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Roeland EJ, Fintelmann FJ, Hilton F, Yang R, Whalen E, Tarasenko L, Calle RA, Bonomi PD. The relationship between weight gain during chemotherapy and outcomes in patients with advanced non-small cell lung cancer. J Cachexia Sarcopenia Muscle 2024; 15:1030-1040. [PMID: 38468440 PMCID: PMC11154746 DOI: 10.1002/jcsm.13426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 11/21/2023] [Accepted: 12/15/2023] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND This post hoc, pooled analysis examined the relationship between different weight gain categories and overall survival (OS) in patients with non-small cell lung cancer (NSCLC) receiving first-line platinum-based chemotherapy. METHODS Data were pooled from the control arms of three phase III clinical studies (NCT00596830, NCT00254891, and NCT00254904), and the maximum weight gain in the first 3 months from treatment initiation was categorised as >0%, >2.5%, and >5.0%. Cox proportional hazard modelling of OS was used to estimate hazard ratios (HRs) for each category, including baseline covariates, time to weight gain, and time to confirmed objective response (RECIST Version 1.0). RESULTS Of 1030 patients with advanced NSCLC (IIIB 11.5% and IV 88.5%), 453 (44.0%), 252 (24.5%), and 120 (11.7%) experienced weight gain from baseline of >0%, >2.5%, and >5.0%, respectively. The median time to weight gain was 23 (>0%), 43 (>2.5%), and 45 (>5.0%) days. After adjusting for a time-dependent confirmed objective response, the risk of death was reduced for patients with any weight gain (>0% vs. ≤0% [HR 0.71; 95% confidence interval-CI 0.61, 0.82], >2.5% vs. ≤2.5% [HR 0.76; 95% CI 0.64, 0.91] and >5.0% vs. ≤5.0% [HR 0.77; 95% CI 0.60, 0.99]). The median OS was 13.5 versus 8.6 months (weight gain >0% vs. ≤0%), 14.4 versus 9.4 months (weight gain >2.5% vs. ≤2.5%), and 13.4 versus 10.2 months (weight gain >5.0% vs. ≤5.0%). CONCLUSIONS Weight gain during treatment was associated with a reduced risk of death, independent of tumour response. The survival benefit was comparable for weight gain >0%, >2.5%, and >5.0%, suggesting that any weight gain may be an early predictor of survival with implications for the design of interventional cancer cachexia studies.
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Affiliation(s)
- Eric J. Roeland
- Knight Cancer InstituteOregon Health and Science UniversityPortlandORUSA
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2
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Changes in Body Weight, Body Composition, Phase Angle, and Resting Metabolic Rate in Male Patients with Stage IV Non-Small-Cell Lung Cancer Undergoing Therapy. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58121779. [PMID: 36556981 PMCID: PMC9784033 DOI: 10.3390/medicina58121779] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 11/22/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022]
Abstract
Background and Objectives: Cancer treatments can adversely influence body weight status, body composition, phase angle (PhA), and resting metabolic rate (RMR), which could possibly affect disease course. Τhe aim was to assess differences in body composition, PhA, RMR, and related parameters in non-small-cell lung cancer (NSCLC) patients after treatment. Methods: The sample consisted of 82 NSCLC (stage IV) male patients (chemotherapy (C) 15.7%; immunotherapy (I) 13.3%; C + I 25.3%; (C) + radiotherapy (R) 22.9 %; and other 15.5%). Body weight and body composition, PhA, RMR, oxygen consumption (VO2), ventilation rate, and diet were assessed at baseline and at 3 months after initiation of therapy. Results: Reductions in PhA, RMR, VO2, ventilation rate, and intracellular water were observed at follow up. Weight loss was evident for 45% of patients who also had a reduction in lean body mass. In the group under C, lean mass was reduced at follow up (55.3 ± 11.53 vs. 52.4 ± 12.6, p = 0.04) without significant weight changes. In subjects with a low adherence to the Mediterranean diet (MedDietScore < 30), RMR (1940 ± 485 vs. 1730 ± 338 Kcal, p = 0.001), VO2 (277.1 ± 70.2 vs. 247 ± 49.1 mL/min, p = 0.001), and ventilation rate (10.1 ± 2.28 vs. 9. ± 2 2.2 L/min, p = 0.03) were significantly reduced. The changes in body weight were positively related to % of change in fat mass (rho = 0.322, p = 0.003) and absolute lean mass change (rho = 0.534, p < 0.001) and negatively associated with % of change in total body water (rho = −0.314, p = 0.004) (Spearman correlation coefficients). Conclusions: In conclusion, cancer therapy related to reductions in PhA and RMR, while lean mass reduction may be related to the type of treatment. Our results emphasize the importance of a more holistic nutritional and body composition assessment beyond body weight, to better address patients’ needs in clinical practice.
