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Two phase I, pharmacokinetic, and pharmacodynamic studies of DFP-10917, a novel nucleoside analog with 14-day and 7-day continuous infusion schedules. Invest New Drugs 2018; 37:76-86. [PMID: 29667134 DOI: 10.1007/s10637-018-0602-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 04/05/2018] [Indexed: 10/17/2022]
Abstract
Purpose DFP-10917 is a novel deoxycytidine analog with a unique mechanism of action. Brief exposure to high concentrations of DFP-10917 inhibits DNA polymerase resulting in S-phase arrest, while prolonged exposure to DFP-10917 at low concentration causes DNA fragmentation, G2/M-phase arrest, and apoptosis. DFP-10917 demonstrated activity in tumor xenografts resistant to other deoxycytidine analogs. Experimental design Two phase I studies assessed the safety, pharmacokinetic, pharmacodynamic and preliminary efficacy of DFP-10917. Patients with refractory solid tumors received DFP-10917 continuous infusion 14-day on/7-day off and 7-day on/7-day off. Enrollment required age > 18 years, ECOG Performance Status 0-2 and adequate organ function. Results 29 patients were dosed in both studies. In 14-day infusion, dose-limiting toxicities (DLT) consisting of febrile neutropenia and thrombocytopenia occurred at 4.0 mg/m2/day. At 3.0 mg/m2/day, 3 patients experienced neutropenia in cycle 2. The dose of 2.0 mg/m2/day was well tolerated in 6 patients. In 7-day infusion, grade 4 neutropenia was DLT at 4.0 mg/m2/day. The maximum tolerated dose was 3 mg/m2/day. Other toxicities included nausea, vomiting, diarrhea, neutropenia, and alopecia. Eight patients had stable disease for >12 weeks. Paired comet assays performed for 7 patients showed an increase in DNA strand breaks at day 8. Pharmacokinetic data showed dose-proportionality for steady-state concentration and AUC of DFP-10917 and its primary metabolite. Conclusion Continuous infusion of DFP-10917 is feasible and well tolerated with myelosuppression as main DLT. The recommended doses are 2.0 mg/m2/day and 3.0 mg/m2/day on the 14-day and 7-day continuous infusion schedules, respectively. Preliminary activity was suggested. Pharmacodynamic data demonstrate biological activity at the tested doses.
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Parrà HS, Latteri F, Cavina R, Sala A, Dambrosio M, Alloisio M, Santoro A. Treatment Perspectives in Advanced Non-Small Cell Lung Cancer. TUMORI JOURNAL 2018. [DOI: 10.1177/03008916000865s109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Héctor Soto Parrà
- Department of Medical Oncology and Hematology, Istituto Clinico Humanitas, Rozzano (Mi)
| | - Fiorenza Latteri
- Department of Medical Oncology and Hematology, Istituto Clinico Humanitas, Rozzano (Mi)
| | - Raffaele Cavina
- Department of Medical Oncology and Hematology, Istituto Clinico Humanitas, Rozzano (Mi)
| | - Alfonso Sala
- Department of Medical Oncology and Hematology, Istituto Clinico Humanitas, Rozzano (Mi)
| | - Mario Dambrosio
- Department of Medical Oncology and Hematology, Istituto Clinico Humanitas, Rozzano (Mi)
| | - Marco Alloisio
- Department of Medical Oncology and Hematology, Istituto Clinico Humanitas, Rozzano (Mi)
| | - Armando Santoro
- Department of Medical Oncology and Hematology, Istituto Clinico Humanitas, Rozzano (Mi)
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Weart TC, Miller KD, Simone CB. Spotlight on dabrafenib/trametinib in the treatment of non-small-cell lung cancer: place in therapy. Cancer Manag Res 2018; 10:647-652. [PMID: 29662327 PMCID: PMC5892608 DOI: 10.2147/cmar.s142269] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Advanced non-small-cell lung cancer (NSCLC) remains a challenging disease. The limited utility of chemotherapy indicates the need for additional therapeutic options. Targeted therapy continues to be an important tool in the treatment of NSCLC. Mutations within the RAS–RAF–MEK–MAPK pathway, specifically the BRAF V600E mutation, have become an important target for the subset of NSCLC patients with this mutation. This paper summarizes the clinical evidence that lead to the recent approval of the combination of dabrafenib and trametinib to treat patients with advanced NSCLC who harbor a BRAF V600E mutation.
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Affiliation(s)
- Thomas C Weart
- Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland Medical Center, Baltimore, MD, USA
| | - Kenneth D Miller
- Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland Medical Center, Baltimore, MD, USA
| | - Charles B Simone
- Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland Medical Center, Baltimore, MD, USA
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Huang CY, Chen BH, Chou WC, Yang CT, Chang JWC. Factors associated with the prognosis and long-term survival of patients with metastatic lung adenocarcinoma: a retrospective analysis. J Thorac Dis 2018; 10:2070-2078. [PMID: 29850110 DOI: 10.21037/jtd.2018.03.143] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Outcome of patients with advanced non-small cell lung cancer (NSCLC) treated with platinum-based doublet chemotherapy is usually poor, with overall survival ranges from 8-13 months. However, the overall survival is improved to 21-28 months in the era of epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI). This study aimed to explore the prognostic factors to predict long-term survival in the era of EGFR TKI. Methods A total 1,030 patients were studied who had been diagnosed with metastatic adenocarcinoma of lung from January 2005 to December 2009 at Linkou Chang Gung Memorial Hospital. Long-term survivors (LTS) were defined as patients who survived five years or more after the initial diagnosis of stage IV disease. Data on patient age, gender, smoking status, performance status at diagnosis, TNM stage, metastatic pattern, number of metastases, and organs with tumor involvement, EGFR gene mutation status, types of treatment received, EGFR TKI treatment and longest EGFR TKI duration were retrospectively obtained from medical charts. We calculated the odds ratio (OR) of long-term survival from collected clinical parameters to predict long-term survival. Results In this large retrospective study, we reported a five-year survival of 5.0% among patients with metastatic adenocarcinoma of lung. A total 52 LTS and 978 non-LTS were identified. Patients had more contralateral or pleural/pericardial metastases in the LTS group than in the non-LTS group (51.9% vs. 19.0%, P<0.001), while less extrathoracic spread than in the non-LTS group (42.3% vs. 79.6%, P<0.001). The mutation of the EGFR gene was more frequent in the LTS group than in the non-LTS group (19.2% vs. 7.1%, P=0.006). Conclusions In conclusion, our results suggest that an age younger than 60 years, absence of extrathoracic spread and EGFR TKI treatment duration of more than one year play an important role in the long-term for survivors who survive for more than 5 years.
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Affiliation(s)
- Chen-Yang Huang
- Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou and Chang Gung University College of Medicine, Taoyuan
| | - Bo-Huan Chen
- Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan
| | - Wen-Chi Chou
- Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou and Chang Gung University College of Medicine, Taoyuan
| | - Cheng-Ta Yang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou and Chang Gung University College of Medicine, Taoyuan
| | - John Wen-Cheng Chang
- Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou and Chang Gung University College of Medicine, Taoyuan
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Rapid Homogeneous Immunoassay to Quantify Gemcitabine in Plasma for Therapeutic Drug Monitoring. Ther Drug Monit 2018; 39:235-242. [PMID: 28490046 DOI: 10.1097/ftd.0000000000000402] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Gemcitabine (2',2'-difluoro-2'-deoxycytidine) is a nucleoside analog used as a single agent and in combination regimens for the treatment of a variety of solid tumors. Several studies have shown a relationship between gemcitabine peak plasma concentration (Cmax) and hematological toxicity. An immunoassay for gemcitabine in plasma was developed and validated to facilitate therapeutic drug monitoring (TDM) by providing an economical, robust method for automated chemistry analyzers. METHODS A monoclonal antibody was coated on nanoparticles to develop a homogenous agglutination inhibition assay. To prevent ex vivo degradation of gemcitabine in blood, tetrahydrouridine was used as a sample stabilizer. Validation was conducted for precision, recovery, cross-reactivity, and linearity on a Beckman Coulter AU480. Verification was performed on an AU5800 in a hospital laboratory. A method comparison was performed with (LC-MS/MS) liquid chromatography tandem mass spectrometry using clinical samples. Selectivity was demonstrated by testing cross-reactivity of the major metabolite, 2',2'-difluorodeoxyuridine. RESULTS Coefficients of variation for repeatability and within-laboratory precision were <8%. The deviation between measured and assigned values was <3%. Linear range was from 0.40 to 33.02 μ/mL (1.5-125.5 μM). Correlation with validated LC-MS/MS methods was R = 0.977. The assay was specific for gemcitabine: there was no cross-reactivity to 2',2'-difluorodeoxyuridine, chemotherapeutics, concomitant, or common medications tested. Tetrahydrouridine was packaged in single-use syringes. Gemcitabine stability in whole blood was extended to 8 hours (at room temperature) and in plasma to 8 days (2-8°C). CONCLUSIONS The assay demonstrated the selectivity, test range, precision, and linearity to perform reliable measurements of gemcitabine in plasma. The addition of stabilizer improved the sample handling. Using general clinical chemistry analyzers, gemcitabine could be measured for TDM.
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Socinski MA, Obasaju C, Gandara D, Hirsch FR, Bonomi P, Bunn PA, Kim ES, Langer CJ, Natale RB, Novello S, Paz-Ares L, Pérol M, Reck M, Ramalingam SS, Reynolds CH, Spigel DR, Wakelee H, Thatcher N. Current and Emergent Therapy Options for Advanced Squamous Cell Lung Cancer. J Thorac Oncol 2018; 13:165-183. [DOI: 10.1016/j.jtho.2017.11.111] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 11/06/2017] [Accepted: 11/09/2017] [Indexed: 12/14/2022]
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Treatment with the nitric oxide synthase inhibitor L-NAME provides a survival advantage in a mouse model of Kras mutation-positive, non-small cell lung cancer. Oncotarget 2018; 7:42385-42392. [PMID: 27285753 PMCID: PMC5173142 DOI: 10.18632/oncotarget.9874] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 05/12/2016] [Indexed: 01/09/2023] Open
Abstract
Oncogenic mutations in the gene KRAS are commonly detected in non-small cell lung cancer (NSCLC). This disease is inherently difficult to treat, and combinations involving platinum-based drugs remain the therapeutic mainstay. In terms of novel, pharmacologically actionable targets, nitric oxide synthases (NOS) have been implicated in the etiology of KRAS-driven cancers, including lung cancer, and small molecular weight NOS inhibitors have been developed for the treatment of other diseases. Thus, we evaluated the anti-neoplastic activity of the oral NOS inhibitor L-NAME in a randomized preclinical trial using a genetically engineered mouse model of Kras and p53 mutation-positive NSCLC. We report here that L-NAME decreased lung tumor growth in vivo, as assessed by sequential radiological imaging, and provided a survival advantage, perhaps the most difficult clinical parameter to improve upon. Moreover, L-NAME enhanced the therapeutic benefit afforded by carboplatin chemotherapy, provided it was administered as maintenance therapy after carboplatin. Collectively, these results support the clinical evaluation of L-NAME for the treatment of KRAS mutation-positive NSCLC.
