of Oncology IOV-IRCCS
- Department of Surgery, Oncology and Gastroenterology, University of Padova
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11
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Surgery for Stage IIIA Non–Small-cell Lung Cancer: Lack of Predictive and Prognostic Factors Identifying Any Subgroup of Patients Benefiting From It. Clin Lung Cancer 2016; 17:107-12. [DOI: 10.1016/j.cllc.2015.11.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Revised: 10/28/2015] [Accepted: 11/03/2015] [Indexed: 02/03/2023]
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12
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Hui L, Sang C, Wang D, Wang X, Wang M, Jia Q, Ma M, Chen S. Newly synthesized podophyllotoxin derivative, LJ12, induces apoptosis and mitotic catastrophe in non-small cell lung cancer cells in vitro. Mol Med Rep 2015; 13:339-46. [PMID: 26573436 DOI: 10.3892/mmr.2015.4561] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 10/14/2015] [Indexed: 11/05/2022] Open
Abstract
Deoxypodophyllotoxin (DPT), an active compound isolated from a number of herbs and used in traditional medicine, has been reported to exhibit promising anti‑tumor activity. A newly synthesized derivative, N-(1-oxyl‑4'-demethyl-4-deoxyp odophyllic)-L‑methine-4'-piperazine carbamate (LJ12) may have improved antitumor activity and fewer side effects. The present study assessed the effect of LJ12 on cell viability, apoptosis, cell cycle distribution and mitotic catastrophe in A549 human lung cancer cells in vitro. The molecular mechanisms underlying the antitumor activity of LJ12 were also examined. The results demonstrated that LJ12 reduced A549 cell viability in a time‑ and dose‑dependent manner, with a lower half maximal inhibitory concentration of ~0.1 µM, compared with another known DPT derivative, etoposide (10 µM). Flow cytometric analysis showed that LJ12 induced tumor cell arrest at the G2/M phase of the cell cycle. The present study also observed an expected concomitant decrease in the numbers of cells cells in the G0/G1 and S phases. LJ12 was found to upregulate the protein expression levels of Cdc2 and Cyclin B1. Furthermore, LJ12 induced tumor cell apoptosis and the protein expression of B cell lymphoma‑2‑associated X protein, caspase‑3 and p53. The present study also observed the formation of giant, multinucleated cells, indicating that LJ12 induced mitotic catastrophe in the tumor cells. These results indicated that LJ12 has anti‑non‑small cell lung cancer activity in vitro. Further investigations aim to develop LJ12 as a therapeutic agent for the treatment of lung cancer.
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Affiliation(s)
- Ling Hui
- Experimental Center of Medicine, General Hospital of Lanzhou Military Area Command, Lanzhou, Gansu 730050, P.R. China
| | - Chunyan Sang
- Experimental Center of Medicine, General Hospital of Lanzhou Military Area Command, Lanzhou, Gansu 730050, P.R. China
| | - Donghong Wang
- Experimental Center of Medicine, General Hospital of Lanzhou Military Area Command, Lanzhou, Gansu 730050, P.R. China
| | - Xiaohui Wang
- Experimental Center of Medicine, General Hospital of Lanzhou Military Area Command, Lanzhou, Gansu 730050, P.R. China
| | - Meiliang Wang
- Experimental Center of Medicine, General Hospital of Lanzhou Military Area Command, Lanzhou, Gansu 730050, P.R. China
| | - Qinghua Jia
- Experimental Center of Medicine, General Hospital of Lanzhou Military Area Command, Lanzhou, Gansu 730050, P.R. China
| | - Mingren Ma
- Experimental Center of Medicine, General Hospital of Lanzhou Military Area Command, Lanzhou, Gansu 730050, P.R. China
| | - Shiwu Chen
- School of Pharmacy, Lanzhou University, Lanzhou, Gansu 730000, P.R. China
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13
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Eberhardt WEE, Pöttgen C, Gauler TC, Friedel G, Veit S, Heinrich V, Welter S, Budach W, Spengler W, Kimmich M, Fischer B, Schmidberger H, De Ruysscher D, Belka C, Cordes S, Hepp R, Lütke-Brintrup D, Lehmann N, Schuler M, Jöckel KH, Stamatis G, Stuschke M. Phase III Study of Surgery Versus Definitive Concurrent Chemoradiotherapy Boost in Patients With Resectable Stage IIIA(N2) and Selected IIIB Non-Small-Cell Lung Cancer After Induction Chemotherapy and Concurrent Chemoradiotherapy (ESPATUE). J Clin Oncol 2015; 33:4194-201. [PMID: 26527789 DOI: 10.1200/jco.2015.62.6812] [Citation(s) in RCA: 226] [Impact Index Per Article: 25.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE Concurrent chemoradiotherapy with or without surgery are options for stage IIIA(N2) non-small-cell lung cancer. Our previous phase II study had shown the efficacy of induction chemotherapy followed by chemoradiotherapy and surgery in patients with IIIA(N2) disease and with selected IIIB disease. Here, we compared surgery with definitive chemoradiotherapy in resectable stage III disease after induction. PATIENTS AND METHODS Patients with pathologically proven IIIA(N2) and selected patients with IIIB disease that had medical/functional operability received induction chemotherapy, which consisted of three cycles of cisplatin 50 mg/m(2) on days 1 and 8 and paclitaxel 175 mg/m(2) on day 1 every 21 days, as well as concurrent chemoradiotherapy to 45 Gy given as 1.5 Gy twice daily, concurrent cisplatin 50 mg/m(2) on days 2 and 9, and concurrent vinorelbine 20 mg/m(2) on days 2 and 9. Those patients whose tumors were reevaluated and deemed resectable in the last week of radiotherapy were randomly assigned to receive a chemoradiotherapy boost that was risk adapted to between 65 and 71 Gy in arm A or to undergo surgery (arm B). The primary end point was overall survival (OS). RESULTS After 246 of 500 planned patients were enrolled, the trial was closed after the second scheduled interim analysis because of slow accrual and the end of funding, which left the study underpowered relative to its primary study end point. Seventy-five patients had stage IIIA disease and 171 had stage IIIB disease according to the Union for International Cancer Control TNM classification, sixth edition. The median age was 59 years (range, 33 to 74 years). After induction, 161 (65.4%) of 246 patients with resectable tumors were randomly assigned; strata were tumor-node group, prophylactic cranial irradiation policy, and region. Patient characteristics were balanced between arms, in which 81 were assigned to surgery and 80 were assigned to a chemoradiotherapy boost. In arm B, 81% underwent R0 resection. With a median follow-up after random assignment of 78 months, 5-year OS and progression-free survival (PFS) did not differ between arms. Results were OS rates of 44% for arm B and 40% for arm A (log-rank P = .34) and PFS rates of 32% for arm B and 35% for arm A (log-rank P = .75). OS at 5 years was 34.1% (95% CI, 27.6% to 40.8%) in all 246 patients, and 216 patients (87.8%) received definitive local treatment. CONCLUSION The 5-year OS and PFS rates in randomly assigned patients with resectable stage III non-small-cell lung cancer were excellent with both treatments. Both are acceptable strategies for this good-prognosis group.
