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Nishioka N, Imai H, Endo M, Notsu A, Doshita K, Igawa S, Yokouchi H, Ninomiya T, Tokito T, Soda S, Fujiwara T, Asao T, Nakamichi S, Kawamura T, Inomata M, Nakashima K, Ito K, Goto Y, Umeda Y, Hirai S, Ushio R, Yokoo K, Takeda T, Fukui T, Ishihara M, Osaki T, Kubo S, Fujiwara T, Yamamoto C, Tsuda T, Tamura N, Hosokawa S, Chihara Y, Ikeda S, Furuya N, Nakahara Y, Miura S, Okamoto H. Real-World Data on Subsequent Therapy for First-Line Osimertinib-Induced Pneumonitis: Safety of EGFR-TKI Rechallenge (Osi-risk Study TORG-TG2101). Target Oncol 2024:10.1007/s11523-024-01048-x. [PMID: 38613731 DOI: 10.1007/s11523-024-01048-x] [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] [Accepted: 03/04/2024] [Indexed: 04/15/2024]
Abstract
BACKGROUND Although osimertinib is a promising therapeutic agent for advanced epidermal growth factor receptor (EGFR) mutation-positive lung cancer, the incidence of pneumonitis is particularly high among Japanese patients receiving the drug. Furthermore, the safety and efficacy of subsequent anticancer treatments, including EGFR-tyrosine kinase inhibitor (TKI) rechallenge, which are to be administered after pneumonitis recovery, remain unclear. OBJECTIVE This study investigated the safety of EGFR-TKI rechallenge in patients who experienced first-line osimertinib-induced pneumonitis, with a primary focus on recurrent pneumonitis. PATIENTS AND METHODS We retrospectively reviewed the data of patients with EGFR mutation-positive lung cancer who developed initial pneumonitis following first-line osimertinib treatment across 34 institutions in Japan between August 2018 and September 2020. RESULTS Among the 124 patients included, 68 (54.8%) patients underwent EGFR-TKI rechallenge. The recurrence rate of pneumonitis following EGFR-TKI rechallenge was 27% (95% confidence interval [CI] 17-39) at 12 months. The cumulative incidence of recurrent pneumonitis was significantly higher in the osimertinib group than in the first- and second-generation EGFR-TKI (conventional EGFR-TKI) groups (hazard ratio [HR] 3.1; 95% CI 1.3-7.5; p = 0.013). Multivariate analysis revealed a significant association between EGFR-TKI type (osimertinib or conventional EGFR-TKI) and pneumonitis recurrence, regardless of severity or status of initial pneumonitis (HR 3.29; 95% CI 1.12-9.68; p = 0.03). CONCLUSIONS Osimertinib rechallenge after initial pneumonitis was associated with significantly higher recurrence rates than conventional EGFR-TKI rechallenge.
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Affiliation(s)
- Naoya Nishioka
- Division of Thoracic Oncology, Shizuoka Cancer Center, Shizuoka, Japan
- Department of Pulmonary Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
- Department of Respiratory Medicine, Fukuchiyama City Hospital, Kyoto, Japan
| | - Hisao Imai
- Department of Respiratory Medicine, Comprehensive Cancer Center, International Medical Center, Saitama Medical University, Yamane 1397-1, Hidaka City, Saitama, Japan.
| | - Masahiro Endo
- Division of Thoracic Oncology, Shizuoka Cancer Center, Shizuoka, Japan
- Division of Diagnostic Radiology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Akifumi Notsu
- Division of Clinical Research Center, Shizuoka Cancer Center, Shizuoka, Japan
| | - Kosei Doshita
- Division of Thoracic Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Satoshi Igawa
- Department of Respiratory Medicine, Kitasato University School of Medicine, Kanagawa, Japan
| | - Hiroshi Yokouchi
- Department of Respiratory Medicine, NHO Hokkaido Cancer Center, Hokkaido, Japan
| | - Takashi Ninomiya
- Department of Thoracic Oncology and Medicine, NHO Shikoku Cancer Center, Matsuyama, Ehime, Japan
| | - Takaaki Tokito
- Division of Respirology, Neurology, and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, Fukuoka, Japan
| | - Sayo Soda
- Department of Pulmonary and Clinical Immunology, Dokkyo Medical University School of Medicine, Tohigi, Japan
| | - Takasato Fujiwara
- Department of Respiratory Internal Medicine, Yokosuka Kyosai Hospital, Kanagawa, Japan
| | - Tetsuhiko Asao
- Department of Respiratory Medicine, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Shinji Nakamichi
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Takahisa Kawamura
- Department of Thoracic Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Minehiko Inomata
- 1st Department of Internal Medicine, Toyama University Hospital, Toyama, Japan
| | - Kazuhisa Nakashima
- Division of Medical Oncology and Respiratory Medicine, Department of Internal Medicine, Faculty of Medicine, Shimane University, Shimane, Japan
| | - Kentaro Ito
- Respiratory Center, Matsusaka Municipal Hospital, Mie, Japan
| | - Yasuhiro Goto
- Department of Respiratory Medicine, Fujita Health University School of Medicine, Aichi, Japan
| | - Yukihiro Umeda
- Third Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Soichi Hirai
- Department of Pulmonary Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Ryota Ushio
- Department of Thoracic Oncology, Kanagawa Cancer Center, Kanagawa, Japan
| | - Keiki Yokoo
- Department of Respiratory Medicine, Teine Keijinkai Hospital, Hokkaido, Japan
| | - Takayuki Takeda
- Department of Respiratory Medicine, Japanese Red Cross Kyoto Daini Hospital, Kyoto, Japan
| | - Tomoya Fukui
- Department of Respiratory Medicine, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Masashi Ishihara
- Division of Medical Oncology, Department of Internal Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Takashi Osaki
- Department of Respiratory Medicine, Shibukawa Medical Center, Gunma, Japan
| | - Sousuke Kubo
- Department of Pulmonology, Yokohama City University Graduate School of Medicine, Kanagawa, Japan
| | - Takumi Fujiwara
- Department of Genomic Medicine, Mie University Hospital, Mie, Japan
| | - Chie Yamamoto
- Department of Respiratory Medicine, Fukuchiyama City Hospital, Kyoto, Japan
| | - Takeshi Tsuda
- Division of Respiratory Medicine, Toyama Prefectural Central Hospital, Toyama, Japan
| | - Nobumasa Tamura
- Division of Respiratory Diseases, Department of Internal Medicine, Atsugi City Hospital, Kanagawa, Japan
| | - Shinobu Hosokawa
- Department of Respiratory Medicine, Japanese Red Cross Okayama Hospital, Okayama, Japan
| | - Yusuke Chihara
- Department of Respiratory Medicine, Uji-Tokushukai Medical Center, Kyoto, Japan
| | - Satoshi Ikeda
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Kanagawa, Japan
| | - Naoki Furuya
- Division of Respiratory Medicine, Department of Internal Medicine, St Marianna University School of Medicine, Kanagawa, Japan
