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Jeon DS, Park C, Kim SJ, Park CK, Chang YS, Jung CY, Lee SY, Lee S, Ryu J, Lee JE, Lee KY, Jang TW, Jang SH, Yoon SH, Lee SH, Choi C, Kim HR, Kim YJ. Real-world outcome of crizotinib for anaplastic lymphoma kinase-positive lung cancer: Multicenter retrospective analysis in South Korea. Thorac Cancer 2024; 15:448-457. [PMID: 38171544 PMCID: PMC10883859 DOI: 10.1111/1759-7714.15213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 12/18/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND About 3%-5% of non-small cell lung cancer (NSCLC) presents positive anaplastic lymphoma kinase (ALK). Recently, several target agents have been approved as a treatment for ALK-positive NSCLC. This study aimed to analyze the real-world efficacy and outcome when administered crizotinib, the first approved target agent for ALK-positive NSCLC, according to first- or late-line treatment. METHODS A total of 290 patients with ALK-positive advanced NSCLC who were treated with crizotinib in 15 institutions in South Korea from January 2009 to December 2018 were enrolled. RESULTS The median age of patients was 57.0 years, and 50.3% were male. The median follow-up duration was 29.3 months. Among them, 113 patients received crizotinib as first-line therapy. The objective response rate (ORR) was 60.1% (57.0% for first-line recipients, 61.8% for second-/later-line). Median (95% CI) progression-free survival (PFS) was 13.7 (11.6-17.0) months. For first-line recipients, overall survival (OS) was 26.3 (17.6-35.0) months. No significant difference in ORR, PFS and OS, according to the setting of crizotinib initiation, was observed. In a multivariate Cox regression analysis, old age, male gender, initially metastatic, and number of metastatic organs were associated with poor PFS and OS. The most common adverse events were nausea and vomiting, and severe adverse event leading to dose adjustment was hepatotoxicity. CONCLUSIONS ORR, PFS, OS, and adverse event profiles were comparable to previous clinical trials. Our findings could aid in the efficient management of ALK-positive lung cancer patients.
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Affiliation(s)
- Da Som Jeon
- Department of Pulmonary and Critical Care MedicineNowon Eulji Medical Center, University of EuljiSeoulSouth Korea
| | - Cheol‐kyu Park
- Department of Pulmonary and Critical Care MedicineChonnam National University Hwasun hospital, Chonnam National UniversityJeollanam‐doRepublic of Korea
| | - Seung Joon Kim
- Department of Internal MedicinePostech‐Catholic Biomedical Engineering Institute, College of Medicine, The Catholic University of KoreaSeoulRepublic of Korea
| | - Chan Kwon Park
- Department of Pulmonary and Critical Care MedicineCatholic University of Korean Yeouido Saint Mary's HospitalSeoulKorea
| | - Yoon Soo Chang
- Department of Internal MedicineYonsei University College of Medicine, 8th Floor Annex Building, Yongdong Severance HospitalSeoulRepublic of Korea
| | - Chi Young Jung
- Department of Internal MedicineDaegu Catholic University School of MedicineDaeguKorea
| | - Sung Yong Lee
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of MedicineSeoulKorea
| | - Shin‐Yup Lee
- Division of Pulmonary and Critical Care MedicineKyungpook National University Chilgok HospitalDaeguKorea
| | - Jeong‐Seon Ryu
- Department of Pulmonary and Critical Care MedicineInha University HospitalIncheonRepublic of Korea
| | - Jeong Eun Lee
- Department of Internal MedicineChungnam National University HospitalDaejeonRepublic of Korea
| | - Kye Young Lee
- Department of Pulmonary MedicineKonkuk University School of MedicineSeoulRepublic of Korea
| | - Tae Won Jang
- Department of Internal MedicineKosin University Medical CollegePusanKorea
| | - Seung Hun Jang
- Department of PulmonaryAllergy and Critical Care Medicine, Hallym University Sacred Heart HospitalAnyangRepublic of Korea
| | - Seong Hoon Yoon
- Department of Internal MedicineSchool of Medicine, Pusan National UniversityYangsanRepublic of Korea
| | - Sang Hoon Lee
- Division of Pulmonology, Institute of Chest Disease, Department of Internal MedicineYonsei University College of MedicineSeoulRepublic of Korea
| | - Chang‐min Choi
- Department of Pulmonary and Critical Care MedicineAsan Medical Centre, University of Ulsan College of MedicineSeoulRepublic of Korea
- Department of OncologyAsan Medical Centre, University of Ulsan College of MedicineSeoulRepublic of Korea
| | - Hyeong Ryul Kim
- Department of Pulmonary and Critical Care MedicineAsan Medical Centre, University of Ulsan College of MedicineSeoulRepublic of Korea
| | - Yeon Joo Kim
- Department of Pulmonary and Critical Care MedicineNowon Eulji Medical Center, University of EuljiSeoulSouth Korea
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Zhu N, Lin S, He L, Wang L, Kong W, Cao C. Successful treatment with crizotinib after alectinib-induced interstitial lung disease. SAGE Open Med Case Rep 2021; 9:2050313X211042991. [PMID: 34484794 PMCID: PMC8411646 DOI: 10.1177/2050313x211042991] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 08/12/2021] [Indexed: 11/30/2022] Open
Abstract
Although alectinib is a well-tolerated and highly effective inhibitor of a
second-generation anaplastic lymphoma kinase, special attention should be paid to the
possibility of potentially severe and fatal adverse events such as interstitial pneumonia.
