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Gomez-Randulfe I, Leporati R, Gupta B, Liu S, Califano R. Recent advances and future strategies in first-line treatment of ES-SCLC. Eur J Cancer 2024; 200:113581. [PMID: 38301317 DOI: 10.1016/j.ejca.2024.113581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 01/11/2024] [Accepted: 01/22/2024] [Indexed: 02/03/2024]
Abstract
Recent advancements in treating extensive-stage small-cell lung cancer (ES-SCLC) have been significantly marked by incorporating immune checkpoint inhibitors (ICIs) into platinum-based chemotherapy, leading to modest yet notable improvements in patient outcomes, which become more evident with longer follow-up. However, critical challenges persist, such as identifying effective biomarkers for accurate patient selection or finding more effective drugs. This review delves into the current and evolving treatment landscape for ES-SCLC, focusing on the most promising therapeutic strategies under investigation. We discuss the latest developments in the use of newer ICIs, antiangiogenic agents, PARP inhibitors (PARPi), lurbinectedin, and anti-DLL3 agents, offering insights into potential future directions in the management of this aggressive cancer.
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Affiliation(s)
- Igor Gomez-Randulfe
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - Rita Leporati
- Fondazione IRCCS Istituto Nazionale dei Tumori, Via G. Venezian 1, 20133 Milan, Italy
| | - Brinda Gupta
- Division of Hematology and Oncology, Department of Medicine, Georgetown University, Washington, DC, USA
| | - Stephen Liu
- Division of Hematology and Oncology, Department of Medicine, Georgetown University, Washington, DC, USA
| | - Raffaele Califano
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, The University of Manchester, Manchester, UK.
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Zheng Z, Zhu D, Liu L, Chen MW, Li G, Geng R, Zhang Y, Huang C, Tian Z, Liu H, Li S, Chen Y. Survival of small-cell lung cancer patients after surgery: A single-center retrospective cohort study. J Investig Med 2023; 71:917-928. [PMID: 37424441 DOI: 10.1177/10815589231185542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
This study summarized and analyzed the clinical characteristics and prognosis of small-cell lung cancer (SCLC) patients after surgical treatment. The clinical data of 130 patients (99 males and 31 females) with SCLC treated by surgery and confirmed by postoperative pathological examination at Peking Union Medical College Hospital from April 2004 to April 2019 were retrospectively analyzed. Clinical characteristics, surgery, pathological stage, and perioperative treatment were summarized. Kaplan-Meier survival curve and Cox regression analysis were performed. Pathological examination revealed that 36 (27.69%) patients had stage I SCLC, 22 (16.92%) patients had stage II SCLC, 65 (50.00%) patients had stage III SCLC, and 7 (5.39%) patients had stage IV SCLC. The overall median survival time was 50 months (95% confidence interval, 10.8-89.2 months). The median survival time of stage I, II, III and IV SCLC patients was 148, 42, 32, and 10 months, respectively. In patients who underwent surgical treatment, postoperative adjuvant therapy and tumor stage were independent prognostic factors for survival (p < 0.05).Lobectomy and lymph nodes resection combined with adjuvant therapy were cautiously recommended for stage I-IIIa SCLC patients.
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Affiliation(s)
- Zhibo Zheng
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
- Department of International Medical Services, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Danyang Zhu
- Department of International Medical Services, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Lei Liu
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Michael W Chen
- Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Guiping Li
- Department of International Medical Services, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Ruixuan Geng
- Department of International Medical Services, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Ying Zhang
- Department of International Medical Services, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Cheng Huang
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Zhenhuan Tian
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Hongsheng Liu
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Shanqing Li
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Yeye Chen
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
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Kubiszewski K, Hunsaker P, Piazza Y, Patel D, Neychev V. An Unusual Presentation of Occult Small-Cell Neuroendocrine Carcinoma as Acalculous Cholecystitis With Widespread Liver Metastasis. Cureus 2023; 15:e45706. [PMID: 37868470 PMCID: PMC10590165 DOI: 10.7759/cureus.45706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2023] [Indexed: 10/24/2023] Open
Abstract
Small-cell neuroendocrine carcinoma, often classified as small-cell lung carcinoma (SCLC) type, is an aggressive neuroendocrine tumor with early metastatic potential that can lead to unexpected patient presentations. We report the case of a 69-year-old man who presented to the emergency department with worsening right upper abdominal pain, nausea, and vomiting for the past several days. The clinical picture and the workup, including the complete metabolic panel and complete blood count, were highly suggestive of acute cholecystitis with transaminitis and direct hyperbilirubinemia. The ultrasound and magnetic resonance cholangiopancreatography of the abdomen revealed a diffusely hyperdense and hypertrophic liver without evidence of choledocholithiasis. After initial resuscitation, the patient underwent laparoscopic cholecystectomy. Intraoperative findings were consistent with diffuse miliary liver metastatic disease of unknown etiology, rigid liver parenchyma, an extremely frail gallbladder wall, and mild ascites. A biopsy of the liver and cholecystectomy were performed. The final pathology revealed metastatic SCLC to the liver and widespread intravascular tumor emboli, causing diffuse ischemia of the entire gallbladder wall. The patient's postoperative course was marked by the development of foudroyant liver insufficiency and worsening severe type B lactic acidosis.
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Affiliation(s)
- Kacper Kubiszewski
- Medical School, University of Central Florida College of Medicine, Orlando, USA
| | - Parker Hunsaker
- Medical School, University of Central Florida College of Medicine, Orlando, USA
| | - Yelena Piazza
- Pathology, University of Central Florida College of Medicine, Orlando, USA
- Pathology, University of Central Florida Lake Nona Hospital, Orlando, USA
| | - Dhruv Patel
- Radiology, University of Central Florida College of Medicine, Orlando, USA
- Radiology, University of Central Florida Lake Nona Hospital, Orlando, USA
| | - Vladimir Neychev
- Surgery, University of Central Florida College of Medicine, Orlando, USA
- Surgery, University of Central Florida Lake Nona Hospital, Orlando, USA
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Mamesaya N, Kodama H, Iida Y, Kobayashi H, Ko R, Wakuda K, Ono A, Kenmotsu H, Naito T, Murakami H, Shimizu T, Gon Y, Takahashi T. Efficacy and safety of carboplatin and etoposide in older extensive-stage small-cell lung cancer patients with a poor performance status. Thorac Cancer 2023; 14:805-814. [PMID: 36700290 PMCID: PMC10040279 DOI: 10.1111/1759-7714.14811] [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: 11/16/2022] [Revised: 01/11/2023] [Accepted: 01/13/2023] [Indexed: 01/27/2023] Open
Abstract
Carboplatin plus etoposide is a standard treatment for older extensive-stage small-cell lung cancer (ES-SCLC) patients with performance status (PS) 2. However, older patients often exhibit poor PS (3, 4), and the treatment effect in them is poorly understood. To determine the therapeutic efficacy and safety of carboplatin plus etoposide therapy for this population, we retrospectively analyzed 63 patients with ES-SCLC with PS ≥2, aged ≥71 years, who had received first-line carboplatin plus etoposide therapy. We compared the treatment efficacy and safety in patients with baseline PS 2 versus those with PS 3-4. In the PS 2 (38 patients) and PS ≥3 (25 patients) groups, the overall response rate was 71.1% and 72.0%, median progression-free survival was 4.6 and 3.1 months, and overall survival was 7.7 and 5.1 months, respectively. PS improved to 0-1 post-treatment in 65.8% and 48.0% of the patients in the PS 2 and PS ≥3 groups, respectively. Patients with PS ≥3 showing improved PS had a progression-free survival of 6.1 months. A higher incidence of grade ≥3 decreased neutrophil counts, febrile neutropenia, and treatment-related death was observed in the PS ≥3 group. The progression-free survival of patients administered prophylactic granulocyte colony-stimulating factor (G-CSF) was 5.2 and 6.1 months in the PS2 and PS ≥3 groups. Overall, carboplatin plus etoposide therapy provided comparable tumor shrinkage, but shorter progression-free and overall survival in older ES-SCLC patients with PS ≥3 than in those with PS 2. Thus, supportive care, such as prophylactic G-CSF administration, may be necessary to ensure safety and survival.
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Affiliation(s)
- Nobuaki Mamesaya
- Division of Thoracic Oncology, Shizuoka Cancer Center, Shizuoka, Japan.,Division of Respiratory Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Hiroaki Kodama
- Division of Thoracic Oncology, Shizuoka Cancer Center, Shizuoka, Japan.,Division of Respiratory Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Yuko Iida
- Division of Thoracic Oncology, Shizuoka Cancer Center, Shizuoka, Japan.,Division of Respiratory Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Haruki Kobayashi
- Division of Thoracic Oncology, Shizuoka Cancer Center, Shizuoka, Japan.,Division of Respiratory Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Ryo Ko
- Division of Thoracic Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Kazushige Wakuda
- Division of Thoracic Oncology, Shizuoka Cancer Center, Shizuoka, Japan.,Division of Respiratory Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Akira Ono
- Division of Thoracic Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | | | - Tateaki Naito
- Division of Thoracic Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Haruyasu Murakami
- Division of Thoracic Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Tetsuo Shimizu
- Division of Respiratory Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Yasuhiro Gon
- Division of Respiratory Medicine, Nihon University School of Medicine, Tokyo, Japan
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Madhavan BK, Han Z, Singh B, Bordt N, Kaymak S, Bandapalli OR, Kihm L, Shahzad K, Isermann B, Herzig S, Nawroth P, Kumar V. Elevated Expression of the RAGE Variant- V in SCLC Mitigates the Effect of Chemotherapeutic Drugs. Cancers (Basel) 2021; 13:cancers13112843. [PMID: 34200336 PMCID: PMC8201239 DOI: 10.3390/cancers13112843] [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: 04/19/2021] [Revised: 05/31/2021] [Accepted: 06/02/2021] [Indexed: 02/01/2023] Open
Abstract
Simple Summary Radiomimetic drugs induce extensive genotoxic insults to their target cells. Irreparable DNA damage leaves cells with the choice between a program leading to cell death or senescence, but not DNA repair. Among the challenges of an advanced stage of small cell lung carcinoma (SCLC), the resistance to radiomimetic drugs is the most prominent one. In SCLC, the initial chemotherapeutic treatment primes cell to modify their DNA repair and cell cycle regulatory systems, using alternative but highly efficient forms of DNA repair and auxiliary factors. This modulated system now bypasses several regulatory controls. Thus, at this stage, cells become resistant to any beneficial effects of chemotherapeutic drugs. In the present study, we observed that variant-V of the receptor for advanced glycation end-products (RAGE) is abundantly expressed in advancing and metastasizing SCLC. Therefore, it may serve as a potential target for specific therapeutic interventions directed to SCLC. Abstract Small cell lung carcinoma (SCLC) is a highly aggressive malignancy with a very high mortality rate. A prominent part of this is because these carcinomas are refractory to chemotherapies, such as etoposide or cisplatin, making effective treatment almost impossible. Here, we report that elevated expression of the RAGE variant-V in SCLC promotes homology-directed DNA DSBs repair when challenged with anti-cancer drugs. This variant exclusively localizes to the nucleus, interacts with members of the double-strand break (DSB) repair machinery and thus promotes the recruitment of DSBs repair factors at the site of damage. Increased expression of this variant thus, promotes timely DNA repair. Congruently, the tumor cells expressing high levels of variant-V can tolerate chemotherapeutic drug treatment better than the RAGE depleted cells. Our findings reveal a yet undisclosed role of the RAGE variant-V in the homology-directed DNA repair. This variant thus can be a potential target to be considered for future therapeutic approaches in advanced SSLC.