| | - Yoshiro Nakahara
- Department of Respiratory Medicine, Kitasato University School of Medicine, Kanagawa, Japan
| | - Satoru Miura
- Department of Internal Medicine, Niigata Cancer Center Hospital, Niigata, Japan
| | - Hiroaki Okamoto
- Department of Respiratory Medicine, Yokohama Municipal Citizen's Hospital, Yokohama, Kanagawa, Japan
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2
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Iida Y, Wakuda K, Kenmotsu H, Doshita K, Kodama H, Nishioka N, Miyawaki E, Miyawaki T, Mamesaya N, Kobayashi H, Omori S, Ko R, Ono A, Naito T, Murakami H, Sugino T, Gon Y, Takahashi T. Efficacy of second-line chemotherapy in patients with pulmonary large cell neuroendocrine carcinoma. Sci Rep 2024; 14:7641. [PMID: 38561461 PMCID: PMC10984918 DOI: 10.1038/s41598-024-58327-w] [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: 05/18/2023] [Accepted: 03/27/2024] [Indexed: 04/04/2024] Open
Abstract
The efficacy of second-line chemotherapy in patients with pulmonary large cell neuroendocrine carcinoma (LCNEC) is unclear. This study aimed to evaluate the efficacy of second-line chemotherapy in patients with pulmonary LCNEC. We retrospectively reviewed patients with pulmonary LCNEC or possible LCNEC (pLCNEC) who received platinum-based chemotherapy as the first-line treatment. Among these patients, we evaluated the efficacy of second-line treatment by comparing patients with small cell lung cancer (SCLC group). Of the 61 patients with LCNEC or pLCNEC (LCNEC group) who received first-line chemotherapy, 39 patients were treated with second-line chemotherapy. Among the 39 patients, 61.5% received amrubicin monotherapy. The median progression-free survival (PFS) and overall survival (OS) in the LCNEC groups were 3.3 and 8.3 months, respectively. No significant differences in the PFS (hazard ratio [HR]: 0.924, 95% confidence interval [CI] 0.647-1.320; P = 0.664) and OS (HR: 0.926; 95% CI 0.648-1.321; P = 0.670) were observed between the LCNEC and SCLC groups. In patients treated with amrubicin, the PFS (P = 0.964) and OS (P = 0.544) were not different between both the groups. Second-line chemotherapy, including amrubicin, may be considered as a treatment option for patients with pulmonary LCNEC.
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Affiliation(s)
- Yuko Iida
- Division of Thoracic Oncology, Shizuoka Cancer Center, Shizuoka, Japan
- Division of Respiratory Medicine, Department of Internal Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Kazushige Wakuda
- Division of Thoracic Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | | | - Kosei Doshita
- Division of Thoracic Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Hiroaki Kodama
- Division of Thoracic Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Naoya Nishioka
- Division of Thoracic Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Eriko Miyawaki
- Division of Thoracic Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Taichi Miyawaki
- Division of Thoracic Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Nobuaki Mamesaya
- Division of Thoracic Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Haruki Kobayashi
- Division of Thoracic Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Shota Omori
- Division of Thoracic Oncology, Shizuoka Cancer Center, Shizuoka, Japan
- Respiratory Medicine and Infectious Diseases, Oita University Faculty of Medicine, Oita, Japan
| | - Ryo Ko
- Division of Thoracic Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Akira Ono
- Division of Thoracic Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Tateaki Naito
- Division of Thoracic Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Haruyasu Murakami
- Division of Thoracic Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Takashi Sugino
- Division of Pathology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Yasuhiro Gon
- Division of Respiratory Medicine, Department of Internal Medicine, Nihon University School of Medicine, Tokyo, Japan
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3
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Iida Y, Wakuda K, Kawata T, Morita M, Sekikawa M, Doshita K, Yabe M, Kodama H, Miura K, Morikawa N, Mamesaya N, Kobayashi H, Ko R, Ono A, Kenmotsu H, Naito T, Murakami H, Gon Y, Takahashi T. Relationship between patterns of immunohistochemical conventional neuroendocrine markers and efficacy of immune check point inhibitors in patients with extensive disease small cell lung cancer. Thorac Cancer 2024; 15:477-485. [PMID: 38243641 PMCID: PMC10883854 DOI: 10.1111/1759-7714.15218] [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: 11/16/2023] [Revised: 12/28/2023] [Accepted: 12/29/2023] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND Which patients benefit from the addition of immune checkpoint inhibitors (ICIs) to chemotherapy for small cell lung cancer (SCLC) remains unclear. There have been few reports on the efficacy of ICIs based on conventional immunohistochemical neuroendocrine (NE) markers (synaptophysin, chromogranin A, and neural cell adhesion molecule [NCAM]). In the present study, we aimed to analyze the relationship between the expression of immunohistochemical NE markers and the efficacy of ICIs in patients with extensive disease (ED)-SCLC, to assess whether conventional NE markers are predictive of ICIs. METHODS Patients with untreated ED-SCLC who received first-line therapy at the Shizuoka Cancer Center between November 2002 and July 2021 were retrospectively reviewed. We evaluated the efficacy of first-line chemotherapy according to the expression status of each immunohistochemical NE marker in patients treated with ICI plus chemotherapy (ICI-chemo group) and with chemotherapy alone (chemo group). RESULTS A total of 227 patients were included in the ICI-chemo and chemo groups, respectively. The progression-free survival (PFS) tended to be better in patients in the ICI-chemo group than those treated with chemotherapy alone in patients with NE marker-positive SCLC. In particular, it was statistically significant in patients with chromogranin A-positive SCLC (p = 0.036). In patients with NE marker-negative SCLC, no significant differences were observed in PFS between the two groups. There were no significant differences in overall survival (OS), regardless of the expression of any conventional NE marker. CONCLUSION Our study suggests that the efficacy of ICIs in addition to chemotherapy may be poor in patients with NE marker-negative SCLC.
