1
|
Evaluation of prognostic factors in lung cancers with surgical complete response after induction treatment. TURK GOGUS KALP DAMAR CERRAHISI DERGISI-TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2021; 29:201-211. [PMID: 34104514 PMCID: PMC8167474 DOI: 10.5606/tgkdc.dergisi.2021.19956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 06/13/2020] [Indexed: 11/22/2022]
Abstract
Background
This study aims to evaluate long-term results of induction treatment and to investigate prognostic factors affecting survival in non-small cell lung cancer patients with a pathological complete response.
Methods
Between January 2010 and December 2017, a total of 39 patients (38 males, 1 female; mean age: 56.2±8.3 years; range, 38 to 77 years) having locally advanced (IIIA-IIIB) non-small cell lung cancer who were given induction treatment and underwent surgery after induction treatment and had a pathological complete response were retrospectively analyzed. Survival rates of the patients and prognostic factors of survival were analyzed.
Results
Clinical staging before induction treatment revealed Stage IIB, IIIA, and IIIB disease in three (7.7%), 26 (66.7%), and 10 (25.6%) patients, respectively. The five-year overall survival rate was 61.2%, and the disease-free survival rate was 55.1%. In nine (23.1%) patients, local and distant recurrences were detected in the postoperative period.
Conclusion
In patients with locally advanced non-small cell lung cancer undergoing surgery after induction treatment, the rates of pathological complete response are at considerable levels. In these patients, the five-year overall survival is quite satisfactory and the most important prognostic factor affecting overall survival is the presence of single-station N2.
Collapse
|
2
|
Lewis J, Gillaspie EA, Osmundson EC, Horn L. Before or After: Evolving Neoadjuvant Approaches to Locally Advanced Non-Small Cell Lung Cancer. Front Oncol 2018; 8:5. [PMID: 29410947 PMCID: PMC5787144 DOI: 10.3389/fonc.2018.00005] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 01/05/2018] [Indexed: 12/13/2022] Open
Abstract
The treatment of patients with stage IIIA (N2) non-small cell lung cancer (NSCLC) is one of the most challenging and controversial areas of thoracic oncology. This heterogeneous group is characterized by varying tumor size and location, the potential for involvement of surrounding structures, and ipsilateral mediastinal lymph node spread. Neoadjuvant chemotherapy, administered prior to definitive local therapy, has been found to improve survival in patients with stage IIIA (N2) NSCLC. Concurrent chemoradiation has also been evaluated in phase III studies in efforts to improve control of locoregional disease. In certain instances, a tri-modality approach involving concurrent chemoradiation followed by surgery, may offer patients the best chance for cure. In this article, we provide an overview of the trials evaluating neoadjuvant therapy in patients with stage IIIA (N2) NSCLC that have resulted in current practice strategies, and we highlight the areas of uncertainty in the management of this challenging disease. We also review the current ongoing research and future directions in the management of stage IIIA (N2) NSCLC.
Collapse
Affiliation(s)
- Jennifer Lewis
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States.,Veterans Health Administration-Tennessee Valley Healthcare System, Geriatric Research Education Clinical Center, HSR&D Center, Nashville, TN, United States
| | - Erin A Gillaspie
- Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Evan C Osmundson
- Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Leora Horn
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
| |
Collapse
|
3
|
Ibuki Y, Tsutani Y, Miyata Y, Nakayama H, Okumura S, Yoshimura M, Okada M. Preoperative predictors of distant recurrence in patients with clinical stage IA lung adenocarcinoma undergoing complete resection. Jpn J Clin Oncol 2017; 47:157-163. [PMID: 28173177 DOI: 10.1093/jjco/hyw162] [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: 06/30/2016] [Revised: 09/07/2016] [Accepted: 10/07/2016] [Indexed: 11/14/2022] Open
Abstract
Objective We aimed to identify patients with clinical Stage IA lung adenocarcinoma who are at high risk for distant recurrence to preoperatively organize treatment strategies. Methods We analyzed correlations between preoperative clinical factors and the incidence of distant recurrence in 609 patients with clinical Stage IA lung adenocarcinoma that had been completely resected at four institutions. We excluded 24 patients with only locoregional recurrence and analyzed data from 585 patients. Results Distant recurrence after complete resection was identified in 34 patients during a median follow-up period of 41.4 months. Multivariate Cox analysis identified solid tumor size on high-resolution computed tomography and the maximum standardized uptake value on F-18-fluorodeoxyglucose positron emission tomography/computed tomography as independent predictors for distant recurrence-free survival. Receiver operating characteristic analyses showed that solid tumor size ≥1.7 cm and the maximum standardized uptake value ≥3.3 were optimal criteria with which to detect patients at high risk for distant recurrence. In fact, 3-year distant recurrence rates were higher in patients who met the criteria for high risk (n = 85) than those who did not (n = 500) (28.1% vs. 3.7%; P < 0.001). A similar trend was also found in patients with pathological node negative. Conclusions Solid tumor size on high-resolution computed tomography and the maximum standardized uptake value on F-18-fluorodeoxyglucose positron emission tomography/computed tomography were clinical predictors of distant recurrence among patients with clinical Stage IA lung adenocarcinoma. Our findings might be useful to determine personalized therapeutic strategies including systemic therapy.
Collapse
Affiliation(s)
- Yuta Ibuki
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Yasuhiro Tsutani
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Yoshihiro Miyata
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Haruhiko Nakayama
- Department of Thoracic Surgery, Kanagawa Cancer Centre, Yokohama, Japan
| | - Sakae Okumura
- Department of Thoracic Surgery, Cancer Institute Hospital, Tokyo, Japan
| | | | - Morihito Okada
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| |
Collapse
|
4
|
Fiteni F, Paillard MJ, Westeel V, Bonnetain F. Time-to-event endpoints in operable non-small-cell lung cancer randomized clinical trials. Expert Rev Anticancer Ther 2016; 17:167-173. [PMID: 27937067 DOI: 10.1080/14737140.2016.1271718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION No guideline for time-to-event endpoints (TTEE) definitions in lung cancer trials exists. Areas covered: The aim of the study was to evaluate the reporting of TTEE in operable non-small-cell lung cancer randomized clinical trials. Expert commentary: Sixty-two TTEE were recorded. In the Methods section, using four key points to define TTEE we observed that the 'starting point', 'events', 'information on censoring', 'assessment of events' were clearly defined for 43 (69.4%), 34 (54.8%), 6 (9.7%), 33 (53.2%) endpoints respectively. In the results section, using five key points, we observed that the 'Kaplan-Meier estimation', 'estimation of effect size', 'precision (confidence interval)', 'number of events', 'number of patients at risk', 'multivariate analysis' were clearly identified for 46 (74.2%), 31 (50%), 30 (48.4%), 37 (59.7%), 28 (45.2%), and 17 (27.4%) endpoints, respectively. A majority of articles failed to provide a complete reporting of TTEE. Guidelines for TTEE is warranted.
Collapse
Affiliation(s)
- Frédéric Fiteni
- a Methodology and Quality of Life in Oncology Unit , University Hospital of Besançon , Besançon , France.,b Department of Medical Oncology , University Hospital of Besançon , Besançon , France.,c Medical Department , European Organisation for Research and Treatment of Cancer , Brussels , Belgium
| | - Marie-Justine Paillard
- a Methodology and Quality of Life in Oncology Unit , University Hospital of Besançon , Besançon , France.,b Department of Medical Oncology , University Hospital of Besançon , Besançon , France
| | - Virginie Westeel
- d Chest disease Department , University Hospital of Besançon , Besançon , France
| | - Franck Bonnetain
- a Methodology and Quality of Life in Oncology Unit , University Hospital of Besançon , Besançon , France.,b Department of Medical Oncology , University Hospital of Besançon , Besançon , France.,e EA 3181 University of Franche-Comté , Besançon , France
| |
Collapse
|
5
|
Radiologic-pathologic correlation of response to chemoradiation in resectable locally advanced NSCLC. Lung Cancer 2016; 102:1-8. [DOI: 10.1016/j.lungcan.2016.10.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 09/01/2016] [Accepted: 10/11/2016] [Indexed: 10/20/2022]
|
6
|
Awan M, Sharma N, Towe CW, Efird JT, Machtay M, Biswas T. Optimum treatment for mediastinal lymph node positive (N2) resectable non-small cell lung cancer: what is the role for surgery? Expert Rev Anticancer Ther 2016; 16:1131-1144. [PMID: 27654059 DOI: 10.1080/14737140.2016.1240039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION A third of patients with Non-Small Cell Lung Cancer (NSCLC) present with Stage III disease with mediastinal (N2) nodal involvement representing an extremely heterogeneous population with a generally poor prognosis. Areas covered: This article describes the complexity of Stage III-N2 patients reviewing the outcomes of key clinical trials while highlighting the trial designs and subtleties that have created controversy in management. Both bimodality approaches combining chemotherapy with either surgery or radiation and trimodality approaches combining chemotherapy with both local therapies are reviewed. Finally, prognostic factors and future directions are explored for the management of this population. Expert commentary: Upfront surgery is not recommended for patients with Stage III-N2 NSCLC. Neoadjuvant approaches with both chemotherapy and chemoradiation are acceptable in a multidisciplinary setting if appropriate surgery is performed by a dedicated thoracic surgeon. Non-operative candidates should receive definitive concurrent chemoradiation. Innovative approaches are necessary to improve outcomes in this population.
