1
|
Qi H, Hou Y, Zheng Z, Zheng M, Qiao Q, Wang Z, Sun X, Xing L. Clinical characteristics and MRI based radiomics nomograms can predict iPFS and short-term efficacy of third-generation EGFR-TKI in EGFR-mutated lung adenocarcinoma with brain metastases. BMC Cancer 2024; 24:362. [PMID: 38515096 PMCID: PMC10956298 DOI: 10.1186/s12885-024-12121-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 03/13/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND Predicting short-term efficacy and intracranial progression-free survival (iPFS) in epidermal growth factor receptor gene mutated (EGFR-mutated) lung adenocarcinoma patients with brain metastases who receive third-generation epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) therapy was of great significance for individualized treatment. We aimed to construct and validate nomograms based on clinical characteristics and magnetic resonance imaging (MRI) radiomics for predicting short-term efficacy and intracranial progression free survival (iPFS) of third-generation EGFR-TKI in EGFR-mutated lung adenocarcinoma patients with brain metastases. METHODS One hundred ninety-four EGFR-mutated lung adenocarcinoma patients with brain metastases who received third-generation EGFR-TKI treatment were included in this study from January 1, 2017 to March 1, 2023. Patients were randomly divided into training cohort and validation cohort in a ratio of 5:3. Radiomics features extracted from brain MRI were screened by least absolute shrinkage and selection operator (LASSO) regression. Logistic regression analysis and Cox proportional hazards regression analysis were used to screen clinical risk factors. Single clinical (C), single radiomics (R), and combined (C + R) nomograms were constructed in short-term efficacy predicting model and iPFS predicting model, respectively. Prediction effectiveness of nomograms were evaluated by calibration curves, Harrell's concordance index (C-index), receiver operating characteristic (ROC) curves and decision curve analysis (DCA). Kaplan-Meier analysis was used to compare the iPFS of high and low iPFS rad-score patients in the predictive iPFS R model and to compare the iPFS of high-risk and low-risk patients in the predictive iPFS C + R model. RESULTS Overall response rate (ORR) was 71.1%, disease control rate (DCR) was 91.8% and median iPFS was 12.67 months (7.88-20.26, interquartile range [IQR]). There were significant differences in iPFS between patients with high and low iPFS rad-scores, as well as between high-risk and low-risk patients. In short-term efficacy model, the C-indexes of C + R nomograms in training cohort and validation cohort were 0.867 (0.835-0.900, 95%CI) and 0.803 (0.753-0.854, 95%CI), while in iPFS model, the C-indexes were 0.901 (0.874-0.929, 95%CI) and 0.753 (0.713-0.793, 95%CI). CONCLUSIONS The third-generation EGFR-TKI showed significant efficacy in EGFR-mutated lung adenocarcinoma patients with brain metastases, and the combined line plot of C + R can be utilized to predict short-term efficacy and iPFS.
Collapse
Affiliation(s)
- Haoran Qi
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University, Shandong Academy of Medical Sciences, 440 Jiyan Road, Jinan, Shandong, 250117, China
| | - Yichen Hou
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University, Shandong Academy of Medical Sciences, 440 Jiyan Road, Jinan, Shandong, 250117, China
| | - Zhonghang Zheng
- Department of Nuclear Medicine, Shandong Cancer Hospital and Institute, Shandong First Medical University, Shandong Academy of Medical Science, Jinan, Shandong, China
| | - Mei Zheng
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University, Shandong Academy of Medical Sciences, 440 Jiyan Road, Jinan, Shandong, 250117, China
| | - Qiang Qiao
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University, Shandong Academy of Medical Sciences, 440 Jiyan Road, Jinan, Shandong, 250117, China
| | - Zihao Wang
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University, Shandong Academy of Medical Sciences, 440 Jiyan Road, Jinan, Shandong, 250117, China
| | - Xiaorong Sun
- Department of Nuclear Medicine, Shandong Cancer Hospital and Institute, Shandong First Medical University, Shandong Academy of Medical Science, Jinan, Shandong, China
| | - Ligang Xing
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University, Shandong Academy of Medical Sciences, 440 Jiyan Road, Jinan, Shandong, 250117, China.
| |
Collapse
|
2
|
Chen X, Zhang H, Pan Y, Zhu N, Zhou L, Chen G, Wang J. Nimbolide Exhibits Potent Anticancer Activity Through ROS-Mediated ER Stress and DNA Damage in Human Non-small Cell Lung Cancer Cells. Appl Biochem Biotechnol 2024; 196:182-202. [PMID: 37103738 DOI: 10.1007/s12010-023-04507-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2023] [Indexed: 04/28/2023]
Abstract
The non-small cell lung cancer (NSCLC) accounts for about 85% of all lung cancers. It is usually diagnosed at an advanced stage with poor prognosis. Nimbolide (NB), a terpenoid limonoid isolated from the flowers and leaves of neem tree, possesses anticancer properties in various cancer cell lines. However, the underlying mechanism of its anticancer effect on human NSCLC cells remains unclear. In the present study, we investigated the effect of NB on A549 human NSCLC cells. We found that NB treatment inhibits A549 cells colony formation in a dose-dependent manner. Mechanistically, NB treatment increases cellular reactive oxygen species (ROS) level, leading to endoplasmic reticulum (ER) stress, DNA damage, and eventually induction of apoptosis in NSCLC cells. Furthermore, all these effects of NB were blocked by pretreatment with antioxidant glutathione (GSH), the specific ROS inhibitor. We further knockdown CHOP protein by siRNA markedly reduced NB-induced apoptosis in A549 cells. Taken together, our findings reveal that NB is an inducer of ER stress and ROS; these findings may contribute to increasing the therapeutic efficiency of NSCLC.
Collapse
Affiliation(s)
- Xi Chen
- Department of Pharmacology, School of Medicine, Taizhou University, Jiaojiang, Taizhou, 318000, Zhejiang, China.
| | - Hangshuo Zhang
- Department of Clinical Medicine, School of Medicine, Taizhou University, Jiaojiang, Taizhou, 318000, Zhejiang, China
| | - Yuzhu Pan
- Department of Clinical Medicine, School of Medicine, Taizhou University, Jiaojiang, Taizhou, 318000, Zhejiang, China
| | - Ning Zhu
- Municipal Hospital Affiliated to Taizhou University, Jiaojiang, Taizhou, 318000, Zhejiang, China
| | - Lisha Zhou
- Department of Biochemistry, School of Medicine, Taizhou University, Jiaojiang, Taizhou, 318000, Zhejiang, China
| | - Guang Chen
- Department of Pharmacology, School of Medicine, Taizhou University, Jiaojiang, Taizhou, 318000, Zhejiang, China
| | - Jiabing Wang
- Municipal Hospital Affiliated to Taizhou University, Jiaojiang, Taizhou, 318000, Zhejiang, China.
| |
Collapse
|
3
|
Song Y, Lin S, Chen J, Dang J. First-line treatment with TKI plus brain radiotherapy versus TKI alone in EGFR-mutated non-small cell Lung cancer with brain metastases: a systematic review and meta-analysis. BMC Cancer 2023; 23:1043. [PMID: 37904083 PMCID: PMC10614414 DOI: 10.1186/s12885-023-11548-0] [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: 04/14/2023] [Accepted: 10/18/2023] [Indexed: 11/01/2023] Open
Abstract
BACKGROUND It remains uncertain whether first-line treatment with upfront brain radiotherapy (RT) in combined with epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) is superior to EGFR-TKIs alone for EGFR-mutated non-small cell lung cancer with newly diagnosed brain metastases (BMs). Therefore, we performed a meta-analysis to address this issue. METHODS We searched PubMed, Embase, Cochrane Library, and Web of Science databases for eligible studies published until February 28, 2023. The primary outcomes of interest were overall survival (OS) and intracranial progression-free survival (iPFS), reported as hazard ratios (HRs) and 95% confidence intervals (CIs). RESULTS Twenty-four retrospective studies with 3184 patients were included. First- or second-generation EGFR-TKIs were used in each study. Upfront brain RT plus EGFR-TKIs significantly prolonged OS (HR = 0.75, 95% CI: 0.64-0.88) and iPFS (HR = 0.61, 95% CI: 0.52-0.72) compared to EGFR-TKIs alone. There were no significant differences in OS and iPFS benefits from the combination therapy between asymptomatic and symptomatic patients, patients with exon 19 and 21 mutations, patients with 1-3 and > 3 BMs, and males and females, respectively (HRs interaction, P > 0.05 for each subgroup comparison). CONCLUSIONS First-line treatment with upfront brain RT plus EGFR-TKIs is likely to be more effective than EGFR-TKIs alone. The benefits of combination therapy did not appear to be significantly affected by BM-related symptoms, EGFR mutation subtype, number of BMs, or sex.
Collapse
Affiliation(s)
- Yaowen Song
- Department of Radiation Oncology, The First Hospital of China Medical University, 155 Nanjing Road, Heping District, Shenyang, 110001, China
| | - Shuiyu Lin
- Department of Radiation Oncology, Harbin Medical University Cancer Hospital, Harbin, 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, 155 Nanjing Road, Heping District, Shenyang, 110001, China.
| |
Collapse
|
4
|
Cui J, Li L, Yuan S. The Value of Radiotherapy for Advanced Non-Small Cell Lung Cancer With Oncogene Driver-Mutation. Front Oncol 2022; 12:863715. [PMID: 35646640 PMCID: PMC9139486 DOI: 10.3389/fonc.2022.863715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 04/11/2022] [Indexed: 11/26/2022] Open
Abstract
Due to the widespread use of tyrosine kinase inhibitors (TKIs), which have largely supplanted cytotoxic chemotherapy as the first-line therapeutic choice for patients with advanced non-small cell lung cancer (NSCLC) who have oncogene driver mutations, advanced NSCLC patients with oncogene driver mutations had much long median survival. However, TKIs’ long-term efficacy is harmed by resistance to them. TKIs proved to have a limited potential to permeate cerebrospinal fluid (CSF) as well. Only a small percentage of plasma levels could be found in CSF at usual doses. Therefore, TKIs monotherapy may have a limited efficacy in individuals with brain metastases. Radiation has been demonstrated to reduce TKIs resistance and disrupt the blood-brain barrier (BBB). Previous trials have shown that local irradiation for bone metastases might improve symptoms, in addition, continuous administration of TKIs combined with radiotherapy was linked with beneficial progression-free survival (PFS) and overall survival (OS) for oligometastasis or bone metastasis NSCLC with oncogene driver mutations. The above implied that radiotherapy combined with targeted therapy may have a synergistic impact in patients with advanced oncogene driver-mutated NSCLC. The objective of this article is to discuss the value of radiotherapy in the treatment of those specific individuals.
Collapse
Affiliation(s)
- Jinfeng Cui
- Clinical Medical College, Shandong University, Jinan, China
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Shandong Cancer Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Li Li
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Shandong Cancer Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Shuanghu Yuan
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Shandong Cancer Hospital Affiliated to Shandong First Medical University, Jinan, China
- Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, China
- Department of Radiation Oncology, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China
- *Correspondence: Shuanghu Yuan,
| |
Collapse
|
5
|
Liu Y, Wang J, Wu J, Yang Q, Zeng Y, Wu D, Tian C, Hu Y, Gu F, Li C, Zhang K, Liu L. The Efficacy of First-Generation EGFR-TKI Combined With Brain Radiotherapy as the First-Line Treatment for Lung Adenocarcinoma Patients With Brain Metastases and EGFR Sensitive Mutations: A Retrospective study. Technol Cancer Res Treat 2021; 20:1533033821997819. [PMID: 33715525 PMCID: PMC7958186 DOI: 10.1177/1533033821997819] [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: 11/22/2022] Open
Abstract
Background: It was controversial that whether LUAD patients with brain metastases (BMs)
and EGFR sensitive mutations should be conducted using brain radiotherapy
when treated with first-generation EGFR-TKI. Herein, a retrospective study
was designed to compare the efficacy of first-generation EGFR-TKI combined
with brain radiotherapy and EGFR-TKI alone as first-line treatment for these
LUAD patients. Patients and Methods: We retrospectively analyzed the status of patients with advanced LUAD
carrying EGFR sensitive mutations who received first-generation EGFR-TKI
treatment in our center. iPFS was the first time of intracranial progression
or death from the diagnosis of BMs, PFS was the time of progression of any
site or death from the diagnosis of BMs, and OS was the time of confirmed
BMs to death or the last follow-up time. Differences in characteristics
between groups were compared using the Chi-square test. The Kaplan-Meier
method was used to calculate the iPFS, PFS, and OS. Univariate analysis,
multivariate analysis, and subgroup analysis were conducted by Cox
regression model. Results: There were 77 patients (77/134, 57.5%) in the TKI + RT group and 57 patients
(57/134, 42.5%) in the TKI group. TKI + RT group had a significant higher
intracranial ORR and DCR, and the combination therapy was independently
significantly associated with a longer iPFS (18.9 vs. 10.5
months, P = 0.0009), systematic PFS (12.5
vs. 8.4 months, P = 0.0071) and OS
(30.8 vs. 22.7 months, P = 0.0183).
Females, non-smokers, and younger patients benefited more from the
combination therapy. Subgroup analysis demonstrated that the combination
therapy could improve the iPFS in patients with more than 3 BMs
(P = 0.005); however, it couldn’t improve the OS for
these patients. Conclusion: Our study confirmed the effect of the combination of EGFR-TKI and brain
radiotherapy as first-line treatment for LUAD patients with BMs and EGFR
sensitive mutations.
