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Bortolot M, Cortiula F, Fasola G, De Ruysscher D, Naidoo J, Hendriks LEL. Treatment of unresectable stage III non-small cell lung cancer for patients who are under-represented in clinical trials. Cancer Treat Rev 2024; 129:102797. [PMID: 38972134 DOI: 10.1016/j.ctrv.2024.102797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Revised: 06/27/2024] [Accepted: 07/02/2024] [Indexed: 07/09/2024]
Abstract
Concurrent chemoradiotherapy (cCRT) followed by one year of consolidation durvalumab is the current standard-of-care for patients with unresectable stage III non-small cell lung cancer (NSCLC), of good functional status. However, cCRT and consolidation durvalumab may be challenging to administer for selected patient populations underrepresented or even excluded in clinical trials: older and/or frail patients; those with cardiovascular or respiratory comorbidities in which treatment-related adverse events may be higher, and patients with pre-existing autoimmune disorders for whom immunotherapy use is controversial. In this narrative review, we discuss the current evidence, challenges, ongoing clinical trials and potential future treatment scenarios in relevant subgroups of patients with locally advanced NSCLC, who are underrepresented in clinical trials.
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Affiliation(s)
- Martina Bortolot
- University of Udine, Department of Medicine (DAME), Udine, Italy; University Hospital of Udine, Department of Oncology, Udine, Italy
| | - Francesco Cortiula
- University Hospital of Udine, Department of Oncology, Udine, Italy; Department of Radiation Oncology (Maastro), Maastricht University Medical Centre (+), GROW School for Oncology and Reproduction, Maastricht, the Netherlands.
| | - Gianpiero Fasola
- University Hospital of Udine, Department of Oncology, Udine, Italy
| | - Dirk De Ruysscher
- Department of Radiation Oncology (Maastro), Maastricht University Medical Centre (+), GROW School for Oncology and Reproduction, Maastricht, the Netherlands
| | - Jarushka Naidoo
- Beaumont Hospital and RCSI University of Health Sciences, Dublin, Ireland; Sidney Kimmel Comprehensive Cancer Centre at Johns Hopkins University, Baltimore, USA
| | - Lizza E L Hendriks
- Department of Pulmonary Diseases, Maastricht University Medical Centre (+), GROW School for Oncology and Reproduction, Maastricht, the Netherlands
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Toublanc AC, Faure M, Verdy G, Rabeau A, Houard V, Veillon R, Bardel C, Vergnenegre C, Dos Santos P, Mazieres J, Zysman M. Prospective cardiovascular events in patients with advanced thoracic cancer treated with immune checkpoint inhibitor. Eur J Cancer 2024; 207:114191. [PMID: 38936104 DOI: 10.1016/j.ejca.2024.114191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 06/18/2024] [Accepted: 06/20/2024] [Indexed: 06/29/2024]
Abstract
INTRODUCTION Myocarditis is the most lethal cardiovascular immune related adverse events with a low incidence, depending on the studies. We prospectively studied the potential interest of a systematic screening to early detect immune related myocarditis and confirm the incidence of immune-induced myocarditis in advanced lung cancer and the impact of troponin systematic screening in early detection of other major cardiovascular events (MACE). MATERIAL AND METHODS This prospective bicentric study includes adults who received at least one dose of immune checkpoint inhibitor (ICI) for advanced lung cancer. Cardiac biomarkers dosage, ECG and transthoracic echography (TTE) were done at baseline. Diagnosis of myocarditis was based on European Society of Cardiology recommendations. MACEs were reported during the observation period. RESULTS Among 298 patients, 5 (1.68 %) immune-induced myocarditis occurred, all being asymptomatic with at first troponin elevation, treated by corticosteroids and ICI's discontinuation. No attributable death occurred, and no specific clinical characteristics were identified with myocarditis onset. Three patients were rechallenged with ICI after troponin normalization in the absence of other therapeutic options. Recurrence occurred in 2 patients, with a re-increase of troponin and a de novo modification of the ECG. Systematic cardiovascular screening also led to 14 cardiovascular diseases detection and 11 MACEs during ICI. CONCLUSION Systematic cardiovascular screening has uncovered slightly more immuno-induced myocarditis cases than reported previously, but without altering treatment strategies due to their subclinical nature. Additionally, it helps detecting other cardiovascular diseases in this comorbid population.
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Affiliation(s)
| | - Maxime Faure
- Heart failure unit, Cardiology Department, CHU Haut-Lévèque, Bordeaux, France
| | - Guillaume Verdy
- Medical Informatics and Archiving Unit, CHU Bordeaux, France
| | | | - Valérie Houard
- Arterial hypertension unit, Cardiology Department, CHU Rangueil, Toulouse, France
| | - Rémi Veillon
- Pulmonary Department, CIC1401, CHU Haut-Lévèque, Bordeaux, France
| | - Claire Bardel
- Pulmonary Department, CIC1401, CHU Haut-Lévèque, Bordeaux, France
| | | | - Pierre Dos Santos
- Heart failure unit, Cardiology Department, CHU Haut-Lévèque, Bordeaux, France; Lyric Institute, Bordeaux University, Pessac, France; University Institute of cancer, INSERM UMR1037, Toulouse, France
| | - Julien Mazieres
- Pulmonary Department, CHU Larrey, Toulouse, France; Oncology Research Center CRCT, INSERM UMR1037, Toulouse, France
| | - Maeva Zysman
- Pulmonary Department, CIC1401, CHU Haut-Lévèque, Bordeaux, France; Bordeaux University, INSERM U1045, Pessac, France
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3
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Wang Y, Deng X, Qiu Q, Wan M. Risk factors of osimertinib-related cardiotoxicity in non-small cell lung cancer. Front Oncol 2024; 14:1431023. [PMID: 39070151 PMCID: PMC11272545 DOI: 10.3389/fonc.2024.1431023] [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: 05/11/2024] [Accepted: 06/28/2024] [Indexed: 07/30/2024] Open
Abstract
Objective To investigate the risk factors associated with cardiotoxicity in patients with non-small cell lung cancer (NSCLC) treated with osimertinib. Methods A total of 268 patients with NSCLC treated with osimertinib in our hospital from June 2019 to December 2023 were selected to observe the occurrence of cardiotoxicity and were divided into cardiotoxicity group and non-cardiotoxicity group. The differences in age, gender, body mass index (BMI), smoking, alcohol consumption, tumor stage, hypertension, diabetes, hyperlipidemia, chemotherapy, radiotherapy, antiangiogenic drugs, and osimertinib treatment time were recorded and analyzed. Logistic regression was used to analyze the risk factors for cardiotoxicity in patients with non-small cell lung cancer caused by osimertinib treatment. Results Among the 268 patients with NSCLC treated with osimertinib, 58 patients developed cardiotoxicity, and the incidence of cardiotoxicity was 21.64%. There were statistically significant differences between the cardiotoxicity group and the non-cardiotoxicity group in terms of smoking history, hyperlipidemia history, combined chemotherapy, and combined radiotherapy (P < 0.05). Further analysis showed that patients with a smoking history were at increased risk of cardiotoxicity compared with non-smoking patients (OR = 2.569, 95% CI = 1.398-6.523). Patients with hyperlipidemia were at increased risk of cardiotoxicity compared with those without hyperlipidemia (OR = 3.412, 95% CI = 2.539-7.628). Patients with chemotherapy were at increased risk of cardiotoxicity compared with those without combination chemotherapy (OR = 2.018, 95% CI = 1.426-4.517). Patients undergoing radiotherapy to the left chest were at increased risk of cardiotoxicity compared with those without combined radiotherapy (OR = 1.629, 95% CI = 1.273-4.206). Conclusion The incidence of cardiotoxicity in patients with NSCLC is high due to osimertinib treatment. A history of smoking, hyperlipidemia, combination chemotherapy, and radiotherapy to the left chest are independent risk factors for cardiotoxicity in patients with NSCLC treated with osimertinib.
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Affiliation(s)
- Yunlong Wang
- Department of Oncology, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
| | - Xuan Deng
- Department of Oncology, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
| | - Qinggui Qiu
- Department of Oncology, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
| | - Mengchao Wan
- Department of Outpatient, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
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Field M, Vinod S, Delaney GP, Aherne N, Bailey M, Carolan M, Dekker A, Greenham S, Hau E, Lehmann J, Ludbrook J, Miller A, Rezo A, Selvaraj J, Sykes J, Thwaites D, Holloway L. Federated Learning Survival Model and Potential Radiotherapy Decision Support Impact Assessment for Non-small Cell Lung Cancer Using Real-World Data. Clin Oncol (R Coll Radiol) 2024; 36:e197-e208. [PMID: 38631978 DOI: 10.1016/j.clon.2024.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 02/07/2024] [Accepted: 03/11/2024] [Indexed: 04/19/2024]
Abstract
AIMS The objective of this study was to develop a two-year overall survival model for inoperable stage I-III non-small cell lung cancer (NSCLC) patients using routine radiation oncology data over a federated (distributed) learning network and evaluate the potential of decision support for curative versus palliative radiotherapy. METHODS A federated infrastructure of data extraction, de-identification, standardisation, image analysis, and modelling was installed for seven clinics to obtain clinical and imaging features and survival information for patients treated in 2011-2019. A logistic regression model was trained for the 2011-2016 curative patient cohort and validated for the 2017-2019 cohort. Features were selected with univariate and model-based analysis and optimised using bootstrapping. System performance was assessed by the receiver operating characteristic (ROC) and corresponding area under curve (AUC), C-index, calibration metrics and Kaplan-Meier survival curves, with risk groups defined by model probability quartiles. Decision support was evaluated using a case-control analysis using propensity matching between treatment groups. RESULTS 1655 patient datasets were included. The overall model AUC was 0.68. Fifty-eight percent of patients treated with palliative radiotherapy had a low-to-moderate risk prediction according to the model, with survival times not significantly different (p = 0.87 and 0.061) from patients treated with curative radiotherapy classified as high-risk by the model. When survival was simulated by risk group and model-indicated treatment, there was an estimated 11% increase in survival rate at two years (p < 0.01). CONCLUSION Federated learning over multiple institution data can be used to develop and validate decision support systems for lung cancer while quantifying the potential impact of their use in practice. This paves the way for personalised medicine, where decisions can be based more closely on individual patient details from routine care.
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Affiliation(s)
- M Field
- South Western Sydney Clinical Campus, School of Clinical Medicine, UNSW, Sydney, New South Wales, Australia; Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia; South Western Sydney Cancer Services, NSW Health, Sydney, New South Wales, Australia.
| | - S Vinod
- South Western Sydney Clinical Campus, School of Clinical Medicine, UNSW, Sydney, New South Wales, Australia; Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia; South Western Sydney Cancer Services, NSW Health, Sydney, New South Wales, Australia
| | - G P Delaney
- South Western Sydney Clinical Campus, School of Clinical Medicine, UNSW, Sydney, New South Wales, Australia; Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia; South Western Sydney Cancer Services, NSW Health, Sydney, New South Wales, Australia
| | - N Aherne
- Mid North Coast Cancer Institute, Coffs Harbour, New South Wales, Australia; Rural Clinical School, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - M Bailey
- Illawarra Cancer Care Centre, Wollongong, New South Wales, Australia
| | - M Carolan
- Illawarra Cancer Care Centre, Wollongong, New South Wales, Australia
| | - A Dekker
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - S Greenham
- Mid North Coast Cancer Institute, Coffs Harbour, New South Wales, Australia
| | - E Hau
- Sydney West Radiation Oncology Network, Sydney, Australia; Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - J Lehmann
- School of Mathematical and Physical Sciences, University of Newcastle, Newcastle, New South Wales, Australia; Department of Radiation Oncology, Calvary Mater, Newcastle, New South Wales, Australia; Institute of Medical Physics, School of Physics, University of Sydney, Sydney, New South Wales, Australia
| | - J Ludbrook
- Department of Radiation Oncology, Calvary Mater, Newcastle, New South Wales, Australia
| | - A Miller
- Illawarra Cancer Care Centre, Wollongong, New South Wales, Australia
| | - A Rezo
- Canberra Health Services, Canberra, Australian Capital Territory, Australia
| | - J Selvaraj
- South Western Sydney Clinical Campus, School of Clinical Medicine, UNSW, Sydney, New South Wales, Australia; Canberra Health Services, Canberra, Australian Capital Territory, Australia
| | - J Sykes
- Sydney West Radiation Oncology Network, Sydney, Australia; Institute of Medical Physics, School of Physics, University of Sydney, Sydney, New South Wales, Australia
| | - D Thwaites
- Institute of Medical Physics, School of Physics, University of Sydney, Sydney, New South Wales, Australia; Radiotherapy Research Group, Leeds Institute for Medical Research, St James's Hospital and the University of Leeds, Leeds, UK
| | - L Holloway
- South Western Sydney Clinical Campus, School of Clinical Medicine, UNSW, Sydney, New South Wales, Australia; Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia; South Western Sydney Cancer Services, NSW Health, Sydney, New South Wales, Australia; Institute of Medical Physics, School of Physics, University of Sydney, Sydney, New South Wales, Australia
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Khokhar B, Chiang B, Iglay K, Reynolds K, Rodriguez-Ormaza N, Spalding W, Freedland E. QT-Interval Prolongation, Torsades de Pointes, and Heart Failure With EGFR Tyrosine Kinase Inhibitors in Non-Small Cell Lung Cancer: Systematic Review. Clin Lung Cancer 2024; 25:285-318. [PMID: 38553324 DOI: 10.1016/j.cllc.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 02/07/2024] [Accepted: 02/11/2024] [Indexed: 06/01/2024]
Abstract
A systematic literature review was conducted to determine the incidence and mortality of QT-interval prolongation (QTp), torsades de pointes (TdP), and heart failure (HF) in patients with non-small cell lung cancer (NSCLC) who received epidermal growth factor receptor (EGFR) TKIs. Of 296 identified publications, 95 met eligibility criteria and were abstracted for QTp/TdP and HF outcomes (QTp/TdP: 83 publications, including 5 case study publications; HF: 79 publications, including 6 case study publications [involving 8 patients]). QTp incidence ranged from 0% to 27.8% in observational studies and from 0% to 11% in clinical trials, with no deaths due to QTp. There were no TdP events or deaths due to TdP. The incidence of HF ranged from 0% to 8%, and HF mortality rates ranged from 0% to 4%. Patients receiving treatment with EGFR TKIs should be monitored for signs of QTp, TdP, and HF per prescribing information. Standardized definitions and methods to improve monitoring of QTp, TdP, and HF-related events are needed in patients with NSCLC.
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Affiliation(s)
- Bilal Khokhar
- Global Evidence and Outcomes, Takeda Development Center Americas, Inc., Lexington, MA.
| | - Beatrice Chiang
- Global Patient Safety Evaluation, Takeda Development Center Americas, Inc., Lexington, MA
| | - Kristy Iglay
- Real-world Evidence and Patient Outcomes, CERobs Consulting, LLC, Wrightsville Beach, NC
| | - Kamika Reynolds
- Real-world Evidence and Patient Outcomes, CERobs Consulting, LLC, Wrightsville Beach, NC; Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Nidia Rodriguez-Ormaza
- Real-world Evidence and Patient Outcomes, CERobs Consulting, LLC, Wrightsville Beach, NC; Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - William Spalding
- Global Evidence and Outcomes, Takeda Development Center Americas, Inc., Lexington, MA
| | - Eric Freedland
- Global Patient Safety Evaluation, Takeda Development Center Americas, Inc., Lexington, MA
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Joshi PR. Pulmonary Diseases in Older Patients: Understanding and Addressing the Challenges. Geriatrics (Basel) 2024; 9:34. [PMID: 38525751 PMCID: PMC10961796 DOI: 10.3390/geriatrics9020034] [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: 01/11/2024] [Revised: 02/22/2024] [Accepted: 03/04/2024] [Indexed: 03/26/2024] Open
Abstract
As the global population ages, pulmonary diseases among older people have emerged as a significant and growing public health concern. The increasing incidence of these conditions has led to higher rates of morbidity and mortality among older adults. This perspective study offers a thorough overview of the prevalent pulmonary diseases affecting the elderly demographic. It delves into the challenges encountered during the diagnosis and management of these conditions in older individuals, considering factors such as comorbidities, functional limitations, and medication complexities. Furthermore, innovative strategies and personalized interventions such as precision medicine, advanced therapies, telemedicine solutions, and patient-centered support systems aimed at enhancing the care provided to older individuals grappling with pulmonary disorders are thoroughly explored. By addressing the unique needs and complexities of this vulnerable population, healthcare systems can strive towards improving outcomes and enhancing the quality of life for elderly individuals affected by pulmonary diseases.
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Affiliation(s)
- Pushpa Raj Joshi
- Institute of General Practice and Family Medicine, Martin-Luther-University Halle-Wittenberg, 06112 Halle (Saale), Germany
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de Jesus M, Chanda A, Grabauskas T, Kumar M, Kim AS. Cardiovascular disease and lung cancer. Front Oncol 2024; 14:1258991. [PMID: 38410099 PMCID: PMC10896114 DOI: 10.3389/fonc.2024.1258991] [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: 07/14/2023] [Accepted: 01/19/2024] [Indexed: 02/28/2024] Open
Abstract
Lung cancer is the second most common cancer worldwide and the leading cause of cancer-related death. While survival rates have improved with advancements in cancer therapeutics, additional health challenges have surfaced. Cardiovascular disease (CVD) is a leading cause of morbidity and mortality in patients with lung cancer. CVD and lung cancer share many risk factors, such as smoking, hypertension, diabetes, advanced age, and obesity. Optimal management of this patient population requires a full understanding of the potential cardiovascular (CV) complications of lung cancer treatment. This review outlines the common shared risk factors, the spectrum of cardiotoxicities associated with lung cancer therapeutics, and prevention and management of short- and long-term CVD in patients with non-small cell (NSCLC) and small cell (SCLC) lung cancer. Due to the medical complexity of these patients, multidisciplinary collaborative care among oncologists, cardiologists, primary care physicians, and other providers is essential.
