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Zhao N, Wu ZP, Yang J, Feng WN, Yang SL, Luo Y, Ye J, Wang F, Zhang XW, Xiao Y, Wu LL, Gu WQ. Epidermal growth factor receptor inhibitors as adjuvant treatment for patients with resected non-small cell lung cancer harboring EGFR mutation: a meta-analysis of randomized controlled clinical trials. World J Surg Oncol 2023; 21:45. [PMID: 36782320 PMCID: PMC9926719 DOI: 10.1186/s12957-023-02925-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 01/30/2023] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND The epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) is still under investigation as adjuvant treatment for early-stage disease. Here, we performed a meta-analysis to evaluate the efficacy of adjuvant EGFR-TKI versus non-EGFR-TKI treatment in patients with completely resected non-small cell lung cancer (NSCLC) harboring EGFR mutation. METHODS Two investigators independently extracted data from databases. A meta-analysis was performed following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The protocol was registered in PROSPERO (ID: CRD42022316481). The primary outcome was disease-free survival (DFS) in patients with EGFR mutation, measured as the hazard ratio (HR). Other outcomes (of subgroup analyses) included overall survival (OS) and DFS. RESULTS After the systematic screening, eight studies with a total of 3098 patients with stage IB-IIIA NSCLC were included. The results show that in patients with EGFR mutation, the DFS in the adjuvant EGFR-TKI group was significantly superior to that in the control group, with a HR of 0.47 (95% confidence interval [CI]: 0.30-0.74; P = 0.001). In subgroup analyses of DFS, the benefit was observed in the EGFR-TKI group versus the chemotherapy group (HR 0.50, 95% CI 0.30-0.84; P = 0.009), the EGFR-TKI combined with chemotherapy group versus the chemotherapy group (HR 0.37, 95% CI 0.16-0.85; P = 0.02), and in stage IIA-IIIA NSCLC (HR 0.45, 95% CI 0.27-0.74; P = 0.002). However, the benefit of DFS did not translate into improved OS in the whole population (HR 0.79, 95% CI 0.54-1.14; P = 0.20). CONCLUSION EGFR-TKIs prolonged DFS but not OS in patients with completely resected stage II-IIIA NSCLC harboring EGFR mutation. Longer follow-ups and new clinical trials that can result in changes in clinical practice are needed.
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Affiliation(s)
- Ning Zhao
- grid.452881.20000 0004 0604 5998Department of Thoracic Surgery, The First People’s Hospital of Foshan, Foshan, 528000 Guangdong China
| | - Zhuo-peng Wu
- grid.452881.20000 0004 0604 5998Department of Thoracic Surgery, The First People’s Hospital of Foshan, Foshan, 528000 Guangdong China
| | - Jie Yang
- grid.452881.20000 0004 0604 5998Department of Thoracic Surgery, The First People’s Hospital of Foshan, Foshan, 528000 Guangdong China
| | - Wei-neng Feng
- grid.452881.20000 0004 0604 5998Department of Head and Neck/Thoracic Medical Oncology, The First People’s Hospital of Foshan, Foshan, China
| | - Sheng-li Yang
- grid.452881.20000 0004 0604 5998Department of Thoracic Surgery, The First People’s Hospital of Foshan, Foshan, 528000 Guangdong China
| | - Ying Luo
- grid.452881.20000 0004 0604 5998Department of Traditional Chinese Medicine, The First People’s Hospital of Foshan, Foshan, China
| | - Jun Ye
- grid.452881.20000 0004 0604 5998Department of Thoracic Surgery, The First People’s Hospital of Foshan, Foshan, 528000 Guangdong China
| | - Fei Wang
- grid.452881.20000 0004 0604 5998Department of Thoracic Surgery, The First People’s Hospital of Foshan, Foshan, 528000 Guangdong China
| | - Xiao-wen Zhang
- grid.452881.20000 0004 0604 5998Department of Thoracic Surgery, The First People’s Hospital of Foshan, Foshan, 528000 Guangdong China
| | - Ye Xiao
- grid.452881.20000 0004 0604 5998Department of Thoracic Surgery, The First People’s Hospital of Foshan, Foshan, 528000 Guangdong China
