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van Geffen WH, Tan DJ, Walters JA, Walters EH. Inhaled corticosteroids with combination inhaled long-acting beta2-agonists and long-acting muscarinic antagonists for chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2023; 12:CD011600. [PMID: 38054551 PMCID: PMC10698842 DOI: 10.1002/14651858.cd011600.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
BACKGROUND Management of chronic obstructive pulmonary disease (COPD) commonly involves a combination of long-acting bronchodilators including beta2-agonists (LABA) and muscarinic antagonists (LAMA). LABA and LAMA bronchodilators are now available in single-combination inhalers. In individuals with persistent symptoms or frequent exacerbations, inhaled corticosteroids (ICS) are also used with combination LABA and LAMA inhalers. However, the benefits and risks of adding ICS to combination LABA/LAMA inhalers as a triple therapy remain unclear. OBJECTIVES To assess the effects of adding an ICS to combination LABA/LAMA inhalers for the treatment of stable COPD. SEARCH METHODS We searched the Cochrane Airways Group Register of Trials, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, and Embase up to 30 November 2022. We also searched ClinicalTrials.gov and the WHO ICTRP up to 30 November 2022. SELECTION CRITERIA We included parallel-group randomised controlled trials of three weeks' duration or longer that compared the treatment of stable COPD with ICS in addition to combination LABA/LAMA inhalers against combination LABA/LAMA inhalers alone. DATA COLLECTION AND ANALYSIS We used standard Cochrane methodological procedures. The primary outcomes were acute exacerbations of COPD, respiratory health-related quality of life, pneumonia and other serious adverse events. The secondary outcomes were symptom scores, lung function, physical capacity, and mortality. We used GRADE to assess certainty of evidence for studies that contributed data to our prespecified outcomes. MAIN RESULTS Four studies with a total of 15,412 participants met the inclusion criteria. The mean age of study participants ranged from 64.4 to 65.3 years; the proportion of female participants ranged from 28% to 40%. Most participants had symptomatic COPD (COPD Assessment Test Score ≥ 10) with severe to very severe airflow limitation (forced expiratory volume in one second (FEV1) < 50% predicted) and one or more moderate-to-severe COPD exacerbations in the last 12 months. Trial medications differed amongst studies. The duration of follow-up was 52 weeks in three studies and 24 weeks in one study. We assessed the risk of selection, performance, and detection bias to be low in the included studies; one study was at high risk of attrition bias, and one study was at high risk of reporting bias. Triple therapy may reduce rates of moderate-to-severe COPD exacerbations compared to combination LABA/LAMA inhalers (rate ratio (RR) 0.74, 95% confidence interval (CI) 0.67 to 0.81; n = 15,397; low-certainty evidence). Subgroup analysis stratifying by blood eosinophil counts showed there may be a greater reduction in rate of moderate-to-severe COPD exacerbations with triple therapy in participants with high-eosinophils (RR 0.67, 95% CI 0.60 to 0.75) compared to low-eosinophils (RR 0.87, 95% CI 0.81 to 0.93) (test for subgroup differences: P < 0.01) (high/low cut-offs: 150 eosinophils/µL in three studies; 200 eosinophils/µL in one study). However, moderate-to-substantial heterogeneity was observed in both high- and low-eosinophil subgroups. These subgroup analyses are observational by nature and thus results should be interpreted with caution. Triple therapy may be associated with reduced rates of severe COPD exacerbations (RR 0.75, 95% CI 0.67 to 0.84; n = 14,131; low-certainty evidence). Triple therapy improved health-related quality of life assessed using the St George's Respiratory Questionnaire (SGRQ) by the minimal clinically important difference (MCID) threshold (4-point decrease) (35.3% versus 42.4%, odds ratio (OR) 1.35, 95% CI 1.26 to 1.45; n = 14,070; high-certainty evidence). Triple therapy may result in fewer symptoms measured using the Transition Dyspnoea Index (TDI) (OR 1.33, 95% CI 1.13 to 1.57; n = 3044; moderate-certainty evidence) and improved lung function as measured by change in trough FEV1 (mean difference 38.68 mL, 95% CI 22.58 to 54.77; n = 11,352; low-certainty evidence). However, these benefits fell below MCID thresholds for TDI (1-unit decrease) and trough FEV1 (100 mL), respectively. Triple therapy is probably associated with a higher risk of pneumonia as a serious adverse event compared to combination LABA/LAMA inhalers (3.3% versus 1.9%, OR 1.74, 95% CI 1.39 to 2.18; n = 15,412; moderate-certainty evidence). In contrast, all-cause serious adverse events may be similar between groups (19.7% versus 19.7%, OR 0.95, 95% CI 0.87 to 1.03; n = 15,412; low-certainty evidence). All-cause mortality may be lower with triple therapy (1.4% versus 2.0%, OR 0.70, 95% CI 0.54 to 0.90; n = 15,397; low-certainty evidence). AUTHORS' CONCLUSIONS The available evidence suggests that triple therapy may reduce rates of COPD exacerbations (low-certainty evidence) and results in an improvement in health-related quality of life (high-certainty evidence) compared to combination LABA/LAMA inhalers, but probably confers an increased pneumonia risk as a serious adverse event (moderate-certainty evidence). Triple therapy probably improves respiratory symptoms and may improve lung function (moderate- and low-certainty evidence, respectively); however, these benefits do not appear to be clinically significant. Triple therapy may reduce the risk of all-cause mortality compared to combination LABA/LAMA inhalers (low-certainty evidence). The certainty of the evidence was downgraded most frequently for inconsistency or indirectness. Across the four included studies, there were important differences in inclusion criteria, trial medications, and duration of follow-up. Investigation of heterogeneity was limited due to the small number of included studies. We found limited data on the effects of triple therapy compared to combination LABA/LAMA inhalers in patients with mild-moderate COPD and those without a recent exacerbation history.
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Affiliation(s)
- Wouter H van Geffen
- Department of Pulmonary Diseases, Medical Center Leeuwarden, Leeuwarden, Netherlands
| | - Daniel J Tan
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | | | - E Haydn Walters
- NHMRC Centre of Research Excellence for Chronic Respiratory Disease, School of Medicine, University of Tasmania, Hobart, Australia
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Asmara OD, Tenda ED, Singh G, Pitoyo CW, Rumende CM, Rajabto W, Ananda NR, Trisnawati I, Budiyono E, Thahadian HF, Boerma EC, Faisal A, Hutagaol D, Soeharto W, Radityamurti F, Marfiani E, Romadhon PZ, Kholis FN, Suryadinata H, Soeroto AY, Gondhowiardjo SA, van Geffen WH. Lung Cancer in Indonesia. J Thorac Oncol 2023; 18:1134-1145. [PMID: 37599047 DOI: 10.1016/j.jtho.2023.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 06/12/2023] [Indexed: 08/22/2023]
Affiliation(s)
- Oke Dimas Asmara
- Division of Respirology and Critical Illness, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia; Department of Sustainable Health, Campus Fryslân, University of Groningen, Leeuwarden, The Netherlands.
| | - Eric Daniel Tenda
- Division of Respirology and Critical Illness, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Gurmeet Singh
- Division of Respirology and Critical Illness, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Ceva Wicaksono Pitoyo
- Division of Respirology and Critical Illness, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Cleopas Martin Rumende
- Division of Respirology and Critical Illness, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Wulyo Rajabto
- Division of Hematology-Medical Oncology, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Nur Rahmi Ananda
- Division of Pulmonology, Department of Internal Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Ika Trisnawati
- Division of Pulmonology, Department of Internal Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Eko Budiyono
- Division of Pulmonology, Department of Internal Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Harik Firman Thahadian
- Division of Pulmonology, Department of Internal Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - E Christiaan Boerma
- Department of Sustainable Health, Campus Fryslân, University of Groningen, Leeuwarden, The Netherlands
| | - Achmad Faisal
- Division of Cardiothoracic and Vascular surgery, Department of Surgery, Fatmawati General Hospital, Jakarta, Indonesia
| | - David Hutagaol
- Division of Cardiothoracic and Vascular surgery, Department of Surgery, Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Wuryantoro Soeharto
- Division of Cardiothoracic and Vascular surgery, Department of Surgery, Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Fahmi Radityamurti
- Department of Radiation Oncology, Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Erika Marfiani
- Department of Internal Medicine, Faculty of Medicine Airlangga University, Surabaya, Indonesia
| | - Pradana Zaky Romadhon
- Department of Internal Medicine, Faculty of Medicine Airlangga University, Surabaya, Indonesia
| | - Fathur Nur Kholis
- Division of Pulmonary Disease and Critical Care Medicine, Department of Internal Medicine, Faculty of Medicine Universitas Diponegoro, Dr. Kariadi Hospital, Semarang, Indonesia
| | - Hendarsyah Suryadinata
- Division of Respirology and Critical Care Medicine, Department of Internal Medicine, Faculty of Medicine Universitas Padjadjaran, Hasan Sadikin General Hospital Bandung, Indonesia
| | - Arto Yuwono Soeroto
- Division of Respirology and Critical Care Medicine, Department of Internal Medicine, Faculty of Medicine Universitas Padjadjaran, Hasan Sadikin General Hospital Bandung, Indonesia
| | - Soehartati A Gondhowiardjo
- Department of Radiation Oncology, Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Wouter H van Geffen
- Department of Pulmonary Diseases, Medical Center Leeuwarden, Leeuwarden, The Netherlands
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Noordhof AL, Swart EM, Damhuis RA, Hendriks LE, Kunst PW, Aarts MJ, van Geffen WH. Prognostic Implication of KRAS G12C Mutation in a Real-World KRAS-Mutated Stage IV NSCLC Cohort Treated With Immunotherapy in The Netherlands. JTO Clin Res Rep 2023; 4:100543. [PMID: 37674812 PMCID: PMC10477684 DOI: 10.1016/j.jtocrr.2023.100543] [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: 03/20/2023] [Revised: 06/09/2023] [Accepted: 06/18/2023] [Indexed: 09/08/2023] Open
Abstract
Introduction With the approval of G12C inhibitors as the second line of treatment for KRAS G12C-mutated NSCLC, and the expanding research regarding targeting KRAS, it is key to understand the prognostic implication of KRAS G12C in the current first line of treatment. We compared overall survival (OS) of patients with stage IV KRAS G12C-mutated NSCLC to those with a KRAS non-G12C mutation in a first-line setting of (chemo)immunotherapy. Methods This nationwide population-based study used real-world data from The Netherlands Cancer Registry. We selected patients with stage IV KRAS-mutated lung adenocarcinoma diagnosed in 2019 to 2020 who received first-line (chemo-)immunotherapy. Primary outcome was OS. Results From 28,120 registered patients with lung cancer, 1185 were selected with a KRAS mutation, of which 494 had a KRAS G12C mutation. Median OS was 15.5 months (95% confidence interval [CI]: 13.6-18.4) for KRAS G12C versus 14.0 months (95% CI:11.2-15.7) for KRAS non-G12C (p = 0.67). In multivariable analysis, KRAS subtype was not associated with OS (hazard ratio = 0.95, 95% CI: 0.82-1.10). For the subgroup with programmed death-ligand 1 at 0% to 49% who received chemoimmunotherapy, median OS was 13.3 months (95% CI: 10.5-15.2) for G12C and 9.8 months (95% CI: 8.6-11.3) for non-G12C (p = 0.48). For the subgroup with programmed death-ligand 1 more than or equal to 50% who received monoimmunotherapy, the median OS was 22.0 months (95% CI: 18.4-27.3) for G12C and 18.9 months (95% CI: 14.9-25.2) for non-G12C (p = 0.36). Conclusions There was no influence of KRAS subtype (G12C versus non-G12C) on OS in patients with KRAS-mutated stage IV NSCLC treated with first-line (chemo)immunotherapy.
