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Chang YP, Huang GK, Chen YC, Huang KT, Chen YM, Lin CY, Huang CC, Lin MC, Wang CC. E-cadherin expression in the tumor microenvironment of advanced epidermal growth factor receptor-mutant lung adenocarcinoma and the association with prognosis. BMC Cancer 2023; 23:569. [PMID: 37340370 DOI: 10.1186/s12885-023-10980-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 05/19/2023] [Indexed: 06/22/2023] Open
Abstract
BACKGROUND The expression of programmed death-ligand 1 (PD-L1), tumor-infiltrating lymphocytes (TILs), E-cadherin, and vimentin in lung cancer tumor microenvironment is known to impact patient survival or response to therapy. The expression of these biomarkers may also differ between primary lung tumors and brain metastatic tumors. In this study, we investigated the interaction between these biomarkers in lung tumors with or without concomitant brain metastasis and the interaction with paired brain metastatic tumors. METHODS The study included 48 patients with stage IV epidermal growth factor receptor (EGFR)-mutant lung adenocarcinoma. Sixteen of the forty-eight patients were diagnosed with brain metastasis, while the remaining thirty-two were not. All sixteen patients with brain metastasis had brain tumors. The expression of PD-L1, TILs (CD8+ T lymphocytes and FOXP3+ regulatory T lymphocytes), E-cadherin, and vimentin were evaluated using immunohistochemical (IHC) staining. RESULTS Patients with brain metastasis exhibited a higher frequency of exon 19 deletion and uncommon EGFR mutations, a higher lung tumor vimentin score, worse progression-free survival (PFS), and overall survival (OS) than patients without brain metastasis. IHC staining showed no difference between paired lung and brain tumors. Patients with low PD-L1 expression had better PFS and OS. After multivariate analysis, higher body mass index, the presence of brain metastasis, bone metastasis, and uncommon EGFR mutations were correlated with worse PFS, while the presence of brain metastasis and high lung tumor E-cadherin score was associated with worse OS. CONCLUSIONS In patients with stage IV EGFR-mutant lung adenocarcinoma, high E-cadherin expression in the lung tumor might be associated with worse OS. Vimentin expression in the lung tumor was positively related to the risk of brain metastasis.
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Affiliation(s)
- Yu-Ping Chang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Gong-Kai Huang
- Department of Pathology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Department of Laboratory Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yung-Che Chen
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Department of Respiratory Therapy, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Kuo-Tung Huang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yu-Mu Chen
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chiung-Yu Lin
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chao-Cheng Huang
- Department of Pathology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Biobank and Tissue Bank, Department of Pathology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Meng-Chih Lin
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chin-Chou Wang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
- Department of Respiratory Therapy, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
- Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan.
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2
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Roh H, Lee SY, Lee J, Hwang SY, Kim JH. Use of thyroid transcription factor 1 and napsin A to predict local failure and survival after Gamma Knife radiosurgery in patients with brain metastases from lung adenocarcinoma. J Neurosurg 2023; 138:663-673. [PMID: 35962961 DOI: 10.3171/2022.6.jns22450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 06/09/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Stereotactic radiosurgery (SRS), combined with contemporary targeted therapies and immunotherapies, has improved the overall survival of patients with lung adenocarcinoma (ADC). Given that histological subtypes reflect prognosis in patients with primary ADC, it is important to integrate pathological biomarkers to predict clinical outcomes after SRS in patients with brain metastases from lung ADC. Therefore, the authors investigated the prognostic relevance of various biomarkers of primary lung ADC for clinical outcomes after SRS. METHODS A total of 95 patients with 136 brain metastases (1-4 oligometastases) who were treated with Gamma Knife radiosurgery between January 2017 and December 2020 were included. The Kaplan-Meier method and univariate and multivariate analyses using Cox proportional hazard regression models were used to identify prognostic factors for local control, survival, and distant brain control. RESULTS Multivariate analysis revealed thyroid transcription factor 1 as an independent prognostic factor for local control (HR 0.098, 95% CI 0.014-0.698, p = 0.0203) and napsin A as a significant predictor of overall survival after SRS (HR 0.080, 95% CI 0.017-0.386, p < 0.01). In a subset analysis of epidermal growth factor receptor (EGFR) mutation, patients with EGFR exon 19 mutations showed better distant brain control than those with EGFR exon 21 mutations (p < 0.01). CONCLUSIONS Pathological biomarkers of primary cancer should be considered to predict clinical outcomes after SRS in patients with lung ADC. Use of such biomarkers may help to provide personalized treatment to each patient, improving clinical outcomes after SRS.
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Affiliation(s)
- Haewon Roh
- 1Department of Neurosurgery, Armed Forces Capital Hospital, Seongnam.,Departments of2Neurosurgery
| | | | - Jinhwan Lee
- 4Pathology, Guro Hospital, Korea University of Medicine, Seoul; and
| | - Soon-Young Hwang
- 5Department of Biostatistics, Korea University of Medicine, Seoul, Republic of Korea
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Gu L, Qing S, Zhang HJ. A new prognostic model for brain metastases of specific primary tumors with stereotactic radiotherapy. Cancer Radiother 2023; 27:183-188. [PMID: 36781369 DOI: 10.1016/j.canrad.2022.08.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 08/16/2022] [Accepted: 08/27/2022] [Indexed: 02/13/2023]
Abstract
PURPOSE Stereotactic radiotherapy (SRT) was widely used in brain metastases (BM), especially in oligometastases. It is imperative to develop a new prognostic score to predict the overall survival (OS) of brain metastases based on prognostic factors for specific primary tumors. MATERIAL AND METHOD One hundred and ninety-seven patients were involved in the training cohort to develop a new prognostic score to predict the overall survival (OS) of brain metastases for specific primary tumors. Independent prognostic factors were confirmed using a Cox regression model. The score was developed based on clinical prognostic factors of OS with Cox proportional hazards model. The result was validated in another cohort with 56 participants to evaluate the performance of the score. RESULTS One hundred and ninety-seven patients with 329 brain metastases received SRT. For NSCLC, the significant prognostic factors were extracranial metastases, target therapy and number of brain metastases. For gastrointestinal cancer, the significant prognostic factors were target therapy and number of brain metastases. CONCLUSION The prognostic factors scores were varied by the histologic types which can be used to efficiently stratify for selected patients with brain-metastasis.
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Affiliation(s)
- L Gu
- Department of Radiation Oncology, The First Affiliated Hospital of Naval Military Medical University, Shanghai,China
| | - S Qing
- Department of Radiation Oncology, The First Affiliated Hospital of Naval Military Medical University, Shanghai,China
| | - H-J Zhang
- Department of Radiation Oncology, The First Affiliated Hospital of Naval Military Medical University, Shanghai,China.
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Perng PS, Hsu HP, Lee PH, Huang CC, Lin CC, Lee JS. Correlation of EGFR mutation subtypes and survival in surgically treated brain metastasis from non-small-cell lung cancer. Asian J Surg 2023; 46:269-276. [PMID: 35393224 DOI: 10.1016/j.asjsur.2022.03.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 03/13/2022] [Accepted: 03/22/2022] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE Epidermal growth factor receptor (EGFR) mutation is a positive prognostic factor for survival in patients with non-small-cell lung cancer (NSCLC). In such patients, brain metastasis signifies negative outcomes. Patients with NSCLC brain metastasis that may benefit from neurosurgery is under investigation. We aim to investigate the impact of different mutation loci in surgically treated NSCLC brain metastasis patients. METHODS This retrospective cohort study included patients with NSCLC brain metastasis who underwent brain lesionectomy, followed by radiotherapy and chemotherapy or targeted therapy. Demographics and tumor characteristics were compared between the EGFR mutant type and wild type groups. Postoperative survival and risk factors were analyzed using log rank and Cox regression methods. RESULTS Overall, 101 patients were included, with 57 belonging to the EGFR mutant type group and 44 to the EGFR wild type group. The median postoperative survival was 17 months for the entire cohort, with the duration being 19 and 14 months for EGFR mutant type and wild type patients (p = 0.013), respectively. Multivariate analysis revealed that exon 19 del (p = 0.02) and a high Karnofsky Performance Scale score (p < 0.01) were independent positive prognostic factors to predict survival. The timing of development of the brain metastasis or the location of the intracranial metastasis was not associated with EGFR mutations. CONCLUSION EGFR mutations are associated with better survival outcomes in patients with NSCLC brain metastasis suitable for surgical treatment. This advantage was attributed to patients having a specific mutation of exon 19 deletion.
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Affiliation(s)
- Pang-Shuo Perng
- Section of Neurosurgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Hui-Ping Hsu
- Section of General Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Po-Hsuan Lee
- Section of Neurosurgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chi-Chen Huang
- Section of Neurosurgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chien-Chung Lin
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Institute of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Biochemistry and Molecular Biology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Jung-Shun Lee
- Section of Neurosurgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Cell Biology and Anatomy, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Institute of Basic Medical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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Lupattelli M, Tini P, Nardone V, Aristei C, Borghesi S, Maranzano E, Anselmo P, Ingrosso G, Deantonio L, di Monale E Bastia MB. Stereotactic radiotherapy for brain oligometastases. Rep Pract Oncol Radiother 2022; 27:15-22. [PMID: 35402029 PMCID: PMC8989457 DOI: 10.5603/rpor.a2021.0133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 11/14/2021] [Indexed: 11/25/2022] Open
Abstract
Brain metastases, the most common metastases in adults, will develop in up to 40% of cancer patients, accounting for more than one-half of all intracranial tumors. They are most associated with breast and lung cancer, melanoma and, less frequently, colorectal and kidney carcinoma. Magnetic resonance imaging (MRI) is the gold standard for diagnosis. For the treatment plan, computed tomography (CT ) images are co-registered and fused with a gadolinium-enhanced T1-weighted MRI where tumor volume and organs at risk are contoured. Alternatively, plain and contrast-enhanced CT scans are co-registered. Single-fraction stereotactic radiotherapy (SRT ) is used to treat patients with good performance status and up to 4 lesions with a diameter of 30 mm or less that are distant from crucial brain function areas. Fractionated SRT (2–5 fractions) is used for larger lesions, in eloquent areas or in proximity to crucial or surgically inaccessible areas and to reduce treatment-related neurotoxicity. The single-fraction SRT dose, which depends on tumor diameter, impacts local control. Fractionated SRT may encompass different schedules. No randomized trial data compared the safety and efficacy of single and multiple fractions. Both single-fraction and fractionated SRT provide satisfactory local control rates, tolerance, a low risk of transient acute adverse events and of radiation necrosis the incidence of which correlated with the irradiated brain volume.
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Affiliation(s)
- Marco Lupattelli
- Radiation Oncology Section, University of Perugia and Perugia General Hospital, Italy
| | - Paolo Tini
- Unit of Radiation Oncology, University Hospital of Siena, Italy
| | - Valerio Nardone
- Unit of Radiation Oncology, Ospedale del Mare, Napoli, Italy
| | - Cynthia Aristei
- Radiation Oncology Section, University of Perugia and Perugia General Hospital, Italy
| | - Simona Borghesi
- Radiation Oncology Unit of Arezzo-Valdarno, Azienda USL Toscana Sud Est, Italy
| | | | - Paola Anselmo
- Radiation Oncology Centre, S. Maria Hospital, Terni, Italy
| | - Gianluca Ingrosso
- Radiation Oncology Section, University of Perugia and Perugia General Hospital, Italy
| | - Letizia Deantonio
- Radiation Oncology Clinic, Oncology Institute of Southern Switzerland, Bellinzona-Lugano, Switzerland
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Ma JW, Li M. Molecular typing of lung adenocarcinoma with computed tomography and CT image-based radiomics: a narrative review of research progress and prospects. Transl Cancer Res 2022; 10:4217-4231. [PMID: 35116717 PMCID: PMC8797562 DOI: 10.21037/tcr-21-1037] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 09/03/2021] [Indexed: 12/21/2022]
Abstract
Objective The purpose of this paper was to perform a narrative review of current research evidence on conventional computed tomography (CT) imaging features and CT image-based radiomic features for predicting gene mutations in lung adenocarcinoma and discuss how to translate the research findings to guide future practice. Background Lung cancer, especially lung adenocarcinoma, is the leading cause of cancer-related deaths. With advances in the diagnosis and treatment of lung adenocarcinoma with the emergence of molecular testing, the prediction of oncogenes and even drug resistance gene mutations have become key to individualized and precise clinical treatment in order to prolong survival and improve quality of life. The progress of imageological examination includes the development of CT and radiomics are promising quantitative methods for predicting different gene mutations in lung adenocarcinoma, especially common mutations, such as epidermal growth factor receptor (EGFR) mutation, anaplastic lymphoma kinase (ALK) mutation and Kirsten rat sarcoma viral oncogene (KRAS) mutation. Methods The PubMed electronic database was searched along with a set of terms specific to lung adenocarcinoma, radiomics (including texture analysis), CT, computed tomography, EGFR, ALK, KRAS, rearranging transfection (RET) rearrangement and c-ros oncogene 1 (ROS-1), v-raf murine sarcoma viral oncogene homolog B1 (BRAF), and human epidermal growth factor receptor 2 (HER2) mutations et al. This review has been reported in compliance with the Narrative Review checklist guidelines. From each full-text article, information was extracted regarding a set of terms above. Conclusions Research on the application of conventional CT features and CT image-based radiomic features for predicting the gene mutation status of lung adenocarcinoma is still in a preliminary stage. Noninvasively determination of mutation status in lung adenocarcinoma before targeted therapy with conventional CT features and CT image-based radiomic features remains both hopes and challenges. Before radiomics could be applied in clinical practice, more work needs to be done.
