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Fan L, Yang Z, Chang M, Chen Z, Wen Q. CT-based delta-radiomics nomogram to predict pathological complete response after neoadjuvant chemoradiotherapy in esophageal squamous cell carcinoma patients. J Transl Med 2024; 22:579. [PMID: 38890720 PMCID: PMC11186275 DOI: 10.1186/s12967-024-05392-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 06/12/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND This study developed a nomogram model using CT-based delta-radiomics features and clinical factors to predict pathological complete response (pCR) in esophageal squamous cell carcinoma (ESCC) patients receiving neoadjuvant chemoradiotherapy (nCRT). METHODS The study retrospectively analyzed 232 ESCC patients who underwent pretreatment and post-treatment CT scans. Patients were divided into training (n = 186) and validation (n = 46) sets through fivefold cross-validation. 837 radiomics features were extracted from regions of interest (ROIs) delineations on CT images before and after nCRT to calculate delta values. The LASSO algorithm selected delta-radiomics features (DRF) based on classification performance. Logistic regression constructed a nomogram incorporating DRFs and clinical factors. Receiver operating characteristic (ROC) and area under the curve (AUC) analyses evaluated nomogram performance for predicting pCR. RESULTS No significant differences existed between the training and validation datasets. The 4-feature delta-radiomics signature (DRS) demonstrated good predictive accuracy for pCR, with α-binormal-based and empirical AUCs of 0.871 and 0.869. T-stage (p = 0.001) and differentiation degree (p = 0.018) were independent predictors of pCR. The nomogram combined the DRS and clinical factors improved the classification performance in the training dataset (AUCαbin = 0.933 and AUCemp = 0.941). The validation set showed similar performance with AUCs of 0.958 and 0.962. CONCLUSIONS The CT-based delta-radiomics nomogram model with clinical factors provided high predictive accuracy for pCR in ESCC patients after nCRT.
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Affiliation(s)
- Liyuan Fan
- Department of Thoracic Surgery, Qilu Hospital of Shandong University, Jinan, 250012, Shandong, China
| | - Zhe Yang
- Department of Radiation Oncology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 324 Jingwu Road, Jinan, 250021, Shandong, China
| | - Minghui Chang
- Department of Radiation Oncology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 324 Jingwu Road, Jinan, 250021, Shandong, China
| | - Zheng Chen
- Department of Radiation Oncology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 324 Jingwu Road, Jinan, 250021, Shandong, China
| | - Qiang Wen
- Department of Radiation Oncology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 324 Jingwu Road, Jinan, 250021, Shandong, China.
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Agarwal M, Liu A, Langlais BT, Leventakos K, Yu NY, Almquist D, Manochakian R, Ernani V. Chemoimmunotherapy as the First-Line Treatment for Patients With Extensive-Stage Small-Cell Lung Cancer and an ECOG Performance Status 2 or 3. Clin Lung Cancer 2023; 24:591-597. [PMID: 37365076 DOI: 10.1016/j.cllc.2023.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 05/21/2023] [Accepted: 05/22/2023] [Indexed: 06/28/2023]
Abstract
BACKGROUND Studies demonstrated that chemoimmunotherapy prolongs progression-free survival (PFS) and overall survival (OS) in patients with extensive-stage small-cell lung cancer (ES-SCLC) and an Eastern Cooperative Oncology Group performance status (ECOG PS) 0 or 1. However, there is little data regarding chemoimmunotherapy in patients with ES-SCLC and an ECOG PS 2 or 3. This study aims to evaluate the benefits of chemoimmunotherapy compared to chemotherapy in the first-line treatment of patients with ES-SCLC and ECOG PS 2 or 3. MATERIALS AND METHODS This retrospective study analyzed 46 adults treated at Mayo Clinic between 2017 and 2020 with de novo ES-SCLC and an ECOG PS 2 or 3. Twenty patients received platinum-etoposide and 26 patients received platinum-etoposide and atezolizumab. Progression-free survival (PFS) and Overall survival (OS) were calculated using Kaplan-Meier methods. RESULTS PFS was longer in the chemoimmunotherapy group compared to the chemotherapy group, 4.1 months (95% confidence interval [CI]: 3.8-6.9) vs. 3.2 months (95% CI: 0.6-4.8), respectively; P = 0.0491. However, there was no statistically significant difference in the OS between the chemoimmunotherapy and chemotherapy group, 9.3 months (95% CI: : 4.9-12.8) vs. 7.6 months (95% CI: 0.6-11.9), respectively; P = .21. CONCLUSION Chemoimmunotherapy prolongs PFS compared to chemotherapy in patients with newly diagnosed ES-SCLC and an ECOG PS 2 or 3. No OS difference was observed among the chemoimmunotherapy and chemotherapy groups; nevertheless, this may be attributed due to the small sample size of the study.