Collapse
Affiliation(s)
- Yuting Liu
- Cancer Center, Union Hospital, Tongji Medical College, 12443Huazhong University of Science and Technology, Wuhan, China
| | - Juanjuan Wang
- Cancer Center, Union Hospital, Tongji Medical College, 12443Huazhong University of Science and Technology, Wuhan, China
| | - Jingjing Wu
- Cancer Center, Union Hospital, Tongji Medical College, 12443Huazhong University of Science and Technology, Wuhan, China
| | - Qifan Yang
- Cancer Center, Union Hospital, Tongji Medical College, 12443Huazhong University of Science and Technology, Wuhan, China
| | - Yulan Zeng
- Cancer Center, Union Hospital, Tongji Medical College, 12443Huazhong University of Science and Technology, Wuhan, China
| | - Di Wu
- Cancer Center, Union Hospital, Tongji Medical College, 12443Huazhong University of Science and Technology, Wuhan, China
| | - Chen Tian
- Cancer Center, Union Hospital, Tongji Medical College, 12443Huazhong University of Science and Technology, Wuhan, China
| | - Yue Hu
- Cancer Center, Union Hospital, Tongji Medical College, 12443Huazhong University of Science and Technology, Wuhan, China
| | - Feifei Gu
- Cancer Center, Union Hospital, Tongji Medical College, 12443Huazhong University of Science and Technology, Wuhan, China
| | - Chang Li
- Cancer Center, Union Hospital, Tongji Medical College, 12443Huazhong University of Science and Technology, Wuhan, China
| | - Kai Zhang
- Cancer Center, Union Hospital, Tongji Medical College, 12443Huazhong University of Science and Technology, Wuhan, China
| | - Li Liu
- Cancer Center, Union Hospital, Tongji Medical College, 12443Huazhong University of Science and Technology, Wuhan, China
| |
Collapse
|
6
|
Prabhash K. Treatment of advanced nonsmall cell lung cancer: First line, maintenance and second line - Indian consensus statement update. South Asian J Cancer 2020; 8:1-17. [PMID: 30766843 PMCID: PMC6348782 DOI: 10.4103/sajc.sajc_227_18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
The management of advanced nonsmall cell lung cancer (NSCLC) patients is becoming increasingly complex with the identification of driver mutations/rearrangements and development/availability of appropriate targeted therapies. In 2017, an expert group of medical oncologists with expertise in treating lung cancer used data from published literature and experience to arrive at practical consensus recommendations on treatment of advanced NSCLC for use by the community oncologists. This was published subsequently in the Indian Journal of Cancer with a plan to be updated annually. The present document is an update to the 2017 document.
Collapse
Affiliation(s)
- Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| |
Collapse
|
7
|
Zhao W, Xie Y. KIAA1429 promotes the progression of lung adenocarcinoma by regulating the m6A level of MUC3A. Pathol Res Pract 2020; 217:153284. [PMID: 33249400 DOI: 10.1016/j.prp.2020.153284] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 11/02/2020] [Accepted: 11/03/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Lung adenocarcinoma (LUAD) is one of the most frequently occurring human malignancies worldwide, but its potential molecular mechanism has not yet been fully elucidated. N6-methyladenosine (m6A), the most common internal chemical modification of mRNAs, is implicated in diverse pathological processes in different human malignancies, but its functions in LUAD remain elusive. The current study aimed to investigate the function and molecular mechanism of KIAA1429 in LUAD. METHODS The KIAA1429 expression level in LUAD tissues was assessed using databases and was detected in LUAD cells and tissues via quantitative reverse transcription-polymerase chain reaction (qRT-PCR) and western blot. m6A levels in LUAD tissues and cells were quantified. Next, correlation between the KIAA1429 expression level and the clinical and pathological features and prognosis of patients with LUAD was analyzed. Further, KIAA1429 levels were decreased, and LUAD cell proliferation, migration, invasion, and cycle were assessed. Prediction websites revealed the aberrant expression and probable methylation modification of MUC3A in LUAD, and correlation between MUC3A and KIAA1429 was analyzed. Ultimately, the impact of the KIAA1429 expression on MUC3A-mediated malignant phenotypes of LUAD was examined by a torsion test. RESULTS KIAA1429 expression was remarkably high and m6A level was aberrantly elevated in LUAD cells and tissues. In addition, high KIAA1429 expression indicated a larger tumor diameter, higher tumor-node-metastasis stage, greater proneness to lymph node and distant metastasis, and lower overall survival rate. siRNA-triggered KIAA1429 downregulation dramatically suppressed LUAD cell proliferation, migration, invasion, and cell cycle arrest in the G1 phase. Bioinformatics analysis revealed that MUC3A was expressed in LUAD at an unusually high level and may be methylated under the control of KIAA1429. Western blot, qRT-PCR, and correlation analyses revealed a positive correlation between KIAA1429 expression level and MUC3A. Finally, torsion test results revealed that low KIAA1429 expression reversed LUAD cell migration, proliferation, and invasion facilitated by low MUC3A expression as well as cell cycle arrest in the G1 phase. CONCLUSION KIAA1429 exhibited an unusually high expression in LUAD cells and tissues, and high KIAA1429 expression was correlated with the clinical and pathological features of patients with LUAD, thereby leading to an unsatisfactory prognosis. Furthermore, KIAA1429 regulates MUC3A expression through m6A modification to modulate LUAD cells to proliferate, migrate, invade, and induce cell cycle arrest.
Collapse
Affiliation(s)
- Wenhua Zhao
- Department of Respiratory Oncology, Affiliated Tumor Hospital of Guangxi Medical University, PR China
| | - Yuan Xie
- Research Department, Affiliated Tumor Hospital of Guangxi Medical University, PR China.
| |
Collapse
|
8
|
Yang SH, Kim HY, Lee SI, Jin SJ. The Effect of Epidermal Growth Factor Receptor Mutation on Intracranial Progression-Free Survival of Non-Small Cell Lung Cancer Patients with Brain Metastasis Underwent Gamma Knife Radiosurgery. Brain Tumor Res Treat 2020; 8:103-108. [PMID: 33118342 PMCID: PMC7595855 DOI: 10.14791/btrt.2020.8.e15] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 05/22/2020] [Accepted: 07/14/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The aim of this study was to survey prognostic factors, particularly those focusing on epidermal growth factor receptor (EGFR) mutations, of patients with non-small cell lung cancer (NSCLC) after Gamma Knife Radiosurgery (GKRS) for metastatic brain tumors. METHODS We retrospectively reviewed the medical records of 98 patients with NSCLC who underwent GKRS for brain metastases from August 2010 to July 2017. The primary endpoint was progression-free survival (PFS) of the intracranial disease. We analyzed variables such as age, sex, Karnofsky Performance Status, recursive partitioning analysis (RPA) class, smoking status, primary cancer pathology, EGFR mutations, and time to brain metastases as prognostic factors. RESULTS The median overall survival (OS) of the patients was 16 months [95% confidence interval (CI), 13-21 months]. Median systemic PFS and intracranial PFS were 9 months (95% CI, 8-11 months) and 11 months (95% CI, 7-14 months), respectively. Kaplan-Meier survival analysis revealed that the patients with EGFR mutations had longer intracranial PFS than those without EGFR mutation (median intracranial PFS: 19 vs. 10 months with p=0.01) while they had no benefits in OS and systemic PFS. Furthermore, the patients harboring adenocarcinoma had longer OS (p<0.01) and intracranial PFS (p<0.01) and the patients with lower RPA class had longer OS (p=0.02) and intracranial PFS (p=0.03). CONCLUSION EGFR mutations, primary cancer pathology, and RPA class may be proposed as prognostic factors for intracranial PFS in NSCLC patients after GKRS for brain metastasis in this study.
Collapse
Affiliation(s)
- Seung Hyeon Yang
- Department of Neurosurgery, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Hae Yu Kim
- Department of Neurosurgery, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea.,Department of Neurosurgery, Gamma Knife Center, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea.
| | - Sun Il Lee
- Department of Neurosurgery, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea.,Department of Neurosurgery, Gamma Knife Center, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Seong Jin Jin
- Department of Neurosurgery, Gamma Knife Center, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| |
Collapse
|
9
|
Li W, Bai R, Cui J. [Targeted Therapies for Driver Gene Mutation-positive Lung Cancer Patients with Brain Metastasis]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2019; 22:719-726. [PMID: 31771742 PMCID: PMC6885421 DOI: 10.3779/j.issn.1009-3419.2019.11.06] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
脑是晚期肺癌转移最常见的部位,驱动基因阳性者脑转移发病率更高,肺癌脑转移患者预后较差,且不同治疗方式的选择影响肺癌脑转移患者的病程转归及预后。近年来,随着精准医学的发展,针对肺癌脑转移,尤其是具有特殊靶点的驱动基因阳性患者治疗方式的选择越来越成为人们的研究热点,并逐步取得进展。本文主要阐述了肺癌脑转移治疗存在的挑战,系统综述了驱动基因阳性肺癌脑转移的靶向治疗进展,以期在精准医学时代下,指导此类患者临床实践中个体化精准治疗方案的抉择。
Collapse
Affiliation(s)
- Wenqian Li
- Cancer Center, The First Hospital of Jilin University, Changchun 130021, China
| | - Rilan Bai
- Cancer Center, The First Hospital of Jilin University, Changchun 130021, China
| | - Jiuwei Cui
- Cancer Center, The First Hospital of Jilin University, Changchun 130021, China
| |
Collapse
|
10
|
Lee HH, Chen CH, Chuang HY, Huang YW, Huang MY. Brain surgery in combination with tyrosine kinase inhibitor and whole brain radiotherapy for epidermal growth factor receptor-mutant non-small-cell lung cancer with brain metastases. Sci Rep 2019; 9:16834. [PMID: 31728013 PMCID: PMC6856342 DOI: 10.1038/s41598-019-53456-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 11/01/2019] [Indexed: 11/12/2022] Open
Abstract
The role of brain surgery (BS) on the survival of patients with non-small-cell lung cancer (NSCLC) and brain metastases (BM), particularly those with epidermal growth factor receptor (EGFR) mutations under tyrosine kinase inhibitors (TKIs) is yet to be defined. We aimed to investigate whether BS could improve the survival of patients in addition to the combination of TKIs and whole brain radiotherapy (WBRT). A cohort of 1394 NSCLC patients between 2011 and 2016 was retrospectively studied. One hundred patients with BM receiving TKI + RT were enrolled. Forty patients (40%) received TKI + BS + RT, and 60 patients (60%) received TKI + RT. Survival time was calculated from the date of BM diagnoses to the date of death or last follow-up. With a median follow-up of 25.6 months (95% CI, 18.6–35.7), the median survival after BM was 18.2 months (95% CI, 10.8 to 27.4) in the TKI + BS + RT group and 11.8 months (95% CI, 5.2 to18) in the TKI + RT group. Cox proportional hazards regression model for the patients with the largest BM over 1 cm showed that TKI + BS + RT group was associated with improved survival relative to TKI + RT group (HR, 0.49; 95% CI, 0.29 to 0.83; P = 0.008). BS adds significant survival benefits in addition to TKIs and WBRT, especially for patients with EGFR-mutant NSCLC and the largest BM over 1 cm.
Collapse
Affiliation(s)
- Hsin-Hua Lee
- Program in Environmental and Occupational Medicine, Kaohsiung Medical University and National Health Research Institutes, Kaohsiung, Taiwan.,Department of Radiation Oncology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Chien-Hung Chen
- Department of Radiation Oncology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
| | - Hung-Yi Chuang
- Department of Occupational and Environmental Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Faculty of Department of Public Health, College of Health Science, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yu-Wei Huang
- Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Ming-Yii Huang
- Program in Environmental and Occupational Medicine, Kaohsiung Medical University and National Health Research Institutes, Kaohsiung, Taiwan. .,Department of Radiation Oncology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan. .,Department of Radiation Oncology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan. .,Drug Development and Value Creation Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan. .,Center for Cancer Research, Kaohsiung Medical University, Kaohsiung, Taiwan.
| |
Collapse
|
11
|
Human serum albumin nanoparticulate system with encapsulation of gefitinib for enhanced anti-tumor effects in non-small cell lung cancer. J Drug Deliv Sci Technol 2019. [DOI: 10.1016/j.jddst.2019.06.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
|
12
|
Hao X, Qu T. Expression of CENPE and its Prognostic Role in Non-small Cell Lung Cancer. Open Med (Wars) 2019; 14:497-502. [PMID: 31259255 PMCID: PMC6592151 DOI: 10.1515/med-2019-0053] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 05/06/2019] [Indexed: 01/04/2023] Open
Abstract
Background Non-small cell lung cancer (NSCLC) is one of the most important causes of death worldwide. Most patients are diagnosed in the advanced stage and have a poor prognosis. This study was to investigate the expression and significance of CENPE in NSCLC. Method Collecting information about CENPE in the Oncoming database, and perform a further analysis of the data in the current database to conduct a meta-analysis for its functional role in NSCLC. Patient life cycle analysis using Kaplan-Meier Plotter and GEPIA databases are used to perform patient survival analysis. Result A total of 12 studies involved the expression of CENPE in NSCLC cancer tissues and normal tissues, including 1195 samples. CENPE was highly expressed in NSCLC cell carcinoma compared with the control group (P < 0.05). Moreover, the expression of CENPE was correlated with the overall survival rate of CENPE. The overall survival rate of patients with high expression of CENPE was poor, and the prognosis of patients with low expression of CENPE was better (P<0.05). Conclusion We propose high expression of CENPE in NSLCL tissue is related to the prognosis of NSCLC, which may provide important basis for the development of tumor drugs.
Collapse
Affiliation(s)
- Xuezhi Hao
- Department of Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Tao Qu
- Department of Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| |
Collapse
|
13
|
Gougis P, Palmieri LJ, Funck-Brentano C, Paci A, Flippot R, Mir O, Coriat R. Major pitfalls of protein kinase inhibitors prescription: A review of their clinical pharmacology for daily use. Crit Rev Oncol Hematol 2019; 141:112-124. [PMID: 31276964 DOI: 10.1016/j.critrevonc.2019.06.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 06/06/2019] [Accepted: 06/07/2019] [Indexed: 12/13/2022] Open
Abstract
Protein kinase inhibitors (PKI) are a growing class of anticancer agents. They are prescribed with flat doses, and their oral administration is associated with interindividual variability in exposure. Patients can be over- or underexposed, due to numerous factors. We reviewed key pharmacokinetic concepts and mechanisms by which PKIs prescription could be altered. Challenging situations that could lead to increased toxicity or to therapeutic failure are described and recommendation for clinicians are proposed. Finally, the interest of therapeutic drug monitoring and indications for its use in daily practice is discussed.
