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Kang DH, Kim JO, Jung SS, Park HS, Chung C, Park D, Lee JE. Efficacy of Vinorelbine Monotherapy as Third- or Further-Line Therapy in Patients with Advanced Non-Small-Cell Lung Cancer. Oncology 2019; 97:356-364. [PMID: 31480050 DOI: 10.1159/000502343] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 07/23/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND The survival rate of patients with lung cancer has increased significantly over the years, but there has been no further progress in third- or fourth-line therapy. We investigated the efficacy and tolerability of monotherapy with weekly vinorelbine, a semi-synthetic vinca alkaloid, in advanced non-small-cell lung cancer (NSCLC) patients who had previously been treated several times. METHODS In all, 159 NSCLC patients who received vinorelbine monotherapy as third- or further-line therapy between January 2008 and July 2017 were included in this study. Patients received vinorelbine intravenously at a dose of 25-30 mg/m2/week. RESULTS Their mean age was 62.4 years. The histologic types of tumor were adenocarcinoma (50.9%), squamous cell carcinoma (42.8%), and others (6.2%). The overall response rate was 19.5% (31/159). The median progression-free survival (PFS) was 3.0 months (95% confidence interval [CI] 2.5-3.5 months), and the median overall survival (OS) after vinorelbine use was 7.6 months (95% CI 6.2-9.0 months). Vinorelbine therapy showed significantly higher efficacy in patients with adenocarcinoma, and these patients had a longer PFS than patients with other types of cancer. Patients who received vinorelbine as fifth- or further-line treatment had a higher response rate and longer PFS and OS than those who received vinorelbine as third- or fourth-line treatment. CONCLUSIONS Weekly vinorelbine monotherapy may be a feasible therapeutic option for patients with heavily treated, advanced NSCLC, particularly lung adenocarcinoma.
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Affiliation(s)
- Da Hyun Kang
- Department of Internal Medicine, College of Medicine, Chungnam National University, Daejeon, Republic of Korea
| | - Ju Ock Kim
- Department of Internal Medicine, College of Medicine, Chungnam National University, Daejeon, Republic of Korea
| | - Sung Soo Jung
- Department of Internal Medicine, College of Medicine, Chungnam National University, Daejeon, Republic of Korea
| | - Hee Sun Park
- Department of Internal Medicine, College of Medicine, Chungnam National University, Daejeon, Republic of Korea
| | - Chaeuk Chung
- Department of Internal Medicine, College of Medicine, Chungnam National University, Daejeon, Republic of Korea
| | - Dongil Park
- Department of Internal Medicine, College of Medicine, Chungnam National University, Daejeon, Republic of Korea
| | - Jeong Eun Lee
- Department of Internal Medicine, College of Medicine, Chungnam National University, Daejeon, Republic of Korea,
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2
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Bao Y, Maciejewski RC, Garrido MM, Shah MA, Maciejewski PK, Prigerson HG. Chemotherapy Use, End-of-Life Care, and Costs of Care Among Patients Diagnosed With Stage IV Pancreatic Cancer. J Pain Symptom Manage 2018; 55:1113-1121.e3. [PMID: 29241809 PMCID: PMC5856587 DOI: 10.1016/j.jpainsymman.2017.12.335] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 11/30/2017] [Accepted: 12/01/2017] [Indexed: 01/05/2023]
Abstract
CONTEXT For patients with metastatic cancer and limited life expectancy, potential benefits of chemotherapy must be balanced against harms to quality of life near death and increased out-of-pocket costs of care. OBJECTIVES To evaluate the association between chemotherapy use by patients with Stage IV pancreatic cancer and health care use and Medicare and out-of-pocket costs in the last 30 days of life. METHODS We conducted a retrospective cohort study of 3825 patients aged 66 years or older when diagnosed with Stage IV pancreatic cancer in 2006-2011, using the linked Surveillance, Epidemiology, and End Results-Medicare data. Using a propensity score matched sample, we examined associations between initiation of chemotherapy shortly after the metastatic diagnosis (and secondarily, continued chemotherapy use in the last 30 days of life) and health care use and costs (both Medicare payment and patient out-of-pocket costs) in the last 30 days of life. RESULTS Chemotherapy use was associated with increased rates of hospital admissions (45.0% vs. 29.2%, P < 0.001), emergency department visits (41.3% vs. 27.2%, P < 0.001), and death in a hospital (14.2% vs. 9.1%, P < 0.001); fewer days in hospice care (11.5 days vs. 15.7 days, P < 0.001); and more than 50% increase in patient out-of-pocket costs for care ($1311.5 vs. $841.0, P < 0.001) in the last 30 days of life. Among patients who initiated chemotherapy, more stark differences in these outcomes were found by whether patients received chemotherapy in the last 30 days of life. CONCLUSION Chemotherapy use among older patients diagnosed with metastatic pancreatic cancer was associated with substantially increased use of health care and higher patient out-of-pocket costs near death.
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Affiliation(s)
- Yuhua Bao
- Department of Healthcare Policy & Research, Weill Cornell Medical College, New York, New York, USA; Department of Psychiatry, Weill Cornell Medical College, New York, New York, USA.