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Yuan Q, Du M, Loehrer E, Johnson BE, Gainor JF, Lanuti M, Li Y, Christiani DC. Postdiagnosis BMI Change Is Associated with Non-Small Cell Lung Cancer Survival. Cancer Epidemiol Biomarkers Prev 2021; 31:262-268. [PMID: 34728470 DOI: 10.1158/1055-9965.epi-21-0503] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 06/24/2021] [Accepted: 10/14/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Body mass index (BMI) change after a lung cancer diagnosis has been associated with non-small cell lung cancer (NSCLC) survival. This study aimed to quantify the association based on a large-scale observational study. METHODS Included in the study were 7,547 patients with NSCLC with prospectively collected BMI data from Massachusetts General Hospital and Brigham and Women's Hospital/Dana-Farber Cancer Institute. Cox proportional hazards regression with time-dependent covariates was used to estimate effect of time-varying postdiagnosis BMI change rate (% per month) on overall survival (OS), stratified by clinical subgroups. Spline analysis was conducted to quantify the nonlinear association. A Mendelian Randomization (MR) analysis with a total of 3,495 patients further validated the association. RESULTS There was a J-shape association between postdiagnosis BMI change and OS among patients with NSCLC. Specifically, a moderate BMI decrease [0.5-2.0; HR = 2.45; 95% confidence interval (CI), 2.25-2.67] and large BMI decrease (≥2.0; HR = 4.65; 95% CI, 4.15-5.20) were strongly associated with worse OS, whereas moderate weight gain (0.5-2.0) reduced the risk for mortality (HR = 0.78; 95% CI, 0.68-0.89) and large weight gain (≥2.0) slightly increased the risk of mortality without reaching statistical significance (HR = 1.10; 95% CI, 0.86-1.42). MR analyses supported the potential causal roles of postdiagnosis BMI change in survival. CONCLUSIONS This study indicates that BMI change after diagnosis was associated with mortality risk. IMPACT Our findings, which reinforce the importance of postdiagnosis BMI surveillance, suggest that weight loss or large weight gain may be unwarranted.
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Affiliation(s)
- Qianyu Yuan
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Mulong Du
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.,Department of Biostatistics, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Elizabeth Loehrer
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Bruce E Johnson
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.,Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Justin F Gainor
- Center for Thoracic Cancers, Massachusetts General Hospital Cancer Center, Boston, Massachusetts.,Department of Medicine, Massachusetts General Hospital Cancer Center, Boston, Massachusetts
| | - Michael Lanuti
- Center for Thoracic Cancers, Massachusetts General Hospital Cancer Center, Boston, Massachusetts
| | - Yi Li
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - David C Christiani
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts. .,Department of Medicine, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts
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Abstract
Bayesian approaches for criterion based selection include the marginal likelihood based highest posterior model (HPM) and the deviance information criterion (DIC). The DIC is popular in practice as it can often be estimated from sampling based methods with relative ease and DIC is readily available in various Bayesian software. We find that sensitivity of DIC based selection can be high, in the range of 90 - 100%. However, correct selection by DIC can be in the range of 0 - 2%. These performances persist consistently with increase in sample size. We establish that both marginal likelihood and DIC asymptotically disfavor under-fitted models, explaining the high sensitivities of both criteria. However, mis-selection probability of DIC remains bounded below by a positive constant in linear models with g -priors whereas mis-selection probability by marginal likelihood converges to 0 under certain conditions. A consequence of our results is that not only the DIC cannot asymptotically differentiate between the data-generating and an over-fitted model, but, in fact, it cannot asymptotically differentiate between two over-fitted models as well. We illustrate these results in multiple simulation studies and in a biomarker selection problem on cancer cachexia of non-small cell lung cancer patients. We further study performances of HPM and DIC in generalized linear model as practitioners often choose to use DIC that is readily available in software in such non-conjugate settings.
