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Pons-Tostivint E, Ezzedine R, Goronflot T, Crequit P, Chatellier T, Raimbourg J, Bennouna J, Giroux Leprieur E, Porte M. Second-line treatment outcomes after first-line chemotherapy plus immunotherapy in Extensive-Stage small cell lung cancer (ES-SCLC) patients: A large French multicenter study. Lung Cancer 2024; 194:107887. [PMID: 38991282 DOI: 10.1016/j.lungcan.2024.107887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Revised: 07/05/2024] [Accepted: 07/06/2024] [Indexed: 07/13/2024]
Abstract
INTRODUCTION Chemotherapy combined with immunotherapy (CT-IO) is the standard treatment for patients with Extensive-Stage Small Cell Lung Cancer (ES-SCLC). This study evaluates the effectiveness of second-line (2L) following CT-IO. PATIENTS AND METHODS All patients from 10 centers who received a 2L after a first-line CT-IO were included. They were divided into 3 groups: platinum-based, lurbinectedin or others (topotecan, CAV, taxanes). We assessed overall survival (OS) and 2L progression-free survival (2L-PFS) according to treatment and platinum free-interval (PFI) < or ≥ 90 days. RESULTS Among 82 patients included, median age was 67.0 years, 29.3 % had a Performans Status ≥ 2, 36.6 % had brain progression, 69.5 % were considered "platine-sensitive" and 30.5 % "platine-resistant" (PFI ≥ or < 90 days, respectively). As 2L, 37/82 patients (45.1 %) received platinum-doublet, 21/82 (25.6 %) lurbinectedin and 24/82 (29.3 %) others. Patients with a PFI ≥ 90 days received mainly platinum-based rechallenge (34/57, 59.6 %). With a median follow-up of 18.5 months, the median OS was 5.0 months (95 %CI, 1.5-7.9) / 6.8 months (95 %CI, 5.5-8.7) for platinum-resistant / sensitive, respectively (log rank p = 0.017). The median 2L-PFS was 1.9 months (95 %CI, 1.2-4.7) / 3.9 months (95 %CI, 2.9-6.0) for platinum-resistant / sensitive, respectively. Median OS was 8.1 (95 %CI, 6.3-12.9) / 4.9 (95 %CI, 3.7-6.8) / 5.1 months (95 %CI, 2.5-7.8) with platinum rechallenge / lurbinectedin / others, respectively (p = 0.017). Median 2L-PFS was 4.6 (95 %CI, 3.9-7.2) / 2.7 (95 %CI, 1.6-3.9) / 2.2 months (95 %CI, 1.5-4.1) with platinum rechallenge / lurbinectedin / others, respectively (p = 0.025). DISCUSSION Platinum-based rechallenge after a first-line CT-IO showed promising results despite particularly unfavorable characteristics within our real-word population. Lurbinectedin when used after IO demonstrated as low efficacy as other platinum-free regimens.
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Affiliation(s)
- Elvire Pons-Tostivint
- Nantes Université, Centre Hospitalier Universitaire Nantes, Medical oncology, F-44000 Nantes, France; Nantes Université, Inserm UMR 1307, CNRS UMR 6075, Université d'Angers, CRCI2NA Nantes, France.
| | - Remy Ezzedine
- Service de pneumologie et oncologie thoracique, CHU d'Ambroise-Paré, Boulogne-Billancourt, France
| | - Thomas Goronflot
- Nantes Université, CHU Nantes, Pôle Hospitalo-Universitaire 11 : Santé Publique, Clinique des données, INSERM, CIC 1413, F-44000 Nantes, France
| | - Perrine Crequit
- Department of Medical Oncology, Hospital Foch, Suresnes, France
| | - Thierry Chatellier
- Medical Oncology Unit, Clinique Mutualiste de l'Estuaire, Saint-Nazaire, France
| | - Judith Raimbourg
- Department of Medical Oncology, Comprehensive Cancer Center, Institut de Cancérologie de l'Ouest, Saint-Herblain, France
| | - Jaafar Bennouna
- Department of Medical Oncology, Hospital Foch, Suresnes, France
| | - Etienne Giroux Leprieur
- Service de pneumologie et oncologie thoracique, CHU d'Ambroise-Paré, Boulogne-Billancourt, France
| | - Marie Porte
- Nantes Université, Centre Hospitalier Universitaire Nantes, Medical oncology, F-44000 Nantes, France
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Trillo Aliaga P, Del Signore E, Fuorivia V, Spitaleri G, Asnaghi R, Attili I, Corvaja C, Carnevale Schianca A, Passaro A, de Marinis F. The Evolving Scenario of ES-SCLC Management: From Biology to New Cancer Therapeutics. Genes (Basel) 2024; 15:701. [PMID: 38927637 PMCID: PMC11203015 DOI: 10.3390/genes15060701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 05/13/2024] [Accepted: 05/23/2024] [Indexed: 06/28/2024] Open
Abstract
Small cell lung cancer (SCLC) is an aggressive neuroendocrine carcinoma accounting for 15% of lung cancers with dismal survival outcomes. Minimal changes in therapy and prognosis have occurred in SCLC for the past four decades. Recent progress in the treatment of extensive-stage disease (ES-SCLC) has been marked by incorporating immune checkpoint inhibitors (ICIs) into platinum-based chemotherapy, leading to modest improvements. Moreover, few second-line-and-beyond treatment options are currently available. The main limitation for the molecular study of SCLC has been the scarcity of samples, because only very early diseases are treated with surgery and biopsies are not performed when the disease progresses. Despite all these difficulties, in recent years we have come to understand that SCLC is not a homogeneous disease. At the molecular level, in addition to the universal loss of retinoblastoma (RB) and TP53 genes, a recent large molecular study has identified other mutations that could serve as targets for therapy development or patient selection. In recent years, there has also been the identification of new genetic subtypes which have shown us how intertumor heterogeneity exists. Moreover, SCLC can also develop intratumoral heterogeneity linked mainly to the concept of cellular plasticity, mostly due to the development of resistance to therapies. The aim of this review is to quickly present the current standard of care of ES-SCLC, to focus on the molecular landscapes and subtypes of SCLC, subsequently present the most promising therapeutic strategies under investigation, and finally recap the future directions of ongoing clinical trials for this aggressive disease which still remains a challenge.
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Affiliation(s)
- Pamela Trillo Aliaga
- Division of Thoracic Oncology, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141 Milan, Italy
| | - Ester Del Signore
- Division of Thoracic Oncology, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141 Milan, Italy
| | - Valeria Fuorivia
- Division of Thoracic Oncology, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141 Milan, Italy
- Division of New Drugs and Early Drug Development for Innovative Therapies, European Institute of Oncology IRCCS, 20141 Milan, Italy
- Department of Oncology and Haematology (DIPO), University of Milan, 20122 Milan, Italy
| | - Gianluca Spitaleri
- Division of Thoracic Oncology, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141 Milan, Italy
| | - Riccardo Asnaghi
- Division of Thoracic Oncology, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141 Milan, Italy
- Division of New Drugs and Early Drug Development for Innovative Therapies, European Institute of Oncology IRCCS, 20141 Milan, Italy
- Department of Oncology and Haematology (DIPO), University of Milan, 20122 Milan, Italy
| | - Ilaria Attili
- Division of Thoracic Oncology, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141 Milan, Italy
| | - Carla Corvaja
- Division of Thoracic Oncology, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141 Milan, Italy
| | - Ambra Carnevale Schianca
- Division of Thoracic Oncology, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141 Milan, Italy
- Division of New Drugs and Early Drug Development for Innovative Therapies, European Institute of Oncology IRCCS, 20141 Milan, Italy
- Department of Oncology and Haematology (DIPO), University of Milan, 20122 Milan, Italy
| | - Antonio Passaro
- Division of Thoracic Oncology, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141 Milan, Italy
| | - Filippo de Marinis
- Division of Thoracic Oncology, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141 Milan, Italy
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Mao Y, Huang M, Liu J. Achieving long-term survival in extensive-stage SCLC: a case report and mini literature review. Lung Cancer Manag 2024; 13:LMT64. [PMID: 38818367 PMCID: PMC11137793 DOI: 10.2217/lmt-2023-0012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 11/18/2023] [Indexed: 06/01/2024] Open
Abstract
Managing extensive-stage SCLC (ES-SCLC) has long been challenging for clinicians and oncologists due to its aggressive nature and poor prognosis. We report a case of a 41-year-old female with ES-SCLC who survived for six years, defying the disease's typically poor prognosis. Through a heavy treatment strategy involving chemotherapy, targeted therapy, and immunotherapy, the patient experienced robust responses and avoided distant metastasis, including brain involvement. The long-term survival case in SCLC highlights the need for further research into personalized strategies and prognostic biomarkers. This case holds significant value for both clinicians and researchers as it challenges the conventional strategies for ES-SCLC and sets the stage for future evidence-based studies aimed at extending survival in SCLC.
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Affiliation(s)
- Yayun Mao
- Fuzhou Pulmonary Hospital of Fujian, Clinical Teaching Hospital of Fujian Medical University, Fuzhou, Fujian, 350008, China
| | - Meiping Huang
- Fuzhou Pulmonary Hospital of Fujian, Clinical Teaching Hospital of Fujian Medical University, Fuzhou, Fujian, 350008, China
| | - Jiafu Liu
- Fuzhou Pulmonary Hospital of Fujian, Clinical Teaching Hospital of Fujian Medical University, Fuzhou, Fujian, 350008, China
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Khurshid H, Ismaila N, Bian J, Dabney R, Das M, Ellis P, Feldman J, Hann C, Kulkarni S, Laskin J, Manochakian R, Mishra DR, Preeshagul I, Reddy P, Saxena A, Weinberg F, Kalemkerian GP. Systemic Therapy for Small-Cell Lung Cancer: ASCO-Ontario Health (Cancer Care Ontario) Guideline. J Clin Oncol 2023; 41:5448-5472. [PMID: 37820295 DOI: 10.1200/jco.23.01435] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 07/17/2023] [Accepted: 07/20/2023] [Indexed: 10/13/2023] Open
Abstract
PURPOSE To provide evidence-based recommendations to practicing clinicians on the management of patients with small-cell lung cancer. METHODS An Expert Panel of medical oncology, thoracic surgery, radiation oncology, pulmonary, community oncology, research methodology, and advocacy experts were convened to conduct a literature search, which included systematic reviews, meta-analyses, and randomized controlled trials published from 1990 through 2022. Outcomes of interest included response rates, overall survival, disease-free survival or recurrence-free survival, and quality of life. Expert Panel members used available evidence and informal consensus to develop evidence-based guideline recommendations. RESULTS The literature search identified 95 relevant studies to inform the evidence base for this guideline. RECOMMENDATIONS Evidence-based recommendations were developed to address systemic therapy options, timing of therapy, treatment in patients who are older or with poor performance status, role of biomarkers, and use of myeloid-supporting agents in patients with small-cell lung cancer.Additional information is available at www.asco.org/thoracic-cancer-guidelines.
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Affiliation(s)
| | - Nofisat Ismaila
- American Society of Clinical Oncology (ASCO), Alexandria, VA
| | | | | | | | - Peter Ellis
- Juravinski Cancer Center, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Jill Feldman
- EGFR Resisters Patient Advocacy Group, Deerfield, IL
| | | | - Swati Kulkarni
- Western University, Windsor Regional Cancer Program, Windsor, Ontario, Canada
| | - Janessa Laskin
- University of British Columbia, Vancouver, British Columbia, Canada
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Su Y, Lu C, Zheng S, Zou H, Shen L, Yu J, Weng Q, Wang Z, Chen M, Zhang R, Ji J, Wang M. Precise prediction of the sensitivity of platinum chemotherapy in SCLC: Establishing and verifying the feasibility of a CT-based radiomics nomogram. Front Oncol 2023; 13:1006172. [PMID: 37007144 PMCID: PMC10061075 DOI: 10.3389/fonc.2023.1006172] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 03/06/2023] [Indexed: 03/18/2023] Open
Abstract
ObjectivesTo develop and validate a CT-based radiomics nomogram that can provide individualized pretreatment prediction of the response to platinum treatment in small cell lung cancer (SCLC).MaterialsA total of 134 SCLC patients who were treated with platinum as a first-line therapy were eligible for this study, including 51 patients with platinum resistance (PR) and 83 patients with platinum sensitivity (PS). The variance threshold, SelectKBest, and least absolute shrinkage and selection operator (LASSO) were applied for feature selection and model construction. The selected texture features were calculated to obtain the radiomics score (Rad-score), and the predictive nomogram model was composed of the Rad-score and the clinical features selected by multivariate analysis. Receiver operating characteristic (ROC) curves, calibration curves, and decision curves were used to assess the performance of the nomogram.ResultsThe Rad-score was calculated using 10 radiomic features, and the resulting radiomics signature demonstrated good discrimination in both the training set (area under the curve [AUC], 0.727; 95% confidence interval [CI], 0.627–0.809) and the validation set (AUC, 0.723; 95% CI, 0.562–0.799). To improve diagnostic effectiveness, the Rad-score created a novel prediction nomogram by combining CA125 and CA72-4. The radiomics nomogram showed good calibration and discrimination in the training set (AUC, 0.900; 95% CI, 0.844-0.947) and the validation set (AUC, 0.838; 95% CI, 0.534-0.735). The radiomics nomogram proved to be clinically beneficial based on decision curve analysis.ConclusionWe developed and validated a radiomics nomogram model for predicting the response to platinum in SCLC patients. The outcomes of this model can provide useful suggestions for the development of tailored and customized second-line chemotherapy regimens.
