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Donnem T, Kilvaer TK, Andersen S, Richardsen E, Paulsen EE, Hald SM, Al-Saad S, Brustugun OT, Helland A, Lund-Iversen M, Solberg S, Gronberg BH, Wahl SGF, Helgeland L, Fløtten O, Pohl M, Al-Shibli K, Sandanger TM, Pezzella F, Busund LT, Bremnes RM. Strategies for clinical implementation of TNM-Immunoscore in resected nonsmall-cell lung cancer. Ann Oncol 2015; 27:225-32. [PMID: 26578726 DOI: 10.1093/annonc/mdv560] [Citation(s) in RCA: 124] [Impact Index Per Article: 13.8] [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: 07/17/2015] [Accepted: 11/07/2015] [Indexed: 02/06/2023] Open
Abstract
Immunoscore is a prognostic tool defined to quantify in situ immune cell infiltrates and appears highly promising as a supplement to the tumor-node-metastasis (TNM) classification of various tumors. In colorectal cancer, an international task force has initiated prospective multicenter studies aiming to implement TNM-Immunoscore (TNM-I) in a routine clinical setting. In breast cancer, recommendations for the evaluation of tumor-infiltrating lymphocytes (TILs) have been proposed by an international working group. Regardless of promising results, there are potential obstacles related to implementing TNM-I into the clinic. Diverse methods may be needed for different malignancies and even within each cancer entity. Nevertheless, a uniform approach across malignancies would be advantageous. In nonsmall-cell lung cancer (NSCLC), there are several previous reports indicating an apparent prognostic importance of TILs, but studies on TILs in a TNM-I setting are sparse and no general recommendations are made. However, recently published data is promising, evoking a realistic hope of a clinical useful NSCLC TNM-I. This review will focus on the TNM-I potential in NSCLC and propose strategies for clinical implementation of a TNM-I in resected NSCLC.
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Affiliation(s)
- T Donnem
- Department of Oncology, University Hospital of North Norway, Tromso Institute of Clinical Medicine, The Arctic University of Norway, Tromso
| | - T K Kilvaer
- Department of Oncology, University Hospital of North Norway, Tromso
| | - S Andersen
- Department of Oncology, University Hospital of North Norway, Tromso
| | - E Richardsen
- Department of Clinical Pathology, University Hospital of North Norway, Tromso Institute of Medical Biology, The Arctic University of Norway, Tromso
| | - E E Paulsen
- Department of Oncology, University Hospital of North Norway, Tromso Institute of Clinical Medicine, The Arctic University of Norway, Tromso
| | - S M Hald
- Institute of Clinical Medicine, The Arctic University of Norway, Tromso
| | - S Al-Saad
- Department of Clinical Pathology, University Hospital of North Norway, Tromso Institute of Medical Biology, The Arctic University of Norway, Tromso
| | - O T Brustugun
- Department of Oncology, Oslo University Hospital, The Norwegian Radium Hospital, Oslo
| | - A Helland
- Department of Oncology, Oslo University Hospital, The Norwegian Radium Hospital, Oslo Department of Cancer Genetics, Oslo University Hospital, The Norwegian Radium Hospital, Oslo
| | - M Lund-Iversen
- Department of Pathology, Oslo University Hospital, The Norwegian Radium Hospital, Oslo
| | - S Solberg
- Department of Cardiothoracic Surgery, Oslo University Hospital, Rikshospitalet, Oslo
| | - B H Gronberg
- The Cancer Clinic, St Olavs Hospital, Trondheim University Hospital, Trondheim Department of Cancer Research and Molecular Medicine, European Palliative Care Research Centre, Norwegian University of Science and Technology, Trondheim
| | - S G F Wahl
- Department of Pathology and Medical Genetics, St Olavs Hospital-Trondheim University Hospital, Trondheim
| | - L Helgeland
- Department of Pathology, Haukeland University Hospital, Bergen, Norway
| | - O Fløtten
- Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway
| | - M Pohl
- Department of Oncology, Rigshospitalet, Copenhagen, Denmark
| | - K Al-Shibli
- Department of Pathology, Nordland Hospital, Bodo
| | - T M Sandanger
- Department of Community Medicine, The Artic University of Tromso, Tromso, Norway
| | - F Pezzella
- Nuffield Department of Clinical Laboratory Sciences, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - L T Busund
- Department of Clinical Pathology, University Hospital of North Norway, Tromso Institute of Medical Biology, The Arctic University of Norway, Tromso
| | - R M Bremnes
- Department of Oncology, University Hospital of North Norway, Tromso Institute of Clinical Medicine, The Arctic University of Norway, Tromso
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Gronberg BH, Bremnes R, Aasebø U, Brunsvig P, Fløtten Ø, Hjelde H, Wammer F, Stornes F, Tollåli T, Sundstrøm SH. Pemetrexed + carboplatin versus gemcitabine + carboplatin in the treatment of stage IIIB/IV non-small cell lung cancer. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.7517] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [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
