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Ahmad U, Abdullah S, Chau DM, Chia SL, Yusoff K, Chan SC, Ong TA, Razack AH, Veerakumarasivam A. Analysis of PPI networks of transcriptomic expression identifies hub genes associated with Newcastle disease virus persistent infection in bladder cancer. Sci Rep 2023; 13:7323. [PMID: 37147328 PMCID: PMC10162992 DOI: 10.1038/s41598-022-20521-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 09/14/2022] [Indexed: 05/07/2023] Open
Abstract
Bladder cancer cells can acquire persistent infection of oncolytic Newcastle disease virus (NDV) but the molecular mechanism(s) remain unelucidated. This poses a major barrier to the effective clinical translation of oncolytic NDV virotherapy of cancers. To improve our understanding of the molecular mechanism(s) associated with the development of NDV persistent infection in bladder cancer, we used mRNA expression profiles of persistently infected bladder cancer cells to construct PPI networks. Based on paths and modules in the PPI network, the bridges were found mainly in the upregulated mRNA-pathways of p53 signalling, ECM-receptor interaction, and TGF-beta signalling and downregulated mRNA-pathways of antigen processing and presentation, protein processing in endoplasmic reticulum, completement and coagulation cascades in persistent TCCSUPPi cells. In persistent EJ28Pi cells, connections were identified mainly through upregulated mRNA-pathways of renal carcinoma, viral carcinogenesis, Ras signalling and cell cycle and the downregulated mRNA-pathways of Wnt signalling, HTLV-I infection and pathways in cancers. These connections were mainly dependent on RPL8-HSPA1A/HSPA4 in TCCSUPPi cells and EP300, PTPN11, RAC1-TP53, SP1, CCND1 and XPO1 in EJ28Pi cells. Oncomine validation showed that the top hub genes identified in the networks that include RPL8, THBS1, F2 from TCCSUPPi and TP53 and RAC1 from EJ28Pi are involved in the development and progression of bladder cancer. Protein-drug interaction networks identified several putative drug targets that could be used to disrupt the linkages between the modules and prevent bladder cancer cells from acquiring NDV persistent infection. This novel PPI network analysis of differentially expressed mRNAs of NDV persistently infected bladder cancer cell lines provide an insight into the molecular mechanisms of NDV persistency of infection in bladder cancers and the future screening of drugs that can be used together with NDV to enhance its oncolytic efficacy.
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Affiliation(s)
- Umar Ahmad
- Medical Genetics Laboratory, Genetics and Regenerative Medicine Research Centre, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 UPM, Serdang, Selangor, Malaysia
- Medical Genetics Unit, Faculty of Basic Medical Sciences, Bauchi State University, Gadau, PMB 65, Itas/Gadau, Nigeria
| | - Syahril Abdullah
- Medical Genetics Laboratory, Genetics and Regenerative Medicine Research Centre, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 UPM, Serdang, Selangor, Malaysia
- MAKNA Cancer Research Laboratory, Institute of Bioscience, Universiti Putra Malaysia, 43400 UPM, Serdang, Selangor, Malaysia
| | - De Ming Chau
- Medical Genetics Laboratory, Genetics and Regenerative Medicine Research Centre, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 UPM, Serdang, Selangor, Malaysia
| | - Suet Lin Chia
- MAKNA Cancer Research Laboratory, Institute of Bioscience, Universiti Putra Malaysia, 43400 UPM, Serdang, Selangor, Malaysia
- Department of Microbiology, Faculty of Biotechnology and Biomolecular Sciences, Universiti Putra Malaysia, 43400 UPM, Serdang, Selangor Darul Ehsan, Malaysia
| | - Khatijah Yusoff
- Department of Microbiology, Faculty of Biotechnology and Biomolecular Sciences, Universiti Putra Malaysia, 43400 UPM, Serdang, Selangor Darul Ehsan, Malaysia
- Malaysia Genome Institute, Ministry of Science, Technology and Innovation, Jalan Bangi, 43000, Kajang, Selangor Darul Ehsan, Malaysia
| | - Soon Choy Chan
- School of Liberal Arts, Science and Technology (PUScLST), Perdana University, Perdana University, 50490, Kuala Lumpur, Malaysia
| | - Teng Aik Ong
- Department of Surgery, Faculty of Medicine, University of Malaya, Wilayah Persekutuan, Kuala Lumpur, Malaysia
| | - Azad Hassan Razack
- Department of Surgery, Faculty of Medicine, University of Malaya, Wilayah Persekutuan, Kuala Lumpur, Malaysia
| | - Abhi Veerakumarasivam
- Medical Genetics Laboratory, Genetics and Regenerative Medicine Research Centre, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 UPM, Serdang, Selangor, Malaysia.
- Department of Biological Sciences, School of Medical and Life Sciences, Sunway University, 47500, Bandar Sunway, Selangor Darul Ehsan, Malaysia.
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McNamee N, da Silva IP, Nagrial A, Gao B. Small-Cell Lung Cancer-An Update on Targeted and Immunotherapies. Int J Mol Sci 2023; 24:8129. [PMID: 37175833 PMCID: PMC10179261 DOI: 10.3390/ijms24098129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 04/23/2023] [Accepted: 04/29/2023] [Indexed: 05/15/2023] Open
Abstract
Small-cell lung cancer (SCLC) is an aggressive disease with distinct biological and clinical features. The clinical course of SCLC is generally characterised by initial sensitivity to DNA-damaging therapies, followed by early relapse and broad cross resistance to second line agents. Whilst there has been an enormous expansion of effective targeted and immune-based therapeutic options for non-small cell lung cancer (NSCLC) in the last decade, little improvement has been achieved in SCLC treatment and survival due, at least in part, to underappreciated inter- and intra-tumoral heterogeneity. Here we review the current treatment paradigm of SCLC including recent advances made in utilizing immunotherapy and the challenges of identifying a predictive biomarker for immunotherapy response. We examine emerging new targeted therapies, combination immunotherapy and future directions of SCLC treatment research.
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Affiliation(s)
| | - Ines Pires da Silva
- Blacktown and Westmead Hospitals, Sydney, NSW 2145, Australia
- Westmead Clinical School, University of Sydney, Sydney, NSW 2145, Australia
| | - Adnan Nagrial
- Blacktown and Westmead Hospitals, Sydney, NSW 2145, Australia
- Westmead Clinical School, University of Sydney, Sydney, NSW 2145, Australia
| | - Bo Gao
- Blacktown and Westmead Hospitals, Sydney, NSW 2145, Australia
- Westmead Clinical School, University of Sydney, Sydney, NSW 2145, Australia
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3
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Zulfiqar B, Farooq A, Kanwal S, Asghar K. Immunotherapy and targeted therapy for lung cancer: Current status and future perspectives. Front Pharmacol 2022; 13:1035171. [PMID: 36518665 PMCID: PMC9742438 DOI: 10.3389/fphar.2022.1035171] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 11/11/2022] [Indexed: 08/30/2023] Open
Abstract
Lung cancer has the highest incidence of morbidity and mortality throughout the globe. A large number of patients are diagnosed with lung cancer at the later stages of the disease. This eliminates surgery as an option and places complete dependence on radiotherapy or chemotherapy, and/or a combination of both, to halt disease progression by targeting the tumor cells. Unfortunately, these therapies have rarely proved to be effective, and this necessitates the search for alternative preventive approaches to reduce the mortality rate of lung cancer. One of the effective therapies against lung cancer comprises targeting the tumor microenvironment. Like any other cancer cells, lung cancer cells tend to use multiple pathways to maintain their survival and suppress different immune responses from the host's body. This review comprehensively covers the role and the mechanisms that involve the nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB) in lung adenocarcinoma and methods of treating it by altering the tumor microenvironment. It focuses on the insight and understanding of the lung cancer tumor microenvironment and chemokines, cytokines, and activating molecules that take part in angiogenesis and metastasis. The review paper accounts for the novel and current immunotherapy and targeted therapy available for lung cancer in clinical trials and in the research phases in depth. Special attention is being paid to mark out single or multiple genes that are required for malignancy and survival while developing targeted therapies for lung cancer treatment.
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Affiliation(s)
- Bilal Zulfiqar
- Griffith Institute for Drug Discovery, Griffith University, Brisbane, QLD, Australia
| | - Asim Farooq
- Department of Clinical Research, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| | - Shahzina Kanwal
- Institute of Molecular Physiology at Shenzhen Bay Laboratory, Shenzhen, China
| | - Kashif Asghar
- Department of Basic Sciences Research, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
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4
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Wang K, Zhang H, Li X, Ding Y, Li J, Wang Z, Liu X, Sun S, Sun D. Bibliometric analysis of global research trends on small-cell lung cancer (2012–2021). Front Oncol 2022; 12:955259. [PMID: 36276088 PMCID: PMC9583519 DOI: 10.3389/fonc.2022.955259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 09/20/2022] [Indexed: 11/13/2022] Open
Abstract
Background Small-cell lung cancer (SCLC) is a recalcitrant tumor with a poor prognosis. With the rise of SCLC research in the past decade, this study aims to analyze the foundation and frontiers of SCLC research through bibliometric analysis. Methods Relevant publications from the Web of Science Core Collection were retrieved on January 3, 2022. R package bibliometrix and EXCEL2019 were used to analyze quantitative variables. Bibliometric mapping was constructed by VOS viewer and CiteSpace software to visualize citation, co-authorship, co-occurrence, and co-citation analysis of countries/regions, organizations, authors, references, and keywords. Results A total of 2,361 publications related to SCLC were identified with the total amount of articles steadily increasing, where China is the most productive country with 859 papers. Scholars and organizations from the United States, China, and Europe are primary sources of this research, among which the University of Texas MD Anderson Cancer Center made the most contribution to the field with 122 papers. Lung Cancer published the highest number of SCLC-related articles with a total of 121, while the Journal of Thoracic Oncology received the most citations totaling 3,098. Rudin, Charles M., and Sage, Julien are the most creative author. Leora, Horn, 2018, New Engl J Med and Rudin, Charles M., Nat Genet, 2012 can be categorized as classic literature owing to their high citations or strong sigma value. “Heterogeneity & Subtypes” and “Immunotherapy” may be the new frontiers in the SCLC domain. Conclusion Research on SCLC showed an upward trend based on the current global situation. Moreover, the current scope of collaboration in SCLC research is chiefly regional, which should further focus on transnational cooperation in the future. More attention should be devoted to “Heterogeneity & Subtypes” and “Immunotherapy”, which will be the hotspots in future research.
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Affiliation(s)
- Kai Wang
- Clinical School of Thoracic, Tianjin Medical University, Tianjin, China
| | - Han Zhang
- Clinical School of Thoracic, Tianjin Medical University, Tianjin, China
| | - Xin Li
- Department of Thoracic Surgery, Tianjin Chest Hospital of Tianjin University, Tianjin, China
| | - Yun Ding
- Clinical School of Thoracic, Tianjin Medical University, Tianjin, China
| | - Jiuzhen Li
- Clinical School of Thoracic, Tianjin Medical University, Tianjin, China
| | - Zixiao Wang
- Clinical School of Thoracic, Tianjin Medical University, Tianjin, China
| | - Xin Liu
- Clinical School of Thoracic, Tianjin Medical University, Tianjin, China
| | - Shuai Sun
- Clinical School of Thoracic, Tianjin Medical University, Tianjin, China
| | - Daqiang Sun
- Department of Thoracic Surgery, Tianjin Chest Hospital of Tianjin University, Tianjin, China
- *Correspondence: Daqiang Sun,
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Montanino A, Manzo A, Carillio G, Palumbo G, Esposito G, Sforza V, Costanzo R, Sandomenico C, Botti G, Piccirillo MC, Cascetta P, Pascarella G, La Manna C, Normanno N, Morabito A. Angiogenesis Inhibitors in Small Cell Lung Cancer. Front Oncol 2021; 11:655316. [PMID: 34123809 PMCID: PMC8195287 DOI: 10.3389/fonc.2021.655316] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 05/03/2021] [Indexed: 12/22/2022] Open
Abstract
Inhibition of angiogenesis has been demonstrated to be an efficacious strategy in treating several tumors. Vascular endothelial growth factor (VEGF) is the most important protein with proangiogenic functions and it is overexpressed in small cell lung cancer (SCLC). Bevacizumab, a monoclonal antibody directed against VEGF, showed a promising activity in combination with etoposide and cisplatin as first-line treatment of patients with extended stage (ES)-SCLC and two randomized studies confirmed that bevacizumab improved PFS, but failed to prolong OS. Instead, disappointing results have been observed with endostar, sunitinib, sorafenib, vandetanib, and thalidomide in combination with chemotherapy in the first-line setting, with sunitinib in the maintenance setting, with sunitinib, cediranib and nintedanib as single agents or ziv-aflibercept in combination with topotecan in second-line setting. Only anlotinib improved OS and PFS as third-line therapy in Chinese patients with SCLC, and it was approved with this indication in China. Future challenges are the evaluation of the role of angiogenesis inhibitors in combination with immune- checkpoint inhibitors and chemotherapy in SCLC patients and the identification of predictive biomarkers of response to both agents.
