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Yamaguchi M, Hirata H, Ebi N, Araki J, Seto T, Maruyama R, Akamine S, Inoue Y, Semba H, Sasaki J, Okamoto T. Phase II study of vinorelbine plus carboplatin with concurrent radiotherapy in elderly patients with non-small cell lung cancer. Jpn J Clin Oncol 2020; 50:318-324. [PMID: 31804689 DOI: 10.1093/jjco/hyz179] [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: 07/08/2019] [Revised: 09/27/2019] [Accepted: 10/27/2019] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Concurrent chemoradiotherapy is the standard treatment for locally advanced non-small cell lung cancer. In the current aging society, the establishment of an ideal treatment strategy for locally advanced non-small cell lung cancer in the elderly is warranted. To assess the efficacy of concurrent chemoradiotherapy with carboplatin and vinorelbine in elderly patients with locally advanced non-small cell lung cancer. PURPOSE To assess the efficacy of concurrent chemoradiotherapy with carboplatin and vinorelbine in elderly patients with locally advanced non-small cell lung cancer. METHODS This multicenter, phase II study included patients with physiologically or medically unresectable stage I-III NSCLC, who were ≥70 years old. The patients received carboplatin (AUC 2) and vinorelbine (15 mg/m2) both on day 1, 8, 22 and 29 concurrently with radiotherapy (2.0 Gy/day, 30 fractions, total 60 Gy). The primary endpoint was the objective response rate. The secondary endpoints were the progression-free survival, overall survival and the incidence of adverse events. RESULTS 50 patients were accrued (42 men and 8 women). The median age was 77 years (range, 70-89 years) and the clinical stage was I/II/III in 3/7/40, respectively. Forty-seven patients completed the planned treatment. The response was complete remission in 4, partial response in 31, stable disease in 12 and progressive disease in 3, giving an objective response rate of 70% (95% confidence interval: 55.4-82.1). Frequent high Grade 3 or higher adverse events were hematologic, but no treatment deaths were noted. The median and 2-year progression-free survival were 8.4 months and 21.1% (95% confidence interval: 9.5-32.7%), respectively, and the median and 2-year overall survival were 15.4 months and 41.1% (95% confidence interval: 27.0-55.2), respectively. CONCLUSION Concurrent chemoradiotherapy with carboplatin and vinorelbine showed an acceptable objective response rate and safety in elderly patients.
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Affiliation(s)
- Masafumi Yamaguchi
- Department of Thoracic Oncology, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
| | - Hideki Hirata
- Department of Radiation Oncology, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
| | - Noriyuki Ebi
- Department of Respiratory Oncology, Iizuka Hospital, Iizuka, Japan
| | - Jun Araki
- Department of Respiratory Medicine, Yamaguchi Prefectural Grand Medical Center, Hofu, Japan
| | - Takashi Seto
- Department of Thoracic Oncology, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
| | - Riichiroh Maruyama
- Department of Thoracic Surgery, Steel Memorial Yawata Hospital, Kitakyushu, Japan
| | - Shinji Akamine
- Department of Chest Surgery, Oita Prefectural Hospital, Oita, Japan
| | - Yuichi Inoue
- Department of Respiratory Medicine, Isahaya General Hospital, Isahaya, Japan
| | - Hiroshi Semba
- Division of Respiratory Diseases, Kumamoto Regional Medical Center, Kumamoto, Japan
| | - Jiichiro Sasaki
- Department of Respiratory Medicine, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Tatsuro Okamoto
- Department of Thoracic Oncology, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
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Miyake A, Okudela K, Matsumura M, Hideaki M, Arai H, Umeda S, Yamanaka S, Ishikawa Y, Tajiri M, Ohashi K. Update on the potential significance of psammoma bodies in lung adenocarcinoma from a modern perspective. Histopathology 2017; 72:609-618. [DOI: 10.1111/his.13397] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 09/06/2017] [Accepted: 09/08/2017] [Indexed: 01/09/2023]
Affiliation(s)
- Akio Miyake
- Division of Diagnostic Pathology; Yokohama City University Hospital; Yokohama Japan