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Affiliation(s)
- Yuko Iida
- Division of Thoracic OncologyShizuoka Cancer CenterShizuokaJapan
- Division of Respiratory Medicine, Department of Internal MedicineNihon University School of MedicineTokyoJapan
| | - Kazushige Wakuda
- Division of Thoracic OncologyShizuoka Cancer CenterShizuokaJapan
| | - Takuya Kawata
- Division of PathologyShizuoka Cancer CenterShizuokaJapan
| | - Meiko Morita
- Division of Thoracic OncologyShizuoka Cancer CenterShizuokaJapan
| | - Motoki Sekikawa
- Division of Thoracic OncologyShizuoka Cancer CenterShizuokaJapan
| | - Kosei Doshita
- Division of Thoracic OncologyShizuoka Cancer CenterShizuokaJapan
| | - Michitoshi Yabe
- Division of Thoracic OncologyShizuoka Cancer CenterShizuokaJapan
| | - Hiroaki Kodama
- Division of Thoracic OncologyShizuoka Cancer CenterShizuokaJapan
| | - Keita Miura
- Division of Thoracic OncologyShizuoka Cancer CenterShizuokaJapan
| | - Noboru Morikawa
- Division of Thoracic OncologyShizuoka Cancer CenterShizuokaJapan
| | - Nobuaki Mamesaya
- Division of Thoracic OncologyShizuoka Cancer CenterShizuokaJapan
| | - Haruki Kobayashi
- Division of Thoracic OncologyShizuoka Cancer CenterShizuokaJapan
| | - Ryo Ko
- Division of Thoracic OncologyShizuoka Cancer CenterShizuokaJapan
| | - Akira Ono
- Division of Thoracic OncologyShizuoka Cancer CenterShizuokaJapan
| | | | - Tateaki Naito
- Division of Thoracic OncologyShizuoka Cancer CenterShizuokaJapan
| | | | - Yasuhiro Gon
- Division of Respiratory Medicine, Department of Internal MedicineNihon University School of MedicineTokyoJapan
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4
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Wakuda K, Morita M, Sekikawa M, Morikawa N, Miura K, Doshita K, Iida Y, Kodama H, Mamesaya N, Kobayashi H, Ko R, Ono A, Kenmotsu H, Naito T, Murakami H, Muramatsu K, Kawata T, Mori K, Shimizu T, Gon Y, Takahashi T. Concordance of ALK fusion gene-rearrangement between immunohistochemistry and next-generation sequencing. Int J Clin Oncol 2024; 29:96-102. [PMID: 38183554 DOI: 10.1007/s10147-023-02451-6] [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: 08/22/2023] [Accepted: 11/24/2023] [Indexed: 01/08/2024]
Abstract
BACKGROUND Although various companion diagnostic tests of ALK fusion gene-rearrangement are approved, few reports have assessed the concordance of ALK fusion gene-rearrangement in two companion diagnostic tests: next-generation sequencing (NGS) testing and immunohistochemistry (IHC). METHODS The samples evaluated for gene alterations using NGS testing between May 2019 and November 2021 were included in this study. The inclusion criteria were as follows: samples were diagnosed with non-small cell lung cancer; the results of the NGS analysis were informative; and samples had residual specimens for IHC. We performed IHC on the residual specimens and retrospectively collected sample characteristics from medical records. RESULTS A total of 185 samples were analyzed using NGS. Twenty-six samples were excluded because of failure to analyze gene alterations using NGS, no residual samples, and inadequate IHC. We analyzed 159 samples. The major histological type was adenocarcinoma (115 samples). The number of surgical and transbronchial lung biopsy specimens was 59 and 56, respectively. ALK fusion gene-rearrangement was detected in four samples using NGS, and five were detected using IHC. The sensitivity and specificity of IHC referred to by NGS were 75.0% and 98.7%, respectively. The concordance rate between IHC and NGS was 98.1%. ALK rearrangement was detected in two patients using IHC but not using NGS. In addition, ALK rearrangement was detected in one patient using NGS but not using IHC. CONCLUSION Our results suggest that IHC and NGS might be complementary tests. In patients suspected of harboring ALK fusion gene-rearrangement, it should be analyzed using another diagnostic method.
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Affiliation(s)
- Kazushige Wakuda
- Division of Thoracic Oncology, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Suntou-gun, Shizuoka, 411-8777, Japan.