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Affiliation(s)
- Yanping Su
- Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, Institute of Imaging Diagnosis and Minimally Invasive Intervention Research, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, Zhejiang, China
- Department of Radiology, Key Laboratory of Intelligent Medical Imaging of Wenzhou, Institute of Aging, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou Medical University, Wenzhou, Zhejiang, China
- Key Laboratory of Alzheimer’s Disease of Zhejiang, Wenzhou, Zhejiang, China
- Clinical College of The Affiliated Central Hospital, School of Medicine, Lishui University, Lishui, Zhejiang, China
| | - Chenying Lu
- Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, Institute of Imaging Diagnosis and Minimally Invasive Intervention Research, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, Zhejiang, China
- Clinical College of The Affiliated Central Hospital, School of Medicine, Lishui University, Lishui, Zhejiang, China
| | - Shenfei Zheng
- Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, Institute of Imaging Diagnosis and Minimally Invasive Intervention Research, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, Zhejiang, China
- Clinical College of The Affiliated Central Hospital, School of Medicine, Lishui University, Lishui, Zhejiang, China
| | - Hao Zou
- Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, Institute of Imaging Diagnosis and Minimally Invasive Intervention Research, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, Zhejiang, China
- Clinical College of The Affiliated Central Hospital, School of Medicine, Lishui University, Lishui, Zhejiang, China
| | - Lin Shen
- Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, Institute of Imaging Diagnosis and Minimally Invasive Intervention Research, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, Zhejiang, China
- Clinical College of The Affiliated Central Hospital, School of Medicine, Lishui University, Lishui, Zhejiang, China
| | - Junchao Yu
- Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, Institute of Imaging Diagnosis and Minimally Invasive Intervention Research, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, Zhejiang, China
- Clinical College of The Affiliated Central Hospital, School of Medicine, Lishui University, Lishui, Zhejiang, China
| | - Qiaoyou Weng
- Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, Institute of Imaging Diagnosis and Minimally Invasive Intervention Research, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, Zhejiang, China
- Clinical College of The Affiliated Central Hospital, School of Medicine, Lishui University, Lishui, Zhejiang, China
| | - Zufei Wang
- Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, Institute of Imaging Diagnosis and Minimally Invasive Intervention Research, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, Zhejiang, China
- Clinical College of The Affiliated Central Hospital, School of Medicine, Lishui University, Lishui, Zhejiang, China
| | - Minjiang Chen
- Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, Institute of Imaging Diagnosis and Minimally Invasive Intervention Research, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, Zhejiang, China
- Clinical College of The Affiliated Central Hospital, School of Medicine, Lishui University, Lishui, Zhejiang, China
| | - Ran Zhang
- AI Research Department, Huiying Medical Technology Co., Ltd, Beijing, China
| | - Jiansong Ji
- Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, Institute of Imaging Diagnosis and Minimally Invasive Intervention Research, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, Zhejiang, China
- Clinical College of The Affiliated Central Hospital, School of Medicine, Lishui University, Lishui, Zhejiang, China
- *Correspondence: Meihao Wang, ; Jiansong Ji,
| | - Meihao Wang
- Department of Radiology, Key Laboratory of Intelligent Medical Imaging of Wenzhou, Institute of Aging, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou Medical University, Wenzhou, Zhejiang, China
- Key Laboratory of Alzheimer’s Disease of Zhejiang, Wenzhou, Zhejiang, China
- *Correspondence: Meihao Wang, ; Jiansong Ji,
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Rittberg R, Leung B, Al-Hashami Z, Ho C. Real World Patient Eligibility for Second Line Lurbinectedin Based Treatment in Small Cell Lung Cancer: Understanding Epidemiology and Estimating Health Care Utilization. Curr Oncol 2022; 29:9744-9752. [PMID: 36547179 PMCID: PMC9776936 DOI: 10.3390/curroncol29120765] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 11/25/2022] [Accepted: 12/02/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND In the ATLANTIS study, second-line lurbinectedin/doxorubicin did not improve overall survival (OS), however patients with a chemotherapy-free interval (CTFI) of ≥180 days had an improved progression free survival (PFS). The objective of this retrospective study was to identify the proportion of real-world small cell lung cancer (SCLC) patients who are suitable for lurbinectedin-based therapy based on these criteria. METHODS A retrospective study of all SCLC referred to BC Cancer between 2012 and 2017 was conducted. Patient demographics, staging, treatment, and survival data were collected retrospectively. Baseline characteristics were compared using descriptive statistics. OS was calculated using Kaplan-Meier curves. Statistically significant p-value was <0.05. RESULTS A total of 1048 patients were identified. Baseline characteristics: median age 68 years, 47% male, 61% current smoking status, 68% extensive disease. Best supportive care was received by 22%. First-line systemic therapy was platinum doublet for 71% of the population. Second-line systemic therapy was delivered to 22%. Of the 219 patients who received second-line systemic therapy after platinum doublet, 183 patients had a CTFI of ≥90 days and 107 patients had a CTFI of ≥180 days. Patients originally treated as limited stage disease, received platinum doublet as second line, received thoracic radiation (RT) or prophylactic cranial irradiation (PCI) were more likely to have a CTFI of ≥90 and ≥180 days. CONCLUSION In our real-world SCLC population, only 21% of the SCLC population received second-line therapy after platinum doublet with 17% achieving CTFI of ≥90 days and 10% CTFI of ≥180 days. Based on this retrospective review, only a small fraction of platinum-treated patients would be preferentially offered lurbinectedin in the second-line setting.
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Affiliation(s)
- Rebekah Rittberg
- BC Cancer, Department of Medical Oncology, Vancouver, BC V5Z 4E6, Canada
- CancerCare Manitoba, Section of Hematology/Oncology, Department of Internal Medicine, University of Manitoba, Winnipeg, MB R3E 0V9, Canada
| | - Bonnie Leung
- BC Cancer, Department of Medical Oncology, Vancouver, BC V5Z 4E6, Canada
| | - Zamzam Al-Hashami
- Sultan Qaboos Comprehensive Cancer Care and Research Center, Muscat P.O. Box 566 P.C 123, Oman
| | - Cheryl Ho
- BC Cancer, Department of Medical Oncology, Vancouver, BC V5Z 4E6, Canada
- Correspondence: ; Tel.: +1-604-877-6000
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Thoracic radiotherapy may improve the outcome of extensive stage small cell lung carcinoma patients treated with first-line immunotherapy plus chemotherapy. Anticancer Drugs 2022; 33:e842-e849. [DOI: 10.1097/cad.0000000000001374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hadoux J, Walter T, Kanaan C, Hescot S, Hautefeuille V, Perrier M, Tauveron I, Laboureau S, Do Cao C, Petorin C, Blanchet O, Faron M, Leteurtre E, Rousselet MC, Joubert Zakeyh J, Marchal A, Chatelain D, Beaulaton C, Hervieu V, Lombard-Bohas C, Ducreux M, Scoazec JY, Baudin E. Second-line treatment and prognostic factors in neuroendocrine carcinoma: the RBNEC study. Endocr Relat Cancer 2022; 29:569-580. [PMID: 35920609 DOI: 10.1530/erc-22-0102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 06/29/2022] [Indexed: 11/08/2022]
Abstract
Neuroendocrine carcinomas (NEC) are aggressive malignant diseases. Etoposide-based rechallenge (EBR) and the prognostic role of RB transcriptional corepressor 1 (RB1) status in second-line chemotherapy (2L) have not been studied. The objectives of this study were to report the results of 2L including EBR as well as prognostic factors in a national retrospective multicentre study. NEC patients treated with 2L and further, with tissue samples available, were included. RB1 status and morphological classification were reviewed centrally. Among the 121 NEC patients (40% female, median age 61 years) included, there were 73 small-cell NEC (60%), 34 large-cell NEC (28%) and 14 NEC (not otherwise specified, 12%). Primary sites were lung (39%), gastroenteropancreatic (36%), other (13%) and unknown (12%). Median Ki-67 index was 80%. Median progression-free survival (PFS) and overall survival (OS) under 2L were 2.1 and 6.2 months, respectively. No difference was observed between patients who received an 'adenocarcinoma-like' or a 'neuroendocrine-like' 2L or according to the RB1 status. Thoracic NEC primary was the only adverse prognostic factor for OS. EBR, administered to 31 patients, resulted in a 62% disease control rate with a median PFS and OS of 3.2 and 11.7 months, respectively. In the 94 patients with a relapse-free interval of ≥3 months after first-line platinum-etoposide chemotherapy, the median OS was 12 months in patients who received EBR as compared to 5.9 months in patients who did not (P = 0.043). EBR could be the best 2L option for patient with initial response to first-line platinum-etoposide lasting at least 3 months. RB1 status does not provide prognostic information in this setting.
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Affiliation(s)
- Julien Hadoux
- Oncologie Endocrinienne, Département d'Imagerie, Gustave Roussy, Villejuif, France
| | - Thomas Walter
- Service d'Oncologie, ENETS Centre of Excellence, Hospices Civils de Lyon et Université de Lyon, Lyon, France
| | - Christina Kanaan
- Service de Pathologie, Département de Biologie et Pathologie Médicale, Gustave Roussy, Villejuif, France
| | | | - Vincent Hautefeuille
- Service d'Hépato-gastro-entérologie et Cancérologie Digestive, CHU Amiens Picardie, Amiens, France
| | - Marine Perrier
- Département d'Hépato-gastro-entérologie, CHU de Reims, Reims, France
| | - Igor Tauveron
- Service d'Endocrinologie, Diabétologie et Maladies Métaboliques, CHU Clermont-Ferrand, Clermont-Ferrand, France
- Laboratoire GReD, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Sandrine Laboureau
- Département d'Endocrinologie-Diabétologie-Nutrition, CHU d'Angers, Angers Cedex 9, France
| | | | - Caroline Petorin
- CHU Clermont-Ferrand, Service de Chirurgie Digestive et Hépatobiliaire, Clermont-Ferrand, France
| | | | - Matthieu Faron
- Département de Chirurgie, Gustave Roussy, Villejuif, France
| | - Emmanuelle Leteurtre
- CANTHER - Cancer Heterogeneity Plasticity and Resistance to Therapies, Université de Lille, CNRS, Inserm, CHU Lille, UMR9020-U1277, Lille, France
| | | | | | - Aude Marchal
- Service d'Anatomo-Pathologie, CHU Reims, Reims, France
| | | | | | - Valérie Hervieu
- Service d'Anatomo-Pathologie, ENETS Centre of Excellence, Hospices Civils de Lyon et Université de Lyon, Lyon, France
| | - Catherine Lombard-Bohas
- Service d'Oncologie, ENETS Centre of Excellence, Hospices Civils de Lyon et Université de Lyon, Lyon, France
| | - Michel Ducreux
- Service d'Oncologie Digestive, Département de Médecine, Gustave Roussy, Villejuif, France
- Faculté de Médecine, Université Paris Saclay, Le Kremlin-Bicêtre, France
| | - Jean-Yves Scoazec
- Service de Pathologie, Département de Biologie et Pathologie Médicale, Gustave Roussy, Villejuif, France
- Faculté de Médecine, Université Paris Saclay, Le Kremlin-Bicêtre, France
| | - Eric Baudin
- Oncologie Endocrinienne, Département d'Imagerie, Gustave Roussy, Villejuif, France
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Marzano L, Darwich AS, Tendler S, Dan A, Lewensohn R, De Petris L, Raghothama J, Meijer S. A novel analytical framework for risk stratification of real-world data using machine learning: A small cell lung cancer study. Clin Transl Sci 2022; 15:2437-2447. [PMID: 35856401 PMCID: PMC9579402 DOI: 10.1111/cts.13371] [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: 05/03/2022] [Revised: 06/26/2022] [Accepted: 07/08/2022] [Indexed: 01/25/2023] Open
Abstract
In recent studies, small cell lung cancer (SCLC) treatment guidelines based on Veterans' Administration Lung Study Group limited/extensive disease staging and resulted in broad and inseparable prognostic subgroups. Evidence suggests that the eight versions of tumor, node, and metastasis (TNM) staging can play an important role to address this issue. The aim of the present study was to improve the detection of prognostic subgroups from a real-word data (RWD) cohort of patients and analyze their patterns using a development pipeline with thoracic oncologists and machine learning methods. The method detected subgroups of patients informing unsupervised learning (partition around medoids) including the impact of covariates on prognosis (Cox regression and random survival forest). An analysis was carried out using patients with SCLC (n = 636) with stage IIIA-IVB according to TNM classification. The analysis yielded k = 7 compacted and well-separated clusters of patients. Performance status (Eastern Cooperative Oncology Group-Performance Status), lactate dehydrogenase, spreading of metastasis, cancer stage, and CRP were the baselines that characterized the subgroups. The selected clustering method outperformed standard clustering techniques, which were not capable of detecting meaningful subgroups. From the analysis of cluster treatment decisions, we showed the potential of future RWD applications to understand disease, develop individualized therapies, and improve healthcare decision making.
