101
|
Chamberlain MC, Baik CS, Gadi VK, Bhatia S, Chow LQM. Systemic therapy of brain metastases: non-small cell lung cancer, breast cancer, and melanoma. Neuro Oncol 2017; 19:i1-i24. [PMID: 28031389 PMCID: PMC5193029 DOI: 10.1093/neuonc/now197] [Citation(s) in RCA: 146] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Brain metastases (BM) occur frequently in many cancers, particularly non-small cell lung cancer (NSCLC), breast cancer, and melanoma. The development of BM is associated with poor prognosis and has an adverse impact on survival and quality of life. Commonly used therapies for BM such as surgery or radiotherapy are associated with only modest benefits. However, recent advances in systemic therapy of many cancers have generated considerable interest in exploration of those therapies for treatment of intracranial metastases.This review discusses the epidemiology of BM from the aforementioned primary tumors and the challenges of using systemic therapies for metastatic disease located within the central nervous system. Cumulative data from several retrospective and small prospective studies suggest that molecularly targeted systemic therapies may be an effective option for the treatment of BM from NSCLC, breast cancer, and melanoma, either as monotherapy or in conjunction with other therapies. Larger prospective studies are warranted to further characterize the efficacy and safety profiles of these targeted agents for the treatment of BM.
Collapse
Affiliation(s)
- Marc C Chamberlain
- Seattle Cancer Center Alliance, Seattle, Washington (M.C.C., C.S.B., V.K.G., S.B., L.Q.M.C.); Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington (C.S.B., V.K.G., L.Q.M.C.); Departments of Neurology and Neurological Surgery, University of Washington, Seattle, Washington (M.C.C.); Division of Medical Oncology, University of Washington, Seattle, Washington (C.S.B., V.K.G., S.B., L.Q.M.C)
| | - Christina S Baik
- Seattle Cancer Center Alliance, Seattle, Washington (M.C.C., C.S.B., V.K.G., S.B., L.Q.M.C.); Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington (C.S.B., V.K.G., L.Q.M.C.); Departments of Neurology and Neurological Surgery, University of Washington, Seattle, Washington (M.C.C.); Division of Medical Oncology, University of Washington, Seattle, Washington (C.S.B., V.K.G., S.B., L.Q.M.C)
| | - Vijayakrishna K Gadi
- Seattle Cancer Center Alliance, Seattle, Washington (M.C.C., C.S.B., V.K.G., S.B., L.Q.M.C.); Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington (C.S.B., V.K.G., L.Q.M.C.); Departments of Neurology and Neurological Surgery, University of Washington, Seattle, Washington (M.C.C.); Division of Medical Oncology, University of Washington, Seattle, Washington (C.S.B., V.K.G., S.B., L.Q.M.C)
| | - Shailender Bhatia
- Seattle Cancer Center Alliance, Seattle, Washington (M.C.C., C.S.B., V.K.G., S.B., L.Q.M.C.); Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington (C.S.B., V.K.G., L.Q.M.C.); Departments of Neurology and Neurological Surgery, University of Washington, Seattle, Washington (M.C.C.); Division of Medical Oncology, University of Washington, Seattle, Washington (C.S.B., V.K.G., S.B., L.Q.M.C)
| | - Laura Q M Chow
- Seattle Cancer Center Alliance, Seattle, Washington (M.C.C., C.S.B., V.K.G., S.B., L.Q.M.C.); Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington (C.S.B., V.K.G., L.Q.M.C.); Departments of Neurology and Neurological Surgery, University of Washington, Seattle, Washington (M.C.C.); Division of Medical Oncology, University of Washington, Seattle, Washington (C.S.B., V.K.G., S.B., L.Q.M.C)
| |
Collapse
|
102
|
Cedrych I, Kruczała MA, Walasek T, Jakubowicz J, Blecharz P, Reinfuss M. Systemic treatment of non-small cell lung cancer brain metastases. Contemp Oncol (Pozn) 2016; 20:352-357. [PMID: 28373815 PMCID: PMC5371701 DOI: 10.5114/wo.2016.64593] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 07/27/2015] [Indexed: 12/02/2022] Open
Abstract
In the systemic treatment of brain metastases from non-small cell lung cancer (BMF-NSCLC) chemo- and targeted therapy are used. Response rates after platinum-based chemotherapy, range from 23% to 45%. Development of epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs): gefitinib or erlotinib, was an improvement in treatment of advanced NSCLC patients. EGFR mutations are present in 10-25% of NSCLC (mostly adenocarcinoma), and up to 55% in never-smoking women of East Asian descent. In the non-selected group of patients with BMF-NSCLC, the overall response rates after gefitinib or erlotinib treatment range from 10% to 38%, and the duration of response ranges from 9 to 13.5 months. In the case of present activating EGFR mutation, the response rate after EGRF-TKIs is greater than 50%, and in selected groups (adenocarcinoma, patients of Asian descent, never-smokers, asymptomatic BMF-NSCLC) even 70%. Gefitinib or erlotinib treatment improves survival of BMF-NSCLC patients with EGFR mutation in comparison to cases without the presence of this mutation. There is no data on the activity of the anti-EML4-ALK agent crizotinib. Bevacizumab, recombinant humanised monoclonal antibody anti-VEGF, in the treatment of advanced non-squamous NSCLC patients is a subject of intense research. Data from a clinical trial enrolling patients with pretreated or occult BMF-NSCLC proved that the addition of bevacizumab to various chemotherapy agents or erlotinib is a safe and efficient treatment, associated with a low incidence of CSN haemorrhages. However, the efficacy and safety of bevacizumab used for therapeutic intent, regarding active brain metastases is unknown.
Collapse
Affiliation(s)
- Ida Cedrych
- Department of Systemic and Generalised Malignancies, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Krakow Branch, Poland
| | - Maksymilian A. Kruczała
- Department of Systemic and Generalised Malignancies, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Krakow Branch, Poland
| | - Tomasz Walasek
- Department of Radiotherapy, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Krakow Branch, Poland
| | - Jerzy Jakubowicz
- Department of Oncology, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Krakow Branch, Poland
| | - Paweł Blecharz
- Department of Gynecologic Oncology, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Krakow Branch, Poland
| | - Marian Reinfuss
- Department of Radiotherapy, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Krakow Branch, Poland
| |
Collapse
|
103
|
Baseline neutrophil-lymphocyte ratio is associated with baseline and subsequent presence of brain metastases in advanced non-small-cell lung cancer. Sci Rep 2016; 6:38585. [PMID: 27924837 PMCID: PMC5141478 DOI: 10.1038/srep38585] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 11/09/2016] [Indexed: 12/22/2022] Open
Abstract
We examined the predictive value of neutrophil–lymphocyte ratio (NLR) by examining their association with the baseline presence and subsequent development of brain metastases in patients with stage IV non-small cell lung cancer (NSCLC). We examined the predictive value of NLR for brain metastasis in 260 stage IV NSCLC. Logistic regression models and competing risk analysis were used to determine the association of NLR with baseline and subsequent presence of brain metastases. Multivariate analysis reveals that patients with high NLR (≥4.95) had significantly more brain metastases at diagnosis than those with low NLR (Odds Ratio = 2.59, P = 0.01). In patients who had no baseline brain metastasis, competing risks analysis revealed that patients with high NLR showed higher cumulative incidence of subsequent brain metastases, compared to those with low NLR (P = 0.017). A high NLR was associated with the baseline presence or the subsequent development of brain metastases, particularly in the group with adenocarcinoma (P = 0.013 and P = 0.044, respectively). Furthermore, an increase in NLR during treatment was associated with subsequent brain metastases (P = 0.004). The NLR is an independent predictive factor for the baseline presence of brain metastases and subsequent brain metastases in stage IV NSCLC.
Collapse
|
104
|
Economopoulou P, Mountzios G. Non-small cell lung cancer (NSCLC) and central nervous system (CNS) metastases: role of tyrosine kinase inhibitors (TKIs) and evidence in favor or against their use with concurrent cranial radiotherapy. Transl Lung Cancer Res 2016; 5:588-598. [PMID: 28149754 DOI: 10.21037/tlcr.2016.12.06] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Central nervous system (CNS) metastases, including brain metastases (BM) and leptomeningeal metastases (LM) represent a frequent complication of non-small cell lung cancer (NSCLC). Patients with BM comprise a heterogeneous group, with a median survival that ranges from 3 to 14 months. However, in the majority of patients, the occurrence of CNS metastases is usually accompanied by severe morbidity and substantial deterioration in quality of life. Local therapies, such as whole brain radiotherapy (WBRT), stereotactic radiosurgery (SRS) or surgical resection, either alone or as part of a multimodality treatment are available treatment strategies for BM and the choice of therapy varies depending on patient group and prognosis. Meanwhile, introduction of tyrosine kinase inhibitors (TKIs) in clinical practice has led to individualization of therapy based upon the presence of the exact abnormality, resulting in a major therapeutic improvement in patients with NSCLC who harbor epidermal growth factor receptor (EGFR) activating mutations or anaplastic lymphoma kinase (ALK) gene rearrangements, respectively. Based on their clinical activity in systemic disease, such molecular agents could offer the promise of improved BM control without substantial toxicity; however, their role in combination with radiotherapy is controversial. In this review, we discuss the controversy regarding the use of TKIs in combination with radiotherapy and illustrate future perspectives in the treatment of BM in NSCLC.
Collapse
Affiliation(s)
| | - Giannis Mountzios
- Department of Medical Oncology, 251 Airforce General Hospital, Athens, Greece
| |
Collapse
|
105
|
Proto C, Imbimbo M, Gallucci R, Brissa A, Signorelli D, Vitali M, Macerelli M, Corrao G, Ganzinelli M, Greco FG, Garassino MC, Lo Russo G. Epidermal growth factor receptor tyrosine kinase inhibitors for the treatment of central nervous system metastases from non-small cell lung cancer: the present and the future. Transl Lung Cancer Res 2016; 5:563-578. [PMID: 28149752 DOI: 10.21037/tlcr.2016.10.16] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Lung cancer is one of the major causes of cancer related mortality worldwide. Brain metastases (BM) complicate clinical evolution of non-small cell lung cancer (NSCLC) in approximately 25-40% of cases, adversely influencing quality of life (QoL) and overall survival (OS). Systemic therapy remains the standard strategy for metastatic disease. Nevertheless, the blood-brain barrier (BBB) makes central nervous system (CNS) a sanctuary site. To date, the combination of chemotherapy with whole brain radiation therapy (WBRT), surgery and/or stereotactic radiosurgery (SRS) represents the most used treatment for patients (pts) with intracranial involvement. However, due to their clinical conditions, many pts are not able to undergo local treatments. Targeted therapies directed against epidermal growth factor receptor (EGFR), such as gefitinib, erlotinib and afatinib, achieved important improvements in EGFR mutated NSCLC with favorable toxicity profile. Although their role is not well defined, the reported objective response rate (ORR) and the good tolerance make EGFR-tyrosine kinase inhibitors (TKIs) an interesting valid alternative for NSCLC pts with BM, especially for those harboring EGFR mutations. Furthermore, new-generation TKIs, such as osimertinib and rociletinib, have already shown important activity on intracranial disease and several trials are still ongoing to evaluate their efficacy. In this review we want to highlight literature data about the use and the effectiveness of EGFR-TKIs in pts with BM from NSCLC.
Collapse
Affiliation(s)
- Claudia Proto
- Department of Medical Oncology, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milano, Italy
| | - Martina Imbimbo
- Department of Medical Oncology, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milano, Italy
| | - Rosaria Gallucci
- Department of Medical Oncology, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milano, Italy
| | - Angela Brissa
- Department of Medical Oncology, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milano, Italy
| | - Diego Signorelli
- Department of Medical Oncology, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milano, Italy
| | - Milena Vitali
- Department of Medical Oncology, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milano, Italy
| | - Marianna Macerelli
- Department of Medical Oncology, University-Hospital of Santa Maria delle Grazie, Udine, Italy
| | - Giulia Corrao
- Department of Medical Oncology, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milano, Italy
| | - Monica Ganzinelli
- Department of Medical Oncology, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milano, Italy
| | | | - Marina Chiara Garassino
- Department of Medical Oncology, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milano, Italy
| | - Giuseppe Lo Russo
- Department of Medical Oncology, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milano, Italy
| |
Collapse
|
106
|
Nanjo S, Ebi H, Arai S, Takeuchi S, Yamada T, Mochizuki S, Okada Y, Nakada M, Murakami T, Yano S. High efficacy of third generation EGFR inhibitor AZD9291 in a leptomeningeal carcinomatosis model with EGFR-mutant lung cancer cells. Oncotarget 2016; 7:3847-56. [PMID: 26716903 PMCID: PMC4826174 DOI: 10.18632/oncotarget.6758] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 11/29/2015] [Indexed: 11/25/2022] Open
Abstract
Leptomeningeal carcinomatosis (LMC) remarkably decreases the quality of life of EGFR-mutant lung cancer patients. In contrast to the lesions outside the central nervous system (CNS), molecular mechanisms of EGFR tyrosine kinase inhibitor (TKI) resistance in CNS lesions including LMC are largely unknown. In this study, we established an in vivo imaging model for LMC with EGFR mutant lung cancer cell lines harboring an exon 19 deletion in EGFR and evaluated the effect of first generation EGFR-TKIs, erlotinib, second generation afatinib, and third generation AZD9291. In PC-9/ffluc model, erlotinib treatment slowed the development of LMC. Importantly, treatment with afatinib or AZD9291 apparently delayed the development of LMC. Moreover, treatment with a higher dose of AZD9291, also associated with inhibited phosphorylation of EGFR downstream molecule S6, regressed LMC refractory to the aforementioned EGFR-TKI treatments. These observations suggest that the third generation EGFR-TKI AZD9291 may be an effective treatment for first or second generation EGFR-TKI resistant LMC caused by EGFR-mutant lung cancer.
