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Koyi H, Wilander E. Refined Diagnosis of Pleural Effusions by Immunocytochemistry of Cell Blocks. Anticancer Res 2023; 43:669-673. [PMID: 36697096 DOI: 10.21873/anticanres.16204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 12/15/2022] [Accepted: 12/20/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND/AIM The main objective of microscopic examination of pleural effusions is to ascertain the presence of malignant cells. Effusions prepared routinely using May-Grünwald-Giemsa (MGG)- and Papanicolaou (PAP)-staining can, in a number of cases, provide inconclusive cytological results regarding malignancy. PATIENTS AND METHODS This report describes the refined diagnosis of such cases based on immunocytochemical analysis of pleural effusion cell blocks. Of the 340 pleural effusions obtained during 2019 at the Department of Clinical Cytology, Gävle Hospital, Sweden, 63 (18.5%) contained atypical cells of undetermined significance or potentially malignant cells. RESULTS This diagnosis could be refined using Epithelial Cell Adhesion Molecule/EPCAM (BEREP4) immunocytochemical analysis of effusion cell blocks, allowing previously inconclusive effusions to be classified as clearly benign 42/63 (66.7%) or malignant 21/63 (33.3%). Effusions initially diagnosed as clearly malignant (27/340; 7.9%) were all 27 (100%) BEREP4-immuno-stained. Most BEREP4-positive effusions (37/48; 77.1%) were also carcinoembryonic antigen (CEA) positive. The number of BEREP4-positive cells, however, tended to exceed that of CEA-positive cells. The BEREP4 positive effusions were further examined using different monoclonal antibodies, such as Thyroid transcription factor 1 (TTF-1) for primary pulmonary adenocarcinoma, to determine the original site of the primary tumour. CONCLUSION Immunohistochemical staining of pleural effusion cell blocks significantly refines the diagnosis of serous pleural effusions, especially in cases where the preliminary diagnosis was atypical cells of undetermined significance or potentially malignant cells. Furthermore, in the cases of malignancy, the origin of the primary tumour could most often be determined.
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Affiliation(s)
- Hirsh Koyi
- Department of Respiratory Medicine, Gävle Hospital, Gävle, Sweden; .,Department of Oncology-Pathology, Karolinska Biomics Center, Karolinska Institute, Stockholm, Sweden.,Centre for Research and Development, Uppsala University/County Council of Gävleborg, Gävle, Sweden
| | - Erik Wilander
- Department of Pathology, Gävle Hospital, Gävle, Sweden
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2
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Isaksson J, Wennström L, Branden E, Koyi H, Berglund A, Micke P, Mattsson JSM, Willén L, Botling J. Highly elevated systemic inflammation is a strong independent predictor of early mortality in advanced non-small cell lung cancer. Cancer Treat Res Commun 2022; 31:100556. [PMID: 35429913 DOI: 10.1016/j.ctarc.2022.100556] [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: 01/28/2022] [Revised: 03/16/2022] [Accepted: 04/02/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Ample evidence support inflammation as a marker of outcome in non-small cell lung cancer (NSCLC). Here we explore the outcome for a subgroup of patients with advanced disease and substantially elevated systemic inflammatory activity. METHODS The source cohort included consecutive patients diagnosed with NSCLC between January 2016 - May 2017 (n = 155). Patients with active infection were excluded. Blood parameters were examined individually, and cut-offs (ESR > 60 mm, CRP > 20 mg/L, WBC > 10 × 109, PLT > 400 × 109) were set to define the group of hyperinflamed patients. A score was developed by assigning one point for each parameter above cut-off (0-4 points). RESULTS High systemic inflammation was associated with advanced stage and was seldom present in limited NSCLC. However, the one year survival of patients in stage IIIB-IV (n = 93) with an inflammation score of ≥2 was 0% compared to 33% and 50% among patients with a score of 1 and 0 respectively. The effect of a high inflammation score on overall survival remained significant in multi-variate analysis adjusted for confounding factors. The independent hazard ratio of an inflammation score ≥ 2 in multi-variate analysis (HR 3.43, CI 1.76-6.71) was comparable to a change in ECOG PS from 0 to 2 (HR 2.42, CI 1.13-5.18). CONCLUSION Our results show that high level systemic inflammation is a strong independent predictor of poor survival in advanced stage NSCLC. This observation may indicate a need to use hyperinflammation as an additional clinical parameter for stratification of patients in clinical studies and warrants further research on underlying mechanisms linked to tumor progression.
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Affiliation(s)
- Johan Isaksson
- Center for Research and Development, Uppsala University/Region Gävleborg, Sweden; Department of Immunology, Genetics and Pathology, Science for Life Laboratory, Uppsala University, Uppsala, Sweden; Department of Respiratory Medicine, Gävle Hospital, Gävle, Sweden
| | - Leo Wennström
- Center for Research and Development, Uppsala University/Region Gävleborg, Sweden; Department of Respiratory Medicine, Gävle Hospital, Gävle, Sweden
| | - Eva Branden
- Center for Research and Development, Uppsala University/Region Gävleborg, Sweden; Department of Respiratory Medicine, Gävle Hospital, Gävle, Sweden
| | - Hirsh Koyi
- Center for Research and Development, Uppsala University/Region Gävleborg, Sweden; Department of Respiratory Medicine, Gävle Hospital, Gävle, Sweden; Department of Oncology-Pathology, Karolinska Biomics Center, Karolinska Institutet, Stockholm, Sweden
| | | | - Patrick Micke
- Department of Immunology, Genetics and Pathology, Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | | | - Linda Willén
- Center for Research and Development, Uppsala University/Region Gävleborg, Sweden; Department of Radiation Sciences and Oncology, Umeå University Hospital, Umeå, Sweden; Department of Oncology, Gävle Hospital, Gävle, Sweden
| | - Johan Botling
- Department of Immunology, Genetics and Pathology, Science for Life Laboratory, Uppsala University, Uppsala, Sweden.
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3
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Björn N, Jakobsen I, Udagawa C, Brandén E, Koyi H, Lewensohn R, De Petris L, Zembutsu H, Gréen H. The association of four genetic variants with myelosuppression in gemcitabine-treated Japanese is not evident in gemcitabine/carboplatin-treated Swedes. Basic Clin Pharmacol Toxicol 2022; 130:513-521. [PMID: 35132780 PMCID: PMC9303231 DOI: 10.1111/bcpt.13712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 01/31/2022] [Accepted: 02/01/2022] [Indexed: 11/26/2022]
Abstract
Gemcitabine/carboplatin‐induced myelosuppressive adverse drug reactions (ADRs) are clinical problems leading to patient suffering and dose alterations. There is a need for personalised medicine to improve treatment effects and patients' well‐being. We tested four genetic variants, rs11141915, rs1901440, rs12046844 and rs11719165, previously suggested as potential biomarkers for gemcitabine‐induced leukopenia/neutropenia in Japanese patients, in 213 Swedish gemcitabine/carboplatin‐treated non‐small cell lung cancer (NSCLC) patients. DNA was genotyped using TaqMan probes and real‐time PCR. The relationships between the risk alleles and low toxicity (non‐ADR: Common Terminology Criteria for Adverse Events [CTCAE] grades 0) or high toxicity (ADR: CTCAE grades 3–4) of platelets, leukocytes and neutrophils were evaluated using Fisher's exact test. The risk alleles did not correlate with myelosuppression, and the strongest borderline significance (not withstanding adjustment for multiple testing) was for rs1901440 (neutropenia, p = 0.043) and rs11719165 (leukopenia, p = 0.049) where the risk alleles trended towards lower toxicity, contrasting with previous study findings. Risk alleles and higher risk scores were more common among our patients. We conclude that the genetic variants do not apply to Swedish patients treated with gemcitabine/carboplatin. However, they can still be important in other populations and cohorts, especially in a gemcitabine monotherapy setting, where the causal genetic variation might influence myelosuppressive ADRs.
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Affiliation(s)
- Niclas Björn
- Division of Clinical Chemistry and Pharmacology, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Ingrid Jakobsen
- Division of Clinical Chemistry and Pharmacology, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.,Department of Laboratory Medicine, Örebro University Hospital, Örebro, Sweden
| | - Chihiro Udagawa
- Department of Genetic Medicine and Services, National Cancer Center Hospital, Tokyo, Japan
| | - Eva Brandén
- Department of Respiratory Medicine, Gävle Hospital, Gävle, Sweden.,Centre for Research and Development, Uppsala University/Region Gävleborg, Gävle, Sweden
| | - Hirsh Koyi
- Department of Respiratory Medicine, Gävle Hospital, Gävle, Sweden.,Centre for Research and Development, Uppsala University/Region Gävleborg, Gävle, Sweden
| | - Rolf Lewensohn
- Thoracic Oncology Unit, Tema Cancer, Karolinska University Hospital, and Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Luigi De Petris
- Thoracic Oncology Unit, Tema Cancer, Karolinska University Hospital, and Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Hitoshi Zembutsu
- Department of Clinical Genomics, National Cancer Center Research Institute, Tokyo, Japan
| | - Henrik Gréen
- Division of Clinical Chemistry and Pharmacology, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.,Department of Forensic Genetics and Forensic Toxicology, National Board of Forensic Medicine, Linköping, Sweden
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4
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Abstract
Objective To explore swallowing function and risk factors associated with delayed recovery of swallowing in COVID-19 patients post invasive mechanical ventilation using the Functional Oral Intake Scale (FOIS). Design Longitudinal cohort study. Setting 3 secondary-level hospitals. Participants Invasively ventilated patients (n=28), hospitalized with severe COVID-19 who were referred to the Speech and Language Pathology (SLP) departments post mechanical ventilation between March 5 and July 5 2020 for an evaluation of swallowing function before commencing oral diet. Interventions SLP assessment, advice and therapy for dysphagia. Main outcome measures Oral intake levels at baseline and hospital discharge according to the Functional Oral Intake Scale (FOIS). Patients were stratified according to FOIS (1-5=dysphagia, 6-7= functional oral intake). Data regarding comorbidities, frailty, intubation and tracheostomy, proning and SLP evaluation were collected. Results Dysphagia was found in 71% of the patients at baseline (in total 79% male, age 61 ±12 years, BMI 30 ±8 kg/m2). Median FOIS score at baseline was 2 (IQR 1) vs 5 (IQR 2.5) at hospital discharge. Patients with dysphagia were older (64 ±8.5 vs 53 ±16 years; p= 0.019), had a higher incidence of hypertension (70% vs 12%; p=0.006) were ventilated invasively longer (16 ±7 vs 10 ±2 days; p=0.017) or with tracheostomy (9 ±9 vs 1 ±2 days; p=0.03) longer. A negative association was found between swallowing dysfunction at bedside and days hospitalized (r=-0.471, p=0.01), and number of days at the Intensive Care Unit (ICU) (r=-0.48, p=0.01). Conclusion Dysphagia is prevalent in COVID-19 patients post invasive mechanical ventilation and is associated with number of days in hospital and number of days in the ICU. Swallowing function and tolerance of oral diet improved at discharge (p<0.001).
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Affiliation(s)
- Margareta Gonzalez Lindh
- Department of Neuroscience, Speech and Language Pathology, Uppsala University, Uppsala, Sweden.,Centre for Research and Development (CFUG), Uppsala University, Region Gävleborg, Gävle, Sweden
| | - Gustav Mattsson
- Centre for Research and Development (CFUG), Uppsala University, Region Gävleborg, Gävle, Sweden
| | - Hirsh Koyi
- Centre for Research and Development (CFUG), Uppsala University, Region Gävleborg, Gävle, Sweden.,Department of Oncology-Pathology, Karolinska Biomics Center, Karolinska Institutet, 17176 Stockholm, Sweden
| | - Monica Blom Johansson
- Department of Neuroscience, Speech and Language Pathology, Uppsala University, Uppsala, Sweden
| | - Robin Razmi
- Centre for Research and Development (CFUG), Uppsala University, Region Gävleborg, Gävle, Sweden.,Section of Infectious Diseases, Department of Medical Sciences, Uppsala Universitet, Uppsala, Sweden
| | - Andreas Palm
- Centre for Research and Development (CFUG), Uppsala University, Region Gävleborg, Gävle, Sweden.,Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala Universitet, Uppsala, Sweden
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5
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Salomonsson A, Jönsson M, Behndig A, Bergman B, Botling J, Brandén E, Koyi H, Brunnström H, De Petris L, Helenius G, Hussein A, Johansson M, Kentson M, Lamberg K, Lewensohn R, Mager U, Monsef N, Ortiz-Villalon C, Patthey A, Sundh J, Vikström A, Wagenius G, Staaf J, Planck M. FP16.04 A Nationwide Population-Based Mapping of Mutations and Gene Fusions in Lung Cancer Among Never-Smokers. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.08.260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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6
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Hallqvist A, Koyi H, de Petris L, Lindberg K, Farooqi S, Helland Å, Wikström A, Johansson M, Planck M, Lindberg L, Yksnøy Ø, Grønberg B, Helbekkmo N, Nyman J. 63MO Safety analysis of durvalumab following stereotactic body radiotherapy (SBRT) in early-stage non-small cell lung cancer (NSCLC) patients: A first report of a randomized phase II trial (ASTEROID). J Thorac Oncol 2021. [DOI: 10.1016/s1556-0864(21)01905-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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7
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Hillerdal G, Koyi H. Intrabronchial stents in heterogenous emphysema: a highly selected material followed 5 years. J Thorac Dis 2020; 12:3524-3528. [PMID: 32802431 PMCID: PMC7399418 DOI: 10.21037/jtd-19-4082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Background Endobronchial lung volume reduction (EBVR) with one-way valves introduced into the most diseased lobe of the lung is a non-invasive method to improve lung function in patients with severe heterogenous emphysema. The problem is to select the right patients for the procedure. Furthermore, the long-term effects have not been reported in most studies. Methods EBVR was performed in 35 patients with severely handicapping emphysema and with one radiologically clearly enlarged (at least 125%) target lung lobe and clearly visible and complete interlobar fissures on CT. Most of the successful survivors have then been followed for five years. Results Five (14%) were primary failures (defined as less than 15% increase of FEV1sec) and 10 (28%) were secondary failures (the valves were coughed up or removed for some reason). In the 21 successful l patients, the improvement of FEV1sec was in the mean 59%. Over the years, FEV1sec gradually decreased but was still higher 5 years later than initially. Of the successful group, 76% were still alive after 5 years, while only 50% were in the refused or failed groups. Conclusions With careful selection of patients remarkably good results in lung function can be achieved, and these improvements will last for years though slowly decrease. In addition, the results indicate an improvement in survival with successful EBVR procedure.
