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Chen Y, Han Q, Huang Z, Lyu M, Ai Z, Liang Y, Yan H, Wang M, Xiang Z. Value of IVIM in Differential Diagnoses between Benign and Malignant Solitary Lung Nodules and Masses: A Meta-analysis. Front Surg 2022; 9:817443. [PMID: 36017515 PMCID: PMC9396547 DOI: 10.3389/fsurg.2022.817443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 05/09/2022] [Indexed: 11/17/2022] Open
Abstract
Purpose This study aims to evaluate the accuracy of intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI) in distinguishing malignant and benign solitary pulmonary nodules and masses. Methods Studies investigating the diagnostic accuracy of IVIM-DWI in lung lesions published through December 2020 were searched. The standardized mean differences (SMDs) of the apparent diffusion coefficient (ADC), tissue diffusivity (D), pseudo-diffusivity (D*), and perfusion fraction (f) were calculated. The sensitivity, specificity, area under the curve (AUC), publication bias, and heterogeneity were then summarized, and the source of heterogeneity and the reliability of combined results were explored by meta-regression and sensitivity analysis. Results A total of 16 studies including 714 malignant and 355 benign lesions were included. Significantly lower ADC, D, and f values were found in malignant pulmonary lesions compared to those in benign lesions. The D value showed the best diagnostic performance (sensitivity = 0.90, specificity = 0.71, AUC = 0.91), followed by ADC (sensitivity = 0.84, specificity = 0.75, AUC = 0.88), f (sensitivity = 0.70, specificity = 0.62, AUC = 0.71), and D* (sensitivity = 0.67, specificity = 0.61, AUC = 0.67). There was an inconspicuous publication bias in ADC, D, D* and f values, moderate heterogeneity in ADC, and high heterogeneity in D, D*, and f values. Subgroup analysis suggested that both ADC and D values had a significant higher sensitivity in “nodules or masses” than that in “nodules.” Conclusions The parameters derived from IVIM-DWI, especially the D value, could further improve the differential diagnosis between malignant and benign solitary pulmonary nodules and masses. Systematic Review Registration:https://www.crd.york.ac.uk/PROSPERO/#myprospero, identifier: CRD42021226664
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Affiliation(s)
- Yirong Chen
- Graduate School, Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Radiology, Guangzhou Panyu Central Hospital, Guangzhou, China
| | - Qijia Han
- Department of Radiology, Guangzhou Panyu Central Hospital, Guangzhou, China
| | - Zhiwei Huang
- Graduate School, Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Radiology, Guangzhou Panyu Central Hospital, Guangzhou, China
| | - Mo Lyu
- Department of Radiology, Guangzhou Panyu Central Hospital, Guangzhou, China
- School of Life Sciences, South China Normal University, Guangzhou, China
| | - Zhu Ai
- Department of Radiology, Guangzhou Panyu Central Hospital, Guangzhou, China
| | - Yuying Liang
- Department of Radiology, Guangzhou Panyu Central Hospital, Guangzhou, China
| | - Haowen Yan
- Department of Oncology, Guangzhou Panyu Central Hospital, Guangzhou, China
| | - Mengzhu Wang
- Department of MR Scientific Marketing, Siemens Healthineers, Guangzhou, China
| | - Zhiming Xiang
- Department of Radiology, Guangzhou Panyu Central Hospital, Guangzhou, China
- Correspondence: Zhiming Xiang
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Xie X, Wang X, Wu S, Yang H, Liu J, Chen H, Ding Y, Ling L, Lin H. Fatal toxic effects related to EGFR tyrosine kinase inhibitors based on 53 cohorts with 9,569 participants. J Thorac Dis 2020; 12:4057-4069. [PMID: 32944317 PMCID: PMC7475571 DOI: 10.21037/jtd-19-4000a] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Background To estimate the incidence and susceptible factors of fatal toxic effects related to epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs). Methods PubMed and Embase were thoroughly searched for clinical trials based on the following terms and corresponding Medical Subject Heading ones: “erlotinib”, “gefitinib”, “afatinib”, “dacomitinib”, “osimertinib”, and “non-small-cell lung cancer (NSCLC)”. A total of 53 eligible cohorts with 9,569 participants were collected. Results A total of 105 cases of fatal toxic effects related to EGFR-TKIs