Collapse
Affiliation(s)
- Paul Gougis
- Sorbonne Université, Faculty of Medicine, AP-HP, Pitié-Salpêtrière Hospital, Department of Pharmacology and Clinical Investigation Center, F-75013, Paris, France; CLIP² Galilée, Pitié-Salpêtrière Hospital, F-75013, Paris, France.
| | - Lola-Jade Palmieri
- AP-HP, Cochin Hospital, Department of gastroenterology and gastrointestinal oncology, Université Paris Descartes, Paris, France
| | - Christian Funck-Brentano
- Sorbonne Université, Faculty of Medicine, AP-HP, Pitié-Salpêtrière Hospital, Department of Pharmacology and Clinical Investigation Center, F-75013, Paris, France; INSERM, CIC-1421 and UMR ICAN 1166, Institute of Cardiometabolism and Nutrition (ICAN), F-75013, Paris, France
| | - Angelo Paci
- Service de Pharmacologie, Département de Biologie et Pathologie Médicales, Gustave Roussy et Université Paris Saclay, Villejuif, France
| | - Ronan Flippot
- Department of Medical Oncology, Gustave Roussy, 114 rue Edouard Vaillant, 94800, Villejuif, France
| | - Olivier Mir
- Department of Medical Oncology, Gustave Roussy, 114 rue Edouard Vaillant, 94800, Villejuif, France; Department of Ambulatory Care, Gustave Roussy Cancer Campus, Villejuif, France
| | - Romain Coriat
- AP-HP, Cochin Hospital, Department of gastroenterology and gastrointestinal oncology, Université Paris Descartes, Paris, France
| |
Collapse
|
14
|
Li C, Guo J, Zhao L, Hu F, Nie W, Wang H, Zheng X, Shen Y, Gu P, Zhang Y, Zhang X. Upfront whole brain radiotherapy for multiple brain metastases in patients with EGFR-mutant lung adenocarcinoma. Cancer Manag Res 2019; 11:3433-3443. [PMID: 31114377 PMCID: PMC6497873 DOI: 10.2147/cmar.s196881] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 02/15/2019] [Indexed: 12/25/2022] Open
Abstract
Purpose: This study aimed to evaluate the efficacy of upfront whole-brain radiotherapy (WBRT) in EGFR-mutant lung adenocarcinoma patients with multiple brain metastases (BM). Methods: In this study, 195 patients with EGFR mutations who had multiple BM at preliminary diagnosis were included and retrospectively reviewed. Patients were admitted to receive the following treatments in a multi-disciplinary setting: upfront WBRT followed by EGFR-TKI, concurrent EGFR-TKI and WBRT and upfront EGFR-TKI followed by WBRT. A disease-specific graded prognostic assessment (DS-GPA) was performed for all the patients. The treatment response and overall survival (OS) were assessed as well. Results: The median OS of these patients was 27 months. Objective response rate (ORR) was significantly better in upfront WBRT group than other two groups (P=0.004). Moreover, patients who received upfront WBRT (n=67) had longer OS than the concomitant group (36 vs 25 months; P=0.006) and the upfront EGFR-TKI group (36 vs 25 months; P<0.0001). The prognosis of patients with different DS-GPA scores significantly differed (P<0.0001). In concomitant group and upfront EGFR-TKIs group, patients with higher DS-GPA scores of 2-3 had more favorable prognosis compared with those with lower DS-GPA scores of 0-1.5 (27 vs 25 months; P=0.023). Patients who received EGFR-TKIs concurrently with WBRT had longer OS than those received upfront EGFR-TKIs with high DS-GPA scores. (37 vs 17 months; P=0.023). Conclusion: The use of upfront WBRT for EGFR-mutated lung adenocarcinoma patients with multiple BM can improve ORR and OS. More importantly, patients with high DS-GPA scores are recommended to receive WBRT immediately after EGFR-TKIs therapy.
Collapse
Affiliation(s)
- Changhui Li
- Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai200030, People’s Republic of China
| | - Jindong Guo
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai200030, People’s Republic of China
| | - Lei Zhao
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai200030, People’s Republic of China
| | - Fang Hu
- Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai200030, People’s Republic of China
| | - Wei Nie
- Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai200030, People’s Republic of China
| | - Huimin Wang
- Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai200030, People’s Republic of China
| | - Xiaoxuan Zheng
- Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai200030, People’s Republic of China
| | - Yinchen Shen
- Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai200030, People’s Republic of China
| | - Ping Gu
- Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai200030, People’s Republic of China
| | - Yujun Zhang
- Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai200030, People’s Republic of China
| | - Xueyan Zhang
- Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai200030, People’s Republic of China
| |
Collapse
|
15
|
He ZY, Li MF, Lin JH, Lin D, Lin RJ. Comparing the efficacy of concurrent EGFR-TKI and whole-brain radiotherapy vs EGFR-TKI alone as a first-line therapy for advanced EGFR-mutated non-small-cell lung cancer with brain metastases: a retrospective cohort study. Cancer Manag Res 2019; 11:2129-2138. [PMID: 30936745 PMCID: PMC6421893 DOI: 10.2147/cmar.s184922] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background Non-small-cell lung cancer (NSCLC) is a global public health problem, and brain is a common metastatic site in advanced NSCLC. Currently, whole-brain radiotherapy (WBRT) remains a major treatment for brain metastases, while EGFR-tyrosine kinase inhibitor (TKI) is the standard treatment for advanced NSCLC harboring EGFR mutations, which is also effective for brain metastases. However, whether EGFR-TKIs plus radiotherapy is superior to EGFR-TKIs alone for the treatment of advanced EGFR-mutant NSCLS with brain metastases remains controversial. This study aimed to compare the efficacy of concurrent EGFR-TKIs and WBRT vs EGFR-TKI alone in a retrospective cohort of advanced EGFR-mutant NSCLS with brain metastases. Patients and methods The medical records of 104 treatment-naïve, advanced EGFR-mutant NSCLC patients with brain metastases were retrospectively reviewed, and there were 56 patients undergoing concurrent EGFR-TKI and WBRT, and 48 patients given EGFR-TKI alone, including 20 cases with salvage WBRT upon brain metastasis progression. The survival prognosis was compared between the two cohorts. Results The baseline clinicopathologic factors were balanced between the two cohorts. After a median follow-up of 23 months, 35.6% of the study subjects survived. Concurrent EGFR-TKI and WBRT significantly improved the median intracranial PFS (iPFS) compared with EGFR-TKI alone (17.7 vs 11.0 months, P=0.015); however, no significant difference was seen in median overall survival between the two cohorts (28.1 vs 24.0 months, P=0.756). In addition, the median iPFS was found to significantly vary in the number of brain metastases (≤3 vs>3 metastases: 18.0 vs 12.5 months, P=0.044). Subgroup analysis showed that concurrent EGFR-TKI and WBRT improved median iPFS compared with EGFR-TKI alone in patients with more than three brain metastases (P=0.001); however, no significant difference was observed between the two regimens in patients with three or less brain metastases (P=0.526). Conclusion Our data demonstrate that concurrent EGFR-TKI and WBRT achieves longer iPFS than EGFR-TKI alone in advanced EGFR-mutant NSCLC with brain metastases. In advanced EGFR-mutant NSCLC with three or less brain metastases, EGFR-TKI alone may be an option as a first-line therapy.
Collapse
Affiliation(s)
- Zhi-Yong He
- Department of Thoracic Medical Oncology, Fujian Cancer Hospital, Fujian Medical University Cancer Hospital, Fuzhou 350014, Fujian Province, People's Republic of China, .,Fujian Provincial Key Laboratory of Translation Cancer Medicine, Fuzhou 350014, Fujian Province, People's Republic of China,
| | - Mei-Fang Li
- Department of Thoracic Medical Oncology, Fujian Cancer Hospital, Fujian Medical University Cancer Hospital, Fuzhou 350014, Fujian Province, People's Republic of China, .,Fujian Provincial Key Laboratory of Translation Cancer Medicine, Fuzhou 350014, Fujian Province, People's Republic of China,
| | - Jing-Hui Lin
- Department of Thoracic Medical Oncology, Fujian Cancer Hospital, Fujian Medical University Cancer Hospital, Fuzhou 350014, Fujian Province, People's Republic of China, .,Fujian Provincial Key Laboratory of Translation Cancer Medicine, Fuzhou 350014, Fujian Province, People's Republic of China,
| | - Dong Lin
- Department of Thoracic Medical Oncology, Fujian Cancer Hospital, Fujian Medical University Cancer Hospital, Fuzhou 350014, Fujian Province, People's Republic of China, .,Fujian Provincial Key Laboratory of Translation Cancer Medicine, Fuzhou 350014, Fujian Province, People's Republic of China,
| | - Ren-Jang Lin
- Department of Molecular and Cellular Biology, Beckman Research Institute of the City of Hope, Duarte, CA 91010, USA
| |
Collapse
|
16
|
Di M, Zhang L. Pembrolizumab for non-small cell lung cancer with central nervous system metastases: A two-case report. Thorac Cancer 2019; 10:381-385. [PMID: 30614652 PMCID: PMC6360200 DOI: 10.1111/1759-7714.12963] [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] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 12/08/2018] [Accepted: 12/12/2018] [Indexed: 12/04/2022] Open
Abstract
Non-small cell lung cancer (NSCLC) accounts for up to 85% of all lung cancers. Central nervous system metastases are a common complication of NSCLC and confer a poor prognosis and a dismal survival rate. Treatment is limited, has poor outcomes, and affects patient quality of life. Pembrolizumab is an anti-PD-1 antibody that has shown good results for the management of NSCLC. However, its penetration of the central nervous system has not been well studied, and patients with untreated brain metastases are excluded from most clinical trials. Herein, we report two cases of NSCLC with brain metastases in patients successfully treated with pembrolizumab, and discuss the efficacy and safety of pembrolizumab in these patients. Pembrolizumab has shown good control and the patients have had long progression-free survival with a high quality of life. Neither patient has experienced serious or grade 3-4 treatment-related adverse events. Pembrolizumab demonstrates activity in brain metastases in NSCLC patients with an acceptable safety profile. Thus, there may be a role for systemic immunotherapy in patients with untreated or progressive brain metastases.
Collapse
Affiliation(s)
- Mingyi Di
- Department of Respiratory Medicine, Peking Union Medical CollegeBeijingChina
| | - Li Zhang
- Department of Respiratory Medicine, Peking Union Medical CollegeBeijingChina
| |
Collapse
|
17
|
Ye L, Li H, Zhang F, Lv T, Liu H, Song Y. [Expression of KIF23 and Its Prognostic Role in Non-small Cell Lung Cancer:
Analysis Based on the Data-mining of Oncomine]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2018; 20:822-826. [PMID: 29277180 PMCID: PMC5973387 DOI: 10.3779/j.issn.1009-3419.2017.12.05] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
背景与目的 非小细胞肺癌(non-small cell lung cancer, NSCLC)是全球引起死亡的最重要原因之一。大多数患者发现时处于中晚期,预后较差。本研究拟探讨驱动蛋白超家族23(kinesin family member 23, KIF23)在NSCLC中的表达及意义。 方法 收集Oncomine数据库中关于KIF23的信息,并对目前数据库中资料进行二次分析,对其在NSCLC中的作用进行荟萃分析。利用Kaplan-Meier Plotter进行患者生存周期分析。 结果 Oncomine数据库中共收集了447项不同类型的研究结果,其中关于KIF23表达有统计学差异的研究结果有67个,KIF23表达增高的研究有64项、表达降低的研究有3项。共有16项研究涉及KIF23在NSCLC癌组织和正常组织中的表达,共包括1, 189个样本,与对照组相比,KIF23在NSCLC细胞癌中高表达(P<0.05)。不仅如此,KIF23表达量与NSCLC总体生存率存在相关性,高表达KIF23的患者总体生存率较差,低表达KIF23的患者预后较好(P<0.05)。进一步亚组分析发现,KIF23表达水平对肺腺癌患者预后有显著影响,而在鳞癌患者中,其表达水平对预后无显著影响。 结论 我们通过对Oncomine基因芯片数据库中肿瘤相关基因信息的深入挖掘,提出KIF23在NSLCL组织中高表达,且与NSCLC预后有关,可能为肿瘤药物的开发提供重要理论依据。
Collapse
Affiliation(s)
- Liang Ye
- Department of Respiratory Medicine, Jinling Clinical Medical College of Nanjing Medical University, Nanjing 210006, China.,Department of Respiratory Medicine, Najing Hospital Affiliated to Nanjing Medical University (Nanjing First Hospital),
Nanjing 210002, China
| | - Huijuan Li
- Department of Respiratory Medicine, Jinling Clinical Medical College of Nanjing Medical University, Nanjing 210006, China
| | - Fang Zhang
- Department of Respiratory Medicine, Jinling Clinical Medical College of Nanjing Medical University, Nanjing 210006, China
| | - Tangfeng Lv
- Department of Respiratory Medicine, Jinling Clinical Medical College of Nanjing Medical University, Nanjing 210006, China
| | - Hongbing Liu
- Department of Respiratory Medicine, Jinling Clinical Medical College of Nanjing Medical University, Nanjing 210006, China
| | - Yong Song
- Department of Respiratory Medicine, Jinling Clinical Medical College of Nanjing Medical University, Nanjing 210006, China
| |
Collapse
|
18
|
Indian consensus statement for treatment of advanced non small cell lung cancer: First line, maintenance, and second line. Indian J Cancer 2018; 54:89-103. [PMID: 29199671 DOI: 10.4103/ijc.ijc_136_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The management of advanced nonsmall cell lung cancer (NSCLC) patients is becoming complex with the identification of driver mutations and targeted therapies. The expert group of academic medical oncologists used data from published literature, practical experience to arrive at practical consensus recommendations to treat advanced NSCLC for use by the community oncologists.
Collapse
|
19
|
Kelly WJ, Shah NJ, Subramaniam DS. Management of Brain Metastases in Epidermal Growth Factor Receptor Mutant Non-Small-Cell Lung Cancer. Front Oncol 2018; 8:208. [PMID: 30018881 PMCID: PMC6037690 DOI: 10.3389/fonc.2018.00208] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 05/22/2018] [Indexed: 01/26/2023] Open
Abstract
Lung cancer remains a leading cause of mortality with 1.69 million deaths worldwide. Activating mutations in epidermal growth factor receptor (EGFR), predominantly exon 19 deletions and exon 21 L858R mutations, are known oncogenic drivers identified in 20-40% of non-small-cell lung cancers (NSCLC). 70% of EGFR-mutant NSCLC patients develop brain metastases (BM), compared to 38% in EGFR wild-type patients. First-generation tyrosine kinase inhibitors (TKIs), such as erlotinib and gefitinib have proven to be superior to chemotherapy in the front-line treatment of EGFR-mutant NSCLC, as has afatinib, a second-generation TKI. The most common acquired resistance mechanism is the development of a gatekeeper mutation in exon 20 T790M. Osimertinib has emerged as a third-generation EGFR TKI with proven activity in the front-line setting as well as in patients with a T790M acquired resistance mutation with remarkable CNS activity. As long-term survival outcomes in EGFR-mutant NSCLC continue to improve, the burden of BM becomes a greater challenge. Here, we review the literature related to the management of BM in EGFR-mutant NSCLC including the role of the three generations of EGFR TKIs, immunotherapy, and brain radiation.
