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Dong J, Zhu D, Tang X, Lu D, Qiu X, Li B, Lin D, Li L, Liu J, Zhou Q. Circulating tumor cells in pulmonary vein and peripheral arterial provide a metric for PD-L1 diagnosis and prognosis of patients with non-small cell lung cancer. PLoS One 2019; 14:e0220306. [PMID: 31348821 PMCID: PMC6660086 DOI: 10.1371/journal.pone.0220306] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Accepted: 07/13/2019] [Indexed: 02/05/2023] Open
Abstract
Background Lung cancer is the leading cause of death caused by malignant tumors. PD-L1(programmed cell death protein-1) has shown tremendous achievement in treating NSCLC. We sought to find the relationship between CTCs in the pulmonary vein and postoperative PFS, besides we detected PD-L1 in CTCs. Method We enrolled 112 NSCLC patients. CTC tests were performed at four time points (preoperative, pulmonary vein, intraoperative and postoperative) on every NSCLC patient who received surgery. The RNA of PD-L1 was tested by FISH. The levels of the PD-L1 mRNA and protein in tissue samples were detected. Results The CTCs in the PV were the highest (P< 0.001), and CTCs in the PPA were the lowest (P< 0.001). The PFS in the group with PV CTCs≥ 16/5 ml was shorter than that in the group with PV CTCs< 16/5 ml (11.1 months vs 21.2 months, respectively; P< 0.001). The PFS in the group with PPA CTCs≥ 3/5 ml was shorter than that in the group with CTCs< 3/5 ml (14.8 months vs 20.7 months, respectively; P< 0.001). The CTCs in stage I were lower than those in stage II-IV (P = 0.025). No linear relationship was found between the CTCs and tumor size (P> 0.05) or LN metastasis (P> 0.05). In total, fifty-two (50.5%) patients had positive PD-L1 expression in CTC. In PD-L1-positive CTC patients, the value of PD-L1 tissue expression was higher than that in PD-L1-negative CTC patients (P = 0.0153). Conclusion CTCs in the pulmonary vein can be an effective prognosis indicator of NSCLC patients.
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Affiliation(s)
- Jingsi Dong
- Department of Lung Cancer Center, Sichuan University West China Hospital, Chengdu, China
| | - Daxing Zhu
- Department of Lung Cancer Center, Sichuan University West China Hospital, Chengdu, China
| | - Xiaojun Tang
- Department of Lung Cancer Center, Sichuan University West China Hospital, Chengdu, China
| | - Dan Lu
- Department of Otorhinolaryngology, Head & Neck Surgery, Sichuan University West China Hospital, Chengdu, China
| | - Xiaoming Qiu
- Department of Lung Cancer Center, Sichuan University West China Hospital, Chengdu, China
| | - Bingjie Li
- Department of Lung Cancer Center, Sichuan University West China Hospital, Chengdu, China
| | - Dan Lin
- Department of Lung Cancer Center, Sichuan University West China Hospital, Chengdu, China
| | - Lu Li
- Department of Lung Cancer Center, Sichuan University West China Hospital, Chengdu, China
| | - Jiewei Liu
- Department of Lung Cancer Center, Sichuan University West China Hospital, Chengdu, China
| | - Qinghua Zhou
- Department of Lung Cancer Center, Sichuan University West China Hospital, Chengdu, China
- * E-mail:
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Liao W, Huang J, Hutton D, Li Q. Cost-effectiveness analysis of first-line pembrolizumab treatment for PD-L1 positive, non-small cell lung cancer in China. J Med Econ 2019; 22:344-349. [PMID: 30646794 DOI: 10.1080/13696998.2019.1570221] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PURPOSE Pembrolizumab was recently approved in several countries as a first-line treatment for patients with PD-L1 positive, non-small cell lung cancer (NSCLC). However, it is expensive. This study aimed to assess the cost-effectiveness of pembrolizumab in treating advanced NSCLC patients with PD-L1 positive cancer in China. METHODS A Markov model was developed to compare the cost-effectiveness of pembrolizumab with chemotherapy for patients with PD-L1 expression on at least 50% of NSCLC tumor cells. Model inputs for transition probabilities and toxicity were derived from published clinical trial data, while health utilities were estimated from a literature review. Costs for drugs were updated to standard fee data from West China Hospital in 2017. Health outcomes were measured in quality-adjusted life years (QALYs), and cost-effectiveness was measured as the incremental cost-effectiveness ratio (ICER). Sensitivity analyses were conducted to test the robustness of the model. RESULTS Pembrolizumab gained 0.45 QALYs at an incremental cost of $46,362 compared to chemotherapy for an ICER of $103,128 per QALY gained. In most scenarios, the ICER exceeded three times the Chinese Gross Domestic Product per capita. Two-way sensitivity analysis showed that, when the utility of the progression-free status increased to the maximal value of 0.845 and the 1 mg dose price decreased to $10.50, the ICER reduced to $25,216/QALY. CONCLUSIONS Pembrolizumab is not likely to be cost-effective in the treatment of PD-L1 positive, NSCLC for Chinese patients. Less aggressive pricing may increase accessibility for patients in China.
