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Chen YF, Lin JW, Ho CC, Yang CY, Chang CH, Huang TM, Chen CY, Chen KY, Shih JY, Yu CJ. Outcomes of cancer therapy administered to treatment-naïve lung cancer patients in the intensive care unit. J Cancer 2017; 8:1995-2003. [PMID: 28819399 PMCID: PMC5559960 DOI: 10.7150/jca.18178] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 05/03/2017] [Indexed: 12/13/2022] Open
Abstract
Objectives: Therapy outcomes for newly diagnosed, critically ill lung cancer patients have seldom been evaluated. This study evaluated therapy outcomes for treatment-naïve lung cancer patients in the intensive care unit (ICU). Materials and Methods: Patients were excluded if they had previously received lung cancer treatment, such as systemic chemotherapy, targeted therapy, radiotherapy, or surgical lung resection before ICU admission. The therapeutic strategies for the treatment-naïve patients were determined while they were in the ICU. The patients' demographic data, clinical outcomes, and treatment-related toxicities were analyzed. Results: Newly diagnosed lung cancer patients (n = 72) who did not receive any anticancer treatment before ICU admission were included. Most patients had locally advanced disease, and 61 (84.7%) required intensive care due to cancer-related events. In the ICU, 24 (33.3%) patients received chemotherapy, 24 (33.3%) received epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI) therapy and 24 (33.3%) received best supportive care (BSC). Patients receiving chemotherapy or EGFR-TKIs in the ICU demonstrated better ICU (p = 0.011) and in-hospital (p = 0.034) survival than those receiving BSC only. Among patients requiring mechanical ventilation, those receiving chemotherapy had higher weaning rates than those receiving EGFR-TKIs or BSC (p = 0.002). In multivariate analysis, receipt of chemotherapy (hazard ratio [HR], 0.443; p = 0.083) and mechanical ventilation (HR, 0.270; p = 0.022) were significantly associated with longer ICU survival after adjusting for clinical factors. Conclusions: Anticancer therapy in the ICU might provide better short-term ICU survival for treatment-naïve, critically ill lung cancer patients.
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Affiliation(s)
- Yen-Fu Chen
- Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, No.579, Sec. 2, Yunlin Rd., Douliou City, Yunlin County 640, Taiwan (R.O.C.)
| | - Jou-Wei Lin
- Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, No.579, Sec. 2, Yunlin Rd., Douliou City, Yunlin County 640, Taiwan (R.O.C.)
| | - Chao-Chi Ho
- Department of Internal Medicine, National Taiwan University Hospital, No.7, Zhongshan South Road, Taipei 100, Taiwan (ROC)
| | - Ching-Yao Yang
- Department of Internal Medicine, National Taiwan University Hospital, No.7, Zhongshan South Road, Taipei 100, Taiwan (ROC)
| | - Chia-Hao Chang
- Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, No. 25, Lane 442, Sec. 1, Jingguo Rd., Hsinchu City 30059, Taiwan (R.O.C.)
| | - Tao-Min Huang
- Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, No.579, Sec. 2, Yunlin Rd., Douliou City, Yunlin County 640, Taiwan (R.O.C.)
| | - Chung-Yu Chen
- Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, No.579, Sec. 2, Yunlin Rd., Douliou City, Yunlin County 640, Taiwan (R.O.C.)
| | - Kuan-Yu Chen
- Department of Internal Medicine, National Taiwan University Hospital, No.7, Zhongshan South Road, Taipei 100, Taiwan (ROC)
| | - Jin-Yuan Shih
- Department of Internal Medicine, National Taiwan University Hospital, No.7, Zhongshan South Road, Taipei 100, Taiwan (ROC)
| | - Chong-Jen Yu
- Department of Internal Medicine, National Taiwan University Hospital, No.7, Zhongshan South Road, Taipei 100, Taiwan (ROC)
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Hotta K, Sasaki J, Saeki S, Takigawa N, Katsui K, Takayama K, Nogami N, Shioyama Y, Bessho A, Kishimoto J, Tanimoto M, Kiura K, Ichinose Y. Gefitinib Combined With Standard Chemoradiotherapy in EGFR-Mutant Locally Advanced Non–Small-Cell Lung Cancer: The LOGIK0902/OLCSG0905 Intergroup Study Protocol. Clin Lung Cancer 2016; 17:75-9. [DOI: 10.1016/j.cllc.2015.08.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Accepted: 08/11/2015] [Indexed: 01/04/2023]
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Hotta K, Kiura K, Takigawa N, Suzuki E, Yoshioka H, Okada T, Kishino D, Ueoka H, Inoue K, Tabata M, Tanimoto M. Association between poor performance status and risk for toxicity during erlotinib monotherapy in Japanese patients with non-small cell lung cancer: Okayama Lung Cancer Study Group experience. Lung Cancer 2010; 70:308-12. [PMID: 20416970 DOI: 10.1016/j.lungcan.2010.03.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2010] [Revised: 03/01/2010] [Accepted: 03/16/2010] [Indexed: 11/19/2022]
Affiliation(s)
- Katsuyuki Hotta
- Department of Respiratory Medicine, Okayama University Hospital, 2-5-1, Shikata-cho, Kitaku, Okayama 700-8558, Japan.
