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Seiwerth F, Bitar L, Samaržija M, Jakopović M. Long-term progression-free survival in non-small cell lung cancer patients: a spotlight on bevacizumab and its biosimilars. Expert Opin Biol Ther 2024:1-8. [PMID: 39285584 DOI: 10.1080/14712598.2024.2405562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Accepted: 09/13/2024] [Indexed: 09/20/2024]
Abstract
INTRODUCTION In the era of immunotherapy, bevacizumab seems to be losing its place in NSCLC treatment algorithms. The aim of this work is to try to define the advantages and disadvantages of NSCLC treatment with bevacizumab in combination regimens. AREAS COVERED We conducted a literature search in PubMed and Google Scholar to review the most important topics regarding bevacizumab treatment in NSCLC, with or without driver mutations, including trials with checkpoint inhibitors. Special emphasis was placed on the analysis of data on the treatment of patients with CNS metastases. EXPERT OPINION Bevacizumab is an antiangiogenic compound whose addition to chemotherapy made the first major breakthrough in the treatment of NSCLC. However, for the last 10 years or so, the use of combination immunotherapy regimens has suppressed the use and acquisition of new knowledge about bevacizumab. Newer data are primarily related to the treatment of EGFR-positive NSCLC patients with bevacizumab, with only a few larger studies investigating the use of a combination of bevacizumab and checkpoint inhibitors. The basic task remains to define the place of bevacizumab in treatment algorithms.
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Affiliation(s)
- Fran Seiwerth
- Department of Lung Diseases Jordanovac, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Lela Bitar
- Department of Lung Diseases Jordanovac, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Miroslav Samaržija
- Department of Lung Diseases Jordanovac, University Hospital Centre Zagreb, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Marko Jakopović
- Department of Lung Diseases Jordanovac, University Hospital Centre Zagreb, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
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Zhou Y, Li J, Li Y, Deng G, Wang Q, Qin H, Li J, Li Z. Bevacizumab improved prognosis for advanced EGFR-mutant lung adenocarcinoma with brain metastasis receiving cerebral radiotherapy. Clin Transl Oncol 2024; 26:1968-1975. [PMID: 38478262 PMCID: PMC11249594 DOI: 10.1007/s12094-024-03418-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 02/23/2024] [Indexed: 07/16/2024]
Abstract
OBJECTIVE This study aimed to determine whether the combined use of bevacizumab could improve overall survival (OS) in patients with brain metastasis (BM), epidermal growth factor receptor (EGFR)-mutant non-small cell lung cancer (NSCLC) undergoing cerebral radiotherapy. MATERIALS AND METHODS A total of 237 patients with EGFR-mutant lung adenocarcinoma and BM met the inclusion criteria for this retrospective study, including 102 patients in the bevacizumab treatment group and 135 in the non-bevacizumab group. The Kaplan-Meier method was used for survival analysis. Univariate and multivariate analyses were performed to identify EGFR-mutated BM prognostic factors for these patients. RESULTS At the end of the last follow-up period, 176 patients (74.3%) had died, and the median overall survival (OS) was 34.2 months. We observed a significant difference in the median OS between the bevacizumab and non-bevacizumab groups (45.8 months vs 30.0 months, P < 0.0001). Among the 178 (75.1%) patients who received cerebral radiotherapy, the median OS of patients in the bevacizumab + cerebral radiotherapy group was 45.8 months versus 32.0 months in the non-bevacizumab + cerebral radiotherapy group, respectively (P = 0.0007). Patients treated with bevacizumab after cerebral radiotherapy had a longer median OS than patients treated with bevacizumab before cerebral radiotherapy (59.4 months vs 33.7 months, P = 0.0198). In the univariate analysis, smoking status, Lung-molGPA scores, and bevacizumab therapy showed correlations (HR = 1.450, P = 0.045; HR = 0.700, P = 0.023; HR = 0.499, P < 0.001). Multivariate analysis showed that bevacizumab therapy alone (hazard ratio [HR] = 0.514; P < 0.001) was independently associated with improved OS. CONCLUSION In patients with BM from EGFR-mutated NSCLC, cerebral radiotherapy with bevacizumab markedly improved OS. This improvement was more evident after cerebral radiotherapy.
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Affiliation(s)
- Yuanliang Zhou
- Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, People's Republic of China
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, 250117, People's Republic of China
| | - Jingchao Li
- The People's Hospital of Zhangqiu Area, Jinan, People's Republic of China
| | - Yankang Li
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, 250117, People's Republic of China
| | - Guangchuan Deng
- Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, People's Republic of China
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, 250117, People's Republic of China
| | - Qi Wang
- Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, People's Republic of China
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, 250117, People's Republic of China
| | - Hongyue Qin
- Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, People's Republic of China
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, 250117, People's Republic of China
| | - Jianbin Li
- Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, People's Republic of China.
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, 250117, People's Republic of China.
| | - Zhenxiang Li
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, 250117, People's Republic of China.