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Affiliation(s)
- Wilfried Ernst Erich Eberhardt
- Wilfried Ernst Erich Eberhardt, Christoph Pöttgen, Thomas Christoph Gauler, Sebastian Cordes, Rodrigo Hepp, Diana Lütke-Brintrup, Nils Lehmann, Martin Schuler, Karl-Heinz Jöckel, and Martin Stuschke, West German Cancer Center, University Hospital Essen, Essen; Stefan Welter and Georgios Stamatis, Ruhrlandklinik, Essen-Heidhausen; Godehard Friedel, Stefanie Veit, and Martin Kimmich, Robert-Bosch-Krankenhaus Klinik Schillerhöhe, Gerlingen; Vanessa Heinrich, Wilfried Budach, and Werner Spengler, Universitätsklinikum Tübingen, Tübingen; Berthold Fischer and Heinz Schmidberger, Universitätsmedizin der Johannes-Gutenberg-Universität Mainz, Mainz; Claus Belka, Klinikum der Universität München, München, Germany; and Dirk De Ruysscher, Maastro Clinic, Maastricht, the Netherlands.
| | - Christoph Pöttgen
- Wilfried Ernst Erich Eberhardt, Christoph Pöttgen, Thomas Christoph Gauler, Sebastian Cordes, Rodrigo Hepp, Diana Lütke-Brintrup, Nils Lehmann, Martin Schuler, Karl-Heinz Jöckel, and Martin Stuschke, West German Cancer Center, University Hospital Essen, Essen; Stefan Welter and Georgios Stamatis, Ruhrlandklinik, Essen-Heidhausen; Godehard Friedel, Stefanie Veit, and Martin Kimmich, Robert-Bosch-Krankenhaus Klinik Schillerhöhe, Gerlingen; Vanessa Heinrich, Wilfried Budach, and Werner Spengler, Universitätsklinikum Tübingen, Tübingen; Berthold Fischer and Heinz Schmidberger, Universitätsmedizin der Johannes-Gutenberg-Universität Mainz, Mainz; Claus Belka, Klinikum der Universität München, München, Germany; and Dirk De Ruysscher, Maastro Clinic, Maastricht, the Netherlands
| | - Thomas Christoph Gauler
- Wilfried Ernst Erich Eberhardt, Christoph Pöttgen, Thomas Christoph Gauler, Sebastian Cordes, Rodrigo Hepp, Diana Lütke-Brintrup, Nils Lehmann, Martin Schuler, Karl-Heinz Jöckel, and Martin Stuschke, West German Cancer Center, University Hospital Essen, Essen; Stefan Welter and Georgios Stamatis, Ruhrlandklinik, Essen-Heidhausen; Godehard Friedel, Stefanie Veit, and Martin Kimmich, Robert-Bosch-Krankenhaus Klinik Schillerhöhe, Gerlingen; Vanessa Heinrich, Wilfried Budach, and Werner Spengler, Universitätsklinikum Tübingen, Tübingen; Berthold Fischer and Heinz Schmidberger, Universitätsmedizin der Johannes-Gutenberg-Universität Mainz, Mainz; Claus Belka, Klinikum der Universität München, München, Germany; and Dirk De Ruysscher, Maastro Clinic, Maastricht, the Netherlands
| | - Godehard Friedel
- Wilfried Ernst Erich Eberhardt, Christoph Pöttgen, Thomas Christoph Gauler, Sebastian Cordes, Rodrigo Hepp, Diana Lütke-Brintrup, Nils Lehmann, Martin Schuler, Karl-Heinz Jöckel, and Martin Stuschke, West German Cancer Center, University Hospital Essen, Essen; Stefan Welter and Georgios Stamatis, Ruhrlandklinik, Essen-Heidhausen; Godehard Friedel, Stefanie Veit, and Martin Kimmich, Robert-Bosch-Krankenhaus Klinik Schillerhöhe, Gerlingen; Vanessa Heinrich, Wilfried Budach, and Werner Spengler, Universitätsklinikum Tübingen, Tübingen; Berthold Fischer and Heinz Schmidberger, Universitätsmedizin der Johannes-Gutenberg-Universität Mainz, Mainz; Claus Belka, Klinikum der Universität München, München, Germany; and Dirk De Ruysscher, Maastro Clinic, Maastricht, the Netherlands
| | - Stefanie Veit
- Wilfried Ernst Erich Eberhardt, Christoph Pöttgen, Thomas Christoph Gauler, Sebastian Cordes, Rodrigo Hepp, Diana Lütke-Brintrup, Nils Lehmann, Martin Schuler, Karl-Heinz Jöckel, and Martin Stuschke, West German Cancer Center, University Hospital Essen, Essen; Stefan Welter and Georgios Stamatis, Ruhrlandklinik, Essen-Heidhausen; Godehard Friedel, Stefanie Veit, and Martin Kimmich, Robert-Bosch-Krankenhaus Klinik Schillerhöhe, Gerlingen; Vanessa Heinrich, Wilfried Budach, and Werner Spengler, Universitätsklinikum Tübingen, Tübingen; Berthold Fischer and Heinz Schmidberger, Universitätsmedizin der Johannes-Gutenberg-Universität Mainz, Mainz; Claus Belka, Klinikum der Universität München, München, Germany; and Dirk De Ruysscher, Maastro Clinic, Maastricht, the Netherlands