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Affiliation(s)
- Mikhail de Jesus
- Department of Cardiology, University of Connecticut Hartford Hospital, Hartford, CT, United States
| | - Anindita Chanda
- Department of Internal Medicine, University of Connecticut School of Medicine, Farmington, CT, United States
| | - Titas Grabauskas
- University of Connecticut School of Medicine, Farmington, CT, United States
| | - Manish Kumar
- Department of Cardiology, Pat & Jim Calhoun Cardiology Center, University of Connecticut School of Medicine, Farmington, CT, United States
| | - Agnes S Kim
- Department of Cardiology, Pat & Jim Calhoun Cardiology Center, University of Connecticut School of Medicine, Farmington, CT, United States
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Piserra López-Fernández De Heredia A, Ruiz Ortiz M, Pérez Cabeza AI, Díaz Expósito A, Fernández Valenzuela MI, Carrillo Bailén M, Alarcón De La Lastra Cubiles I, Moreno Vega A, Zalabardo Aguilar M, Chaparro Muñoz M, García Manrique T, Torres Llergo J, Ortega Granados AL, Sánchez Fernández JJ, Calvete Cadenas J, Mesa Rubio D. Clinical outcomes and mortality in patients with atrial fibrillation and recently diagnosed lung cancer in oncology outpatient settings. Curr Probl Cardiol 2024; 49:102239. [PMID: 38056515 DOI: 10.1016/j.cpcardiol.2023.102239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 11/28/2023] [Indexed: 12/08/2023]
Abstract
INTRODUCTION Our aim was to investigate the prevalence of atrial fibrillation (AF) and recently diagnosed lung cancer in the outpatient oncology clinic and to describe the clinical profile, management and outcomes of this population. METHODS Among 6984 patients visited at the outpatient oncology clinics attending lung cancer patients in five university hospitals from 2017 to 2019, all consecutive subjects with recently diagnosed (<1 year) disease and AF were retrospectively selected and events in follow up were registered. RESULTS A total of 269 patients (3.9 % of all attended, 71 ± 8 years, 91 % male) were included. Charlson, CHA2DS2-VASc and HAS-BLED indexes were 6.7 ± 2.9, 2.9 ± 1.5 y 2.5 ± 1.2, respectively. Tumour stage was I, II, III and IV in 11 %, 11 %, 33 % and 45 % of them, respectively. Anticoagulants were prescribed to 226 patients (84 %): direct anticoagulants (n = 99;44 %), low molecular weight heparins (n = 69;30 %) and vitamin K antagonists (n = 58;26 %). After 46 months of maximum follow-up, 186 patients died (69 %). Cumulative incidences of events at 3 years were 3.3 ± 1.3 % for stroke/systemic embolism (n = 7); 8.9 ± 2.2 % for thrombotic events (n = 18); 9.9 ± 2.6 % for major bleeding (n = 16), and 15.9 ± 3,0 % for cardiovascular events (n = 33). In patients with early stages of cancer (I-II), 2-year mortality was significantly higher in those with cardiovascular events or major bleeding (85 % vs 25 %, p = 0.01). CONCLUSION Nearly 4 % or all outpatients in the oncology clinic attending lung cancer present recently diagnosed disease and AF. Major bleeding and cardiovascular event rates are high in this population, with an impact on mortality in early stages of cancer.
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Affiliation(s)
| | - Martín Ruiz Ortiz
- Department of Cardiology, Reina Sofia University Hospital, Cordoba, Spain; Maimonides Institute for Biomedical Research of Cordoba, IMIBIC, Cordoba, Spain.
| | | | | | | | | | | | - Alberto Moreno Vega
- Department of Medical Oncology, Reina Sofia University Hospital, Cordoba, Spain
| | | | | | | | | | | | | | | | - Dolores Mesa Rubio
- Department of Cardiology, Reina Sofia University Hospital, Cordoba, Spain; Maimonides Institute for Biomedical Research of Cordoba, IMIBIC, Cordoba, Spain
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Zhang S, Liu L, Shi S, He H, Shen Q, Wang H, Qin S, Chang J, Zhong R. Bidirectional Association Between Cardiovascular Disease and Lung Cancer in a Prospective Cohort Study. J Thorac Oncol 2024; 19:80-93. [PMID: 37703998 DOI: 10.1016/j.jtho.2023.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 09/01/2023] [Accepted: 09/01/2023] [Indexed: 09/15/2023]
Abstract
INTRODUCTION The study aimed to prospectively investigate the bidirectional association between cardiovascular disease (CVD) and lung cancer, and whether this association differs across genetic risk levels. METHODS This study prospectively followed 455,804 participants from the United Kingdom Biobank cohort who were free of lung cancer at baseline. Cox proportional hazard models were used to estimate the hazard ratio (HR) for incident lung cancer according to CVD status. In parallel, similar approaches were used to assess the risk of incident CVD according to lung cancer status among 478,756 participants free of CVD at baseline. The bidirectional causal relations between these conditions were assessed using Mendelian randomization analysis. Besides, polygenic risk scores were estimated by integrating genome-wide association studies identified risk variants. RESULTS During 4,007,477 person-years of follow-up, 2006 incident lung cancer cases were documented. Compared with participants without CVD, those with CVD had HRs (95% confidence interval [CI]) of 1.49 (1.30-1.71) for NSCLC, 1.80 (1.39-2.34) for lung squamous cell carcinoma (LUSC), and 1.25 (1.01-1.56) for lung adenocarcinoma (LUAD). After stratification by smoking status, significant associations of CVD with lung cancer risk were observed in former smokers (HR = 1.44, 95% CI: 1.20-1.74) and current smokers (HR = 1.38, 95% CI: 1.13-1.69), but not in never-smokers (HR = 0.98, 95% CI: 0.60-1.61). In addition, CVD was associated with lung cancer risk across each genetic risk level (pheterogeneity = 0.336). In the second analysis, 32,974 incident CVD cases were recorded. Compared with those without lung cancer, the HRs (95% CI) for CVD were 2.33 (1.29-4.21) in NSCLC, 3.66 (1.65-8.14) in LUAD, and 1.98 (0.64-6.14) in LUSC. In particular, participants with lung cancer had a high risk of incident CVD at a high genetic risk level (HR = 3.79, 95% CI: 1.57-9.13). No causal relations between these conditions were observed in Mendelian randomization analysis. CONCLUSIONS CVD is associated with an increased risk of NSCLC including LUSC and LUAD. NSCLC, particularly LUAD, is associated with a higher CVD risk. Awareness of this bidirectional association may improve prevention and treatment strategies for both diseases. Future clinical demands will require a greater focus on cardiac oncology.
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Affiliation(s)
- Shanshan Zhang
- Department of Epidemiology and Biostatistics and Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Lei Liu
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Shanshan Shi
- Department of Pathology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, People's Republic of China
| | - Heng He
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, People's Republic of China
| | - Qian Shen
- Department of Epidemiology and Biostatistics and Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Haoxue Wang
- Department of Epidemiology and Biostatistics and Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Shifan Qin
- Department of Epidemiology and Biostatistics and Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Jiang Chang
- Department of Epidemiology and Biostatistics and Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Rong Zhong
- Department of Epidemiology and Biostatistics and Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China.
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LIANG HY, LIU D, WANG H, BA ZQ, XIAO Y, LIU YL, WANG Y, YUAN JS. Pre-existing cardiometabolic comorbidities and survival of middle-aged and elderly non-small cell lung cancer patients. J Geriatr Cardiol 2023; 20:737-747. [PMID: 37970226 PMCID: PMC10630173 DOI: 10.26599/1671-5411.2023.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023] Open
Abstract
BACKGROUND Both lung cancer and cardiometabolic diseases are leading causes of death in China, and they share some common risk factors. However, the prevalence and long-term effect of pre-existing cardiometabolic comorbidities (CMCs) on the survival of middle-aged and elderly lung cancer patients are still not clear. METHODS We consecutively recruited 3477 non-small cell lung cancer (NSCLC) patients between January 2011 and December 2018 from four cancer specialty hospitals in China. Univariable and multivariable adjusted Cox proportional hazard models were conducted to evaluate the risk factors associated with mortality. Hazard ratio (HR) for mortality and corresponding 95% CI were calculated. RESULTS The prevalence of CMCs was 30.0% in middle-aged NSCLC patients and 45.5% in elderly NSCLC patients. Log-rank analysis presented statistically significant differences in median survival time between patients with CMCs and without CMCs in both the middle-aged group (21.0 months vs. 32.0 months, P < 0.01) and the elderly group (13.0 months vs. 17.0 months, P = 0.01). Heart failure (HR = 1.754, 95% CI: 1.436-2.144, P < 0.001) and venous thrombus embolism (HR = 2.196, 95% CI: 1.691-2.853, P < 0.001) were independent risk factors for the survival of middle-aged NSCLC patients, while heart failure (HR = 1.709, 95% CI: 1.371-2.130, P < 0.001) continued to decrease overall survival in the elderly group. Hyperlipidemia may be a protective factor for survival in middle-aged group (HR = 0.741, 95% CI: 0.566-0.971, P = 0.030). CONCLUSIONS Our findings demonstrate for the first time the prevalence and prognostic value of pre-existing CMCs in Chinese middle-aged and elderly NSCLC patients.
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Affiliation(s)
- Han-Yang LIANG
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Dong LIU
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Hao WANG
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Zheng-Qing BA
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Ying XIAO
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Yi-Lu LIU
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Yong WANG
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
- Key Laboratory of Pulmonary Vascular Medicine, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Jian-Song YUAN
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
- Key Laboratory of Pulmonary Vascular Medicine, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
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11
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Fink CA, Weykamp F, Adeberg S, Bozorgmehr F, Christopoulos P, Lang K, König L, Hörner-Rieber J, Thomas M, Steins M, El-Shafie RA, Rieken S, Bernhardt D, Debus J. Comorbidity in limited disease small-cell lung cancer: Age-adjusted Charlson comorbidity index and its association with overall survival following chemoradiotherapy. Clin Transl Radiat Oncol 2023; 42:100665. [PMID: 37564923 PMCID: PMC10410177 DOI: 10.1016/j.ctro.2023.100665] [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: 04/22/2023] [Revised: 07/03/2023] [Accepted: 07/22/2023] [Indexed: 08/12/2023] Open
Abstract
Background Combined, platinum-based thoracic chemoradiotherapy (TCR) is the current state-of-the-art treatment for patients with limited disease (LD) small-cell lung cancer (SCLC). There is only limited data available regarding the effect of comorbidities on survival following TRC. The purpose of this study is to assess the age-adjusted Charlson comorbidity index (ACCI) as a predictor of overall survival in LD-SCLC patients undergoing TCR. Patients and methods We retrospectively analyzed 367 SCLC patients diagnosed with LD-SCLC who received TCR between 2003 and 2017. We evaluated the ACCI (n = 348) as a predictor of overall survival (OS). In this cohort, 322 patients (88%) received platinum-based TCR (either cisplatin or carboplatin), and 37 (10%) patients received vincristine based TCR. Median radiation dose was 60 Gy (range 24-66 Gy). Additionally, 83% of patients (n = 303) received prophylactic cranial irradiation (PCI, 30 Gy in 2 Gy fractions). Kaplan-Meier survival analysis was performed for OS. For comparison of survival curves, Log-rank (Mantel-Cox) test was used. Univariate and multivariate Cox proportional-hazards ratios (HRs) were used to assess the influence of cofactors on OS. Results Patients with an ACCI > 6 had a significantly shorter OS compared with patients with an ACCI ≤ 6 (median 11 vs. 20 months; p = 0.005). Univariate analysis for OS revealed a statistically significant effect for ACCI > 6 (HR 1.7; 95% CI 1.2-2.4; p = 0.003), PCI (HR 0.5; 95% CI 0.3-0.7; p < 0.001), and Karnofsky performance status ≤ 70% (KPS) (HR 1.4; 95% CI 1.1-1.90; p = 0.015). In multivariate analysis, OS was significantly associated with PCI (HR 0.6; 95% CI 0.4-0.9; p = 0.022) and ACCI > 6 (HR 1.5; 95% CI 1.0-2.1; p = 0.049). Conclusion Comorbidity is significantly associated with survival in patients with LD-SCLC undergoing TCR. The ACCI may be a valuable tool to identify patients with a shorter survival and thus might be used for risk stratification and oncological decision making.
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Affiliation(s)
- Christoph A. Fink
- University Hospital Heidelberg, Department of Radiation Oncology, Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), Germany
- National Center for Tumor diseases (NCT), Heidelberg, Germany
| | - Fabian Weykamp
- University Hospital Heidelberg, Department of Radiation Oncology, Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), Germany
- National Center for Tumor diseases (NCT), Heidelberg, Germany
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Sebastian Adeberg
- University Hospital Heidelberg, Department of Radiation Oncology, Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), Germany
- National Center for Tumor diseases (NCT), Heidelberg, Germany
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Marburg Ion-Beam Therapy Center (MIT), Department of Radiation Oncology, Heidelberg University Hospital, Marburg, Germany
- Department of Radiation Oncology, Marburg University Hospital, Marburg, Germany
| | - Farastuk Bozorgmehr
- National Center for Tumor diseases (NCT), Heidelberg, Germany
- Department of Thoracic Oncology, Thoraxklinik, Heidelberg University, Heidelberg, Germany Translational Lung Research Centre Heidelberg (TLRC-H), Germany
- Member of the German Centre for Lung Research (DZL), Heidelberg, Germany
| | - Petros Christopoulos
- Department of Thoracic Oncology, Thoraxklinik, Heidelberg University, Heidelberg, Germany Translational Lung Research Centre Heidelberg (TLRC-H), Germany
- Member of the German Centre for Lung Research (DZL), Heidelberg, Germany
| | - Kristin Lang
- University Hospital Heidelberg, Department of Radiation Oncology, Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), Germany
- National Center for Tumor diseases (NCT), Heidelberg, Germany
| | - Laila König
- University Hospital Heidelberg, Department of Radiation Oncology, Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), Germany
- National Center for Tumor diseases (NCT), Heidelberg, Germany
| | - Juliane Hörner-Rieber
- University Hospital Heidelberg, Department of Radiation Oncology, Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), Germany
- National Center for Tumor diseases (NCT), Heidelberg, Germany
| | - Michael Thomas
- Department of Thoracic Oncology, Thoraxklinik, Heidelberg University, Heidelberg, Germany Translational Lung Research Centre Heidelberg (TLRC-H), Germany
- Member of the German Centre for Lung Research (DZL), Heidelberg, Germany
| | - Martin Steins
- Department of Thoracic Oncology, Thoraxklinik, Heidelberg University, Heidelberg, Germany Translational Lung Research Centre Heidelberg (TLRC-H), Germany
| | - Rami A. El-Shafie
- University Hospital Heidelberg, Department of Radiation Oncology, Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), Germany
- National Center for Tumor diseases (NCT), Heidelberg, Germany
- Department of Radiation Oncology, University Hospital Goettingen, Goettingen, Germany
- Comprehensive Cancer Center Niedersachsen, partner site Goettingen, Germany
| | - Stefan Rieken
- University Hospital Heidelberg, Department of Radiation Oncology, Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), Germany
- National Center for Tumor diseases (NCT), Heidelberg, Germany
- Department of Radiation Oncology, University Hospital Goettingen, Goettingen, Germany
- Comprehensive Cancer Center Niedersachsen, partner site Goettingen, Germany
| | - Denise Bernhardt
- Department of Radiation Oncology, Technical University, Klinikum rechts der Isar, Munich, Germany
| | - Jürgen Debus
- University Hospital Heidelberg, Department of Radiation Oncology, Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), Germany
- National Center for Tumor diseases (NCT), Heidelberg, Germany
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Heidelberg Ion-Beam Therapy Center (HIT), Heidelberg, Germany
- German Cancer Consortium (DKTK), partner site Heidelberg, Germany
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12
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Anderson R, Rapoport BL, Steel HC, Theron AJ. Pro-Tumorigenic and Thrombotic Activities of Platelets in Lung Cancer. Int J Mol Sci 2023; 24:11927. [PMID: 37569299 PMCID: PMC10418868 DOI: 10.3390/ijms241511927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 07/17/2023] [Accepted: 07/19/2023] [Indexed: 08/13/2023] Open
Abstract
Aside from their key protective roles in hemostasis and innate immunity, platelets are now recognized as having multifaceted, adverse roles in the pathogenesis, progression and outcome of many types of human malignancy. The most consistent and compelling evidence in this context has been derived from the notable association of elevated circulating platelet counts with the onset and prognosis of various human malignancies, particularly lung cancer, which represents the primary focus of the current review. Key topics include an overview of the association of lung cancer with the circulating platelet count, as well as the mechanisms of platelet-mediated, pro-tumorigenic immunosuppression, particularly the role of transforming growth factor beta 1. These issues are followed by a discussion regarding the pro-tumorigenic role of platelet-derived microparticles (PMPs), the most abundant type of microparticles (MPs) in human blood. In this context, the presence of increased levels of PMPs in the blood of lung cancer patients has been associated with tumor growth, invasion, angiogenesis and metastasis, which correlate with disease progression and decreased survival times. The final section of the review addresses, firstly, the role of cancer-related platelet activation and thrombosis in the pathogenesis of secondary cardiovascular disorders and the associated mortality, particularly in lung cancer, which is second only to disease progression; secondly, the review addresses the potential role of antiplatelet agents in the adjunctive therapy of cancer.
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Affiliation(s)
- Ronald Anderson
- Department of Immunology, Faculty of Health Sciences, University of Pretoria, Pretoria 0001, South Africa; (B.L.R.); (H.C.S.); (A.J.T.)
| | - Bernardo L. Rapoport
- Department of Immunology, Faculty of Health Sciences, University of Pretoria, Pretoria 0001, South Africa; (B.L.R.); (H.C.S.); (A.J.T.)
- The Medical Oncology Centre of Rosebank, Johannesburg 2196, South Africa
| | - Helen C. Steel
- Department of Immunology, Faculty of Health Sciences, University of Pretoria, Pretoria 0001, South Africa; (B.L.R.); (H.C.S.); (A.J.T.)
| | - Annette J. Theron
- Department of Immunology, Faculty of Health Sciences, University of Pretoria, Pretoria 0001, South Africa; (B.L.R.); (H.C.S.); (A.J.T.)