| | - Koji Okudela
- Department of Pathology; Yokohama University Graduate School of Medicine; Yokohama Japan
| | - Mai Matsumura
- Division of Diagnostic Pathology; Yokohama City University Hospital; Yokohama Japan
| | - Mitsui Hideaki
- Department of Pathology; Yokohama University Graduate School of Medicine; Yokohama Japan
| | - Hiromasa Arai
- Division of General Thoracic Surgery; Kanagawa Prefectural Cardiovascular and, Respiratory Centre Hospital; Yokohama Japan
| | - Shigeaki Umeda
- Department of Pathology; Yokohama University Graduate School of Medicine; Yokohama Japan
| | - Shoji Yamanaka
- Division of Diagnostic Pathology; Yokohama City University Hospital; Yokohama Japan
| | - Yoshihiro Ishikawa
- Division of General Thoracic Surgery; Yokohama City University Hospital; Yokohama Japan
| | - Michihiko Tajiri
- Division of General Thoracic Surgery; Kanagawa Prefectural Cardiovascular and, Respiratory Centre Hospital; Yokohama Japan
| | - Kenichi Ohashi
- Division of Diagnostic Pathology; Yokohama City University Hospital; Yokohama Japan
- Department of Pathology; Yokohama University Graduate School of Medicine; Yokohama Japan
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3
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Okudela K, Mitsui H, Matsumura M, Arai H, Shino K, Sekine A, Woo T, Suzuki T, Ishikawa Y, Umeda S, Tajiri M, Masuda M, Ohashi K. The potential significance of alpha-enolase (ENO1) in lung adenocarcinomas - A utility of the immunohistochemical expression in pathologic diagnosis. Pathol Int 2017; 67:602-609. [DOI: 10.1111/pin.12607] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Accepted: 09/28/2017] [Indexed: 12/28/2022]
Affiliation(s)
| | | | | | - Hiromasa Arai
- Surgery; Yokohama City University Graduate School of Medicine; 3-9, Future, Kanazawa-ku 236-0004 Yokohama Japan
- Divisions of General Thoracic Surgery
| | | | - Akimasa Sekine
- Respiratory Medicine; Kanagawa Prefectural Cardiovascular and Respiratory Center Hospital; 6-16-1, Tomioka-higashi Kanazawa-ku 230-0051, Yokohama Japan
| | - Tetsukan Woo
- Surgery; Yokohama City University Graduate School of Medicine; 3-9, Future, Kanazawa-ku 236-0004 Yokohama Japan
| | | | - Yoshihiro Ishikawa
- Surgery; Yokohama City University Graduate School of Medicine; 3-9, Future, Kanazawa-ku 236-0004 Yokohama Japan
| | | | | | - Munetaka Masuda
- Surgery; Yokohama City University Graduate School of Medicine; 3-9, Future, Kanazawa-ku 236-0004 Yokohama Japan
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4
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Okudela K, Mitsui H, Woo T, Arai H, Suzuki T, Matsumura M, Kojima Y, Umeda S, Tateishi Y, Masuda M, Ohashi K. Alterations in cathepsin L expression in lung cancers. Pathol Int 2016; 66:386-92. [PMID: 27327955 DOI: 10.1111/pin.12424] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 05/09/2016] [Accepted: 05/19/2016] [Indexed: 12/19/2022]
Abstract
We herein investigated the potential role of cathepsin L in lung carcinogenesis. Lung cancer cell lines and surgically resected tumors were examined for the expression of the cathepsin L protein and copy number alterations in its gene locus. Cathepsin L was stably expressed in bronchiolar epithelial cells. Neoplastic cells expressed cathepsin L at various levels, whereas its expression was completely lost in most of the lung cancer cell lines (63.6%, 7/11) examined. Furthermore, expression levels were lower in a large fraction of lung tumors (69.5%, 139/200) than in bronchiolar epithelia. The expression of cathepsin L was lost in some tumors (16.0%, 32/200). In adenocarcinomas, expression levels were significantly lower in high-grade tumors than in low-grade tumors (one-way ANOVA, P < 0.0500). Copy number alterations were found in 18.0% (36 [32 gain + 4 loss] /200) of lung tumors. No relationship existed between cathepsin L protein expression levels and the copy number of its gene locus (Spearman's rank-order correlation, P = 0.3096). Collectively, these results suggest that the down-regulated expression of cathepsin L, which is caused by an undefined mechanism other than copy number alterations, is involved in the progression of lung adenocarcinomas.
