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Lowczak A, Kolasinska-Cwikla A, Osowiecka K, Glinka L, Palucki J, Rzepko R, Doboszynska A, Cwikla JB. Outcomes of Patients with Pulmonary Large Cell Neuroendocrine Carcinoma in I-IV Stage. ACTA ACUST UNITED AC 2021; 57:medicina57020118. [PMID: 33525370 PMCID: PMC7911070 DOI: 10.3390/medicina57020118] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/11/2021] [Accepted: 01/26/2021] [Indexed: 02/06/2023]
Abstract
Background and Objectives: Large cell neuroendocrine cancer is characterised by poor prognosis. The standard of treatment is still not established. The aim of this study was to assess the predictive factors of overall survival (OS) and progression-free survival (PFS) of pulmonary large cell neuroendocrine carcinoma (LCNEC) and combined LCNEC. Materials and Methods: All patients had confirmed pathology stage I-IV disease recorded between period 2002–2018. Survival curves were estimated by Kaplan–Meier method. Uni- and multivariable analysis was conducted using Cox-regression analysis. Results: A total of 132 patients with LCNEC and combined LCNEC were included. Half of them had clinical stage IIIB/C-IV. Patients were treated with radical (n = 67, including surgery alone; resection with neo-adjuvant or adjuvant chemotherapy, radiochemotherapy, or adjuvant radiotherapy; patients treated with radiochemotherapy alone), palliative (n = 41) or symptomatic (n = 24) intention. Seventeen patients were treated with resection margin R1 or R2. Non-small cell carcinoma (NSCLC) chemotherapy (platinum-vinorelbine; PN schedule) and small-cell lung carcinoma (SCLC) chemotherapy approaches (platinum/carboplatinum-etoposide; PE/KE schedule) were administered in 20 and in 55 patients, respectively. The median (95% Confidence Interval (CI)) OS and PFS were 17 months (9.0–36.2 months) and 7 months (3.0–15.0 months), respectively. Patients treated with negative resection margin, with lower clinical stage, without lymph node metastasis, and with size of primary tumour ≤4 cm showed significantly better OS and PFS. The main risk factors with an adverse effect on survival were advanced CS and positive resection margin. Conclusions: Patients with LCNEC characterized poor prognosis. Independent prognostic factors influencing PFS were initial clinical stage and resection margin R0 vs. R1-2.
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Affiliation(s)
- Anna Lowczak
- Department of Pulmonology, Faculty of Medicine, University of Warmia and Mazury in Olsztyn, Jagiellonska 78, 11-041 Olsztyn, Poland;
- Correspondence: ; Tel.: +48-89-532-29-85
| | - Agnieszka Kolasinska-Cwikla
- Department of Oncology and Radiotherapy, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland Roentgena 5, 02-781 Warsaw, Poland;
| | - Karolina Osowiecka
- Department of Psychology and Sociology of Health and Public Health, School of Public Health, University of Warmia and Mazury in Olsztyn, Warszawska 30, 11-041 Olsztyn, Poland;
| | - Lidia Glinka
- Department of Anesthesiology and Intensive Care Faculty of Medicine, University of Warmia and Mazury in Olsztyn, Warszawska 30, 10-082 Olsztyn, Poland;
| | - Jakub Palucki
- Department of Radiology, Maria Sklodowska-Curie Institute of Oncology in Warsaw, Roentgena 5, 02-781 Warsaw, Poland;
| | - Robert Rzepko
- Specialist Hospital in Prabuty, Kuracyjna 30, 82-550 Prabuty, Poland;
| | - Anna Doboszynska
- Department of Pulmonology, Faculty of Medicine, University of Warmia and Mazury in Olsztyn, Jagiellonska 78, 11-041 Olsztyn, Poland;
| | - Jaroslaw B. Cwikla
- Department of Cardiology and Internal Medicine Faculty of Medicine, University of Warmia and Mazury in Olsztyn, Warszawska 30, 10-082 Olsztyn, Poland;
