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Bian DJ, Lazaratos AM, Maritan SM, Quaiattini A, Zeng Z, Zhu Z, Sener U, Malani R, Kim YJ, Ichihara E, Cohen V, Rose AA, Bouganim N, Dankner M. Osimertinib is associated with improved outcomes in pre-treated non-small cell lung cancer leptomeningeal metastases: A systematic review and meta-analysiss. Heliyon 2024; 10:e29668. [PMID: 38698967 PMCID: PMC11064091 DOI: 10.1016/j.heliyon.2024.e29668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 04/11/2024] [Accepted: 04/12/2024] [Indexed: 05/05/2024] Open
Abstract
Purpose Leptomeningeal metastasis (LM) is a severe complication of non-small cell lung cancer (NSCLC). In patients with NSCLC LM harboring epidermal growth factor receptor (EGFR) mutations, osimertinib is favored over alternative EGFR tyrosine kinase inhibitors (TKIs). However, the efficacy of osimertinib relative to other EGFR-TKIs is not well established for patients with LM. We aimed to compare the efficacy of EGFR-TKIs in EGFR-mutated NSCLC LM. Methods This systematic review and meta-analysis performed according to PRISMA guidelines included studies of adult patients with EGFR-mutated NSCLC and a diagnosis of LM who received an EGFR-TKI for the treatment of LM. We searched Medline ALL, Embase, Cochrane Central Register of Controlled Trials, Scopus, and Web of Science Core Collection. The evaluation of biases was done by using the Ottawa-Newscastle scale. The hazard ratio was used as the parameter of interest for overall survival (OS) and central nervous system-specific progression-free survival (PFS). Results 128 publications were included with 243 patients and 282 lines of EGFR-TKI for NSCLC LM that met inclusion criteria. The median PFS in patients receiving any EGFR-TKI was 9.1 months, and the median OS was 14.5 months. In univariate analyses of the entire cohort, osimertinib treatment demonstrated significantly prolonged PFS, but not OS, compared to other EGFR-TKIs. Osimertinib demonstrated significantly prolonged PFS and OS in the subset of patients who were previously treated with EGFR-TKIs, but not in EGFR-TKI naïve patients. Conclusion Osimertinib is associated with improved outcomes compared to other EGFR-TKIs, particularly in patients previously treated with EGFR-TKIs. An important limitation is that most patients were derived from retrospective reports. These results highlight the need for prospective studies for this difficult-to-treat patient population.
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Affiliation(s)
- David J.H. Bian
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Anna-Maria Lazaratos
- Rosalind and Morris Goodman Cancer Institute, Montreal, Quebec, Canada
- Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Sarah M. Maritan
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
- Rosalind and Morris Goodman Cancer Institute, Montreal, Quebec, Canada
- Department of Medicine, Division of Experimental Medicine, McGill University, Montreal, Quebec, Canada
| | - Andrea Quaiattini
- Schulich Library of Physical Sciences, Life Sciences, and Engineering, McGill University, Montreal, Quebec, Canada
| | - Zhimin Zeng
- Department of Oncology, the Second affiliated hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Zhengfei Zhu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center Shanghai, Shanghai, China
| | - Ugur Sener
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Rachna Malani
- Department of Neurosurgery, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Yu Jung Kim
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Eiki Ichihara
- Department of Allergy and Respiratory Medicine, Okayama University Hospital, Shikata-cho, Kita-Ku, Okayama City, Okayama, Japan
| | - Victor Cohen
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
- Gerald Bronfman Department of Oncology, Faculty of Medicine and Health Sciences, McGill University Health Centre, McGill University, Montreal, Quebec, Canada
- Lady Davis Institute, Segal Cancer Centre, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - April A.N. Rose
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
- Gerald Bronfman Department of Oncology, Faculty of Medicine and Health Sciences, McGill University Health Centre, McGill University, Montreal, Quebec, Canada
- Lady Davis Institute, Segal Cancer Centre, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Nathaniel Bouganim
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
- Gerald Bronfman Department of Oncology, Faculty of Medicine and Health Sciences, McGill University Health Centre, McGill University, Montreal, Quebec, Canada
- McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | - Matthew Dankner
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
- Rosalind and Morris Goodman Cancer Institute, Montreal, Quebec, Canada
- Lady Davis Institute, Segal Cancer Centre, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
- McGill University Health Centre, McGill University, Montreal, Quebec, Canada
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Nosaki K, Yamanaka T, Hamada A, Shiraishi Y, Harada T, Himeji D, Kitazaki T, Ebi N, Shimose T, Seto T, Takenoyama M, Sugio K. Erlotinib for Non-Small Cell Lung Cancer with Leptomeningeal Metastases: A Phase II Study (LOGIK1101). Oncologist 2020; 25:e1869-e1878. [PMID: 32654250 DOI: 10.1634/theoncologist.2020-0640] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 06/28/2020] [Indexed: 01/06/2023] Open
