201
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Soria JC, Márk Z, Zatloukal P, Szima B, Albert I, Juhász E, Pujol JL, Kozielski J, Baker N, Smethurst D, Hei YJ, Ashkenazi A, Stern H, Amler L, Pan Y, Blackhall F. Randomized phase II study of dulanermin in combination with paclitaxel, carboplatin, and bevacizumab in advanced non-small-cell lung cancer. J Clin Oncol 2011; 29:4442-51. [PMID: 22010015 DOI: 10.1200/jco.2011.37.2623] [Citation(s) in RCA: 183] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To evaluate the efficacy and safety of dulanermin combined with paclitaxel and carboplatin (PC) and bevacizumab (PCB) as first-line treatment for advanced or recurrent non-small-cell lung cancer (NSCLC). PATIENTS AND METHODS Patients with squamous NSCLC and/or CNS metastases received PC every 3 weeks alone (arm 1) or with dulanermin 8 mg/kg for 5 days (arm 2). Patients with nonsquamous NSCLC received PCB alone (arm 3) or with dulanermin 8 mg/kg for 5 days (arm 4) or 20 mg/kg for 2 days (arm 5). The primary end point was the objective response rate (ORR). RESULTS Overall, 213 patients were randomly assigned (arm 1, n = 41; arm 2, n = 39; arm 3, n = 42; arm 4, n = 40; arm 5, n = 41). The ORR in arms 1 to 5 was 39% (95% CI, 24% to 56%), 38% (95% CI, 24% to 54%), 50% (95% CI, 35% to 65%), 40% (95% CI, 25% to 56%), and 40% (95% CI, 25% to 56%), respectively. The odds ratio for ORR was 1.04 (P = 1.000) for arm 1 versus arm 2, 1.53 (P = .391) for arm 3 and versus arm 4, and 1.53 (P = .391) for arm 3 versus arm 5. The most common grade ≥ 3 adverse events were neutropenia, asthenia, anemia, thrombocytopenia, and hemoptysis. Of 161 available serum samples, a trend toward increased caspase-cleaved cytokeratin-18 was observed after dulanermin treatment in cycles 1 and 2. Among 84 patients evaluated for GalNT14 expression, there was a trend toward favorable progression-free survival and overall survival with dulanermin treatment in those with high GalNT14 expression. CONCLUSION The addition of dulanermin to PC and PCB did not improve outcomes in unselected patients with previously untreated advanced or recurrent NSCLC.
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202
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Barbareschi M, Cantaloni C, Del Vescovo V, Cavazza A, Monica V, Carella R, Rossi G, Morelli L, Cucino A, Silvestri M, Tirone G, Pelosi G, Graziano P, Papotti M, Palma PD, Doglioni C, Denti MA. Heterogeneity of large cell carcinoma of the lung: an immunophenotypic and miRNA-based analysis. Am J Clin Pathol 2011; 136:773-82. [PMID: 22031317 DOI: 10.1309/ajcpyy79xagraycj] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Large cell carcinomas (LCCs) of the lung are heterogeneous and may be of different cell lineages. We analyzed 56 surgically resected lung tumors classified as LCC on the basis of pure morphologic grounds, using a panel of immunophenotypic markers (adenocarcinoma [ADC]-specific, thyroid transcription factor-1, cytokeratin 7, and napsin A; squamous cell carcinoma [SQCC]-specific, p63, cytokeratin 5, desmocollin 3, and Δnp63) and the quantitative analysis of microRNA-205 (microRNA sample score [mRSS]). Based on immunoprofiles 19 (34%) of the cases were reclassified as ADC and 14 (25%) as SQCC; 23 (41%) of the cases were unclassifiable. Of these 23 cases, 18 were classified as ADC and 5 as SQCC according to the mRSS. Our data show that an extended panel of immunohistochemical markers can reclassify around 60% of LCCs as ADC or SQCC. However, a relevant percentage of LCCs may escape convincing immunohistochemical classification, and mRSS could be used for further typing, but its clinical relevance needs further confirmation.