Collapse
Affiliation(s)
- Shigeki Nanjo
- Department of Medical Oncology, Kanazawa University Cancer Research Institute, Kanazawa, Japan
| | - Hiromichi Ebi
- Department of Medical Oncology, Kanazawa University Cancer Research Institute, Kanazawa, Japan
| | - Sachiko Arai
- Department of Medical Oncology, Kanazawa University Cancer Research Institute, Kanazawa, Japan
| | - Shinji Takeuchi
- Department of Medical Oncology, Kanazawa University Cancer Research Institute, Kanazawa, Japan
| | - Tadaaki Yamada
- Department of Medical Oncology, Kanazawa University Cancer Research Institute, Kanazawa, Japan
| | - Satsuki Mochizuki
- Department of Pathology, Keio University School of Medicine, Tokyo, Japan
| | - Yasunori Okada
- Department of Pathology, Keio University School of Medicine, Tokyo, Japan
| | - Mitsutoshi Nakada
- Department of Neurosurgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
| | - Takashi Murakami
- Laboratory of Tumor Biology, Takasaki University of Health and Welfare, Takasaki, Japan
| | - Seiji Yano
- Department of Medical Oncology, Kanazawa University Cancer Research Institute, Kanazawa, Japan
| |
Collapse
|
107
|
Jiang T, Su C, Li X, Zhao C, Zhou F, Ren S, Zhou C, Zhang J. EGFR TKIs plus WBRT Demonstrated No Survival Benefit Other Than That of TKIs Alone in Patients with NSCLC and EGFR Mutation and Brain Metastases. J Thorac Oncol 2016; 11:1718-28. [DOI: 10.1016/j.jtho.2016.05.013] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 05/03/2016] [Accepted: 05/05/2016] [Indexed: 11/30/2022]
|
108
|
Khalifa J, Amini A, Popat S, Gaspar LE, Faivre-Finn C. Brain Metastases from NSCLC: Radiation Therapy in the Era of Targeted Therapies. J Thorac Oncol 2016; 11:1627-43. [PMID: 27343440 DOI: 10.1016/j.jtho.2016.06.002] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 06/02/2016] [Accepted: 06/09/2016] [Indexed: 02/07/2023]
Abstract
Brain metastases (BMs) will develop in a large proportion of patients with NSCLC throughout the course of their disease. Among patients with NSCLC with oncogenic drivers, mainly EGFR activating mutations and anaplastic lymphoma receptor tyrosine kinase gene (ALK) rearrangements, the presence of BM is a common secondary localization of disease both at the time of diagnosis and at relapse. Because of the limited penetration of a wide range of drugs across the blood-brain barrier, radiotherapy is considered the cornerstone of treatment of BMs. However, evidence of dramatic intracranial response rates has been reported in recent years with targeted therapies such as tyrosine kinase inhibitors and has been supported by new insights into pharmacokinetics to increase rates of tyrosine kinase inhibitors' penetration of the cerebrospinal fluid (CSF). In this context, the combination of brain radiotherapy and targeted therapies seems relevant, and there is a strong radiobiological rationale to harness the radiosentizing effect of the drugs. Nevertheless, to date, there is a paucity of high-level clinical evidence supporting the combination of brain radiotherapy and targeted therapies in patients with NSCLC and BMs, and there are often methodological biases in reported studies, such as the lack of stratification by mutation status. Moreover, among asymptomatic patients not suitable for ablative treatment, this strategy is challenged by the promising results associated with the administration of targeted therapies alone. Herein, we review the biological rationale to combine targeted therapies and brain radiotherapy for patients with NSCLC and BMs, report the clinical data available to date, and discuss future directions to improve outcome in this group of patients.
Collapse
Affiliation(s)
- Jonathan Khalifa
- Radiotherapy Related Research, The Christie National Health Service Foundation Trust, Manchester, United Kingdom.
| | - Arya Amini
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
| | - Sanjay Popat
- Lung Cancer Unit, Royal Marsden Hospital, London, United Kingdom
| | - Laurie E Gaspar
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
| | - Corinne Faivre-Finn
- Radiotherapy Related Research, The Christie National Health Service Foundation Trust, Manchester, United Kingdom; Manchester Academic Health Science Centre, Institute of Cancer Sciences, Manchester Cancer Research Centre, The University of Manchester, Manchester, United Kingdom
| |
Collapse
|
109
|
Chen LF, Patel JD, Lukas RV. Advances in brain metastases presented at the American Society of Clinical Oncology 2016 Annual Meeting: Part II. Future Oncol 2016; 12:2669-2672. [PMID: 27605123 DOI: 10.2217/fon-2016-0378] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
American Society of Clinical Oncology Annual Meeting, Chicago, IL, USA, 3-7 June 2016 The American Society of Clinical Oncology Annual Meeting took place in Chicago, IL, USA, from 3 to 7 June 2016. Over 30,000 oncologists, researchers, related professionals and advocates participated in the conference, which covered all aspects of oncology. An overview of the key studies in brain metastases presented at the 2016 American Society of Clinical Oncology Annual Meeting is highlighted here. Key data presented on radiotherapy, and systemic therapy for brain metastases are reviewed.
Collapse
Affiliation(s)
- Lucy F Chen
- Section of Hematology & Oncology, University of Illinois at Chicago, Chicago, IL, USA
| | - Jyoti D Patel
- Section of Hematology & Oncology, University of Chicago, Chicago, IL, USA
| | - Rimas V Lukas
- Department of Neurology, University of Chicago, Chicago, IL, USA
| |
Collapse
|
110
|
Hung JJ, Jeng WJ, Wu YC, Chou TY, Hsu WH. Factors predicting organ-specific distant metastasis in patients with completely resected lung adenocarcinoma. Oncotarget 2016; 7:58261-58273. [PMID: 27542223 PMCID: PMC5295429 DOI: 10.18632/oncotarget.11338] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2015] [Accepted: 07/17/2016] [Indexed: 02/07/2023] Open
Abstract
The aim of the study is to demonstrate the relationship between clinicopathological variables and organ sites of metastasis in resected lung adenocarcinoma. The clinicopathological characteristics of 748 patients of resected lung adenocarcinoma at Taipei Veterans General Hospital between 2004 and 2012 were retrospectively reviewed. The prognostic value of clinicopathological variables for specific organ site metastasis-free survival was demonstrated. Among the 182 patients with distant metastasis, 93 (51.1%) patients developed contralateral lung metastasis, 81 (44.5%) had brain metastasis, 71 (39.0%) had bone metastasis, and 18 (8.9%) had liver metastasis during follow-up. Acinar predominant (Hazard ratio [HR], 0.468; 95% confidence interval [CI]: 0.250 to 0.877; P = 0.018) was significantly associated with less contralateral lung metastasis in multivariate analysis. Micropapillary predominant (HR, 2.686; 95% CI, 1.270 to 5.683; P = 0.010) was significantly associated with brain metastasis. Acinar predominant (HR, 0.461; 95% CI, 0.216 to 0.986; P = 0.046) was a significant prognostic factor for better contralateral lung metastasis-free survival in multivariate analysis. Micropapillary predominant (HR, 2.186; 95% CI, 1.148 to 4.163; P = 0.017) and solid predominant (HR, 4.093; 95% CI, 1.340 to 12.504; P = 0.013) were significant prognostic factors for worse brain metastasis-free survival and liver metastasis free-survival, respectively. There are significant differences in metastatic behavior between predominant pathological subtypes of lung adenocarcinoma. This information is important for patient follow-up strategy and identification of organ-specific distant metastasis. Prospective multi-institutional studies are mandatory for further validation.
Collapse
Affiliation(s)
- Jung-Jyh Hung
- Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital and School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Wen-Juei Jeng
- Department of Internal Medicine, Chang Gung Memorial Hospital and School of Medicine, Chang Gung University, Taipei, Taiwan
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yu-Chung Wu
- Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital and School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Teh-Ying Chou
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wen-Hu Hsu
- Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital and School of Medicine, National Yang-Ming University, Taipei, Taiwan
| |
Collapse
|
111
|
Ochiai S, Nomoto Y, Watanabe Y, Yamashita Y, Toyomasu Y, Kawamura T, Takada A, Noriko, Sakuma H. The impact of epidermal growth factor receptor mutations on patterns of disease recurrence after chemoradiotherapy for locally advanced non-small cell lung cancer: a literature review and pooled analysis. JOURNAL OF RADIATION RESEARCH 2016; 57:449-459. [PMID: 27534790 PMCID: PMC5045087 DOI: 10.1093/jrr/rrw075] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 04/27/2016] [Accepted: 05/25/2016] [Indexed: 06/15/2024]
Abstract
The purpose of this review was to evaluate the impact of epidermal growth factor receptor (EGFR) mutation status on disease recurrence in patients treated with chemoradiotherapy (CRT) for locally advanced non-small cell lung cancer (NSCLC). A literature search was conducted and a total of three studies were analyzed. There was no significant difference in the objective response rate between the EGFR mutation group and the EGFR wild-type group (odds ratios [OR] 1.46, 95% CI, 0.79-2.70, P = 0.228), and there was no significant difference in the incidence of disease recurrence (OR 1.37, 95% CI, 0.68-2.75, P = 0.379) between the two groups. There were significant difference in the incidence of local/locoregional progression (LP) (OR 0.35, 95% CI, 0.18-0.71, P = 0.003) and distant progression (DP) (OR 2.97, 95% CI, 1.59-5.54, P < 0.001). Brain metastasis (BM) was one of the main recurrence patterns of DP, and the incidence was significantly higher in the EGFR mutant group (OR 2.75, 95% CI, 1.43-5.31, P = 0.003). There were no statistically significant heterogeneities in these pooled analyses. The patterns of recurrence after CRT for locally advanced NSCLC were different according to EGFR mutation status. LP after CRT in patients with EGFR mutation was less frequent, but the high incidence of DP, especially BM, continued to be the major problem. On the other hand, LP continued to be the major problem in EGFR wild-type patients. In multimodality treatment for inoperable locally advanced NSCLC, we may need to consider different treatment strategies according to EGFR mutation status.
Collapse
Affiliation(s)
- Satoru Ochiai
- Department of Radiation Oncology, Matsusaka Central Hospital, 102 Kobou Kawai-machi, Matsusaka, Mie 515-8566, Japan
| | - Yoshihito Nomoto
- Department of Radiology, Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | - Yui Watanabe
- Department of Radiology, Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | - Yasufumi Yamashita
- Department of Radiation Oncology, Matsusaka Central Hospital, 102 Kobou Kawai-machi, Matsusaka, Mie 515-8566, Japan
| | - Yutaka Toyomasu
- Department of Radiology, Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | - Tomoko Kawamura
- Department of Radiology, Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | - Akinori Takada
- Department of Radiology, Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | - Noriko
- Department of Radiology, Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | - Hajime Sakuma
- Department of Radiology, Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| |
Collapse
|
112
|
Luo YH, Wu CH, Huang CY, Wu CW, Wu WS, Lee YC, Whang-Peng J, Chen YM. Brain metastasis features and association with tumor epidermal growth factor receptor mutation in patients with adenocarcinoma of the lung. Asia Pac J Clin Oncol 2016; 13:e440-e448. [PMID: 27550395 DOI: 10.1111/ajco.12576] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2015] [Revised: 05/01/2016] [Accepted: 05/31/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Yung-Hung Luo
- Department of Chest Medicine; Taipei Veterans General Hospital; Taiwan Republic of China
- School of Medicine; National Yang-Ming University; Taiwan Republic of China
| | - Chieh-Hung Wu
- Department of Chest Medicine; Taipei Veterans General Hospital; Taiwan Republic of China
- School of Medicine; National Yang-Ming University; Taiwan Republic of China
| | - Chu-Yun Huang
- Hsinchu Mackay Memorial Hospital; Taiwan Republic of China
| | - Chih-Wei Wu
- Taipei Tzu Chi Hospital; Taiwan Republic of China
| | - Wen-Shuo Wu
- Department of Chest Medicine; Taipei Veterans General Hospital; Taiwan Republic of China
- School of Medicine; National Yang-Ming University; Taiwan Republic of China
| | - Yu-Chin Lee
- Sijhih Cathay General Hospital; Taiwan Republic of China
| | - Jacqueline Whang-Peng
- Taipei Cancer Center, College of Medical Science and Technology; Taipei Medical University; Taiwan Republic of China
| | - Yuh-Min Chen
- Department of Chest Medicine; Taipei Veterans General Hospital; Taiwan Republic of China
- School of Medicine; National Yang-Ming University; Taiwan Republic of China
- Taipei Cancer Center, College of Medical Science and Technology; Taipei Medical University; Taiwan Republic of China
| |
Collapse
|
113
|
Russo A, Franchina T, Ricciardi GRR, Picone A, Ferraro G, Zanghì M, Toscano G, Giordano A, Adamo V. A decade of EGFR inhibition in EGFR-mutated non small cell lung cancer (NSCLC): Old successes and future perspectives. Oncotarget 2016; 6:26814-25. [PMID: 26308162 PMCID: PMC4694955 DOI: 10.18632/oncotarget.4254] [Citation(s) in RCA: 132] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2015] [Accepted: 06/01/2015] [Indexed: 12/23/2022] Open
Abstract
The discovery of Epidermal Growth Factor Receptor (EGFR) mutations in Non Small Cell Lung Cancer (NSCLC) launched the era of personalized medicine in advanced NSCLC, leading to a dramatic shift in the therapeutic landscape of this disease. After ten years from the individuation of activating mutations in the tyrosine kinase domain of the EGFR in NSCLC patients responding to the EGFR tyrosine kinase inhibitor (TKI) Gefitinib, several progresses have been done and first line treatment with EGFR TKIs is a firmly established option in advanced EGFR-mutated NSCLC patients. During the last decade, different EGFR TKIs have been developed and three inhibitors have been approved so far in these selected patients. However, despite great breakthroughs have been made, treatment of these molecularly selected patients poses novel therapeutic challenges, such as emerging of acquired resistance, brain metastases development or the need to translate these treatments in earlier clinical settings, such as adjuvant therapy. The aim of this paper is to provide a comprehensive review of the major progresses reported so far in the EGFR inhibition in this molecularly-selected subgroup of NSCLC patients, from the early successes with first generation EGFR TKIs, Erlotinib and Gefitinib, to the novel irreversible and mutant-selective inhibitors and ultimately the emerging challenges that we, in the next future, are called to deal with.