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13
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Galang K, Polychronopoulou E, Sharma G, Nishi SP. A Closer Look-Who Are We Screening for Lung Cancer? Mayo Clin Proc Innov Qual Outcomes 2023; 7:171-177. [PMID: 37293510 PMCID: PMC10244365 DOI: 10.1016/j.mayocpiqo.2023.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 03/31/2023] [Accepted: 04/05/2023] [Indexed: 06/10/2023] Open
Abstract
Objective To evaluate the characteristics of individuals receiving lung cancer screening (LCS) and identify those with potentially limited benefit owing to coexisting chronic illnesses and/or comorbidities. Patients and Methods In this retrospective study in the United States, patients were selected from a large clinical database who received LCS from January 1, 2019, through December 31, 2019, with at least 1 year of continuous enrollment. We assessed for potentially limited benefit in LCS defined strictly as not meeting the traditional risk factor inclusion criteria (age <55 years or >80 years, previous computed tomography scan within 11 months before an LCS examination, or a history of nonskin cancer) or liberally as having the potential exclusion criteria related to comorbid life-limiting conditions, such as cardiac and/or respiratory disease. Results A total of 51,551 patients were analyzed. Overall, 8391 (16.3%) individuals experienced a potentially limited benefit from LCS. Among those who did not meet the strict traditional inclusion criteria, 317 (3.8%) were because of age, 2350 (28%) reported a history of nonskin malignancy, and 2211 (26.3%) underwent a previous computed tomography thorax within 11 months before an LCS examination. Of those with potentially limited benefit owing to comorbidity, 3680 (43.9%) were because of severe respiratory comorbidity (937 [25.5%] with any hospitalization for coronary obstructive pulmonary disease, interstitial lung disease, or respiratory failure; 131 [3.6%] with hospitalization for respiratory failure requiring mechanical ventilation; or 3197 [86.9%] with chronic obstructive disease/interstitial lung disease requiring outpatient oxygen) and 721 (8.59%) with cardiac comorbidity. Conclusion Up to 1 of 6 low-dose computed tomography examinations may have limited benefit from LCS.
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Affiliation(s)
- Kristine Galang
- Department of Internal Medicine, University of Texas Medical Branch–Galveston, Galveston, TX
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Texas Medical Branch–Galveston, Galveston, TX
| | | | - Gulshan Sharma
- Department of Internal Medicine, University of Texas Medical Branch–Galveston, Galveston, TX
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Texas Medical Branch–Galveston, Galveston, TX
- Sealy Center on Aging, University of Texas Medical Branch–Galveston, Galveston, TX
| | - Shawn P.E. Nishi
- Department of Internal Medicine, University of Texas Medical Branch–Galveston, Galveston, TX
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Texas Medical Branch–Galveston, Galveston, TX
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14
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Godoy LA, Chen J, Ma W, Lally J, Toomey KA, Rajappa P, Sheridan R, Mahajan S, Stollenwerk N, Phan CT, Cheng D, Knebel RJ, Li T. Emerging precision neoadjuvant systemic therapy for patients with resectable non-small cell lung cancer: current status and perspectives. Biomark Res 2023; 11:7. [PMID: 36650586 PMCID: PMC9847175 DOI: 10.1186/s40364-022-00444-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 12/16/2022] [Indexed: 01/19/2023] Open
Abstract
Over the past decade, targeted therapy for oncogene-driven NSCLC and immune checkpoint inhibitors for non-oncogene-driven NSCLC, respectively, have greatly improved the survival and quality of life for patients with unresectable NSCLC. Increasingly, these biomarker-guided systemic therapies given before or after surgery have been used in patients with early-stage NSCLC. In March 2022, the US FDA granted the approval of neoadjuvant nivolumab and chemotherapy for patients with stage IB-IIIA NSCLC. Several phase II/III trials are evaluating the clinical efficacy of various neoadjuvant immune checkpoint inhibitor combinations for non-oncogene-driven NSCLC and neoadjuvant molecular targeted therapies for oncogene-driven NSCLC, respectively. However, clinical application of precision neoadjuvant treatment requires a paradigm shift in the biomarker testing and multidisciplinary collaboration at the diagnosis of early-stage NSCLC. In this comprehensive review, we summarize the current diagnosis and treatment landscape, recent advances, new challenges in biomarker testing and endpoint selections, practical considerations for a timely multidisciplinary collaboration at diagnosis, and perspectives in emerging neoadjuvant precision systemic therapy for patients with resectable, early-stage NSCLC. These biomarker-guided neoadjuvant therapies hold the promise to improve surgical and pathological outcomes, reduce systemic recurrences, guide postoperative therapy, and improve cure rates in patients with resectable NSCLC.
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Affiliation(s)
- Luis A Godoy
- Division of Thoracic Surgery, Department of Surgery, University of California Davis School of Medicine, Sacramento, CA, USA
| | - Joy Chen
- Medical Student, University of California Davis School of Medicine, Sacramento, CA, USA
| | - Weijie Ma
- Division of Hematology/Oncology, Department of Internal Medicine, University of California Davis School of Medicine, University of California Davis Comprehensive Cancer Center, Sacramento, CA, USA
| | - Jag Lally
- Division of Hematology/Oncology, Department of Internal Medicine, University of California Davis School of Medicine, University of California Davis Comprehensive Cancer Center, Sacramento, CA, USA
| | - Kyra A Toomey
- Division of Hematology/Oncology, Department of Internal Medicine, University of California Davis School of Medicine, University of California Davis Comprehensive Cancer Center, Sacramento, CA, USA
| | - Prabhu Rajappa
- Medical Service, Hematology and Oncology, Veterans Affairs Northern California Health Care System, Mather, CA, USA
| | - Roya Sheridan
- Medical Service, Hematology and Oncology, Veterans Affairs Northern California Health Care System, Mather, CA, USA
| | - Shirish Mahajan
- Medical Service, Hematology and Oncology, Veterans Affairs Northern California Health Care System, Mather, CA, USA
| | - Nicholas Stollenwerk
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, University of California Davis School of Medicine, Sacramento, CA, USA
- Medical Service, Pulmonology, Veterans Affairs Northern California Health Care System, Mather, CA, USA
| | - Chinh T Phan
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, University of California Davis School of Medicine, Sacramento, CA, USA
- Medical Service, Pulmonology, Veterans Affairs Northern California Health Care System, Mather, CA, USA
| | - Danny Cheng
- Department of Radiology, Interventional Radiology, Veterans Affairs Northern California Health Care System, Mather, CA, USA
| | - Robert J Knebel
- Department of Radiology, Interventional Radiology, Veterans Affairs Northern California Health Care System, Mather, CA, USA
| | - Tianhong Li
- Division of Hematology/Oncology, Department of Internal Medicine, University of California Davis School of Medicine, University of California Davis Comprehensive Cancer Center, Sacramento, CA, USA.
- Medical Service, Hematology and Oncology, Veterans Affairs Northern California Health Care System, Mather, CA, USA.
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15
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Mo Y, Tian B, Wu M, Chen M, Chen D, Yu J. Dual effect of radiotherapy related concomitant cardiovascular diseases in non-small cell lung cancer. Cancer Med 2023; 12:1025-1034. [PMID: 35754191 PMCID: PMC9883436 DOI: 10.1002/cam4.4948] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 05/12/2022] [Accepted: 05/28/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Nowadays, cancer and cardiac diseases are two of the most causes of death, so cancer treatment-related cardiac death cannot be ignored. For lung cancer, chest radiotherapy (RT) is essential, but the related cardiotoxicity has not been fully studied. METHODS We reviewed the data of 11,455 patients with non-small cell lung cancer (NSCLC) from the Surveillance, Epidemiology, and End Results database from 2001 to 2015. The change trend for concomitant cardiovascular diseases (CVD)-specific death was calculated and graphically demonstrated. Univariate and multivariate analyses for survival were performed using Cox risk regression model. RESULTS In our analysis, the overall incidence and mortality from NSCLC declined, but CVD-specific death increased. Both chemoradiotherapy and radiotherapy alone played a significant role in CVD-specific death. Analyzed longitudinally from diagnosis, we found that the effect of RT in CVD-specific death increased continuously over the third years and the hazard ratio for CVD-specific death was 1.386 times between RT and non-RT group (HR = 1.386, 95% CI 1.322-1.452; p < 0.0001). On the other hand, RT played a protective role in CVD-specific death before the second years, especially in recent years from 2013 to 2015 (HR = 0.843, 95% CI 0.740-0.959; p = 0.009). CONCLUSIONS Although the mortality from NSCLC decreased, but radiotherapy-related CVD-specific mortality cannot be ignored. In the long-term over 3 years, RT significantly promoted CVD-specific death. However, RT turned to be a protective role in the short-term within 2 years. In clinical practice, we need to comprehensively consider the dual effects of radiotherapy on the side effect of heart.
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Affiliation(s)
- You Mo
- Shantou University Medical College, Shantou, China;Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Baoqing Tian
- Department of Radiation OncologyShandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical SciencesJinanChina
| | - Meng Wu
- Department of Radiation OncologyShandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical SciencesJinanChina
| | - Minxin Chen
- Department of Radiation OncologyShandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical SciencesJinanChina
| | - Dawei Chen
- Shantou University Medical College, Shantou, China
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Jinming Yu
- Shantou University Medical College, Shantou, China
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
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16
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Yu NY, DeWees TA, Voss MM, Breen WG, Chiang JS, Ding JX, Daniels TB, Owen D, Olivier KR, Garces YI, Park SS, Sarkaria JN, Yang P, Savvides PS, Ernani V, Liu W, Schild SE, Merrell KW, Sio TT. Cardiopulmonary Toxicity Following Intensity-Modulated Proton Therapy (IMPT) Versus Intensity-Modulated Radiation Therapy (IMRT) for Stage III Non-Small Cell Lung Cancer. Clin Lung Cancer 2022; 23:e526-e535. [PMID: 36104272 DOI: 10.1016/j.cllc.2022.07.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 07/14/2022] [Accepted: 07/24/2022] [Indexed: 01/27/2023]
Abstract
INTRODUCTION Intensity-modulated proton therapy (IMPT) has the potential to reduce radiation dose to normal organs when compared to intensity-modulated radiation therapy (IMRT). We hypothesized that IMPT is associated with a reduced rate of cardiopulmonary toxicities in patients with Stage III NSCLC when compared with IMRT. METHODS We analyzed 163 consecutively treated patients with biopsy-proven, stage III NSCLC who received IMPT (n = 35, 21%) or IMRT (n = 128, 79%). Patient, tumor, and treatment characteristics were analyzed. Overall survival (OS), freedom-from distant metastasis (FFDM), freedom-from locoregional relapse (FFLR), and cardiopulmonary toxicities (CTCAE v5.0) were calculated using the Kaplan-Meier estimate. Univariate cox regressions were conducted for the final model. RESULTS Median follow-up of surviving patients was 25.5 (range, 4.6-58.1) months. Median RT dose was 60 (range, 45-72) Gy [RBE]. OS, FFDM, and FFLR were not different based on RT modality. IMPT provided significant dosimetric pulmonary and cardiac sparing when compared to IMRT. IMPT was associated with a reduced rate of grade more than or equal to 3 pneumonitis (HR 0.25, P = .04) and grade more than or equal to 3 cardiac events (HR 0.33, P = .08). Pre-treatment predicted diffusing capacity for carbon monoxide less than equal to 57% (HR 2.8, P = .04) and forced expiratory volume in the first second less than equal to 61% (HR 3.1, P = .03) were associated with an increased rate of grade more than or equal to 3 pneumonitis. CONCLUSIONS IMPT is associated with a reduced risk of clinically significant pneumonitis and cardiac events when compared with IMRT without compromising tumor control in stage III NSCLC. IMPT may provide a safer treatment option, particularly for high-risk patients with poor pretreatment pulmonary function.
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Affiliation(s)
- Nathan Y Yu
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ
| | - Todd A DeWees
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Scottsdale, AZ
| | - Molly M Voss
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Scottsdale, AZ
| | - William G Breen
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | | | - Julia X Ding
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ
| | - Thomas B Daniels
- Department of Radiation Oncology, NYU Langone Health, New York, NY
| | - Dawn Owen
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | | | | | - Sean S Park
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - Jann N Sarkaria
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - Ping Yang
- Department of Health Sciences Research, Mayo Clinic, Scottsdale, AZ
| | | | - Vinicius Ernani
- Department of Hematology and Medical Oncology, Mayo Clinic, Phoenix, AZ
| | - Wei Liu
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ
| | | | | | - Terence T Sio
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ.
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17
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Leiter A, Kong CY, Gould MK, Kale MS, Veluswamy RR, Smith CB, Mhango G, Huang BZ, Wisnivesky JP, Sigel K. The benefits and harms of adjuvant chemotherapy for non-small cell lung cancer in patients with major comorbidities: A simulation study. PLoS One 2022; 17:e0263911. [PMID: 36378625 PMCID: PMC9665372 DOI: 10.1371/journal.pone.0263911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 09/27/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Randomized controlled trials (RCTs) have demonstrated a survival benefit for adjuvant platinum-based chemotherapy after resection of locoregional non-small cell lung cancer (NSCLC). The relative benefits and harms and optimal approach to treatment for NSCLC patients who have major comorbidities (chronic obstructive pulmonary disease [COPD], coronary artery disease [CAD], and congestive heart failure [CHF]) are unclear, however. METHODS We used a simulation model to run in-silico comparative trials of adjuvant chemotherapy versus observation in locoregional NSCLC in patients with comorbidities. The model estimated quality-adjusted life years (QALYs) gained by each treatment strategy stratified by age, comorbidity, and stage. The model was parameterized using outcomes and quality-of-life data from RCTs and primary analyses from large cancer databases. RESULTS Adjuvant chemotherapy was associated with clinically significant QALY gains for all patient age/stage combinations with COPD except for patients >80 years old with Stage IB and IIA cancers. For patients with CHF and Stage IB and IIA disease, adjuvant chemotherapy was not advantageous; in contrast, it was associated with QALY gains for more advanced stages for younger patients with CHF. For stages IIB and IIIA NSCLC, most patient groups benefited from adjuvant chemotherapy. However, In general, patients with multiple comorbidities benefited less from adjuvant chemotherapy than those with single comorbidities and women with comorbidities in older age categories benefited more from adjuvant chemotherapy than their male counterparts. CONCLUSIONS Older, multimorbid patients may derive QALY gains from adjuvant chemotherapy after NSCLC surgery. These results help extend existing clinical trial data to specific unstudied, high-risk populations and may reduce the uncertainty regarding adjuvant chemotherapy use in these patients.
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Affiliation(s)
- Amanda Leiter
- Division of Endocrinology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Chung Yin Kong
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Michael K. Gould
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California, United States of America
| | - Minal S. Kale
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Rajwanth R. Veluswamy
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Cardinale B. Smith
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Grace Mhango
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Brian Z. Huang
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, United States of America
| | - Juan P. Wisnivesky
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Keith Sigel
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
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18
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Kim KH, Oh J, Yang G, Lee J, Kim J, Gwak SY, Cho I, Lee SH, Byun HK, Choi HK, Kim J, Chang JS, Kang SM, Yoon HI. Association of Sinoatrial Node Radiation Dose With Atrial Fibrillation and Mortality in Patients With Lung Cancer. JAMA Oncol 2022; 8:1624-1634. [PMID: 36136325 PMCID: PMC9501754 DOI: 10.1001/jamaoncol.2022.4202] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 07/19/2022] [Indexed: 11/14/2022]
Abstract
Importance Atrial fibrillation (AF) can develop following thoracic irradiation. However, the critical cardiac substructure responsible for AF has not been properly studied. Objective To describe the incidence of AF in patients with lung cancer and determine predictive cardiac dosimetric parameters. Design, Setting, and Participants This retrospective cohort study was performed at a single referral center and included 239 patients diagnosed with limited-stage small cell lung cancer (SCLC) and 321 patients diagnosed with locally advanced non-small cell lung cancer (NSCLC) between August 2008 and December 2019 who were treated with definitive chemoradiotherapy. Exposures Radiation dose exposure to cardiac substructures, including the chambers, coronary arteries, and cardiac conduction nodes, were calculated for each patient. Main Outcomes and Measures Main outcomes were AF and overall survival. Results Of the 239 and 321 patients with SCLC and NSCLC, the median (IQR) age was 68 (60-73) years and 67 (61-75) years, and 207 (86.6%) and 261 (81.3%) were men, respectively. At a median (IQR) follow-up time of 32.7 (22.1-56.6) months, 9 and 17 patients experienced new-onset AF in the SCLC and NSCLC cohorts, respectively. The maximum dose delivered to the sinoatrial node (SAN Dmax) exhibited the highest predictive value for prediction of AF. A higher SAN Dmax significantly predicted an increased risk of AF in patients with SCLC (adjusted hazard ratio [aHR], 14.91; 95% CI, 4.00-55.56; P < .001) and NSCLC (aHR, 15.67; 95% CI, 2.08-118.20; P = .008). However, SAN Dmax was not associated with non-AF cardiac events. Increased SAN Dmax was significantly associated with poor overall survival in patients with SCLC (aHR, 2.68; 95% CI, 1.53-4.71; P < .001) and NSCLC (aHR, 1.97; 95% CI, 1.45-2.68; P < .001). Conclusions and Relevance In this cohort study, results suggest that incidental irradiation of the SAN during chemoradiotherapy may be associated with the development of AF and increased mortality. This supports the need to minimize radiation dose exposure to the SAN during radiotherapy planning and to consider close follow-up for the early detection of AF in patients receiving thoracic irradiation.