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Affiliation(s)
- Koji Okudela
- Department of Pathology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Hideaki Mitsui
- Department of Pathology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Tetsukan Woo
- Department of Surgery, Yokohama City University, Graduate School of Medicine, Yokohama, Japan
| | - Hiromasa Arai
- Division of General Thoracic Surgery, Kanagawa Prefectural Cardiovascular and Respiratory Center Hospital, Yokohama, Japan
| | - Takehisa Suzuki
- Department of Pathology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Mai Matsumura
- Department of Pathology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Yoko Kojima
- Department of Pathology, Yokohama City University Graduate School of Medicine, Yokohama, Japan.,Department of Surgery, Yokohama City University, Graduate School of Medicine, Yokohama, Japan
| | - Shigeaki Umeda
- Department of Pathology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Yoko Tateishi
- Department of Pathology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Munetaka Masuda
- Department of Surgery, Yokohama City University, Graduate School of Medicine, Yokohama, Japan
| | - Kenichi Ohashi
- Department of Pathology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
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Faria SL. Role of radiotherapy in metastatic non-small cell lung cancer. Front Oncol 2014; 4:229. [PMID: 25353005 PMCID: PMC4195278 DOI: 10.3389/fonc.2014.00229] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Accepted: 08/08/2014] [Indexed: 11/13/2022] Open
Abstract
Radiotherapy has had important role in the palliation of NSCLC. Randomized trials tend to suggest that, in general, short regimens give similar palliation and toxicity compared to longer regimens. The benefit of combining chemotherapy to radiosensitize the palliative radiation treatment is an open question, but so far it has not been proved to be very useful in NSCLC. The addition of molecular targeted drugs to radiotherapy outside of approved regimens or clinical trials warrants careful consideration for every single case and probably should not be used as a routine management. Stereotactic radiosurgery (SRS) and stereotactic body radiation therapy (SBRT) are modern techniques being used each time more frequently in the treatment of single or oligometastases. In general, they offer good tumor control with little toxicity (with a more expensive cost) compared to the traditionally fractionated radiotherapy regimens.
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Affiliation(s)
- Sergio L Faria
- Department of Radiation Oncology, McGill University Health Centre, Montreal General Hospital , Montreal, QC , Canada
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OKUDELA KOJI, SUZUKI TAKESHISA, UMEDA SHIGEAKI, TATEISHI YOKO, MITSUI HIDEAKI, MIYAGI YOHEI, OHASHI KENICHI. A comprehensive search for microRNAs with expression profiles modulated by oncogenic KRAS: Potential involvement of miR-31 in lung carcinogenesis. Oncol Rep 2014; 32:1374-84. [DOI: 10.3892/or.2014.3339] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Accepted: 05/13/2014] [Indexed: 11/06/2022] Open
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7
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Okudela K, Tateishi Y, Umeda S, Mitsui H, Suzuki T, Saito Y, Woo T, Tajiri M, Masuda M, Miyagi Y, Ohashi K. Allelic imbalance in the miR-31 host gene locus in lung cancer--its potential role in carcinogenesis. PLoS One 2014; 9:e100581. [PMID: 24978700 PMCID: PMC4076198 DOI: 10.1371/journal.pone.0100581] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Accepted: 05/26/2014] [Indexed: 11/22/2022] Open
Abstract
Small non-protein coding RNA, microRNA (miR), which regulate messenger RNA levels, have recently been identified, and may play important roles in the pathogenesis of various diseases. The present study focused on miR-31 and investigated its potential involvement in lung carcinogenesis. The expression of miR-31 was altered in lung cancer cells through either the amplification or loss of the host gene locus. The strong expression of miR-31 in large cell carcinomas was attributed to the gene amplification. Meanwhile, the loss of miR-31 expression was more frequently observed in aggressive adenocarcinomas. Thus, miR-31 may play a pleiotropic role in the development of lung cancers among different histological types. To the best of our knowledge, this is the first study to show the potential causative mechanism of the altered expression of miR-31 and suggest its potentially diverse significance in the different histological types of lung cancers.
