1
|
Xiu W, Guo X, Yu M, Li Y, Xu Y, Zhu J, Luo J. Combination of Palliative Thoracic Radiotherapy With Bevacizumab for Stage IV Nonsquamous NSCLC: Is There Any Impact of Time Interval on Survival? Clin Med Insights Oncol 2022; 16:11795549221106462. [PMID: 35770233 PMCID: PMC9234832 DOI: 10.1177/11795549221106462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 05/24/2022] [Indexed: 02/05/2023] Open
Abstract
Background: The time interval between palliative thoracic radiotherapy and bevacizumab
treatment strongly influences the frequency of adverse events (AEs) when
both are concurrently applied to patients with advanced lung cancer. Herein,
we aimed to elucidate the optimal time interval between the treatments in
these patients. Methods: The medical records of patients with stage IV nonsquamous non–small-cell lung
cancer (NSCLC) without epidermal growth factor receptor and anaplastic
lymphoma kinase alteration who underwent palliative thoracic radiotherapy
and bevacizumab treatment from January 2008 to January 2020 were collected
and analyzed. Patients were divided into 2 groups based on the time interval
between treatments: <3 weeks (⩽3W group) and >3 weeks (>3W group).
The progression-free survival (PFS) and overall survival (OS) for the time
intervals were evaluated using the Kaplan-Meier method and Cox proportional
hazard models. Adverse events were assessed by the fifth version of the
Common Terminology Criteria for Adverse Events. Results: In total, 72 patients with stage IV NSCLC (⩽3W group, 37 patients; >3W
group, 35 patients) who concurrently or sequentially received palliative
thoracic radiotherapy and bevacizumab treatment were included in this study.
In the >3W and ⩽3W groups, the median PFS (8 vs 6 months, respectively)
and OS (15 vs 12 months, respectively) differed significantly. Multivariate
analyses findings revealed significantly shorter OS in the latter group. In
addition, the frequency of most AEs was marginally higher in the latter
group (P > .05). Conclusions: The time interval between palliative thoracic radiotherapy and bevacizumab
treatment that offers optimal safety is >3 weeks.
Collapse
Affiliation(s)
- Weigang Xiu
- Department of Thoracic Oncology and State Key Laboratory of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, P.R. China
| | - Xiaotong Guo
- Department of Thoracic Oncology and State Key Laboratory of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, P.R. China
| | - Min Yu
- Department of Thoracic Oncology and State Key Laboratory of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, P.R. China
| | - Yanying Li
- Department of Thoracic Oncology and State Key Laboratory of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, P.R. China
| | - Yong Xu
- Department of Thoracic Oncology and State Key Laboratory of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, P.R. China
| | - Jiang Zhu
- Department of Thoracic Oncology and State Key Laboratory of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, P.R. China
| | - Jingjing Luo
- Department of Laboratory Medicine, West China Second University Hospital, Sichuan University, Chengdu, P.R. China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, P.R. China
| |
Collapse
|
2
|
Wang T, Thakur A, Chen B. Bevacizumab-induced esophageal pleural fistula during maintenance therapy without radiation in lung cancer. BMC Pulm Med 2021; 21:384. [PMID: 34823496 PMCID: PMC8620549 DOI: 10.1186/s12890-021-01750-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 11/16/2021] [Indexed: 12/05/2022] Open
Abstract
Background Esophageal pleural fistula (EPF) is a rare but fatal complication associated with bevacizumab use; however, cases reports of EPF caused by bevacizumab have not been previously published. Case presentation A 66-year-old male patient diagnosed with stage IV lung adenocarcinoma on April 24, 2020 received 6 cycles of platinum-containing dual chemotherapy combined with bevacizumab followed by three cycles of bevacizumab monotherapy. Five days before admission, he experienced chest tightness, dyspnea, and right chest pain. Bed-side X-ray examination revealed a massive right hydrothorax, and food was found in the extracted pleural effusion. EPF was further confirmed by upper gastrointestinal radiography after oral administration of iohexol. The patient underwent jejunostomy as the distal esophagus could not be identified on gastroscopy, and eventually died of septic shock on January 16, 2021. Conclusions It is necessary to pay attention to EPF during bevacizumab use in patients with or without risk factors.
Collapse
Affiliation(s)
- Ting Wang
- Department of Respiratory Medicine, Xi'an People's Hospital (Xi'an No.4 Hospital), No.21 Jiefang Road, Xi'an, 710004, China
| | | | - Baoqing Chen
- Department of Respiratory Medicine, Xi'an People's Hospital (Xi'an No.4 Hospital), No.21 Jiefang Road, Xi'an, 710004, China.
| |
Collapse
|
3
|
Castro-Varela A, Molina S, Grosu HB. Tracheomediastinal Fistula Formation After Endobronchial Ultrasound Transbronchial Needle Aspiration While on Bevacizumab Treatment. Cureus 2021; 13:e14189. [PMID: 33936899 PMCID: PMC8083991 DOI: 10.7759/cureus.14189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A 63-year-old male with non-small-cell lung cancer (NSCLC) developed a tracheomediastinal fistula after endobronchial ultrasound transbronchial needle aspiration while on treatment with bevacizumab. This vascular endothelial growth factor-specific angiogenesis inhibitor is a first-line treatment for unresectable or metastatic NSCLC and has been reported to cause fatal non-gastrointestinal fistulas. Respiratory tract fistulas are a known rare complication after bevacizumab therapy characterized by a high mortality rate.
