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Cui X, Li S, Gu J, Lin Z, Lai B, Huang L, Feng J, Liu B, Zhou Y. Retrospective study on the efficacy of bisphosphonates in tyrosine kinase inhibitor-treated patients with non-small cell lung cancer exhibiting bone metastasis. Oncol Lett 2019; 18:5437-5447. [PMID: 31612052 PMCID: PMC6781563 DOI: 10.3892/ol.2019.10870] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Accepted: 08/14/2019] [Indexed: 01/04/2023] Open
Abstract
Bisphosphonates (Bps) inhibit the maturation of osteoclasts and suppress the adhesion of cancer cells to the bone matrix. They are recommended as the standard treatment for tumors exhibiting bone metastasis (BM). However, whether Bps can improve the prognosis of patients with tyrosine kinase inhibitor (TKI)-treated non-small cell lung cancer (NSCLC) exhibiting BM remains unclear. A total of 129 patients with NSCLC initially diagnosed with BM at The First Affiliated Hospital of Sun Yat-Sen University (Guangzhou, China) between January 2005 and December 2017 were analyzed in the present retrospective study. Median progression free survival (mPFS) time, median bone metastasis overall survival (mBM-OS) time and bone-associated progression-free survival were analyzed. Among the 129 patients, patients treated with Bps experienced significantly prolonged PFS time [mPFS: 7.1 vs. 5.1 months; hazard ratio (HR), 0.51; confidence interval (CI), 0.30-0.87; P=0.0114] in comparison with patients not treated with Bps. Of the 49 patients treated with frontline TKIs (EGFR TKIs or ALK TKI), 32 received Bps at the same time, while 17 patients received TKIs alone. The results revealed that mPFS time was significantly greater in the TKIs plus Bps group than in the TKIs alone group (mPFS: 11.2 vs. 6.9 months; HR, 0.13; CI, 0.05-0.35; P<0.0001). Significantly prolonged BM-OS time was also observed in the combination group in comparison with the TKIs alone group (mBM-OS: 31 vs. 22 months; HR, 0.31; CI, 0.10-0.96; P=0.0413). The present study demonstrated that among the patients who received TKIs (EGFR TKIs or ALK TKIs), those who also received Bps experienced significantly longer PFS time and tended to exhibit significantly improved BM-OS time, which indicated that Bps should be added to the treatment regimen of patients with NSCLC exhibiting genetic mutations and bone metastasis who have been prescribed TKIs (EGFR TKIs or ALK TKIs).
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Affiliation(s)
- Xiaoxian Cui
- Department of Respiratory Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510080, P.R. China
| | - Shaoli Li
- Department of Respiratory Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510080, P.R. China
| | - Jincui Gu
- Department of Respiratory Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510080, P.R. China
| | - Ziying Lin
- Department of Respiratory Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510080, P.R. China
| | - Bipeng Lai
- Department of Respiratory Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510080, P.R. China
| | - Lixia Huang
- Department of Respiratory Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510080, P.R. China
| | - Jinlun Feng
- Department of Respiratory Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510080, P.R. China
| | - Baomo Liu
- Department of Respiratory Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510080, P.R. China
| | - Yanbin Zhou
- Department of Respiratory Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510080, P.R. China
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Kunikane H, Yokota I, Katakami N, Takeda K, Takayama K, Sawa T, Saito H, Harada M, Yokota S, Ando K, Saito Y, Ohashi Y, Eguchi K. Prospective analysis of the association between skeletal-related events and quality of life in patients with advanced lung cancer (CSP-HOR13). Oncol Lett 2018; 17:1320-1326. [PMID: 30655901 DOI: 10.3892/ol.2018.9680] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 10/15/2018] [Indexed: 11/06/2022] Open
Abstract
A prospective study has previously reported on the incidence of bone metastasis (BM) and skeletal-related events (SREs) in patients with advanced lung cancer. The aim of the present study was to prospectively investigate how the quality of life (QOL) of patients with advanced lung cancer was affected by SREs. Patients with stage IIIB or IV non-small cell lung cancer (NSCLC) or small cell lung cancer (SCLC) at any stage were followed up every four weeks to determine if they had developed SREs. QOL questionnaires were conducted at enrollment, at 3- and 12-months later and at 1 month after the onset of SREs, using QOL scores including the EuroQOL-5 Dimension (EQ-5D), Functional Assessment of Cancer Therapy-General (FACT-G) and activities of daily living (ADL) scores obtained by the Barthel Index. A total of 274 patients were enrolled in the study. At enrollment the EQ-5D and Barthel Index scores were lower in patients with SREs compared with patients without SREs. A chronological analysis revealed no statistically significant changes in either QOL or ADL in any of the patients. For 14 patients in whom QOL data was collected following the onset of SREs, the evaluation undertaken on the four subscales of the FACT-G revealed a significant decline in emotional functioning following the onset of SREs.
