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Zhang R, Zhang X, Gao Q, Zhang H, Gu L, Guo X, Zhang J, Zheng J, Jiang M. Prognostic significance of total metabolic tumor volume on baseline 18F-FDG PET/CT in patients with lung adenocarcinoma: further stratification of the ninth edition of TNM staging subgroups. Nucl Med Commun 2025:00006231-990000000-00410. [PMID: 40084511 DOI: 10.1097/mnm.0000000000001976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2025]
Abstract
BACKGROUND This study aimed to investigate the prognostic value of baseline total metabolic tumor volume (TMTV) on 18F-fluorodeoxyglucose positron emission tomography/computed tomography and its potential for further stratification within the ninth tumor-node-metastasis (TNM) staging system in patients with lung adenocarcinoma (LUAD). METHODS A cohort of 384 patients with LUAD who had undergone pretreatment PET/CT were included in this retrospective study. The optimal cutoff value for TMTV was determined through analysis of time-dependent receiver operating characteristic curves. The analysis of overall survival (OS) was conducted utilizing Kaplan-Meier curves. Predictive capacity was evaluated using the C statistic. RESULTS The optimal cutoff value for TMTV was 40.13 ml. The survival rates of patients varied significantly across stages I (n = 164), II (n = 37), III (n = 46), and IV (n = 137); however, there was no statistically significant difference between stages II and III (P = 0.440). In stages II-IV, the 2-year OS rates for patients with TMTV less than 40.13 ml were significantly higher at 81.7 and 86.7%, respectively, compared with patients with TMTV greater than equal to 40.13 ml who had rates of only 56.5 and 42.5%. No patients with stage I presented TMTV greater than or equal to 40.13 ml, and the 2-year OS rate was 98.3%. The C index did not reveal a significant difference between TNM and TMTV in their predictive ability for OS (0.83 vs. 0.85, P = 0.159). CONCLUSION The TNM staging system demonstrates robust prognostic utility in patients with LUAD, while the incorporation of baseline TMTV may offer additional risk stratification within distinct TNM stages.
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Affiliation(s)
- Ruiqiu Zhang
- Graduate Joint Training Base, Zhejiang Chinese Medical University
- Department of Radiology
- Department of Nuclear Medicine, Ningbo No.2 Hospital, Ningbo, China
| | | | | | - Han Zhang
- School of Medicine, Shaoxing University, Shaoxing, China
| | - Lianyu Gu
- School of Medicine, Shaoxing University, Shaoxing, China
| | | | - Jingfeng Zhang
- Graduate Joint Training Base, Zhejiang Chinese Medical University
- Department of Radiology
| | - Jianjun Zheng
- Graduate Joint Training Base, Zhejiang Chinese Medical University
- Department of Radiology
| | - Maoqing Jiang
- Graduate Joint Training Base, Zhejiang Chinese Medical University
- Department of Radiology
- Department of Nuclear Medicine, Ningbo No.2 Hospital, Ningbo, China
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Kotoulas SC, Spyratos D, Porpodis K, Domvri K, Boutou A, Kaimakamis E, Mouratidou C, Alevroudis I, Dourliou V, Tsakiri K, Sakkou A, Marneri A, Angeloudi E, Papagiouvanni I, Michailidou A, Malandris K, Mourelatos C, Tsantos A, Pataka A. A Thorough Review of the Clinical Applications of Artificial Intelligence in Lung Cancer. Cancers (Basel) 2025; 17:882. [PMID: 40075729 PMCID: PMC11898928 DOI: 10.3390/cancers17050882] [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: 09/15/2024] [Revised: 02/06/2025] [Accepted: 02/25/2025] [Indexed: 03/14/2025] Open
Abstract
According to data from the World Health Organization (WHO), lung cancer is becoming a global epidemic. It is particularly high in the list of the leading causes of death not only in developed countries, but also worldwide; furthermore, it holds the leading place in terms of cancer-related mortality. Nevertheless, many breakthroughs have been made the last two decades regarding its management, with one of the most prominent being the implementation of artificial intelligence (AI) in various aspects of disease management. We included 473 papers in this thorough review, most of which have been published during the last 5-10 years, in order to describe these breakthroughs. In screening programs, AI is capable of not only detecting suspicious lung nodules in different imaging modalities-such as chest X-rays, computed tomography (CT), and positron emission tomography (PET) scans-but also discriminating between benign and malignant nodules as well, with success rates comparable to or even better than those of experienced radiologists. Furthermore, AI seems to be able to recognize biomarkers that appear in patients who may develop lung cancer, even years before this event. Moreover, it can also assist pathologists and cytologists in recognizing the type of lung tumor, as well as specific histologic or genetic markers that play a key role in treating the disease. Finally, in the treatment field, AI can guide in the development of personalized options for lung cancer patients, possibly improving their prognosis.