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Affiliation(s)
- Anneloes L. Noordhof
- Department of Respiratory Medicine, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - Esther M. Swart
- Department of Research & Development, Netherlands Comprehensive Cancer Organization, Utrecht, The Netherlands
| | - Ronald A.M. Damhuis
- Department of Research & Development, Netherlands Comprehensive Cancer Organization, Utrecht, The Netherlands
| | - Lizza E.L. Hendriks
- Department of Respiratory Medicine, GROW-School for Oncology and Reproduction, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Peter W.A. Kunst
- Department of Respiratory Medicine, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Mieke J. Aarts
- Department of Research & Development, Netherlands Comprehensive Cancer Organization, Utrecht, The Netherlands
| | - Wouter H. van Geffen
- Department of Respiratory Medicine, Medical Center Leeuwarden, Leeuwarden, The Netherlands
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Gijtenbeek RG, de Jong K, Venmans BJ, van Vollenhoven FH, Ten Brinke A, Van der Wekken AJ, van Geffen WH. Best first-line therapy for people with advanced non-small cell lung cancer, performance status 2 without a targetable mutation or with an unknown mutation status. Cochrane Database Syst Rev 2023; 7:CD013382. [PMID: 37419867 PMCID: PMC10327404 DOI: 10.1002/14651858.cd013382.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/09/2023]
Abstract
BACKGROUND Most people who are newly diagnosed with non-small cell lung cancer (NSCLC) have advanced disease. For these people, survival is determined by various patient- and tumor-related factors, of which the performance status (PS) is the most important prognostic factor. People with PS 0 or 1 are usually treated with systemic therapies, whereas people with PS 3 or 4 most often receive supportive care. However, treatment for people with PS 2 without a targetable mutation remains unclear. Historically, people with a PS 2 cancer are frequently excluded from (important) clinical trials because of poorer outcomes and increased toxicity. We aim to address this knowledge gap, as this group of people represents a significant proportion (20% to 30%) of the total population with newly diagnosed lung cancer. OBJECTIVES To identify the best first-line therapy for advanced lung cancer in people with performance status 2 without a targetable mutation or with an unknown mutation status. SEARCH METHODS We used standard, extensive Cochrane search methods. The latest search date was 17 June 2022. SELECTION CRITERIA We included randomized controlled trials (RCTs) that compared different chemotherapy (with or without angiogenesis inhibitor) or immunotherapy regimens, specifically designed for people with PS 2 only or studies including a subgroup of these people. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Our primary outcomes were 1. overall survival (OS), 2. health-related quality of life (HRQoL), and 3. toxicity/adverse events. Our secondary outcomes were 4. tumor response rate, 5. progression-free survival, and 6. survival rates at six and 12 months' treatment. We used GRADE to assess certainty of evidence for each outcome. MAIN RESULTS We included 22 trials in this review and identified one ongoing trial. Twenty studies compared chemotherapy with different regimens, of which 11 compared non-platinum therapy (monotherapy or doublet) versus platinum doublet. We found no studies comparing best supportive care with chemotherapy and only two abstracts analyzing chemotherapy versus immunotherapy. We found that platinum doublet therapy showed superior OS compared to non-platinum therapy (hazard ratio [HR] 0.67, 95% confidence interval [CI] 0.57 to 0.78; 7 trials, 697 participants; moderate-certainty evidence). There were no differences in six-month survival rates (risk ratio [RR] 1.00, 95% CI 0.72 to 1.41; 6 trials, 632 participants; moderate-certainty evidence), whereas 12-month survival rates were improved for treatment with platinum doublet therapy (RR 0.92, 95% CI 0.87 to 0.97; 11 trials, 1567 participants; moderate-certainty evidence). PFS and tumor response rate were also better for people treated with platinum doublet therapy, with moderate-certainty evidence (PFS: HR 0.57, 95% CI 0.42 to 0.77; 5 trials, 487 participants; tumor response rate: RR 2.25, 95% CI 1.67 to 3.05; 9 trials, 964 participants). When analyzing toxicity rates, we found that platinum doublet therapy increased grade 3 to 5 hematologic toxicities, all with low-certainty evidence (anemia: RR 1.98, 95% CI 1.00 to 3.92; neutropenia: RR 2.75, 95% CI 1.30 to 5.82; thrombocytopenia: RR 3.96, 95% CI 1.73 to 9.06; all 8 trials, 935 participants). Only four trials reported HRQoL data; however, the methodology was different per trial and we were unable to perform a meta-analysis. Although evidence is limited, there were no differences in 12-month survival rates or tumor response rates between carboplatin and cisplatin regimens. With an indirect comparison, carboplatin seemed to have better 12-month survival rates than cisplatin compared to non-platinum therapy. The assessment of the efficacy of immunotherapy in people with PS 2 was limited. There might be a place for single-agent immunotherapy, but the data provided by the included studies did not encourage the use of double-agent immunotherapy. AUTHORS' CONCLUSIONS This review showed that as a first-line treatment for people with PS 2 with advanced NSCLC, platinum doublet therapy seems to be preferred over non-platinum therapy, with a higher response rate, PFS, and OS. Although the risk for grade 3 to 5 hematologic toxicity is higher, these events are often relatively mild and easy to treat. Since trials using checkpoint inhibitors in people with PS 2 are scarce, we identified an important knowledge gap regarding their role in people with advanced NSCLC and PS 2.
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Affiliation(s)
- Rolof Gp Gijtenbeek
- Department of Pulmonary Diseases, Medical Center Leeuwarden, Leeuwarden, Netherlands
| | - Kim de Jong
- Department of Epidemiology, Medical Center Leeuwarden, Leeuwarden, Netherlands
| | - Ben Jw Venmans
- Department of Pulmonary Diseases, Medical Center Leeuwarden, Leeuwarden, Netherlands
| | | | - Anneke Ten Brinke
- Department of Pulmonary Diseases, Medical Center Leeuwarden, Leeuwarden, Netherlands
| | - Anthonie J Van der Wekken
- Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Wouter H van Geffen
- Department of Pulmonary Diseases, Medical Center Leeuwarden, Leeuwarden, Netherlands
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Swart EM, Noordhof AL, Damhuis RAM, Kunst PWA, De Ruysscher DKM, Hendriks LEL, van Geffen WH, Aarts MJ. Survival of patients with KRAS G12C mutated stage IV non-small cell lung cancer with and without brain metastases treated with immune checkpoint inhibitors. Lung Cancer 2023; 182:107290. [PMID: 37419045 DOI: 10.1016/j.lungcan.2023.107290] [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: 04/20/2023] [Revised: 06/29/2023] [Accepted: 06/30/2023] [Indexed: 07/09/2023]
Abstract
INTRODUCTION Few data is available on whether brain metastases (BM) influence survival in patients with stage IV KRAS G12C mutated (KRAS G12C+ ) non-small cell lung cancer (NSCLC) treated with first-line immune checkpoint inhibitor (ICI) +/- chemotherapy ([chemo]-ICI). METHODS Data was retrospectively collected from the population-based Netherlands Cancer Registry. The cumulative incidence of intracranial progression, overall survival (OS) and progression free survival (PFS) was determined for patients with KRAS G12C+ stage IV NSCLC diagnosed January 1 - June 30, 2019, treated with first-line (chemo)-ICI. OS and PFS were estimated using Kaplan-Meier methods and BM+ and BM- groups were compared using log-rank tests. RESULTS Of 2489 patients with stage IV NSCLC, 153 patients had KRAS G12C+ and received first-line (chemo)-ICI. Of those patients, 35% (54/153) underwent brain imaging (CT and/or MRI), of which 85% (46/54) MRI. Half of the patients with brain imaging (56%; 30/54) had BM, concerning one-fifth (20%; 30/153) of all patients, of which 67% was symptomatic. Compared to BM-, patients with BM+ were younger and had more organs affected with metastasis. Around one-third (30%) of patients with BM+ had ≥5 BM at diagnosis. Three quarters of patients with BM+ received cranial radiotherapy prior to start of (chemo)-ICI. The 1-year cumulative incidence of intracranial progression was 33% for patients with known baseline BM and 7% for those without (p = 0.0001). Median PFS was 6.6 (95% CI 3.0-15.9) and 6.7 (95% CI 5.1-8.5) months for BM+ and BM- (p = 0.80), respectively. Median OS was 15.7 (95% CI 6.2-27.3) and 17.8 (95% CI 13.4-22.0) months for BM+ and BM- (p = 0.77), respectively. CONCLUSION Baseline BM are common in patients with metastatic KRAS G12C+ NSCLC. During (chemo)-ICI treatment, intracranial progression was more frequent in patients with known baseline BM, justifying regular imaging during treatment. In our study, presence of known baseline BM did not influence OS or PFS.