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Affiliation(s)
- Jing-Wen Ma
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Meng Li
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Shao J, Li J, Song L, He Q, Wu Y, Li L, Liu D, Wang C, Li W. The number of brain metastases predicts the survival of non-small cell lung cancer patients with EGFR mutation status. Cancer Rep (Hoboken) 2021; 5:e1550. [PMID: 34766737 PMCID: PMC9458511 DOI: 10.1002/cnr2.1550] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 08/21/2021] [Accepted: 08/24/2021] [Indexed: 02/05/2023] Open
Abstract
Background Lung cancer is the common cause of cancer‐related deaths throughout the world, and brain is a frequent metastatic site of lung cancer. Aim This research sought to evaluate the impact of the number of brain metastases in prognosticating non‐small cell lung cancer (NSCLC) patients accounting to the role of epidermal growth factor receptor (EGFR) mutations. Methods and Results NSCLC patients with brain metastases diagnosed/treated in West China Hospital, Sichuan University between 2009 and 2017 were identified retrospectively. Kaplan–Meier approach was adopted to estimate OS. And we performed univariate and multivariate Cox proportional hazards regression analyses of characteristics related to overall survival (OS) in both EGFR‐mutated and wild‐type cohorts. In total, this study included 611 eligible NSCLC patients with brain metastases. Extracranial metastases and chemotherapy were independent prognostic factors of OS in both cohorts. As the disease progressed, EGFR‐mutated patients had brain metastasis significantly earlier (P < .0001), but they also had notably better survival outcomes than wild‐type patients (P < .0001). And the number of brain metastases impacted the survival incidence in the progression significantly in both EGFR‐mutated and wild‐type groups (P = .0087/.037, respectively). Conclusion The number of brain metastases was a prognostic factor for lung cancer patients either with EGFR mutations or with wild‐type EGFR, with larger number indicating more unfavorble clinical outcomes. Patients with EGFR mutations had a better survival.
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Affiliation(s)
- Jun Shao
- Department of Respiratory and Critical Care Medicine, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan, China
| | - Jingwei Li
- Department of Respiratory and Critical Care Medicine, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan, China
| | - Lujia Song
- Department of Respiratory and Critical Care Medicine, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan, China
| | - Qiuyao He
- Department of Respiratory and Critical Care Medicine, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan, China
| | - Yuxuan Wu
- Department of Respiratory and Critical Care Medicine, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan, China
| | - Linhui Li
- Department of Respiratory and Critical Care Medicine, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan, China
| | - Dan Liu
- Department of Respiratory and Critical Care Medicine, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan, China
| | - Chengdi Wang
- Department of Respiratory and Critical Care Medicine, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan, China
| | - Weimin Li
- Department of Respiratory and Critical Care Medicine, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan, China
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Karimpour M, Ravanbakhsh R, Maydanchi M, Rajabi A, Azizi F, Saber A. Cancer driver gene and non-coding RNA alterations as biomarkers of brain metastasis in lung cancer: A review of the literature. Biomed Pharmacother 2021; 143:112190. [PMID: 34560543 DOI: 10.1016/j.biopha.2021.112190] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 09/08/2021] [Accepted: 09/10/2021] [Indexed: 02/07/2023] Open
Abstract
Brain metastasis (BM) is the most common event in patients with lung cancer. Despite multimodal treatments and advances in systemic therapies, development of BM remains one of the main factors associated with poor prognosis and mortality in patients with lung cancer. Therefore, better understanding of mechanisms involved in lung cancer brain metastasis (LCBM) is of great importance to suppress cancer cells and to improve the overall survival of patients. Several cancer-related genes such as EGFR and KRAS have been proposed as potential predictors of LCBM. In addition, there is ample evidence supporting crucial roles of non-coding RNAs (ncRNAs) in mediating LCBM. In this review, we provide comprehensive information on risk assessment, predictive, and prognostic panels for early detection of BM in patients with lung cancer. Moreover, we present an overview of LCBM molecular mechanisms, cancer driver genes, and ncRNAs which may predict the risk of BM in lung cancer patients. Recent clinical studies have focused on determining mechanisms involved in LCBM and their association with diagnosis, prognosis, and treatment outcomes. These studies have shown that alterations in EGFR, KRAS, BRAF, and ALK, as the most frequent coding gene alterations, and dysregulation of ncRNAs such as miR-423, miR-330-3p, miR-145, piR-651, and MALAT1 can be considered as potential biomarkers of LCBM.
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Affiliation(s)
- Mina Karimpour
- Department of Genetics, Faculty of Biological Sciences, Tarbiat Modares University, Tehran, Iran
| | - Reyhaneh Ravanbakhsh
- Department of Aquatic Biotechnology, Artemia and Aquaculture Research Institute, Urmia University, Urmia, Iran
| | - Melika Maydanchi
- Zimagene Medical Genetics Laboratory, Avicenna St., Hamedan, Iran
| | - Ali Rajabi
- Department of Animal Biology, Faculty of Natural Sciences, University of Tabriz, Tabriz, Iran
| | - Faezeh Azizi
- Genetics Office, Non-Communicable Disease Control Department, Public Health Department, Ministry of Health and Medical Education, Tehran, Iran
| | - Ali Saber
- Zimagene Medical Genetics Laboratory, Avicenna St., Hamedan, Iran.
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Gutiérrez L, Royuela A, Carcereny E, López-Castro R, Rodríguez-Abreu D, Massuti B, González-Larriba JL, García-Campelo R, Bosch-Barrera J, Guirado M, Camps C, Dómine M, Bernabé R, Casal J, Oramas J, Ortega AL, Sala MA, Padilla A, Aguiar D, Juan-Vidal O, Blanco R, del Barco E, Martínez-Banaclocha N, Benítez G, de Vega B, Hernández A, Saigi M, Franco F, Provencio M. Prognostic model of long-term advanced stage (IIIB-IV) EGFR mutated non-small cell lung cancer (NSCLC) survivors using real-life data. BMC Cancer 2021; 21:977. [PMID: 34465283 PMCID: PMC8406921 DOI: 10.1186/s12885-021-08713-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 08/16/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND There is a lack of useful diagnostic tools to identify EGFR mutated NSCLC patients with long-term survival. This study develops a prognostic model using real world data to assist clinicians to predict survival beyond 24 months. METHODS EGFR mutated stage IIIB and IV NSCLC patients diagnosed between January 2009 and December 2017 included in the Spanish Lung Cancer Group (SLCG) thoracic tumor registry. Long-term survival was defined as being alive 24 months after diagnosis. A multivariable prognostic model was carried out using binary logistic regression and internal validation through bootstrapping. A nomogram was developed to facilitate the interpretation and applicability of the model. RESULTS 505 of the 961 EGFR mutated patients identified in the registry were included, with a median survival of 27.73 months. Factors associated with overall survival longer than 24 months were: being a woman (OR 1.78); absence of the exon 20 insertion mutation (OR 2.77); functional status (ECOG 0-1) (OR 4.92); absence of central nervous system metastases (OR 2.22), absence of liver metastases (OR 1.90) or adrenal involvement (OR 2.35) and low number of metastatic sites (OR 1.22). The model had a good internal validation with a calibration slope equal to 0.781 and discrimination (optimism corrected C-index 0.680). CONCLUSIONS Survival greater than 24 months can be predicted from six pre-treatment clinicopathological variables. The model has a good discrimination ability. We hypothesized that this model could help the selection of the best treatment sequence in EGFR mutation NSCLC patients.
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Affiliation(s)
- Lourdes Gutiérrez
- Medical Oncology Department, Hospital Universitario Puerta de Hierro, Calle Joaquín Rodrigo n1, 28222, Majadahonda, Madrid, Spain
| | - Ana Royuela
- Biostatistics Unit, Puerta de Hierro Biomedical Research Institute (IDIPHISA), CIBERESP, Madrid, Spain
| | - Enric Carcereny
- Catalan Institute of Oncology, Hospital Universitari Germans Trias i Pujol, B-ARGO, IGTP, 08916 Badalona, Barcelona Spain
| | | | | | - Bartomeu Massuti
- Hospital General Universitario de Alicante, 03010 Alicante, Spain
| | | | | | - Joaquim Bosch-Barrera
- Catalan Institute of Oncology, Hospital Universitari Dr. Josep Trueta 17007, Girona, Spain
| | - María Guirado
- Hospital General Universitario de Elche, 03203 Elche, Alicante Spain
| | - Carlos Camps
- Hospital General Universitario de Valencia, Universitat De València, CIBERONC, 46014 Valencia, Spain
| | - Manuel Dómine
- Hospital Universitario Fundación Jiménez Diaz, IIS-FJD, 28040 Madrid, Spain
| | - Reyes Bernabé
- Hospital Universitario Virgen del Rocío, 41013 Sevilla, Spain
| | - Joaquín Casal
- Complexo Hospitalario Universitario A Coruña, 15006 A Coruña, Spain
| | - Juana Oramas
- Hospital Universitario de Canarias, 38320 San Cristóbal de La Laguna, Santa Cruz de Tenerife, Spain
| | | | - Mª. Angeles Sala
- Hospital Universitario Basurto - OSI Bilbao Basurto, 48013 Bilbao, Spain
| | - Airam Padilla
- Hospital Universitario Nuestra Señora de la Candelaria, 38010 Santa Cruz de Tenerife, Spain
| | - David Aguiar
- Hospital Universitario de Gran Canaria Dr. Negrín, 35010 Las Palmas de Gran Canaria, Las Palmas, Spain
| | - Oscar Juan-Vidal
- Hospital Universitario y Politécnico La Fe, 46026 Valencia, Spain
| | - Remei Blanco
- Oncology Service, Consorci Sanitari de Terrassa, 08191 Rubí, Barcelona, Spain
| | - Edel del Barco
- Hospital Clínico Universitario de Salamanca, 37007 Salamanca, Spain
| | | | - Gretel Benítez
- Hospital Universitario Insular de Gran Canaria, 35016 Las Palmas de Gran Canaria, Spain
| | - Blanca de Vega
- Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain
| | - Ainhoa Hernández
- Catalan Institute of Oncology, Hospital Universitari Germans Trias i Pujol, B-ARGO, IGTP, 08916 Badalona, Barcelona Spain
| | - Maria Saigi
- Catalan Institute of Oncology, Hospital Universitari Germans Trias i Pujol, B-ARGO, IGTP, 08916 Badalona, Barcelona Spain
| | - Fernando Franco
- Hospital Universitario Puerta de Hierro, 28222 Majadahonda, Madrid, Spain
| | - Mariano Provencio
- Hospital Universitario Puerta de Hierro, 28222 Majadahonda, Madrid, Spain
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Elsayed M, Christopoulos P. Therapeutic Sequencing in ALK + NSCLC. Pharmaceuticals (Basel) 2021; 14:ph14020080. [PMID: 33494549 PMCID: PMC7912146 DOI: 10.3390/ph14020080] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 01/14/2021] [Accepted: 01/16/2021] [Indexed: 12/17/2022] Open
Abstract
Anaplastic lymphoma kinase-rearranged non-small-cell lung cancer (ALK+ NSCLC) is a model disease for the use of targeted pharmaceuticals in thoracic oncology. Due to higher systemic and intracranial efficacy, the second-generation ALK tyrosine kinase inhibitors (TKI) alectinib and brigatinib have irrevocably displaced crizotinib as standard first-line treatment, based on the results of the ALEX and ALTA-1L trials. Besides, lorlatinib and brigatinib are the preferred second-line therapies for progression under second-generation TKI and crizotinib, respectively, based on the results of several phase II studies. Tissue or liquid rebiopsies at the time of disease progression, even though not mandated by the approval status of any ALK inhibitor, are gaining importance for individualization and optimization of patient management. Of particular interest are cases with off-target resistance, for example MET, HER2 or KRAS alterations, which require special therapeutic maneuvers, e.g., inclusion in early clinical trials or off-label administration of respectively targeted drugs. On the other hand, up to approximately half of the patients failing TKI, develop anatomically restricted progression, which can be initially tackled with local ablative measures without switch of systemic therapy. Among the overall biologically favorable ALK+ tumors, with a mean tumor mutational burden uniquely below 3 mutations per Mb and the longest survival among NSCLC currently, presence of the EML4-ALK fusion variant 3 and/or TP53 mutations identify high-risk cases with earlier treatment failure and a need for more aggressive surveillance and treatment strategies. The potential clinical utility of longitudinal ctDNA assays for earlier detection of disease progression and improved guidance of therapy in these patients is a currently a matter of intense investigation. Major pharmaceutical challenges for the field are the development of more potent, fourth-generation TKI and effective immuno-oncological interventions, especially ALK-directed cell therapies, which will be essential for further improving survival and achieving cure of ALK+ tumors.