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Affiliation(s)
- Gunnar Hillerdal
- Department of Respiratory Medicine, Regional Hospital, Gavle, Sweden.,Department of Respiratory Medicine an Allergy, Karolinska University Hospital, Stockholm, Sweden
| | - Hirsh Koyi
- Department of Respiratory Medicine, Regional Hospital, Gavle, Sweden.,Department of Respiratory Medicine an Allergy, Karolinska University Hospital, Stockholm, Sweden.,Karolinska Institute, Stockholm, Sweden.,Uppsala University/County Council of Gavleborg, Gavle, Sweden
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8
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Liljedahl H, Karlsson A, Oskarsdottir GN, Salomonsson A, Brunnström H, Erlingsdottir G, Jönsson M, Isaksson S, Arbajian E, Ortiz-Villalón C, Hussein A, Bergman B, Vikström A, Monsef N, Branden E, Koyi H, de Petris L, Patthey A, Behndig AF, Johansson M, Planck M, Staaf J. A gene expression-based single sample predictor of lung adenocarcinoma molecular subtype and prognosis. Int J Cancer 2020; 148:238-251. [PMID: 32745259 PMCID: PMC7689824 DOI: 10.1002/ijc.33242] [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: 03/25/2020] [Revised: 07/03/2020] [Accepted: 07/07/2020] [Indexed: 12/14/2022]
Abstract
Disease recurrence in surgically treated lung adenocarcinoma (AC) remains high. New approaches for risk stratification beyond tumor stage are needed. Gene expression-based AC subtypes such as the Cancer Genome Atlas Network (TCGA) terminal-respiratory unit (TRU), proximal-inflammatory (PI) and proximal-proliferative (PP) subtypes have been associated with prognosis, but show methodological limitations for robust clinical use. We aimed to derive a platform independent single sample predictor (SSP) for molecular subtype assignment and risk stratification that could function in a clinical setting. Two-class (TRU/nonTRU=SSP2) and three-class (TRU/PP/PI=SSP3) SSPs using the AIMS algorithm were trained in 1655 ACs (n = 9659 genes) from public repositories vs TCGA centroid subtypes. Validation and survival analysis were performed in 977 patients using overall survival (OS) and distant metastasis-free survival (DMFS) as endpoints. In the validation cohort, SSP2 and SSP3 showed accuracies of 0.85 and 0.81, respectively. SSPs captured relevant biology previously associated with the TCGA subtypes and were associated with prognosis. In survival analysis, OS and DMFS for cases discordantly classified between TCGA and SSP2 favored the SSP2 classification. In resected Stage I patients, SSP2 identified TRU-cases with better OS (hazard ratio [HR] = 0.30; 95% confidence interval [CI] = 0.18-0.49) and DMFS (TRU HR = 0.52; 95% CI = 0.33-0.83) independent of age, Stage IA/IB and gender. SSP2 was transformed into a NanoString nCounter assay and tested in 44 Stage I patients using RNA from formalin-fixed tissue, providing prognostic stratification (relapse-free interval, HR = 3.2; 95% CI = 1.2-8.8). In conclusion, gene expression-based SSPs can provide molecular subtype and independent prognostic information in early-stage lung ACs. SSPs may overcome critical limitations in the applicability of gene signatures in lung cancer.
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Affiliation(s)
- Helena Liljedahl
- Division of Oncology and Pathology, Department of Clinical Sciences Lund, Lund University, Medicon Village, Lund, Sweden
| | - Anna Karlsson
- Division of Oncology and Pathology, Department of Clinical Sciences Lund, Lund University, Medicon Village, Lund, Sweden
| | - Gudrun N Oskarsdottir
- Division of Oncology and Pathology, Department of Clinical Sciences Lund, Lund University, Medicon Village, Lund, Sweden.,Department of Respiratory Medicine and Allergology, Skåne University Hospital, Lund, Sweden
| | - Annette Salomonsson
- Division of Oncology and Pathology, Department of Clinical Sciences Lund, Lund University, Medicon Village, Lund, Sweden
| | - Hans Brunnström
- Division of Oncology and Pathology, Department of Clinical Sciences Lund, Lund University, Medicon Village, Lund, Sweden.,Department of Pathology, Laboratory Medicine Region Skåne, Lund, Sweden
| | - Gigja Erlingsdottir
- Department of Pathology, Landspitali University Hospital, Reykjavik, Iceland.,Department of Laboratory Medicine, Department of Pathology, Skåne University Hospital, Malmö, Sweden
| | - Mats Jönsson
- Division of Oncology and Pathology, Department of Clinical Sciences Lund, Lund University, Medicon Village, Lund, Sweden
| | - Sofi Isaksson
- Division of Oncology and Pathology, Department of Clinical Sciences Lund, Lund University, Medicon Village, Lund, Sweden
| | - Elsa Arbajian
- Division of Oncology and Pathology, Department of Clinical Sciences Lund, Lund University, Medicon Village, Lund, Sweden
| | | | - Aziz Hussein
- Department of Pathology and Cytology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Bengt Bergman
- Department of Respiratory Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Anders Vikström
- Department of Pulmonary Medicine, University Hospital Linköping, Linköping, Sweden
| | - Nastaran Monsef
- Department of Pathology and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Eva Branden
- Respiratory Medicine Unit, Department of Medicine Solna and CMM, Karolinska Institute and Karolinska University Hospital Solna, Stockholm, Sweden.,Centre for Research and Development, Uppsala University/Region Gävleborg, Gävle, Sweden
| | - Hirsh Koyi
- Respiratory Medicine Unit, Department of Medicine Solna and CMM, Karolinska Institute and Karolinska University Hospital Solna, Stockholm, Sweden.,Centre for Research and Development, Uppsala University/Region Gävleborg, Gävle, Sweden
| | - Luigi de Petris
- Thoracic Oncology Unit, Karolinska University Hospital and Department Oncology-Pathology, Karolinska Institute, Stockholm, Sweden
| | - Annika Patthey
- Department of Medical Biosciences, Pathology, Umeå University, Umeå, Sweden
| | - Annelie F Behndig
- Department of Public Health and Clinical Medicine, Division of Medicine, Umeå University, Umeå, Sweden
| | - Mikael Johansson
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden
| | - Maria Planck
- Division of Oncology and Pathology, Department of Clinical Sciences Lund, Lund University, Medicon Village, Lund, Sweden.,Department of Respiratory Medicine and Allergology, Skåne University Hospital, Lund, Sweden
| | - Johan Staaf
- Division of Oncology and Pathology, Department of Clinical Sciences Lund, Lund University, Medicon Village, Lund, Sweden
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9
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Svedberg A, Björn N, Sigurgeirsson B, Pradhananga S, Brandén E, Koyi H, Lewensohn R, De Petris L, Apellániz-Ruiz M, Rodríguez-Antona C, Lundeberg J, Gréen H. Genetic association of gemcitabine/carboplatin-induced leukopenia and neutropenia in non-small cell lung cancer patients using whole-exome sequencing. Lung Cancer 2020; 147:106-114. [PMID: 32683206 DOI: 10.1016/j.lungcan.2020.07.005] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 06/26/2020] [Accepted: 07/03/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Gemcitabine/carboplatin treatment is known to cause severe adverse drug reactions which can lead to the need for reduction or cessation of chemotherapy. It would be beneficial to identify patients at risk of severe hematological toxicity in advance before treatment start. This study aims to identify genetic markers for gemcitabine/carboplatin-induced leukopenia and neutropenia in non-small cell lung cancer patients. MATERIAL AND METHODS Whole-exome sequencing was performed on 215 patients. Association analysis was performed on single-nucleotide variants (SNVs) and genes, and the validation was based on an independent genome-wide association study (GWAS). Based on the association and validation analyses the genetic variants were then selected for and used in weighted genetic risk score (wGRS) prediction models for leukopenia and neutropenia. RESULTS Association analysis identified 50 and 111 SNVs, and 12 and 20 genes, for leukopenia and neutropenia, respectively. Of these SNVS 20 and 19 were partially validated for leukopenia and neutropenia, respectively. The genes SVIL (p = 2.48E-06) and EFCAB2 (p = 4.63E-06) were significantly associated with leukopenia contain the partially validated SNVs rs3740003, rs10160013, rs1547169, rs10927386 and rs10927387. The wGRS prediction models showed significantly different risk scores for high and low toxicity patients. CONCLUSION We have identified and partially validated genetic biomarkers in SNVs and genes correlated to gemcitabine/carboplatin-induced leukopenia and neutropenia and created wGRS models for predicting the risk of chemotherapy-induced hematological toxicity. These results provide a strong foundation for further studies of chemotherapy-induced toxicity.
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Affiliation(s)
- Anna Svedberg
- Clinical Pharmacology, Division of Drug Research, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Niclas Björn
- Clinical Pharmacology, Division of Drug Research, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Benjamín Sigurgeirsson
- Science for Life Laboratory, School of Engineering Sciences in Chemistry, Biotechnology and Health, Department of Gene Technology, KTH Royal Institute of Technology, Solna, Sweden; School of Engineering and Natural Sciences, University of Iceland, Reykjavík, Iceland
| | - Sailendra Pradhananga
- Science for Life Laboratory, School of Engineering Sciences in Chemistry, Biotechnology and Health, Department of Gene Technology, KTH Royal Institute of Technology, Solna, Sweden
| | - Eva Brandén
- Department of Respiratory Medicine, Gävle Hospital, Gävle, Sweden; Centre for Research and Development, Uppsala University/Region Gävleborg, Gävle, Sweden
| | - Hirsh Koyi
- Department of Respiratory Medicine, Gävle Hospital, Gävle, Sweden; Centre for Research and Development, Uppsala University/Region Gävleborg, Gävle, Sweden
| | - Rolf Lewensohn
- Thoracic Oncology Unit, Tema Cancer, Karolinska University Hospital, and Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Luigi De Petris
- Thoracic Oncology Unit, Tema Cancer, Karolinska University Hospital, and Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - María Apellániz-Ruiz
- Hereditary Endocrine Cancer Group, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | | | - Joakim Lundeberg
- Science for Life Laboratory, School of Engineering Sciences in Chemistry, Biotechnology and Health, Department of Gene Technology, KTH Royal Institute of Technology, Solna, Sweden
| | - Henrik Gréen
- Clinical Pharmacology, Division of Drug Research, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden; Science for Life Laboratory, School of Engineering Sciences in Chemistry, Biotechnology and Health, Department of Gene Technology, KTH Royal Institute of Technology, Solna, Sweden; Department of Forensic Genetics and Forensic Toxicology, National Board of Forensic Medicine, Linköping, Sweden.
