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Elbahrawy MM, Kamel MK, Rodriguez-Quintero JH, Vimolratana M, Chudgar NP, Stiles BM. Association of socioeconomic factors with the receipt of neoadjuvant therapy for patients with non-small cell lung cancer. J Thorac Cardiovasc Surg 2024; 167:1458-1466.e4. [PMID: 37741315 PMCID: PMC11000266 DOI: 10.1016/j.jtcvs.2023.09.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 08/29/2023] [Accepted: 09/13/2023] [Indexed: 09/25/2023]
Abstract
BACKGROUND Neoadjuvant therapy (NT) will be increasingly used for patients with non-small cell lung cancer (NSCLC), particularly given the recent approval of neoadjuvant chemoimmunotherapy. Several barriers may prevent the uptake of NT and should be identified and addressed. We queried the National Cancer Database (NCDB) to determine predictors of the use of NT. METHODS Using the NCDB (2006-2019), we identified 80,707 patients who underwent surgery for clinical stage II and III NSCLC. Sociodemographic and clinical factors were reviewed, and univariable and multivariable analyses were performed to identify associations with the uptake of NT. In propensity score-matched groups, survival was determined using the Kaplan-Meier method. RESULTS Among 80,707 eligible patients, 17,262 (21.4%) received NT. Clinical stage and node positivity were associated with receipt of NT. On multivariable analysis, factors associated with lower rates of NT included black race (odds ratio [OR], 0.78; 95% confidence interval [CI], 0.67-0.90), Charlson Comorbidity Index ≥2 (OR, 0.75; 95% CI, 0.67-0.85), Medicaid/Medicare insurance (OR, 0.82; 95% CI, 0.75-0.90), lower income level (OR, 0.79; 95% CI, 0.71-0.87), and treatment at a community center (OR, 0.81; 95% CI, 0.67-0.96). In an exploratory analysis, those patients who received NT had longer 5-year overall survival compared with those who did not (48.3% vs 46.0%; P < .001). CONCLUSIONS Rates of NT are relatively low for patients with clinical stage II/III NSCLC treated prior to recent chemoimmunotherapy trials. Socioeconomic barriers to the uptake of NT include race, insurance status, income, and area of residence. As NT becomes more widely offered, accessibility for vulnerable populations must be assured.
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Affiliation(s)
- Mostafa M Elbahrawy
- Department of Cardiovascular and Thoracic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY
| | - Mohamed K Kamel
- Division of Thoracic and Foregut Surgery, University of Rochester Medical Center, Rochester, NY
| | - J Humberto Rodriguez-Quintero
- Department of Cardiovascular and Thoracic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY
| | - Marc Vimolratana
- Department of Cardiovascular and Thoracic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY
| | - Neel P Chudgar
- Department of Cardiovascular and Thoracic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY
| | - Brendon M Stiles
- Department of Cardiovascular and Thoracic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY.
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Lin L, Barkman HJ, Smit EF, de Langen AJ, Steeghs N, Beijnen JH, Huitema ADR. Clinical Relevance of High Plasma Trough Levels of the Kinase Inhibitors Crizotinib, Alectinib, Osimertinib, Dabrafenib, and Trametinib in NSCLC Patients. Ther Drug Monit 2024; 46:73-79. [PMID: 37348074 PMCID: PMC10769168 DOI: 10.1097/ftd.0000000000001120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 12/13/2022] [Indexed: 06/24/2023]
Abstract
BACKGROUND the study aims to evaluate whether high plasma trough levels of the kinase inhibitors (K.I.s) crizotinib, alectinib, osimertinib, dabrafenib, and trametinib were associated with a higher risk of toxicity in non-small-cell lung cancer patients. METHODS In this retrospective cohort study, patients with non-small-cell lung cancer treated with the selected K.I.s were included if at least one plasma trough level at steady state (C min,ss ) was available. Data were extracted from electronic medical records and laboratory databases. The high group for each K.I. was defined as 10% of patients with the highest first C min,ss . The remaining patients were placed in the non-high group. The frequency of dose-limiting toxicities (DLTs), defined as adverse events leading to dose reduction, dose interruption, or permanent discontinuation, was compared between the 2 groups. RESULTS A total of 542 patients were included in the different K.I. groups. A high C min,ss of crizotinib (n = 96), alectinib (n = 105), osimertinib (n = 227), dabrafenib (n = 52), and trametinib (n = 62) correlated with a C min,ss ≥490, ≥870, ≥405, ≥150, and ≥25 ng/mL, respectively. DLTs were more common in the alectinib high group than in the alectinib non-high group (64% vs. 29%, P = 0.036). Liver toxicity was observed in 4 (36%) patients in the high group and 5 (5%) patients in the non-high group ( P = 0.007). For other K.I.s, no significant differences were observed in the frequency of DLTs between the high and non-high groups. CONCLUSIONS For alectinib, high C min,ss was correlated with a higher risk of DLT. No differences in the frequency of DLTs were observed between the high and non-high groups for crizotinib, osimertinib, dabrafenib, and trametinib.
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Affiliation(s)
- Lishi Lin
- Department of Pharmacy and Pharmacology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Hannerieke J. Barkman
- Department of Pharmacy and Pharmacology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Egbert F. Smit
- Department of Thoracic Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands
- Department of Pulmonology, Leiden University Medical Center, Leiden, The Netherlands
| | - Adrianus J. de Langen
- Department of Thoracic Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Neeltje Steeghs
- Department of Medical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Jos H. Beijnen
- Department of Pharmacy and Pharmacology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
- Department of Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Alwin D. R. Huitema
- Department of Pharmacy and Pharmacology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
- Department of Pharmacology, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands; and
- Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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Nguyen KT, Van TT. Treatment of Stage IV Non-Small Cell Lung Cancer with Pembrolizumab in Combination with Platinum-Based Doublet Chemotherapy in Vietnam. J Immunother Precis Oncol 2023; 6:133-140. [PMID: 37637233 PMCID: PMC10448733 DOI: 10.36401/jipo-23-12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 06/11/2023] [Accepted: 06/17/2023] [Indexed: 08/29/2023]
Abstract
Introduction Lung cancer has been one of the most prevalent cancers worldwide in recent decades. According to the findings of the KEYNOTE-407 (2018) study on patients with stage IV squamous cell lung cancer, the combination of pembrolizumab and chemotherapy in the first-line treatment prolongs overall survival compared with chemotherapy alone. This study aimed to evaluate the efficacy and side effects of treating patients with stage IV non-small cell lung cancer with pembrolizumab in combination with platinum-based doublet chemotherapy. Methods A retrospective multicenter study on 46 patients at four hospitals in Vietnam between June 2018 and August 2022. Patients received first-line treatment with a protocol of pembrolizumab in combination with platinum-based doublet chemotherapy (pemetrexed plus carboplatin or paclitaxel plus carboplatin). The study's primary endpoints were progression-free survival and safety. The secondary endpoint was overall survival. Results The median progression-free survival was 11.0 months (95% CI, 7.4-14.7 months). The median overall survival was 23.1 months (95% CI, 18.4-27.8 months). The survival rate of patients after 1 and 2 years was 82.3% and 43.3%, respectively. The most common side effects were anemia and elevated liver enzymes, but they were primarily mild or moderate severity. Progression-free survival did not depend on cancer type based on histology (p = 0.13). The progression-free survival was independent of programmed death ligand-1 expression levels < 50% or ≥ 50% (p = 0.68). Conclusion Treatment of stage IV non-small cell lung cancer without EGFR and ALK gene mutations with the immunotherapy protocol of pembrolizumab in combination with platinum-based doublet chemotherapy resulted in favorable outcomes without any new safety concerns. A larger sample size and longer follow-up in the future are necessary to yield more complete results.
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Affiliation(s)
- Khanh Toan Nguyen
- Department of Oncology, Hanoi Medical University, Hanoi City, Hanoi, Vietnam
- Department of Medical Oncology 2, Nghe An Oncology Hospital, Nghe An Province, Nghe An, Vietnam
| | - To Ta Van
- Department of Oncology, Hanoi Medical University, Hanoi City, Hanoi, Vietnam
- Center of Pathology and Molecular Biology, National Cancer Hospital, Hanoi City, Hanoi, Vietnam
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Alali M, Saifo M. Optimizing the Treatment for Advanced Non-Small-Cell Lung Cancer with Mutated Epidermal Growth Factor Receptor in Low-Income Countries: A Review. J Immunother Precis Oncol 2023; 6:140-149. [PMID: 37637235 PMCID: PMC10448734 DOI: 10.36401/jipo-22-29] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 02/27/2023] [Accepted: 03/03/2023] [Indexed: 08/29/2023]
Abstract
Introduction Osimertinib is the treatment of choice for epidermal growth factor receptor (EGFR)-mutated advanced non-small-cell lung cancer (NSCLC). Because of its high price, many low-income countries, such as Syria, cannot provide osimertinib, which makes it difficult to choose the appropriate treatment for these patients. This study aimed to review articles that assessed tyrosine kinase inhibitors (TKIs) for advanced NSCLC and developed an appropriate treatment plan for Syrian patients. Methods An electronic literature search was conducted of published phase II and III studies that assessed the efficacy of EGFR-TKIs for advanced NSCLC between January 2003 and May 2022. Results Seventeen articles were reviewed. The results were similar when erlotinib or icotinib was compared with gefitinib. Progression-free survival and overall survival for afatinib and dacomitinib were longer than for gefitinib, with small significant differences. Osimertinib was the only TKI that showed efficacy against the T790M mutation, which showed an improvement over the first- and second-generation TKIs. Osimertinib as a first-line therapy is not cost-effective compared with first- and second-generation TKIs. Conclusion Osimertinib is the preferred first-line treatment in patients with advanced EGFR-mutated NSCLC. First- and second-generation TKIs are still considered good options, especially in low-income countries that cannot cover the costs of osimertinib.
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Affiliation(s)
- Mousa Alali
- Department of Oncology, Albairouni University Hospital, Faculty of Medicine, Damascus University, Damascus, Syrian Arab Republic
| | - Maher Saifo
- Department of Oncology, Albairouni University Hospital, Faculty of Medicine, Damascus University, Damascus, Syrian Arab Republic
- Faculty of Pharmacy, Alsham Private University, Damascus, Syrian Arab Republic
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Chakravarthy VB, Schachner B, Amin AG, Reiner AS, Yamada Y, Schmitt A, Higginson DS, Laufer I, Bilsky MH, Barzilai O. The Impact of Targetable Mutations on Clinical Outcomes of Metastatic Epidural Spinal Cord Compression in Patients With Non-Small-Cell Lung Cancer Treated With Hybrid Therapy (Surgery Followed by Stereotactic Body Radiation Therapy). Neurosurgery 2023; 92:557-564. [PMID: 36477376 PMCID: PMC10158890 DOI: 10.1227/neu.0000000000002247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 09/19/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND In treatment of metastatic epidural spinal cord compression (MESCC), hybrid therapy, consisting of separation surgery, followed by stereotactic body radiation therapy, has become the mainstay of treatment for radioresistant pathologies, such as non-small-cell lung cancer (NSCLC). OBJECTIVE To evaluate clinical outcomes of MESCC secondary to NSCLC treated with hybrid therapy and to identify clinical and molecular prognostic predictors. METHODS This is a single-center, retrospective study. Adult patients (≥18 years old) with pathologically confirmed NSCLC and spinal metastasis who were treated with hybrid therapy for high-grade MESCC or nerve root compression from 2012 to 2019 are included. Outcome variables evaluated included overall survival (OS) and progression-free survival, local tumor control in the competing risks setting, surgical and radiation complications, and clinical-genomic correlations. RESULTS One hundred and three patients met inclusion criteria. The median OS for this cohort was 6.5 months, with progression of disease noted in 5 (5%) patients at the index tumor level requiring reoperation and/or reirradiation at a mean of 802 days after postoperative stereotactic body radiation therapy. The 2-year local control rate was 94.6% (95% CI: 89.8-99.3). Epidermal growth factor receptor (EGFR) treatment-naïve patients who initiated EGFR-targeted therapy after hybrid therapy had significantly longer OS (hazard ratio 0.47, 95% CI 0.23-0.95, P = .04) even after adjusting for smoking status. The presence of EGFR exon 21 mutation was predictive of improved progression-free survival. CONCLUSION Hybrid therapy in NSCLC resulted in 95% local control at 2 years after surgery. EGFR treatment-naïve patients initiating therapy after hybrid therapy had significantly improved survival advantage. EGFR-targeted therapy initiated before hybrid therapy did not confer survival benefit.
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Affiliation(s)
- Vikram B. Chakravarthy
- Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | | | - Anubhav G. Amin
- Department of Neurosurgery, University of Washington, Seattle, Washington, USA
| | - Anne S. Reiner
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Yoshiya Yamada
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Adam Schmitt
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Daniel S. Higginson
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Ilya Laufer
- Department of Neurosurgery, New York University Grossman School of Medicine, New York, New York, USA
| | - Mark H. Bilsky
- Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Ori Barzilai
- Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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Shen J, Ni Y, Guan Q, Li R, Cao H, Geng Y, You Q. Stenotrophomonas maltophilia promotes lung adenocarcinoma progression by upregulating histone deacetylase 5. Front Microbiol 2023; 14:1121863. [PMID: 36819033 PMCID: PMC9929947 DOI: 10.3389/fmicb.2023.1121863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 01/13/2023] [Indexed: 02/04/2023] Open
Abstract
Introduction Lung cancer is the leading cause of cancer death worldwide, and lung adenocarcinoma (LADC) is the most common lung cancer. Lung cancer has a distinct microbiome composition correlated with patients' smoking status. However, the causal evidence of microbial impacts on LADC is largely unknown. Methods We investigated microbial communities' differences in Formalin-Fixed Paraffin-Embedded tissues of ever-smoke (n = 22) and never-smoke (n = 31) patients with LADC through bacterial 16S rRNA gene high-throughput sequencing. Then nitrosamines 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK)-induced lung cancer mouse model and A549 cells were used to study the effect of Stenotrophomonas maltophilia (S. maltophilia) in LADC. Results and Discussion We found a significant increase of genus Stenotrophomonas in LADC tissues of patients with primary tumor size greater than 3 cm and never-smoker patients. We further found that intratracheal infection with S. maltophilia promoted tumor progression in the NNK-induced lung cancer mouse model. We performed RNA-seq analysis on lung tissues and found that S. maltophilia treatment drove inflammation and upregulated tumor associated cell signaling, including Apelin signaling pathway. Mechanistically, histone deacetylase 5 (HDAC5) gene expression was significantly upregulated in S. maltophilia treated groups, and was required for S. maltophilia induced cell proliferation and migration in LADC cell line A549. Therefore, we provide in vivo and in vitro evidence to demonstrate that S. maltophilia promotes LADC progression, in part, through HDAC5.
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Affiliation(s)
- Jiyu Shen
- Department of Oncology, Affiliated Hospital of Jiangnan University, Wuxi, China
| | - Yalan Ni
- Department of Oncology, Affiliated Hospital of Jiangnan University, Wuxi, China,Key Laboratory of Carbohydrate Chemistry and Biotechnology, Ministry of Education; School of Biotechnology, Jiangnan University, Wuxi, Jiangsu, China
| | - Qijie Guan
- National Engineering Research Center of Cereal Fermentation and Food Biomanufacturing, Jiangnan University, Wuxi, China
| | - Rui Li
- Key Laboratory of Carbohydrate Chemistry and Biotechnology, Ministry of Education; School of Biotechnology, Jiangnan University, Wuxi, Jiangsu, China
| | - Hong Cao
- Department of Nutrition, Affiliated Hospital of Jiangnan University, Wuxi, China
| | - Yan Geng
- School of Life Science and Health Engineering, Jiangnan University, Wuxi, China,*Correspondence: Yan Geng, ✉
| | - Qingjun You
- Department of Oncology, Affiliated Hospital of Jiangnan University, Wuxi, China,Key Laboratory of Carbohydrate Chemistry and Biotechnology, Ministry of Education; School of Biotechnology, Jiangnan University, Wuxi, Jiangsu, China,Qingjun You, ✉
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Abstract
Purpose: This study investigated the impact of skeletal muscle quality on the outcomes of patients undergoing surgery for early-stage non–small-cell lung cancer (NSCLC). Methods: A total of 98 patients with pathological stage I–II NSCLC who underwent lobectomy or segmentectomy were retrospectively analyzed. Along with skeletal muscle quantity, muscle quality was evaluated by intramuscular adipose tissue content (IMAC) at the first lumbar vertebral level; a higher IMAC indicates lower skeletal muscle quality. Patients were divided into two groups according to the gender-specific quartiles of IMAC, and the prognostic impact of IMAC was investigated. Results: No significant differences in the body and skeletal mass indices, which indicate skeletal muscle quantity, were observed between patients with high and those with normal IMAC. Patients with high IMAC (n = 23) showed a significantly poorer prognosis in overall and disease-specific survivals than those with normal IMAC (n = 75; P <0.001 and P = 0.048, respectively). In a bivariate analysis that included other clinicopathological factors, a high IMAC was independently associated with worse overall survival. Conclusion: The skeletal muscle quality evaluated by IMAC could be used to predict survival risk after surgery for early-stage NSCLC.