Abstract
LESSONS LEARNED This phase II trial evaluated the efficacy of erlotinib for patients with non-small cell lung cancer with leptomeningeal metastasis. The 17 cerebrospinal fluid specimens that were available for epidermal growth factor receptor mutation analysis were all negative for the resistance-conferring T790M mutation. The cytological objective clearance rate was 30.0% (95% confidence interval: 11.9%-54.3%). The median time to progression was 2.2 months. The rate of cerebrospinal fluid penetration among these patients was equivalent to those in previous reports regarding leptomeningeal metastasis. BACKGROUND Leptomeningeal metastases (LM) occur in approximately 5% of patients with non-small cell lung cancer (NSCLC) and are associated with a poor prognosis. However, no prospective study has identified an active chemotherapeutic drug in this setting. METHODS Patients were considered eligible to receive erlotinib if they had NSCLC with cytologically confirmed LM. The objective cytological clearance rate, time to LM progression (TTP), overall survival (OS), quality of life outcomes, and pharmacokinetics were analyzed. This study was closed because of slow accrual at 21 of the intended 32 patients (66%). RESULTS Between December 2011 and May 2015, 21 patients (17 with activating epidermal growth factor receptor [EGFR] mutations) were enrolled. The 17 cerebrospinal fluid specimens available were all negative for the T790M mutation, which confers erlotinib resistance. The clearance rate was 30.0% (95% confidence interval [CI]: 11.9%-54.3%), the median TTP was 2.2 months, and the median OS was 3.4 months. Significantly longer TTP and OS times were observed in patients with mutant EGFR (p = .0113 and p < .0054, respectively). The mean cerebrospinal fluid penetration rate was 3.31% ± 0.77%. There was a good correlation between plasma and cerebrospinal fluid (CSF) concentrations, although there was no clear correlation between pharmacokinetic parameters and clinical outcome. CONCLUSION Erlotinib was active for LM and may be a treatment option for patients with EGFR-mutated NSCLC and LM.
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Affiliation(s)
- Kaname Nosaki
- Department of Thoracic Oncology, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
| | - Takeharu Yamanaka
- Department of Biostatistics, Yokohama City University, Yokohama, Japan
| | - Akinobu Hamada
- Division of Molecular Pharmacology, National Cancer Center Research Institute, Tokyo, Japan
| | - Yoshimasa Shiraishi
- Department of Respiratory Disease, National Hospital Organization Fukuoka-Higashi Medical Center, Koga, Japan
| | - Taishi Harada
- Department of Respiratory Medicine, Japan Community Health Care Organization (JCHO) Kyushu Hospital, Kitakyushu, Japan
| | - Daisuke Himeji
- Department of Internal Medicine, Miyazaki Prefectural Miyazaki Hospital, Miyazaki, Japan
| | - Takeshi Kitazaki
- Department of Respiratory Disease, Japan Red Cross Nagasaki Genbaku Hospital, Nagasaki, Japan
| | - Noriyuki Ebi
- Department of Respiratory Oncology, Iizuka Hospital, Iizuka, Japan
| | | | - Takashi Seto
- Department of Thoracic Oncology, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
| | - Mitsuhiro Takenoyama
- Department of Thoracic Oncology, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
| | - Kenji Sugio
- Department of Thoracic Oncology, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
- Department of Thoracic and Breast Surgery, Oita University, Yufu, Japan
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Xu Y, Zhong W, Zhao J, Chen M, Li L, Wang M. [Clinical Features of Intradural Extramedullary Spinal Cord Metastases
in Primary Lung Cancer]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2017; 19:539-44. [PMID: 27561805 PMCID: PMC5972978 DOI: 10.3779/j.issn.1009-3419.2016.08.10] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
背景与目的 肺癌硬膜下脊髓外转移罕见, 可导致严重的神经损害, 本研究旨在阐明其临床特征。 方法 2013年5月-2016年5月, 北京协和医院8例确诊硬膜下脊髓外转移肺癌患者纳入该研究, 系统回顾分析临床资料。 结果 7例非小细胞肺癌及1例小细胞肺癌合并硬膜下脊髓外转移。马尾综合征是最常见的临床表现。行腰椎穿刺的5例(100%)患者脑脊液找到肿瘤细胞。脊髓增强核磁(magnetic resonance imaging, MRI)发现, 3例软脊膜弥漫线样增强, 4例硬膜下脊髓外多发结节, 1例具有上述两种表现。4例接受靶向治疗和/或放疗患者神经系统症状改善或稳定。中位生存时间是5.8个月。 结论 硬膜下脊髓外转移需依靠神经系统症状及增强MRI影像学检查诊断。靶向治疗和/或放疗可能有效。
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Affiliation(s)
- Yan Xu
- Department of Respiratory Disease, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - Wei Zhong
- Department of Respiratory Disease, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - Jing Zhao
- Department of Respiratory Disease, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - Minjiang Chen
- Department of Respiratory Disease, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - Longyun Li
- Department of Respiratory Disease, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - Mengzhao Wang
- Department of Respiratory Disease, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