7517 Background: A prospective, randomized, multicentre study was conducted to compare pemetrexed + carboplatin (PC) with a standard regimen, gemcitabine + carboplatin (GC). Methods: Chemonaive patients with verified non-small cell lung cancer, stage IIIB (ineligible for curative radiotherapy) or stage IV, WHO performance status (PS) 0–2, adequate hematology and creatinine-clearance > 45 ml/min were eligible. All patients were supplemented with folic acid 0.4 mg OD and vitamin B12 1 mg IM every 9 weeks, from >= 5 days before and through the treatment period. Patients were randomized to receive either pemetrexed 500 mg/m2 + carboplatin AUC=5 (Calvert) day 1 or gemcitabine 1,000 mg/m2 day 1 & 8 + carboplatin AUC=5 (Calvert) day 1. Maximum 4 courses every 3 weeks were given. Primary endpoints: QoL defined as global health status, nausea/vomiting, dyspnea and fatigue - measured by the EORTC QLQ-C30 and LC13 before every cycle and 3 & 11 weeks after the last cycle. Secondary endpoints: Overall survival (OS) and toxicity measured by the CTCAE v3.0. Stratification was done for age (−75 vs +75 years), stage (IIIB vs IV) and PS (0–1 vs 2). 190 evaluable patients in each arm were required to detect a 15% improvement on predefined QoL parameters with an a of 0.05 and β of 0.80. A 15% loss to follow up was expected. Results: 446 patients were included from Apr 05 - Jul 06. The two arms were well balanced with respect to age, sex, stage, PS and histological classification. 436 patients were eligible for the primary QoL-analyses. No statistical significant differences in mean score of the QoL-scales were observed between the arms. So far, 384 patients have been analysed for toxicity. Significantly more patients in the GC arm experienced grade 3–4 thrombocytopenia (48 vs 107, p<0.001), leucopenia (44 vs 89, p<0.001) and granulocytopenia (78 vs 98, p=0.02). No difference in the frequency of neutropenic fever was recorded. More patients in the GC arm received transfusion of platelets (5 vs 19, p=0.02). At present, 291 patients are deceased. We expect to present complete OS analyses for a minimum of 380 patients at the annual meeting. Conclusions: No differences were detected between the two arms with respect to the primary QoL outcome. Patients in the PC arm experienced less toxicity. No significant financial relationships to disclose.
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Affiliation(s)
- B. H. Gronberg
- St. Olavs Hospital, Trondheim, Norway; University Hospital of North Norway, Tromsø, Norway; The Norwegian Radiumhospital, Oslo, Norway; Haukeland University Hospital, Bergen, Norway; Ålesund Hospital, Ålesund, Norway; Ullevål University Hospital, Oslo, Norway; Bodø Hospital, Bodø, Norway
| | - R. Bremnes
- St. Olavs Hospital, Trondheim, Norway; University Hospital of North Norway, Tromsø, Norway; The Norwegian Radiumhospital, Oslo, Norway; Haukeland University Hospital, Bergen, Norway; Ålesund Hospital, Ålesund, Norway; Ullevål University Hospital, Oslo, Norway; Bodø Hospital, Bodø, Norway
| | - U. Aasebø
- St. Olavs Hospital, Trondheim, Norway; University Hospital of North Norway, Tromsø, Norway; The Norwegian Radiumhospital, Oslo, Norway; Haukeland University Hospital, Bergen, Norway; Ålesund Hospital, Ålesund, Norway; Ullevål University Hospital, Oslo, Norway; Bodø Hospital, Bodø, Norway
| | - P. Brunsvig
- St. Olavs Hospital, Trondheim, Norway; University Hospital of North Norway, Tromsø, Norway; The Norwegian Radiumhospital, Oslo, Norway; Haukeland University Hospital, Bergen, Norway; Ålesund Hospital, Ålesund, Norway; Ullevål University Hospital, Oslo, Norway; Bodø Hospital, Bodø, Norway
| | - Ø. Fløtten
- St. Olavs Hospital, Trondheim, Norway; University Hospital of North Norway, Tromsø, Norway; The Norwegian Radiumhospital, Oslo, Norway; Haukeland University Hospital, Bergen, Norway; Ålesund Hospital, Ålesund, Norway; Ullevål University Hospital, Oslo, Norway; Bodø Hospital, Bodø, Norway
| | - H. Hjelde
- St. Olavs Hospital, Trondheim, Norway; University Hospital of North Norway, Tromsø, Norway; The Norwegian Radiumhospital, Oslo, Norway; Haukeland University Hospital, Bergen, Norway; Ålesund Hospital, Ålesund, Norway; Ullevål University Hospital, Oslo, Norway; Bodø Hospital, Bodø, Norway
| | - F. Wammer
- St. Olavs Hospital, Trondheim, Norway; University Hospital of North Norway, Tromsø, Norway; The Norwegian Radiumhospital, Oslo, Norway; Haukeland University Hospital, Bergen, Norway; Ålesund Hospital, Ålesund, Norway; Ullevål University Hospital, Oslo, Norway; Bodø Hospital, Bodø, Norway
| | - F. Stornes
- St. Olavs Hospital, Trondheim, Norway; University Hospital of North Norway, Tromsø, Norway; The Norwegian Radiumhospital, Oslo, Norway; Haukeland University Hospital, Bergen, Norway; Ålesund Hospital, Ålesund, Norway; Ullevål University Hospital, Oslo, Norway; Bodø Hospital, Bodø, Norway
| | - T. Tollåli
- St. Olavs Hospital, Trondheim, Norway; University Hospital of North Norway, Tromsø, Norway; The Norwegian Radiumhospital, Oslo, Norway; Haukeland University Hospital, Bergen, Norway; Ålesund Hospital, Ålesund, Norway; Ullevål University Hospital, Oslo, Norway; Bodø Hospital, Bodø, Norway
| | - S. H. Sundstrøm
- St. Olavs Hospital, Trondheim, Norway; University Hospital of North Norway, Tromsø, Norway; The Norwegian Radiumhospital, Oslo, Norway; Haukeland University Hospital, Bergen, Norway; Ålesund Hospital, Ålesund, Norway; Ullevål University Hospital, Oslo, Norway; Bodø Hospital, Bodø, Norway
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