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Wang C, Zhu S, Miao C, Wang Y, Chen J, Yuan S, Hu X. Safety and efficacy of pegylated recombinant human granulocyte colony-stimulating factor during concurrent chemoradiotherapy for small-cell lung cancer: a retrospective, cohort-controlled trial. BMC Cancer 2022; 22:542. [PMID: 35562713 PMCID: PMC9107159 DOI: 10.1186/s12885-022-09644-8] [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: 12/26/2021] [Accepted: 05/05/2022] [Indexed: 11/15/2022] Open
Abstract
Objective To investigate pegylated recombinant human granulocyte colony-stimulating factor (PEG-rhG-CSF) safety and efficacy in preventing hematological toxicity during concurrent chemoradiotherapy (CCRT) for small-cell lung cancer (SCLC). Methods We retrospectively assessed 80 SCLC patients treated with CCRT from January 2013 to December 2018 who received PEG-rhG-CSF within 48 hours after the end of chemotherapy, defined as prophylactic use, as the experimental group. An additional 80 patients who were not treated with PEG-rhG-CSF were matched 1:1 by the propensity score matching method and served as the control group. The main observations were differences in hematological toxicity, neutrophil changes, febrile neutropenia (FN) incidence and adverse reactions. Progression-free survival (PFS) and overall survival (OS) were analyzed with regular assessment and follow-up. Results The leukocyte, neutrophil, erythrocyte, and platelet counts and hemoglobin level decreased after CCRT, but the experimental group had slightly higher leukocyte and neutrophil counts than the control group (P < 0.05). The incidences of grade III-IV leukopenia (18.75% vs. 61.25%) and neutropenia (23.75% vs. 67.5%) in the experimental group were significantly lower than those in the control group (P < 0.05). The absolute neutrophil count was 4.17 ± 0.79 (× 109/L) on day 1 and peaked 6.81 ± 2.37 (× 109/L) on day 10 in the experimental group; the value in the control group was 2.81 ± 0.86 (× 109/L) on day 1. It decreased significantly and reached the minimum 0.91 ± 0.53 (× 109/L) on day 10 (P < 0.05). The experimental group had a lower FN incidence than the control group (P < 0.05). There was also no significant acute esophagitis or pulmonary toxicity. The treatment had no significant effect on PFS (11.4 months vs. 8.7 months, P = 0.958) or OS (23.9 months vs. 17.3 months, P = 0.325) over an 18.6-month median follow-up time. Conclusion PEG-rhG-CSF has good efficacy and safety in preventing hematological toxicity in SCLC patients during CCRT and has no significant effects on PFS or OS. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-022-09644-8.
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Affiliation(s)
- Cunliang Wang
- Shandong First Medical University, Jinan, 250000, Shandong, China.,Department of Radiation Oncology, Shandong Cancer Hospital, Shandong Cancer Hospital affiliated to Shandong First Medical University, No. 440 Jiyan Road, Jinan, 250117, Shandong, China
| | - Shouhui Zhu
- Department of Radiation Oncology, Shandong Cancer Hospital, Shandong Cancer Hospital affiliated to Shandong First Medical University, No. 440 Jiyan Road, Jinan, 250117, Shandong, China
| | - Chuanwang Miao
- Department of Radiation Oncology, Shandong Cancer Hospital, Shandong Cancer Hospital affiliated to Shandong First Medical University, No. 440 Jiyan Road, Jinan, 250117, Shandong, China
| | - Yu Wang
- Department of Radiation Oncology, Shandong Second Provincial General Hospital, Jinan, 250022, Shandong, China
| | - Jiazhen Chen
- Shandong First Medical University, Jinan, 250000, Shandong, China.,Department of Radiation Oncology, Shandong Cancer Hospital, Shandong Cancer Hospital affiliated to Shandong First Medical University, No. 440 Jiyan Road, Jinan, 250117, Shandong, China
| | - Shuanghu Yuan
- Shandong First Medical University, Jinan, 250000, Shandong, China.,Department of Radiation Oncology, Shandong Cancer Hospital, Shandong Cancer Hospital affiliated to Shandong First Medical University, No. 440 Jiyan Road, Jinan, 250117, Shandong, China
| | - Xudong Hu
- Shandong First Medical University, Jinan, 250000, Shandong, China. .,Department of Radiation Oncology, Shandong Cancer Hospital, Shandong Cancer Hospital affiliated to Shandong First Medical University, No. 440 Jiyan Road, Jinan, 250117, Shandong, China.