| | - Renee C Maciejewski
- Center for Research on End-of-Life Care, Weill Cornell Medical College, New York, New York, USA
| | - Melissa M Garrido
- Department of Geriatrics and Palliative Medicine, Mount Sinai School of Medicine, New York, New York, USA; James J Peters Veterans Affairs Medical Center, Bronx, New York, USA
| | - Manish A Shah
- Medical Oncology/Solid Tumor Program, Meyer Cancer Center at Weill Cornell Medicine, New York, New York, USA
| | - Paul K Maciejewski
- Center for Research on End-of-Life Care, Weill Cornell Medical College, New York, New York, USA; Department of Radiology, Weill Cornell Medical College, New York, New York, USA; Division of Geriatrics and Palliative Medicine, Department of Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Holly G Prigerson
- Center for Research on End-of-Life Care, Weill Cornell Medical College, New York, New York, USA; Division of Geriatrics and Palliative Medicine, Department of Medicine, Weill Cornell Medical College, New York, New York, USA
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3
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Smith TJ, Hanna N, Johnson D, Baker S, Biermann WA, Brahmer J, Ellis PM, Giaccone G, Hesketh PJ, Jaiyesimi I, Leighl NB, Riely GJ, Schiller JH, Schneider BJ, Tashbar J, Temin S, Masters G. Case for Stopping Targeted Therapy When Lung Cancer Progresses on Treatment in Hospice-Eligible Patients. J Oncol Pract 2017; 13:780-783. [PMID: 28981389 DOI: 10.1200/jop.2017.027367] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Thomas J Smith
- Johns Hopkins, Baltimore, MD; Indiana University, Bloomington, IN; UT Southwestern Medical School, Dallas, TX; Virginia Commonwealth University Massey Cancer Center, Richmond; Inova Schar Cancer Institute, Falls Church; ASCO, Alexandria, VA; Einstein Medical Center, Philadelphia, PA; Juravinski Cancer Centre, Hamilton; Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Lombardi Cancer Center, Washington, DC; Lahey Hospital & Medical Center, Burlington, MA; William Beaumont Hospital, Royal Oak; University of Michigan, Ann Arbor, MI; Memorial Sloan Kettering Cancer Center, New York, NY; Circle of Hope for Cancer Research, St Cloud, FL; and Helen F. Graham Cancer Center, Newark, DE
| | - Nasser Hanna
- Johns Hopkins, Baltimore, MD; Indiana University, Bloomington, IN; UT Southwestern Medical School, Dallas, TX; Virginia Commonwealth University Massey Cancer Center, Richmond; Inova Schar Cancer Institute, Falls Church; ASCO, Alexandria, VA; Einstein Medical Center, Philadelphia, PA; Juravinski Cancer Centre, Hamilton; Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Lombardi Cancer Center, Washington, DC; Lahey Hospital & Medical Center, Burlington, MA; William Beaumont Hospital, Royal Oak; University of Michigan, Ann Arbor, MI; Memorial Sloan Kettering Cancer Center, New York, NY; Circle of Hope for Cancer Research, St Cloud, FL; and Helen F. Graham Cancer Center, Newark, DE
| | - David Johnson
- Johns Hopkins, Baltimore, MD; Indiana University, Bloomington, IN; UT Southwestern Medical School, Dallas, TX; Virginia Commonwealth University Massey Cancer Center, Richmond; Inova Schar Cancer Institute, Falls Church; ASCO, Alexandria, VA; Einstein Medical Center, Philadelphia, PA; Juravinski Cancer Centre, Hamilton; Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Lombardi Cancer Center, Washington, DC; Lahey Hospital & Medical Center, Burlington, MA; William Beaumont Hospital, Royal Oak; University of Michigan, Ann Arbor, MI; Memorial Sloan Kettering Cancer Center, New York, NY; Circle of Hope for Cancer Research, St Cloud, FL; and Helen F. Graham Cancer Center, Newark, DE
| | - Sherman Baker
- Johns Hopkins, Baltimore, MD; Indiana University, Bloomington, IN; UT Southwestern Medical School, Dallas, TX; Virginia Commonwealth University Massey Cancer Center, Richmond; Inova Schar Cancer Institute, Falls Church; ASCO, Alexandria, VA; Einstein Medical Center, Philadelphia, PA; Juravinski Cancer Centre, Hamilton; Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Lombardi Cancer Center, Washington, DC; Lahey Hospital & Medical Center, Burlington, MA; William Beaumont Hospital, Royal Oak; University of Michigan, Ann Arbor, MI; Memorial Sloan Kettering Cancer Center, New York, NY; Circle of Hope for Cancer Research, St Cloud, FL; and Helen F. Graham Cancer Center, Newark, DE
| | - William A Biermann
- Johns Hopkins, Baltimore, MD; Indiana University, Bloomington, IN; UT Southwestern Medical School, Dallas, TX; Virginia Commonwealth University Massey Cancer Center, Richmond; Inova Schar Cancer Institute, Falls Church; ASCO, Alexandria, VA; Einstein Medical Center, Philadelphia, PA; Juravinski Cancer Centre, Hamilton; Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Lombardi Cancer Center, Washington, DC; Lahey Hospital & Medical Center, Burlington, MA; William Beaumont Hospital, Royal Oak; University of Michigan, Ann Arbor, MI; Memorial Sloan Kettering Cancer Center, New York, NY; Circle of Hope for Cancer Research, St Cloud, FL; and Helen F. Graham Cancer Center, Newark, DE
| | - Julie Brahmer
- Johns Hopkins, Baltimore, MD; Indiana University, Bloomington, IN; UT Southwestern Medical School, Dallas, TX; Virginia Commonwealth University Massey Cancer Center, Richmond; Inova Schar Cancer Institute, Falls Church; ASCO, Alexandria, VA; Einstein Medical Center, Philadelphia, PA; Juravinski Cancer Centre, Hamilton; Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Lombardi Cancer Center, Washington, DC; Lahey Hospital & Medical Center, Burlington, MA; William Beaumont Hospital, Royal Oak; University of Michigan, Ann Arbor, MI; Memorial Sloan Kettering Cancer Center, New York, NY; Circle of Hope for Cancer Research, St Cloud, FL; and Helen F. Graham Cancer Center, Newark, DE
| | - Peter M Ellis
- Johns Hopkins, Baltimore, MD; Indiana University, Bloomington, IN; UT Southwestern Medical School, Dallas, TX; Virginia Commonwealth University Massey Cancer Center, Richmond; Inova Schar Cancer Institute, Falls Church; ASCO, Alexandria, VA; Einstein Medical Center, Philadelphia, PA; Juravinski Cancer Centre, Hamilton; Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Lombardi Cancer Center, Washington, DC; Lahey Hospital & Medical Center, Burlington, MA; William Beaumont Hospital, Royal Oak; University of Michigan, Ann Arbor, MI; Memorial Sloan Kettering Cancer Center, New York, NY; Circle of Hope for Cancer Research, St Cloud, FL; and Helen F. Graham Cancer Center, Newark, DE
| | - Giuseppe Giaccone
- Johns Hopkins, Baltimore, MD; Indiana University, Bloomington, IN; UT Southwestern Medical School, Dallas, TX; Virginia Commonwealth University Massey Cancer Center, Richmond; Inova Schar Cancer Institute, Falls Church; ASCO, Alexandria, VA; Einstein Medical Center, Philadelphia, PA; Juravinski Cancer Centre, Hamilton; Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Lombardi Cancer Center, Washington, DC; Lahey Hospital & Medical Center, Burlington, MA; William Beaumont Hospital, Royal Oak; University of Michigan, Ann Arbor, MI; Memorial Sloan Kettering Cancer Center, New York, NY; Circle of Hope for Cancer Research, St Cloud, FL; and Helen F. Graham Cancer Center, Newark, DE
| | - Paul J Hesketh
- Johns Hopkins, Baltimore, MD; Indiana University, Bloomington, IN; UT Southwestern Medical School, Dallas, TX; Virginia Commonwealth University Massey Cancer Center, Richmond; Inova Schar Cancer Institute, Falls Church; ASCO, Alexandria, VA; Einstein Medical Center, Philadelphia, PA; Juravinski Cancer Centre, Hamilton; Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Lombardi Cancer Center, Washington, DC; Lahey Hospital & Medical Center, Burlington, MA; William Beaumont Hospital, Royal Oak; University of Michigan, Ann Arbor, MI; Memorial Sloan Kettering Cancer Center, New York, NY; Circle of Hope for Cancer Research, St Cloud, FL; and Helen F. Graham Cancer Center, Newark, DE