| | - Vanessa Heinrich
- Wilfried Ernst Erich Eberhardt, Christoph Pöttgen, Thomas Christoph Gauler, Sebastian Cordes, Rodrigo Hepp, Diana Lütke-Brintrup, Nils Lehmann, Martin Schuler, Karl-Heinz Jöckel, and Martin Stuschke, West German Cancer Center, University Hospital Essen, Essen; Stefan Welter and Georgios Stamatis, Ruhrlandklinik, Essen-Heidhausen; Godehard Friedel, Stefanie Veit, and Martin Kimmich, Robert-Bosch-Krankenhaus Klinik Schillerhöhe, Gerlingen; Vanessa Heinrich, Wilfried Budach, and Werner Spengler, Universitätsklinikum Tübingen, Tübingen; Berthold Fischer and Heinz Schmidberger, Universitätsmedizin der Johannes-Gutenberg-Universität Mainz, Mainz; Claus Belka, Klinikum der Universität München, München, Germany; and Dirk De Ruysscher, Maastro Clinic, Maastricht, the Netherlands
| | - Stefan Welter
- Wilfried Ernst Erich Eberhardt, Christoph Pöttgen, Thomas Christoph Gauler, Sebastian Cordes, Rodrigo Hepp, Diana Lütke-Brintrup, Nils Lehmann, Martin Schuler, Karl-Heinz Jöckel, and Martin Stuschke, West German Cancer Center, University Hospital Essen, Essen; Stefan Welter and Georgios Stamatis, Ruhrlandklinik, Essen-Heidhausen; Godehard Friedel, Stefanie Veit, and Martin Kimmich, Robert-Bosch-Krankenhaus Klinik Schillerhöhe, Gerlingen; Vanessa Heinrich, Wilfried Budach, and Werner Spengler, Universitätsklinikum Tübingen, Tübingen; Berthold Fischer and Heinz Schmidberger, Universitätsmedizin der Johannes-Gutenberg-Universität Mainz, Mainz; Claus Belka, Klinikum der Universität München, München, Germany; and Dirk De Ruysscher, Maastro Clinic, Maastricht, the Netherlands
| | - Wilfried Budach
- Wilfried Ernst Erich Eberhardt, Christoph Pöttgen, Thomas Christoph Gauler, Sebastian Cordes, Rodrigo Hepp, Diana Lütke-Brintrup, Nils Lehmann, Martin Schuler, Karl-Heinz Jöckel, and Martin Stuschke, West German Cancer Center, University Hospital Essen, Essen; Stefan Welter and Georgios Stamatis, Ruhrlandklinik, Essen-Heidhausen; Godehard Friedel, Stefanie Veit, and Martin Kimmich, Robert-Bosch-Krankenhaus Klinik Schillerhöhe, Gerlingen; Vanessa Heinrich, Wilfried Budach, and Werner Spengler, Universitätsklinikum Tübingen, Tübingen; Berthold Fischer and Heinz Schmidberger, Universitätsmedizin der Johannes-Gutenberg-Universität Mainz, Mainz; Claus Belka, Klinikum der Universität München, München, Germany; and Dirk De Ruysscher, Maastro Clinic, Maastricht, the Netherlands
| | - Werner Spengler
- Wilfried Ernst Erich Eberhardt, Christoph Pöttgen, Thomas Christoph Gauler, Sebastian Cordes, Rodrigo Hepp, Diana Lütke-Brintrup, Nils Lehmann, Martin Schuler, Karl-Heinz Jöckel, and Martin Stuschke, West German Cancer Center, University Hospital Essen, Essen; Stefan Welter and Georgios Stamatis, Ruhrlandklinik, Essen-Heidhausen; Godehard Friedel, Stefanie Veit, and Martin Kimmich, Robert-Bosch-Krankenhaus Klinik Schillerhöhe, Gerlingen; Vanessa Heinrich, Wilfried Budach, and Werner Spengler, Universitätsklinikum Tübingen, Tübingen; Berthold Fischer and Heinz Schmidberger, Universitätsmedizin der Johannes-Gutenberg-Universität Mainz, Mainz; Claus Belka, Klinikum der Universität München, München, Germany; and Dirk De Ruysscher, Maastro Clinic, Maastricht, the Netherlands
| | - Martin Kimmich
- Wilfried Ernst Erich Eberhardt, Christoph Pöttgen, Thomas Christoph Gauler, Sebastian Cordes, Rodrigo Hepp, Diana Lütke-Brintrup, Nils Lehmann, Martin Schuler, Karl-Heinz Jöckel, and Martin Stuschke, West German Cancer Center, University Hospital Essen, Essen; Stefan Welter and Georgios Stamatis, Ruhrlandklinik, Essen-Heidhausen; Godehard Friedel, Stefanie Veit, and Martin Kimmich, Robert-Bosch-Krankenhaus Klinik Schillerhöhe, Gerlingen; Vanessa Heinrich, Wilfried Budach, and Werner Spengler, Universitätsklinikum Tübingen, Tübingen; Berthold Fischer and Heinz Schmidberger, Universitätsmedizin der Johannes-Gutenberg-Universität Mainz, Mainz; Claus Belka, Klinikum der Universität München, München, Germany; and Dirk De Ruysscher, Maastro Clinic, Maastricht, the Netherlands