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Lee JS, Lee KA, Lee KH, Moon SY, Kim IA, Jeon SJ, Min JK, Kim HJ, Lee KY. Efficacy of epidermal growth factor receptor-tyrosine kinase inhibitors for patient with leptomeningeal metastasis of epidermal growth factor receptor mutant non-small cell lung cancer. Yeungnam Univ J Med 2016. [DOI: 10.12701/yujm.2016.33.1.64] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Jong Sik Lee
- Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Kyung Ann Lee
- Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Kang Hoon Lee
- Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Sun Young Moon
- Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - In Ae Kim
- Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Sung Jin Jeon
- Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Jae Ki Min
- Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Hee Joung Kim
- Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Kye Young Lee
- Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
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Epidermal Growth Factor Receptor Tyrosine Kinase Inhibitors for Non–Small-Cell Lung Cancer Patients with Leptomeningeal Carcinomatosis. J Thorac Oncol 2015; 10:1754-61. [DOI: 10.1097/jto.0000000000000669] [Citation(s) in RCA: 119] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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6
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Kim HJ, Kim WS, Kwon DH, Cho YH, Choi CM. Effects of an Epithelial Growth Factor Receptor-Tyrosine Kinase Inhibitor Add-on in Stereotactic Radiosurgery for Brain Metastases Originating from Non-Small-Cell Lung Cancer. J Korean Neurosurg Soc 2015; 58:205-10. [PMID: 26539262 PMCID: PMC4630350 DOI: 10.3340/jkns.2015.58.3.205] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Revised: 02/24/2015] [Accepted: 05/06/2015] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE This study was aimed at optimizing the treatment of non-small-cell lung cancer (NSCLC) patients who are candidates for stereotactic radiosurgery (SRS) for brain metastases and harbor activating epithelial growth factor receptor (EGFR) mutations. METHODS We retrospectively reviewed the medical records from 2005 to 2010 of NSCLC patients with brain metastases harboring an activating EGFR mutation. Patients who received a combination therapy of SRS and EGFR-tyrosine kinase inhibitor (TKI) for brain metastases and those who received SRS without EGFR-TKI were compared. The primary endpoint was progression-free survival (PFS) of the brain metastases. RESULTS Thirty-one patients were eligible for enrolment in this study (SRS with TKI, 18; SRS without TKI, 13). Twenty-two patients (71.0%) were women and the median overall age was 56.0 years. PFS of brain lesions was not significantly prolonged in SRS with TKI treatment group than in SRS without TKI group (17.0 months vs. 9.0 months, p=0.45). Local tumor control rate was 83.3% in the combination therapy group, and 61.5% in the SRS monotherapy group (p=0.23). There were no severe adverse events related with treatment in both groups. CONCLUSIONS Therapeutic outcome of concurrent SRS and TKI treatment was not superior to SRS monotherapy, however, there was no additive adverse events related with combined treatment.
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Affiliation(s)
- Hyun Jung Kim
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Woo Sung Kim
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Do Hoon Kwon
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young Hyun Cho
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chang-Min Choi
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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CNS metastases in non-small-cell lung cancer: Current role of EGFR-TKI therapy and future perspectives. Lung Cancer 2013; 80:242-8. [DOI: 10.1016/j.lungcan.2013.02.004] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Revised: 01/30/2013] [Accepted: 02/03/2013] [Indexed: 11/30/2022]
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Kurishima K, Miyazaki K, Tamura T, Ohara G, Kagohashi K, Kawaguchi M, Satoh H. Peritoneal and meningeal relapse from lung adenocarcinoma after a response to gefitinib: A case report. Mol Clin Oncol 2013; 1:785-787. [PMID: 24649247 PMCID: PMC3915655 DOI: 10.3892/mco.2013.122] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2013] [Accepted: 05/10/2013] [Indexed: 11/21/2022] Open
Abstract
The prognosis of carcinomatous peritonitis and meningitis is poor since ascites and focal neurological dysfunctions usually do not improve despite the available treatment options for this devastating disease. This is a case report of peritoneal and meningeal relapse from lung adenocarcinoma following a response to gefitinib. A 72-year-old woman was diagnosed with adenocarcinoma in the upper lobe of the left lung, accompanied by a massive carcinomatous pleural effusion. Following a cisplati-based chemotherapy, gefitinib was initiated, achieving satisfactory disease control. At 8 months after gefitinib initiation, the patient developed abdominal distension, gait disturbance and visual disorder of the right eye. Adenocarcinoma cells were detected in the ascitic and pleural fluids. The findings of this case report suggest that clinicians should remain vigilant for this type of metastasis, although it is rarely encountered.