Collapse
Affiliation(s)
- Musaddiq Awan
- a Department of Radiation Oncology , Case Western Reserve University , Cleveland , OH , USA
| | - Neelesh Sharma
- b Department of Medical Oncology , Case Western Reserve University , Cleveland , OH , USA
| | - Christopher W Towe
- c Department of Surgery, Division of Thoracic and Esophageal Surgery , University Hospitals Case Medical Center , Cleveland , OH , USA
| | - Jimmy T Efird
- d Center for Health Disparities, Brody School of Medicine and Office of Research, College of Nursing , East Carolina University , Greenville , NC , USA
| | - Mitchell Machtay
- a Department of Radiation Oncology , Case Western Reserve University , Cleveland , OH , USA
| | - Tithi Biswas
- a Department of Radiation Oncology , Case Western Reserve University , Cleveland , OH , USA
| |
Collapse
|
7
|
|
8
|
Naylor EC. Adjuvant Therapy for Stage I and II Non–Small Cell Lung Cancer. Surg Oncol Clin N Am 2016; 25:585-99. [DOI: 10.1016/j.soc.2016.03.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
|
9
|
Calvo Temprano D, Esteban E, Jiménez Fonseca P, Fernández-Mariño B. CT scan prior to radiotherapy in unresectable, locally advanced, non-small cell carcinoma of the lung: is it always necessary? Clin Transl Oncol 2016; 19:105-110. [PMID: 27091132 DOI: 10.1007/s12094-016-1510-4] [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: 09/25/2015] [Accepted: 04/05/2016] [Indexed: 11/26/2022]
Abstract
PURPOSE There is broad consensus regarding evaluating response to chemotherapy (CHT) by means of computerized tomography (CT) in patients with localized or locally advanced non-small cell lung carcinoma (NSCLC). We present a study comparing the usefulness of CT versus chest X-ray (XR) and clinical findings when indicating radiotherapy (RT) following CHT. METHODS Ninety-eight of 150 subjects with unresectable locally advanced NSCLC were blindly and independently evaluated by XR and CT, with pairs of chest XR and CT (before and after CHT). A null hypothesis (H0) was established of the conditioned probability of detecting progression by CT and not by XR of 10 % or more, with a statistical power of 80 %. RESULTS Sensitivity, specificity, positive and negative predictive value of XR versus CT were 98, 89, 99, and 80 % respectively. A 4 % (p = 0.0451) probability of improvement of CT versus XR was calculated, enabling the H0 to be ruled out. CONCLUSION The CT failed to prove to be significantly superior to the chest XR + clinical picture in indicating a change in treatment approach in patients with unresectable locally advanced NSCLC after CHT.
Collapse
MESH Headings
- Adenocarcinoma/diagnostic imaging
- Adenocarcinoma/pathology
- Adenocarcinoma/radiotherapy
- Adult
- Aged
- Carcinoma, Large Cell/diagnostic imaging
- Carcinoma, Large Cell/pathology
- Carcinoma, Large Cell/radiotherapy
- Carcinoma, Non-Small-Cell Lung/diagnostic imaging
- Carcinoma, Non-Small-Cell Lung/pathology
- Carcinoma, Non-Small-Cell Lung/radiotherapy
- Carcinoma, Squamous Cell/diagnostic imaging
- Carcinoma, Squamous Cell/pathology
- Carcinoma, Squamous Cell/radiotherapy
- Female
- Follow-Up Studies
- Humans
- Lung Neoplasms/diagnostic imaging
- Lung Neoplasms/pathology
- Lung Neoplasms/radiotherapy
- Male
- Middle Aged
- Neoplasm Staging
- Prognosis
- Radiography, Thoracic/methods
- Tomography, X-Ray Computed/methods
Collapse
Affiliation(s)
- D Calvo Temprano
- Radiology Service, Hospital Universitario Central de Asturias, Avenida de Roma, s/n, ES-33011, Oviedo, Asturias, Spain.
| | - E Esteban
- Medical Oncology Service, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - P Jiménez Fonseca
- Medical Oncology Service, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - B Fernández-Mariño
- Radiology Service, Hospital Universitario Central de Asturias, Avenida de Roma, s/n, ES-33011, Oviedo, Asturias, Spain
| |
Collapse
|
10
|
Fennell DA, Summers Y, Cadranel J, Benepal T, Christoph DC, Lal R, Das M, Maxwell F, Visseren-Grul C, Ferry D. Cisplatin in the modern era: The backbone of first-line chemotherapy for non-small cell lung cancer. Cancer Treat Rev 2016; 44:42-50. [PMID: 26866673 DOI: 10.1016/j.ctrv.2016.01.003] [Citation(s) in RCA: 258] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 01/12/2016] [Accepted: 01/15/2016] [Indexed: 01/25/2023]
Abstract
The treatment of advanced non-small cell lung cancer (NSCLC) may be changing, but the cisplatin-based doublet remains the foundation of treatment for the majority of patients with advanced NSCLC. In this respect, changes in practice to various aspects of cisplatin use, such as administration schedules and the choice of methods and frequency of monitoring for toxicities, have contributed to an incremental improvement in patient management and experience. Chemoresistance, however, limits the clinical utility of this drug in patients with advanced NSCLC. Better understanding of the molecular mechanisms of cisplatin resistance, identification of predictive markers and the development of newer, more effective and less toxic platinum agents is required. In addition to maximising potential benefits from advances in molecular biology and associated therapeutics, modification of existing cisplatin-based treatments can still lead to improvements in patient outcomes and experiences.
Collapse
Affiliation(s)
- D A Fennell
- Cancer Research UK Centre, University of Leicester & University Hospitals of Leicester, NHS Trust, Leicester, UK.
| | - Y Summers
- The Christie Hospital NHS Foundation Trust, 550 Wilmslow Road, Manchester M20 4BX, UK.
| | - J Cadranel
- Chest Department and Expert Center in Thoracic Oncology, APHP Hôpital Tenon and Sorbonne Universités, UPMC Univ Paris 06, Paris, France.
| | - T Benepal
- St Georges Hospital NHS Trust, Blackshaw Road, Tooting, London SW17 0QT, UK.
| | - D C Christoph
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Hufelandstraße 55, D-45147, Essen, Germany.
| | - R Lal
- Guy's and St Thomas' Foundation Trust, Westminster Bridge Road, London SE1 7EH, UK.
| | - M Das
- Eli Lilly and Company, Lilly House, Priestley Road, Basingstoke, Hampshire RG24 9NL, UK.
| | - F Maxwell
- Eli Lilly and Company, Lilly House, Priestley Road, Basingstoke, Hampshire RG24 9NL, UK.
| | - C Visseren-Grul
- Eli Lilly and Company, Grootslag 1-5, 3991 RA Houten, The Netherlands.
| | - D Ferry
- Eli Lilly and Company, Lilly House, Priestley Road, Basingstoke, Hampshire RG24 9NL, UK.
| |
Collapse
|
11
|
Milleron B, Westeel V, Gounant V, Wislez M, Quoix E. La réponse complète histologique : un facteur prédictif de survie après chimiothérapie néoadjuvante dans le cancer bronchopulmonaire. Bull Cancer 2016; 103:66-72. [DOI: 10.1016/j.bulcan.2015.11.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 11/05/2015] [Accepted: 11/05/2015] [Indexed: 10/22/2022]
|
12
|
Moro-Sibilot D, Audigier-Valette C, Merle P, Quoix E, Souquet PJ, Barlesi F, Chouaid C, Molinier O, Bennouna J, Lavolé A, Mazières J, Toffart AC, Langlais A, Morin F, Zalcman G. Non-small cell lung cancer recurrence following surgery and perioperative chemotherapy: Comparison of two chemotherapy regimens (IFCT-0702: A randomized phase 3 final results study). Lung Cancer 2015; 89:139-45. [PMID: 26059274 DOI: 10.1016/j.lungcan.2015.05.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Revised: 05/13/2015] [Accepted: 05/16/2015] [Indexed: 11/28/2022]
Abstract
INTRODUCTION This study compared the efficacy of docetaxel alone vs. docetaxel plus cisplatin/carboplatin in resected NSCLC patients relapsing after preoperative, adjuvant, or perioperative platinum-based chemotherapy. MATERIALS AND METHODS Patients were randomly assigned to receive docetaxel plus cisplatin/carboplatin (Arm A) or docetaxel alone (Arm B). Primary endpoint was progression-free survival (PFS). Secondary endpoints were response rate at 6 weeks, toxicity, quality of life, and overall survival (OS). RESULTS From November 2007 to August 2012, 88 patients were enrolled. Due to an unexpectedly slow accrual, the trial was prematurely stopped. Adding platinum to docetaxel caused a non-significant increase in PFS. Median PFS was 8.0 months (95% CI: 5.3-10.4) for Arm A vs. 5.6 months (95% CI: 4.0-7.3) for Arm B (HR: 0.71, 95% CI: 0.45-1.1, p=0.15). Median OS was 16.0 months (95% CI: 10.1-23.9) for Arm A vs. 12.4 months (95% CI: 8.2-19.6) for Arm B. In pre-planned subgroup analyses, a time to recurrence ≥12 months and non-squamous histology favorably influenced OS (HR: 0.51, 95% CI: 0.29-0.91, p=0.02 and HR: 0.54, 95% CI: 0.33-0.91, p=0.02, respectively). There were no unexpected adverse events, and Grade 3-4 toxicity was comparable in both groups. CONCLUSIONS Our study failed to demonstrate significant PFS improvement with the docetaxel-platinum doublet compared to single-agent docetaxel. The 3.6-month improvement in OS with the cisplatin-based doublet proves, however, appealing and merits further investigation.
