Treatment of advanced lung cancer in the elderly

Targeting mitochondrial one-carbon enzyme MTHFD2 together with pemetrexed confers therapeutic advantages in lung adenocarcinoma

Metabolic remodeling is the fundamental molecular feature of malignant tumors. Cancer cells require sufficient energy supplies supporting their high proliferative rate. MTHFD2, a mitochondrial one-carbon metabolic enzyme, is dysregulated in several malignancies and may serve as a promising therapeutic candidate in cancer treatment. Here, our data confirmed that MTHFD2 gene and protein was upregulated in the cancerous tissues of LUAD patients and was correlated with a poor survival in LUAD. MTHFD2 was involved in lung cancer cell proliferation, migration, and apoptosis by mediating its downstream molecules, such as DNA helicases (MCM4 and MCM7), as well as ZEB1, Vimentin and SNAI1, which contributed to tumor cell growth and epithelial-to-mesenchymal transition (EMT) process. Moreover, we identified that miRNA-99a-3p appeared to be an upstream mediator directly regulating MTHFD2 and MCM4 expression. Moreover, specific inhibition of MTHFD2 functions by siRNA or a chemical compound, improved anti-tumor sensitivities induced by pemetrexed in LUAD. Taken together, our study revealed the underlying molecular mechanisms of MTHFD2 in regulating cell proliferation and identified a novel therapeutic strategy improving the treatment efficacies in LUAD.

Chinese herbal medicines of supplementing Qi and nourishing Yin combined with chemotherapy for non-small cell lung cancer: A meta-analysis and systematic review

BACKGROUND

Non-small cell lung cancer (NSCLC) is one of the malignant tumors with the highest incidence and mortality. This meta-analysis aimed to explore the efficacy of the supplementing Qi and nourishing Yin method combined with chemotherapy for the treatment of NSCLC based on qualified randomized controlled trials.

METHOD

PubMed, Cochrane, and Embase databases were searched by the index words to identify the eligible studies, and relevant literature sources were also searched. The latest research was performed in December 2017. Of the eligible studies, only those involving randomized controlled trials were included. Relative risks (RR) along with 95% confidence interval (95% CI) were used to analyze the main outcomes.

RESULT

A total of 41 studies were involved in the meta-analysis with 1335 objects in the treatment group and 1272 objects in the control group. Compared with chemotherapy, supplementing Qi and nourishing Yin combined with chemotherapy significantly increased the effective rate (RR: 1.37, 95% CI: 1.24-1.51), increased the Karnofsky score (RR: 1.50, 95% CI: 1.39-1.61), and improved the TCM symptom (RR: 1.69, 95% CI: 1.55-1.85).

CONCLUSION

These results demonstrated that supplementing Qi and nourishing Yin combined with chemotherapy would have better clinical efficacy in effective rate, the Karnofsky score, and TCM symptom. Most of the included studies had a low Jadad score; however, there is still a need for high-quality, larger-sample, multicentric, and long-term follow-up randomized controlled trials to confirm our conclusion.

Treatment Toxicity in Elderly Patients With Advanced Non-Small Cell Lung Cancer

OBJECTIVES

Toxicity is a main concern limiting the use of chemotherapy and radiotherapy (RT) for elderly patients with non-small cell lung cancer (NSCLC). The objective of this study was to assess the rates of treatment-related toxicity among elderly stage IIIB and IV NSCLC patients.

MATERIALS AND METHODS

We used the Surveillance, Epidemiology, and End Results registry linked to Medicare records to identify 2596 stage IIIB and 14,803 stage IV NSCLC patients aged 70 years and above, diagnosed in 2000 or later. We compared rates of toxicity requiring hospitalization according to treatment (chemotherapy, RT, or chemoradiation [CRT]) in unadjusted and adjusted models controlling for selection bias using propensity scores.

RESULTS

Among stage IIIB patients, rates of any severe toxicity were 10.1%, 23.8%, 30.4%, and 39.2% for patients who received no treatment, RT, chemotherapy alone, and CRT, respectively. In stage IV patients, rates of any severe toxicity were 31.5% versus 13.5% among those treated with and without chemotherapy, respectively. In stage IIIB patients treated with CRT, the most common toxicities was esophagitis (odds ratio, 48.5; 95% confidence interval, 6.7-350.5). Among stage IV patients treated with chemotherapy, the risk of toxicity was highest for neutropenia (odds ratio, 8.4; 95% confidence interval, 6.1-11.5).

CONCLUSIONS

Toxicity was relatively common among stage IIIB patients with up to a 6-fold increase in elderly individuals treated with CRT and a 4-fold increase in toxicities among stage IV patients. This information should be helpful to guide discussions about the risk-benefit ratio of chemotherapy and RT in elderly patients with advanced NSCLC.

Causes of death of patients with lung cancer

CONTEXT

The causes of death for patients with lung cancer are inadequately described.

OBJECTIVE

To categorize the immediate and contributing causes of death for patients with lung cancer.

DESIGN

The autopsies from 100 patients who died of lung cancer between 1990 and February 2011 were analyzed.

RESULTS

Tumor burden was judged the immediate cause of death in 30 cases, including 26 cases of extensive metastases and 4 cases with wholly or primarily lung tumor burden (causing respiratory failure). Infection was the immediate cause of death for 20 patients, including 8 with sepsis and 12 with pneumonia. Complications of metastatic disease were the immediate causes of death in 18 cases, including 6 cases of hemopericardium from pericardial metastases, 3 from myocardial metastases, 3 from liver metastases, and 3 from brain metastases. Other immediate causes of death were pulmonary hemorrhage (12 cases), pulmonary embolism (10 cases, 2 tumor emboli), and pulmonary diffuse alveolar damage (7 cases). From a functional (pathophysiologic) perspective, respiratory failure could be regarded as the immediate cause of death (or mechanism of death) in 38 cases, usually because of a combination of lung conditions, including emphysema, airway obstruction, pneumonia, hemorrhage, embolism, resection, and lung injury in addition to the tumor. For 94 of the 100 patients, there were contributing causes of death, with an average of 2.5 contributing causes and up to 6 contributing causes of death.

CONCLUSIONS

The numerous and complex ways lung cancer kills patients pose a challenge for efforts to extend and improve their lives.