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Affiliation(s)
- Koichi Kurishima
- Division of Respiratory Medicine, Mito Medical Center, University of Tsukuba, Mito, Ibaraki 310-0015, Japan
| | - Kunihiko Miyazaki
- Division of Respiratory Medicine, Mito Medical Center, University of Tsukuba, Mito, Ibaraki 310-0015, Japan
| | - Tomohiro Tamura
- Division of Respiratory Medicine, Mito Medical Center, University of Tsukuba, Mito, Ibaraki 310-0015, Japan
| | - Gen Ohara
- Division of Respiratory Medicine, Mito Medical Center, University of Tsukuba, Mito, Ibaraki 310-0015, Japan
| | - Katsunori Kagohashi
- Division of Respiratory Medicine, Mito Medical Center, University of Tsukuba, Mito, Ibaraki 310-0015, Japan
| | - Mio Kawaguchi
- Division of Respiratory Medicine, Mito Medical Center, University of Tsukuba, Mito, Ibaraki 310-0015, Japan
| | - Hiroaki Satoh
- Division of Respiratory Medicine, Mito Medical Center, University of Tsukuba, Mito, Ibaraki 310-0015, Japan
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Yuan Y, Tan C, Li M, Shen H, Fang X, Hu Y, Ma S. Activity of pemetrexed and high-dose gefitinib in an EGFR-mutated lung adenocarcinoma with brain and leptomeningeal metastasis after response to gefitinib. World J Surg Oncol 2012; 10:235. [PMID: 23134665 PMCID: PMC3542167 DOI: 10.1186/1477-7819-10-235] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2012] [Accepted: 10/18/2012] [Indexed: 11/22/2022] Open
Abstract
About 20% to 40% of patients with non-small cell lung cancer (NSCLC) will develop brain metastases during the natural course of their disease. The prognosis for such patients is very poor with limited survival. In addition to the standard whole brain radiation therapy (WBRT), some studies have shown that chemotherapy drugs and/or epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKI) can improve the outcome of these patients. Here, we report a stage IIIA patient who developed multiple brain metastases one year after operation. Oral gefitinib with concurrent WBRT were given as first-line therapy. Complete response and a 50-month progression-free survival (PFS) were obtained. Double dosage of gefitinib (500 mg per day) together with pemetrexed were given as the second-line therapy after the patient developed new brain lesions and leptomeningeal metastasis during the maintenance therapy of gefitinib. The PFS for the second-line therapy was six months. In total, the patient obtained an overall survival of 59 months since the first diagnosis of brain metastases. Mutational analysis showed a 15-nucleotide deletion and a missense mutation in exon 19 of the EGFR gene, and a missense mutation at codon 12 of the K-ras gene. These underlying genetic changes might partially explain the long-term survival of this patient after brain metastases when treated with concurrent or sequential therapies of EGFR-TKI, radiotherapy and chemotherapy.
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Affiliation(s)
- Ying Yuan
- Department of Medical Oncology, Second Affiliated Hospital Zhejiang University College of Medicine, 88, Jiefang Road, Hangzhou 310009, Zhejiang, China
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Cerebrospinal fluid concentrations of gefitinib in patients with lung adenocarcinoma. Clin Lung Cancer 2012; 14:188-93. [PMID: 22846582 DOI: 10.1016/j.cllc.2012.06.004] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2012] [Revised: 06/10/2012] [Accepted: 06/11/2012] [Indexed: 11/20/2022]
Abstract
BACKGROUND Epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs), such as gefitinib and erlotinib, have high response and disease control rates in patients with central nervous system (CNS) metastases. However there have been only a few case reports on the penetration of gefitinib into the cerebrospinal fluid (CSF). The aim of this study was to investigate the CSF concentration of gefitinib in Chinese patients with lung adenocarcinomas. METHODS From March 2007 to December 2010, 22 patients were sequentially enrolled in this study at Peking Union Medical College Hospital (PUMCH). CSF and plasma samples were collected at the same time from each patient after at least 7 doses of gefitinib. The concentrations of gefitinib in the CSF and plasma were measured by high performance liquid chromatography coupled with tandem mass spectrometry. The clinical factors that may affect gefitinib penetration were analyzed. RESULTS The mean plasma and CSF concentrations of gefitinib were 491.8 ± 184.2 ng/mL and 6.2 ± 4.6 ng/mL, respectively, and the mean ratio of CSF-plasma concentration was 1.3% ± 0.7%. There was a good correlation between CSF and plasma gefitinib concentrations (R = 0.556, P = .006). The presence of CNS metastases was associated with increased gefitinib CSF penetration (1.46% vs. 0.95%; P = .042). CONCLUSIONS The concentration of gefitinib in CSF was low, and it was significantly related to the plasma gefitinib concentration. Because of the inadequate CNS drug exposure, patients in whom the extracranial lesions were well controlled may benefit from increasing gefitinib dose for the new intracranial lesions.