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Dixit K, Singer L, Grimm SA, Lukas RV, Schwartz MA, Rademaker A, Zhang H, Kocherginsky M, Chernet S, Sharp L, Nelson V, Raizer JJ, Kumthekar P. A Phase II Trial of Bevacizumab in Patients with Recurrent/Progressive Solid Tumor Brain Metastases That Have Progressed Following Whole-Brain Radiation Therapy. Cancers (Basel) 2024; 16:2133. [PMID: 38893252 PMCID: PMC11171490 DOI: 10.3390/cancers16112133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 05/23/2024] [Accepted: 05/30/2024] [Indexed: 06/21/2024] Open
Abstract
Patients with solid tumor brain metastases that progress after whole-brain radiation have limited options. This prospective trial investigated the efficacy, safety, and tolerability of bevacizumab as salvage therapy in this population. Eligible patients received bevacizumab 10 mg/kg intravenously every 2 weeks until progression. The primary endpoint was radiologic response using Response Assessment in Neuro-Oncology (RANO) criteria. The secondary endpoints were progression-free survival (PFS), overall survival (OS), duration of response, and safety. Quality of life (QOL) was studied using the Functional Assessment of Cancer Therapy-Brain (FACT-Br) scale. Twenty-seven patients were enrolled, with twenty-four having evaluable data for response. The majority of histologies (n = 21, 78%) were breast cancer. The remaining histologies were non-small-cell lung cancer (n = 4, 15%), neuroendocrine cancer (n = 1, 3%), and papillary fallopian serous adenocarcinoma (n = 1, 3%). Eighteen patients had radiologic response, with two patients demonstrating partial response (8.33%) and sixteen patients demonstrating stable disease (66.7%). The median duration of response was 203 days. PFS at 6 months was 46%, median PFS was 5.3 m, and median OS was 9.5 m. Treatment was well tolerated, with six patients experiencing grade 3 lymphopenia and hypertension. There was one grade 3 thromboembolism. QOL was not negatively impacted. Bevacizumab is a safe and feasible salvage treatment with durable response and favorable overall survival for patients with progressive brain metastases after whole-brain radiation.
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Affiliation(s)
- Karan Dixit
- Department of Neurology, Northwestern University, Chicago, IL 60611, USA; (K.D.); (R.V.L.); (M.A.S.); (S.C.); (J.J.R.)
| | - Lauren Singer
- Department of Neurology, University of Chicago, Chicago, IL 60611, USA;
| | - Sean Aaron Grimm
- Department of Neuro-Oncology, Rush University, Chicago, IL 60611, USA;
| | - Rimas V. Lukas
- Department of Neurology, Northwestern University, Chicago, IL 60611, USA; (K.D.); (R.V.L.); (M.A.S.); (S.C.); (J.J.R.)
| | - Margaret A. Schwartz
- Department of Neurology, Northwestern University, Chicago, IL 60611, USA; (K.D.); (R.V.L.); (M.A.S.); (S.C.); (J.J.R.)
| | - Alfred Rademaker
- Division of Biostatistics, Department of Preventive Medicine, Northwestern University, Chicago, IL 60611, USA; (A.R.); (H.Z.); (M.K.); (L.S.)
| | - Hui Zhang
- Division of Biostatistics, Department of Preventive Medicine, Northwestern University, Chicago, IL 60611, USA; (A.R.); (H.Z.); (M.K.); (L.S.)
| | - Masha Kocherginsky
- Division of Biostatistics, Department of Preventive Medicine, Northwestern University, Chicago, IL 60611, USA; (A.R.); (H.Z.); (M.K.); (L.S.)
| | - Sofia Chernet
- Department of Neurology, Northwestern University, Chicago, IL 60611, USA; (K.D.); (R.V.L.); (M.A.S.); (S.C.); (J.J.R.)
| | - Laura Sharp
- Division of Biostatistics, Department of Preventive Medicine, Northwestern University, Chicago, IL 60611, USA; (A.R.); (H.Z.); (M.K.); (L.S.)
| | - Valerie Nelson
- Department of Hematology and Oncology, Northwestern University, Chicago, IL 60611, USA;
| | - Jeffrey J. Raizer
- Department of Neurology, Northwestern University, Chicago, IL 60611, USA; (K.D.); (R.V.L.); (M.A.S.); (S.C.); (J.J.R.)
| | - Priya Kumthekar
- Department of Neurology, Northwestern University, Chicago, IL 60611, USA; (K.D.); (R.V.L.); (M.A.S.); (S.C.); (J.J.R.)
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Peng S, Huang H, Chen J, Ding X, Zhu X, Liu Y, Chen L, Lu Z. Impact of Anti-angiogenic Drugs on Severity of COVID-19 in Patients with Non-Small Cell Lung Cancer. Technol Cancer Res Treat 2024; 23:15330338241248573. [PMID: 38656242 PMCID: PMC11044805 DOI: 10.1177/15330338241248573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024] Open
Abstract
Introduction: The 2019 coronavirus disease (COVID-19) pandemic has reshaped oncology practice, but the impact of anti-angiogenic drugs on the severity of COVID-19 in patients with non-small cell lung cancer (NSCLC) remains unclear. Patients and Methods: We carried out a retrospective study involving 166 consecutive patients with NSCLC who were positive for COVID-19, aiming to determine the effects of anti-angiogenic drugs on disease severity, as defined by severe/critical symptoms, intensive care unit (ICU) admission/intubation, and mortality outcomes. Risk factors were identified using univariate and multivariate logistic regression models. Results: Of the participants, 73 had been administered anti-angiogenic drugs (termed the anti-angiogenic therapy (AT) group), while 93 had not (non-AT group). Comparative analyses showed no significant disparity in the rates of severe/critical symptoms (21.9% vs 35.5%, P = 0.057), ICU admission/intubation (6.8% vs 7.5%, P = 0.867), or death (11.0% vs 9.7%, P = 0.787) between these two groups. However, elevated risk factors for worse outcomes included age ≥ 60 (odds ratio (OR): 2.52, 95% confidence interval (CI): 1.07-5.92), Eastern Cooperative Oncology Group performance status of 2 or higher (OR: 21.29, 95% CI: 4.98-91.01), chronic obstructive pulmonary disease (OR: 7.25, 95% CI: 1.65-31.81), hypertension (OR: 2.98, 95% CI: 1.20-7.39), and use of immunoglobulin (OR: 5.26, 95% CI: 1.06-26.25). Conclusion: Our data suggests that the use of anti-angiogenic drugs may not exacerbate COVID-19 severity in NSCLC patients, indicating their potential safe application even during the pandemic period.