| | - Ishmael Jaiyesimi
- Johns Hopkins, Baltimore, MD; Indiana University, Bloomington, IN; UT Southwestern Medical School, Dallas, TX; Virginia Commonwealth University Massey Cancer Center, Richmond; Inova Schar Cancer Institute, Falls Church; ASCO, Alexandria, VA; Einstein Medical Center, Philadelphia, PA; Juravinski Cancer Centre, Hamilton; Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Lombardi Cancer Center, Washington, DC; Lahey Hospital & Medical Center, Burlington, MA; William Beaumont Hospital, Royal Oak; University of Michigan, Ann Arbor, MI; Memorial Sloan Kettering Cancer Center, New York, NY; Circle of Hope for Cancer Research, St Cloud, FL; and Helen F. Graham Cancer Center, Newark, DE
| | - Natasha B Leighl
- Johns Hopkins, Baltimore, MD; Indiana University, Bloomington, IN; UT Southwestern Medical School, Dallas, TX; Virginia Commonwealth University Massey Cancer Center, Richmond; Inova Schar Cancer Institute, Falls Church; ASCO, Alexandria, VA; Einstein Medical Center, Philadelphia, PA; Juravinski Cancer Centre, Hamilton; Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Lombardi Cancer Center, Washington, DC; Lahey Hospital & Medical Center, Burlington, MA; William Beaumont Hospital, Royal Oak; University of Michigan, Ann Arbor, MI; Memorial Sloan Kettering Cancer Center, New York, NY; Circle of Hope for Cancer Research, St Cloud, FL; and Helen F. Graham Cancer Center, Newark, DE
| | - Gregory J Riely
- Johns Hopkins, Baltimore, MD; Indiana University, Bloomington, IN; UT Southwestern Medical School, Dallas, TX; Virginia Commonwealth University Massey Cancer Center, Richmond; Inova Schar Cancer Institute, Falls Church; ASCO, Alexandria, VA; Einstein Medical Center, Philadelphia, PA; Juravinski Cancer Centre, Hamilton; Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Lombardi Cancer Center, Washington, DC; Lahey Hospital & Medical Center, Burlington, MA; William Beaumont Hospital, Royal Oak; University of Michigan, Ann Arbor, MI; Memorial Sloan Kettering Cancer Center, New York, NY; Circle of Hope for Cancer Research, St Cloud, FL; and Helen F. Graham Cancer Center, Newark, DE
| | - Joan H Schiller
- Johns Hopkins, Baltimore, MD; Indiana University, Bloomington, IN; UT Southwestern Medical School, Dallas, TX; Virginia Commonwealth University Massey Cancer Center, Richmond; Inova Schar Cancer Institute, Falls Church; ASCO, Alexandria, VA; Einstein Medical Center, Philadelphia, PA; Juravinski Cancer Centre, Hamilton; Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Lombardi Cancer Center, Washington, DC; Lahey Hospital & Medical Center, Burlington, MA; William Beaumont Hospital, Royal Oak; University of Michigan, Ann Arbor, MI; Memorial Sloan Kettering Cancer Center, New York, NY; Circle of Hope for Cancer Research, St Cloud, FL; and Helen F. Graham Cancer Center, Newark, DE
| | - Bryan J Schneider
- Johns Hopkins, Baltimore, MD; Indiana University, Bloomington, IN; UT Southwestern Medical School, Dallas, TX; Virginia Commonwealth University Massey Cancer Center, Richmond; Inova Schar Cancer Institute, Falls Church; ASCO, Alexandria, VA; Einstein Medical Center, Philadelphia, PA; Juravinski Cancer Centre, Hamilton; Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Lombardi Cancer Center, Washington, DC; Lahey Hospital & Medical Center, Burlington, MA; William Beaumont Hospital, Royal Oak; University of Michigan, Ann Arbor, MI; Memorial Sloan Kettering Cancer Center, New York, NY; Circle of Hope for Cancer Research, St Cloud, FL; and Helen F. Graham Cancer Center, Newark, DE
| | - Joan Tashbar
- Johns Hopkins, Baltimore, MD; Indiana University, Bloomington, IN; UT Southwestern Medical School, Dallas, TX; Virginia Commonwealth University Massey Cancer Center, Richmond; Inova Schar Cancer Institute, Falls Church; ASCO, Alexandria, VA; Einstein Medical Center, Philadelphia, PA; Juravinski Cancer Centre, Hamilton; Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Lombardi Cancer Center, Washington, DC; Lahey Hospital & Medical Center, Burlington, MA; William Beaumont Hospital, Royal Oak; University of Michigan, Ann Arbor, MI; Memorial Sloan Kettering Cancer Center, New York, NY; Circle of Hope for Cancer Research, St Cloud, FL; and Helen F. Graham Cancer Center, Newark, DE
| | - Sarah Temin
- Johns Hopkins, Baltimore, MD; Indiana University, Bloomington, IN; UT Southwestern Medical School, Dallas, TX; Virginia Commonwealth University Massey Cancer Center, Richmond; Inova Schar Cancer Institute, Falls Church; ASCO, Alexandria, VA; Einstein Medical Center, Philadelphia, PA; Juravinski Cancer Centre, Hamilton; Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Lombardi Cancer Center, Washington, DC; Lahey Hospital & Medical Center, Burlington, MA; William Beaumont Hospital, Royal Oak; University of Michigan, Ann Arbor, MI; Memorial Sloan Kettering Cancer Center, New York, NY; Circle of Hope for Cancer Research, St Cloud, FL; and Helen F. Graham Cancer Center, Newark, DE
| | - Gregory Masters
- Johns Hopkins, Baltimore, MD; Indiana University, Bloomington, IN; UT Southwestern Medical School, Dallas, TX; Virginia Commonwealth University Massey Cancer Center, Richmond; Inova Schar Cancer Institute, Falls Church; ASCO, Alexandria, VA; Einstein Medical Center, Philadelphia, PA; Juravinski Cancer Centre, Hamilton; Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Lombardi Cancer Center, Washington, DC; Lahey Hospital & Medical Center, Burlington, MA; William Beaumont Hospital, Royal Oak; University of Michigan, Ann Arbor, MI; Memorial Sloan Kettering Cancer Center, New York, NY; Circle of Hope for Cancer Research, St Cloud, FL; and Helen F. Graham Cancer Center, Newark, DE
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Bakitas MA, El-Jawahri A, Farquhar M, Ferrell B, Grudzen C, Higginson I, Temel JS, Zimmermann C, Smith TJ. The TEAM Approach to Improving Oncology Outcomes by Incorporating Palliative Care in Practice. J Oncol Pract 2017; 13:557-566. [DOI: 10.1200/jop.2017.022939] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Palliative care (PC) concurrent with usual oncology care is now the standard of care that is recommended for any patient with advanced cancer to begin within 8 weeks of diagnosis on the basis of evidence-driven national clinical practice guidelines; however, there are not enough interdisciplinary palliative care teams to provide such care. How and what can an oncology office incorporate into usual care, borrowing the tools used in PC randomized clinical trials (RCTs), to improve care for patients and their caregivers? We reviewed the multiple RCTs for common practical elements and identified methods and techniques that oncologists can use to deliver some parts of concurrent interdisciplinary PC. We recommend the standardized assessment of patient-reported outcomes, including the evaluation of symptoms with such tools as the Edmonton or Memorial Symptom Assessment Scales, spirituality with the FICA Spiritual History Tool or similar questions, and psychosocial distress with the Distress Thermometer. All patients should be assessed for how they prefer to receive information, their current understanding of their situation, and if they have considered some advance care planning. Approximately 1 hour of additional time with the patient is required each month. If the oncologist does not have established ties with spiritual care and social work, he or she should establish these relationships for counseling as required. Caregivers should be asked about coping and support needs. Oncologists can adapt PC techniques to achieve results that are similar to those in the RCTs of PC plus usual care compared with usual care alone. This is comparable to using data from RCTs of trastuzamab or placebo, adopting what was used in the RCTs without modification or dilution.