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Affiliation(s)
| | - Sanjib Basu
- University of Illinois at Chicago, Chicago, IL
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5
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Wang Y, Zhao B, Chen W, Liu L, Chen W, Zhou L, Kong Z, Dai C, Wang Y, Ma W. Pretreatment Geriatric Assessments of Elderly Patients with Glioma: Development and Implications. Aging Dis 2020; 11:448-461. [PMID: 32257553 PMCID: PMC7069455 DOI: 10.14336/ad.2019.0527] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Accepted: 05/27/2019] [Indexed: 12/13/2022] Open
Abstract
Glioma is the most frequent primary brain tumor affecting adults, and the most lethal type is glioblastoma (GBM); currently, the available therapies only provide palliation. The treatments for low-grade glioma (LGG) include neurosurgical resection, watchful waiting, radiotherapy and chemotherapy, while the therapeutic strategies for high-grade glioma (HGG), particularly in elderly patients, have evolved to include radiotherapy, chemotherapy, and targeted monotherapy based on the characteristics of the investigated patients. Proper assessments aiming to predict and achieve the most satisfying prognosis among patients prior to surgery, radiotherapy, chemotherapy, targeted therapy or immunotherapy help summarize the pretreatment characteristics of patients, providing doctors comprehensive information to consider while determining whether the patients could benefit from ongoing treatments and deciding the proper treatment strategy for subsequent phases. This article aims to rigorously review the most recent evidence and discuss current mainstream assessments before the initiation of proper treatments for glioma, thus highlighting the potential necessity of pretreatment assessments.
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Affiliation(s)
- Yaning Wang
- Departments of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Binghao Zhao
- Departments of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wanqi Chen
- Departments of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lei Liu
- Departments of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wenlin Chen
- Departments of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lizhou Zhou
- Departments of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ziren Kong
- Departments of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Congxin Dai
- Departments of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yu Wang
- Departments of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wenbin Ma
- Departments of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Trestini I, Gkountakos A, Carbognin L, Avancini A, Lanza M, Molfino A, Friso S, Corbo V, Tortora G, Scarpa A, Milella M, Bria E, Pilotto S. Muscle derangement and alteration of the nutritional machinery in NSCLC. Crit Rev Oncol Hematol 2019; 141:43-53. [DOI: 10.1016/j.critrevonc.2019.06.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 06/08/2019] [Accepted: 06/09/2019] [Indexed: 01/06/2023] Open
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7
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Bonomi P, Batus M, Fidler MJ, Borgia JA. Practical and theoretical implications of weight gain in advanced non-small cell lung cancer patients. ANNALS OF TRANSLATIONAL MEDICINE 2017; 5:152. [PMID: 28462232 DOI: 10.21037/atm.2017.03.20] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Philip Bonomi
- Division of Hematology/Oncology, Rush University Medical Center, Chicago, IL 60612, USA
| | - Marta Batus
- Division of Hematology/Oncology, Rush University Medical Center, Chicago, IL 60612, USA
| | - Mary Jo Fidler
- Division of Hematology/Oncology, Rush University Medical Center, Chicago, IL 60612, USA
| | - Jeffrey A Borgia
- Department of Pathology, Rush University Medical Center, Chicago, IL 60612, USA
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8
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Derman BA, Macklis JN, Azeem MS, Sayidine S, Basu S, Batus M, Esmail F, Borgia JA, Bonomi P, Fidler MJ. Relationships between longitudinal neutrophil to lymphocyte ratios, body weight changes, and overall survival in patients with non-small cell lung cancer. BMC Cancer 2017; 17:141. [PMID: 28209123 PMCID: PMC5312530 DOI: 10.1186/s12885-017-3122-y] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 02/08/2017] [Indexed: 01/06/2023] Open
