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Pankaj G, Ullas B, Doval DC, Parveen J, Amitabh UK, Dash PK, Akhil J, Agarwal M, Rajat B. Efficacy and toxicity profile of maintenance pemetrexed in patients with stage IV adenocarcinoma lung in Indian population. South Asian J Cancer 2020; 5:196-203. [PMID: 28032090 PMCID: PMC5184760 DOI: 10.4103/2278-330x.195345] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Context: Lung cancer has been the most common cancer in the world for several decades. Pemetrexed is recommended as an option for the maintenance treatment in metastatic adenocarcinoma lung, if disease has not progressed immediately following platinum-based chemotherapy. Aims: To study efficacy and toxicity profile of pemetrexed as a maintenance chemotherapeutic agent in patients with stage IV adenocarcinoma lung, not progressing after first line chemotherapy. Settings and Design: This was an observational, prospective. We enrolled patients with stage IV adenocarcinoma lung who has not progressed on first line chemotherapy, from September 2013 to August 2014 at a tertiary care cancer institute in North India. Materials and Methods: In all, 108 patients with stage IV adenocarcinoma lung were started on induction pemetrexed/platinum chemotherapy. 60 patients with no disease progression & ECOG PS 0-2 were started on Pemetrexed maintenance. Progression free survival (PFS) and toxicity profile were recorded. Results: The mean number of maintenance cycles was 8.3 (range 2-28). 13 (21.6%) patients took >10 maintenance cycles. Pemetrexed maintenance therapy resulted in progression free survival (PFS) of 5.4 months. PFS on pemetrexed was consistent for all patient subgroups, including induction response: complete/partial responders (n-31) and stable disease (n-29). 14 patients had grade III/IV adverse events with anemia being the most common in 3/60 patients (5%). 3 patients (5%) developed renal dysfunction out of which 1 was grade III. Conclusions: Pemetrexed continuation maintenance chemotherapy is active and well tolerated. Pemetrexed maintenance should be considered in patients with advanced adenocarcinoma lung patients who have not progressed on completion of induction chemotherapy.
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Affiliation(s)
- Goyal Pankaj
- Department of Medical Oncology, Rajiv Gandhi Cancer Institute, Rohini, New Delhi, India
| | - Batra Ullas
- Department of Medical Oncology, Rajiv Gandhi Cancer Institute, Rohini, New Delhi, India
| | - Dinesh Chandra Doval
- Department of Medical Oncology, Rajiv Gandhi Cancer Institute, Rohini, New Delhi, India
| | - Jain Parveen
- Department of Medical Oncology, Rajiv Gandhi Cancer Institute, Rohini, New Delhi, India
| | | | - Prasanta Kumar Dash
- Department of Medical Oncology, Rajiv Gandhi Cancer Institute, Rohini, New Delhi, India
| | - Jain Akhil
- Department of Medical Oncology, Rajiv Gandhi Cancer Institute, Rohini, New Delhi, India
| | - Mohit Agarwal
- Department of Medical Oncology, Rajiv Gandhi Cancer Institute, Rohini, New Delhi, India
| | - Bajaj Rajat
- Department of Medical Oncology, Rajiv Gandhi Cancer Institute, Rohini, New Delhi, India
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Phase II Study of Immunotherapy With Tecemotide and Bevacizumab After Chemoradiation in Patients With Unresectable Stage III Non-Squamous Non-Small-Cell Lung Cancer (NS-NSCLC): A Trial of the ECOG-ACRIN Cancer Research Group (E6508). Clin Lung Cancer 2020; 21:520-526. [PMID: 32807654 DOI: 10.1016/j.cllc.2020.06.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 05/19/2020] [Accepted: 06/04/2020] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Although chemoradiotherapy (CRT) is the standard of care for patients with unresectable stage III non-small-cell lung cancer (LA-NSCLC), most patients relapse. Tecemotide is a MUC1 antigen-specific cancer immunotherapy vaccine. Bevacizumab improves survival in advanced nonsquamous (NS)-NSCLC and has a role in immune modulation. This phase II trial tested the combination of tecemotide and bevacizumab following CRT in patients with LA-NSCLC. PATIENTS AND METHODS Subjects with stage III NS-NSCLC suitable for CRT received carboplatin/paclitaxel weekly + 66 Gy followed by 2 cycles of consolidation carboplatin/paclitaxel ≤ 4 weeks of completion of CRT (Step 1). Patients with partial response/stable disease after consolidation therapy were registered onto step 2, which was 6 weekly tecemotide injections followed by every 6 weekly injections and bevacizumab every 3 weeks for up to 34 doses. The primary endpoint was to determine the safety of this regimen. RESULTS Seventy patients were enrolled; 68 patients (median age, 63 years; 56% male; 57% stage IIIA) initiated therapy, but only 39 patients completed CRT and consolidation therapy per protocol, primarily owing to disease progression or toxicity. Thirty-three patients (median age, 61 years; 58% male; 61% stage IIIA) were registered to step 2 (tecemotide + bevacizumab). The median number of step 2 cycles received was 11 (range, 2-25). Step 2 worst toxicity included grade 3, N = 9; grade 4, N = 1; and grade 5, N = 1. Grade 5 toxicity in step 2 was esophageal perforation attributed to bevacizumab. Among the treated and eligible patients (n = 32) who were treated on step 2, the median overall survival was 42.7 months (95% confidence interval, 21.7-63.3 months), and the median progression-free survival was 14.9 months (95% confidence interval, 11.0-20.9 months) from step 1 registration. CONCLUSIONS This cooperative group trial met its endpoint, demonstrating tolerability of bevacizumab + tecemotide after CRT and consolidation. In this selected group of patients, the median progression-free survival and overall survival are encouraging. Given that consolidation immunotherapy is now a standard of care following CRT in patients with LA-NSCLC, these results support a role for continued investigation of antiangiogenic and immunotherapy combinations in LA-NSCLC.
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Huang W, Ray P, Ji W, Wang Z, Nancarrow D, Chen G, Galbán S, Lawrence TS, Beer DG, Rehemtulla A, Ramnath N, Ray D. The cytochrome P450 enzyme CYP24A1 increases proliferation of mutant KRAS-dependent lung adenocarcinoma independent of its catalytic activity. J Biol Chem 2020; 295:5906-5917. [PMID: 32165494 DOI: 10.1074/jbc.ra119.011869] [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: 11/12/2019] [Revised: 03/05/2020] [Indexed: 11/06/2022] Open
Abstract
We previously reported that overexpression of cytochrome P450 family 24 subfamily A member 1 (CYP24A1) increases lung cancer cell proliferation by activating RAS signaling and that CYP24A1 knockdown inhibits tumor growth. However, the mechanism of CYP24A1-mediated cancer cell proliferation remains unclear. Here, we conducted cell synchronization and biochemical experiments in lung adenocarcinoma cells, revealing a link between CYP24A1 and anaphase-promoting complex (APC), a key cell cycle regulator. We demonstrate that CYP24A1 expression is cell cycle-dependent; it was higher in the G2-M phase and diminished upon G1 entry. CYP24A1 has a functional destruction box (D-box) motif that allows binding with two APC adaptors, CDC20-homologue 1 (CDH1) and cell division cycle 20 (CDC20). Unlike other APC substrates, however, CYP24A1 acted as a pseudo-substrate, inhibiting CDH1 activity and promoting mitotic progression. Conversely, overexpression of a CYP24A1 D-box mutant compromised CDH1 binding, allowing CDH1 hyperactivation, thereby hastening degradation of its substrates cyclin B1 and CDC20, and accumulation of the CDC20 substrate p21, prolonging mitotic exit. These activities also occurred with a CYP24A1 isoform 2 lacking the catalytic cysteine (Cys-462), suggesting that CYP24A1's oncogenic potential is independent of its catalytic activity. CYP24A1 degradation reduced clonogenic survival of mutant KRAS-driven lung cancer cells, and calcitriol treatment increased CYP24A1 levels and tumor burden in Lsl-KRASG12D mice. These results disclose a catalytic activity-independent growth-promoting role of CYP24A1 in mutant KRAS-driven lung cancer. This suggests that CYP24A1 could be therapeutically targeted in lung cancers in which its expression is high.
