Describing differences among populations of thoracic tumors patients under and over 80 years: Data analysis from the SLCG thoracic tumor registry

OBJECTIVES

Cancer is a disease of old age; however, most studies usually included minority of patients fit elderly. The purpose is to investigate the clinical characteristics and genetic information of patients with thoracic tumors who are 80 years old or older compared to those under 80 years old.

STUDY DESIGN AND METHODS

The Thoracic Tumor Registry (TTR) is a Spanish observational, prospective cohort study that included patients diagnosed with thoracic tumors. Data were collected from medical records related to sociodemographic, epidemiological, clinical, molecular/genetic, and treatment outcome variables.

RESULTS

The total number of patients, recruited from August 2016 to April 2023, was 26.193 (93,1 % were younger than 80 years and 6,9 % were 80 years or older). In the group of older patients: the male ratio increased (72,9 % vs. 80 %); the number of elderly people who had never smoked or were ex-smokers increased (9,9 % vs. 21,1 % and 44,8 % vs. 61,3 %, respectively) and the number of current smokers decreased (43,3 % vs. 17,5 %); had higher ECOG performance status at diagnosis (for ECOG ≥ 2, 15 % vs. 32,9 %), and there were more patients with previous cancer (17,3 % vs. 28 %). The proportion of men is higher than that of women (73 % vs. 27 % in <80 years and 80 % vs. 20 % in ≥80 years). For all biomarkers, the proportion of patients who had a molecular determination was lower in older patients. There were no differences in terms of alterations in the biomarkers tested; except for EGFR, for which the positivity rate was higher in patients aged 80 years and older (25 % vs. 15,3 %).

CONCLUSION

The proportion of older patients with targeted mutations is higher. So, at least at diagnosis, it should be proceeded in a standard way. Then, when it comes to treatment, comorbidities and patient's baseline situation should be considered.

CLINICAL TRIAL REGISTRATION

NCT02941458.

Impact of smoking status on the relative efficacy of the EGFR TKI/angiogenesis inhibitor combination therapy in advanced NSCLC-a systematic review and meta-analysis

Background

The ETOP 10-16 BOOSTER trial failed to demonstrate a progression-free survival (PFS) benefit for adding bevacizumab to osimertinib in second line. An exploratory subgroup analysis, however, suggested a PFS benefit of the combination in patients with a smoking history and prompted us to do this study.

Methods

A systematic review and meta-analysis to evaluate the differential effect of smoking status on the benefit of adding an angiogenesis inhibitor to epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitor therapy was carried out. All relevant randomized controlled trials appearing in main oncology congresses or in PubMed as of 1 November 2021 were used according to the Preferred Reporting Items for Systematic Review and Meta-Analyses statement. Primarily PFS according to smoking status, and secondarily overall survival (OS) were of interest. Pooled and interaction hazard ratios (HRs) were estimated by fixed or random effects models, depending on the detected degree of heterogeneity. Bias was assessed using the revised Cochrane tool for randomized controlled trials (RoB 2).

Results

Information by smoking was available for 1291 patients for PFS (seven studies) and 678 patients for OS (four studies). The risk of bias was low for all studies. Combination treatment significantly prolonged PFS for smokers [n = 502, HR = 0.55, 95% confidence interval (CI): 0.44-0.69] but not for nonsmokers (n = 789, HR = 0.92, 95% CI: 0.66-1.27; treatment-by-smoking interaction P = 0.02). Similarly, a significant OS benefit was found for smokers (n = 271, HR = 0.66, 95% CI: 0.47-0.93) but not for nonsmokers (n = 407, HR = 1.07, 95% CI: 0.82-1.42; treatment-by-smoking interaction P = 0.03).

Conclusion

In advanced EGFR-non-small-cell lung cancer patients, the addition of an angiogenesis inhibitor to EGFR-tyrosine kinase inhibitor therapy provides a statistically significant PFS and OS benefit in smokers, but not in non-smokers. The biological basis for this observation should be pursued and could determine whether this might be due to a specific co-mutational pattern produced by tobacco exposure.

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Target population consists of EGFR-non-small-cell lung cancer patients.

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The relative effect of adding an angiogenesis inhibitor to EGFR tyrosine kinase inhibitor by smoking status was explored.

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In patients with smoking history, the addition of an angiogenesis inhibitor provides significant PFS and OS benefit.

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This is not the case in patients with a negative smoking history.

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The biological basis for this observation should be pursued.