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Affiliation(s)
- Esther M Swart
- Netherlands Comprehensive Cancer Organisation (IKNL), Department of Research and Development, Utrecht, The Netherlands
| | - Anneloes L Noordhof
- Department of Respiratory Medicine, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - Ronald A M Damhuis
- Netherlands Comprehensive Cancer Organisation (IKNL), Department of Research and Development, Utrecht, The Netherlands
| | - Peter W A Kunst
- Netherlands Comprehensive Cancer Organisation (IKNL), Department of Research and Development, Utrecht, The Netherlands; Department of Respiratory Medicine, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Dirk K M De Ruysscher
- Maastricht University Medical Center, GROW School for Oncology and Developmental Biology, Department of Radiation Oncology (MAASTRO Clinic), Maastricht, The Netherlands; Department of Radiation Oncology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands
| | - Lizza E L Hendriks
- Maastricht University Medical Center, GROW School for Oncology and Developmental Biology, Department of Pulmonary Diseases, Maastricht, The Netherlands
| | - Wouter H van Geffen
- Department of Respiratory Medicine, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - Mieke J Aarts
- Netherlands Comprehensive Cancer Organisation (IKNL), Department of Research and Development, Utrecht, The Netherlands.
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Kort S, Brusse-Keizer M, Schouwink H, Citgez E, de Jongh FH, van Putten JWG, van den Borne B, Kastelijn EA, Stolz D, Schuurbiers M, van den Heuvel MM, van Geffen WH, van der Palen J. Diagnosing Non-Small Cell Lung Cancer by Exhaled Breath Profiling Using an Electronic Nose: A Multicenter Validation Study. Chest 2023; 163:697-706. [PMID: 36243060 DOI: 10.1016/j.chest.2022.09.042] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [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: 05/04/2022] [Revised: 09/02/2022] [Accepted: 09/23/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Despite the potential of exhaled breath analysis of volatile organic compounds to diagnose lung cancer, clinical implementation has not been realized, partly due to the lack of validation studies. RESEARCH QUESTION This study addressed two questions. First, can we simultaneously train and validate a prediction model to distinguish patients with non-small cell lung cancer from non-lung cancer subjects based on exhaled breath patterns? Second, does addition of clinical variables to exhaled breath data improve the diagnosis of lung cancer? STUDY DESIGN AND METHODS In this multicenter study, subjects with non-small cell lung cancer and control subjects performed 5 min of tidal breathing through the aeoNose, a handheld electronic nose device. A training cohort was used for developing a prediction model based on breath data, and a blinded cohort was used for validation. Multivariable logistic regression analysis was performed, including breath data and clinical variables, in which the formula and cutoff value for the probability of lung cancer were applied to the validation data. RESULTS A total of 376 subjects formed the training set, and 199 subjects formed the validation set. The full training model (including exhaled breath data and clinical parameters from the training set) were combined in a multivariable logistic regression analysis, maintaining a cut off of 16% probability of lung cancer, resulting in a sensitivity of 95%, a specificity of 51%, and a negative predictive value of 94%; the area under the receiver-operating characteristic curve was 0.87. Performance of the prediction model on the validation cohort showed corresponding results with a sensitivity of 95%, a specificity of 49%, a negative predictive value of 94%, and an area under the receiver-operating characteristic curve of 0.86. INTERPRETATION Combining exhaled breath data and clinical variables in a multicenter, multi-device validation study can adequately distinguish patients with lung cancer from subjects without lung cancer in a noninvasive manner. This study paves the way to implement exhaled breath analysis in the daily practice of diagnosing lung cancer. CLINICAL TRIAL REGISTRATION The Netherlands Trial Register; No.: NL7025; URL: https://trialregister.nl/trial/7025.
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Affiliation(s)
- Sharina Kort
- Department of Respiratory Medicine, Medisch Spectrum Twente Enschede, Enschede, The Netherlands.
| | - Marjolein Brusse-Keizer
- Medical School Twente, Enschede, The Netherlands; Universiteit of Twente, Faculty of Behavioural Management and Social Sciences, Enschede, The Netherlands
| | - Hugo Schouwink
- Department of Respiratory Medicine, Medisch Spectrum Twente Enschede, Enschede, The Netherlands
| | - Emanuel Citgez
- Department of Respiratory Medicine, Medisch Spectrum Twente Enschede, Enschede, The Netherlands
| | - Frans H de Jongh
- Department of Respiratory Medicine, Medisch Spectrum Twente Enschede, Enschede, The Netherlands; Universiteit of Twente, Faculty of Behavioural Management and Social Sciences, Enschede, The Netherlands
| | - Jan W G van Putten
- Department of Respiratory Medicine, Martini Ziekenhuis, Groningen, The Netherlands
| | - Ben van den Borne
- Department of Respiratory Medicine, Catharina Ziekenhuis, Eindhoven, The Netherlands
| | - Elisabeth A Kastelijn
- Department of Respiratory Medicine, Sint Antonius Ziekenhuis, Utrecht, The Netherlands
| | - Daiana Stolz
- Clinic for Pulmonary Medicine and Respiratory Cell Research, Universitätspital Basel, Basel, Switzerland; Clinic for Respiratory Medicine, Medical Center, University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Milou Schuurbiers
- Department of Respiratory Medicine, Radboud UMC, Nijmegen, The Netherlands
| | | | - Wouter H van Geffen
- Department of Respiratory Medicine, Medisch Centrum Leeuwarden, Leeuwarden, The Netherlands
| | - Job van der Palen
- Medical School Twente, Enschede, The Netherlands; Universiteit of Twente, Faculty of Behavioural Management and Social Sciences, Enschede, The Netherlands
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Gijtenbeek RG, Damhuis RA, van der Wekken AJ, Hendriks LE, Groen HJ, van Geffen WH. Overall survival in advanced epidermal growth factor receptor mutated non-small cell lung cancer using different tyrosine kinase inhibitors in The Netherlands: a retrospective, nationwide registry study. Lancet Reg Health Eur 2023; 27:100592. [PMID: 36817181 PMCID: PMC9932646 DOI: 10.1016/j.lanepe.2023.100592] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 01/18/2023] [Accepted: 01/19/2023] [Indexed: 02/08/2023]
Abstract
Background Clinical guidelines advise osimertinib as preferred first line treatment for advanced epidermal growth factor receptor (EGFR) mutated non-small cell lung cancer (NSCLC) with deletions in exon 19 (del19) or exon 21 L858R mutation. However, for first-line osimertinib the real world overall survival (OS) in mutation subgroups remains unknown. Therefore, the aim of this study was to evaluate the real-world OS of those patients treated with different generations of EGFR-tyrosine kinase inhibitors (TKI), and to identify predictors of survival. Methods Using real-world data from the Netherlands Cancer Registry (NCR) we assessed patients diagnosed with stage IV NSCLC with del19 or L858R mutation between January 1, 2015, and December 31, 2020, primarily treated with then regularly available TKIs (including osimertinib). Findings Between January 1, 2015, and December 31, 2020, 57,592 patients were included in the NCR. Within this cohort we identified 1109 patients, 654 (59%) with del19 and 455 (41%) with L858R mutations, respectively; 230 (21%) patients were diagnosed with baseline brain metastases (BM). Patients were treated with gefitinib (19%, 213/1109), erlotinib (42%, 470/1109), afatinib (15%, 161/1109) or osimertinib (24%, 265/1109). Median OS was superior for del19 versus L858R (28.4 months (95% CI 25.6-30.6) versus 17.7 months (95% CI 16.1-19.5), p < 0.001. In multivariable analysis, no difference in survival was observed between various TKIs in both groups. Only in the subgroup of patients with del19 and baseline BM, a benefit was observed for treatment with osimertinib. Interpretation In this nationwide real-world cohort, survival of Dutch patients with advanced NSCLC and an EGFR del19 mutation was superior versus those harboring an L858R mutation. Osimertinib performed only better as first-line treatment in patients with del19 and BM. Funding None.
