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Chen Y, Qin J, Wu Y, Lin Q, Wang J, Zhang W, Liang F, Hui Z, Zhao M, Wang J. Does major pathological response after neoadjuvant Immunotherapy in resectable nonsmall-cell lung cancers predict prognosis? A systematic review and meta-analysis. Int J Surg 2023; 109:2794-2807. [PMID: 37247009 PMCID: PMC10498860 DOI: 10.1097/js9.0000000000000496] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 05/11/2023] [Indexed: 05/30/2023]
Abstract
OBJECTIVE Overall survival is the gold-standard outcome measure for phase 3 trials, but the need for a long follow-up period can delay the translation of potentially effective treatment to clinical practice. The validity of major pathological response (MPR) as a surrogate of survival for non small cell lung cancer (NSCLC) after neoadjuvant immunotherapy remains unclear. METHODS Eligibility was resectable stage I-III NSCLC and delivery of PD-1/PD-L1/CTLA-4 inhibitors prior to resection; other forms/modalities of neoadjuvant and/or adjuvant therapies were allowed. Statistics utilized the Mantel-Haenszel fixed-effect or random-effect model depending on the heterogeneity ( I2 ). RESULTS Fifty-three trials (seven randomized, 29 prospective nonrandomized, 17 retrospective) were identified. The pooled rate of MPR was 53.8%. Compared to neoadjuvant chemotherapy, neoadjuvant chemo-immunotherapy achieved higher MPR (OR 6.19, 4.39-8.74, P <0.00001). MPR was associated with improved disease-free survival/progression-free survival/event-free survival (HR 0.28, 0.10-0.79, P =0.02) and overall survival (HR 0.80, 0.72-0.88, P <0.0001). Patients with stage III (vs I/II) and PD-L1 ≥1% (vs <1%) more likely achieved MPR (OR 1.66,1.02-2.70, P =0.04; OR 2.21,1.28-3.82, P =0.004). CONCLUSIONS The findings of this meta-analysis suggest that neoadjuvant chemo-immunotherapy achieved higher MPR in NSCLC patients, and increased MPR might be associated with survival benefits treated with neoadjuvant immunotherapy. It appears that the MPR may serve as a surrogate endpoint of survival to evaluate neoadjuvant immunotherapy.
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Affiliation(s)
- Yujia Chen
- Department of Radiation Oncology, the Fourth Hospital of Hebei Medical University, Hebei Clinical Research Center for Radiation Oncology
| | - Jianjun Qin
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yajing Wu
- Department of Radiation Oncology, the Fourth Hospital of Hebei Medical University, Hebei Clinical Research Center for Radiation Oncology
| | - Qiang Lin
- Department of Oncology, North China Petroleum Bureau General Hospital, Hebei Medical University, Renqiu
| | - Jianing Wang
- Department of Radiation Oncology, the Fourth Hospital of Hebei Medical University, Hebei Clinical Research Center for Radiation Oncology
| | - Wei Zhang
- Department of Radiation Oncology, the Fourth Hospital of Hebei Medical University, Hebei Clinical Research Center for Radiation Oncology
| | - Fei Liang
- Department of Biostatistics, Zhongshan Hospital, Fudan University, Shanghai
| | - Zhouguang Hui
- Department of VIP Medical Services & Radiation Oncology
| | - Min Zhao
- Department of Oncology, the First Hospital of Hebei Medical University, Shijiazhuang
| | - Jun Wang
- Department of Radiation Oncology, the Fourth Hospital of Hebei Medical University, Hebei Clinical Research Center for Radiation Oncology
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Huang Y, Sun J, Li J, Zhu D, Dong M, Dou S, Tang Y, Shi W, Sun Q, Zhao T, Zhou Z, Zhou X, Liu Y, Li J, Zhu G, Zhang D, Chen Y, Zhu Q, Ju W, Zhong L. Neoadjuvant immunochemotherapy for locally advanced resectable oral squamous cell carcinoma: a prospective single-arm trial (Illuminate Trial). Int J Surg 2023; 109:2220-2227. [PMID: 37288582 PMCID: PMC10442116 DOI: 10.1097/js9.0000000000000489] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 05/09/2023] [Indexed: 06/09/2023]
Abstract
BACKGROUND Locally advanced oral squamous cell carcinoma (LAOSCC) is associated with a high rate of recurrence and poor survival. Given the recent successes of neoadjuvant immunochemotherapy (NAICT) in solid tumors, it is promising to use this treatment modality to achieve a better pathological response and improve the survival of LAOSCC, and clinical evidence is needed to assess its safety and efficacy. PATIENTS AND METHODS A prospective trial of NAICT with toripalimab (PD-1 inhibitor) and albumin paclitaxel/cisplatin (TTP) was conducted in patients with clinical stage III and IVA OSCC. Intravenous albumin paclitaxel (260 mg/m 2 ), cisplatin (75 mg/m 2 ), and toripalimab (240 mg) were given in sequence on day 1 of each 21 day cycle for two cycles, followed by radical surgery and risk-adapted adjuvant (chemo)radiotherapy. The primary endpoints were safety and major pathological response (MPR). Targeted next generation sequencing and multiplex immunofluorescence were performed to assess clinical molecular characteristics and the tumor immune microenvironment in the pre-NAICT and post-NAICT tumor samples. RESULTS Twenty patients were enrolled. NAICT was well-tolerated with a low incidence of grades 3-4 adverse events in three patients. The completion rates of NAICT and subsequent R0 resection were 100%. The MPR rate was 60%, including a 30% pathological complete response. MPR was achieved in all four patients with a combined positive score of PD-L1>10. The density of tertiary lymphatic structure in post-NAICT tumor samples predicted the pathological response to NAICT. During the median 23-month follow-up, the disease-free survival was 90%, and the overall survival was 95%. CONCLUSIONS NAICT with the TTP protocol in LAOSCC is feasible and well tolerated, with a promising MPR and no obstruction on subsequent surgery. This trial is supportive of further randomized trials using NAICT in LAOSCC.
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Affiliation(s)
- Yingying Huang
- Department of Oral and Maxillofacial-Head and Neck Oncology
| | - Jingjing Sun
- Department of Oral Pathology, Ninth People’s Hospital, College of Stomatology
| | - Jun Li
- Department of Oral and Maxillofacial-Head and Neck Oncology
| | - Dongwang Zhu
- Department of Oral and Maxillofacial-Head and Neck Oncology
| | | | - Shengjin Dou
- Department of Oral and Maxillofacial-Head and Neck Oncology
| | | | - Wentao Shi
- Department of Biostatistics in Clinical Research Unit, Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine
| | | | - Tongchao Zhao
- Department of Oral and Maxillofacial-Head and Neck Oncology
| | - Zhihang Zhou
- Department of Oral and Maxillofacial-Head and Neck Oncology
| | - Xinyu Zhou
- Department of Oral and Maxillofacial-Head and Neck Oncology
| | - Ying Liu
- Department of Oral and Maxillofacial-Head and Neck Oncology
| | - Jiang Li
- Department of Oral Pathology, Ninth People’s Hospital, College of Stomatology
| | - Guopei Zhu
- Department of Oral and Maxillofacial-Head and Neck Oncology
| | - Ding Zhang
- The Medical Department, 3D Medicines Inc
| | - Yanan Chen
- The Medical Department, 3D Medicines Inc
| | - Qi Zhu
- Department of Oral and Maxillofacial-Head and Neck Oncology
- Huangpu Branch
| | - Wutong Ju
- Department of Oral and Maxillofacial-Head and Neck Oncology
| | - Laiping Zhong
- Department of Oral and Maxillofacial-Head and Neck Oncology
- Huangpu Branch
- National Center for Stomatology
- National Clinical Research Center for Oral Diseases
- Shanghai Key Laboratory of Stomatology, Shanghai, People’s Republic China
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Li X, Chen M, Xu J, Wu D, Ye M, Wang C, Liu W. Interpretatively automated identification of circulating tumor cells from human peripheral blood with high performance. Front Bioeng Biotechnol 2023; 11:1013107. [PMID: 36845198 PMCID: PMC9947588 DOI: 10.3389/fbioe.2023.1013107] [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: 08/06/2022] [Accepted: 01/31/2023] [Indexed: 02/11/2023] Open
Abstract
The detection and analysis of circulating tumor cells (CTCs) would be of aid in a precise cancer diagnosis and an efficient prognosis assessment. However, traditional methods that rely heavily on the isolation of CTCs based on their physical or biological features suffer from intensive labor, thus being unsuitable for rapid detection. Furthermore, currently available intelligent methods are short of interpretability, which creates a lot of uncertainty during diagnosis. Therefore, we propose here an automated method that takes advantage of bright-field microscopic images with high resolution, so as to take an insight into cell patterns. Specifically, the precise identification of CTCs was achieved by using an optimized single-shot multi-box detector (SSD)-based neural network with integrated attention mechanism and feature fusion modules. Compared to the conventional SSD system, our method exhibited a superior detection performance with the recall rate of 92.2%, and the maximum average precision (AP) value of 97.9%. To note, the optimal SSD-based neural network was combined with advanced visualization technology, i.e., the gradient-weighted class activation mapping (Grad-CAM) for model interpretation, and the t-distributed stochastic neighbor embedding (T-SNE) for data visualization. Our work demonstrates for the first time the outstanding performance of SSD-based neural network for CTCs identification in human peripheral blood environment, showing great potential for the early detection and continuous monitoring of cancer progression.