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Affiliation(s)
- Hiroshi Kunikane
- Department of Palliative Medicine, Yokohama Municipal Citizen's Hospital, Yokohama, Kanagawa 240-8555, Japan
| | - Isao Yokota
- Department of Biostatistics, Kyoto Prefectural University of Medicine, Kyoto, Kyoto 602-8566, Japan
| | - Nobuyuki Katakami
- Division of Integrated Oncology, Institute of Biomedical Research and Innovation, Kobe, Hyōgo 650-0047, Japan
| | - Koji Takeda
- Division of Medical Oncology, Osaka City General Hospital, Osaka, Osaka 534-0021, Japan
| | - Koichi Takayama
- Department of Pulmonary Medicine, Kyoto Prefectural University of Medicine, Kyoto, Kyoto 602-8566, Japan
| | - Toshiyuki Sawa
- Division of Respiratory Medicine and Oncology, Gifu Municipal Hospital, Gifu, Gifu 500-8513, Japan
| | - Hiroshi Saito
- Department of Respiratory Medicine, Aichi Cancer Center Aichi Hospital, Okazaki, Aichi 444-0011, Japan
| | - Masao Harada
- Department of Respiratory Medicine, National Hospital Organization Hokkaido Cancer Center, Sapporo, Hokkaido 003-0804, Japan
| | - Soichiro Yokota
- Department of Respiratory Medicine, Toneyama National Hospital, Toyonaka, Osaka 560-0045, Japan
| | - Kiyoshi Ando
- Division of Hematology/Oncology, Tokai University School of Medicine, Isehara, Kanagawa 259-1193, Japan
| | - Yuko Saito
- Clinical Trial Coordination Office, Shizuoka Cancer Center, Shizuoka, Shizuoka 411-8777, Japan
| | - Yasuo Ohashi
- Department of Integrated Science and Engineering for Sustainable Society, Chuo University, Tokyo 112-8551, Japan
| | - Kenji Eguchi
- Medical Oncology, Teikyo University School of Medicine, Tokyo 173-8606, Japan
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Yoo HS, Kim JM, Jo E, Cho CK, Lee SY, Kang HS, Lee MG, Yang PY, Jang IS. Modified Panax ginseng extract regulates autophagy by AMPK signaling in A549 human lung cancer cells. Oncol Rep 2017; 37:3287-3296. [PMID: 28440448 DOI: 10.3892/or.2017.5590] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 10/17/2016] [Indexed: 11/06/2022] Open
Abstract
Panax ginseng has been used worldwide as a traditional medicine for the treatment of cancer and other diseases. The antiproliferative activity of ginseng has been increased after enzymatic processing of ginseng saponin, which may result in the accumulation of minor saponins, such as Rh2, Rg3, compound K and protopanaxatriol type (PPT) in modified regular ginseng extract (MRGX). In the present study, the anticancer activity and the associated mechanisms of MRGX were investigated using A549 human lung cancer cells. To elucidate the mechanisms underlying the effects of MRGX, we performed a microarray analysis of gene expression in the A549 cells. Molecular mechanisms that were associated with the anticancer activity of MRGX were studied, with a special focus on the autophagy-related multiple signaling pathways in lung cancer cells. Microarray analyses elucidated autophagy-related genes affected by MRGX. Administration of MRGX at 100 µg/ml induced punctate cytoplasmic expression of LC3, Beclin-1 and ATG5 and increased expression of endogenous LC3-II whereas 50 µg/ml did not inhibit the proliferation of A549 cells. Compared to the control cells, in cells treated with MRGX at 100 µg/ml, the level of p-Akt was increased, while that of mTOR-4EBP1 was decreased. Downregulation of mTOR and 4EBP1 in the MRGX-treated cells was found not to be a p-Ulk (S757)-dependent pathway, but a p-Ulk (S317)-dependent autophagic pathway, using AMPK. These data suggest that MRGX regulates AMPK and induces autophagy in lung cancer cells.
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Affiliation(s)
- Hwa-Seung Yoo
- East-West Cancer Center, Dunsan Oriental Hospital of Daejeon University, Daejeon 302-122, Republic of Korea
| | - Jung Min Kim
- NAR Center, Inc. & Genoplan Korea, Inc., Seoul 06221, Republic of Korea
| | - Eunbi Jo
- Division of Bioconvergence Analysis, Korea Basic Science Institute, Daejeon 305-333, Republic of Korea
| | - Chong-Kwan Cho
- East-West Cancer Center, Dunsan Oriental Hospital of Daejeon University, Daejeon 302-122, Republic of Korea
| | - Seung-Yeul Lee
- Division of Bioconvergence Analysis, Korea Basic Science Institute, Daejeon 305-333, Republic of Korea
| | - Hwan Su Kang
- Division of Bioconvergence Analysis, Korea Basic Science Institute, Daejeon 305-333, Republic of Korea
| | - Min-Goo Lee
- Department of Physiology, Korea University College of Medicine, Seoul 02841, Republic of Korea
| | - Pei-Ying Yang
- Departments of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Ik-Soon Jang
- Division of Bioconvergence Analysis, Korea Basic Science Institute, Daejeon 305-333, Republic of Korea
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Luo YH, Wu CH, Huang CY, Wu CW, Wu WS, Lee YC, Whang-Peng J, Chen YM. Brain metastasis features and association with tumor epidermal growth factor receptor mutation in patients with adenocarcinoma of the lung. Asia Pac J Clin Oncol 2016; 13:e440-e448. [PMID: 27550395 DOI: 10.1111/ajco.12576] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2015] [Revised: 05/01/2016] [Accepted: 05/31/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Yung-Hung Luo
- Department of Chest Medicine; Taipei Veterans General Hospital; Taiwan Republic of China
- School of Medicine; National Yang-Ming University; Taiwan Republic of China
| | - Chieh-Hung Wu
- Department of Chest Medicine; Taipei Veterans General Hospital; Taiwan Republic of China
- School of Medicine; National Yang-Ming University; Taiwan Republic of China
| | - Chu-Yun Huang
- Hsinchu Mackay Memorial Hospital; Taiwan Republic of China
| | - Chih-Wei Wu
- Taipei Tzu Chi Hospital; Taiwan Republic of China
| | - Wen-Shuo Wu