We report a case of a patient with advanced non-small cell lung cancer treated with
alectinib who developed immunohistochemically positive anaplastic lymphoma kinase
(ALK(IHC +)) . However, due to the rapid emergence of drug-induced interstitial lung
disease, alectinib treatment was halted. Once the interstitial lung disease had been
successfully treated, we reluctantly chose crizotinib as a second-line treatment for
ALK + NSCLC in this patient as he refused all other available treatments. Contrary to
expectation, crizotinib performed well both in terms of its safety and efficacy. Our
results suggest that crizotinib may provide a promising therapy option for patients with
ALK + NSCLC accompanied by alectinib-induced interstitial lung disease. To our knowledge,
this is a rare report of successful treatment of ALK + NSCLC with crizotinib after
alectinib-induced interstitial lung disease.
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Affiliation(s)
- Ning Zhu
- Department of Respiratory and Critical Care Medicine, Ningbo First Hospital, Ningbo, China
| | - Shanhong Lin
- Department of Ultrasound, Ningbo First Hospital, Ningbo, China
| | - Lei He
- Department of Respiratory and Critical Care Medicine, Ningbo First Hospital, Ningbo, China
| | - Linfeng Wang
- Department of Respiratory and Critical Care Medicine, Ningbo First Hospital, Ningbo, China
| | - Weiliang Kong
- Department of Respiratory and Critical Care Medicine, Ningbo First Hospital, Ningbo, China
| | - Chao Cao
- Department of Respiratory and Critical Care Medicine, Ningbo First Hospital, Ningbo, China
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Elliott J, Bai Z, Hsieh SC, Kelly SE, Chen L, Skidmore B, Yousef S, Zheng C, Stewart DJ, Wells GA. ALK inhibitors for non-small cell lung cancer: A systematic review and network meta-analysis. PLoS One 2020; 15:e0229179. [PMID: 32074131 PMCID: PMC7029857 DOI: 10.1371/journal.pone.0229179] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 02/01/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND We sought to assess the relative effects of individual anaplastic lymphoma kinase (ALK) inhibitors for the treatment of non-small cell lung cancer (NSCLC). METHODS We searched MEDLINE, Embase, Cochrane CENTRAL, and grey literature (July 23, 2019) for randomized controlled trials (RCTs) that included participants with ALK- or ROS1-positive NSCLC who received any ALK inhibitor compared with placebo, another ALK inhibitor, or the same ALK inhibitor at a different dose. The primary outcome was treatment-related death. Secondary outcomes were overall survival (OS), progression-free survival (PFS), and serious adverse events. Data were pooled via meta-analysis and network meta-analysis, and risk of bias was assessed. PROSPERO: CRD42017077046. RESULTS Thirteen RCTs reporting outcomes of interest among participants with ALK-positive NSCLC were identified. Treatment-related deaths were rare, with 10 deaths attributed to crizotinib (risk difference v. chemotherapy: 0.49, 95% credible interval [CrI] -0.16 to 1.46; odds ratio 2.58 (0.76-11.37). All ALK inhibitors improved PSF relative to chemotherapy (hazard ratio [95% CrI]: crizotinib 0.46 [0.39-0.54]; ceritinib 0.52 [0.42-0.64]; alectinib 300 BID 0.16 [0.08-0.33]; alectinib 600 BID 0.23 [0.17-0.30]; brigatinib 0.23 [0.15-0.35]), while alectinib and brigatinib improved PFS over crizotinib and ceritinib (alectinib v. crizotinib 0.34 [0.17-0.70]; alectinib v. ceritinib 0.30 [0.14-0.64]; brigatinib v. crizotinib 0.49 [0.33-0.73]; brigatinib v. ceritinib 0.43 [0.27-0.70]). OS was improved with alectinib compared with chemotherapy (HR 0.57 [95% CrI 0.39-0.83]) and crizotinib (0.68 [0.48-0.96]). Use of crizotinib (odds ratio 2.08 [95% CrI 1.56-2.79]) and alectinib (1.60 [1.00-2.58]) but not ceritinib (1.25 [0.90-1.74), increased the risk of serious adverse events compared with chemotherapy. Results were generally consistent among treatment-experienced or naïve participants. CONCLUSION(S) Treatment-related deaths were infrequent among ALK-positive NSCLC. PFS may be improved by alectinib and brigatinib relative to other ALK inhibitors; however, the assessment of OS is likely confounded by treatment crossover and should be interpreted with caution.
