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Nardone V, Reginelli A, De Marco G, Natale G, Patanè V, De Chiara M, Buono M, Russo GM, Monti R, Balestrucci G, Salvarezza M, Di Guida G, D’Ippolito E, Sangiovanni A, Grassi R, D’Onofrio I, Belfiore MP, Cimmino G, Della Corte CM, Vicidomini G, Fiorelli A, Gambardella A, Morgillo F, Cappabianca S. Role of Cardiac Biomarkers in Non-Small Cell Lung Cancer Patients. Diagnostics (Basel) 2023; 13:diagnostics13030400. [PMID: 36766506 PMCID: PMC9914841 DOI: 10.3390/diagnostics13030400] [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: 12/01/2022] [Revised: 01/17/2023] [Accepted: 01/18/2023] [Indexed: 01/24/2023] Open
Abstract
Treatment-induced cardiac toxicity represents an important issue in non-small cell lung cancer (NSCLC) patients, and no biomarkers are currently available in clinical practice. A novel and easy-to-calculate marker is the quantitative analysis of calcium plaque in the coronary, calculated on CT. It is called the Agatston score (or CAD score). At the same time, other potential predictors include cardiac ultrasonography and anamnesis of the patients. Our work aimed to correlate cardiac biomarkers with overall survival (OS) in NSCLC patients. We retrospectively analyzed patients with NSCLC discussed in the Multidisciplinary Tumor Board of our Institute for the present analysis between January 2018 and July 2022. Inclusion criteria were the availability of basal CT imaging of the thorax, cardiac ultrasonography with the calculation of ejection fraction (EF), and complete anamnesis, including assessment of co-pathologies and pharmacological drugs. The clinical data of the patients were retrospectively collected, and the CAD scores was calculated on a CT scan. All of these parameters were correlated with overall survival (OS) with univariate analysis (Kaplan-Meier analysis) and multivariate analysis (Cox regression analysis). Following the above-mentioned inclusion criteria, 173 patients were included in the present analysis. Of those, 120 patients died in the follow-up period (69.6%), and the median overall survival (OS) was 28 months (mean 47.2 months, 95% CI, 36-57 months). In univariate analysis, several parameters that significantly correlated with lower OS were the stage (p < 0.001), the CAD grading (p < 0.001), history of ischemic heart disease (p: 0.034), use of beta blocker drugs (p: 0.036), and cardiac ejection fraction (p: 0.005). In multivariate analysis, the only parameters that remained significant were as follows: CAD score (p: 0.014, OR 1.56, 95% CI: 1.04-1.83), stage (p: 0.016, OR: 1.26, 95% CI: 1.05-1.53), and cardiac ejection fraction (p: 0.011, OR 0.46, 95% CI: 0.25-0.84). Both CAD score and ejection fraction are correlated with survival in NSCLC patients at all stages of the disease. Independently from the treatment choice, a cardiological evaluation is mandatory for patients with NSCLC.
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Affiliation(s)
- Valerio Nardone
- Department of Precision Medicine, University of Campania “L. Vanvitelli”, 80138 Naples, Italy
- Correspondence:
| | - Alfonso Reginelli
- Department of Precision Medicine, University of Campania “L. Vanvitelli”, 80138 Naples, Italy
| | - Giuseppina De Marco
- Department of Precision Medicine, University of Campania “L. Vanvitelli”, 80138 Naples, Italy
| | - Giovanni Natale
- Department of Translational Medical Science, University of Campania “L. Vanvitelli”, 80138 Naples, Italy
| | - Vittorio Patanè
- Department of Precision Medicine, University of Campania “L. Vanvitelli”, 80138 Naples, Italy
| | - Marco De Chiara
- Department of Precision Medicine, University of Campania “L. Vanvitelli”, 80138 Naples, Italy
| | - Mauro Buono
- Department of Precision Medicine, University of Campania “L. Vanvitelli”, 80138 Naples, Italy
| | - Gaetano Maria Russo
- Department of Precision Medicine, University of Campania “L. Vanvitelli”, 80138 Naples, Italy
| | - Riccardo Monti
- Department of Precision Medicine, University of Campania “L. Vanvitelli”, 80138 Naples, Italy
| | - Giovanni Balestrucci
- Department of Precision Medicine, University of Campania “L. Vanvitelli”, 80138 Naples, Italy
| | - Maria Salvarezza
- Department of Precision Medicine, University of Campania “L. Vanvitelli”, 80138 Naples, Italy
| | - Gaetano Di Guida
- Department of Precision Medicine, University of Campania “L. Vanvitelli”, 80138 Naples, Italy
| | - Emma D’Ippolito
- Department of Precision Medicine, University of Campania “L. Vanvitelli”, 80138 Naples, Italy
| | - Angelo Sangiovanni
- Department of Precision Medicine, University of Campania “L. Vanvitelli”, 80138 Naples, Italy
| | - Roberta Grassi
- Department of Precision Medicine, University of Campania “L. Vanvitelli”, 80138 Naples, Italy
| | - Ida D’Onofrio
- Department of Precision Medicine, University of Campania “L. Vanvitelli”, 80138 Naples, Italy
- Radiotherapy Unit, Ospedale del Mare, ASL Napoli 1 Centro, 80138 Naples, Italy
| | - Maria Paola Belfiore
- Department of Precision Medicine, University of Campania “L. Vanvitelli”, 80138 Naples, Italy
| | - Giovanni Cimmino
- Department of Translational Medical Science, University of Campania “L. Vanvitelli”, 80138 Naples, Italy
| | | | - Giovanni Vicidomini
- Department of Translational Medical Science, University of Campania “L. Vanvitelli”, 80138 Naples, Italy
| | - Alfonso Fiorelli