- Department of Chest Medicine; Taipei Veterans General Hospital; Taiwan Republic of China
- School of Medicine; National Yang-Ming University; Taiwan Republic of China
| | - Yu-Chin Lee
- Sijhih Cathay General Hospital; Taiwan Republic of China
| | - Jacqueline Whang-Peng
- Taipei Cancer Center, College of Medical Science and Technology; Taipei Medical University; Taiwan Republic of China
| | - Yuh-Min Chen
- Department of Chest Medicine; Taipei Veterans General Hospital; Taiwan Republic of China
- School of Medicine; National Yang-Ming University; Taiwan Republic of China
- Taipei Cancer Center, College of Medical Science and Technology; Taipei Medical University; Taiwan Republic of China
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Tang Y, Qu J, Wu J, Li S, Zhou Y, Xiao J. Metastatic Spinal Cord Compression from Non-Small-Cell Lung Cancer Treated with Surgery and Adjuvant Therapies: A Retrospective Analysis of Outcomes and Prognostic Factors in 116 Patients. J Bone Joint Surg Am 2015; 97:1418-25. [PMID: 26333737 PMCID: PMC7535090 DOI: 10.2106/jbjs.n.01124] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Metastatic spinal cord compression is a disastrous consequence of non-small-cell lung cancer (NSCLC). There have been few studies of the outcomes or prognostic factors in patients with metastatic spinal cord compression from NSCLC treated with surgery and adjuvant therapies. METHODS From 2002 to 2013, 116 patients with metastatic spinal cord compression from NSCLC treated with surgery and adjuvant therapies were enrolled in this retrospective analysis. Kaplan-Meier methods and Cox regression analysis were used to estimate overall survival and identify prognostic factors for survival. RESULTS Multivariate analysis suggested that the Eastern Cooperative Oncology Group performance status (ECOG-PS), preoperative and postoperative Frankel scores, postoperative adjuvant radiation therapy, and target therapy were independent prognostic factors. Ninety patients died at a median of twelve months (range, three to forty-seven months) postoperatively, and twenty-six patients were still alive at the time of final follow-up (at a median of fifteen months [range, five to fifty-four months]). CONCLUSIONS The complete disappearance of deficits in spinal cord function after surgery was the most robust predictor of survival. Adjuvant radiation therapy and target therapy were also associated with a better prognosis. LEVEL OF EVIDENCE Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Yu Tang
- Department of Orthopaedic Surgery, Affiliated Xinqiao Hospital, The Third Military Medical University, No. 2, Xinqiao Street, Shapingba District, Chongqing 400037, People’s Republic of China. E-mail address for Y. Zhou:
| | - Jintao Qu
- Department of Orthopaedic Surgery, No. 44 Military Hospital, No. 67 Huang He Road, Xiao He District, Guiyang, Guizhou 550009, People’s Republic of China
| | - Juan Wu
- Department of Pharmacy, General Hospital of Chengdu Military Region, Chengdu 610083, People’s Republic of China
| | - Song Li
- Department of Bone Tumors, Changzheng Hospital, The Second Military Medical University, No. 415 Feng Yang Road, Huang Pu District, Shanghai 200003, People’s Republic of China. E-mail address for J. Xiao:
| | - Yue Zhou
- Department of Orthopaedic Surgery, Affiliated Xinqiao Hospital, The Third Military Medical University, No. 2, Xinqiao Street, Shapingba District, Chongqing 400037, People’s Republic of China. E-mail address for Y. Zhou:
| | - Jianru Xiao
- Department of Bone Tumors, Changzheng Hospital, The Second Military Medical University, No. 415 Feng Yang Road, Huang Pu District, Shanghai 200003, People’s Republic of China. E-mail address for J. Xiao:
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Wnt signaling pathway pharmacogenetics in non-small cell lung cancer. THE PHARMACOGENOMICS JOURNAL 2014; 14:509-22. [PMID: 24980784 PMCID: PMC4237616 DOI: 10.1038/tpj.2014.21] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Revised: 04/02/2014] [Accepted: 04/15/2014] [Indexed: 12/27/2022]
Abstract
Wnt/β-catenin pathway alterations in non-small cell lung cancer (NSCLC) are associated with poor prognosis and resistance. In 598 stage III-IV NSCLC patients receiving platinum-based chemotherapy at MD Anderson Cancer Center (MDACC), we correlated survival with 441 host SNPs in 50 Wnt pathway genes. We then assessed the most significant SNPs in 240 Mayo Clinic patients receiving platinum-based chemotherapy for advanced NSCLC, 127 MDACC patients receiving platinum-based adjuvant chemotherapy and 340 early stage MDACC patients undergoing surgery alone (cohorts 2–4). In multivariate analysis, survival correlates with SNPs for AXIN2 (rs11868547 and rs4541111, of which rs11868547 was assessed in cohorts 2–4), Wnt-5B (rs12819505), CXXC4 (rs4413407) and WIF-1 (rs10878232). Median survival was 19.7, 15.6, and 10.7 months for patients with 1, 2, and 3–5 unfavorable genotypes, respectively (p= 3.8×10−9). Survival tree analysis classified patients into two groups (MST 11.3 vs 17.3 months, p=4.7×10−8). None of the SNPs achieved significance in cohorts 2–4; however, there was a trend in the same direction as cohort 1 for 3 of the SNPs. Using online databases, we found rs10878232 displayed expression quantitative trait loci (eQTL) correlation with the expression of LEMD3, a neighboring gene previously associated with NSCLC survival. In conclusion, results from cohort 1 provide further evidence for an important role for Wnt in NSCLC. Investigation of Wnt inhibitors in advanced NSCLC would be reasonable. Lack of a SNP association with outcome in cohorts 2–4 could be due to low statistical power, impact of patient heterogeneity, or false positive observations in cohort 1.