| | - Meiko Morita
- Division of Thoracic Oncology, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Suntou-gun, Shizuoka, 411-8777, Japan
| | - Motoki Sekikawa
- Division of Thoracic Oncology, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Suntou-gun, Shizuoka, 411-8777, Japan
| | - Noboru Morikawa
- Division of Thoracic Oncology, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Suntou-gun, Shizuoka, 411-8777, Japan
| | - Keita Miura
- Division of Thoracic Oncology, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Suntou-gun, Shizuoka, 411-8777, Japan
| | - Kosei Doshita
- Division of Thoracic Oncology, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Suntou-gun, Shizuoka, 411-8777, Japan
| | - Yuko Iida
- Division of Thoracic Oncology, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Suntou-gun, Shizuoka, 411-8777, Japan
| | - Hiroaki Kodama
- Division of Thoracic Oncology, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Suntou-gun, Shizuoka, 411-8777, Japan
| | - Nobuaki Mamesaya
- Division of Thoracic Oncology, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Suntou-gun, Shizuoka, 411-8777, Japan
| | - Haruki Kobayashi
- Division of Thoracic Oncology, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Suntou-gun, Shizuoka, 411-8777, Japan
| | - Ryo Ko
- Division of Thoracic Oncology, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Suntou-gun, Shizuoka, 411-8777, Japan
| | - Akira Ono
- Division of Thoracic Oncology, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Suntou-gun, Shizuoka, 411-8777, Japan
| | - Hirotsugu Kenmotsu
- Division of Thoracic Oncology, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Suntou-gun, Shizuoka, 411-8777, Japan
| | - Tateaki Naito
- Division of Thoracic Oncology, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Suntou-gun, Shizuoka, 411-8777, Japan
| | - Haruyasu Murakami
- Division of Thoracic Oncology, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Suntou-gun, Shizuoka, 411-8777, Japan
| | - Koji Muramatsu
- Division of Pathology, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Suntou-gun, Shizuoka, 411-8777, Japan
| | - Takuya Kawata
- Division of Pathology, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Suntou-gun, Shizuoka, 411-8777, Japan
| | - Keita Mori
- Department of Biostatistics, Clinical Research Support Center, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo Nagaizumi-cho Suntou-gun, Shizuoka, 411-8777, Japan
| | - Tetsuo Shimizu
- Division of Respiratory Medicine, Nihon University School of Medicine, 30-1 Ohyaguchi-Kamicho, Itabashiku, Tokyo, 173-8610, Japan
| | - Yasuhiro Gon
- Division of Respiratory Medicine, Nihon University School of Medicine, 30-1 Ohyaguchi-Kamicho, Itabashiku, Tokyo, 173-8610, Japan
| | - Toshiaki Takahashi
- Division of Thoracic Oncology, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Suntou-gun, Shizuoka, 411-8777, Japan
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5
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Sekikawa M, Murakami H, Morita M, Doshita K, Miura K, Kodama H, Morikawa N, Iida Y, Mamesaya N, Kobayashi H, Ko R, Wakuda K, Ono A, Kenmotsu H, Naito T, Chiba H, Takahashi T. Safety and efficacy of amrubicin with primary prophylactic pegfilgrastim as second-line chemotherapy in patients with small cell lung cancer. Thorac Cancer 2023; 14:3475-3482. [PMID: 37873674 PMCID: PMC10719656 DOI: 10.1111/1759-7714.15140] [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: 09/19/2023] [Revised: 10/06/2023] [Accepted: 10/09/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND Amrubicin (AMR) regimens have shown efficacy as second-line treatment in patients with small cell lung cancer (SCLC); however, adverse events such as febrile neutropenia (FN) sometimes preclude their use. Further, the safety and efficacy of AMR with primary prophylactic pegfilgrastim (P-PEG) have not been sufficiently evaluated. In this study, we evaluated the safety and efficacy of AMR with or without P-PEG as second-line chemotherapy for SCLC. METHODS We retrospectively reviewed patients with SCLC who received AMR as second-line chemotherapy at Shizuoka Cancer Center, between December 2014 and November 2021. Based on presence/absence of P-PEG in their regimen, patients (n = 60) were divided into P-PEG (n = 21) and non-P-PEG groups, and their clinical outcomes were evaluated. RESULTS Median of AMR treatment cycles was five (range: 1-39 cycles) in P-PEG group and four (range: 1-15 cycles) in non-P-PEG group. The incidence of FN (4.8% vs. 30.8%; p = 0.02) and AMR dose reduction because of adverse events (4.8% vs. 25.6%; p = 0.08) were lower in the P-PEG group than in the non-P-PEG group. The objective response rates were 52.4% and 30.8%, and median progression-free and overall survival were 4.7 and 3.0 months, and 9.6 and 6.8 months, in the P-PEG and non-P-PEG groups, respectively. CONCLUSIONS AMR with P-PEG as second-line chemotherapy for SCLC reduced the incidence of FN at a maintained AMR dose intensity and was associated with favorable tumor responses and survival outcomes. P-PEG should be considered for patients treated with AMR for SCLC including refractory relapsed SCLC.
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Affiliation(s)
- Motoki Sekikawa
- Division of Thoracic OncologyShizuoka Cancer CenterShizuokaJapan
- Department of Respiratory Medicine and AllergologySapporo Medical University School of MedicineSapporoJapan
| | | | - Meiko Morita
- Division of Thoracic OncologyShizuoka Cancer CenterShizuokaJapan
| | - Kosei Doshita
- Division of Thoracic OncologyShizuoka Cancer CenterShizuokaJapan
| | - Keita Miura
- Division of Thoracic OncologyShizuoka Cancer CenterShizuokaJapan
| | - Hiroaki Kodama
- Division of Thoracic OncologyShizuoka Cancer CenterShizuokaJapan
| | - Noboru Morikawa
- Division of Thoracic OncologyShizuoka Cancer CenterShizuokaJapan
| | - Yuko Iida
- Division of Thoracic OncologyShizuoka Cancer CenterShizuokaJapan
| | - Nobuaki Mamesaya
- Division of Thoracic OncologyShizuoka Cancer CenterShizuokaJapan
| | - Haruki Kobayashi
- Division of Thoracic OncologyShizuoka Cancer CenterShizuokaJapan
| | - Ryo Ko
- Division of Thoracic OncologyShizuoka Cancer CenterShizuokaJapan
| | - Kazushige Wakuda
- Division of Thoracic OncologyShizuoka Cancer CenterShizuokaJapan
| | - Akira Ono
- Division of Thoracic OncologyShizuoka Cancer CenterShizuokaJapan
| | | | - Tateaki Naito
- Division of Thoracic OncologyShizuoka Cancer CenterShizuokaJapan
| | - Hirofumi Chiba
- Department of Respiratory Medicine and AllergologySapporo Medical University School of MedicineSapporoJapan
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6
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Doshita K, Tabuchi Y, Kenmotsu H, Omori S, Kawabata T, Kodama H, Nishioka N, Miyawaki E, Iida Y, Mamesaya N, Kobayashi H, Ko R, Wakuda K, Ono A, Naito T, Murakami H, Mori K, Harada H, Kaneko T, Takahashi T. Incidence and Treatment Outcome of Radiation Pneumonitis in Patients With Limited-stage Small Cell Lung Cancer Treated With Concurrent Accelerated Hyperfractionated Radiation Therapy and Chemotherapy. Adv Radiat Oncol 2022; 8:101129. [PMID: 36845617 PMCID: PMC9943774 DOI: 10.1016/j.adro.2022.101129] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 11/15/2022] [Indexed: 11/25/2022] Open
Abstract
Purpose This study aimed to clarify the characteristics of and evaluate the risk factors for radiation pneumonitis (RP) induced by chemoradiation therapy (CRT) using accelerated hyperfractionated (AHF) radiation therapy (RT) in patients with limited-stage small cell lung cancer (LS-SCLC). Methods and Materials Between September 2002 and February 2018, 125 patients with LS-SCLC were treated with early concurrent CRT using AHF-RT. Chemotherapy was comprised of carboplatin/cisplatin with etoposide. RT was administered twice daily (45 Gy/30 fractions). We collected data regarding onset and treatment outcomes for RP, and analyzed the relationship between RP and total lung dose-volume histogram findings. Uni- and multivariate analyses were performed to assess patient- and treatment-related factors for grade ≥2 RP. Results The median age of patients was 65 years, and 73.6% of participants were men. In addition, 20% and 80.0% of participants presented with disease stage II and III, respectively. The median follow-up time was 73.1 months. Grades 1, 2, and 3 RP were observed in 69, 17, and 12 patients, respectively. Grades 4 to 5 RP were not observed. RP was treated with corticosteroids in patients with grade ≥2 RP, without recurrence. The median time from initiation of RT to onset of RP was 147 days. Three patients developed RP within 59 days, 6 within 60 to 89 days, 16 within 90 to 119 days, 29 within 120 to 149 days, 24 within 150 to 179 days, and 20 within ≥180 days. Among the dose-volume histogram parameters, the percentage of lung volume receiving >30 Gy (V30) was most strongly related to the incidence of grade ≥2 RP, and the optimal threshold to predict RP incidence was V30 ≥20%. On multivariate analysis, V30 ≥20% was an independent risk factor for grade ≥2 RP. Conclusions The incidence of grade ≥2 RP correlated strongly with a V30 of ≥20%. Contrarily, the onset of RP induced by concurrent CRT using AHF-RT may occur later. RP is manageable in patients with LS-SCLC.
