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Ma F, Lin Y, Ni Z, Wang S, Zhang M, Wang X, Zhang Z, Luo X, Miao X. Microwave ablation enhances the systemic immune response in patients with lung cancer. Oncol Lett 2024; 27:106. [PMID: 38298427 PMCID: PMC10829076 DOI: 10.3892/ol.2024.14239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 11/06/2023] [Indexed: 02/02/2024] Open
Abstract
Microwave ablation (MWA) is a key alternative therapy to conventional surgery for the treatment of lung cancer. In addition to eliminating local tumors, MWA may promote antitumor immunological responses, such as abscopal effects in distant lesions. However, the intensity of MWA is limited and the underlying mechanisms are not well-defined. The present study assessed the impact of MWA on immune cell subsets and cytokines in patients with lung cancer. A total of 45 patients with lung cancer who underwent percutaneous lung tumor MWA were enrolled. Peripheral blood samples were collected before and 24 h after MWA and changes in immune cell subsets [lymphocytes, CD3+, CD4+ and CD8+ T cells, B cells and natural killer (NK) cells] and serum cytokine levels (IL-1β, IL-2, IL-4-6, IL-8, IL-10, IL-12p70, IL-17A and F, IL-22, TNF-α, TNF-β and IFN-γ) were assessed by flow cytometry and ELISA. The number of total lymphocytes, CD4+ T and NK cells in the peripheral blood significantly decreased 24 h after MWA, while number of CD8+ T cells remained stable, leading to a higher proportion of CD8+ T cells. In addition, the serum levels of IL-2, IL-1β, IL-6, IL-12p70, IL-22, TNF-α and IFN-γ were significantly increased 24 h after MWA, indicating a T helper 1 type immune response. The immune response in patients with advanced stage disease was comparable with patients in the early stage group; however, the number of total lymphocytes and CD3+ T cells significantly decreased and the ratio of CD4/CD8 and IL-2 levels significantly increased. The early immune response after MWA may contribute to systemic antitumor immunity in patients with both early and advanced disease. Thus, MWA may exhibit potential as a local therapy and trigger abscopal effects in distant lesions in patients with lung cancer.
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Affiliation(s)
- Fuqi Ma
- Department of Respiratory Medicine, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200062, P.R. China
| | - Yuhua Lin
- Department of Respiratory Medicine, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200062, P.R. China
| | - Zhenhua Ni
- Central Lab, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200062, P.R. China
| | - Shiqiang Wang
- Department of Respiratory Medicine, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200062, P.R. China
| | - Mengjie Zhang
- Department of Respiratory Medicine, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200062, P.R. China
| | - Xiaoe Wang
- Department of Respiratory Medicine, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200062, P.R. China
| | - Zhuhua Zhang
- Department of Respiratory Medicine, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200062, P.R. China
| | - Xuming Luo
- Department of Respiratory Medicine, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200062, P.R. China
| | - Xiayi Miao
- Department of Respiratory Medicine, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200062, P.R. China
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Rizzo A, Schipilliti FM, Di Costanzo F, Acquafredda S, Arpino G, Puglisi F, Del Mastro L, Montemurro F, De Laurentiis M, Giuliano M. Discontinuation rate and serious adverse events of chemoimmunotherapy as neoadjuvant treatment for triple-negative breast cancer: a systematic review and meta-analysis. ESMO Open 2023; 8:102198. [PMID: 38100933 PMCID: PMC10774952 DOI: 10.1016/j.esmoop.2023.102198] [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: 06/21/2023] [Revised: 10/30/2023] [Accepted: 10/31/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND The use of combination of chemotherapy with immune checkpoint inhibitors (ICIs) has shown efficacy in triple-negative breast cancer (TNBC), and chemoimmunotherapy has been introduced in clinical practice. However, limited data are available on the discontinuation rate and serious adverse events of these treatments, particularly in the neoadjuvant setting. Herein, we carried out a comprehensive systematic review and meta-analysis to assess discontinuation rate and serious adverse events of chemoimmunotherapy compared to chemotherapy alone in phase II and III neoadjuvant clinical trials in TNBC. MATERIALS AND METHODS Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, EMBASE, Cochrane Library, and PubMed/Medline were searched for articles published from June 2008 to May 2023. The outcomes of interest were the discontinuation rate, serious adverse events, and grade 3-4 adverse events. RESULTS Four studies were included in the analysis. The pooled odds ratios (ORs) for discontinuation rate and serious adverse events were 1.26 [95% confidence interval (CI) 0.78-2.06] and 1.79 (95% CI 1.4-2.28), respectively, in patients receiving chemoimmunotherapy compared to chemotherapy alone as neoadjuvant treatment for TNBC. The chemoimmunotherapy group had a higher risk of grade 3-4 adverse events (OR 1.30, 95% CI 1.07-1.59). The analysis showed substantial heterogeneity, and the risk of discontinuation rate was heavily influenced by the KEYNOTE-522 trial. CONCLUSIONS Our findings highlight the need for clinical trials specifically focused on safety, quality of life, and treatment adherence in TNBC patients receiving neoadjuvant treatment. Close monitoring of tolerability remains crucial in this clinical setting.