Collapse
Affiliation(s)
- Alessandro Russo
- Medical Oncology Unit AOOR Papardo-Piemonte & Department of Human Pathology, University of Messina, Messina, Italy
| | - Tindara Franchina
- Medical Oncology Unit AOOR Papardo-Piemonte & Department of Human Pathology, University of Messina, Messina, Italy
| | | | - Antonio Picone
- Medical Oncology Unit AOOR Papardo-Piemonte & Department of Human Pathology, University of Messina, Messina, Italy
| | - Giuseppa Ferraro
- Medical Oncology Unit AOOR Papardo-Piemonte & Department of Human Pathology, University of Messina, Messina, Italy
| | - Mariangela Zanghì
- Medical Oncology Unit AOOR Papardo-Piemonte & Department of Human Pathology, University of Messina, Messina, Italy
| | - Giuseppe Toscano
- Medical Oncology Unit AOOR Papardo-Piemonte & Department of Human Pathology, University of Messina, Messina, Italy
| | - Antonio Giordano
- Sbarro Institute for Cancer Research and Molecular Medicine, Center for Biotechnology, Temple University, Philadelphia, Pennsylvania, USA
| | - Vincenzo Adamo
- Medical Oncology Unit AOOR Papardo-Piemonte & Department of Human Pathology, University of Messina, Messina, Italy
| |
Collapse
|
114
|
Jin Y, Xin T. [Research Progress of EGFR-TKI Therapy for Patients with Central Nervous System
Metastases from Non-small Cell Lung Cancer]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2016; 19:496-500. [PMID: 27561797 PMCID: PMC5972986 DOI: 10.3779/j.issn.1009-3419.2016.08.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Approximately half of all patients with non-small cell lung cancer (NSCLC) develop central nervous system metastases during the course of their disease which indicate poor prognosis. A part of NSCLC patients demonstrates activating epidermal growth factor receptor gene (EGFR) mutations who represent effectiveness and well tolerance of EGFR-specific tyrosine kinase inhibitors (TKIs) therapy. Although the systemic efficacy of targeted agents is established, the efficacy of central nervous system (CNS) metastases is not as well characterized. In this article, we review recent data on the use of EGFR inhibitors for treatment of patients with NSCLC and CNS metastases.
Collapse
Affiliation(s)
- Yinghua Jin
- The Second Affiliated Hospital of Harbin Medical University, Harbin 150001, China
| | - Tao Xin
- The Second Affiliated Hospital of Harbin Medical University, Harbin 150001, China
| |
Collapse
|
115
|
Wei Z, Ye X, Yang X, Huang G, Li W, Wang J, Han X, Meng M, Ni Y. Advanced non small cell lung cancer: response to microwave ablation and EGFR Status. Eur Radiol 2016; 27:1685-1694. [PMID: 27436020 DOI: 10.1007/s00330-016-4474-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Revised: 05/12/2016] [Accepted: 06/16/2016] [Indexed: 12/22/2022]
|
116
|
Lee DW, Lee KH, Kim JW, Keam B. Molecular Targeted Therapies for the Treatment of Leptomeningeal Carcinomatosis: Current Evidence and Future Directions. Int J Mol Sci 2016; 17:ijms17071074. [PMID: 27399673 PMCID: PMC4964450 DOI: 10.3390/ijms17071074] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 06/26/2016] [Accepted: 06/28/2016] [Indexed: 12/16/2022] Open
Abstract
Leptomeningeal carcinomatosis (LMC) is the multifocal seeding of cerebrospinal fluid and leptomeninges by malignant cells. The incidence of LMC is approximately 5% in patients with malignant tumors overall and the rate is increasing due to increasing survival time of cancer patients. Eradication of the disease is not yet possible, so the treatment goals of LMC are to improve neurologic symptoms and to prolong survival. A standard treatment for LMC has not been established due to low incidences of LMC, the rapidly progressing nature of the disease, heterogeneous populations with LMC, and a lack of randomized clinical trial results. Treatment options for LMC include intrathecal chemotherapy, systemic chemotherapy, and radiation therapy, but the prognoses remain poor with a median survival of <3 months. Recently, molecular targeted agents have been applied in the clinic and have shown groundbreaking results in specific patient groups epidermal growth factor receptor (EGFR)-targeted therapy or an anaplastic lymphoma kinase (ALK) inhibitor in lung cancer, human epidermal growth factor receptor 2 (HER2)-directed therapy in breast cancer, and CD20-targeted therapy in B cell lymphoma). Moreover, there are results indicating that the use of these agents under proper dose and administration routes can be effective for managing LMC. In this article, we review molecular targeted agents for managing LMC.
Collapse
Affiliation(s)
- Dae-Won Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul 03080, Korea.
| | - Kyung-Hun Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul 03080, Korea.
- Cancer Research Institute, Seoul National University College of Medicine, Seoul 03080, Korea.
| | - Jin Wook Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul 03080, Korea.
| | - Bhumsuk Keam
- Department of Internal Medicine, Seoul National University Hospital, Seoul 03080, Korea.
- Cancer Research Institute, Seoul National University College of Medicine, Seoul 03080, Korea.
| |
Collapse
|
117
|
Wang DD, Chen X, Yu DD, Yang SJ, Shen HY, Sha HH, Zhong SL, Zhao JH, Tang JH. miR-197: A novel biomarker for cancers. Gene 2016; 591:313-9. [PMID: 27320730 DOI: 10.1016/j.gene.2016.06.035] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 06/06/2016] [Accepted: 06/15/2016] [Indexed: 12/19/2022]
Abstract
microRNAs (miRNAs) are small noncoding RNAs that could regulate post-transcription level through binding to 3' untranslated region (3'UTR) of target messenger RNAs (mRNAs), which were reported to be related with the incidence and development of diverse neoplasms. Among them, miR-197 was confirmed to play a vital role of oncogene or anti-oncogene in different cancers via targeting key tumorigenic or tumor-suppressive genes. Additionally, miR-197 had extensively been studied in carcinogenesis progression of cancers through various mechanisms, including apoptosis, proliferation, angiogenesis, metastasis, drug resistance and tumor suppressor, and also played a role in prognosis of cancers. In this review, we summarized the roles of miR-197 in cancers and considered it as a potentially novel biomarker for different cancers, offering an alternatively secure and effective tool in molecular targeting cancer treatment.
Collapse
Affiliation(s)
- Dan-Dan Wang
- The First Clinical School of Nanjing Medical University, Nanjing 210009, China; The Forth Clinical School of Nanjing Medical University, Nanjing 210009, China
| | - Xiu Chen
- The Forth Clinical School of Nanjing Medical University, Nanjing 210009, China; Department of General Surgery, Nanjing Medical University Affiliated Cancer Hospital Cancer Institute of Jiangsu Province, Baiziting 42, Nanjing 210009, China
| | - Dan-Dan Yu
- The First Clinical School of Nanjing Medical University, Nanjing 210009, China; Department of General Surgery, Nanjing Medical University Affiliated Cancer Hospital Cancer Institute of Jiangsu Province, Baiziting 42, Nanjing 210009, China
| | - Su-Jin Yang
- The Forth Clinical School of Nanjing Medical University, Nanjing 210009, China; Department of General Surgery, Nanjing Medical University Affiliated Cancer Hospital Cancer Institute of Jiangsu Province, Baiziting 42, Nanjing 210009, China
| | - Hong-Yu Shen
- The Forth Clinical School of Nanjing Medical University, Nanjing 210009, China; Department of General Surgery, Nanjing Medical University Affiliated Cancer Hospital Cancer Institute of Jiangsu Province, Baiziting 42, Nanjing 210009, China
| | - Huan-Huan Sha
- The Forth Clinical School of Nanjing Medical University, Nanjing 210009, China; Department of General Surgery, Nanjing Medical University Affiliated Cancer Hospital Cancer Institute of Jiangsu Province, Baiziting 42, Nanjing 210009, China
| | - Shan-Liang Zhong
- Center of Clinical Laboratory, Nanjing Medical University Affiliated Cancer Hospital Cancer Institute of Jiangsu Province, Baiziting 42, Nanjing 210009, China
| | - Jian-Hua Zhao
- Center of Clinical Laboratory, Nanjing Medical University Affiliated Cancer Hospital Cancer Institute of Jiangsu Province, Baiziting 42, Nanjing 210009, China
| | - Jin-Hai Tang
- Department of General Surgery, the First Affiliated Hospital with Nanjing Medical University, Nanjing 210029, China; Department of General Surgery, Nanjing Medical University Affiliated Cancer Hospital Cancer Institute of Jiangsu Province, Baiziting 42, Nanjing 210009, China.
| |
Collapse
|
118
|
Hsu F, De Caluwe A, Anderson D, Nichol A, Toriumi T, Ho C. EGFR mutation status on brain metastases from non-small cell lung cancer. Lung Cancer 2016; 96:101-7. [DOI: 10.1016/j.lungcan.2016.04.004] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 03/03/2016] [Accepted: 04/05/2016] [Indexed: 10/22/2022]
|
119
|
Xu J, Liu X, Yang S, Zhang X, Shi Y. Efficacy and safety of icotinib in patients with brain metastases from lung adenocarcinoma. Onco Targets Ther 2016; 9:2911-7. [PMID: 27274284 PMCID: PMC4876100 DOI: 10.2147/ott.s102472] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE The objective of this study was to evaluate the efficacy and safety of icotinib in patients with brain metastases (BMs) from lung adenocarcinoma. PATIENTS AND METHODS Clinical data of 28 cases with BMs from lung adenocarcinoma were retrospectively analyzed. All the patients took 125 mg icotinib orally three times a day. Progression of disease, intolerable adverse reactions, and number of deaths were recorded. RESULTS For all the patients, the remission rate of icotinib was 67.8% and the disease control rate was 96.4%. The median overall survival time of patients was 21.2 months, and the median progression-free survival time of patients was 10.9 months. Only mild adverse events of grade 1/2 were observed during the treatment. CONCLUSION Icotinib was an effective and safe strategy to treat patients with BMs from lung adenocarcinoma.
Collapse
Affiliation(s)
- Jianping Xu
- Department of Internal Medicine, Cancer Hospital, Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Xiaoyan Liu
- Department of Internal Medicine, Cancer Hospital, Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Sheng Yang
- Department of Internal Medicine, Cancer Hospital, Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Xiangru Zhang
- Department of Internal Medicine, Cancer Hospital, Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Yuankai Shi
- Department of Internal Medicine, Cancer Hospital, Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| |
Collapse
|
120
|
Hanibuchi M, Kim SJ, Fidler IJ, Nishioka Y. The molecular biology of lung cancer brain metastasis: an overview of current comprehensions and future perspectives. THE JOURNAL OF MEDICAL INVESTIGATION 2016; 61:241-53. [PMID: 25264041 DOI: 10.2152/jmi.61.241] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Brain metastases occur in 20-40% of patients with advanced malignancies and lung cancer is one of the most common causes of brain metastases. The occurrence of brain metastases is associated with poor prognosis and high morbidity in patients with advanced lung cancer, even after intensive multimodal therapy. Progress in treating brain metastases has been hampered by a lack of model systems, a lack of human tissue samples, and the exclusion of brain metastatic patients from many clinical trials. While the biology of brain metastasis is still poorly understood, it is encouraging to see more efforts are beginning to be directed toward the study of brain metastasis. During the multi-step process of metastasis, functional significance of gene expressions, changes in brain vasculature, abnormal secretion of soluble factors and activation of autocrine/paracrine signaling are considered to contribute to the brain metastasis development. A better understanding of the mechanism of this disease will help us to identify the appropriate therapeutic strategies, which leads to circumvent brain metastases. Recent findings on the biology of lung cancer brain metastases and translational leads identified by molecular studies are discussed in this review.
Collapse
Affiliation(s)
- Masaki Hanibuchi
- Department of Respiratory Medicine and Rheumatology, Institute of Health Biosciences, The University of Tokushima Graduate School
| | | | | | | |
Collapse
|
121
|
Xu JP, Liu XY, Yang S, Zhang CG, Wang L, Shi YK. Icotinib as initial treatment in lung adenocarcinoma patients with brain metastases. Thorac Cancer 2016; 7:437-41. [PMID: 27385986 PMCID: PMC4930963 DOI: 10.1111/1759-7714.12351] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 12/20/2015] [Indexed: 11/29/2022] Open
Abstract
Background To evaluate the antitumor activity and toxicity of icotinib as initial treatment in lung adenocarcinoma patients with brain metastases. Methods Twenty‐one patients with histologically or pathologically documented brain metastatic lung cancer were administered icotinib as initial treatment from 2011 to 2015 at the Cancer Institute and Hospital, Chinese Academy of Medical Sciences. Chemotherapy response was assessed by Response Evaluation Criteria in Solid Tumors and toxicity was evaluated according to National Cancer Institute‐Common Toxicity Criteria. Icotinib was administered three times per day at a dose of 125mg. Results The median overall and progression‐free survival rates were 15.2 (1.2–31.5 months, 95% confidence interval [CI] 6.6–23.7 months) and 8.9 months (0.6–30.5 months, 95% CI 3.4–14.3 months), respectively. The overall response and disease control rates were 61.9% and 90.5%, respectively. Icotinib was well tolerated, and no grade 3/4 adverse events were observed. The most common grade 1/2 adverse events included acneiform eruptions (38.1%), diarrhea (19.0%), and stomatitis (9.5%). Conclusion Icotinib is effective and well tolerated as initial treatment in lung adenocarcinoma patients with brain metastases.
