1
|
Qin B, Xin L, Hou Q, Yang B, Zhang J, Qi X, Wei Y, Hu Y, Xiong Q. Response to first-line treatment predicts progression-free survival benefit of small-cell lung cancer patients treated with anlotinib. Cancer Med 2021; 10:3896-3904. [PMID: 33960145 PMCID: PMC8209577 DOI: 10.1002/cam4.3941] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 02/23/2021] [Accepted: 04/08/2021] [Indexed: 12/16/2022] Open
Abstract
Background Anlotinib significantly extended progression‐free survival (PFS) and overall survival (OS) in small‐cell lung cancer (SCLC) as third or later line treatment. Methods In this study, we retrospectively analyzed the efficacy and safety of anlotinib in the clinical practice and aimed to identify risk factors for predicting the clinical benefit of anlotinib in SCLC patients. 29 SCLC patients treated with anlotinib monotherapy or combination therapy as second or later line treatment were included. PFS, OS, objective response rate (ORR), disease control rate (DCR), and adverse events (AEs) were analyzed. Results In whole patients, the median PFS was 2.1 months (95% confidence interval (CI): 1.1–3.2 months); The ORR and DCR were 10.3% and 48.3%, respectively; The median OS was 7.2 months (95%CI: 3.2–11.2 months). Cox regression analysis demonstrated that response to first‐line treatment was the independent risk factor for PFS. The ORR (20.0% vs. 0%) and DCR (53.3% vs. 42.9%) were promoted in patients treated with anlotinib combination therapy comparing to anlotinib monotherapy. The most common AEs were hoarseness, fatigue, decreased appetite, oral mucositis, and anemia. No treatment‐related AEs graded 3 or more. Conclusion Anlotinib is an effective option for SCLC patients with tolerable toxicity as second or later line treatment. Patients sensitive to first‐line treatment had longer PFS when treated with anlotinib. Anloitnib combined with other therapy increased the efficacy without adding toxicity.
Collapse
Affiliation(s)
- Boyu Qin
- Department of Oncology, General Hospital of Chinese PLA, Beijing, China
| | - Lingli Xin
- Department of Gynaecology and Obstetrics, PLA Rocket Force Characteristic Medical Center, Beijing, China
| | - Qingxiang Hou
- Department of Gynaecology and Obstetrics, PLA Rocket Force Characteristic Medical Center, Beijing, China
| | - Bo Yang
- Department of Oncology, General Hospital of Chinese PLA, Beijing, China
| | - Jing Zhang
- Department of Oncology, General Hospital of Chinese PLA, Beijing, China
| | - Xiaoguang Qi
- Department of Oncology, General Hospital of Chinese PLA, Beijing, China
| | - Yingtian Wei
- Department of Radiology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yi Hu
- Department of Oncology, General Hospital of Chinese PLA, Beijing, China
| | - Qi Xiong
- Department of Oncology, General Hospital of Chinese PLA, Beijing, China
| |
Collapse
|
2
|
Ishii H, Azuma K, Kawahara A, Matsuo N, Tokito T, Hoshino T. Atezolizumab plus carboplatin and etoposide in small cell lung cancer patients previously treated with platinum-based chemotherapy. Invest New Drugs 2020; 39:269-271. [PMID: 32783090 DOI: 10.1007/s10637-020-00983-6] [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: 07/18/2020] [Accepted: 08/04/2020] [Indexed: 01/22/2023]
Abstract
Although immune checkpoint inhibitors have improved the survival of small cell lung cancer (SCLC) patients, their efficacy in SCLC patients who relapsed after systemic chemotherapy is unclear. This retrospective study aimed to investigate the utility of treatment with atezolizumab plus carboplatin and etoposide in SCLC patients previously treated with platinum-based chemotherapy. We retrospectively screened consecutive eight SCLC patients who received atezolizumab plus carboplatin and etoposide after platinum-based chemotherapy. We evaluated the efficacy of this treatment and its association with programmed cell death-ligand 1 (PD-L1) expression. Three and five patients had sensitive relapse and refractory relapse for first-line platinum-based chemotherapy, respectively. The overall response rate and disease control rate was 37.5% and 75.0%, respectively. Median progression-free survival was 4.0 months. Out of three patients who achieved clinical response, two patients had refractory relapse for first-line platinum-based chemotherapy. No patient exhibited PD-L1 expression. Atezolizumab plus carboplatin and etoposide therapy was effective in SCLC patients with sensitive and refractory relapse and might be a second-line treatment option for SCLC patients previously treated with platinum-based chemotherapy.