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Affiliation(s)
- Mei Elsayed
- Department of Thoracic Oncology, Thoraxklinik and National Center for Tumor Diseases (NCT) at Heidelberg University Hospital, 69126 Heidelberg, Germany;
| | - Petros Christopoulos
- Department of Thoracic Oncology, Thoraxklinik and National Center for Tumor Diseases (NCT) at Heidelberg University Hospital, 69126 Heidelberg, Germany;
- Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research (DZL), 69126 Heidelberg, Germany
- Correspondence: ; Tel.: +49-6221-396-1371
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11
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Guo D, Wang M, Shen Z, Zhu J. A new immune signature for survival prediction and immune checkpoint molecules in lung adenocarcinoma. J Transl Med 2020; 18:123. [PMID: 32143735 PMCID: PMC7060601 DOI: 10.1186/s12967-020-02286-z] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 02/27/2020] [Indexed: 12/20/2022] Open
Abstract
Background Lung adenocarcinoma (LUAD) is the most frequent subtype of lung cancer. The prognostic signature could be reliable to stratify LUAD patients according to risk, which helps the management of the systematic treatments. In this study, a systematic and reliable immune signature was performed to estimate the prognostic stratification in LUAD. Methods The profiles of immune-related genes for patients with LUAD were used as one TCGA training set: n = 494, other validation set 1: n = 226 and validation set 2: n = 398. Univariate Cox survival analysis was used to identify the candidate immune-related genes from each cohort. Then, the immune signature was developed and validated in the training and validation sets. Results In this study, functional analysis showed that immune-related genes involved in immune regulation and MAPK signaling pathway. A prognostic signature based on 10 immune-related genes was established in the training set and patients were divided into high-risk and low-risk groups. Our 10 immune-related gene signature was significantly related to worse survival, especially during early-stage tumors. Further stratification analyses revealed that this 10 immune-related gene signature was still an effective tool for predicting prognosis in smoking or nonsmoking patients, patients with KRAS mutation or KRAS wild-type, and patients with EGFR mutation or EGFR wild-type. Our signature was negatively correlated with B cell, CD4+ T cell, CD8+ T cell, neutrophil, dendritic cell (DC), and macrophage immune infiltration, and immune checkpoint molecules PD-1 and CTLA-4 (P < 0.05). Conclusions These findings suggested that our signature was a promising biomarker for prognosis prediction and can facilitate the management of immunotherapy in LUAD.
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Affiliation(s)
- Dina Guo
- Department of Infectious Diseases, Ningbo Yinzhou No.2 Hospital, Ningbo, 315100, Zhejiang, China
| | - Mian Wang
- Department of Infectious Diseases, Ningbo Yinzhou No.2 Hospital, Ningbo, 315100, Zhejiang, China
| | - Zhihong Shen
- Department of Infectious Diseases, Ningbo Yinzhou No.2 Hospital, Ningbo, 315100, Zhejiang, China
| | - Jiaona Zhu
- Department of Infectious Diseases, Ningbo Yinzhou No.2 Hospital, Ningbo, 315100, Zhejiang, China.
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12
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Arrieta O, Ramírez-Tirado LA, Caballé-Perez E, Mejia-Perez A, Zatarain-Barrón ZL, Cardona AF, Lozano-Ruíz F, Segura-González M, Cruz-Rico G, Maldonado F, Rosell R. Response rate of patients with baseline brain metastases from recently diagnosed non-small cell lung cancer receiving radiotherapy according to EGFR, ALK and KRAS mutation status. Thorac Cancer 2020; 11:1026-1037. [PMID: 32072746 PMCID: PMC7113051 DOI: 10.1111/1759-7714.13359] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 01/29/2020] [Indexed: 01/15/2023] Open
Abstract
Background Previous studies have identified that patients with EGFR mutations tend to have better responses to targeted therapy, as well as chemotherapy; however, the effect of genetic alterations in terms of radiotherapy (RT)‐related outcomes has not been fully assessed. We studied the impact of common non‐small cell lung cancer (NSCLC) genetic alterations (EGFR, ALK and KRAS) in relation to objective response rate (ORR) to RT in patients with brain metastases. Methods From 2009–2015, 153 patients with an available genotyping status were treated with whole‐brain irradiation (WBI) before receiving systemic therapy. Primary outcome was ORR; secondary outcomes included intracranial progression‐free survival (IPFS) and overall survival (OS). Results Overall, ORR was 47.1%. ORR to RT varied significantly according to molecular status: EGFR (64.5%) ALK (54.5%) KRAS (20%) and WT (35.4%) (P = 0.001). EGFR mutation was the only independently associated factor for response to WBI (RR 3.52 [95% CI 1.6–7.7]; P = 0.002). Median IPFS was 10.8 months [95% CI 8.2–13.5] overall; however, IPFS also varied significantly according to molecular status: EGFR (18.2 months), ALK (18.4 months), KRAS (6.0 months) and WT (8.7 months) (P < 0.0001). OS for EGFR, ALK, KRAS and WT patients was 36.6, 32.2, 15.5 and 22.4 months, respectively (P = 0.014). Intracranial‐ORR (HR 0.4 [95% CI 0.2–0.6], P < 0.001) and mutation status (HR 0.7 [95% CI 0.6–0.9], P < 0.042) were independently associated with a higher OS. Conclusions RT response varies as per tumor molecular status. The presence of EGFR mutations favors the organ‐specific response to RT, and is associated with longer OS in patients with NSCLC and BM. Key points This study addressed for the first time the difference in radiotherapy‐related outcomes in patients with different genotypes of non‐small cell lung cancer (NSCLC) before they received systemic therapy. Results show that response to radiotherapy varies as per tumor molecular status, particularly EGFR‐mutated tumors, have a favorable response to radiotherapy, contrary to KRAS‐mutated tumors.
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Affiliation(s)
- Oscar Arrieta
- Thoracic Oncology Unit, National Cancer Institute (INCan), México City, Mexico.,Experimental Oncology Laboratory, National Cancer Institute (INCan), Mexico City, Mexico
| | - Laura-Alejandra Ramírez-Tirado
- Thoracic Oncology Unit, National Cancer Institute (INCan), México City, Mexico.,Experimental Oncology Laboratory, National Cancer Institute (INCan), Mexico City, Mexico
| | | | - Alberto Mejia-Perez
- Department of Imagenology, National Cancer Institute (INCan), Mexico City, Mexico
| | | | - Andrés F Cardona
- Clinical and Translational Oncology Group, Institute of Oncology, Clínica del Country, Bogotá, Colombia
| | | | | | - Graciela Cruz-Rico
- Experimental Oncology Laboratory, National Cancer Institute (INCan), Mexico City, Mexico
| | - Federico Maldonado
- Thoracic Oncology Unit, National Cancer Institute (INCan), México City, Mexico
| | - Rafael Rosell
- Personalized Medicine Program, Catalan Institute of Oncology-ICO, Barcelona, Spain
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13
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Singh R, Lehrer EJ, Ko S, Peterson J, Lou Y, Porter AB, Kotecha R, Brown PD, Zaorsky NG, Trifiletti DM. Brain metastases from non-small cell lung cancer with EGFR or ALK mutations: A systematic review and meta-analysis of multidisciplinary approaches. Radiother Oncol 2019; 144:165-179. [PMID: 31812932 DOI: 10.1016/j.radonc.2019.11.010] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Revised: 11/05/2019] [Accepted: 11/11/2019] [Indexed: 01/04/2023]
Abstract
BACKGROUND AND PURPOSE To analyze outcomes of non-small cell lung cancer (NSCLC) patients with brain metastases harboring EGFR or ALK mutations and examine for differences between tyrosine kinase inhibitors (TKIs) alone, radiotherapy (RT) alone (either whole brain radiation therapy (WBRT) or stereotactic radiosurgery (SRS)), or combined TKIs and RT. MATERIALS AND METHODS Thirty studies were identified. PATIENTS with brain metastases from NSCLC. INTERVENTION initial TKIs alone with optional salvage RT, RT alone, or TKIs and RT. CONTROL wild-type NSCLC and TKIs alone for mutational and treatment analysis, respectively. OUTCOMES overall survival (OS) and intracranial progression-free survival (PFS). SETTING studies with mutation information. RESULTS A total of 2649 patients were included. Patients with ALK and EGFR mutations had significantly higher median OS (48.5 months, p < 0.0001; and 20.9 months; p = 0.0006, respectively) compared to wild-type patients (9.9 months). Similar median OS was noted between TKIs and RT (28.3 months), RT alone (32.2 months; p = 0.22), or TKIs alone (23.9 months; p = 0.2). Patients treated with TKIs and RT had higher median PFS (18.6 months; p = 0.06) compared to TKIs alone (13.6 months) with no difference between TKIs and RT vs. RT alone (16.9 months; p = 0.72). No PFS difference was found between WBRT and TKI (23.2 months; p = 0.72) vs. WBRT alone (24 months) or SRS and TKI (16.7 months; p = 0.56) vs. SRS alone (13.6 months). CONCLUSION NSCLC patients with brain metastases harboring EGFR or ALK mutations have superior OS compared to wild-type patients. No PFS or OS benefit was found with the addition of TKIs to RT.
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Affiliation(s)
- Raj Singh
- Department of Radiation Oncology, Virginia Commonwealth University Health System, Richmond, USA.
| | - Eric J Lehrer
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Stephen Ko
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, USA.
| | | | - Yanyan Lou
- Department of Medical Oncology, Mayo Clinic, Jacksonville, USA.
| | | | - Rupesh Kotecha
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, USA.
| | - Paul D Brown
- Department of Radiation Oncology, Mayo Clinic, Rochester, USA.
| | - Nicholas G Zaorsky
- Department of Radiation Oncology, Penn State Cancer Institute, Hershey, USA.
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14
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Li WY, Zhao TT, Xu HM, Wang ZN, Xu YY, Han Y, Song YX, Wu JH, Xu H, Yin SC, Liu XY, Miao ZF. The role of EGFR mutation as a prognostic factor in survival after diagnosis of brain metastasis in non-small cell lung cancer: a systematic review and meta-analysis. BMC Cancer 2019; 19:145. [PMID: 30760227 PMCID: PMC6375157 DOI: 10.1186/s12885-019-5331-z] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Accepted: 01/30/2019] [Indexed: 01/08/2023] Open
Abstract
Background The brain is a common site for metastasis in non-small-cell lung cancer (NSCLC). This study was designed to evaluate the relationship between the mutational of the epidermal growth factor receptor (EGFR) and overall survival (OS) in NSCLC patients with brain metastases. Methods Searches were performed in PubMed, EmBase, and the Cochrane Library to identify studies evaluating the association of EGFR mutation with OS in NSCLC patients through September 2017. Results 4373 NSCLC patients with brain metastases in 18 studies were involved. Mutated EGFR associated with significantly improved OS compared with wild type. Subgroup analyses suggested that this relationship persisted in studies conducted in Eastern, with retrospective design, with sample size ≥500, mean age of patients ≥65.0 years, percentage male < 50.0%, percentage of patients receiving tyrosine kinase inhibitor ≥30.0%. Finally, although significant publication bias was observed using the Egger test, the results were not changed after adjustment using the trim and fill method. Conclusions This meta-analysis suggests that EGFR mutation is an important predictive factor linked to improved OS for NSCLC patients with brain metastases. It can serve as a useful index in the prognostic assessment of NSCLC patients with brain metastases. Electronic supplementary material The online version of this article (10.1186/s12885-019-5331-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Wen-Ya Li
- Department of Thoracic Surgery, First Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Ting-Ting Zhao
- Department of Breast Surgery, First Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Hui-Mian Xu
- Department of Surgical Oncology, First Hospital of China Medical University, Shenyang, 110001, Liaoning Province, China
| | - Zhen-Ning Wang
- Department of Surgical Oncology, First Hospital of China Medical University, Shenyang, 110001, Liaoning Province, China
| | - Ying-Ying Xu
- Department of Breast Surgery, First Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Yunan Han
- Department of Breast Surgery, First Hospital of China Medical University, Shenyang, Liaoning Province, China.,Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, Saint Louis, MO, USA
| | - Yong-Xi Song
- Department of Surgical Oncology, First Hospital of China Medical University, Shenyang, 110001, Liaoning Province, China
| | - Jian-Hua Wu
- Department of Surgical Oncology, First Hospital of China Medical University, Shenyang, 110001, Liaoning Province, China
| | - Hao Xu
- Department of Medical Oncology, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Song-Cheng Yin
- Department of Surgical Oncology, First Hospital of China Medical University, Shenyang, 110001, Liaoning Province, China
| | - Xing-Yu Liu
- Department of Surgical Oncology, First Hospital of China Medical University, Shenyang, 110001, Liaoning Province, China
| | - Zhi-Feng Miao
- Department of Surgical Oncology, First Hospital of China Medical University, Shenyang, 110001, Liaoning Province, China.
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15
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Abstract
Brain metastases (BM) are the most commonly diagnosed type of central nervous system tumor in the United States. Estimates of the frequency of BM vary significantly, as there is no nationwide reporting system for metastases. BM may be the first sign of a previously undiagnosed cancer, or occur years or decades after the primary cancer was diagnosed. Incidence of BM varies significantly by primary cancer site. Lung, breast, and melanoma continue to be the leading cause of BM. These tumors are increasingly more common as new therapeutics, advanced imaging, and improved screening have led to lengthened survival after primary diagnosis for cancer patients. BM are difficult to treat, and for most individuals the diagnosis of BM generally portends a poor prognosis.
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Affiliation(s)
- Quinn T Ostrom
- Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, OH, United States
| | - Christina Huang Wright
- Brain Tumor and Neuro-oncology Center, Department of Neurosurgery, University Hospitals Case Medical Center, Case Western Reserve School of Medicine, Cleveland, OH, United States
| | - Jill S Barnholtz-Sloan
- Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, OH, United States.