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10
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Ramqvist T, Ortiz-Villalon C, Brandén E, Koyi H, de Petris L, Wagenius G, Brodin O, Reuterswärd C, Dalianis T, Jönsson M, Staaf J, Lewensohn R, Planck M. Analysis of human papillomaviruses and human polyomaviruses in lung cancer from Swedish never-smokers. Acta Oncol 2020; 59:28-32. [PMID: 31460811 DOI: 10.1080/0284186x.2019.1657588] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Torbjörn Ramqvist
- Department of Oncology-Pathology, Karolinska Institutet, Karolinska University Hospital, Solna, Sweden
| | - Christian Ortiz-Villalon
- Department of Oncology-Pathology, Karolinska Institutet, Karolinska University Hospital, Solna, Sweden
| | - Eva Brandén
- Centre for Research and Development, Uppsala University, Gävle, Sweden
| | - Hirsh Koyi
- Centre for Research and Development, Uppsala University, Gävle, Sweden
| | - Luigi de Petris
- Department of Oncology-Pathology, Karolinska Institutet, Karolinska University Hospital, Solna, Sweden
| | - Gunnar Wagenius
- National Lung Cancer Registry, Regional Cancer Centre Uppsala Örebro, Uppsala University Hospital, Uppsala, Sweden
| | - Ola Brodin
- Department of Oncology-Pathology, Karolinska Institutet, Karolinska University Hospital, Solna, Sweden
| | - Christel Reuterswärd
- Department of Clinical Sciences Lund, Division of Oncology, Lund University, Lund, Sweden
| | - Tina Dalianis
- Department of Oncology-Pathology, Karolinska Institutet, Karolinska University Hospital, Solna, Sweden
| | - Mats Jönsson
- Department of Clinical Sciences Lund, Division of Oncology, Lund University, Lund, Sweden
| | - Johan Staaf
- Department of Clinical Sciences Lund, Division of Oncology, Lund University, Lund, Sweden
| | - Rolf Lewensohn
- Department of Oncology-Pathology, Karolinska Institutet, Karolinska University Hospital, Solna, Sweden
| | - Maria Planck
- Department of Clinical Sciences Lund, Division of Oncology, Lund University, Lund, Sweden
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11
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Björn N, Sigurgeirsson B, Svedberg A, Pradhananga S, Brandén E, Koyi H, Lewensohn R, de Petris L, Apellániz-Ruiz M, Rodríguez-Antona C, Lundeberg J, Gréen H. Genes and variants in hematopoiesis-related pathways are associated with gemcitabine/carboplatin-induced thrombocytopenia. Pharmacogenomics J 2019; 20:179-191. [DOI: 10.1038/s41397-019-0099-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 09/10/2019] [Accepted: 10/01/2019] [Indexed: 12/30/2022]
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12
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Koyi H, Daham K, Al-Ameri M, Branden E. Stereotactic body radiotherapy (SBRT) or surgery in early stage (I & II) non small cell lung cancer (NSCLC). J Glob Oncol 2019. [DOI: 10.1200/jgo.2019.5.suppl.99] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
99 Background: For patients with NSCLC clinical stages I and II disease with no medical contraindications, surgery is treatment of choice showing 5-year survival rates of about 60–80% for stage I and 40–50% for stage II, respectively. However, for patients who are medically or technically unfit for surgery and for patients refusing surgery, SBRT is an alternative with local control rates > 90% at 3 years. Methods: Medical journals in all patients with stage I or II NSCLC who were underwent surgery and treated with SBRT at the Department of oncology or thoracic surgery, Karolinska University Hospital, Sweden from 2003 to 2010 were retrospectively reviewed. Results: In all, 267 (74.8%) underwent surgery and 90 (25.2%) were treated with SBRT. Mean, median and range of age among the surgery group was 69.2, 70.0 and 41-85 years, while in the SBRT group, these figures were 77.6, 79.0 and 52-90 years. The difference in age between the groups was significant (p < 0.001).There were significantly more comorbidites in the SBRT group. Among the surgery group, 90.2% were smokers or former smokers. The figures for SBRT group was 91.1%. The difference in smoking habits between the groups was not significant (p < 0.713). There was a significant difference in performance status (PS) between the groups (p < 0.001) with with PS 0-1 in 99.3% in the surgery group compared with 66.7% in the SBRT group. There was a significant difference in lung function with median FEV1 2.11 liter in surgery group compared to 1.3 in the SBRT group. The figures for median FEV1% was 85.0% respectively 57.0%. The median overall survival was 7.7 years for the surgery group and 3.72 years for the SBRT group (p < 0.001). Five years survival was 65.5% in the surgery group and 31.6% in the SBRT group (p < 0.001). Conclusions: The much worse median overall survival in the SBRT group can be explained by the selection of patients, but still, a median survival for nearly 4 years in an elderly group with so many comorbidities and a poor PS indicates that SBRT has been of value.
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Affiliation(s)
- Hirsh Koyi
- Dept of Resp Medicine, Gävle Hospital, Gävle, Sweden
| | - Kameran Daham
- Department of Respiratory Medicine and Allergy, Karokinska University Hospital-Solna, Stockholm, Sweden
| | - Mamdoh Al-Ameri
- Department of Surgery, Karolinska University Hospital-Solna, Stockholm, Taiwan
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13
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Salomonsson A, Jönsson M, Reuterswärd C, Behndig A, Bergman B, Botling J, Brandén E, Brunnström H, De Petris L, Hussein A, Johansson M, Koyi H, Lundström KL, Lewensohn R, Monsef N, Ortiz-Villalón C, Patthey A, Vikström A, Wagenius G, Staaf J, Planck M. P1.14-37 Lung Cancer in Never-Smokers: A Nationwide Population Based Mapping of Targetable Alterations. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.1188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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14
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Gonzalez Lindh M, Malinovschi A, Brandén E, Janson C, Ställberg B, Bröms K, Blom Johansson M, Lisspers K, Koyi H. Subjective swallowing symptoms and related risk factors in COPD. ERJ Open Res 2019; 5:00081-2019. [PMID: 31579679 PMCID: PMC6759627 DOI: 10.1183/23120541.00081-2019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 07/29/2019] [Indexed: 11/05/2022] Open
Abstract
Objectives This study aimed to investigate the prevalence of subjective (i.e. self-reported) swallowing symptoms in a large cohort of patients with stable chronic obstructive pulmonary disease (COPD) and to identify potential related risk factors. Methods A total of 571 patients with COPD, investigated in a stable phase, participated in this multicentre study (335 females, 236 males; mean age: 68.6 years (sd 7.7)). Data were derived from spirometry, a questionnaire and a 30-metre walking test. Results In total, 33% (n=186) patients reported at least some degree of swallowing problem. The most frequently reported symptom was food lodging in the throat (23%). A significant relationship was found between swallowing symptoms and dyspnoea, assessed as modified Medical Research Council (mMRC) ≥2 compared with <2 (46% versus 22%; p<0.001) and health-related quality of life, assessed as the COPD Assessment Test (CAT) ≥10 (40% versus 19%; p<0.001). Swallowing problems were also related to lower physical capacity (p=0.02) but not to lung function (p>0.28). Conclusion Subjective swallowing symptoms seem to be a common problem in patients with stable COPD. This problem is seen in all stages of the disease, but is more common in symptomatic patients and in patients with lower physical capacity.
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Affiliation(s)
- Margareta Gonzalez Lindh
- Centre for Research and Development, Uppsala University/Region Gävleborg, Gävle, Sweden.,Dept of Neuroscience, Uppsala University, Uppsala, Sweden
| | - Andrei Malinovschi
- Dept of Medical Sciences, Clinical Physiology, Uppsala University, Uppsala, Sweden
| | - Eva Brandén
- Respir. Med. Unit, Dept Med. Solna and CMM, Karolinska Institutet and Karolinska University Hospital Solna, Solna, Sweden.,Centre for Research and Development, Uppsala University/Region Gävleborg, Gävle, Sweden
| | - Christer Janson
- Dept of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Björn Ställberg
- Dept of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden
| | - Kristina Bröms
- Dept of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden.,Centre for Research and Development, Uppsala University/Region Gävleborg, Gävle, Sweden
| | | | - Karin Lisspers
- Dept of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden
| | - Hirsh Koyi
- Respir. Med. Unit, Dept Med. Solna and CMM, Karolinska Institutet and Karolinska University Hospital Solna, Solna, Sweden.,Centre for Research and Development, Uppsala University/Region Gävleborg, Gävle, Sweden
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15
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Svedberg A, Vikingsson S, Vikström A, Hornstra N, Kentson M, Branden E, Koyi H, Bergman B, Gréen H. Erlotinib treatment induces cytochrome P450 3A activity in non-small cell lung cancer patients. Br J Clin Pharmacol 2019; 85:1704-1709. [PMID: 30945322 DOI: 10.1111/bcp.13953] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 03/25/2019] [Accepted: 03/26/2019] [Indexed: 01/26/2023] Open
Abstract
AIMS Erlotinib is a tyrosine kinase inhibitor used in the treatment of non-small cell lung cancer highly metabolized by the cytochrome P450 (CYP) 3A. Hence, CYP3A4 activity might be a useful predictor of erlotinib pharmacokinetics in personalized medicine. The effect of erlotinib on CYP3A activity was therefore studied in non-small cell lung cancer patients. METHODS The study included 32 patients scheduled for erlotinib monotherapy. CYP3A activity was assessed using quinine as a probe before and during erlotinib treatment. Plasma from blood samples drawn 16 hours post quinine administration were analysed using HPLC with fluorescence detection to determine the quinine/3-OH-quinine ratio. RESULTS Matched samples, available from 13 patients, showed an induction of CYP3A activity (P = 0.003, Wilcoxon's signed rank test) after 2 months of treatment. The quinine/3-OH-quinine ratio decreased from 20.2 (± 13.4) at baseline to 11.0 (± 4.34). Single-point samples, available from 19 patients, supported the decrease in ratio (P = 0.007, Mann-Whitney U-test). Generally, females had a higher CYP3A activity both at baseline and after two months of treatment. Statistical analysis by gender also showed significant increase in CYP3A activity (males, n = 10, P = 0.001, and females, n = 22, P = 0.001). CONCLUSIONS An induction of CYP3A activity was observed after 2 months of erlotinib treatment which was also seen when subdividing based on gender. It could be important to take this into consideration for patients co-administering other CYP3A-metabolizing drugs during erlotinib treatment and also makes it difficult to use baseline CYP3A activity to predict erlotinib pharmacokinetics.
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Affiliation(s)
- Anna Svedberg
- Clinical Pharmacology, Division of Drug Research, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Svante Vikingsson
- Clinical Pharmacology, Division of Drug Research, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.,Department of Forensic Genetics and Forensic Toxicology, National Board of Forensic Medicine, Linköping, Sweden
| | - Anders Vikström
- Department of Pulmonary Medicine, Linköping University Hospital, Linköping, Sweden
| | - Niels Hornstra
- Department of Pulmonary Medicine, Kalmar County Hospital, Kalmar, Sweden
| | - Magnus Kentson
- Division of Medicine, Department of Pulmonary Medicine, Ryhov Hospital, Jönköping, Sweden.,Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Eva Branden
- Department of Respiratory Medicine, Gävle Hospital, Gävle, Sweden.,Centre for Research and Development, Uppsala University/Region Gävleborg, Gävle, Sweden
| | - Hirsh Koyi
- Department of Respiratory Medicine, Gävle Hospital, Gävle, Sweden.,Centre for Research and Development, Uppsala University/Region Gävleborg, Gävle, Sweden
| | - Bengt Bergman
- Department of Respiratory Medicine and Allergology, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Henrik Gréen
- Clinical Pharmacology, Division of Drug Research, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.,Department of Forensic Genetics and Forensic Toxicology, National Board of Forensic Medicine, Linköping, Sweden
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16
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Koyi H, Xanthoulis P, Gonzalez M, Sulku J. THE IMPACT OF COPD ON ICU ADMISSION. Chest 2019. [DOI: 10.1016/j.chest.2019.02.094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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17
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Edlund K, Madjar K, Mattsson JSM, Djureinovic D, Lindskog C, Brunnström H, Koyi H, Brandén E, Jirström K, Pontén F, Rahnenführer J, Micke P, Hengstler JG. Prognostic Impact of Tumor Cell Programmed Death Ligand 1 Expression and Immune Cell Infiltration in NSCLC. J Thorac Oncol 2019; 14:628-640. [PMID: 30639618 DOI: 10.1016/j.jtho.2018.12.022] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 11/18/2018] [Accepted: 12/25/2018] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Infiltration of T and B/plasma cells has been linked to NSCLC prognosis, but this has not been thoroughly investigated in relation to the expression of programmed death ligand 1 (PD-L1). Here, we determine the association of lymphocytes and PD-L1 with overall survival (OS) in two retrospective cohorts of operated NSCLC patients who were not treated with checkpoint inhibitors targeting the programmed death 1/PD-L1 axis. Moreover, we evaluate how PD-L1 positivity and clinicopathologic factors affect the prognostic association of lymphocytes. METHODS Cluster of differentiation (CD) 3 (CD3)-, CD8-, CD4-, forkhead box P3 (FOXP3)-, CD20-, CD79A-, and immunoglobulin kappa constant (IGKC)-positive immune cells, and tumor PD-L1 positivity, were determined by immunohistochemistry on tissue microarrays (n = 705). Affymetrix data was analyzed for a patient subset, and supplemented with publicly available transcriptomics data (N = 1724). Associations with OS were assessed by Kaplan-Meier plots and uni- and multivariate Cox regression. RESULTS Higher levels of T and B plasma cells were associated with longer OS (p = 0.004 and p < 0.001, for CD8 and IGKC, respectively). Highly proliferative tumors with few lymphocytes had the worst outcome. No association of PD-L1 positivity with OS was observed in a nonstratified patient population; however, a significant association with shorter OS was observed in never-smokers (p = 0.009 and p = 0.002, 5% and 50% cutoff). Lymphocyte infiltration was not associated with OS in PD-L1-positive tumors (50% cutoff). The prognostic association of lymphocyte infiltration also depended on the patients' smoking history and histologic subtype. CONCLUSIONS Proliferation, PD-L1 status, smoking history, and histology should be considered if lymphocyte infiltration is to be used as a prognostic biomarker.