Abstract
Background There is emerging evidence showing a significant relationship between overall survival (OS) in non-small cell lung cancer NSCLC patients and weight change during chemotherapy or chemoradiation. A high neutrophil/lymphocyte ratio (NLR) at baseline and at follow-up is associated with shorter survival in cancer patients and may be a surrogate for ongoing inflammation, implicated in cancer cachexia and tumor progression. The objective of this study is to explore potential relationships between OS, serial weights, and serial NLRs in advanced NSCLC patients receiving chemotherapy. Methods One hundred thirty-nine patients with chemotherapy-naïve NSCLC, predominantly with stage III/IV disease, were treated with first-line platinum doublets from June, 2011 to August, 2012. NLR, tumor response, and body weight were recorded at baseline, 6, and 12 weeks from initiation of therapy and correlated with OS. The association between NLR and OS was assessed using Cox PH (proportional hazards) analysis, the association between NLR and weight change was assessed using a simple regression analysis, and the association between NLR and tumor response was assessed using the Fisher’s exact test. Results One hundred thirty-nine patients with median age 68, PS 0-1/2 = 83/17%, male/female = 58%/42%. Median NLR at baseline was 3.6 (range 0.1898 to 30.910), at 6 weeks 3.11 (range 0.2703 to 42.11), and at 12 weeks 3.52 (range 0.2147 to 42.93). A Higher NLR at baseline, 6, and 12 weeks was associated with decreased OS (baseline: HR 1.06, p < 0.001; 6 weeks: HR 1.07, p = 0.001; 12 weeks: HR 1.05, p < 0.001), and longitudinal NLR, as a time-dependent covariate, was also associated with decreased OS (HR = 1.06, p < 0.001). Baseline weight and NLR were inversely related (cor = −0.267, p = 0.001), and weight change and NLR were inversely related at 12 weeks (cor = −0.371, p < 0.001). Longitudinal measurements of weight and NLR were also negatively associated (slope = −0.06, p < 0.001). Using a cutoff of NLR > 5, there was a significant association between progressive disease and NLR > 5 at 6 weeks (p = 0.02) and 12 weeks (p = 0.03). Conclusions High baseline and progressive increases in NLRs are associated with progressive disease, inferior OS and weight loss in NSCLC patients. In addition to having prognostic significance, these observations suggest that studying molecular mediators of cachexia/inflammation and their relationships to tumor progression may identify new therapeutic targets in the large subset of NSCLC patients who have cancer cachexia.
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Affiliation(s)
- B A Derman
- Rush University Medical Center, Chicago, IL, USA. .,Department of Internal Medicine, 1717 W Congress Parkway, 1025 Kellogg, Chicago, IL, 606012, USA.
| | - J N Macklis
- Rush University Medical Center, Chicago, IL, USA.,Division of Hematology/Oncology, 1725 W. Harrison St., Suite 809, Chicago, IL, 60612, USA
| | - M S Azeem
- University of Texas Southwestern Medical Center, Dallas, TX, USA.,Division of Hematology/Oncology, 5323 Harry Hines Boulevard, Dallas, TX, 75390, USA
| | - S Sayidine
- Rush University Medical Center, Chicago, IL, USA.,Department of Pathology, 1750 W. Harrison St., Suite 1415, Chicago, IL, 60612, USA
| | - S Basu
- Rush University Medical Center, Chicago, IL, USA.,Division of Hematology/Oncology, 1725 W. Harrison St., Suite 809, Chicago, IL, 60612, USA
| | - M Batus
- Rush University Medical Center, Chicago, IL, USA.,Division of Hematology/Oncology, 1725 W. Harrison St., Suite 809, Chicago, IL, 60612, USA
| | - F Esmail
- Rush University Medical Center, Chicago, IL, USA.,Department of Internal Medicine, 1717 W. Congress Parkway, 10 Kellogg, Chicago, IL, 60612, USA
| | - J A Borgia
- Rush University Medical Center, Chicago, IL, USA.,Department of Pathology, 1750 W. Harrison St., Suite 1415, Chicago, IL, 60612, USA
| | - P Bonomi
- Rush University Medical Center, Chicago, IL, USA.,Division of Hematology/Oncology, 1725 W. Harrison St., Suite 809, Chicago, IL, 60612, USA
| | - M J Fidler
- Rush University Medical Center, Chicago, IL, USA.,Division of Hematology/Oncology, 1725 W. Harrison St., Suite 809, Chicago, IL, 60612, USA
