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Barlesi F, Deyme L, Imbs DC, Cousin E, Barbolosi M, Bonnet S, Tomasini P, Greillier L, Galloux M, Testot-Ferry A, Pelletier A, André N, Ciccolini J, Barbolosi D. Revisiting metronomic vinorelbine with mathematical modelling: a Phase I trial in lung cancer. Cancer Chemother Pharmacol 2022; 90:149-160. [PMID: 35867144 DOI: 10.1007/s00280-022-04455-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 06/28/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND A phase Ia/Ib trial of metronomic oral vinorelbine (MOV) driven by a mathematical model was performed in heavily pretreated metastatic Non-Small Cell Lung Cancer or Pleural Mesothelioma patients. Disease Control Rate, progression free survival, toxicity and PK/PD were the main endpoints. METHODS Best MOV scheduling was selected using a simplified phenomenological, semi-mechanistic model with a total weekly dose of 150-mg vinorelbine. Computation of individual PK parameters was performed using population approach. RESULTS The mathematical model proposed the following metronomic schedule for a 150-mg weekly dose of vinorelbine: 60 mg D1, 30 mg D2, 60 mg D4. A total of 37 heavily pre-treated patients (30 evaluable) were enrolled. Grade III/IV neutropenia was observed in 30% patients. Median PFS was 11 weeks. Disease Control Rate was 73% (i.e.; 13% partial response and 60% stable disease). A large variability in drug exposure (AUC0-24 h: 53%) and PK parameters (Cl: 83%) were observed among patients. Simulated trough levels after D2 and D4 showed similarly 56-73% variability among patients. Drug exposure was not associated with efficacy, but neutropenia was more frequent in patients with AUC > 250 ng/ml.h. Tumor burden, performance status and neutrophils-to-lymphocyte ratio (NLR) were associated with PFS, suggesting that MOV would be indicated in selected patients. We built a composite score to predict efficacy, mixing baseline tumor size and NLR showing 84% selectivity and 75% specificity. CONCLUSIONS MOV was characterized by important variability in drug exposure among patients. However, and despite being all heavily pre-treated, 73% of disease control rate and 11 weeks PFS were achieved with manageable toxicities. PK/PD relationships yielded conflicting results depending on the initial tumor burden and BSA, suggesting that patients should be carefully selected prior to be scheduled for metronomic regimen. Possible role NLR could play as a predictive marker suggests immunomodulating features with MOV.
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Affiliation(s)
- Fabrice Barlesi
- Marseille Early Phases Cancer Trials Center CLIP, Aix Marseille University, APHM, Marseille, France.,SMARTc Unit Centre de Recherche en Cancérologie de Marseille Inserm U1068, Aix Marseille University, Marseille, France.,Gustave Roussy Cancer Campus, Villejuif, France
| | - Laure Deyme
- SMARTc Unit Centre de Recherche en Cancérologie de Marseille Inserm U1068, Aix Marseille University, Marseille, France.,Department of Pharmacology Marseille, Aix Marseille University, APHM, Marseille, France
| | - Diane-Charlotte Imbs
- SMARTc Unit Centre de Recherche en Cancérologie de Marseille Inserm U1068, Aix Marseille University, Marseille, France.,Department of Pharmacology Marseille, Aix Marseille University, APHM, Marseille, France
| | - Elissa Cousin
- SMARTc Unit Centre de Recherche en Cancérologie de Marseille Inserm U1068, Aix Marseille University, Marseille, France.,Department of Pharmacology Marseille, Aix Marseille University, APHM, Marseille, France
| | - Mathieu Barbolosi
- Marseille Early Phases Cancer Trials Center CLIP, Aix Marseille University, APHM, Marseille, France
| | - Sylvanie Bonnet
- SMARTc Unit Centre de Recherche en Cancérologie de Marseille Inserm U1068, Aix Marseille University, Marseille, France.,Department of Pharmacology Marseille, Aix Marseille University, APHM, Marseille, France
| | - Pascale Tomasini
- Marseille Early Phases Cancer Trials Center CLIP, Aix Marseille University, APHM, Marseille, France.,Department of Pharmacology Marseille, Aix Marseille University, APHM, Marseille, France
| | - Laurent Greillier
- Marseille Early Phases Cancer Trials Center CLIP, Aix Marseille University, APHM, Marseille, France.,SMARTc Unit Centre de Recherche en Cancérologie de Marseille Inserm U1068, Aix Marseille University, Marseille, France
| | - Melissa Galloux
- Marseille Early Phases Cancer Trials Center CLIP, Aix Marseille University, APHM, Marseille, France
| | - Albane Testot-Ferry
- Marseille Early Phases Cancer Trials Center CLIP, Aix Marseille University, APHM, Marseille, France
| | - Annick Pelletier
- Marseille Early Phases Cancer Trials Center CLIP, Aix Marseille University, APHM, Marseille, France
| | - Nicolas André
- Marseille Early Phases Cancer Trials Center CLIP, Aix Marseille University, APHM, Marseille, France. .,SMARTc Unit Centre de Recherche en Cancérologie de Marseille Inserm U1068, Aix Marseille University, Marseille, France. .,Metronomics Global Health Initiative, Marseille, France.