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Affiliation(s)
- Kosei Doshita
- Division of Thoracic Oncology, Shizuoka Cancer Center, Nagaizumi-cho Sunto-gun, Shizuoka, Japan,Department of Pulmonology, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan
| | - Yuya Tabuchi
- Radiation and Proton Therapy Center, Shizuoka Cancer Center, Nagaizumi-cho Suntou-gun, Shizuoka, Japan
| | - Hirotsugu Kenmotsu
- Division of Thoracic Oncology, Shizuoka Cancer Center, Nagaizumi-cho Sunto-gun, Shizuoka, Japan,Corresponding author: Hirotsugu Kenmotsu, PhD
| | - Shota Omori
- Division of Thoracic Oncology, Shizuoka Cancer Center, Nagaizumi-cho Sunto-gun, Shizuoka, Japan
| | - Takanori Kawabata
- Clinical Research Center, Shizuoka Cancer Center, Nagaizumi-cho Sunto-gun, Shizuoka, Japan
| | - Hiroaki Kodama
- Division of Thoracic Oncology, Shizuoka Cancer Center, Nagaizumi-cho Sunto-gun, Shizuoka, Japan
| | - Naoya Nishioka
- Division of Thoracic Oncology, Shizuoka Cancer Center, Nagaizumi-cho Sunto-gun, Shizuoka, Japan
| | - Eriko Miyawaki
- Division of Thoracic Oncology, Shizuoka Cancer Center, Nagaizumi-cho Sunto-gun, Shizuoka, Japan
| | - Yuko Iida
- Division of Thoracic Oncology, Shizuoka Cancer Center, Nagaizumi-cho Sunto-gun, Shizuoka, Japan
| | - Nobuaki Mamesaya
- Division of Thoracic Oncology, Shizuoka Cancer Center, Nagaizumi-cho Sunto-gun, Shizuoka, Japan
| | - Haruki Kobayashi
- Division of Thoracic Oncology, Shizuoka Cancer Center, Nagaizumi-cho Sunto-gun, Shizuoka, Japan
| | - Ryo Ko
- Division of Thoracic Oncology, Shizuoka Cancer Center, Nagaizumi-cho Sunto-gun, Shizuoka, Japan
| | - Kazushige Wakuda
- Division of Thoracic Oncology, Shizuoka Cancer Center, Nagaizumi-cho Sunto-gun, Shizuoka, Japan
| | - Akira Ono
- Division of Thoracic Oncology, Shizuoka Cancer Center, Nagaizumi-cho Sunto-gun, Shizuoka, Japan
| | - Tateaki Naito
- Division of Thoracic Oncology, Shizuoka Cancer Center, Nagaizumi-cho Sunto-gun, Shizuoka, Japan
| | - Haruyasu Murakami
- Division of Thoracic Oncology, Shizuoka Cancer Center, Nagaizumi-cho Sunto-gun, Shizuoka, Japan
| | - Keita Mori
- Clinical Research Center, Shizuoka Cancer Center, Nagaizumi-cho Sunto-gun, Shizuoka, Japan
| | - Hideyuki Harada
- Radiation and Proton Therapy Center, Shizuoka Cancer Center, Nagaizumi-cho Suntou-gun, Shizuoka, Japan
| | - Takeshi Kaneko
- Department of Pulmonology, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan
| | - Toshiaki Takahashi
- Division of Thoracic Oncology, Shizuoka Cancer Center, Nagaizumi-cho Sunto-gun, Shizuoka, Japan
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7
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Miyawaki T, Kenmotsu H, Doshita K, Kodama H, Nishioka N, Iida Y, Miyawaki E, Mamesaya N, Kobayashi H, Omori S, Ko R, Wakuda K, Ono A, Naito T, Murakami H, Mori K, Harada H, Endo M, Takahashi K, Takahashi T. Clinical impact of tumour burden on the efficacy of PD-1/PD-L1 inhibitors plus chemotherapy in non-small-cell lung cancer. Cancer Med 2022; 12:1451-1460. [PMID: 35848053 PMCID: PMC9883568 DOI: 10.1002/cam4.5035] [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: 01/25/2022] [Revised: 06/27/2022] [Accepted: 06/29/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Programmed cell death 1 (PD-1)/programmed cell death ligand (PD-L1) inhibitors plus chemotherapy (ICI + Chemo) is the standard treatment for advanced non-small-cell lung cancer (NSCLC). However, the impact of tumour burden on the efficacy of ICI + Chemo remains unknown. METHODS We retrospectively evaluated 92 patients with advanced NSCLC treated with ICI + Chemo. Tumour burden was assessed as the sum of the longest diameter of the target lesion (BSLD) and number of metastatic lesions (BNMLs). We categorised the patients into three groups based on the combined BSLD and BNML values. RESULTS Sixty-eight patients (74%) had progressive disease or died. Forty-four patients (48%) in the low-BSLD group had a median progression-free survival (PFS) of 9.5 months, whereas patients in the high-BSLD group had a median PFS of 4.6 months (hazard ratio [HR] = 0.54, p = 0012). Twenty-five patients (27%) in the low-BNML group had a median PFS of 9.6 months, whereas patients in the high-BNML group had a median PFS of 6.5 months (HR = 0.51, p = 0.029). Low-BSLD and low-BNML were associated independently with improved PFS in multivariate analysis. Analysis of the tumour burden combined with BSLD and BNML revealed a trend towards improved PFS as the tumour burden decreased, with median PFS of 22.3, 8.7, and 3.9 months in the low- (N = 13), medium- (N = 42) and high-burden (N = 37) groups respectively. CONCLUSIONS Our findings demonstrated that a high tumour burden negatively impacts the efficacy of ICI + Chemo in patients with advanced NSCLC.