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Affiliation(s)
- Bindhu K. Madhavan
- Department of Medicine I and Clinical Chemistry, University Hospital of Heidelberg, INF 410, 69120 Heidelberg, Germany; (B.K.M.); (Z.H.); (B.S.); (N.B.); (S.K.); (L.K.); (P.N.)
| | - Zhe Han
- Department of Medicine I and Clinical Chemistry, University Hospital of Heidelberg, INF 410, 69120 Heidelberg, Germany; (B.K.M.); (Z.H.); (B.S.); (N.B.); (S.K.); (L.K.); (P.N.)
| | - Bishal Singh
- Department of Medicine I and Clinical Chemistry, University Hospital of Heidelberg, INF 410, 69120 Heidelberg, Germany; (B.K.M.); (Z.H.); (B.S.); (N.B.); (S.K.); (L.K.); (P.N.)
| | - Nico Bordt
- Department of Medicine I and Clinical Chemistry, University Hospital of Heidelberg, INF 410, 69120 Heidelberg, Germany; (B.K.M.); (Z.H.); (B.S.); (N.B.); (S.K.); (L.K.); (P.N.)
| | - Serap Kaymak
- Department of Medicine I and Clinical Chemistry, University Hospital of Heidelberg, INF 410, 69120 Heidelberg, Germany; (B.K.M.); (Z.H.); (B.S.); (N.B.); (S.K.); (L.K.); (P.N.)
| | - Obul Reddy Bandapalli
- Hopp Children’s Cancer Center (KiTZ), 69120 Heidelberg, Germany;
- Medical Faculty, Heidelberg University, 69117 Heidelberg, Germany
| | - Lars Kihm
- Department of Medicine I and Clinical Chemistry, University Hospital of Heidelberg, INF 410, 69120 Heidelberg, Germany; (B.K.M.); (Z.H.); (B.S.); (N.B.); (S.K.); (L.K.); (P.N.)
| | - Khurrum Shahzad
- Institute for Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University Hospital Leipzig, 04103 Leipzig, Germany; (K.S.); (B.I.)
| | - Berend Isermann
- Institute for Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University Hospital Leipzig, 04103 Leipzig, Germany; (K.S.); (B.I.)
| | - Stephan Herzig
- German Center for Diabetes Research (DZD), 85764 Neuherberg, Germany;
- Molecular Metabolic Control, Technical University Munich, 80333 Munich, Germany
- Helmholtz Center Munich, Institute for Diabetes and Cancer, D-85764 Neuherberg, Germany
- Joint Heidelberg-IDC Translational Diabetes Programm, Helmholtz-Zentrum, 69120 Heidelberg, Germany
| | - Peter Nawroth
- Department of Medicine I and Clinical Chemistry, University Hospital of Heidelberg, INF 410, 69120 Heidelberg, Germany; (B.K.M.); (Z.H.); (B.S.); (N.B.); (S.K.); (L.K.); (P.N.)
- German Center for Diabetes Research (DZD), 85764 Neuherberg, Germany;
- Joint Heidelberg-IDC Translational Diabetes Programm, Helmholtz-Zentrum, 69120 Heidelberg, Germany
| | - Varun Kumar
- Department of Medicine I and Clinical Chemistry, University Hospital of Heidelberg, INF 410, 69120 Heidelberg, Germany; (B.K.M.); (Z.H.); (B.S.); (N.B.); (S.K.); (L.K.); (P.N.)
- German Center for Diabetes Research (DZD), 85764 Neuherberg, Germany;
- European Molecular Biology Laboratory, Advanced Light Microscopy Facility, 69117 Heidelberg, Germany
- Correspondence: ; Tel.: +49-6221-56-6960
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Church M, Carter L, Blackhall F. Liquid Biopsy in Small Cell Lung Cancer-A Route to Improved Clinical Care? Cells 2020; 9:E2586. [PMID: 33287165 PMCID: PMC7761700 DOI: 10.3390/cells9122586] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 11/27/2020] [Accepted: 11/30/2020] [Indexed: 01/22/2023] Open
Abstract
Small cell lung cancer (SCLC) has a particularly poor prognosis despite the high initial response to first-line systemic therapy, and there is a well-recognised lack of meaningful treatments beyond the second line. A number of reasons have been put forward to explain this, including a lack of common, easily-druggable genetic mutations in SCLC and rarity of high-quality tissue samples due to late presentation. Liquid biopsies, including circulating tumour cells (CTCs) and circulating tumour DNA (ctDNA) are increasingly used as surrogates for tumour tissue and have the advantage of being easily obtained serially to inform on the biology of disease progression and acquired chemoresistance, and may provide a pathway to improve care in this notoriously refractory disease. Here we discuss the current evidence behind these liquid biopsy methods in SCLC, and how they could be employed in future clinical care.
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Affiliation(s)
- Matt Church
- Division of Cancer Sciences, Faculty of Biology Medicine and Health, University of Manchester, Manchester M13 9PL, UK; (M.C.); (L.C.)
| | - Louise Carter
- Division of Cancer Sciences, Faculty of Biology Medicine and Health, University of Manchester, Manchester M13 9PL, UK; (M.C.); (L.C.)
- The Christie NHS Foundation Trust, Wilmslow Road, Manchester M20 4BX, UK
| | - Fiona Blackhall
- Division of Cancer Sciences, Faculty of Biology Medicine and Health, University of Manchester, Manchester M13 9PL, UK; (M.C.); (L.C.)
- The Christie NHS Foundation Trust, Wilmslow Road, Manchester M20 4BX, UK
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Neutrophil-to-lymphocyte ratio can predict outcome in extensive-stage small cell lung cancer. Radiol Oncol 2020; 54:437-446. [PMID: 32960780 PMCID: PMC7585340 DOI: 10.2478/raon-2020-0054] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 07/22/2020] [Indexed: 12/20/2022] Open
Abstract
Background The neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and lymphocyte-to-monocyte ratio (LMR) were analyzed in various carcinomas and their potential prognostic significance was determined. The objective of present study was to determine the correlation between these parameters and the survival of patients with small cell lung cancer (SCLC), since very few studies have been published on this type of carcinoma. Patients and methods One hundred and forty patients diagnosed with SCLC at University Hospital Center Zagreb, between 2012 and 2016 were retrospectively analyzed. Extensive-stage disease (ED) was verified in 80 patients and limited-stage disease (LD) in 60 patients. We analyzed the potential prognostic significance of various laboratory parameters, including NLR, PLR, and LMR, measured before the start of treatment. Results Disease extension, response to therapy, chest irradiation and prophylactic cranial irradiation (PCI), as well as hemoglobin, monocyte count, C-reactive protein (CRP), and lactate dehydrogenase (LDH) showed a prognostic significance in all patients. When we analyzed the patients separately, depending on the disease extension, we found that only skin metastases as well as LDH and NLR values, regardless of the cut-off value, had a prognostic significance in ED. Meanwhile, the ECOG performance status, chest irradiation, PCI, and hemoglobin and creatinine values had a prognostic significance in LD. Conclusions NLR calculated before the start of the treatment had a prognostic significance for ED, while PLR and LMR had no prognostic significance in any of the analyzed groups of patients.
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Kim T, Choi H, Oak CH, Jang TW, Jung MH, Kim J. Correlation between stage of small-cell lung cancer and inflammatory factors. Asian Cardiovasc Thorac Ann 2019; 27:554-558. [PMID: 31379186 DOI: 10.1177/0218492319868407] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Several biochemical markers are associated with the stage of small-cell lung cancer. Neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio are useful inflammatory markers and related to poor survival. This study aimed to evaluate the correlation between the disease extent of small-cell lung cancer and neutrophil-to-lymphocyte ratio or platelet-to-lymphocyte ratio. Methods The study was performed retrospectively in a single South Korean medical center from 2010 to 2016. Of 217 patients pathologically diagnosed with small-cell lung cancer, 157 were included in the analysis. The correlation between disease extent and neutrophil-to-lymphocyte ratio or platelet-to-lymphocyte ratio was measured by Student’s t test and analysis of variance. Results Neutrophil-to-lymphocyte ratio (limited disease: 2.38 ± 1.53, extensive disease: 3.25 ± 2.20, p = 0.004) and platelet-to-lymphocyte ratio (limited disease: 122.21 ± 63.13, extensive disease: 153.09 ± 98.57, p = 0.026) were highly associated with disease extent. Neutrophil-to-lymphocyte ratio was associated with advanced TNM stage (stage I: 3.53 ± 3.44, stage II: 2.66 ± 0.95, stage III: 2.34 ± 1.49, stage IV: 3.26 ± 2.22, p = 0.049), and platelet-to-lymphocyte ratio was proportional to the TNM stage but there was no statistical significance (stage I: 111.77 ± 30.76, stage II: 110.71 ± 34.04, stage III: 123.42 ± 64.48, stage IV: 154.68, p = 0.105). Conclusions Neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio were increased in advanced stages of small-cell lung cancer, especially when stage was classified into extensive and limited disease. It is necessary to analyze the effect on survival outcome.
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Affiliation(s)
- Taeyun Kim
- 1 Department of Pulmonology, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, South Korea
| | - Hyunji Choi
- 2 Department of Laboratory Medicine, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, South Korea
| | - Chul-Ho Oak
- 1 Department of Pulmonology, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, South Korea
| | - Tae-Won Jang
- 1 Department of Pulmonology, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, South Korea
| | - Mann-Hong Jung
- 1 Department of Pulmonology, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, South Korea
| | - Jehun Kim
- 1 Department of Pulmonology, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, South Korea
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Wang Y, Wu L, Yao Y, Lu G, Xu L, Zhou J. Polo-like kinase 1 inhibitor BI 6727 induces DNA damage and exerts strong antitumor activity in small cell lung cancer. Cancer Lett 2018; 436:1-9. [PMID: 30118839 DOI: 10.1016/j.canlet.2018.08.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 07/14/2018] [Accepted: 08/09/2018] [Indexed: 11/29/2022]
Abstract
The prognosis of small cell lung cancer (SCLC) is poor despite its good initial response to chemotherapy. Polo-like kinase 1 (PLK1) is a crucial mitotic regulator that is overexpressed in many tumors, and its overexpression is associated with tumor aggressiveness and a poor prognosis. However, its role in SCLC is still poorly characterized. Based on immunohistochemistry findings, the PLK1 protein is expressed at higher levels in SCLC tumor samples than in normal lung tissue samples. The selective PLK1 inhibitor BI 6727 significantly induced the inhibition of proliferation and apoptosis in a dose-dependent manner in SCLC cell lines. FACS analysis showed an increase in the population of cells in the G2/M phase, followed by DNA damage and the consequent activation of the ataxia telangiectasia and Rad3-related (ATR)/ataxia telangiectasia mutated (ATM)-Chk1/Chk2 checkpoint pathway. In addition, BI 6727 treatment resulted in clearly attenuated growth and apoptosis in NCI-H446 xenografts. The level of histone H2AX phosphorylation at serine-139 (γH2AX) was markedly increased both in vitro and in vivo. Our findings indicate that BI 6727 has therapeutic potential for SCLC patients.
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Affiliation(s)
- Yuehong Wang
- Department of Respiratory Disease, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Linying Wu
- Department of Respiratory Disease, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Yinan Yao
- Department of Respiratory Disease, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Guohua Lu
- Department of Respiratory Disease, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Liming Xu
- Department of Pathology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Jianying Zhou
- Department of Respiratory Disease, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.
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Abstract
BACKGROUND Two types of ectopic Cushing syndrome (ECS) are described: ECS associated with aggressive neoplasms, and ECS with indolent and occult tumors, however, there is a lack of studies that thoroughly review their characteristics. METHODS A systematic review was carried out on PUBMED of all the papers about the ECS, in order to better define the types of this subcategory of Cushing's syndrome, highlighting the differential aspects between these subgroups. RESULTS It was found that in 50% of cases the prototypic "aggressive" ECS is caused by small cell lung carcinomas (SCLC). In these cases, the clinical presentation may be atypical, predominating the signs and symptoms derived from the protein catabolism. Cortisol and ACTH levels are extremely high, the clinical presentation is abrupt (< 3-6 months) and the tumor is usually advanced, being impossible a curative treatment. On the other hand, "indolent" ECS is mainly represented by carcinoid tumors (CT). In these cases the clinical presentation overlaps enormously with that of Cushing's disease (CD). Cortisol and ACTH levels are slightly elevated, the clinical presentation is progressive (> 6 months) and the prognosis is usually good, and a curative treatment is possible in about 75% of the cases. CONCLUSION Although there is no absolute differentiation between the two extremes of ECS, a classification could be established in two groups, guided by its clinical and biochemical characteristics, and mainly by the type and stage of the ACTH-secreting tumor. However, a small percentage of tumors do not fit in this simple grouping, and may present both phenotypes or an intermediate one.