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Affiliation(s)
- Marie A. Bakitas
- University of Alabama at Birmingham, AL; Partners–Massachusetts General Hospital, Boston, MA; City of Hope Medical Center, Duarte, CA; New York University School of Medicine, New York, NY; University of East Anglia, Norwich; Kings College London, London, United Kingdom; Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; and Johns Hopkins University, Baltimore, MD
| | - Areej El-Jawahri
- University of Alabama at Birmingham, AL; Partners–Massachusetts General Hospital, Boston, MA; City of Hope Medical Center, Duarte, CA; New York University School of Medicine, New York, NY; University of East Anglia, Norwich; Kings College London, London, United Kingdom; Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; and Johns Hopkins University, Baltimore, MD
| | - Morag Farquhar
- University of Alabama at Birmingham, AL; Partners–Massachusetts General Hospital, Boston, MA; City of Hope Medical Center, Duarte, CA; New York University School of Medicine, New York, NY; University of East Anglia, Norwich; Kings College London, London, United Kingdom; Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; and Johns Hopkins University, Baltimore, MD
| | - Betty Ferrell
- University of Alabama at Birmingham, AL; Partners–Massachusetts General Hospital, Boston, MA; City of Hope Medical Center, Duarte, CA; New York University School of Medicine, New York, NY; University of East Anglia, Norwich; Kings College London, London, United Kingdom; Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; and Johns Hopkins University, Baltimore, MD
| | - Corita Grudzen
- University of Alabama at Birmingham, AL; Partners–Massachusetts General Hospital, Boston, MA; City of Hope Medical Center, Duarte, CA; New York University School of Medicine, New York, NY; University of East Anglia, Norwich; Kings College London, London, United Kingdom; Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; and Johns Hopkins University, Baltimore, MD
| | - Irene Higginson
- University of Alabama at Birmingham, AL; Partners–Massachusetts General Hospital, Boston, MA; City of Hope Medical Center, Duarte, CA; New York University School of Medicine, New York, NY; University of East Anglia, Norwich; Kings College London, London, United Kingdom; Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; and Johns Hopkins University, Baltimore, MD
| | - Jennifer S. Temel
- University of Alabama at Birmingham, AL; Partners–Massachusetts General Hospital, Boston, MA; City of Hope Medical Center, Duarte, CA; New York University School of Medicine, New York, NY; University of East Anglia, Norwich; Kings College London, London, United Kingdom; Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; and Johns Hopkins University, Baltimore, MD
| | - Camilla Zimmermann
- University of Alabama at Birmingham, AL; Partners–Massachusetts General Hospital, Boston, MA; City of Hope Medical Center, Duarte, CA; New York University School of Medicine, New York, NY; University of East Anglia, Norwich; Kings College London, London, United Kingdom; Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; and Johns Hopkins University, Baltimore, MD
| | - Thomas J. Smith
- University of Alabama at Birmingham, AL; Partners–Massachusetts General Hospital, Boston, MA; City of Hope Medical Center, Duarte, CA; New York University School of Medicine, New York, NY; University of East Anglia, Norwich; Kings College London, London, United Kingdom; Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; and Johns Hopkins University, Baltimore, MD
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5
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Ferrell BR, Temel JS, Temin S, Alesi ER, Balboni TA, Basch EM, Firn JI, Paice JA, Peppercorn JM, Phillips T, Stovall EL, Zimmermann C, Smith TJ. Integration of Palliative Care Into Standard Oncology Care: American Society of Clinical Oncology Clinical Practice Guideline Update. J Clin Oncol 2016; 35:96-112. [PMID: 28034065 DOI: 10.1200/jco.2016.70.1474] [Citation(s) in RCA: 1258] [Impact Index Per Article: 157.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Purpose To provide evidence-based recommendations to oncology clinicians, patients, family and friend caregivers, and palliative care specialists to update the 2012 American Society of Clinical Oncology (ASCO) provisional clinical opinion (PCO) on the integration of palliative care into standard oncology care for all patients diagnosed with cancer. Methods ASCO convened an Expert Panel of members of the ASCO Ad Hoc Palliative Care Expert Panel to develop an update. The 2012 PCO was based on a review of a randomized controlled trial (RCT) by the National Cancer Institute Physicians Data Query and additional trials. The panel conducted an updated systematic review seeking randomized clinical trials, systematic reviews, and meta-analyses, as well as secondary analyses of RCTs in the 2012 PCO, published from March 2010 to January 2016. Results The guideline update reflects changes in evidence since the previous guideline. Nine RCTs, one quasiexperimental trial, and five secondary analyses from RCTs in the 2012 PCO on providing palliative care services to patients with cancer and/or their caregivers, including family caregivers, were found to inform the update. Recommendations Inpatients and outpatients with advanced cancer should receive dedicated palliative care services, early in the disease course, concurrent with active treatment. Referral of patients to interdisciplinary palliative care teams is optimal, and services may complement existing programs. Providers may refer family and friend caregivers of patients with early or advanced cancer to palliative care services.
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Affiliation(s)
- Betty R Ferrell
- Betty R. Ferrell, City of Hope Medical Center, Duarte, CA; Jennifer S. Temel and Jeffrey M. Peppercorn, Massachusetts General Hospital; Tracy A. Balboni, Dana-Farber Cancer Institute, Boston, MA; Sarah Temin, American Society of Clinical Oncology, Alexandria; Erin R. Alesi, Virginia Commonwealth University Health System, Richmond, VA; Ethan M. Basch, University of North Carolina at Chapel Hill, Chapel Hill, NC; Janice I. Firn, University of Michigan Health System, Ann Arbor, MI; Judith A. Paice, Northwestern University, Evanston, IL; Tanyanika Phillips, CHRISTUS St Frances Cabrini Hospital, Alexandria, LA; Ellen L. Stovall, National Coalition for Cancer Survivorship, Silver Spring; Thomas J. Smith, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD; and Camilla Zimmermann, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Jennifer S Temel