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Topkan E. Weight gain as a surrogate marker of longer survival in advanced non-small cell lung cancer patients. ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:381. [PMID: 27826583 DOI: 10.21037/atm.2016.09.33] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Weight loss (WL), as a key step of the irreversible and fatal cancer-related anorexia cachexia syndrome is present to some degree in 80% of non-small cell lung cancer (NSCLC) patients upon diagnosis which has been clearly proved to negatively alter patients' performance status, quality of life (QOL), response to treatment, and prognosis. However, WL is not a problem encountered only upon diagnosis but is also commonly reported during the course of aggressive chemotherapy, radiotherapy (RT) and particularly the concurrent chemoradiotherapy (C-CRT) which may further diminish QOL measures and clinical outcomes. In general, the NSCLC literature has concentrated on WL during the treatment course, but recent studies have demonstrated that it is possible to preserve or even experience weight gain (WG) during or just short after the discontinuation of various cancer treatments in approximately 40% to 45% NSCLC patients. Considering the fact that recent evidence suggest a prognostic and predictive role for WG in anticipation of longer survival times and better response rates in weight gainers, this current manuscript will specifically aim to realize the actual value of WG in locally advanced and metastatic NSCLC patients which may potentially be added to the conventional prognostic and predictive factors as a novel surrogate marker of outcomes in such patients.
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Affiliation(s)
- Erkan Topkan
- Department of Radiation Oncology, Baskent University Medical Faculty, Adana Research and Treatment Center, Adana, Turkey
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Patel J, Pereira J, Chen J, Liu J, Guba S, John W, Orlando M, Scagliotti G, Bonomi P. Relationship between efficacy outcomes and weight gain during treatment of advanced, non-squamous, non-small-cell lung cancer patients. Ann Oncol 2016; 27:1612-9. [DOI: 10.1093/annonc/mdw211] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 05/11/2016] [Indexed: 01/03/2023] Open
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Efficacy and Tolerability of Palliative Split-Course Thoracic Chemoradiotherapy for Symptomatic Non-Small Cell Lung Cancer. Am J Clin Oncol 2014; 38:605-9. [PMID: 24781341 DOI: 10.1097/coc.0000000000000007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION To assess the efficacy and tolerability of palliative split-course concurrent thoracic chemoradiotherapy (CRT) in patients with incurable locally advanced and metastatic non-small cell lung cancer. METHODS All patients with incurable non-small cell lung cancer and symptomatic thoracic disease treated with palliative split-course CRT between March 2006 and February 2013 at a single institution were included in this retrospective study. The primary endpoint was improvement in presenting thoracic symptoms. Secondary endpoints included toxicity, overall survival, and the cumulative incidence of locoregional failure. RESULTS Fifty-five patients were identified, of whom 89% had distant metastatic disease at the initiation of treatment. The median radiotherapy dose delivered was 40 Gy over 20 fractions. Over 90% of patients were able to complete at least 2 cycles of chemotherapy, and 89% of patients completed the prescribed course of radiotherapy. Forty percent of patients had improvement in all presenting symptoms and 78% experienced improvement in at least 1 symptom. Nine and 2 patients, respectively, experienced grade 1 and 2 esophagitis and 1 patient experienced grade 2 pneumonitis. There were no cases of grade 3 toxicity. With a median follow-up for surviving patients of 4.5 months, the estimated actuarial 6-, 12-, and 24-month overall survival was 56%, 25%, and 13%, respectively. The actuarial 6-, 12-, and 24-month cumulative incidence of locoregional failure was 6%, 14%, and 22%, respectively. DISCUSSION Split-course CRT allows for early introduction of systemic therapy while providing durable locoregional control with tolerable morbidity and significant improvement in chest symptomatology. This paradigm is a viable model for chest palliation in selected patients with intact performance status.
