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Takeda T, Yamada T, Kunimatsu Y, Tanimura K, Morimoto K, Shiotsu S, Chihara Y, Okada A, Horiuchi S, Hibino M, Uryu K, Honda R, Yamanaka Y, Yoshioka H, Kurata T, Takayama K. Age-Stratified Analysis of First-Line Chemoimmunotherapy for Extensive-Stage Small Cell Lung Cancer: Real-World Evidence from a Multicenter Retrospective Study. Cancers (Basel) 2023; 15:cancers15051543. [PMID: 36900334 PMCID: PMC10001399 DOI: 10.3390/cancers15051543] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 02/23/2023] [Accepted: 02/27/2023] [Indexed: 03/06/2023] Open
Abstract
Chemoimmunotherapy improved overall survival (OS) and progression-free survival (PFS) in patients with extensive-stage small cell lung cancer (ES-SCLC) in two phase III trials. They set the age-stratified subgroup analyses at 65 years; however, over half of the patients with lung cancer were newly diagnosed at ≥75 years in Japan. Therefore, treatment efficacy and safety in elderly patients ≥ 75 years with ES-SCLC should be evaluated through real-world Japanese evidence. Consecutive Japanese patients with untreated ES-SCLC or limited-stage SCLC unfit for chemoradiotherapy between 5 August 2019 and 28 February 2022 were evaluated. Patients treated with chemoimmunotherapy were divided into the non-elderly (<75 years) and elderly (≥75 years) groups, and efficacy, including PFS, OS, and post-progression survival (PPS) were evaluated. In total, 225 patients were treated with first-line therapy, and 155 received chemoimmunotherapy (98 non-elderly and 57 elderly patients). The median PFS and OS in non-elderly and elderly were 5.1 and 14.1 months and 5.5 and 12.0 months, respectively, without significant differences. Multivariate analyses revealed that age and dose reduction at the initiation of the first chemoimmunotherapy cycle were not correlated with PFS or OS. In addition, patients with an Eastern Cooperative Oncology Group performance status (ECOG-PS) = 0 who underwent second-line therapy had significantly longer PPS than those with ECOG-PS = 1 at second-line therapy initiation (p < 0.001). First-line chemoimmunotherapy had similar efficacy in elderly and non-elderly patients. Individual ECOG-PS maintenance during first-line chemoimmunotherapy is crucial for improving the PPS of patients proceeding to second-line therapy.
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Affiliation(s)
- Takayuki Takeda
- Department of Respiratory Medicine, Japanese Red Cross Kyoto Daini Hospital, Kyoto 602-8026, Japan
- Correspondence: ; Tel.: +81-75-231-5171
| | - Tadaaki Yamada
- Department of Pulmonary Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan
| | - Yusuke Kunimatsu
- Department of Respiratory Medicine, Japanese Red Cross Kyoto Daini Hospital, Kyoto 602-8026, Japan
| | - Keiko Tanimura
- Department of Respiratory Medicine, Japanese Red Cross Kyoto Daini Hospital, Kyoto 602-8026, Japan
| | - Kenji Morimoto
- Department of Pulmonary Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan
| | - Shinsuke Shiotsu
- Department of Respiratory Medicine, Japanese Red Cross Kyoto Daiichi Hospital, Kyoto 605-0981, Japan
| | - Yusuke Chihara
- Department of Respiratory Medicine, Uji-Tokushukai Medical Center, Kyoto 611-0041, Japan
| | - Asuka Okada
- Department of Respiratory Medicine, Saiseikai Suita Hospital, Osaka 564-0013, Japan
| | - Shigeto Horiuchi
- Department of Respiratory Medicine, Shonan Fujisawa Tokushukai Hospital, Kanagawa 251-0041, Japan
| | - Makoto Hibino
- Department of Respiratory Medicine, Shonan Fujisawa Tokushukai Hospital, Kanagawa 251-0041, Japan
| | - Kiyoaki Uryu
- Department of Respiratory Medicine, Yao Tokushukai General Hospital, Osaka 581-0011, Japan
| | - Ryoichi Honda
- Department of Respiratory Medicine, Asahi General Hospital, Chiba 289-2511, Japan
| | - Yuta Yamanaka
- Department of Thoracic Oncology, Kansai Medical University Hospital, Osaka 573-1191, Japan
| | - Hiroshige Yoshioka
- Department of Thoracic Oncology, Kansai Medical University Hospital, Osaka 573-1191, Japan
| | - Takayasu Kurata
- Department of Thoracic Oncology, Kansai Medical University Hospital, Osaka 573-1191, Japan
| | - Koichi Takayama
- Department of Pulmonary Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan
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Chambers A, Damone E, Chen YT, Nyrop K, Deal A, Muss H, Charlot M. Social support and outcomes in older adults with lung cancer. J Geriatr Oncol 2022; 13:214-219. [PMID: 34629320 PMCID: PMC8970686 DOI: 10.1016/j.jgo.2021.09.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 07/24/2021] [Accepted: 09/10/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Insufficient social support is associated with increased mortality among older adults. Lung cancer is primarily a disease of older adults and is the leading cause of all cancer deaths. We assessed the association of social support with outcomes among older adults with lung cancer. MATERIALS AND METHODS Adults age 65 and older with lung cancer with a completed geriatric assessment (GA) were assessed. Emotional social support (ES) and tangible (material, instrumental) support (TS) measures and patient characteristics were obtained from the GA. The electronic health record was used to extract clinical variables. Simple linear regression models evaluated the association between social support scales with patient and clinical factors. RESULTS 79 adults were assessed. White race was positively associated with ES score (p=.04), while higher BMI (p=.03), depression (p=.03) and anxiety (p=.02) were associated with worse ES. Higher BMI was associated with higher/better TS score (p=.02) while living alone was associated with lower/worse TS score (p=.03). Completion of platinum-based doublet chemotherapy with immunotherapy as planned was associated with higher ES scores (p=.02) and higher TS scores (p=.02). Disease progression was associated with lower ES scores (p=.03). CONCLUSION Social support may influence clinical outcomes in older adults with lung cancer. As lung cancer often portends to poor prognosis, social support may be an important prognostic indicator.
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Affiliation(s)
- Andrew Chambers
- Campbell University School of Osteopathic Medicine, United States of America.
| | - Emily Damone
- UNC Gillings School of Global Health, University of North Carolina Chapel Hill, United States of America.
| | - Yi Tang Chen
- University of North Carolina Chapel Hill, UNC Department of Biostatistics, United States of America.
| | - Kirsten Nyrop
- University of North Carolina Chapel Hill, Lineberger Comprehensive Cancer Center, United States of America.
| | - Allison Deal
- University of North Carolina Chapel Hill, Lineberger Comprehensive Cancer Center, United States of America.
| | - Hyman Muss
- University of North Carolina Chapel Hill, Lineberger Comprehensive Cancer Center, United States of America.
| | - Marjory Charlot
- University of North Carolina Chapel Hill, Lineberger Comprehensive Cancer Center, United States of America.
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Tu Z, Chen X, Tian T, Chen G, Huang M. Prognostic significance of epigenetic regulatory gene expression in patients with non-small-cell lung cancer. Aging (Albany NY) 2021; 13:7397-7415. [PMID: 33658396 PMCID: PMC7993691 DOI: 10.18632/aging.202600] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 11/08/2020] [Indexed: 02/05/2023]
Abstract
In this study, we used public databases to investigate the prognostic significance of epigenetic regulatory gene expression in patients with non small-cell lung cancer (NSCLC). Oncomine database analysis showed that the mRNA levels of seven epigenetic regulatory genes, UHRF1, EZH2, TTF2, SUV39H2, PCNA, WHSC1 and RAD54L, genes were significantly upregulated in NSCLC patients as compared to normal lung tissues. Functional enrichment analysis of these seven genes showed that the most enriched GO terms were DNA repair and rhythmic process, whereas, the most enriched KEGG pathway was lysine degradation pathway. The mRNA and protein expression levels of UHRF1, EZH2, TTF2, WHSC1 and RAD54L significantly correlated with tumor stage in NSCLC patients. Moreover, NSCLC patients exhibiting higher UHRF1, EZH2, WHSC1 and RAD54L mRNA and protein expression levels had poorer progression-free survival and overall survival. These findings demonstrate that UHRF1, EZH2, WHSC1 and RAD54L are potential prognostic biomarkers to distinguish high-risk from low-risk NSCLC patients.