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Affiliation(s)
- A Rizzo
- IRCCS Istituto Tumori "Giovanni Paolo II", Bari
| | - F M Schipilliti
- Oncological Department, Sant'Andrea Hospital, University Sapienza in Rome, Rome
| | - F Di Costanzo
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples
| | | | - G Arpino
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples
| | - F Puglisi
- Department of Medicine, University of Udine, Udine; Department of Medical Oncology-CRO Aviano, National Cancer Institute, IRCCS, Aviano
| | - L Del Mastro
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova; Medical Oncology Department, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova
| | | | - M De Laurentiis
- Istituto Nazionale Tumori IRCCS "Fondazione Pascale", Napoli, Italy
| | - M Giuliano
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples.
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Masi G, Pham MC, Karatz T, Oh S, Payne AS, Nowak RJ, Howard JF, Guptill JT, Juel VC, O'Connor KC. Clinicoserological insights into patients with immune checkpoint inhibitor-induced myasthenia gravis. Ann Clin Transl Neurol 2023; 10:825-831. [PMID: 36924454 PMCID: PMC10187728 DOI: 10.1002/acn3.51761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 03/01/2023] [Accepted: 03/03/2023] [Indexed: 03/18/2023] Open
Abstract
To compare the immunopathology of immune checkpoint inhibitor-induced myasthenia gravis (ICI-MG) and idiopathic MG, we profiled the respective AChR autoantibody pathogenic properties. Of three ICI-MG patients with AChR autoantibodies, only one showed complement activation and modulation/blocking potency, resembling idiopathic MG. In contrast, AChR autoantibody-mediated effector functions were not detected in the other two patients, questioning the role of their AChR autoantibodies as key mediators of pathology. The contrasting properties of AChR autoantibodies in these cases challenge the accuracy of serological testing in establishing definite ICI-MG diagnoses and underscore the importance of a thorough clinical assessment when evaluating ICI-related adverse events.
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Affiliation(s)
- Gianvito Masi
- Department of Immunobiology, Yale School of Medicine, New Haven, Connecticut, 06511, USA
- Department of Neurology, Yale School of Medicine, New Haven, Connecticut, 06511, USA
| | - Minh C Pham
- Department of Immunobiology, Yale School of Medicine, New Haven, Connecticut, 06511, USA
| | - Tabitha Karatz
- Neuromuscular Division, Department of Neurology, Duke University Medical Center, Durham, North Carolina, 27710, USA
| | - Sangwook Oh
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, 19104, USA
| | - Aimee S Payne
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, 19104, USA
| | - Richard J Nowak
- Department of Neurology, Yale School of Medicine, New Haven, Connecticut, 06511, USA
| | - James F Howard
- Department of Neurology, The University of North Carolina at Chapel Hill, CB#7025, Houpt Building, 170 Manning Drive, Chapel Hill, North Carolina, 27599-7025, USA
| | - Jeffrey T Guptill
- Neuromuscular Division, Department of Neurology, Duke University Medical Center, Durham, North Carolina, 27710, USA
| | - Vern C Juel
- Neuromuscular Division, Department of Neurology, Duke University Medical Center, Durham, North Carolina, 27710, USA
| | - Kevin C O'Connor
- Department of Immunobiology, Yale School of Medicine, New Haven, Connecticut, 06511, USA
- Department of Neurology, Yale School of Medicine, New Haven, Connecticut, 06511, USA
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Zou Z, Li J, Ji X, Wang T, Chen Q, Liu Z, Ji S. Naples Prognostic Score as an Independent Predictor of Survival Outcomes for Resected Locally Advanced Non-Small Cell Lung Cancer Patients After Neoadjuvant Treatment. J Inflamm Res 2023; 16:793-807. [PMID: 36860794 PMCID: PMC9969868 DOI: 10.2147/jir.s401446] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 02/16/2023] [Indexed: 02/24/2023] Open
Abstract
Background The Naples Prognostic Score (NPS) can reflect patient's nutritional and inflammatory status, which is identified as a prognostic indicator for various malignant tumors. However, its significance in patients with resected locally advanced non-small cell lung cancer (LA-NSCLC) patients who receive neoadjuvant treatment remains unclear so far. Methods A total of 165 LA-NSCLC patients surgically treated from May 2012 to November 2017 were retrospectively investigated. The LA-NSCLC patients were divided into three groups according to NPS scores. The receiver operating curve (ROC) analysis was performed to reveal the discriminatory ability of NPS and other indicators for predicting the survival. The NPS and clinicopathological variables were further evaluated the prognostic value by univariate and multivariate Cox analysis. Results The NPS was related to age (P = 0.046), smoking history (P = 0.004), Eastern Cooperative Oncology Group (ECOG) score (P = 0.005), and adjuvant treatment (P = 0.017). Patients with high NPS scores had worse overall survival (OS) (group 1 vs 0, P = 0.006; group 2 vs 0, P < 0.001) and disease-free survival (DFS) (group 1 vs 0, P < 0.001; group 2 vs 0, P < 0.001). The ROC analysis demonstrated that NPS had better predictive ability than other prognostic indicators. Multivariate analysis revealed that NPS was independent prognostic indicator of OS (group 1 vs 0, hazard ratio [HR] =2.591, P = 0.023; group 2 vs 0, HR = 8.744, P = 0.001) and DFS (group 1 vs 0, HR =3.754, P < 0.001; group 2 vs 0, HR = 9.673, P < 0.001). Conclusion The NPS could be an independent prognostic indicator in patients with resected LA-NSCLC receiving neoadjuvant treatment and more reliable than the other nutritional and inflammatory indicators.