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Affiliation(s)
- Luca Marzano
- Division of Health Informatics and LogisticsSchool of Engineering Sciences in Chemistry, Biotechnology and Health (CBH), KTH Royal Institute of TechnologyHuddingeSweden
| | - Adam S. Darwich
- Division of Health Informatics and LogisticsSchool of Engineering Sciences in Chemistry, Biotechnology and Health (CBH), KTH Royal Institute of TechnologyHuddingeSweden
| | - Salomon Tendler
- Department of Oncology‐PathologyKarolinska Institutet and the Thoracic Oncology Center, Karolinska University HospitalStockholmSweden
| | - Asaf Dan
- Department of Oncology‐PathologyKarolinska Institutet and the Thoracic Oncology Center, Karolinska University HospitalStockholmSweden
| | - Rolf Lewensohn
- Department of Oncology‐PathologyKarolinska Institutet and the Thoracic Oncology Center, Karolinska University HospitalStockholmSweden
| | - Luigi De Petris
- Department of Oncology‐PathologyKarolinska Institutet and the Thoracic Oncology Center, Karolinska University HospitalStockholmSweden
| | - Jayanth Raghothama
- Division of Health Informatics and LogisticsSchool of Engineering Sciences in Chemistry, Biotechnology and Health (CBH), KTH Royal Institute of TechnologyHuddingeSweden
| | - Sebastiaan Meijer
- Division of Health Informatics and LogisticsSchool of Engineering Sciences in Chemistry, Biotechnology and Health (CBH), KTH Royal Institute of TechnologyHuddingeSweden
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10
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Hack J, Crabb SJ. Platinum-Based Chemotherapy 'Rechallenge' in Advanced Non-ovarian Solid Malignancies. Clin Oncol (R Coll Radiol) 2022; 34:e329-e344. [PMID: 35282934 DOI: 10.1016/j.clon.2022.02.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/26/2022] [Accepted: 02/17/2022] [Indexed: 01/02/2023]
Abstract
Platinum-based chemotherapy forms the backbone of treatment for many solid cancers. However, resistance inevitably develops in those with advanced disease. Platinum rechallenge is a well-established concept in the management of ovarian cancer, small cell lung cancer and germ cell tumours. In other solid malignancies there is a lack of quality evidence to support platinum rechallenge, yet it is a widely adopted strategy. Often, patients are within the last year of life, making questions of efficacy, treatment-related toxicity and quality of life critical factors for treatment recommendations. In this overview we appraise the available evidence for platinum rechallenge and strategies being developed to attempt resensitisation of tumours to platinum-based chemotherapy.
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Affiliation(s)
- J Hack
- Southampton Clinical Trials Unit, University of Southampton, Southampton General Hospital, Southampton, UK.
| | - S J Crabb
- Southampton Clinical Trials Unit, University of Southampton, Southampton General Hospital, Southampton, UK
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11
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Toublanc AC, Guecamburu M, Veillon R, Rosellini P, Girodet PO, Zysman M. Second-line lurbinectedin as a new treatment option for small-cell lung cancer: Preliminary results in real-clinical practice. Thorac Cancer 2022; 13:2248-2252. [PMID: 35715960 PMCID: PMC9346176 DOI: 10.1111/1759-7714.14464] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 04/24/2022] [Accepted: 04/25/2022] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION Few strategies exist for treatment of patients with small-cell lung cancer (SCLC) extended-stage after failure of first-line platinum-based chemotherapy. Lurbinectedin is a novel RNA-polymerase-II inhibitor investigated as a second-line therapy for SCLC. However, its efficacy and safety profile in real clinical practice remain to be determined. OBJECTIVE To determine the efficacy and safety of lurbinectedin in real-life among patients with SCLC previously treated with first-line platinum-based chemotherapy. METHODS We retrospectively evaluated patients who received at least one dose of lurbinectedin (3.2 mg/m2 ) between March 2020 and November 2021, in the pulmonary department of Bordeaux University Hospital. Endpoints were time to treatment discontinuation, progression-free survival, overall survival, and safety profile. RESULTS Thirteen patients were included. The median age was 60 years (range: 42-77), seven (54%) were females, nine (69%) having a performance status of 0-1. Lurbinectedin was given as second-line treatment before platinum rechallenge in four (31%) patients. After a mean follow-up of 4.1 months, the objective response rate (ORR) was 17%. The median time to treatment discontinuation (TTD) was 2.3 months (interquartile range [IQR], 1.2-3.6). The median progression-free survival (PFS) and overall survival (OS) were, respectively, 1.9 (IQR, 0.1.8) and 4.1 (IQR, 2.0-3.5) months. No significant difference regarding TTD, PFS or OS was found in the two groups according to treatment history or according to chemotherapy-free intervall (CMI) 〈1 or 〉1 month. The most common adverse events (AEs) were asthenia, nausea, and anemia in nine (70%) patients. Grade 3 AEs were reported, fatigue, vomiting, nausea, anorexia, and neutropenia. CONCLUSIONS Lurbinectedin in real clinical practice could have had a lower efficacy than in phase II trial, but a better hematological and bioclinical tolerance than previously reported. Early relapse after platinum-based chemotherapy seems to have a lower response to lurbinectedin.
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Affiliation(s)
| | - Marina Guecamburu
- Pulmonary Department, Pôle Cardio-thoracique, CHU de Bordeaux, Bordeaux, France
| | - Rémi Veillon
- Pulmonary Department, Pôle Cardio-thoracique, CHU de Bordeaux, Bordeaux, France
| | - Pietro Rosellini
- Pulmonary Department, Pôle Cardio-thoracique, CHU de Bordeaux, Bordeaux, France.,INSERM, Centre de Recherche Cardio-Thoracique de Bordeaux, Bordeaux, France
| | - Pierre-Olivier Girodet
- Pulmonary Department, Pôle Cardio-thoracique, CHU de Bordeaux, Bordeaux, France.,INSERM, Centre de Recherche Cardio-Thoracique de Bordeaux, Bordeaux, France.,Centre de Recherche Cardio-thoracique de Bordeaux, Univ-Bordeaux, Bordeaux, France
| | - Maeva Zysman
- Pulmonary Department, Pôle Cardio-thoracique, CHU de Bordeaux, Bordeaux, France.,INSERM, Centre de Recherche Cardio-Thoracique de Bordeaux, Bordeaux, France.,Centre de Recherche Cardio-thoracique de Bordeaux, Univ-Bordeaux, Bordeaux, France
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12
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Xu Y, Huang Z, Fang J, Liu A, Lu H, Yu X, Chen K, Xu X, Ma X, Shi W, Kim YH, Hakozaki T, Addeo A, Shen Y, Li S, Fan Y. Tolerability, safety, and preliminary antitumor activity of fuzuloparib in combination with SHR-1316 in patients with relapsed small cell lung cancer: a multicenter, open-label, two-stage, phase Ib trial. Transl Lung Cancer Res 2022; 11:1069-1078. [PMID: 35832454 PMCID: PMC9271434 DOI: 10.21037/tlcr-22-356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 06/14/2022] [Indexed: 11/17/2022]
Abstract
Background Second-line treatment options for small cell lung cancer (SCLC) are limited. Preclinical research shows that inhibition of poly (ADP-ribose) polymerase (PARP) could upregulate programmed death-ligand 1 (PD-L1), and thus render cancer cells more sensitive to immune checkpoint inhibitors. This study investigated the tolerability, safety, and preliminary antitumor activity of fuzuloparib (a PARP inhibitor) plus SHR-1316 (a PD-L1 inhibitor) for relapsed SCLC. Methods Patients with SCLC who failed previous first-line platinum-based therapy were enrolled in this two-stage phase Ib trial. In stage 1, 2 dose levels were designed: fuzuloparib 100 mg or 150 mg twice daily plus SHR-1316 600 mg every 2 weeks, with 6 patients in each dose level. Based on the tolerability during the first 28-day cycle and the preliminary antitumor activity in stage 1, a recommended phase II dose (RP2D) was determined and introduced in the stage 2 expansion phase. The primary endpoints were safety and RP2D in stage 1 and objective response rate (ORR) in stage 2. Results A total of 23 patients were enrolled, with 16 receiving fuzuloparib 100 mg plus SHR-1316 and 7 receiving fuzuloparib 150 mg plus SHR-1316. At data cutoff on April 23, 2021, the median follow-up duration was 6.4 months (IQR, 3.0–9.7 months). All patients discontinued study treatment. One patient receiving fuzuloparib 150 mg plus SHR-1316 had clinically significant toxicities, and fuzuloparib 100 mg plus SHR-1316 was considered as the RP2D. In the RP2D cohort, the confirmed ORR was 6.3% (95% CI: 0.2–30.2%), and the disease control rate was 37.5% (95% CI: 15.2–64.6%). The median progression-free survival was 1.4 months (95% CI: 1.3–2.8 months), and the median overall survival was 5.6 months (95% CI: 3.0–16.7 months). Grade ≥3 treatment-related adverse events (TRAE) occurred in 8 patients (34.8%). No treatment-related death occurred, and no patients discontinued treatment due to TRAEs. Conclusions Fuzuloparib combined with SHR-1316 failed to improve the outcomes in unselected patients with relapsed SCLC. Future studies with biomarker analysis are warranted to select patients most likely to benefit from this combination treatment. Fuzuloparib 100 and 150 mg plus SHR-1316 were both tolerable with no new signals observed.
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Affiliation(s)
- Yanjun Xu
- Department of Medical Thoracic Oncology, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, China
| | - Zhiyu Huang
- Department of Medical Thoracic Oncology, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, China
| | - Jian Fang
- Department of Thoracic Oncology II, Peking University Cancer Hospital, Beijing, China
| | - Anwen Liu
- Department of Oncology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Hongyang Lu
- Department of Medical Thoracic Oncology, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, China
| | - Xinmin Yu
- Department of Medical Thoracic Oncology, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, China
| | - Kaiyan Chen
- Department of Medical Thoracic Oncology, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, China
| | - Xiaoling Xu
- Department of Medical Thoracic Oncology, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, China
| | - Xinjing Ma
- Clinical Research and Development, Jiangsu Hengrui Pharmaceuticals Co., Ltd., Shanghai, China
| | - Wei Shi
- Clinical Research and Development, Jiangsu Hengrui Pharmaceuticals Co., Ltd., Shanghai, China
| | - Young Hak Kim
- Department of Pulmonary Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Taiki Hakozaki
- Department of Thoracic Oncology and Respiratory Medicine, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Alfredo Addeo
- Oncology Department, University Hospital of Geneva, Geneva, Switzerland
| | - Yu Shen
- Clinical Research and Development, Jiangsu Hengrui Pharmaceuticals Co., Ltd., Shanghai, China
| | - Shaorong Li
- Clinical Research and Development, Jiangsu Hengrui Pharmaceuticals Co., Ltd., Shanghai, China
| | - Yun Fan
- Department of Medical Thoracic Oncology, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, China
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13
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Plaja A, Moran T, Carcereny E, Saigi M, Hernández A, Cucurull M, Domènech M. Small-Cell Lung Cancer Long-Term Survivor Patients: How to Find a Needle in a Haystack? Int J Mol Sci 2021; 22:ijms222413508. [PMID: 34948300 PMCID: PMC8707503 DOI: 10.3390/ijms222413508] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 12/09/2021] [Accepted: 12/13/2021] [Indexed: 12/28/2022] Open
Abstract
Small-cell lung cancer (SCLC) is an aggressive malignancy characterized by a rapid progression and a high resistance to treatments. Unlike other solid tumors, there has been a scarce improvement in emerging treatments and survival during the last years. A better understanding of SCLC biology has allowed for the establishment of a molecular classification based on four transcription factors, and certain therapeutic vulnerabilities have been proposed. The universal inactivation of TP53 and RB1, along with the absence of mutations in known targetable oncogenes, has hampered the development of targeted therapies. On the other hand, the immunosuppressive microenvironment makes the success of immune checkpoint inhibitors (ICIs), which have achieved a modest improvement in overall survival in patients with extensive disease, difficult. Currently, atezolizumab or durvalumab, in combination with platinum–etoposide chemotherapy, is the standard of care in first-line setting. However, the magnitude of the benefit is scarce and no predictive biomarkers of response have yet been established. In this review, we describe SCLC biology and molecular classification, examine the SCLC tumor microenvironment and the challenges of predictive biomarkers of response to new treatments, and, finally, assess clinical and molecular characteristics of long-term survivor patients in order to identify possible prognostic factors and treatment vulnerabilities.