- Betty R. Ferrell, City of Hope Medical Center, Duarte, CA; Jennifer S. Temel and Jeffrey M. Peppercorn, Massachusetts General Hospital; Tracy A. Balboni, Dana-Farber Cancer Institute, Boston, MA; Sarah Temin, American Society of Clinical Oncology, Alexandria; Erin R. Alesi, Virginia Commonwealth University Health System, Richmond, VA; Ethan M. Basch, University of North Carolina at Chapel Hill, Chapel Hill, NC; Janice I. Firn, University of Michigan Health System, Ann Arbor, MI; Judith A. Paice, Northwestern University, Evanston, IL; Tanyanika Phillips, CHRISTUS St Frances Cabrini Hospital, Alexandria, LA; Ellen L. Stovall, National Coalition for Cancer Survivorship, Silver Spring; Thomas J. Smith, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD; and Camilla Zimmermann, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Sarah Temin
- Betty R. Ferrell, City of Hope Medical Center, Duarte, CA; Jennifer S. Temel and Jeffrey M. Peppercorn, Massachusetts General Hospital; Tracy A. Balboni, Dana-Farber Cancer Institute, Boston, MA; Sarah Temin, American Society of Clinical Oncology, Alexandria; Erin R. Alesi, Virginia Commonwealth University Health System, Richmond, VA; Ethan M. Basch, University of North Carolina at Chapel Hill, Chapel Hill, NC; Janice I. Firn, University of Michigan Health System, Ann Arbor, MI; Judith A. Paice, Northwestern University, Evanston, IL; Tanyanika Phillips, CHRISTUS St Frances Cabrini Hospital, Alexandria, LA; Ellen L. Stovall, National Coalition for Cancer Survivorship, Silver Spring; Thomas J. Smith, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD; and Camilla Zimmermann, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Erin R Alesi
- Betty R. Ferrell, City of Hope Medical Center, Duarte, CA; Jennifer S. Temel and Jeffrey M. Peppercorn, Massachusetts General Hospital; Tracy A. Balboni, Dana-Farber Cancer Institute, Boston, MA; Sarah Temin, American Society of Clinical Oncology, Alexandria; Erin R. Alesi, Virginia Commonwealth University Health System, Richmond, VA; Ethan M. Basch, University of North Carolina at Chapel Hill, Chapel Hill, NC; Janice I. Firn, University of Michigan Health System, Ann Arbor, MI; Judith A. Paice, Northwestern University, Evanston, IL; Tanyanika Phillips, CHRISTUS St Frances Cabrini Hospital, Alexandria, LA; Ellen L. Stovall, National Coalition for Cancer Survivorship, Silver Spring; Thomas J. Smith, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD; and Camilla Zimmermann, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Tracy A Balboni
- Betty R. Ferrell, City of Hope Medical Center, Duarte, CA; Jennifer S. Temel and Jeffrey M. Peppercorn, Massachusetts General Hospital; Tracy A. Balboni, Dana-Farber Cancer Institute, Boston, MA; Sarah Temin, American Society of Clinical Oncology, Alexandria; Erin R. Alesi, Virginia Commonwealth University Health System, Richmond, VA; Ethan M. Basch, University of North Carolina at Chapel Hill, Chapel Hill, NC; Janice I. Firn, University of Michigan Health System, Ann Arbor, MI; Judith A. Paice, Northwestern University, Evanston, IL; Tanyanika Phillips, CHRISTUS St Frances Cabrini Hospital, Alexandria, LA; Ellen L. Stovall, National Coalition for Cancer Survivorship, Silver Spring; Thomas J. Smith, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD; and Camilla Zimmermann, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Ethan M Basch
- Betty R. Ferrell, City of Hope Medical Center, Duarte, CA; Jennifer S. Temel and Jeffrey M. Peppercorn, Massachusetts General Hospital; Tracy A. Balboni, Dana-Farber Cancer Institute, Boston, MA; Sarah Temin, American Society of Clinical Oncology, Alexandria; Erin R. Alesi, Virginia Commonwealth University Health System, Richmond, VA; Ethan M. Basch, University of North Carolina at Chapel Hill, Chapel Hill, NC; Janice I. Firn, University of Michigan Health System, Ann Arbor, MI; Judith A. Paice, Northwestern University, Evanston, IL; Tanyanika Phillips, CHRISTUS St Frances Cabrini Hospital, Alexandria, LA; Ellen L. Stovall, National Coalition for Cancer Survivorship, Silver Spring; Thomas J. Smith, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD; and Camilla Zimmermann, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Janice I Firn
- Betty R. Ferrell, City of Hope Medical Center, Duarte, CA; Jennifer S. Temel and Jeffrey M. Peppercorn, Massachusetts General Hospital; Tracy A. Balboni, Dana-Farber Cancer Institute, Boston, MA; Sarah Temin, American Society of Clinical Oncology, Alexandria; Erin R. Alesi, Virginia Commonwealth University Health System, Richmond, VA; Ethan M. Basch, University of North Carolina at Chapel Hill, Chapel Hill, NC; Janice I. Firn, University of Michigan Health System, Ann Arbor, MI; Judith A. Paice, Northwestern University, Evanston, IL; Tanyanika Phillips, CHRISTUS St Frances Cabrini Hospital, Alexandria, LA; Ellen L. Stovall, National Coalition for Cancer Survivorship, Silver Spring; Thomas J. Smith, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD; and Camilla Zimmermann, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Judith A Paice
- Betty R. Ferrell, City of Hope Medical Center, Duarte, CA; Jennifer S. Temel and Jeffrey M. Peppercorn, Massachusetts General Hospital; Tracy A. Balboni, Dana-Farber Cancer Institute, Boston, MA; Sarah Temin, American Society of Clinical Oncology, Alexandria; Erin R. Alesi, Virginia Commonwealth University Health System, Richmond, VA; Ethan M. Basch, University of North Carolina at Chapel Hill, Chapel Hill, NC; Janice I. Firn, University of Michigan Health System, Ann Arbor, MI; Judith A. Paice, Northwestern University, Evanston, IL; Tanyanika Phillips, CHRISTUS St Frances Cabrini Hospital, Alexandria, LA; Ellen L. Stovall, National Coalition for Cancer Survivorship, Silver Spring; Thomas J. Smith, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD; and Camilla Zimmermann, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Jeffrey M Peppercorn
- Betty R. Ferrell, City of Hope Medical Center, Duarte, CA; Jennifer S. Temel and Jeffrey M. Peppercorn, Massachusetts General Hospital; Tracy A. Balboni, Dana-Farber Cancer Institute, Boston, MA; Sarah Temin, American Society of Clinical Oncology, Alexandria; Erin R. Alesi, Virginia Commonwealth University Health System, Richmond, VA; Ethan M. Basch, University of North Carolina at Chapel Hill, Chapel Hill, NC; Janice I. Firn, University of Michigan Health System, Ann Arbor, MI; Judith A. Paice, Northwestern University, Evanston, IL; Tanyanika Phillips, CHRISTUS St Frances Cabrini Hospital, Alexandria, LA; Ellen L. Stovall, National Coalition for Cancer Survivorship, Silver Spring; Thomas J. Smith, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD; and Camilla Zimmermann, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Tanyanika Phillips
- Betty R. Ferrell, City of Hope Medical Center, Duarte, CA; Jennifer S. Temel and Jeffrey M. Peppercorn, Massachusetts General Hospital; Tracy A. Balboni, Dana-Farber Cancer Institute, Boston, MA; Sarah Temin, American Society of Clinical Oncology, Alexandria; Erin R. Alesi, Virginia Commonwealth University Health System, Richmond, VA; Ethan M. Basch, University of North Carolina at Chapel Hill, Chapel Hill, NC; Janice I. Firn, University of Michigan Health System, Ann Arbor, MI; Judith A. Paice, Northwestern University, Evanston, IL; Tanyanika Phillips, CHRISTUS St Frances Cabrini Hospital, Alexandria, LA; Ellen L. Stovall, National Coalition for Cancer Survivorship, Silver Spring; Thomas J. Smith, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD; and Camilla Zimmermann, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Ellen L Stovall