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Iizuka K, Zhang C, Eshima K, Jin C, Eshima K, Fukushima M. Analysis of the prolonged infusion of DFP-10917, a deoxycytidine analog, as a therapeutic strategy for the treatment of human tumor xenografts in vivo. Int J Oncol 2018; 52:851-860. [PMID: 29344636 DOI: 10.3892/ijo.2018.4246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 01/12/2018] [Indexed: 11/05/2022] Open
Abstract
2'-C-cyano-2'-deoxy-1-β-D-arabino-pentofranocyl-cytosine (DFP-10917, CNDAC) is a 2'-deoxycytidine analog with antitumor activity against various tumor cells. However, a clinically available therapeutic regimen for this compound needs to be established and its functional mechanisms in relation to the dosing schedule need to be clarified. In this study, we evaluated the antitumor activity and toxicity of DFP-10917 by varying the dose and administration schedule in human solid tumor and leukemia xenografts in vivo. Compared to a 1-day infusion with a high-dose of DFP-10917 (30 mg/kg/day), a prolonged 14-day infusion with a low-dose (4.5 mg/kg/day) exerted superior tumor growth inhibitory effects without decreasing the body weights of mice in our human tumor xenograft model. In addition, we found that a 14-day infusion of low-dose DFP-10917 markedly prolonged the lifespan of nude mice bearing both acute leukemia and ovarian cancer cell-derived tumors. On the other hand, gemcitabine (GEM) and cytosine arabinoside (Ara-C), which are similar deoxycytidine analogs and are widely used clinically as standard regimens, exerted less potent antitumor effects than DFP-10917 on these tumors. To elucidate the possible functional mechanisms of the prolonged infusion of DFP-10197 compared with that of GEM or Ara-C, the rate of DNA damage in CCRF-CEM and HeLa cells treated with DFP-10917, Ara-C and GEM was detected using a comet assay. DFP-10917, at a range of 0.05 to 1 µM, induced a clear tailed-DNA pattern in both the CCRF-CEM and HeLa cells; Ara-C and GEM did not have any effect. It was thus suggested that a low concentration and long-term exposure to DFP-10917 aggressively introduced the fragmentation of DNA molecules, namely the so-called double-strand breaks in tumor cells, leading to potent cytotoxicity. Moreover, treatment with DFP-10917 at a low-dose with a long-term exposure specifically increased the population of cells in the G2/M phase, while GEM reduced this cell population, suggesting a unique function (G2/M arrest) of DFP-10917. On the whole, our findings indicate that the prolonged infusion of low-dose DFP-10917 mainly displays a novel functional mechanism as a DNA-damaging drug and may thus prove to be useful in the treatment of cancer patients who are resistant to other cytosine nucleosides, or in patients in which these other nucleosides have been shown to be ineffective.
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Affiliation(s)
- Kenzo Iizuka
- Division of Oncology Research and Development, Delta-Fly Pharma Inc., Kawauchi-cho, Tokushima 771-0116, Japan
| | - Chun Zhang
- Division of Oncology Research and Development, Delta-Fly Pharma Inc., Kawauchi-cho, Tokushima 771-0116, Japan
| | - Kokoro Eshima
- Division of Oncology Research and Development, Delta-Fly Pharma Inc., Kawauchi-cho, Tokushima 771-0116, Japan
| | - Cheng Jin
- Division of Oncology Research and Development, Delta-Fly Pharma Inc., Kawauchi-cho, Tokushima 771-0116, Japan
| | - Kiyoshi Eshima
- Division of Oncology Research and Development, Delta-Fly Pharma Inc., Kawauchi-cho, Tokushima 771-0116, Japan
| | - Masakazu Fukushima
- Division of Oncology Research and Development, Delta-Fly Pharma Inc., Kawauchi-cho, Tokushima 771-0116, Japan
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Schuette W, Schneider CP, Engel-Riedel W, Schumann C, Kohlhaeufl M, Serke MHU, Hoeffken G, Kortsik C, Reck M. 65Plus: open-label study of bevacizumab in combination with pemetrexed or pemetrexed/carboplatin as first-line treatment of patients with advanced or recurrent nonsquamous non-small-cell lung cancer. LUNG CANCER-TARGETS AND THERAPY 2017; 8:217-229. [PMID: 29158696 PMCID: PMC5683796 DOI: 10.2147/lctt.s142972] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background The aim of the study was to investigate in terms of noninferiority the efficacy and safety of a monochemotherapy regimen of pemetrexed plus bevacizumab (BevPem) versus carboplatin/pemetrexed plus bevacizumab (BevCPem) in elderly patients as first-line treatment for advanced metastatic or recurrent nonsquamous non-small-cell lung cancer (NSCLC). Materials and methods 65Plus was a Phase III, randomized, open-label study. In total, 253 patients received BevPem (n=119) or BevCPem (n=134). The primary outcome measure was progression-free survival. Secondary end points were overall survival, tumor response, and safety outcomes. Evaluations were performed for the whole study population and stratified according to Eastern Cooperative Oncology Group (ECOG) performance status (PS). Results Noninferiority of BevPem in comparison to BevCPem could not be demonstrated for the overall population (P=0.7864). Significant superiority of the combined treatment BevCPem was seen in patients of ECOG PS 0-1 (median PFS 5.1 vs 6.9 months, HR 1.353, 95% CI 1.03-1.777), while the opposite tendency was observed in patients with ECOG PS 2 (median PFS 2.9 vs 1.5 months, HR 0.628, 95% CI 0.195-2.025). Overall, better tolerability was found for the BevPem group, irrespective of ECOG PS. Conclusion Results from the 65plus study give evidence that BevPem and BevCPem treatments may exert differential effects on PFS, depending on the patients ECOG PS. It appears that patients with better ECOG PS (0-1) benefited more from the combined treatment with carboplatin, while the group comprising more severely impaired patients (ECOG PS 2) benefited more from the monochemotherapy.
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Affiliation(s)
- Wolfgang Schuette
- Department of Internal Medicine II, Hospital Martha-Maria Halle-Doelau, Halle
| | - Claus-Peter Schneider
- Department of Pneumonology, Central Hospital, Bad Berka.,Department of Internal Medicine, DRK Manniske Hospital, Bad Frankenhausen
| | | | - Christian Schumann
- Pneumonology, Department of Internal Medicine II, University Hospital Ulm.,Clinic for Pneumology, Thoracic Oncology, Sleep, and Respiratory Critical Care, Kempten-Oberallgäu
| | - Martin Kohlhaeufl
- Center of Pneumonology and Chest Surgery, Hospital Schillerhoehe, Gerlingen
| | | | - Gert Hoeffken
- Center of Pneumonology, Chest and Vascular Surgery, Specialty Hospital Coswig, Coswig
| | | | - Martin Reck
- Department of Thoracic Oncology, Lung Clinic, Grosshansdorf, Germany
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Dhande R, Tyagi A, Sharma RK, Thakkar H. Biodistribution study of 99mTc-gemcitabine-loaded spherulites in Sprague-Dawley rats by gamma scintigraphy to investigate its lung targeting potential. J Microencapsul 2017; 34:623-634. [PMID: 28845737 DOI: 10.1080/02652048.2017.1373156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Gemcitabine hydrochloride (GCH) is drug of choice for treatment of non-small cell lung cancer. This project aims to formulate GCH-loaded spherulites for lung targeting using soyabean phosphatidylcholine, cholesterol (Chol) and 1,2-distearoyl-sn-glycero-3-phosphoethanolamine-N-[amino(polyethylene glycol)-2000]. Vesicles were characterised for size, entrapment efficiency, drug release and in vitro cytotoxicity. Radiolabelling of GCH was done using reduced technetium-99 m to study biodistribution in Sprague-Dawley rats. Discrete and spherical, PEGylated and non-PEGylated spherulites with an average size of 200 nm as seen in transmission electron microscopy had an entrapment efficiency of 76.28% and 77.42%, respectively. PEGylated spherulites showed sustained release followed by non-PEGylated and plain drug. GCH spherulites exhibited significantly higher cytotoxicity and apoptosis at reduced concentration than GCH solution. The radiolabelled complex showed high binding and radiolabelling efficiency. Gamma scintigraphy showed that GCH-loaded PEGylated spherulites were able to localise within lungs in higher concentration than non-PEGylated followed by plain drug.
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Affiliation(s)
- Rahul Dhande
- a Shri G.H. Patel Pharmacy Building, Centre for Postgraduate Studies in Pharmacy, TIFAC Core in NDDS , Vadodara , India
| | - Amit Tyagi
- b Institute of Nuclear Medicine and Allied Sciences , Delhi , India
| | | | - Hetal Thakkar
- a Shri G.H. Patel Pharmacy Building, Centre for Postgraduate Studies in Pharmacy, TIFAC Core in NDDS , Vadodara , India
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Battisti NML, Sehovic M, Extermann M. Assessment of the External Validity of the National Comprehensive Cancer Network and European Society for Medical Oncology Guidelines for Non–Small-Cell Lung Cancer in a Population of Patients Aged 80 Years and Older. Clin Lung Cancer 2017; 18:460-471. [DOI: 10.1016/j.cllc.2017.03.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Revised: 03/04/2017] [Accepted: 03/06/2017] [Indexed: 12/25/2022]
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Aguiar PN, De Mello RA, Barreto CMN, Perry LA, Penny-Dimri J, Tadokoro H, Lopes GDL. Immune checkpoint inhibitors for advanced non-small cell lung cancer: emerging sequencing for new treatment targets. ESMO Open 2017; 2:e000200. [PMID: 29209522 PMCID: PMC5703392 DOI: 10.1136/esmoopen-2017-000200] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 06/08/2017] [Accepted: 06/09/2017] [Indexed: 12/20/2022] Open
Abstract
Lung cancer is the leading cause of cancer-related deaths in the world. Immune checkpoint inhibitors (ICI) stimulate cytotoxic lymphocyte activity against tumour cells. These agents are available for the treatment of non-small cell lung cancer (NSCLC) after failure of platinum-based therapy. One recent study has demonstrated that ICI monotherapy was superior to platinum-based chemotherapy for first-line treatment. Nevertheless, this benefit was only for a minority of the population (30%) whose tumour programmed death receptor ligand-1 (PD-L1) expression was above 50%. Therefore, several strategies are under investigation. One option for patients with PD-L1 expression lower than 50% may be the combination of ICI with platinum-based chemotherapy or with ICIs against different targets. However, all of these combinations are at an early stage of investigation and may be very expensive or toxic, producing several harmful adverse events.
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Affiliation(s)
| | - Ramon Andrade De Mello
- Department of Biomedical Sciences and Medicine, Division of Medical Oncology, University of Algarve, Faro, Portugal
| | | | | | | | - Hakaru Tadokoro
- Division of Medical Oncology, Federal University of São Paulo, São Paulo, Brazil
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A methoxyflavanone derivative from the Asian medicinal herb (Perilla frutescens) induces p53-mediated G 2/M cell cycle arrest and apoptosis in A549 human lung adenocarcinoma. Cytotechnology 2017; 70:899-912. [PMID: 28710570 DOI: 10.1007/s10616-017-0116-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 06/15/2017] [Indexed: 12/20/2022] Open
Abstract
Perilla frutescens is an Asian dietary herb consumed as an essential seasoning in Japanese cuisine as well as used for a Chinese medicine. Here, we report that a newly found methoxyflavanone derivative from P. frutescens (Perilla-derived methoxyflavanone, PDMF; 8-hydroxy-5,7-dimethoxyflavanone) shows carcinostatic activity on human lung adenocarcinoma, A549. We found that treatment with PDMF significantly inhibited cell proliferation and decreased viability through induction of G2/M cell cycle arrest and apoptosis. The PDMF stimulation induces phosphorylation of tumor suppressor p53 on Ser15, and increases its protein amount in conjunction with up-regulation of downstream cyclin-dependent kinase inhibitor p21Cip1/Waf1 and proapoptotic caspases, caspase-9 and caspase-3. We also found that small interfering RNA knockdown of p53 completely abolished the PDMF-induced G2/M cell cycle arrest, and substantially abrogated its proapoptotic potency. These results suggest that PDMF represents a useful tumor-preventive phytochemical that triggers p53-driven G2/M cell cycle arrest and apoptosis.
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Lakdawalla DN, Shafrin J, Hou N, Peneva D, Vine S, Park J, Zhang J, Brookmeyer R, Figlin RA. Predicting Real-World Effectiveness of Cancer Therapies Using Overall Survival and Progression-Free Survival from Clinical Trials: Empirical Evidence for the ASCO Value Framework. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2017; 20:866-875. [PMID: 28712615 DOI: 10.1016/j.jval.2017.04.003] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 03/23/2017] [Accepted: 04/09/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To measure the relationship between randomized controlled trial (RCT) efficacy and real-world effectiveness for oncology treatments as well as how this relationship varies depending on an RCT's use of surrogate versus overall survival (OS) endpoints. METHODS We abstracted treatment efficacy measures from 21 phase III RCTs reporting OS and either progression-free survival or time to progression endpoints in breast, colorectal, lung, ovarian, and pancreatic cancers. For these treatments, we estimated real-world OS as the mortality hazard ratio (RW MHR) among patients meeting RCT inclusion criteria in Surveillance and Epidemiology End Results-Medicare data. The primary outcome variable was real-world OS observed in the Surveillance and Epidemiology End Results-Medicare data. We used a Cox proportional hazard regression model to calibrate the differences between RW MHR and the hazard ratios on the basis of RCTs using either OS (RCT MHR) or progression-free survival/time to progression surrogate (RCT surrogate hazard ratio [SHR]) endpoints. RESULTS Treatment arm therapies reduced mortality in RCTs relative to controls (average RCT MHR = 0.85; range 0.56-1.10) and lowered progression (average RCT SHR = 0.73; range 0.43-1.03). Among real-world patients who used either the treatment or the control arm regimens evaluated in the relevant RCT, RW MHRs were 0.6% (95% confidence interval -3.5% to 4.8%) higher than RCT MHRs, and RW MHRs were 15.7% (95% confidence interval 11.0% to 20.5%) higher than RCT SHRs. CONCLUSIONS Real-world OS treatment benefits were similar to those observed in RCTs based on OS endpoints, but were 16% less than RCT efficacy estimates based on surrogate endpoints. These results, however, varied by tumor and line of therapy.