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Affiliation(s)
- Kyung Hwan Kim
- Department of Radiation Oncology, Yonsei Cancer Center, Heavy Ion Therapy Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jaewon Oh
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Gowoon Yang
- Department of Radiation Oncology, Yonsei Cancer Center, Heavy Ion Therapy Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Joongyo Lee
- Department of Radiation Oncology, Yonsei Cancer Center, Heavy Ion Therapy Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jihun Kim
- Department of Radiation Oncology, Yonsei Cancer Center, Heavy Ion Therapy Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seo-yeon Gwak
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Iksung Cho
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seung Hyun Lee
- Department of Biochemistry and Molecular Biology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hwa Kyung Byun
- Department of Radiation Oncology, Yonsei Cancer Center, Heavy Ion Therapy Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyo-Kyoung Choi
- Research Group of Healthcare, Korea Food Research Institute, Wanju-gun, Jeollabuk-do, Republic of Korea
| | - Jinsung Kim
- Department of Radiation Oncology, Yonsei Cancer Center, Heavy Ion Therapy Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jee Suk Chang
- Department of Radiation Oncology, Yonsei Cancer Center, Heavy Ion Therapy Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seok-Min Kang
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hong In Yoon
- Department of Radiation Oncology, Yonsei Cancer Center, Heavy Ion Therapy Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
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19
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De Lazzari N, Wichum F, Götte M, David C, Seid K, Tewes M. Entwicklung einer KI-gestützten Bewegungstherapie bei
onkologischen Palliativpatienten. B&G BEWEGUNGSTHERAPIE UND GESUNDHEITSSPORT 2022. [DOI: 10.1055/a-1909-5766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Zusammenfassung
HintergrundDie wechselnde Symptomlast ist eine große Hürde
in der Sporttherapie von onkologischen Palliativpatienten. Die täglich
variierende Symptomstärke erschwert die Einstellung einer optimalen
Trainingsbelastung und stellt neben der Motivation eine große Barriere
für die Teilnahme an bewegungstherapeutischen Interventionen dar. Ein
durch Künstliche Intelligenz (KI) gesteuertes Training könnte
helfen, die Trainingseinheiten individuell anzupassen und die Autonomie von
Palliativpatienten zu erhalten.
Methoden Fünf Patienten mit fortgeschrittener unheilbarer
Krebsdiagnose haben im Rahmen der Routineversorgung eine supervidierte
Bewegungstherapie absolviert. Dabei wurde ein Elektrokardiogramm über
einen Polar H10 Brustgurt aufgezeichnet und daraus kardiale und respiratorische
Vitalparameter extrahiert. Eine Klassifikation in drei Intensitätsstufen
über KI erfolgte anhand von neuronalen Netzen.
Ergebnisse Das KI-gesteuerte Training hat eine sehr hohe
Klassifikationsgüte (F1-Score: 0,95±0,05) durch die Vereinigung
von respiratorischen und kardialen Vitalparametern. Diese Kombination erzielt
genauere Klassifikationsergebnisse als die einzelnen Datensätze
für kardiale Parameter (0,93±0,06) und respiratorische Parameter
(0,72±0,06). Die Berücksichtigung einer Baselinemessung hat eine
positive Wirkung auf die Klassifikationsgenauigkeit.
Diskussion Diese Studie stellt die erste Untersuchung zum Einsatz von KI
zur Klassifizierung von trainingswissenschaftlichen Inhalten bei onkologischen
Palliativpatienten dar. Diese vulnerable Patientengruppe kann von einer
objektiven Erfassung des Belastungsniveaus anhand von Parametern des
kardiovaskulären Systems profitieren. Mit nur fünf Patienten
wird die Aussagekraft dieser explorativen Studie über Kreuzvalidierung
hergestellt. Zukünftig sollen weitere Parameter wie ein subjektives
Empfinden, Alter, Größe und Geschlecht die Klassifikation weiter
verbessern. In einem integrierten System ist eine individuelle
Trainingssteuerung in Echtzeit möglich.
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Affiliation(s)
- Nico De Lazzari
- Westdeutsches Tumorzentrum – Comprehensive Cancer Center,
Innere Klinik (Tumorforschung), Universitätsklinikum Essen, 45122 Essen,
Deutschland
| | - Felix Wichum
- Fraunhofer IMS, Universität Duisburg-Essen, 47057 Duisburg,
Deutschland
| | - Miriam Götte
- Westdeutsches Tumorzentrum – Comprehensive Cancer Center,
Klinik für Kinderheilkunde 3, Universitätsklinikum Essen, 45122
Essen, Deutschland
| | - Corinna David
- Fachhochschule Münster, Fachbereich
Physikingenieurwesen
| | - Karsten Seid
- Fraunhofer-Institut für Mikroelektronische Schaltungen und
Systeme (IMS), 47057 Duisburg und Fachgebiet Elektronische Bauelemente und
Schaltungen (EBS), Universität Duisburg-Essen
| | - Mitra Tewes
- Palliativmedizin der Universitätsmedizin Essen,
Universitätsklinikum Essen, 45122 Essen, Deutschland
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20
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Chouinard G, Roy P, Blais MC, Lippens A, Pelletier É, Roy E, Marcoux M, Ugalde PA, Rheault J, Pigeon MA, Nicodème F, Lacasse Y, Maltais F. Exercise testing and postoperative complications after minimally invasive lung resection: A cohort study. Front Physiol 2022; 13:951460. [PMID: 36213231 PMCID: PMC9540366 DOI: 10.3389/fphys.2022.951460] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 08/24/2022] [Indexed: 11/15/2022] Open
Abstract
Background: Peak oxygen uptake (V˙O2) during cardiospulmonary exercise testing (CPET) is used to stratify postoperative risk following lung cancer resection but peak V˙O2 thresholds to predict post-operative mortality and morbidity were derived mostly from patients who underwent thoracotomy. Objectives: We evaluated whether peak V˙O2 or other CPET-derived variables predict post-operative mortality and cardiopulmonary morbidity after minimally invasive video-assisted thoracoscopic surgery (VATS) for lung cancer resection. Methods: A retrospective analysis of patients who underwent VATS lung resection between 2002 and 2019 and in whom CPET was performed. Logistic regression models were used to determine predictors of postoperative outcomes until 30 days after surgery. The ability of peak V˙O2 to discriminate between patients with and without post-operative complications was evaluated using Receiver operating characteristic (ROC) analysis. Results: Among the 593 patients, postoperative cardiopulmonary complications occurred in 92 (15.5%) individuals, including three deaths. Mean peak V˙O2 was 18.8 ml⋅kg−1⋅min−1, ranging from 7.0 to 36.4 ml⋅kg−1⋅min−1. Best predictors of postoperative morbidity and mortality were peripheral arterial disease, bilobectomy or pneumonectomy (versus sublobar resection), preoperative FEV1, peak V˙O2 , and peak V˙E/V˙CO2. The proportion of patients with peak V˙O2 of < 15 ml⋅kg−1⋅min−1, 15 to < 20 ml⋅kg−1⋅min−1 and ≥ 20 ml⋅kg−1⋅min−1 experiencing at least one postoperative complication was 23.8, 16.3 and 10.4%, respectively. The area under the ROC curve for peak V˙O2 was 0.63 (95% CI: 0.57–0.69). Conclusion: Although lower peak V˙O2 was a predictor of postoperative complications following VATS lung cancer resection, its ability to discriminate patients with or without complications was limited.
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Affiliation(s)
- Gabriel Chouinard
- Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec, QC, Canada
| | - Pascalin Roy
- Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec, QC, Canada
| | - Marie-Christine Blais
- Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec, QC, Canada
| | - Alexandre Lippens
- Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec, QC, Canada
| | - Éliane Pelletier
- Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec, QC, Canada
| | - Emma Roy
- Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec, QC, Canada
| | - Mathieu Marcoux
- Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec, QC, Canada
- Centre hospitalier universitaire de Québec, Université Laval, Québec, QC, Canada
| | - Paula A. Ugalde
- Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec, QC, Canada
| | - Justine Rheault
- Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec, QC, Canada
| | - Marc-Antoine Pigeon
- Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec, QC, Canada
| | - Frédéric Nicodème
- Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec, QC, Canada
| | - Yves Lacasse
- Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec, QC, Canada
| | - François Maltais
- Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec, QC, Canada
- *Correspondence: François Maltais,
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21
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Mędrek S, Szmit S. Are cardiovascular comorbidities always associated with a worse prognosis in patients with lung cancer? Front Cardiovasc Med 2022; 9:984951. [PMID: 36211566 PMCID: PMC9537604 DOI: 10.3389/fcvm.2022.984951] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 09/01/2022] [Indexed: 12/01/2022] Open
Abstract
Many factors contribute to mortality in lung cancer, including the presence of concomitant cardiovascular disease. In the treatment of early stage of lung cancer, the presence of comorbidities and occurence of cardiotoxicity may be prognostic. The effect of cardiotoxicity of radiotherapy and chemoradiotherapy on overall survival has been documented. Acute arterial and venous thromboembolic events seem to correlate with the degree of the histological malignancy, its clinical advancement, and even with optimal cardiac treatment, they may influence the survival time. In the case of high-grade and advanced lung cancer stage especially in an unresectable stadium, the prognosis depends primarily on the factors related to the histopathological and molecular diagnosis. Electrocardiographic and echocardiographic abnormalities may be prognostic factors, as they seem to correlate with the patient's performance status as well as tumor localization and size.
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Affiliation(s)
- Sabina Mędrek
- Department of Cardiology, Subcarpathian Oncological Center, Brzozów, Poland
- *Correspondence: Sabina Mędrek
| | - Sebastian Szmit
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre, Otwock, Poland
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22
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Rodrigues ED, Gonsalves D, Teixeira L, López E. Frailty-the missing constraint in radiotherapy treatment planning for older adults. Aging Clin Exp Res 2022; 34:2295-2304. [PMID: 36056189 DOI: 10.1007/s40520-022-02200-1] [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: 05/30/2022] [Accepted: 07/13/2022] [Indexed: 11/01/2022]
Abstract
Current demographic changes translate into an increased frequency of cancer in older adults. Available data show that about 45-55% of the new cancer patients will need RT treatments, with an expected increase of 20-30% in the future. To provide the best cancer care it is mandatory to assess frailty, offer appropriate curative treatments to patients and personalise them for the frail. Based on published data, the median prevalence of frailty in older population is about 42%. Recently, the free radical theory of frailty has been proposed stating that oxidative damage is more prevalent in frail patients. In parallel, RT is one of the most frequent cancer treatments offered to older adults and is a source of external free radicals. RT dose constraints correlate with toxicity rates, so we open the question whether frailty should be considered when defining these constraints. Thus, for this paper, we will highlight the importance of frailty evaluation for RT treatment decisions and outcomes.
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Affiliation(s)
- Edna Darlene Rodrigues
- Departamento de Estudo de Populações, ICBAS, Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Rua de Jorge Viterbo Ferreira, n° 228, 4050-313, Porto, Portugal. .,Center for Health Technology and Services Research, CINTESIS, Rua Dr. Plácido da Costa, s/n, 4200-450, Porto, Portugal. .,EIT Health Ageing PhD School, Munich, Germany.
| | - Daniela Gonsalves
- GenesisCare en Madrid, Hospital San Francisco de Asís, Calle de Joaquín Costa, 28, 28002, Madrid, Spain
| | - Laetitia Teixeira
- Departamento de Estudo de Populações, ICBAS, Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Rua de Jorge Viterbo Ferreira, n° 228, 4050-313, Porto, Portugal.,Center for Health Technology and Services Research, CINTESIS, Rua Dr. Plácido da Costa, s/n, 4200-450, Porto, Portugal
| | - Escarlata López
- GenesisCare en Madrid, Hospital Vithas La Milagrosa, Calle de Modesto Lafuente, 14, 28010, Madrid, Spain
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23
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Field M, I Thwaites D, Carolan M, Delaney GP, Lehmann J, Sykes J, Vinod S, Holloway L. Infrastructure platform for privacy-preserving distributed machine learning development of computer-assisted theragnostics in cancer. J Biomed Inform 2022; 134:104181. [PMID: 36055639 DOI: 10.1016/j.jbi.2022.104181] [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: 02/13/2022] [Revised: 04/29/2022] [Accepted: 08/20/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Emerging evidence suggests that data-driven support tools have found their way into clinical decision-making in a number of areas, including cancer care. Improving them and widening their scope of availability in various differing clinical scenarios, including for prognostic models derived from retrospective data, requires co-ordinated data sharing between clinical centres, secondary analyses of large multi-institutional clinical trial data, or distributed (federated) learning infrastructures. A systematic approach to utilizing routinely collected data across cancer care clinics remains a significant challenge due to privacy, administrative and political barriers. METHODS An information technology infrastructure and web service software was developed and implemented which uses machine learning to construct clinical decision support systems in a privacy-preserving manner across datasets geographically distributed in different hospitals. The infrastructure was deployed in a network of Australian hospitals. A harmonized, international ontology-linked, set of lung cancer databases were built with the routine clinical and imaging data at each centre. The infrastructure was demonstrated with the development of logistic regression models to predict major cardiovascular events following radiation therapy. RESULTS The infrastructure implemented forms the basis of the Australian computer-assisted theragnostics (AusCAT) network for radiation oncology data extraction, reporting and distributed learning. Four radiation oncology departments (across seven hospitals) in New South Wales (NSW) participated in this demonstration study. Infrastructure was deployed at each centre and used to develop a model predicting for cardiovascular admission within a year of receiving curative radiotherapy for non-small cell lung cancer. A total of 10417 lung cancer patients were identified with 802 being eligible for the model. Twenty features were chosen for analysis from the clinical record and linked registries. After selection, 8 features were included and a logistic regression model achieved an area under the receiver operating characteristic (AUROC) curve of 0.70 and C-index of 0.65 on out-of-sample data. CONCLUSION The infrastructure developed was demonstrated to be usable in practice between clinical centres to harmonize routinely collected oncology data and develop models with federated learning. It provides a promising approach to enable further research studies in radiation oncology using real world clinical data.
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Affiliation(s)
- Matthew Field
- South Western Sydney Clinical Campus, School of Clinical Medicine, University of New South Wales, NSW, Australia; South Western Sydney Cancer Services, NSW Health, Sydney, NSW, Australia; Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia.
| | - David I Thwaites
- Institute of Medical Physics, School of Physics, University of Sydney, NSW, Australia
| | - Martin Carolan
- Illawarra Cancer Care Centre, Wollongong, NSW, Australia
| | - Geoff P Delaney
- South Western Sydney Clinical Campus, School of Clinical Medicine, University of New South Wales, NSW, Australia; South Western Sydney Cancer Services, NSW Health, Sydney, NSW, Australia; Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
| | - Joerg Lehmann
- Institute of Medical Physics, School of Physics, University of Sydney, NSW, Australia; Department of Radiation Oncology, Calvary Mater Newcastle, NSW, Australia
| | - Jonathan Sykes
- Institute of Medical Physics, School of Physics, University of Sydney, NSW, Australia; Blacktown Haematology and Oncology Cancer Care Centre, Blacktown Hospital, Blacktown, NSW, Australia; Crown Princess Mary Cancer Centre, Westmead Hospital, Westmead, NSW, Australia
| | - Shalini Vinod
- South Western Sydney Clinical Campus, School of Clinical Medicine, University of New South Wales, NSW, Australia; South Western Sydney Cancer Services, NSW Health, Sydney, NSW, Australia; Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
| | - Lois Holloway
- South Western Sydney Clinical Campus, School of Clinical Medicine, University of New South Wales, NSW, Australia; South Western Sydney Cancer Services, NSW Health, Sydney, NSW, Australia; Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia; Institute of Medical Physics, School of Physics, University of Sydney, NSW, Australia
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24
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Yamada Y, Shimada Y, Makino Y, Kudo Y, Maehara S, Yamada T, Hagiwara M, Kakihana M, Ohira T, Ikeda N. Clinical utility of psoas muscle volume in assessment of sarcopenia in patients with early-stage non-small cell lung cancer. J Cancer Res Clin Oncol 2022:10.1007/s00432-022-04234-4. [PMID: 35916994 DOI: 10.1007/s00432-022-04234-4] [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: 05/19/2022] [Accepted: 07/20/2022] [Indexed: 10/16/2022]
Abstract
PURPOSE Sarcopenia influences postoperative outcomes of patients with non-small cell lung cancer (NSCLC). Imaging tools for evaluating and diagnosing sarcopenia have developed, and a novel method of psoas volume index (PVI) obtained by measuring bilateral psoas major muscle volume has been reported. However, the relationship between sarcopenia based on PVI and clinical outcomes has not been fully investigated for patients with early-stage NSCLC. This study aimed to clarify the utility of PVI values in assessing the relationshipe between sarcopenia and clinical outcomes. METHODS This study included 645 patients with stage I-II NSCLC who underwent curative lung resection between 2012 and 2017. Bilateral psoas major muscle volumes were calculated semi-automatically using a three-dimensional workstation. The cutoff value of PVI for defining sarcopenia was < 60.5 cm3/m3 for men and < 43.6 cm3/m3 for women. RESULTS The avrage time to obtaine PVI was only 25 s with the 3D system, and interobserver agreements for evauating sarcopenia on PVI was 1. A total of 159 patients (24.7%) were preoperatively diagnosed with sarcopenia. On multivariate analysis, sarcopenia was an independent prognostic factor for overall survival (OS, p < 0.001), recurrence-free survival (RFS, p < 0.001), and lung cancer-specific survival (LCS, p < 0.001). The 5-year OS, RFS, and LCS were significantly worse in sarcopenic patients than non-sarcopenic patients (88.8 vs. 72.4%, p < 0.001; 80.1 vs. 65.0%, p < 0.001; 92.4 vs. 78.9%, p < 0.001, respectively). CONCLUSION Sarcopenia diagnosed using PVI is an independent prognostic predictor of OS, RFS, and LCS in early-stage NSCLC.