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MESH Headings
- Adenocarcinoma/genetics
- Adenocarcinoma/pathology
- Adenocarcinoma/surgery
- Allelic Imbalance
- Carcinogenesis/genetics
- Carcinogenesis/pathology
- Carcinoma, Large Cell/genetics
- Carcinoma, Large Cell/pathology
- Carcinoma, Large Cell/surgery
- Carcinoma, Small Cell/genetics
- Carcinoma, Small Cell/pathology
- Carcinoma, Small Cell/surgery
- Carcinoma, Squamous Cell/genetics
- Carcinoma, Squamous Cell/pathology
- Carcinoma, Squamous Cell/surgery
- Cell Line, Tumor
- Gene Dosage
- Gene Expression Regulation, Neoplastic
- Genetic Loci
- Genetic Pleiotropy
- Humans
- Lung Neoplasms/genetics
- Lung Neoplasms/pathology
- Lung Neoplasms/surgery
- MicroRNAs/genetics
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Affiliation(s)
- Koji Okudela
- Department of Pathology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
- * E-mail:
| | - Yoko Tateishi
- Department of Pathology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Shigeaki Umeda
- Department of Pathology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Hideaki Mitsui
- Department of Pathology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Takeshisa Suzuki
- Department of Pathology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Yuichi Saito
- Department of Pathology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Tetsukan Woo
- Department of Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Michihiko Tajiri
- Division of General Thoracic Surgery, Kanagawa Cardiovascular and Respiratory Disease Center Hospital, Yokohama, Japan
| | - Munetaka Masuda
- Department of Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Yohei Miyagi
- Clinical Research Institute, Kanagawa Prefectural Cancer Center Hospital, Yokohama, Japan
| | - Kenichi Ohashi
- Department of Pathology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
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8
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Ishida K, Hirose T, Yokouchi J, Oki Y, Kusumoto S, Sugiyama T, Ishida H, Shirai T, Nakashima M, Yamaoka T, Ohnishi T, Ohmori T, Kagami Y. Phase II study of concurrent chemoradiotherapy with carboplatin and vinorelbine for locally advanced non-small-cell lung cancer. Mol Clin Oncol 2014; 2:405-410. [PMID: 24772308 DOI: 10.3892/mco.2014.252] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Accepted: 01/01/2014] [Indexed: 11/05/2022] Open
Abstract
Patients with non-small cell lung cancer (NSCLC) have locally advanced disease with poor prognosis. Although concurrent chemoradiotherapy is the standard treatment, more effective regimens are required. The aim of this study was to assess the safety and efficacy of concurrent chemoradiotherapy with a divided schedule of carboplatin and vinorelbine in patients with locally advanced NSCLC. Patients with unresectable, stage IIIA or IIIB NSCLC were eligible for enrollment if they exhibited a performance status of 0-2 and were ≤75 years of age. Patients were treated with carboplatin at an area under the plasma concentration vs. time curve of 2.5 mg/ml/min and vinorelbine at 20 mg/m2 on days 1 and 8 every 3 weeks. Thoracic radiotherapy at a total dose of 60 Gy was concurrently administered (2 Gy per fraction). Twenty-eight patients (23 men and 5 women; median age, 67 years; range 47-75 years) were enrolled in the present study. The overall response rate was 85.7% [95% confidence interval (CI), 67.3-96.0%] and the disease control rate was 96.4% (95% CI, 81.7-99.9%). The median survival time (MST) was 23 months and the median progression-free survival (PFS) time was 8 months. Grade 3-4 toxicities included neutropenia, thrombocytopenia, anemia and infection in 100, 14, 46 and 36% of patients, respectively. One patient (4%) developed grade 3 radiation esophagitis that resolved completely without residual dilation. Grade 3 radiation pneumonitis occurred in 2 patients (7%); however, the symptoms and radiographic abnormalities subsided with corticosteroid therapy. In conclusion, concurrent chemoradiotherapy with a divided schedule of carboplatin and vinorelbine is well-tolerated and effective in patients with locally advanced NSCLC.
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Affiliation(s)
- Koko Ishida
- Division of Respiratory Medicine and Allergology, Department of Internal Medicine, Showa University School of Medicine, Shinagawa, Tokyo 142-8666
| | - Takashi Hirose
- Department of Respirology, National Hospital Organization, Tokyo Hospital, Tokyo 204-8585
| | - Junichi Yokouchi
- Department of Radiology, Showa University School of Medicine, Shinagawa, Tokyo 142-8666, Japan
| | - Yasunari Oki
- Division of Respiratory Medicine and Allergology, Department of Internal Medicine, Showa University School of Medicine, Shinagawa, Tokyo 142-8666
| | - Sojiro Kusumoto
- Division of Respiratory Medicine and Allergology, Department of Internal Medicine, Showa University School of Medicine, Shinagawa, Tokyo 142-8666
| | - Tomohide Sugiyama
