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Nakamura R, Yamada T, Tokuda S, Morimoto K, Katayama Y, Matsui Y, Hirai S, Ishida M, Kawachi H, Sawada R, Tachibana Y, Osoegawa A, Horinaka M, Sakai T, Yasuhiro T, Kozaki R, Yano S, Takayama K. Triple combination therapy comprising osimertinib, an AXL inhibitor, and an FGFR inhibitor improves the efficacy of EGFR-mutated non-small cell lung cancer. Cancer Lett 2024; 598:217124. [PMID: 39059573 DOI: 10.1016/j.canlet.2024.217124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2024] [Revised: 07/11/2024] [Accepted: 07/17/2024] [Indexed: 07/28/2024]
Abstract
We previously reported that combined therapy with epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) osimertinib and AXL inhibitor ONO-7475 is effective in preventing the survival of drug-tolerant cells in high-AXL-expressing EGFR-mutated non-small cell lung cancer (NSCLC) cells. Nevertheless, certain residual cells are anticipated to eventually develop acquired resistance to this combination therapy. In this study, we attempted to establish a multidrug combination therapy from the first-line setting to overcome resistance to this combination therapy in high-AXL-expressing EGFR-mutated NSCLC. siRNA screening assay showed that fibroblast growth factor receptor 1 (FGFR1) knockdown induced pronounced inhibition of cell viability in the presence of the osimertinib-ONO-7475 combination, which activates FGFR1 by upregulating FGF2 via the c-Myc pathway. Cell-based assays showed that triple therapy with osimertinib, ONO-7475, and the FGFR inhibitor BGJ398 significantly increased apoptosis by increasing expression of proapoptotic factor Bim and reduced cell viability compared with that observed for the osimertinib-ONO-7475 therapy. Xenograft models showed that triple therapy considerably suppressed tumor regrowth. A novel therapeutic strategy of additional initial FGFR1 inhibition may be highly effective in suppressing the emergence of osimertinib- and ONO-7475-resistant cells.
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MESH Headings
- Animals
- Female
- Humans
- Mice
- Acrylamides/pharmacology
- Aniline Compounds/pharmacology
- Antineoplastic Combined Chemotherapy Protocols/pharmacology
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Apoptosis/drug effects
- Axl Receptor Tyrosine Kinase
- Benzocycloheptenes
- Carcinoma, Non-Small-Cell Lung/drug therapy
- Carcinoma, Non-Small-Cell Lung/genetics
- Carcinoma, Non-Small-Cell Lung/pathology
- Cell Line, Tumor
- Cell Survival/drug effects
- Drug Resistance, Neoplasm/drug effects
- ErbB Receptors/antagonists & inhibitors
- ErbB Receptors/genetics
- Indoles
- Lung Neoplasms/drug therapy
- Lung Neoplasms/genetics
- Lung Neoplasms/pathology
- Mice, Inbred BALB C
- Mice, Nude
- Mutation
- Phenylurea Compounds/pharmacology
- Phenylurea Compounds/administration & dosage
- Piperazines/pharmacology
- Protein Kinase Inhibitors/pharmacology
- Proto-Oncogene Proteins/genetics
- Proto-Oncogene Proteins/antagonists & inhibitors
- Proto-Oncogene Proteins/metabolism
- Pyrimidines/pharmacology
- Receptor Protein-Tyrosine Kinases/antagonists & inhibitors
- Receptor Protein-Tyrosine Kinases/genetics
- Receptor, Fibroblast Growth Factor, Type 1/antagonists & inhibitors
- Receptor, Fibroblast Growth Factor, Type 1/genetics
- Receptor, Fibroblast Growth Factor, Type 1/metabolism
- Triazoles
- Xenograft Model Antitumor Assays
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Affiliation(s)
- Ryota Nakamura
- Department of Pulmonary Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Tadaaki Yamada
- Department of Pulmonary Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
| | - Shinsaku Tokuda
- Department of Pulmonary Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kenji Morimoto
- Department of Pulmonary Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yuki Katayama
- Department of Pulmonary Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yohei Matsui
- Department of Pulmonary Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Soichi Hirai
- Department of Pulmonary Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Masaki Ishida
- Department of Pulmonary Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hayato Kawachi
- Department of Pulmonary Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Ryo Sawada
- Department of Pulmonary Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yusuke Tachibana
- Department of Pulmonary Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Atsushi Osoegawa
- Department of Thoracic and Breast Surgery, Oita University Faculty of Medicine, Oita, Japan
| | - Mano Horinaka
- Department of Drug Discovery Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Toshiyuki Sakai
- Department of Drug Discovery Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Tomoko Yasuhiro
- Research Center of Oncology, Discovery and Research, Ono Pharmaceutical Co., Ltd., Osaka, Japan
| | - Ryohei Kozaki
- Research Center of Oncology, Discovery and Research, Ono Pharmaceutical Co., Ltd., Osaka, Japan
| | - Seiji Yano
- Department of Respiratory Medicine, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan; Division of Medical Oncology, Cancer Research Institute, Kanazawa University, Kanazawa, Japan; WPI-Nano Life Science Institute (WPI-Nano LSI), Kanazawa University, Kanazawa, Japan
| | - Koichi Takayama
- Department of Pulmonary Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Gan J, Huang M, Wang W, Fu G, Hu M, Zhong H, Ye X, Cao Q. Novel genome-wide DNA methylation profiling reveals distinct epigenetic landscape, prognostic model and cellular composition of early-stage lung adenocarcinoma. J Transl Med 2024; 22:428. [PMID: 38711158 DOI: 10.1186/s12967-024-05146-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 03/31/2024] [Indexed: 05/08/2024] Open
Abstract
BACKGROUND Lung adenocarcinoma (LUAD) has been a leading cause of cancer-related mortality worldwide. Early intervention can significantly improve prognosis. DNA methylation could occur in the early stage of tumor. Comprehensive understanding the epigenetic landscape of early-stage LUAD is crucial in understanding tumorigenesis. METHODS Enzymatic methyl sequencing (EM-seq) was performed on 23 tumors and paired normal tissue to reveal distinct epigenetic landscape, for compared with The Cancer Genome Atlas (TCGA) 450K methylation microarray data. Then, an integrative analysis was performed combined with TCGA LUAD RNA-seq data to identify significant differential methylated and expressed genes. Subsequently, the prognostic risk model was constructed and cellular composition was analyzed. RESULTS Methylome analysis of EM-seq comparing tumor and normal tissues identified 25 million cytosine-phosphate-guanine (CpG) sites and 30,187 differentially methylated regions (DMR) with a greater number of untraditional types. EM-seq identified a significantly higher number of CpG sites and DMRs compared to the 450K microarray. By integrating the differentially methylated genes (DMGs) with LUAD-related differentially expressed genes (DEGs) from the TCGA database, we constructed prognostic model based on six differentially methylated-expressed genes (MEGs) and verified our prognostic model in GSE13213 and GSE42127 dataset. Finally, cell deconvolution based on the in-house EM-seq methylation profile was used to estimate cellular composition of early-stage LUAD. CONCLUSIONS This study firstly delves into novel pattern of epigenomic DNA methylation and provides a multidimensional analysis of the role of DNA methylation revealed by EM-seq in early-stage LUAD, providing distinctive insights into its potential epigenetic mechanisms.
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Affiliation(s)
- Junwen Gan
- Department of Thoracic Surgery, The Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, 519000, Guangdong, China
| | - Meng Huang
- Zhuhai Sanmed Biotech Ltd, No. 266 Tongchang Road, Xiang Zhou District, Zhuhai, Guangdong, P. R. China
- Joint Research Center of Liquid Biopsy in Guangdong, Hong Kong, and Macao, Zhuhai, China
| | - Weishi Wang
- Zhuhai Sanmed Biotech Ltd, No. 266 Tongchang Road, Xiang Zhou District, Zhuhai, Guangdong, P. R. China
- Joint Research Center of Liquid Biopsy in Guangdong, Hong Kong, and Macao, Zhuhai, China
| | - Guining Fu
- Department of Thoracic Surgery, The Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, 519000, Guangdong, China
| | - Mingyuan Hu
- Department of Thoracic Surgery, The Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, 519000, Guangdong, China
| | - Hongcheng Zhong
- Department of Thoracic Surgery, The Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, 519000, Guangdong, China.
| | - Xin Ye
- Zhuhai Sanmed Biotech Ltd, No. 266 Tongchang Road, Xiang Zhou District, Zhuhai, Guangdong, P. R. China.
- Joint Research Center of Liquid Biopsy in Guangdong, Hong Kong, and Macao, Zhuhai, China.
| | - Qingdong Cao
- Department of Thoracic Surgery, The Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, 519000, Guangdong, China.
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Chen W, Cheng W, Chen C, Liao W, Chen C, Chen H, Tu C, Lin C, Hsia T. Assessing EGFR-mutated NSCLC with bone metastasis: Clinical features and optimal treatment strategy. Cancer Med 2024; 13:e7152. [PMID: 38549499 PMCID: PMC10979184 DOI: 10.1002/cam4.7152] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 12/06/2023] [Accepted: 03/16/2024] [Indexed: 04/01/2024] Open
Abstract
BACKGROUND This study aimed to examine the clinical characteristics of bone metastasis (BoM) in patients with non-small cell lung cancer (NSCLC) who have an epidermal growth factor receptor (EGFR) mutation and to identify the most effective treatment strategy using EGFR-tyrosine kinase inhibitors (TKIs). METHODS The study included patients with stage IV EGFR-mutated NSCLC who were receiving first-line treatment with EGFR-TKIs between January 2014 and December 2020. These patients were divided into two groups based on the presence or absence of BoM at the time of initial diagnosis. The BoM group was further subdivided based on whether they received denosumab or not. RESULTS The final analysis included 247 patients. Those with BoM at initial diagnosis had shorter progression-free survival (12.6 vs. 10.5 months, p = 0.002) and overall survival (OS) (49.7 vs. 30.9 months, p = 0.002) compared to those without BoM. There was a difference in the location of metastatic sites between the two groups, with a higher incidence of extrathoracic metastasis in the BoM group (p < 0.001). The incidence of T790M was higher in patients with BoM than in those without (47.4% vs. 33.9%, p = 0.042). Multivariate Cox regression analysis revealed that sequential osimertinib treatment and the addition of antiangiogenic therapy (AAT) and denosumab therapy improved OS in patients with BoM. CONCLUSIONS The presence of BoM is a negative prognostic factor for NSCLC patients with an EGFR mutation, possibly due to the presence of extrathoracic metastases. However, adding AAT and denosumab, along with sequential osimertinib, to the treatment regimen for patients with BoM can improve survival outcomes.
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Affiliation(s)
- Wei‐Chun Chen
- Division of Pulmonary and Critical Care, Department of Internal MedicineChina Medical University HospitalTaichungTaiwan
- School of Medicine, College of Medicine, China Medical UniversityTaichungTaiwan
- Department of Life ScienceNational Chung Hsing UniversityTaichungTaiwan
- National Chung Hsing UniversityTaichungTaiwan
- Rong Hsing Research Center for Translational MedicineNational Chung Hsing UniversityTaichungTaiwan
| | - Wen‐Chien Cheng
- Division of Pulmonary and Critical Care, Department of Internal MedicineChina Medical University HospitalTaichungTaiwan
- School of Medicine, College of Medicine, China Medical UniversityTaichungTaiwan
- Department of Life ScienceNational Chung Hsing UniversityTaichungTaiwan
- National Chung Hsing UniversityTaichungTaiwan
- Rong Hsing Research Center for Translational MedicineNational Chung Hsing UniversityTaichungTaiwan
| | - Chieh‐Lung Chen
- Division of Pulmonary and Critical Care, Department of Internal MedicineChina Medical University HospitalTaichungTaiwan
| | - Wei‐Chih Liao
- Division of Pulmonary and Critical Care, Department of Internal MedicineChina Medical University HospitalTaichungTaiwan
- School of Medicine, College of Medicine, China Medical UniversityTaichungTaiwan
| | - Chia‐Hung Chen
- Division of Pulmonary and Critical Care, Department of Internal MedicineChina Medical University HospitalTaichungTaiwan
- School of Medicine, College of Medicine, China Medical UniversityTaichungTaiwan
| | - Hung‐Jen Chen
- Division of Pulmonary and Critical Care, Department of Internal MedicineChina Medical University HospitalTaichungTaiwan
- School of Medicine, College of Medicine, China Medical UniversityTaichungTaiwan
| | - Chih‐Yen Tu
- Division of Pulmonary and Critical Care, Department of Internal MedicineChina Medical University HospitalTaichungTaiwan
- School of Medicine, College of Medicine, China Medical UniversityTaichungTaiwan
| | - Chi‐Chen Lin
- Department of Life ScienceNational Chung Hsing UniversityTaichungTaiwan
- Institute of Biomedical Science, The iEGG and Animal Biotechnology CenterNational Chung‐Hsing UniversityTaichungTaiwan
- Department of Medical ResearchChina Medical University HospitalTaichungTaiwan
- Department of Medical ResearchTaichung Veterans General HospitalTaichungTaiwan
- Department of PharmacologyCollege of Medicine, Kaohsiung Medical UniversityKaohsiungTaiwan
| | - Te‐Chun Hsia
- Division of Pulmonary and Critical Care, Department of Internal MedicineChina Medical University HospitalTaichungTaiwan
- School of Medicine, College of Medicine, China Medical UniversityTaichungTaiwan
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4
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Gong J, Hu S, Shan Q, Qin J, Han N, Xie F, Lu H. Bone metastasis in non-small-cell lung cancer: genomic characterization and exploration of potential targets. Ther Adv Med Oncol 2024; 16:17588359241239293. [PMID: 38510678 PMCID: PMC10953105 DOI: 10.1177/17588359241239293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 02/27/2024] [Indexed: 03/22/2024] Open
Abstract
Background Bone metastasis (BM) seriously affects the quality of life and reduces the survival time of patients with non-small-cell lung cancer (NSCLC). The genomic characteristics and potential targets of BMs are yet to be fully explored. Objective To explore the genetic characteristics and potential targets of BM in NSCLC. Design In all, 83 patients with NSCLC were retrospectively selected in this study. Genomic characterization of BMs was explored with the analysis of NGS results from primary tumors and BMs in 6 patients, then combined with NGS results of lung tumors in 16 patients with initial recurrence in bone to analyze mutations potentially associated with BMs, and finally, the correlation was further validated in 61 postoperative patients. Methods The next generation sequencing (NGS) was performed to identify genomic differences between pulmonary primary tumors and BM. Fluorescence in situ hybridization and immunohistochemistry were performed in postoperative tumor tissues from patients who had undergone radical surgery to validate the predictive role of molecular targets for BM. The correlation between cyclin-dependent kinase 4 (CDK4) and BM was evaluated by Pearson's chi-square test. The university of alabama at birminghan cancer data analysis portal (UALCAN) was carried out for the detection of CDK4 expression in lung cancer and the relationship between CDK4 and clinicopathological parameters. The relationship between prognosis and CDK4 expression was analyzed by the Kaplan-Meier plotter. Results The rate of gene amplification was increased (24% versus 36%) while gene substitution/indel was decreased (64% versus 52%) in BMs. The BM-specific mutations were analyzed in 16 recurrent patients which revealed the highest incidence of CDK4 amplification (18.8%). According to the Kaplan-Meier plotter database, the NSCLC patients with high CDK4 gene expression showed poor overall survival (OS) and recurrence-free survival (RFS) (p < 0.05). The incidence of CDK4 amplification tended to be higher in recurrent patients compared to the patients without BM (18.8% versus 4.7%, p = 0.118). Conclusion Compared to the primary tumors of NSCLC, the genome of BMs showed an increased proportion of amplification and a decreased proportion of gene substitution/indel. Furthermore, the CDK4 amplification ratio seemed to be elevated in NSCLC patients with BM which may be associated with poor OS and RFS.