Collapse
Affiliation(s)
- Denis Moro-Sibilot
- Department of Thoracic Oncology, Pole Thorax Vaisseaux, CHU Grenoble and INSERM U 823, CS10217, Grenoble, France.
| | | | - Patrick Merle
- Department of Pneumology-Thoracic Oncology, CHU Hôpital Gabriel Montpied, Clermont-Ferrand, France
| | - Elisabeth Quoix
- Department of Pneumology, Nouvel hôpital civil, Hôpitaux universitaires de Strasbourg, Strasbourg, France
| | - Pierre-Jean Souquet
- Department of Pneumology, Centre Hospitalier Lyon Sud, Pierre-Bénite, France
| | - Fabrice Barlesi
- Aix Marseille Université, Assistance Publique Hôpitaux de Marseille, Multidisciplinary Oncology and Therapeutic Innovation Unit, Hôpital Nord, Centre d'investigation clinique, Marseille, France
| | - Christos Chouaid
- Department of Pneumology, Centre hospitalier intercommunal de Créteil, Créteil, France
| | | | | | | | | | - Anne-Claire Toffart
- Department of Thoracic Oncology, Pole Thorax Vaisseaux, CHU Grenoble and INSERM U 823, CS10217, Grenoble, France
| | | | - Franck Morin
- French Cooperative Thoracic Intergroup (IFCT), Paris, France
| | - Gérard Zalcman
- Department of Pneumology and Thoracic Oncology, CHU Caen, Côte de Nacre, Caen, France
| |
Collapse
|
13
|
Pagès PB, Pforr A, Delpy JP, Abou Hanna H, Bernard A. [Is there a place for surgical management in stage IIIA N2 non-small cell lung cancer?]. Rev Mal Respir 2014; 32:485-92. [PMID: 25498767 DOI: 10.1016/j.rmr.2014.07.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2014] [Accepted: 07/12/2014] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Non-small cell lung cancer (NSCLC) remains a major health problem, with a 5-year overall survival of 25%. Surgical management of stage IIIA NSCLC is still controversial. We conduct a systematic analysis of the different management strategies for stage IIIA-N2 NSCLC. METHODS We analyzed randomized control trials published between January 1990 to December 2013, comparing induction chemotherapy followed by surgery vs. surgery alone, and those comparing induction chemo or radiotherapy followed by surgery vs. induction chemotherapy followed by radiotherapy for stage IIIA-N2 NSCLC. RESULTS A 16% significant increase in overall survival was found in favor of induction chemotherapy followed by surgery vs. surgery alone. However, there was no significant difference in overall survival between induction chemo- or radiotherapy followed by surgery and induction chemotherapy followed by radiotherapy. CONCLUSION Current scientific data do not permit the exclusion of surgery as an option in the management of stage IIIA-N2 NSCLC.
Collapse
Affiliation(s)
- P-B Pagès
- Service de chirurgie cardiovasculaire et thoracique, université de Bourgogne, CHU Bocage central, CHU de Dijon, BP 77908, 14, rue Gaffarel, 21079 Dijon cedex, France.
| | - A Pforr
- Service de chirurgie cardiovasculaire et thoracique, université de Bourgogne, CHU Bocage central, CHU de Dijon, BP 77908, 14, rue Gaffarel, 21079 Dijon cedex, France
| | - J-P Delpy
- Service de chirurgie cardiovasculaire et thoracique, université de Bourgogne, CHU Bocage central, CHU de Dijon, BP 77908, 14, rue Gaffarel, 21079 Dijon cedex, France
| | - H Abou Hanna
- Service de chirurgie cardiovasculaire et thoracique, université de Bourgogne, CHU Bocage central, CHU de Dijon, BP 77908, 14, rue Gaffarel, 21079 Dijon cedex, France
| | - A Bernard
- Service de chirurgie cardiovasculaire et thoracique, université de Bourgogne, CHU Bocage central, CHU de Dijon, BP 77908, 14, rue Gaffarel, 21079 Dijon cedex, France
| |
Collapse
|
14
|
Badrzadeh F, Rahmati-Yamchi M, Badrzadeh K, Valizadeh A, Zarghami N, Farkhani SM, Akbarzadeh A. Drug delivery and nanodetection in lung cancer. ARTIFICIAL CELLS NANOMEDICINE AND BIOTECHNOLOGY 2014; 44:618-34. [DOI: 10.3109/21691401.2014.975237] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
|
15
|
|
16
|
Jeremić B. Standard treatment option in stage III non-small-cell lung cancer: case against trimodal therapy and consolidation drug therapy. Clin Lung Cancer 2014; 16:80-5. [PMID: 25450877 DOI: 10.1016/j.cllc.2014.08.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2014] [Revised: 08/18/2014] [Accepted: 08/26/2014] [Indexed: 11/30/2022]
Abstract
Prospective randomized trials and meta-analyses established concurrent radiochemotherapy (RT-CHT) as standard treatment approach in patients with inoperable, locally advanced (stage IIIA and B) non-small-cell lung cancer (NSCLC). In patients with either clinically (c) or pathologically (p) staged disease (stage IIIA), including those with pN2 disease, trimodal therapy was also frequently practiced in the past and is currently still advocated by large cooperative groups and organizations. Similarly, consolidation CHT provided after concurrent RT-CHT was suggested to be feasible and effective in inoperable stage III NSCLC. Contrasting these practices and suggestions, there is no evidence that trimodal therapy in stage IIIA (clinically or pathologically staged) or consolidation CHT in inoperable stage III NSCLC plays any role in its treatment. In both cases, evidence clearly demonstrates that concurrent RT-CHT is of similar efficacy and less toxic, and it should be considered a standard treatment option for all patients with stage III NSCLC.
Collapse
Affiliation(s)
- Branislav Jeremić
- Insitute for Lung Diseases, Sremska Kamenica, Serbia; BioIRC Centre for Biomedical Research, Kragujevac, Serbia.
| |
Collapse
|
17
|
Phase II study of perioperative chemotherapy with cisplatin and pemetrexed in non-small-cell lung cancer. J Thorac Oncol 2014; 9:222-30. [PMID: 24419420 DOI: 10.1097/jto.0000000000000062] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Pathologic complete response (pCR) with neoadjuvant chemotherapy is associated with improved survival in many solid tumors. We evaluated pCR rate of cisplatin with pemetrexed in non-small-cell lung cancer. METHODS Patients with stages IB to IIIA non-small-cell lung cancer, Eastern Cooperative Oncology Group performance status 0 to 1 were enrolled in this single-arm phase II trial using two-stage design with 90% power to detect pCR rate of more than or equal to 10%. Pretreatment mediastinal lymph node biopsy was required. Patients received three cycles of cisplatin 75 mg/m with pemetrexed 500 mg/m (day 1 every 21 days) preoperatively and additional two cycles within 60 to 80 days after surgery. The primary end point was pCR. Polymorphisms in FPGS, GGH, SLC19A1, and TYMS genes were correlated with treatment outcomes. RESULTS Thirty-eight patients were enrolled, with median age of 62.5 years. Preoperatively, 26% had squamous histology, and 34% had biopsy-proven N2 involvement. R0 resection was achieved in 94% of the 34 patients who underwent surgery, and 54% had documented N2 clearance. There was no pCR seen. Median disease-free survival (DFS) and overall survival of these patients have not yet been reached in contrast to median of 13.8 and 24.2 months, respectively, in patients with persistent N2 disease (p = 0.3241 and p = 0.1022, respectively). There was a statistically significant association between DFS and postoperative tumor, node, metastasis stage (p = 0.0429), SLC19A1 rs3788189 TT genotype (p = 0.0821), and viable tumor defined as less than or equal to 10% of resected specimen (p = 0.026). CONCLUSION The primary end point was not met. Patients with N2 clearance, less than or equal to 10% viable tumor in the resected specimen, and SLC19A1 rs3788189 TT genotype have favorable DFS outcomes.
Collapse
|
18
|
Preoperative endobronchial photodynamic therapy improves resectability in initially irresectable (inoperable) locally advanced non small cell lung cancer. Photodiagnosis Photodyn Ther 2014; 11:259-64. [DOI: 10.1016/j.pdpdt.2014.03.011] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2013] [Revised: 03/22/2014] [Accepted: 03/24/2014] [Indexed: 11/17/2022]
|
19
|
Current status of induction treatment for N2-Stage III non-small cell lung cancer. Gen Thorac Cardiovasc Surg 2014; 62:651-9. [PMID: 25355643 DOI: 10.1007/s11748-014-0447-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Indexed: 12/25/2022]
Abstract
Locally advanced non-small cell lung cancer (NSCLC), particularly clinical Stage IIIA NSCLC with mediastinal lymph node metastasis, is known to be quite heterogeneous, comprising approximately one-fourth of cases of NSCLC. In this subset, patients with a minor tumor load in the mediastinal lymph nodes, such as microscopically or pathologically proven N2 in the resected specimens, are treated with surgery followed by adjuvant chemotherapy. Meanwhile, the current standard of care for patients with bulky or infiltrative N2 disease is concurrent chemoradiotherapy. The potential role of surgery in multi-modality treatment for clinical N2-Stage IIIA remains controversial. Several prospective clinical trials of this subset have been conducted; however, the heterogeneity of the N2 status and differences in chemotherapy regimens and/or radiation modalities between clinical trials make the results difficult to compare. No optimal chemotherapy regimen has been established to control possible micrometastasis, and radiotherapy is often used to achieve maximum local disease control and minimize post-surgical complications. This review summarizes the findings of prospective clinical trials that assessed the role of surgery in treating clinical N2-Stage IIIA patients within the last two decades and discusses the present status of induction treatment followed by surgery for clinical N2-Stage IIIA NSCLC.