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Affiliation(s)
- Sujuan Peng
- Department of Oncology, The First Affiliated Hospital of Nanchang University, Jiangxi, China
| | - Hongxiang Huang
- Department of Oncology, The First Affiliated Hospital of Nanchang University, Jiangxi, China
| | - Jinhong Chen
- Department of Oncology, The First Affiliated Hospital of Nanchang University, Jiangxi, China
| | - Xinjing Ding
- Department of Oncology, The First Affiliated Hospital of Nanchang University, Jiangxi, China
| | - Xie Zhu
- Department of Oncology, The First Affiliated Hospital of Nanchang University, Jiangxi, China
| | - Yangyang Liu
- Department of Oncology, The First Affiliated Hospital of Nanchang University, Jiangxi, China
| | - Li Chen
- Department of Oncology, The First Affiliated Hospital of Nanchang University, Jiangxi, China
| | - Zhihui Lu
- Department of Oncology, The First Affiliated Hospital of Nanchang University, Jiangxi, China
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Qu A, Zhang S, Zou H, Li S, Chen D, Zhang Y, Li S, Zhang H, Yang J, Yang Y, Huang Y, Li X, Zhang Y. Outcome benefits of bevacizumab biosimilar (SIBP04) combined with carboplatin and paclitaxel in advanced non-squamous non-small-cell lung cancer patients with EGFR mutation: subgroup analysis of a prospective, randomized phase III clinical trial. J Cancer Res Clin Oncol 2023; 149:12713-12721. [PMID: 37452849 DOI: 10.1007/s00432-023-05103-4] [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: 05/31/2023] [Accepted: 06/30/2023] [Indexed: 07/18/2023]
Abstract
PURPOSE SIBP04 is a bevacizumab biosimilar, and bevacizumab combined with carboplatin and paclitaxel in advanced non-squamous non-small-cell lung cancer (nsqNSCLC) has been recommended as the first-line treatment choice. However, the efforts of bevacizumab combined with carboplatin and paclitaxel for nsqNSCLC patients with EGFR mutation remained unclear. Here we report an EGFR mutation subgroup analysis of a prospective, randomized phase III clinical trial (NCT05318443). METHODS In this randomized, double-blind, multi-center, parallel controlled, phase III clinical trial, locally advanced, metastatic NSCLC patients were enrolled, and EGFR expression was examined and considered as a stratification factor. All patients received 4 to 6 cycles of paclitaxel and carboplatin plus SIBP04 or bevacizumab 15 mg/kg intravenously followed by SIBP04 15 mg/kg maintenance until intolerable toxicity, disease progression or death. Patients with EGFR mutation and wild-type were assessed for progression-free survival (PFS) and overall survival (OS). RESULTS EGFR expression was examined in 398 NSCLC patients (142 with EGFR mutation, 256 with EGFR wild type). PFS in EGFR mutation patients was significantly longer than EGFR wild-type patients (10.91 vs. 7.82 months; HR = 0.692, 95% CI 0.519-0.921, P = 0.011). The median OS in patients with EGFR mutation was not reached while that of EGFR wild-type group was 17.54 months (HR = 0.398, 95% CI 0.275-0.575, P < 0.001). However, there were no significant differences in objective response rate (61.97% vs. 55.86%, P = 0.237) or disease control rate (90.14% vs. 89.84%, P = 0.925). CONCLUSION Bevacizumab combined with chemotherapy significantly prolonged the PFS and OS of advanced nsqNSCLC patients with EGFR mutation.
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Affiliation(s)
- Aidong Qu
- Shanghai Institute of Biological Products Company Limited, 1262 Yanan West Changning District Rd, Shanghai, 200052, China
| | - Shiying Zhang
- China National Biotec Group Company Limited, B2 Shuangqiao Rd, Chaoyang District, Beijing, 10020, China
| | - Hongxia Zou
- China National Biotec Group Company Limited, B2 Shuangqiao Rd, Chaoyang District, Beijing, 10020, China
| | - Sixiu Li
- China National Biotec Group Company Limited, B2 Shuangqiao Rd, Chaoyang District, Beijing, 10020, China
| | - Dandan Chen
- Shanghai Institute of Biological Products Company Limited, 1262 Yanan West Changning District Rd, Shanghai, 200052, China
| | - Yaowen Zhang
- China National Biotec Group Company Limited, B2 Shuangqiao Rd, Chaoyang District, Beijing, 10020, China
| | - Songsong Li
- China National Biotec Group Company Limited, B2 Shuangqiao Rd, Chaoyang District, Beijing, 10020, China
| | - Huijun Zhang
- China National Biotec Group Company Limited, B2 Shuangqiao Rd, Chaoyang District, Beijing, 10020, China
| | - Ji Yang
- China National Biotec Group Company Limited, B2 Shuangqiao Rd, Chaoyang District, Beijing, 10020, China
| | - Yunkai Yang
- China National Biotec Group Company Limited, B2 Shuangqiao Rd, Chaoyang District, Beijing, 10020, China.
| | - Yubao Huang
- China National Biotec Group Company Limited, B2 Shuangqiao Rd, Chaoyang District, Beijing, 10020, China.
| | - Xiuling Li
- Shanghai Institute of Biological Products Company Limited, 1262 Yanan West Changning District Rd, Shanghai, 200052, China.
| | - Yuntao Zhang
- China National Biotec Group Company Limited, B2 Shuangqiao Rd, Chaoyang District, Beijing, 10020, China.