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Affiliation(s)
- Serafeim-Chrysovalantis Kotoulas
- Adult ICU, General Hospital of Thessaloniki “Ippokrateio”, Konstantinoupoleos 49, 54642 Thessaloniki, Greece; (C.M.); (I.A.); (V.D.); (K.T.); (A.S.); (A.M.); (E.A.)
| | - Dionysios Spyratos
- Pulmonary Department, Unit of thoracic Malignancies Research, General Hospital of Thessaloniki “G. Papanikolaou”, Aristotle’s University of Thessaloniki, Leoforos Papanikolaou Municipality of Chortiatis, 57010 Thessaloniki, Greece; (D.S.); (K.P.); (K.D.)
| | - Konstantinos Porpodis
- Pulmonary Department, Unit of thoracic Malignancies Research, General Hospital of Thessaloniki “G. Papanikolaou”, Aristotle’s University of Thessaloniki, Leoforos Papanikolaou Municipality of Chortiatis, 57010 Thessaloniki, Greece; (D.S.); (K.P.); (K.D.)
| | - Kalliopi Domvri
- Pulmonary Department, Unit of thoracic Malignancies Research, General Hospital of Thessaloniki “G. Papanikolaou”, Aristotle’s University of Thessaloniki, Leoforos Papanikolaou Municipality of Chortiatis, 57010 Thessaloniki, Greece; (D.S.); (K.P.); (K.D.)
| | - Afroditi Boutou
- Pulmonary Department General, Hospital of Thessaloniki “Ippokrateio”, Konstantinoupoleos 49, 54642 Thessaloniki, Greece; (A.B.); (A.T.)
| | - Evangelos Kaimakamis
- 1st ICU, Medical Informatics Laboratory, General Hospital of Thessaloniki “G. Papanikolaou”, Aristotle’s University of Thessaloniki, Leoforos Papanikolaou Municipality of Chortiatis, 57010 Thessaloniki, Greece;
| | - Christina Mouratidou
- Adult ICU, General Hospital of Thessaloniki “Ippokrateio”, Konstantinoupoleos 49, 54642 Thessaloniki, Greece; (C.M.); (I.A.); (V.D.); (K.T.); (A.S.); (A.M.); (E.A.)
| | - Ioannis Alevroudis
- Adult ICU, General Hospital of Thessaloniki “Ippokrateio”, Konstantinoupoleos 49, 54642 Thessaloniki, Greece; (C.M.); (I.A.); (V.D.); (K.T.); (A.S.); (A.M.); (E.A.)
| | - Vasiliki Dourliou
- Adult ICU, General Hospital of Thessaloniki “Ippokrateio”, Konstantinoupoleos 49, 54642 Thessaloniki, Greece; (C.M.); (I.A.); (V.D.); (K.T.); (A.S.); (A.M.); (E.A.)
| | - Kalliopi Tsakiri
- Adult ICU, General Hospital of Thessaloniki “Ippokrateio”, Konstantinoupoleos 49, 54642 Thessaloniki, Greece; (C.M.); (I.A.); (V.D.); (K.T.); (A.S.); (A.M.); (E.A.)
| | - Agni Sakkou
- Adult ICU, General Hospital of Thessaloniki “Ippokrateio”, Konstantinoupoleos 49, 54642 Thessaloniki, Greece; (C.M.); (I.A.); (V.D.); (K.T.); (A.S.); (A.M.); (E.A.)
| | - Alexandra Marneri
- Adult ICU, General Hospital of Thessaloniki “Ippokrateio”, Konstantinoupoleos 49, 54642 Thessaloniki, Greece; (C.M.); (I.A.); (V.D.); (K.T.); (A.S.); (A.M.); (E.A.)
| | - Elena Angeloudi
- Adult ICU, General Hospital of Thessaloniki “Ippokrateio”, Konstantinoupoleos 49, 54642 Thessaloniki, Greece; (C.M.); (I.A.); (V.D.); (K.T.); (A.S.); (A.M.); (E.A.)