| | - Berthold Fischer
- Wilfried Ernst Erich Eberhardt, Christoph Pöttgen, Thomas Christoph Gauler, Sebastian Cordes, Rodrigo Hepp, Diana Lütke-Brintrup, Nils Lehmann, Martin Schuler, Karl-Heinz Jöckel, and Martin Stuschke, West German Cancer Center, University Hospital Essen, Essen; Stefan Welter and Georgios Stamatis, Ruhrlandklinik, Essen-Heidhausen; Godehard Friedel, Stefanie Veit, and Martin Kimmich, Robert-Bosch-Krankenhaus Klinik Schillerhöhe, Gerlingen; Vanessa Heinrich, Wilfried Budach, and Werner Spengler, Universitätsklinikum Tübingen, Tübingen; Berthold Fischer and Heinz Schmidberger, Universitätsmedizin der Johannes-Gutenberg-Universität Mainz, Mainz; Claus Belka, Klinikum der Universität München, München, Germany; and Dirk De Ruysscher, Maastro Clinic, Maastricht, the Netherlands
| | - Heinz Schmidberger
- Wilfried Ernst Erich Eberhardt, Christoph Pöttgen, Thomas Christoph Gauler, Sebastian Cordes, Rodrigo Hepp, Diana Lütke-Brintrup, Nils Lehmann, Martin Schuler, Karl-Heinz Jöckel, and Martin Stuschke, West German Cancer Center, University Hospital Essen, Essen; Stefan Welter and Georgios Stamatis, Ruhrlandklinik, Essen-Heidhausen; Godehard Friedel, Stefanie Veit, and Martin Kimmich, Robert-Bosch-Krankenhaus Klinik Schillerhöhe, Gerlingen; Vanessa Heinrich, Wilfried Budach, and Werner Spengler, Universitätsklinikum Tübingen, Tübingen; Berthold Fischer and Heinz Schmidberger, Universitätsmedizin der Johannes-Gutenberg-Universität Mainz, Mainz; Claus Belka, Klinikum der Universität München, München, Germany; and Dirk De Ruysscher, Maastro Clinic, Maastricht, the Netherlands
| | - Dirk De Ruysscher
- Wilfried Ernst Erich Eberhardt, Christoph Pöttgen, Thomas Christoph Gauler, Sebastian Cordes, Rodrigo Hepp, Diana Lütke-Brintrup, Nils Lehmann, Martin Schuler, Karl-Heinz Jöckel, and Martin Stuschke, West German Cancer Center, University Hospital Essen, Essen; Stefan Welter and Georgios Stamatis, Ruhrlandklinik, Essen-Heidhausen; Godehard Friedel, Stefanie Veit, and Martin Kimmich, Robert-Bosch-Krankenhaus Klinik Schillerhöhe, Gerlingen; Vanessa Heinrich, Wilfried Budach, and Werner Spengler, Universitätsklinikum Tübingen, Tübingen; Berthold Fischer and Heinz Schmidberger, Universitätsmedizin der Johannes-Gutenberg-Universität Mainz, Mainz; Claus Belka, Klinikum der Universität München, München, Germany; and Dirk De Ruysscher, Maastro Clinic, Maastricht, the Netherlands
| | - Claus Belka
- Wilfried Ernst Erich Eberhardt, Christoph Pöttgen, Thomas Christoph Gauler, Sebastian Cordes, Rodrigo Hepp, Diana Lütke-Brintrup, Nils Lehmann, Martin Schuler, Karl-Heinz Jöckel, and Martin Stuschke, West German Cancer Center, University Hospital Essen, Essen; Stefan Welter and Georgios Stamatis, Ruhrlandklinik, Essen-Heidhausen; Godehard Friedel, Stefanie Veit, and Martin Kimmich, Robert-Bosch-Krankenhaus Klinik Schillerhöhe, Gerlingen; Vanessa Heinrich, Wilfried Budach, and Werner Spengler, Universitätsklinikum Tübingen, Tübingen; Berthold Fischer and Heinz Schmidberger, Universitätsmedizin der Johannes-Gutenberg-Universität Mainz, Mainz; Claus Belka, Klinikum der Universität München, München, Germany; and Dirk De Ruysscher, Maastro Clinic, Maastricht, the Netherlands
| | - Sebastian Cordes