Collapse
|
20
|
Hu YM, Li J, Yu LC, Shi SB, Du YJ, Wu JN, Shi WL. Survivin mRNA Level in Blood Predict the Efficacy of Neoadjuvant Chemotherapy in Patients with Stage IIIA-N2 Non-Small Cell Lung Cancer. Pathol Oncol Res 2014; 21:257-65. [PMID: 24980156 DOI: 10.1007/s12253-014-9816-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2013] [Accepted: 06/18/2014] [Indexed: 12/22/2022]
Abstract
In a previous study, survivin mRNA expression in non-small cell lung cancer (NSCLC) tissue had been demonstrated to be associated with unfavorable prognosis of patients treated with chemotherapy. In this study, we investigated the survivin mRNA levels in blood of patients with stage IIIA-N2 NSCLC and their association with the efficacy of neoadjuvant chemotherapy (NCT) and disease-free survival (DFS) and overall survival (OS). Blood specimens were collected from 56 patients with stage IIIA-N2 NSCLC before (N0) and after the complete of NCT (N1). Survivin mRNA was measured by real-time quantitative-PCR assay. Receiver operating characteristics curve analysis was undertaken to determine the best cutoff value for survivin mRNA. Results showed that high blood survivin mRNA levels at N0 and N1 were significantly associated with clinical (P = 0.01 and P = 0.008, respectively) and pathologic response (both P = 0.004, respectively). Moreover, the change of blood survivin mRNA levels in these NSCLC patients is associated with the clinical and pathologic response to NCT. Patients with high survivin mRNA levels at N0 and N1 had significantly shorter DFS and OS than those with low survivin mRNA levels (P = 0.021 and P = 0.014, respectively for DFS; P = 0.009 and P = 0.005, respectively for OS). Multivariate analysis demonstrated that high blood survivin mRNA level was an independent predictor for worse DFS and OS in the NSCLC patients receiving NCT. In conclusion, survivin mRNA level in blood from stage IIIA-N2 NSCLC patients receiving NCT is predictive of cancer outcome.
Collapse
Affiliation(s)
- Yi-Ming Hu
- Department of Pulmonary Medicine, Affiliated Hospital of Jiangsu University, 438 North Jiefang Street, Zhenjiang, 212001, China
| | | | | | | | | | | | | |
Collapse
|
21
|
Chudacek J, Bohanes T, Klein J, Benedikova A, Srovnal J, Szkorupa M, Skalicky P, Skarda J, Hajduch M, Neoral C. Detection of minimal residual disease in lung cancer. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2014; 158:189-93. [DOI: 10.5507/bp.2013.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Accepted: 02/28/2013] [Indexed: 11/23/2022] Open
|
22
|
Miyata Y, Okada M. [Lung cancer: progress in diagnosis and treatments. Topics: III. Treatment; 1. Surgery, sublobar resection and adjuvant and neoadjuvant therapy for non small cell lung cancer]. NIHON NAIKA GAKKAI ZASSHI. THE JOURNAL OF THE JAPANESE SOCIETY OF INTERNAL MEDICINE 2014; 103:1293-9. [PMID: 25151793 DOI: 10.2169/naika.103.1293] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
23
|
Abstract
BACKGROUND Individual participant data meta-analyses of postoperative chemotherapy have shown improved survival for patients with non-small-cell lung cancer (NSCLC). We aimed to do a systematic review and individual participant data meta-analysis to establish the effect of preoperative chemotherapy for patients with resectable NSCLC. METHODS We systematically searched for trials that started after January, 1965. Updated individual participant data were centrally collected, checked, and analysed. Results from individual randomised controlled trials (both published and unpublished) were combined using a two-stage fixed-effect model. Our primary outcome, overall survival, was defined as the time from randomisation until death (any cause), with living patients censored on the date of last follow-up. Secondary outcomes were recurrence-free survival, time to locoregional and distant recurrence, cause-specific survival, complete and overall resection rates, and postoperative mortality. Prespecified analyses explored any variation in effect by trial and patient characteristics. All analyses were by intention to treat. FINDINGS Analyses of 15 randomised controlled trials (2385 patients) showed a significant benefit of preoperative chemotherapy on survival (hazard ratio [HR] 0·87, 95% CI 0·78-0·96, p=0·007), a 13% reduction in the relative risk of death (no evidence of a difference between trials; p=0·18, I(2)=25%). This finding represents an absolute survival improvement of 5% at 5 years, from 40% to 45%. There was no clear evidence of a difference in the effect on survival by chemotherapy regimen or scheduling, number of drugs, platinum agent used, or whether postoperative radiotherapy was given. There was no clear evidence that particular types of patient defined by age, sex, performance status, histology, or clinical stage benefited more or less from preoperative chemotherapy. Recurrence-free survival (HR 0·85, 95% CI 0·76-0·94, p=0·002) and time to distant recurrence (0·69, 0·58-0·82, p<0·0001) results were both significantly in favour of preoperative chemotherapy although most patients included were stage IB-IIIA. Results for time to locoregional recurrence (0·88, 0·73-1·07, p=0·20), although in favour of preoperative chemotherapy, were not statistically significant. INTERPRETATION Findings, which are based on 92% of all patients who were randomised, and mainly stage IB-IIIA, show preoperative chemotherapy significantly improves overall survival, time to distant recurrence, and recurrence-free survival in resectable NSCLC. The findings suggest this is a valid treatment option for most of these patients. Toxic effects could not be assessed. FUNDING Medical Research Council UK.
Collapse
|
24
|
Peng C, Hao Y, Zhao Y, Sun Q, Zhao X, Cong B. Effect of Smac and Taxol on non-small-cell lung cancer. Acta Biochim Biophys Sin (Shanghai) 2014; 46:387-93. [PMID: 24681884 DOI: 10.1093/abbs/gmu018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
A series of structurally unique second mitochondria-derived activator of caspases (Smacs) that act as antagonists of the inhibitor of apoptosis proteins (IAPs) directly have been discovered. They play crucial roles in mitochondrial apoptosis pathways and promote chemotherapy-induced apoptosis. In this study, we constructed a eukaryotic expression vector pcDNA3.1/Smac and transfected it into A549 human lung cancer cells. Then we analyzed the cell invasive and cloning ability, as well as cell apoptosis induced by Taxol. The results showed that over-expressed Smac significantly inhibited A549 cell invasive and cloning ability and promoted apoptosis following Taxol treatment. This finding provides a potential approach for the biological therapy of lung cancer.
Collapse
Affiliation(s)
- Chuanliang Peng
- Thoracic Department, The second Hospital of Shandong University, Jinan 250033, China
| | | | | | | | | | | |
Collapse
|
25
|
Soussan M, Cyrta J, Pouliquen C, Chouahnia K, Orlhac F, Martinod E, Eder V, Morère JF, Buvat I. Fluorine 18 fluorodeoxyglucose PET/CT volume-based indices in locally advanced non-small cell lung cancer: prediction of residual viable tumor after induction chemotherapy. Radiology 2014; 272:875-84. [PMID: 24761836 DOI: 10.1148/radiol.14132191] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
PURPOSE To study whether volume-based indices of fluorine 18 fluorodeoxyglucose positron emission tomographic (PET)/computed tomographic (CT) imaging is an accurate tool to predict the amount of residual viable tumor after induction chemotherapy in patients with locally advanced non-small cell lung cancer (NSCLC). MATERIALS AND METHODS This study was approved by institutional review board with waivers of informed consent. Twenty-two patients with locally advanced NSCLC underwent surgery after induction chemotherapy. All had pre- and posttreatment FDG PET/CT scans. CT largest diameter, CT volume, maximum standardized uptake value (SUVmax), mean SUV (SUVmean), metabolic tumor volume (TV), and total lesion glycolysis of primary tumor were calculated. Changes in tumor measurements were determined by dividing follow-up by baseline measurement (ratio index). Amounts of residual viable tumor, necrosis, fibrous tissue, inflammatory infiltrate, and Ki-67 proliferative index were estimated on resected tumor. Correlations between imaging indices and histologic parameters were estimated by using Spearman correlation coefficients or Mann-Whitney tests. RESULTS No baseline or posttreatment indices correlated with percentage of residual viable tumor. TV ratio was the only index that correlated with percentage of residual viable tumor (r = 0.61 [95% confidence interval: 0.24, 0.81]; P = .003). Conversely, SUVmax and SUVmean ratios were only indices correlated with Ki-67 (r = 0.62 [95% confidence interval: 0.24, 0.82]; P = .003; and r = 0.60 [95% confidence interval: 0.21, 0.81]; P = .004, respectively). Total lesion glycolysis ratio was moderately correlated with residual viable tumor (r = 0.53 [95% confidence interval: 0.13, 0.78]; P = .01) and with Ki-67 (r = 0.57 [95% confidence interval: 0.18, 0.80]; P = .006). No ratios were correlated with presence of inflammatory infiltrate or foamy macrophages. CONCLUSION TV and total lesion glycolysis ratios were the only indices correlated with residual viable tumor after induction chemotherapy in locally advanced NSCLC.
