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Welty NE, Gill SI. Cancer Immunotherapy Beyond Checkpoint Blockade: JACC: CardioOncology State-of-the-Art Review. JACC CardioOncol 2022; 4:563-578. [PMID: 36636439 PMCID: PMC9830230 DOI: 10.1016/j.jaccao.2022.11.006] [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: 07/19/2022] [Revised: 11/02/2022] [Accepted: 11/03/2022] [Indexed: 12/24/2022] Open
Abstract
Avoidance of immune destruction is recognized as one of the hallmarks of cancer development. Although first predicted as a potential antitumor treatment modality more than 50 years ago, the widespread clinical use of cancer immunotherapies has only recently become a reality. Cancer immunotherapy works by reactivation of a stalled pre-existing immune response or by eliciting a de novo immune response, and its toolkit comprises antibodies, vaccines, cytokines, and cell-based therapies. The treatment paradigm in some malignancies has completely changed over the past 10 to 15 years. Massive efforts in preclinical development have led to a surge of clinical trials testing innovative therapeutic approaches as monotherapy and, increasingly, in combination. Here we provide an overview of approved and emerging antitumor immune therapies, focusing on the rich landscape of therapeutic approaches beyond those that block the canonical PD-1/PD-L1 and CTLA-4 axes and placing them in the context of the latest understanding of tumor immunology.
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Key Words
- BiTE, bispecific T cell engager
- CAR, chimeric antigen receptor
- CRS, cytokine-release syndrome
- FDA, U.S. Food and Drug Administration
- HLA, human leukocyte antigen
- ICI, immune checkpoint inhibitor
- IL, interleukin
- NK, natural killer
- NSCLC, non–small cell lung cancer
- TIL, tumor-infiltrating lymphocyte
- alloHCT, allogeneic hematopoietic stem cell transplantation
- cancer
- immune therapy
- immunotherapy
- innovation
- mAb, monoclonal antibody
- treatment
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Affiliation(s)
- Nathan E. Welty
- Center for Cellular Immunotherapies, University of Pennsylvania, Philadelphia, Pennsylvania, USA,Division of Hematology/Oncology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Saar I. Gill
- Center for Cellular Immunotherapies, University of Pennsylvania, Philadelphia, Pennsylvania, USA,Division of Hematology/Oncology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA,Address for correspondence: Dr Saar I. Gill, Smilow Center for Translational Research, Room 8-101, 3400 Civic Center Boulevard, Philadelphia, Pennsylvania 19104, USA.
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2
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Feldman HA, Zhou N, Deboever N, Hofstetter W, Mehran R, Rajaram R, Rice D, Roth JA, Sepesi B, Swisher S, Vaporciyan A, Walsh G, Godoy M, Strange C, Antonoff MB. Intraoperative challenges after induction therapy for non-small cell lung cancer: Effect of nodal disease on technical complexity. JTCVS Open 2022; 12:372-84. [PMID: 36590745 DOI: 10.1016/j.xjon.2022.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 09/16/2022] [Accepted: 09/22/2022] [Indexed: 11/11/2022]
Abstract
Objectives Neoadjuvant therapy has been theorized to increase complexity of non-small cell lung cancer resections; however, specific factors that contribute to intraoperative challenges after induction therapy have not been well described. We aimed to characterize the effect of nodal involvement and nodal treatment response on surgical complexity after neoadjuvant therapy. Methods We identified patients treated with neoadjuvant therapy followed by anatomic lung resection for cN + non-small cell lung cancer between 2010 and 2020. Patients were categorized according to clinical N1 versus N2 disease. To evaluate the effect of nodal response to therapy, thoracic radiologists measured clinically suspected and pathologically involved lymph nodes before and after induction therapy. Operative reports were reviewed to identify technical challenges specifically related to nodal disease. Categorical outcomes were compared using Fisher exact test. Results One hundred twenty-four patients met inclusion criteria, among whom 107 (86.3%) were treated with neoadjuvant chemotherapy, whereas chemoradiation (n = 8) and targeted therapy (n = 9) were less common. In cases with N1 disease, 8/38 (21.0%) required proximal pulmonary arterial control, whereas this was necessary in only 2/88 (2.3%) of N2 cases (P = .001). Likewise, sleeve resection and arterioplasty were needed more frequently during resection of N1 disease (7/38, 18.4%) versus N2 disease (0/88, P < .001). Increased nodal response to therapy was associated with greater likelihood of requiring change in vascular approach (P = .011). Conclusions After induction therapy, N1 disease was associated with greater need for complex surgical maneuvers than N2 disease. Likewise, substantial treatment response was associated with increased intraoperative technical challenges. Recognizing such factors enables surgical teams to engage in appropriate operative planning to ensure patient safety.
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Yoshida Y, Saeki N, Yotsukura M, Nakagawa K, Watanabe H, Yatabe Y, Watanabe SI. Visualization of patterns of lymph node metastases in non-small cell lung cancer using network analysis. JTCVS Open 2022; 12:410-425. [PMID: 36590713 PMCID: PMC9801281 DOI: 10.1016/j.xjon.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 09/21/2022] [Accepted: 10/06/2022] [Indexed: 11/06/2022]
Abstract
Objective We aimed to visualize complicated patterns of lymph node metastases in surgically resected non-small cell lung cancer by applying a data mining technique. Methods In this retrospective study, 783 patients underwent lobectomy or pneumonectomy with systematic mediastinal lymph node dissection for non-small cell lung cancer between January 2010 and December 2018. Surgically resected lymph nodes were classified according to the International Association for the Study of Lung Cancer lymph node map. Network analysis generated patterns of lymph node metastases from stations 1 to 14, and the degree of connection between 2 lymph node stations was assessed. Results The median number of lymph nodes examined per patient was 20, and the pathological N category was pN0 in 428 cases, pN1 in 132, pN2 in 221, and pN3 in 2. N1 lymph node stations had strong associations with superior mediastinal lymph node stations for patients with primary tumors in the upper lobes and with station 7 for the lower lobes. There was also a connection from the N1 lymph node stations to superior mediastinal lymph node stations in the lower lobes. In the right middle lobe, an even distribution from station 12m toward stations 2R, 4R, and 7 was noted. We released an interactive web application to visualize these data: http://www.canexapp.com. Conclusions Lymph node metastasis patterns differed according to the lobe bearing the tumor. Our results support the need for clinical trials to further investigate selective mediastinal lymph node dissection.
