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Mai S, Liu H, Zeng H, Cheng Z, Huang J, Shi G, Li Y, Wu Z. Diagnostic challenge and survival analysis of pulmonary oligometastases and primary lung cancer in breast cancer patients. Thorac Cancer 2024; 15:1017-1028. [PMID: 38494913 PMCID: PMC11045338 DOI: 10.1111/1759-7714.15285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 02/28/2024] [Accepted: 03/01/2024] [Indexed: 03/19/2024] Open
Abstract
BACKGROUND The aim of this study was to compare breast cancer patients with pulmonary oligometastases (POM) and primary lung cancer (PLC) and to assess whether there were differences in clinical features, CT features, and survival outcomes between the two groups. METHODS From January 2010 to December 2021, the clinical records of 437 with malignant pulmonary nodules who had breast cancer patients were reviewed. POM was identified in 45 patients and PLC in 43 patients after the initial detection of pulmonary nodules. The clinicopathological characteristics, CT appearance of pulmonary nodules, and survival of the two groups were compared. RESULTS Stage II to IV breast tumors (p < 0.001), high pathological grade of breast cancer (p = 0.001), low proportion of luminal-type breast cancer (p = 0.003), and the higher serum CYFRA 21-1 level (p = 0.046) were the clinical characteristics of pulmonary nodules suggestive of POM rather than PLC. The CT features of lung nodules indicative of PLC rather than POM were the subsolid component (p < 0.001), lobulation (p = 0.010), air bronchogram (p < 0.001) and pleural indentation (p = 0.004). Ten-year survival rate for PLC was 93.2%, which was higher compared with 57.8% in those with POM (p = 0.001). CONCLUSIONS Elevated serum CYFRA 21-1 levels and late-stage breast cancer may be beneficial for the diagnosis of POM. CT imaging appearances of the subsolid component, lobulation, air bronchogram, and pleural indentation increase the likelihood of PLC. Breast cancer patients with PLC presented better survival with attentive monitoring than those with POM.
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Affiliation(s)
- Siyao Mai
- Department of Radiology, Sun Yat‐Sen Memorial HospitalSun Yat‐Sen UniversityGuangzhouChina
| | - Haiqing Liu
- Department of Radiology, Sun Yat‐Sen Memorial HospitalSun Yat‐Sen UniversityGuangzhouChina
| | - Hong Zeng
- Department of Pathology, Sun Yat‐Sen Memorial HospitalSun Yat‐Sen UniversityGuangzhouChina
| | - Ziliang Cheng
- Department of Radiology, Sun Yat‐Sen Memorial HospitalSun Yat‐Sen UniversityGuangzhouChina
| | - Jingwen Huang
- Department of Radiology, Sun Yat‐Sen Memorial HospitalSun Yat‐Sen UniversityGuangzhouChina
| | - Guangzi Shi
- Department of Radiology, Sun Yat‐Sen Memorial HospitalSun Yat‐Sen UniversityGuangzhouChina
| | - Yong Li
- Department of Radiology, Sun Yat‐Sen Memorial HospitalSun Yat‐Sen UniversityGuangzhouChina
| | - Zhuo Wu
- Department of Radiology, Sun Yat‐Sen Memorial HospitalSun Yat‐Sen UniversityGuangzhouChina
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Ryu HS, Lee HN, Kim JI, Ryu JK, Lim YJ. Incidental detection of ground glass nodules and primary lung cancer in patients with breast cancer: prevalence and long-term follow-up on chest computed tomography. J Thorac Dis 2024; 16:1804-1814. [PMID: 38617779 PMCID: PMC11009589 DOI: 10.21037/jtd-23-1605] [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: 10/17/2023] [Accepted: 01/24/2024] [Indexed: 04/16/2024]
Abstract
Background Patients with breast cancer have a higher risk of developing lung cancer than the general population. The study aimed to evaluate the prevalence of ground glass nodule (GGN) and risk factors for GGN growth in patients with breast cancer and to evaluate the prevalence and pathologic features of lung cancer. Methods We retrospectively reviewed the clinical data and chest computed tomography (CT) of 1,384 patients diagnosed with breast cancer who underwent chest CT between January 2008 and December 2022. We evaluated the prevalence of GGNs and their size changes on follow-up chest CT with volume doubling time (VDT) and identified independent risk factors associated with the growth of GGN using multivariable logistic regression analyses. Furthermore, the prevalence and pathologic features of lung cancer were also evaluated. Results We detected persistent GGNs in 69 of 1,384 (5.0%) patients. The initial diameter of GGNs was 6.3±3.6 mm on average, with primarily (85.5%) pure GGNs. Among them, 27 (39.1%) exhibited interval growth with a median VDT of 1,006.0 days (interquartile range, 622.0-1,528.0 days) during the median 959.0 days (interquartile range, 612.0-1,645.0 days) follow-up period. Older age (P=0.026), part-solid nodules (P=0.006), and total number of GGNs (≥2) (P=0.007) were significant factors for GGN growth. Lung cancer was confirmed in 13 of 1,384 patients (0.9%), all with adenocarcinoma, including one case of minimally invasive adenocarcinoma. The cancers demonstrated a high rate of epidermal growth factor receptor (EGFR) mutation (69.2%). Conclusions Persistent GGNs in breast cancer patients with high-risk factors should be adequately monitored for early detection and treatment of lung cancer.
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Affiliation(s)
- Hye Sun Ryu
- Department of Radiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Han Na Lee
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jung Im Kim
- Department of Radiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Jung Kyu Ryu
- Department of Radiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Yu Jin Lim
- Department of Radiation Oncology, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, Republic of Korea
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Mitchell MI, Ben-Dov IZ, Liu C, Wang T, Hazan RB, Bauer TL, Zakrzewski J, Donnelly K, Chow K, Ma J, Loudig O. Non-invasive detection of orthotopic human lung tumors by microRNA expression profiling of mouse exhaled breath condensates and exhaled extracellular vesicles. EXTRACELLULAR VESICLES AND CIRCULATING NUCLEIC ACIDS 2024; 5:138-164. [PMID: 38863869 PMCID: PMC11165456 DOI: 10.20517/evcna.2023.77] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/13/2024]
Abstract
Aim The lung is the second most frequent site of metastatic dissemination. Early detection is key to improving survival. Given that the lung interfaces with the external environment, the collection of exhaled breath condensate (EBC) provides the opportunity to obtain biological material including exhaled miRNAs that originate from the lung. Methods In this proof-of-principal study, we used the highly metastatic MDA-MB-231 subline 3475 breast cancer cell line (LM-3475) to establish an orthotopic lung tumor-bearing mouse model and investigate non-invasive detection of lung tumors by analysis of exhaled miRNAs. We initially conducted miRNA NGS and qPCR validation analyses on condensates collected from unrestrained animals and identified significant miRNA expression differences between the condensates of lung tumor-bearing and control mice. To focus our purification of EBC and evaluate the origin of these differentially expressed miRNAs, we developed a system to collect EBC directly from the nose and mouth of our mice. Results Using nanoparticle distribution analyses, TEM, and ONi super-resolution nanoimaging, we determined that human tumor EVs could be increasingly detected in mouse EBC during the progression of secondary lung tumors. Using our customizable EV-CATCHER assay, we purified human tumor EVs from mouse EBC and demonstrated that the bulk of differentially expressed exhaled miRNAs originate from lung tumors, which could be detected by qPCR within 1 to 2 weeks after tail vein injection of the metastatic cells. Conclusion This study is the first of its kind and demonstrates that lung tumor EVs are exhaled in mice and provide non-invasive biomarkers for detection of lung tumors.
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Affiliation(s)
- Megan I. Mitchell
- Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, NJ 07110, USA
- Hackensack University Medical Center, Hackensack Meridian Health, Hackensack, NJ 07601, USA
| | - Iddo Z. Ben-Dov
- Laboratory of Medical Transcriptomics, Hadassah-Hebrew University Medical Center, Jerusalem 91120, Israel
| | - Christina Liu
- Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, NJ 07110, USA
| | - Tao Wang
- Department of Epidemiology and Population Health, The Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 10461, USA
| | - Rachel B. Hazan
- Department of Pathology, The Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 10461, USA
| | - Thomas L. Bauer
- Jersey Shore University Medical Center, Hackensack Meridian Health, Neptune City, NJ 07753, USA
| | - Johannes Zakrzewski
- Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, NJ 07110, USA
- Hackensack University Medical Center, Hackensack Meridian Health, Hackensack, NJ 07601, USA
| | - Kathryn Donnelly
- Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, NJ 07110, USA
| | - Kar Chow
- Hackensack University Medical Center, Hackensack Meridian Health, Hackensack, NJ 07601, USA
| | - Junfeng Ma
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC 20007, USA
| | - Olivier Loudig
- Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, NJ 07110, USA
- Hackensack University Medical Center, Hackensack Meridian Health, Hackensack, NJ 07601, USA
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Shi J, Liu J, Tian G, Li D, Liang D, Wang J, He Y. Association of radiotherapy for stage I-III breast cancer survivors and second primary malignant cancers: a population-based study. Eur J Cancer Prev 2024; 33:115-128. [PMID: 37669169 DOI: 10.1097/cej.0000000000000837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/07/2023]
Abstract
PURPOSE With life span extending, breast cancer survivors may face the possibility of developing second primary cancers (SPCs). The objective of this research is to investigate the risk factors, risk attribute to radiotherapy and the survivalship for SPCs. METHODS A total of 445 523 breast cancer patients were enrolled from Surveillance, Epidemiology, and End Results database in 2000-2018. The risk factors for SPCs development were confirmed by competing risk model, and then were integrated to the nomogram establishment. The cumulative incidence of SPCs including SBC (second breast cancer), SGC (second gynecological cancer), and SLC (second lung cancer) were estimated. The radiotherapy-associated risk for SPCs were evaluated by Poisson regression in radiotherapy and no-radiotherapy. Propensity score matching was used to reduce possible bias for survival comparison. RESULTS There were 57.63% patients in radiotherapy. The risk factors for developing SPCs were age, year, race, tumor size, stage, radiotherapy, grade, surgery, and histology. The cumulative incidence of SPCs was 7.75% in no-radiotherapy and 10.33% in radiotherapy. SLC, SBC, and SGC also appeared the similar results. The increased risk of developing SPCs were associated with radiotherapy in majority subgroups. The dynamic radiotherapy-associated risk for SPCs by age slightly increased risk was observed. Regardless radiotherapy or no-radiotherapy, the 10-year overall survival for SBC (radiotherapy: 59.41%; no-radiotherapy: 55.53%) and SGC (radiotherapy: 48.61%; no-radiotherapy: 35.53%) were worse than that among matched patients with only primary cancers. CONCLUSIONS Breast cancer survivors remained a high radiotherapy-associated risk for developing SPCs. The prognosis in radiotherapy was better than in no-radiotherapy for some specific SPCs. Largely attention should be paid to these patients.