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Affiliation(s)
- Jesse Elliott
- Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, Ottawa, Canada
| | - Zemin Bai
- Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, Ottawa, Canada
| | - Shu-Ching Hsieh
- Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, Ottawa, Canada
| | - Shannon E. Kelly
- Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, Ottawa, Canada
| | - Li Chen
- Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, Ottawa, Canada
| | | | - Said Yousef
- Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, Ottawa, Canada
| | - Carine Zheng
- Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, Ottawa, Canada
| | - David J. Stewart
- Division of Medical Oncology, University of Ottawa and The Ottawa Hospital, Ottawa, Canada
| | - George A. Wells
- Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, Ottawa, Canada
- * E-mail:
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Abstract
Alectinib (Alecensa®) is a potent and highly selective anaplastic lymphoma kinase (ALK) tyrosine kinase inhibitor. Oral alectinib monotherapy is approved in the EU as first-line treatment for adults with advanced ALK-positive non-small cell lung cancer (NSCLC) and for the treatment of adults with advanced ALK-positive NSCLC previously treated with crizotinib. In the USA, alectinib is indicated for the treatment of adults with ALK-positive metastatic NSCLC. The recommended dosage for alectinib in the EU and USA is 600 mg twice daily. Well-designed phase III studies in patients with ALK-positive NSCLC showed that during up to ≈ 19 months' follow-up, progression-free survival (PFS) was significantly improved with alectinib relative to crizotinib as first-line therapy (ALEX study), and relative to chemotherapy in patients previously treated with crizotinib and platinum-doublet chemotherapy (ALUR study). Central nervous system (CNS)-related outcomes were significantly improved with alectinib in both these settings. Two phase II registrational studies (NP28673 and NP28761) in patients previously treated with crizotinib also demonstrated the efficacy of alectinib, as assessed by objective response rates (ORRs), during up to 21 months' follow-up. Overall, alectinib had a manageable tolerability profile in these settings, with most adverse events (AEs) of mild or moderate severity. Current evidence indicates that alectinib is an important treatment option for patients with advanced ALK-positive NSCLC who are previously untreated or those previously treated with crizotinib. Given its efficacy and tolerability, current guidelines include alectinib as a treatment option in these settings, with the NCCN guidelines recommending it as a preferred option for first-line therapy.
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Affiliation(s)
- Julia Paik
- Springer, Private Bag 65901, Mairangi Bay, 0754, Auckland, New Zealand.