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Van Nguyen H, Phung DT, Nguyen TT, Tran BT, Thi Mai KN, Le Trinh H. Management of brain metastasis from rectal cancer using whole‑brain radiation therapy followed by bevacizumab and chemotherapy: A case report. Oncol Lett 2023; 26:446. [PMID: 37720667 PMCID: PMC10502923 DOI: 10.3892/ol.2023.14033] [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: 02/07/2023] [Accepted: 07/17/2023] [Indexed: 09/19/2023] Open
Abstract
Brain metastases in colorectal cancer are uncommon, which has resulted in a shortage of data concerning their screening and management. Multiple therapeutic modalities with chemotherapy, chemoradiation and targeted therapy, including bevacizumab and cetuximab regimens, have shown promising results. The present study describes the case of a 47-year-old male, diagnosed with T4N2M1 rectal cancer who underwent systemic therapy with modified FOLFOXIRI and cetuximab. The patient achieved a complete clinical response after 12 cycles. Following the discontinuation of cetuximab, the patient was given capecitabine as a maintenance therapy and subsequently developed brain metastasis. The patient received whole-brain radiation therapy (WBRT) followed by a bevacizumab plus FOLFIRI regimen. The patient showed a good response as revealed by cranial magnetic resonance imaging, with a reduction in lesion size and no sign of cerebral edema. In addition, the patient maintained a stable neurological condition for >10 months. These findings suggest that the early detection of brain metastases requires the close monitoring of neurological symptoms. In addition, WBRT followed by bevacizumab and chemotherapy is a potential management plan for brain metastasis from rectal cancer.
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Affiliation(s)
- Hung Van Nguyen
- Department of Oncology and Palliative Care, Hanoi Medical University Hospital, Hanoi 100000, Vietnam
- Department of Oncology, Hanoi Medical University, Hanoi 100000, Vietnam
| | - Duong Thuy Phung
- Department of Oncology, Hanoi Medical University, Hanoi 100000, Vietnam
| | | | - Bach Trung Tran
- Department of Oncology, Hanoi Medical University, Hanoi 100000, Vietnam
| | - Kim Ngan Thi Mai
- Department of Oncology and Palliative Care, Hanoi Medical University Hospital, Hanoi 100000, Vietnam
- Department of Oncology, Hanoi Medical University, Hanoi 100000, Vietnam
| | - Huy Le Trinh
- Department of Oncology and Palliative Care, Hanoi Medical University Hospital, Hanoi 100000, Vietnam
- Department of Oncology, Hanoi Medical University, Hanoi 100000, Vietnam
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Song Z, Ren G, Wang X, Hu L. The Effect of the Kirsten Rat Sarcoma Viral Oncogene Homolog ( Kras) Proto-Oncogene, GTPase Genetic Polymorphism on the Safety and Efficacy of Bevacizumab Combination Treatment Regimens for Patients with Nonsquamous, Non-Small Cell Lung Cancer with Brain Metastases. Genet Test Mol Biomarkers 2022; 26:290-297. [PMID: 35638910 PMCID: PMC9150132 DOI: 10.1089/gtmb.2021.0219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background: Non-small cell lung cancer with brain metastasis (NSCLCBM) is normally observed in advanced-stage patients. Bevacizumab has shown to improve survival in the first-line treatment of metastatic brain NSCLC when added as a bolus plus irinotecan. However, a better understanding of the molecular mechanism is required to further drive progress in this field. Methods: A total of 155 patients were selected, including 42.10% with Kirsten rat sarcoma viral oncogene homolog (Kras)-mutant tumors. Of the 155 patients, 62.04% had developed brain metastasis (BM). Seven functional single-nucleotide polymorphisms (SNPs) in the Kras gene were extracted from the HapMap SNP database and were used for genotyping. The haplologit command in Statistical Software for Data Science (STATA) was used to model the association between haplotypes and case status. A Cox analysis was used to evaluate the prognostic value of the SNPs. Results: Among the patients treated with combination regimens, recurrence after local treatment was more frequent in those with two types of Kras mutations (odds ratio [OR] = 2.033 [0.5015-4.2552], p = 0.009). Among the patients with untreated BM, overall survival was shorter than that of patients with Kras mutations according to univariate analysis (OR = 5.130 [1.240-41.012], p = 0.033). Conclusions: Kras mutations have a predictive role for BM recurrence and outcome in patients with NSCLC treated with bevacizumab combination regimens.
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Affiliation(s)
- Zizheng Song
- Hebei Key Laboratory of Cancer Radiotherapy and Chemotherapy, Department of Medical Oncology, Affiliated Hospital of Hebei University, Baoding, People's Republic of China
| | - Guanying Ren
- Hebei Key Laboratory of Cancer Radiotherapy and Chemotherapy, Department of Medical Oncology, Affiliated Hospital of Hebei University, Baoding, People's Republic of China
| | - Xiaolei Wang
- Hebei Key Laboratory of Cancer Radiotherapy and Chemotherapy, Department of Medical Oncology, Affiliated Hospital of Hebei University, Baoding, People's Republic of China
| | - Ling Hu
- Hebei Key Laboratory of Cancer Radiotherapy and Chemotherapy, Department of Medical Oncology, Affiliated Hospital of Hebei University, Baoding, People's Republic of China
- Address correspondence to: Ling Hu, MD, Hebei Key Laboratory of Cancer Radiotherapy and Chemotherapy, Department of Medical Oncology, Affiliated Hospital of Hebei University, Baoding 071000, People's Republic of China
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Strickland MR, Alvarez-Breckenridge C, Gainor JF, Brastianos PK. Tumor Immune Microenvironment of Brain Metastases: Toward Unlocking Antitumor Immunity. Cancer Discov 2022; 12:1199-1216. [PMID: 35394521 DOI: 10.1158/2159-8290.cd-21-0976] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 12/19/2021] [Accepted: 02/17/2022] [Indexed: 11/16/2022]
Abstract
Brain metastasis (BrM) is a devastating complication of solid tumors associated with poor outcomes. Immune-checkpoint inhibitors (ICI) have revolutionized the treatment of cancer, but determinants of response are incompletely understood. Given the rising incidence of BrM, improved understanding of immunobiologic principles unique to the central nervous system (CNS) and dissection of those that govern the activity of ICIs are paramount toward unlocking BrM-specific antitumor immunity. In this review, we seek to discuss the current clinical landscape of ICI activity in the CNS and CNS immunobiology, and we focus, in particular, on the role of glial cells in the CNS immune response to BrM. SIGNIFICANCE There is an urgent need to improve patient selection for and clinical activity of ICIs in patients with cancer with concomitant BrM. Increased understanding of the unique immunobiologic principles that govern response to ICIs in the CNS is critical toward identifying targets in the tumor microenvironment that may potentiate antitumor immunity.