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Affiliation(s)
- Yukihiro Yoshida
- Department of Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan,Address for reprints: Yukihiro Yoshida, MD, Department of Thoracic Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045 Japan.
| | - Nozomu Saeki
- Graduate School of Environmental and Life Science, Okayama University, Okayama, Japan
| | - Masaya Yotsukura
- Department of Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Kazuo Nakagawa
- Department of Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Hirokazu Watanabe
- Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan
| | - Yasushi Yatabe
- Department of Diagnostic Pathology, National Cancer Center Hospital, Tokyo, Japan
| | - Shun-ichi Watanabe
- Department of Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan
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4
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Krantz SB, Zeeshan K, Kuchta KM, Hensing TA, Mangold KA, Zheng SL, Xu J. Germline mutations in high penetrance genes are associated with worse clinical outcomes in patients with non-small cell lung cancer. JTCVS Open 2022; 12:399-409. [PMID: 36590722 PMCID: PMC9801288 DOI: 10.1016/j.xjon.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 08/10/2022] [Accepted: 08/29/2022] [Indexed: 01/04/2023]
Abstract
Objective To determine the frequency of pathogenic mutations in high-penetrance genes (HPGs) in patients with non-small cell lung cancer (NSCLC) and identify whether such mutations are associated with clinicopathologic outcomes. Methods Patients with NSCLC who had consented to participate in a linked clinical database and biorepository underwent germline DNA sequencing using a next-generation sequencing panel that included cancer-associated HPGs and cancer risk-associated single nucleotide polymorphisms (SNPs). These data were linked to the clinical database to assess for associations between germline variants and clinical phenotype using Fisher's exact test and multivariable logistic and Cox regression. Results We analyzed 151 patients, among whom 33% carried any pathogenic HPG mutation and 23% had a genetic risk score (GRS) >1.5. Among the patients without any pathogenic mutation, 31% were at cancer stage II or higher, compared with 55% of those with 2 types of HPG mutations (P = .0293); 40% of patients with both types of HPG mutations had cancer recurrence, compared with 21% of patients without both types (P = .0644). In multivariable analysis, the presence of 2 types of HPG mutations was associated with higher cancer stage (odds ratio [OR], 3.32; P = .0228), increased recurrence of primary tumor (OR, 2.93; P = .0527), shorter time to recurrence (hazard ratio [HR], 3.03; P = .0119), and decreased cancer-specific (HR, 3.53; P = .0039) and overall survival (HR, 2.44; P = .0114). Conclusions The presence of mutations in HPGs is associated with higher cancer stage, increased risk of recurrence, and worse cancer-specific and overall survival in patients with NSCLC. Further large studies are needed to better delineate the role of HPGs in cancer recurrence and the potential benefit of adjuvant treatment in patients harboring such mutations.
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Affiliation(s)
- Seth B. Krantz
- Department of Surgery, NorthShore University HealthSystem, Evanston, Ill,Department of Surgery, Pritzker School of Medicine, University of Chicago, Chicago, Ill,Address for reprints: Seth B. Krantz, MD, NorthShore University HealthSystem, 2650 Ridge Ave, Walgreen Suite 2507, Evanston, IL 60201.
| | - Kanwal Zeeshan
- Department of Surgery, NorthShore University HealthSystem, Evanston, Ill
| | - Kristine M. Kuchta
- Department of Bioinformatics and Research Core, NorthShore University HealthSystem, Evanston, Ill
| | - Thomas A. Hensing
- Department of Medicine, NorthShore University HealthSystem, Evanston, Ill,Department of Medicine, Pritzker School of Medicine, University of Chicago, Chicago, Ill
| | - Kathy A. Mangold
- Department of Pathology, NorthShore University HealthSystem, Evanston, Ill,Department of Pathology, Pritzker School of Medicine, University of Chicago, Chicago, Ill
| | - S. Lilly Zheng
- Program for Personalized Cancer Care, NorthShore University HealthSystem, Evanston, Ill
| | - Jianfeng Xu
- Department of Surgery, Pritzker School of Medicine, University of Chicago, Chicago, Ill,Department of Medicine, Pritzker School of Medicine, University of Chicago, Chicago, Ill
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Zhang C, Hong HZ, Wu YL, Zhong WZ. Short-term outcome of neoadjuvant immunotherapy and chemotherapy in non-small cell lung cancer: A systematic review and meta-analysis. JTCVS Open 2021; 8:588-607. [PMID: 36004199 PMCID: PMC9390514 DOI: 10.1016/j.xjon.2021.08.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 08/25/2021] [Indexed: 11/08/2022]
Abstract
Background Previously reported results have shown promising efficacy of neoadjuvant immunotherapy for resectable non–small cell lung cancer (NSCLC). However, no randomized control trials comparing neoadjuvant immunotherapy with chemotherapy have yet been reported. The aim of the present study was to evaluate the superiority of neoadjuvant immunotherapy compared with standard neoadjuvant chemotherapy in resectable NSCLC in terms of short-term clinical outcomes and surgical outcomes. Methods We searched PubMed, Embase, the Cochrane Central Register of Controlled Trials, the ClinicalTrials.gov database, Web of Science, and abstracts derived from multiple major cancer meetings up to March 1, 2020. Short-term clinical outcomes (including objective response rate [ORR], major pathologic response, and pathologic complete response [pCR]) and surgical outcomes (including surgical resection rate and R0 resection rate) were reported. Data were summarized as the estimated pooled value of each evaluated index. The risk of bias of included studies was assessed using standard methods. Results This systematic review and meta-analysis of 21 trials on neoadjuvant immunotherapy and neoadjuvant chemotherapy for NSCLC included 1795 patients. Patients who received Programmed death ligand 1 (PD-1/PD-L1) inhibitors (NeoIO) alone (13.3%; 95% confidence interval [CI], 9.0%-19.3%) had the lowest ORR compared with those who received NeoIO plus chemotherapy (CT) (62.5%; 95% CI, 54.4%-70.0%) or CT alone (41.6%; 95% CI, 36.8%-46.7%) (NeoIO vs CT, P < .001; NeoIO + CT vs CT, P < .001). Receipt of NeoIO + CT (36.2%; 95% CI, 19.2%-57.6%) was associated with an elevated pCR rate compared with receipt of NeoIO alone (10.6%; 95% CI, 6.5%-16.9%; P < .001) or standard CT (7.5%; 95% CI, 5.7%-9.8%; P < .001). Neoadjuvant CT (87.2%; 95% CI, 74.9%-94.0%) was associated with a lower R0 resection rate compared with NeoIO alone (92.7%; 95% CI, 83.4%-97.0%; P = .360) or NeoIO + CT (91.6%; 95% CI, 84.3%-95.7%; P = .409). Meta-regression showed that a higher proportion of stage III patients was correlated with decreased surgical resection and R0 resection rates, whereas no impact was observed with neoadjuvant immunotherapy. Conclusions Current data suggest that compared with neoadjuvant chemotherapy, immunotherapy-based regimens may provide superior pathological response along with a higher rate of complete resection. Immunotherapy combined with chemotherapy in neoadjuvant chemotherapy may be a more favorable clinical option. Further randomized controlled trials are warranted to provide long-term results of neoadjuvant immunotherapy for localized NSCLC and help guide clinical practice.