Collapse
Affiliation(s)
| | | | - Deepa S. Subramaniam
- Division of Hematology-Oncology, Georgetown University, Washington, DC, United States
| |
Collapse
|
20
|
Zhang S, Zhu L, Xia B, Chen E, Zhao Q, Zhang X, Chen X, Chen X, Ma S. Epidermal growth factor receptor (EGFR) T790M mutation identified in plasma indicates failure sites and predicts clinical prognosis in non-small cell lung cancer progression during first-generation tyrosine kinase inhibitor therapy: a prospective observational study. Cancer Commun (Lond) 2018; 38:28. [PMID: 29789021 PMCID: PMC5993134 DOI: 10.1186/s40880-018-0303-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 11/26/2017] [Indexed: 12/21/2022] Open
Abstract
Introduction Plasma circulating tumor DNA (ctDNA) is an ideal approach to detecting the epidermal growth factor receptor (EGFR) T790M mutation, which is a major mechanism of resistance to first-generation EGFR-tyrosine kinase inhibitor (TKI) therapy. The present study aimed to explore the association of ctDNA-identified T790M mutation with disease failure sites and clinical prognosis in non-small cell lung cancer (NSCLC) patients. Methods Patients who progressed on first-generation TKIs were categorized into failure site groups of chest limited (CF), brain limited (BF) and other (OF). Amplification refractory mutation system (ARMS) and droplet digital PCR (ddPCR) were used to identify the T790M mutation in ctDNA. Prognosis was analyzed with Kaplan–Meier methods. Results Overall concordance between the two methods was 78.3%. According to both ARMS and ddPCR, patients in the OF group had a significantly higher rate of T790M mutation than did patients in the BF and CF groups (P < 0.001), and a significantly higher T790M mutation rate was also observed in OF-group patients than in those in the CF and BF groups (P < 0.001). AZD9291 was found to be an excellent treatment option and yielded the longest survival for T790M+ patients in all groups who had progressed on EGFR-TKIs; for other treatments, the prognosis of T790M− patient subgroups varied. Conclusions The present study demonstrates that T790M mutation in ctDNA is associated with failure sites for NSCLC patients after EGFR-TKI therapy and indicates that both failure site and T790M mutational status greatly influence treatment selection and prognosis. Electronic supplementary material The online version of this article (10.1186/s40880-018-0303-2) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Shirong Zhang
- Center for Translational Medicine, Hangzhou First People's Hospital, Nanjing Medical University, No. 261 Huansha Road, Shangcheng District, Hangzhou, 310006, Zhejiang, China.,Department of Oncology, Hangzhou First People's Hospital, Nanjing Medical University, Hangzhou, 310006, Zhejiang, China
| | - Lucheng Zhu
- Department of Oncology, Hangzhou First People's Hospital, Nanjing Medical University, Hangzhou, 310006, Zhejiang, China.,Department of Oncology, Hangzhou Cancer Hospital, Hangzhou, 310000, Zhejiang, China
| | - Bing Xia
- Department of Oncology, Hangzhou Cancer Hospital, Hangzhou, 310000, Zhejiang, China
| | - Enguo Chen
- Department of Respiratory, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310020, Zhejiang, China
| | - Qiong Zhao
- Department of Oncology, the First Affiliated Hospital, Zhejiang University, Hangzhou, 310006, Zhejiang, China
| | - Xiaochen Zhang
- Department of Oncology, the First Affiliated Hospital, Zhejiang University, Hangzhou, 310006, Zhejiang, China
| | - Xueqin Chen
- Department of Oncology, Hangzhou Cancer Hospital, Hangzhou, 310000, Zhejiang, China
| | - Xufeng Chen
- Department of Cancer Genetics and Epigenetics, City of Hope National Medical Center, Duarte, CA, 91010, USA
| | - Shenglin Ma
- Center for Translational Medicine, Hangzhou First People's Hospital, Nanjing Medical University, No. 261 Huansha Road, Shangcheng District, Hangzhou, 310006, Zhejiang, China. .,Department of Oncology, Hangzhou First People's Hospital, Nanjing Medical University, Hangzhou, 310006, Zhejiang, China.
| |
Collapse
|
21
|
Remon J, Besse B. Brain Metastases in Oncogene-Addicted Non-Small Cell Lung Cancer Patients: Incidence and Treatment. Front Oncol 2018; 8:88. [PMID: 29696132 PMCID: PMC5904204 DOI: 10.3389/fonc.2018.00088] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 03/14/2018] [Indexed: 12/11/2022] Open
Abstract
Brain metastases (BM) are common in non-small cell lung cancer patients including in molecularly selected populations, such as EGFR-mutant and ALK-rearranged tumors. They are associated with a reduced quality of life, and are commonly the first site of progression for patients receiving tyrosine kinase inhibitors (TKIs). In this review, we summarize incidence of BM and intracranial efficacy with TKI agents according to oncogene driver mutations, focusing on important clinical issues, notably optimal first-line treatment in oncogene-addicted lung tumors with upfront BM (local therapies followed by TKI vs. TKI monotherapy). We also discuss the potential role of newly emerging late-generation TKIs as new standard treatment in oncogene-addicted lung cancer tumors compared with sequential strategies.
Collapse
Affiliation(s)
- J. Remon
- Medical Oncology Department, Hospital Universitari Vall d’Hebron, Barcelona, Spain
| | - Benjamin Besse
- Cancer Medicine Department, Institut Gustave Roussy, Villejuif, France
- University Paris-Sud, Orsay, France
| |
Collapse
|
22
|
Nishiyama A, Yamada T, Kita K, Wang R, Arai S, Fukuda K, Tanimoto A, Takeuchi S, Tange S, Tajima A, Furuya N, Kinoshita T, Yano S. Foretinib Overcomes Entrectinib Resistance Associated with the NTRK1 G667C Mutation in NTRK1 Fusion-Positive Tumor Cells in a Brain Metastasis Model. Clin Cancer Res 2018; 24:2357-2369. [PMID: 29463555 DOI: 10.1158/1078-0432.ccr-17-1623] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Revised: 09/28/2017] [Accepted: 02/15/2018] [Indexed: 12/21/2022]
Abstract
Purpose: Rearrangement of the neurotrophic tropomyosin receptor kinase 1 (NTRK1) gene, which encodes tyrosine receptor kinase A (TRK-A), occurs in various cancers, including colon cancer. Although entrectinib is effective in the treatment of central nervous system (CNS) metastases that express NTRK1 fusion proteins, acquired resistance inevitably results in recurrence. The CNS is a sanctuary for targeted drugs; however, the mechanism by which CNS metastases become entrectinib-resistant remains elusive and must be clarified to develop better therapeutics.Experimental Design: The entrectinib-resistant cell line KM12SM-ER was developed by continuous treatment with entrectinib in the brain metastasis-mimicking model inoculated with the entrectinib-sensitive human colon cancer cell line KM12SM, which harbors the TPM3-NTRK1 gene fusion. The mechanism of entrectinib resistance in KM12SM-ER cells was examined by next-generation sequencing. Compounds that overcame entrectinib resistance were screened from a library of 122 kinase inhibitors.Results: KM12SM-ER cells, which showed moderate resistance to entrectinib in vitro, had acquired the G667C mutation in NTRK1 The kinase inhibitor foretinib inhibited TRK-A phosphorylation and the viability of KM12SM-ER cells bearing the NTRK1-G667C mutation in vitro Moreover, foretinib markedly inhibited the progression of entrectinib-refractory KM12SM-ER-derived liver metastases and brain tumors in animal models, predominantly through inhibition of TRK-A phosphorylation.Conclusions: These results suggest that foretinib may be effective in overcoming entrectinib resistance associated with the NTRK1-G667C mutation in NTRK1 fusion-positive tumors in various organs, including the brain, and provide a rationale for clinical trials of foretinib in cancer patients with entrectinib-resistant tumors harboring the NTRK1-G667C mutation, including patients with brain metastases. Clin Cancer Res; 24(10); 2357-69. ©2018 AACR.
Collapse
Affiliation(s)
- Akihiro Nishiyama
- Division of Medical Oncology, Cancer Research Institute, Kanazawa University, Kanazawa, Japan
| | - Tadaaki Yamada
- Division of Medical Oncology, Cancer Research Institute, Kanazawa University, Kanazawa, Japan.,Department of Pulmonary Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kenji Kita
- Division of Medical Oncology, Cancer Research Institute, Kanazawa University, Kanazawa, Japan
| | - Rong Wang
- Division of Medical Oncology, Cancer Research Institute, Kanazawa University, Kanazawa, Japan
| | - Sachiko Arai
- Division of Medical Oncology, Cancer Research Institute, Kanazawa University, Kanazawa, Japan
| | - Koji Fukuda
- Division of Medical Oncology, Cancer Research Institute, Kanazawa University, Kanazawa, Japan
| | - Azusa Tanimoto
- Division of Medical Oncology, Cancer Research Institute, Kanazawa University, Kanazawa, Japan
| | - Shinji Takeuchi
- Division of Medical Oncology, Cancer Research Institute, Kanazawa University, Kanazawa, Japan
| | - Shoichiro Tange
- Department of Bioinformatics and Genomics, Graduate School of Advanced Preventive Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Atsushi Tajima
- Department of Bioinformatics and Genomics, Graduate School of Advanced Preventive Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Noritaka Furuya
- Graduate School of Science, Osaka Prefecture University, Osaka, Japan.,Kissei Pharmaceutical, Nagano, Japan
| | | | - Seiji Yano
- Division of Medical Oncology, Cancer Research Institute, Kanazawa University, Kanazawa, Japan.
| |
Collapse
|
23
|
Continued EGFR-TKI with concurrent radiotherapy to improve time to progression (TTP) in patients with locally progressive non-small cell lung cancer (NSCLC) after front-line EGFR-TKI treatment. Clin Transl Oncol 2017; 20:366-373. [DOI: 10.1007/s12094-017-1723-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Accepted: 07/24/2017] [Indexed: 01/06/2023]
|
24
|
Zheng H, Liu QX, Hou B, Zhou D, Li JM, Lu X, Wu QP, Dai JG. Clinical outcomes of WBRT plus EGFR-TKIs versus WBRT or TKIs alone for the treatment of cerebral metastatic NSCLC patients: a meta-analysis. Oncotarget 2017; 8:57356-57364. [PMID: 28915676 PMCID: PMC5593647 DOI: 10.18632/oncotarget.19054] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 06/24/2017] [Indexed: 02/05/2023] Open
Abstract
Whether WBRT plus EGFR-TKIs has a greater survival benefit than EGFR-TKIs alone or WBRT alone remains controversial in NSCLC patients with multiple brain metastases. To rectify this, we conducted a systematic meta-analysis based on 9 retrospective studies and 1 randomized controlled study published between 2012 and 2016, comprising 1041 patients. Five studies were included in the comparison of WBRT plus EGFR-TKIs and EGFR-TKIs alone. The combined HR for OS of patients with EGFR mutation was 1.25 [95% CI 0.98–2.15; P = 0.08] and for intracranial PFS was 1.30 [95% CI 1.03–1.65; P = 0.03], which revealed that EGFR-TKIs alone produced a superior intracranial PFS than WBRT plus EGFR-TKIs. Five studies were included in the comparison of WBRT plus EGFR-TKIs and WBRT alone. The combined HR for OS, intracranial PFS and extracranial PFS were 0.52 [95% CI 0.37–0.75; P = 0.0004], 0.36 [95% CI 0.24–0.53; P < 0.001] and 0.52 [95% CI 0.38–0.71; P < 0.001], respectively, which revealed a significant benefit of WBRT plus EGFR-TKIs compared with WBRT alone. The results indicated that EGFR-TKIs alone should be the first option for the treatment of NSCLC patients with multiple BM, especially with EGFR mutation, since it provides similar OS and extracranial PFS but superior intracranial PFS compared with WBRT plus EGFR-TKIs.
Collapse
Affiliation(s)
- Hong Zheng
- Department of Thoracic Surgery, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China
| | - Quan-Xing Liu
- Department of Thoracic Surgery, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China
| | - Bin Hou
- Department of Thoracic Surgery, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China
| | - Dong Zhou
- Department of Thoracic Surgery, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China
| | - Jing-Meng Li
- Department of Thoracic Surgery, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China
| | - Xiao Lu
- Department of Thoracic Surgery, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China
| | - Qiu-Ping Wu
- Department of Thoracic Surgery, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China
| | - Ji-Gang Dai
- Department of Thoracic Surgery, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China
| |
Collapse
|
25
|
Lee PL, Jung SM, Guertin DA. The Complex Roles of Mechanistic Target of Rapamycin in Adipocytes and Beyond. Trends Endocrinol Metab 2017; 28:319-339. [PMID: 28237819 PMCID: PMC5682923 DOI: 10.1016/j.tem.2017.01.004] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 01/20/2017] [Accepted: 01/23/2017] [Indexed: 01/01/2023]
Abstract
Having healthy adipose tissue is essential for metabolic fitness. This is clear from the obesity epidemic, which is unveiling a myriad of comorbidities associated with excess adipose tissue including type 2 diabetes, cardiovascular disease, and cancer. Lipodystrophy also causes insulin resistance, emphasizing the importance of having a balanced amount of fat. In cells, the mechanistic target of rapamycin (mTOR) complexes 1 and 2 (mTORC1 and mTORC2, respectively) link nutrient and hormonal signaling with metabolism, and recent studies are shedding new light on their in vivo roles in adipocytes. In this review, we discuss how recent advances in adipose tissue and mTOR biology are converging to reveal new mechanisms that maintain healthy adipose tissue, and discuss ongoing mysteries of mTOR signaling, particularly for the less understood complex mTORC2.