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Affiliation(s)
- Yuki Yamada
- Department of Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Yoshihisa Shimada
- Department of Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan.
| | - Yojiro Makino
- Department of Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Yujin Kudo
- Department of Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Sachio Maehara
- Department of Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Takafumi Yamada
- Department of Radiology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Masaru Hagiwara
- Department of Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Masatoshi Kakihana
- Department of Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Tatsuo Ohira
- Department of Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Norihiko Ikeda
- Department of Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
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25
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Abravan A, Price G, Banfill K, Marchant T, Craddock M, Wood J, Aznar MC, McWilliam A, van Herk M, Faivre-Finn C. Role of Real-World Data in Assessing Cardiac Toxicity After Lung Cancer Radiotherapy. Front Oncol 2022; 12:934369. [PMID: 35928875 PMCID: PMC9344971 DOI: 10.3389/fonc.2022.934369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 06/13/2022] [Indexed: 11/13/2022] Open
Abstract
Radiation-induced heart disease (RIHD) is a recent concern in patients with lung cancer after being treated with radiotherapy. Most of information we have in the field of cardiac toxicity comes from studies utilizing real-world data (RWD) as randomized controlled trials (RCTs) are generally not practical in this field. This article is a narrative review of the literature using RWD to study RIHD in patients with lung cancer following radiotherapy, summarizing heart dosimetric factors associated with outcome, strength, and limitations of the RWD studies, and how RWD can be used to assess a change to cardiac dose constraints.
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Affiliation(s)
- Azadeh Abravan
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
- Department of Radiotherapy Related Research, The Christie National Health Service (NHS) Foundation Trust, Manchester, United Kingdom
| | - Gareth Price
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
- Department of Radiotherapy Related Research, The Christie National Health Service (NHS) Foundation Trust, Manchester, United Kingdom
| | - Kathryn Banfill
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Tom Marchant
- Department of Radiotherapy Related Research, The Christie National Health Service (NHS) Foundation Trust, Manchester, United Kingdom
| | - Matthew Craddock
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
- Department of Radiotherapy Related Research, The Christie National Health Service (NHS) Foundation Trust, Manchester, United Kingdom
| | - Joe Wood
- Christie Medical Physics and Engineering, The Christie National Health Service (NHS) Foundation Trust, Manchester, United Kingdom
| | - Marianne C. Aznar
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
- Department of Radiotherapy Related Research, The Christie National Health Service (NHS) Foundation Trust, Manchester, United Kingdom
| | - Alan McWilliam
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
- Department of Radiotherapy Related Research, The Christie National Health Service (NHS) Foundation Trust, Manchester, United Kingdom
| | - Marcel van Herk
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
- Department of Radiotherapy Related Research, The Christie National Health Service (NHS) Foundation Trust, Manchester, United Kingdom
| | - Corinne Faivre-Finn
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
- Department of Radiotherapy Related Research, The Christie National Health Service (NHS) Foundation Trust, Manchester, United Kingdom
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Faubry C, Faure M, Toublanc AC, Veillon R, Lemaître AI, Vergnenègre C, Cochet H, Khan S, Raherison C, Dos Santos P, Zysman M. A Prospective Study to Detect Immune Checkpoint Inhibitors Associated With Myocarditis Among Patients Treated for Lung Cancer. Front Cardiovasc Med 2022; 9:878211. [PMID: 35734278 PMCID: PMC9207328 DOI: 10.3389/fcvm.2022.878211] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 04/25/2022] [Indexed: 11/27/2022] Open
Abstract
Background Immune checkpoint inhibitors (ICIs) are widely used in lung cancer management. However, myocarditis, which is a rare, yet potentially severe adverse-related event associated with ICIs, could be under-reported. Objectives This study is aimed to prospectively evaluate the cumulative incidence rate of myocarditis, through systematic screening, among patients receiving ICIs for lung cancer. Methods All patients who received the first administration of ICIs for non-small cell (NSCLC) and small cell lung cancer (SCLC), between May and November 2020, in the pulmonary department of Bordeaux University Hospital, were included. Echocardiography (ECG), troponin-I, and natriuretic peptide dosages before ICIs' first administration and before each infusion were recorded. ECG and magnetic resonance imaging (MRI) were done additionally, in case of at least three times increase in troponin levels, ECG modifications, and the onset of cardiovascular symptoms. Second, if possible, coronarography than endomyocardial biopsy was assessed. The primary outcome was defined as ICIs related to myocarditis onset, while secondary outcomes included other cardiovascular events, disease-free, and overall survival. Results During the period of interest, 99 patients received their first infusion of ICIs for lung cancer (mean age 64 ± 9 years; 52 men, 67% with adenocarcinoma). Three cases of myocarditis without major adverse cardiac events (MACEs) occurred (two definite and one possible), and the mean duration between the first ICIs' administration and myocarditis onset was 144 ± 3 days. Median disease-free survival and overall survival were 169 [102; 233] days and 209 [147; 249] days, respectively. Conclusion In our study, systematic screening of myocarditis associated with ICIs leads to a more frequent incidence and a later onset than previously reported. None of them were severe. Additional prospective evidence is needed before we could adopt routine cardiac screening in unselected patients starting ICIs; however, these data shed new light on the risk of myocarditis associated with ICIs administration.
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Affiliation(s)
- Clara Faubry
- Pulmonary Department, Centre Hospitalier Universitaire (CHU) Haut-Lévèque, Bordeaux, France
| | - Maxime Faure
- Heart Failure Unit, Cardiology Department, Centre Hospitalier Universitaire (CHU) Haut-Lévèque, Bordeaux, France
| | - Anne-Claire Toublanc
- Pulmonary Department, Centre Hospitalier Universitaire (CHU) Haut-Lévèque, Bordeaux, France
| | - Rémi Veillon
- Pulmonary Department, Centre Hospitalier Universitaire (CHU) Haut-Lévèque, Bordeaux, France
| | - Anne-Iris Lemaître
- Heart Failure Unit, Cardiology Department, Centre Hospitalier Universitaire (CHU) Haut-Lévèque, Bordeaux, France
| | - Charlotte Vergnenègre
- Pulmonary Department, Centre Hospitalier Universitaire (CHU) Haut-Lévèque, Bordeaux, France
| | - Hubert Cochet
- Department Cardiology, Lyric Institute, Fondation Bordeaux Université, Bordeaux, France
- Department Medicine, Universitaire Bordeaux, Institut National de la Santé et de la Recherche Médicale (INSERM), Bordeaux, France
- Department of Cardiovascular Imaging, Centre Hospitalier Universitaire (CHU) Bordeaux, Bordeaux, France
| | - Sadia Khan
- Bordeaux University, Institut National de la Santé et de la Recherche Médicale (INSERM), Bordeaux Population Health Research Center, Bordeaux, France
| | - Chantal Raherison
- Pulmonary Department, Centre Hospitalier Universitaire (CHU) Haut-Lévèque, Bordeaux, France
- Bordeaux University, Institut National de la Santé et de la Recherche Médicale (INSERM), Bordeaux Population Health Research Center, Bordeaux, France
| | - Pierre Dos Santos
- Heart Failure Unit, Cardiology Department, Centre Hospitalier Universitaire (CHU) Haut-Lévèque, Bordeaux, France
- Department Cardiology, Lyric Institute, Fondation Bordeaux Université, Bordeaux, France
- Department Medicine, Universitaire Bordeaux, Institut National de la Santé et de la Recherche Médicale (INSERM), Bordeaux, France
| | - Maeva Zysman
- Pulmonary Department, Centre Hospitalier Universitaire (CHU) Haut-Lévèque, Bordeaux, France
- Centre de Recherche Cardio-Thoracique, Universitaire Bordeaux, Institut National de la Santé et de la Recherche Médicale (INSERM), Bordeaux, France
- *Correspondence: Maeva Zysman
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Miao E, Klugman M, Rohan T, Dean Hosgood H. Hypothesized Explanations for the Observed Lung Cancer Survival Benefit Among Hispanics/Latinos in the United States. J Racial Ethn Health Disparities 2022; 10:1339-1348. [PMID: 35524005 DOI: 10.1007/s40615-022-01319-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 04/13/2022] [Accepted: 04/25/2022] [Indexed: 12/24/2022]
Abstract
Hispanic/Latino ethnicity is associated with improved survival from non-small cell lung cancer compared to that for non-Hispanic Whites even though Hispanics/Latinos are more likely to potentially have inferior access-to-care and experience greater health disparities. To this end, we conducted a literature review to identify possible explanations for this survival benefit, including the role of chronic obstructive pulmonary disease and cardiovascular diseases, genetic variation, cultural influences, and immigration factors. Overall, intermittent smoking patterns, genetic variation, co-morbidities, and cultural influences were all factors likely to partially explain this survival benefit. On the other hand, immigration factors, acculturation, and access-to-care were less likely to support the survival advantage. Future research should analyze relevant Hispanic/Latino subgroups (e.g., Mexican, Puerto Rican, Cuban, Dominican, Central American, South American) and specifically focus on the relationship between Hispanic/Latino ethnicity and different lung cancer subtypes. If the Hispanic/Latino mortality benefit observed in lung cancer truly exists, a better understanding of the underlying mechanism(s) may help extend these benefits to other ethnic and racial groups.
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Affiliation(s)
- Emily Miao
- Albert Einstein College of Medicine, Bronx, NY, USA
| | - Madelyn Klugman
- New York Presbyterian Hospital-Weill Cornell Medical Center, New York, NY, USA
| | - Thomas Rohan
- Albert Einstein College of Medicine, Bronx, NY, USA
| | - H Dean Hosgood
- Albert Einstein College of Medicine, Bronx, NY, USA. .,Department of Epidemiology and Population Health, Division of Epidemiology, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Belfer 1309, Bronx, NY, 10461, USA.
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Baseline Electrocardiographic and Echocardiographic Assessment May Help Predict Survival in Lung Cancer Patients-A Prospective Cardio-Oncology Study. Cancers (Basel) 2022; 14:cancers14082010. [PMID: 35454916 PMCID: PMC9032028 DOI: 10.3390/cancers14082010] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 03/28/2022] [Accepted: 04/12/2022] [Indexed: 12/24/2022] Open
Abstract
Cardiovascular disease and cancer coexist and lead to exertional dyspnea. The aim of the study was to determine the prognostic significance of cardiac comorbidities, ECG and baseline echocardiography in lung cancer patients with varying degrees of reduced performance status. This prospective study included 104 patients with histopathologically confirmed lung cancer, pre-qualified for systemic treatment due to metastatic or locally advanced malignancy but not eligible for thoracic surgery. The patients underwent a comprehensive cardio-oncological evaluation. Overall survival negative predictors included low ECOG 2 (Eastern Cooperative Oncology Group) performance status, stage IV (bone or liver/adrenal metastases in particular), pleural effusion, the use of analgesics and among cardiac factors, two ECG parameters: atrial fibrillation (HR = 2.39) and heart rate >90/min (HR = 1.67). Among echocardiographic parameters, RVSP > 39 mmHg was a negative predictor (HR = 2.01), while RVSP < 21 mmHg and RV free wall strain < −30% were positive predictors (HR = 0.36 and HR = 0.56, respectively), whereas RV GLS < −25.5% had a borderline significance (HR = 0.59; p = 0.05). Logistical regression analysis showed ECOG = 2 significantly correlated with the following echocardiographic parameters: increasing RVSP, RV GLS, RV free wall strain and decreasing ACT, FAC (p < 0.05). Selected echocardiographic parameters may be helpful in predicting poor performance in lung cancer patients and, supplemented with ECG evaluation, broaden the possibilities of prognostic evaluation.
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Ghandourh W, Holloway L, Batumalai V, Chlap P, Field M, Jacob S. Optimal and actual rates of Stereotactic Ablative Body Radiotherapy (SABR) utilisation for primary lung cancer in Australia. Clin Transl Radiat Oncol 2022; 34:7-14. [PMID: 35282142 PMCID: PMC8907547 DOI: 10.1016/j.ctro.2022.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 03/01/2022] [Indexed: 12/02/2022] Open
Abstract
Stereotactic Ablative Body Radiotherapy (SABR) plays a major role in the management of early-stage non-small cell lung cancer (NSCLC). An evidence-based model is developed to estimate optimal rates of lung SABR utilisation within the Australian population. Optimal utilisation rates are compared against actual utilisation rates to evaluate service provision.
Background and purpose Radiotherapy utilisation rates considerably vary across different countries and service providers, highlighting the need to establish reliable benchmarks against which utilisation rates can be assessed. Here, optimal utilisation rates of Stereotactic Ablative Body Radiotherapy (SABR) for lung cancer are estimated and compared against actual utilisation rates to identify potential shortfalls in service provision. Materials and Methods An evidence-based optimal utilisation model was constructed after reviewing practice guidelines and identifying indications for lung SABR based on the best available evidence. The proportions of patients likely to develop each indication were obtained, whenever possible, from Australian population-based studies. Sensitivity analysis was performed to account for variations in epidemiological data. Practice pattern studies were reviewed to obtain actual utilisation rates. Results A total of 6% of all lung cancer patients were estimated to optimally require SABR at least once during the course of their illness (95% CI: 4–6%). Optimal utilisation rates were estimated to be 32% for stage I and 10% for stage II NSCLC. Actual utilisation rates for stage I NSCLC varied between 6 and 20%. For patients with inoperable stage I, 27–74% received SABR compared to the estimated optimal rate of 82%. Conclusion The estimated optimal SABR utilisation rates for lung cancer can serve as useful benchmarks to highlight gaps in service delivery and help plan for more adequate and efficient provision of care. The model can be easily modified to determine optimal utilisation rates in other populations or updated to reflect any changes in practice guidelines or epidemiological data.
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Tjong MC, Bitterman DS, Brantley K, Nohria A, Hoffmann U, Atkins KM, Mak RH. Major adverse cardiac event risk prediction model incorporating baseline cardiac disease, hypertension, and logarithmic left anterior descending coronary artery radiation dose in lung cancer (CHyLL). Radiother Oncol 2022; 169:105-113. [PMID: 35182687 DOI: 10.1016/j.radonc.2022.02.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 01/13/2022] [Accepted: 02/10/2022] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND PURPOSE In patients with locally advanced non-small cell lung cancer (LA-NSCLC) post-radiotherapy, mean heart dose (MHD) and the percent of left anterior descending (LAD) coronary artery receiving ≥15Gy (LADV15) are associated with major adverse cardiac events (MACE). We developed a MACE prediction model in this population. MATERIALS AND METHODS Total 701 patients with LA-NSCLC treated with curative-intent radiotherapy reviewed, split by diagnosis date into "development" (n=500) and later (n=201) "test" cohorts. Development patients were analyzed using a multivariable Cox-proportional hazard model with backward elimination scheme (Bonferroni-adjusted α=0.025). Potential predictors were selected a priori: age, coronary heart disease (CHD), Framingham Risk, hypertension, MHD, LADV15, intensity modulated radiotherapy use, and CHD and LADV15 interaction (CHD:LADV15). Cardiac doses as quadratic, square root, and logarithmic (ln[X+1]) forms were explored. Models were internally validated with bootstrapping. RESULTS Final model incorporated CHD, Hypertension, Logarithmic LADV15, and CHD:ln[LADV15+1] (CHyLL; β coefficients: 5.51, 1.28, 1.48, -1.36; all p<0.006; bootstrapping c-index: 0.80; test cohort c-index: 0.76). Possible risk score range: 0-8.11. MACE incidence was 6.8% and 23.6% at 48 months (p=0.041), and survival rates were 51.6% and 35.0% (p=0.099), in the low-risk (score <5.00) and high-risk (score ≥5) test groups, respectively. Using the model, calculated LADV15 constraints for patients without CHD were 11.3% and 28.3% for those with and without hypertension, respectively, to remain low-risk. CONCLUSIONS Pre-existing CHD, hypertension, and LADV15 were important factors in predicting MACE after radiotherapy. CHyLL has the potential to estimate personalized LADV15 constraints based on cardiac risk factors and acceptable MACE thresholds.
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Affiliation(s)
- Michael C Tjong
- Department of Radiation Oncology, Princess Margaret Cancer Centre, 610 University Avenue, Toronto, Ontario, Canada; Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, 450 Brookline Avenue, Boston, Massachusetts, United States; Department of Epidemiology, Harvard TH Chan School of Public Health, 677 Huntington Ave, Boston, Massachusetts, United States.
| | - Danielle S Bitterman
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, 450 Brookline Avenue, Boston, Massachusetts, United States
| | - Kristen Brantley
- Department of Epidemiology, Harvard TH Chan School of Public Health, 677 Huntington Ave, Boston, Massachusetts, United States
| | - Anju Nohria
- Department of Cardiovascular Medicine, Dana-Farber Cancer Institute and Brigham and Women's Hospital, 450 Brookline Avenue, Boston, Massachusetts, United States
| | - Udo Hoffmann
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, 55 Fruit St, Boston, Massachusetts, United States
| | - Katelyn M Atkins
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, 450 Brookline Avenue, Boston, Massachusetts, United States; Department of Radiation Oncology, Cedars-Sinai Medical Center, 8700 Beverly Blvd #2900A, Los Angeles, California, United States
| | - Raymond H Mak
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, 450 Brookline Avenue, Boston, Massachusetts, United States.
