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McDonald F, Popat S. Combining targeted agents and hypo- and hyper-fractionated radiotherapy in NSCLC. J Thorac Dis 2014; 6:356-68. [PMID: 24688780 DOI: 10.3978/j.issn.2072-1439.2013.12.05] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Accepted: 12/03/2013] [Indexed: 12/12/2022]
Abstract
Radical radiotherapy remains the cornerstone of treatment for patients with unresectable locally advanced non small cell lung cancer (NSCLC) either as single modality treatment for poor performance status patients or with sequential or concomitant chemotherapy for good performance status patients. Advances in understanding of tumour molecular biology, targeted drug development and experiences of novel agents in the advanced disease setting have brought targeted agents into the NSCLC clinic. In parallel experience using modified accelerated fractionation schedules in locally advanced disease have demonstrated improved outcomes compared to conventional fractionation in the single modality and sequential chemo-radiotherapy settings. Early studies of targeted agents combined with (chemo-) radiotherapy in locally advanced disease in different clinical settings are discussed below and important areas for future studies are high-lighted.
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Abstract
SUMMARY Pemetrexed, a multitargeted antifolate agent, is currently used in the treatment of non-small-cell lung cancer. Strong evidence has shown a treatment-by-histology interaction, with pemetrexed acting significantly better in the nonsquamous cell subtype. Therefore, all pemetrexed indications are restricted to this histology. Associated initially with somewhat high toxicity, the use of vitamin supplementation and corticoid premedication turned pemetrexed into one of the most convenient chemotherapy agents. At present pemetrexed is recommended as one of the preferred platinum partners in first line and as a single agent in the second-line setting for nonsquamous histology. The particular efficacy/toxicity profile has confirmed pemetrexed as the only chemotherapy agent approved for both continuation and switch maintenance therapy.
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Affiliation(s)
- Mircea Dediu
- Medical Oncology Department, Institute of Oncology 'Alexandru Trestioreanu' Bucharest, Sos Fundeni 252, 022328, Bucharest, Romania
| | - Aurelia Alexandru
- Medical Oncology Department, Institute of Oncology 'Alexandru Trestioreanu' Bucharest, Sos Fundeni 252, 022328, Bucharest, Romania
| | - Florentina Bratu
- Medical Oncology Department, Institute of Oncology 'Alexandru Trestioreanu' Bucharest, Sos Fundeni 252, 022328, Bucharest, Romania
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Zhuang H, Zhao X, Zhao L, Chang JY, Wang P. Progress of clinical research on targeted therapy combined with thoracic radiotherapy for non-small-cell lung cancer. Drug Des Devel Ther 2014; 8:667-75. [PMID: 24936128 PMCID: PMC4047835 DOI: 10.2147/dddt.s61977] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
The combination of radiotherapy and targeted therapy is an important approach in the application of targeted therapy in clinical practice, and represents an important opportunity for the development of radiotherapy itself. Numerous agents, including epidermal growth factor receptor, monoclonal antibodies, tyrosine kinase inhibitors, and antiangiogenic therapies, have been used for targeted therapy. A number of studies of radiotherapy combined with targeted therapy in non-small-cell lung carcinoma have been completed or are ongoing. This paper briefly summarizes the drugs involved and the important related clinical research, and indicates that considerable progress has been made with the joint efforts of the two disciplines. Many issues, including drug selection, identification of populations most likely to benefit, timing of administration of medication, and side effects of treatment require further investigation. However, further fundamental research and accumulation of clinical data will provide a more comprehensive understanding of these therapies. Targeted therapy in combination with radiotherapy has a bright future.
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Affiliation(s)
- Hongqing Zhuang
- Department of Radiotherapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Key Laboratory of Cancer Prevention and Therapy, and Tianjin Lung Cancer Center, Tianjin, People’s Republic of China
| | - Xianzhi Zhao
- Department of Radiotherapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Key Laboratory of Cancer Prevention and Therapy, and Tianjin Lung Cancer Center, Tianjin, People’s Republic of China
| | - Lujun Zhao
- Department of Radiotherapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Key Laboratory of Cancer Prevention and Therapy, and Tianjin Lung Cancer Center, Tianjin, People’s Republic of China
| | - Joe Y Chang
- Department of Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ping Wang
- Department of Radiotherapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Key Laboratory of Cancer Prevention and Therapy, and Tianjin Lung Cancer Center, Tianjin, People’s Republic of China
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de Mello RA, Madureira P, Carvalho LS, Araújo A, O'Brien M, Popat S. EGFR and KRAS mutations, and ALK fusions: current developments and personalized therapies for patients with advanced non-small-cell lung cancer. Pharmacogenomics 2014; 14:1765-77. [PMID: 24192124 DOI: 10.2217/pgs.13.177] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Personalized therapy has significantly developed in lung cancer treatment over recent years. VEGF and EGF play a major role in non-small-cell lung cancer (NSCLC) tumor angiogenesis and aggressiveness. EGFR mutation as well as KRAS and ALK rearrangements are important biomarkers in the field owing to potential targeted therapies involved in clinical practice: erlotinib, geftinib, cetuximab and crizotinib. More recently, regulation of tumor immunity through CTLA4 and PD1/L1 has emerged as a promising field in NSCLC management. This review will focus on the current and future biomarkers in the advanced NSCLC field and also address potential related targeted therapies for these patients.
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Affiliation(s)
- Ramon Andrade de Mello
- Department of Medical Oncology, Portuguese Oncology Institute, Rua Dr António Bernardino de Almeida, 4200-072, Porto, Portugal
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Wang M, Kern AM, Hülskötter M, Greninger P, Singh A, Pan Y, Chowdhury D, Krause M, Baumann M, Benes CH, Efstathiou JA, Settleman J, Willers H. EGFR-mediated chromatin condensation protects KRAS-mutant cancer cells against ionizing radiation. Cancer Res 2014; 74:2825-34. [PMID: 24648348 PMCID: PMC4278592 DOI: 10.1158/0008-5472.can-13-3157] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Therapeutics that target the epidermal growth factor receptor (EGFR) can enhance the cytotoxic effects of ionizing radiation (IR). However, predictive genomic biomarkers of this radiosensitization have remained elusive. By screening 40 non-small cell lung cancer cell (NSCLC) lines, we established a surprising positive correlation between the presence of a KRAS mutation and radiosensitization by the EGFR inhibitors erlotinib and cetuximab. EGFR signaling in KRAS-mutant NSCLC cells promotes chromatin condensation in vitro and in vivo, thereby restricting the number of DNA double-strand breaks (DSB) produced by a given dose of IR. Chromatin condensation in interphase cells is characterized by an unexpected mitosis-like colocalization of serine 10 phosphorylation and lysine 9 trimethylation on histone H3. Aurora B promotes this process in a manner that is codependent upon EGFR and protein kinase C α (PKCα). PKCα, in addition to MEK/ERK signaling, is required for the suppression of DSB-inducible premature senescence by EGFR. Blockade of autophagy results in a mutant KRAS-dependent senescence-to-apoptosis switch in cancer cells treated with IR and erlotinib. In conclusion, we identify EGFR as a molecular target to overcome a novel mechanism of radioresistance in KRAS-mutant tumor cells, which stands in contrast to the unresponsiveness of KRAS-mutant cancers to EGFR-directed agents in monotherapy. Our findings may reposition EGFR-targeted agents for combination with DSB-inducing therapies in KRAS-mutant NSCLC.