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Affiliation(s)
- Marta Araujo Castro
- Department Endocrinology, Hospital Universitario de la Princesa, Madrid, Spain.
- Department Endocrinology, Hospital Universitario Rey Juan Carlos, Madrid, Spain.
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Zeng H, Liu Y, Xia X, Li J, He J. [Prognostic Analysis of Lobectomy versus Sublobar Resection in Patients Aged ≥60 Years with Stage Ia Small Cell Lung Cancer]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2018; 21:8-15. [PMID: 29357967 PMCID: PMC5972352 DOI: 10.3779/j.issn.1009-3419.2018.01.02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
背景与目的 目前,肺叶切除与亚肺叶切除治疗Ia期小细胞肺癌(small cell lung cancer, SCLC)的预后比较鲜有报道。本研究通过对年龄≥60岁的T1N0M0(≤3 cm)SCLC进行回顾性研究,旨在探索肺叶切除与亚肺叶切除治疗Ia期SCLC预后的对比分析。 方法 纳入“监测,流行病学和结果数据库”(Surveillance, Epidemiology and End Results database, SEER)在1992年-2010年间经病理诊断为Ia期SCLC患者共515例,数据使用Kaplan-Meier(Log-rank检验)和Cox模型进行比较统计分析。 结果 肺叶切除组(n=110)、亚肺叶切除组(n=57)、和非手术治疗组(n=348)的中位生存期分别为45个月、23个月和16个月;该三组相应的5年总生存期(OS)分别为44%、30%和14%(Lob vs Sub, χ2=4.851, P=0.028; Sub vs non-surgical, χ2=6.529, P=0.011)。SCLC有、无淋巴结采样/清扫患者的预后无显著差异(P=0.107);肺叶切除+放化疗组(Lob+CR, n=59)的5年OS为50%。Cox分析证实,手术(肺叶与亚肺叶切除术)方式为独立预后预测因素之一。 结论 年龄≥60岁的Ia期SCLC患者,我们推荐解剖性肺叶切除联合辅助放化疗治疗。
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Affiliation(s)
- Haikang Zeng
- Department of Thoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Yang Liu
- Department of Thoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Xiaojun Xia
- Department of Thoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Jin Li
- State Key Laboratory of Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Jianxing He
- Department of Thoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
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12
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Glatzer M, Rittmeyer A, Müller J, Opitz I, Papachristofilou A, Psallidas I, Früh M, Born D, Putora PM. Treatment of limited disease small cell lung cancer: the multidisciplinary team. Eur Respir J 2017; 50:50/2/1700422. [PMID: 28838979 DOI: 10.1183/13993003.00422-2017] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 05/16/2017] [Indexed: 12/17/2022]
Abstract
Small cell lung cancer (SCLC) presents multiple interdisciplinary challenges with several paradigm shifts in its treatment in recent years. SCLC treatment requires multidisciplinary management and timely treatment. The aim of this review is to focus on the team management aspects in the treatment of limited disease SCLC and how this can contribute towards improving outcomes.
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Affiliation(s)
- Markus Glatzer
- Dept of Radiation Oncology, Kantonsspital St Gallen, St Gallen, Switzerland
| | - Achim Rittmeyer
- Dept of Thoracic Oncology, Lungenfachklinik Immenhausen, Immenhausen, Germany
| | - Joachim Müller
- Dept of Radiology and Nuclear Medicine, Kantonsspital St Gallen, St Gallen, Switzerland
| | - Isabelle Opitz
- Dept of Thoracic Surgery, University Hospital Zürich, Zürich, Switzerland
| | | | - Ioannis Psallidas
- Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford, UK.,Oxford Respiratory Trials Unit, Churchill Hospital, Oxford, UK
| | - Martin Früh
- Dept of Oncology and Haematology, Kantonsspital St Gallen, St Gallen, Switzerland
| | - Diana Born
- Institute of Pathology, Kantonsspital St Gallen, St Gallen, Switzerland
| | - Paul Martin Putora
- Dept of Radiation Oncology, Kantonsspital St Gallen, St Gallen, Switzerland
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13
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Kono M, Allen PK, Lin SH, Wei X, Jeter MD, Welsh JW, Cox JD, Komaki R. Incidence of Second Malignancy after Successful Treatment of Limited-Stage Small-Cell Lung Cancer and Its Effects on Survival. J Thorac Oncol 2017; 12:1696-1703. [PMID: 28804012 DOI: 10.1016/j.jtho.2017.07.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 07/13/2017] [Accepted: 07/26/2017] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Extended survival outcomes from improved treatments for patients with cancer come with an increased risk for development of a metachronous second malignancy (MSM). We evaluated the incidence of MSM after successful treatment of SCLC and compared survival between patients with SCLC in whom MSM developed and those in whom it did not. METHODS Selection criteria were a diagnosis of limited-stage SCLC and receipt of at least 45 Gy of radiotherapy and chemotherapy at a single institution in 1985-2012. MSM was defined as a tumor of a different histologic type than the primary that appeared more than 2 years after the diagnosis of SCLC. RESULTS Of 704 patients identified, 32 were excluded for lack of follow-up, 48 for having SCLC as MSM after treatment of another type of cancer, 37 for nonmelanoma skin cancer as MSM, and 46 for MSM within 2 years after SCLC diagnosis. Of the remaining 541 patients, 346 had recurrent SCLC, 180 had no second malignancy and no recurrence, and 15 (2.8%) had MSM (13 in a lung [eight adenocarcinomas and five squamous cell carcinomas], one sarcoma, and one acute myeloid leukemia). All 15 patients with MSM achieved complete response to the SCLC treatment. Overall survival was longer for patients with MSM than for patients with no other malignancies and no recurrence, with 10-year rates of 61.9% (95% confidence interval: 30.0%-82.6%) and 29.9% (95% confidence interval: 21.5%-38.6%), respectively (p = 0.03). CONCLUSIONS Long-term survivors after treatment for SCLC should be made aware of the risk for MSM and the necessity of follow-up.
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Affiliation(s)
- Miho Kono
- Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas; Research Institute for Radiation Biology and Medicine, Hiroshima University, 1-2-3 Kasumi Minamiku, Hiroshima, Japan
| | - Pamela K Allen
- Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
| | - Steven H Lin
- Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
| | - Xiong Wei
- Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
| | - Melenda D Jeter
- Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
| | - James W Welsh
- Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
| | - James D Cox
- Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
| | - Ritsuko Komaki
- Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas.
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14
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Moraes RM, Alves FA, Carvalho BFDC, Costa FD, Lopes RN, Jaguar GC. Mandible metastasis of small cell lung cancer mimicking a residual cyst. Autops Case Rep 2017; 7:37-41. [PMID: 28536686 PMCID: PMC5436920 DOI: 10.4322/acr.2017.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Accepted: 01/19/2017] [Indexed: 11/24/2022]
Abstract
Small cell lung carcinoma (SCLC) is an uncommon tumor characterized by an aggressive behavior with early metastasis, usually to the contralateral lung, liver, brain, and bones. There are only five cases of this particular tumor metastasizing to the oral cavity described in the English literature. We present the case of metastatic SCLC in the mandible with radiographic findings resembling a residual cyst. A 66-year-old man with previous diagnosis and treatment for a SCLC was referred to the Stomatology Department with a history of persistent pain in the mandible 1 year after the inferior right pre-molar tooth extraction. The radiographic exam showed a well-delimited radiolucent area on that extracted tooth’s region resembling a residual cyst. Biopsy was performed yielding the diagnosis of metastatic SCLC. The patient was referred to the clinical oncologist for chemotherapy. Although uncommon, this tumor should be included in the differential diagnosis of jawbone lesions, particularly when the patient presents a previous diagnosis of SCLC.
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Affiliation(s)
| | - Fabio Abreu Alves
- Stomatology Department - A.C. Camargo Cancer Center, São Paulo/SP - Brazil.,Stomatology Department - Universidade de São Paulo, São Paulo/SP - Brazil
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15
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Todd DL, Laucirica R, Ostrowski ML, Brown R, Truong LD. Transitional Cell Carcinoma Metastatic to Lung, With Dedifferentiation Into Small Cell Undifferentiated Carcinoma. Int J Surg Pathol 2016. [DOI: 10.1177/106689699400200211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Small-cell undifferentiated carcinoma (SCUC) has been increasingly recognized in the urinary tract. 1,2,3 Up to 66% of SCUCs in this location are associated with a minor component of a more differentiated carcinoma that most frequently represents transi tional-cell carcinoma (TCC), but adenocarcinoma, squamous-cell carcinoma, spindle- cell carcinoma, and carcinoid carcinoma have all been described. We report a case of low-grade TCC of the urinary tract metastasizing to a distant location and therein dedifferentiating into an SCUC and discuss the clinical and biologic implication of the process of dedifferentiation. Int J Surg Pathol 2(2):157-162, 1994
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Affiliation(s)
- David L. Todd
- Departments of Pathology, The Methodist Hospital and Baylor College of Medicine, Houston, Texas
| | - Rodolfo Laucirica
- Departments of Pathology, The Methodist Hospital and Baylor College of Medicine, Houston, Texas
| | - Mary L. Ostrowski
- Departments of Pathology, The Methodist Hospital and Baylor College of Medicine, Houston, Texas
| | - Richard Brown
- Departments of Pathology, The Methodist Hospital and Baylor College of Medicine, Houston, Texas
| | - Luan D. Truong
- Departments of Pathology, The Methodist Hospital and Baylor College of Medicine, Houston, Texas
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16
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Roviello G, Zanotti L, Cappelletti MR, Gobbi A, Senti C, Bottini A, Generali D. No Advantage in Survival With Targeted Therapies as Maintenance in Patients With Limited and Extensive-Stage Small Cell Lung Cancer: A Literature-Based Meta-Analysis of Randomized Trials. Clin Lung Cancer 2016; 17:334-340. [PMID: 27346522 DOI: 10.1016/j.cllc.2016.05.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 05/20/2016] [Accepted: 05/24/2016] [Indexed: 01/27/2023]
Abstract
Small cell lung cancer (SCLC) is a lethal disease with a very restricted armamentarium of active treatments. In the new era of targeted therapies, several attempts based on the combination of chemotherapy with new compounds has been made but with a low rate of success. The idea of using the new targeted therapies as maintenance treatment after their combination with chemotherapy has been pursued. The aim of the present study was to analyze the available clinical data regarding the effect of the targeted agents as maintenance therapy on survival in patients with SCLC. A literature-based meta-analysis of randomized controlled trials, in accordance with the preferences for reported items in systematic reviews and meta-analyses guidelines, was performed. PubMed, the Cochrane Library, and a search of abstracts presented at American Society of Clinical Oncology meetings were searched for relevant studies. The primary outcome was overall survival (OS). Nine studies, with a total of 1385 patients, were included. The pooled analysis revealed that the new targeted therapies did not improve survival compared with the control arm (placebo, hazard ratio, 1.02; 95% confidence interval, 0.91-1.15; P = .69). However, a small advantage in the 1-year OS rate (risk ratio, 1.21; 95% confidence interval, 0.9-1.63; P = .21) was observed. Maintenance with targeted therapies failed to improve the survival of patients with SCLC with an increased rate of toxicity. The detected survival advantage suggests that perhaps the maintenance approach could be used to increase the 1-year OS rate. However, this finding requires confirmation in further studies, perhaps of patients selected according to their tumor biologic profile.