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Affiliation(s)
| | | | - Justin F Gainor
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Chiu TH, Tung PH, Huang CH, Ju JS, Huang ACC, Wang CC, Ko HW, Hsu PC, Fang YF, Guo YK, Kuo CHS, Yang CT. The different overall survival between single-agent EGFR-TKI treatment and with bevacizumab in non-small cell lung cancer patients with brain metastasis. Sci Rep 2022; 12:4398. [PMID: 35292755 PMCID: PMC8924189 DOI: 10.1038/s41598-022-08449-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 03/07/2022] [Indexed: 11/09/2022] Open
Abstract
Comparison of epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) monotherapy or with bevacizumab in real-world non-small cell lung cancer (NSCLC) patients was lacking. 310 patients of advanced NSCLC with common EGFR mutation receiving first-generation EGFR-TKI monotherapy or with bevacizumab were included and propensity-score matched. Progression-free survival (PFS), overall survival (OS) and secondary T790M mutation were analysed. Patients receiving EGFR-TKI and bevacizumab were significantly younger, had better performance status and with high incidence of brain metastasis (55.8%). In the propensity-score matched cohort, PFS (13.5 vs. 13.7 months; log-rank p = 0.700) was similar between the two groups. The OS (61.3 vs. 34.2 months; log-rank p = 0.010) and risk reduction of death (HR 0.42 [95% CI 0.20–0.85]; p = 0.017) were significantly improved in EGFR-TKI plus bevacizumab group. Analysis of treatment by brain metastasis status demonstrated EGFR-TKI plus bevacizumab in patients with brain metastasis was associated with significant OS benefit compared to other groups (log-rank p = 0.030) and these patients had lower early-CNS and early-systemic progressions. The secondary T790M did not significantly differ between EGFR-TKI plus bevacizumab and EGFR-TKI monotherapy groups (66.7% vs. 75.0%, p = 0.460). Forty-one (31.1%) and 31 (23.5%) patients received subsequent osimertinib and chemotherapy, respectively. The post-progression OS of osimertinib and chemotherapy were 22.1 and 44.9 months in EGFR-TKI plus bevacizumab group and were 10.0 and 14.1 months in EGFR-TKI monotherpay group, respectively. First-generation EGFR-TKI with bevacizumab improved treatment efficacy in real-world patients of NSCLC with EGFR mutation. Patients with brain metastasis received additional OS benefit from this treatment.
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Affiliation(s)
- Tzu-Hsuan Chiu
- Division of Thoracic Oncology, Department of Thoracic Medicine, College of Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan
| | - Pi-Hung Tung
- Division of Thoracic Oncology, Department of Thoracic Medicine, College of Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan
| | - Chi-Hsien Huang
- Division of Thoracic Oncology, Department of Thoracic Medicine, College of Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan
| | - Jia-Shiuan Ju
- Division of Thoracic Oncology, Department of Thoracic Medicine, College of Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan.,Thoracic Oncology Unit, Chang Gung Memorial Hospital Cancer Center, Taipei, Taiwan
| | - Allen Chung-Cheng Huang
- Division of Thoracic Oncology, Department of Thoracic Medicine, College of Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan.,Thoracic Oncology Unit, Chang Gung Memorial Hospital Cancer Center, Taipei, Taiwan
| | - Chin-Chou Wang
- Division of Pulmonary and Critical Care Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Ho-Wen Ko
- Division of Thoracic Oncology, Department of Thoracic Medicine, College of Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan.,Thoracic Oncology Unit, Chang Gung Memorial Hospital Cancer Center, Taipei, Taiwan
| | - Ping-Chih Hsu
- Division of Thoracic Oncology, Department of Thoracic Medicine, College of Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan.,Thoracic Oncology Unit, Chang Gung Memorial Hospital Cancer Center, Taipei, Taiwan
| | - Yueh-Fu Fang
- Division of Thoracic Oncology, Department of Thoracic Medicine, College of Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan
| | - Yi-Ke Guo
- Department of Computing, Data Science Institute, Imperial College London, London, UK
| | - Chih-Hsi Scott Kuo
- Division of Thoracic Oncology, Department of Thoracic Medicine, College of Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan. .,Thoracic Oncology Unit, Chang Gung Memorial Hospital Cancer Center, Taipei, Taiwan. .,Department of Computing, Data Science Institute, Imperial College London, London, UK.
| | - Cheng-Ta Yang
- Division of Thoracic Oncology, Department of Thoracic Medicine, College of Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan.,Thoracic Oncology Unit, Chang Gung Memorial Hospital Cancer Center, Taipei, Taiwan
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10
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Patel SA, Herynk MH, Cascone T, Saigal B, Nilsson MB, Tran H, Ramachandran S, Diao L, Wang J, Le X, Minna J, Wistuba II, Heymach JV. Estrogen Promotes Resistance to Bevacizumab in Murine Models of NSCLC. J Thorac Oncol 2021; 16:2051-2064. [PMID: 34311109 DOI: 10.1016/j.jtho.2021.07.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 06/19/2021] [Accepted: 07/07/2021] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Subgroup analyses from clinical studies have suggested that among patients with metastatic NSCLC receiving chemotherapy, females may derive less benefit from the addition of the vascular endothelial growth factor (VEGF) monoclonal antibody bevacizumab (BV) than males. This has raised the question of whether estrogen may affect the response to antiangiogenic therapy. METHODS To address this, we investigated the effects of estrogen on tumor growth, angiogenesis, and the response to BV in human xenograft models of NSCLC. RESULTS We observed that estrogen induced marked resistance to BV, which was accompanied by a 2.3-fold increase in tumor vascular pericyte coverage (p = 0.01) and an up-regulation of proangiogenic factors, VEGF and platelet-derived growth factor-BB. We also investigated the role of infiltrating myeloid cells, a population that has been associated with resistance to anti-VEGF therapies. We observed that estrogen induced a greater than twofold increase (p = 0.001) in the recruitment of tumor-infiltrating myeloid cells and concomitant increases in the myeloid recruitment factors, G-CSF and CXCL1. Blockade of the estrogen receptor pathway using fulvestrant resensitized tumors to VEGF targeting as evidenced by reduced tumor vasculature and an increase in overall survival in our NSCLC xenograft models. CONCLUSIONS Collectively, these data provide evidence that estrogen may promote resistance to VEGF-targeted therapies, potentially by enhancing pericyte coverage and myeloid recruitment, and suggest that estrogen receptor blockade merits further investigation as an approach to enhance the effects of antiangiogenic therapy.