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Affiliation(s)
- Wei Huang
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan 48109
| | - Paramita Ray
- Department of Radiation Oncology, University of Michigan Medical School, Ann Arbor, Michigan 48109
| | - Wenbin Ji
- Department of Radiation Oncology, University of Michigan Medical School, Ann Arbor, Michigan 48109
| | - Zhuwen Wang
- Department of Surgery, University of Michigan Medical School, Ann Arbor, Michigan 48109
| | - Derek Nancarrow
- Department of Surgery, University of Michigan Medical School, Ann Arbor, Michigan 48109
| | - Guoan Chen
- Department of Surgery, University of Michigan Medical School, Ann Arbor, Michigan 48109
| | - Stefanie Galbán
- Department of Radiology, University of Michigan Medical School, Ann Arbor, Michigan 48109
| | - Theodore S Lawrence
- Department of Radiation Oncology, University of Michigan Medical School, Ann Arbor, Michigan 48109
| | - David G Beer
- Department of Radiation Oncology, University of Michigan Medical School, Ann Arbor, Michigan 48109; Department of Surgery, University of Michigan Medical School, Ann Arbor, Michigan 48109
| | - Alnawaz Rehemtulla
- Department of Radiation Oncology, University of Michigan Medical School, Ann Arbor, Michigan 48109
| | - Nithya Ramnath
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan 48109; Veterans Administration, Ann Arbor Healthcare System, Ann Arbor, Michigan 48105.
| | - Dipankar Ray
- Department of Radiation Oncology, University of Michigan Medical School, Ann Arbor, Michigan 48109.
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Liu L, Zhang Y, Wei J, Chen Z, Yu J. VEGFR-TKIs combined with chemotherapy for advanced non-small cell lung cancer: A systematic review. J Cancer 2019; 10:799-809. [PMID: 30854085 PMCID: PMC6400799 DOI: 10.7150/jca.29643] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Accepted: 01/09/2019] [Indexed: 12/18/2022] Open
Abstract
Introduction: To estimate the efficacy and safety of vascular endothelial growth factor receptor tyrosine kinase inhibitors (VEGFR-TKIs) in combination with chemotherapy for patients with advanced non-small cell lung cancer (NSCLC). Methods: We searched PubMed, PMC database, EMBASE, EBSCO-Medline, Cochrane Central Register of Controlled Trials (CENTRAL), American Society of Clinical Oncology (ASCO), International Association for the Study of Lung Cancer (IASLC) and the European Society of Medical Oncology (ESMO), http://www.clinicaltrials.gov/, CNKI, and Wanfang databases to identify primary research reporting the survival outcomes and safety of VEGFR-TKIs in patients with advanced NSCLC. A meta-analysis was conducted to generate combined hazard ratios (HRs) with 95% confidence intervals (CI) for overall survival (OS), progression-free survival (PFS), objective response rate (ORR), disease control rate (DCR), and risk ratios (RRs) with 95% CI for adverse events (AEs). Results: A total of 20 RCTs (8,366 participants) were included. The VEGFR-TKIs resulted in improved PFS (HR 0.82, 95% CI 0.78-0.87), ORR (HR 1.72, 95% CI 1.34-2.22), and DCR (1.45, 1.26-1.67) in patients with advanced NSCLC, but had no impact on OS (HR 0.94, 95% CI 0.89-1.00). The incidence of some high grade (≥ 3) AEs increased, such as hemorrhage, hypertension and neutropenia. Conclusions: Our study demonstrated that regimens with VEGFR-TKIs combined with chemotherapy improved PFS, ORR and DCR in patients with advanced NSCLC, but had no impact on OS. VEGFR-TKIs induced more frequent and serious AEs compared with control therapies.
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Affiliation(s)
- Lian Liu
- Cancer Center, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong An Road, Xi Cheng District, Beijing, 100050, China
| | - Yue Zhang
- Cancer Center, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong An Road, Xi Cheng District, Beijing, 100050, China
| | - Jia Wei
- Cancer Center, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong An Road, Xi Cheng District, Beijing, 100050, China
| | - Zhaoxin Chen
- Cancer Center, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong An Road, Xi Cheng District, Beijing, 100050, China
| | - Jing Yu
- Cancer Center, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong An Road, Xi Cheng District, Beijing, 100050, China
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Baxevanos P, Mountzios G. Novel chemotherapy regimens for advanced lung cancer: have we reached a plateau? ANNALS OF TRANSLATIONAL MEDICINE 2018; 6:139. [PMID: 29862228 DOI: 10.21037/atm.2018.04.04] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Lung cancer remains the most significant contributor of cancer-related mortality globally. Despite the significant progress over the last decade with the introduction of targeted and immunotherapeutic agents in the treatment of advanced non-small cell lung cancer (NSCLC), chemotherapy is still the appropriate treatment for the majority of patients. Based on clinical evidence, platinum-containing regimens have been established as the cornerstone of treatment as of today. Research efforts to optimize chemotherapy outcomes have led to novel chemotherapy regimens such as the combination of platinum plus pemetrexed as well as the addition of bevacizumab in patients with advanced non squamous NSCLC, and the combination of carboplatin with nanoparticle-albumin bound paclitaxel regardless of histology. In this article, we review clinical data regarding the recent evolution of chemotherapy in the advanced NSCLC setting, and critically evaluate the progress in therapeutic efficacy in terms of survival. We conclusively state that chemotherapy alone has reached a therapeutic plateau and report the current trends in clinical research combining chemotherapy with novel systemic therapies.