- Wilfried Ernst Erich Eberhardt, Christoph Pöttgen, Thomas Christoph Gauler, Sebastian Cordes, Rodrigo Hepp, Diana Lütke-Brintrup, Nils Lehmann, Martin Schuler, Karl-Heinz Jöckel, and Martin Stuschke, West German Cancer Center, University Hospital Essen, Essen; Stefan Welter and Georgios Stamatis, Ruhrlandklinik, Essen-Heidhausen; Godehard Friedel, Stefanie Veit, and Martin Kimmich, Robert-Bosch-Krankenhaus Klinik Schillerhöhe, Gerlingen; Vanessa Heinrich, Wilfried Budach, and Werner Spengler, Universitätsklinikum Tübingen, Tübingen; Berthold Fischer and Heinz Schmidberger, Universitätsmedizin der Johannes-Gutenberg-Universität Mainz, Mainz; Claus Belka, Klinikum der Universität München, München, Germany; and Dirk De Ruysscher, Maastro Clinic, Maastricht, the Netherlands
| | - Rodrigo Hepp
- Wilfried Ernst Erich Eberhardt, Christoph Pöttgen, Thomas Christoph Gauler, Sebastian Cordes, Rodrigo Hepp, Diana Lütke-Brintrup, Nils Lehmann, Martin Schuler, Karl-Heinz Jöckel, and Martin Stuschke, West German Cancer Center, University Hospital Essen, Essen; Stefan Welter and Georgios Stamatis, Ruhrlandklinik, Essen-Heidhausen; Godehard Friedel, Stefanie Veit, and Martin Kimmich, Robert-Bosch-Krankenhaus Klinik Schillerhöhe, Gerlingen; Vanessa Heinrich, Wilfried Budach, and Werner Spengler, Universitätsklinikum Tübingen, Tübingen; Berthold Fischer and Heinz Schmidberger, Universitätsmedizin der Johannes-Gutenberg-Universität Mainz, Mainz; Claus Belka, Klinikum der Universität München, München, Germany; and Dirk De Ruysscher, Maastro Clinic, Maastricht, the Netherlands
| | - Diana Lütke-Brintrup
- Wilfried Ernst Erich Eberhardt, Christoph Pöttgen, Thomas Christoph Gauler, Sebastian Cordes, Rodrigo Hepp, Diana Lütke-Brintrup, Nils Lehmann, Martin Schuler, Karl-Heinz Jöckel, and Martin Stuschke, West German Cancer Center, University Hospital Essen, Essen; Stefan Welter and Georgios Stamatis, Ruhrlandklinik, Essen-Heidhausen; Godehard Friedel, Stefanie Veit, and Martin Kimmich, Robert-Bosch-Krankenhaus Klinik Schillerhöhe, Gerlingen; Vanessa Heinrich, Wilfried Budach, and Werner Spengler, Universitätsklinikum Tübingen, Tübingen; Berthold Fischer and Heinz Schmidberger, Universitätsmedizin der Johannes-Gutenberg-Universität Mainz, Mainz; Claus Belka, Klinikum der Universität München, München, Germany; and Dirk De Ruysscher, Maastro Clinic, Maastricht, the Netherlands
| | - Nils Lehmann
- Wilfried Ernst Erich Eberhardt, Christoph Pöttgen, Thomas Christoph Gauler, Sebastian Cordes, Rodrigo Hepp, Diana Lütke-Brintrup, Nils Lehmann, Martin Schuler, Karl-Heinz Jöckel, and Martin Stuschke, West German Cancer Center, University Hospital Essen, Essen; Stefan Welter and Georgios Stamatis, Ruhrlandklinik, Essen-Heidhausen; Godehard Friedel, Stefanie Veit, and Martin Kimmich, Robert-Bosch-Krankenhaus Klinik Schillerhöhe, Gerlingen; Vanessa Heinrich, Wilfried Budach, and Werner Spengler, Universitätsklinikum Tübingen, Tübingen; Berthold Fischer and Heinz Schmidberger, Universitätsmedizin der Johannes-Gutenberg-Universität Mainz, Mainz; Claus Belka, Klinikum der Universität München, München, Germany; and Dirk De Ruysscher, Maastro Clinic, Maastricht, the Netherlands
| | - Martin Schuler
- Wilfried Ernst Erich Eberhardt, Christoph Pöttgen, Thomas Christoph Gauler, Sebastian Cordes, Rodrigo Hepp, Diana Lütke-Brintrup, Nils Lehmann, Martin Schuler, Karl-Heinz Jöckel, and Martin Stuschke, West German Cancer Center, University Hospital Essen, Essen; Stefan Welter and Georgios Stamatis, Ruhrlandklinik, Essen-Heidhausen; Godehard Friedel, Stefanie Veit, and Martin Kimmich, Robert-Bosch-Krankenhaus Klinik Schillerhöhe, Gerlingen; Vanessa Heinrich, Wilfried Budach, and Werner Spengler, Universitätsklinikum Tübingen, Tübingen; Berthold Fischer and Heinz Schmidberger, Universitätsmedizin der Johannes-Gutenberg-Universität Mainz, Mainz; Claus Belka, Klinikum der Universität München, München, Germany; and Dirk De Ruysscher, Maastro Clinic, Maastricht, the Netherlands
| | - Karl-Heinz Jöckel