| | - Sohita Dhillon
- Springer, Private Bag 65901, Mairangi Bay, 0754, Auckland, New Zealand
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Fan J, Fong T, Xia Z, Zhang J, Luo P. The efficacy and safety of ALK inhibitors in the treatment of ALK-positive non-small cell lung cancer: A network meta-analysis. Cancer Med 2018; 7:4993-5005. [PMID: 30230699 PMCID: PMC6198244 DOI: 10.1002/cam4.1768] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 07/14/2018] [Accepted: 08/19/2018] [Indexed: 12/22/2022] Open
Abstract
PURPOSE The current study was carried out to compare the effectiveness and safety of different ALK inhibitors in treating ALK+ NSCLC. METHODS Progression-free survival (PFS), disease control rate (DCR), overall response rate (ORR), and intracranial ORR and DCR have been aggregated to appraise the effectiveness of each ALKi. The discontinuation rate due to adverse events (AEs) was pooled to evaluate their safety. Bayesian network meta-analyses were used to compare the ORR, DCR, PFS, and discontinuation rate of patients treated with alectinib, ceritinib, crizotinib, and chemotherapy. RESULTS Compared with chemotherapy, ALK inhibitors significantly prolonged PFS [hazard ratio (HR) and 95% confidence interval (CI): alectinib, 0.50 (0.43-0.58); ceritinib, 0.75 (0.69-0.83); crizotinib, 0.71 (0.66-0.76)]. The ORRs were significantly higher for ALK inhibitors than for chemotherapy [odds ratio (OR) and corresponding 95% CI: alectinib, 11.69 (4.29-36.56); ceritinib, 7.85 (3.44-19.27); crizotinib, 6.04 (3.33-11.71)]. The discontinuation rates were lower for ALK inhibitors than for chemotherapy [OR and corresponding 95% CI: alectinib, 0.42 (0.12-1.36); ceritinib, 0.52 (0.20-1.35); crizotinib, 0.70 (0.30-1.62)]. CONCLUSIONS ALK+ NSCLC patients treated with ALKi tend to have longer PFS than those treated with chemotherapy. ALKi-naïve patients tended to response better than their ALKi-pretreated counterparts. Alectinib appeared to be preferable for treating brain metastases due to its high intracranial efficacy. Patients treated with alectinib or ceritinib tended to have higher ORR and DCR than patients with similar baselines treated with crizotinib or chemotherapy. No significant differences in discontinuation rate were found for alectinib, ceritinib, crizotinib, and chemotherapy.
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Affiliation(s)
- Junsheng Fan
- Department of OncologyZhujiang Hospital of Southern Medical UniversityGuangzhouChina
- Department of Respiratory MedicineShanghai Tenth People's HospitalTongji UniversityShanghaiChina
| | - Tszhei Fong
- Department of OncologyZhujiang Hospital of Southern Medical UniversityGuangzhouChina
| | - Zengfei Xia
- Department of OncologyZhujiang Hospital of Southern Medical UniversityGuangzhouChina
| | - Jian Zhang
- Department of OncologyZhujiang Hospital of Southern Medical UniversityGuangzhouChina
| | - Peng Luo
- Department of OncologyZhujiang Hospital of Southern Medical UniversityGuangzhouChina
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Zhao X, Feng Z, Wang G, Pang H, Wang M. Ceritinib Alone for Crizotinib-naive Versus Crizotinib-pretreated for Management of Anaplastic Lymphoma Kinase-rearrangement Non-Small-cell Lung Cancer: A Systematic Review. Clin Lung Cancer 2018; 19:e945-e956. [PMID: 30228011 DOI: 10.1016/j.cllc.2018.08.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 07/17/2018] [Accepted: 08/11/2018] [Indexed: 11/16/2022]
Abstract
Ceritinib shows a promising efficacy in patients with anaplastic lymphoma kinase (ALK)-rearrangement non-small-cell lung cancer (NSCLC). The present systematic review determined the whole body and intracranial effectiveness and safety of ceritinib in crizotinib-naive versus crizotinib-pretreated regimens in ALK-rearrangement NSCLC. A comprehensive search of databases, including PubMed, EMBASE, Ovid, Web of Science, and COCHRANE, was performed to identify clinical trials in English-language journals. We estimated the pooled progression-free survival (PFS) and overall response rate (ORR) for ceritinib in whole body and intracranial responses to find differences between crizotinib-naive and crizotinib-pretreated regimens. The intracranial disease control rate in both crizotinib-naive and crizotinib-pretreated regimens was also estimated. The pooled efficacy parameters were as follows: ORR, 56.9% (95% confidence interval [CI], 53.6%-60.1%); PFS, 8.26 months (95% CI, 6.18-11.07 months); intracranial ORR, 41.3% (95% CI, 35.3%-47.6%); and intracranial disease control rate, 79.8% (95% CI, 73.8%-84.7%). The pooled ceritinib for crizotinib-naive showed a trend toward greater ORR and longer PFS compared with ceritinib for crizotinib-pretreated (68.9% and 14.62 months vs. 48.2% and 6.32 months, respectively). The intracranial ORR for ceritinib as the initial regimen was 50.6% compared with 33.6% for crizotinib-pretreated. The discontinuation and dose reduction rates were 3.1% and 38.4%, respectively. The most common grade 3/4 adverse effects were increased alanine aminotransferase (25.5%), increased γ-glutamyltransferase (12.6%), and increased aspartate aminotransferase (11.1%). Ceritinib is an effective agent for both crizotinib-naive and crizotinib-pretreated patients with locally advanced or metastatic ALK-rearranged NSCLC. Ceritinib has significant activity in crizotinib-naive patients with brain metastases.