A randomised phase II study of osimertinib and bevacizumab versus osimertinib alone as second-line targeted treatment in advanced NSCLC with confirmed EGFR and acquired T790M mutations: the European Thoracic Oncology Platform (ETOP 10-16) BOOSTER trial

BACKGROUND

While osimertinib, a third-generation epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI) is the standard treatment in patients with advanced non-small-cell lung cancer (NSCLC) with sensitising EGFR and acquired T790M mutations, progression inevitably occurs. The angiogenic pathway is implicated in EGFR TKI resistance.

PATIENTS AND METHODS

BOOSTER is an open-label randomised phase II trial investigating the efficacy and safety of combined osimertinib 80 mg daily and bevacizumab 15 mg/kg every 3 weeks, versus osimertinib alone, in patients with EGFR-mutant advanced NSCLC and acquired T790M mutations after failure on previous EGFR TKI therapy. Primary endpoint was investigator-assessed progression-free survival (PFS). Secondary endpoints were overall survival (OS), objective response rate (ORR) and adverse events (AEs).

RESULTS

Between May 2017 and February 2019, 155 patients were randomised (combination: 78; osimertinib: 77). At data cut-off of 22 February 2021, median follow-up was 33.8 months [interquartile range (IQR): 26.5-37.6 months] and 129 (83.2%) PFS events were reported in the intention-to-treat population. There was no difference in median PFS between the combination [15.4 months; 95% confidence interval (CI) 9.2-18.0 months] and osimertinib arm (12.3 months; 95% CI 6.2-17.2 months; stratified log-rank P = 0.83), [hazard ratio (HR) = 0.96; 95% CI 0.68-1.37]. Median OS was 24.0 months (95% CI 17.8-32.1 months) in the combination arm and 24.3 months (95% CI 16.9-37.0 months) in the osimertinib arm (stratified log-rank P = 0.91), (HR = 1.03; 95% CI 0.67-1.56). Exploratory analysis revealed a significant interaction of smoking history with treatment for PFS (adjusted P = 0.0052) with a HR of 0.52 (95% CI 0.30-0.90) for smokers, and 1.47 (95% CI 0.92-2.33) for never smokers. ORR was 55% in both arms and the median time to treatment failure was significantly shorter in the combination than in the osimertinib arm, 8.2 months versus 10.8 months, respectively (P = 0.0074). Safety of osimertinib and bevacizumab was consistent with previous reports with grade ≥3 treatment-related AEs (TRAEs) reported in 47% and 18% of patients on combination and osimertinib alone, respectively.

CONCLUSIONS

No difference in PFS was observed between osimertinib plus bevacizumab and osimertinib alone. Grade ≥3 TRAEs were more common in patients on combination.

Indications for diagnostic open biopsy of mammographic screen-detected lesions preoperatively diagnosed as fibroadenomas by needle biopsy and their outcomes

AIM

To identify the clinical, radiological, and histopathological factors that resulted in a diagnostic open biopsy of mammographic screen-detected lesions diagnosed preoperatively as fibroadenomas by needle biopsy.

MATERIALS AND METHODS

BreastScreen WA data over 10 year period from 1 January 1999 to 31 December 2008 was reviewed.

RESULTS

Among the 760,027 women screened in Western Australia between 1999 and 2008, 31 had a fine-needle aspiration (FNA) or a core biopsy (CB) diagnosing a fibroadenoma and subsequently underwent a diagnostic open biopsy (DOB). Three were preoperatively diagnosed as fibroadenoma by initial FNA but subsequent CB showed that these were not fibroadenomas and, therefore, were excluded from the present series. Of the 28 cases, DOB identified 21 fibroadenomas, two cellular fibroadenomas, two benign phyllodes tumours, one malignant phyllodes tumour, one fibroadenoma containing ductal carcinoma in situ (DCIS), and one case of a 40mm adenosis tumour with a small 5mm fibroadenoma. The lesions ranged from 5-100mm in size with an average size of 28mm. DOB and CB results were concordant in 25 (89%) of the cases. The primary clinical indications for undergoing DOB included indeterminate histopathological findings of cellular fibroadenomas versus phyllodes tumour (n = 10), enlarging size (n = 4), large size (n = 5), fibroadenomas with atypia (n = 1), discordant radiological and pathological findings (n = 3), patient preference (n = 1), association with a second screen-detected lesion requiring excision (n = 2), and an unknown indication (n = 1).