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Affiliation(s)
- Darius N Lakdawalla
- Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, USA.
| | | | - Ningqi Hou
- Precision Health Economics, Los Angeles, CA, USA
| | - Desi Peneva
- Precision Health Economics, Los Angeles, CA, USA
| | - Seanna Vine
- Precision Health Economics, Los Angeles, CA, USA
| | - Jinhee Park
- Novartis Pharmaceuticals, East Hanover, NJ, USA
| | - Jie Zhang
- Novartis Pharmaceuticals, East Hanover, NJ, USA
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Abstract
Progression-free survival (PFS) and overall survival (OS) are two common endpoints in cancer trials. OS is usually preferred, because it is reliable, precise, meaningful, and can easily be documented. However, subsequent lines of therapy might confound the effects of first-line treatment on OS. Whether PFS or OS is the more appropriate endpoint in clinical trials of metastatic cancer remains controversial. Previous reports on lung cancer have shown that an increase in PFS does not necessarily result in an increase in OS; however, post-progression survival (PPS) is strongly associated with OS after early-line treatment. The significance of PPS after first and second-line therapy at the individual level in patients with advanced lung cancer has also recently been reported. Findings of previous reports indicate that PPS is highly associated with OS after first and second-line chemotherapy in patients with advanced non-small cell lung cancer and small cell lung cancer, whereas PFS is only moderately associated with OS. Therefore, subsequent treatment after disease progression following early-line treatments may greatly influence OS. This review demonstrates that even in advanced lung cancer, PPS, rather than PFS, has become more strongly associated with OS over the years, potentially because of intensive post-study treatments. As a result of the increasing impact of PPS on OS, a PFS-related advantage does not necessarily indicate an OS-related advantage. Thus, the prolongation of PPS might limit the classical role of OS for assessing true efficacy derived from early-line chemotherapy in future clinical trials.
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Affiliation(s)
- Hisao Imai
- Division of Respiratory Medicine, Gunma Prefectural Cancer Center, Ota, Japan
| | - Kyoichi Kaira
- Department of Oncology Clinical Development, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Koichi Minato
- Division of Respiratory Medicine, Gunma Prefectural Cancer Center, Ota, Japan
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66
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Mannargudi MB, Deb S. Clinical pharmacology and clinical trials of ribonucleotide reductase inhibitors: is it a viable cancer therapy? J Cancer Res Clin Oncol 2017. [PMID: 28624910 DOI: 10.1007/s00432-017-2457-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE Ribonucleotide reductase (RR) enzymes (RR1 and RR2) play an important role in the reduction of ribonucleotides to deoxyribonucleotides which is involved in DNA replication and repair. Augmented RR activity has been ascribed to uncontrolled cell growth and tumorigenic transformation. METHODS This review mainly focuses on several biological and chemical RR inhibitors (e.g., siRNA, GTI-2040, GTI-2501, triapine, gemcitabine, and clofarabine) that have been evaluated in clinical trials with promising anticancer activity from 1960's till 2016. A summary on whether their monotherapy or combination is still effective for further use is discussed. RESULTS Among the RR2 inhibitors evaluated, GTI-2040, siRNA, gallium nitrate and didox were more efficacious as a monotherapy, whereas triapine was found to be more efficacious as combination agent. Hydroxyurea is currently used more in combination therapy, even though it is efficacious as a monotherapy. Gallium nitrate showed mixed results in combination therapy, while the combination activity of didox is yet to be evaluated. RR1 inhibitors that have long been used in chemotherapy such as gemcitabine, cladribine, fludarabine and clofarabine are currently used mostly as a combination therapy, but are equally efficacious as a monotherapy, except tezacitabine which did not progress beyond phase I trials. CONCLUSIONS Based on the results of clinical trials, we conclude that RR inhibitors are viable treatment options, either as a monotherapy or as a combination in cancer chemotherapy. With the recent advances made in cancer biology, further development of RR inhibitors with improved efficacy and reduced toxicity is possible for treatment of variety of cancers.
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Affiliation(s)
- Mukundan Baskar Mannargudi
- Clinical Pharmacology Program, Medical Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, 20892, USA
| | - Subrata Deb
- Department of Biopharmaceutical Sciences, Roosevelt University College of Pharmacy, 1400 N. Roosevelt Blvd., Schaumburg, IL, 60173, USA.
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67
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Moraes FY, Perry LA, Penny-Dimri JC, Ramson D, de Castria TB, Bowman RV, Santos FN, Fong KM, Riera R. Immune checkpoint inhibitors (anti PD-1 or anti PD-L1) versus chemotherapy for second- or third-line treatment of metastatic non-small cell lung cancer. Hippokratia 2017. [DOI: 10.1002/14651858.cd012644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Fabio Y Moraes
- Hospital Sirio Libanes; Department of Radiation Oncology; Rua Dona Adma Jafet, 91 Bela Vista Sao Paulo, SP Brazil 01308-050
- Princess Margaret Cancer Centre; Radiation Medical Program; 610 University Avenue Toronto ON Canada M5G 2M9
| | | | | | | | - Tiago B de Castria
- Instituto do Câncer do Estado de São Paulo (ICESP/FMUSP); Clinical Oncology; Av. Doutor Arnaldo 251 - Cerqueira César São Paulo Brazil 01246-000
| | - Rayleen V Bowman
- The Prince Charles Hospital; Department of Thoracic Medicine; Brisbane Queensland Australia 4072
| | - Fábio N Santos
- AC Camargo Cancer Center; Medical Oncology; Rua Prof. Antonio Prudente, 211 São Paulo São Paulo Brazil 01509-900
| | - Kwun M Fong
- The Prince Charles Hospital; Department of Thoracic Medicine; Brisbane Queensland Australia 4072
| | - Rachel Riera
- Centro de Estudos de Saúde Baseada em Evidências e Avaliação Tecnológica em Saúde; Cochrane Brazil; Rua Borges Lagoa, 564 cj 63 São Paulo SP Brazil 04038-000
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68
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Aggarwal C, Borghaei H. Treatment Paradigms for Advanced Non-Small Cell Lung Cancer at Academic Medical Centers: Involvement in Clinical Trial Endpoint Design. Oncologist 2017; 22:700-708. [PMID: 28408617 PMCID: PMC5469580 DOI: 10.1634/theoncologist.2016-0345] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 01/03/2017] [Indexed: 12/25/2022] Open
Abstract
Selection of appropriate clinical endpoints for examining the efficacy of investigational agents for non‐small cell lung cancer is of vital importance in clinical trial design. This review provides an overview of the study designs of clinical trials for approved agents in non‐small cell lung cancer and focuses on the validity of alternative endpoints for such trials. Based on the positive results of various clinical trials, treatment options for non‐small cell lung cancer (NSCLC) have expanded greatly over the last 25 years. While regulatory approvals of chemotherapeutic agents for NSCLC have largely been based on improvements in overall survival, recent approvals of many targeted agents for NSCLC (afatinib, crizotinib, ceritinib, osimertinib) have been based on surrogate endpoints such as progression‐free survival and objective response. As such, selection of appropriate clinical endpoints for examining the efficacy of investigational agents for NSCLC is of vital importance in clinical trial design. This review provides an overview of clinical trial endpoints previously utilized for approved agents for NSCLC and highlights the key efficacy results for these trials. Trends for more recent approvals in NSCLC, including those for the immunotherapeutic agents nivolumab and pembrolizumab, are also discussed. The results of a correlative analysis of endpoints from 18 clinical trials that supported approvals of investigational agents in clinical trials for NSCLC are also presented. Implications for Practice. While improving survival remains the ultimate goal of oncology clinical trials, overall survival may not always be the most feasible or appropriate endpoint to assess patient response. Recently, several investigational agents, both targeted agents and immunotherapies, have gained U.S. Food and Drug Administration approval in non‐small cell lung cancer based on alternate endpoints such as progression‐free survival or response rate. An understanding of the assessment of response and trial endpoint choice is important for future oncology clinical trial design.
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Affiliation(s)
- Charu Aggarwal
- Division of Hematology/Oncology, Abramson Cancer Center, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Hossein Borghaei
- Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
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69
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Lu CL, Lin HI, Chen BF, Jow GM. Beauvericin-induced cell apoptosis through the mitogen-activated protein kinase pathway in human nonsmall cell lung cancer A549 cells. J Toxicol Sci 2017; 41:429-37. [PMID: 27193734 DOI: 10.2131/jts.41.429] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Beauvericin (BEA) is a cyclic hexadepsipeptide that derives from Codyceps cicadae. Our previous study results indicated that the cytotoxic effects of BEA on human A549 lung cancer cells BEA occur through an apoptotic pathway, which involves the up-regulation of cytochrome c release from mitochondria, upregulation of caspase 3 activity, and cellular and morphological changes. In this study, we identified that the mitogen-activated protein kinase (MAPK) inhibitor U0126 inhibits the cytotoxic effects of BEA on A549 cells. After exposing human A549 cells to 10 μM BEA, we observed a significant and dose-dependent increase in the percentage of hypoploid (sub-G1) phase cells in the A549 population. Following the pretreatment of the A549 cells with 25 μM U0126, the distribution of A549 cells in the sub-G1 phase decreased significantly. The BEA treatment resulted in a significant increase apoptosis in A549 cells by in situ terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) assay. Moreover, the MEK1/2 (mitogen-activated protein kinase kinase)-ERK42/44 (extracellular signal-regulated kinases)-90RSK (ribosomal s6 kinase) signaling pathway was activated in BEA-induced apoptotic A549 cells. Furthermore, treatment with MEK1/2 inhibitor U0126 was capable to attenuate the BEA induced typical apoptotic morphological change, apoptotic cells, and MEK1/2-ERK42/44-90RSK signaling pathway. These results suggested that MEK1/2-ERK42/44-90RSK signaling pathway may play a important role in BEA-induced apoptosis in human NSCLC A549 cancer cells.
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Affiliation(s)
- Chien-Lin Lu
- School of Medicine, Fu Jen Catholic University, Taiwan
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70
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Ruiz-Ceja KA, Chirino YI. Current FDA-approved treatments for non-small cell lung cancer and potential biomarkers for its detection. Biomed Pharmacother 2017; 90:24-37. [PMID: 28340378 DOI: 10.1016/j.biopha.2017.03.018] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 02/21/2017] [Accepted: 03/07/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Lung cancer is the leading worldwide cancer with almost 1.5 million deaths every year. Some drugs for lung cancer treatment have been available on the market for decades, but novel drugs have emerged promising better outcomes, especially for Non-Small Cell Lung Cancer (NSCLC), which represents 75% of lung cancer cases. However, how much do drugs have evolved for NSCLC treatment? Are they sharing the same mechanism of action? AIM In this review we analyzed how the approved drugs by Federal Drug Agency for NSCLC have advanced in the last four decades identifying shared mechanism of action of medicines against NSCLC treatment and some of the potential biomarkers for early detection. RESULTS Cisplatin and its derivatives are still the most used therapy in combination with some other more specific drugs. However, increasing the survival rates seems to be a great challenge and research is moving into early detection through biomarkers but also trying to identify molecules such as those derived from the immune system, cell-free DNA, non-coding RNAs, but also polymorphisms to detect early tumor formation. CONCLUSIONS Cisplatin and derivatives have been one of the most successful therapies in spite of their side effects and low specificity. Some of the drugs developed after cisplatin discovery, have been targeted the epidermal growth factor receptor, anaplastic lymphoma kinase, programmed cell death 1 ligand and vascular endothelial growth factor. Since none of the pharmacological treatments in combination with radiation/surgery have extended dramatically the survival rate, research is now focused in early cancer detection in combination with precision medicine, which attempts to treat patients individually according to their stage and tumor characteristics.
