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Knetki-Wróblewska M, Dziadziuszko R, Jankowski T, Krawczyk P, Bryl M, Stencel K, Wrona A, Bandura A, Smok-Kalwat J, Rok-Knapińska J, Szydziak-Zwierzyńska K, Rogoziewicz K, Czyżewicz G, Wójtowicz M, Wojtukiewicz M, Kalinka E, Wysocki PJ, Łobacz M, Milanowski J, Pawlik H, Kowalski DM, Krzakowski M. Pembrolizumab-combination therapy for NSCLC- effectiveness and predictive factors in real-world practice. Front Oncol 2024; 14:1341084. [PMID: 38322415 PMCID: PMC10844541 DOI: 10.3389/fonc.2024.1341084] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 01/08/2024] [Indexed: 02/08/2024] Open
Abstract
Introduction Pembrolizumab combined with chemotherapy has become the standard of care for patients with non-small-cell lung cancer (NSCLC) and the expression of programmed death ligand 1 (PD-L1) in <50% of tumour cells (TC). Methods We evaluated the efficacy of the treatment in real-world practice, paying attention to the predictive factors, with a special focus on low level of PD-L1 expression. This study is a multicenter retrospective analysis of patients with stage IV NSCLC. Results A group of 339 consecutive patients was analysed, among them 51% patients with low PD-L1 expression. In the overall population, the ORR was 40.6%, median PFS and OS were 13 months (95% CI 11.4-15) and 16.8 months (95% CI 13.3-20.3), respectively. In multivariate analysis for the entire study population, performance status - ECOG 1 vs. 0 (HR 2.2, 95%CI 1.1-4.6; p=0.02), neutrophil to lymphocyte ratio (NLR)>3 (HR 2.3, 95%CI 1.3-4.2; p=0.04), presence of liver (HR 2.0, 95%CI 1-3.7; p=0. 03) and bone metastases (HR 1.3, 95%CI 1-3; p=0.04), weight loss (HR 1.8, 95%CI 1.1-2.8; p=0.01) and sum of measurable lesions diameters >110 mm (HR 1.7, 95%CI 1-2.9, p=0.049) had a negative impact on OS. Conclusions In the real world, patients can clinically benefit from immunochemotherapy, regardless of the expression of PD-L1 and the histological type. Other clinicopathological factors such as performance status, extent, and location of secondary lesions have prognostic significance.
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Affiliation(s)
- Magdalena Knetki-Wróblewska
- Department of Lung Cancer and Chest Tumours, The Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Rafał Dziadziuszko
- Department of Oncology and Radiotherapy, Medical University of Gdansk, Gdansk, Poland
| | - Tomasz Jankowski
- Department of Pneumonology, Oncology and Allergology, Medical University of Lublin, Lublin, Poland
| | - Paweł Krawczyk
- Department of Pneumonology, Oncology and Allergology, Medical University of Lublin, Lublin, Poland
| | - Maciej Bryl
- Department of Clinical Oncology with the Subdepartment of Diurnal Chemotherapy E. J. Zeyland Wielkopolska Center of Pulmonology and Thoracic Surgery, Poznan, Poland
| | - Katarzyna Stencel
- Department of Clinical Oncology with the Subdepartment of Diurnal Chemotherapy E. J. Zeyland Wielkopolska Center of Pulmonology and Thoracic Surgery, Poznan, Poland
| | - Anna Wrona
- Department of Oncology and Radiotherapy, Medical University of Gdansk, Gdansk, Poland
| | - Artur Bandura
- Department of Oncology and Radiotherapy, Medical University of Gdansk, Gdansk, Poland
| | | | | | | | - Krzysztof Rogoziewicz
- Department of Clinical Oncology, Lower Silesian Oncology, Pulmonology and Hematology Center, Wroclaw, Poland
| | - Grzegorz Czyżewicz
- Department of Clinical Oncology, The John Paul II Specialist Hospital, Cracow, Poland
| | - Monika Wójtowicz
- Department of Clinical Oncology, Medical University of Bialystok, Bialystok, Poland
| | - Marek Wojtukiewicz
- Department of Clinical Oncology, Medical University of Bialystok, Bialystok, Poland
| | - Ewa Kalinka
- Department of Clinical Oncology, Polish Mother’s Memorial Hospital Research Institute, Łódź, Poland
| | - Piotr J. Wysocki
- Department of Clinical Oncology, Jagiellonian University-Collegium Medicum Hospital, Cracow, Poland
| | - Mateusz Łobacz
- Department of Clinical Oncology, Jagiellonian University-Collegium Medicum Hospital, Cracow, Poland
| | - Janusz Milanowski
- Department of Pneumonology, Oncology and Allergology, Medical University of Lublin, Lublin, Poland
| | - Hubert Pawlik
- Computational Oncology Department, The Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Dariusz M. Kowalski
- Department of Lung Cancer and Chest Tumours, The Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Maciej Krzakowski
- Department of Lung Cancer and Chest Tumours, The Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