| | - Ioanna Papagiouvanni
- 4th Internal Medicine Department, General Hospital of Thessaloniki “Ippokrateio”, Aristotle’s University of Thessaloniki, Konstantinoupoleos 49, 54642 Thessaloniki, Greece;
| | - Anastasia Michailidou
- 2nd Propaedeutic Internal Medicine Department, General Hospital of Thessaloniki “Ippokrateio”, Aristotle’s University of Thessaloniki, Konstantinoupoleos 49, 54642 Thessaloniki, Greece;
| | - Konstantinos Malandris
- 2nd Internal Medicine Department, General Hospital of Thessaloniki “Ippokrateio”, Aristotle’s University of Thessaloniki, Konstantinoupoleos 49, 54642 Thessaloniki, Greece;
| | - Constantinos Mourelatos
- Biology and Genetics Laboratory, Aristotle’s University of Thessaloniki, 54624 Thessaloniki, Greece;
| | - Alexandros Tsantos
- Pulmonary Department General, Hospital of Thessaloniki “Ippokrateio”, Konstantinoupoleos 49, 54642 Thessaloniki, Greece; (A.B.); (A.T.)
| | - Athanasia Pataka
- Respiratory Failure Clinic and Sleep Laboratory, General Hospital of Thessaloniki “G. Papanikolaou”, Aristotle’s University of Thessaloniki, Leoforos Papanikolaou Municipality of Chortiatis, 57010 Thessaloniki, Greece;
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Facheris G, Cossali G, Imbrescia J, La Mattina S, Mataj E, Meli N, Volpi G, Triggiani L, Guerini AE, Levi G, Grisanti S, Buglione di Monale e Bastia M, Borghetti P. Real-World Insights into the Impact of Durvalumab on Stage III Unresectable Non-Small Cell Lung Cancer-A Narrative Review. Cancers (Basel) 2025; 17:874. [PMID: 40075721 PMCID: PMC11899213 DOI: 10.3390/cancers17050874] [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: 01/24/2025] [Revised: 02/24/2025] [Accepted: 03/02/2025] [Indexed: 03/14/2025] Open
Abstract
INTRODUCTION AND AIM Stage III Non-Small Cell Lung Cancer (NSCLC) has a poor prognosis, with median survival ranging from 9 to 34 months. The PACIFIC trial demonstrated that durvalumab after platinum-based chemoradiotherapy (CRT) improves overall survival (OS) and progression-free survival (PFS). This review evaluates real-world evidence (RWE) on durvalumab's efficacy and safety, focusing on patient characteristics, prognostic factors, treatment protocols, and outcomes beyond progression. MATERIALS AND METHODS A literature search of PubMed, Embase, and Google Scholar identified 49 observational studies published from January 2017 to August 2024 on unresectable stage III NSCLC. Clinical trials, early-stage disease, and alternative treatments were excluded. RESULTS Compared to the PACIFIC trial, real-world patients were older, had poorer ECOG performance (≥2), and more comorbidities like COPD. Despite this, durvalumab provided consistent survival benefits. Positive prognostic factors included non-squamous histology, high PD-L1 expression, and timely durvalumab initiation (≤42 days post-CRT). Most radiotherapy regimens mirrored PACIFIC (54-66 Gy). Concomitant CRT was used in 90% of cases, with sequential CRT for frail patients. Chemotherapy regimens varied. Immune-mediated pneumonitis was a major adverse event, with incidence rates between 15% and 100%. Severe cases led to treatment discontinuation, impacting survival. Treatment beyond progression remains uncertain, with limited benefits from immunotherapy rechallenge. CONCLUSIONS RWE supports durvalumab's efficacy, emphasizing the need for personalized treatment strategies and further research to improve long-term outcomes.
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Affiliation(s)
- Giorgio Facheris
- Radiation Oncology Department, ASST Spedali Civili and University of Brescia, 25123 Brescia, Italy; (G.C.); (E.M.); (L.T.); (A.E.G.); (M.B.d.M.e.B.); (P.B.)
| | - Gianluca Cossali
- Radiation Oncology Department, ASST Spedali Civili and University of Brescia, 25123 Brescia, Italy; (G.C.); (E.M.); (L.T.); (A.E.G.); (M.B.d.M.e.B.); (P.B.)
| | - Jessica Imbrescia
- Radiation Oncology Unit, Department of Oncology and Hematology, University Hospital of Modena, 41124 Modena, Italy;
| | - Salvatore La Mattina
- Departement of Radiation Oncology, San Matteo Hospital Foundation Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 27100 Pavia, Italy;
| | - Eneida Mataj
- Radiation Oncology Department, ASST Spedali Civili and University of Brescia, 25123 Brescia, Italy; (G.C.); (E.M.); (L.T.); (A.E.G.); (M.B.d.M.e.B.); (P.B.)
| | - Nicole Meli
- Oncology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health Medical, ASST-Spedali Civili, University of Brescia, 25123 Brescia, Italy; (N.M.); (S.G.)
