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Mehra R, Yong C, Seal B, van Keep M, Raad A, Zhang Y. Cost-Effectiveness of Durvalumab After Chemoradiotherapy in Unresectable Stage III NSCLC: A US Healthcare Perspective. J Natl Compr Canc Netw 2021; 19:153-162. [PMID: 33545688 DOI: 10.6004/jnccn.2020.7621] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 07/14/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Durvalumab was approved by the FDA in February 2018 for patients with unresectable stage III NSCLC that has not progressed after platinum-based concurrent chemoradiotherapy (cCRT), and this regimen is the current standard of care. The objective of this study was to examine the cost-effectiveness of durvalumab following cCRT versus cCRT alone in patients with locally advanced, unresectable stage III NSCLC. METHODS A 3-state semi-Markov model was used. Modeling was performed in a US healthcare setting from Medicare and commercial payer perspectives over a 30-year time horizon. Clinical efficacy (progression-free and post progression survival) and utility inputs were based on PACIFIC study data (ClinicalTrials.gov identifier: NCT02125461; data cutoff March 22, 2018). Overall survival extrapolation was validated using overall survival data from a later data cutoff (January 31, 2019). The main outcome was the incremental cost-effectiveness ratio (ICER) of durvalumab following cCRT versus cCRT alone, calculated as the difference in total costs between treatment strategies per quality-adjusted life-year (QALY) gained. RESULTS In the base-case analysis, durvalumab following cCRT was cost-effective versus cCRT alone from Medicare and commercial insurance perspectives, with ICERs of $55,285 and $61,111, respectively, per QALY gained. Durvalumab was thus considered cost-effective at the $100,000 willingness-to-pay (WTP) threshold. Sensitivity analyses revealed the model was particularly affected by variables associated with subsequent treatment, although no tested variable increased the ICER above the WTP threshold. Scenario analyses showed the model was most sensitive to assumptions regarding time horizon, treatment effect duration, choice of fitted progression-free survival curve, subsequent immunotherapy treatment duration, and use of a partitioned survival model structure. CONCLUSIONS In a US healthcare setting, durvalumab was cost-effective compared with cCRT alone, further supporting the adoption of durvalumab following cCRT as the new standard of care in patients with unresectable stage III NSCLC.
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Affiliation(s)
- Ranee Mehra
- 1University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore, Maryland
| | - Candice Yong
- 2AstraZeneca Pharmaceuticals LP, Gaithersburg, Maryland
| | - Brian Seal
- 2AstraZeneca Pharmaceuticals LP, Gaithersburg, Maryland
| | | | - Angie Raad
- 4BresMed Health Solutions, Sheffield, United Kingdom
| | - Yiduo Zhang
- 2AstraZeneca Pharmaceuticals LP, Gaithersburg, Maryland
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Tsay JCJ, Wu BG, Sulaiman I, Gershner K, Schluger R, Li Y, Yie TA, Meyn P, Olsen E, Perez L, Franca B, Carpenito J, Iizumi T, El-Ashmawy M, Badri M, Morton JT, Shen N, He L, Michaud G, Rafeq S, Bessich JL, Smith RL, Sauthoff H, Felner K, Pillai R, Zavitsanou AM, Koralov SB, Mezzano V, Loomis CA, Moreira AL, Moore W, Tsirigos A, Heguy A, Rom WN, Sterman DH, Pass HI, Clemente JC, Li H, Bonneau R, Wong KK, Papagiannakopoulos T, Segal LN. Lower Airway Dysbiosis Affects Lung Cancer Progression. Cancer Discov 2021; 11:293-307. [PMID: 33177060 PMCID: PMC7858243 DOI: 10.1158/2159-8290.cd-20-0263] [Citation(s) in RCA: 148] [Impact Index Per Article: 49.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 09/15/2020] [Accepted: 10/27/2020] [Indexed: 11/16/2022]
Abstract
In lung cancer, enrichment of the lower airway microbiota with oral commensals commonly occurs, and ex vivo models support that some of these bacteria can trigger host transcriptomic signatures associated with carcinogenesis. Here, we show that this lower airway dysbiotic signature was more prevalent in the stage IIIB-IV tumor-node-metastasis lung cancer group and is associated with poor prognosis, as shown by decreased survival among subjects with early-stage disease (I-IIIA) and worse tumor progression as measured by RECIST scores among subjects with stage IIIB-IV disease. In addition, this lower airway microbiota signature was associated with upregulation of the IL17, PI3K, MAPK, and ERK pathways in airway transcriptome, and we identified Veillonella parvula as the most abundant taxon driving this association. In a KP lung cancer model, lower airway dysbiosis with V. parvula led to decreased survival, increased tumor burden, IL17 inflammatory phenotype, and activation of checkpoint inhibitor markers. SIGNIFICANCE: Multiple lines of investigation have shown that the gut microbiota affects host immune response to immunotherapy in cancer. Here, we support that the local airway microbiota modulates the host immune tone in lung cancer, affecting tumor progression and prognosis.See related commentary by Zitvogel and Kroemer, p. 224.This article is highlighted in the In This Issue feature, p. 211.
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Affiliation(s)
- Jun-Chieh J Tsay
- Division of Pulmonary and Critical Care Medicine, New York University School of Medicine, New York, New York
- Division of Pulmonary and Critical Care Medicine, VA New York Harbor Healthcare System, New York, New York
| | - Benjamin G Wu
- Division of Pulmonary and Critical Care Medicine, New York University School of Medicine, New York, New York
- Division of Pulmonary and Critical Care Medicine, VA New York Harbor Healthcare System, New York, New York
| | - Imran Sulaiman
- Division of Pulmonary and Critical Care Medicine, New York University School of Medicine, New York, New York
| | - Katherine Gershner
- Section of Pulmonary, Critical Care, Allergy and Immunology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Rosemary Schluger
- Division of Pulmonary and Critical Care Medicine, New York University School of Medicine, New York, New York
| | - Yonghua Li
- Division of Pulmonary and Critical Care Medicine, New York University School of Medicine, New York, New York
| | - Ting-An Yie
- Division of Pulmonary and Critical Care Medicine, New York University School of Medicine, New York, New York
| | - Peter Meyn
- NYU Langone Genomic Technology Center, New York University School of Medicine, New York, New York
| | - Evan Olsen
- Division of Pulmonary and Critical Care Medicine, New York University School of Medicine, New York, New York
| | - Luisannay Perez
- Division of Pulmonary and Critical Care Medicine, New York University School of Medicine, New York, New York
| | - Brendan Franca
- Division of Pulmonary and Critical Care Medicine, New York University School of Medicine, New York, New York
| | - Joseph Carpenito
- Division of Pulmonary and Critical Care Medicine, New York University School of Medicine, New York, New York
| | - Tadasu Iizumi
- Division of Pulmonary and Critical Care Medicine, New York University School of Medicine, New York, New York
| | - Mariam El-Ashmawy
- Department of Medicine, New York University School of Medicine, New York, New York
| | - Michelle Badri
- Department of Biology, New York University, New York, New York
| | - James T Morton
- Center for Computational Biology, Flatiron Institute, Simons Foundation, New York, New York
| | - Nan Shen
- Department of Genetics and Genomic Sciences and Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Linchen He
- Department of Population Health, New York University School of Medicine, New York, New York
| | - Gaetane Michaud
- Division of Pulmonary and Critical Care Medicine, New York University School of Medicine, New York, New York
| | - Samaan Rafeq
- Division of Pulmonary and Critical Care Medicine, New York University School of Medicine, New York, New York
| | - Jamie L Bessich
- Division of Pulmonary and Critical Care Medicine, New York University School of Medicine, New York, New York
| | - Robert L Smith
- Division of Pulmonary and Critical Care Medicine, VA New York Harbor Healthcare System, New York, New York
| | - Harald Sauthoff
- Division of Pulmonary and Critical Care Medicine, VA New York Harbor Healthcare System, New York, New York
| | - Kevin Felner
- Division of Pulmonary and Critical Care Medicine, VA New York Harbor Healthcare System, New York, New York
| | - Ray Pillai
- Division of Pulmonary and Critical Care Medicine, New York University School of Medicine, New York, New York
| | | | - Sergei B Koralov
- Department of Pathology, New York University School of Medicine, New York, New York
| | - Valeria Mezzano
- Department of Pathology, New York University School of Medicine, New York, New York
| | - Cynthia A Loomis
- Department of Pathology, New York University School of Medicine, New York, New York
| | - Andre L Moreira
- Department of Pathology, New York University School of Medicine, New York, New York
| | - William Moore
- Department of Radiology, New York University School of Medicine, New York, New York
| | - Aristotelis Tsirigos
- Department of Pathology, New York University School of Medicine, New York, New York
| | - Adriana Heguy
- NYU Langone Genomic Technology Center, New York University School of Medicine, New York, New York
- Department of Pathology, New York University School of Medicine, New York, New York
| | - William N Rom
- Division of Pulmonary and Critical Care Medicine, New York University School of Medicine, New York, New York
| | - Daniel H Sterman
- Division of Pulmonary and Critical Care Medicine, New York University School of Medicine, New York, New York
| | - Harvey I Pass
- Department of Cardiothoracic Surgery, New York University School of Medicine, New York, New York
| | - Jose C Clemente
- Department of Genetics and Genomic Sciences and Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Huilin Li
- Department of Population Health, New York University School of Medicine, New York, New York
| | - Richard Bonneau
- Department of Biology, New York University, New York, New York
- Center for Computational Biology, Flatiron Institute, Simons Foundation, New York, New York
- Center for Data Science, New York University School of Medicine, New York, New York
| | - Kwok-Kin Wong
- Division of Hematology and Oncology, New York University School of Medicine, New York, New York
| | | | - Leopoldo N Segal
- Division of Pulmonary and Critical Care Medicine, New York University School of Medicine, New York, New York.
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Popat S, Navani N, Kerr KM, Smit EF, Batchelor TJ, Van Schil P, Senan S, McDonald F. Navigating Diagnostic and Treatment Decisions in Non-Small Cell Lung Cancer: Expert Commentary on the Multidisciplinary Team Approach. Oncologist 2021; 26:e306-e315. [PMID: 33145902 PMCID: PMC7873339 DOI: 10.1002/onco.13586] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 10/20/2020] [Indexed: 12/11/2022] Open
Abstract
Non-small cell lung cancer (NSCLC) accounts for approximately one in five cancer-related deaths, and management requires increasingly complex decision making by health care professionals. Many centers have therefore adopted a multidisciplinary approach to patient care, using the expertise of various specialists to provide the best evidence-based, personalized treatment. However, increasingly complex disease staging, as well as expanded biomarker testing and multimodality management algorithms with novel therapeutics, have driven the need for multifaceted, collaborative decision making to optimally guide the overall treatment process. To keep up with the rapidly evolving treatment landscape, national-level guidelines have been introduced to standardize patient pathways and ensure prompt diagnosis and treatment. Such strategies depend on efficient and effective communication between relevant multidisciplinary team members and have both improved adherence to treatment guidelines and extended patient survival. This article highlights the value of a multidisciplinary approach to diagnosis and staging, treatment decision making, and adverse event management in NSCLC. IMPLICATIONS FOR PRACTICE: This review highlights the value of a multidisciplinary approach to the diagnosis and staging of non-small cell lung cancer (NSCLC) and makes practical suggestions as to how multidisciplinary teams (MDTs) can be best deployed at individual stages of the disease to improve patient outcomes and effectively manage common adverse events. The authors discuss how a collaborative approach, appropriately leveraging the diverse expertise of NSCLC MDT members (including specialist radiation and medical oncologists, chest physicians, pathologists, pulmonologists, surgeons, and nursing staff) can continue to ensure optimal per-patient decision making as treatment options become ever more specialized in the era of biomarker-driven therapeutic strategies.
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Affiliation(s)
- Sanjay Popat
- Lung Unit, Royal Marsden HospitalLondonUnited Kingdom
- The Institute of Cancer Research, University of LondonLondonUnited Kingdom
| | - Neal Navani
- Lungs for Living Research Centre, University College London (UCL) Respiratory, UCL and Department of Thoracic Medicine, University College London Hospitals NHS Foundation TrustLondonUnited Kingdom
| | - Keith M. Kerr
- Department of Pathology, Aberdeen University Medical School and Aberdeen Royal InfirmaryAberdeenUnited Kingdom
| | - Egbert F. Smit
- Department of Pulmonary Diseases, VU University Medical Center and Department of Thoracic Oncology, The Netherlands Cancer InstituteAmsterdamThe Netherlands
| | - Timothy J.P. Batchelor
- Department of Thoracic Surgery, University Hospitals Bristol and Weston National Health Service Foundation TrustBristolUnited Kingdom
| | - Paul Van Schil
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital and Antwerp UniversityAntwerpBelgium
| | - Suresh Senan
- Department of Radiation Oncology, Amsterdam University Medical Center, Free University Amsterdam, Cancer Center AmsterdamAmsterdamThe Netherlands
| | - Fiona McDonald
- Lung Unit, Royal Marsden HospitalLondonUnited Kingdom
- The Institute of Cancer Research, University of LondonLondonUnited Kingdom
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104
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Chang CY, Lu YCA, Ting WC, Shen TWD, Peng WC. An artificial immune system with bootstrap sampling for the diagnosis of recurrent endometrial cancers. Open Med (Wars) 2021; 16:237-245. [PMID: 33585700 PMCID: PMC7863001 DOI: 10.1515/med-2021-0226] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 12/11/2020] [Accepted: 12/29/2020] [Indexed: 12/24/2022] Open
Abstract
Endometrial cancer is one of the most common gynecological malignancies in developed countries. The prevention of the recurrence of endometrial cancer has always been a clinical challenge. Endometrial cancer is asymptomatic in the early stage, and there remains a lack of time-series correlation patterns of clinical pathway transfer, recurrence, and treatment. In this study, the artificial immune system (AIS) combined with bootstrap sampling was compared with other machine learning techniques, which included both supervised and unsupervised learning categories. The back propagation neural network, support vector machine (SVM) with a radial basis function kernel, fuzzy c-means, and ant k-means were compared with the proposed method to verify the sensitivity and specificity of the datasets, and the important factors of recurrent endometrial cancer were predicted. In the unsupervised learning algorithms, the AIS algorithm had the highest accuracy (83.35%), sensitivity (77.35%), and specificity (92.31%); in supervised learning algorithms, the SVM algorithm had the highest accuracy (97.51%), sensitivity (95.02%), and specificity (99.29%). The results of our study showed that histology and chemotherapy are important factors affecting the prediction of recurrence. Finally, behavior code and radiotherapy for recurrent endometrial cancer are important factors for future adjuvant treatment.
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Affiliation(s)
- Chih-Yen Chang
- Department of Medical Education and Research, Jen-Ai Hospital, Taichung, Taiwan.,Department of Elderly Care, Central Taiwan University of Science and Technology, Taichung, Taiwan
| | - Yen-Chiao Angel Lu
- School of Nursing, College of Medicine, Chung-Shan Medical University, Taichung, Taiwan
| | - Wen-Chien Ting
- Division of Colorectal Surgery, Department of Surgery, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Tsu-Wang David Shen
- Department of Automatic Control Engineering, Feng Chia University, No. 100, Wenhwa Road, Seatwen, Taichung, 40724, Taiwan.,Master's Program in Biomedical Informatics and Biomedical Engineering, Feng Chia University, No. 100, Wenhwa Road, Seatwen, Taichung, 40724, Taiwan
| | - Wen-Chen Peng
- Department of Long-Term Care, Jen-Ai hospital, Taichung, Taiwan
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105
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Katagiri Y, Jingu K, Yamamoto T, Matsushita H, Umezawa R, Ishikawa Y, Takahashi N, Takeda K, Tasaka S, Kadoya N. Differences in patterns of recurrence of squamous cell carcinoma and adenocarcinoma after radiotherapy for stage III non-small cell lung cancer. Jpn J Radiol 2021; 39:611-617. [PMID: 33484424 DOI: 10.1007/s11604-021-01091-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 01/04/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the differences in patterns of recurrence and treatment results by histology after definitive radiotherapy for stage III non-small cell lung cancer (NSCLC) in Japan. MATERIALS AND METHODS Patients with stage III NSCLC who underwent definitive radiotherapy between 2000 and 2016 in our institution were included. A total of 217 patients were enrolled. Propensity score matching was used to exclude the following confounding factors: (1) age (≥70 years or <70 years), (2) gender, (3) T factor, (4) N factor, (5) Eastern Cooperative Oncology Group performance status score and (6) smoking status (Brinkman index ≥400 or <400). RESULTS The median observation period for survivors was 55.1 months. After propensity score matching, the Sqcc and adenocarcinoma groups each included 62 paired patients. There was no significant difference in OS or PFS between the adenocarcinoma and Sqcc groups. However, rates of recurrence in the GTV-primary site (p = 0.009) and GTV-lymph node site (p = 0.037) were significantly higher in patients with Sqcc than in patients with adenocarcinoma. New metastatic recurrence was more frequent in patients with adenocarcinoma than in patients with Sqcc (p = 0.025). CONCLUSION There were significant differences in patterns of recurrence after definitive (chemo)radiotherapy between patients with Sqcc and patients with adenocarcinoma.