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Affiliation(s)
- Zegui Tu
- Department of Thoracic Oncology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, P.R. China.,West China Medical School, Sichuan University, Chengdu 610041, P.R. China
| | - Xiancheng Chen
- State Key Laboratory of Biotherapy/Collaborative Innovation Center for Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, P.R. China
| | - Tian Tian
- Department of Thoracic Oncology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, P.R. China.,West China Medical School, Sichuan University, Chengdu 610041, P.R. China
| | - Guo Chen
- Global Infotech Software Limited Corporation, Chengdu 610041, Sichuan, P.R. China
| | - Meijuan Huang
- Department of Thoracic Oncology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, P.R. China.,West China Medical School, Sichuan University, Chengdu 610041, P.R. China.,State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, P.R. China
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Blakely AM, Hu H, Wong FL, Raz D, Erhunmwunsee L, Kim JY, Sun V. Deterioration in health-related quality of life is associated with lower lung resection rates in older adults. J Geriatr Oncol 2020; 12:422-427. [PMID: 32933871 DOI: 10.1016/j.jgo.2020.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 06/10/2020] [Accepted: 09/01/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Lung cancer disproportionately affects older adults. Surgical treatment may result in decreased functional status and health-related quality of life (HRQOL). Population-based data about patient-reported health outcomes for patients with early-stage lung cancer who do not undergo surgery is lacking. METHODS We identified lung cancer patients with localized disease from the SEER-Medicare Health Outcomes Survey (MHOS) linked database. Patients with baseline HRQOL survey prior to cancer diagnosis and follow-up survey ≥1 year after diagnosis were selected. Generalized estimating equation (GEE) model was used to compare patients who underwent surgery versus those who did not by demographics and HRQOL measures. RESULTS Overall, 108 patients were evaluated, of whom 75 (69%) underwent surgery. Surgical patients were younger (mean 73 versus 80 years, p < 0.001); otherwise, patient groups were similar. Surgery was not performed based on surgeon recommendation (n = 21, 64%), contraindication(s), or patients' decision. Both groups experienced similar declines in physical HRQOL, mental HRQOL, and activities of daily living (ADL) scores; and increased major comorbidities. However, non-surgical patients had significant declines in mobility and personal care activities compared to surgical counterparts. On GEE, non-surgical patients were significantly more likely to experience an increase in number of comorbidities (OR 3.3, p = 0.02) compared to surgical patients. CONCLUSIONS Patients undergoing lung cancer surgery experience significant declines in functional status and HRQOL. However, similar declines are seen in non-surgical patients. More information is needed about long term QOL trajectories with and without surgery so that patients and surgeons can make informed decisions balancing survival benefit and QOL interests.
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Affiliation(s)
- Andrew M Blakely
- Department of Surgery, City of Hope National Medical Center, Duarte, CA, USA.
