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Servetto A, Di Maio M, Salomone F, Napolitano F, Paratore C, Di Costanzo F, Viscardi G, Santaniello A, Formisano L, Bianco R. Analysis of phase III clinical trials in metastatic NSCLC to assess the correlation between QoL results and survival outcomes. BMC Med 2023; 21:234. [PMID: 37400832 DOI: 10.1186/s12916-023-02953-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 06/20/2023] [Indexed: 07/05/2023] Open
Abstract
BACKGROUND In addition to improving survival outcomes, new oncology treatments should lead to amelioration of patients' quality of life (QoL). Herein, we examined whether QoL results correlated with PFS and OS outcomes in phase III randomized controlled trials (RCTs) investigating new systemic treatments in metastatic non-small cell lung cancer (NSCLC). METHODS The systematic search of PubMed was conducted in October 2022. We identified 81 RCTs testing novel drugs in metastatic NSCLC and published in the English language in a PubMed-indexed journal between 2012 and 2021. Only trials reporting QoL results and at least one survival outcome between OS and PFS were selected. For each RCT, we assessed whether global QoL was "superior," "inferior," or with "non-statistically significant difference" in the experimental arm compared to the control arm. RESULTS Experimental treatments led to superior QoL in 30 (37.0%) RCTs and inferior QoL in 3 (3.7%) RCTs. In the remaining 48 (59.3%) RCTs, a statistically significant difference between the experimental and control arms was not found. Of note, we found a statistically significant association between QoL and PFS improvements (X2 = 3.93, p = 0.0473). In more detail, this association was not significant in trials testing immunotherapy or chemotherapy. On the contrary, in RCTs testing target therapies, QoL results positively correlated with PFS outcomes (p = 0.0196). This association was even stronger in the 32 trials testing EGFR or ALK inhibitors (p = 0.0077). On the other hand, QoL results did not positively correlate with OS outcomes (X2 = 0.81, p = 0.368). Furthermore, we found that experimental treatments led to superior QoL in 27/57 (47.4%) trials with positive results and in 3/24 (12.5%) RCTs with negative results (p = 0.0028). Finally, we analyzed how QoL data were described in publications of RCTs in which QoL outcomes were not improved (n = 51). We found that a favorable description of QoL results was associated with sponsorship by industries (p = 0.0232). CONCLUSIONS Our study reveals a positive association of QoL results with PFS outcomes in RCTs testing novel treatments in metastatic NSCLC. This association is particularly evident for target therapies. These findings further emphasize the relevance of an accurate assessment of QoL in RCTs in NSCLC.
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Affiliation(s)
- Alberto Servetto
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Sergio Pansini 5, Naples, Italy
| | - Massimo Di Maio
- Department of Oncology, University of Turin, Division of Medical Oncology, Ordine Mauriziano Hospital, Turin, Italy
| | - Fabio Salomone
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Sergio Pansini 5, Naples, Italy
| | - Fabiana Napolitano
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Sergio Pansini 5, Naples, Italy
| | - Chiara Paratore
- Department of Oncology, University of Turin, Division of Medical Oncology, Ordine Mauriziano Hospital, Turin, Italy
- Department of Oncology, ASL TO4, Ivrea Community Hospital, Ivrea, Italy
| | - Fabrizio Di Costanzo
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Sergio Pansini 5, Naples, Italy
| | - Giuseppe Viscardi
- Department of Pneumology and Oncology, AORN Ospedali Dei Colli-Monaldi, Naples, Italy
| | - Antonio Santaniello
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Sergio Pansini 5, Naples, Italy
| | - Luigi Formisano
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Sergio Pansini 5, Naples, Italy
| | - Roberto Bianco
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Sergio Pansini 5, Naples, Italy.