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Affiliation(s)
- Chao Zhang
- Guangdong Lung Cancer Institute, Guangdong Provincial Key Laboratory of Translational Medicine in Lung Cancer, Guangdong Provincial People's Hospital & Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Hui-Zhao Hong
- Guangdong Lung Cancer Institute, Guangdong Provincial Key Laboratory of Translational Medicine in Lung Cancer, Guangdong Provincial People's Hospital & Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yi-Long Wu
- Department of Medical Oncology, Guangdong Lung Cancer Institute, Guangdong Provincial Key Laboratory of Translational Medicine in Lung Cancer, Guangdong Provincial People's Hospital & Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Wen-Zhao Zhong
- Guangdong Lung Cancer Institute, Guangdong Provincial Key Laboratory of Translational Medicine in Lung Cancer, Guangdong Provincial People's Hospital & Guangdong Academy of Medical Sciences, Guangzhou, China
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Bergom C, Bradley JA, Ng AK, Samson P, Robinson C, Lopez-Mattei J, Mitchell JD. Past, Present, and Future of Radiation-Induced Cardiotoxicity: Refinements in Targeting, Surveillance, and Risk Stratification. JACC CardioOncol 2021; 3:343-359. [PMID: 34604796 PMCID: PMC8463722 DOI: 10.1016/j.jaccao.2021.06.007] [Citation(s) in RCA: 64] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 06/07/2021] [Accepted: 06/09/2021] [Indexed: 12/13/2022] Open
Abstract
Radiation therapy is an important component of cancer therapy for many malignancies. With improvements in cardiac-sparing techniques, radiation-induced cardiac dysfunction has decreased but remains a continued concern. In this review, we provide an overview of the evolution of radiotherapy techniques in thoracic cancers and associated reductions in cardiac risk. We also highlight data demonstrating that in some cases radiation doses to specific cardiac substructures correlate with cardiac toxicities and/or survival beyond mean heart dose alone. Advanced cardiac imaging, cardiovascular risk assessment, and potentially even biomarkers can help guide post-radiotherapy patient care. In addition, treatment of ventricular arrhythmias with the use of ablative radiotherapy may inform knowledge of radiation-induced cardiac dysfunction. Future efforts should explore further personalization of radiotherapy to minimize cardiac dysfunction by coupling knowledge derived from enhanced dosimetry to cardiac substructures, post-radiation regional dysfunction seen on advanced cardiac imaging, and more complete cardiac toxicity data.
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Key Words
- CAC, coronary artery calcium
- CAD, coronary artery disease
- CMRI, cardiac magnetic resonance imaging
- CT, computed tomography
- HL, Hodgkin lymphoma
- LAD, left anterior descending artery
- LV, left ventricular
- MHD, mean heart dose
- NSCLC, non–small cell lung cancer
- RICD, radiation-induced cardiovascular disease
- RT, radiation therapy
- SBRT, stereotactic body radiation therapy
- breast cancer
- cancer survivorship
- childhood cancer
- esophageal cancer
- imaging
- lung cancer
- lymphoma
- radiation physics
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Affiliation(s)
- Carmen Bergom
- Department of Radiation Oncology, Washington University, Saint Louis, Missouri, USA
- Cardio-Oncology Center of Excellence, Washington University, St. Louis, Missouri, USA
- Alvin J. Siteman Center, Washington University, St. Louis, Missouri, USA
| | - Julie A. Bradley
- Department of Radiation Oncology, University of Florida, Jacksonville, Florida, USA
| | - Andrea K. Ng
- Department of Radiation Oncology, Dana-Farber/Brigham and Women’s Cancer Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Pamela Samson
- Department of Radiation Oncology, Washington University, Saint Louis, Missouri, USA
- Alvin J. Siteman Center, Washington University, St. Louis, Missouri, USA
| | - Clifford Robinson
- Department of Radiation Oncology, Washington University, Saint Louis, Missouri, USA
- Alvin J. Siteman Center, Washington University, St. Louis, Missouri, USA
- Division of Cardiology, Department of Medicine, Washington University, St. Louis, Missouri, USA
| | - Juan Lopez-Mattei
- Departments of Cardiology and Thoracic Imaging, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Joshua D. Mitchell
- Cardio-Oncology Center of Excellence, Washington University, St. Louis, Missouri, USA
- Alvin J. Siteman Center, Washington University, St. Louis, Missouri, USA
- Division of Cardiology, Department of Medicine, Washington University, St. Louis, Missouri, USA
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7
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Sadeghi AH, Maat APM, Taverne YJJ, Cornelissen R, Dingemans AMC, Bogers AJC, Mahtab EA. Virtual reality and artificial intelligence for 3-dimensional planning of lung segmentectomies. JTCVS Tech 2021; 7:309-321. [PMID: 34318279 PMCID: PMC8312141 DOI: 10.1016/j.xjtc.2021.03.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 03/10/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND There has been an increasing trend toward pulmonary segmentectomies to treat early-stage lung cancer, small intrapulmonary metastases, and localized benign pathology. A complete preoperative understanding of pulmonary anatomy is essential for accurate surgical planning and case selection. Identifying intersegmental divisions is extremely difficult when performed on computed tomography. For the preoperative planning of segmentectomies, virtual reality (VR) and artificial intelligence could allow 3-dimensional visualization of the complex anatomy of pulmonary segmental divisions, vascular arborization, and bronchial anatomy. This technology can be applied by surgeons preoperatively to gain better insight into a patient's anatomy for planning segmentectomy. METHODS In this prospective observational pilot study, we aim to assess and demonstrate the technical feasibility and clinical applicability of the first dedicated artificial intelligence-based and immersive 3-dimensional-VR platform (PulmoVR; jointly developed and manufactured by Department of Cardiothoracic Surgery [Erasmus Medical Center, Rotterdam, The Netherlands], MedicalVR [Amsterdam, The Netherlands], EVOCS Medical Image Communication [Fysicon BV, Oss, The Netherlands], and Thirona [Nijmegen, The Netherlands]) for preoperative planning of video-assisted thoracoscopic segmentectomies. RESULTS A total of 10 eligible patients for segmentectomy were included in this study after referral through the institutional thoracic oncology multidisciplinary team. PulmoVR was successfully applied as a supplementary imaging tool to perform video-assisted thoracoscopic segmentectomies. In 40% of the cases, the surgical strategy was adjusted due to the 3-dimensional-VR-based evaluation of anatomy. This underlines the potential benefit of additional VR-guided planning of segmentectomy for both surgeon and patient. CONCLUSIONS Our study demonstrates the successful development and clinical application of the first dedicated artificial intelligence and VR platform for the planning of pulmonary segmentectomy. This is the first study that shows an immersive virtual reality-based application for preoperative planning of segmentectomy to the best of our knowledge.