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Affiliation(s)
- Yu Katagiri
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-chou, Aoba-ku, Sendai, 980-8574, Japan
| | - Keiichi Jingu
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-chou, Aoba-ku, Sendai, 980-8574, Japan.
| | - Takaya Yamamoto
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-chou, Aoba-ku, Sendai, 980-8574, Japan
| | - Haruo Matsushita
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-chou, Aoba-ku, Sendai, 980-8574, Japan
| | - Rei Umezawa
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-chou, Aoba-ku, Sendai, 980-8574, Japan
| | - Yojiro Ishikawa
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-chou, Aoba-ku, Sendai, 980-8574, Japan
| | - Noriyoshi Takahashi
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-chou, Aoba-ku, Sendai, 980-8574, Japan
| | - Kazuya Takeda
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-chou, Aoba-ku, Sendai, 980-8574, Japan
| | - Shun Tasaka
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-chou, Aoba-ku, Sendai, 980-8574, Japan
| | - Noriyuki Kadoya
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-chou, Aoba-ku, Sendai, 980-8574, Japan
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106
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Faivre-Finn C, Vicente D, Kurata T, Planchard D, Paz-Ares L, Vansteenkiste JF, Spigel DR, Garassino MC, Reck M, Senan S, Naidoo J, Rimner A, Wu YL, Gray JE, Özgüroğlu M, Lee KH, Cho BC, Kato T, de Wit M, Newton M, Wang L, Thiyagarajah P, Antonia SJ. Four-Year Survival With Durvalumab After Chemoradiotherapy in Stage III NSCLC-an Update From the PACIFIC Trial. J Thorac Oncol 2021; 16:860-867. [PMID: 33476803 DOI: 10.1016/j.jtho.2020.12.015] [Citation(s) in RCA: 287] [Impact Index Per Article: 95.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 12/02/2020] [Accepted: 12/23/2020] [Indexed: 12/25/2022]
Abstract
INTRODUCTION In the Phase 3, placebo-controlled PACIFIC trial of patients with unresectable, stage III NSCLC without disease progression after concurrent chemoradiotherapy, consolidative durvalumab was associated with significant improvements in the primary end points of overall survival (OS) (hazard ratio [HR] = 0.68; 95% confidence interval [CI]: 0.53-0.87; p = 0.00251; data cutoff, March 22, 2018) and progression-free survival (PFS) (blinded independent central review; Response Evaluation Criteria in Solid Tumors version 1.1) (HR = 0.52; 95% CI: 0.42-65; p < 0.0001; February 13, 2017) with manageable safety. Here, we report updated analyses of OS and PFS, approximately 4 years after the last patient was randomized. METHODS Patients with WHO performance status of 0 or 1 (and any tumor programmed death-ligand 1 status) were randomized (2:1) to intravenous durvalumab (10 mg/kg) or placebo, administered every 2 weeks (≤12 months), stratified by age, sex, and smoking history. OS and PFS were analyzed using a stratified log-rank test in the intent-to-treat population. Medians and 4-year OS and PFS rates were estimated by the Kaplan-Meier method. RESULTS Overall, 709 of 713 randomized patients received durvalumab (n/N=473/476) or placebo (n/N=236/237). As of March 20, 2020 (median follow-up = 34.2 months; range: 0.2-64.9), updated OS (HR = 0.71; 95% CI: 0.57-0.88) and PFS (HR = 0.55; 95% CI: 0.44-0.67) remained consistent with the primary analyses. The median OS for durvalumab was reached (47.5 mo; placebo, 29.1 months). Estimated 4-year OS rates were 49.6% versus 36.3% for durvalumab versus placebo, and 4-year PFS rates were 35.3% versus 19.5% respectively. CONCLUSION These updated exploratory analyses demonstrate durable PFS and sustained OS benefit with durvalumab after chemoradiotherapy. An estimated 49.6% of patients randomized to durvalumab remain alive at 4 years (placebo, 36.3%), and 35.3% remain alive and progression-free (placebo, 19.5%).
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Affiliation(s)
- Corinne Faivre-Finn
- The University of Manchester, Manchester, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom.
| | - David Vicente
- Department of Medical Oncology, Hospital Universitario Virgen Macarena, Seville, Spain
| | - Takayasu Kurata
- Department of Internal Medicine, Kansai Medical University Hospital, Hirakata, Japan
| | - David Planchard
- Department of Medical Oncology, Thoracic Unit, Gustave Roussy, Villejuif, France
| | - Luis Paz-Ares
- CiberOnc, Universidad Complutense, Madrid, Spain; Centro Nacional De Investigaciones Oncologicas (CNIO), Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Johan F Vansteenkiste
- Department of Chronic Disease and Metabolism, University Hospitals KU Leuven, Leuven, Belgium
| | - David R Spigel
- Sarah Cannon Research Institute/Tennessee Oncology, Nashville, Tennessee
| | - Marina C Garassino
- Division of Medical Oncology, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, Milan, Italy
| | - Martin Reck
- Lung Clinic Grosshansdorf, Airway Research Center North, German Center for Lung Research, Grosshansdorf, Germany
| | - Suresh Senan
- Department of Radiation Oncology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Jarushka Naidoo
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, Maryland; Bloomberg-Kimmel Institute for Cancer Immunotherapy at John Hopkins University, Baltimore, Maryland
| | - Andreas Rimner
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Yi-Long Wu
- Department of Pulmonary Oncology, Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital & Guangdong Academy of Medical Sciences, Guangzhou, People's Republic of China
| | - Jhanelle E Gray
- Department of Thoracic Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Mustafa Özgüroğlu
- Division of Medical Oncology, Department of Internal Medicine, Cerrahpaşa School of Medicine, Istanbul University - Cerrahpaşa, Istanbul, Turkey
| | - Ki H Lee
- Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Byoung C Cho
- Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Terufumi Kato
- Department of Thoracic Oncology, Kanagawa Cancer Center, Yokohama, Japan
| | - Maike de Wit
- Department of Hematology, Oncology, and Palliative Medicine, Vivantes Klinikum Neukölln, Berlin, Germany
| | - Michael Newton
- Department of Clinical Oncology, AstraZeneca, Gaithersburg, Maryland
| | - Lu Wang
- Department of Clinical Oncology, AstraZeneca, Gaithersburg, Maryland
| | | | - Scott J Antonia
- Department of Thoracic Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
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Detection of programmed cell death-ligand 1 using 22C3 antibody in patients with unresectable stage III non-small cell lung cancer receiving chemoradiotherapy. Int J Clin Oncol 2021; 26:659-669. [PMID: 33415571 DOI: 10.1007/s10147-020-01856-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 12/15/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND The expression of programmed cell death-ligand 1 (PD-L1) is a biomarker for administering immune check point inhibitors in patients with advanced stage non-small cell lung cancer. Although the consolidation therapy of durvalumab after definitive chemoradiotherapy has become the new standard of care for patients with unresectable stage III non-small cell lung cancer, the prevalence and prognostic role of PD-L1 expression in this population remain unclear. METHODS We retrospectively reviewed data from patients with unresectable stage III non-small cell lung cancer who received definitive chemoradiotherapy at our institution between 2012 and 2017. Levels of PD-L1 were assessed using 22C3 antibody, and associations of progression-free and overall survival rates with PD-L1 statuses at a tumor proportion score cutoff of 1% were analyzed. RESULTS Among the 104 patients enrolled, PD-L1 statuses were as follows: tumor proportion score < 1%, 73 (70.2%); 1-49%, 21 (20.2%); and ≥ 50%, 10 (9.6%). The number of patients with stage III non-small cell lung cancer with pretreatment PD-L1 tumor proportion score ≥ 1% was less than the number with advanced stage disease. There was no association between patient characteristics and PD-L1 status, and no significant differences were observed in progression-free and overall survival rates relative to PD-L1 status. CONCLUSION Expression of PD-L1 in patients with stage III non-small cell cancer before chemoradiotherapy should be assessed because of the low prevalence of tumors with tumor proportion scores ≥ 1%. Further studies are needed to clarify whether durvalumab improves survival after definitive chemoradiotherapy, irrespective of tumor PD-L1 expression.
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108
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Phase 2 Study of Nimotuzumab in Combination With Concurrent Chemoradiotherapy in Patients With Locally Advanced Non-Small-Cell Lung Cancer. Clin Lung Cancer 2020; 22:134-141. [PMID: 33518480 DOI: 10.1016/j.cllc.2020.12.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 12/17/2020] [Accepted: 12/18/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND We evaluated the tolerability and efficacy of nimotuzumab, a humanized IgG1 monoclonal anti-epidermal growth factor receptor antibody, with concurrent chemoradiotherapy in patients with unresectable locally advanced non-small-cell lung cancer. PATIENTS AND METHODS In this multicenter, single-arm, open-label, phase 2 trial conducted in Japan (JapicCTI-090825), patients received thoracic radiotherapy (60 Gy, 2 Gy per fraction, 6 weeks) and four 4-week cycles of chemotherapy (day 1, cisplatin 80 mg/m2; days 1 and 8, vinorelbine 20 mg/m2). Nimotuzumab 200 mg was administrated weekly for 16 weeks. The primary endpoint was treatment completion rate, defined as the percentage of patients completing 60 Gy of radiotherapy within 8 weeks, 2 cycles of chemotherapy, and at least 75% of the required nimotuzumab dose during the initial 2-cycle concurrent chemoradiotherapy period. RESULTS Of 40 patients enrolled, 39 received the study treatment, which was well tolerated, with a completion rate of 87.2%. Thirty-eight patients completed 60 Gy of radiotherapy within 8 weeks. Infusion reaction, grade 3 or higher rash, grade 3 or higher radiation pneumonitis, or grade 4 or higher nonhematologic toxicity were not observed. The objective response rate was 69.2%. The median progression-free survival (PFS) and 5-year PFS rate were 508 days and 29.0%, respectively. The 5-year PFS rate in patients with non-squamous cell carcinoma (n = 23) was 13.7% and in patients with squamous cell carcinoma (n = 16) was 50.0%. The 5-year overall survival rate was 58.4%. CONCLUSION Addition of nimotuzumab to the concurrent chemoradiotherapy regimen was well tolerated and showed potential for treating patients with locally advanced non-small-cell lung cancer, particularly squamous cell carcinoma.
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Sardaro A, McDonald F, Bardoscia L, Lavrenkov K, Singh S, Ashley S, Traish D, Ferrari C, Meattini I, Asabella AN, Brada M. Dyspnea in Patients Receiving Radical Radiotherapy for Non-Small Cell Lung Cancer: A Prospective Study. Front Oncol 2020; 10:594590. [PMID: 33425746 PMCID: PMC7787051 DOI: 10.3389/fonc.2020.594590] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 11/18/2020] [Indexed: 12/19/2022] Open
Abstract
Background and Purpose Dyspnea is an important symptomatic endpoint for assessment of radiation-induced lung injury (RILI) following radical radiotherapy in locally advanced disease, which remains the mainstay of treatment at the time of significant advances in therapy including combination treatments with immunotherapy and chemotherapy and the use of local ablative radiotherapy techniques. We investigated the relationship between dose-volume parameters and subjective changes in dyspnea as a measure of RILI and the relationship to spirometry. Material and Methods Eighty patients receiving radical radiotherapy for non-small cell lung cancer were prospectively assessed for dyspnea using two patient-completed tools: EORTC QLQ-LC13 dyspnea quality of life assessment and dyspnea visual analogue scale (VAS). Global quality of life, spirometry and radiation pneumonitis grade were also assessed. Comparisons were made with lung dose-volume parameters. Results The median survival of the cohort was 26 months. In the evaluable group of 59 patients there were positive correlations between lung dose-volume parameters and a change in dyspnea quality of life scale at 3 months (V30 p=0.017; V40 p=0.026; V50 p=0.049; mean lung dose p=0.05), and a change in dyspnea VAS at 6 months (V30 p=0.05; V40 p=0.026; V50 p=0.028) after radiotherapy. Lung dose-volume parameters predicted a 10% increase in dyspnea quality of life score at 3 months (V40; p=0.041, V50; p=0.037) and dyspnea VAS score at 6 months (V40; p=0.027) post-treatment. Conclusions Worsening of dyspnea is an important symptom of RILI. We demonstrate a relationship between lung dose-volume parameters and a 10% worsening of subjective dyspnea scores. Our findings support the use of subjective dyspnea tools in future studies on radiation-induced lung toxicity, particularly at doses below conventional lung radiation tolerance limits.
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Affiliation(s)
- Angela Sardaro
- Lung Research Unit, The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom.,Interdisciplinary Department of Medicine, Nuclear Medicine Unit and Section of Radiology and Radiation Oncology, University of Bari Aldo Moro, Bari, Italy
| | - Fiona McDonald
- Lung Research Unit, The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom.,Academic Radiotherapy Unit, The Institute of Cancer Research, Sutton, United Kingdom
| | - Lilia Bardoscia
- Radiation Therapy Unit, Department of Oncology and Advanced Technology, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Konstantin Lavrenkov
- Lung Research Unit, The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom.,Department of Oncology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Shalini Singh
- Lung Research Unit, The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom.,Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Department of Radiotherapy, Lucknow, India
| | - Sue Ashley
- Lung Research Unit, The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - Daphne Traish
- Lung Research Unit, The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - Cristina Ferrari
- Interdisciplinary Department of Medicine, Nuclear Medicine Unit and Section of Radiology and Radiation Oncology, University of Bari Aldo Moro, Bari, Italy
| | - Icro Meattini
- Lung Research Unit, The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom.,Department of Biomedical, Experimental, and Clinical Sciences, University of Florence, Radiation Oncology Unit - Oncology Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Artor Niccoli Asabella
- Interdisciplinary Department of Medicine, Nuclear Medicine Unit and Section of Radiology and Radiation Oncology, University of Bari Aldo Moro, Bari, Italy
| | - Michael Brada
- Lung Research Unit, The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom.,Academic Radiotherapy Unit, The Institute of Cancer Research, Sutton, United Kingdom.,Department of Radiation Oncology, University of Liverpool and Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, United Kingdom
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Faehling M, Schumann C, Christopoulos P, Hoffknecht P, Alt J, Horn M, Eisenmann S, Schlenska-Lange A, Schütt P, Steger F, Brückl WM, Christoph DC. Durvalumab after definitive chemoradiotherapy in locally advanced unresectable non-small cell lung cancer (NSCLC): Real-world data on survival and safety from the German expanded-access program (EAP). Lung Cancer 2020; 150:114-122. [DOI: 10.1016/j.lungcan.2020.10.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 09/26/2020] [Accepted: 10/09/2020] [Indexed: 02/08/2023]
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Guinde J, Bourdages-Pageau E, Ugalde PA, Fortin M. Central location and risk of imaging occult mediastinal lymph node involvement in cN0T2-4 non-small cell lung cancer. J Thorac Dis 2020; 12:7156-7163. [PMID: 33447404 PMCID: PMC7797819 DOI: 10.21037/jtd-20-1565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 10/15/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Appropriate pre-operative staging is a cornerstone in the treatment of non-small cell lung cancer (NSCLC). Central location and size greater than 3 cm are amongst indications for pre-operative invasive mediastinal staging but the quality of the evidence behind this recommendation is low. METHODS We retrospectively reviewed all cases of cT2-4N0M0 NSCLCL after CT and TEP-CT which underwent surgical resection with lymph node dissection or had a positive invasive pre-operative mediastinal staging in our institution from 2014 to 2018. RESULTS Three hundred and ten patients met inclusion criteria, 79 (25.5%) central and 231 (74.5%) peripheral tumors. Central tumor location was associated with a higher prevalence of pN2-3 disease (17.7% vs. 6.1%, P<0.001). In a multivariate analysis, central tumor location remained the only factor statistically associated with imaging occult mediastinal disease (OR 3.23, 95% CI: 1.45-7.18). NPV of PET-CT for occult mediastinal disease was 0.83 (95% CI: 0.72-0.90) in central and 0.94 (95% CI: 0.90-0.97) in peripheral tumor. Central location was also associated with a higher prevalence of occult N1 to N3 disease (43.0% vs. 15.2%, P<0.001). CONCLUSIONS This study suggests that invasive mediastinal staging is required in central cT2-4N0 NSCLC but can be questioned in peripheral one, especially in cT2N2 subgroup if the patient is a candidate for lobar resection.
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Affiliation(s)
- Julien Guinde
- Department of Pulmonology and Thoracic Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec, Canada
- Department of Thoracic Oncology, Pleural Diseases and Interventional Pulmonology, Marseille, France
| | - Etienne Bourdages-Pageau
- Department of Pulmonology and Thoracic Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec, Canada
| | - Paula Antonia Ugalde
- Department of Pulmonology and Thoracic Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec, Canada
| | - Marc Fortin
- Department of Pulmonology and Thoracic Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec, Canada
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Faivre-Finn C, Spigel DR, Senan S, Langer C, Perez BA, Özgüroğlu M, Daniel D, Villegas A, Vicente D, Hui R, Murakami S, Paz-Ares L, Broadhurst H, Wadsworth C, Dennis PA, Antonia SJ. Impact of prior chemoradiotherapy-related variables on outcomes with durvalumab in unresectable Stage III NSCLC (PACIFIC). Lung Cancer 2020; 151:30-38. [PMID: 33285469 DOI: 10.1016/j.lungcan.2020.11.024] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 09/29/2020] [Accepted: 11/23/2020] [Indexed: 01/10/2023]
Abstract
INTRODUCTION The PACIFIC trial demonstrated that durvalumab significantly improved progression-free and overall survival (PFS/OS), versus placebo, in patients with Stage III NSCLC and stable or responding disease following concurrent, platinum-based chemoradiotherapy (CRT). A range of CT and RT regimens were permitted, and used, in the trial. We report post-hoc, exploratory analyses of clinical outcomes from PACIFIC according to CRT-related variables. METHODS Patients were randomized 2:1 (1-42 days post-CRT) to up to 12 months durvalumab (10 mg/kg intravenously every 2 weeks) or placebo. Efficacy and safety were analyzed in patient subgroups defined by the following baseline variables: platinum-based CT (cisplatin/carboplatin); vinorelbine, etoposide, or taxane-based CT (all yes/no); total RT dose (<60 Gy/60-66 Gy/>66 Gy); time from last RT dose to randomization (<14 days/≥14 days); and use of pre-CRT induction CT (yes/no). Treatment effects for time-to-event endpoints were estimated by hazard ratios (HRs) from unstratified Cox-proportional-hazards models. RESULTS Overall, 713 patients were randomized, of whom 709 received treatment in either the durvalumab (n/N = 473/476) or placebo arms (n/N = 236/237). Durvalumab improved PFS, versus placebo, across all subgroups (median follow up, 14.5 months; HR range, 0.34-0.63). Durvalumab improved OS across most subgroups (median follow up, 25.2 months; HR range, 0.35-0.86); however, the 95 % confidence interval (CI) of the estimated treatment effect crossed one for the subgroups of patients who received induction CT (HR, 0.78 [95 % CI, 0.51-1.20]); carboplatin (0.86 [0.60-1.23]); vinorelbine (0.79 [0.49-1.27]); and taxane-based CT (0.73 [0.51-1.04]); and patients who were randomized ≥14 days post-RT (0.81 [0.62-1.06]). Safety was broadly similar across the CRT subgroups. CONCLUSION Durvalumab prolonged PFS and OS irrespective of treatment variables related to prior CRT to which patients with Stage III NSCLC had previously stabilized or responded. Limited patient numbers and imbalances in baseline factors in each subgroup preclude robust conclusions.