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Affiliation(s)
- Atsushi Kamigaichi
- Department of Thoracic Surgery, National Hospital Organization Higashihiroshima Medical Center, Higashihiroshima, Hiroshima, Japan
| | - Hiroaki Harada
- Department of Thoracic Surgery, National Hospital Organization Higashihiroshima Medical Center, Higashihiroshima, Hiroshima, Japan
| | - Satoshi Shibata
- Department of Thoracic Surgery, National Hospital Organization Higashihiroshima Medical Center, Higashihiroshima, Hiroshima, Japan
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Walia M, Singhal MK, Kamle MS. Ideal sequencing in Stage IV epidermal growth factor receptor mutant Non-Small-Cell Lung Cancer. Indian J Cancer 2022; 59:S80-S89. [PMID: 35343193 DOI: 10.4103/ijc.ijc_50_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Evidence from several studies has shown improved progression-free survival (PFS) with first- or second-generation epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitors (TKIs) compared with chemotherapy for advanced NSCLC patients. But resistance to first or second-generation TKI therapies after 9 to 12 months of treatment initiation is a concern. Osimertinib is a third-generation, irreversible, oral EGFR-TKI that potently and selectively inhibits both EGFRm (epidermal growth factor receptor mutated) and EGFR T790M and has demonstrated efficacy in NSCLC central nervous system (CNS) metastases. Trials have reported significantly longer PFS and higher median duration of response with osimertinib compared with first-generation EGFR-TKIs (erlotinib, gefitinib) and chemotherapy, respectively. And relatively lower rates of discontinuation due to adverse events (AEs). Significant improvement in overall survival was also observed when used as first-line treatment. Because EGFR-mutated tumors are highly dependent on EGFR signaling, optimal sequence of available TKIs - erlotinib, gefitinib, afatinib, dacomitinib, and osimertinib - is necessary. The sequencing of EGFR-TKIs has changed over the past decade and depends on factors such as expected efficacy, CNS activity, tolerability, and options available after progression. Third-generation TKI may be the preferred first-line treatment because patients may not opt for or die before the start of second-line therapy, and it is difficult to predict which patients will eventually develop T790M mutation. The favorable tolerability profile alongside a longer time to disease progression makes osimertinib a preferred first-line treatment. Though clinical practice guidelines do not provide clear consensus on the most preferred EGFR-TKI, recent updates recommend osimertinib as a first-line treatment for advanced NSCLC patients. Also, improved patient selection incorporating clinical and molecular characteristics will help translate to better survival outcomes and improved quality of life. This review aims to determine the optimal sequence of administration of the EGFR-TKIs considering toxicity, quality of life, and survival outcomes among advanced NSCLC patients.
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Affiliation(s)
- Meenu Walia
- Department of Medical Oncology, Max Super Specialty Hospital, Patparganj, New Delhi, India
| | - Manish K Singhal
- Department of Medical Oncology, Apollo Hospital, Sarita Vihar, New Delhi, India
| | - Mangesh S Kamle
- Department of Oncology, AstraZeneca Pharma India Limited, India
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Chen M, Yang L, Yu H, Yu H, Wang S, Tian L, Liu S. Early Palliative Care in Patients With Non-Small-Cell Lung Cancer: A Randomized Controlled Trial in Southwest China. Am J Hosp Palliat Care 2022; 39:1304-1311. [PMID: 35088602 DOI: 10.1177/10499091211072502] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 01/26/2023] Open
Abstract
PURPOSE Effective interventions to improve prognosis in non-small-cell lung cancer (NSCLC) are urgently needed. We assessed the effect of the early integration of interdisciplinary palliative care (based on WARM model) for patients with NSCLC on the quality of life (QoL), psychological state, cancer pain and nutritional status. METHODS In this randomized controlled trial, 120 newly diagnosed NSCLC patients were enrolled and randomly assigned (1:1) to the combined early palliative care (CEPC) group integrated with standard oncologic care or standard oncological care (SC) group. QoL and psychological state were assessed at baseline and at 24 weeks by Functional Assessment of Cancer Therapy-Lung (FACT-L) scale, the Hospital Anxiety and Depression Scale (HADS) and Patient Health Questionnaire-9 (PHQ-9), respectively. Cancer nutritional and pain status were assessed with the use of the Patient-Generated Subjective Global Assessment (PG-SGA) and Numerical Rating Scale (NRS), respectively. The primary outcome was the change in the quality of life, psychological state and nutritional status at 24 weeks. Analysis was by intention to treat. RESULTS 120 patients were enrolled: 60 in CEPC group (38 completed) and 60 in the SC group (32 completed). CEPC group had a better QoL than SC group (P < .05). In addition, fewer patients in the CEPC group than in the SC group had depressive (P = .005) symptoms. Furthermore, patients in CEPC group had a better nutritional status than SC group (P = .001). CONCLUSION Among patients with non-small-cell lung cancer, early palliative care led to significant improvements in quality of life, psychological state and nutritional status.
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Affiliation(s)
- Mengting Chen
- 605425Chongqing University Cancer Hospital, Chongqing, P.R. China
| | - Liejun Yang
- 605425Chongqing University Cancer Hospital, Chongqing, P.R. China
| | - Huiqing Yu
- 605425Chongqing University Cancer Hospital, Chongqing, P.R. China
| | - Huijuan Yu
- College of Arts, 605425Chongqing University, Chongqing, P.R. China
| | - Sixiong Wang
- 605425Chongqing University Cancer Hospital, Chongqing, P.R. China
| | - Ling Tian
- 605425Chongqing University Cancer Hospital, Chongqing, P.R. China
| | - Shihong Liu
- 605425Chongqing University Cancer Hospital, Chongqing, P.R. China
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Miyazawa T, Otsubo K, Sakai H, Kimura H, Chosokabe M, Morikawa K, Furuya N, Marushima H, Kojima K, Mineshita M, Koike J, Saji H. Combining PD-L1 Expression and Standardized Uptake Values in FDG-PET/CT Can Predict Prognosis in Patients With Resectable Non-Small-Cell Lung Cancer. Cancer Control 2021; 28:10732748211038314. [PMID: 34384268 PMCID: PMC8369954 DOI: 10.1177/10732748211038314] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background This study aimed to determine the relationship of programmed death-ligand 1 (PD-L1) expression and standardized uptake values in fluorodeoxyglucose–positron emission tomography/computed tomography (FDG-PET/CT) with prognosis in non–small-cell lung cancer (NSCLC). Methods We retrospectively analyzed 328 NSCLC patients who underwent lobectomy/segmentectomy with lymph node dissection. PD-L1 expression was detected by immunohistochemically stained using the murine monoclonal antibody clone 22C3. The preoperative maximum standardized uptake value (SUVmax) of FDG-PET/CT at the primary lesion; pathological factors including histological type, microscopic lymphatic, venous, and pleural invasion; and lymph node metastases in resected specimens was determined. Significant prognostic clinicopathologic factors were analyzed by univariate and multivariate analyses. Results PD-L1 expression was higher in men, smokers, squamous cell carcinoma, advanced pathologic stages, positive venous invasion, positive pleural invasion, and high preoperative SUVmax (≥3). Postoperative survival analysis showed that both PD-L1 expression and preoperative SUVmax were significantly negative prognostic factors in univariate analysis for overall survival (OS) (P = 0.0123 and P < 0.0001) and relapse-free survival (RFS) (P = 0.0012 and P < 0.0001). Kaplan–Meier survival curves showed that the OS and RFS were the best in patients with negative PD-L1 expression and SUVmax < 3, intermediate in patients with positive PD-L1 expression and SUVmax < 3 and those with negative PD-L1 expression and SUVmax ≥ 3, and poor in patients with positive PD-L1 expression and SUVmax ≥ 3. Conclusion Combining PD-L1 expression and preoperative FDG-PET/CT SUVmax in primary tumor might help in accurate prediction of postoperative prognosis in NSCLC patients.
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Affiliation(s)
- Tomoyuki Miyazawa
- Departments of Chest Surgery, 12927St Marianna University School of Medicine, Kawasaki, Japan
| | - Kanji Otsubo
- Departments of Chest Surgery, 12927St Marianna University School of Medicine, Kawasaki, Japan
| | - Hiroki Sakai
- Departments of Chest Surgery, 12927St Marianna University School of Medicine, Kawasaki, Japan
| | - Hiroyuki Kimura
- Departments of Chest Surgery, 12927St Marianna University School of Medicine, Kawasaki, Japan
| | - Motohiro Chosokabe
- Pathology, 12927St Marianna University School of Medicine, Kawasaki, Japan
| | - Kei Morikawa
- Division of Respiratory Medicine, Department of Internal Medicine, 12927St Marianna University School of Medicine, Kawasaki, Japan
| | - Naoki Furuya
- Division of Respiratory Medicine, Department of Internal Medicine, 12927St Marianna University School of Medicine, Kawasaki, Japan
| | - Hideki Marushima
- Departments of Chest Surgery, 12927St Marianna University School of Medicine, Kawasaki, Japan
| | - Koji Kojima
- Departments of Chest Surgery, 12927St Marianna University School of Medicine, Kawasaki, Japan
| | - Masamichi Mineshita
- Division of Respiratory Medicine, Department of Internal Medicine, 12927St Marianna University School of Medicine, Kawasaki, Japan
| | - Junki Koike
- Pathology, 12927St Marianna University School of Medicine, Kawasaki, Japan
| | - Hisashi Saji
- Departments of Chest Surgery, 12927St Marianna University School of Medicine, Kawasaki, Japan
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11
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Zheng Y, Yao M, Yang Y. Higher Tumor Mutation Burden Was a Predictor for Better Outcome for NSCLC Patients Treated with PD-1 Antibodies: A Systematic Review and Meta-analysis. SLAS Technol 2021; 26:605-614. [PMID: 34180302 DOI: 10.1177/24726303211024557] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
This study was conducted to evaluate the predictive efficacy of tumor mutation burden (TMB) in patients with non-small-cell lung cancer (NSCLC) receiving PD-1 antibodies. Embase, PubMed, Ovid Medline, and the Cochrane Library were systematically searched until May 24, 2020. The keywords included "PD-1," "TMB," and "NSCLC." Overall survival (OS) and progression-free survival (PFS) were summarized and combined using the hazard ratio (HR) and 95% confidence interval. Twenty-one studies with 9883 patients were included in the meta-analysis. The overall relapse rate ranged from 39.3% to 64.3% in the higher TMB group as compared with 0% to 40% in the lower TMB group. The median OS ranged from 2.9 to 23 mo in the higher TMB group as compared with 4.3 to 16.2 mo in the lower TMB group. Patients with a higher TMB had a better OS as compared with patients with a lower TMB (HR = 0.61, P < 0.001). Similarly, a higher TMB was also a good predictor of PFS in patients treated with PD1/PDL1 antibodies (HR = 0.55, P < 0.001). Our results suggest that among NSCLC patients receiving PD1/PDL1 antibodies, patients with higher TMB could have a better survival outcome.
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Affiliation(s)
- Yuhui Zheng
- Department of Pathology, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
| | - Meihong Yao
- Department of Pathology, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
| | - Yinghong Yang
- Department of Pathology, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
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12
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Nugent SM, Golden SE, Hooker ER, Sullivan DR, Thomas CR Jr, Deffebach ME, Sukumar MS, Schipper PH, Tieu BH, Moghanaki D, Wisnivesky J, Samson P, Robinson C, Slatore CG. Longitudinal Health-related Quality of Life among Individuals Considering Treatment for Stage I Non-Small-Cell Lung Cancer. Ann Am Thorac Soc 2020; 17:988-97. [PMID: 32433897 DOI: 10.1513/AnnalsATS.202001-029OC] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Rationale: Because of improvements in screening, there is an increasing number of patients with early-stage non-small-cell lung cancer (NSCLC) who are making treatment decisions.Objectives: Among patients with suspected stage I NSCLC, we evaluated longitudinal patient-centered outcomes (PCOs) and the association of changes in PCOs with treatment modality, stereotactic body radiotherapy (SBRT) compared with surgical resection.Methods: We conducted a multisite, prospective, observational cohort study at seven medical institutions. We evaluated minimum clinically important differences of PCOs at four time points (during treatment, 4-6 wk after treatment, 6 mo after treatment, and 12 mo after treatment) compared with pretreatment values using validated instruments. We used adjusted linear mixed models to examine whether the association between treatment and European Organization for Research and Treatment of Cancer global and physical quality-of-life (QOL) scales differed over time.Results: We included 127 individuals with stage I NSCLC (53 surgery, 74 SBRT). At 12 months, approximately 30% of patients remaining in each group demonstrated a clinical deterioration on global QOL from baseline. There was a significant difference in slopes between treatment groups on global QOL (-12.86; 95% confidence interval [CI], -13.34 to -12.37) and physical QOL (-28.71; 95% CI, -29.13 to -28.29) between baseline and during treatment, with the steeper decline observed among those who underwent surgery. Differences in slopes between treatment groups were not significant at all other time points.Conclusions: Approximately 30% of patients with stage I NSCLC have a clinically significant decrease in QOL 1 year after SBRT or surgical resection. Surgical resection was associated with steeper declines in QOL immediately after treatment compared with SBRT; however, these declines were not lasting and resolved within a year for most patients. Our results may facilitate treatment option discussions for patients receiving treatment for early-stage NSCLC.
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13
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Yang B, Zhao F, Yao L, Zong Z, Xiao L. CircRNA circ_0006677 Inhibits the Progression and Glycolysis in Non-Small-Cell Lung Cancer by Sponging miR-578 and Regulating SOCS2 Expression. Front Pharmacol 2021; 12:657053. [PMID: 34054537 PMCID: PMC8155686 DOI: 10.3389/fphar.2021.657053] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 03/30/2021] [Indexed: 01/22/2023] Open
Abstract
Objective: Circular RNAs (circRNAs) have been demonstrated in playing an important role in the physiological and pathological processes (such as cancer). This paper aims to clarify the role of Circ_0006677 in non–small-cell lung cancer (NSCLC) progression. Methods: Using clinical data and in vitro cell line models, we revealed the tumor-suppressive role of circ_0006677 in lung cancer. Using the online bioinformatics tool, we predicted the target of circ_0006677 and further validated its regulatory mechanisms responsible for its tumor suppressor function in NSCLC. Results: Circ_0006677 expression was reduced in NSCLC tissues of patients and lung cancer cells in comparison to adjacent normal tissues. Lower expression of circ_0006677 was significantly associated with poorer patient survival. Overexpression of circ_0006677 significantly inhibited the ability of NSCLC cell proliferation, migration, invasion, and glycolysis. Mechanically, circ_0006677 could inhibit NSCLC progression and glycolysis by regulating the expression of the signal transducer inhibitor SOSC2 through sponging microRNA-578 (miR-578). Conclusion: Circ_0006677 prevents the progression of NSCLC via modulating the miR-578/SOSC2 axis.
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Affiliation(s)
- Bo Yang
- Department of Thoracic Surgery, Cangzhou Central Hospital, Hebei, China
| | - Fang Zhao
- Department of Hematology, Cangzhou Central Hospital, Hebei, China
| | - Lei Yao
- Department of Thoracic Surgery, Cangzhou Central Hospital, Hebei, China
| | - Zhenfeng Zong
- Department of Thoracic Surgery, Cangzhou Central Hospital, Hebei, China
| | - Li Xiao
- Department of Oncology, Zhongshan Hospital Xiamen University, Xiamen, China
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14
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Gan J, Meng Q, Li Y. Corrigendum: Systematic Analysis of Expression Profiles and Prognostic Significance for FAM83 Family in Non-Small-Cell Lung Cancer. Front Mol Biosci 2021; 8:653454. [PMID: 33928124 PMCID: PMC8078412 DOI: 10.3389/fmolb.2021.653454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 02/09/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Junqing Gan
- Department of Medical Oncology, Harbin Medical University Cancer Hospital, Harbin, China
| | - Qingwei Meng
- Department of Medical Oncology, Harbin Medical University Cancer Hospital, Harbin, China
| | - Yanjing Li
- Department of Gastrointestinal Oncology, Harbin Medical University Cancer Hospital, Harbin, China
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15
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Zhao D, Xu YM, Cao LQ, Yu F, Zhou H, Qin W, Li HJ, He CX, Xing L, Zhou X, Li PQ, Jin X, He Y, He JH, Cao HL. Complex Crystal Structure Determination and in vitro Anti-non-small Cell Lung Cancer Activity of Hsp90 N Inhibitor SNX-2112. Front Cell Dev Biol 2021; 9:650106. [PMID: 33855025 PMCID: PMC8039390 DOI: 10.3389/fcell.2021.650106] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 02/23/2021] [Indexed: 11/13/2022] Open
Abstract
SNX-2112, as a promising anticancer lead compound targeting heat shock protein 90 (Hsp90), absence of complex crystal structure of Hsp90N-SNX-2112 hindered further structural optimization and understanding on molecular interaction mechanism. Herein, a high-resolution complex crystal structure of Hsp90N-SNX-2112 was successfully determined by X-ray diffraction, resolution limit, 2.14 Å, PDB ID 6LTK, and their molecular interaction was analyzed in detail, which suggested that SNX-2112 was well accommodated in the ATP-binding pocket to disable molecular chaperone activity of Hsp90, therefore exhibiting favorable inhibiting activity on three non–small cell lung cancer (NSCLC) cell lines (IC50, 0.50 ± 0.01 μM for A549, 1.14 ± 1.11 μM for H1299, 2.36 ± 0.82 μM for H1975) by inhibited proliferation, induced cell cycle arrest, and aggravated cell apoptosis. SNX-2112 exhibited high affinity and beneficial thermodynamic changes during the binding process with its target Hsp90N confirmed by thermal shift assay (TSA, ΔTm, and −9.51 ± 1.00°C) and isothermal titration calorimetry (Kd, 14.10 ± 1.60 nM). Based on the complex crystal structure and molecular interaction analysis, 32 novel SNX-2112 derivatives were designed, and 25 new ones displayed increased binding force with the target Hsp90N verified by molecular docking evaluation. The results would provide new references and guides for anti-NSCLC new drug development based on the lead compound SNX-2112.