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Hatakeyama Y, Kobayashi K, Nagano T, Tamura D, Yamamoto M, Tachihara M, Kotani Y, Nishimura Y. Synergistic effects of pemetrexed and amrubicin in non-small cell lung cancer cell lines: Potential for combination therapy. Cancer Lett 2013; 343:74-9. [PMID: 24139969 DOI: 10.1016/j.canlet.2013.09.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2012] [Revised: 09/10/2013] [Accepted: 09/14/2013] [Indexed: 10/26/2022]
Abstract
The purpose is to examine the synergistic effect of pemetrexed (PEM) and amrubicin (AMR) on the proliferation of lung cancer cell lines. In vitro, dose-dependent synergistic effects of concurrent PEM and AMRol, which is an active metabolite of AMR were observed in A549 and H460 cells. In real-time RT-qPCR analysis and western blotting, expression of the target enzymes of PEM were suppressed in cells treated with amrubicinol alone. In vivo, AMR/PEM treatment also showed synergistic antitumor activity both in A549-bearing and H520-bearing mice. PEM and AMR work synergistically to inhibit the proliferation of several different lung cancer cell lines.
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Affiliation(s)
- Yukihisa Hatakeyama
- Division of Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan
| | - Kazuyuki Kobayashi
- Division of Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan.
| | - Tatsuya Nagano
- Division of Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan
| | - Daisuke Tamura
- Division of Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan
| | - Masatsugu Yamamoto
- Division of Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan
| | - Motoko Tachihara
- Division of Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan
| | - Yoshikazu Kotani
- Division of Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan
| | - Yoshihiro Nishimura
- Division of Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan
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Brodowicz T, O'Byrne K, Manegold C. Bone matters in lung cancer. Ann Oncol 2012; 23:2215-2222. [PMID: 22357445 PMCID: PMC3425370 DOI: 10.1093/annonc/mds009] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2011] [Revised: 01/10/2012] [Accepted: 01/11/2012] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Bone metastases are a significant and undertreated clinical problem in patients with advanced lung cancer. DESIGN We reviewed the incidence of bone metastases and skeletal-related events (SREs) in patients with lung cancer and examined the burden on patients' lives and on health care systems. Available therapies to improve survival and lessen the impact of SREs on quality of life (QoL) were also investigated. RESULTS Bone metastases are common in lung cancer; however, owing to short survival times, data on the incidences of SREs are limited. As with other cancers, the costs associated with treating SREs in lung cancer are substantial. Bisphosphonates reduce the frequency of SREs and improve measures of pain and QoL in patients with lung cancer; however, nephrotoxicity is a common complication of therapy. Denosumab, a recently approved bone-targeted therapy, is superior to zoledronic acid in increasing the time to first on-study SRE in patients with solid tumours, including lung cancer. Additional roles of bone-targeted therapies beyond the prevention of SREs are under investigation. CONCLUSIONS With increasing awareness of the consequences of SREs, bone-targeted therapies may play a greater role in the management of patients with lung cancer, with the aim of delaying disease progression and preserving QoL.
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Affiliation(s)
- T Brodowicz
- Clinical Division of Oncology, Department of Medicine I, Medical University of Vienna General Hospital, Vienna, Austria.
| | - K O'Byrne
- HOPE Department, St James's Hospital, Dublin, Ireland
| | - C Manegold
- Interdisciplinary Thoracic Oncology and Department of Surgery, University Medical Centre Mannheim, Mannheim, Germany
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Pirl WF, Greer JA, Traeger L, Jackson V, Lennes IT, Gallagher ER, Perez-Cruz P, Heist RS, Temel JS. Depression and survival in metastatic non-small-cell lung cancer: effects of early palliative care. J Clin Oncol 2012; 30:1310-5. [PMID: 22430269 DOI: 10.1200/jco.2011.38.3166] [Citation(s) in RCA: 164] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
PURPOSE In a randomized trial, early palliative care (EPC) in patients with metastatic non-small-cell lung cancer (NSCLC) was observed to improve survival. In a secondary analysis, we explored the hypothesis that the survival benefit resulted from improving depression. PATIENTS AND METHODS In total, 151 patients with newly diagnosed metastatic NSCLC participated in a randomized trial of EPC integrated with standard oncology care versus standard oncology care alone. Depression was assessed at baseline and at 12 weeks with the Patient Health Questionnaire-9 (PHQ-9) and was scored diagnostically by using Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, criteria for major depression syndrome (MDS). Depression response was considered ≥ 50% reduction in PHQ-9 scores at 12 weeks. Survival differences were tested with log-rank and Cox proportional hazards models. RESULTS At baseline, 21 patients (14%) met MDS criteria. MDS significantly predicted worse survival (hazard ratio, 1.82; P = .02). Patients assigned to EPC had greater improvements in PHQ-9 scores at 12 weeks (P < .001); among patients with MDS, those receiving EPC had greater rates of depression response at 12 weeks (P = .04). However, improvement in PHQ-9 scores was not associated with improved survival, except in a sensitivity analysis in which patients who died before 12 weeks were modeled to have worse depression. The group randomly assigned to EPC remained independently associated with survival after adding improvement in PHQ-9 scores to the survival model. CONCLUSION Depression predicted worse survival in patients with newly diagnosed metastatic NSCLC. Although EPC was associated with greater improvement in depression at 12 weeks, the data do not support the hypothesis that treatment of depression mediated the observed survival benefit from EPC.
