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Cheng SH, Tu KY, Lee HH. The dynamic duo: A narrative review on the synergy between stereotactic body radiotherapy and immunotherapy in lung cancer treatment (Review). Oncol Rep 2024; 52:96. [PMID: 38874014 PMCID: PMC11188053 DOI: 10.3892/or.2024.8755] [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: 01/08/2024] [Accepted: 05/10/2024] [Indexed: 06/15/2024] Open
Abstract
Immunotherapy, particularly immune checkpoint inhibitors (ICIs), is undoubtedly one of the major breakthroughs in lung cancer research. Patient survival and prognosis have all been improved as a result, although numerous patients do not respond to immunotherapy due to various immune escape mechanisms of the tumor cells. Recent preclinical and clinical evidence has shown that stereotactic body radiotherapy (SBRT), also known as stereotactic ablative radiotherapy, has a prominent immune priming effect that could elicit antitumor immunity against specific tumor antigens and destroy distant tumor cells, thereby achieving the elusive abscopal effect, with the resulting immuno‑active tumor environment also being more conducive to ICIs. Some landmark trials have already demonstrated the survival benefit of the dynamic duo of SBRT plus immunotherapy in metastatic non‑small‑cell lung cancer, while others such as PEMBRO‑RT further suggest that the addition of SBRT to immunotherapy could expand the current indication to those who have historically responded poorly to ICIs. In the present review, the biological mechanisms that drive the synergistic effect of SBRT and immunotherapy were first briefly outlined; then, the current understanding from clinical trials was summarized and new insight into the evolving role of immunotherapy and SBRT synergy in lung cancer treatment was provided. Finally, novel avenues for discovery were highlighted. The innovation of the present review lies in the inclusion of non‑ICI immunotherapy in the discussion, which provides a more comprehensive view on the current development and future trend of SBRT + immunotherapy synergy.
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Affiliation(s)
- Sarah Hsin Cheng
- Department of Clinical Education and Training, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan, R.O.C
| | - Kuan-Yi Tu
- School of Post Baccalaureate Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan, R.O.C
| | - Hsin-Hua Lee
- Department of Radiation Oncology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan, R.O.C
- PhD Program in Environmental and Occupational Medicine, Kaohsiung Medical University and National Health Research Institutes, Kaohsiung 807, Taiwan, R.O.C
- Department of Radiation Oncology, Faculty of Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan, R.O.C
- Center for Cancer Research, Kaohsiung Medical University, Kaohsiung 807, Taiwan, R.O.C
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Tramontano S, Sarno G, Prisco V, Tedesco AM, Gargiulo A, Bracale U. Case Report: Recurrent colonic metastasis from lung cancer-diagnostic pitfalls and therapeutic challenge of a peculiar case. Front Surg 2023; 10:1288940. [PMID: 38186393 PMCID: PMC10766848 DOI: 10.3389/fsurg.2023.1288940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 09/26/2023] [Indexed: 01/09/2024] Open
Abstract
Lung cancer (LC) mortality exceeds 20%, and detecting metastases from LC is becoming a challenging step in understanding the real prognostic role of specific localization. We report a case of a patient with lung metastasis to the colon with local recurrence at the anastomosis after radical resection for metastasis. In both cases, the diagnosis was on oncological follow-up, and surgery was offered in consideration of reasonable life expectancy, good control of LC, and high risk of intestinal occlusion. A 67-year-old male, with a history of LC 18 months ago, was referred to our surgical unit after a positron emission tomography CT total body, where an area of intense glucose metabolism (SUV max: 35.6) at the hepatic colic flexure was reported. A colonoscopy revealed an ulcerated, bleeding large neoplasm distally to hepatic flexure, almost causing resulting total occlusion. Histologic examination revealed a tumor with complete wall thickness infiltration, which appears extensively ulcerated, from poorly differentiated squamous carcinoma (G3), not keratinizing, with growth in large solid nests, often centered by central necrosis. Two of the 30 isolated lymph nodes were metastatic. The omental flap and resection margins were free from infiltration. The malignant cells exhibited strong positive immunoreactivity only for p40. The features supported metastatic squamous carcinoma of lung origin rather than primary colorectal adenocarcinoma. After 8 months from surgery, intense Fluorodeoxyglucose (FDG) uptake of tissue was confirmed in the transverse colon. Colonoscopy evidenced an ulcerated substenotic area that involved ileocolic anastomosis on both sides. Reoperation consisted of radical resection of ileocolic anastomosis with local lymphadenectomy and ileotransverse anastomosis. The second histologic examination also revealed poorly differentiated squamous carcinoma (G3), not keratinizing, with positive immunoreactivity only for p40, suggesting the origin of LC. This case report confirmed that the possibility of colonic secondary disease should be part of the differential diagnosis in asymptomatic patients and those with a history of LC diagnosis. In addition, relapse of colonic metastasis is infrequent but should be considered during follow-up of LC. More studies on colonic metastasis of LC are required to better understand the clinical features and outcomes.
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Affiliation(s)
- Salvatore Tramontano
- Department of Physics, University of Salerno, Salerno, Italy
- Department of General and Emergency Surgery, Ospedali Riuniti San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - Gerardo Sarno
- Department of Physics, University of Salerno, Salerno, Italy
- Department of General and Emergency Surgery, Ospedali Riuniti San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - Vera Prisco
- Department of Physics, University of Salerno, Salerno, Italy
| | | | - Antonio Gargiulo
- Department of Surgery, University of Naples Federico II, Naples, Italy
| | - Umberto Bracale
- Department of Physics, University of Salerno, Salerno, Italy
- Department of General and Emergency Surgery, Ospedali Riuniti San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
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Cabezón-Gutiérrez L, Sereno M, Cervera-Calero R, Mielgo-Rubio X, Higuera O. High tumor burden in non-small-cell lung cancer: A review of the literature. J Clin Transl Res 2022; 8:403-413. [PMID: 36518549 PMCID: PMC9741935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 07/17/2022] [Accepted: 07/27/2022] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND AND AIM Lung cancer is the leading cause of cancer death worldwide and the majority of the patients have advanced/metastatic disease on presentation. In clinical practice, several biomarkers and clinical factors are taken into account when choosing the best treatment option in advanced non-small-cell lung cancer (NSCLC). One potential marker may be tumor burden (TB). However, this concept is not specifically defined in NSCLC, and usually, it is used as a synonymous for aggressive disease. METHODS A non-systematic literature review was conducted. We searched for eligible randomized controlled trials from PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials with a cutoff at February 2021. The keywords included non-small-cell lung cancer, tumor burden, aggressive disease, prognosis biomarker, predictive biomarker, and immunotherapy. RESULTS AND CONCLUSIONS This review addresses the definition of TB in advanced NSCLC, the pathophysiology of high TB lesions, and the role of TB as a prognosis biomarker. RELEVANCE FOR PATIENTS The concept of aggressive disease, as high tumor burden definition, remains poorly defined and rarely considered in clinical research or clinical practice in oncology. The identification of this subgroup of patients could be interesting for defining and optimizing a more aggressive treatment strategy.