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Affiliation(s)
- Xiaolei Li
- Sino-European School of Technology of Shanghai University, Shanghai University, Shanghai, China
| | - Mingcan Chen
- Sino-European School of Technology of Shanghai University, Shanghai University, Shanghai, China
| | - Jingjing Xu
- Sino-European School of Technology of Shanghai University, Shanghai University, Shanghai, China,*Correspondence: Jingjing Xu, ; Chi Wang, ; Wanyu Liu,
| | - Dihang Wu
- Sino-European School of Technology of Shanghai University, Shanghai University, Shanghai, China
| | - Mengxue Ye
- Sino-European School of Technology of Shanghai University, Shanghai University, Shanghai, China
| | - Chi Wang
- School of Mechatronic Engineering and Automation, Shanghai University, Shanghai, China,*Correspondence: Jingjing Xu, ; Chi Wang, ; Wanyu Liu,
| | - Wanyu Liu
- Sino-European School of Technology of Shanghai University, Shanghai University, Shanghai, China,*Correspondence: Jingjing Xu, ; Chi Wang, ; Wanyu Liu,
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Yu Y, Zheng J, Han Z, Cui H. Suggestions on "Pathological complete response to neoadjuvant chemoimmunotherapy correlates with peripheral blood immune cell subsets and metastatic status of mediastinal lymph nodes (N2 lymph nodes) in non-small cell lung cancer". Lung Cancer 2023; 175:152-153. [PMID: 36114065 DOI: 10.1016/j.lungcan.2022.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 09/07/2022] [Indexed: 01/25/2023]
Affiliation(s)
- Yixuan Yu
- Graduate School, Beijing University of Chinese Medicine, Beijing 100029, China; Oncology Department of Integrative Medicine, China-Japan Friendship Hospital, Beijing 100029, China
| | - Jiabin Zheng
- Oncology Department of Integrative Medicine, China-Japan Friendship Hospital, Beijing 100029, China
| | - Zelu Han
- Graduate School, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
| | - Huijuan Cui
- Oncology Department of Integrative Medicine, China-Japan Friendship Hospital, Beijing 100029, China.