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Salomone F, Di Costanzo F, Pecoraro G, Viscardi G, Viggiano A, Napolitano F, Santaniello A, Formisano L, Bianco R, Servetto A. Health-related quality of life is underestimated and underreported in phase III clinical trials in NSCLC. Lung Cancer 2022; 174:36-44. [PMID: 36302311 DOI: 10.1016/j.lungcan.2022.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 10/07/2022] [Accepted: 10/14/2022] [Indexed: 11/06/2022]
Abstract
Major associations of medical oncologists remark that novel anticancer treatments should guarantee improvement of survival outcomes as well as of patients' quality of life (QoL). Herein, we investigated QoL assessment and reporting in phase III randomized controlled trials (RCTs) testing new drugs in metastatic non-small cell lung cancer (NSCLC), published between 2010 and 2021. We selected 172 RCTs for further analysis. Only 2/172 (1.2%) trial included QoL among primary study endpoints. Of note, 40/172 (23.3%) trials did not include QoL assessment among endpoints. The majority of RCTs (102/172, 59.3%) did not report QoL results in primary publications. Particularly, RCTs testing immunotherapy, target therapy and chemotherapy did not disclose QoL data in primary publications in 97.0%, 51.5% and 46.5% of cases, respectively. Next, we found that only 43/95 (45.3%) positive studies reported QoL results in primary articles. Of the 102 trials missing QoL data in primary manuscripts, only 21 (20.6%) disclosed QoL results in a secondary publication. Finally, we found a common fail in adherence to CONSORT-PROs items in publications reporting QoL results. In summary, our study reveals a relevant inadequate assessment and under-reporting of QoL in RCTs of novel systemic treatments for patients with metastatic NSCLC.
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Affiliation(s)
- Fabio Salomone
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Fabrizio Di Costanzo
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Giovanna Pecoraro
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Giuseppe Viscardi
- Department of Pneumology and Oncology, AORN Ospedali dei Colli-Monaldi, Naples, Italy
| | - Angela Viggiano
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Fabiana Napolitano
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Antonio Santaniello
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Luigi Formisano
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Roberto Bianco
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy.
| | - Alberto Servetto
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy.
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Szentkereszty M, Komlósi ZI, Szűcs G, Barna G, Tamási L, Losonczy G, Gálffy G. Effect of COPD on Inflammation, Lymphoid Functions and Progression-Free Survival during First-Line Chemotherapy in Advanced Non-small Cell Lung Cancer. Pathol Oncol Res 2019; 26:1117-1128. [PMID: 31090020 PMCID: PMC7242273 DOI: 10.1007/s12253-019-00661-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 04/01/2019] [Indexed: 10/26/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is a common comorbidity of non-small cell lung cancer (NSCLC). COPD is characterized by systemic inflammation and lymphocyte dysfunction, mechanisms that are also known to accelerate progression of advanced (IIIB-IV) stage NSCLC. We aimed to find out whether COPD exerts an influence on tumor induced inflammatory and lymphoid responses and progression-free survival (PFS) after first-line treatment in advanced NSCLC. Patients suffering from NSCLC (n = 95), COPD (n = 54), NSCLC+COPD (n = 80) and healthy controls (n = 60) were included. PFS, neutrophil granulocyte and lymphocyte cell counts were recorded. Serum IFNγ, TNFα, VEGF concentrations were measured by using multiplex cytometric bead-based immunoassay. Prevalence of myeloid-derived suppressor cell populations (MDSC-s), and signs of T cell exhaustion were tested by using flow cytometry. Median PFS increased in the NSCLC+COPD group compared to NSCLC patients without COPD (7.4 vs 4.9 months, p < 0.01). NSCLC+COPD patients had 1.7 times (1.2-2.4) more likely to have longer PFS compared to NSCLC patients without COPD (Cox analysis, p < 0.01). Neutrophil cell counts, CRP, IFNγ and TNFα concentrations were all reduced in NSCLC+COPD (all p < 0.05 vs NSCLC). NSCLC+COPD was also associated with reduced serum IL-10 concentration and increased granzyme-B positive CD8 cell counts compared to NSCLC without COPD. The effects of VEGF and MDSC-s on systemic inflammation appeared to be blunted by COPD in patients suffering from advanced NSCLC. Concomitant COPD moderates tumor-induced inflammation and supports some effector lymphoid functions and thereby may be an independent positive predictive factor of longer PFS after first-line therapy in advanced NSCLC.
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Affiliation(s)
- Márton Szentkereszty
- Department of Pulmonology, Semmelweis University, Diós árok 1/C, Budapest, H-1121, Hungary.,1st Department of Pathology and Experimental Cancer Research, Semmelweis University, Üllői út 26, Budapest, H-1085, Hungary
| | - Zsolt István Komlósi
- Department of Pulmonology, Semmelweis University, Diós árok 1/C, Budapest, H-1121, Hungary
| | - Gergő Szűcs
- Department of Pulmonology, Semmelweis University, Diós árok 1/C, Budapest, H-1121, Hungary
| | - Gábor Barna
- 1st Department of Pathology and Experimental Cancer Research, Semmelweis University, Üllői út 26, Budapest, H-1085, Hungary
| | - Lilla Tamási
- Department of Pulmonology, Semmelweis University, Diós árok 1/C, Budapest, H-1121, Hungary
| | - György Losonczy
- Department of Pulmonology, Semmelweis University, Diós árok 1/C, Budapest, H-1121, Hungary.