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Tavakkoli M, Wilkins CR, Mones JV, Mauro MJ. A Novel Paradigm Between Leukocytosis, G-CSF Secretion, Neutrophil-to-Lymphocyte Ratio, Myeloid-Derived Suppressor Cells, and Prognosis in Non-small Cell Lung Cancer. Front Oncol 2019; 9:295. [PMID: 31080780 PMCID: PMC6497733 DOI: 10.3389/fonc.2019.00295] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 03/29/2019] [Indexed: 12/23/2022] Open
Abstract
Leukocytosis is a common feature of malignancies. While controversial, there appears to be an association between the degree of tumor-related leukocytosis and prognosis. In this paper, we provide evidence supporting an untapped clinical paradigm linking G-CSF secretion to the induction of leukocytosis and expansion of myeloid-derived suppressor cells, providing an explanation for the association between leukocytosis, elevated neutrophil-to-lymphocyte ratios and prognosis in non-small cell lung cancer. Clinically validating this mechanism may identify MDSCs and G-CSF as dynamic markers of early disease progression and therapeutic response, and shed light onto novel therapeutic avenues for the treatment of patients with non-small cell lung cancer.
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Affiliation(s)
- Montreh Tavakkoli
- Department of Internal Medicine, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY, United States
| | - Cy R Wilkins
- Department of Hematology, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Jodi V Mones
- Department of Hematology, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Michael J Mauro
- Department of Hematology Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, United States
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Abstract
PURPOSE OF REVIEW Most patients affected by lung cancer are treated with chemotherapy, and hence are at risk of myelosuppression. Hematopoietic growth factors have a relevant role in this setting, as they can improve quality of life, reduce the rate of chemotherapy-induced complications and allow the administration of full-dose chemotherapy. RECENT FINDINGS Most data of hematologic growth factors in lung cancer come from dated publications or large trials involving different malignancies, thus limiting specific information for lung neoplasms. Nonetheless, most studies consistently identified myeloid growth factors as effective on specific end-points such as the duration and severity of neutropenia, or complications such as hospitalizations and febrile neutropenia; on the other hand, erythropoiesis-stimulating agents (ESAs) consistently improved anemia-specific end-points including hemoglobin values, transfusions rate and fatigue, although some specific safety issues characterized this drug class. The most recent international guidelines address these characteristics and include the main indications for hematologic growth factors in solid neoplasms, including lung cancer. SUMMARY Myeloid growth factors and ESAs have a relevant role in selected patients undergoing chemotherapy for nonsmall cell lung cancer and small cell lung cancer. Notably, a comprehensive risk-benefit assessment is required in the specific case of ESAs.
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Detection of microRNA-200b may predict the inhibitory effect of gefitinib on non-small cell lung cancer and its potential mechanism. Oncol Lett 2016; 12:5349-5355. [PMID: 28101246 DOI: 10.3892/ol.2016.5365] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 09/28/2016] [Indexed: 12/11/2022] Open
Abstract
The present study aimed to investigate the association and underlying mechanisms between microRNA-200b level and the inhibitory effect of gefitinib on non-small cell lung cancer. In total, 100 patients (43 males and 57 females; median age, 63 years) with advanced non-small cell lung cancer (NSCLC) were selected. All patients were administered with gefitinib orally (250 mg/day) and the effect of gefitinib was evaluated according to the Response Evaluation Criteria in Solid Tumors guidelines. Tumor tissue and plasma samples were collected prior to and subsequent to therapy. The microRNA-200b levels in tissues and plasma were determined by quantitative polymerase chain reaction (PCR). A549 cells were cultured in vitro and transfected with microRNA-200b mimic. Using Cell Counting Kit-8 assay, the proliferation inhibition detected was induced by 0.1 µM gefitinib in transfected or non-transfected A549 cells. Cell apoptosis and cell cycle progression were analyzed by flow cytometry and the migration of cells was observed by Transwell assay. In addition, mRNA and protein levels of insulin-like growth factor 1 receptor (IGF-1R), protein kinase B (AKT) and extracellular signal-related kinase (ERK), together with the phosphorylation of AKT and ERK in A549 cells, were determined by quantitative PCR and western blot analysis, respectively. The microRNA-200b levels in gefitinib-insensitive patients were decreased compared with gefitinib-sensitive patients. Transfection with microRNA-200b mimic increased the gefitinib induced proliferation inhibition, apoptosis and cell cycle arrest in A549 cells. Also, transfection with microRNA-200b mimic increased the migration inhibitory effect of gefitinib on A549 cells. Decreased IGF-1R expression together with reduced phosphorylation of AKT and ERK were observed following transfection of A549 cells with the microRNA 200b mimic. In conclusion, detection of microRNA-200b may predict the inhibitory effect of gefitinib on NSCLC. Upregulation of microRNA-200b led to the elevated sensitivity of glioma cells to gefitinib, and this effect may be explained as microRNA-200b being able to inhibit the expression of IGF-1R, thereby reducing the activation of downstream phosphoinositide 3-kinase/AKT and mitogen-activated protein kinase signaling pathways.