| | - Ling-ling Wu
- grid.452881.20000 0004 0604 5998Department of Thoracic Surgery, The First People’s Hospital of Foshan, Foshan, 528000 Guangdong China
| | - Wei-quan Gu
- grid.452881.20000 0004 0604 5998Department of Thoracic Surgery, The First People’s Hospital of Foshan, Foshan, 528000 Guangdong China
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Yu Q, Zhao L, Yan XX, Li Y, Chen XY, Hu XH, Bu Q, Lv XP. Identification of a TGF-β signaling-related gene signature for prediction of immunotherapy and targeted therapy for lung adenocarcinoma. World J Surg Oncol 2022; 20:183. [PMID: 35668494 PMCID: PMC9172180 DOI: 10.1186/s12957-022-02595-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 04/16/2022] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Transforming growth factor (TGF)-β signaling functions importantly in regulating tumor microenvironment (TME). This study developed a prognostic gene signature based on TGF-β signaling-related genes for predicting clinical outcome of patients with lung adenocarcinoma (LUAD). METHODS TGF-β signaling-related genes came from The Molecular Signature Database (MSigDB). LUAD prognosis-related genes were screened from all the genes involved in TGF-β signaling using least absolute shrinkage and selection operator (LASSO) Cox regression analysis and then used to establish a risk score model for LUAD. ESTIMATE and CIBERSORT analyzed infiltration of immune cells in TME. Immunotherapy response was analyzed by the TIDE algorithm. RESULTS A LUAD prognostic 5-gene signature was developed based on 54 TGF-β signaling-related genes. Prognosis of high-risk patients was significantly worse than low-risk patients. Both internal validation and external dataset validation confirmed a high precision of the risk model in predicting the clinical outcomes of LUAD patients. Multivariate Cox analysis demonstrated the model independence in OS prediction of LUAD. The risk model was significantly related to the infiltration of 9 kinds of immune cells, matrix, and immune components in TME. Low-risk patients tended to respond more actively to anti-PD-1 treatment, while high-risk patients were more sensitive to chemotherapy and targeted therapy. CONCLUSIONS The 5-gene signature based on TGF-β signaling-related genes showed potential for LUAD management.
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Affiliation(s)
- Qian Yu
- Department of Oncology, the First Affiliated Hospital of Guangxi Medical University, Guangxi Zhuang Autonomous Region, No. 6 Shuangyong Rd, Nanning, 450100, China
| | - Liang Zhao
- Department of Oncology, the First Affiliated Hospital of Guangxi Medical University, Guangxi Zhuang Autonomous Region, No. 6 Shuangyong Rd, Nanning, 450100, China
| | - Xue-Xin Yan
- Department of Oncology, the First Affiliated Hospital of Guangxi Medical University, Guangxi Zhuang Autonomous Region, No. 6 Shuangyong Rd, Nanning, 450100, China
| | - Ye Li
- Department of Oncology, the First Affiliated Hospital of Guangxi Medical University, Guangxi Zhuang Autonomous Region, No. 6 Shuangyong Rd, Nanning, 450100, China
| | - Xin-Yu Chen
- Department of Oncology, the First Affiliated Hospital of Guangxi Medical University, Guangxi Zhuang Autonomous Region, No. 6 Shuangyong Rd, Nanning, 450100, China
| | - Xiao-Hua Hu
- Department of Oncology, the First Affiliated Hospital of Guangxi Medical University, Guangxi Zhuang Autonomous Region, No. 6 Shuangyong Rd, Nanning, 450100, China.
| | - Qing Bu
- Department of Oncology, the First Affiliated Hospital of Guangxi Medical University, Guangxi Zhuang Autonomous Region, No. 6 Shuangyong Rd, Nanning, 450100, China.
| | - Xiao-Ping Lv
- Department of Gastroenterology, the First Affiliated Hospital of Guangxi Medical University, Guangxi Zhuang Autonomous Region, No. 6 Shuangyong Rd, Nanning, 450100, China.