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Affiliation(s)
- Panagiotis Baxevanos
- Department of Medical Oncology, Naval and Veterans Hospital of Athens, Athens, Greece
| | - Giannis Mountzios
- Department of Medical Oncology, 251 Air Force General Hospital, Athens, Greece
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Grossi F, Rijavec E, Genova C, Barletta G, Biello F, Maggioni C, Burrafato G, Sini C, Dal Bello MG, Meyer K, Roder J, Roder H, Grigorieva J. Serum proteomic test in advanced non-squamous non-small cell lung cancer treated in first line with standard chemotherapy. Br J Cancer 2016; 116:36-43. [PMID: 27898657 PMCID: PMC5220151 DOI: 10.1038/bjc.2016.387] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 09/24/2016] [Accepted: 10/31/2016] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND VeriStrat is a blood-based proteomic test with predictive and prognostic significance in second-line treatments for non-small cell lung cancer (NSCLC). This trial was designed to investigate the role of VeriStrat in first-line treatment of advanced NSCLC with standard chemotherapy. Here we present the results for 76 non-squamous patients treated with a combination of carboplatin or cisplatin with pemetrexed. METHODS The test-assigned classifications of VeriStrat Good or VeriStrat Poor to samples collected at baseline. The primary end point was progression-free survival (PFS); secondary end points included overall survival (OS) and objective response. Exploratory analyses of end points separately in carboplatin/pemetrexed and cisplatin/pemetrexed subgroups were also conducted. RESULTS Patients classified as VeriStrat Good had longer PFS and OS than VeriStrat Poor: 6.5 vs 1.6 months and 10.8 vs 3.4 months, respectively; the corresponding hazard ratios (HRs) were 0.36 (P<0.0001) and 0.26 (P<0.0001); they were also more likely to achieve objective response. Prognostic significance of VeriStrat was confirmed in multivariate analysis. Significant differences in OS and PFS between Veristrat classifications were also found when treatment subgroups were analysed separately. CONCLUSIONS The trial demonstrated clinical utility of VeriStrat as a prognostic test for standard first-line chemotherapy of non-squamous advanced NSCLC.
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Affiliation(s)
- F Grossi
- Lung Cancer Unit, IRCCS AOU San Martino - IST Istituto Nazionale per la Ricerca sul Cancro, Largo R. Benzi 10, 16132 Genova, Italy
| | - E Rijavec
- Lung Cancer Unit, IRCCS AOU San Martino - IST Istituto Nazionale per la Ricerca sul Cancro, Largo R. Benzi 10, 16132 Genova, Italy
| | - C Genova
- Lung Cancer Unit, IRCCS AOU San Martino - IST Istituto Nazionale per la Ricerca sul Cancro, Largo R. Benzi 10, 16132 Genova, Italy
| | - G Barletta
- Lung Cancer Unit, IRCCS AOU San Martino - IST Istituto Nazionale per la Ricerca sul Cancro, Largo R. Benzi 10, 16132 Genova, Italy
| | - F Biello
- Lung Cancer Unit, IRCCS AOU San Martino - IST Istituto Nazionale per la Ricerca sul Cancro, Largo R. Benzi 10, 16132 Genova, Italy
| | - C Maggioni
- Lung Cancer Unit, IRCCS AOU San Martino - IST Istituto Nazionale per la Ricerca sul Cancro, Largo R. Benzi 10, 16132 Genova, Italy
| | - G Burrafato
- Lung Cancer Unit, IRCCS AOU San Martino - IST Istituto Nazionale per la Ricerca sul Cancro, Largo R. Benzi 10, 16132 Genova, Italy
| | - C Sini
- Lung Cancer Unit, IRCCS AOU San Martino - IST Istituto Nazionale per la Ricerca sul Cancro, Largo R. Benzi 10, 16132 Genova, Italy
| | - M G Dal Bello
- Lung Cancer Unit, IRCCS AOU San Martino - IST Istituto Nazionale per la Ricerca sul Cancro, Largo R. Benzi 10, 16132 Genova, Italy
| | - K Meyer
- Biodesix, 2970 Wilderness Place, Boulder, CO 80301, USA
| | - J Roder
- Biodesix, 2970 Wilderness Place, Boulder, CO 80301, USA
| | - H Roder
- Biodesix, 2970 Wilderness Place, Boulder, CO 80301, USA
| | - J Grigorieva
- Biodesix, 2970 Wilderness Place, Boulder, CO 80301, USA
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Yap TA, Macklin-Doherty A, Popat S. Continuing EGFR inhibition beyond progression in advanced non-small cell lung cancer. Eur J Cancer 2016; 70:12-21. [PMID: 27866095 DOI: 10.1016/j.ejca.2016.10.014] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 09/29/2016] [Accepted: 10/18/2016] [Indexed: 01/31/2023]
Abstract
The majority of patients with epidermal growth factor receptor (EGFR) mutant non-small cell lung cancer (NSCLC) respond to first-line EGFR tyrosine kinase inhibitors (TKIs), but nearly all inevitably acquire resistance and develop disease progression. Conventional practice would be to switch treatments to second-line therapy. However, continuing TKIs beyond progression is becoming increasingly commonplace in patients with indolent, small volume asymptomatic growth, who may potentially continue to derive ongoing clinical benefit and to avoid a 'withdrawal tumour flare'. Nevertheless, there are limitations to our current criteria for assessing disease response, which are based on radiological assessments without considering symptomatic benefit, or the complex molecular and clinical heterogeneity of tumour growth and drug response patterns. In this article, we review the rationale for continuing EGFR inhibitors in patients with EGFR mutant NSCLC beyond disease progression and discuss strategies that have been pursued in the context of molecularly and clinically heterogeneous populations of tumour growth depending on the different clinical scenarios encountered. We discuss the management of systemic disease progression, including continuing EGFR TKIs alone, introducing a drug holiday, or combining TKIs with chemotherapy or other molecularly targeted agents. We also focus on approaches in managing patients with indolent, small volume asymptomatic growth (non-CNS oligometastatic disease progression) and those with oligometastatic EGFR mutant NSCLC with involvement of the central nervous system. We envision future precision medicine strategies through the use of next generation sequencing strategies of serial tumour rebiopsies and circulating plasma DNA to individualise the management for such patients during disease progression.
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Affiliation(s)
- Timothy A Yap
- Department of Medicine, Royal Marsden Hospital, London, UK; Division of Clinical Studies, The Institute of Cancer Research, London, UK
| | | | - Sanjay Popat
- Department of Medicine, Royal Marsden Hospital, London, UK; Section of Genomic Medicine, National Heart and Lung Institute, Imperial College, London, UK.
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Tisnado D, Malin J, Kahn K, Landrum MB, Fletcher R, Klabunde C, Clauser S, Rogers SO, Keating NL. Variations in Oncologist Recommendations for Chemotherapy for Stage IV Lung Cancer: What Is the Role of Performance Status? J Oncol Pract 2016; 12:653-62. [PMID: 27271507 DOI: 10.1200/jop.2015.008425] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
PURPOSE Chemotherapy prolongs survival in patients with advanced non-small-cell lung cancer. However, few studies have included patients with poor performance status. This study examined rates of oncologists' recommendations for chemotherapy by patient performance status and symptoms and how physician characteristics influence chemotherapy recommendations. METHODS We surveyed medical oncologists involved in the care of a population-based cohort of patients with lung cancer from the CanCORS (Cancer Care Outcomes Research and Surveillance) study. Physicians were queried about their likelihood to recommend chemotherapy to patients with stage IV lung cancer with varying performance status (Eastern Cooperative Oncology Group performance status 0 [good] v 3 [poor]) and presence or absence of tumor-related pain. Repeated measures logistic regression was used to estimate the independent associations of patients' performance status and symptoms and physicians' demographic and practice characteristics with chemotherapy recommendations. RESULTS Nearly all physicians (adjusted rate, 97% to 99%) recommended chemotherapy for patients with good performance status, and approximately half (adjusted rate, 38% to 53%) recommended chemotherapy for patients with poor performance status (P < .001). Compared with patient factors, physician and practice characteristics were less strongly associated with chemotherapy recommendations in adjusted analyses. CONCLUSION Strong consensus among oncologists exists for chemotherapy in patients with advanced non-small-cell lung cancer and good performance status. However, the relatively high rate of chemotherapy recommendations for patients with poor performance status despite the unfavorable risk-benefit profile highlights the need for ongoing work to define high-value care in oncology and to implement and evaluate strategies to align incentives for such care.