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Umemura S, Tsubouchi K, Yoshioka H, Hotta K, Takigawa N, Fujiwara K, Horita N, Segawa Y, Hamada N, Takata I, Yamane H, Kamei H, Kiura K, Tanimoto M. Clinical outcome in patients with leptomeningeal metastasis from non-small cell lung cancer: Okayama Lung Cancer Study Group. Lung Cancer 2012; 77:134-9. [PMID: 22487432 DOI: 10.1016/j.lungcan.2012.03.002] [Citation(s) in RCA: 90] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2011] [Revised: 12/23/2011] [Accepted: 03/01/2012] [Indexed: 12/15/2022]
Abstract
OBJECTIVE We examined the prognosis of patients with leptomeningeal metastasis (LM) from non-small cell lung cancer (NSCLC) and that stratified by epidermal growth factor receptor (EGFR) mutation status in LM patients receiving EGFR-tyrosine kinase inhibitors (TKIs). METHODS We retrospectively analyzed a series of 91 consecutive NSCLC patients with LM between 2001 and 2010. RESULTS Most of the LM patients had adenocarcinoma histology and a poor performance status (PS). The median survival time (MST) for all patients was 3.6 months. Adenocarcinoma and TKI treatment were associated with a better prognosis. Among the patients, 51 received EGFR-TKIs. Of these, the EGFR mutation status was assessed in 30 patients; 7 (23%) showed no mutation (group 1), 10 (33%) had a mutation in exon 21 (group 2), and 13 (43%) had deletions in exon 19 (group 3). Interestingly, PS was significantly improved in groups 2 and 3 but not in group 1. The MST in these subgroups was 1.4, 7.1, and 11.0 months in groups 1, 2, and 3, respectively (p<0.001). The median time to progression or symptom deterioration was 0.9, 2.0, and 7.8 months for groups 1, 2, and 3, respectively (p<0.001). A multivariate analysis showed that EGFR-mutant tumors were associated with a better prognosis in patients receiving EGFR-TKIs. CONCLUSIONS The prognosis for patients with LM from NSCLC was still poor. Survival after the initiation of EGFR-TKI treatment differed according to the type of EGFR mutation, suggesting the potential benefit of TKIs for patients with EGFR mutations, even though they suffered from LM.
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Affiliation(s)
- Shigeki Umemura
- Division of Clinical Oncology, Sumitomo Besshi Hospital, 3-1 Ohji-cho, Niihama, Japan.
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Detection of Epithelial Growth Factor Receptor Mutations in Cerebrospinal Fluid from Patients with Lung Adenocarcinoma Suspected of Neoplastic Meningitis. J Thorac Oncol 2011; 6:1215-20. [DOI: 10.1097/jto.0b013e318219aaae] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Erlotinib efficacy and cerebrospinal fluid concentration in patients with lung adenocarcinoma developing leptomeningeal metastases during gefitinib therapy. Cancer Chemother Pharmacol 2011; 67:1465-9. [PMID: 21274533 DOI: 10.1007/s00280-011-1555-6] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2010] [Accepted: 01/10/2011] [Indexed: 12/29/2022]
Abstract
PURPOSE We have treated patients with non-small-cell lung cancer (NSCLC) who developed leptomeningeal metastases (LM) during gefitinib therapy, and then found symptomatic improvement following treatment change to erlotinib. Based on this experience, we wondered whether erlotinib could be detected in cerebrospinal fluid (CSF) when it was used for NSCLC patients with LM. This study was conducted to determine erlotinib concentrations in CSF and assess responses to erlotinib in patients with NSCLC developing LM during gefitinib therapy. METHODS Three advanced NSCLC patients with LM that developed during gefitinib therapy were treated with erlotinib. On day 28 after the initiation of erlotinib treatment, plasma and CSF were obtained and the concentrations of erlotinib in these samples were measured. Eastern Cooperative Oncology Group (ECOG) performance status (PS) and neurologic symptoms were determined. RESULTS Erlotinib CSF penetration was 6.3% ± 6.1% (mean ± SD). In cases 1 and 2, we observed improvements in ECOG PS and neurologic symptoms. In case 3, cytological improvement was seen in the CSF. In each patient, deletion of exon 19 or exon 21 L858R mutation of the epidermal growth factor receptor (EGFR) gene was detected in carcinoma cells from the CSF. CONCLUSIONS We report on 3 patients with NSCLC who had developed LM during gefitinib treatment and showed clinical improvements following change to erlotinib therapy. In all cases, small but measurable penetration of erlotinib into CSF was observed. Because EGFR mutations were detected in all cases, we suggest that erlotinib is a therapeutic option for LM carcinoma cells with EGFR mutations.