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Affiliation(s)
- Agnese Montanino
- Thoracic Department, Istituto Nazionale Tumori, IRCCS "Fondazione G.Pascale", Naples, Italy
| | - Anna Manzo
- Thoracic Department, Istituto Nazionale Tumori, IRCCS "Fondazione G.Pascale", Naples, Italy
| | - Guido Carillio
- Department of Oncology and Hematology, Azienda Ospedaliera Pugliese-Ciaccio, Catanzaro, Italy
| | - Giuliano Palumbo
- Thoracic Department, Istituto Nazionale Tumori, IRCCS "Fondazione G.Pascale", Naples, Italy
| | - Giovanna Esposito
- Thoracic Department, Istituto Nazionale Tumori, IRCCS "Fondazione G.Pascale", Naples, Italy
| | - Vincenzo Sforza
- Thoracic Department, Istituto Nazionale Tumori, IRCCS "Fondazione G.Pascale", Naples, Italy
| | - Raffaele Costanzo
- Thoracic Department, Istituto Nazionale Tumori, IRCCS "Fondazione G.Pascale", Naples, Italy
| | - Claudia Sandomenico
- Thoracic Department, Istituto Nazionale Tumori, IRCCS "Fondazione G.Pascale", Naples, Italy
| | - Gerardo Botti
- Scientific Directorate, Istituto Nazionale Tumori, "Fondazione G. Pascale" - IRCCS, Naples, Italy
| | - Maria C Piccirillo
- Scientific Department, Istituto Nazionale Tumori, "Fondazione G.Pascale" - IRCCS, Naples, Italy
| | | | - Giacomo Pascarella
- Scientific Directorate, Istituto Nazionale Tumori, "Fondazione G. Pascale" - IRCCS, Naples, Italy
| | - Carmine La Manna
- Thoracic Department, Istituto Nazionale Tumori, IRCCS "Fondazione G.Pascale", Naples, Italy
| | - Nicola Normanno
- Scientific Department, Istituto Nazionale Tumori, "Fondazione G.Pascale" - IRCCS, Naples, Italy
| | - Alessandro Morabito
- Thoracic Department, Istituto Nazionale Tumori, IRCCS "Fondazione G.Pascale", Naples, Italy
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Zhou T, Zhang Z, Luo F, Zhao Y, Hou X, Liu T, Wang K, Zhao H, Huang Y, Zhang L. Comparison of First-Line Treatments for Patients With Extensive-Stage Small Cell Lung Cancer: A Systematic Review and Network Meta-analysis. JAMA Netw Open 2020; 3:e2015748. [PMID: 33074323 PMCID: PMC7573680 DOI: 10.1001/jamanetworkopen.2020.15748] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
IMPORTANCE Combinations of chemotherapy with immunotherapy or bevacizumab in first-line treatments of extensive-stage small cell lung cancer (ES-SCLC) have been evaluated in various clinical trials. However, it remains unclear what the optimal combination regimen is. OBJECTIVE To clarify which first-line combination regimen is associated with the best tumor response among patients with ES-SCLC. DATA SOURCES Electronic databases (PubMed, Embase, Cochrane Central Register of Controlled Trials, and Web of Science) were systematically searched to extract eligible literature from database inception to December 2019. STUDY SELECTION Head-to-head randomized clinical trials on first-line treatments for patients with ES-SCLC were included with outcomes and toxic effects reported, including objective response rate (ORR, involving complete response and partial response), disease control rate (DCR, involving complete response, partial response, and stable disease), progression-free survival (PFS), overall survival (OS), and treatment related adverse events (TRAEs) of grades 3 to 5. Of 199 eligible articles, 14 were included. DATA EXTRACTION AND SYNTHESIS Data were independently extracted and collected by 2 reviewers based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. Data were pooled using a random-effects model. MAIN OUTCOMES AND MEASURES Main outcomes were OS, PFS, DCR, ORR, and TRAEs of grades 3 to 5. RESULTS A total of 3 phase 2 and 11 phase 3 randomized clinical trials involving 4838 patients were included. Programmed cell death ligand 1 (PD-L1) inhibitor (durvalumab and atezolizumab) plus etoposide-based chemotherapy, compared with etoposide-based chemotherapy alone, showed the most favorable OS (hazard ratio, 1.40; 95% CI, 1.09-1.80) and the best DCR (odds ratio [OR], 0.42; 95% CI, 0.21-0.81). Bevacizumab plus etoposide-based chemotherapy provided the best PFS compared with etoposide-based chemotherapy alone (hazard ratio, 1.54; 95% CI, 1.09-2.27), although this was not translated into OS benefit. The addition of PD-L1 inhibitors to etoposide-platinum chemotherapy caused no more toxic effects in general (compared with etoposide-based chemotherapy alone: OR, 1.14; 95% CI, 0.36-2.31), while bevacizumab plus etoposide-platinum regimen induced the most TRAEs grades 3 to 5 among all first-line treatments (eg, compared with irinotecan-platinum regimen: OR, 4.24; 95% CI, 1.26-14.57). Based on the surface under the cumulative ranking curve value, PD-L1 inhibitor plus etoposide-platinum had the highest probability of being ranked first for OS (0.87) and DCR (0.97). CONCLUSIONS AND RELEVANCE The findings of this systematic review and network meta-analysis suggest that the combination of a PD-L1 inhibitor (durvalumab and atezolizumab) and etoposide-based chemotherapy may be an optimal first-line treatment option for patients with ES-SCLC patients.
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Affiliation(s)
- Ting Zhou
- Department of Medical Oncology, Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, People’s Republic of China
- Department of Clinical Laboratory, Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, People’s Republic of China
| | - Zhonghan Zhang
- Department of Medical Oncology, Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, People’s Republic of China
- Department of Clinical Laboratory, Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, People’s Republic of China
| | - Fan Luo
- Department of Medical Oncology, Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, People’s Republic of China
- Department of Clinical Laboratory, Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, People’s Republic of China
| | - Yuanyuan Zhao
- Department of Medical Oncology, Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, People’s Republic of China
- Department of Clinical Laboratory, Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, People’s Republic of China
| | - Xue Hou
- Department of Medical Oncology, Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, People’s Republic of China
- Department of Clinical Laboratory, Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, People’s Republic of China
| | - Tingting Liu
- Department of Medical Oncology, Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, People’s Republic of China
- Department of Clinical Laboratory, Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, People’s Republic of China
| | - Kai Wang
- Department of Medical Oncology, Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, People’s Republic of China
- Department of Clinical Laboratory, Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, People’s Republic of China
| | - Hongyun Zhao
- Department of Medical Oncology, Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, People’s Republic of China
- Department of Clinical Laboratory, Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, People’s Republic of China
| | - Yan Huang
- Department of Medical Oncology, Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, People’s Republic of China
- Department of Clinical Laboratory, Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, People’s Republic of China
| | - Li Zhang
- Department of Medical Oncology, Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, People’s Republic of China
- Department of Clinical Laboratory, Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, People’s Republic of China
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Abstract
Small cell lung cancer (SCLC) is an aggressive malignant tumour which accounts for approximately 13-15% of all newly diagnosed lung cancer cases. To date, platinum-based chemotherapy are still the first-line treatments for SCLC. However, chemotherapy resistance and systemic toxicity limit the long-term clinical outcome of first-line treatment in SCLC. Recent years, targeted therapy and immunotherapy have made great breakthrough in cancer therapy, and researchers aim to exploit both as a single agent or in combination with chemotherapy to improve the survival of SCLC patients, but limited effectiveness and the adverse events remain the major obstacles in the treatment of SCLC. To overcome these challenges for SCLC therapies, prevention and early diagnosis for this refractory disease is very important. At the same time, we should reveal more information about the pathogenesis of SCLC and the mechanism of drug resistance. Finally, new treatment strategies should also be taken into considerations, such as repurposing drug, optimising of targets, combination therapy strategies or prognostic biomarkers to enhance therapeutic effects and decrease the adverse events rates in SCLC patients. This article will review the molecular biology characteristics of SCLC and discuss the opportunities and obstacles of the current therapy for SCLC patients.
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Affiliation(s)
- Lin Yu
- The Clinical Laboratory of Mianyang Central Hospital, Mianyang, China.,Collaborative Innovation Center for Biotherapy, West China Hospital, West China Medical School, Sichuan University, Chengdu, China
| | - Qinhuai Lai
- Collaborative Innovation Center for Biotherapy, West China Hospital, West China Medical School, Sichuan University, Chengdu, China
| | - Lantu Gou
- Collaborative Innovation Center for Biotherapy, West China Hospital, West China Medical School, Sichuan University, Chengdu, China
| | - Jiafu Feng
- The Clinical Laboratory of Mianyang Central Hospital, Mianyang, China
| | - Jinliang Yang
- Collaborative Innovation Center for Biotherapy, West China Hospital, West China Medical School, Sichuan University, Chengdu, China
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8
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Shi X, Dong X, Young S, Chen AM, Liu X, Zheng Z, Huang K, Lu D, Feng S, Morahan G, Cai K. The impact of angiogenesis inhibitors on survival of patients with small cell lung cancer. Cancer Med 2019; 8:5930-5938. [PMID: 31433125 PMCID: PMC6792507 DOI: 10.1002/cam4.2462] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 07/11/2019] [Accepted: 07/16/2019] [Indexed: 12/19/2022] Open
Abstract
Background Small cell lung cancer (SCLC) is a highly invasive and lethal neuroendocrine tumor. Antiangiogenic drugs have been reported in the treatment of SCLC. We aimed to provide a comprehensive evaluation of the impact of angiogenic inhibitors on SCLC survival using network meta‐analysis. Methods The impact of five angiogenesis inhibitors, that is, vandetanib (Van), bevacizumab (Bev), Rh‐endostatin (End), sunitinib (Sun), and thalidomide (Tha), on progression‐free survival (PFS) and overall survival (OS) was evaluated by conducting a network meta‐analysis. RNA sequencing data were downloaded from publicly available databases. Results Nine phase II and III randomized controlled trials (RCTs), that involved 1599 participants, that investigated angiogenesis inhibitors in the treatment of SCLC were included in this meta‐analysis. Sun and Bev achieved better PFS than Tha (Bev VS. Tha, HR = 0.88, 95% CI: 0.79‐0.98, Sun VS. Tha, HR = 0.80, 95% CI: 0.65‐1.00). Moreover, Sun and Bev were superior to placebo in terms of PFS (Bev VS. Placebo, HR = 0.89, 95%CI: 0.81‐0.97, Sun VS. Placebo, HR = 0.81, 95% CI: 0.66‐1.00). Based on this study, we found no significant difference of OS of SCLC. The angiogenesis pathway and expression of target genes were globally deactivated in SCLC tissue. Conclusion Results of this network meta‐analysis indicate that the PFS outcome of SCLC with Sun or Bev drugs is superior to that of Tha. The improved therapeutic impact of angiogenesis inhibitors on SCLC needs more evidence, such as long‐term observation in clinical trials, to be validated.
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Affiliation(s)
- Xiaoshun Shi
- Department of Thoracic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, P. R. China.,Harry Perkins Institute of Medical Research, Centre for Medical Research, University of Western Australia, Nedlands, WA, Australia
| | - Xiaoying Dong
- Department of Thoracic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, P. R. China
| | - Sylvia Young
- Harry Perkins Institute of Medical Research, Centre for Medical Research, University of Western Australia, Nedlands, WA, Australia
| | - Allen Menglin Chen
- Mendel Genes Inc, Guangzhou, China.,Mendel Genes Inc, Manhattan Beach, CA, USA
| | - Xiguang Liu
- Department of Thoracic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, P. R. China
| | - Zhouxia Zheng
- Mendel Genes Inc, Guangzhou, China.,Mendel Genes Inc, Manhattan Beach, CA, USA
| | - Kailing Huang
- Mendel Genes Inc, Guangzhou, China.,Mendel Genes Inc, Manhattan Beach, CA, USA
| | - Di Lu
- Department of Thoracic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, P. R. China
| | - Siyang Feng
- Department of Thoracic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, P. R. China
| | - Grant Morahan
- Harry Perkins Institute of Medical Research, Centre for Medical Research, University of Western Australia, Nedlands, WA, Australia
| | - Kaican Cai
- Department of Thoracic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, P. R. China
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9
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Li H, Zeng J, Jin X, Yu X, Zhou G, Hong W. Apatinib for chemotherapy-refractory extensive-stage SCLC: a retrospective study. Cancer Chemother Pharmacol 2019; 83:1083-1090. [PMID: 30937519 DOI: 10.1007/s00280-019-03823-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Accepted: 03/19/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE There is no standard treatment strategy for patients with extensive-stage small cell lung cancer (SCLC) who have failed two or more prior chemotherapeutic regimens. In this study, we retrospectively evaluated the efficacy and safety of apatinib in patients with extensive-stage SCLC after failure of more than second-line chemotherapy. METHODS A study group comprised of 22 patients with extensive-stage SCLC after failure of more than two prior chemotherapeutic regimens was given apatinib orally at an initial dose of 500 mg daily until disease progression or unacceptable toxicity. This study was analyzed according to the National Cancer Institute Common Toxicity Criteria for adverse events (AEs) and Response Evaluation Criteria in Solid Tumors (RECIST) for response assessment. RESULTS Between August 30, 2015, and May 26, 2017, 22 patients were enrolled for evaluating the efficacy and safety of apatinib. Among them, 12/22 (54.5%) underwent dose reduction during treatment. Up to July 31, 2018, the median progression-free survival rate was 135.0 days [95% confidence interval (CI) 63.8-206.2]. According to the RECIST criteria, the disease control rate (DCR) was 86.4%, 19/22 [comprised of partial response (PR) 18.2%, 4/22; and stable disease (SD) 68.2%, 15/22 patients]. The most frequent AEs were hand-foot syndrome (45.5%, 10/22), secondary hypertension (45.5%, 10/22) and fatigue (40.9%, 9/22). The primary grade 3 or 4 toxicities were hypertension (22.7%, 5/22), hand-foot syndrome (13.6%, 3/22), and proteinuria (9.1%, 2/22). CONCLUSIONS Apatinib exhibits modest activity and acceptable toxicity for patients with heavily pretreated extensive-stage SCLC.