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Affiliation(s)
- Corinne Faivre-Finn
- The University of Manchester, Manchester, UK; The Christie NHS Foundation Trust, Manchester, UK.
| | - David R Spigel
- Tennessee Oncology, Chattanooga, TN, USA; Sarah Cannon Research Institute, Nashville, TN, USA
| | - Suresh Senan
- Department of Radiation Oncology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Corey Langer
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Bradford A Perez
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Mustafa Özgüroğlu
- Istanbul University - Cerrahpaşa, Cerrahpaşa School of Medicine, Istanbul, Turkey
| | - Davey Daniel
- Tennessee Oncology, Chattanooga, TN, USA; Sarah Cannon Research Institute, Nashville, TN, USA
| | | | - David Vicente
- Hospital Universitario Virgen Macarena, Seville, Spain
| | - Rina Hui
- Westmead Hospital and the University of Sydney, Sydney, NSW, Australia
| | | | - Luis Paz-Ares
- Hospital Universitario 12 de Octubre, Lung Cancer Unit CNIO-H12o, CiberOnc and Universidad Complutense, Madrid, Spain
| | | | | | | | - Scott J Antonia
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
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Desilets A, Blanc-Durand F, Lau S, Hakozaki T, Kitadai R, Malo J, Belkaid W, Richard C, Messaoudene M, Cvetkovic L, Kazandjian S, Tehfe M, Florescu M, Jao K, Daaboul N, Owen S, Shieh B, Agulnik J, Cohen V, Charbonneau C, Marcoux N, Blais N, Leighl NB, Bradbury PA, Liu G, Shepherd FA, Bahig H, Routy B, Sacher A, Elkrief A. Durvalumab therapy following chemoradiation compared with a historical cohort treated with chemoradiation alone in patients with stage III non-small cell lung cancer: A real-world multicentre study. Eur J Cancer 2020; 142:83-91. [PMID: 33242835 DOI: 10.1016/j.ejca.2020.10.008] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 09/30/2020] [Accepted: 10/08/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND The PACIFIC trial demonstrated that durvalumab therapy following chemoradiation (CRT) was associated with improved overall survival (OS) in patients with stage III non-small cell lung cancer (NSCLC). It is unclear whether the results obtained as part of randomised controlled trials are a reflection of real-world (RW) data. Several questions remain unanswered with regard to RW durvalumab use, such as optimal time to durvalumab initiation, incidence of pneumonitis and response in PD-L1 subgroups. METHODS In this multicentre retrospective analysis, 147 patients with stage III NSCLC treated with CRT followed by durvalumab were compared with a historical cohort of 121 patients treated with CRT alone. Survival curves were estimated using the Kaplan-Meier method and compared with the log-rank test in univariate analysis. Multivariate analysis was performed to evaluate the effect of standard prognostic factors for durvalumab use. RESULTS Median OS was not reached in the durvalumab group, compared with 26.9 months in the historical group (hazard ratio [HR]: 0.56, 95% confidence interval [CI]: 0.37-0.85, p = 0.001). In the durvalumab group, our data suggest improved 12-month OS in patients with PD-L1 expression ≥50% (100% vs 86%, HR: 0.25, 95% CI: 0.11-0.58, p = 0.007). There was no difference in OS between patients with a PD-L1 expression of 1-49% and patients with PD-L1 expression <1%. Delay in durvalumab initiation beyond 42 days did not impact OS. Incidence of pneumonitis was similar in the durvalumab and historical groups. In the durvalumab group, patients who experienced any-grade pneumonitis had a lower 12-month OS than patients without pneumonitis (85% vs 95%, respectively; HR: 3.3, 95% CI: 1.2-9.0, p = 0.006). CONCLUSIONS This multicentre analysis suggests that PD-L1 expression ≥50% was associated with favourable OS in patients with stage III NSCLC treated with durvalumab after CRT, whereas the presence of pneumonitis represented a negative prognostic factor.
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Affiliation(s)
- Antoine Desilets
- Centre de Recherche Du Centre Hospitalier de L'Université de Montréal (CRCHUM), 900, Rue Saint-Denis, Pavillon R, H2X 0A9, Montreal, Quebec, Canada; Department of Hematology and Oncology, Centre Hospitalier de L'Université de Montréal (CHUM), 1051, Rue Sanguinet, H2X 3E4, Montreal, Quebec, Canada.
| | - Félix Blanc-Durand
- Centre de Recherche Du Centre Hospitalier de L'Université de Montréal (CRCHUM), 900, Rue Saint-Denis, Pavillon R, H2X 0A9, Montreal, Quebec, Canada; Department of Hematology and Oncology, Centre Hospitalier de L'Université de Montréal (CHUM), 1051, Rue Sanguinet, H2X 3E4, Montreal, Quebec, Canada.
| | - Sally Lau
- Princess Margaret Cancer Centre, University Health Network (UNH), 610 University Ave, M5G 2C1, Toronto, Ontario, Canada.
| | - Taiki Hakozaki
- Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Honkomagome, 113-8677, Bunkyo City, Tokyo, Japan.
| | - Rui Kitadai
- Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Honkomagome, 113-8677, Bunkyo City, Tokyo, Japan.
| | - Julie Malo
- Centre de Recherche Du Centre Hospitalier de L'Université de Montréal (CRCHUM), 900, Rue Saint-Denis, Pavillon R, H2X 0A9, Montreal, Quebec, Canada.
| | - Wiam Belkaid
- Centre de Recherche Du Centre Hospitalier de L'Université de Montréal (CRCHUM), 900, Rue Saint-Denis, Pavillon R, H2X 0A9, Montreal, Quebec, Canada.
| | - Corentin Richard
- Centre de Recherche Du Centre Hospitalier de L'Université de Montréal (CRCHUM), 900, Rue Saint-Denis, Pavillon R, H2X 0A9, Montreal, Quebec, Canada.
| | - Meriem Messaoudene
- Centre de Recherche Du Centre Hospitalier de L'Université de Montréal (CRCHUM), 900, Rue Saint-Denis, Pavillon R, H2X 0A9, Montreal, Quebec, Canada.
| | - Lena Cvetkovic
- Department of Hematology and Oncology, Centre Hospitalier de L'Université de Montréal (CHUM), 1051, Rue Sanguinet, H2X 3E4, Montreal, Quebec, Canada.
| | - Suzanne Kazandjian
- Department of Hematology and Oncology, Centre Hospitalier de L'Université de Montréal (CHUM), 1051, Rue Sanguinet, H2X 3E4, Montreal, Quebec, Canada.
| | - Mustapha Tehfe
- Department of Hematology and Oncology, Centre Hospitalier de L'Université de Montréal (CHUM), 1051, Rue Sanguinet, H2X 3E4, Montreal, Quebec, Canada.
| | - Marie Florescu
- Department of Hematology and Oncology, Centre Hospitalier de L'Université de Montréal (CHUM), 1051, Rue Sanguinet, H2X 3E4, Montreal, Quebec, Canada.
| | - Kevin Jao
- Department of Hematology and Oncology, Hôpital Du Sacré Coeur de Montréal, 5400, Boulevard Gouin Ouest, H4J 1C5, Montreal, Quebec, Canada.
| | - Nathalie Daaboul
- Integrated Cancer Center, Charles-Le-Moyne Hospital, 3120, Boulevard Taschereau, J4V 2H1, Greenfield Park, Quebec, Canada.
| | - Scott Owen
- Cedars Cancer Center, McGill University Healthcare Center (MUHC), 1001, Boulevard Décarie, H4A 3J1, Montreal, Quebec, Canada.
| | - Benjamin Shieh
- Cedars Cancer Center, McGill University Healthcare Center (MUHC), 1001, Boulevard Décarie, H4A 3J1, Montreal, Quebec, Canada.
| | - Jason Agulnik
- Segal Cancer Center, Jewish General Hospital, 3755, Chemin de La Côte-Sainte-Catherine, H3T 1E2, Montreal, Quebec, Canada.
| | - Victor Cohen
- Segal Cancer Center, Jewish General Hospital, 3755, Chemin de La Côte-Sainte-Catherine, H3T 1E2, Montreal, Quebec, Canada.
| | - Chloé Charbonneau
- Department of Hematology and Oncology, Centre Hospitalier de L'Université de Québec (CHUQ), 11, Côte Du Palais, G1R 2J6, Quebec City, Quebec, Canada.
| | - Nicolas Marcoux
- Department of Hematology and Oncology, Centre Hospitalier de L'Université de Québec (CHUQ), 11, Côte Du Palais, G1R 2J6, Quebec City, Quebec, Canada.
| | - Normand Blais
- Department of Hematology and Oncology, Centre Hospitalier de L'Université de Montréal (CHUM), 1051, Rue Sanguinet, H2X 3E4, Montreal, Quebec, Canada.
| | - Natasha B Leighl
- Princess Margaret Cancer Centre, University Health Network (UNH), 610 University Ave, M5G 2C1, Toronto, Ontario, Canada.
| | - Penelope A Bradbury
- Princess Margaret Cancer Centre, University Health Network (UNH), 610 University Ave, M5G 2C1, Toronto, Ontario, Canada.
| | - Geoffrey Liu
- Princess Margaret Cancer Centre, University Health Network (UNH), 610 University Ave, M5G 2C1, Toronto, Ontario, Canada.
| | - Frances A Shepherd
- Princess Margaret Cancer Centre, University Health Network (UNH), 610 University Ave, M5G 2C1, Toronto, Ontario, Canada.
| | - Houda Bahig
- Centre de Recherche Du Centre Hospitalier de L'Université de Montréal (CRCHUM), 900, Rue Saint-Denis, Pavillon R, H2X 0A9, Montreal, Quebec, Canada; Department of Hematology and Oncology, Centre Hospitalier de L'Université de Montréal (CHUM), 1051, Rue Sanguinet, H2X 3E4, Montreal, Quebec, Canada.
| | - Bertrand Routy
- Centre de Recherche Du Centre Hospitalier de L'Université de Montréal (CRCHUM), 900, Rue Saint-Denis, Pavillon R, H2X 0A9, Montreal, Quebec, Canada; Department of Hematology and Oncology, Centre Hospitalier de L'Université de Montréal (CHUM), 1051, Rue Sanguinet, H2X 3E4, Montreal, Quebec, Canada.
| | - Adrian Sacher
- Princess Margaret Cancer Centre, University Health Network (UNH), 610 University Ave, M5G 2C1, Toronto, Ontario, Canada.
| | - Arielle Elkrief
- Centre de Recherche Du Centre Hospitalier de L'Université de Montréal (CRCHUM), 900, Rue Saint-Denis, Pavillon R, H2X 0A9, Montreal, Quebec, Canada; Cedars Cancer Center, McGill University Healthcare Center (MUHC), 1001, Boulevard Décarie, H4A 3J1, Montreal, Quebec, Canada; Segal Cancer Center, Jewish General Hospital, 3755, Chemin de La Côte-Sainte-Catherine, H3T 1E2, Montreal, Quebec, Canada.
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Mielgo-Rubio X, Rojo F, Mezquita-Pérez L, Casas F, Wals A, Juan M, Aguado C, Garde-Noguera J, Vicente D, Couñago F. Deep diving in the PACIFIC: Practical issues in stage III non-small cell lung cancer to avoid shipwreck. World J Clin Oncol 2020; 11:898-917. [PMID: 33312885 PMCID: PMC7701908 DOI: 10.5306/wjco.v11.i11.898] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 07/30/2020] [Accepted: 10/12/2020] [Indexed: 02/06/2023] Open
Abstract
After publication of the PACIFIC trial results, immune checkpoint inhibitor-based immunotherapy was included in the treatment algorithm of locally advanced non-small cell lung cancer (NSCLC). The PACIFIC trial demonstrated that 12 mo of durvalumab consolidation therapy after radical-intent platinum doublet chemotherapy with concomitant radiotherapy improved both progression-free survival and overall survival in patients with unresectable stage III NSCLC. This is the first treatment in decades to successfully improve survival in this clinical setting, with manageable toxicity and without deterioration in quality of life. The integration of durvalumab in the management of locally advanced NSCLC accentuates the need for multidisciplinary, coordinated decision-making among lung cancer specialists, bringing new challenges and controversies as well as important changes in clinical work routines. The aim of the present article is to review-from a practical, multidisciplinary perspective-the findings and implications of the PACIFIC trial. We evaluate the immunobiological basis of durvalumab as well as practical aspects related to programmed cell death ligand 1 determination. In addition, we comprehensively assess the efficacy and toxicity data from the PACIFIC trial and discuss the controversies and practical aspects of incorporating durvalumab into routine clinical practice. Finally, we discuss unresolved questions and future challenges. In short, the present document aims to provide clinicians with a practical guide for the application of the PACIFIC regimen in routine clinical practice.
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Affiliation(s)
- Xabier Mielgo-Rubio
- Department of Medical Oncology, Hospital Universitario Fundación Alcorcón, Madrid 28922, Spain
| | - Federico Rojo
- Department of Pathology, IIS-Jiménez Díaz-CIBERONC Foundation, Madrid 28040, Spain
| | - Laura Mezquita-Pérez
- Department of Medical Oncology, Hospital Clinic, Laboratory of Translational Genomics and Targeted Therapeutics in Solid Tumors, IDIBAPS, Barcelona 08036, Spain
| | - Francesc Casas
- Department of Radiation Oncology, Hospital Clinic, Barcelona 08036, Spain
| | - Amadeo Wals
- Department of Radiation Oncology, Hospital Universitario Virgen Macarena, Sevilla 41009, Spain
| | - Manel Juan
- Department of Immunology Service, Hospital Clínic, Universitat de Barcelona, Barcelona 08036, Spain
| | - Carlos Aguado
- Department of Medical Oncology, Hospital Universitario Clínico San Carlos, Madrid 28040, Spain
| | - Javier Garde-Noguera
- Department of Medical Oncology, Hospital Arnau de Vilanova, Valencia 46015, Spain
| | - David Vicente
- Department of Medical Oncology, Hospital Universitario Virgen Macarena, Sevilla 49001, Spain
| | - Felipe Couñago
- Department of Radiation Oncology, Hospital Universitario Quirónsalud Madrid, Hospital La Luz, Universidad Europea de Madrid, Madrid 28028, Spain
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Balasubramanian A, Onggo J, Gunjur A, John T, Parakh S. Immune Checkpoint Inhibition With Chemoradiotherapy in Stage III Non-small-cell Lung Cancer: A Systematic Review and Meta-analysis of Safety Results. Clin Lung Cancer 2020; 22:74-82. [PMID: 33414053 DOI: 10.1016/j.cllc.2020.10.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 10/21/2020] [Accepted: 10/30/2020] [Indexed: 12/23/2022]
Abstract
The role of immune checkpoint inhibitors (ICIs) administered concurrently with or after definitive chemoradiation (CRT) in stage III non-small-cell lung cancer (NSCLC) has been detailed in several studies. We performed a systematic review to determine pneumonitis rates using ICIs with CRT. MEDLINE and EMBASE databases were searched using keywords and MeSH terms. Studies using anti-programmed cell death protein 1 (PD-1) or anti-programmed death-ligand 1 (PD-L1) therapy, either sequentially or concurrently with CRT, for patients with stage III NSCLC were included. A meta-analysis of pneumonitis rates was performed based on weighted pooled proportion, using random-effects models. Weighting was performed by the inverse variance or standard error of event rates. Comparative analysis between groups was performed. Odds ratios (OR) were used as the primary summary statistics. A total of 13 studies were identified (6 prospective clinical trials and 7 real-world reports). Rates of grade ≥ 3 pneumonitis were significantly higher in clinical trials using anti-PD-1 therapy compared with PD-L1 inhibitors (8.6%; 95% confidence interval [CI], 6.2%-11.9% vs. 4.4%; 95% CI, 3.0%-6.6%; OR, 2.0; P = .01). Clinical trials using concurrent ICI therapy with CRT had greater rates of grade 2 pneumonitis compared with sequential administration (23.0%; 95% CI, 15.8%-32.3% vs. 11.0%; 95% CI, 6.6%-17.8%; OR, 0.42; P = .02). Higher rates of grade ≥ 3 pneumonitis were observed in real-world studies compared with clinical trials involving sequential PD-L1 therapy (9.9%; 95% CI, 5.3%-17.9% vs. 4.4%; 95% CI, 2.9%-6.7%; OR, 0.43; P < .01). The suggestion of increased pneumonitis with a concurrent ICI strategy and using anti-PD-1 therapies warrants further consideration in future comparative studies.