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Affiliation(s)
- Zhonghua Zou
- Department of Radiotherapy & Oncology, the Affiliated Suzhou Hospital of Nanjing Medical University, Gusu School, Nanjing Medical University, Suzhou, People’s Republic of China
| | - Jinping Li
- Department of Gastroenterology, Fangzi People’s Hospital, Weifang, People’s Republic of China
| | - Xiang Ji
- Department of Gastroenterology, Fangzi People’s Hospital, Weifang, People’s Republic of China
| | - Tingxing Wang
- Department of Radiotherapy & Oncology, the Affiliated Suzhou Hospital of Nanjing Medical University, Gusu School, Nanjing Medical University, Suzhou, People’s Republic of China
| | - Qingqing Chen
- Department of Radiotherapy & Oncology, the Affiliated Suzhou Hospital of Nanjing Medical University, Gusu School, Nanjing Medical University, Suzhou, People’s Republic of China
| | - Zhengcao Liu
- Department of Radiotherapy & Oncology, the Affiliated Suzhou Hospital of Nanjing Medical University, Gusu School, Nanjing Medical University, Suzhou, People’s Republic of China
| | - Shengjun Ji
- Department of Radiotherapy & Oncology, the Affiliated Suzhou Hospital of Nanjing Medical University, Gusu School, Nanjing Medical University, Suzhou, People’s Republic of China,Correspondence: Shengjun Ji, Department of Radiotherapy & Oncology, the affiliated Suzhou Hospital of Nanjing Medical University, Gusu School, Nanjing Medical University, No. 16 Baita Road, Suzhou, 215001, People’s Republic of China, Email
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Martin CM, Puello‐Guerrero A, Mas‐Lopez LA, Campos‐Gómez S, Orlando‐Orlandi FJ, Tejado Gallegos LF, Huggenberger R. Real-world KINDLE-Latin America subset data on treatment patterns and clinical outcomes in patients with stage III non-small-cell lung cancer. Cancer Med 2022; 12:1247-1259. [PMID: 35789068 PMCID: PMC9883579 DOI: 10.1002/cam4.4990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 04/13/2022] [Accepted: 04/25/2022] [Indexed: 02/02/2023] Open
Abstract
INTRODUCTION Stage III non-small-cell lung cancer (NSCLC) management is challenging given the heterogeneous nature of the disease. The LATAM subset of the real-world, global KINDLE study reported the treatment patterns and clinical outcomes for LATAM from the pre-immuno-oncology era. METHODS The study was conducted in seven countries (Argentina, Chile, Colombia, Dominican Republic, Mexico, Peru and Uruguay) in stage III NSCLC (American Joint Committee on Cancer, 7th edition) diagnosed between January 2013 and December 2017. Retrospective data from patients' medical records (index date to the end of follow-up) were collected. Summary statistics, Kaplan-Meier survival estimates and a two-sided 95% confidence interval (CI) were provided. Cox proportional hazard model was used for univariate and multi-variate analyses. RESULTS A total of 231 patients was enrolled, the median age was 65.0 years (range 21.0-89.0), 60.6% were males, 76.6% had smoking history, 64.0% had adenocarcinoma and 28.7% underwent curative resection. Multiple treatment regimens (>25) were used; chemotherapy alone was the most common (24.8%). The overall median progression-free survival (mPFS) and median overall survival (mOS) were 14.8 months (95% CI, 12.1-18.6) and 48.6 months (95% CI, 34.7 to not calculable). Significantly better mPFS and mOS were observed for stage IIIA with curative surgery and resectable tumours and stage IIIB with an Eastern Cooperative Oncology Group score of 0/1, female gender, resectable tumours, adenocarcinoma and curative surgery (p < 0.05). CONCLUSION Results show diversity in treatment practices and the corresponding clinical outcomes in stage III NSCLC. There is a need to streamline treatment selection and sequencing to decrease relapse rates after initial therapy.