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Body mass index and its association with clinical outcomes for advanced non-small-cell lung cancer patients enrolled on Eastern Cooperative Oncology Group clinical trials. J Thorac Oncol 2014; 8:1121-7. [PMID: 23887169 DOI: 10.1097/jto.0b013e31829cf942] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Obesity increases the risk of death from many adverse health outcomes and has also been linked with cancer outcomes. The impact of obesity on outcomes of advanced non-small-cell lung cancer patients is unclear. METHODS The authors evaluated the association of body mass index (BMI) and outcomes in 2585 eligible patients enrolled in three consecutive first-line trials conducted by the Eastern Cooperative Oncology Group. BMI was categorized as underweight (BMI < 18.5 kg/m), normal weight (BMI: 18.5 to < 25 kg/m), overweight (BMI: 25 to < 30 kg/m), and obese (BMI ≥ 30 kg/m). In addition to analyzing overall and progression-free survival, reasons for treatment discontinuation were also assessed by BMI group. RESULTS Of the patients enrolled, 4.6% were underweight, 44.1% were normal weight, 34.3% of patients were classified as overweight, and 16.9% were obese. Nonproportional hazards existed for obese patients relative to the other three groups of patients, with a change in overall survival hazard occurring at approximately 16 months. In multivariable Cox models, obese patients had superior outcomes earlier on study compared with normal/overweight patients 0.86 (HR=0.86, p=0.04; 95% CI: 0.75-0.99), but later experienced increased hazard (HR=1.54, p< 0.001; 95% CI: 1.22-1.94), indicating a time effect while undergoing treatment. CONCLUSION Data from these three trials suggest differential outcomes associated with BMI, and additional studies of the mechanisms underlying this observation, as well as dietary and lifestyle interventions, are warranted to help optimize therapy.
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Russell K, Healy B, Pantarotto J, Laurie SA, MacRae R, Sabri E, Wheatley-Price P. Prognostic factors in the radical nonsurgical treatment of stage IIIB non-small-cell lung cancer. Clin Lung Cancer 2013; 15:237-43. [PMID: 24461300 DOI: 10.1016/j.cllc.2013.12.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Revised: 12/21/2013] [Accepted: 12/23/2013] [Indexed: 12/28/2022]
Abstract
BACKGROUND Many patients diagnosed with stage IIIB (AJCC sixth edition; T4, N3, or both; no pleural effusion) non-small-cell lung cancer (NSCLC) are treated with curative intent, despite a low cure rate. Guidelines are required to help select patients for radical therapy so that the patients with little chance of cure may be spared the toxicities of aggressive treatment. A retrospective analysis was performed to investigate factors influencing outcomes in these patients. MATERIALS AND METHODS From 2002 to 2009, all cases of stage IIIB NSCLC from the authors' institution were identified. Patients treated with radical radiotherapy (minimum dose, 50 Gy), with or without chemotherapy, were included. Charts were reviewed for patient demographic data, baseline blood work, tumor factors, treatment factors, and hospitalizations. The primary outcome was overall survival (OS), measured from time of diagnosis. RESULTS Of 238 patients identified, 184 eligible cases were reviewed. The median follow-up for all patients was 17.2 months (range, 1.7-237.1). The median progression-free survival was 10.8 months (95% CI, 9.6-12.4). Median survival was 17.9 months, and OS was 68%, 42%, and 28% at 1, 2, and 3 years, respectively. In multivariate analysis, female gender (hazard ratio [HR], 0.58; 95% CI, 0.37-0.88; P = .0013), ≤ 5% weight loss (HR, 0.64; 95% CI, 0.43-0.93; P = .01), and absence of N3 disease (HR, 0.64; 95% CI, 0.42-0.96; P = .03) were associated with significantly longer survival. CONCLUSION OS was significantly longer in women, in patients with ≤ 5% weight loss, and in those without N3 disease. Good patient selection remains important in the radical treatment of stage IIIB NSCLC.
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Affiliation(s)
- Kent Russell
- Division of Medical Oncology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Brian Healy
- Division of Medical Oncology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Jason Pantarotto
- Division of Radiation Oncology, Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Scott A Laurie
- Division of Medical Oncology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Robert MacRae
- Division of Radiation Oncology, Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Elham Sabri
- Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Paul Wheatley-Price
- Division of Medical Oncology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada.