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16
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Han G, Bi J, Tan W, Wei X, Wang X, Ying X, Guo X, Zhou X, Hu D, Zhen W. A retrospective analysis in patients with EGFR-mutant lung adenocarcinoma: is EGFR mutation associated with a higher incidence of brain metastasis? Oncotarget 2018; 7:56998-57010. [PMID: 27486770 PMCID: PMC5302968 DOI: 10.18632/oncotarget.10933] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 07/19/2016] [Indexed: 01/25/2023] Open
Abstract
Lung adenocarcinomas are more commonly associated with brain metastases (BM). Epidermal growth factor receptor (EGFR) mutations have been demonstrated to be both predictive and prognostic for patients with lung adenocarcinoma. We aimed to explore the potential association between EGFR mutation and the risk of BM in pulmonary adenocarcinoma patients. Data of 234 patients from 2007 to 2014 were retrospectively reviewed. A total of 108 patients had EGFR mutations in the entire cohort. Among them, 76 patients developed BM during their disease course. The incidence of BM was statistically higher in patients with EGFR mutations both at initial diagnosis (P=0.014) and at last follow-up (P<0.001). Multivariate logistic regression analysis revealed that EGFR mutation significantly increased the risk of BM at initial diagnosis (OR=2.515, P=0.022). In patients without BM at initial diagnosis, the accumulative rate of subsequent BM was significantly higher with EGFR mutations (P=0.001). Multivariate Cox regression analysis identified EGFR mutation as the only independent risk factor for subsequent BM (HR=3.036, P=0.001). Patients with EGFR mutations demonstrated longer overall survival (OS) after BM diagnosis than patients with wild-type EGFR (P=0.028). Our data suggest that EGFR mutation is an independent predictive and prognostic risk factor for BM and a positive predictive factor for OS in patients with BM.
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Affiliation(s)
- Guang Han
- Department of Radiation Oncology, Hubei Cancer Hospital, Wuhan, HB, China
| | - Jianping Bi
- Department of Radiation Oncology, Hubei Cancer Hospital, Wuhan, HB, China
| | - Wenyong Tan
- Department of Oncology, Shenzhen People Hospital, Shenzhen, China
| | - Xueyan Wei
- Department of Radiation Oncology, Hubei Cancer Hospital, Wuhan, HB, China
| | - Xiaohong Wang
- Department of Radiation Oncology, Hubei Cancer Hospital, Wuhan, HB, China
| | - Xiaofang Ying
- Department of Radiation Oncology, Hubei Cancer Hospital, Wuhan, HB, China
| | - Xiaofang Guo
- Department of Radiology, Hubei Cancer Hospital, Wuhan, HB, China
| | - Xiaoyi Zhou
- Department of Radiation Oncology, Hubei Cancer Hospital, Wuhan, HB, China
| | - Desheng Hu
- Department of Radiation Oncology, Hubei Cancer Hospital, Wuhan, HB, China
| | - Weining Zhen
- Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, NE, USA
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17
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Russo A, Franchina T, Ricciardi GRR, Fanizza C, Scimone A, Chiofalo G, Giordano A, Adamo V. Influence of EGFR mutational status on metastatic behavior in non squamous non small cell lung cancer. Oncotarget 2018; 8:8717-8725. [PMID: 28060728 PMCID: PMC5352435 DOI: 10.18632/oncotarget.14427] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 12/01/2016] [Indexed: 12/25/2022] Open
Abstract
Epidermal Growth Factor Receptor (EGFR) mutated Non Small Cell Lung Cancers (NSCLCs) are a molecularly subgroup of patients with peculiar clinic-pathological characteristics. Previous studies have suggested a possible interaction between oncogene status and metastatic behavior in non squamous NSCLCs with conflicting results. The aim of this study was to compare the different metastatic patterns, at baseline and during the course of the disease, in a cohort of 137 Caucasian patients with non-squamous NSCLC according to the EGFR mutational status and survival differences according to the different metastatic behavior. We observed unique metastatic distributions between EGFR-mutated and EGFR wild type non-squamous NSCLCs. These data support the hypothesis that tumor bio-molecular characteristics and genotype may influence the metastatic process in NSCLC and might help the development of enrichment strategies for tumor genotyping in these tumors, especially in the presence of limited tissue availability.
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Affiliation(s)
- Alessandro Russo
- Medical Oncology Unit A.O. Papardo & Department of Human Pathology University of Messina, Italy
| | - Tindara Franchina
- Medical Oncology Unit A.O. Papardo & Department of Human Pathology University of Messina, Italy
| | | | | | - Antonino Scimone
- Medical Oncology Unit A.O. Papardo & Department of Human Pathology University of Messina, Italy
| | - Giuseppe Chiofalo
- Medical Oncology Unit A.O. Papardo & Department of Human Pathology University of Messina, Italy
| | - Antonio Giordano
- Department of Medicine, Surgery and Neuroscience, University of Siena and Istituto Toscano Tumori (ITT), Siena, Italy.,Sbarro Institute for Cancer Research and Molecular Medicine, Center for Biotechnology, College of Science and Technology, Temple University, Philadelphia PA, USA
| | - Vincenzo Adamo
- Medical Oncology Unit A.O. Papardo & Department of Human Pathology University of Messina, Italy
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18
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Li H, Lian J, Han S, Wang W, Jia H, Cao J, Zhang X, Song X, Jia S, Ren J, Yang W, Xi Y, Lan S. Applicability of graded prognostic assessment of lung cancer using molecular markers to lung adenocarcinoma patients with brain metastases. Oncotarget 2017; 8:70727-70735. [PMID: 29050314 PMCID: PMC5642589 DOI: 10.18632/oncotarget.19980] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 07/11/2017] [Indexed: 01/19/2023] Open
Abstract
Several scoring systems are available to estimate prognosis and assist in selecting treatment methods for non-small cell lung cancer (NSCLC) patients with brain metastasis, including recursive partitioning analysis (RPA), basic score for brain metastases (BS-BM), and diagnosis-specific graded prognostic assessment (DS-GPA). Lung-molGPA is an update of the DS-GPA that incorporates EGFR and/or ALK mutation status. The present study tested the applicability of these four indexes in 361 lung adenocarcinoma patients with brain metastasis. Potential predictive factors in our independent multivariate analysis included patient age, Karnofsky performance status, EGFR and ALK mutation status, and use of targeted therapy. In the log-rank test, all four systems predicted overall survival (OS) (P<0.001). Harrell’s C indexes were 0.732, 0.724, 0.729, and 0.747 for RPA, BS-BM, DS-GPA, and Lung-molGPA, respectively. Our results confirmed that the Lung-molGPA index was useful for estimating OS in our patient cohort, and appeared to provide the most accurate predictions. However, the independent prognostic factors identified in our study were not entirely in agreement with the Lung-molGPA factors. In an era of targeted therapy, Lung-molGPA must be further updated to incorporate more specific prognostic factors based on additional patient data.
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Affiliation(s)
- Hongwei Li
- Department of Radiation Oncology, Shanxi Provincial Cancer Hospital, Shanxi Medical University, Taiyuan, Shanxi Province 030013, People's Republic of China
| | - Jianhong Lian
- Department of Surgery, Shanxi Provincial Cancer Hospital, Shanxi Medical University, Taiyuan, Shanxi Province 030013, People's Republic of China
| | - Songyan Han
- Department of Chemotherapy, Shanxi Provincial Cancer Hospital, Shanxi Medical University, Taiyuan, Shanxi Province 030013, People's Republic of China
| | - Weili Wang
- Department of Radiation Oncology, Shanxi Provincial Cancer Hospital, Shanxi Medical University, Taiyuan, Shanxi Province 030013, People's Republic of China
| | - Haixia Jia
- Department of Radiation Oncology, Shanxi Provincial Cancer Hospital, Shanxi Medical University, Taiyuan, Shanxi Province 030013, People's Republic of China
| | - Jianzhong Cao
- Department of Radiation Oncology, Shanxi Provincial Cancer Hospital, Shanxi Medical University, Taiyuan, Shanxi Province 030013, People's Republic of China
| | - Xiaqin Zhang
- Department of Radiation Oncology, Shanxi Provincial Cancer Hospital, Shanxi Medical University, Taiyuan, Shanxi Province 030013, People's Republic of China
| | - Xin Song
- Department of Radiation Oncology, Shanxi Provincial Cancer Hospital, Shanxi Medical University, Taiyuan, Shanxi Province 030013, People's Republic of China
| | - Sufang Jia
- Department of Radiation Oncology, Shanxi Provincial Cancer Hospital, Shanxi Medical University, Taiyuan, Shanxi Province 030013, People's Republic of China
| | - Jiwei Ren
- Department of Medical Imageology, Shanxi Provincial Cancer Hospital, Shanxi Medical University, Taiyuan, Shanxi Province 030013, People's Republic of China
| | - Weihua Yang
- Department of Chemotherapy, Shanxi Provincial Cancer Hospital, Shanxi Medical University, Taiyuan, Shanxi Province 030013, People's Republic of China
| | - Yanfeng Xi
- Department of Pathology, Shanxi Provincial Cancer Hospital, Shanxi Medical University, Taiyuan, Shanxi Province 030013, People's Republic of China
| | - Shengmin Lan
- Department of Radiation Oncology, Shanxi Provincial Cancer Hospital, Shanxi Medical University, Taiyuan, Shanxi Province 030013, People's Republic of China
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19
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Li H, Wang W, Jia H, Lian J, Cao J, Zhang X, Song X, Jia S, Li Z, Cao X, Zhou W, Han S, Yang W, Xi Y, Lian S. Prognostic model for brain metastases from lung adenocarcinoma identified with epidermal growth factor receptor mutation status. Thorac Cancer 2017; 8:436-442. [PMID: 28597503 PMCID: PMC5582515 DOI: 10.1111/1759-7714.12460] [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: 03/26/2017] [Revised: 05/03/2017] [Accepted: 05/08/2017] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Several indices have been developed to predict survival of brain metastases (BM) based on prognostic factors. However, such models were designed for general brain metastases from different kinds of cancers, and prognostic factors vary between cancers and histological subtypes. Recently, studies have indicated that epidermal growth factor receptor (EGFR) mutation status may be a potential prognostic biological factor in BM from lung adenocarcinoma. Thus, we sought to define the role of EGFR mutation in prognoses and introduce a prognostic model specific for BM from lung adenocarcinoma. METHODS Data of 256 patients with BM from lung adenocarcinoma identified with EGFR mutations were collected. Independent prognostic factors were confirmed using a Cox regression model. The new prognostic model was developed based on the results of multivariable analyses. The score of each factor was calculated by six-month survival. Prognostic groups were divided into low, medium, and high risk based on the total scores. The prediction ability of the new model was compared to the three existing models. RESULTS EGFR mutation and Karnofsky performance status were independent prognostic factors and were thus integrated into the new prognostic model. The new model was superior to the three other scoring systems regarding the prediction of three, six, and 12-month survival by pairwise comparison of the area under the curve. CONCLUSION Our proposed prognostic model specific for BM from lung adenocarcinoma incorporating EGFR mutation status was valid in predicting patient survival. Further verification is warranted, with prospective testing using large sample sizes.
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Affiliation(s)
- Hongwei Li
- Department of Radiation Oncology, Shanxi Provincial Cancer Hospital, Shanxi Medical University, Taiyuan, China
| | - Weili Wang
- Department of Radiation Oncology, Shanxi Provincial Cancer Hospital, Shanxi Medical University, Taiyuan, China
| | - Haixia Jia
- Department of Radiation Oncology, Shanxi Provincial Cancer Hospital, Shanxi Medical University, Taiyuan, China
| | - Jianhong Lian
- Department of Surgery, Shanxi Provincial Cancer Hospital, Shanxi Medical University, Taiyuan, China
| | - Jianzhong Cao
- Department of Radiation Oncology, Shanxi Provincial Cancer Hospital, Shanxi Medical University, Taiyuan, China
| | - Xiaqin Zhang
- Department of Radiation Oncology, Shanxi Provincial Cancer Hospital, Shanxi Medical University, Taiyuan, China
| | - Xing Song
- Department of Radiation Oncology, Shanxi Provincial Cancer Hospital, Shanxi Medical University, Taiyuan, China
| | - Sufang Jia
- Department of Radiation Oncology, Shanxi Provincial Cancer Hospital, Shanxi Medical University, Taiyuan, China
| | - Zhengran Li
- Department of Radiation Oncology, Shanxi Provincial Cancer Hospital, Shanxi Medical University, Taiyuan, China
| | - Xing Cao
- Department of Radiation Oncology, Shanxi Provincial Cancer Hospital, Shanxi Medical University, Taiyuan, China
| | - Wei Zhou
- Department of Radiation Oncology, Shanxi Provincial Cancer Hospital, Shanxi Medical University, Taiyuan, China
| | - Songye Han
- Department of Chemotherapy, Shanxi Provincial Cancer Hospital, Shanxi Medical University, Taiyuan, China
| | - Weihua Yang
- Department of Chemotherapy, Shanxi Provincial Cancer Hospital, Shanxi Medical University, Taiyuan, China
| | - Yanfen Xi
- Department of Pathology, Shanxi Provincial Cancer Hospital, Shanxi Medical University, Taiyuan, China
| | - Shenming Lian
- Department of Radiation Oncology, Shanxi Provincial Cancer Hospital, Shanxi Medical University, Taiyuan, China
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20
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Hwang W, Chiu YF, Kuo MH, Lee KL, Lee AC, Yu CC, Chang JL, Huang WC, Hsiao SH, Lin SE, Chou YT. Expression of Neuroendocrine Factor VGF in Lung Cancer Cells Confers Resistance to EGFR Kinase Inhibitors and Triggers Epithelial-to-Mesenchymal Transition. Cancer Res 2017; 77:3013-3026. [PMID: 28381546 DOI: 10.1158/0008-5472.can-16-3168] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Revised: 01/04/2017] [Accepted: 03/31/2017] [Indexed: 11/16/2022]
Abstract
Mutations in EGFR drive tumor growth but render tumor cells sensitive to treatment with EGFR tyrosine kinase inhibitors (TKI). Phenotypic alteration in epithelial-to-mesenchymal transition (EMT) has been linked to the TKI resistance in lung adenocarcinoma. However, the mechanism underlying this resistance remains unclear. Here we report that high expression of a neuroendocrine factor termed VGF induces the transcription factor TWIST1 to facilitate TKI resistance, EMT, and cancer dissemination in a subset of lung adenocarcinoma cells. VGF silencing resensitized EGFR-mutated lung adenocarcinoma cells to TKI. Conversely, overexpression of VGF in sensitive cells conferred resistance to TKIs and induced EMT, increasing migratory and invasive behaviors. Correlation analysis revealed a significant association of VGF expression with advanced tumor grade and poor survival in patients with lung adenocarcinoma. In a mouse xenograft model of lung adenocarcinoma, suppressing VGF expression was sufficient to attenuate tumor growth. Overall, our findings show how VGF can confer TKI resistance and trigger EMT, suggesting its potential utility as a biomarker and therapeutic target in lung adenocarcinoma. Cancer Res; 77(11); 3013-26. ©2017 AACR.