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Affiliation(s)
- Giandomenico Roviello
- Section of Pharmacology and University Center DIFF-Drug Innovation Forward Future, Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy; US Terapia Molecolare e Farmacogenomica, Azienda Socio-Sanitaria Territoriale di Cremona, Cremona, Italy.
| | - Laura Zanotti
- US Terapia Molecolare e Farmacogenomica, Azienda Socio-Sanitaria Territoriale di Cremona, Cremona, Italy
| | - Maria Rosa Cappelletti
- US Terapia Molecolare e Farmacogenomica, Azienda Socio-Sanitaria Territoriale di Cremona, Cremona, Italy
| | - Angela Gobbi
- US Terapia Molecolare e Farmacogenomica, Azienda Socio-Sanitaria Territoriale di Cremona, Cremona, Italy
| | - Chiara Senti
- US Terapia Molecolare e Farmacogenomica, Azienda Socio-Sanitaria Territoriale di Cremona, Cremona, Italy
| | - Alberto Bottini
- US Terapia Molecolare e Farmacogenomica, Azienda Socio-Sanitaria Territoriale di Cremona, Cremona, Italy
| | - Daniele Generali
- US Terapia Molecolare e Farmacogenomica, Azienda Socio-Sanitaria Territoriale di Cremona, Cremona, Italy; Department of Medical, Surgery and Health Sciences, University of Trieste, Trieste, Italy
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17
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Potter DS, Galvin M, Brown S, Lallo A, Hodgkinson CL, Blackhall F, Morrow CJ, Dive C. Inhibition of PI3K/BMX Cell Survival Pathway Sensitizes to BH3 Mimetics in SCLC. Mol Cancer Ther 2016; 15:1248-60. [PMID: 27197306 DOI: 10.1158/1535-7163.mct-15-0885] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 03/10/2016] [Indexed: 11/16/2022]
Abstract
Most small cell lung cancer (SCLC) patients are initially responsive to cytotoxic chemotherapy, but almost all undergo fatal relapse with progressive disease, highlighting an urgent need for improved therapies and better patient outcomes in this disease. The proapoptotic BH3 mimetic ABT-737 that targets BCL-2 family proteins demonstrated good single-agent efficacy in preclinical SCLC models. However, so far clinical trials of the BH3 mimetic Navitoclax have been disappointing. We previously demonstrated that inhibition of a PI3K/BMX cell survival signaling pathway sensitized colorectal cancer cells to ABT-737. Here, we show that SCLC cell lines, which express high levels of BMX, become sensitized to ABT-737 upon inhibition of PI3K in vitro, and this is dependent on inhibition of the PI3K-BMX-AKT/mTOR signaling pathway. Consistent with these cell line data, when combined with Navitoclax, PI3K inhibition suppressed tumor growth in both an established SCLC xenograft model and in a newly established circulating tumor cell-derived explant (CDX) model generated from a blood sample obtained at presentation from a chemorefractory SCLC patient. These data show for the first time that a PI3K/BMX signaling pathway plays a role in SCLC cell survival and that a BH3 mimetic plus PI3K inhibition causes prolonged tumor regression in a chemorefractory SCLC patient-derived model in vivo These data add to a body of evidence that this combination should move toward the clinic. Mol Cancer Ther; 15(6); 1248-60. ©2016 AACR.
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Affiliation(s)
- Danielle S Potter
- Clinical and Experimental Pharmacology Group, Cancer Research UK Manchester Institute, University of Manchester, Manchester, United Kingdom
| | - Melanie Galvin
- Clinical and Experimental Pharmacology Group, Cancer Research UK Manchester Institute, University of Manchester, Manchester, United Kingdom
| | - Stewart Brown
- Clinical and Experimental Pharmacology Group, Cancer Research UK Manchester Institute, University of Manchester, Manchester, United Kingdom
| | - Alice Lallo
- Clinical and Experimental Pharmacology Group, Cancer Research UK Manchester Institute, University of Manchester, Manchester, United Kingdom
| | - Cassandra L Hodgkinson
- Clinical and Experimental Pharmacology Group, Cancer Research UK Manchester Institute, University of Manchester, Manchester, United Kingdom
| | - Fiona Blackhall
- Institute of Cancer Sciences, University of Manchester, Manchester, United Kingdom. Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Christopher J Morrow
- Clinical and Experimental Pharmacology Group, Cancer Research UK Manchester Institute, University of Manchester, Manchester, United Kingdom
| | - Caroline Dive
- Clinical and Experimental Pharmacology Group, Cancer Research UK Manchester Institute, University of Manchester, Manchester, United Kingdom. CRUK Lung Cancer Centre of Excellence, Manchester, United Kingdom.
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18
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Koinis F, Kotsakis A, Georgoulias V. Small cell lung cancer (SCLC): no treatment advances in recent years. Transl Lung Cancer Res 2016; 5:39-50. [PMID: 26958492 PMCID: PMC4758968 DOI: 10.3978/j.issn.2218-6751.2016.01.03] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 10/28/2015] [Indexed: 12/23/2022]
Abstract
Small cell lung cancer (SCLC) is an aggressive malignancy with a distinct natural history and dismal prognosis. Given its predisposition for early dissemination, patients are commonly diagnosed with metastatic disease and chemotherapy is regarded as the cornerstone of approved treatment strategies. However, over the last 30 years there has been a distinct paucity of significant breakthroughs in SCLC therapy. Thus, SCLC is characterized as a recalcitrant neoplasm with limited therapeutic options. By employing well-established research approaches, proven to be efficacious in non-small cell lung cancer (NSCLC), a growing amount of data has shed light on the molecular biology of SCLC and enhanced our knowledge of the "drivers" of tumor cell survival and proliferation. New therapeutic targets have emerged, but no significant improvement in patients' survival has been demonstrated thus far. In a sense, the more we know, the more we fail. Nowadays this is starting to change and methodical research efforts are underway. It is anticipated that the next decade will see a revolution in the treatment of SCLC patients with the application of effective precision medicine and immunotherapy strategies.
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19
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Gozzard P, Chapman C, Vincent A, Lang B, Maddison P. Novel Humoral Prognostic Markers in Small-Cell Lung Carcinoma: A Prospective Study. PLoS One 2015; 10:e0143558. [PMID: 26606748 PMCID: PMC4659625 DOI: 10.1371/journal.pone.0143558] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 11/05/2015] [Indexed: 01/01/2023] Open
Abstract
Purpose Favourable small cell lung carcinoma (SCLC) survival outcomes have been reported in patients with paraneoplastic neurological disorders (PNDs) associated with neuronal antibodies (Neur-Abs), but the presence of a PND might have expedited diagnosis. Our aim was to establish whether neuronal antibodies, independent of clinical neurological features, correlate with SCLC survival. Experimental Design 262 consecutive SCLC patients were examined: of these, 24 with neurological disease were excluded from this study. The remaining 238 were tested for a broad array of Neur-Abs at the time of cancer diagnosis; survival time was established from follow-up clinical data. Results Median survival of the non-PND cohort (n = 238) was 9.5 months. 103 patients (43%) had one or more antigen-defined Neur-Abs. We found significantly longer median survival in 23 patients (10%) with HuD/anti-neuronal nuclear antibody type 1 (ANNA-1, 13.0 months P = 0.037), but not with any of the other antigen-defined antibodies, including the PND-related SOX2 (n = 56, 24%). An additional 28 patients (12%) had uncharacterised anti-neuronal nuclear antibodies (ANNA-U); their median survival time was longer still (15.0 months, P = 0.0048), contrasting with the survival time in patients with non-neuronal anti-nuclear antibodies (detected using HEp-2 cells, n = 23 (10%), 9.25 months). In multivariate analyses, both ANNA-1 and ANNA-U independently reduced the mortality hazard by a ratio of 0.532 (P = 0.01) and 0.430 (P<0.001) respectively. Conclusions ANNAs, including the newly described ANNA-U, may be key components of the SCLC immunome and have a potential role in predicting SCLC survival; screening for them could add prognostic value that is similar in magnitude to that of limited staging at diagnosis.
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Affiliation(s)
- Paul Gozzard
- Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom
- * E-mail:
| | - Caroline Chapman
- Division of Medical Sciences & Graduate Entry Medicine, University of Nottingham, Royal Derby Hospital, Derby, United Kingdom
| | - Angela Vincent
- Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom
| | - Bethan Lang
- Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom
| | - Paul Maddison
- Division of Clinical Neuroscience, University of Nottingham, Queen’s Medical Centre, Nottingham, United Kingdom
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20
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Petrioli R, Roviello G, Laera L, Luzzi L, Paladini P, Ghiribelli C, Voltolini L, Martellucci I, Bianco V, Francini E. Cisplatin, Etoposide, and Bevacizumab Regimen Followed by Oral Etoposide and Bevacizumab Maintenance Treatment in Patients With Extensive-Stage Small Cell Lung Cancer: A Single-Institution Experience. Clin Lung Cancer 2015; 16:e229-34. [DOI: 10.1016/j.cllc.2015.05.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 05/08/2015] [Accepted: 05/12/2015] [Indexed: 01/05/2023]
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21
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Abstract
Lung cancer is the leading cause of cancer deaths, with small cell lung cancer (SCLC) representing the most aggressive subtype. Standard treatments have not changed in decades, and the 5-year survival rate has remained <7%. Genomic analyses have identified key driver mutations of SCLC that were subsequently validated in animal models of SCLC. To provide better treatment options, a deeper understanding of the cellular and molecular mechanisms underlying SCLC initiation, progression, metastasis, and acquisition of resistance is required. In this review, we describe the genetic landscape of SCLC, features of the cell of origin, and targeted therapeutic approaches.
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Affiliation(s)
- Ekaterina A Semenova
- Division of Molecular Genetics, The Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands
| | - Remco Nagel
- Division of Molecular Genetics, The Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands
| | - Anton Berns
- Division of Molecular Genetics, The Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands
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22
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Behera M, Ragin C, Kim S, Pillai RN, Chen Z, Steuer CE, Saba NF, Belani CP, Khuri FR, Ramalingam SS, Owonikoko TK. Trends, predictors, and impact of systemic chemotherapy in small cell lung cancer patients between 1985 and 2005. Cancer 2015; 122:50-60. [PMID: 26441041 DOI: 10.1002/cncr.29674] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Revised: 08/03/2015] [Accepted: 08/03/2015] [Indexed: 11/10/2022]
Abstract
BACKGROUND The last 3 decades have witnessed limited therapeutic advances in small cell lung cancer (SCLC) management. This study evaluated real-world trends in the use of systemic therapies and the impact on patient outcomes in the United States. METHODS The Surveillance, Epidemiology, and End Results-Medicare database was used to find patients diagnosed with SCLC between 1985 and 2005. The 1985-1990 period served as the baseline for a temporal analysis conducted at 5-year intervals (1985-1990, 1991-1995, 1996-2000, and 2001-2005). Cox proportional models were used to estimate the effect of chemotherapy on survival. Results were validated with a propensity-matched analysis. RESULTS There were 47,351 eligible patients: 52% were male; the median age was 71 years; and 87% were white, 7% were black, and 1.4% were Asian. The proportion of patients treated with chemotherapy was low but increased over time (38%, 55%, 50%, and 53%; P < .001). Race, diagnosis period, age, stage, and location of residence significantly predicted chemotherapy use. Females (51%), Asians (53%), and rural residents (60%) were more likely to receive chemotherapy. The median overall survival with and without chemotherapy was 9.6 and 3.6 months, respectively. Linear trend analyses showed a modest reduction in the impact of chemotherapy on survival for patients treated with chemotherapy versus untreated patients (hazard ratios [HRs], 0.59, 0.61, 0.64, and 0.62; P < .001) but an overall trend of improved survival for treated (HRs, 1.0, 1.03, 1.00, and 0.96; P = .005) and untreated patients (HRs, 1.0, 0.99, 0.94, and 0.92; P < .001). There was no survival difference between patients treated with carboplatin and patients treated with cisplatin (HR, 0.99; confidence interval [CI], 0.81-1.19; P = .875). Additional therapy beyond platinum-based chemotherapy was associated with a survival benefit (HR, 0.78; CI, 0.75-0.81; P < .001). CONCLUSIONS Chemotherapy use was associated with a survival benefit in Medicare patients with SCLC treated in a real-world setting.