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Gabryel P, Skrzypczak P, Roszak M, Campisi A, Zielińska D, Bryl M, Stencel K, Piwkowski C. Influencing Factors on the Quality of Lymph Node Dissection for Stage IA Non-Small Cell Lung Cancer: A Retrospective Nationwide Cohort Study. Cancers (Basel) 2024; 16:346. [PMID: 38254835 PMCID: PMC10814584 DOI: 10.3390/cancers16020346] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 01/08/2024] [Accepted: 01/11/2024] [Indexed: 01/24/2024] Open
Abstract
Lymphadenectomy is an essential part of complete surgical operation for non-small cell lung cancer (NSCLC). This retrospective, multicenter cohort study aimed to identify factors that influence the lymphadenectomy quality. Data were obtained from the Polish Lung Cancer Study Group Database. The primary endpoint was lobe-specific mediastinal lymph node dissection (L-SMLND). The study included 4271 patients who underwent VATS lobectomy for stage IA NSCLC, operated between 2007 and 2022. L-SMLND was performed in 1190 patients (27.9%). The remaining 3081 patients (72.1%) did not meet the L-SMLND criteria. Multivariate logistic regression analysis showed that patients with PET-CT (OR 3.238, 95% CI: 2.315 to 4.529; p < 0.001), with larger tumors (pT1a vs. pT1b vs. pT1c) (OR 1.292; 95% CI: 1.009 to 1.653; p = 0.042), and those operated on by experienced surgeons (OR 1.959, 95% CI: 1.432 to 2.679; p < 0.001) had a higher probability of undergoing L-SMLND. The quality of lymphadenectomy decreased over time (OR 0.647, 95% CI: 0.474 to 0.884; p = 0.006). An analysis of propensity-matched groups showed that more extensive lymph node dissection was not related to in-hospital mortality, complication rates, and hospitalization duration. Actions are needed to improve the quality of lymphadenectomy for NSCLC.
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Affiliation(s)
- Piotr Gabryel
- Department of Thoracic Surgery, Poznan University of Medical Sciences, Szamarzewskiego 62 Street, 60-569 Poznan, Poland
| | - Piotr Skrzypczak
- Department of Thoracic Surgery, Poznan University of Medical Sciences, Szamarzewskiego 62 Street, 60-569 Poznan, Poland
| | - Magdalena Roszak
- Department of Computer Science and Statistics, Poznan University of Medical Sciences, Rokietnicka 7 Street, 60-806 Poznan, Poland
| | - Alessio Campisi
- Department of Thoracic Surgery, University and Hospital Trust–Ospedale Borgo Trento, Piazzale Aristide Stefani 1, 37126 Verona, Italy
| | - Dominika Zielińska
- Department of Thoracic Surgery, Poznan University of Medical Sciences, Szamarzewskiego 62 Street, 60-569 Poznan, Poland
| | - Maciej Bryl
- Department of Thoracic Surgery, Poznan University of Medical Sciences, Szamarzewskiego 62 Street, 60-569 Poznan, Poland
| | - Katarzyna Stencel
- Department of Thoracic Surgery, Poznan University of Medical Sciences, Szamarzewskiego 62 Street, 60-569 Poznan, Poland
| | - Cezary Piwkowski
- Department of Thoracic Surgery, Poznan University of Medical Sciences, Szamarzewskiego 62 Street, 60-569 Poznan, Poland
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Grodzka A, Knopik-Skrocka A, Kowalska K, Kurzawa P, Krzyzaniak M, Stencel K, Bryl M. Molecular alterations of driver genes in non-small cell lung cancer: from diagnostics to targeted therapy. EXCLI J 2023; 22:415-432. [PMID: 37346803 PMCID: PMC10279966 DOI: 10.17179/excli2023-6122] [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] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 05/09/2023] [Indexed: 06/23/2023]
Abstract
Lung cancer is the leading cause of cancer death all over the world. The majority (80-85 %) of lung cancer cases are classified as non-small cell lung cancer (NSCLC). Within NSCLC, adenocarcinoma (AC) and squamous cell carcinoma (SCC) are the most often recognized. The histological and immunohistochemical examination of NSCLC is a basic diagnostic tool, but insufficient for comprehensive therapeutic decisions. In some NSCLC patients, mainly adenocarcinoma, molecular alterations in driver genes, like EGFR, KRAS, HER2, ALK, MET, BRAF, RET, ROS1, and NTRK are recognized. The frequency of some of those changes is different depending on race, and between smokers and non-smokers. The molecular diagnostics of NSCLC using modern methods, like next-generation sequencing, is essential in estimating targeted, personalized therapy. In recent years, a breakthrough in understanding the importance of molecular studies for the precise treatment of NSCLC has been observed. Many new drugs were approved, including tyrosine kinase and immune checkpoint inhibitors. Clinical trials testing novel molecules like miRNAs and trials with CAR-T cells (chimeric antigen receptor - T cells) dedicated to NSCLC patients are ongoing.