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Affiliation(s)
- Karla A Ruiz-Ceja
- Licenciatura en Biología, Facultad de Estudios Superiores Iztacala, Universidad Nacional Autónoma de México, CP 54059, Estado de México, Mexico
| | - Yolanda I Chirino
- Laboratorio de Carcinogénesis y Toxicología, Unidad de Biomedicina, Facultad de Estudios Superiores Iztacala, Universidad Nacional Autónoma de México, CP 54059, Estado de México, Mexico.
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71
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Mehta HJ, Jantz MA. Endobronchial Ultrasound-guided Intratumoral Injection of Cisplatin for the Treatment of Isolated Mediastinal Recurrence of Lung Cancer. J Vis Exp 2017. [PMID: 28287519 DOI: 10.3791/54855] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Isolated hilar and mediastinal recurrence (IMHR) following external beam radiation therapy (EBRT) in patients with lung cancer is common. These patients do not have many treatment options and are usually offered palliative chemotherapy or best supportive care. Endobronchial ultrasound (EBUS)-guided intratumoral injection of cisplatin (ITC) is a novel approach for these patients. The procedure is performed under conscious sedation. The lesion is located with a bronchoscopy using EBUS, and a 22-gauge EBUS needle is advanced through the working channel of the scope and locked in position. Under ultrasound guidance, the wall of the tracheobronchial tree is punctured and the needle is moved into the target lesion. The needle stylet is then removed and cisplatin (40 mg/40 mL) is injected into the lesion. One to two sites are treated per session. Details of the procedure are described in the protocol section of paper. At our center, 50 sites were treated in 36 patients (19 males, 17 females). The mean age of our cohort was 61.9 ±8.5 years. We performed final analyses on 35 patients and 41 sites. 24/35 (69%) had complete or partial response (responders), whereas 11/35 (31%) had stable or progressive disease (non-responders). Overall, survival in our group was 8 months (95% CI of 6-11 months), with patients who responded having significantly better survival than the ones who did not.
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Affiliation(s)
- Hiren J Mehta
- Division of Pulmonary/Critical care/Sleep Medicine, University of Florida College of Medicine;
| | - Michael A Jantz
- Division of Pulmonary/Critical care/Sleep Medicine, University of Florida College of Medicine
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72
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Kotzabasaki M, Galdadas I, Tylianakis E, Klontzas E, Cournia Z, Froudakis GE. Multiscale simulations reveal IRMOF-74-III as a potent drug carrier for gemcitabine delivery. J Mater Chem B 2017; 5:3277-3282. [DOI: 10.1039/c7tb00220c] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Kotzabasaki et al. use a multiscale computational approach to investigate the microscopic behaviour of gemcitabine stored in (OH)-IRMOF-74-III. The principles can be exploited for nano-carrier screening purposes prior to experimental investigation.
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Affiliation(s)
| | - Ioannis Galdadas
- Biomedical Research Foundation Academy of Athens
- 115 27 Athens
- Greece
| | - Emmanuel Tylianakis
- Materials Science and Technology Department
- University of Crete
- Heraklion
- Greece
| | | | - Zoe Cournia
- Biomedical Research Foundation Academy of Athens
- 115 27 Athens
- Greece
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73
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Kanigel Winner KR, Costello JC. A SPATIOTEMPORAL MODEL TO SIMULATE CHEMOTHERAPY REGIMENS FOR HETEROGENEOUS BLADDER CANCER METASTASES TO THE LUNG. PACIFIC SYMPOSIUM ON BIOCOMPUTING. PACIFIC SYMPOSIUM ON BIOCOMPUTING 2017; 22:611-622. [PMID: 27897011 PMCID: PMC5154750 DOI: 10.1142/9789813207813_0056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Tumors are composed of heterogeneous populations of cells. Somatic genetic aberrations are one form of heterogeneity that allows clonal cells to adapt to chemotherapeutic stress, thus providing a path for resistance to arise. In silico modeling of tumors provides a platform for rapid, quantitative experiments to inexpensively study how compositional heterogeneity contributes to drug resistance. Accordingly, we have built a spatiotemporal model of a lung metastasis originating from a primary bladder tumor, incorporating in vivo drug concentrations of first-line chemotherapy, resistance data from bladder cancer cell lines, vascular density of lung metastases, and gains in resistance in cells that survive chemotherapy. In metastatic bladder cancer, a first-line drug regimen includes six cycles of gemcitabine plus cisplatin (GC) delivered simultaneously on day 1, and gemcitabine on day 8 in each 21-day cycle. The interaction between gemcitabine and cisplatin has been shown to be synergistic in vitro, and results in better outcomes in patients. Our model shows that during simulated treatment with this regimen, GC synergy does begin to kill cells that are more resistant to cisplatin, but repopulation by resistant cells occurs. Post-regimen populations are mixtures of the original, seeded resistant clones, and/or new clones that have gained resistance to cisplatin, gemcitabine, or both drugs. The emergence of a tumor with increased resistance is qualitatively consistent with the five-year survival of 6.8% for patients with metastatic transitional cell carcinoma of the urinary bladder treated with a GC regimen. The model can be further used to explore the parameter space for clinically relevant variables, including the timing of drug delivery to optimize cell death, and patient-specific data such as vascular density, rates of resistance gain, disease progression, and molecular profiles, and can be expanded for data on toxicity. The model is specific to bladder cancer, which has not previously been modeled in this context, but can be adapted to represent other cancers.
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Affiliation(s)
- Kimberly R Kanigel Winner
- Computational Bioscience Program, University of Colorado Anschutz Medical Campus 12801 E. 17th Ave. MailStop 8303, Aurora, CO 80045, USA2Department of Pharmacology, University of Colorado Anschutz Medical Campus 12801 E. 17th Ave. MailStop 8303, Aurora, CO 80045, USA,
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74
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Wang T, Liu Y, Zhou B, Hao S, Wang Z, Liang N, Liu J, Wang S. Retrospective analysis of icotinib neoadjuvant therapy of 63 lung cancer patients. Indian J Cancer 2017; 54:215-222. [DOI: 10.4103/0019-509x.219585] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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75
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Incremental Innovation and Progress in Advanced Squamous Cell Lung Cancer: Current Status and Future Impact of Treatment. J Thorac Oncol 2016; 11:2066-2081. [DOI: 10.1016/j.jtho.2016.08.138] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 08/09/2016] [Accepted: 08/19/2016] [Indexed: 11/20/2022]
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76
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Wang F, Wang Y, Ma Q, Cao Y, Yu B. Development and characterization of folic acid-conjugated chitosan nanoparticles for targeted and controlled delivery of gemcitabinein lung cancer therapeutics. ARTIFICIAL CELLS NANOMEDICINE AND BIOTECHNOLOGY 2016; 45:1530-1538. [PMID: 27894196 DOI: 10.1080/21691401.2016.1260578] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The present study was designed to investigate the tumor-targeting potential of gemcitabine (GEM)-loaded surface-tailored chitosan (CS)/poly (ethylene glycol) nanoparticles (FA-PEG-GEM-NPs). The nanoparticles encapsulated with GEM were prepared, characterized, and tethered with folic acid. The developed formulations were characterized with respect to particle size/poly-dispersity index, shape, and zeta potential analysis. The in vitro study shows the sustained drug-release kinetics during 48 h. The present result shows remarkable cytotoxicity rendered by GEM when delivered through FA-PEG-GEM-NPs formulation. The microscopic assessment is suggestive of significant uptake of FA-PEG-GEM-NPs in comparison with the unmodified PEG-GEM-NPs and free drug. Finally, our results advocate for the sizeable compatibility, comparatively less organ toxicity, and higher anti-tumor activity of ligand-anchored and PEGylated CS nanoparticles in vitro and corroborated by in vivo investigations. In conclusion, it is interpreted that surface-tailored nanoparticles are capable to ferry bioactives selectively and specifically to tumor sites with the interception of minimal side effects, thereby suggesting their potential application in cancer therapeutics.
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Affiliation(s)
- Fengqiang Wang
- a Department of Respiratory Medicine , Liaocheng People's Hospital , Liaocheng , China
| | - Yan Wang
- a Department of Respiratory Medicine , Liaocheng People's Hospital , Liaocheng , China
| | - Qingzhu Ma
- b Department of Gastroenterology , Liaocheng People's Hospital , Liaocheng , China
| | - Yuan Cao
- a Department of Respiratory Medicine , Liaocheng People's Hospital , Liaocheng , China
| | - Bo Yu
- a Department of Respiratory Medicine , Liaocheng People's Hospital , Liaocheng , China
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77
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Poon C, Duan X, Chan C, Han W, Lin W. Nanoscale Coordination Polymers Codeliver Carboplatin and Gemcitabine for Highly Effective Treatment of Platinum-Resistant Ovarian Cancer. Mol Pharm 2016; 13:3665-3675. [PMID: 27712076 PMCID: PMC5673481 DOI: 10.1021/acs.molpharmaceut.6b00466] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Due to the ability of ovarian cancer (OCa) to acquire drug resistance, it has been difficult to develop efficient and safe chemotherapy for OCa. Here, we examined the therapeutic use of a new self-assembled core-shell nanoscale coordination polymer nanoparticle (NCP-Carbo/GMP) that delivers high loadings of carboplatin (28.0 ± 2.6 wt %) and gemcitabine monophosphate (8.6 ± 1.5 wt %). A strong synergistic effect was observed between carboplatin and gemcitabine against platinum-resistant OCa cells, SKOV-3 and A2780/CDPP, in vitro. The coadministration of carboplatin and gemcitabine in the NCP led to prolonged blood circulation half-life (11.8 ± 4.8 h) and improved tumor uptake of the drugs (10.2 ± 4.4% ID/g at 24 h), resulting in 71% regression and 80% growth inhibition of SKOV-3 and A2780/CDDP tumors, respectively. Our findings demonstrate that NCP particles provide great potential for the codelivery of multiple chemotherapeutics for treating drug-resistant cancer.
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Affiliation(s)
| | | | - Christina Chan
- Department of Chemistry, University of Chicago, 929 East 57th Street, Chicago, Illinois 60637, United States
| | - Wenbo Han
- Department of Chemistry, University of Chicago, 929 East 57th Street, Chicago, Illinois 60637, United States
| | - Wenbin Lin
- Department of Chemistry, University of Chicago, 929 East 57th Street, Chicago, Illinois 60637, United States
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78
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Kohutek F, Stratena M, Rosik A, Tamasova M, Bystricky B. First-line treatment of nonsquamous NSCLC using gemcitabine: a retrospective study of real-life practice. Lung Cancer Manag 2016; 5:123-130. [PMID: 30643556 DOI: 10.2217/lmt-2016-0011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 10/10/2016] [Indexed: 11/21/2022] Open
Abstract
We present results of retrospective real-life data of nonsquamous lung cancer patients treated in first-line (platinum-based chemotherapy with gemcitabine without bevacizumab). 56 patients with satisfactory performance status for cytotoxic chemotherapy were treated in 2010-2014. Median progression-free survival was 6.48 months (95% CI: 4.44-9.48), time to progression was 10.19 months (95% CI: 7.59-12.19). Median overall survival was 10.8 months (95% CI: 6.72-14.52). Although our group of patients had higher proportion of elderly patients with somewhat limited performance status, progression-free survival rate was comparable to large registration studies. Overall survival, despite intervening comorbidities and subsequent limited use of second-line treatment was analogous to large gemcitabine/platinum Phase III studies in nonsquamous population. We believe our data represent real-life survival rates of unselected patients with advanced NSCLC of nonsquamous type from mostly rural catchment area.