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Affiliation(s)
- Meng Wang
- Authors' Affiliations: Department of Radiation Oncology, Massachusetts General Hospital; Center for Cancer Research, Massachusetts General Hospital Cancer Center; Department of Radiation Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts; Department of Radiation Oncology, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden; OncoRay-National Center for Radiation Research in Oncology, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden; Institute of Radiation Oncology, Helmholtz-Zentrum Dresden-Rossendorf, Dresden; and Cancer Consortium (DKTK) Partner Site Dresden and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Ashley M Kern
- Authors' Affiliations: Department of Radiation Oncology, Massachusetts General Hospital; Center for Cancer Research, Massachusetts General Hospital Cancer Center; Department of Radiation Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts; Department of Radiation Oncology, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden; OncoRay-National Center for Radiation Research in Oncology, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden; Institute of Radiation Oncology, Helmholtz-Zentrum Dresden-Rossendorf, Dresden; and Cancer Consortium (DKTK) Partner Site Dresden and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Marieke Hülskötter
- Authors' Affiliations: Department of Radiation Oncology, Massachusetts General Hospital; Center for Cancer Research, Massachusetts General Hospital Cancer Center; Department of Radiation Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts; Department of Radiation Oncology, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden; OncoRay-National Center for Radiation Research in Oncology, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden; Institute of Radiation Oncology, Helmholtz-Zentrum Dresden-Rossendorf, Dresden; and Cancer Consortium (DKTK) Partner Site Dresden and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Patricia Greninger
- Authors' Affiliations: Department of Radiation Oncology, Massachusetts General Hospital; Center for Cancer Research, Massachusetts General Hospital Cancer Center; Department of Radiation Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts; Department of Radiation Oncology, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden; OncoRay-National Center for Radiation Research in Oncology, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden; Institute of Radiation Oncology, Helmholtz-Zentrum Dresden-Rossendorf, Dresden; and Cancer Consortium (DKTK) Partner Site Dresden and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Anurag Singh
- Authors' Affiliations: Department of Radiation Oncology, Massachusetts General Hospital; Center for Cancer Research, Massachusetts General Hospital Cancer Center; Department of Radiation Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts; Department of Radiation Oncology, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden; OncoRay-National Center for Radiation Research in Oncology, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden; Institute of Radiation Oncology, Helmholtz-Zentrum Dresden-Rossendorf, Dresden; and Cancer Consortium (DKTK) Partner Site Dresden and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Yunfeng Pan
- Authors' Affiliations: Department of Radiation Oncology, Massachusetts General Hospital; Center for Cancer Research, Massachusetts General Hospital Cancer Center; Department of Radiation Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts; Department of Radiation Oncology, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden; OncoRay-National Center for Radiation Research in Oncology, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden; Institute of Radiation Oncology, Helmholtz-Zentrum Dresden-Rossendorf, Dresden; and Cancer Consortium (DKTK) Partner Site Dresden and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Dipanjan Chowdhury
- Authors' Affiliations: Department of Radiation Oncology, Massachusetts General Hospital; Center for Cancer Research, Massachusetts General Hospital Cancer Center; Department of Radiation Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts; Department of Radiation Oncology, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden; OncoRay-National Center for Radiation Research in Oncology, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden; Institute of Radiation Oncology, Helmholtz-Zentrum Dresden-Rossendorf, Dresden; and Cancer Consortium (DKTK) Partner Site Dresden and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Mechthild Krause
- Authors' Affiliations: Department of Radiation Oncology, Massachusetts General Hospital; Center for Cancer Research, Massachusetts General Hospital Cancer Center; Department of Radiation Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts; Department of Radiation Oncology, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden; OncoRay-National Center for Radiation Research in Oncology, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden; Institute of Radiation Oncology, Helmholtz-Zentrum Dresden-Rossendorf, Dresden; and Cancer Consortium (DKTK) Partner Site Dresden and German Cancer Research Center (DKFZ), Heidelberg, GermanyAuthors' Affiliations: Department of Radiation Oncology, Massachusetts General Hospital; Center for Cancer Research, Massachusetts General Hospital Cancer Center; Department of Radiation Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts; Department of Radiation Oncology, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden; OncoRay-National Center for Radiation Research in Oncology, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden; Institute of Radiation Oncology, Helmholtz-Zentrum Dresden-Rossendorf, Dresden; and Cancer Consortium (DKTK) Partner Site Dresden and German Cancer Research Center (DKFZ), Heidelberg, GermanyAuthors' Affiliations: Department of Radiation Oncology, Massachusetts General Hospital; Center for Cancer Research, Massachusetts General Hospital Cancer Center; Department of Radiation Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts; Department of Radiation Oncology, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden; OncoRay-National Center for Radiation Research in Oncology, Medical F
| | - Michael Baumann
- Authors' Affiliations: Department of Radiation Oncology, Massachusetts General Hospital; Center for Cancer Research, Massachusetts General Hospital Cancer Center; Department of Radiation Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts; Department of Radiation Oncology, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden; OncoRay-National Center for Radiation Research in Oncology, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden; Institute of Radiation Oncology, Helmholtz-Zentrum Dresden-Rossendorf, Dresden; and Cancer Consortium (DKTK) Partner Site Dresden and German Cancer Research Center (DKFZ), Heidelberg, GermanyAuthors' Affiliations: Department of Radiation Oncology, Massachusetts General Hospital; Center for Cancer Research, Massachusetts General Hospital Cancer Center; Department of Radiation Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts; Department of Radiation Oncology, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden; OncoRay-National Center for Radiation Research in Oncology, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden; Institute of Radiation Oncology, Helmholtz-Zentrum Dresden-Rossendorf, Dresden; and Cancer Consortium (DKTK) Partner Site Dresden and German Cancer Research Center (DKFZ), Heidelberg, GermanyAuthors' Affiliations: Department of Radiation Oncology, Massachusetts General Hospital; Center for Cancer Research, Massachusetts General Hospital Cancer Center; Department of Radiation Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts; Department of Radiation Oncology, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden; OncoRay-National Center for Radiation Research in Oncology, Medical F
| | - Cyril H Benes
- Authors' Affiliations: Department of Radiation Oncology, Massachusetts General Hospital; Center for Cancer Research, Massachusetts General Hospital Cancer Center; Department of Radiation Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts; Department of Radiation Oncology, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden; OncoRay-National Center for Radiation Research in Oncology, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden; Institute of Radiation Oncology, Helmholtz-Zentrum Dresden-Rossendorf, Dresden; and Cancer Consortium (DKTK) Partner Site Dresden and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Jason A Efstathiou
- Authors' Affiliations: Department of Radiation Oncology, Massachusetts General Hospital; Center for Cancer Research, Massachusetts General Hospital Cancer Center; Department of Radiation Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts; Department of Radiation Oncology, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden; OncoRay-National Center for Radiation Research in Oncology, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden; Institute of Radiation Oncology, Helmholtz-Zentrum Dresden-Rossendorf, Dresden; and Cancer Consortium (DKTK) Partner Site Dresden and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Jeff Settleman
- Authors' Affiliations: Department of Radiation Oncology, Massachusetts General Hospital; Center for Cancer Research, Massachusetts General Hospital Cancer Center; Department of Radiation Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts; Department of Radiation Oncology, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden; OncoRay-National Center for Radiation Research in Oncology, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden; Institute of Radiation Oncology, Helmholtz-Zentrum Dresden-Rossendorf, Dresden; and Cancer Consortium (DKTK) Partner Site Dresden and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Henning Willers
- Authors' Affiliations: Department of Radiation Oncology, Massachusetts General Hospital; Center for Cancer Research, Massachusetts General Hospital Cancer Center; Department of Radiation Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts; Department of Radiation Oncology, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden; OncoRay-National Center for Radiation Research in Oncology, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden; Institute of Radiation Oncology, Helmholtz-Zentrum Dresden-Rossendorf, Dresden; and Cancer Consortium (DKTK) Partner Site Dresden and German Cancer Research Center (DKFZ), Heidelberg, Germany
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106
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Molecular targeted therapy for early-stage non-small-cell lung cancer: Will it increase the cure rate? Lung Cancer 2014; 84:97-100. [DOI: 10.1016/j.lungcan.2014.01.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Accepted: 01/21/2014] [Indexed: 11/22/2022]
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107
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Parlak C, Mertsoylu H, Güler OC, Onal C, Topkan E. Definitive Chemoradiation Therapy Following Surgical Resection or Radiosurgery Plus Whole-Brain Radiation Therapy in Non-Small Cell Lung Cancer Patients With Synchronous Solitary Brain Metastasis: A Curative Approach. Int J Radiat Oncol Biol Phys 2014; 88:885-91. [DOI: 10.1016/j.ijrobp.2013.12.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Revised: 12/11/2013] [Accepted: 12/13/2013] [Indexed: 12/28/2022]
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108
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Tomasini P, Greillier L, Khobta N, Barlesi F. The place of pemetrexed in the management of non-small-cell lung cancer patients. Expert Rev Anticancer Ther 2014; 13:257-66. [PMID: 23477511 DOI: 10.1586/era.12.171] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Non-small cell lung cancer (NSCLC) remains the leading cause of cancer death worldwide. Chemotherapy is included in the management of the majority of NSCLC patients either in addition to a local treatment (surgery/radiotherapy) or alone. In this setting, pemetrexed has become one of the most important partners of current chemotherapy regimens for nonsquamous NSCLC patients. Indeed, pemetrexed demonstrated a comparable efficacy to other previously available drugs in NSCLC, with however a better safety profile and an easier schedule of administration. In addition, pemetrexed demonstrated a greater efficacy in nonsquamous NSCLC that lead to an exploration of the underlying potential biological background. It is now suggested that the tumor thymidylate synthase level may act as a predictor of pemetrexed efficacy, therefore potentially providing clinicians in the future with a predictor of efficacy, which it is usually lacking with standard chemotherapies.
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Affiliation(s)
- Pascale Tomasini
- Aix-Marseille Université - Assistance Publique Hôpitaux de Marseille, Multidisciplinary Oncology & Therapeutic Innovations Department, Chemin des Bourrely, 13915 Marseille Cedex 20, France
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109
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First assessment of whole-brain radiation therapy combined with pemetrexed-based chemotherapy in non-small-cell lung carcinoma: data on safety and efficacy. Anticancer Drugs 2014; 24:736-42. [PMID: 23542752 DOI: 10.1097/cad.0b013e328360974d] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The folate antimetabolite pemetrexed was approved for the treatment of patients with metastatic nonsquamous non-small-cell lung carcinoma. Its activity on brain metastases makes pemetrexed attractive in combination with whole-brain radiation therapy (WBRT), but it could also potentially increase toxicity. We examined the medical records of 43 consecutive patients with brain metastases from non-small-cell lung carcinoma. Patients received pemetrexed-based chemotherapy at a dose of 500 mg/m. The median total number of pemetrexed-based chemotherapy cycles was 4 (range: 1-28). During the course of chemotherapy, patients received WBRT delivering 30 Gy in 10 fractions (n=34) or 20 Gy in five fractions (n=9). The median follow-up time was 30.5 weeks (range: 1-79 weeks). Intracranial progression was a cause of death in nine patients (20.9%). Clinical benefit of WBRT was reported in 30 patients (69.8%). The best radiological response was a complete response in eight patients (18.6%), a partial response in 16 patients (37.2%), stable disease in 11 patients (25.6%), and progression in four patients (9.3%). A stable intracranial disease until the last follow-up was observed in 26 patients (60.5%). The median estimated overall survival was 31 weeks (95% CI: 24-37 weeks). Most WBRT-related toxicities were low and 21 patients (48.9%) had no reported acute neurological toxicity. One patient developed unexplained encephalopathy 5 weeks after WBRT completion in the context of progressive diffuse brain metastases. The combination of pemetrexed with WBRT led to considerable clinical improvement and tumor responses in most patients. Overall neurological toxicity was rather low. A clinical trial is essential for better analysis of the potential synergistic effects of a drug with radiation and evaluation of neurological toxicity.
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110
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Dose-Escalation Study of Thoracic Radiotherapy in Combination With Pemetrexed Plus Cisplatin in Japanese Patients With Locally Advanced Nonsquamous Non-Small Cell Lung Cancer: A Post Hoc Analysis of Survival and Recurrent Sites. Am J Clin Oncol 2014; 39:132-5. [PMID: 24441582 DOI: 10.1097/coc.0000000000000030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES We performed a post hoc analysis of progression-free survival (PFS), overall survival (OS), and recurrent sites in patients with locally advanced nonsquamous non-small cell lung cancer who were enrolled in a phase I trial of combination chemotherapy consisting of pemetrexed plus cisplatin with concurrent thoracic radiotherapy. METHODS Patients received pemetrexed (500 mg/m²) plus cisplatin (75 mg/m²) on day 1 every 3 weeks for 3 cycles plus concurrent thoracic radiotherapy consisting of 60 Gy (n=6) or 66 Gy (n=12); 4 to 6 weeks thereafter, patients received consolidation treatment with pemetrexed (500 mg/m) every 3 weeks for up to 3 cycles. We reviewed the medial records to collect data on progression, recurrent sites, late toxicity, and survival. RESULTS No late radiation morbidity was observed. Thirteen patients (72%) exhibited disease progression: 8 patients had distant metastases, 8 patients had local recurrence (within the radiation field [n=6], outside the radiation field [n=2], and both [n=1]), and 3 patients had local recurrence plus distant metastases. The median PFS was 10.5 months (95% confidence interval [CI], 8.8-12.3), and the 3-year PFS rate was 28% (95% CI, 7.0-48.6). Ten of the 18 patients died of lung cancer. The median follow-up time for the censored cases was 42.8 months (range, 38.1 to 52.9 mo). The median OS was 27.3 months (95% CI, 13.1-41.6), and the 3-year OS rate was 50% (95% CI, 26.9-73.1). CONCLUSIONS The median PFS and OS in our study were comparable to those of historical chemoradiotherapy controls.