| | - Joseph Ciccolini
- SMARTc Unit Centre de Recherche en Cancérologie de Marseille Inserm U1068, Aix Marseille University, Marseille, France.,Department of Pharmacology Marseille, Aix Marseille University, APHM, Marseille, France
| | - Dominique Barbolosi
- SMARTc Unit Centre de Recherche en Cancérologie de Marseille Inserm U1068, Aix Marseille University, Marseille, France.,Department of Pharmacology Marseille, Aix Marseille University, APHM, Marseille, France
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2
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[Consensus of Chinese Experts on Medical Treatment of Advanced Lung Cancer
in the Elderly (2022 Edition)]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2022; 25:363-384. [PMID: 35747916 PMCID: PMC9244502 DOI: 10.3779/j.issn.1009-3419.2022.101.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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3
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Arnold CR, Lindner AK, Schachtner G, Tulchiner G, Tulchiner N, Mangesius J, Maffei M, Horninger W, Kouvaiou O, Lukas P, Ganswindt U, Pichler R, Skvortsov S. Vinorelbine in bladder-preserving multimodality treatment for muscle-invasive bladder cancer-a valid option for cisplatin-unfit patients? Strahlenther Onkol 2021; 198:25-32. [PMID: 34414475 PMCID: PMC8760228 DOI: 10.1007/s00066-021-01837-7] [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: 02/10/2021] [Accepted: 06/13/2021] [Indexed: 11/17/2022]
Abstract
Purpose Treatment of muscle-invasive bladder cancer (MIBC) remains challenging, especially for elderly and/or comorbid patients. Patients who are unfit for or refuse surgery should receive bladder-preserving multimodality treatment (BPMT), consisting of transurethral resection of the bladder tumor (TURB) followed by combined chemoradiotherapy (CRT). We aimed to investigate the effectiveness of vinorelbine, a chemotherapeutic agent not routinely used for MIBC, in patients referred to CRT who are unfit for standard chemotherapy and would thus rely solely on radiotherapy (RT). Methods We retrospectively analyzed 52 consecutive patients with MIBC who received standard CRT with cisplatin (n = 14), CRT with vinorelbine (n = 26), or RT alone (n = 12). Primary endpoints were median overall survival (OS) and median cancer-specific survival (CSS). Secondary endpoints were median local control (LC), median distant control (DC), and OS, CSS, LC, and DC after 1, 2, and 3 years, respectively. Results Median OS and CSS were significantly higher for patients who received vinorelbine as compared to RT alone (OS 8 vs. 22 months, p = 0.003; CSS 11 months vs. not reached, p = 0.001). Median LC and DC did not differ significantly between groups. Vinorelbine was well tolerated with no reported side effects >grade II. Conclusion Our results suggest that CRT with vinorelbine is well tolerated and superior to RT alone in terms of OS and CSS. Therefore, this treatment regime might constitute a new treatment option for patients with MIBC who are unfit for or refuse surgery or standard chemotherapy. This study encourages a randomized controlled trial to compare this new regime to current standard therapies.
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Affiliation(s)
- C R Arnold
- Department of Therapeutic Radiology and Oncology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - A K Lindner
- Department of Urology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - G Schachtner
- Department of Urology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - G Tulchiner
- Department of Urology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - N Tulchiner
- Department of Urology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - J Mangesius
- Department of Therapeutic Radiology and Oncology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - M Maffei
- Department of Radiation Oncology, General Hospital Bolzano, Lorenz Böhler Straße 5, 39100, Bolzano, Italy
| | - W Horninger
- Department of Urology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - O Kouvaiou
- Department of Therapeutic Radiology and Oncology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - P Lukas
- Department of Therapeutic Radiology and Oncology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - U Ganswindt
- Department of Therapeutic Radiology and Oncology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - R Pichler
- Department of Urology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria.
| | - S Skvortsov
- Department of Therapeutic Radiology and Oncology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria.