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Affiliation(s)
- Filip Kohutek
- Oncology Department, Faculty Hospital Trencin, Trencin, Slovakia.,Oncology Department, Faculty Hospital Trencin, Trencin, Slovakia
| | - Miroslava Stratena
- Oncology Department, Faculty Hospital Trencin, Trencin, Slovakia.,Oncology Department, Faculty Hospital Trencin, Trencin, Slovakia
| | - Andrej Rosik
- Oncology Department, Faculty Hospital Trencin, Trencin, Slovakia.,Oncology Department, Faculty Hospital Trencin, Trencin, Slovakia
| | - Maria Tamasova
- Department of Pneumology & Phtiseology, University Hospital Bratislava-Ruzinov, Comenius University, Bratislava, Slovakia.,Department of Pneumology & Phtiseology, University Hospital Bratislava-Ruzinov, Comenius University, Bratislava, Slovakia
| | - Branislav Bystricky
- Oncology Department, Faculty Hospital Trencin, Trencin, Slovakia.,Oncology Department, Faculty Hospital Trencin, Trencin, Slovakia
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79
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Ernani V, Steuer CE, Jahanzeb M. The End of Nihilism: Systemic Therapy of Advanced Non-Small Cell Lung Cancer. Annu Rev Med 2016; 68:153-168. [PMID: 27618751 DOI: 10.1146/annurev-med-042915-102442] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Lung cancer is the leading cause of cancer death in the United States and many other parts of the world. Non-small cell lung cancer (NSCLC) comprises 85-90% of lung cancers. Historically, the expected survival of patients with advanced disease has been estimated in months. In recent years, however, lung cancer has come to be seen as a treatable disease with multiple therapeutic options. Enormous advances in the understanding of its pathways and mechanisms have enabled personalized therapy in NSCLC. The evolving approach to therapy focuses on genomic profiling of the tumors to find molecular targets and develop specific agents for individualized therapy. In addition, maintenance therapy has emerged as a valid approach, and the choice of chemotherapy now varies by histology. Most recently, immunotherapy with checkpoint inhibitors has shown promising results, with impressive durations of response and a tolerable toxicity profile. Together, these discoveries have improved overall survival substantially in patient populations that have access to these advancements. We review the clinical data surrounding these impressive improvements.
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Affiliation(s)
- Vinicius Ernani
- Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, Nebraska 68198
| | - Conor E Steuer
- Winship Cancer Institute, Emory University, Atlanta, Georgia 30322
| | - Mohammad Jahanzeb
- Sylvester Comprehensive Cancer Center, University of Miami School of Medicine, Deerfield Beach, Florida 33442;
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80
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Rodriguez-Ruiz V, Maksimenko A, Anand R, Monti S, Agostoni V, Couvreur P, Lampropoulou M, Yannakopoulou K, Gref R. Efficient "green" encapsulation of a highly hydrophilic anticancer drug in metal-organic framework nanoparticles. J Drug Target 2016; 23:759-67. [PMID: 26453171 DOI: 10.3109/1061186x.2015.1073294] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Metal-organic frameworks (MOFs) are coordination polymers of interest for biomedical applications. Of particular importance, nanoparticles made of iron(III) trimesate (MIL-100, MIL standing for Material Institut Lavoisier) (nanoMOFs) can be conveniently synthesised under mild and green conditions. They were shown to be biodegradable, biocompatible and efficient to encapsulate a variety of active molecules. We have addressed here the challenges to encapsulate a highly hydrophilic anticancer prodrug, phosphated gemcitabin (Gem-MP) known for its instability and inability to bypass cell membranes. MIL-100 nanoMOFs acted as efficient "nanosponges", soaking Gem-MP from its aqueous solution with almost perfect efficiency (>98%). Maximal loadings reached ∼30 wt% reflecting the strong interaction between the drug and the iron trimesate matrices. Neither degradation nor loss of crystalline structure was observed after the loading process. Storage of the loaded nanoMOFs in water did not result in drug release over three days. However, Gem-MP was released in media containing phosphates, as a consequence to particle degradation. Drug-loaded nanoMOFs were effective against pancreatic PANC-1 cells, in contrast to free drug and empty nanoMOFs. However, an efflux phenomenon could contribute to reduce the efficacy of the nanocarriers. Size optimization and surface modification of the nanoMOFs are expected to further improve these findings.
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Affiliation(s)
| | - Andrei Maksimenko
- a Institut Galien (UMR CNRS 8612), Université Paris-Sud , Châtenay-Malabry , France
| | - Resmi Anand
- b National Centre for Scientific Research "Demokritos", Institute of Nanoscience & Nanotechnology , Ag. Paraskevi , Athens , Greece , and
| | - Sandra Monti
- c Istituto per la Sintesi Organica e la Fotoreattività-CNR , Bologna , Italy
| | - Valentina Agostoni
- a Institut Galien (UMR CNRS 8612), Université Paris-Sud , Châtenay-Malabry , France
| | - Patrick Couvreur
- a Institut Galien (UMR CNRS 8612), Université Paris-Sud , Châtenay-Malabry , France
| | - Maria Lampropoulou
- b National Centre for Scientific Research "Demokritos", Institute of Nanoscience & Nanotechnology , Ag. Paraskevi , Athens , Greece , and
| | - Konstantina Yannakopoulou
- b National Centre for Scientific Research "Demokritos", Institute of Nanoscience & Nanotechnology , Ag. Paraskevi , Athens , Greece , and
| | - Ruxandra Gref
- a Institut Galien (UMR CNRS 8612), Université Paris-Sud , Châtenay-Malabry , France
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Liang YH, Shao YY, Liao BC, Lee HS, Yang JCH, Chen HM, Chiang CJ, Cheng AL, Lai MS. Cytotoxic Chemotherapy as First-Line Therapy for Advanced Non-Small-Cell Lung Cancer in Taiwan: Daily Practice. J Cancer 2016; 7:1515-23. [PMID: 27471567 PMCID: PMC4964135 DOI: 10.7150/jca.15180] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 05/24/2016] [Indexed: 12/02/2022] Open
Abstract
Aim: Cytotoxic chemotherapy is the standard first-line therapy for patients with advanced non-small cell lung cancer (NSCLC) without specific gene alterations. This study examined the prescription pattern and the survival outcome of cytotoxic chemotherapy regimens in daily practice in Taiwan. Methods:We established a population-based cohort of patients diagnosed with advanced NSCLC between 2005 and 2009 using the databases of Taiwan Cancer Registry and National Health Insurance in Taiwan. We then analyzed chemotherapy prescriptions and the survival outcomes of patients. Results:A total of 25,008 patients with advanced NSCLC were identified, 17,443 (70.0%) of which received first-line chemotherapy and were therefore included in this study. Among them, 11,551 (66.2%) patients had adenocarcinoma and 3,292 (18.9%) patients had squamous cell carcinoma (SCC). Approximately 70% of the patients were diagnosed with NSCLC in medical centers. Platinum-based doublet chemotherapy was administered to 66.9% of the patients. Among all chemotherapy regimens, platinum with gemcitabine (33.8%) was the most common, irrespective of geographic region. The second and third most common regimens were vinorelbine alone (13.0%) and platinum with docetaxel (11.6%). The prevalence of platinum-based doublet chemotherapy regimens decreased from 71.4% in 2005 to 64.1% in 2009. Among patients with adenocarcinoma histology, those who received platinum with pemetrexed had longer OS than did patients who received other platinum-based regimens (p < 0.001). Conclusion: Our findings reaffirm that in real-world practice, treatment plans of advanced NSCLC should be drawn up according to histology type.
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Affiliation(s)
- Yi-Hsin Liang
- 1. Department of Oncology, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu, Taiwan; 2. Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan; 5. Graduate Institute of Oncology, National Taiwan University College of Medicine
| | - Yu-Yun Shao
- 2. Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan; 4. National Taiwan University Cancer Center, Taipei, Taiwan; 5. Graduate Institute of Oncology, National Taiwan University College of Medicine
| | - Bin-Chi Liao
- 2. Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan; 4. National Taiwan University Cancer Center, Taipei, Taiwan
| | - Ho-Sheng Lee
- 9. Division of Pulmonary Medicine, Department of Internal Medicine, E-Da Hospital, Kaohsiung, Taiwan
| | - James Chih-Hsin Yang
- 2. Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan; 3. Medical Research, National Taiwan University Hospital, Taipei, Taiwan; 4. National Taiwan University Cancer Center, Taipei, Taiwan; 5. Graduate Institute of Oncology, National Taiwan University College of Medicine
| | - Ho-Min Chen
- 2. Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
| | - Chun-Ju Chiang
- 7. Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan; 8. Taiwan Cancer Registry, Department of Internal Medicine, E-Da Hospital, Kaohsiung, Taiwan
| | - Ann-Lii Cheng
- 2. Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan; 4. National Taiwan University Cancer Center, Taipei, Taiwan; 5. Graduate Institute of Oncology, National Taiwan University College of Medicine; 6. Department of Internal Medicine, National Taiwan University College of Medicine
| | - Mei-Shu Lai
- 7. Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan; 8. Taiwan Cancer Registry, Department of Internal Medicine, E-Da Hospital, Kaohsiung, Taiwan
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82
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Abstract
Use of platinum-based chemotherapy doublets is the standard of care for patients with advanced-stage non-small cell lung cancer, being associated with improved survival compared with best supportive care in fit patients with good performance status. Randomized studies showed that the addition of monoclonal antibodies against vascular endothelial growth factor receptor or epidermal growth factor receptor may increase the survival compared to chemotherapy alone. Patients with either advanced age or poor performance status can also benefit from chemotherapy. Docetaxel with or without ramucirumab, pemetrexed, and erlotinib are approved for previously treated patients. New treatment approaches are needed to improve the outcomes in this patient population.
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83
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Restoration of Patency to Central Airways Occluded by Malignant Endobronchial Tumors Using Intratumoral Injection of Cisplatin. Ann Am Thorac Soc 2016; 12:1345-50. [PMID: 26072968 DOI: 10.1513/annalsats.201503-131oc] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
RATIONALE Malignant airway obstruction is commonly found in patients with lung cancer and is associated with significant morbidity and mortality. Relieving malignant obstruction may improve symptoms, quality of life, and life expectancy. OBJECTIVES The objective of this study was to analyze our experience with bronchoscopic endobronchial intratumoral injection of cisplatin for malignant airway obstruction. METHODS We conducted a retrospective analysis of patients with malignant airway obstruction treated with bronchoscopic intratumoral injection of cisplatin. Patient characteristics, histology, degree of airway obstruction, procedural methods, treatment cycles, performance status, and therapeutic outcomes were evaluated. Tumor response was analyzed based on bronchoscopic measurements performed on completion the of final treatment session. Adverse events and overall survival were abstracted. MEASUREMENTS AND MAIN RESULTS Between January 2009 and September 2014, 22 patients (10 men, 12 women; mean age ± SD, 64.4 ± 9.5 yr) were treated with one to four injections of 40 mg of cisplatin mixed in 40 ml of 0.9% NaCl. Treatments were completed 1 week apart. The primary etiologies of airway obstruction included squamous cell carcinoma (n = 11), adenocarcinoma (n = 6), small cell carcinoma (n = 2), large cell undifferentiated carcinoma (n = 1), and metastatic endobronchial cancer (n = 2). Twenty-one of 22 patients were evaluable for response. The majority of patients (15/21, 71.4%) responded to therapy, defined as greater than 50% relative reduction in obstruction from baseline. Treatment response was obtained regardless of tumor histology, concurrent systemic therapy, number of treatment cycles administered, performance status, or use of additional ablative interventions. Responders had significantly improved overall survival as compared with nonresponders, although the difference was small. Severe treatment-related side effects or complications were not observed. CONCLUSIONS Subject to the limitations of a single-center retrospective study and a subjective primary outcome measure, we have demonstrated the feasibility of improving the patency of central airways that are largely or completely occluded by endobronchial malignant tumor using intraluminal injection of cisplatin. Additional longer-term, larger-scale safety and comparative effectiveness studies of this palliative treatment modality are warranted.
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84
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Yang S. A Pooled Study on Combination of Gemcitabine and Nedaplatin for Treating Patients with Non-small Cell Lung Cancer. Asian Pac J Cancer Prev 2016; 16:5963-6. [PMID: 26320480 DOI: 10.7314/apjcp.2015.16.14.5963] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This analysis was conducted to evaluate the efficacy and safety of a combination of gemcitabine and nedaplatin in treating patients with non-small cell lung cancer. METHODS Clinical studies evaluating the efficacy and safety of a combination of gemcitabine and nedaplatin with attention to response and safety for patients with non-small cell lung cancer were identified using a predefined search strategy. Pooled response rates for gemcitabine and nedaplatin were calculated. RESULTS In gemcitabine and nedaplatin based regimens, 4 clinical studies including 112 patients with non-small cell lung cancer were considered eligible for inclusion. The pooled analysis suggested that the pooled reponse rate was 40.2% (45/112). Main side effects included grade 3-4 neutropenia, thrombocytopenia, and anemia. Grade 3-4 nonhematological toxicity included nausea and vomiting, diarrhea, and hepatic dysfunction. There were no treatment-related deaths. CONCLUSION This evidence based analysis suggests that the combination of gemcitabine and nedaplatin is associated with good response rate and accepted toxicity for treating patients with non-small cell lung cancer.