occurred in 53 cohorts. The overall incidence was 1.33% [95% confidence interval (CI): 1.08–1.63%]. The odds and incidence were apparently higher in Japanese group (compared with non-East Asian group) [2.72 vs. 1.30, P=0.015; odds ratio (OR): 2.26, 95% CI: 1.17–4.37, P=0.015], in first-line treatment group (compared with EGFR-TKI retreatment group) (1.54 vs. 0.69, P=0.028; OR: 2.41, 95% CI: 1.10–5.26, P=0.028), and in the trial phase II (compared with trial phase III) (1.82% vs. 1.11%, P=0.009; OR: 1.73, 95% CI: 1.15–2.62, P=0.009). Notably, the Japanese group was higher than non-East Asian group after controlling for the treatment-line and trial phase (OR: 2.16, 95% CI: 1.12–4.16, P=0.022). Interstitial lung disease (ILD) was predominant in 29 fatal causes followed by pneumonia, respiratory failure and diarrhea. Conclusions The overall incidence of fatal toxic effects related to EGFR-TKIs was 1.33%, and the major fatal cause was ILD, followed by pneumonia, respiratory failure and diarrhea. The susceptible factor of fatal toxic effects related to EGFR-TKIs was the Japanese group. This study provided a capability for clinicians to predict and detect high-risk populations of fatal toxic effects.
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Affiliation(s)
- Xianhe Xie
- Department of Chemotherapy, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Xuewen Wang
- Department of Oncology, The 900th Hospital of the People's Liberation Army Joint Service Support Force, Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Sumei Wu
- Department of Chemotherapy, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Haitao Yang
- Department of Chemotherapy, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Junjin Liu
- Department of Chemotherapy, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Huijuan Chen
- Department of Chemotherapy, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Yin Ding
- Department of Chemotherapy, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Liting Ling
- Department of Chemotherapy, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Heng Lin
- Department of Chemotherapy, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
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Marcus MW, Duffy SW, Devaraj A, Green BA, Oudkerk M, Baldwin D, Field J. Probability of cancer in lung nodules using sequential volumetric screening up to 12 months: the UKLS trial. Thorax 2019; 74:761-767. [PMID: 31028232 DOI: 10.1136/thoraxjnl-2018-212263] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 01/06/2019] [Accepted: 02/11/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND Estimation of the clinical probability of malignancy in patients with pulmonary nodules will facilitate early diagnosis, determine optimum patient management strategies and reduce overall costs. METHODS Data from the UK Lung Cancer Screening trial were analysed. Multivariable logistic regression models were used to identify independent predictors and to develop a parsimonious model to estimate the probability of lung cancer in lung nodules detected at baseline and at 3-month and 12-month repeat screening. RESULTS Of 1994 participants who underwent CT scan, 1013 participants had a total of 5063 lung nodules and 52 (2.6%) of the participants developed lung cancer during a median follow-up of 4 years. Covariates that predict lung cancer in our model included female gender, asthma, bronchitis, asbestos exposure, history of cancer, early and late onset of family history of lung cancer, smoking duration, FVC, nodule type (pure ground-glass and part-solid) and volume as measured by semiautomated volumetry. The final model incorporating all predictors had excellent discrimination: area under the receiver operating characteristic curve (AUC 0.885, 95% CI 0.880 to 0.889). Internal validation suggested that the model will discriminate well when applied to new data (optimism-corrected AUC 0.882, 95% CI 0.848 to 0.907). The risk model had a good calibration (goodness-of-fit χ[8] 8.13, p=0.42). CONCLUSIONS Our model may be used in estimating the probability of lung cancer in nodules detected at baseline and at 3 months and 12 months from baseline, allowing more efficient stratification of follow-up in population-based lung cancer screening programmes. TRIAL REGISTRATION NUMBER 78513845.