Collapse
Affiliation(s)
- Peter L Lee
- Program in Molecular Medicine, University of Massachusetts Medical School, 373 Plantation Street, Worcester, MA 01605, USA
| | - Su Myung Jung
- Program in Molecular Medicine, University of Massachusetts Medical School, 373 Plantation Street, Worcester, MA 01605, USA
| | - David A Guertin
- Program in Molecular Medicine, University of Massachusetts Medical School, 373 Plantation Street, Worcester, MA 01605, USA.
| |
Collapse
|
26
|
Zhong W, Hu C. [Tumor Cells and Micro-environment in Brain Metastases]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2017; 19:626-35. [PMID: 27666556 PMCID: PMC5972957 DOI: 10.3779/j.issn.1009-3419.2016.09.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
近年来,随着早期诊断的方法的出现及精准治疗的应用,肺癌患者的生存及生活质量都得到很大改善。然而,对于肺癌的脑转移病灶,目前仍缺乏一个理想的治疗方案,严重影响了该部分患者生存状态。了解肿瘤细胞如何在中枢神经系统定植、生长和侵袭等相关生物学行为及其产生机制对预防及治疗肿瘤细胞脑转移病灶具有重大的意义。“种子-土壤”这一假说可以很好的解释这一过程,这一假说的关键即肿瘤细胞可与中枢神经系统微环境各组成之间产生相互适应性变化,正是这种相互作用决定了脑转移病灶的发生发展。本文就脑转移肿瘤细胞、脑转移肿瘤微环境及他们之间的相互作用进行综述,旨在为脑转移病灶的治疗提供新的思路。
Collapse
Affiliation(s)
- Wen Zhong
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Chengping Hu
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha 410008, China
| |
Collapse
|
27
|
|
28
|
How J, Mann J, Laczniak AN, Baggstrom MQ. Pulsatile Erlotinib in EGFR-Positive Non-Small-Cell Lung Cancer Patients With Leptomeningeal and Brain Metastases: Review of the Literature. Clin Lung Cancer 2017; 18:354-363. [PMID: 28245967 DOI: 10.1016/j.cllc.2017.01.013] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 01/24/2017] [Accepted: 01/31/2017] [Indexed: 02/08/2023]
Abstract
Patients with epidermal growth factor receptor (EGFR)-positive (EGFR+) non-small-cell lung cancer (NSCLC) show improved response rates when treated with tyrosine kinase inhibitors (TKIs) such as erlotinib. However, standard daily dosing of erlotinib often does not reach therapeutic concentrations within the cerebrospinal fluid (CSF), resulting in progression of central nervous system (CNS) disease. Intermittent, high-dose administration of erlotinib reaches therapeutic concentrations within the CSF and is well tolerated in patients. Experience with "pulsatile" dosing, however, is limited. We review the literature on the pharmacology and clinical outcomes of pulsatile erlotinib in the treatment of EGFR+ NSCLC with brain and leptomeningeal metastases, and include available data on the use of next-generation TKIs in CNS progression. We also provide our institution's experience with patients treated with pulsatile erlotinib for CNS metastasis, and propose clinical criteria for its use. Pulsatile erlotinib is a reasonable alternative in EGFR+ patients with new or worsening CNS disease, without evidence of systemic progression, and without confirmed T790M resistance mutations within the CNS.
Collapse
Affiliation(s)
- Joan How
- Barnes-Jewish Hospital, St Louis, MO
| | - Janelle Mann
- Mallinckrodt Institute of Radiology at Washington University, St Louis, MO
| | - Andrew N Laczniak
- Division of Pharmacology, Washington University School of Medicine, St Louis, MO
| | - Maria Q Baggstrom
- Division of Oncology, Washington University School of Medicine, St Louis, MO.
| |
Collapse
|
29
|
Lockney NA, Wu AJ. Alectinib for the management of ALK-positive non-small cell lung cancer brain metastases. J Thorac Dis 2017; 9:E152-E154. [PMID: 28275502 DOI: 10.21037/jtd.2017.02.05] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Natalie A Lockney
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, NY 10065, USA
| | - Abraham J Wu
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, NY 10065, USA
| |
Collapse
|
30
|
Zhang SR, Zhu LC, Jiang YP, Zhang J, Xu RJ, Xu YS, Xia B, Ma SL. Efficacy of afatinib, an irreversible ErbB family blocker, in the treatment of intracerebral metastases of non-small cell lung cancer in mice. Acta Pharmacol Sin 2017; 38:233-240. [PMID: 27840411 DOI: 10.1038/aps.2016.107] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 08/23/2016] [Indexed: 12/21/2022] Open
Abstract
Few effective therapeutic options are currently available for the treatment of non-small cell lung cancer (NSCLC) with brain metastases (BM). Recent evidence shows that NSCLC patients with BMs respond well to afatinib, but little is known about the underlying mechanisms. In this study, we evaluated the efficacy of afatinib in treatment of BMs in mice and investigated whether afatinib could actively penetrate the brain-blood barrier and bind to its target. NSCLC BM model was established in nude mice by intracerebral injection of PC-9.luc cells. The tumors were measured weekly using in vivo quantitative bioluminescence. The mice are administrated afatinib (15, 30 mg·kg-1·d-1, ig) for 14 d. The antitumor efficacy of afatinib was determined by tumor growth inhibition (TGI), which was calculated as [1-(change of tumor volume in treatment group/control group)×100]. Pharmacokinetic characteristics were measure in mice receiving a single dose of afatinib (30 mg/kg, ig). Pharmacodynamics of afatinib was also assessed by detecting the expression of pEGFR (Tyr1068) in brain tumor foci using immunohistochemistry. Administration of afatinib (15, 30 mg·kg-1·d-1) dose-dependently inhibited PC-9 tumor growth in the brain with a TGI of 90.2% and 105%, respectively, on d 14. After administration of afatinib (30 mg/kg), the plasma concentration of afatinib was 91.4±31.2 nmol/L at 0.5 h, reached a peak (417.1±119.9 nmol/L) at 1 h, and was still detected after 24 h. The cerebrospinal fluid (CSF) concentrations followed a similar pattern. The T1/2 values of afatinib in plasma and CSF were 5.0 and 3.7 h, respectively. The AUC(0-24 h) values for plasma and CSF were 2375.5 and 29.1 nmol/h, respectively. The plasma and CSF concentrations were correlated (r=0.844, P<0.01). Pharmacodynamics study showed that the expression levels of pEGFR were reduced by 90% 1 h after afatinib administration. The Emax was 86.5%, and the EC50 was 0.26 nmol/L. A positive correlation between CSF concentrations and pEGFR modulation was revealed. Afatinib penetrates the BBB in NSCLC BM mice and contributes to the brain tumor response. The CSF exposure level is correlated with the plasma level, which in turn is correlated with the modulation of pEGFR in the tumor tissues. The results support for the potential application of afatinib in NSCLC patients with BMs.
Collapse
|
31
|
Nanjo S, Arai S, Wang W, Takeuchi S, Yamada T, Hata A, Katakami N, Okada Y, Yano S. MET Copy Number Gain Is Associated with Gefitinib Resistance in Leptomeningeal Carcinomatosis of EGFR-mutant Lung Cancer. Mol Cancer Ther 2017; 16:506-515. [PMID: 28138027 DOI: 10.1158/1535-7163.mct-16-0522] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 11/16/2016] [Accepted: 11/19/2016] [Indexed: 01/13/2023]
Abstract
Leptomeningeal carcinomatosis occurs frequently in EGFR-mutant lung cancer, and develops acquired resistance to EGFR tyrosine kinase inhibitors (EGFR-TKIs). This study aimed to clarify the mechanism of EGFR-TKI resistance in leptomeningeal carcinomatosis and seek for a novel therapeutic strategy. We examined EGFR mutations, including the T790M gatekeeper mutation, in 32 re-biopsy specimens from 12 leptomeningeal carcinomatosis and 20 extracranial lesions of EGFR-mutant lung cancer patients who became refractory to EGFR-TKI treatment. All the 32 specimens had the same baseline EGFR mutations, but the T790M mutation was less frequent in leptomeningeal carcinomatosis specimens than in extracranial specimens (8% vs. 55%, P < 0.01). To study molecular mechanisms of acquired EGFR-TKI resistance in leptomeningeal carcinomatosis, we utilized our previously developed mouse model of leptomeningeal carcinomatosis with the EGFR-mutant lung cancer cell line PC-9/ffluc cells, in which acquired resistance to gefitinib was induced by continuous oral treatment. Compared with subcutaneously inoculated gefitinib-resistant tumors, the T790M mutation was less frequent in leptomeningeal carcinomatosis that acquired resistance to gefitinib. PC-9/LMC-GR cells were established from the gefitinib-resistant leptomeningeal carcinomatosis model, and they were found to be intermediately resistant to gefitinib and osimertinib (third-generation EGFR-TKI). Although EGFR-T790M was negative, gefitinib resistance of PC-9/LMC-GR cells was related to MET copy number gain with MET activation. Moreover, combined use of EGFR-TKI and crizotinib, a MET inhibitor, dramatically regressed leptomeningeal carcinomatosis with acquired resistance to gefitinib or osimertinib. These findings suggest that combination therapy with MET inhibitors may be promising for controlling leptomeningeal carcinomatosis that acquires resistance to EGFR-TKIs. Mol Cancer Ther; 16(3); 506-15. ©2017 AACR.
Collapse
Affiliation(s)
- Shigeki Nanjo
- Division of Medical Oncology, Kanazawa University Cancer Research Institute, Kanazawa, Japan.,Division of Integrated Oncology, Institute of Biomedical Research and Innovation, Chuo-ku, Kobe, Japan
| | - Sachiko Arai
- Division of Medical Oncology, Kanazawa University Cancer Research Institute, Kanazawa, Japan
| | - Wei Wang
- Division of Medical Oncology, Kanazawa University Cancer Research Institute, Kanazawa, Japan.,Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, P.R. China
| | - Shinji Takeuchi
- Division of Medical Oncology, Kanazawa University Cancer Research Institute, Kanazawa, Japan
| | - Tadaaki Yamada
- Division of Medical Oncology, Kanazawa University Cancer Research Institute, Kanazawa, Japan
| | - Akito Hata
- Division of Integrated Oncology, Institute of Biomedical Research and Innovation, Chuo-ku, Kobe, Japan
| | - Nobuyuki Katakami
- Division of Integrated Oncology, Institute of Biomedical Research and Innovation, Chuo-ku, Kobe, Japan
| | - Yasunori Okada
- Department of Pathology, Keio University School of Medicine, Tokyo, Japan.,Department of Pathophysiology for Locomotive and Neoplastic Diseases, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Seiji Yano
- Division of Medical Oncology, Kanazawa University Cancer Research Institute, Kanazawa, Japan.
| |
Collapse
|
32
|
Enhancing Anticancer Effect of Gefitinib across the Blood-Brain Barrier Model Using Liposomes Modified with One α-Helical Cell-Penetrating Peptide or Glutathione and Tween 80. Int J Mol Sci 2016; 17:ijms17121998. [PMID: 27916828 PMCID: PMC5187798 DOI: 10.3390/ijms17121998] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2016] [Revised: 11/22/2016] [Accepted: 11/22/2016] [Indexed: 02/01/2023] Open
Abstract
Epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKI), such as gefitinib, have been demonstrated to effectively treat the patients of extracranial non-small cell lung cancer (NSCLC). However, these patients often develop brain metastasis (BM) during their disease course. The major obstacle to treat BM is the limited penetration of anticancer drugs across the blood-brain barrier (BBB). In the present study, we utilized gefitinib-loaded liposomes with different modifications to improve gefitinib delivery across the in vitro BBB model of bEnd.3 cells. Gefitinib was encapsulated in small unilamellar liposomes modified with glutathione (GSH) and Tween 80 (SUV-G+T; one ligand plus one surfactant) or RF (SUV-RF; one α-helical cell-penetrating peptide). GSH, Tween 80, and RF were tested by the sulforhodamine B (SRB) assay to find their non-cytotoxic concentrations on bEnd.3 cells. The enhancement on gefitinib across the BBB was evaluated by cytotoxicity assay on human lung adenocarcinoma PC9 cells under the bEnd.3 cells grown on the transwell inserts. Our findings showed that gefitinib incorporated in SUV-G+T or SUV-RF across the bEnd.3 cells significantly reduced the viability of PC9 cells more than that of free gefitinib. Furthermore, SUV-RF showed no cytotoxicity on bEnd.3 cells and did not affect the transendothelial electrical resistance (TEER) and transendothelial permeability of sodium fluorescein across the BBB model. Moreover, flow cytometry and confocal laser scanning microscopy were employed to evaluate the endocytosis pathways of SUV-RF. The results indicated that the uptake into bEnd.3 cells was mainly through adsorptive-mediated mechanism via electrostatic interaction and partially through clathrin-mediated endocytosis. In conclusion, cell penetrating peptide-conjugated SUV-RF shed light on improving drug transport across the BBB via modulating the transcytosis pathway(s).
Collapse
|
33
|
Nanjo S, Ebi H, Arai S, Takeuchi S, Yamada T, Mochizuki S, Okada Y, Nakada M, Murakami T, Yano S. High efficacy of third generation EGFR inhibitor AZD9291 in a leptomeningeal carcinomatosis model with EGFR-mutant lung cancer cells. Oncotarget 2016; 7:3847-56. [PMID: 26716903 PMCID: PMC4826174 DOI: 10.18632/oncotarget.6758] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 11/29/2015] [Indexed: 11/25/2022] Open
Abstract
Leptomeningeal carcinomatosis (LMC) remarkably decreases the quality of life of EGFR-mutant lung cancer patients. In contrast to the lesions outside the central nervous system (CNS), molecular mechanisms of EGFR tyrosine kinase inhibitor (TKI) resistance in CNS lesions including LMC are largely unknown. In this study, we established an in vivo imaging model for LMC with EGFR mutant lung cancer cell lines harboring an exon 19 deletion in EGFR and evaluated the effect of first generation EGFR-TKIs, erlotinib, second generation afatinib, and third generation AZD9291. In PC-9/ffluc model, erlotinib treatment slowed the development of LMC. Importantly, treatment with afatinib or AZD9291 apparently delayed the development of LMC. Moreover, treatment with a higher dose of AZD9291, also associated with inhibited phosphorylation of EGFR downstream molecule S6, regressed LMC refractory to the aforementioned EGFR-TKI treatments. These observations suggest that the third generation EGFR-TKI AZD9291 may be an effective treatment for first or second generation EGFR-TKI resistant LMC caused by EGFR-mutant lung cancer.