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14
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Ganti AKP, Loo BW, Bassetti M, Blakely C, Chiang A, D'Amico TA, D'Avella C, Dowlati A, Downey RJ, Edelman M, Florsheim C, Gold KA, Goldman JW, Grecula JC, Hann C, Iams W, Iyengar P, Kelly K, Khalil M, Koczywas M, Merritt RE, Mohindra N, Molina J, Moran C, Pokharel S, Puri S, Qin A, Rusthoven C, Sands J, Santana-Davila R, Shafique M, Waqar SN, Gregory KM, Hughes M. Small Cell Lung Cancer, Version 2.2022, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2021; 19:1441-1464. [PMID: 34902832 DOI: 10.6004/jnccn.2021.0058] [Citation(s) in RCA: 158] [Impact Index Per Article: 52.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Small Cell Lung Cancer (SCLC) provide recommended management for patients with SCLC, including diagnosis, primary treatment, surveillance for relapse, and subsequent treatment. This selection for the journal focuses on metastatic (known as extensive-stage) SCLC, which is more common than limited-stage SCLC. Systemic therapy alone can palliate symptoms and prolong survival in most patients with extensive-stage disease. Smoking cessation counseling and intervention should be strongly promoted in patients with SCLC and other high-grade neuroendocrine carcinomas. The "Summary of the Guidelines Updates" section in the SCLC algorithm outlines the most recent revisions for the 2022 update, which are described in greater detail in this revised Discussion text.
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Affiliation(s)
| | | | | | | | | | | | | | - Afshin Dowlati
- Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | | | | | | | | | | | - John C Grecula
- The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | - Christine Hann
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
| | | | | | | | | | | | - Robert E Merritt
- The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | - Nisha Mohindra
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | | | - Cesar Moran
- The University of Texas MD Anderson Cancer Center
| | | | - Sonam Puri
- Huntsman Cancer Institute at the University of Utah
| | - Angel Qin
- University of Michigan Rogel Cancer Center
| | | | - Jacob Sands
- Dana Farber/Brigham and Women's Cancer Center
| | | | | | - Saiama N Waqar
- Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
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15
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Choi MK, Cha Y, Baek JY. Retreatment of Irinotecan in Later Lines of Therapy for Metastatic Colorectal Cancer: A Retrospective Study. Oncology 2021; 99:665-672. [PMID: 34515197 DOI: 10.1159/000518041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 06/22/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Due to few efficacious options in later lines of therapy in metastatic colorectal cancer (mCRC), there has been considerable interest in the possibility of retreatment with previously administered agents. This study investigated the efficacy and safety of irinotecan retreatment (IRI2) in patients with refractory mCRC. METHODS We performed a retrospective analysis of patients with mCRC who were retreated with irinotecan-based regimens. The retreatment regimens with anti-epidermal growth factor receptor therapies were excluded. RESULTS A total of 64 patients were included. Patients had a median age of 56 years and were offered mainly in the setting of third- or fourth-line therapy with IRI2. The disease control rate was 78.2% including an objective response of 23.5%. Median progression-free survival and overall survival were 5.5 and 19.3 months, respectively. The most frequent grade 3 or higher toxicities were nausea/vomiting (27.9%) and neutropenia (25%). CONCLUSION IRI2 might be a reasonable option for heavily pretreated patients with mCRC who achieved disease control with prior irinotecan therapy.
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Affiliation(s)
- Moon Ki Choi
- Center for Colorectal Cancer, National Cancer Center, Goyang, Republic of Korea
| | - Yongjun Cha
- Center for Colorectal Cancer, National Cancer Center, Goyang, Republic of Korea
| | - Ji Yeon Baek
- Center for Colorectal Cancer, National Cancer Center, Goyang, Republic of Korea
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16
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Chiang CL, Hsieh WT, Tang CH, Sheu ML, Chen YM. Treatment patterns and survival in patients with small cell lung cancer in Taiwan. J Chin Med Assoc 2021; 84:772-777. [PMID: 34183592 DOI: 10.1097/jcma.0000000000000576] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Small cell lung cancer (SCLC) is the most aggressive form of lung cancer. The chemotherapy regimens and their efficacy in practice are seldom reported. We aimed to investigate treatment patterns and survival outcomes of patients with SCLC in Taiwan. METHODS Patients newly diagnosed with SCLC from 2011 to 2015 were identified from the Cancer Registry database. Their clinical characteristics, treatment regimens, and survival status were obtained from National Health Insurance Research database. The Kaplan-Meier method and Cox-proportional hazard model were used to analyze the survival outcomes. RESULTS Among a total of 2707 patients enrolled, 439 were in the limited stage (LS, 16.22%) and 2268 were in the extensive stage of the disease (ES, 83.78%). The median age was 66 and the majority were male (90.36%). The first-line regimen used for the patients was etoposide/cisplatin-based treatment, followed by etoposide/carboplatin-based regimen, and etoposide only. The median overall survival (OS) was 16.92 months (95% confidence interval [CI] 15.31-18.92) and 8.71 months (95% CI 8.38-9.07) in LS and ES patients, respectively. Chemotherapy regimen, Eastern Cooperative Oncology Group performance status, and history of radiotherapy were significant factors associated with OS. On the other hand, the major second-line treatment was a topotecan-based regimen (68.3%). However, this showed inferior survival outcome compared to etoposide-based regimen (5.09 months [95% CI 4.76-5.62] versus 8.77 months [95% CI 6.31-11.89], p < 0.001). CONCLUSION Etoposide is the preferred and superior first-line chemotherapy regimen in combination with platinum, and an alternative choice of second-line regimen for Taiwanese patients with SCLC.
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Affiliation(s)
- Chi-Lu Chiang
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Wen-Ting Hsieh
- School of Health Care Administration, Taipei Medical University, Taipei, Taiwan, ROC
| | - Chao-Hsiun Tang
- School of Health Care Administration, Taipei Medical University, Taipei, Taiwan, ROC
| | - Mei-Ling Sheu
- School of Health Care Administration, Taipei Medical University, Taipei, Taiwan, ROC
| | - Yuh-Min Chen
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
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17
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de Velasco G, Ruiz-Granados Á, Reig O, Massari F, Climent Duran MA, Verzoni E, Graham J, Llarena R, De Tursi M, Donskov F, Iglesias C, Pandha HS, Garcia Del Muro X, Procopio G, Oudard S, Castellano D, Albiges L. Outcomes of systemic targeted therapy in recurrent renal cell carcinoma treated with adjuvant sunitinib. BJU Int 2021; 128:254-261. [PMID: 33547860 DOI: 10.1111/bju.15356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess the efficacy and tolerability of rechallenge with sunitinib and other targeted therapies (TTs) in patitents with relapsed recurrent renal cell carcinoma (RCC) in the advanced setting. METHODS In this multi-institutional retrospective study, patients with relapsed RCC were rechallenged with sunitinib or other systemic TTs as a first-line therapeutic approach after failed adjuvant sunitinib treatment. Patient characteristics, treatments and clinical outcomes were recorded. The primary endpoint was progression-free survival (PFS). Secondary endpoints were objective response rate (ORR) and overall survival (OS). RESULTS A total of 34 patients with relapses were recorded, and 25 of these (73.5%) were men. Twenty-five patients were treated with systemic TT: 65% of patients received TT against the vascular endothelial growth factor pathway (including sunitinib), 21.7% received mammalian target of rapamycin inhibitors and 13% received immunotherapy. The median (interquartile range) time to relapse was 20.3 (5.2-20.4) months from diagnosis, and 7.5 months (1.0-8.5) from the end of adjuvant suntinib treatment. At a median follow-up of 23.5 months, 24 of the 25 patients had progressed on first-line systemic therapy. The median PFS was 12.0 months (95% confidence interval [CI] 5.78-18.2). There were no statistical differences in PFS between different treatments or sunitinib rechallenge. PFS was not statistically different in patients relapsing on or after adjuvant suntinib treatment (≤ 6 or >6 months after adjuvant suntinib ending). The ORR was 20.5%. The median OS was 29.1 months (95% CI 16.4-41.8). CONCLUSIONS Rechallenge with sunitinib or other systemic therapies is still a feasible therapeutic option that provides patients with advanced or metastastic RCC with additional clinical benefits with regard to PFS and OS after failed response to adjuvant sunitinib.
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Affiliation(s)
- Guillermo de Velasco
- Medical Oncology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Álvaro Ruiz-Granados
- Medical Oncology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Oscar Reig
- Translational Genomics and Targeted Therapeutics in Solid Tumours Lab, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Francesco Massari
- Oncologia Medica, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italia.,Division of Oncology, S. Orsola-Malpighi Hospital, Bologna, Italy
| | | | - Elena Verzoni
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | | | | | - Michele De Tursi
- Department of Oncology and Neurosciences, Consorzio Interuniversitario Nazionale per la Bio-Oncologia, University G. d'Annunzio, Chieti, Italy
| | - Frede Donskov
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Clara Iglesias
- Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | - Xavier Garcia Del Muro
- Department of Medical Oncology, Institut Català d'Oncologia L'Hospitalet, Hospital Duran i Reynals, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Giuseppe Procopio
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Stephane Oudard
- Medical Oncology Department, Georges Pompidou Hospital, University of Paris, Paris, France
| | - Daniel Castellano
- Medical Oncology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Laurence Albiges
- Medical Oncology, Gustave Roussy, Université Paris-Saclay, Villejuif, France
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18
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Real World Analysis of Small Cell Lung Cancer Patients: Prognostic Factors and Treatment Outcomes. ACTA ACUST UNITED AC 2021; 28:317-331. [PMID: 33435584 PMCID: PMC7903279 DOI: 10.3390/curroncol28010036] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 12/02/2020] [Accepted: 12/03/2020] [Indexed: 01/22/2023]
Abstract
In this observational study, we assessed treatment patterns and prognostic factors in patients with small cell lung cancer (SCLC) in a large state-mandated healthcare organization in Israel. Methods: All incident cases with histologically confirmed SCLC who initiated systemic anti-cancer treatment between 2011 and 2017 were identified. Treatment patterns and overall survival (OS) were evaluated for each line of therapy. Results: A total of 235 patients were identified (61% male, median age 64 years, 95% ever smokers, 64% had extensive stage). The first-line treatment was platinum-etoposide regimen for 98.7% of the cohort. The second and third-line regimen were given to 43% and 12% of patients, respectively. Mean OS for extensive and limited stage patients was 9.1 and 23.5 months respectively. In a multivariable model, increased risk for mortality was observed among patients with an ECOG performance status (PS) of 2 compared to a PS of 0-1 for the extensive stage patients (Hazard ratio (HR) = 1.63, 95% confidence ratios (CI): 1.00-2.65); and for males compared to females for the limited stage patients (HR = 2.17; 95% CI: 1.12-4.20). Regarding all 2nd line patients in a multivariable model incorporating relevant confounding factors, demonstrated a significantly better outcome with platinum-based regimens compared to topotecan. Median survival after initiation of 2nd line in platinum-sensitive patients was longer (p = 0.056) for those re-challenged with platinum-based regimen (n = 7): 6.8mo (6.1-not reported (NR)), compared with those switched to a different treatment (n = 27): 4.5 mo (2.6-6.6) for extensive stage patients, and a non-significant difference was also observed for limited stage patients. Conclusion: To our knowledge, this is one of the largest real-world studies of SCLC patients. OS for SCLC patients was similar to that reported in clinical trials. PS for extensive stage patients and sex for limited stage patients were significant correlates of prognosis. Re-challenge of the platinum-based doublet was associated with longer OS compared to switching treatment in extensive stage patients.