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Affiliation(s)
- Dong Zhao
- Shaanxi Key Laboratory of Ischemic Cardiovascular Disease, Institute of Basic & Translational Medicine, Xi'an Medical University, Xi'an, China
| | - Yi-Ming Xu
- Department of Medicinal Chemistry, Virginia Commonwealth University, Richmond, VA, United States
| | - Lu-Qi Cao
- Shaanxi Key Laboratory of Ischemic Cardiovascular Disease, Institute of Basic & Translational Medicine, Xi'an Medical University, Xi'an, China
| | - Feng Yu
- Shanghai Synchrotron Radiation Facility, Shanghai Advanced Research Institute, Chinese Academy of Sciences, Shanghai, China
| | - Huan Zhou
- Shanghai Synchrotron Radiation Facility, Shanghai Advanced Research Institute, Chinese Academy of Sciences, Shanghai, China
| | - Wei Qin
- Shaanxi Key Laboratory of Ischemic Cardiovascular Disease, Institute of Basic & Translational Medicine, Xi'an Medical University, Xi'an, China
| | - Hui-Jin Li
- Shaanxi Key Laboratory of Ischemic Cardiovascular Disease, Institute of Basic & Translational Medicine, Xi'an Medical University, Xi'an, China
| | - Chun-Xia He
- Shaanxi Key Laboratory of Ischemic Cardiovascular Disease, Institute of Basic & Translational Medicine, Xi'an Medical University, Xi'an, China
| | - Lu Xing
- Shaanxi Key Laboratory of Ischemic Cardiovascular Disease, Institute of Basic & Translational Medicine, Xi'an Medical University, Xi'an, China
| | - Xin Zhou
- Shaanxi Key Laboratory of Ischemic Cardiovascular Disease, Institute of Basic & Translational Medicine, Xi'an Medical University, Xi'an, China
| | - Peng-Quan Li
- Shaanxi Key Laboratory of Ischemic Cardiovascular Disease, Institute of Basic & Translational Medicine, Xi'an Medical University, Xi'an, China
| | - Xin Jin
- Shaanxi Key Laboratory of Ischemic Cardiovascular Disease, Institute of Basic & Translational Medicine, Xi'an Medical University, Xi'an, China
| | - Yuan He
- College of Chemistry and Materials Science, Key Laboratory of Synthetic and Natural Functional Molecule, Ministry of Education, Northwest University, Xi'an, China
| | - Jian-Hua He
- Shanghai Synchrotron Radiation Facility, Shanghai Advanced Research Institute, Chinese Academy of Sciences, Shanghai, China.,Institute for Advanced Studies, Wuhan University, Wuhan, China
| | - Hui-Ling Cao
- Shaanxi Key Laboratory of Ischemic Cardiovascular Disease, Institute of Basic & Translational Medicine, Xi'an Medical University, Xi'an, China.,College of Chemistry and Materials Science, Key Laboratory of Synthetic and Natural Functional Molecule, Ministry of Education, Northwest University, Xi'an, China
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16
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Li M, Hou X, Zhou C, Feng W, Jiang G, Long H, Yang S, Chen J, Wang N, Wang K, Chen L. Prevalence and Clinical Impact of Concomitant Mutations in Anaplastic Lymphoma Kinase Rearrangement Advanced Non-small-Cell Lung Cancer (Guangdong Association of Thoracic Oncology Study 1055). Front Oncol 2020; 10:1216. [PMID: 32974126 PMCID: PMC7471725 DOI: 10.3389/fonc.2020.01216] [Citation(s) in RCA: 6] [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] [Received: 04/11/2020] [Accepted: 06/15/2020] [Indexed: 12/02/2022] Open
Abstract
Background: In patients with anaplastic lymphoma kinase (ALK) rearrangement-positive advanced non–small-cell lung cancer (NSCLC), ALK inhibitors are now the standard treatment, but their clinical efficacy varies widely for each patient. In this multicenter retrospective study, we evaluated the clinical efficacy of crizotinib according to the ALK rearrangement variants and concomitant mutations present. Patients and Methods: A total 132 patients with ALK rearrangement advanced NSCLC from 4 centers in Guangdong province, China were evaluated. All patients received crizotinib treatment and their ALK rearrangement status was identified by next-generation sequencing (NGS). Results: The median progression-free survival (PFS) in patients with EML4-ALK rearrangement (n = 121), non-EML4-ALK rearrangement (n = 5), and EML4-ALK arrangement accompanied by non-EML4-ALK rearrangement (n = 6) was 12.8, 7.5, and 7.4 months, respectively, with no significant difference between them (p = 0.1554). Similarly, among patients with various EML4-ALK variants (variant 1, variant 3a/b, and other variants), the median PFS values were again comparable. According to baseline NGS data, the median PFS in patients who had ALK rearrangement only, ALK rearrangement and concomitant tumor-suppressor gene mutations, and ALK rearrangement and concomitant oncogene mutations was 14.2, 10.9, and 4.9 months, respectively; (p = 0.0002). A multivariable analysis indicated that concomitant oncogene mutations and tumor-suppressor gene mutations were both negative factors influencing the efficacy of crizotinib in ALK rearrangement NSCLC. Conclusion: Concomitant oncogene mutations and tumor-suppressor gene mutations had negative effects on the efficacy of crizotinib, while various ALK variants had a similar influence.
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Affiliation(s)
- Meichen Li
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Xue Hou
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Chengzhi Zhou
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Weineng Feng
- Department of Head and Neck/Thoracic Medical Oncology, The First People's Hospital of Foshan, Foshan, China
| | | | - Hao Long
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Shuang Yang
- Department of Head and Neck/Thoracic Medical Oncology, The First People's Hospital of Foshan, Foshan, China
| | - Jing Chen
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Na Wang
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Kaicheng Wang
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Likun Chen
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
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17
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Affiliation(s)
- Dipesh Uprety
- Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota, USA
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18
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Abstract
Liquid biopsy is an emerging technique for noninvasive detection of various cancers. Majority of liquid biopsy tests still, however, use solitary type of biomarkers with unsatisfactory sensitivity and specificity. To this end, a combined approach of circulating tumor cells (CTCs) and salivary mRNA biomarkers was evaluated for discriminating non-small-cell lung cancer (NSCLC) from healthy controls.Our study included a discovery phase to find multiple biomarkers, and an independent validation phase to confirm the applicability of the selected biomarkers. In the discovery phase, CTC level in blood and 5 mRNA biomarkers in saliva (i.e., CCNI, Epidermal growth factor receptor [EGFR], FGF19, FRS2, and GREB1) were measured for 140 NSCLC patients and 140 healthy controls, followed by developing a predictive model. Next, this panel of biomarkers was applied to another patient cohort consisted of 60 patients with NSCLC and 60 healthy controls in the validation phase.We found that our novel biomarker panel could differentiate patients with NSCLC from healthy controls with high sensitivity (92.1%) and high specificity (92.9%) in the discovery phase. In the validation phase, we achieved sensitivity of 88.3% and specificity of 90.0%.To our best knowledge, it is the first time that a combined use of CTC and salivary mRNA biomarkers were applied for noninvasive detection of NSCLC.
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Affiliation(s)
- Xianwen Gu
- The First Department of Thoracic Surgery
| | - Junfeng He
- The Second Department of Abdominal Surgery, Linyi Cancer Hospital, Shandong, China
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19
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Gu L, Qing S, Zhu X, Ju X, Cao Y, Jia Z, Shen Y, Cao F, Fang F, Zhang H. Stereotactic Radiation Therapy (SRT) for Brain Metastases of Multiple Primary Tumors: A Single Institution Retrospective Analysis. Front Oncol 2020; 9:1352. [PMID: 31921625 PMCID: PMC6914765 DOI: 10.3389/fonc.2019.01352] [Citation(s) in RCA: 5] [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] [Received: 07/11/2019] [Accepted: 11/15/2019] [Indexed: 11/23/2022] Open
Abstract
Purpose: To evaluate the efficiency and side effects of stereotactic radiation therapy (SRT) with or without other treatments for brain metastases (BM) from various primary tumors. Methods: This was a retrospective analysis of 161 patients with brain metastases treated with SRT. Clinical data, EGFR mutation status and survival data were collected. Follow-up data was analyzed until December 2018. Kaplan-Meier and Cox proportional hazards regression analyses were used for the survival analysis. Results: The median overall survival (OS) was 19 months. No difference was observed in OS between SRT group and SRT + whole brain radiation therapy (WBRT) groups (p = 0.717). Statistically significant factors of better OS after univariable analysis were no extracranial metastases (p = 0.016), BED10-SRT≥50Gy (p = 0.049), oligometastases (1–3 brain metastases) (p < 0.001), GPA score≥2.5 (p = 0.003), RPA class I (p = 0.026), NSCLC tumor type (p = 0.006), targeted therapy (p < 0.001) and controlled extracranial disease (p = 0.011). Multivariate analysis indicated that higher BED10-SRT (≥50Gy, HR = 0.504, p = 0.027), controlled extracranial disease (HR = 0.658, p = 0.039) and targeted therapy (HR = 0.157, <0.001) were independent favorable predictors for OS. Besides that, we also find that the median overall survival (OS) was 22 months in NSCLC patients and controlled extracranial disease (HR = 0.512, p = 0.012) and targeted therapy (HR = 0.168, < 0.001) were independent favorable predictors for OS. Conclusion: For patients with brain metastases, stable extracranial disease, higher BED10-SRT (≥50Gy) and targeted therapy may predict a favorable prognosis.
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Affiliation(s)
- Lei Gu
- Department of Radiation Oncology, Changhai Hospital Affiliated to Second Military Medical University, Shanghai, China
| | - Shuiwang Qing
- Department of Radiation Oncology, Changhai Hospital Affiliated to Second Military Medical University, Shanghai, China
| | - Xiaofei Zhu
- Department of Radiation Oncology, Changhai Hospital Affiliated to Second Military Medical University, Shanghai, China
| | - Xiaoping Ju
- Department of Radiation Oncology, Changhai Hospital Affiliated to Second Military Medical University, Shanghai, China
| | - Yangsen Cao
- Department of Radiation Oncology, Changhai Hospital Affiliated to Second Military Medical University, Shanghai, China
| | - Zhen Jia
- Department of Radiation Oncology, Changhai Hospital Affiliated to Second Military Medical University, Shanghai, China
| | - Yuxin Shen
- Department of Radiation Oncology, Changhai Hospital Affiliated to Second Military Medical University, Shanghai, China
| | - Fei Cao
- Department of Radiation Oncology, Changhai Hospital Affiliated to Second Military Medical University, Shanghai, China
| | - Fang Fang
- Department of Radiation Oncology, Changhai Hospital Affiliated to Second Military Medical University, Shanghai, China
| | - Huojun Zhang
- Department of Radiation Oncology, Changhai Hospital Affiliated to Second Military Medical University, Shanghai, China
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20
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Nakashima K, Kimura M, Akamatsu H, Daga H, Imai H, Taira T, Ko R, Hisamatsu Y, Nishino K, Sugimoto T, Miyashita Y, Takahashi T. Osimertinib for patients with EGFR T790M mutation-positive non-small-cell lung cancer and a poor performance status. Jpn J Clin Oncol 2019; 49:671-675. [PMID: 30920616 DOI: 10.1093/jjco/hyz041] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 02/22/2019] [Accepted: 03/19/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Osimertinib is a third-generation epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI) that is effective against EGFR T790M mutation-positive non-small-cell lung cancer (NSCLC) in patients who have good performance status (PS). However, the efficacy and safety of osimertinib for patients with poor PS is unknown. METHODS We retrospectively evaluated the efficacy and safety of osimertinib in patients with EGFR T790M mutation-positive NSCLC who had Eastern Cooperative Oncology Group PS scores of 2-4 and who were administered 80 mg of osimertinib once daily between March 2016 and February 2017. RESULTS Thirty patients (8 men and 22 women) with EGFR T790M mutation-positive NSCLC were evaluated; their median age was 66 years (range: 39-89 years). Twenty-four and six patients had PS scores of 2 and 3, respectively; none had a PS score of 4. All patients had previously been treated with first- or second-generation EGFR-TKIs. T790M was detected in the tumor samples of 23 patients, the blood samples of two patients, and both the tumor and blood samples of five patients. The overall response rate was 53% (95% confidence interval: 36-70%), and the PS score improvement rate was 63%. The median progression-free survival was 8.2 months (95% confidence interval: 4.3-13.2 months), while the median overall survival time was not reached. No patient required treatment cessation owing to adverse events, and no treatment-related deaths occurred. CONCLUSIONS Osimertinib therapy demonstrates promising efficacy and acceptable safety in patients with EGFR T790M mutation-positive NSCLC who have poor PS.
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Affiliation(s)
| | - Madoka Kimura
- Department of Thoracic Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Hiroaki Akamatsu
- Internal Medicine III, Wakayama Medical University, Wakayama, Japan
| | - Haruko Daga
- Department of Medical Oncology, Osaka City General Hospital, Osaka, Japan
| | - Hisao Imai
- Division of Respiratory Medicine, Gunma Prefectural Cancer Center, Gunma, Japan
| | - Tetsuhiko Taira
- Division of Pulmonary Medicine, Minami Kyushu National Hospital, Kagoshima, Japan
| | - Ryo Ko
- Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yasushi Hisamatsu
- Department of Thoracic Medical Oncology, Oita Prefectural Hospital, Oita, Japan
| | - Kazumi Nishino
- Department of Thoracic Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Takeya Sugimoto
- Internal Medicine III, Wakayama Medical University, Wakayama, Japan
| | - Yosuke Miyashita
- Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
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Sheervalilou R, Lotfi H, Shirvaliloo M, Sharifi A, Nazemiyeh M, Zarghami N. Circulating MiR-10b, MiR-1 and MiR-30a Expression Profiles in Lung Cancer: Possible Correlation with Clinico-pathologic Characteristics and Lung Cancer Detection. Int J Mol Cell Med 2019; 8:118-129. [PMID: 32215263 DOI: 10.22088/ijmcm.bums.8.2.118] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Accepted: 08/13/2019] [Indexed: 12/29/2022]
Abstract
Circulating microRNAs have been recognized as promising biomarkers for the detection of lung cancer. The objective of this study was to evaluate miR-10b, miR-1 and, miR-30a in the plasma samples of lung cancer patients to confirm any possible relevance in the early detection of lung cancer. Plasma samples from 47 non-small-cell lung cancer patients and 41 cancer-free subjects were evaluated for selected microRNAs using the real-time PCR method. To evaluate the tobacco smoking effects on microRNAs expression, the studied groups were categorized into two subgroups: never-smokers and smokers. MiR-1/miR-30a expression levels were significantly reduced in lung cancer, while the miR-10b level was significantly elevated. We found that smoking had significant effects on the levels of circulating microRNAs in the smokers of the cancer-free group (a significant up-regulation of miR-10b and significant down-regulation of miR-1/miR-30a), and lung cancer patients (a significant elevation of miR-10b). Receiver operating characteristic curve analysis showed that miR-10b with an area under the curve of 0.861, and miR-1/miR-30a with values of0.905 and 0.889 for the same parameter, could distinguish non-small-cell lung cancer patients from cancer-free subjects. Our findings demonstrated significant differences in the expression of microRNAs in lung cancer and the considerable effects of smoking on microRNAs levels. Area under curve analysis showed that miR-10b with 78% sensitivity/78% specificity, miR-1 with 95% sensitivity/80% specificity and miR-30a with 87% sensitivity/83% specificity,might be good (miR-10b/miR-30a) and excellent (miR-1) markers for lung cancer detection.
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Affiliation(s)
- Roghayeh Sheervalilou
- Pharmacology Research Center, Zahedan University of Medical Sciences, Zahedan, Iran.,Tuberculosis and Lung Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hajie Lotfi
- Department of Medical Biotechnology, Faculty of Advanced Medical Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Milad Shirvaliloo
- Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.,Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Akbar Sharifi
- Tuberculosis and Lung Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Masoud Nazemiyeh
- Tuberculosis and Lung Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Nosratollah Zarghami
- Tuberculosis and Lung Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.,Department of Medical Biotechnology, Faculty of Advanced Medical Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
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22
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Hung MS, Wu YF, Chen YC. Efficacy of chemoradiotherapy versus radiation alone in patients with inoperable locally advanced non-small-cell lung cancer: A meta-analysis and systematic review. Medicine (Baltimore) 2019; 98:e16167. [PMID: 31277121 PMCID: PMC6635168 DOI: 10.1097/md.0000000000016167] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND This meta-analysis compared radiotherapy (RT) versus concurrent chemoradiotherapy (RT+CT) in treating patients with inoperable stage III non-small-cell lung cancer (NSCLC). METHODS Medline, Cochrane, EMBASE, Google Scholar databases were searched until July 28, 2015 using the following keywords non-small cell lung cancer, advanced cancer, incurable/inoperable/unresectable, chemotherapy, radiotherapy, chemoradiotherapy/chemoradiation. Randomized controlled trials (RCTs) and two-armed prospective studies that compared combined RT+CT with RT alone in patients with locally advanced (stage III) nonresectable NSCLC were eligible for inclusion. Treatment effect on overall survival, progression-free survival (PFS), and objective response rate (ORR) were evaluated. RESULTS Ultimately, 13 RCT studies were included in the systematic review and meta-analysis. The 13 studies included a total of 1936 patients with incurable/inoperable stage III NSCLC, of which 975 received RT alone and 961 received RT+CT combination therapy. The average age ranged from 54 to 77 years. At 1 and 2 years after treatment, the pooled data reveal that patients receiving CT+RT combination therapy had higher overall survival (pooled hazard ratio (HR), 0.72; 95% CI, 0.62-0.84; P < .001; 1-yr: HR, 0.67; 95% CI, 0.54-0.84; P < .001; 2-year: HR, 0.57; 95% CI, 0.45-0.73; P < .001), higher PFS (pooled HR, 0.73, 95% CI, 0.60-0.89; P = .002; 1-year: HR, 0.36; 95% CI, 0.24-0.53; P < .001; 2-year: HR, 0.38; 95% CI, 0.23-0.63; P < .001). CONCLUSION Our findings show higher efficacy for concurrent CT+RT over RT alone in treating locally-advanced, unresectable stage III NSCLC.
