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Tan I, Ramchandran K. The role of palliative care in the management of patients with lung cancer. Lung Cancer Manag 2020; 9:LMT39. [PMID: 33318757 PMCID: PMC7729591 DOI: 10.2217/lmt-2020-0016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Palliative care (PC) is the care of patients and their families with serious illness and is rapidly becoming an important part of the care of cancer patients. Patients with advanced lung cancer are a highly symptomatic population of patients and clearly experience benefits in quality of life and potentially benefits in overall survival when PC is incorporated early on after diagnosis. However, referrals to PC are still reliant on clinical judgment of patient prognosis and symptom burden. Moving forward, improving the integration of PC and lung cancer care will require more efficient real-time screening of patient symptoms, which may be accomplished through the use of patient-reported outcomes.
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Affiliation(s)
- Irena Tan
- Stanford Cancer Center, 875 Blake Wilbur Dr, Palo Alto, CA 94304, USA
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Papachristofilou A, Hipp MM, Klinkhardt U, Früh M, Sebastian M, Weiss C, Pless M, Cathomas R, Hilbe W, Pall G, Wehler T, Alt J, Bischoff H, Geißler M, Griesinger F, Kallen KJ, Fotin-Mleczek M, Schröder A, Scheel B, Muth A, Seibel T, Stosnach C, Doener F, Hong HS, Koch SD, Gnad-Vogt U, Zippelius A. Phase Ib evaluation of a self-adjuvanted protamine formulated mRNA-based active cancer immunotherapy, BI1361849 (CV9202), combined with local radiation treatment in patients with stage IV non-small cell lung cancer. J Immunother Cancer 2019; 7:38. [PMID: 30736848 PMCID: PMC6368815 DOI: 10.1186/s40425-019-0520-5] [Citation(s) in RCA: 112] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 01/27/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Preclinical studies demonstrate synergism between cancer immunotherapy and local radiation, enhancing anti-tumor effects and promoting immune responses. BI1361849 (CV9202) is an active cancer immunotherapeutic comprising protamine-formulated, sequence-optimized mRNA encoding six non-small cell lung cancer (NSCLC)-associated antigens (NY-ESO-1, MAGE-C1, MAGE-C2, survivin, 5T4, and MUC-1), intended to induce targeted immune responses. METHODS We describe a phase Ib clinical trial evaluating treatment with BI1361849 combined with local radiation in 26 stage IV NSCLC patients with partial response (PR)/stable disease (SD) after standard first-line therapy. Patients were stratified into three strata (1: non-squamous NSCLC, no epidermal growth factor receptor (EGFR) mutation, PR/SD after ≥4 cycles of platinum- and pemetrexed-based treatment [n = 16]; 2: squamous NSCLC, PR/SD after ≥4 cycles of platinum-based and non-platinum compound treatment [n = 8]; 3: non-squamous NSCLC, EGFR mutation, PR/SD after ≥3 and ≤ 6 months EGFR-tyrosine kinase inhibitor (TKI) treatment [n = 2]). Patients received intradermal BI1361849, local radiation (4 × 5 Gy), then BI1361849 until disease progression. Strata 1 and 3 also had maintenance pemetrexed or continued EGFR-TKI therapy, respectively. The primary endpoint was evaluation of safety; secondary objectives included assessment of clinical efficacy (every 6 weeks during treatment) and of immune response (on Days 1 [baseline], 19 and 61). RESULTS Study treatment was well tolerated; injection site reactions and flu-like symptoms were the most common BI1361849-related adverse events. Three patients had grade 3 BI1361849-related adverse events (fatigue, pyrexia); there was one grade 3 radiation-related event (dysphagia). In comparison to baseline, immunomonitoring revealed increased BI1361849 antigen-specific immune responses in the majority of patients (84%), whereby antigen-specific antibody levels were increased in 80% and functional T cells in 40% of patients, and involvement of multiple antigen specificities was evident in 52% of patients. One patient had a partial response in combination with pemetrexed maintenance, and 46.2% achieved stable disease as best overall response. Best overall response was SD in 57.7% for target lesions. CONCLUSION The results support further investigation of mRNA-based immunotherapy in NSCLC including combinations with immune checkpoint inhibitors. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01915524 .