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Affiliation(s)
- Diana Tisnado
- California State University Fullerton; Anthem, Woodland Hills; David Geffen School of Medicine, University of California Los Angeles, Los Angeles; RAND Corporation, Santa Monica, CA; Harvard Medical School; Brigham and Women's Hospital, Boston, MA; National Cancer Institute, Bethesda, MD; Patient-Centered Outcomes Research Institute, Washington, DC; and University of Texas Medical Branch Health, Galveston, TX
| | - Jennifer Malin
- California State University Fullerton; Anthem, Woodland Hills; David Geffen School of Medicine, University of California Los Angeles, Los Angeles; RAND Corporation, Santa Monica, CA; Harvard Medical School; Brigham and Women's Hospital, Boston, MA; National Cancer Institute, Bethesda, MD; Patient-Centered Outcomes Research Institute, Washington, DC; and University of Texas Medical Branch Health, Galveston, TX
| | - Katherine Kahn
- California State University Fullerton; Anthem, Woodland Hills; David Geffen School of Medicine, University of California Los Angeles, Los Angeles; RAND Corporation, Santa Monica, CA; Harvard Medical School; Brigham and Women's Hospital, Boston, MA; National Cancer Institute, Bethesda, MD; Patient-Centered Outcomes Research Institute, Washington, DC; and University of Texas Medical Branch Health, Galveston, TX
| | - Mary Beth Landrum
- California State University Fullerton; Anthem, Woodland Hills; David Geffen School of Medicine, University of California Los Angeles, Los Angeles; RAND Corporation, Santa Monica, CA; Harvard Medical School; Brigham and Women's Hospital, Boston, MA; National Cancer Institute, Bethesda, MD; Patient-Centered Outcomes Research Institute, Washington, DC; and University of Texas Medical Branch Health, Galveston, TX
| | - Robert Fletcher
- California State University Fullerton; Anthem, Woodland Hills; David Geffen School of Medicine, University of California Los Angeles, Los Angeles; RAND Corporation, Santa Monica, CA; Harvard Medical School; Brigham and Women's Hospital, Boston, MA; National Cancer Institute, Bethesda, MD; Patient-Centered Outcomes Research Institute, Washington, DC; and University of Texas Medical Branch Health, Galveston, TX
| | - Carrie Klabunde
- California State University Fullerton; Anthem, Woodland Hills; David Geffen School of Medicine, University of California Los Angeles, Los Angeles; RAND Corporation, Santa Monica, CA; Harvard Medical School; Brigham and Women's Hospital, Boston, MA; National Cancer Institute, Bethesda, MD; Patient-Centered Outcomes Research Institute, Washington, DC; and University of Texas Medical Branch Health, Galveston, TX
| | - Steven Clauser
- California State University Fullerton; Anthem, Woodland Hills; David Geffen School of Medicine, University of California Los Angeles, Los Angeles; RAND Corporation, Santa Monica, CA; Harvard Medical School; Brigham and Women's Hospital, Boston, MA; National Cancer Institute, Bethesda, MD; Patient-Centered Outcomes Research Institute, Washington, DC; and University of Texas Medical Branch Health, Galveston, TX
| | - Selwyn O Rogers
- California State University Fullerton; Anthem, Woodland Hills; David Geffen School of Medicine, University of California Los Angeles, Los Angeles; RAND Corporation, Santa Monica, CA; Harvard Medical School; Brigham and Women's Hospital, Boston, MA; National Cancer Institute, Bethesda, MD; Patient-Centered Outcomes Research Institute, Washington, DC; and University of Texas Medical Branch Health, Galveston, TX
| | - Nancy L Keating
- California State University Fullerton; Anthem, Woodland Hills; David Geffen School of Medicine, University of California Los Angeles, Los Angeles; RAND Corporation, Santa Monica, CA; Harvard Medical School; Brigham and Women's Hospital, Boston, MA; National Cancer Institute, Bethesda, MD; Patient-Centered Outcomes Research Institute, Washington, DC; and University of Texas Medical Branch Health, Galveston, TX
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Wang XQ, Liu J, Lin HS, Hou W. A multicenter randomized controlled open-label trial to assess the efficacy of compound kushen injection in combination with single-agent chemotherapy in treatment of elderly patients with advanced non-small cell lung cancer: study protocol for a randomized controlled trial. Trials 2016; 17:124. [PMID: 26956875 PMCID: PMC4782312 DOI: 10.1186/s13063-016-1231-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 02/13/2016] [Indexed: 12/03/2022] Open
Abstract
Background With the aging of the global population, an increasing number of elderly are diagnosed with advanced non-small cell lung cancer. Although systematic chemotherapy has been one of the primary treatments for advanced non-small cell lung cancer worldwide, the elderly cannot always tolerate standard platinum-based doublet chemotherapy, thus resulting in treatment failure. To reduce toxicity, single-agent chemotherapy is often used to treat the elderly with non-small cell lung cancer; however, this may increase the risk of treatment failure due to an inadequate dose. It has been shown that compound kushen injection in combination with chemotherapy can enhance the efficacy and reduce the toxicity. The aim of this trial is to assess the clinical effectiveness and safety of compound kushen injection in combination with single-agent chemotherapy versus platinum-based doublet chemotherapy in the treatment of elderly patients with advanced non-small cell lung cancer. Methods This multicenter study will be an open-label, randomized controlled trial. Three hundred seventy elderly patients with advanced non-small cell lung cancer will be randomly divided into experimental (n = 185) and control groups (n = 185) to receive compound kushen injection in combination with single-agent chemotherapy or standard platinum-based doublet chemotherapy for two cycles. After two cycles, the disease control rate, objective response rate, clinical symptoms, quality of life, Karnofsky Performance Status, and side effects will be assessed. Follow-up evaluations will be performed every 8 weeks to evaluate the progression-free and overall survival. Discussion Before the trial was designed, compound kushen injection was shown to be effective for lung cancer through basic experiments and clinical trials. This study will determine whether or not the efficacy of compound kushen injection in combination with single-agent chemotherapy is comparable to that of platinum-based doublet chemotherapy, and whether or not the toxicity of compound kushen injection in combination with single-agent chemotherapy is lower than that of platinum-based doublet chemotherapy. Trial registration ChiCTR-IPR-14005484 (16 November 2014).