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Affiliation(s)
- Karolina Edlund
- Leibniz Research Centre for Working Environment and Human Factors (IfADo) at TU Dortmund University, Dortmund, Germany.
| | - Katrin Madjar
- Department of Statistics, TU Dortmund University, Dortmund, Germany
| | - Johanna S M Mattsson
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Dijana Djureinovic
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Cecilia Lindskog
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Hans Brunnström
- Department of Clinical Sciences, Division of Oncology and Pathology, Lund University, Lund, Sweden
| | - Hirsh Koyi
- Department of Respiratory Medicine, Gävle Hospital, Gävle, Sweden; Centre for Research and Development, Uppsala University/Region Gävleborg, Gävle, Sweden
| | - Eva Brandén
- Department of Respiratory Medicine, Gävle Hospital, Gävle, Sweden; Centre for Research and Development, Uppsala University/Region Gävleborg, Gävle, Sweden
| | - Karin Jirström
- Department of Clinical Sciences, Division of Oncology and Pathology, Lund University, Lund, Sweden
| | - Fredrik Pontén
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | | | - Patrick Micke
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Jan G Hengstler
- Leibniz Research Centre for Working Environment and Human Factors (IfADo) at TU Dortmund University, Dortmund, Germany
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18
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Salomonsson A, Patthey A, Reuterswärd C, Jönsson M, Botling J, Brunnström H, Hussein A, Monsef N, Ortiz-Villalon C, Bergman B, De Petris L, Lamberg K, Vikström A, Wagenius G, Behndig A, Brandén E, Johansson M, Koyi H, Staaf J, Planck M. MA21.07 A Nation-Wide Population-Based Mapping of Targetable Alterations in Smoking-Independent Lung Cancer. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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19
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Hydbring P, De Petris L, Zhang Y, Brandén E, Koyi H, Novak M, Kanter L, Hååg P, Hurley J, Tadigotla V, Zhu B, Skog J, Viktorsson K, Ekman S, Lewensohn R. Exosomal RNA-profiling of pleural effusions identifies adenocarcinoma patients through elevated miR-200 and LCN2 expression. Lung Cancer 2018; 124:45-52. [PMID: 30268479 DOI: 10.1016/j.lungcan.2018.07.018] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 06/20/2018] [Accepted: 07/11/2018] [Indexed: 12/31/2022]
Abstract
HYPOTHESIS The inherent challenges associated with tissue biopsies from lung have spurred an interest in the use of liquid biopsies. Pleural effusions are one source of liquid biopsy. Recently, extracellular vesicles of endocytic origin, exosomes, have attracted interest as liquid biopsy of tumors as they are thought to be a mirror of their tumor of origin. Here, we aimed to analyze if RNA profiling of exosomes isolated from pleural effusions could differentiate patients with lung adenocarcinoma from patients with benign inflammatory processes. METHODS Exosomes were isolated from 36 pleural effusions from patients with adenocarcinoma (n = 18) and patients with benign inflammatory processes (n = 18). The two groups were balanced with respect to age and smoking history but with a gender bias towards males in the benign group. Profiling was conducted using RT-qPCR arrays covering 754 microRNAs and 624 mRNAs followed by statistical ranking of differentially regulated transcripts between the two patient cohorts. RESULTS RNA profiling revealed differential expression of 17 microRNAs and 71 mRNAs in pleural effusions collected from patients with lung adenocarcinoma compared to pleural effusions from benign lung disease. Overall, top differentially expressed microRNAs, including miR-200 family microRNAs, provided a stronger diagnostic power compared to top differentially expressed mRNAs. However, the mRNA transcript encoding Lipocalin-2 (LCN2) displayed the strongest diagnostic power of all analyzed transcripts (AUC: 0.9916). CONCLUSIONS Our study demonstrates that exosomal RNA profiling from pleural effusions can be used to identify patients with lung adenocarcinoma from individuals with benign processes and further proposes miR-200 microRNAs and LCN2 as diagnostic markers in lung cancer liquid biopsies.
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Affiliation(s)
- Per Hydbring
- Department of Oncology-Pathology, Karolinska Institutet, S-17176 Stockholm, Sweden
| | - Luigi De Petris
- Department of Oncology-Pathology, Karolinska Institutet, S-17176 Stockholm, Sweden
| | - Yanming Zhang
- SinoGenoMax Co, Ltd/Chinese National Human Genome Center, Beijing, 100176, China
| | - Eva Brandén
- Department of Medicine, Division of Respiratory Medicine, Karolinska Institutet, S-17176 Stockholm, Sweden
| | - Hirsh Koyi
- Department of Medicine, Division of Respiratory Medicine, Karolinska Institutet, S-17176 Stockholm, Sweden
| | - Metka Novak
- Department of Oncology-Pathology, Karolinska Institutet, S-17176 Stockholm, Sweden
| | - Lena Kanter
- Department of Oncology-Pathology, Karolinska Institutet, S-17176 Stockholm, Sweden
| | - Petra Hååg
- Department of Oncology-Pathology, Karolinska Institutet, S-17176 Stockholm, Sweden
| | | | | | - Baoli Zhu
- Institute of Microbiology, Chinese Academy of Sciences, Beijing, China; CCID, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China; School of Basic Medical Sciences, Southwest Medical University, Zhongshan Road, Luzhou, Sichuan, China
| | - Johan Skog
- Exosome Diagnostics Inc. Waltham, MA 02451, USA
| | - Kristina Viktorsson
- Department of Oncology-Pathology, Karolinska Institutet, S-17176 Stockholm, Sweden
| | - Simon Ekman
- Department of Oncology-Pathology, Karolinska Institutet, S-17176 Stockholm, Sweden
| | - Rolf Lewensohn
- Department of Oncology-Pathology, Karolinska Institutet, S-17176 Stockholm, Sweden.
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20
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Koyi H, Brandén E, Kasim I, Wilander E. Co-localisation of Glandular and Squamous Cell Markers in Non-small Cell Lung Cancer. Anticancer Res 2018; 38:3341-3346. [PMID: 29848682 DOI: 10.21873/anticanres.12600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 04/20/2018] [Accepted: 04/23/2018] [Indexed: 11/10/2022]
Abstract
AIM Accurate classification of lung carcinomas is crucial for selecting appropriate and adequate chemotherapy treatment. In this study, glandular (adenocarcinoma), and squamous cell differentiation were examined in non-small cell lung carcinoma (NSCLC) without obvious light-microscopic signs of squamous and glandular differentiation. MATERIALS AND METHODS All lung tumours diagnosed as NSCLC (n=61), without obvious squamous or glandular features, were obtained by bronchial biopsy or core biopsy supported by computed tomography. They were diagnosed during 1996-2009, at the Department of Pathology, Gävle Hospital, Sweden. The tumours were examined immunohistochemically with antibodies against CK5/6, p63 (squamous cell markers) and carcinoembryonic antigen (CEA) (adenocarcinoma cell marker). Double immunostaining (p63/CEA) was also performed on individual tumours. RESULTS The tumours originated from 36 males and 25 females, aged 54-83 years. Pure squamous cell differentiation (CK5/6 positive only) occurred in 34.4% (n=21) tumours and pure adenocarcinoma cell differentiation (CEA positive only) was present in 14.9% (n=9). Tumours with both squamous and adenocarcinoma features (CK5/6 and CEA positive) were most prevalent (47.5%, n=29). Two tumours (3.3%) were negative with both stains (and also synaptophysin negative). Double immunostaining (p63/CEA) revealed that squamous and adenocarcinoma markers were co-localised in cells in certain tumours. CONCLUSION Co-localisation of squamous and adenocarcinoma markers in the same tumour cell suggests that additional analyses for novel biomarkers of specific lung cancer types may subsequently lead to a refined treatment choice for patients with the goal of improving clinical outcomes.
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Affiliation(s)
- Hirsh Koyi
- Department of Respiratory Medicine, Gävle Hospital, Gävle, Sweden .,Karolinska Institute, Stockholm, Sweden.,Centre for Research and Development, Uppsala University, Gävleborg Region, Gävle, Sweden
| | - Eva Brandén
- Department of Respiratory Medicine, Gävle Hospital, Gävle, Sweden.,Karolinska Institute, Stockholm, Sweden.,Centre for Research and Development, Uppsala University, Gävleborg Region, Gävle, Sweden
| | - Ihsan Kasim
- Department of Pathology, Gävle County Hospital, Gävle, Sweden
| | - Erik Wilander
- Department of Pathology, Gävle County Hospital, Gävle, Sweden
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21
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La Fleur L, Boura VF, Alexeyenko A, Berglund A, Pontén V, Mattsson JSM, Djureinovic D, Persson J, Brunnström H, Isaksson J, Brandén E, Koyi H, Micke P, Karlsson MCI, Botling J. Expression of scavenger receptor MARCO defines a targetable tumor-associated macrophage subset in non-small cell lung cancer. Int J Cancer 2018; 143:1741-1752. [PMID: 29667169 DOI: 10.1002/ijc.31545] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [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: 09/27/2017] [Revised: 03/14/2018] [Accepted: 03/28/2018] [Indexed: 12/14/2022]
Abstract
Tumor-associated macrophages (TAMs) are attractive targets for immunotherapy. Recently, studies in animal models showed that treatment with an anti-TAM antibody directed against the scavenger receptor MARCO resulted in suppression of tumor growth and metastatic dissemination. Here we investigated the expression of MARCO in relation to other macrophage markers and immune pathways in a non-small cell lung cancer (NSCLC) cohort (n = 352). MARCO, CD68, CD163, MSR1 and programmed death ligand-1 (PD-L1) were analyzed by immunohistochemistry and immunofluorescence, and associations to other immune cells and regulatory pathways were studied in a subset of cases (n = 199) with available RNA-seq data. We observed a large variation in macrophage density between cases and a strong correlation between CD68 and CD163, suggesting that the majority of TAMs present in NSCLC exhibit a protumor phenotype. Correlation to clinical data only showed a weak trend toward worse survival for patients with high macrophage infiltration. Interestingly, MARCO was expressed on a distinct subpopulation of TAMs, which tended to aggregate in close proximity to tumor cell nests. On the transcriptomic level, we found a positive association between MARCO gene expression and general immune response pathways including strong links to immunosuppressive TAMs, T-cell infiltration and immune checkpoint molecules. Indeed, a higher macrophage infiltration was seen in tumors expressing PD-L1, and macrophages residing within tumor cell nests co-expressed MARCO and PD-L1. Thus, MARCO is a potential new immune target for anti-TAM treatment in a subset of NSCLC patients, possibly in combination with available immune checkpoint inhibitors.