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Affiliation(s)
- Anna Grodzka
- Department of Cell Biology, Faculty of Biology, Adam Mickiewicz University of Poznan, Poland
| | | | - Katarzyna Kowalska
- Department of Oncological Pathology, University Clinical Hospital in Poznan, Poznan University of Medical Sciences, Poland
| | - Pawel Kurzawa
- Department of Oncological Pathology, University Clinical Hospital in Poznan, Poznan University of Medical Sciences, Poland
- Department of Clinical Pathology and Immunology, Poznan University of Medical Sciences, Poland
| | - Monika Krzyzaniak
- Department of Oncological Pathology, University Clinical Hospital in Poznan, Poznan University of Medical Sciences, Poland
| | - Katarzyna Stencel
- Department of Clinical Oncology with the Subdepartment of Diurnal Chemotherapy, E. J. Zeyland Wielkopolska Center of Pulmonology and Thoracic Surgery, Poznan, Poland
| | - Maciej Bryl
- Department of Clinical Oncology with the Subdepartment of Diurnal Chemotherapy, E. J. Zeyland Wielkopolska Center of Pulmonology and Thoracic Surgery, Poznan, Poland
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Stencel K, Langfort R, Ramlau R. The role of diagnostics and treatment — lung cancer with ALK rearrangement. Oncol Clin Pract 2021. [DOI: 10.5603/ocp.2020.0019] [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: 11/25/2022] Open
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Stencel K, Chmielewska I, Milanowski J, Ramlau R. Non-Small-Cell Lung Cancer: New Rare Targets-New Targeted Therapies-State of The Art and Future Directions. Cancers (Basel) 2021; 13:cancers13081829. [PMID: 33921237 PMCID: PMC8070470 DOI: 10.3390/cancers13081829] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 02/06/2021] [Revised: 04/03/2021] [Accepted: 04/06/2021] [Indexed: 12/22/2022] Open
Abstract
Lung cancer is the most common cause of cancer-related death worldwide, and the prognosis for stage IV remains poor. The presence of genetic alterations in tumor cells, such as EGFR and BRAF gene mutations, as well as ALK and ROS1 gene rearrangements, are indications for targeted therapies. Many such treatments are already registered and used on a wide scale. In comparison to standard chemotherapy, they can prolong not only progression-free survival but also overall survival. Moreover, they are able to provide excellent quality of life and rapid improvement of cancer-related symptoms such as dyspnea, cough and pain. Recent years have witnessed great advances in both molecular diagnostics and new molecular therapies for non-small-cell lung cancer. This review presents new therapeutic targets in NSCLC, as well as drugs of which the activity against NTRK, RET, MET or HER2 gene alterations (including EGFR exon 20 insertions) has either been confirmed or is currently being evaluated. Although these particular genetic alterations in NSCLC are generally rare, each accounting for 1-2% of patients, in total about half of all patients have molecular alterations and may ultimately receive targeted therapies.
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Affiliation(s)
- Katarzyna Stencel
- Oncology Clinic, Poznan University of Medical Sciences, 61-701 Poznań, Poland;
- Department of Chemotherapy, Clinical Hospital of Lord’s Transfiguration, 60-569 Poznan, Poland
- Correspondence:
| | - Izabela Chmielewska
- Chair and Department of Pneumonology, Oncology and Allergology, Medical University of Lublin, 20-059 Lublin, Poland; (I.C.); (J.M.)
| | - Janusz Milanowski
- Chair and Department of Pneumonology, Oncology and Allergology, Medical University of Lublin, 20-059 Lublin, Poland; (I.C.); (J.M.)