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Affiliation(s)
- Ming-Szu Hung
- Division of Thoracic Oncology, Department of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital, Chiayi branch
- Department of Medicine, College of Medicine, Chang Gung University, Taoyuan
- Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi Campus, Chiayi
| | - Yi-Fang Wu
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Chiayi branch
| | - Yi-Chuan Chen
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Chiayi branch
- Department of Nursing, Chang Gung University of Science and Technology, Chiayi Campus, Chiayi, Taiwan ROC
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Dietel M, Savelov N, Salanova R, Micke P, Bigras G, Hida T, Antunez J, Guldhammer Skov B, Hutarew G, Sua LF, Akita H, Chan OSH, Piperdi B, Burke T, Khambata-Ford S, Deitz AC. Real-world prevalence of programmed death ligand 1 expression in locally advanced or metastatic non-small-cell lung cancer: The global, multicenter EXPRESS study. Lung Cancer 2019; 134:174-179. [PMID: 31319978 DOI: 10.1016/j.lungcan.2019.06.012] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 06/05/2019] [Accepted: 06/11/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Tumor programmed death ligand 1 (PD-L1) expression is associated with improved clinical benefit from immunotherapies targeting the PD-1 pathway. We conducted a global, multicenter, retrospective observational study to determine real-world prevalence of tumor PD-L1 expression in patients with NSCLC. MATERIALS AND METHODS Patients ≥18 years with histologically confirmed stage IIIB/IV NSCLC and a tumor tissue block (≤5 years old) obtained before treatment were identified in 45 centers across 18 countries. Tumor samples from eligible patients were selected consecutively, when possible. PD-L1 expression was evaluated at each center using the PD-L1 IHC 22C3 pharmDx kit (Agilent, Santa Clara, CA, USA). RESULTS Of 2617 patients who met inclusion criteria, 2368 (90%) had PD-L1 data; 530 (22%) patients had PD-L1 TPS ≥ 50%, 1232 (52%) had PD-L1 TPS ≥ 1%, and 1136 (48%) had PD-L1 TPS < 1%. The most common reason for not having PD-L1 data (n = 249) was insufficient tumor cells (<100) on the slide (n = 170 [6%]). Percentages of patients with PD-L1 TPS ≥ 50% and TPS ≥ 1%, respectively were: 22%/52% in Europe; 22%/53% in Asia Pacific; 21%/47% in the Americas, and 24%/55% in other countries. Prevalence of EGFR mutations (19%) and ALK alterations (3%) was consistent with prior reports from metastatic NSCLC studies. Among 1064 patients negative for both EGFR mutation and ALK alteration, the percentage with PD-L1 TPS ≥ 50% and TPS ≥ 1%, respectively, were 27% and 53%. CONCLUSIONS This is the largest real-world study in advanced NSCLC to date evaluating PD-L1 tumor expression using the 22C3 pharmDx kit. Testing failure rate was low with local evaluation of PD-L1 TPS across a large number of centers. Prevalence of PD-L1 TPS ≥ 50% and TPS ≥ 1% among patients with stage IIIB/IV NSCLC was similar across geographic regions and broadly consistent with central testing results from clinical trial screening populations.
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Affiliation(s)
- M Dietel
- Institute of Pathology, Charité, University Medicine Berlin, Berlin, Germany.
| | - N Savelov
- Department of Pathology, Moscow City Oncology Hospital #62, Moscow, Russian Federation
| | - R Salanova
- Department of Pathology, Hospital de Gastroenterología Dr. Carlos Bonorino Udaondo, Buenos Aires, Argentina
| | - P Micke
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - G Bigras
- Cross Cancer Institute, University of Alberta, Edmonton, AB, Canada
| | - T Hida
- Department of Thoracic Oncology, Aichi Cancer Center, Nagoya, Japan
| | - J Antunez
- Pathology Department, University Hospital of Santiago de Compostela, La Coruña, Spain
| | | | - G Hutarew
- Institute of Pathology, University Hospital and Paracelsus Medical University Salzburg, Salzburg, Austria
| | - L F Sua
- Department of Pathology and Laboratory Medicine, Clinical Research Center, Fundación Valle del Lili, Cali, Colombia
| | - H Akita
- Department of Medical Oncology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - O S H Chan
- Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong
| | - B Piperdi
- Merck & Co., Inc., Kenilworth, NJ, USA
| | - T Burke
- Center for Observational and Real-World Evidence, Merck & Co., Inc., Kenilworth, NJ, USA
| | | | - A C Deitz
- Center for Observational and Real-World Evidence, Merck & Co., Inc., Kenilworth, NJ, USA
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Kaira K, Ono A, Kamide Y, Sunaga N, Koga Y, Saitoh JI, Shirai K, Ebara T, Hisada T, Ishizuka T. Phase I dose escalation study of pemetrexed and concurrent thoracic radiation in elderly patients with non-squamous non-small-cell lung cancer. J Radiat Res 2019; 60:228-233. [PMID: 30496584 PMCID: PMC6430250 DOI: 10.1093/jrr/rry058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 06/04/2018] [Indexed: 06/09/2023]
Abstract
The aim of our study was to determine the maximum tolerated dose (MTD) and recommended dose of pemetrexed with concurrent thoracic radiation therapy for elderly patients with previously untreated locally advanced non-squamous non-small-cell lung cancer (NSCLC). Pemetrexed was administered intravenously on Days 1, 22, 43, 64, 85 and 106. The initial doses of pemetrexed were planned as follows: Level 1 (400 mg/m2) and Level 2 (500 mg/m2). Concurrent thoracic radiation therapy was administered in 2-Gy fractions five times weekly, to a total of 60 Gy. Six patients were enrolled in the current study. The full thoracic radiotherapy dose (60 Gy) was administered for all patients. The full number of cycles (6 cycles) of chemotherapy, including induction and consolidation phases, were administered to 4 of 6 (66%) patients. At Level 1 and Level 2, none experienced a dose-limiting toxicity (DLT). There were no severe toxicities such as pulmonary toxicities, treatment-related death or Grade 2 or more radiation pneumonitis. Therefore, Level 2 was considered the MTD and was also defined as the recommended dose. An objective response was observed in 66.7% of all patients. This regimen was well tolerated and observed to be safe for the treatment of elderly patients with locally advanced non-squamous NSCLC.
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Affiliation(s)
- Kyoichi Kaira
- Department of Oncology Clinical Development, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
- Department of Respiratory Medicine
| | | | | | | | | | - Jun-ichi Saitoh
- Department of Radiation Oncology, Gunma University Graduate School of Medicine
| | - Katsuyuki Shirai
- Department of Radiation Oncology, Gunma University Graduate School of Medicine
| | - Takeshi Ebara
- Department of Radiation Oncology, Gunma Prefectural Cancer Center, Gunma, Japan
| | | | - Tamotsu Ishizuka
- Third Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, Eiheiji, Fukui
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Li X, Li W, Hou L. A Trial-Based Cost-Effectiveness Analysis of Bevacizumab and Chemotherapy Versus Chemotherapy Alone for Advanced Nonsquamous Non-Small-Cell Lung Cancer in China. Value Health Reg Issues 2019; 18:1-7. [PMID: 30412913 DOI: 10.1016/j.vhri.2018.05.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 03/18/2018] [Accepted: 05/29/2018] [Indexed: 01/06/2023]
Abstract
BACKGROUND The first-line bevacizumab plus chemotherapy resulted in a clinical efficacy for Chinese patients with advanced nonsquamous non-small-cell lung cancer (NSCLC). Some economic analyses have carried out various methods to evaluate the cost-effectiveness of bevacizumab as the first-line treatment for NSCLC in other countries. Our objective was to assess the cost-effectiveness of bevacizumab plus chemotherapy compared with chemotherapy alone for the first-line treatment of advanced nonsquamous NSCLC. METHODS A Markov model was applied from the perspective of the Chinese health care system to assess cost-effectiveness. It was based on the clinical trial BEYOND that compared bevacizumab plus carboplatin/paclitaxel (B+CP) with placebo plus carboplatin and paclitaxel (PI+CP) for advanced nonsquamous NSCLC. Ten-year quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs) were calculated. One-way sensitivity analysis and probabilistic sensitivity analyses (PSA) were performed. RESULTS QALYs were 1.17 years in the B+CP group and 0.83 years in the PI+CP group, resulting in a difference of 0.34 years. The ICER was $130,937.09/QALY, which was far beyond the willing-to-pay threshold of $24,314/QALY. At a threshold of $130,584/QALY, addition of bevacizumab had a 50% probability of being cost-effective. CONCLUSIONS Bevacizumab is not cost-effective when combined with chemotherapy for patients with advanced nonsquamous NSCLC based on the Chinese health care system, resulting in a less demand in the Chinese market.
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Luo Y, McShan D, Ray D, Matuszak M, Jolly S, Lawrence T, Ming Kong F, Ten Haken R, El Naqa I. Development of a Fully Cross-Validated Bayesian Network Approach for Local Control Prediction in Lung Cancer. IEEE Trans Radiat Plasma Med Sci 2018; 3:232-241. [PMID: 30854500 DOI: 10.1109/trpms.2018.2832609] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [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: 12/25/2022]
Abstract
The purpose of this study is to demonstrate that a Bayesian network (BN) approach can explore hierarchical biophysical relationships that influence tumor response and predict tumor local control (LC) in non-small-cell lung cancer (NSCLC) patients before and during radiotherapy from a large-scale dataset. Our BN building approach has two steps. First, relevant biophysical predictors influencing LC before and during the treatment are selected through an extended Markov blanket (eMB) method. From this eMB process, the most robust BN structure for LC prediction was found via a wrapper-based approach. Sixty-eight patients with complete feature information were used to identify a full BN model for LC prediction before and during the treatment. Fifty more recent patients with some missing information were reserved for independent testing of the developed pre- and during-therapy BNs. A nested cross-validation (N-CV) was developed to evaluate the performance of the two-step BN approach. An ensemble BN model is generated from the N-CV sampling process to assess its similarity with the corresponding full BN model, and thus evaluate the sensitivity of our BN approach. Our results show that the proposed BN development approach is a stable and robust approach to identify hierarchical relationships among biophysical features for LC prediction. Furthermore, BN predictions can be improved by incorporating during treatment information.
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Affiliation(s)
- Yi Luo
- Department of Radiation Oncology, University of Michigan, Ann Arbor, USA,
| | - Daniel McShan
- Department of Radiation Oncology, University of Michigan, Ann Arbor, USA
| | - Dipankar Ray
- Department of Radiation Oncology, University of Michigan, Ann Arbor, USA
| | - Martha Matuszak
- Department of Radiation Oncology, University of Michigan, Ann Arbor, USA
| | - Shruti Jolly
- Department of Radiation Oncology, University of Michigan, Ann Arbor, USA
| | - Theodore Lawrence
- Department of Radiation Oncology, University of Michigan, Ann Arbor, USA
| | - Feng Ming Kong
- Department of Radiation Oncology, Indiana University, Indianapolis, USA
| | - Randall Ten Haken
- Department of Radiation Oncology, University of Michigan, Ann Arbor, USA
| | - Issam El Naqa
- Department of Radiation Oncology, University of Michigan, Ann Arbor, USA
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Xu H, Lee MS, Tsai PY, Adler AS, Curry NL, Challa S, Freinkman E, Hitchcock DS, Copps KD, White MF, Bronson RT, Marcotrigiano M, Wu Y, Clish CB, Kalaany NY. Ablation of insulin receptor substrates 1 and 2 suppresses Kras-driven lung tumorigenesis. Proc Natl Acad Sci U S A 2018; 115:4228-33. [PMID: 29610318 DOI: 10.1073/pnas.1718414115] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Non-small-cell lung cancer (NSCLC) is a leading cause of cancer death worldwide, with 25% of cases harboring oncogenic Kirsten rat sarcoma (KRAS). Although KRAS direct binding to and activation of PI3K is required for KRAS-driven lung tumorigenesis, the contribution of insulin receptor (IR) and insulin-like growth factor 1 receptor (IGF1R) in the context of mutant KRAS remains controversial. Here, we provide genetic evidence that lung-specific dual ablation of insulin receptor substrates 1/2 (Irs1/Irs2), which mediate insulin and IGF1 signaling, strongly suppresses tumor initiation and dramatically extends the survival of a mouse model of lung cancer with Kras activation and p53 loss. Mice with Irs1/Irs2 loss eventually succumb to tumor burden, with tumor cells displaying suppressed Akt activation and strikingly diminished intracellular levels of essential amino acids. Acute loss of IRS1/IRS2 or inhibition of IR/IGF1R in KRAS-mutant human NSCLC cells decreases the uptake and lowers the intracellular levels of amino acids, while enhancing basal autophagy and sensitivity to autophagy and proteasome inhibitors. These findings demonstrate that insulin/IGF1 signaling is required for KRAS-mutant lung cancer initiation, and identify decreased amino acid levels as a metabolic vulnerability in tumor cells with IR/IGF1R inhibition. Consequently, combinatorial targeting of IR/IGF1R with autophagy or proteasome inhibitors may represent an effective therapeutic strategy in KRAS-mutant NSCLC.
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28
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Karube M, Yamamoto N, Shioyama Y, Saito J, Matsunobu A, Okimoto T, Ohno T, Tsuji H, Nakano T, Kamada T. Carbon-ion radiotherapy for patients with advanced stage non-small-cell lung cancer at multicenters. J Radiat Res 2017; 58:761-764. [PMID: 28992088 PMCID: PMC5737392 DOI: 10.1093/jrr/rrx037] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 05/12/2017] [Indexed: 05/21/2023]
Abstract
Carbon-ion radiation therapy (CIRT) for advanced non-small-cell lung cancer (NSCLC) has not been well studied to date. This paper aimed to analyze a retrospective multicenter survey for detecting problems with the use of CIRT for Stage II and III NSCLC (7th UICC TNM Staging System). Inclusion was restricted to patients with Stage II and III NSCLC who received CIRT from November 2003 to December 2014. We gathered the data from three CIRT operating centers on July 2015. Patients with radiotherapy history, patients with cancers other than lung cancer, and those receiving palliative therapies were excluded. The patient characteristics, prescribed dose/fraction, survival rates, and adverse effects were analyzed. The total number of patients was 64 (male: 49, female: 15). Of these, 53 patients were medically inoperable. The median age was 76 years (range 46-91), and the median follow-up period was 18.5 months (range 3.2-121.5). The clinical staging consisted of 10 Stage IIA, 30 Stage IIB, 23 Stage IIIA and 1 Stage IIIB. The median prescribed dose was 72.0 Gy (RBE) (range 52.8-72.0) in 16 fractions (range 4-16). The 2-year overall survival, progression-free survival, and local control rates were 62.2% [confidence interval (CI): 47.5-76.9], 42.3% (CI: 28.8-55.8) and 81.8% (CI: 69.9-94.0), respectively. There were no higher than Grade 2 adverse effects observed. CIRT for inoperable Stage II and III NSCLC could be implemented without severe adverse effects, but the clinical staging (including lymph node status) was inhomogeneous. In addition, the prescribed dose and fractionation were not standardized. Further data accumulation and a multiple centers prospective trial for evaluating clinical stage-based results are required.
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Affiliation(s)
- Masataka Karube
- National Institute of Radiological Sciences Hospital, National Institutes for Quantum and Radiological Sciences and Technology, 4-9-1, Anagawa, Inage-ku, Chiba, Chiba 263-8555, Japan
- Department of Radiotherapy, Mitsui Memorial Hospital
- Corresponding author. National Institute of Radiological Sciences Hospital, National Institutes for Quantum and Radiological Sciences and Technology, 4-9-1, Anagawa, Inage-ku, Chiba city, Chiba 263-8555, Japan. Tel: +81-43-206-3306; Fax: +81-43-284-0198;
| | - Naoyoshi Yamamoto
- National Institute of Radiological Sciences Hospital, National Institutes for Quantum and Radiological Sciences and Technology, 4-9-1, Anagawa, Inage-ku, Chiba, Chiba 263-8555, Japan
| | | | - Junichi Saito
- Department of Radiation Oncology, Gunma University Graduate School of Medicine
| | | | | | - Tatsuya Ohno
- Department of Radiation Oncology, Gunma University Graduate School of Medicine
| | - Hiroshi Tsuji
- National Institute of Radiological Sciences Hospital, National Institutes for Quantum and Radiological Sciences and Technology, 4-9-1, Anagawa, Inage-ku, Chiba, Chiba 263-8555, Japan
| | - Takashi Nakano
- Department of Radiation Oncology, Gunma University Graduate School of Medicine
| | - Tadashi Kamada
- National Institute of Radiological Sciences Hospital, National Institutes for Quantum and Radiological Sciences and Technology, 4-9-1, Anagawa, Inage-ku, Chiba, Chiba 263-8555, Japan
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Sun H, Ma H, Wang J, Xia L, Zhu G, Wang Z, Sun J, Chen Z. Phosphatase and tensin homolog deleted on chromosome 10 degradation induced by NEDD4 promotes acquired erlotinib resistance in non-small-cell lung cancer. Tumour Biol 2017; 39:1010428317709639. [PMID: 28714370 DOI: 10.1177/1010428317709639] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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: 01/16/2023] Open
Abstract
Acquired resistance to epidermal growth factor receptor-tyrosine kinase inhibitors, such as gefitinib and erlotinib, is a critical issue in the treatment of patients with epidermal growth factor receptor mutant-positive non-small-cell lung cancer. Recent evidence suggests that downregulation of gene of phosphatase and tensin homolog deleted on chromosome 10 plays an important role in acquired resistance to epidermal growth factor receptor-tyrosine kinase inhibitors in various types of cancers, including lung cancer. It was reported that the E3 ubiquitin ligase neural precursor cell expressed developmentally downregulated gene (NEDD4) (also known as NEDD4-1) negatively regulated phosphatase and tensin homolog deleted on chromosome 10 protein levels through poly-ubiquitination and proteolysis in carcinomas of the prostate, lung, and bladder. Whether this process plays a role in epidermal growth factor receptor-tyrosine kinase inhibitors resistance in non-small-cell lung cancer has not been studied extensively. In view of this, we investigated the involvement of NEDD4 and phosphatase and tensin homolog deleted on chromosome 10 in acquired erlotinib resistance with tyrosine kinase inhibitor-sensitive (HCC827) or tyrosine kinase inhibitor-resistant (Erlotinib-resistant HCC827/ER cells which harbored exon 19 deletion. Overexpression of NEDD4 in HCC827/ER cells was detected, and the reverse correlation between NEDD4 and phosphatase and tensin homolog deleted on chromosome 10 expression in these cells was also revealed. In HCC827/ER cells with knockdown of NEDD4, phosphatase and tensin homolog deleted on chromosome 10 and p-Akt expressions were decreased; the sensitivity of HCC827/ER cells to erlotinib was partially restored. Similar results were also observed in vivo. In H1650/ER cells harboring both exon 19 and phosphatase and tensin homolog deleted on chromosome 10 deletion, expression of p-Akt and sensitivity to erlotinib were not affected by simple knockdown of NEDD4 but affected after transfection of phosphatase and tensin homolog deleted on chromosome 10 into H1650/ER cells. Our results demonstrate that NEDD4 may promote the acquired resistance of non-small-cell lung cancer cells to erlotinib by decreasing phosphatase and tensin homolog deleted on chromosome 10 protein expression. Targeted decrease in NEDD4 expression may be a potential therapeutic strategy for tyrosine kinase inhibitor-resistant non-small-cell lung cancer.