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Affiliation(s)
- Luis Cabezón-Gutiérrez
- Medical Oncology, Hospital Universitario de Torrejón. Universidad Francisco Vitoria. Madrid, Spain
| | - María Sereno
- Medical Oncology, Sofía University Hospital; European University of Madrid. Madrid, Spain
| | | | - Xabier Mielgo-Rubio
- Medical Oncology. Hospital Universitario Fundación de Alcorcón. Alcorcón. Spain
| | - Oliver Higuera
- Medical Oncology, Hospital Universitario La Paz. Madrid, Spain
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4
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Li Y, Xu C, Yu Q. Risk factor analysis of bone metastasis in patients with non-small cell lung cancer. Am J Transl Res 2022; 14:6696-6702. [PMID: 36247263 PMCID: PMC9556442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 07/25/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE Bone tissue is the most common metastatic location besides lung and liver. 30%~40% of patients with non-small cell lung cancer (NSCLC) will have bone metastasis (BM) in the development of the disease. This study aims to explore the relevant risk factors through multivariate analysis, in order to provide basis for the prevention of BM and bone related events of NSCLC. METHODS We analyzed 152 patients, with 67 in BM group and 85 in non-BM group. The general clinical data and laboratory indicators (mainly coagulation function) of patients were compared through univariate and multivarijate analysis. Finally, the independent risk factors of BM in patients with NSCLC were screened out. RESULTS The results of univariate analysis show that thrombosis, clinical stage, tumor-node-metastasis (TNM) stage, prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT), fibrinogen (FIB), D-Dimer (D-D), platelet (PLT) and alkaline phosphatase (AKP) are the risk factors of BM in patients with NSCLC (p<0.05). Further multivariate logistic regression analysis suggests that the independent risk factors of BM in patients with NSCLC are clinical stage III-IV, TNM stage T1-T3, TNM stage N2-N3, FIB, APTT, D-D and AKP (P<0.05). CONCLUSION Clinical stage III-IV, TNM stage T1-T3, TNM stage N2-N3, FIB, APTT, D-D and AKP are the independent risk factors of BM in patients with NSCLC. Meanwhile, patients with these risk factors should be screened in time, which is of great significance to prevent bone related events and relieve pain.
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Affiliation(s)
- Yang Li
- Department of Thoracic Surgery, Long Hua Hospital, Shanghai University of Traditional Chinese MedicineShanghai, China
| | - Chongqing Xu
- Department of Thoracic Surgery, Long Hua Hospital, Shanghai University of Traditional Chinese MedicineShanghai, China
- Department of Orthopaedics, Long Hua Hospital, Shanghai University of Traditional Chinese MedicineShanghai, China
| | - Qiquan Yu
- Department of Thoracic Surgery, Long Hua Hospital, Shanghai University of Traditional Chinese MedicineShanghai, China
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Saad J, Hameed A, Sidhu A, Ellis-Clark J. Colonic metastasis from pleomorphic sarcomatoid non-small cell lung cancer. ANZ J Surg 2022; 92:2753-2754. [PMID: 35416415 DOI: 10.1111/ans.17707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 04/03/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Jeremy Saad
- Department of Colorectal Surgery, Nepean Hospital, Sydney, New South Wales, Australia
| | - Ahmer Hameed
- Department of Colorectal Surgery, Nepean Hospital, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Ankur Sidhu
- Department of Colorectal Surgery, Nepean Hospital, Sydney, New South Wales, Australia
| | - Jodie Ellis-Clark
- Department of Colorectal Surgery, Nepean Hospital, Sydney, New South Wales, Australia
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6
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Reddy R, Reddy S. Trends in Imaging Patterns of Bronchogenic Carcinoma: Reality or a Statistical Variation? A Single-Center Cross-Sectional Analysis of Outcomes. Med Princ Pract 2022; 31:480-485. [PMID: 36195060 PMCID: PMC9801366 DOI: 10.1159/000527246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 09/25/2022] [Indexed: 01/02/2023] Open
Abstract
INTRODUCTION Bronchogenic carcinoma accounts for more cancer-related deaths than any other malignancy and is the most frequently diagnosed cancer in the world. Bronchogenic carcinoma is by far the leading cause of cancer death among both men and women, making up almost 25% of all cancer deaths. The objective of this study was to identify the changing trends, if any, in radiological patterns of bronchogenic carcinoma to document the various computed tomography (CT) appearances of bronchogenic carcinoma with histopathologic correlation. METHODS This was a single-center cross-sectional study on 162 patients with clinical or radiological suspicion of bronchogenic carcinoma with histopathological confirmation of diagnosis. RESULTS There was a male preponderance with bronchogenic carcinoma and smoking being the most common risk factor. Squamous cell carcinoma followed by adenocarcinoma and small cell carcinoma is the most common histologic subtype. Squamous cell carcinoma was noted to be present predominantly in the peripheral location (55.5%), and adenocarcinoma was noted to be present predominantly in the central location (68.4%). CONCLUSION CT is the imaging modality of choice for evaluating bronchogenic carcinoma and provides for precise characterization of the size, extent, and staging of the carcinoma. Among 162 bronchogenic carcinoma cases evaluated in the current study, a definite changing trend in the radiological pattern of squamous cell carcinoma and adenocarcinoma was observed. Squamous cell carcinoma was predominantly noted to be a peripheral tumor, and adenocarcinoma is predominantly noted to be a central tumor. Surveillance or restaging scans are recommended, considering the high mortality rate in patients with bronchogenic carcinoma.
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Affiliation(s)
- Ravikanth Reddy
- Department of Radiology, St. John's Hospital, Kattappana, India
| | - Sandeep Reddy
- Department of Radiology, St. John's Hospital, Bengaluru, India
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Yin Q, Dai L, Sun R, Ke P, Liu L, Jiang B. Clinical Efficacy of Immune Checkpoint Inhibitors in Non-small-cell Lung Cancer Patients with Liver Metastases: A Network Meta-Analysis of Nine Randomized Controlled Trials. Cancer Res Treat 2021; 54:803-816. [PMID: 34696564 PMCID: PMC9296924 DOI: 10.4143/crt.2021.764] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 10/21/2021] [Indexed: 11/21/2022] Open
Abstract
Purpose This network meta-analysis (NMA) was conducted to compare the efficacy of immune checkpoint inhibitors (ICIs) in advanced non-small cell lung cancer (NSCLC) patients with liver metastases. Materials and Methods English literature was retrieved from the PubMed, American Society of Clinical Oncology (ASCO), and European Society for Medical Oncology (ESMO) databases from January 2015 to January 2021. We pooled the overall survival (OS) and progression-free survival (PFS) hazard ratios (HRs) using a network meta-analysis and ranked treatments by the surface under the cumulative ranking curve (SUCRA). Publication bias was evaluated by Begg's and Egger's tests. STATA15.0 was used for the sensitivity analysis, and the remaining statistical analyses were performed using R 4.0.2. Results Nine eligible phase III randomized controlled trials (RCTs) were included, including 1,141 patients with liver metastases. Pembrolizumab + chemotherapy ranked highest, followed by atezolizumab + bevacizumab + chemotherapy and nivolumab. However, no significant difference in OS rates was observed across these three treatments (HR, 0.98; 95% CI: 0.43-2.22 for pembrolizumab + chemotherapy vs. atezolizumab + bevacizumab + chemotherapy; HR, 0.91; 95% CI: 0.52-1.57 for pembrolizumab + chemotherapy vs. nivolumab). Regarding the PFS rate, atezolizumab + bevacizumab + chemotherapy and pembrolizumab + chemotherapy ranked highest and no significant difference was observed between them (HR, 0.79; 95% CI: 0.36-1.70 for atezolizumab + bevacizumab + chemotherapy vs. pembrolizumab + chemotherapy). Conclusion Pembrolizumab + chemotherapy, atezolizumab + bevacizumab + chemotherapy, and nivolumab were superior to other treatments in NSCLC patients with liver metastases. These new findings may help clinicians better select therapeutic strategies for NSCLC patients with liver metastases.