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19
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Subbiah V, Paz-Ares L, Besse B, Moreno V, Peters S, Sala MA, López-Vilariño JA, Fernández C, Kahatt C, Alfaro V, Siguero M, Zeaiter A, Zaman K, López R, Ponce S, Boni V, Arrondeau J, Delord JP, Martínez M, Wannesson L, Antón A, Valdivia J, Awada A, Kristeleit R, Olmedo ME, Rubio MJ, Sarantopoulos J, Chawla SP, Mosquera-Martinez J, D' Arcangelo M, Santoro A, Villalobos VM, Sands J, Trigo J. Antitumor activity of lurbinectedin in second-line small cell lung cancer patients who are candidates for re-challenge with the first-line treatment. Lung Cancer 2020; 150:90-96. [PMID: 33096421 DOI: 10.1016/j.lungcan.2020.10.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 10/05/2020] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The National Comprehensive Cancer Network guidelines recommend re-challenge with the first-line treatment for relapsed small cell lung cancer (SCLC) with chemotherapy-free interval (CTFI)≥180 days. A phase II study (NCT02454972) showed remarkable antitumor activity in SCLC patients treated with lurbinectedin 3.2 mg/m2 1 -h intravenous infusion every 3 weeks as second-line therapy. We report results for the pre-planned subset of patients with CTFI ≥ 180 days. MATERIAL AND METHODS Twenty patients aged ≥18 years with pathologically proven SCLC diagnosis, pretreated with only one prior platinum-containing line, no CNS metastases, and with CTFI ≥ 180 days were evaluated. The primary efficacy endpoint was the overall response rate (ORR) assessed by the Investigators according to RECIST v1.1. RESULTS ORR was 60.0 % (95 %CI, 36.1-86.9), with a median duration of response of 5.5 months (95 %CI, 2.9-11.2) and disease control rate of 95.0 % (95 %CI, 75.1-99.9). Median progression-free survival was 4.6 months (95 %CI, 2.6-7.3). With a censoring of 55.0 %, the median overall survival was 16.2 months (95 %CI, 9.6-upper level not reached). Of note, 60.9 % and 27.1 % of patients were alive at 1 and 2 years, respectively. The most common grade 3/4 adverse events and laboratory abnormalities were hematological disorders (neutropenia, 55.0 %; anemia; 10.0 % thrombocytopenia, 10.0 %), fatigue (10.0 %) and increased liver function tests (GGT, 10 %; ALT and AP, 5.0 % each). No febrile neutropenia was reported. CONCLUSION Lurbinectedin is an effective treatment for platinum-sensitive relapsed SCLC, especially in patients with CTFI ≥ 180 days, with acceptable safety and tolerability. These encouraging results suggest that lurbinectedin can be another valuable therapeutic option rather than platinum re-challenge.
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Affiliation(s)
- Vivek Subbiah
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Luis Paz-Ares
- Hospital Universitario Doce de Octubre, Madrid, Spain
| | | | - Victor Moreno
- START Madrid-FJD, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | | | | | | | | | | | | | | | | | | | - Rafael López
- Hospital Clínico Universitario de Santiago de Compostela, Santiago De Compostela, Spain
| | | | - Valentina Boni
- START Madrid-CIOCC, Hospital Universitario Sanchinarro, Madrid, Spain
| | | | | | | | | | - Antonio Antón
- Hospital Universitario Miguel Servet, Zaragoza, Spain
| | | | - Ahmad Awada
- Institut Jules Bordet, Université Libre De Bruxelles, Brussels, Belgium
| | | | | | | | - John Sarantopoulos
- Institute for Drug Development, Mays Cancer Center at University of Texas Health San Antonio MD Anderson Cancer Center, San Antonio, TX, USA
| | | | | | | | | | | | - Jacob Sands
- Dana-Farber Cancer Institute, Boston, MA, USA
| | - José Trigo
- Hospital Universitario Virgen de la Victoria, Málaga, Spain
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20
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Chouaïd C, Baize N, Monnet I. Second-line therapy for disseminated small-cell lung cancer: optimal management remains to be defined. Transl Lung Cancer Res 2020; 9:1732-1735. [PMID: 33209596 PMCID: PMC7653159 DOI: 10.21037/tlcr-20-362] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Christos Chouaïd
- Univ Paris Est Créteil, INSERM, IMRB, Equipe CEpiA, 94010 Créteil, France.,Service de Pneumologie, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | | | - Isabelle Monnet
- Univ Paris Est Créteil, INSERM, IMRB, Equipe CEpiA, 94010 Créteil, France.,Service de Pneumologie, Centre Hospitalier Intercommunal de Créteil, Créteil, France
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21
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Serzan MT, Farid S, Liu SV. Drugs in development for small cell lung cancer. J Thorac Dis 2020; 12:6298-6307. [PMID: 33209468 PMCID: PMC7656445 DOI: 10.21037/jtd-2019-sclc-10] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 05/13/2020] [Indexed: 12/30/2022]
Abstract
Small cell lung cancer (SCLC) is a particularly lethal subtype of lung cancer whose treatment landscape has been relatively devoid of advance. The recent integration of immunotherapy in the first-line treatment of SCLC has improved overall survival (OS), prompting the first major paradigm shift for this disease in decades. Despite this improvement in outcomes, most patients with SCLC will relapse after initial response. Standard salvage systemic therapy for SCLC remains disappointing, with few approved agents and consistently poor outcomes. The need for novel agents to combat this disease remains pressing. Fortunately, there are several agents in various stages of development that hold potential as novel treatments for advanced SCLC. Lurbinectedin, which targets active transcription, has shown activity in platinum-sensitive and platinum-resistant SCLC as monotherapy and in combination with doxorubicin. Aurora A kinase (AAK) inhibitors showed initial activity when given with paclitaxel but in randomized studies, failed to improve outcomes over paclitaxel plus placebo. However, in the subset of patients with MYC expression, targeting AAK was effective. Similarly, agents targeting poly-ADP ribose (PARP) pair well with other DNA damaging drugs but in the subset of patients whose tumors express Schlafen-11 (SLFN-11), efficacy appeared greater. CDK 4/6 inhibition is being explored, primarily as a means to protect myeloid cells during cytotoxic chemotherapy in a strategy expected to be uniquely effective in SCLC. Ongoing trials are also studying are novel formulations of established cytotoxic agents. Delta-like protein 3 (DLL3) is an appealing therapeutic target given its selective expression on SCLC cells, but after initial exciting results, the antibody-drug conjugate (ADC) Rovalpituzumab tesirine (Rova-T) did not have a favorable efficacy to toxicity profile in randomized trials. Other agents targeting DLL3 are under study. Targeting angiogenesis has yielded modest improvements in the past but newer agents such as anlotinib are renewing interest. While the current therapeutic landscape beyond chemo-immunotherapy remains the same as it was decades ago, drug development for SCLC is rapidly moving forward and promises to deliver the needed novel agents in the very near future.
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Affiliation(s)
- Michael T. Serzan
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Saira Farid
- Department of Internal Medicine, Medstar Washington Hospital Center, Washington DC, USA
| | - Stephen V. Liu
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
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22
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Carboplatin plus etoposide versus topotecan as second-line treatment for patients with sensitive relapsed small-cell lung cancer: an open-label, multicentre, randomised, phase 3 trial. Lancet Oncol 2020; 21:1224-1233. [DOI: 10.1016/s1470-2045(20)30461-7] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 06/16/2020] [Accepted: 06/17/2020] [Indexed: 12/12/2022]
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23
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Trigo J, Subbiah V, Besse B, Moreno V, López R, Sala MA, Peters S, Ponce S, Fernández C, Alfaro V, Gómez J, Kahatt C, Zeaiter A, Zaman K, Boni V, Arrondeau J, Martínez M, Delord JP, Awada A, Kristeleit R, Olmedo ME, Wannesson L, Valdivia J, Rubio MJ, Anton A, Sarantopoulos J, Chawla SP, Mosquera-Martinez J, D'Arcangelo M, Santoro A, Villalobos VM, Sands J, Paz-Ares L. Lurbinectedin as second-line treatment for patients with small-cell lung cancer: a single-arm, open-label, phase 2 basket trial. Lancet Oncol 2020; 21:645-654. [DOI: 10.1016/s1470-2045(20)30068-1] [Citation(s) in RCA: 143] [Impact Index Per Article: 35.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 01/20/2020] [Accepted: 01/22/2020] [Indexed: 12/12/2022]
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24
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Abstract
Small cell lung cancer (SCLC) is an aggressive malignancy and carries a poor prognosis with limited effective treatments in the advanced setting. SCLC is characterized by a high tumor mutation burden and alterations in Notch signaling and DNA damage repair pathways, providing rationale for the use of immunotherapy and targeted therapies. Immunotherapies have led to the most significant advances in treating SCLC in decades, and several promising targeted approaches have emerged from the increased understanding of the biology of SCLC. However, responses to these novel approaches are far from universal, and efforts to refine these therapies are ongoing.
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25
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Tendler S, Zhan Y, Pettersson A, Lewensohn R, Viktorsson K, Fang F, De Petris L. Treatment patterns and survival outcomes for small-cell lung cancer patients - a Swedish single center cohort study. Acta Oncol 2020; 59:388-394. [PMID: 31910696 DOI: 10.1080/0284186x.2019.1711165] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Objectives: This real-world study on small-cell lung cancer (SCLC) patients aimed to investigate treatment patterns, outcome of re-challenge with platinum doublet chemotherapy (PDCT), and associations between clinical characteristics and survival outcomes.Material and methods: This retrospective single center cohort study was based on patients diagnosed with SCLC between 2008 and 2016 at the Karolinska University Hospital, Stockholm, Sweden. Patients were divided into two subgroups; limited disease (LD), receiving concomitant chemo- and radiotherapy and extensive disease (ED), receiving palliative PDCT. The progression-free survival (PFS) was defined as the interval between the start of CT and the earliest date of documented progression. 'Refractory relapse' (Rr) and 'Sensitive relapse' (Sr) were defined as relapse occurring < or ≥180 days after start of PDCT, respectively. The results for treatment patterns were reported as numbers and percentages of patients, and descriptive analyses including medians and 95% confidence intervals (CIs). The Cox proportional hazards regression model was applied to assess the relationship between clinical characteristics and overall survival (OS).Results: The study included 544 patients; 408 with ED and 136 patients had LD. The median PFS and OS for ED patients were 5.1 and 7.0, respectively. In the ED subgroup, Sr occurred in 169 patients (41%), with a longer median OS when compared to Rr patients (10.8 vs. 3.6 months). Patients with LD had a median PFS and OS of 12 and 24 months, respectively. Some LD patients did not show a sign of relapse (22%). The majority of LD patients who relapsed had Sr (66%), with a longer median OS when compared to patients with Rr (20.9 vs. 7.8 mo).Conclusions: The survival outcomes for ED and LD SCLC patients correspond to historical data. Patients with Sr after 1st line therapy might benefit from re-challenge with PDCT in the 2nd line setting.
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Affiliation(s)
- Salomon Tendler
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
- Theme Cancer, Patient Area Head and Neck, Lung, and Skin Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Yiqiang Zhan
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Andreas Pettersson
- Department of Medicine Solna, Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden
| | - Rolf Lewensohn
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
- Theme Cancer, Patient Area Head and Neck, Lung, and Skin Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Kristina Viktorsson
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
- Theme Cancer, Patient Area Head and Neck, Lung, and Skin Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Fang Fang
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Luigi De Petris
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
- Theme Cancer, Patient Area Head and Neck, Lung, and Skin Cancer, Karolinska University Hospital, Stockholm, Sweden
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26
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Früh M, Panje CM, Reck M, Blackhall F, Califano R, Cappuzzo F, Besse B, Novello S, Garrido P, Felip E, O'Brien M, Paz Ares L, de Marinis F, Westeel V, De Ruysscher D, Putora PM. Choice of second-line systemic therapy in stage IV small cell lung cancer (SCLC) - A decision-making analysis amongst European lung cancer experts. Lung Cancer 2020; 146:6-11. [PMID: 32485661 DOI: 10.1016/j.lungcan.2020.03.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 03/17/2020] [Accepted: 03/20/2020] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Stage IV small cell lung cancer (SCLC) is associated with short survival and progression after first-line systemic therapy frequently occurs within months. Although topotecan is approved for second-line treatment, its efficacy is limited, and treatment heterogeneity exists. MATERIAL AND METHODS The decision-making patterns for second line treatment of 13 European medical oncologists with expertise in SCLC were analyzed. RESULTS The two criteria most relevant to decision-making were the performance status and the interval of recurrence since first-line treatment. With an interval of less than 3 months since the end of first-line chemotherapy, 62 % of the experts recommended cyclophosphamide, doxorubicin and vincristine (CAV) for fit patients and 54 % recommended topotecan for unfit patients. For an interval of more than 6 months, a clear consensus for a re-challenge with a platinum doublet was achieved (92 %). However, there was no consensus on the second-line therapy with an interval of 3-6 months since the end of first-line therapy. CONCLUSION Real world practice may differ from recommendations in general guidelines and cannot always be directly derived from trial results as other factor such as habits, patient's preference, convenience or costs have to be factored in.