| | - Giulia Volpi
- Azienda Ospedaliera Universitaria Integrata Verona, Radiation Oncology, 37126 Verona, Italy;
| | - Luca Triggiani
- Radiation Oncology Department, ASST Spedali Civili and University of Brescia, 25123 Brescia, Italy; (G.C.); (E.M.); (L.T.); (A.E.G.); (M.B.d.M.e.B.); (P.B.)
| | - Andrea Emanuele Guerini
- Radiation Oncology Department, ASST Spedali Civili and University of Brescia, 25123 Brescia, Italy; (G.C.); (E.M.); (L.T.); (A.E.G.); (M.B.d.M.e.B.); (P.B.)
| | - Guido Levi
- Pulmonology Department, ASST Spedali Civili di Brescia, 25123 Brescia, Italy;
- Department of Clinical and Experimental Sciences, University of Brescia, 25121 Brescia, Italy
| | - Salvatore Grisanti
- Oncology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health Medical, ASST-Spedali Civili, University of Brescia, 25123 Brescia, Italy; (N.M.); (S.G.)
| | - Michela Buglione di Monale e Bastia
- Radiation Oncology Department, ASST Spedali Civili and University of Brescia, 25123 Brescia, Italy; (G.C.); (E.M.); (L.T.); (A.E.G.); (M.B.d.M.e.B.); (P.B.)
| | - Paolo Borghetti
- Radiation Oncology Department, ASST Spedali Civili and University of Brescia, 25123 Brescia, Italy; (G.C.); (E.M.); (L.T.); (A.E.G.); (M.B.d.M.e.B.); (P.B.)
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Xu Y, Chen R, Pan R, Gao X, Huang H, Wang M. Clinical management of checkpoint inhibitor pneumonitis: Focus, challenges, and future directions. CHINESE MEDICAL JOURNAL PULMONARY AND CRITICAL CARE MEDICINE 2025; 3:29-40. [PMID: 40226598 PMCID: PMC11993061 DOI: 10.1016/j.pccm.2024.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Indexed: 04/15/2025]
Abstract
Immune checkpoint inhibitors (ICIs) have revolutionized the treatment landscape for various malignancies by demonstrating exceptional antitumor effects and significant improvement in patient survival. Despite their overt therapeutic advantages, ICIs also induce immune-related adverse events (irAEs). Of these, checkpoint inhibitor pneumonitis (CIP) represents a prominent manifestation of pulmonary toxicity following ICI therapy, with incidence rates ranging from 2.7 % to 20.0 %. Notably, a substantial proportion of CIP cases show severe manifestations, often leading to life-threatening complications, which emphasizes its clinical significance. Understanding the risk factors and potential pathogenetic mechanisms of CIP, combined with vigilant monitoring during immunotherapy, is pivotal for early detection and management of this condition. Proactive strategies for the timely identification, accurate diagnosis, and effective management of CIP are essential to optimize patient outcomes. However, several challenges persist in CIP management, including management of severe and refractory cases, determining the timing of ICI rechallenge after CIP, management of long-term chronic CIP, and mitigating secondary infections. In order to manage this potentially life-threatening irAE effectively, it is urgent to establish multi-disciplinary treatment (MDT) management, precision CIP management, and practical surveillance systems for CIP monitoring, diagnosis, and management and to call for prospective multi-center clinical trials.