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Affiliation(s)
| | | | | | - Martin Früh
- Hospital of St Gallen, St Gallen and University of Bern, Bern, Switzerland
| | | | | | - Miklos Pless
- Cantonal Hospital of Winterthur, Winterthur, Switzerland
| | | | - Wolfgang Hilbe
- Medical Department, Center for Oncology and Hematology, Wilhelminenspital, Wien, Austria
| | - Georg Pall
- University Hospital Innsbruck, Innsbruck, Austria
| | - Thomas Wehler
- Department of Internal Medicine III, University Medical Center Mainz, Mainz, Germany
| | - Jürgen Alt
- Department of Internal Medicine III, University Medical Center Mainz, Mainz, Germany
| | | | - Michael Geißler
- Klinik für Allg Innere Medizin, Onkolologie/ Hämatologie, Gastroenterologie, Infektiologie, Esslingen, Germany
| | - Frank Griesinger
- Department Hematology and Oncology, Pius Hospital University, Oldenburg, Germany
- Department Internal Medicine-Oncology, Medical Campus University of Oldenburg, Oldenburg, Germany
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Personalized Radiation Therapy (PRT) for Lung Cancer. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2016; 890:175-202. [DOI: 10.1007/978-3-319-24932-2_10] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Palliative thoracic radiotherapy for patients with advanced non-small cell lung cancer and poor performance status. Lung Cancer 2015; 87:130-5. [DOI: 10.1016/j.lungcan.2014.11.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2014] [Revised: 11/18/2014] [Accepted: 11/24/2014] [Indexed: 11/15/2022]
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Sebastian M, Papachristofilou A, Weiss C, Früh M, Cathomas R, Hilbe W, Wehler T, Rippin G, Koch SD, Scheel B, Fotin-Mleczek M, Heidenreich R, Kallen KJ, Gnad-Vogt U, Zippelius A. Phase Ib study evaluating a self-adjuvanted mRNA cancer vaccine (RNActive®) combined with local radiation as consolidation and maintenance treatment for patients with stage IV non-small cell lung cancer. BMC Cancer 2014; 14:748. [PMID: 25288198 PMCID: PMC4195907 DOI: 10.1186/1471-2407-14-748] [Citation(s) in RCA: 92] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Accepted: 09/25/2014] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Advanced non-small cell lung cancer (NSCLC) represents a significant unmet medical need. Despite advances with targeted therapies in a small subset of patients, fewer than 20% of patients survive for more than two years after diagnosis. Cancer vaccines are a promising therapeutic approach that offers the potential for durable responses through the engagement of the patient's own immune system. CV9202 is a self-adjuvanting mRNA vaccine that targets six antigens commonly expressed in NSCLC (NY-ESO-1, MAGEC1, MAGEC2, 5 T4, survivin, and MUC1). METHODS/DESIGN The trial will assess the safety and tolerability of CV9202 vaccination combined with local radiation designed to enhance immune responses and will include patients with stage IV NSCLC and a response or stable disease after first-line chemotherapy or therapy with an EGFR tyrosine kinase inhibitor. Three histological and molecular subtypes of NSCLC will be investigated (squamous and non-squamous cell with/without EGFR mutations). All patients will receive two initial vaccinations with CV9202 prior to local radiotherapy (5 GY per day for four successive days) followed by further vaccinations until disease progression. The primary endpoint of the study is the number of patients experiencing Grade >3 treatment-related adverse events. Pharmacodynamic analyses include the assessment of immune responses to the antigens encoded by CV9202 and others not included in the panel (antigen spreading) and standard efficacy assessments. DISCUSSION RNActive self-adjuvanted mRNA vaccines offer the potential for simultaneously inducing immune responses to a wide panel of antigens commonly expressed in tumors. This trial will assess the feasibility of this approach in combination with local radiotherapy in NSCLC patients. TRIAL REGISTRATION Clinicaltrials.gov: NCT01915524/EudraCT No.: 2012-004230-41.
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Affiliation(s)
- Martin Sebastian
- />Department of Hematology and Oncology, Johann-Wolfgang-Goethe-Universität, Frankfurt, Germany
| | | | - Christian Weiss
- />Department of Radiation Therapy and Oncology, Goethe University, Frankfurt am Main, Germany
| | - Martin Früh
- />Department of Medical Oncology and Hematology, Kantonsspital St Gallen, St Gallen, Switzerland
| | | | - Wolfgang Hilbe
- />Department of General Internal Medicine, Oncology, University Hospital, Innsbruck, Austria
| | - Thomas Wehler
- />Third Department of Internal Medicine, University Hospital Mainz, Mainz, Germany
| | | | | | | | | | | | | | | | - Alfred Zippelius
- />Department of Oncology, University Hospital Basel, Petersgraben 4, CH - 4031 Basel, Switzerland
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Does high-dose radiotherapy benefit palliative lung cancer patients? Strahlenther Onkol 2013; 189:771-6. [DOI: 10.1007/s00066-013-0360-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Accepted: 03/25/2013] [Indexed: 10/26/2022]
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Abstract
Palliative radiotherapy has been prescribed since shortly after the discovery of the x-ray in the late 1800s, and it provides symptom relief that is successful, time-efficient, and cost-effective. Although palliative radiotherapy is worthwhile in a wide variety of clinical circumstances, there are situations where it is less worthwhile. We contrast the effective use of palliative radiotherapy with its ineffective use because of issues related to the patient, treatment, or health care system.