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First-line gefitinib treatment for patients with advanced non-small cell lung cancer with poor performance status. J Thorac Oncol 2010; 5:361-8. [PMID: 20107420 DOI: 10.1097/jto.0b013e3181cee1ea] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Best supportive care only is recommended for patients with advanced non-small cell lung cancer (NSCLC) with poor performance status (PS) of Eastern Cooperative Oncology Group 3 or 4. Recently, the possibility of using epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor therapy has been reported for poor PS patients harboring EGFR mutations. METHODS We retrospectively analyzed 74 patients with advanced NSCLC who were treated with first-line gefitinib during hospitalization for Eastern Cooperative Oncology Group PS 3 or 4. All patients were classified according to three clinical parameters: smoking history, gender, and histology type. RESULTS The median age was 64 years (range, 35-86 years). The proportions of females, never smokers, and adenocarcinoma were 51.4%, 54.1%, and 78.4%, respectively. An overall response rate, median progression-free survival (PFS), and median overall survival (OS) was 27.0%, 32 days (95% confidence interval [CI], 22-48 days), and 61 days (95% CI, 7-115 days), respectively. Female gender, never smoking, and adenocarcinoma histology were strong predictors of tumor response. Never smoking and adenocarcinoma were independent predictors of better PFS but not of OS. Seven patients experienced treatment-related adverse effects of grade 3 to 4, which included anorexia (n = 2), pneumonitis (n = 4), and elevated liver enzymes (n = 1). Never-smoker females with adenocarcinoma exhibited a response rate of 50.0%, median PFS of 130 days (95% CI, 51-209 days), and median OS of 236 days (95% CI, 150-322 days). CONCLUSIONS Gefitinib may provide clinical benefits for patients with NSCLC with poor PS who were selected according to clinically favorable parameters.
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Comparison of the incidence and pattern of interstitial lung disease during erlotinib and gefitinib treatment in Japanese Patients with non-small cell lung cancer: the Okayama Lung Cancer Study Group experience. J Thorac Oncol 2010; 5:179-84. [PMID: 20101144 DOI: 10.1097/jto.0b013e3181ca12e0] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Data comparing the incidence and pattern of interstitial lung disease (ILD) in non-small cell lung cancer patients receiving treatment with gefitinib versus erlotinib, both of which are epidermal growth factor receptor tyrosine kinase inhibitors, are scarce. We investigated the incidence of ILD in Japanese patients treated with gefitinib or erlotinib. METHODS We reviewed the clinical records of 209 patients treated with erlotinib in 2008 (cohort A) and 330 treated with gefitinib between 2000 and 2003 (cohort B). Toxicity within the first month of treatment was investigated. RESULTS The patients in cohort A had fewer known risk factors for ILD (e.g., poor performance status and prior pulmonary fibrosis). ILD was detected in two patients (1.0%) from cohort A and eight patients (2.4%) from cohort B during the first month of treatment. The events were graded as follows: one patient each in grades 1 and 2 (cohort A), and one, one, and six patients in grades 3, 4, and 5, respectively (cohort B). Multivariate analysis revealed that poor performance status and prior pulmonary fibrosis were significantly correlated with the occurrence of ILD, but the type of epidermal growth factor receptor tyrosine kinase inhibitor administered was not. CONCLUSION There was a somewhat lower incidence of ILD with erlotinib therapy than with gefitinib therapy, despite no statistically significant difference. Patient selection based on awareness by Japanese physicians of the risk factors for ILD, rather than the type of agent, may explain the difference in ILD incidence between the two treatments.