Collapse
Affiliation(s)
- Jian-Ping Xu
- Department of Medical Oncology Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College Beijing China
| | - Xiao-Yan Liu
- Department of Medical Oncology Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College Beijing China
| | - Sheng Yang
- Department of Medical Oncology Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College Beijing China
| | - Chang-Gong Zhang
- Department of Medical Oncology Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College Beijing China
| | - Lin Wang
- Department of Medical Oncology Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College Beijing China
| | - Yuan-Kai Shi
- Department of Medical Oncology Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College Beijing China
| |
Collapse
|
122
|
The impact of brain metastasis on quality of life, resource utilization and survival in patients with non-small-cell lung cancer. Cancer Treat Rev 2016; 45:139-62. [DOI: 10.1016/j.ctrv.2016.03.009] [Citation(s) in RCA: 137] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 03/08/2016] [Accepted: 03/09/2016] [Indexed: 01/17/2023]
|
123
|
Brower JV, Robins HI. Erlotinib for the treatment of brain metastases in non-small cell lung cancer. Expert Opin Pharmacother 2016; 17:1013-21. [DOI: 10.1517/14656566.2016.1165206] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
124
|
Xu J, Liu X, Yang S, Zhang X, Shi Y. [Clinical Experience of Gefitinib in the Treatment of 32 Lung Adenocarcinoma Patients with Brain Metastases]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2016; 18:554-8. [PMID: 26383979 PMCID: PMC6000113 DOI: 10.3779/j.issn.1009-3419.2015.09.05] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
背景与目的 脑转移是晚期非小细胞肺癌(non-small cell lung cancer, NSCLC)常见的转移部位,预后欠佳。吉非替尼是一种表皮生长因子受体(epithelial growth factor receptor, EGFR)酪氨酸激酶抑制剂,用于治疗晚期NSCLC。本研究旨在探讨吉非替尼治疗肺腺癌脑转移的疗效及毒副反应。 方法 回顾性分析32例肺腺癌脑转移患者的临床资料,所有患者均口服吉非替尼250 mg Qd,直到疾病进展或发生不可耐受的毒副反应。 结果 全组32例患者的中位生存时间(median overall survival, mOS)和中位无进展生存时间(median progression-free survival, mPFS)分别为24.7个月和11.2个月,有效率(response rate, RR)和疾病控制率(disease control rate, DCR)分别为62.5%和93.8%。吉非替尼用于初治患者的mOS和mPFS分别为35.6个月和11.3个月,RR和DCR分别为75.0%和100.0%。吉非替尼用于复治患者的mOS和mPFS分别为18.6个月和6.7个月,RR和DCR分别为50.0%和83.3%。EGFR敏感性突变患者的mOS和mPFS分别为24.8个月和10.8个月,RR和DCR分别为75.0%和100.0%。EGFR突变状态不明患者的mOS和mPFS分别为35.6个月和12.3个月,RR和DCR分别为53.3%和86.7%。全组患者耐受性好,未观察到严重毒副反应。常见的毒副反应包括:皮疹15例(46.9%)、腹泻7例(21.9%)、口腔溃疡1例(3.1%)。 结论 吉非替尼对肺腺癌脑转移患者有效率较高且耐受性好,可以作为肺腺癌脑转移患者的一种治疗选择。
Collapse
Affiliation(s)
- Jianping Xu
- Department of Medical Oncology, Cancer Hospital Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100021, China
| | - Xiaoyan Liu
- Department of Medical Oncology, Cancer Hospital Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100021, China
| | - Sheng Yang
- Department of Medical Oncology, Cancer Hospital Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100021, China
| | - Xiangru Zhang
- Department of Medical Oncology, Cancer Hospital Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100021, China
| | - Yuankai Shi
- Department of Medical Oncology, Cancer Hospital Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100021, China
| |
Collapse
|
125
|
Lu Y, Fan Y. Combined action of EGFR tyrosine kinase inhibitors and whole-brain radiotherapy on EGFR-mutated non-small-cell lung cancer patients with brain metastasis. Onco Targets Ther 2016; 9:1135-43. [PMID: 27022274 PMCID: PMC4790505 DOI: 10.2147/ott.s95871] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background Lung cancer is the most common type of cancer to spread to the brain (brain metastasis [BM]). This study assessed the effect of epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) in combination with whole-brain radiotherapy (WBRT) on EGFR-mutant non-small-cell lung cancer (NSCLC) patients with BM. Patients and methods Thirty-nine patients, who had receieved different EGFR TKIs plus 30 Gy WBRT until disease progression, were retrospectively analyzed between 2010 and 2014. Treatment response was evaluated and survival data were collected and analyzed. Results Among the 39 patients, 18 had an EGFR exon 19 deletion and 21 had an EGFR exon 21 point mutation. After therapy, 19 (48.7%) patients had complete remission, 12 (30.8%) had partial remission, and eight (20.5%) had stable disease in the intracranial lesions. Besides, there was no single case of complete remission, 21 (53.8%) had partial remission, and 18 (46.2%) had stable disease of the extracranial lesions. The median progression-free survival (PFS) of intracranial lesions and extracranial lesions was 18 and 12 months, respectively. The median overall survival (OS) was 26 months. The univariate analysis showed that graded prognostic assessment (P=0.006) and Karnofsky Performance Scale (P=0.045) were associated with intracranial progression-free survival (iPFS), while recursive partitioning analysis (P=0.049) was associated with OS of patients. Conclusion EGFR TKIs plus concomitant WBRT controlled intracranial lesions of lung cancer metastasis and significantly improved OS of patients. Further studies will be needed to confirm whether this combination treatment could be used as a standard therapy for EGFR-mutated NSCLC patients with BM.
Collapse
Affiliation(s)
- Yunyun Lu
- The Key Laboratory of Diagnosis and Treatment Technology for Thoracic Oncology (Esophagus and Lung), Zhejiang Cancer Hospital, Zhejiang, People's Republic of China
| | - Yun Fan
- The Key Laboratory of Diagnosis and Treatment Technology for Thoracic Oncology (Esophagus and Lung), Zhejiang Cancer Hospital, Zhejiang, People's Republic of China
| |
Collapse
|
126
|
Yang TJ, Wu AJ. Cranial irradiation in patients with EGFR-mutant non-small cell lung cancer brain metastases. Transl Lung Cancer Res 2016; 5:134-7. [PMID: 26958508 DOI: 10.3978/j.issn.2218-6751.2016.01.08] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
The most effective treatment approach for brain metastases in patients with non-small cell lung cancer (NSCLC) and activating epidermal growth factor receptor (EGFR) mutations is a current subject of investigation. Cranial irradiation is the standard treatment for brain metastases, but tyrosine kinase inhibitors (TKIs) such as erlotinib have also activity against brain metastases in this subset of patients. The combination of TKI and radiotherapy is a promising one, but data is lacking to indicate whether this is superior to erlotinib or whole brain radiation therapy (WBRT) alone. Retrospective data suggest that WBRT achieves more durable intracranial control compared to erlotinib alone. Randomized, prospective studies will be necessary to determine whether TKI, cranial irradiation, or both is the optimal initial treatment for brain metastases in EGFR-mutant NSCLC.
Collapse
Affiliation(s)
- T Jonathan Yang
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Abraham J Wu
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| |
Collapse
|
127
|
Radiographic patterns and survival of patients with early and late brain metastases in EGFR wild type and mutant non small cell lung cancer. J Neurooncol 2016; 127:525-33. [DOI: 10.1007/s11060-016-2057-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 01/07/2016] [Indexed: 01/26/2023]
|
128
|
Li BT, Lou E, Hsu M, Yu HA, Naidoo J, Zauderer MG, Sima C, Johnson ML, Daras M, DeAngelis LM, Fleisher M, Kris MG, Azzoli CG. Serum Biomarkers Associated with Clinical Outcomes Fail to Predict Brain Metastases in Patients with Stage IV Non-Small Cell Lung Cancers. PLoS One 2016; 11:e0146063. [PMID: 26730601 PMCID: PMC4701719 DOI: 10.1371/journal.pone.0146063] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 12/11/2015] [Indexed: 01/13/2023] Open
Abstract
Background Lung cancers account for the majority of brain metastases which pose major therapeutic challenges. Biomarkers prognosticating for the development of brain metastases in patients with non-small cell lung cancers (NSCLC) may improve personalized care. Six serum proteomic biomarkers were previously investigated at Memorial Sloan Kettering but their associations with brain metastases were unknown. Methods Serum NSE, CYFRA 21–1, ProGRP, SCC-Ag, TIMP1, and HE4 by ELISA-based proteomic assays were prospectively collected from consecutive patients with stage IV NSCLC. Pre-treatment serum biomarker levels as well as age, histology, and epidermal growth factor receptor (EGFR) mutation status were evaluated for association with the baseline presence of brain metastases using logistic regression and multivariable analysis. For patients without brain metastases at baseline, the cumulative incidence of subsequent brain metastases were compared according to baseline biomarkers and clinical factors using Gray’s test. Results A total of 118 patients were enrolled, 31 (26%; 95% CI 0.19–0.35) had brain metastases at baseline and a further 26 (22%; 95% CI 0.15–0.30) developed brain metastases subsequently. Pre-treatment serum biomarker levels were available in 104 patients. There was no significant association between the six serum biomarkers and the baseline presence or subsequent development of brain metastases. Age younger than 65 years was the only clinical factor significantly associated with brain metastasis at baseline (OR 3.00; 95% CI 1.22–7.34, P = 0.02) by multivariable analysis. A trend toward increased cumulative incidence of subsequent brain metastases was observed in patients with EGFR mutation (p = 0.2), but this was not statistically significant possibly due to small sample size. Conclusions Serum NSE, CYFRA 21–1, Pro-GRP, SCC-Ag, TIMP1, and HE4 are not significantly associated with brain metastases. Our methods taking into account follow-up time may be applied to independent datasets to identify a patient cohort with a higher biologic propensity for developing brain metastases. Such information may be useful for the study of agents targeting the development of brain metastases.
Collapse
Affiliation(s)
- Bob T. Li
- Thoracic Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, 300 E 66th Street, 12 Floor, New York, NY, 10065, United States of America
- Sydney Medical School, University of Sydney, Sydney, NSW, 2006, Australia
- * E-mail:
| | - Emil Lou
- Division of Hematology, Oncology and Transplantation, University of Minnesota, Mayo Mail Code 480, 420 Delaware Street SE, Minneapolis, MN, 55455, United States of America
| | - Meier Hsu
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, 485 Lexington Avenue, New York, NY, 10017, United States of America
| | - Helena A. Yu
- Thoracic Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, 300 E 66th Street, 12 Floor, New York, NY, 10065, United States of America
| | - Jarushka Naidoo
- Thoracic Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, 300 E 66th Street, 12 Floor, New York, NY, 10065, United States of America
| | - Marjorie G. Zauderer
- Thoracic Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, 300 E 66th Street, 12 Floor, New York, NY, 10065, United States of America
| | - Camelia Sima
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, 485 Lexington Avenue, New York, NY, 10017, United States of America
| | - Melissa L. Johnson
- Thoracic Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, 300 E 66th Street, 12 Floor, New York, NY, 10065, United States of America
| | - Mariza Daras
- Department of Neurology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, United States of America
| | - Lisa M. DeAngelis
- Department of Neurology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, United States of America
| | - Martin Fleisher
- Clinical Chemistry Service, Department of Laboratory Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, United States of America
| | - Mark G. Kris
- Thoracic Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, 300 E 66th Street, 12 Floor, New York, NY, 10065, United States of America
| | - Christopher G. Azzoli
- Thoracic Oncology Program, Massachusetts General Hospital Cancer Center, 55 Fruit Street, Boston, MA, 02114–2696, United States of America
| |
Collapse
|
129
|
Venur VA, Ahluwalia MS. Targeted Therapy in Brain Metastases: Ready for Primetime? Am Soc Clin Oncol Educ Book 2016; 35:e123-e130. [PMID: 27249714 DOI: 10.1200/edbk_100006] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Brain metastasis is a serious complication of cancer that causes significant morbidity for patients. Over the last decade, numerous new driver somatic mutations have been recognized and targeted therapies are changing the landscape of treatment in lung cancer, breast cancer, and melanoma, which are also the three most common cancers that result in brain metastases. The common actionable mutations include the EGFR mutation and anaplastic lymphoma kinase (ALK) translocations in non-small cell lung cancer, the HER2 mutation in breast cancer, and the BRAF mutation in melanoma. However, most of the early trials with targeted agents excluded patients with brain metastases. With a better understanding of the biology, several recent trials of targeted therapy that focus on brain metastases have been reported and others are ongoing. Novel agents with better penetration across the blood-brain barrier are currently being investigated for patients with brain metastases. In this review, we discuss the current state of use and future directions of targeted therapies in brain metastases.
Collapse
Affiliation(s)
- Vyshak A Venur
- From the Division of Hematology and Oncology, Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA; Burkhardt Brain Tumor and Neuro-Oncology Center, Department of Medicine, Neurologic Institute, Cleveland Clinic, Cleveland, OH; Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - Manmeet S Ahluwalia
- From the Division of Hematology and Oncology, Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA; Burkhardt Brain Tumor and Neuro-Oncology Center, Department of Medicine, Neurologic Institute, Cleveland Clinic, Cleveland, OH; Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| |
Collapse
|
130
|
Jackman DM, Cioffredi LA, Jacobs L, Sharmeen F, Morse LK, Lucca J, Plotkin SR, Marcoux PJ, Rabin MS, Lynch TJ, Johnson BE, Kesari S. A phase I trial of high dose gefitinib for patients with leptomeningeal metastases from non-small cell lung cancer. Oncotarget 2015; 6:4527-36. [PMID: 25784657 PMCID: PMC4414209 DOI: 10.18632/oncotarget.2886] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2014] [Accepted: 12/09/2014] [Indexed: 11/25/2022] Open
Abstract
Introduction There are few effective treatment options for leptomeningeal metastasis (LM) in non-small-cell lung cancer (NSCLC). This study assessed the feasibility of high-dose gefitinib in patients with LM from NSCLC harboring EGFR mutations or prior systemic response to EGFR-TKI. Methods This phase I open-label trial of a novel gefitinib dosing schedule employed a 3+3 design. Eligible NSCLC patients with LM had known EGFR mutations and/or prior response to EGFR-TKI. Patients alternated 2 weeks of high-dose daily gefitinib (dose levels: 750 mg, 1000 mg, 1250 mg) with 2 weeks of maintenance therapy (500 mg daily). Primary endpoints were safety and toxicity. Secondary endpoints included overall survival (OS), neurological progression-free survival, radiological response, and cytological response in cerebrospinal fluid (CSF). Results Seven patients were treated: 3 at 750 mg dose level, 4 at 1000 mg dose level. There were no DLTs at the 750 mg dose level, and one DLT (toxic epidermal necrolysis) at the 1000 mg dose level. The study was closed due to slow accrual. Median neurological PFS was 2.3months (range 1.6–4.0 months); median OS was 3.5months (range 1.6–5.1months). Though there were no radiologically documented remissions of LM disease, four patients had improvement in neurological symptoms. One patient cleared their CSF of NSCLC cells, while 2 others had decrease in malignant cells in CSF. Conclusion Although the MTD was not defined due to slow accrual, this study provides important information about the tolerability and CSF penetration of high-dose gefitinib as a therapeutic option for modest palliation for NSCLC patients with LM and a known EGFR mutation.