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Topkan E, Parlak C, Selek U. Impact of weight change during the course of concurrent chemoradiation therapy on outcomes in stage IIIB non-small cell lung cancer patients: retrospective analysis of 425 patients. Int J Radiat Oncol Biol Phys 2013; 87:697-704. [PMID: 24035331 DOI: 10.1016/j.ijrobp.2013.07.033] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Revised: 07/17/2013] [Accepted: 07/29/2013] [Indexed: 12/28/2022]
Abstract
PURPOSE We retrospectively investigated the impact of weight change (WC) during concurrent chemoradiation therapy (C-CRT) on clinical outcomes of stage 3B non-small cell lung cancer (NSCLC) patients. METHODS AND MATERIALS A total of 425 patients treated with C-CRT were included. All patients received 60 to 66 Gy of thoracic radiation therapy concurrently with 1 to 3 cycles of platinum-based chemotherapy. Pre- and posttreatment weight measurements on first and last days of C-CRT were used for WC. Patients were divided into 2 groups: group 1=weight loss (WL); group 2=weight preservation/gain (WP) for comparative analyses. RESULTS Following C-CRT, 252 patients (59.3%) experienced WL, while 89 patients (20.9%) and 84 patients (19.8%) showed WP or WG. At median 24.2 months of follow-up, 142 patients (33.4%) were alive (84 WP [48.6%] and 58 WL [23.0%]), and 58 (13.6%) of them were free of disease progression (41 [23.7%] for WP and 17 [6.7%] for WL). Median overall survival (OS), locoregional progression-free survival (LRPFS), progression-free survival (PFS), and distant metastases-free survival (DMFS) for the entire population were 22.8, 14.4, 10.6, and 11.7 months, respectively. Intergroup comparisons between WP and WL cohorts revealed significantly superior OS, LRPFS, PFS, and DMFS in WP patients (P<.05 for each). On multivariate analyses, only WL and advanced T stage were associated with poor prognosis (P<.05). CONCLUSIONS Present results in 425 stage 3B NSCLC patients demonstrated that WL during C-CRT is strongly associated with inferior survival outcomes compared to WP. This emerging finding might be useful by forming an encouraging basis for future investigations in facilitating a way to improve the outcomes of these patients experiencing WL during C-CRT.
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Affiliation(s)
- Erkan Topkan
- Department of Radiation Oncology, Baskent University Adana Medical Faculty, Adana, Turkey.
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Outcomes of aggressive concurrent radiochemotherapy in highly selected septuagenarians with stage IIIB non-small cell lung carcinoma: Retrospective analysis of 89 patients. Lung Cancer 2013; 81:226-30. [DOI: 10.1016/j.lungcan.2013.05.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2012] [Revised: 04/06/2013] [Accepted: 05/01/2013] [Indexed: 12/28/2022]
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16
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Sher DJ, Gielda BT, Liptay MJ, Warren WH, Batus M, Fidler MJ, Garg S, Bonomi P. Prognostic significance of weight gain during definitive chemoradiotherapy for locally advanced non-small-cell lung cancer. Clin Lung Cancer 2012; 14:370-5. [PMID: 23260389 DOI: 10.1016/j.cllc.2012.10.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Revised: 10/05/2012] [Accepted: 10/16/2012] [Indexed: 12/28/2022]
Abstract
BACKGROUND The successful treatment of locally advanced non-small-cell lung cancer (NSCLC) with chemoradiotherapy (CRT) is still compromised by poor locoregional and distant control rates. Given the morbidity associated with treatment, it is critical to determine clinical prognostic factors to risk stratify patients before and after aggressive therapy. This study aimed to discern the prognostic value of weight gain during CRT in patients with locally advanced NSCLC. PATIENTS AND METHODS This was a retrospective analysis of 92 patients treated with definitive split-course CRT between 2004 and 2010 at Rush University Medical Center. Weight gain was defined as a weight change greater than the highest quartile of change between the start and finish of CRT (4.5 lb). Overall survival (OS), locoregional progression-free survival (PFS), and distant metastasis-free survival (DMFS) were determined using Kaplan-Meier analysis, and the cumulative incidences of locoregional and distant recurrence were calculated. Cox regression (multivariate analysis) was used to determine independent predictors of OS. RESULTS With a median follow-up of 50 months for surviving patients, the median, 3- and 5-year OS probabilities were 25 months, 37%, and 29%, respectively. The 3-year cumulative risks of locoregional and distant metastases were 51% and 64%. Patients who experienced weight gain were significantly more likely to survive (3-year OS, 55% vs. 31%; P = .04) and prolonged DMFS resulted. Weight gain was the only significant predictor of survival on multivariate analysis. CONCLUSIONS Weight gain during split-course CRT was associated with superior OS and DMFS. The presence of weight gain may have utility in risk stratification after CRT as well as in identifying novel treatment approaches for patients with locally advanced NSCLC.