| | - Hengrui Hu
- Department of Population Sciences, City of Hope National Medical Center, Duarte, CA, USA
| | - F Lennie Wong
- Department of Population Sciences, City of Hope National Medical Center, Duarte, CA, USA
| | - Dan Raz
- Department of Surgery, City of Hope National Medical Center, Duarte, CA, USA
| | | | - Jae Y Kim
- Department of Surgery, City of Hope National Medical Center, Duarte, CA, USA
| | - Virginia Sun
- Department of Surgery, City of Hope National Medical Center, Duarte, CA, USA; Department of Population Sciences, City of Hope National Medical Center, Duarte, CA, USA
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Deterioration in Health-Related Quality of Life Diminishes Benefit of Lung Cancer Resection in Older Adults. Clin Lung Cancer 2020; 22:e544-e551. [PMID: 32727705 DOI: 10.1016/j.cllc.2020.06.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 06/08/2020] [Accepted: 06/29/2020] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Outcomes of oncologic resection are related to tumor biology and patient-reported health factors. However, data regarding changes in functional status and health-related quality of life (HRQOL) before and after lung surgery for older adults are lacking. PATIENTS AND METHODS We identified lung cancer patients from the Surveillance, Epidemiology, and End Results (SEER)-Medicare Health Outcomes Survey (MHOS) linked database. HRQOL surveys captured physical/mental health, activity of daily living (ADLs), and medical comorbidities. Patients who underwent surgery with baseline prediagnosis HRQOL survey and postdiagnosis follow-up survey were selected. Patient, disease, and HRQOL measures were analyzed by Cox proportional hazards regression for overall and disease-specific survival. RESULTS Overall, 138 patients were evaluated. Disease extent was localized for 75 (54%) and regional for 58 (42%). The cohort experienced an increase in the number of major comorbidities and declines in physical HRQOL, mental HRQOL, and ADLs. Median overall survival was 74 months. Decreased overall survival was independently associated with male sex (hazard ratio [HR] = 1.7, P = .03), more advanced disease (regional vs. localized: HR = 1.8, P = .01; distant vs. localized: HR = 2.1, P = .22), and decline in ADLs (HR = 1.8, P = .02). Decreased disease-specific survival was independently associated with male sex (HR = 2.2, P = .03), more advanced disease (regional vs. localized: HR = 2.9, P = .002; distant vs. localized: HR = 3.1, P = .22), and decline in mental HRQOL (odds ratio = 2.1, P = .02). CONCLUSION The potential survival benefit of lung resection for malignancy is diminished by declines in physical and mental health. Among older surgical patients at risk for functional and HRQOL deterioration, identification and mitigation of such deterioration may optimize oncologic outcomes.
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Mihai A, Milano MT, Santos A, Kennedy A, Thirion P, McDermott RS, Westrup J, Rock L, Armstrong J. Treatment completion, treatment compliance and outcomes of old and very old patients treated by dose adapted stereotactic ablative radiotherapy (SABR) for T1-T3N0M0 non-small cell lung cancer. J Geriatr Oncol 2018; 10:442-448. [PMID: 30420322 DOI: 10.1016/j.jgo.2018.10.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Revised: 09/10/2018] [Accepted: 10/17/2018] [Indexed: 12/25/2022]
Abstract
AIM This is a retrospective single-institution review of the treatment completion and clinical outcomes of patients aged 75 and older, treated with stereotactic ablative body radiotherapy (SABR) for T1-T3 N0 M0 non-small cell lung cancer (NSCLC). MATERIAL METHODS From April 2008 to September 2015, 200 patients, aged 75-93, received respiratory-managed, intensity-modulated-based SABR. Dose fractionation was risk-adapted and delivered in 2-3 weekly treatments. Treatment completion, local control, overall survival and treatment-related toxicities were evaluated. RESULTS All patients completed the prescribed SABR course. However, 29 patients required interruption of at least one fraction of SABR and optimization of pain control before continuation of the fraction. Median follow-up was 20.9 months. The median OS was 31.6 months with 1-,3-year survival rates of 80.7%, and 44.4% respectively. Local control at 1- and 3- years were 97.6%, 83.5% respectively. Treatment was well-tolerated. However, there were two (1%) G5 (fatal) toxicities: one acute sudden dyspnoea of unknown cause and one late SABR-related haemoptysis. No statistically significant differences in outcomes/toxicities were observed between old (75-84 years old) and very old patients (>85 years old). CONCLUSIONS Old and very old patients can successfully complete SABR for NSCLC, with good local control, survival and acceptable toxicity. Old patients might require increased supportive care for successful treatment delivery.