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Weiss JM, Csoszi T, Maglakelidze M, Hoyer RJ, Beck JT, Domine Gomez M, Lowczak A, Aljumaily R, Rocha Lima CM, Boccia RV, Hanna W, Nikolinakos P, Chiu VK, Owonikoko TK, Schuster SR, Hussein MA, Richards DA, Sawrycki P, Bulat I, Hamm JT, Hart LL, Adler S, Antal JM, Lai AY, Sorrentino JA, Yang Z, Malik RK, Morris SR, Roberts PJ, Dragnev KH. Myelopreservation with the CDK4/6 inhibitor trilaciclib in patients with small-cell lung cancer receiving first-line chemotherapy: a phase Ib/randomized phase II trial. Ann Oncol 2019; 30:1613-1621. [PMID: 31504118 PMCID: PMC6857609 DOI: 10.1093/annonc/mdz278] [Citation(s) in RCA: 94] [Impact Index Per Article: 18.8] [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] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Chemotherapy-induced damage of hematopoietic stem and progenitor cells (HSPC) causes multi-lineage myelosuppression. Trilaciclib is an intravenous CDK4/6 inhibitor in development to proactively preserve HSPC and immune system function during chemotherapy (myelopreservation). Preclinically, trilaciclib transiently maintains HSPC in G1 arrest and protects them from chemotherapy damage, leading to faster hematopoietic recovery and enhanced antitumor immunity. PATIENTS AND METHODS This was a phase Ib (open-label, dose-finding) and phase II (randomized, double-blind placebo-controlled) study of the safety, efficacy and PK of trilaciclib in combination with etoposide/carboplatin (E/P) therapy for treatment-naive extensive-stage small-cell lung cancer patients. Patients received trilaciclib or placebo before E/P on days 1-3 of each cycle. Select end points were prespecified to assess the effect of trilaciclib on myelosuppression and antitumor efficacy. RESULTS A total of 122 patients were enrolled, with 19 patients in part 1 and 75 patients in part 2 receiving study drug. Improvements were seen with trilaciclib in neutrophil, RBC (red blood cell) and lymphocyte measures. Safety on trilaciclib+E/P was improved with fewer ≥G3 adverse events (AEs) in trilaciclib (50%) versus placebo (83.8%), primarily due to less hematological toxicity. No trilaciclib-related ≥G3 AEs occurred. Antitumor efficacy assessment for trilaciclib versus placebo, respectively, showed: ORR (66.7% versus 56.8%, P = 0.3831); median PFS [6.2 versus 5.0 m; hazard ratio (HR) 0.71; P = 0.1695]; and OS (10.9 versus 10.6 m; HR 0.87; P = 0.6107). CONCLUSION Trilaciclib demonstrated an improvement in the patient's tolerability of chemotherapy as shown by myelopreservation across multiple hematopoietic lineages resulting in fewer supportive care interventions and dose reductions, improved safety profile, and no detriment to antitumor efficacy. These data demonstrate strong proof-of-concept for trilaciclib's myelopreservation benefits. CLINICAL TRAIL NUMBER NCT02499770.
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Affiliation(s)
- J M Weiss
- Division of Hematology and Oncology, Lineberger Comprehensive Cancer Center at the University of North Carolina, Chapel Hill, USA
| | - T Csoszi
- Oncology, Hetenyi Geza Korhaz, Onkologiai Kozpont, Szolnok, Hungary
| | - M Maglakelidze
- Department of Oncology, Research Institute of Clinical Medicine, Tbilisi, Georgia, USA
| | - R J Hoyer
- Department of Oncology, Memorial Hospital, University of Colorado Health, Colorado Springs, USA
| | - J T Beck
- Department of Medical Oncology and Hematology, Highlands Oncology Group, Fayetteville, USA
| | - M Domine Gomez
- Department of Oncology, University Hospital Fundacion Jimenez Diaz, IIS-FJD, Madrid, Spain
| | - A Lowczak
- Department of Pulmonology, Faculty of Health and Science, University of Warmia and Mazury in Olsztyn, Poland
| | - R Aljumaily
- Stephenson Cancer Center, University of Oklahoma, Oklahoma City, USA
| | - C M Rocha Lima
- Gibbs Cancer Center and Research Institute, Spartanburg, USA
| | - R V Boccia
- Center for Cancer and Blood Disorders, Bethesda, USA
| | - W Hanna
- Hematology/Oncology, University of Tennessee Medical Center, Knoxville, USA
| | - P Nikolinakos
- University Cancer & Blood Center, LLC, Athens, Greece
| | - V K Chiu
- Department of Hematology/Oncology, University of New Mexico Comprehensive Cancer Center, Albuquerque, USA
| | - T K Owonikoko
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, USA
| | | | - M A Hussein
- Department of Oncology, Florida Cancer Specialists, Leesburg, USA
| | - D A Richards
- Department of Oncology, US Oncology Research, Tyler, USA
| | - P Sawrycki
- Department of Cancer Chemotherapy, Provincial Hospital, Toruń, Poland