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Affiliation(s)
- Hui Li
- Department of Medical Oncology, Zhejiang Cancer Hospital, Hangzhou, 310022, China
| | - Jian Zeng
- Department of Department of Thoracic Surgery, Zhejiang Cancer Hospital, Hangzhou, 310022, China
| | - Xiangyu Jin
- Department of Medical Oncology, Zhejiang Cancer Hospital, Hangzhou, 310022, China
| | - Xinmin Yu
- Department of Medical Oncology, Zhejiang Cancer Hospital, Hangzhou, 310022, China
| | - Guoming Zhou
- Department of Laboratory Medicines, Zhejiang Cancer Hospital, Hangzhou, 310022, China
| | - Wei Hong
- Department of Medical Oncology, Zhejiang Cancer Hospital, Hangzhou, 310022, China.
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10
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Zimmerman S, Das A, Wang S, Julian R, Gandhi L, Wolf J. 2017-2018 Scientific Advances in Thoracic Oncology: Small Cell Lung Cancer. J Thorac Oncol 2019; 14:768-783. [PMID: 30763729 DOI: 10.1016/j.jtho.2019.01.022] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 01/22/2019] [Accepted: 01/22/2019] [Indexed: 01/04/2023]
Abstract
SCLC remains an aggressive, deadly cancer with only modest effect on survival from standard chemotherapy. However, with the advent of immunotherapy and comprehensive genomic and transcriptomic profiling, multiple new targets are showing promise in the clinical arena, and just recently programmed death ligand 1 inhibition has been shown to improve the efficacy of standard chemotherapy in extended-disease SCLC. Our increasing understanding of the interactions between different pathways will enable more tailored immunotherapy and targeted therapies based on specific biomarkers and rational combinations. Here we discuss the preclinical and clinical strides in 2017 and 2018 that put us on the threshold of a new era in therapeutics and will, it is hoped, translate into significant improvements in survival.
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Affiliation(s)
- Stefan Zimmerman
- Oncology Department, Service of Immuno-Oncology, Lausanne University Hospital, Lausanne, Switzerland.
| | - Arundhati Das
- New York University Langone Health, New York, New York
| | - Shuhang Wang
- Peking University Cancer Hospital, Beijing, People's Republic of China
| | - Ricklie Julian
- New York University Langone Health, New York, New York; Laura and Isaac Perlmutter Cancer Center, New York, New York; New York University School of Medicine, New York, New York
| | - Leena Gandhi
- New York University Langone Health, New York, New York; Laura and Isaac Perlmutter Cancer Center, New York, New York; New York University School of Medicine, New York, New York
| | - Juergen Wolf
- Center for Integrated Oncology Köln Bonn, University Clinic Köln, Köln, Germany
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12
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Baize N, Monnet I, Greillier L, Quere G, Kerjouan M, Janicot H, Vergnenegre A, Auliac JB, Chouaid C. Second-line treatments of small-cell lung cancers. Expert Rev Anticancer Ther 2017; 17:1033-1043. [DOI: 10.1080/14737140.2017.1372198] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Nathalie Baize
- UTTIOM (Unité Transversale de Thérapeutiques Innovantes en Oncologie Médicale), CHU Angers, France
| | - Isabelle Monnet
- Department of Pulmonology, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Laurent Greillier
- Service d’Oncologie Multidisciplinaire et Innovations Thérapeutiques, AP-HM, Aix-Marseille Université, Marseille, France
| | - Gilles Quere
- Respiratory Disease Department, Brest University Brest, Brest, France
| | - Mallorie Kerjouan
- Respiratory Disease Department, Pontchaillou University Hospital, Rennes, France
| | - Henri Janicot
- Service de pneumologie, CHU Clermont-Ferrand, Clermont Ferrand, France
| | - Alain Vergnenegre
- UOTC (Unité d’Oncologie Thoracique et Cutanée), CHU Limoges, Limoges, France
| | | | - Christos Chouaid
- Department of Pulmonology, Centre Hospitalier Intercommunal de Créteil, Créteil, France
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13
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Koinis F, Agelaki S, Karavassilis V, Kentepozidis N, Samantas E, Peroukidis S, Katsaounis P, Hartabilas E, Varthalitis II, Messaritakis I, Fountzilas G, Georgoulias V, Kotsakis A. Second-line pazopanib in patients with relapsed and refractory small-cell lung cancer: a multicentre phase II study of the Hellenic Oncology Research Group. Br J Cancer 2017; 117:8-14. [PMID: 28510571 PMCID: PMC5520202 DOI: 10.1038/bjc.2017.137] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 04/19/2017] [Accepted: 04/24/2017] [Indexed: 01/15/2023] Open
Abstract
Background: Pazopanib is a tyrosine kinase inhibitor with antiangiogenic activity. Vascular endothelial growth factor expression is increased in SCLC and is correlated with poor prognosis. The efficacy and tolerance of second-line pazopanib in SCLC was evaluated. Patients and methods: Patients with platinum-sensitive (cohort A; n=39) and -resistant/refractory (cohort B; n=19) SCLC were enrolled in a multicentre phase II study. The primary end point was the progression-free survival rate (PFS-R) at week 8 in each cohort. Pazopanib (800 mg per day per os) was administered until progressive disease (PD). Circulating tumour cells (CTCs) were enumerated using the Cellsearch assay. Results: All patients were evaluable for response and toxicity. In the intention-to-treat analysis, eight (13.8%) patients achieved partial response (PR) (95% confidence interval (CI): 5.0–22.7), 20 (34.5%) stable disease (SD) and 30 (51.7%) PD. Accrual in cohort B was halted because the hard-stop rule was met; in cohort A, the PFS-R was 59% (95% CI: 43.5–74.4; PR=7, SD=16). Nine (23.1%) patients received pazopanib for >6 months and 3 of them for >12 months. One pazopanib cycle resulted to a significant decrease to the number of patients with ⩾5 CTCs/7.5 ml of blood (20%) compared with baseline (50%). The median PFS and OS for all patients was 2.5 months (95% CI: 1.9–3.1 months) and 6.0 months (95% CI: 3.8–8.2 months), respectively (cohort A: PFS=3.7 months and OS=8.0 months). No unexpected toxicity was observed. Conclusions: Second-line treatment with pazopanib in platinum-sensitive SCLC is well tolerated and resulted in promising objective responses and disease control; CTC enumeration might serve as a reliable surrogate biomarker of response.
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Affiliation(s)
- F Koinis
- Hellenic Oncology Research Group (HORG), 55, Lombardou Street, Athens 11474, Greece
| | - S Agelaki
- Hellenic Oncology Research Group (HORG), 55, Lombardou Street, Athens 11474, Greece
| | - V Karavassilis
- Hellenic Oncology Research Group (HORG), 55, Lombardou Street, Athens 11474, Greece
| | - N Kentepozidis
- Hellenic Oncology Research Group (HORG), 55, Lombardou Street, Athens 11474, Greece
| | - E Samantas
- Hellenic Oncology Research Group (HORG), 55, Lombardou Street, Athens 11474, Greece
| | - S Peroukidis
- Hellenic Oncology Research Group (HORG), 55, Lombardou Street, Athens 11474, Greece
| | - P Katsaounis
- Hellenic Oncology Research Group (HORG), 55, Lombardou Street, Athens 11474, Greece
| | - E Hartabilas
- Hellenic Oncology Research Group (HORG), 55, Lombardou Street, Athens 11474, Greece
| | - I I Varthalitis
- Hellenic Oncology Research Group (HORG), 55, Lombardou Street, Athens 11474, Greece
| | - I Messaritakis
- Hellenic Oncology Research Group (HORG), 55, Lombardou Street, Athens 11474, Greece
| | - G Fountzilas
- Hellenic Oncology Research Group (HORG), 55, Lombardou Street, Athens 11474, Greece
| | - V Georgoulias
- Hellenic Oncology Research Group (HORG), 55, Lombardou Street, Athens 11474, Greece
| | - A Kotsakis
- Hellenic Oncology Research Group (HORG), 55, Lombardou Street, Athens 11474, Greece
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14
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Tartarone A, Giordano P, Lerose R, Rodriquenz MG, Conca R, Aieta M. Progress and challenges in the treatment of small cell lung cancer. Med Oncol 2017; 34:110. [PMID: 28456992 DOI: 10.1007/s12032-017-0966-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 04/18/2017] [Indexed: 12/17/2022]
Abstract
Small cell lung cancer (SCLC) is a very aggressive malignancy characterized by high cellular proliferation and early metastatic spread. In fact, although SCLC is a chemosensitive and radiosensitive disease, the initial responsiveness to chemotherapy is usually followed by development of resistance and the prognosis remains poor with a median survival of less than 12 months in patients with extensive disease (ED-SCLC). Furthermore, no significant progress has been made over the last years, with no newly approved drug. For all these reasons, SCLC represents for the oncologists a major challenge and an exciting field of clinical research. In this review, we analyze the most promising advances in development for SCLC with a special focus on antiangiogenic treatments, immunotherapy, novel chemotherapeutic and targeted agents.
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15
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Li Q, Wu T, Jing L, Li MJ, Tian T, Ruan ZP, Liang X, Nan KJ, Liu ZY, Yao Y, Guo H. Angiogenesis inhibitors for the treatment of small cell lung cancer (SCLC): A meta-analysis of 7 randomized controlled trials. Medicine (Baltimore) 2017; 96:e6412. [PMID: 28353568 PMCID: PMC5380252 DOI: 10.1097/md.0000000000006412] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 02/22/2017] [Accepted: 02/27/2017] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND This study aimed to assess the effectiveness and safety of angiogenesis inhibitors for the treatment of patients with small cell lung cancer (SCLC) via meta-analysis. METHODS Electronic databases including PubMed, Embase, and Cochrane Library were searched to look for eligible studies through February 1, 2016. RCTs comprising angiogenesis inhibitors and nonangiogenesis inhibitors for SCLC patients were investigated. The extracted data including overall survival (OS), progression-free survival (PFS), and objective response rate (ORR) were summarized. In addition, the common adverse events (AEs) were also explored. RESULTS There were 7 phase II/III RCTs, encompassing 1322 SCLC patients eligible for meta-analysis. In comparison to nonangiogenesis inhibitors, angiogenesis inhibitors treatment was not associated with improvement of PFS [HR = 0.87, 95% CI (0.74-1.02), P = 0.09), OS [HR = 0.99, 95% CI (0.88-1.12), P = 0.91], or ORR [OR = 1.12, 95% CI (0.85-1.47), P = 0.41). Also, there was no improvement in 1-year survival rate [OR = 0.96, 95% CI (0.74-1.19), P = 0.63)], 2-year survival rate [OR = 1.00, 95% CI (0.66-1.51), P = 1.00)] or 1-year progression-free survival rates [OR = 0.95, 95% CI (0.69-1.31), P = 0.76)]. However, from subgroup analyses, it was observed that angiogenesis inhibitors improved ORR [HR = 1.66 (95% CI 1.02-2.71), P = 0.04] in phase II studies and bevacizumab improved PFS [HR = 0.73 (95% CI 0.42-0.97), P = 0.04]. It is important to note that angiogenesis inhibitors reduced emesis [OR = 0.38, 95% CI (0.17-0.85), P = 0.02], but increased incidence of constipation [OR = 4.02, 95% CI (2.14-7.55), P < 0.0001) and embolism [OR = 2.24, 95% CI (1.45-3.47), P = 0.0003). CONCLUSION Adding angiogenesis inhibitors to chemotherapy did not improve PFS, OS, ORR, 1-year survival rate, 2-year survival rate or 1-year progression-free survival rate for SCLC. However, subgroup analysis revealed that bevacizumab enhanced PFS. Angiogenesis inhibitors also had a high incidence of constipation and embolism.