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Affiliation(s)
- Qing Yin
- Cadre Medical Department, The Third Affiliated Hospital of Kunming Medical University, Yunnan, China
| | - Longguo Dai
- Cadre Medical Department, The Third Affiliated Hospital of Kunming Medical University, Yunnan, China
| | - Ruizhu Sun
- Cadre Medical Department, The Third Affiliated Hospital of Kunming Medical University, Yunnan, China
| | - Ping Ke
- Cadre Medical Department, The Third Affiliated Hospital of Kunming Medical University, Yunnan, China
| | - Liya Liu
- Cadre Medical Department, The Third Affiliated Hospital of Kunming Medical University, Yunnan, China
| | - Bo Jiang
- Cadre Medical Department, The Third Affiliated Hospital of Kunming Medical University, Yunnan, China
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8
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Leem G, Park J, Jeon M, Kim ES, Kim SW, Lee YJ, Choi SJ, Choi B, Park S, Ju YS, Jung I, Kim S, Shin EC, Lee JY, Park SH. 4-1BB co-stimulation further enhances anti-PD-1-mediated reinvigoration of exhausted CD39 + CD8 T cells from primary and metastatic sites of epithelial ovarian cancers. J Immunother Cancer 2021; 8:jitc-2020-001650. [PMID: 33335029 PMCID: PMC7745695 DOI: 10.1136/jitc-2020-001650] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2020] [Indexed: 11/16/2022] Open
Abstract
Background Responses to immunotherapy vary between different cancer types and sites. Here, we aimed to investigate features of exhaustion and activation in tumor-infiltrating CD8 T cells at both the primary and metastatic sites in epithelial ovarian cancer. Methods Tumor tissues and peripheral blood were obtained from 65 patients with ovarian cancer. From these samples, we isolated tumor-infiltrating lymphocytes (TILs) and peripheral blood mononuclear cells. These cells were used for immunophenotype using multicolor flow cytometry, gene expression profile using RNA sequencing and ex vivo functional restoration assays. Results We found that CD39+ CD8 TILs were enriched with tumor-specific CD8 TILs, and that the activation status of these cells was determined by the differential programmed cell death protein 1 (PD-1) expression level. CD39+ CD8 TILs with high PD-1 expression (PD-1high) exhibited features of highly tumor-reactive and terminally exhausted phenotypes. Notably, PD-1high CD39+ CD8 TILs showed similar characteristics in terms of T-cell exhaustion and activation between the primary and metastatic sites. Among co-stimulatory receptors, 4-1BB was exclusively overexpressed in CD39+ CD8 TILs, especially on PD-1high cells, and 4-1BB-expressing cells displayed immunophenotypes indicating higher degrees of T-cell activation and proliferation, and less exhaustion, compared with cells not expressing 4-1BB. Importantly, 4-1BB agonistic antibodies further enhanced the anti-PD-1-mediated reinvigoration of exhausted CD8 TILs from both primary and metastatic sites. Conclusion Severely exhausted PD-1high CD39+ CD8 TILs displayed a distinctly heterogeneous exhaustion and activation status determined by differential 4-1BB expression levels, providing rationale and evidence for immunotherapies targeting co-stimulatory receptor 4-1BB in ovarian cancers.
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Affiliation(s)
- Galam Leem
- Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea
| | - Junsik Park
- Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Minwoo Jeon
- Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea
| | - Eui-Soon Kim
- Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea
| | - Sang Wun Kim
- Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yong Jae Lee
- Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seong Jin Choi
- Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea
| | - Baekgyu Choi
- Department of Biological Sciences, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea
| | - Seongyeol Park
- Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea
| | - Young Seok Ju
- Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea
| | - Inkyung Jung
- Department of Biological Sciences, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea
| | - Sunghoon Kim
- Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Eui-Cheol Shin
- Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea
| | - Jung Yun Lee
- Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Su-Hyung Park
- Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea
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Qin A, Zhao S, Miah A, Wei L, Patel S, Johns A, Grogan M, Bertino EM, He K, Shields PG, Kalemkerian GP, Gadgeel SM, Ramnath N, Schneider BJ, Hassan KA, Szerlip N, Chopra Z, Journey S, Waninger J, Spakowicz D, Carbone DP, Presley CJ, Otterson GA, Green MD, Owen DH. Bone Metastases, Skeletal-Related Events, and Survival in Patients With Metastatic Non-Small Cell Lung Cancer Treated With Immune Checkpoint Inhibitors. J Natl Compr Canc Netw 2021; 19:915-921. [PMID: 33878726 DOI: 10.6004/jnccn.2020.7668] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 10/07/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Bone metastases and skeletal-related events (SREs) are a frequent cause of morbidity in patients with metastatic non-small cell lung cancer (mNSCLC). Data are limited on bone metastases and SREs in patients with mNSCLC treated using immune checkpoint inhibitors (ICIs), and on the efficacy of bone-modifying agents (BMAs) in this setting. Here we report the incidence, impact on survival, risk factors for bone metastases and SREs, and impact of BMAs in patients with mNSCLC treated with ICIs in a multi-institutional cohort. PATIENTS AND METHODS We conducted a retrospective study of patients with mNSCLC treated with ICIs at 2 tertiary care centers from 2014 through 2017. Overall survival (OS) was compared between patients with and without baseline bone metastases using a log-rank test. A Cox regression model was used to evaluate the association between OS and the presence of bone metastases at ICI initiation, controlling for other confounding factors. RESULTS We identified a cohort of 330 patients who had received ICIs for metastatic disease. Median patient age was 63 years, most patients were treated in the second line or beyond (n=259; 78%), and nivolumab was the most common ICI (n=211; 64%). Median OS was 10 months (95% CI, 8.4-12.0). In our cohort, 124 patients (38%) had baseline bone metastases, and 43 (13%) developed SREs during or after ICI treatment. Patients with bone metastases had a higher hazard of death after controlling for performance status, histology, line of therapy, and disease burden (hazard ratio, 1.57; 95% CI, 1.19-2.08; P=.001). Use of BMAs was not associated with OS or a decreased risk of SREs. CONCLUSIONS Presence of bone metastases at baseline was associated with a worse prognosis for patients with mNSCLC treated with ICI after controlling for multiple clinical characteristics. Use of BMAs was not associated with reduced SREs or a difference in survival.