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Affiliation(s)
- Wen Hwang
- Institute of Biotechnology, College of Life Science, National Tsing Hua University, Hsinchu, Taiwan
| | - Yu-Fan Chiu
- Institute of Biotechnology, College of Life Science, National Tsing Hua University, Hsinchu, Taiwan
| | - Ming-Han Kuo
- Institute of Biotechnology, College of Life Science, National Tsing Hua University, Hsinchu, Taiwan
| | - Kuan-Lin Lee
- Institute of Biotechnology, College of Life Science, National Tsing Hua University, Hsinchu, Taiwan
| | - An-Chun Lee
- Institute of Biotechnology, College of Life Science, National Tsing Hua University, Hsinchu, Taiwan
| | - Chia-Cherng Yu
- Department of Medical Research, National Taiwan University Hospital, Taipei, Taiwan
| | - Junn-Liang Chang
- Department of Pathology and Laboratory Medicine, Taoyuan Armed Forces General Hospital, Taoyuan, Taiwan.,Department of Biomedical Engineering, Ming Chuan University, Taoyuan, Taiwan
| | - Wen-Chien Huang
- Department of Thoracic Surgery, Mackay Memorial Hospital, Taipei, Taiwan
| | - Shih-Hsin Hsiao
- Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan
| | - Sey-En Lin
- Department of Pathology, Taipei Medical University Hospital, Taipei, Taiwan.,Department of Pathology, Taipei Municipal Wan Fang Hospital, Taipei, Taiwan
| | - Yu-Ting Chou
- Institute of Biotechnology, College of Life Science, National Tsing Hua University, Hsinchu, Taiwan.
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21
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Zheng Z, Jin X, Lin B, Su H, Chen H, Fei S, Zhao L, Deng X, Xie D, Xie C. Efficacy of Second-line Tyrosine Kinase Inhibitors in the Treatment of Metastatic Advanced Non-small-cell Lung Cancer Harboring Exon 19 and 21 EGFR Mutations. J Cancer 2017; 8:597-605. [PMID: 28367239 PMCID: PMC5370503 DOI: 10.7150/jca.16959] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Accepted: 10/29/2016] [Indexed: 01/28/2023] Open
Abstract
Background: Although superior clinical benefits of first-line epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) in the treatment of advanced non-small-cell lung cancer (NSCLC) had been reported with different sensitivity, the sensitivity of second-line TKIs in NSCLC patients with different EFGR mutations was unknown. The purpose of this study is to investigate the clinical outcome of second-line EGFR-TKIs in the treatment of NSCLC patients according to different EGFR genotypes. Methods: The treatment outcomes of 166 NSCLC patients with different EGFR mutations treated by second-line TKIs were retrospectively reviewed. The efficacy was evaluated with Pearson chi-square or Fisher's exact tests, Log-rank test and Cox proportional hazards model. Results: The disease control rate (DCR) and objective response rate (ORR) of enrolled NSCLC patients were 77.7% and 11.4%, respectively. The exon 19 deletion group had a significantly longer median progression-free survival (PFS) (6.7 vs. 4.5 months, P=0.002) and overall survival (OS) (13.7 vs. 11.7 months, P=0.02) compared with the exon 19 L858R mutation group for NSCLC patients, as well for patients with brain metastasis [PFS: (6.7 vs. 3.9 months, p<0.001), OS: (13.7 vs. 7.9 months, p=0.006)]. No significant difference on PFS and OS was observed between exon 19 deletion and L858R mutation group for patients with bone metastasis. EGFR genotype and ECOG PS were independent predictors of PFS. Never smoking, exon 19 deletion, EGOC PS (0-1) and no brain metastasis were correlated with longer OS. No significant difference on side effect between exon 19 and 21 mutation group was observed. Conclusions: NSCLC patients harboring exon 19 deletion achieved better PFS and OS than those with L858R mutation, indicating that EGFR mutation is a significant prognostic factor for advanced NSCLC patients with and without brain metastasis receiving second-line EGFR-TKIs treatment.
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Affiliation(s)
- Zhen Zheng
- Department of Radiotherapy and Chemotherapy, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China, 325000
| | - Xiance Jin
- Department of Radiotherapy and Chemotherapy, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China, 325000
| | - Baochai Lin
- Department of Radiotherapy and Chemotherapy, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China, 325000
| | - Huafang Su
- Department of Radiotherapy and Chemotherapy, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China, 325000
| | - Hanbin Chen
- Department of Radiotherapy and Chemotherapy, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China, 325000
| | - Shaoran Fei
- Department of Radiotherapy and Chemotherapy, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China, 325000
| | - Lihao Zhao
- Department of Radiotherapy and Chemotherapy, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China, 325000
| | - Xia Deng
- Department of Radiotherapy and Chemotherapy, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China, 325000
| | - Deyao Xie
- Department of Thoracic Surgery, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China, 325000
| | - Congying Xie
- Department of Radiotherapy and Chemotherapy, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China, 325000
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22
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Ochiai S, Nomoto Y, Watanabe Y, Yamashita Y, Toyomasu Y, Kawamura T, Takada A, Noriko, Sakuma H. The impact of epidermal growth factor receptor mutations on patterns of disease recurrence after chemoradiotherapy for locally advanced non-small cell lung cancer: a literature review and pooled analysis. JOURNAL OF RADIATION RESEARCH 2016; 57:449-459. [PMID: 27534790 PMCID: PMC5045087 DOI: 10.1093/jrr/rrw075] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 04/27/2016] [Accepted: 05/25/2016] [Indexed: 06/15/2024]
Abstract
The purpose of this review was to evaluate the impact of epidermal growth factor receptor (EGFR) mutation status on disease recurrence in patients treated with chemoradiotherapy (CRT) for locally advanced non-small cell lung cancer (NSCLC). A literature search was conducted and a total of three studies were analyzed. There was no significant difference in the objective response rate between the EGFR mutation group and the EGFR wild-type group (odds ratios [OR] 1.46, 95% CI, 0.79-2.70, P = 0.228), and there was no significant difference in the incidence of disease recurrence (OR 1.37, 95% CI, 0.68-2.75, P = 0.379) between the two groups. There were significant difference in the incidence of local/locoregional progression (LP) (OR 0.35, 95% CI, 0.18-0.71, P = 0.003) and distant progression (DP) (OR 2.97, 95% CI, 1.59-5.54, P < 0.001). Brain metastasis (BM) was one of the main recurrence patterns of DP, and the incidence was significantly higher in the EGFR mutant group (OR 2.75, 95% CI, 1.43-5.31, P = 0.003). There were no statistically significant heterogeneities in these pooled analyses. The patterns of recurrence after CRT for locally advanced NSCLC were different according to EGFR mutation status. LP after CRT in patients with EGFR mutation was less frequent, but the high incidence of DP, especially BM, continued to be the major problem. On the other hand, LP continued to be the major problem in EGFR wild-type patients. In multimodality treatment for inoperable locally advanced NSCLC, we may need to consider different treatment strategies according to EGFR mutation status.
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Affiliation(s)
- Satoru Ochiai
- Department of Radiation Oncology, Matsusaka Central Hospital, 102 Kobou Kawai-machi, Matsusaka, Mie 515-8566, Japan
| | - Yoshihito Nomoto
- Department of Radiology, Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | - Yui Watanabe
- Department of Radiology, Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | - Yasufumi Yamashita
- Department of Radiation Oncology, Matsusaka Central Hospital, 102 Kobou Kawai-machi, Matsusaka, Mie 515-8566, Japan
| | - Yutaka Toyomasu
- Department of Radiology, Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | - Tomoko Kawamura
- Department of Radiology, Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | - Akinori Takada
- Department of Radiology, Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | - Noriko
- Department of Radiology, Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | - Hajime Sakuma
- Department of Radiology, Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
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23
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Li JR, Zhang Y, Zheng JL. Icotinib combined whole brain radiotherapy for patients with brain metastasis from lung adenocarcinoma harboring epidermal growth factor receptor mutation. J Thorac Dis 2016; 8:1504-12. [PMID: 27499937 DOI: 10.21037/jtd.2016.05.70] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND The brain is a metastatic organ that is most prone to lung adenocarcinoma (LAC). However, the prognosis of patients with brain metastasis remains very poor. In this study, we evaluated the efficacy of icotinib plus whole brain radiation therapy (WBRT) for treating patients with brain metastasis from epidermal growth factor receptor (EGFR)-mutated LAC. METHODS All patients received standard WBRT administered to the whole brain in 30 Gy in 10 daily fractions. Each patient was also instructed to take 125 mg icotinib thrice per day beginning from the first day of the WBRT. After completing the WBRT, maintenance icotinib was administered until the disease progressed or intolerable adverse effects were observed. Cranial progression-free survival (CPFS) and overall survival (OS) times were the primary endpoints. RESULTS A total of 43 patients were enrolled in this study. Two patients (4.7%) presented a complete response (CR), whereas 20 patients (46.5%) presented a partial response (PR). The median CPFS and OS times were 11.0 and 15.0 months, respectively. The one-year CPFS rate was 40.0% for the patients harboring EGFR exon 19 deletion and 16.7% for the patients with EGFR exon 21 L858R (P=0.027). CONCLUSIONS The concurrent administration of icotinib and WBRT exhibited favorable effects on the patients with brain metastasis. EGFR exon 19 deletion was predictive of a long CPFS following icotinib plus WBRT.
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Affiliation(s)
- Jin-Rui Li
- Department of Medical Oncology, The First Hospital of Jiaxing, Jiaxing 314001, China
| | - Ye Zhang
- Department of Medical Oncology, The First Hospital of Jiaxing, Jiaxing 314001, China
| | - Jia-Lian Zheng
- Department of Medical Oncology, The First Hospital of Jiaxing, Jiaxing 314001, China
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24
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Lu Y, Fan Y. Combined action of EGFR tyrosine kinase inhibitors and whole-brain radiotherapy on EGFR-mutated non-small-cell lung cancer patients with brain metastasis. Onco Targets Ther 2016; 9:1135-43. [PMID: 27022274 PMCID: PMC4790505 DOI: 10.2147/ott.s95871] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background Lung cancer is the most common type of cancer to spread to the brain (brain metastasis [BM]). This study assessed the effect of epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) in combination with whole-brain radiotherapy (WBRT) on EGFR-mutant non-small-cell lung cancer (NSCLC) patients with BM. Patients and methods Thirty-nine patients, who had receieved different EGFR TKIs plus 30 Gy WBRT until disease progression, were retrospectively analyzed between 2010 and 2014. Treatment response was evaluated and survival data were collected and analyzed. Results Among the 39 patients, 18 had an EGFR exon 19 deletion and 21 had an EGFR exon 21 point mutation. After therapy, 19 (48.7%) patients had complete remission, 12 (30.8%) had partial remission, and eight (20.5%) had stable disease in the intracranial lesions. Besides, there was no single case of complete remission, 21 (53.8%) had partial remission, and 18 (46.2%) had stable disease of the extracranial lesions. The median progression-free survival (PFS) of intracranial lesions and extracranial lesions was 18 and 12 months, respectively. The median overall survival (OS) was 26 months. The univariate analysis showed that graded prognostic assessment (P=0.006) and Karnofsky Performance Scale (P=0.045) were associated with intracranial progression-free survival (iPFS), while recursive partitioning analysis (P=0.049) was associated with OS of patients. Conclusion EGFR TKIs plus concomitant WBRT controlled intracranial lesions of lung cancer metastasis and significantly improved OS of patients. Further studies will be needed to confirm whether this combination treatment could be used as a standard therapy for EGFR-mutated NSCLC patients with BM.
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Affiliation(s)
- Yunyun Lu
- The Key Laboratory of Diagnosis and Treatment Technology for Thoracic Oncology (Esophagus and Lung), Zhejiang Cancer Hospital, Zhejiang, People's Republic of China
| | - Yun Fan
- The Key Laboratory of Diagnosis and Treatment Technology for Thoracic Oncology (Esophagus and Lung), Zhejiang Cancer Hospital, Zhejiang, People's Republic of China
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25
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Renaud S, Schaeffer M, Voegeli AC, Legrain M, Guérin E, Meyer N, Mennecier B, Quoix E, Falcoz PE, Guénot D, Massard G, Noël G, Beau-Faller M. Impact of EGFR mutations and KRAS amino acid substitution on the response to radiotherapy for brain metastasis of non-small-cell lung cancer. Future Oncol 2015; 12:59-70. [PMID: 26616848 DOI: 10.2217/fon.15.273] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Our study aimed to evaluate response rate (RR) to brain metastasis radiotherapy (RT), depending on the genomic status of non-small-cell lung cancer. MATERIAL & METHODS We retrospectively reviewed 1971 non-small-cell lung cancer files of patients with EGFR and KRAS testing and focused on 157 patients who had undergone RT for brain metastasis. RESULTS A total of 16 patients (10.2%) harbored EGFR mutations (mEGFR) and 45 patients (28.7%) KRAS (mKRAS). In univariate analysis, RR was significantly higher for mEGFR compared with wild-type EGFR/KRAS (odds ratio [OR]: 4.96; p = 0.05) or mKRAS (OR: 1.81; p = 0.03). In multivariate analysis, KRAS G12V or G12C status was associated with both poor RR (OR: 0.1; p < 0.0001) and overall survival (OR: 3.41; p < 0.0001). CONCLUSION mEGFR are associated with higher RR to brain RT than wild-type EGFR/RAS or mKRAS.