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4
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Anti-Cancer Treatment Strategies in the Older Population: Time to Test More? Geriatrics (Basel) 2021; 6:geriatrics6020042. [PMID: 33921136 PMCID: PMC8167638 DOI: 10.3390/geriatrics6020042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 04/12/2021] [Accepted: 04/13/2021] [Indexed: 12/29/2022] Open
Abstract
Aging is a well-recognized risk factor for the development of cancer. The incidence of new cancer diagnoses has increased globally given the rising senior population. Many hypotheses for this increased risk have been postulated over decades, including increased genetic and epigenetic mutations and the concept of immunosenescence. The optimal treatment strategies for this population with cancer are unclear. Older cancer patients are traditionally under-represented in clinical trials developed to set the standard of care, leading to undertreatment or increased toxicity. With this background, it is crucial to investigate new opportunities that belong to the most recent findings of an anti-cancer agent, such as immune-checkpoint inhibitors, to manage these daily clinical issues and eventually combine them with alternative administration strategies of antiblastic drugs such as metronomic chemotherapy.
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5
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Gebbia V, Aiello MM, Banna G, Blanco G, Blasi L, Borsellino N, Giuffrida D, Mauro ML, Mancuso G, Piazza D, Savio G, Parra HS, Valerio MR, Verderame F, Vigneri P. Metronomic oral vinorelbine in patients with advanced non-small cell lung cancer progressing after nivolumab immunotherapy: a retrospective analysis. Ecancermedicalscience 2020; 14:1113. [PMID: 33144881 PMCID: PMC7581333 DOI: 10.3332/ecancer.2020.1113] [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: 04/23/2020] [Indexed: 11/06/2022] Open
Abstract
Purpose: The availability of immune checkpoint inhibitors has deeply changed the therapeutic scenario of patients with advanced non-small cell lung cancer (NSCLC). Up until now, chemotherapy still represents the first-line treatment for patients with advanced NSCLC not harbouring genetic mutations or lacking high expression of programmed death ligand even if the addition of immunotherapy to first-line chemotherapy has recently been shown to improve clinical outcome. We carried out a multi-institutional retrospective analysis on third-line chemotherapy with metronomic oral vinorelbine (VNR) in a series of patients with metastatic NSCLC pre-treated with first-line chemotherapy and second-line immunotherapy. Patients and methods: Thirty patients with metastatic NSCLC with progressive disease after first-line chemotherapy and subsequent immunotherapy were treated with metronomic oral VNR continuously at the fixed dose of 30 mg three times per week. Results: A partial response was achieved in 4 patients (13.3%), while 10 patients (33.3%) displayed disease stabilisation for an overall disease control rate of 46.7%. Median progression-free survival was 3.9 months (range 1–13 months) and median OS reached 8.1 months (range 4.0–24.0+ months) with a 12-month survival rate of 22%. Conclusion: Oral metronomic VNR appears to be active and safe in patients with metastatic NSCLC in progression after first-line chemotherapy and second-line immunotherapy. The results reported, although from a limited sample, may suggest its use for long-term stabilisation of the disease with good patient compliance.