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Affiliation(s)
- Mattia Barbareschi
- Unit of Surgical Pathology, Trento, Italy
- Laboratory of Molecular Pathology, Trento, Italy
- Trentino Biobank, Unit of Surgical Pathology, Trento, Italy
| | - Chiara Cantaloni
- Unit of Surgical Pathology, Trento, Italy
- Trentino Biobank, Unit of Surgical Pathology, Trento, Italy
| | | | - Alberto Cavazza
- Unit of Pathologic Anatomy, Arcispedale S. Maria Nuova, Reggio Emilia, Italy
| | - Valentina Monica
- Unit of Pathologic Anatomy, San Luigi Hospital and University of Turin, Orbassano, Italy
| | - Rodolfo Carella
- Unit of Surgical Pathology, S. Maurizio Hospital, Bolzano, Italy
| | - Giulio Rossi
- Section of Pathologic Anatomy, Azienda Ospedaliera-Universitaria Policlinico, Modena, Italy
| | | | | | | | | | - Giuseppe Pelosi
- Unit of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Paolo Graziano
- Unit of Pathologic Anatomy, Forlanini Hospital, Rome, Italy
| | - Mauro Papotti
- Unit of Pathologic Anatomy, San Luigi Hospital and University of Turin, Orbassano, Italy
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203
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Bulman W, Saqi A, Powell CA. Acquisition and processing of endobronchial ultrasound-guided transbronchial needle aspiration specimens in the era of targeted lung cancer chemotherapy. Am J Respir Crit Care Med 2011; 185:606-11. [PMID: 22071327 DOI: 10.1164/rccm.201107-1199ci] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Recent advances in therapy for non-small cell lung carcinoma have shown that a personalized approach to treatment has the potential to significantly reduce lung cancer mortality. Concurrently, endoscopic ultrasound transbronchial needle aspiration has emerged as an accurate and sensitive tool for the diagnosis and staging of this disease. As knowledge of the molecular mechanisms that drive lung cancer progression increases, the amount of information that must be derived from a tumor specimen will also increase. Recent clinical studies have demonstrated that small specimens acquired by endoscopic ultrasound transbronchial needle aspiration are sufficient for molecular testing if specimen acquisition and processing are done with these needs in mind. Optimum use of this procedure requires a coordinated effort between the bronchoscopist and the cytopathologist to collect and triage specimens for diagnostic testing. When feasible, rapid onsite evaluation should be performed to assess the specimen for both diagnostic quality and quantity and to allocate the specimen for cell-block and possible immunohistochemistry and molecular studies. It is necessary for pulmonologists and bronchoscopists to understand the rationale for histologic and molecular testing of lung cancer diagnostic specimens and to ensure that specimens are acquired and processed in a fashion that provides information from small cytologic specimens that is sufficient to guide treatment in this era of targeted therapy.
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Affiliation(s)
- William Bulman
- Division of Pulmonary and Critical Care Medicine, Columbia University Medical Center, New York, New York, USA
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204
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Gao L, Li F, Thrall MJ, Yang Y, Xing J, Hammoudi AA, Zhao H, Massoud Y, Cagle PT, Fan Y, Wong KK, Wang Z, Wong STC. On-the-spot lung cancer differential diagnosis by label-free, molecular vibrational imaging and knowledge-based classification. JOURNAL OF BIOMEDICAL OPTICS 2011; 16:096004. [PMID: 21950918 DOI: 10.1117/1.3619294] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
We report the development and application of a knowledge-based coherent anti-Stokes Raman scattering (CARS) microscopy system for label-free imaging, pattern recognition, and classification of cells and tissue structures for differentiating lung cancer from non-neoplastic lung tissues and identifying lung cancer subtypes. A total of 1014 CARS images were acquired from 92 fresh frozen lung tissue samples. The established pathological workup and diagnostic cellular were used as prior knowledge for establishment of a knowledge-based CARS system using a machine learning approach. This system functions to separate normal, non-neoplastic, and subtypes of lung cancer tissues based on extracted quantitative features describing fibrils and cell morphology. The knowledge-based CARS system showed the ability to distinguish lung cancer from normal and non-neoplastic lung tissue with 91% sensitivity and 92% specificity. Small cell carcinomas were distinguished from nonsmall cell carcinomas with 100% sensitivity and specificity. As an adjunct to submitting tissue samples to routine pathology, our novel system recognizes the patterns of fibril and cell morphology, enabling medical practitioners to perform differential diagnosis of lung lesions in mere minutes. The demonstration of the strategy is also a necessary step toward in vivo point-of-care diagnosis of precancerous and cancerous lung lesions with a fiber-based CARS microendoscope.