Collapse
Affiliation(s)
- David M Jackman
- Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | | | | | - Farhana Sharmeen
- Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Linda K Morse
- Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Joan Lucca
- Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Scott R Plotkin
- Harvard Medical School, Boston, MA.,Stephen E. & Catherine Pappas Center for Neuro-Oncology, Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | - Paul J Marcoux
- Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Michael S Rabin
- Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Thomas J Lynch
- Smilow Cancer Hospital at Yale-New Haven, Yale Cancer Center, New Haven, CT, USA.,Yale University, New Haven, CT, USA
| | - Bruce E Johnson
- Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Santosh Kesari
- Department of Neurosciences, Translational Neuro-Oncology Laboratories, Moores UCSD Cancer Center, University of California, San Diego, La Jolla CA, USA
| |
Collapse
|
131
|
Renaud S, Schaeffer M, Voegeli AC, Legrain M, Guérin E, Meyer N, Mennecier B, Quoix E, Falcoz PE, Guénot D, Massard G, Noël G, Beau-Faller M. Impact of EGFR mutations and KRAS amino acid substitution on the response to radiotherapy for brain metastasis of non-small-cell lung cancer. Future Oncol 2015; 12:59-70. [PMID: 26616848 DOI: 10.2217/fon.15.273] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Our study aimed to evaluate response rate (RR) to brain metastasis radiotherapy (RT), depending on the genomic status of non-small-cell lung cancer. MATERIAL & METHODS We retrospectively reviewed 1971 non-small-cell lung cancer files of patients with EGFR and KRAS testing and focused on 157 patients who had undergone RT for brain metastasis. RESULTS A total of 16 patients (10.2%) harbored EGFR mutations (mEGFR) and 45 patients (28.7%) KRAS (mKRAS). In univariate analysis, RR was significantly higher for mEGFR compared with wild-type EGFR/KRAS (odds ratio [OR]: 4.96; p = 0.05) or mKRAS (OR: 1.81; p = 0.03). In multivariate analysis, KRAS G12V or G12C status was associated with both poor RR (OR: 0.1; p < 0.0001) and overall survival (OR: 3.41; p < 0.0001). CONCLUSION mEGFR are associated with higher RR to brain RT than wild-type EGFR/RAS or mKRAS.
Collapse
Affiliation(s)
- Stéphane Renaud
- Thoracic Surgery Department, Strasbourg University Hospital, France.,Research Unit EA 3430 & Translational Medicine Federation, Strasbourg University, France
| | | | - Anne-Claire Voegeli
- Department of Biochemistry & Molecular Biology, Oncobiology laboratory, Regional Institute of Cancer, Strasbourg University Hospital, France
| | - Michèle Legrain
- Department of Biochemistry & Molecular Biology, Oncobiology laboratory, Regional Institute of Cancer, Strasbourg University Hospital, France
| | - Eric Guérin
- Department of Biochemistry & Molecular Biology, Oncobiology laboratory, Regional Institute of Cancer, Strasbourg University Hospital, France
| | - Nicolas Meyer
- Statistical Department, Strasbourg University Hospital, France
| | | | | | | | - Dominique Guénot
- Research Unit EA 3430 & Translational Medicine Federation, Strasbourg University, France
| | - Gilbert Massard
- Thoracic Surgery Department, Strasbourg University Hospital, France
| | - Georges Noël
- Department of Radiotherapy, Centre Paul Strauss, Strasbourg, France
| | - Michèle Beau-Faller
- Research Unit EA 3430 & Translational Medicine Federation, Strasbourg University, France.,Department of Biochemistry & Molecular Biology, Oncobiology laboratory, Regional Institute of Cancer, Strasbourg University Hospital, France
| |
Collapse
|
132
|
Shi W, Dicker AP. CNS Metastases in Patients With Non-Small-Cell Lung Cancer and ALK Gene Rearrangement. J Clin Oncol 2015; 34:107-9. [PMID: 26628475 DOI: 10.1200/jco.2015.63.9682] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Wenyin Shi
- Thomas Jefferson University, Philadelphia, PA
| | | |
Collapse
|
133
|
Takano K, Kinoshita M, Takagaki M, Sakai M, Tateishi S, Achiha T, Hirayama R, Nishino K, Uchida J, Kumagai T, Okami J, Kawaguchi A, Hashimoto N, Nakanishi K, Imamura F, Higashiyama M, Yoshimine T. Different spatial distributions of brain metastases from lung cancer by histological subtype and mutation status of epidermal growth factor receptor. Neuro Oncol 2015; 18:716-24. [PMID: 26519739 DOI: 10.1093/neuonc/nov266] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 09/28/2015] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The purpose of this study was to test the hypothesis that the genetic backgrounds of lung cancers could affect the spatial distribution of brain metastases. METHODS CT or MR images of 200 patients with a total of 1033 treatment-naive brain metastases from lung cancer were retrospectively reviewed (23 by CT and 177 by MRI). All images were standardized to the human brain MRI atlas provided by the Montreal Neurological Institute 152 database. Locations, depths from the brain surface, and sizes of the lesions after image standardization were analyzed. RESULTS The posterior fossa, the anatomic "watershed areas," and the gray-white matter junction were confirmed to be more commonly affected by lung cancer brain metastases, and brain metastases with epidermal growth factor receptor (EGFR) L858R mutation occurred more often in the caudate, cerebellum, and temporal lobe than those with exon 19 deletion of EGFR. Median depths of the lesions from the brain surface were 13.7 mm (range, 8.6-21.9) for exon 19 deleted EGFR, 11.5 mm (6.6-16.8) for L858R mutated, and 15.0 mm (10.0-20.7) for wild-type EGFR. Lesions with L858R mutated EGFR were located significantly closer to the brain surface than lesions with exon 19 deleted or wild-type EGFR (P = .0032 and P < .0001, respectively). Furthermore, brain metastases of adenocarcinoma lung cancer patients with a history of chemotherapy but not molecular targeted therapy were located significantly deeper from the brain surface (P = .0002). CONCLUSION This analysis is the first to reveal the relationship between EGFR mutation status and the spatial distribution of brain metastases of lung cancer.
Collapse
Affiliation(s)
- Koji Takano
- Department of Neurosurgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan (K.T., M.K., M.T., T.A.); Department of Radiology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan (M.S., S.T., K.N.); Department of Thoracic Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan (K.N., J.U., T.K., F.I.); Department of General Thoracic Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan (J.O., M.H.); Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Japan (R.H., N.H., T.Y.); Department of Biomedical Statistics and Bioinformatics, Kyoto University Graduate School of Medicine, Kyoto, Japan (A.K.)
| | - Manabu Kinoshita
- Department of Neurosurgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan (K.T., M.K., M.T., T.A.); Department of Radiology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan (M.S., S.T., K.N.); Department of Thoracic Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan (K.N., J.U., T.K., F.I.); Department of General Thoracic Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan (J.O., M.H.); Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Japan (R.H., N.H., T.Y.); Department of Biomedical Statistics and Bioinformatics, Kyoto University Graduate School of Medicine, Kyoto, Japan (A.K.)
| | - Masatoshi Takagaki
- Department of Neurosurgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan (K.T., M.K., M.T., T.A.); Department of Radiology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan (M.S., S.T., K.N.); Department of Thoracic Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan (K.N., J.U., T.K., F.I.); Department of General Thoracic Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan (J.O., M.H.); Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Japan (R.H., N.H., T.Y.); Department of Biomedical Statistics and Bioinformatics, Kyoto University Graduate School of Medicine, Kyoto, Japan (A.K.)
| | - Mio Sakai
- Department of Neurosurgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan (K.T., M.K., M.T., T.A.); Department of Radiology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan (M.S., S.T., K.N.); Department of Thoracic Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan (K.N., J.U., T.K., F.I.); Department of General Thoracic Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan (J.O., M.H.); Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Japan (R.H., N.H., T.Y.); Department of Biomedical Statistics and Bioinformatics, Kyoto University Graduate School of Medicine, Kyoto, Japan (A.K.)
| | - Souichirou Tateishi
- Department of Neurosurgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan (K.T., M.K., M.T., T.A.); Department of Radiology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan (M.S., S.T., K.N.); Department of Thoracic Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan (K.N., J.U., T.K., F.I.); Department of General Thoracic Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan (J.O., M.H.); Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Japan (R.H., N.H., T.Y.); Department of Biomedical Statistics and Bioinformatics, Kyoto University Graduate School of Medicine, Kyoto, Japan (A.K.)
| | - Takamune Achiha
- Department of Neurosurgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan (K.T., M.K., M.T., T.A.); Department of Radiology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan (M.S., S.T., K.N.); Department of Thoracic Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan (K.N., J.U., T.K., F.I.); Department of General Thoracic Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan (J.O., M.H.); Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Japan (R.H., N.H., T.Y.); Department of Biomedical Statistics and Bioinformatics, Kyoto University Graduate School of Medicine, Kyoto, Japan (A.K.)
| | - Ryuichi Hirayama
- Department of Neurosurgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan (K.T., M.K., M.T., T.A.); Department of Radiology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan (M.S., S.T., K.N.); Department of Thoracic Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan (K.N., J.U., T.K., F.I.); Department of General Thoracic Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan (J.O., M.H.); Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Japan (R.H., N.H., T.Y.); Department of Biomedical Statistics and Bioinformatics, Kyoto University Graduate School of Medicine, Kyoto, Japan (A.K.)
| | - Kazumi Nishino
- Department of Neurosurgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan (K.T., M.K., M.T., T.A.); Department of Radiology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan (M.S., S.T., K.N.); Department of Thoracic Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan (K.N., J.U., T.K., F.I.); Department of General Thoracic Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan (J.O., M.H.); Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Japan (R.H., N.H., T.Y.); Department of Biomedical Statistics and Bioinformatics, Kyoto University Graduate School of Medicine, Kyoto, Japan (A.K.)
| | - Junji Uchida
- Department of Neurosurgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan (K.T., M.K., M.T., T.A.); Department of Radiology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan (M.S., S.T., K.N.); Department of Thoracic Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan (K.N., J.U., T.K., F.I.); Department of General Thoracic Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan (J.O., M.H.); Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Japan (R.H., N.H., T.Y.); Department of Biomedical Statistics and Bioinformatics, Kyoto University Graduate School of Medicine, Kyoto, Japan (A.K.)
| | - Toru Kumagai
- Department of Neurosurgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan (K.T., M.K., M.T., T.A.); Department of Radiology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan (M.S., S.T., K.N.); Department of Thoracic Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan (K.N., J.U., T.K., F.I.); Department of General Thoracic Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan (J.O., M.H.); Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Japan (R.H., N.H., T.Y.); Department of Biomedical Statistics and Bioinformatics, Kyoto University Graduate School of Medicine, Kyoto, Japan (A.K.)
| | - Jiro Okami
- Department of Neurosurgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan (K.T., M.K., M.T., T.A.); Department of Radiology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan (M.S., S.T., K.N.); Department of Thoracic Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan (K.N., J.U., T.K., F.I.); Department of General Thoracic Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan (J.O., M.H.); Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Japan (R.H., N.H., T.Y.); Department of Biomedical Statistics and Bioinformatics, Kyoto University Graduate School of Medicine, Kyoto, Japan (A.K.)
| | - Atsushi Kawaguchi
- Department of Neurosurgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan (K.T., M.K., M.T., T.A.); Department of Radiology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan (M.S., S.T., K.N.); Department of Thoracic Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan (K.N., J.U., T.K., F.I.); Department of General Thoracic Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan (J.O., M.H.); Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Japan (R.H., N.H., T.Y.); Department of Biomedical Statistics and Bioinformatics, Kyoto University Graduate School of Medicine, Kyoto, Japan (A.K.)
| | - Naoya Hashimoto
- Department of Neurosurgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan (K.T., M.K., M.T., T.A.); Department of Radiology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan (M.S., S.T., K.N.); Department of Thoracic Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan (K.N., J.U., T.K., F.I.); Department of General Thoracic Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan (J.O., M.H.); Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Japan (R.H., N.H., T.Y.); Department of Biomedical Statistics and Bioinformatics, Kyoto University Graduate School of Medicine, Kyoto, Japan (A.K.)
| | - Katsuyuki Nakanishi
- Department of Neurosurgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan (K.T., M.K., M.T., T.A.); Department of Radiology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan (M.S., S.T., K.N.); Department of Thoracic Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan (K.N., J.U., T.K., F.I.); Department of General Thoracic Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan (J.O., M.H.); Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Japan (R.H., N.H., T.Y.); Department of Biomedical Statistics and Bioinformatics, Kyoto University Graduate School of Medicine, Kyoto, Japan (A.K.)
| | - Fumio Imamura
- Department of Neurosurgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan (K.T., M.K., M.T., T.A.); Department of Radiology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan (M.S., S.T., K.N.); Department of Thoracic Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan (K.N., J.U., T.K., F.I.); Department of General Thoracic Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan (J.O., M.H.); Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Japan (R.H., N.H., T.Y.); Department of Biomedical Statistics and Bioinformatics, Kyoto University Graduate School of Medicine, Kyoto, Japan (A.K.)
| | - Masahiko Higashiyama
- Department of Neurosurgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan (K.T., M.K., M.T., T.A.); Department of Radiology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan (M.S., S.T., K.N.); Department of Thoracic Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan (K.N., J.U., T.K., F.I.); Department of General Thoracic Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan (J.O., M.H.); Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Japan (R.H., N.H., T.Y.); Department of Biomedical Statistics and Bioinformatics, Kyoto University Graduate School of Medicine, Kyoto, Japan (A.K.)
| | - Toshiki Yoshimine
- Department of Neurosurgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan (K.T., M.K., M.T., T.A.); Department of Radiology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan (M.S., S.T., K.N.); Department of Thoracic Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan (K.N., J.U., T.K., F.I.); Department of General Thoracic Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan (J.O., M.H.); Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Japan (R.H., N.H., T.Y.); Department of Biomedical Statistics and Bioinformatics, Kyoto University Graduate School of Medicine, Kyoto, Japan (A.K.)
| |
Collapse
|
134
|
Shin SM, Cooper BT, Chachoua A, Butler J, Donahue B, Silverman JS, Kondziolka D. Survival but not brain metastasis response relates to lung cancer mutation status after radiosurgery. J Neurooncol 2015; 126:483-91. [DOI: 10.1007/s11060-015-1986-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 10/27/2015] [Indexed: 10/22/2022]
|
135
|
Xu Y, Li L, Wang M. [Diagnosis and Treatment of Leptomeningeal Metastasis in Non-small Cell Lung Cancer]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2015; 18:626-32. [PMID: 26483335 PMCID: PMC6000085 DOI: 10.3779/j.issn.1009-3419.2015.10.05] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 07/06/2015] [Indexed: 11/05/2022]
Abstract
Leptomeningeal metastasis (LM) is one of the disastrous events in managing advanced non-small cell lung cancer (NSCLC) due to severe clinical symptoms and a grave prognosis. Although intrathecal (IT) chemotherapy show some effects for LM in advanced NSCLC, the prognosis is still poor (12 wk-14 wk). A large majority (84%-97%) of the patients were found to have adenocarcinoma histology. Epidermal growth factor receptor (EGFR) senstive mutations were detected in 43.0%-70.5% adenocarcinoma patients with LM. EGFR tyrosine kinase inhibitors (TKIs) showed to be effective for LM in selected NSCLC patients in some reseaches, and confer a survival benefit. Furthermore, future trials need be done to determine the effect of EGFR-TKIs treatment in NSCLC-LM patients.