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Affiliation(s)
- William F Pirl
- Massachusetts General Hospital Cancer Center, Center for Psychiatric Oncology and Behavioral Sciences, Yawkey 9A, 55 Fruit St, Boston, MA 02114, USA.
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Sekine A, Kato T, Hagiwara E, Shinohara T, Komagata T, Iwasawa T, Satoh H, Tamura K, Kasamatsu T, Hayashihara K, Saito T, Takahashi H, Ogura T. Metastatic brain tumors from non-small cell lung cancer with EGFR mutations: distinguishing influence of exon 19 deletion on radiographic features. Lung Cancer 2012; 77:64-9. [PMID: 22335887 DOI: 10.1016/j.lungcan.2011.12.017] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2011] [Revised: 12/21/2011] [Accepted: 12/26/2011] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Miliary brain metastasis is a rarity and refers to the presence of numerous small tumors in a perivascular distribution without intraparenchymal invasion and focal edema. Although the presence of epidermal growth factor receptor (EGFR) mutation and good response to gefitinib have been reported in non-small cell lung cancer (NSCLC) patients with miliary brain metastases, the influence of the EGFR mutations on the radiographic features remains unclear. PATIENTS AND METHODS All NSCLC patients with synchronous brain metastases detected at the time of a new diagnosis of NSCLC from March 2005 through May 2011 were divided according to EGFR mutation status. The number of brain tumors, size of the largest brain tumors, and size of peritumoral brain edema were compared among the groups. RESULTS Fifty-seven patients who met the criteria were divided into three groups: wild-type EGFR group (31 patients), exon 19 deletion group (18 patients), and exon 21 point mutation group (8 patients). The exon 19 deletion group had more multiple and smaller brain tumors with smaller peritumoral brain edema than did the wild-type group (P = 0.024, P = 0.0016, and P = 0.0036, respectively). The exon 21 point mutation group showed no significant difference in any of the radiographic values when compared with the wild-type group. CONCLUSION Our results indicate that NSCLC patients with the exon 19 deletion have such a peculiar pattern of brain metastases as multiple small metastases with small brain edema. This metastatic pattern may be similar to that of miliary brain metastases. Because it is unclear whether or not severe neurologic symptoms develop during their clinical courses like miliary brain metastases, regular evaluation with brain magnetic resonance imaging (MRI) should be considered, regardless of the presence of neurologic symptoms. Accumulation of knowledge about specific pattern of brain metastasis will help approach to "individual" management.
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Affiliation(s)
- Akimasa Sekine
- Department of Respiratory Medicine, Kanagawa Prefectural Cardiovascular and Respiratory Center, Yokohama, Japan.
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Joshi AD, Carter JA, Botteman MF, Kaura S. Cost-effectiveness of zoledronic acid in the management of skeletal metastases in patients with lung cancer in France, Germany, Portugal, the Netherlands, and the United kingdom. Clin Ther 2011; 33:291-304.e8. [PMID: 21600384 DOI: 10.1016/j.clinthera.2011.04.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2011] [Indexed: 01/15/2023]
Abstract
BACKGROUND Zoledronic acid (ZOL) significantly reduces the risk of new skeletal-related events (SREs) in patients with non-small cell lung cancer (NSCLC) who have bone metastases. OBJECTIVE The purpose of this study was to assess the cost and cost-effectiveness of ZOL in the management of skeletal metastases in this population across 5 European countries (France, Germany, United Kingdom, Portugal, and the Netherlands) from the perspective of national health care. METHODS This cost-effectiveness analysis was based on a subset of patients with NSCLC who were enrolled in a Phase III trial of patients with bone metastases secondary to a variety of solid tumors. In this trial, patients were randomized to receive ZOL or placebo every 3 weeks for up to 21 months. Survival, SRE incidence, and number of infusions administered were derived from the clinical trial. Costs of SREs were estimated using hospital Diagnosis Related Group tariffs and published data. Drug, drug administration, and supply costs were obtained from published and internet sources. Quality-adjusted life-years (QALYs) were estimated based on the published utilities and modeled survival and frequency of SREs. Uncertainty surrounding outcomes was addressed via univariate and probabilistic sensitivity analyses. RESULTS Compared with patients receiving placebo (n = 120), patients receiving ZOL (n = 124) experienced an estimated 0.79 fewer SREs and gained an estimated 0.02 QALYs. ZOL use in patients with NSCLC and bone metastases was associated with a reduction in SRE costs (ranging from €1547 to €1893 [2007-2008 €], depending on the country). After adding drug and drug administration costs, ZOL use resulted in a net savings of €288 per patient in Germany, €209 in the United Kingdom, and €113 in Portugal. In France and the Netherlands, costs increased (€17 and €178, respectively), but the costs per QALY gained were low (€786 and €8278, respectively). In univariate sensitivity analyses, the cost per QALY for ZOL versus placebo was ≤€50,000 for all scenarios tested. The results were most sensitive to assumptions regarding survival, number of ZOL infusions, and the costs of SREs. The probabilistic sensitivity analysis indicated that ZOL cost ≤€50,000 per QALY in 65% to 83% of model simulations (depending on country). However, some degree of uncertainty remained as the 95th percentile of cost per QALY was high. CONCLUSIONS This analysis is subject to the usual limitations of cost-effectiveness models, which combine assumptions and data from multiple sources. Nevertheless, based on the assumptions used herein, the present model suggests that ZOL increases QALYs and is cost saving and/or cost effective compared with placebo in patients with NSCLC in France, Germany, the United Kingdom, Portugal, and the Netherlands.