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Liu W, Zhang T, Zhang Q, Li L, Xu C. A systematic review and meta-analysis of neoadjuvant chemoimmunotherapy in stage III non-small cell lung cancer. BMC Pulm Med 2022; 22:490. [PMID: 36582007 PMCID: PMC9798701 DOI: 10.1186/s12890-022-02292-5] [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: 08/20/2022] [Accepted: 12/20/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Stage III non-small cell lung cancer (NSCLC) is a heterogeneous disease with different subtypes, multidisciplinary teams-led management, and a poor prognosis. Currently, the clinical benefits of stage III NSCLC in the neoadjuvant setting are still unclear. We performed a meta-analysis of published data on neoadjuvant chemoimmunotherapy in stage III NSCLC to systematically evaluate its efficacy and safety. METHODS We searched the databases to identify eligible studies of neoadjuvant chemoimmunotherapy for stage III NSCLC. The primary outcomes mainly included pathological and radiological response outcomes, the feasibility of surgery, and the safety of the regimen. The pathological and radiological response included the rate of major pathologic response (MPR), complete pathologic response (pCR), radiological response outcomes, and R0 resection; The feasibility included the rate of surgical resection, conversion to thoracotomy, surgical complications, pathological downstaging of clinical disease stage. The safety included the incidence of treatment-related adverse events (TRAEs) and severe adverse events (SAEs). R 4.1.3 software was conducted for data analysis, and p < 0.05 was considered statistically significant. RESULTS Nine trials containing a total of 382 populations were eligible for the meta-analysis, with the pooled surgical resection rate of 90%. Owing to the large heterogeneity of the single-rate meta-analysis, the random effect model was adopted. The estimated pooled prevalence of MPR was 56% (95%CI 0.39-0.72) and of pCR was 39% (95%CI 0.28-0.51). The pooled rate of TRAEs was 65% (95%CI 0.17-0.99) and SAEs was 24% (95%CI 0.05-0.49). CONCLUSION Compared to neoadjuvant chemotherapy or immunotherapy, neoadjuvant chemoimmunotherapy achieved more pathological and radiological relief, and has a high surgical resection rate and low risk of conversion to thoracotomy and surgical complications, with poor tolerance of toxicity but rarely developing life-threatening adverse events. In conclusion, neoadjuvant chemoimmunotherapy is suggested to be beneficial for stage III NSCLC.
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Affiliation(s)
- Wei Liu
- grid.89957.3a0000 0000 9255 8984Department of Respiratory Medicine, The Affiliated Nanjing Brain Hospital of Nanjing Medical University, 215 Guangzhou Road, Nanjing, 210029 Jiangsu Province China ,Clinical Center of Nanjing Respiratory Diseases and Imaging, Nanjing, 210029 Jiangsu China
| | - Tiantian Zhang
- grid.89957.3a0000 0000 9255 8984Department of Respiratory Medicine, The Affiliated Nanjing Brain Hospital of Nanjing Medical University, 215 Guangzhou Road, Nanjing, 210029 Jiangsu Province China ,Clinical Center of Nanjing Respiratory Diseases and Imaging, Nanjing, 210029 Jiangsu China
| | - Qian Zhang
- grid.89957.3a0000 0000 9255 8984Department of Respiratory Medicine, The Affiliated Nanjing Brain Hospital of Nanjing Medical University, 215 Guangzhou Road, Nanjing, 210029 Jiangsu Province China ,Clinical Center of Nanjing Respiratory Diseases and Imaging, Nanjing, 210029 Jiangsu China
| | - Li Li
- grid.89957.3a0000 0000 9255 8984Department of Respiratory Medicine, The Affiliated Nanjing Brain Hospital of Nanjing Medical University, 215 Guangzhou Road, Nanjing, 210029 Jiangsu Province China ,Clinical Center of Nanjing Respiratory Diseases and Imaging, Nanjing, 210029 Jiangsu China
| | - Chunhua Xu
- grid.89957.3a0000 0000 9255 8984Department of Respiratory Medicine, The Affiliated Nanjing Brain Hospital of Nanjing Medical University, 215 Guangzhou Road, Nanjing, 210029 Jiangsu Province China ,Clinical Center of Nanjing Respiratory Diseases and Imaging, Nanjing, 210029 Jiangsu China
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Predicting Tumor Mutation Burden and EGFR Mutation Using Clinical and Radiomic Features in Patients with Malignant Pulmonary Nodules. J Pers Med 2022; 13:jpm13010016. [PMID: 36675677 PMCID: PMC9865229 DOI: 10.3390/jpm13010016] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 12/08/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022] Open
Abstract
Pulmonary nodules (PNs) shown as persistent or growing ground-glass opacities (GGOs) are usually lung adenocarcinomas or their preinvasive lesions. Tumor mutation burden (TMB) and somatic mutations are important determinants for the choice of strategy in patients with lung cancer during therapy. A total of 93 post-operative patients with 108 malignant PNs were enrolled for analysis (75 cases in the training cohort and 33 cases in the validation cohort). Radiomics features were extracted from preoperative non-contrast computed tomography (CT) images of the entire tumor. Using commercial next generation sequencing, we detected TMB status and somatic mutations of all FFPE samples. Here, 870 quantitative radiomics features were extracted from the segmentations of PNs, and pathological and clinical characteristics were collected from medical records. The LASSO (least absolute shrinkage and selection operator) regression and stepwise logistic regressions were performed to establish the predictive model. For the epidermal growth factor receptor (EGFR) mutation, the AUCs of the clinical model and the integrative model validated by the validation set were 0.6726 (0.4755-0.8697) and 0.7421 (0.5698-0.9144). For the TMB status, the ROCs showed that AUCs of the clinical model and the integrative model validated by the validation set were 0.7808 (0.6231-0.9384) and 0.8462 (0.7132-0.9791). The quantitative radiomics signatures showed potential value in predicting the EGFR mutant and TMB status in GGOs. Moreover, the integrative model provided sufficient information for the selection of therapy and deserves further analysis.