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Affiliation(s)
- Sonia A Patel
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Matthew H Herynk
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Tina Cascone
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Babita Saigal
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Monique B Nilsson
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Hai Tran
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sumankalai Ramachandran
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Lixia Diao
- Department of Bioinformatics and Computational Biology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jing Wang
- Department of Bioinformatics and Computational Biology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Xiuning Le
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - John Minna
- Hamon Center for Therapeutic Oncology Research, Harold C. Simmons Comprehensive Cancer Center, The University of Texas Southwestern Medical Center, Dallas, Texas; Department of Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Ignacio I Wistuba
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - John V Heymach
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
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11
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Zhang L, Yao J, Wei Y, Zhou Z, Li P, Qu J, Badu-Nkansah A, Yuan X, Huang YW, Fukumura K, Mao X, Chang WC, Saunus J, Lakhani S, Huse JT, Hung MC, Yu D. Blocking immunosuppressive neutrophils deters pY696-EZH2-driven brain metastases. Sci Transl Med 2021; 12:12/545/eaaz5387. [PMID: 32461334 DOI: 10.1126/scitranslmed.aaz5387] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 04/15/2020] [Indexed: 12/12/2022]
Abstract
The functions of immune cells in brain metastases are unclear because the brain has traditionally been considered "immune privileged." However, we found that a subgroup of immunosuppressive neutrophils is recruited into the brain, enabling brain metastasis development. In brain metastatic cells, enhancer of zeste homolog 2 (EZH2) is highly expressed and phosphorylated at tyrosine-696 (pY696)-EZH2 by nuclear-localized Src tyrosine kinase. Phosphorylation of EZH2 at Y696 changes its binding preference from histone H3 to RNA polymerase II, which consequently switches EZH2's function from a methyltransferase to a transcription factor that increases c-JUN expression. c-Jun up-regulates protumorigenic inflammatory cytokines, including granulocyte colony-stimulating factor (G-CSF), which recruits Arg1+- and PD-L1+ immunosuppressive neutrophils into the brain to drive metastasis outgrowth. G-CSF-blocking antibodies or immune checkpoint blockade therapies combined with Src inhibitors impeded brain metastasis in multiple mouse models. These findings indicate that pY696-EZH2 can function as a methyltransferase-independent transcription factor to facilitate the brain infiltration of immunosuppressive neutrophils, which could be clinically targeted for brain metastasis treatment.
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Affiliation(s)
- Lin Zhang
- Department of Molecular and Cellular Oncology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.,MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, TX 77030, USA
| | - Jun Yao
- Department of Molecular and Cellular Oncology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Yongkun Wei
- Department of Molecular and Cellular Oncology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Zhifen Zhou
- Department of Molecular and Cellular Oncology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Ping Li
- Department of Molecular and Cellular Oncology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Jingkun Qu
- Department of Molecular and Cellular Oncology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Akosua Badu-Nkansah
- Department of Molecular and Cellular Oncology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Xiangliang Yuan
- Department of Molecular and Cellular Oncology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Yu-Wen Huang
- Department of Molecular and Cellular Oncology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.,Center for Molecular Medicine, China Medical University, Taichung 40402, Taiwan
| | - Kazutaka Fukumura
- Department of Pathology and Translational Molecular Pathology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Xizeng Mao
- Department of Genomic Medicine, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Wei-Chao Chang
- Center for Molecular Medicine, China Medical University, Taichung 40402, Taiwan
| | - Jodi Saunus
- Faculty of Medicine, University of Queensland, St Lucia, QLD 4072, Australia
| | - Sunil Lakhani
- Faculty of Medicine, University of Queensland, St Lucia, QLD 4072, Australia.,Pathology Queensland, The Royal Brisbane & Women's Hospital, Herston, QLD 4029, Australia
| | - Jason T Huse
- Department of Pathology and Translational Molecular Pathology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Mien-Chie Hung
- Center for Molecular Medicine, China Medical University, Taichung 40402, Taiwan
| | - Dihua Yu
- Department of Molecular and Cellular Oncology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA. .,MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, TX 77030, USA.,Center for Molecular Medicine, China Medical University, Taichung 40402, Taiwan
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12