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Affiliation(s)
- Madhusmita Behera
- Department of Hematology and Medical Oncology, Emory University, Atlanta, Georgia
| | - Camille Ragin
- Cancer Prevention and Control Program, Fox Chase Cancer Center, Temple Health, Philadelphia, Pennsylvania
| | - Sungjin Kim
- Biostatistics and Bioinformatics Research Center, Cedars-Sinai Medical Center, Los Angeles, California
| | - Rathi N Pillai
- Department of Hematology and Medical Oncology, Emory University, Atlanta, Georgia
| | - Zhengjia Chen
- Biostatistics Core, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Conor E Steuer
- Department of Hematology and Medical Oncology, Emory University, Atlanta, Georgia
| | - Nabil F Saba
- Department of Hematology and Medical Oncology, Emory University, Atlanta, Georgia
| | | | - Fadlo R Khuri
- Department of Hematology and Medical Oncology, Emory University, Atlanta, Georgia.,Biostatistics Core, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Suresh S Ramalingam
- Department of Hematology and Medical Oncology, Emory University, Atlanta, Georgia.,Biostatistics Core, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Taofeek K Owonikoko
- Department of Hematology and Medical Oncology, Emory University, Atlanta, Georgia.,Biostatistics Core, Winship Cancer Institute, Emory University, Atlanta, Georgia
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23
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Zhang J, Wang HT, Li BG. Prognostic significance of circulating tumor cells in small--cell lung cancer patients: a meta-analysis. Asian Pac J Cancer Prev 2015; 15:8429-33. [PMID: 25339041 DOI: 10.7314/apjcp.2014.15.19.8429] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Circulating tumor cells (CTCs) are believed to be particularly important and a reliable marker of malignancy. However, the prognostic significance of CTCs detected in patients with small cell lung cancer (SCLC) is still unclear. We therefore aimed to assess the prognostic relevance of CTCs using a meta-analysis. We searched PubMed for relevant studies and statistical analyses were conducted to calculate the hazard ratio (HR) and 95% confidence intervals (CIs) using fixed or random-effect models according to the heterogeneity of included studies. A total of 7 papers covering 440 SCLC patients were combined in the final analysis. The meta-analysis revealed that CTCs were significantly associated with shorter overall survival (HR=1.9; 95%CI: 1.19-3.04; Z=2.67; P<0.0001) and progression-free survival (HR=2.6; 95%CI: 1.9-3.54; Z=6.04; P<0.0001). The results thus suggest that the presence of CTCs indicates a poor prognosis in patients with SCLC. Further well-designed prospective studies are required to explore the clinical applications of CTCs in SCLC.
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Affiliation(s)
- Jiao Zhang
- Department of Interventional Therapy, Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China E-mail :
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Ulger S, Demirci NY, Aydinkarahaliloglu E, Kahraman FC, Ozmen O, Erdogan Y, Cetin E, Avci E, Cengiz M. PET-CT guided curative conformal radiation therapy in limited stage small cell lung cancer. J Thorac Dis 2015; 7:295-302. [PMID: 25922706 DOI: 10.3978/j.issn.2072-1439.2015.02.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 01/09/2015] [Indexed: 11/14/2022]
Abstract
BACKGROUND The prognosis of small cell lung cancer (SCLC) has been improving with the advances in diagnostic and therapeutic modalities. Positron emission tomography/computed tomography (FDG-PET/CT) which has been studied in non-small cell lung cancer (NSCLC) for a long time, and it has only recently been applied to SCLC. Therefore we sought to observe firstly the prognostic importance of the FDG uptake in limited disease small cell lung cancer (LD-SCLC) patients and secondly the clinical outcomes and toxicity profiles of LD-SCLC patients treated with conformal radiation therapy (RT) using FDG-PET/CT simulation. METHODS Between 2009 and 2011, 33 LD-SCLC patients with LD-SCLC underwent disease staging using FDG-PET/CT conformal RT. Thoracic radiation was administered at a daily fraction of 2 Gy. Total dose was prescribed according to the treatment protocol such as, concurrent or sequential chemotherapy and in some patients according to the response of CT. All patients underwent chemotherapy. Survival was estimated using the Kaplan-Meier method. RESULTS The median age of the patients was 58 years (range, 38-77 years). The median follow-up time was 20 months (range, 6.6-47.6 months). The 3-year overall survival (OS) and locoregional control rates were 23% and 48%, respectively. CONCLUSIONS There are few studies examining the impact of PET-CT and the prognostic significance of FDG-uptake on outcomes in patients with LD-SCLC. Higher RT doses in response to higher FDG uptake may be safely applied for the purpose of locoregional control.
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Affiliation(s)
- Sukran Ulger
- 1 Department of Radiation Oncology, 2 Department of Chest Disease, Faculty of Medicine, Gazi University, Ankara, Turkey ; 3 Department of Radiation Oncology, 4 Department of Nuclear Medicine, 5 Department of Chest Disease, Ataturk Chest Disease and Thoracic Surgery Training and Research Hospital, Ankara, Turkey ; 6 Department of Public Health, Faculty of Medicine, Gazi University, Ankara, Turkey ; 7 Department of Radiation Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Nilgun Yilmaz Demirci
- 1 Department of Radiation Oncology, 2 Department of Chest Disease, Faculty of Medicine, Gazi University, Ankara, Turkey ; 3 Department of Radiation Oncology, 4 Department of Nuclear Medicine, 5 Department of Chest Disease, Ataturk Chest Disease and Thoracic Surgery Training and Research Hospital, Ankara, Turkey ; 6 Department of Public Health, Faculty of Medicine, Gazi University, Ankara, Turkey ; 7 Department of Radiation Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ercan Aydinkarahaliloglu
- 1 Department of Radiation Oncology, 2 Department of Chest Disease, Faculty of Medicine, Gazi University, Ankara, Turkey ; 3 Department of Radiation Oncology, 4 Department of Nuclear Medicine, 5 Department of Chest Disease, Ataturk Chest Disease and Thoracic Surgery Training and Research Hospital, Ankara, Turkey ; 6 Department of Public Health, Faculty of Medicine, Gazi University, Ankara, Turkey ; 7 Department of Radiation Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Fatih Caglar Kahraman
- 1 Department of Radiation Oncology, 2 Department of Chest Disease, Faculty of Medicine, Gazi University, Ankara, Turkey ; 3 Department of Radiation Oncology, 4 Department of Nuclear Medicine, 5 Department of Chest Disease, Ataturk Chest Disease and Thoracic Surgery Training and Research Hospital, Ankara, Turkey ; 6 Department of Public Health, Faculty of Medicine, Gazi University, Ankara, Turkey ; 7 Department of Radiation Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ozlem Ozmen
- 1 Department of Radiation Oncology, 2 Department of Chest Disease, Faculty of Medicine, Gazi University, Ankara, Turkey ; 3 Department of Radiation Oncology, 4 Department of Nuclear Medicine, 5 Department of Chest Disease, Ataturk Chest Disease and Thoracic Surgery Training and Research Hospital, Ankara, Turkey ; 6 Department of Public Health, Faculty of Medicine, Gazi University, Ankara, Turkey ; 7 Department of Radiation Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Yurdanur Erdogan
- 1 Department of Radiation Oncology, 2 Department of Chest Disease, Faculty of Medicine, Gazi University, Ankara, Turkey ; 3 Department of Radiation Oncology, 4 Department of Nuclear Medicine, 5 Department of Chest Disease, Ataturk Chest Disease and Thoracic Surgery Training and Research Hospital, Ankara, Turkey ; 6 Department of Public Health, Faculty of Medicine, Gazi University, Ankara, Turkey ; 7 Department of Radiation Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Eren Cetin
- 1 Department of Radiation Oncology, 2 Department of Chest Disease, Faculty of Medicine, Gazi University, Ankara, Turkey ; 3 Department of Radiation Oncology, 4 Department of Nuclear Medicine, 5 Department of Chest Disease, Ataturk Chest Disease and Thoracic Surgery Training and Research Hospital, Ankara, Turkey ; 6 Department of Public Health, Faculty of Medicine, Gazi University, Ankara, Turkey ; 7 Department of Radiation Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Emine Avci
- 1 Department of Radiation Oncology, 2 Department of Chest Disease, Faculty of Medicine, Gazi University, Ankara, Turkey ; 3 Department of Radiation Oncology, 4 Department of Nuclear Medicine, 5 Department of Chest Disease, Ataturk Chest Disease and Thoracic Surgery Training and Research Hospital, Ankara, Turkey ; 6 Department of Public Health, Faculty of Medicine, Gazi University, Ankara, Turkey ; 7 Department of Radiation Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Mustafa Cengiz
- 1 Department of Radiation Oncology, 2 Department of Chest Disease, Faculty of Medicine, Gazi University, Ankara, Turkey ; 3 Department of Radiation Oncology, 4 Department of Nuclear Medicine, 5 Department of Chest Disease, Ataturk Chest Disease and Thoracic Surgery Training and Research Hospital, Ankara, Turkey ; 6 Department of Public Health, Faculty of Medicine, Gazi University, Ankara, Turkey ; 7 Department of Radiation Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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Wallace AS, Arya M, Frazier SR, Westgate S, Wang Z, Doll D. Combined small-cell lung carcinoma: An institutional experience. Thorac Cancer 2014; 5:57-62. [PMID: 26766973 DOI: 10.1111/1759-7714.12059] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Accepted: 06/07/2013] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The purpose of this study is to determine prognostic factors and survival in patients who present with combined small-cell lung cancer (SCLC). METHODS A retrospective review of combined SCLC histology in patients treated between1995-2010 was undertaken. Demographics, diagnostic information, disease characteristics, treatment modality, and survival were captured. Survival estimates were performed using Kaplan Meier analysis. Statistical significance was defined as P < 0.05. RESULTS Forty-one patients were identified, and 35 records were available for analysis. Median age at diagnosis was 68 (range 50-85). The study included 20 (57%) women and 15 (43%) men; and 94% had a current or former history of smoking. Histology was SCLC/large cell carcinoma not otherwise specified in 28 (80%), and SCLC/adenocarcinoma or SCLC/squamous cell carcinoma in seven (20%). Cardiac or pulmonary comorbidities were present in 80% of patients, and 24 patients had metastatic disease at presentation. Twenty-eight patients received treatment of chemotherapy (n = 24), cranial radiotherapy (n = 5), or thoracic radiotherapy (n = 7). Staging was as follows: stage I-III (n = 11), stage IV (n = 24). Median survival was 15.4 months (range <1-53 months) and 3.4 months (range <1-21.9 months) for American Joint Committee on Cancer (AJCC) stage I-III and stage IV, respectively. Estimated overall six and 12 month survival was 82%, 55%, 37%, and 17% for stage I-III and stage IV, respectively. An improved overall survival rate was found for patients with an Eastern Cooperative Oncology Group performance status of <2, and no weight loss (P < 0.05). CONCLUSION Akin to SCLC, advanced stage combined SCLC portends a poor prognosis. Perhaps novel chemotherapeutic drugs or targeted agents may improve outcomes for future patient populations.