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Wang H, Liu T, Chen J, Dang J. Neoadjuvant immunotherapy and neoadjuvant chemotherapy in resectable non-small cell lung cancer: A systematic review and single-arm meta-analysis. Front Oncol 2022; 12:901494. [PMID: 36212419 PMCID: PMC9533019 DOI: 10.3389/fonc.2022.901494] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 09/02/2022] [Indexed: 12/25/2022] Open
Abstract
BackgroundIt remains uncertain whether neoadjuvant immune checkpoint inhibitor (nICI) is superior to neoadjuvant chemotherapy (nCT) in resectable non-small cell lung cancer. In addition, there are outstanding questions for nICI such as the ideal treatment mode and predictors.MethodsPubMed, Embase, Cochrane Library, Web of Science, and scientific meetings were searched for eligible single-arm or multi-arm trials until 31 December 2021. The primary outcomes of interest were major pathological response (MPR) and pathological complete response (pCR). The random-effect model was used for statistical analysis.ResultsTwenty-four trials of nICI (n = 1,043) and 29 trials of nCT (n = 2,337) were identified. nICI combination therapy was associated with higher MPR (63.2%, 95% CI: 54.2%–72.1%) and pCR (35.3%, 95% CI: 27.4%–43.3%) rates compared to nCT (16.2%, 95% CI: 7.5%–25.0%, P < 0.001 and 5.5%, 95% CI: 3.5%–7.5%, P < 0.001) and nICI monotherapy (23.3%, 95% CI: 12.7%–33.8%, P < 0.001, and 6.5%, 95% CI: 1.7%–11.2%, P < 0.001). As for safety, nICI monotherapy had the best tolerability; nICI combination showed a similar surgical resection rate and higher R0 resection rate compared to nCT. PD-1 inhibitor and high PD-L1 expression (≥1% or ≥50%) were correlated with higher MPR and pCR rates compared to PD-L1 inhibitor and PD-L1 expression <1%.ConclusionsnICI combination therapy is associated with higher MPR and pCR rates compared to nCT and nICI monotherapy. PD-1 inhibitor seems to be superior to PD-L1 inhibitor. PD-L1 status appears to be predictive of MPR and pCR for patients receiving nICI.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=278661, CRD42021278661.
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Affiliation(s)
- He Wang
- Department of Radiation Oncology, The First Hospital of China Medical University, Shenyang, China
| | - Tingting Liu
- Department of Radiation Oncology, Anshan Cancer Hospital, Anshan, China
| | - Jun Chen
- Department of Radiation Oncology, Shenyang Tenth People’s Hospital, Shenyang, China
| | - Jun Dang
- Department of Radiation Oncology, The First Hospital of China Medical University, Shenyang, China
- *Correspondence: Jun Dang,
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Lim JU, Kang HS. Expert consensus on perioperative immunotherapy for locally advanced non-small cell lung cancer. Transl Lung Cancer Res 2021; 10:3709-3712. [PMID: 34733622 PMCID: PMC8512462 DOI: 10.21037/tlcr-21-764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 09/26/2021] [Indexed: 12/03/2022]
Affiliation(s)
- Jeong Uk Lim
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hye Seon Kang
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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