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Affiliation(s)
- Yan Xu
- Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Ruxuan Chen
- Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Ruili Pan
- Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Xiaoxing Gao
- Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Hui Huang
- Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Mengzhao Wang
- Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
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Yan T, Long M, Liu C, Zhang J, Wei X, Li F, Liao D. Immune-related adverse events with PD-1/PD-L1 inhibitors: insights from a real-world cohort of 2523 patients. Front Pharmacol 2025; 16:1519082. [PMID: 39959424 PMCID: PMC11825824 DOI: 10.3389/fphar.2025.1519082] [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: 10/29/2024] [Accepted: 01/13/2025] [Indexed: 02/18/2025] Open
Abstract
Purpose Immune checkpoint inhibitors (ICIs) have significantly changed cancer therapy, improving patient survival rates and clinical outcomes. Nevertheless, the use of PD-1/PD-L1 inhibitors can result in immune-related adverse events (irAEs). This study aims to investigate the prevalence and associated risk factors of irAEs in a real-world setting, as well as to assess their effects on optimal therapeutic outcomes. Methods A retrospective analysis involved 2523 patients with cancer who received inpatient PD-1/PD-L1 inhibitors treatment between January 2018 and December 2022. We documented patients' demographic and clinical characteristics, PD-1 or PD-L1 inhibitors, treatment modalities, incidences, timing, and severity of irAEs, and efficacy outcomes by reviewing inpatient records. Patients were categorized into an irAEs group and a non-irAEs group, with the former further subdivided into a multiple irAEs group and a single irAE group. Chi-square tests were employed to evaluate differences in baseline characteristics and efficacy outcomes between the irAEs and non-irAEs groups, as well as between the multiple and single irAE groups. Additionally, logistic regression analysis was utilized to identify risk factors linked to irAEs. Results Among 2523 eligible patients, 1096 reported 1802 irAEs, with an incidence incidence of 43.4%. Among 1096 individuals, 92.1% were classified as grade 1-2, while 7.9% were grade 3 or higher. IrAEs affected various organ systems, with endocrine toxicity (17.7%), hepatic toxicity (17.2%), and hematologic toxicity (11.4%) being the most common. 20.5% patients experienced multi-system irAEs. The average time for patients to develop irAEs was within four treatment cycles. Significant differences in patient gender, age, Eastern Cooperative Oncology Group (ECOG) Performance Status (PS), comorbidities, PD-1 or PD-L1 inhibitors, and treatment modalities were observed between the irAEs and non-irAEs groups, but not between the multiple irAEs and single irAE groups. Compared to the non-irAEs group, the irAEs group exhibited a higher objective response rate (ORR) and disease control rate (DCR), and the multiple irAEs group also showed a higher ORR than the single irAE group. Conclusion This real-world study indicated that the occurrence of irAEs is related to patient gender, age, ECOG PS, comorbidities, PD-1/PD-L1 inhibitors, and treatment modalities. The occurrence of irAEs may be associated with better treatment benefits.
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Affiliation(s)
- Ting Yan
- Department of Pharmacy, Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Minghui Long
- Department of Pharmacy, Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Chaoyi Liu
- Department of Information, Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Jiwen Zhang
- Department of Pharmacy, Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
- School of Pharmacy, University of South China, Hengyang, China
| | - Xingyu Wei
- Department of Pharmacy, Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
- School of Pharmacy, University of South China, Hengyang, China
| | - Fei Li
- Department of Pharmacy, Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
- School of Pharmacy, University of South China, Hengyang, China
| | - Dehua Liao
- Department of Pharmacy, Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
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Fan T, Zhu S, Wang H, Dong Y, Zhou Y, Song Y, Pan S, Wu Q, Smith GD, Li Y, Han Y. Development and validation of the self-report symptom inventory of immune-related adverse events in patients with lung cancer. Asia Pac J Oncol Nurs 2024; 11:100603. [PMID: 39641008 PMCID: PMC11617387 DOI: 10.1016/j.apjon.2024.100603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2024] [Accepted: 10/09/2024] [Indexed: 12/07/2024] Open
Abstract
Objective This study aims to develop and validate the Self-Report Symptom Inventory of immune-related Adverse Events in Patients with Lung Cancer (SRSI-irAEs-LC) to allow for systematic assessment of symptomatic irAEs in patients with lung cancer treated with programmed cell death protein 1 (PD-1)/programmed death-ligand 1 (PD-L1) immune checkpoint inhibitors (ICIs). Methods A sequential two-phase mixed-methods study was conducted. In phase I, a draft version of the SRSI-irAEs-LC was constructed through item generation and draft inventory construction. Delphi expert consultation, cognitive interviews and a pilot study were conducted to evaluate the content validity and refine the scale. In phase II, psychometric testing was performed on 512 patients with lung cancer treated with PD-1/PD-L1 ICIs using item analysis, exploratory factor analysis (EFA), confirmatory factor analysis (CFA), criterion validity, discriminant validity, and reliability evaluations. Results Through 5 sequential steps in phase I, the preliminary version of the SRSI-irAEs-LC comprised 10 dimensions with 41 items. Through EFA, the final version of the SRSI-irAEs-LC included 8 dimensions and 26 items that explained 62.33% of the variance. The CFA model showed that the 8-factor model fitted the data well. Good criteria validity and known-groups discriminant validity were demonstrated. Cronbach's alpha, split-half reliability, and test-retest reliability of the scale were 0.824, 0.725, and 0.851, respectively. Conclusions Preliminarily, the SRSI-irAEs-LC is a valid and reliable instrument for assessing symptomatic irAEs in patients with lung cancer treated with PD-1/PD-L1 ICIs. Further research is needed to confirm its generalizability to a broader population as well as its validity and reliability.