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Bittar CS. Neoplasms and the Evaluation of Risk of Cardiovascular Disease. Arq Bras Cardiol 2022; 118:486-487. [PMID: 35262585 PMCID: PMC8856679 DOI: 10.36660/abc.20220007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Cristina Salvadori Bittar
- InCorSão PauloSPBrasilInstituto do Coração - InCor,São Paulo, SP – Brasil
- ICESPSão PauloSPBrasilInstituto do Câncer - ICESP,São Paulo, SP – Brasil
- Hospital Sírio LibanêsSão PauloSPBrasilHospital Sírio Libanês, São Paulo, SP – Brasil
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Waliany S, Zhu H, Wakelee H, Padda SK, Das M, Ramchandran K, Myall NJ, Chen T, Witteles RM, Neal JW. Pharmacovigilance Analysis of Cardiac Toxicities Associated With Targeted Therapies for Metastatic NSCLC. J Thorac Oncol 2021; 16:2029-2039. [PMID: 34418561 DOI: 10.1016/j.jtho.2021.07.030] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 06/24/2021] [Accepted: 07/21/2021] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Targeted therapies have transformed treatment of driver-mutated metastatic NSCLC. We compared cardiovascular adverse events between and within targeted therapy classes. METHODS We used WHO pharmacovigilance database VigiBase to compare odds of heart failure, conduction disease, QT prolongation, supraventricular tachycardia (SVT), and ventricular arrhythmias between inhibitors of EGFR (erlotinib, gefitinib, afatinib, osimertinib), BRAF (dabrafenib), MEK (trametinib), and ALK and ROS1 (alectinib, brigatinib, ceritinib, crizotinib, lorlatinib). RESULTS Of 98,765 adverse reactions reported with NSCLC targeted therapies, 1783 (1.8%) were arrhythmias and 1146 (1.2%) were heart failure. ALK and ROS1 inhibitors were associated with increased odds of conduction disease (reporting OR [ROR] = 12.95, 99% confidence interval [CI]: 10.14-16.55) and QT prolongation (ROR = 5.16, 99% CI: 3.92-6.81) relative to BRAF and EGFR inhibitors. Among ALK and ROS1 inhibitors, crizotinib had highest odds of conduction disease (ROR = 1.75, 99% CI: 1.30-2.36) and QT prolongation (ROR = 1.91, 99% CI: 1.22-3.00). Dabrafenib (ROR = 2.24, 99% CI: 1.86-2.70) and trametinib (ROR = 2.44, 99% CI: 2.03-2.92) had higher odds of heart failure than other targeted therapies. Osimertinib was strongly associated with QT prolongation (ROR = 6.13, 99% CI: 4.43-8.48), heart failure (ROR = 3.64, 99% CI: 2.94-4.50), and SVT (ROR = 1.90, 99% CI: 1.26-2.86) relative to other targeted therapies. CONCLUSIONS ALK and ROS1 inhibitors are associated with higher odds of conduction disease and QT prolongation than other targeted therapies. Osimertinib is strongly associated with QT prolongation, SVT, and heart failure relative to other EGFR inhibitors and targeted therapies. Monitoring for heart failure and arrhythmias should be considered with NSCLC targeted therapies, especially osimertinib.
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Affiliation(s)
- Sarah Waliany
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Han Zhu
- Department of Medicine, Stanford University School of Medicine, Stanford, California; Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California; Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California
| | - Heather Wakelee
- Department of Medicine, Stanford University School of Medicine, Stanford, California; Division of Oncology, Stanford University School of Medicine, Stanford, California; Stanford Cancer Institute, Stanford, California
| | - Sukhmani K Padda
- Department of Medicine, Stanford University School of Medicine, Stanford, California; Division of Oncology, Stanford University School of Medicine, Stanford, California; Stanford Cancer Institute, Stanford, California
| | - Millie Das
- Department of Medicine, Stanford University School of Medicine, Stanford, California; Division of Oncology, Stanford University School of Medicine, Stanford, California; Stanford Cancer Institute, Stanford, California; Department of Medicine, VA Palo Alto Health Care System, Palo Alto, California
| | - Kavitha Ramchandran
- Department of Medicine, Stanford University School of Medicine, Stanford, California; Division of Oncology, Stanford University School of Medicine, Stanford, California; Stanford Cancer Institute, Stanford, California
| | - Nathaniel J Myall
- Department of Medicine, Stanford University School of Medicine, Stanford, California; Division of Oncology, Stanford University School of Medicine, Stanford, California; Stanford Cancer Institute, Stanford, California
| | - Thomas Chen
- Division of Oncology, Stanford Cancer Center South Bay, San Jose, California
| | - Ronald M Witteles
- Department of Medicine, Stanford University School of Medicine, Stanford, California; Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California
| | - Joel W Neal
- Department of Medicine, Stanford University School of Medicine, Stanford, California; Division of Oncology, Stanford University School of Medicine, Stanford, California; Stanford Cancer Institute, Stanford, California.
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Wu C, Lin D, Ma F, Jiang F, Wang Y. New progress in elucidating the relationship between cancer therapy and cardiovascular toxicity. Biosci Trends 2021; 15:211-218. [PMID: 34305102 DOI: 10.5582/bst.2021.01278] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Onco-cardiology is an emerging field linking cancer with cardiovascular injury. Understanding the mechanism of cardiac injury helps improve the quality of life of cancer survivors. A series of studies on adverse reactions to cancer or oncological treatments has indicated that adverse cardiovascular events related to cancer treatments may occur over a longer period of survival, and even years after therapy has concluded. Current cancer therapies, including chemotherapy, radiotherapy, targeted therapy, and immunotherapy, have been found to have latent cardiovascular toxicity. These toxic effects are often progressive and irreversible and ultimately lead to cardiovascular events such as heart failure, hypertension, coronary heart diseases, arrhythmia, and thromboembolism. Therefore, more emphasis should be placed on revealing the mechanism of cancer treatment-related cardiovascular toxicity. This would help to guide prevention, diagnosis, and treatment of CVDs in cancer survivors.
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Affiliation(s)
- Chen Wu
- Department of Cardiology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dawei Lin
- Department of Cardiology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fei Ma
- Department of Oncology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Feng Jiang
- Clinical Research & Innovation Unit, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Chongming Branch, Shanghai, China
| | - Yaosheng Wang
- Department of Cardiology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Clinical Research & Innovation Unit, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Sase K, Fujisaka Y, Shoji M, Mukai M. Cardiovascular Complications Associated with Contemporary Lung Cancer Treatments. Curr Treat Options Oncol 2021; 22:71. [PMID: 34110522 DOI: 10.1007/s11864-021-00869-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2021] [Indexed: 12/24/2022]
Abstract
OPINION STATEMENT Lung cancer is the most common form of cancer in humans and the leading cause of cancer-related death worldwide. Traditionally, lung cancer has been diagnosed as either small cell lung cancer (SCLC) or non-small cell lung cancer (NSCLC). However, recent developments in molecular pathology have revolutionized the diagnosis and treatment of the disease, thus improving patient prognosis and increasing the number of survivors. In advanced NSCLC cases, molecularly targeted drugs for patients with positive driver gene mutation/rearrangement, and immune checkpoint inhibitors for those with a positive biomarker, have changed the standard of care. SCLC is a highly malignant entity. In addition to the chemotherapy and radiotherapy, immune checkpoint inhibitors have recently provided some hope for extended-stage SCLC. Smoking cessation is related to decreased morbidity. However, early metastasis remains a significant challenge. Recently, cancer therapy-related cardiovascular disease (CTRCD) has emerged as diverse pathophysiology, including fulminant myocarditis, fatal arrhythmia, pericarditis, hypertension, and thrombosis, that emerged with modern lung cancer therapies. Cardio-oncology is a new interdisciplinary collaboration to develop methodologies to manage cardiovascular risk factors and CTRCDs with the common goal of minimizing unnecessary interruption of cancer treatment and maximizing outcomes of lung cancer survivors.
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Affiliation(s)
- Kazuhiro Sase
- Clinical Pharmacology and Regulatory Science, Juntendo University Graduate School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan. .,Institute for Medical Regulatory Science, Organization for University Research Initiatives, Waseda University, Tokyo, Japan.
| | - Yasuhito Fujisaka
- Department of Respiratory Medicine and Thoracic Oncology/Clinical Research Center, Osaka Medical and Pharmaceutical University Hospital, Osaka, Japan
| | - Masaaki Shoji
- Department of General Internal Medicine/Oncologic Emergencies, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Mikio Mukai
- Osaka Prefectural Hospital Organization, Osaka International Cancer Institute, Department of Medical Check-up, Osaka, Japan
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Petrelli F, Ghidini A, Cabiddu M, Perego G, Lonati V, Ghidini M, Oggionni E, Galli E, Moleri G, Barni S, Bossi AC, Colombelli PL, Dognini G, Sganzerla P. Effects of hypertension on cancer survival: A meta-analysis. Eur J Clin Invest 2021; 51:e13493. [PMID: 33470426 DOI: 10.1111/eci.13493] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 01/03/2021] [Accepted: 01/16/2021] [Indexed: 01/15/2023]
Abstract
BACKGROUND Hypertension is usually associated with increased cardiovascular mortality. Uncertainty exists about the possible role of hypertension as a poor prognostic factor for cancer-specific mortality (CSM). To assess the association between pre-existing hypertension and the risk of mortality and relapse after a diagnosis of cancer, we performed a systematic review and meta-analysis of published studies. METHODS PubMed, Scopus, Web of Science, the Cochrane Library and EMBASE were searched from inception until May 2020, without language restrictions, for observational studies reporting the prognosis of patients with hypertension and cancer. The primary outcome of the study refers to CSM in hypertensive vs nonhypertensive patients, and secondary endpoints were overall mortality (OM) and progression- or relapse-free survival. The effect size was reported as hazard ratios (HRs) with 95% CIs. RESULTS Mortality and relapse associated with hypertension in patients with various cancers were evaluated among 1 603 437 participants (n = 66 studies). Overall, diagnosis of cancer and hypertension was associated with an increased independent risk of OM (HR = 1.2 [95% CI, 1.13-1.27], P < .01) and CSM (HR = 1.12 [95% CI, 1.04-1.21], P < .01) but not of relapse (HR = 1.08 [95% CI, 0.98-1.19], P = .14). CONCLUSIONS Among cancer patients, those with pre-existing hypertension have a poorer outcome, probably due to multifactorial reasons. Adequate control of lifestyle, more intensive follow-ups, monitoring for hypertension- and anticancer-related cardiovascular complications, and establishing multidisciplinary cardio-oncology units can be useful measures for reducing mortality and improving care in this setting.
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Affiliation(s)
| | | | - Mary Cabiddu
- Oncology Unit, ASST Bergamo Ovest, Treviglio, Italy
| | | | | | - Michele Ghidini
- Oncology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | | | - Emilio Galli
- Nephrology Unit, ASST Bergamo Ovest, Treviglio, Italy
| | - Giovanna Moleri
- Direzione Socio-Sanitaria, Centro Servizi, ASST Bergamo Ovest, Treviglio, Italy
| | - Sandro Barni
- Oncology Unit, ASST Bergamo Ovest, Treviglio, Italy
| | - Antonio Carlo Bossi
- Endocrine Diseases Unit-Diabetes regional center, ASST Bergamo Ovest, Treviglio, Italy
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Zhou C, Li S, Liu J, Chu Q, Miao L, Cai L, Cai X, Chen Y, Cui F, Dong Y, Dong W, Fang W, He Y, Li W, Li M, Liang W, Lin G, Lin J, Lin X, Liu H, Liu M, Mu X, Hu Y, Hu J, Jin Y, Li Z, Qin Y, Ren S, Sun G, Shen Y, Su C, Tang K, Wu L, Wang M, Wang H, Wang K, Wang Y, Wang P, Wang H, Wang Q, Wang Z, Xie X, Xie Z, Xu X, Xu F, Yang M, Yang B, Yi X, Ye X, Ye F, Yu Z, Yue D, Zhang B, Zhang J, Zhang J, Zhang X, Zhang W, Zhao W, Zhu B, Zhu Z, Zhong W, Bai C, Chen L, Han B, Hu C, Lu S, Li W, Song Y, Wang J, Zhou C, Zhou J, Zhou Y, Saito Y, Ichiki Y, Igai H, Watanabe S, Bravaccini S, Fiorelli A, Petrella F, Nakada T, Solli P, Tsoukalas N, Kataoka Y, Goto T, Berardi R, He J, Zhong N. International consensus on severe lung cancer-the first edition. Transl Lung Cancer Res 2021; 10:2633-2666. [PMID: 34295668 PMCID: PMC8264326 DOI: 10.21037/tlcr-21-467] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 06/17/2021] [Indexed: 02/05/2023]
Affiliation(s)
- Chengzhi Zhou
- State Key Laboratory of Respiratory Disease, National Clinical Research Centre for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Shiyue Li
- State Key Laboratory of Respiratory Disease, National Clinical Research Centre for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Jun Liu
- State Key Laboratory of Respiratory Disease, National Clinical Research Centre for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Qian Chu
- Department of Oncology, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Liyun Miao
- Department of Respiratory and Critical Care Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Linbo Cai
- Department of Oncology, Guangdong Sanjiu Brain Hospital, Guangzhou, China
| | - Xiuyu Cai
- Department of General Internal Medicine, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Yu Chen
- State Key Laboratory of Respiratory Disease, National Clinical Research Centre for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Fei Cui
- State Key Laboratory of Respiratory Disease, National Clinical Research Centre for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Yuchao Dong
- Department of Pulmonary and Critical Care Medicine, Shanghai Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Wen Dong
- Department of Oncology, Hainan Cancer Hospital, Haikou, China
| | - Wenfeng Fang
- Department of Medical Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Yong He
- Department of Respiratory Medicine, Daping Hospital, Army Medical University, Chongqing, China
| | - Weifeng Li
- Department of Respiratory Medicine, General Hospital of Guangzhou Military Command of PLA, Guangzhou, China
| | - Min Li
- Department of Respiratory Medicine, Xiangya Cancer Center, Xiangya Hospital, Central South University, Changsha, China
| | - Wenhua Liang
- State Key Laboratory of Respiratory Disease, National Clinical Research Centre for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Gen Lin
- Department of Thoracic Oncology, Fujian Cancer Hospital and Fujian Medical University Cancer Hospital, Fuzhou, China
| | - Jie Lin
- Department of Medical Oncology, the Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Xinqing Lin
- State Key Laboratory of Respiratory Disease, National Clinical Research Centre for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Hongbing Liu
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Ming Liu
- State Key Laboratory of Respiratory Disease, National Clinical Research Centre for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Xinlin Mu
- Department of Respiratory and Critical Care Medicine, Peking University People's Hospital, Beijing, China
| | - Yi Hu
- Department of Medical Oncology, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Jie Hu
- Department of Respiratory Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yang Jin
- Department of Respiratory and Critical Care Medicine, NHC Key Laboratory of Pulmonary Diseases, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ziming Li
- Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yinyin Qin
- State Key Laboratory of Respiratory Disease, National Clinical Research Centre for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Shengxiang Ren
- Department of Medical Oncology, Shanghai Pulmonary Hospital, Thoracic Cancer Institute, Tongji University School of Medicine, Shanghai, China
| | - Gengyun Sun
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yihong Shen
- Department of Respiratory Disease, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Chunxia Su
- Department of Medical Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Kejing Tang
- Division of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Sun Yat-sen University, Institute of Pulmonary Diseases, Sun Yat-sen University, Guangzhou, China
| | - Lin Wu
- Thoracic Medicine Department II, Hunan Cancer Hospital, Changsha, China
| | - Mengzhao Wang
- Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Beijing, China
| | - Huijuan Wang
- Department of Medical Oncology, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Kai Wang
- Department of Respiratory Medicine, Fourth Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Yuehong Wang
- Department of Respiratory Disease, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Ping Wang
- Department of Respiratory and Critical Care Medicine, the Eighth Medical Center of PLA General Hospital, Beijing, China
| | - Hongmei Wang
- Department of Respiratory and Critical Care Medicine, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Qi Wang
- Department of Respiratory Medicine, The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Zhijie Wang
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaohong Xie
- State Key Laboratory of Respiratory Disease, National Clinical Research Centre for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Zhanhong Xie
- State Key Laboratory of Respiratory Disease, National Clinical Research Centre for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Xin Xu
- State Key Laboratory of Respiratory Disease, National Clinical Research Centre for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Fei Xu
- Department of Respiratory Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Meng Yang
- Department of Respiratory Disease, China-Japan Friendship Hospital, Beijing, China
| | - Boyan Yang
- Department of Comprehensive Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China.,Department of Comprehensive Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiangjun Yi
- Department of Medical Oncology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xiaoqun Ye
- Department of Respiratory Diseases, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Feng Ye
- Department of Medical Oncology, The first affiliated hospital of Xiamen University, Xiamen, China
| | - Zongyang Yu
- Department of Pulmonary and Critical Care Medicine, The th Hospital of Joint Logistic Support Force, PLA, Fuzhou, China
| | - Dongsheng Yue
- Department of Lung Cancer, Tianjin Lung Cancer Center, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Bicheng Zhang
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Jian Zhang
- Department of Pulmonary and Critical Care Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Jianqing Zhang
- Second Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Xiaoju Zhang
- Department of Respiratory and Critical Care Medicine, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Wei Zhang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Wei Zhao
- Department of Pulmonary and Critical Care Medicine, The General Hospital of People's Liberation Army, Beijing, China
| | - Bo Zhu
- Institute of Cancer, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Zhengfei Zhu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Wenzhao Zhong
- Guangdong Lung Cancer Institute, Guangdong General Hospital, and Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Chunxue Bai
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Liangan Chen
- Department of Respiratory, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Baohui Han
- Department of Pulmonology, Shanghai Chest Hospital, Shanghai, China
| | - Chengping Hu
- Department of Pulmonary Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Shun Lu
- Department of Oncology, Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Weimin Li
- Department of Respiratory and Critical Care Medicine, Clinical Research Center for Respiratory Disease, West China Hospital, Sichuan University, Chengdu, China
| | - Yong Song
- Department of Respiratory and Critical Care Medicine, Jinling Hospital, Nanjing, China
| | - Jie Wang
- Key Laboratory of Respiratory Disease Pathogenomics, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Caicun Zhou
- Department of Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jianying Zhou
- Department of Respiratory Diseases, The First Affiliated Hospital of College of Medicine, Zhejiang University, Hangzhou, China
| | - Yanbin Zhou
- Department of Internal Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yuichi Saito
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Yoshinobu Ichiki
- Department of General Thoracic Surgery, National Hospital Organization, Saitama Hospital, Wako, Japan
| | - Hitoshi Igai
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Maebashi, Gunma, Japan
| | - Satoshi Watanabe
- Department of Respiratory Medicine and Infectious Diseases, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Sara Bravaccini
- IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Alfonso Fiorelli
- Thoracic Surgery Unit, Universitàdella Campania Luigi Vanvitelli, Naples, Italy
| | - Francesco Petrella
- Division of Thoracic Surgery, IRCCS European Institute of Oncology, Milan, Italy.,Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - Takeo Nakada
- Division of Thoracic Surgery, Department of Surgery, the Jikei University School of Medicine, Tokyo, Japan
| | - Piergiorgio Solli
- Department of Cardio-Thoracic Surgery and Hearth & Lung Transplantation, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | | | - Yuki Kataoka
- Department of Internal Medicine, Kyoto Min-Iren Asukai Hospital, Kyoto, Japan
| | - Taichiro Goto
- Lung Cancer and Respiratory Disease Center, Yamanashi Central Hospital, Yamanashi, Japan
| | - Rossana Berardi
- Clinica Oncologica, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I, GM Lancisi, G Salesi di Ancona, Italy
| | - Jianxing He
- State Key Laboratory of Respiratory Disease, National Clinical Research Centre for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Nanshan Zhong
- State Key Laboratory of Respiratory Disease, National Clinical Research Centre for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
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Steponavičienė R, Jonušas J, Griškevičius R, Venius J, Cicėnas S. A Pilot Study of Safer Radiation Dosage to the Heart and Its Subregions. ACTA ACUST UNITED AC 2021; 57:medicina57040320. [PMID: 33807209 PMCID: PMC8065397 DOI: 10.3390/medicina57040320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 03/23/2021] [Accepted: 03/26/2021] [Indexed: 12/24/2022]
Abstract
Background and Objectives: The real impact of ionizing radiation on the heart and poorer overall survival for patients with non small cell lung cancer (NSCLC) remains unclear. This study aims to determine the safe dose constraints to the heart’s subregions that could prevent patients’ early non-cancerous death and improve their quality of life. Methods and Materials: A retrospective cohort study was performed containing 51 consecutive patients diagnosed with stage III NSCLC and treated using 3D, Intensity-modulated radiation therapy (IMRT), and Volumetric modulated arc therapy (VMAT) radiotherapy. For a dosimetric analysis, these structures were chosen: heart, heart base (HB), and region of great blood vessels (GBV). Dose–volume histograms (DVH) were recorded for all mentioned structures. Maximum and mean doses to the heart, HB, the muscle mass of the HB, and GBV were obtained. V10–V60 (%) parameters were calculated from the DVH. After performed statistical analysis, logistic regression models were created, and critical doses calculated. Results: The critical dose for developing a fatal endpoint for HB was 30.5 Gy, while for GBV, it was 46.3 Gy. Increasing the average dose to the HB or GBV by 1 Gy from the critical dose further increases the possibility of early death by 22.0% and 15.8%, respectively. Conclusions: We suggest that the non-canonical sub-regions of the heart (HB and GBV) should be considered during the planning stage. Additional constraints of the heart subregions should be chosen accordingly, and we propose that the mean doses to these regions be 30.5 Gy and 46.3 Gy, respectively, or less. Extrapolated DVH curves for both regions may be used during the planning stage with care.