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Affiliation(s)
- Vittorio Gebbia
- Medical Oncology Unit, La Maddalena Clinic for Cancer Medical Oncology, Palermo 90100, Italy.,PROMISE Department, University of Palermo, Palermo 90100, Italy
| | - Marco Maria Aiello
- Policlinico-Vittorio Emanuele, Università di Catania, Catania 95100, Italy
| | - Giuseppe Banna
- Medical Oncology Unit, Ospedale Cannizzaro, Catania 95100, Italy
| | - Giusi Blanco
- Medical Oncology Unit, IOM, Catania 95100, Italy
| | - Livio Blasi
- Medical Oncology Unit, ARNAS Civico, Palermo 90100, Italy
| | - Nicolò Borsellino
- Medical Oncology Unit, Ospedale Buccheri La Ferla, Palermo 90100, Italy
| | | | - Mario Lo Mauro
- Medical Oncology Unit, Ospedale Buccheri La Ferla, Palermo 90100, Italy
| | - Gianfranco Mancuso
- Medical Oncology Unit, La Maddalena Clinic for Cancer Medical Oncology, Palermo 90100, Italy
| | | | | | - Hector Soto Parra
- Policlinico-Vittorio Emanuele, Università di Catania, Catania 95100, Italy
| | | | | | - Paolo Vigneri
- Medical Oncology Unit, La Maddalena Clinic for Cancer Medical Oncology, Palermo 90100, Italy
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6
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Shu Y, Weng S, Zheng S. Metronomic chemotherapy in non-small cell lung cancer. Oncol Lett 2020; 20:307. [PMID: 33093916 DOI: 10.3892/ol.2020.12170] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Accepted: 07/15/2020] [Indexed: 12/17/2022] Open
Abstract
Metronomic chemotherapy (MCT) is defined as the rhythmic chemotherapy of low-dose cytotoxic drugs with short or no drug-free breaks over prolonged periods. MCT affects tumor cells and the tumor microenvironment. Particularly, the low-dose schedule impairs the repair process of endothelial cells, resulting in an anti-angiogenesis effect. By stimulating the immune system to eliminate tumor cells, MCT induces immunological activation. Furthermore, combined with targeted therapy, anti-angiogenic drugs enhance the efficacy of MCT. The present review is an overview of phase I, II and III clinical trials focusing on the efficacy, toxicity and mechanism of MCT in patients with non-small cell lung cancer (NSCLC). Furthermore, the prospects of MCT in NSCLC have been discussed. The present review indicated that MCT is an efficacious treatment for selected patients with NSCLC, with acceptable systemic side effects and economic viability for public health.
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Affiliation(s)
- Yefei Shu
- Department of Medical Oncology, Hangzhou Cancer Hospital, Hangzhou, Zhejiang 310002, P.R. China
| | - Shanshan Weng
- Department of Medical Oncology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, P.R. China
| | - Song Zheng
- Department of Medical Oncology, Hangzhou Cancer Hospital, Hangzhou, Zhejiang 310002, P.R. China.,Department of Medical Oncology, Key Laboratory of Clinical Cancer Pharmacology and Toxicology Research of Zhejiang, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310006, P.R. China
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7
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Rossi D, Lippe P, Rocchi MBL, Sarti D, Catalano V, Graziano F, Giordani P, Baldelli A, Fedeli SL, Imperatori L, Laici G, Cappelletti C, Tamburrano T, Bracci R, Alessandroni P. Metronomic Oral Vinorelbine: An Alternative Schedule in Elderly and Patients PS2 With Local/Advanced and Metastatic NSCLC Not Oncogene-addicted. In Vivo 2020; 34:2687-2691. [PMID: 32871800 DOI: 10.21873/invivo.12088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 05/01/2020] [Accepted: 05/06/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND The MILES and ELVIS studies showed that vinorelbine is one of the best options for elderly patients with advanced non-small-cell-lung cancer (NSCLC). Oral vinorelbine at standard schedule (60-80 mg/m2/weekly) has good activity in terms of response rates and progression-free survival. In recent years, a metronomic schedule of oral vinorelbine (40-50 mg/m2 three times a week, continuously) has been studied in phase II trials, especially in unfit and elderly patients. In the MOVE trial metronomic oral vinorelbine had a clinical benefit [partial response (PR)+stable disease (SD) >12 weeks] in 58.1% of patients with mild toxicity. On this basis, in 2017 we started a phase II study with metronomic oral vinorelbine in elderly (over 70 years) or unfit [Eastern Cooperative Oncology Group performance score (ECOG-PS) of 2] patients with locally/advanced and metastatic NSCLC. Primary aims were clinical benefit (PR+SD ≥6 months) and toxicity; secondary aims were progression-free survival and overall survival. PATIENTS AND METHODS A total of 25 patients entered the study: 11 with local/advanced and 14 with metastatic NSCLC (five squamous and 20 adenocarcinoma). None of the patients had epidermal growth factor receptor (EGFR) mutations, anaplastic lymphoma kinase (ALK) translocation, or programmed death ligand 1 (PDL1) expression; those with squamous carcinoma did not have PDL1 expression. The median age was 79 (range=44-90) years. The PS was 0 in 12 patients (48%), 1 in four patients (16%) and 2 in nine patients (36%). Oral vinorelbine was administered at 40 mg three times a week continuously. RESULTS Clinical benefit was achieved in eight patients (32%). Objective responses were partial response in two patients (8%), stable disease in seven (28%), progressive disease in nine (36%); seven patients were not evaluable for response (28%). Median progression-free survival was 2 months; median overall survival was 4 months but four out of eight patients with clinical benefit were still alive at 18 months. Overall survival at 1 year was 32%. Toxicity was mild: only one patient experienced grade 4 neutropenia, one grade 3 peripheral neuropathy, four grade 2 asthenia, one grade 2 mucositis, and one grade 2 diarrhoea. The dose needed to be reduced to 30 mg/m2/three times a week in three patients. CONCLUSION Our study confirmed the activity and safety of metronomic oral vinorelbine in patients with wild-type local/advanced and metastatic NSCLC unsuitable for treatment with standard i.v. chemotherapy, allowing patients a comfortable home-based therapy, thereby avoiding frequent hospital visits.