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Affiliation(s)
- Jiali Gong
- Zhejiang Key Laboratory of Diagnosis and Treatment Technology on Thoracic Oncology (Lung and Esophagus), Zhejiang Cancer Hospital, Institute of Basic and Cancer Medicine, Gongshu, Hangzhou, P.R. China
- Department of Thoracic Medical Oncology, Zhejiang Cancer Hospital, Institute of Basic and Cancer Medicine, Gongshu, Hangzhou, P.R. China
- Department of Hematology and Oncology, Ningbo No. 2 Hospital, Ningbo, Zhejiang, P.R. China
| | - Shumin Hu
- Zhejiang Key Laboratory of Diagnosis and Treatment Technology on Thoracic Oncology (Lung and Esophagus), Zhejiang Cancer Hospital, Institute of Basic and Cancer Medicine, Gongshu, Hangzhou, P.R. China
- Department of Thoracic Medical Oncology, Zhejiang Cancer Hospital, Institute of Basic and Cancer Medicine, Gongshu, Hangzhou, P.R. China
| | - Qianyun Shan
- Zhejiang Key Laboratory of Diagnosis and Treatment Technology on Thoracic Oncology (Lung and Esophagus), Zhejiang Cancer Hospital, Institute of Basic and Cancer Medicine, Gongshu, Hangzhou, P.R. China
- Department of Thoracic Medical Oncology, Zhejiang Cancer Hospital, Institute of Basic and Cancer Medicine, Gongshu, Hangzhou, P.R. China
| | - Jing Qin
- Zhejiang Key Laboratory of Diagnosis and Treatment Technology on Thoracic Oncology (Lung and Esophagus), Zhejiang Cancer Hospital, Institute of Basic and Cancer Medicine, Gongshu, Hangzhou, P.R. China
- Department of Thoracic Medical Oncology, Zhejiang Cancer Hospital, Institute of Basic and Cancer Medicine, Gongshu, Hangzhou, P.R. China
| | - Na Han
- Zhejiang Key Laboratory of Diagnosis and Treatment Technology on Thoracic Oncology (Lung and Esophagus), Zhejiang Cancer Hospital, Institute of Basic and Cancer Medicine, Gongshu, Hangzhou, P.R. China
- Department of Thoracic Medical Oncology, Zhejiang Cancer Hospital, Institute of Basic and Cancer Medicine, Gongshu, Hangzhou, P.R. China
| | - Fajun Xie
- Zhejiang Key Laboratory of Diagnosis and Treatment Technology on Thoracic Oncology (Lung and Esophagus), Zhejiang Cancer Hospital, Institute of Basic and Cancer Medicine, Gongshu, Hangzhou, P.R. China
- Department of Thoracic Medical Oncology, Zhejiang Cancer Hospital, Institute of Basic and Cancer Medicine, Gongshu, Hangzhou, P.R. China
| | - Hongyang Lu
- Zhejiang Key Laboratory of Diagnosis and Treatment Technology on Thoracic Oncology (Lung and Esophagus), Zhejiang Cancer Hospital, Institute of Basic and Cancer Medicine, No. 1 East Banshan Road, Gongshu, Hangzhou 310022, P.R. China
- Department of Thoracic Medical Oncology, Zhejiang Cancer Hospital, Institute of Basic and Cancer Medicine, Gongshu, Hangzhou 310022, P.R. China
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Kishi N, Matsuo Y, Shintani T, Ogura M, Mitsuyoshi T, Araki N, Fujii K, Okumura S, Nakamatsu K, Kishi T, Atsuta T, Sakamoto T, Ohtsu S, Katagiri T, Narabayashi M, Fujishiro S, Iizuka Y, Ozasa H, Hirai T, Mizowaki T. Recurrence patterns and progression-free survival after chemoradiotherapy with or without consolidation durvalumab for stage III non-small cell lung cancer. JOURNAL OF RADIATION RESEARCH 2023; 64:142-153. [PMID: 36149029 PMCID: PMC9855316 DOI: 10.1093/jrr/rrac057] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 07/16/2022] [Indexed: 05/28/2023]
Abstract
Chemoradiotherapy followed by consolidation durvalumab (CCRT+D) improves survival in patients with stage III non-small-cell lung cancer (NSCLC). We compared recurrence patterns and survival in the CCRT+D and CCRT cohorts. We conducted a multicenter, retrospective study in Japan. Patients who received CCRT for stage III NSCLC were included in this study. Of 178 eligible patients, 136 were in the CCRT+D and 42 were in the CCRT cohorts. Locoregional recurrence (LR), LR plus distant metastases (DM), and DM were observed in 20.6%, 8.8%, 27.9% of the CCRT+D, and 26.2%, 16.7% and 33.3% of the CCRT cohorts, respectively. In-field recurrence was the most common LR pattern in both cohorts. Squamous cell carcinoma and PD-L1 expression < 1%, and female sex and EGFR mutations were significantly associated with an increased risk of LR and DM. In patients with any risk factors for LR, the incidence of LR was similar in the CCRT+D and CCRT (39.5% vs 45.5%). The 24 month progression-free survival (PFS) and overall survival (OS) were 40.3% and 69.4% in the CCRT+D and 24.7% and 61.0% in the CCRT cohorts, respectively. Poor performance status and no consolidation durvalumab were significantly associated with shorter PFS. There was a significant difference in PFS between the CCRT+D and CCRT in the propensity score-matched cohort (HR = 0.51, P = 0.005). In conclusion, consolidation durvalumab decreased both LR and DM, and significantly improved PFS. However, in-field recurrence was still a major problem, as well as DM.
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Affiliation(s)
- Noriko Kishi
- Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Yukinori Matsuo
- Corresponding author. Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan. Tel: +81-75-751-3762; Fax: +81-75-771-9749;
| | - Takashi Shintani
- Department of Radiology, Japanese Red Cross Fukui Hospital, 2-4-1 Tsukimi, Fukui, 918-8501, Japan
| | - Masakazu Ogura
- Department of Radiation Oncology, Kishiwada City Hospital, 1001 Gakuhara-cho, Kishiwada, Osaka, 596-8501, Japan
| | - Takamasa Mitsuyoshi
- Department of Radiation Oncology, Kobe City Medical Center General Hospital, 2-1-1, Minatojimaminamimachi, Chuo-ku, Kobe, Hyogo, 650-0047, Japan
| | - Norio Araki
- Department of Radiology, National Hospital Organization Kyoto Medical Center, 1-1 Fukakusamukaihata-cho, Fushimi-ku, Kyoto, 612-8555, Japan
| | - Kota Fujii
- Department of Radiation Oncology, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama, 710-8602, Japan
| | - Setsuko Okumura
- Department of Radiation Oncology, Hyogo Prefectural Amagasaki General Medical Center, 2-17-77 Higashinanba-cho, Amagasaki, Hyogo, 660-8550, Japan
| | - Kiyoshi Nakamatsu
- Department of Radiation Oncology, Kindai University Faculty of Medicine, 377-2, Onohigashi, Osakasayama-shi, Osaka, 589-8511, Japan
| | - Takahiro Kishi
- Department of Radiation Oncology, Osaka Red Cross Hospital, 5-30 Fudegasaki-cho, Tennoji-ku, Osaka, 543-8555, Japan
| | - Tomoko Atsuta
- Department of Radiation Oncology, Kitano Hospital, Tazuke Kofukai Medical Research Institute, 2-4-20, Ohgimachi, Kita-ku, Osaka, 530-8480, Japan
| | - Takashi Sakamoto
- Department of Radiation Oncology, Kyoto Katsura Hospital, 17 Yamadahirao-cho, Nishikyo-ku, Kyoto, 615-8256, Japan
| | - Shuji Ohtsu
- Department of Radiation Oncology, Kyoto City Hospital, 1-2 Mibuhigashitakada-cho, Nakagyo-ku, Kyoto, 604-8845, Japan
| | - Tomohiro Katagiri
- Department of Radiation Oncology, Tenri Hospital, 200 Mishima-cho, Tenri, Nara, 632-8552, Japan
| | - Masaru Narabayashi
- Department of Radiology, Japanese Red Cross Fukui Hospital, 2-4-1 Tsukimi, Fukui, 918-8501, Japan
| | - Satsuki Fujishiro
- Department of Radiation Oncology, Shinko Hospital, 1-4-47 Wakihama-cho, Chuo-ku, Kobe, Hyogo, 651-0072, Japan
| | - Yusuke Iizuka
- Department of Radiation Oncology, Shizuoka City Shizuoka Hospital, 10-93 Otemachi, Aoi-ku, Shizuoka, 420-8630, Japan
| | - Hiroaki Ozasa
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Toyohiro Hirai
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Takashi Mizowaki
- Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
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Worldwide Prevalence of Epidermal Growth Factor Receptor Mutations in Non-Small Cell Lung Cancer: A Meta-Analysis. Mol Diagn Ther 2021; 26:7-18. [PMID: 34813053 PMCID: PMC8766385 DOI: 10.1007/s40291-021-00563-1] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2021] [Indexed: 01/22/2023]
Abstract
Background Identification of variable epidermal growth factor receptor (EGFR) gene mutations in non-small cell lung cancer (NSCLC) is important for the selection of appropriate targeted therapies. This meta-analysis was conducted to provide a worldwide overview of EGFR mutation and submutation (specifically exon 19 deletions, exon 21 L858R substitutions, and others) prevalence, and identify important covariates that influence EGFR mutation status in patients with advanced NSCLC to address this clinical data gap. Methods Embase® and MEDLINE® in Ovid were searched for studies published between 2004 and 2019 with cohorts of ≥ 50 adults with EGFR mutations, focusing on stage III/IV NSCLC (≤ 20% of patients with stage I/II NSCLC). Linear mixed-effects models were fitted to EGFR mutation endpoints using logistic transformation (logit), assuming a binomial distribution. The model included terms for an intercept reflecting European studies and further additive terms for other continents. EGFR submutations examined were exon 19 deletions, exon 21 L858R substitutions, and others. Results Of 3969 abstracts screened, 57 studies were included in the overall EGFR mutation analysis and 74 were included in the submutation analysis relative to the overall EGFR mutation population (Europe, n = 12; Asia, n = 51; North America, n = 5; Central America, n = 1; South America, n = 1; Oceania, n = 1; Global, n = 3). The final overall EGFR mutations model estimated Asian and European prevalence of 49.1% and 12.8%, respectively, and included an additive covariate for the proportion of male patients in a study. There were no significant covariates in the submutation analyses. Most submutations were actionable: exon 19 deletions (49.2% [Asia]; 48.4% [Europe]); exon 21 L858R substitutions (41.1% [Asia]; 29.9% [Europe]). Conclusions Although EGFR mutation prevalence was higher in Asian than Western countries, data support worldwide testing for EGFR overall and submutations to inform appropriate targeted treatment decisions. Supplementary Information The online version contains supplementary material available at 10.1007/s40291-021-00563-1.
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7
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Wang B, Chen S, Xiao H, Zhang J, Liang D, Shan J, Zou H. Analysis of risk factors and gene mutation characteristics of different metastatic sites of lung cancer. Cancer Med 2021; 11:268-280. [PMID: 34799997 PMCID: PMC8704150 DOI: 10.1002/cam4.4424] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 10/11/2021] [Accepted: 10/21/2021] [Indexed: 01/12/2023] Open
Abstract
Risk factors vary in terms of the pattern of lung cancer metastasis and specific metastatic organs. In this study, we retrospectively analyzed the clinical risk factors of tumor metastasis in lung cancer patients and used second‐generation gene sequencing to characterize relevant gene mutations. The risk factors of different metastatic sites of real‐world lung cancer were explored to find the differentially expressed genes and risk factors in different metastatic organs, which laid a foundation for further study on the metastasis patterns and mechanisms of lung cancer. The clinical risk factors of tumor metastasis in 137 lung cancer patients who attended our department from May 2017 to March 2019 were retrospectively analyzed and grouped based on bone metastasis, brain metastasis, other distant metastasis, and no metastasis. Single‐ or multi‐factor logistic regression analysis was performed to analyze the effect of neutrophil/lymphocyte ratio/platelet/lymphocyte ratio/lymphocyte to monocyte ratio on platelets (PLTs) and bone metastasis by combining PLT values, age, pathology type, gender, and smoking history. Based on the presence or absence of bone metastasis, distal metastasis, and PLT values of lung cancer, 39 tissue specimens of primary lung cancer were taken for 773 gene grouping and gene mutation characterization. The tumor mutation load, gene copy number instability, microsatellite instability, and tumor heterogeneity among different groups were analyzed. Age and PLT level were independent risk factors for bone metastasis and distal metastasis, but not for brain metastasis. The RB1 gene was mutated during bone metastasis, and tumor heterogeneity was less in the elevated PLT group. PLT values were an independent risk factor for distant metastases from lung cancer other than the brain. Age has a significant effect on bone metastasis formation. RB1 gene mutation was significantly associated with bone metastasis.
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Affiliation(s)
- Bin Wang
- Department of Oncology, Daping Hospital, Army Medical University, Chongqing, China.,Department of Cell Biology and Genetics, Chongqing Medical University, Chongqing, China
| | - Shu Chen
- Department of Oncology, Daping Hospital, Army Medical University, Chongqing, China
| | - He Xiao
- Department of Oncology, Daping Hospital, Army Medical University, Chongqing, China
| | - Jiao Zhang
- Genecast Biotechnology Co., Ltd, Wuxi City, China
| | - Dandan Liang
- Genecast Biotechnology Co., Ltd, Wuxi City, China
| | - Jinlu Shan
- Department of Oncology, Daping Hospital, Army Medical University, Chongqing, China
| | - Hua Zou
- Department of Oncology, Daping Hospital, Army Medical University, Chongqing, China
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8
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Confavreux CB, Follet H, Mitton D, Pialat JB, Clézardin P. Fracture Risk Evaluation of Bone Metastases: A Burning Issue. Cancers (Basel) 2021; 13:cancers13225711. [PMID: 34830865 PMCID: PMC8616502 DOI: 10.3390/cancers13225711] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 11/07/2021] [Accepted: 11/10/2021] [Indexed: 11/16/2022] Open
Abstract
Major progress has been achieved to treat cancer patients and survival has improved considerably, even for stage-IV bone metastatic patients. Locomotive health has become a crucial issue for patient autonomy and quality of life. The centerpiece of the reflection lies in the fracture risk evaluation of bone metastasis to guide physician decision regarding physical activity, antiresorptive agent prescription, and local intervention by radiotherapy, surgery, and interventional radiology. A key mandatory step, since bone metastases may be asymptomatic and disseminated throughout the skeleton, is to identify the bone metastasis location by cartography, especially within weight-bearing bones. For every location, the fracture risk evaluation relies on qualitative approaches using imagery and scores such as Mirels and spinal instability neoplastic score (SINS). This approach, however, has important limitations and there is a need to develop new tools for bone metastatic and myeloma fracture risk evaluation. Personalized numerical simulation qCT-based imaging constitutes one of these emerging tools to assess bone tumoral strength and estimate the femoral and vertebral fracture risk. The next generation of numerical simulation and artificial intelligence will take into account multiple loadings to integrate movement and obtain conditions even closer to real-life, in order to guide patient rehabilitation and activity within a personalized-medicine approach.
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Affiliation(s)
- Cyrille B. Confavreux
- Centre Expert des Métastases Osseuses (CEMOS), Département de Rhumatologie, Institut de Cancérologie des Hospices Civils de Lyon (IC-HCL), Hôpital Lyon Sud, Hospices Civils de Lyon, 69310 Pierre Bénite, France
- Université de Lyon, Université Claude Bernard Lyon 1, 69100 Villeurbanne, France; (H.F.); (J.B.P.); (P.C.)
- Institut National de la Santé et de la Recherche Médicale INSERM, LYOS UMR1033, 69008 Lyon, France
- Correspondence:
| | - Helene Follet
- Université de Lyon, Université Claude Bernard Lyon 1, 69100 Villeurbanne, France; (H.F.); (J.B.P.); (P.C.)
- Institut National de la Santé et de la Recherche Médicale INSERM, LYOS UMR1033, 69008 Lyon, France
| | - David Mitton
- Université de Lyon, Université Gustave Eiffel, Université Claude Bernard Lyon 1, LBMC, UMR_T 9406, 69622 Lyon, France;
| | - Jean Baptiste Pialat
- Université de Lyon, Université Claude Bernard Lyon 1, 69100 Villeurbanne, France; (H.F.); (J.B.P.); (P.C.)
- CREATIS, CNRS UMR 5220, INSERM U1294, INSA Lyon, Université Jean Monnet Saint-Etienne, 42000 Saint-Etienne, France
- Service de Radiologie, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, 69310 Pierre Bénite, France
| | - Philippe Clézardin
- Université de Lyon, Université Claude Bernard Lyon 1, 69100 Villeurbanne, France; (H.F.); (J.B.P.); (P.C.)
- Institut National de la Santé et de la Recherche Médicale INSERM, LYOS UMR1033, 69008 Lyon, France
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Chai X, Yinwang E, Wang Z, Wang Z, Xue Y, Li B, Zhou H, Zhang W, Wang S, Zhang Y, Li H, Mou H, Sun L, Qu H, Wang F, Zhang Z, Chen T, Ye Z. Predictive and Prognostic Biomarkers for Lung Cancer Bone Metastasis and Their Therapeutic Value. Front Oncol 2021; 11:692788. [PMID: 34722241 PMCID: PMC8552022 DOI: 10.3389/fonc.2021.692788] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 08/30/2021] [Indexed: 12/25/2022] Open
Abstract
Lung cancer is the leading cause of cancer-related death worldwide. Bone metastasis, which usually accompanies severe skeletal-related events, is the most common site for tumor distant dissemination and detected in more than one-third of patients with advanced lung cancer. Biopsy and imaging play critical roles in the diagnosis of bone metastasis; however, these approaches are characterized by evident limitations. Recently, studies regarding potential biomarkers in the serum, urine, and tumor tissue, were performed to predict the bone metastases and prognosis in patients with lung cancer. In this review, we summarize the findings of recent clinical research studies on biomarkers detected in samples obtained from patients with lung cancer bone metastasis. These markers include the following: (1) bone resorption-associated markers, such as N-terminal telopeptide (NTx)/C-terminal telopeptide (CTx), C-terminal telopeptide of type I collagen (CTx-I), tartrate-resistant acid phosphatase isoform 5b (TRACP-5b), pyridinoline (PYD), and parathyroid hormone related peptide (PTHrP); (2) bone formation-associated markers, including total serum alkaline phosphatase (ALP)/bone specific alkaline phosphatase(BAP), osteopontin (OP), osteocalcin (OS), amino-terminal extension propeptide of type I procollagen/carboxy-terminal extension propeptide of type I procollagen (PICP/PINP); (3) signaling markers, including epidermal growth factor receptor/Kirsten rat sarcoma/anaplastic lymphoma kinase (EGFR/KRAS/ALK), receptor activator of nuclear factor κB ligand/receptor activator of nuclear factor κB/osteoprotegerin (RANKL/RANK/OPG), C-X-C motif chemokine ligand 12/C-X-C motif chemokine receptor 4 (CXCL12/CXCR4), complement component 5a receptor (C5AR); and (4) other potential markers, such as calcium sensing receptor (CASR), bone sialoprotein (BSP), bone morphogenetic protein 2 (BMP2), cytokeratin 19 fragment/carcinoembryonic antigen (CYFRA/CEA), tissue factor, cell-free DNA, long non-coding RNA, and microRNA. The prognostic value of these markers is also investigated. Furthermore, we listed some clinical trials targeting hotspot biomarkers in advanced lung cancer referring for their therapeutic effects.