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Affiliation(s)
- Qing Li
- Department of Medical Oncology, The First Affiliated Hospital of Xi’an JiaoTong University
| | - Tao Wu
- Department of Medical Oncology, The First Affiliated Hospital of Xi’an JiaoTong University
| | - Li Jing
- Department of Medical Oncology, The First Affiliated Hospital of Xi’an JiaoTong University
| | - Miao-Jing Li
- Department of Medical Oncology, The First Affiliated Hospital of Xi’an JiaoTong University
| | - Tao Tian
- Department of Medical Oncology, The First Affiliated Hospital of Xi’an JiaoTong University
| | - Zhi-Ping Ruan
- Department of Medical Oncology, The First Affiliated Hospital of Xi’an JiaoTong University
| | - Xuan Liang
- Department of Medical Oncology, The First Affiliated Hospital of Xi’an JiaoTong University
| | - Ke-Jun Nan
- Department of Medical Oncology, The First Affiliated Hospital of Xi’an JiaoTong University
| | - Zhi-Yan Liu
- Department of Respiratory Medicine, Xi’an Central Hospital, Xi’an, Shaanxi, P.R. China
| | - Yu Yao
- Department of Medical Oncology, The First Affiliated Hospital of Xi’an JiaoTong University
| | - Hui Guo
- Department of Medical Oncology, The First Affiliated Hospital of Xi’an JiaoTong University
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16
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Abstract
Small-cell lung cancer (SCLC), a poorly differentiated neuroendocrine malignancy, has a rapid growth rate, strong aggressiveness, early metastases, and poor prognosis. Angiogenesis greatly contributes to the metastatic process of SCLC, which has a higher vascularization compared with non-small-cell lung cancer (NSCLC). SCLC might constitute an ideal malignancy for assessing new antiangiogenic drugs and therapeutic strategies. Combining bevacizumab with paclitaxel has therapeutic benefits in chemoresistant, relapsed SCLC. The cisplatin–etoposide and bevacizumab combination, as the first-line treatment for extensive-stage SCLC, can improve progression-free survival (PFS), with an acceptable toxicity profile. Ziv-aflibercept combined with topotecan is promising for platinum-refractory SCLC. Chemotherapy combined with thalidomide cannot prolong survival. Maintenance sunitinib of 37.5 mg/day in extensive-stage SCLC patients following induction chemotherapy with platinum/etoposide improves median PFS by 1.6 months. Serum angiopoietin-2 concentrations and vascular endothelial growth factor levels correlate with poor prognosis. Bevacizumab, ziv-aflibercept, and sunitinib are worthy of further evaluation. Thalidomide, sorafenib, pomalidomide, and cediranib may not be suitable for SCLC.
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Affiliation(s)
- Hongyang Lu
- Zhejiang Key Laboratory of Diagnosis & Treatment Technology on Thoracic Oncology (Lung and Esophagus); Department of Thoracic Medical Oncology, Zhejiang Cancer Hospital, Hangzhou, People's Republic of China
| | - Zhiming Jiang
- Department of Thoracic Medical Oncology, Zhejiang Cancer Hospital, Hangzhou, People's Republic of China
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17
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Qiu YF, Liu ZG, Yang WJ, Zhao Y, Tang J, Tang WZ, Jin Y, Li F, Zhong R, Wang H. Research progress in the treatment of small cell lung cancer. J Cancer 2017; 8:29-38. [PMID: 28123595 PMCID: PMC5264037 DOI: 10.7150/jca.16822] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 09/18/2016] [Indexed: 01/04/2023] Open
Abstract
Small cell lung cancer (SCLC) accounts for approximately 10-15% of all lung cancers. No significant improvement has been made for patients with SCLC in the past several decades. The main progresses were the thoracic radiation and prophylactic cranial irradiation (PCI) that improved the patient survival rate. For patients with limited disease and good performance status (PS), concurrent chemoradiotherapy (CCRT) followed by PCI should be considered. For extensive disease, the combination of etoposide and platinum-based chemotherapy remains the standard treatment and consolidative thoracic radiotherapy is beneficial for patients who have a significant respond to initial chemotherapy. However, the prognosis still remains poor. Recently, efforts have been focused on molecular targets and immunotherapy. But numerous molecular targets methods have failed to show a significant clinical benefit in patients with SCLC. It is anticipated that further development of research will depend on the on-going trials for molecular targeted therapy and immunotherapy which are promising and may improve the outcomes for SCLC in the next decade.
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Affiliation(s)
| | - Zhi-gang Liu
- ✉ Corresponding authors: Hui Wang, M.D., Department of Radiation Oncology, Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University; E-mail: Fax: 0731-88651999. Zhi-gang Liu, M.D., Ph.D., Department of Radiation Oncology, Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University. E-mail:
| | | | | | | | | | | | | | | | - Hui Wang
- Key Laboratory of Translational Radiation Oncology, Hunan Province. Department of Radiation Oncology, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, China
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18
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Abstract
Small cell lung cancer (SCLC) is a highly aggressive and lethal malignancy. Despite high initial response rates to systemic chemotherapy, the disease eventually relapses; further treatment only modestly improves outcomes and overall survival (OS) for patients with extensive stage disease is less than one year. Little progress has been made during the past decades, with no new drugs approved. Consequently, the development of novel strategies is an unmet need. The inhibition of angiogenesis, a defining characteristic of cancer, has demonstrated modest efficacy in several human malignancies, including non-small cell lung cancer (NSCLC). However, results from clinical trials in SCLC have been disappointing, and no anti-angiogenic agent has received regulatory approval due to lack of clinical efficacy. The elucidation of underlying mechanisms responsible for tumor resistance to angiogenic therapy and the simultaneous blockade of multiple elements that play a role in angiogenesis need to be further explored.
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Affiliation(s)
- Michalis Stratigos
- Department of Medical Oncology, University General Hospital of Heraklion, Heraklion, Crete, Greece
| | - Alexios Matikas
- Department of Medical Oncology, University General Hospital of Heraklion, Heraklion, Crete, Greece;; Hellenic Oncology Research Group (HORG), Athens, Greece
| | - Alexandra Voutsina
- Laboratory of Translational Oncology, University of Crete, School of Medicine, Heraklion, Crete, Greece
| | - Dimitrios Mavroudis
- Department of Medical Oncology, University General Hospital of Heraklion, Heraklion, Crete, Greece;; Laboratory of Translational Oncology, University of Crete, School of Medicine, Heraklion, Crete, Greece
| | - Vassilis Georgoulias
- Hellenic Oncology Research Group (HORG), Athens, Greece;; Laboratory of Translational Oncology, University of Crete, School of Medicine, Heraklion, Crete, Greece
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19
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Sanborn RE, Patel JD, Masters GA, Jayaram N, Stephens A, Guarino M, Misleh J, Wu J, Hanna N. A randomized, double-blind, phase 2 trial of platinum therapy plus etoposide with or without concurrent vandetanib (ZD6474) in patients with previously untreated extensive-stage small cell lung cancer: Hoosier Cancer Research Network LUN06-113. Cancer 2016; 123:303-311. [DOI: 10.1002/cncr.30287] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 07/25/2016] [Accepted: 07/28/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Rachel E. Sanborn
- Earle A. Chiles Research Institute, Providence Cancer Center; Portland Oregon
| | - Jyoti D. Patel
- Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine; Northwestern University; Chicago Illinois
| | | | - Nagesh Jayaram
- Southeastern Medical Oncology; Jacksonville North Carolina
| | - Anthony Stephens
- Oncology Hematology Associates Southwest Indiana; Newburgh Indiana
| | | | | | - Jingwei Wu
- Department of Biostatistics; Indiana University; Indianapolis Indiana
| | - Nasser Hanna
- Indiana University Simon Cancer Center; Indianapolis Indiana
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20
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Ethier JL, Lheureux S, Oza A. The role of cediranib in ovarian cancer: current status and further investigation. Expert Opin Orphan Drugs 2016. [DOI: 10.1080/21678707.2016.1196130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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21
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Han J, Kim HY, Lim KY, Hwangbo B, Lee JS. A phase II study of nintedanib in patients with relapsed small cell lung cancer. Lung Cancer 2016; 96:108-12. [DOI: 10.1016/j.lungcan.2016.04.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 04/01/2016] [Accepted: 04/04/2016] [Indexed: 11/22/2022]
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22
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Bunn PA, Minna JD, Augustyn A, Gazdar AF, Ouadah Y, Krasnow MA, Berns A, Brambilla E, Rekhtman N, Massion PP, Niederst M, Peifer M, Yokota J, Govindan R, Poirier JT, Byers LA, Wynes MW, McFadden DG, MacPherson D, Hann CL, Farago AF, Dive C, Teicher BA, Peacock CD, Johnson JE, Cobb MH, Wendel HG, Spigel D, Sage J, Yang P, Pietanza MC, Krug LM, Heymach J, Ujhazy P, Zhou C, Goto K, Dowlati A, Christensen CL, Park K, Einhorn LH, Edelman MJ, Giaccone G, Gerber DE, Salgia R, Owonikoko T, Malik S, Karachaliou N, Gandara DR, Slotman BJ, Blackhall F, Goss G, Thomas R, Rudin CM, Hirsch FR. Small Cell Lung Cancer: Can Recent Advances in Biology and Molecular Biology Be Translated into Improved Outcomes? J Thorac Oncol 2016; 11:453-74. [PMID: 26829312 PMCID: PMC4836290 DOI: 10.1016/j.jtho.2016.01.012] [Citation(s) in RCA: 124] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 01/03/2016] [Accepted: 01/05/2016] [Indexed: 12/16/2022]
Affiliation(s)
- Paul A Bunn
- University of Colorado Cancer Center, Aurora, Colorado
| | - John D Minna
- University of Texas Southwestern Medical Center, Dallas, Texas
| | | | - Adi F Gazdar
- University of Texas Southwestern Medical Center, Dallas, Texas
| | | | | | - Anton Berns
- Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | | | | | | | | | - Jun Yokota
- Institute of Predictive and Personalized Medicine of Cancer, Barcelona, Spain; National Cancer Center Research Institute, Tokyo, Japan
| | | | - John T Poirier
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Lauren A Byers
- University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Murry W Wynes
- International Association for the Study of Lung Cancer, Aurora, Colorado
| | | | | | | | - Anna F Farago
- Massachusetts General Hospital, Boston, Massachusetts
| | - Caroline Dive
- Cancer Research UK Manchester Institute, Manchester, United Kingdom
| | | | | | - Jane E Johnson
- University of Texas Southwestern Medical Center, Dallas, Texas
| | - Melanie H Cobb
- University of Texas Southwestern Medical Center, Dallas, Texas
| | | | - David Spigel
- Sara Cannon Research Institute, Nashville, Tennessee
| | | | - Ping Yang
- Mayo Clinic Cancer Center, Rochester, Minnesota
| | | | - Lee M Krug
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - John Heymach
- University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Caicun Zhou
- Cancer Institute of Tongji University Medical School, Shanghai, China
| | - Koichi Goto
- National Cancer Center Hospital East, Chiba, Japan
| | - Afshin Dowlati
- Case Western Reserve University and University Hospitals Case Medical Center, Cleveland, Ohio
| | | | - Keunchil Park
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | | | - Martin J Edelman
- University of Maryland, Greenebaum Cancer Center, Baltimore, Maryland
| | | | - David E Gerber
- University of Texas Southwestern Medical Center, Dallas, Texas
| | | | | | | | | | - David R Gandara
- University of California Davis Comprehensive Cancer Center, Davis, California
| | - Ben J Slotman
- Vrije Universiteit Medical Center, Amsterdam, Netherlands
| | | | | | | | | | - Fred R Hirsch
- University of Colorado Cancer Center, Aurora, Colorado.
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23
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Abstract
In contrast to non-small-cell lung cancer (NSCLC), few advances have been made in systemic treatment of small-cell lung cancer (SCLC) in recent years. Most patients are diagnosed with extensive stage disease and are commonly treated with platinum-based chemotherapy which, although attaining high initial objective responses, has a limited impact on survival. Due to the dismal prognosis of SCLC, novel and more effective treatment strategies are urgently needed. A deeper characterization of the genomic landscape of SCLC has led to the development of rational and promising targeted agents. However, despite a large number of clinical trials, results have been disappointing and there are still no approved targeted drugs for SCLC. Recent comprehensive genomic studies suggest SCLC is a heterogeneous disease, characterized by genomic alterations targeting a broad variety of genes, including those involved in transcription regulation and chromatin modification which seem to be a hallmark of this specific lung cancer subtype. Current research efforts are focusing on further understanding of the cellular and molecular abnormalities underlying SCLC development, progression and resistance to chemotherapy. Unraveling the genomic complexity of SCLC could be the key to optimize existing treatments, including chemotherapy and radiotherapy, and for identifying those patients most likely to benefit from selected targeted therapeutic approaches.