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Affiliation(s)
- Rolof G.P. Gijtenbeek
- Department of Respiratory Medicine, Medical Center Leeuwarden, Henri Dunantweg 2, 8934 AD, Leeuwarden, Netherlands
| | - Ronald A.M. Damhuis
- Department of Research, Comprehensive Cancer Organization, Plesmanlaan 121, 1066 CX, Utrecht, Netherlands
| | - Anthonie J. van der Wekken
- Department of Pulmonary Diseases, University Medical Center Groningen and University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, Netherlands
| | - Lizza E.L. Hendriks
- Department of Respiratory Medicine, Maastricht University Medical Centre, GROW School for Oncology and Reproduction, P. Debyelaan 25, 6229 HX, Maastricht, Netherlands
| | - Harry J.M. Groen
- Department of Pulmonary Diseases, University Medical Center Groningen and University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, Netherlands
| | - Wouter H. van Geffen
- Department of Respiratory Medicine, Medical Center Leeuwarden, Henri Dunantweg 2, 8934 AD, Leeuwarden, Netherlands,Corresponding author. Department of Respiratory Medicine, Medical Center Leeuwarden, Henri Dunantweg 2, 8934 AD Leeuwarden, Netherlands.
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8
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Veenstra P, Veeger NJGM, Koppers RJH, Duiverman ML, van Geffen WH. High-flow nasal cannula oxygen therapy for admitted COPD-patients. A retrospective cohort study. PLoS One 2022; 17:e0272372. [PMID: 36197917 PMCID: PMC9534431 DOI: 10.1371/journal.pone.0272372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 07/18/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The use of High-flow nasal cannula (HFNC) is increasing in admitted COPD-patients and could provide a step in between non-invasive ventilation (NIV) and standard oxygen supply. Recent studies demonstrated that HFNC is capable of facilitating secretion removal and reduce the work of breathing. Therefore, it might be of advantage in the treatment of acute exacerbations of COPD (AECOPD). No randomized trials have assessed this for admitted COPD-patients on a regular ward and only limited data from non-randomized studies is available. OBJECTIVES The aim of our study was to identify the reasons to initiate treatment with HFNC in a group of COPD-patients during an exacerbation, further identify those most likely to benefit from HFNC treatment and to find factors associated with treatment success on the pulmonary ward. MATERIAL AND METHODS This retrospective study included COPD-patients admitted to the pulmonary ward and treated with HFNC from April 2016 until April 2019. Only patients admitted with severe acute exacerbations were included. Patients who had an indication for NIV-treatment where treated with NIV and were included only if they subsequently needed HFNC, e.g. when they did not tolerate NIV. Known asthma patients were excluded. RESULTS A total of 173 patients were included. Stasis of sputum was the indication most reported to initiate HFNC-treatment. Treatment was well tolerated in 83% of the patients. Cardiac and vascular co-morbidities were significantly associated with a smaller chance of successful treatment (Respectively OR = 0.435; p = 0.013 and OR = 0.493;p = 0.035). Clinical assessment judged HFNC-treatment to be successful in 61% of the patients. Furthermore, in-hospital treatment with NIV was associated with a higher chance of HFNC failure afterwards (OR = 0.439; p = 0.045). CONCLUSION This large retrospective study showed that HFNC-treatment in patients with an AECOPD was initiated most often for sputum stasis as primary reason. Factors associated with improved outcomes of HFNC-treatment was the absence of vascular and/or cardiac co-morbidities and no need for in-hospital NIV-treatment.
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Affiliation(s)
- Pieter Veenstra
- Department of Respiratory Medicine, Medical Center Leeuwarden, Leeuwarden, Netherlands
| | - Nic J. G. M. Veeger
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Ralph J. H. Koppers
- Department of Respiratory Medicine, Medical Center Leeuwarden, Leeuwarden, Netherlands
| | - Marieke L. Duiverman
- Department of Pulmonary Diseases/Home Mechanical Ventilation, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Wouter H. van Geffen
- Department of Respiratory Medicine, Medical Center Leeuwarden, Leeuwarden, Netherlands
- * E-mail:
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9
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Gijtenbeek RG, van der Noort V, Aerts JG, Staal-van den Brekel JA, Smit EF, Krouwels FH, Wilschut FA, Hiltermann TJN, Timens W, Schuuring E, Janssen JD, Goosens M, van den Berg PM, de Langen AJ, Stigt JA, van den Borne BE, Groen HJ, van Geffen WH, van der Wekken AJ. Randomised controlled trial of first-line tyrosine-kinase inhibitor (TKI) versus intercalated TKI with chemotherapy for EGFR-mutated nonsmall cell lung cancer. ERJ Open Res 2022; 8:00239-2022. [PMID: 36267895 PMCID: PMC9574558 DOI: 10.1183/23120541.00239-2022] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 07/05/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction Previous studies have shown interference between epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors and chemotherapy in the cell cycle, thus reducing efficacy. In this randomised controlled trial we investigated whether intercalated erlotinib with chemotherapy was superior compared to erlotinib alone in untreated advanced EGFR-mutated nonsmall cell lung cancer (NSCLC). Materials and methods Treatment-naïve patients with an activating EGFR mutation, ECOG performance score of 0-3 and adequate organ function were randomly assigned 1:1 to either four cycles of cisplatin-pemetrexed with intercalated erlotinib (day 2-16 out of 21 days per cycle) followed by pemetrexed and erlotinib maintenance (CPE) or erlotinib monotherapy. The primary end-point was progression-free survival (PFS). Secondary end-points were overall survival, objective response rate (ORR) and toxicity. Results Between April 2014 and September 2016, 22 patients were randomised equally into both arms; the study was stopped due to slow accrual. Median follow-up was 64 months. Median PFS was 13.7 months (95% CI 5.2-18.8) for CPE and 10.3 months (95% CI 7.1-15.5; hazard ratio (HR) 0.62, 95% CI 0.25-1.57) for erlotinib monotherapy; when compensating for number of days receiving erlotinib, PFS of the CPE arm was superior (HR 0.24, 95% CI 0.07-0.83; p=0.02). ORR was 64% for CPE versus 55% for erlotinib monotherapy. Median overall survival was 31.7 months (95% CI 21.8-61.9 months) for CPE compared to 17.2 months (95% CI 11.5-45.5 months) for erlotinib monotherapy (HR 0.58, 95% CI 0.22-1.41 months). Patients treated with CPE had higher rates of treatment-related fatigue, anorexia, weight loss and renal toxicity. Conclusion Intercalating erlotinib with cisplatin-pemetrexed provides a longer PFS compared to erlotinib alone in EGFR-mutated NSCLC at the expense of more toxicity.
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Affiliation(s)
- Rolof G.P. Gijtenbeek
- Dept of Respiratory Medicine, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
| | - Vincent van der Noort
- Dept of Biometrics, Netherlands Cancer Institute – Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Joachim G.J.V. Aerts
- Dept of Pulmonary Diseases, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | | | - Egbert F. Smit
- Dept of Pulmonology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Frans H. Krouwels
- Dept of Respiratory Medicine, Spaarne Hospital, Hoofddorp, The Netherlands
| | - Frank A. Wilschut
- Dept of Respiratory Medicine, Gelderse Vallei Hospital, Ede, The Netherlands
| | - T. Jeroen N. Hiltermann
- Dept of Pulmonary Diseases, University of Groningen and University Medical Centre Groningen, Groningen, The Netherlands
| | - Wim Timens
- Dept of Pathology and Medical Biology, University of Groningen and University Medical Centre Groningen, Groningen, The Netherlands
| | - Ed Schuuring
- Dept of Pathology and Medical Biology, University of Groningen and University Medical Centre Groningen, Groningen, The Netherlands
| | - Joost D.J. Janssen
- Dept of Respiratory Medicine, Máxima Medical Centre, Eindhoven/Veldhoven, The Netherlands
| | - Martijn Goosens
- Dept of Pulmonary Medicine, Gelre Hospitals, Zutphen, The Netherlands
| | | | - A. Joop de Langen
- Dept of Thoracic Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Jos A. Stigt
- Dept of Respiratory Medicine, Isala Hospital, Zwolle, The Netherlands
| | | | - Harry J.M. Groen
- Dept of Pulmonary Diseases, University of Groningen and University Medical Centre Groningen, Groningen, The Netherlands
| | - Wouter H. van Geffen
- Dept of Respiratory Medicine, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
| | - Anthonie J. van der Wekken
- Dept of Pulmonary Diseases, University of Groningen and University Medical Centre Groningen, Groningen, The Netherlands
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10
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Rutgers A, Westerweel PE, van der Holt B, Postma S, van Vonderen MGA, Piersma DP, Postma D, van den Berge M, Jong E, de Vries M, van der Burg L, Huugen D, van der Poel M, Kampschreur LM, Nijland M, Strijbos JH, Tamminga M, Mutsaers PGNJ, Schol-Gelok S, Dijkstra-Tiekstra M, Sidorenkov G, Vincenten J, van Geffen WH, Knoester M, Kosterink J, Gans R, Stegeman C, Huls G, van Meerten T. Timely administration of tocilizumab improves outcome of hospitalized COVID-19 patients. PLoS One 2022; 17:e0271807. [PMID: 35960720 PMCID: PMC9374226 DOI: 10.1371/journal.pone.0271807] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 06/25/2022] [Indexed: 01/08/2023] Open
Abstract
Introduction The aim of this study was to determine the efficacy of early tocilizumab treatment for hospitalized patients with COVID-19 disease. Methods Open-label randomized phase II clinical trial investigating tocilizumab in patients with proven COVID-19 admitted to the general ward and in need of supplemental oxygen. The primary endpoint of the study was 30-day mortality with a prespecified 2-sided significance level of α = 0.10. A post-hoc analysis was performed for a combined endpoint of mechanical ventilation or death at 30 days. Secondary objectives included comparing the duration of hospital stay, ICU admittance and duration of ICU stay and the duration of mechanical ventilation. Results A total of 354 patients (67% men; median age 66 years) were enrolled of whom 88% received dexamethasone. Thirty-day mortality was 19% (95% CI 14%-26%) in the standard arm versus 12% (95% CI: 8%-18%) in the tocilizumab arm, hazard ratio (HR) = 0.62 (90% CI 0.39–0.98; p = 0.086). 17% of patients were admitted to the ICU in each arm (p = 0.89). The median stay in the ICU was 14 days (IQR 9–28) in the standard arm versus 9 days (IQR 5–14) in the tocilizumab arm (p = 0.014). Mechanical ventilation or death at thirty days was 31% (95% CI 24%-38%) in the standard arm versus 21% (95% CI 16%-28%) in the tocilizumab arm, HR = 0.65 (95% CI 0.42–0.98; p = 0.042). Conclusions This randomized phase II study supports efficacy for tocilizumab when given early in the disease course in hospitalized patients who need oxygen support, especially when concomitantly treated with dexamethasone. Trial registration https://www.trialregister.nl/trial/8504.