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Affiliation(s)
- Xupeng Chai
- Department of Orthopedics, Musculoskeletal Tumor Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China.,Institute of Orthopedic Research, Zhejiang University, Hangzhou, China
| | - Eloy Yinwang
- Department of Orthopedics, Musculoskeletal Tumor Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China.,Institute of Orthopedic Research, Zhejiang University, Hangzhou, China
| | - Zenan Wang
- Department of Orthopedics, Musculoskeletal Tumor Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China.,Institute of Orthopedic Research, Zhejiang University, Hangzhou, China
| | - Zhan Wang
- Department of Orthopedics, Musculoskeletal Tumor Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China.,Institute of Orthopedic Research, Zhejiang University, Hangzhou, China
| | - Yucheng Xue
- Department of Orthopedics, Musculoskeletal Tumor Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China.,Institute of Orthopedic Research, Zhejiang University, Hangzhou, China
| | - Binghao Li
- Department of Orthopedics, Musculoskeletal Tumor Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China.,Institute of Orthopedic Research, Zhejiang University, Hangzhou, China
| | - Hao Zhou
- Department of Orthopedics, Musculoskeletal Tumor Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China.,Institute of Orthopedic Research, Zhejiang University, Hangzhou, China
| | - Wenkan Zhang
- Department of Orthopedics, Musculoskeletal Tumor Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China.,Institute of Orthopedic Research, Zhejiang University, Hangzhou, China
| | - Shengdong Wang
- Department of Orthopedics, Musculoskeletal Tumor Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China.,Institute of Orthopedic Research, Zhejiang University, Hangzhou, China
| | - Yongxing Zhang
- Department of Orthopedics, Musculoskeletal Tumor Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China.,Institute of Orthopedic Research, Zhejiang University, Hangzhou, China
| | - Hengyuan Li
- Department of Orthopedics, Musculoskeletal Tumor Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China.,Institute of Orthopedic Research, Zhejiang University, Hangzhou, China
| | - Haochen Mou
- Department of Orthopedics, Musculoskeletal Tumor Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China.,Institute of Orthopedic Research, Zhejiang University, Hangzhou, China
| | - Lingling Sun
- Department of Orthopedics, Musculoskeletal Tumor Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China.,Institute of Orthopedic Research, Zhejiang University, Hangzhou, China
| | - Hao Qu
- Department of Orthopedics, Musculoskeletal Tumor Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China.,Institute of Orthopedic Research, Zhejiang University, Hangzhou, China
| | - Fangqian Wang
- Department of Orthopedics, Musculoskeletal Tumor Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China.,Institute of Orthopedic Research, Zhejiang University, Hangzhou, China
| | - Zengjie Zhang
- Department of Orthopedics, Musculoskeletal Tumor Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China.,Institute of Orthopedic Research, Zhejiang University, Hangzhou, China
| | - Tao Chen
- Department of Orthopedics, Musculoskeletal Tumor Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China.,Institute of Orthopedic Research, Zhejiang University, Hangzhou, China
| | - Zhaoming Ye
- Department of Orthopedics, Musculoskeletal Tumor Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China.,Institute of Orthopedic Research, Zhejiang University, Hangzhou, China
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10
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Abbott A, Kendal JK, Hewison C, Puloski S, Monument M. Longitudinal survival trends of patients with cancer with surgically managed appendicular metastatic bone disease: systematic review. Can J Surg 2021; 64:E550-E560. [PMID: 34728520 PMCID: PMC8565884 DOI: 10.1503/cjs.015520] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2020] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Advances in systemic cancer therapies have improved survival for patients with metastatic carcinoma; however, it is unknown whether these advances have translated to improved survival for patients with appendicular metastatic bone disease (A-MBD) after orthopedic interventions. We conducted a study to evaluate the trend in overall survival for patients who underwent orthopedic surgery for A-MBD between 1968 and 2018. METHODS A systematic search of Embase and Medline to identify studies published since 1968 evaluating patients treated with orthopedic surgery for A-MBD was conducted for a previously published scoping review. We used a meta-regression model to assess the longitudinal trends in 1-, 2- and 5-year overall survival between 1968 and 2018. The midpoint year of patient inclusion for each study was used for analysis. We categorized primary tumour types into a tumour severity score according to prognosis for a further meta-regression analysis. RESULTS Of the 5747 studies identified, 103 were retained for analysis. Meta-regression analysis showed no significant effect of midpoint study year on survival across all time points. There was no effect of the weighted average of tumour severity scores for each study on 1-year survival over time. CONCLUSION There was no significant improvement in overall survival between 1968 and 2018 for patients with A-MBD who underwent orthopedic surgery. Orthopedic intervention remains a poor prognostic variable for patients with MBD. This finding highlights the need for improved collection of prospective data in this population to identify patients with favourable survival outcomes who may benefit from personalized oncologic surgical interventions.
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Affiliation(s)
- Annalise Abbott
- From the Section of Orthopaedic Surgery, Department of Surgery, University of Calgary, Calgary, Alta. (Abbott, Kendal, Hewison, Puloski, Monument); the McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alta. (Puloski, Monument); and the Arnie Charbonneau Cancer Institute, University of Calgary, Calgary, Alta. (Monument)
| | - Joseph K Kendal
- From the Section of Orthopaedic Surgery, Department of Surgery, University of Calgary, Calgary, Alta. (Abbott, Kendal, Hewison, Puloski, Monument); the McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alta. (Puloski, Monument); and the Arnie Charbonneau Cancer Institute, University of Calgary, Calgary, Alta. (Monument)
| | - Christopher Hewison
- From the Section of Orthopaedic Surgery, Department of Surgery, University of Calgary, Calgary, Alta. (Abbott, Kendal, Hewison, Puloski, Monument); the McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alta. (Puloski, Monument); and the Arnie Charbonneau Cancer Institute, University of Calgary, Calgary, Alta. (Monument)
| | - Shannon Puloski
- From the Section of Orthopaedic Surgery, Department of Surgery, University of Calgary, Calgary, Alta. (Abbott, Kendal, Hewison, Puloski, Monument); the McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alta. (Puloski, Monument); and the Arnie Charbonneau Cancer Institute, University of Calgary, Calgary, Alta. (Monument)
| | - Michael Monument
- From the Section of Orthopaedic Surgery, Department of Surgery, University of Calgary, Calgary, Alta. (Abbott, Kendal, Hewison, Puloski, Monument); the McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alta. (Puloski, Monument); and the Arnie Charbonneau Cancer Institute, University of Calgary, Calgary, Alta. (Monument)
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11
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Huang ACC, Huang CH, Ju JS, Chiu TH, Tung PH, Wang CC, Liu CY, Chung FT, Fang YF, Guo YK, Kuo CHS, Yang CT. First- or second-generation epidermal growth factor receptor tyrosine kinase inhibitors in a large, real-world cohort of patients with non-small cell lung cancer. Ther Adv Med Oncol 2021; 13:17588359211035710. [PMID: 34377157 PMCID: PMC8326821 DOI: 10.1177/17588359211035710] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 07/09/2021] [Indexed: 11/16/2022] Open
Abstract
Background There are limited comparisons of first- and second-generation EGFR tyrosine kinase inhibitors (TKIs) in large, real-world cohorts of non-small cell lung cancer (NSCLC) patients with epidermal growth factor receptor (EGFR) mutations. Methods Patients with advanced NSCLC (N = 612) with common EGFR mutations receiving first-line gefitinib/erlotinib and afatinib were grouped and propensity-score matched. Progression-free survival (PFS), overall survival (OS) and secondary T790M mutations were analyzed. Results The gefitinib/erlotinib and afatinib groups each contained 206 patients after matching. Compared with gefitinib/erlotinib, patients receiving afatinib achieved longer median PFS (16.3 versus 14.2 months; log-rank test p = 0.020) and had a lower risk of progression [hazard ratio (HR) 0.73 (95% confidence interval (CI), 0.57-0.94); p = 0.017]. Median OS (37.3 versus 34.2 months; log-rank test p = 0.500) and reduction in risk of death [HR 0.89 (95% CI, 0.65-1.23); p = 0.476] did not differ significantly between groups. T790M positivity was significantly higher in the gefitinib/erlotinib than afatinib group (70.9% versus 44.6%, p < 0.001). Multivariate analysis demonstrated that afatinib was independently associated with lower T790M positivity [odds ratio (OR) 0.27 (95% CI, 0.14-0.53); p < 0.001], whereas ⩾12 months PFS after EGFR-TKI treatment [OR 3.00 (95% CI, 1.56-5.98); p = 0.001] and brain metastasis [OR 2.12 (95% CI, 1.08-4.26); p = 0.030] were associated with higher T790M positivity. Sequential third-generation EGFR-TKI treatment was administered to 63 patients, in whom median OS after the second-third-generation and first-third-generation EGFR-TKI sequences were 38.8 and 29.1 months, respectively. Conclusion Compared with gefitinib/erlotinib, afatinib had a higher treatment efficacy and a lower secondary T790M positivity in a large, real-world cohort of Asian patients with EGFR-mutated NSCLC.
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Affiliation(s)
- Allen Chung-Cheng Huang
- Division of Thoracic Oncology, Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Gueishan
| | - Chi-Hsien Huang
- Division of Thoracic Oncology, Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Gueishan
| | - Jia-Shiuan Ju
- Division of Thoracic Oncology, Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Gueishan
| | - Tzu-Hsuan Chiu
- Division of Thoracic Oncology, Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Gueishan
| | - Pi-Hung Tung
- Division of Thoracic Oncology, Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Gueishan
| | - Chin-Chou Wang
- Division of Pulmonary & Critical Care Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Niaosung
| | - Chien-Ying Liu
- Division of Thoracic Oncology, Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Gueishan
| | - Fu-Tsai Chung
- Division of Thoracic Oncology, Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Gueishan
| | - Yueh-Fu Fang
- Division of Thoracic Oncology, Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Gueishan
| | - Yi-Ke Guo
- Data Science Institute, Department of Computing, Imperial College London, London, UK
| | - Chih-Hsi Scott Kuo
- Division of Thoracic Oncology, Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, No 199, Tun-Hwa Nr Rd, Taipei, Gueishan, 333
| | - Cheng-Ta Yang
- Division of Thoracic Oncology, Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taiyuan
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12
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Ren M, Yang H, Lai Q, Shi D, Liu G, Shuang X, Su J, Xie L, Dong Y, Jiang X. MRI-based radiomics analysis for predicting the EGFR mutation based on thoracic spinal metastases in lung adenocarcinoma patients. Med Phys 2021; 48:5142-5151. [PMID: 34318502 DOI: 10.1002/mp.15137] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 07/08/2021] [Accepted: 07/21/2021] [Indexed: 11/11/2022] Open
Abstract
PURPOSE This study aims to develop and evaluate multi-parametric MRI-based radiomics for preoperative identification of epidermal growth factor receptor (EGFR) mutation, which is important in treatment planning for patients with thoracic spinal metastases from primary lung adenocarcinoma. METHODS A total of 110 patients were enrolled between January 2016 and March 2019 as a primary cohort. A time-independent validation cohort was conducted containing 52 patients consecutively enrolled from July 2019 to April 2021. The patients were pathologically diagnosed with thoracic spinal metastases from primary lung adenocarcinoma; all underwent T1-weighted (T1W), T2-weighted (T2W), and T2-weighted fat-suppressed (T2FS) MRI scans of the thoracic spinal. Handcrafted and deep learning-based features were extracted and selected from each MRI modality, and used to build the radiomics signature. Various machine learning classifiers were developed and compared. A clinical-radiomics nomogram integrating the combined rad signature and the most important clinical factor was constructed with receiver operating characteristic (ROC), calibration, and decision curves analysis (DCA) to evaluate the prediction performance. RESULTS The combined radiomics signature derived from the joint of three modalities can effectively classify EGFR mutation and EGFR wild-type patients, with an area under the ROC curve (AUC) of 0.886 (95% confidence interval [CI]: 0.826-0.947, SEN =0.935, SPE =0.688) in the training group and 0.803 (95% CI: 0.682-0.924, SEN = 0.700, SPE = 0.818) in the time-independent validation group. The nomogram incorporating the combined radiomics signature and smoking status achieved the best prediction performance in the training (AUC = 0.888, 95% CI: 0.849-0.958, SEN = 0.839, SPE = 0.792) and time-independent validation (AUC = 0.821, 95% CI: 0.692-0.929, SEN = 0.667, SPE = 0.909) cohorts. The DCA confirmed potential clinical usefulness of our nomogram. CONCLUSION Our study demonstrated the potential of multi-parametric MRI-based radiomics on preoperatively predicting the EGFR mutation. The proposed nomogram model can be considered as a new biomarker to guide the selection of individual treatment strategies for patients with thoracic spinal metastases from primary lung adenocarcinoma.
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Affiliation(s)
- Meihong Ren
- Department of Biomedical Engineering, School of Fundamental Sciences, China Medical University, Shenyang, P.R. China
| | - Huazhe Yang
- Department of Biophysics, School of Fundamental Sciences, China Medical University, Shenyang, P.R. China
| | - Qingyuan Lai
- Department of Radiology, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang, P.R. China
| | - Dabao Shi
- Department of Radiology, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang, P.R. China
| | - Guanyu Liu
- Department of Radiology, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang, P.R. China
| | - Xue Shuang
- Department of Biomedical Engineering, School of Fundamental Sciences, China Medical University, Shenyang, P.R. China
| | - Juan Su
- Department of Biomedical Engineering, School of Fundamental Sciences, China Medical University, Shenyang, P.R. China
| | - Liping Xie
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang, P.R. China
| | - Yue Dong
- Department of Radiology, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang, P.R. China
| | - Xiran Jiang
- Department of Biomedical Engineering, School of Fundamental Sciences, China Medical University, Shenyang, P.R. China
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Brouns A, Dursun S, Bootsma G, Dingemans AMC, Hendriks L. Reporting of Incidence and Outcome of Bone Metastases in Clinical Trials Enrolling Patients with Epidermal Growth Factor Receptor Mutated Lung Adenocarcinoma-A Systematic Review. Cancers (Basel) 2021; 13:3144. [PMID: 34201833 PMCID: PMC8267949 DOI: 10.3390/cancers13133144] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 06/07/2021] [Accepted: 06/21/2021] [Indexed: 11/17/2022] Open
Abstract
Bone metastases, occurring in 30-60% of patients with non-small cell lung cancer (NSCLC), are associated with decreased survival, cancer-induced bone pain, and skeletal-related events (SREs). Those with an activating epidermal growth factor mutation (EGFR+) seem to be more prone to develop bone metastases. To gain more insight into bone metastases-related outcomes in EGFR+ NSCLC, we performed a systematic review on Pubmed (2006-2021). Main inclusion criteria: prospective, phase II/III trials evaluating EGFR-tyrosine kinase inhibitors, ≥10 EGFR+ patients included, data on bone metastases and/or bone-related outcomes available. Out of 663 articles, 21 (3176 EGFR+ patients) met the eligibility criteria; 4 phase III (one double blind), 17 phase II trials (three randomized) were included. In seven trials dedicated bone imaging was performed at baseline. Mean incidence of bone metastases at diagnosis was 42%; 3-33% had progression in the bone upon progression. Except for one trial, it was not specified whether the use of bone target agents was permitted, and in none of the trials, occurrence of SREs was reported. Despite the high incidence of bone metastases in EGFR+ adenocarcinoma, there is a lack of screening for, and reporting on bone metastases in clinical trials, as well as permitted bone-targeted agents and SREs.
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Affiliation(s)
- Anita Brouns
- Department of Pulmonary Diseases, Zuyderland, 6162 BG Geleen, The Netherlands; (A.B.); (G.B.)
- Maastricht University Medical Center+, Department of Pulmonary Diseases, GROW-School for Oncology and Developmental Biology, 6229 HX Maastricht, The Netherlands; (S.D.); (A.-M.C.D.)
| | - Safiye Dursun
- Maastricht University Medical Center+, Department of Pulmonary Diseases, GROW-School for Oncology and Developmental Biology, 6229 HX Maastricht, The Netherlands; (S.D.); (A.-M.C.D.)
| | - Gerben Bootsma
- Department of Pulmonary Diseases, Zuyderland, 6162 BG Geleen, The Netherlands; (A.B.); (G.B.)
| | - Anne-Marie C. Dingemans
- Maastricht University Medical Center+, Department of Pulmonary Diseases, GROW-School for Oncology and Developmental Biology, 6229 HX Maastricht, The Netherlands; (S.D.); (A.-M.C.D.)
- Department of Respiratory Medicine, Erasmus MC Cancer Institute, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
| | - Lizza Hendriks
- Maastricht University Medical Center+, Department of Pulmonary Diseases, GROW-School for Oncology and Developmental Biology, 6229 HX Maastricht, The Netherlands; (S.D.); (A.-M.C.D.)
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14
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Chen YY, Wang PP, Fu Y, Li Q, Tian JF, Liu T, Lin Z, Ding ZY. Inferior outcome of bone metastasis in non-small-cell-lung-cancer patients treated with epidermal growth factor receptor inhibitors. J Bone Oncol 2021; 29:100369. [PMID: 34036039 PMCID: PMC8138759 DOI: 10.1016/j.jbo.2021.100369] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 04/12/2021] [Accepted: 04/13/2021] [Indexed: 02/08/2023] Open
Abstract
BoM was prone to multiple organs metastases and had more complex aberrations. BoM was associated with worse prognosis which cannot be salvaged by Osimertinib. BoM was an independent prognostic factor for EGFR-TKI treatment in PFS and OS.