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Affiliation(s)
- Amir H. Sadeghi
- Department of Cardiothoracic Surgery, Thoraxcenter, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Alexander P.W. M. Maat
- Department of Cardiothoracic Surgery, Thoraxcenter, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Yannick J.H. J. Taverne
- Department of Cardiothoracic Surgery, Thoraxcenter, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Robin Cornelissen
- Department of Pulmonary Medicine, Erasmus Medical Center Cancer Institute, Rotterdam, The Netherlands
| | - Anne-Marie C. Dingemans
- Department of Pulmonary Medicine, Erasmus Medical Center Cancer Institute, Rotterdam, The Netherlands
| | - Ad J.J. C. Bogers
- Department of Cardiothoracic Surgery, Thoraxcenter, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Edris A.F. Mahtab
- Department of Cardiothoracic Surgery, Thoraxcenter, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
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Abstract
Intratumoral heterogeneity is tightly associated with the failure of anticancer treatment modalities including conventional chemotherapy, radiation therapy, and molecularly targeted therapy. Such heterogeneity is generated in an evolutionary manner not only as a result of genetic alterations but also by the presence of cancer stem cells (CSCs). CSCs are proposed to exist at the top of a tumor cell hierarchy and are undifferentiated tumor cells that manifest enhanced tumorigenic and metastatic potential, self-renewal capacity, and therapeutic resistance. Properties that contribute to the robustness of CSCs include the abilities to withstand redox stress, to rapidly repair damaged DNA, to adapt to a hyperinflammatory or hyponutritious tumor microenvironment, and to expel anticancer drugs by the action of ATP-binding cassette transporters as well as plasticity with regard to the transition between dormant CSC and transit-amplifying progenitor cell phenotypes. In addition, CSCs manifest the phenomenon of metabolic reprogramming, which is essential for maintenance of their self-renewal potential and their ability to adapt to changes in the tumor microenvironment. Elucidation of the molecular underpinnings of these biological features of CSCs is key to the development of novel anticancer therapies. In this review, we highlight the pathological relevance of CSCs in terms of their hallmarks and identification, the properties of their niche—both in primary tumors and at potential sites of metastasis—and their resistance to oxidative stress dependent on system xc (−). Intratumoral heterogeneity driven by CSCs is responsible for therapeutic resistance. CTCs survive in the distant organs and achieve colonization, causing metastasis. E/M hybrid cancer cells due to partial EMT exhibit the highest metastatic potential. The CSC niche regulates stemness in metastatic disease as well as in primary tumor. Activation of system xc(-) by CD44 variant in CSCs is a promising therapeutic target.
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Key Words
- ABC, ATP-binding cassette
- ALDH, Aldehyde dehydrogenase
- BMP, Bone morphogenetic protein
- CAF, Cancer-associated fibroblast
- CD44 variant
- CD44v, CD44 variant
- CSC, Cancer stem cell
- CTC, Circulating tumor cell
- CagA, Cytotoxin-associated gene A
- Cancer stem cell
- DTC, Disseminated tumor cell
- E/M, Epithelial/mesenchymal
- ECM, Extracellular matrix
- EGF, Epidermal growth factor
- EMT, Epithelial-to-mesenchymal transition
- EpCAM, Epithelial cell adhesion moleculeE
- Epithelial-to-mesenchymal transition (EMT)
- GSC, Glioma stem cell
- GSH, reduced glutathione
- HGF, Hepatocyte growth factor
- HNSCC, Head and neck squamous cell cancer
- IL, Interleukin
- Intratumoral heterogeneity
- MAPK, mitogen-activated protein kinase
- MET, mesenchymal-to-epithelial transition
- NSCLC, non–small cell lung cancer
- Niche
- Nrf2, nuclear factor erythroid 2–related factor 2
- OXPHOS, Oxidative phosphorylation
- Plasticity
- Prrx1, Paired-related homeodomain transcription factor 1
- ROS, Reactive oxygen species
- SRP1, Epithelial splicing regulatory protein 1
- TGF-β, Transforming growth factor–β
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Affiliation(s)
- Go J Yoshida
- Division of Gene Regulation, Institute for Advanced Medical Research (IAMR), Keio University School of Medicine, Tokyo, Japan
| | - Hideyuki Saya
- Division of Gene Regulation, Institute for Advanced Medical Research (IAMR), Keio University School of Medicine, Tokyo, Japan
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9
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Yotsukura M, Okubo Y, Yoshida Y, Nakagawa K, Watanabe SI. Indocyanine green imaging for pulmonary segmentectomy. JTCVS Tech 2021; 6:151-158. [PMID: 34318180 PMCID: PMC8300924 DOI: 10.1016/j.xjtc.2020.12.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [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: 12/21/2020] [Accepted: 12/21/2020] [Indexed: 11/26/2022] Open
Abstract
Objective Delineation of the intersegmental plane during pulmonary segmentectomy by systemic injection of indocyanine green (ICG) has been rapidly emerging. We evaluated the feasibility of the use of ICG in a large-scale cohort according to the type of segmentectomy and the presence of obstructive lung disorder and compared the demarcation status with air injection. Methods We collected the data of 209 patients who underwent segmentectomy using ICG at National Cancer Center Hospital, Tokyo, Japan. Data of the operation including the demarcation status of the intersegmental plane were analyzed retrospectively. Results The median operation duration and blood loss were 105 minutes (interquartile range, 94-118 minutes) and 12 mL (interquartile range, 5-24 mL), respectively. Good demarcation of the intersegmental plane by ICG was observed in 184 (88.0%) cases, with no correlation to the type of resected segments or the presence of obstructive lung disorder. Postoperative complications of Clavien–Dindo classification grade 3 or more were observed in 5 cases (2.4%), and no ICG-related adverse event was noted. High-frequency jet ventilation was also used in 160 cases (76.6%) to delineate the intersegmental inflation–deflation plane. The air injected by high-frequency jet ventilation tended to spread further beyond the intersegmental plane that was depicted by ICG. Conclusions The use of ICG might demarcate the intersegmental plane more restricted to the target segment compared with air injection. Delineation of the intersegmental plane by ICG is feasible regardless of the type of segmentectomy or the presence of obstructive lung disorder, and it can be commonly applicable in pulmonary segmentectomy.