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Affiliation(s)
- Weiting Liao
- a Department of Medical Oncology , Cancer Center, West China Hospital, Sichuan University , Chengdu 610041 , PR China
- b West China Biomedical Big Data Center, Sichuan University , Chengdu 610041 , PR China
| | - Jiaxing Huang
- a Department of Medical Oncology , Cancer Center, West China Hospital, Sichuan University , Chengdu 610041 , PR China
- b West China Biomedical Big Data Center, Sichuan University , Chengdu 610041 , PR China
| | - David Hutton
- c Department of Health Management and Policy , University of Michigan , Ann Arbor , MI 48109 , USA
| | - Qiu Li
- a Department of Medical Oncology , Cancer Center, West China Hospital, Sichuan University , Chengdu 610041 , PR China
- b West China Biomedical Big Data Center, Sichuan University , Chengdu 610041 , PR China
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Del C Monroig-Bosque P, Driver B, Morales-Rosado JA, Deavers M, Tacha D, Bernicker E, Cagle PT, Miller RA. Correlation Between Programmed Death Receptor-1 Expression in Tumor-Infiltrating Lymphocytes and Programmed Death Ligand-1 Expression in Non-Small Cell Lung Carcinoma. Arch Pathol Lab Med 2018; 142:1388-1393. [PMID: 29431467 DOI: 10.5858/arpa.2017-0516-oa] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT.— The interaction between programmed death ligand-1 (PD-L1) and programmed death receptor-1 (PD-1) on activated T cells sends an inhibitory signal that dampens the immune response. Tumors can express PD-L1 and evade the immune system. In advanced non-small cell lung carcinoma, expression of PD-1 in tumor-infiltrating lymphocytes (TILs) correlates with PD-L1 expression in tumor cells (TCs). However, this relationship has not been thoroughly explored in early disease. OBJECTIVE.— To investigate the correlation of PD-1 and PD-L1 in non-small cell lung carcinoma tumor samples, with emphasis on stage I disease. DESIGN.— Whole tissue sections from non-small cell lung carcinoma tumors were retrospectively evaluated by immunohistochemistry for PD-1 and PD-L1 expression. The scoring was based on the percentage of cells positive for PD-1 in TILs and PD-L1 in TCs and tumor-infiltrating immune cells (ICs). RESULTS.— Expression of PD-1 in TILs was observed in 147 of 161 non-small cell lung carcinoma cases (91%). The majority of cases negative for PD-1 also lacked PD-L1 in TCs. The 68 cases with highest PD-1 expression in TILs included 33 (49%) with expression of PD-L1 in TCs and ICs. Strong correlations were observed in patients with elevated PD-1 expression in TILs and PD-L1 in TCs ( P = .01) and ICs ( P = .003). Expression of PD-1 also correlated with increased PD-L1 in TCs and ICs when the 2 were grouped together ( P < .001). Finally, stage I patients with negative PD-1 and PD-L1 expression showed trends toward increased disease-specific survival. CONCLUSIONS.— Expression of PD-1 in TILs correlates with PD-L1 expression in both TCs and ICs. Furthermore, negative expression of PD-1 and PD-L1 suggest trends toward disease-specific survival, even in early disease stages.