- Wilfried Ernst Erich Eberhardt, Christoph Pöttgen, Thomas Christoph Gauler, Sebastian Cordes, Rodrigo Hepp, Diana Lütke-Brintrup, Nils Lehmann, Martin Schuler, Karl-Heinz Jöckel, and Martin Stuschke, West German Cancer Center, University Hospital Essen, Essen; Stefan Welter and Georgios Stamatis, Ruhrlandklinik, Essen-Heidhausen; Godehard Friedel, Stefanie Veit, and Martin Kimmich, Robert-Bosch-Krankenhaus Klinik Schillerhöhe, Gerlingen; Vanessa Heinrich, Wilfried Budach, and Werner Spengler, Universitätsklinikum Tübingen, Tübingen; Berthold Fischer and Heinz Schmidberger, Universitätsmedizin der Johannes-Gutenberg-Universität Mainz, Mainz; Claus Belka, Klinikum der Universität München, München, Germany; and Dirk De Ruysscher, Maastro Clinic, Maastricht, the Netherlands
| | - Georgios Stamatis
- Wilfried Ernst Erich Eberhardt, Christoph Pöttgen, Thomas Christoph Gauler, Sebastian Cordes, Rodrigo Hepp, Diana Lütke-Brintrup, Nils Lehmann, Martin Schuler, Karl-Heinz Jöckel, and Martin Stuschke, West German Cancer Center, University Hospital Essen, Essen; Stefan Welter and Georgios Stamatis, Ruhrlandklinik, Essen-Heidhausen; Godehard Friedel, Stefanie Veit, and Martin Kimmich, Robert-Bosch-Krankenhaus Klinik Schillerhöhe, Gerlingen; Vanessa Heinrich, Wilfried Budach, and Werner Spengler, Universitätsklinikum Tübingen, Tübingen; Berthold Fischer and Heinz Schmidberger, Universitätsmedizin der Johannes-Gutenberg-Universität Mainz, Mainz; Claus Belka, Klinikum der Universität München, München, Germany; and Dirk De Ruysscher, Maastro Clinic, Maastricht, the Netherlands
| | - Martin Stuschke
- Wilfried Ernst Erich Eberhardt, Christoph Pöttgen, Thomas Christoph Gauler, Sebastian Cordes, Rodrigo Hepp, Diana Lütke-Brintrup, Nils Lehmann, Martin Schuler, Karl-Heinz Jöckel, and Martin Stuschke, West German Cancer Center, University Hospital Essen, Essen; Stefan Welter and Georgios Stamatis, Ruhrlandklinik, Essen-Heidhausen; Godehard Friedel, Stefanie Veit, and Martin Kimmich, Robert-Bosch-Krankenhaus Klinik Schillerhöhe, Gerlingen; Vanessa Heinrich, Wilfried Budach, and Werner Spengler, Universitätsklinikum Tübingen, Tübingen; Berthold Fischer and Heinz Schmidberger, Universitätsmedizin der Johannes-Gutenberg-Universität Mainz, Mainz; Claus Belka, Klinikum der Universität München, München, Germany; and Dirk De Ruysscher, Maastro Clinic, Maastricht, the Netherlands
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14
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Affiliation(s)
- Wilfried E E Eberhardt
- Department of Medical Oncology, West German Cancer Centre, Ruhrlandklinik, University Hospital Essen, University Duisburg-Essen, 45122 Essen, Germany.
| | - Martin Stuschke
- Department of Radiation Oncology, West German Tumour Centre, University Hospital Essen, Essen, Germany
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15
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Eberhardt WEE, De Ruysscher D, Weder W, Le Péchoux C, De Leyn P, Hoffmann H, Westeel V, Stahel R, Felip E, Peters S. 2nd ESMO Consensus Conference in Lung Cancer: locally advanced stage III non-small-cell lung cancer. Ann Oncol 2015; 26:1573-88. [PMID: 25897013 DOI: 10.1093/annonc/mdv187] [Citation(s) in RCA: 271] [Impact Index Per Article: 30.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Accepted: 04/09/2015] [Indexed: 12/25/2022] Open
Abstract
To complement the existing treatment guidelines for all tumour types, ESMO organises consensus conferences to focus on specific issues in each type of tumour. The 2nd ESMO Consensus Conference on Lung Cancer was held on 11-12 May 2013 in Lugano. A total of 35 experts met to address several questions on non-small-cell lung cancer (NSCLC) in each of four areas: pathology and molecular biomarkers, first-line/second and further lines of treatment in advanced disease, early-stage disease and locally advanced disease. For each question, recommendations were made including reference to the grade of recommendation and level of evidence. This consensus paper focuses on locally advanced disease.