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Affiliation(s)
- Jin Shi
- Cancer Institute, The Fourth Hospital of Hebei Medical University, The Tumor Hospital of Hebei Province
| | - Jian Liu
- The Service Center of Comprehensive Supervision Health Commission of Hebei Province
| | - Guo Tian
- Department of Medical Records, The Fourth Hospital of Hebei Medical University, The Tumor Hospital of Hebei Province
| | - Daojuan Li
- Cancer Institute, The Fourth Hospital of Hebei Medical University, The Tumor Hospital of Hebei Province
| | - Di Liang
- Cancer Institute, The Fourth Hospital of Hebei Medical University, The Tumor Hospital of Hebei Province
| | - Jun Wang
- Department of Radiation Oncology, The Fourth Hospital of Hebei Medical University, The Tumor Hospital of Hebei Province, Shijiazhuang, Hebei, China
| | - Yutong He
- Cancer Institute, The Fourth Hospital of Hebei Medical University, The Tumor Hospital of Hebei Province
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Yan S, Cheng M, Peng W, Liu T, Zhang J, Sheng M, Ren R, Chen Q, Gong W, Wu Y. Incidence and risk of remnant gastric cancer after gastrectomy for gastric cancer: a population-based study from the SEER database. BMC Gastroenterol 2024; 24:35. [PMID: 38229048 DOI: 10.1186/s12876-024-03133-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 01/12/2024] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND Gastric cancer (GC) constitutes a major global health problem, of which remnant gastric cancer (RGC) occurs less frequently. The rate of RGCs after gastrectomy for GC is increasing recently due to improved survival and screening, however, their incidence and risk have not been reported in the U.S. POPULATION The objective of this study was to evaluate the incidence and elevated risk of RGC after GC gastrectomy in this population, and to identify the risk factors. METHODS Patients underwent gastrectomy for first primary GC in 2000-2015 and those who developed RGC were identified from Surveillance, Epidemiology and End Results (SEER) database. Fine-Gray regression was used to estimate the cumulative incidence and to identify risk factors. Standardized incidence ratios (SIRs) were calculated by Poisson regression to compare the risk with the general population. RESULTS Among 21,566 patients included in the cohort, 227 developed RGC. The 20-year cumulative incidence of RGC was 1.88%. Multivariate analysis revealed that older age, invasion depth, male sex, marital status, and lower income are independent risk factors for RGC development. SIR was 7.70 overall and > 4.5 in each stratum. CONCLUSIONS Cumulative incidence and risk for RGCs increased continuously in patients underwent GC gastrectomy. Close and lifelong endoscopy surveillance should be recommended for patients who received GC gastrectomy, especially those with high-risk factors.
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Affiliation(s)
- Shangcheng Yan
- Department of Gastrointestinal Surgery, Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Ming Cheng
- Department of Gastrointestinal Surgery, Second Affiliated Hospital of Soochow University, Suzhou, China
- Department of Gastroenterology and Minimally Invasive Surgery, Juntendo University Hospital, Tokyo, 113- 8431, Japan
| | - Wei Peng
- Department of Gastrointestinal Surgery, Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Tianhua Liu
- Department of Gastrointestinal Surgery, Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Jingyu Zhang
- Department of Gastrointestinal Surgery, Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Mengchao Sheng
- Department of Gastrointestinal Surgery, Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Rui Ren
- Department of Gastrointestinal Surgery, Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Qiang Chen
- Department of Gastrointestinal Surgery, Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Wei Gong
- Department of Gastrointestinal Surgery, Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Yongyou Wu
- Department of Gastrointestinal Surgery, Second Affiliated Hospital of Soochow University, Suzhou, China.
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Florez N, Kiel L, Riano I, Patel S, DeCarli K, Dhawan N, Franco I, Odai-Afotey A, Meza K, Swami N, Patel J, Sequist LV. Lung Cancer in Women: The Past, Present, and Future. Clin Lung Cancer 2024; 25:1-8. [PMID: 37940410 DOI: 10.1016/j.cllc.2023.10.007] [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: 06/12/2023] [Revised: 09/29/2023] [Accepted: 10/18/2023] [Indexed: 11/10/2023]
Abstract
Lung cancer is the leading cause of cancer death for women in multiple countries including the United States. Women are exposed to unique risk factors that remain largely understudied such as indoor pollution, second-hand tobacco exposure, biological differences, gender differences in tolerability and response to therapy in lung cancer, and societal gender roles, that create distinct survivorship needs. Women continue to lack representation in lung cancer clinical trials and are typically treated with data generated from majority male patient study populations, which may be inappropriate to extrapolate and generalize to females. Current lung cancer treatment and screening guidelines do not incorporate sex-specific differences and physicians also often do not account for gender differences when choosing treatments or discussing survivorship needs. To best provide targeted treatment approaches, greater representation of women in lung cancer clinical trials and further research is necessary. Clinicians should understand the unique factors and consequences associated with lung cancer in women; thus, a holistic approach that acknowledges environmental and societal factors is necessary.
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Affiliation(s)
- Narjust Florez
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA.
| | | | - Ivy Riano
- Section of Hematology and Medical Oncology, Dartmouth Cancer Center, Geisel School of Medicine Dartmouth, Lebanon, NH
| | - Shruti Patel
- Department of Medicine, Division of Medical Oncology, Stanford University, Stanford, CA
| | - Kathryn DeCarli
- Division of Hematology/Oncology, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Natasha Dhawan
- Section of Hematology and Medical Oncology, Dartmouth Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH
| | - Ivy Franco
- Department of Radiation Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | | | - Kelly Meza
- Dana-Farber Cancer Institute, Boston, MA
| | - Nishwant Swami
- University of Massachusetts Medical School, Worcester, MA; Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA
| | | | - Lecia V Sequist
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA
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Zhou J, Wang T, Xia L, Zheng Q, Wu D, Lin M, Lu T, Ma L. Effect of a prior thyroid cancer on the survival of lung cancer patients: a retrospective study based on SEER database. Endocrine 2024; 83:142-149. [PMID: 37632636 DOI: 10.1007/s12020-023-03474-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 07/26/2023] [Indexed: 08/28/2023]
Abstract
PURPOSE The effect of a history of thyroid cancer on the prognosis of lung cancer patients has not been fully investigated. Therefore, we aimed to evaluate this effect based on a large cohort. METHODS Data of 154844 lung cancer patients, of whom 406 had prior thyroid cancer, were collected from SEER database. Primary survival analysis was conducted between patients with and without prior thyroid cancer using Kaplan-Meier method. Secondary survival analysis was conducted to investigate the effects of the stage and histological subtype of the prior thyroid cancer on the survival of lung cancer patients. Propensity adjustment was used to reduce confounding effect. RESULTS Compared to patients without prior malignancy, patients with prior thyroid cancer were predominantly female (72.4% vs. 48.7%, p < 0.001), had lower stage (proportion of localized tumor: 40.4% vs. 25.6%, p < 0.001), and larger proportion of surgery (52.2% vs. 29.4%, p < 0.001), and had better survival (5-year survival rate: 55.53% vs. 33.16%, p < 0.001). After propensity adjustment, the survival was similar between the groups (5-year survival rate: 55.53% vs. 51.78%, p = 0.24). The survival of patients with different stages (localized tumor vs. regional tumor: p = 0.88) or different histological subtypes (p = 0.46) of prior thyroid cancer were comparable. CONCLUSION Survival of lung cancer patients with or without prior thyroid cancer was similar after propensity adjustment, and the stage or histological subtype of the prior thyroid cancer had no significant effect on the survival of lung cancer patients.
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Affiliation(s)
- Jian Zhou
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Tengyong Wang
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Liang Xia
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Quan Zheng
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Dongsheng Wu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Mingying Lin
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Tianyi Lu
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Lin Ma
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China.
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Wang KY, Lee CS, Vempati P, Sharma R, Kohn N, Seetharamu N. Characteristics of Patients With Second Primary Lung Cancer Following Breast Cancer: A Retrospective Descriptive Study. Clin Lung Cancer 2023; 24:e198-e204. [PMID: 37268494 DOI: 10.1016/j.cllc.2023.04.007] [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: 01/23/2023] [Revised: 04/08/2023] [Accepted: 04/13/2023] [Indexed: 06/04/2023]
Abstract
BACKGROUND Breast cancer (BC) is the most common noncutaneous malignancy in women and survivors are at an increased risk for secondary malignancy with lung cancer (LC) being the most common. There are few studies that have explored the clinicopathological specifics of LC in BC survivors. METHODS In this single-institution, retrospective study, we identified BC survivors who subsequently developed LC, examined their breast and LC clinical and pathological characteristics and compared them to the general BC and LC population as published in the literature. RESULTS In our study, we found the following associations that could be meaningful: an association between receiving radiation (RT) and LC (including a statistically significant P = .03 chance of ipsilateral LC after BC treatment with RT), a higher incidence and amount of smoking and LC, high BRCA positivity (78.9%) in the few patients who had germline testing, and a higher incidence of EGFR mutations in NSCLC after BC (60.9%) as well as an earlier stage of NSCLC disease. CONCLUSION Treatments such as RT, genetic factors such as BRCA mutations, and tobacco use may increase the risk of developing LC amongst BC survivors. Exploring this further can potentially lead to better risk stratification through modified low-dose CT chest screening protocols to catch LCs earlier and ultimately improve outcomes. Past studies have shown that BC survivors who are subsequently diagnosed with NSCLC may have improved OS compared with primary NSCLC and our study showed a high incidence of EGFR mutated NSCLC, which also suggest both improved prognosis and a different molecular profile of NSCLC, which warrants further investigation. Lastly, BC survivors who subsequently are diagnosed with NSCLC had earlier stage disease in our study, perhaps a result of surveillance, highlighting the importance of close monitoring of BC survivors.
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Affiliation(s)
- Kevin Yu Wang
- Northwell Health/Zucker School of Medicine, Hofstra/Northwell, Manhasset, NY.
| | - Chung-Shien Lee
- Northwell Health/Zucker School of Medicine, Hofstra/Northwell, Manhasset, NY
| | - Prashant Vempati
- Northwell Health/Zucker School of Medicine, Hofstra/Northwell, Manhasset, NY
| | - Rajiv Sharma
- Northwell Health/Zucker School of Medicine, Hofstra/Northwell, Manhasset, NY
| | - Nina Kohn
- Northwell Health/Zucker School of Medicine, Hofstra/Northwell, Manhasset, NY
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Sirhan Z, Alojair R, Thyagarajan A, Sahu RP. Therapeutic Implications of PTEN in Non-Small Cell Lung Cancer. Pharmaceutics 2023; 15:2090. [PMID: 37631304 PMCID: PMC10458395 DOI: 10.3390/pharmaceutics15082090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 07/29/2023] [Accepted: 08/01/2023] [Indexed: 08/27/2023] Open
Abstract
Lung cancer remains one of the major human malignancies affecting both men and women worldwide, with non-small cell lung cancer (NSCLC) being the most prevalent type. Multiple mechanisms have been identified that favor tumor growth as well as impede the efficacy of therapeutic regimens in lung cancer patients. Among tumor suppressor genes that play critical roles in regulating cancer growth, the phosphatase and tensin homolog (PTEN) constitutes one of the important family members implicated in controlling various functional activities of tumor cells, including cell proliferation, apoptosis, angiogenesis, and metastasis. Notably, clinical studies have also documented that lung tumors having an impaired, mutated, or loss of PTEN are associated with low survival or high tumor recurrence rates. To that end, PTEN has been explored as a promising target for anti-cancer agents. Importantly, the ability of PTEN to crosstalk with several signaling pathways provides new approaches to devise effective treatment options for lung cancer treatment. The current review highlights the significance of PTEN and its implications in therapeutic approaches against NSCLC.
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Affiliation(s)
| | | | - Anita Thyagarajan
- Department of Pharmacology and Toxicology, Boonshoft School of Medicine, Wright State University, Dayton, OH 45435, USA; (Z.S.); (R.A.)
| | - Ravi P. Sahu
- Department of Pharmacology and Toxicology, Boonshoft School of Medicine, Wright State University, Dayton, OH 45435, USA; (Z.S.); (R.A.)
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Haque E, Mushtaq AH, Alkhatib R, Alhusaini H, Suleman K. An Unexpected Diagnosis of Second Primary Malignancy in a Breast Cancer Survivor: A Case Report. Cureus 2023; 15:e42819. [PMID: 37664269 PMCID: PMC10471315 DOI: 10.7759/cureus.42819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2023] [Indexed: 09/05/2023] Open
Abstract
BACKGROUND Breast cancer survival rates are increasing more than ever with the development of better diagnostic and therapeutic techniques. Survivors of breast cancer have an increased risk of developing second primary malignancies, which may be mistaken for breast cancer recurrence and lead to delayed diagnosis and poor prognosis. CASE REPORT We report a case of a 62-year-old female who presented with shortness of breath and bone pain. She had a history of left triple-positive invasive ductal carcinoma (T1N0M0) treated with bilateral skin-sparing mastectomy, adjuvant Taxotere, and trastuzumab-based therapy and then continued on trastuzumab and letrozole. She underwent imaging to explore the source of her symptoms at which new pulmonary nodules were discovered. During workup, she was found to have elevated tumor markers. They were initially suspected to be breast cancer recurrence metastases based on elevated tumor markers; however, further investigations confirmed that the nodules were a second primary lung adenocarcinoma with a different molecular profile. The patient had disease progression despite chemotherapy and eventually succumbed to her disease. CONCLUSION This case highlights the importance of considering second primary malignancies in breast cancer survivors and utilizing advanced diagnostic modalities to efficiently diagnose such cases.