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Affiliation(s)
- Taichi Miyawaki
- Division of Thoracic OncologyShizuoka Cancer CentreShizuokaJapan,Department of Respiratory MedicineJuntendo University Graduate School of MedicineTokyoJapan
| | | | - Kosei Doshita
- Division of Thoracic OncologyShizuoka Cancer CentreShizuokaJapan
| | - Hiroaki Kodama
- Division of Thoracic OncologyShizuoka Cancer CentreShizuokaJapan
| | - Naoya Nishioka
- Division of Thoracic OncologyShizuoka Cancer CentreShizuokaJapan
| | - Yuko Iida
- Division of Thoracic OncologyShizuoka Cancer CentreShizuokaJapan
| | - Eriko Miyawaki
- Division of Thoracic OncologyShizuoka Cancer CentreShizuokaJapan
| | - Nobuaki Mamesaya
- Division of Thoracic OncologyShizuoka Cancer CentreShizuokaJapan
| | - Haruki Kobayashi
- Division of Thoracic OncologyShizuoka Cancer CentreShizuokaJapan
| | - Shota Omori
- Division of Thoracic OncologyShizuoka Cancer CentreShizuokaJapan
| | - Ryo Ko
- Division of Thoracic OncologyShizuoka Cancer CentreShizuokaJapan
| | - Kazushige Wakuda
- Division of Thoracic OncologyShizuoka Cancer CentreShizuokaJapan
| | - Akira Ono
- Division of Thoracic OncologyShizuoka Cancer CentreShizuokaJapan
| | - Tateaki Naito
- Division of Thoracic OncologyShizuoka Cancer CentreShizuokaJapan
| | | | - Keita Mori
- Clinical Research Support CenterShizuoka Cancer CentreShizuokaJapan
| | - Hideyuki Harada
- Radiation and Proton Therapy CentreShizuoka Cancer CentreShizuokaJapan
| | - Masahiro Endo
- Division of Diagnostic RadiologyShizuoka Cancer CentreShizuokaJapan
| | - Kazuhisa Takahashi
- Department of Respiratory MedicineJuntendo University Graduate School of MedicineTokyoJapan
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8
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Miyawaki T, Naito T, Doshita K, Kodama H, Mori M, Nishioka N, Iida Y, Miyawaki E, Mamesaya N, Kobayashi H, Omori S, Ko R, Wakuda K, Ono A, Kenmotsu H, Murakami H, Mori K, Harada H, Endo M, Takahashi K, Takahashi T. Predicting the efficacy of first-line immunotherapy by combining cancer cachexia and tumor burden in advanced non-small cell lung cancer. Thorac Cancer 2022; 13:2064-2074. [PMID: 35698259 PMCID: PMC9284192 DOI: 10.1111/1759-7714.14529] [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: 04/15/2022] [Revised: 05/17/2022] [Accepted: 05/19/2022] [Indexed: 11/26/2022] Open
Abstract
Background Cancer cachexia and tumor burden predict efficacies of programmed cell death‐1 (PD‐1)/programmed death‐ligand 1 (PD‐L1) inhibitors and chemotherapy or pembrolizumab in non‐small cell lung cancer (NSCLC). There are no predictive models that simultaneously assess cancer cachexia and tumor burden. Methods In the present retrospective study, we reviewed the medical records of patients with advanced NSCLC who received cancer immunotherapy as first‐line systemic therapy. Clinical immune predictive scores were defined according to multivariate analysis of progression‐free survival (PFS) and overall survival (OS). Results A total of 157 patients were included in the present study (75 treated with PD‐1/PD‐L1 inhibitors + chemotherapy; 82, pembrolizumab monotherapy). Multivariate analysis for PFS revealed that PD‐L1 tumor proportion scores <50%, a total target lesion diameter ≥76 mm, and cancer cachexia were independently associated with poor PFS. Multivariate analysis for OS revealed that ≥4 metastases and cancer cachexia were significantly associated with poor OS. In the immune predictive model, the median PFS was 21.7 months in the low‐risk group (N = 41); 7.6 in the medium‐risk group (N = 64); and 3.0 in the high‐risk group (N = 47). The median OS were not reached, 22.4 and 9.1 months respectively. Our immune predictive model was significantly associated with PFS (p < 0.001) and OS (p < 0.001). Conclusion We proposed the immune predictive model, including tumor burden and cancer cachexia, which may predict the efficacy and survival outcome of first‐line immunotherapy in advanced NSCLC.