- Division of Respiratory Medicine and Allergology, Department of Internal Medicine, Showa University School of Medicine, Shinagawa, Tokyo 142-8666
| | - Hiroo Ishida
- Division of Respiratory Medicine and Allergology, Department of Internal Medicine, Showa University School of Medicine, Shinagawa, Tokyo 142-8666
| | - Takao Shirai
- Division of Respiratory Medicine and Allergology, Department of Internal Medicine, Showa University School of Medicine, Shinagawa, Tokyo 142-8666
| | - Masanao Nakashima
- Division of Respiratory Medicine and Allergology, Department of Internal Medicine, Showa University School of Medicine, Shinagawa, Tokyo 142-8666
| | - Toshimitsu Yamaoka
- Institute of Molecular Oncology, Showa University School of Medicine, Shinagawa, Tokyo 142-8666, Japan
| | - Tsukasa Ohnishi
- Division of Respiratory Medicine and Allergology, Department of Internal Medicine, Showa University School of Medicine, Shinagawa, Tokyo 142-8666
| | - Tohru Ohmori
- Institute of Molecular Oncology, Showa University School of Medicine, Shinagawa, Tokyo 142-8666, Japan
| | - Yoshikazu Kagami
- Department of Radiology, Showa University School of Medicine, Shinagawa, Tokyo 142-8666, Japan
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Okudela K, Katayama A, Woo T, Mitsui H, Suzuki T, Tateishi Y, Umeda S, Tajiri M, Masuda M, Nagahara N, Kitamura H, Ohashi K. Proteome analysis for downstream targets of oncogenic KRAS--the potential participation of CLIC4 in carcinogenesis in the lung. PLoS One 2014; 9:e87193. [PMID: 24503901 PMCID: PMC3913595 DOI: 10.1371/journal.pone.0087193] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Accepted: 12/20/2013] [Indexed: 01/27/2023] Open
Abstract
This study investigated the proteome modulated by oncogenic KRAS in immortalized airway epithelial cells. Chloride intracellular channel protein 4 (CLIC4), S100 proteins (S100A2 and S100A11), tropomyosin 2, cathepsin L1, integrinsα3, eukaryotic elongation factor 1, vimentin, and others were discriminated. We here focused on CLIC4 to investigate its potential involvement in carcinogenesis in the lung because previous studies suggested that some chloride channels and chloride channel regulators could function as tumor suppressors. CILC4 protein levels were reduced in some lung cancer cell lines. The restoration of CLIC4 in lung cancer cell lines in which CLIC4 expression was reduced attenuated their growth activity. The immunohistochemical expression of the CLIC4 protein was weaker in primary lung cancer cells than in non-tumorous airway epithelial cells and was occasionally undetectable in some tumors. CLIC4 protein levels were significantly lower in a subtype of mucinous ADC than in others, and were also significantly lower in KRAS-mutated ADC than in EGFR-mutated ADC. These results suggest that the alteration in CLIC4 could be involved in restrictedly the development of a specific fraction of lung adenocarcinomas. The potential benefit of the proteome modulated by oncogenic KRAS to lung cancer research has been demonstrated.
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Affiliation(s)
- Koji Okudela
- Department of Pathology, Yokohama City University Graduate School of Medicine, 3-9, Future, Kanazawa-ku, Yokohama, Japan
- * E-mail:
| | - Akira Katayama
- Department of Biochemistry/Cell Biology, Nippon Medical University, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, Japan
| | - Tetsukan Woo
- Department of Surgey, Yokohama City University Graduate School of Medicine, 3-9, Future, Kanazawa-ku, Yokohama, Japan
| | - Hideaki Mitsui
- Department of Pathology, Yokohama City University Graduate School of Medicine, 3-9, Future, Kanazawa-ku, Yokohama, Japan
| | - Takehisa Suzuki
- Department of Pathology, Yokohama City University Graduate School of Medicine, 3-9, Future, Kanazawa-ku, Yokohama, Japan
| | - Yoko Tateishi
- Department of Pathology, Yokohama City University Graduate School of Medicine, 3-9, Future, Kanazawa-ku, Yokohama, Japan
| | - Shigeaki Umeda
- Department of Pathology, Yokohama City University Graduate School of Medicine, 3-9, Future, Kanazawa-ku, Yokohama, Japan
| | - Michihiko Tajiri
- Division of General Thoracic Surgery, Kanagawa Prefectural Cardiovascular and Respiratory Center Hospital, 6-16-1, Tomioka-higashi, Kanazawa-ku, Yokohama, Japan
| | - Munetaka Masuda
- Department of Surgey, Yokohama City University Graduate School of Medicine, 3-9, Future, Kanazawa-ku, Yokohama, Japan
| | - Noriyuki Nagahara
- Department of Enviromental Medicine, Nippon Medical University, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, Japan
| | - Hitoshi Kitamura
- Department of Pathology, Yokohama City University Graduate School of Medicine, 3-9, Future, Kanazawa-ku, Yokohama, Japan
| | - Kenichi Ohashi
- Department of Pathology, Yokohama City University Graduate School of Medicine, 3-9, Future, Kanazawa-ku, Yokohama, Japan