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Affiliation(s)
| | - James Onggo
- Department of Surgery, Eastern Health, Melbourne, Victoria, Australia
| | - Ashray Gunjur
- Department of Medical Oncology, Austin Health, Melbourne, Victoria, Australia
| | - Thomas John
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Sagun Parakh
- Department of Medical Oncology, Austin Health, Melbourne, Victoria, Australia; Olivia-Newton John Cancer Research Institute, Melbourne, Victoria, Australia; School of Cancer Medicine, La Trobe University, Melbourne, Victoria, Australia.
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Circ-ZNF124 downregulation inhibits non-small cell lung cancer progression partly by inactivating the Wnt/β-catenin signaling pathway via mediating the miR-498/YES1 axis. Anticancer Drugs 2020; 32:257-268. [PMID: 33186139 DOI: 10.1097/cad.0000000000001014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Non-small cell lung cancer (NSCLC) is a major type of lung cancer, leading to a high fatality rate. The role of circular RNAs (circRNAs) in cancer has been increasingly emphasized and studied. However, the function of circ-ZNF124 in NSCLC is largely unclear, and associated regulatory mechanism is not studied. Here, we examined the expression pattern of circ-ZNF124 using quantitative real-time PCR. For functional analysis, cell proliferation, cell apoptosis/cycle and cell invasion were investigated using MTT [3-(4, 5-dimethylthiazol-2-yl)-2, 5-diphenyltetrazolium bromide] assay, flow cytometry assay and transwell assay, respectively. As results, we found that the expression of circ-ZNF124 was elevated in NSCLC tissues and cells. Functionally, circ-ZNF124 downregulation inhibited NSCLC cell proliferation and invasion but induced apoptosis and cycle arrest in vitro, and blocked tumor growth in vivo by animal experiments. Mechanistically, we identified that miR-498 was a target of circ-ZNF124, and miR-498 directly bound to YES proto-oncogene 1 (YES1). Besides, rescue experiments discovered that the cellular effects caused by circ-ZNF124 downregulation could be reversed by miR-498 inhibition or YES1 overexpression. Moreover, we discovered that circ-ZNF124 downregulation inactivated the expression of β-catenin and c-Myc by mediating the miR-498/YES axis. In conclusion, these findings supported that circ-ZNF124 regulated the expression of YES1 by acting as a sponge of miR-498, thus restraining NSCLC development by inactivating the Wnt/β-catenin signaling pathway, which provided a novel strategy to treat NSCLC.
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Matiello J, Dal Pra A, Zardo L, Silva R, Berton DC. Impacts of post-radiotherapy lymphocyte count on progression-free and overall survival in patients with stage III lung cancer. Thorac Cancer 2020; 11:3139-3144. [PMID: 32956564 PMCID: PMC7606004 DOI: 10.1111/1759-7714.13621] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 07/27/2020] [Accepted: 07/29/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND We evaluated the impact of thoracic radiation in patients with non-small cell lung cancer (NSCLC), considering the depletion of total lymphocytes, use or not of chemotherapy, and radiation doses in healthy lung tissue. METHODS Patients with stage III NSCLC, ECOG 0 to 2, receiving radiotherapy with or without chemotherapy were prospectively evaluated. All patients should be treated with three-dimensional radiotherapy and received biologically effective doses (BED10α/β 10) of 48 to 80 Gy. Peripheral blood lymphocyte total counts were measured at the start of radiotherapy and at 2, 6 and 12 months after radiotherapy. Along with lymphocytes, PTV and doses of 5 Gy and 20 Gy in healthy lung tissue were also evaluated as potential factors influencing overall survival (OS) and progression-free survival (PFS). RESULTS A total of 46 patients were prospectively evaluated from April 2016 to August 2019, with a median follow-up of 13 months (interquartile range, 1-39 months). The median of OS of all cohort was 22,8 months (IC 95% 17,6-28,1) and the median PFS was 19,5 months (IC 95%: 14,7-24,2). Most patients received concurrent or neoadjuvant chemotherapy (43; 93.4%). No patient received adjuvant immunotherapy. The lower the lymphocyte loss at 6 months after radiotherapy (every 100 lymphocytes/mcL), the greater the chance of PFS (HR, 0.44; 95%CI, 0.25-0.77; P = 0.004) and OS (HR, 0.83; 95%CI, 0.70-0.98; P = 0.025; P = 0.025). BED was a protective factor for both PFS (HR, 0.52; 95%CI 0.33-0.83; P = 0.0006) and OS (HR, 0.73; 95%CI 0.54-0.97; P = 0.029). CONCLUSIONS Our results suggest that lymphocyte depletion after radiotherapy reduces tumor control and survival in patients with stage III lung cancer. Radiation doses equal or higher than 60 Gy (BED10 72 Gy) improve PFS and OS, but they negatively affect lymphocyte counts for months, which reduces survival and the potential of immunotherapy. KEY POINTS SIGNIFICANT FINDINGS OF THE STUDY: Thoracic irradiation for locally advanced lung cancer depletes T lymphocytes for months. Patients whose lymphocyte loss is lower have better overall survival and progression-free survival. WHAT THIS STUDY ADDS It is necessary to protect the lymphocyte population, as well as other organs at risk. New forms of irradiation for large fields are needed. Furthermore, could immunotherapy before chemo-radiotherapy, with a greater number of lymphocytes, bring an even better result?
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Affiliation(s)
- Juliana Matiello
- Department of Radiation OncologySanta Casa de Porto AlegrePorto AlegreBrazil
| | - Alan Dal Pra
- Department of Radiation OncologyUHealth Radiation OncologyMiamiFloridaUSA
| | - Laise Zardo
- Department of Radiation OncologySanta Casa de Porto AlegrePorto AlegreBrazil
| | - Ricardo Silva
- Department of Radiation OncologySanta Casa de Porto AlegrePorto AlegreBrazil
| | - Danilo C Berton
- Department of Pneumological SciencesUniversidade Federal do Rio Grande do SulPorto AlegreBrazil
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Hung HY, Tseng YH, Chao HS, Chiu CH, Hsu WH, Hsu HS, Wu YC, Chou TY, Chen CK, Lan KL, Chen YW, Wu YH, Chen YM. Multidisciplinary team discussion results in survival benefit for patients with stage III non-small-cell lung cancer. PLoS One 2020; 15:e0236503. [PMID: 33031375 PMCID: PMC7544080 DOI: 10.1371/journal.pone.0236503] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 07/07/2020] [Indexed: 12/25/2022] Open
Abstract
Background The treatment for stage III non-small cell lung cancer (NSCLC) often involves multi-modality treatment. This retrospective study aimed to evaluate whether multidisciplinary team (MDT) discussion results in better patient survival. Materials and methods MDT discussion was optional before February 2016 and was actively encouraged by the MDT committee beginning February 2016. We reviewed the medical charts and computer records of patients with stage III NSCLC between January 2013 and December 2018. Results A total of 515 patients were included. The median survival of all the patients was 33.9 months (M). The median survival of patients who were treated after MDT discussion was 41.2 M and that of patients treated without MDT discussion was 25.7 M (p = 0.018). The median survival of patients treated before February 2016 was 25.7 M and that of patients treated after February 2016 was 33.9 M (p = 0.003). The median survival of patients with stage IIIA tumors and those with stage IIIB tumors was 39.4 M and 25.7 M, respectively (p = 0.141). Multivariate analysis showed that MDT or not (p<0.001), T staging (p = 0.009), performance status (p<0.001), and surgery (p = 0.016) to be significant prognostic factors. Conclusion The results of the study show that MDT discussion results in survival benefit in patients with stage III NSCLC. The MDT discussion, performance status, and if surgery was performed were independent prognostic factors for patients with stage III NSCLC.
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Affiliation(s)
- Hsiu-Ying Hung
- Nursing Department, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yen-Han Tseng
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China (R.O.C)
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C
| | - Heng-Sheng Chao
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China (R.O.C)
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C
| | - Chao-Hua Chiu
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China (R.O.C)
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C
| | - Wen-Hu Hsu
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C
- Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C
| | - Han-Shui Hsu
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C
- Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C
| | - Yu-Chung Wu
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C
- Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C
| | - Teh-Ying Chou
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C
- Division of Molecular Pathology, Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C
| | - Chun-Ku Chen
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C
| | - Keng-Li Lan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C
- Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yi-Wei Chen
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C
- Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yuan-Hung Wu
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C
- Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yuh-Min Chen
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China (R.O.C)
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C
- Taipei Cancer Center, Taipei Medical University, Taipei, Taiwan, R.O.C
- * E-mail:
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Degens J, De Ruysscher D, Houben R, Kietselaer B, Bootsma G, Hendriks L, Huijbers E, Schols A, Dingemans AMC. Are patients with stage III non-small cell lung cancer treated with chemoradiotherapy at risk for cardiac events? Results from a retrospective cohort study. BMJ Open 2020; 10:e036492. [PMID: 32988942 PMCID: PMC7523207 DOI: 10.1136/bmjopen-2019-036492] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES Dyspnoea is one of the symptoms frequently encountered after treatment with chemoradiotherapy (CRT) in stage III non-small cell lung cancer (NSCLC). Long-term data on mild to moderately severe cardiac events as underlying cause of dyspnoea in patients with stage III NSCLC are lacking. Therefore, the incidence of new cardiac events, with a common terminology criteria for adverse events (CTCAE) score of ≥2 within 5 years after diagnosis, were analysed. DESIGN Retrospective multicentre cohort study of patients with stage III NSCLC treated with CRT from 2006 to 2013. The medical files of the treated patients were reviewed. OUTCOME MEASURES The primary endpoint of the study was the incidence of new cardiac events with a CTCAE score of ≥2 within 5 years after diagnosis. Secondary endpoint was to identify risk factors associated with the development of a cardiac event. RESULTS Four hundred and sixty patients were included in the study. Of all patients, 150 (32.6%) developed a new cardiac event. In patients with a known cardiac history (n=138), 44.2% developed an event. The most common cardiac events were arrhythmia (14.6%), heart failure (7.6%) and symptomatic coronary artery disease (6.8%). Pre-existent cardiac comorbidity (HR 1.96; p<0.01) and WHO-performance score ≥2 (HR 2.71; p<0.01) were significantly associated with developing a cardiac event. The majority of patients did not have pre-existent cardiac comorbidity (n=322). Elevated WHO/International Society of Hypertension score was not identified as a significant predictor for cardiac events. CONCLUSION One-third of patients with stage III NSCLC treated in daily clinical practice develop a new cardiac event within 5 years after CRT. All physicians confronted with patients with NSCLC should take cardiac comorbidity as a serious possible explanation for dyspnoea after treatment with CRT.
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Affiliation(s)
- Juliette Degens
- Departement of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht Universitair Medisch Centrum+, Maastricht, the Netherlands
| | - D De Ruysscher
- Department of Radiation Oncology, GROW School for Oncology and Developmental Biology, MAASTRO, Maastricht, the Netherlands
| | - Ruud Houben
- Department of Radiation Oncology, MAASTRO, Maastricht, the Netherlands
| | - Bastiaan Kietselaer
- Department of Cardiology, Zuyderland Medical Centre Heerlen, Heerlen, the Netherlands
| | - Gerben Bootsma
- Department of Respiratory Medicine, Zuyderland Medical Centre Heerlen, Heerlen, the Netherlands
| | - Lizza Hendriks
- Department of Respiratory Medicine, GROW School for Oncology and Developmental Biology, Maastricht Universitair Medisch Centrum+, Maastricht, the Netherlands
| | - Ellen Huijbers
- General Practitioner, focus on Cardio-Vascular Risk Management, DOH Zorggroep, Eindhoven, the Netherlands
| | - Annemie Schols
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
| | - Anne-Marie C Dingemans
- GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands
- Department of Respiratory Medicine, Erasmus Medical Center, Rotterdam, the Netherlands
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Zhou F, Wang M, Aibaidula M, Zhang Z, Aihemaiti A, Aili R, Chen H, Dong S, Wei W, Maimaitiaili A. TPX2 Promotes Metastasis and Serves as a Marker of Poor Prognosis in Non-Small Cell Lung Cancer. Med Sci Monit 2020; 26:e925147. [PMID: 32748897 PMCID: PMC7427348 DOI: 10.12659/msm.925147] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Metastasis contributes to the high mortality rate of non-small cell lung cancer (NSCLC), and gaining a better understanding of its metastatic mechanisms would aid in initiating effective clinical treatment. MATERIAL AND METHODS In this study, bioinformatics analyses of the GEO database and TCGA-LUAD were first used to identify the key node gene regulating NSCLC malignant progression. Further in vitro experiments, including wound healing assay, invasion assay, Western blot assay, and luciferase report assay, were used to clarify the functions and mechanism of TPX2 in NSCLC. RESULTS Results of the TCGA analysis showed that TPX2 was significantly positively correlated with tumor metastasis and growth and the clinical stage of NSCLC. In addition, high levels of TPX2 significantly indicated a poor survival rate. In vitro experimental results also revealed that the upregulation of TPX2 significantly promoted NSCLC cell migration and invasion and could affect cell replasticity. Further results indicated that TPX2 significantly activated the epithelial-mesenchymal transition process and promoted the expression and activities of matrix metalloproteinase (MMP)2 and MMP9. CONCLUSIONS This study demonstrated that TPX2 promotes the metastasis and malignant progression of NSCLC and could thus serve as a marker of poor prognosis in NSCLC.
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Affiliation(s)
- Fang Zhou
- Department of Thoracic Surgery, Tianjin Chest Hospital, Tianjin, China (mainland)
| | - Meng Wang
- Department of Thoracic Surgery, Tianjin Chest Hospital, Tianjin, China (mainland)
| | - Mijiti Aibaidula
- Department of Cardiothoracic Surgery, People's Hospital of Hetian, Hetian, Xinjiang, China (mainland)
| | - Zhiguo Zhang
- Department of Cardiothoracic Surgery, People's Hospital of Hetian, Hetian, Xinjiang, China (mainland)
| | - Abudusaimaiti Aihemaiti
- Department of Cardiothoracic Surgery, People's Hospital of Hetian, Hetian, Xinjiang, China (mainland)
| | - Rezhake Aili
- Department of Cardiothoracic Surgery, People's Hospital of Hetian, Hetian, Xinjiang, China (mainland)
| | - Hao Chen
- Department of Cardiothoracic Surgery, People's Hospital of Hetian, Hetian, Xinjiang, China (mainland)
| | - Shuangfeng Dong
- Department of Cardiothoracic Surgery, People's Hospital of Hetian, Hetian, Xinjiang, China (mainland)
| | - Wei Wei
- Department of Cardiothoracic Surgery, People's Hospital of Hetian, Hetian, Xinjiang, China (mainland)
| | - Abulizi Maimaitiaili
- Department of Cardiothoracic Surgery, People's Hospital of Hetian, Hetian, Xinjiang, China (mainland)
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Han J, Tian K, Yang J, Gong Y. Durvalumab vs placebo consolidation therapy after chemoradiotherapy in stage III non-small-cell lung cancer: An updated PACIFIC trial-based cost-effectiveness analysis. Lung Cancer 2020; 146:42-49. [DOI: 10.1016/j.lungcan.2020.05.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 05/08/2020] [Accepted: 05/10/2020] [Indexed: 12/22/2022]
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Cui Y, Li X, Du B, Diao Y, Li Y. PD-L1 in Lung Adenocarcinoma: Insights into the Role of 18F-FDG PET/CT. Cancer Manag Res 2020; 12:6385-6395. [PMID: 32801879 PMCID: PMC7394511 DOI: 10.2147/cmar.s256871] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 06/20/2020] [Indexed: 12/25/2022] Open
Abstract
Purpose This study aimed to evaluate the role of 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET)/computed tomography (CT) in expression of tumor programmed death ligand-1 (PD-L1) expression and prognostic significance of 18F-FDG PET/CT at different PD-L1 status in patients with lung adenocarcinoma. Patients and Methods Seventy-three patients with primary lung adenocarcinoma who received 18F-FDG PET/CT before treatment were retrospectively included in this study. Expression of tumor PD-L1, programmed death-1 (PD-1) and glucose metabolic parameters were evaluated. Results Tumor PD-L1 expression was positively correlated with maximum standardized uptake value (SUVmax), total lesion glycolysis (TLG), hexokinase II (HK-II) and glucose transporter 1 (GLUT-1) (P<0.0001 for all). SUVmax was a unique independent predictor of tumor PD-L1 expression, with an optimal cut-off value of 9.5. For all the patients, tumor stage (P<0.001) and SUVmax (P=0.009) were independent prognostic indicators of disease-free survival (DFS)/progression-free survival (PFS) while carcino-embryonic antigen (CEA) (P=0.003), Ki67 (P=0.042), PD-L1 (P=0.048) and TLG (P=0.004) were independent prognostic indicators of overall survival (OS). Tumor stage (P=0.004) and SUVmax (P=0.022) were independent prognostic indicators of DFS/PFS while TLG (P=0.012) and CEA (P=0.045) were independent prognostic indicators of OS in the PD-L1-positive group. In the PD-L1-negative group, tumor stage (P=0.002) and CEA (P=0.006) were unique independent prognostic indicators of DFS/PFS and OS, respectively. Conclusion 18F-FDG PET/CT may potentially predict tumor PD-L1 expression and play a role in predicting prognosis of PD-L1/PD-1 immunotherapy in lung adenocarcinoma.