CONCLUSION

CB diagnosis of fibroadenomas is a safe diagnosis unless it has atypical clinical, radiological, or pathological features.

Two biomarker-directed randomized trials in European and Chinese patients with nonsmall-cell lung cancer: the BRCA1-RAP80 Expression Customization (BREC) studies

BACKGROUND

In a Spanish Lung Cancer Group (SLCG) phase II trial, the combination of BRCA1 and receptor-associated protein 80 (RAP80) expression was significantly associated with outcome in Caucasian patients with nonsmall-cell lung cancer (NSCLC). The SLCG therefore undertook an industry-independent collaborative randomized phase III trial comparing nonselected cisplatin-based chemotherapy with therapy customized according to BRCA1/RAP80 expression. An analogous randomized phase II trial was carried out in China under the auspices of the SLCG to evaluate the effect of BRCA1/RAP80 expression in Asian patients.

PATIENTS AND METHODS

Eligibility criteria included stage IIIB-IV NSCLC and sufficient tumor specimen for molecular analysis. Randomization to the control or experimental arm was 1 : 1 in the SLCG trial and 1 : 3 in the Chinese trial. In both trials, patients in the control arm received docetaxel/cisplatin; in the experimental arm, patients with low RAP80 expression received gemcitabine/cisplatin, those with intermediate/high RAP80 expression and low/intermediate BRCA1 expression received docetaxel/cisplatin, and those with intermediate/high RAP80 expression and high BRCA1 expression received docetaxel alone. The primary end point was progression-free survival (PFS).

RESULTS

Two hundred and seventy-nine patients in the SLCG trial and 124 in the Chinese trial were assessable for PFS. PFS in the control and experimental arms in the SLCG trial was 5.49 and 4.38 months, respectively [log rank P = 0.07; hazard ratio (HR) 1.28; P = 0.03]. In the Chinese trial, PFS was 4.74 and 3.78 months, respectively (log rank P = 0.82; HR 0.95; P = 0.82).

CONCLUSION

Accrual was prematurely closed on the SLCG trial due to the absence of clinical benefit in the experimental over the control arm. However, the BREC studies provide proof of concept that an international, nonindustry, biomarker-directed trial is feasible. Thanks to the groundwork laid by these studies, we expect that ongoing further research on alternative biomarkers to elucidate DNA repair mechanisms will help define novel therapeutic approaches.

TRIAL REGISTRATION

NCT00617656/GECP-BREC and ChiCTR-TRC-12001860/BREC-CHINA.

Teratogenic Effects of the Interaction Acetylsalicylic Acid (ASA) and Ethanol: Morphologic and Morphometric Evaluation of the Lingual Epithelium in Rat Fetuses

The objective of the present work was to evaluate the teratogenic effects of the interaction between acetylsalicylic acid (ASA) and ethanol on the epithelium of the lingual mucosa in rat fetuses. On the 10th pregnancy day, a single intraperitoneal ethanol dose (2.96 g/kg body weight) (Group I), ASA (200 mg/kg body weight) (Group II) and ASA plus ethanol, in the same doses (Group III), or saline (Group IV - control), were administrated. The epithelial alterations were assessed by means of histological and morphometric methods, on posterior dorsal, anterior dorsal and ventral regions of the tongue. ASA reduced, in rat fetuses, the ethanol deleterious effects on nuclear size in the epithelial prickle cell of the lingual mucosa. On the other hand, ASA did not influence the effects of ethanol in both epithelial layers of the lingual mucosa, when the nuclear shape, cell volume or epithelial layers thickness were evaluated.

A morphometric study of maternal smoking on apoptosis in the syncytiotrophoblast

OBJECTIVES

To study syncytiotrophoblast apoptosis in the placenta of smoking and non-smoking pregnant women.

METHODS

Twelve neonates, pregnancies and placentas were available for study. Eight mothers smoked during pregnancy and the remaining four were non-smokers used as control subjects. The main outcome measure was the apoptotic syncytiotrophoblast index for each group. Apoptosis was detected by immunohistochemistry using the TUNEL method and quantitatively measured using a Merz grid. The apoptotic syncytiotrophoblast index was calculated as the ratio of mean apoptotic labeling to percent terminal villus area using high-power field microscopy.

RESULTS

Significant differences in apoptotic syncytiotrophoblast index were observed between the control group (15.06+/-3.72) and the smoker group (1.66+/-1.74) (P < 0.0001, Mann-Whitney test), but no differences were detected in clinical or morphometric data between groups.