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Affiliation(s)
- Song Yang
- Taizhou People's Hospital , Taizhou, Jiangsu Province, China E-mail :
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85
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Biomaterial-based regional chemotherapy: Local anticancer drug delivery to enhance chemotherapy and minimize its side-effects. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2016; 62:927-42. [DOI: 10.1016/j.msec.2016.01.063] [Citation(s) in RCA: 111] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 01/19/2016] [Accepted: 01/24/2016] [Indexed: 02/06/2023]
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86
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Saini P, Li Y, Dobbelstein M. Wee1 is required to sustain ATR/Chk1 signaling upon replicative stress. Oncotarget 2016; 6:13072-87. [PMID: 25965828 PMCID: PMC4537000 DOI: 10.18632/oncotarget.3865] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 03/31/2015] [Indexed: 12/12/2022] Open
Abstract
The therapeutic efficacy of nucleoside analogues, e.g. gemcitabine, against cancer cells can be augmented by inhibitors of checkpoint kinases, including Wee1, ATR, and Chk1. We have compared the chemosensitizing effect of these inhibitors in cells derived from pancreatic cancer, a tumor entity where gemcitabine is part of the first-line therapeutic regimens, and in osteosarcoma-derived cells. As expected, all three inhibitors rendered cancer cells more sensitive to gemcitabine, but Wee1 inhibition proved to be particularly efficient in this context. Investigating the reasons for this potent sensitizing effect, we found that Wee1 inhibition or knockdown not only blocked Wee1 activity, but also reduced the activation of ATR/Chk1 in gemcitabine-treated cells. Combination of several inhibitors revealed that Wee1 inhibition requires Cyclin-dependent kinases 1 and 2 (Cdk1/2) and Polo-like kinase 1 (Plk1) to reduce ATR/Chk1 activity. Through activation of Cdks and Plk1, Wee1 inhibition reduces Claspin and CtIP levels, explaining the impairment in ATR/Chk1 activity. Taken together, these results confer a consistent signaling pathway reaching from Wee1 inhibition to impaired Chk1 activity, mechanistically dissecting how Wee1 inhibitors not only dysregulate cell cycle progression, but also enhance replicative stress and chemosensitivity towards nucleoside analogues.
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Affiliation(s)
- Priyanka Saini
- Institute of Molecular Oncology, Göttingen Centre of Molecular Biosciences (GZMB), Faculty of Medicine, University of Göttingen, Göttingen, Germany
| | - Yizhu Li
- Institute of Molecular Oncology, Göttingen Centre of Molecular Biosciences (GZMB), Faculty of Medicine, University of Göttingen, Göttingen, Germany
| | - Matthias Dobbelstein
- Institute of Molecular Oncology, Göttingen Centre of Molecular Biosciences (GZMB), Faculty of Medicine, University of Göttingen, Göttingen, Germany
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87
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Kontopodis E, Kotsakis A, Kentepozidis N, Syrigos K, Ziras N, Moutsos M, Filippa G, Mala A, Vamvakas L, Mavroudis D, Georgoulias V, Agelaki S. A phase II, open-label trial of bortezomib (VELCADE(®)) in combination with gemcitabine and cisplatin in patients with locally advanced or metastatic non-small cell lung cancer. Cancer Chemother Pharmacol 2016; 77:949-56. [PMID: 26994909 DOI: 10.1007/s00280-016-2997-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 02/23/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND Bortezomib is a selective reversible proteasome inhibitor with proapoptotic effects. Preclinical and phase I clinical data suggest activity of bortezomib in NSCLC, either as monotherapy or in combination with chemotherapeutic agents including gemcitabine and cisplatin. METHODS Chemotherapy-naïve patients with inoperable stage IIIB or IV NSCLC were administered bortezomib 1 mg/m(2) i.v. on days 1 and 8, and starting on day 21 (cycle 2), bortezomib (days 1 and 8) in combination with gemcitabine 1000 mg/m(2), (days 1 and 8), and cisplatin 70 mg/m(2) (day 1) in cycles of 21 days. Up to 8 cycles of combination therapy could be administered; single-agent bortezomib was continued until disease progression or unacceptable toxicity. RESULTS Fifty-three patients [median age 66 years; 79.2 % male; 96.2 % stage IV; performance status (ECOG) 0/1 73.6/26.4 %; adenocarcinoma 45.3 %, squamous cell carcinoma 41.5 %] were enrolled. All patients were evaluable for toxicity and 43 for efficacy. Grade 3-4 hematologic toxicity consisted of neutropenia (22.6 %) and thrombocytopenia (17 %). Grade 2-4 non-hematologic adverse events were fever (9.4 %), fatigue (20.8 %), infection (18.9 %), and dyspnea (15.1 %). There was no >grade 2 neurotoxicity. Febrile neutropenia occurred in two (1.9 %) patients, and there were three possibly treatment-related deaths (5.4 %). In the intention-to-treat population, the objective response rate was 17 % (95 % CI 6.9-27.1 %). No difference in response rate was observed for squamous versus other histology (18.2 vs. 16.1 %, p = 0.845). The median progression-free survival was 2.5 months, the median overall survival 10.6 months and the 1-year survival rate 38.1 %. CONCLUSION The incorporation of bortezomib into the gemcitabine/cisplatin regimen, in the dose and schedule used in this study, could not improve the efficacy of the chemotherapy regimen and has not to be further investigated.
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Affiliation(s)
- E Kontopodis
- Hellenic Oncology Research Group (HORG), 55 Lomvardou Street, 11471, Athens, Greece
| | - A Kotsakis
- Hellenic Oncology Research Group (HORG), 55 Lomvardou Street, 11471, Athens, Greece
| | - N Kentepozidis
- Hellenic Oncology Research Group (HORG), 55 Lomvardou Street, 11471, Athens, Greece
| | - K Syrigos
- Hellenic Oncology Research Group (HORG), 55 Lomvardou Street, 11471, Athens, Greece
| | - N Ziras
- Hellenic Oncology Research Group (HORG), 55 Lomvardou Street, 11471, Athens, Greece
| | - M Moutsos
- Hellenic Oncology Research Group (HORG), 55 Lomvardou Street, 11471, Athens, Greece
| | - G Filippa
- Hellenic Oncology Research Group (HORG), 55 Lomvardou Street, 11471, Athens, Greece
| | - A Mala
- Hellenic Oncology Research Group (HORG), 55 Lomvardou Street, 11471, Athens, Greece
| | - L Vamvakas
- Hellenic Oncology Research Group (HORG), 55 Lomvardou Street, 11471, Athens, Greece
| | - D Mavroudis
- Hellenic Oncology Research Group (HORG), 55 Lomvardou Street, 11471, Athens, Greece
| | - V Georgoulias
- Hellenic Oncology Research Group (HORG), 55 Lomvardou Street, 11471, Athens, Greece.
| | - S Agelaki
- Hellenic Oncology Research Group (HORG), 55 Lomvardou Street, 11471, Athens, Greece
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88
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Shafrin J, Brookmeyer R, Peneva D, Park J, Zhang J, Figlin RA, Lakdawalla DN. The value of surrogate endpoints for predicting real-world survival across five cancer types. Curr Med Res Opin 2016; 32:731-9. [PMID: 26743800 DOI: 10.1185/03007995.2016.1140027] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE It is unclear how well different outcome measures in randomized controlled trials (RCTs) perform in predicting real-world cancer survival. We assess the ability of RCT overall survival (OS) and surrogate endpoints - progression-free survival (PFS) and time to progression (TTP) - to predict real-world OS across five cancers. METHODS We identified 20 treatments and 31 indications for breast, colorectal, lung, ovarian, and pancreatic cancer that had a phase III RCT reporting median OS and median PFS or TTP. Median real-world OS was determined using a Kaplan-Meier estimator applied to patients in the Surveillance and Epidemiology End Results (SEER)-Medicare database (1991-2010). Performance of RCT OS and PFS/TTP in predicting real-world OS was measured using t-tests, median absolute prediction error, and R(2) from linear regressions. RESULTS Among 72,600 SEER-Medicare patients similar to RCT participants, median survival was 5.9 months for trial surrogates, 14.1 months for trial OS, and 13.4 months for real-world OS. For this sample, regression models using clinical trial OS and trial surrogates as independent variables predicted real-world OS significantly better than models using surrogates alone (P = 0.026). Among all real-world patients using sample treatments (N = 309,182), however, adding trial OS did not improve predictive power over predictions based on surrogates alone (P = 0.194). Results were qualitatively similar using median absolute prediction error and R(2) metrics. CONCLUSIONS Among the five tumor types investigated, trial OS and surrogates were each independently valuable in predicting real-world OS outcomes for patients similar to trial participants. In broader real-world populations, however, trial OS added little incremental value over surrogates alone.
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Affiliation(s)
- Jason Shafrin
- a Precision Health Economics , Los Angeles , CA , USA
| | - Ron Brookmeyer
- b Fielding School of Public Health, University of California Los Angeles , Los Angeles , CA , USA
| | - Desi Peneva
- a Precision Health Economics , Los Angeles , CA , USA
| | - Jinhee Park
- c Worldwide Health Outcomes, Value & Access, Novartis Pharmaceuticals , East Hanover , NJ , USA
| | - Jie Zhang
- c Worldwide Health Outcomes, Value & Access, Novartis Pharmaceuticals , East Hanover , NJ , USA
| | - Robert A Figlin
- d Division of Hematology/Oncology , Cedars-Sinai Medical Center , Los Angeles , CA , USA
| | - Darius N Lakdawalla
- e Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California , Los Angeles , CA , USA
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89
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Abstract
Non-small cell lung cancer has seen an unprecedented augmentation of therapeutic options over the last couple of years. Improved understanding of molecular drivers and the role of the immune system in cancer therapy have brought new drugs to the armamentarium. Despite these advances, cytotoxic chemotherapy remains a substantial part of therapy for most patients in locally advanced and metastatic stage. Initially thought to be a chemotherapy-resistant entity, meta-analyses in the mid-1990s demonstrated modest efficacy of platinum-based therapy. Further combination trials demonstrated enhanced efficacy for several regimen in first and second lines, including the introduction of antimetabolites, taxanes, and anti-angiogenic agents. Maintenance chemotherapy has been another novel, successful approach for management of metastatic disease. Herein, we summarize the current concepts of chemotherapy, its applicability to the different histologies, and novel concepts of therapy.
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Affiliation(s)
- Martin F Dietrich
- Harold C. Simmons Cancer Center, Division of Hematology-Oncology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, 8852, Dallas, TX, 75390-8852, USA.
| | - David E Gerber
- Harold C. Simmons Cancer Center, Division of Hematology-Oncology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, 8852, Dallas, TX, 75390-8852, USA.
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90
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Chen Q, Ji X, Zhou X, Shi Q, Yu H, Fu H. Clinical observation of docetaxel or gemcitabine combined with cisplatin in the chemotherapy after surgery for stage II-III non-small cell lung cancer. Pak J Med Sci 2015; 31:1095-8. [PMID: 26648993 PMCID: PMC4641262 DOI: 10.12669/pjms.315.7380] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective: This study aimed to compare the efficacy and toxicity of docetaxel combined with cisplatin (DP) and gemcitabine combined with cisplatin (GP) in postoperative chemotherapy after surgery of non-small cell lung cancer (NSCLC). Methods: A total of 92 patients diagnosed with NSCLC after surgery were enrolled, and they were treated with DP (DP group) and GP (GP group). The efficacy and toxicity of the medications were then compared. Results: Approximately 92.4% (85 out of 92) of the patients received chemotherapy for more than three weeks. In DP and GP groups, the incidence rates of grade III-IV thrombocytopenia were 24.4% and 6.38%, respectively, whereas the incidence rates of alopecia were 88.9% and 25.5%, respectively. The difference between the two groups was statistically significant (P < 0.05). Disease-free survival rates in DP group in one and two years were 76.5% and 50.47%, respectively, whereas in GP group were 77.8% and 49.52%, respectively. No significant difference was observed between the two groups (P > 0.05). Conclusion: These results showed similar disease-free survival rates of DP and GP therapies in one and two years after surgery for NSCLC. However, DP group exhibited higher incidence of grade III-IV thrombocytopenia and alopecia than GP group. Therefore, we should select a specific treatment for each patient according to individual differences.