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Rodrigues G, Videtic GMM, Sur R, Bezjak A, Bradley J, Hahn CA, Langer C, Miller KL, Moeller BJ, Rosenzweig K, Movsas B. Palliative thoracic radiotherapy in lung cancer: An American Society for Radiation Oncology evidence-based clinical practice guideline. Pract Radiat Oncol 2011; 1:60-71. [PMID: 25740118 PMCID: PMC3808743 DOI: 10.1016/j.prro.2011.01.005] [Citation(s) in RCA: 139] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2011] [Accepted: 01/28/2011] [Indexed: 12/14/2022]
Abstract
PURPOSE To provide guidance to physicians and patients with regard to the use of external beam radiotherapy, endobronchial brachytherapy, and concurrent chemotherapy in the setting of palliative thoracic treatment for lung cancer, based on available evidence complemented by expert opinion. METHODS AND MATERIALS A Task Force authorized by the American Society for Radiation Oncology (ASTRO) Board of Directors synthesized and assessed evidence from 3 systematic reviews on the following topics: (1) dose fractionation in thoracic external beam radiotherapy (EBRT); (2) clinical utility of initial and salvage endobronchial brachytherapy (EBB); and (3) use of concurrent chemotherapy (CC) with palliative thoracic radiotherapy. Practice guideline recommendations were produced and are contained herein. RESULTS Studies suggest that higher dose/fractionation palliative EBRT regimens (eg, 30 Gy/10 fraction equivalent or greater) are associated with modest improvements in survival and total symptom score, particularly in patients with good performance status. As these improvements are associated with an increase in esophageal toxicity, various shorter EBRT dose/fractionation schedules (eg, 20 Gy in 5 fractions, 17 Gy in 2 weekly fractions, 10 Gy in 1 fraction), which provide good symptomatic relief with fewer side effects, can be used for patients requesting a shorter treatment course and/or in those with a poor performance status. No defined role for EBB in the routine initial palliative treatment of chest disease has been demonstrated; however, EBB can be a reasonable option for the palliation of endobronchial lesions causing obstructive symptomatology including lung collapse, or for hemoptysis after EBRT failure. The integration of concurrent chemotherapy with palliative intent/fractionated radiotherapy is not currently supported by the medical literature. CONCLUSION This Guideline is intended to serve as a guide for the use of EBRT, EBB, and CC in thoracic palliation of lung cancer outside the clinical trial setting. Further prospective clinical investigations with relevant palliative endpoints into the respective roles of EBB and CC/targeted therapy in the thoracic palliation of lung cancer are warranted, given the current state of the medical literature in these areas.
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Affiliation(s)
- George Rodrigues
- Department of Radiation Oncology, London Health Sciences Centre, London, ON, Canada.
| | | | - Ranjan Sur
- Department of Radiation Oncology, Juravinski Cancer Centre, Hamilton, ON, Canada
| | - Andrea Bezjak
- Department of Radiation Medicine, Princess Margaret Hospital, Toronto, ON, Canada
| | - Jeffrey Bradley
- Department of Radiation Oncology, University of Washington School of Medicine, St Louis, Missouri
| | - Carol A Hahn
- Department of Radiation Oncology, Duke University Medical School, Durham, North Carolina
| | - Corey Langer
- Department of Medical Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Keith L Miller
- Department of Radiation Oncology, 21st Century Oncology, Fort Myers, Florida
| | - Benjamin J Moeller
- Department of Radiation Oncology, M.D. Anderson Cancer Center, Houston, Texas
| | - Kenneth Rosenzweig
- Department of Radiation Oncology, Mount Sinai School of Medicine, New York, New York
| | - Benjamin Movsas
- Department of Radiation Oncology, Henry Ford Hospital, Detroit, Michigan
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Michael M, Wirth A, Ball DL, MacManus M, Rischin D, Mileshkin L, Solomon B, McKendrick J, Milner AD. A phase I trial of high-dose palliative radiotherapy plus concurrent weekly Vinorelbine and Cisplatin in patients with locally advanced and metastatic NSCLC. Br J Cancer 2005; 93:652-61. [PMID: 16222311 PMCID: PMC2361626 DOI: 10.1038/sj.bjc.6602759] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