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Affiliation(s)
- Abraham Rutgers
- Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, Groningen, The Netherlands
- * E-mail:
| | - Peter E. Westerweel
- Department of Internal Medicine, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - Bronno van der Holt
- HOVON Data Center, Department of Haematology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Simone Postma
- Department of Haematology, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Djura P. Piersma
- Department of Internal Medicine, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Douwe Postma
- Department of Internal Medicine, University Medical Center Groningen, Groningen, The Netherlands
| | - Maarten van den Berge
- Department of Pulmonology, University Medical Center Groningen, Groningen, The Netherlands
| | - Eefje Jong
- Department of Infectious Diseases, Meander MC, Amersfoort, The Netherlands
| | - Marten de Vries
- Department of Pulmonology, Tjongerschans Hospital, Heerenveen, The Netherlands
| | - Leonie van der Burg
- Department of Internal Medicine, Antonius Hospital Sneek, Sneek, The Netherlands
| | - Dennis Huugen
- Department of Internal Medicine, Deventer Hospital, Deventer, The Netherlands
| | - Marjolein van der Poel
- Department of Internal Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Linda M. Kampschreur
- Department of Internal Medicine, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - Marcel Nijland
- Department of Haematology, University Medical Center Groningen, Groningen, The Netherlands
| | - Jaap H. Strijbos
- Department of Pulmonology, Nij Smellinghe Hospital, Drachten, The Netherlands
| | - Menno Tamminga
- Department of Pulmonology, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Suzanne Schol-Gelok
- Department of Internal Medicine, Albert Schweitzer Hospital, Dordrecht, The Netherlands
- Department of Emergency Medicine, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | | | - Grigory Sidorenkov
- Department of Epidemiology, University Medical Center Groningen, Groningen, The Netherlands
| | - Julien Vincenten
- Department of Pulmonology, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - Wouter H. van Geffen
- Department of Pulmonology, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - Marjolein Knoester
- Department of Medical Microbiology, University Medical Center Groningen, Groningen, The Netherlands
| | - Jos Kosterink
- Pharmacy, University Medical Center Groningen, Groningen, The Netherlands
| | - Reinold Gans
- Department of Internal Medicine, University Medical Center Groningen, Groningen, The Netherlands
| | - Coen Stegeman
- Department of Internal Medicine, University Medical Center Groningen, Groningen, The Netherlands
| | - Gerwin Huls
- Department of Haematology, University Medical Center Groningen, Groningen, The Netherlands
| | - Tom van Meerten
- Department of Haematology, University Medical Center Groningen, Groningen, The Netherlands
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11
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Hartman JE, Klooster K, Augustijn SWS, van Geffen WH, Garner JL, Shah PL, Ten Hacken NHT, Slebos DJ. Identifying Responders and Exploring Mechanisms of Action of the Endobronchial Coil Treatment for Emphysema. Respiration 2021; 100:443-451. [PMID: 33744899 PMCID: PMC8220926 DOI: 10.1159/000514319] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 08/27/2020] [Accepted: 12/28/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND So far, 3 randomized controlled trials have shown that the endobronchial treatment using coils is safe and effective. However, the more exact underlying mechanism of the treatment and best predictors of response are unknown. OBJECTIVES The aim of the study was to gain more knowledge about the underlying physiological mechanism of the lung volume reduction coil treatment and to identify potential predictors of response to this treatment. METHODS This was a prospective nonrandomized single-center study which included patients who were bilaterally treated with coils. Patients underwent an extensive number of physical tests at baseline and 3 months after treatment. RESULTS Twenty-four patients (29% male, mean age 62 years, forced expiratory volume in 1 s [FEV1] 26% pred, residual volume (RV) 231% pred) were included. Three months after treatment, significant improvements were found in spirometry, static hyperinflation, air trapping, airway resistance, treated lobe RV and treated lobes air trapping measured on CT scan, exercise capacity, and quality of life. The change in RV and airway resistance was significantly associated with a change in FEV1, forced vital capacity, air trapping, maximal expiratory pressure, dynamic compliance, and dynamic hyperinflation. Predictors of treatment response at baseline were a higher RV, larger air trapping, higher emphysema score in the treated lobes, and a lower physical activity level. CONCLUSIONS Our results confirm that emphysema patients benefit from endobronchial coil treatment. The primary mechanism of action is decreasing static hyperinflation with improvement of airway resistance which consequently changes dynamic lung mechanics. However, the right patient population needs to be selected for the treatment to be beneficial which should include patients with severe lung hyperinflation, severe air trapping, and significant emphysema in target lobes.
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Affiliation(s)
- Jorine E Hartman
- Department of Pulmonary Diseases and Groningen Research Institute for Asthma and COPD, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands,
| | - Karin Klooster
- Department of Pulmonary Diseases and Groningen Research Institute for Asthma and COPD, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Sonja W S Augustijn
- Department of Pulmonary Diseases and Groningen Research Institute for Asthma and COPD, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Wouter H van Geffen
- Department of Pulmonary diseases, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - Justin L Garner
- Royal Brompton Hospital, London, United Kingdom
- National Heart & Lung Institute, Imperial College, London, United Kingdom
- Chelsea & Westminster Hospital, London, United Kingdom
| | - Pallav L Shah
- Royal Brompton Hospital, London, United Kingdom
- National Heart & Lung Institute, Imperial College, London, United Kingdom
- Chelsea & Westminster Hospital, London, United Kingdom
| | - Nick H T Ten Hacken
- Department of Pulmonary Diseases and Groningen Research Institute for Asthma and COPD, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Dirk-Jan Slebos
- Department of Pulmonary Diseases and Groningen Research Institute for Asthma and COPD, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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van Geffen WH, Carpaij OA, Westbroek LF, Seigers D, Niemeijer A, Vonk JM, Kerstjens HAM. Long-acting dual bronchodilator therapy (indacaterol/glycopyrronium) versus nebulized short-acting dual bronchodilator (salbutamol/ipratropium) in chronic obstructive pulmonary disease: A double-blind, randomized, placebo-controlled trial. Respir Med 2020; 171:106064. [PMID: 32917359 DOI: 10.1016/j.rmed.2020.106064] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 04/25/2020] [Accepted: 06/08/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Most guidelines recommend long-acting bronchodilators over short-acting bronchodilators for patients with chronic obstructive pulmonary disease (COPD). The available evidence for the guidelines was based on dry powder or pressurized metered dose inhalers, but not nebulizations. Nevertheless, there is considerable, poorly evidenced based, use of short acting nebulized bronchodilators. METHODS This was an investigator initiated, randomized, active controlled, cross-over, double-blind and double-dummy single centre study in patients with stable COPD. The active comparators were indacaterol/glycopyrronium 110/50 μg as Ultibro® via Breezhaler® (IND/GLY) and salbutamol/ipratropium 2,5/0,5 mg via air driven nebulization (SAL/IPR), both given as a single dose on separate days. The primary end point was the area under the FEV1 curve from baseline till 6 h. Secondary end points included change in Borg dyspnoea score, adverse events and change in hyperinflation measured by the inspiratory capacity. RESULTS A total of 33 COPD patients completed the trial and were evaluable, most of them were ex-smokers. The difference between the tested regimens for the primary endpoint, FEV1 AUC 0-6 h, 2965 ± 1544 mL (mean ± SD) for IND/GLY versus 3513 ± 1762 mL for SAL/IPR, was not significant (P = 0.08). The peak in FEV1 was higher and was reached faster with SAL/IPR compared to IND/GLY. No other significant differences were detected for the secondary endpoints including the Borg score, or adverse events. CONCLUSION Among patients with stable COPD, dry powder long-acting single inhalation of a LABA and a LAMA (IND/GLY) was not superior compared to nebulized short-acting salbutamol plus ipratropium (SAL/IPR) in its bronchodilating effects over 6 h.The effects of the nebulization kicked in faster and peaked higher. The observed differences may be caused by the difference in dosing between the two regimens. The improvement in Borg dyspnoea score did not favour the nebulization. Long-term outcomes were not assessed in this study.