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Affiliation(s)
| | - Adrián Puello‐Guerrero
- Universidad Autónoma de Santo Domingo (UASD), Instituto Nacional del Cáncer (INCART)Santo DomingoDominican Republic
| | | | - Saul Campos‐Gómez
- Centro Oncológico EstatalInstituto de Seguridad Social del Estado de México y MunicipiosTolucaMexico
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Van Dao T, Diep TB, Le Phuong T, Huggenberger R, Kumar A. Real-World Treatment Patterns and Clinical Outcomes in Patients With Stage III Non-Small-Cell Lung Cancer: Results of KINDLE-Vietnam Cohort. Front Oncol 2022; 12:842296. [PMID: 35677172 PMCID: PMC9169691 DOI: 10.3389/fonc.2022.842296] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 04/13/2022] [Indexed: 12/24/2022] Open
Abstract
Objective KINDLE-Vietnam was a part of a real-world KINDLE study with an aim to characterise treatment patterns and clinical outcomes of patients with stage III non-small cell lung cancer (NSCLC). Materials and Methods Retrospective data from patients diagnosed with stage III NSCLC (American Joint Committee on Cancer, 7th edition) between January 2013 and December 2017 with at least 9 months of follow-up were collected from 2 centres in Vietnam. Descriptive statistics were used to summarise demographics, disease characteristics and treatment modalities. Kaplan-Meier methodology evaluated survival estimates; 2-sided 95% confidence intervals (CIs) were computed. Inferential statistics were used to correlate clinical and treatment variables with median progression-free survival (mPFS) and median overall survival (mOS). Results A total of 150 patients (median age: 60 years [range 26-82]) were enrolled; 75.3% were male, 62.0% had smoking history, 56.4% had stage IIIB disease and 62.5% had adenocarcinoma. The majority of the cases (97.3%) were not discussed at a multidisciplinary team meeting. Overall, chemotherapy alone (43.3%), radiotherapy alone (17.0%), sequential chemoradiation (13.5%) and concurrent chemoradiation (12.8%) were preferred as initial therapy. Surgery-based treatment was administered in limited patients (stage IIIA, 10%; stage IIIB, 1.3%). Palliative therapy was the most commonly administered treatment upon relapse in the second-and third-line setting. The mPFS and mOS for the Vietnam cohort were 8.7 months (95% CI, 7.59-9.72) and 25.7 months (95% CI, 19.98-42.61), respectively. The mPFS and mOS for stage IIIA were 11.9 months (95% CI, 8.64-14.95) and 28.2 months (95% CI, 24.15-not-calculable) and for stage IIIB were 7.8 months (95% CI, 6.64-8.71) and 20.0 months (95% CI, 13.01-42.61). Conclusions KINDLE-Vietnam offers insights into the clinical findings of stage III NSCLC. There is a high unmet need for identifying patients in the early stages of NSCLC. Strategies for improving clinical outcomes in this patient population include physician education, multidisciplinary management and catering to increased access to novel agents like immunotherapy and targeted therapy.
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Affiliation(s)
- Tu Van Dao
- Cancer Research and Clinical Trials Center, Vietnam National Cancer Hospital, Hanoi, Vietnam.,Oncology Department, Hanoi Medical University, Hanoi, Vietnam
| | - Tuan Bao Diep
- Ho Chi Minh City Oncology Hospital, Ho Chi Minh City, Vietnam
| | - Tri Le Phuong
- Medical Affairs, AstraZeneca Vietnam, Ho Chi Minh, Vietnam
| | | | - Amit Kumar
- Medical Affairs, AstraZeneca India, Bangalore, India
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Jazieh A, Sağlam EK, Önal H, Abdelkader Y, Gaafar R, Dawoud E, Nassar M, Alshorbagy D, El Ashry H, Alsayed M. Real-world Treatment Patterns and Outcomes in Stage III Non-small Cell Lung Cancer: Middle East and Africa – KINDLE Study. Clin Lung Cancer 2022; 23:364-373. [DOI: 10.1016/j.cllc.2022.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 02/01/2022] [Accepted: 02/03/2022] [Indexed: 11/03/2022]
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Le DT, Huynh TR, Burt B, Van Buren G, Abeynaike SA, Zalfa C, Nikzad R, Kheradmand F, Tyner JJ, Paust S. Natural killer cells and cytotoxic T lymphocytes are required to clear solid tumor in a patient-derived xenograft. JCI Insight 2021; 6:e140116. [PMID: 34081628 PMCID: PMC8410059 DOI: 10.1172/jci.insight.140116] [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] [Indexed: 12/31/2022] Open
Abstract
Existing patient-derived xenograft (PDX) mouse models of solid tumors lack a fully tumor donor-matched, syngeneic, and functional immune system. We developed a model that overcomes these limitations by engrafting lymphopenic recipient mice with a fresh, undisrupted piece of solid tumor, whereby tumor-infiltrating lymphocytes (TILs) persisted in the recipient mice for several weeks. Successful tumor engraftment was achieved in 83% to 89% of TIL-PDX mice, and these were seen to harbor exhausted immuno-effector as well as functional immunoregulatory cells persisting for at least 6 months postengraftment. Combined treatment with interleukin-15 stimulation and immune checkpoint inhibition resulted in complete or partial tumor response in this model. Further, depletion of cytotoxic T lymphocytes and/or natural killer cells before combined immunotherapy revealed that both cell types were required for maximal tumor regression. Our TIL-PDX model provides a valuable resource for powerful mechanistic and therapeutic studies in solid tumors.