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MESH Headings
- Adenocarcinoma/chemistry
- Adenocarcinoma/classification
- Adenocarcinoma/diagnosis
- Adenocarcinoma of Lung
- Carcinoma, Non-Small-Cell Lung/chemistry
- Carcinoma, Non-Small-Cell Lung/classification
- Carcinoma, Non-Small-Cell Lung/diagnosis
- Carcinoma, Squamous Cell/chemistry
- Carcinoma, Squamous Cell/classification
- Carcinoma, Squamous Cell/diagnosis
- Databases, Factual
- Diagnosis, Differential
- Histocytochemistry
- Humans
- Image Interpretation, Computer-Assisted/methods
- Image Processing, Computer-Assisted/methods
- Least-Squares Analysis
- Lung Neoplasms/chemistry
- Lung Neoplasms/classification
- Lung Neoplasms/diagnosis
- Pneumonia
- Sensitivity and Specificity
- Small Cell Lung Carcinoma/chemistry
- Small Cell Lung Carcinoma/classification
- Small Cell Lung Carcinoma/diagnosis
- Spectrum Analysis, Raman/methods
- Support Vector Machine
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Affiliation(s)
- Liang Gao
- Weill Cornell Medical College, The Methodist Hospital Research Institute, Department of Systems Medicine and Bioengineering, Houston, Texas 77030, USA
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205
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Affiliation(s)
| | - Benjamin Besse
- Institut de Cancérologie Gustave Roussy and Institut national de la santé et de la recherche médicale Unit 981, Villejuif, France
| | | | - Elizabeth Brambilla
- Centre Hospitalier Universitaire Albert Michallon Institute de Biologie, Institut national de la santé et de la recherche médicale Unit 823, Centre de Recherche Albert Bonniot; University Joseph Fourrier, Grenoble, France
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206
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Kulesza P, Ramchandran K, Patel JD. Emerging concepts in the pathology and molecular biology of advanced non-small cell lung cancer. Am J Clin Pathol 2011; 136:228-38. [PMID: 21757595 DOI: 10.1309/ajcpo66oirulfnlz] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Non-small cell lung cancer (NSCLC) is traditionally classified histologically, but until recently, the histologic subtype has had little impact on the selection of therapy. Drugs such as pemetrexed and bevacizumab are indicated for specific NSCLC subtypes, and this type of stratification represents the first step toward individualizing therapy in NSCLC. Beyond histologic features, the status of molecular targets, such as the epidermal growth factor receptor (EGFR) gene, has been shown to correlate with response to treatment with EGFR tyrosine kinase inhibitors in patients with relapsed or refractory disease and in the first-line therapy setting. New therapies targeting the EGFR and other molecular aberrations are under way to help define specific subsets of patients responsive to certain molecularly targeted treatments. The role of pathologists in guiding treatment decisions will increase because molecular profiling, together with pathologic and histologic analysis, represents the future of personalizing medicine for patients with NSCLC.
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207
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Halmos B, Powell CA. Update in lung cancer and oncological disorders 2010. Am J Respir Crit Care Med 2011; 184:297-302. [PMID: 21804121 PMCID: PMC3175537 DOI: 10.1164/rccm.201103-0370up] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2011] [Accepted: 05/04/2011] [Indexed: 01/15/2023] Open
Affiliation(s)
| | - Charles A. Powell
- Division of Pulmonary and Critical Care Medicine, Columbia University Medical Center, New York, New York
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208
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Saijo N. Problems involved in the clinical trials for non-small cell lung carcinoma. Cancer Treat Rev 2011; 38:194-202. [PMID: 21775064 DOI: 10.1016/j.ctrv.2011.06.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2011] [Revised: 05/31/2011] [Accepted: 06/02/2011] [Indexed: 12/21/2022]
Abstract
Along with changes in smoking habits, non-small cell lung carcinoma (NSCLC) has come to account for about 90% of all cases of lung cancer. For the treatment of NSCLC, cytocidal antineoplastic drugs such as pemetrexed and molecular-targeted drugs such as gefitinib, erlotinib, and bevacizumab have been approved globally and used as a part of the standard treatment. The importance of better patient selection based on the optimum indication of these drugs is attracting much attention. Additionally, timing for the use of these drugs also seems to be an important issue. The present review presents a critical discussion about the following issues based on the results of clinical studies: (1) whether or not the assessment of the EGFR mutation status in NSCLC patients is indispensable; (2) whether gefitinib and erlotinib have different effects; (3) the need to sub-classify NSCLC by histologic type; (4) significance of maintenance therapy for NSCLC; and (5) whether platinum-doublet chemotherapy plus bevacizumab is a standard treatment for non-squamous cell carcinoma.
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Affiliation(s)
- Nagahiro Saijo
- Kinki University School of Medicine, Osaka-Sayama, Osaka, Japan.