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Affiliation(s)
- Masaya Yotsukura
- Department of Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Yu Okubo
- Department of Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Yukihiro Yoshida
- Department of Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Kazuo Nakagawa
- Department of Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Shun-Ichi Watanabe
- Department of Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan
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Affiliation(s)
- Chase W Kwon
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
| | - Rajini K Murthy
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia.,Total Skin & Beauty Dermatology Center, Birmingham, Alabama
| | - Ragini Kudchadkar
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, Georgia
| | - Benjamin K Stoff
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia.,Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia
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11
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Chatzantonis G, Evers G, Meier C, Bietenbeck M, Florian A, Klingel K, Bleckmann A, Yilmaz A. Immune Checkpoint Inhibitor-Associated Myocarditis: A Run of Bad Luck or Rather Deficient-Monitoring Protocol? JACC Case Rep 2020; 2:630-5. [PMID: 34317309 DOI: 10.1016/j.jaccas.2019.12.047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 12/23/2019] [Accepted: 12/26/2019] [Indexed: 01/23/2023]
Abstract
Immune checkpoint inhibitors (ICIs) can induce immunity-related adverse events. We demonstrate the clinical use of cardiac magnetic resonance and endomyocardial biopsy in the diagnosis and subsequent monitoring of ICI-associated myocarditis, suggesting the need to establish and evaluate a cardiac monitoring protocol for patients under ICI therapy. (Level of Difficulty: Intermediate.)
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Key Words
- CMR
- CMR, cardiac magnetic resonance
- ICI, immune checkpoint inhibitor
- LGE, late gadolinium enhancement
- LV, left ventricular
- LVEF, left ventricular ejection fraction
- MMF, mycophenolate mofetil
- NSCLC, non–small cell lung cancer
- PD, programmed death
- PD-L, programmed death-ligand
- RR, reference range
- VT, ventricular tachycardia
- irAE
- irAE, immune-related adverse event
- myocarditis
- pembrolizumab
- ventricular tachycardia
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Abstract
Osimertinib is the preferred treatment in patients with metastatic non-small cell lung cancer with epidermal growth factor receptor mutations. We report a case series of acute cardiomyopathy with heart failure exacerbation during osimertinib treatment. We suggest that cardiotoxicity from osimertinib is reversible and occurs at a dose of 80 mg/day. (Level of Difficulty: Intermediate.).
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Affiliation(s)
- Shruti R. Patel
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | | | - Jilan E. Kubusek
- Department of Medical Oncology, Mayo Clinic, Rochester, Minnesota
| | | | - Narjust Duma
- Division of Medical Oncology, University of Wisconsin, Madison, Wisconsin
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13
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Cohen M, Mustafa S, Elkherpitawy I, Meleka M. A Fatal Case of Pembrolizumab-Induced Myocarditis in Non-Small Cell Lung Cancer. JACC Case Rep 2020; 2:426-430. [PMID: 34317255 PMCID: PMC8311714 DOI: 10.1016/j.jaccas.2019.12.045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 12/26/2019] [Indexed: 01/07/2023]
Abstract
Immune channel inhibitor–induced myocarditis is rare, and its management is challenging. Recently, guidelines were established for all ICIs, yet they do not take into account individual drug toxicities or screening protocols for prevention. We present a rare case of rapidly progressive pembrolizumab-induced fatal myocarditis in an initially asymptomatic patient. (Level of Difficulty: Beginner.)
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Affiliation(s)
- Max Cohen
- New York Institute of Technology College of Osteopathic Medicine, Glen Head, New York
| | - Saim Mustafa
- Lake Erie College of Osteopathic Medicine, Erie, Pennsylvania
| | - Islam Elkherpitawy
- Jersey Shore University Hospital and Medical Center, Neptune, New Jersey
| | - Matthew Meleka
- Jersey Shore University Hospital and Medical Center, Neptune, New Jersey
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14
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Kunimasa K, Kamada R, Oka T, Oboshi M, Kimura M, Inoue T, Tamiya M, Nishikawa T, Yasui T, Shioyama W, Nishino K, Imamura F, Kumagai T, Fujita M. Cardiac Adverse Events in EGFR-Mutated Non-Small Cell Lung Cancer Treated With Osimertinib. JACC CardioOncol 2020; 2:1-10. [PMID: 34396203 PMCID: PMC8352275 DOI: 10.1016/j.jaccao.2020.02.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [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: 08/28/2019] [Revised: 01/31/2020] [Accepted: 02/03/2020] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES The purpose of this study was to assess osimertinib-associated cardiac adverse events (AEs) in a real-world setting, using a retrospective single-center cohort study in Japan. BACKGROUND Cases of osimertinib-associated cardiac AEs have been reported but remain poorly understood. METHODS A total of 123 cases of advanced non-small cell lung cancer (NSCLC) with confirmed EGFR mutations who received osimertinib monotherapy from 2014 to 2019 at the Osaka International Cancer Institute (Osaka, Japan) were evaluated. Cardiac AEs were defined according to Common Terminology Criteria for Adverse Events (CTCAE) version 5.0. Changes in left ventricular ejection fraction (LVEF) and rates of cancer therapeutics-related cardiac dysfunction (CTRCD), defined as a ≥10 % absolute decline in LVEF from baseline to a value of <53%, were further assessed in 36 patients in whom serial measurements of LVEF were obtained before and during osimertinib treatment. RESULTS Severe cardiac AEs (CTCAE grade 3 or higher) occurred in 6 patients (4.9%) after osimertinib administration. These AEs included acute myocardial infarction (n = 1), heart failure with reduced LVEF (n = 3), and valvular heart disease (n = 2). Five of the 6 patients had a history of cardiovascular risk factors or disease. Myocardial biopsies in 2 of the patients showed cardiomyocyte hypertrophy and lipofuscin deposition. In 36 patients assessed with serial LVEF, LVEF declined from 69.4 ± 4.2% to 63.4 ± 10.5% with osimertinib therapy (p < 0.001). CTRCD occurred in 4 patients with a nadir LVEF of 40.3 ± 9.1% with osimertinib. CONCLUSIONS In this retrospective cohort analysis, the incidence of cardiac AEs in patients treated with osimertinib was 4.9%. Additional prospective data collected from patients with NSCLC treated with osimertinib will be important in understanding the incidence, pathophysiology, and management of cardiac AEs with osimertinib.