Collapse
Affiliation(s)
- Alejandra Castro-Varela
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, USA.,School of Medicine and Health Sciences, Tecnológico de Monterrey, Monterrey, MEX
| | - Sofia Molina
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Horiana B Grosu
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, USA
| |
Collapse
|
4
|
Deng P, Hu C, Li Y, Cao L, Yang H, Li M, An J, Jiang J, Gu Q. Bronchial Fistula: Rare Complication of Treatment with Anlotinib. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2020; 23:858-865. [PMID: 32987493 PMCID: PMC7583880 DOI: 10.3779/j.issn.1009-3419.2020.102.40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Anlotinib is a newly developed small molecule multiple receptor tyrosine kinase (RTK) inhibitor that was approved for the treatment of patients with lung cancer in China. We aim to report 3 cases of rare complication of anlotinib-bronchial fistula (BF) during the treatment of lung cancer patients and summarize the possible causes. METHODS We collected three patients who developed BF due to anlotinib treatment, and conducted a search of Medline and PubMed for medical literature published between 2018 and 2020 using the following search terms: "anlotinib," "lung cancer," and "fistula." RESULTS Our literature search produced two case reports (three patients) which, in addition to our three patients. We collated the patients' clinical characteristics including demographic information, cancer type, imaging features, treatment received, risk factors for anlotinib related BF, and treatment-related outcomes. The six patients shared some common characteristics: advanced age, male, concurrent infection symptoms, diabetes mellitus (DM), advanced squamous cell and small cell lung cancers, centrally located tumors, tumor measuring ≥5 cm in longest diameter, and newly formed tumor cavitation after multi-line treatment especially after receiving radiotherapy. Fistula types included broncho-pericardial fistula, broncho-pleural fistula, and esophago-tracheobronchial fistula. Six patients all died within 6 months. CONCLUSIONS Although anlotinib is relatively safe, it is still necessary to pay attention to the occurrence of BF, a rare treatment side effect that threatens the quality of life and overall survival of patients. Anlotinib, therefore, requires selective use and close observation of high-risk patients.
Collapse
Affiliation(s)
- Pengbo Deng
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha 410008, China.,Xiangya Lung Cancer Center, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Chengping Hu
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha 410008, China.,Xiangya Lung Cancer Center, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Yuanyuan Li
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha 410008, China.,Xiangya Lung Cancer Center, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Liming Cao
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha 410008, China.,Xiangya Lung Cancer Center, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Huaping Yang
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha 410008, China.,Xiangya Lung Cancer Center, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Min Li
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha 410008, China.,Xiangya Lung Cancer Center, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Jian An
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha 410008, China.,Xiangya Lung Cancer Center, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Juan Jiang
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha 410008, China.,Xiangya Lung Cancer Center, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Qihua Gu
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha 410008, China.,Xiangya Lung Cancer Center, Xiangya Hospital, Central South University, Changsha 410008, China
| |
Collapse
|
5
|
Mizuguchi S, Takahama M, Nakajima R, Inoue H, Ito R, Yamamoto R. Rapid Progression of Tracheoesophageal Fistula Caused by Immunotherapy Administered after Tracheal Stent Placement. Biomed Hub 2020; 4:1-5. [PMID: 31993425 PMCID: PMC6985888 DOI: 10.1159/000501157] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 05/23/2019] [Indexed: 11/19/2022] Open
Abstract
Development of a tracheoesophageal fistula (TEF) is a serious complication of treatment for esophageal or lung cancer, especially following radiation therapy. However, development of a TEF as a complication of chemotherapy or tracheal stenting after surgical debulking is quite uncommon. We herein report a rare case involving a patient with advanced adenocarcinoma invading the mediastinum who rapidly developed a TEF after placement of a tracheal stent and administration of nivolumab immunotherapy. A 55-year-old heavy ex-smoker was diagnosed with lung adenocarcinoma with mediastinal invasion. Nine months after first-line therapy (chemotherapy and radiation therapy), he underwent treatment with nivolumab (3 mg/kg) as fourth-line therapy. Two weeks after the first dose, he underwent mechanical debulking of the tumor with tracheal stenting because of the rapid development of paraesophageal lymph node swelling and severe tracheal stenosis. He received a second dose of nivolumab 2 weeks later; however, imaging studies 12 days after this second dose revealed a huge fistula between the upper trachea and esophagus through a metastatic lymph node. Neither an additional stent nor replacement of the stent was considered because of the fistula site expansion and suffocation risk. Despite further treatment, the patient died of his primary disease 2 months later. Our findings will be of great interest to the readers, especially those involved in the clinical treatment of patients with advanced lung cancer treated by immunotherapy. The knowledge of potentially devastating TEF formation in the presence of transmural tracheal metastasis/invasion will allow clinicians to provide the best possible care for their patients.
Collapse
Affiliation(s)
- Shinjiro Mizuguchi
- Department of Thoracic Surgery, Osaka City General Hospital, Osaka, Japan
| | - Makoto Takahama
- Department of Thoracic Surgery, Osaka City General Hospital, Osaka, Japan
| | - Ryu Nakajima
- Department of Thoracic Surgery, Osaka City General Hospital, Osaka, Japan
| | - Hidetoshi Inoue
- Department of Thoracic Surgery, Osaka City General Hospital, Osaka, Japan
| | - Ryuichi Ito
- Department of Thoracic Surgery, Osaka City General Hospital, Osaka, Japan
| | - Ryoji Yamamoto
- Department of Thoracic Surgery, Osaka City General Hospital, Osaka, Japan
| |
Collapse
|