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Affiliation(s)
- Huake Sun
- Cancer Institute of PLA, Xinqiao Hospital, Third Military Medical University, Chongqing, P.R. China
| | - Huiwen Ma
- Cancer Institute of PLA, Xinqiao Hospital, Third Military Medical University, Chongqing, P.R. China
| | - Jianmin Wang
- Cancer Institute of PLA, Xinqiao Hospital, Third Military Medical University, Chongqing, P.R. China
| | - Liqin Xia
- Cancer Institute of PLA, Xinqiao Hospital, Third Military Medical University, Chongqing, P.R. China
| | - Guangkuo Zhu
- Cancer Institute of PLA, Xinqiao Hospital, Third Military Medical University, Chongqing, P.R. China
| | - Zhoufei Wang
- Cancer Institute of PLA, Xinqiao Hospital, Third Military Medical University, Chongqing, P.R. China
| | - Jianguo Sun
- Cancer Institute of PLA, Xinqiao Hospital, Third Military Medical University, Chongqing, P.R. China
| | - Zhengtang Chen
- Cancer Institute of PLA, Xinqiao Hospital, Third Military Medical University, Chongqing, P.R. China
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Monk BJ, Lammers PE, Cartwright T, Jacobs I. Barriers to the Access of Bevacizumab in Patients with Solid Tumors and the Potential Impact of Biosimilars: A Physician Survey. Pharmaceuticals (Basel) 2017; 10:ph10010019. [PMID: 28134851 PMCID: PMC5374423 DOI: 10.3390/ph10010019] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 01/23/2017] [Accepted: 01/23/2017] [Indexed: 01/03/2023] Open
Abstract
Access to bevacizumab, an important component of oncology treatment regimens, may be limited. This survey of oncologists in the US (n = 150), Europe (n = 230), and emerging markets (EM: Brazil, Mexico, and Turkey; n = 130) examined use of and barriers to accessing bevacizumab as treatment of advanced solid tumors. We also assessed the likelihood that physicians would prescribe a bevacizumab biosimilar, if available. Bevacizumab was frequently used as early-line therapy in metastatic colorectal cancer, metastatic non-squamous non-small-cell lung cancer, and metastatic ovarian cancer (all markets), and as a second-line therapy in glioblastoma multiforme (US, EM). A greater percentage of EM-based physicians cited access-related issues as a barrier to prescribing bevacizumab versus US and EU physicians. Lack of reimbursement and high out-of-pocket costs were cited as predominant barriers to prescribing and common reasons for reducing the number of planned cycles. Overall, ~50% of physicians reported they "definitely" or "probably" would prescribe a bevacizumab biosimilar, if available. Efficacy and safety data in specific tumor types and lower cost were factors cited that would increase likelihood to prescribe a bevacizumab biosimilar. A lower cost bevacizumab biosimilar could address the unmet needs of patients and physicians worldwide, and may have the greatest impact on patient outcomes in EM.
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Affiliation(s)
- Bradley J Monk
- Arizona Oncology (US Oncology Network), University of Arizona, College of Medicine, Creighton University School of Medicine at St. Joseph's Hospital, 2222 E. Highland Ave., Suite 400, Phoenix, AZ 85016, USA.
| | - Philip E Lammers
- Meharry Medical College, 1005 Dr. D.B. Todd Jr. Blvd., Nashville, TN 37208-3501, USA.
| | - Thomas Cartwright
- Florida Cancer Affiliates, 433 SW 10th Street, Ocala, FL 34471, USA.
| | - Ira Jacobs
- Pfizer Inc, 235 East 42nd Street, New York, NY 10017-5755, USA.
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Bade BC, Brooks MC, Nietert SB, Ulmer A, Thomas DD, Nietert PJ, Scott JB, Silvestri GA. Assessing the Correlation Between Physical Activity and Quality of Life in Advanced Lung Cancer. Integr Cancer Ther 2016; 17:73-79. [PMID: 28024420 PMCID: PMC5647199 DOI: 10.1177/1534735416684016] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [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: 11/16/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Increasing physical activity (PA) is safe and beneficial in lung cancer (LC) patients. Advanced-stage LC patients are under-studied and have worse symptoms and quality of life (QoL). We evaluated the feasibility of monitoring step count in advanced LC as well as potential correlations between PA and QoL. METHODS This is a prospective, observational study of 39 consecutive patients with advanced-stage LC. Daily step count over 1 week (via Fitbit Zip), QoL, dyspnea, and depression scores were collected. Spearman rank testing was used to assess correlations. Correlation coefficients (ρ) >0.3 or <-0.3 (more and less correlated, respectively) were considered potentially clinically significant. RESULTS Most (83%) of the patients were interested in participating, and 67% of those enrolled were adherent with the device. Of those using the device (n = 30), the average daily step count was 4877 (range = 504-12 118) steps/d. Higher average daily step count correlated with higher QoL (ρ = 0.46), physical (ρ = 0.61), role (ρ = 0.48), and emotional functioning (ρ = 0.40) scores as well as lower depression (ρ = -0.40), dyspnea (ρ = -0.54), and pain (ρ = -0.37) scores. CONCLUSION Remote PA monitoring (Fitbit Zip) is feasible in advanced-stage LC patients. Interest in participating in this PA study was high with comparable adherence to other PA studies. In those utilizing the device, higher step count correlates with higher QoL as well as lower dyspnea, pain, and depression scores. PA monitoring with wearable devices in advanced-stage LC deserves further study.
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Affiliation(s)
- Brett C Bade
- 1 Medical University of South Carolina (MUSC), Charleston, SC, USA
| | - Mary C Brooks
- 1 Medical University of South Carolina (MUSC), Charleston, SC, USA
| | | | - Ansley Ulmer
- 2 Academic Magnet High School, North Charleston, SC, USA
| | - D David Thomas
- 1 Medical University of South Carolina (MUSC), Charleston, SC, USA
| | - Paul J Nietert
- 1 Medical University of South Carolina (MUSC), Charleston, SC, USA
| | - JoAnn B Scott
- 1 Medical University of South Carolina (MUSC), Charleston, SC, USA
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Shen R, Li J, Ye D, Wang Q, Fei J. Combination of onconase and dihydroartemisinin synergistically suppresses growth and angiogenesis of non-small-cell lung carcinoma and malignant mesothelioma. Acta Biochim Biophys Sin (Shanghai) 2016; 48:894-901. [PMID: 27590062 DOI: 10.1093/abbs/gmw082] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [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: 03/14/2016] [Accepted: 07/25/2016] [Indexed: 12/31/2022] Open
Abstract
Onconase (Onc) is a cytotoxic ribonuclease derived from leopard frog oocytes or early embryos, and has been applied to the treatment of malignant mesothelioma in clinics. Onc also exhibits effective growth suppression of human non-small-cell lung cancer (NSCLC). Artemisinin (Art) and its derivatives are novel antimalarial drugs that exhibit antitumor and antivirus activities. In this study, we investigated the antitumor effects of combinations of Onc and an Art derivative, dihydroartemisinin (DHA), both in vitro and in vivo Isobologram analyses showed synergistic effects on the proliferation of NSCLC cells under the treatment with Onc and DHA. In vivo experiments also showed that the antitumor effect of Onc was markedly enhanced by DHA in mouse xenograft models. No obvious adverse effect was observed after the treatment. The density of microvasculature in the tumor tissues treated with Onc/DHA combination was lower than those treated with Onc or DHA alone. The above results are consistent with the results of the matrigel plug test for angiogenesis suppression using the Onc/DHA combination. These results imply that the anti-angiogenesis effects may make important contributions to the in vivo antitumor effects of the Onc/DHA combination treatment. The Onc/DHA combination therapy may have the potential to become a novel regimen for NSCLC and mesothelioma.
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Affiliation(s)
- Ruling Shen
- School of Life Science and Technology, Tongji University, Shanghai 200092, China Shanghai Research Center for Model Organisms, Pudong New Area, Shanghai 201203, China
| | - Jun Li
- Shanghai Research Center for Model Organisms, Pudong New Area, Shanghai 201203, China
| | - Danrong Ye
- Shanghai Research Center for Model Organisms, Pudong New Area, Shanghai 201203, China
| | - Qingcheng Wang
- Shanghai Research Center for Model Organisms, Pudong New Area, Shanghai 201203, China
| | - Jian Fei
- School of Life Science and Technology, Tongji University, Shanghai 200092, China Shanghai Research Center for Model Organisms, Pudong New Area, Shanghai 201203, China
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Soh J, Okumura N, Nakata M, Nakamura H, Fukuda M, Kataoka M, Kajiwara S, Sano Y, Aoe M, Kataoka K, Hotta K, Matsuo K, Toyooka S, Date H. Randomized feasibility study of S-1 for adjuvant chemotherapy in completely resected Stage IA non-small-cell lung cancer: results of the Setouchi Lung Cancer Group Study 0701. Jpn J Clin Oncol 2016; 46:741-7. [PMID: 27207886 PMCID: PMC5025397 DOI: 10.1093/jjco/hyw062] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 04/17/2016] [Indexed: 11/13/2022] Open
Abstract
The feasibility of the S-1 administration schedules (the 4-week versus the 2-week) showed no significant difference for adjuvant chemotherapy among pathological-Stage IA non–small-cell lung cancer patients. Objective The aim of this multicenter study was to determine the appropriate administration schedule for S-1, an oral fluoropyrimidine, for adjuvant chemotherapy in patients with completely resected pathological-Stage IA (tumor diameter, 2–3 cm) non–small-cell lung cancer. Methods Patients were randomly assigned to receive adjuvant chemotherapy consisting of either the 4-week oral administration of S-1 (80–120 mg/body/day) followed by a 2-week rest (Group A), or the 2-week oral administration of S-1 (80–120 mg/body/day) followed by a 1-week rest (Group B). The duration of adjuvant chemotherapy was 1 year in both arms. The primary endpoint was compliance, namely drug discontinuation-free survival, which was calculated using the Kaplan–Meier method with log-rank test. Results Eighty patients were enrolled in this study, and 76 patients actually received S-1 treatment. The drug discontinuation-free survival rates at 1 year were 49.1% in Group A and 52.7% in Group B (P = 0.373). The means of the relative dose intensities were 55.3% in Group A and 64.6% in Group B (P = 0.237). There were no treatment-related deaths. Patients with grade 3/4 toxicities were significantly more frequent in Group A (40.5%) than in Group B (15.4%, P = 0.021). The 2-year relapse-free survival rates were 97.5% in Group A and 92.5% in Group B, and the 2-year overall survival rates were 100% in both groups. Conclusions The feasibility showed no significant difference between the two groups among patients with completely resected Stage IA (tumor diameter, 2–3 cm) non–small-cell lung cancer.
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Affiliation(s)
- Junichi Soh
- Department of Thoracic, Breast and Endocrinological Surgery, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama
| | - Norihito Okumura
- Department of Thoracic Surgery, Kurashiki Central Hospital, Kurashiki, Okayama
| | - Masao Nakata
- Department of General Thoracic Surgery, Kawasaki Medical School, Kurashiki, Okayama
| | - Hiroshige Nakamura
- Division of General Thoracic Surgery, Tottori University Hospital, Yonago, Tottori
| | - Minoru Fukuda
- Second Department of Internal Medicine, Nagasaki University Hospital, Nagasaki Clinical Oncology Center, Nagasaki University Hospital, Nagasaki
| | - Masafumi Kataoka
- Department of Surgery, Okayama Saiseikai General Hospital, Okayama
| | | | - Yoshifumi Sano
- Center of Chest Medicine and Surgery, Ehime University, Toon, Ehime
| | - Motoi Aoe
- Department of Surgery, Kagawa Prefectural Central Hospital, Takamatsu, Kagawa
| | - Kazuhiko Kataoka
- Department of Thoracic Surgery, National Hospital Organization Iwakuni Clinical Center, Iwakuni, Yamaguchi
| | - Katsuyuki Hotta
- Department of Hematology, Oncology and Respiratory Medicine, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama
| | - Keitaro Matsuo
- Division of Molecular Medicine, Aichi Cancer Center Research Institute, Nagoya, Aichi
| | - Shinichi Toyooka
- Department of Thoracic, Breast and Endocrinological Surgery, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama Department of Clinical Genomic Medicine, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama
| | - Hiroshi Date
- Department of Thoracic Surgery, Kyoto University, Kyoto, Japan
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Veenstra CM, Vachani A, Ciunci CA, Zafar HM, Epstein AJ, Paulson EC. Trends in the Use of (18)F-Fluorodeoxyglucose PET Imaging in Surveillance of Non-Small-Cell Lung and Colorectal Cancer. J Am Coll Radiol 2016; 13:491-6. [PMID: 26774883 PMCID: PMC6750770 DOI: 10.1016/j.jacr.2015.11.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 11/09/2015] [Accepted: 11/14/2015] [Indexed: 11/18/2022]
Abstract
PURPOSE Surveillance PET after curative-intent treatment of non-small-cell lung cancer (NSCLC) or colorectal cancer (CRC) is not clearly supported by available evidence or the Choosing Wisely campaign. However, the frequency of PET imaging during the surveillance period is relatively unknown. METHODS Using Surveillance, Epidemiology, and End Results-Medicare data, 65,748 patients aged 66 years or older who were diagnosed with stage I to IIIA NSCLC or stage I to III CRC from 2001 through 2009 and who underwent surgical resection were identified. Trends in "any PET" or "PET-only" use 6 to 18 months postoperatively were assessed. RESULTS Any PET use more than doubled over the study period. Eleven percent of patients with NSCLC and 4% of those with CRC diagnosed in 2001 received any PET, compared with 25% of patients with NSCLC and 13% of those with CRC in 2009 (P < .001 for both). Higher stage disease was correlated with higher PET utilization and faster growth in use over the study period. PET-only use also increased over the study period, especially in higher stage disease. Fewer than 2% of patients diagnosed with stage IIIA NSCLC in 2001 received PET only, compared with 15% of patients diagnosed in 2009 (P = .014). Similarly, 1% of patients diagnosed with stage III CRC in 2001 received PET only, compared with 8% of patients diagnosed in 2009 (P < .001). CONCLUSIONS PET utilization during the surveillance period increased between 2001 and 2009. Further research is needed to determine the factors driving use of surveillance PET and to examine relationships between PET and patient outcomes.
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Affiliation(s)
- Christine M Veenstra
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan.
| | - Anil Vachani
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Philadelphia VA Medical Center, Philadelphia, Pennsylvania
| | - Christine A Ciunci
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Hanna M Zafar
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Andrew J Epstein
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania; Philadelphia VA Medical Center, Philadelphia, Pennsylvania
| | - E Carter Paulson
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania; Philadelphia VA Medical Center, Philadelphia, Pennsylvania; Division of Colon and Rectal Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
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Hasegawa T, Futamura Y, Horiba A, Yoshida T, Suzuki T, Kato T, Kaito D, Ohno Y, Iida T, Hayashi S, Sawa T. A phase II study of nab-paclitaxel plus carboplatin in combination with thoracic radiation in patients with locally advanced non-small-cell lung cancer. J Radiat Res 2016; 57:50-54. [PMID: 26442970 PMCID: PMC4708916 DOI: 10.1093/jrr/rrv062] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2015] [Revised: 08/07/2015] [Accepted: 08/25/2015] [Indexed: 06/05/2023]
Abstract
We investigated the efficacy and safety of albumin-bound paclitaxel (nab-PTX) and carboplatin (CBDCA) with concurrent radiotherapy for unresectable locally advanced non-small-cell lung cancer (NSCLC). Patients with Stage III NSCLC and an Eastern Cooperative Oncology Group performance status of 0 or 1 were eligible. Concurrent chemoradiotherapy consisted of weekly administration of nab-PTX (40 mg/m(2)) plus CBDCA (area under the plasma concentration time curve (AUC) 2) and thoracic radiotherapy (60 Gy/30 fractions) for a total of 6 weeks. After concurrent chemoradiotherapy, patients received an additional two cycles of consolidation phase chemotherapy that consisted of 4-week cycles of nab-PTX (100 mg/m(2) on Days 1, 8 and 15)/CBDCA (AUC 5 mg/ml/min on Day 1). Response was evaluated in accordance with the Response Evaluation Criteria in Solid Tumors. Progression-free survival and overall survival were estimated using the Kaplan-Meier method. Toxicity was graded using the National Cancer Institute Common Terminology Criteria for Adverse Events. A total of 10 patients were enrolled in this trial between September 2013 and January 2014 from three institutes. The overall response rate was 40.0% and the median progression-free survival was 6.7 months. Treatment-related death occurred in two patients. Grade 2 or worse severe radiation pneumonitis was observed in all three patients that had the volume of lung receiving at least 20 Gy (V20) >30%. The results of this study indicate that no further investigation is warranted into nab-PTX and CBDCA with concurrent thoracic radiation for Stage III NSCLC with V20 > 30% due to severe toxicity.