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Key Words
- ACE, angiotensin-converting enzyme
- AE, adverse event
- ARB, angiotensin II receptor blocker
- CTCAE, common terminology criteria for adverse event
- CTRCD, cancer therapeutics-related cardiac dysfunction
- EGFR mutations
- EGRF, epidermal growth factor receptor
- HER, human epidermal growth factor receptor
- LVEF, left ventricular ejection fraction
- LVIDd, left ventricular internal end-diastolic diameter
- LVIDs, left ventricular internal end-systolic diameter
- MR, mitral regurgitation
- NSCLC, non–small cell lung cancer
- NT-proBNP, N-terminal pro–B-type natriuretic peptide
- PASP, pulmonary artery systolic pressure
- TKI, tyrosine kinase inhibitor
- TR, tricuspid regurgitation
- VEGF, vascular endothelial growth factor
- cardiac adverse events
- cardiac dysfunction
- myocardial biopsy
- non–small cell lung cancer
- osimertinib
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Affiliation(s)
- Kei Kunimasa
- Department of Thoracic Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Risa Kamada
- Department of Onco-Cardiology, Osaka International Cancer Institute, Osaka, Japan
| | - Toru Oka
- Department of Onco-Cardiology, Osaka International Cancer Institute, Osaka, Japan
| | - Makiko Oboshi
- Department of Onco-Cardiology, Osaka International Cancer Institute, Osaka, Japan
| | - Madoka Kimura
- Department of Thoracic Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Takako Inoue
- Department of Thoracic Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Motohiro Tamiya
- Department of Thoracic Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Tatsuya Nishikawa
- Department of Onco-Cardiology, Osaka International Cancer Institute, Osaka, Japan
| | - Taku Yasui
- Department of Onco-Cardiology, Osaka International Cancer Institute, Osaka, Japan
| | - Wataru Shioyama
- Department of Onco-Cardiology, Osaka International Cancer Institute, Osaka, Japan
| | - Kazumi Nishino
- Department of Thoracic Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Fumio Imamura
- Department of Thoracic Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Toru Kumagai
- Department of Thoracic Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Masashi Fujita
- Department of Onco-Cardiology, Osaka International Cancer Institute, Osaka, Japan
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15
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Anand K, Ensor J, Trachtenberg B, Bernicker EH. Osimertinib-Induced Cardiotoxicity: A Retrospective Review of the FDA Adverse Events Reporting System (FAERS). JACC CardioOncol 2019; 1:172-178. [PMID: 34396179 PMCID: PMC8352117 DOI: 10.1016/j.jaccao.2019.10.006] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 10/22/2019] [Accepted: 10/29/2019] [Indexed: 12/19/2022]
Abstract
Objectives The goal of this study was to compare the risk of cardiotoxicity with osimertinib versus all other drugs and versus epidermal growth factor receptor (EGFR)–tyrosine kinase inhibitors (TKIs) (erlotinib, afatinib, and gefitinib) in the U.S. Food and Drug Administration Adverse Events Reporting System (FAERS), a pharmacovigilance database. Background Osimertinib has been shown to improve outcomes in T790M-positive non–small cell lung cancer patients who progress on EGFR-TKI therapy and in the frontline setting in EGFR mutated non–small cell lung cancer. In pivotal trials, osimertinib was associated with higher rates of cardiotoxicity compared with the control arm. Methods FAERS was queried for “Cardiac failure,” “Electrocardiogram QT-prolonged,” “Atrial Fibrillation (AF),” “Myocardial Infarction (MI),” and “Pericardial Effusion” secondary to “Osimertinib,” “Erlotinib,” “Afatinib,” “Gefitinib,” and all other drugs from 2016 to 2018. Disproportionality signal analysis was performed by calculating the reporting odds ratio (ROR) with its 95% confidence interval (CI). The ROR was considered significant when the lower limit of the 95% CI was >1.0. Results The ROR (95% CI) for cardiac failure, atrial fibrillation (AF), QT prolongation, myocardial infarction, and pericardial effusion due to osimertinib versus all other drugs in FAERS was 5.4 (4.2 to 7.1), 4.0 (2.8 to 5.8), 11.2 (7.9 to 15.8), 1.6 (0.9 to 2.6), and 8.2 (4.8 to 14), respectively. The ROR (95% CI) for cardiac failure, AF, QT prolongation, myocardial infarction, and pericardial effusion in comparing osimertinib versus other EGFR-TKIs was 2.2 (1.5 to 3.2), 2.1 (1.3 to 3.5), 6.6 (3.4 to 12.8), 1.2 (0.6 to 2.3), and 1.6 (0.8 to 3.3). Conclusions The RORs for cardiac failure, AF, and QT prolongation were higher due to osimertinib compared with other TKIs. Electrocardiographic monitoring for QT prolongation and monitoring for signs and symptoms of heart failure should be considered in patients taking osimertinib.