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Affiliation(s)
- Michael W Marcus
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
| | - Stephen W Duffy
- Barts and London, Wolfson Institute of Preventive Medicine, London, UK
| | - Anand Devaraj
- Department of Radiology, Royal Brompton Hospital London, London, UK
| | - Beverley A Green
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
| | - Matthijs Oudkerk
- Center for Medical Imaging (CMI), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | | | - John Field
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
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Update on Cardiovascular Safety of Tyrosine Kinase Inhibitors: With a Special Focus on QT Interval, Left Ventricular Dysfunction and Overall Risk/Benefit. Drug Saf 2016; 38:693-710. [PMID: 26008987 DOI: 10.1007/s40264-015-0300-1] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
We previously reviewed the cardiovascular safety of 16 tyrosine kinase inhibitors (TKIs), approved for use in oncology as of 30 September 2012. Since then, the indications for some of them have been widened and an additional nine TKIs have also been approved as of 30 April 2015. Eight of these nine are indicated for use in oncology and one (nintedanib) for idiopathic pulmonary fibrosis. This report is an update on the cardiovascular safety of those 16 TKIs, including the post-marketing data concerning their pro-arrhythmic effects, and reviews the cardiovascular safety of the nine new TKIs approved since (afatinib, cabozantinib, ceritinib, dabrafenib, ibrutinib, lenvatinib, nintedanib, ponatinib, and trametinib). As before, we focus on specific aspects of cardiovascular safety, namely their potential to induce QT interval prolongation, left ventricular (LV) dysfunction and hypertension but now also summarise the risks of arterial thromboembolic events (ATEs) associated with these agents. Of the newer TKIs, cabozantinib and ceritinib have been shown to induce a mild to moderate degree of QTc interval prolongation while cardiac dysfunction has been reported with the use of afatinib, dabrafenib, lenvatinib, ponatinib and trametinib. The label for axitinib was revised to include a new association with cardiac dysfunction. Hypertension is associated with cabozantinib, lenvatinib, nintedanib, ponatinib and trametinib. Ponatinib, within 10 months of its approval in December 2012, required voluntary (temporary) suspension of its marketing until significant safety revisions (restricted indication, additional warnings and precautions about the risk of arterial occlusion and thromboembolic events and amended dose) were made to its label. Compared with the previous 16 TKIs, more of the recently introduced TKIs are associated with the risk of LV dysfunction, and fewer with QT prolongation. Available data on morbidity and mortality associated with TKIs, together with post-marketing experience with lapatinib and ponatinib, emphasise the need for effective pharmacovigilance and ongoing re-assessment of their risk/benefit after approval of these novel agents. If not adequately managed, these cardiovascular effects significantly decrease the quality of life and increase the morbidity and mortality in a population already at high risk. Evidence accumulated over the last decade suggests that their clinical benefit, although worthwhile, is modest and extends only to progression-free survival and complete response without any effect on overall survival. During uncontrolled use in routine clinical practice, their risk/benefit is likely to be inferior to that perceived from highly controlled clinical trials.