| | - Gabriella Gálffy
- Department of Pulmonology, Semmelweis University, Diós árok 1/C, Budapest, H-1121, Hungary
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Fernández-López C, Calleja-Hernández MÁ, Balbino JE, Cabeza-Barrera J, Expósito-Hernández J. Trends in endpoint selection and result interpretation in advanced non-small cell lung cancer clinical trials published between 2000 and 2012: A retrospective cohort study. Thorac Cancer 2019; 10:904-908. [PMID: 30868737 PMCID: PMC6449273 DOI: 10.1111/1759-7714.13024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Revised: 01/31/2019] [Accepted: 02/01/2019] [Indexed: 11/30/2022] Open
Abstract
Background The objective of this review was to investigate trends in clinical trial design, specifically, the primary outcomes used, interpretation of results, and the magnitude of the benefits described in phase III controlled clinical trials in the first‐line treatment of patients with advanced non‐small cell lung cancer (NSCLC). Methods Seventy‐six trials published between 2000 and 2012 were selected from a total of 122 identified in a structured search. Results Overall survival (OS) was evaluated as the primary study endpoint in 50 (65.8%) trials, followed by progression‐free survival (PFS) in 15 (19.7%), and other variables, such as toxicity, quality of life (QoL), and response rate in 11 (14.5%). Ten (66.7%) out of 15 clinical trials using PFS as the primary endpoint were published between 2010 and 2012. Median overall survival (mOS) was 9.90 months (interquartile range: 3.5) with an increase of 0.384 months per year of publication (P < 0.001). A statistically significant improvement in mOS was obtained in only 13 (18.8%) trials. A total of 41 (53.9%) studies concluded that the result was positive. Of these, only 16 (39.1%) showed a statistically significant benefit in OS. QoL was assessed in 46 trials (60.5%) and of these, 10 (21.7%) reported significant improvements. Conclusions These findings raise important questions about how clinical benefits are measured in clinical trials in advanced NSCLC. Appropriate clinically relevant outcome variables should be established and validated, and post‐marketing studies should be requested by regulatory authorities to ensure meaningful clinical benefits in OS and QoL.
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Affiliation(s)
| | | | - Jaime Espín Balbino
- Andalusian School of Public Health (EASP), Granada, Spain.,Health Research Institute of Granada (ibs.GRANADA), University Hospitals of Granada/University of Granada, Granada, Spain
| | - José Cabeza-Barrera
- Department of Pharmacy, Biosanitary Research Institute of Granada, San Cecilio University Hospital, Granada, Spain
| | - José Expósito-Hernández
- Department of Oncology, University Hospitals of Granada, Health Research Institute of Granada (ibs.GRANADA), Spain
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Aggarwal C, Borghaei H. Treatment Paradigms for Advanced Non-Small Cell Lung Cancer at Academic Medical Centers: Involvement in Clinical Trial Endpoint Design. Oncologist 2017; 22:700-708. [PMID: 28408617 PMCID: PMC5469580 DOI: 10.1634/theoncologist.2016-0345] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 01/03/2017] [Indexed: 12/25/2022] Open
Abstract
Selection of appropriate clinical endpoints for examining the efficacy of investigational agents for non‐small cell lung cancer is of vital importance in clinical trial design. This review provides an overview of the study designs of clinical trials for approved agents in non‐small cell lung cancer and focuses on the validity of alternative endpoints for such trials. Based on the positive results of various clinical trials, treatment options for non‐small cell lung cancer (NSCLC) have expanded greatly over the last 25 years. While regulatory approvals of chemotherapeutic agents for NSCLC have largely been based on improvements in overall survival, recent approvals of many targeted agents for NSCLC (afatinib, crizotinib, ceritinib, osimertinib) have been based on surrogate endpoints such as progression‐free survival and objective response. As such, selection of appropriate clinical endpoints for examining the efficacy of investigational agents for NSCLC is of vital importance in clinical trial design. This review provides an overview of clinical trial endpoints previously utilized for approved agents for NSCLC and highlights the key efficacy results for these trials. Trends for more recent approvals in NSCLC, including those for the immunotherapeutic agents nivolumab and pembrolizumab, are also discussed. The results of a correlative analysis of endpoints from 18 clinical trials that supported approvals of investigational agents in clinical trials for NSCLC are also presented. Implications for Practice. While improving survival remains the ultimate goal of oncology clinical trials, overall survival may not always be the most feasible or appropriate endpoint to assess patient response. Recently, several investigational agents, both targeted agents and immunotherapies, have gained U.S. Food and Drug Administration approval in non‐small cell lung cancer based on alternate endpoints such as progression‐free survival or response rate. An understanding of the assessment of response and trial endpoint choice is important for future oncology clinical trial design.