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Affiliation(s)
- David Rossi
- Operative Oncology Unit, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro, Italy
| | - Paolo Lippe
- Operative Oncology Unit, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro, Italy
| | | | - Donatella Sarti
- Operative Oncology Unit, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro, Italy
| | - Vincenzo Catalano
- Operative Oncology Unit, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro, Italy
| | - Francesco Graziano
- Operative Oncology Unit, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro, Italy
| | - Paolo Giordani
- Operative Oncology Unit, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro, Italy
| | - Annamaria Baldelli
- Operative Oncology Unit, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro, Italy
| | - Stefano Luzi Fedeli
- Operative Oncology Unit, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro, Italy
| | - Luca Imperatori
- Operative Oncology Unit, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro, Italy
| | - Gianluca Laici
- Operative Oncology Unit, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro, Italy
| | - Claudia Cappelletti
- Operative Oncology Unit, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro, Italy
| | - Tiziana Tamburrano
- Operative Oncology Unit, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro, Italy
| | - Raffaella Bracci
- Operative Oncology Unit, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro, Italy
| | - Paolo Alessandroni
- Operative Oncology Unit, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro, Italy
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8
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Camerini A, Banna GL, Cinieri S, Pezzuto A, Mencoboni M, Rosetti F, Figueiredo A, Rizzo P, Ricci A, Langenhoven L, Santo A, Addeo A, Amoroso D, Barata F. Metronomic oral vinorelbine for the treatment of advanced non-small cell lung cancer: a multicenter international retrospective analysis. Clin Transl Oncol 2018; 21:790-795. [PMID: 30448956 DOI: 10.1007/s12094-018-1989-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 11/09/2018] [Indexed: 01/14/2023]
Abstract
PURPOSE Metronomic oral vinorelbine (MOV) could be a treatment option for unfit patients with advanced non-small cell lung cancer (NSCLC) based on its safety profile and high patient compliance. METHODS We retrospectively collected data on 270 patients [median age 76 (range 48-92) years, M/F 204/66, PS 0 (27)/1 (110)/≥ 2 (133), median of 3 serious comorbidities] with stage IIIB-IV NSCLC treated with MOV as first (T1) (67%), second (T2) (19%) or subsequent (T3) (14%) line. Schedules consisted of vinorelbine 50 mg (138), 40 mg (68) or 30 mg (64) three times a week continuously. RESULTS Patients received an overall median of 6 (range 1-25) cycles with a total of 1253 cycles delivered. The overall response rate was 17.8% with 46 partial and 2 complete responses and 119 patients (44.1%) experienced stable disease > 12 weeks with an overall disease control rate of 61.9%. Median overall time to progression was 5 (range 1-21) months [T1 7 (1-21), T2 5.5 (1-19) and T3 4 (1-19) months] and median overall survival 9 (range 1-36) months [T1 10 (1-31), T2 8 (1-36) and T3 6.5 (2-29) months]. Treatment was extremely well tolerated with 2% (25/1253) G3/4 toxicity (mainly G3 fatigue and anemia) and no toxic deaths. We observed the longer OS 14 (range 7-36) months in a subset of squamous NSCLC patients receiving immunotherapy after metronomic oral vinorelbine. CONCLUSION We confirmed MOV as an extremely safe treatment in a large real world population of advanced NSCLC with an interesting activity mainly consisting of long-term disease stabilization. We speculate the possibility of a synergistic effect with subsequent immunotherapy.