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Affiliation(s)
- Duy Tri Le
- Department of Pediatrics, Texas Children's Hospital, Houston, Texas, USA
| | - Tridu R Huynh
- Scripps Research Translational Institute, La Jolla, California, USA.,Division of Internal Medicine, Scripps Clinic/Scripps Green Hospital, La Jolla, California, USA.,Department of Immunology and Microbiology, The Scripps Research Institute, La Jolla, California, USA
| | - Bryan Burt
- Division of General Thoracic Surgery and
| | - George Van Buren
- Division of Surgical Oncology, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA.,Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas, USA
| | - Shawn A Abeynaike
- Department of Immunology and Microbiology, The Scripps Research Institute, La Jolla, California, USA
| | - Cristina Zalfa
- Department of Immunology and Microbiology, The Scripps Research Institute, La Jolla, California, USA
| | - Rana Nikzad
- Department of Immunology and Microbiology, The Scripps Research Institute, La Jolla, California, USA
| | - Farrah Kheradmand
- Margaret M. and Albert B. Alkek Department of Medicine, Baylor College of Medicine and Michael E. DeBakey VA Medical Center, US Department of Veterans Affairs, Houston, Texas, USA
| | - John J Tyner
- Division of Cardiovascular/Thoracic Surgery, Scripps Clinic, La Jolla, California, USA
| | - Silke Paust
- Department of Pediatrics, Texas Children's Hospital, Houston, Texas, USA.,Department of Immunology and Microbiology, The Scripps Research Institute, La Jolla, California, USA
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Jazieh AR, Onal HC, Tan DSW, Soo RA, Prabhash K, Kumar A, Huggenberger R, Robb S, Cho BC. Real-World Treatment Patterns and Clinical Outcomes in Patients With Stage III NSCLC: Results of KINDLE, a Multicountry Observational Study. J Thorac Oncol 2021; 16:1733-1744. [PMID: 34051381 DOI: 10.1016/j.jtho.2021.05.003] [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: 03/01/2021] [Revised: 05/11/2021] [Accepted: 05/12/2021] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Stage III NSCLC is a heterogeneous disease requiring a multimodal management approach. We conducted a real-world, global study to characterize patients, treatment patterns, and their associated clinical outcomes for stage III NSCLC. METHODS KINDLE was a retrospective study in patients with stage III NSCLC (American Joint Committee on Cancer, seventh edition) diagnosed between January 2013 and December 2017, with at least 9 months of documented follow-up since index diagnosis. In addition to descriptive statistics, Kaplan-Meier methodology evaluated survival estimates; two-sided 95% confidence interval was computed. Cox proportional hazards model was used for univariate and multivariate analyses. RESULTS A total of 3151 patients from more than 100 centers across 19 countries from Asia, Middle East, Africa, and Latin America were enrolled. Median age was 63.0 years (range: 21.0-92.0); 76.5% were males, 69.2% had a smoking history, 53.7% had adenocarcinoma, and 21.4% underwent curative resection. Of greater than 25 treatment regimens, concurrent chemoradiotherapy was the most common (29.4%). The overall median progression-free survival (95% confidence interval) and median overall survival (mOS) were 12.5 months (12.06-13.14) and 34.9 months (32.00-38.01), respectively. Significant associations (p < 0.05) were observed for median progression-free survival and mOS with respect to sex, region, smoking status, stage, histology, and Eastern Cooperative Oncology Group status. In univariate and multivariate analyses, younger age, stage IIIA, better Eastern Cooperative Oncology Group status, concurrent chemoradiotherapy, and surgery as initial therapy predicted better mOS. CONCLUSIONS KINDLE reveals the diversity in treatment practices and outcomes in stage III NSCLC in a real-world setting in the preimmuno-oncology era. There is a high unmet medical need, necessitating novel approaches to optimize outcomes.
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Affiliation(s)
- Abdul Rahman Jazieh
- Department of Oncology, King Abdulaziz Medical City, King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia.
| | - Huseyin Cem Onal
- Department of Radiation Oncology, Adana Dr. Turgut Noyan Research and Treatment Centre, Baskent University Faculty of Medicine, Adana, Turkey
| | - Daniel Shao Weng Tan
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Ross A Soo
- Department of Haematology-Oncology, National University Cancer Institute, Singapore, Singapore
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | | | | | | | - Byoung-Chul Cho
- Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea
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10
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Chen H, Xia R, Jiang L, Zhou Y, Xu H, Peng W, Yao C, Zhou G, Zhang Y, Xia H, Wang Y. Overexpression of RhoV Promotes the Progression and EGFR-TKI Resistance of Lung Adenocarcinoma. Front Oncol 2021; 11:619013. [PMID: 33767988 PMCID: PMC7986718 DOI: 10.3389/fonc.2021.619013] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 01/12/2021] [Indexed: 11/13/2022] Open
Abstract
Background The Rho GTPase family with ~20 member genes play central roles in a wide variety of cellular processes and tumor cell migration and metastasis. Different Rho GTPase may play different roles in the progression of lung adenocarcinoma. Methods We comprehensively examined the expression of all Rho GTPase family member genes in a panel of lung adenocarcinoma patient’s tumors and matched normal tissues. We next investigated the critical role of RhoV in different lung adenocarcinoma cells and animal models. Results RhoV was identified as one of the most significantly overexpressed Rho GTPases in lung adenocarcinoma and associated with patients’ survival. Silencing RhoV expression inhibits proliferation, migration and invasion, and tumorigenicity capacities of lung adenocarcinoma cells. Moreover, knockdown RhoV promoted the sensitivity of EGFR-TKI in the gefitinib resistant PC9 cells (PC9-GR) and aggravated gefitinib-induced lung cancer cell apoptosis both in PC9 and PC9-GR cells. Our data also indicated that RhoV induced progression and EGFR-TKI resistance of lung adenocarcinoma may be related to the activation of the AKT/ERK pathway. Conclusion Overexpression of RhoV in lung adenocarcinoma promotes the progression and EGFR-TKI resistance, suggesting RhoV is a promising prognosis and therapeutic target of lung adenocarcinoma.
