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Hui C, Brown E, Wong S, Das M, Wakelee H, Neal J, Ramchandran K, Myall NJ, Pham D, Xing L, Yang Y, Kovalchuk N, Yuan Y, Lu Y, Xiang M, Chin A, Diehn M, Loo BW, Vitzthum LK. Personalized Accelerated ChEmoRadiation (PACER) for Lung Cancer: Protocol for a Bayesian Optimal Phase I/II Trial. Clin Lung Cancer 2024; 25:186-189. [PMID: 38040540 DOI: 10.1016/j.cllc.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 11/07/2023] [Indexed: 12/03/2023]
Abstract
INTRODUCTION Prior attempts to escalate radiation dose for non-small cell lung cancer (NSCLC) have not improved survival. Given the high risk for cardiopulmonary toxicity with treatment and heterogenous presentation of locally advanced NSCLC, it is unlikely that a single dose regimen is optimal for all patients. This phase I/II trial aims to evaluate a novel treatment approach where the level of accelerated hypofractionation is determined by the predicted toxicity from dose to organs at risk (OARs). METHODS Patients ≥ 18 years old with lung cancer planned for fractionated radiotherapy to the lung with concurrent chemotherapy will be eligible. Radiation therapy (RT) will be delivered to a total dose of 60 to 66 Gy in 30, 25, or 20 fractions depending on the ability to meet constraints to key organs at risk including the lungs, heart, and esophagus. The primary endpoint is high grade pulmonary, esophageal, or cardiac toxicity. A Bayesian optimized design is used to determine stopping boundaries and evaluate the primary endpoint. CONCLUSION PACER will evaluate the safety and feasibility of personalized accelerated chemoradiotherapy for lung cancer.
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Affiliation(s)
- Caressa Hui
- Department of Radiation Oncology, Stanford University, Stanford, CA
| | - Eleanor Brown
- Department of Radiation Oncology, Stanford University, Stanford, CA
| | - Samantha Wong
- Department of Radiation Oncology, Stanford University, Stanford, CA
| | - Millie Das
- Department of Medical Oncology, Stanford University, Stanford, CA
| | - Heather Wakelee
- Department of Medical Oncology, Stanford University, Stanford, CA
| | - Joel Neal
- Department of Medical Oncology, Stanford University, Stanford, CA
| | | | | | - Daniel Pham
- Department of Radiation Oncology, Stanford University, Stanford, CA
| | - Lei Xing
- Department of Radiation Oncology, Stanford University, Stanford, CA
| | - Yong Yang
- Department of Radiation Oncology, Stanford University, Stanford, CA
| | | | - Ying Yuan
- Department of Biostatistics, Stanford University, Stanford, CA
| | - Ying Lu
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Stanford, CA
| | - Michael Xiang
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA
| | - Alex Chin
- Department of Radiation Oncology, Stanford University, Stanford, CA
| | - Maximilian Diehn
- Department of Radiation Oncology, Stanford University, Stanford, CA
| | - Billy W Loo
- Department of Radiation Oncology, Stanford University, Stanford, CA
| | - Lucas K Vitzthum
- Department of Radiation Oncology, Stanford University, Stanford, CA.
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Ohri N, Chudgar NP, Vimolratana M, Cheng H, Stiles B. Comments on "Effect of Surgical Treatment for N2-Positive c-Stage III Non-Small Cell Lung Carcinoma in the "PACIFIC" Era". Clin Lung Cancer 2024; 25:e75-e76. [PMID: 38057187 DOI: 10.1016/j.cllc.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 11/01/2023] [Indexed: 12/08/2023]
Affiliation(s)
- Nitin Ohri
- Montefiore Einstein Comprehensive Cancer Center, Bronx, NY.