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Affiliation(s)
- Takaaki Hasegawa
- Department of Respiratory Medicine and Medical Oncology, Gifu Municipal Hospital, 7-1 Kashima-cho, Gifu-shi, Gifu 500-8323, Japan
| | - Yohei Futamura
- Department of Respiratory Medicine and Medical Oncology, Gifu Municipal Hospital, 7-1 Kashima-cho, Gifu-shi, Gifu 500-8323, Japan
| | - Akane Horiba
- Department of Respiratory Medicine and Medical Oncology, Gifu Municipal Hospital, 7-1 Kashima-cho, Gifu-shi, Gifu 500-8323, Japan
| | - Tsutomu Yoshida
- Department of Respiratory Medicine and Medical Oncology, Gifu Municipal Hospital, 7-1 Kashima-cho, Gifu-shi, Gifu 500-8323, Japan
| | - Toshitaka Suzuki
- Respirtory Medicine, National Hospital Organization Nagara Medical Center, 1300-7, Nagara, Gifu-shi, Gifu 502-8558, Japan
| | - Tatsuo Kato
- Respirtory Medicine, National Hospital Organization Nagara Medical Center, 1300-7, Nagara, Gifu-shi, Gifu 502-8558, Japan
| | - Daizo Kaito
- Department of Respirology, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu-shi, Gifu 501-1194, Japan
| | - Yasuhi Ohno
- Department of Respirology, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu-shi, Gifu 501-1194, Japan
| | - Takayoshi Iida
- Department of Radiology, Gifu Municipal Hospital, 7-1 Kashima-cho, Gifu-shi, Gifu 500-8323, Japan
| | - Shinya Hayashi
- Department of Radiology, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu-shi, Gifu 501-1194, Japan
| | - Toshiyuki Sawa
- Department of Respiratory Medicine and Medical Oncology, Gifu Municipal Hospital, 7-1 Kashima-cho, Gifu-shi, Gifu 500-8323, Japan
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Fujii A, Harada T, Iwama E, Ota K, Furuyama K, Ijichi K, Okamoto T, Okamoto I, Takayama K, Nakanishi Y. Hypermethylation of the CpG dinucleotide in epidermal growth factor receptor codon 790: implications for a mutational hotspot leading to the T790M mutation in non-small-cell lung cancer. Cancer Genet 2015; 208:271-8. [PMID: 25682017 DOI: 10.1016/j.cancergen.2014.12.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Revised: 12/25/2014] [Accepted: 12/27/2014] [Indexed: 11/30/2022]
Abstract
Nearly one half of all cases of acquired resistance to epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) for non-small-cell lung cancer (NSCLC) are due to the T790M mutation in EGFR exon 20. The T790M mutation is a C→T transition mutation at a CpG dinucleotide. DNA methylation of cytosine (5-methylcytosine (5-mC)) in CpG dinucleotides is a common DNA modification; CpG dinucleotides are considered to be mutational hotspots that cause genetic diseases and cancers through spontaneous deamination of 5-mC, resulting in C→T transition mutations. This study aimed to examine the methylation level of cytosine of EGFR codon 790 and investigate whether DNA methylation was involved in acquiring the T790M mutation. We examined 18 NSCLC tumor tissues, 7 normal lymph node tissues, and 4 NSCLC cell lines (PC9, HCC827, 11-18, and A549). 5-mC was checked by bisulfite sequencing and quantified by pyrosequencing. We found that all tissue samples and cell lines had 5-mC in EGFR codon 790. The 5-mC range was 58.4-90.8%. Our results imply that hypermethylation of the CpG dinucleotide in EGFR codon 790 leads to the C→T transition mutation, causing resistance to EGFR-TKI treatment.
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Affiliation(s)
- Akiko Fujii
- Research Institute for Diseases of the Chest, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Taishi Harada
- Research Institute for Diseases of the Chest, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
| | - Eiji Iwama
- Research Institute for Diseases of the Chest, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Faculty of Medical Sciences, Department of Comprehensive Clinical Oncology, Kyushu University, Fukuoka, Japan
| | - Keiichi Ota
- Research Institute for Diseases of the Chest, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kazuto Furuyama
- Research Institute for Diseases of the Chest, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kayo Ijichi
- Research Institute for Diseases of the Chest, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Division of Pathophysiological and Experimental Pathology, Department of Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tatsuro Okamoto
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Isamu Okamoto
- Research Institute for Diseases of the Chest, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Center for Clinical and Traditional Research, Kyushu University Hospital, Fukuoka, Japan
| | - Koichi Takayama
- Research Institute for Diseases of the Chest, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yoichi Nakanishi
- Research Institute for Diseases of the Chest, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Hoffknecht P, Tufman A, Wehler T, Pelzer T, Wiewrodt R, Schütz M, Serke M, Stöhlmacher-Williams J, Märten A, Maria Huber R, Dickgreber NJ. Efficacy of the irreversible ErbB family blocker afatinib in epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI)-pretreated non-small-cell lung cancer patients with brain metastases or leptomeningeal disease. J Thorac Oncol 2015; 10:156-63. [PMID: 25247337 PMCID: PMC4276567 DOI: 10.1097/jto.0000000000000380] [Citation(s) in RCA: 201] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Afatinib is an effective first-line treatment in patients with epidermal growth factor receptor (EGFR)-mutated non-small-cell lung cancer (NSCLC) and has shown activity in patients progressing on EGFR-tyrosine kinase inhibitors (TKIs). First-line afatinib is also effective in patients with central nervous system (CNS) metastasis. Here we report on outcomes of pretreated NSCLC patients with CNS metastasis who received afatinib within a compassionate use program. METHODS Patients with NSCLC progressing after at least one line of chemotherapy and one line of EGFR-TKI treatment received afatinib. Medical history, patient demographics, EGFR mutational status, and adverse events including tumor progression were documented. RESULTS From 2010 to 2013, 573 patients were enrolled and 541 treated with afatinib. One hundred patients (66% female; median age, 60 years) had brain metastases and/or leptomeningeal disease with 74% having documented EGFR mutation. Median time to treatment failure for patients with CNS metastasis was 3.6 months, and did not differ from a matched group of 100 patients without CNS metastasis. Thirty-five percent (11 of 31) of evaluable patients had a cerebral response, five (16%) responded exclusively in brain. Response duration (range) was 120 (21-395) days. Sixty-six percent (21 of 32) of patients had cerebral disease control on afatinib. Data from one patient with an impressive response showed an afatinib concentration in the cerebrospinal fluid of nearly 1 nMol. CONCLUSION Afatinib appears to penetrate into the CNS with concentrations high enough to have clinical effect on CNS metastases. Afatinib may therefore be an effective treatment for heavily pretreated patients with EGFR-mutated or EGFR-TKI-sensitive NSCLC and CNS metastasis.
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Affiliation(s)
- Petra Hoffknecht
- Department of Pneumology, Thoracic Oncology and Respiratory Care Medicine, Mathias Spital Rheine, Rheine, Germany; Department of Internal Medicine V, Division of Respiratory Medicine and Thoracic Oncology, University of Munich, Thoracic Oncology Centre Munich, Comprehensive Pneumology Center, Member of the German Center for Lung Research, München, Germany; III. Medical Department, University Hospital Mainz, Mainz, Germany; Department of Medicine 1, University of Wuerzburg, Wuerzburg, Germany; Department of Medicine A, University Hospital, Westfaelische Wilhelms-University, Muenster, Germany; Department of Pneumology and Pulmonary Oncology, Klinikum München, München, Germany; Department of Pneumologie III, Lungenklinik Hemer, Hemer, Germany; Privat Clinic, Bonn, Germany; Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim am Rhein, Germany; and Members of the Afatinib Compassionate Use Consortium (ACUC) are listed in Appendix
| | - Amanda Tufman
- Department of Pneumology, Thoracic Oncology and Respiratory Care Medicine, Mathias Spital Rheine, Rheine, Germany; Department of Internal Medicine V, Division of Respiratory Medicine and Thoracic Oncology, University of Munich, Thoracic Oncology Centre Munich, Comprehensive Pneumology Center, Member of the German Center for Lung Research, München, Germany; III. Medical Department, University Hospital Mainz, Mainz, Germany; Department of Medicine 1, University of Wuerzburg, Wuerzburg, Germany; Department of Medicine A, University Hospital, Westfaelische Wilhelms-University, Muenster, Germany; Department of Pneumology and Pulmonary Oncology, Klinikum München, München, Germany; Department of Pneumologie III, Lungenklinik Hemer, Hemer, Germany; Privat Clinic, Bonn, Germany; Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim am Rhein, Germany; and Members of the Afatinib Compassionate Use Consortium (ACUC) are listed in Appendix
| | - Thomas Wehler
- Department of Pneumology, Thoracic Oncology and Respiratory Care Medicine, Mathias Spital Rheine, Rheine, Germany; Department of Internal Medicine V, Division of Respiratory Medicine and Thoracic Oncology, University of Munich, Thoracic Oncology Centre Munich, Comprehensive Pneumology Center, Member of the German Center for Lung Research, München, Germany; III. Medical Department, University Hospital Mainz, Mainz, Germany; Department of Medicine 1, University of Wuerzburg, Wuerzburg, Germany; Department of Medicine A, University Hospital, Westfaelische Wilhelms-University, Muenster, Germany; Department of Pneumology and Pulmonary Oncology, Klinikum München, München, Germany; Department of Pneumologie III, Lungenklinik Hemer, Hemer, Germany; Privat Clinic, Bonn, Germany; Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim am Rhein, Germany; and Members of the Afatinib Compassionate Use Consortium (ACUC) are listed in Appendix
| | - Theo Pelzer
- Department of Pneumology, Thoracic Oncology and Respiratory Care Medicine, Mathias Spital Rheine, Rheine, Germany; Department of Internal Medicine V, Division of Respiratory Medicine and Thoracic Oncology, University of Munich, Thoracic Oncology Centre Munich, Comprehensive Pneumology Center, Member of the German Center for Lung Research, München, Germany; III. Medical Department, University Hospital Mainz, Mainz, Germany; Department of Medicine 1, University of Wuerzburg, Wuerzburg, Germany; Department of Medicine A, University Hospital, Westfaelische Wilhelms-University, Muenster, Germany; Department of Pneumology and Pulmonary Oncology, Klinikum München, München, Germany; Department of Pneumologie III, Lungenklinik Hemer, Hemer, Germany; Privat Clinic, Bonn, Germany; Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim am Rhein, Germany; and Members of the Afatinib Compassionate Use Consortium (ACUC) are listed in Appendix
| | - Rainer Wiewrodt
- Department of Pneumology, Thoracic Oncology and Respiratory Care Medicine, Mathias Spital Rheine, Rheine, Germany; Department of Internal Medicine V, Division of Respiratory Medicine and Thoracic Oncology, University of Munich, Thoracic Oncology Centre Munich, Comprehensive Pneumology Center, Member of the German Center for Lung Research, München, Germany; III. Medical Department, University Hospital Mainz, Mainz, Germany; Department of Medicine 1, University of Wuerzburg, Wuerzburg, Germany; Department of Medicine A, University Hospital, Westfaelische Wilhelms-University, Muenster, Germany; Department of Pneumology and Pulmonary Oncology, Klinikum München, München, Germany; Department of Pneumologie III, Lungenklinik Hemer, Hemer, Germany; Privat Clinic, Bonn, Germany; Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim am Rhein, Germany; and Members of the Afatinib Compassionate Use Consortium (ACUC) are listed in Appendix
| | - Martin Schütz
- Department of Pneumology, Thoracic Oncology and Respiratory Care Medicine, Mathias Spital Rheine, Rheine, Germany; Department of Internal Medicine V, Division of Respiratory Medicine and Thoracic Oncology, University of Munich, Thoracic Oncology Centre Munich, Comprehensive Pneumology Center, Member of the German Center for Lung Research, München, Germany; III. Medical Department, University Hospital Mainz, Mainz, Germany; Department of Medicine 1, University of Wuerzburg, Wuerzburg, Germany; Department of Medicine A, University Hospital, Westfaelische Wilhelms-University, Muenster, Germany; Department of Pneumology and Pulmonary Oncology, Klinikum München, München, Germany; Department of Pneumologie III, Lungenklinik Hemer, Hemer, Germany; Privat Clinic, Bonn, Germany; Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim am Rhein, Germany; and Members of the Afatinib Compassionate Use Consortium (ACUC) are listed in Appendix
| | - Monika Serke
- Department of Pneumology, Thoracic Oncology and Respiratory Care Medicine, Mathias Spital Rheine, Rheine, Germany; Department of Internal Medicine V, Division of Respiratory Medicine and Thoracic Oncology, University of Munich, Thoracic Oncology Centre Munich, Comprehensive Pneumology Center, Member of the German Center for Lung Research, München, Germany; III. Medical Department, University Hospital Mainz, Mainz, Germany; Department of Medicine 1, University of Wuerzburg, Wuerzburg, Germany; Department of Medicine A, University Hospital, Westfaelische Wilhelms-University, Muenster, Germany; Department of Pneumology and Pulmonary Oncology, Klinikum München, München, Germany; Department of Pneumologie III, Lungenklinik Hemer, Hemer, Germany; Privat Clinic, Bonn, Germany; Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim am Rhein, Germany; and Members of the Afatinib Compassionate Use Consortium (ACUC) are listed in Appendix
| | - Jan Stöhlmacher-Williams
- Department of Pneumology, Thoracic Oncology and Respiratory Care Medicine, Mathias Spital Rheine, Rheine, Germany; Department of Internal Medicine V, Division of Respiratory Medicine and Thoracic Oncology, University of Munich, Thoracic Oncology Centre Munich, Comprehensive Pneumology Center, Member of the German Center for Lung Research, München, Germany; III. Medical Department, University Hospital Mainz, Mainz, Germany; Department of Medicine 1, University of Wuerzburg, Wuerzburg, Germany; Department of Medicine A, University Hospital, Westfaelische Wilhelms-University, Muenster, Germany; Department of Pneumology and Pulmonary Oncology, Klinikum München, München, Germany; Department of Pneumologie III, Lungenklinik Hemer, Hemer, Germany; Privat Clinic, Bonn, Germany; Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim am Rhein, Germany; and Members of the Afatinib Compassionate Use Consortium (ACUC) are listed in Appendix
| | - Angela Märten
- Department of Pneumology, Thoracic Oncology and Respiratory Care Medicine, Mathias Spital Rheine, Rheine, Germany; Department of Internal Medicine V, Division of Respiratory Medicine and Thoracic Oncology, University of Munich, Thoracic Oncology Centre Munich, Comprehensive Pneumology Center, Member of the German Center for Lung Research, München, Germany; III. Medical Department, University Hospital Mainz, Mainz, Germany; Department of Medicine 1, University of Wuerzburg, Wuerzburg, Germany; Department of Medicine A, University Hospital, Westfaelische Wilhelms-University, Muenster, Germany; Department of Pneumology and Pulmonary Oncology, Klinikum München, München, Germany; Department of Pneumologie III, Lungenklinik Hemer, Hemer, Germany; Privat Clinic, Bonn, Germany; Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim am Rhein, Germany; and Members of the Afatinib Compassionate Use Consortium (ACUC) are listed in Appendix
| | - Rudolf Maria Huber
- Department of Pneumology, Thoracic Oncology and Respiratory Care Medicine, Mathias Spital Rheine, Rheine, Germany; Department of Internal Medicine V, Division of Respiratory Medicine and Thoracic Oncology, University of Munich, Thoracic Oncology Centre Munich, Comprehensive Pneumology Center, Member of the German Center for Lung Research, München, Germany; III. Medical Department, University Hospital Mainz, Mainz, Germany; Department of Medicine 1, University of Wuerzburg, Wuerzburg, Germany; Department of Medicine A, University Hospital, Westfaelische Wilhelms-University, Muenster, Germany; Department of Pneumology and Pulmonary Oncology, Klinikum München, München, Germany; Department of Pneumologie III, Lungenklinik Hemer, Hemer, Germany; Privat Clinic, Bonn, Germany; Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim am Rhein, Germany; and Members of the Afatinib Compassionate Use Consortium (ACUC) are listed in Appendix
| | - Nicolas J. Dickgreber
- Department of Pneumology, Thoracic Oncology and Respiratory Care Medicine, Mathias Spital Rheine, Rheine, Germany; Department of Internal Medicine V, Division of Respiratory Medicine and Thoracic Oncology, University of Munich, Thoracic Oncology Centre Munich, Comprehensive Pneumology Center, Member of the German Center for Lung Research, München, Germany; III. Medical Department, University Hospital Mainz, Mainz, Germany; Department of Medicine 1, University of Wuerzburg, Wuerzburg, Germany; Department of Medicine A, University Hospital, Westfaelische Wilhelms-University, Muenster, Germany; Department of Pneumology and Pulmonary Oncology, Klinikum München, München, Germany; Department of Pneumologie III, Lungenklinik Hemer, Hemer, Germany; Privat Clinic, Bonn, Germany; Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim am Rhein, Germany; and Members of the Afatinib Compassionate Use Consortium (ACUC) are listed in Appendix
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Douillard JY, Ostoros G, Cobo M, Ciuleanu T, Cole R, McWalter G, Walker J, Dearden S, Webster A, Milenkova T, McCormack R. Gefitinib treatment in EGFR mutated caucasian NSCLC: circulating-free tumor DNA as a surrogate for determination of EGFR status. J Thorac Oncol 2014; 9:1345-53. [PMID: 25122430 PMCID: PMC4224589 DOI: 10.1097/jto.0000000000000263] [Citation(s) in RCA: 359] [Impact Index Per Article: 35.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
INTRODUCTION In the phase IV, open-label, single-arm study NCT01203917, first-line gefitinib 250 mg/d was effective and well tolerated in Caucasian patients with epidermal growth factor receptor (EGFR) mutation-positive non-small-cell lung cancer (previously published). Here, we report EGFR mutation analyses of plasma-derived, circulating-free tumor DNA. METHODS Mandatory tumor and duplicate plasma (1 and 2) baseline samples were collected (all screened patients; n = 1060). Preplanned, exploratory analyses included EGFR mutation (and subtype) status of tumor versus plasma and between plasma samples. Post hoc, exploratory analyses included efficacy by tumor and plasma EGFR mutation (and subtype) status. RESULTS Available baseline tumor samples were 1033 of 1060 (118 positive of 859 mutation status known; mutation frequency, 13.7%). Available plasma 1 samples were 803 of 1060 (82 positive of 784 mutation status known; mutation frequency, 10.5%). Mutation status concordance between 652 matched tumor and plasma 1 samples was 94.3% (95% confidence interval [CI], 92.3-96.0) (comparable for mutation subtypes); test sensitivity was 65.7% (95% CI, 55.8-74.7); and test specificity was 99.8% (95% CI, 99.0-100.0). Twelve patients of unknown tumor mutation status were subsequently identified as plasma mutation-positive. Available plasma 2 samples were 803 of 1060 (65 positive of 224 mutation status-evaluable and -known). Mutation status concordance between 224 matched duplicate plasma 1 and 2 samples was 96.9% (95% CI, 93.7-98.7). Objective response rates are as follows: mutation-positive tumor, 70% (95% CI, 60.5-77.7); mutation-positive tumor and plasma 1, 76.9% (95% CI, 65.4-85.5); and mutation-positive tumor and mutation-negative plasma 1, 59.5% (95% CI, 43.5-73.7). Median progression-free survival (months) was 9.7 (95% CI, 8.5-11.0; 61 events) for mutation-positive tumor and 10.2 (95% CI, 8.5-12.5; 36 events) for mutation-positive tumor and plasma 1. CONCLUSION The high concordance, specificity, and sensitivity demonstrate that EGFR mutation status can be accurately assessed using circulating-free tumor DNA. Although encouraging and suggesting that plasma is a suitable substitute for mutation analysis, tumor tissue should remain the preferred sample type when available.