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Affiliation(s)
- Avani D Joshi
- Health Economics, Pharmerit International, Bethesda, Maryland, USA
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Wang G, Dong W, Shen H, Mu X, Li Z, Lin X, Liu Y, Du J. A comparison of Twist and E-cadherin protein expression in primary non-small-cell lung carcinoma and corresponding metastases. Eur J Cardiothorac Surg 2011; 39:1028-32. [PMID: 21376622 DOI: 10.1016/j.ejcts.2011.01.023] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2010] [Revised: 12/28/2010] [Accepted: 01/10/2011] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE The metastasis of solid tumors is directly or indirectly responsible for most cancer-related deaths. It has already been known that in non-small-cell lung carcinoma cells, up-regulation of Twist (a highly conserved basic helix-loop-helix transcription factor) can promote epithelial-mesenchymal transition through down-regulation of E-cadherin. The main aim of this study was to determine whether the expression of Twist and E-cadherin differs between primary and metastatic lung carcinoma and to correlate Twist and E-cadherin expression in primary and metastatic non-small-cell lung carcinoma. METHODS Thirteen patients with non-small-cell lung carcinoma and hematogenous metastases were studied in retrospect, and Twist and E-cadherin were detected by immunohistochemistry in 26 tissue samples from the 13 patients. RESULTS We demonstrated that the expression of Twist was higher in metastatic non-small-cell lung carcinoma tissues than in primary non-small-cell lung carcinoma (p=0.008) and discordance of Twist expression was observed in 11 (85%) patients. For E-cadherin, 12 cases (92%) showed discordance between primary tumor and metastasis (p=0.002): E-cadherin expressed higher in the primary tumor than in the metastasis in 12 cases. We also found that increased Twist expression was correlated with decreased membranous E-cadherin expression (p=0.009). CONCLUSIONS Our data imply that Twist induces epithelial-mesenchymal transition in non-small-cell lung carcinoma by reducing E-cadherin, then promoting metastasis.
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Affiliation(s)
- Guanghui Wang
- Department of Thoracic Surgery, Provincial Hospital Affiliated to Shandong University, Jinan, PR China
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Navaratnam S, Kliewer EV, Butler J, Demers AA, Musto G, Badiani K. Population-based patterns and cost of management of metastatic non-small cell lung cancer after completion of chemotherapy until death. Lung Cancer 2010; 70:110-5. [PMID: 20153911 DOI: 10.1016/j.lungcan.2010.01.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2009] [Revised: 12/11/2009] [Accepted: 01/17/2010] [Indexed: 11/27/2022]
Abstract
BACKGROUND The aim of this study was to examine the patterns and costs of management of non-small cell lung cancer (NSCLC) after completion of chemotherapy until death in a population of patients in Manitoba, Canada. PATIENTS AND METHODS Stage IIIB and IV NSCLC patients diagnosed between January 1997 and June 2000 who received chemotherapy as the primary treatment, completed their chemotherapy and survived for at least 28 days since their last treatment, and were on best supportive care (BSC) were selected. Treatment, services received, costs, and survival were determined by chart review and examining various databases including the Manitoba Cancer Registry, medical claims, hospitalizations, and prescription drugs. Costs of treatment, average cost per patient, and lifetime treatment costs were calculated. RESULTS Of the 2463 patients diagnosed with NSCLC over the study period, 150 patients matched our study criteria. From the beginning of the first chemotherapy treatment, the median survival time was 31.8 weeks, while from the date of BSC the median survival time was 13.8 weeks. The average cost per case was $10,805 from last date of chemotherapy and $8654 during the BSC period. The average cost per patient-month ranged from $1645 to $1792 in current prices. Lifetime treatment costs ranged from $8702 to $11,057. Hospitalizations accounted for 80% of the total treatment costs. CONCLUSION The largest overall component of cost after the end of chemotherapy was hospitalizations. Effective new therapies that reduce the episodes of hospitalizations would have a significant impact on decreasing aggregate costs.
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Affiliation(s)
- Sri Navaratnam
- Department of Internal Medicine, University of Manitoba, Faculty of Medicine, 675 McDermot Avenue, Winnipeg, R3E 0V9 Canada.