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Affiliation(s)
- Stéphane Renaud
- Thoracic Surgery Department, Strasbourg University Hospital, France.,Research Unit EA 3430 & Translational Medicine Federation, Strasbourg University, France
| | | | - Anne-Claire Voegeli
- Department of Biochemistry & Molecular Biology, Oncobiology laboratory, Regional Institute of Cancer, Strasbourg University Hospital, France
| | - Michèle Legrain
- Department of Biochemistry & Molecular Biology, Oncobiology laboratory, Regional Institute of Cancer, Strasbourg University Hospital, France
| | - Eric Guérin
- Department of Biochemistry & Molecular Biology, Oncobiology laboratory, Regional Institute of Cancer, Strasbourg University Hospital, France
| | - Nicolas Meyer
- Statistical Department, Strasbourg University Hospital, France
| | | | | | | | - Dominique Guénot
- Research Unit EA 3430 & Translational Medicine Federation, Strasbourg University, France
| | - Gilbert Massard
- Thoracic Surgery Department, Strasbourg University Hospital, France
| | - Georges Noël
- Department of Radiotherapy, Centre Paul Strauss, Strasbourg, France
| | - Michèle Beau-Faller
- Research Unit EA 3430 & Translational Medicine Federation, Strasbourg University, France.,Department of Biochemistry & Molecular Biology, Oncobiology laboratory, Regional Institute of Cancer, Strasbourg University Hospital, France
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26
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Li H, Zhang X, Cao J, Su P, Lian J, Song X, Yang W, Han S, Xi Y, Wang Y. Exon 19 deletion of epidermal growth factor receptor is associated with prolonged survival in brain metastases from non-small-cell lung cancer. Tumour Biol 2015; 36:9251-8. [PMID: 26091796 DOI: 10.1007/s13277-015-3653-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 06/09/2015] [Indexed: 11/25/2022] Open
Abstract
Brain metastasis (BM) is a poor prognostic factor for non-small-cell lung cancer (NSCLC). Recent studies have shown that oral epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) were effective for BM from NSCLC with EGFR mutation. However, the relationship between EGFR mutations and prognosis of NSCLC BM patients remains to be determined. In this study, we investigated the impact of EGFR mutation status on the survival of BM patients from NSCLC. One hundred six patients with BM from NSCLC were retrospectively reviewed. Thirty-three subjects (24.3 %) were confirmed to have an exon 19 deletion, while another 33 had an exon 21 point mutation (L858R) (24.3 %). Log-rank test and Cox proportional hazards model were used to analyze the impact of variables on survival. The median survival of NSCLC with BM was 8 months. Log-rank test analysis showed that Eastern Cooperative Oncology Group Performance Status (ECOG-PS) at BM (p < 0.0001), control of primary tumor (p = 0.005), pathology (p = 0.01), EGFR mutations (p = 0.045), and 19 exon deletion (p = 0.007) were associated with a longer survival. In a Cox proportional hazards model, EGFR exon 19 deletion (p = 0.034), control of primary tumor (p = 0.024), and ECOG PS at BM (p = 0.006) were found to be independent prognostic factors. Moreover, there were prognostic differences between groups according to Radiation Therapy Oncology Group (RTOG) recursive partitioning analysis (RPA) classification system (p < 0.0001). Exon 19 deletion is an independent prognostic factor in BM from NSCLC. It should be integrated into the prognostic scoring classification system for NSCLC.
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Affiliation(s)
- Hongwei Li
- Department of Radiation Oncology, Shanxi Provincial Cancer Hospital, Shanxi Medical University, Taiyuan, Shanxi, 030013, People's Republic of China.
- Department of Radiotherapy, Shanxi Provincial Cancer Hospital, Shanxi Medical University, Taiyuan, Shanxi, 030013, People's Republic of China.
| | - Xiaqin Zhang
- Department of Radiation Oncology, Shanxi Provincial Cancer Hospital, Shanxi Medical University, Taiyuan, Shanxi, 030013, People's Republic of China
| | - Jianzhong Cao
- Department of Radiation Oncology, Shanxi Provincial Cancer Hospital, Shanxi Medical University, Taiyuan, Shanxi, 030013, People's Republic of China.
| | - Pengcheng Su
- Department of Radiation Oncology, Shanxi Provincial Cancer Hospital, Shanxi Medical University, Taiyuan, Shanxi, 030013, People's Republic of China
| | - Jianhong Lian
- Department of Surgery, Shanxi Provincial Cancer Hospital, Shanxi Medical University, Taiyuan, Shanxi, 030013, People's Republic of China
| | - Xing Song
- Department of Radiation Oncology, Shanxi Provincial Cancer Hospital, Shanxi Medical University, Taiyuan, Shanxi, 030013, People's Republic of China
| | - Weihua Yang
- Department of Chemotherapy, Shanxi Provincial Cancer Hospital, Shanxi Medical University, Taiyuan, Shanxi, 030013, People's Republic of China
| | - Songyan Han
- Department of Chemotherapy, Shanxi Provincial Cancer Hospital, Shanxi Medical University, Taiyuan, Shanxi, 030013, People's Republic of China
| | - Yanfeng Xi
- Department of Pathology, Shanxi Provincial Cancer Hospital, Shanxi Medical University, Taiyuan, Shanxi, 030013, People's Republic of China
| | - Yaohua Wang
- Department of Pathology, Shanxi Provincial Cancer Hospital, Shanxi Medical University, Taiyuan, Shanxi, 030013, People's Republic of China
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27
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Wang TJC, Saad S, Qureshi YH, Jani A, Nanda T, Yaeh AM, Rozenblat T, Sisti MB, Bruce JN, McKhann GM, Lesser J, Halmos B, Stoopler MB, Lassman AB, Cheng SK, Isaacson SR. Does lung cancer mutation status and targeted therapy predict for outcomes and local control in the setting of brain metastases treated with radiation? Neuro Oncol 2015; 17:1022-8. [PMID: 25910841 DOI: 10.1093/neuonc/nov043] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Accepted: 02/24/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND We investigated effects of genetic alterations in epidermal growth factor receptor (EGFR), anaplastic lymphoma kinase (ALK), and Kirsten rat sarcoma viral oncogene homolog (KRAS) on overall survival (OS) and local control after stereotactic radiosurgery for brain metastases in non-small cell lung cancer (NSCLC). METHODS A cohort of 89 out of 262 NSCLC patients (2003-2013) treated with gamma knife radiosurgery for brain metastases had genotyping available and were selected as our study population. RESULTS Median follow-up was 12 months. Median OS rates for the EGFR, KRAS, echinoderm microtubule-associated protein-like 4 (EML4)-ALK mutated, and wild-type cohorts were 17, 7, 27, and 12 months, respectively (P = .019), and for targeted versus nontargeted therapy 21 and 11 months, respectively (P = .071). Targeted therapy was a strong predictor of increased OS on univariate (P = .037) and multivariate (P = .022) analysis. Gender, primary tumor controlled status, recursive partitioning analysis class, and graded prognostic assessment score were associated with OS (P < .05). On multivariate analysis, positive EGFR mutational status was a highly significant predictor for decreased survival (hazard ratio: 8.2; 95% CI: 2.0-33.7; P = .003). However, when we recategorized EGFR-mutant cases based on whether they received tyrosine kinase inhibitor, OS was no longer significantly shorter (hazard ratio: 1.5; P = .471). Median OS for patients with and without local failure was 17 and 12 months, respectively (P = .577). Local failure rates for EGFR, KRAS, EML4-ALK mutated, and wild-type cohorts by lesion were 8.7%, 5.4%, 4.3%, and 5.1%, respectively. CONCLUSIONS This study suggests that EGFR tyrosine kinase mutation and ALK translocation results in improved survival to targeted therapies and that mutation status itself does not predict survival and local control in patients with brain metastases from NSCLC.
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Affiliation(s)
- Tony J C Wang
- Department of Radiation Oncology (T.J.C.W., S.S., A.J., T.N., A.M.Y., T.R., J.L., S.K.C., S.R.I.); Herbert Irving Comprehensive Cancer Center (T.J.C.W., M.B.Si., J.N.B., G.M.M., B.H., M.B.St., A.B.L., S.K.C., S.R.I.); The Taub Institute for Research on Alzheimer's Disease and the Aging Brain (Y.H.Q.); Department of Neurological Surgery (M.B.Si., J.N.B., G.M.M.); Department of Neurology (A.B.L.); and Division of Hematology/Oncology (B.H., M.B.St.), Columbia University Medical Center, New York, New York
| | - Shumaila Saad
- Department of Radiation Oncology (T.J.C.W., S.S., A.J., T.N., A.M.Y., T.R., J.L., S.K.C., S.R.I.); Herbert Irving Comprehensive Cancer Center (T.J.C.W., M.B.Si., J.N.B., G.M.M., B.H., M.B.St., A.B.L., S.K.C., S.R.I.); The Taub Institute for Research on Alzheimer's Disease and the Aging Brain (Y.H.Q.); Department of Neurological Surgery (M.B.Si., J.N.B., G.M.M.); Department of Neurology (A.B.L.); and Division of Hematology/Oncology (B.H., M.B.St.), Columbia University Medical Center, New York, New York
| | - Yasir H Qureshi
- Department of Radiation Oncology (T.J.C.W., S.S., A.J., T.N., A.M.Y., T.R., J.L., S.K.C., S.R.I.); Herbert Irving Comprehensive Cancer Center (T.J.C.W., M.B.Si., J.N.B., G.M.M., B.H., M.B.St., A.B.L., S.K.C., S.R.I.); The Taub Institute for Research on Alzheimer's Disease and the Aging Brain (Y.H.Q.); Department of Neurological Surgery (M.B.Si., J.N.B., G.M.M.); Department of Neurology (A.B.L.); and Division of Hematology/Oncology (B.H., M.B.St.), Columbia University Medical Center, New York, New York
| | - Ashish Jani
- Department of Radiation Oncology (T.J.C.W., S.S., A.J., T.N., A.M.Y., T.R., J.L., S.K.C., S.R.I.); Herbert Irving Comprehensive Cancer Center (T.J.C.W., M.B.Si., J.N.B., G.M.M., B.H., M.B.St., A.B.L., S.K.C., S.R.I.); The Taub Institute for Research on Alzheimer's Disease and the Aging Brain (Y.H.Q.); Department of Neurological Surgery (M.B.Si., J.N.B., G.M.M.); Department of Neurology (A.B.L.); and Division of Hematology/Oncology (B.H., M.B.St.), Columbia University Medical Center, New York, New York
| | - Tavish Nanda
- Department of Radiation Oncology (T.J.C.W., S.S., A.J., T.N., A.M.Y., T.R., J.L., S.K.C., S.R.I.); Herbert Irving Comprehensive Cancer Center (T.J.C.W., M.B.Si., J.N.B., G.M.M., B.H., M.B.St., A.B.L., S.K.C., S.R.I.); The Taub Institute for Research on Alzheimer's Disease and the Aging Brain (Y.H.Q.); Department of Neurological Surgery (M.B.Si., J.N.B., G.M.M.); Department of Neurology (A.B.L.); and Division of Hematology/Oncology (B.H., M.B.St.), Columbia University Medical Center, New York, New York
| | - Andrew M Yaeh
- Department of Radiation Oncology (T.J.C.W., S.S., A.J., T.N., A.M.Y., T.R., J.L., S.K.C., S.R.I.); Herbert Irving Comprehensive Cancer Center (T.J.C.W., M.B.Si., J.N.B., G.M.M., B.H., M.B.St., A.B.L., S.K.C., S.R.I.); The Taub Institute for Research on Alzheimer's Disease and the Aging Brain (Y.H.Q.); Department of Neurological Surgery (M.B.Si., J.N.B., G.M.M.); Department of Neurology (A.B.L.); and Division of Hematology/Oncology (B.H., M.B.St.), Columbia University Medical Center, New York, New York
| | - Tzlil Rozenblat
- Department of Radiation Oncology (T.J.C.W., S.S., A.J., T.N., A.M.Y., T.R., J.L., S.K.C., S.R.I.); Herbert Irving Comprehensive Cancer Center (T.J.C.W., M.B.Si., J.N.B., G.M.M., B.H., M.B.St., A.B.L., S.K.C., S.R.I.); The Taub Institute for Research on Alzheimer's Disease and the Aging Brain (Y.H.Q.); Department of Neurological Surgery (M.B.Si., J.N.B., G.M.M.); Department of Neurology (A.B.L.); and Division of Hematology/Oncology (B.H., M.B.St.), Columbia University Medical Center, New York, New York
| | - Michael B Sisti
- Department of Radiation Oncology (T.J.C.W., S.S., A.J., T.N., A.M.Y., T.R., J.L., S.K.C., S.R.I.); Herbert Irving Comprehensive Cancer Center (T.J.C.W., M.B.Si., J.N.B., G.M.M., B.H., M.B.St., A.B.L., S.K.C., S.R.I.); The Taub Institute for Research on Alzheimer's Disease and the Aging Brain (Y.H.Q.); Department of Neurological Surgery (M.B.Si., J.N.B., G.M.M.); Department of Neurology (A.B.L.); and Division of Hematology/Oncology (B.H., M.B.St.), Columbia University Medical Center, New York, New York
| | - Jeffrey N Bruce
- Department of Radiation Oncology (T.J.C.W., S.S., A.J., T.N., A.M.Y., T.R., J.L., S.K.C., S.R.I.); Herbert Irving Comprehensive Cancer Center (T.J.C.W., M.B.Si., J.N.B., G.M.M., B.H., M.B.St., A.B.L., S.K.C., S.R.I.); The Taub Institute for Research on Alzheimer's Disease and the Aging Brain (Y.H.Q.); Department of Neurological Surgery (M.B.Si., J.N.B., G.M.M.); Department of Neurology (A.B.L.); and Division of Hematology/Oncology (B.H., M.B.St.), Columbia University Medical Center, New York, New York