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Affiliation(s)
- Angel Qin
- Division of Hematology and Oncology, University of Michigan, Ann Arbor, Michigan
| | | | | | | | - Sandipkumar Patel
- Department of Internal Medicine, The Ohio State University, Columbus, Ohio
| | - Andrew Johns
- Department of Internal Medicine, The Ohio State University, Columbus, Ohio
| | | | | | - Kai He
- Division of Medical Oncology, and
| | | | | | - Shirish M Gadgeel
- Division of Hematology and Oncology, University of Michigan, Ann Arbor, Michigan.,Division of Hematology and Oncology, Henry Ford Cancer Center, Detroit, Michigan
| | - Nithya Ramnath
- Division of Hematology and Oncology, University of Michigan, Ann Arbor, Michigan
| | - Bryan J Schneider
- Division of Hematology and Oncology, University of Michigan, Ann Arbor, Michigan
| | - Khaled A Hassan
- Division of Hematology and Oncology, University of Michigan, Ann Arbor, Michigan.,Department of Hematology and Oncology, Cleveland Clinic, Cleveland, Ohio; and
| | | | | | | | | | | | | | | | | | - Michael D Green
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
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10
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Zhu H, Zhou L, Guo Y, Yang G, Dong Q, Zhang Z, Chen M, Yang Q. Factors for incidence risk and prognosis in non-small-cell lung cancer patients with synchronous brain metastasis: a population-based study. Future Oncol 2021; 17:2461-2473. [PMID: 33706557 DOI: 10.2217/fon-2021-0103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background: We aimed to investigate the epidemiology of synchronous brain metastasis (SBM) in non-small-cell lung cancer (NSCLC) patients. Methods: Logistic regression and Cox regression were used to identify the related factors of SBM incidence and cancer-specific survival (CSS). A nomogram for predicting CSS was developed and validated. Results: The incidence of SBM in NSCLC patients was 12.58%. The median CSS was 5 months. Patients with younger age, female gender, and adenocarcinoma had higher odd ratios for developing SBM. In addition, a nomogram was developed based on significant factors from Cox regression. The validation of the nomogram showed that it had good calibration and discrimination. Conclusions: SBM was highly prevalent in NSCLC patients, who also had poor survival.
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Affiliation(s)
- Haizhen Zhu
- Department of Oncology, Guizhou Provincial People's Hospital, Guizhou Cancer Center, Guiyang, 550002, China
| | - Lin Zhou
- School of Nursing, Fudan University, Shanghai, 310000, China
| | - Yi Guo
- Department of Basic Knowledge, Guiyang Nursing Vocational College, Guiyang, 550081, China
| | - Guangrong Yang
- Department of Oncology, Qijiang Hospital of The First Affiliated Hospital of Chongqing Medical University, Qijiang, 401420, China
| | - Qiang Dong
- Department of General Medicine, Qijiang Hospital of The First Affiliated Hospital of Chongqing Medical University, Qijiang, 401420, China
| | - Zhijia Zhang
- Department of Clinical Laboratory, Xinqiao Hospital, Army Medical University, Chongqing, 400037, China
| | - Mingjing Chen
- Department of Infectious Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Qiao Yang
- Department of Ultrasound, The 941st Hospital of the PLA Joint Logistic Support Force, Xining, 810007, China
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11
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Lin HM, Pan X, Hou P, Huang H, Wu Y, Ren K, Jahanzeb M. Economic burden in patients with ALK + non-small cell lung cancer, with or without brain metastases, receiving second-line anaplastic lymphoma kinase (ALK) inhibitors. J Med Econ 2020; 23:894-901. [PMID: 32347754 DOI: 10.1080/13696998.2020.1762620] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Aims: To describe the real-world economic burden of patients with anaplastic lymphoma kinase-positive (ALK+) non-small cell lung cancer (NSCLC) treated with post-crizotinib, second-line ALK inhibitor therapy.Materials and methods: Retrospective analysis using data from US Optum: Clinformatics Data Mart administrative claims database. Adult patients with ALK + NSCLC treated with ceritinib or alectinib as second-line ALK inhibitors between 1 January 2011 and 30 September 2017 were included. Healthcare costs and resource utilization for up to 1 year of therapy were calculated on a per-patient-per-month (PPPM) basis and stratified by presence or absence of brain metastases (BM). Multivariate regression analysis was performed to identify factors associated with costs. Top ten cost drivers of non-inpatient procedure costs were recorded.Results: One hundred and twelve patients received second-line ALK inhibitors. Total mean PPPM healthcare costs were $23,984 for all patients receiving up to 1 year of post-crizotinib, second-line ALK inhibitor therapy. Total mean PPPM costs for patients with BM on or prior to post-crizotinib, second-line ALK inhibitor therapy were 1.37-times as high as those for patients without BM (p = 0.0406). Mean PPPM outpatient visits and inpatient hospitalization stays were higher for patients with BM versus no BM. The main cost drivers for non-inpatient procedures were radiation therapy, medications, and diagnostic radiology.Limitations: Analyses did not include newer ALK-directed therapies. BM development after the index date (defined as the date of the first claim for a second-line ALK inhibitor) may have been misclassified as non-BM. Findings may not be generalizable to patients with no health insurance coverage.Conclusions: Treatment of patients with ALK + NSCLC with ceritinib or alectinib as post-crizotinib, second-line ALK inhibitor therapy represents a high economic burden. Healthcare costs and resource utilization were significantly higher for patients with ALK + NSCLC with BM versus no BM.