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Affiliation(s)
- Kartik Anand
- Houston Methodist Cancer Center/Weill Cornell Medicine, Houston, Texas, USA
| | - Joe Ensor
- Houston Methodist Research Institute, Houston, Texas, USA
| | - Barry Trachtenberg
- Division of Cardiology, DeBakey Heart and Vascular Institute, Houston Methodist Hospital, Houston, Texas, USA
| | - Eric H Bernicker
- Houston Methodist Cancer Center/Weill Cornell Medicine, Houston, Texas, USA
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16
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Sidiropoulou P, Sgontzou T, Kostara I, Sgouros D, Theologi B, Zouridaki E, Kontochristopoulos G, Rigopoulos D, J Stratigos A. Nivolumab in non-small cell lung cancer: A novel case of an erythema annulare centrifugum-like eruption. JAAD Case Rep 2019; 5:572-575. [PMID: 31312704 PMCID: PMC6610637 DOI: 10.1016/j.jdcr.2019.04.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Polytimi Sidiropoulou
- 1st Department of Dermatology-Venereology, National and Kapodistrian University of Athens, Faculty of Medicine, "A. Sygros" Hospital for Cutaneous & Venereal Diseases, Athens, Greece
| | - Themis Sgontzou
- 1st Department of Dermatology-Venereology, National and Kapodistrian University of Athens, Faculty of Medicine, "A. Sygros" Hospital for Cutaneous & Venereal Diseases, Athens, Greece
| | - Ioanna Kostara
- 1st Department of Respiratory Medicine, National and Kapodistrian University of Athens, Faculty of Medicine, "Sotiria" General Hospital, Athens, Greece
| | - Dimitrios Sgouros
- 1st Department of Dermatology-Venereology, National and Kapodistrian University of Athens, Faculty of Medicine, "A. Sygros" Hospital for Cutaneous & Venereal Diseases, Athens, Greece
| | - Barbara Theologi
- Pathology Department, "A. Sygros" Hospital for Cutaneous & Venereal Diseases, Athens, Greece
| | - Eftychia Zouridaki
- State Department of Dermatology-Venereology, "A. Sygros" Hospital for Cutaneous & Venereal Diseases, Athens, Greece
| | - Georgios Kontochristopoulos
- State Department of Dermatology-Venereology, "A. Sygros" Hospital for Cutaneous & Venereal Diseases, Athens, Greece
| | - Dimitris Rigopoulos
- 1st Department of Dermatology-Venereology, National and Kapodistrian University of Athens, Faculty of Medicine, "A. Sygros" Hospital for Cutaneous & Venereal Diseases, Athens, Greece
| | - Alexander J Stratigos
- 1st Department of Dermatology-Venereology, National and Kapodistrian University of Athens, Faculty of Medicine, "A. Sygros" Hospital for Cutaneous & Venereal Diseases, Athens, Greece
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17
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Affiliation(s)
- Cory Kosche
- Department of Dermatology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Nisha Mohindra
- Department of Internal Medicine, Division of Hematology and Oncology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Jennifer N Choi
- Department of Dermatology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
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18
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Vial MR, Eapen GA, Casal RF, Sarkiss MG, Ost DE, Vakil E, Grosu HB. Combined pleuroscopy and endobronchial ultrasound for diagnosis and staging of suspected lung cancer. Respir Med Case Rep 2017; 23:49-51. [PMID: 29276672 PMCID: PMC5734695 DOI: 10.1016/j.rmcr.2017.11.009] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 11/29/2017] [Accepted: 11/29/2017] [Indexed: 12/01/2022] Open
Abstract
The standard approach to staging of lung cancer in patients with pleural effusion (clinical M1a) is thoracentesis followed by pleural biopsies if the cytologic analysis is negative. If pleural biopsy findings are negative, endobronchial ultrasound-guided transbronchial needle aspiration is used to complete the staging process and, in some cases, obtain diagnosis. In this case series we report 7 patients in which a combined procedure was performed for staging of known or suspected lung cancer. We found that the combined approach was both feasible and safe in this case series.
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Affiliation(s)
- Macarena R Vial
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States.,Department of Pulmonary Medicine, Clinica Alemana de Santiago, Universidad del Desarrollo, Santiago, Chile
| | - George A Eapen
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Roberto F Casal
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Mona G Sarkiss
- Department of Anesthesiology & Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - David E Ost
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Erik Vakil
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Horiana B Grosu
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
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19
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Hobbs CJ, Ko SJ, Paryani NN, Accurso JM, Olivier KR, Garces YI, Park SS, Hallemeier CL, Schild SE, Vora SA, Ashman JB, Rule WG, Bowers JR, Heckman MG, Diehl NN, Miller RC. Stereotactic Body Radiotherapy for Medically Inoperable Stage I-II Non-Small Cell Lung Cancer: The Mayo Clinic Experience. Mayo Clin Proc Innov Qual Outcomes 2017; 2:40-48. [PMID: 30225431 PMCID: PMC6124323 DOI: 10.1016/j.mayocpiqo.2017.11.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Objective To examine disease control and survival after stereotactic body radiotherapy (SBRT) for medically inoperable, early-stage non-small cell lung cancer (NSCLC) and determine associations of pretreatment 18F-fluorodeoxyglucose-positron emission tomography (FDG-PET) maximum standardized uptake values (SUVmax), biologically effective dose, and mediastinal staging with disease control and survival outcomes. Patients and Methods We retrospectively reviewed the cases of consecutive patients with FDG-PET-staged, medically inoperable NSCLC treated with SBRT at our institution between January 1, 2008, and August 4, 2014. Cumulative incidences of recurrence were estimated, accounting for the competing risk of death. Associations of SUVmax, biologically effective dose, and mediastinal staging with outcomes were evaluated using Cox proportional hazards regression models. Results Among 282 patients, 2-year cumulative incidences of recurrence were 4.9% (95% CI, 2.6%-8.3%) for local, 9.8% (95% CI, 6.3%-14.2%) for nodal, 10.8% (95% CI, 7.0%-15.5%) for ipsilateral lung, 6.0% (3.3%-9.8%) for contralateral lung, 9.7% (95% CI, 6.3%-14.0%) for distant recurrence, and 26.1% (95% CI, 20.4%-32.0%) for any recurrence. The 2-year overall survival was 70.4% (95% CI, 64.5%-76.8%), and the 2-year disease-free survival was 51.2% (95% CI, 44.9%-58.5%). Risk of any recurrence was significantly higher for patients with higher SUVmax (hazard ratio [per each doubling], 1.29 [95% CI, 1.05-1.59]; P=.02). A similar association with SUVmax was observed when considering the composite outcome of any recurrence or death (hazard ratio, 1.23 [95% CI, 1.05-1.44]; P=.01). The SUVmax was not significantly associated with other outcomes (P≥0.69). Two-year cumulative incidences of local recurrence for patients receiving 48 Gy in 4 fractions, 54 Gy in 3 fractions, or 50 Gy in 5 fractions were 1.7% (95% CI, 0.3%-5.6%), 3.7% (95% CI, 0.7%-11.4%), and 15.3% (95% CI, 5.9%-28.9%), respectively (P=.02); this difference was independent of lesion size (P=.02). Conclusion Disease control was excellent for patients who received SBRT for early-stage NSCLC, and this series represents the largest single-institution experience from the United States on SBRT for early-stage inoperable NSCLC. Higher pretreatment FDG-PET SUVmax was associated with increased risk of any recurrence, and the 50 Gy in 5 fractions dose prescription was associated with increased risk of local recurrence.