| | - Rodryg Ramlau
- Oncology Clinic, Poznan University of Medical Sciences, 61-701 Poznań, Poland;
- Department of Chemotherapy, Clinical Hospital of Lord’s Transfiguration, 60-569 Poznan, Poland
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Grenda A, Krawczyk P, Kucharczyk T, Błach J, Reszka K, Chmielewska I, Buczkowski J, Kieszko R, Siwiec J, Kubiatowski T, Bożyk A, Krukowska K, Jarosz B, Paśnik I, Pankowski J, Świniuch D, Stencel K, Gil M, Lew K, Ramlau R, Szczęsna A, Fidler S, Sieracki A, Każarnowicz A, Serwatowski P, Grodzki T, Milanowski J. Impact of copy number variant and single nucleotide polymorphism of the programmed death-ligand 1 gene, programmed death-ligand 1 protein expression and therapy regimens on overall survival in a large group of Caucasian patients with non-small cell lung carcinoma. Oncol Lett 2021; 21:449. [PMID: 33868487 PMCID: PMC8045160 DOI: 10.3892/ol.2021.12710] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 01/14/2021] [Indexed: 11/30/2022] Open
Abstract
Anti-programmed death-1 or anti-programmed death-ligand 1 (PD-L1) blockade may be ineffective in some patients with non-small cell lung cancer (NSCLC) with high percentage of tumor cells with PD-L1 expression. In addition, immunotherapy may provide great benefits in patients without PD-L1 expression. The present study assessed PD-L1 protein expression by immunohistochemistry, copy number variation (CNV) of PD-L1 and two single nucleotide polymorphisms (SNPs), rs822335 and rs822336, in the promoter of PD-L1 by quantitative PCR in 673 patients with NSCLC. Overall survival time of patients with NSCLC depending on the assessed predictive factors (PD-L1 CNV or SNP) and the treatment methods (immunotherapy in first/second line of treatment or chemotherapy) was analyzed. The present study revealed significantly higher PD-L1 copies number in patients with ≥10% and ≥50% of tumor cells with PD-L1 expression compared to patients with lower percentage of PD-L1-positive tumor cells (P=0.02 and P=0.0002, respectively). There was a significant positive correlation (R=0.2; P=0.01) between number of PD-L1 copies and percentage of tumor cells with PD-L1 protein expression. Percentage of tumor cells with PD-L1 expression was lower in patients with TT genotype of the rs822335 polymorphism compared to those with CC genotype (P=0.03). The present study observed significantly higher risk of death in patients treated with chemotherapy compared to those treated with immunotherapy (P<0.0001; hazard ratio=2.4768; 95% confidence interval, 2.0120–3.0490). The present study demonstrated a close relationship between PD-L1 copies number, genotype of rs822335 PD-L1 polymorphism and PD-L1 protein expression on tumor cells. However, the impact of CNV and SNPs of PD-L1 on overall survival of patients with NSCLC requires further investigation.
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Affiliation(s)
- Anna Grenda
- Chair and Department of Pneumology, Oncology and Allergology, Medical University of Lublin, 20-090 Lublin, Poland
| | - Paweł Krawczyk
- Chair and Department of Pneumology, Oncology and Allergology, Medical University of Lublin, 20-090 Lublin, Poland
| | - Tomasz Kucharczyk
- Chair and Department of Pneumology, Oncology and Allergology, Medical University of Lublin, 20-090 Lublin, Poland
| | - Justyna Błach
- Chair and Department of Pneumology, Oncology and Allergology, Medical University of Lublin, 20-090 Lublin, Poland
| | - Katarzyna Reszka
- Institute of Genetics and Immunology Genim LCC, 20-609 Lublin, Poland
| | - Izabela Chmielewska
- Chair and Department of Pneumology, Oncology and Allergology, Medical University of Lublin, 20-090 Lublin, Poland
| | - Jarosław Buczkowski
- Chair and Department of Pneumology, Oncology and Allergology, Medical University of Lublin, 20-090 Lublin, Poland
| | - Robert Kieszko
- Chair and Department of Pneumology, Oncology and Allergology, Medical University of Lublin, 20-090 Lublin, Poland
| | - Jan Siwiec
- Chair and Department of Pneumology, Oncology and Allergology, Medical University of Lublin, 20-090 Lublin, Poland
| | - Tomasz Kubiatowski
- Department of Clinical Oncology, Saint Jan of Dukla Oncology Centre of the Lublin Region, 20-090 Lublin, Poland
| | - Aleksandra Bożyk
- Chair and Department of Pneumology, Oncology and Allergology, Medical University of Lublin, 20-090 Lublin, Poland
| | - Kinga Krukowska
- Institute of Genetics and Immunology Genim LCC, 20-609 Lublin, Poland
| | - Bożena Jarosz
- Chair and Department of Neurosurgery and Paediatric Neurosurgery, Medical University of Lublin, 20-090 Lublin, Poland
| | - Iwona Paśnik
- Chair and Department of Clinical Pathomorphology, Medical University of Lublin, 20-090 Lublin, Poland
| | - Juliusz Pankowski
- Department of Pathology, Specialist Hospital for Lung Diseases 'Rebirth' Klara Jelska, 34-500 Zakopane, Poland
| | - Daria Świniuch
- Chair and Department of Clinical Oncology, Poznań University of Medical Sciences, 60-569 Poznań, Poland
| | - Katarzyna Stencel
- Chair and Department of Clinical Oncology, Poznań University of Medical Sciences, 60-569 Poznań, Poland
| | - Michał Gil
- Institute of Genetics and Immunology Genim LCC, 20-609 Lublin, Poland
| | - Kinga Lew
- Chair and Department of Pneumology, Oncology and Allergology, Medical University of Lublin, 20-090 Lublin, Poland