Collapse
Affiliation(s)
- Shigeki Nanjo
- Department of Medical Oncology, Kanazawa University Cancer Research Institute, Kanazawa, Japan
| | - Hiromichi Ebi
- Department of Medical Oncology, Kanazawa University Cancer Research Institute, Kanazawa, Japan
| | - Sachiko Arai
- Department of Medical Oncology, Kanazawa University Cancer Research Institute, Kanazawa, Japan
| | - Shinji Takeuchi
- Department of Medical Oncology, Kanazawa University Cancer Research Institute, Kanazawa, Japan
| | - Tadaaki Yamada
- Department of Medical Oncology, Kanazawa University Cancer Research Institute, Kanazawa, Japan
| | - Satsuki Mochizuki
- Department of Pathology, Keio University School of Medicine, Tokyo, Japan
| | - Yasunori Okada
- Department of Pathology, Keio University School of Medicine, Tokyo, Japan
| | - Mitsutoshi Nakada
- Department of Neurosurgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
| | - Takashi Murakami
- Laboratory of Tumor Biology, Takasaki University of Health and Welfare, Takasaki, Japan
| | - Seiji Yano
- Department of Medical Oncology, Kanazawa University Cancer Research Institute, Kanazawa, Japan
| |
Collapse
|
34
|
Pareek V, Welch M, Ravera E, Zampolin RL, Sequist LV, Halmos B. Marked Differences in CNS Activity among EGFR Inhibitors: Case Report and Mini-Review. J Thorac Oncol 2016; 11:e135-e139. [DOI: 10.1016/j.jtho.2016.07.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Revised: 07/06/2016] [Accepted: 07/13/2016] [Indexed: 01/04/2023]
|
35
|
Jiang T, Su C, Li X, Zhao C, Zhou F, Ren S, Zhou C, Zhang J. EGFR TKIs plus WBRT Demonstrated No Survival Benefit Other Than That of TKIs Alone in Patients with NSCLC and EGFR Mutation and Brain Metastases. J Thorac Oncol 2016; 11:1718-28. [DOI: 10.1016/j.jtho.2016.05.013] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 05/03/2016] [Accepted: 05/05/2016] [Indexed: 11/30/2022]
|
36
|
Lee AJX, Benamore R, Hofer M, Chitnis M. Leptomeningeal carcinomatosis in non-small-cell lung cancer: initial response to erlotinib followed by relapse despite continuing radiological resolution of disease. Oxf Med Case Reports 2016; 2016:omw069. [PMID: 27617103 PMCID: PMC5015419 DOI: 10.1093/omcr/omw069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 06/28/2016] [Accepted: 07/07/2016] [Indexed: 11/21/2022] Open
Abstract
A 60-year-old male was diagnosed with T3, N3, M1b epidermal growth factor receptor (EGFR) mutant lung adenocarcinoma. Five months later he developed significant headaches, weakness and numbness of the left leg, and unsteadiness of gait. Magnetic resonance imaging (MRI) brain demonstrated subtle gyral enhancement indicative of early leptomeningeal infiltration. He was commenced on second-line erlotinib which improved his lower limb symptoms. Three months later he developed increased urinary frequency and redeveloped leg symptoms. MRI brain showed improvement in the gyral enhancement. Four weeks later, the patient developed new onset confusion and decrease in mobility. Examination of the cerebrospinal fluid (CSF) demonstrated leptomeningeal carcinomatosis. This case demonstrates radiological and clinical response of leptomeningeal disease to erlotinib in EGFR mutant lung cancer with subsequent clinical relapse despite continued radiological resolution of leptomeningeal disease. This suggests that CSF examination should be considered when monitoring leptomeningeal disease response following treatment as the disease can be undetectable on repeat radiological imaging.
Collapse
Affiliation(s)
- Alvin J X Lee
- Department of Oncology , Oxford University Hospitals NHS Foundation Trust , Churchill Hospital , Old Road , Oxford OX3 7LE, UK
| | - Rachel Benamore
- Department of Radiology , Oxford University Hospitals NHS Foundation Trust , Churchill Hospital , Old Road , Oxford OX3 7LE, UK
| | - Monika Hofer
- Department of Neuropathology , Oxford University Hospitals NHS Foundation Trust , John Radcliffe Hospital , Headley Way , Oxford OX3 9DU, UK
| | - Meenali Chitnis
- Department of Oncology , Oxford University Hospitals NHS Foundation Trust , Churchill Hospital , Old Road , Oxford OX3 7LE, UK
| |
Collapse
|
37
|
He G, Xiao X, Zou M, Zhang C, Xia S. Pemetrexed/cisplatin as first-line chemotherapy for advanced lung cancer with brain metastases: A case report and literature review. Medicine (Baltimore) 2016; 95:e4401. [PMID: 27512852 PMCID: PMC4985307 DOI: 10.1097/md.0000000000004401] [Citation(s) in RCA: 8] [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] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Brain metastases (BMs) are a common and serious complication of non-small cell lung cancer (NSCLC). Whole-brain radiotherapy (WBRT), surgery, and molecular targeted therapy are usually used to treat NSCLC with BM. Chemotherapeutic options for BM are limited by tumor resistance, ineffective agents, and the blood-brain barrier. Pemetrexed/cisplatin is the preferred chemotherapy in nonsquamous NSCLC, but the efficacy of this treatment for nonsquamous NSCLC with BM is uncertain. METHODS We present a case of nonsquamous NSCLC with asymptomatic BM presenting with irritating cough and right shoulder back pain (unknown sensitizing epidermal growth factor receptor mutations or anaplastic lymphoma kinase). RESULTS He benefited from administration of first-line chemotherapy of pemetrexed/cisplatin. Partial remission was achieved in the primary lesion of the lungs and BM lesion. He was further given 3 cycles of pemetrexed monotherapy and WBRT. Complete remission was further achieved in BM lesion. CONCLUSION The findings of clinical trials and theoretical studies about the current pemetrexed/cisplatin in the treatment of nonsquamous NSCLC with BM are also summarized to provide a reference for the application of pemetrexed/cisplatin in nonsquamous NSCLC with BM. Whether or not pemetrexed/cisplatin is definitely effective in nonsquamous NSCLC with BM must be proven by subsequent phase III clinical trials.
Collapse
Affiliation(s)
- Guangzhao He
- Department of Pharmacy, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Hankou, Wuhan
- Department of Pharmacy, Changzhou Tumor Hospital, Changzhou
| | - Xiaoguang Xiao
- Department of Oncology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Hankou, Wuhan, P.R. China
| | - Man Zou
- Department of Oncology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Hankou, Wuhan, P.R. China
| | - Chengliang Zhang
- Department of Pharmacy, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Hankou, Wuhan
| | - Shu Xia
- Department of Oncology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Hankou, Wuhan, P.R. China
| |
Collapse
|
38
|
Sun L, Qi Y, Sun X, Yu J, Meng X. Orbital metastasis as the initial presentation of lung adenocarcinoma: a case report. Onco Targets Ther 2016; 9:2743-8. [PMID: 27274270 PMCID: PMC4869644 DOI: 10.2147/ott.s99583] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Orbital metastasis as the initial presentation of lung adenocarcinoma is very rare, and so the lack of knowledge about this phenomenon can easily result in misdiagnosis, either as a orbital primary tumor or benign lesion. Here, we report a rare case in which the orbital symptom appeared first without any pulmonary manifestations. Our patient developed decreasing vision in his right eye over a 3-month duration. He then presented with proptosis and multiple aches from head to back. After systemic evaluation, our patient was diagnosed with Stage IV non-small-cell lung cancer and was managed with palliative chemoradiotherapy. The final result of treatment suggests that the therapeutic efficacy of chemotherapy on orbital metastasis is uncertain, and only some orbital metastatic masses may have a favorable response to radiation. Furthermore, we review the recent data and provide an in-depth discussion on the clinical features and course of ocular pulmonary metastases, and explain a new type of non-small-cell lung cancer metastatic pattern for ophthalmologists and oncologists to help them distinguish the orbital metastasis as the first manifestation.
Collapse
Affiliation(s)
- Liangchao Sun
- Medical College of Shandong University, Shandong Academy of Medical Science, Jinan; Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Science, Jinan
| | - Yali Qi
- Medical College of Shandong University, Shandong Academy of Medical Science, Jinan; Department of Oncology, The Second Hospital of Lanzhou University, Lanzhou, People's Republic of China
| | - Xindong Sun
- Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Science, Jinan
| | - Jinming Yu
- Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Science, Jinan
| | - Xue Meng
- Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Science, Jinan
| |
Collapse
|
39
|
Wang Z, Zhou PU, Li G. Bevacizumab to combat EGFR-TKI resistance in a patient with advanced non-small cell lung cancer harboring an EGFR mutation: A case report. Oncol Lett 2016; 12:356-360. [PMID: 27347151 DOI: 10.3892/ol.2016.4574] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2015] [Accepted: 04/25/2016] [Indexed: 01/14/2023] Open
Abstract
Treatment with epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) is the first-line strategy for patients with non-small cell lung cancer (NSCLC) harboring EGFR-activating mutations. Acquired resistance to EGFR-TKIs is inevitable in patients receiving EGFR-TKI therapy. Treatment with bevacizumab can induce a marked improvement in the overall and progression-free survival of patients with NSCLC; however, the effect of bevacizumab on TKI resistance in patients with NSCLC with an activating EGFR mutation is largely unknown. The present study reports the case of a patient with advanced, metastatic lung adenocarcinoma harboring 19 Del mutations, and who developed resistance to afatinib. The addition of bevacizumab to afatinib treatment was shown to overcome the acquired TKI resistance in the patient, as well as to promote an improved outcome for her brain metastases.
Collapse
Affiliation(s)
- Zhiyi Wang
- Institute for Cancer Research in People's Liberation Army, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, P.R. China
| | - P U Zhou
- Institute for Cancer Research in People's Liberation Army, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, P.R. China
| | - Guanghui Li
- Institute for Cancer Research in People's Liberation Army, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, P.R. China
| |
Collapse
|
40
|
Couñago F, Rodríguez A, Calvo P, Luna J, Monroy JL, Taboada B, Díaz V, Rodríguez de Dios N. Targeted therapy combined with radiotherapy in non-small-cell lung cancer: a review of the Oncologic Group for the Study of Lung Cancer (Spanish Radiation Oncology Society). Clin Transl Oncol 2016; 19:31-43. [PMID: 27106020 DOI: 10.1007/s12094-016-1512-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 04/09/2016] [Indexed: 02/06/2023]
Abstract
In recent years, major advances in our understanding of the molecular biology of lung cancer, together with significant improvements in radiotherapy technologies, have revolutionized the treatment of non-small cell lung cancer (NSCLC). This has led to the development of new therapies that target molecular mutations specific to each tumor type, acting on the cell surface antigens or intracellular signaling pathways, or directly affecting cell survival. At the same time, ablative dose radiotherapy can be delivered safely in the context of metastatic disease. In this article, the GOECP/SEOR (Oncological Group for Study of Lung Cancer/Spanish Society of Radiation Oncology) reviews the role of new targeted therapies used in combination with radiotherapy in patients with locally advanced (stage III) NSCLC and in patients with advanced, metastatic (stage IV) NSCLC.
Collapse
Affiliation(s)
- F Couñago
- Department of Radiation Oncology, Hospital Universitario Quirón, Calle Diego de Velázquez, 1, 28223, Pozuelo de Alarcón, Madrid, Spain
| | - A Rodríguez
- Department of Radiation Oncology, Hospital Ruber Internacional, Calle de la Masó, 38, 28034, Madrid, Spain
| | - P Calvo
- Department of Radiation Oncology, Hospital Universitario Santiago de Compostela, Travesía de Choupana, s/n, 15706, Santiago de Compostela, Spain
| | - J Luna
- Department of Radiation Oncology, Hospital Universitario Fundación Jiménez Díaz, Avda. Reyes Católicos, 2, 28040, Madrid, Spain
| | - J L Monroy
- Department of Radiation Oncology, Hospital Universitario La Ribera, Carretera de Corbera, km 1, 46600, Alzira, Valencia, Spain
| | - B Taboada
- Department of Radiation Oncology, Hospital Universitario Santiago de Compostela, Travesía de Choupana, s/n, 15706, Santiago de Compostela, Spain
| | - V Díaz
- Department of Radiation Oncology, Hospital Universitario Puerta del Mar, Av. Ana de Viya, 21, 11009, Cádiz, Spain
| | - N Rodríguez de Dios
- Department of Radiation Oncology, Hospital de la Esperanza, Parc de Salut Mar, Barcelona, Spain. .,IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain. .,Universitat Pompeu Fabra, San josé de la Montaña 12, 08024, Barcelona, Spain.
| |
Collapse
|
41
|
He Y, Sun W, Wang Y, Ren S, Li X, Li J, Rivard CJ, Zhou C, Hirsch FR. Comparison of erlotinib and pemetrexed as second-/third-line treatment for lung adenocarcinoma patients with asymptomatic brain metastases. Onco Targets Ther 2016; 9:2409-14. [PMID: 27143936 PMCID: PMC4844452 DOI: 10.2147/ott.s102236] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective Brain metastases occur in one-third of all non-small-cell lung cancer patients. Due to restrictive transport at the blood–brain barrier, many drugs provide poor control of metastases in the brain. The aim of this study was to compare erlotinib with pemetrexed as second-/third-line treatment in patients with lung adenocarcinoma with asymptomatic brain metastases. Methods From January 2012 to June 2014, all lung adenocarcinoma patients with asymptomatic brain metastases who received treatment with erlotinib or pemetrexed as second-/third-line treatment were retrospectively reviewed. Chi-square and log-rank tests were used to perform statistical analysis. Results The study enrolled 99 patients, of which 44 were positive for EGFR mutation. Median progression-free survival (PFS) in months was not significantly different between the erlotinib- and pemetrexed-treated groups (4.2 vs 3.4 months; 95% confidence interval [CI]: 2.01–6.40 vs 2.80–5.00, respectively; P=0.635). Median PFS was found to be significantly longer in EGFR mutation–positive patients in the erlotinib-treated group (8.0 months; 95% CI 5.85–10.15) compared to the pemetrexed group (3.9 months; 95% CI: 1.25–6.55; P=0.032). The most common treatment-related side effect was mild-to-moderate rash and the most common drug-related side effects in the pemetrexed-group were vomiting and nausea. Conclusion Erlotinib and pemetrexed may be used as second-/third-line treatment in lung adenocarcinoma patients with asymptomatic brain metastases, and detection of EGFR mutation status is very important in these patients. EGFR mutation–positive lung adenocarcinoma patients with asymptomatic brain metastases showed longer PFS when treated with erlotinib as opposed to pemetrexed.