Collapse
Affiliation(s)
- Yan Xu
- Department of Respiratory Disease, Peking Union Medical College Hospital, Chinese Academy of Medical Science
& Peking Union Medical College, Beijing 100730, China
| | - Longyun Li
- Department of Respiratory Disease, Peking Union Medical College Hospital, Chinese Academy of Medical Science
& Peking Union Medical College, Beijing 100730, China
| | - Mengzhao Wang
- Department of Respiratory Disease, Peking Union Medical College Hospital, Chinese Academy of Medical Science
& Peking Union Medical College, Beijing 100730, China
| |
Collapse
|
136
|
Targeted Therapy for Brain Metastases in EGFR-Mutated and ALK-Rearranged Non-Small-Cell Lung Cancer. J Thorac Oncol 2015; 10:1268-1278. [DOI: 10.1097/jto.0000000000000615] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
137
|
Kuiper JL, Hendriks LE, van der Wekken AJ, de Langen AJ, Bahce I, Thunnissen E, Heideman DA, Berk Y, Buijs EJ, Speel EJM, Krouwels FH, Smit HJ, Groen HJ, Dingemans AMC, Smit EF. Treatment and survival of patients with EGFR -mutated non-small cell lung cancer and leptomeningeal metastasis: A retrospective cohort analysis. Lung Cancer 2015; 89:255-61. [DOI: 10.1016/j.lungcan.2015.05.023] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 05/19/2015] [Accepted: 05/28/2015] [Indexed: 11/16/2022]
|
138
|
Jiang J, Hu C. [Research Progress of Mechanisms on Intracranial Metastasis of Non-small Cell Lung Cancer after Clinical Benefit from EGFR-TKI]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2015; 18:518-22. [PMID: 26302350 PMCID: PMC6000228 DOI: 10.3779/j.issn.1009-3419.2015.08.09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
表皮生长因子受体酪氨酸激酶抑制剂(epidermal growth factor receptor tyrosine kinase inhibitor, EGFR-TKI)广泛用于治疗EGFR突变阳性的非小细胞肺癌(non-small cell lung cancer, NSCLC)。然而,部分患者在接受EGFR-TKI治疗后、原发病灶稳定甚至缩小的同时,却出现了新发颅内转移灶或者原有颅内病灶进展,其机制未明。近年来多项研究表明,这种现象可能与EGFR-TKI的药物代谢动力学、NSCLC原发灶与转移灶的异质性、EGFR突变本身特质及患者生存期的延长有关。因此,本文就NSCLC患者在EGFR-TKI治疗临床获益后发生颅内转移的相关机制研究进展作一综述。
Collapse
Affiliation(s)
- Juan Jiang
- Department of Respiratory Medicine, Central South University Xiangya Hospital, Changsha 410008, China
| | - Chengping Hu
- Department of Respiratory Medicine, Central South University Xiangya Hospital, Changsha 410008, China
| |
Collapse
|
139
|
Berghoff AS, Preusser M. The future of targeted therapies for brain metastases. Future Oncol 2015; 11:2315-27. [DOI: 10.2217/fon.15.127] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Brain metastases (BM) are an increasing challenge in the management of patients with advanced cancer. Treatment options for BM are limited and mainly focus on the application of local therapies. Systemic therapies including targeted therapies are only poorly investigated, as patients with BM were frequently excluded from clinical trials. Several targeted therapies have shown promising activity in patients with BM. In the present review we discuss existing and emerging targeted therapies for the most frequent BM primary tumor types. We focus on challenges in the conduction of clinical trials on targeted therapies in BM patients such as patient selection, combination with radiotherapy, the obstacles of the blood–brain barrier and the definition of study end points.
Collapse
Affiliation(s)
- Anna S Berghoff
- Department for Medicine I, Comprehensive Cancer Center Central Nervous System Unit (CCC-CNS), Clinical Division of Oncology, Medical University of Vienna, Vienna, Austria
- Comprehensive Cancer Center – CNS Tumors Unit, Medical University of Vienna, Vienna, Austria
| | - Matthias Preusser
- Department for Medicine I, Comprehensive Cancer Center Central Nervous System Unit (CCC-CNS), Clinical Division of Oncology, Medical University of Vienna, Vienna, Austria
- Comprehensive Cancer Center – CNS Tumors Unit, Medical University of Vienna, Vienna, Austria
| |
Collapse
|
140
|
Remon J, Alvarez-Berdugo D, Majem M, Moran T, Reguart N, Lianes P. miRNA-197 and miRNA-184 are associated with brain metastasis in EGFR-mutant lung cancers. Clin Transl Oncol 2015. [DOI: 10.1007/s12094-015-1347-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
|
141
|
Li H, Zhang X, Cao J, Su P, Lian J, Song X, Yang W, Han S, Xi Y, Wang Y. Exon 19 deletion of epidermal growth factor receptor is associated with prolonged survival in brain metastases from non-small-cell lung cancer. Tumour Biol 2015; 36:9251-8. [PMID: 26091796 DOI: 10.1007/s13277-015-3653-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 06/09/2015] [Indexed: 11/25/2022] Open
Abstract
Brain metastasis (BM) is a poor prognostic factor for non-small-cell lung cancer (NSCLC). Recent studies have shown that oral epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) were effective for BM from NSCLC with EGFR mutation. However, the relationship between EGFR mutations and prognosis of NSCLC BM patients remains to be determined. In this study, we investigated the impact of EGFR mutation status on the survival of BM patients from NSCLC. One hundred six patients with BM from NSCLC were retrospectively reviewed. Thirty-three subjects (24.3 %) were confirmed to have an exon 19 deletion, while another 33 had an exon 21 point mutation (L858R) (24.3 %). Log-rank test and Cox proportional hazards model were used to analyze the impact of variables on survival. The median survival of NSCLC with BM was 8 months. Log-rank test analysis showed that Eastern Cooperative Oncology Group Performance Status (ECOG-PS) at BM (p < 0.0001), control of primary tumor (p = 0.005), pathology (p = 0.01), EGFR mutations (p = 0.045), and 19 exon deletion (p = 0.007) were associated with a longer survival. In a Cox proportional hazards model, EGFR exon 19 deletion (p = 0.034), control of primary tumor (p = 0.024), and ECOG PS at BM (p = 0.006) were found to be independent prognostic factors. Moreover, there were prognostic differences between groups according to Radiation Therapy Oncology Group (RTOG) recursive partitioning analysis (RPA) classification system (p < 0.0001). Exon 19 deletion is an independent prognostic factor in BM from NSCLC. It should be integrated into the prognostic scoring classification system for NSCLC.
Collapse
Affiliation(s)
- Hongwei Li
- Department of Radiation Oncology, Shanxi Provincial Cancer Hospital, Shanxi Medical University, Taiyuan, Shanxi, 030013, People's Republic of China.
- Department of Radiotherapy, Shanxi Provincial Cancer Hospital, Shanxi Medical University, Taiyuan, Shanxi, 030013, People's Republic of China.
| | - Xiaqin Zhang
- Department of Radiation Oncology, Shanxi Provincial Cancer Hospital, Shanxi Medical University, Taiyuan, Shanxi, 030013, People's Republic of China
| | - Jianzhong Cao
- Department of Radiation Oncology, Shanxi Provincial Cancer Hospital, Shanxi Medical University, Taiyuan, Shanxi, 030013, People's Republic of China.
| | - Pengcheng Su
- Department of Radiation Oncology, Shanxi Provincial Cancer Hospital, Shanxi Medical University, Taiyuan, Shanxi, 030013, People's Republic of China
| | - Jianhong Lian
- Department of Surgery, Shanxi Provincial Cancer Hospital, Shanxi Medical University, Taiyuan, Shanxi, 030013, People's Republic of China
| | - Xing Song
- Department of Radiation Oncology, Shanxi Provincial Cancer Hospital, Shanxi Medical University, Taiyuan, Shanxi, 030013, People's Republic of China
| | - Weihua Yang
- Department of Chemotherapy, Shanxi Provincial Cancer Hospital, Shanxi Medical University, Taiyuan, Shanxi, 030013, People's Republic of China
| | - Songyan Han
- Department of Chemotherapy, Shanxi Provincial Cancer Hospital, Shanxi Medical University, Taiyuan, Shanxi, 030013, People's Republic of China
| | - Yanfeng Xi
- Department of Pathology, Shanxi Provincial Cancer Hospital, Shanxi Medical University, Taiyuan, Shanxi, 030013, People's Republic of China
| | - Yaohua Wang
- Department of Pathology, Shanxi Provincial Cancer Hospital, Shanxi Medical University, Taiyuan, Shanxi, 030013, People's Republic of China
| |
Collapse
|
142
|
Li B, Sun SZ, Yang M, Shi JL, Xu W, Wang XF, Song MM, Chen HM. The correlation between EGFR mutation status and the risk of brain metastasis in patients with lung adenocarcinoma. J Neurooncol 2015; 124:79-85. [DOI: 10.1007/s11060-015-1776-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 04/02/2015] [Indexed: 10/23/2022]
|
143
|
Liu S, Qiu B, Chen L, Wang F, Liang Y, Cai P, Zhang L, Chen Z, Liu S, Liu M, Liu H. Radiotherapy for asymptomatic brain metastasis in epidermal growth factor receptor mutant non-small cell lung cancer without prior tyrosine kinase inhibitors treatment: a retrospective clinical study. Radiat Oncol 2015; 10:118. [PMID: 26014133 PMCID: PMC4490723 DOI: 10.1186/s13014-015-0421-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 05/14/2015] [Indexed: 11/30/2022] Open
Abstract
Background Non-small cell lung cancer (NSCLC) with brain metastasis (BM) harboring an epidermal growth factor receptor (EGFR) mutation shows good response to tyrosine kinase inhibitors (TKIs). This study is to assess the appropriate timing of brain radiotherapy (RT) for asymptomatic BM in EGFR mutant NSCLC patients. Methods There were 628 patients diagnosed with EGFR mutant NSCLC between October 2005 and December 2011. Treatment outcomes had been retrospectively evaluated in 96 patients with asymptomatic BM without prior TKI treatment. 39 patients received first-line brain RT, 23 patients received delayed brain RT, and 34 patients did not receive brain RT. Results With a median follow-up of 26 months, the 2-year OS was 40.6 %. Univariate analyses revealed that ECOG performance status (p = 0.006), other distant metastases (p = 0.002) and first line systemic treatment (p = 0.032) were significantly associated with overall survival (OS). Multivariate analyses revealed that other sites of distant metastases (p = 0.030) were prognostic factor. The timing of brain RT was not significantly related to OS (p = 0.246). The 2-year BM progression-free survival (PFS) was 26.9 %. Brain RT as first-line therapy failed to demonstrate a significant association with BM PFS (p = 0.643). Conclusions First-line brain RT failed to improve long-term survival in TKI-naïve EGFR mutant NSCLC patients with asymptomatic BM. Prospective studies are needed to validate these clinical findings.