| | - Rodryg Ramlau
- Chair and Department of Clinical Oncology, Poznań University of Medical Sciences, 60-569 Poznań, Poland
| | - Aleksandra Szczęsna
- Department of Lung Diseases with Oncology Subdivision, Mazovian Center for the Treatment of Lung Diseases and Tuberculosis, 60-569 Otwock, Poland
| | - Sebastian Fidler
- Department of Oncology, Provincial Hospital Center of The Jeleniogórska Valley, 58-506 Jelenia Góra, Poland
| | - Andrzej Sieracki
- Department of Clinical Oncology, Independent Public Provincial Hospital Pope John Paul II in Zamość, 22-404 Zamość, Poland
| | - Andrzej Każarnowicz
- Department of Oncology, Chemotherapy Subdivision, Independent Public Group of Tuberculosis and Pulmonary Diseases in Olsztyn, 10-357 Olsztyn, Poland
| | - Piotr Serwatowski
- Department of Clinical Oncology and Chemotherapy, Pomeranian Medical University, 70-891 Szczecin, Poland
| | - Tomasz Grodzki
- Chair and Department of Thoracic Surgery, Pomeranian Medical University, 70-891 Szczecin, Poland
| | - Janusz Milanowski
- Chair and Department of Pneumology, Oncology and Allergology, Medical University of Lublin, 20-090 Lublin, Poland
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Rybarczyk-Kasiuchnicz A, Ramlau R, Stencel K. Treatment of Brain Metastases of Non-Small Cell Lung Carcinoma. Int J Mol Sci 2021; 22:ijms22020593. [PMID: 33435596 PMCID: PMC7826874 DOI: 10.3390/ijms22020593] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 12/28/2020] [Accepted: 12/30/2020] [Indexed: 02/07/2023] Open
Abstract
Lung cancer is one of the most common malignant neoplasms. As a result of the disease's progression, patients may develop metastases to the central nervous system. The prognosis in this location is unfavorable; untreated metastatic lesions may lead to death within one to two months. Existing therapies-neurosurgery and radiation therapy-do not improve the prognosis for every patient. The discovery of Epidermal Growth Factor Receptor (EGFR)-activating mutations and Anaplastic Lymphoma Kinase (ALK) rearrangements in patients with non-small cell lung adenocarcinoma has allowed for the introduction of small-molecule tyrosine kinase inhibitors to the treatment of advanced-stage patients. The Epidermal Growth Factor Receptor (EGFR) is a transmembrane protein with tyrosine kinase-dependent activity. EGFR is present in membranes of all epithelial cells. In physiological conditions, it plays an important role in the process of cell growth and proliferation. Binding the ligand to the EGFR causes its dimerization and the activation of the intracellular signaling cascade. Signal transduction involves the activation of MAPK, AKT, and JNK, resulting in DNA synthesis and cell proliferation. In cancer cells, binding the ligand to the EGFR also leads to its dimerization and transduction of the signal to the cell interior. It has been demonstrated that activating mutations in the gene for EGFR-exon19 (deletion), L858R point mutation in exon 21, and mutation in exon 20 results in cancer cell proliferation. Continuous stimulation of the receptor inhibits apoptosis, stimulates invasion, intensifies angiogenesis, and facilitates the formation of distant metastases. As a consequence, the cancer progresses. These activating gene mutations for the EGFR are present in 10-20% of lung adenocarcinomas. Approximately 3-7% of patients with lung adenocarcinoma have the echinoderm microtubule-associated protein-like 4 (EML4)/ALK fusion gene. The fusion of the two genes EML4 and ALK results in a fusion gene that activates the intracellular signaling pathway, stimulates the proliferation of tumor cells, and inhibits apoptosis. A new group of drugs-small-molecule tyrosine kinase inhibitors-has been developed; the first generation includes gefitinib and erlotinib and the ALK inhibitor crizotinib. These drugs reversibly block the EGFR by stopping the signal transmission to the cell. The second-generation tyrosine kinase inhibitor (TKI) afatinib or ALK inhibitor alectinib block the receptor irreversibly. Clinical trials with TKI in patients with non-small cell lung adenocarcinoma with central nervous system (CNS) metastases have shown prolonged, progression-free survival, a high percentage of objective responses, and improved quality of life. Resistance to treatment with this group of drugs emerging during TKI therapy is the basis for the detection of resistance mutations. The T790M mutation, present in exon 20 of the EGFR gene, is detected in patients treated with first- and second-generation TKI and is overcome by Osimertinib, a third-generation TKI. The I117N resistance mutation in patients with the ALK mutation treated with alectinib is overcome by ceritinib. In this way, sequential therapy ensures the continuity of treatment. In patients with CNS metastases, attempts are made to simultaneously administer radiation therapy and tyrosine kinase inhibitors. Patients with lung adenocarcinoma with CNS metastases, without activating EGFR mutation and without ALK rearrangement, benefit from immunotherapy. This therapeutic option blocks the PD-1 receptor on the surface of T or B lymphocytes or PD-L1 located on cancer cells with an applicable antibody. Based on clinical trials, pembrolizumab and all antibodies are included in the treatment of non-small cell lung carcinoma with CNS metastases.