Background Targeted therapy has been established as the standard-of-care for patients with advanced non-small cell lung cancer (NSCLC) with epidermal growth factor receptor (EGFR) mutations. Among patients with advanced lung cancer, 30–40% have bone metastases (BoM) at first diagnosis. However, little is known on the clinical characteristics and prognostic factors of BoM in patients with NSCLC harboring EGFR mutations. Methods Treatment-naive patients with advanced NSCLC harboring EGFR mutations who were prescribed tyrosine kinase inhibitors (TKIs) were screened and enrolled between June 2009 and April 2019 from West China Hospital. Patients were dichotomized according to whether they had BoM. The demographic characteristics, gene mutation status and therapeutic efficacy, including objective response rate (ORR), progression-free survival (PFS) and overall survival (OS), were collected. Results A cohort of 604 patients were enrolled. The BoM group had worse PFS (11.7 vs. 14.0 months, HR = 0.73, p = 0.00013) and OS (32.8 vs. 46.1 months, HR = 0.54, p < 0.0001) compared with the non-BoM group. No significant differences were observed in disease control rate (p = 0.407) or ORR (p = 0.537) between the two groups. The metastatic sites in the two groups exhibited obvious differences. In multivariate analysis, BoM was found to be an independent factor of worse prognosis. Conclusion BoM was identified as an independent inferior prognostic factor for EGFR-TKI treatment, and may have complex biological implications.
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Affiliation(s)
- Yue-Yun Chen
- Department of Biotherapy, Cancer Center, West China Hospital, West China Medical School, Sichuan University, Chengdu, China
| | - Pei-Pei Wang
- Department of Biotherapy, Cancer Center, West China Hospital, West China Medical School, Sichuan University, Chengdu, China
| | - Yang- Fu
- Department of Biotherapy, Cancer Center, West China Hospital, West China Medical School, Sichuan University, Chengdu, China
| | - Qing- Li
- Department of Biotherapy, Cancer Center, West China Hospital, West China Medical School, Sichuan University, Chengdu, China
| | - Jiang-Fang Tian
- Department of Biotherapy, Cancer Center, West China Hospital, West China Medical School, Sichuan University, Chengdu, China
| | - Ting- Liu
- Department of Biotherapy, Cancer Center, West China Hospital, West China Medical School, Sichuan University, Chengdu, China
| | - Zhen Lin
- Department of Biotherapy, Cancer Center, West China Hospital, West China Medical School, Sichuan University, Chengdu, China
| | - Zhen-Yu Ding
- Department of Biotherapy, Cancer Center, West China Hospital, West China Medical School, Sichuan University, Chengdu, China
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15
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Wang L, Shi T, Feng L, Fan Z, Xu X, Zhou X, Zhang X, Han J, Jing L, Liu J, Shan Y, Liu F, Zuo J, Wang Y. The Prognostic Value of Baseline Distant Metastasis in Icotinib-Treated Patients with EGFR-Mutated Stage IV Non-Small Cell Lung Cancer. Cancer Manag Res 2021; 13:2613-2622. [PMID: 33776479 PMCID: PMC7987279 DOI: 10.2147/cmar.s298579] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 02/22/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose Several studies have revealed the prognostic value distant metastasis in non-small-cell lung cancer (NSCLC) patients receiving first-line epidermal growth factor receptor (EGFR) inhibitors. However, the question of whether the specific metastatic site could predict survival outcomes remain elusive. This study evaluated the prognostic value of specific metastatic site at diagnosis in first-line icotinib-treated patients with EGFR-mutated advanced NSCLC. Methods A total of 216 patients with EGFR-mutated stage IV NSCLC who received first-line icotinib treatment were retrospectively enrolled. The associations between the presence of distant metastasis to certain organs at diagnosis and survival outcomes were analyzed. Patients and methods The presence of distant metastases was not associated with progression-free survival. Patients with liver metastasis showed a significantly shorter OS than those without liver metastasis (14.6m vs 33.0m, p=0.024). Patients with brain metastasis showed a marginally shorter OS than those without brain metastasis (26.5m vs 33.8m, p=0.051). Patients with lung metastasis showed a significantly longer OS than those without lung metastasis (36.0m vs 28.6m, p=0.038). Multivariable Cox regression analysis showed the presence of liver metastasis (HR [hazard ratio]: 2.265, 95% CI [confidence interval]: 1.239-4.139, p=0.008) and brain metastasis (HR: 1.493, 95% CI: 1.012-2.202, p=0.043) were independent predictors for unfavorable OS, while lung metastasis (HR: 0.669, 95% CI: 0.460-0.971, p=0.034) was an independent predictor for favorable OS. Conclusion The presence of liver and brain metastasis predicted unfavorable OS, while the presence of lung metastasis predicted favorable OS in first-line icotinib-treated patients with EGFR-mutated stage IV NSCLC.
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Affiliation(s)
- Long Wang
- Department of Medical Oncology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, People's Republic of China
| | - Tiantian Shi
- Department of Medical Oncology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, People's Republic of China
| | - Li Feng
- Department of Medical Oncology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, People's Republic of China
| | - Zhisong Fan
- Department of Medical Oncology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, People's Republic of China
| | - Xiaoli Xu
- Department of Medical Records, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, People's Republic of China
| | - Xinliang Zhou
- Department of Medical Oncology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, People's Republic of China
| | - Xue Zhang
- Department of Medical Oncology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, People's Republic of China
| | - Jing Han
- Department of Medical Oncology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, People's Republic of China
| | - Li Jing
- Department of Medical Oncology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, People's Republic of China
| | - Jiayin Liu
- Department of Medical Oncology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, People's Republic of China
| | - Yujie Shan
- Department of Medical Oncology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, People's Republic of China
| | - Fengling Liu
- Department of Medical Oncology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, People's Republic of China
| | - Jing Zuo
- Department of Medical Oncology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, People's Republic of China
| | - Yudong Wang
- Department of Medical Oncology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, People's Republic of China
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16
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Xiong A, Li C, Xu J, Yang X, Nie W, Zhong H, Chu T, Zhang W, Zhong R, Pan F, Shen Y, Lou Y, Zhang B, Han B, Zhang X. Solid subtype predicts early bone metastases in sensitive EGFR-mutated lung adenocarcinoma patients after surgery. Lung Cancer 2021; 154:124-130. [PMID: 33657514 DOI: 10.1016/j.lungcan.2021.02.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 02/17/2021] [Accepted: 02/21/2021] [Indexed: 12/21/2022]
Abstract
This study aimed to explore the prognostic significance of solid pattern for bone metastases (BM) in epidermal growth factor receptor (EGFR)-mutated lung adenocarcinoma patients after surgery. A total of 237 stage I-III lung adenocarcinoma patients with EGFR mutation were analyzed after procedure. The patients were divided into four groups: the solid-present patients with BM, the solid-absent patients with BM, the solid-present patients without BM and the solid-absent patients without BM. The bone disease-free survival (bDFS), systemic disease-free survival (DFS) and overall survival (OS) were assessed. The results revealed that the patients with solid pattern had shorter DFS (15 months vs. 19 months; P < 0.001) and OS (47 months vs. 77 months; P = 0.001). Moreover, bDFS of solid-present patients was significantly shorter than solid-absent patients (27 months vs. 14 months; P < 0.001). In addition, patients with solid component had worsened bDFS, no matter with BM as first-site development (12.5 months vs. 16.5 months; P = 0.016) or non-first-site development (16.5 months vs. 45.5 months; P < 0.001). These findings suggested that solid pattern predicted worse DFS and OS and also showed shortened interval between surgery and BM.
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Affiliation(s)
- Anning Xiong
- Department of Pulmonary, Shanghai Chest Hospital, Shanghai Jiao Tong University, China
| | - Changhui Li
- Department of Pulmonary, Shanghai Chest Hospital, Shanghai Jiao Tong University, China
| | - Jianlin Xu
- Department of Pulmonary, Shanghai Chest Hospital, Shanghai Jiao Tong University, China
| | - Xiaohua Yang
- Department of Pulmonary, Shanghai Chest Hospital, Shanghai Jiao Tong University, China
| | - Wei Nie
- Department of Pulmonary, Shanghai Chest Hospital, Shanghai Jiao Tong University, China
| | - Hua Zhong
- Department of Pulmonary, Shanghai Chest Hospital, Shanghai Jiao Tong University, China
| | - Tianqing Chu
- Department of Pulmonary, Shanghai Chest Hospital, Shanghai Jiao Tong University, China
| | - Wei Zhang
- Department of Pulmonary, Shanghai Chest Hospital, Shanghai Jiao Tong University, China
| | - Runbo Zhong
- Department of Pulmonary, Shanghai Chest Hospital, Shanghai Jiao Tong University, China
| | - Feng Pan
- Department of Pulmonary, Shanghai Chest Hospital, Shanghai Jiao Tong University, China
| | - Yinchen Shen
- Department of Pulmonary, Shanghai Chest Hospital, Shanghai Jiao Tong University, China
| | - Yuqing Lou
- Department of Pulmonary, Shanghai Chest Hospital, Shanghai Jiao Tong University, China
| | - Bo Zhang
- Department of Pulmonary, Shanghai Chest Hospital, Shanghai Jiao Tong University, China
| | - Baohui Han
- Department of Pulmonary, Shanghai Chest Hospital, Shanghai Jiao Tong University, China.
| | - Xueyan Zhang
- Department of Pulmonary, Shanghai Chest Hospital, Shanghai Jiao Tong University, China.
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17
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Chen Y, Deng J, Liu Y, Wang H, Zhao S, He Y, Zhou C. Analysis of metastases in non-small cell lung cancer patients with epidermal growth factor receptor mutation. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:206. [PMID: 33708833 PMCID: PMC7940889 DOI: 10.21037/atm-20-2925] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background Most lung cancer patients are diagnosed at an advanced stage with metastases. There was no population-based data on metastases in non-small cell lung cancer (NSCLC) patients with epidermal growth factor receptor (EGFR) mutation. This study focused on the metastases in NSCLC patients with EGFR mutation. Methods In our research, we retrospectively studied 365 NSCLC patients with EGFR mutation (EGFR positive-mutant group) were not resistant to first-generation EGFR TKIs and 316 NSCLC patients with T790M mutation (T790M-mutant group) who were resistant to first-generation EGFR TKIs. In the study, we also investigated sex, smoking status, age at diagnosis, histology, T, N, and M stage, and mutation status. In addition, we analyzed metastatic sites in stage IV patients. Results Among the EGFR positive-mutant group, 248 (67.95%) patients were stage IV disease. Among them, 41 patients had brain metastases, 86 patients had bone metastases, 16 patients had liver metastases, 168 patients had intrapulmonary metastases, and 39 patients had metastases in other sites. Among the T790M-mutant group, 277 (87.66%) patients were stage IV disease. Among them, 158 patients had brain metastases, 82 patients had bone metastases, 241 patients had liver metastases, 53 patients had intrapulmonary metastases, and 229 patients had metastases in other sites. We also found that lung cancer patients in the T790M-mutant group had higher incidences of the brain (P<0.001), bone (P<0.001), liver (P=0.001), and intrapulmonary metastases (P<0.001). Moreover, wherever the metastatic site was, the metastasis time all centrally distributed in the first two months after diagnosis. Conclusions For patients with metastatic lung cancer, most metastases happened before diagnosis, which indicated that metastases related to driving mutations, such as EGFR positive mutation or T790M mutation, but not to the survival time. Lung cancer patients with T790M mutation were more likely to metastasize before the diagnosis.
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Affiliation(s)
- Yu Chen
- Department of Orthopedic, Spine Center, Shanghai Changzheng Hospital, Shanghai, China
| | - Juan Deng
- Department of Orthopedic, Spine Center, Shanghai Changzheng Hospital, Shanghai, China.,Department of Medical Oncology, Shanghai Pulmonary Hospital, Tongji University Medical School Cancer Institute, Tongji University School of Medicine, Shanghai, China
| | - Yu Liu
- Department of Medical Oncology, Shanghai Pulmonary Hospital, Tongji University Medical School Cancer Institute, Tongji University School of Medicine, Shanghai, China.,Tongji University, Shanghai, China
| | - Hao Wang
- Department of Medical Oncology, Shanghai Pulmonary Hospital, Tongji University Medical School Cancer Institute, Tongji University School of Medicine, Shanghai, China.,Tongji University, Shanghai, China
| | - Sha Zhao
- Department of Medical Oncology, Shanghai Pulmonary Hospital, Tongji University Medical School Cancer Institute, Tongji University School of Medicine, Shanghai, China
| | - Yayi He
- Department of Medical Oncology, Shanghai Pulmonary Hospital, Tongji University Medical School Cancer Institute, Tongji University School of Medicine, Shanghai, China
| | - Caicun Zhou
- Department of Medical Oncology, Shanghai Pulmonary Hospital, Tongji University Medical School Cancer Institute, Tongji University School of Medicine, Shanghai, China
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18
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Xu Y, Li H, Weng L, Qiu Y, Zheng J, He H, Zheng D, Pan J, Wu F, Chen Y. Single nucleotide polymorphisms within the Wnt pathway predict the risk of bone metastasis in patients with non-small cell lung cancer. Aging (Albany NY) 2020; 12:9311-9327. [PMID: 32453708 PMCID: PMC7288946 DOI: 10.18632/aging.103207] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 04/17/2020] [Indexed: 12/19/2022]
Abstract
The Wingless-type (Wnt) signaling pathway plays an important role in the development and progression of cancer. This study aimed to evaluate the relationship between single nucleotide polymorphisms (SNPs) in the Wnt pathway and the risk of bone metastasis in patients with non-small cell lung cancer (NSCLC). We collected 500 blood samples from patients with NSCLC and genotyped eight SNPs from four core genes (WNT2, AXIN1, CTNNB1 and APC) present within the WNT pathway. Moreover, we assessed the potential relationship of these genes with bone metastasis development. Our results showed that the AC/AA genotype of CTNNB1: rs1880481 was associated with a decreased risk of bone metastasis. Polymorphisms with an HR of < 1 had a cumulative protective impact on the risk of bone metastasis. Furthermore, patients with the AC/AA genotype of CTNNB1: rs1880481 was associated with Karnofsky performance status score, squamous cell carcinoma antigen and Ki-67 proliferation index. Lastly, patients with the AC/AA genotype of CTNNB1: rs1880481 had significantly longer median progression free survival time than those with the CC genotype. In conclusion, SNPs within the Wnt signaling pathway are associated with a decreased risk of bone metastasis, and may be valuable biomarkers for bone metastasis in patients with NSCLC.
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Affiliation(s)
- Yiquan Xu
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou 350001, China
| | - Hongru Li
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou 350001, China.,Department of Respiratory Medicine and Critical Care Medicine, Fujian Provincial Hospital, Fuzhou 350001, China.,Fujian Provincial Researching Laboratory of Respiratory Diseases, Fuzhou 350001, China
| | - Lihong Weng
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou 350001, China
| | - Yanqin Qiu
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou 350001, China
| | - Junqiong Zheng
- Department of Medical Oncology, Longyan First Hospital Affiliated to Fujian Medical University, Longyan 364000, China
| | - Huaqiang He
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou 350001, China
| | - Dongmei Zheng
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou 350001, China
| | - Junfan Pan
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou 350001, China
| | - Fan Wu
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou 350001, China
| | - Yusheng Chen
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou 350001, China.,Department of Respiratory Medicine and Critical Care Medicine, Fujian Provincial Hospital, Fuzhou 350001, China.,Fujian Provincial Researching Laboratory of Respiratory Diseases, Fuzhou 350001, China
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19
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Dormieux A, Mezquita L, Cournede PH, Remon J, Tazdait M, Lacroix L, Rouleau E, Adam J, Bluthgen MV, Facchinetti F, Tselikas L, Aboubakar F, Naltet C, Lavaud P, Gazzah A, Le Pechoux C, Lassau N, Balleyguier C, Planchard D, Besse B, Caramella C. Association of metastatic pattern and molecular status in stage IV non-small cell lung cancer adenocarcinoma. Eur Radiol 2020; 30:5021-5028. [PMID: 32323012 DOI: 10.1007/s00330-020-06784-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 02/02/2020] [Accepted: 02/28/2020] [Indexed: 12/25/2022]
Abstract
OBJECTIVES The aim of our study was to investigate the association between driver oncogene alterations and metastatic patterns on imaging assessment, in a large cohort of metastatic lung adenocarcinoma patients. METHODS From January 2010 to May 2017, 550 patients with stage IV lung adenocarcinoma with molecular analysis were studied retrospectively including 135 EGFR-mutated, 81 ALK-rearrangement, 47 BRAF-mutated, 141 KRAS-mutated, and 146 negative tumors for these 4 mutations (4N). After review of the complete imaging report by two radiologists (junior and senior) to identify metastatic sites, univariate correlation analyzes were performed. RESULTS We found differences in metastatic tropism depending on the molecular alteration type when compared with the non-mutated 4N group: in the EGFR group, pleural metastases were more frequent (32% versus 20%; p = 0.021), and adrenal and node metastases less common (6% versus 23%; p < 0.001 and 11% versus 23%; p = 0.011). In the ALK group, there were more brain and lung metastases (respectively 42% versus 29%; p = 0.043 and 37% versus 24%; p = 0.037). In the BRAF group, pleural and pericardial metastases were more common (respectively 47% versus 20%; p < 0.001 and 11% versus 3%; p = 0.04) and bone metastases were rarer (21% versus 42%; p = 0.011). Lymphangitis was more frequent in EGFR, ALK, and BRAF groups (respectively 6%, 7%, and 15% versus 1%); p = 0.016; p = 0.009; and p < 0.001. CONCLUSION The application of these correlations between molecular status and metastatic tropism in clinical practice may lead to earlier and more accurate identification of patients for targeted therapy. KEY POINTS • Bone and brain metastasis are the most common organs involved in lung adenocarcinoma but the relative incidence of each metastatic site depends on the molecular alteration. • EGFR-mutated tumors preferentially spread to the pleura and less commonly to adrenals, ALK-rearrangement tumors usually spread to the brain and the lungs, whereas BRAF-mutated tumors are unlikely to spread to bones and have a serous (pericardial ad pleural) tropism. • These correlations could help in the clinical management of patients with metastatic lung adenocarcinoma.