Collapse
Affiliation(s)
- Michael Soussan
- From the Departments of Nuclear Medicine (M.S., V.E.), Pathology (J.C., C.P.), Oncology (K.C., J.F.M.), and Thoracic Surgery (E.M.), AP-HP, Avicenne Hospital, 125 rue de Stalingrad, 93000 Bobigny, France; and IMNC-UMR 8165 CNRS-Universités Paris 7 and 11, Orsay, France (M.S., F.O.); and CEA-SHFJ, Orsay, France (I.B.)
| | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Azzoli CG, Pisters KM. Neoadjuvant Chemotherapy for Resectable Non-Small Cell Lung Cancer. Lung Cancer 2014. [DOI: 10.1002/9781118468791.ch19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
27
|
Hellmann MD, Chaft JE, William WN, Rusch V, Pisters KMW, Kalhor N, Pataer A, Travis WD, Swisher SG, Kris MG. Pathological response after neoadjuvant chemotherapy in resectable non-small-cell lung cancers: proposal for the use of major pathological response as a surrogate endpoint. Lancet Oncol 2014; 15:e42-50. [PMID: 24384493 DOI: 10.1016/s1470-2045(13)70334-6] [Citation(s) in RCA: 378] [Impact Index Per Article: 37.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Improvements in outcomes for patients with resectable lung cancers have plateaued. Clinical trials of resectable non-small-cell lung cancers with overall survival as the primary endpoint require a decade or longer to complete, are expensive, and limit innovation. A surrogate for survival, such as pathological response to neoadjuvant chemotherapy, has the potential to improve the efficiency of trials and expedite advances. 10% or less residual viable tumour after neoadjuvant chemotherapy, termed here major pathological response, meets criteria for a surrogate; major pathological response strongly associates with improved survival, is reflective of treatment effect, and captures the magnitude of the treatment benefit on survival. We support the incorporation of major pathological response as a surrogate endpoint for survival in future neoadjuvant trials of resectable lung cancers. Additional prospective studies are needed to confirm the validity and reproducibility of major pathological response within individual histological and molecular subgroups and with new drugs.
Collapse
Affiliation(s)
- Matthew D Hellmann
- Thoracic Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Jamie E Chaft
- Thoracic Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - William N William
- Department of Thoracic/Head and Neck Medical Oncology, Division of Cancer Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Valerie Rusch
- Thoracic Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Katherine M W Pisters
- Department of Thoracic/Head and Neck Medical Oncology, Division of Cancer Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Neda Kalhor
- Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Apar Pataer
- Department of Thoracic and Cardiovascular Surgery, Division of Surgery, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - William D Travis
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Stephen G Swisher
- Department of Thoracic and Cardiovascular Surgery, Division of Surgery, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mark G Kris
- Thoracic Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
| | | |
Collapse
|
28
|
Moreno AC, Morgensztern D, Boffa DJ, Decker RH, Yu JB, Detterbeck FC, Wang Z, Rose MG, Kim AW. Treating locally advanced disease: an analysis of very large, hilar lymph node positive non-small cell lung cancer using the National Cancer Data Base. Ann Thorac Surg 2014; 97:1149-55. [PMID: 24582051 DOI: 10.1016/j.athoracsur.2013.12.045] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Revised: 12/11/2013] [Accepted: 12/18/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND Very large, locally advanced non-small cell lung cancers (NSCLC) remain a therapeutic challenge. This retrospective study compares the effect of treatment modalities on survival of patients with large NSCLC with hilar lymph node involvement (T3>7 cmN1). METHODS The National Cancer Data Base was used to identify adult patients who were diagnosed with T3>7 cmN1 NSCLC from 1999 to 2005 (n=642). Nonsurgical treatments included chemoradiation, chemotherapy, radiation therapy, or no treatment, whereas primary surgical treatments included surgery, chemoradiation or chemotherapy prior to surgery, chemoradiation or chemotherapy after surgery, or postoperative radiotherapy. Five-year overall survival (OS) was estimated by the Kaplan-Meier method and comparisons made using log-rank tests and Cox regression models. RESULTS A total of 642 patients were evaluated; 425 nonsurgical (66%) and 217 surgical (34%). Primary surgical therapy was associated with improved 5-year OS; 28% versus 8% and 4% for nonsurgical and no treatment, respectively (p<0.001). The 5-year OS were 11%, 5%, 2%, and 4% for chemoradiation, chemotherapy, radiation therapy, and no treatment, respectively (p<0.001). The 5-year OS were 16% for surgery only, 40% and 44% for neoadjuvant chemoradiation or chemotherapy with surgery, respectively, 40% and 38% for adjuvant chemoradiation or chemotherapy with surgery, respectively, and 18% for postoperative radiotherapy (p<0.001). On multivariate analysis, surgery and chemotherapy in most combinations were associated with significantly improved OS compared with chemoradiation only. CONCLUSIONS Surgery with systemic therapy delivered in a neoadjuvant or adjuvant fashion for patients with T3>7 cmN1 NSCLCs is associated with improvements in OS.
Collapse
Affiliation(s)
- Amy C Moreno
- Section of Thoracic Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Daniel Morgensztern
- Section of Medical Oncology, Yale School of Medicine, New Haven, Connecticut
| | - Daniel J Boffa
- Section of Thoracic Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Roy H Decker
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut
| | - James B Yu
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut
| | - Frank C Detterbeck
- Section of Thoracic Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Zuoheng Wang
- Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut
| | - Michal G Rose
- Medical Oncology, West Haven Connecticut Veteran's Affairs Hospital, West Haven, Connecticut
| | - Anthony W Kim
- Section of Thoracic Surgery, Yale School of Medicine, New Haven, Connecticut; Cardiothoracic Surgery, West Haven Connecticut Veteran's Affairs Hospital, West Haven, Connecticut.
| |
Collapse
|
29
|
Improved survival associated with neoadjuvant chemoradiation in patients with clinical stage IIIA(N2) non-small-cell lung cancer. J Thorac Oncol 2014; 8:915-22. [PMID: 23608815 DOI: 10.1097/jto.0b013e31828f68b4] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Optimal management of clinical stage IIIA-N2 non-small-cell lung cancer (NSCLC) is controversial. This study examines whether neoadjuvant chemoradiation plus surgery improves survival rates when compared with other recommended treatment strategies. METHODS Adult patients from the National Cancer Database, with clinical stage IIIA-N2 disease definitively treated between 1998 and 2004 at American College of Surgeons Commission on Cancer accredited facilities, were included in the study. Treatment was defined as neoadjuvant chemoradiation plus either lobectomy (NeoCRT+L) or pneumonectomy (NeoCRT+P), lobectomy plus adjuvant therapy (L+AT), pneumonectomy plus adjuvant therapy (P+AT), and concurrent chemoradiation (CRT). Median follow-up and overall survival (OS) were defined from date of diagnosis to last contact. Five-year OS was estimated using Kaplan-Meier methods. Cox proportional hazard regression was used to estimate hazard ratios and 95% confidence intervals (CIs), adjusting for sociodemographic, clinical, and facility characteristics. RESULTS Median follow-up was 11.8 months for 11,242 eligible patients. Five-year OS was 33.5%, 20.7%, 20.3%, 13.35%, and 10.9% for NeoCRT+L, NeoCRT+P, L+AT, P+AT, and CRT, respectively (p < 0.0001). On multivariable analysis, the estimated hazard ratio was 0.51 (CI: 0.45-0.58) for NeoCRT+L; 0.77 (0.63-0.95) for NeoCRT+P; 0.66 (0.59-0.75) for L+AT; 0.69 (0.54-0.88) for P+AT; and 1.0 (reference) for the CRT group. Comorbidity did not attenuate the relationship between treatment and survival. CONCLUSION This large study demonstrates that patients with clinical stage IIIA-N2 NSCLC, who underwent neoadjuvant chemoradiation followed by lobectomy, were associated with an improved survival.
Collapse
|
30
|
Abstract
Of the new chemotherapeutic substances of the last decade, gemcitabine (Gemzar, Eli Lilly) is probably the most valuable for the treatment of early and advanced stage non-small cell lung cancer (NSCLC). When used as a single agent in both chemotherapeutically pretreated and chemotherapy-naive patients, gemcitabine shows an objective tumor regression rate of approximately 20%. Gemcitabine's unique mechanism of action and its lack of overlapping toxicity with other cytotoxic agents also define it as an ideal candidate for combination therapy. Early clinical development has included single-agent first- and second-line treatment, doublet combination regimens and incorporation into multimodality treatment strategies for operable and inoperable locally advanced nonmetastatic NSCLC. Gemcitabine/platinum-based combination chemotherapy has become the most attractive treatment standard for NSCLC patients in good clinical condition. The role of gemcitabine in the concurrent or sequential application of chemo- and radiotherapy for inoperable locally advanced NSCLC has also been addressed in several Phase I and II studies. Based on data available, gemcitabine can be safely administered in combination with radiotherapy. This review summarizes results from representative Phase I, II and III studies in order to underline gemcitabine's clinical importance for patients suffering from early and advanced NSCLC.