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Zhou JG, Tian X, Cheng L, Zhou Q, Liu Y, Zhang Y, Bai YJ, Ma H. The Risk of Neutropenia and Leukopenia in Advanced Non-Small Cell Lung Cancer Patients Treated With Erlotinib: A Prisma-Compliant Systematic Review and Meta-Analysis. Medicine (Baltimore) 2015; 94:e1719. [PMID: 26448029 PMCID: PMC4616758 DOI: 10.1097/md.0000000000001719] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) are a critical member of systemic therapy for advanced non-small-cell lung cancer (NSCLC). Erlotinib is the first-generation EGFR-TKIs, the National Comprehensive Cancer Network (NCCN) guidelines recommend it as a first-line agent in patients with sensitizing EGFR mutations. However, the safety of erlotinib plus chemotherapy (CT) or erlotinib alone for advanced NSCLC remains controversial. We carried out a systematic meta-analysis to determine the overall risk of neutropenia and leukopenia associated with erlotinib. PubMed, EMBASE, CBM, CNKI, WanFang database, The Cochrane library, Web of Science, as well as abstracts presented at ASCO conferences and ClinicalTrials.gov were searched to identify relevant studies. RR with 95% CIs for neutropenia and leukopenia were all extracted. The random-effects model was used to calculate pooled RRs and 95% CIs. Power calculation was performed using macro embedded in SAS software after all syntheses were conducted. We identified 12 eligible studies involving 3932 patients. Erlotinib plus CT or alone relative to CT is associated with significantly decreased risks of neutropenia and leukopenia in patients with advanced NSCLC (RR, 0.38; 95% CI, 0.21-0.71; P = 0.00; incidence: 9.9 vs. 35.2%) and (RR, 0.32; 95% CI, 0.11-0.93; P = 0.04; incidence: 3.5 vs. 11.6%), respectively. The subgroup analysis by erlotinib with or without CT showed that erlotinib combine with CT have no significance decrease the relative risks of neutropenia or leukopenia (RR, 0.98; 95% CI, 0.78-1.23; P = 0.87; incidence: 26.2 vs. 30.5%) and (RR, 0.81; 95% CI, 0.34-1.95; P = 0.64; incidence: 6.5 vs. 9.3%), respectively. However, erlotinib alone could decrease incidence of neutropenia (RR, 0.14; 95% CI, 0.07-0.27; P = 0.00; incidence: 3.7 vs. 40.8%) or leukopenia (RR, 0.07; 95% CI, 0.01-0.45; P = 0.01; incidence: 0.8 vs. 15.7%). The power analysis suggests that a power of 61.31% was determined to detect an RR of 0.38 for neutropenia, and 78.03% for an RR of 0.32 for leukopenia. The present meta-analysis suggested that erlotinib could decrease the incidence of neutropenia and leukopenia in patients with advanced NSCLC undergoing erlotinib regardless of whether combined with CT or not. The subgroup analysis revealed that erlotinib combine with CT did not affect the incidence; however, erlotinib alone could significantly decrease the incidence of neutropenia and leukopenia compared with CT alone.
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Affiliation(s)
- Jian-Guo Zhou
- From the Department of Oncology, Affiliated Hospital of Zunyi Medical University (JGZ, LC,YZ,YJB, HM); Center for Translational Medicine, Zunyi Medical University, Zunyi (JGZ, HM); Graduate College (XT); School of Nursing, Tianjin University of Traditional Chinese Medicine, Tianjin (XT); Department of Science and Education, First People's Hospital of Changde City, Changde (QZ); Department of Pharmacology (YL); and Key Laboratory of Basic Pharmacology of Ministry of Education, Zunyi Medical University, Zunyi, China (YL)
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Momcilovic M, Shackelford DB. Targeting LKB1 in cancer - exposing and exploiting vulnerabilities. Br J Cancer 2015; 113:574-84. [PMID: 26196184 PMCID: PMC4647688 DOI: 10.1038/bjc.2015.261] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 06/02/2015] [Accepted: 06/07/2015] [Indexed: 12/13/2022] Open
Abstract
The LKB1 tumour suppressor is a serine/threonine kinase that functions as master regulator of cell growth, metabolism, survival and polarity. LKB1 is frequently mutated in human cancers and research spanning the last two decades have begun decoding the cellular pathways deregulated following LKB1 inactivation. This work has led to the identification of vulnerabilities present in LKB1-deficient tumour cells. Pre-clinical studies have now identified therapeutic strategies targeting this subset of tumours that promise to benefit this large patient population harbouring LKB1 mutations. Here, we review the current efforts that are underway to translate pre-clinical discovery of therapeutic strategies targeting LKB1 mutant cancers into clinical practice.