Collapse
Affiliation(s)
- Yayi He
- Department of Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Wenwen Sun
- Clinic and Research Center of Tuberculosis, Shanghai Key Laboratory of Tuberculosis, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Yan Wang
- Department of Lung Cancer and Immunology, Shanghai Pulmonary Hospital, Tongji University Medical School Cancer Institute, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Shengxiang Ren
- Department of Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Xuefei Li
- Department of Lung Cancer and Immunology, Shanghai Pulmonary Hospital, Tongji University Medical School Cancer Institute, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Jiayu Li
- Department of Lung Cancer and Immunology, Shanghai Pulmonary Hospital, Tongji University Medical School Cancer Institute, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Christopher J Rivard
- Division of Medical Oncology, Department of Medicine, University of Colorado, Aurora, CO, USA
| | - Caicun Zhou
- Department of Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Fred R Hirsch
- Division of Medical Oncology, Department of Medicine, University of Colorado, Aurora, CO, USA
| |
Collapse
|
42
|
Jiang T, Min W, Li Y, Yue Z, Wu C, Zhou C. Radiotherapy plus EGFR TKIs in non-small cell lung cancer patients with brain metastases: an update meta-analysis. Cancer Med 2016; 5:1055-65. [PMID: 26990668 PMCID: PMC4924363 DOI: 10.1002/cam4.673] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 01/26/2016] [Accepted: 01/27/2016] [Indexed: 12/12/2022] Open
Abstract
Brain metastasis (BM) is the common complication of non‐small cell lung cancer (NSCLC) with a poor prognosis and dismal survival rate. This update meta‐analysis aimed to derive a more precise estimation of radiotherapy plus epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) in NSCLC patients with BM. PubMed, EMBASE, Web of Science, Google Scholar, and Cochrane Library were searched to identify any relevant publications. After screening the literature and undertaking quality assessment and data extraction, the meta‐analysis was performed using STATA Version 12.0. In total, 15 studies involving 1552 participants were included. The results indicated that radiotherapy plus EGFR TKIs was more effective at improving response rate and disease control rate (DCR) (risk ratio (RR) = 1.48, 95% confidence interval [CI]: 1.12–1.96, P = 0.005; RR = 1.29, 95% CI: 1.02–1.60, P = 0.035; respectively) than radiotherapy alone or plus chemotherapy. Moreover, radiotherapy plus EGFR TKIs significantly prolonged the time to central nervous system progression (CNS‐TTP) (HR = 0.56, 95% CI [0.33, 0.80]; P = 0.000) and median overall survival (OS) (HR = 0.58, 95% CI [0.42, 0.74]; P = 0.000) but significantly increased adverse events (any grade) (RR = 1.25, 95% CI [1.01, 1.57]; P = 0.009), especially rash and dry skin. These results suggested that radiotherapy plus EGFR TKIs produced superior response rate and DCR and markedly prolonged the CNS‐TTP and OS of NSCLC patients with BM. However, combined groups had the higher rate of incidence of overall adverse effects, especially rash and dry skin.
Collapse
Affiliation(s)
- Tao Jiang
- Department of Medical Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, 507 Zhengmin Road, Yangpu District, Shanghai, 200433, China
| | - Weijie Min
- Department of Neurosurgery, Changhai Hospital, Second Military Medical University, 168 Changhai Road, Yangpu District, Shanghai, 200433, China
| | - Yanan Li
- Department of Neurosurgery, Changhai Hospital, Second Military Medical University, 168 Changhai Road, Yangpu District, Shanghai, 200433, China
| | - Zhijian Yue
- Department of Neurosurgery, Changhai Hospital, Second Military Medical University, 168 Changhai Road, Yangpu District, Shanghai, 200433, China
| | - Chunyan Wu
- Department of Pathology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, 507 Zhengmin Road, Yangpu District, Shanghai, 200433, China
| | - Caicun Zhou
- Department of Medical Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, 507 Zhengmin Road, Yangpu District, Shanghai, 200433, China
| |
Collapse
|
43
|
Takei H, Rouah E, Ishida Y. Brain metastasis: clinical characteristics, pathological findings and molecular subtyping for therapeutic implications. Brain Tumor Pathol 2015; 33:1-12. [DOI: 10.1007/s10014-015-0235-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 10/04/2015] [Indexed: 01/30/2023]
|
44
|
Li SH, Hsieh MH, Fang YF. Afatinib in Treatment-Naive Patients With EGFR-Mutated Lung Adenocarcinoma With Brain Metastasis: A Case Series. Medicine (Baltimore) 2015; 94:e1739. [PMID: 26469914 PMCID: PMC4616807 DOI: 10.1097/md.0000000000001739] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Tyrosine kinase inhibitors (TKIs) of epidermal growth factor receptor (EGFR) were previously the standard first-line treatments for lung cancers with activating EGFR mutations. The first-generation reversible EGFR TKIs, gefitinib and erlotinib, demonstrated substantial efficacy in the treatment of brain metastases from EGFR-mutated lung adenocarcinoma. However, the efficacy of afatinib, the second-generation irreversible EGFR TKI, as the first-line treatment in lung adenocarcinoma patients with brain metastasis has yet to be evaluated.Here, we report cases of 3 patients who received afatinib alone as the first-line treatment in combination with whole-brain radiotherapy or following surgical resection of brain metastases. All 3 patients had EGFR L858R mutation. The first patient had lung adenocarcinoma with brain metastasis and no neurologic symptoms. After consultation, she received afatinib as a first-line treatment. Chest computed tomography and brain magnetic resonance imaging (MRI) showed partial response. The second patient had lung adenocarcinoma accompanied with a metastatic brain lesion associated with seizures. This patient received whole-brain radiotherapy and afatinib treatment following brain MRI and subsequently showed significant regression of the brain metastasis. The third patient had strabismus of the right eye, and brain MRI showed a single tumor at the cerebellar pontine angle. This patient underwent surgical resection of the tumor followed by afatinib treatment. He refused adjuvant radiotherapy after surgery for brain metastasis. The brain MRI showed no recurrent brain metastasis, and the patient had relatively less neurologic deficiency.This series of 3 cases indicate that afatinib may be an appropriate first-line treatment alternative in patients having lung adenocarcinoma with EGFR mutations. Further retrospective analyses and prospective clinical trials are required to substantiate the efficacy of afatinib in the treatment of brain metastases of lung adenocarcinoma.
Collapse
Affiliation(s)
- Shih-Hong Li
- From the Department of Thoracic Medicine (S-HL, M-HH, Y-FF), Chang Gung Foundation, Chang Gung Memorial Hospital; and College of Medicine (S-HL, M-HH, Y-FF), Chang Gung University, Taoyuan, Taiwan
| | | | | |
Collapse
|
45
|
Puhalla S, Elmquist W, Freyer D, Kleinberg L, Adkins C, Lockman P, McGregor J, Muldoon L, Nesbit G, Peereboom D, Smith Q, Walker S, Neuwelt E. Unsanctifying the sanctuary: challenges and opportunities with brain metastases. Neuro Oncol 2015; 17:639-51. [PMID: 25846288 PMCID: PMC4482864 DOI: 10.1093/neuonc/nov023] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 01/18/2015] [Indexed: 12/22/2022] Open
Abstract
While the use of targeted therapies, particularly radiosurgery, has broadened therapeutic options for CNS metastases, patients respond minimally and prognosis remains poor. The inability of many systemic chemotherapeutic agents to penetrate the blood-brain barrier (BBB) has limited their use and allowed brain metastases to become a burgeoning clinical challenge. Adequate preclinical models that appropriately mimic the metastatic process, the BBB, and blood-tumor barriers (BTB) are needed to better evaluate therapies that have the ability to enhance delivery through or penetrate into these barriers and to understand the mechanisms of resistance to therapy. The heterogeneity among and within different solid tumors and subtypes of solid tumors further adds to the difficulties in determining the most appropriate treatment approaches and methods of laboratory and clinical studies. This review article discusses therapies focused on prevention and treatment of CNS metastases, particularly regarding the BBB, and the challenges and opportunities these therapies present.
Collapse
Affiliation(s)
- Shannon Puhalla
- Division of Hematology/Oncology, University of Pittsburgh, Pittsburgh, Pennsylvania (S.P.); Department of Pharmaceutics, University of Minnesota, Minneapolis, Minnesota (W.E.); Department of Hematology/Oncology, Children's Hospital Los Angeles, Los Angeles, California (D.F.); Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland (L.K.); Department of Pharmaceutical Sciences, School of Pharmacy, Texas Tech University Health Sciences Center, Amarillo, Texas (C.A.); Department of Pharmaceutical Sciences, School of Pharmacy, West Virginia University and the Mary Babb Randolph Cancer Center, Morgantown, West Virginia (P.L.); Department of Neurological Surgery, The Ohio State University Medical Center, Columbus, Ohio (J.M.); Blood Brain-Barrier Program, Oregon Health & Science University, Portland, Oregon (L.M., E.N.); Dotter Radiology/Neuroradiology, Oregon Health & Science University, Portland, Oregon (G.N.); Brain Tumor and Neuro-Oncology Center, Cleveland Clinic Foundation, Cleveland, Ohio (D.P.); School of Pharmacy, Texas Tech University, Health Sciences Center, Amarillo, Texas (Q.S.); Department of Psychiatry, Oregon Health & Science University, Portland, Oregon (S.W.); Portland Veterans Affairs Medical Center, Portland, Oregon (E.N.)
| | - William Elmquist
- Division of Hematology/Oncology, University of Pittsburgh, Pittsburgh, Pennsylvania (S.P.); Department of Pharmaceutics, University of Minnesota, Minneapolis, Minnesota (W.E.); Department of Hematology/Oncology, Children's Hospital Los Angeles, Los Angeles, California (D.F.); Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland (L.K.); Department of Pharmaceutical Sciences, School of Pharmacy, Texas Tech University Health Sciences Center, Amarillo, Texas (C.A.); Department of Pharmaceutical Sciences, School of Pharmacy, West Virginia University and the Mary Babb Randolph Cancer Center, Morgantown, West Virginia (P.L.); Department of Neurological Surgery, The Ohio State University Medical Center, Columbus, Ohio (J.M.); Blood Brain-Barrier Program, Oregon Health & Science University, Portland, Oregon (L.M., E.N.); Dotter Radiology/Neuroradiology, Oregon Health & Science University, Portland, Oregon (G.N.); Brain Tumor and Neuro-Oncology Center, Cleveland Clinic Foundation, Cleveland, Ohio (D.P.); School of Pharmacy, Texas Tech University, Health Sciences Center, Amarillo, Texas (Q.S.); Department of Psychiatry, Oregon Health & Science University, Portland, Oregon (S.W.); Portland Veterans Affairs Medical Center, Portland, Oregon (E.N.)
| | - David Freyer
- Division of Hematology/Oncology, University of Pittsburgh, Pittsburgh, Pennsylvania (S.P.); Department of Pharmaceutics, University of Minnesota, Minneapolis, Minnesota (W.E.); Department of Hematology/Oncology, Children's Hospital Los Angeles, Los Angeles, California (D.F.); Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland (L.K.); Department of Pharmaceutical Sciences, School of Pharmacy, Texas Tech University Health Sciences Center, Amarillo, Texas (C.A.); Department of Pharmaceutical Sciences, School of Pharmacy, West Virginia University and the Mary Babb Randolph Cancer Center, Morgantown, West Virginia (P.L.); Department of Neurological Surgery, The Ohio State University Medical Center, Columbus, Ohio (J.M.); Blood Brain-Barrier Program, Oregon Health & Science University, Portland, Oregon (L.M., E.N.); Dotter Radiology/Neuroradiology, Oregon Health & Science University, Portland, Oregon (G.N.); Brain Tumor and Neuro-Oncology Center, Cleveland Clinic Foundation, Cleveland, Ohio (D.P.); School of Pharmacy, Texas Tech University, Health Sciences Center, Amarillo, Texas (Q.S.); Department of Psychiatry, Oregon Health & Science University, Portland, Oregon (S.W.); Portland Veterans Affairs Medical Center, Portland, Oregon (E.N.)
| | - Lawrence Kleinberg
- Division of Hematology/Oncology, University of Pittsburgh, Pittsburgh, Pennsylvania (S.P.); Department of Pharmaceutics, University of Minnesota, Minneapolis, Minnesota (W.E.); Department of Hematology/Oncology, Children's Hospital Los Angeles, Los Angeles, California (D.F.); Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland (L.K.); Department of Pharmaceutical Sciences, School of Pharmacy, Texas Tech University Health Sciences Center, Amarillo, Texas (C.A.); Department of Pharmaceutical Sciences, School of Pharmacy, West Virginia University and the Mary Babb Randolph Cancer Center, Morgantown, West Virginia (P.L.); Department of Neurological Surgery, The Ohio State University Medical Center, Columbus, Ohio (J.M.); Blood Brain-Barrier Program, Oregon Health & Science University, Portland, Oregon (L.M., E.N.); Dotter Radiology/Neuroradiology, Oregon Health & Science University, Portland, Oregon (G.N.); Brain Tumor and Neuro-Oncology Center, Cleveland Clinic Foundation, Cleveland, Ohio (D.P.); School of Pharmacy, Texas Tech University, Health Sciences Center, Amarillo, Texas (Q.S.); Department of Psychiatry, Oregon Health & Science University, Portland, Oregon (S.W.); Portland Veterans Affairs Medical Center, Portland, Oregon (E.N.)
| | - Chris Adkins
- Division of Hematology/Oncology, University of Pittsburgh, Pittsburgh, Pennsylvania (S.P.); Department of Pharmaceutics, University of Minnesota, Minneapolis, Minnesota (W.E.); Department of Hematology/Oncology, Children's Hospital Los Angeles, Los Angeles, California (D.F.); Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland (L.K.); Department of Pharmaceutical Sciences, School of Pharmacy, Texas Tech University Health Sciences Center, Amarillo, Texas (C.A.); Department of Pharmaceutical Sciences, School of Pharmacy, West Virginia University and the Mary Babb Randolph Cancer Center, Morgantown, West Virginia (P.L.); Department of Neurological Surgery, The Ohio State University Medical Center, Columbus, Ohio (J.M.); Blood Brain-Barrier Program, Oregon Health & Science University, Portland, Oregon (L.M., E.N.); Dotter Radiology/Neuroradiology, Oregon Health & Science University, Portland, Oregon (G.N.); Brain Tumor and Neuro-Oncology Center, Cleveland Clinic Foundation, Cleveland, Ohio (D.P.); School of Pharmacy, Texas Tech University, Health Sciences Center, Amarillo, Texas (Q.S.); Department of Psychiatry, Oregon Health & Science University, Portland, Oregon (S.W.); Portland Veterans Affairs Medical Center, Portland, Oregon (E.N.)