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Affiliation(s)
- Linnéa La Fleur
- Department of Immunology, Genetics and Pathology, Science for Life Laboratory, Uppsala University, Department of Pathology, Uppsala University Hospital, Uppsala, Sweden
| | - Vanessa F Boura
- Department of Microbiology, Tumor and Cell biology, Karolinska institutet, Stockholm, Sweden
| | - Andrey Alexeyenko
- Department of Microbiology, Tumor and Cell biology, Karolinska institutet, Stockholm, Sweden.,Science for Life Laboratory, National Bioinformatics Infrastructure Sweden, Solna, Sweden
| | | | - Victor Pontén
- Department of Immunology, Genetics and Pathology, Science for Life Laboratory, Uppsala University, Department of Pathology, Uppsala University Hospital, Uppsala, Sweden
| | - Johanna S M Mattsson
- Department of Immunology, Genetics and Pathology, Science for Life Laboratory, Uppsala University, Department of Pathology, Uppsala University Hospital, Uppsala, Sweden
| | - Dijana Djureinovic
- Department of Immunology, Genetics and Pathology, Science for Life Laboratory, Uppsala University, Department of Pathology, Uppsala University Hospital, Uppsala, Sweden
| | - Johan Persson
- Department of Immunology, Genetics and Pathology, Science for Life Laboratory, Uppsala University, Department of Pathology, Uppsala University Hospital, Uppsala, Sweden
| | - Hans Brunnström
- Division of Pathology, Lund University, Skåne University Hospital, Lund, Sweden
| | - Johan Isaksson
- Department of Immunology, Genetics and Pathology, Science for Life Laboratory, Uppsala University, Department of Pathology, Uppsala University Hospital, Uppsala, Sweden.,Department of Respiratory Medicine, Gävle Hospital, Gävle, Sweden.,County Council of Gävleborg, Centre for Research and Development, Uppsala University, Uppsala, Sweden
| | - Eva Brandén
- Department of Respiratory Medicine, Gävle Hospital, Gävle, Sweden.,County Council of Gävleborg, Centre for Research and Development, Uppsala University, Uppsala, Sweden
| | - Hirsh Koyi
- Department of Respiratory Medicine, Gävle Hospital, Gävle, Sweden.,County Council of Gävleborg, Centre for Research and Development, Uppsala University, Uppsala, Sweden
| | - Patrick Micke
- Department of Immunology, Genetics and Pathology, Science for Life Laboratory, Uppsala University, Department of Pathology, Uppsala University Hospital, Uppsala, Sweden
| | - Mikael C I Karlsson
- Department of Microbiology, Tumor and Cell biology, Karolinska institutet, Stockholm, Sweden
| | - Johan Botling
- Department of Immunology, Genetics and Pathology, Science for Life Laboratory, Uppsala University, Department of Pathology, Uppsala University Hospital, Uppsala, Sweden
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22
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Abstract
INTRODUCTION Atrial fibrillation (AF) causes ischaemic stroke and based on risk factor evaluation warrants anticoagulation therapy. In stroke survivors, AF is typically detected with short-term ECG monitoring in the stroke unit. Prolonged continuous ECG monitoring requires substantial resources while insertable cardiac monitors are invasive and costly. Chest and thumb ECG could provide an alternative for AF detection poststroke.The primary objective of our study is to assess the incidence of newly diagnosed AF during 28 days of chest and thumb ECG monitoring in cryptogenic stroke. Secondary objectives are to assess health-related quality of life (HRQoL) using short-form health survey (SF-36) and the feasibility of the Coala Heart Monitor in patients who had a stroke. METHODS Stroke survivors in Region Gävleborg, Sweden, will be eligible for the study from October 2017. Patients with a history of ischaemic stroke without documented AF before or during ECG evaluation in the stroke unit will be evaluated by the chest and thumb ECG system Coala Heart Monitor. The monitoring system is connected to a smartphone application which allows for remote monitoring and prompt advice on clinical management. Over a period of 28 days, patients will be monitored two times a day and may activate the ECG recording at symptoms. On completion, the system is returned by mail. This system offers a possibility to evaluate the presence of AF poststroke, but the feasibility of this system in patients who recently suffered from a stroke is unknown. In addition, HRQoL using SF-36 in comparison to Swedish population norms will be assessed. The feasibility of the Coala Heart Monitor will be assessed by a self-developed questionnaire. ETHICS AND DISSEMINATION The study was approved by The Regional Ethical Committee in Uppsala (2017/321). The database will be closed after the last follow-up, followed by statistical analyses, interpretation of results and dissemination to a scientific journal. TRIAL REGISTRATION NUMBER NCT03301662; Pre-results.
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Affiliation(s)
- Peter Magnusson
- Cardiology Research Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
- Centre for Research and Development, Uppsala University/Region Gävleborg, Gävle, Sweden
| | - Hirsh Koyi
- Centre for Research and Development, Uppsala University/Region Gävleborg, Gävle, Sweden
| | - Gustav Mattsson
- Centre for Research and Development, Uppsala University/Region Gävleborg, Gävle, Sweden
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Koyi H, Melas N. PS02.03 Treatment of Elderly (70 years or older) with Lung Cancer: A Five Year Material in Clinical Practice from Gävle Hospital -Sweden. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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24
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Backman M, Kurppa P, Djureinovic D, La Fleur L, Persson J, Mattsson J, Botling J, Branden E, Koyi H, Ponten F, Micke P. MA 06.01 Cancer Testis Antigens and Mutational Load in Relation to the Immune Landscape of Non-Small Cell Lung Cancer. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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25
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La Fleur L, Falk-Sörqvist E, Smeds P, Mattsson J, Sundström M, Branden E, Koyi H, Isaksson J, Brunnström H, Nilsson M, Micke P, Moens L, Botling J. P2.02-015 Mutation Patterns in a Swedish Non-Small Cell Lung Cancer Cohort. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.1192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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La Fleur L, Boura V, Berglund A, Mattsson J, Djureinovic D, Persson J, Brunnström H, Isaksson J, Branden E, Koyi H, Micke P, Karlsson M, Botling J. MA 05.13 Scavenger Receptor MARCO Defines a Targetable Tumor-Associated Macrophage Subset in Lung Cancer. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Pedersen JH, Sørensen JB, Saghir Z, Fløtten Ø, Brustugun OT, Ashraf H, Strand TE, Friesland S, Koyi H, Ek L, Nyrén S, Bergman P, Jekunen A, Nieminen EM, Gudbjartsson T. Implementation of lung cancer CT screening in the Nordic countries. Acta Oncol 2017; 56:1249-1257. [PMID: 28571524 DOI: 10.1080/0284186x.2017.1329592] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION We review the current knowledge of CT screening for lung cancer and present an expert-based, joint protocol for the proper implementation of screening in the Nordic countries. MATERIALS AND METHODS Experts representing all the Nordic countries performed literature review and concensus for a joint protocol for lung cancer screening. RESULTS AND DISCUSSION Areas of concern and caution are presented and discussed. We suggest to perform CT screening pilot studies in the Nordic countries in order to gain experience and develop specific and safe protocols for the implementation of such a program.
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Affiliation(s)
- Jesper Holst Pedersen
- Department of Cardiothoracic Surgery RT Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Jens Benn Sørensen
- Department of Oncology, Finsen Centre/Rigshospitalet Copenhagen, Copenhagen, Denmark
| | - Zaigham Saghir
- Department of Pulmonary Medicine, Gentofte University Hospital, Hellerup, Denmark
| | - Øystein Fløtten
- Department of Pulmonary Medicine, Haukeland universitetssjukehus, Bergen, Norway
| | - Odd Terje Brustugun
- Section of Oncology, Drammen Hospital, Vestre Viken Hospital Trust, Drammen, Norway
| | - Haseem Ashraf
- Department of Pulmonary Medicine, Gentofte University Hospital, Hellerup, Denmark
- Department of Radiology, Akershus University Hospital, Loerenskog, Norway
| | | | - Signe Friesland
- Karolinska University Hospital, Karolinska Institute, Stockholm, Sweden
| | - Hirsh Koyi
- Department of Respiratory Medicine, Gävle Hospital, Gävle, Sweden
| | - Lars Ek
- Department of Heart and Lung Diseases, Skåne University Hospital, Sweden
| | - Sven Nyrén
- Department of Thoraxradiology, Karolinska University Hospital, Stockholm, Sweden
| | - Per Bergman
- Department of Cardiothoracic Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Antti Jekunen
- Vaasa Oncology Clinic, Turku University, Turku, Finland
| | - Eeva-Maija Nieminen
- Helsinki University, Helsinki University Hospital, Heart and Lung Centre, Helsinki, Finland
| | - Tomas Gudbjartsson
- Department of Cardiothoracic Surgery, Faculty of Medicine, Landspitli University Hospital, University of Iceland, Reykjavik, Iceland
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Svedberg A, Sigurgeirsson B, Björn N, Pradhananga S, Brandén E, Koyi H, Lewensohn R, Petris LD, Rodríguez-Antona C, Apellániz-Ruiz M, Lundeberg J, Gréen H. Abstract 5026: Association to drug-induced leukopenia using whole-exome sequencing of non-small cell lung cancer patients on gemcitabine/carboplatin regimen. Cancer Res 2017. [DOI: 10.1158/1538-7445.am2017-5026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
A classical non-small cell lung cancer (NSCLC) chemotherapy treatment is gemcitabine in combination with carboplatin. The treatment is known to cause severe hematological toxicity such as leukopenia, which can lead to chemotherapy cessation or even death. It would therefore a priori be of advantage to identify patients at risk of severe leukopenia to allow for a personalized treatment approach. In this study we aim to identify genetic markers for chemotherapy induced leukopenia in non-small cell lung cancer.
In total, 212 non-small cell lung cancer patients treated with gemcitabine and carboplatin regimen were included in the study. Whole blood extracted DNA was prepared with Nextera Rapid Capture kit and whole exome sequenced using Illumina HiSeq 2500. Leukopenia was assessed from leukocyte particle count at baseline and the first cycle nadir values.
The statistical approach was to study association of single common variants (MAF > 0.01) to leukopenia using linear regression in PLINK and association of genes (common and rare variants) to leukopenia using SKATO in the R-package SKAT. An enrichment analysis, with input from the association results (p < 0.001), was performed using the online tool ConsensusPathDB-human to identify overrepresented pathways. A prediction model was created from the single variant analysis results (n=10 causal and n=10 protective) using weighted genetic risk score from the R-package PredictABEL.
The single variant analysis of common variants identified 133 variants (p < 0.001) and the gene based analysis identified 54 genes (p < 0.001). The pathway analysis identified 20 enriched pathways (p < 0.05). A prediction model was created to assess the risk of leukopenia.
The top pathway, HIF-1-alpha transcription factor network, overlaps with four genes (HDAC7, NDRG1, HK2 and CP). It can be of interest to leukopenia as regulation of HIF-1 alpha is essential for maintenance of hematopoietic stem cells in the bone marrow hypoxic niche. It has also been shown that HIF-1 alpha knocked mice are more sensitive to myelosuppressive treatment compared to unknocked mice, supporting the involvement of the pathway in chemotherapy induced myelosuppression.
We have identified variants located in genes and pathways likely to be involved in leukocyte sensitivity after exposure of gemcitabine and carboplatin. A prediction model has been created to estimate the risk that patients will suffer from severe leukopenia. The biological connection of the pathway HIF-1-alpha transcription factor network to leukopenia supports the relevance of these results. Further studies on this are of interest to improve identification of patients at high risk of severe leukopenia after gemcitabine and carboplatin treatment.
Citation Format: Anna Svedberg, Benjamín Sigurgeirsson, Niclas Björn, Sailendra Pradhananga, Eva Brandén, Hirsh Koyi, Rolf Lewensohn, Luigi De Petris, Cristina Rodríguez-Antona, María Apellániz-Ruiz, Joakim Lundeberg, Henrik Gréen. Association to drug-induced leukopenia using whole-exome sequencing of non-small cell lung cancer patients on gemcitabine/carboplatin regimen [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 5026. doi:10.1158/1538-7445.AM2017-5026
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Affiliation(s)
- Anna Svedberg
- 1Clinical Pharmacology, Division of Drug Research, Linköping, Sweden
| | | | - Niclas Björn
- 1Clinical Pharmacology, Division of Drug Research, Linköping, Sweden
| | | | - Eva Brandén
- 3Department of Respiratory Medicine, Gävle, Sweden
| | - Hirsh Koyi
- 3Department of Respiratory Medicine, Gävle, Sweden
| | | | | | | | | | | | - Henrik Gréen
- 1Clinical Pharmacology, Division of Drug Research, Linköping, Sweden
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Koyi H, Hillerdal G, Kölbeck KG, Brodin D, Liv P, Brandén E. Non-small Cell Lung Cancer (NSCLC) in Octogenarians in Clinical Practice. Anticancer Res 2017; 36:5397-5402. [PMID: 27798905 DOI: 10.21873/anticanres.11115] [Citation(s) in RCA: 5] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 09/06/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Globally, an increasing proportion of cancer patients are aged >65 years and many are aged >70 years. Treatment of the elderly with lung cancer has, therefore, become an important issue. We performed a retrospective study of our patients to demonstrate how octogenarians with non-small cell lung cancer (NSCLC) are treated in real-life clinical practice. PATIENTS AND METHODS This was a retrospective observational study of all elderly (≥80 years) patients with NSCLC referred to the Department of Respiratory Medicine and Allergy, Karolinska Hospital, Sweden, 2003-2010, and followed until June, 2016. RESULTS In total, 452 patients, 216 (47.8%) men and 236 (52.2%) women, were included. The mean and median age was 83 years; 28 (6.2%) were aged 90 years or more. Current or former smokers constituted 91.1%, with men having smoked more (p<0.001). There was no difference in performance status (PS) between genders with PS 0-1 in 45.4%, PS 2 in 25.6% and PS3-4 in 29%. About a third each was diagnosed in stages 1-II, III and IV. Adenocarcinoma was most common (45.6%), 18.1% had squamous cell carcinoma, while histological diagnosis was unavailable in 23.2%. Best supportive care (BSC) was given only to 209 patients (46.2%). Potentially curative therapy was administered to 16.5% of men and 20.3% of the women with surgery performed in 35 patients (7.8%) and stereotactic body radiation therapy (SBRT) in 48 patients (10.6%). Chemotherapy was given to 51 patients (11.2%) and palliative radiotherapy to 77 (17.0%). Second-line chemotherapy was given in 4% and third-line in 1.5%. Only one patient received fourth-line. Male patients who received chemotherapy survived a mean of 281 days and for female patients it was 332 days (not significant). Median overall survival (OS) was 115 days in patients receiving BSC and 362 days in patients given any therapy. Patients who underwent surgery for stage I-II had a median OS of 5.6 years compared to 3.5 years for patients given SBRT. CONCLUSION Treatment of NSCLC patients 80 years and older with any modality is feasible with a good PS. Survival is fairly good with surgery or SBRT.