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Affiliation(s)
- Charu Aggarwal
- Division of Hematology/Oncology, Abramson Cancer Center, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Hossein Borghaei
- Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
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Nakashima K, Horita N, Nagai K, Manabe S, Murakami S, Ota E, Kaneko T. Progression-Free Survival, Response Rate, and Disease Control Rate as Predictors of Overall Survival in Phase III Randomized Controlled Trials Evaluating the First-Line Chemotherapy for Advanced, Locally Advanced, and Recurrent Non-Small Cell Lung Carcinoma. J Thorac Oncol 2016; 11:1574-85. [PMID: 27178983 DOI: 10.1016/j.jtho.2016.04.025] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Revised: 04/16/2016] [Accepted: 04/18/2016] [Indexed: 12/09/2022]
Abstract
INTRODUCTION Recent improvements in chemotherapy agents have prolonged postprogression survival of non-small cell lung cancer. Thus, primary outcomes other than overall survival (OS) have been frequently used for recent phase III trials to obtain quick results. However, no systematic review had assessed whether progression-free survival (PFS), response rate (RR), and disease control rate (DCR) can serve as surrogates for OS at the trial level in the phase III first-line chemotherapy setting. METHODS We included phase III randomized clinical trials (RCTs) comparing two arms that were reported as a full article regardless of their primary end point. We included only RCTs that evaluated chemonaive patients with advanced, locally advanced, or metastatic non-small cell lung cancer and were published after January 1, 2005. We systematically searched four public electronic databases. Two investigators independently screened and scrutinized candidate articles. How surrogate outcomes represented hazard ratios (HRs) for OS was examined. RESULTS Among 1907 articles, we ultimately found 44 eligible articles covering 22,709 subjects. HR for PFS, median PFS in the experimental arm minus median PFS in the control arm in months, OR for RR (ORrr), and OR for DCR were evaluated in 34, 35, 44, and 35 RCTs, respectively. HR for OS (HRos), median PFS in the experimental arm minus median PFS in the control arm, ORrr, and OR for DCR had weighted Spearman's rank correlation coefficients with an HRos of 0.496, 0.477, 0.570, and 0.470, respectively; the standardized weighted regression coefficients were 0.439, -0.376, -0.605, and -0.381, respectively; and the adjusted weighted coefficients of determination were 0.224, 0.161, 0.350, and 0.176, respectively. CONCLUSIONS ORrr, followed by HRpfs, had the strongest association with HRos at the trial level. However, these measures were not strong enough to replace OS.
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Affiliation(s)
- Kentaro Nakashima
- Department of Pulmonology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Nobuyuki Horita
- Department of Pulmonology, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
| | - Kenjiro Nagai
- Department of Pulmonology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Saki Manabe
- Department of Thoracic Oncology, Kanagawa Cancer Center, Kanagawa, Japan
| | - Shuji Murakami
- Department of Thoracic Oncology, Kanagawa Cancer Center, Kanagawa, Japan
| | - Erika Ota
- Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan
| | - Takeshi Kaneko
- Department of Pulmonology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
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Pilotto S, Carbognin L, Karachaliou N, Garassino M, Cuppone F, Petraglia S, Rosell R, Tortora G, Bria E. Moving towards a customized approach for drug development: lessons from clinical trials with immune checkpoint inhibitors in lung cancer. Transl Lung Cancer Res 2016; 4:704-12. [PMID: 26798579 DOI: 10.3978/j.issn.2218-6751.2015.10.08] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Lung cancer has recently been discovered to be an immunological targetable disease, on the basis of the exciting results of the randomized trials with immune checkpoint inhibitors. Nevertheless, the survival benefit appears to not be entirely captured by the usual outcome measures, thus requiring a deep reflection about the appropriateness of the traditional statistical methodologies in this context. The intrinsic biological differences existing both in terms of mechanism of action and kinetic between immunotherapy and chemotherapy or targeted therapy, impact on patients' outcome, requiring a global revolution in the way to design clinical studies with the ideal aim to evolve towards trials carefully 'customized' on the basis of the investigational drug, the specific disease and the biological background. The exciting data recently obtained with immune checkpoint inhibitors, offer an ideal context and background to explore the major questions and future perspectives about the development of immunotherapeutic agents. In this regard, the choice of adequate endpoints, the use of modified statistical methods and the potential introduction of predictive biomarkers for immunotherapy clinical trials, will be discuss in this review in order to provide practical and rationale suggestions aimed to improve the existing model for cancer immunotherapy investigation.