| | - I Bulat
- ARENSIA Oncology Unit, Institute of Oncology, Chisinau, Moldova
| | - J T Hamm
- Department of Medical Oncology, Norton Health Care, Louisville, USA
| | - L L Hart
- Drug Development Program, Floridia Cancer Specialists, Fort Myers, USA
| | - S Adler
- Clinical Research, G1 Therapeutics, Inc., Research Triangle Park, USA
| | - J M Antal
- Clinical Research, G1 Therapeutics, Inc., Research Triangle Park, USA
| | - A Y Lai
- Clinical Research, G1 Therapeutics, Inc., Research Triangle Park, USA
| | - J A Sorrentino
- Clinical Research, G1 Therapeutics, Inc., Research Triangle Park, USA
| | - Z Yang
- Clinical Research, G1 Therapeutics, Inc., Research Triangle Park, USA
| | - R K Malik
- Clinical Research, G1 Therapeutics, Inc., Research Triangle Park, USA
| | - S R Morris
- Clinical Research, G1 Therapeutics, Inc., Research Triangle Park, USA
| | - P J Roberts
- Clinical Research, G1 Therapeutics, Inc., Research Triangle Park, USA
| | - K H Dragnev
- Department of Hematology/Oncology, Norris Cotton Cancer Center Dartmouth-Hitchcock Medical Center, Lebanon, USA.
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Sezer A, Gogishvili M, Bentsion D, Kilickap S, Lowczak A, Gumus M, Gladkov O, Clingan P, Sriuranpong V, Rizvi N, Lee S, Li S, Snodgrass P, Navarro M, Lowy I, Rietschel P. P2.01-01 Cemiplimab, a Human PD-1 Monoclonal Antibody, Versus Chemotherapy in First-Line Treatment of Advanced NSCLC with PD-L1 ≥50%. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.1345] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Dragnev K, Owonikoko T, Csoszi T, Maglakelidze M, Beck J, Domine Gomez M, Lowczak A, Fulop A, Hoyer R, Hanna W, Lowry P, Aljumaily R, Chiu V, Bulat I, Yang Z, Roberts P, Antal J, Malik R, Morris S, Weiss J. Trilaciclib (T) decreases multi-lineage myelosuppression in extensive-stage small cell lung cancer (ES-SCLC) patients receiving first-line chemotherapy. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy298.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Filosso PL, Kidd M, Roffinella M, Lewczuk A, Chung KM, Kolasinska-Cwikla A, Cwikla J, Lowczak A, Doboszynska A, Malczewska A, Catalano M, Zunino V, Boita M, Arvat E, Cristofori R, Guerrera F, Oliaro A, Tesselaar M, Buikhuisen W, Kos-Kudla B, Papotti M, Bodei L, Drozdov I, Modlin I. The utility of blood neuroendocrine gene transcript measurement in the diagnosis of bronchopulmonary neuroendocrine tumours and as a tool to evaluate surgical resection and disease progression†. Eur J Cardiothorac Surg 2017; 53:631-639. [DOI: 10.1093/ejcts/ezx386] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 09/30/2017] [Indexed: 01/04/2023] Open
Affiliation(s)
- Pier Luigi Filosso
- Department of Thoracic Surgery and Department of Oncology, University of Torino, Torino, Italy
| | - Mark Kidd
- Wren Laboratories, Branford, CT, USA
| | - Matteo Roffinella
- Department of Thoracic Surgery and Department of Oncology, University of Torino, Torino, Italy
| | - Anna Lewczuk
- Department of Endocrinology, Medical University of Gdansk, Gdansk, Poland
| | | | | | - Jaroslaw Cwikla
- Department of Radiology, University of Warmia and Mazury, Olsztyn, Poland
| | - Anna Lowczak
- Department of Radiology, University of Warmia and Mazury, Olsztyn, Poland
| | - Anna Doboszynska
- Department of Radiology, University of Warmia and Mazury, Olsztyn, Poland
| | - Anna Malczewska
- Department of Endocrinology, Medical University of Silesia, Katowice, Poland
| | - Maria Catalano
- Department of Thoracic Surgery and Department of Oncology, University of Torino, Torino, Italy
| | - Valentina Zunino
- Department of Thoracic Surgery and Department of Oncology, University of Torino, Torino, Italy
| | - Monica Boita
- Department of Thoracic Surgery and Department of Oncology, University of Torino, Torino, Italy
| | - Emanuela Arvat
- Department of Thoracic Surgery and Department of Oncology, University of Torino, Torino, Italy
| | - Riccardo Cristofori
- Department of Thoracic Surgery and Department of Oncology, University of Torino, Torino, Italy
| | - Francesco Guerrera
- Department of Thoracic Surgery and Department of Oncology, University of Torino, Torino, Italy