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Joerger M, Finn SP, Cuffe S, Byrne AT, Gray SG. The IL-17-Th1/Th17 pathway: an attractive target for lung cancer therapy? Expert Opin Ther Targets 2016; 20:1339-1356. [PMID: 27353429 DOI: 10.1080/14728222.2016.1206891] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION There is strong pharmaceutical development of agents targeting the IL-17-TH17 pathway for the treatment of psoriasis (Ps) and psoriatic arthritis (PsA). Lung cancer accounts for 28% of all cancer-related deaths worldwide, and roughly 80% of patients with newly-diagnosed non-small cell lung cancer (NSCLC) present with metastatic disease, with a poor prognosis of around 12 months. Therefore, there is a high unmet medical need for the development of new and potent systemic treatments in this deadly disease. The emergence of immunotherapies such as anti-PD-1 or anti-PDL1 as candidate therapies in non-small cell lung cancer (NSCLC) indicates that targeting critical immuno-modulatory cytokines including those within the IL-17-Th1/Th17 axis may have proven benefit in the treatment of lung cancer. Areas covered: In this review we describe the current evidence for aberrant IL-17-Th1/Th17 settings in cancer, particularly with regard to targeting this axis in NSCLC. We further discuss the current agents under pharmaceutical development which could potentially target this axis, and discuss the current limitations and areas of concern regarding the use of these in lung cancer. Expert opinion: Current evidence suggests that moving forward agents targeting the IL-17-Th1/Th17 pathway may have novel new oncoimmunology indications in the treatment paradigm for NSCLC.
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Affiliation(s)
- Markus Joerger
- a Department of Medical Oncology & Hematology , Cantonal Hospital , St. Gallen , Switzerland
| | - Stephen P Finn
- b Department of Histopathology & Morbid Anatomy , Trinity College Dublin , Dublin , Ireland
| | - Sinead Cuffe
- c HOPE Directorate , St James's Hospital , Dublin , Ireland
| | - Annette T Byrne
- d Department of Physiology and Medical Physics & Centre for Systems Medicine , Royal College of Surgeons in Ireland , Dublin , Ireland
| | - Steven G Gray
- e Thoracic Oncology Research Group , IMM, St James's Hospital , Dublin , Ireland.,f Department of Clinical Medicine , Trinity College Dublin , Dublin , Ireland
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Zhou C, Huang Y, Wang D, An C, Zhou F, Li Y, Chen G, Wu C, He J, Wu G, Song X, Gao J, Liu W, Li B, Shi J, Huang C, Yu J, Feng J, Yue H, Shi M, Xia J. A Randomized Multicenter Phase III Study of Single Administration of Mecapegfilgrastim (HHPG-19K), a Pegfilgrastim Biosimilar, for Prophylaxis of Chemotherapy-Induced Neutropenia in Patients With Advanced Non-Small-Cell Lung Cancer (NSCLC). Clin Lung Cancer 2015; 17:119-27. [PMID: 26781346 DOI: 10.1016/j.cllc.2015.12.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 12/07/2015] [Accepted: 12/09/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Mecapegfilgrastim (code name HHPG-19K) is a biosimilar to pegylated recombinant human granulocyte-colony stimulating factor (PEG-rhG-CSF). The efficacy and safety of mecapegfilgrastim, using a regimen of once-per-cycle injection of 100-μg/kg or a fixed 6-mg dose, were evaluated for the prophylactic therapy for neutropenia in patients with advanced non-small-cell lung cancer (NSCLC) who were treated with myelosuppressive chemotherapy. MATERIALS AND METHODS Patients were randomized (1:1:1) blindly to 3 treatment arms to receive a single injection of mecapegfilgrastim 100 μg/kg, a 6-mg fixed dose of mecapegfilgrastim, or saline (control) in cycle 1. In cycles 2 to 4 following unblinding at the end