Collapse
Affiliation(s)
- Christian Manegold
- Thoraxklinik Heidelberg GmBH, Innere Medizin/Onkologie, Amalienstrasse 5, 69126 Heidelberg, Germany.
| |
Collapse
|
31
|
Santos ES, Castrellon A, Blaya M, Raez LE. Controversies in the management of stage IIIA non-small-cell lung cancer. Expert Rev Anticancer Ther 2014; 8:1913-29. [DOI: 10.1586/14737140.8.12.1913] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
|
32
|
Vansteenkiste JF, Schildermans RH. The future of adjuvant chemotherapy for resected non-small cell lung cancer. Expert Rev Anticancer Ther 2014; 5:165-75. [PMID: 15757448 DOI: 10.1586/14737140.5.1.165] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Non-small cell lung cancer is a frequent type of cancer, with approximately 1.2 million cases per year expected worldwide. A total of 20-30% of patients with early stage non-small cell lung cancer are amenable to radical surgery, although only 40-50% of these patients are cured. An improvement in survival has never been demonstrated for postoperative radiotherapy. However, a major step forward is several recent large randomized studies that have demonstrated improved survival with postoperative chemotherapy. This review covers the historic data on adjuvant chemotherapy for non-small cell lung cancer, meta-analyses, modern studies with cisplatin-based or other chemotherapy, implications for current clinical practice and guidelines, some practical recommendations and, finally, the questions for future studies.
Collapse
Affiliation(s)
- Johan F Vansteenkiste
- Respiratory Oncology Unit (Pulmonology), Leuven Lung Cancer Group, University Hospital Gasthuisberg, Herestraat 49, B-3000 Leuven, Belgium.
| | | |
Collapse
|
33
|
Powell E, Chow LQM. BLP-25 liposomal vaccine: a promising potential therapy in nonsmall-cell lung cancer. Expert Rev Respir Med 2014; 2:37-45. [DOI: 10.1586/17476348.2.1.37] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
34
|
Biswas T, Sharma N, Machtay M. Controversies in the management of stage III non-small-cell lung cancer. Expert Rev Anticancer Ther 2014; 14:333-47. [PMID: 24397773 DOI: 10.1586/14737140.2014.867809] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Lung cancer remains the leading cause of death in the USA and is the most common cancer both in incidence and in mortality globally (1.35 million deaths annually). Non-small-cell lung cancer accounts for >80% of all lung cancers [1] . About 35-45% of non-small-cell lung cancer patients present with locally advanced non-metastatic stage III disease. However, confirmed stage III disease represents a very heterogeneous group ranging from borderline surgical candidate with minimal mediastinal involvement to bulky mediastinal nodes or contralateral nodal involvement with significant controversy regarding optimal management in these various situations. This article specifically addresses the role of surgery, radiotherapy and chemotherapy in multimodal approach to treat stage III patients with N2/N3 involvement and controversies surrounding these recommendations.
Collapse
Affiliation(s)
- Tithi Biswas
- University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH 44106, USA
| | | | | |
Collapse
|
35
|
Hishida T, Yoshida J, Ohe Y, Aokage K, Ishii G, Nagai K. Surgical outcomes after initial surgery for clinical single-station N2 non-small-cell lung cancer. Jpn J Clin Oncol 2013; 44:85-92. [PMID: 24203815 DOI: 10.1093/jjco/hyt164] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Single-station N2 (Stage IIIA) non-small-cell lung cancer has been reported to have a relatively favorable prognosis after surgery. However, most previous studies examined surgical outcomes in N2 disease by pathologic nodal status but not by clinical nodal status. The objective of this study was to clarify the surgical outcomes in clinical single-station N2 non-small-cell lung cancer patients. METHODS A total of 125 consecutive patients with clinical single-station N2 non-small-cell lung cancer were treated in our institution between 1992 and 2008. Among them, 97 (78%) patients underwent thoracotomy, and were included in this retrospective study. We defined clinical single-station N2 node as a node measuring 1-2 cm in a single mediastinal station observed on contrast-enhanced computed tomography. The median follow-up period was 5.9 years (range, 1.8-12.6). RESULTS Eighty-eight (91%) patients underwent lung resection. Of them, 17 (19%) had true (pathologic) single-station N2 disease. Twenty-eight (32%) had pathologic multistation N2 and 43 (49%) had pN0-1 disease with favorable prognoses. The overall survival of the clinical single-station N2/pathologic N2 patients after initial surgery was unsatisfactory with a 5-year overall survival of 23.6%, but their prognoses were heterogeneous. True single-station pathologic N2 status (hazard ratio = 0.35, P = 0.008) and negative subcarinal node status (hazard ratio = 0.34, P = 0.022) were independent favorable prognostic factors after initial resection for clinical single-station N2/ pathologic N2 patients. The patients with both factors revealed a relatively favorable 5-year overall survival of 43.8%. CONCLUSION Clinical single-station N2 status does not always correspond with pathologic true N2 status. From a prognostic point of view, initial surgery for clinical single-station N2 patients is indicated if their true single-station N2 status and negative subcarinal involvement are preoperatively confirmed.
Collapse
Affiliation(s)
- Tomoyuki Hishida
- *Division of Thoracic Surgery, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, Chiba 277-8577, Japan.
| | | | | | | | | | | |
Collapse
|
36
|
Horita N, Miyazawa N, Morita S, Kojima R, Kimura N, Kaneko T, Ishigatsubo Y. Preoperative Chemotherapy Is Effective for Stage III Resectable Non–Small-Cell Lung Cancer: Metaanalysis of 16 Trials. Clin Lung Cancer 2013; 14:488-94. [DOI: 10.1016/j.cllc.2013.03.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2012] [Revised: 02/20/2013] [Accepted: 03/26/2013] [Indexed: 11/17/2022]
|
37
|
Moreno AC, Morgensztern D, Yu JB, Boffa DJ, Decker RH, Detterbeck FC, Kim AW. Impact of preoperative radiation on survival of patients with T3N0 >7-cm non–small cell lung cancers treated with anatomic resection using the Surveillance, Epidemiology, and End Results database. J Surg Res 2013; 184:10-8. [DOI: 10.1016/j.jss.2013.03.053] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2013] [Revised: 02/28/2013] [Accepted: 03/14/2013] [Indexed: 11/16/2022]
|
38
|
Computed tomography RECIST assessment of histopathologic response and prediction of survival in patients with resectable non-small-cell lung cancer after neoadjuvant chemotherapy. J Thorac Oncol 2013; 8:222-8. [PMID: 23287849 DOI: 10.1097/jto.0b013e3182774108] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
INTRODUCTION This study's objectives were to determine whether tumor response measured by computed tomography (CT) and evaluated using Response Evaluation Criteria in Solid Tumors (RECIST) correlated with overall survival (OS) in patients with non-small-cell lung cancer (NSCLC) after neoadjuvant chemotherapy and surgical resection. METHODS We measured primary tumor size on CT before and after neoadjuvant chemotherapy in 160 NSCLC patients who underwent surgical resection. The relationship between CT-measured response (RECIST) and histopathologic response (≤ 10% viable tumor) and OS were assessed by Kaplan-Meier survival, univariable, and multivariable Cox proportional hazards regression. RESULTS There was a statistically significant association between CT-measured response (RECIST) and OS (p = 0.03). However, histopathologic response was a stronger predictor of OS (p = 0.002), with a more pronounced separation of the survival curves when compared with CT-measured response. In multivariable Cox regression analysis, only pathologic stage and histopathologic response were significant predictors of OS. A 41% overall discordance rate was noted between CT RECIST response and histopathologic response. CT RECIST classified as nonresponders a subset of patients with histopathologic response (8 out of 30 points, 27%) who demonstrated prolonged survival after neoadjuvant chemotherapy. CONCLUSION We were unable to show that CT RECIST is a reliable predictor of OS in patients with NSCLC undergoing surgical resection after neoadjuvant chemotherapy. The failure of CT RECIST to predict long-term outcome may be because of the inability of CT imaging to consistently identify patients with histopathologic response. CT RECIST may have only a limited role as an efficacy endpoint after neoadjuvant chemotherapy in patients with resectable NSCLC.