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Affiliation(s)
- Wouter H van Geffen
- Medical Centre Leeuwarden, Department of Respiratory Medicine, Leeuwarden, the Netherlands; University of Groningen, University Medical Center Groningen, Department of Pulmonary Diseases, Groningen, the Netherlands.
| | - Orestes A Carpaij
- University of Groningen, University Medical Center Groningen, Department of Pulmonary Diseases, Groningen, the Netherlands; University of Groningen, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD, Groningen, the Netherlands
| | - Lotte F Westbroek
- University of Groningen, University Medical Center Groningen, Department of Pulmonary Diseases, Groningen, the Netherlands; University of Groningen, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD, Groningen, the Netherlands
| | - Dianne Seigers
- University of Groningen, University Medical Center Groningen, Department of Pulmonary Diseases, Groningen, the Netherlands; University of Groningen, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD, Groningen, the Netherlands
| | - Alice Niemeijer
- University of Groningen, University Medical Center Groningen, Department of Pulmonary Diseases, Groningen, the Netherlands; University of Groningen, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD, Groningen, the Netherlands
| | - Judith M Vonk
- University of Groningen, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD, Groningen, the Netherlands; University of Groningen, University Medical Center Groningen, Department of Epidemiology, Groningen, the Netherlands
| | - Huib A M Kerstjens
- University of Groningen, University Medical Center Groningen, Department of Pulmonary Diseases, Groningen, the Netherlands; University of Groningen, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD, Groningen, the Netherlands
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13
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Zeng H, Hendriks LEL, van Geffen WH, Witlox WJA, Eekers DBP, De Ruysscher DKM. Risk factors for neurocognitive decline in lung cancer patients treated with prophylactic cranial irradiation: A systematic review. Cancer Treat Rev 2020; 88:102025. [PMID: 32512415 DOI: 10.1016/j.ctrv.2020.102025] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 02/28/2020] [Revised: 04/21/2020] [Accepted: 04/28/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Prophylactic cranial irradiation (PCI) reduces brain metastasis incidence in lung cancer, however with risk of neurocognitive decline. Nevertheless, risk factors for neurocognitive decline after PCI remain unclear. METHODS We systematically reviewed the PubMed database according to the PRISMA guideline. Inclusion criteria were: randomized clinical trials (RCTs) and observational/single arm trials evaluating PCI, including ≥20 patients, reporting neurocognitive test results for lung cancer. Primary aim: evaluate risk factors associated with neurocognitive decline after PCI. RESULTS Twenty records were eligible (8 different RCTs, 8 observational studies), including 3553 patients in total (858 NSCLC, 2695 SCLC) of which 73.6% received PCI. Incidence of mild/moderate cognitive decline after PCI varied from 8 to 89% (grading not always provided); for those without PCI, this was 3.4-42%. Interestingly, 23-95% had baseline cognitive impairment. Risk factors were often not reported. In one trial, both age (>60 years) and higher PCI dose (36 Gy) including twice-daily PCI were associated with a higher risk of cognitive decline. In one trial, white matter abnormalities were more frequent in the concurrent or sandwiched PCI arm, but without significant neuropsychological differences. One trial identified hippocampal sparing PCI to limit the neurocognitive toxicities of PCI and another reported an association between hippocampal dose volume effects and memory decline. As neurocognition was a secondary endpoint in most RCTs, and was assessed by various instruments with often poor/moderate compliance, high-quality data is lacking. CONCLUSIONS Age, PCI dose, regimen and timing might be associated with cognitive impairment after PCI in lung cancer patients, but high-quality data is lacking. Future PCI trials should collect and evaluate possible risk factors systematically.
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Affiliation(s)
- Haiyan Zeng
- Department of Radiation Oncology (Maastro), GROW School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, The Netherlands.
| | - Lizza E L Hendriks
- Department of Pulmonary Diseases, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, the Netherlands.
| | - Wouter H van Geffen
- Department of Respiratory Medicine, Medical Centre Leeuwarden, Leeuwarden, the Netherlands.
| | - Willem J A Witlox
- Department of Clinical Epidemiology and Medical Technology Assessment, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, the Netherlands.
| | - Danielle B P Eekers
- Department of Radiation Oncology (Maastro), GROW School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, The Netherlands.
| | - Dirk K M De Ruysscher
- Department of Radiation Oncology (Maastro), GROW School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, The Netherlands.
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van Geffen WH, Lamote K, Costantini A, Hendriks LEL, Rahman NM, Blum TG, van Meerbeeck J. The electronic nose: emerging biomarkers in lung cancer diagnostics. Breathe (Sheff) 2020; 15:e135-e141. [PMID: 32280381 PMCID: PMC7121878 DOI: 10.1183/20734735.0309-2019] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Lung cancer is very common and the most common cause of cancer death worldwide. Despite recent progress in the systemic treatment of lung cancer (checkpoint inhibitors and tyrosine kinase inhibitors), each year, >1.5 million people die due to this disease. Most lung cancer patients already have advanced disease at the time of diagnosis. Computed tomography screening of high-risk individuals can detect lung cancer at an earlier stage but at a cost of false-positive findings. Biomarkers could lead towards a reduction of these false-positive findings and earlier lung cancer diagnosis, and have the potential to improve outcomes and treatment monitoring. To date, there is a lack of such biomarkers for lung cancer and other thoracic malignancies, although electronic nose (e-nose)-derived biomarkers are of interest. E-nose techniques using exhaled breath component measurements can detect lung cancer with a sensitivity ranging from 71% to 96% and specificity from 33 to 100%. In some case series, such results have been validated but this is mostly using internal validation and hence, more work is needed. Furthermore, standardised sampling and analysis methods are lacking, impeding interstudy comparison and clinical implementation. In this narrative review, we provide an overview of the currently available data on E-nose technology for lung cancer detection.
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Affiliation(s)
- Wouter H van Geffen
- Dept of Pulmonary Medicine, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
| | - Kevin Lamote
- Dept of Pulmonology, Antwerp University Hospital, Edegem, Belgium.,Laboratory of Experimental Medicine and Pediatrics, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Infla-Med Consortium of Excellence, University of Antwerp, Antwerp, Belgium.,Internal Medicine and Paediatrics, Ghent University, Ghent, Belgium
| | - Adrien Costantini
- Dept of Respiratory Diseases and Thoracic Oncology, APHP, Hôpital Ambroise Paré, Boulogne-Billancourt, France
| | - Lizza E L Hendriks
- Dept of Pulmonary Medicine, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Najib M Rahman
- Oxford Respiratory Trials Unit, Nuffield Dept of Medicine, University of Oxford, Oxford, UK.,Oxford NIHR Biomedical Research Centre, Oxford, UK
| | - Torsten G Blum
- Lungenklinik Heckeshorn, Helios Klinikum Emil von Behring, Berlin, Germany
| | - Jan van Meerbeeck
- Dept of Pulmonology, Antwerp University Hospital, Edegem, Belgium.,Laboratory of Experimental Medicine and Pediatrics, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Infla-Med Consortium of Excellence, University of Antwerp, Antwerp, Belgium.,Internal Medicine and Paediatrics, Ghent University, Ghent, Belgium
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15
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van Geffen WH, Blum TG, Aliberti S, Blyth KG, Bostantzoglou C, Farr A, Grigoriu B, Hardavella G, Huber RM, Maskell N, Massard G, Rahman NM, Stolz D, van Meerbeeck J. Continuous professional development: elevating thoracic oncology education in Europe. Breathe (Sheff) 2019; 15:279-285. [PMID: 31803262 PMCID: PMC6885339 DOI: 10.1183/20734735.0296-2019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The @EuroRespSoc launches a new thoracic oncology continuous professional development programme http://bit.ly/31ShuTp.