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Affiliation(s)
- Huamao M Lin
- Global Outcomes Research, Millennium Pharmaceuticals, Inc. (A wholly owned subsidiary of Takeda Pharmaceutical Company Limited), Cambridge, MA, USA
| | - Xiaoyun Pan
- Global Outcomes Research, Millennium Pharmaceuticals, Inc. (A wholly owned subsidiary of Takeda Pharmaceutical Company Limited), Cambridge, MA, USA
| | - Peijie Hou
- Global Outcomes Research, Millennium Pharmaceuticals, Inc. (A wholly owned subsidiary of Takeda Pharmaceutical Company Limited), Cambridge, MA, USA
| | - Hui Huang
- Global Outcomes Research, Millennium Pharmaceuticals, Inc. (A wholly owned subsidiary of Takeda Pharmaceutical Company Limited), Cambridge, MA, USA
| | - Yanyu Wu
- Global Outcomes Research, Millennium Pharmaceuticals, Inc. (A wholly owned subsidiary of Takeda Pharmaceutical Company Limited), Cambridge, MA, USA
| | - Kaili Ren
- Global Outcomes Research, Millennium Pharmaceuticals, Inc. (A wholly owned subsidiary of Takeda Pharmaceutical Company Limited), Cambridge, MA, USA
| | - Mohammad Jahanzeb
- Florida Precision Oncology, a division of 21st Century Oncology, Boca Raton, FL, USA
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12
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Wang X, Wang Z, Pan J, Lu ZY, Xu D, Zhang HJ, Wang SH, Huang DY, Chen XF. Patterns of Extrathoracic Metastases in Different Histological Types of Lung Cancer. Front Oncol 2020; 10:715. [PMID: 32509574 PMCID: PMC7248315 DOI: 10.3389/fonc.2020.00715] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Accepted: 04/16/2020] [Indexed: 12/25/2022] Open
Abstract
Lung cancer is the leading cause of cancer-related deaths mainly attributable to metastasis, especially extrathoracic metastasis. This large-cohort research is aimed to explore metastatic profiles in different histological types of lung cancer, as well as to assess clinicopathological and survival significance of diverse metastatic lesions. Lung cancer cases were extracted and enrolled from the Surveillance, Epidemiology, and End Results (SEER) database. χ2-tests were conducted to make comparisons of metastatic distribution among different histological types and odds ratios were calculated to analyze co-occurrence relationships between different metastatic lesions. Kaplan–Meier methods were performed to analyze survival outcomes according to different metastatic sites and Cox regression models were conducted to identify independent prognostic factors. In total, we included 159,241 lung cancer cases with detailed metastatic status and complete follow-up information. In order to understand their metastatic patterns, we elucidated the following points in this research: (1) Comparing the frequencies of different metastatic lesions in different histological types. The frequency of bone metastasis was highest in adenocarcinoma, squamous cell carcinoma, LCLC and NSCLC/NOS, while liver was the most common metastatic site in SCLC. (2) Elaborating the tendency of combined metastases. Bi-site metastases occurred more common than tri-site and tetra-site metastases. And several metastatic sites, such as bone and liver, intended to co-metastasize preferentially. (3) Clarifying the prognostic significance of single-site and bi-site metastases. All single-site metastases were independent prognostic factors and co-metastases ended up with even worse survival outcomes. Thus, our findings would be beneficial for research design and clinical practice.
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Affiliation(s)
- Xuan Wang
- Department of Thoracic Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Zheng Wang
- Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Junjie Pan
- Department of General Surgery, Huashan Hospital, Cancer Metastasis Institute, Fudan University, Shanghai, China
| | - Zhou-Yi Lu
- Department of Thoracic Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Dong Xu
- Department of Thoracic Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Hui-Jun Zhang
- Department of Thoracic Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Shao-Hua Wang
- Department of Thoracic Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Da-Yu Huang
- Department of Thoracic Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Xiao-Feng Chen
- Department of Thoracic Surgery, Huashan Hospital, Fudan University, Shanghai, China
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13
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Landi L, D'Incà F, Gelibter A, Chiari R, Grossi F, Delmonte A, Passaro A, Signorelli D, Gelsomino F, Galetta D, Giannarelli D, Soto Parra H, Minuti G, Tiseo M, Migliorino MR, Cognetti F, Toschi L, Bidoli P, Piantedosi F, Calabro' L, Cappuzzo F. Bone metastases and immunotherapy in patients with advanced non-small-cell lung cancer. J Immunother Cancer 2019; 7:316. [PMID: 31752994 PMCID: PMC6868703 DOI: 10.1186/s40425-019-0793-8] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 10/30/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Bone metastases (BoM) are a negative prognostic factor in non-small-cell lung cancer (NSCLC). Beyond its supportive role, bone is a hematopoietic organ actively regulating immune system. We hypothesized that BoM may influence sensitivity to immunotherapy. METHODS Pretreated non-squamous (cohort A) and squamous (cohort B) NSCLCs included in the Italian Expanded Access Program were evaluated for nivolumab efficacy according to BoM. RESULTS Cohort A accounted for 1588 patients with non-squamous NSCLC, including 626 (39%) with (BoM+) and 962 (61%) without BoM (BoM-). Cohort B accounted for 371 patients with squamous histology including 120 BoM+ (32%) and 251 (68%) BoM- cases. BoM+ had lower overall response rate (ORR; Cohort A: 12% versus 23%, p < 0.0001; Cohort B: 13% versus 22%, p = 0.04), shorter progression free survival (PFS; Cohort A: 3.0 versus 4.0 months, p < 0.0001; Cohort B: 2.7 versus 5.2 months, p < 0.0001) and overall survival (OS; Cohort A: 7.4 versus 15.3 months, p < 0.0001; Cohort B: 5.0 versus 10.9 months, p < 0.0001). Moreover, BoM negatively affected outcome irrespective of performance status (PS; OS in both cohorts: p < 0.0001) and liver metastases (OS cohort A: p < 0.0001; OS Cohort B: p = 0.48). At multivariate analysis, BoM independently associated with higher risk of death (cohort A: HR 1.50; cohort B: HR 1.78). CONCLUSIONS BoM impairs immunotherapy efficacy. Accurate bone staging should be included in clinical trials with immunotherapy.
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Affiliation(s)
- Lorenza Landi
- Department of Oncology and Hematology, AUSL Romagna, Ravenna, Italy
| | | | | | - Rita Chiari
- Medical Oncology, Santa Maria della Misericordia Hospital, Perugia, Italy
| | - Francesco Grossi
- Division of Medical Oncology, IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Angelo Delmonte
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Antonio Passaro
- Division of Thoracic Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | | | | | - Domenico Galetta
- Oncologia Medica Toracica, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | | | | | - Gabriele Minuti
- UO Oncologia Medica, Azienda Usl Toscana Nord Ovest, Livorno, Italy
| | - Marcello Tiseo
- Medical Oncology Unit, University Hospital, Parma, Italy
| | | | | | - Luca Toschi
- Humanitas Cancer Center, Rozzano, Milan, Italy
| | - Paolo Bidoli
- Oncology Unit, ASST, Ospedale S. Gerardo, Monza, Italy
| | | | - Luana Calabro'
- Medical Oncology and Immunotherapy, Center for Immuno-Oncology, University Hospital of Siena, Siena, Italy
| | - Federico Cappuzzo
- Department of Oncology and Hematology, AUSL Romagna, Ravenna, Italy.