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Affiliation(s)
- Alison Dormieux
- Imaging Department, Gustave Roussy, Université Paris-Saclay, F-94805, Villejuif, France
| | - Laura Mezquita
- Cancer Medicine Department, Gustave Roussy, Université Paris-Saclay, F-94805, Villejuif, France
| | - Paul Henry Cournede
- MICS laboratory, CentraleSupélec, Université Paris-Saclay, Gif-sur-Yvette, France
| | - Jordi Remon
- Medical Oncology Department, Centro Integral Oncología Clara Campal Bacelona, HM-Delfos, Barcelona, Spain
| | - Melodie Tazdait
- Imaging Department, Gustave Roussy, Université Paris-Saclay, F-94805, Villejuif, France
| | - Ludovic Lacroix
- Molecular Biology Department, Gustave Roussy, Université Paris-Saclay, F-94805, Villejuif, France
| | - Etienne Rouleau
- Molecular Biology Department, Gustave Roussy, Université Paris-Saclay, F-94805, Villejuif, France
| | - Julien Adam
- Pathology Department, Gustave Roussy, Université Paris-Saclay, F-94805, Villejuif, France
| | - Maria-Virginia Bluthgen
- Cancer Medicine Department, Gustave Roussy, Université Paris-Saclay, F-94805, Villejuif, France
| | - Francesco Facchinetti
- Research Department (U981), Gustave Roussy Cancer Campus, Université Paris-Saclay, F-94805, Villejuif, France
| | - Lambros Tselikas
- Imaging Department, Gustave Roussy, Université Paris-Saclay, F-94805, Villejuif, France
| | - Frank Aboubakar
- Cancer Medicine Department, Gustave Roussy, Université Paris-Saclay, F-94805, Villejuif, France
| | - Charles Naltet
- Cancer Medicine Department, Gustave Roussy, Université Paris-Saclay, F-94805, Villejuif, France
| | - Pernelle Lavaud
- Cancer Medicine Department, Gustave Roussy, Université Paris-Saclay, F-94805, Villejuif, France
| | - Anas Gazzah
- Cancer Medicine Department, Gustave Roussy, Université Paris-Saclay, F-94805, Villejuif, France
| | - Cécile Le Pechoux
- Radiation Therapy Department, Gustave Roussy, Université Paris-Saclay, F-94805, Villejuif, France
| | - Nathalie Lassau
- Imaging Department, Gustave Roussy, Université Paris-Saclay, F-94805, Villejuif, France
- IR4M, UMR 8081, CNRS, Université Paris-Saclay, F-91400, Orsay, France
| | - Corinne Balleyguier
- Imaging Department, Gustave Roussy, Université Paris-Saclay, F-94805, Villejuif, France
- IR4M, UMR 8081, CNRS, Université Paris-Saclay, F-91400, Orsay, France
| | - David Planchard
- Cancer Medicine Department, Gustave Roussy, Université Paris-Saclay, F-94805, Villejuif, France
| | - Benjamin Besse
- Cancer Medicine Department, Gustave Roussy, Université Paris-Saclay, F-94805, Villejuif, France
| | - Caroline Caramella
- Imaging Department, Gustave Roussy, Université Paris-Saclay, F-94805, Villejuif, France.
- IR4M, UMR 8081, CNRS, Université Paris-Saclay, F-91400, Orsay, France.
- Radiology Department, Gustave Roussy, 114 Rue Édouard-Vaillant, 94805, Villejuif Cedex, France.
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20
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Zhou B, Xiong J. [Research Progress in Consistency of Driver Gene Status between Primary and Corresponding Metastatic Lesions in Non-small Cell Lung Cancer]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2020; 23:196-203. [PMID: 32102137 PMCID: PMC7118335 DOI: 10.3779/j.issn.1009-3419.2020.03.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
非小细胞肺癌(non-small cell lung cancer, NSCLC)作为肺癌最常见的病理类型,具有恶性程度高和侵袭性强的特点,晚期极易发生淋巴结和不同脏器转移。近年来,随着精准医学应用的深入,不断出现NSCLC转移部位的耐药和治疗失效为分子靶向治疗带来困扰,研究证实这些可能与肿瘤转移后发生的分子学改变有关。本文旨在阐述NSCLC原发灶与转移部位驱动基因状态,系统性综述两者间驱动基因状态一致性的研究进展,为探讨转移性NSCLC的分子靶向治疗提供新的思路。
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Affiliation(s)
- Bing Zhou
- Department of Pathology, The Affiliated Jiujiang Hospital of Nanchang University, Jiujiang 332000, China
| | - Jianping Xiong
- Department of Oncology, The First Affiliated Hospital of Nanchang University, Nanchang 330006, China
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21
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Bersanelli M, Lattanzi E, D'Abbiero N, Buti S, Leonetti A, Canè MG, Trapani S, Gravina G, Porzio G, Cannita K, Marino PD, Grassadonia A, Tinari N, Tursi MD, Giaiacopi E, Michiara M, Bordi P, Perrone F, Caravatta L, Trignani M, Genovesi D, Natoli C, Ficorella C, Tiseo M, Cortellini A. Palliative radiotherapy in advanced cancer patients treated with immune-checkpoint inhibitors: The PRACTICE study. Biomed Rep 2019; 12:59-67. [PMID: 31929875 PMCID: PMC6951237 DOI: 10.3892/br.2019.1265] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 11/06/2019] [Indexed: 12/16/2022] Open
Abstract
In the present study, the influence of purely palliative radiotherapy (pRT) on the outcomes of patients with advanced cancer undergoing immune checkpoint blockade was evaluated. Patients were stratified into three groups: Patients who had received pRT within 6 months prior to the initiation of immunotherapy (previous pRT); patients who received pRT during immunotherapy (concurrent pRT); and patients who did not receive RT prior to or during immunotherapy (no RT group), and these groups were compared. The median overall survival (mOS), median progression free survival (mPFS) and median time-to-treatment failure (mTTF) for the previous pRT group were significantly shorter compared with the no RT group (mOS, 3.6 vs. 12.1 months, respectively, P=0.0095; mPFS 1.8 vs. 5.4 months, respectively, P=0.0016; mTTF 1.8 vs. 5.7 months, respectively, P=0.0035). The concurrent pRT group had a longer mTTF compared with the previous pRT group and similar outcomes to the no RT group. In the previous pRT group, 26.9% of the patients experienced immune-related adverse events compared with 40.1% of patients in the no RT group. Despite the use of pRT during immunotherapy being considered safe, the results of the present study suggest that pRT has a negative effect on immune balance.
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Affiliation(s)
- Melissa Bersanelli
- Department of Medicine and Surgery, University Hospital of Parma, I-43126 Parma, Italy.,Medical Oncology Unit, University Hospital of Parma, I-43126 Parma, Italy
| | | | | | - Sebastiano Buti
- Medical Oncology Unit, University Hospital of Parma, I-43126 Parma, Italy
| | | | - Maria Giulia Canè
- Radiotherapy Unit, University Hospital of Parma, I-43126 Parma, Italy
| | - Salvatore Trapani
- Medical Oncology Unit, University Hospital of Parma, I-43126 Parma, Italy
| | - Gianluca Gravina
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, I-67100 L'Aquila, Italy
| | - Giampiero Porzio
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, I-67100 L'Aquila, Italy.,Medical Oncology Unit, St. Salvatore Hospital, I-67100 L'Aquila, Italy
| | - Katia Cannita
- Medical Oncology Unit, St. Salvatore Hospital, I-67100 L'Aquila, Italy
| | - Pietro Di Marino
- Clinical Oncology Unit, Santissima Annunziata Hospital, Gabriele D'Annunzio University of Chieti-Pescara, I-66100 Chieti, Italy
| | - Antonino Grassadonia
- Department of Medical, Oral and Biotechnological Sciences, Gabriele D'Annunzio University of Chieti-Pescara, I-66100 Chieti, Italy
| | - Nicola Tinari
- Department of Medical, Oral and Biotechnological Sciences, Gabriele D'Annunzio University of Chieti-Pescara, I-66100 Chieti, Italy
| | - Michele De Tursi
- Department of Medical, Oral and Biotechnological Sciences, Gabriele D'Annunzio University of Chieti-Pescara, I-66100 Chieti, Italy
| | - Elisa Giaiacopi
- Medical Oncology Unit, University Hospital of Parma, I-43126 Parma, Italy
| | - Maria Michiara
- Medical Oncology Unit, University Hospital of Parma, I-43126 Parma, Italy
| | - Paola Bordi
- Medical Oncology Unit, University Hospital of Parma, I-43126 Parma, Italy
| | - Fabiana Perrone
- Medical Oncology Unit, University Hospital of Parma, I-43126 Parma, Italy
| | - Luciana Caravatta
- Department of Radiation Oncology, Santissima Annunziata Hospital, Gabriele D'Annunzio University of Chieti-Pescara, I-66100 Chieti, Italy
| | - Marianna Trignani
- Department of Radiation Oncology, Santissima Annunziata Hospital, Gabriele D'Annunzio University of Chieti-Pescara, I-66100 Chieti, Italy
| | - Domenico Genovesi
- Department of Radiation Oncology, Santissima Annunziata Hospital, Gabriele D'Annunzio University of Chieti-Pescara, I-66100 Chieti, Italy
| | - Clara Natoli
- Department of Medical, Oral and Biotechnological Sciences, Gabriele D'Annunzio University of Chieti-Pescara, I-66100 Chieti, Italy
| | - Corrado Ficorella
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, I-67100 L'Aquila, Italy.,Medical Oncology Unit, St. Salvatore Hospital, I-67100 L'Aquila, Italy
| | - Marcello Tiseo
- Department of Medicine and Surgery, University Hospital of Parma, I-43126 Parma, Italy.,Medical Oncology Unit, University Hospital of Parma, I-43126 Parma, Italy
| | - Alessio Cortellini
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, I-67100 L'Aquila, Italy.,Medical Oncology Unit, St. Salvatore Hospital, I-67100 L'Aquila, Italy
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22
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Patil T, Mushtaq R, Marsh S, Azelby C, Pujara M, Davies KD, Aisner DL, Purcell WT, Schenk EL, Pacheco JM, Bunn PA, Camidge DR, Doebele RC. Clinicopathologic Characteristics, Treatment Outcomes, and Acquired Resistance Patterns of Atypical EGFR Mutations and HER2 Alterations in Stage IV Non-Small-Cell Lung Cancer. Clin Lung Cancer 2019; 21:e191-e204. [PMID: 31859066 DOI: 10.1016/j.cllc.2019.11.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 10/28/2019] [Accepted: 11/10/2019] [Indexed: 01/06/2023]
Abstract
BACKGROUND The clinicopathologic characteristics, acquired resistance patterns, and outcomes among patients with atypical EGFR mutations and HER2 alterations remain underexplored. PATIENTS AND METHODS A single-center retrospective review was conducted. Oncogenes assessed include typical EGFR (t-EGFR; exon 19 del and L858R), atypical EGFR (a-EGFR; G719X, exon 20, L861Q), HER2 (exon 19, exon 20, amplifications), gene fusions (ALK, ROS1, RET), RAS (KRAS, NRAS), and RAF (BRAF V600E). Progression-free survival (PFS), overall survival (OS), disease control rate, and objective response rate (Response Evaluation Criteria in Solid Tumors 1.1) were collected. RESULTS Among 570 patients, we found 55 a-EGFR mutations (13 G719X, 38 exon 20, 4 L861Q) and 31 HER2 alterations (2 exon 19 mutations, 27 exon 20 insertions, 2 amplifications). Patients with EGFR and HER2 alterations had increased lung and bone metastases relative to patients with gene fusions, RAS/RAF mutations, and no identified driver oncogenes (P < .001). Patients with EGFR exon 20 insertions had a median PFS to EGFR tyrosine kinase inhibitors (TKIs) of 5 months and an OS of 16 months-significantly worse than exon 19 del and L858R (Bonferroni correction; P < .001), but not G719X or L861Q. Relative to t-EGFR mutations, T790M and MET amplification occurred less frequently as acquired resistance mechanisms among a-EGFR samples (P < .001). Ten patients with a-EGFR mutations and HER2 alterations received single-agent immune checkpoint inhibitors (ICIs) with no radiographic responses and a median PFS of 2 months. CONCLUSION EGFR and HER2-mutated NSCLC have a high rate of synchronous lung and bone metastases. Patients with a-EGFR mutations have inferior responses to EGFR-directed therapies with lower rates of acquired T790M and MET amplification. Responses to ICIs are uniformly poor. Novel therapeutic approaches are needed.
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Affiliation(s)
- Tejas Patil
- Division of Medical Oncology, University of Colorado School of Medicine, Aurora, CO.
| | - Rao Mushtaq
- Division of Medical Oncology, University of Colorado School of Medicine, Aurora, CO
| | - Sydney Marsh
- Department of Internal Medicine, University of Colorado School of Medicine, Aurora, CO
| | - Christine Azelby
- Department of Internal Medicine, University of Colorado School of Medicine, Aurora, CO
| | - Miheer Pujara
- Department of Internal Medicine, University of Colorado School of Medicine, Aurora, CO
| | - Kurtis D Davies
- Department of Pathology, University of Colorado School of Medicine, Aurora, CO
| | - Dara L Aisner
- Department of Pathology, University of Colorado School of Medicine, Aurora, CO
| | - William T Purcell
- Division of Medical Oncology, University of Colorado School of Medicine, Aurora, CO
| | - Erin L Schenk
- Division of Medical Oncology, University of Colorado School of Medicine, Aurora, CO
| | - Jose M Pacheco
- Division of Medical Oncology, University of Colorado School of Medicine, Aurora, CO
| | - Paul A Bunn
- Division of Medical Oncology, University of Colorado School of Medicine, Aurora, CO
| | - D Ross Camidge
- Division of Medical Oncology, University of Colorado School of Medicine, Aurora, CO
| | - Robert C Doebele
- Division of Medical Oncology, University of Colorado School of Medicine, Aurora, CO
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23
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Ock CY, Yoo SH, Keam B, Kim M, Kim TM, Jeon YK, Kim DW, Chung DH, Heo DS. Clinical factors affecting progression-free survival with crizotinib in ALK-positive non-small cell lung cancer. Korean J Intern Med 2019; 34:1116-1124. [PMID: 29950554 PMCID: PMC6718771 DOI: 10.3904/kjim.2018.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Accepted: 03/27/2018] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND/AIMS Although crizotinib is standard chemotherapy for advanced anaplastic lymphoma kinase (ALK)-positive non-small cell lung cancer (NSCLC), clinical factors affecting progression-free survival (PFS) have not been reported. The purpose of this study was to identify clinical factors affecting PFS of crizotinib and develop a prognostic model for advanced ALK-positive NSCLC. METHODS Clinicopathologic features of patients enrolled in PROFILE 1001, 1005, 1007, and 1014 (training cohort) were reviewed. We conducted multivariate Cox analysis for PFS and overall survival (OS) in the training cohort (n = 159) and generated a proportional hazards model based on significant clinicopathologic factors, and then validated the model in an independent validation cohort (n = 40). RESULTS In the training cohort, the objective response rate was 81.5%. Median PFS and OS from the start of crizotinib were 12.4 and 31.3 months, respectively. Multivariate Cox analysis showed poor performance status, number of metastatic organs (≥ 3), and no response to crizotinib independently associated shorter PFS. Based on a score derived from these three factors, median PFS and OS of patients with one or two factors were significantly shorter compared to those without these factors (median PFS, 22.4 months vs. 10.5 months vs. 6.5 months; median OS, not reached vs. 29.1 months vs. 11.8 months, respectively; p < 0.001 for each group). This model also had validated in an independent validation cohort. CONCLUSION Performance status, number of metastatic organs, and response to crizotinib affected PFS of crizotinib in ALK-positive NSCLC. Based on these factors, we developed a simple and useful prediction model for PFS.
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Affiliation(s)
- Chan-Young Ock
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Shin-Hye Yoo
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Bhumsuk Keam
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
- Correspondence to Bhumsuk Keam, M.D. Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea Tel: +82-2-2072-7215 Fax: +82-2-2072-7379 E-mail:
| | - Miso Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Tae Min Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Yoon Kyung Jeon
- Department of Pathology, Seoul National University Hospital, Seoul, Korea
| | - Dong-Wan Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Doo Hyun Chung
- Department of Pathology, Seoul National University Hospital, Seoul, Korea
| | - Dae Seog Heo
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
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24
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A Comprehensive Meta-Analysis of Association between EGFR Mutation Status and Brain Metastases in NSCLC. Pathol Oncol Res 2019; 25:791-799. [PMID: 30761450 DOI: 10.1007/s12253-019-00598-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 01/15/2019] [Indexed: 02/07/2023]
Abstract
Non-small cell lung cancer (NSCLC) with epidermal growth factor receptor (EGFR) mutation have different clinicopathological characteristics compared with EGFR wild type NSCLC. A growing number of studies focused on the relevance between EGFR mutation status and brain metastases (BM) in NSCLC, but it remains controversial. Therefore, this study performed a comprehensive meta-analysis to untangle this issue. Several electronic databases including Pubmed, Embase, Web of science and Cochrane database were thoroughly searched. The odds ratio (OR) with 95% confidence interval (95%CI) was pooled to evaluate the relevance. Meta-regression analysis and subgroup analysis were conducted according to the heterogeneity. A total of 26 studies were identified finally in this meta-analysis. The overall OR was 1.58 (95%CI: 1.36-1.84), which indicated that EGFR mutation had a positive association with BM of NSCLC. The subgroup analysis resulted from eleven studies with lung adenocarcinoma revealed a higher possibility of BM in NSCLC with EGFR mutation compared with EGFR wild (p < 0.05). There was no significant difference in the risk of BM between NSCLC EGFR exon 19 mutation and exon 21 point mutation (p = 0.23). This meta-analysis suggests that EGFR mutation can be a risk factor for BM in NSCLC.