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Affiliation(s)
- A Camerini
- Medical Oncology, Versilia Hospital - ASL Toscana Nord-Ovest, via Aurelia 335, 55043, Lido di Camaiore, LU, Italy.
| | - G L Banna
- Division of Medical Oncology, Cannizzaro Hospital, via Messina 829, 95126, Catania, Italy
| | - S Cinieri
- Medical Oncology, Perrino Hospital, Strada Statale 7 per Mesagne, 72100, Brindisi, Italy
| | - A Pezzuto
- Department of Cardio-Thoracic-Vascular Science, S. Andrea Hospital, Via di Grottarossa, 1035, 00189, Rome, Italy
| | - M Mencoboni
- Medical Oncology, ASL 3 Genovese, Ospedale Villa Scassi, Corso Onofrio Scassi 1, 16121, Genoa, Italy
| | - F Rosetti
- Medical Oncology, ULSS3 Serenissima, Distretto Mirano-Dolo, Via Pasteur, 30031, Dolo, VE, Italy
| | - A Figueiredo
- Pneumology, Centro Hospitalar e Universitario de Coimbra, Avenida Doutor Bissaya Barreto S/N, Praceta De Mota Pinto, Celas-Coimbra, Portugal
| | - P Rizzo
- Medical Oncology, Perrino Hospital, Strada Statale 7 per Mesagne, 72100, Brindisi, Italy
| | - A Ricci
- Department of Molecular and Clinical Medicine, S. Andrea Hospital, Via di Grottarossa, 1035, 00189, Rome, Italy
| | - L Langenhoven
- Clinical Oncology, Panorama Oncology Centre, 43 Hennie Winterbach St, Panorama, Cape Town, 7500, South Africa
| | - A Santo
- Medical Oncology, University Hospital of Verona, Piazzale Aristide Stefani 1, 37126, Verona, Italy
| | - A Addeo
- Oncology Department, University Hospital Geneva, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland
| | - D Amoroso
- Medical Oncology, Versilia Hospital - ASL Toscana Nord-Ovest, via Aurelia 335, 55043, Lido di Camaiore, LU, Italy
| | - F Barata
- Pneumology, Centro Hospitalar e Universitario de Coimbra, Avenida Doutor Bissaya Barreto S/N, Praceta De Mota Pinto, Celas-Coimbra, Portugal
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9
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Zhang H, Shen J, Yi L, Zhang W, Luo P, Zhang J. Efficacy and Safety of Ipilimumab plus Chemotherapy for Advanced Lung Cancer: A Systematic Review and Meta-Analysis. J Cancer 2018; 9:4556-4567. [PMID: 30519362 PMCID: PMC6277638 DOI: 10.7150/jca.27368] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Accepted: 08/21/2018] [Indexed: 12/19/2022] Open
Abstract
Lung cancer is the leading cause of cancer-related deaths worldwide, with poor prognosis in advanced lung cancer patients. Platinum-based chemotherapy has always been a first-line treatment for the majority of advanced lung cancer patients, but its long-term survival benefit is limited. Ipilimumab is an immune drug that targets the CTLA-4 protein in T cells. Therefore, we evaluated the efficacy and safety of adding ipilimumab to simple chemotherapy for patients with advanced lung cancer. We searched literatures in PubMed, Web of Science, EMBASE, the Cochrane Library and cliniclatrials.gov. The primary end points of this assessment were overall survival (OS), progression-free survival (PFS) and immune-related PFS(irPFS) of lung cancer patients. Other end points were objective response rate (ORR), disease control rate (DCR) and safety. The results of this study will be presented by the risk ratio (RR) of the endpoints and the 95% confidence interval (CI) of the various effect sizes. And when the p value is less than 0.05, we think there is a statistical difference. Finally, 6 RCTs and 2,037 patients including 953 with advanced or recurrent non-small cell lung cancer (NSCLC) and 1084 with extensive-disease small-cell lung cancer (ED-SCLC) were identified. Among them, 1089 received immunochemotherapy, and 948 patients received chemotherapy alone. Immunochemotherapy can't improve OS (6months: risk ratio (RR)=0.97 P=0.11; 1year: RR=1.05 P=0.36), ORR (RR=1.00 P=0.95) and DCR (RR=0.92, 95%CI 0.85-1.00, P=0.04) of patients with lung cancer compared to pure chemotherapy, but it can improve the PFS (6months: RR=1.16 P=0.02; 1year: RR=1.39 P=0.02) and 6months-irPFS(RR=1.60 P=0.004). However, due to the addition of ipilimumab, the immune-related toxicities are more apparent in immunochemotherapy group.