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14
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Lin YT, Liu YN, Shih JY. The Impact of Clinical Factors, ALK Fusion Variants, and BIM Polymorphism on Crizotinib-Treated Advanced EML4-ALK Rearranged Non-small Cell Lung Cancer. Front Oncol 2019; 9:880. [PMID: 31608224 PMCID: PMC6768009 DOI: 10.3389/fonc.2019.00880] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 08/27/2019] [Indexed: 11/23/2022] Open
Abstract
Patients' clinical factors and genetics factors such as anaplastic lymphoma kinase (ALK) fusion variants and BIM (Bcl-2-like 11) polymorphism were reported to be associated with clinical outcome in crizotinib-treated advanced non-small cell lung cancer (NSCLC). However, the results were still controversial. We analyzed outcome of 54 patients with known ALK fusion variants who received crizotinib for advanced NSCLC. Thirty of them had successful BIM polymorphism analysis and 6 (20%) had a BIM deletion. Multivariate Cox regression analysis found that previous anticancer therapy [adjusted hazard ratio (aHR) 1.35, 95% confidence interval (CI), 1.04–1.76 for each additional line of therapy, p = 0.025] and Eastern Cooperative Oncology Group (ECOG) performance status ≥2 (aHR 8.35, 95% CI, 1.52–45.94, p = 0.015) were independent factors for progression-free survival (PFS). Only ECOG performance status ≥2 (aHR 7.20, 95% CI, 1.27–40.79, p = 0.026) was an independent factor for overall survival (OS). Neither ALK fusion variants nor the presence of a BIM deletion was associated with crizotinib PFS or OS. After adjusting with clinical factors, different ALK variants and BIM polymorphism might not be independent factors for crizotinib PFS or OS in advanced NSCLC with ALK rearrangement.
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Affiliation(s)
- Yen-Ting Lin
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.,Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yi-Nan Liu
- Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Jin-Yuan Shih
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.,Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan
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15
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Takahashi Y, Adachi H, Mizukami Y, Yokouchi H, Oizumi S, Watanabe A. Patient outcomes post-pulmonary resection for synchronous bone-metastatic non-small cell lung cancer. J Thorac Dis 2019; 11:3836-3845. [PMID: 31656656 DOI: 10.21037/jtd.2019.09.17] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background The efficacy of curative-intent pulmonary resection for non-small cell lung cancer (NSCLC) patients with certain types of oligometastases, particularly brain and adrenal metastases, has previously been described. We investigated the outcomes of curative-intent pulmonary resection for NSCLC patients with synchronous isolated bone metastases, which have been less clear to date. Methods We retrospectively reviewed the clinical and pathological records of 41 patients with NSCLC and synchronous isolated bone metastases who underwent radical treatments (surgery and/or chemotherapy and/or radiotherapy) for both their primary tumors and bone metastases at the National Hospital Organization, Hokkaido Cancer Center, between 2008 and 2013. Results Nine of the 41 patients underwent pulmonary primary tumor resection; the rate of clinical N0-1 disease among these 9 patients (100%) was significantly higher than that among the 32 patients who did not undergo resection (34.4%). The five-year overall survival (OS), progression-free survival (PFS), and disease-free survival (DFS) rates of the nine patients who underwent pulmonary resection were 66.7%, 55.6%, and 44.4%, respectively. On multivariate analysis, the predictors of longer OS among all 41 patients were primary site resection [hazard ratio (HR) =4.18, 95% CI, 1.20-14.6, P=0.025] and epidermal growth factor receptor (EGFR) mutation (HR =3.30, 95% CI, 1.08-10.1, P=0.036). The former was also a predictor of longer PFS (HR =3.75, 95% CI, 1.27-11.0, P=0.016). Conclusions Patients with clinical N0-1 NSCLC and synchronous isolated bone metastases may achieve longer survival rates following primary lung tumor resection.
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Affiliation(s)
- Yuki Takahashi
- Department of Thoracic Surgery, National Hospital Organization, Hokkaido Cancer Center, Sapporo, Japan.,Department of Thoracic Surgery, Sapporo Medical University, School of Medicine and Hospital, Sapporo, Japan
| | - Hirofumi Adachi
- Department of Thoracic Surgery, National Hospital Organization, Hokkaido Cancer Center, Sapporo, Japan
| | - Yasushi Mizukami
- Department of Thoracic Surgery, National Hospital Organization, Hokkaido Cancer Center, Sapporo, Japan
| | - Hiroshi Yokouchi
- Department of Respiratory Medicine, National Hospital Organization, Hokkaido Cancer Center, Sapporo, Japan
| | - Satoshi Oizumi
- Department of Respiratory Medicine, National Hospital Organization, Hokkaido Cancer Center, Sapporo, Japan
| | - Atsushi Watanabe
- Department of Thoracic Surgery, Sapporo Medical University, School of Medicine and Hospital, Sapporo, Japan
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16
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Kanaji N, Tadokoro A, Watanabe N, Inoue T, Kadowaki N, Ishii T. Association of specific metastatic organs with the prognosis and chemotherapeutic response in patients with advanced lung cancer. Respir Investig 2019; 57:472-480. [PMID: 31327681 DOI: 10.1016/j.resinv.2019.06.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 05/22/2019] [Accepted: 06/12/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND This study was performed to investigate the influence of specific metastatic organs on the prognosis and therapeutic effect in patients with advanced lung cancer. METHODS We retrospectively analyzed 400 patients with pathologically diagnosed advanced lung cancer to determine the association of the patients' metastatic status with their prognoses and responses to first-line therapy. Metastases within the chest cavity (pulmonary metastasis, pleural effusion, and pericardial effusion) were counted as one organ. RESULTS The numbers of metastatic organs in the patients were as follows: one (n=199 patients), two (n=99), three (n=61), and four or more (n=41). A multivariate analysis showed that liver and muscle metastases were independently associated with shorter overall survival (median of 207 and 120 days, respectively) and shorter progression-free survival (median of 125 and 53 days, respectively). Chest cavity, bone, brain, and lymph node metastases were not associated with survival. The presence of either muscle or skin metastasis was associated with a lower response rate to first-line therapy than was the absence of each metastasis (14.3% vs. 49.4% and 11.1% vs. 48.9% in patients with vs. without muscle or skin metastasis, respectively). CONCLUSIONS Muscle and liver metastases were associated with poor outcomes. Muscle and skin metastases were associated with a lower response rate to treatment. For patients with advanced lung cancer, oncologists should select treatment strategies considering the patients' metastatic statuses as well as other clinical characteristics.
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Affiliation(s)
- Nobuhiro Kanaji
- Department of Internal Medicine, Division of Hematology, Rheumatology and Respiratory Medicine, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa 761-0793, Japan.