| | - Guy M McKhann
- Department of Radiation Oncology (T.J.C.W., S.S., A.J., T.N., A.M.Y., T.R., J.L., S.K.C., S.R.I.); Herbert Irving Comprehensive Cancer Center (T.J.C.W., M.B.Si., J.N.B., G.M.M., B.H., M.B.St., A.B.L., S.K.C., S.R.I.); The Taub Institute for Research on Alzheimer's Disease and the Aging Brain (Y.H.Q.); Department of Neurological Surgery (M.B.Si., J.N.B., G.M.M.); Department of Neurology (A.B.L.); and Division of Hematology/Oncology (B.H., M.B.St.), Columbia University Medical Center, New York, New York
| | - Jeraldine Lesser
- Department of Radiation Oncology (T.J.C.W., S.S., A.J., T.N., A.M.Y., T.R., J.L., S.K.C., S.R.I.); Herbert Irving Comprehensive Cancer Center (T.J.C.W., M.B.Si., J.N.B., G.M.M., B.H., M.B.St., A.B.L., S.K.C., S.R.I.); The Taub Institute for Research on Alzheimer's Disease and the Aging Brain (Y.H.Q.); Department of Neurological Surgery (M.B.Si., J.N.B., G.M.M.); Department of Neurology (A.B.L.); and Division of Hematology/Oncology (B.H., M.B.St.), Columbia University Medical Center, New York, New York
| | - Balazs Halmos
- Department of Radiation Oncology (T.J.C.W., S.S., A.J., T.N., A.M.Y., T.R., J.L., S.K.C., S.R.I.); Herbert Irving Comprehensive Cancer Center (T.J.C.W., M.B.Si., J.N.B., G.M.M., B.H., M.B.St., A.B.L., S.K.C., S.R.I.); The Taub Institute for Research on Alzheimer's Disease and the Aging Brain (Y.H.Q.); Department of Neurological Surgery (M.B.Si., J.N.B., G.M.M.); Department of Neurology (A.B.L.); and Division of Hematology/Oncology (B.H., M.B.St.), Columbia University Medical Center, New York, New York
| | - Mark B Stoopler
- Department of Radiation Oncology (T.J.C.W., S.S., A.J., T.N., A.M.Y., T.R., J.L., S.K.C., S.R.I.); Herbert Irving Comprehensive Cancer Center (T.J.C.W., M.B.Si., J.N.B., G.M.M., B.H., M.B.St., A.B.L., S.K.C., S.R.I.); The Taub Institute for Research on Alzheimer's Disease and the Aging Brain (Y.H.Q.); Department of Neurological Surgery (M.B.Si., J.N.B., G.M.M.); Department of Neurology (A.B.L.); and Division of Hematology/Oncology (B.H., M.B.St.), Columbia University Medical Center, New York, New York
| | - Andrew B Lassman
- Department of Radiation Oncology (T.J.C.W., S.S., A.J., T.N., A.M.Y., T.R., J.L., S.K.C., S.R.I.); Herbert Irving Comprehensive Cancer Center (T.J.C.W., M.B.Si., J.N.B., G.M.M., B.H., M.B.St., A.B.L., S.K.C., S.R.I.); The Taub Institute for Research on Alzheimer's Disease and the Aging Brain (Y.H.Q.); Department of Neurological Surgery (M.B.Si., J.N.B., G.M.M.); Department of Neurology (A.B.L.); and Division of Hematology/Oncology (B.H., M.B.St.), Columbia University Medical Center, New York, New York
| | - Simon K Cheng
- Department of Radiation Oncology (T.J.C.W., S.S., A.J., T.N., A.M.Y., T.R., J.L., S.K.C., S.R.I.); Herbert Irving Comprehensive Cancer Center (T.J.C.W., M.B.Si., J.N.B., G.M.M., B.H., M.B.St., A.B.L., S.K.C., S.R.I.); The Taub Institute for Research on Alzheimer's Disease and the Aging Brain (Y.H.Q.); Department of Neurological Surgery (M.B.Si., J.N.B., G.M.M.); Department of Neurology (A.B.L.); and Division of Hematology/Oncology (B.H., M.B.St.), Columbia University Medical Center, New York, New York
| | - Steven R Isaacson
- Department of Radiation Oncology (T.J.C.W., S.S., A.J., T.N., A.M.Y., T.R., J.L., S.K.C., S.R.I.); Herbert Irving Comprehensive Cancer Center (T.J.C.W., M.B.Si., J.N.B., G.M.M., B.H., M.B.St., A.B.L., S.K.C., S.R.I.); The Taub Institute for Research on Alzheimer's Disease and the Aging Brain (Y.H.Q.); Department of Neurological Surgery (M.B.Si., J.N.B., G.M.M.); Department of Neurology (A.B.L.); and Division of Hematology/Oncology (B.H., M.B.St.), Columbia University Medical Center, New York, New York
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Le Rhun É, Taillibert S, Blonski M, Jouniaux Delbez N, Delgadillo D, Taillia H, Auquier P, Belin C, Bonnetain F, Varin D, Tallet A, Taillandier L. [Supportive care, cognition and quality of life in brain metastases]. Cancer Radiother 2015; 19:55-60. [PMID: 25640218 DOI: 10.1016/j.canrad.2014.11.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 11/26/2014] [Indexed: 10/24/2022]
Abstract
Brain metastases impact on the survival of the patients, but on their quality of life as well. The objective of the management of these patients is then double. Currently, due to medical advances, survivals tend to improve, especially for some tumor subtypes. During the course of the disease, different neurological signs and symptoms can be observed according to the location, the number and the volume of the metastase(s). Patients and caregivers are especially worried about the loss of autonomy and cognitive impairments. A permanent dialogue, during the course of the disease, is mandatory, in order to adapt the management to the objectives determined by the patients and the medical team. These objectives may vary according to the objective response rates of the disease to anticancer therapies, according to the impact of the disease and its management in daily living. Anticancer therapies and supportive care must be appreciated according to their impact on the survival, on the preservation of the functional independence and the quality of life of the patient, on their abilities to preserve the neurological status and delay the apparition of new neurological signs and symptoms, and their adverse events. Supportive care, cognition and quality of life should be regularly evaluated and adapted according to the objectives of the management of brain metastases patients. Different approaches are described in this paper.
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Affiliation(s)
- É Le Rhun
- Neuro-oncologie, département de neurochirurgie, hôpital Roger-Salengro, CHRU, rue Émile-Laine, 59037 Lille cedex, France; Oncologie médicale, centre Oscar-Lambret, 3, rue Frédéric-Combemale, BP 307, 59020 Lille cedex, France; Inserm U1192, laboratoire Prism, université Lille 1, bâtiment SN3 1(er) étage, 59655 Villeneuve d'Ascq cedex, France; Groupe de réflexion sur la prise en charge des métastases cérébrales (GRPCMaC), 13273 Marseille cedex 09, France.
| | - S Taillibert
- Neuro-oncologie, neurologie 2, groupe hospitalier Pitié Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France; Radiothérapie et neuro-oncologie, groupe hospitalier Pitié Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - M Blonski
- Neuro-oncologie, CHU de Nancy, 29, avenue du Maréchal-de-Lattre-de-Tassigny, CO 60034, 54035 Nancy, France
| | - N Jouniaux Delbez
- Neuro-oncologie, neurologie 2, groupe hospitalier Pitié Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - D Delgadillo
- Neuro-oncologie, neurologie 2, groupe hospitalier Pitié Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - H Taillia
- Neurologie, hôpital d'instruction des armées du Val-de-Grâce, 74, boulevard de Port-Royal, 75230 Paris cedex 05, France
| | - P Auquier
- Unité de recherche en santé publique, maladies chroniques et qualité de vie, faculté de médecine Timone, 27, boulevard Jean-Moulin, 13005 Marseille, France
| | - C Belin
- Service de neurologie, CHU Avicenne AP-HP, 125, rue de Stalingrad, 93009 Bobigny cedex, France
| | - F Bonnetain
- Méthodologie et qualité de vie en oncologie, EA 3181, CHU de Besançon, 2, boulevard Fleming, 25030 Besançon, France; Plateforme qualité de vie et recherche clinique en oncologie, CHU de Besançon, 2, boulevard Fleming, 25030 Besançon, France
| | - D Varin
- Soins palliatifs, groupe hospitalier Pitié Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - A Tallet
- Groupe de réflexion sur la prise en charge des métastases cérébrales (GRPCMaC), 13273 Marseille cedex 09, France; Département d'oncologie-radiothérapie, institut Paoli-Calmettes, 232, boulevard Sainte-Marguerite, 13009 Marseille, France
| | - L Taillandier
- Inserm U1192, laboratoire Prism, université Lille 1, bâtiment SN3 1(er) étage, 59655 Villeneuve d'Ascq cedex, France
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Soon YY, Leong CN, Koh WY, Tham IWK. EGFR tyrosine kinase inhibitors versus cranial radiation therapy for EGFR mutant non-small cell lung cancer with brain metastases: a systematic review and meta-analysis. Radiother Oncol 2015; 114:167-72. [PMID: 25583566 DOI: 10.1016/j.radonc.2014.12.011] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Revised: 12/02/2014] [Accepted: 12/21/2014] [Indexed: 01/06/2023]
Abstract
BACKGROUND AND PURPOSE EGFR TKIs alone have demonstrated activity against intracranial disease in EGFR mutant non-small cell lung cancer (NSCLC). This study aimed to determine if upfront cranial radiotherapy improves intracranial disease control and survival outcomes in EGFR mutant NSCLC with brain metastases relative to TKIs alone. MATERIALS AND METHODS We searched MEDLINE and various conference proceedings from 2008 to July 2014 for eligible studies where patients received upfront cranial radiotherapy or TKIs alone. Outcomes of interest were overall intracranial disease response rate (ORR), four-month intracranial disease progression-free survival (PFS), two-year overall survival (OS) and neurological adverse events (AE). We used random effects models to pool outcomes across studies and compared them using interaction tests. RESULTS We found 12 non-comparative observational studies (n=363) with severe methodological limitations. Upfront cranial radiotherapy results in similar intracranial disease ORR (relative risk (RR) 0.93, 95% confidence interval (CI) 0.82-1.06; interaction p value (p)=0.53), improved four-month intracranial disease PFS (RR 1.06, 95% CI 1.00-1.12; p=0.03), improved two-year OS (RR 1.33, 95% CI 1.00-1.77; p=0.05) but caused more neurological AEs than TKIs alone. CONCLUSION There is evidence, albeit of low quality, that upfront cranial radiotherapy may improve intracranial disease control and survival outcomes compared with TKI alone.
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Affiliation(s)
- Yu Yang Soon
- Department of Radiation Oncology, National University Cancer Institute, Singapore, National University Health System, National University of Singapore, Singapore.
| | - Cheng Nang Leong
- Department of Radiation Oncology, National University Cancer Institute, Singapore, National University Health System, National University of Singapore, Singapore
| | - Wee Yao Koh
- Department of Radiation Oncology, National University Cancer Institute, Singapore, National University Health System, National University of Singapore, Singapore
| | - Ivan Weng Keong Tham
- Department of Radiation Oncology, National University Cancer Institute, Singapore, National University Health System, National University of Singapore, Singapore
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Iuchi T, Shingyoji M, Itakura M, Yokoi S, Moriya Y, Tamura H, Yoshida Y, Ashinuma H, Kawasaki K, Hasegawa Y, Sakaida T, Iizasa T. Frequency of brain metastases in non-small-cell lung cancer, and their association with epidermal growth factor receptor mutations. Int J Clin Oncol 2014; 20:674-9. [PMID: 25336382 DOI: 10.1007/s10147-014-0760-9] [Citation(s) in RCA: 116] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 10/08/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND The brain is a frequent site of metastases from non-small-cell lung cancer (NSCLC). We analyzed the frequency of brain metastases (BMs) from NSCLC in the era of magnetic resonance images, and evaluated the correlation between epidermal growth factor receptor (EGFR) mutations and BMs among East Asian patients. METHODS Frequency, number, and size of BMs, and survival of 1,127 NSCLC patients were retrospectively reviewed. Mutation status of EGFR was evaluated in all cases, and its association with BMs was statistically evaluated. RESULTS EGFR mutations were found for 331 cases (29.4 %). BM was the cause of primary symptoms for 52 patients (4.6 %), and found before initiation of treatment for 102 other patients (9.1 %); In addition to these 154 patients, 107 patients (9.5 %) developed BMs, giving a total of 261 patients (23.2 %) who developed BMs from 1,127 with NSCLC. BM frequency was higher among EGFR-mutated cases (31.4 %) than EGFR-wild cases (19.7 %; odds ratio: 1.86; 95 % confidence interval (CI) 1.39-2.49; P < 0.001). BMs from EGFR-mutated NSCLC were small, but often became disseminated. EGFR mutations accounted for 39.9 % of BMs, but patient survival after BMs was significantly longer for EGFR-mutated cases than for EGFR-wild cases (hazard ratio: 2.23; 95 % CI 1.62-3.10; P < 0.001). CONCLUSIONS Patients with EGFR-mutated NSCLC were more likely to develop BMs, but apparently also survived longer after BMs.