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Affiliation(s)
- Yan Cui
- Department of Nuclear Medicine, The First Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China
| | - Xuena Li
- Department of Nuclear Medicine, The First Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China
| | - Bulin Du
- Department of Nuclear Medicine, The First Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China
| | - Yao Diao
- Department of Nuclear Medicine, The First Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China
| | - Yaming Li
- Department of Nuclear Medicine, The First Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China
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Plodkowski AJ, Araujo-Filho JAB, Simmers CDA, Girshman J, Raj M, Zheng J, Rimner A, Ginsberg MS. Pre-treatment CT imaging in stage IIIA lung cancer: Can we predict local recurrence after definitive chemoradiotherapy? Clin Imaging 2020; 69:133-138. [PMID: 32721848 DOI: 10.1016/j.clinimag.2020.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 06/19/2020] [Accepted: 07/13/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The aim of this study was to delineate computed tomography (CT) features of stage IIIA non-small cell lung cancers on pre-treatment staging studies and identify features that could predict local recurrence after definitive concurrent chemoradiotherapy. MATERIALS AND METHODS We retrospectively reviewed pre- and post-treatment CT scans for 91 patients with Stage IIIA non-small cell lung cancer undergoing definitive concurrent chemoradiotherapy. Pre-treatment CT qualitative features were evaluated by consensus. The primary endpoint was local recurrence as determined on post-treatment CT scans along with the radiotherapy fields. Local recurrence was defined as intrathoracic in-field and marginal as opposed to out-of-field failures. Competing risk regressions were used to examine associations between CT features and recurrence. RESULTS The median follow-up was 51.5 months (range 2.4-111.2). Median overall survival was 25.6 months (95% CI: 20.4-30). At last follow-up, 72 (79.1%) patients had died, 48 (52.7%) had in-field recurrence, and 30 (32.9%) presented with out-of-field recurrence. On pre-treatment CT scans, tumors presenting as pulmonary consolidations (hazard ratio = 2.34, 95% CI: 1.05-5.22; p 0.038) were more likely to have in-field failure. Tumors with 50-100% necrosis (hazard ratio = 0.15, 95% CI: 0.02-1.06) were associated with decreased out-of-field failure (overall p = 0.038). However, these were rare features in our sample which limit the ability of these features to be associated with such outcomes. CONCLUSIONS Pre-treatment CT features alone are limited in predicting locoregional recurrence. Larger studies using quantitative tools are needed to predict such outcomes.
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Affiliation(s)
- Andrew J Plodkowski
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.
| | | | - Cameron D A Simmers
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Jeffrey Girshman
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Micheal Raj
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Junting Zheng
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Andreas Rimner
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Michelle S Ginsberg
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
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Hochmair MJ. Resistance to chemoimmunotherapy in non-small-cell lung cancer. CANCER DRUG RESISTANCE (ALHAMBRA, CALIF.) 2020; 3:445-453. [PMID: 35582443 PMCID: PMC8992480 DOI: 10.20517/cdr.2020.09] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 05/14/2020] [Accepted: 06/12/2020] [Indexed: 12/14/2022]
Abstract
Recent clinical trials evaluating the combination of chemotherapy with immune checkpoint inhibition for the primary treatment of lung cancer showed increased progression-free and overall survival compared with chemotherapy alone. However, the combination of these two modalities is less than additive and the mechanisms of resistance to this therapeutic intervention are discussed here. So far, the conventional biomarkers for immunotherapy, namely programmed death-ligand 1 expression or tumor mutational burden are poor predictors of the efficacy of immunochemotherapy, and the optimal sequence of chemotherapy and immunotherapy has yet to be defined.
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Cotarla I, Boron ML, Cullen SL, Spinner DS, Faulkner EC, Carroll MC, Shah S, Yagui-Beltran A. Treatment Decision Drivers in Stage III Non-Small-Cell Lung Cancer: Outcomes of a Web-Based Survey of Oncologists in the United States. JCO Oncol Pract 2020; 16:e1232-e1242. [PMID: 32552457 DOI: 10.1200/jop.19.00781] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
PURPOSE We conducted a cross-sectional survey of practicing medical oncologists in the United States to obtain insight into physician and patient treatment decision making in stage III non-small-cell lung cancer (NSCLC). METHODS A convenience sample of 150 oncologists completed a 38-question Web-based survey in January 2019. RESULTS Surveyed oncologists (82% community based) had an average of 15 years of clinical experience and had treated an average of 20 patients newly diagnosed with stage III NSCLC in the previous 6 months. Oncologists reported presenting 55% of their patients with stage III NSCLC to tumor boards. For patients with new unresectable stage III NSCLC seen in the previous 6 months, concurrent chemoradiation therapy (cCRT) was reported as the initial treatment in an average of 48% of patients. The most frequent reason for delays in starting the initial chosen treatment was insurance preauthorization processes (reported by 65% of oncologists). A total of 55% of all patients with unresectable stage III NSCLC who received cCRT went on to receive consolidation immunotherapy; for patients who received consolidation chemotherapy after cCRT, the rate of immunotherapy was lower (42%). Biomarker test results were given as the reason for oncologists not recommending immunotherapy after cCRT in approximately a quarter of cases. The 112 oncologists with eligible patients who declined immunotherapy reported previous treatment fatigue as the reason in 34% of patients and insurance challenges in 19% of patients. CONCLUSION Oncologists reported notable deviations from treatment guidelines for stage III NSCLC. Our findings highlight important opportunities to improve decision making and the coordination of care in stage III NSCLC.
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Phase II Study of Immunotherapy With Tecemotide and Bevacizumab After Chemoradiation in Patients With Unresectable Stage III Non-Squamous Non-Small-Cell Lung Cancer (NS-NSCLC): A Trial of the ECOG-ACRIN Cancer Research Group (E6508). Clin Lung Cancer 2020; 21:520-526. [PMID: 32807654 DOI: 10.1016/j.cllc.2020.06.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 05/19/2020] [Accepted: 06/04/2020] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Although chemoradiotherapy (CRT) is the standard of care for patients with unresectable stage III non-small-cell lung cancer (LA-NSCLC), most patients relapse. Tecemotide is a MUC1 antigen-specific cancer immunotherapy vaccine. Bevacizumab improves survival in advanced nonsquamous (NS)-NSCLC and has a role in immune modulation. This phase II trial tested the combination of tecemotide and bevacizumab following CRT in patients with LA-NSCLC. PATIENTS AND METHODS Subjects with stage III NS-NSCLC suitable for CRT received carboplatin/paclitaxel weekly + 66 Gy followed by 2 cycles of consolidation carboplatin/paclitaxel ≤ 4 weeks of completion of CRT (Step 1). Patients with partial response/stable disease after consolidation therapy were registered onto step 2, which was 6 weekly tecemotide injections followed by every 6 weekly injections and bevacizumab every 3 weeks for up to 34 doses. The primary endpoint was to determine the safety of this regimen. RESULTS Seventy patients were enrolled; 68 patients (median age, 63 years; 56% male; 57% stage IIIA) initiated therapy, but only 39 patients completed CRT and consolidation therapy per protocol, primarily owing to disease progression or toxicity. Thirty-three patients (median age, 61 years; 58% male; 61% stage IIIA) were registered to step 2 (tecemotide + bevacizumab). The median number of step 2 cycles received was 11 (range, 2-25). Step 2 worst toxicity included grade 3, N = 9; grade 4, N = 1; and grade 5, N = 1. Grade 5 toxicity in step 2 was esophageal perforation attributed to bevacizumab. Among the treated and eligible patients (n = 32) who were treated on step 2, the median overall survival was 42.7 months (95% confidence interval, 21.7-63.3 months), and the median progression-free survival was 14.9 months (95% confidence interval, 11.0-20.9 months) from step 1 registration. CONCLUSIONS This cooperative group trial met its endpoint, demonstrating tolerability of bevacizumab + tecemotide after CRT and consolidation. In this selected group of patients, the median progression-free survival and overall survival are encouraging. Given that consolidation immunotherapy is now a standard of care following CRT in patients with LA-NSCLC, these results support a role for continued investigation of antiangiogenic and immunotherapy combinations in LA-NSCLC.
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Jung HA, Sun JM, Lee SH, Ahn JS, Ahn MJ, Park K. Ten-year patient journey of stage III non-small cell lung cancer patients: A single-center, observational, retrospective study in Korea (Realtime autOmatically updated data warehOuse in healTh care; UNIVERSE-ROOT study). Lung Cancer 2020; 146:112-119. [PMID: 32526601 DOI: 10.1016/j.lungcan.2020.05.033] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 05/23/2020] [Accepted: 05/26/2020] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Until the recent approval of immunotherapy after completing concurrent chemoradiotherapy (CCRT), there has been little progress in treating unresectable stage III non-small cell lung cancer (NSCLC). This prompted us to search real-world data (RWD) to better understand diagnosis and treatment patterns, and outcomes. METHODS This non-interventional observational study used a unique, novel algorithm for big data analysis to collect and assess anonymized patient electronic medical records from a clinical data warehouse (CDW) over a 10-year period to capture real-world patterns of diagnosis, treatment, and outcomes of stage III NSCLC patients. We describe real-world patterns of diagnosis and treatment of patients with newly-diagnosed stage III NSCLC, and patients' characteristics, and assessment of treatment outcomes. RESULTS We analyzed clinical variables from 23,735 NSCLC patients. Stage III patients (N = 4138, 18.2 %) were diagnosed as IIIA (N = 2,547, 11.2 %) or IIIB (N = 1,591. 7.0 %). Treated stage III patients (N = 2530, 61.1 %) had a median age of 64.2 years, were mostly male (78.5 %) and had an ECOG performance status of 1 (65.2 %). Treatment comprised curative-intent surgery (N = 1,254, 49.6 %) with 705 receiving neoadjuvant therapy; definitive CRT (N = 648, 25.6 %); palliative CT (N = 270, 10.7 %), or thoracic RT (N = 170, 6.7 %). Median OS (range) for neoadjuvant, surgery, CRT, palliative chemotherapy, lung RT alone, and supportive care was 49.2 (42.0-56.5), 52.5 (43.1-61.9), 30.3 (26.6-34.0), 14.7 (13.0-16.4), 8.8 (6.2-11.3), and 2.0 (1.0-3.0) months, respectively. CONCLUSIONS This unique in-house algorithm enabled a rapid and comprehensive analysis of big data through a CDW, with daily automatic updates that documented real-world PFS and OS consistent with the published literature, and real-world treatment patterns and clinical outcomes in stage III NSCLC patients.
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Affiliation(s)
- Hyun Ae Jung
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jong-Mu Sun
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Se-Hoon Lee
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jin Seok Ahn
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Myung-Ju Ahn
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Keunchil Park
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
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Stage III Non-small Cell Lung Cancer Management in England. Clin Oncol (R Coll Radiol) 2020; 31:688-696. [PMID: 31514942 DOI: 10.1016/j.clon.2019.07.020] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 07/03/2019] [Accepted: 07/26/2019] [Indexed: 12/13/2022]
Abstract
AIMS We present the first analysis of the management and outcomes of stage III non-small cell lung cancer (NSCLC) conducted in England using National Lung Cancer Audit data. MATERIALS AND METHODS Patients diagnosed with stage III NSCLC in 2016 were identified. Linked datasets (including Hospital Episode Statistics, the National Radiotherapy Dataset, the Systemic Anti-Cancer Dataset, pathology reports and death certificate data) were used to categorise the treatment received. Kaplan-Meier survival curves were obtained, with survival defined from the date of diagnosis to the date of death. RESULTS In total, 6276 cases of stage III NSCLC were analysed: 3827 stage IIIA and 2449 stage IIIB; 1047 (17%) patients were treated with radical radiotherapy with 676 (11%) of these also receiving chemotherapy. Twenty per cent of patients with stage IIIA disease underwent surgery, with half of these also receiving chemotherapy, predominantly delivered in the adjuvant setting. Of note, 2148 (34%) patients received palliative-intent treatment and 2265 (36%) received no active anti-cancer treatment. The 1-year survival was 32.9% (37.4% for stage IIIA), with the highest survival seen for those patients receiving chemotherapy and surgery. CONCLUSIONS We highlight important gaps in the optimal care of patients with stage III NSCLC in England. Multimodality treatment with either surgery or radical radiotherapy combined with chemotherapy was delivered to less than one-fifth of patients, even though these regimens are considered optimal. Timely access to specialist resources and staff, the practice of effective shared decision making and challenging preconceptions have the potential to optimise management.
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Zhang M, Sun L, Ru Y, Zhang S, Miao J, Guo P, Lv J, Guo F, Liu B. A risk score system based on DNA methylation levels and a nomogram survival model for lung squamous cell carcinoma. Int J Mol Med 2020; 46:252-264. [PMID: 32377703 PMCID: PMC7255475 DOI: 10.3892/ijmm.2020.4590] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Accepted: 01/30/2020] [Indexed: 12/20/2022] Open
Abstract
Lung squamous cell carcinoma (LSCC) is one of the primary types of non-small cell lung carcinoma, and patients with recurrent LSCC usually have a poor prognosis. The present study was conducted to build a risk score (RS) system for LSCC. Methylation data on LSCC (training set) and on head and neck squamous cell carcinoma (validation set 2) were obtained from The Cancer Genome Atlas database, and GSE39279 (validation set 1) was retrieved from the Gene Expression Omnibus database. Differentially methylated protein-coding genes (DMGs)/long non-coding RNAs (DM-lncRNAs) between recurrence-associated samples and nonrecurrence samples were screened out using the limma package, and their correlation analysis was conducted using the cor.test() function. Following identification of the optimal combinations of DMGs or DM-lncRNAs using the penalized package in R, RS systems were built, and the system with optimal performance was selected. Using the rms package, a nomogram survival model was then constructed. For the differentially expressed genes (DEGs) between the high- and low-risk groups, pathway enrichment analysis was performed by Gene Set Enrichment Analysis. There were 335 DMGs and DM-lncRNAs in total. Following screening out of the top 10 genes (aldehyde dehydrogenase 7 family member A1, chromosome 8 open reading frame 48, cytokine-like 1, heat shock protein 90 alpha family class A member 1, isovaleryl-CoA dehydrogenase, phosphodiesterase 3A, PNMA family member 2, SAM domain, SH3 domain and nuclear localization signals 1, thyroid hormone receptor interactor 13 and zinc finger protein 878) and 6 top lncRNAs, RS systems were constructed. According to Kaplan-Meier analysis, the DNA methylation level-based RS system exhibited the best performance. In combination with independent clinical prognostic factors, a nomogram survival model was built and successfully predicted patient survival. Furthermore, 820 DEGs between the high- and low-risk groups were identified, and 3 pathways were identified to be enriched in this gene set. The 10-DMG methylation level-based RS system and the nomogram survival model may be applied for predicting the outcomes of patients with LSCC.
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Affiliation(s)
- Ming Zhang
- Department of Oncology, The Affiliated Suzhou Municipal Hospital of Nanjing Medical University, Suzhou, Jiangsu 215001, P.R. China
| | - Libing Sun
- Department of Oncology, The Affiliated Suzhou Municipal Hospital of Nanjing Medical University, Suzhou, Jiangsu 215001, P.R. China
| | - Yi Ru
- Department of Oncology, The Affiliated Suzhou Municipal Hospital of Nanjing Medical University, Suzhou, Jiangsu 215001, P.R. China
| | - Shasha Zhang
- Department of Oncology, The Affiliated Suzhou Municipal Hospital of Nanjing Medical University, Suzhou, Jiangsu 215001, P.R. China
| | - Junjun Miao
- Department of Oncology, The Affiliated Suzhou Municipal Hospital of Nanjing Medical University, Suzhou, Jiangsu 215001, P.R. China
| | - Pengda Guo
- Department of Oncology, The Affiliated Suzhou Municipal Hospital of Nanjing Medical University, Suzhou, Jiangsu 215001, P.R. China
| | - Jinghuan Lv
- Department of Oncology, The Affiliated Suzhou Municipal Hospital of Nanjing Medical University, Suzhou, Jiangsu 215001, P.R. China
| | - Feng Guo
- Department of Oncology, The Affiliated Suzhou Municipal Hospital of Nanjing Medical University, Suzhou, Jiangsu 215001, P.R. China
| | - Biao Liu
- Department of Oncology, The Affiliated Suzhou Municipal Hospital of Nanjing Medical University, Suzhou, Jiangsu 215001, P.R. China
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Cost-effectiveness and Net Monetary Benefit of Durvalumab Consolidation Therapy Versus No Consolidation Therapy After Chemoradiotherapy in Stage III Non-small Cell Lung Cancer in the Italian National Health Service. Clin Ther 2020; 42:830-847. [PMID: 32354495 DOI: 10.1016/j.clinthera.2020.03.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 03/15/2020] [Accepted: 03/22/2020] [Indexed: 12/13/2022]
Abstract
PURPOSE The aim of this study was to evaluate the cost-effectiveness and net monetary benefit of durvalumab consolidation therapy compared with no consolidation therapy after chemoradiotherapy in patients with stage III non-small cell lung cancer with programmed cell death 1 ligand 1 expression ≥1% from the Italian National Health Service perspective. METHODS We developed a 12-month decision tree combined with a lifetime cohort Markov model in which patients were assigned to receive durvalumab consolidation therapy or active follow-up (Italian standard of care) after chemoradiotherapy to compare cost-effectiveness and net monetary benefit of the two strategies during a 40-year period. Clinical outcomes data were obtained from the respective clinical trials and extrapolated using survival analysis; cost data were derived from Italian official sources and relevant real-world studies. The incremental cost-effectiveness ratio, incremental cost-utility ratio, and incremental net monetary benefit were computed and compared against a 16,372 € per quality-adjusted life-year (QALY) willingness-to-pay threshold. We performed deterministic sensitivity analysis and probabilistic sensitivity analysis to assess how uncertainty affected results; we also performed scenario analyses to compare results under different pricing settings. FINDINGS In the base-case scenario, during a 40-year period, the total costs for patients treated with durvalumab consolidation therapy and active follow-up were €59,860 and €49,840 respectively; life-years gained were 3.47 and 3.31, respectively; and QALYs gained were 2.73 and 2.50, respectively, with an incremental cost-effectiveness ratio of €62,131 per life-year, an incremental cost-utility ratio of €42,322 per QALY, and an incremental net monetary benefit of €-6,144. We found that durvalumab was cost-effective (incremental net monetary benefit = 0) when a discount of 13% and 30% on its official price was applied, considering all other drugs priced according to official or maximum selling prices, respectively. Results were most sensitive to the progression-free survival rate for durvalumab and active follow-up, health utility in progression-free state, and price of subsequent treatments. IMPLICATIONS Our analysis indicates that durvalumab consolidation is cost-effective when a discount is applied on its official price. These results suggest that durvalumab may deliver an incremental health benefit with a contained upfront cost during a 40-year period, from the Italian National Health Service perspective, providing added value in a potentially curative care setting.