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Affiliation(s)
| | | | | | | | | | | | | | - Ross A Miller
- From the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Drs Monroig-Bosque, Deavers, Bernicker, Cagle, and Miller); the Department of Pathology, Weill Cornell Medicine, New York, New York (Drs Monroig-Bosque, Bernicker, Cagle, and Miller); the Department of Pathology, University of Arkansas for Medical Science, Little Rock (Dr Driver); the Department of Medicine, University of Puerto Rico Medical Sciences Campus, San Juan (Dr Morales-Rosado); and Biocare Medical LLC, Pacheco, California (Dr Tacha)
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Safi S, Yamauchi Y, Rathinasamy A, Stamova S, Eichhorn M, Warth A, Rauch G, Dienemann H, Hoffmann H, Beckhove P. Functional T cells targeting tumor-associated antigens are predictive for recurrence-free survival of patients with radically operated non-small cell lung cancer. Oncoimmunology 2017; 6:e1360458. [PMID: 29147626 DOI: 10.1080/2162402x.2017.1360458] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Revised: 07/20/2017] [Accepted: 07/21/2017] [Indexed: 10/18/2022] Open
Abstract
In this prospective study, we examined postoperative follow-up and preoperative IFN-γ T cell responses against 14 non-small cell lung cancer (NSCLC)-associated antigens in the blood of 51 patients with NSCLC, 7 patients with benign pulmonary tumors, and 10 tumor-free patients by enzyme-linked immunospot assay. The phenotype and function of T cells specific for tumor-associated antigens (TAAs) in the blood or tumor tissue of 9 NSCLC patients were characterized in detail using TNF-α, IL-2, and IFN-γ cytokine capture assays. We found that circulating TAA-specific T cells were significantly enriched in NSCLC compared with tumor-free patients. The most frequently recognized TAAs were Aurora kinase A, HER2/neu, NY-ESO-1, and p53. TNF-α was the most abundant cytokine secreted by TAA-specific T cells in the blood as well as by in situ-activated tumor-infiltrating lymphocytes, most of which were effector memory cells. The absence of TAA-reactive T cells identified patients at higher risk of tumor recurrence, irrespective of tumor stage (OR = 8.76, 95% CI: 1.57-34.79, p = 0.008). We conclude that pre-existing TAA-reactive circulating T cells are a strong independent prognostic factor for recurrence-free survival. These data may help discriminating high-risk from low-risk patients, improving prognostication, and redirecting adjuvant therapy. Our findings suggest the therapeutic relevance of Aurora kinase A, HER2/neu, NY-ESO-1, and p53 as targets for immunotherapy. This study is registered on Clinicaltrials.gov with trial identification number: NCT02515760.
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Affiliation(s)
- Seyer Safi
- Department of Thoracic Surgery, Thoraxklinik, Heidelberg University Hospital, Roentgenstrasse 1, Heidelberg, BW, Germany
| | - Yoshikane Yamauchi
- Department of Thoracic Surgery, Thoraxklinik, Heidelberg University Hospital, Roentgenstrasse 1, Heidelberg, BW, Germany
| | - Anchana Rathinasamy
- Regensburg Center for Interventional Immunology and Hematology Department University Clinic and University of Regensburg, Am Biopark 9, Regensburg, BY, Germany
| | - Slava Stamova
- Regensburg Center for Interventional Immunology and Hematology Department University Clinic and University of Regensburg, Am Biopark 9, Regensburg, BY, Germany
| | - Martin Eichhorn
- Department of Thoracic Surgery, Thoraxklinik, Heidelberg University Hospital, Roentgenstrasse 1, Heidelberg, BW, Germany
| | - Arne Warth
- Institute of Pathology, Heidelberg University, Im Neuenheimer Feld 224, Heidelberg, BW, Germany
| | - Geraldine Rauch
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg, Eppendorf, Martinistrasse 52, Hamburg, HH, Germany
| | - Hendrik Dienemann
- Department of Thoracic Surgery, Thoraxklinik, Heidelberg University Hospital, Roentgenstrasse 1, Heidelberg, BW, Germany
| | - Hans Hoffmann
- Department of Thoracic Surgery, Thoraxklinik, Heidelberg University Hospital, Roentgenstrasse 1, Heidelberg, BW, Germany
| | - Philipp Beckhove
- Regensburg Center for Interventional Immunology and Hematology Department University Clinic and University of Regensburg, Am Biopark 9, Regensburg, BY, Germany
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