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Affiliation(s)
- M Früh
- Department of Medical Oncology/Hematology, Cantonal Hospital of St. Gallen, St. Gallen, Switzerland; University of Bern, Bern, Switzerland.
| | - C M Panje
- Department of Radiation Oncology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - M Reck
- LungenClinic Airway Research Center North (ARCN), German Center for Lung Research, Grosshansdorf, Germany
| | - F Blackhall
- Division of Cancer Sciences, University of Manchester & The Christie NHS Foundation Trust Manchester, United Kingdom
| | - R Califano
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom; Department of Medical Oncology, Manchester University NHS Foundation Trust, Manchester, United Kingdom; Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom
| | - F Cappuzzo
- Oncology and Hematology Department, AUSL Romagna, Viale Randi 5, Ravenna, Italy
| | - B Besse
- Institut Gustave Roussy, Villejuif, France; Université Paris Sud, Le Kremlin Bicetre, France
| | - S Novello
- Oncology Department, AOU San Luigi, University of Turin, Italy
| | - P Garrido
- Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - E Felip
- Vall d'Hebron University Hospital and Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - M O'Brien
- Department of Medicine, The Royal Marsden NHS Foundation Trust, Sutton, Surrey, United Kingdom
| | - L Paz Ares
- Hospital Universitario 12 de Octubre, Madrid, Spain
| | - F de Marinis
- Division of Thoracic Oncology, European Institute of Oncology, IRCCS, Milan, Italy
| | | | - D De Ruysscher
- Maastricht University Medical Center, Department of Radiation Oncology (Maastro Clinic), School for Oncology and Developmental Biology (GROW), Maastricht, the Netherlands
| | - P M Putora
- University of Bern, Bern, Switzerland; Department of Radiation Oncology, Kantonsspital St. Gallen, St. Gallen, Switzerland
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27
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Wakuda K, Miyawaki T, Miyawaki E, Mamesaya N, Kawamura T, Kobayashi H, Omori S, Nakashima K, Ono A, Kenmotsu H, Naito T, Murakami H, Mori K, Endo M, Takahashi T. Efficacy of Second-line Chemotherapy in Patients With Sensitive Relapsed Small-cell Lung Cancer. In Vivo 2020; 33:2229-2234. [PMID: 31662561 DOI: 10.21873/invivo.11727] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 09/16/2019] [Accepted: 09/17/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND/AIM To evaluate treatment efficacy of cisplatin, etoposide, and irinotecan combined therapy (PEI), platinum-rechallenge chemotherapy (Pt-Re) and amrubicin monotherapy (AMR) for patients with sensitive relapsed small cell lung cancer (SCLC). PATIENTS AND METHODS We defined sensitive relapse as treatment-free interval (TFI) ≥90 days. We retrospectively collected patients' data from medical records between September 2002 and December 2016. Patients with sensitive relapsed SCLC who received second-line chemotherapy were separated into those treated with PEI, with Pt-Re, or with AMR. RESULTS Seventy-one patients (16 PEI group, 27 Pt-Re group, and 28 AMR group) were assessable for efficacy. No significant differences in patient characteristics were found among the three groups. The median overall survival (MST) was 29.3 months in the PEI group, 24.6 months in the Pt-Re group, and 20.6 months in the AMR group (p=0.042). CONCLUSION A significant difference was observed in the overall survival of patients treated with PEI, Pt-Re and AMR and the MST of PEI was the longest.
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Affiliation(s)
- Kazushige Wakuda
- Division of Thoracic Oncology, Shizuoka Cancer Center, Nagaizumi, Japan
| | - Taichi Miyawaki
- Division of Thoracic Oncology, Shizuoka Cancer Center, Nagaizumi, Japan
| | - Eriko Miyawaki
- Division of Thoracic Oncology, Shizuoka Cancer Center, Nagaizumi, Japan
| | - Nobuaki Mamesaya
- Division of Thoracic Oncology, Shizuoka Cancer Center, Nagaizumi, Japan
| | - Takahisa Kawamura
- Division of Thoracic Oncology, Shizuoka Cancer Center, Nagaizumi, Japan
| | - Haruki Kobayashi
- Division of Thoracic Oncology, Shizuoka Cancer Center, Nagaizumi, Japan
| | - Shota Omori
- Division of Thoracic Oncology, Shizuoka Cancer Center, Nagaizumi, Japan
| | | | - Akira Ono
- Division of Thoracic Oncology, Shizuoka Cancer Center, Nagaizumi, Japan
| | | | - Tateaki Naito
- Division of Thoracic Oncology, Shizuoka Cancer Center, Nagaizumi, Japan
| | - Haruyasu Murakami
- Division of Thoracic Oncology, Shizuoka Cancer Center, Nagaizumi, Japan
| | - Keita Mori
- Clinical Trial Coordination Office, Shizuoka Cancer Center, Nagaizumi, Japan
| | - Masahiro Endo
- Division of Diagnostic Radiology, Shizuoka Cancer Center, Nagaizumi, Japan
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28
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von Eiff D, Bozorgmehr F, Chung I, Bernhardt D, Rieken S, Liersch S, Muley T, Kobinger S, Thomas M, Christopoulos P, Steins M. Paclitaxel for treatment of advanced small cell lung cancer (SCLC): a retrospective study of 185 patients. J Thorac Dis 2020; 12:782-793. [PMID: 32274145 PMCID: PMC7139030 DOI: 10.21037/jtd.2019.12.74] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background Etoposide-/platinum-based chemotherapy is the standard first-line treatment for extensive-disease small cell lung cancer (SCLC), but responses are short-lived and subsequent options limited. Here, we present our experience with paclitaxel in advanced treatment lines. Methods We retrospectively studied the clinical course of all paclitaxel-treated SCLC patients between 2005 and 2015 in our institution. Prognostic and predictive factors were analyzed by Kaplan-Meier and Cox regression analyses. Results A total of 185 patients [119 men, median age 65 years, median ECOG performance status (PS) 1] were identified. One hundred and sixty-eight patients had extensive disease (ED) at the time of paclitaxel therapy. Paclitaxel was mainly given as third- or fourth-line therapy (93%). The response rate (RR) was 17% and disease control rate (DCR) 28%. Patients reached a median progression-free survival (PFS) of 1.6 (95% CI: 1.4-1.8) months and median overall survival (OS) of 3.3 (95% CI: 2.8-3.9) months. Main toxicities were fatigue (25%) and polyneuropathy (17%). Dose reduction of ≥25% was associated with shorter PFS [1.9 (95% CI: 1.5-2.3) vs. 1.4 (95% CI: 1.3-1.5) months; P=0.004]. Further independent predictive factors for PFS were gender, age, and hepatic/brain metastases (P<0.05). Tumor response to paclitaxel, PS, number and location of metastases, dose reduction, and smoking history were significant factors for OS in univariable analyses (P<0.05), while PS, dose reduction, status of cerebral/hepatic metastases, tumor response, and smoking history were retained as independent prognostic factors in multivariable testing. Notably, ECOG PS 2 patients had toxicity rates similar to ECOG PS 0-1 patients (63% vs. 62%), as well as a comparable DCR (29% vs. 28%), which was associated with prolonged survival (4.5 vs. 3.2 months for refractory cases, P=0.034). Conclusions Paclitaxel has clinically relevant activity in heavily pretreated SCLC. While patients with good PS and no cerebral/hepatic metastases derive the greatest benefit, ECOG PS 2 per se should not be used as a criterion to exclude patients.
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Affiliation(s)
- Damian von Eiff
- Department of Thoracic Oncology, Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany.,Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research (DZL), Germany
| | - Farastuk Bozorgmehr
- Department of Thoracic Oncology, Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany.,Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research (DZL), Germany
| | - Inn Chung
- Department of Thoracic Oncology, Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany.,Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research (DZL), Germany
| | - Denise Bernhardt
- Heidelberg University Hospital, Department of Radiation Oncology, Heidelberg, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany
| | - Stefan Rieken
- Heidelberg University Hospital, Department of Radiation Oncology, Heidelberg, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany
| | - Stephan Liersch
- Pharmacy Department, Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany
| | - Thomas Muley
- Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research (DZL), Germany.,Translational Research Unit, Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany
| | - Sonja Kobinger
- Translational Research Unit, Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany
| | - Michael Thomas
- Department of Thoracic Oncology, Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany.,Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research (DZL), Germany
| | - Petros Christopoulos
- Department of Thoracic Oncology, Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany.,Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research (DZL), Germany
| | - Martin Steins
- Department of Thoracic Oncology, Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany.,Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research (DZL), Germany
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29
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Real-World Adherence to Guideline-Recommended Treatment for Small Cell Lung Cancer. Am J Clin Oncol 2019; 43:236-242. [DOI: 10.1097/coc.0000000000000657] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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30
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Nachbargauer S, Bruchbacher A, Fajkovic H, Remzi M, Schmidinger M. Sunitinib Rechallenge in Patients With Metastatic Renal Cell Carcinoma. Clin Genitourin Cancer 2019; 18:e277-e283. [PMID: 31902715 DOI: 10.1016/j.clgc.2019.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 11/02/2019] [Accepted: 11/27/2019] [Indexed: 01/10/2023]
Abstract
BACKGROUND Sunitinib has been the standard of care for patients with metastatic renal cell carcinoma (mRCC). However, nearly all patients will eventually develop resistance. Before the introduction of novel agents, few treatment options remained after sunitinib failure. Sunitinib rechallenge is a strategy based on the presumption that resistance might be only temporary. The aim of this analysis was to evaluate the efficacy and safety of sunitinib rechallenge in patients with mRCC. PATIENTS AND METHODS Patients who had undergone sunitinib rechallenge (SU2) at the Medical University of Vienna from 2010 to 2017 were identified for the present retrospective study. The primary endpoint was the treatment duration with rechallenge (TDSU2). The secondary endpoints included the treatment duration with upfront sunitinib (TDSU1), progression-free survival (PFSSU1 and PFSSU2), overall survival (OSSU1 and OSSU2), the objective response rate in both settings (ORRSU1 and ORRSU2), and toxicity. RESULTS A total of 31 patients were eligible. The median TDSU2 was 7.2 months, and the median TDSU1 was 17.8 months. The median OSSU1 and OSSU2 was 57.9 months and 14.7 months, respectively. The median PFSSU1 and PFSSU2 was 14.2 months and 5.6 months, respectively. The ORRSU1 and ORRSU2 was 34% and 16%, and another 48% and 42% achieved stable disease (SD), respectively. Fatigue and hypertension were the most common adverse events. CONCLUSIONS Sunitinib rechallenge appears to benefit patients in later treatment lines. With the abundance of novel treatment options available, this approach might appear less relevant. However, novel agents are not yet available everywhere. Thus, sunitinib rechallenge could be an additional strategy to improve the outcomes of patients with mRCC.
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Affiliation(s)
- Sebastian Nachbargauer
- Clinical Division of Oncology and Comprehensive Cancer Center, Department of Medicine I, Medical University of Vienna, Vienna, Austria.
| | - Andreas Bruchbacher
- Clinical Division of Oncology and Comprehensive Cancer Center, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Harun Fajkovic
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Mesut Remzi
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Manuela Schmidinger
- Clinical Division of Oncology and Comprehensive Cancer Center, Department of Medicine I, Medical University of Vienna, Vienna, Austria
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Povsic M, Enstone A, Wyn R, Kornalska K, Penrod JR, Yuan Y. Real-world effectiveness and tolerability of small-cell lung cancer (SCLC) treatments: A systematic literature review (SLR). PLoS One 2019; 14:e0219622. [PMID: 31318909 PMCID: PMC6638917 DOI: 10.1371/journal.pone.0219622] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 06/27/2019] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVES SCLC makes up approximately 15% of all lung carcinomas and is characterized by relatively aggressive spread and poorer prognosis compared to other lung cancers. Treatment options are limited, and their efficacy in randomized trials is poor, whilst outcomes in clinical practice remain unclear. The aim of this study was to assess the real-world effectiveness and tolerability of SCLC treatments. METHODS An SLR was conducted across nine databases accessed through OVID, capturing observational, non-randomized studies published between 01/2006-11/2018. In total, 554 abstracts were retrieved and systematically screened for eligibility. The eligible publications included effectiveness and tolerability data from adult SCLC patients (at any line of therapy). Additional grey literature searches were conducted. RESULTS Forty-three publications were included in this review-data from first-line therapies were captured most often (n = 32), while data from second (n = 14) and third line (n = 7) and beyond (n = 7) were less frequent. The publications reported primarily on chemotherapy/radiotherapy. The majority of publications lacked robustness and only 14/43 conducted statistical analyses or controlled for bias. Median OS for the largest SCLC populations were 9.6 months at first line (n = 23,535) and 4.9 months at second line (n = 254) for treatment with chemotherapy, and 4.7 months at third line (n = 120) for predominantly platinum-based chemotherapy or cyclophosphamide/adriamycin/vincristine. Hematologic toxicities (such as neutropenia, thrombocytopenia and anemia) were the most frequently reported TRAEs (n = 9). CONCLUSIONS Real-world treatment effectiveness and tolerability data were fragmented and inconsistently reported, and available publications were primarily of poor quality and lacked statistical analyses. This SLR showed limited treatment options and poor OS in SCLC, with no treatment option being clearly superior. TRAEs additionally increased the burden of this already challenging disease. Recent data suggest real-world outcomes are even poorer that those reported in clinical trials, and that novel therapies are needed to offer new treatment options for patients.