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Biswas T, Sharma N, Machtay M. Controversies in the management of stage III non-small-cell lung cancer. Expert Rev Anticancer Ther 2014; 14:333-47. [PMID: 24397773 DOI: 10.1586/14737140.2014.867809] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Lung cancer remains the leading cause of death in the USA and is the most common cancer both in incidence and in mortality globally (1.35 million deaths annually). Non-small-cell lung cancer accounts for >80% of all lung cancers [1] . About 35-45% of non-small-cell lung cancer patients present with locally advanced non-metastatic stage III disease. However, confirmed stage III disease represents a very heterogeneous group ranging from borderline surgical candidate with minimal mediastinal involvement to bulky mediastinal nodes or contralateral nodal involvement with significant controversy regarding optimal management in these various situations. This article specifically addresses the role of surgery, radiotherapy and chemotherapy in multimodal approach to treat stage III patients with N2/N3 involvement and controversies surrounding these recommendations.
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Affiliation(s)
- Tithi Biswas
- University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH 44106, USA
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112
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van den Heuvel MM, Uyterlinde W, Vincent AD, de Jong J, Aerts J, Koppe F, Knegjens J, Codrington H, Kunst PW, Dieleman E, Verheij M, Belderbos J. Additional weekly Cetuximab to concurrent chemoradiotherapy in locally advanced non-small cell lung carcinoma: Efficacy and safety outcomes of a randomized, multi-center phase II study investigating. Radiother Oncol 2014; 110:126-31. [DOI: 10.1016/j.radonc.2013.10.009] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Revised: 10/07/2013] [Accepted: 10/13/2013] [Indexed: 12/25/2022]
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113
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Qi WX, Sun YJ, Shen Z, Yao Y. Risk of anti-EGFR monoclonal antibody-related skin rash: an up-to-date meta-analysis of 25 randomized controlled trials. J Chemother 2013; 26:359-68. [DOI: 10.1179/1973947813y.0000000155] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Predictors of biomarkers guiding targeted therapeutic strategies in locally advanced lung cancer. Cancer J 2013; 19:263-71. [PMID: 23708073 DOI: 10.1097/ppo.0b013e318297216a] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Lung cancer accounts for the majority of cancer-related deaths worldwide. We sought out to summarize the current state of molecular predictors for response and toxicity in locally advanced lung cancer. Several changes have been introduced in recent years in the standard-of-care treatment of advanced non-small cell lung cancer based on the identification of specific molecular alterations that determine response probability to certain therapies. Eligibility for these treatments is assessed by a biomarker test, evaluating if the molecular alteration is present or not in a patient's tumor. In particular, tissue testing for epidermal growth factor receptor and anaplastic lymphoma kinase alterations is currently recommended for certain patients with advanced non-small cell lung cancer, whereas excision repair cross-complementation group 1 and ribonucleotide reductase 1 as markers for outcome after platinum and gemcitabine therapy are promising but are currently not recommended outside a clinical trial. However, their application to the therapy of locally advanced disease is still mostly investigational. Moreover, additional candidate markers for response and toxicity for locally advanced lung cancer are under further investigation.
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Laine AM, Westover KD, Choy H. Radiation therapy as a backbone of treatment of locally advanced non-small cell lung cancer. Semin Oncol 2013; 41:57-68. [PMID: 24565581 DOI: 10.1053/j.seminoncol.2013.12.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Locally advanced non-small cell lung cancer (LA-NSCLC) is a heterogeneous disease, encompassing stage IIIA, for which surgery in combination with chemotherapy and/or radiation therapy (RT) represents a potential treatment approach for select patients, and stage IIIB, for which chemoradiation represents the standard of care. Recent advances in systemic cytotoxic and molecularly targeted therapies coupled with technologic innovations in radiotherapy have the potential to improve outcomes for this patient population. Many ongoing clinical trials use specific genetic mutations or histologic status to determine the combination of targeted therapies and RT, as well as to determine the optimal chemoradiotherapy platforms. Additionally, use of modern RT techniques has improved outcomes for some patients with limited metastatic disease, thereby prompting further studies on how to best integrate aggressive management of oligometastases using RT with chemotherapeutic regimens.
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Affiliation(s)
- Aaron M Laine
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Kenneth D Westover
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Hak Choy
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX.
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Li X, Shan BE, Wang J, Xing LP, Guo XJ, Zhang YH, Shi PH, Wang ZY. Incidence and risk of treatment-related mortality with anti-epidermal growth factor receptor monoclonal antibody in cancer patients: a meta-analysis of 21 randomized controlled trials. PLoS One 2013; 8:e81897. [PMID: 24312376 PMCID: PMC3842967 DOI: 10.1371/journal.pone.0081897] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2013] [Accepted: 10/14/2013] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Anti-epidermal growth factor receptor (EGFR) monoclonal antibodies (MoAbs) cetuximab and panitumumab have emerged as an effective targeted therapy in the treatment of cancer patients, but the overall incidence and risk of fatal adverse events (FAEs) associated with these agents is still unclear. METHODS Databases from PubMed, Web of Science and abstracts presented at ASCO meeting up to May 31, 2013 were searched to identify relevant studies. Eligible studies included prospective randomized controlled trials evaluating MoAbs in cancer patients with adequate data on FAEs. Statistical analyses were conducted to calculate the summary incidence, odds ratio and 95% confidence intervals (CIs) by using either random effects or fixed effect models according to the heterogeneity of included studies. RESULTS A total of 14,776 patients with a variety of solid tumors from 21 clinical trials were included in our analysis. The overall incidence of MoAbs associated FAEs was 1.7% (95%CI: 1.1-2.5%), and the incidence of cetuximab-related FAEs was higher than that of panitumumab (2.0% versus 0.9%). Compared with the controls, the use of MoAbs was associated with a significantly increased risk of FAEs, with an OR of 1.37 (95%CI: 1.04-1.81, p=0.024). Subgroup analysis based on EGFR-MoAbs drugs, phase of trials and tumor types demonstrated a tendency to increase the risk of FAEs, but the risk did not increase in breast cancer, esophagus cancer and phase II trials. CONCLUSIONS With present evidence, the use of EGFR-MoAbs is associated with an increased risk of FAEs in patients with advanced solid tumors.
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Affiliation(s)
- Xing Li
- Department of Biotherapy, Fourth Hospital of Hebei Medical University, Shijiazhuang, People’s Republic of China
| | - Bao-En Shan
- Centre of Scientific Research, Fourth Hospital of Hebei Medical University, Shijiazhuang, People’s Republic of China
| | - Juan Wang
- Department of Biotherapy, Fourth Hospital of Hebei Medical University, Shijiazhuang, People’s Republic of China
| | - Lian-Ping Xing
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, New York, United States of America
| | - Xiao-Jin Guo
- Department of Biotherapy, Fourth Hospital of Hebei Medical University, Shijiazhuang, People’s Republic of China
| | - Yue-Hua Zhang
- Department of Biotherapy, Fourth Hospital of Hebei Medical University, Shijiazhuang, People’s Republic of China
| | - Peng-Hui Shi
- Department of Biotherapy, Fourth Hospital of Hebei Medical University, Shijiazhuang, People’s Republic of China
| | - Zhi-Yu Wang
- Department of Biotherapy, Fourth Hospital of Hebei Medical University, Shijiazhuang, People’s Republic of China
- * E-mail:
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Reber J, Haller S, Leamon CP, Müller C. 177Lu-EC0800 combined with the antifolate pemetrexed: preclinical pilot study of folate receptor targeted radionuclide tumor therapy. Mol Cancer Ther 2013; 12:2436-45. [PMID: 24030631 DOI: 10.1158/1535-7163.mct-13-0422-t] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Targeted radionuclide therapy has shown impressive results for the palliative treatment of several types of cancer diseases. The folate receptor has been identified as specifically associated with a variety of frequent tumor types. Therefore, it is an attractive target for the development of new radionuclide therapies using folate-based radioconjugates. Previously, we found that pemetrexed (PMX) has a favorable effect in reducing undesired renal uptake of radiofolates. Moreover, PMX also acts as a chemotherapeutic and radiosensitizing agent on tumors. Thus, the aim of our study was to investigate the combined application of PMX and the therapeutic radiofolate (177)Lu-EC0800. Determination of the combination index (CI) revealed a synergistic inhibitory effect of (177)Lu-EC0800 and PMX on the viability of folate receptor-positive cervical (KB) and ovarian (IGROV-1) cancer cells in vitro (CI < 0.8). In an in vivo study, tumor-bearing mice were treated with (177)Lu-EC0800 (20 MBq) and a subtherapeutic (0.4 mg) or therapeutic amount (1.6 mg) of PMX. Application of (177)Lu-EC0800 with PMXther resulted in a two- to four-fold enhanced tumor growth delay and a prolonged survival of KB and IGROV-1 tumor-bearing mice, as compared to the combination with PMXsubther or untreated control mice. PMXsubther protected the kidneys from undesired side effects of (177)Lu-EC0800 (20 MBq) by reducing the absorbed radiation dose. Intact kidney function was shown by determination of plasma parameters and quantitative single-photon emission computed tomography using (99m)Tc-DMSA. Our results confirmed the anticipated dual role of PMX. Its unique features resulted in an improved antitumor effect of folate-based radionuclide therapy and prevented undesired radio-nephrotoxicity.
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Affiliation(s)
- Josefine Reber
- Corresponding Author: Cristina Müller, Center for Radiopharmaceutical Sciences ETH-PSI-USZ, Paul Scherrer Institute, 5232 Villigen-PSI, Switzerland.