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Affiliation(s)
- Rita Steponavičienė
- External Beam Radiotherapy Department, National Cancer Institute, Santariskiu Str. 1, LT-08406 Vilnius, Lithuania
| | - Justinas Jonušas
- Vilnius University Hospital Santaros Klinikos, Santariskiu Str. 2, LT-08410 Vilnius, Lithuania
| | - Romualdas Griškevičius
- Medical Physics Department, National Cancer Institute, Santariskiu Str. 1, LT-08406 Vilnius, Lithuania
| | - Jonas Venius
- Medical Physics Department, National Cancer Institute, Santariskiu Str. 1, LT-08406 Vilnius, Lithuania
- Laboratory of Biomedical Physics, National Cancer Institute, Baublio 3b, LT-08406 Vilnius, Lithuania
| | - Saulius Cicėnas
- Department of Thoracic Surgery and Oncology, National Cancer Institute, Santariskiu Str. 1, LT-08406 Vilnius, Lithuania
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38
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Sun JY, Zhang ZY, Qu Q, Wang N, Zhang YM, Miao LF, Wang J, Wu LD, Liu Y, Zhang CY, Wang RX. Cardiovascular disease-specific mortality in 270,618 patients with non-small cell lung cancer. Int J Cardiol 2021; 330:186-193. [PMID: 33581175 DOI: 10.1016/j.ijcard.2021.02.025] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 01/22/2021] [Accepted: 02/08/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND This study aimed to investigate the trend of cardiovascular disease (CVD)-specific mortality in patients with non-small cell lung cancer (NSCLC) and identify prognostic factors for CVD-specific death in stage NSCLC patients. METHODS In this study, 270,618 NSCLC patients were collected from the Surveillance, Epidemiology, and End Results database. CVD- and NSCLC-specific cumulative mortality and proportion of death were calculated and graphically displayed to describe the probability of specific endpoints. Prognostic factors for CVD-specific mortality were evaluated by cause-specific hazard ratios (HR) with 95% confidence intervals (CI) using the competing risk model with non-cardiovascular death as competing risks. RESULTS Among all competing causes of death, lung cancer resulted in the highest cumulative mortality, followed by CVDs and other causes. In the proportion of cause-specific death, heart diseases accounted for approximately 5.3% of the total death, only secondary to primary cancer. In all three stages, higher age, squamous cell carcinoma, and no-or-unknown chemotherapy and/or radiotherapy were associated with a higher risk of CVD-specific death, while surgery treatment seemed to be a protective factor. Female gender was statistically related to CVD-specific death in stage I and III patients with HRs of 0.84 (0.78-0.91) and 0.84 (0.77-0.93), respectively. Interestingly, right-sided laterality was correlated with lower CVD-specific mortality with HR of 0.82 (0.74-0.90) in stage III. CONCLUSIONS This study illustrated the historical trend of CVD-specific death in NSCLC patients and assesses potential prognostic risk factors, highlighting the involvement of cardio-oncology teams in cancer treatment to provide optimal comprehensive care and long-term surveillance for cancer patients.
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Affiliation(s)
- Jin-Yu Sun
- Department of Cardiology, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi 214023, China; The First Clinical Medical College of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Zhen-Ye Zhang
- Department of Cardiology, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi 214023, China
| | - Qiang Qu
- Department of Cardiology, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi 214023, China; The First Clinical Medical College of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Ning Wang
- Department of Cardiology, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi 214023, China
| | - Yu-Min Zhang
- Department of Cardiology, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi 214023, China
| | - Ling-Feng Miao
- Department of Cardiology, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi 214023, China
| | - Ji Wang
- The First Clinical Medical College of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Li-Da Wu
- Department of Cardiology, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi 214023, China
| | - Ying Liu
- Department of Cardiology, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi 214023, China
| | - Chang-Ying Zhang
- Department of Cardiology, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi 214023, China.
| | - Ru-Xing Wang
- Department of Cardiology, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi 214023, China.
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Banfill K, Giuliani M, Aznar M, Franks K, McWilliam A, Schmitt M, Sun F, Vozenin MC, Faivre Finn C. Cardiac Toxicity of Thoracic Radiotherapy: Existing Evidence and Future Directions. J Thorac Oncol 2021; 16:216-227. [PMID: 33278607 PMCID: PMC7870458 DOI: 10.1016/j.jtho.2020.11.002] [Citation(s) in RCA: 103] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 11/01/2020] [Accepted: 11/02/2020] [Indexed: 12/13/2022]
Abstract
The impact of radiotherapy on the heart has become an area of interest in recent years. Many different cardiac dose-volume constraints have been associated with cardiac toxicity and survival; however, no consistent constraint has been found. Many patients undergoing treatment for lung cancer have risk factors for cardiovascular disease or known cardiac comorbidities; however, there is little evidence on the effects of radiotherapy on the heart in these patients. We aim to provide a summary of the existing literature on cardiac toxicity of lung cancer radiotherapy, propose strategies to avoid and manage cardiac toxicity, and suggest avenues for future research.
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Affiliation(s)
- Kathryn Banfill
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom.
| | - Meredith Giuliani
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Marianne Aznar
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Kevin Franks
- Leeds Cancer Centre, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom; Radiotherapy Research Group, Leeds Institute of Medical Research at St James's, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom
| | - Alan McWilliam
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Matthias Schmitt
- Cardiovascular Division, Manchester University Foundation Trust, North West Heart Centre, Wythenshawe Campus, Manchester, United Kingdom
| | - Fei Sun
- Leeds Cancer Centre, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom; Radiotherapy Research Group, Leeds Institute of Medical Research at St James's, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom
| | - Marie Catherine Vozenin
- Laboratory of Radiation Oncology/DO/Radio-Oncology/CHUV, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Corinne Faivre Finn
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom
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40
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Comorbidity Patterns of Older Lung Cancer Patients in Northeast China: An Association Rules Analysis Based on Electronic Medical Records. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17239119. [PMID: 33291317 PMCID: PMC7729838 DOI: 10.3390/ijerph17239119] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 12/04/2020] [Accepted: 12/04/2020] [Indexed: 12/12/2022]
Abstract
Purposes: This study aims to identify the comorbidity patterns of older men with lung cancer in China. Methods: We analyzed the electronic medical records (EMRs) of lung cancer patients over age 65 in the Jilin Province of China. The data studied were obtained from 20 hospitals of Jilin Province in 2018. In total, 1510 patients were identified. We conducted a rank–frequency analysis and social network analysis to identify the predominant comorbidities and comorbidity networks. We applied the association rules to mine the comorbidity combination with the values of confidence and lift. A heatmap was utilized to visualize the rules. Results: Our analyses discovered that (1) there were 31 additional medical conditions in older patients with lung cancer. The most frequent comorbidities were pneumonia, cerebral infarction, and hypertension. (2) The network-based analysis revealed seven subnetworks. (3) The association rules analysis provided 41 interesting rules. The results revealed that hypertension, ischemic cardiomyopathy, and pneumonia are the most frequent comorbid combinations. Heart failure may not have a strong implicating role in these comorbidity patterns. Cerebral infarction was rarely combined with other diseases. In addition, glycoprotein metabolism disorder comorbid with hyponatremia or hypokalemia increased the risk of anemia by more than eight times in older lung cancer patients. Conclusions: This study provides evidence on the comorbidity patterns of older men with lung cancer in China. Understanding the comorbidity patterns of older patients with lung cancer can assist clinicians in their diagnoses and contribute to developing healthcare policies, as well as allocating resources.
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41
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Cuomo A, Pirozzi F, Attanasio U, Franco R, Elia F, De Rosa E, Russo M, Ghigo A, Ameri P, Tocchetti CG, Mercurio V. Cancer Risk in the Heart Failure Population: Epidemiology, Mechanisms, and Clinical Implications. Curr Oncol Rep 2020; 23:7. [PMID: 33263821 PMCID: PMC7716920 DOI: 10.1007/s11912-020-00990-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2020] [Indexed: 12/11/2022]
Abstract
PURPOSE OF REVIEW Along with population aging, the incidence of both heart failure (HF) and cancer is increasing. However, little is known about new-onset cancer in HF patients. This review aims at showing recent discoveries concerning this subset of patients. RECENT FINDINGS Not only cancer and HF share similar risk factors but also HF itself can stimulate cancer development. Some cytokines produced by the failing heart induce mild inflammation promoting carcinogenesis, as it has been recently suggested by an experimental model of HF in mice. The incidence of new-onset cancer is higher in HF patients compared to the general population, and it significantly worsens their prognosis. Moreover, the management of HF patients developing new-onset cancer is challenging, especially due to the limited therapeutic options for patients affected by both cancer and HF and the higher risk of cardiotoxicity from anticancer drugs.
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Affiliation(s)
- Alessandra Cuomo
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Flora Pirozzi
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Umberto Attanasio
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Riccardo Franco
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Francesco Elia
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Eliana De Rosa
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Michele Russo
- Department of Molecular Biotechnology and Health Sciences, Molecular Biotechnology Center, University of Torino, Torino, Italy
| | - Alessandra Ghigo
- Department of Molecular Biotechnology and Health Sciences, Molecular Biotechnology Center, University of Torino, Torino, Italy
| | - Pietro Ameri
- Cardiovascular Disease Unit, IRCCS Italian Cardiovascular Network, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Internal Medicine, University of Genova, Genoa, Italy
| | - Carlo Gabriele Tocchetti
- Department of Translational Medical Sciences, Federico II University, Naples, Italy.
- Interdepartmental Center of Clinical and Translational Research, Federico II University, Naples, Italy.
| | - Valentina Mercurio
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
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42
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Pelizzari G, Cortiula F, Giavarra M, Bartoletti M, Lisanti C, Buoro V, Cattaneo M, Rossetto C, Rizzato S, Puglisi F, Macerelli M, Fasola G, Follador A. Platinum-Based Chemotherapy in Older Patients with Non-Small Cell Lung Cancer: What to Expect in the Real World. Drugs Aging 2020; 37:677-689. [PMID: 32681401 DOI: 10.1007/s40266-020-00785-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND The role of platinum-based chemotherapy (PBC) for the treatment of older patients with non-small cell lung cancer (NSCLC) is still a matter of debate, despite the advent of immunotherapy. OBJECTIVE The aim of the study was to identify factors associated with first-line PBC prescription and, secondly, to evaluate the impact of first-line PBC on survival, treatment intensity, risk of hospitalization, and subsequent treatments. PATIENTS AND METHODS We reviewed a consecutive series of 474 older patients (age ≥ 70 years) diagnosed with stage IIIB-IV NSCLC at the Department of Oncology, University Hospital of Udine, Italy from January 2009 to March 2017. RESULTS Overall, 198 patients were deemed eligible, and 65.2% received a PBC. At multivariate analysis, older age was the only factor associated with PBC prescription. In the whole cohort, 46 patients (23.2%) were hospitalized for chemotherapy-related toxicity. Both PBC prescription (odds ratio [OR] 2.23, 95% confidence interval [CI] 1.02-4.87, p = 0.04) and tumor burden (OR 2.39, 95% CI 1.07-5.32, p = 0.03) emerged as independent risk factors for hospitalization. Moving to significant predictors of patterns of care, Eastern Cooperative Oncology Group (ECOG) performance status > 0 was associated with greater risk of first-line failure (OR 2.20, 95% CI 1.15-4.20, p = 0.02), while bone metastases (OR 0.29, 95% CI 0.12-0.69, p = 0.005) and a Charlson Comorbidity Index score ≥ 3 (OR 0.40, 95% CI 0.19-0.84, p = 0.016) independently predicted lower probability of receiving second-line therapy. Remarkably, PBC did not significantly impact overall survival (hazard ratio [HR] 0.83, 95% CI 0.61-1.14, p = 0.24) and progression-free survival (HR 0.95, 95% CI 0.70-1.28, p = 0.73) compared to single-agent chemotherapy (SAC). However, according to an exploratory landmark analysis, patients who received four cycles of treatment or maintenance therapy experienced prolonged overall survival, regardless of PBC use. CONCLUSIONS This study evaluated the real-world use of PBC in older patients with NSCLC, offering an insight into the determinants of its prescription and the pattern of care of these patients. Of note, PBC use was associated with a higher likelihood of hospitalization for chemotherapy-related toxicity, with no benefit on survival compared to SAC.
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Affiliation(s)
- Giacomo Pelizzari
- Department of Medicine (DAME), University of Udine, 33100, Udine, Italy. .,Department of Oncology, Santa Maria Della Misericordia Hospital (ASUFC), 33100, Udine, Italy.
| | - Francesco Cortiula
- Department of Medicine (DAME), University of Udine, 33100, Udine, Italy.,Department of Oncology, Santa Maria Della Misericordia Hospital (ASUFC), 33100, Udine, Italy
| | - Marco Giavarra
- Department of Medicine (DAME), University of Udine, 33100, Udine, Italy.,Department of Oncology, Santa Maria Della Misericordia Hospital (ASUFC), 33100, Udine, Italy
| | - Michele Bartoletti
- Department of Medicine (DAME), University of Udine, 33100, Udine, Italy.,Department of Oncology, Santa Maria Della Misericordia Hospital (ASUFC), 33100, Udine, Italy
| | - Camilla Lisanti
- Department of Medicine (DAME), University of Udine, 33100, Udine, Italy.,Department of Oncology, Santa Maria Della Misericordia Hospital (ASUFC), 33100, Udine, Italy
| | - Vanessa Buoro
- Department of Medicine (DAME), University of Udine, 33100, Udine, Italy.,Department of Oncology, Santa Maria Della Misericordia Hospital (ASUFC), 33100, Udine, Italy
| | - Monica Cattaneo
- Department of Medicine (DAME), University of Udine, 33100, Udine, Italy.,Department of Oncology, Santa Maria Della Misericordia Hospital (ASUFC), 33100, Udine, Italy
| | - Ciro Rossetto
- Department of Oncology, Santa Maria Della Misericordia Hospital (ASUFC), 33100, Udine, Italy
| | - Simona Rizzato
- Department of Oncology, Santa Maria Della Misericordia Hospital (ASUFC), 33100, Udine, Italy
| | - Fabio Puglisi
- Department of Medicine (DAME), University of Udine, 33100, Udine, Italy.,Dipartimento Di Oncologia Medica, Oncologia Medica E Prevenzione Oncologica, Centro Di Riferimento Oncologico Di Aviano (CRO), IRCCS, 33081, Aviano, Italy
| | - Marianna Macerelli
- Department of Oncology, Santa Maria Della Misericordia Hospital (ASUFC), 33100, Udine, Italy
| | - Gianpiero Fasola
- Department of Oncology, Santa Maria Della Misericordia Hospital (ASUFC), 33100, Udine, Italy
| | - Alessandro Follador
- Department of Oncology, Santa Maria Della Misericordia Hospital (ASUFC), 33100, Udine, Italy
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Impact of pre-existing cardiovascular disease on treatment patterns and survival outcomes in patients with lung cancer. BMC Cancer 2020; 20:1004. [PMID: 33059611 PMCID: PMC7559447 DOI: 10.1186/s12885-020-07487-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 10/02/2020] [Indexed: 12/15/2022] Open
Abstract
Background Baseline cardiovascular disease (CVD) can impact the patterns of treatment and hence the outcomes of patients with lung cancer. This study aimed to characterize treatment trends and survival outcomes of patients with pre-existing CVD prior to their diagnosis of lung cancer. Methods We conducted a retrospective, population-based cohort study of patients with lung cancer diagnosed from 2004 to 2015 in a large Canadian province. Multivariable logistic regression and Cox regression models were constructed to determine the associations between CVD and treatment patterns, and its impact on overall (OS) and cancer-specific survival (CSS), respectively. A competing risk multistate model was developed to determine the excess mortality risk of patients with pre-existing CVD. Results A total of 20,689 patients with lung cancer were eligible for the current analysis. Men comprised 55%, and the median age at diagnosis was 70 years. One-third had at least one CVD, with the most common being congestive heart failure in 15% of patients. Pre-existing CVD was associated with a lower likelihood of receiving chemotherapy (odds ratio [OR], 0.53; 95% confidence interval [CI], 0.48–0.58; P < .0001), radiotherapy (OR, 0.76; 95% CI, 0.7–0.82; P < .0001), and surgery (OR, 0.56; 95% CI, 0.44–0.7; P < .0001). Adjusting for measured confounders, the presence of pre-existing CVD predicted for inferior OS (hazard ratio [HR], 1.1; 95% CI, 1.1–1.2; P < .0001) and CSS (HR, 1.1; 95% CI, 1.1–1.1; P < .0001). However, in the competing risk multistate model that adjusted for baseline characteristics, prior CVD was associated with increased risk of non-cancer related death (HR, 1.48; 95% CI, 1.33–1.64; P < 0.0001) but not cancer related death (HR, 0.98; 95% CI, 0.94–1.03; P = 0.460). Conclusions Patients with lung cancer and pre-existing CVD are less likely to receive any modality of cancer treatment and are at a higher risk of non-cancer related deaths. As effective therapies such as immuno-oncology drugs are introduced, early cardio-oncology consultation may optimize management of lung cancer.