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Affiliation(s)
- Taichi Miyawaki
- Division of Thoracic Oncology, Shizuoka Cancer Center, Shizuoka, Japan.,Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Tateaki Naito
- Division of Thoracic Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Kosei Doshita
- Division of Thoracic Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Hiroaki Kodama
- Division of Thoracic Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Mikiko Mori
- Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Naoya Nishioka
- Division of Thoracic Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Yuko Iida
- Division of Thoracic Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Eriko Miyawaki
- Division of Thoracic Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Nobuaki Mamesaya
- Division of Thoracic Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Haruki Kobayashi
- Division of Thoracic Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Shota Omori
- Division of Thoracic Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Ryo Ko
- Division of Thoracic Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Kazushige Wakuda
- Division of Thoracic Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Akira Ono
- Division of Thoracic Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | | | - Haruyasu Murakami
- Division of Thoracic Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Keita Mori
- Clinical Research Center, Shizuoka Cancer Center, Shizuoka, Japan
| | - Hideyuki Harada
- Radiation and Proton Therapy Center, Shizuoka Cancer Center, Shizuoka, Japan
| | - Masahiro Endo
- Division of Diagnostic Radiology, Shizuoka Cancer Centre, Shizuoka, Japan
| | - Kazuhisa Takahashi
- Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
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9
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Nishioka N, Naito T, Miyawaki T, Yabe M, Doshita K, Kodama H, Miyawaki E, Iida Y, Mamesaya N, Kobayashi H, Omori S, Ko R, Wakuda K, Ono A, Kenmotsu H, Murakami H, Takayama K, Takahashi T. Impact of losing adipose tissue on outcomes from PD-1/PD-L1 inhibitor monotherapy in non-small cell lung cancer. Thorac Cancer 2022; 13:1496-1504. [PMID: 35420262 PMCID: PMC9108048 DOI: 10.1111/1759-7714.14421] [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: 01/05/2022] [Revised: 03/25/2022] [Accepted: 03/28/2022] [Indexed: 11/30/2022] Open
Abstract
Background Adipose tissue induces inflammation, which desensitizes the efficacy of immunotherapy. However, several reports show that the therapeutic effect of programed cell death 1 (PD‐1)/programed death‐ligand 1 (PD‐L1) inhibitor(s) monotherapy is significantly better in obese patients. Therefore, the effect of adipose tissue on immunotherapy is unclear. Methods In this study, we retrospectively reviewed patients with advanced non‐small cell lung cancer (NSCLC) who received PD‐1/PD‐L1 inhibitor monotherapy between May 2016 and December 2018. We classified patients into total adipose tissue maintenance or loss groups according to adipose tissue change during the 6 months before treatment and compared the therapeutic effect of PD‐1/PD‐L1 inhibitors between these groups along with the presence or absence of cachexia, a poor prognostic factor. Results Of the 74 patients, 40 (54.1%) were cachexic. Among cachexic patients, we found no clear difference in the overall response rate (ORR) and progression‐free survival (PFS) between the total adipose tissue maintenance and loss group. However, among noncachexic patients, the total adipose tissue loss group had a higher ORR (64.7% vs. 23.5%, p < 0.05) and longer PFS (18.5 months vs. 2.86 months, p = 0.037) than the maintenance group. Conclusions This study showed that decreasing adipose tissue without cachexia might favor the therapeutic effects of immunotherapy.
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Affiliation(s)
- Naoya Nishioka
- Division of Thoracic Oncology, Shizuoka Cancer Center, Shizuoka, Japan.,Department of Pulmonary Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Tateaki Naito
- Division of Thoracic Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Taichi Miyawaki
- Department of Respiratory Medicine, Juntendo University School of Medicine, Tokyo, Japan
| | - Michitoshi Yabe
- Department of Respiratory Medicine, Oita Prefectural Hospital, Oita City, Oita, Japan
| | - Kosei Doshita
- Division of Thoracic Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Hiroaki Kodama
- Division of Thoracic Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Eriko Miyawaki
- Division of Thoracic Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Yuko Iida
- Division of Thoracic Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Nobuaki Mamesaya
- Division of Thoracic Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Haruki Kobayashi
- Division of Thoracic Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Shota Omori
- Division of Thoracic Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Ryo Ko
- Division of Thoracic Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Kazushige Wakuda
- Division of Thoracic Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Akira Ono
- Division of Thoracic Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | | | - Haruyasu Murakami
- Division of Thoracic Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Koichi Takayama
- Department of Pulmonary Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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10
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Doshita K, Kenmotsu H, Omori S, Tabuchi Y, Kawabata T, Kodama H, Nishioka N, Miyawaki E, Iida Y, Miyawaki T, Mamesaya N, Kobayashi H, Ko R, Wakuda K, Ono A, Naito T, Murakami H, Mori K, Harada H, Kaneko T, Takahashi T. Long-term survival data of patients with limited disease small cell lung cancer: a retrospective analysis. Invest New Drugs 2021; 40:411-419. [PMID: 34716848 DOI: 10.1007/s10637-021-01183-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 08/14/2021] [Accepted: 09/16/2021] [Indexed: 12/24/2022]
Abstract
INTRODUCTION In patients with limited disease small cell lung cancer (LD-SCLC) treated with concurrent chemoradiotherapy (CCRT), long-term survival data have not been fully evaluated. Moreover, the association between long-term prognosis and prognostic factors has not been sufficiently investigated. METHODS In this retrospective study, we evaluated the efficacy of CCRT in 120 patients with LD-SCLC with a plan for curative CRT using concurrent accelerated hyperfractionated radiotherapy. RESULTS The patients had a median age of 65.5 years, predominantly male (73%), and had clinical stage III disease (80%). The median follow-up time for overall survival (OS) was 72.2 months, median OS was 42.5 months, and the 3-year and 5-year survival rates were 52.4% and 41.8%, respectively. The median progression-free survival (PFS) was 12.5 months, and the 3-year and 5-year PFS rates were 37.6% and 33.6%, respectively. The 5-year OS rates of patients who achieved PFS at each time point were 70.9%, 83.6%, and 91.9% at 12, 24, and 36 months, respectively. The gradual increase in the 5-year OS rate following PFS extension and initial depression of the Kaplan-Meier curve showed disease progression frequently occurred in the first 2 years after initiation of CCRT. The Cox proportional hazards model showed no significant factors correlated with long-term survival through univariate and multivariate analyses. Although the prognostic factors associated with long-term prognosis in LD-SCLC were not identified, the 5-year survival rate was 41.8%, and among patients without disease progression at 2 years, the 5-year survival rate was 83.6%. CONCLUSION These data suggested that the prognosis of patients with LD-SCLC was improving.