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Affiliation(s)
| | - Monika Arya
- Division of Hematology and Medical Oncology, University of Missouri, School of Medicine Columbia, MO, USA
| | - Shellaine R Frazier
- Department of Pathology and Anatomical Science, University of Missouri, School of Medicine Columbia, MO, USA
| | - Steven Westgate
- Department of Radiology, University of Missouri, School of Medicine Columbia, MO, USA
| | - Zhenyu Wang
- Department of Statistics, University of Missouri Columbia, MO, USA
| | - Donald Doll
- Division of Hematology and Medical Oncology, University of Missouri, School of Medicine Columbia, MO, USA
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Chan BA, Coward JIG. Chemotherapy advances in small-cell lung cancer. J Thorac Dis 2013; 5 Suppl 5:S565-78. [PMID: 24163749 PMCID: PMC3804877 DOI: 10.3978/j.issn.2072-1439.2013.07.43] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Accepted: 07/30/2013] [Indexed: 12/26/2022]
Abstract
Although chemotherapeutic advances have recently been heralded in lung adenocarcinomas, such success with small-cell lung cancer (SCLC) has been ominously absent. Indeed, the dismal outlook of this disease is exemplified by the failure of any significant advances in first line therapy since the introduction of the current standard platinum-etoposide doublet over 30 years ago. Moreover, such sluggish progress is compounded by the dearth of FDA-approved agents for patients with relapsed disease. However, over the past decade, novel formulations of drug classes commonly used in SCLC (e.g. topoisomerase inhibitors, anthracyclines, alkylating and platinum agents) are emerging as potential alternatives that could effectively add to the armamentarium of agents currently at our disposal. This review is introduced with an overview on the historical development of chemotherapeutic regimens used in this disease and followed by the recent encouraging advances witnessed in clinical trials with drugs such as amrubicin and belotecan which are forging new horizons for future treatment algorithms.
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Affiliation(s)
- Bryan A. Chan
- Mater Adult Hospital, Department of Medical Oncology, Raymond Terrace, Brisbane, QLD 4101, Australia
- School of Medicine, University of Queensland, St Lucia, Brisbane, QLD 4072, Australia
| | - Jermaine I. G. Coward
- Mater Adult Hospital, Department of Medical Oncology, Raymond Terrace, Brisbane, QLD 4101, Australia
- School of Medicine, University of Queensland, St Lucia, Brisbane, QLD 4072, Australia
- Inflammation & Cancer Therapeutics Group, Mater Research, Level 4, Translational Research Institute, Woolloongabba, Brisbane, QLD 4102, Australia
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Ost DE, Jim Yeung SC, Tanoue LT, Gould MK. Clinical and organizational factors in the initial evaluation of patients with lung cancer: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 2013; 143:e121S-e141S. [PMID: 23649435 PMCID: PMC4694609 DOI: 10.1378/chest.12-2352] [Citation(s) in RCA: 110] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Accepted: 11/30/2012] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND This guideline is intended to provide an evidence-based approach to the initial evaluation of patients with known or suspected lung cancer. It also includes an assessment of the impact of timeliness of care and multidisciplinary teams on outcome. METHODS The applicable current medical literature was identified by a computerized search and evaluated using standardized methods. Recommendations were framed using the approach described by the Guidelines Oversight Committee of the American College of Chest Physicians. Data sources included MEDLINE and the Cochrane Database of Systematic Reviews. RESULTS Initial evaluation should include a thorough history and physical examination; CT imaging; pulmonary function tests; and hemoglobin, electrolyte, liver function, and calcium levels. Additional testing for distant metastases and paraneoplastic syndromes should be determined on the basis of these results. Paraneoplastic syndromes may have an adverse impact on cancer treatment, so they should be controlled rapidly with the goal of proceeding with definitive cancer treatment in a timely manner. Although the relationship between timeliness of care and survival is difficult to quantify, efforts to deliver timely care are reasonable and should be balanced with the need to attend to other dimensions of health-care quality (eg, safety, effectiveness, efficiency, equality, consistency with patient values and preferences). Quality care will require multiple disciplines. Although it is difficult to assess the impact, we suggest that a multidisciplinary team approach to care be used, particularly for patients requiring multimodality therapy. CONCLUSIONS The initial evaluation of patients with lung cancer should include a thorough history and physical examination, pulmonary function tests, CT imaging, basic laboratory tests, and selective testing for distant metastases and paraneoplastic syndromes.
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Affiliation(s)
- David E Ost
- Department of Pulmonary Medicine, MD Anderson Cancer Center, The University of Texas, Houston, TX.
| | - Sai-Ching Jim Yeung
- Department of Emergency Medicine, MD Anderson Cancer Center, The University of Texas, Houston, TX; Department of Endocrine, Neoplasia & Hormonal Disorders, MD Anderson Cancer Center, The University of Texas, Houston, TX
| | - Lynn T Tanoue
- Department of Medicine, Section of Pulmonary and Critical Care Medicine, Yale University, New Haven, CT
| | - Michael K Gould
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
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Small cell carcinoma of the larynx treated by concurrent chemoradiotherapy: a case report. Case Rep Otolaryngol 2012; 2012:316165. [PMID: 22953108 PMCID: PMC3420722 DOI: 10.1155/2012/316165] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2011] [Accepted: 02/01/2012] [Indexed: 12/26/2022] Open
Abstract
Small cell carcinoma (SmCC) generally occurs in the lung and extrapulmonary SmCC is a relatively rare entity. Here, we present a case of a 42-year-old male with SmCC of the larynx diagnosed as cT3N0M0. Concurrent chemoradiotherapy using cisplatin (CDDP) and etoposide (VP-16) was given, which achieved complete response (CR). Lung metastasis became evident in 16 months whereas the locoregional control remained good. In spite of intensive chemotherapy using CDDP and irinotecan (CPT-11), the patient died of disease in 34 months after the first interview. Since the prognosis of laryngeal SmCC is extremely poor, organ preservation therapy should be considered instead of radical laryngectomy.
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Affiliation(s)
- Seth Kligerman
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland, Baltimore, MD 20201, USA.
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Abstract
The incidence and mortality of small-cell lung cancer worldwide make this disease a notable health-care issue. Diagnosis relies on histology, with the use of immunohistochemical studies to confirm difficult cases. Typical patients are men older than 70 years who are current or past heavy smokers and who have pulmonary and cardiovascular comorbidities. Patients often present with rapid-onset symptoms due to local intrathoracic tumour growth, extrapulmonary distant spread, paraneoplastic syndromes, or a combination of these features. Staging aims ultimately to define disease as metastatic or non-metastatic. Combination chemotherapy, generally platinum-based plus etoposide or irinotecan, is the mainstay first-line treatment for metastatic small-cell lung cancer. For non-metastatic disease, evidence supports early concurrent thoracic radiotherapy. Prophylactic cranial irradiation should be considered for patients with or without metastases whose disease does not progress after induction chemotherapy and radiotherapy. Despite high initial response rates, most patients eventually relapse. Except for topotecan, few treatment options then remain. Signalling pathways have been identified that might yield new drug targets.
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Affiliation(s)
- Jan P van Meerbeeck
- Department of Respiratory Medicine and Lung Oncological Network, Ghent University Hospital, Ghent, Belgium.
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Abstract
PURPOSE OF REVIEW Paraneoplastic syndromes occur commonly in patients with lung cancer, especially cancers of neuroendocrine origin. The syndromes can be the first clinical manifestation of malignant disease or a harbinger of cancer recurrence. To update the knowledge that would facilitate the care of lung cancer patients with paraneoplastic syndromes, this review focuses on the epidemiology, pathogenesis, clinical features, and current management of the more common and clinically relevant syndromes. RECENT FINDINGS Certain combinations of clinical signs and symptoms (endocrine, neurologic, immunologic, dermatologic, metabolic, constitutional, and hematologic) are associated with lung carcinoma as a manifestation of the secretion of cytokines and hormones by these cells or as an associated immunologic response. These syndromes can be categorized by common causative mechanisms: hormonal syndromes, autoimmune syndromes, and other syndromes of less clear cause. Recent advances in medical technology have allowed better understanding of these syndromes and the development of novel diagnostic and therapeutic tools. SUMMARY Increased awareness of paraneoplastic syndromes associated with lung cancer should lead to the earlier recognition and diagnosis of malignancies, thereby improving the overall prognosis of patients and alleviating associated comorbidities. Despite the recent advances in recognizing and treating paraneoplastic syndromes, many questions remain to be answered.
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Ejaz S, Vassilopoulou-Sellin R, Busaidy NL, Hu MI, Waguespack SG, Jimenez C, Ying AK, Cabanillas M, Abbara M, Habra MA. Cushing syndrome secondary to ectopic adrenocorticotropic hormone secretion: the University of Texas MD Anderson Cancer Center Experience. Cancer 2011; 117:4381-9. [PMID: 21412758 DOI: 10.1002/cncr.26029] [Citation(s) in RCA: 104] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2010] [Revised: 12/28/2010] [Accepted: 01/18/2011] [Indexed: 12/20/2022]
Abstract
BACKGROUND Cushing syndrome (CS) secondary to ectopic adrenocorticotropic hormone (ACTH) secretion (EAS) has been described in association with a variety of tumors. The current experience with this syndrome was based on a few case series and individual case reports. Limited data were available about the tumors associated with CS-EAS in a cancer center setting. In this report, the authors have described their experience with CS-EAS at The University of Texas MD Anderson Cancer Center to further enhance the current understanding and management of this syndrome. METHODS This was a retrospective review of 43 patients with CS-EAS who were diagnosed between 1979 and 2009 at The University of Texas MD Anderson Cancer Center. RESULTS Different neuroendocrine tumors were associated with CS-EAS. Twenty-one patients (48.9%) had tumors located in the chest cavity, with bronchial carcinoid and small cell lung cancer representing the 2 most common causes. The ACTH source remained occult in 4 patients (9.3%) despite extensive workup. Clinical presentation varied, and the classic features of CS were not evident in some patients. Death occurred in 27 patients (62.8%), and the median overall survival was 32.2 months. Major morbidities included new-onset or worsening hyperglycemia (77%), symptomatic venous thromboembolism (14%), and infections (23%). CONCLUSIONS In patients with CS-EAS who attended a comprehensive cancer center, tumors originating in the chest cavity were the leading tumors associated with this syndrome. The authors suspect that CS-EAS is under reported because of the atypical presentation in some patients. Thus, they suggest careful evaluation of patients with neuroendocrine tumors to avoid missing coexisting CS-EAS.
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Affiliation(s)
- Shamim Ejaz
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Moran CA, Suster S, Coppola D, Wick MR. Neuroendocrine carcinomas of the lung: a critical analysis. Am J Clin Pathol 2009; 131:206-21. [PMID: 19141381 DOI: 10.1309/ajcp9h1otmucskqw] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Neuroendocrine carcinomas represent an important group of primary neoplasms in the lung. During the last decades, the nomenclature of these tumors has evolved and the current use of immunohistochemical and molecular biology studies have, to some extent, expanded the conventional view of these tumors. However, the primary diagnosis of most of these lesions is performed on limited biopsy specimens, which may not translate well when one is confronted with a nomenclature that is based on resected material. In addition, for some of these specific entities, some confusion and controversy apparently remain, allowing for the proliferations of different terms that, although they may be dismissed as "semantics," may have a role in interpretation, further subclassification, and, possibly, treatment. Herein we review current concepts regarding the classification of these neoplasms and the role of this classification in our daily practice and discuss how it may impact treatment.