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Key Words
- BED, biologically effective dose
- CT, computed tomography
- DFS, disease-free survival
- EBUS, endobronchial ultrasonography
- FDG-PET, 18F-fludeoxyglucose–positron emission tomography
- HR, hazard ratio
- ITV, internal target volume
- LC, local control
- NSCLC, non–small cell lung cancer
- OS, overall survival
- PET, positron emission tomography
- RTOG, Radiation Therapy Oncology Group
- SBRT, stereotactic body radiotherapy
- SUVmax, maximum standardized uptake value
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Affiliation(s)
- Corey J Hobbs
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL
| | - Stephen J Ko
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL
| | | | | | | | | | - Sean S Park
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | | | - Steven E Schild
- Department of Radiation Oncology, Mayo Clinic Hospital, Phoenix, AZ
| | - Sujay A Vora
- Department of Radiation Oncology, Mayo Clinic Hospital, Phoenix, AZ
| | | | - William G Rule
- Department of Radiation Oncology, Mayo Clinic Hospital, Phoenix, AZ
| | - Johnny R Bowers
- Department of Radiation Oncology, Mayo Clinic Hospital, Phoenix, AZ
| | | | | | - Robert C Miller
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL
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Yang Y, Qin SK, Zhu J, Wang R, Li YM, Xie ZY, Wu Q. A Rare STRN-ALK Fusion in Lung Adenocarcinoma Identified Using Next-Generation Sequencing-Based Circulating Tumor DNA Profiling Exhibits Excellent Response to Crizotinib. Mayo Clin Proc Innov Qual Outcomes 2017; 1:111-116. [PMID: 30225407 PMCID: PMC6134903 DOI: 10.1016/j.mayocpiqo.2017.04.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The ALK gene fusion has been identified as a new driver gene in non–small cell lung cancer (NSCLC). It includes the EML4-ALK rearrangement as a recurring event that renders the tumor sensitive to ALK tyrosine kinase inhibitor crizotinib. In addition, several other fusion partners to ALK kinase domain (eg, TFG, KLC1, and KIF5B) have been identified in NSCLC. However, clinical data relevant to response in lung cancer harboring these rare ALK translocations are not fully available. A nonsmoking Chinese male originally diagnosed with “stage Ib lung adenocarcinoma” showed metastases in regional lymph nodes, pleura, and bone 1 year after surgery. The patient refused invasive tissue biopsy, and chemotherapy was administrated, which failed as a first- and second-line treatment. We then identified a rare fusion gene of ALK and Striatin (STRN) using next-generation sequencing (NGS)–based circulating tumor DNA (ctDNA) analysis. The NGS of the patient’s originally paraffin-embedded surgical tumor samples also indicated the fusion. Reverse transcription–polymerase chain reaction and Sanger sequencing further confirmed the results. The STRN-ALK involves the fusion of exon 3 of STRN retaining a coiled-coil domain to exon 20 of ALK containing a kinase domain. The patient was treated with crizotinib and showed excellent clinical, radiographic, and molecular response. Repetitive dynamic ctDNA analysis revealed that the fraction of molecular alterations in plasma was closely associated with response to crizotinib treatment. This is the first clinical evidence involving advanced NSCLC due to a rare STRN-ALK fusion and has been effectively treated with crizotinib.
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Affiliation(s)
- Yan Yang
- Department of Medical Oncology, The First Affiliated Hospital of Bengbu Medical College, Bengbu, People's Republic of China
| | - Shu-Kui Qin
- Department of Medical Oncology, PLA Cancer Center, Nanjing Bayi Hospital, Nanjing, People's Republic of China
| | - Jian Zhu
- Department of Cardiovasology, The First Affiliated Hospital of Bengbu Medical College, Bengbu, People's Republic of China
| | - Rui Wang
- Department of Medical Oncology, The First Affiliated Hospital of Bengbu Medical College, Bengbu, People's Republic of China
| | - Yu-Mei Li
- Department of Medical Oncology, The First Affiliated Hospital of Bengbu Medical College, Bengbu, People's Republic of China
| | - Zong-Yu Xie
- Department of Radiology, The First Affiliated Hospital of Bengbu Medical College, Bengbu, People's Republic of China
| | - Qiong Wu
- Department of Medical Oncology, The First Affiliated Hospital of Bengbu Medical College, Bengbu, People's Republic of China
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21
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Affiliation(s)
| | - Daniel B Costa
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Peggy A Wu
- Department of Dermatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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22
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Ye Z, Shen N, Weng Y, Li K, Hu L, Liao H, An J, Liu L, Lao S, Cai S. Low miR-145 silenced by DNA methylation promotes NSCLC cell proliferation, migration and invasion by targeting mucin 1. Cancer Biol Ther 2015; 16:1071-9. [PMID: 25961369 DOI: 10.1080/15384047.2015.1046024] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
MiR-145 has been implicated in the progression of non-small cell lung cancer (NSCLC); however, its exact mechanism is not well established. Here, we report that miR-145 expression is decreased in NSCLC cell lines and tumor tissues and that this low level of expression is associated with DNA methylation. MiR-145 methylation in NSCLC was correlated with a more aggressive tumor phenotype and was associated with poor survival time, as shown by Kaplan-Meier analysis. Additional multivariate Cox regression analysis indicated that miR-145 methylation was an independent prognostic factor for poor survival in patients with NSCLC. Furthermore, we found that restoration of miR-145 expression inhibited proliferation, migration and invasion of NSCLC by the direct targeting of mucin 1 by miR-145. Our results indicate that low miR-145 expression, due to methylation, promotes NSCLC cell proliferation, migration and invasion by targeting mucin 1. Therefore, miR-145 may be a valuable therapeutic target for NSCLC.
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Affiliation(s)
- Zhiqiang Ye
- a Department of Emergency; Third Affiliated Hospital; Sun Yat-sen University ; Guangzhou , Guangdong , PR China
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