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Affiliation(s)
- Mariacarmela Santarpia
- 1 Medical Oncology Unit, Department of Human Pathology "G. Barresi", University of Messina, Messina, Italy ; 2 Dr Rosell Oncology Institute, Quirón Dexeus University Hospital, Barcelona, Spain ; 3 Division of Thoracic Oncology, European Institute of Oncology, Milan, Italy ; 4 Pangaea Biotech, Barcelona, Spain ; 5 Cancer Biology and Precision Medicine Program, Catalan Institute of Oncology, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain ; 6 Germans Trias i Pujol Health Sciences Institute and Hospital, Campus Can Ruti, Badalona, Barcelona, Spain ; 7 Molecular Oncology Research (MORe) Foundation, Barcelona, Spain
| | - Maria Grazia Daffinà
- 1 Medical Oncology Unit, Department of Human Pathology "G. Barresi", University of Messina, Messina, Italy ; 2 Dr Rosell Oncology Institute, Quirón Dexeus University Hospital, Barcelona, Spain ; 3 Division of Thoracic Oncology, European Institute of Oncology, Milan, Italy ; 4 Pangaea Biotech, Barcelona, Spain ; 5 Cancer Biology and Precision Medicine Program, Catalan Institute of Oncology, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain ; 6 Germans Trias i Pujol Health Sciences Institute and Hospital, Campus Can Ruti, Badalona, Barcelona, Spain ; 7 Molecular Oncology Research (MORe) Foundation, Barcelona, Spain
| | - Niki Karachaliou
- 1 Medical Oncology Unit, Department of Human Pathology "G. Barresi", University of Messina, Messina, Italy ; 2 Dr Rosell Oncology Institute, Quirón Dexeus University Hospital, Barcelona, Spain ; 3 Division of Thoracic Oncology, European Institute of Oncology, Milan, Italy ; 4 Pangaea Biotech, Barcelona, Spain ; 5 Cancer Biology and Precision Medicine Program, Catalan Institute of Oncology, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain ; 6 Germans Trias i Pujol Health Sciences Institute and Hospital, Campus Can Ruti, Badalona, Barcelona, Spain ; 7 Molecular Oncology Research (MORe) Foundation, Barcelona, Spain
| | - Maria González-Cao
- 1 Medical Oncology Unit, Department of Human Pathology "G. Barresi", University of Messina, Messina, Italy ; 2 Dr Rosell Oncology Institute, Quirón Dexeus University Hospital, Barcelona, Spain ; 3 Division of Thoracic Oncology, European Institute of Oncology, Milan, Italy ; 4 Pangaea Biotech, Barcelona, Spain ; 5 Cancer Biology and Precision Medicine Program, Catalan Institute of Oncology, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain ; 6 Germans Trias i Pujol Health Sciences Institute and Hospital, Campus Can Ruti, Badalona, Barcelona, Spain ; 7 Molecular Oncology Research (MORe) Foundation, Barcelona, Spain
| | - Chiara Lazzari
- 1 Medical Oncology Unit, Department of Human Pathology "G. Barresi", University of Messina, Messina, Italy ; 2 Dr Rosell Oncology Institute, Quirón Dexeus University Hospital, Barcelona, Spain ; 3 Division of Thoracic Oncology, European Institute of Oncology, Milan, Italy ; 4 Pangaea Biotech, Barcelona, Spain ; 5 Cancer Biology and Precision Medicine Program, Catalan Institute of Oncology, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain ; 6 Germans Trias i Pujol Health Sciences Institute and Hospital, Campus Can Ruti, Badalona, Barcelona, Spain ; 7 Molecular Oncology Research (MORe) Foundation, Barcelona, Spain
| | - Giuseppe Altavilla
- 1 Medical Oncology Unit, Department of Human Pathology "G. Barresi", University of Messina, Messina, Italy ; 2 Dr Rosell Oncology Institute, Quirón Dexeus University Hospital, Barcelona, Spain ; 3 Division of Thoracic Oncology, European Institute of Oncology, Milan, Italy ; 4 Pangaea Biotech, Barcelona, Spain ; 5 Cancer Biology and Precision Medicine Program, Catalan Institute of Oncology, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain ; 6 Germans Trias i Pujol Health Sciences Institute and Hospital, Campus Can Ruti, Badalona, Barcelona, Spain ; 7 Molecular Oncology Research (MORe) Foundation, Barcelona, Spain
| | - Rafael Rosell
- 1 Medical Oncology Unit, Department of Human Pathology "G. Barresi", University of Messina, Messina, Italy ; 2 Dr Rosell Oncology Institute, Quirón Dexeus University Hospital, Barcelona, Spain ; 3 Division of Thoracic Oncology, European Institute of Oncology, Milan, Italy ; 4 Pangaea Biotech, Barcelona, Spain ; 5 Cancer Biology and Precision Medicine Program, Catalan Institute of Oncology, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain ; 6 Germans Trias i Pujol Health Sciences Institute and Hospital, Campus Can Ruti, Badalona, Barcelona, Spain ; 7 Molecular Oncology Research (MORe) Foundation, Barcelona, Spain
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Abstract
Small cell lung cancer (SCLC) is an aggressive neuroendocrine malignancy with a unique natural history characterized by a short doubling time, high growth fraction, and early development of widespread metastases. Although a chemotherapy- and radiation-sensitive disease, SCLC typically recurs rapidly after primary treatment, with only 6% of patients surviving 5 years from diagnosis. This disease has been notable for the absence of major improvements in its treatment: Nearly four decades after the introduction of a platinum-etoposide doublet, therapeutic options have remained virtually unchanged, with correspondingly little improvement in survival rates. Here, we summarize specific barriers and challenges inherent to SCLC research and care that have limited progress in novel therapeutic development to date. We discuss recent progress in basic and translational research, especially in the development of mouse models, which will provide insights into the patterns of metastasis and resistance in SCLC. Opportunities in clinical research aimed at exploiting SCLC biology are reviewed, with an emphasis on ongoing trials. SCLC has been described as a recalcitrant cancer, for which there is an urgent need for accelerated progress. The NCI convened a panel of laboratory and clinical investigators interested in SCLC with a goal of defining consensus recommendations to accelerate progress in the treatment of SCLC, which we summarize here.
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Affiliation(s)
- M Catherine Pietanza
- Thoracic Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, New York.
| | - Lauren Averett Byers
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - John D Minna
- Hamon Center for Therapeutic Oncology Research, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Charles M Rudin
- Thoracic Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, New York
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25
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Abstract
Small cell lung cancer (SCLC) is an aggressive, poorly differentiated neuroendocrine carcinoma with distinct clinical, pathological and molecular characteristics. Despite robust responses to initial chemotherapy and radiation, the prognosis of patients with SCLC remains poor with an overall 5-year survival rate of less than 10 %. Despite the fact that numerous molecularly targeted approaches have thus far failed to demonstrate clinical utility in SCLC, further advances will rely on better definition of the biological pathways that drive survival, proliferation and metastasis. Recent next-generation, molecular profiling studies have identified many new therapeutic targets in SCLC, as well as extreme genomic instability which explains the high degree of resistance. A wide variety of anti-angiogenic agents, growth factor inhibitors, pro-apoptotic agents, and epigenetic modulators have been evaluated in SCLC and many studies of these strategies are on-going. Perhaps the most promising approaches involve agents targeting cancer stem cell pathways and immunomodulatory drugs that interfere with the PD1 and CTLA-4 pathways. SCLC offers many barriers to the development of successful therapy, including limited tumor samples, inadequate preclinical models, high mutational burden, and aggressive tumor growth which impairs functional status and hampers enrollment on clinical trials.
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Affiliation(s)
- Bryan J Schneider
- Division of Hematology/Oncology, University of Michigan, C411 Med Inn-SPC 5848, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109-5848, USA.
| | - Gregory P Kalemkerian
- Division of Hematology/Oncology, University of Michigan, C350 Med Inn-SPC 5848, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109-5848, USA.
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26
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Wasserstrum Y, Kornowski R, Raanani P, Leader A, Pasvolsky O, Iakobishvili Z. Hypertension in cancer patients treated with anti-angiogenic based regimens. Cardiooncology 2015; 1:6. [PMID: 33530150 PMCID: PMC7837153 DOI: 10.1186/s40959-015-0009-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 11/25/2015] [Indexed: 02/08/2023]
Abstract
New anti-cancer drugs that inhibit the vascular endothelial growth factor (VEGF) signaling pathway are highly effective in the treatment of solid tumors, however concerns remain regarding their cardiovascular safety. The most common side effect of VEGF signaling pathway (VSP) inhibition is the development of systemic hypertension. We review the incidence, possible mechanisms, significance and management of hypertension in patients treated with VSP inhibitors.
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Affiliation(s)
- Yishay Wasserstrum
- Department of Cardiology, Rabin Medical Center, Petah Tikva, 49100, Israel.,Sackler School of Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ran Kornowski
- Department of Cardiology, Rabin Medical Center, Petah Tikva, 49100, Israel.,Sackler School of Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Pia Raanani
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah Tikva, Israel.,Sackler School of Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Avi Leader
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah Tikva, Israel.,Sackler School of Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Oren Pasvolsky
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah Tikva, Israel.,Sackler School of Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Zaza Iakobishvili
- Department of Cardiology, Rabin Medical Center, Petah Tikva, 49100, Israel. .,Sackler School of Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Pilotto S, Novello S, Peretti U, Kinspergher S, Ciuffreda L, Milella M, Carbognin L, Vavalà T, Ferrara R, Caccese M, Tortora G, Bria E. An overview of angiogenesis inhibitors in Phase II studies for non-small-cell lung cancer. Expert Opin Investig Drugs 2015; 24:1143-61. [DOI: 10.1517/13543784.2015.1056341] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Arcaro A. Targeted therapies for small cell lung cancer: Where do we stand? Crit Rev Oncol Hematol 2015; 95:154-64. [PMID: 25800975 DOI: 10.1016/j.critrevonc.2015.03.001] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Revised: 01/23/2015] [Accepted: 03/04/2015] [Indexed: 12/19/2022] Open
Abstract
Small cell lung cancer (SCLC) accounts for 15% of lung cancer cases and is associated with a dismal prognosis. Standard therapeutic regimens have been improved over the past decades, but without a major impact on patient survival. The development of targeted therapies based on a better understanding of the molecular basis of the disease is urgently needed. At the genetic level, SCLC appears very heterogenous, although somatic mutations targeting classical oncogenes and tumor suppressors have been reported. SCLC also possesses somatic mutations in many other cancer genes, including transcription factors, enzymes involved in chromatin modification, receptor tyrosine kinases and their downstream signaling components. Several avenues have been explored to develop targeted therapies for SCLC. So far, however, there has been limited success with these targeted approaches in clinical trials. Further progress in the optimization of targeted therapies for SCLC will require the development of more personalized approaches for the patients.
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Affiliation(s)
- Alexandre Arcaro
- Department of Clinical Research, University of Bern, CH-3010 Bern, Switzerland.
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Gaumann AKA, Kiefer F, Alfer J, Lang SA, Geissler EK, Breier G. Receptor tyrosine kinase inhibitors: Are they real tumor killers? Int J Cancer 2015; 138:540-54. [PMID: 25716346 DOI: 10.1002/ijc.29499] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 02/13/2015] [Indexed: 12/11/2022]
Abstract
Inhibiting tumor growth by targeting the tumor vasculature was first proposed by Judah Folkman almost 40 years ago. Since then, different approaches and numerous drugs and agents have been developed to achieve this goal, either with the aim of inhibiting tumor neoangiogenesis or normalizing the tumor vasculature. Among the most promising therapeutic targets are receptor tyrosine kinases (RTKs), some of which are predominantly expressed on tumor endothelial cells, although they are sometimes also present on tumor cells. The majority of RTK inhibitors investigated over the past two decades competes with ATP at the active site of the kinase and therefore block the phosphorylation of intracellular targets. Some of these drugs have been approved for therapy, whereas others are still in clinical trials. Here, we discuss the scientific basis, current status, problems and future prospects of RTK inhibition in anti-tumor therapy.
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Affiliation(s)
- Andreas K A Gaumann
- Institute of Pathology Kaufbeuren-Ravensburg, Kaufbeuren, Germany
- Institute of Pathology, University of Regensburg, Medical Center, Regensburg, Germany
| | - Friedemann Kiefer
- Mammalian Cell Signaling Laboratory, Max Planck Institute for Molecular Biomedicine, Münster, North Rhine-Westphalia, Germany
| | - Joachim Alfer
- Institute of Pathology Kaufbeuren-Ravensburg, Kaufbeuren, Germany
| | - Sven A Lang
- Department of Surgery, University of Regensburg, Medical Center, Regensburg, Germany
| | - Edward K Geissler
- Department of Surgery, University of Regensburg, Medical Center, Regensburg, Germany
| | - Georg Breier
- Institute of Pathology, Technical University Dresden, Dresden, Germany
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30
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Ready NE, Pang HH, Gu L, Otterson GA, Thomas SP, Miller AA, Baggstrom M, Masters GA, Graziano SL, Crawford J, Bogart J, Vokes EE. Chemotherapy With or Without Maintenance Sunitinib for Untreated Extensive-Stage Small-Cell Lung Cancer: A Randomized, Double-Blind, Placebo-Controlled Phase II Study-CALGB 30504 (Alliance). J Clin Oncol 2015; 33:1660-5. [PMID: 25732163 DOI: 10.1200/jco.2014.57.3105] [Citation(s) in RCA: 102] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To evaluate the efficacy of maintenance sunitinib after chemotherapy for small-cell lung cancer (SCLC). PATIENTS AND METHODS The Cancer and Leukemia Group B 30504 trial was a randomized, placebo-controlled, phase II study that enrolled patients before chemotherapy (cisplatin 80 mg/m(2) or carboplatin area under the curve of 5 on day 1 plus etoposide 100 mg/m(2) per day on days 1 to 3 every 21 days for four to six cycles). Patients without progression were randomly assigned 1:1 to placebo or sunitinib 37.5 mg per day until progression. Cross-over after progression was allowed. The primary end point was progression-free survival (PFS) from random assignment for maintenance placebo versus sunitinib using a one-sided log-rank test with α = .15; 80 randomly assigned patients provided 89% power to detect a hazard ratio (HR) of 1.67. RESULTS One hundred forty-four patients were enrolled; 138 patients received chemotherapy. Ninety-five patients were randomly assigned; 10 patients did not receive maintenance therapy (five on each arm). Eighty-five patients received maintenance therapy (placebo, n = 41; sunitinib, n = 44). Grade 3 adverse events with more than 5% incidence were fatigue (19%), decreased neutrophils (14%), decreased leukocytes (7%), and decreased platelets (7%) for sunitinib and fatigue (10%) for placebo; grade 4 adverse events were GI hemorrhage (n = 1) and pancreatitis, hypocalcemia, and elevated lipase (n = 1; all in same patient) for sunitinib and thrombocytopenia (n = 1) and hypernatremia (n = 1) for placebo. Median PFS on maintenance was 2.1 months for placebo and 3.7 months for sunitinib (HR, 1.62; 70% CI, 1.27 to 2.08; 95% CI, 1.02 to 2.60; one-sided P = .02). Median overall survival from random assignment was 6.9 months for placebo and 9.0 months for sunitinib (HR, 1.28; 95% CI, 0.79 to 2.10; one-sided P = .16). Three sunitinib and no placebo patients achieved complete response during maintenance. Ten (77%) of 13 patients evaluable after cross-over had stable disease on sunitinib (6 to 27 weeks). CONCLUSION Maintenance sunitinib was safe and improved PFS in extensive-stage SCLC.