of cycle 1, patients in the control arm received daily injections of short-acting rhG-CSF at a dose of 5 μg/kg, whereas patients in the 2 mecapegfilgrastim arms continued the same treatment as in cycle 1. All patients received 4 chemotherapy cycles of docetaxel combined with cisplatin or carboplatin every 21 days. The primary endpoint was the incidence of grade ≥ 3 neutropenia in cycle 1. RESULTS A single dose of 100 μg/kg or a fixed 6-mg dose of mecapegfilgrastim per cycle effectively reduced chemotherapy-induced neutropenia and was comparable to daily rhG-CSF with regard to all efficacy endpoints, including incidence of grade ≥ 3 neutropenia, incidence of febrile neutropenia, duration of grade ≥ 3 neutropenia, and time to neutrophil recovery. No difference in efficacy parameters was observed between the 2-dose regimens of mecapegfilgrastim across all cycles. Mecapegfilgrastim was well-tolerated and was as safe as daily rhG-CSF. CONCLUSION Once-per-cycle injection of mecapegfilgrastim is as effective and safe as daily rhG-CSF for prophylaxis of chemotherapy-induced neutropenia in patients with NSCLC. Mecapegfilgrastim (fixed 6-mg dose) is recommended in clinical practice for its convenient dose management.
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Affiliation(s)
- Caicun Zhou
- Department of Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.
| | - Yunchao Huang
- Department of Thoracic Surgery, Cancer Hospital of Yunnan Provience, Kunming, China
| | - Donglin Wang
- Department of Oncology, Chongqing Cancer Hospital, Chongqing, China
| | - Changshan An
- Department of Respiration Medicine, Yanbian University Hospital, Yanbian, China
| | - Fuxiang Zhou
- Department of Radiotherapy and Chemotherapy, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Yali Li
- Department of Respiration Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, Xian, China
| | - Gongyan Chen
- Department of Respiration Oncology, Harbin Medical University Cancer Hospital, Harbin, China
| | - Changping Wu
- Department of Oncology, The First People's Hospital of Changzhou, Changzhou, China
| | - Jianxing He
- Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Gang Wu
- Department of Oncology, Wuhan Union Hospital, Wuhan, China
| | - Xia Song
- Department of Respiration Medicine, Cancer Hospital of Shanxi Provence, Taiyuan, China
| | - Jianfei Gao
- Department of Oncology, Wuhan General Hospital of Guangzhou Military, Wuhan, China
| | - Wei Liu
- Department of Oncology, Tumor Hospital of Hebei Provence, Shijiazhuang, China
| | - Baolan Li
- Department of General Medicine, Beijing Chest Hospital, Capital Medical University, Beijing, China
| | - Jianhua Shi
- Department of Oncology, Linyi Cancer Hospital, Linyi, China
| | - Cheng Huang
- Department of Oncology, Fujian Provincial Cancer Hospital, Fuzhou, China
| | - Jingrui Yu
- Department of Oncology, The Second People's Hospital of Sichuan, Chengdu, China
| | - Jueping Feng
- Department of Oncology, Wuhan Puai Hospital, Wuhan, China
| | - Hongmei Yue
- Department of Respiration Medicine, The First Hospital of Lanzhou University, Lanzhou, China
| | - Meiqi Shi
- Department of Oncology, Jiangsu Cancer Hospital, Nanjing, China
| | - Jielai Xia
- Department of Statistics, The Fourth Military Medical University, Xi'an, China
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7
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Yang XB, Wu WY, Long SQ, Deng H, Pan ZQ, He WF, Zhou YS, Liao GY, Li QP, Xiao SJ, Cai JZ. Fuzheng Kang'ai decoction combined with gefitinib in advanced non-small cell lung cancer patients with epidermal growth factor receptor mutations: study protocol for a randomized controlled trial. Trials 2015; 16:146. [PMID: 25873045 PMCID: PMC4396173 DOI: 10.1186/s13063-015-0685-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 03/26/2015] [Indexed: 12/28/2022] Open