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Affiliation(s)
- Manca Povsic
- Adelphi Values, Bollington, Cheshire, United Kingdom
| | | | - Robin Wyn
- Adelphi Values, Bollington, Cheshire, United Kingdom
| | | | - John R. Penrod
- Bristol-Myers Squibb, Princeton, NJ, United States of America
| | - Yong Yuan
- Bristol-Myers Squibb, Princeton, NJ, United States of America
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Mignard X, Ruppert AM, Lavolé A, Vieira T, Rozensztajn N, Cadranel J, Wislez M. Is chemotherapy rechallenge feasible in advanced-stage non-small-cell lung cancer? Bull Cancer 2019; 106:725-733. [PMID: 31202557 DOI: 10.1016/j.bulcan.2019.04.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Revised: 12/02/2018] [Accepted: 04/27/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Despite recent progress, non-small cell lung cancer (NSCLC) first-line treatment remains a platinum-based doublet in most cases. No guidelines exist beyond third line. Chemotherapy rechallenge is an option, but little data is available in NSCLC. Our study aims to describe patients who underwent chemotherapy rechallenge while assessing its efficacy and safety. METHODS Consecutive patients with advanced-stage NSCLC receiving first-line treatment in Tenon hospital in 2011 were included, with a 5-year follow-up. Patients were analyzed according to chemotherapy rechallenge or not. Chemotherapy rechallenge was defined as re-initiation of a previously administered chemotherapy agent at any point in the treatment sequence, with at least one treatment regimen between first use and rechallenge. RESULTS Of 149 patients, 18 underwent chemotherapy rechallenge (12%). They were younger (56 vs. 61 years, P=0.04), mostly women (61% vs. 30%, P=0.02), with lepidic adenocarcinoma (23% vs. 3.5%, P=0.03), a better general state of health (100% performance status 0-1 vs. 74%, P=0.04), and fewer cardiovascular comorbidities (16% vs. 42%, P=0.04). They were more likely to have received a receptor tyrosine kinase inhibitor treatment (89% vs. 43%, P=0.0003). Progression-free survival was longer at first use than at rechallenge (median 9.2 vs. 2.7 months, P=0.002). No increased toxicity was observed at rechallenge compared to first use. Finally, a subsequent line of treatment was given after rechallenge in 61% of the patients. CONCLUSION Patients eligible for chemotherapy rechallenge were those with good prognostic factors. Chemotherapy rechallenge may provide a well-tolerated additional line of treatment, with decreased efficacy compared to its first application.
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Affiliation(s)
- Xavier Mignard
- Sorbonne université, UPMC Univ Paris 06, GRC n(o) 04, Theranoscan, 75252 Paris, France
| | - Anne-Marie Ruppert
- AP-HP, Tenon university hospital, pneumology department, 75970 Paris, France
| | - Armelle Lavolé
- AP-HP, Tenon university hospital, pneumology department, 75970 Paris, France
| | - Thibault Vieira
- Institut Mutualiste Montsouris, pneumology department, Paris, France
| | | | - Jacques Cadranel
- AP-HP, Tenon university hospital, pneumology department, 75970 Paris, France
| | - Marie Wislez
- AP-HP, Tenon university hospital, pneumology department, 75970 Paris, France; Sorbonne université, UPMC Univ Paris 06, GRC n(o) 04, Theranoscan, 75252 Paris, France.
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Nasu S, Suzuki H, Moriizumi K, Hara Y, Tanaka S, Takada H, Morita S, Tanaka A, Shiroyama T, Morishita N, Okamoto N, Hirashima T. Re-challenge chemotherapy in patients with sensitive relapse small-cell lung cancer and interstitial lung disease. J Thorac Dis 2019; 11:514-520. [PMID: 30962995 DOI: 10.21037/jtd.2019.01.26] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Treatment modalities for small-cell lung cancer (SCLC) with pre-existing interstitial lung disease (ILD) are limited. Although re-challenge with first-line chemotherapy can be effective for sensitive relapse SCLC, its safety and efficacy are uncertain in cases with ILD. This study aimed to investigate both the efficacy and safety of re-challenge chemotherapy in patients with sensitive relapse SCLC with ILD. Methods Patients with sensitive relapse SCLC with ILD who received re-challenge chemotherapy were studied retrospectively. Sensitive relapse was defined as a treatment-free interval (TFI) of more than 60 days after first-line platinum-based treatment. The endpoints were progression-free survival (PFS), overall survival (OS), and safety. Results Re-challenge platinum and etoposide were administered in 11 patients, with the median re-challenge cycle of 3. The overall response rate was 55%. The median PFS and OS from the time of re-challenge treatment were 4 months (95% CI, 2.9-NA) and 9.2 months (95% CI, 8.0-NA), respectively. One patient developed acute exacerbation of ILD 173 days after the last course of re-challenge treatment. Conclusions Re-challenge chemotherapy can be effective and considered in SCLC patients with pre-existing ILD.
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Affiliation(s)
- Shingo Nasu
- Department of Thoracic Oncology, Osaka Prefectural Hospital Organization Osaka Habikino Medical Center, Osaka, Japan
| | - Hidekazu Suzuki
- Department of Thoracic Oncology, Osaka Prefectural Hospital Organization Osaka Habikino Medical Center, Osaka, Japan
| | - Kazunori Moriizumi
- Department of Thoracic Oncology, Osaka Prefectural Hospital Organization Osaka Habikino Medical Center, Osaka, Japan
| | - Yuki Hara
- Department of Thoracic Oncology, Osaka Prefectural Hospital Organization Osaka Habikino Medical Center, Osaka, Japan
| | - Satoshi Tanaka
- Department of Thoracic Oncology, Osaka Prefectural Hospital Organization Osaka Habikino Medical Center, Osaka, Japan
| | - Hiromune Takada
- Department of Thoracic Oncology, Osaka Prefectural Hospital Organization Osaka Habikino Medical Center, Osaka, Japan
| | - Satomu Morita
- Department of Thoracic Oncology, Osaka Prefectural Hospital Organization Osaka Habikino Medical Center, Osaka, Japan
| | - Ayako Tanaka
- Department of Thoracic Oncology, Osaka Prefectural Hospital Organization Osaka Habikino Medical Center, Osaka, Japan
| | - Takayuki Shiroyama
- Department of Thoracic Oncology, Osaka Prefectural Hospital Organization Osaka Habikino Medical Center, Osaka, Japan
| | - Naoko Morishita
- Department of Thoracic Oncology, Osaka Prefectural Hospital Organization Osaka Habikino Medical Center, Osaka, Japan
| | - Norio Okamoto
- Department of Thoracic Oncology, Osaka Prefectural Hospital Organization Osaka Habikino Medical Center, Osaka, Japan
| | - Tomonori Hirashima
- Department of Thoracic Oncology, Osaka Prefectural Hospital Organization Osaka Habikino Medical Center, Osaka, Japan
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Pacheco J, Bunn PA. Advancements in Small-cell Lung Cancer: The Changing Landscape Following IMpower-133. Clin Lung Cancer 2019; 20:148-160.e2. [PMID: 30686680 DOI: 10.1016/j.cllc.2018.12.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 12/12/2018] [Accepted: 12/25/2018] [Indexed: 12/30/2022]
Abstract
The treatment landscape of small-cell lung cancer is rapidly evolving. Results of the first-line randomized trial comparing etoposide/carboplatin/placebo with etoposide/carboplatin/atezolizumab (IMpower-133) were recently published, showing a longer progression-free survival and overall survival for patients receiving atezolizumab. These results changed the standard first-line therapy for the first time in several decades. There are 4 additional ongoing randomized trials comparing chemotherapy alone with chemotherapy plus immune checkpoint inhibition as initial treatment. In addition to these major changes in first-line treatment, multiple second or later line options with new agents are likely to change therapeutic standards in these settings. In this article, we discuss the changing treatment landscape following IMpower-133, highlight new second/subsequent line approaches, and discuss the role of biomarkers in patient selection for these treatments.
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Affiliation(s)
- Jose Pacheco
- University of Colorado Cancer Center, Aurora, CO.
| | - Paul A Bunn
- University of Colorado Cancer Center, Aurora, CO
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Shiozawa T, Sekine I, Aida Y, Watanabe H, Nakazawa K, Kurishima K, Satoh H, Hizawa N. Rechallenge with First-Line Platinum Chemotherapy for Sensitive-Relapsed Small-Cell Lung Cancer. Case Rep Oncol 2018; 11:622-632. [PMID: 30323752 PMCID: PMC6180263 DOI: 10.1159/000492780] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 08/07/2018] [Indexed: 11/19/2022] Open
Abstract
Background Sensitive-relapsed small-cell lung cancer (SCLC) is thought to be sensitive to chemotherapy; therefore, second-line chemotherapy is recommended. Although platinum rechallenge is performed in the second-line chemotherapy for sensitive-relapsed SCLC, it remains unclear whether such a strategy is effective. Methods We retrospectively analyzed the outcome of rechallenge chemotherapy for sensitive-relapsed SCLC. The endpoints of this study were progression-free survival from the time of relapse (PFS-Re) and overall survival from the time of relapse (OS-Re). We also compared the toxicity profile of rechallenge chemotherapy to that of first-line chemotherapy. Results Of the 133 SCLC patients who received first-line treatment, 20 patients satisfied the definition of sensitive relapse and received rechallenge chemotherapy. Combined carboplatin and etoposide was the most commonly used rechallenge regimen, and 17 (85%) received it at a reduced dose due to hematological toxicity during the first-line treatment. Median PFS-Re and OS-Re were 4.5 months (95% CI: 3.5–5.4) and 10.5 months (95% CI: 7.9–13.0), respectively. There was no association between dose adjustment and survival. The frequency of hematologic toxicity tended to be lower with rechallenge than first-line treatment. The incidence of grade 3 febrile neutropenia decreased from 40% in first-line treatment to 15% in rechallenge. Conclusion Platinum rechallenge could be a useful second-line option for sensitive-relapsed SCLC, having favorable efficacy and safety. Dose adjustment at rechallenge based on the toxicity profile during the first-line chemotherapy could reduce toxicity without weakening efficacy.
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Affiliation(s)
- Toshihiro Shiozawa
- Department of Respiratory Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Ikuo Sekine
- Department of Medical Oncology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Yuka Aida
- Department of Respiratory Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Hiroko Watanabe
- Department of Respiratory Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Kensuke Nakazawa
- Department of Respiratory Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Koichi Kurishima
- Division of Respiratory Medicine, Tsukuba Medical Center Hospital, Tsukuba, Japan
| | - Hiroaki Satoh
- Department of Respiratory Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Nobuyuki Hizawa
- Department of Respiratory Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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Franceschi E, Lamberti G, Visani M, Paccapelo A, Mura A, Tallini G, Pession A, De Biase D, Minichillo S, Tosoni A, Di Battista M, Cubeddu A, Bartolini S, Brandes AA. Temozolomide rechallenge in recurrent glioblastoma: when is it useful? Future Oncol 2018; 14:1063-1069. [PMID: 29741106 DOI: 10.2217/fon-2017-0681] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
AIM To identify patients with recurrent glioblastoma after temozolomide (TMZ) concurrent with and adjuvant to radiotherapy who could benefit from TMZ rechallenge at the time of disease progression. METHODS We retrospectively evaluated 106 glioblastoma patients who had nonprogressive disease at first magnetic resonance imaging after completion of TMZ concurrent with and adjuvant to radiotherapy, a treatment-free interval (TFI) of at least 8 weeks and received TMZ rechallenge or a nitrosourea at the time of progression. RESULTS In patients with TFI ≥5 months, median survival was 17.7 and 11.6 months and median progression-free survival was 8.1 and 5.8 months in the TMZ and nitrosourea group, respectively. Longer TFI was associated with reduced risk for death (p = 0.002) and for disease progression (p = 0.005). CONCLUSION TFI ≥5 months represents a predictor of retained TMZ sensitivity.