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Stencel K, Świniuch D, Ramlau R. LECZENIE UKIERUNKOWANE MOLEKULARNIE CHORYCH NA NIEDROBNOKOMÓRKOWEGO RAKA PŁUCA. Oncol Clin Pract 2020. [DOI: 10.5603/ocp.2019.0025] [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: 11/25/2022] Open
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Nietupski KE, Kulik A, Wiechno P, Demkow T, Peczkowski P, Pilichowska M, Poniatowska GM, Michalski W, Rzymkowska J, Sadowska M, Ligaj M, Kucharz J, Jonska-Gmyrek J, Wieczorek E, Stencel K. The prospective assessment of the prostatic cancer mortality with PSA progression in the groups treated or not treated by salvage local brachytherapy. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.6_suppl.85] [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
85 Background: The effectiveness of diagnostics of local recurrence of prostatic adenocarcinoma after radical radiotherapy and local retreatment high definition brachytherapy and its influence on the prostatic cancer survival. Methods: 55 patients with locally advanced prostatic adenocarcinoma with rising PSA level after radical radiotherapy and exclusion of distant metastases underwent prostatic biopsy. ECOG performance status 0-1 were eligible. The histopathological confirmation was obtained in 22 cases, and 33 patients had negative biopsy. In the case of positive biopsy radical salvage brachytherapy was performed in all patients. In the case of negative biopsy definitive anti-androgen therapy was administered in patients with PSA progression. Anti – androgen therapy was performed as adjuvant and neoadjuvant treatment after brachytherapy. In the course of the long (median 108months) observation we assessed prostatic specific mortality in both groups. In addition we assessed time to PSA progression during the antiandrogen therapy Results: From Mar 2002 we observed 55 patients with rising PSA after radical radiotherapy for the prostatic adenocarcinoma. We confirmed local recurrence of prostatic adenocarcinoma in 22 cases. The median time to biopsy after radiotherapy was 41months. The median observation time after post-radiotherapy biopsy was 108 months. All of the 22 patients were treated with salvage brachytherapy. There were 8 prostatic cancer specific deaths, 1 in the group treated by brachytherapy and 7 in the non-treated group. Median prostatic cancer survival (PCSOS) was 120 months in the treated group vs 75,6 months non-treated, but this difference was not statistically significant (P value 0,49). Median time to progression PSA was 108 months in the treated group vs 48 months non-treated and was not statistically significant. Significant toxicity were not reported. Conclusions: In long time observation we revealed, including the time of antiandrogen treatment depletion therapy, that in the patients with rising PSA and local recurrence treated with high-dose brachytherapy have no worse prognosis than patients with no local progression.