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Yu XY, Jin X, Shou ZX. Surface-engineered smart nanocarrier-based inhalation formulations for targeted lung cancer chemotherapy: a review of current practices. Drug Deliv 2021; 28:1995-2010. [PMID: 34569401 PMCID: PMC8477964 DOI: 10.1080/10717544.2021.1981492] [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: 12/24/2022] Open
Abstract
Lung cancer is the second most common and lethal cancer in the world. Chemotherapy is the preferred treatment modality for lung cancer and prolongs patient survival by effective controlling of tumor growth. However, owing to the nonspecific delivery of anticancer drugs, systemic chemotherapy has limited clinical efficacy and significant systemic adverse effects. Inhalation routes, on the other hand, allow for direct delivery of drugs to the lungs in high local concentrations, enhancing their anti-tumor activity with minimum side effects. Preliminary research studies have shown that inhaled chemotherapy may be tolerated with manageable adverse effects such as bronchospasm and cough. Enhancing the anticancer drugs deposition in tumor cells and limiting their distribution to other healthy cells will therefore increase their clinical efficacy and decrease their local and systemic toxicities. Because of the controlled release and localization of tumors, nanoparticle formulations are a viable option for the delivery of chemotherapeutics to lung cancers via inhalation. The respiratory tract physiology and lung clearance mechanisms are the key barriers to the effective deposition and preservation of inhaled nanoparticle formulations in the lungs. Designing and creating smart nanoformulations to optimize lung deposition, minimize pulmonary clearance, and improve cancerous tissue targeting have been the subject of recent research studies. This review focuses on recent examples of work in this area, along with the opportunities and challenges for the pulmonary delivery of smart nanoformulations to treat lung cancers.
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Affiliation(s)
- Xian-Yan Yu
- Department of Respiratory Medicine, Chun'an First People's Hospital, (Zhejiang Provincial People's Hospital Chun'an Branch), Hangzhou, PR China
| | - Xue Jin
- Clinical Pharmacy Center, Department of Pharmacy, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, PR China
| | - Zhang-Xuan Shou
- Clinical Pharmacy Center, Department of Pharmacy, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, PR China.,Department of Pharmacy, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, PR China
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Jiang F, Wang C, Yang P, Sun P, Liu J. Pathological cytomorphologic features and the percentage of ALK FISH-positive cells predict pulmonary adenocarcinoma prognosis: a prospective cohort study. World J Surg Oncol 2021; 19:278. [PMID: 34530849 PMCID: PMC8447701 DOI: 10.1186/s12957-021-02386-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 08/31/2021] [Indexed: 11/16/2022] Open
Abstract
Background We conducted a study to explore the relationship between pathological cytomorphologic features and the percentage of anaplastic lymphoma kinase (ALK)-positive cells to better predict pulmonary adenocarcinoma prognosis with crizotinib treatment. Patients and methods We investigated 60 cases of patients with ALK-positive advanced or metastatic non-small cell lung cancer (NSCLC). Immunohistochemistry was performed to screen for ALK rearrangement. Fluorescence in situ hybridization (FISH) was used to detect the percentage of ALK-positive cells. The primary objectives of the study were the progression-free survival (PFS), the 3-year overall survival, and the 3-year overall survival (OS) rates. The secondary objectives of the study were the disease control rate (DCR) and the overall response rate (ORR). Results We compared the pathological cytomorphologic features of 60 cases of ALK-positive pulmonary adenocarcinoma, of which 21 cases were ALK-positive with signet ring cell cytomorphologic characteristics. There were statistical differences in the ORR (p = 0.019), DCR (p = 0.032), and PFS (p = 0.047) between the signet ring cell group and group without signet ring cells. Of these, 37 cases were ALK-positive with EML4 (echinoderm microtubule associated protein like 4)-ALK high percentage of positivity group. These cases benefited more from crizotinib treatment in the ORR (p = 0.046) and achieved a longer PFS (p = 0.036) compared to those with EML4-ALK low percentage of positivity group. Conclusions Signet ring cell cytomorphologic characteristics of pulmonary adenocarcinoma are associated with the percentage of ALK-positive cells. Signet ring cell cytomorphologic characteristics and the percentage of ALK-positive cells might predict the prognosis of pulmonary adenocarcinoma with crizotinib treatment. Trial registration The study was approved by the Institutional Review Board (Medical Ethics Committee of Yantai Yuhuangding Hospital). The registration number is NO.2016[193].