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Deutsch E, Lemanski C, Pignon JP, Levy A, Delarochefordiere A, Martel-Lafay I, Rio E, Malka D, Conroy T, Miglianico L, Becouarn Y, Malekzadeh K, Paris E, Juzyna B, Ezra P, Azria D. Unexpected toxicity of cetuximab combined with conventional chemoradiotherapy in patients with locally advanced anal cancer: results of the UNICANCER ACCORD 16 phase II trial. Ann Oncol 2013; 24:2834-8. [PMID: 24026540 DOI: 10.1093/annonc/mdt368] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND The ACCORD 16 phase II trial aimed to evaluate the objective response rate after combination of conventional chemoradiotherapy (CRT) and cetuximab in locally advanced anal canal carcinoma (LAACC). PATIENTS AND METHODS Immunocompetent patients with histologically confirmed LAACC received CRT [45 gray (Gy)] in 25 fractions over 5 weeks, fluorouracil and cisplatin during weeks 1 and 5), in combination with weekly dose of cetuximab (250 mg/m(2) with a loading dose of 400 mg/m(2) 1 week before irradiation), and a standard dose boost (20 Gy). The trial was originally designed to include 81 patients to detect a 15% of objective response increase with the new combination in comparison with CRT. RESULTS The trial was prematurely stopped after the declaration of 15 serious adverse events (SAEs) in 14 out of 16 patients. Five patients received the entire planned treatment, and the compliance was higher after amendments of the protocol. Among the 15 SAEs, 6 were unexpected. Grade (G) 3/4 acute toxic effects, observed in 88% patients, were general (n = 13, 81%), digestive (n = 9, 56%), dermatological (n = 5, 31%), infectious (n = 4, 25%), haematological (n = 3, 19%), and others (n = 9); and three patients suffered from six G3/4 late toxic effects. No treatment-related death was reported. All 11 assessable patients had an objective response consisting of six complete (55%) and five partial (45%) response 2 months after the end of the treatment. Thirteen patients were followed up with a median of 22 months [95% confidence interval (CI ): 18-27] and had a 1-year colostomy-free survival, progression-free and overall survival rate of 67% (95% CI: 40%-86%), 62% (95% CI: 36%-82%), and 92% (95% CI: 67%-99%), respectively. CONCLUSION CRT plus cetuximab was unacceptably toxic in this population of patients. Results of others phase II trials evaluating this combination are awaited to confirm these findings. EUDRA CT NO 2007-007029-38.
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Affiliation(s)
- E Deutsch
- Department of Radiotherapy, Institut Gustave-Roussy, Villejuif
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Is Consolidation Chemotherapy after Concurrent Chemo-Radiotherapy Beneficial for Patients with Locally Advanced Non–Small-Cell Lung Cancer?: A Pooled Analysis of the Literature. J Thorac Oncol 2013; 8:1181-9. [DOI: 10.1097/jto.0b013e3182988348] [Citation(s) in RCA: 90] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Chen Y, Moon J, Pandya KJ, Lau DHM, Kelly K, Hirsch FR, Gaspar LE, Redman M, Gandara DR. A Pilot Study (SWOG S0429) of Weekly Cetuximab and Chest Radiotherapy for Poor-Risk Stage III Non-Small Cell Lung Cancer. Front Oncol 2013; 3:219. [PMID: 24010120 PMCID: PMC3755267 DOI: 10.3389/fonc.2013.00219] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Accepted: 08/09/2013] [Indexed: 12/28/2022] Open
Abstract
PURPOSE Stage III non-small cell lung cancer (NSCLC) patients with poor performance status (PS) or co-morbidities are often not candidates for standard chemoradiotherapy (chemoRT) due to poor tolerance to treatments. A pilot study for poor-risk stage III NSCLC patients was conducted combining cetuximab, a chimeric monoclonal antibody targeting epidermal growth factor receptor (EGFR), with chest radiation (RT). METHODS Stage III NSCLC patients with Zubrod PS 2, or Zubrod PS 0-1 with poor pulmonary function and co-morbidities prohibiting chemoRT were eligible. A loading dose of cetuximab (400 mg/m(2)) was delivered week 1, followed by weekly cetuximab (250 mg/m(2))/RT to 64.8 Gy in 1.8 Gy daily fractions, and maintenance weekly cetuximab (250 mg/m(2)) for 2 years or until disease progression. H-score for EGFR protein expression was conducted in available tumors. RESULTS Twenty-four patients were enrolled. Twenty-two were assessed for outcome and toxicity. Median survival was 14 months and median progression-free survival was 8 months. The response rate was 47% and disease control rate was 74%. Toxicity assessment revealed 22.7% overall ≥Grade 3 non-hematologic toxicities. Grade 3 esophagitis was observed in one patient (5%). The skin reactions were mostly Grade 1 or 2 except two of 22 (9%) had Grade 3 acne and one of 22 (5%) had Grade 3 radiation skin burn. Grade 3-4 hypomagnesemia was seen in four (18%) patients. One patient (5%) had elevated cardiac troponin and pulmonary emboli. H-score did not reveal prognostic significance. An initially planned second cohort of the study did not commence due to slow accrual, which would have added weekly docetaxel to cetuximab/RT after completion of the first cohort of patients. CONCLUSION Concurrent weekly cetuximab/chest RT followed by maintenance cetuximab for poor-risk stage III NSCLC was well tolerated. Further studies with larger sample sizes will be useful to establish the optimal therapeutic ratio of this regimen.
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Affiliation(s)
- Yuhchyau Chen
- Department of Radiation Oncology, University of Rochester, Rochester, NY, USA
| | - James Moon
- SWOG Statistical Center, Seattle, WA, USA
| | - Kishan J. Pandya
- Hematology Oncology, University of Rochester, Rochester, NY, USA
| | - Derick H. M. Lau
- Hematology Oncology, University of California at Davis, Sacramento, CA, USA
| | - Karen Kelly
- Hematology Oncology, University of California at Davis, Sacramento, CA, USA
| | - Fred R. Hirsch
- Department of Medicine and Pathology, University of Colorado, Denver, CO, USA
| | - Laurie E. Gaspar
- Department of Radiation Oncology, University of Colorado, Denver, CO, USA
| | | | - David R. Gandara
- Hematology Oncology, University of California at Davis, Sacramento, CA, USA
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Outcomes of aggressive concurrent radiochemotherapy in highly selected septuagenarians with stage IIIB non-small cell lung carcinoma: Retrospective analysis of 89 patients. Lung Cancer 2013; 81:226-30. [DOI: 10.1016/j.lungcan.2013.05.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2012] [Revised: 04/06/2013] [Accepted: 05/01/2013] [Indexed: 12/28/2022]
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Lloyd S, Decker RH. Conference Scene: Notable trial results in radiation therapy for lung cancer at the ASCO 2013 Annual Meeting. Lung Cancer Manag 2013. [DOI: 10.2217/lmt.13.33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The theme of the American Society of Clinical Oncology 2013 Annual Meeting was ‘building bridges to conquer cancer’. With its diverse attendees and collaborative nature, this meeting provided an excellent forum to define the optimal use of radiation therapy for lung cancer in today’s multimodality environment. Research presented at the meeting touched on core issues including: the optimal dose of radiation for locally advanced lung cancer patients, the efficacy and safety of stereotactic body radiation therapy for early-stage operable lung cancer patients, and the interpretation of surveillance imaging findings in patients treated with radiation therapy. These presentations are recapped and discussed.
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Affiliation(s)
- Shane Lloyd
- Yale School of Medicine, Department of Therapeutic Radiology, 33 Cedar Street, PO Box 208040, New Haven, CT 06520-8040, USA
| | - Roy H Decker
- Yale School of Medicine, Department of Therapeutic Radiology, 33 Cedar Street, PO Box 208040, New Haven, CT 06520-8040, USA.
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Ramalingam SS, Kotsakis A, Tarhini AA, Heron DE, Smith R, Friedland D, Petro DP, Raez LE, Brahmer JR, Greenberger JS, Dacic S, Hershberger P, Landreneau RJ, Luketich JD, Belani CP, Argiris A. A multicenter phase II study of cetuximab in combination with chest radiotherapy and consolidation chemotherapy in patients with stage III non-small cell lung cancer. Lung Cancer 2013; 81:416-421. [PMID: 23849982 DOI: 10.1016/j.lungcan.2013.06.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Revised: 05/09/2013] [Accepted: 06/04/2013] [Indexed: 12/28/2022]
Abstract
BACKGROUND Cetuximab has demonstrated improved efficacy in combination with chemotherapy and radiotherapy. We evaluated the integration of cetuximab in the combined modality treatment of stage III non-small cell lung cancer (NSCLC). METHODS Patients with surgically unresectable stage IIIA or IIIB NSCLC were treated with chest radiotherapy, 73.5 Gy (with lung and tissue heterogeneity corrections) in 35 fractions/7 weeks, once daily (63 Gy without heterogeneity corrections). Cetuximab was given weekly during radiotherapy and continued during consolidation therapy with carboplatin and paclitaxel up to a maximum of 26 weekly doses. The primary endpoint was overall survival. Baseline tumor tissue was analyzed for EGFR by fluorescence in situ hybridization (FISH). RESULTS Forty patients were enrolled in this phase II study. The median overall survival was 19.4 months and the median progression-free survival 9.3 months. The best overall response rate in 31 evaluable patients was 67%. No grade 3 or 4 esophagitis was observed. Three patients experienced grade 3 rash; 16 patients (69%) developed grade 3/4 neutropenia during consolidation therapy. One patient died of pneumonitis, possibly related to cetuximab. EGFR gene copy number on baseline tumor tissues, analyzed by FISH, was not predictive of efficacy outcomes. CONCLUSIONS The addition of cetuximab to chest radiotherapy and consolidation chemotherapy was tolerated well and had modest efficacy in stage III NSCLC. Taken together with the lower incidence of esophagitis, our results support evaluation of targeted agents instead of chemotherapy with concurrent radiotherapy in this setting.
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Affiliation(s)
- S S Ramalingam
- Department of Hematology/Oncology, Winship Cancer Institute of Emory University School of Medicine, Atlanta, USA
| | - A Kotsakis
- Department of Medical Oncology, University Hospital of Heraklion, Crete, Greece
| | - A A Tarhini
- Department of Medicine, Division of Hematology/Oncology, University of Pittsburgh Medical Center, Pittsburgh, USA
| | - D E Heron
- Department of Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, USA
| | - R Smith
- Department of Medicine, Division of Hematology/Oncology, University of Pittsburgh Medical Center, Pittsburgh, USA
| | - D Friedland
- Department of Medicine, Division of Medical Oncology, University of Pittsburgh Medical Center, Pittsburgh, USA
| | - D P Petro
- Department of Medicine, Division of Medical Oncology, University of Pittsburgh Medical Center, Pittsburgh, USA
| | - L E Raez
- Department of Medical Oncology, Memorial Cancer Institute, Pembroke Pines, USA
| | - J R Brahmer
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, USA
| | - J S Greenberger
- Department of Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, USA
| | - S Dacic
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, USA
| | - P Hershberger
- Department of Pharmacology and Chemical Biology, University of Pittsburgh Medical Center, Pittsburgh, USA
| | - R J Landreneau
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, USA
| | - J D Luketich
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, USA
| | - C P Belani
- Department of Medicine, Division of Hematology/Oncology, Penn State Hershey Cancer Institute, Hershey, USA
| | - A Argiris
- Department of Medicine, Division of Hematology/Oncology, Cancer Therapy and Research Center, University of Texas Health Science Center at San Antonio, San Antonio, USA.