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Affiliation(s)
- Emaan Haque
- Department of Medicine, Alfaisal University, Riyadh, SAU
| | - Ali H Mushtaq
- Department of Medicine, Cleveland Clinic, Cleveland, USA
- Department of Medicine, Alfaisal University, Riyadh, SAU
| | | | - Hamed Alhusaini
- Department of Oncology, King Faisal Specialist Hospital and Research Centre, Riyadh, SAU
| | - Kausar Suleman
- Department of Oncology, King Faisal Specialist Hospital and Research Centre, Riyadh, SAU
- Department of Medicine, Alfaisal University, Riyadh, SAU
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Lee NY, Hum M, Zihara S, Wang L, Myint MK, Lim DWT, Toh CK, Skanderup A, Samol J, Tan MH, Ang P, Lee SC, Tan EH, Lai GGY, Tan DSW, Yap YS, Lee ASG. Landscape of germline pathogenic variants in patients with dual primary breast and lung cancer. Hum Genomics 2023; 17:66. [PMID: 37461096 PMCID: PMC10353088 DOI: 10.1186/s40246-023-00510-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 07/10/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Cancer predisposition is most often studied in the context of single cancers. However, inherited cancer predispositions can also give rise to multiple primary cancers. Yet, there is a paucity of studies on genetic predisposition in multiple primary cancers, especially those outside of well-defined cancer predisposition syndromes. This study aimed to identify germline variants associated with dual primary cancers of the breast and lung. METHODS Exome sequencing was performed on germline DNA from 55 Singapore patients (52 [95%] never-smokers) with dual primaries in the breast and lung, confirmed by histopathology. Using two large control cohorts: the local SG10K_Health (n = 9770) and gnomAD non-cancer East Asians (n = 9626); and two additional local case cohorts of early-onset or familial breast cancer (n = 290), and lung cancer (n = 209), variants were assessed for pathogenicity in accordance with ACMG/AMP guidelines. In particular, comparisons were made with known pathogenic or likely pathogenic variants in the ClinVar database, pathogenicity predictions were obtained from in silico prediction software, and case-control association analyses were performed. RESULTS Altogether, we identified 19 pathogenic or likely pathogenic variants from 16 genes, detected in 17 of 55 (31%) patients. Six of the 19 variants were identified using ClinVar, while 13 variants were classified pathogenic or likely pathogenic using ACMG/AMP guidelines. The 16 genes include well-known cancer predisposition genes such as BRCA2, TP53, and RAD51D; but also lesser known cancer genes EXT2, WWOX, GATA2, and GPC3. Most of these genes are involved in DNA damage repair, reaffirming the role of impaired DNA repair mechanisms in the development of multiple malignancies. These variants warrant further investigations in additional populations. CONCLUSIONS We have identified both known and novel variants significantly enriched in patients with primary breast and lung malignancies, expanding the body of known cancer predisposition variants for both breast and lung cancer. These variants are mostly from genes involved in DNA repair, affirming the role of impaired DNA repair in the predisposition and development of multiple cancers.
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Affiliation(s)
- Ning-Yuan Lee
- Division of Cellular and Molecular Research, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
| | - Melissa Hum
- Division of Cellular and Molecular Research, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
| | - Sabna Zihara
- Division of Cellular and Molecular Research, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
| | - Lanying Wang
- Division of Medical Oncology, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
| | - Matthew K Myint
- Division of Cellular and Molecular Research, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
| | - Darren Wan-Teck Lim
- Division of Medical Oncology, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
- SingHealth Duke-NUS Oncology Academic Clinical Programme (ONCO ACP), Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
| | - Chee-Keong Toh
- Division of Medical Oncology, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
| | - Anders Skanderup
- Genome Institute of Singapore, 60 Biopolis St, Singapore, 138672, Singapore
| | - Jens Samol
- Medical Oncology Department, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore
- Johns Hopkins University, Baltimore, MD, 21218, USA
| | - Min-Han Tan
- Lucence Diagnostics Pte Ltd, 211 Henderson Road, Singapore, 159552, Singapore
| | - Peter Ang
- Oncocare Cancer Centre, Gleneagles Medical Centre, 6 Napier Road, Singapore, 258499, Singapore
| | - Soo-Chin Lee
- Department of Hematology-Oncology, National University Cancer Institute, Singapore (NCIS), National University Health System, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore
- Cancer Science Institute, Singapore (CSI), National University of Singapore, 14 Medical Dr, Singapore, 117599, Singapore
| | - Eng-Huat Tan
- Division of Medical Oncology, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
- Clinical Trials and Epidemiological Sciences, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
| | - Gillianne G Y Lai
- Division of Medical Oncology, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
- SingHealth Duke-NUS Oncology Academic Clinical Programme (ONCO ACP), Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
| | - Daniel S W Tan
- Division of Medical Oncology, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
- SingHealth Duke-NUS Oncology Academic Clinical Programme (ONCO ACP), Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
- Genome Institute of Singapore, 60 Biopolis St, Singapore, 138672, Singapore
- Clinical Trials and Epidemiological Sciences, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
| | - Yoon-Sim Yap
- Division of Medical Oncology, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
- SingHealth Duke-NUS Oncology Academic Clinical Programme (ONCO ACP), Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
| | - Ann S G Lee
- Division of Cellular and Molecular Research, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore.
- SingHealth Duke-NUS Oncology Academic Clinical Programme (ONCO ACP), Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore.
- Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, 2 Medical Drive, Singapore, 117593, Singapore.
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12
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Inoue C, Miki Y, Suzuki T. New Perspectives on Sex Steroid Hormones Signaling in Cancer-Associated Fibroblasts of Non-Small Cell Lung Cancer. Cancers (Basel) 2023; 15:3620. [PMID: 37509283 PMCID: PMC10377312 DOI: 10.3390/cancers15143620] [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: 04/30/2023] [Revised: 06/30/2023] [Accepted: 07/10/2023] [Indexed: 07/30/2023] Open
Abstract
The importance of sex hormones, especially estrogen, in the pathogenesis of non-small-cell lung cancer (NSCLC) has attracted attention due to its high incidence among young adults and nonsmokers, especially those who are female. Cancer-associated fibroblasts (CAFs) reside in the cancer stroma and influence cancer growth, invasion, metastasis, and acquisition of drug resistance through interactions with cancer cells and other microenvironmental components. Hormone-mediated cell-cell interactions are classic cell-cell interactions and well-known phenomena in breast cancer and prostate cancer CAFs. In cancers of other organs, including NSCLC, the effects of CAFs on hormone-receptor expression and hormone production in cancer tissues have been reported; however, there are few such studies. Many more studies have been performed on breast and prostate cancers. Recent advances in technology, particularly single-cell analysis techniques, have led to significant advances in the classification and function of CAFs. However, the importance of sex hormones in cell-cell interactions of CAFs in NSCLC remains unclear. This review summarizes reports on CAFs in NSCLC and sex hormones in cancer and immune cells surrounding CAFs. Furthermore, we discuss the prospects of sex-hormone research involving CAFs in NSCLC.
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Affiliation(s)
- Chihiro Inoue
- Department of Anatomic Pathology, Tohoku University Graduate School of Medicine, Sendai 980-8575, Japan
| | - Yasuhiro Miki
- Department of Anatomic Pathology, Tohoku University Graduate School of Medicine, Sendai 980-8575, Japan
| | - Takashi Suzuki
- Department of Anatomic Pathology, Tohoku University Graduate School of Medicine, Sendai 980-8575, Japan
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13
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陈 迪, 肖 要, 钟 铠. [Risk Factors and Pathogenic Mechanism for Secondary Primary Lung Cancer
in Breast Cancer Patients: A Review]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2022; 25:750-755. [PMID: 36167461 PMCID: PMC9619345 DOI: 10.3779/j.issn.1009-3419.2022.101.46] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 08/12/2022] [Accepted: 08/15/2022] [Indexed: 01/25/2023]
Abstract
Breast cancer and lung cancer are the two most common malignancies in China. With the continuous improvement of breast cancer diagnosis and treatment technology, the survival time of breast cancer patients has been prolonged, and the number of breast cancer patients with second primary lung cancer (SPLC) has increased. In addition, breast cancer is the most common primary cancer in female patients with SPLC, and SPLC is the main cause of death in this population. More and more physicians pay attention to this clinical phenomenon. This paper summarized the risk and risk factors of SPLC in breast cancer patients, and elaborated its pathogenesis, in order to provide a theoretical basis for the clinical management of breast cancer patients and achieve accurate early intervention as soon as possible.
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Affiliation(s)
- 迪 陈
- 272000 济宁,济宁医学院临床医学院Clinical College of Jining Medical University, Jining 272000, China
| | - 要来 肖
- 272000 济宁,济宁市第一人民医院呼吸与危重症医学科Department of Respiratory and Critical Care Medicine, Jining No.1 People's Hospital, Jining 272000, China
| | - 铠泽 钟
- 272000 济宁,济宁市第一人民医院胸外科Department of Thoracic Surgery, Jining No.1 People's Hospital, Jining 272000, China
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14
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Zeng T, Xu H, Liu Y, Sun C, Yang F, Liang Y, Huang X, Fu Z, Li W, Yin Y. High rate of epidermal growth factor receptor-mutated primary lung cancer in patients with primary breast cancer. Front Oncol 2022; 12:985734. [PMID: 36313724 PMCID: PMC9606206 DOI: 10.3389/fonc.2022.985734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 09/29/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundWith increased survival in breast cancer, resulting from advances in treatment, patients incur the possibility of subsequent primary malignancies, especially lung cancer. The aim of this study was to assess the frequency of CT-detected pulmonary ground-glass nodules and lung cancer following breast cancer diagnosis, the associations between breast cancer and lung cancer, the pathological features of double primary cancer, and the status of epidermal growth factor receptor (EGFR) mutations in second primary lung cancer.MethodsClinical data from more than 9000 individuals who were diagnosed with primary breast cancer at Jiangsu Province Hospital (Jiangsu, China) between January 2008 and December 2021 were retrospectively analyzed.ResultsOf the 9179 patients, 6512 underwent diagnostic CT, 55 (0.8%) were diagnosed with a second primary lung cancer, which accounted for approximately 18.4% of the pulmonary ground-glass nodules (GGNs) detected. The incidence was higher than in the general female population (standardized incidence ratio 1.4 [95% confidence interval (CI): 1.25-1.55]). Patients who experienced a second primary lung cancer exhibited a significantly higher rate of EGFR mutation (78.5%) than those with lung adenocarcinoma alone, with most exhibiting low-grade malignancy, older age, estrogen receptor negativity, low Ki67, and no lymph node metastasis.ConclusionsBreast cancer patients, especially those with low-grade malignancy, were at high risk for developing primary lung cancer. For isolated GGN in patients with high-risk factors, clinicians should insist on close follow-up. Furthermore, EGFR may play an important role in primary lung adenocarcinomas and breast cancer.