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Affiliation(s)
- Fenge Jiang
- Department of Oncology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, 264000, People's Republic of China
| | - Congcong Wang
- Department of Oncology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, 264000, People's Republic of China
| | - Ping Yang
- Department of Pathology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, 264000, People's Republic of China
| | - Ping Sun
- Department of Oncology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, 264000, People's Republic of China
| | - Jiannan Liu
- Department of Oncology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, 264000, People's Republic of China.
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Xu X, Li R, Zhu P, Zhang P, Chen J, Lin Y, Chen Y. Clinical efficacy and safety of maintenance therapy for advanced non-small cell lung cancer: a retrospective real-world study. World J Surg Oncol 2021; 19:231. [PMID: 34362384 PMCID: PMC8349029 DOI: 10.1186/s12957-021-02340-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 07/19/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The clinical efficacy and safety of maintenance therapy (MT) for patients with advanced non-small cell lung cancer (NSCLC) have not been determined in the real word. This retrospective study of real-world data analyzed these issues in patients with advanced NSCLC and stable or responsive tumors after 4-6 cycles of first-line chemotherapy. METHODS We classified 158 patients into MT (34 IIIB and 37 IV stage) and non-MT (47 IIIB and 40 IV stage) groups and then compared the clinical outcomes of progression-free survival (PFS) and overall survival (OS). The influences of maintaining chemotherapy or targeted drugs, regimens, and duration on PFS were also investigated. Prognostic factors for OS were identified by univariate and multivariate analyses. RESULTS Among the patients, 71 received MT and 87 did not. The median PFS and OS were significantly prolonged in the MT group than non-MT group (5.6 and 14.2 vs. 2.8 and 9.8 months, respectively; both p < 0.0001). The PFS was extended when patients were maintained with targeted drugs compared with chemotherapy, > 4 cycles of chemotherapy, and targeted drugs for > 3 months (all P < 0.0001). Patients with adenocarcinoma and without distant metastasis derived a better OS benefit from MT (P = 0.041 and P = 0.037, respectively). Multivariate analysis revealed that female sex and MT were independent prognostic factors for extended OS (P = 0.039 and P < 0.0001, respectively). The major adverse events of MT comprised tolerable hematological toxicity and gastrointestinal reactions. CONCLUSIONS MT was advantageous and tolerable for patients with advanced NSCLC, especially those with adenocarcinomas without distant metastasis who were treated with targeted drugs, which was an independent prognostic factor for OS.
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Affiliation(s)
- Xiangwei Xu
- Department of Pharmacy, The First People's Hospital of Yongkang, Yongkang, 321300, Zhejiang, China
| | - Ruya Li
- Department of Pharmacy, People's Hospital of Jinyun, Lishui, Zhejiang, 323000, China
| | - Peizhen Zhu
- Department of Medical Oncology, The First People's Hospital of Yongkang, No. 599 jinshan West Road, dongcheng Street, Yongkang, 321300, Zhejiang, China
| | - Penghai Zhang
- Department of Medical Oncology, The First People's Hospital of Yongkang, No. 599 jinshan West Road, dongcheng Street, Yongkang, 321300, Zhejiang, China
| | - Jun Chen
- Department of Pharmacy, The First People's Hospital of Yongkang, Yongkang, 321300, Zhejiang, China
| | - Yongsheng Lin
- Department of Medical Oncology, The First People's Hospital of Yongkang, No. 599 jinshan West Road, dongcheng Street, Yongkang, 321300, Zhejiang, China
| | - Yinqiao Chen
- Department of Medical Oncology, The First People's Hospital of Yongkang, No. 599 jinshan West Road, dongcheng Street, Yongkang, 321300, Zhejiang, China.
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