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Bobbili P, Ryan K, DerSarkissian M, Dua A, Yee C, Duh MS, Gomez JE. Predictors of chemoradiotherapy versus single modality therapy and overall survival among patients with unresectable, stage III non-small cell lung cancer. PLoS One 2020; 15:e0230444. [PMID: 32187231 PMCID: PMC7080248 DOI: 10.1371/journal.pone.0230444] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 02/29/2020] [Indexed: 12/25/2022] Open
Abstract
Introduction Concurrent chemoradiotherapy (cCRT) was the standard of care for patients with unresectable stage III non-small cell lung cancer (NSCLC) prior to the PACIFIC trial, however, patients also received single modality therapy. This study identified predictors of therapy and differences in overall survival (OS). Methods This retrospective study included stage III NSCLC patients aged ≥65 years, with ≥1 claim for systemic therapy (ST) or radiotherapy (RT) within 90 days of diagnosis, identified in SEER-Medicare data (2009–2014). Patients who had overlapping claims for chemotherapy and RT ≤90 days from start of therapy were classified as having received cCRT. Patients who received sequential CRT or surgical resection of tumor were excluded. Predictors of cCRT were analyzed using logistic regression. OS was compared between therapies using adjusted Cox proportional hazards models. Results Of 3,799 patients identified, 21.7% received ST; 26.3% received RT; and 52.0% received cCRT. cCRT patients tended to be younger (p <0.001), White (p = 0.002), and have a good predicted performance status (p<0.001). Patients who saw all three specialist types (medical oncologist, radiation oncologist, and surgeon) had increased odds of receiving cCRT (p<0.001). ST and RT patients had higher mortality risk versus cCRT patients (hazard ratio [95% CI]: ST: 1.38 [1.26–1.51]; RT: 1.75 [1.61, 1.91]); p<0.001). Conclusions Several factors contributed to treatment selection, including patient age and health status, and whether the patient received multidisciplinary care. Given the survival benefit of receiving cCRT over single-modality therapy, physicians should discuss treatment within a multidisciplinary team, and be encouraged to pursue cCRT for patients with unresectable stage III NSCLC.
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Affiliation(s)
- Priyanka Bobbili
- Analysis Group, Inc., Boston, Massachusetts, United States of America
- * E-mail:
| | - Kellie Ryan
- AstraZeneca, Gaithersburg, Maryland, United States of America
| | | | - Akanksha Dua
- Analysis Group, Inc., Boston, Massachusetts, United States of America
| | - Christopher Yee
- Analysis Group, Inc., Boston, Massachusetts, United States of America
| | - Mei Sheng Duh
- Analysis Group, Inc., Boston, Massachusetts, United States of America
| | - Jorge E. Gomez
- Icahn School of Medicine at Mt. Sinai, New York, New York, United States of America
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Naidoo J, Nishino M, Patel SP, Shankar B, Rekhtman N, Illei P, Camus P. Immune-Related Pneumonitis After Chemoradiotherapy and Subsequent Immune Checkpoint Blockade in Unresectable Stage III Non-Small-Cell Lung Cancer. Clin Lung Cancer 2020; 21:e435-e444. [PMID: 32576443 DOI: 10.1016/j.cllc.2020.02.025] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 02/06/2020] [Accepted: 02/29/2020] [Indexed: 12/28/2022]
Abstract
Approximately one third of patients with non-small-cell lung cancer (NSCLC) present with stage III or locally advanced NSCLC. These patients have historically been managed with chemoradiotherapy. However, outcomes for these patients remain poor, with a 5-year survival rate between 15% and 32%. Immune checkpoint inhibitors have revolutionized the treatment of patients with NSCLC. One such agent, durvalumab, a selective high-affinity human immunoglobulin G1 monoclonal antibody that blocks programmed cell death ligand 1 binding to programmed cell death protein 1 and cluster of differentiation 80, was recently approved in the consolidation setting after completion of definitive platinum-based chemoradiotherapy and has become the current standard of care for patients with stage III locally advanced NSCLC. Immune checkpoint blockade is associated with increased risk of immunotherapy-related adverse events, which can be managed most effectively when detected early, ideally in the context of a multidisciplinary approach. Pneumonitis represents the potentially most severe and life-threatening of all reported immunotherapy-related adverse events, but it is further complicated in the context of recent prior therapies also known to cause pulmonary toxicity, such as radiotherapy. However, there are major gaps in our ability to identify immunotherapy-related pneumonitis and distinguish it from radiation pneumonitis. This review aims to define the key steps in the detection, diagnosis, and treatment of immunotherapy-related pneumonitis.
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Affiliation(s)
- Jarushka Naidoo
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, MD, USA; Bloomberg-Kimmel Institute for Cancer Immunotherapy at Johns Hopkins University, Baltimore, MD, USA.
| | - Mizuki Nishino
- Department of Radiology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, MA, USA
| | - Sandip Pravin Patel
- Division of Hematology/Oncology, Department of Medicine, University of California San Diego, Moores Cancer Center, La Jolla, CA, USA
| | - Bairavi Shankar
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, MD, USA
| | - Natasha Rekhtman
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Peter Illei
- Department of Pathology and Oncology, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, MD, USA
| | - Phillipe Camus
- Department of Pulmonary Medicine and Critical Care, Centre Hospitalier et Université de Bourgogne, Dijon, France
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Takehara T, Tani T, Takiue H, Takeshita R, Iwamaru A, Yamamoto T, Koh H. Outcome of patients with lung cancer and severe psychiatric disorder admitted to a medical psychiatric unit. Mol Clin Oncol 2020; 12:273-277. [PMID: 32064106 DOI: 10.3892/mco.2020.1974] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 09/19/2019] [Indexed: 12/25/2022] Open
Abstract
The purpose of the present study was to evaluate the clinical profiles and treatment outcomes of patients with lung cancer admitted to the Medical Psychiatric Unit (MPU), which is built for patients with physical and severe psychiatric disorders. All medical records of patients with lung cancer admitted to the MPU of Tachikawa hospital were reviewed. The clinical outcomes of these patients were retrospectively evaluated between January 2010 and December 2016. A total of 24 patients in the MPU were histologically or cytologically diagnosed with primary lung cancer. Of these, 20 patients had schizophrenia, and 4 patients had a mood disorder. There were 15 patients who were diagnosed using bronchoscopy. The histology indicated adenocarcinoma, squamous cell carcinoma and non-small-cell lung cancer-not otherwise specified were in 11, 8, and 1 patient, respectively, while small-cell lung cancer was indicated in 4 patients. Surgery, chemoradiotherapy, radiotherapy, chemotherapy was performed in 13, 4, 2, 1 and 4 patients, respectively. The median survival time was 76.7 months for patients who underwent surgery, while it was 14.4 months for those who underwent chemoradiotherapy. In the MPU, patients with lung cancer and severe psychiatric disorders could be safely diagnosed, and patients with early-stage lung cancer exhibited long-term survival.
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Affiliation(s)
- Tomohiro Takehara
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo 190-8531, Japan.,Division of Pulmonary Medicine, Department of Internal Medicine, Federation of National Public Service Personnel Mutual Aid Associations, Tachikawa Hospital, Tokyo 190-8531, Japan
| | - Tetsuo Tani
- Division of Pulmonary Medicine, Department of Internal Medicine, Federation of National Public Service Personnel Mutual Aid Associations, Tachikawa Hospital, Tokyo 190-8531, Japan
| | - Hiroyuki Takiue
- Department of Neuropsychiatry, Federation of National Public Service Personnel Mutual Aid Associations, Tachikawa Hospital, Tokyo 190-8531, Japan
| | - Ryo Takeshita
- Division of Pulmonary Medicine, Department of Internal Medicine, Federation of National Public Service Personnel Mutual Aid Associations, Tachikawa Hospital, Tokyo 190-8531, Japan
| | - Arifumi Iwamaru
- Department of Surgery, Federation of National Public Service Personnel Mutual Aid Associations, Tachikawa Hospital, Tokyo 190-8531, Japan
| | - Tatsuya Yamamoto
- Department of Surgery, Federation of National Public Service Personnel Mutual Aid Associations, Tachikawa Hospital, Tokyo 190-8531, Japan
| | - Hidefumi Koh
- Division of Pulmonary Medicine, Department of Internal Medicine, Federation of National Public Service Personnel Mutual Aid Associations, Tachikawa Hospital, Tokyo 190-8531, Japan
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Rajaram R, Correa AM, Xu T, Nguyen QN, Antonoff MB, Rice D, Mehran R, Roth J, Walsh G, Swisher S, Hofstetter WL, Vaporciyan A, Cascone T, Tsao AS, Papadimitrakopoulou VA, Gandhi S, Liao Z, Sepesi B. Locoregional Control, Overall Survival, and Disease-Free Survival in Stage IIIA (N2) Non-Small-Cell Lung Cancer: Analysis of Resected and Unresected Patients. Clin Lung Cancer 2020; 21:e294-e301. [PMID: 32089476 DOI: 10.1016/j.cllc.2020.01.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 12/06/2019] [Accepted: 01/20/2020] [Indexed: 01/15/2023]
Abstract
INTRODUCTION The standard of care for stage IIIA (N2) non-small-cell lung cancer (NSCLC) includes concurrent definitive chemoradiation (dCRT) followed by durvalumab, thus challenging the role of surgery in resectable patients. We assessed locoregional disease control and survival in patients with surgically resected and unresected stage IIIA (N2) NSCLC disease. PATIENTS AND METHODS We conducted a retrospective analysis from prospectively collected databases at MD Anderson Cancer Center. Patients undergoing neoadjuvant chemotherapy and surgery or dCRT for clinical stage IIIA (N2) disease (2004-2014) were evaluated. Primary outcomes included locoregional disease control, disease-free survival (DFS), and overall survival (OS). Kaplan-Meier outcome analyses were performed. RESULTS Of the 159 resected patients, the majority had lobectomy (82.4%), followed by pneumonectomy (11.9%) and sublobar resection (5.7%). The 30- and 90-day mortality rates were 0.6% and 1.3%, respectively. At median follow-up of 52.8 months, recurrence was 55.3%, with 44.0% having distant and 15.1% locoregional recurrence. At 5 years, OS was 50.8% and DFS was 33.1% Median OS was 61.2 months. A total of 366 patients underwent dCRT, with intensity-modulated radiation in 64.5%, proton therapy in 26.0%, and 3-dimensional conformal radiotherapy in 9.6%. The mean dose was 68.1 Gy. At median follow-up of 20.8 months, recurrence was 53.6%, with distant and locoregional recurrence of 40.7% and 30.3%, respectively. At 5 years, OS was 29.2% and DFS was 20.5%. Median OS was 27.5 months. CONCLUSION Stage IIIA (N2) NSCLC continues to be a heterogeneous disease, and patients with surgically resected and unresected disease represent different risk populations. Ongoing immunotherapy trials may further redefine treatment algorithms in this complex patient population.
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Affiliation(s)
- Ravi Rajaram
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX.
| | - Arlene M Correa
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ting Xu
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Quynh-Nhu Nguyen
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Mara B Antonoff
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - David Rice
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Reza Mehran
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jack Roth
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Garrett Walsh
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Stephen Swisher
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Wayne L Hofstetter
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ara Vaporciyan
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Tina Cascone
- Department of Thoracic Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Anne S Tsao
- Department of Thoracic Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Saumil Gandhi
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Zhongxing Liao
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Boris Sepesi
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
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135
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Veronesi G, Novellis P, Voulaz E, Bruschini P. Robotic assisted lung resection for locally advanced lung cancer. Expert Rev Respir Med 2019; 14:121-124. [PMID: 31779503 DOI: 10.1080/17476348.2020.1697235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Giulia Veronesi
- Division of Thoracic and General Surgery, Humanitas Clinical and Research Center - IRCCS, Rozzano, Italy
| | - Pierluigi Novellis
- Division of Thoracic and General Surgery, Humanitas Clinical and Research Center - IRCCS, Rozzano, Italy
| | - Emanuele Voulaz
- Division of Thoracic and General Surgery, Humanitas Clinical and Research Center - IRCCS, Rozzano, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Pietro Bruschini
- Division of Thoracic and General Surgery, Humanitas Clinical and Research Center - IRCCS, Rozzano, Italy
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136
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Tan WL, Chua KLM, Lin CC, Lee VHF, Tho LM, Chan AW, Ho GF, Reungwetwattana T, Yang JC, Kim DW, Soo RA, Ahn YC, Onishi H, Ahn MJ, Mok TSK, Tan DSW, Yang F. Asian Thoracic Oncology Research Group Expert Consensus Statement on Optimal Management of Stage III NSCLC. J Thorac Oncol 2019; 15:324-343. [PMID: 31733357 DOI: 10.1016/j.jtho.2019.10.022] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 10/24/2019] [Accepted: 10/24/2019] [Indexed: 12/25/2022]
Abstract
Stage III NSCLC represents a heterogeneous disease for which optimal treatment continues to pose a clinical challenge. Recent changes in the American Joint Commission on Cancer staging to the eighth edition has led to a shift in TNM stage grouping and redefined the subcategories (IIIA-C) in stage III NSCLC for better prognostication. Although concurrent chemoradiotherapy has remained standard-of-care for stage III NSCLC for almost 2 decades, contemporary considerations include the impact of different molecular subsets of NSCLC, and the roles of tyrosine kinase inhibitors post-definitive therapy and of immune checkpoint inhibitors following chemoradiotherapy. With rapid evolution of diagnostic algorithms and expanding treatment options, the need for interdisciplinary input involving multiple specialists (medical oncologists, radiation oncologists, pulmonologists, radiologists, pathologists and thoracic surgeons) has become increasingly important. The unique demographics of Asian NSCLC pose further challenges when applying clinical trial data into clinical practice. This includes differences in smoking rates, prevalence of oncogenic driver mutations, and access to health care resources including molecular testing, prompting the need for critical review of existing data and identification of current gaps. In this expert consensus statement by the Asian Thoracic Oncology Research Group, an interdisciplinary group of experts representing Hong Kong, Korea, Japan, Taiwan, Singapore, Thailand, Malaysia, and Mainland China was convened. Standard clinical practices for stage III NSCLC across different Asian countries were discussed from initial diagnosis and staging through to multi-modality approaches including surgery, chemotherapy, radiation, targeted therapies, and immunotherapy.
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Affiliation(s)
- Wan Ling Tan
- Division of Medical Oncology, National Cancer Centre Singapore
| | - Kevin L M Chua
- Division of Radiation Oncology, National Cancer Centre Singapore
| | - Chia-Chi Lin
- Department of Oncology, National Taiwan University Hospital, Taipei City, Taiwan
| | - Victor H F Lee
- Department of Clinical Oncology, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Lye Mun Tho
- Clinical Oncology, Beacon Hospital, Petaling Jaya, Malaysia
| | - Anthony W Chan
- Department of Anatomical and Cellular Pathology, The Chinese University of Hong Kong, Hong Kong
| | - Gwo Fuang Ho
- Department of Clinical Oncology, University Malaya Medical Centre, Selangor, Malaysia
| | - Thanyanan Reungwetwattana
- Department of Internal Medicine, Division of Medical Oncology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - James C Yang
- Department of Oncology, National Taiwan University Hospital, Taipei City, Taiwan
| | - Dong-Wan Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Ross A Soo
- Department of Hematology Oncology, National University Hospital, Singapore
| | - Yong Chan Ahn
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hiroshi Onishi
- Department of Radiology, University of Yamanashi, Yamanashi, Japan
| | - Myung-Ju Ahn
- Department of Internal Medicine, Division of Medical Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Tony S K Mok
- Department of Clinical Oncology, State Key Laboratory of Translational Oncology, The Chinese University of Hong Kong, Hong Kong
| | - Daniel S W Tan
- Division of Medical Oncology, National Cancer Centre Singapore.
| | - Fan Yang
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing, China
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137
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Image-guided interstitial high-dose-rate brachytherapy for dose escalation in the radiotherapy treatment of locally advanced lung cancer: A single-institute experience. Brachytherapy 2019; 18:829-834. [DOI: 10.1016/j.brachy.2019.08.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 07/02/2019] [Accepted: 08/06/2019] [Indexed: 12/20/2022]
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138
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He C, Bai X, Li Y, Sun H, Kong X, Fu B, Chen L, Zhu K, Li P, Xu S. Runt-related transcription factor 1 contributes to lung cancer development by binding to tartrate-resistant acid phosphatase 5. Cell Cycle 2019; 18:3404-3419. [PMID: 31650885 DOI: 10.1080/15384101.2019.1678966] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Lung cancer (LC) is one of the malignant tumors with growing morbidity and mortality. The involvement of runt-related transcription factor 1 (RUNX1) in LC patients has been elucidated. We intended to research mechanisms of RUNX1 and tartrate-resistant acid phosphatase 5 (ACP5) in LC. Firstly, ACP5 levels in LC tissues, paracancerous tissues, LC cells and tracheal epithelial cells were detected. RUNX1 overexpression plasmid and interference plasmid were constructed and transfected into 95C cells and A549 cells, respectively. The binding of RUNX1 to ACP5 promoter was tested. Additionally, the gain- and loss-of-function were performed to explore the effects of ACP5 and RUNX1 on LC biological process. The xenograft tumor in nude mice was constructed in vivo to verify in vitro results. Functional rescue experiment was performed by adding MAPK-specific activator P79350 to A549 cells with si-ACP5 to measure the effects of ERK/MAPK axis on LC progression. Consequently, we found ACP5 expression was higher in LC tissues and cells, and ACP5 silencing suppressed LC cell growth. Overexpression of ACP5 promoted malignant biological behavior of LC cells. RUNX1 could bind to ACP5 promoter, and overexpressed RUNX1 promoted ACP5 expression and LC cell growth. Moreover, ACP5 upregulated the ERK/MAPK axis and thus promoted LC progression. The results of xenograft tumor in nude mice showed that silencing ACP5 could inhibit the growth of LC cells in vivo. To conclude, silenced RUNX1 inhibits LC progression through the ERK/MAPK axis by binding to ACP5. This study may provide new approaches for LC treatment.