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Treszl A, Schally AV, Seitz S, Szalontay L, Rick FG, Szepeshazi K, Halmos G. Inhibition of human non-small cell lung cancers with a targeted cytotoxic somatostatin analog, AN-162. Peptides 2009; 30:1643-50. [PMID: 19524629 DOI: 10.1016/j.peptides.2009.06.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2009] [Revised: 06/03/2009] [Accepted: 06/03/2009] [Indexed: 01/03/2023]
Abstract
Human non-small cell lung cancers (NSCLCs) express receptors for somatostatin. The cytotoxic analog of somatostatin AN-162 (AEZS-124), consisting of doxorubicin linked to a somatostatin analog RC-121 binds to receptors for somatostatin and is targeted to tumors expressing these receptors. The aim of this study was to investigate the effect of targeted cytotoxic somatostatin analog AN-162 on a panel of human NSCLC cell lines (A549, H460, H838, H1299) in vitro (at 0.5-100 microM concentrations) and in vivo on H460 and H1299 NSCLCs xenografted into nude mice (at the dose of 2.5 micromol/kg, i.v., once a week). The expression of mRNA for somatostatin receptor subtypes was investigated by RT-PCR in cell lines and tumor tissues. Somatostatin receptor proteins were also characterized by ligand competition assay and Western blotting. AN-162 significantly decreased cell proliferation in vitro and tumor growth (p<0.05 vs. all groups) of H460 and H1299 NSCLCs in vivo. Based on real-time PCR array data, AN-162 induced several apoptosis-related genes in vivo in both models. Our results suggest that cytotoxic somatostatin analog AN-162 (AEZS-124) should be considered for the further development of a therapy of patients with NSCLC.
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Affiliation(s)
- Andrea Treszl
- Endocrine, Polypeptide and Cancer Institute, Veterans Affairs Medical Center and South Florida Veterans Affairs Foundation for Research and Education, 1201 NW 16th Street,Miami, FL 33125, USA
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García B, Neninger E, de la Torre A, Leonard I, Martínez R, Viada C, González G, Mazorra Z, Lage A, Crombet T. Effective inhibition of the epidermal growth factor/epidermal growth factor receptor binding by anti-epidermal growth factor antibodies is related to better survival in advanced non-small-cell lung cancer patients treated with the epidermal growth factor cancer vaccine. Clin Cancer Res 2008; 14:840-6. [PMID: 18245547 DOI: 10.1158/1078-0432.ccr-07-1050] [Citation(s) in RCA: 84] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE Epidermal growth factor (EGF) might be a suitable immunotherapeutic target in non-small-cell lung cancer (NSCLC). Our approach consists of active immunotherapy with EGF. The aim of the study is to characterize the humoral response and its effects on signal transduction in relation with the clinical outcome. EXPERIMENTAL DESIGN Eighty NSCLC patients treated with first-line chemotherapy were randomized to receive the EGF vaccine or supportive care. EGF concentration in sera, anti-EGF antibodies and their capacity to inhibit the binding between EGF/EGF receptor (EGFR), and the EGFR phosphorylation were measured. RESULTS Seventy-three percent of vaccinated patients developed a good antibody response, whereas none of the controls did. In good antibody-responder patients, self EGF in sera was significantly reduced. In 58% of vaccinated patients, the post-immune sera inhibited EGF/EGFR binding; in the control group, no inhibition occurred. Post-immune sera inhibited the EGFR phosphorylation whereas sera from control patients did not have this capacity. Good antibody-responder patients younger than 60 years had a significantly better survival. A high correlation between anti-EGF antibody titers, EGFR phosphorylation inhibition, and EGF/EGFR binding inhibition was found. There was a significantly better survival for vaccinated patients that showed the higher capacity to inhibit EGF/EGFR binding and for those who showed an immunodominance by the central region of EGF molecule. CONCLUSIONS Immunization with the EGF vaccine induced neutralizing anti-EGF antibodies capable of inhibiting EGFR phosphorylation. There was a significant positive correlation between antibody titers, EGF/EGFR binding inhibition, immunodominance of anti-EGF antibodies, and survival in advanced NSCLC patients.
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Affiliation(s)
- Beatriz García
- Center of Molecular Immunology, Clinical Imunology Department, Havana, Cuba.
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Zoledronic Acid and Survival in Patients with Metastatic Bone Disease from Lung Cancer and Elevated Markers of Osteoclast Activity. J Thorac Oncol 2008; 3:228-36. [DOI: 10.1097/jto.0b013e3181651c0e] [Citation(s) in RCA: 131] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Zhong H, Han B, Tourkova IL, Lokshin A, Rosenbloom A, Shurin MR, Shurin GV. Low-dose paclitaxel prior to intratumoral dendritic cell vaccine modulates intratumoral cytokine network and lung cancer growth. Clin Cancer Res 2007; 13:5455-62. [PMID: 17875775 PMCID: PMC2474691 DOI: 10.1158/1078-0432.ccr-07-0517] [Citation(s) in RCA: 99] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE The main goal of this study was to provide the "proof-of-principle" that low-dose paclitaxel is able to change the tumor microenvironment and improve the outcome of intratumoral dendritic cell vaccine in a murine lung cancer model. EXPERIMENTAL DESIGN We evaluated the antitumor potential and changes in the intratumoral milieu of a combination of low-dose chemotherapy and dendritic cell vaccine in the Lewis lung carcinoma model in vivo. RESULTS The low-dose paclitaxel, which induced apoptosis in approximately 10% of tumor cells, was not toxic to bone marrow cells and dendritic cells and stimulated dendritic cell maturation and function in vitro. Although tumor cells inhibited dendritic cell differentiation in vitro, this immunosuppressive effect was abrogated by the pretreatment of tumor cells with low-dose paclitaxel. Based on these data, we next tested whether pretreatment of tumor-bearing mice with low-dose paclitaxel in vivo would improve the antitumor potential of dendritic cell vaccine administered intratumorally. Significant inhibition of tumor growth in mice treated with low-dose paclitaxel plus intratumoral dendritic cell vaccine, associated with increased tumor infiltration by CD4(+) and CD8(+) T cells and elevated tumor-specific IFN-gamma production by draining lymph node cells, was revealed. Using a novel intratumoral microdialysis technique and Luminex technology for collecting and characterizing soluble factors released within the tumor bed for several days in live freely moving animals, we showed that low-dose paclitaxel altered the cytokine network at the tumor site. CONCLUSIONS Our data indicate that low-dose chemotherapy before intratumoral delivery of dendritic cells might be associated with beneficial alterations of the intratumoral microenvironment and thus support antitumor immunity.