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Affiliation(s)
- Sara Pilotto
- 1 Department of Medical Oncology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy ; 2 Instituto Oncológico Dr Rosell, Quiron-Dexeus University Hospital, Barcelona, Spain ; 3 Istituto Nazionale Tumori, Milano, Italy ; 4 Italian Medicines Agency, Roma, Italy ; 5 Pangaea Biotech, Barcelona, Spain ; 6 Catalan Institute of Oncology, Hospital Germans Trias i Pujol, Badalona, Spain ; 7 Molecular Oncology Research (MORe) Foundation, Barcelona, Spain ; 8 Germans Trias i Pujol Health Sciences Institute and Hospital, Campus Can Ruti, Barcelona, Spain
| | - Luisa Carbognin
- 1 Department of Medical Oncology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy ; 2 Instituto Oncológico Dr Rosell, Quiron-Dexeus University Hospital, Barcelona, Spain ; 3 Istituto Nazionale Tumori, Milano, Italy ; 4 Italian Medicines Agency, Roma, Italy ; 5 Pangaea Biotech, Barcelona, Spain ; 6 Catalan Institute of Oncology, Hospital Germans Trias i Pujol, Badalona, Spain ; 7 Molecular Oncology Research (MORe) Foundation, Barcelona, Spain ; 8 Germans Trias i Pujol Health Sciences Institute and Hospital, Campus Can Ruti, Barcelona, Spain
| | - Niki Karachaliou
- 1 Department of Medical Oncology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy ; 2 Instituto Oncológico Dr Rosell, Quiron-Dexeus University Hospital, Barcelona, Spain ; 3 Istituto Nazionale Tumori, Milano, Italy ; 4 Italian Medicines Agency, Roma, Italy ; 5 Pangaea Biotech, Barcelona, Spain ; 6 Catalan Institute of Oncology, Hospital Germans Trias i Pujol, Badalona, Spain ; 7 Molecular Oncology Research (MORe) Foundation, Barcelona, Spain ; 8 Germans Trias i Pujol Health Sciences Institute and Hospital, Campus Can Ruti, Barcelona, Spain
| | - Marina Garassino
- 1 Department of Medical Oncology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy ; 2 Instituto Oncológico Dr Rosell, Quiron-Dexeus University Hospital, Barcelona, Spain ; 3 Istituto Nazionale Tumori, Milano, Italy ; 4 Italian Medicines Agency, Roma, Italy ; 5 Pangaea Biotech, Barcelona, Spain ; 6 Catalan Institute of Oncology, Hospital Germans Trias i Pujol, Badalona, Spain ; 7 Molecular Oncology Research (MORe) Foundation, Barcelona, Spain ; 8 Germans Trias i Pujol Health Sciences Institute and Hospital, Campus Can Ruti, Barcelona, Spain
| | - Federica Cuppone
- 1 Department of Medical Oncology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy ; 2 Instituto Oncológico Dr Rosell, Quiron-Dexeus University Hospital, Barcelona, Spain ; 3 Istituto Nazionale Tumori, Milano, Italy ; 4 Italian Medicines Agency, Roma, Italy ; 5 Pangaea Biotech, Barcelona, Spain ; 6 Catalan Institute of Oncology, Hospital Germans Trias i Pujol, Badalona, Spain ; 7 Molecular Oncology Research (MORe) Foundation, Barcelona, Spain ; 8 Germans Trias i Pujol Health Sciences Institute and Hospital, Campus Can Ruti, Barcelona, Spain
| | - Sandra Petraglia
- 1 Department of Medical Oncology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy ; 2 Instituto Oncológico Dr Rosell, Quiron-Dexeus University Hospital, Barcelona, Spain ; 3 Istituto Nazionale Tumori, Milano, Italy ; 4 Italian Medicines Agency, Roma, Italy ; 5 Pangaea Biotech, Barcelona, Spain ; 6 Catalan Institute of Oncology, Hospital Germans Trias i Pujol, Badalona, Spain ; 7 Molecular Oncology Research (MORe) Foundation, Barcelona, Spain ; 8 Germans Trias i Pujol Health Sciences Institute and Hospital, Campus Can Ruti, Barcelona, Spain
| | - Rafael Rosell