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Affiliation(s)
- Changjun He
- Department of Thoracic Surgery, Harbin Medical University Cancer Hospital, Harbin, Heilongjiang, P.R. China
| | - Xue Bai
- Department of Thoracic Surgery, Harbin Medical University Cancer Hospital, Harbin, Heilongjiang, P.R. China
| | - Yingbin Li
- Department of Surgery, First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, P.R.China
| | - Haobo Sun
- Department of Thoracic Surgery, Harbin Medical University Cancer Hospital, Harbin, Heilongjiang, P.R. China
| | - Xianglong Kong
- Department of Thoracic Surgery, Harbin Medical University Cancer Hospital, Harbin, Heilongjiang, P.R. China
| | - Bicheng Fu
- Department of Thoracic Surgery, Harbin Medical University Cancer Hospital, Harbin, Heilongjiang, P.R. China
| | - Lantao Chen
- Department of Thoracic Surgery, Harbin Medical University Cancer Hospital, Harbin, Heilongjiang, P.R. China
| | - Kaibin Zhu
- Department of Thoracic Surgery, Harbin Medical University Cancer Hospital, Harbin, Heilongjiang, P.R. China
| | - Pengju Li
- Department of Thoracic Surgery, Harbin Medical University Cancer Hospital, Harbin, Heilongjiang, P.R. China
| | - Shidong Xu
- Department of Thoracic Surgery, Harbin Medical University Cancer Hospital, Harbin, Heilongjiang, P.R. China
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139
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Tsuchiya-Kawano Y, Sasaki T, Yamaguchi H, Hirano K, Horiike A, Satouchi M, Hosokawa S, Morinaga R, Komiya K, Inoue K, Fujita Y, Toyozawa R, Kimura T, Takahashi K, Nishikawa K, Kishimoto J, Nakanishi Y, Okamoto I. Updated Survival Data for a Phase I/II Study of Carboplatin plus Nab-Paclitaxel and Concurrent Radiotherapy in Patients with Locally Advanced Non-Small Cell Lung Cancer. Oncologist 2019; 25:475-e891. [PMID: 31649134 DOI: 10.1634/theoncologist.2019-0746] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Accepted: 09/30/2019] [Indexed: 12/21/2022] Open
Abstract
LESSONS LEARNED Updated survival data for a phase I/II study of carboplatin plus nab-paclitaxel and concurrent radiotherapy were collected. In the group of 58 patients who were enrolled at 14 institutions in Japan, the median overall survival was not reached and the 2-year overall survival rate was 66.1% (95% confidence interval, 52.1%-76.8%). Results reveal encouraging feasibility and activity for this regimen. BACKGROUND We report the updated survival data for a phase I/II study of carboplatin plus nab-paclitaxel (nab-P/C) and concurrent radiotherapy (CRT) in patients with locally advanced non-small cell lung cancer (NSCLC). METHODS Individuals between 20 and 74 years of age with unresectable NSCLC of stage IIIA or IIIB and a performance status of 0 or 1 were eligible for the study. Patients received weekly nab-paclitaxel at 50 mg/m2 for 6 weeks together with weekly carboplatin at an area under the curve (AUC) of 2 mg/ml/min and concurrent radiotherapy with 60 Gy in 30 fractions. This concurrent phase was followed by a consolidation phase consisting of two 3-week cycles of nab-paclitaxel (100 mg/m2 on days 1, 8, and 15) plus carboplatin (AUC of 6 on day 1). After the treatment, patients were observed off therapy. The primary endpoint of the phase II part of the study was progression-free survival (PFS). RESULTS Between October 2014 and November 2016, 58 patients were enrolled at 14 institutions in Japan, with 56 of these individuals being evaluable for treatment efficacy and safety. At the median follow-up time of 26.0 months (range, 4.0-49.6 months), the median overall survival (OS) was not reached (95% confidence interval [CI], 25.3 months to not reached) and the 2-year OS rate was 66.1% (95% CI, 52.1%-76.8%). The median PFS was 11.8 months (95% CI, 8.2-21.0 months), and the 2-year PFS rate was 35.9% (95% CI, 23.1%-48.9%). Subgroup analysis according to tumor histology or patient age revealed no differences in median PFS or OS. Long-term follow-up of toxicities did not identify new safety signals, and no treatment-related deaths occurred during the study period. CONCLUSION Concurrent chemoradiation with nab-P/C was safe and provided a long-term survival benefit for patients with locally advanced NSCLC.
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Affiliation(s)
- Yuko Tsuchiya-Kawano
- Department of Respiratory Medicine, Kitakyushu Municipal Medical Center, Kitakyushu, Japan
| | - Tomonari Sasaki
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hiroyuki Yamaguchi
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Katsuya Hirano
- Department of Respiratory Medicine, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | - Atsushi Horiike
- Department of Thoracic Medical Oncology, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Miyako Satouchi
- Department of Thoracic Oncology, Hyogo Cancer Center, Akashi, Japan
| | - Shinobu Hosokawa
- Department of Respiratory Medicine, Japanese Red Cross Okayama Hospital, Okayama, Japan
| | - Ryotaro Morinaga
- Department of Thoracic Medical Oncology, Oita Prefectural Hospital, Oita, Japan
| | - Kazutoshi Komiya
- Division of Hematology, Respiratory Medicine, and Oncology, Saga University Hospital, Saga, Japan
| | - Koji Inoue
- Department of Respiratory Medicine, Kitakyushu Municipal Medical Center, Kitakyushu, Japan
| | - Yuka Fujita
- Department of Respiratory Medicine, National Hospital Organization Asahikawa Medical Center, Asahikawa, Japan
| | - Ryo Toyozawa
- Department of Thoracic Oncology, National Kyushu Cancer Center, Fukuoka, Japan
| | - Tomoki Kimura
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, Seto, Japan
| | - Kosuke Takahashi
- Department of Respiratory Medicine, Anjo Kosei Hospital, Anjo, Japan
| | - Kazuo Nishikawa
- Department of Medical Oncology and Hematology, Oita University Faculty of Medicine, Oita, Japan
| | - Junji Kishimoto
- Center for Clinical and Translational Research, Kyushu University Hospital, Fukuoka, Japan
| | | | - Isamu Okamoto
- Research Institute for Diseases of the Chest, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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140
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Gray JE, Villegas A, Daniel D, Vicente D, Murakami S, Hui R, Kurata T, Chiappori A, Lee KH, Cho BC, Planchard D, Paz-Ares L, Faivre-Finn C, Vansteenkiste JF, Spigel DR, Wadsworth C, Taboada M, Dennis PA, Özgüroğlu M, Antonia SJ. Three-Year Overall Survival with Durvalumab after Chemoradiotherapy in Stage III NSCLC-Update from PACIFIC. J Thorac Oncol 2019; 15:288-293. [PMID: 31622733 PMCID: PMC7244187 DOI: 10.1016/j.jtho.2019.10.002] [Citation(s) in RCA: 288] [Impact Index Per Article: 57.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 09/24/2019] [Accepted: 10/02/2019] [Indexed: 12/24/2022]
Abstract
Introduction: In the phase 3 PACIFIC study of patients with unresectable stage III NSCLC without progression after chemoradiotherapy, durvalumab demonstrated significant improvements versus placebo in the primary end points of progression-free survival (hazard ratio [HR] = 0.52, 95% confidence interval [CI]: 0.42–65, p < 0.0001) and overall survival (OS) (HR = 0.68, 95% CI: 0.53–0.87, p = 0.00251), with manageable safety and no detrimental effect on patient-reported outcomes. Here, we report 3-year OS rates for all patients randomized in the PACIFIC study. Methods: Patients, stratified by age, sex, and smoking history, were randomized (2:1) to receive durvalumab, 10 mg/kg intravenously every 2 weeks, or placebo for up to 12 months. OS was analyzed by using a stratified log-rank test in the intention-to-treat population. Medians and rates at 12, 24, and 36 months were estimated by the Kaplan-Meier method. Results: As of January 31, 2019, 48.2% of patients had died (44.1% and 56.5% in the durvalumab and placebo groups, respectively). The median duration of follow-up was 33.3 months. The updated OS remained consistent with that previously reported (stratified HR = 0.69 [95% CI: 0.55– 0.86]); the median OS was not reached with durvalumab but was 29.1 months with placebo. The 12-, 24- and 36- month OS rates with durvalumab and placebo were 83.1% versus 74.6%, 66.3% versus 55.3%, and 57.0% versus 43.5%, respectively. All secondary outcomes examined showed improvements consistent with previous analyses. Conclusions: Updated OS data from PACIFIC, including 3-year survival rates, demonstrate the long-term clinical benefit with durvalumab after chemoradiotherapy and further establish the PACIFIC regimen as the standard of care in this population.
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Affiliation(s)
- Jhanelle E Gray
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.
| | | | - Davey Daniel
- Tennessee Oncology, Chattanooga, Tennessee; Sarah Cannon Research Institute, Nashville, Tennessee
| | | | | | - Rina Hui
- Westmead Hospital, Sydney, New South Wales, Australia; University of Sydney, Sydney, New South Wales, Australia
| | | | | | - Ki Hyeong Lee
- Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Byoung Chul Cho
- Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea
| | | | - Luis Paz-Ares
- University Hospital October 12, CiberOnc, Complutense University of Madrid, Madrid, Spain; National Cancer Research Center, Madrid, Spain
| | - Corinne Faivre-Finn
- The University of Manchester and The Christie National Health Service Foundation Trust, Manchester, United Kingdom
| | | | | | | | | | | | - Mustafa Özgüroğlu
- Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Istanbul, Turkey
| | - Scott J Antonia
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
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141
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Hui R, Özgüroğlu M, Villegas A, Daniel D, Vicente D, Murakami S, Yokoi T, Chiappori A, Lee KH, de Wit M, Cho BC, Gray JE, Rydén A, Viviers L, Poole L, Zhang Y, Dennis PA, Antonia SJ. Patient-reported outcomes with durvalumab after chemoradiotherapy in stage III, unresectable non-small-cell lung cancer (PACIFIC): a randomised, controlled, phase 3 study. Lancet Oncol 2019; 20:1670-1680. [PMID: 31601496 DOI: 10.1016/s1470-2045(19)30519-4] [Citation(s) in RCA: 111] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 06/20/2019] [Accepted: 06/21/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND In the ongoing, phase 3 PACIFIC trial, durvalumab improved the primary endpoints of progression-free survival and overall survival compared with that for placebo, with similar safety, in patients with unresectable, stage III non-small-cell lung cancer. In this analysis, we aimed to evaluate one of the secondary endpoints, patient-reported outcomes (PROs). METHODS PACIFIC is an ongoing, international, multicentre, double-blind, randomised, controlled, phase 3 trial. Eligible patients were aged at least 18 years, had a WHO performance status of 0 or 1, with histologically or cytologically documented stage III, unresectable non-small-cell lung cancer, for which they had received at least two cycles of platinum-based chemoradiotherapy, with no disease progression after this treatment. We randomly assigned patients (2:1) using an interactive voice response system and a blocked design (block size=3) stratified by age, sex, and smoking history to receive 10 mg/kg intravenous durvalumab or matching placebo 1-42 days after concurrent chemoradiotherapy, then every 2 weeks up to 12 months. The primary endpoints of progression-free survival and overall survival have been reported previously. PROs were a prespecified secondary outcome. We assessed PRO symptoms, functioning, and global health status or quality of life in the intention-to-treat population with the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire-Core 30 (QLQ-C30) version 3 and its lung cancer module, the Quality of Life Questionnaire-Lung Cancer 13 (QLQ-LC13) at the time of random allocation to groups, at weeks 4 and 8, every 8 weeks until week 48, and then every 12 weeks until progression. Changes from baseline to 12 month in key symptoms were analysed with mixed model for repeated measures (MMRM) and time-to-event analyses. A 10-point or greater change from baseline (deterioration or improvement) was deemed clinically relevant. This study is registered with ClinicalTrials.gov, NCT02125461, and EudraCT, 2014-000336-42. FINDINGS Between May 9, 2014, and April 22, 2016, 476 patients were assigned to receive durvalumab, and 237 patients were assigned to receive placebo. As of March 22, 2018, the median follow-up was 25·2 months (IQR 14·1-29·5). More than 79% of patients given durvalumab and more than 82% of patients given placebo completed questionnaires up to week 48. Between baseline and 12 months, the prespecified longitudinal PROs of interest, cough (MMRM-adjusted mean change 1·8 [95% CI 0·06 to 3·54] in the durvalumab group vs 0·7 [-1·91 to 3·30] in the placebo group), dyspnoea (3·1 [1·75 to 4·36] vs 1·4 [-0·51 to 3·34]), chest pain (-3·1 [-4·57 to -1·60] vs -3·5 [-5·68 to -1·29]), fatigue (-3·0 [-4·53 to -1·50] vs -5·2 [-7·45 to -2·98]), appetite loss (-5·8 [-7·28 to -4·36] vs -7·0 [-9·17 to -4·87]), physical functioning (0·1 [-1·10 to 1·28] vs 2·0 [0·22 to 3·73]), and global health status or quality of life (2·6 [1·21 to 3·94] vs 1·8 [-0·25 to 3·81]) remained stable with both treatments, with no clinically relevant changes from baseline. The between-group differences in changes from baseline to 12 months in cough (difference in adjusted mean changes 1·1, 95% CI -1·89 to 4·11), dyspnoea (1·6, -0·58 to 3·87), chest pain (0·4, -2·13 to 2·93), fatigue (2·2, -0·38 to 4·78), appetite loss (1·2, -1·27 to 3·67), physical functioning (-1·9, -3·91 to 0·15), or global health status or quality of life (0·8, -1·55 to 3·14) were not clinically relevant. Generally, there were no clinically important between-group differences in time to deterioration of prespecified key PRO endpoints. INTERPRETATION Our findings suggest that a clinical benefit with durvalumab can be attained without compromising PROs. This result is of note because the previous standard of care was observation alone, with no presumed detriment to PROs. FUNDING AstraZeneca.
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Affiliation(s)
- Rina Hui
- Department of Medical Oncology, Westmead Hospital and the University of Sydney, Sydney, NSW, Australia.
| | - Mustafa Özgüroğlu
- Division of Medical Oncology, Department of Internal Medicine, Cerrahpaşa School of Medicine, Istanbul University Cerrahpaşa, Istanbul, Turkey
| | | | - Davey Daniel
- Sarah Cannon Research Institute, Nashville and Tennessee Oncology, Chattanooga, TN, USA
| | - David Vicente
- Department of Medical Oncology, Hospital Universitario Virgen Macarena, Seville, Spain
| | - Shuji Murakami
- Department of Thoracic Oncology, Kanagawa Cancer Centre, Kanagawa, Japan
| | - Takashi Yokoi
- Department of Thoracic Oncology, Kansai Medical University Hospital, Hirakata, Japan
| | - Alberto Chiappori
- Thoracic Oncology Program, H Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Ki Hyeong Lee
- Department of Internal Medicine, College of Medicine, Chungbuk National University Hospital, Cheongju, Korea
| | - Maike de Wit
- Department of Internal Medicine-Hematology, Oncology and Palliative Medicine, Vivantes Klinikum Neukölln, Berlin, Germany
| | - Byoung Chul Cho
- Department of Internal Medicine, Yonsei Cancer Centre, Yonsei University College of Medicine, Seoul, South Korea
| | - Jhanelle E Gray
- Thoracic Oncology Program, H Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | | | | | | | | | | | - Scott J Antonia
- Thoracic Oncology Program, H Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
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142
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Bobbili P, Ryan K, Duh MS, Dua A, Fernandes AW, Pavilack M, Gomez JE. Treatment patterns and overall survival among patients with unresectable, stage III non-small-cell lung cancer. Future Oncol 2019; 15:3381-3393. [PMID: 31544510 DOI: 10.2217/fon-2019-0282] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Aim: To analyze treatment patterns and overall survival (OS) across time (2009-2014) among patients with unresected, stage III non-small-cell lung cancer (NSCLC). Patients & methods: Stage III NSCLC patients aged ≥65 years who initiated therapy were identified using SEER-Medicare data. Results: Among 4564 patients, 84% received chemotherapy (with or without radiotherapy), and 59% received chemoradiotherapy (CRT). Carboplatin + paclitaxel was the most frequent regimen. Median (interquartile range) OS among chemotherapy patients was 13.2 (6.0-28.9) months, and 14.8 (6.7-33.4) months among CRT patients. Among CRT patients, there was no difference in OS across years of CRT initiation. Conclusion: OS remained static across 2009-2014, indicating stagnancy in clinical outcomes for stage III NSCLC patients and a need for more effective therapeutic options.