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Nieder C, Pawinski A, Andratschke NH. Combined radio- and chemotherapy for non-small cell lung cancer: systematic review of landmark studies based on acquired citations. Front Oncol 2013; 3:176. [PMID: 23847765 PMCID: PMC3705186 DOI: 10.3389/fonc.2013.00176] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Accepted: 06/21/2013] [Indexed: 12/25/2022] Open
Abstract
The important role of combined chemoradiation for several groups of patients with non-small cell lung cancer (NSCLC) is reflected by the large number of scientific articles published during the last 30 years. Different measures of impact and clinical relevance of published research are available, each with its own pros and cons. For this review, article citation rate was chosen. Highly cited articles were identified through systematic search of the citation database Scopus. Among the 100 most often cited articles, meta-analyses (n = 5) achieved a median of 203 citations, guidelines (n = 7) 97, phase III trials (n = 29) 168, phase II trials (n = 21) 135, phase I trials (n = 7) 88, and others combined 115.5 (p = 0.001). Numerous national and international cooperative groups and several single institutions were actively involved in performing often cited, high-impact trials, reflecting the fact that NSCLC is a world-wide challenge that requires research collaboration. Platinum-containing combinations have evolved into a standard of care, typically administered concurrently. The issue of radiotherapy fractionation and total dose has also been studied extensively, yet with less conclusive results. Differences in target volume definition have been addressed. However, it was not possible to test all theoretically possible combinations of radiotherapy regimens, drugs, and drug doses (lower radiosensitizing doses compared to higher systemically active doses). That is why current guidelines offer physicians a choice of different, presumably equivalent treatment alternatives. This review identifies open questions and strategies for further research.
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Affiliation(s)
- Carsten Nieder
- Department of Oncology and Palliative Medicine, Nordland Hospital , Bodø , Norway ; Institute of Clinical Medicine, Faculty of Health Sciences, University of Tromsø , Tromsø , Norway
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Farhat FS, Houhou W. Targeted therapies in non-small cell lung carcinoma: what have we achieved so far? Ther Adv Med Oncol 2013; 5:249-70. [PMID: 23858333 PMCID: PMC3707340 DOI: 10.1177/1758834013492001] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
The search for innovative therapeutic agents in non-small cell lung cancer (NSCLC) has witnessed a swift evolution. The number of targeted drugs that can improve patient outcomes with an acceptable safety profile is steadily increasing. In this review, we highlight current drugs that have already been approved or are under evaluation for the treatment of patients with NSCLC, either in monotherapy or combined therapy for both the first- and second-line settings. Experience with drugs targeting the vascular endothelial growth factor and its receptor, as well as the epidermal growth factor receptor is summarized. Moreover, we provide an overview of more novel targets in NSCLC and initial experience with the respective therapeutic agents.
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Affiliation(s)
- Fadi S Farhat
- Hematology-Oncology Division (Head), Hammoud Hospital University Medical Center, Ghassan Hammoud Street, 652, Saida, Lebanon
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Ding X, Li H, Wang Z, Huang W, Li B, Zang R, Sun H, Yi Y. A Clinical Study of Shrinking Field Radiation Therapy Based on 18F-FDG PET/CT for Stage III Non-Small Cell Lung Cancer. Technol Cancer Res Treat 2013; 12:251-7. [PMID: 23289475 DOI: 10.7785/tcrt.2012.500310] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The aim is to investigate the feasibility of shrinking field technique after 40 Gy for stage III non-small cell lung cancer (NSCLC) during radiation therapy. Eighty-seven consecutive patients treated with intensity-modulated radiation therapy or three-dimensional conformal radiation therapy were enrolled in this study. 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) scanning was performed prior to treatment and repeated after 40 Gy, and the delineation of target volume was based on fused images of PET and CT. After 40 Gy of conventional fractionated radiotherapy to the initial planning target volume (PTV), a boost of 19.6–39.2 Gy was delivered to the shrunken PTV through late course accelerated hyperfractionated radiotherapy, and the median total dose was 66.0 Gy (range, 59.6–79.2 Gy). Gross tumor volume (GTV) and PTV regressions were recorded, and prescription doses with or without shrinking field were calculated. Local recurrence patterns were investigated through follow-up. The tumor volumes regressed in 84 (96.6%) patients and increased in 3 (3.4%) patients after 40 Gy. The mean GTV and PTV reduction was 38% (range, −13–95%) and 30% (range, −5–95%). Mean total prescription dose escalated from 62.0 Gy to 68.5 Gy through shrinking field technique. The median follow-up was 17 months, ranging from 5 to 46 months, and the 1- and 2-year overall survival rates in our study were 74.7% and 34.6%. The response rate was 79.5%, and radiation toxicity was acceptable. Tumor progression occurred in 67.8% (59/87) patients. Numbers of patients who had outfield, infield and both infield and outfield recurrences were 3 (3.4%), 26 (29.5%), and 3 (3.4%), respectively. In conclusion, significant tumor regression was observed after 40 Gy, and radiation dose escalated after shrinking field with acceptable toxicity and outfield relapse. Shrinking field radiotherapy based on 18F-FDG PET/CT after 40 Gy was safe and feasible for stage III NSCLC.
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Affiliation(s)
- Xiuping Ding
- Department of Radiation Oncology, Shandong Cancer Hospital, Shandong Academy of Medical Sciences, Jinan, P.R. China
- Shandong's Key Laboratory of Radiation Oncology, Jinan, P.R. China
| | - Hongsheng Li
- Department of Radiation Oncology, Shandong Cancer Hospital, Shandong Academy of Medical Sciences, Jinan, P.R. China
- Shandong's Key Laboratory of Radiation Oncology, Jinan, P.R. China
- Department of Radiation Oncology, Cancer Hospital, Tianjin Medical University, Tianjin, P.R. China
| | - Zhongtang Wang
- Department of Radiation Oncology, Shandong Cancer Hospital, Shandong Academy of Medical Sciences, Jinan, P.R. China
- Shandong's Key Laboratory of Radiation Oncology, Jinan, P.R. China
| | - Wei Huang
- Department of Radiation Oncology, Shandong Cancer Hospital, Shandong Academy of Medical Sciences, Jinan, P.R. China
- Shandong's Key Laboratory of Radiation Oncology, Jinan, P.R. China
| | - Baosheng Li
- Department of Radiation Oncology, Shandong Cancer Hospital, Shandong Academy of Medical Sciences, Jinan, P.R. China
- Shandong's Key Laboratory of Radiation Oncology, Jinan, P.R. China
| | - Rukun Zang
- Department of Radiation Oncology, Cancer Hospital, Tianjin Medical University, Tianjin, P.R. China
- Department of Radiation Oncology, Yantai Yuhuangding Hospital, Yantai, P.R. China
| | - Hongfu Sun
- Department of Radiation Oncology, Shandong Cancer Hospital, Shandong Academy of Medical Sciences, Jinan, P.R. China
- Shandong's Key Laboratory of Radiation Oncology, Jinan, P.R. China
| | - Yan Yi
- Department of Radiation Oncology, Shandong Cancer Hospital, Shandong Academy of Medical Sciences, Jinan, P.R. China
- Shandong's Key Laboratory of Radiation Oncology, Jinan, P.R. China
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Garrido P, Olmedo E. State of the art of radiotherapy. Transl Lung Cancer Res 2013; 2:189-99. [PMID: 25806232 DOI: 10.3978/j.issn.2218-6751.2013.03.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2013] [Accepted: 03/06/2013] [Indexed: 11/14/2022]
Abstract
Locally advanced or stage III disease accounts for ~30% of patients with non-small-cell lung cancer (NSCLC), which means only in the United States, more than 50,000 new patients each year. Stage III is a very heterogeneous disease, the management of patients is complex and several conditions (performance status, weight loss, comorbidities, characteristics of nodal involvement or resectability) must be considered before selecting the best treatment, which in most cases is chemotherapy (CT) and radiotherapy (RT). In this article, we will review key changes in the management of unresectable stage III during the last decades. Also we will highlight some challenges and areas of active research.
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Affiliation(s)
- Pilar Garrido
- Medical Oncology Department, IRYCIS, Hospital Universitario Ramón y Cajal, Carretera Colmenar Viejo km 9100, 28034, Madrid, Spain
| | | | - Eugenia Olmedo
- Medical Oncology Department, IRYCIS, Hospital Universitario Ramón y Cajal, Carretera Colmenar Viejo km 9100, 28034, Madrid, Spain
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128
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Molecularly targeted therapies in locally advanced non-small-cell lung cancer. Clin Lung Cancer 2013; 14:467-72. [PMID: 23684057 DOI: 10.1016/j.cllc.2013.03.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2013] [Accepted: 03/19/2013] [Indexed: 11/22/2022]
Abstract
Approximately a third of the patients with non-small cell lung cancer (NSCLC) present with locally advanced disease not amenable to curative resection. Concurrent chemoradiation is currently the treatment of choice for these patients. Outcomes in patients with locally advanced NSCLC treated with concurrent chemoradiation are modest at best. No significant progress has been made over the past decade in this subset of patients with NSCLC. Several trials have examined the role of molecular targeted therapies in this setting. We review the results of these trials and present the outline of a proposed prospective clinical trial to evaluate targeted drugs in molecularly selected group of patients with locally advanced NSCLC.