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Affiliation(s)
- W E E Eberhardt
- Department of Medical Oncology, West German Cancer Centre, University Hospital, University Duisburg-Essen, Ruhrlandklinik, Essen, Germany
| | - D De Ruysscher
- Department of Radiation Oncology, KU Leuven-University of Leuven, University Hospitals Leuven, Leuven, Belgium
| | - W Weder
- Division of Thoracic Surgery, University Hospital Zürich, Zürich, Switzerland
| | - C Le Péchoux
- Department of Radiation Oncology, Gustave Roussy Cancer Institute, Villejuif, France
| | - P De Leyn
- Department of Thoracic Surgery, University Hospitals, KU Leuven, Leuven, Belgium
| | - H Hoffmann
- Department of Thoracic Surgery, Thoraxklinik, University of Heidelberg, Heidelberg, Germany
| | - V Westeel
- Department of Chest Disease, University Hospital, Besançon, France
| | - R Stahel
- Clinic of Oncology, University Hospital Zürich, Zürich, Switzerland
| | - E Felip
- Department of Medical Oncology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - S Peters
- Département d'Oncologie, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
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16
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Yalman D. Neoadjuvant radiotherapy/chemoradiotherapy in locally advanced non-small cell lung cancer. Balkan Med J 2015; 32:1-7. [PMID: 25759765 DOI: 10.5152/balkanmedj.2014.14573] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Accepted: 09/09/2014] [Indexed: 12/25/2022] Open
Abstract
Locally advanced non-small cell lung cancer (NSCLC) consists of a heterogeneous group of patients, and the optimal treatment is still controversial. The current standard of care is concurrent chemoradiotherapy. The prognosis is still poor, with high rates of local and distant failure despite multimodality treatment. One of the efforts to improve outcomes in these patients is to use neoadjuvant treatment to improve resectability, and downstaging the nodal disease, which has a clear impact on prognosis. Radiotherapy as the sole neoadjuvant modality has been used historically without any survival benefit, but with increased toxicity. After the demonstrating a survival benefit by combining radiotherapy and chemotherapy, phase II studies were started to determine the neoadjuvant administration of these two modalities together. Although the results of these studies revealed a heterogeneous postinduction pathologic complete response, tumor and nodal down-staging can be achieved at the cost of a slightly higher morbidity and mortality. Subsequent phase III trials also failed to show a survival benefit to surgery, but indicated that there may be a subset of patients with locally advanced disease who can benefit from resection unless pneumonectomy is not provided. In order to increase the efficacy of radiotherapy, hyperfractionated-accelerated schedules have been used with promising complete pathologic response rates, which might improve prognosis. Recently, studies applying high radiotherapy doses in the neoadjuvant setting demonstrated the safety of resection after radiotherapy, with high nodal clearance rates and encouraging long-term survival results. In conclusion, neoadjuvant treatment of locally advanced NSCLC is one of the most challenging issues in the treatment of this disease, but it can be offered to appropriately selected patients, and should be done by a multidisciplinary team. Individual risk profiles, definite role of radiotherapy with optimal timing, and dose need to be clarified by carefully designed clinical trials.
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Affiliation(s)
- Deniz Yalman
- Department of Radiation Oncology, Ege University Faculty of Medicine, İzmir, Turkey
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17
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Bloy N, Pol J, Manic G, Vitale I, Eggermont A, Galon J, Tartour E, Zitvogel L, Kroemer G, Galluzzi L. Trial Watch: Radioimmunotherapy for oncological indications. Oncoimmunology 2014; 3:e954929. [PMID: 25941606 DOI: 10.4161/21624011.2014.954929] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Accepted: 07/18/2014] [Indexed: 02/06/2023] Open
Abstract
During the past two decades, it has become increasingly clear that the antineoplastic effects of radiation therapy do not simply reflect the ability of X-, β- and γ-rays to damage transformed cells and directly cause their permanent proliferative arrest or demise, but also involve cancer cell-extrinsic mechanisms. Indeed, among other activities, radiotherapy has been shown to favor the establishment of tumor-specific immune responses that operate systemically, underpinning the so-called 'out-of-field' or 'abscopal' effect. Thus, ionizing rays appear to elicit immunogenic cell death, a functionally peculiar variant of apoptosis associated with the emission of a particularly immunostimulatory combination of damage-associated molecular patterns. In line with this notion, radiation therapy fosters, and thus exacerbates, the antineoplastic effects of various treatment modalities, including surgery, chemotherapy and various immunotherapeutic agents. Here, we summarize recent advances in the use of ionizing rays as a means to induce or potentiate therapeutically relevant anticancer immune responses. In addition, we present clinical trials initiated during the past 12 months to test the actual benefit of radioimmunotherapy in cancer patients.
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Affiliation(s)
- Norma Bloy
- Gustave Roussy Cancer Campus ; Villejuif, France ; INSERM, U1138 ; Paris, France ; Equipe 11 labellisée par la Ligue Nationale contre le Cancer; Centre de Recherche des Cordeliers ; Paris, France ; Université Paris-Sud/Paris XI ; Paris, France
| | - Jonathan Pol
- Gustave Roussy Cancer Campus ; Villejuif, France ; INSERM, U1138 ; Paris, France ; Equipe 11 labellisée par la Ligue Nationale contre le Cancer; Centre de Recherche des Cordeliers ; Paris, France
| | - Gwenola Manic
- Regina Elena National Cancer Institute ; Rome, Italy
| | - Ilio Vitale
- Regina Elena National Cancer Institute ; Rome, Italy
| | | | - Jérôme Galon
- INSERM, U1138 ; Paris, France ; Université Paris Descartes/Paris V; Sorbonne Paris Cité ; Paris, France ; Université Pierre et Marie Curie/Paris VI ; Paris, France ; Laboratory of Integrative Cancer Immunology, Centre de Recherche des Cordeliers ; Paris, France
| | - Eric Tartour
- Université Paris Descartes/Paris V; Sorbonne Paris Cité ; Paris, France ; INSERM, U970 ; Paris, France ; Pôle de Biologie, Hôpital Européen Georges Pompidou, AP-HP ; Paris, France
| | - Laurence Zitvogel