- 1 Department of Medical Oncology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy ; 2 Instituto Oncológico Dr Rosell, Quiron-Dexeus University Hospital, Barcelona, Spain ; 3 Istituto Nazionale Tumori, Milano, Italy ; 4 Italian Medicines Agency, Roma, Italy ; 5 Pangaea Biotech, Barcelona, Spain ; 6 Catalan Institute of Oncology, Hospital Germans Trias i Pujol, Badalona, Spain ; 7 Molecular Oncology Research (MORe) Foundation, Barcelona, Spain ; 8 Germans Trias i Pujol Health Sciences Institute and Hospital, Campus Can Ruti, Barcelona, Spain
| | - Giampaolo Tortora
- 1 Department of Medical Oncology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy ; 2 Instituto Oncológico Dr Rosell, Quiron-Dexeus University Hospital, Barcelona, Spain ; 3 Istituto Nazionale Tumori, Milano, Italy ; 4 Italian Medicines Agency, Roma, Italy ; 5 Pangaea Biotech, Barcelona, Spain ; 6 Catalan Institute of Oncology, Hospital Germans Trias i Pujol, Badalona, Spain ; 7 Molecular Oncology Research (MORe) Foundation, Barcelona, Spain ; 8 Germans Trias i Pujol Health Sciences Institute and Hospital, Campus Can Ruti, Barcelona, Spain
| | - Emilio Bria
- 1 Department of Medical Oncology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy ; 2 Instituto Oncológico Dr Rosell, Quiron-Dexeus University Hospital, Barcelona, Spain ; 3 Istituto Nazionale Tumori, Milano, Italy ; 4 Italian Medicines Agency, Roma, Italy ; 5 Pangaea Biotech, Barcelona, Spain ; 6 Catalan Institute of Oncology, Hospital Germans Trias i Pujol, Badalona, Spain ; 7 Molecular Oncology Research (MORe) Foundation, Barcelona, Spain ; 8 Germans Trias i Pujol Health Sciences Institute and Hospital, Campus Can Ruti, Barcelona, Spain
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Zhao X, Wang S, Wu J, Li X, Wang X, Gao Z, Wu W, Wang H, Wang J, Qian J, Ma K, Li H, Han B, Bai C, Li Q, Liu W, Lu D. Association of TERT Polymorphisms with Clinical Outcome of Non-Small Cell Lung Cancer Patients. PLoS One 2015; 10:e0129232. [PMID: 26020272 PMCID: PMC4447454 DOI: 10.1371/journal.pone.0129232] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 05/06/2015] [Indexed: 11/19/2022] Open
Abstract
TERT is of great importance in cancer initiation and progression. Many studies have demonstrated the TERT polymorphisms as risk factors for many cancer types, including lung cancer. However, the impacts of TERT variants on cancer progression and treatment efficacy have remained controversial. This study aimed to investigate the association of TERT polymorphisms with clinical outcome of advanced non-small cell lung cancer (NSCLC) patients receiving first-line platinum-based chemotherapy, including response rate, clinical benefit, progression-free survival (PFS), overall survival (OS), and grade 3 or 4 toxicity. Seven polymorphisms of TERT were assessed, and a total of 1004 inoperable advanced NSCLC patients treated with platinum-based chemotherapy were enrolled. It is exhibited that the variant heterozygote of rs4975605 showed significant association with a low rate of clinical benefit, and displayed a much stronger effect in never-smoking female subset, leading to the clinical benefit rate decreased from 82.9% (C/C genotype) to 56.4% (C/A genotype; adjusted OR, 3.58; P=1.40×10(-4)). It is also observed that the polymorphism rs2736109 showed significant correlation with PFS (log-rank P=0.023). In age > 58 subgroup, patients carrying the heterozygous genotype had a longer median PFS than those carrying the wild-type genotypes (P=0.002). The results from the current study, for the first time to our knowledge, provide suggestive evidence of an effect of TERT polymorphisms on disease progression variability among Chinese patients with platinum-treated advanced NSCLC.