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Cerebrospinal Fluid Concentration of Erlotinib and its Active Metabolite OSI-420 in Patients with Central Nervous System Metastases of Non-small Cell Lung Cancer. J Thorac Oncol 2010; 5:950-5. [DOI: 10.1097/jto.0b013e3181e2138b] [Citation(s) in RCA: 102] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Yamanaka R, Koga H, Yamamoto Y, Yamada S, Sano T, Fukushige T. Characteristics of patients with brain metastases from lung cancer in a palliative care center. Support Care Cancer 2010; 19:467-73. [PMID: 20217148 DOI: 10.1007/s00520-010-0838-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2009] [Accepted: 02/16/2010] [Indexed: 12/01/2022]
Abstract
PURPOSE AND METHODS Patients with brain metastases present severe symptoms owing to the tumor growth or treatment side effects, and supportive measures are often critical for the patients and their families. However, there is currently a lack of palliative care and end-of-life (EoL) provision for patients affected by advanced brain tumors. We performed a retrospective analysis of the characteristics of patients with brain metastases from lung cancer between August 1998 and December 2008 in our palliative care center. RESULTS During this period, 55 such patients died. The male/female ratio was 0.86, and the mean age was 60.7 years. The duration of the last stay before death varied between 2 and 196 days (mean, 42.6 days). Death appeared predictable as the consequence of end-stage disease in all cases. The most frequent general clinical complaints were pain (64.8%), general fatigue (46.2%), and dyspnea (31.4%). The most frequent symptoms related to the brain tumors were consciousness deterioration (33%), headache (26%), cranial nerve palsy (19%), and delirium (19%). The symptoms in patients with carcinomatous meningitis were headache (63.6%), cranial nerve palsy (45.4%), epilepsy (27.2%), and nausea and vomiting (27.2%). The therapy tools used were chemotherapy in 9% and steroids and glycerol in 32.7%. Four patients who had leptomeningeal carcinomatosis suffered from hydrocephalus, and treatments for vasogenic edema or antalgics were less effective. In such cases, cerebrospinal fluid drainage may be effective if there are no space-occupying lesions. One patient had cortical atrophy with cognitive impairment and another had a cerebral infarction during admission. CONCLUSION Optimization of the quality of life in its final stages requires efficient palliative care, which involves considerable psychological, sociological, technical, and financial burdens. Palliative management of brain metastases requires a multidisciplinary approach performed by a well-trained neuro-oncology team, and it is important to avoid any treatment that is harmful or has a poor toxicity/efficacy ratio to avoid inappropriate prolongation of dying.
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Affiliation(s)
- Ryuya Yamanaka
- Research Center for Innovative Cancer Therapy, School of Medicine, Kurume University, Kurume, Fukuoka, Japan.
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16
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Tam IYS, Leung ELH, Tin VPC, Chua DTT, Sihoe ADL, Cheng LC, Chung LP, Wong MP. Double EGFR mutants containing rare EGFR mutant types show reduced in vitro response to gefitinib compared with common activating missense mutations. Mol Cancer Ther 2009; 8:2142-51. [PMID: 19671738 DOI: 10.1158/1535-7163.mct-08-1219] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Epidermal growth factor receptor (EGFR) mutations are common in lung adenocarcinomas, especially from nonsmoking women of Asian descent. We have previously shown EGFR mutations occur in >70% of lung adenocarcinoma from nonsmokers in our population with a complex mutational profile, including 13% of EGFR double mutations. In this study, we investigated the in vitro gefitinib response of four EGFR double mutants identified in untreated patients, including Q787R+L858R, E709A+G719C, T790M+L858R, and H870R+L858R. The phosphorylation profiles of EGFR and downstream effectors AKT, STAT3/5, and ERK1/2 were compared by immunoblot analyses among the single and double mutants transfected into H358 cells. Results showed that mutants responded to in vitro gefitinib treatment with different sensitivities. The G719C and L858R single mutants showed the highest gefitinib sensitivity compared with the corresponding coexisting single mutants E709A, Q787R, H870R, and T790M. The double mutants E709A+G719C, Q787R+L858R, and H870R+L858R showed attenuated responses to gefitinib in the EGFR and downstream effector phosphorylation profiles compared with G719C or L858R alone. T790M+L858R showed strong resistance to gefitinib. Clinically, the patient whose tumor contained H870R+L858R showed tumor stabilization by 250 mg oral gefitinib daily but cerebral metastasis developed 6 months later. Correlation with the in vitro phosphorylation profile of H870R+L858R suggested that treatment failure was probably due to inadequate suppression of EGFR signaling by the drug level attainable in the cerebrospinal fluid at the given oral dosage. Overall, the findings suggested that rare types of EGFR substitution mutations could confer relative gefitinib resistance when combined with the common activating mutants.