Abstract
Background Patients with advanced non-small cell lung cancer (NSCLC) harboring mutations of the epidermal growth factor receptor (EGFR) gene respond well to the EGFR tyrosine kinase inhibitor (TKI) gefitinib. Chinese herbal medicine (CHM) has been used as a complementary therapy for cancer for decades in China. CHM was proved to be effective in improving the quality of life (QOL) and reducing the toxicity associated with chemotherapy in patients with NSCLC. The purpose of the present trial is to determine whether CHM (Fuzheng Kang’ai decoction (FZKA), a CHM formula) combined with gefitinib results in longer progression-free survival with less toxicity than gefitinib alone. Methods/Design This is a randomized, placebo-controlled, double-blind trial. This trial is designed to determine if CHM (FZKA) combined with gefitinib results in longer progression-free survival with less toxicity than gefitinib alone. A total of 70 NSCLC patients with EGFR mutations will be randomly assigned to treatment group (gefitinib plus FZKA granules) or control group (gefitinib plus placebo). The primary endpoint is progression-free survival. Secondary endpoints are: (1) overall survival; (2) disease control rate; (3) QOL, measured with the questionnaire of Functional Assessment of Cancer Therapy-lung (FACT-L 4.0) and Lung Cancer Symptom Scale and (4) safety. Discussion In previous clinical practice, we found that CHM (FZKA) could improve the therapeutic efficacy of gefitinib. This study will provide objective evidence to evaluate the efficiency of CHM combined with gefitinib in NSCLC patients with EGFR mutations, and may provide a novel regimen for patients with NSCLC. Trial registration Chinese Clinical Trial Registry (www.chictr.org): ChiCTR-IOR-14005679, registered 17 December 2014.
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Affiliation(s)
- Xiao-Bing Yang
- Department of Oncology, Guangdong Provincial Hospital of Traditional Chinese Medicine, No. 111 Dade Road, Guangzhou, Guangdong, 510120, China.
| | - Wan-Yin Wu
- Department of Oncology, Guangdong Provincial Hospital of Traditional Chinese Medicine, No. 111 Dade Road, Guangzhou, Guangdong, 510120, China.
| | - Shun-Qin Long
- Department of Oncology, Guangdong Provincial Hospital of Traditional Chinese Medicine, No. 111 Dade Road, Guangzhou, Guangdong, 510120, China.
| | - Hong Deng
- Department of Oncology, Guangdong Provincial Hospital of Traditional Chinese Medicine, No. 111 Dade Road, Guangzhou, Guangdong, 510120, China.
| | - Zong-Qi Pan
- Department of Oncology, Guangdong Provincial Hospital of Traditional Chinese Medicine, No. 111 Dade Road, Guangzhou, Guangdong, 510120, China.
| | - Wen-Feng He
- Department of Oncology, Guangdong Provincial Hospital of Traditional Chinese Medicine, No. 111 Dade Road, Guangzhou, Guangdong, 510120, China.
| | - Yu-Shu Zhou
- Department of Oncology, Guangdong Provincial Hospital of Traditional Chinese Medicine, No. 111 Dade Road, Guangzhou, Guangdong, 510120, China.
| | - Gui-Ya Liao
- Department of Oncology, Guangdong Provincial Hospital of Traditional Chinese Medicine, No. 111 Dade Road, Guangzhou, Guangdong, 510120, China.
| | - Qiu-Ping Li
- Department of Oncology, Guangdong Provincial Hospital of Traditional Chinese Medicine, No. 111 Dade Road, Guangzhou, Guangdong, 510120, China.
| | - Shu-Jing Xiao
- Department of Oncology, Guangdong Provincial Hospital of Traditional Chinese Medicine, No. 111 Dade Road, Guangzhou, Guangdong, 510120, China.
| | - Jiao-Zhi Cai
- Department of Oncology, Guangdong Provincial Hospital of Traditional Chinese Medicine, No. 111 Dade Road, Guangzhou, Guangdong, 510120, China.