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Affiliation(s)
- Xuewei Zhao
- Department of Clinical Pharmacology, Hebei Medical University Fourth Affiliated Hospital and Hebei Provincial Tumor Hospital, Shijiazhuang, China
| | - Zhangying Feng
- Department of Clinical Pharmacology, Hebei Medical University Fourth Affiliated Hospital and Hebei Provincial Tumor Hospital, Shijiazhuang, China
| | - Guanqi Wang
- Department of Clinical Pharmacology, Hebei Medical University Fourth Affiliated Hospital and Hebei Provincial Tumor Hospital, Shijiazhuang, China
| | | | - Mingxia Wang
- Department of Clinical Pharmacology, Hebei Medical University Fourth Affiliated Hospital and Hebei Provincial Tumor Hospital, Shijiazhuang, China.
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Fan J, Xia Z, Zhang X, Chen Y, Qian R, Liu S, You D, Zhang J, Luo P. The efficacy and safety of alectinib in the treatment of ALK+ NSCLC: a systematic review and meta-analysis. Onco Targets Ther 2018. [PMID: 29535535 PMCID: PMC5840301 DOI: 10.2147/ott.s156170] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background Alectinib is a second-generation anaplastic lymphoma kinase (ALK) inhibitor approved by the US Food and Drug Administration to treat crizotinib-refractory non-small cell lung cancer. We performed this meta-analysis to synthesize the results of different clinical trials to evaluate the efficacy and safety of alectinib. Methods A search of 3 databases, including PubMed, Web of Science, and the Cochrane Library, was performed from the inception of each database through September 5, 2017. We have pooled the overall response rate (ORR), disease control rate, progression-free survival, and intracranial ORR to evaluate the efficacy of alectinib. Discontinuation rate, rate of dose reduction or interruption due to adverse events as well as the incidence of several adverse events were aggregated to evaluate its safety. Results A total of 8 studies with 626 patients have been included in our study. The pooled efficacy parameters are as follows: ORR 70% (95% CI: 57% to 82%), disease control rate 88% (95% CI: 82% to 94%), progression-free survival 9.36 months (95% CI: 7.38% to 11.34%), and intracranial ORR 52% (95% CI: 45% to 59%). ALK inhibitor-naïve patients tend to have better responses than crizotinib-pretreated patients. The aggregate discontinuation rate is 7% (95% CI: 4% to 10%), and the pooled rate of dose reduction or interruption is 33% (95% CI: 24% to 42%). The incidences of most adverse events were relatively low, while the incidences of 2 frequently reported adverse events, myalgia (18%) and anemia (25%), were even higher than with the first-generation ALK inhibitor crizotinib. Conclusion Generally, alectinib is a drug with preferable efficacy and tolerable adverse effects, and it is suitable for the treatment of intracranial metastases.
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Affiliation(s)
- Junsheng Fan
- Department of Oncology, Zhujiang Hospital of Southern Medical University, Guangzhou, China.,Department of Respiratory Medicine, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China
| | - Zengfei Xia
- Department of Oncology, Zhujiang Hospital of Southern Medical University, Guangzhou, China
| | - Xiaoli Zhang
- Department of Oncology, Zhujiang Hospital of Southern Medical University, Guangzhou, China
| | - Yuqing Chen
- Department of Oncology, Zhujiang Hospital of Southern Medical University, Guangzhou, China
| | - Ruolan Qian
- Department of Oncology, Zhujiang Hospital of Southern Medical University, Guangzhou, China
| | - Sihan Liu
- Department of Oncology, Zhujiang Hospital of Southern Medical University, Guangzhou, China
| | - Danming You
- Department of Oncology, Zhujiang Hospital of Southern Medical University, Guangzhou, China
| | - Jian Zhang
- Department of Oncology, Zhujiang Hospital of Southern Medical University, Guangzhou, China
| | - Peng Luo
- Department of Oncology, Zhujiang Hospital of Southern Medical University, Guangzhou, China
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