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Affiliation(s)
- Hirsh Koyi
- Department of Respiratory Medicine, Gävle Hospital, Gävle, Sweden .,Karolinska Institutet, Stockholm, Sweden.,Centre for Research and Development, Uppsala University/County Council of Gävleborg, Gävle, Sweden
| | - Gunnar Hillerdal
- Department of Respiratory Medicine, Gävle Hospital, Gävle, Sweden.,Department of Respiratory Medicine and Allergy, Karolinska University Hospital, Solna, Stockholm, Sweden
| | - Karl-Gustav Kölbeck
- Department of Respiratory Medicine and Allergy, Karolinska University Hospital, Solna, Stockholm, Sweden
| | - Daniel Brodin
- Department of Respiratory Medicine and Allergy, Karolinska University Hospital, Solna, Stockholm, Sweden
| | - Per Liv
- Centre for Research and Development, Uppsala University/County Council of Gävleborg, Gävle, Sweden
| | - Eva Brandén
- Department of Respiratory Medicine, Gävle Hospital, Gävle, Sweden.,Karolinska Institutet, Stockholm, Sweden.,Centre for Research and Development, Uppsala University/County Council of Gävleborg, Gävle, Sweden
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Gonzalez Lindh M, Blom Johansson M, Jennische M, Koyi H. Prevalence of swallowing dysfunction screened in Swedish cohort of COPD patients. Int J Chron Obstruct Pulmon Dis 2017; 12:331-337. [PMID: 28176891 PMCID: PMC5261551 DOI: 10.2147/copd.s120207] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background COPD is a common problem associated with morbidity and mortality. COPD may also affect the dynamics and coordination of functions such as swallowing. A misdirected swallow may, in turn, result in the bolus entering the airway. A growing body of evidence suggests that a subgroup of people with COPD is prone to oropharyngeal dysphagia. The aim of this study was to evaluate swallowing dysfunction in patients with stable COPD and to determine the relation between signs and symptoms of swallowing dysfunction and lung function (forced expiratory volume in 1 second percent predicted). Methods Fifty-one patients with COPD in a stable phase participated in a questionnaire survey, swallowing tests, and spirometry. A post-bronchodilator ratio of the forced expiratory volume in 1 second/best of forced vital capacity and vital capacity <0.7 was used to define COPD. Swallowing function was assessed by a questionnaire and two swallowing tests (water and cookie swallow tests). Results Sixty-five percent of the patients reported subjective signs and symptoms of swallowing dysfunction in the questionnaire and 49% showed measurable ones in the swallowing tests. For the combined subjective and objective findings, 78% had a coexisting swallowing dysfunction. No significant difference was found between male and female patients. Conclusion Swallowing function is affected in COPD patients with moderate to severe airflow limitation, and the signs and symptoms of this swallowing dysfunction were subjective, objective, or both.
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Affiliation(s)
- Margareta Gonzalez Lindh
- Department of Neuroscience, Speech and Language Pathology, Uppsala University, Uppsala, Sweden; Centre for Research and Development (CFUG), Uppsala University, County Council of Gävleborg, Gävle, Sweden
| | - Monica Blom Johansson
- Department of Neuroscience, Speech and Language Pathology, Uppsala University, Uppsala, Sweden
| | - Margareta Jennische
- Department of Neuroscience, Speech and Language Pathology, Uppsala University, Uppsala, Sweden
| | - Hirsh Koyi
- Centre for Research and Development (CFUG), Uppsala University, County Council of Gävleborg, Gävle, Sweden; Department of Respiratory Medicine, Gävle Hospital, Gävle, Sweden
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Koyi H, Hillerdal G, Kölbeck KG, Brodin D, Brandén E. P2.03a-013 Chemotherapy is Beneficial for Octogenarians with Non-Small Cell Lung Cancer (NSCLC). J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2016.11.1222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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32
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Hillerdal G, Koyi H. P1.03-008 Clinical Importance of Indolent Lung Cancers. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2016.11.679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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33
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Koyi H, Hillerdal G, Kölbeck KG, Brodin D, Brandén E. P1.06-008 Non-Small Cell Lung Cancer in Octogenarians: Real-Life Clinical Practice; Characteristics, Therapy and Survival. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2016.11.872] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Koyi H, Hillerdal G, Andersson O, Högberg H, Brandén E. Lung cancer among native and foreign-born Swedes: histopathology, treatment, and survival. Acta Oncol 2016; 55:1344-1348. [PMID: 27556916 DOI: 10.1080/0284186x.2016.1189095] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Lung cancer (LC) is the leading cause of cancer-related death worldwide, including Sweden. Several studies have shown that socioeconomic status affects the risk, treatment, and survival of LC. Due to immigration after Second World War, foreign-born people constitute 12.5% of the Swedish population. We wanted to investigate if there were any differences in LC management, treatment and survival among the foreign-born Swedes (FBS) compared to the native Swedish population (NatS) in Stockholm. MATERIAL AND METHODS A retrospective analysis of all patients diagnosed with non-small cell lung cancer (NSCLC) at the Department of Respiratory Medicine and Allergy, Karolinska University Hospital, Solna from 1 January 2003 to 31 December 2008 was made. In all, 2041 cases of LC were diagnosed, thereof 1803 with NSCLC. Of these, 211 (11.7%) were FBS. RESULTS The mean age of NatS and FBS patients was 69.9 years, median 70 (range 26-96) and 66.0 years, median 66 (range 38-94), respectively (p < 0.001). In all, 89.8% of NatS and 90.0% of FBS were either smokers or former smokers. Adenocarcinoma was the most common subtype in both groups (NatS 54.7%, FBS 48.3%). In 140 (8.8%) of the NatS and 17 (8.1%) of the FBS the diagnosis was clinical only. There were no significant differences in stage at diagnosis, nor in performance status (PS) or different therapies between the groups. The median overall survival time for the NatS was 272 days and for FBS 328 days, again no significant difference. However, the median overall survival time for female NatS was 318 days and for female FBS 681 days (p = 0.002). CONCLUSION FBS patients were significantly younger than NatS at diagnosis, and female FBS lived longer than female NatS, but otherwise there were no significant differences between NatS and FBS patients with LC regarding diagnosis, treatment, and survival.
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Affiliation(s)
- Hirsh Koyi
- Department of Respiratory Medicine, Gävle Hospital, Gävle, Sweden
- Karolinska Institutet, Stockholm, Sweden
- Centre for Research and Development, Uppsala University/County Council of Gävleborg, Gävle, Sweden
| | - Gunnar Hillerdal
- Department of Respiratory Medicine and Allergy, Karolinska University Hospital, Solna, Stockholm, Sweden
| | - Olov Andersson
- Department of Respiratory Medicine and Allergy, Karolinska University Hospital, Solna, Stockholm, Sweden
| | - Hans Högberg
- Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, University of Gävle, Gävle, Sweden
| | - Eva Brandén
- Department of Respiratory Medicine, Gävle Hospital, Gävle, Sweden
- Karolinska Institutet, Stockholm, Sweden
- Centre for Research and Development, Uppsala University/County Council of Gävleborg, Gävle, Sweden
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Mattsson JSM, Brunnström H, Jabs V, Edlund K, Jirström K, Mindus S, la Fleur L, Pontén F, Karlsson MG, Karlsson C, Koyi H, Brandén E, Botling J, Helenius G, Micke P, Svensson MA. Inconsistent results in the analysis of ALK rearrangements in non-small cell lung cancer. BMC Cancer 2016; 16:603. [PMID: 27495736 PMCID: PMC4974795 DOI: 10.1186/s12885-016-2646-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Accepted: 07/28/2016] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Identification of targetable EML4-ALK fusion proteins has revolutionized the treatment of a minor subgroup of non-small cell lung cancer (NSCLC) patients. Although fluorescence in situ hybridization (FISH) is regarded as the gold standard for detection of ALK rearrangements, ALK immunohistochemistry (IHC) is often used as screening tool in clinical practice. In order to unbiasedly analyze the diagnostic impact of such a screening strategy, we compared ALK IHC with ALK FISH in three large representative Swedish NSCLC cohorts incorporating clinical parameters and gene expression data. METHODS ALK rearrangements were detected using FISH on tissue microarrays (TMAs), including tissue from 851 NSCLC patients. In parallel, ALK protein expression was detected using IHC, applying the antibody clone D5F3 with two different protocols (the FDA approved Ventana CDx assay and our in house Dako IHC protocol). Gene expression microarray data (Affymetrix) was available for 194 patients. RESULTS ALK rearrangements were detected in 1.7 % in the complete cohort and 2.0 % in the non-squamous cell carcinoma subgroup. ALK protein expression was observed in 1.8 and 1.4 % when applying the Ventana assay or the in house Dako protocol, respectively. The specificity and accuracy of IHC was high (> 98 %), while the sensitivity was between 69 % (Ventana) and 62 % (in house Dako protocol). Furthermore, only 67 % of the ALK IHC positive cases were positive with both IHC assays. Gene expression analysis revealed that 6/194 (3 %) tumors showed high ALK gene expression (≥ 6 AU) and of them only three were positive by either FISH or IHC. CONCLUSION The overall frequency of ALK rearrangements based on FISH was lower than previously reported. The sensitivity of both IHC assays was low, and the concordance between the FISH and the IHC assays poor, questioning current strategies to screen with IHC prior to FISH or completely replace FISH by IHC.
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Affiliation(s)
- Johanna S M Mattsson
- Department of Immunology, Genetics and Pathology, Uppsala University, 751 85, Uppsala, Sweden.
| | - Hans Brunnström
- Department of Clinical Sciences Lund, Division of Oncology and Pathology, Lund University, Lund, Sweden.,Department of Pathology, Regional Laboratories Region Skåne, SE-221 85, Lund, Sweden
| | - Verena Jabs
- Department of Statistics, TU Dortmund University, Dortmund, Germany
| | - Karolina Edlund
- Leibniz Research Centre for Working Environment and Human Factors (IfADo) at Dortmund TU, Dortmund, Germany
| | - Karin Jirström
- Department of Clinical Sciences Lund, Division of Oncology and Pathology, Lund University, Lund, Sweden
| | - Stephanie Mindus
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Linnéa la Fleur
- Department of Immunology, Genetics and Pathology, Uppsala University, 751 85, Uppsala, Sweden
| | - Fredrik Pontén
- Department of Immunology, Genetics and Pathology, Uppsala University, 751 85, Uppsala, Sweden
| | - Mats G Karlsson
- Department of Research and Education, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | | | - Hirsh Koyi
- Department of Respiratory Medicine, Gävle hospital, Gävle; Centre for Research and Development, Uppsala University/County Council of Gävleborg, Gävle, Sweden
| | - Eva Brandén
- Department of Respiratory Medicine, Gävle hospital, Gävle; Centre for Research and Development, Uppsala University/County Council of Gävleborg, Gävle, Sweden
| | - Johan Botling
- Department of Immunology, Genetics and Pathology, Uppsala University, 751 85, Uppsala, Sweden
| | - Gisela Helenius
- Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Patrick Micke
- Department of Immunology, Genetics and Pathology, Uppsala University, 751 85, Uppsala, Sweden
| | - Maria A Svensson
- Clinical Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Djureinovic D, Hallström BM, Horie M, Mattsson JSM, La Fleur L, Fagerberg L, Brunnström H, Lindskog C, Madjar K, Rahnenführer J, Ekman S, Ståhle E, Koyi H, Brandén E, Edlund K, Hengstler JG, Lambe M, Saito A, Botling J, Pontén F, Uhlén M, Micke P. Profiling cancer testis antigens in non-small-cell lung cancer. JCI Insight 2016; 1:e86837. [PMID: 27699219 PMCID: PMC5033889 DOI: 10.1172/jci.insight.86837] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 05/26/2016] [Indexed: 12/31/2022] Open
Abstract
Cancer testis antigens (CTAs) are of clinical interest as biomarkers and present valuable targets for immunotherapy. To comprehensively characterize the CTA landscape of non-small-cell lung cancer (NSCLC), we compared RNAseq data from 199 NSCLC tissues to the normal transcriptome of 142 samples from 32 different normal organs. Of 232 CTAs currently annotated in the Caner Testis Database (CTdatabase), 96 were confirmed in NSCLC. To obtain an unbiased CTA profile of NSCLC, we applied stringent criteria on our RNAseq data set and defined 90 genes as CTAs, of which 55 genes were not annotated in the CTdatabase, thus representing potential new CTAs. Cluster analysis revealed that CTA expression is histology dependent and concurrent expression is common. IHC confirmed tissue-specific protein expression of selected new CTAs (TKTL1, TGIF2LX, VCX, and CXORF67). Furthermore, methylation was identified as a regulatory mechanism of CTA expression based on independent data from The Cancer Genome Atlas. The proposed prognostic impact of CTAs in lung cancer was not confirmed, neither in our RNAseq cohort nor in an independent meta-analysis of 1,117 NSCLC cases. In summary, we defined a set of 90 reliable CTAs, including information on protein expression, methylation, and survival association. The detailed RNAseq catalog can guide biomarker studies and efforts to identify targets for immunotherapeutic strategies.