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Affiliation(s)
- Xue-Qian Wang
- Oncology Department of Guang'anmen Hospital, Affiliated to China Academy of Chinese Medical Sciences, No. 5, Bei Xian-ge Road, Xi Cheng District, Beijing, 100053, China. .,Beijing University of Chinese Medicine, No. 11, East Road North 3rd Ring Road, Chao Yang District, Beijing, 100029, China.
| | - Jie Liu
- Oncology Department of Guang'anmen Hospital, Affiliated to China Academy of Chinese Medical Sciences, No. 5, Bei Xian-ge Road, Xi Cheng District, Beijing, 100053, China.
| | - Hong-Sheng Lin
- Oncology Department of Guang'anmen Hospital, Affiliated to China Academy of Chinese Medical Sciences, No. 5, Bei Xian-ge Road, Xi Cheng District, Beijing, 100053, China. .,Beijing University of Chinese Medicine, No. 11, East Road North 3rd Ring Road, Chao Yang District, Beijing, 100029, China.
| | - Wei Hou
- Oncology Department of Guang'anmen Hospital, Affiliated to China Academy of Chinese Medical Sciences, No. 5, Bei Xian-ge Road, Xi Cheng District, Beijing, 100053, China.
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Kim SH, Ryu HG, Lee J, Shin J, Harikishore A, Jung HY, Kim YS, Lyu HN, Oh E, Baek NI, Choi KY, Yoon HS, Kim KT. Ursolic acid exerts anti-cancer activity by suppressing vaccinia-related kinase 1-mediated damage repair in lung cancer cells. Sci Rep 2015; 5:14570. [PMID: 26412148 PMCID: PMC4585938 DOI: 10.1038/srep14570] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 09/04/2015] [Indexed: 01/26/2023] Open
Abstract
Many mitotic kinases have been targeted for the development of anti-cancer drugs, and inhibitors of these kinases have been expected to perform well for cancer therapy. Efforts focused on selecting good targets and finding specific drugs to target are especially needed, largely due to the increased frequency of anti-cancer drugs used in the treatment of lung cancer. Vaccinia-related kinase 1 (VRK1) is a master regulator in lung adenocarcinoma and is considered a key molecule in the adaptive pathway, which mainly controls cell survival. We found that ursolic acid (UA) inhibits the catalytic activity of VRK1 via direct binding to the catalytic domain of VRK1. UA weakens surveillance mechanisms by blocking 53BP1 foci formation induced by VRK1 in lung cancer cells, and possesses synergistic anti-cancer effects with DNA damaging drugs. Taken together, UA can be a good anti-cancer agent for targeted therapy or combination therapy with DNA damaging drugs for lung cancer patients.
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Affiliation(s)
- Seong-Hoon Kim
- Department of Life Sciences, Pohang University of Science and Technology, Pohang 790-784, Republic of Korea
| | - Hye Guk Ryu
- Department of Life Sciences, Pohang University of Science and Technology, Pohang 790-784, Republic of Korea
| | - Juhyun Lee
- Division of Integrative Biosciences and Biotechnology, Pohang University of Science and Technology, Pohang 790-784, Republic of Korea
| | - Joon Shin
- School of Biological Sciences, Nanyang Technological University, Singapore 637551
| | | | - Hoe-Youn Jung
- Division of Integrative Biosciences and Biotechnology, Pohang University of Science and Technology, Pohang 790-784, Republic of Korea
| | - Ye Seul Kim
- Department of Life Sciences, Pohang University of Science and Technology, Pohang 790-784, Republic of Korea
| | - Ha-Na Lyu
- Department of Life Sciences, Pohang University of Science and Technology, Pohang 790-784, Republic of Korea
| | - Eunji Oh
- The Graduate School of Biotechnology and Plant Metabolism Research Center, Kyung-Hee University, Suwon 449-701, Republic of Korea
| | - Nam-In Baek
- The Graduate School of Biotechnology and Plant Metabolism Research Center, Kyung-Hee University, Suwon 449-701, Republic of Korea
| | - Kwan-Yong Choi
- Division of Integrative Biosciences and Biotechnology, Pohang University of Science and Technology, Pohang 790-784, Republic of Korea
| | - Ho Sup Yoon
- School of Biological Sciences, Nanyang Technological University, Singapore 637551
- Department of Genetic Engineering, College of Life Sciences, Kyung-Hee University, Suwon 449-701, Republic of Korea
| | - Kyong-Tai Kim
- Department of Life Sciences, Pohang University of Science and Technology, Pohang 790-784, Republic of Korea
- Division of Integrative Biosciences and Biotechnology, Pohang University of Science and Technology, Pohang 790-784, Republic of Korea
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11
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Cheng T, Dai X, Zhou DL, Lv Y, Miao LY. Correlation of apolipoprotein A-I kinetics with survival and response to first-line platinum-based chemotherapy in advanced non-small cell lung cancer. Med Oncol 2014; 32:407. [PMID: 25465061 DOI: 10.1007/s12032-014-0407-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 11/24/2014] [Indexed: 01/05/2023]
Abstract
The aim of this study was to determine whether apolipoprotein A-I (ApoA-I) kinetics predict the overall survival in patients with advanced-stage non-small cell lung cancer (NSCLC) during platinum-based first-line therapy. A total of 125 NSCLC patients from January 2008 to September 2014 were retrospectively reviewed. Serum ApoA-I level was measured at baseline and thereafter at the start of each palliative chemotherapy cycle for all patients. Patients were divided into four groups according to ApoA-I kinetics. Patients whose ApoA-I ≥ 1.01 g/L and never decreased during treatment, patients whose ApoA-I ≥ 1.01 g/L and decreased (ApoA-I < 1.01 g/L) at least one time during treatment, patients whose ApoA-I < 1.01 g/L and normalized (ApoA-I ≥ 1.01) at least one time during treatment, and patients whose ApoA-I < 1.01 g/L and never normalized during treatment were assigned to non-decreased, decreased, normalized, and non-normalized ApoA-I groups, respectively. Overall survival rates were significantly different between the four groups, with 2-year survival rates of 88.6 and 17.5 % for the non-decreased and the decreased ApoA-I groups, respectively, and none survived 2 years later in the normalized and the non-normalized ApoA-I groups. When compared with the non-decreased group, the hazard ratios of death were 0.05, 0.44, and 1.73 in the normalized, decreased, and non-normalized groups, respectively (P < 0.001). Normalization of ApoA-I was associated with a low risk of progression, whereas patients with a decreased level of ApoA-I showed a progression of disease in most cases. ApoA-I can be a novel, widely available biomarker for patients with NSCLC.
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Affiliation(s)
- Ting Cheng
- Department of Clinical Pharmacy, China Pharmaceutical University, Nanjing, 210009, China
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12
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Rewiring of human lung cell lineage and mitotic networks in lung adenocarcinomas. Nat Commun 2013; 4:1701. [PMID: 23591868 PMCID: PMC4450149 DOI: 10.1038/ncomms2660] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2012] [Accepted: 02/26/2013] [Indexed: 12/21/2022] Open
Abstract
Analysis of gene expression patterns in normal tissues and their perturbations in tumors can help to identify the functional roles of oncogenes or tumor suppressors and identify potential new therapeutic targets. Here, gene expression correlation networks were derived from 92 normal human lung samples and patient-matched adenocarcinomas. The networks from normal lung show that NKX2-1 is linked to the alveolar type 2 lineage, and identify PEBP4 as a novel marker expressed in alveolar type 2 cells. Differential correlation analysis shows that the NKX2-1 network in tumors includes pathways associated with glutamate metabolism, and identifies Vaccinia-related kinase (VRK1) as a potential drug target in a tumor-specific mitotic network. We show that VRK1 inhibition cooperates with inhibition of PARP signaling to inhibit growth of lung tumor cells. Targeting of genes that are recruited into tumor mitotic networks may provide a wider therapeutic window than that seen by inhibition of known mitotic genes.