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Ren Y, Wang SB, Zhou L, Liu SQ, Du LY, Li T, Jiang MQ, Lei KJ, Tan BX, Jia YM. Continuous Low-Dose Apatinib Combined With WBRT Significantly Reduces Peritumoral Edema and Enhances the Efficacy of Symptomatic Multiple Brain Metastases in NSCLC. Technol Cancer Res Treat 2021; 20:15330338211011968. [PMID: 33955301 PMCID: PMC8111549 DOI: 10.1177/15330338211011968] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Symptomatic multiple brain metastases with peritumoral brain edema (PTBE) occur in non-small cell lung cancer patients (NSCLC) who are without driver mutations or are resistant to epidermal growth factor tyrosine kinase (EGFR-TKI) are often associated with an unfavorable prognosis. Whole brain radiation therapy (WBRT) which comes with many complications and unsatisfactory effects, is the only option for the treatment. Previous studies have shown that bevacizumab can reduce the volume of PTBE and improve efficiency of radiotherapy. This study evaluated the effects and safety of apatinib combined with WBRT in NSCLC patients with symptomatic multiple brain metastases and PTBE. METHODS We performed a retrospective review of 34 patients with symptomatic multiple brain metastases from NSCLC (number >4, and at least 1 measurable brain metastasis lesion with cerebral edema). Intracranial objective response rate (IORR), peritumoral edema and intracranial tumor volumetric measurement, Karnofsky performance status (KPS) and adverse events (AEs) were evaluated. Median intracranial progression-free survival (mIPFS) and median overall survival (mOS) were also analyzed. RESULTS Thirteen cases received apatinib (125 mg or 250 mg, QD, oral) combined with WBRT and 21 cases received chemotherapy combined with WBRT were inclued. Apatinib combination group can better reduce the volume of intracranial tumors and PTBE and total steroid dosage used. It was associated with a better IORR (84.6% vs 47.6%, P = 0.067), longer mIPFS (6.97 vs 4.77months; P = 0.014). There was no significant difference in mOS(7.70 vs 6.67 months; P = 0.14) between the 2 groups. The most common adverse events of apatinib combination WBRT included grade 1/2 nausea (4/13), fatigue (3/13), hypertension (2/13) and white blood cell decrease (2/13). No grade 3/4 AEs were observed. CONCLUSION Apatinib plus WBRT is well tolerated and may be a potential choice for relapsed or drug-resistant advanced NSCLC patients with symptomatic multiple brain metastases and PTBE.
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Affiliation(s)
- Yue Ren
- 74655North Sichuan Medical College, Nanchong, Sichuan, China.,Department of Oncology, The Second People's Hospital of Yibin, Yibin, Sichuan, China
| | - Shan-Bing Wang
- Department of Oncology, The Second People's Hospital of Yibin, Yibin, Sichuan, China
| | - Lin Zhou
- West China Hospital, 34753Sichuan University, Cheng du, China
| | - Si-Qiao Liu
- 12599University of Electronic Science and Technology of China, Sichuan, China
| | - Lei-Ya Du
- Department of Oncology, The Second People's Hospital of Yibin, Yibin, Sichuan, China
| | - Ting Li
- Department of Oncology, The Second People's Hospital of Yibin, Yibin, Sichuan, China
| | - Mao-Qiong Jiang
- Department of Oncology, The Second People's Hospital of Yibin, Yibin, Sichuan, China
| | - Kai-Jian Lei
- Department of Oncology, The Second People's Hospital of Yibin, Yibin, Sichuan, China
| | - Bang-Xian Tan
- 74655North Sichuan Medical College, Nanchong, Sichuan, China
| | - Yu-Ming Jia
- Department of Oncology, The Second People's Hospital of Yibin, Yibin, Sichuan, China
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13
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Rational Application of First-Line EGFR-TKIs Combined with Antiangiogenic Inhibitors in Advanced EGFR-Mutant Non-Small-Cell Lung Cancer: A Systematic Review and Meta-Analysis. BIOMED RESEARCH INTERNATIONAL 2021; 2021:8850256. [PMID: 33575349 PMCID: PMC7861921 DOI: 10.1155/2021/8850256] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 12/18/2020] [Accepted: 01/11/2021] [Indexed: 12/25/2022]
Abstract
Purpose A meta-analysis of randomized controlled trials (RCTs) was conducted to compare the difference in efficacy and safety between epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) with antiangiogenic inhibitors (A + T) and EGFR-TKI monotherapy in patients with treatment-naïve advanced EGFR-mutant non-small-cell lung cancer (NSCLC). Methods PubMed, Embase, Web of Science, and Cochrane electronic databases were searched for relevant RCTs. Meeting abstracts were also reviewed to identify appropriate studies. The endpoints included progression-free survival (PFS), overall survival (OS), 1- and 2-year OS rates, objective response rate (ORR), and grade ≥ 3 adverse events. All pooled outcomes were expressed using hazard ratios (HRs) or relative risk ratios (RRs). Results Data were collected from six eligible RCTs, which included 1,244 participants (619 in the A + T group and 625 in the TKI alone group). PFS was significantly improved with A + T compared to TKI alone (HR = 0.60; P < 0.01) regardless of EGFR mutation types (exon 19 deletion or L858R) and brain metastasis status (with or without brain metastases). There was no significant difference in median OS between the A + T and TKI alone groups (HR = 0.933; P = 0.551) regardless of EGFR mutation type. The ORR for A + T combination therapy was significantly increased compared to TKI monotherapy in exon 19 deletion subgroups (RR = 0.774; P = 0.008). There was no difference in the positive rates of acquired T790M mutation between the two groups (RR = 0.967; P = 0.846). More patients in the TKI alone group received a variety of subsequent systemic treatments than those in the A + T group (RR = 0.881; P = 0.002). Conclusion Addition of antiangiogenic inhibitors to first-line EGFR-TKI therapy significantly reduced the risk of disease progression for patients with advanced EGFR-mutant NSCLC regardless of EGFR mutation type and brain metastasis status. The lack of OS benefit may be explained by differences in subsequent treatments rather than drug resistance mechanisms.