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Affiliation(s)
- Hua Zhong
- Shanghai Chest Hospital, Shanghai, China
| | - Baohui Han
- Shanghai Chest Hospital, Shanghai, China
| | | | - Anna Lokshin
- Departments of Medicine, University of Pittsburgh Medical Center
| | - Alan Rosenbloom
- Molecular Biosensors and Imaging Center, Carnegie Mellon University, Pittsburgh, Pennsylvania Received 3/5/07; revised 5/10/07; accepted 5/31/07
| | - Michael R. Shurin
- Departments of Pathology, University of Pittsburgh Medical Center
- Departments of Immunology, University of Pittsburgh Medical Center
| | - Galina V. Shurin
- Departments of Pathology, University of Pittsburgh Medical Center
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Antitumor activity of cytokine-induced killer cells against human lung cancer. Int Immunopharmacol 2007; 7:1802-7. [DOI: 10.1016/j.intimp.2007.08.016] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2007] [Revised: 08/16/2007] [Accepted: 08/16/2007] [Indexed: 11/22/2022]
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Baas P. Treatment options in stage IIIB non-small cell lung cancer: Making the proper choice. EJC Suppl 2007. [DOI: 10.1016/s1359-6349(07)70054-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Naime FF, Younes RN, Kersten BG, Anelli A, Beato CAM, Andrade RM, Carrara MP, Gross JL. Metastatic non-small cell lung cancer in Brazil: treatment heterogeneity in routine clinical practice. Clinics (Sao Paulo) 2007; 62:397-404. [PMID: 17823701 DOI: 10.1590/s1807-59322007000400005] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2007] [Accepted: 03/27/2007] [Indexed: 11/21/2022] Open
Abstract
UNLABELLED Lung cancer is one of the main causes of cancer related deaths. Approximately three quarters of these tumors are non-small cell carcinomas. When diagnosed the majority of patients show the disease locally advanced or metastatic. The chemotherapy is the chosen therapy for patients with advanced lung cancer. The majority of published studies with chemotherapy are performed in academic centers under a strict control of research protocols. PURPOSE The aim of this study is to evaluate the usual management of metastatic NSCLC patients outside of a clinical trial setting in three different oncologic centers in Brazil. METHODS This is a retrospective study of patients with metastatic non-small cell lung cancer admitted for treatment in three different Cancer Centers in Brazil. 564 patients from Brazilian public heath system and private/health insurance system were considered for the present study. RESULTS Among 564 patients in this study, 335 (59.4%) received chemotherapy. For all patients, 47 different regimens of chemotherapy were identified. The median follow-up time was eight months and the overall median survival of all patient population submitted to chemotherapy was 9.7 months. DISCUSSION There was a great heterogeneity in the regimens of drugs to treat metastatic NSCLC patients. The overall survival was significantly better for patients treated with first line chemotherapy compared to patients that only received best supportive care. Results of prospective randomized clinical trials should be carefully analyzed before transferred to the daily clinical practice.
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Affiliation(s)
- Fauzia F Naime
- Instituto Paulista de Cancerologia, Department of Clinical Oncology, São Paulo, SP, Brazil.
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Lutterbach B, Zeng Q, Davis LJ, Hatch H, Hang G, Kohl NE, Gibbs JB, Pan BS. Lung cancer cell lines harboring MET gene amplification are dependent on Met for growth and survival. Cancer Res 2007; 67:2081-8. [PMID: 17332337 DOI: 10.1158/0008-5472.can-06-3495] [Citation(s) in RCA: 262] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Recent clinical successes of small-molecule epidermal growth factor receptor (EGFR) inhibitors in treating advanced non-small cell lung cancer (NSCLC) have raised hopes that the identification of other deregulated growth factor pathways in NSCLC will lead to new therapeutic options for NSCLC. Met, the receptor for hepatocyte growth factor, has been implicated in growth, invasion, and metastasis of many tumors including NSCLC. To assess the functional role for Met in NSCLC, we evaluated a panel of nine lung cancer cell lines for Met gene amplification, Met expression, Met pathway activation, and the sensitivity of the cell lines to short hairpin RNA (shRNA)-mediated Met knockdown. Two cell lines, EBC-1 and H1993, showed significant Met gene amplification and overexpressed Met receptors which were constitutively phosphorylated. The other seven lines did not exhibit Met amplification and expressed much lower levels of Met, which was phosphorylated only on addition of hepatocyte growth factor. We also found a strong up-regulation of tyrosine phosphorylation in beta-catenin and p120/delta-catenin in the Met-amplified EBC-1 and H1993 cell lines. ShRNA-mediated Met knockdown induced significant growth inhibition, G(1)-S arrest, and apoptosis in EBC-1 and H1993 cells, whereas it had little or no effect on the cell lines that do not have Met amplification. These results strongly suggest that Met amplification identifies a subset of NSCLC likely to respond to new molecular therapies targeting Met.
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Affiliation(s)
- Bart Lutterbach
- Cancer Biology and Therapeutics, Department of Molecular Oncology, Merck Research Laboratories, 33 Avenue Louis Pasteur, Boston, MA 02115, USA.
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