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Cimino GD, Pan CX, Henderson PT. Personalized medicine for targeted and platinum-based chemotherapy of lung and bladder cancer. Bioanalysis 2013; 5:369-91. [PMID: 23394702 PMCID: PMC3644565 DOI: 10.4155/bio.12.325] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The personalized medicine revolution is occurring for cancer chemotherapy. Biomarkers are increasingly capable of distinguishing genotypic or phenotypic traits of individual tumors, and are being linked to the selection of treatment protocols. This review covers the molecular basis for biomarkers of response to targeted and cytotoxic lung and bladder cancer treatment with an emphasis on platinum-based chemotherapy. Platinum derivatives are a class of drugs commonly employed against solid tumors that kill cells by covalent attachment to DNA. Platinum-DNA adduct levels in patient tissues have been correlated to response and survival. The sensitivity and precision of adduct detection has increased to the point of enabling subtherapeutic dosing for diagnostics applications, termed diagnostic microdosing, prior to the initiation of full-dose therapy. The clinical status of this unique phenotypic marker for lung and bladder cancer applications is detailed along with discussion of future applications.
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Affiliation(s)
- George D Cimino
- Accelerated Medical Diagnostics, Inc., 2121 Second Street, B101, Davis, CA 95618, USA
| | - Chong-xian Pan
- University of California Davis, Department of Internal Medicine, Division of Hematology & Oncology & the UC Davis Comprehensive Cancer Center, 4501 X Street, Suite 3016, Sacramento, CA 94568, USA
- Hematology/Oncology, VA Northern California Health Care System, 10535 Hospital Way, Mather, CA 95655, USA
| | - Paul T Henderson
- Accelerated Medical Diagnostics, Inc., 2121 Second Street, B101, Davis, CA 95618, USA
- University of California Davis, Department of Internal Medicine, Division of Hematology & Oncology & the UC Davis Comprehensive Cancer Center, 4501 X Street, Suite 3016, Sacramento, CA 94568, USA
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Furrukh M, Burney IA, Kumar S, Zahid KF, Al-Moundhri M. Improving Outcomes in Advanced Lung Cancer: Maintenance therapy in non-small-cell lung carcinoma. Sultan Qaboos Univ Med J 2013; 13:3-18. [PMID: 23573377 PMCID: PMC3616797 DOI: 10.12816/0003190] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2012] [Revised: 08/30/2012] [Accepted: 10/14/2012] [Indexed: 01/27/2023] Open
Abstract
Systemic chemotherapy has remained the traditional treatment for metastatic non-small-cell lung carcinoma (NSCLC), enhancing survival rate at 1 year to 29%. The median survival had plateaued at around 10 months until early 2008, and in an attempt to enhance survival in advanced disease, maintenance chemotherapy trials were initiated which had recently demonstrated prolongation of survival by an additional 2-3 months in patients who had performance status (PS) 0-1 and well-preserved organ functions. Suitable patients with any degree of clinical benefit are treated with 4-6 cycles, and then one of the active agents is continued until best response, or toxicity (continued maintenance), or changed to a cross non-resistant single agent (switch maintenance). The article briefly reviews the evolution of systemic therapy and describes key randomised trials of maintenance therapy instituting chemotherapy and targeted agents in an attempt to improve outcomes in advanced metastatic NSCLC, based on certain clinical features, histology, and genetics.
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Affiliation(s)
- Muhammad Furrukh
- Department of Medicine, Sultan Qaboos University Hospital & Sultan Qaboos University, Muscat, Oman
| | - Ikram A. Burney
- Department of Medicine, Sultan Qaboos University Hospital & Sultan Qaboos University, Muscat, Oman
| | - Shiyam Kumar
- Department of Medicine, Sultan Qaboos University Hospital & Sultan Qaboos University, Muscat, Oman
| | - Khwaja F. Zahid
- Department of Medicine, Sultan Qaboos University Hospital & Sultan Qaboos University, Muscat, Oman
| | - Mansour Al-Moundhri
- College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman
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Gachechiladze M, Uberall I, Kolek V, Klein J, Krejci V, Stastna J, Radova L, Fridman E, Skarda J. Correlation between BRCA1 expression and clinicopathological factors including brain metastases in patients with non-small-cell lung cancer. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2012; 157:227-32. [PMID: 23128816 DOI: 10.5507/bp.2012.099] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2012] [Accepted: 10/19/2012] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Previously identified as a breast and ovarian cancer susceptibility gene, BRCA1 has gained major scientific interest as a potential prognostic and/or predictive marker for various tumors, including non-small-cell lung cancer (NSCLC), the leading cause of cancer related mortality worldwide. BRCA1 plays a central role in DNA damage response (DDR. It undergoes phosphorylation by various DDR kinases at different serine residues, of which ser1524 is known to be specifically phosphorylated by ATM in response to genotoxic stress. METHODS We performed BRCA1 immunohistochemistry on several tissue microarrays (TMAs) of 113 early (I, II stage) and advanced (III, IV stage) NSCLCs, using MS110 antibody against the BRCA1 N-terminal and S1524 antibody against the phosphorylated form of BRCA1 protein at ser1524 (Abcam). Patients with III and IV stage disease were treated by adjuvant cisplatin-based chemotherapy. Staining results were correlated with overall survival (OS), disease free survival (DFS) and with the occurrence of brain metastases. RESULTS BRCA1 S1524 nuclear positivity was significantly correlated with longer OS and DFS in stage I and II patients (P<0.05), while OS and DFS were shorter in S1524 positive stage III and IV patients (P<0.05). No significant correlation was found with brain metastases. CONCLUSION The results show that BRCA1 phosphorylaton, at least in ser1524, differentiates the fate of early and advanced NSCLC as well as response to chemotherapy, but the underlying mechanisms are not completely understood. Detection of phosphorylated forms of BRCA1 might serve as a useful prognostic and predictive marker for patients with NSCLC.
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Affiliation(s)
- Mariam Gachechiladze
- Laboratory of Molecular Pathology, Department of Pathology, Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic
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16
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Gachechiladze M, Skarda J. The role of BRCA1 in non-small cell lung cancer. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2012; 156:200-3. [PMID: 23069884 DOI: 10.5507/bp.2012.049] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2011] [Accepted: 04/13/2012] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND BRCA1 (Breast cancer 1) was previously identified as a breast and ovarian cancer susceptibility gene, but recently gained a major scientific interest as a prognostic and/or predictive marker for various tumors, including non-small cell lung cancer (NSCLC), which is the leading cause of cancer related mortality in the world. We aimed to review the role of BRCA1 in NSCLC based on currently available literature. METHODS We performed the literature search in Pubmed database, using key words: BRCA1, non small cell lung cancer, chemotherapy, drug resistance. Articles published in English were selected for review. RESULTS Research papers are mainly focused on BRCA1 mRNA expression studies in response to DNA damaging chemotherapy. Several articles about genetic and epigenetic changes of BRCA1 in NSCLC were also available. CONCLUSIONS BRCA1 is a multifunctional tumor supressor protein, which plays a key role in essential cellular processes and modulates the cellular response to cytotoxic chemotherapy. With the difference from breast and ovarian cancer, BRCA1 has no role in NSCLC cancerogenesis and mainly discussed as a promising genomic marker for customized chemotherapy in NSCLC patients.