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Effect of gefitinib plus Chinese herbal medicine (CHM) in patients with advanced non-small-cell lung cancer: a retrospective case-control study. Complement Ther Med 2014; 22:1010-8. [PMID: 25453521 DOI: 10.1016/j.ctim.2014.10.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2014] [Revised: 08/25/2014] [Accepted: 10/03/2014] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Some patients with non-small-cell lung cancer (NSCLC) respond well to the EGFR tyrosine kinase inhibitor gefitinib. Chinese herbal medicine (CHM) was effective in improving the quality of life and prolonging overall survival in patient with NSCLC. We aim to determine whether gefitinib plus CHM could prolong the progression-free survival (PFS) or median survival time (MST) in patients with NSCLC than gefitinib alone. METHODS We retrospectively analyzed 159 non-small-cell lung cancer patients with the method of retrospective case-control study, matching factors included gender, age categories (30-39,40-49,50-59,60-69,70-79), pathological stage (IIIB or IV), smoking status (never: <100 lifetime cigarettes, or ever: ≥100 lifetime cigarettes), pathology, and performance status. Among the 159 patients, 100 patients treated with gefitinib (250mg/day orally) plus CHM ("Fuzheng Kang'ai" decoction, a Chinese herbal medicine, 250ml/bid/day orally), 59 patients treated with gefitinib (250mg/day orally) only. PFS and MST were analyzed for the whole population. RESULTS 58 pairs were matched successfully. 1 patient (treated with gefitinib) with the age of 27 years failed to be matched. Progression-free survival was significantly longer in patients treated with gefitinib plus CHM than with gefitinib: median PFS was 13.1 months (95% CI 6.50-19.70) with gefitinib plus CHM versus 11.43 months (95% CI 7.95-14.91) with gefitinib (log-rank P=0.013). Median overall survival was longer with gefitinib plus CHM than with gefitinib: median MST was 22.83 months (95% CI 17.51-28.16) with gefitinib plus CHM versus 18.7 months (95% CI 16.83-20.57) with gefitinib (log-rank P=0.049). The most common adverse event was rash, the incidence in the gefitinib plus CHM group was 41.38% while in the gefitinib group was 24.14% (P=0.048). CONCLUSIONS This case-control analysis suggested that treatment with gefitinib plus CHM prolonged PFS and MST compared with gefitinib in patients with NSCLC, and it is worthy of further study.
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Smith TJ, Hillner BE. A way forward on the medically appropriate use of white cell growth factors. J Clin Oncol 2012; 30:1584-7. [PMID: 22370327 PMCID: PMC3383110 DOI: 10.1200/jco.2011.39.9980] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Thomas J Smith
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD 21287-0005, USA.
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Schnipper LE, Smith TJ, Raghavan D, Blayney DW, Ganz PA, Mulvey TM, Wollins DS. American Society of Clinical Oncology identifies five key opportunities to improve care and reduce costs: the top five list for oncology. J Clin Oncol 2012; 30:1715-24. [PMID: 22493340 DOI: 10.1200/jco.2012.42.8375] [Citation(s) in RCA: 447] [Impact Index Per Article: 37.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Lowell E Schnipper
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA.
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Chen S, Flower A, Ritchie A, Liu J, Molassiotis A, Yu H, Lewith G. Oral Chinese herbal medicine (CHM) as an adjuvant treatment during chemotherapy for non-small cell lung cancer: A systematic review. Lung Cancer 2010; 68:137-45. [DOI: 10.1016/j.lungcan.2009.11.008] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2009] [Revised: 10/30/2009] [Accepted: 11/15/2009] [Indexed: 10/20/2022]
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12
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Simon GR, Extermann M, Chiappori A, Williams CC, Begum M, Kapoor R, Haura EB, Ismail-Khan R, Schell MJ, Antonia SJ, Bepler G. Phase 2 trial of docetaxel and gefitinib in the first-line treatment of patients with advanced nonsmall-cell lung cancer (NSCLC) who are 70 years of age or older. Cancer 2008; 112:2021-9. [DOI: 10.1002/cncr.23360] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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13
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Merad-Taoufik M, Antoun S, Ruffié P. [Fever and infectious complications in patient with lung cancer]. REVUE DE PNEUMOLOGIE CLINIQUE 2008; 64:99-103. [PMID: 18589291 DOI: 10.1016/j.pneumo.2008.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The respiratory infections are very frequent during lung cancer. Their diagnosis is often difficult because of the various etiologies (cancer, chemotherapy, radiotherapy) and this complexity can make discuss a preliminary bronchial exploration before any therapeutics. When it is about a located infection, germs in cause are often the same that in the community respiratory infections, in particular bacilli Gram negative, and it is thus logical to treat by the penicillin A. In front of an interstitial syndrome, it is necessary to evoke the opportunist infections, which are increasing in patients with cancer because of the multimodality therapeutic and the elongation of the survival. The neutropenic patient must be distinguished because of its specificities. The pulmonary infections lead to an important mortality. According to the patient (advanced age, underlying chronic obstructive pulmonary disease [COPD]) and to the treatment (chemotherapy, pneumonectomy), prevention must be discussed as the pneumococcal and Haemophilus influenzae vaccination.