- Betty R. Ferrell, City of Hope Medical Center, Duarte, CA; Jennifer S. Temel and Jeffrey M. Peppercorn, Massachusetts General Hospital; Tracy A. Balboni, Dana-Farber Cancer Institute, Boston, MA; Sarah Temin, American Society of Clinical Oncology, Alexandria; Erin R. Alesi, Virginia Commonwealth University Health System, Richmond, VA; Ethan M. Basch, University of North Carolina at Chapel Hill, Chapel Hill, NC; Janice I. Firn, University of Michigan Health System, Ann Arbor, MI; Judith A. Paice, Northwestern University, Evanston, IL; Tanyanika Phillips, CHRISTUS St Frances Cabrini Hospital, Alexandria, LA; Ellen L. Stovall, National Coalition for Cancer Survivorship, Silver Spring; Thomas J. Smith, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD; and Camilla Zimmermann, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Camilla Zimmermann
- Betty R. Ferrell, City of Hope Medical Center, Duarte, CA; Jennifer S. Temel and Jeffrey M. Peppercorn, Massachusetts General Hospital; Tracy A. Balboni, Dana-Farber Cancer Institute, Boston, MA; Sarah Temin, American Society of Clinical Oncology, Alexandria; Erin R. Alesi, Virginia Commonwealth University Health System, Richmond, VA; Ethan M. Basch, University of North Carolina at Chapel Hill, Chapel Hill, NC; Janice I. Firn, University of Michigan Health System, Ann Arbor, MI; Judith A. Paice, Northwestern University, Evanston, IL; Tanyanika Phillips, CHRISTUS St Frances Cabrini Hospital, Alexandria, LA; Ellen L. Stovall, National Coalition for Cancer Survivorship, Silver Spring; Thomas J. Smith, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD; and Camilla Zimmermann, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Thomas J Smith
- Betty R. Ferrell, City of Hope Medical Center, Duarte, CA; Jennifer S. Temel and Jeffrey M. Peppercorn, Massachusetts General Hospital; Tracy A. Balboni, Dana-Farber Cancer Institute, Boston, MA; Sarah Temin, American Society of Clinical Oncology, Alexandria; Erin R. Alesi, Virginia Commonwealth University Health System, Richmond, VA; Ethan M. Basch, University of North Carolina at Chapel Hill, Chapel Hill, NC; Janice I. Firn, University of Michigan Health System, Ann Arbor, MI; Judith A. Paice, Northwestern University, Evanston, IL; Tanyanika Phillips, CHRISTUS St Frances Cabrini Hospital, Alexandria, LA; Ellen L. Stovall, National Coalition for Cancer Survivorship, Silver Spring; Thomas J. Smith, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD; and Camilla Zimmermann, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
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Masters GA, Temin S, Azzoli CG, Giaccone G, Baker S, Brahmer JR, Ellis PM, Gajra A, Rackear N, Schiller JH, Smith TJ, Strawn JR, Trent D, Johnson DH. Systemic Therapy for Stage IV Non-Small-Cell Lung Cancer: American Society of Clinical Oncology Clinical Practice Guideline Update. J Clin Oncol 2015; 33:3488-515. [PMID: 26324367 PMCID: PMC5019421 DOI: 10.1200/jco.2015.62.1342] [Citation(s) in RCA: 370] [Impact Index Per Article: 41.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
PURPOSE To provide evidence-based recommendations to update the American Society of Clinical Oncology guideline on systemic therapy for stage IV non-small-cell lung cancer (NSCLC). METHODS An Update Committee of the American Society of Clinical Oncology NSCLC Expert Panel based recommendations on a systematic review of randomized controlled trials from January 2007 to February 2014. RESULTS This guideline update reflects changes in evidence since the previous guideline. RECOMMENDATIONS There is no cure for patients with stage IV NSCLC. For patients with performance status (PS) 0 to 1 (and appropriate patient cases with PS 2) and without an EGFR-sensitizing mutation or ALK gene rearrangement, combination cytotoxic chemotherapy is recommended, guided by histology, with early concurrent palliative care. Recommendations for patients in the first-line setting include platinum-doublet therapy for those with PS 0 to 1 (bevacizumab may be added to carboplatin plus paclitaxel if no contraindications); combination or single-agent chemotherapy or palliative care alone for those with PS 2; afatinib, erlotinib, or gefitinib for those with sensitizing EGFR mutations; crizotinib for those with ALK or ROS1 gene rearrangement; and following first-line recommendations or using platinum plus etoposide for those with large-cell neuroendocrine carcinoma. Maintenance therapy includes pemetrexed continuation for patients with stable disease or response to first-line pemetrexed-containing regimens, alternative chemotherapy, or a chemotherapy break. In the second-line setting, recommendations include docetaxel, erlotinib, gefitinib, or pemetrexed for patients with nonsquamous cell carcinoma; docetaxel, erlotinib, or gefitinib for those with squamous cell carcinoma; and chemotherapy or ceritinib for those with ALK rearrangement who experience progression after crizotinib. In the third-line setting, for patients who have not received erlotinib or gefitinib, treatment with erlotinib is recommended. There are insufficient data to recommend routine third-line cytotoxic therapy. Decisions regarding systemic therapy should not be made based on age alone. Additional information can be found at http://www.asco.org/guidelines/nsclc and http://www.asco.org/guidelineswiki.
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Affiliation(s)
- Gregory A Masters
- Gregory A. Masters, Helen F. Graham Cancer Center, Newark, DE; Sarah Temin, American Society of Clinical Oncology, Alexandria; Sherman Baker Jr, Virginia Commonwealth University; David Trent, Virginia Cancer Center, Richmond, VA; Christopher G. Azzoli, Massachusetts General Hospital Cancer Center, Boston, MA; Giuseppe Giaccone, Lombardi Cancer Center, Georgetown University, Washington, DC; Julie R. Brahmer and Thomas J. Smith, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins, Baltimore, MD; Peter M. Ellis, Juravinski Cancer Centre, Hamilton, Ontario, Canada; Ajeet Gajra, Upstate Medical University, Syracuse, NY; Nancy Rackear, Uniting Against Lung Cancer, Fort Lauderdale, FL; Joan H. Schiller, University of Texas Southwestern; David H. Johnson, University of Texas Southwestern Medical Center at Dallas, Dallas; and John R. Strawn, patient representative, Houston, TX
| | - Sarah Temin
- Gregory A. Masters, Helen F. Graham Cancer Center, Newark, DE; Sarah Temin, American Society of Clinical Oncology, Alexandria; Sherman Baker Jr, Virginia Commonwealth University; David Trent, Virginia Cancer Center, Richmond, VA; Christopher G. Azzoli, Massachusetts General Hospital Cancer Center, Boston, MA; Giuseppe Giaccone, Lombardi Cancer Center, Georgetown University, Washington, DC; Julie R. Brahmer and Thomas J. Smith, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins, Baltimore, MD; Peter M. Ellis, Juravinski Cancer Centre, Hamilton, Ontario, Canada; Ajeet Gajra, Upstate Medical University, Syracuse, NY; Nancy Rackear, Uniting Against Lung Cancer, Fort Lauderdale, FL; Joan H. Schiller, University of Texas Southwestern; David H. Johnson, University of Texas Southwestern Medical Center at Dallas, Dallas; and John R. Strawn, patient representative, Houston, TX