| | - Alberto Oliaro
- Department of Thoracic Surgery and Department of Oncology, University of Torino, Torino, Italy
| | - Margot Tesselaar
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Wieneke Buikhuisen
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Beata Kos-Kudla
- Department of Endocrinology, Medical University of Silesia, Katowice, Poland
| | - Mauro Papotti
- Department of Thoracic Surgery and Department of Oncology, University of Torino, Torino, Italy
| | - Lisa Bodei
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Irvin Modlin
- Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
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Jagiello-Gruszfeld AI, Lowczak A, Zbrzezniak-Smilgiewicz J, Szablowska-Siwik S, Licznerska G, Wasilewska-Tesluk E. Anthracycline-containing regimen in early breast cancer: Analysis of toxicity. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.11104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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
11104 Background: The anthracycline-containing regimens is considered to be more beneficial to patients (pts) with early breast cancer (EBC). However at this moment is not clear which kind of regimen should be used in adjuvant setting. Methods: In our center, from Jan 2004 to Sep 2006, 248 breast cancer pts, who were qualified to the adjuvant chemotherapy received FEC100 (104 pts), AC (126 pts). or sequentially AC- taxans (18). Pts with many poor prognostic factors (N+, T3, G3, HER2/neu 3+) received 6 cycles of FEC100 or AC-taxans. Pts with better prognosis (Intermediate Risk Group according St.Gallen’s guidelines for 2005) received usually 4 cycles of AC. Besides, in most cases, internet access to the adjuvantonline! program was used during making decision. ER-ve or PR-ve positive pts received sequentially hormonal treatment. The radiotherapy (if needed) was delivered at the end of the chemotherapy. Results: During the treatment, toxicity of the chemotherapy was evaluated by NCI CTC v. 3. There was no toxic deaths. Median follow-up period was 19 months (range: 6–36). The febrile neutropenia was observed in 4 pts in FEC100 and in 5 pts in AC group. There was also no significant differences in the grade 3 or 4 neutropenia, anemia, thrombocytopenia and alopecia. In 3 pts treated with FEC100 and 1 with AC, cardiotoxicity grade 2 or 3 was diagnosed. Grade 2 or 3 asthenia was frequent in FEC100 group (44% vs 21% vs11%). In all pts prophylaxis of nausea/vomiting was used. However pts treated with FEC100 needed more 5HT3. Vomiting grade 2 or 3 were observed significantly more often in pts who received FEC100 (58% vs 26% vs 23%). Only at 1 pts in each group the chemotherapy was interrupted due to toxicity (asthenia gr 3, vomiting gr 3 and weight loss gr 2). The relative dose intensities of FEC100 and AC were 87% and 96% of planned doses, respectively. Conclusions: The acute symptoms of toxicity were important for breast cancer pts who received the adjuvant chemotherapy. According the adjuvantonline! 6 cycles of FEC100 were more effective than 4 cycles of AC. Nevertheless tolerability of AC is better. Many pts prefer only the hormonal treatment, even if it is not the optimal option, in fear of nausea or vomiting. The ongoing clinical trials should further define the best choice of anthracycline-containing regimen in the adjuvant setting. No significant financial relationships to disclose.
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Affiliation(s)
| | - A. Lowczak
- ZOZ MSWiA z Warminsko-Mazurskim Centrum Onkologii, Olsztyn, Poland
| | | | | | - G. Licznerska
- ZOZ MSWiA z Warminsko-Mazurskim Centrum Onkologii, Olsztyn, Poland
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Jagiello-Gruszfeld A, Lowczak A, Zbrzezniak-Smilgiewicz J, Szablowska-Siwik S, Licznerska G. P103 Toxicity and tolerability of the anthracycline-containing regimen in adjuvant chemotherapy for breast cancer. Breast 2007. [DOI: 10.1016/s0960-9776(07)70163-7] [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] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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