| | - Neel P Chudgar
- Montefiore Einstein Comprehensive Cancer Center, Bronx, NY
| | | | - Haiying Cheng
- Montefiore Einstein Comprehensive Cancer Center, Bronx, NY
| | - Brendon Stiles
- Montefiore Einstein Comprehensive Cancer Center, Bronx, NY
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Ohri N, Jolly S, Cooper BT, Kabarriti R, Bodner WR, Klein J, Guha C, Viswanathan S, Shum E, Sabari JK, Cheng H, Gucalp RA, Castellucci E, Qin A, Gadgeel SM, Halmos B. Selective Personalized RadioImmunotherapy for Locally Advanced Non-Small-Cell Lung Cancer Trial (SPRINT). J Clin Oncol 2024; 42:562-570. [PMID: 37988638 DOI: 10.1200/jco.23.00627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 07/25/2023] [Accepted: 09/29/2023] [Indexed: 11/23/2023] Open
Abstract
PURPOSE Standard therapy for locally advanced non-small-cell lung cancer (LA-NSCLC) is concurrent chemoradiotherapy followed by adjuvant durvalumab. For biomarker-selected patients with LA-NSCLC, we hypothesized that sequential pembrolizumab and risk-adapted radiotherapy, without chemotherapy, would be well-tolerated and effective. METHODS Patients with stage III NSCLC or unresectable stage II NSCLC and an Eastern Cooperative Oncology Group performance status of 0-1 were eligible for this trial. Patients with a PD-L1 tumor proportion score (TPS) of ≥50% received three cycles of induction pembrolizumab (200 mg, once every 21 days), followed by a 20-fraction course of risk-adapted thoracic radiotherapy (55 Gy delivered to tumors or lymph nodes with metabolic volume exceeding 20 cc, 48 Gy delivered to smaller lesions), followed by consolidation pembrolizumab to complete a 1-year treatment course. The primary study end point was 1-year progression-free survival (PFS). Secondary end points included response rates after induction pembrolizumab, overall survival (OS), and adverse events. RESULTS Twenty-five patients with a PD-L1 TPS of ≥50% were enrolled. The median age was 71, most patients (88%) had stage IIIA or IIIB disease, and the median PD-L1 TPS was 75%. Two patients developed disease progression during induction pembrolizumab, and two patients discontinued pembrolizumab after one infusion because of immune-related adverse events. Using RECIST criteria, 12 patients (48%) exhibited a partial or complete response after induction pembrolizumab. Twenty-four patients (96%) received definitive thoracic radiotherapy. The 1-year PFS rate is 76%, satisfying our efficacy objective. One- and 2-year OS rates are 92% and 76%, respectively. The most common grade 3 adverse events were colitis (n = 2, 8%) and esophagitis (n = 2, 8%), and no higher-grade treatment-related adverse events have occurred. CONCLUSION Pembrolizumab and risk-adapted radiotherapy, without chemotherapy, are a promising treatment approach for patients with LA-NSCLC with a PD-L1 TPS of ≥50%.
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Affiliation(s)
- Nitin Ohri
- Department of Radiation Oncology, Montefiore Einstein Comprehensive Cancer Center, Bronx, NY
| | - Shruti Jolly
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI
| | - Benjamin T Cooper
- Department of Radiation Oncology, Perlmutter Cancer Center, New York University Grossman School of Medicine, New York, NY
| | - Rafi Kabarriti
- Department of Radiation Oncology, Montefiore Einstein Comprehensive Cancer Center, Bronx, NY
| | - William R Bodner
- Department of Radiation Oncology, Montefiore Einstein Comprehensive Cancer Center, Bronx, NY
| | - Jonathan Klein
- Department of Radiation Oncology, Montefiore Einstein Comprehensive Cancer Center, Bronx, NY
| | - Chandan Guha
- Department of Radiation Oncology, Montefiore Einstein Comprehensive Cancer Center, Bronx, NY
| | - Shankar Viswanathan
- Department of Epidemiology and Population Health, Montefiore Einstein Comprehensive Cancer Center, Bronx, NY
| | - Elaine Shum
- Division of Medical Oncology, Department of Medicine, Perlmutter Cancer Center, New York University Grossman School of Medicine, New York, NY
| | - Joshua K Sabari
- Division of Medical Oncology, Department of Medicine, Perlmutter Cancer Center, New York University Grossman School of Medicine, New York, NY
| | - Haiying Cheng
- Department of Oncology, Montefiore Einstein Comprehensive Cancer Center, Bronx, NY
| | - Rasim A Gucalp
- Department of Oncology, Montefiore Einstein Comprehensive Cancer Center, Bronx, NY
| | - Enrico Castellucci
- Department of Oncology, Montefiore Einstein Comprehensive Cancer Center, Bronx, NY
| | - Angel Qin
- Department of Internal Medicine, Division of Hematology-Oncology, University of Michigan, Ann Arbor, MI
| | - Shirish M Gadgeel