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Affiliation(s)
- Muskan Agarwal
- Department of Internal Medicine, Mayo Clinic, Phoenix, AZ
| | - Alex Liu
- Division of Hematology-Oncology, Mayo Clinic Cancer Center, Phoenix, AZ
| | - Blake T Langlais
- Department of Quantitative Health Sciences, Mayo Clinic, Scottsdale, AZ
| | | | - Nathan Y Yu
- Department of Radiation Oncology, Mayo Clinic Cancer Center, Phoenix, AZ
| | - Daniel Almquist
- Department of Hematology-Oncology, Sanford Roger Maris Cancer Center, Fargo, ND
| | - Rami Manochakian
- Division of Hematology-Oncology, Mayo Clinic Cancer Center, Jacksonville, FL
| | - Vinicius Ernani
- Division of Hematology-Oncology, Mayo Clinic Cancer Center, Phoenix, AZ.
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Mischel AM, Rosielle DA. Eastern Cooperative Oncology Group Performance Status #434. J Palliat Med 2022; 25:508-510. [PMID: 35230903 DOI: 10.1089/jpm.2021.0599] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
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Krishnan M, Kasinath P, High R, Yu F, Teply BA. Impact of Performance Status on Response and Survival Among Patients Receiving Checkpoint Inhibitors for Advanced Solid Tumors. JCO Oncol Pract 2021; 18:e175-e182. [PMID: 34351819 DOI: 10.1200/op.20.01055] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Clinical trials, which led to the approval of immune checkpoint inhibitors (ICI), have been almost exclusively performed in patients with good Eastern Cooperative Oncology Group performance status (ECOG PS of 0-1). However, ICI remains an attractive option for patients with advanced tumors and poor PS. We hypothesized that patients with ECOG PS ≥ 2 would have worse outcomes with ICI. METHODS We retrospectively identified patients with advanced solid tumors who were treated with ICI at our institution. The log-rank test compared the survival among patients with different ECOG PS. We used a proportional hazards model to assess association between ECOG PS and overall survival (OS) with adjustment for covariates including age, sex, malignancy type, time from advance disease diagnosis, and line of therapy. We compared overall response rates between groups with Pearson chi-square exact test. We also analyzed in-hospital mortality and hospice referral rates. RESULTS We identified 257 patients treated with ICI. One hundred eighty-two patients had ECOG PS 0-1, and 75 had ECOG PS ≥ 2. The median overall survival was 12.6 months for the ECOG PS 0-1 group compared with 3.1 months for the ECOG PS ≥ 2 group (P < .001). The overall response rate for patients with ECOG PS 0-1 was 23% compared with 8% for those with poor PS (P = .005). Patients with poor PS treated with ICI had similar hospice referral rates (67% for ECOG PS ≥ 2 v 61.9% for ECOG PS 0-1, P = .50) but were more likely to have in-hospital death as compared with the good PS group (28.6% v 15.1%, P = .035). CONCLUSION Despite the appeal of ICI in patients with advanced malignancy and poor PS, outcomes in this cohort were poor. Prospective trials defining the activity and role of ICI in poor PS are urgently needed.
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Affiliation(s)
- Mridula Krishnan
- Division of Hematology Oncology, University of Nebraska Medical Center, Omaha, NE
| | | | - Robin High
- Department of Biostatistics, University of Nebraska Medical Center, College of Public Health, Omaha, NE
| | - Fang Yu
- Department of Biostatistics, University of Nebraska Medical Center, College of Public Health, Omaha, NE
| | - Benjamin A Teply
- Division of Hematology Oncology, University of Nebraska Medical Center, Omaha, NE
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Lin J, Gautam S, Hu N, Adeboyeje G, Kachroo S. Clinical effectiveness outcomes and healthcare resource utilization of patients diagnosed with small-cell lung cancer. Future Oncol 2020; 17:443-453. [PMID: 33300811 DOI: 10.2217/fon-2020-0958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: Real-world data are lacking on patients with small-cell lung cancer (SCLC) with extensive-stage SCLC (eSCLC) and poor performance status (PS). Patients & methods: Eligible patients diagnosed with eSCLC between 1 January 2008 and 31 December 2017 were included in this retrospective, observational study. Results: The study included 406 patients, with 14.3% impaired PS. Progression-free survival and overall survival were not significantly different between impaired (Eastern Cooperative Oncology Group ≥2) and not impaired patients (median, 4.5 vs 5.3 months, and 7.2 vs 8.4 months, respectively). Impaired patients used more supportive care drugs (mean, 3.0 vs 2.0; p = 0.033). Conclusion: Effectiveness outcomes among patients with and without impaired PS did not differ in the real-world setting. Progression-free survival and overall survival were similar to data from clinical trials.