CONCLUSIONS

The human placental syncytiotrophoblast undergoes apoptosis and this process is associated with inhibition of apoptosis by the smoking habit. The same way as the presence of trophoblast apoptosis is associated with modifications of the maternal-fetal exchange, the inhibitory effect of the smoking habit on syncytiotrophoblast could be responsible for the poor prognosis of pregnancy in the presence of maternal smoking.

[Experimental hypervitaminosis A in the rat. 14. Morphological and morphometric study of changes in the esophageal epithelium]

Male rats were subjected to hypervitamin A treatment by daily intraperitoneal injections of 150 UI Arovit per g body weight. Another group of rats were injected intraperitoneally with saline solution for ten days and were used as controls. The results indicated that: 1) the body weight of animals treated with excess vitamin A was decreased; 2) histological analysis of the esophageal epithelium in treated animals showed increased thickness, characterizing a picture of hyperplasia and hypertrophy. On the basis of the results obtained, we suggest that excess vitamin A may act on the esophageal epithelium by direct action on the epithelial structures, stimulating and increase of the mitosis, and on the epithelium (mediated by the adrenals), resulting in increased thickness due to the concentration of a larger number of more immature cells. These alterations were more evident in the lower esophageal third.

Morphological, morphometric and stereological study of submandibular glands in rats with lesion of the anteroventral region of the third ventricle (AV3V)

Lesions of the antero-ventral region of the third ventricle induce in the rat submandibular gland parenchyma, atrophy through vascular ischemia, and simultaneously increased fibrosis of the connective tissue, probably by alteration of the pituitary gonadotropins (FSH, LH), thyrotrophic hormone (TSH), growth hormone and probably insulin levels.

[Morphometric and stereologic study of changes in the submandibular gland of mice with hypervitaminosis A]

Daily administration of 150 IU vitamin A/gram of body weight in mice, during 10 days, led the authors to observe: submandibular glands showed acini of slightly reduced size, with lower cells whose contours were not always sharp and containing smaller number of cytoplasmic granules. The nuclei of the acinar cells were reduced in volume. The granulose ducts were similar to those of the controls in size but showed signs of degeneration as well as cell nuclei of reduced volume. The striated ducts were smaller than those of the controls, while the excretory ducts were dilated, with lower cells and nuclei of reduced volume. General examination showed that the hypervitaminotic animals had more abundant connective stroma than the controls. The glandular structures were studied morphometrically and estereologically.

Placental characteristics in twin transfusion syndrome

The authors describe the histological features of the placenta in a typical case of twin-to-twin transfusion, with particular attention focused on the stereologic aspects. Villi from the anemic placental portion were slightly edematous, with small and inconspicuous vessels. The stereologic characteristics of this portion were nearer values of normal placentas. The plethoric region appears as a postmature organ, with a very thin trophoblast layer and numerous vasculo-syncytial membranes. The most dramatic alterations of this region were mainly related to the foetal capillary. According to the stereologic results, the consecutive circulatory alterations would facilitate the maternal-fetal exchanges in the plethoric placental territory, thus justifying the greater development of this twin.

Histochemical study of the fetal membranes in the human term pregnancy

The histochemical distribution of polysaccharides and proteins was studied in the human fetal membranes from term pregnancies. The neutral polysaccharide reactions were stronger in the trophoblast layer of the chorion and in the decidua, whereas the acid mucopolysaccharides were equally intense in the connective layers and in the decidua. The protein reactions were always stronger in the decidua. It was demonstrated the existence of a cover of acid mucopolysaccharides over the apical surface of the amniotic epithelium. The possible participation of this cover in water and electrolytes transfer is discussed.

A stereologic study on the thickness of the trophoblastic layer and its regional variation in the human term placenta

A new stereological method was applied to estimate the average thickness of the trophoblastic layer in chorial villi from different regions of the human term placenta. Statistically significant differences were demonstrated among the 5 regions considered. The results suggest that the thickness of the trophoblastic layer is related to the pO2 gradient in the intervillous space blood.