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Kepka L, Olszyna-Serementa M. Palliative thoracic radiotherapy for lung cancer. Expert Rev Anticancer Ther 2010; 10:559-69. [PMID: 20397921 DOI: 10.1586/era.10.22] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Despite an increasing use of chemotherapy in the palliative setting for lung cancer, the role of palliative thoracic radiotherapy should not be disregarded. It offers quick and efficient palliation, with improvement observed in approximately two-thirds of treated patients. There is evidence that the short and long radiotherapy schedules are equally effective for poor performance patients. Higher radiation doses delivered via protracted schedules give a modest survival benefit for good performance patients. The current review covers the issues related to the use of palliative thoracic radiotherapy, such as total dose, fractionation, delayed versus immediate use, external-beam radiotherapy versus endobronchial brachytherapy, combination with chemotherapy, re-irradiation and palliation with radiation in small-cell lung cancer.
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Affiliation(s)
- Lucyna Kepka
- Department of Radiation Oncology, M. Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, ul Roentgena 5, 02-781 Warsaw, Poland.
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Wagner H. Just enough palliation: radiation dose and outcome in patients with non-small-cell lung cancer. J Clin Oncol 2008; 26:3920-2. [PMID: 18711179 DOI: 10.1200/jco.2008.17.3674] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Wan J, Milosevic M, Brade AM. Use of palliative radiotherapy trials for clinical biomarker development. Cancer Metastasis Rev 2008; 27:435-43. [PMID: 18392923 DOI: 10.1007/s10555-008-9132-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Approximately one quarter of all cancer patients will require palliative radiation treatment at some point during the course of their disease, but only a minority of these patients are entered in clinical trials. ETHICAL ASSESSMENT OF BIOMARKERS IN PALLIATIVE RADIOTHERAPY TRIALS We review the literature debating the ethics of inclusion of "palliative" patients on clinical trials. We suggest that these patients provide a potentially valuable resource that can be leveraged to facilitate the discovery and validation of biomarkers predictive of radiation response and toxicity. In addition, this patient population offers valuable opportunities to test combination of radiation and targeted therapies to screen for activity, toxicity and biomarkers in a relatively safe manner. CONCLUSION Patients undergoing palliative radiation therapy may provide new opportunities for the development and testing of predictive radiotherapy biomarkers as well as affording opportunities to test combinations of radiation and targeted therapies.
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Affiliation(s)
- Jonathan Wan
- Radiation Medicine Program, Princess Margaret Hospital, University Health Network, 610 University Avenue, Toronto, ON, M5G 2M9, Canada
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Rose SC, Thistlethwaite PA, Sewell PE, Vance RB. Lung cancer and radiofrequency ablation. J Vasc Interv Radiol 2006; 17:927-51; quiz 951. [PMID: 16778226 DOI: 10.1097/01.rvi.0000222707.44902.66] [Citation(s) in RCA: 87] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Radiofrequency (RF) ablation is a recently developed technique for image-guided local destruction of selected tumors. Because the lung is a common site for cancer and usually has substantial functional reserve, RF ablation of lung cancers is an attractive option for minimally invasive treatment. The primary goal of the present review is to describe the natural history, staging systems, and conventional therapies for primary and secondary treatment of lung cancer, as well as the results of RF ablation in animal models and in humans for pulmonary applications, to clarify the appropriate role and limitations of this technology. The secondary goals are to review the principles of how RF works and to describe RF ablation techniques to familiarize interventionalists who may consider incorporating this technology into their practice and inform diagnostic radiologists of expected imaging findings and clinicians of their patients' anticipated courses and outcomes.
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Affiliation(s)
- Steven C Rose
- Department of Radiology, University of California San Diego Medical Center, 200 West Arbor Drive, San Diego, California 92103, USA.
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Abstract
Radiation plays an important role in the treatment of thoracic tumors. During the last 10 years there have been several major advances in thoracic RT including the incorporation of concurrent chemotherapy and the application of con-formal radiation-delivery techniques (eg, stereotactic RT, three-dimensional conformal RT, and intensity-modulated RT) that allow radiation dose escalation. Radiation as a local measure remains the definitive treatment of medically inoperable or surgically unresectable disease in NSCLC and part of a multimodality regimen for locally advanced NSCLC, limited stage SCLC, esophageal cancer, thymoma, and mesothelioma.
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Affiliation(s)
- Feng-Ming Spring Kong
- Department of Radiation Therapy, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA.
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Gustafson PR. Letters to the editor. Am J Hosp Palliat Care 2005; 22:255. [PMID: 16082908 DOI: 10.1177/104990910502200405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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