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Affiliation(s)
- Tianyu Zeng
- Department of Oncology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Hai Xu
- Department of Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yincheng Liu
- Department of Plastic Surgery, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Chunxiao Sun
- Department of Oncology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Fan Yang
- Department of Oncology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yan Liang
- Department of Oncology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xiang Huang
- Department of Oncology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Ziyi Fu
- Department of Oncology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- Nanjing Maternal and Child Health Medical Institute, Obstetrics and Gynecology Hospital Affiliated of Nanjing Medical University, Nanjing, China
| | - Wei Li
- Department of Oncology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- *Correspondence: Yongmei Yin, ; Wei Li,
| | - Yongmei Yin
- Department of Oncology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- *Correspondence: Yongmei Yin, ; Wei Li,
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15
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Ghosh S, Mishra P, Banerjee S, Maiti K, Khopade A, Misra A, Sawant K, Bhowmick S. Exploration of the cardinal formulation parameters influencing the encapsulation and physicochemical properties of co-loaded anticancer dual drug nanoliposomes. J Drug Deliv Sci Technol 2022. [DOI: 10.1016/j.jddst.2022.103295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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16
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Ragavan M, Patel MI. The evolving landscape of sex-based differences in lung cancer: a distinct disease in women. Eur Respir Rev 2022; 31:210100. [PMID: 35022255 PMCID: PMC9488944 DOI: 10.1183/16000617.0100-2021] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 08/16/2021] [Indexed: 12/11/2022] Open
Abstract
In stark contrast to a few decades ago when lung cancer was predominantly a disease of men who smoke, incidence rates of lung cancer in women are now comparable to or higher than those in men and are rising alarmingly in many parts of the world. Women face a unique set of risk factors for lung cancer compared to men. These include exogenous exposures including radon, prior radiation, and fumes from indoor cooking materials such as coal, in addition to endogenous exposures such as oestrogen and distinct genetic polymorphisms. Current screening guidelines only address tobacco use and likely underrepresent lung cancer risk in women. Women were also not well represented in some of the landmark prospective studies that led to the development of current screening guidelines. Women diagnosed with lung cancer have a clear mortality benefit compared to men even when other clinical and demographic characteristics are accounted for. However, there may be sex-based differences in outcomes and side effects of systemic therapy, particularly with chemotherapy and immunotherapy. Ongoing research is needed to better investigate these differences to address the rapidly changing demographics of lung cancer worldwide.
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Affiliation(s)
- Meera Ragavan
- Division of Hematology/Oncology, Dept of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Manali I Patel
- Division of Oncology, Dept of Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Division of Oncology, VA Palo Alto Healthcare System, Palo Alto, CA, USA
- Dept of Medicine, Center for Health Policy/Primary Care Outcomes Research, Stanford University School of Medicine, Stanford, CA, USA
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17
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Gao Y, Qiu J, Gu L, Yang Y, Kang H, Zhang Y, Zhang S, Zhang Y, Wang H, Zhang Y, Qian J. Secondary primary lung cancer after esophageal cancer: a population-based study of 44,172 patients. Scand J Gastroenterol 2022; 57:222-231. [PMID: 34726133 DOI: 10.1080/00365521.2021.1994639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The present study aimed to assess the survival, incidence, and characteristics of secondary primary lung cancer (SPLC) after esophageal cancer (EC-LC). METHODS The patients with esophageal cancer (EC) who developed SPLC and patients with first primary lung cancer (LC-1) were retrospectively reviewed in the Surveillance, Epidemiology, and End Results 18 registries covering 2000-2016. Overall survival and characteristics were compared between patients with EC-LC and patients with LC-1. The independent relation between a history of EC and death was evaluated by calculating hazard ratios in multivariate Cox regression analysis propensity score-matching analysis, and multiple imputation for cases with missing information. RESULTS In comparison with the general population, the patients with EC had a higher risk for developing secondary primary lung cancer (SIR =1.86, 95% confidence interval (CI): 1.69-2.05). A history of EC was found to be an independent risk factor of death for lung squamous carcinoma (LUSC) and lung adenocarcinoma (LUAD) patients in localized stage based on multivariate Cox regression analysis, propensity score-matching analysis and multiple imputation. CONCLUSIONS There is a significantly increased risk of secondary primary lung cancer in EC survivors and a history of EC adversely affects overall survival in individuals who subsequently develop localized LUSC and LUAD. Clinicians should moderately strengthen lung tissue protection during the management of EC patients.
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Affiliation(s)
- Yadong Gao
- Department of Gastroenterology, Affiliated Hospital 2 of Nantong University, Nantong, Jiangsu, China.,Department of Gastroenterology, the First People's Hospital of Nantong, Nantong, Jiangsu, China.,Medical Research Center, Affiliated Hospital 2 of Nantong University, Nantong, Jiangsu, China.,Nantong Clinical College of Kangda College, Nanjing Medical University, Nantong, Jiangsu, China
| | - Jianwei Qiu
- Department of Gastroenterology, Affiliated Hospital 2 of Nantong University, Nantong, Jiangsu, China.,Department of Gastroenterology, the First People's Hospital of Nantong, Nantong, Jiangsu, China.,Medical Research Center, Affiliated Hospital 2 of Nantong University, Nantong, Jiangsu, China
| | - Liugen Gu
- Department of Gastroenterology, Affiliated Hospital 2 of Nantong University, Nantong, Jiangsu, China.,Department of Gastroenterology, the First People's Hospital of Nantong, Nantong, Jiangsu, China
| | - Yanmei Yang
- Department of Gastroenterology, Affiliated Hospital 2 of Nantong University, Nantong, Jiangsu, China.,Department of Gastroenterology, the First People's Hospital of Nantong, Nantong, Jiangsu, China.,Medical Research Center, Affiliated Hospital 2 of Nantong University, Nantong, Jiangsu, China
| | - Haifeng Kang
- Department of Gastroenterology, Affiliated Hospital 2 of Nantong University, Nantong, Jiangsu, China.,Department of Gastroenterology, the First People's Hospital of Nantong, Nantong, Jiangsu, China
| | - Yong Zhang
- Medical Research Center, Affiliated Hospital 2 of Nantong University, Nantong, Jiangsu, China
| | - Shenglai Zhang
- Department of Gastroenterology, Affiliated Hospital 2 of Nantong University, Nantong, Jiangsu, China.,Department of Gastroenterology, the First People's Hospital of Nantong, Nantong, Jiangsu, China
| | - Yan Zhang
- Department of Gastroenterology, Affiliated Hospital 2 of Nantong University, Nantong, Jiangsu, China.,Department of Gastroenterology, the First People's Hospital of Nantong, Nantong, Jiangsu, China.,Medical Research Center, Affiliated Hospital 2 of Nantong University, Nantong, Jiangsu, China
| | - Huimin Wang
- Department of Cardiovasology, Affiliated Hospital 2 of Nantong University, Nantong, Jiangsu, China
| | - Yi Zhang
- Department of Neurosurgery, Affiliated Hospital 2 of Nantong University, Nantong, Jiangsu, China
| | - Junbo Qian
- Department of Gastroenterology, Affiliated Hospital 2 of Nantong University, Nantong, Jiangsu, China.,Department of Gastroenterology, the First People's Hospital of Nantong, Nantong, Jiangsu, China.,Medical Research Center, Affiliated Hospital 2 of Nantong University, Nantong, Jiangsu, China
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18
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Nimkar A, Mandel M, Buyuk A, Stavropoulos C, Naaraayan A. Spindle Cell Hemangioma of the Lung: A Case Report. Cureus 2022; 14:e21191. [PMID: 35178307 PMCID: PMC8842454 DOI: 10.7759/cureus.21191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2022] [Indexed: 11/05/2022] Open
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19
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Rosenberg J, Butow PN, Shaw JM. The untold story of late effects: a qualitative analysis of breast cancer survivors' emotional responses to late effects. Support Care Cancer 2022; 30:177-185. [PMID: 34245359 DOI: 10.1007/s00520-021-06402-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 06/26/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE Breast cancer survivors are at increased risk of adverse outcomes, called late effects, years after the completion of active treatment. Late effects can significantly impair physical functioning. The current study aimed to explore breast cancer survivors' experiences of late effects, their emotional responses to existing or potential late effects and their perceived impact. METHODS A total of 36 women treated for breast cancer in the last 10 years participated in semi-structured telephone interviews. Participant views were sought with respect to knowledge, experience, and perceived longer-term risk. A thematic analysis was conducted. RESULTS Four themes emerged from the data: (1) late effects awareness, (2) framing and coping, (3) uncertainty and (4) management. There was a range of emotional responses to late effects; however, many participants reported being unaware of their risk of late effects. Participants conceptualised late effects as any long-term effect of treatment regardless of the time of onset. Women reported living with constant uncertainty and feared cancer recurrence. Many were focused on managing long-term treatment side effects, rather than late effects. CONCLUSION Many women undergo treatment and remain unaware of associated late effect risks. National guidelines recommend patients be informed about late effects; however, the results of this study suggest a gap between policy and practice. Evidence-based interventions are needed to equip women with strategies to physically and emotionally manage late effects.
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Affiliation(s)
- Jodie Rosenberg
- School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia. .,Psycho-Oncology Co-Operative Research Group, School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia.
| | - Phyllis N Butow
- School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia.,Psycho-Oncology Co-Operative Research Group, School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia
| | - Joanne M Shaw
- School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia.,Psycho-Oncology Co-Operative Research Group, School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia
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20
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Long Q, Wang Y, Che G. Primary Lung Cancer After Treatment for Breast Cancer. Int J Womens Health 2021; 13:1217-1225. [PMID: 34908880 PMCID: PMC8665870 DOI: 10.2147/ijwh.s338910] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 11/18/2021] [Indexed: 02/05/2023] Open
Abstract
Breast cancer is the most common malignancy in women and the second most common cause of cancer-related death. Due to advances in the diagnosis and treatment technologies for breast cancer, patients with breast cancer are living longer than before, resulting in an increased risk of developing subsequent malignancies, among which lung cancer is the most common. This review presents the current evidence about the risk, influencing factors and prognostic factors of developing primary lung cancer after treatment for breast cancer. The aim is to help clinicians improve their understanding, diagnosis and treatment of lung cancer after breast cancer.
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Affiliation(s)
- Qian Long
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China
| | - Yan Wang
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China
| | - Guowei Che
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China
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21
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Nobel TB, Carr RA, Caso R, Livschitz J, Nussenzweig S, Hsu M, Tan KS, Sihag S, Adusumilli PS, Bott MJ, Downey RJ, Huang J, Isbell JM, Park BJ, Rocco G, Rusch VW, Jones DR, Molena D. Primary lung cancer in women after previous breast cancer. BJS Open 2021; 5:6510887. [PMID: 35040941 PMCID: PMC8765335 DOI: 10.1093/bjsopen/zrab115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 10/20/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Breast cancer is the most common malignancy among women in the USA. Improved survival has resulted in increasing incidence of second primary malignancies, of which lung cancer is the most common. The United States Preventive Services Task Force (USPSTF) guidelines for lung-cancer screening do not include previous malignancy as a high-risk feature requiring evaluation. The aim of this study was to compare women undergoing resection for lung cancer with and without a history of breast cancer and to assess whether there were differences in stage at diagnosis, survival and eligibility for lung-cancer screening between the two groups. METHODS Women who underwent lung-cancer resection between 2000 and 2017 were identified. Demographic, clinicopathological, treatment and outcomes data were compared between patients with a history of breast cancer (BC-Lung) and patients without a history of breast cancer (P-Lung) before lung cancer. RESULTS Of 2192 patients included, 331 (15.1 per cent) were in the BC-Lung group. The most common method of lung-cancer diagnosis in the BC-Lung group was breast-cancer surveillance or work-up imaging. Patients in the BC-Lung group had an earlier stage of lung cancer at the time of diagnosis. Five-year overall survival was not statistically significantly different between groups (73.3 per cent for both). Overall, 58.4 per cent of patients (1281 patients) had a history of smoking, and 33.3 per cent (731 patients) met the current criteria for lung-cancer screening. CONCLUSION Differences in stage at diagnosis of lung cancer and treatment selection were observed between patients with and without a history of breast cancer. Overall, there were no statistically significant differences in genomic or oncogenic pathway alterations between the two groups, which suggests that lung cancer in patients who previously had breast cancer may not be affected at the genomic level by the previous breast cancer. The most important finding of the study was that a high percentage of women with lung cancer, regardless of breast-cancer history, did not meet the current USPSTF criteria for lung-cancer screening.