| | - Paul Lockman
- Division of Hematology/Oncology, University of Pittsburgh, Pittsburgh, Pennsylvania (S.P.); Department of Pharmaceutics, University of Minnesota, Minneapolis, Minnesota (W.E.); Department of Hematology/Oncology, Children's Hospital Los Angeles, Los Angeles, California (D.F.); Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland (L.K.); Department of Pharmaceutical Sciences, School of Pharmacy, Texas Tech University Health Sciences Center, Amarillo, Texas (C.A.); Department of Pharmaceutical Sciences, School of Pharmacy, West Virginia University and the Mary Babb Randolph Cancer Center, Morgantown, West Virginia (P.L.); Department of Neurological Surgery, The Ohio State University Medical Center, Columbus, Ohio (J.M.); Blood Brain-Barrier Program, Oregon Health & Science University, Portland, Oregon (L.M., E.N.); Dotter Radiology/Neuroradiology, Oregon Health & Science University, Portland, Oregon (G.N.); Brain Tumor and Neuro-Oncology Center, Cleveland Clinic Foundation, Cleveland, Ohio (D.P.); School of Pharmacy, Texas Tech University, Health Sciences Center, Amarillo, Texas (Q.S.); Department of Psychiatry, Oregon Health & Science University, Portland, Oregon (S.W.); Portland Veterans Affairs Medical Center, Portland, Oregon (E.N.)
| | - John McGregor
- Division of Hematology/Oncology, University of Pittsburgh, Pittsburgh, Pennsylvania (S.P.); Department of Pharmaceutics, University of Minnesota, Minneapolis, Minnesota (W.E.); Department of Hematology/Oncology, Children's Hospital Los Angeles, Los Angeles, California (D.F.); Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland (L.K.); Department of Pharmaceutical Sciences, School of Pharmacy, Texas Tech University Health Sciences Center, Amarillo, Texas (C.A.); Department of Pharmaceutical Sciences, School of Pharmacy, West Virginia University and the Mary Babb Randolph Cancer Center, Morgantown, West Virginia (P.L.); Department of Neurological Surgery, The Ohio State University Medical Center, Columbus, Ohio (J.M.); Blood Brain-Barrier Program, Oregon Health & Science University, Portland, Oregon (L.M., E.N.); Dotter Radiology/Neuroradiology, Oregon Health & Science University, Portland, Oregon (G.N.); Brain Tumor and Neuro-Oncology Center, Cleveland Clinic Foundation, Cleveland, Ohio (D.P.); School of Pharmacy, Texas Tech University, Health Sciences Center, Amarillo, Texas (Q.S.); Department of Psychiatry, Oregon Health & Science University, Portland, Oregon (S.W.); Portland Veterans Affairs Medical Center, Portland, Oregon (E.N.)
| | - Leslie Muldoon
- Division of Hematology/Oncology, University of Pittsburgh, Pittsburgh, Pennsylvania (S.P.); Department of Pharmaceutics, University of Minnesota, Minneapolis, Minnesota (W.E.); Department of Hematology/Oncology, Children's Hospital Los Angeles, Los Angeles, California (D.F.); Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland (L.K.); Department of Pharmaceutical Sciences, School of Pharmacy, Texas Tech University Health Sciences Center, Amarillo, Texas (C.A.); Department of Pharmaceutical Sciences, School of Pharmacy, West Virginia University and the Mary Babb Randolph Cancer Center, Morgantown, West Virginia (P.L.); Department of Neurological Surgery, The Ohio State University Medical Center, Columbus, Ohio (J.M.); Blood Brain-Barrier Program, Oregon Health & Science University, Portland, Oregon (L.M., E.N.); Dotter Radiology/Neuroradiology, Oregon Health & Science University, Portland, Oregon (G.N.); Brain Tumor and Neuro-Oncology Center, Cleveland Clinic Foundation, Cleveland, Ohio (D.P.); School of Pharmacy, Texas Tech University, Health Sciences Center, Amarillo, Texas (Q.S.); Department of Psychiatry, Oregon Health & Science University, Portland, Oregon (S.W.); Portland Veterans Affairs Medical Center, Portland, Oregon (E.N.)
| | - Gary Nesbit
- Division of Hematology/Oncology, University of Pittsburgh, Pittsburgh, Pennsylvania (S.P.); Department of Pharmaceutics, University of Minnesota, Minneapolis, Minnesota (W.E.); Department of Hematology/Oncology, Children's Hospital Los Angeles, Los Angeles, California (D.F.); Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland (L.K.); Department of Pharmaceutical Sciences, School of Pharmacy, Texas Tech University Health Sciences Center, Amarillo, Texas (C.A.); Department of Pharmaceutical Sciences, School of Pharmacy, West Virginia University and the Mary Babb Randolph Cancer Center, Morgantown, West Virginia (P.L.); Department of Neurological Surgery, The Ohio State University Medical Center, Columbus, Ohio (J.M.); Blood Brain-Barrier Program, Oregon Health & Science University, Portland, Oregon (L.M., E.N.); Dotter Radiology/Neuroradiology, Oregon Health & Science University, Portland, Oregon (G.N.); Brain Tumor and Neuro-Oncology Center, Cleveland Clinic Foundation, Cleveland, Ohio (D.P.); School of Pharmacy, Texas Tech University, Health Sciences Center, Amarillo, Texas (Q.S.); Department of Psychiatry, Oregon Health & Science University, Portland, Oregon (S.W.); Portland Veterans Affairs Medical Center, Portland, Oregon (E.N.)
| | - David Peereboom
- Division of Hematology/Oncology, University of Pittsburgh, Pittsburgh, Pennsylvania (S.P.); Department of Pharmaceutics, University of Minnesota, Minneapolis, Minnesota (W.E.); Department of Hematology/Oncology, Children's Hospital Los Angeles, Los Angeles, California (D.F.); Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland (L.K.); Department of Pharmaceutical Sciences, School of Pharmacy, Texas Tech University Health Sciences Center, Amarillo, Texas (C.A.); Department of Pharmaceutical Sciences, School of Pharmacy, West Virginia University and the Mary Babb Randolph Cancer Center, Morgantown, West Virginia (P.L.); Department of Neurological Surgery, The Ohio State University Medical Center, Columbus, Ohio (J.M.); Blood Brain-Barrier Program, Oregon Health & Science University, Portland, Oregon (L.M., E.N.); Dotter Radiology/Neuroradiology, Oregon Health & Science University, Portland, Oregon (G.N.); Brain Tumor and Neuro-Oncology Center, Cleveland Clinic Foundation, Cleveland, Ohio (D.P.); School of Pharmacy, Texas Tech University, Health Sciences Center, Amarillo, Texas (Q.S.); Department of Psychiatry, Oregon Health & Science University, Portland, Oregon (S.W.); Portland Veterans Affairs Medical Center, Portland, Oregon (E.N.)
| | - Quentin Smith
- Division of Hematology/Oncology, University of Pittsburgh, Pittsburgh, Pennsylvania (S.P.); Department of Pharmaceutics, University of Minnesota, Minneapolis, Minnesota (W.E.); Department of Hematology/Oncology, Children's Hospital Los Angeles, Los Angeles, California (D.F.); Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland (L.K.); Department of Pharmaceutical Sciences, School of Pharmacy, Texas Tech University Health Sciences Center, Amarillo, Texas (C.A.); Department of Pharmaceutical Sciences, School of Pharmacy, West Virginia University and the Mary Babb Randolph Cancer Center, Morgantown, West Virginia (P.L.); Department of Neurological Surgery, The Ohio State University Medical Center, Columbus, Ohio (J.M.); Blood Brain-Barrier Program, Oregon Health & Science University, Portland, Oregon (L.M., E.N.); Dotter Radiology/Neuroradiology, Oregon Health & Science University, Portland, Oregon (G.N.); Brain Tumor and Neuro-Oncology Center, Cleveland Clinic Foundation, Cleveland, Ohio (D.P.); School of Pharmacy, Texas Tech University, Health Sciences Center, Amarillo, Texas (Q.S.); Department of Psychiatry, Oregon Health & Science University, Portland, Oregon (S.W.); Portland Veterans Affairs Medical Center, Portland, Oregon (E.N.)
| | - Sara Walker
- Division of Hematology/Oncology, University of Pittsburgh, Pittsburgh, Pennsylvania (S.P.); Department of Pharmaceutics, University of Minnesota, Minneapolis, Minnesota (W.E.); Department of Hematology/Oncology, Children's Hospital Los Angeles, Los Angeles, California (D.F.); Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland (L.K.); Department of Pharmaceutical Sciences, School of Pharmacy, Texas Tech University Health Sciences Center, Amarillo, Texas (C.A.); Department of Pharmaceutical Sciences, School of Pharmacy, West Virginia University and the Mary Babb Randolph Cancer Center, Morgantown, West Virginia (P.L.); Department of Neurological Surgery, The Ohio State University Medical Center, Columbus, Ohio (J.M.); Blood Brain-Barrier Program, Oregon Health & Science University, Portland, Oregon (L.M., E.N.); Dotter Radiology/Neuroradiology, Oregon Health & Science University, Portland, Oregon (G.N.); Brain Tumor and Neuro-Oncology Center, Cleveland Clinic Foundation, Cleveland, Ohio (D.P.); School of Pharmacy, Texas Tech University, Health Sciences Center, Amarillo, Texas (Q.S.); Department of Psychiatry, Oregon Health & Science University, Portland, Oregon (S.W.); Portland Veterans Affairs Medical Center, Portland, Oregon (E.N.)
| | - Edward Neuwelt
- Division of Hematology/Oncology, University of Pittsburgh, Pittsburgh, Pennsylvania (S.P.); Department of Pharmaceutics, University of Minnesota, Minneapolis, Minnesota (W.E.); Department of Hematology/Oncology, Children's Hospital Los Angeles, Los Angeles, California (D.F.); Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland (L.K.); Department of Pharmaceutical Sciences, School of Pharmacy, Texas Tech University Health Sciences Center, Amarillo, Texas (C.A.); Department of Pharmaceutical Sciences, School of Pharmacy, West Virginia University and the Mary Babb Randolph Cancer Center, Morgantown, West Virginia (P.L.); Department of Neurological Surgery, The Ohio State University Medical Center, Columbus, Ohio (J.M.); Blood Brain-Barrier Program, Oregon Health & Science University, Portland, Oregon (L.M., E.N.); Dotter Radiology/Neuroradiology, Oregon Health & Science University, Portland, Oregon (G.N.); Brain Tumor and Neuro-Oncology Center, Cleveland Clinic Foundation, Cleveland, Ohio (D.P.); School of Pharmacy, Texas Tech University, Health Sciences Center, Amarillo, Texas (Q.S.); Department of Psychiatry, Oregon Health & Science University, Portland, Oregon (S.W.); Portland Veterans Affairs Medical Center, Portland, Oregon (E.N.)
| |
Collapse
|
46
|
Kudo Y, Shimada Y, Saji H, Kato Y, Yoshida K, Matsubayashi J, Nagase S, Kakihana M, Kajiwara N, Ohira T, Nagao T, Ikeda N. Prognostic Factors for Survival After Recurrence in Patients With Completely Resected Lung Adenocarcinoma: Important Roles of Epidermal Growth Factor Receptor Mutation Status and the Current Staging System. Clin Lung Cancer 2015; 16:e213-21. [PMID: 25986624 DOI: 10.1016/j.cllc.2015.04.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 04/10/2015] [Accepted: 04/14/2015] [Indexed: 12/13/2022]
Abstract
UNLABELLED Epidermal growth factor receptor (EGFR) status and pathological stage (p-stage) were shown to be essential prognostic factors for estimating survival after recurrence of lung adenocarcinoma. In patients with EGFR mutations, those with early p-stage tumors showed better survival after disease recurrence than those with advanced p-stage tumors. The EGFR mutation status and p-stage could also prompt the design of clinical trials on adjuvant therapy for patients after complete surgical resection. BACKGROUND The current staging system and epidermal growth factor receptor (EGFR) mutation status are key factors for predicting survival. However, the significance of these factors as predictors of survival after disease recurrence (PRS) has not been sufficiently elucidated. The objective of this study was to investigate the clinicopathological factors, particularly the EGFR mutation status and pathological stage (p-stage), which affect PRS in patients with completely resected lung adenocarcinoma. PATIENTS AND METHODS We retrospectively reviewed the data of 198 consecutive lung adenocarcinoma patients with disease recurrence who previously underwent complete surgical resection in our hospital. RESULTS Of the 198 patients, 117 were examined for EGFR mutations (mutants). Mutants were detected in 57 patients (28.7%). The patients with mutants had a significantly better 3-year PRS (3y-PRS) rate (68.6%) than those with an EGFR wild type (WT) status (51.7%) or an unknown (UN) status (27.0%). The 3y-PRS rates for p-stage I to II (p-I-II) and p-stage III (p-III) were 52.5% and 29.3%, respectively. Multivariate survival analysis showed that the EGFR mutation status and p-stage had significant associations with favorable PRS. The 3y-PRS rate for mutants/p-I-II (81.4%) was significantly better than that for mutants/p-III (48.0%). Conversely, there was no significant difference between mutants/p-III and WT/UN/p-I-II (3y-PRS: 40.7%) or between mutants/p-III and WT/UN/p-III (3y-PRS: 24.4%). CONCLUSION EGFR status and p-stage were shown to be essential prognostic factors for estimating PRS. In patients with mutants, those with early p-stage tumors showed better PRS than those with advanced p-stage tumors.
Collapse
Affiliation(s)
- Yujin Kudo
- Department of Thoracic Surgery, Tokyo Medical University, Tokyo, Japan.
| | - Yoshihisa Shimada
- Department of Thoracic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Hisashi Saji
- Department of Thoracic Surgery, Tokyo Medical University, Tokyo, Japan; Department of Chest Surgery, St Marianna University School of Medicine, Kanagawa, Japan
| | - Yasufumi Kato
- Department of Thoracic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Koichi Yoshida
- Department of Thoracic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Jun Matsubayashi
- Department of Anatomic Pathology, Tokyo Medical University, Tokyo, Japan
| | - Seisuke Nagase
- Department of Thoracic Surgery, Tokyo Medical University, Tokyo, Japan
| | | | - Naohiro Kajiwara
- Department of Thoracic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Tatsuo Ohira
- Department of Thoracic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Toshitaka Nagao
- Department of Anatomic Pathology, Tokyo Medical University, Tokyo, Japan
| | - Norihiko Ikeda
- Department of Thoracic Surgery, Tokyo Medical University, Tokyo, Japan
| |
Collapse
|