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Affiliation(s)
- Junji Lin
- ConcertAI 6555 Quince, Suite 400, Memphis, TN 38119, USA
| | - Santosh Gautam
- ConcertAI 6555 Quince, Suite 400, Memphis, TN 38119, USA
| | - Nan Hu
- ConcertAI 6555 Quince, Suite 400, Memphis, TN 38119, USA
| | - Gboyega Adeboyeje
- Merck & Co., Inc. 2000 Galloping Hill Rd., Kenilworth, NJ 07033, USA
| | - Sumesh Kachroo
- Merck & Co., Inc. 2000 Galloping Hill Rd., Kenilworth, NJ 07033, USA
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Noronha V, Ravind R, Patil VM, Mokal S, Joshi A, Menon N, Kapoor A, Mahajan A, Janu A, Nakti D, Shah L, Shah S, Prabhash K. The role of chemotherapy in patients with small cell lung cancer and poor performance status. Acta Oncol 2020; 59:1520-1527. [PMID: 32924733 DOI: 10.1080/0284186x.2020.1819562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND There are limited data on the role of chemotherapy in patients with small cell lung cancer (SCLC) and poor performance status (PS). METHODS This was a retrospective analysis of a prospective observational study in patients with SCLC and PS 3 or 4. We recorded the initial therapy, symptom improvement, response rate, overall survival (OS), and the impact of various factors on OS. RESULTS From June 2010 to August 2019, we enrolled 234 patients; 185 (79%) with PS 3 and 49 (21%) PS 4. Initial therapy was best supportive care (BSC) in 49 patients (21%), standard full dose chemotherapy in 31 (13%), and attenuated chemotherapy in 154 (66%). In 89% patients treated with attenuated chemotherapy, symptom-relief occurred at a median of 3 days (IQR, 1-7). Grade 3 and higher toxicities developed in 60% patients treated with initial attenuated chemotherapy, commonly hyponatremia in 39%, neutropenia in 16%, anemia in 11%, and infection in 10%. Grade 3 and higher toxicities as a result of standard chemotherapy occurred in 89% patients treated with upfront standard full dose chemotherapy compared to 69% of patients who received initial attenuated chemotherapy with subsequent treatment escalation. Overall, there were 6 (2.6%) toxic deaths. The response rate to chemotherapy was 77%. The median OS of the patients who received any chemotherapy was significantly longer at 6 months (95% CI, 4.8-7.2) compared to 1 month (95% CI, 0.4-1.6 months) in patients who were managed with BSC, p < 0.001; hazard ratio, 0.39 (95% CI, 0.27-0.56). The disease stage, lactate dehydrogenase level, and receipt of chemotherapy significantly impacted survival. CONCLUSION Chemotherapy prolongs survival in patients with SCLC and poor PS. Administering an initial attenuated chemotherapy regimen followed by standard full-dose chemotherapy when the PS improves may lower toxicity and improve tolerance.
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Affiliation(s)
- Vanita Noronha
- Department of Medical Oncology, Tata Memorial Hospital, Tata Memorial Center, Mumbai, India
- Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Rahul Ravind
- Department of Medical Oncology, Tata Memorial Hospital, Tata Memorial Center, Mumbai, India
- Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Vijay M. Patil
- Department of Medical Oncology, Tata Memorial Hospital, Tata Memorial Center, Mumbai, India
- Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Smruti Mokal
- Homi Bhabha National Institute (HBNI), Mumbai, India
- Clinical Research Secretariat, Tata Memorial Hospital, Tata Memorial Center, Mumbai, India
| | - Amit Joshi
- Department of Medical Oncology, Tata Memorial Hospital, Tata Memorial Center, Mumbai, India
- Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Nandini Menon
- Department of Medical Oncology, Tata Memorial Hospital, Tata Memorial Center, Mumbai, India
- Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Akhil Kapoor
- Department of Medical Oncology, Tata Memorial Hospital, Tata Memorial Center, Mumbai, India
- Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Abhishek Mahajan
- Homi Bhabha National Institute (HBNI), Mumbai, India
- Department of Radiodiagnosis, Tata Memorial Hospital, Tata Memorial Center, Mumbai, India
| | - Amit Janu
- Homi Bhabha National Institute (HBNI), Mumbai, India
- Department of Radiodiagnosis, Tata Memorial Hospital, Tata Memorial Center, Mumbai, India
| | - Dipti Nakti
- Department of Medical Oncology, Tata Memorial Hospital, Tata Memorial Center, Mumbai, India
- Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Leena Shah
- Department of Medical Oncology, Tata Memorial Hospital, Tata Memorial Center, Mumbai, India
- Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Srushti Shah
- Department of Medical Oncology, Tata Memorial Hospital, Tata Memorial Center, Mumbai, India
- Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Hospital, Tata Memorial Center, Mumbai, India
- Homi Bhabha National Institute (HBNI), Mumbai, India
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The impact of symptoms and comorbidity on health utility scores and health-related quality of life in small cell lung cancer using real world data. Qual Life Res 2020; 30:445-454. [PMID: 32851601 DOI: 10.1007/s11136-020-02615-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2020] [Indexed: 01/12/2023]
Abstract
PURPOSE Small cell lung cancer (SCLC) is a highly fatal disease associated with significant morbidity, with a need for real-world symptom and health utility score (HUS) data. HUS can be measured using an EQ-5D-5L questionnaire, however most captured data is available in non-SCLC (NSCLC) only. As new treatment regimens become available in SCLC it becomes important to understand factors which influence health-related quality of life and health utility. METHODS A prospective observational cohort study (2012-2017) of ambulatory histologically confirmed SCLC evaluated patient-reported EQ-5D-5L-derived HUS, toxicity and symptoms. A set of NSCLC patients was used to compare differential factors affecting HUS. Clinical and demographic factors were evaluated for differential interactions between lung cancer types. Comorbidity scores were documented for each patient. RESULTS In 75 SCLC and 150 NSCLC patients, those with SCLC had lower mean HUS ((SCLC vs NSCLC: mean 0.69 vs 0.79); (p < 0.001)) when clinically stable and with progressive disease: ((SCLC mean HUS = 0.60 vs NSCLC mean HUS = 0.77), (p = 0.04)). SCLC patients also had higher comorbidity scores ((1.11 vs 0.73); (p < 0.015)). In multivariable analyses, increased symptom severity and comorbidity scores decreased HUS in both SCLC and NSCLC (p < 0.001); however, only comorbidity scores differentially affected HUS (p < 0.0001), with a greater reduction of HUS adjusted per unit of comorbidity in SCLC. CONCLUSION Patients with advanced SCLC had significantly lower HUS than NSCLC. Both patient cohorts are impacted by symptoms and comorbidity, however, comorbidity had a greater negative effect in SCLC patients.
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Friedlaender A, Liu SV, Passaro A, Metro G, Banna G, Addeo A. The Role of Performance Status in Small-Cell Lung Cancer in the Era of Immune Checkpoint Inhibitors. Clin Lung Cancer 2020; 21:e539-e543. [PMID: 32499210 DOI: 10.1016/j.cllc.2020.04.006] [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: 01/06/2020] [Revised: 03/17/2020] [Accepted: 04/03/2020] [Indexed: 10/24/2022]
Abstract
After decades of platinum-based chemotherapy for advanced small-cell lung cancer, there has finally been a therapeutic advance. The combination of a platinum chemotherapy, etoposide, and an immune checkpoint inhibitor has yielded overall survival benefits in two successive phase 3 trials. Unfortunately, these trials only included fit patients, namely those with an Eastern Cooperative Oncology Group performance status of 0-1. In the real-world setting, roughly a third of patients with advanced small-cell lung cancer has a performance status of 2, and an additional 15% have a performance status of 3 or 4, meaning that approximately half of all patients are excluded from chemoimmunotherapy trials. Poor performance status is a known negative prognostic factor, with a dismal prognosis among patients with disease that does not respond to the first cycle of chemotherapy.We review current data on immunotherapy in advanced small-cell lung cancer and discuss how we integrate the new therapeutic options into daily practice.
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Affiliation(s)
- Alex Friedlaender
- Oncology Department, University Hospital of Geneva, Geneva, Switzerland
| | - Stephen V Liu
- Georgetown Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
| | - Antonio Passaro
- Division of Thoracic Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Giulio Metro
- Department of Medical Oncology, Santa Maria della Misericordia Hospital, Perugia, Italy
| | - Giuseppe Banna
- Deparment of Oncology, United Lincolnshire NHS Hospital Trust, Lincoln, UK
| | - Alfredo Addeo
- Oncology Department, University Hospital of Geneva, Geneva, Switzerland.