The role of concurrent chemoradiotherapy (CRT) in patients with non-small-cell lung cancer (NSCLC) unsuitable for radical therapy but who require locoregional treatment has not been defined. The aims of this phase I trial were thus to develop a novel regimen of weekly chemotherapy concurrent with high-dose palliative RT (40 Gy/20 fractions) and assess its tolerability, objective and symptomatic response rates. Eligible patients had stage I–IIIB NSCLC unsuitable for radical RT or limited stage IV disease, ECOG PS⩽1 and required locoregional therapy. Treatment was RT (40 Gy/20 fractions/5 per week) and weekly Vinorelbine plus Cisplatin escalated in six planned dose levels (DLs). At 4 weeks post-RT, patients received two cycles of Cisplatin 80 mg m−2 day 1+Vinorelbine 25 mg m−2 days 1, 8, 15. Dose-limiting toxicities (DLTs) were defined in the CRT phase. Disease-related symptoms were assessed by the Lung Cancer Symptom Scale. In all, 24 patients accrued, stage IIIB (n=12) and IV disease (n=10). The highest administered dose was at DL 4, Vinorelbine 30 mg m−2+Cisplatin 20 mg m−2 with DLTs of grade 4 neutropenia in two of three patients. No grade 3 or 4 nonhaematological toxicities were observed. The overall radiological response rate was 65% (n=23: complete response 4% and partial response 61%) and infield FDG-PET responses were seen in 89% (n=18). There was an improvement or stabilisation of symptoms and quality of life. Dose level 3, Vinorelbine 25 mg m−2+Cisplatin 20 mg m−2, is recommended for further assessment. This regimen was tolerable and produced meaningful responses for patients for whom locoregional control is required, but who are unsuitable for radical CRT.
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Affiliation(s)
- M Michael
- The Division of Haematology and Medical Oncology, Peter MacCallum Cancer Centre, Locked Bag 1, A'Beckett St, Victoria 8006, Australia.
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Abstract
The treatment of lung cancer has changed rapidly over the last few years and now more than ever a multi-disciplinary approach is vital to patient care. Surgical resection remains the mainstay of treatment for patients with operable disease. Recent studies have clearly demonstrated the survival benefits of adjuvant chemotherapy and this is now considered the standard of care. Despite efforts to improve early detection the majority of patients present with advanced lung cancer. The combination of radiation and chemotherapy should be considered for patients with locally advanced disease. Chemotherapy and the newer generation of molecularly targeted agents, provide quality of life benefits and modest gains in survival for patients with metastatic disease. Though there is room for improvement there is no justification for the therapeutic nihilism once surrounding the treatment of lung cancer.
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Affiliation(s)
- Janessa J Laskin
- Division of Medical Oncology, British Columbia Cancer Agency, Vancouver, British Columbia, Canada.
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Affiliation(s)
- Giuseppe Giaccone
- Division of Medical Oncology, Vrijie Universiteit Medical Center, Amsterdam and Martini Hospital , Groningnen, Amsterdam, The Netheslands.
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Argiris A, Liptay M, LaCombe M, Marymont M, Kies MS, Sundaresan S, Masters G. A phase I/II trial of induction chemotherapy with carboplatin and gemcitabine followed by concurrent vinorelbine and paclitaxel with chest radiation in patients with stage III non-small cell lung cancer. Lung Cancer 2004; 45:243-53. [PMID: 15246197 DOI: 10.1016/j.lungcan.2004.02.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2003] [Revised: 02/11/2004] [Accepted: 02/17/2004] [Indexed: 01/02/2023]
Abstract
PURPOSE We designed a phase I/II trial in order to evaluate the efficacy and tolerability of induction carboplatin and gemcitabine and the maximum tolerated dose (MTD) and dose-limiting toxicity (DLT) of subsequent chemoradiotherapy with weekly vinorelbine and paclitaxel in patients with stage III non-small cell lung cancer (NSCLC). PATIENTS AND METHODS Patients had pathologically confirmed N2-N3 stage NSCLC, adequate end-organ function, and ECOG performance status 0-2. Carboplatin was administered at an AUC of 5 on day 1 and gemcitabine 1000 mg/m2 on days 1 and 8, every 21 days, for two cycles, followed by weekly vinorelbine 10-15 mg/m2 and paclitaxel 50 mg/m2 and conventional chest radiotherapy up to 66 Gy. Patients with resectable disease underwent thoracotomy after 40-45 Gy. RESULTS Thirty-nine eligible patients were enrolled; 17 had stage IIIB NSCLC. Grade 3 esophagitis developed in 4/5 patients on the second dose level of chemoradiotherapy (i.e. vinorelbine 15 mg/m2) and was considered dose-limiting. Of 34 patients treated at the maximum tolerated dose (i.e. vinorelbine 10 mg/m2), 2 patients (6%) had pneumonitis >grade 2 and 3 (9%), esophagitis >grade 2. Induction chemotherapy was well tolerated with only one patient developing >grade 2 non-hematologic toxicity (nausea). Forty-one percent of patients had an objective response after induction chemotherapy and 51% after chemoradiotherapy. Nineteen patients, 16 of whom had stage IIIA, underwent surgical resection. The pathologic complete response rate was 16% (42% in the mediastinal lymph nodes). With a median follow-up of 31 months, the 3-year progression-free survival (PFS) and overall survival (OS) rates were 23 and 34%, respectively, and the median OS was 25 months. CONCLUSIONS We identified a well-tolerated and active chemoradiotherapy regimen. Survival results are promising and the addition of a biologic agent to this regimen is of interest.