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Affiliation(s)
- Neal E Ready
- Neal E. Ready and Jeffrey Crawford, Duke University Medical Center; Herbert H. Pang and Lin Gu, Alliance Statistics and Data Center, Duke University Medical Center, Durham; Antonius A. Miller, Wake Forest University Medical Center, Winston Salem, NC; Gregory A. Otterson, Ohio State University Medical Center, Columbus, OH; Sachdev P. Thomas, Illinois Oncology Research Association Community Clinical Oncology Program, Illinois Cancer Care, Peoria; Everett E. Vokes, University of Chicago, Chicago, IL; Maria Baggstrom, Washington University School of Medicine, St Louis, MO; Gregory A. Masters, Christiana Healthcare Services, Christiana Hospital, Newark, DE; Stephen L. Graziano and Jeffrey Bogart, State University of New York Upstate Medical University, Syracuse, NY.
| | - Herbert H Pang
- Neal E. Ready and Jeffrey Crawford, Duke University Medical Center; Herbert H. Pang and Lin Gu, Alliance Statistics and Data Center, Duke University Medical Center, Durham; Antonius A. Miller, Wake Forest University Medical Center, Winston Salem, NC; Gregory A. Otterson, Ohio State University Medical Center, Columbus, OH; Sachdev P. Thomas, Illinois Oncology Research Association Community Clinical Oncology Program, Illinois Cancer Care, Peoria; Everett E. Vokes, University of Chicago, Chicago, IL; Maria Baggstrom, Washington University School of Medicine, St Louis, MO; Gregory A. Masters, Christiana Healthcare Services, Christiana Hospital, Newark, DE; Stephen L. Graziano and Jeffrey Bogart, State University of New York Upstate Medical University, Syracuse, NY
| | - Lin Gu
- Neal E. Ready and Jeffrey Crawford, Duke University Medical Center; Herbert H. Pang and Lin Gu, Alliance Statistics and Data Center, Duke University Medical Center, Durham; Antonius A. Miller, Wake Forest University Medical Center, Winston Salem, NC; Gregory A. Otterson, Ohio State University Medical Center, Columbus, OH; Sachdev P. Thomas, Illinois Oncology Research Association Community Clinical Oncology Program, Illinois Cancer Care, Peoria; Everett E. Vokes, University of Chicago, Chicago, IL; Maria Baggstrom, Washington University School of Medicine, St Louis, MO; Gregory A. Masters, Christiana Healthcare Services, Christiana Hospital, Newark, DE; Stephen L. Graziano and Jeffrey Bogart, State University of New York Upstate Medical University, Syracuse, NY
| | - Gregory A Otterson
- Neal E. Ready and Jeffrey Crawford, Duke University Medical Center; Herbert H. Pang and Lin Gu, Alliance Statistics and Data Center, Duke University Medical Center, Durham; Antonius A. Miller, Wake Forest University Medical Center, Winston Salem, NC; Gregory A. Otterson, Ohio State University Medical Center, Columbus, OH; Sachdev P. Thomas, Illinois Oncology Research Association Community Clinical Oncology Program, Illinois Cancer Care, Peoria; Everett E. Vokes, University of Chicago, Chicago, IL; Maria Baggstrom, Washington University School of Medicine, St Louis, MO; Gregory A. Masters, Christiana Healthcare Services, Christiana Hospital, Newark, DE; Stephen L. Graziano and Jeffrey Bogart, State University of New York Upstate Medical University, Syracuse, NY
| | - Sachdev P Thomas
- Neal E. Ready and Jeffrey Crawford, Duke University Medical Center; Herbert H. Pang and Lin Gu, Alliance Statistics and Data Center, Duke University Medical Center, Durham; Antonius A. Miller, Wake Forest University Medical Center, Winston Salem, NC; Gregory A. Otterson, Ohio State University Medical Center, Columbus, OH; Sachdev P. Thomas, Illinois Oncology Research Association Community Clinical Oncology Program, Illinois Cancer Care, Peoria; Everett E. Vokes, University of Chicago, Chicago, IL; Maria Baggstrom, Washington University School of Medicine, St Louis, MO; Gregory A. Masters, Christiana Healthcare Services, Christiana Hospital, Newark, DE; Stephen L. Graziano and Jeffrey Bogart, State University of New York Upstate Medical University, Syracuse, NY
| | - Antonius A Miller
- Neal E. Ready and Jeffrey Crawford, Duke University Medical Center; Herbert H. Pang and Lin Gu, Alliance Statistics and Data Center, Duke University Medical Center, Durham; Antonius A. Miller, Wake Forest University Medical Center, Winston Salem, NC; Gregory A. Otterson, Ohio State University Medical Center, Columbus, OH; Sachdev P. Thomas, Illinois Oncology Research Association Community Clinical Oncology Program, Illinois Cancer Care, Peoria; Everett E. Vokes, University of Chicago, Chicago, IL; Maria Baggstrom, Washington University School of Medicine, St Louis, MO; Gregory A. Masters, Christiana Healthcare Services, Christiana Hospital, Newark, DE; Stephen L. Graziano and Jeffrey Bogart, State University of New York Upstate Medical University, Syracuse, NY
| | - Maria Baggstrom
- Neal E. Ready and Jeffrey Crawford, Duke University Medical Center; Herbert H. Pang and Lin Gu, Alliance Statistics and Data Center, Duke University Medical Center, Durham; Antonius A. Miller, Wake Forest University Medical Center, Winston Salem, NC; Gregory A. Otterson, Ohio State University Medical Center, Columbus, OH; Sachdev P. Thomas, Illinois Oncology Research Association Community Clinical Oncology Program, Illinois Cancer Care, Peoria; Everett E. Vokes, University of Chicago, Chicago, IL; Maria Baggstrom, Washington University School of Medicine, St Louis, MO; Gregory A. Masters, Christiana Healthcare Services, Christiana Hospital, Newark, DE; Stephen L. Graziano and Jeffrey Bogart, State University of New York Upstate Medical University, Syracuse, NY
| | - Gregory A Masters
- Neal E. Ready and Jeffrey Crawford, Duke University Medical Center; Herbert H. Pang and Lin Gu, Alliance Statistics and Data Center, Duke University Medical Center, Durham; Antonius A. Miller, Wake Forest University Medical Center, Winston Salem, NC; Gregory A. Otterson, Ohio State University Medical Center, Columbus, OH; Sachdev P. Thomas, Illinois Oncology Research Association Community Clinical Oncology Program, Illinois Cancer Care, Peoria; Everett E. Vokes, University of Chicago, Chicago, IL; Maria Baggstrom, Washington University School of Medicine, St Louis, MO; Gregory A. Masters, Christiana Healthcare Services, Christiana Hospital, Newark, DE; Stephen L. Graziano and Jeffrey Bogart, State University of New York Upstate Medical University, Syracuse, NY
| | - Stephen L Graziano
- Neal E. Ready and Jeffrey Crawford, Duke University Medical Center; Herbert H. Pang and Lin Gu, Alliance Statistics and Data Center, Duke University Medical Center, Durham; Antonius A. Miller, Wake Forest University Medical Center, Winston Salem, NC; Gregory A. Otterson, Ohio State University Medical Center, Columbus, OH; Sachdev P. Thomas, Illinois Oncology Research Association Community Clinical Oncology Program, Illinois Cancer Care, Peoria; Everett E. Vokes, University of Chicago, Chicago, IL; Maria Baggstrom, Washington University School of Medicine, St Louis, MO; Gregory A. Masters, Christiana Healthcare Services, Christiana Hospital, Newark, DE; Stephen L. Graziano and Jeffrey Bogart, State University of New York Upstate Medical University, Syracuse, NY
| | - Jeffrey Crawford
- Neal E. Ready and Jeffrey Crawford, Duke University Medical Center; Herbert H. Pang and Lin Gu, Alliance Statistics and Data Center, Duke University Medical Center, Durham; Antonius A. Miller, Wake Forest University Medical Center, Winston Salem, NC; Gregory A. Otterson, Ohio State University Medical Center, Columbus, OH; Sachdev P. Thomas, Illinois Oncology Research Association Community Clinical Oncology Program, Illinois Cancer Care, Peoria; Everett E. Vokes, University of Chicago, Chicago, IL; Maria Baggstrom, Washington University School of Medicine, St Louis, MO; Gregory A. Masters, Christiana Healthcare Services, Christiana Hospital, Newark, DE; Stephen L. Graziano and Jeffrey Bogart, State University of New York Upstate Medical University, Syracuse, NY
| | - Jeffrey Bogart
- Neal E. Ready and Jeffrey Crawford, Duke University Medical Center; Herbert H. Pang and Lin Gu, Alliance Statistics and Data Center, Duke University Medical Center, Durham; Antonius A. Miller, Wake Forest University Medical Center, Winston Salem, NC; Gregory A. Otterson, Ohio State University Medical Center, Columbus, OH; Sachdev P. Thomas, Illinois Oncology Research Association Community Clinical Oncology Program, Illinois Cancer Care, Peoria; Everett E. Vokes, University of Chicago, Chicago, IL; Maria Baggstrom, Washington University School of Medicine, St Louis, MO; Gregory A. Masters, Christiana Healthcare Services, Christiana Hospital, Newark, DE; Stephen L. Graziano and Jeffrey Bogart, State University of New York Upstate Medical University, Syracuse, NY
| | - Everett E Vokes
- Neal E. Ready and Jeffrey Crawford, Duke University Medical Center; Herbert H. Pang and Lin Gu, Alliance Statistics and Data Center, Duke University Medical Center, Durham; Antonius A. Miller, Wake Forest University Medical Center, Winston Salem, NC; Gregory A. Otterson, Ohio State University Medical Center, Columbus, OH; Sachdev P. Thomas, Illinois Oncology Research Association Community Clinical Oncology Program, Illinois Cancer Care, Peoria; Everett E. Vokes, University of Chicago, Chicago, IL; Maria Baggstrom, Washington University School of Medicine, St Louis, MO; Gregory A. Masters, Christiana Healthcare Services, Christiana Hospital, Newark, DE; Stephen L. Graziano and Jeffrey Bogart, State University of New York Upstate Medical University, Syracuse, NY
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Gervais R, Le Caer H, Monnet I, Falchero L, Baize N, Olivero G, Thomas P, Berard H, Auliac JB, Chouaid C. Second-Line Oral Chemotherapy (Lomustine, Cyclophosphamide, Etoposide) Versus Intravenous Therapy (Cyclophosphamide, Doxorubicin, and Vincristine) in Patients With Relapsed Small Cell Lung Cancer: A Randomized Phase II Study of GFPC 0501. Clin Lung Cancer 2015; 16:100-5. [DOI: 10.1016/j.cllc.2014.10.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 10/19/2014] [Accepted: 10/21/2014] [Indexed: 10/24/2022]
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Pujol JL, Lavole A, Quoix E, Molinier O, Souquet PJ, Barlesi F, Le Caer H, Moro-Sibilot D, Fournel P, Oster JP, Chatellain P, Barre P, Jeannin G, Mourlanette P, Derollez M, Herman D, Renault A, Dayen C, Lamy PJ, Langlais A, Morin F, Zalcman G. Randomized phase II-III study of bevacizumab in combination with chemotherapy in previously untreated extensive small-cell lung cancer: results from the IFCT-0802 trial†. Ann Oncol 2015; 26:908-914. [PMID: 25688059 DOI: 10.1093/annonc/mdv065] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 01/31/2015] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND This randomized phase II-III trial sought to evaluate the efficacy and safety of adding bevacizumab (Bev) following induction chemotherapy (CT) in extensive small-cell lung cancer (SCLC). PATIENTS AND METHODS Enrolled SCLC patients received two induction cycles of CT. Responders were randomly assigned 1:1 to receive four additional cycles of CT alone or CT plus Bev (7.5 mg/kg), followed by single-agent Bev until progression or unacceptable toxicity. The primary end point was the percentage of patients for whom disease remained controlled (still in response) at the fourth cycle. RESULTS In total, 147 patients were enrolled. Partial response was observed in 103 patients, 74 of whom were eligible for Bev and randomly assigned to the CT alone group (n = 37) or the CT plus Bev group (n = 37). Response assessment at the end of the fourth cycle showed that disease control did not differ between the two groups (89.2% versus 91.9% of patients remaining responders in CT alone versus CT plus Bev, respectively; Fisher's exact test: P = 1.00). Progression-free survival (PFS) since randomization did not significantly differ, with a median PFS of 5.5 months [95% confidence interval (CI) 4.9% to 6.0%] versus 5.3 months (95% CI 4.8% to 5.8%) in the CT alone and CT plus Bev groups, respectively [hazard ratio (HR) for CT alone: 1.1; 95% CI 0.7% to 1.7%; unadjusted P = 0.82]. Grade ≥2 hypertension and grade ≥3 thrombotic events were observed in 40% and 11% of patients, respectively, in the CT plus Bev group. Serum vascular endothelial growth factor (VEGF) and soluble VEGF receptor titrations failed to identify predictive biomarkers. CONCLUSION Administering 7.5 mg/kg Bev after induction did not improve outcome in extensive SCLC patients.