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Affiliation(s)
- Wouter H van Geffen
- Dept of Pulmonary Medicine, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
| | - Torsten G Blum
- Lungenklinik Heckeshorn, Helios Klinikum Emil von Behring, Berlin, Germany
| | - Stefano Aliberti
- Dept of Pathophysiology and Transplantation, University of Milan, Milan, Italy.,Respiratory Dept, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Kevin G Blyth
- Glasgow Pleural Disease Unit, Queen Elizabeth University Hospital Glasgow, Glasgow, UK
| | - Clementine Bostantzoglou
- 7th Respiratory Medicine Dept and Asthma Center, Athens Chest Hospital "Sotiria", Athens, Greece
| | - Amy Farr
- European Respiratory Society, Lausanne, Switzerland
| | - Bogdan Grigoriu
- Service de médecine interne, Institut Jules Bordet, Brussels, Belgium
| | - Georgia Hardavella
- 10th Dept of Respiratory Medicine, Athens Chest Diseases Hospital "Sotiria", Athens, Greece
| | - Rudolf M Huber
- Thoracic Oncology Centre Munich, University of Munich, Munich, Germany, member of the German Center for Respiratory Research (DZL-CPC-M)
| | - Nick Maskell
- Academic Respiratory Unit, University of Bristol, Bristol, UK
| | - Gilbert Massard
- Service de Chirurgie Thoracique, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Najib M Rahman
- Oxford Centre for Respiratory Medicine, University College, Oxford, UK
| | - Daiana Stolz
- Clinic for Respiratory Medicine and Pulmonary Cell Research, University Hospital Basel, Basel, Switzerland
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Gijtenbeek RGP, de Jong K, Venmans BJW, van Vollenhoven FHM, Ten Brinke A, Van der Wekken AJ, van Geffen WH. Best first-line therapy for patients with advanced non-small cell lung cancer, performance status 2 without a targetable mutation or with an unknown mutation status. Hippokratia 2019. [DOI: 10.1002/14651858.cd013382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Rolof GP Gijtenbeek
- Medical Center Leeuwarden; Department of Pulmonary Diseases; Henri Dunantweg 2 Leeuwarden Netherlands
| | - Kim de Jong
- Medical Center Leeuwarden; Department of Epidemiology; Henri Dunantweg 2 Leeuwarden Friesland Netherlands
| | - Ben JW Venmans
- Medical Center Leeuwarden; Department of Pulmonary Diseases; Henri Dunantweg 2 Leeuwarden Netherlands
| | - Femke HM van Vollenhoven
- Medical Center Leeuwarden; Department of Pulmonary Diseases; Henri Dunantweg 2 Leeuwarden Netherlands
| | - Anneke Ten Brinke
- Medical Center Leeuwarden; Department of Pulmonary Diseases; Henri Dunantweg 2 Leeuwarden Netherlands
| | - Anthonie J Van der Wekken
- University of Groningen, University Medical Center Groningen; Department of Pulmonary Diseases; Hanzeplein 1 Groningen Netherlands
| | - Wouter H van Geffen
- Medical Center Leeuwarden; Department of Pulmonary Diseases; Henri Dunantweg 2 Leeuwarden Netherlands
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van Geffen WH, Hajian B, Vos W, De Backer J, Cahn A, Usmani OS, Van Holsbeke C, Pistolesi M, Kerstjens HA, De Backer W. Functional respiratory imaging: heterogeneity of acute exacerbations of COPD. Int J Chron Obstruct Pulmon Dis 2018; 13:1783-1792. [PMID: 29881268 PMCID: PMC5985851 DOI: 10.2147/copd.s152463] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background Exacerbations of COPD are a major burden to patients, and yet little is understood about heterogeneity. It contributes to the current persistent one-size-fits-all treatment. To replace this treatment by more personalized, precision medicine, new insights are required. We assessed the heterogeneity of exacerbations by functional respiratory imaging (FRI) in 3-dimensional models of airways and lungs. Methods The trial was designed as a multicenter trial of patients with an acute exacerbation of COPD who were assessed by FRI, pulmonary function tests, and patient-reported outcomes, both in the acute stage and during resolution. Results Forty seven patients were assessed. FRI analyses showed significant improvements in hyperinflation (a decrease in total volume at functional residual capacity of −0.25±0.61 L, p≤0.01), airway volume at total lung capacity (+1.70±4.65 L, p=0.02), and airway resistance. As expected, these improvements correlated partially with changes in the quality of life and in conventional lung function test parameters. Patients with the same changes in pulmonary function differ in regional disease activity measured by FRI. Conclusion FRI is a useful tool to get a better insight into exacerbations of COPD, and significant improvements in its indices can be demonstrated from the acute phase to resolution even in relatively small groups. It clearly visualizes the marked variability within and between individuals in ventilation and resistance during exacerbations and is a tool for the assessment of the heterogeneity of COPD exacerbations.
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Affiliation(s)
- Wouter H van Geffen
- Department of Respiratory Medicine, Medical Centre Leeuwarden, Leeuwarden, the Netherlands.,Department of Pulmonary Diseases, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD, University of Groningen, the Netherlands
| | - Bita Hajian
- Department of Pulmonary Diseases, Antwerp University Hospital, Antwerp, Belgium
| | - Wim Vos
- FLUIDDA nv, Kontich, Belgium
| | | | | | - Omar S Usmani
- Faculty of Medicine, National Heart & Lung Institute, Imperial College London, London, UK
| | | | - Massimo Pistolesi
- Department of Experimental and Clinical Medicine, Section of Respiratory Medicine, University of Florence, Florence, Italy
| | - Huib Am Kerstjens
- Department of Pulmonary Diseases, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD, University of Groningen, the Netherlands
| | - Wilfried De Backer
- Department of Pulmonary Diseases, Antwerp University Hospital, Antwerp, Belgium
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van Geffen WH, Herth FJ, Deslee G, Slebos DJ, Shah PL. Lung volume reduction for emphysema - Authors' reply. Lancet Respir Med 2018; 5:e24. [PMID: 28664863 DOI: 10.1016/s2213-2600(17)30232-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2017] [Accepted: 05/30/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Wouter H van Geffen
- Department of Pulmonary diseases, Medical Center Leeuwarden, Leeuwarden, Netherlands
| | - Felix J Herth
- Department of Pneumology and Critical Care Medicine, Thoraxklinik, Translational Lung Research Center Heidelberg, University of Heidelberg, Heidelberg, Germany
| | - Gaetan Deslee
- Department of Pulmonary Medicine, University Hospital of Reims, Reims, France
| | - Dirk-Jan Slebos
- Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Netherlands
| | - Pallav L Shah
- Royal Brompton & Harefield NHS Foundation Trust, London SW3 6NP, UK; Chelsea and Westminster Hospital NHS Foundation Trust, London UK.
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van Geffen WH, Kerstjens HA. Static and dynamic hyperinflation during severe acute exacerbations of chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis 2018; 13:1269-1277. [PMID: 29713160 PMCID: PMC5912369 DOI: 10.2147/copd.s154878] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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] [Indexed: 11/23/2022] Open
Abstract
Background Static hyperinflation is known to be increased during moderate acute exacerbations of chronic obstructive pulmonary disease (COPD) (AECOPD), but few data exist in patients with severe exacerbations of COPD. The role of dynamic hyperinflation during exacerbations is unclear. Methods In a prospective, observational cohort study, we recruited patients admitted to hospital for AECOPD. The following measurements were performed upon admission and again after resolution (stable state) at least 42 days later: inspiratory capacity (IC), body plethysmography, dynamic hyperinflation by metronome-paced IC measurement, health-related quality of life and dyspnea. Results Forty COPD patients were included of whom 28 attended follow-up. The IC was low at admission (2.05±0.11 L) and increased again during resolution by 15.6%±23.1% or 0.28±0.08 L (mean ± standard error of the mean, p<0.01). Testing of metronome-paced changes in IC was feasible, and it decreased by 0.74±0.06 L at admission, similarly to at stable state. Clinical COPD Questionnaire score was 3.7±0.2 at admission and improved by 1.7±0.2 points (p<0.01), and the Borg dyspnea score improved by 2.2±0.5 points from 4.4±0.4 at admission (p<0.01). Conclusion Static hyperinflation is increased during severe AECOPD requiring hospitalization compared with stable state. We could measure metronome-paced dynamic hyperinflation during severe AECOPD but found no increase.
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Affiliation(s)
- Wouter H van Geffen
- Department of Respiratory Medicine, Medical Centre Leeuwarden, Leeuwarden, the Netherlands.,Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Huib Am Kerstjens
- Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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20
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Hajian B, De Backer J, Vos W, van Geffen WH, De Winter P, Usmani O, Cahn T, Kerstjens HA, Pistolesi M, De Backer W. Changes in ventilation-perfusion during and after an COPD exacerbation: an assessment using fluid dynamic modeling. Int J Chron Obstruct Pulmon Dis 2018; 13:833-842. [PMID: 29563783 PMCID: PMC5846311 DOI: 10.2147/copd.s153295] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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] [Indexed: 01/18/2023] Open
Abstract
Introduction Severe exacerbations associated with chronic obstructive pulmonary disease (COPD) that require hospitalization significantly contribute to morbidity and mortality. Definitions for exacerbations are very broad, and it is unclear whether there is one predominant underlying mechanism that leads to them. Functional respiratory imaging (FRI) with modeling provides detailed information about airway resistance, hyperinflation, and ventilation–perfusion (V/Q) mismatch during and following an acute exacerbation. Materials and methods Forty-two patients with COPD participating in a multicenter study were assessed by FRI, pulmonary function tests, and self-reported outcome measures during an acute exacerbation and following resolution. Arterial blood gasses and lung function parameters were measured. Results A significant correlation was found between alveolar–arterial gradient and image-based V/Q (iV/Q), suggesting that iV/Q represents V/Q mismatch during an exacerbation (p<0.05). Conclusion Recovery of an exacerbation is due to decreased (mainly distal) airway resistance (p<0.05). Improvement in patient-reported outcomes were also associated with decreased distal airway resistance (p<0.05), but not with forced expiratory volume. FRI is, therefore, a sensitive tool to describe changes in airway caliber, ventilation, and perfusion during and after exacerbation. On the basis of the fact that FRI increased distal airway resistance seems to be the main cause of an exacerbation, therapy should mainly focus on decreasing it during and after the acute event.