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Affiliation(s)
- Tamar B Nobel
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Rebecca A Carr
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Raul Caso
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jennifer Livschitz
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Samuel Nussenzweig
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Meier Hsu
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Kay See Tan
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Smita Sihag
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Prasad S Adusumilli
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Matthew J Bott
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Robert J Downey
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - James Huang
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - James M Isbell
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Bernard J Park
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Gaetano Rocco
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Valerie W Rusch
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - David R Jones
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Daniela Molena
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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22
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Bao S, Jiang M, Wang X, Hua Y, Zeng T, Yang Y, Yang F, Yan X, Sun C, Yang M, Fu Z, Huang X, Li J, Wu H, Li W, Tang J, Yin Y. Nonmetastatic breast cancer patients subsequently developing second primary malignancy: A population-based study. Cancer Med 2021; 10:8662-8672. [PMID: 34643330 PMCID: PMC8633251 DOI: 10.1002/cam4.4351] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 09/04/2021] [Accepted: 09/05/2021] [Indexed: 12/24/2022] Open
Abstract
Background With life span extending, breast cancer (BC) survivors may face the possibility of developing second primary cancer (SPC) and considerably shorten survivorship. However, little is known about multiple primary cancer (MPC) patients with nonmetastatic breast cancer as a first primary malignancy (BCFPM). Methods Here, we retrospectively analyzed data on cancer survivors with BCFPM diagnosed between 2010 and 2015 from the Surveillance, Epidemiology, and End Results (SEER) database. The prognostic factors for breast cancer‐specific survival (BCSS) were ascertained by the stepwise regression analysis and a competing risk model, and were integrated to the establishment of prognostic nomogram, of which the accuracy was measured by the calibration curve and the concordance index (C‐index). Results In total, 8616 patients were identified with 4.6% of 3‐year breast cancer‐ specific death (BCSD) and 8.6% of 5‐year BCSD. The most common SPC among BCFPM patients were female BC and lung cancer. Besides, the median latency time between BC and SPC was 22 months. At a ratio of 7:3, all patients were randomly categorized into a training cohort (n = 6032) and a validation cohort (n = 2584). By a proportional subdistribution hazards regression analysis, the following factors were considered to own independent prognostic abilities of BCSS: subtypes, grade, T classification, N classification, radiation, and sites of SPC. The nomogram could accurately predict 3‐year and 5‐year breast cancer‐associated survival of BCFPM patients with high internal and external validated C‐index, 0.715 (95% CI, 0.691–0.739), and 0.683 (95% CI, 0.642–0.724), respectively. Conclusions BC survivors remained a high risk of developing SPC and considerably shortened survival time. In this study, a favorable nomogram was constructed to as a prediction model for 3‐year and 5‐year BCSS of BCFPM patients, largely intending to prolong the life of these patients by assisting clinicians to make individualized follow‐up plans.
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Affiliation(s)
- Shengnan Bao
- Department of Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.,The First Clinical College of Nanjing Medical University, Nanjing, China
| | - Mengping Jiang
- Department of Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.,The First Clinical College of Nanjing Medical University, Nanjing, China
| | - Xi Wang
- Department of Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.,The First Clinical College of Nanjing Medical University, Nanjing, China
| | - Yijia Hua
- Department of Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.,The First Clinical College of Nanjing Medical University, Nanjing, China
| | - Tianyu Zeng
- Department of Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.,The First Clinical College of Nanjing Medical University, Nanjing, China
| | - Yiqi Yang
- Department of Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.,The First Clinical College of Nanjing Medical University, Nanjing, China
| | - Fan Yang
- Department of Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.,The First Clinical College of Nanjing Medical University, Nanjing, China
| | - Xueqi Yan
- Department of Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.,The First Clinical College of Nanjing Medical University, Nanjing, China
| | - Chunxiao Sun
- Department of Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Mengzhu Yang
- Department of Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Ziyi Fu
- Department of Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xiang Huang
- Department of Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jun Li
- Department of Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Hao Wu
- Department of Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Wei Li
- Department of Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jinhai Tang
- Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yongmei Yin
- Department of Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.,Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Personalized Cancer Medicine, Nanjing Medical University, Nanjing, China
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23
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Triple negative breast cancer and non-small cell lung cancer: Clinical challenges and nano-formulation approaches. J Control Release 2021; 337:27-58. [PMID: 34273417 DOI: 10.1016/j.jconrel.2021.07.014] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 07/08/2021] [Accepted: 07/10/2021] [Indexed: 02/06/2023]
Abstract
Triple negative breast cancer (TNBC) and non-small cell lung cancer (NSCLC) are amongst the most aggressive forms of solid tumors. TNBC is highlighted by absence of genetic components of progesterone receptor, HER2/neu and estrogen receptor in breast cancer. NSCLC is characterized by integration of malignant carcinoma into respiratory system. Both cancers are associated with poor median and overall survival rates with low progression free survival with high incidences of relapse. These cancers are characterized by tumor heterogeneity, genetic mutations, generation of cancer-stem cells, immune-resistance and chemoresistance. Further, these neoplasms have been reported for tumor cross-talk into second primary cancers for each other. Current chemotherapeutic regimens include usage of multiple agents in tandem to affect tumor cells through multiple mechanisms with various such combinations being clinically tested. However, lack of controlled delivery and effective temporospatial presence of chemotherapeutics has resulted in suboptimal therapeutic response. Consequently, passive targeted albumin bound paclitaxel and PEGylated liposomal doxorubicin have been clinically used and tested with newer drugs for improved therapeutic efficacy in these cancers. Active targeting of nanocarriers against surface overexpressed proteins in both neoplasms have been explored. However, use of single agent nanoparticulate formulations against both cancers have failed to elicit desired outcomes. This review aims to identify clinical unmet need in these cancers while establishing a correlation with tested nano-formulation approaches and issues with preclinical to clinical translation. Lipid and polymer-based drug-drug and drug-gene combinatorial nanocarriers delivering multiple chemotherapeutics simultaneously to desired site of action have been detailed. Finally, emerging opportunities such as pharmacological targets (immune check point and epigentic modulators) as well as gene-based modulation (siRNA/CRISPR/Cas9) and the nano-formulation challenges for effective treatment of both cancers have been explored.
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24
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Wang Y, Li J, Chang S, Dong Y, Che G. Risk and Influencing Factors for Subsequent Primary Lung Cancer After Treatment of Breast Cancer: A Systematic Review and Two Meta-Analyses Based on Four Million Cases. J Thorac Oncol 2021; 16:1893-1908. [PMID: 34256110 DOI: 10.1016/j.jtho.2021.07.001] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 07/03/2021] [Accepted: 07/04/2021] [Indexed: 02/05/2023]
Abstract
INTRODUCTION To compare the risk of developing lung cancer between patients with breast cancer and the general population and explore the risk factors for the development of primary lung cancer after treatment for breast cancer. METHODS The PubMed, EMBASE, and Web of Science databases were searched from the establishment date to October 11, 2020. Two separate meta-analyses were performed: one focused on studies reporting the risk of subsequent lung cancer after breast cancer and one focused on studies exploring the risk factors for subsequent lung cancer in patients with breast cancer. The standardized incidence ratios with 95% confidence intervals were combined to compare the risk of developing lung cancer between patients with breast cancer and the general population. The relative risks (RRs) or ORs with 95% confidence intervals were combined to assess the association of clinicopathological parameters with the risk of developing lung cancer after breast cancer. All statistical analyses were conducted by STATA 12.0. RESULTS A total of 15 studies involving 1,161,979 patients were eventually included in the first meta-analysis, and the pooled results indicated that female patients with breast cancer revealed a significantly higher risk of developing subsequent lung cancer (standardized incidence ratio = 1.25, p < 0.001). In addition, a total of 22 articles involving 3,090,620 patients were included in the second meta-analysis. The pooled results indicated that smoking (OR = 9.73, p < 0.001) and radiotherapy (RR = 1.40, p < 0.001) were risk factors for developing subsequent lung cancer in patients with breast cancer, and chemotherapy (RR = 0.69, p = 0.002), positive estrogen receptor status (RR = 0.93, p = 0.014) and positive progesterone receptor status (RR = 0.86, p < 0.001) were protective factors. Meanwhile, subgroup analysis based on the relative position of the breast and lung cancers (ipsilateral versus contralateral) was conducted, which indicated that radiotherapy only increased the risk of ipsilateral lung cancer in patients with breast cancer (RR = 1.27, p = 0.001). CONCLUSIONS Patients with breast cancer are more likely to develop lung cancer than the general population, and the risk of developing primary lung cancer after breast cancer is affected by smoking, radiotherapy, chemotherapy, estrogen receptor status and progesterone receptor status.
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Affiliation(s)
- Yan Wang
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Jialong Li
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Shuai Chang
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Yingxian Dong
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Guowei Che
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China.
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25
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Wang Y, Li J, Chang S, Dong Y, Che G. Prognostic Characteristics of Operated Breast Cancer Patients with Second Primary Lung Cancer: A Retrospective Study. Cancer Manag Res 2021; 13:5309-5316. [PMID: 34262340 PMCID: PMC8275045 DOI: 10.2147/cmar.s312419] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 06/09/2021] [Indexed: 02/05/2023] Open
Abstract
Background and Purpose The number of breast cancer patients with second primary lung cancer is increasing year by year. The aim of this study was to explore the prognostic characteristics of these multiple primary breast and lung cancer patients. Methods Operated breast cancer patients with subsequent lung cancer who were admitted to our hospital from January, 2010 to August, 2020 were retrospectively analyzed. The univariate and multivariate Cox regression analyses were conducted to explore the prognostic risk factors of such patients. Meanwhile, the propensity score match (PSM) method was applied to compare the prognosis between lung cancer patients with and without the history of breast cancer. Results A total of 137 cases were included and most of them (94.9%) were asynchronous multiple primary carcinomas. The median interval between the diagnoses of breast cancer and lung cancer was 60 months (2-456 months), median age at the diagnosis of breast cancer was 49.5 (28-81) years old and median age at the diagnosis of lung cancer was 58 (31-84) years old. Univariate and multivariate Cox regression analysis indicated that poor differentiation [hazard ratio (HR)=6.372, 95% confidence interval (CI): 2.441-16.633, P<0.001] and pTNM stage III/IV (HR=5.830, 95% CI: 2.295-14.813, P<0.001) of lung cancer were independent prognostic risk factors for these patients. Before and after the PSM, the overall survival (OS) of lung cancer patients with breast cancer was significantly worse than that of single primary lung cancer patients (P<0.001, P=0.002). Conclusion Differentiation status and pTNM stage were independent prognostic factors in operated breast cancer patients with second primary lung cancer. Meanwhile, the prognosis of this group of patients was worse than single primary lung cancer patients, which indicated that the medical history of breast cancer was also a prognostic risk factor of female lung cancer patients.
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Affiliation(s)
- Yan Wang
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Jialong Li
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Shuai Chang
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Yingxian Dong
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Guowei Che
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
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26
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Wennstig AK, Wadsten C, Garmo H, Johansson M, Fredriksson I, Blomqvist C, Holmberg L, Nilsson G, Sund M. Risk of primary lung cancer after adjuvant radiotherapy in breast cancer-a large population-based study. NPJ Breast Cancer 2021; 7:71. [PMID: 34075042 PMCID: PMC8169889 DOI: 10.1038/s41523-021-00280-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 05/11/2021] [Indexed: 11/24/2022] Open
Abstract
Adjuvant radiotherapy (RT) for breast cancer (BC) has been associated with an increased risk of later radiation-induced lung cancer (LC). We examined the risk of primary LC in a population-based cohort of 52300 women treated for BC during 1992 to 2012, and 253796 age-matched women without BC. Cumulative incidence of LC was calculated by the Kaplan-Meier method, and the risk of LC after BC treatment was estimated by Cox proportional hazards regression analyses. Women with BC receiving RT had a higher cumulative incidence of LC compared to women with BC not receiving RT and women without BC. This became apparent 5 years after RT and increased with longer follow-up. Women with BC receiving RT had a Hazard ratio of 1.59 (95% confidence interval 1.37-1.84) for LC compared to women without BC. RT techniques that lower the incidental lung doses, e.g breathing adaption techniques, may lower this risk.
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Affiliation(s)
- Anna-Karin Wennstig
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden.