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Rittberg R, Green S, Aquin T, Bucher O, Banerji S, Dawe DE. Effect of Hospitalization During First Chemotherapy and Performance Status on Small-cell Lung Cancer Outcomes. Clin Lung Cancer 2020; 21:e388-e404. [PMID: 32197856 DOI: 10.1016/j.cllc.2020.02.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 01/23/2020] [Accepted: 02/13/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Small-cell lung cancer (SCLC) is highly responsive to chemotherapy (CT) and one of the few malignancies treated in hospitalized patients with poor Eastern Cooperative Oncology Group (ECOG) performance status (PS). Because of the little current information available on the outcomes experienced by hospitalized patients with SCLC receiving CT, we explored the outcomes for these patients to improve the evidence base for practice. MATERIALS AND METHODS We conducted a retrospective cohort study to evaluate patients with a diagnosis of SCLC and treated with CT during a 10-year period. Progression-free survival (PFS) and overall survival (OS) were evaluated according to site of first CT (inpatient vs. outpatient) and PS. Multivariable analysis was completed to assess for independent survival predictors. RESULTS A total of 530 patients with SCLC were treated, with 82 (15%) receiving their first CT in hospital. Inpatients had a greater burden of disease and poorer PS. Neutropenia, thrombocytopenia, nephrotoxicity, and fatigue were all experienced less often by the inpatient cohort (P < .001, P < .001, P < .001, and P = .007, respectively). For inpatients and outpatients, the OS rate at 12, 24, and 60 months was 22%, 9%, and 7% and 43%, 20%, and 9%, respectively (P < .001 for all). The median PFS and OS were longer for outpatients and highly functional patients. On multivariable analysis, ECOG PS was an independent predictor of the outcome and the site of first CT was not (P = .04 and P = .49, respectively). CONCLUSION Patients with SCLC initially treated as inpatients and those with poor functional status had shorter PFS and OS; however, some experienced long-term survival, including 5-year survival of 7% for the inpatient cohort and 5% for the ECOG PS 3-4 cohort. CT toxicities were less common in the inpatient cohort, validating that administration of CT in hospital should be considered for these patients because they could experience a meaningful long-term response to therapy.
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Affiliation(s)
- Rebekah Rittberg
- Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada; Department of Hematology and Medical Oncology, CancerCare Manitoba, Winnipeg, MB, Canada
| | - Susan Green
- Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada; Department of Hematology and Medical Oncology, CancerCare Manitoba, Winnipeg, MB, Canada
| | - Trevor Aquin
- Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Oliver Bucher
- Department of Epidemiology, CancerCare Manitoba, Winnipeg, MB, Canada
| | - Shantanu Banerji
- Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada; Department of Hematology and Medical Oncology, CancerCare Manitoba, Winnipeg, MB, Canada; Research Institute in Oncology and Hematology, CancerCare Manitoba, Winnipeg, MB, Canada
| | - David E Dawe
- Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada; Department of Hematology and Medical Oncology, CancerCare Manitoba, Winnipeg, MB, Canada; Research Institute in Oncology and Hematology, CancerCare Manitoba, Winnipeg, MB, Canada.
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A systematic review of survival following anti-cancer treatment for small cell lung cancer. Lung Cancer 2020; 141:44-55. [PMID: 31955000 DOI: 10.1016/j.lungcan.2019.12.015] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 12/13/2019] [Accepted: 12/24/2019] [Indexed: 02/08/2023]
Abstract
OBJECTIVES We conducted a systematic review and meta-analysis of survival following treatment recommended by the European Society of Medical Oncology for SCLC in order to determine a benchmark for novel therapies to be compared with. MATERIALS AND METHODS Randomized controlled trials and observational studies reporting overall survival following chemotherapy for SCLC were included. We calculated survival at 30 and 90-days along with 1-year, 2-year and median. RESULTS We identified 160 for inclusion. There were minimal 30-day deaths. Survival was 99 % (95 %CI 98.0-99.0 %, I233.9 %, n = 77) and 90 % (95 %CI 89.0-92.0 %, I279.5 %, n = 73) at 90 days for limited (LD-SCLC) and extensive stage (ED-SCLC) respectively. The median survival for LD-SCLC was 18.1 months (95 %CI 17.0-19.1 %, I277.3 %, n = 110) and early thoracic radiotherapy (thoracic radiotherapy 18.4 months (95 %CI 17.3-19.5, I278.4 %, n = 100)) vs no radiotherapy 11.7 months (95 %CI 9.1-14.3, n = 10), prophylactic cranial irradiation (PCI 19.7 months vs No PCI 13.0 months (95 %CI 18.5-21.0, I275.7 %, n = 78 and 95 %CI 10.5-16.6, I281.1 %, n = 15 respectively)) and better performance status (PS0-1 22.5 months vs PS0-4 15.3 months (95 %CI 18.7-26.1, I272.4 %, n = 11 and 95 %CI 11.5-19.1 I277.9 %, n = 13)) augmented this. For ED-SCLC the median survival was 9.6 months (95 %CI 8.9-10.3 %, I295.2 %, n = 103) and this improved when irinotecan + cisplatin was used, however studies that used this combination were mostly conducted in Asian populations where survival was better. Survival was not improved with the addition of thoracic radiotherapy or PCI. Survival for both stages of cancer was better in modern studies and Asian cohorts. It was poorer for studies administering carboplatin + etoposide but this regimen was used in studies that had fewer patient selection criteria. CONCLUSION Early thoracic radiotherapy and PCI should be offered to people with LD-SCLC in accordance with guideline recommendations. The benefit of the aforementioned therapies to treat ED-SCLC and the use of chemotherapy in people with poor PS is less clear.