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Affiliation(s)
- J-L Pujol
- Pneumology Department, University Hospital, Montpellier.
| | - A Lavole
- Pneumology Department, AP-HP Hospital Tenon, Paris
| | - E Quoix
- Pneumology Department, University Hospital, Strasbourg
| | - O Molinier
- Respiratory Diseases Department, Le Mans Hospital, Le Mans
| | - P-J Souquet
- Pneumology Department, Pierre-Bénite Hospital, Lyon
| | - F Barlesi
- Oncology Department, Hopital Nord, Aix-Marseille University
| | - H Le Caer
- Pneumology Department, Draguignan Hospital, Draguignan
| | | | - P Fournel
- Oncology Department, Loire Cancer Institute, St-Priest-en-Jarez
| | - J P Oster
- Pneumology Department, Colmar Hospital, Colmar
| | - P Chatellain
- Pneumology Department, Alpes-Léman Hospital, Ambilly
| | - P Barre
- Pneumology Department, Jean Rougier Hospital, Cahors
| | - G Jeannin
- Pneumology Department, Gabriel Montpied University Hospital, Clermont-Ferrand
| | - P Mourlanette
- Pneumology Department, Private Hospital, Cornebarrieu
| | - M Derollez
- Pneumology Department, Private Hospital, Maubeuge
| | - D Herman
- Pneumology Department, Nevers Hospital, Nevers
| | - A Renault
- Pneumology Department, Pau Hospital, Pau
| | - C Dayen
- Pneumology Department, Saint-Quentin Hospital, Saint-Quentin
| | - P J Lamy
- Department of Biopathology and Oncogenetics, Regional Cancer Institute, Montpellier
| | - A Langlais
- French Cooperative Thoracic Intergroup (IFCT), Paris
| | - F Morin
- French Cooperative Thoracic Intergroup (IFCT), Paris
| | - G Zalcman
- Pneumology Department, University Hospital, Caen, France
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Abstract
INTRODUCTION Small cell lung cancer (SCLC) is an aggressive malignancy characterized by early metastatic dissemination and responsiveness to initial therapy. The incidence of SCLC has been declining over the past two decades. Limited-stage SCLC is a potentially curable disease with long-term survival of ∼ 20% when treated with platinum-based chemotherapy plus concurrent thoracic radiation and prophylactic cranial irradiation. For patients with extensive-stage SCLC, survival can be increased with combination platinum-based chemotherapy, but the disease remains incurable. AREAS COVERED This review looks at the current advances in pharmacotherapy for SCLC. EXPERT OPINION Many chemotherapeutic strategies and newer cytotoxic agents have been evaluated in SCLC, and some had promising activity in early clinical trials. However, none have demonstrated consistent improvements in outcome over standard platinum-based treatment. Similarly, although many potential molecular targets have been identified in preclinical studies of SCLC, molecularly targeted therapy has yet to demonstrate any substantial activity in clinical trials. Nonetheless, future advances in this disease will undoubtedly depend on improvements in our understanding of the molecular mechanisms that drive the proliferation and survival of SCLC cells.
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Affiliation(s)
- Gregory P Kalemkerian
- University of Michigan - Hematology/Oncology , C350 Med Inn - SPC 5848 1500 E. Medical Center Dr., Ann Arbor, MI 48109-5848 , USA
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Deng J, Shao J, Markowitz JS, An G. ABC transporters in multi-drug resistance and ADME-Tox of small molecule tyrosine kinase inhibitors. Pharm Res 2014; 31:2237-2255. [PMID: 24842659 DOI: 10.1007/s11095-014-1389-0/tables/1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Accepted: 04/15/2014] [Indexed: 05/26/2023]
Abstract
The past decade has seen tremendous efforts in the research and development of new chemotherapeutic drugs using target-based approaches. These efforts have led to the discovery of small molecule tyrosine kinase inhibitors (TKIs). Following the initial approval of imatinib by the US FDA in 2001, more than 15 TKIs targeting different tyrosine kinases have been approved, and numerous others are in various phases of clinical evaluation. Unlike conventional chemotherapy that can cause non-discriminating damage to both normal and cancerous cells, TKIs attack cancer-specific targets and therefore have a more favorable safety profile. However, although TKIs have had outstanding success in cancer therapy, there has been increasing evidence of resistance to TKIs. The enhanced efflux of TKIs by ATP-binding cassette (ABC) transporters over-expressed in cancer cells has been found to be one such important resistance mechanism. Another major drawback of TKI therapies that has been increasingly recognized is the extensive inter-individual pharmacokinetic variability, in which ABC transporters seem to play a major role as well. This review covers recent findings on the interactions of small molecule TKIs with ABC transporters. The effects of ABC transporters on anticancer efficacy and the absorption, distribution, metabolism, excretion, and toxicity (ADME-Tox) of the small molecule TKIs are summarized in detail. Since TKIs have been found to not only serve as substrates of ABC transporters, but also as modulators of these proteins via inhibition or induction, their influence upon ABC transporters and potential role on TKI-drug interactions are discussed as well.
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Affiliation(s)
- Jiexin Deng
- Department of Pharmaceutics, College of Pharmacy, University of Florida, 6550 Sanger Road, Orlando, Florida, 32827, USA
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Deng J, Shao J, Markowitz JS, An G. ABC Transporters in Multi-Drug Resistance and ADME-Tox of Small Molecule Tyrosine Kinase Inhibitors. Pharm Res 2014; 31:2237-55. [DOI: 10.1007/s11095-014-1389-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Accepted: 04/15/2014] [Indexed: 12/31/2022]
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Zhang ZF, Wang T, Liu LH, Guo HQ. Risks of proteinuria associated with vascular endothelial growth factor receptor tyrosine kinase inhibitors in cancer patients: a systematic review and meta-analysis. PLoS One. 2014;9:e90135. [PMID: 24621598 PMCID: PMC3951202 DOI: 10.1371/journal.pone.0090135] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Accepted: 01/28/2014] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Vascular endothelial growth factor tyrosine-kinase inhibitors (VEGFR-TKIs) have emerged as an effective targeted therapy in the treatment of cancer patients, the overall incidence and risk of proteinuria associated these drugs is unclear. We performed a systematic review and meta-analysis of published clinical trials to quantify the incidence and risk of proteinuria associated with VEGFR-TKIs. METHODOLOGY Databases from PubMed, Web of Science and abstracts presented at ASCO meeting up to May 31, 2013 were searched to identify relevant studies. Eligible studies included prospective phase II and III trials evaluating VEGFR-TKIs in cancer patients with adequate data on proteinuria. Statistical analyses were conducted to calculate the summary incidence, Odds ratio (OR) and 95% confidence intervals (CIs) by using either random effects or fixed effect models according to the heterogeneity of included studies. PRINCIPAL FINDINGS A total of 6,882 patients with a variety of solid tumors from 33 clinical trials were included in our analysis. The incidence of all-grade and high-grade (grade 3 or higher) proteinuria was 18.7% (95% CI, 13.3%-25.6%) and 2.4% (95% CI, 1.6%-3.7%), respectively. Patients treated with VEGFR-TKIs had a significantly increased risk of all-grade (OR 2.92, 95%CI: 1.09-7.82, p = 0.033) and high-grade proteinuria (OR 1.97, 95%CI: 1.01-3.84, p = 0.046) when compared to patients treated with control medication. No evidence of publication bias was observed. CONCLUSIONS The use of VEGFR-TKIs is associated with a significant increased risk of developing proteinuria. Physicians should be aware of this adverse effect and should monitor cancer patients receiving VEGFR-TKIs.
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Abstract
Small cell lung cancer (SCLC) remains a fatal disease due to limited therapeutic options. Systemic chemotherapy is the bedrock of treatment for both the limited and extensive stages of the disease. However, the established management paradigm of platinum-based chemotherapy has reached an efficacy plateau. A modest survival improvement, approximately 5%, was witnessed with the addition of cranial or thoracic radiation to systemic chemotherapy. Other strategies to improve outcome of platinum-based chemotherapy in the last two decades have met with minimal success. The substitution of irinotecan for etoposide in the frontline treatment of SCLC achieved significant efficacy benefit in Japanese patients, but similar benefit could not be reproduced in other patient populations. Salvage treatment for recurrent or progressive SCLC is particularly challenging, where topotecan remains the only agent with regulatory approval to date. Ongoing evaluation of biologic agents targeting angiogenesis, sonic hedgehog pathway, DNA repair pathway, and immune checkpoint modulators hold some promise for improved outcome in SCLC. It is hoped that the coming decade will witness the application of new molecular biology and genomic research techniques to improve our understanding of SCLC biology and identification of molecular subsets that can be targeted appropriately using established and emerging biological agents similar to the accomplishments of the last decade with non-small cell lung cancer (NSCLC).
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Affiliation(s)
- Rathi N Pillai
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Winship Cancer Institute, Atlanta, GA
| | - Taofeek K Owonikoko
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Winship Cancer Institute, Atlanta, GA.
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Sharma N, Pennell N, Nickolich M, Halmos B, Ma P, Mekhail T, Fu P, Dowlati A. Phase II trial of sorafenib in conjunction with chemotherapy and as maintenance therapy in extensive-stage small cell lung cancer. Invest New Drugs 2014; 32:362-8. [PMID: 24420556 DOI: 10.1007/s10637-013-0061-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Accepted: 12/26/2013] [Indexed: 01/01/2023]
Abstract
OBJECTIVES Sorafenib is a multi-tyrosine kinase inhibitor of Raf kinase, VEGFR, and PDGFR. Angiogenesis is important for growth and progression of SCLC. This trial was conducted to evaluate whether the combination of cisplatin and etoposide plus concurrent and sequential sorafenib could prolong survival in patients with previously untreated SCLC. METHODS Previously untreated patients with extensive stage SCLC were treated with cisplatin and etoposide days 1, 2, 3 for four cycles, concurrent with sorafenib 200 mg orally bid starting day 1 cycle 1. Patients with no disease progression after four cycles continued sorafenib 400 mg orally bid as maintenance for maximum of 12 months. The primary endpoint was 1 year survival with response rate and safety as secondary endpoints. RESULTS A total of 18 patients were enrolled with 17 evaluable patients. One patient had a complete response, seven patients had a partial response (overall response rate of 47 %) and one patient had stable disease. Overall median survival was 7.4 months and 1 year survival was 25 %. The most common treatment-related adverse events included fatigue, anorexia, rash, diarrhea, neutropenia and weight loss. Grade 5 GI bleeding, pulmonary hemorrhage and neutropenia occurred in one pt (6 %) each. Accrual was halted on the basis of safety profile as well as preliminary efficacy data. CONCLUSIONS The combination of platinum based chemotherapy and sorafenib has significant toxicity at current dose levels and is associated with disappointing efficacy data.
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Affiliation(s)
- Neelesh Sharma
- University Hospitals Seidman Cancer Center, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH, USA,
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Klempner SJ, Myers AP, Mills GB, Westin SN. Clinical investigation of receptor and non-receptor tyrosine kinase inhibitors for the treatment of epithelial ovarian cancer. Expert Opin Pharmacother 2013; 14:2171-82. [PMID: 23937415 PMCID: PMC4103698 DOI: 10.1517/14656566.2013.826650] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Epithelial ovarian cancer (EOC) is the second most common gynecologic malignancy and the leading cause of death from gynecologic cancer in the USA. EOC is an exquisitely chemo-sensitive disease with response rates of over 75% in the upfront setting. Despite this, due to high rates of recurrence and development of chemo-resistance, the overall survival of EOC remains about 25%. Thus, there is a great need for new therapeutic approaches to render more durable responses. Based on preclinical and early phase clinical studies, key targeted pathways include targets that drive angiogenesis and chemo-resistance. Receptor tyrosine kinases and non-receptor tyrosine kinases play important roles in these processes and several small molecule tyrosine kinase inhibitors (TKIs) are in clinical development. AREAS COVERED This review summarizes clinical rationale, mechanisms of action and clinical data for the TKIs under evaluation in the Phase III setting for EOC. EXPERT OPINION Despite reasonable preclinical activity, small molecule TKIs are unlikely to improve patient survival as single agent therapies in an unselected EOC population. Incorporation of tissue evaluation during ongoing clinical trials is required to identify molecularly defined groups that respond to single agents and direct rational combination strategies based on mechanisms of resistance to improve outcomes in EOC.