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Affiliation(s)
- Qiuqiang Chen
- Qiuqiang Chen, Department of Thoracic Surgery, The Directly Affiliated Hospital of Huzhou Teachers College, Huzhou, Zhejiang 313000, China
| | - Xuexian Ji
- Xuexian Ji, Department of Pathology, People's Hospital of Deqing County, Wukang, Zhejiang, 313200, China
| | - Xiao Zhou
- Xiao Zhou, Department of Respiratory Medicine, The Directly Affiliated Hospital of Huzhou Teachers College, Huzhou, Zhejiang 313000, China
| | - Qilin Shi
- Qilin Shi, Department of Pathology, The Directly Affiliated Hospital of Huzhou Teachers College, Huzhou, Zhejiang 313000, China
| | - Huanming Yu
- Huanming Yu, Department of Thoracic Surgery, The Directly Affiliated Hospital of Huzhou Teachers College, Huzhou, Zhejiang 313000, China
| | - Hengqin Fu
- Hengqin Fu, Department of Respiratory Medicine, The Directly Affiliated Hospital of Huzhou Teachers College, Huzhou, Zhejiang 313000, China
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91
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Jia Y, Xie J. Promising molecular mechanisms responsible for gemcitabine resistance in cancer. Genes Dis 2015; 2:299-306. [PMID: 30258872 PMCID: PMC6150077 DOI: 10.1016/j.gendis.2015.07.003] [Citation(s) in RCA: 108] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Accepted: 07/20/2015] [Indexed: 01/18/2023] Open
Abstract
Gemcitabine is the first-line treatment for pancreatic ductual adenocarcinoma (PDAC) as well as acts against a wide range of other solid tumors. Patients usually have a good initial response to gemcitabine-based chemotherapy but would eventually develop resistance. To improve survival and prognosis of cancer patients, better understanding of the mechanisms responsible for gemcitabine resistance and discovery of new therapeutic strategies are in great need. Amounting evidence indicate that the developmental pathways, such as Hedgehog (Hh), Wnt and Notch, become reactivated in gemcitabine-resistant cancer cells. Thus, the strategies for targeting these pathways may sensitize cancer cells to gemcitabine treatment. In this review, we will summarize recent development in this area of research and discuss strategies to overcome gemcitabine resistance. Given the cross-talk between these three developmental signaling pathways, designing clinical trials using a cocktail of inhibitory agents targeting all these pathways may be more effective. Ultimately, our hope is that targeting these developmental pathways may be an effective way to improve the gemcitabine treatment outcome in cancer patients.
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Affiliation(s)
- Yanfei Jia
- Central Laboratory, Jinan Central Hospital Affiliated to Shandong University, Jinan 250013, China
| | - Jingwu Xie
- Division of Hematology and Oncology, Department of Pediatrics, Wells Center for Pediatric Research, Indiana University Simon Cancer Center, Indiana University, Indianapolis, IN 46202, USA
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92
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Lee WH, Loo CY, Traini D, Young PM. Inhalation of nanoparticle-based drug for lung cancer treatment: Advantages and challenges. Asian J Pharm Sci 2015. [DOI: 10.1016/j.ajps.2015.08.009] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
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93
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Wu TT, Lu CL, Lin HI, Chen BF, Jow GM. β-Elemonic acid inhibits the cell proliferation of human lung adenocarcinoma A549 cells: The role of MAPK, ROS activation and glutathione depletion. Oncol Rep 2015; 35:227-34. [PMID: 26530631 DOI: 10.3892/or.2015.4368] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 09/17/2015] [Indexed: 11/06/2022] Open
Abstract
β-elemonic acid, a known triterpene, exhibits anti-inflammatory effects, yet research on the pharmacological effects of β-elemonic acid is rare. We investigated the anticancer effects and the related molecular mechanisms of β-elemonic acid on human non-small cell lung cancer (NSCLC) A549 cells. The effects of β-elemonic acid on the growth of A549 cells were studied using a 3-(4,5)-2,5-diphenyltetrazolium bromide (MTT) assay. Apoptosis was detected using Annexin V staining. The effect of β-elemonic acid on the cell cycle of A549 cells was assessed using the propidium iodide method. The change in reactive oxygen species (ROS) was detected using a dichlorodihydrofluorescein diacetate (DCFH-DA) assay with microscopic examination. The expression levels of Bcl-2 family proteins, mitogen-activated protein kinase (MAPK) family proteins and cyclooxygenase 2 (COX-2) were detected using western blot analysis. Our data revealed that β-elemonic acid strongly induced human A549 lung cancer cell death in a dose- and time-dependent manner as determined by the MTT assay. β-elemonic acid-induced cell death was considered to be apoptotic when the phosphatidylserine exposure was observed using Annexin V staining. The death of human A549 lung cancer cells was caused by apoptosis induced by activation of ROS activity, increase in the sub-G1 proportion, downregulation of Bcl-2 expression, upregulation of Bax expression and inhibition of the MAPK signaling pathways. These results clearly demonstrated that β-elemonic acid inhibits proliferation by inducing hypoploid cells and cell apoptosis. Moreover, the anticancer effects of β-elemonic acid were related to the MAPK signaling pathway, ROS activation and glutathione depletion in human A549 lung cancer cells.
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Affiliation(s)
- Tsu-Tuan Wu
- Department of Respiratory Therapy, Fu Jen Catholic University, New Taipei City, Taiwan, R.O.C
| | - Chien-Lin Lu
- Division of Nephrology, Department of Medicine, Shin‑Kong Wu Ho‑Su Memorial Hospital, Taipei, Taiwan, R.O.C
| | - Hen-I Lin
- School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan, R.O.C
| | - Bing-Fang Chen
- School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan, R.O.C
| | - Guey-Mei Jow
- School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan, R.O.C
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Zeng J, Yin J, Yuan D, Yang W, Liang W, Wu G, Song Y. Assessing the clinical outcome of nab-paclitaxel in Chinese patients with advanced non-small-cell lung cancer. CLINICAL RESPIRATORY JOURNAL 2015; 11:632-639. [PMID: 26404101 DOI: 10.1111/crj.12394] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Revised: 07/01/2015] [Accepted: 09/24/2015] [Indexed: 11/29/2022]
Abstract
PURPOSE Nab-paclitaxel [nab-P, 130-nm albumin-bound paclitaxel particles] is a new solvent-free paclitaxel that allows for high intratumoral concentration and has been approved for use in various solid tumours. The aim of our study was to evaluate the efficacy and safety of nab-paclitaxel in the treatment of advanced non-small-cell lung cancer [NSCLC]. PATIENTS AND METHODS We assessed 101 Chinese patients who were diagnosed with Stage IIIB or IV NSCLC from August 2009 to November 2014.The patients were injected with nab-paclitaxel [260 mg/m2 , day1] with or without platinum. Patients who completed more than two treatment cycles were assessed for response and survival. All patients were assessed for adverse events. RESULTS The efficacy was evaluated in 79 patients; the overall response rate was 32.9%, and the disease control rate was 89.9%. Subgroup analysis found patients with squamous cell carcinoma, and combination therapies showed better outcomes. The median progression-free survival was 5.3 months [95%CI: 4.6-5.9], and the median overall survival was 8.9 months [95%CI: 6.1-11.6]. The main grades 3/4 adverse events were peripheral neuropathy [5.9%], leukopenia [5.0%], and anaemia [3.0%]. Additionally, severe abnormal hepatic function [2.0%], alopecia [2.0%], thrombocytopenia [1.0%] and fatigue [1.0%] could also be identified in some patients. CONCLUSION The nab-paclitaxel chemotherapy could achieve significant tumour responses and encourage survival in advanced NSCLC patients with tolerable toxicities. Further clinical studies are needed to explore the optimal therapy regimen and target users.
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Affiliation(s)
- Junli Zeng
- Department of Respiratory Medicine, Jinling Hospital, Southern Medical University [Guangzhou], Nanjing, 210002, China
| | - Jie Yin
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210002, China
| | - Dongmei Yuan
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210002, China
| | - Wen Yang
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210002, China
| | - Wenjun Liang
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210002, China
| | - Guannan Wu
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210002, China
| | - Yong Song
- Department of Respiratory Medicine, Jinling Hospital, Southern Medical University [Guangzhou], Nanjing, 210002, China.,Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210002, China
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95
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Mehta HJ, Begnaud A, Penley AM, Wynne J, Malhotra P, Fernandez-Bussy S, Cope JM, Shuster JJ, Jantz MA. Treatment of isolated mediastinal and hilar recurrence of lung cancer with bronchoscopic endobronchial ultrasound guided intratumoral injection of chemotherapy with cisplatin. Lung Cancer 2015; 90:542-7. [PMID: 26477968 DOI: 10.1016/j.lungcan.2015.10.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Revised: 09/22/2015] [Accepted: 10/04/2015] [Indexed: 11/28/2022]
Abstract
PURPOSE A common pattern of recurrence in lung cancer after receiving full dose external beam radiation therapy (EBRT) to targeted sites is isolated mediastinal and hilar recurrence (IMHR). Treatment options for these patients are limited to palliative radiation, chemotherapy, and/or best supportive care. We describe our experience with treating IMHR with bronchoscopic endobronchial ultrasound (EBUS) guided intratumoral injection of cisplatin (ITC). METHODS Patients treated between Jan 2009-September 2014 with ITC for IMHR were included. Patient demographics, tumor histology, size, concurrent therapy, location, number of sites treated, treatment sessions, and encounters were abstracted. Responses were analyzed on follow-up scans 8-12 weeks after the last treatment session using RECIST 1.1 criteria. Locoregional recurrence, progression-free survival (PFS), and overall survival were measured. RESULTS 50 sites were treated in 36 patients (19 males, 17 females) with mean age 61.9±8.5 years. Eight sites treated on subsequent encounters were excluded and one patient had an unevaluable response, leaving 35 patients and 41 sites for final analysis. 24/35 (69%) had complete or partial response (responders), whereas 11/35 (31%) had stable or progressive disease (non-responders). There were no significant differences in response based on histology, size, and concurrent therapy. Median survival for the group was 8 months (95% CI of 6-11 mo). Responders had significantly higher survival and PFS than non-responders. Two patients treated with concurrent EBRT, developed broncho-mediastinal fistula. CONCLUSION EBUS guided intratumoral cisplatin for IMHR appears to be safe and effective, and may represent a new treatment paradigm for this patient population.
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Affiliation(s)
- Hiren J Mehta
- Division of Pulmonary, Critical care, Sleep Medicine, University of Florida, College of Medicine, United States.
| | - Abbie Begnaud
- Division of Pulmonary, Critical care, Sleep Medicine, University of Minnesota College of Medicine, United States
| | - Andrea M Penley
- Division of Pulmonary, Critical care, Sleep Medicine, University of Florida, College of Medicine, United States
| | - John Wynne
- Division of Pulmonary, Critical care, Sleep Medicine, University of Florida, College of Medicine, United States
| | - Paras Malhotra
- Division of Pulmonary, Critical care, West Virginia University Charleston Division, United States
| | | | - Jessica M Cope
- UF Health Shands Hospital, Department of Pharmacy, Gainesville, FL, United States
| | - Jonathan J Shuster
- Department of Health Outcomes and Policy, College of Medicine, University of Florida, United States
| | - Michael A Jantz
- Division of Pulmonary, Critical care, Sleep Medicine, University of Florida, College of Medicine, United States
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96
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Venugopal B, Awada A, Evans TRJ, Dueland S, Hendlisz A, Rasch W, Hernes K, Hagen S, Aamdal S. A first-in-human phase I and pharmacokinetic study of CP-4126 (CO-101), a nucleoside analogue, in patients with advanced solid tumours. Cancer Chemother Pharmacol 2015; 76:785-92. [PMID: 26289594 DOI: 10.1007/s00280-015-2846-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Accepted: 08/05/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND CP-4126 (gemcitabine elaidate, previously CO-101) is a lipid-drug conjugate of gemcitabine designed to circumvent human equilibrative nucleoside transporter1-related resistance to gemcitabine. The purpose of this study was to determine the maximum tolerated dose (MTD) and the recommended phase II dose (RP2D) of CP-4126, and to describe its pharmacokinetic profile. METHODS Eligible patients with advanced refractory solid tumours, and adequate performance status, haematological, renal and hepatic function, were treated with one of escalating doses of CP-4126 administered by a 30-min intravenous infusion on days 1, 8 and 15 of a 28-day cycle. Blood and urine samples were collected to determine the pharmacokinetics (PKs) of CP-4126. RESULTS Forty-three patients, median age 59 years (range 18-76; male = 27, female = 16), received one of ten dose levels (30-1600 mg/m(2)). Dose-limiting toxicities included grade 3 anaemia, grade 3 fatigue and grade 3 elevation of transaminases. The MTD and RP2D were 1250 mg/m(2) on basis of the toxicity and PK data. CP-4126 followed dose-dependent kinetics and maximum plasma concentrations occurred at the end of CP-4126 infusion. Seven patients achieved stable disease sustained for ≥3 months, including two patients with pancreatic cancer who had progressed on or after gemcitabine exposure. CONCLUSIONS CP-4126 was well tolerated with comparable toxicity profile to gemcitabine. Future studies are required to determine its anti-tumour efficacy, either alone or in combination with other cytotoxic chemotherapy regimens.