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Affiliation(s)
- Cesar A. Moran
- Departments of Pathology, University of Texas, M.D. Anderson Cancer Center, Houston
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Amarasena IU, Walters JAE, Wood-Baker R, Fong K. Platinum versus non-platinum chemotherapy regimens for small cell lung cancer. Cochrane Database Syst Rev 2008:CD006849. [PMID: 18843733 DOI: 10.1002/14651858.cd006849.pub2] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Small cell lung cancer (SCLC) is a very fast growing form of cancer and is characterised by early metastasis. As a result, chemotherapy is the mainstay of treatment. A number of different platinum-based chemotherapy regimens and non-platinum-based chemotherapy regimens have been used for the treatment of SCLC, with varying results. This review was conducted to analyse the data from these trials in order to compare their effectiveness. OBJECTIVES To determine the effectiveness of platinum chemotherapy regimens compared with non-platinum chemotherapy regimens in the treatment of SCLC with respect to survival, tumour response, toxicity and quality of life. SEARCH STRATEGY We searched the biomedical literature databases CENTRAL (The Cochrane Library 2007, Issue 2), MEDLINE, EMBASE and CINAHL from 1966 to April 2007. In addition, we handsearched reference lists from relevant resources. SELECTION CRITERIA All randomised controlled trials involving patients with pathologically confirmed (cytological or histological) SCLC and the use of a platinum-based chemotherapy regimen in at least one treatment arm and a non-platinum-based chemotherapy regimen in a separate arm. DATA COLLECTION AND ANALYSIS Two authors independently assessed search results. We assessed included studies for methodological quality and recorded the following outcome data: survival, tumour response, toxicity and quality of life. We combined the results of the survival, tumour response and toxicity data in a meta-analysis. MAIN RESULTS A total of 29 trials involving 5530 patients were included in this systematic review. There was no statistically significant difference between treatment groups in terms of survival at 6 months, 12 months and 24 months. There was also no statistically significant difference in terms of overall tumour response. However, platinum-based treatment regimens did have a significantly higher rate of complete response. Platinum-based chemotherapy regimens had significantly higher rates of nausea and vomiting, anaemia and thrombocytopenia toxicity. Three trials presented quality of life data but the data presented were not complete and therefore could not be combined in a meta-analysis. AUTHORS' CONCLUSIONS Platinum-based chemotherapy regimens did not offer a statistically significant benefit in survival or overall tumour response compared with non-platinum-based regimens. However, platinum-based chemotherapy regimens did increase complete response rates, at the cost of higher adverse events including nausea and vomiting, anaemia and thrombocytopenia toxicity. These data suggest non-platinum chemotherapy regimens have a more advantageous risk-benefit profile. This systematic review highlights the lack of quality of life data in trials involving chemotherapy treatment for SCLC. With poor long-term survival associated with both treatment groups, the issue of the quality of the survival period takes on even more significance. It would be beneficial for future trials in this area to include a quality of life assessment.
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Affiliation(s)
- Isuru U Amarasena
- School of Medicine, Faculty of Health Science, University of Tasmania, 43 Collins Street, Hobart, Tasmania, Australia, 2005.
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Abstract
Small cell carcinoma (SCC) has become recognized as a distinct, though relatively infrequent, clinical pathology that occurs in multiple sites throughout the head and neck. Excluding cases that are considered to arise from skin, SCC in the head and neck has been found to develop in nearly all structures associated with the upper aerodigestive tract. Among the head and neck sites, the frequency of SCC is greatest in the larynx, with salivary glands and the sinonasal region comprising the other principle areas of origin. Controversy exist as to whether SCC can develop as a distinct entity in the thyroid, with most tumors that previously would have been considered as SCC now found to be lymphomas or variant forms of other types of thyroid malignancy. While there seems to be some differences among tumors arising from the various subsites, in general all SCC that originate in the head and neck have a tendency for aggressive local invasion and a strong propensity for both regional and distant metastasis. Treatment may include surgical resection, radiotherapy, chemotherapy, or some combination of these modalities. Due to the infrequency of these tumors, it is very unlikely that any large, controlled study will ever be done. For this reason, recommendations for treatment of SCC arising in the head and neck are based primarily on retrospective data from various small case series and on comparative data for treatment of SCC of bronchogenic and other extrapulmonary origin. Although patients with truly limited local disease may enjoy some prolonged survival, most patients with this tumor do poorly despite all current attempts at treatment.
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Affiliation(s)
- Gregory Renner
- Department of Otolaryngology - Head and Neck Surgery, University of Missouri School of Medicine, Columbia, MO 65212, USA.
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Noguchi K, Urade M, Sakurai K, Nishimura N, Hashitani S, Kishimoto H. Small cell neuroendocrine carcinoma of the maxillary sinus--a case report and nude mouse transplantable model. Head Neck 2002; 24:491-6. [PMID: 12001080 DOI: 10.1002/hed.10059] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A rare case of small cell neuroendocrine carcinoma (SNEC) arising in the maxillary sinus is presented, and a SNEC tumor line serially transplantable in nude mice was established. Tumor marker for SNEC is also discussed. METHODS The tumor tissues obtained from operated material were heterotransplanted subcutaneously into nude mice. Histopathologic studies and immunoradiometric assays for NSE and pro-GRP in serum were performed. RESULTS The primary lesion was composed of tumor nests of small cells with hyperchromatic nuclei and was positive for NSE and chromogranin A immunohistochemically. Serum levels of NSE and pro-GRP changed dynamically, reflecting the clinical status. Nude mouse tumor showed similar histologic features to those of original tumor and expressed NSE. Neuroendocrine granules were detected in tumor cells in electron microscopy. Serum NSE level in nude mice was elevated in proportion to the relative tumor weight. CONCLUSIONS Serum NSE and pro-GRP were useful tumor markers for extrapulmonary SNEC. A SNEC tumor transplantable in nude mice would provide a valuable model for characterization of this lesion.
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Affiliation(s)
- Kazuma Noguchi
- Department of Oral and Maxillofacial Surgery, Hyogo College of Medicine, 1-1, Mukogawa-cho, Nishinomiya, Hyogo 663-8501, Japan
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Abstract
Ectopic POMC syndrome remains one of the most challenging differential diagnoses in endocrinology. Recent progress in the understanding of the tissue specific regulation of POMC gene expression and new insights into the processing of the POMC peptide in nonpituitary tissues has helped elucidate some of the molecular events leading to ectopic expression and secretion of POMC peptides. Corticotropin and other POMC-derived peptides have diverse effects on adrenal steroidogenesis, growth, and extra-adrenal tissues. Differences in POMC gene regulation in the corticotrope versus ectopic POMC-producing tumors provides a scientific framework for the clinical distinction between eutopic and ectopic Cushing's syndrome. In an attempt to revisit recent basic and clinical advances in the diagnosis of ectopic POMC syndrome the authors undertook an extensive literature review of 530 cases in 197 published papers and provided a molecular biologic, demographic and diagnostic update. According to this review, the four most common causes of ectopic POMC syndrome are the small cell carcinoma of the lung (27%), bronchial carcinoids (21%), islet cell tumor of the pancreas (16%), and thymic carcinoids (10%). Although the clinical features of patients with ectopic POMC syndrome are similar to those with Cushing's disease, subgroup analysis reveals a broad spectrum of severity and progression of signs and symptoms of hypercortisolism. The endocrine workup of a patient with suspected ectopic POMC syndrome includes the establishment of pathologic hypercortisolism, diagnosis of corticotropin dependency, and the differential diagnosis of corticotropin-dependent Cushing's syndrome. The use of a variety of baseline endocrine values, dynamic endocrine testing, and invasive procedures leads to the correct diagnosis in the majority of patients with ectopic POMC syndrome. Diagnostic imaging, including conventional radiological techniques and somatostatin receptor scintigraphy, aids in the correct localization and eventual treatment of ectopic POMC production.
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Affiliation(s)
- Felix Beuschlein
- Division of Endocrinology and Metabolism, Department of Internal Medicine, University of Michigan, 5560A MSRB II, 1150 West Medical Center Dr., Ann Arbor, MI 48109-0678, USA
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Affiliation(s)
- L Bollanti
- INRCA, Italian National Research Centers on Aging, Endocrine Unit, Rome
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39
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Niell HB, Perry MC, Clamon G, Crawford J, Miller AA, Herndon J, Green MR. Carboplatin/Etoposide/Paclitaxel in the Treatment of Patients with Extensive Small-Cell Lung Cancer. Clin Lung Cancer 2001; 2:204-9. [PMID: 14700479 DOI: 10.3816/clc.2001.n.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The purpose of this study was to examine the safety and efficacy of carboplatin/etoposide/paclitaxel in patients with untreated stage IV non-small-cell lung cancer (NSCLC) and extensive small-cell lung cancer (SCLC). Carboplatin was administered intravenously (i.v.) at an area under the curve (AUC) of 6 with etoposide at either 80 or 100 mg/m2 i.v. days 1-3 and paclitaxel at 175 or 200 mg/m2 i.v. over 3 hours along with 5 g/kg of granulocyte colony-stimulating factor subcutaneously on days 4-18, repeated every 3 weeks for 6 courses. Thirty-one patients (five NSCLC and 26 SCLC) entered into this phase I study. The median age was 63 (range, 42 to 74 years), with 24 males and seven females. The recommended dose level for phase II testing was carboplatin AUC = 6, etoposide 80 mg/m2 days 1-3, and paclitaxel 175 mg/m2 over 3 hours. With seven patients at this level, 14% had grade 4 neutropenia, 14% had grade 4 thrombocytopenia, none had grade 2/3 neurotoxicity, and no toxic deaths occurred. One of five (20%) patients with NSCLC responded, and 19 of 22 (86%) evaluable SCLC patients experienced a response to therapy. SCLC patients had a median survival of 10 months. The combination of carboplatin/etoposide/paclitaxel has significant activity with acceptable toxicity in patients with extensive SCLC.
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Affiliation(s)
- H B Niell
- Division of Hematology/Oncology, University of Tennessee, Memphis, Memphis, TN 38163, USA.
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40
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Eftekhari F, Wallace S, Silva EG, Lenzi R. Merkel cell carcinoma of the skin: imaging and clinical features in 93 cases. Br J Radiol 1996; 69:226-33. [PMID: 8800866 DOI: 10.1259/0007-1285-69-819-226] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Clinical, pathological and imaging data for 93 patients with Merkel cell carcinoma were reviewed. Median survival duration from the date of diagnosis was estimated using the Kaplan-Meier product-limit method. Survival durations of patients with no metastastic disease, with regional lymph node metastasis only and with distant metastases were compared using the Cox-Mantel log-rank test. The median age for patients with Merkel cell carcinoma was 70 years (range 35-91 years). The tumour occurred in 71 men and 22 women. The most common primary site was the head and neck region (64 patients), followed by the extremities (21 patients) and the trunk (10 patients). Median survival duration for the whole group was 33 months (range 2-140 months). Imaging studies of the primary sites were available for 10 patients and of metastatic sites for seven patients. Sonograms of the primary skin lesions showed single or multicentric hypoechoic nodules arising from the dermis and growing into the subcutaneous tissues. CT scans showed single or multiple minimally enhancing soft tissue nodules, in two instances associated with lytic bone erosion. The metastatic lesions were moderately hypoechoic on sonography and target-shaped with or without ring-enhancement on CT. Imaging studies have a limited role in diagnosis of the clinically evident primary skin lesions, but may be helpful in the assessment of the depth of the invasion and are crucial in the evaluation of regional and distant metastatic disease. If regional adenopathy is found then CT of the chest, abdomen and pelvis may be in order.
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Affiliation(s)
- F Eftekhari
- Department of Diagnostic Radiology, University of Texas M D Anderson Cancer Center, Houston 77030, USA
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41
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Fukunaga M, Shinozaki N. Immunohistochemical and flow cytometric study of neuroendocrine carcinoma of the skin. Pathol Int 1995; 45:513-9. [PMID: 7551012 DOI: 10.1111/j.1440-1827.1995.tb03494.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Immunohistochemical and flow cytometric analysis using formalin-fixed, paraffin-embedded sections was performed on 10 neuroendocrine carcinomas of the skin (NCS). Grimelius staining was positive in seven tumors. All tumors showed coexpression of CAM 5.2 and neuron-specific enolase with paranuclear dot-like or diffuse cytoplasmic reactivity. Neurofilament was positive in five cases, chromogranin in six, calcitonin and carcinoembryonic antigen in two each, and somatostatin and S-100 protein in one each. Eight primary lesions were diploid and the remaining two were aneuploid; however, two diploid NCS presented as aneuploid metastatic tumors. The follow-up periods ranged from 3 to 66 months (mean 13.6). Six patients died of metastatic diseases between 3 and 33 months (mean 9.2) after the diagnosis. There were no significant correlations among histologic features, DNA ploidy, S-phase fraction, and clinical outcome of the patients with NCS. These results indicate that a panel of antibodies may be required for immunohistochemical confirmation of neuroendocrine differentiation and that a flow cytometric analysis is not a good tool to predict the biologic behavior of NCS.