Collapse
|
39
|
Eichhorn F, Storz K, Hoffmann H, Muley T, Dienemann H. Sleeve Pneumonectomy for Central Non-Small Cell Lung Cancer: Indications, Complications, and Survival. Ann Thorac Surg 2013; 96:253-8. [DOI: 10.1016/j.athoracsur.2013.03.065] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Revised: 03/03/2013] [Accepted: 03/27/2013] [Indexed: 10/26/2022]
|
40
|
Westeel V, Quoix E, Puyraveau M, Lavolé A, Braun D, Laporte S, Bigay-Game L, Pujol JL, Ozenne G, Rivière A, Douillard JY, Lebeau B, Debieuvre D, Poudenx M, David P, Molinier O, Zalcman G, Lemarié E, Morin F, Depierre A, Milleron B. A randomised trial comparing preoperative to perioperative chemotherapy in early-stage non-small-cell lung cancer (IFCT 0002 trial). Eur J Cancer 2013; 49:2654-64. [PMID: 23735703 DOI: 10.1016/j.ejca.2013.04.013] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Revised: 04/01/2013] [Accepted: 04/05/2013] [Indexed: 11/27/2022]
Abstract
HYPOTHESIS There will be a detectable increase in overall survival (OS) using preoperative (PRE) as opposed to perioperative (PERI) chemotherapy in resectable StageI-II non-small-cell lung cancer (NSCLC). METHODS This multicenter, open-label, randomised trial with a 2×2 factorial design first compared two chemotherapy strategies (PRE versus PERI), then two chemotherapy regimens (gemcitabine-cisplatin [GP] versus paclitaxel-carboplatin [TC]). The PRE group received two preoperative cycles followed by two additional preoperative cycles, while the PERI group underwent two preoperative cycles followed by two postoperative cycles, the 3rd and 4th cycles being given only to responders in both cases. RESULTS A total of 528 patients were randomised, 267 of which were assigned to the PRE group and 261 to the PERI group. Three-year OS did not differ between the two groups (67.4% and 67.7%, respectively; hazard ratio (HR)=1.01 [0.79-1.30], p=0.92), nor did 3-year disease-free survival, response rates, toxicity, or postoperative mortality. Pathological complete response was observed in 22 (8.2%) and 16 patients (6.1%), respectively. Although quality of life did not differ significantly, chemotherapy compliance was significantly higher in the PRE group. The proportion of responders who received Cycles 3 and 4 was significantly higher in the PRE group (90.4% versus 75.2%, p=0.001). In responders, the dose intensity of Cycles 3 and 4 was higher in the PRE group than in the PERI group (mean relative dose intensity of 90.4% versus 82.6%, respectively; p=0.0007). There was no difference between GP and TC in 3-year OS (HR=0.97 [95% confidence interval (CI): 0.76-1.25], p=0.80) or response rates. However, the regimens' toxicity profiles differed. CONCLUSIONS This study failed to demonstrate any difference in survival between patients receiving preoperative and perioperative chemotherapy in early-stage NSCLC. The increase from two to four preoperative chemotherapy cycles did not increase the pathological response rate.
Collapse
Affiliation(s)
- Virginie Westeel
- Centre Hospitalier Régional Universitaire de Besançon, Université de Franche-Comté, EA 3181, France.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
41
|
Kesarwala AH, Grover S, Rengan R. Role of particle beam therapy in a trimodality approach to locally advanced non-small cell lung cancer. Thorac Cancer 2013; 4:95-101. [PMID: 28920191 DOI: 10.1111/j.1759-7714.2012.00174.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Accepted: 09/14/2012] [Indexed: 12/25/2022] Open
Abstract
Lung cancer accounts for nearly one-fifth of all cancer deaths worldwide and is the most common cause of cancer-related death in the United States. Outcomes for locally advanced non-small cell lung cancer remain extremely poor with regards to both local control and overall survival. Modest gains in local control were obtained with the incorporation of multimodality treatment, including preoperative chemotherapy followed by surgical resection; combination chemoradiotherapy also improved survival, secondary to improved local control. While the natural progression to trimodality therapy resulted in superior local control, it did not translate to improved overall survival, secondary to increased toxicity. The additional morbidity is likely from radiation toxicity, the minimization of which will be crucial to the future success of trimodality therapy. One strategy to decrease toxicity is to utilize charged particles, such as protons, which deposit a high dose at the Bragg peak with a minimal dose beyond the peak, thereby reducing the dose to distal normal tissues. Trimodality therapy incorporating preoperative proton radiation therapy and chemotherapy, followed by surgery, is currently being evaluated as a potential strategy to achieve improved local control and overall survival in locally advanced non-small cell lung cancer.
Collapse
Affiliation(s)
- Aparna H Kesarwala
- Radiation Oncology Branch, National Institutes of Health, National Cancer Institute, Bethesda, MD, USA
| | - Surbhi Grover
- Department of Radiation Oncology, Perelman Center for Advanced Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Ramesh Rengan
- Department of Radiation Oncology, Perelman Center for Advanced Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
42
|
Lv C, Ma Y, Wu N, Yan S, Zheng Q, Sun Y, Li S, Fang J, Yang Y. A retrospective study: platinum-based induction chemotherapy combined with gemcitabine or paclitaxel for stage IIB-IIIA central non-small-cell lung cancer. World J Surg Oncol 2013; 11:76. [PMID: 23517534 PMCID: PMC3621287 DOI: 10.1186/1477-7819-11-76] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Accepted: 02/23/2013] [Indexed: 12/25/2022] Open
Abstract
Background Several encouraging phase III clinical trials have evaluated platinum-based induction chemotherapy against stage IIB-IIIA non-small-cell lung cancer (NSCLC). Chemotherapy efficacy was assessed using common regimens in this retrospective analysis. Methods From 2007 to 2011, the clinical records of stage IIB-IIIA NSCLC patients undergoing surgery after neoadjuvant chemotherapy were reviewed. Gathered data were tested for significance and variables impacting survival were assessed by univariate and Cox regression analyses. Results Overall, 84% of patients were male and 93% had central disease. Platinum-based chemotherapy protocols with gemcitabine or paclitaxel gave an overall response rate of 55% (45/82) and 6.1% pathological complete response (5/82). Clinical response was unassociated with regimen or histology, while more pneumonectomies were performed in the stable compared to partial response disease group (P =0.040). Postoperative mortality was 1.2% (1/82), and complications, unassociated with regimen or histology, were atelectasis (26.8%) and supraventricular arrhythmias (13.4%). Right-sided procedures appeared to increase the incidence of bronchopleural fistula (P =0.073). The median disease-free survival time was 18 months and median overall survival time was not reached. Disease-free survival rates at one, two, and three years were 54%, 47%, and 33%, while the overall survival rate was 73%, 69%, and 59%, respectively. Disease-free survival predictors were radiographic response and mediastinal lymphadenopathy before chemotherapy (P =0.012 and 0.002, respectively). Conclusions Two cycles of platinum-based chemotherapy with gemcitabine or paclitaxel is efficacious for patients with stage IIB-IIIA central disease. Patients achieving clinical response had improved disease-free survival times, while those with mediastinal lymphadenopathy had a higher postoperative recurrence risk.
Collapse
Affiliation(s)
- Chao Lv
- Department of Thoracic Surgery II, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Peking, China
| | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Jeremić B, Miličić B, Milisavljević S. Radiotherapy Alone vs. Radiochemotherapy in Patients With Favorable Prognosis of Clinical Stage IIIA Non–Small-Cell Lung Cancer. Clin Lung Cancer 2013; 14:172-80. [DOI: 10.1016/j.cllc.2012.10.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Revised: 09/29/2012] [Accepted: 10/08/2012] [Indexed: 12/28/2022]
|
44
|
Abstract
INTRODUCTION In patients with resected lung cancer, sarcomatoid carcinomas are reputed to carry a worse prognosis. Although generally felt to be chemo-refractory, little data are available about chemotherapy in these patients. We sought to determine the effect of perioperative chemotherapy in patients with completely resected sarcomatoid carcinomas of the lung. METHODS We reviewed the pathology reports of 4675 patients consecutively resected at Memorial Sloan-Kettering between 2000 and 2010. Charts and images were reviewed for patients with a histologic diagnosis of sarcomatoid carcinoma. Response to neoadjuvant chemotherapy was assessed radiographically. Kaplan-Meier disease-free probability (DFP) curves were compared for patients who did and did not receive perioperative chemotherapy, stratified by pathological stage. RESULTS Of the 4675 patients who underwent an R0 lung cancer resection, 56 (1%) were diagnosed with sarcomatoid carcinomas. Twenty received neoadjuvant and/or adjuvant chemotherapy. Overall radiographic response rate (minor + major) to neoadjuvant chemotherapy was 73% (95% confidence interval 48-90%) in the 15 evaluable patients. The median DFP of patients who received chemotherapy was 34 months versus 12 months in those who did not (p = 0.37). Subset analysis did not reveal a benefit to perioperative chemotherapy in patients with stage Ib-IIa, whereas a benefit was seen in patients with IIb-IIIa disease (p = 0.02). CONCLUSIONS Although sarcomatoid carcinomas are felt to be chemo-refractory, our results demonstrate radiographic responses to neoadjuvant chemotherapy and an improvement in DFP in patients with stage IIb-IIIa disease. The use of pathological stage in this analysis may underestimate this benefit. Perioperative chemotherapy should be considered in these patients.