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Affiliation(s)
- Jean-Yves Douillard
- Institut de Cancerologie, Centre René Gauducheau, Nantes, France; National Koranyi Institute of Pulmonology, Budapest, Hungary; Hospital Regional Universitario, Malaga, Spain; Institutul Oncologic Prof. Dr. Ion Chiricuta and University of Medicine and Pharmacy Iuliu Hatieganu, Cluj-Napoca, Romania; and AstraZeneca, Macclesfield, United Kingdom
| | - Gyula Ostoros
- Institut de Cancerologie, Centre René Gauducheau, Nantes, France; National Koranyi Institute of Pulmonology, Budapest, Hungary; Hospital Regional Universitario, Malaga, Spain; Institutul Oncologic Prof. Dr. Ion Chiricuta and University of Medicine and Pharmacy Iuliu Hatieganu, Cluj-Napoca, Romania; and AstraZeneca, Macclesfield, United Kingdom
| | - Manuel Cobo
- Institut de Cancerologie, Centre René Gauducheau, Nantes, France; National Koranyi Institute of Pulmonology, Budapest, Hungary; Hospital Regional Universitario, Malaga, Spain; Institutul Oncologic Prof. Dr. Ion Chiricuta and University of Medicine and Pharmacy Iuliu Hatieganu, Cluj-Napoca, Romania; and AstraZeneca, Macclesfield, United Kingdom
| | - Tudor Ciuleanu
- Institut de Cancerologie, Centre René Gauducheau, Nantes, France; National Koranyi Institute of Pulmonology, Budapest, Hungary; Hospital Regional Universitario, Malaga, Spain; Institutul Oncologic Prof. Dr. Ion Chiricuta and University of Medicine and Pharmacy Iuliu Hatieganu, Cluj-Napoca, Romania; and AstraZeneca, Macclesfield, United Kingdom
| | - Rebecca Cole
- Institut de Cancerologie, Centre René Gauducheau, Nantes, France; National Koranyi Institute of Pulmonology, Budapest, Hungary; Hospital Regional Universitario, Malaga, Spain; Institutul Oncologic Prof. Dr. Ion Chiricuta and University of Medicine and Pharmacy Iuliu Hatieganu, Cluj-Napoca, Romania; and AstraZeneca, Macclesfield, United Kingdom
| | - Gael McWalter
- Institut de Cancerologie, Centre René Gauducheau, Nantes, France; National Koranyi Institute of Pulmonology, Budapest, Hungary; Hospital Regional Universitario, Malaga, Spain; Institutul Oncologic Prof. Dr. Ion Chiricuta and University of Medicine and Pharmacy Iuliu Hatieganu, Cluj-Napoca, Romania; and AstraZeneca, Macclesfield, United Kingdom
| | - Jill Walker
- Institut de Cancerologie, Centre René Gauducheau, Nantes, France; National Koranyi Institute of Pulmonology, Budapest, Hungary; Hospital Regional Universitario, Malaga, Spain; Institutul Oncologic Prof. Dr. Ion Chiricuta and University of Medicine and Pharmacy Iuliu Hatieganu, Cluj-Napoca, Romania; and AstraZeneca, Macclesfield, United Kingdom
| | - Simon Dearden
- Institut de Cancerologie, Centre René Gauducheau, Nantes, France; National Koranyi Institute of Pulmonology, Budapest, Hungary; Hospital Regional Universitario, Malaga, Spain; Institutul Oncologic Prof. Dr. Ion Chiricuta and University of Medicine and Pharmacy Iuliu Hatieganu, Cluj-Napoca, Romania; and AstraZeneca, Macclesfield, United Kingdom
| | - Alan Webster
- Institut de Cancerologie, Centre René Gauducheau, Nantes, France; National Koranyi Institute of Pulmonology, Budapest, Hungary; Hospital Regional Universitario, Malaga, Spain; Institutul Oncologic Prof. Dr. Ion Chiricuta and University of Medicine and Pharmacy Iuliu Hatieganu, Cluj-Napoca, Romania; and AstraZeneca, Macclesfield, United Kingdom
| | - Tsveta Milenkova
- Institut de Cancerologie, Centre René Gauducheau, Nantes, France; National Koranyi Institute of Pulmonology, Budapest, Hungary; Hospital Regional Universitario, Malaga, Spain; Institutul Oncologic Prof. Dr. Ion Chiricuta and University of Medicine and Pharmacy Iuliu Hatieganu, Cluj-Napoca, Romania; and AstraZeneca, Macclesfield, United Kingdom
| | - Rose McCormack
- Institut de Cancerologie, Centre René Gauducheau, Nantes, France; National Koranyi Institute of Pulmonology, Budapest, Hungary; Hospital Regional Universitario, Malaga, Spain; Institutul Oncologic Prof. Dr. Ion Chiricuta and University of Medicine and Pharmacy Iuliu Hatieganu, Cluj-Napoca, Romania; and AstraZeneca, Macclesfield, United Kingdom
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Shi Y, Au JSK, Thongprasert S, Srinivasan S, Tsai CM, Khoa MT, Heeroma K, Itoh Y, Cornelio G, Yang PC. A prospective, molecular epidemiology study of EGFR mutations in Asian patients with advanced non-small-cell lung cancer of adenocarcinoma histology (PIONEER). J Thorac Oncol 2014; 9:154-62. [PMID: 24419411 PMCID: PMC4132036 DOI: 10.1097/jto.0000000000000033] [Citation(s) in RCA: 960] [Impact Index Per Article: 96.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
INTRODUCTION PIONEER (NCT01185314) was a prospective, multinational, epidemiological study of epidermal growth factor receptor (EGFR) mutations in patients from Asia with newly diagnosed advanced lung adenocarcinoma. METHODS Eligible patients (aged ≥20 years) had untreated stage IIIB/IV adenocarcinoma. The EGFR mutation status (primary end point: positive, negative, or undetermined) of tumor samples (biopsy, surgical specimen, or cytology) was determined (Scorpion amplification refractory mutation system). EGFR mutation frequency was calculated and compared between demographic and clinical subgroups. RESULTS Of 1482 patients from seven Asian regions, 43.4% of patients were female, median age was 60 years (range, 17-94), and 52.6% of patients were never-smokers. EGFR mutation status was evaluable in tumors from 1450 patients (97.8%) (746 [51.4%] positive; 704 [48.6%] negative). Country, sex, ethnicity, smoking status, pack-years (all p < 0.001), disease stage (p = 0.009), and histology type (p = 0.016) correlated significantly with EGFR mutation frequency. Mutation frequency was 61.1% in females, 44.0% in males; lower in patients from India (22.2%) compared with other areas (47.2%-64.2%); highest among never-smokers (60.7%); and decreased as pack-year number increased (>0-10 pack-years, 57.9%; >50 pack-years, 31.4%) (similar trend by sex). Ethnic group (p < 0.001) and pack-years (p < 0.001) had statistically significant associations with mutation frequency (multivariate analysis); sex was not significant when adjusted for smoking status. CONCLUSION PIONEER is the first prospective study to confirm high EGFR mutation frequency (51.4% overall) in tumors from Asian patients with adenocarcinoma. The observed high mutation frequency in demographic/clinical subgroups compared with white populations suggests that mutation testing should be considered for all patients with stage IIIB/IV adenocarcinoma, even males and regular smokers, among Asian populations.
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Affiliation(s)
- Yuankai Shi
- Department of Medical Oncology, Cancer Institute/Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College; Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing, China; Department of Clinical Oncology, Queen Elizabeth Hospital, Kowloon, Hong Kong; Department of Internal Medicine, Maharaj Nakorn Chiang Mai Hospital; Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; Medical Oncology Department, Apollo Speciality Hospital, Anna Salai, Chennai, India; Chest Department, Taipei Veteran’s General Hospital, Taipei, Taiwan; Nuclear Medicine and Oncology Center, Bach Mai Hospital, Hanoi, Vietnam; Medical Department, AstraZeneca, Singapore; Clinical Science Division, AstraZeneca, Osaka, Japan; St. Peregrine Oncology Unit, San Juan De Dios Hospital, Pasay City, Philippines; and Department of Internal Medicine, National Taiwan University College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Joseph Siu-Kie Au
- Department of Medical Oncology, Cancer Institute/Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College; Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing, China; Department of Clinical Oncology, Queen Elizabeth Hospital, Kowloon, Hong Kong; Department of Internal Medicine, Maharaj Nakorn Chiang Mai Hospital; Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; Medical Oncology Department, Apollo Speciality Hospital, Anna Salai, Chennai, India; Chest Department, Taipei Veteran’s General Hospital, Taipei, Taiwan; Nuclear Medicine and Oncology Center, Bach Mai Hospital, Hanoi, Vietnam; Medical Department, AstraZeneca, Singapore; Clinical Science Division, AstraZeneca, Osaka, Japan; St. Peregrine Oncology Unit, San Juan De Dios Hospital, Pasay City, Philippines; and Department of Internal Medicine, National Taiwan University College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Sumitra Thongprasert
- Department of Medical Oncology, Cancer Institute/Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College; Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing, China; Department of Clinical Oncology, Queen Elizabeth Hospital, Kowloon, Hong Kong; Department of Internal Medicine, Maharaj Nakorn Chiang Mai Hospital; Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; Medical Oncology Department, Apollo Speciality Hospital, Anna Salai, Chennai, India; Chest Department, Taipei Veteran’s General Hospital, Taipei, Taiwan; Nuclear Medicine and Oncology Center, Bach Mai Hospital, Hanoi, Vietnam; Medical Department, AstraZeneca, Singapore; Clinical Science Division, AstraZeneca, Osaka, Japan; St. Peregrine Oncology Unit, San Juan De Dios Hospital, Pasay City, Philippines; and Department of Internal Medicine, National Taiwan University College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Sankar Srinivasan
- Department of Medical Oncology, Cancer Institute/Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College; Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing, China; Department of Clinical Oncology, Queen Elizabeth Hospital, Kowloon, Hong Kong; Department of Internal Medicine, Maharaj Nakorn Chiang Mai Hospital; Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; Medical Oncology Department, Apollo Speciality Hospital, Anna Salai, Chennai, India; Chest Department, Taipei Veteran’s General Hospital, Taipei, Taiwan; Nuclear Medicine and Oncology Center, Bach Mai Hospital, Hanoi, Vietnam; Medical Department, AstraZeneca, Singapore; Clinical Science Division, AstraZeneca, Osaka, Japan; St. Peregrine Oncology Unit, San Juan De Dios Hospital, Pasay City, Philippines; and Department of Internal Medicine, National Taiwan University College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chun-Ming Tsai
- Department of Medical Oncology, Cancer Institute/Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College; Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing, China; Department of Clinical Oncology, Queen Elizabeth Hospital, Kowloon, Hong Kong; Department of Internal Medicine, Maharaj Nakorn Chiang Mai Hospital; Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; Medical Oncology Department, Apollo Speciality Hospital, Anna Salai, Chennai, India; Chest Department, Taipei Veteran’s General Hospital, Taipei, Taiwan; Nuclear Medicine and Oncology Center, Bach Mai Hospital, Hanoi, Vietnam; Medical Department, AstraZeneca, Singapore; Clinical Science Division, AstraZeneca, Osaka, Japan; St. Peregrine Oncology Unit, San Juan De Dios Hospital, Pasay City, Philippines; and Department of Internal Medicine, National Taiwan University College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Mai Trong Khoa
- Department of Medical Oncology, Cancer Institute/Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College; Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing, China; Department of Clinical Oncology, Queen Elizabeth Hospital, Kowloon, Hong Kong; Department of Internal Medicine, Maharaj Nakorn Chiang Mai Hospital; Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; Medical Oncology Department, Apollo Speciality Hospital, Anna Salai, Chennai, India; Chest Department, Taipei Veteran’s General Hospital, Taipei, Taiwan; Nuclear Medicine and Oncology Center, Bach Mai Hospital, Hanoi, Vietnam; Medical Department, AstraZeneca, Singapore; Clinical Science Division, AstraZeneca, Osaka, Japan; St. Peregrine Oncology Unit, San Juan De Dios Hospital, Pasay City, Philippines; and Department of Internal Medicine, National Taiwan University College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Karin Heeroma
- Department of Medical Oncology, Cancer Institute/Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College; Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing, China; Department of Clinical Oncology, Queen Elizabeth Hospital, Kowloon, Hong Kong; Department of Internal Medicine, Maharaj Nakorn Chiang Mai Hospital; Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; Medical Oncology Department, Apollo Speciality Hospital, Anna Salai, Chennai, India; Chest Department, Taipei Veteran’s General Hospital, Taipei, Taiwan; Nuclear Medicine and Oncology Center, Bach Mai Hospital, Hanoi, Vietnam; Medical Department, AstraZeneca, Singapore; Clinical Science Division, AstraZeneca, Osaka, Japan; St. Peregrine Oncology Unit, San Juan De Dios Hospital, Pasay City, Philippines; and Department of Internal Medicine, National Taiwan University College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yohji Itoh
- Department of Medical Oncology, Cancer Institute/Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College; Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing, China; Department of Clinical Oncology, Queen Elizabeth Hospital, Kowloon, Hong Kong; Department of Internal Medicine, Maharaj Nakorn Chiang Mai Hospital; Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; Medical Oncology Department, Apollo Speciality Hospital, Anna Salai, Chennai, India; Chest Department, Taipei Veteran’s General Hospital, Taipei, Taiwan; Nuclear Medicine and Oncology Center, Bach Mai Hospital, Hanoi, Vietnam; Medical Department, AstraZeneca, Singapore; Clinical Science Division, AstraZeneca, Osaka, Japan; St. Peregrine Oncology Unit, San Juan De Dios Hospital, Pasay City, Philippines; and Department of Internal Medicine, National Taiwan University College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Gerardo Cornelio
- Department of Medical Oncology, Cancer Institute/Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College; Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing, China; Department of Clinical Oncology, Queen Elizabeth Hospital, Kowloon, Hong Kong; Department of Internal Medicine, Maharaj Nakorn Chiang Mai Hospital; Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; Medical Oncology Department, Apollo Speciality Hospital, Anna Salai, Chennai, India; Chest Department, Taipei Veteran’s General Hospital, Taipei, Taiwan; Nuclear Medicine and Oncology Center, Bach Mai Hospital, Hanoi, Vietnam; Medical Department, AstraZeneca, Singapore; Clinical Science Division, AstraZeneca, Osaka, Japan; St. Peregrine Oncology Unit, San Juan De Dios Hospital, Pasay City, Philippines; and Department of Internal Medicine, National Taiwan University College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Pan-Chyr Yang
- Department of Medical Oncology, Cancer Institute/Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College; Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing, China; Department of Clinical Oncology, Queen Elizabeth Hospital, Kowloon, Hong Kong; Department of Internal Medicine, Maharaj Nakorn Chiang Mai Hospital; Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; Medical Oncology Department, Apollo Speciality Hospital, Anna Salai, Chennai, India; Chest Department, Taipei Veteran’s General Hospital, Taipei, Taiwan; Nuclear Medicine and Oncology Center, Bach Mai Hospital, Hanoi, Vietnam; Medical Department, AstraZeneca, Singapore; Clinical Science Division, AstraZeneca, Osaka, Japan; St. Peregrine Oncology Unit, San Juan De Dios Hospital, Pasay City, Philippines; and Department of Internal Medicine, National Taiwan University College of Medicine, National Taiwan University, Taipei, Taiwan
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Shepelev MV, Korobko IV. The RHOV gene is overexpressed in human non-small cell lung cancer. Cancer Genet 2013; 206:393-7. [PMID: 24388711 DOI: 10.1016/j.cancergen.2013.10.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Revised: 10/20/2013] [Accepted: 10/30/2013] [Indexed: 01/29/2023]
Abstract
Rho family GTPases act as molecular switches to regulate numerous cellular processes, including malignant transformation. Commonly, overexpression of Rho GTPases contributes to tumorigenesis. Elevated expression of several Rho GTPases has been reported in lung cancer and is associated with poor prognosis. The RHOV gene encodes the atypical Rho family GTPase Chp/RhoV, which is capable of transforming fibroblasts, although other functions of Chp remain largely elusive. RHOV is expressed in normal lung tissue in rats, but not in humans. RHOV expression was found in several human cancer cell lines, including non-small-cell lung cancer (NSCLC) cell line A549, but expression of RHOV in NSCLC tumors has never been investigated. Here we studied the expression of the RHOV gene in lung cancer cell lines and in 29 matched pairs of NSCLC tumors and adjacent nontumorous tissues. We found that RHOV is expressed in lung cancer cell lines and is upregulated in the majority of studied lung tumors. Analysis of the Oncomine database revealed correlation between elevated RHOV level and poor patient survival. We propose that the RHOV gene could be validated as a diagnostic or prognostic marker for NSCLC, and that observed overexpression of RHOV might contribute to tumorigenesis.