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MESH Headings
- Adolescent
- Adult
- Aged
- Antimetabolites, Antineoplastic/administration & dosage
- Antimetabolites, Antineoplastic/adverse effects
- Antimetabolites, Antineoplastic/pharmacokinetics
- Antimetabolites, Antineoplastic/therapeutic use
- Cohort Studies
- Deoxycytidine/administration & dosage
- Deoxycytidine/adverse effects
- Deoxycytidine/analogs & derivatives
- Deoxycytidine/pharmacokinetics
- Deoxycytidine/therapeutic use
- Disease Progression
- Dose-Response Relationship, Drug
- Drug Monitoring
- Drug Resistance, Neoplasm
- Drugs, Investigational/administration & dosage
- Drugs, Investigational/adverse effects
- Drugs, Investigational/pharmacokinetics
- Drugs, Investigational/therapeutic use
- Female
- Half-Life
- Humans
- Male
- Metabolic Clearance Rate
- Middle Aged
- Neoplasms/blood
- Neoplasms/drug therapy
- Neoplasms/metabolism
- Neoplasms/pathology
- Tumor Burden/drug effects
- Young Adult
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Affiliation(s)
- B Venugopal
- Beatson West of Scotland Cancer Centre, 1053 Great Western Road, Glasgow, G12 0YN, UK.
- Institute of Cancer Sciences, University of Glasgow, Switchback Road, Glasgow, G61 1BD, UK.
| | - A Awada
- Institut Jules Bordet, Université Libre de Bruxelles, 121, Boulevard de Waterloo, 1000, Brussels, Belgium
| | - T R J Evans
- Beatson West of Scotland Cancer Centre, 1053 Great Western Road, Glasgow, G12 0YN, UK
- Institute of Cancer Sciences, University of Glasgow, Switchback Road, Glasgow, G61 1BD, UK
| | - S Dueland
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - A Hendlisz
- Institut Jules Bordet, Université Libre de Bruxelles, 121, Boulevard de Waterloo, 1000, Brussels, Belgium
| | - W Rasch
- Clavis Pharma ASA, Parkveien 53 B, 0256, Oslo, Norway
| | - K Hernes
- Clavis Pharma ASA, Parkveien 53 B, 0256, Oslo, Norway
| | - S Hagen
- Clavis Pharma ASA, Parkveien 53 B, 0256, Oslo, Norway
| | - S Aamdal
- Department of Oncology, Oslo University Hospital, Oslo, Norway
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97
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Clinical observation of docetaxel or gemcitabine combined with cisplatin in the chemotherapy after surgery for stage II-III non-small cell lung cancer. Contemp Oncol (Pozn) 2015; 19:323-6. [PMID: 26557781 PMCID: PMC4631300 DOI: 10.5114/wo.2015.53373] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Revised: 09/25/2013] [Accepted: 12/03/2013] [Indexed: 11/18/2022] Open
Abstract
Aim of the study This study aimed to compare the efficacy and toxicity of docetaxel combined with cisplatin (DP) and gemcitabine combined with cisplatin (GP) in postoperative chemotherapy after surgery of non-small cell lung cancer (NSCLC). Material and methods A total of 92 patients diagnosed with NSCLC after surgery were enrolled, and they were treated with DP (DP group) and GP (GP group). The efficacy and toxicity of the medications were then compared. Results Approximately 92.4% (85 out of 92) of the patients received chemotherapy for more than three weeks. In the DP and GP groups, the incidence rates of grade III–IV thrombocytopenia were 24.4% and 6.38%, respectively, whereas the incidence rates of alopecia were 88.9% and 25.5%, respectively. The difference between the two groups was statistically significant (p < 0.05). Disease-free survival rates in DP group in one and two years were 76.5% and 50.47%, respectively, whereas in the GP group they were 77.8% and 49.52%, respectively. No significant difference was observed between the two groups (p > 0.05). Conclusions These results showed similar disease-free survival rates of DP and GP therapies in one and two years after surgery for NSCLC. However, the DP group exhibited higher incidence rates of grade III–IV thrombocytopenia and alopecia than the GP group. Therefore, we should select a specific treatment for each patient according to individual differences.
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98
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Zhang X, Li H, Chen W, Yang Y, Wang C, Zhang Y. Efficacy and safety of chemotherapy for newly diagnosed advanced non-small cell lung cancer with venous thromboembolism. Thorac Cancer 2015; 6:772-7. [PMID: 26557917 PMCID: PMC4632931 DOI: 10.1111/1759-7714.12278] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2015] [Accepted: 04/20/2015] [Indexed: 11/30/2022] Open
Abstract
Background Venous thromboembolism (VTE) is a serious complication in patients with lung cancer. The benefit of chemotherapy for lung cancer patients with VTE remains unknown. This study was conducted to elucidate the efficacy and safety of chemotherapy for advanced non-small cell lung cancer (NSCLC) in patients with VTE. Methods Newly diagnosed patients with advanced (i.e. stage IIIB and IV) NSCLC with VTE who received systemic chemotherapy were studied. Response rates, progression-free survival (PFS), overall survival (OS), and toxicity were retrospectively analyzed. Results In this study, 21 patients who received chemotherapy plus anticoagulation therapy between December 2009 and February 2011 were included. The objective response and disease control rates within the first regimen were 14.29% (3/21) and 76.19 %(16/21), respectively. The median PFS, one-year survival rate, and median OS were 5.50 months, 33.30%, and 8.70 months, respectively. The main grade 3/4 toxicities observed included neutropenia (28.57%), nausea 4 (19.05%), and anemia 2 (9.52%). Major bleeding was not observed. Conclusion Chemotherapy for newly diagnosed patients with advanced NSCLC and VTE was feasible and had acceptable toxicity; however, the survival of these patients remained inferior to that of patients without VTE.
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Affiliation(s)
- Xueli Zhang
- Beijing Institute of Respiratory Medicine, Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing Chao-Yang Hospital, Capital Medical University Beijing, China ; Department of Respiratory Medicine, Beijing Shunyi District Hospital, China Medical University Beijing, China
| | - Huiqiao Li
- Beijing Institute of Respiratory Medicine, Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing Chao-Yang Hospital, Capital Medical University Beijing, China
| | - Wenhui Chen
- Beijing Institute of Respiratory Medicine, Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing Chao-Yang Hospital, Capital Medical University Beijing, China
| | - Yuanhua Yang
- Beijing Institute of Respiratory Medicine, Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing Chao-Yang Hospital, Capital Medical University Beijing, China
| | - Chen Wang
- Beijing Institute of Respiratory Medicine, Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing Chao-Yang Hospital, Capital Medical University Beijing, China
| | - Yuhui Zhang
- Beijing Institute of Respiratory Medicine, Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing Chao-Yang Hospital, Capital Medical University Beijing, China
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99
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Effects of cigarette smoking on metabolism and effectiveness of systemic therapy for lung cancer. J Thorac Oncol 2015; 9:917-926. [PMID: 24926542 DOI: 10.1097/jto.0000000000000191] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Cigarette smoke associated polycyclic aromatic hydrocarbons can induce key drug-metabolizing enzymes of cytochrome P450 and isoforms of the glucuronyl transferases families. These enzymes metabolize several systemic therapies for lung cancer. Induction of these enzymes may lead to accelerated clearance with resultant impact on systemic therapy efficacy and toxicity in smokers compared with nonsmokers. This article reviews published literature regarding the influence of smoking as it relates to alteration of metabolism of systemic therapy in lung cancer. METHODS A structured search of the National Library of Medicine's PubMed/MEDLINE identified relevant articles. Data were abstracted and analyzed to summarize the findings. RESULTS Studies that analyzed pharmacokinetic data were prospective. Smokers receiving erlotinib exhibited rapid clearance, requiring a higher dose to reach equivalent systemic exposure compared with nonsmokers. Smokers receiving irinotecan also demonstrated increased clearance and lower systemic exposure. There was no difference in clearance of paclitaxel or docetaxel in smokers. Chemotherapy-associated neutropenia was worse in nonsmokers compared with smokers in patients treated with paclitaxel, docetaxel, irinotecan, and gemcitabine. CONCLUSIONS Systemic therapy for lung cancer has a narrow therapeutic index such that small changes in plasma concentrations or exposure in smokers may result in suboptimal therapy and poor outcomes. Smoking cessation must be emphasized at each clinical visit. However, prospective trials should take into consideration the effects of smoking history on drug pharmacokinetics and efficacy. The metabolizing enzyme phenotype in smokers may require individualized dose algorithms for specific agents.
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100
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Meng X, Wang G, Guan R, Jia X, Gao W, Wu J, Yu J, Liu P, Yu Y, Sun W, Dong H, Fu S. Predicting chemosensitivity to gemcitabine and cisplatin based on gene polymorphisms and mRNA expression in non-small-cell lung cancer cells. Pharmacogenomics 2015; 16:23-34. [DOI: 10.2217/pgs.14.159] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Aim: We used a panel of 17 non-small-cell lung cancer cell lines to investigate whether the presence of polymorphisms in the RRM1, ERCC1, ABCB1 and MTHFR genes and alterations in their mRNA expression can affect the in vitro chemosensitivity to cisplatin and gemcitabine. Materials & methods: Polymorphisms in these genes were evaluated by direct sequencing. mRNA expression levels were assessed by realtime PCR. In vitro chemosensitivity to cisplatin and gemcitabine was expressed as IC50 values, using the MTT (3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyltetrazolium bromide) assay. Results: There was a significant, positive correlation between RRM1 mRNA expression and IC50 values for gemcitabine (r = 0.6533, p = 0.0045), and there was a significant, negative correlation between ABCB1 mRNA expression and IC50 values for cisplatin (r = -0.5459, p = 0.0287). When examining the association between the polymorphisms and IC50, we found that only the MTHFR 1298A>C polymorphism showed a tendency to be more chemosensitive to gemcitabine (p = 0.0440). Conclusion: These in vitro results suggest that mRNA expression levels of the RRM1 and ABCB1 genes may be useful indicators of chemosensitivity to gemcitabine and cisplatin, respectively. The MTHFR 1298A>C polymorphism was associated with gemcitabine chemosensitivity, which require further functional analysis with co-expressed genes and should be explored in prospective clinical studies to determine its potential clinical application as a predictive biomarker. Original submitted 11 February 2014; Revision submitted 3 November 2014
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Affiliation(s)
- Xiangning Meng
- Laboratory of Medical Genetics, Harbin Medical University, Harbin 150081, China
| | - Geng Wang
- Department of Anatomy, Harbin Medical University, Harbin 150081, China
| | - Rongwei Guan
- Laboratory of Medical Genetics, Harbin Medical University, Harbin 150081, China
| | - Xueyuan Jia
- Laboratory of Medical Genetics, Harbin Medical University, Harbin 150081, China
| | - Wei Gao
- Laboratory of Medical Genetics, Harbin Medical University, Harbin 150081, China
| | - Jie Wu
- Laboratory of Medical Genetics, Harbin Medical University, Harbin 150081, China
| | - Jingcui Yu
- The Second Affiliated Hospital, Harbin Medical University, Harbin 150081, China
| | - Peng Liu
- Laboratory of Medical Genetics, Harbin Medical University, Harbin 150081, China
| | - Yang Yu
- Laboratory of Medical Genetics, Harbin Medical University, Harbin 150081, China
| | - Wenjing Sun
- Laboratory of Medical Genetics, Harbin Medical University, Harbin 150081, China
| | - Haiying Dong
- Department of Internal Medicine-Oncology, Zhejiang Province People's Hospital, Hangzhou 310014, China
| | - Songbin Fu
- Laboratory of Medical Genetics, Harbin Medical University, Harbin 150081, China
- Key Laboratory of Medical Genetics (Harbin Medical University), Heilongjiang Higher Education Institutions, Harbin 150081, China
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