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Yoon DW, Shin DW, Cho JH, Lee JH, Yang JH, Han K, Park SH. Impact of previous percutaneous coronary intervention on cardiovascular outcomes and mortality after lung cancer surgery: A nationwide study in Korea. Thorac Cancer 2020; 11:2517-2528. [PMID: 32657054 PMCID: PMC7471042 DOI: 10.1111/1759-7714.13563] [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: 03/15/2020] [Revised: 06/12/2020] [Accepted: 06/17/2020] [Indexed: 11/25/2022] Open
Abstract
Background The number of patients with operable lung cancer with a history of percutaneous coronary intervention (PCI) has increased. However, cardiovascular outcomes and mortality, according to the time from PCI to surgery, and the follow‐up time after surgery are largely unknown. Here, we aimed to compare the cardiovascular outcomes and mortality of these patients with a history of PCI to those of patients without a history of PCI. Methods Using the Korean National Health Insurance Service Database, we selected 30 750 patients who underwent surgery for lung cancer between 2006 and 2014. Study outcome variables were all‐cause mortality, revascularization, intensive care unit (ICU) readmission, and stroke incidence. Patients were followed‐up until 2016. Results Of the 30 750 patients, 513 (1.7%) underwent PCI before surgery. The PCI group did not show an increased risk of death, ICU readmission, or stroke within one year of surgery, despite an increased risk of revascularization. However, one year after surgery, they showed a higher risk of death and revascularization than the non‐PCI group. The risk of revascularization was highest when the interval between PCI and surgery was <1 year and remained high when the interval was >3 years. Conclusions Patients who underwent PCI before surgery for lung cancer were at a higher risk of death than those in the non‐PCI group at one year after surgery. In addition, they showed higher short‐ and long‐term risks of revascularization than patients in the non‐PCI group. Careful long‐term management of cardiovascular risk is necessary for this population.
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Affiliation(s)
- Dong Woog Yoon
- Department of Thoracic and Cardiovascular Surgery, Armed Forces Capital Hospital, Seongnam, South Korea
| | - Dong Wook Shin
- Supportive Care Center/Department of Family Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.,Department of Digital Health, SAIHST, Sungkyunkwan University, Seoul, South Korea
| | - Jong Ho Cho
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jong-Hwan Lee
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jeong Hoon Yang
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Kyungdo Han
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.,Department of Medical Statistics, The Catholic University of Korea, Seoul, South Korea
| | - Sang Hyun Park
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.,Department of Medical Statistics, The Catholic University of Korea, Seoul, South Korea
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Cho IY, Han K, Shin DW, Park SH, Yoon DW, Shin S, Jeong SM, Cho JH. Cardiovascular risk and undertreatment of dyslipidemia in lung cancer survivors: A nationwide population-based study. Curr Probl Cancer 2020; 45:100615. [PMID: 32636025 DOI: 10.1016/j.currproblcancer.2020.100615] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 06/01/2020] [Accepted: 06/10/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND In lung cancer survivors, cardiovascular diseases (CVDs) are the leading cause of noncancer deaths. Nonetheless, there is lack of information on management of dyslipidemia, a major risk factor for future CVD events, in lung cancer survivors. This study aimed to assess dyslipidemia management and prevalence of statin eligibility in lung cancer survivors. METHODS From the Korean National Health Insurance Service database, we selected 7349 lung cancer survivors who received surgery for lung cancer from 2007 to 2014. We used descriptive statistics for analyses of dyslipidemia management status on the basis of the National Cholesterol Education Program Adult Treatment Panel III guidelines. We also identified those who met the criteria for treatment on the basis of CVD risk according to the 2018 American College of Cardiology and American Heart Association (ACC/AHA) guidelines. RESULTS The overall awareness and treatment rates for lung cancer survivors with dyslipidemia were 31.8% and 29.7%, respectively. The overall control rate for those receiving treatment was 88.7%, but was lowest in the highest risk group (78.1%). Furthermore, undertreatment of dyslipidemia was more prominent in young, male lung cancer survivors and those diagnosed with lung cancer within 3 years. Among those not receiving treatment for dyslipidemia, 61.7% were indicated for statin according to the ACC/AHA guidelines. CONCLUSION Over half of lung cancer survivors were not receiving treatment, although they were eligible for statin under current guidelines. To reduce noncancer mortality, statin use and adequate management of CVD risk factors should be encouraged in lung cancer survivors.
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Affiliation(s)
- In Young Cho
- Department of Family Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea
| | - Dong Wook Shin
- Department of Family Medicine & Supportive Care Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Department of Digital Health, Samsung Advanced Institute of Health Science and Technology (SAIHST), Sungkyunkwan University, Seoul, Republic of Korea.
| | - Sang Hyun Park
- Department of Biostatistics, The Catholic University of Korea, Seoul, Republic of Korea
| | - Dong Woog Yoon
- Department of Thoracic and Cardiovascular Surgery, Armed Forces Capital Hospital, Seongnam, Republic of Korea
| | - Sujeong Shin
- Department of Family Medicine & Supportive Care Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Su-Min Jeong
- Department of Family Medicine, Boramae Medical Center, Seoul, Republic of Korea
| | - Jong Ho Cho
- Department of Thoracic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Atherosclerotic diseases and lung cancer - a ten-year cross-sectional study in Cyprus. ACTA ACUST UNITED AC 2020; 5:e72-e78. [PMID: 32529109 PMCID: PMC7277524 DOI: 10.5114/amsad.2020.95570] [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: 04/10/2020] [Accepted: 04/25/2020] [Indexed: 11/24/2022]
Abstract
Introduction The main purpose of this work is to study atherosclerotic diseases and lung cancer in Cyprus during the period 2007–2017 with the aim of finding not only the atherosclerotic diseases with the highest risk but also a possible association between these diseases and lung cancer. Material and methods The statistical methods used to extract the results of this work are Student’s t-test and one-way analysis of variance (ANOVA), in order to check the statistical significance of atherosclerotic diseases with regard to the characteristics of the patients. Additionally, a multiple logistic regression analysis was used with the aim of finding the disease with the highest risk. Pearson’s r was used to find a possible association between atherosclerotic diseases and lung cancer. Results As specified by multiple logistic regression analysis, the atherosclerotic diseases with the highest risk of death are intracranial haemorrhage (OR = 17.3), heart failure (OR = 3.29), and stroke (OR = 3.02), with females having higher risk compared to men. Moreover, a statistically significant relation was found between heart failure and cerebral infarction with lung cancer. Conclusions The results of this work highlight the statistically significant characteristics of patients with atherosclerotic diseases and identify the risk of death according to the type of the disease. A link between these diseases and cancer was also identified.
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Alsugair F, Aljomah A, Fathala E, Fathala A. Predictors of Myocardial Ischemia in Preoperative Oncology Patients Who Underwent Fluorodeoxyglucose-Positron Emission Tomography Study. INDIAN JOURNAL OF NUCLEAR MEDICINE : IJNM : THE OFFICIAL JOURNAL OF THE SOCIETY OF NUCLEAR MEDICINE, INDIA 2020; 35:136-142. [PMID: 32351268 PMCID: PMC7182329 DOI: 10.4103/ijnm.ijnm_167_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 10/01/2019] [Accepted: 10/16/2019] [Indexed: 11/16/2022]
Abstract
Background: Coronary artery calcification (CAC) can be visually estimated on computed tomography (CT) attenuation correction (CTAC) of positron emission tomography (PET). The visual estimation of CAC from CTAC scans performed for PET/CT is comparable to the standard CAC score scan. Myocardial perfusion imaging (MPI) with single-photon emission CT (SPECT) is commonly performed for risk stratification before oncologic surgery. Objective: We investigated the value of visual estimation of CAC from CTAC of PET/CT as well as other factors such as coronary artery disease (CAD) risk factors and type of cancer as predictors of MPI ischemia. Methods: Retrospectively, we identified 268 patients who underwent PET/CT and MPI for preoperative cardiac evaluation. Visual estimation of CAC was performed and classified into four categories. Results: The results of visual CAC were as follows: 47.8% – zero CAC, 32.8% – mild CAC, 14.2% – moderate CAC, and 5.2% – severe CAC. The majority of patients (85.8%) had normal MPI, whereas 14.2% were abnormal. There was a strong association between ischemia on MPI and CAC seen on CTAC (P < 0.01), dyslipidemia (P < 0.01), family history of CAD (P < 0.05), smoking (P < 0.01), and type of malignancy (P < 0.01). Conclusion: A strong association exists between visual estimation of CAC on CTAC and MPI. Zero is highly associated with normal MPI, but moderate-to-severe CAC is associated with abnormal MPI, in addition smoking, dyslipidemia, and certain cancer are associated with ischemic MPI; subsequently, preoperative cardiac testing is warranted in these subsets of patients.
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Affiliation(s)
- Faisal Alsugair
- Department of Radiology Nuclear Medicine /PET/CT and Cardiovascular Imaging, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabai, Saudi Arabia
| | - Ali Aljomah
- Department of Radiology Nuclear Medicine /PET/CT and Cardiovascular Imaging, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabai, Saudi Arabia
| | - Eman Fathala
- Department of Radiology Nuclear Medicine /PET/CT and Cardiovascular Imaging, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabai, Saudi Arabia
| | - Ahmed Fathala
- Department of Radiology Nuclear Medicine /PET/CT and Cardiovascular Imaging, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabai, Saudi Arabia
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Zaborowska-Szmit M, Krzakowski M, Kowalski DM, Szmit S. Cardiovascular Complications of Systemic Therapy in Non-Small-Cell Lung Cancer. J Clin Med 2020; 9:E1268. [PMID: 32349387 PMCID: PMC7287714 DOI: 10.3390/jcm9051268] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 04/23/2020] [Accepted: 04/24/2020] [Indexed: 12/11/2022] Open
Abstract
Cardiovascular diseases may determine therapy outcomes of non-small-cell lung cancer (NSCLC). The evidence for how iatrogenic cardiovascular complications contribute to ceasing anticancer treatment, decreasing the quality of life or even premature death, is unclear. Older patients and smokers are at risk of atherosclerosis and arterial thromboembolic events (TE), such as myocardial infarction or stroke. Venous TE can be observed in up to 15% of NSCLC patients, but the risk increases three to five times in ALK (anaplastic lymphoma kinase)-rearranged NSCLC. ALK inhibitors are associated with electrophysiological disorders. Cytotoxic agents and anti-VEGF inhibitors mainly cause vascular complications, including venous or arterial TE. Cardiac dysfunction and arrhythmias seem to be less frequent. Chemotherapy is often administered in two-drug regimens. Clinical events can be triggered by different mechanisms. Among epidermal growth factor inhibitors, erlotinib and gefitinib can lead to coronary artery events; however, afatinib and osimertinib can be associated with the development of heart failure. During anti-PD1/anti-PDL1 therapy, myocarditis is possible, which must be differentiated from acute coronary syndrome and heart failure. Awareness of all possible cardiovascular complications in NSCLC encourages vigilance in early diagnostics and treatment.
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Affiliation(s)
- Magdalena Zaborowska-Szmit
- Department of Lung Cancer and Thoracic Tumors, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (M.Z.-S.); (M.K.); (D.M.K.)
| | - Maciej Krzakowski
- Department of Lung Cancer and Thoracic Tumors, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (M.Z.-S.); (M.K.); (D.M.K.)
| | - Dariusz M. Kowalski
- Department of Lung Cancer and Thoracic Tumors, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (M.Z.-S.); (M.K.); (D.M.K.)
| | - Sebastian Szmit
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre, 05-400 Otwock, Poland
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Shepherd SJ, Creber N, Mansour K, Wiesenfeld D, Iseli TA, Amott D. Relationship between age, comorbidities and complications in head and neck cancer patients undergoing curative surgery. ANZ J Surg 2019; 90:851-855. [DOI: 10.1111/ans.15611] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 10/30/2019] [Accepted: 11/17/2019] [Indexed: 12/22/2022]
Affiliation(s)
- Sally J. Shepherd
- Head and Neck Oncology Tumour Stream, Department of SurgeryThe Royal Melbourne Hospital, The University of Melbourne Melbourne Victoria Australia
| | - Nathan Creber
- Head and Neck Oncology Tumour Stream, Department of SurgeryThe Royal Melbourne Hospital, The University of Melbourne Melbourne Victoria Australia
| | - Kristy Mansour
- Head and Neck Oncology Tumour Stream, Department of SurgeryThe Royal Melbourne Hospital, The University of Melbourne Melbourne Victoria Australia
| | - David Wiesenfeld
- Head and Neck Oncology Tumour Stream, Department of SurgeryThe Royal Melbourne Hospital, The University of Melbourne Melbourne Victoria Australia
| | - Tim A. Iseli
- Head and Neck Oncology Tumour Stream, Department of SurgeryThe Royal Melbourne Hospital, The University of Melbourne Melbourne Victoria Australia
| | - Deborah Amott
- Head and Neck Oncology Tumour Stream, Department of SurgeryThe Royal Melbourne Hospital, The University of Melbourne Melbourne Victoria Australia
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Chitturi KR, Xu J, Araujo-Gutierrez R, Bhimaraj A, Guha A, Hussain I, Kassi M, Bernicker EH, Trachtenberg BH. Immune Checkpoint Inhibitor-Related Adverse Cardiovascular Events in Patients With Lung Cancer. JACC CardioOncol 2019; 1:182-192. [PMID: 34396181 PMCID: PMC8352266 DOI: 10.1016/j.jaccao.2019.11.013] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 11/10/2019] [Accepted: 11/11/2019] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES The purpose of this study was to evaluate whether immune checkpoint inhibitors (ICIs) are associated with an increased risk of major adverse cardiovascular events (MACE) compared with non-ICI therapies in patients with lung cancer. BACKGROUND ICIs activate the host immune system to target cancer cells. Though uncommon, cardiovascular immune-related adverse events can be life-threatening. METHODS A retrospective single-institution cohort study of 252 patients with pathologically confirmed lung cancer who received ICI or non-ICI therapy was analyzed. The primary endpoint was MACE, defined as a composite of cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, and hospitalization for heart failure. RESULTS During a median follow-up of 6 months, MACE occurred in 13.3% of ICI-treated patients, with a median time to event of 51 days, compared with 10.3% and 64 days in non-ICI patients. ICIs were not associated with MACE (hazard ratio [HR]: 1.18; 95% confidence interval [CI]: 0.57 to 2.43; p = 0.66) in a univariable Fine-Gray regression analysis incorporating noncardiovascular death as a competing risk. Multivariable regression analyses determined that patients treated with ICIs with elevated serum troponin I >0.01 ng/ml (HR: 7.27; 95% CI: 2.72 to 19.43; p < 0.001) and B-type natriuretic peptide (BNP) >100 pg/ml (HR: 2.65; 95% CI: 1.01 to 6.92; p = 0.047) had an increased risk of MACE. Patients pre-treated or receiving combined immunotherapy with ICIs and vascular endothelial growth factor inhibitors (VEGFIs) or tyrosine kinase inhibitors (TKIs) had an increased risk of MACE (HR: 2.15; 95% CI: 1.05 to 4.37; p = 0.04). CONCLUSIONS ICIs were not independently associated with an increased risk of MACE in patients with lung cancer, although power is an important limitation in these analyses. ICI-associated cardiotoxicity was associated with elevations in serum troponin and BNP, and combined immunotherapy with VEGFIs or TKIs. Future studies are needed to further define the role of cardiac biomarkers as a monitoring strategy with ICI therapy.
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Key Words
- BNP
- BNP, B-type natriuretic peptide
- CI, confidence interval
- HR, hazard ratio
- ICI, immune checkpoint inhibitor
- IQR, interquartile range
- LVEF, left ventricular ejection fraction
- MACE
- MACE, major adverse cardiovascular events
- PD, programmed cell death protein
- PD-L1, programmed cell death-ligand 1
- TKI, tyrosine kinase inhibitor
- TnI, troponin I
- VEGFI, vascular endothelial growth factor inhibitor
- cardiotoxicity
- immune checkpoint inhibitors
- lung cancer
- troponin
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Affiliation(s)
| | - Jiaqiong Xu
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA
- Center for Outcomes Research, Houston Methodist Research Institute, Houston, Texas, USA
| | | | - Arvind Bhimaraj
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA
| | - Ashrith Guha
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA
| | - Imad Hussain
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA
| | - Mahwash Kassi
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA
| | - Eric H. Bernicker
- Department of Medical Oncology, Houston Methodist Cancer Center, Houston, Texas, USA
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