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Affiliation(s)
- Hongjin Chen
- Department of Pathology, School of Basic Medical Sciences & Sir Run Run Hospital & Key Laboratory of Antibody Technique of National Health Commission, Nanjing Medical University, Nanjing, China
| | - Ruixue Xia
- Department of Respiratory and Critical Care Medicine, Henan University Huaihe Hospital, Kaifeng, China
| | - Long Jiang
- Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yong Zhou
- Nanjing Drum Tower Hospital Affiliated to Medical School of Nanjing University, Nanjing, China
| | - Haojun Xu
- Department of Pathology, School of Basic Medical Sciences & Sir Run Run Hospital & Key Laboratory of Antibody Technique of National Health Commission, Nanjing Medical University, Nanjing, China
| | - Weiwei Peng
- Jiangsu Cancer Hospital & The Affiliated Cancer Hospital of Nanjing Medical University & Jiangsu Institute of Cancer Research, Nanjing, China
| | - Chengyun Yao
- Jiangsu Cancer Hospital & The Affiliated Cancer Hospital of Nanjing Medical University & Jiangsu Institute of Cancer Research, Nanjing, China
| | - Guoren Zhou
- Jiangsu Cancer Hospital & The Affiliated Cancer Hospital of Nanjing Medical University & Jiangsu Institute of Cancer Research, Nanjing, China
| | - Yijie Zhang
- Department of Respiratory and Critical Care Medicine, Henan University Huaihe Hospital, Kaifeng, China
| | - Hongping Xia
- Department of Pathology, School of Basic Medical Sciences & Sir Run Run Hospital & Key Laboratory of Antibody Technique of National Health Commission, Nanjing Medical University, Nanjing, China.,Department of Respiratory and Critical Care Medicine, Henan University Huaihe Hospital, Kaifeng, China.,Jiangsu Cancer Hospital & The Affiliated Cancer Hospital of Nanjing Medical University & Jiangsu Institute of Cancer Research, Nanjing, China
| | - Yongsheng Wang
- Nanjing Drum Tower Hospital Affiliated to Medical School of Nanjing University, Nanjing, China
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11
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Chen D, Mao Y, Ding Q, Wang W, Zhu F, Chen C, Chen Y. Prognostic implications of programmed death ligand 1 expression in resected lung adenocarcinoma: a systematic review and meta-analysis. Eur J Cardiothorac Surg 2020; 58:888-898. [PMID: 32596715 DOI: 10.1093/ejcts/ezaa172] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 03/31/2020] [Accepted: 04/15/2020] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVES Conflicting results have been reported about the prognostic value of programmed death ligand 1 (PD-L1) protein and gene expression in lung adenocarcinoma. METHODS We performed a comprehensive online search to explore the association between PD-L1 expression (protein and messenger RNA) and overall survival (OS) or disease-free survival. Outcomes also included pooled rates of high PD-L1 protein expression in different cell types, per threshold used and per antibody used. A pooled gene expression analysis was also performed on 3 transcriptomic data sets that were obtained from The Cancer Genome Atlas database and the Gene Expression Omnibus database. RESULTS A total of 6488 patients from 25 studies were included. The pooled results suggested that high PD-L1 expression was associated with shorter OS [hazard ratio (HR) 1.57; P < 0.001] and disease-free survival (HR 1.341; P = 0.037) in the overall population. The overall pooled rate of high PD-L1 protein expression was 29% (95% confidence interval 23-34%) in tumour cells. In subgroup analysis, high PD-L1 protein expression in tumour cells predicted worse OS and disease-free survival. A pooled analysis of The Cancer Genome Atlas and Gene Expression Omnibus data sets revealed that higher levels of PD-L1 messenger RNA predicted poorer OS in the entire population. CONCLUSIONS This study is, to our knowledge, the largest pooled analysis on the subject to shed light on the high expression rate of PD-L1 and the prognostic value of high PD-L1 expression in resected lung adenocarcinomas. PD-L1 gene expression is a promising prognostic factor for patients with surgically resected lung adenocarcinoma. Standardization of staining should be underscored prior to routine implementation.