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Affiliation(s)
- Issan Yee-San Tam
- Department of Pathology, The University of Hong Kong, Queen Mary Hospital, Hong Kong
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17
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So T, Inoue M, Chikaishi Y, Nose N, Sugio K, Yasumoto K. Gefitinib and a ventriculo-peritoneal shunt to manage carcinomatous meningitis from non-small-cell lung cancer: report of two cases. Surg Today 2009; 39:598-602. [PMID: 19562448 DOI: 10.1007/s00595-008-3909-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2008] [Accepted: 12/26/2008] [Indexed: 10/20/2022]
Abstract
The prognosis of patients with carcinomatous meningitis from non-small-cell lung cancer (NSCLC) remains poor, and the available treatment options for the lung cancer do not relieve the severe symptoms of this sequela. We report the successful treatment of two cases of carcinomatous meningitis caused by NSCLC, using gefitinib and a ventriculo-peritoneal (V-P) shunt. The first patient was a 43-year-old woman with pT1N0M0 adenocarcinoma. Multiple brain and vertebral metastases were found 13 months after surgery. She had undergone gamma-knife radiosurgery for the brain metastases, radiotherapy for the vertebral metastases, and two regimens of systemic chemotherapy, before carcinomatous meningitis was diagnosed. She was given gefitinib, and then a V-P shunt was placed. She continued to take gefitinib and was free of subjected symptoms for 5 months until she died. The second patient was a 64-year-old woman with cT4N0M0 adenocarcinoma. After local chemotherapy using cisplatin and OK-432 for carcinomatosis pleuritis and two regimens of systemic chemotherapy, carcinomatous meningitis was detected. A V-P shunt was placed, and she was sequentially given gefitinib. At her 15-month follow-up, she was free of symptoms of carcinomatous meningitis. No adverse effects or shunt problems were detected in either patient. This therapeutic modality may liberate carcinomatous meningitis patients with severe symptoms from hospitalization and improve their quality of life.
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Affiliation(s)
- Tetsuya So
- Department of Thoracic Surgery, Niigata Rosai Hospital, Joetsu, Niigata, Japan
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18
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Liu R, Chang SM, Prados M. Recent advances in the treatment of central nervous system tumors. ACTA ACUST UNITED AC 2008. [DOI: 10.1016/j.uct.2007.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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19
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Fukuhara T, Saijo Y, Sakakibara T, Inoue A, Morikawa N, Kanamori M, Nakashima I, Nukiwa T. Successful Treatment of Carcinomatous Meningitis with Gefitinib in a Patient with Lung Adenocarcinoma Harboring a Mutated EGF Receptor Gene. TOHOKU J EXP MED 2008; 214:359-63. [DOI: 10.1620/tjem.214.359] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Tatsuro Fukuhara
- Department of Respiratory Oncology and Molecular Medicine, Institute of Development, Aging and Cancer, Tohoku University
| | - Yasuo Saijo
- Department of Medical Oncology, Hirosaki University Graduate School of Medicine
| | - Tomohiro Sakakibara
- Department of Respiratory Oncology and Molecular Medicine, Institute of Development, Aging and Cancer, Tohoku University
| | - Akira Inoue
- Department of Respiratory Oncology and Molecular Medicine, Institute of Development, Aging and Cancer, Tohoku University
| | - Naoto Morikawa
- Department of Respiratory Oncology and Molecular Medicine, Institute of Development, Aging and Cancer, Tohoku University
| | - Masayuki Kanamori
- Department of Neurosurgery, Tohoku University Graduate School of Medicine
| | - Ichiro Nakashima
- Department of Neurology, Tohoku University Graduate School of Medicine
| | - Toshihiro Nukiwa
- Department of Respiratory Oncology and Molecular Medicine, Institute of Development, Aging and Cancer, Tohoku University
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20
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Abstract
Cerebral metastases remain a common complication among patients with cancer. Surgery and radiotherapy remain the principal therapeutic interventions. In contrast, the benefit of chemotherapy has long been viewed with skepticism. Nonetheless, as survival in cancer patients improves and the incidence of cerebral metastases increases, so does the demand for effective therapies. It is now recognized that the blood-brain barrier within metastases is permeable and thus allows entry of otherwise excluded drugs. Limited data have suggested that cerebral metastases have modest sensitivity to chemotherapy. Furthermore, novel agents and delivery strategies have been developed to facilitate central nervous system penetration. Nonetheless, data are limited by methodological flaws, including heterogeneous inclusion criteria, small sample sizes, lack of randomization, and inconsistencies in defined end points and response assessment criteria. Well-designed clinical trials are needed to address the effect of chemotherapy. Acceptable control arms must be established to measure the effect of chemotherapies. Standardized response criteria and disease-specific studies are essential.