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Affiliation(s)
- Xueying Zhao
- State Key Laboratory of Genetic Engineering and MOE Key Laboratory of Contemporary Anthropology, Institute of Genetics, School of Life Sciences, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Crime Scene Evidence, Shanghai Research Institute of Criminal Science and Technology, Shanghai, China
| | - Shiming Wang
- State Key Laboratory of Genetic Engineering and MOE Key Laboratory of Contemporary Anthropology, Institute of Genetics, School of Life Sciences, Fudan University, Shanghai, China
| | - Junjie Wu
- State Key Laboratory of Genetic Engineering and MOE Key Laboratory of Contemporary Anthropology, Institute of Genetics, School of Life Sciences, Fudan University, Shanghai, China
- Department of Pneumology, Changhai Hospital of Shanghai, Second Military Medical University, Shanghai, China
| | - Xiaoying Li
- State Key Laboratory of Genetic Engineering and MOE Key Laboratory of Contemporary Anthropology, Institute of Genetics, School of Life Sciences, Fudan University, Shanghai, China
| | - Xun Wang
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zhiqiang Gao
- Department of Respiratory Disease, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Wenting Wu
- State Key Laboratory of Genetic Engineering and MOE Key Laboratory of Contemporary Anthropology, Institute of Genetics, School of Life Sciences, Fudan University, Shanghai, China
| | - Haijian Wang
- State Key Laboratory of Genetic Engineering and MOE Key Laboratory of Contemporary Anthropology, Institute of Genetics, School of Life Sciences, Fudan University, Shanghai, China
| | - Jiucun Wang
- State Key Laboratory of Genetic Engineering and MOE Key Laboratory of Contemporary Anthropology, Institute of Genetics, School of Life Sciences, Fudan University, Shanghai, China
| | - Ji Qian
- State Key Laboratory of Genetic Engineering and MOE Key Laboratory of Contemporary Anthropology, Institute of Genetics, School of Life Sciences, Fudan University, Shanghai, China
| | - Ke Ma
- Shanghai Key Laboratory of Crime Scene Evidence, Shanghai Research Institute of Criminal Science and Technology, Shanghai, China
| | - Hui Li
- Shanghai Key Laboratory of Crime Scene Evidence, Shanghai Research Institute of Criminal Science and Technology, Shanghai, China
| | - Baohui Han
- Department of Respiratory Disease, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Chunxue Bai
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Qiang Li
- Department of Pneumology, Changhai Hospital of Shanghai, Second Military Medical University, Shanghai, China
| | - Wenbin Liu
- Shanghai Key Laboratory of Crime Scene Evidence, Shanghai Research Institute of Criminal Science and Technology, Shanghai, China
- * E-mail: (WL); (DL)
| | - Daru Lu
- State Key Laboratory of Genetic Engineering and MOE Key Laboratory of Contemporary Anthropology, Institute of Genetics, School of Life Sciences, Fudan University, Shanghai, China
- * E-mail: (WL); (DL)
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Langer NH, Christensen TN, Langer SW, Kjaer A, Fischer BM. PET/CT in therapy evaluation of patients with lung cancer. Expert Rev Anticancer Ther 2014; 14:595-620. [PMID: 24702537 DOI: 10.1586/14737140.2014.883280] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
FDG-PET/CT is a well documented and widespread used imaging modality for the diagnosis and staging of patient with lung cancer. FDG-PET/CT is increasingly used for the assessment of treatment effects during and after chemotherapy. However, PET is not an accepted surrogate end-point for assessment of response rate in clinical trials. The aim of this review is to present current evidence on the use of PET in response evaluation of patients with lung cancer and to introduce the pearls and pitfalls of the PET-technology relating to response assessment. Based on this and relating to validation criteria, including stable technology, standardization, reproducibility and broad availability, the review discusses why, despite numerous studies on response assessment indicating a possible role for FDG-PET/CT, PET still has no place in guidelines relating to response evaluation in lung cancer.
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Affiliation(s)
- Natasha Hemicke Langer
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, DK-2100 Copenhagen, Denmark
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10
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Sacher AG, Le LW, Leighl NB. Shifting patterns in the interpretation of phase III clinical trial outcomes in advanced non-small-cell lung cancer: the bar is dropping. J Clin Oncol 2014; 32:1407-11. [PMID: 24590634 DOI: 10.1200/jco.2013.52.7804] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
PURPOSE Despite multiple trials of new agents in advanced non-small-cell lung cancer (NSCLC), outcomes remain poor. This study explores how the design and interpretation of randomized trials in advanced NSCLC has changed over time. METHODS Phase III randomized controlled trials of systemic therapy for advanced NSCLC between 1980 and 2010 were identified, and their primary end point, outcome, statistical significance, and conclusions were recorded. RESULTS Of 245 trials identified, 203 were eligible for study inclusion. Although overall survival remains the most common primary end point of phase III trials, more trials from the last decade have used progression-free survival instead (none in 1980 to 1990, 13% in 2001 to 2010; P = .002). The percentage of trials meeting their primary statistical end points remained stable over time; however, the percentage of trials reporting a positive outcome without meeting that end point increased (30% in 1980 to 1990, 53% in 2001 to 2010; P < .001). A trend toward decreasing magnitude of survival gain in positive trials was seen over time (3.9 months in 1980 to 1990, 2.5 months in 2001 to 2010; P = .11), with a concomitant increase in the sample size of clinical trials over the same time period (median: 152 patients in 1980 to 1990, 413 in 2001 to 2010; P < .001). Only studies predating 1990 reported negative results as a result of insufficient magnitude of survival benefit despite statistical significance. CONCLUSION A significant shift has occurred over the past three decades in the design and interpretation of phase III trials in advanced NSCLC. The use of survival as the primary measure of benefit is declining, as is the magnitude of benefit deemed clinically relevant.