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Affiliation(s)
- Donglai Chen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, School of Medicine, Shanghai, China
| | - Yiming Mao
- Department of Thoracic Surgery, Suzhou Kowloon Hospital, Shanghai Jiaotong University School of Medicine, Suzhou, China
| | - Qifeng Ding
- Department of Thoracic Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Wei Wang
- Department of Thoracic Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Feng Zhu
- Department of Thoracic Surgery, Suzhou Kowloon Hospital, Shanghai Jiaotong University School of Medicine, Suzhou, China
| | - Chang Chen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, School of Medicine, Shanghai, China
| | - Yongbing Chen
- Department of Thoracic Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, China
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12
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Yao J, Xue X, Qu D, Westphalen CB, Ge Y, Zhang L, Li M, Gao T, Chandrakesan P, Vega KJ, Peng J, An G, Weygant N. Reverse engineering a predictive signature characterized by proliferation, DNA damage, and immune escape from stage I lung adenocarcinoma recurrence. Acta Biochim Biophys Sin (Shanghai) 2020; 52:638-653. [PMID: 32395755 DOI: 10.1093/abbs/gmaa036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 03/14/2020] [Indexed: 12/24/2022] Open
Abstract
Identifying early-stage cancer patients at risk for progression is a major goal of biomarker research. This report describes a novel 19-gene signature (19-GCS) that predicts stage I lung adenocarcinoma (LAC) recurrence and response to therapy and performs comparably in pancreatic adenocarcinoma (PAC), which shares LAC molecular traits. Kaplan-Meier, Cox regression, and cross-validation analyses were used to build the signature from training, test, and validation sets comprising 831 stage I LAC transcriptomes from multiple independent data sets. A statistical analysis was performed using the R language. Pathway and gene set enrichment were used to identify underlying mechanisms. 19-GCS strongly predicts overall survival and recurrence-free survival in stage I LAC (P=0.002 and P<0.001, respectively) and in stage I-II PAC (P<0.0001 and P<0.0005, respectively). A multivariate cox regression analysis demonstrated the independence of 19-GCS from significant clinical factors. Pathway analyses revealed that 19-GCS high-risk LAC and PAC tumors are characterized by increased proliferation, enhanced stemness, DNA repair deficiency, and compromised MHC class I and II antigen presentation along with decreased immune infiltration. Importantly, high-risk LAC patients do not appear to benefit from adjuvant cisplatin while PAC patients derive additional benefit from FOLFIRINOX compared with gemcitabine-based regimens. When validated prospectively, this proof-of-concept biomarker may contribute to tailoring treatment, recurrence reduction, and survival improvements in early-stage lung and pancreatic cancers.
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Affiliation(s)
- Jiannan Yao
- Department of Oncology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China
| | - Xinying Xue
- Department of Respiratory and Critical Care Medicine, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
| | - Dongfeng Qu
- Department of Medicine, The University of Oklahoma Health Sciences Center, Oklahoma City, 73103, OK, USA
- Stephenson Cancer Center, Oklahoma City, 73104, OK, USA
| | - C Benedikt Westphalen
- Comprehensive Cancer Center Munich & Department of Medicine III, Ludwig Maximilian University of Munich, 81377, Munich, Germany
| | - Yang Ge
- Department of Oncology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China
| | - Liyang Zhang
- Xiangya Hospital, Central South University, Changsha 410008, China
| | - Manyu Li
- Department of Oncology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China
| | - Tianbo Gao
- Department of Oncology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China
| | - Parthasarathy Chandrakesan
- Department of Medicine, The University of Oklahoma Health Sciences Center, Oklahoma City, 73103, OK, USA
- Stephenson Cancer Center, Oklahoma City, 73104, OK, USA
| | - Kenneth J Vega
- Division of Gastroenterology and Hepatology, Augusta University, Augusta, 30912, GA, USA
| | - Jun Peng
- Academy of Integrative Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou 350122, China
- Fujian Key Laboratory of Integrative Medicine in Geriatrics, Fuzhou 350122, China
| | - Guangyu An
- Department of Oncology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China
| | - Nathaniel Weygant
- Academy of Integrative Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou 350122, China
- Fujian Key Laboratory of Integrative Medicine in Geriatrics, Fuzhou 350122, China
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13
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Zhang N, Wu J, Yu J, Zhu H, Yang M, Li R. Integrating Imaging, Histologic, and Genetic Features to Predict Tumor Mutation Burden of Non-Small-Cell Lung Cancer. Clin Lung Cancer 2019; 21:e151-e163. [PMID: 31734072 DOI: 10.1016/j.cllc.2019.10.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 10/04/2019] [Accepted: 10/19/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Immune checkpoint inhibitors have dramatically changed the landscape of therapeutic management of non-small-cell lung cancer (NSCLC). Tumor mutation burden (TMB) is an important biomarker of the response to cancer immunotherapy. We investigated the relationship between TMB and the imaging, histologic, and genetic features in NSCLC. MATERIALS AND METHODS We evaluated the associations between the semantic imaging features (7 quantitative or semiquantitative imaging features and 13 qualitative features that reflect the tumor characteristics) and TMB and built an imaging signature for TMB using logistic regression. Finally, we integrated the imaging signature, histologic type, and TP53 genotype into a composite model. RESULTS Among 89 patients, 37 (41.6%) had low TMB and 52 (58.4%) had high TMB. Tumors with high TMB were more prevalent in squamous cell carcinoma (P = .017) and those with a TP53 mutation (P < .0001). The absence of concavity was significantly associated with higher TMB (P = .008). An imaging signature containing 5 features, including concavity, border definition, spiculation, thickened adjacent bronchovascular bundle and size, achieved good discrimination between tumors with low and high TMB (area under the curve [AUC], 0.79; 95% confidence interval [CI], 0.69-0.89). The composite model integrating the imaging signature, histologic type, and TP53 genotype improved the classification (AUC, 0.89; 95% CI, 0.82-0.95) compared with the imaging signature alone using the DeLong test (P = .012). The composite model achieved a high sensitivity of 95% and a specificity of 62%. CONCLUSION Specific computed tomography features are associated with TMB in NSCLC, and the integration of imaging, histologic, and genetic information might allow for accurate prediction of TMB.