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Affiliation(s)
| | - Anna Kulik
- Centrum Onkologii -Instytut, Warszawa, Warsaw, Poland
| | - Pawel Wiechno
- Centrum Onkologii -Instytut, Warszawa, Warsaw, Poland
| | - Tomasz Demkow
- Centrum Onkologii-Instytut im Sklodowskiej-Curie, Warsaw, Poland
| | | | | | | | | | | | | | - Marcin Ligaj
- Centrum Onkologii -Instytut, Warszawa, Warsaw, Poland
| | - Jakub Kucharz
- Krakow University Hospital Department of Oncology, Krakow, Poland
| | | | - Ewa Wieczorek
- Centrum Onkologii -Instytut, Warszawa, Warsaw, Poland
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Ramlau R, Krawczyk P, Dziadziuszko R, Chmielewska I, Milanowski J, Olszewski W, Stencel K, Ramlau-Piątek K, Segiet A, Skroński M, Grudny J, Chorostowska-Wynimko J. Predictors of EGFR mutation and factors associated with clinical tumor stage at diagnosis: Experience of the INSIGHT study in Poland. Oncol Lett 2017; 14:5611-5618. [PMID: 29113190 DOI: 10.3892/ol.2017.6907] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 02/24/2017] [Accepted: 08/03/2017] [Indexed: 12/20/2022] Open
Abstract
Targeted therapy of non-small cell lung cancer (NSCLC) patients with mutations in the epidermal growth factor receptor (EGFR) gene has been associated with improved prognosis. However, there is a shortage on data from real-world clinical practice in management of EGFR-positive NSCLC patients in Poland. The present study retrospectively analyzed data from the INSIGHT study to evaluate the incidence and clinical management of EGFR-positive NSCLC in Poland. The authors additionally aimed to identify predictors of the EGFR mutation and factors associated with clinical stage of the tumor at diagnosis. Incidence of EGFR mutations was 11.8% and the most common mutations were a deletion on exon 19 and an L858R substitution on exon 21. Mutations were strongly associated with female gender [male vs. female odds ratio (OR): 0.51; P=0.004] and never having smoked (current/past smoker vs. never smoked OR: 0.16; P<0.001), and advanced clinical stage (stage IV vs. stage I/II OR: 2.89; P=0.029). Patients with EGFR mutation were also observed to have a greater propensity to develop bone metastasis (OR: 11.62; P=0.008). Multivariate regression analysis demonstrated that patients with past or current smoking history or a poor performance on the Eastern Cooperative Oncology Group (ECOG) scale were less likely to have the EGFR mutation. Furthermore, EGFR-positive patients with greater ECOG scores and a tumor other than adenocarcinoma or squamous cell carcinoma were more likely to present advanced tumors. Early screening for EGFR mutation and the use of EGFR-targeting therapies as first-line agents may lead to better prognosis and successful clinical management of EGFR-positive NSCLC patients.
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Affiliation(s)
- Rodryg Ramlau
- Department of Oncology, Poznan University of Medical Sciences, 60-569 Poznan, Poland
| | - Paweł Krawczyk
- Department of Pneumology, Oncology and Allergology, Medical University of Lublin, 20-954 Lublin, Poland
| | - Rafał Dziadziuszko
- Department of Oncology and Radiotherapy, Medical University of Gdansk, 80-211 Gdansk, Poland
| | - Izabela Chmielewska
- Department of Pneumology, Oncology and Allergology, Medical University of Lublin, 20-954 Lublin, Poland
| | - Janusz Milanowski
- Department of Pneumology, Oncology and Allergology, Medical University of Lublin, 20-954 Lublin, Poland
| | | | - Katarzyna Stencel
- Department of Chemotherapy, Poznan University of Medical Sciences, 60-569 Poznan, Poland
| | | | - Agnieszka Segiet
- First Faculty of Medicine, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Michał Skroński
- Department of Genetics and Clinical Immunology, National Institute of Tuberculosis and Lung Diseases, 01-138 Warsaw, Poland
| | - Jacek Grudny
- III Department of Lung Diseases, National Institute of Tuberculosis and Lung Diseases, 01-138 Warsaw, Poland
| | - Joanna Chorostowska-Wynimko
- Department of Genetics and Clinical Immunology, National Institute of Tuberculosis and Lung Diseases, 01-138 Warsaw, Poland
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Krawczyk P, Kowalski DM, Ramlau R, Kalinka-Warzocha E, Winiarczyk K, Stencel K, Powrózek T, Reszka K, Wojas-Krawczyk K, Bryl M, Wójcik-Superczyńska M, Głogowski M, Barinow-Wojewódzki A, Milanowski J, Krzakowski M. Comparison of the effectiveness of erlotinib, gefitinib, and afatinib for treatment of non-small cell lung cancer in patients with common and rare EGFR gene mutations. Oncol Lett 2017; 13:4433-4444. [PMID: 28599445 DOI: 10.3892/ol.2017.5980] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [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: 10/26/2016] [Accepted: 01/04/2017] [Indexed: 11/06/2022] Open
Abstract
Epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) are routinely used to treat non-small cell lung cancer (NSCLC) in patients with common activating mutations of the EGFR gene. The aim of the study was to compare the efficacies of EGFR-TKIs in patients with common (exon 19 deletions and exon 21 p.Leu858Arg) and rare EGFR mutations. A retrospective analysis of 180 NSCLC patients with common (n=167) and rare (n=13) EGFR mutations treated with erlotinib (n=98), gefitinib (n=66) and afatinib (n=16) was performed. EGFR mutations were determined using RT-PCR and the EntroGen EGFR Mutations Analysis kit. Partial and complete response (PR and CR), progression-free survival (PFS), and overall survival (OS) were analyzed. Demographic and clinical factors had no impact on PFS or OS in patients treated with EGFR-TKIs. Erlotinib, gefitinib, and afatinib showed similar efficacies based on treatment response, median PFS, and OS. The type of EGFR mutation had no impact on median OS; however, median PFS was significantly longer in patients with the exon 19 deletion compared to patients with the exon 21 p.Leu858Arg substitution and rare EGFR gene mutations (P=0.013). Patients with common EGFR mutations showed significantly longer median PFS than those with rare EGFR mutations (10 vs. 5 months; P=0.009). Erlotinib, gefitinib, and afatinib show similar efficacies in NSCLC patients with both common and rare EGFR mutations. When undergoing EGFR-TKI treatment, patients with rare EGFR mutations showed similar OS but poorer PFS. Further investigation into the associations between particular rare EGFR mutations and EGFR-TKIs treatment outcomes is required.