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Affiliation(s)
- Mariam Gachechiladze
- Department of Clinical and Molecular Pathology, Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic.
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Abstract
The management of advanced non-small-cell lung cancer (a-nsclc) is currently undergoing one of its rare paradigm shifts. Just as the nihilism of the 1970s gave way to the empiricism of the 1980s and 1990s, so the current decade has seen the first truly rational therapies based on informed design. In addition, molecular markers and traditional parameters can now be combined to provide a framework of knowledge that will guide the application of not just the new therapies, but also the older ones that remain effective. This framework—as important a component of the rational paradigm as the new drugs themselves are—is necessary to decide who should and, crucially, who should not receive the various components of this rapidly expanding armamentarium. Here, I have provided a historical overview of the drug treatment of a-nsclc, a mini-review of important new data, and an integrative approach that tries to ensure that patients receive the optimal treatment choice at the appropriate time. The speed at which new knowledge now arrives, coupled with the persistent high level of unmet medical need, suggests that the traditional pace of evidence-based review needs to be accelerated. Indeed, the increased scope for personalized management constitutes something of a challenge to “business as usual” evidence-based medicine. As a result, substantial investment on the part of payers, which may or may not be possible, will be required. In the meantime, some patients may wish and may be financially able to take advantage of modern developments before they have been fully digested by the public-payer system. Responsive clinicians face difficult tradeoffs as they try to balance the pros and cons of early adoption versus excessive conservatism. The present article is my personal view of how to navigate these waters, and although it is written especially for patients who like to be the captain of their own ship, there is good reason to believe that all patients will eventually be managed by similar, if not identical, means. Nonetheless, the recommendations herein should not be construed as appropriately reviewed provincial or national guidelines. Finally, if appropriate, a clinical trial should always be offered.
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Affiliation(s)
- M D Vincent
- Medical Oncology, London Regional Cancer Program, London, ON.
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18
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Glenny A, Furness S, Worthington HV, Conway DI, Oliver R, Clarkson JE, Macluskey M, Pavitt S, Chan KKW, Brocklehurst P, The CSROC Expert Panel. Interventions for the treatment of oral cavity and oropharyngeal cancer: radiotherapy. Cochrane Database Syst Rev 2010; 2010:CD006387. [PMID: 21154367 PMCID: PMC10749265 DOI: 10.1002/14651858.cd006387.pub2] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The management of advanced oral cavity and oropharyngeal cancers is problematic and has traditionally relied on surgery and radiotherapy, both of which are associated with substantial adverse effects. Radiotherapy has been in use since the 1950s and has traditionally been given as single daily doses. This method of dividing up the total dose, or fractionation, has been modified over the years and a variety of approaches have been developed with the aim of improving survival whilst maintaining acceptable toxicity. OBJECTIVES To determine which radiotherapy regimens for oral cavity and oropharyngeal cancers result in increased overall survival, disease free survival, progression free survival and locoregional control. SEARCH STRATEGY The following electronic databases were searched: the Cochrane Oral Health Group's Trials Register (to 28 July 2010), CENTRAL (The Cochrane Library 2010, Issue 3), MEDLINE via OVID (1950 to 28 July 2010) and EMBASE via OVID (1980 to 28 July 2010). There were no restrictions regarding language or date of publication. SELECTION CRITERIA Randomised controlled trials where more than 50% of participants had primary tumours of the oral cavity or oropharynx, and which compared two or more radiotherapy regimens, radiotherapy versus other treatment modality, or the addition of radiotherapy to other treatment modalities. DATA COLLECTION AND ANALYSIS Data extraction and assessment of risk of bias was undertaken independently by two or more authors. Study authors were contacted for additional information as required. Adverse events data were collected from published trials. MAIN RESULTS 30 trials involving 6535 participants were included. Seventeen trials compared some form of altered fractionation (hyperfractionation/accelerated) radiotherapy with conventional radiotherapy; three trials compared different altered fractionation regimens; one trial compared timing of radiotherapy, five trials evaluated neutron therapy and four trials evaluated the addition of pre-operative radiotherapy. Pooling trials of any altered fractionation radiotherapy compared to a conventional schedule showed a statistically significant reduction in total mortality (hazard ratio (HR) 0.86, 95% confidence interval (CI) 0.76 to 0.98). In addition, a statistically significant difference in favour of the altered fractionation was shown for the outcome of locoregional control (HR 0.79, 95% CI 0.70 to 0.89). No statistically significant difference was shown for disease free survival.No statistically significant difference was shown for any other comparison. AUTHORS' CONCLUSIONS Altered fractionation radiotherapy is associated with an improvement in overall survival and locoregional control in patients with oral cavity and oropharyngeal cancers. More accurate methods of reporting adverse events are needed in order to truly assess the clinical performance of different radiotherapy regimens.