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Affiliation(s)
- Tiantian Fan
- Thoracic Surgery Area Three, Guangzhou Institute of Cancer Research, The Affiliated Cancer Hospital, Guangzhou Medical University, Guangzhou, China
| | - Siying Zhu
- School of Nursing, Guangzhou Medical University, Guangzhou, China
| | - Hong Wang
- School of Nursing, Guangzhou Medical University, Guangzhou, China
| | - Yan Dong
- School of Nursing, Guangzhou Medical University, Guangzhou, China
| | - Ying Zhou
- School of Nursing, Guangzhou Medical University, Guangzhou, China
| | - Yalan Song
- Nursing Department, Guangzhou Institute of Cancer Research, The Affiliated Cancer Hospital, Guangzhou Medical University, Guangzhou, China
| | - Shan Pan
- Internal Medicine Oncology, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Qiujuan Wu
- Internal Medicine Oncology, The Fifth Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | | | - Yumei Li
- Nursing Department, Guangzhou Institute of Cancer Research, The Affiliated Cancer Hospital, Guangzhou Medical University, Guangzhou, China
| | - Yuan Han
- School of Nursing, Guangzhou Medical University, Guangzhou, China
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Zhang D, Fan J, Liu X, Gao X, Zhou Q, Zhao J, Xu Y, Zhong W, Oh IJ, Chen M, Wang M. Lower respiratory tract microbiome is associated with checkpoint inhibitor pneumonitis in lung cancer patients. Transl Lung Cancer Res 2024; 13:3189-3201. [PMID: 39670023 PMCID: PMC11632428 DOI: 10.21037/tlcr-24-853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2024] [Accepted: 11/14/2024] [Indexed: 12/14/2024]
Abstract
Background The gut microbiome is associated with the occurrence and severity of immune-related adverse events (irAEs) in cancer patients undergoing immunotherapy. However, the relationship between the lower respiratory tract (LRT) microbiome and checkpoint inhibitor pneumonitis (CIP) in lung cancer patients who underwent immunotherapy is unclear. The aim of the present study was to investigate the associations between the LRT microbiome and CIP in lung cancer patients receiving immunotherapy. Methods This retrospective study included lung cancer patients who received immunotherapy and had metagenomic next-generation sequencing (mNGS) results of LRT specimens [bronchoalveolar lavage fluid (BALF)]. Based on their final diagnosis, the patients were allocated to either the CIP group or the non-CIP group. We conducted an exploratory analysis of the LRT microbiome in the CIP and non-CIP patients, delineating the microbial composition, and comparing the differences between the two groups. Results In total, 52 lung patients were included in the study, of whom 33 were allocated to the CIP group and 19 to the non-CIP group. The alpha- and beta-diversity analyses revealed no significant differences between the two groups. In the CIP group, the dominant phyla were Firmicutes (41.7%), Acinetobacter (18.2%), and Proteobacteria (16.3%). In the non-CIP group, the dominant phyla were Firmicutes (38.2%), Acinetobacter (18.4%), and Proteobacteria (17.8%). Notably, the relative abundance of the Proteobacteria phylum (P<0.001) and Firmicutes phylum (P=0.01) was significantly higher in the CIP group than the non-CIP group. Conclusions The elevated relative abundance of the Proteobacteria and Firmicutes phyla in the LRT samples is associated with CIP in lung cancer patients.
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Affiliation(s)
- Dongming Zhang
- Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Junping Fan
- Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xiaoyan Liu
- Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xiaoxing Gao
- Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Qing Zhou
- Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jing Zhao
- Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yan Xu
- Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Wei Zhong
- Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - In-Jae Oh
- Department of Internal Medicine, Chonnam National University Medical School and Hwasun Hospital, Jeonnam, Republic of Korea
| | - Minjiang Chen
- Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Mengzhao Wang
- Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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Ulas A, Temel B, Kos FT. Comparison of Prognostic Values of Seven Immune Indexes in Advanced Non-Small-Cell Lung Cancer Treated with Nivolumab: How Effective Can They Be Regarding Our Treatment Decisions? MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1792. [PMID: 39596977 PMCID: PMC11596302 DOI: 10.3390/medicina60111792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2024] [Revised: 10/27/2024] [Accepted: 10/30/2024] [Indexed: 11/29/2024]
Abstract
Background and Objectives: In this study, we evaluated the impact of seven immune indexes on treatment response and survival outcomes in advanced non-small-cell lung cancer (NSCLC) patients receiving second-line and subsequent nivolumab treatment under real-life conditions. Materials and Methods: The pan-immune inflammation value (PIV), systemic immune inflammation value (SII), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), derived neutrophil-to-lymphocyte ratio (d-NLR), and prognostic nutritional index (PNI) were calculated. All immune indexes were classified as low and high based on cut-off values. Kaplan-Meier and Cox hazard models were used for survival analysis. Results: The median follow-up was 22.0 months (6.0-96.0). The median overall survival (OS) was 30.0 months and the median progression-free survival (PFS) was 7.0 months. In the univariate analysis, comorbidity (p = 0.03) and nivolumab use for more than eight cycles (p < 0.0001) were associated with an increase in PFS, while smoking history (p < 0.005) and d-NLR (p < 0.05) were more effective regarding OS. Patients who received more than eight cycles of nivolumab had longer median PFS (4 vs. 19 months, p < 0.001) and OS (23 vs. 43 months, p < 0.001). We found longer median OS in the PLR (45.7 vs. 75.4 months; p = 0.05), PIV (53.0 vs. 66.4 months; p = 0.19), SII (50.0 vs. 71.9 vs. months, p = 0.19), and NLR (49.9 vs. 74.55 months, p = 0.10) indexes in nivolumab long-term users (high vs. low groups, respectively). In short-term users of nivolumab, only d-NLR median OS (high vs. low, 19 vs. 75.2 months, p = 0.07) was different. Complete and partial response rates to nivolumab treatment were higher in the PNI-high group (p = 0.04). Conclusions: In these real-life data, we determined that the PLR, PIV, SII, and NLR indexes were effective in the prognosis of patients who received PD1 inhibitor nivolumab for a long time, and the d-NLR index was effective in those who developed progression in a short time. We found that the PNI was effective in patients who responded well to ICI treatment.
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Affiliation(s)
- Arife Ulas
- Department of Medical Oncology, University of Health Sciences, Bursa City Education and Research Hospital, 16059 Bursa, Turkey
| | - Beyza Temel
- Department of Internal Medicine, University of Health Sciences, Bursa City Education and Research Hospital, 16059 Bursa, Turkey;
| | - Fahriye Tugba Kos
- Department of Medical Oncology, University of Health Sciences, Ankara City Education and Research Hospital, 06290 Ankara, Turkey;
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Fenech M, Ajanaku A, Hsuan J, McCormick A, Shamas S, Ghadiri N. Immune checkpoint inhibitors and the orbit; two cases of reactive dacryoadenitis. Orbit 2024:1-5. [PMID: 39109960 DOI: 10.1080/01676830.2024.2385010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2024] [Accepted: 07/17/2024] [Indexed: 01/11/2025]
Abstract
Immune checkpoints refer to mechanisms entrusted with the modulation of immune responses in peripheral tissues and are required for minimising collateral damage. Immune checkpoint inhibitors (ICPi) work through numerous pathways, including the anti-CTLA-4 (cytotoxic T-lymphocyte-associated protein 4), anti-PD-1 (programmed cell death protein 1) and the PD-L1 (protein cell death protein-ligand-1) pathways. They are proving to be an exciting therapeutic avenue in the attempt to activate anti-tumour activity. Ipilimumab is a fully human monoclonal antibody working on the anti-CTLA-4 pathway, while nivolumab and pembrolizumab are humanised monoclonal IgG4 antibodies that work on the PD-1 pathway. Despite a growing body of research pertinent to these novel therapies, early indications show that they are limited by their side effect profile. Furthermore, their efficacy appears to be greater in cancers with a high mutational burden. We present two female patients with bilateral reactive dacryoadenitis secondary to ICPi therapy, a finding that to the best of our knowledge was not previously described in the literature.