- Gustave Roussy Cancer Campus ; Villejuif, France ; INSERM, U1015; CICBT507 ; Villejuif, France
| | - Guido Kroemer
- INSERM, U1138 ; Paris, France ; Equipe 11 labellisée par la Ligue Nationale contre le Cancer; Centre de Recherche des Cordeliers ; Paris, France ; Université Paris Descartes/Paris V; Sorbonne Paris Cité ; Paris, France ; Pôle de Biologie, Hôpital Européen Georges Pompidou, AP-HP ; Paris, France ; Metabolomics and Cell Biology Platforms; Gustave Roussy Cancer Campus ; Villejuif, France
| | - Lorenzo Galluzzi
- Gustave Roussy Cancer Campus ; Villejuif, France ; Equipe 11 labellisée par la Ligue Nationale contre le Cancer; Centre de Recherche des Cordeliers ; Paris, France ; Université Paris Descartes/Paris V; Sorbonne Paris Cité ; Paris, France
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18
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Vrankar M, Zwitter M, Bavcar T, Milic A, Kovac V. Induction gemcitabine in standard dose or prolonged low-dose with cisplatin followed by concurrent radiochemotherapy in locally advanced non-small cell lung cancer: a randomized phase II clinical trial. Radiol Oncol 2014; 48:369-80. [PMID: 25435850 PMCID: PMC4230557 DOI: 10.2478/raon-2014-0026] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Accepted: 04/18/2014] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The optimal combination of chemotherapy with radiation therapy for treatment locally advanced non-small cell lung cancer (NSCLC) remains an open issue. This randomized phase II study compared gemcitabine in two different schedules and cisplatin - as induction chemotherapy, followed by radiation therapy concurrent with cisplatin and etoposid. PATIENTS AND METHODS Eligible patients had microscopically confirmed inoperable non-metastatic non-small cell lung cancer; fulfilled the standard criteria for platin-based chemotherapy; and signed informed consent. Patients were treated with 3 cycles of induction chemotherapy with gemcitabine and cisplatin. Two different aplications of gemcitabine were compared: patients in arm A received gemcitabine at 1250 mg/m(2) in a standard half hour i.v. infusion on days 1 and 8; patients in arm B received gemcitabine at 250 mg/m(2) in prolonged 6-hours i.v. infusion on days 1 and 8. In both arms, cisplatin 75 mg/m(2) on day 2 was administered. All patients continued treatment with radiation therapy with 60-66 Gy concurrent with cisplatin 50 mg/m(2) on days 1, 8, 29 and 36 and etoposid 50 mg/m(2) on days 1-5 and 29-33. The primary endpoint was response rate (RR) after induction chemotherapy; secondary endpoints were toxicity, progression-free survival (PFS) and overall survival (OS). RESULTS From September 2005 to November 2010, 106 patients were recruited to this study. No statistically signifficant differences were found in RR after induction chemotherapy between the two arms (48.1% and 57.4%, p = 0.34). Toxicity profile was comparable and mild with grade 3/4 neutropenia as primary toxicity in both arms. One patient in arm B suffered from acute peripheral ischemia grade 4 and an amputation of lower limb was needed. With a median follow-up of 69.3 months, progression-free survival and median survival in arm A were 15.7 and 24.8 months compared to 18.9 and 28.6 months in arm B. The figures for 1- and 3-year overall survival were 73.1% and 30.8% in arm A, and 81.5 % and 44.4% in arm B, respectively. CONCLUSIONS Among the two cisplatin-based doublets of induction chemotherapy for inoperable NSCLC, both schedules of gemcitabine have a comparable toxicity profile. Figures for RR, PFS and OS are among the best reported in current literature. While there is a trend towards better efficacy of the treament with prolonged infusion of gemcitabine, the difference between the two arms did not reach statistical significance.
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Affiliation(s)
| | - Matjaz Zwitter
- Institute of Oncology Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Maribor, Slovenia
| | - Tanja Bavcar
- Clinical Radiology Institute, University Medical Centre Ljubljana, Slovenia
| | - Ana Milic
- Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Viljem Kovac
- Institute of Oncology Ljubljana, Ljubljana, Slovenia
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19
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Askoxylakis V, Tanner J, Kappes J, Hoffmann H, Nicolay NH, Rief H, Debus J, Thomas M, Bischof M. Trimodal therapy for stage III-N2 non-small-cell lung carcinoma: a single center retrospective analysis. BMC Cancer 2014; 14:572. [PMID: 25104240 PMCID: PMC4137085 DOI: 10.1186/1471-2407-14-572] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Accepted: 07/24/2014] [Indexed: 12/19/2022] Open
Abstract
Background Treatment of locally advanced non-small-cell lung cancer is based on a combined approach. To study the impact of trimodal therapy for stage III-N2 NSCLC a single centre retrospective evaluation focusing on survival and therapy-related toxicity was performed. Methods 71 patients diagnosed between March 2001 and August 2008 with pathologically confirmed stage III-N2 non-small-cell lung cancer at the University Clinic of Heidelberg were retrospectively analyzed. All patients were treated within trimodal therapy strategies including surgery, induction or adjuvant chemotherapy and postoperative radiotherapy. Overall survival (OS) and disease free survival (DFS) rates were calculated using the Kaplan-Meier method. The log-rank test and Fishers Exact test were applied for univariate analysis and Cox proportional regression model for multivariate analysis. Results Median survival was 32 months. 1-, 3- and 5-year overall survival (OS) rates were 84.5%, 49.6% and 35.5% respectively. Disease free survival rates at 1, 3 and 5 years were 70.4%, 41.8% and 27.4% respectively. 9 patients (12.6%) were diagnosed with a local recurrence. Multivariate analysis did not reveal any independent prognostic factors for OS, but indicated a trend for pT stage and type of surgery. In regard to toxicity 8.4% of the patients developed a clinically relevant ≥ grade 2 pneumonitis. Evaluation of the forced expiratory volume in 1 second per unit of vital capacity (FEV1/VC) before and 1-3 years post radiotherapy revealed a median decrease of 2.1%. Conclusions Our descriptive data indicate that trimodal therapy represents an effective and safe treatment approach for patients with stage III-N2 non-small-cell lung cancer. Further prospective clinical trials are necessary in order to clearly define the impact of multimodal strategies and optimize NSCLC treatment.
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