| | - Christopher G Azzoli
- Gregory A. Masters, Helen F. Graham Cancer Center, Newark, DE; Sarah Temin, American Society of Clinical Oncology, Alexandria; Sherman Baker Jr, Virginia Commonwealth University; David Trent, Virginia Cancer Center, Richmond, VA; Christopher G. Azzoli, Massachusetts General Hospital Cancer Center, Boston, MA; Giuseppe Giaccone, Lombardi Cancer Center, Georgetown University, Washington, DC; Julie R. Brahmer and Thomas J. Smith, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins, Baltimore, MD; Peter M. Ellis, Juravinski Cancer Centre, Hamilton, Ontario, Canada; Ajeet Gajra, Upstate Medical University, Syracuse, NY; Nancy Rackear, Uniting Against Lung Cancer, Fort Lauderdale, FL; Joan H. Schiller, University of Texas Southwestern; David H. Johnson, University of Texas Southwestern Medical Center at Dallas, Dallas; and John R. Strawn, patient representative, Houston, TX
| | - Giuseppe Giaccone
- Gregory A. Masters, Helen F. Graham Cancer Center, Newark, DE; Sarah Temin, American Society of Clinical Oncology, Alexandria; Sherman Baker Jr, Virginia Commonwealth University; David Trent, Virginia Cancer Center, Richmond, VA; Christopher G. Azzoli, Massachusetts General Hospital Cancer Center, Boston, MA; Giuseppe Giaccone, Lombardi Cancer Center, Georgetown University, Washington, DC; Julie R. Brahmer and Thomas J. Smith, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins, Baltimore, MD; Peter M. Ellis, Juravinski Cancer Centre, Hamilton, Ontario, Canada; Ajeet Gajra, Upstate Medical University, Syracuse, NY; Nancy Rackear, Uniting Against Lung Cancer, Fort Lauderdale, FL; Joan H. Schiller, University of Texas Southwestern; David H. Johnson, University of Texas Southwestern Medical Center at Dallas, Dallas; and John R. Strawn, patient representative, Houston, TX
| | - Sherman Baker
- Gregory A. Masters, Helen F. Graham Cancer Center, Newark, DE; Sarah Temin, American Society of Clinical Oncology, Alexandria; Sherman Baker Jr, Virginia Commonwealth University; David Trent, Virginia Cancer Center, Richmond, VA; Christopher G. Azzoli, Massachusetts General Hospital Cancer Center, Boston, MA; Giuseppe Giaccone, Lombardi Cancer Center, Georgetown University, Washington, DC; Julie R. Brahmer and Thomas J. Smith, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins, Baltimore, MD; Peter M. Ellis, Juravinski Cancer Centre, Hamilton, Ontario, Canada; Ajeet Gajra, Upstate Medical University, Syracuse, NY; Nancy Rackear, Uniting Against Lung Cancer, Fort Lauderdale, FL; Joan H. Schiller, University of Texas Southwestern; David H. Johnson, University of Texas Southwestern Medical Center at Dallas, Dallas; and John R. Strawn, patient representative, Houston, TX
| | - Julie R Brahmer
- Gregory A. Masters, Helen F. Graham Cancer Center, Newark, DE; Sarah Temin, American Society of Clinical Oncology, Alexandria; Sherman Baker Jr, Virginia Commonwealth University; David Trent, Virginia Cancer Center, Richmond, VA; Christopher G. Azzoli, Massachusetts General Hospital Cancer Center, Boston, MA; Giuseppe Giaccone, Lombardi Cancer Center, Georgetown University, Washington, DC; Julie R. Brahmer and Thomas J. Smith, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins, Baltimore, MD; Peter M. Ellis, Juravinski Cancer Centre, Hamilton, Ontario, Canada; Ajeet Gajra, Upstate Medical University, Syracuse, NY; Nancy Rackear, Uniting Against Lung Cancer, Fort Lauderdale, FL; Joan H. Schiller, University of Texas Southwestern; David H. Johnson, University of Texas Southwestern Medical Center at Dallas, Dallas; and John R. Strawn, patient representative, Houston, TX
| | - Peter M Ellis
- Gregory A. Masters, Helen F. Graham Cancer Center, Newark, DE; Sarah Temin, American Society of Clinical Oncology, Alexandria; Sherman Baker Jr, Virginia Commonwealth University; David Trent, Virginia Cancer Center, Richmond, VA; Christopher G. Azzoli, Massachusetts General Hospital Cancer Center, Boston, MA; Giuseppe Giaccone, Lombardi Cancer Center, Georgetown University, Washington, DC; Julie R. Brahmer and Thomas J. Smith, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins, Baltimore, MD; Peter M. Ellis, Juravinski Cancer Centre, Hamilton, Ontario, Canada; Ajeet Gajra, Upstate Medical University, Syracuse, NY; Nancy Rackear, Uniting Against Lung Cancer, Fort Lauderdale, FL; Joan H. Schiller, University of Texas Southwestern; David H. Johnson, University of Texas Southwestern Medical Center at Dallas, Dallas; and John R. Strawn, patient representative, Houston, TX
| | - Ajeet Gajra
- Gregory A. Masters, Helen F. Graham Cancer Center, Newark, DE; Sarah Temin, American Society of Clinical Oncology, Alexandria; Sherman Baker Jr, Virginia Commonwealth University; David Trent, Virginia Cancer Center, Richmond, VA; Christopher G. Azzoli, Massachusetts General Hospital Cancer Center, Boston, MA; Giuseppe Giaccone, Lombardi Cancer Center, Georgetown University, Washington, DC; Julie R. Brahmer and Thomas J. Smith, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins, Baltimore, MD; Peter M. Ellis, Juravinski Cancer Centre, Hamilton, Ontario, Canada; Ajeet Gajra, Upstate Medical University, Syracuse, NY; Nancy Rackear, Uniting Against Lung Cancer, Fort Lauderdale, FL; Joan H. Schiller, University of Texas Southwestern; David H. Johnson, University of Texas Southwestern Medical Center at Dallas, Dallas; and John R. Strawn, patient representative, Houston, TX
| | - Nancy Rackear
- Gregory A. Masters, Helen F. Graham Cancer Center, Newark, DE; Sarah Temin, American Society of Clinical Oncology, Alexandria; Sherman Baker Jr, Virginia Commonwealth University; David Trent, Virginia Cancer Center, Richmond, VA; Christopher G. Azzoli, Massachusetts General Hospital Cancer Center, Boston, MA; Giuseppe Giaccone, Lombardi Cancer Center, Georgetown University, Washington, DC; Julie R. Brahmer and Thomas J. Smith, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins, Baltimore, MD; Peter M. Ellis, Juravinski Cancer Centre, Hamilton, Ontario, Canada; Ajeet Gajra, Upstate Medical University, Syracuse, NY; Nancy Rackear, Uniting Against Lung Cancer, Fort Lauderdale, FL; Joan H. Schiller, University of Texas Southwestern; David H. Johnson, University of Texas Southwestern Medical Center at Dallas, Dallas; and John R. Strawn, patient representative, Houston, TX
| | - Joan H Schiller