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Affiliation(s)
- Kosei Doshita
- Division of Thoracic Oncology, Shizuoka Cancer Center, Nagaizumi-Sho Sunto-Gun, Shimonagakubo Shizuoka, 1007411-8777, Japan.,Department of Pulmonology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan
| | - Hirotsugu Kenmotsu
- Division of Thoracic Oncology, Shizuoka Cancer Center, Nagaizumi-Sho Sunto-Gun, Shimonagakubo Shizuoka, 1007411-8777, Japan.
| | - Shota Omori
- Division of Thoracic Oncology, Shizuoka Cancer Center, Nagaizumi-Sho Sunto-Gun, Shimonagakubo Shizuoka, 1007411-8777, Japan
| | - Yuya Tabuchi
- Radiation and Proton Therapy Center, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Suntou-gun, Shizuoka, 411-8777, Japan
| | - Takanori Kawabata
- Clinical Research Center, Shizuoka Cancer Center, Nagaizumi-Cho Sunto-Gun, Shimonagakubo Shizuoka, 1007411-8777, Japan
| | - Hiroaki Kodama
- Division of Thoracic Oncology, Shizuoka Cancer Center, Nagaizumi-Sho Sunto-Gun, Shimonagakubo Shizuoka, 1007411-8777, Japan
| | - Naoya Nishioka
- Division of Thoracic Oncology, Shizuoka Cancer Center, Nagaizumi-Sho Sunto-Gun, Shimonagakubo Shizuoka, 1007411-8777, Japan
| | - Eriko Miyawaki
- Division of Thoracic Oncology, Shizuoka Cancer Center, Nagaizumi-Sho Sunto-Gun, Shimonagakubo Shizuoka, 1007411-8777, Japan
| | - Yuko Iida
- Division of Thoracic Oncology, Shizuoka Cancer Center, Nagaizumi-Sho Sunto-Gun, Shimonagakubo Shizuoka, 1007411-8777, Japan
| | - Taichi Miyawaki
- Division of Thoracic Oncology, Shizuoka Cancer Center, Nagaizumi-Sho Sunto-Gun, Shimonagakubo Shizuoka, 1007411-8777, Japan
| | - Nobuaki Mamesaya
- Division of Thoracic Oncology, Shizuoka Cancer Center, Nagaizumi-Sho Sunto-Gun, Shimonagakubo Shizuoka, 1007411-8777, Japan
| | - Haruki Kobayashi
- Division of Thoracic Oncology, Shizuoka Cancer Center, Nagaizumi-Sho Sunto-Gun, Shimonagakubo Shizuoka, 1007411-8777, Japan
| | - Ryo Ko
- Division of Thoracic Oncology, Shizuoka Cancer Center, Nagaizumi-Sho Sunto-Gun, Shimonagakubo Shizuoka, 1007411-8777, Japan
| | - Kazushige Wakuda
- Division of Thoracic Oncology, Shizuoka Cancer Center, Nagaizumi-Sho Sunto-Gun, Shimonagakubo Shizuoka, 1007411-8777, Japan
| | - Akira Ono
- Division of Thoracic Oncology, Shizuoka Cancer Center, Nagaizumi-Sho Sunto-Gun, Shimonagakubo Shizuoka, 1007411-8777, Japan
| | - Tateaki Naito
- Division of Thoracic Oncology, Shizuoka Cancer Center, Nagaizumi-Sho Sunto-Gun, Shimonagakubo Shizuoka, 1007411-8777, Japan
| | - Haruyasu Murakami
- Division of Thoracic Oncology, Shizuoka Cancer Center, Nagaizumi-Sho Sunto-Gun, Shimonagakubo Shizuoka, 1007411-8777, Japan
| | - Keita Mori
- Clinical Research Center, Shizuoka Cancer Center, Nagaizumi-Cho Sunto-Gun, Shimonagakubo Shizuoka, 1007411-8777, Japan
| | - Hideyuki Harada
- Radiation and Proton Therapy Center, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Suntou-gun, Shizuoka, 411-8777, Japan
| | - Takeshi Kaneko
- Department of Pulmonology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan
| | - Toshiaki Takahashi
- Division of Thoracic Oncology, Shizuoka Cancer Center, Nagaizumi-Sho Sunto-Gun, Shimonagakubo Shizuoka, 1007411-8777, Japan
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11
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Aoki A, Hara Y, Okudela K, Ishikawa Y, Doshita K, Hashimoto H, Nakashima K, Horita N, Kobayashi N, Kaneko T. Unusual lung involvements of invasive mucinous adenocarcinoma with chylothorax. Thorac Cancer 2020; 11:3407-3408. [PMID: 32945109 PMCID: PMC7605987 DOI: 10.1111/1759-7714.13665] [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: 08/02/2020] [Revised: 09/02/2020] [Accepted: 09/02/2020] [Indexed: 11/28/2022] Open
Abstract
A 77-year-old man who had a persistent productive cough for one month was admitted to our hospital. Chest computed tomography (CT) revealed subpleural nodular opacities, irregular pleural thickening with bilateral basal predominance, and a small right pleural effusion. Aspirated fluid was exudative and had the appearance of chylothorax without malignant cells. Surgical lung biopsy specimen showed focal proliferation of neoplastic epithelial cells with lepidic-predominant pattern and abundant mucus in the alveolar spaces, consistent with invasive mucinous adenocarcinoma (IMA). The results of PD-L1 expression and the EGFR, ALK, ROS1, and BRAF mutation status analyzed by next generation sequencer were all negative. IMA should be considered in the differential diagnosis of subpleural micronodular opacities accompanied by pleural effusion (chylothorax) on chest CT. KEY POINTS: Significant findings of the study This case showed subpleural micronodular opacities and chylothorax as unusual chest computed tomography (CT) patterns for invasive mucinous adenocarcinoma (IMA). What this study adds Invasive mucinous adenocarcinoma (IMA) should be considered in the differential diagnosis of subpleural micronodular opacities accompanied by pleural effusion on chest CT.
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Affiliation(s)
- Ayako Aoki
- Department of Pulmonology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Yu Hara
- Department of Pulmonology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Koji Okudela
- Department of Pathology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Yoshihiro Ishikawa
- Department of Thoracic Surgery, Yokohama City University Hospital, Yokohama, Japan
| | - Kosei Doshita
- Department of Pulmonology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Hisashi Hashimoto
- Department of Pulmonology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Kentaro Nakashima
- Department of Pulmonology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Nobuyuki Horita
- Department of Pulmonology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Nobuaki Kobayashi
- Department of Pulmonology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Takeshi Kaneko
- Department of Pulmonology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
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