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209
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Fischer AH, Cibas ES, Howell LP, Kurian EM, Laucirica R, Moriarty AT, Renshaw AA, Zakowski MF, Young NA. Role of cytology in the management of non-small-cell lung cancer. J Clin Oncol 2011; 29:3331-2; author reply 3332-3. [PMID: 21768461 DOI: 10.1200/jco.2011.35.2534] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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210
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Ponz-Sarvisé M, Nguewa PA, Pajares MJ, Agorreta J, Lozano MD, Redrado M, Pio R, Behrens C, Wistuba II, García-Franco CE, García-Foncillas J, Montuenga LM, Calvo A, Gil-Bazo I. Inhibitor of differentiation-1 as a novel prognostic factor in NSCLC patients with adenocarcinoma histology and its potential contribution to therapy resistance. Clin Cancer Res 2011; 17:4155-66. [PMID: 21540238 DOI: 10.1158/1078-0432.ccr-10-3381] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE High inhibitor of differentiation-1 (Id1) levels have been found in some tumor types. We aimed to study Id1 levels and their prognostic impact in a large series of stages I to IV non-small cell lung cancer (NSCLC) patients. Experiments in cell lines and cells derived from malignant pleural effusions (MPE) were also carried out. EXPERIMENTAL DESIGN A total of 346 NSCLC samples (three different cohorts), including 65 matched nonmalignant tissues, were evaluated for Id1 expression by using immunohistochemistry. Additional data from a fourth cohort including 111 patients were obtained for Id1 mRNA expression analysis by using publicly available microarrays. In vitro proliferation assays were conducted to characterize the impact of Id1 on growth and treatment sensitivity. RESULTS Significantly higher Id1 protein levels were found in tumors compared with normal tissues (P < 0.001) and in squamous carcinomas compared with adenocarcinomas (P < 0.001). In radically treated stages I to III patients and stage IV patients treated with chemotherapy, higher Id1 levels were associated with a shorter disease-free survival and overall survival in adenocarcinoma patients in a log-rank test. A Cox model confirmed the independent prognostic value of Id1 levels for both stages I to III and stage IV patients. In silico analysis confirmed a correlation between higher Id1 mRNA levels and poor prognosis for adenocarcinoma subjects. In vitro Id1 silencing in radio/chemotherapy-resistant adenocarcinoma cells from MPEs restored sensitivity to both therapies. CONCLUSIONS In our series, Id1 levels showed an independent prognostic value in patients with adenocarcinoma, regardless of the stage. Id1 silencing may sensitize adenocarcinoma cells to radiotherapy and chemotherapy.
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Affiliation(s)
- Mariano Ponz-Sarvisé
- Departments of Oncology, Pathology, and Thoracic Surgery, Clínica Universidad de Navarra; Division of Oncology, Center for Applied Medical Research (CIMA), Pamplona, Spain
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211
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Should Large Cell Neuroendocrine Lung Carcinoma be Classified and Treated as a Small Cell Lung Cancer or with Other Large Cell Carcinomas? J Thorac Oncol 2011; 6:1050-8. [DOI: 10.1097/jto.0b013e318217b6f8] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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212
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Ohashi K, Pao W. A New Target for Therapy in Squamous Cell Carcinoma of the Lung: Table 1. Cancer Discov 2011; 1:23-4. [DOI: 10.1158/2159-8274.cd-11-0069] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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213
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Ambrosini V, Nicolini S, Caroli P, Nanni C, Massaro A, Marzola MC, Rubello D, Fanti S. PET/CT imaging in different types of lung cancer: an overview. Eur J Radiol 2011; 81:988-1001. [PMID: 21458181 DOI: 10.1016/j.ejrad.2011.03.020] [Citation(s) in RCA: 103] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2011] [Accepted: 03/04/2011] [Indexed: 01/03/2023]
Abstract
Lung cancer (LC) still represents one of the most common tumours in both women and men. PET/CT is a whole-body non-invasive imaging procedure that has been increasingly used for the assessment of LC patients. In particular, PET/CT added value to CT is mainly related to a more accurate staging of nodal and metastatic sites and to the evaluation of the response to therapy. Although the most common PET tracer for LC evaluation is 18F-FDG, new tracers have been proposed for the evaluation of lung neuroendocrine tumours (68Ga-DOTA-peptides, 18F-DOPA) and for the assessment of central nervous system metastasis (11C-methionine). This review focuses on the main clinical applications and accuracy of PET/CT for the detection of non-small cells lung cancer (NSCLC), broncho-alveolar carcinoma (BAC), small cells lung cancer (SCLC), lung neuroendocrine tumours (NET) and solitary pulmonary nodules (SPN).
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Affiliation(s)
- Valentina Ambrosini
- Department of Nuclear Medicine, Sant' Orsola-Malpighi Hospital, Bologna, Italy
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