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Dziadziuszko R, Jassem J. Epidermal growth factor receptor (EGFR) inhibitors and derived treatments. Ann Oncol 2013; 23 Suppl 10:x193-6. [PMID: 22987961 DOI: 10.1093/annonc/mds351] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Epidermal growth factor receptor inhibitors are used to treat advanced lung cancer patients for almost a decade. Current knowledge on their role in the first or subsequent lines of therapy serves as a model for other targeted therapies in development. Several molecular predictors of outcomes were successfully identified in preclinical and clinical studies. Evaluation of EGFR-activating mutations is currently used to define biologically distinct patient subsets with important consequences for prognosis and therapy. Ongoing translational and clinical research exploring EGFR inhibition in lung cancer focuses on better understanding of biology of EGFR-driven disease, efficacy of novel irreversible EGFR inhibitors and monoclonal antibodies, efficacy of combination strategies, and attempts to move EGFR inhibitors into therapy portfolio for early-stage disease.
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Affiliation(s)
- R Dziadziuszko
- Department of Oncology and Radiotherapy, Medical University of Gdańsk, Gdańsk, Poland.
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130
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Phase I study of pemetrexed and cisplatin with concurrent high-dose thoracic radiation after induction chemotherapy in patients with unresectable locally advanced non-small cell lung cancer. Lung Cancer 2013; 80:68-74. [DOI: 10.1016/j.lungcan.2012.12.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Revised: 11/28/2012] [Accepted: 12/03/2012] [Indexed: 11/21/2022]
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131
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Salama JK, Vokes EE. New radiotherapy and chemoradiotherapy approaches for non-small-cell lung cancer. J Clin Oncol 2013; 31:1029-38. [PMID: 23401449 DOI: 10.1200/jco.2012.44.5064] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Recent advances in systemic cytotoxic and molecularly targeted therapies coupled with technologic strides in radiotherapy have the potential to improve outcomes for patients with non-small-cell lung cancer (NSCLC). Investigations are ongoing to identify optimal cytotoxin-based chemoradiotherapy platforms. The influence of specific histologic and molecular mutation status on the combination of targeted therapies and radiotherapy is also being actively studied. Although there are no convincing randomized phase III data to date supporting a survival advantage for combining molecularly targeted agents with radiation or chemoradiotherapy in the setting of locally advanced NSCLC, phase II and III studies targeted to elderly patients and those with poor performance status are elucidating preferred chemoradiotherapy strategies. Radiotherapy dose escalation did not improve chemoradiotherapy outcomes, although increasing radiation dose-intensity with modern techniques is being actively studied. As modern radiotherapy techniques have been shown to improve outcomes of some patients with limited metastatic disease, investigations are ongoing regarding how to optimally integrate them with standard chemotherapy platforms.
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132
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Robinson C, Stephans K. Neoadjuvant chemoradiotherapy for stage III (N2/3) non-small-cell lung cancer: a review of prospective studies. Lung Cancer Manag 2013. [DOI: 10.2217/lmt.12.52] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
SUMMARY Trimodality therapy, a maximal combination of chemotherapy, radiotherapy and surgical resection, for stage III non-small-cell lung cancer promises improved outcomes through optimizing local, regional and distant control. Phase II trials of neoadjuvant chemoradiotherapy have explored a number of different radiotherapy dose and fractionation schemes, and have identified an important subset of patients who achieve mediastinal nodal clearance and may achieve long-term survival. Phase III trials of various combinations of chemotherapy, radiotherapy and surgery have demonstrated mixed results with regard to each modality’s impact on progression-free or overall survival. In this review, we focus on the historical lessons learned from prospective trials of trimodality therapy completed over the last 30 years and set the stage for future studies of neoadjuvant chemoradiotherapy for stage III non-small-cell lung cancer.
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Affiliation(s)
- Cliff Robinson
- Washington University in St Louis, Department of Radiation Oncology, 4921 Parkview Place, St Louis, MO 63110, USA
| | - Kevin Stephans
- Cleveland Clinic Taussig Cancer Center, Department of Radiation Oncology, T28, 9500 Euclid Avenue, Cleveland, OH 44195, USA
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133
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Lo E, Daly ME, Mack PC, Kelly K, Lara Jr PN. Integration of targeted therapy in the management of locally advanced, unresectable non-small-cell lung cancer. Lung Cancer Manag 2013. [DOI: 10.2217/lmt.12.58] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
SUMMARY The standard of care for unresectable, locally advanced non-small-cell lung cancer (NSCLC; stage IIIA and IIIB) in the past decade has been concomitant platinum-based chemoradiation therapy. Unfortunately, a plateau has been reached in terms of response and survival rates with the present chemotherapeutic paradigm. Targeted biological agents have significantly altered the treatment landscape for stage IV NSCLC and offer an opportunity to do the same for locally advanced NSCLC. While some early trials using unselected patients have shown modest promise for several biologic agents, the overall data remain mixed. One limitation of these trials has been the lack of patient enrichment based on molecular phenotype most likely to benefit from a particular targeted therapy. This review summarizes the most recent data for select classes of targeted agents being tested in the locally advanced NSCLC setting, and gives insights into future developments in this clinical area.
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Affiliation(s)
- Ernest Lo
- Departments of Internal Medicine, Division of Hematology/Oncology, Sacramento, CA, USA
- UC Davis Comprehensive Cancer Center, Sacramento, CA, USA
| | - Megan E Daly
- UC Davis Comprehensive Cancer Center, Sacramento, CA, USA
- Radiation Oncology, University of California Davis School of Medicine, Sacramento, CA, USA
| | - Philip C Mack
- Departments of Internal Medicine, Division of Hematology/Oncology, Sacramento, CA, USA
- UC Davis Comprehensive Cancer Center, Sacramento, CA, USA
| | - Karen Kelly
- Departments of Internal Medicine, Division of Hematology/Oncology, Sacramento, CA, USA
- UC Davis Comprehensive Cancer Center, Sacramento, CA, USA
| | - Primo N Lara Jr
- UC Davis Comprehensive Cancer Center, Sacramento, CA, USA
- Departments of Internal Medicine, Division of Hematology/Oncology, Sacramento, CA, USA
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134
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Clinical meta-analyses of targeted therapies in adenocarcinoma. Target Oncol 2013; 8:35-45. [PMID: 23354875 DOI: 10.1007/s11523-013-0262-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Accepted: 01/15/2013] [Indexed: 01/01/2023]
Abstract
Although the interpretation of the data reported in meta-analyses may hide several issues, it is undoubtable that this methodological approach may significantly contribute to implement the results of clinical trials, and represent a useful and practical tool for the evidence-based medicine process. Indeed, level-one recommendations should consider well-conducted meta-analyses as well as large and adequately powered randomized trials as the main contributors for the definition of guidelines for clinical practice. In addition, the role of meta-analyses for issues whereas conflicting data (and/or unpowered results) are provided, is well established. In the field of lung cancer, meta-analyses already participated to change the current standard, and are now facing the challenging issues of predictive biomarkers of prognosis and/or efficacy of targeted agents. With this aim, the meta-analytic approach helped in the recent years to implement the quantification of the magnitude of the benefit of targeted agents, and added new insights by interpreting the data coming from clinical trials by integrating them with biomarkers. The treatment-interaction analyses according to putative predictive factors of efficacy may clarify unknown issues and generate new hypotheses for future perspectives. The current review attempts to put in the context of the clinical data of targeted agents for lung cancer all the pros and cons of the meta-analytic process published to date, and critically analyze all the potential perspectives which this methodology may add for both current practice and forthcoming research.
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135
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Chi A, Remick S, Tse W. EGFR inhibition in non-small cell lung cancer: current evidence and future directions. Biomark Res 2013; 1:2. [PMID: 24252457 PMCID: PMC3776244 DOI: 10.1186/2050-7771-1-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Accepted: 10/12/2012] [Indexed: 12/28/2022] Open
Abstract
EGFR inhibition has emerged to be an important strategy in the treatment of non-small cell lung cancer (NSCLC). Small molecule tyrosine kinase inhibitors (TKIs) and mono-clonal antibodies (mAbs) to the EGFR have been tested in multiple large randomized phase III studies alone or combined with chemotherapy, as well as small phase I-II studies which investigated their efficacy as radiosensitizers when combined with radiotherapy. In this review, we described the current clinical outcome after treatment with EGFR TKIs and mAbs alone or combined with chemotherapy in advanced stage NSCLC, as well as the early findings in feasibility/phase I or II studies regarding to whether EGFR TKI or mAb can be safely and effectively combined with radiotherapy in the treatment of locally advanced NSCLC. Furthermore, we explore the potential predictive biomarkers for response to EGFR TKIs or mAbs in NSCLC patients based on the findings in the current clinical trials; the mechanisms of resistance to EGFR inhibition; and the strategies of augmenting the antitumor activity of the EGFR inhibitors alone or when combined with chemotherapy or radiotherapy.
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Affiliation(s)
- Alexander Chi
- Department of Radiation Oncology, West Virginia University, Morgantown, WV, 26506, USA.
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136
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EGFR-directed monoclonal antibodies in non-small cell lung cancer. Target Oncol 2013; 8:47-53. [PMID: 23300028 DOI: 10.1007/s11523-012-0244-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Accepted: 12/06/2012] [Indexed: 10/27/2022]
Abstract
Several monoclonal antibodies directed against the epidermal growth factor receptor (EGFR) have been evaluated in patients with non-small cell lung cancer (NSCLC). Cetuximab, a chimeric monoclonal antibody, has been studied in combination with first-line chemotherapy in phase II and two phase III trials in patients with advanced NSCLC. The phase III FLEX trial demonstrated an increase in survival for cisplatin/vinorelbine plus cetuximab compared to chemotherapy alone in patients with advanced EGFR-expressing NSCLC. Cetuximab added to carboplatin/paclitaxel failed to improve progression-free survival in the BMS099 phase III trial. However, a meta-analysis of four randomized trials confirmed a significant survival benefit for platinum-based chemotherapy plus cetuximab compared to chemotherapy alone. High EGFR expression of tumor cells was then shown to predict the benefit of cetuximab, whereas KRAS mutations and EGFR fluorescent in situ hybridization analysis were without predictive value. Matuzumab and panitumumab have also been studied in phase II trials. Necitumumab, a fully human monoclonal antibody, is currently evaluated in combination with chemotherapy in two phase III trials in patients with advanced NSCLC. Cetuximab is also studied in combination with chemoradiotherapy in patients with locally advanced NSCLC.