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Affiliation(s)
| | - Kellie Ryan
- US Medical Affairs, AstraZeneca, Gaithersburg, MD 20878, USA
| | - Mei S Duh
- Analysis Group, Inc., Boston, MA 02199, USA
| | | | | | | | - Jorge E Gomez
- Icahn School of Medicine at Mt Sinai, New York, NY 10029, USA
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143
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Amino Y, Kitazono S, Uematsu S, Hasegawa T, Yoshizawa T, Uchibori K, Yanagitani N, Horiike A, Horai T, Kasahara K, Nishio M. Efficacy of anti-PD-1 therapy for recurrence after chemoradiotherapy in locally advanced NSC LC. Int J Clin Oncol 2019; 25:67-73. [PMID: 31506751 DOI: 10.1007/s10147-019-01537-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 08/28/2019] [Indexed: 12/19/2022]
Abstract
PURPOSE Chemoradiotherapy (CRT) is the standard treatment for locally advanced non-small cell lung cancer (NSCLC). Recently, anti-PD-1 antibody therapy became a key treatment for stage IV NSCLC as the combination of immune checkpoint inhibitors (ICIs) and platinum doublet chemotherapy. However, the efficacy and toxicity of anti-PD-1 therapy for recurrence after CRT in stage III NSCLC are not well examined. METHODS Patients who received anti-PD-1 therapy for recurrence after CRT were identified in our clinical database. The safety and efficacy of anti-PD-1 therapy were retrospectively analyzed. RESULTS From March 1, 2013 to April 30, 2018, there were 20 patients who received anti-PD-1 therapy for recurrence after CRT. The median duration from CRT to initial anti-PD-1 therapy was 9.3 months. 12 patients (60%) were alive and 7 patients (35%) were still receiving anti-PD-1 therapy at the data cutoff point (median follow-up, 13.5 months). The ORR for anti-PD-1 therapy was 45.0%. Median progression-free survival (PFS) and overall survival (OS) from initiation of anti-PD-1 therapy was 8.4 months and 26.2 months, respectively. PFS in patients who had a short interval from last CRT to initial anti-PD-1 therapy seemed to have better outcomes (duration from last CRT to initial anti-PD-1 therapy < 9.3 months vs. ≥ 9.3 months; median PFS, 17.0 months vs. 4.9 months). Grade 3 or 4 immune-related adverse events occurred in 5% of patients. Only grade 1 pneumonitis was observed. CONCLUSION The efficacy of anti-PD-1 therapy for recurrence after CRT in stage III NSCLC might better than in stage IV NSCLC. The duration from CRT to initial anti-PD-1 therapy might be related to efficacy.
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Affiliation(s)
- Yoshiaki Amino
- Department of Thoracic Medical Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Ariake 3-8-31, Koto, Tokyo, 1358550, Japan.
| | - Satoru Kitazono
- Department of Thoracic Medical Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Ariake 3-8-31, Koto, Tokyo, 1358550, Japan
| | - Shinya Uematsu
- Department of Thoracic Medical Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Ariake 3-8-31, Koto, Tokyo, 1358550, Japan
| | - Tsukasa Hasegawa
- Department of Thoracic Medical Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Ariake 3-8-31, Koto, Tokyo, 1358550, Japan
| | - Takahiro Yoshizawa
- Department of Thoracic Medical Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Ariake 3-8-31, Koto, Tokyo, 1358550, Japan
| | - Ken Uchibori
- Department of Thoracic Medical Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Ariake 3-8-31, Koto, Tokyo, 1358550, Japan
| | - Noriko Yanagitani
- Department of Thoracic Medical Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Ariake 3-8-31, Koto, Tokyo, 1358550, Japan
| | - Atsushi Horiike
- Department of Thoracic Medical Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Ariake 3-8-31, Koto, Tokyo, 1358550, Japan
| | - Takeshi Horai
- Department of Thoracic Medical Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Ariake 3-8-31, Koto, Tokyo, 1358550, Japan
| | - Kazuo Kasahara
- Hematology/Respiratory Medicine, Kanazawa University Faculty of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa, Ishikawa, Japan
| | - Makoto Nishio
- Department of Thoracic Medical Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Ariake 3-8-31, Koto, Tokyo, 1358550, Japan
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144
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Khorrami M, Jain P, Bera K, Alilou M, Thawani R, Patil P, Ahmad U, Murthy S, Stephans K, Fu P, Velcheti V, Madabhushi A. Predicting pathologic response to neoadjuvant chemoradiation in resectable stage III non-small cell lung cancer patients using computed tomography radiomic features. Lung Cancer 2019; 135:1-9. [PMID: 31446979 PMCID: PMC6711393 DOI: 10.1016/j.lungcan.2019.06.020] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 05/08/2019] [Accepted: 06/23/2019] [Indexed: 12/25/2022]
Abstract
OBJECTIVE The use of a neoadjuvant chemoradiation followed by surgery in patients with stage IIIA NSCLC is controversial and the benefit of surgery is limited. There are currently no clinically validated biomarkers to select patients for such an approach. In this study we evaluate computed tomography (CT) derived intratumoral and peritumoral texture and nodule shape features in their ability to predict major pathological response (MPR). MPR being defined as ≤10% of residual viable tumor, assessed at the time of surgery. MATERIAL AND METHODS Ninety patients with stage III NSCLC treated with chemoradiation prior to surgical resection were selected. The patients were divided randomly into two equal sets, one for training and one for independent testing. The radiomic texture and shape features were extracted from within the nodule (intra) and from the parenchymal regions immediately surrounding the nodule (peritumoral). A univariate regression analysis was performed on the image and clinicopathologic variables and then included into a multivariable logistic regression (MLR) for binary outcome prediction of MPR. The radiomic signature risk-score was generated by using a multivariate Cox regression model and association of the signature with OS and DFS was also evaluated. RESULTS Thirteen stable and predictive intratumoral and peritumoral radiomic texture features were found to be predictive of MPR. The MLR classifier yielded an AUC of 0.90 ± 0.025 within the training set and a corresponding AUC = 0.86 in prediction of MPR within the test set. The radiomic signature was also significantly associated with OS (HR = 11.18, 95% CI = 3.17, 44.1; p-value = 0.008) and DFS (HR = 2.78, 95% CI = 1.11, 4.12; p-value = 0.0042) in the testing set. CONCLUSION Texture features extracted within and around the lung tumor on CT images appears to be associated with the likelihood of MPR, OS and DFS to chemoradiation.
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Affiliation(s)
- Mohammadhadi Khorrami
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - Prantesh Jain
- Department of Hematology/Oncology, University Hospitals Seidman Cancer Center, Case Comprehensive Cancer Center, Cleveland, OH, USA
| | - Kaustav Bera
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - Mehdi Alilou
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - Rajat Thawani
- Maimonides Medical Center, 4802 10th Ave, Brooklyn, NY 11219, USA
| | - Pradnya Patil
- Department of Solid Tumor Oncology, Cleveland Clinic, Cleveland, OH, USA
| | - Usman Ahmad
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Sudish Murthy
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Kevin Stephans
- Department of Radiation Oncology, Cleveland Clinic, Cleveland, OH, USA
| | - Pinfu Fu
- Department of Population and Quantitative Health Sciences, CWRU, Cleveland, OH, USA
| | - Vamsidhar Velcheti
- Department of Hematology and Oncology, NYU Langone Health, New York, NY, USA
| | - Anant Madabhushi
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA; Louis Stokes Cleveland Veterans Administration Medical Center, OH, USA.
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145
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TIMP-1-Mediated Chemoresistance via Induction of IL-6 in NSCLC. Cancers (Basel) 2019; 11:cancers11081184. [PMID: 31443242 PMCID: PMC6721590 DOI: 10.3390/cancers11081184] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 08/05/2019] [Accepted: 08/11/2019] [Indexed: 01/28/2023] Open
Abstract
Elevated tissue inhibitor of metalloproteinase-1 (TIMP-1) is a negative prognosticator in non-small cell lung carcinoma NSCLC patients. This study sought to identify mechanisms whereby TIMP-1 impacts anticancer therapy. Using NSCLC cells and their TIMP-1 knockdown clones, we examined the chemoresistance against two chemotherapeutic agents, Gemcitabine and Cisplatin, as identified by increased apoptosis in the knockdown clones. A bead-based cytokine screening assay identified interleukin-6 (IL-6) as a key factor in chemoresistance. Exogenous human recombinant rhTIMP-1 or rhIL-6 resulted in reduced apoptosis. IL-6 expression was closely correlated with TIMP-1 kinetics and was upregulated by the addition of exogenous TIMP-1 while TIMP-1 neutralizing antibodies delayed IL-6 elevation. IL-6 production was regulated by TIMP-1, exerting its effect via activation of downstream signal transducer and activator of transcription 3 (STAT3) signaling. Both molecules and their documented transcription factors were upregulated and activated in chemoresistant NSCLC cells, confirming the roles of TIMP-1 and IL-6 in chemoresistance. To examine the role of these genes in patients, survival data from lung adenocarcinoma (LUAD) patients was curated from the cancer genome atlas (TCGA) database. Kaplan-Meier analysis found that individuals expressing low TIMP-1 and IL-6 have a higher survival rate and that the two-gene signature was more significant than the single-gene status. We define for the first time, a regulatory relationship between TIMP-1 and IL-6 in NSCLCs, suggesting that the TIMP-1/IL6 axis may be a valuable prognostic biomarker. Therapeutic interventions directed at this dual target may improve overall prognosis while negatively affecting the development of chemoresistance in NSCLC.
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146
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Duma N, Santana-Davila R, Molina JR. Non-Small Cell Lung Cancer: Epidemiology, Screening, Diagnosis, and Treatment. Mayo Clin Proc 2019; 94:1623-1640. [PMID: 31378236 DOI: 10.1016/j.mayocp.2019.01.013] [Citation(s) in RCA: 1148] [Impact Index Per Article: 229.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 01/04/2019] [Accepted: 01/21/2019] [Indexed: 02/08/2023]
Abstract
Lung cancer remains the leading cause of cancer deaths in the United States. In the past decade, significant advances have been made in the science of non-small cell lung cancer (NSCLC). Screening has been introduced with the goal of early detection. The National Lung Screening Trial found a lung cancer mortality benefit of 20% and a 6.7% decrease in all-cause mortality with the use of low-dose chest computed tomography in high-risk individuals. The treatment of lung cancer has also evolved with the introduction of several lines of tyrosine kinase inhibitors in patients with EGFR, ALK, ROS1, and NTRK mutations. Similarly, immune checkpoint inhibitors (ICIs) have dramatically changed the landscape of NSCLC treatment. Furthermore, the results of new trials continue to help us understand the role of these novel agents and which patients are more likely to benefit; ICIs are now part of the first-line NSCLC treatment armamentarium as monotherapy, combined with chemotherapy, or after definite chemoradiotherapy in patients with stage III unresectable NSCLC. Expression of programmed cell death protein-ligand 1 in malignant cells has been studied as a potential biomarker for response to ICIs. However, important drawbacks exist that limit its discriminatory potential. Identification of accurate predictive biomarkers beyond programmed cell death protein-ligand 1 expression remains essential to select the most appropriate candidates for ICI therapy. Many questions remain unanswered regarding the proper sequence and combinations of these new agents; however, the field is moving rapidly, and the overall direction is optimistic.
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Affiliation(s)
- Narjust Duma
- Division of Medical Oncology, Mayo Clinic, Rochester, MN
| | - Rafael Santana-Davila
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle
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147
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Veronesi G, Park B, Cerfolio R, Dylewski M, Toker A, Fontaine JP, Hanna WC, Morenghi E, Novellis P, Velez-Cubian FO, Amaral MH, Dieci E, Alloisio M, Toloza EM. Robotic resection of Stage III lung cancer: an international retrospective study. Eur J Cardiothorac Surg 2019; 54:912-919. [PMID: 29718155 DOI: 10.1093/ejcts/ezy166] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 03/25/2018] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Minimally invasive surgery is accepted for early-stage lung cancer, but its role in locally advanced disease is controversial, especially using a robotic platform. The aim of this retrospective study was to assess the safety and effectiveness of robot-assisted resection in patients with Stage IIIA non-small-cell lung cancer (NSCLC) or carcinoid tumours in the series as a whole and in different subgroups according to adjuvant treatment. METHODS This was a retrospective multicentre study of consecutive patients with clinically evident or occult N2 disease (210 NSCLC and 13 carcinoid) who, in 2007-2016, underwent robot-assisted resection at 7 high-volume centres. Perioperative outcomes, recurrences and overall survival were assessed. RESULTS N2 disease was diagnosed preoperatively in 72 (32%) patients and intraoperatively in 151 (68%) patients. Surgical margins were negative in 98.4% of cases with available data. Thirty-four (15.2%) patients received neoadjuvant treatment, 140 (63%) patients received postoperative treatment, and 49 (22%) patients underwent surgery only. There were 22 (9.9%) conversions to thoracotomy, 23 (10.3%) had serious (Grades III-IV) postoperative morbidity and the mean hospital stay was 5.3 days. Complications and outcomes did not differ significantly between treatment groups. Of the 34 patients who were given neoadjuvant chemotherapy, all had R0 resection, 5 (15%) patients required conversion but none required conversion because of bleeding and 4 (12%) patients had Grade III or IV postoperative complications. After a median of 18 (interquartile range 8-33) months, 3-year overall survival in NSCLC patients was 61.2% and 60.3% (P = 0.6) of patients in the subgroup were given induction treatment. However, overall survival was significantly better (P = 0.012) in NSCLC patients with ≤2 positive nodes (vs >2). Nineteen (8.5%) patients developed local recurrence. CONCLUSIONS Robot-assisted lobectomy is safe and effective in patients with Stage III NSCLC or carcinoid tumours with low conversions and complications. Among patients with NSCLC, including those who were given induction chemotherapy, survival was similar to that reported for open surgery.
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Affiliation(s)
- Giulia Veronesi
- Division of Thoracic Surgery, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Bernard Park
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Robert Cerfolio
- Thoracic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Mark Dylewski
- Department of Cardiothoracic Surgery, Baptist Health South Florida-South Miami Hospital, South Miami, FL, USA
| | - Alpert Toker
- Department of Thoracic Surgery, Group Florence Nightingale Hospitals, Istanbul, Turkey
| | - Jacques P Fontaine
- Department of Thoracic Oncology, Moffitt Cancer Center, Tampa, FL, USA.,Department of Surgery, Morsani College of Medicine, University of South Florida Health, Tampa, FL, USA.,Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida Health, Tampa, FL, USA
| | - Wael C Hanna
- Department of Surgery, Division of Thoracic Surgery, St Joseph's Healthcare Hamilton, Hamilton, ON, Canada.,Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Emanuela Morenghi
- Biostatistics Unit, Humanitas Clinical and Research Center, Rozzano, Milan, Italy.,Department of Biomedical Science, Humanitas University, Rozzano, Milan, Italy
| | - Pierluigi Novellis
- Division of Thoracic Surgery, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Frank O Velez-Cubian
- Department of Surgery, Morsani College of Medicine, University of South Florida Health, Tampa, FL, USA
| | - Marisa H Amaral
- Department of Thoracic Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Elisa Dieci
- Division of Thoracic Surgery, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Marco Alloisio
- Division of Thoracic Surgery, Humanitas Clinical and Research Center, Rozzano, Milan, Italy.,Department of Biomedical Science, Humanitas University, Rozzano, Milan, Italy
| | - Eric M Toloza
- Department of Thoracic Oncology, Moffitt Cancer Center, Tampa, FL, USA.,Department of Surgery, Morsani College of Medicine, University of South Florida Health, Tampa, FL, USA.,Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida Health, Tampa, FL, USA
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148
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Jain NA, Otterson GA. Immunotherapy in inoperable stage III non-small cell lung cancer: a review. Drugs Context 2019; 8:212578. [PMID: 31258616 PMCID: PMC6586171 DOI: 10.7573/dic.212578] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 05/17/2019] [Accepted: 05/20/2019] [Indexed: 12/25/2022] Open
Abstract
The leading cause of cancer-related deaths in the United States continues to be lung cancer. Approximately 25–30% of patients are diagnosed with locally advanced non-small cell lung cancer (NSCLC). Concurrent chemoradiation with a platinum-based doublet is the current standard of care for patients with inoperable stage III NSCLC. Unfortunately, only 15–20% of patients treated with definitive chemoradiation are alive at 5 years. Thus, there has been a major unmet need in this area. In this article, we summarize the current status and ongoing clinical trials incorporating immunotherapy into the management of inoperable stage III NSCLC, and we also present our perspective on the future directions.
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Affiliation(s)
- Natasha A Jain
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center
| | - Gregory A Otterson
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center
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149
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Ineligibility for the PACIFIC trial in unresectable stage III non-small cell lung cancer patients. Cancer Chemother Pharmacol 2019; 84:275-280. [DOI: 10.1007/s00280-019-03885-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 06/04/2019] [Indexed: 12/17/2022]
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150
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Wang S, Xing HX, Li J, Zhang YJ, Fan TY, Yuan SH, Hu XD, Xu M. Correlation of displacement of mediastinal metastatic lymph nodes with adjacent organs in non-small cell lung cancer on four-dimensional computed tomography. PRECISION RADIATION ONCOLOGY 2019. [DOI: 10.1002/pro6.64] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Suzhen Wang
- Shandong Cancer Hospital Affiliated to Shandong University; Department of Radiation Oncology; Shandong China
| | - Huai-Xin Xing
- Shandong Cancer Hospital & Institute; Department of Anesthesiology; Shandong China
| | - Jianbin Li
- Shandong Cancer Hospital Affiliated to Shandong University; Department of Radiation Oncology; Shandong Cancer Hospital & Institute; Shandong China
| | | | - Ting-Yong Fan
- Shandong Cancer Hospital & Institute; Shandong China
| | | | - Xu-Dong Hu
- Shandong Cancer Hospital & Institute; Shandong China
| | - Min Xu
- Shandong Cancer Hospital & Institute; Shandong China
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