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Affiliation(s)
- Robert Cavaliere
- Dardinger Neuro-Oncology Center, The Ohio State University, Columbus, Ohio, USA
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21
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Kanaji N, Bandoh S, Nagamura N, Kushida Y, Haba R, Ishida T. Significance of an epidermal growth factor receptor mutation in cerebrospinal fluid for carcinomatous meningitis. Intern Med 2007; 46:1651-5. [PMID: 17917328 DOI: 10.2169/internalmedicine.46.0335] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We report a case of epidermal growth factor receptor (EGFR) inhibitor-sensitive lung adenocarcinoma with carcinomatous meningitis who showed a good response to gefitinib, an oral tyrosine kinase inhibitor of EGFR. This good response to gefitinib treatment was attributed to evidence of an EGFR mutation, L858R in exon 21, which was detected in a small amount of cerebrospinal fluid (CSF) before the positive CSF cytology. Patients with carcinomatous meningitis often have a poor performance status, and therefore diagnostic approaches and therapeutic methods are also often limited. Detection of EGFR mutations may be a useful method for non-small cell lung cancer diagnosis, and also facilitate determination of appropriate therapeutic protocols.
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Affiliation(s)
- Nobuhiro Kanaji
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Hematology, Rheumatology and Respiratory Medicine, Faculty of Medicine, Kagawa University.
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22
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Ano S, Satoh H, Nakazawa K, Ohtsuka M, Anami Y, Noguchi M, Hizawa N. Malignant meningitis secondary to lung adenocarcinoma: an unusual relapse. Intern Med 2007; 46:1749-51. [PMID: 17938533 DOI: 10.2169/internalmedicine.46.0277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We describe a 64-year-old man with locally advanced lung adenocarcinoma who had meningeal relapse soon after the completion of intensive chemo-radiotherapy. Diagnosis of the malignant meningitis was established by cytological examination of the cerebrospinal fluid, which showed malignant cells consistent with adenocarcinoma from the primary site. Although very rare, it is possible that successful chemo-radiotherapy for locally advanced lung cancer could not prevent malignant meningitis as observed in our patient. Physicians should consider performance of brain MRI or contrast CT of the brain and a lumbar puncture to exclude the diagnosis of malignant meningitis, an uncommon but devastating complication of malignancy.
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Affiliation(s)
- Satoshi Ano
- Division of Respiratory Medicine, Institute of Clinical Medicine, University of Tsukuba
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23
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Meléndez B, Fiaño C, Ruano Y, Hernández-Moneo JL, Mollejo M, Martinez P. BCR gene disruption in a pilomyxoid astrocytoma. Neuropathology 2006; 26:442-6. [PMID: 17080723 DOI: 10.1111/j.1440-1789.2006.00712.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We report here a 4-month-old child with a large, solid enhancing mass involving predominantly the suprasellar and diencephalic regions, with extension of both hemispheres. The patient underwent partial resection of the mass by right temporal craniotomy. Histological diagnosis was of a low-grade glioma consistent with pilomyxoid astrocytoma. Cytogenetic analyses revealed an insertion on chromosome 17 that involved disruption of the BCR gene. This finding suggests a possible rearrangement of this gene that could act in a similar way to chronic myeloid leukemia with formation of a chimeric tyrosine kinase protein. This study may suggest the use of inhibitors of tyrosine kinase proteins as an alternative treatment approach in cases of refractory or disseminated pilocytic astrocytomas.
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Affiliation(s)
- Bárbara Meléndez
- Genetics Department, Hospital Virgen de la Salud, Avda. Barber, 30 Toledo 45005, Spain.
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24
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Kim YC, Kim KS. Drugs for Lung Cancer Treatment. Tuberc Respir Dis (Seoul) 2006. [DOI: 10.4046/trd.2006.60.2.123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Young-Chul Kim
- Division of Pulmonology, Internal Medicine, Chonnam National University Medical School, Hwasun Hospital, Korea
| | - Kyu-Sik Kim
- Division of Pulmonology, Internal Medicine, Chonnam National University Medical School, Hwasun Hospital, Korea
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