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137
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Lawrence YR, Vikram B, Dignam JJ, Chakravarti A, Machtay M, Freidlin B, Takebe N, Curran WJ, Bentzen SM, Okunieff P, Coleman CN, Dicker AP. NCI-RTOG translational program strategic guidelines for the early-stage development of radiosensitizers. J Natl Cancer Inst 2013; 105:11-24. [PMID: 23231975 PMCID: PMC3536642 DOI: 10.1093/jnci/djs472] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Revised: 09/15/2012] [Accepted: 10/02/2012] [Indexed: 12/21/2022] Open
Abstract
The addition of chemotherapeutic agents to ionizing radiation has improved survival in many malignancies. Cure rates may be further improved by adding novel targeted agents to current radiotherapy or radiochemotherapy regimens. Despite promising laboratory data, progress in the clinical development of new drugs with radiation has been limited. To define and address the problems involved, a collaborative effort between individuals within the translational research program of the Radiation Oncology Therapy Group and the National Cancer Institute was established. We discerned challenges to drug development with radiation including: 1) the limited relevance of preclinical work, 2) the pharmaceutical industry's diminished interest, and 3) the important individual skills and institutional commitments required to ensure a successful program. The differences between early-phase trial designs with and without radiation are noted as substantial. The traditional endpoints for early-phase clinical trials-acute toxicity and maximum-tolerated dose-are of limited value when combining targeted agents with radiation. Furthermore, response rate is not a useful surrogate marker of activity in radiation combination trials.Consequently, a risk-stratified model for drug-dose escalation with radiation is proposed, based upon the known and estimated adverse effects. The guidelines discuss new clinical trial designs, such as the time-to-event continual reassessment method design for phase I trials, randomized phase II "screening" trials, and the use of surrogate endpoints, such as pathological response. It is hoped that by providing a clear pathway, this article will accelerate the rate of drug development with radiation.
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138
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Miller DS, Tai DF, Obasaju C, Vergote I. Safety and efficacy of pemetrexed in gynecologic cancers: A systematic literature review. ACTA ACUST UNITED AC 2013. [DOI: 10.4236/mc.2013.22004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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139
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Niho S, Kubota K, Nihei K, Sekine I, Sumi M, Sekiguchi R, Funai J, Enatsu S, Ohe Y, Tamura T. Dose-Escalation Study of Thoracic Radiotherapy in Combination With Pemetrexed Plus Cisplatin Followed by Pemetrexed Consolidation Therapy in Japanese Patients With Locally Advanced Nonsquamous Non–Small-Cell Lung Cancer. Clin Lung Cancer 2013; 14:62-9. [DOI: 10.1016/j.cllc.2012.03.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2012] [Revised: 03/07/2012] [Accepted: 03/12/2012] [Indexed: 12/28/2022]
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140
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Abstract
Lung cancer is a heterogenous disease with 2 main subtypes: non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC). Early-stage NSCLC is managed primarily by surgical resection, with adjuvant chemotherapy for selected patients with stage IB, II, and III disease. Patients with locally advanced stage III NSCLC are usually treated with combined modality therapy. Advanced NSCLC remains an incurable disease. Further advances will rely on improvements in understanding of the molecular events driving the malignant phenotype and the development of novel, targeted therapeutic strategies.
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Affiliation(s)
- Shirish M Gadgeel
- Department of Hematology and Oncology, Wayne State University, Karmanos Cancer Institute, 4HWCRC, 4100 John R Street, Detroit, MI 48201, USA
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141
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Socinski MA, Stinchcombe TE, Moore DT, Gettinger SN, Decker RH, Petty WJ, Blackstock AW, Schwartz G, Lankford S, Khandani A, Morris DE. Incorporating Bevacizumab and Erlotinib in the Combined-Modality Treatment of Stage III Non–Small-Cell Lung Cancer: Results of a Phase I/II Trial. J Clin Oncol 2012; 30:3953-9. [DOI: 10.1200/jco.2012.41.9820] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Bevacizumab and erlotinib have been shown to improve survival in stage IV non–small-cell lung cancer (NSCLC). This phase I/II trial was designed to incorporate these agents with induction and concurrent chemoradiotherapy in stage III NSCLC. Patients and Methods Patients received induction chemotherapy (carboplatin area under the curve [AUC] 6, paclitaxel 225 mg/m2, and bevacizumab 15 mg/kg on days 1 and 22) followed by concurrent chemotherapy (carboplatin AUC 2 and paclitaxel 45 mg/m2 weekly with bevacizumab 10 mg/kg every other week for four doses) and thoracic conformal radiation therapy (TCRT) to 74 Gy. In the phase I portion, cohort 1 received no erlotinib, whereas cohorts 2 and 3 received erlotinib at 100 and 150 mg, respectively, Tuesday through Friday, during TCRT. Consolidation therapy with erlotinib (150 mg daily) and bevacizumab (15 mg/kg every 3 weeks) was planned 3 to 6 weeks later for six cycles. Results Forty-five eligible patients were enrolled. The objective response rates to induction and overall treatment were 39% (95% CI, 24% to 55%) and 60% (95% CI, 44% to 75%), respectively. The median progression-free and overall survival times were 10.2 months (95% CI, 8.4 to 18.3 months) and 18.4 months (95% CI, 13.4 to 31.7 months), respectively. The principal toxicity was esophagitis (29% grade 3 or 4 esophagitis, with one patient with grade 3 tracheoesophageal fistula), which was often prolonged. Consolidation therapy with bevacizumab and erlotinib was not feasible. Conclusion The use of bevacizumab and erlotinib as administered in this trial is not recommended given the lack of an efficacy signal and the substantial risk of esophageal toxicity.
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Affiliation(s)
- Mark A. Socinski
- Mark A. Socinski, Thomas E. Stinchcombe, Dominic T. Moore, Amir Khandani, and David E. Morris, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill; W. Jeffrey Petty and A. William Blackstock, Wake Forest University, Winston-Salem; Garry Schwartz and Scott Lankford, Carolinas Medical Center-Northeast, Concord, NC; and Scott N. Gettinger and Roy H. Decker, Yale University School of Medicine, New Haven, CT
| | - Thomas E. Stinchcombe
- Mark A. Socinski, Thomas E. Stinchcombe, Dominic T. Moore, Amir Khandani, and David E. Morris, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill; W. Jeffrey Petty and A. William Blackstock, Wake Forest University, Winston-Salem; Garry Schwartz and Scott Lankford, Carolinas Medical Center-Northeast, Concord, NC; and Scott N. Gettinger and Roy H. Decker, Yale University School of Medicine, New Haven, CT
| | - Dominic T. Moore
- Mark A. Socinski, Thomas E. Stinchcombe, Dominic T. Moore, Amir Khandani, and David E. Morris, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill; W. Jeffrey Petty and A. William Blackstock, Wake Forest University, Winston-Salem; Garry Schwartz and Scott Lankford, Carolinas Medical Center-Northeast, Concord, NC; and Scott N. Gettinger and Roy H. Decker, Yale University School of Medicine, New Haven, CT
| | - Scott N. Gettinger
- Mark A. Socinski, Thomas E. Stinchcombe, Dominic T. Moore, Amir Khandani, and David E. Morris, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill; W. Jeffrey Petty and A. William Blackstock, Wake Forest University, Winston-Salem; Garry Schwartz and Scott Lankford, Carolinas Medical Center-Northeast, Concord, NC; and Scott N. Gettinger and Roy H. Decker, Yale University School of Medicine, New Haven, CT
| | - Roy H. Decker
- Mark A. Socinski, Thomas E. Stinchcombe, Dominic T. Moore, Amir Khandani, and David E. Morris, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill; W. Jeffrey Petty and A. William Blackstock, Wake Forest University, Winston-Salem; Garry Schwartz and Scott Lankford, Carolinas Medical Center-Northeast, Concord, NC; and Scott N. Gettinger and Roy H. Decker, Yale University School of Medicine, New Haven, CT
| | - W. Jeffrey Petty
- Mark A. Socinski, Thomas E. Stinchcombe, Dominic T. Moore, Amir Khandani, and David E. Morris, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill; W. Jeffrey Petty and A. William Blackstock, Wake Forest University, Winston-Salem; Garry Schwartz and Scott Lankford, Carolinas Medical Center-Northeast, Concord, NC; and Scott N. Gettinger and Roy H. Decker, Yale University School of Medicine, New Haven, CT
| | - A. William Blackstock
- Mark A. Socinski, Thomas E. Stinchcombe, Dominic T. Moore, Amir Khandani, and David E. Morris, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill; W. Jeffrey Petty and A. William Blackstock, Wake Forest University, Winston-Salem; Garry Schwartz and Scott Lankford, Carolinas Medical Center-Northeast, Concord, NC; and Scott N. Gettinger and Roy H. Decker, Yale University School of Medicine, New Haven, CT
| | - Garry Schwartz
- Mark A. Socinski, Thomas E. Stinchcombe, Dominic T. Moore, Amir Khandani, and David E. Morris, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill; W. Jeffrey Petty and A. William Blackstock, Wake Forest University, Winston-Salem; Garry Schwartz and Scott Lankford, Carolinas Medical Center-Northeast, Concord, NC; and Scott N. Gettinger and Roy H. Decker, Yale University School of Medicine, New Haven, CT
| | - Scott Lankford
- Mark A. Socinski, Thomas E. Stinchcombe, Dominic T. Moore, Amir Khandani, and David E. Morris, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill; W. Jeffrey Petty and A. William Blackstock, Wake Forest University, Winston-Salem; Garry Schwartz and Scott Lankford, Carolinas Medical Center-Northeast, Concord, NC; and Scott N. Gettinger and Roy H. Decker, Yale University School of Medicine, New Haven, CT
| | - Amir Khandani
- Mark A. Socinski, Thomas E. Stinchcombe, Dominic T. Moore, Amir Khandani, and David E. Morris, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill; W. Jeffrey Petty and A. William Blackstock, Wake Forest University, Winston-Salem; Garry Schwartz and Scott Lankford, Carolinas Medical Center-Northeast, Concord, NC; and Scott N. Gettinger and Roy H. Decker, Yale University School of Medicine, New Haven, CT
| | - David E. Morris
- Mark A. Socinski, Thomas E. Stinchcombe, Dominic T. Moore, Amir Khandani, and David E. Morris, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill; W. Jeffrey Petty and A. William Blackstock, Wake Forest University, Winston-Salem; Garry Schwartz and Scott Lankford, Carolinas Medical Center-Northeast, Concord, NC; and Scott N. Gettinger and Roy H. Decker, Yale University School of Medicine, New Haven, CT
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142
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Raben D, Bunn PA. Biologically Targeted Therapies Plus Chemotherapy Plus Radiotherapy in Stage III Non–Small-Cell Lung Cancer: A Case of the Icarus Syndrome? J Clin Oncol 2012; 30:3909-12. [DOI: 10.1200/jco.2012.43.1866] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Affiliation(s)
- David Raben
- University of Colorado School of Medicine, Aurora, CO
| | - Paul A. Bunn
- University of Colorado School of Medicine, Aurora, CO
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143
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Topkan E, Parlak C, Topuk S, Pehlivan B. Influence of oral glutamine supplementation on survival outcomes of patients treated with concurrent chemoradiotherapy for locally advanced non-small cell lung cancer. BMC Cancer 2012; 12:502. [PMID: 23113946 PMCID: PMC3529187 DOI: 10.1186/1471-2407-12-502] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2012] [Accepted: 10/18/2012] [Indexed: 12/25/2022] Open
Abstract
Background Glutamine (Gln) supplementation during concurrent chemoradiotherapy (C-CRT) effectively reduces the incidence and severity of acute radiation-induced esophagitis (RIE). However, there are concerns that Gln might stimulate tumor growth, and therefore negatively impact the outcomes of anticancer treatment. We retrospectively investigated the effect of co-administration of oral Gln during C-CRT on survival outcomes of patients with stage IIIB non-small cell lung carcinoma (NSCLC). We additionally evaluated role of oral Gln in preventing C-CRT-induced weight change, acute and late toxicities. Methods The study included 104 patients: 56 (53.8%) received prophylactic powdered Gln (Gln+) orally at a dose of 10 g/8 h and 48 (46.2%) did not receive Gln (Gln-) and served as controls. The prescribed radiation dose to the planning target volume was 66 Gy in 2-Gy fractions. Primary endpoints of progression-free survival (PFS), local/regional progression-free survival (LRPFS), and overall survival (OS) were correlated with status of Gln supplementation. Results Oral Gln was well tolerated except for mild nausea/vomiting in 14 (25.0%) patients. There was no C-CRT-related acute or late grade 4–5 toxicity. Administration of Gln was associated with a decrease in the incidence of grade 3 acute radiation-induced esophagitis (RIE) (7.2% vs. 16.7% for Gln+ vs. Gln-; p=0.02) and late-RIE (0% vs. 6.3%; p=0.06), a reduced need for unplanned treatment breaks (7.1% vs. 20.8%; p=0.04), and reduced incidence of weight loss (44.6% vs. 72.9%; p=0.002). At a median follow-up of 24.2 months (range 9.2-34.4) the median OS, LRPFS, and PFS for Gln+ vs. Gln- cohorts were 21.4 vs. 20.4 (p=0.35), 14.2 vs.11.3 (p=0.16), and 10.2 vs. 9.0 months (p=0.11), respectively. Conclusion In our study, supplementation with Gln during C-CRT had no detectable negative impact on tumor control and survival outcomes in patients with Stage IIIB NSCLC. Furthermore, Gln appeared to have a beneficial effect with respect to prevention of weight loss and unplanned treatment delays, and reduced the severity and incidence of acute- and late-RIE.