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Affiliation(s)
- Dijana Djureinovic
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Björn M. Hallström
- Science for Life Laboratory, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Masafumi Horie
- Department of Respiratory Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | | | - Linnea La Fleur
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Linn Fagerberg
- Science for Life Laboratory, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Hans Brunnström
- Department of Pathology, Regional Laboratories Region Skåne, Lund, Sweden
| | - Cecilia Lindskog
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Katrin Madjar
- Department of Statistics, Technical University of Dortmund, Dortmund, Germany
| | - Jörg Rahnenführer
- Department of Statistics, Technical University of Dortmund, Dortmund, Germany
| | - Simon Ekman
- Department of Radiology, Oncology and Radiation Sciences, Section of Oncology, and
| | - Elisabeth Ståhle
- Department of Clinical Sciences, Uppsala University, Uppsala, Sweden
| | - Hirsh Koyi
- Department of Respiratory Medicine, Centre for Research and Development, Uppsala University, County Council of Gävleborg, Gävle, Sweden
| | - Eva Brandén
- Department of Respiratory Medicine, Centre for Research and Development, Uppsala University, County Council of Gävleborg, Gävle, Sweden
| | - Karolina Edlund
- Leibniz Research Centre for Working Environment and Human Factors, Technical University of Dortmund, Dortmund, Germany
| | - Jan G. Hengstler
- Leibniz Research Centre for Working Environment and Human Factors, Technical University of Dortmund, Dortmund, Germany
| | - Mats Lambe
- Uppsala University Hospital, Regional Cancer Center, Uppsala, Sweden
| | - Akira Saito
- Department of Respiratory Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Johan Botling
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Fredrik Pontén
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Mathias Uhlén
- Science for Life Laboratory, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Patrick Micke
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
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Koyi H, Johansson L, From J, Nyrén S. Biopsy testing in an inoperable, non-small cell lung cancer population-a retrospective, real-life study in Sweden. J Thorac Dis 2016; 7:2226-33. [PMID: 26793344 DOI: 10.3978/j.issn.2072-1439.2015.12.52] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Correct diagnosis and staging are required for optimal treatment choice in lung cancer patients. This retrospective, patient medical records study investigated the clinical practice of lung cancer biopsy procedures and testing in Sweden. METHODS Consecutive patients with a recorded inoperable, malignant tumour of bronchus and lung were retrospectively identified at geographically widespread pulmonology clinics (NCT01139619). Data, including diagnostic sampling methodology [bronchoscopy, biopsy by pulmonologist and computed tomography (CT)-guided biopsy], were collected for patients diagnosed between 1 June 2009-31 May 2010, and analysed using descriptive statistics. A study-predefined algorithm, including six criteria on tumour localization and size, forced expiratory volume in one second (FEV1), blood saturation and risk of bleeding theoretically categorizing patient suitability for CT-guided biopsy, was used. RESULTS In total, 132 patients (mean age 68 years, 48% women, 61% adenocarcinoma, 86% current/ former smokers, 96% performance status ≤2, mean FEV1 volume ≥2 L) were included. The majority were examined by >1 diagnostic procedure (29% by CT-guided biopsy). Median overall time from first hospital contact to established diagnosis was 12.0 days (10.0 and 28.0 days for bronchoscopy and CT-guided biopsy, respectively). No major differences in lung function, age, performance status or predefined algorithm criteria were noted for patients examined by CT-guided biopsy versus bronchoscopy or biopsy. Complications were reported for 11 patients, including pneumothorax in six patients. Histopathology was used most frequently to diagnose and subtype (70%), although 66% of patients examined solely by bronchoscopy were diagnosed by cytology. For 26.5% of patients, epidermal growth factor receptor (EGFR) mutation testing was recorded. CONCLUSIONS No limitations regarding patient suitability or methodological complications were noted in this real-life, observational study. The CT-guided biopsy is a relatively safe and well-established method, and may need to be utilized further to fulfil current and future demands for faster diagnosis and high quality tissue as new tumour markers and targeted therapies become available.
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Affiliation(s)
- Hirsh Koyi
- 1 Department of Respiratory Medicine, Gävle Hospital; Centre for Research and Development Uppsala University, County Council of Gävleborg; and Karolinska Institutet, Stockholm, Sweden ; 2 Department of Pathology, Skåne University Hospital, Lund, Sweden ; 3 AstraZeneca NordicBaltic, Södertälje, Sweden ; 4 Department of Radiology, Solna, Karolinska University Hospital; and Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Leif Johansson
- 1 Department of Respiratory Medicine, Gävle Hospital; Centre for Research and Development Uppsala University, County Council of Gävleborg; and Karolinska Institutet, Stockholm, Sweden ; 2 Department of Pathology, Skåne University Hospital, Lund, Sweden ; 3 AstraZeneca NordicBaltic, Södertälje, Sweden ; 4 Department of Radiology, Solna, Karolinska University Hospital; and Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Jesper From
- 1 Department of Respiratory Medicine, Gävle Hospital; Centre for Research and Development Uppsala University, County Council of Gävleborg; and Karolinska Institutet, Stockholm, Sweden ; 2 Department of Pathology, Skåne University Hospital, Lund, Sweden ; 3 AstraZeneca NordicBaltic, Södertälje, Sweden ; 4 Department of Radiology, Solna, Karolinska University Hospital; and Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Sven Nyrén
- 1 Department of Respiratory Medicine, Gävle Hospital; Centre for Research and Development Uppsala University, County Council of Gävleborg; and Karolinska Institutet, Stockholm, Sweden ; 2 Department of Pathology, Skåne University Hospital, Lund, Sweden ; 3 AstraZeneca NordicBaltic, Södertälje, Sweden ; 4 Department of Radiology, Solna, Karolinska University Hospital; and Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
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Gréen H, Hasmats J, Kupershmidt I, Edsgärd D, de Petris L, Lewensohn R, Blackhall F, Vikingsson S, Besse B, Lindgren A, Brandén E, Koyi H, Peterson C, Lundeberg J. Using Whole-Exome Sequencing to Identify Genetic Markers for Carboplatin and Gemcitabine-Induced Toxicities. Clin Cancer Res 2016; 22:366-73. [PMID: 26378035 DOI: 10.1158/1078-0432.ccr-15-0964] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 08/11/2015] [Indexed: 11/16/2022]
Abstract
PURPOSE Chemotherapies are associated with significant interindividual variability in therapeutic effect and adverse drug reactions. In lung cancer, the use of gemcitabine and carboplatin induces grade 3 or 4 myelosuppression in about a quarter of the patients, while an equal fraction of patients is basically unaffected in terms of myelosuppressive side effects. We therefore set out to identify genetic markers for gemcitabine/carboplatin-induced myelosuppression. EXPERIMENTAL DESIGN We exome sequenced 32 patients that suffered extremely high neutropenia and thrombocytopenia (grade 3 or 4 after first chemotherapy cycle) or were virtually unaffected (grade 0 or 1). The genetic differences/polymorphism between the groups were compared using six different bioinformatics strategies: (i) whole-exome nonsynonymous single-nucleotide variants association analysis, (ii) deviation from Hardy-Weinberg equilibrium, (iii) analysis of genes selected by a priori biologic knowledge, (iv) analysis of genes selected from gene expression meta-analysis of toxicity datasets, (v) Ingenuity Pathway Analysis, and (vi) FunCoup network enrichment analysis. RESULTS A total of 53 genetic variants that differed among these groups were validated in an additional 291 patients and were correlated to the patients' myelosuppression. In the validation, we identified rs1453542 in OR4D6 (P = 0.0008; OR, 5.2; 95% CI, 1.8-18) as a marker for gemcitabine/carboplatin-induced neutropenia and rs5925720 in DDX53 (P = 0.0015; OR, 0.36; 95% CI, 0.17-0.71) as a marker for thrombocytopenia. Patients homozygous for the minor allele of rs1453542 had a higher risk of neutropenia, and for rs5925720 the minor allele was associated with a lower risk for thrombocytopenia. CONCLUSIONS We have identified two new genetic markers with the potential to predict myelosuppression induced by gemcitabine/carboplatin chemotherapy.
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Affiliation(s)
- Henrik Gréen
- Science for Life Laboratory, School of Biotechnology, Division of Gene Technology, Royal Institute of Technology, Solna, Sweden. Department of Forensic Genetics and Forensic Toxicology, National Board of Forensic Medicine, Linköping, Sweden. Division of Drug Research, Clinical Pharmacology, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
| | - Johanna Hasmats
- Science for Life Laboratory, School of Biotechnology, Division of Gene Technology, Royal Institute of Technology, Solna, Sweden
| | - Ilya Kupershmidt
- Science for Life Laboratory, School of Biotechnology, Division of Gene Technology, Royal Institute of Technology, Solna, Sweden. NextBio, Cupertino, California
| | - Daniel Edsgärd
- Science for Life Laboratory, School of Biotechnology, Division of Gene Technology, Royal Institute of Technology, Solna, Sweden
| | - Luigi de Petris
- Department of Oncology and Pathology, Karolinska Institute and Oncology Clinic, Karolinska University Hospital, Stockholm, Sweden
| | - Rolf Lewensohn
- Department of Oncology and Pathology, Karolinska Institute and Oncology Clinic, Karolinska University Hospital, Stockholm, Sweden
| | - Fiona Blackhall
- Department of Medical Oncology, Christie Hospital, Manchester, United Kingdom. Institute of Cancer Sciences, University of Manchester, Manchester, United Kingdom
| | - Svante Vikingsson
- Division of Drug Research, Clinical Pharmacology, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Benjamin Besse
- Unité INSERM U 981, Université Paris Sud, Département de Médecine, Institut Gustave Roussy, Villejuif, France
| | - Andrea Lindgren
- Department of Clinical Physiology, University Hospital, Linköping, Sweden. Department of Medical and Health Sciences, Linköping University, Linköping, Sweden. Department of Pulmonary Medicine, University Hospital, Linköping, Sweden
| | - Eva Brandén
- Department of Oncology and Pathology, Karolinska Institute and Oncology Clinic, Karolinska University Hospital, Stockholm, Sweden
| | - Hirsh Koyi
- Department of Oncology and Pathology, Karolinska Institute and Oncology Clinic, Karolinska University Hospital, Stockholm, Sweden
| | - Curt Peterson
- Division of Drug Research, Clinical Pharmacology, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Joakim Lundeberg
- Science for Life Laboratory, School of Biotechnology, Division of Gene Technology, Royal Institute of Technology, Solna, Sweden
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Iadaresta F, Crescenzi C, Amini A, Colmsjö A, Koyi H, Abdel-Rehim M. Application of graphitic sorbent for online microextraction of drugs in human plasma samples. J Chromatogr A 2015; 1422:34-42. [DOI: 10.1016/j.chroma.2015.10.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Revised: 10/07/2015] [Accepted: 10/07/2015] [Indexed: 12/13/2022]
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Elmongy H, Ahmed H, Wahbi AA, Koyi H, Abdel-Rehim M. Online post-column solvent assisted and direct solvent-assisted electrospray ionization for chiral analysis of propranolol enantiomers in plasma samples. J Chromatogr A 2015; 1418:110-118. [PMID: 26422307 DOI: 10.1016/j.chroma.2015.09.051] [Citation(s) in RCA: 8] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 09/09/2015] [Accepted: 09/15/2015] [Indexed: 11/26/2022]
Abstract
An Online post-column solvent-assisted ionization (OPSAI) method was developed for enhancing the ionization of the beta-blocker propranolol utilizing normal phase LC-MS/MS. Solvent-assisted electrospray ionization (SAESI) was studied by the introduction of the assistant solvents A: 0.5% Formic acid in Isopropanolol, B: 0.5% Formic acid in Isopropanolol-Water (1:1), and C: 0.5% Formic acid in water into the electrospray ionization chamber using a spray needle. Analyte molecules can be directly ionized by the aid of the assistant solvent spray. Both methods were applied to the chiral separation of propranolol enantiomers using normal phase analysis on cellulose-based chiral column. Interestingly, both methods are easy to handle and offer a wide range of assistant solvents that can be used in order to gain the optimum ionization of the analyte molecules. The both methods considerably improved the analyte signal and the peak area greatly increased. The propranolol average signal-to-noise (S/N) ratio was enhanced from 26±1 and 42±1 to 2341±61 and 1725±29 for R-propranolol and S-propranolol, respectively, when the post-column solvent method (OPSAI) was used with isopropanol-assistant solvent (A). While in case of solvent-assisted electrospray ionization method (SAESI) signal was enhanced from 26±1 and 42±1 to 2223±72 and 2155±58 for R-propranolol and S-propranolol, respectively, with water as an assistant solvent. The limit of detection was 10ng/mL and the method was linear in the range 50-2000ng/mL. The NPLC-MS method was applied for the determination of propranolol enantiomers in human plasma after microextraction by packed C18 sorbent.