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Affiliation(s)
- A Argiris
- Division of Hematology-Oncology, Department of Medicine, The Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA.
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Abstract
All of the third-generation chemotherapeutic agents reviewed in this article are independently active against NSCLC, although the agents differ significantly in their cellular and molecular mechanisms of cytotoxicity. All have also been shown to potentiate radiation effects, and thus are promising in exerting further cytotoxicity when used in combination chemoradiation therapy for locally advanced NSCLC. Although the toxicity to normal tissue varies among these agents when used alone, phase I/II clinical results consistently demonstrated higher risk and severity of esophagitis and pneumonitis when these agents were administered concurrently with thoracic radiation. These results were consistent with the radiosensitization properties of all these agents. Nonetheless, most chemoradiation combinations have been made feasible through careful phase I studies that establish safe doses of these agents given concurrently with radiation. Indeed, phase I outcomes consistently have demonstrated the need for dose reduction compared with doses applied in the stage IV, metastatic disease setting (see Tables 1 and 2). There have been many different dose schedules in phase I/II studies for stage III NSCLC, and most have yielded improved response rates with these agents. For all these agents discussed, multiagent chemoradiation increased toxicity when compared with single agent chemoradiation, particularly in the risk of neutropenia, and the tumor response rates were no better than single-agent chemoradiation. Most studies have not reached an adequate interval for survival endpoint to assess the impact on survival using multiagent chemoradiation. A few earlier studies using paclitaxel chemoradiation, in fact, showed that the significant improvement in tumor response rate resulted in only a small gain in survival outcome. Despite much preclinical research conducted with these agents, the optimal sequence and dose of drug and the optimal schedule for combining the two modalities remain unknown. Optimal sequencing of the chemoradiation regimens may improve distant disease control and primary tumor control, as was seen in studies that administered both full-dose induction chemotherapy and concurrent chemoradiation at reduced drug dose and in studies that administered consolidative, full-dose chemotherapy after chemoradiation. Strategically altering the treatment schedule may also enhance the radiosensitizing effects while keeping toxicity low, such as was seen in the pulsed low-dose paclitaxel chemoradiation reported by Chen et al . This pulsed low-dose schedule resulted in superior tumor response (100%) and durable primary tumor control while keeping the toxicity low. Other methods to minimize normal tissue injury and to deliver higher radiation doses, such as conformal three-dimensional radiotherapy that excludes nontarget tissues from the radiation field, are under investigation. Marks and colleagues were able to deliver radiation to 80 Gy using accelerated hyperfractionation radiation after induction chemotherapy. Intensity-modulated radiotherapy is expected to revolutionize the targeting of tumor and exclusion of normal tissues from the high-dose radiation volume in the future. Integrating biologic response modifiers, radioprotectors, and molecular targeting strategies also are being investigated. It remains unclear which agent among the third-generation drugs performs better for combination chemoradiation. The CALGB 9431 study reported by Vokes et al provided some preliminary information, in that it was a randomized phase II study of a three-arm comparison of cisplatin-containing, two-drug combination chemoradiation with one of the third-generation agents. Although direct statistical comparison between the treatment arms was not valid for a phase II setting, such an analysis did indeed reveal similar overall response rates for these three arms. Chemoradiation using third-generation chemotherapeutic agents has improved local tumor response rates, with enhanced radiation toxicity such as esophagitis and pneumonitis. The challenge of targeting distant disease control for locally advanced NSCLC continues.
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Affiliation(s)
- Yuhchyau Chen
- Department of Radiation Oncology, University of Rochester Medical Center, 600 Elmwood Avenue, Box 647, Rochester, NY 14642, USA.
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