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Affiliation(s)
- Adrian G Sacher
- All authors: Princess Margaret Cancer Centre/University Health Network, University of Toronto, Toronto, Ontario, Canada
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11
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Factors affecting the association between overall survival and progression-free survival in clinical trials of first-line treatment for patients with advanced non-small cell lung cancer. J Cancer Res Clin Oncol 2014; 140:839-48. [PMID: 24562618 PMCID: PMC3983956 DOI: 10.1007/s00432-014-1617-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Accepted: 02/08/2014] [Indexed: 12/17/2022]
Abstract
PURPOSE New treatment strategies, particularly the introduction of molecular-targeted agents and appropriate patient selection based on histology and/or genotyping, have progressed markedly in recent years, and the overall survival (OS) in advanced non-small cell lung cancer (NSCLC) patients has improved. The aim of the study was to identify factors affecting longer OS than that estimated from progression-free survival (PFS) in first-line treatment for advanced NSCLC. METHODS Sixty-five controlled trials for first-line treatment of advanced NSCLC were extracted for the study. Factors influencing higher than predicted OS were examined by logistic regression analysis between the OS-extended group and the OS-association group. RESULTS PFS was moderately associated with OS. Twenty arms of 14 trials were categorized as an OS-extended group, in which the ratio of observed OS to estimated OS was found to be over 1.2. On multivariate logistic regression analysis, number of patients lower than 150, average age younger than 63 years, and percentage of squamous carcinoma <30 % were found to significantly affect this relationship. CONCLUSION We identified number of patients and well-known prognostic factors including age and histological cancer type as factors influencing longer OS. These factors should be considered for patient eligibility, when PFS is used as a surrogate primary endpoint for OS in randomized clinical trials of first-line treatment for patients with advanced NSCLC.
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12
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Ghimire S, Kyung E, Kim E. Reporting trends of outcome measures in phase II and phase III trials conducted in advanced-stage non-small-cell lung cancer. Lung 2013; 191:313-9. [PMID: 23715997 DOI: 10.1007/s00408-013-9479-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Accepted: 05/09/2013] [Indexed: 12/11/2022]
Abstract
BACKGROUND The methodology of conducting clinical trials in lung cancer has been challenged by the particular characteristics of new targeted agents. Thus, the choice of correct outcome measures and selection of best study designs are essential. We assessed the trends in reporting of outcome measures in phase II and phase III trials conducted in advanced non-small-cell lung cancer (NSCLC) patients. METHODS Data from September 2000 to September 2012 were extracted from the ClinicalTrials.gov database, and a descriptive-comparative analysis was performed to evaluate outcome-measures reporting for the two phases. RESULTS We identified 459 phase II and 128 phase III trials that met our inclusion criteria. The frequently reported primary outcomes in phase II trials were progression-free survival (PFS; 32%), response rate (RR; 21.4%), and safety and toxicity (adverse events [AEs]; 14.6%). In contrast, overall survival (OS; 60.9%) and PFS (26.6%) were frequently reported primary outcomes in phase III trials. AEs were reported as a secondary outcome measure in 50.1 and 64.8% of phase II and phase III trials, respectively. Improvement in quality of life was identified as a secondary outcome measure significantly more frequently in phase III than in phase II trials. CONCLUSIONS Our study identified recent trends in reports of outcome measures in advanced-stage NSCLC phase II and phase III trials. The outcomes of this study can be valuable for investigators with minimal or some experience in the field of oncology who are conducting clinical research.
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Affiliation(s)
- Saurav Ghimire
- Department of Clinical Pharmacy, College of Pharmacy, Chungnam National University, Daejeon, 305-764, South Korea
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