- Department of Translational Medical Science, University of Campania “L. Vanvitelli”, 80138 Naples, Italy
| | - Antonio Gambardella
- Department of Precision Medicine, University of Campania “L. Vanvitelli”, 80138 Naples, Italy
| | - Floriana Morgillo
- Department of Precision Medicine, University of Campania “L. Vanvitelli”, 80138 Naples, Italy
| | - Salvatore Cappabianca
- Department of Precision Medicine, University of Campania “L. Vanvitelli”, 80138 Naples, Italy
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Senan S, Özgüroğlu M, Daniel D, Villegas A, Vicente D, Murakami S, Hui R, Faivre-Finn C, Paz-Ares L, Wu YL, Mann H, Dennis PA, Antonia SJ. Outcomes with durvalumab after chemoradiotherapy in stage IIIA-N2 non-small-cell lung cancer: an exploratory analysis from the PACIFIC trial. ESMO Open 2022; 7:100410. [PMID: 35247871 PMCID: PMC9058904 DOI: 10.1016/j.esmoop.2022.100410] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 01/11/2022] [Accepted: 01/22/2022] [Indexed: 12/25/2022] Open
Abstract
Background The phase III PACIFIC trial (NCT02125461) established consolidation durvalumab as standard of care for patients with unresectable, stage III non-small-cell lung cancer (NSCLC) and no disease progression following chemoradiotherapy (CRT). In some cases, patients with stage IIIA-N2 NSCLC are considered operable, but the relative benefit of surgery is unclear. We report a post hoc, exploratory analysis of clinical outcomes in the PACIFIC trial, in patients with or without stage IIIA-N2 NSCLC. Materials and methods Patients with unresectable, stage III NSCLC and no disease progression after ≥2 cycles of platinum-based, concurrent CRT were randomized 2 : 1 to receive durvalumab (10 mg/kg intravenously; once every 2 weeks for up to 12 months) or placebo, 1-42 days after CRT. The primary endpoints were progression-free survival (PFS; assessed by blinded independent central review according to RECIST version 1.1) and overall survival (OS). Treatment effects within subgroups were estimated by hazard ratios (HRs) from unstratified Cox proportional hazards models. Results Of 713 randomized patients, 287 (40%) had stage IIIA-N2 disease. Baseline characteristics were similar between patients with and without stage IIIA-N2 NSCLC. With a median follow-up of 14.5 months (range: 0.2-29.9 months), PFS was improved with durvalumab versus placebo in both patients with [HR = 0.46; 95% confidence interval (CI), 0.33-0.65] and without (HR = 0.62; 95% CI 0.48-0.80) stage IIIA-N2 disease. Similarly, with a median follow-up of 25.2 months (range: 0.2-43.1 months), OS was improved with durvalumab versus placebo in patients with (HR = 0.56; 95% CI 0.39-0.79) or without (HR = 0.78; 95% CI 0.57-1.06) stage IIIA-N2 disease. Durvalumab had a manageable safety profile irrespective of stage IIIA-N2 status. Conclusions Consistent with the intent-to-treat population, treatment benefits with durvalumab were confirmed in patients with stage IIIA-N2, unresectable NSCLC. Prospective studies are needed to determine the optimal treatment approach for patients who are deemed operable. The PACIFIC trial established durvalumab after CRT as standard of care for unresectable, stage III NSCLC. The optimum multimodal treatment strategy for patients with potentially resectable, stage IIIA-N2 NSCLC is unknown. Survival benefit with durvalumab was observed in patients with stage IIIA-N2, unresectable NSCLC in this post hoc analysis. Durvalumab after CRT also exhibited a manageable safety profile in this subpopulation from PACIFIC. Studies of surgical vs. non-surgical strategies are needed to establish the best approach for potentially operable patients.
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Affiliation(s)
- S Senan
- Department of Radiation Oncology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands.
| | - M Özgüroğlu
- Istanbul University-Cerrahpaşa, Cerrahpaşa School of Medicine, Istanbul, Turkey
| | - D Daniel
- Tennessee Oncology, Chattanooga, USA; Sarah Cannon Research Institute, Nashville, USA
| | - A Villegas
- Cancer Specialists of North Florida, Jacksonville, USA
| | - D Vicente
- Hospital Universitario Virgen Macarena, Seville, Spain
| | | | - R Hui
- Westmead Hospital and the University of Sydney, Sydney, Australia
| | - C Faivre-Finn
- The University of Manchester and The Christie NHS Foundation Trust, Manchester, UK
| | - L Paz-Ares
- Universidad Complutense, CiberOnc, CNIO and Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Y L Wu
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital & Guangdong Academy of Medical Sciences, Guangzhou, China
| | - H Mann
- AstraZeneca, Cambridge, UK
| | | | - S J Antonia
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, USA
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Zhao Y, Liang W, He J. Reply. Ann Thorac Surg 2019; 108:962-963. [PMID: 30959017 DOI: 10.1016/j.athoracsur.2019.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 03/02/2019] [Indexed: 10/27/2022]
Affiliation(s)
- Yi Zhao
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Wenhua Liang
- Guangzhou Institute of Respiratory Disease, Guangzhou, China; State Key Laboratory of Respiratory Disease, Guangzhou, China
| | - Jianxing He
- National Clinical Research Center for Respiratory Disease, Yanjiang Rd 151, Guangzhou 510120, China.
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