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Affiliation(s)
- Samuel J. Klempner
- Division of Hematology-Oncology, Beth Israel Deaconess Medical Center, Boston, MA 02215
| | - Andrea P. Myers
- Division of Hematology-Oncology, Beth Israel Deaconess Medical Center, Boston, MA 02215
- Department of Gynecologic Oncology, Dana Farber Cancer Institute, Boston, MA, 02215
| | - Gordon B. Mills
- Department of Systems Biology, University of Texas M. D. Anderson Cancer Center, Houston TX, 77030
| | - Shannon N. Westin
- Departments of Gynecologic Oncology and Reproductive Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, 77030
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Abstract
Small cell lung cancer (SCLC) is a highly aggressive cancer usually with distal metastasis and very poor prognosis. Chemotherapy is the treatment of choice for SCLC in all stages and an initial good response, but there is a high chance of disease relapse with an overall poor median survival for both stages. With increasing translational research and a better understanding of the molecular basis of cancer, a number of molecular targets have been identified in various preclinical studies. Targeted drugs have less toxicity than chemotherapy drugs, but no targeted agents have been approved for use in the treatment of SCLC patients to date. This review focuses on targeted therapies in SCLC.
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Affiliation(s)
- Yalei Zhang
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Guangzhou Medical College, Guangzhou 510120, China
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Dahut WL, Madan RA, Karakunnel JJ, Adelberg D, Gulley JL, Turkbey IB, Chau CH, Spencer SD, Mulquin M, Wright J, Parnes HL, Steinberg SM, Choyke PL, Figg WD. Phase II clinical trial of cediranib in patients with metastatic castration-resistant prostate cancer. BJU Int 2013; 111:1269-80. [PMID: 23419134 PMCID: PMC3660464 DOI: 10.1111/j.1464-410x.2012.11667.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To assess the efficacy and toxicity of cediranib, a highly potent inhibitor of vascular endothelial growth factor receptor tyrosine kinases, in patients with metastatic castration-resistant prostate cancer (CRPC) previously treated with docetaxel-based therapy. PATIENTS AND METHODS The study used a Simon two-stage trial design, which required at least two of 12 patients in the first cohort to be progression-free at 6 months. We enrolled a total of 35 evaluable patients who all received cediranib 20 mg orally daily. In a second cohort, 23 additional patients received prednisone 10 mg daily with cediranib. Endpoints included tumour response, progression-free survival (PFS), overall survival (OS), vascular permeability via dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI), and toxicity. RESULTS A total of 59 patients were enrolled, of whom 67% had received two or more previous chemotherapy regimens. Six of 39 patients with measurable disease had confirmed partial responses and one had an unconfirmed partial response. At 6 months, 43.9% of patients were progression-free; the median PFS and OS periods for all patients were 3.7 months and 10.1 months, respectively. We found that the DCE-MRI variables baseline transport constant (Ktrans ) and rate constant at day 28 were significantly associated with PFS in univariate analyses, but only baseline Ktrans remained significant when considered jointly. The most frequent toxicities were hypertension, fatigue, anorexia and weight loss; the addition of prednisone reduced the incidence of constitutional toxicities. CONCLUSION This study demonstrated that cediranib was generally well tolerated with some anti-tumour activity in highly pretreated patients with metastatic CRPC who had progressive disease after docetaxel-based therapy.
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Affiliation(s)
- William L. Dahut
- Medical Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Ravi A. Madan
- Medical Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Joyson J. Karakunnel
- Medical Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - David Adelberg
- Medical Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - James L. Gulley
- Medical Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Ismail B. Turkbey
- Molecular Imaging Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Cindy H. Chau
- Medical Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Shawn D. Spencer
- Clinical Pharmacology Program, SAIC-Frederick, Inc., National Cancer Institute-Frederick
| | - Marcia Mulquin
- Medical Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - John Wright
- Cancer Therapy Evaluation Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Howard L. Parnes
- Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Seth M. Steinberg
- Biostatistics and Data Management Section, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Peter L. Choyke
- Molecular Imaging Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - William D. Figg
- Medical Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
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Abstract
Cediranib is a potent inhibitor of the VEGF family receptor tyrosine kinases, and a new agent in cancer treatment. The drug has shown promising activity in a variety of solid malignancies, in preclinical models and in clinical trials. Its pharmacokinetics allow for a convenient once-daily administration, with a toxicity profile that is very similar to other VEGF inhibitors. Its main side effects include hypertension, nausea, dysphonia, fatigue and diarrhea. Adverse events seem to be manageable, especially when used in doses lower than 45 mg/day. Studies have shown some activity as a single agent or in combination in advanced tumors, but not enough to secure its approval for routine use up to now. Clinical trials are still evaluating the role of cediranib in combination chemotherapy with cytotoxic agents.
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Affiliation(s)
- Marina Sahade
- Discipline of Oncology, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo & Hospital Sírio Libanês, Avenida Dr Arnaldo, 251, CEP 01246-000, São Paulo, Brazil.
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Zhu AX, Ancukiewicz M, Supko JG, Sahani DV, Blaszkowsky LS, Meyerhardt JA, Abrams TA, McCleary NJ, Bhargava P, Muzikansky A, Sheehan S, Regan E, Vasudev E, Knowles M, Fuchs CS, Ryan DP, Jain RK, Duda DG. Efficacy, safety, pharmacokinetics, and biomarkers of cediranib monotherapy in advanced hepatocellular carcinoma: a phase II study. Clin Cancer Res 2013; 19:1557-66. [PMID: 23362324 DOI: 10.1158/1078-0432.ccr-12-3041] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE We conducted a single-arm phase II study of cediranib, a pan-VEGFR tyrosine kinase inhibitor, in patients with advanced hepatocellular carcinoma (HCC). EXPERIMENTAL DESIGN Patients with histologically confirmed measurable advanced HCC and adequate hematologic, hepatic, and renal functions received cediranib 30-mg orally once daily (4 weeks/cycle). The primary endpoint was progression-free survival (PFS) rate at 3 months. Other endpoints included response rates, overall survival (OS), pharmacokinetics (PK), and biomarkers for cediranib. RESULTS Cediranib treatment resulted in an estimated 3-month PFS rate of 77% (60%, 99%). Median PFS was 5.3 (3.5,9.7) months, stable disease was seen in 5/17 patients (29%), and median OS was 11.7 (7.5-13.6) months. Grade 3 toxicities included hypertension (29%), hyponatremia (29%), and hyperbilirubinemia (18%). Cediranib PK were comparable to those seen in cancer patients with normal hepatic function. Plasma levels of VEGF and PlGF increased and sVEGFR1, sVEGFR2, and Ang-2 decreased after cediranib treatment. PFS was inversely correlated with baseline levels of VEGF, sVEGFR2, and bFGF and with on-treatment levels of bFGF and IGF-1, and directly associated with on-treatment levels of IFN-γ. OS was inversely correlated with baseline levels of sVEGFR1, Ang-2, TNF-α, CAIX, and CD34(+)CD133(+)CD45(dim) circulating progenitor cells and on-treatment levels of sVEGFR2. CONCLUSIONS Despite the limitations of primary endpoint selection, cediranib at 30-mg daily showed a high incidence of toxicity and preliminary evidence of antitumor activity in advanced HCC. Hepatic dysfunction did not seem to affect the steady-state PK of cediranib. Exploratory studies suggested proangiogenic and inflammatory factors as potential biomarkers of anti-VEGF therapy in HCC.
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Affiliation(s)
- Andrew X Zhu
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts 02114, USA.
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Abstract
Lung cancer is the leading cause of cancer-related deaths world-wide and small-cell lung cancer (SCLC) accounts for up to 25% of lung cancer deaths. There has been a considerable amount of research in the understanding of the depth of biology of SCLC and utilizing this knowledge to develop targeted approaches. The treatment of SCLC remains a challenge, despite remarkable initial efficacy to combination chemotherapy and radiation therapy. The response is usually short-lived and the prognosis of SCLC has not changed over the past few decades, necessitating the critical need for evaluating novel agents/therapies. Several signaling pathways have been found to be activated in SCLC tumor cells, forming a rationale for blocking some of the drugable targets. Molecular changes and biological markers have been identified but remain to be validated. Novel and targeted agents have been evaluated but without much success. Increasing understanding of the biology and potential clinical evaluation of biomarkers will pave the way for more effective treatments.
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Affiliation(s)
- Monika Joshi
- Department of Medicine, Penn State Hershey Medical Center, 500 University Drive, CH72, Hershey, PA 17033, USA.
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47
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Abstract
Lung cancer is the leading cause of cancer-related mortality. Small cell lung cancer (SCLC) accounted for 12.95% of all lung cancer histological types in 2002. Despite trends toward modest improvement in survival, the outcome remains extremely poor. Chemotherapy is the cornerstone of treatment in SCLC. More than two-thirds of patients who succumb to lung cancer in the United States are over 65 years old. Elderly patients tolerate chemotherapy poorly and need novel therapeutic agents. Targeted drugs have less toxicity than chemotherapy drugs, but no targeted agents have been approved for use in the treatment of SCLC patients to date. Certain new targeted agents, including gefitinib, bevacizumab and Bcl-2 inhibitors, offer a promise of improved outcomes, however negative results are more commonly reported than positive. This review focuses on targeted therapies in SCLC.
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Affiliation(s)
- HONG-YANG LU
- Zhejiang Key Laboratory of Diagnosis and Treatment Technology on Thoracic Oncology (Lung and Esophagus), Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310022,
P.R. China
| | - XIAO-JIA WANG
- Zhejiang Key Laboratory of Diagnosis and Treatment Technology on Thoracic Oncology (Lung and Esophagus), Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310022,
P.R. China
| | - WEI-MIN MAO
- Zhejiang Key Laboratory of Diagnosis and Treatment Technology on Thoracic Oncology (Lung and Esophagus), Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310022,
P.R. China
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Han JY, Kim HY, Lim KY, Han JH, Lee YJ, Kwak MH, Kim HJ, Yun T, Kim HT, Lee JS. A phase II study of sunitinib in patients with relapsed or refractory small cell lung cancer. Lung Cancer 2012. [PMID: 23182663 DOI: 10.1016/j.lungcan.2012.09.019] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE This study was conducted to evaluate the efficacy and safety of sunitinib in patients with relapsed or refractory small cell lung cancer (SCLC). PATIENTS AND METHODS Eligibility included histologic or cytologic diagnosis of SCLC, ECOG PS of 0-2, cancer progression following one or two prior chemotherapy or chemo-radiotherapy (CRT) and adequate organ functions. Treatment regimen consisted of a 6-week cycle of sunitinib given as 50mg p.o. daily for 4 weeks followed by 2 weeks off. The primary end point was objective response rate (ORR). RESULTS From March 2008 to October 2010, 25 patients were enrolled and 24 received treatment. The median age was 64.5 years; 22 patients (92%) were male. Eight patients (33%) displayed sensitive relapse. Seven patients (29%) received CRT and fifteen patients (63%) had received one prior chemotherapy. A median of 1 cycle (range 1-4) of sunitinib was administered, and 23 patients were evaluable for response. Two patients displayed partial response, and seven patients presented stable disease with a ORR of 9% (95% CI, 1-28%). The median progression-free (PFS) and overall survivals were 1.4 months (95% CI, 1.1-1.7) and 5.6 months (95% CI, 3.5-7.7), respectively. The common grade 3 or 4 toxicities included thrombocytopenia (63%), asthenia (29%) and neutropenia (25%). CONCLUSIONS Although tumor response was noted in 2 patients, the median PFS was short and most patients were unable to tolerate the treatment. At the current dose schedule, sunitinib does not appear to warrant further evaluation.
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Affiliation(s)
- Ji-Youn Han
- Center for Lung Cancer, Research Institute and Hospital, National Cancer Center, Goyang-si, Gyeonggi-do, Republic of Korea.
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Dansin E, Lauridant G, Chahine B. [Antiangiogenic agents: current limits in thoracic oncology]. Bull Cancer 2012; 99:1083-91. [PMID: 23113985 DOI: 10.1684/bdc.2012.1655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Antiangiogenic agents appear as major therapeutic options in renal, colorectal and breast cancer. Their part in thoracic oncology is still limited today except for bevacizumab. We review the current limits of antiangiogenic agents in terms of efficacy, activity, tolerance and therapeutic strategies. Problems about predictive biomarkers and cost-effectiveness of antiangiogenic agents in thoracic oncology are also mentioned.
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Abstract
The development and use of antiangiogenesis agents, particularly those targeting vascular endothelial growth factor (VEGF), has become an integral component of anticancer regimens for many tumor types. This review is intended to highlight some of the most important clinical successes and failures of anti-VEGF therapies, and where possible, to suggest important lessons that have been learned. This review emphasizes data from agents that have been FDA approved and/or have completed phase III studies.
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Affiliation(s)
- Kellen L Meadows
- Duke University Medical Center, Durham, North Carolina 27710, USA
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