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Affiliation(s)
- Bita Hajian
- Department of Respiratory Medicine, University Hospital Antwerp, Edegem, Belgium
| | | | - Wim Vos
- FLUIDDA nv, Kontich, Belgium
| | - Wouter H van Geffen
- Department of Respiratory Medicine, University Medical Center Groningen, Groningen, the Netherlands
| | - Paul De Winter
- Department of Respiratory Medicine, University Hospital Antwerp, Edegem, Belgium
| | - Omar Usmani
- Department of Pulmonology, Brompton Hospital, London, UK
| | | | - Huib Am Kerstjens
- Department of Respiratory Medicine, University Medical Center Groningen, Groningen, the Netherlands
| | - Massimo Pistolesi
- Department of Pulmonary Diseases, University of Firenze, Florence, Italy
| | - Wilfried De Backer
- Department of Respiratory Medicine, University Hospital Antwerp, Edegem, Belgium
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22
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van Geffen WH, Klooster K, Hartman JE, Ten Hacken NHT, Kerstjens HAM, Wolf RFE, Slebos DJ. Pleural Adhesion Assessment as a Predictor for Pneumothorax after Endobronchial Valve Treatment. Respiration 2017. [PMID: 28637047 DOI: 10.1159/000477258] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Pneumothorax after bronchoscopic lung volume reduction using one-way endobronchial valves (EBVs) in patients with advanced emphysema occurs in approximately 20% of patients. It is not well known which factors predict the development of pneumothorax. OBJECTIVE To assess whether pleural adhesions on pretreatment high-resolution computed tomography (HRCT) scans are associated with pneumothorax occurrence after EBV treatment. METHODS HRCT scan analyses were performed on all patients who received EBV treatment in a randomized controlled trial. Three blinded readers scored adhesions by number and by measuring the longest axis of each pleural adhesion in the treated lung. The Pleural Adhesion Score (PAS) was calculated by adding 1 point for each small pleural lesion (<1 mm), 5 points for each medium-sized lesion (1-5 mm), and 10 points for each large lesion (>5 mm). RESULTS The HRCT scans of 64 treated patients were assessed, of whom 14 developed pneumothorax. Patients who developed pneumothorax had a higher median number of pleural adhesions, 2.7 (IQR 1.9-4) compared to 1.7 (1-2.7) adhesions in the group without pneumothorax (p < 0.01). The PAS in the group with pneumothorax was higher compared to that in the group without: 14.3 (12.4-24.1) versus 6.7 (3.7-11.2) (p < 0.01). A threshold PAS of ≥12 was associated with a higher risk of pneumothorax (OR 13.0, 95% CI 3.1-54.9). A score <12 did not rule out the occurrence of pneumothorax. CONCLUSION A higher number of pleural adhesions on HRCT with a subsequent higher PAS in the treated lung is associated with a higher occurrence of pneumothorax after EBV treatment.
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Affiliation(s)
- Wouter H van Geffen
- Department of Respiratory Medicine, Medical Center Leeuwarden, Leeuwarden, The Netherlands
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Pouwels SD, van Geffen WH, Jonker MR, Kerstjens HAM, Nawijn MC, Heijink IH. Increased neutrophil expression of pattern recognition receptors during COPD exacerbations. Respirology 2016; 22:401-404. [DOI: 10.1111/resp.12912] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 07/14/2016] [Accepted: 08/15/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Simon D. Pouwels
- Department of Pathology and Medical Biology, University of Groningen; University Medical Center Groningen; Groningen The Netherlands
- GRIAC Research Institute, University of Groningen; University Medical Center Groningen; Groningen The Netherlands
| | - Wouter H. van Geffen
- GRIAC Research Institute, University of Groningen; University Medical Center Groningen; Groningen The Netherlands
- Department of Pulmonology, University of Groningen; University Medical Center Groningen; Groningen The Netherlands
| | - Marnix R. Jonker
- Department of Pathology and Medical Biology, University of Groningen; University Medical Center Groningen; Groningen The Netherlands
- GRIAC Research Institute, University of Groningen; University Medical Center Groningen; Groningen The Netherlands
| | - Huib A. M. Kerstjens
- GRIAC Research Institute, University of Groningen; University Medical Center Groningen; Groningen The Netherlands
- Department of Pulmonology, University of Groningen; University Medical Center Groningen; Groningen The Netherlands
| | - Martijn C. Nawijn
- Department of Pathology and Medical Biology, University of Groningen; University Medical Center Groningen; Groningen The Netherlands
- GRIAC Research Institute, University of Groningen; University Medical Center Groningen; Groningen The Netherlands
| | - Irene H. Heijink
- Department of Pathology and Medical Biology, University of Groningen; University Medical Center Groningen; Groningen The Netherlands
- GRIAC Research Institute, University of Groningen; University Medical Center Groningen; Groningen The Netherlands
- Department of Pulmonology, University of Groningen; University Medical Center Groningen; Groningen The Netherlands
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Abstract
BACKGROUND Bronchodilators are a central component for treating exacerbations of chronic obstructive pulmonary disease (COPD) all over the world. Clinicians often use nebulisers as a mode of delivery, especially in the acute setting, and many patients seem to benefit from them. However, evidence supporting this choice from systematic analysis is sparse, and available data are frequently biased by the inclusion of asthma patients. Therefore, there is little or no formal guidance regarding the mode of delivery, which has led to a wide variation in practice between and within countries and even among doctors in the same hospital. We assessed the available randomised controlled trials (RCTs) to help guide practice in a more uniform way. OBJECTIVES To compare the effects of nebulisers versus pressurised metered dose inhalers (pMDI) plus spacer or dry powder inhalers (DPI) in bronchodilator therapy for exacerbations of COPD. SEARCH METHODS We searched the Cochrane Airways Group Trial Register and reference lists of articles up to 1 July 2016. SELECTION CRITERIA RCTs of both parallel and cross-over designs. We included RCTs during COPD exacerbations, whether measured during hospitalisation or in an outpatient setting. We excluded RCTs involving mechanically ventilated patients due to the different condition of both patients and airways in this setting. DATA COLLECTION AND ANALYSIS Two review authors independently assessed studies for inclusion, extracted data and assessed the risk of bias. We report results with 95% confidence intervals (CIs). MAIN RESULTS This review includes eight studies with a total of 250 participants comparing nebuliser versus pMDI plus spacer treatment. We identified no studies comparing DPI with nebulisers. We found two studies assessing the primary outcome of 'change in forced expiratory volume in one second (FEV1) one hour after dosing'. We could not pool these studies, but both showed a non-significant difference in favour of the nebuliser group, with similar frequencies of serious adverse events. For the secondary outcome, 'change in FEV1 closest to one hour after dosing': we found a significant difference of 83 ml (95% CI 10 to 156, P = 0.03) in favour of nebuliser treatment. For the secondary outcome of adverse events, we found a non-significant odds ratio of 1.65 (95% CI 0.42 to 6.48) in favour of the pMDI plus spacer group. AUTHORS' CONCLUSIONS There is a lack of evidence in favour of one mode of delivery over another for bronchodilators during exacerbations of COPD. We found no difference between nebulisers versus pMDI plus spacer regarding the primary outcomes of FEV1 at one hour and safety. For the secondary outcome 'change in FEV1 closest to one hour after dosing' during an exacerbation of COPD, we found a greater improvement in FEV1 when treating with nebulisers than with pMDI plus spacers.A limited amount of data are available (eight studies involving 250 participants). These studies were difficult to pool, of low quality and did not provide enough evidence to favour one mode of delivery over another. No data of sufficient quality have been published comparing nebulisers versus DPIs in this setting. More studies are required to assess the optimal mode of delivery during exacerbations of COPD.
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Affiliation(s)
- Wouter H van Geffen
- University of Groningen, University Medical Center GroningenDepartment of Pulmonary Diseases and TuberculosisHanzeplein 1GroningenNetherlands9713 GZ
- Medical Center LeeuwardenDepartment of Pulmonary DiseasesHenri Dunantweg 2LeeuwardenNetherlands8934 AD
| | - W R Douma
- University of Groningen, University Medical Center GroningenDepartment of Pulmonary Diseases and TuberculosisHanzeplein 1GroningenNetherlands9713 GZ
| | - Dirk Jan Slebos
- University of Groningen, University Medical Center GroningenDepartment of Pulmonary Diseases and TuberculosisHanzeplein 1GroningenNetherlands9713 GZ
| | - Huib AM Kerstjens
- University of Groningen, University Medical Center GroningenDepartment of Pulmonary Diseases and TuberculosisHanzeplein 1GroningenNetherlands9713 GZ
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van Geffen WH, Bruins M, Kerstjens HAM. Diagnosing viral and bacterial respiratory infections in acute COPD exacerbations by an electronic nose: a pilot study. J Breath Res 2016; 10:036001. [DOI: 10.1088/1752-7155/10/3/036001] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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van Geffen WH, Slebos DJ, Kerstjens HAM. Hyperinflation in COPD exacerbations. The Lancet Respiratory Medicine 2015; 3:e43-4. [DOI: 10.1016/s2213-2600(15)00459-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 10/22/2015] [Indexed: 11/17/2022]
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van Geffen WH, Douma WR, Slebos DJ, Kerstjens HA. Bronchodilators delivered by nebuliser versus pMDI with spacer or DPI for exacerbations of COPD. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2015. [DOI: 10.1002/14651858.cd011826] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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van Geffen WH, Hiltermann TJN, Groen HJM. Surviving respiratory insufficiency with intensive care support in a pretreated, extensively metastasized patient with an EML4-ALK translocation. J Thorac Oncol 2013; 8:e1-2. [PMID: 23242444 DOI: 10.1097/jto.0b013e3182762812] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Wouter H van Geffen
- Department of Pulmonary Diseases, University Medical Center Groningen, Groningen, The Netherlands.
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Brandsma CA, Kerstjens HA, van Geffen WH, Geerlings M, Postma DS, Hylkema MN, Timens W. Differential switching to IgG and IgA in active smoking COPD patients and healthy controls. Eur Respir J 2012; 40:313-21. [DOI: 10.1183/09031936.00011211] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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van Geffen WH, Sietsma J, Roelofs PMM, Hiltermann TJN. A malignant retroperitoneal mass--a rare presentation of recurrent thymoma. BMJ Case Rep 2011; 2011:bcr.09.2011.4737. [PMID: 22674945 DOI: 10.1136/bcr.09.2011.4737] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 60-year-old man presented with a suspected retroperitoneal mass, after primarily resected thymoma (type B1/B2, Masaoke stage 1). A germ cell tumour was excluded and a diagnostic biopsy was performed. The mass appeared to be a local recurrence of the primary thymoma, for example, a droplet metastasis, progressed to type B3.
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Affiliation(s)
- Wouter H van Geffen
- Department of Pulmonology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.
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