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Affiliation(s)
- Matthew Fenech
- Department of Ophthalmology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Ayodeji Ajanaku
- Department of Ophthalmology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - James Hsuan
- Department of Ophthalmology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Austin McCormick
- Department of Ophthalmology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Simon Shamas
- Department of Oncology, The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, UK
| | - Nima Ghadiri
- Department of Ophthalmology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
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10
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Gong B, Li Y, Guo Y, Wang J, Liu W, Zhou G, Song J, Pan F, Yang L, Liang B. The impact of pulmonary artery to ascending aorta diameter ratio progression on the prognosis of NSCLC patients treated with immune checkpoint inhibitors. Front Immunol 2024; 15:1302233. [PMID: 38348049 PMCID: PMC10859503 DOI: 10.3389/fimmu.2024.1302233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 01/15/2024] [Indexed: 02/15/2024] Open
Abstract
Background Immunotherapy, represented by immune checkpoint inhibitors (ICIs), is a major breakthrough in cancer treatment. Studies have reported that the use of ICIs is associated with an increase in the pulmonary artery to ascending aorta diameter (PAD/AoD) ratio. However, the impact of PAD/AoD ratio progression on the prognosis of patients is unclear. Methods This retrospective cohort study included patients with stage III or IV non-small cell lung cancer (NSCLC) treated with ICIs at the Wuhan Union Hospital between March 1, 2020, and September 1, 2022. The baseline and post-treatment PAD/AoD ratios of patients were evaluated through chest CT scans. The primary outcome of this study was overall survival (OS), while the secondary outcomes included progression-free survival (PFS), objective response rate (ORR) and disease control rate (DCR). Results The PAD/AoD ratio increased after the initiation of ICIs (from 0.75 to 0.78; P < 0.001). A total of 441 patients were divided into severe group (n=221) and non-severe group (n=220) according to the median increase of PAD/AoD ratio (1.06). Compared with the non-severe group, the severe group had a lower DCR (87.8% vs. 96.0%, P = 0.005) and ORR (87.5% vs. 96.0%, P = 0.063). Over the entire duration of follow-up (median 22.0 months), 85 (38.5%) patients in the severe group and 30 (7.3%) patients in the non-severe group died. An increased PAD/AoD ratio was associated with shorter PFS (Hazard ratio (HR): 1.48 [95% CI, 1.14 to 1.93]; P = 0.003) and OS (HR: 3.50 [95% CI, 2.30 to 5.30]; P < 0.001). Similar results were obtained across subgroups. Conclusions ICI treatment exacerbates an increase in the PAD/AoD ratio in patients with cancer, and greater increase in the PAD/AoD ratio was associated with a worse prognosis. PAD/AoD ratio could be a biomarker to stratify prognosis of NSCLC patients treated with ICIs.
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Affiliation(s)
- Bingxin Gong
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Key Laboratory of Molecular Imaging, Wuhan, China
| | - Yi Li
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Key Laboratory of Molecular Imaging, Wuhan, China
| | - Yusheng Guo
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Key Laboratory of Molecular Imaging, Wuhan, China
| | - Jing Wang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Key Laboratory of Molecular Imaging, Wuhan, China
| | - Weiwei Liu
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Key Laboratory of Molecular Imaging, Wuhan, China
| | - Guofeng Zhou
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Key Laboratory of Molecular Imaging, Wuhan, China
| | - Jiyu Song
- Department of Pathology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Feng Pan
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Key Laboratory of Molecular Imaging, Wuhan, China
| | - Lian Yang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Key Laboratory of Molecular Imaging, Wuhan, China
| | - Bo Liang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Key Laboratory of Molecular Imaging, Wuhan, China
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Sacchi de Camargo Correia G, Pai T, Li S, Connor D, Zhao Y, Lou Y, Manochakian R. Immune-Related Adverse Events in Patients with Lung Cancer. Curr Oncol Rep 2023; 25:1259-1275. [PMID: 37782426 DOI: 10.1007/s11912-023-01462-w] [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] [Accepted: 08/30/2023] [Indexed: 10/03/2023]
Abstract
PURPOSE OF REVIEW Immune checkpoint inhibitors (ICI) have been widely adopted for the treatment of lung cancer since receiving first U.S Food and Drug Administration (FDA) approval in 2015. However, along with their use, the occurrence of immune-related adverse events (irAEs) has presented a challenge for both patients and oncology providers. In this manuscript, we reviewed the clinical trials that led to the approval of ICI by the FDA for the treatment of lung cancer between 2015 and 2023 to establish the frequency of irAEs in this patient population. Among the adverse events associated with ICI, we focused on the most common and relevant ones, including hypothyroidism, pneumonitis, diarrhea/colitis, skin rash, and hepatitis. RECENT FINDINGS We thoroughly examined the available literature, including society guidelines concerning these complications, to discuss various aspects such as their pathophysiology, epidemiology, diagnostic process, grading system, and clinical management. Additionally, we explored the association between irAEs and disease response. The management of irAEs is a crucial aspect of oncologic care, particularly due to their potential to cause severe and life-threatening clinical manifestations. We present each pertinent aspect in a concise and organized manner to provide guidance and assistance to oncology providers managing these patients in both outpatient and inpatient settings.
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Affiliation(s)
| | - Tanmayi Pai
- Division of Hematology and Medical Oncology, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA
| | - Shenduo Li
- Division of Hematology and Medical Oncology, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA
| | - Dana Connor
- Division of Hematology and Medical Oncology, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA
| | - Yujie Zhao
- Division of Hematology and Medical Oncology, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA
| | - Yanyan Lou
- Division of Hematology and Medical Oncology, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA
| | - Rami Manochakian
- Division of Hematology and Medical Oncology, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA.
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