- Department of Oncology, Sundsvall Hospital, Sundsvall, Sweden.
| | - Charlotta Wadsten
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
- Department of Surgery, Sundsvall Hospital, Sundsvall, Sweden
| | - Hans Garmo
- Regional Cancer Center, Uppsala University/ Uppsala University Hospital, Uppsala, Sweden
| | | | - Irma Fredriksson
- Department of Breast-and Endocrine Surgery, Karolinska University Hospital, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Carl Blomqvist
- Department of Oncology, Örebro University, University Hospital, Örebro, Sweden
| | - Lars Holmberg
- Translational Oncology & Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Greger Nilsson
- Department of Immunology, Genetics and Pathology, Section of Experimental and Clinical Oncology, Uppsala University, University Hospital, Uppsala, Sweden
- Department of Oncology, Gävle Hospital, Gävle, Sweden
- Department of Oncology, Visby Hospital, Visby, Sweden
| | - Malin Sund
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
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27
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Wang KY, Newman J, Lee CS, Seetharamu N. Epidemiology and clinicopathological features of lung cancer in patients with prior history of breast cancer. SAGE Open Med 2021; 9:20503121211017757. [PMID: 34104436 PMCID: PMC8155786 DOI: 10.1177/20503121211017757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 03/25/2021] [Indexed: 11/16/2022] Open
Abstract
Breast cancer is the most common malignancy in women, and lung cancer, the leading cause of cancer-related mortality in the United States, is the most common subsequent primary cancer among breast cancer survivors. In this review, we examine the risk factors that cause subsequent primary lung cancer after breast cancer (referred to herein as BCLC patients) as well as the prognostic factors that may affect survival. Notable clinicopathological features include patient characteristics such as age, smoking history, and the presence of EGFR or BRCA mutations, as well as factors related to the treatment of breast cancer such as radiation, surgery, chemotherapy, stage, anti-estrogen therapy, and ER/PR/HER2 status.
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Affiliation(s)
- Kevin Y Wang
- Department of Internal Medicine, Northshore University Hospital, Manhasset, NY, USA
| | - James Newman
- Department of Hematology Oncology, Northshore University Hospital, Manhasset, NY, USA
| | - Chung-Shien Lee
- St. John's University College of Pharmacy and Health Sciences, Queens, NY, USA
| | - Nagashree Seetharamu
- Department of Hematology Oncology, Northshore University Hospital, Manhasset, NY, USA
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28
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Abera SF, Mikolajczyk RT, Kantelhardt EJ, Efremov L, Bedir A, Ostheimer C, Glowka A, Vordermark D, Medenwald D. Lung Cancer Attributed Mortality Among 316,336 Early Stage Breast Cancer Cases Treated by Radiotherapy and/or Chemotherapy, 2000-2015: Evidence From the SEER Database. Front Oncol 2021; 10:602397. [PMID: 33718108 PMCID: PMC7947230 DOI: 10.3389/fonc.2020.602397] [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: 09/03/2020] [Accepted: 11/02/2020] [Indexed: 11/13/2022] Open
Abstract
Objective To estimate the risk of death from lung cancer in patients treated for breast cancer (BC) in relation to the general population. Methods BC data, covering 2000 to 2015, were extracted from the Surveillance, Epidemiology and End Results-18 (SEER-18) cancer registry database. A comparison of lung cancer attributed mortality between BC patients and the general population was performed using standardized mortality ratios (SMRs) and SMRs conditional on survival length (cSMRs). Prognostic factors of lung cancer mortality were identified using flexible parametric modelling. Our model adjusts the effect of downstream (histopathological BC tumor grade and hormone receptor status) and upstream (age at diagnosis, ethnicity, and marital status) factors. Results The median follow-up was 6.4 years (interquartile range, 3.0–10.3 years). BC cases who received only radiotherapy (cSMR = 0.93; 95%CI: 0.77–1.13), only chemotherapy (cSMR = 0.91; 0.62–1.33), and radio-and chemotherapy (cSMR = 1.04; 0.77–1.39) had no evidence of increased lung cancer mortality relative to the general population. The adjusted model identified that lung cancer mortality was higher for women who were older at diagnosis compared to those <50 years (ranging from HR50-59 = 3.41 [95%CI: 2.72–4.28] to HR70-79 = 10.53 [95%CI: 8.44–13.13]) and for cases with negative estrogen and progesterone receptors (HR =1.38; 95% CI: 1.21–1.57). Compared to married cases, widowed, divorced, single or others had a 76%, 45%, and 25% higher hazard of lung cancer mortality, respectively. Lung cancer mortality was lower for American Indian/Alaska Native and Asian/Pacific Islander ethnicities (HR = 0.51; 95% CI: 0.40–0.64) compared to BC cases with white ethnic background. Conclusions There is no evidence for a higher lung cancer mortality in BC patients when compared to the general population.
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Affiliation(s)
- Semaw Ferede Abera
- Department of Radiation Oncology, Faculty of Medicine, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Rafael T Mikolajczyk
- Institute for Medical Epidemiology, Biometrics and Informatics (IMEBI), Interdisciplinary Center for Health Sciences, Medical School of the Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Eva Johanna Kantelhardt
- Institute for Medical Epidemiology, Biometrics and Informatics (IMEBI), Interdisciplinary Center for Health Sciences, Medical School of the Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany.,Department of Gynaecology, Faculty of Medicine, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Ljupcho Efremov
- Department of Radiation Oncology, Faculty of Medicine, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany.,Institute for Medical Epidemiology, Biometrics and Informatics (IMEBI), Interdisciplinary Center for Health Sciences, Medical School of the Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Ahmed Bedir
- Department of Radiation Oncology, Faculty of Medicine, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Christian Ostheimer
- Department of Radiation Oncology, Faculty of Medicine, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - André Glowka
- Department of Radiation Oncology, Faculty of Medicine, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Dirk Vordermark
- Department of Radiation Oncology, Faculty of Medicine, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Daniel Medenwald
- Department of Radiation Oncology, Faculty of Medicine, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany.,Institute for Medical Epidemiology, Biometrics and Informatics (IMEBI), Interdisciplinary Center for Health Sciences, Medical School of the Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
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29
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Chaturvedi VK, Rai SN, Tabassum N, Yadav N, Singh V, Bohara RA, Singh MP. Rapid eco-friendly synthesis, characterization, and cytotoxic study of trimetallic stable nanomedicine: A potential material for biomedical applications. Biochem Biophys Rep 2020; 24:100812. [PMID: 33083576 PMCID: PMC7551978 DOI: 10.1016/j.bbrep.2020.100812] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 08/27/2020] [Accepted: 08/31/2020] [Indexed: 12/17/2022] Open
Abstract
In the current scenario of the fight against cancer Integration of potential elements seems to be the best alternative since it overcomes the weaknesses of individuals and the combination of elements makes them formidable in the fight against the cancer war. Inspired by this objective and trusting our knowledge of paddy straw grown oyster mushroom, Pleurotus florida (Pf) mediated synthesis; a first-of-kind approach has been developed for the rapid synthesis of Au-Pt-Ag trimetallic nanoparticles (TMNPs). The developed method was successful, which was confirmed by Ultraviolet-Visible, X-ray diffraction, Transmission Electron Microscopy, Energy Dispersive Spectroscopy. Specifically, prepared TMNPs have been studied for their stability and size as a primary prerequisite for nanomedicine. Finally, the stable nanomedicine developed has been assessed for its performance against the highly metastatic breast cancer cell line (mda-mb-231). The performance was assessed using MTT assay and morphological readings, which were integrated with the cell viability data. We also determined the IC50 value, which was far superior to individual components and motivated us to postulate the possible breast cancer cell killing mechanism of TMNPs. The present study unlocks the new paths for the mushroom-mediated environmentally friendly, economic synthesis of trimetallic nanoparticles, which can be effectively used in cancer nanomedicine.
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Affiliation(s)
| | - Sachchida Nand Rai
- Centre of Biotechnology, University of Allahabad, Prayagraj, 211002, India
| | - Nazish Tabassum
- Centre of Biotechnology, University of Allahabad, Prayagraj, 211002, India
| | - Navneet Yadav
- Department of Physics, University of Allahabad, Prayagraj, 211002, India
| | - Veer Singh
- School of Bio-Chemical Engineering, IIT-BHU, Varanasi, 221005, India
| | - Raghvendra A. Bohara
- CÚRAM, SFI Research Centre for Medical Devices, National University of Ireland, Galway, Ireland
- Centre for Interdisciplinary Research, D.Y. Patil Education Society (Institution Deemed to be University), Kolhapur, 416006, MS, India
| | - Mohan P. Singh
- Centre of Biotechnology, University of Allahabad, Prayagraj, 211002, India
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30
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Ghosh S, Lalani R, Maiti K, Banerjee S, Patel V, Bhowmick S, Misra A. Optimization and efficacy study of synergistic vincristine coloaded liposomal doxorubicin against breast and lung cancer. Nanomedicine (Lond) 2020; 15:2585-2607. [DOI: 10.2217/nnm-2020-0169] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Aim: To improve the efficacy of poly-ethylene glycol (PEG)ylated liposomes coloaded with doxorubicin and vincristine against triple-negative breast cancer (TNBC) and non-small-cell lung cancer (NSCLC). Methods: The combinatorial index of the drugs was established using the Chou-Talalay method in MDA-MB-231 and A549 cell lines. The most effective ratio was co-encapsulated in factorial design optimized nanoliposomes which were characterized for similarity to clinical standard and evaluated in vitro and in vivo for therapeutic efficacy. Results & conclusion: The formulation exhibited more than 95% co-encapsulation, a size of 95.74 ± 2.65 nm and zeta potential of -9.17 ± 1.19 mV while having no significant differences in physicochemical and biochemical characteristics as compared with the clinical standard. Efficacy evaluation studies showed significantly improved cytotoxicity and tumor regression compared with liposomal doxorubicin indicating improvement in efficacy against TNBC and NSCLC.
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Affiliation(s)
- Saikat Ghosh
- Department of Pharmaceutics, Faculty of Pharmacy, Kalabhavan Campus, The Maharaja Sayajirao University of Baroda, Vadodara, Gujarat - 390001, India
- Formulation Research & Development Department, Sun Pharmaceutical Industries Ltd, Vadodara, Gujarat-390012, India
| | - Rohan Lalani
- Department of Pharmaceutics, Faculty of Pharmacy, Kalabhavan Campus, The Maharaja Sayajirao University of Baroda, Vadodara, Gujarat - 390001, India
| | - Kuntal Maiti
- Formulation Research & Development Department, Sun Pharmaceutical Industries Ltd, Vadodara, Gujarat-390012, India
| | - Shubhadeep Banerjee
- Formulation Research & Development Department, Sun Pharmaceutical Industries Ltd, Vadodara, Gujarat-390012, India
| | - Vivek Patel
- Department of Pharmaceutics, Faculty of Pharmacy, Kalabhavan Campus, The Maharaja Sayajirao University of Baroda, Vadodara, Gujarat - 390001, India
| | - Subhas Bhowmick
- Department of Pharmaceutics, Faculty of Pharmacy, Kalabhavan Campus, The Maharaja Sayajirao University of Baroda, Vadodara, Gujarat - 390001, India
- Formulation Research & Development Department, Sun Pharmaceutical Industries Ltd, Vadodara, Gujarat-390012, India
| | - Ambikanandan Misra
- Department of Pharmaceutics, Faculty of Pharmacy, Kalabhavan Campus, The Maharaja Sayajirao University of Baroda, Vadodara, Gujarat - 390001, India
- Pharmaceutical Research, Shobhaben Pratapbhai Patel School of Pharmacy & Technology Management, SVKM's NMIMS University, VL Mehta Road, Vile Parle (W), Mumbai, Maharashtra - 400 056, Maharashtra India
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31
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Ghosh S, Lalani R, Maiti K, Banerjee S, Bhatt H, Bobde YS, Patel V, Biswas S, Bhowmick S, Misra A. Synergistic co-loading of vincristine improved chemotherapeutic potential of pegylated liposomal doxorubicin against triple negative breast cancer and non-small cell lung cancer. NANOMEDICINE-NANOTECHNOLOGY BIOLOGY AND MEDICINE 2020; 31:102320. [PMID: 33075540 DOI: 10.1016/j.nano.2020.102320] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 08/06/2020] [Accepted: 10/06/2020] [Indexed: 11/15/2022]
Abstract
The current work aims to explore the biological characteristics of vincristine synergistic co-loading into pegylated liposomal doxorubicin in non-indicated modalities of non-small cell lung cancer (NSCLC) and triple negative breast cancer (TNBC). The combinatorial liposome prepared by active co-loading of the drugs against modified ammonium ion gradient exhibited 95% encapsulation of both drugs. The cellular uptake studies using confocal microscopy and flow cytometry showed significantly increased uptake of dual drug formulation as against liposomal doxorubicin. The co-loaded liposome formulation had significantly increased cell cycle arrest in G2/M phase with subsequent apoptosis and reduced cell viability in both tumor cell lines than doxorubicin liposome. This carrier exhibited similar acute toxicity, pharmacokinetic and tissue distribution profiles with significant increase in tumor regression as compared to liposomal doxorubicin. These results indicate that co-encapsulation of vincristine into clinically used pegylated liposomal doxorubicin significantly improved in-vitro and in-vivo therapeutic efficacy against NSCLC and TNBC.