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Abstract
OBJECTIVES Small cell lung carcinoma (SCLC) is a highly malignant tumor characterized by early metastasis even at the time of diagnosis. Although pancreatic metastasis occurring in SCLC is a common observation in the literatures, there is currently very limited experience with the metastasis-induced acute pancreatitis in SCLC patients. METHODS Here we retrospectively analyzed patients with metastasis-induced acute pancreatitis and SCLC in West China Hospital between 2009 and 2017. The patients were diagnosed as having SCLC by bronchoscopic biopsy or computed tomography-guided percutaneous biopsy. Metastasis-induced pancreatitis was established by clinical symptoms, radiologic surveillance, serum amylase, and lipase level. The series included 14 patients, 4 women and 10 men, with a mean age of 54 years (range, 29-76 years). The patients underwent chemotherapy plus palliative treatment (n = 8) or palliative care alone (n = 6). RESULTS Compared with patients receiving palliative treatment alone, a trend toward improved survival was observed in patients who underwent chemotherapy. CONCLUSION Our personal experience indicated that chemotherapy might provide a survival benefit in SCLC patients with metastasis-induced pancreatitis, especially those with good performance status.
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Bahij R, Jeppesen SS, Olsen KE, Halekoh U, Holmskov K, Hansen O. Outcome of treatment in patients with small cell lung cancer in poor performance status. Acta Oncol 2019; 58:1612-1617. [PMID: 31282251 DOI: 10.1080/0284186x.2019.1637934] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Patients with small cell lung cancer (SCLC) with poor performance status (PS) especially in the elderly may not benefit from chemotherapy. The aim of this study was to compare survival of treated patients with PS 3-4 with untreated patients.Material and methods: We reviewed the medical records and pathology data for 448 patients diagnosed with small cell carcinoma from 2010 to 2015 and selected all patients in PS 3-4 for review.Results: A total of 87 patients fulfilled the inclusion criteria. Of these, 53 (61%) received chemotherapy (CT), while 34 (39%) did not. The median overall survival (OS) was 5.1 months for the treated patients and 0.7 month for the untreated (p < .001). Multivariate analysis identified lack of treatment with chemotherapy, extensive disease, and PS 4 as independent factors associated with poor prognosis, while age and gender were not. Also, patients with aged ≥70 years who had extended disease had significant improved OS when treated with CT. However, the chance of being treated with CT was significantly influenced by age.Conclusion: CT was associated with improved survival in patients with SCLC with PS 3-4 independent of age and stage of disease. Neither ED, high age, nor poor PS should be used as criteria for omitting CT.
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Affiliation(s)
- Rana Bahij
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - Stefan Starup Jeppesen
- Department of Oncology, Odense University Hospital, Odense, Denmark
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Karen Ege Olsen
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Pathology, Odense University Hospital, Odense, Denmark
| | - Ulrich Halekoh
- Institute of Epidemiology, Biostatics and Biodemography, University of Southern Denmark, Odense, Denmark
| | - Karin Holmskov
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - Olfred Hansen
- Department of Oncology, Odense University Hospital, Odense, Denmark
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
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Aida Y, Nakazawa K, Shiozawa T, Ogawa R, Kiwamoto T, Morishima Y, Sakamoto T, Sekine I, Hizawa N. Small-Cell Lung Cancer Treatment of Newly Diagnosed Patients with Poor Performance Status. Case Rep Oncol 2019; 12:613-620. [PMID: 31543777 PMCID: PMC6738152 DOI: 10.1159/000501548] [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: 06/15/2019] [Accepted: 06/18/2019] [Indexed: 02/05/2023] Open
Abstract
Small-cell lung cancer (SCLC) is highly sensitive to platinum-based chemotherapy. However, its indication in patients with a poor performance status (PS) at initial diagnosis is controversial. We retrospectively reviewed all clinical courses of pathologically diagnosed SCLC patients with poor PS, Eastern Cooperative Oncology Group PS 3 and 4. Among 18 patients, 12 were treated with chemotherapy and 6 with supportive care alone. During the chemotherapy courses, PS improved in 7 (58.3%, including the PS 4 cases), remained stable in 2 (16.7%), and deteriorated in 3 (25%) patients. Moreover, 5 patients showed partial responses to chemotherapy (response rate of 41.7%). Grade 3–4 neutropenia developed in 10 (83.3%) patients and grade 3 febrile neutropenia occurred in 5 (41.7%) patients, but no grade 4 non-hematological toxicity was noted. Mortality associated with lung toxicity (grade 5) due to treatment occurred in a 77-year-old-male patient with PS 3. No substantial difference in survival was observed between patients with PS 3 and 4, even when including those treated with supportive care alone. Treatment had a positive effect on survival: after chemotherapy, the 6-month survival rate of PS 3 and 4 patients was 66.7%. In contrast, all patients treated with supportive care alone died within 5 months. These findings suggest that chemotherapy is indicated in selected SCLC patients not only with PS 3, but also with PS 4.