| | - Akira Tadokoro
- Department of Internal Medicine, Division of Hematology, Rheumatology and Respiratory Medicine, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa 761-0793, Japan
| | - Naoki Watanabe
- Department of Internal Medicine, Division of Hematology, Rheumatology and Respiratory Medicine, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa 761-0793, Japan
| | - Takuya Inoue
- Department of Internal Medicine, Division of Hematology, Rheumatology and Respiratory Medicine, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa 761-0793, Japan
| | - Norimitsu Kadowaki
- Department of Internal Medicine, Division of Hematology, Rheumatology and Respiratory Medicine, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa 761-0793, Japan
| | - Tomoya Ishii
- Department of Internal Medicine, Division of Hematology, Rheumatology and Respiratory Medicine, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa 761-0793, Japan
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17
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Wang B, Chen L, Huang C, Lin J, Pan X, Shao Z, Hu S, Zhang X, Wang X. The homogeneous and heterogeneous risk factors for occurrence and prognosis in lung cancer patients with bone metastasis. J Bone Oncol 2019; 17:100251. [PMID: 31372332 PMCID: PMC6661364 DOI: 10.1016/j.jbo.2019.100251] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 07/08/2019] [Accepted: 07/08/2019] [Indexed: 01/26/2023] Open
Abstract
Purpose To analyse the homogeneous and heterogeneous risk factors for occurrence and prognosis in lung cancer patients diagnosed with bone metastasis (BM) by using the Surveillance, Epidemiology, and End Results (SEER) database. Patients and methods The medical records of lung cancer patients with or without bone metastasis were identified in the SEER database between 2010 and 2015. A multivariate logistic regression analysis was performed to identify risk factors, and a multivariate Cox regression was used to determine the prognostic effects of every variable on survival. Results In total, 34,585 eligible patients from the SEER database were included in the analysis. Male gender and metastasis to the liver were factors that were both positively associated with a risk for the development and prognosis of bone metastasis in patients with lung cancer. Younger age, poor tumour differentiation grade, higher N stage (N3), adenocarcinoma and metastasis to the brain were all positively correlated with a risk of occurrence of BM, but these factors were not correlated with an unfavourable prognosis. Age, race, marital status, tumour size and pathologic type were independent risk factors for the prognosis of bone metastasis. Conclusion The morbidity of bone metastasis in lung cancer patients is dismal, with a rate of 25.9%. The findings of this study estimate the homogeneous and heterogeneous risk factors for the occurrence and prognosis of bone metastasis in lung cancer patients, which may provide clinical guidelines for physicians.
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Affiliation(s)
- Ben Wang
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325027, Zhejiang, China.,Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou 325027, Zhejiang, China.,The Second School of Medicine, Wenzhou Medical University, Wenzhou 325027, Zhejiang, China
| | - Lijie Chen
- Department of Surgical Oncology, Taizhou Hospital of Wenzhou Medical University, Taizhou 317000, Zhejiang, China
| | - Chongan Huang
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325027, Zhejiang, China.,Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou 325027, Zhejiang, China.,The Second School of Medicine, Wenzhou Medical University, Wenzhou 325027, Zhejiang, China
| | - Jialiang Lin
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325027, Zhejiang, China.,Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou 325027, Zhejiang, China.,The Second School of Medicine, Wenzhou Medical University, Wenzhou 325027, Zhejiang, China
| | - Xiangxiang Pan
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325027, Zhejiang, China.,Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou 325027, Zhejiang, China.,The Second School of Medicine, Wenzhou Medical University, Wenzhou 325027, Zhejiang, China
| | - Zhenxuan Shao
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325027, Zhejiang, China.,Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou 325027, Zhejiang, China.,The Second School of Medicine, Wenzhou Medical University, Wenzhou 325027, Zhejiang, China
| | - Sunli Hu
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325027, Zhejiang, China.,Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou 325027, Zhejiang, China.,The Second School of Medicine, Wenzhou Medical University, Wenzhou 325027, Zhejiang, China
| | - Xiaolei Zhang
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325027, Zhejiang, China.,Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou 325027, Zhejiang, China.,The Second School of Medicine, Wenzhou Medical University, Wenzhou 325027, Zhejiang, China.,Chinese Orthopaedic Regenerative Medicine Society, Hangzhou, Zhejiang, China
| | - Xiangyang Wang
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325027, Zhejiang, China.,Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou 325027, Zhejiang, China.,The Second School of Medicine, Wenzhou Medical University, Wenzhou 325027, Zhejiang, China
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18
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Budnik J, Suri J, Bates JE, Bylund KC, Milano MT. Prognostic Significance of Sites of Visceral Metastatic Disease in Prostate Cancer: A Population-based Study of 12,180 Patients. Clin Genitourin Cancer 2019; 17:260-267. [PMID: 31101579 DOI: 10.1016/j.clgc.2019.03.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 02/28/2019] [Accepted: 03/21/2019] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Metastatic prostate cancer (MPC) prognosis is variable. Few population-based studies have examined the impact of particular visceral metastatic sites on MPC survival outcomes. We investigated this using the Surveillance, Epidemiology, and End Results (SEER) database. MATERIALS AND METHODS We analyzed the overall survival (OS) and prostate cancer mortality (PCM) risk of 12,180 patients, from SEER 18 registries, diagnosed with MPC from 2010 to 2014. We identified those with metastatic disease in bone, brain, liver, and lung. Kaplan-Meier analyses, competing risks regression, and Cox proportional hazards models were used to assess the impact of visceral metastatic disease sites on OS and PCM. RESULTS Most patients were coded as having metastatic disease in the bone without disease in the brain, liver, or lung (bone group, n = 10,620; 87% of total). On Cox multivariable regression analysis, patients with lung metastases, with or without bone metastases, did not differ significantly from patients in the bone group with respect to OS (hazard ratio, 0.82; 95% confidence interval, 0.63-1.06; P = .13 and hazard ratio, 1.12; 95% confidence interval, 0.98-1.28; P = .10, respectively). These patients also did not differ from the bone group with respect to PCM incidence on competing risks regression analysis. CONCLUSIONS This study suggests that patients with MPC confined to bone and/or lung may have improved survival relative to those with MPC affecting other visceral sites. Although it was anticipated that patients with bone metastases would represent a favorable subgroup, the favorable outcomes in patents with lung metastases (with or without bone metastases) was unexpected. These findings may inform future therapeutic investigations to improve the prognosis of patients with MPC.
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Affiliation(s)
- Justin Budnik
- Department of Radiation Oncology, University of Rochester, Rochester, NY.
| | - Jaipreet Suri
- Department of Radiation Oncology, University of Rochester, Rochester, NY
| | - James E Bates
- Department of Radiation Oncology, University of Florida, Gainesville, FL
| | - Kevin C Bylund
- Department of Radiation Oncology, University of Rochester, Rochester, NY
| | - Michael T Milano
- Department of Radiation Oncology, University of Rochester, Rochester, NY
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19
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Gibson AJW, Li H, D'Silva A, Tudor RA, Elegbede AA, Otsuka SM, Bebb DG, Cheung WY. Impact of number versus location of metastases on survival in stage IV M1b non-small cell lung cancer. Med Oncol 2018; 35:117. [PMID: 30073425 DOI: 10.1007/s12032-018-1182-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Accepted: 07/31/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND To assess the impact of location versus number of extra-pulmonary metastatic sites (EPMS) on survival in stage IV non-small cell lung cancer (NSCLC). METHODS AND MATERIALS Retrospective analysis was conducted on patients diagnosed during 1999-2013 with stage IV, M1b (AJCC 7th edition) NSCLC using the large, institutional Glans-Look Database, which contains patient demographic, clinical, pathological, treatment, and outcome information. We assessed the impact of location and number of EPMS and identified correlates of overall survival using the Kaplan-Meier method and Cox regression. RESULTS We identified a total of 2065 NSCLC patients with EPMS. Median age was 67 (IQR 58-75) years, 52% were men, and 78% were current or former smokers. 60% had one EPMS, and 40% had two or more EPMS. Among those with only one EPMS, most frequent organ involvement included bone (40%), brain (32%), and liver (13%). Median overall survival (mOS) was worst in those with liver metastasis and best in those with adrenal metastasis (2.0 vs. 5.2 months, p = 0.015). However, outcomes based on site of organ involvement were not significantly different in multivariable analysis. Compared to patients with one EPMS, individuals with two or more EPMS experienced worse outcomes (mOS ≤ 2.9 vs. 3.9 months, p < 0.001), and were associated with worse prognosis in Cox regression analysis (HR 1.5, 95% CI 1.3-1.7, p < 0.001). CONCLUSIONS Number rather than location of EPMS is a prognostic factor in patients with stage IV M1b NSCLC. This information is relevant for accurate prognostication, stratification of participants in future clinical trials, and timely and appropriate advanced care planning.