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Affiliation(s)
- M Fukunaga
- Department of Pathology, Jikei University School of Medicine, Tokyo, Japan
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42
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Amsler UJ, Pasi A, Qu BX. A novel hypothesis: specific oncogenes and tumor suppression genes are involved in the expression of the proopiomelanocortin gene by small cell lung cancer. Med Hypotheses 1994; 42:397-9. [PMID: 7935088 DOI: 10.1016/0306-9877(94)90162-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The endogenous opioid beta-endorphin, a derivative of proopiomelanocortin, stimulates the growth of cloned human small cell lung carcinoma. The present hypothesis states that mutations of the retinoblastoma gene (a tumor suppressor gene) associated to the malignant transformation of bronchial cells would trigger a cascade of biomolecular events leading to 'de novo' proopiomelanocortin expression in small cell lung carcinoma.
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MESH Headings
- ACTH Syndrome, Ectopic/etiology
- Carcinoma, Small Cell/genetics
- Carcinoma, Small Cell/metabolism
- Cushing Syndrome/etiology
- Cushing Syndrome/genetics
- Female
- Gene Expression Regulation, Neoplastic
- Genes, Retinoblastoma
- Genes, fos
- Hormones, Ectopic/biosynthesis
- Hormones, Ectopic/genetics
- Humans
- Lung Neoplasms/genetics
- Lung Neoplasms/metabolism
- Models, Biological
- Neoplasm Proteins/biosynthesis
- Neoplasm Proteins/genetics
- Pro-Opiomelanocortin/biosynthesis
- Pro-Opiomelanocortin/genetics
- Protein Processing, Post-Translational
- Proto-Oncogene Proteins c-fos/physiology
- Retinoblastoma Protein/deficiency
- Retinoblastoma Protein/physiology
- beta-Endorphin/metabolism
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Affiliation(s)
- U J Amsler
- Department of Radiology, University of California, San Francisco 94143
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43
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Abstract
The treatment of choice for most cases of non-small-cell lung cancer is surgical resection; however, which patients with stage IIIA disease are surgical candidates is debatable. For many patients with stage IIIA or IIIB disease, the preferred modality is thoracic radiotherapy. In several randomized prospective trials, the addition of chemotherapy to thoracic radiotherapy produced a significant but clinically small survival advantage over radiotherapy alone. For patients with stage IV lung cancer, no curative treatment or "standard therapy" is available. Accordingly, many patients are offered investigational agents in phase I or II clinical trials. Small-cell lung cancer has a 60 to 90% rate of initial response to available chemotherapeutic agents. Patients with limited disease are generally given combination chemotherapy and thoracic radiotherapy, approximately 50% of whom have a complete clinical remission. Patients with extensive disease (spread beyond one radiation port) also have a high rate of initial response to chemotherapy, but only 20 to 40% have a complete remission and few survive for 5 years. New agents are being tested in previously untreated patients with extensive small-cell lung cancer. Promising new chemotherapeutic agents for lung cancer are being studied in clinical trials. Currently, only 1% of patients with lung cancer in the United States are enrolled in prospective clinical trials. Primary-care physicians are urged to encourage their patients to consider participation in approved prospective clinical trials at reputable medical centers, in an effort to discover new, effective agents with novel mechanisms of action. Information about such studies is available through Physician Desk Query (PDQ) or the cancer hotline (1-800-4-CANCER).
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Affiliation(s)
- J R Jett
- Division of Thoracic Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota
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44
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Black M, Carey FA, Farquharson MA, Murray GD, McNicol AM. Expression of the pro-opiomelanocortin gene in lung neuroendocrine tumours: in situ hybridization and immunohistochemical studies. J Pathol 1993; 169:329-34. [PMID: 8388056 DOI: 10.1002/path.1711690309] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Neuroendocrine tumours of the lung may be associated with the ectopic adrenocorticotrophin (ACTH) syndrome and may synthesize and secrete ACTH-related peptides in the absence of the syndrome. However, immunocytochemical analysis may not confirm these biochemical findings, particularly in small cell carcinoma, which is poorly granulated. To investigate further the morphological evidence for expression of the pro-opiomelanocortin (POMC) gene in neuroendocrine lung tumours, we have examined a series of 46 small cell carcinomas and 13 carcinoid tumours of the lung by in situ hybridization for POMC mRNA using a digoxigenin-labelled oligoprobe. We have compared the findings with the immunocytochemical detection of ACTH and beta-endorphin. In situ hybridization was positive in 15 of 46 small cell carcinomas (33 per cent) and in 8 of 13 carcinoid tumours (62 per cent). Immunocytochemical staining was positive in only one carcinoid tumour. These in situ hybridization studies have corroborated biochemical data indicating POMC gene expression in a high proportion of lung neuroendocrine tumours. This suggests that the low levels of expression detected by immunocytochemistry may be due to low levels of hormone storage. Multivariate analysis showed a weak negative association between POMC expression and survival in small cell carcinomas, although this did not reach statistical significance.
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Affiliation(s)
- M Black
- University Department of Pathology, Royal Infirmary, Glasgow, U.K
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45
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Abstract
The authors report a patient with ectopic adrenocorticotropic hormone (ACTH) syndrome (EAS) resulting from small cell lung cancer. Treatment with ketoconazole (KCZ) resulted in significant suppression of serum cortisol levels. The authors confirmed KCZ to be a useful adjunct in the treatment of Cushing's syndrome.
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Affiliation(s)
- D M Hoffman
- Department of Medical Oncology, Prince of Wales Hospital, Sydney, NSW, Australia
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46
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Hiperpigmentacion cutanea por secrecion ectopica de ACTH debida a un tumor carcinoide bronquial. Arch Bronconeumol 1989. [DOI: 10.1016/s0300-2896(15)31706-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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47
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Gephardt GN, Grady KJ, Ahmad M, Tubbs RR, Mehta AC, Shepard KV. Peripheral small cell undifferentiated carcinoma of the lung. Clinicopathologic features of 17 cases. Cancer 1988; 61:1002-8. [PMID: 2827882 DOI: 10.1002/1097-0142(19880301)61:5<1002::aid-cncr2820610524>3.0.co;2-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Seventeen cases of resectable peripheral small cell undifferentiated carcinoma of the lung were studied (average size, 2.1 cm; range, 0.9-3.5 cm). The carcinomas exhibited predominantly mixed intermediate and fusiform/spindle subtypes; in seven carcinomas there were at least some foci of oat cell subtype. There was no histologic evidence of typical carcinoid tumor. Seven cases were fixed in solutions appropriate for immunohistologic study; these exhibited prominent neuron-specific enolase activity but less prominent and more variable staining for the carcinoembryonic antigen and cytokeratins. All 17 cases were deemed resectable and had no clinical or radiologic evidence of metastasis. Seven (41%) patients died with recurrent and/or metastatic carcinoma (average survival, 1.7 years); five of these patients had carcinomas with at least some foci of oat cell foci subtype.
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Affiliation(s)
- G N Gephardt
- Department of Pathology, Cleveland Clinic Foundation, OH 44106
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48
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Rodriguez Vaca MD, Angel M, Halperin I, Freixenet J, Marti M, Martinez Osaba MJ, Sanchez Lloret J, Palacin A, Vilardell E. Diagnosis of lung carcinoid with cutaneous hyperpigmentation eight years after bilateral adrenalectomy. J Endocrinol Invest 1987; 10:537-40. [PMID: 2831264 DOI: 10.1007/bf03346989] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
A 26-yr-old male was submitted to bilateral adrenalectomy in 1977 for Cushing's syndrome. Some months later he developed intense skin hyperpigmentation together with increased ACTH levels (149 to 4000 ng/l). The sellar region was always normal in X-ray studies. In April 1985, when the patient complained of chest pain, a chest x-ray showed a polycyclic mass in the upper left lobe of the lung. ACTH ranged from 20,000 to 100,000 ng/l, with no response to CRF or cyproheptadine administration. Urinary 5-OH-indolacetic acid was negative. Thoracotomy was performed in July 1985 with resection of two intrapulmonary masses. Histologic study demonstrated a carcinoid tumor, with positive neuron-specific enolase and ACTH immunochemical stain. ACTH concentration in tumoral tissue was 91 pg/g tissue. After surgery ACTH fell dramatically to 37 ng/l, and has remained at this level since then, associated with resolution of the skin hyperpigmentation.
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Affiliation(s)
- M D Rodriguez Vaca
- Endocrinology and Diabetes Unit, Hospital Clinic, School of Medicine, Barcelona, Spain
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49
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Leong AS, Phillips GE, Pieterse AS, Milios J. Criteria for the diagnosis of primary endocrine carcinoma of the skin (Merkel cell carcinoma). A histological, immunohistochemical and ultrastructural study of 13 cases. Pathology 1986; 18:393-9. [PMID: 2434904 DOI: 10.3109/00313028609087558] [Citation(s) in RCA: 72] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Thirteen cases of primary endocrine carcinoma of the skin (Merkel cell carcinoma) were reviewed with the aim of defining the morphological, immunohistochemical and ultrastructural criteria for diagnosis. The tumour cells were characterized by their scanty cytoplasm, generally small uniform nuclei with finely dispersed chromatin and multiple small nucleoli. Nuclear shapes varied from round to spindle, with larger and pleomorphic forms predominating in 2 tumours. A striking feature seen in 12 tumours was the occurrence of a "ball-in-mitt" pattern represented by 1 or 2 crescentic tumour cells closely wrapped around an oval cell. Staining for neuron-specific enolase was the most consistent marker of the tumour and the characteristic juxtanuclear globular staining for keratin and cytokeratin and the occasional coexpression of neurofilament set this tumour apart from other cutaneous neoplasms, in particular, metastatic carcinoid tumours and oat cell carcinoma from the lung. The fine structural features of note were striking paranuclear or juxtanuclear whorls of intermediate filaments, seen in 7 cases, the presence of variable numbers of membrane-bound dense core granules of 80-150 nm diameter in all cases and cytoplasmic spinous or microvillous projections containing microfilaments in 4 cases. Less consistent characteristics of primary endocrine carcinomas of the skin included cell moulding, argyrophilia and immunohistochemical staining for ACTH, VIP and calcitonin. The high frequency of vessel invasion in this series is in keeping with the high rate of local recurrence, lymph node metastases and visceral dissemination reported. The distinction from other similar appearing tumours in the skin is discussed.
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50
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Leong AS, Dixon BR. Bidirectional differentiation in a large cell pleomorphic primary endocrine carcinoma of the skin (a variant of malignant Merkel cell tumour). Pathology 1986; 18:256-61. [PMID: 3763247 DOI: 10.3109/00313028609059471] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
A primary endocrine carcinoma of the skin is described in which the tumour cells showed the unusual features of large size and marked nuclear pleomorphism. Ultrastructural examination revealed combined features of squamous and endocrine differentiation in the same cells, a phenotype which has been previously anticipated but only recently described in endocrine carcinomas of the skin. In addition, immunocytochemical staining showed the co-expression of cytokeratin and neurofilament. The globular masses of cytokeratin corresponded to paranuclear whorls of intermediate filaments and there was also strong and diffuse staining for neuron specific enolase. Many tumour cells stained for calcitonin, VIP, ACTH, and S100 protein. Large tumour cells with markedly pleomorphic nuclei and co-expression of cytokeratin and neurofilament add to the expanding morphological spectrum of primary endocrine carcinomas of the skin.
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