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Affiliation(s)
- M Merad-Taoufik
- Service des Urgences, Institut Gustave-Roussy, 39 Rue Camille-Desmoulins, 94805 Villejuif Cedex, France.
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Kouroukis CT, Chia S, Verma S, Robson D, Desbiens C, Cripps C, Mikhael J. Canadian supportive care recommendations for the management of neutropenia in patients with cancer. Curr Oncol 2008; 15:9-23. [PMID: 18317581 PMCID: PMC2259432 DOI: 10.3747/co.2008.198] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Hematologic toxicities of cancer chemotherapy are common and often limit the ability to provide treatment in a timely and dose-intensive manner. These limitations may be of utmost importance in the adjuvant and curative intent settings. Hematologic toxicities may result in febrile neutropenia, infections, fatigue, and bleeding, all of which may lead to additional complications and prolonged hospitalization. The older cancer patient and patients with significant comorbidities may be at highest risk of neutropenic complications. Colony-stimulating factors (csfs) such as filgrastim and pegfilgrastim can effectively attenuate most of the neutropenic consequences of chemotherapy, improve the ability to continue chemotherapy on the planned schedule, and minimize the risk of febrile neutropenia and infectious morbidity and mortality. The present consensus statement reviews the use of csfs in the management of neutropenia in patients with cancer and sets out specific recommendations based on published international guidelines tailored to the specifics of the Canadian practice landscape. We review existing international guidelines, the indications for primary and secondary prophylaxis, the importance of maintaining dose intensity, and the use of csfs in leukemia, stem-cell transplantation, and radiotherapy. Specific disease-related recommendations are provided related to breast cancer, non-Hodgkin lymphoma, lung cancer, and gastrointestinal cancer. Finally, csf dosing and schedules, duration of therapy, and associated acute and potential chronic toxicities are examined.
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Gridelli C, Aapro MS, Barni S, Beretta GD, Colucci G, Daniele B, Del Mastro L, Di Maio M, De Petris L, Perrone F, Thatcher N, De Marinis F. Role of colony stimulating factors (CSFs) in solid tumours: Results of an expert panel. Crit Rev Oncol Hematol 2007; 63:53-64. [PMID: 17368037 DOI: 10.1016/j.critrevonc.2007.01.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2006] [Revised: 12/22/2006] [Accepted: 01/26/2007] [Indexed: 11/25/2022] Open
Abstract
Febrile neutropenia is a relatively frequent event in cancer patients treated with chemotherapy. A relevant body of scientific evidence has been produced in the last 2 decades, through clinical trials addressing the efficacy of colony stimulating factors (CSFs) in the prevention and treatment of febrile neutropenia. The correct use of CSFs needs to be optimized, and several guidelines have been produced and periodically updated, in order to uniform and guide clinical practice. The aim of this review is to synthesize the most relevant clinical trials and the most important existing guidelines about the role of CSFs in solid tumours. Role of CSFs as primary prophylaxis, secondary prophylaxis and treatment of afebrile and febrile neutropenia is discussed. A special focus is dedicated to neutropenia and the use of CSFs in the treatment of the three "big killers" among the solid tumours: breast cancer, lung cancer and colorectal cancer.
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Affiliation(s)
- Cesare Gridelli
- Division of Medical Oncology, S.G. Moscati Hospital, Contrada Amoretta, 83100 Avellino, Italy.
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