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Affiliation(s)
| | | | | | | | - Peng Luo
- Department of Oncology, Zhujiang Hospital, Southern Medical University, 253 Industrial Avenue, Guangzhou, 510282, Guangdong, People's Republic of China
| | - Jian Zhang
- Department of Oncology, Zhujiang Hospital, Southern Medical University, 253 Industrial Avenue, Guangzhou, 510282, Guangdong, People's Republic of China
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Qin RS, Zhang ZH, Zhu NP, Chen F, Guo Q, Hu HW, Fu SZ, Liu SS, Chen Y, Fan J, Han YW. Enhanced antitumor and anti-angiogenic effects of metronomic Vinorelbine combined with Endostar on Lewis lung carcinoma. BMC Cancer 2018; 18:967. [PMID: 30305062 PMCID: PMC6180630 DOI: 10.1186/s12885-018-4738-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 08/09/2018] [Indexed: 12/13/2022] Open
Abstract
Background Conventional chemotherapy is commonly used to treat non-small cell lung cancer (NSCLC) however it increases therapeutic resistance. In contrast, metronomic chemotherapy (MET) is based on frequent drug administration at lower doses, resulting in inhibition of neovascularization and induction of tumor dormancy. This study aims to evaluate the inhibitory effects, adverse events, and potential mechanisms of MET Vinorelbine (NVB) combined with an angiogenesis inhibitor (Endostar). Methods Circulating endothelial progenitor cells (CEPs), apoptosis rate, expression of CD31, vascular endothelial growth factor (VEGF), hypoxia inducible factor-1 (HIF-1α) were determined using flow cytometry, western blot analysis, immunofluorescence staining and Enzyme-linked immunosorbent assay (ELISA) analysis. And some animals were also observed using micro fluorine-18-deoxyglucose PET/computed tomography (18F-FDG PET/CT) to identify changes by comparing SUVmax values. In addition, white blood cell (WBC) counts and H&E-stained sections of liver, lungs, kidney, and heart were performed in order to monitor toxicity assessments. Results We found that treatment with MET NVB + Endo was most effective in inhibiting tumor growth, decreasing expression of CD31, VEGF, HIF-1α, and CEPs, and reducing side effects, inducing apoptosis, such as expression of Bcl-2, Bax and caspase-3. Administration with a maximum tolerated dose of NVB combined with Endostar (MTD NVB + Endo) demonstrated similar anti-tumor effects, including changes in glucose metabolism with micro fluorine-18-deoxyglucose PET/computed tomography (18F-FDG PET/CT) imaging, however angiogenesis was not inhibited. Compared with either agent alone, the combination of drugs resulted in better anti-tumor effects. Conclusion These results indicated that MET NVB combined with Endo significantly enhanced anti-tumor and anti-angiogenic responses without overt toxicity in a xenograft model of human lung cancer.
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Affiliation(s)
- Rong-Sheng Qin
- Suining first people's hospital, Sichuan Province, Suining, 629000, China
| | - Zhen-Hua Zhang
- Department of Oncology, the Affiliated Hospital of Southwest Medical University, Sichuan Province, Luzhou, 646000, China
| | - Neng-Ping Zhu
- Department of Oncology, the Affiliated Hospital of Southwest Medical University, Sichuan Province, Luzhou, 646000, China
| | - Fei Chen
- Suining first people's hospital, Sichuan Province, Suining, 629000, China
| | - Qian Guo
- Suining first people's hospital, Sichuan Province, Suining, 629000, China
| | - Hao-Wen Hu
- Suining first people's hospital, Sichuan Province, Suining, 629000, China
| | - Shao-Zhi Fu
- Department of Oncology, the Affiliated Hospital of Southwest Medical University, Sichuan Province, Luzhou, 646000, China
| | - Shan-Shan Liu
- Department of Oncology, the Affiliated Hospital of Southwest Medical University, Sichuan Province, Luzhou, 646000, China
| | - Yue Chen
- Department of Nuclear Medicine, the Affiliated Hospital of Southwest Medical University, Sichuan Province, Luzhou, 646000, China
| | - Juan Fan
- Department of Oncology, the Affiliated Hospital of Southwest Medical University, Sichuan Province, Luzhou, 646000, China.
| | - Yun-Wei Han
- Department of Oncology, the Affiliated Hospital of Southwest Medical University, Sichuan Province, Luzhou, 646000, China.
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