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25
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Veena VS, George PS, Rajan K, Chandramohan K, Jayasree K, Sujathan K. Immunocytochemistry on Sputum Samples Predicts Prognosis of Lung Cancer. J Cytol 2019; 36:38-43. [PMID: 30745738 PMCID: PMC6343390 DOI: 10.4103/joc.joc_103_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Context Despite sputum cytology being accepted as a simple and noninvasive diagnostic method for lung cancer, the clinical usefulness of sputum for evaluation of prognosis is yet to be explored. Validation of some of the markers in sputum for prognosis prediction will be highly useful for selective therapy. Aims This study was aimed to evaluate a reliable panel of immunocytochemical markers for their significance to predict survival. Materials and Methods We have analyzed the expression of p53, p16, galectin-3, and epidermal growth factor receptor (EGFR) proteins in sputum samples processed in a mucolytic agent/cellblock and compared the same with that of the corresponding tissue samples. Results Overexpression of p16 and EGFR was found to have a better survival benefit, whereas positive p53 and galectin-3 expressions had shorter period of survival. Expression patterns of all these four proteins were more or less similar in smears, cellblocks of sputum, and tissue samples except for slight changes in staining intensity which was not found to be statistically significant. No significant difference was found in the association of these proteins with survival pattern between sputum and tissue samples. Conclusion This is the first report of immunocytochemistry of a panel of markers on cells exfoliated in sputum samples which suggests that analysis of immunocytochemical markers in sputum samples can be attempted as a cost-effective and reliable predictor of prognosis and survival. Accumulation of mutated p53, overexpression of galectin-3, and lower expression of p16 and EGFR proteins were found to predict poor prognosis for lung cancer.
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Affiliation(s)
- V S Veena
- Division of Pathology, Regional Cancer Centre, Trivandrum, Kerala, India
| | - Preethi Sara George
- Division of Cancer Epidemiology, Regional Cancer Centre, Trivandrum, Kerala, India
| | - K Rajan
- Division of Respiratory Medicine, Medical College, Trivandrum, Kerala, India
| | - K Chandramohan
- Division of Surgical Oncology, Regional Cancer Centre, Trivandrum, Kerala, India
| | - K Jayasree
- Division of Pathology, Regional Cancer Centre, Trivandrum, Kerala, India
| | - K Sujathan
- Division of Cancer Research, Regional Cancer Centre, Trivandrum, Kerala, India
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Yoshimura A, Yamada T, Tsuji T, Hamashima R, Shiotsu S, Yuba T, Takumi C, Uchino J, Hiraoka N, Takayama K. Prognostic impact of pleural effusion in EGFR-mutant non-small cell lung cancer patients without brain metastasis. Thorac Cancer 2019; 10:557-563. [PMID: 30672656 PMCID: PMC6397904 DOI: 10.1111/1759-7714.12979] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 12/25/2018] [Accepted: 12/25/2018] [Indexed: 01/11/2023] Open
Abstract
Background In epidermal growth factor receptor (EGFR)‐mutant non‐small cell lung cancer (NSCLC), brain metastasis is known as a poor prognosis factor. However, prognostic factors in the patients without brain metastasis remain unclear. In this study, we aimed to clarify the differences between metastatic site and prognosis in common EGFR‐mutant NSCLC patients without brain metastasis. Methods Chemotherapy‐naïve, advanced EGFR‐mutant NSCLC patients without brain metastasis diagnosed between January 2010 and March 2016 were enrolled. We evaluated prognosis according to the presence or absence of bone metastases, liver metastasis, and pleural effusion. Results A total of 50 EGFR‐mutant NSCLC patients without brain metastasis were enrolled. The median progression‐free survival and overall survival were significantly shorter in patients with pleural effusion than in those patients without (progression‐free survival 7.0 months, 95% confidence interval [CI] 3.7–13.0 vs. 13.0 months, 95% CI 9.1–21.7, hazard ratio [HR] 2.29, 95% CI 1.11–4.73, P = 0.020; overall survival 19.5 months, 95% CI 5.7–28.8 vs. 55.3 months, 95% CI 24.0–not evaluable, HR 3.00, 95% CI 1.35–6.68, P = 0.005). Pleural effusion was an independent factor of poor prognosis for progression‐free survival (HR 3.44, 95% CI 1.50–7.88, P = 0.003) and overall survival (HR 2.34, 95% CI 1.00–5.44, P = 0.049). Conclusion Pleural effusion might be a poor prognosis factor for advanced EGFR‐mutant NSCLC patients without brain metastasis treated with first‐generation EGFR‐tyrosine kinase inhibitors. Further precision medicine according to the metastatic site is required.
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Affiliation(s)
- Akihiro Yoshimura
- Department of Pulmonary Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Tadaaki Yamada
- Department of Pulmonary Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Taisuke Tsuji
- Department of Respiratory Medicine, Japanese Red Cross Kyoto Daiichi Hospital, Kyoto, Japan
| | - Ryosuke Hamashima
- Department of Respiratory Medicine, Japanese Red Cross Kyoto Daiichi Hospital, Kyoto, Japan
| | - Shinsuke Shiotsu
- Department of Respiratory Medicine, Japanese Red Cross Kyoto Daiichi Hospital, Kyoto, Japan
| | - Tatsuya Yuba
- Department of Respiratory Medicine, Japanese Red Cross Kyoto Daiichi Hospital, Kyoto, Japan
| | - Chieko Takumi
- Department of Respiratory Medicine, Japanese Red Cross Kyoto Daiichi Hospital, Kyoto, Japan
| | - Junji Uchino
- Department of Pulmonary Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Noriya Hiraoka
- Department of Respiratory Medicine, Japanese Red Cross Kyoto Daiichi Hospital, Kyoto, Japan
| | - Koichi Takayama
- Department of Pulmonary Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
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27
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Gao G, Deng L. [Association between EGFR, ALK and KRAS Gene Status and Synchronous Distant
Organ Metastasis in Non-small Cell Lung Cancer]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2018; 21:536-542. [PMID: 30037374 PMCID: PMC6058661 DOI: 10.3779/j.issn.1009-3419.2018.07.06] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
肺癌是我国恶性肿瘤的首位死亡疾病,据统计大约57%的肺癌患者就诊时已经出现了远处转移,临床预后较差。抗肺癌转移是当前治疗晚期转移性肺癌的新方向和思路。既往研究表明肿瘤的生物学改变在一定程度上能够影响肿瘤的转移行为和侵袭扩散模式,而目前的基础及临床研究尚未阐明导致肺癌相关信号转导途径中发生特异性器官转移的分子机制,有关驱动基因突变与器官转移之间相关性的研究也较为罕见。本篇综述旨在对近几年有关非小细胞肺癌表皮生长因子受体(epidermal growth factor receptor, EGFR)、间变性淋巴瘤激酶(anaplastic lymphoma kinase, ALK)、Kristen鼠肉瘤病毒原癌基因同源体(V-Ki-ras2 Kirsten rat sarcoma viral oncogene homologue, KRAS)驱动基因表达的特点以及与转移器官分布之间相关性的文献进行小结。
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Affiliation(s)
- Ge Gao
- Department of Oncology, The Second Affiliated Hospital of Harbin Medical University, Harbin 150086, Chinaa
| | - LiLi Deng
- Department of Oncology, The Second Affiliated Hospital of Harbin Medical University, Harbin 150086, Chinaa
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Mousa SA, Glinsky GV, Lin HY, Ashur-Fabian O, Hercbergs A, Keating KA, Davis PJ. Contributions of Thyroid Hormone to Cancer Metastasis. Biomedicines 2018; 6:biomedicines6030089. [PMID: 30135398 PMCID: PMC6165185 DOI: 10.3390/biomedicines6030089] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 08/14/2018] [Accepted: 08/18/2018] [Indexed: 12/17/2022] Open
Abstract
Acting at a cell surface receptor on the extracellular domain of integrin αvβ3, thyroid hormone analogues regulate downstream the expression of a large panel of genes relevant to cancer cell proliferation, to cancer cell survival pathways, and to tumor-linked angiogenesis. Because αvβ3 is involved in the cancer cell metastatic process, we examine here the possibility that thyroid hormone as l-thyroxine (T4) and the thyroid hormone antagonist, tetraiodothyroacetic acid (tetrac), may respectively promote and inhibit metastasis. Actions of T4 and tetrac that are relevant to cancer metastasis include the multitude of synergistic effects on molecular levels such as expression of matrix metalloproteinase genes, angiogenesis support genes, receptor tyrosine kinase (EGFR/ERBB2) genes, specific microRNAs, the epithelial–mesenchymal transition (EMT) process; and on the cellular level are exemplified by effects on macrophages. We conclude that the thyroid hormone-αvβ3 interaction is mechanistically linked to cancer metastasis and that modified tetrac molecules have antimetastatic activity with feasible therapeutic potential.
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Affiliation(s)
- Shaker A Mousa
- Pharmaceutical Research Institute, Albany College of Pharmacy and Health Sciences, Rensselaer, NY 12144, USA.
| | - Gennadi V Glinsky
- Institute of Engineering in Medicine, University of California, San Diego, CA 92093, USA.
| | - Hung-Yun Lin
- Pharmaceutical Research Institute, Albany College of Pharmacy and Health Sciences, Rensselaer, NY 12144, USA.
- PhD Program for Cancer Molecular Biology and Drug Discovery, College of Medical Science and Technology, Taipei Medical University, Taipei 11031, Taiwan.
- Taipei Cancer Center, Taipei Medical University, Taipei 11031 Taiwan.
- Traditional Herbal Medicine Research Center of Taipei Medical University Hospital, Taipei 11031, Taiwan.
- TMU Research Center of Cancer Translational Medicine, Taipei Medical University, Taipei 11031, Taiwan.
| | - Osnat Ashur-Fabian
- Department of Human Molecular Genetics and Biochemistry, Tel Aviv University, Tel Aviv 69978, Israel.
| | - Aleck Hercbergs
- Department of Radiation Oncology, Cleveland Clinic, Cleveland, OH 44195, USA.
| | - Kelly A Keating
- Pharmaceutical Research Institute, Albany College of Pharmacy and Health Sciences, Rensselaer, NY 12144, USA.
| | - Paul J Davis
- Pharmaceutical Research Institute, Albany College of Pharmacy and Health Sciences, Rensselaer, NY 12144, USA.
- Department of Medicine, Albany Medical College, Albany, NY 12208, USA.
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29
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Han G, Bi J, Tan W, Wei X, Wang X, Ying X, Guo X, Zhou X, Hu D, Zhen W. A retrospective analysis in patients with EGFR-mutant lung adenocarcinoma: is EGFR mutation associated with a higher incidence of brain metastasis? Oncotarget 2018; 7:56998-57010. [PMID: 27486770 PMCID: PMC5302968 DOI: 10.18632/oncotarget.10933] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 07/19/2016] [Indexed: 01/25/2023] Open
Abstract
Lung adenocarcinomas are more commonly associated with brain metastases (BM). Epidermal growth factor receptor (EGFR) mutations have been demonstrated to be both predictive and prognostic for patients with lung adenocarcinoma. We aimed to explore the potential association between EGFR mutation and the risk of BM in pulmonary adenocarcinoma patients. Data of 234 patients from 2007 to 2014 were retrospectively reviewed. A total of 108 patients had EGFR mutations in the entire cohort. Among them, 76 patients developed BM during their disease course. The incidence of BM was statistically higher in patients with EGFR mutations both at initial diagnosis (P=0.014) and at last follow-up (P<0.001). Multivariate logistic regression analysis revealed that EGFR mutation significantly increased the risk of BM at initial diagnosis (OR=2.515, P=0.022). In patients without BM at initial diagnosis, the accumulative rate of subsequent BM was significantly higher with EGFR mutations (P=0.001). Multivariate Cox regression analysis identified EGFR mutation as the only independent risk factor for subsequent BM (HR=3.036, P=0.001). Patients with EGFR mutations demonstrated longer overall survival (OS) after BM diagnosis than patients with wild-type EGFR (P=0.028). Our data suggest that EGFR mutation is an independent predictive and prognostic risk factor for BM and a positive predictive factor for OS in patients with BM.
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Affiliation(s)
- Guang Han
- Department of Radiation Oncology, Hubei Cancer Hospital, Wuhan, HB, China
| | - Jianping Bi
- Department of Radiation Oncology, Hubei Cancer Hospital, Wuhan, HB, China
| | - Wenyong Tan
- Department of Oncology, Shenzhen People Hospital, Shenzhen, China
| | - Xueyan Wei
- Department of Radiation Oncology, Hubei Cancer Hospital, Wuhan, HB, China
| | - Xiaohong Wang
- Department of Radiation Oncology, Hubei Cancer Hospital, Wuhan, HB, China
| | - Xiaofang Ying
- Department of Radiation Oncology, Hubei Cancer Hospital, Wuhan, HB, China
| | - Xiaofang Guo
- Department of Radiology, Hubei Cancer Hospital, Wuhan, HB, China
| | - Xiaoyi Zhou
- Department of Radiation Oncology, Hubei Cancer Hospital, Wuhan, HB, China
| | - Desheng Hu
- Department of Radiation Oncology, Hubei Cancer Hospital, Wuhan, HB, China
| | - Weining Zhen
- Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, NE, USA
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Matched-pair analysis of a multi-institutional cohort reveals that epidermal growth factor receptor mutation is not a risk factor for postoperative recurrence of lung adenocarcinoma. Lung Cancer 2017; 114:23-30. [DOI: 10.1016/j.lungcan.2017.09.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 08/17/2017] [Accepted: 09/03/2017] [Indexed: 12/27/2022]
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Tan J, Li M, Zhong W, Hu C, Gu Q, Xie Y. Tyrosine kinase inhibitors show different anti-brain metastases efficacy in NSCLC: A direct comparative analysis of icotinib, gefitinib, and erlotinib in a nude mouse model. Oncotarget 2017; 8:98771-98781. [PMID: 29228726 PMCID: PMC5716766 DOI: 10.18632/oncotarget.21936] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Accepted: 08/26/2017] [Indexed: 12/27/2022] Open
Abstract
Brain metastasis is an increasing problem in non-small cell lung cancer (NSCLC) patients. Tyrosine kinase inhibitors (TKIs), including gefitinib, erlotinib, and icotinib, are reported to be effective in patients with brain metastases. However, direct comparative studies of the pharmacokinetics and efficacy of these three drugs in treating brain metastases are lacking. In the present investigation, we found that gefitinib penetrated the blood-tumor barrier and was distributed to brain metastases more effectively than erlotinib or icotinib in a nude mouse model. The 1-h ratio of brain metastases to plasma concentration for gefitinib, erlotinib, and icotinib was 9.82±1.03%, 4.83±0.25%, and 2.62±0.21%, respectively. The 2-h ratio of brain metastases to plasma concentration for gefitinib, erlotinib, and icotinib was 15.11±2.00%, 5.73±1.31%, and 2.69±0.31%, respectively. Gefitinib exhibited the strongest antitumor activity (pgefitinib vs. erlotinib=0.005; pgefitinib vs. icotinib=0.002). Notably, erlotinib exhibited a better treatment efficacy than icotinib (p=0.037). Consistently, immunohistochemical data showed that TKIs differentially inhibit the proliferation of metastatical tumor cells. Gefitinib and erlotinib markedly inhibited the proliferation of tumor cells, while there were more ki-67-positive tumor cells in the icotinib group. Additionally, gefitinib inhibited the phosphorylation of EGFR better than the other drugs, whereas pEGFR expression levels in erlotinib groups were lower than levels in the icotinib group (pgefitinib vs. erlotinib=0.995; pgefitinib vs. icotinib=0.028; perlotinib vs. icotinib=0.042).Altogether, our findings suggest that gefitinib and erlotinib can inhibit the growth of PC-9-luc brain tumors. Gefitinib demonstrated better antitumor activity and penetration rate in brain metastases than erlotinib or icotinib.