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Affiliation(s)
- Alina Mihai
- Beacon Hospital, Dept of Radiotherapy, Dublin, Ireland.
| | - Michael T Milano
- University of Rochester School of Medicine and Dentistry, Dept of Radiation Oncology, Rochester, New York, USA
| | - Ana Santos
- Beacon Hospital, Dept of Medical Oncology, Dublin, Ireland
| | | | | | | | | | - Luke Rock
- Beacon Hospital, Dept of Radiotherapy, Dublin, Ireland
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Engelhardt KE, Odell DD, DeCamp MM. Comparing apples to oranges: short-term mortality after surgery versus stereotactic body radiotherapy for early-stage non-small cell lung cancer. J Thorac Dis 2018; 10:S1974-S1976. [PMID: 30023094 PMCID: PMC6036034 DOI: 10.21037/jtd.2018.04.66] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 04/09/2018] [Indexed: 12/25/2022]
Affiliation(s)
- Kathryn E. Engelhardt
- Surgical Outcomes and Quality Improvement Center, Department of Surgery and Center for Healthcare Studies, Feinberg School of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - David D. Odell
- Surgical Outcomes and Quality Improvement Center, Department of Surgery and Center for Healthcare Studies, Feinberg School of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Division of Thoracic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Malcolm M. DeCamp
- Division of Thoracic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Pinto CB, Vélez FGS, French MN, Zeng D, Crandell D, Bolognini N, Merabet LB, Fregni F. STRATEGIES TO ENHANCE RECRUITMENT METHODS IN PHANTOM LIMB PAIN CLINICAL TRIALS. ACTA ACUST UNITED AC 2017; 4:72-79. [PMID: 29683138 DOI: 10.18203/2349-3259.ijct20171917] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Phantom Limp Pain (PLP) was first described in 1551. To date, its mechanisms and novel interventions remain mostly untested. Only limited conclusions can be drawn from few and small randomized clinical trials (RCTs) on PLP. In this scenario, recruitment strategies are crucial in order to overcome inherent challenges to recruit PLP subjects for clinical trials. Although there are many methods to enhance recruitment and also retention, in this article we discuss these methods based on a common topic: dissemination. We summarize and discuss 10 strategies of recruitment related to the dissemination of information based on the notion that an increase in trial awareness may lead to both increased recruitment and also increased external generalizability. In addition, in our discussion we included insights based on our experience recruiting PLP patients for our large NIH-sponsored clinical trial. Although specific regulatory considerations need to be considered when choosing the methods of recruitment, which may vary across different countries and Institutional Review Boards (IRBs), these strategies may be applicable to most of research settings.
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Affiliation(s)
- Camila Bonin Pinto
- Laboratory of Neuromodulation & Center for Clinical Research Learning, Physics and Rehabilitation Department, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, USA.,Department of Neuroscience and Behavior, Psychology Institute, University of Sao Paulo, Sao Paulo, Brazil
| | - Faddi Ghassan Saleh Vélez
- Laboratory of Neuromodulation & Center for Clinical Research Learning, Physics and Rehabilitation Department, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, USA
| | - Melanie N French
- Laboratory of Neuromodulation & Center for Clinical Research Learning, Physics and Rehabilitation Department, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, USA
| | - Dian Zeng
- Laboratory of Neuromodulation & Center for Clinical Research Learning, Physics and Rehabilitation Department, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, USA
| | - David Crandell
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, USA
| | - Nadia Bolognini
- Department of Psychology, Milan Center for Neuroscience - NeuroMi, University of Milano-Bicocca, Milano, Italy.,Neuropsychological Laboratory, IRCCS Istituto Auxologico Italiano, Milano, Italy
| | - Lotfi B Merabet
- The Laboratory for Visual Neuroplasticity, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, USA
| | - Felipe Fregni
- Laboratory of Neuromodulation & Center for Clinical Research Learning, Physics and Rehabilitation Department, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, USA
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