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Affiliation(s)
- Saikat Ghosh
- Department of Pharmaceutics, Faculty of Pharmacy, Kalabhavan Campus, The Maharaja Sayajirao University of Baroda, Vadodara, Gujarat, India; Formulation Development Department - Novel Drug Delivery Systems, Sun Pharmaceutical Industries Ltd, Vadodara, Gujarat, India
| | - Rohan Lalani
- Department of Pharmaceutics, Faculty of Pharmacy, Kalabhavan Campus, The Maharaja Sayajirao University of Baroda, Vadodara, Gujarat, India
| | - Kuntal Maiti
- Department of Pharmaceutics, Faculty of Pharmacy, Kalabhavan Campus, The Maharaja Sayajirao University of Baroda, Vadodara, Gujarat, India; Formulation Development Department - Novel Drug Delivery Systems, Sun Pharmaceutical Industries Ltd, Vadodara, Gujarat, India
| | - Shubhadeep Banerjee
- Formulation Development Department - Novel Drug Delivery Systems, Sun Pharmaceutical Industries Ltd, Vadodara, Gujarat, India
| | - Himanshu Bhatt
- Department of Pharmacy, Birla Institute of Technology & Science-Pilani, Hyderabad Campus, Medchal, Hyderabad, Telangana, India
| | - Yamini Shankar Bobde
- Department of Pharmacy, Birla Institute of Technology & Science-Pilani, Hyderabad Campus, Medchal, Hyderabad, Telangana, India
| | - Vivek Patel
- Department of Pharmaceutics, Faculty of Pharmacy, Kalabhavan Campus, The Maharaja Sayajirao University of Baroda, Vadodara, Gujarat, India
| | - Swati Biswas
- Department of Pharmacy, Birla Institute of Technology & Science-Pilani, Hyderabad Campus, Medchal, Hyderabad, Telangana, India
| | - Subhas Bhowmick
- Department of Pharmaceutics, Faculty of Pharmacy, Kalabhavan Campus, The Maharaja Sayajirao University of Baroda, Vadodara, Gujarat, India; Formulation Development Department - Novel Drug Delivery Systems, Sun Pharmaceutical Industries Ltd, Vadodara, Gujarat, India.
| | - Ambikanandan Misra
- Department of Pharmaceutics, Faculty of Pharmacy, Kalabhavan Campus, The Maharaja Sayajirao University of Baroda, Vadodara, Gujarat, India; Pharmaceutical Research, Shobhaben Pratapbhai Patel School of Pharmacy & Technology Management, SVKM's NMIMS University, Mumbai, Maharashtra, India.
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Bian K, Zhou M, Hu F, Lai W. RF-PCA: A New Solution for Rapid Identification of Breast Cancer Categorical Data Based on Attribute Selection and Feature Extraction. Front Genet 2020; 11:566057. [PMID: 33033496 PMCID: PMC7510777 DOI: 10.3389/fgene.2020.566057] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 08/19/2020] [Indexed: 11/29/2022] Open
Abstract
Breast cancer is one of the most common cancer diseases in women. The rapid and accurate diagnosis of breast cancer is of great significance for the treatment of cancer. Artificial intelligence and machine learning algorithms are used to identify breast malignant tumors, which can effectively solve the problems of insufficient recognition accuracy and long time-consuming in traditional breast cancer diagnosis methods. To solve these problems, we proposed a method of attribute selection and feature extraction based on random forest (RF) combined with principal component analysis (PCA) for rapid and accurate diagnosis of breast cancer. Firstly, RF was used to reduce 30 attributes of breast cancer categorical data. According to the average importance of attributes and out of bag error, 21 relatively important attribute data were selected for feature extraction based on PCA. The seven features extracted from PCA were used to establish an extreme learning machine (ELM) classification model with different activation functions. By comparing the classification accuracy and training time of these different models, the activation function of the hidden layer was determined as the sigmoid function. When the number of neurons in the hidden layer was 27, the accuracy of the test set was 98.75%, the accuracy of the training set was 99.06%, and the training time was only 0.0022 s. Finally, in order to verify the superiority of this method in breast cancer diagnosis, we compared with the ELM model based on the original breast cancer data and other intelligent classification algorithm models. The algorithm used in this article has a faster recognition time and a higher recognition accuracy than other algorithms. We also used the breast cancer data of breast tissue reactance features to verify the reliability of this method, and ideal results were obtained. The experimental results show that RF-PCA combined with ELM can significantly reduce the time required for the diagnosis of breast cancer, which has the ability of rapid and accurate identification of breast cancer and provides a theoretical basis for the intelligent diagnosis of breast cancer.
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Affiliation(s)
- Kai Bian
- School of Electrical and Information Engineering, Anhui University of Science and Technology, Huainan, China
| | - Mengran Zhou
- School of Electrical and Information Engineering, Anhui University of Science and Technology, Huainan, China.,State Key Laboratory of Mining Response and Disaster Prevention and Control in Deep Coal Mines, Anhui University of Science and Technology, Huainan, China
| | - Feng Hu
- School of Electrical and Information Engineering, Anhui University of Science and Technology, Huainan, China
| | - Wenhao Lai
- School of Electrical and Information Engineering, Anhui University of Science and Technology, Huainan, China
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Coco S, Boccardo S, Mora M, Fontana V, Vanni I, Genova C, Alama A, Salvi S, Dal Bello MG, Bonfiglio S, Rijavec E, Sini C, Barletta G, Biello F, Carli F, Cavalieri Z, Burrafato G, Longo L, Ballestrero A, Grossi F. Radiation-Related Deregulation of TUBB3 and BRCA1/2 and Risk of Secondary Lung Cancer in Women With Breast Cancer. Clin Breast Cancer 2020; 21:218-230.e6. [PMID: 33008754 DOI: 10.1016/j.clbc.2020.09.001] [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: 06/10/2020] [Revised: 08/05/2020] [Accepted: 09/02/2020] [Indexed: 01/15/2023]
Abstract
INTRODUCTION Breast cancer survivors are at increased risk of developing unrelated primary cancers, particularly lung cancer. Evidence indicates that sex hormones as well as a deregulation of DNA-repair pathways may contribute to lung cancer onset. We investigated whether the hormone status and expression of markers involved in DNA repair (BRCA1/2, ERCC1, and P53R2), synthesis (TS and RRM1), and cell division (TUBB3) might be linked to lung cancer risk. PATIENTS AND METHODS Thirty-seven breast cancer survivors with unrelated lung cancer and 84 control subjects comprising women with breast cancer (42/84) or lung cancer (42/84) were enrolled. Immunohistochemistry on tumor tissue was performed. Geometric mean ratio was used to assess the association of marker levels with patient groups. RESULTS Estrogen receptor was expressed in approximately 90% of the breast cancer group but was negative in the majority of the lung cancer group, a result similar to the lung cancer control group. Likewise, ER isoform β was weakly expressed in the lung cancer group. Protein analysis of breast cancer versus control had a significantly lower expression of BRCA1, P53R2, and TUBB3. Likewise, a BRCA1 reduction was observed in the lung cancer group concomitant with a BRCA2 increase. Furthermore, BRCA2 and TUBB3 increased in ipsilateral lung cancer in women who had previously received radiotherapy for breast cancer. CONCLUSION The decrease of DNA-repair proteins in breast cancer could make these women more susceptible to therapy-related cancer. The increase of BRCA2 and TUBB3 in lung cancer from patients who previously received radiotherapy for breast cancer might reflect a tissue response to exposure to ionizing radiation.
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Affiliation(s)
- Simona Coco
- Lung Cancer Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
| | - Simona Boccardo
- Lung Cancer Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | | | - Vincenzo Fontana
- Clinical Epidemiology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Irene Vanni
- Lung Cancer Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy; Department of Internal Medicine and Medical Specialties (DIMI), University of Genoa
| | - Carlo Genova
- Lung Cancer Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy; Department of Internal Medicine and Medical Specialties (DIMI), University of Genoa
| | - Angela Alama
- Lung Cancer Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | | | | | - Silvia Bonfiglio
- Centre for Translational Genomics and Bioinformatics, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Erika Rijavec
- UOC Oncologia Medica, IRCCS Cà Granda Foundation, Ospedale Maggiore Policlinico, Milan, Italy
| | - Claudio Sini
- Oncologia Medica e CPDO, ASSL di Olbia-ATS Sardegna, Olbia, Italy
| | - Giulia Barletta
- Lung Cancer Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | | | | | - Zita Cavalieri
- Lung Cancer Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | | | - Luca Longo
- Lung Cancer Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Alberto Ballestrero
- Department of Internal Medicine and Medical Specialties (DIMI), University of Genoa
| | - Francesco Grossi
- UOC Oncologia Medica, IRCCS Cà Granda Foundation, Ospedale Maggiore Policlinico, Milan, Italy
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Paganetti H, Depauw N, Johnson A, Forman RB, Lau J, Jimenez R. The risk for developing a secondary cancer after breast radiation therapy: Comparison of photon and proton techniques. Radiother Oncol 2020; 149:212-218. [PMID: 32464163 PMCID: PMC11293368 DOI: 10.1016/j.radonc.2020.05.035] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 05/18/2020] [Accepted: 05/19/2020] [Indexed: 01/28/2023]
Abstract
BACKGROUND AND PURPOSE To compare secondary malignancy risks of modern proton and photon therapy techniques for locally advanced breast cancer. METHODS AND MATERIALS We utilized dosimetric data from 34 [10 photon-VMAT, 10 photon-3DCRT, 14 pencil beam scanning proton (PBS)] breast cancer patients who received comprehensive nodal irradiation. Employing a model based on organ equivalent dose to account for both inhomogeneous organ dose distributions and non-linear functional dose relationships, we estimated excess absolute risk, excess relative risk, and lifetime attributable risk (LAR) for secondary malignancies. The model uses dose distribution, number of fractions, age at exposure, attained age, the linear-quadratic dose response relationship for cell survival, repopulation factor, as well as gender specific age dependencies, and initial slopes of dose response curves. RESULTS The LAR for carcinoma at age 70 was estimated to be up to 3.64% for esophagus with an advantage of 3DCRT over PBS and VMAT. For the ipsilateral lung, risks were lowest for PBS (up to 5.56%), followed by 3DCRT (up to 6.54%) and VMAT (up to 7.7%). For the contralateral lung, there is a clear advantage of 3DCRT and PBS techniques (risk <0.86%) over VMAT (up to 4.4%). The risk for the contralateral breast is negligible for 3DCRT and PBS but was estimated as up to 1.2% for VMAT. Risks for the thyroid are overall negligible. Independently performed comparative treatment plans on 10 patients revealed that the risk for the contralateral lung and breast using VMAT can be more than an order of magnitude higher compared to PBS. Sarcoma risks were estimated as well showing similar trends but were overall lower compared to carcinoma. CONCLUSION Conventional (3DCRT) techniques led to the lowest estimated risks of, thyroid and esophageal secondary cancers while PBS demonstrated a benefit for secondary lung and contralateral breast cancer risks, with the highest risks overall associated with VMAT techniques.