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Inoue A, Kobayashi K, Usui K, Maemondo M, Okinaga S, Mikami I, Ando M, Yamazaki K, Saijo Y, Gemma A, Miyazawa H, Tanaka T, Ikebuchi K, Nukiwa T, Morita S, Hagiwara K. First-line gefitinib for patients with advanced non-small-cell lung cancer harboring epidermal growth factor receptor mutations without indication for chemotherapy. J Clin Oncol 2009; 27:1394-400. [PMID: 19224850 DOI: 10.1200/jco.2008.18.7658] [Citation(s) in RCA: 359] [Impact Index Per Article: 23.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
PURPOSE This multicenter phase II study was undertaken to investigate the efficacy and feasibility of gefitinib for patients with advanced non-small-cell lung cancer (NSCLC) harboring epidermal growth factor receptor (EGFR) mutations without indication for chemotherapy as a result of poor performance status (PS). PATIENTS AND METHODS Chemotherapy-naïve patients with poor PS (patients 20 to 74 years of age with Eastern Cooperative Oncology Group PS 3 to 4, 75 to 79 years of age with PS 2 to 4, and >or= 80 years of age with PS 1 to 4) who had EGFR mutations examined by the peptide nucleic acid-locked nucleic acid polymerase chain reaction clamp method were enrolled and received gefitinib (250 mg/d) alone. RESULTS Between February 2006 and May 2007, 30 patients with NSCLC and poor PS, including 22 patients with PS 3 to 4, were enrolled. The overall response rate was 66% (90% CI, 51% to 80%), and the disease control rate was 90%. PS improvement rate was 79% (P < .00005); in particular, 68% of the 22 patients improved from >or= PS 3 at baseline to <or= PS 1. The median progression-free survival, median survival time, and 1-year survival rate were 6.5 months, 17.8 months, and 63%, respectively. No treatment-related deaths were observed. CONCLUSION This is the first report indicating that EGFR mutation-positive patients with extremely poor PS benefit from first-line gefitinib. Because there previously has been no standard treatment for these patients with short life expectancy other than best supportive care, examination of EGFR mutations as a biomarker is recommended in this patient population.
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Affiliation(s)
- Akira Inoue
- Tohoku University, Graduate School of Medicine and School of Medicine, Japan
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Epidermal growth factor receptor tyrosine kinase inhibitors in elderly or poor performance status patients with advanced non-small cell lung cancer. Target Oncol 2009; 4:37-44. [DOI: 10.1007/s11523-009-0104-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2008] [Accepted: 01/02/2009] [Indexed: 10/21/2022]
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Simon GR, Extermann M, Chiappori A, Williams CC, Begum M, Kapoor R, Haura EB, Ismail-Khan R, Schell MJ, Antonia SJ, Bepler G. Phase 2 trial of docetaxel and gefitinib in the first-line treatment of patients with advanced nonsmall-cell lung cancer (NSCLC) who are 70 years of age or older. Cancer 2008; 112:2021-9. [DOI: 10.1002/cncr.23360] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Yang CH, Shih JY, Chen KC, Yu CJ, Yang TY, Lin CP, Su WP, Gow CH, Hsu C, Chang GC, Yang PC. Survival outcome and predictors of gefitinib antitumor activity in East Asian chemonaive patients with advanced nonsmall cell lung cancer. Cancer 2006; 107:1873-82. [PMID: 16989002 DOI: 10.1002/cncr.22220] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Chemonaive patients had higher response rates than chemotherapy-treated patients in previous analyses of East Asian patients with advanced nonsmall cell lung cancer. The survival outcome and the predictors for antitumor activity in chemonaive patients who received gefitinib as first-line treatment are unclear. METHODS Clinicopathologic predictive factors, objective tumor responses, and the survival of consecutive patients with advanced, chemonaive nonsmall cell lung cancer who received gefitinib as first-line treatment were collected and analyzed. Multivariate analysis was conducted to determine independent predictive factors for gefitinib antitumor efficacy. RESULTS One hundred ninety-six patients (112 males and 84 females) were analyzed. Ninety-six patients (49%) were never smokers. One hundred forty-four patients (73%) had adenocarcinoma or bronchioloalveolar carcinoma histology. One hundred twenty patients had an Eastern Cooperative Oncology Group performance status 0 to 2. Eighty-three patients (42%; 95% confidence interval, 36-49%) had an objective tumor response. An additional 35 patients had stable disease (disease control rate, 61%). The tumor response rate was 52% in patients who had a good performance status. Female gender, nonsmoking status, and adenocarcinoma histology all were independent predictors of response or disease control in multivariate analysis. The median survival was 11.1 months, and the 1-year survival rate of patients who had a good performance status was 47.5%. CONCLUSIONS The response rate to gefitinib was high in East Asian chemonaive patients with advanced nonsmall cell lung cancer. Female gender, adenocarcinoma histology, and nonsmoking status all were independent predictors of gefitinib response. The survival outcome of these patients was similar to that of patients who initially received chemotherapy.
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Affiliation(s)
- Chih-Hsin Yang
- Department of Oncology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan, Republic of China
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