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Liu B, Feng Y, Zhang JY, Li HM, Li XD, Jia HL, Li ZY, Feng J. Imaging of bronchioloalveolar carcinoma in the mice with the αⅤβ3 integrin-targeted tracer (99m)Tc-RGD-4CK. Transl Res 2013; 162:174-80. [PMID: 23867618 DOI: 10.1016/j.trsl.2013.06.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Revised: 06/25/2013] [Accepted: 06/29/2013] [Indexed: 12/22/2022]
Abstract
Receptor-based imaging agents have shown improved specificity and sensitivity of cancer diagnosis by targeting the specific features of cancer. Here we reported the (99m)Tc-labeling of a cyclic polypeptide RGD-4CK and the characterization of this agent in vitro and in bronchioloalveolar carcinoma (BAC) xenograft model. The αⅤβ3 integrin receptor binding affinity of (99m)Tc-RGD-4CK was determined in BAC. The cancer targeting properties of (99m)Tc-RGD-4CK were determined in NCI-H358 xenografted nude mice. Moreover, the BAC uptake of (99m)Tc-RGD-4CK was blocked with nonradiolabeled RGD-4CK in xenografts. The competitive assay showed that (99m)Tc-RGD-4CK exhibited high specificity to BAC cell line NCI-H358. Biodistribution studies indicated that (99m)Tc-RGD-4CK exhibited high tumor uptake (4.12 ± 1.21% injected dose/g 120 minutes after injection) and prolonged tumor retention (2.08 ± 0.33% injected dose/g 240 minutes after injection) in NCI-H358 xenografted nude mice. Moreover, (99m)Tc-RGD-4CK produced a good tumor-to-lung ratio (2.38) because of low lung activity accumulation 120 minutes postinjection. BAC on the flank of xenografted mice was clearly visualized by single photon emission computed tomography/computed tomography imaging using (99m)Tc-RGD-4CK. In conclusion, this study provides evidence that (99m)Tc-RGD-4CK is a promising agent for noninvasive determination of αⅤβ3 integrin status and therapy monitoring in BAC.
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Affiliation(s)
- Bin Liu
- Department of Nuclear Medicine, The Second Affiliated Hospital of Hebei Medical University, Shijiazhuang, China
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Hickey R, Vouche M, Sze D, Hohlastos E, Collins J, Schirmang T, Memon K, Ryu RK, Sato K, Chen R, Gupta R, Resnick S, Carr J, Chrisman H, Nemcek A, Vogelzang R, Lewandowski RJ, Salem R. Cancer concepts and principles: primer for the interventional oncologist-part II. J Vasc Interv Radiol 2013; 24:1167-88. [PMID: 23810312 PMCID: PMC3800031 DOI: 10.1016/j.jvir.2013.04.023] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Revised: 04/20/2013] [Accepted: 04/20/2013] [Indexed: 02/07/2023] Open
Abstract
This is the second of a two-part overview of the fundamentals of oncology for interventional radiologists. The first part focused on clinical trials, basic statistics, assessment of response, and overall concepts in oncology. This second part aims to review the methods of tumor characterization; principles of the oncology specialties, including medical, surgical, radiation, and interventional oncology; and current treatment paradigms for the most common cancers encountered in interventional oncology, along with the levels of evidence that guide these treatments.
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Affiliation(s)
- Ryan Hickey
- Department of Radiology, Division of Interventional Oncology, Northwestern University, Chicago IL
| | - Michael Vouche
- Department of Radiology, Division of Interventional Oncology, Northwestern University, Chicago IL
| | - Daniel Sze
- Department of Radiology, Stanford University, Palo Alto, CA
| | - Elias Hohlastos
- Department of Radiology, Division of Interventional Oncology, Northwestern University, Chicago IL
| | - Jeremy Collins
- Department of Radiology, Division of Interventional Oncology, Northwestern University, Chicago IL
| | - Todd Schirmang
- Department of Radiology, Division of Interventional Oncology, Northwestern University, Chicago IL
| | - Khairuddin Memon
- Department of Radiology, Division of Interventional Oncology, Northwestern University, Chicago IL
| | - Robert K Ryu
- Department of Radiology, Division of Interventional Oncology, Northwestern University, Chicago IL
| | - Kent Sato
- Department of Radiology, Division of Interventional Oncology, Northwestern University, Chicago IL
| | - Richard Chen
- Department of Radiology, Division of Interventional Oncology, Northwestern University, Chicago IL
| | - Ramona Gupta
- Department of Radiology, Division of Interventional Oncology, Northwestern University, Chicago IL
| | - Scott Resnick
- Department of Radiology, Division of Interventional Oncology, Northwestern University, Chicago IL
| | - James Carr
- Department of Radiology, Division of Interventional Oncology, Northwestern University, Chicago IL
| | - Howard Chrisman
- Department of Radiology, Division of Interventional Oncology, Northwestern University, Chicago IL
| | - Al Nemcek
- Department of Radiology, Division of Interventional Oncology, Northwestern University, Chicago IL
| | - Robert Vogelzang
- Department of Radiology, Division of Interventional Oncology, Northwestern University, Chicago IL
| | - Robert J Lewandowski
- Department of Radiology, Division of Interventional Oncology, Northwestern University, Chicago IL
| | - Riad Salem
- Department of Radiology, Division of Interventional Oncology, Northwestern University, Chicago IL
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Yuan Z, Li WT, Ye XD, Dong S, Peng WJ. Intra-arterial infusion chemotherapy for advanced non-small-cell lung cancer: preliminary experience on the safety, efficacy, and clinical outcomes. J Vasc Interv Radiol 2013; 24:1521-8.e4. [PMID: 23906798 DOI: 10.1016/j.jvir.2013.05.065] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [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: 09/10/2012] [Revised: 05/28/2013] [Accepted: 05/28/2013] [Indexed: 01/14/2023] Open
Abstract
PURPOSE To investigate the effectiveness and toxicity of intra-arterial infusion chemotherapy as a therapeutic modality for advanced non-small-cell lung cancer (NSCLC). MATERIALS AND METHODS In a retrospective study, 40 patients with stage III NSCLC received intra-arterial infusion chemotherapy with gemcitabine and cisplatin. Tumor staining was graded based on angiography, and the number of NSCLC feeding arteries detected was recorded. Toxicity was assessed according to National Cancer Institute Common Toxicity Criteria for Adverse Events. The response to treatment was evaluated per Response Evaluation Criteria In Solid Tumors (RECIST). Efficacy was assessed based on time to tumor progression (TTP), and survival was estimated by Kaplan-Meier analysis. Prognostic factors influencing TTP and overall survival rate were evaluated by Cox regression analysis. RESULTS The most frequent drug-related adverse events were cough (n = 17; 42.5%), anorexia (n = 14; 35%), and pain (n = 9; 22.5%). Evaluated per RECIST, a total of 47.5% of patients (n = 19) exhibited response to therapy after completion of the first three cycles of intra-arterial infusion chemotherapy. The median TTP was 5 months. Patients had a median life expectancy of 9 months. By Cox regression analysis, tumor staining was shown to be an independent prognostic factor for TTP (relative risk, 0.405; 95% confidence interval, 0.216-0.760) and overall survival (relative risk, 0.348; 95% confidence interval, 0.185-0.656). CONCLUSIONS Intra-arterial infusion chemotherapy for advanced lung cancer has the potential to reduce the size of tumors and has no severe adverse effects.
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Affiliation(s)
- Zheng Yuan
- Department of Radiology, Shanghai Cancer Hospital, Fudan University, 270 Dong An Rd., Shanghai 200032, People's Republic of China; Department of Radiology, Nanjing Jinling Hospital, Clinical School of Medical College, Nanjing University, Nanjing, People's Republic of China.
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Rosenzweig KE, Chang JY, Chetty IJ, Decker RH, Ginsburg ME, Kestin LL, Kong FMS, Lally BE, Langer CJ, Movsas B, Videtic GMM, Willers H. ACR appropriateness criteria nonsurgical treatment for non-small-cell lung cancer: poor performance status or palliative intent. J Am Coll Radiol 2013; 10:654-64. [PMID: 23890874 DOI: 10.1016/j.jacr.2013.05.031] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Accepted: 05/29/2013] [Indexed: 12/25/2022]
Abstract
Radiation therapy plays a potential curative role in the treatment of patients with non-small-cell lung cancer with locoregional disease who are not surgical candidates and a palliative role for patients with metastatic disease. Stereotactic body radiation therapy is a relatively new technique in patients with early-stage non-small-cell lung cancer. A trial from RTOG(®) reported >97% local control at 3 years. For patients with locally advanced disease, thoracic radiation to a dose of 60 Gy remains the standard of care. Sequential chemotherapy or radiation alone can be used for patients with poor performance status who cannot tolerate more aggressive approaches. Chemotherapy should be used for patients with metastatic disease. Radiation therapy is useful for palliation of symptomatic tumors, and a dose of approximately 30 Gy is commonly used. Endobronchial brachytherapy is useful for patients with symptomatic endobronchial tumors. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
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Uyterlinde W, Belderbos J, Baas C, van Werkhoven E, Knegjens J, Baas P, Smit A, Rikers C, van den Heuvel M. Prediction of acute toxicity grade ≥ 3 in patients with locally advanced non-small-cell lung cancer receiving intensity modulated radiotherapy and concurrent low-dose Cisplatin. Clin Lung Cancer 2013; 14:541-8. [PMID: 23835165 DOI: 10.1016/j.cllc.2013.04.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Revised: 04/05/2013] [Accepted: 04/16/2013] [Indexed: 12/25/2022]
Abstract
BACKGROUND Intensity modulated radiotherapy (IMRT) is increasingly used with concurrent chemotherapy but toxicity data are not well investigated. We correlated clinical and dosimetric parameters with acute toxicity grade ≥ 3 in patients with locally advanced NSCLC treated with IMRT and concurrent low-dose cisplatin. PATIENTS AND METHODS We analyzed age, PS, comorbidities, gross tumor volume, and the volume of the esophagus irradiated with 50 Gy (V50oes) in relation with acute toxicity. The mean lung dose (MLD) and pulmonary toxicity was described. Treatment consisted of 24 × 2, 75 Gy, and daily cisplatin 6 mg/m². Patients with an MLD ≥ 20 Gy or a PS > 2 were excluded from CCRT. Toxicity was prospectively scored using the Common Toxicity Criteria for adverse events version 3.0. The Charlson Comorbidity Index (CCI) was applied for scoring comorbidities. Multivariable logistic regressions for toxicity and survival estimates (Kaplan-Meier) were used for evaluation. RESULTS From 2008 to 2011, 188 patients received standard CCRT. In 35% of the patients, acute toxicity grade ≥ 3 was reported. Grade 5 toxicity was scored in 1% of the patients. V50oes (odds ratio [OR], 1.33 per 10% increase; P = .01) and PS ≥ 2 (OR, 3.45; P = .07) were significantly correlated with acute toxicity ≥ grade 3. No differences in toxicity were observed between age groups (< 70 and ≥ 70; P = .26), and those with a CCI score < 5 and ≥ 5, and acute severe toxicity (P = .36). Grade ≥ 3 pulmonary toxicity was seen in 7%. The 1- and 2-year overall survival in stage III disease were 78% and 52%, respectively. Patients with a poor PS or a high CCI score had similar survival outcomes. CONCLUSION Concurrent low-dose cisplatin using IMRT is effective in a large cohort of consecutive patients with NSCLC and life threatening toxicity is rare (1%). PS ≥ 2 and V50oes are correlated with acute toxicity grade ≥ 3.
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Affiliation(s)
- Wilma Uyterlinde
- Department of Thoracic Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
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Marshall D, Laberge JM, Firetag B, Miller T, Kerlan RK. The changing face of percutaneous image-guided biopsy: molecular profiling and genomic analysis in current practice. J Vasc Interv Radiol 2013; 24:1094-103. [PMID: 23806383 DOI: 10.1016/j.jvir.2013.04.027] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2013] [Revised: 04/25/2013] [Accepted: 04/25/2013] [Indexed: 12/19/2022] Open
Abstract
Oncology is undergoing a revolutionary change. Image-guided biopsy is expected to play an increasingly important role in this radical transformation. Current concepts of disease and treatment are based on an established set of physical signs and symptoms and laboratory tests broken down by organ system. However, soon diseases will be categorized and treated based on much more specific and detailed molecular and genetic information. This transformation in how disease is categorized and treated will depend on the ability to harvest tissue from tumors and analyze it appropriately.
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Affiliation(s)
- Dustyn Marshall
- Department of Radiology, University of California, San Francisco, San Francisco, CA 94143-0628, USA.
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Tsao AS, Liu S, Lee JJ, Alden C, Blumenschein G, Herbst R, Davis SE, Kim E, Lippman S, Stewart D, Tang XM, Wistuba I, Hong WK. Clinical outcomes and biomarker profiles of elderly pretreated NSCLC patients from the BATTLE trial. J Thorac Oncol 2012; 7:1645-52. [PMID: 23059780 PMCID: PMC5161038 DOI: 10.1097/jto.0b013e31826910ff] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Treating elderly non-small-cell lung cancer (NSCLC) patients in the salvage setting is challenging because of concerns of intolerance to therapy. Here we report outcomes (survival and toxicity) of elderly patients on the Biomarker-Integrated Approaches of Targeted Therapy for Lung Cancer Elimination (BATTLE) trial. METHODS Two hundred and fifty-five chemorefractory NSCLC patients received tumor molecular analysis, and were randomized to erlotinib, erlotinib-bexarotene, vandetanib, or sorafenib. Retrospective subgroup analyses were conducted comparing outcomes among age groups (< 65 versus ≥ 65 years; < 70 versus ≥ 70 years; < 75 versus ≥ 75 years), treatments, and sex. RESULTS Median age was 62 years (range, 26-84); 38% were aged 65 years or more. No significant differences among age groups were seen in rates of biopsy-related pneumothorax, treatment-related death, compliance, grade 3 to 4 hematologic toxicities, response rate, nor overall survival. However, older women aged 65 years or more had more grade 3 to 4 nonhematologic toxicities (p = 0.05). Elderly men aged 65 years or more (p = 0.008) had a higher disease-control rate at 8 weeks and a better progression-free survival (PFS) (p = 0.0068). Elderly women aged 70 years or more had a trend toward higher 8-week disease-control rate (p = 0.06). Older men aged 65 years or more treated with vandetanib had a better median PFS (p = 0.03) whereas PFS of older women aged 70 years or more was worse (p = 0.03) compared with younger patients. Elderly men aged 70 years or more treated with sorafenib had a higher overall survival compared with younger men (p = 0.04). Tumor tissue biomarkers show distinct differences by sex and age. CONCLUSION Fit elderly NSCLC patients should be considered for salvage targeted therapy. In this subset of patients, older men seem to have significant clinical benefit from certain agents. Tumor biomarker analysis demonstrates sex and age variations, and is hypothesis-generating.
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Affiliation(s)
- Anne S Tsao
- Department of Thoracic/Head & Neck Medical Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX, USA.
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William WN, Khuri FR, Fossella FV, Glisson BS, Zinner RG, Lee JJ, Herbst RS, Lippman SM, Kim ES. Phase II study of vinorelbine and docetaxel in the treatment of advanced non-small-cell lung cancer as frontline and second-line therapy. Am J Clin Oncol 2010; 33:148-52. [PMID: 19687727 PMCID: PMC5118944 DOI: 10.1097/coc.0b013e318199fb99] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Combination chemotherapy with third-generation, nonplatinum agents (ie, gemcitabine, vinorelbine, taxanes, or camptothecins) represents a well-tolerated frontline treatment option for metastatic non-small-cell lung cancer and might play a role as salvage therapy as well. The aim of this phase 2 study was to investigate the use of docetaxel and vinorelbine in the frontline and second-line setting in patients with incurable non-small-cell lung cancer. PATIENTS AND METHODS Seventy-eight patients (42 untreated, 36 previously treated) were administered vinorelbine (20 mg/m) on days 1 and 8 and docetaxel (75 mg/m for untreated patients; 60 mg/m for previously treated patients for cycle 1, increased to 75 mg/m for the subsequent cycles in the absence of grade 3 fever/neutropenia) on day 8, repeated every 21 days, with routine filgrastim support. RESULTS The most common grade 3 to 4 nonhematologic toxicities were diarrhea, dyspnea, fatigue, and nausea/vomiting (5% each). Grade 3 to 4 granulocytopenia occurred in 55% of the patients, however only 5% experienced febrile neutropenia. Response rates were 13% in the chemotherapy-naive cohort and 9% in previously treated patients. Median time to progression was 2.9 and 3.0 months and median overall survival was 15.0 and 6.2 months, for the frontline and second-line patients, respectively. CONCLUSIONS Compared with historical controls, in the first-line setting, the combination of docetaxel and vinorelbine did not demonstrate increased efficacy advantages over platinum- or other nonplatinum-based doublets. In the second-line setting, single agent chemotherapy is as effective as, and less toxic than the docetaxel-vinorelbine combination, and the former remains the cytotoxic treatment of choice.
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Affiliation(s)
- William N. William
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - Fadlo R. Khuri
- Department of Hematology and Medical Oncology, Emory Winship Cancer Institute, Atlanta, GA
| | - Frank V. Fossella
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - Bonnie S. Glisson
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - Ralph G. Zinner
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - J. Jack Lee
- Department of Biostatistics and Applied Mathematics, The University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - Roy S. Herbst
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - Scott M. Lippman
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - Edward S. Kim
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX
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