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Affiliation(s)
- Enrico Franceschi
- Department of Medical Oncology, Bellaria-Maggiore Hospitals, Azienda USL, IRCCS Institute of Neurological Sciences, Bologna, Italy
| | - Giuseppe Lamberti
- Department of Medical Oncology, Bellaria-Maggiore Hospitals, Azienda USL, IRCCS Institute of Neurological Sciences, Bologna, Italy
| | - Michela Visani
- Department of Medicine (Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale) - Molecular Diagnostic Unit, Azienda USL di Bologna, University of Bologna School of Medicine, Bologna, Italy
| | - Alexandro Paccapelo
- Department of Medical Oncology, Bellaria-Maggiore Hospitals, Azienda USL, IRCCS Institute of Neurological Sciences, Bologna, Italy
| | - Antonella Mura
- Department of Medical Oncology, Bellaria-Maggiore Hospitals, Azienda USL, IRCCS Institute of Neurological Sciences, Bologna, Italy
| | - Giovanni Tallini
- Department of Medicine (Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale) - Molecular Diagnostic Unit, Azienda USL di Bologna, University of Bologna School of Medicine, Bologna, Italy
| | - Annalisa Pession
- Department of Pharmacy & Biotechnology (Dipartimento di Farmacia e Biotecnologie) - Molecular Diagnostic Unit, Azienda USL di Bologna, University of Bologna, Bologna, Italy
| | - Dario De Biase
- Department of Pharmacy & Biotechnology (Dipartimento di Farmacia e Biotecnologie) - Molecular Diagnostic Unit, Azienda USL di Bologna, University of Bologna, Bologna, Italy
| | - Santino Minichillo
- Department of Medical Oncology, Bellaria-Maggiore Hospitals, Azienda USL, IRCCS Institute of Neurological Sciences, Bologna, Italy
| | - Alicia Tosoni
- Department of Medical Oncology, Bellaria-Maggiore Hospitals, Azienda USL, IRCCS Institute of Neurological Sciences, Bologna, Italy
| | - Monica Di Battista
- Department of Medical Oncology, Bellaria-Maggiore Hospitals, Azienda USL, IRCCS Institute of Neurological Sciences, Bologna, Italy
| | - Alessio Cubeddu
- Department of Medical Oncology, Bellaria-Maggiore Hospitals, Azienda USL, IRCCS Institute of Neurological Sciences, Bologna, Italy
| | - Stefania Bartolini
- Department of Medical Oncology, Bellaria-Maggiore Hospitals, Azienda USL, IRCCS Institute of Neurological Sciences, Bologna, Italy
| | - Alba A Brandes
- Department of Medical Oncology, Bellaria-Maggiore Hospitals, Azienda USL, IRCCS Institute of Neurological Sciences, Bologna, Italy
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Rossi A, Tay R, Chiramel J, Prelaj A, Califano R. Current and future therapeutic approaches for the treatment of small cell lung cancer. Expert Rev Anticancer Ther 2018; 18:473-486. [PMID: 29544351 DOI: 10.1080/14737140.2018.1453361] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Small-cell lung cancer (SCLC) is a very aggressive disease characterized by a high response rate to first-line chemotherapy, but most patients relapse within 1 year with disappointing results to second-line treatments. Chemotherapy has reached a plateau of effectiveness and new therapeutic strategies are needed to change the natural history of SCLC. Areas covered: This review will focus on the current results and the future development of the therapeutic approaches for the treatment of SCLC. Expert commentary: Immunotherapy is becoming a new frontier for the management of SCLC with preliminary interesting results. To date, no targeted drugs have been approved for clinical practice but several novel agents are in an advanced stage of clinical development in SCLC.
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Affiliation(s)
- Antonio Rossi
- a Division of Medical Oncology , Scientific Institute for Research and Health Care (IRCCS) "Casa Sollievo della Sofferenza" , San Giovanni Rotondo , Italy
| | - Rebecca Tay
- b Department of Medical Oncology , The Christie NHS Foundation Trust , Manchester , UK
| | - Jaseela Chiramel
- b Department of Medical Oncology , The Christie NHS Foundation Trust , Manchester , UK
| | - Arsela Prelaj
- b Department of Medical Oncology , The Christie NHS Foundation Trust , Manchester , UK.,c Department of Radiological , Pathological and Oncological Science, Sapienza University of Rome , Italy
| | - Raffaele Califano
- b Department of Medical Oncology , The Christie NHS Foundation Trust , Manchester , UK.,d Department of Medical Oncology , Manchester University NHS Foundation Trust , Manchester , UK.,e Division of Cancer Sciences , University of Manchester , Manchester , UK
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Calvo E, Moreno V, Flynn M, Holgado E, Olmedo ME, Lopez Criado MP, Kahatt C, Lopez-Vilariño JA, Siguero M, Fernandez-Teruel C, Cullell-Young M, Soto Matos-Pita A, Forster M. Antitumor activity of lurbinectedin (PM01183) and doxorubicin in relapsed small-cell lung cancer: results from a phase I study. Ann Oncol 2017; 28:2559-2566. [PMID: 28961837 PMCID: PMC5834091 DOI: 10.1093/annonc/mdx357] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Lurbinectedin (PM01183) has synergistic antitumor activity when combined with doxorubicin in mice with xenografted tumors. This phase I trial determined the recommended dose (RD) of doxorubicin (bolus) and PM01183 (1-h intravenous infusion) on day 1 every 3 weeks (q3wk), and obtained preliminary evidence of antitumor activity for this combination in small-cell lung cancer (SCLC). PATIENTS AND METHODS Patients with advanced solid tumors received doxorubicin and PM01183 following a standard dose escalation design and expansion at the RD. Twenty-seven patients had relapsed SCLC: 12 with sensitive disease (platinum-free interval ≥90 days) and 15 with resistant disease (platinum-free interval <90 days). RESULTS Doxorubicin 50 mg/m2 and PM01183 4.0 mg flat dose was the RD. In relapsed SCLC, treatment tolerance at the RD was manageable. Transient and reversible myelosuppression (including neutropenia, thrombocytopenia, and febrile neutropenia) was the main toxicity, managed with dose adjustment and colony-stimulating factors. Fatigue (79%), nausea/vomiting (58%), decreased appetite (53%), mucositis (53%), alopecia (42%), diarrhea/constipation (42%), and asymptomatic creatinine (68%) and transaminase increases (alanine aminotransferase 42%; aspartate aminotransferase 32%) were common, and mostly mild or moderate. Complete (n = 2, 8%) and partial response (n = 13, 50%) occurred in relapsed SCLC, mostly at the RD. Response rates at second line were 91.7% in sensitive disease [median progression-free survival (PFS)=5.8 months] and 33.3% in resistant disease (median PFS = 3.5 months). At third line, response rate was 20.0% (median PFS = 1.2 months), all in resistant disease. CONCLUSION Doxorubicin 50 mg/m2 and PM01183 4.0 mg flat dose on day 1 q3wk has shown remarkable activity, mainly in second line, with manageable tolerance in relapsed SCLC, leading to further evaluation of this combination within an ongoing phase III trial.
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Affiliation(s)
- E Calvo
- START Madrid - Oncology, HM CIOCC, Hospital Madrid Norte Sanchinarro, Madrid
| | - V Moreno
- START Madrid - Oncology, FJD (Hospital Fundación Jiménez Díaz), Madrid, Spain
| | - M Flynn
- Department of Oncology, University College of London Hospital and UCL Cancer Institute, London, UK
| | - E Holgado
- START Madrid - Oncology, HM CIOCC, Hospital Madrid Norte Sanchinarro, Madrid
| | - M E Olmedo
- Department of Oncology, Hospital Ramon y Cajal, Madrid
| | | | - C Kahatt
- Clinical R&D, Pharma Mar, S.A., Colmenar Viejo, Madrid, Spain
| | | | - M Siguero
- Clinical R&D, Pharma Mar, S.A., Colmenar Viejo, Madrid, Spain
| | | | - M Cullell-Young
- Clinical R&D, Pharma Mar, S.A., Colmenar Viejo, Madrid, Spain
| | | | - M Forster
- Department of Oncology, University College of London Hospital and UCL Cancer Institute, London, UK;.
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Affiliation(s)
- Antonio Rossi
- Division of Medical Oncology, "S.G. Moscati" Hospital, Avellino, Italy
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40
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Romanidou O, Imbimbo M, Mountzios G, Abidin A, Morgillo F, Califano R. Therapies in the pipeline for small-cell lung cancer. Br Med Bull 2016; 119:37-48. [PMID: 27325208 DOI: 10.1093/bmb/ldw022] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/13/2016] [Indexed: 11/12/2022]
Abstract
INTRODUCTION OR BACKGROUND Small-cell lung cancer (SCLC) represents ~15% of all cases of lung cancer and is characterized by a rapid tumour doubling time, early onset disease dissemination and high sensitivity to chemotherapy. SOURCES OF DATA We searched MEDLINE and OVID databases for articles in English published from January 1980 to February 2015. AREAS OF AGREEMENT Platinum-based chemotherapy, thoracic radiotherapy and prophylactic cranial irradiation are standard of care. Benefit from second-line chemotherapy is limited. AREAS OF CONTROVERSY The role of platinum/irinotecan chemotherapy in the Western population and the role of maintenance therapies remain to be established. GROWING POINTS Knowledge of the biology of SCLC has expanded exponentially and many potential therapeutic targets have been identified. AREAS TIMELY FOR DEVELOPING RESEARCH The use of circulating tumour cells can help investigating molecular alterations occurring within tumour cells, understanding drug resistance mechanisms and evaluating new treatments.
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Affiliation(s)
- Ourania Romanidou
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester M20 4BX, UK Department of Medical Oncology, Papageorgiou General Hospital, Thessaloniki 56403, Greece
| | - Martina Imbimbo
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester M20 4BX, UK Head and Neck Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Aidalena Abidin
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester M20 4BX, UK
| | - Floriana Morgillo
- Dipartimento di internistica clinica e sperimentale 'F. Magrassi e A. Lanzara', Seconda Università degli studi di Napoli, Naples, Italy
| | - Raffaele Califano
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester M20 4BX, UK Department of Medical Oncology, University Hospital of South Manchester, Manchester M23 9LT, UK
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Paglialunga L, Salih Z, Ricciuti B, Califano R. Immune checkpoint blockade in small cell lung cancer: is there a light at the end of the tunnel? ESMO Open 2016; 1:e000022. [PMID: 27843619 PMCID: PMC5070242 DOI: 10.1136/esmoopen-2015-000022] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Revised: 06/13/2016] [Accepted: 07/05/2016] [Indexed: 12/24/2022] Open
Abstract
Small cell lung cancer (SCLC) is a very aggressive disease, characterised by rapid growth, high response rates to both chemotherapy and radiotherapy and subsequent development of treatment resistance in the vast majority of patients. In the past 30 years, little progress has been made in systemic treatments and the established management paradigm of platinum-based chemotherapy has reached an efficacy plateau. Several clinical trials have investigated targeted therapies, without producing clinically significant benefits. Recently presented early phase clinical trials with immune checkpoint inhibitors (blockade of the cytotoxic T-lymphocyte antigen-4 (CTLA-4) and blockade of the programmed cell death-1 (PD-1) receptor) have shown promising results. In this review, we present the emerging evidence on immune checkpoint blockade for SCLC.
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Affiliation(s)
- Luca Paglialunga
- Department of Medical Oncology , Santa Maria della Misericordia Hospital , Perugia , Italy
| | - Zena Salih
- Department of Medical Oncology , The Christie NHS Foundation Trust , Manchester , UK
| | - Biagio Ricciuti
- Department of Medical Oncology , Santa Maria della Misericordia Hospital , Perugia , Italy
| | - Raffaele Califano
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK; Department of Medical Oncology, University Hospital of South Manchester NHS Foundation Trust, Manchester, UK
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Rossi A, Sacco PC, Sgambato A, Casaluce F, Santabarbara G, Palazzolo G, Maione P, Gridelli C. Optimal drugs for second-line treatment of patients with small-cell lung cancer. Expert Opin Pharmacother 2016; 17:969-76. [DOI: 10.1517/14656566.2016.1154539] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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