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Affiliation(s)
- Erkan Topkan
- Department of Radiation Oncology, Baskent University Adana Medical Faculty, Adana, Turkey.
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144
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Carillio G, Montanino A, Costanzo R, Sandomenico C, Piccirillo MC, Di Maio M, Daniele G, Giordano P, Bryce J, Normanno N, Rocco G, Perrone F, Morabito A. Cetuximab in non-small-cell lung cancer. Expert Rev Anticancer Ther 2012; 12:163-75. [PMID: 22316364 DOI: 10.1586/era.11.178] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Cetuximab is a chimeric human-mouse anti-EGF receptor monoclonal antibody. In Phase I studies, no dose-limiting toxicities were observed with cetuximab as a single agent or combined with chemotherapy; pharmacokinetic and pharmacodynamic analyses supported 250 mg/m(2) weekly administration. Skin toxicity, diarrhea and fatigue were the most common toxicities. The positive results obtained in Phase II trials in patients with advanced non-small-cell lung cancer prompted two randomized Phase III trials evaluating cetuximab in addition to first-line chemotherapy. Both trials showed a small benefit in overall survival for the experimental treatment, which was considered insufficient by the EMA for marketing approval. However, a subgroup analysis of the FLEX Phase III trial recently demonstrated a larger survival benefit from the experimental treatment in patients with high immunohistochemical EGF receptor expression. This finding, if confirmed prospectively, could represent a new opportunity for positioning cetuximab into the standard treatment of advanced non-small-cell lung carcinoma.
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Affiliation(s)
- Guido Carillio
- Medical Oncology Unit, Azienda Ospedaliera Pugliese-Ciaccio, Catanzaro, Italy
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Koh PK, Faivre-Finn C, Blackhall FH, De Ruysscher D. Targeted agents in non-small cell lung cancer (NSCLC): Clinical developments and rationale for the combination with thoracic radiotherapy. Cancer Treat Rev 2012; 38:626-40. [DOI: 10.1016/j.ctrv.2011.11.003] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2011] [Accepted: 11/14/2011] [Indexed: 02/07/2023]
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146
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Abstract
Over the past decade, concomitant chemotherapy and radiotherapy has become the established treatment for patients with stage III non-small-cell lung cancer (NSCLC). Unfortunately, many patients with NSCLC are too old or have multiple comorbidities to withstand such aggressive treatments. Attempts to improve outcomes have included studies of radiotherapy dose escalation and new chemotherapy combinations, as well as adding biological agents and cancer vaccines to existing regimens. Technical radiotherapy modifications, including intensity-modulated radiotherapy and particle beam therapy, have also been investigated. Given the number of potential advances to current models of treatment development, phase III trials of any single new treatment can take years to complete, which is inadequate. To advance research within shorter timescales to improve patient outcomes, we need methods of improving clinical trial accrual, which might require changes in models of research governance, cooperative group activity, trial design and patient consent.
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147
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[Targeted agents in the treatment of lung cancer]. ACTA ACUST UNITED AC 2012; 60:246-53. [PMID: 22743094 DOI: 10.1016/j.patbio.2012.05.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2012] [Accepted: 05/02/2012] [Indexed: 01/05/2023]
Abstract
Lung cancer is in France, the leading cause of cancer death. Despite the dramatic advances that have allowed in a few years to go, for metastatic cancer, from a median survival without specific treatment of 4.5 months and now almost always more than one year, survival remains disappointing and further improvements are needed. Progress in the accumulated knowledge of the inner workings of normal and tumoral cells have paved the way for the development of targeted therapeutics called biological or simply targeted therapies. Two biological processes are already the target of marketed drugs, this is the way the receptor of epidermal growth factor (EGFR) and the path of neo-angiogenesis. It is almost assumed that, in the very near future, the inhibition of EML4-ALK will also be the subject of new drugs. In the medium term, it is conceivable that the molecular dissection of the tumors actually lead to the prescription of treatments tailored to mutations and other abnormalities that direct the growth of cancers.
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148
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Kim DN, Nam TK, Choe KS, Choy H. Personalized Combined Modality Therapy for Locally Advanced Non-small Cell Lung Cancer. Cancer Res Treat 2012; 44:74-84. [PMID: 22802745 PMCID: PMC3394867 DOI: 10.4143/crt.2012.44.2.74] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2011] [Accepted: 12/20/2011] [Indexed: 11/21/2022] Open
Abstract
Locally advanced non-small cell lung cancer (NSCLC) is a heterogeneous disease, and we have embarked on an era where patients will benefit from individualized therapeutic strategies based on identifiable molecular characteristics of the tumor. The landmark studies demonstrating the importance of molecular characterization of tumors for NSCLC patients, the promising molecular pathways, and the potential molecular targets/agents for treatment of this disease will be reviewed. Understanding these issues will aid in the development of rationally designed clinical trials, so as to determine best means of appropriately incorporating these molecular strategies, to the current standard of radiation and chemotherapy regimens, for the treatment of locally advanced NSCLC.
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Affiliation(s)
- D Nathan Kim
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX, USA
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149
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Stinchcombe TE, Bogart JA. Novel approaches of chemoradiotherapy in unresectable stage IIIA and stage IIIB non-small cell lung cancer. Oncologist 2012; 17:682-93. [PMID: 22531360 DOI: 10.1634/theoncologist.2012-0020] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Approximately one third of patients with non-small cell lung cancer have unresectable stage IIIA or stage IIIB disease, and appropriate patients are candidates for chemoradiotherapy with curative intent. The optimal treatment paradigm is currently undefined. Concurrent chemoradiotherapy, compared with sequential chemotherapy and thoracic radiation therapy (TRT), results in superior overall survival outcomes as a result of better locoregional control. Recent trials have revealed efficacy for newer chemotherapy combinations similar to that of older chemotherapy combinations with concurrent TRT and a lower rate of some toxicities. Ongoing phase III trials will determine the roles of cisplatin and pemetrexed concurrent with TRT in patients with nonsquamous histology, cetuximab, and the L-BLP25 vaccine. It is unlikely that bevacizumab will have a role in stage III disease because of its toxicity. Erlotinib, gefitinib, and crizotinib have not been evaluated in stage III patients selected based on molecular characteristics. The preliminary results of a phase III trial that compared conventionally fractionated standard-dose TRT (60 Gy) with high-dose TRT (74 Gy) revealed an inferior survival outcome among patients assigned to the high-dose arm. Hyperfractionation was investigated previously with promising results, but adoption has been limited because of logistical considerations. More recent trials have investigated hypofractionated TRT in chemoradiotherapy. Advances in tumor targeting and radiation treatment planning have made this approach more feasible and reduced the risk for normal tissue toxicity. Adaptive radiotherapy uses changes in tumor volume to adjust the TRT treatment plan during therapy, and trials using this strategy are ongoing. Ongoing trials with proton therapy will provide initial efficacy and safety data.
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Affiliation(s)
- Thomas E Stinchcombe
- Division of Hematology and Oncology, Lineberger Comprehensive Cancer Center at the University of North Carolina, Chapel Hill, North Carolina 27599-7305, USA.
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150
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Wang HQ, Ren Y, Qian ZZ, Fu K, Zhang HL, Li W, Hou Y, Zhou SY, Hao XS, Xie CH. Nimotuzumab combined with gemcitabine and cisplatin as second-line chemotherapy for advanced non-small-cell lung cancer. Thorac Cancer 2012; 3:72-78. [DOI: 10.1111/j.1759-7714.2011.00083.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
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