Collapse
Affiliation(s)
- SongRan Liu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, China. .,Guangdong Esophogeal Cancer Research Institute, Guangzhou, China. .,Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, China.
| | - Bo Qiu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, China. .,Guangdong Esophogeal Cancer Research Institute, Guangzhou, China. .,Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, China.
| | - LiKun Chen
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, China. .,Guangdong Esophogeal Cancer Research Institute, Guangzhou, China. .,Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China.
| | - Fang Wang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, China. .,Guangdong Esophogeal Cancer Research Institute, Guangzhou, China. .,Department of Molecular Diagnosis, Sun Yat-sen University Cancer Center, Guangzhou, China.
| | - Ying Liang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, China. .,Guangdong Esophogeal Cancer Research Institute, Guangzhou, China. .,Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China.
| | - PeiQiang Cai
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, China. .,Guangdong Esophogeal Cancer Research Institute, Guangzhou, China. .,Department of Radiology, Sun Yat-sen University Cancer Center, Guangzhou, China.
| | - Li Zhang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, China. .,Guangdong Esophogeal Cancer Research Institute, Guangzhou, China. .,Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China.
| | - ZhaoLin Chen
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, China. .,Guangdong Esophogeal Cancer Research Institute, Guangzhou, China. .,Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, China.
| | - ShiLiang Liu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, China. .,Guangdong Esophogeal Cancer Research Institute, Guangzhou, China. .,Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, China.
| | - MengZhong Liu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, China. .,Guangdong Esophogeal Cancer Research Institute, Guangzhou, China. .,Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, China.
| | - Hui Liu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, China. .,Guangdong Esophogeal Cancer Research Institute, Guangzhou, China. .,Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, China.
| |
Collapse
|
144
|
Wang TJC, Saad S, Qureshi YH, Jani A, Nanda T, Yaeh AM, Rozenblat T, Sisti MB, Bruce JN, McKhann GM, Lesser J, Halmos B, Stoopler MB, Lassman AB, Cheng SK, Isaacson SR. Does lung cancer mutation status and targeted therapy predict for outcomes and local control in the setting of brain metastases treated with radiation? Neuro Oncol 2015; 17:1022-8. [PMID: 25910841 DOI: 10.1093/neuonc/nov043] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Accepted: 02/24/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND We investigated effects of genetic alterations in epidermal growth factor receptor (EGFR), anaplastic lymphoma kinase (ALK), and Kirsten rat sarcoma viral oncogene homolog (KRAS) on overall survival (OS) and local control after stereotactic radiosurgery for brain metastases in non-small cell lung cancer (NSCLC). METHODS A cohort of 89 out of 262 NSCLC patients (2003-2013) treated with gamma knife radiosurgery for brain metastases had genotyping available and were selected as our study population. RESULTS Median follow-up was 12 months. Median OS rates for the EGFR, KRAS, echinoderm microtubule-associated protein-like 4 (EML4)-ALK mutated, and wild-type cohorts were 17, 7, 27, and 12 months, respectively (P = .019), and for targeted versus nontargeted therapy 21 and 11 months, respectively (P = .071). Targeted therapy was a strong predictor of increased OS on univariate (P = .037) and multivariate (P = .022) analysis. Gender, primary tumor controlled status, recursive partitioning analysis class, and graded prognostic assessment score were associated with OS (P < .05). On multivariate analysis, positive EGFR mutational status was a highly significant predictor for decreased survival (hazard ratio: 8.2; 95% CI: 2.0-33.7; P = .003). However, when we recategorized EGFR-mutant cases based on whether they received tyrosine kinase inhibitor, OS was no longer significantly shorter (hazard ratio: 1.5; P = .471). Median OS for patients with and without local failure was 17 and 12 months, respectively (P = .577). Local failure rates for EGFR, KRAS, EML4-ALK mutated, and wild-type cohorts by lesion were 8.7%, 5.4%, 4.3%, and 5.1%, respectively. CONCLUSIONS This study suggests that EGFR tyrosine kinase mutation and ALK translocation results in improved survival to targeted therapies and that mutation status itself does not predict survival and local control in patients with brain metastases from NSCLC.
Collapse
Affiliation(s)
- Tony J C Wang
- Department of Radiation Oncology (T.J.C.W., S.S., A.J., T.N., A.M.Y., T.R., J.L., S.K.C., S.R.I.); Herbert Irving Comprehensive Cancer Center (T.J.C.W., M.B.Si., J.N.B., G.M.M., B.H., M.B.St., A.B.L., S.K.C., S.R.I.); The Taub Institute for Research on Alzheimer's Disease and the Aging Brain (Y.H.Q.); Department of Neurological Surgery (M.B.Si., J.N.B., G.M.M.); Department of Neurology (A.B.L.); and Division of Hematology/Oncology (B.H., M.B.St.), Columbia University Medical Center, New York, New York
| | - Shumaila Saad
- Department of Radiation Oncology (T.J.C.W., S.S., A.J., T.N., A.M.Y., T.R., J.L., S.K.C., S.R.I.); Herbert Irving Comprehensive Cancer Center (T.J.C.W., M.B.Si., J.N.B., G.M.M., B.H., M.B.St., A.B.L., S.K.C., S.R.I.); The Taub Institute for Research on Alzheimer's Disease and the Aging Brain (Y.H.Q.); Department of Neurological Surgery (M.B.Si., J.N.B., G.M.M.); Department of Neurology (A.B.L.); and Division of Hematology/Oncology (B.H., M.B.St.), Columbia University Medical Center, New York, New York
| | - Yasir H Qureshi
- Department of Radiation Oncology (T.J.C.W., S.S., A.J., T.N., A.M.Y., T.R., J.L., S.K.C., S.R.I.); Herbert Irving Comprehensive Cancer Center (T.J.C.W., M.B.Si., J.N.B., G.M.M., B.H., M.B.St., A.B.L., S.K.C., S.R.I.); The Taub Institute for Research on Alzheimer's Disease and the Aging Brain (Y.H.Q.); Department of Neurological Surgery (M.B.Si., J.N.B., G.M.M.); Department of Neurology (A.B.L.); and Division of Hematology/Oncology (B.H., M.B.St.), Columbia University Medical Center, New York, New York
| | - Ashish Jani
- Department of Radiation Oncology (T.J.C.W., S.S., A.J., T.N., A.M.Y., T.R., J.L., S.K.C., S.R.I.); Herbert Irving Comprehensive Cancer Center (T.J.C.W., M.B.Si., J.N.B., G.M.M., B.H., M.B.St., A.B.L., S.K.C., S.R.I.); The Taub Institute for Research on Alzheimer's Disease and the Aging Brain (Y.H.Q.); Department of Neurological Surgery (M.B.Si., J.N.B., G.M.M.); Department of Neurology (A.B.L.); and Division of Hematology/Oncology (B.H., M.B.St.), Columbia University Medical Center, New York, New York
| | - Tavish Nanda
- Department of Radiation Oncology (T.J.C.W., S.S., A.J., T.N., A.M.Y., T.R., J.L., S.K.C., S.R.I.); Herbert Irving Comprehensive Cancer Center (T.J.C.W., M.B.Si., J.N.B., G.M.M., B.H., M.B.St., A.B.L., S.K.C., S.R.I.); The Taub Institute for Research on Alzheimer's Disease and the Aging Brain (Y.H.Q.); Department of Neurological Surgery (M.B.Si., J.N.B., G.M.M.); Department of Neurology (A.B.L.); and Division of Hematology/Oncology (B.H., M.B.St.), Columbia University Medical Center, New York, New York
| | - Andrew M Yaeh
- Department of Radiation Oncology (T.J.C.W., S.S., A.J., T.N., A.M.Y., T.R., J.L., S.K.C., S.R.I.); Herbert Irving Comprehensive Cancer Center (T.J.C.W., M.B.Si., J.N.B., G.M.M., B.H., M.B.St., A.B.L., S.K.C., S.R.I.); The Taub Institute for Research on Alzheimer's Disease and the Aging Brain (Y.H.Q.); Department of Neurological Surgery (M.B.Si., J.N.B., G.M.M.); Department of Neurology (A.B.L.); and Division of Hematology/Oncology (B.H., M.B.St.), Columbia University Medical Center, New York, New York
| | - Tzlil Rozenblat
- Department of Radiation Oncology (T.J.C.W., S.S., A.J., T.N., A.M.Y., T.R., J.L., S.K.C., S.R.I.); Herbert Irving Comprehensive Cancer Center (T.J.C.W., M.B.Si., J.N.B., G.M.M., B.H., M.B.St., A.B.L., S.K.C., S.R.I.); The Taub Institute for Research on Alzheimer's Disease and the Aging Brain (Y.H.Q.); Department of Neurological Surgery (M.B.Si., J.N.B., G.M.M.); Department of Neurology (A.B.L.); and Division of Hematology/Oncology (B.H., M.B.St.), Columbia University Medical Center, New York, New York
| | - Michael B Sisti
- Department of Radiation Oncology (T.J.C.W., S.S., A.J., T.N., A.M.Y., T.R., J.L., S.K.C., S.R.I.); Herbert Irving Comprehensive Cancer Center (T.J.C.W., M.B.Si., J.N.B., G.M.M., B.H., M.B.St., A.B.L., S.K.C., S.R.I.); The Taub Institute for Research on Alzheimer's Disease and the Aging Brain (Y.H.Q.); Department of Neurological Surgery (M.B.Si., J.N.B., G.M.M.); Department of Neurology (A.B.L.); and Division of Hematology/Oncology (B.H., M.B.St.), Columbia University Medical Center, New York, New York
| | - Jeffrey N Bruce
- Department of Radiation Oncology (T.J.C.W., S.S., A.J., T.N., A.M.Y., T.R., J.L., S.K.C., S.R.I.); Herbert Irving Comprehensive Cancer Center (T.J.C.W., M.B.Si., J.N.B., G.M.M., B.H., M.B.St., A.B.L., S.K.C., S.R.I.); The Taub Institute for Research on Alzheimer's Disease and the Aging Brain (Y.H.Q.); Department of Neurological Surgery (M.B.Si., J.N.B., G.M.M.); Department of Neurology (A.B.L.); and Division of Hematology/Oncology (B.H., M.B.St.), Columbia University Medical Center, New York, New York
| | - Guy M McKhann
- Department of Radiation Oncology (T.J.C.W., S.S., A.J., T.N., A.M.Y., T.R., J.L., S.K.C., S.R.I.); Herbert Irving Comprehensive Cancer Center (T.J.C.W., M.B.Si., J.N.B., G.M.M., B.H., M.B.St., A.B.L., S.K.C., S.R.I.); The Taub Institute for Research on Alzheimer's Disease and the Aging Brain (Y.H.Q.); Department of Neurological Surgery (M.B.Si., J.N.B., G.M.M.); Department of Neurology (A.B.L.); and Division of Hematology/Oncology (B.H., M.B.St.), Columbia University Medical Center, New York, New York
| | - Jeraldine Lesser
- Department of Radiation Oncology (T.J.C.W., S.S., A.J., T.N., A.M.Y., T.R., J.L., S.K.C., S.R.I.); Herbert Irving Comprehensive Cancer Center (T.J.C.W., M.B.Si., J.N.B., G.M.M., B.H., M.B.St., A.B.L., S.K.C., S.R.I.); The Taub Institute for Research on Alzheimer's Disease and the Aging Brain (Y.H.Q.); Department of Neurological Surgery (M.B.Si., J.N.B., G.M.M.); Department of Neurology (A.B.L.); and Division of Hematology/Oncology (B.H., M.B.St.), Columbia University Medical Center, New York, New York
| | - Balazs Halmos
- Department of Radiation Oncology (T.J.C.W., S.S., A.J., T.N., A.M.Y., T.R., J.L., S.K.C., S.R.I.); Herbert Irving Comprehensive Cancer Center (T.J.C.W., M.B.Si., J.N.B., G.M.M., B.H., M.B.St., A.B.L., S.K.C., S.R.I.); The Taub Institute for Research on Alzheimer's Disease and the Aging Brain (Y.H.Q.); Department of Neurological Surgery (M.B.Si., J.N.B., G.M.M.); Department of Neurology (A.B.L.); and Division of Hematology/Oncology (B.H., M.B.St.), Columbia University Medical Center, New York, New York
| | - Mark B Stoopler
- Department of Radiation Oncology (T.J.C.W., S.S., A.J., T.N., A.M.Y., T.R., J.L., S.K.C., S.R.I.); Herbert Irving Comprehensive Cancer Center (T.J.C.W., M.B.Si., J.N.B., G.M.M., B.H., M.B.St., A.B.L., S.K.C., S.R.I.); The Taub Institute for Research on Alzheimer's Disease and the Aging Brain (Y.H.Q.); Department of Neurological Surgery (M.B.Si., J.N.B., G.M.M.); Department of Neurology (A.B.L.); and Division of Hematology/Oncology (B.H., M.B.St.), Columbia University Medical Center, New York, New York
| | - Andrew B Lassman
- Department of Radiation Oncology (T.J.C.W., S.S., A.J., T.N., A.M.Y., T.R., J.L., S.K.C., S.R.I.); Herbert Irving Comprehensive Cancer Center (T.J.C.W., M.B.Si., J.N.B., G.M.M., B.H., M.B.St., A.B.L., S.K.C., S.R.I.); The Taub Institute for Research on Alzheimer's Disease and the Aging Brain (Y.H.Q.); Department of Neurological Surgery (M.B.Si., J.N.B., G.M.M.); Department of Neurology (A.B.L.); and Division of Hematology/Oncology (B.H., M.B.St.), Columbia University Medical Center, New York, New York
| | - Simon K Cheng
- Department of Radiation Oncology (T.J.C.W., S.S., A.J., T.N., A.M.Y., T.R., J.L., S.K.C., S.R.I.); Herbert Irving Comprehensive Cancer Center (T.J.C.W., M.B.Si., J.N.B., G.M.M., B.H., M.B.St., A.B.L., S.K.C., S.R.I.); The Taub Institute for Research on Alzheimer's Disease and the Aging Brain (Y.H.Q.); Department of Neurological Surgery (M.B.Si., J.N.B., G.M.M.); Department of Neurology (A.B.L.); and Division of Hematology/Oncology (B.H., M.B.St.), Columbia University Medical Center, New York, New York
| | - Steven R Isaacson
- Department of Radiation Oncology (T.J.C.W., S.S., A.J., T.N., A.M.Y., T.R., J.L., S.K.C., S.R.I.); Herbert Irving Comprehensive Cancer Center (T.J.C.W., M.B.Si., J.N.B., G.M.M., B.H., M.B.St., A.B.L., S.K.C., S.R.I.); The Taub Institute for Research on Alzheimer's Disease and the Aging Brain (Y.H.Q.); Department of Neurological Surgery (M.B.Si., J.N.B., G.M.M.); Department of Neurology (A.B.L.); and Division of Hematology/Oncology (B.H., M.B.St.), Columbia University Medical Center, New York, New York
| |
Collapse
|
145
|
Kudo Y, Shimada Y, Saji H, Kato Y, Yoshida K, Matsubayashi J, Nagase S, Kakihana M, Kajiwara N, Ohira T, Nagao T, Ikeda N. Prognostic Factors for Survival After Recurrence in Patients With Completely Resected Lung Adenocarcinoma: Important Roles of Epidermal Growth Factor Receptor Mutation Status and the Current Staging System. Clin Lung Cancer 2015; 16:e213-21. [PMID: 25986624 DOI: 10.1016/j.cllc.2015.04.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 04/10/2015] [Accepted: 04/14/2015] [Indexed: 12/13/2022]
Abstract
UNLABELLED Epidermal growth factor receptor (EGFR) status and pathological stage (p-stage) were shown to be essential prognostic factors for estimating survival after recurrence of lung adenocarcinoma. In patients with EGFR mutations, those with early p-stage tumors showed better survival after disease recurrence than those with advanced p-stage tumors. The EGFR mutation status and p-stage could also prompt the design of clinical trials on adjuvant therapy for patients after complete surgical resection. BACKGROUND The current staging system and epidermal growth factor receptor (EGFR) mutation status are key factors for predicting survival. However, the significance of these factors as predictors of survival after disease recurrence (PRS) has not been sufficiently elucidated. The objective of this study was to investigate the clinicopathological factors, particularly the EGFR mutation status and pathological stage (p-stage), which affect PRS in patients with completely resected lung adenocarcinoma. PATIENTS AND METHODS We retrospectively reviewed the data of 198 consecutive lung adenocarcinoma patients with disease recurrence who previously underwent complete surgical resection in our hospital. RESULTS Of the 198 patients, 117 were examined for EGFR mutations (mutants). Mutants were detected in 57 patients (28.7%). The patients with mutants had a significantly better 3-year PRS (3y-PRS) rate (68.6%) than those with an EGFR wild type (WT) status (51.7%) or an unknown (UN) status (27.0%). The 3y-PRS rates for p-stage I to II (p-I-II) and p-stage III (p-III) were 52.5% and 29.3%, respectively. Multivariate survival analysis showed that the EGFR mutation status and p-stage had significant associations with favorable PRS. The 3y-PRS rate for mutants/p-I-II (81.4%) was significantly better than that for mutants/p-III (48.0%). Conversely, there was no significant difference between mutants/p-III and WT/UN/p-I-II (3y-PRS: 40.7%) or between mutants/p-III and WT/UN/p-III (3y-PRS: 24.4%). CONCLUSION EGFR status and p-stage were shown to be essential prognostic factors for estimating PRS. In patients with mutants, those with early p-stage tumors showed better PRS than those with advanced p-stage tumors.