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Affiliation(s)
- Harald Paganetti
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States.
| | - Nicolas Depauw
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Andrew Johnson
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, United States
| | - Rachel Beth Forman
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, United States
| | - Jackson Lau
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, United States
| | - Rachel Jimenez
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
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35
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Zhong M, He X, Lei K. Survival of Patients with First and Metachronous Second Primary Breast Cancer or Lung Cancer Malignancy: Comparisons Using the SEER Database. Adv Ther 2020; 37:2236-2245. [PMID: 32274747 DOI: 10.1007/s12325-020-01322-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Breast cancer (BC) and lung cancer (LuC) are common malignancies. The survival of patients with metachronous second primary malignancy (MSPM) of BC and LuC after a first primary of BC and LuC remains unclear. METHODS Data of patients with BC and LuC, with or without MSPM of BC and LuC, who were diagnosed from 2000 to 2014, were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. The baseline characteristics of the different groups were compared using chi-square tests. The survival curves were compared using the log-rank test. Survival analysis was also performed in other malignancies with data extracted from the SEER database using the same method. RESULTS Significant differences in most of the demographics and clinicopathological factors were found between the groups. Patients with LuC with an MSPM of BC (LuC2BC) exhibited better survival than those with LuC (P < 0.001), while patients with BC with an MSPM of LuC (BC2LuC) exhibited worse survival than those with BC (P < 0.001). A similar trend was found in other malignancies. Prostate cancer (PC) followed by thyroid cancer (TC) (PC2TC) and TC followed by PC (TC2PC) did not show an obvious survival trend against their index malignancy (IM). CONCLUSIONS MSPM benefits the IM prognosis if the survival rate of MSPM is better than that of the IM and vice versa. However, the situation is somewhat confusing when the survival differences between MSPM and IM are minimal.
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Affiliation(s)
- Miaochun Zhong
- Department of General Surgery, Zhejiang Provincial People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Xianghong He
- Public Basic Courses Department, Guangdong University of Science and Technology, Dongguan, Guangdong, China
| | - Kefeng Lei
- Department of General Surgery, The 7th Affiliated Hospital of Sun Yat-Sen University, Shenzhen, Guangdong, China.
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36
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Hu Z, Zou X, Qin S, Li Y, Wang H, Yu H, Sun S, Wu X, Wang J, Chang J. Hormone receptor expression correlates with EGFR gene mutation in lung cancer in patients with simultaneous primary breast cancer. Transl Lung Cancer Res 2020; 9:325-336. [PMID: 32420072 PMCID: PMC7225161 DOI: 10.21037/tlcr-20-513] [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] [Indexed: 01/05/2023]
Abstract
Background The coexistence of double primaries of lung cancer (LC) and breast cancer (BC) are not uncommon in women, but there has been limited research conducted of their molecular association. To decipher the internal pathogenesis of LC in patients with concurrent BC and LC, this study explored the clinical factors and relationship between hormone receptor (HR) expression and epidermal growth factor receptor (EGFR) gene mutation. Methods The clinicopathological characteristics of 400 female patients clinically diagnosed with double primary LC and BC at Fudan University Shanghai Cancer Center were collected. Pathological discrimination was performed to further confirm the double primaries in patients with available tissues. LC samples were then examined to detect EGFR gene mutation status by PCR-based assays and HR expression by immunohistochemistry (IHC). As a control cohort, the characteristics of 114 consecutive patients with LC only were compared with the double-primary patient group. Results A total of 169 patients were pathologically confirmed with simultaneous LC and BC between January 2010 and October 2018. The dominant LC subtype was adenocarcinoma (ADC) (95.1%), and invasive ductal carcinoma (IDC) was the main BC subtype (71.0%). Synchronous and metachronous double primary BC-LC cases accounted for 39.1% and 60.9% of the patients, respectively. The absence of family cancer history was associated with a shorter interval between the two primary cancer diagnoses. Among 64 patients with EGFR mutations, 34.4% had HR-positive LC tissue, compared with 0/24 (0%) of those with EGFR wild-type LC (P<0.001). All of the patients with positive HR expression harbored an activating EGFR mutation (n=22); however, no correlation was observed in the control cohort. Conclusions Double primary BC-LC patients have distinctive clinicopathological features compared to those with LC only. The expression of HRs is significantly correlated with EGFR mutation status of LC tissues.
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Affiliation(s)
- Zhihuang Hu
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China.,Institute of Thoracic Oncology, Fudan University, Shanghai 200032, China
| | - Xuan Zou
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Shanshan Qin
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,Center for Tumor Diagnosis and Therapy, Jinshan Hospital of Fudan University, Shanghai 201508, China
| | - Yuan Li
- Institute of Thoracic Oncology, Fudan University, Shanghai 200032, China.,Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai 200032, China
| | - Huijie Wang
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Hui Yu
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Si Sun
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Xianghua Wu
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Jialei Wang
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Jianhua Chang
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China.,Institute of Thoracic Oncology, Fudan University, Shanghai 200032, China
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37
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Smida T, Bruno TC, Stabile LP. Influence of Estrogen on the NSCLC Microenvironment: A Comprehensive Picture and Clinical Implications. Front Oncol 2020; 10:137. [PMID: 32133288 PMCID: PMC7039860 DOI: 10.3389/fonc.2020.00137] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 01/27/2020] [Indexed: 12/15/2022] Open
Abstract
Lung cancer mortality represents the leading cause of cancer related deaths in the United States and worldwide. Almost half of these deaths occur in female patients, making lung cancer the most common cause of cancer mortality in women with a higher annual mortality rate than breast, uterine, and ovarian cancers combined. The distinct epidemiological, histological and biological presentation of non-small cell lung cancer (NSCLC) in women combined with extensive preclinical data have demonstrated that the female sex hormone β-estradiol (E2) plays an important role in NSCLC tumorigenesis, prognosis, and treatment response. Estrogen receptors are widely expressed on stromal and immune cells, and estrogen-linked signaling pathways are known to be involved in regulating the response of both the innate and adaptive immune system. Immune evasion has been recognized as a “hallmark” of cancer and immunotherapy has re-defined standard of care treatment for NSCLC. Despite these advancements, the low response rates observed in patients treated with immune checkpoint inhibitors has led to a search for mediators of immunosuppression and ways to augment the action of these agents. We focus on emerging data describing sex differences that modulate immunotherapy efficacy in NSCLC, immunosuppressive properties of E2 that lead to a pro-tumor microenvironment (TME), and the translational potential of altering the immune microenvironment by targeting the estrogen signaling pathway. E2-induced modulation affects multiple cell types within the TME, including cancer-associated fibroblasts, tumor infiltrating myeloid cells, and tumor infiltrating lymphocytes, all of which interplay with lung tumor cells via E2 and estrogen receptor engagement, ultimately shaping the TME that may, in part, be responsible for the sex-based disparities observed in NSCLC. An improved understanding of the role of the estrogen pathway in NSCLC anti-cancer immunity may lead to novel therapeutic approaches for altering the TME to improve the efficacy of immunotherapy agents.
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Affiliation(s)
- Tanner Smida
- Department of Immunology, University of Pittsburgh, Pittsburgh, PA, United States
| | - Tullia C Bruno
- Department of Immunology, University of Pittsburgh, Pittsburgh, PA, United States.,UPMC Hillman Cancer Center, Pittsburgh, PA, United States
| | - Laura P Stabile
- UPMC Hillman Cancer Center, Pittsburgh, PA, United States.,Department of Pharmacology & Chemical Biology, University of Pittsburgh, Pittsburgh, PA, United States
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38
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Wu J, Ye J, Wu W, Fang D, Wang K, Yang L, Jiang X, Wang Q, Li L. Racial disparities in young-onset patients with colorectal, breast and testicular cancer. J Cancer 2019; 10:5388-5396. [PMID: 31632483 PMCID: PMC6775692 DOI: 10.7150/jca.32435] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 06/11/2019] [Indexed: 12/12/2022] Open
Abstract
Aims: Racial disparities in cancer mortality persist despite rapid developments in cancer treatment strategies. In recent decades, an increased frequency of patients with young-onset cancer has been reported. However, few studies have assessed racial disparities in clinical features and overall survival among young-onset patients with colorectal, breast, and testicular cancer. Therefore, we evaluated racial disparities in cancer mortality for these three cancer types. Methods: We extracted the data of eligible patients from the Surveillance, Epidemiology and End Results (SEER) database from 1973 to 2014. Overall and cancer-specific survival rates were compared among races using Kaplan-Meier curves. Adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated, and the association of race with survival was influenced by marital status, surgery and disease stage in Cox proportional hazard models. Results: We collected the data of 19,574 patients with colorectal cancer, 68,733 with breast cancer, and 26,410 with testicular cancer; all were aged 25-40 years. A higher proportion of Blacks presented with a distant stage at diagnosis compared to Whites and Others (colorectal cancer: 18.0%, 18.5% and 18.4%, respectively, P = 0.004; breast cancer: 3.5%, 6.3% and 4.0%, respectively, P < 0.001; testicular cancer: 6.9%, 10.8% and 8.6%, respectively, P < 0.001). Multivariate analysis showed that Blacks had the highest overall mortality rate (colorectal cancer, HR, 1.277, 95% CI: 1.198, 1.361, P < 0.001; breast cancer, HR, 1.471, 95% CI: 1.420, 1.525, P < 0.001; testicular cancer, HR, 1.887, 95% CI: 1.562, 2.281, P < 0.001). In stratified analyses, Unmarried Blacks had a higher mortality rates (colorectal cancer, HR, 1.318, 95% CI: 1.211, 1.435, P < 0.001; breast cancer, HR, 1.465, 95% CI: 1.394, 1.541, P < 0.001; testicular cancer, HR, 1.944, 95% CI: 1.544, 2.447, P < 0.001). Furthermore, Blacks with colorectal and breast cancer had a higher risk of mortality than Whites at every disease stage, with greatest disparities occurred among individuals at localized stage. The influence of racial disparities on survival was consistent among patients who accepted surgery, but was weak among those who did not undergo surgery for colorectal cancer (Blacks, HR, 1.027, 95% CI: 0.866, 1.219, P = 0.758; Others, HR, 0.919, 95% CI: 0.760, 1.112, P = 0.386) and testicular cancer (Blacks, HR, 1.039, 95% CI: 0.538, 2.007, P = 0.909; Others, HR, 0.772, 95% CI: 0.388, 1.533, P = 0.459). Conclusions: We demonstrated that Blacks had a worse prognosis for young-onset colorectal, breast, and testicular cancer. Marital status, cancer-directed surgery and disease stage may influence the association of race with the risk of mortality. Equal access to high-quality medical care among races, greater social support and comprehensive interventions are required. Moreover, further studies need to clarify the effects of biological properties like genetic differences between races on cancer patient survival.
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Affiliation(s)
- Jingjing Wu
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Jianzhong Ye
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Wenrui Wu
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Daiqiong Fang
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Kaicen Wang
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Liya Yang
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Xianwan Jiang
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Qiangqiang Wang
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Lanjuan Li
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
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Velez MA, Burns TF, Stabile LP. The estrogen pathway as a modulator of response to immunotherapy. Immunotherapy 2019; 11:1161-1176. [PMID: 31361169 DOI: 10.2217/imt-2019-0024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Lung cancer is the leading cause of cancer deaths worldwide, with a 5-year survival rate of about 18%. Thus, there is a great need for novel therapeutic approaches to treat non-small-cell lung cancer (NSCLC). Immune checkpoint inhibitors (ICIs) have improved outcomes for a subset of patients, especially those with high programmed death-ligand 1 expression and/or high tumor mutational burden, but have failed in the majority of patients. Increasing evidence suggests that the estrogen signaling pathway may be a therapeutic target in metastatic NSCLC and that the estrogen pathway may play a role in sex-based responses to ICIs. This report will review the epidemiologic, preclinical and clinical data on the estrogen pathway in NSCLC, its implications in sex-based responses to ICIs and the potential use of antiestrogen therapy in combination with ICIs.
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Affiliation(s)
- Maria A Velez
- Department of Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Timothy F Burns
- Department of Pharmacology & Chemical Biology, University of Pittsburgh, Pittsburgh, PA, USA.,Department of Medicine, Division of Hematology-Oncology, University of Pittsburgh, Pittsburgh, PA, USA.,UPMC Hillman Cancer Center, Pittsburgh, PA, USA
| | - Laura P Stabile
- Department of Pharmacology & Chemical Biology, University of Pittsburgh, Pittsburgh, PA, USA.,UPMC Hillman Cancer Center, Pittsburgh, PA, USA
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