- Gregory A. Masters, Helen F. Graham Cancer Center, Newark, DE; Sarah Temin, American Society of Clinical Oncology, Alexandria; Sherman Baker Jr, Virginia Commonwealth University; David Trent, Virginia Cancer Center, Richmond, VA; Christopher G. Azzoli, Massachusetts General Hospital Cancer Center, Boston, MA; Giuseppe Giaccone, Lombardi Cancer Center, Georgetown University, Washington, DC; Julie R. Brahmer and Thomas J. Smith, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins, Baltimore, MD; Peter M. Ellis, Juravinski Cancer Centre, Hamilton, Ontario, Canada; Ajeet Gajra, Upstate Medical University, Syracuse, NY; Nancy Rackear, Uniting Against Lung Cancer, Fort Lauderdale, FL; Joan H. Schiller, University of Texas Southwestern; David H. Johnson, University of Texas Southwestern Medical Center at Dallas, Dallas; and John R. Strawn, patient representative, Houston, TX
| | - Thomas J Smith
- Gregory A. Masters, Helen F. Graham Cancer Center, Newark, DE; Sarah Temin, American Society of Clinical Oncology, Alexandria; Sherman Baker Jr, Virginia Commonwealth University; David Trent, Virginia Cancer Center, Richmond, VA; Christopher G. Azzoli, Massachusetts General Hospital Cancer Center, Boston, MA; Giuseppe Giaccone, Lombardi Cancer Center, Georgetown University, Washington, DC; Julie R. Brahmer and Thomas J. Smith, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins, Baltimore, MD; Peter M. Ellis, Juravinski Cancer Centre, Hamilton, Ontario, Canada; Ajeet Gajra, Upstate Medical University, Syracuse, NY; Nancy Rackear, Uniting Against Lung Cancer, Fort Lauderdale, FL; Joan H. Schiller, University of Texas Southwestern; David H. Johnson, University of Texas Southwestern Medical Center at Dallas, Dallas; and John R. Strawn, patient representative, Houston, TX
| | - John R Strawn
- Gregory A. Masters, Helen F. Graham Cancer Center, Newark, DE; Sarah Temin, American Society of Clinical Oncology, Alexandria; Sherman Baker Jr, Virginia Commonwealth University; David Trent, Virginia Cancer Center, Richmond, VA; Christopher G. Azzoli, Massachusetts General Hospital Cancer Center, Boston, MA; Giuseppe Giaccone, Lombardi Cancer Center, Georgetown University, Washington, DC; Julie R. Brahmer and Thomas J. Smith, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins, Baltimore, MD; Peter M. Ellis, Juravinski Cancer Centre, Hamilton, Ontario, Canada; Ajeet Gajra, Upstate Medical University, Syracuse, NY; Nancy Rackear, Uniting Against Lung Cancer, Fort Lauderdale, FL; Joan H. Schiller, University of Texas Southwestern; David H. Johnson, University of Texas Southwestern Medical Center at Dallas, Dallas; and John R. Strawn, patient representative, Houston, TX
| | - David Trent
- Gregory A. Masters, Helen F. Graham Cancer Center, Newark, DE; Sarah Temin, American Society of Clinical Oncology, Alexandria; Sherman Baker Jr, Virginia Commonwealth University; David Trent, Virginia Cancer Center, Richmond, VA; Christopher G. Azzoli, Massachusetts General Hospital Cancer Center, Boston, MA; Giuseppe Giaccone, Lombardi Cancer Center, Georgetown University, Washington, DC; Julie R. Brahmer and Thomas J. Smith, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins, Baltimore, MD; Peter M. Ellis, Juravinski Cancer Centre, Hamilton, Ontario, Canada; Ajeet Gajra, Upstate Medical University, Syracuse, NY; Nancy Rackear, Uniting Against Lung Cancer, Fort Lauderdale, FL; Joan H. Schiller, University of Texas Southwestern; David H. Johnson, University of Texas Southwestern Medical Center at Dallas, Dallas; and John R. Strawn, patient representative, Houston, TX
| | - David H Johnson
- Gregory A. Masters, Helen F. Graham Cancer Center, Newark, DE; Sarah Temin, American Society of Clinical Oncology, Alexandria; Sherman Baker Jr, Virginia Commonwealth University; David Trent, Virginia Cancer Center, Richmond, VA; Christopher G. Azzoli, Massachusetts General Hospital Cancer Center, Boston, MA; Giuseppe Giaccone, Lombardi Cancer Center, Georgetown University, Washington, DC; Julie R. Brahmer and Thomas J. Smith, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins, Baltimore, MD; Peter M. Ellis, Juravinski Cancer Centre, Hamilton, Ontario, Canada; Ajeet Gajra, Upstate Medical University, Syracuse, NY; Nancy Rackear, Uniting Against Lung Cancer, Fort Lauderdale, FL; Joan H. Schiller, University of Texas Southwestern; David H. Johnson, University of Texas Southwestern Medical Center at Dallas, Dallas; and John R. Strawn, patient representative, Houston, TX
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Haque A, Rahman MA, Fuchs JR, Chen ZG, Khuri FR, Shin DM, Amin ARMR. FLLL12 induces apoptosis in lung cancer cells through a p53/p73-independent but death receptor 5-dependent pathway. Cancer Lett 2015; 363:166-75. [PMID: 25917567 DOI: 10.1016/j.canlet.2015.04.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 04/14/2015] [Accepted: 04/16/2015] [Indexed: 01/17/2023]
Abstract
Unlike chemotherapy drugs, the safety of natural compounds such as curcumin has been well established. However, the potential use of curcumin in cancer has been compromised by its low bioavailability, limited tissue distribution and rapid biotransformation leading to low in vivo efficacy. To circumvent these problems, more potent and bioavailable analogs have been synthesized. In the current study, we investigated the mechanism of anti-tumor effect of one such analog, FLLL12, in lung cancers. IC50 values measured by sulforhodamine B (SRB) assay at 72 h and apoptosis assays (annexin V staining, cleavage of PARP and caspase-3) suggest that FLLL12 is 5-10-fold more potent than curcumin against a panel of premalignant and malignant lung cancer cell lines, depending on the cell line. Moreover, FLLL12 induced the expression of death receptor-5 (DR5). Ablation of the expression of the components of the extrinsic apoptotic pathway (DR5, caspase-8 and Bid) by siRNA significantly protected cells from FLLL12-induced apoptosis (p < 0.05). Analysis of mRNA expression revealed that FLLL-12 had no significant effect on the expression of DR5 mRNA expression. Interestingly, inhibition of global phosphatase activity as well as protein tyrosine phosphatases (PTPs), but not of alkaline phosphatases, strongly inhibited DR5 expression and significantly inhibited apoptosis (p < 0.05), suggesting the involvement of PTPs in the regulation of DR5 expression and apoptosis. We further showed that the apoptosis is independent of p53 and p73. Taken together, our results strongly suggest that FLLL12 induces apoptosis of lung cancer cell lines by posttranscriptional regulation of DR5 through activation of protein tyrosine phosphatase(s).
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Affiliation(s)
- Abedul Haque
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA 30322, USA
| | - Mohammad A Rahman
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA 30322, USA
| | - James R Fuchs
- Deaprtment of Medicinal Chemistry and Pharmacognosy, College of Pharmacy, Ohio State University, Columbus, OH, USA
| | - Zhuo Georgia Chen
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA 30322, USA
| | - Fadlo R Khuri
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA 30322, USA
| | - Dong M Shin
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA 30322, USA
| | - A R M Ruhul Amin
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA 30322, USA.
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