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Affiliation(s)
- Pawel Krawczyk
- Department of Pneumonology, Oncology and Allergology, Medical University of Lublin, 20-954 Lublin, Poland
| | - Dariusz M Kowalski
- Department of Lung Cancer and Chest Tumours, The Maria Skłodowska-Curie Memorial Cancer Center and Institute, 02-034 Warsaw, Poland
| | - Rodryg Ramlau
- Department of Clinical Oncology, Poznan University of Medical Science, 60-569 Poznan, Poland
| | | | - Kinga Winiarczyk
- Department of Lung Cancer and Chest Tumours, The Maria Skłodowska-Curie Memorial Cancer Center and Institute, 02-034 Warsaw, Poland
| | - Katarzyna Stencel
- Department of Clinical Oncology, Poznan University of Medical Science, 60-569 Poznan, Poland
| | - Tomasz Powrózek
- Department of Pneumonology, Oncology and Allergology, Medical University of Lublin, 20-954 Lublin, Poland
| | - Katarzyna Reszka
- GENIM Ltd. Institute of Genetics and Immunology, 20-609 Lublin, Poland
| | - Kamila Wojas-Krawczyk
- Department of Pneumonology, Oncology and Allergology, Medical University of Lublin, 20-954 Lublin, Poland
| | - Maciej Bryl
- E.J. Zeyland Wielkopolska Center of Pulmonology and Thoracic Surgery, 60-101 Poznan, Poland
| | | | - Maciej Głogowski
- Department of Lung Cancer and Chest Tumours, The Maria Skłodowska-Curie Memorial Cancer Center and Institute, 02-034 Warsaw, Poland
| | | | - Janusz Milanowski
- Department of Pneumonology, Oncology and Allergology, Medical University of Lublin, 20-954 Lublin, Poland
| | - Maciej Krzakowski
- Department of Lung Cancer and Chest Tumours, The Maria Skłodowska-Curie Memorial Cancer Center and Institute, 02-034 Warsaw, Poland
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Huczyński A, Markowska J, Sajdak S, Szubert S, Stencel K. Salinomycin – a breakthrough in the treatment of ovarian cancer? ACTA ACUST UNITED AC 2016. [DOI: 10.15557/cgo.2016.0018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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13
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Quesenberry PJ, Stewart FM, Becker P, D'Hondt L, Frimberger A, Lambert JF, Colvin GA, Miller C, Heyes C, Abedi M, Dooner M, Carlson J, Reilly J, McAuliffe C, Stencel K, Ballen K, Emmons R, Doyle P, Zhong S, Wang H, Habibian H. Stem cell engraftment strategies. Ann N Y Acad Sci 2001; 938:54-61; discussion 61-2. [PMID: 11458526 DOI: 10.1111/j.1749-6632.2001.tb03574.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The donor stem cell phenotype and host microenvironment determine the outcome of a stem cell transplant. In a series of transplant studies in syngeneic male to female or congenic Ly5.1/Ly5.2 models in which hosts have received no or minimal irradiation (100 cGy), evidence overwhelmingly supports the concept that syngeneic engraftment is determined by stem cell competition. These approaches can be extended to H-2 mismatched allogeneic mouse combination when antigen pre-exposure and CD40-CD40 ligand antibody blockage are employed. A human trial in patients with resistant neoplasia infusing pheresed blood with 10(8) CD3 cells/kg showed that tumor responses and complete chimerism occur with very low levels of CD34+ cells/kg and that the extent of previous treatment is a critical factor in determining chimerism. A major feature of transplants is the phenotype of the donor stem cell. This phenotype shows dramatic reversible plasticity involving differentiation, adhesion protein expression, and engraftment with cytokine-induced cell-cycle transit. Homing is probably also plastic. Marked fluctuations in engraftment capacity are also seen at different points in marrow circadian rhythm.
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Affiliation(s)
- P J Quesenberry
- Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts 01655, USA
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