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Affiliation(s)
- M Momcilovic
- Department of Pulmonary and Critical Care Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA
| | - D B Shackelford
- Department of Pulmonary and Critical Care Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA
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Soura E, Chasapi V, Stratigos AJ. Pharmacologic treatment options for advanced epithelial skin cancer. Expert Opin Pharmacother 2015; 16:1479-93. [DOI: 10.1517/14656566.2015.1052743] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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8
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Qi WX, Sun YJ, Shen Z, Yao Y. Risk of interstitial lung disease associated with EGFR-TKIs in advanced non-small-cell lung cancer: a meta-analysis of 24 phase III clinical trials. J Chemother 2014; 27:40-51. [PMID: 24724908 DOI: 10.1179/1973947814y.0000000189] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
PURPOSE To assess the risk of interstitial lung disease (ILD) with epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) gefitinib, erlotinib, and afatinib. METHOD PubMed databases were searched for relevant articles. Statistical analyses were conducted to calculate the summary incidence, odds ratio (OR), and 95% confidence intervals (CIs) by using either random-effects or fixed-effect models. RESULTS The incidence of all-grade and high-grade (≧ grade 3) ILD associated with EGFR-TKIs was 1.6% (95% CI, 1.0-2.4%) and 0.9% (95% CI, 0.6%-1.4%), with a mortality of 13.0% (95% CI, 7.6-21.6%). Patients treated with EGFR-TKIs had a significantly increased risk of developing all-grade (OR, 1.74; 95% CI, 1.25-2.43; P = 0.001) and high-grade (OR, 4.38; 95% CI, 2.18-8.79; P<0.001) ILD. No significant difference in the risk of ILD was found in sub-group analysis according to EGFR-TKIs, percentage of EGFR mutation, study location, EGFR-TKIs-based regimens, and controlled therapy. CONCLUSIONS Treatment with EGFR-TKIs is associated with a significantly increased risk of developing ILD.
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Li X, Shan BE, Wang J, Xing LP, Guo XJ, Zhang YH, Shi PH, Wang ZY. Incidence and risk of treatment-related mortality with anti-epidermal growth factor receptor monoclonal antibody in cancer patients: a meta-analysis of 21 randomized controlled trials. PLoS One 2013; 8:e81897. [PMID: 24312376 PMCID: PMC3842967 DOI: 10.1371/journal.pone.0081897] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2013] [Accepted: 10/14/2013] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Anti-epidermal growth factor receptor (EGFR) monoclonal antibodies (MoAbs) cetuximab and panitumumab have emerged as an effective targeted therapy in the treatment of cancer patients, but the overall incidence and risk of fatal adverse events (FAEs) associated with these agents is still unclear. METHODS Databases from PubMed, Web of Science and abstracts presented at ASCO meeting up to May 31, 2013 were searched to identify relevant studies. Eligible studies included prospective randomized controlled trials evaluating MoAbs in cancer patients with adequate data on FAEs. Statistical analyses were conducted to calculate the summary incidence, odds ratio and 95% confidence intervals (CIs) by using either random effects or fixed effect models according to the heterogeneity of included studies. RESULTS A total of 14,776 patients with a variety of solid tumors from 21 clinical trials were included in our analysis. The overall incidence of MoAbs associated FAEs was 1.7% (95%CI: 1.1-2.5%), and the incidence of cetuximab-related FAEs was higher than that of panitumumab (2.0% versus 0.9%). Compared with the controls, the use of MoAbs was associated with a significantly increased risk of FAEs, with an OR of 1.37 (95%CI: 1.04-1.81, p=0.024). Subgroup analysis based on EGFR-MoAbs drugs, phase of trials and tumor types demonstrated a tendency to increase the risk of FAEs, but the risk did not increase in breast cancer, esophagus cancer and phase II trials. CONCLUSIONS With present evidence, the use of EGFR-MoAbs is associated with an increased risk of FAEs in patients with advanced solid tumors.
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Affiliation(s)
- Xing Li
- Department of Biotherapy, Fourth Hospital of Hebei Medical University, Shijiazhuang, People’s Republic of China
| | - Bao-En Shan
- Centre of Scientific Research, Fourth Hospital of Hebei Medical University, Shijiazhuang, People’s Republic of China
| | - Juan Wang
- Department of Biotherapy, Fourth Hospital of Hebei Medical University, Shijiazhuang, People’s Republic of China
| | - Lian-Ping Xing
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, New York, United States of America
| | - Xiao-Jin Guo
- Department of Biotherapy, Fourth Hospital of Hebei Medical University, Shijiazhuang, People’s Republic of China
| | - Yue-Hua Zhang
- Department of Biotherapy, Fourth Hospital of Hebei Medical University, Shijiazhuang, People’s Republic of China
| | - Peng-Hui Shi
- Department of Biotherapy, Fourth Hospital of Hebei Medical University, Shijiazhuang, People’s Republic of China
| | - Zhi-Yu Wang
- Department of Biotherapy, Fourth Hospital of Hebei Medical University, Shijiazhuang, People’s Republic of China
- * E-mail:
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