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Affiliation(s)
- Yuka Aida
- Department of Respiratory Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.,Department of Medical Oncology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Kensuke Nakazawa
- Department of Respiratory Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Toshihiro Shiozawa
- Department of Respiratory Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Ryoko Ogawa
- Department of Respiratory Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Takumi Kiwamoto
- Department of Respiratory Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Yuko Morishima
- Department of Respiratory Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Toru Sakamoto
- Department of Respiratory Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Ikuo Sekine
- Department of Medical Oncology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Nobuyuki Hizawa
- Department of Respiratory Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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Oki M, Saka H. Airway stenting for patients with airway stenosis because of small cell lung cancer. CLINICAL RESPIRATORY JOURNAL 2018; 12:2257-2263. [DOI: 10.1111/crj.12901] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 03/28/2018] [Accepted: 04/08/2018] [Indexed: 12/22/2022]
Affiliation(s)
- Masahide Oki
- Department of Respiratory Medicine; Nagoya Medical Center; Nagoya Japan
| | - Hideo Saka
- Department of Respiratory Medicine; Nagoya Medical Center; Nagoya Japan
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Tendler S, Grozman V, Lewensohn R, Tsakonas G, Viktorsson K, De Petris L. Validation of the 8th TNM classification for small-cell lung cancer in a retrospective material from Sweden. Lung Cancer 2018; 120:75-81. [PMID: 29748020 DOI: 10.1016/j.lungcan.2018.03.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 03/02/2018] [Accepted: 03/29/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND The purpose of this study was to evaluate on a Swedish cohort of small cell lung cancer (SCLC) patients whether the 8th TNM staging system can provide additional prognostic information in comparison with the previous 6th and 7th TNM versions and the older 2-stage LD vs ED system. METHODS We reviewed the medical records of patients (pts) with SCLC diagnosed between January 2008 and February 2016 in the Stockholm and Gotland region. Each patient file was revised and reclassified from the VASGL system to the 6th, 7th and 8th TNM system respectively. We assessed overall survival (OS) according to the T, N, M-descriptor and compared LD/ED with the 6th, -7th, -8th editions of TNM. Four separate multivariate models adjusted for basic patient characteristics were performed. RESULTS In total, 706 pts were eligible for the study. Median OS was 7.7 months. Differences in survival between less advanced stages (IA-IIB) were difficult to assess since there were few patients (n = 32). The majority of patients (78%) migrated to new stage categories in the 8th TNM edition; IIIC, IVA and IVB. In the 8th TNM edition subjects with M1a disease had a similar prognosis to patients with multiple metastatic diseases, M1c. Conversely, subjects with a single metastasis had a similar prognosis to M0-disease. On multivariate analysis, stage was an independent prognostic factor independently of the classification system used. CONCLUSION In this cohort, the 8th TNM classification system seems to provide more accurate prognostic information in patients with SCLC when compared to the previous TNM versions. There were few cases with Stages I and II and therefore no robust conclusions can be drawn in this category. The reason single metastatic lesions (M1b) had a better prognosis when compared to M1c could be due to a more aggressive treatment approach in these patients.
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Affiliation(s)
- Salomon Tendler
- Department of Oncology and Pathology, Karolinska Institute, Stockholm, Sweden
| | - Vitali Grozman
- Department of Radiology, Karolinska University Hospital, Stockholm, Sweden
| | - Rolf Lewensohn
- Department of Oncology and Pathology, Karolinska Institute, Stockholm, Sweden
| | - Georgios Tsakonas
- Department of Oncology and Pathology, Karolinska Institute, Stockholm, Sweden
| | - Kristina Viktorsson
- Department of Oncology and Pathology, Karolinska Institute, Stockholm, Sweden
| | - Luigi De Petris
- Department of Oncology and Pathology, Karolinska Institute, Stockholm, Sweden.