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14
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Chu C, Davis CM, Lan X, Hienz RD, Jablonska A, Thomas AM, Velarde E, Li S, Janowski M, Kai M, Walczak P. Neuroinflammation After Stereotactic Radiosurgery-Induced Brain Tumor Disintegration Is Linked to Persistent Cognitive Decline in a Mouse Model of Metastatic Disease. Int J Radiat Oncol Biol Phys 2020; 108:745-757. [PMID: 32470502 PMCID: PMC8758056 DOI: 10.1016/j.ijrobp.2020.05.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 04/20/2020] [Accepted: 05/18/2020] [Indexed: 11/23/2022]
Abstract
PURPOSE Improved efficacy of anticancer therapy and a growing pool of survivors give rise to a question about their quality of life and return to premorbid status. Radiation is effective in brain metastasis eradication, although the optimal approach and long-term effects on brain function are largely unknown. We studied the effects of radiosurgery on brain function. METHODS AND MATERIALS Adult C57BL/6J mice with or without brain metastases (rat 9L gliosarcoma) were treated with cone beam single-arc stereotactic radiosurgery (SRS; 40 Gy). Tumor growth was monitored using bioluminescence, whereas longitudinal magnetic resonance imaging, behavioral studies, and histologic analysis were performed to evaluate brain response to the treatment for up to 18 months. RESULTS Stereotactic radiosurgery (SRS) resulted in 9L metastases eradication within 4 weeks with subsequent long-term survival of all treated animals, whereas all nontreated animals succumbed to the brain tumor. Behavioral impairment, as measured with a recognition memory test, was observed earlier in mice subjected to radiosurgery of tumors (6 weeks) in comparison to SRS of healthy brain tissue (10 weeks). Notably, the deficit resolved by 18 weeks only in mice not bearing a tumor, whereas tumor eradication was complicated by the persistent cognitive deficits. In addition, the results of magnetic resonance imaging were unremarkable in both groups, and histopathology revealed changes. SRS-induced tumor eradication triggered long-lasting and exacerbated neuroinflammatory response. No demyelination, neuronal loss, or hemorrhage was detected in any of the groups. CONCLUSIONS Tumor disintegration by SRS leads to exacerbated neuroinflammation and persistent cognitive deficits; therefore, methods aiming at reducing inflammation after tumor eradication or other therapeutic methods should be sought.
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Affiliation(s)
- Chengyan Chu
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland; The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Catherine M Davis
- Division of Behavioral Biology, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Xiaoyan Lan
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland; The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Robert D Hienz
- Division of Behavioral Biology, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Anna Jablonska
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland; The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Aline M Thomas
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Esteban Velarde
- Department of Radiation Oncology, Johns Hopkins University, School of Medicine, Baltimore, Maryland
| | - Shen Li
- Department of Neurology, Dalian Municipal Central Hospital, Dalian, Liaoning, China
| | - Miroslaw Janowski
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland; The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Mihoko Kai
- Department of Radiation Oncology, Johns Hopkins University, School of Medicine, Baltimore, Maryland.
| | - Piotr Walczak
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland; The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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15
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Liang P, Wang YD, Wei ZM, Deng QJ, Xu T, Liu J, Luo N, Hou J. Bevacizumab for non-small cell lung cancer patients with brain metastasis: A meta-analysis. Open Med (Wars) 2020; 15:589-597. [PMID: 33313410 PMCID: PMC7706125 DOI: 10.1515/med-2020-0192] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 05/21/2020] [Accepted: 05/22/2020] [Indexed: 12/17/2022] Open
Abstract
This study evaluates the efficacy and safety of bevacizumab (BEV) in the treatment of non-small cell lung cancer (NSCLC) patients with brain metastases (BM) by performing meta-analyses of response and survival indices. Seventeen studies were included. BEV treatment was associated with a lower new BM incidence (hazard ratio: 0.30 [95% confidence interval (CI): 0.14, 0.46]) during follow-up. Disease control rate (DCR) of BEV-treated patients with BM was 91% [95% CI: 85, 95]. However, intracranial DCR was relatively higher (94% [95% CI: 87, 98]) than extracranial DCR (86% [95% CI: 74, 96]). DCR of NSCLC patients with BM was significantly better with BEV than with control therapies (odds ratio: 2.71 [95% CI: 1.26, 5.86], P = 0.01). Progression-free survival (PFS) of BEV-treated patients with and without BM was 7.1 months [95% CI: 6.2, 8.0] and 7.4 months [95% CI: 6.3, 8.4], respectively. Intracranial PFS of BEV-treated patients with BM was 8.0 months [95% CI: 6.0, 10.0]. Overall survival of BEV-treated NSCLC patients with and without BM was 13.5 months [95% CI: 11.4, 15.6] and 12.5 months [95% CI: 10.2, 14.8], respectively. The incidence of bleeding/hemorrhage in the central nervous system was 1% with BEV treatment.
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Affiliation(s)
- Ping Liang
- Department of Pharmacy, The Fourth Hospital of Hebei Medical University, No. 169, Tianshan Street, Shijiazhuang, Hebei 050011, China
| | - Yu-Dong Wang
- Department of Oncology, Hebei Medical University, Shijiazhuang, Hebei 050011, China
| | - Zong-Min Wei
- Department of Pharmacy, The Fourth Hospital of Hebei Medical University, No. 169, Tianshan Street, Shijiazhuang, Hebei 050011, China
| | - Qi-Jun Deng
- Department of Pharmacy, The Fourth Hospital of Hebei Medical University, No. 169, Tianshan Street, Shijiazhuang, Hebei 050011, China
| | - Tong Xu
- Department of Pharmacy, The Fourth Hospital of Hebei Medical University, No. 169, Tianshan Street, Shijiazhuang, Hebei 050011, China
| | - Jiang Liu
- Department of Pharmacy, The Fourth Hospital of Hebei Medical University, No. 169, Tianshan Street, Shijiazhuang, Hebei 050011, China
| | - Na Luo
- Department of Science and Technology, Beijing You'an Hospital, Capital Medical University, Beijing 100069, China
| | - Juan Hou
- Department of Pharmacy, The Fourth Hospital of Hebei Medical University, No. 169, Tianshan Street, Shijiazhuang, Hebei 050011, China
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