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Affiliation(s)
- Toshihiko Iuchi
- Division of Neurological Surgery, Chiba Cancer Center, Chiba, 260-8717, Japan,
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Sekine A, Satoh H, Iwasawa T, Tamura K, Hayashihara K, Saito T, Kato T, Arai M, Okudela K, Ohashi K, Ogura T. Prognostic factors for brain metastases from non-small cell lung cancer with EGFR mutation: influence of stable extracranial disease and erlotinib therapy. Med Oncol 2014; 31:228. [PMID: 25208818 DOI: 10.1007/s12032-014-0228-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 09/02/2014] [Indexed: 11/26/2022]
Abstract
The aim of this study was to explore prognostic factors for non-small cell lung cancer (NSCLC) patients with brain metastases (BM) on the basis of EGFR mutation status. Among 779 consecutive NSCLC patients who underwent EGFR mutation screening, all 197 patients with BM were divided according to the EGFR mutation status. The prognostic factors, including patient characteristics at the time of BM diagnosis, treatment history, and radiologic features, were analyzed. Of 197 patients with BM, 108 had wild-type EGFR and 89 had EGFR mutation. The patients with EGFR mutation presented longer overall survival after BM diagnosis (OS) than those with wild-type EGFR, regardless of whether BM was synchronous or metachronous. For the patients with EGFR mutation, favorable prognostic factors in multivariate analysis were age<65 (p=0.037), good performance status (PS) (p<0.0001), cranial radiotherapy (p=0.020), previous chemotherapy≤1 regimen (p=0.009), stable extracranial disease at BM diagnosis (p=0.022), and erlotinib therapy after BM diagnosis (p=0.0015). On the other hand, favorable prognostic factors for the patients with wild-type EGFR were only good PS (p=0.0037) and cranial radiotherapy (p=0.0005). Among patients treated with erlotinib after BM diagnosis, the patients with exon 19 deletion showed longer OS than those with exon 21 point mutation (p=0.019). The prognostic factors for NSCLC patients with BM were different according to the EGFR mutation status. Particularly in NSCLC patients with EGFR mutation and stable extracranial disease, regular cranial evaluation for detecting asymptomatic BM would lead to good prognosis. In addition, erlotinib therapy would be preferable in NSCLC patients with BM and EGFR mutation, especially those with exon 19 deletion.
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Affiliation(s)
- Akimasa Sekine
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Tomioka-Higashi 6-16-1, Kanazawa-ku, Yokohama, Japan,
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Systemic treatments for brain metastases from breast cancer, non-small cell lung cancer, melanoma and renal cell carcinoma: An overview of the literature. Cancer Treat Rev 2014; 40:951-9. [DOI: 10.1016/j.ctrv.2014.05.007] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Revised: 05/16/2014] [Accepted: 05/19/2014] [Indexed: 11/24/2022]
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Brain metastases in lung adenocarcinoma: impact of EGFR mutation status on incidence and survival. Radiol Oncol 2014; 48:173-83. [PMID: 24991207 PMCID: PMC4078036 DOI: 10.2478/raon-2014-0016] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Accepted: 03/03/2014] [Indexed: 01/07/2023] Open
Abstract
Background The brain represents a frequent progression site in lung adenocarcinoma. This study was designed to analyse the association between the epidermal growth factor receptor (EGFR) mutation status and the frequency of brain metastases (BM) and survival in routine clinical practice. Patients and methods We retrospectively analysed the medical records of 629 patients with adenocarcinoma in Slovenia who were tested for EGFR mutations in order to analyse the cumulative incidence of BM, the time from the diagnosis to the development of BM (TDBM), the time from BM to death (TTD) and the median survival. Results Out of 629 patients, 168 (27%) had BM, 90 patients already at the time of diagnosis. Additional 78 patients developed BM after a median interval of 14.3 months; 25.8 months in EGFR positive and 11.8 months in EGFR negative patients, respectively (p = 0.002). EGFR mutations were present in 47 (28%) patients with BM. The curves for cumulative incidence of BM in EGFR positive and negative patients demonstrate a trend for a higher incidence of BM in EGFR mutant patients at diagnosis (19% vs. 13%, p = 0.078), but no difference later during the course of the disease. The patients with BM at diagnosis had a statistically longer TTD (7.3 months) than patients who developed BM later (3.1 months). The TTD in EGFR positive patients with BM at diagnosis was longer than in EGFR negative patients (12.6 vs. 6.8, p = 0.005), while there was no impact of EGFR status on the TTD of patients who developed BM later. Conclusions Except for a non-significant increase of frequency of BM at diagnosis in EGFR positive patients, EGFR status had no influence upon the cumulative incidence of BM. EGFR positive patients had a longer time to CNS progression. While EGFR positive patients with BM at diagnosis had a longer survival, EGFR status had no influence on TTD in patients who developed BM later during the course of disease.
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Zhang Y, Yang H, Yang X, Deng Q, Zhao M, Xu X, He J. Erlotinib with pemetrexed/cisplatin for patients with EGFR wild-type lung adenocarcinoma with brain metastases. Mol Clin Oncol 2014; 2:449-453. [PMID: 24772316 DOI: 10.3892/mco.2014.256] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Accepted: 01/22/2014] [Indexed: 11/06/2022] Open
Abstract
Erlotinib and pemetrexed have been approved for the second-line treatment of non-small cell lung cancer. Recent reports indicated that erlotinib and pemetrexed exerted synergistic effects against lung adenocarcinoma. The available treatment options for lung cancer with brain metastases (BM) are currently limited. In the present study, we investigated the efficacy of the combined administration of erlotinib and pemetrexed in 9 patients with epidermal growth factor receptor (EGFR) wild-type lung adenocarcinoma with BM. Pemetrexed (500 mg/m2) and cisplatin (20 mg/m2) were administered on day 1 and days 1-3, respectively. Erlotinib (150 mg) was administered daily on days 4-20. The 9 patients harbored EGFR wild-type mutation in the primary tumor tissues. With regard to the BM, no patients achieved complete remission, 7 patients exhibited a partial response (PR), 1 had stable disease (SD) and 1 had progressive disease (PD). As regards the extracranial tumors, 3 patients exhibited a PR, 2 had SD, 3 had PD and 1 was not applicable. The performance status and the symptoms improved in 3 patients following treatment. The median progression-free survival for intracranial and extracranial disease control was 179 and 146.5 days, respectively. The median overall survival was 197.4 days. Therefore, erlotinib combined with pemetrexed/cisplatin, was found to be effective in the treatment of patients with EGFR wild-type lung adenocarcinoma.
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Affiliation(s)
- Yalei Zhang
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510120, P.R. China ; State Key Laboratory of Respiratory Diseases, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510120, P.R. China
| | - Haihong Yang
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510120, P.R. China ; State Key Laboratory of Respiratory Diseases, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510120, P.R. China
| | - Xinyun Yang
- State Key Laboratory of Respiratory Diseases, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510120, P.R. China ; Department of Pharmacy, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510120, P.R. China
| | - Qiuhua Deng
- State Key Laboratory of Respiratory Diseases, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510120, P.R. China ; Center for Translational Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510120, P.R. China
| | - Meilin Zhao
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510120, P.R. China ; State Key Laboratory of Respiratory Diseases, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510120, P.R. China
| | - Xin Xu
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510120, P.R. China ; State Key Laboratory of Respiratory Diseases, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510120, P.R. China
| | - Jianxing He
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510120, P.R. China ; State Key Laboratory of Respiratory Diseases, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510120, P.R. China
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Hendriks LEL, Smit EF, Vosse BAH, Mellema WW, Heideman DAM, Bootsma GP, Westenend M, Pitz C, de Vries GJ, Houben R, Grünberg K, Bendek M, Speel EJM, Dingemans AMC. EGFR mutated non-small cell lung cancer patients: more prone to development of bone and brain metastases? Lung Cancer 2014; 84:86-91. [PMID: 24529684 DOI: 10.1016/j.lungcan.2014.01.006] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Accepted: 01/12/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Both bone and brain are frequent sites of metastasis in non-small cell lung cancer (NSCLC). Conflicting data exist whether EGFR mutant (+) patients are more prone to develop brain metastases or have a better outcome with brain metastases compared to EGFR/KRAS wildtype (WT) or KRAS+ patients. For bone metastases this has not been studied. METHODS In this retrospective case-control study all EGFR+ (exons 19 and 21) patients diagnosed at two pathology departments were selected (2004/2008 to 2012). For every EGFR+ patient a consecutive KRAS+ and WT patient with metastatic NSCLC (mNSCLC) was identified. Patients with another malignancy within 2 years of mNSCLC diagnosis were excluded. Data regarding age, gender, performance score, histology, treatment, bone/brain metastases diagnosis, skeletal related events (SRE) and subsequent survival were collected. RESULTS 189 patients were included: 62 EGFR+, 65 KRAS+, 62 WT. 32%, 35% and 40%, respectively, had brain metastases (p=0.645). Mean time to brain metastases was 20.8 [± 12.0], 10.8 [± 9.8], 16.4 [± 10.2] months (EGFR+-KRAS+, p = 0.020, EGFR+-WT, p = 0.321). Median post brain metastases survival was 12.1 [5.0-19.1], 7.6 [1.2-14.0], 10.7 [1.5-19.8] months (p = 0.674). 60%, 52% and 50% had metastatic bone disease (p=0.528). Mean time to development of metastatic bone disease was 13.4 [± 10.6], 23.3 [± 19.4], 16.4 [± 9.6] months (p = 0.201). Median post metastatic bone disease survival was 15.0 [10.6-20.3], 9.0 [5.2-12.9], 3.2 [0.0-6.9] months (p = 0.010). Time to 1st SRE was not significantly different. CONCLUSIONS Incidence of brain and bone metastases was not different between EGFR+, KRAS+ and WT patients. Post brain metastases survival, time from mNSCLC diagnosis to metastatic bone disease and 1st SRE did not differ either. Post metastatic bone disease survival was significantly longer in EGFR+ patients. Although prevention of SRE's is important for all patients, the latter finding calls for a separate study for SRE preventing agents in EGFR+ patients.
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Affiliation(s)
- L E L Hendriks
- Department of Pulmonary Diseases, Maastricht University Medical Center+, PO Box 5800, 6202 AZ Maastricht, The Netherlands.
| | - E F Smit
- Department of Pulmonary Diseases, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands
| | - B A H Vosse
- Department of Pulmonary Diseases, Maastricht University Medical Center+, PO Box 5800, 6202 AZ Maastricht, The Netherlands
| | - W W Mellema
- Department of Pulmonary Diseases, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands
| | - D A M Heideman
- Department of Pathology, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands
| | - G P Bootsma
- Department of Pulmonary Diseases, Atrium Medical Center, H. Dunantstraat 5, 6419 PC Heerlen, The Netherlands
| | - M Westenend
- Department of Pulmonary Diseases, VieCuri, Tegelseweg 210, 5912 BL Venlo, The Netherlands
| | - C Pitz
- Department of Pulmonary Diseases, Laurentius Hospital, Mgr. Driessenstraat 6, 6043 CV Roermond, The Netherlands
| | - G J de Vries
- Department of Pulmonary Diseases, Orbis Medical Center, PO Box 5500, 6130 MB Sittard, The Netherlands
| | - R Houben
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Center+, PO Box 3035, 6202 NA Maastricht, The Netherlands
| | - K Grünberg
- Department of Pathology, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands
| | - M Bendek
- Department of Pathology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center+, PO Box 5800, 6202 AZ Maastricht, The Netherlands
| | - E-J M Speel
- Department of Pathology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center+, PO Box 5800, 6202 AZ Maastricht, The Netherlands
| | - A-M C Dingemans
- Department of Pulmonary Diseases, Maastricht University Medical Center+, PO Box 5800, 6202 AZ Maastricht, The Netherlands
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36
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Lin NU, Wefel JS, Lee EQ, Schiff D, van den Bent MJ, Soffietti R, Suh JH, Vogelbaum MA, Mehta MP, Dancey J, Linskey ME, Camidge DR, Aoyama H, Brown PD, Chang SM, Kalkanis SN, Barani IJ, Baumert BG, Gaspar LE, Hodi FS, Macdonald DR, Wen PY. Challenges relating to solid tumour brain metastases in clinical trials, part 2: neurocognitive, neurological, and quality-of-life outcomes. A report from the RANO group. Lancet Oncol 2013; 14:e407-16. [PMID: 23993385 DOI: 10.1016/s1470-2045(13)70308-5] [Citation(s) in RCA: 94] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Neurocognitive function, neurological symptoms, functional independence, and health-related quality of life are major concerns for patients with brain metastases. The inclusion of these endpoints in trials of brain metastases and the methods by which these measures are assessed vary substantially. If functional independence or health-related quality of life are planned as key study outcomes, then the reliability and validity of these endpoints can be crucial because methodological issues might affect the interpretation and acceptance of findings. The Response Assessment in Neuro-Oncology (RANO) working group is an independent, international, and collaborative effort to improve the design of clinical trials in patients with brain tumours. In this report, the second in a two-part series, we review clinical trials of brain metastases in relation to measures of clinical benefit and provide a framework for the design and conduct of future trials.
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Affiliation(s)
- Nancy U Lin
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.
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