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Affiliation(s)
- Jianlong Tan
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China
| | - Min Li
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China
| | - Wen Zhong
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China
| | - Chengping Hu
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China
| | - Qihua Gu
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China
| | - Yali Xie
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China
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Taniguchi Y, Tamiya A, Nakahama K, Naoki Y, Kanazu M, Omachi N, Okishio K, Kasai T, Atagi S. Impact of metastatic status on the prognosis of EGFR mutation-positive non-small cell lung cancer patients treated with first-generation EGFR-tyrosine kinase inhibitors. Oncol Lett 2017; 14:7589-7596. [PMID: 29344206 DOI: 10.3892/ol.2017.7125] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 09/28/2017] [Indexed: 12/21/2022] Open
Abstract
The aim of the present study was to analyze the impact of metastatic status on the prognosis of epithelial growth factor receptor (EGFR) mutation-positive patients with non-small cell lung cancer (NSCLC) treated with first-generation EGFR-tyrosine kinase inhibitors (TKIs). A total of 178 EGFR mutation-positive patients with stage IIIB-IV and relapsed NSCLC who were treated with gefitinib or erlotinib as the first-line treatment were enrolled in the present study. Metastatic status, progression-free survival (PFS), overall survival (OS) and treatment-response rates were investigated. The association between the number of metastatic organ sites and patient prognosis was also investigated. The median age at the time of treatment was 72 (range, 39-91) years. A total of 168 patients had adenocarcinoma; 156 were treated with gefitinib. Patients with brain metastases, bone metastases, liver metastases and pleural effusion exhibited a significantly reduced PFS and OS time in the univariate analysis, compared with patients without each of these symptoms. In the multivariate analysis, bone metastasis was associated with a poorer PFS (hazard ratio, 2.11; 95% confidence interval, 1.44-3.09; P<0.001) and brain metastasis was associated with a poorer OS (hazard ratio, 2.41; 95% confidence interval, 1.46-3.95; P<0.001). No association was observed between metastatic status and treatment response rates. Higher numbers of different sites of organ metastases were associated with significantly poorer PFS and OS. Bone, brain metastasis and higher numbers of metastatic organ sites are negative prognostic factors for EGFR mutation-positive NSCLC patients treated with first-generation EGFR-TKIs.
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Affiliation(s)
- Yoshihiko Taniguchi
- Department of Internal Medicine, National Hospital Organization Kinki-chuo Chest Medical Center, Sakai, Osaka 591-8555, Japan
| | - Akihiro Tamiya
- Department of Internal Medicine, National Hospital Organization Kinki-chuo Chest Medical Center, Sakai, Osaka 591-8555, Japan
| | - Kenji Nakahama
- Department of Internal Medicine, National Hospital Organization Kinki-chuo Chest Medical Center, Sakai, Osaka 591-8555, Japan
| | - Yoko Naoki
- Department of Internal Medicine, National Hospital Organization Kinki-chuo Chest Medical Center, Sakai, Osaka 591-8555, Japan
| | - Masaki Kanazu
- Department of Thoracic Oncology, National Hospital Organization Toneyama National Hospital, Toyonaka, Osaka 560-8552, Japan
| | - Naoki Omachi
- Department of Internal Medicine, National Hospital Organization Kinki-chuo Chest Medical Center, Sakai, Osaka 591-8555, Japan
| | - Kyoichi Okishio
- Department of Clinical Research Center, National Hospital Organization Kinki-chuo Chest Medical Center, Sakai, Osaka 591-8555, Japan
| | - Takahiko Kasai
- Department of Pathology, National Hospital Organization Kinki-chuo Chest Medical Center, Sakai, Osaka 591-8555, Japan
| | - Shinji Atagi
- Department of Clinical Research Center, National Hospital Organization Kinki-chuo Chest Medical Center, Sakai, Osaka 591-8555, Japan
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Kim HS, Yoon YC, Kwon S, Lee JH, Ahn S, Ahn HS. Dynamic Contrast-enhanced MR Imaging Parameters in Bone Metastases from Non–Small Cell Lung Cancer: Comparison between Lesions with and Lesions without Epidermal Growth Factor Receptor Mutation in Primary Lung Cancer. Radiology 2017; 284:815-823. [DOI: 10.1148/radiol.2017162336] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- Hyun Su Kim
- From the Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Ilwon-Ro, Gangnam-gu, Seoul 135-710, Korea (H.S.K., Y.C.Y., S.K., J.H.L.); Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Korea (Y.C.Y.); and Statistics and Data Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Korea (S.A., H.S.A.)
| | - Young Cheol Yoon
- From the Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Ilwon-Ro, Gangnam-gu, Seoul 135-710, Korea (H.S.K., Y.C.Y., S.K., J.H.L.); Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Korea (Y.C.Y.); and Statistics and Data Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Korea (S.A., H.S.A.)
| | - Soyi Kwon
- From the Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Ilwon-Ro, Gangnam-gu, Seoul 135-710, Korea (H.S.K., Y.C.Y., S.K., J.H.L.); Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Korea (Y.C.Y.); and Statistics and Data Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Korea (S.A., H.S.A.)
| | - Ji Hyun Lee
- From the Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Ilwon-Ro, Gangnam-gu, Seoul 135-710, Korea (H.S.K., Y.C.Y., S.K., J.H.L.); Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Korea (Y.C.Y.); and Statistics and Data Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Korea (S.A., H.S.A.)
| | - Soohyun Ahn
- From the Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Ilwon-Ro, Gangnam-gu, Seoul 135-710, Korea (H.S.K., Y.C.Y., S.K., J.H.L.); Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Korea (Y.C.Y.); and Statistics and Data Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Korea (S.A., H.S.A.)
| | - Hyeon Seon Ahn
- From the Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Ilwon-Ro, Gangnam-gu, Seoul 135-710, Korea (H.S.K., Y.C.Y., S.K., J.H.L.); Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Korea (Y.C.Y.); and Statistics and Data Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Korea (S.A., H.S.A.)
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Li L, Luo S, Lin H, Yang H, Chen H, Liao Z, Lin W, Zheng W, Xie X. Correlation between EGFR mutation status and the incidence of brain metastases in patients with non-small cell lung cancer. J Thorac Dis 2017; 9:2510-2520. [PMID: 28932557 DOI: 10.21037/jtd.2017.07.57] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Lung cancer is the leading cause of cancer-related death worldwide. Numerous studies have been performed to investigate the correlation between epidermal growth factor receptor (EGFR) mutation status and the incidence of brain metastases (BMs) in patients with non-small cell lung cancer (NSCLC), however, the outcomes were inconsistent. Thus, we performed this study to establish the role of EGFR mutation status in BMs. METHODS Electronic databases PubMed, Embase, Cochrane Library, CBM, WanFang, CNKI were searched to identify relevant trials. The primary endpoint was the incidence of BMs in EGFR mutations or wild type NSCLC and the secondary endpoint was overall survival calculated from the BMs emerging (BMOS). RESULTS Twenty-two studies incorporating 8,152 participants were eligible. EGFR mutations group possessed a significantly higher risk of BMs (OR =1.99; 95% CI, 1.59-2.48; P=0.000) than EGFR wild type group. In the stratified analysis, compared with EGFR wild type group, EGFR mutations group had a significant higher incidence (OR =2.01; 95% CI, 1.56-2.59; P=0.000) of subsequent BMs while only a trend of increasing the incidence of initial BMs (OR =1.38; 95% CI, 0.98-1.94; P=0.066). Moreover, exon 19 deletion had a trend of increasing the incidence of BMs than exon 21 mutation (OR =1.44; 95% CI, 0.77-2.68; P=0.252). Compared with EGFR wild type group, EGFR mutations group possessed a prolonged overall BMOS (HR =0.68; 95% CI, 0.47-0.98; P=0.038) and a longer BMOS in initial BMs (HR =0.50; 95% CI, 0.31-0.80; P=0.004) but no significant difference in NSCLC with subsequent BMs (HR =0.95; 95% CI, 0.42-2.15; P=0.901). CONCLUSIONS Patients with EGFR mutations were more susceptible to develop into BMs than those with EGFR wild type, especially during the course of disease.
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Affiliation(s)
- Lina Li
- Department of Chemotherapy, The First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, China
| | - Shuimei Luo
- Department of Chemotherapy, The First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, China
| | - Heng Lin
- Department of Chemotherapy, The First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, China.,Department of Oncology, Fuzhou Pulmonary Hospital, Fuzhou 350008, China
| | - Haitao Yang
- Department of Chemotherapy, The First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, China
| | - Huijuan Chen
- Department of Chemotherapy, The First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, China
| | - Ziyuan Liao
- Department of Chemotherapy, The First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, China
| | - Wanzun Lin
- Department of Chemotherapy, The First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, China
| | - Weili Zheng
- Department of Chemotherapy, The First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, China
| | - Xianhe Xie
- Department of Chemotherapy, The First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, China
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In GK, Mason J, Lin S, Newton PK, Kuhn P, Nieva J. Development of metastatic brain disease involves progression through lung metastases in
EGFR
mutated non-small cell lung cancer. CONVERGENT SCIENCE PHYSICAL ONCOLOGY 2017. [DOI: 10.1088/2057-1739/aa7a8d] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Li H, Cao J, Zhang X, Song X, Wang W, Jia S, Li Z, Jia H, Cao X, Zhou W, Lian J, Han S, Yang W, Xi Y, Lian S, Jing H. Correlation between status of epidermal growth factor receptor mutation and distant metastases of lung adenocarcinoma upon initial diagnosis based on 1063 patients in China. Clin Exp Metastasis 2016; 34:63-71. [PMID: 27888377 DOI: 10.1007/s10585-016-9822-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 09/23/2016] [Indexed: 01/02/2023]
Abstract
The study aimed to explore the correlations between status of epidermal growth factor receptor (EGFR) mutations and distant metastases. A total of 1063 patients with lung adenocarcinoma indentified with status of EGFR mutations from August 2010 to May 2015 at Shanxi Cancer Hospital were enrolled. 456 patients were confirmed with EGFR mutations. The associations among EGFR mutations, clinical factors, and distant metastases at initial diagnosis were evaluated. Patients harboring EGFR mutation were more likely to be female (P < 0.001), with no smoking history (P < 0.001), brain metastases (P = 0.029), and higher ECOG performance scores (P = 0.025). The correlation between EGFR mutation status and distant metastases showed statistical significance both in univariate (P = 0.022) and in multivariate analysis (OR 1.573, 95 % CI 1.202-2.059, P = 0.001) especially in brain metastases (OR 1.675, 95 % CI 1.132-2.479, P = 0.010) and lung metastases (OR 1.571, 59 % CI 1.101-2.243 P = 0.013). Furthermore, the 19del mutations showed associations with brain metastases (OR 1.586, 95 % CI 1.028-2.447, P = 0.037), and lung metastases (OR 1.587, 95 % CI 1.065-2.346, P = 0.023). The exon 21 point mutations showed statistically significant differences in liver metastases (OR 1.987, 95 % CI 1.094-3.067, P = 0.024). In conclusion, the EGFR mutations in lung adenocarcinoma patients were independently correlated with distant metastases. Subgroup analyses showed that patients harboring 19del mutations presented different distant metastases compared with those harboring 21 point mutaions.
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Affiliation(s)
- Hongwei Li
- Department of Radiation Oncology, Shanxi Provincial Cancer Hospital, Shanxi Medical University, Taiyuan, 030013, Shanxi, People's Republic of China.
- Department of Radiotherapy, Shanxi Provincial Cancer Hospital, Shanxi Medical University, Taiyuan, 030013, Shanxi, People's Republic of China.
| | - Jianzhong Cao
- Department of Radiation Oncology, Shanxi Provincial Cancer Hospital, Shanxi Medical University, Taiyuan, 030013, Shanxi, People's Republic of China
| | - Xiaqin Zhang
- Department of Radiation Oncology, Shanxi Provincial Cancer Hospital, Shanxi Medical University, Taiyuan, 030013, Shanxi, People's Republic of China
| | - Xing Song
- Department of Radiation Oncology, Shanxi Provincial Cancer Hospital, Shanxi Medical University, Taiyuan, 030013, Shanxi, People's Republic of China
| | - Weili Wang
- Department of Radiation Oncology, Shanxi Provincial Cancer Hospital, Shanxi Medical University, Taiyuan, 030013, Shanxi, People's Republic of China
| | - Sufang Jia
- Department of Radiation Oncology, Shanxi Provincial Cancer Hospital, Shanxi Medical University, Taiyuan, 030013, Shanxi, People's Republic of China
| | - Zhengran Li
- Department of Radiation Oncology, Shanxi Provincial Cancer Hospital, Shanxi Medical University, Taiyuan, 030013, Shanxi, People's Republic of China
| | - Haixia Jia
- Department of Radiation Oncology, Shanxi Provincial Cancer Hospital, Shanxi Medical University, Taiyuan, 030013, Shanxi, People's Republic of China
| | - Xing Cao
- Department of Radiation Oncology, Shanxi Provincial Cancer Hospital, Shanxi Medical University, Taiyuan, 030013, Shanxi, People's Republic of China
| | - Wei Zhou
- Department of Radiation Oncology, Shanxi Provincial Cancer Hospital, Shanxi Medical University, Taiyuan, 030013, Shanxi, People's Republic of China
| | - Jianhong Lian
- Department of Surgery, Shanxi Provincial Cancer Hospital, Shanxi Medical University, Taiyuan, 030013, Shanxi, People's Republic of China
| | - Songye Han
- Department of Chemotherapy, Shanxi Provincial Cancer Hospital, Shanxi Medical University, Taiyuan, 030013, Shanxi, People's Republic of China
| | - Weihua Yang
- Department of Chemotherapy, Shanxi Provincial Cancer Hospital, Shanxi Medical University, Taiyuan, 030013, Shanxi, People's Republic of China
| | - Yanfen Xi
- Department of Pathology, Shanxi Provincial Cancer Hospital, Shanxi Medical University, Taiyuan, 030013, Shanxi, People's Republic of China
| | - Shenming Lian
- Department of Radiation Oncology, Shanxi Provincial Cancer Hospital, Shanxi Medical University, Taiyuan, 030013, Shanxi, People's Republic of China
| | - Haoxing Jing
- Department of Pathology, Shanxi Provincial Cancer Hospital, Shanxi Medical University, Taiyuan, 030013, Shanxi, People's Republic of China.
- Department of Medical Imageology, Shanxi Provincial Cancer Hospital, Shanxi Medical University, Taiyuan, 030013, Shanxi, People's Republic of China.
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Park S, Kim HJ, Choi CM, Lee DH, Kim SW, Lee JS, Kim WS, Choi SH, Rho JK, Lee JC. Predictive factors for a long-term response duration in non-squamous cell lung cancer patients treated with pemetrexed. BMC Cancer 2016; 16:417. [PMID: 27388008 PMCID: PMC4936194 DOI: 10.1186/s12885-016-2457-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 06/24/2016] [Indexed: 12/19/2022] Open
Abstract
Background Pemetrexed is widely used for the treatment of advanced non-squamous non-small-cell lung cancer (NSCLC). However, factors that can predict the benefits of pemetrexed therapy have not yet been defined. Methods We compared the clinical and molecule pathological characteristics of good and poor responders among a cohort of 1,848 non-squamous NSCLC patients who had received at least two cycles of pemetrexed therapy between November 2006 and February 2015. Among these cases, 92 good responders who were the top 5 % in terms of progression-free survival (PFS) and 222 poor responders who had progressive disease after only 2 cycles of therapy were selected for the analysis. Results The median PFS of the good responders was 29.9 months (range; 20.9–90.0) and the median number of cycle was 37 (range; 18–129). Although 53.5 % of patients showed stable disease (SD), this response was sustained (median PFS in SD, 29.6 months). A never-smoking status was related to better survival outcome, whereas EGFR mutation, two or more metastatic sites, and intra-abdominal metastasis were each associated with a poor PFS. ALK translocation showed a tendency for a positive impact on response to pemetrexed, whereas metastatic lesion to liver, adrenal gland or bone showed a tendency for a negative impact despite not reaching our threshold for statistical significance. Conclusions Predictive factors, such as smoking status, the status of genetic alteration and tumor burden, should be considered when administering pemetrexed therapy for non-squamous NSCLC.
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Affiliation(s)
- Sojung Park
- Department of Pulmonary and Critical Care Medicine, University of Ulsan, College of Medicine, Asan Medical Center, 388-1 Pungnap-Dong, Songpa-gu, Seoul, 05505, South Korea
| | - Hyun Jung Kim
- Department of Internal Medicine, Kyungpook National University Hospital, Kyungpook National University School of Medicine, 130 Dongdeok-ro, Jung-gu, Daegu, 41944, South Korea
| | - Chang-Min Choi
- Department of Pulmonary and Critical Care Medicine, University of Ulsan, College of Medicine, Asan Medical Center, 388-1 Pungnap-Dong, Songpa-gu, Seoul, 05505, South Korea.,Department of Oncology, University of Ulsan, College of Medicine, Asan Medical Center, 388-1 Pungnap-Dong, Songpa-gu, Seoul, 05505, South Korea
| | - Dae Ho Lee
- Department of Oncology, University of Ulsan, College of Medicine, Asan Medical Center, 388-1 Pungnap-Dong, Songpa-gu, Seoul, 05505, South Korea
| | - Sang-We Kim
- Department of Oncology, University of Ulsan, College of Medicine, Asan Medical Center, 388-1 Pungnap-Dong, Songpa-gu, Seoul, 05505, South Korea
| | - Jung-Shin Lee
- Department of Oncology, University of Ulsan, College of Medicine, Asan Medical Center, 388-1 Pungnap-Dong, Songpa-gu, Seoul, 05505, South Korea
| | - Woo Sung Kim
- Department of Pulmonary and Critical Care Medicine, University of Ulsan, College of Medicine, Asan Medical Center, 388-1 Pungnap-Dong, Songpa-gu, Seoul, 05505, South Korea
| | - Se Hoon Choi
- Department of Thoracic and Cardiovascular Surgery, University of Ulsan, College of Medicine, Asan Medical Center, 388-1 Pungnap-Dong, Songpa-gu, Seoul, 05505, South Korea
| | - Jin Kyung Rho
- Asan Institute for Life Sciences, Asan Medical Center, 388-1 Pungnap-Dong, Songpa-gu, Seoul, 05505, South Korea
| | - Jae Cheol Lee
- Department of Oncology, University of Ulsan, College of Medicine, Asan Medical Center, 388-1 Pungnap-Dong, Songpa-gu, Seoul, 05505, South Korea.