- Department of Internal Medicine, Henry Ford Cancer Institute, Henry Ford Health System, Detroit, MI
| | - Balazs Halmos
- Department of Oncology, Montefiore Einstein Comprehensive Cancer Center, Bronx, NY
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Liu W, Qiao X, Ge H, Zhang S, Sun X, Li J, Chen W, Gu W, Yuan S. Recurrence patterns are significantly associated with the 18F‑FDG PET/CT radiomic features of patients with locally advanced non‑small cell lung cancer treated with chemoradiotherapy. Oncol Lett 2023; 26:317. [PMID: 37332327 PMCID: PMC10272971 DOI: 10.3892/ol.2023.13903] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 05/22/2023] [Indexed: 06/20/2023] Open
Abstract
A model for predicting the recurrence pattern of patients with locally advanced non-small cell lung cancer (LA-NSCLC) treated with chemoradiotherapy is of great importance for precision treatment. The present study analyzed whether the comprehensive quantitative values (CVs) of the fluorine-18(18F)-fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) radiomic features and metastasis tumor volume (MTV) combined with clinical characteristics could predict the recurrence pattern of patients with LA-NSCLC treated with chemoradiotherapy. Patients with LA-NSCLC treated with chemoradiotherapy were divided into training and validation sets. The recurrence profile of each patient, including locoregional recurrence (LR), distant metastasis (DM) and both LR/DM were recorded. In the training set of patients, the primary tumor prior radiotherapy with 18F-FDG PET/CT and both primary tumors and lymph node metastasis were considered as the regions of interest (ROIs). The CVs of ROIs were calculated using principal component analysis. Additionally, MTVs were obtained from ROIs. The CVs, MTVs and the clinical characteristics of patients were subjected to aforementioned analysis. Furthermore, for the validation set of patients, the CVs and clinical characteristics of patients with LA-NSCLC were also subjected to logistic regression analysis and the area under the curve (AUC) values calculated. A total of 86 patients with LA-NSCLC were included in the analysis, including 59 and 27 patients in the training and validation sets of patients, respectively. The analysis revealed 22 and 12 cases with LR, 24 and 6 cases with DM and 13 and 9 cases with LR/DM in the training and validation sets of patients, respectively. Histological subtype, CV2-5 and CV3-4 were identified as independent variables in the logistic regression analysis (P<0.05). In addition, the AUC values for diagnosing LR, DM and LR/DM were 0.873, 0.711 and 0.826, and 0.675, 0.772 and 0.708 in the training and validation sets of patients, respectively. Overall, the results demonstrated that the spatial and metabolic heterogeneity quantitative values from the primary tumor combined with the histological subtype could predict the recurrence pattern of patients with LA-NSCLC treated with chemoradiotherapy.
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Affiliation(s)
- Wenju Liu
- Department of Radiation Oncology, Shandong University Cancer Center, Jinan, Shandong 250117, P.R. China
- Department of Radiation Oncology, Liaocheng People's Hospital, Liaocheng, Shandong 252000, P.R. China
| | - Xu Qiao
- School of Control Science and Engineering, Shandong University, Jinan, Shandong 250117, P.R. China
| | - Hong Ge
- Department of Radiation Oncology, The Affiliated Cancer Hospital of Zhengzhou University (Henan Cancer Hospital), Zhengzhou, Henan 450000, P.R. China
| | - Sheng Zhang
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, P.R. China
| | - Xiaojiang Sun
- Department of Radiation Oncology, The Cancer Hospital of the University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310022, P.R. China
| | - Jiancheng Li
- Department of Radiation Oncology, Fujian Cancer Hospital, College of Clinical Medicine for Oncology, Fujian Medical University, Fuzhou, Fujian 350000, P.R. China
| | - Weilin Chen
- Department of Radiation Oncology, Zhangzhou Hospital Affiliated to Fujian Medical University, Zhangzhou, Fujian 363000, P.R. China
| | - Wendong Gu
- Department of Radiation Oncology, The Third Hospital Afiliated to Suzhou University, Changzhou, Jiangsu 213000, P.R. China
| | - Shuanghu Yuan
- Department of Radiation Oncology, Shandong University Cancer Center, Jinan, Shandong 250117, P.R. China
- Department of Radiation Oncology, The Affiliated Cancer Hospital of Zhengzhou University (Henan Cancer Hospital), Zhengzhou, Henan 450000, P.R. China
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong 250117, P.R. China
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