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Affiliation(s)
- Amanda Jane Williams Gibson
- Department of Oncology, Cumming School of Medicine, University of Calgary, 1331 29th St NW, Calgary, AB, T2N 4N2, Canada
| | - Haocheng Li
- Department of Oncology, Cumming School of Medicine, University of Calgary, 1331 29th St NW, Calgary, AB, T2N 4N2, Canada
| | - Adrijana D'Silva
- Department of Oncology, Cumming School of Medicine, University of Calgary, 1331 29th St NW, Calgary, AB, T2N 4N2, Canada
| | - Roxana A Tudor
- Department of Oncology, Cumming School of Medicine, University of Calgary, 1331 29th St NW, Calgary, AB, T2N 4N2, Canada
| | - Anifat A Elegbede
- Department of Oncology, Cumming School of Medicine, University of Calgary, 1331 29th St NW, Calgary, AB, T2N 4N2, Canada
| | - Shannon Mary Otsuka
- Department of Oncology, Cumming School of Medicine, University of Calgary, 1331 29th St NW, Calgary, AB, T2N 4N2, Canada
| | - D Gwyn Bebb
- Department of Oncology, Cumming School of Medicine, University of Calgary, 1331 29th St NW, Calgary, AB, T2N 4N2, Canada
- Tom Baker Cancer Centre, Alberta Health Services, 1331 29th St NW, Calgary, AB, T2N 4N2, Canada
| | - Winson Y Cheung
- Department of Oncology, Cumming School of Medicine, University of Calgary, 1331 29th St NW, Calgary, AB, T2N 4N2, Canada.
- Tom Baker Cancer Centre, Alberta Health Services, 1331 29th St NW, Calgary, AB, T2N 4N2, Canada.
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20
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Yao Y, Zhou Y, Yang Z, Shen H. [Risk Factors of Non-small Cell Lung Cancer with Bone Metastasis after Therapy]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2018; 21:476-480. [PMID: 29945707 PMCID: PMC6022027 DOI: 10.3779/j.issn.1009-3419.2018.06.09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
背景与目的 肺癌目前是死亡率最高的肿瘤, 非小细胞肺癌(non-small cell lung cancer, NSCLC)患者在手术后通常会发生远处转移, 如骨转移、脑转移、肺转移等。本研究旨在探究NSCLC患者术后发生骨转移的危险因素。 方法 选择本院于2009年5月-2011年5月确诊收治的NSCLC患者176例, 按照是否发生骨转移将患者分为两组, 即骨转移组和无骨转移组。对比两组患者的一般临床病理资料, 并通过多因素分析对比发生骨转移的独立危险因素。 结果 NSCLC患者的一般临床病理资料中血栓与否, 肿瘤-淋巴结-转移(tumor-node-metastasis, TNM)分期与是否发生骨转移关系密切, 有统计学意义(均P < 0.01);在两组患者的凝血功能指标中发现凝血酶原时间、活化部分凝血酶活酶时间、纤维蛋白原、凝血酶时间、血小板计数、D-二聚体以及碱性磷酸酶之间存在明显的差异性, 有统计学意义(均P < 0.05);Logistic回归分析发现纤维蛋白原、碱性磷酸酶、T4期、N3期和D-二聚体为NSCLC患者发生骨转移的独立危险因素。 结论 纤维蛋白原、活化部分凝血酶活酶时间、碱性磷酸酶、T3期、N2期和D-二聚体为NSCLC患者发生骨转移的独立危险因素。
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Affiliation(s)
- Yuanshan Yao
- Department of Thoracic Surgery, Ningbo No.2 Hospital, Ningbo 315010, China
| | - Yinjie Zhou
- Department of Thoracic Surgery, Ningbo No.2 Hospital, Ningbo 315010, China
| | - Zhenhua Yang
- Department of Thoracic Surgery, Ningbo No.2 Hospital, Ningbo 315010, China
| | - Haibo Shen
- Department of Thoracic Surgery, Ningbo No.2 Hospital, Ningbo 315010, China
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Jones CM, Brunelli A, Callister ME, Franks KN. Multimodality Treatment of Advanced Non-small Cell Lung Cancer: Where are we with the Evidence? CURRENT SURGERY REPORTS 2018; 6:5. [PMID: 29456881 PMCID: PMC5805813 DOI: 10.1007/s40137-018-0202-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSE OF REVIEW The majority of patients with non-small cell lung cancer (NSCLC) present with advanced disease and overall survival rates are poor. This article outlines the current and outstanding evidence for the use of multimodality treatment in this group of patients, including in combination with an increasing number of treatment options, such as immunotherapy and genotype-targeted small molecule inhibitors. RECENT FINDINGS Optimal therapy for surgically resectable stage III disease remains debatable and currently the choice of treatment reflects each individual patient's disease characteristics and the expertise and opinion of the thoracic multi-disciplinary team. Evidence for a distinct oligometastatic state in which improved outcomes can be achieved remains minimal and there is as yet no consensus definition for oligometastatic lung cancer. Whilst there is supporting evidence for the aggressive management of isolated metastases, the use of consolidative therapy for multiple metastases remains unproven. SUMMARY Evolution of new RT technologies, improved surgical technique and a plethora of interventional-radiology-guided ablative therapies are widening the choice of available treatment modalities to patients with NSCLC. In the setting of resectable locally advanced disease and the oligometastatic state, there is a growing need for randomised comparison of the available treatment modalities to guide both treatment and patient selection.
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Affiliation(s)
- Christopher M. Jones
- Leeds Institute of Cancer & Pathology, Faculty of Medicine & Health, University of Leeds, Leeds, UK
- Radiotherapy Research Group, Leeds Cancer Centre, The Leeds Teaching Hospitals NHS Trust, Leeds, UK
- School of Molecular & Cellular Biology, Faculty of Biological Sciences, University of Leeds, Leeds, UK
| | - Alessandro Brunelli
- Department of Thoracic Surgery, The Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Matthew E. Callister
- Department of Respiratory Medicine, The Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Kevin N. Franks
- Leeds Institute of Cancer & Pathology, Faculty of Medicine & Health, University of Leeds, Leeds, UK
- Radiotherapy Research Group, Leeds Cancer Centre, The Leeds Teaching Hospitals NHS Trust, Leeds, UK
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