Cytogenetic and dermatoglyphic studies of newborns with single umbilical artery

Cytogenetic studies were carried out on 24 newborns with single umbilical artery (SUA), whereas dermatoglyphic analysis were performed on 14 of them. Metaphase examination showed increased size of the short arm of an acrocentric chromosome of group D or of group G in 6 of the 24 SUA babies studied. Numerous chromosome breaks were detected in one other case. Dermatologlyphic data showed that the total finger ridge count did not deviate from normal patterns, whereas the aTd angle showed increased values in 5 of the 14 cases studied. The absence of major chromosome aberrations does not exclude the possibility of chromosomal etiology for SUA, since the increased frequency of acrocentric polymorphism found in the present series and the 5 cases of increased aTd angle suggest such an occurrence.

Regional variation in the frequency of fibrinoid degeneration in the human term placenta

The frequency of fibrinoid degeneration in different regions of the human mature placenta was determined employing stereologic methods. The results showed the existence of significantly more frequent fibrinoid degeneration in the venous regions. It is suggested that the hypoxia and/or the relative stasis at these levels could stimulate the fibrinoid degeneration of villi.

The importance of placental examination in newborns with single umbilical artery

Examination of placentas from newborns with single umbilical artery (SUA) can furnish valuable data to Perinatologists. Thus, 33.3% of the SUA newborns with gross macroscopic alterations of the placenta were malformed. In the other hand, 75% of the malformed SUA newborns had gross placental alterations. It is pointed out the importance of examination of the placenta, even at unaided eye, as a tool to prevent the Perinatologist in search of probable malformations (both apparent or occult).

Estimation of the average diameter of human placental villi by a stereologic method

A stereologic technique for estimating the average villi diameter was applied to study random samples of 12 human term placentas. The determined values were compared with those previously obtained by others with different techniques.

Pathology of the trophoblast and fetal vessels of the placenta in maternal diabetes mellitus

The morphologic characteristics of the chorial villi from normal full-term placentas and from placentas of different clinical types of diabetic women were studied. The latter showed early maturation of the trophoblast, higher percentage of villi with stromal edema, and higher percentage of vessels of the villous trunks with lesions causing partial or total obstruction of the vascular lumen. The fact that the diabetic patients were treated suggests that the metabolic correction of diabetes mellitus prevents the occurrence or development of the multiple disturbances which the disease produces in the evolution of human pregnancy.

Persistent estrus in rats after anterolateral hypothalamic microinjections of 6-hydroxydopamine

Bilateral injections of 30 mug of 6-hydroxydopamine (6-OHDA, as base) into the anterolateral hypothalamic area induced constant vaginal cornification (CVC), polyfollicular ovaries and uterine hypertrophy in cyclic adult female rats. There were no important changes in the vaginal patterns or ovarian and uterine morphology in animals given injections in the same area with the solvent only and in animals given injections with 6-OHDA in the anterior amygdaloid area. It is suggested that the persistent estrus after anterolateral hypothalamic injections of 6-OHDA results from lesions of central catecholaminergic pathways, which are probably involved in gonadotropin secretion.

[Effects of hypothalamic microinjections of 6-hydroxydopamine (6-OHDA) on estral cycle and morphology of the genital tract in the female rat (author's transl)]

To determine whether central catecholaminergic pathways are involved in the neural contral of gonadotrophin secretion, they were interrupted at the hypothalamic level by microinjections of 6-hydroxydopamine (6-OHDA). The effects on ovulation, estral cycle and ovarian and uterine histology were studied. Microinjections of 50 mug of 6-OHDA hydrobromyde were made bilaterally into the anterolateral hypothalamus in a group of rats. Another group was injected with 25 mug of 6-OHDA, while a control group recieved an equivalent volume (5 mul) of saline with ascorbic acid. Animals injected with 50 mug of 6-OHDA showed blockade of ovulation, vaginal cytology characteristics of persistent estrous, polyfollicular ovaries and enlarged uteri with hypertrophic endometrial glands. In the group injected with 25 mug, similiar effects were demonstrated, but the number of affected animals was smaller than that in the 50 mug group. Control animals dit not show modifications, either in estral cycle or in ovarian and uterine histology. These results suggest that 6-OHDA injected into the anterolateral hypothalmus interferes with catecholaminergic pathways that participate in the neural control of ovulation.

Total water content in different areas of the human term placenta

The authors study the total water content in two different areas (parabasal and subchorial), in 40 normal, full-term placentas. The water content is found to be different in these two areas. As an average, it is 0.90% higher in the parabasal area. This difference persists even after washing off the fetal placental blood by perfusión with saline. The difference in the total water content between both areas, which is added to other differences previously demonstrated, must be related to a different functional role of the placental areas.