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Affiliation(s)
- David J Sher
- Department of Radiation Oncology, Rush University Medical Center, Chicago, IL 60612, USA.
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Garg S, Gielda BT, Turian JV, Liptay M, Warren WH, Bonomi P, Sher DJ. Patterns of regional failure in stage III non-small cell lung cancer treated with neoadjuvant chemoradiation therapy and resection. Pract Radiat Oncol 2012; 3:287-93. [PMID: 24674400 DOI: 10.1016/j.prro.2012.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2012] [Revised: 07/30/2012] [Accepted: 09/17/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE Treatment of locally advanced non-small cell lung cancer (LA-NSCLC) involves definitive chemoradiation therapy (CRT) or neoadjuvant CRT and resection, but radiation treatment volumes remain in question. With CRT, involved-field radiation therapy (IFRT) is replacing elective nodal irradiation, reducing toxicity, and allowing dose escalation. However, prior reports of IFRT describe failures only after radical CRT; with improved local control after resection, IFRT may lead to more regional recurrences. Our objective is to evaluate pattern-of-failure in patients with LA-NSCLC treated with split-course IFRT, chemotherapy, and subsequent surgery. METHODS AND MATERIALS Patients treated between December 2004 and 2010 were included. Imaging scans demonstrating failure were fused into the radiation therapy planning computed tomography, and recurrent nodes were contoured to determine pattern-of-failure (involved versus elective nodal failure [INF vs ENF]). Locoregional progression-free survival and distant metastasis-free survival were calculated using Kaplan-Meier methodology. The cumulative incidence of regional recurrence (CIRR) was determined with death as a competing risk. RESULTS Forty-five patients met inclusion criteria, and patients with RR had a lower rate of pN0 than those without RR (20% vs 60%, P = .02). With a median follow-up of 2.9 years, median survival was not reached, and 3-year locoregional progression-free survival and distant metastasis-free survival were 53% and 35%, respectively. Two and 3-year CIRR were 25% and 33%, respectively. There were no local failures. Thirteen (29%) patients had RR, 8 with INF only and 5 with ENF alone or both, totaling 27 recurrences. Only 2 (4%) ENF occurred without INF, both with distant metastasis, and no elective node was the first and only site of failure. CONCLUSIONS Our data suggest that IFRT does not compromise regional control in the neoadjuvant management of LA-NSCLC. Tailoring nodal volumes may improve treatment-related morbidity and allow for dose intensification of involved nodes. Further research is necessary to improve regional and distant control.
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Affiliation(s)
- Shalini Garg
- Department of Radiation Oncology, Rush University Medical Center, Chicago, Illinois.
| | - Benjamin T Gielda
- Department of Radiation Oncology, Rush University Medical Center, Chicago, Illinois
| | - Julius V Turian
- Department of Radiation Oncology, Rush University Medical Center, Chicago, Illinois
| | - Michael Liptay
- Department of Cardiothoracic Surgery, Rush University Medical Center, Chicago, Illinois
| | - William H Warren
- Department of Cardiothoracic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Philip Bonomi
- Section of Medical Oncology, Rush University Medical Center, Chicago, Illinois
| | - David J Sher
- Department of Radiation Oncology, Rush University Medical Center, Chicago, Illinois
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Marsh JC, Wendt JA, Walker A, Turian JV, Kie K. Clinical predictive factors for radiation pneumonitis and pulmonary fibrosis during split course concurrent chemoirradiation for locally advanced non-small cell lung cancer. ACTA ACUST UNITED AC 2012. [DOI: 10.7243/2049-7962-1-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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