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Affiliation(s)
- Hatem Elmongy
- Department of Environmental Science and Analytical Chemistry, Stockholm University, SE10691, Stockholm, Sweden; Pharmaceutical Analysis Department, Faculty of Pharmacy, Damanhour University, Damanhour, 22511, Egypt
| | - Hytham Ahmed
- Pharmaceutical Analysis Department, Faculty of Pharmacy, Damanhour University, Damanhour, 22511, Egypt
| | - Abdel-Aziz Wahbi
- Department of Pharmaceutical Analytical Chemistry, Faculty of Pharmacy, University of Alexandria, Alexandria, 21521, Egypt
| | - Hirsh Koyi
- Department of Respiratory Medicine, Gävle Hospital and Centre for Research at Uppsala University/County Council of Gävleborg, Gävle, Sweden
| | - Mohamed Abdel-Rehim
- Department of Environmental Science and Analytical Chemistry, Stockholm University, SE10691, Stockholm, Sweden.
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Sandelin M, Berglund A, Sundström M, Micke P, Ekman S, Bergqvist M, Bergström S, Koyi H, Brandén E, Janson C, Botling J. Patients with Non-small Cell Lung Cancer Analyzed for EGFR: Adherence to Guidelines, Prevalence and Outcome. Anticancer Res 2015; 35:3979-3985. [PMID: 26124345] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Epidermal growth factor receptor (EGFR) analysis is the first molecular test introduced in the routine care of patients with non-small cell lung cancer (NSCLC). In the present study, we describe the prevalence of EGFR mutations and the adherence to testing and treatment guidelines in a population-based Swedish NSCLC cohort. MATERIALS AND METHODS Patients with NSCLC analyzed for EGFR mutations were identified and their characteristics and survival data were retrieved. We compared the study cohort to a matched lung cancer population. RESULTS The EGFR mutation frequency was 10%. Mutations were enriched in women and in adenocarcinoma cases. Out of patients with advanced-stage NSCLC with non-squamous histology, only 49% were referred for EGFR analysis. Out of the patients with EGFR mutation and advanced disease, only 38% received EGFR-tyrosine kinase inhibitor (TKI) in first-line therapy. CONCLUSION The EGFR-mutated NSCLC population studied is similar to other Western populations. Surprisingly, a large proportion of patients were not referred for EGFR analysis. Out of the patients with EGFR mutation, fewer than 40% received EGFR-TKI as first-line treatment. Our results highlight the need for follow-up of treatment and diagnostic algorithms in routine healthcare.
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Affiliation(s)
- Martin Sandelin
- Department of Medical Sciences, Respiratory Medicine, Uppsala University, Uppsala, Sweden
| | | | - Magnus Sundström
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden Unit of Molecular Pathology, Uppsala University Hospital, Uppsala, Sweden
| | - Patrick Micke
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden Unit of Molecular Pathology, Uppsala University Hospital, Uppsala, Sweden
| | - Simon Ekman
- Section of Oncology, Department of Radiology, Oncology and Radiation Sciences, Uppsala University, Uppsala, Sweden
| | | | | | - Hirsh Koyi
- Department of Respiratory Medicine, Gävle Hospital, Gävle, Sweden Centre for Research and Development Uppsala University/County Council of Gävleborg, Gävle, Sweden
| | - Eva Brandén
- Department of Respiratory Medicine, Gävle Hospital, Gävle, Sweden Centre for Research and Development Uppsala University/County Council of Gävleborg, Gävle, Sweden
| | - Christer Janson
- Department of Medical Sciences, Respiratory Medicine, Uppsala University, Uppsala, Sweden
| | - Johan Botling
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden Unit of Molecular Pathology, Uppsala University Hospital, Uppsala, Sweden
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Holgersson G, Bergqvist M, Koyi H, Berglund A, Lambe M, Bergström S. [Waiting time in lung cancer care. Patient guides provided faster flow]. Lakartidningen 2015; 112:DEYE. [PMID: 26035533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The work-up process for lung cancer patients consists of several steps from suspicion of malignant disease to start of treatment. Delays between these steps should be minimized. Data in the Swedish National Lung Cancer Register show that the work-up times for lung cancer patients vary greatly between different counties in central Sweden. In order to reduce delays, a trial of implementing patient guides (Sw: patientlotsar) for patients referred to the hospital was conducted. When comparing the work-up times before and after implementation of patient guides the median waiting time from suspicion of lung cancer to start of treatment in the region was reduced from 71 to 45 days. Furthermore, the duration of most of the steps in the work-up process were shortened despite more complex investigation procedures, e.g. increased use of PET/CT in the guided patient group.
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Affiliation(s)
- Georg Holgersson
- Gävle sjukhus - Onkologikliniken Gävle, Sweden Onkologikliniken - Gävle sjukhus Gävle, Sweden
| | - Michael Bergqvist
- Gävle sjukhus - Onkologikliniken Gävle, Sweden Gävle sjukhus - Gävle, Sweden
| | - Hirsh Koyi
- Gävle sjukhus - Gävle, Sweden Gävle sjukhus - Gävle, Sweden
| | - Anders Berglund
- Regionalt cancercentrum - Uppsala, Sweden Regionalt cancercentrum - Uppsala, Sweden
| | - Mats Lambe
- Regionalt cancercentrum - Uppsala, Sweden -
| | - Stefan Bergström
- Gävle sjukhus - Onkologikliniken Gävle, Sweden Gävle sjukhus - Onkologikliniken Gävle, Sweden
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Holgersson G, Bergström S, Harmenberg J, Ringbom M, Klockare M, Jerling M, Ekman S, Lundström KL, Koyi H, Brandén E, Larsson O, Bergqvist M. A phase I pilot study of the insulin-like growth factor 1 receptor pathway modulator AXL1717 in combination with gemcitabine HCl and carboplatin in previously untreated, locally advanced, or metastatic non-small cell lung cancer. Med Oncol 2015; 32:129. [PMID: 25794491 DOI: 10.1007/s12032-015-0578-y] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 03/14/2015] [Indexed: 11/24/2022]
Abstract
AXL1717 is an orally bioavailable IGF-1R pathway modulator that has been shown to have anti-tumoral effects. The objectives of the present study were to define maximum tolerated dose and the recommended phase II dose (RPTD) of AXL1717 in combination with gemcitabine HCl and carboplatin in non-small cell lung cancer (NSCLC). Patients with previously untreated, locally advanced, or metastatic NSCLC (squamous cell cancer or adenocarcinoma) in good performance status and with preserved major organ functions were enrolled in the study. The study was an open-label phase I study with planned cohorts of three patients per dose level of AXL1717 (215, 290, and 390 mg BID). In total, 12 patients were enrolled in the study, and of these, two were prematurely excluded. AXL1717 was administered at one dose level, 215 mg BID. A total number of 81 unique adverse events were reported. Bone marrow toxicity was reported in 10 out of 12 patients, and this organ class showed the largest number of related events. AXL1717 in combination with gemcitabine HCl and carboplatin is a possible treatment approach in previously untreated, locally advanced, or metastatic non-small cell lung cancer. However, due to the bone marrow toxicity profile shown in the present study, further dose increases of AXL1717 above 215 mg BID will probably not be feasible. Therefore, 215 mg BID constitutes maximum tolerated dose and RPTD.
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Affiliation(s)
- Georg Holgersson
- Department of Radiology, Oncology and Radiation Science, Uppsala University, Uppsala, Sweden,
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Branden E, Hillerdal G, Kolbeck K, Koyi H. Pemetrexed and gemcitabine versus carboplatin and gemcitabine in non-small cell lung cancer: a randomized noninferiority phase II study in one center. Oncologist 2015; 20:365. [PMID: 25732264 DOI: 10.1634/theoncologist.2014-0181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 01/29/2015] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The standard treatment for non-small cell lung cancer (NSCLC) stages IIIb and IV is a platinum compound combined with a third-generation cytotoxic agent. We decided to conduct a phase II study to assess whether the platinum compound could be replaced with pemetrexed with similar results and without an increase in side effects. METHODS Consecutive eligible patients were randomized to either the standard arm of gemcitabine plus carboplatin (GC) or the experimental arm of gemcitabine plus pemetrexed (GP). RESULTS Fifty evaluable patients were enrolled in the GC arm, and 44 received GP. There were 10 partial responses in the GC arm and 16 in the GP arm. With GC, mean survival was 9 months compared with 15 months with GP. The side effects were similar in both groups. CONCLUSION Pemetrexed can replace platinum compounds in the first-line treatment of stage IIIb and IV NSCLC without increasing the side effects. A trend toward better survival was observed in the patients receiving pemetrexed instead of a platinum compound, and this should be studied further.
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Koyi H, Hillerdal G. [Screening for lung cancer in Sweden requires large resources]. Lakartidningen 2015; 112:DCCP. [PMID: 25647109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Hirsh Koyi
- Gävle sjukhus - Gävle, Sweden Gävle sjukhus - Gävle, Sweden
| | - Gunnar Hillerdal
- Karolinska Hospital - Pulmonary Stockholm, Sweden Karolinska Hospital - Pulmonary Stockholm, Sweden
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Brandén E, Wallgren S, Högberg H, Koyi H. Computer tomography-guided core biopsies in a county hospital in Sweden: Complication rate and diagnostic yield. Ann Thorac Med 2014; 9:149-53. [PMID: 24987473 PMCID: PMC4073571 DOI: 10.4103/1817-1737.134069] [Citation(s) in RCA: 11] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Accepted: 01/31/2014] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Core biopsies are valuable in obtaining sufficient tissue to ensure diagnosis of diseases in the thorax. OBJECTIVE To evaluate the complication rate and the diagnostic yield in computer tomography (CT)-guided core biopsies performed in a county hospital in Sweden. METHODS Medical journals, spirometry results, pathology reports and CT scans were reviewed in 463 consecutive cases, where a transthoracic core biopsy was performed between January 2005 and December 2010. Of these 380 (82%) were lung lesions, 48 (10%) were mediastinal lesions and 35 (8%) were pleural lesions. RESULTS All patients underwent a chest X-ray 4 hours post-biopsy and pneumothorax was seen in 156/463 (34%) patients: 137 after lung biopsy and 17 after mediastinal biopsy. Chest tube insertion was required for 27 (17%) of these patients (6% of all core biopsies). Small intraparenchymal hemorrhages and hemoptysis were observed with subjective difficulty in one case. The diagnostic yield for the 463 patients was 212 (46%) cases of lung cancer, 188 (41%) benign lesions and 39 (8%) pulmonary metastases. CONCLUSIONS A transthoracic core biopsy ensures diagnosis with a low complication rate and is suitable as an outpatient procedure. An increased risk for pneumothorax was observed when the biopsied lesion was small or when emphysema was in the path of the biopsy needle. Reduced lung function pre-biopsy or emphysema in the path of the biopsy needle increased the need for chest tube treatment of pneumothorax. A CT-guided core biopsy is safe and applicable in a county hospital.
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Affiliation(s)
- Eva Brandén
- Department of Respiratory Medicine, Gävle Hospital, Karolinska Institutet, Stockholm, Sweden ; Centre for Research and Development Uppsala University/County Council of Gävleborg, Sweden ; Karolinska Institutet, Stockholm, Sweden
| | - Stig Wallgren
- Department of Radiology, Gävle Hospital, Gävle, Sweden
| | - Hans Högberg
- Centre for Research and Development Uppsala University/County Council of Gävleborg, Sweden ; Department of Public Health Medicine, County Council of Gävleborg, Sweden
| | - Hirsh Koyi
- Department of Respiratory Medicine, Gävle Hospital, Karolinska Institutet, Stockholm, Sweden ; Centre for Research and Development Uppsala University/County Council of Gävleborg, Sweden ; Karolinska Institutet, Stockholm, Sweden
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Koyi H, Hillerdal G. [Screening for lung cancer can save lives, according to US study. Too early for mass screening--but refer smokers to CT on broad indications]. Lakartidningen 2012; 109:208-209. [PMID: 22458128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Koyi H, Brandén E, Hillerdal G. Treatment of Elderly (=> 75 Years) With Lung Cancer. A Four-Year Material in Clinical Practice From Karolinska University Hospital - Sweden. Chest 2011. [DOI: 10.1378/chest.1118509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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De Petris L, Forshed J, Antti H, Brandén E, Koyi H, Johnsson A, Lewensohn R, Lehtiö J. 1099 POSTER Plasma Metabolomics in Non-small-cell Lung Cancer. Eur J Cancer 2011. [DOI: 10.1016/s0959-8049(11)70742-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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