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Obtaining tissue diagnosis in lung cancer patients with poor performance status and its influence on treatment and survival. Respir Med 2017; 124:30-35. [PMID: 28284318 DOI: 10.1016/j.rmed.2017.01.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Revised: 11/24/2016] [Accepted: 01/12/2017] [Indexed: 11/20/2022]
Abstract
INTRODUCTION 25% of patients with lung cancer have performance status 3 or 4. A pragmatic approach to investigative procedures is often adopted based on the risks and benefits in these patients and whether tissue diagnosis is necessary for anticipated future treatment. This cohort study investigated factors influencing a clinician's decision to pursue a tissue diagnosis in patients with lung cancer and performance status 3 and 4 and to examine the association of tissue diagnosis with subsequent management and survival. METHODS All patients with lung cancer diagnosed in North Glasgow from 2009 to 2012 were prospectively recorded in a registry. We investigated the relationships between achieving a tissue diagnosis, treatment and survival. RESULTS Of 2493 patients diagnosed with lung cancer, 490 patients (20%) were PS 3 and 122 patients (5%) were PS 4. Tissue diagnosis was attempted in 60% and 35% patients with PS 3 and PS 4 respectively. Younger age, better performance status and having stage 4 disease were independently associated with a diagnostic procedure being performed. Only 5% of patients with poor performance status received treatment conventionally requiring a tissue diagnosis. Age, stage and performance status were independent predictors of mortality. Achieving a tissue diagnosis was not associated with mortality. Receiving treatment requiring tissue diagnosis is associated with survival benefit. CONCLUSIONS The majority of patients with poor fitness undergo a diagnostic procedure which does not influence further treatment or affect survival. However, the cohort of patients who do undergo therapy determined by tissue diagnosis have improved survival.
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Kumar RV, Bhasker S. Health-care related supportive-care factors may be responsible for poorer survival of cancer patients in developing countries. J Cancer Policy 2015. [DOI: 10.1016/j.jcpo.2015.05.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Active treatment given in the last weeks of life: poor quality cancer care or justifiable behavior? Support Care Cancer 2014; 22:2813-9. [DOI: 10.1007/s00520-014-2268-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2013] [Accepted: 04/28/2014] [Indexed: 10/25/2022]
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Small steps of improvement in small-cell lung cancer (SCLC) within two decades: A comprehensive analysis of 484 patients. Lung Cancer 2014; 84:168-74. [DOI: 10.1016/j.lungcan.2014.02.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Revised: 01/18/2014] [Accepted: 02/10/2014] [Indexed: 11/21/2022]
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Zhang P, Xu N, Zhou L, Xu X, Wang Y, Li K, Zeng Z, Wang X, Zhang X, Bai C. A linear polyethylenimine mediated siRNA-based therapy targeting human epidermal growth factor receptor in SPC-A1 xenograft mice. TRANSLATIONAL RESPIRATORY MEDICINE 2013; 1:2. [PMID: 27234384 PMCID: PMC6733432 DOI: 10.1186/2213-0802-1-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2012] [Accepted: 11/08/2012] [Indexed: 01/16/2023]
Abstract
Background Linear polyethylenimine (LPEI) is considered as a desirable gene in vivo delivery system, but whether it could deliver the specific siRNA targeted EGFR to the tumor site to inhibit the growth of NSCLC xenograft in nude mice still needs to be examined. Methods In this study, LPEI/siRNA was made into a complex and SPC-A1-xenografted mice model was established. Then, stable LPEI/siRNA-EGFR complexes were intraperitoneally administrated. Afterwards, tumor growth was measured every 3 days. At the end of the experiment, tumor volume was calculated, and tumors were weighed, and examined for EGFR expression, proliferation, and apoptosis evaluations. By using blood samples, toxicity tests including aspartate aminotransferase (AST), alanine aminotransferase (ALT), urea and creatinine (Cr) were measured for liver and renal function evaluation. Serum concentrations of TNF-α and IFN-γ were also examined. Results Our results demonstrated that LPEI/siRNA-EGFR complexes could downregulate EGFR expression in SPC-A1 xenografted tumor upon single i.p. injection. LPEI/siRNA-EGFR complexes inhibited tumor growth and did not induce organ toxicity in SPC-A1-xenografted mice. At the end of the experiment no significant IFN-α increase was detected in LPEI/siRNA complexes or glucose-treated groups. Conclusions The novel modality of siRNA-based therapy targeting EGFR may be of great potential in NSCLC treatment. Electronic supplementary material The online version of this article (doi:10.1186/2213-0802-1-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Pinghai Zhang
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, 20032, China
| | - Nuo Xu
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, 20032, China
| | - Lei Zhou
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, 20032, China
| | - Xin Xu
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, 20032, China
| | - Yuehong Wang
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, 20032, China
| | - Ka Li
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, 20032, China
| | - Zhaochong Zeng
- Department of Radiotherapy, Zhongshan Hospital, Fudan University, Shanghai, 20032, China
| | - Xiangdong Wang
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, 20032, China
| | - Xin Zhang
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, 20032, China
| | - Chunxue Bai
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, 20032, China.
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