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Kotecki N, Hiret S, Etienne PL, Penel N, Tresch E, François E, Galais MP, Ben Abdelghani M, Michel P, Dahan L, Ghiringelli F, Bedenne L, Samalin E, Piessen G, Bennouna J, Peugniez C, El Hajbi F, Clisant S, Kramar A, Mariette C, Adenis A. First-Line Chemotherapy for Metastatic Esophageal Squamous Cell Carcinoma: Clinico-Biological Predictors of Disease Control. Oncology 2016; 90:88-96. [PMID: 26784946 DOI: 10.1159/000442947] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 11/30/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVE This study aimed to identify predictors of tumor control (TC) in metastatic esophageal squamous cell carcinoma patients receiving first-line chemotherapy. METHODS A development cohort of 68 patients from a prospective multicenter trial (NCT01248299) was used to identify predictors of TC at first radiological tumor assessment and to generate a predictive score for TC. That score was applied in an independent retrospective single-center validation cohort of 60 consecutive patients. RESULTS Multivariate analysis identified three predictors of TC: body mass index ≥18.5 (OR 4.5, 95% CI 0.91-22.5), absence of bone metastasis (OR 4.6, 95% CI 0.91-23.2) and albumin ≥35 g/l (OR 3.5, 95% CI 1.0-12.1). Based on the presence or absence of these three independent prognosticators, we built a predictive model using a score from 0 to 3. In the development cohort, the TC rates were 14.3 and 78.0% and in the validation cohort 12.5 and 44.2%, for scores of 0-1 and 2-3, respectively. With negative predictive values of 85 and 88% in the development and validation cohorts, respectively, we were able to identify patients with a very low probability of TC. CONCLUSION We have developed and validated a score that can be easily determined at the bedside to predict TC in metastatic esophageal squamous cell carcinoma patients.
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EGFR mutations are associated with higher incidence of distant metastases and smaller tumor size in patients with non-small-cell lung cancer based on PET/CT scan. Med Oncol 2015; 33:1. [PMID: 26589606 DOI: 10.1007/s12032-015-0714-8] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 11/03/2015] [Indexed: 01/13/2023]
Abstract
The study aimed to explore the correlation of epidermal growth factor receptor (EGFR) mutation with tumor node metastasis (TNM) stage in patients with non-small-cell lung cancer (NSCLC) who underwent positron emission tomography/computed tomography (PET/CT) scan. Patients diagnosed with NSCLC who underwent EGFR mutation status testing and PET/CT or PET/CT plus brain magnetic resonance imaging scan at initial diagnosis in Nanfang Hospital between July 2010 and June 2014 were consecutively enrolled. The correlation of EGFR mutation status with TNM stage and distant metastasis organs including brain, bone, liver, pleural, adrenals and contralateral lobe of lung were analyzed. A total of 401 patients were enrolled. Tumor size in EGFR mutation group was significantly smaller than the wild-type group (P < 0.001). Further, patients with EGFR mutations were demonstrated significantly more frequent in patients with distant metastasis than non-metastasis (45.7 vs 32.2 %, P = 0.007). The rates of bone (32.2 vs 22.8 %, P = 0.007) and brain (16.3 vs 9.4 %, P = 0.008) metastasis were significantly higher in EGFR mutation group than the wild-type group. In the subgroup of 199 metastatic NSCLC patients, patients with EGFR mutation were significantly associated with a smaller tumor size (P = 0.013) and earlier N stage (P = 0.033). Of note, compared with the EGFR wild-type group, patients had a higher likelihood of developing brain plus bone metastases at initial diagnosis of EGFR mutation group (20.9 vs 7.5 %, P = 0.018). Taken together, we identify that EGFR mutations might associate with more aggressive tumor progression than the wild types in NSCLC. In addition, patients with tumor having EGFR mutation had a smaller tumor size than without mutation.
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Sugita S, Murakami H, Kato S, Tanaka S, Tsuchiya H. Disappearance of lung adenocarcinoma after total en bloc spondylectomy using frozen tumor-bearing vertebra for reconstruction. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2015; 25 Suppl 1:53-7. [PMID: 26100278 DOI: 10.1007/s00586-015-4077-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2014] [Revised: 06/14/2015] [Accepted: 06/14/2015] [Indexed: 11/24/2022]
Abstract
PURPOSE Total en bloc spondylectomy (TES) is a surgical procedure performed to achieve complete resection of an aggressive benign spinal tumor or a malignant spinal tumor. When reconstructing the spine after resection, we have been using liquid nitrogen-frozen resected spine bearing tumor as a bone graft, expecting an immunological response to tumor-specific antigen(s). The purpose of this article is to report a successful treatment case of lung adenocarcinoma metastasis with TES and this cryotherapy. METHODS A 59-year-old male presented with rapid progression of neurological deterioration of the lower limbs due to a spinal metastasis from T8 to T10. The primary lung adenocarcinoma had already been excised under thoracoscopy. The patient underwent TES with reconstruction using frozen tumor-bearing vertebra for the bone graft. RESULTS One month after surgery, a new nodule appeared at the right middle lobe of the lung. However, we carried out no biopsy of the newly emerged nodule and the patient received no adjuvant chemotherapy or radiotherapy. Six months after surgery, the tumor vanished. No local recurrence or metastasis of the tumor has been observed until now. CONCLUSIONS TES with a liquid nitrogen-frozen tumor specimen could be a promising therapeutic option for cancer patients with spine metastasis.
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Affiliation(s)
- Shurei Sugita
- Department of Orthopaedic Surgery, Kanazawa University, 13-1, Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan.
| | - Hideki Murakami
- Department of Orthopaedic Surgery, Kanazawa University, 13-1, Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Satoshi Kato
- Department of Orthopaedic Surgery, Kanazawa University, 13-1, Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopaedic Surgery, Kanazawa University, 13-1, Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan
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Wu KL, Tsai MJ, Yang CJ, Chang WA, Hung JY, Yen CJ, Shen CH, Kuo TY, Lee JY, Chou SH, Liu TC, Chong IW, Huang MS. Liver metastasis predicts poorer prognosis in stage IV lung adenocarcinoma patients receiving first-line gefitinib. Lung Cancer 2015; 88:187-94. [PMID: 25747806 DOI: 10.1016/j.lungcan.2015.02.012] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Revised: 02/01/2015] [Accepted: 02/13/2015] [Indexed: 01/13/2023]
Abstract
OBJECTIVES Gefitinib is currently used as a first-line therapy in patients of advanced non-small cell lung cancer (NSCLC) with susceptible epidermal growth factor receptor (EGFR) mutations. However, treatment outcomes of these patients vary. This study was conducted to evaluate the impact of specific metastatic sites on treatment outcomes of patients with stage IV lung adenocarcinoma with susceptible EGFR mutations receiving first-line gefitinib, focusing on the impact of liver metastasis. MATERIALS AND METHODS Between October 2009 and April 2014, patients of stage IV lung adenocarcinoma harboring EGFR mutation in exon 19 or 21, who received first-line gefitinib treatment, were enrolled in two hospitals and followed until December 22, 2014. The impacts of various clinical features, including sex, age, smoking history, performance status, EGFR mutation site, metastatic sites, etc., on progression-free survival (PFS) and overall survival (OS) were analyzed. RESULTS A total of 148 patients were eligible for analysis. Patients with liver metastasis on initial diagnosis (n=19) had shorter PFS and OS than those without liver metastasis did (median of PFS, 6.7 vs. 11.2 months, p<0.0001; median of OS, 9.2 vs. 17.5 months, p<0.0001). Multivariable Cox regression analysis showed liver metastasis was an independent poor prognostic factor for PFS (HR=2.939 [95% CI: 1.729-4.997], p<0.0001) and OS (HR=3.300 [95% CI: 1.708-6.373], p=0.0004). CONCLUSION Liver metastasis predicts poorer PFS and OS in stage IV lung adenocarcinoma patients with susceptible gene mutations receiving first-line gefitinib. Further study is warranted to elucidate the underlying mechanisms and find treatment modalities to improve prognosis of these patients.
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Affiliation(s)
- Kuan-Li Wu
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, No. 100, Tz-You 1st Road, 807 Kaohsiung, Taiwan; Department of Internal Medicine, Pingtung Hospital, Ministry of Health and Welfare, Pingtung, Taiwan
| | - Ming-Ju Tsai
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, No. 100, Tz-You 1st Road, 807 Kaohsiung, Taiwan; Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chih-Jen Yang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, No. 100, Tz-You 1st Road, 807 Kaohsiung, Taiwan; Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan; Department of Internal Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wei-An Chang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, No. 100, Tz-You 1st Road, 807 Kaohsiung, Taiwan; Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jen-Yu Hung
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, No. 100, Tz-You 1st Road, 807 Kaohsiung, Taiwan; Department of Internal Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chun-Ju Yen
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, No. 100, Tz-You 1st Road, 807 Kaohsiung, Taiwan; Department of Nursing, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chi-Hsiang Shen
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, No. 100, Tz-You 1st Road, 807 Kaohsiung, Taiwan; Department of Nursing, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Tzu-Yu Kuo
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, No. 100, Tz-You 1st Road, 807 Kaohsiung, Taiwan
| | - Jui-Ying Lee
- Division of Chest Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shah-Hwa Chou
- Division of Chest Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Respiratory Care, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ta-Chih Liu
- Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Division of Hematology and Oncology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Inn-Wen Chong
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, No. 100, Tz-You 1st Road, 807 Kaohsiung, Taiwan; Department of Respiratory Care, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ming-Shyan Huang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, No. 100, Tz-You 1st Road, 807 Kaohsiung, Taiwan; Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Internal Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
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Fujimoto D, Shimizu R, Morimoto T, Kato R, Sato Y, Kogo M, Ito J, Teraoka S, Otoshi T, Nagata K, Nakagawa A, Otsuka K, Katakami N, Tomii K. Analysis of advanced lung cancer patients diagnosed following emergency admission. Eur Respir J 2014; 45:1098-107. [PMID: 25323241 DOI: 10.1183/09031936.00068114] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Data on prognosis and predictors of overall survival in advanced lung cancer patients diagnosed following emergency admission (DFEA) are currently lacking. We retrospectively analysed data from 771 patients with advanced nonsmall cell lung cancer between April 2004 and April 2012. Of the 771 patients, 103 (13%) were DFEA. DFEA was not an independent predictor of overall survival by multivariate Cox proportional hazard models, whereas good performance status (PS), epidermal growth factor receptor gene mutation, stage IIIB, adenocarcinoma and chemotherapy were independent predictors of overall survival (hazard ratio (95% CI) 0.36 (0.29-0.44), p<0.001; 0.49 (0.38-0.63), p<0.001; 0.64 (0.51-0.80), p<0.001; 0.81 (0.67-0.99), p=0.044; and 0.40 (0.31-0.52), p<0.001, respectively). Good PS just prior to opting for chemotherapy, but not at emergency admission, was a good independent predictor of overall survival in DFEA patients (hazard ratio (95% CI) 0.26 (0.12-0.55); p<0.001). DFEA is relatively common. DFEA and PS at emergency admission were not independent predictors of overall survival, but good PS just prior to opting for chemotherapy was an independent predictor of longer overall survival. Efforts to improve patient PS after admission should be considered vital in such circumstances.
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Affiliation(s)
- Daichi Fujimoto
- Dept of Respiratory Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Ryoko Shimizu
- Dept of Respiratory Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Takeshi Morimoto
- Clinical Research Center, Kobe City Medical Center General Hospital, Kobe, Japan Division of General Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Ryoji Kato
- Dept of Respiratory Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Yuki Sato
- Dept of Respiratory Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Mariko Kogo
- Dept of Respiratory Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Jiro Ito
- Dept of Respiratory Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Shunsuke Teraoka
- Dept of Respiratory Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Takehiro Otoshi
- Dept of Respiratory Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Kazuma Nagata
- Dept of Respiratory Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Atsushi Nakagawa
- Dept of Respiratory Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Kojiro Otsuka
- Dept of Respiratory Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Nobuyuki Katakami
- Dept of Respiratory Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Keisuke Tomii
- Dept of Respiratory Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
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Mak KS, Gainor JF, Niemierko A, Oh KS, Willers H, Choi NC, Loeffler JS, Sequist LV, Shaw AT, Shih HA. Significance of targeted therapy and genetic alterations in EGFR, ALK, or KRAS on survival in patients with non-small cell lung cancer treated with radiotherapy for brain metastases. Neuro Oncol 2014; 17:296-302. [PMID: 25053852 DOI: 10.1093/neuonc/nou146] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND We determined the impact of genetic alterations in EGFR, ALK, or KRAS on survival after radiotherapy for brain metastases in non-small cell lung cancer (NSCLC). METHODS Of 172 genotyped NSCLC patients treated with radiotherapy for brain metastases in 2005-2012, 54 had cancers with EGFR mutations, 12 had ALK rearrangements, 38 had KRAS mutations, and 68 were wild-type (WT). Overall survival (OS) was determined. RESULTS Median follow-up was 8.6 months. Median OS was 13.6 months for patients with EGFR mutations and 26.3 months for patients with ALK rearrangements, in contrast to 5.7 months for KRAS-mutant patients and 5.5 months for WT patients (P = .001). On multivariate analysis, adjusting for receipt of targeted therapy after cranial radiotherapy, ALK rearrangements were associated with improved OS (HR, 0.31; 95% CI, 0.13-0.74; P = .008). EGFR mutations were not significantly associated with improved OS on multivariate analysis (HR, 0.71; 95% CI, 0.37-1.38; P = .3). KRAS mutations were also not associated with improved OS (HR, 0.93; 95% CI, 0.59-1.47; P = .8). Receipt of targeted therapy after cranial radiotherapy was independently associated with improved OS (HR, 0.30; 95% CI, 0.17-0.54; P < .001). Receipt of chemotherapy after cranial radiotherapy, number of brain metastases, extracranial metastases, age, and performance status were also associated with OS. CONCLUSIONS NSCLC patients with genetic alterations in ALK have improved survival outcomes after radiotherapy for brain metastases compared with EGFR, KRAS, or WT. Subsequent receipt of targeted therapy was associated with additional improvement in OS.
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Affiliation(s)
- Kimberley S Mak
- Harvard Radiation Oncology Program, Massachusetts General Hospital, Boston, Massachusetts (K.S.M.); Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts (J.F.G.); Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts (A.N., K.S.O., H.W., N.C.C., J.S.L., H.A.S.); Massachusetts General Hospital Cancer Center, Boston, Massachusetts (L.V.S., A.T.S.)
| | - Justin F Gainor
- Harvard Radiation Oncology Program, Massachusetts General Hospital, Boston, Massachusetts (K.S.M.); Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts (J.F.G.); Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts (A.N., K.S.O., H.W., N.C.C., J.S.L., H.A.S.); Massachusetts General Hospital Cancer Center, Boston, Massachusetts (L.V.S., A.T.S.)
| | - Andrzej Niemierko
- Harvard Radiation Oncology Program, Massachusetts General Hospital, Boston, Massachusetts (K.S.M.); Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts (J.F.G.); Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts (A.N., K.S.O., H.W., N.C.C., J.S.L., H.A.S.); Massachusetts General Hospital Cancer Center, Boston, Massachusetts (L.V.S., A.T.S.)
| | - Kevin S Oh
- Harvard Radiation Oncology Program, Massachusetts General Hospital, Boston, Massachusetts (K.S.M.); Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts (J.F.G.); Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts (A.N., K.S.O., H.W., N.C.C., J.S.L., H.A.S.); Massachusetts General Hospital Cancer Center, Boston, Massachusetts (L.V.S., A.T.S.)
| | - Henning Willers
- Harvard Radiation Oncology Program, Massachusetts General Hospital, Boston, Massachusetts (K.S.M.); Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts (J.F.G.); Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts (A.N., K.S.O., H.W., N.C.C., J.S.L., H.A.S.); Massachusetts General Hospital Cancer Center, Boston, Massachusetts (L.V.S., A.T.S.)
| | - Noah C Choi
- Harvard Radiation Oncology Program, Massachusetts General Hospital, Boston, Massachusetts (K.S.M.); Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts (J.F.G.); Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts (A.N., K.S.O., H.W., N.C.C., J.S.L., H.A.S.); Massachusetts General Hospital Cancer Center, Boston, Massachusetts (L.V.S., A.T.S.)
| | - Jay S Loeffler
- Harvard Radiation Oncology Program, Massachusetts General Hospital, Boston, Massachusetts (K.S.M.); Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts (J.F.G.); Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts (A.N., K.S.O., H.W., N.C.C., J.S.L., H.A.S.); Massachusetts General Hospital Cancer Center, Boston, Massachusetts (L.V.S., A.T.S.)
| | - Lecia V Sequist
- Harvard Radiation Oncology Program, Massachusetts General Hospital, Boston, Massachusetts (K.S.M.); Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts (J.F.G.); Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts (A.N., K.S.O., H.W., N.C.C., J.S.L., H.A.S.); Massachusetts General Hospital Cancer Center, Boston, Massachusetts (L.V.S., A.T.S.)
| | - Alice T Shaw
- Harvard Radiation Oncology Program, Massachusetts General Hospital, Boston, Massachusetts (K.S.M.); Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts (J.F.G.); Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts (A.N., K.S.O., H.W., N.C.C., J.S.L., H.A.S.); Massachusetts General Hospital Cancer Center, Boston, Massachusetts (L.V.S., A.T.S.)
| | - Helen A Shih
- Harvard Radiation Oncology Program, Massachusetts General Hospital, Boston, Massachusetts (K.S.M.); Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts (J.F.G.); Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts (A.N., K.S.O., H.W., N.C.C., J.S.L., H.A.S.); Massachusetts General Hospital Cancer Center, Boston, Massachusetts (L.V.S., A.T.S.)
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