Collapse
Affiliation(s)
- Yujin Kudo
- Department of Thoracic Surgery, Tokyo Medical University, Tokyo, Japan.
| | - Yoshihisa Shimada
- Department of Thoracic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Hisashi Saji
- Department of Thoracic Surgery, Tokyo Medical University, Tokyo, Japan; Department of Chest Surgery, St Marianna University School of Medicine, Kanagawa, Japan
| | - Yasufumi Kato
- Department of Thoracic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Koichi Yoshida
- Department of Thoracic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Jun Matsubayashi
- Department of Anatomic Pathology, Tokyo Medical University, Tokyo, Japan
| | - Seisuke Nagase
- Department of Thoracic Surgery, Tokyo Medical University, Tokyo, Japan
| | | | - Naohiro Kajiwara
- Department of Thoracic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Tatsuo Ohira
- Department of Thoracic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Toshitaka Nagao
- Department of Anatomic Pathology, Tokyo Medical University, Tokyo, Japan
| | - Norihiko Ikeda
- Department of Thoracic Surgery, Tokyo Medical University, Tokyo, Japan
| |
Collapse
|
146
|
Rangachari D, Yamaguchi N, VanderLaan PA, Folch E, Mahadevan A, Floyd SR, Uhlmann EJ, Wong ET, Dahlberg SE, Huberman MS, Costa DB. Brain metastases in patients with EGFR-mutated or ALK-rearranged non-small-cell lung cancers. Lung Cancer 2015; 88:108-11. [PMID: 25682925 PMCID: PMC4355240 DOI: 10.1016/j.lungcan.2015.01.020] [Citation(s) in RCA: 343] [Impact Index Per Article: 38.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 01/16/2015] [Accepted: 01/24/2015] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Brain metastases (BM) are common in non-small-cell lung cancer (NSCLC). However, the baseline incidence and evolution of BM over time in oncogene-driven NSCLCs are seldom reported. In this study, we evaluated the frequency of BM in patients with epidermal growth factor receptor (EGFR)-mutated or anaplastic lymphoma kinase (ALK)-rearranged NSCLC. METHODS The presence of BM, clinicopathologic data, and tumor genotype were retrospectively compiled and analyzed from a cohort of 381 patients. RESULTS We identified 86 EGFR-mutated (90.7% with metastatic disease; 85.9% received an EGFR inhibitor) and 23 ALK-rearranged (91.3% with metastatic disease; 85.7% received an ALK inhibitor) NSCLCs. BM were present in 24.4% of EGFR-mutated and 23.8% of ALK-rearranged NSCLCs at the time of diagnosis of advanced disease. This study did not demonstrate a difference in the cumulative incidence of BM over time between the two cohorts (EGFR/ALK cohort competing risk regression [CRR] coefficient of 0.78 [95% CI 0.44-1.39], p=0.41). In still living patients with advanced EGFR-mutated NSCLC, 34.2% had BM at 1 year, 38.4% at 2 years, 46.7% at 3 years, 48.7% at 4 years, and 52.9% at 5 years. In still living patients with advanced ALK-rearranged NSCLC, 23.8% had BM at 1 year, 45.5% at 2 years, and 58.4% at 3 years. CONCLUSIONS BM are frequent in advanced EGFR-mutated or ALK-rearranged NSCLCs, with an estimated >45% of patients with CNS involvement by three years of survival with the use of targeted therapies. These data point toward the CNS as an important unmet clinical need in the evolving schema for personalized care in NSCLC.
Collapse
Affiliation(s)
- Deepa Rangachari
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Norihiro Yamaguchi
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Paul A VanderLaan
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Erik Folch
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States; Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Anand Mahadevan
- Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Scott R Floyd
- Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Erik J Uhlmann
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Eric T Wong
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Suzanne E Dahlberg
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute and Harvard School of Public Health, Harvard Medical School, Boston, MA, United States
| | - Mark S Huberman
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Daniel B Costa
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States.
| |
Collapse
|
147
|
Whitsett TG, Inge LJ, Dhruv HD, Cheung PY, Weiss GJ, Bremner RM, Winkles JA, Tran NL. Molecular determinants of lung cancer metastasis to the central nervous system. Transl Lung Cancer Res 2015; 2:273-83. [PMID: 25806243 DOI: 10.3978/j.issn.2218-6751.2013.03.12] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Accepted: 03/29/2013] [Indexed: 12/19/2022]
Abstract
Lung cancer remains the leading cause of cancer-related mortality worldwide. The propensity for metastasis to the central nervous system (CNS) is a major clinical hurdle contributing to the low five-year survival rate of advanced disease. CNS metastases significantly outnumber primary brain tumors and carry a dismal prognosis in part due to the inability of therapeutic agents to cross the blood brain barrier. Standard treatment using radiation has been largely ineffective in improving mortality, suggesting the need for new agents targeting the critical metastatic drivers. The genetic and molecular events governing CNS metastasis from the lung are poorly understood at this time. This review highlights genetic events associated with CNS dissemination from the lung and molecular mechanisms associated with CNS metastasis. In vivo model systems that faithfully recapitulate escape from the lung and colonization of the CNS are described as tools for understanding the metastatic phenotype and for testing new therapeutic agents. A deeper understanding of the mechanisms of lung cancer metastasis to the CNS is needed to elucidate novel therapeutic avenues towards the improvement of the mortality associated with advanced stage lung cancer.
Collapse
Affiliation(s)
- Timothy G Whitsett
- Cancer and Cell Biology Division, The Translational Genomics Research Institute (TGen), Phoenix, AZ, USA
| | - Landon J Inge
- Center for Thoracic and Esophageal Disease, Heart and Lung Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Harshil D Dhruv
- Cancer and Cell Biology Division, The Translational Genomics Research Institute (TGen), Phoenix, AZ, USA
| | - Philip Y Cheung
- Cancer and Cell Biology Division, The Translational Genomics Research Institute (TGen), Phoenix, AZ, USA
| | - Glen J Weiss
- Cancer and Cell Biology Division, The Translational Genomics Research Institute (TGen), Phoenix, AZ, USA ; ; Medical Oncology, Cancer Treatment Centers of America, Goodyear, AZ, USA
| | - Ross M Bremner
- Center for Thoracic and Esophageal Disease, Heart and Lung Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Jeffrey A Winkles
- Departments of Surgery and Physiology, Center for Vascular and Inflammatory Diseases and the Greenebaum Cancer Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Nhan L Tran
- Cancer and Cell Biology Division, The Translational Genomics Research Institute (TGen), Phoenix, AZ, USA
| |
Collapse
|
148
|
Seidel C, Kortmann RD. [Brain metastases in pulmonary adenocarcinoma with EGFR mutation: how important is therapy with erlotinib compared to radiotherapy?]. Strahlenther Onkol 2015; 191:205-7. [PMID: 25793246 DOI: 10.1007/s00066-014-0772-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
149
|
Le Rhun É, Taillibert S, Blonski M, Jouniaux Delbez N, Delgadillo D, Taillia H, Auquier P, Belin C, Bonnetain F, Varin D, Tallet A, Taillandier L. [Supportive care, cognition and quality of life in brain metastases]. Cancer Radiother 2015; 19:55-60. [PMID: 25640218 DOI: 10.1016/j.canrad.2014.11.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 11/26/2014] [Indexed: 10/24/2022]
Abstract
Brain metastases impact on the survival of the patients, but on their quality of life as well. The objective of the management of these patients is then double. Currently, due to medical advances, survivals tend to improve, especially for some tumor subtypes. During the course of the disease, different neurological signs and symptoms can be observed according to the location, the number and the volume of the metastase(s). Patients and caregivers are especially worried about the loss of autonomy and cognitive impairments. A permanent dialogue, during the course of the disease, is mandatory, in order to adapt the management to the objectives determined by the patients and the medical team. These objectives may vary according to the objective response rates of the disease to anticancer therapies, according to the impact of the disease and its management in daily living. Anticancer therapies and supportive care must be appreciated according to their impact on the survival, on the preservation of the functional independence and the quality of life of the patient, on their abilities to preserve the neurological status and delay the apparition of new neurological signs and symptoms, and their adverse events. Supportive care, cognition and quality of life should be regularly evaluated and adapted according to the objectives of the management of brain metastases patients. Different approaches are described in this paper.
Collapse
Affiliation(s)
- É Le Rhun
- Neuro-oncologie, département de neurochirurgie, hôpital Roger-Salengro, CHRU, rue Émile-Laine, 59037 Lille cedex, France; Oncologie médicale, centre Oscar-Lambret, 3, rue Frédéric-Combemale, BP 307, 59020 Lille cedex, France; Inserm U1192, laboratoire Prism, université Lille 1, bâtiment SN3 1(er) étage, 59655 Villeneuve d'Ascq cedex, France; Groupe de réflexion sur la prise en charge des métastases cérébrales (GRPCMaC), 13273 Marseille cedex 09, France.
| | - S Taillibert
- Neuro-oncologie, neurologie 2, groupe hospitalier Pitié Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France; Radiothérapie et neuro-oncologie, groupe hospitalier Pitié Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - M Blonski
- Neuro-oncologie, CHU de Nancy, 29, avenue du Maréchal-de-Lattre-de-Tassigny, CO 60034, 54035 Nancy, France
| | - N Jouniaux Delbez
- Neuro-oncologie, neurologie 2, groupe hospitalier Pitié Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - D Delgadillo
- Neuro-oncologie, neurologie 2, groupe hospitalier Pitié Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - H Taillia
- Neurologie, hôpital d'instruction des armées du Val-de-Grâce, 74, boulevard de Port-Royal, 75230 Paris cedex 05, France
| | - P Auquier
- Unité de recherche en santé publique, maladies chroniques et qualité de vie, faculté de médecine Timone, 27, boulevard Jean-Moulin, 13005 Marseille, France
| | - C Belin
- Service de neurologie, CHU Avicenne AP-HP, 125, rue de Stalingrad, 93009 Bobigny cedex, France
| | - F Bonnetain
- Méthodologie et qualité de vie en oncologie, EA 3181, CHU de Besançon, 2, boulevard Fleming, 25030 Besançon, France; Plateforme qualité de vie et recherche clinique en oncologie, CHU de Besançon, 2, boulevard Fleming, 25030 Besançon, France
| | - D Varin
- Soins palliatifs, groupe hospitalier Pitié Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - A Tallet
- Groupe de réflexion sur la prise en charge des métastases cérébrales (GRPCMaC), 13273 Marseille cedex 09, France; Département d'oncologie-radiothérapie, institut Paoli-Calmettes, 232, boulevard Sainte-Marguerite, 13009 Marseille, France
| | - L Taillandier
- Inserm U1192, laboratoire Prism, université Lille 1, bâtiment SN3 1(er) étage, 59655 Villeneuve d'Ascq cedex, France
| |
Collapse
|
150
|
Shingyoji M, Iuchi T. Considerations on the management of EGF receptor-TKIs for brain metastases in EGFR-mutant lung carcinoma patients. Lung Cancer Manag 2015. [DOI: 10.2217/lmt.14.44] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
SUMMARY Approximately 20–30% of patients with NSCLC are present with brain metastases. The standard management for brain metastases is radiotherapy. Despite the administration of radiation therapy for brain metastases, the prognosis is still poor. The poor prognosis is related to the progression of extracranial lesions. Therefore, systemic therapy is important to improve survival of patients with brain metastases. EGF receptor-tyrosine kinase inhibitor (EGFR-TKI) is a standard treatment for advanced NSCLC patients with sensitive EGFR mutations and is also effective in controlling brain metastasis in such patients. Upfront EGFR-TKI therapy might be one of the treatment choices for EGFR-mutant NSCLC patients with asymptomatic brain metastases. However, it is unclear whether upfront EGFR-TKI or radiation therapy is more preferable. New EGFR-TKIs and combination with existing EGFR-TKIs and other drugs are being investigated for treatment options. Further investigations are required to determine the future direction for management of EGFR-mutant NSCLC patients with brain metastasis.
Collapse
Affiliation(s)
| | - Toshihiko Iuchi
- Division of Neurological Surgery, Chiba Cancer Center, Chiba, Japan
| |
Collapse
|