Collapse
|
45
|
Liao WY, Chen JH, Wu M, Shih JY, Chen KY, Ho CC, Yang JCH, Yu CJ. Neoadjuvant chemotherapy with docetaxel-cisplatin in patients with stage III N2 non-small-cell lung cancer. Clin Lung Cancer 2013; 14:418-24. [PMID: 23291258 DOI: 10.1016/j.cllc.2012.10.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2012] [Revised: 09/24/2012] [Accepted: 10/08/2012] [Indexed: 10/27/2022]
Abstract
INTRODUCTION To assess the efficacy and potential prognostic factors of patients with stage III N2 non-small-cell lung cancer (NSCLC) treated with neoadjuvant docetaxel-cisplatin (DP) chemotherapy followed by surgical resection. METHODS Sixty-two patients with NSCLC treated with DP as neoadjuvant chemotherapy between November 2003 and December 2009 were identified and reviewed in this study. Tumor response, survival, and clinicopathologic data were collected retrospectively. The time to event was analyzed by fitting Cox proportional hazards models. RESULTS Fifty-eight (94%) of 62 patients eventually underwent surgical resection after DP. The overall clinical response rate to induction DP chemotherapy was 42%. Patients with squamous cell carcinoma (SCC) histology were more likely to response to the DP regimen than those with adenocarcinoma histology (68% vs. 33%, P = .006). With a median follow-up of 82.4 months among the 58 patients, there were 41 (71%) tumor relapses and 27 (47%) deaths. The median event-free survival was 27.5 months (95% CI, 22.3-32.7 months), and the median overall survival was 66.7 months (95% CI, 35.1-98.3 months). In multivariate analysis, when fitting the Cox proportional hazards model, SCC histology (hazard ratio [HR] 0.234 [95% CI, 0.098-0.560]; P = .001) and mediastinal downstaging to N0 (HR 0.451 [95% CI, 0.226-0.898]; P = .024) were independent predictors of better event-free survival. CONCLUSIONS Neoadjuvant chemotherapy with the DP regimen is both active and well tolerated in patients with stage III N2 NSCLC. SCC histology predicted a better treatment response and survival outcome than adenocarcinoma histology in this patient group. Further investigation of combined-modality treatment is warranted to improve survival in the adenocarcinoma subset of stage III N2 NSCLC.
Collapse
Affiliation(s)
- Wei-Yu Liao
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | | | | | | | | | | | | | | |
Collapse
|
46
|
Qin S, Yang C, Wang X, Xu C, Li S, Zhang B, Ren H. Overexpression of Smac promotes Cisplatin-induced apoptosis by activating caspase-3 and caspase-9 in lung cancer A549 cells. Cancer Biother Radiopharm 2012; 28:177-82. [PMID: 23252748 DOI: 10.1089/cbr.2012.1261] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Second mitochondrial-derived activator of caspase (Smac) plays crucial roles in mitochondrial apoptosis pathways and promotes chemotherapy-induced apoptosis. In this study, Smac levels were examined in various lung cancer cell lines, and the effects of overexpressed Smac in the nonsmall-cell lung cancer cell line A549 were assayed by stable transfection of Smac. Subsequently, MTT assays, cell counting, and flow cytometry were applied to show that overexpression of Smac inhibits cell viability and cell growth and enhances apoptosis after cisplatin treatment. Western blotting was performed before and after cisplatin treatment to demonstrate that drug treatment could release Smac from mitochondria into the cytosol and promote apoptosis by activating caspase-3 and caspase-9. Promotion of apoptosis by cytosolic Smac could be blocked by pretreating cells with the caspase-9 inhibitor z-LEHD-FMK. Our findings indicate that overexpressed Smac significantly inhibited A549 cell growth and promoted apoptosis following cisplatin treatment due to the release of Smac from mitochondria into the cytosol, which increased the activities of caspase-3 and caspase-9.
Collapse
Affiliation(s)
- Sida Qin
- Department of Thoracic Surgery, First Affiliated Hospital, School of Medicine, Xi'an Jiaotong University, Xi'an, P.R. China
| | | | | | | | | | | | | |
Collapse
|
47
|
Bonnette P. [Chemo-radiotherapy before surgery in stage III non-small-cell lung cancer]. Rev Mal Respir 2012; 30:105-14. [PMID: 23419441 DOI: 10.1016/j.rmr.2012.08.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2012] [Accepted: 08/21/2012] [Indexed: 10/27/2022]
Abstract
Surgery is often performed when N2 non-small-cell lung cancer can be resected by lobectomy since the publication of the "EORTC 08941" and "RTOG 9309" trials (the latter showed high mortality rate after pneumonectomy). The usefulness of adjuvant chemotherapy has been proved, and that of modern adjuvant radiotherapy is suspected, but neoadjuvant chemotherapy is also routinely performed in France. Neoadjuvant chemo-radiotherapy is more accepted in the USA and northern Europe. Four randomized trials have not shown any advantage in comparison with neoadjuvant chemotherapy, due to increased postoperative mortality, but retrospective studies in specialized centers have demonstrated low operative risks, even after high-dose radiation, or pneumonectomy. In the case of invasive apical tumors, neoadjuvant chemo-radiotherapy is recommended. In case of local recurrence without distant recurrence after exclusive chemo-radiotherapy, curative surgery may be envisaged.
Collapse
Affiliation(s)
- P Bonnette
- Chirurgie thoracique, hôpital Foch, 40, rue Worth, 92151 Suresnes, France.
| |
Collapse
|
48
|
Pathologic complete response to preoperative chemotherapy predicts cure in early-stage non-small-cell lung cancer: combined analysis of two IFCT randomized trials. J Thorac Oncol 2012; 7:841-9. [PMID: 22722786 DOI: 10.1097/jto.0b013e31824c7d92] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Our study aimed to evaluate whether pathologic complete response (pCR) in early-stage non-small-cell lung cancer (NSCLC) after neoadjuvant chemotherapy resulted in improved outcome, and to determine predictive factors for pCR. METHODS Eligible patients with stage-IB or -II NSCLC were included in two consecutive Intergroupe Francophone de Cancérologie Thoracique phase-III trials evaluating platinum-based neoadjuvant chemotherapy, with pCR defined by the absence of viable cancer cells in the resected surgical specimen. RESULTS Among the 492 patients analyzed, 41 (8.3%) achieved pCR. In the pCR group, 5-year overall survival was 80.0% compared with 55.8% in the non-pCR group (p = 0.0007). In multivariate analyses, pCR was a favorable prognostic factor of overall survival (relative risk = 0.34; 95% confidence interval = 0.18-0.64) in addition to squamous-cell carcinoma, weight loss less than or equal to 5%, and stage-IB disease. Five-year disease-free survival was 80.1% in the pCR group compared to 44.8% in the non-pCR group (p < 0.0001). Two patients (4.9%) in the pCR group experienced disease recurrence compared to 193 patients (42.8%) in the non-pCR group. SCC subtype was the only independent predictor of pCR (odds ratio [OR] = 4.30; 95% confidence interval = 1.90-9.72). CONCLUSION Our results showed that pCR after preoperative chemotherapy was a favorable prognostic factor in stage-IB-II NSCLC. Our study is the largest published series evaluating pCRs after preoperative chemotherapy. The only factor predictive of pCR was squamous-cell carcinoma. Identifying molecular predictive markers for pCR may help in distinguishing patients likely to benefit from neoadjuvant chemotherapy and in choosing the most adequate preoperative chemotherapy regimen.
Collapse
|
49
|
Final results and pharmacoeconomic analysis of a trial comparing two neoadjuvant chemotherapy (CT) regimens followed by surgery in patients with resectable non-small cell lung cancer (NSCLC): A phase II randomised study by the European Lung Cancer Working Party. Lung Cancer 2012; 77:605-10. [DOI: 10.1016/j.lungcan.2012.04.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2011] [Revised: 03/27/2012] [Accepted: 04/28/2012] [Indexed: 11/22/2022]
|
50
|
Abstract
Among all nonmetastatic non-small-cell lung cancer (NSCLC) patients, the best survival rates are observed in patients who undergo surgery. Nevertheless, 5-year survival rates vary between 20% and 60% depending on the stage of the disease. Several combined modality treatments have been investigated to improve outcome in localized NSCLC. These include local treatment, systemic before local treatment, concomitant systemic and local treatments, and systemic after local treatment. Preoperative irradiation was shown to be of no benefit on local recurrence rates or overall survival. Even doses of radiation >/=40 grays (Gy) were associated with lower survival rates. Postoperative irradiation did not influence survival in stage III disease and seemed to be deleterious in stages I and II disease. Modern radiotherapy techniques might be of interest in this setting but have been insufficiently tested. The early phase III studies of preoperative chemotherapy versus primary surgery in stage III NSCLC showed a tremendous difference in favor of chemotherapy. A larger study did not confirm these results but suggested that preoperative chemotherapy might have a greater effect in stages I and II of the disease. In locally advanced disease, chemotherapy followed by radiotherapy was shown to increase survival when compared with radiotherapy alone. Studies comparing concurrent chemoradiation with radiotherapy only were in favor of the concomitant schedule, which improved local control. Promising results have been reported with chemoradiation followed by surgery in stage IIIa and even stage IIIb disease. Randomized studies of postoperative chemotherapy demonstrated a 5% improvement in 5-year survival over adjuvant-free treatment. Postoperative chemoradiation showed no advantage over postoperative radiotherapy. Several trials that are ongoing or whose accrual was recently completed should further define the role of perioperative chemotherapy in resectable NSCLC and of trimodality treatments in advanced disease. Targeted agents are being developed in the postoperative setting. New schedules of chemoradiation with higher therapeutic indexes are also being investigated in nonresectable stage III NSCLC.
Collapse
Affiliation(s)
- Virginie Westeel
- Chest Disease Department, Jean Minjoz University Hospital, Besançon Cedex, France.
| | | |
Collapse
|