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Affiliation(s)
- Nasha Zhang
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong Province, China; Department of Radiation Oncology, Stanford University School of Medicine, Palo Alto, CA
| | - Jia Wu
- Department of Radiation Oncology, Stanford University School of Medicine, Palo Alto, CA
| | - Jinming Yu
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong Province, China
| | - Hui Zhu
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong Province, China; Department of Radiation Oncology, Stanford University School of Medicine, Palo Alto, CA
| | - Ming Yang
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong Province, China.
| | - Ruijiang Li
- Department of Radiation Oncology, Stanford University School of Medicine, Palo Alto, CA.
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14
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Wu S, Hu C, Wu F, Wu Y, Liu P. [Progress in Clinical Researches of PD-1/PD-L1 Checkpoint Inhibitor for Non-small Cell Lung Cancer]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2019; 22:440-448. [PMID: 31315783 PMCID: PMC6712270 DOI: 10.3779/j.issn.1009-3419.2019.07.06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
非小细胞肺癌(non-small cell lung cancer, NSCLC)是肺癌最常见的病理类型。近年来,免疫治疗迅速发展,免疫检查点抑制剂尤其是程序性死亡因子-1(programmed death-1, PD-1)/程序性死亡因子配体-1(programmed death-ligand 1, PD-L1)抑制剂已在NSCLC的治疗中取得突破性进展,改变了NSCLC治疗的格局。以PD-1/PD-L1为靶点的免疫检查点抑制剂无论在晚期NSCLC的一线和二线治疗,局部晚期NSCLC的辅助治疗,还是早期NSCLC的新辅助治疗中均为患者带来获益,在NSCLC的综合治疗中显示出重要地位。本文针对以PD-1/PD-L1为靶点的免疫检查点抑制剂在NSCLC中的临床研究进展展开综述。
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Affiliation(s)
- Sixuan Wu
- Department of Oncology, the Second Xiangya Hospital, Central South University, Changsha 410011, China
| | - Chunhong Hu
- Department of Oncology, the Second Xiangya Hospital, Central South University, Changsha 410011, China
| | - Fang Wu
- Department of Oncology, the Second Xiangya Hospital, Central South University, Changsha 410011, China
| | - Yuanqiang Wu
- Department of Oncology, the Second Xiangya Hospital, Central South University, Changsha 410011, China
| | - Ping Liu
- Department of Oncology, the Second Xiangya Hospital, Central South University, Changsha 410011, China
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15
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Liu Y, Zhou S, Du Y, Sun L, Jiang H, Zhang B, Sun G, Wang R. Efficacy and safety of programmed death 1 inhibitors in patients with advanced non-small cell lung cancer: a meta-analysis. Cancer Manag Res 2019; 11:4619-4630. [PMID: 31191023 PMCID: PMC6535411 DOI: 10.2147/cmar.s193394] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Accepted: 04/11/2019] [Indexed: 12/26/2022] Open
Abstract
Objective: This study aims to perform systematic review and meta-analysis of all randomized controlled trials that compare the efficacy and safety of programmed death 1 (PD-1) inhibitors versus chemotherapy alone in previously untreated advanced non-small cell lung cancer (NSCLC). Materials and methods: Several databases, including Medline, Cochrane Library, Embase, and Web of Science, were searched. The main outcome measures included overall survival (OS), progression-free survival (PFS), objective response rate (ORR), and adverse events (AEs). Results: The results of meta-analysis are expressed as the hazard ratio (HR) or risk ratio (RR) with their corresponding 95% confidence intervals (CIs). The final analysis included six trials for 3,930 patients. PD-1 inhibitors led to a statistically superior survival benefit over chemotherapy in patients with advanced NSCLC. OS was longer in patients who received PD-1 inhibitors (HR =0.71, 95% CI =0.62–0.74, P=0.000). Furthermore, PD-1 inhibitors had significantly higher objective response rate than chemotherapy (RR =0.20,95% CI =0.17–0.23, P=0.000). Meta-analysis showed that the AEs of any grade with PD-1 inhibitors were lower than those with chemotherapy (RR =0.78; 95% CI =0.75–0.81, P=0.000). Conclusion: PD-1 inhibitors showed a clinically meaningful survival benefit and an improved safety profile in patients with previously treated NSCLC.
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Affiliation(s)
- Yi Liu
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, People's Republic of China
| | - Sijing Zhou
- Hefei Prevention and Treatment Center for Occupational Diseases, Hefei 230022, People's Republic of China
| | - Yongsheng Du
- Department of General Medicine, Hefei Second People's Hospital, Hefei 230022, People's Republic of China
| | - Li Sun
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, People's Republic of China
| | - Huihui Jiang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, People's Republic of China
| | - Binbin Zhang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, People's Republic of China
| | - Gengyun Sun
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, People's Republic of China
| | - Ran Wang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, People's Republic of China
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