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Affiliation(s)
- Anne‐Marie Glenny
- School of Dentistry, The University of ManchesterCochrane Oral Health GroupCoupland III Building, Oxford RoadManchesterUKM13 9PL
| | - Susan Furness
- The University of ManchesterCochrane Oral Health Group, School of DentistryCoupland III Bldg, Oxford RdManchesterUKM13 9PL
| | - Helen V Worthington
- School of Dentistry, The University of ManchesterCochrane Oral Health GroupCoupland III Building, Oxford RoadManchesterUKM13 9PL
| | - David I Conway
- University of GlasgowGlasgow Dental School378 Sauchiehall StreetGlasgowUKG2 3JZ
| | - Richard Oliver
- RED (Research and Education in Dentistry)10 Longbow Close, Harlescott LaneShrewsburyUKSY1 3GZ
| | - Jan E Clarkson
- Cochrane Oral Health Group, The University of ManchesterDental Health Services & Research Unit, University of Dundee, DundeeManchesterUK
| | - Michaelina Macluskey
- University of DundeeUnit of Oral Surgery and MedicineUniversity of Dundee Dental Hospital and SchoolPark PlaceDundeeScotlandUKDD1 4NR
| | - Sue Pavitt
- University of LeedsClinical Trials Research UnitClinical Trials Research House71‐75 Clarendon RoadLeedsUKLS2 9NP
| | - Kelvin KW Chan
- Princess Margaret Hospital610 University AvenueTorontoOntarioCanadaM5G 2M9
| | - Paul Brocklehurst
- School of Dentistry, The University of ManchesterCoupland III BuildingOxford RoadManchesterUKM13 9PL
| | - The CSROC Expert Panel
- School of Dentistry, The University of ManchesterCochrane Oral Health GroupCoupland III Building, Oxford RoadManchesterUKM13 9PL
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Recursive Partitioning Analysis Groups II-III brain metastases of non-small cell lung cancer: a phase II randomized study comparing two concurrent chemoradiotherapy regimens. J Thorac Oncol 2010; 5:846-51. [PMID: 20421817 DOI: 10.1097/jto.0b013e3181db3db9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To compare the response rates and safety profiles of two investigational chemotherapies that were delivered concurrently with whole-brain radiotherapy in a population of patients with chemonaive non-small cell lung cancer. METHODS Eligible patients included those presenting with brain metastases belonging to the Recursive Partitioning Analysis of prognostic factors from the Radiation Therapy Oncology groups II or III, who were not able to undergo surgery or stereotactic radiotherapy. Other main eligibility criteria were age <75 years and Eastern Cooperative Oncology Group performance status = 0 to 2. The study design was as follows: all patients received whole-brain radiotherapy in three split courses of 18 gy/10 fractions. They were randomly (1:1) assigned to regimen A, consisting of a triplet cisplatin-vinorelbine-ifosfomide, or to regimen B, consisting of high-dose single-drug ifosfamide. In both groups, chemotherapy was delivered on a 4-week cycle, for three courses. Each course was delivered concurrently with radiotherapy. Brain and other tumor lesion assessments were performed in both groups at the end of the three courses (RECIST). Neurologic symptoms were evaluated quantitatively at each step of the treatment program. All analyses were carried out in an intention to treat basis, and statistical tests were two sided. RESULTS Seventy patients were randomly allocated into groups A (n = 37) and B (n = 33). With regards to the whole lesions, overall response rates did not significantly differ between the groups (group A: 45.9%; group B: 33.3%; chi(2); p = 0.28). When brain-target lesions were separately analyzed, respective response rates were 59.5% and 48.5%; (chi(2); p = 0.0.53). Febrile neutropenia was more frequently observed in the former group (n = 19, 54.29%) than in the latter (n = 12, 36.36%; p = 0.13), and a similar difference was also observed regarding documented infections. Red blood cell transfusions and readmission for antibiotic infusions significantly affected more patients in group A than in group B. The longitudinal evaluation of neurologic symptoms (by means of Generalized Estimating Equation) slightly improved during the treatment program, and there was no difference between the groups. Median overall survival did not significantly differ between the two groups (months [95% confidence interval], 8.5 [6.4-10.8] and 5.7 [4.6-11.9] in groups A B, respectively; p= 0.82). In the Cox model, a high neuron-specific enolase serum level was the only significant prognostic determinant. CONCLUSION Both regimens were active and induced a high rate of response, particularly for brain-target lesions. Myelotoxicity jeopardizes the acceptability of both regimens. Despite such an aggressive approach, none of the regimens suggested a putative overall improvement of outcome in this poor prognosis presentation of metastatic non-small cell lung cancer. The search for alternative therapies to chemotherapy, such as targeted therapy, is urgently warranted in this setting.
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Xu R, Sciubba DM, Gokaslan ZL, Bydon A. Metastasis to the occipitocervical junction: A case report and review of the literature. Surg Neurol Int 2010; 1:16. [PMID: 20657697 PMCID: PMC2908354 DOI: 10.4103/2152-7806.63911] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2010] [Accepted: 04/29/2010] [Indexed: 12/02/2022] Open
Abstract
Background The management of metastatic spinal disease is generally considered palliative, as the progression of systemic disease is likely to hinder survival. Although the occurrence of C1-C2 instability due to metastatic disease is not uncommon and thus treatment options have been well-defined, craniocervical instability due to lesions occurring at the junction of the occiput and atlas is more rare, and treatment for metastasis to this region is less well-defined. Case Description We present a patient with non-small-cell lung cancer metastatic to the atlanto-occipital facet joint complex. A drastic improvement in the presenting debilitating mechanical neck pain was noted following an occipitocervical fusion. A literature review of published cases of metastases to the occipitocervical junction was conducted along with treatment options. Conclusions The atlanto-occipital facet joint is a rare site of metastatic disease. Destruction of this joint can lead to significant neck pain secondary to instability. Spinal fusion may afford significant and rapid resolution of these symptoms, and should be considered in the management of patients—even those with end-stage oncologic disease.
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Affiliation(s)
- Risheng Xu
- Medical Scientist Training Program, Johns Hopkins School of Medicine, Baltimore, Maryland
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21
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Hehr T, Friedel G, Steger V, Spengler W, Eschmann SM, Bamberg M, Budach W. Neoadjuvant Chemoradiation With Paclitaxel/Carboplatin for Selected Stage III Non–Small-Cell Lung Cancer: Long-Term Results of a Trimodality Phase II Protocol. Int J Radiat Oncol Biol Phys 2010; 76:1376-81. [DOI: 10.1016/j.ijrobp.2009.03.077] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2009] [Revised: 03/11/2009] [Accepted: 03/25/2009] [Indexed: 01/08/2023]
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Kasymjanova G, Correa JA, Kreisman H, Dajczman E, Pepe C, Dobson S, Lajeunesse L, Sharma R, Small D. Prognostic Value of the Six-Minute Walk in Advanced Non-small Cell Lung Cancer. J Thorac Oncol 2009; 4:602-7. [DOI: 10.1097/jto.0b013e31819e77e8] [Citation(s) in RCA: 107] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Wilop S, von Hobe S, Crysandt M, Esser A, Osieka R, Jost E. Impact of angiotensin I converting enzyme inhibitors and angiotensin II type 1 receptor blockers on survival in patients with advanced non-small-cell lung cancer undergoing first-line platinum-based chemotherapy. J Cancer Res Clin Oncol 2009; 135:1429-35. [PMID: 19399518 DOI: 10.1007/s00432-009-0587-3] [Citation(s) in RCA: 115] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2009] [Accepted: 04/07/2009] [Indexed: 01/10/2023]
Abstract
PURPOSE The renin-angiotensin system plays a crucial role in maintaining vascular homeostasis. Stimulation of angiotensin II type 1 receptors (AT1R) acts proangiogenically by increasing levels of vascular endothelial growth factor (VEGF). Consequently, cell culture experiments and animal studies have shown antiproliferative effects of AT1R blockers (ARB) and angiotensin I converting enzyme inhibitors (ACEI) in several malignancies. Until now, very limited clinical data for this antiangiogenic effect exists for combinations with antineoplastic chemotherapy. METHODS A total of 287 patients with advanced non-small-cell lung cancer undergoing first-line platinum-based chemotherapy were retrospectively analysed regarding long-term medication with ACEI and ARB as well as histological type, stage, performance status, gender, age, dose-intensity of chemotherapy and survival. RESULTS Patients receiving either ACEI or ARB had a 3.1 months longer median survival than non-recipients (11.7 vs. 8.6 months, HR 0.56, P = 0.03). This survival advantage could not be attributed to other established risk-factors or dose intensity of chemotherapy. CONCLUSIONS Addition of ACEI or ARB to platinum-based first-line chemotherapy may contribute to prolonged survival in patients with advanced lung cancer.
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Affiliation(s)
- Stefan Wilop
- Medizinische Klinik IV, Universitaetsklinikum Aachen, RWTH Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany.
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Reguart N, Cardona AF, Carrasco E, Gomez P, Taron M, Rosell R. BRCA1: A New Genomic Marker for Non–Small-Cell Lung Cancer. Clin Lung Cancer 2008; 9:331-9. [PMID: 19073515 DOI: 10.3816/clc.2008.n.048] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Noemí Reguart
- Medical Oncology Service, Catalan Institute of Oncology, ICO, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain
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