Collapse
Affiliation(s)
- Hidenobu Ishii
- Division of Respirology, Neurology, and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan.
| | - Koichi Azuma
- Division of Respirology, Neurology, and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
| | - Akihiko Kawahara
- Department of Diagnostic Pathology, Kurume University Hospital, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
| | - Norikazu Matsuo
- Division of Respirology, Neurology, and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
| | - Takaaki Tokito
- Division of Respirology, Neurology, and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
| | - Tomoaki Hoshino
- Division of Respirology, Neurology, and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
| |
Collapse
|
3
|
Saltos A, Shafique M, Chiappori A. Update on the Biology, Management, and Treatment of Small Cell Lung Cancer (SCLC). Front Oncol 2020; 10:1074. [PMID: 32766139 PMCID: PMC7378389 DOI: 10.3389/fonc.2020.01074] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 05/29/2020] [Indexed: 12/12/2022] Open
Abstract
Small-cell lung cancer (SCLC) accounts for 13-15% of all new lung cancer cases in the US. The tumor has a tendency to disseminate early resulting in 80-85% of patients being diagnosed with extensive disease (ES-SCLC). Chemotherapy has provided SCLC patients considerable survival benefits over the past three decades. Nonetheless, most patients relapse and rarely survive beyond 2 years. Despite consistent overall response rates of ≥50%, until recently, median survival times and 2-year survivals only ranged between 7-10 months and 10-20%, respectively. Several chemotherapy agents possess activity against SCLC, both, as single agents and in combinations but etoposide-platinum emerged as the preferred first line regimen. Upon relapse, many patients remain candidates for additional therapy. However, the sensitivity of relapsed SCLC to further therapies is markedly reduced and dependent upon the level and duration of response to the initial treatment (platinum-sensitive vs. resistant relapse). Multiple factors suggest a therapeutic role for immunotherapy in SCLC: SCLC has been associated with immune-mediated paraneoplastic processes (cerebellar degeneration, limbic encephalitis, and Lambert-Eaton syndrome) and patients presenting with these paraneoplastic syndromes have shown more favorable outcomes, suggesting an underlying immune response mechanism.Comprehensive genomic profiling of SCLC indicates that the majority lack functional p53 (90%) and Rb1 (65%). These universal genetic aberrations facilitate poor genomic stability, thus perpetuating the generation of tumor associated antigens, amenable to targeting with immunotherapy.SCLC has one of the highest mutational loads, likely a reflection of the myriad of insults inflicted by smoking-related carcinogens. The relationship between tumor mutational load and response to immune checkpoint inhibitors has been established in multiple solid tumors, including preliminary results in relapsed SCLC. In this manuscript, we review the early (some failed and discontinued, some partly successful, and still ongoing) attempts to incorporate immunotherapy (particularly vaccine based approaches) to the treatment of SCLC, and the latest attempts (mostly incorporating the use of checkpoint inhibitors), including those with favorable but preliminary results (CheckMate 032, Keynote 028 and 158), and those with more definitive positive (iMpower 133 and CASPIAN) and negative (CheckMate 331 and 451) results.
Collapse
Affiliation(s)
| | | | - Alberto Chiappori
- Department of Thoracic Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, United States
| |
Collapse
|
4
|
Byron E, Chiappori A. Amrubicin hydrochloride for relapsed small-cell lung cancer. Expert Opin Orphan Drugs 2013. [DOI: 10.1517/21678707.2013.854163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
5
|
Iclozan C, Antonia S, Chiappori A, Chen DT, Gabrilovich D. Therapeutic regulation of myeloid-derived suppressor cells and immune response to cancer vaccine in patients with extensive stage small cell lung cancer. Cancer Immunol Immunother 2013; 62:909-18. [PMID: 23589106 DOI: 10.1007/s00262-013-1396-8] [Citation(s) in RCA: 244] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Accepted: 01/19/2013] [Indexed: 12/19/2022]
Abstract
Myeloid-derived suppressor cells (MDSC) are one of the major factors limiting the efficacy of immune therapy. In a clinical trial of patients with extensive stage small cell lung cancer (SCLC), we tested the possibility that targeting MDSC can improve the induction of immune responses by a cancer vaccine. Forty-one patients with extensive stage SCLC were randomized into three arms: arm A--control, arm B--vaccination with dendritic cells transduced with wild-type p53, and arm C--vaccination in combination with MDSC targeted therapy with all-trans-retinoic acid (ATRA). Interim results of the ongoing clinical trial are presented. Pre-treatment levels of MDSC populations in patients from all three arms were similar. Vaccine alone did not affect the proportion of MDSC, whereas in patients treated with ATRA, the MDSC decreased more than twofold (p = 0.02). Before the start of treatment, no patients had detectable p53-specific responses in IFN-γ ELISPOT. Sequential measurements did not show positive p53 responses in any of the 14 patients from arm A. After immunization, only 3 out of 15 patients (20 %) from arm B developed a p53-specific response (p = 0.22). In contrast, in arm C, 5 out of 12 patients (41.7 %) had detectable p53 responses (p = 0.012). The proportion of granzyme B-positive CD8(+) T cells was increased only in patients from arm C but not in arm B. Depletion of MDSC substantially improved the immune response to vaccination, suggesting that this approach can be used to enhance the effect of immune interventions in cancer.
Collapse
|
6
|
Li C, Cui J, Wang C, Li Y, Zhang L, Xiu X, Li Y, Wei N, Zhang L, Wang P. Novel sulfobutyl ether cyclodextrin gradient leads to highly active liposomal irinotecan formulation. ACTA ACUST UNITED AC 2011; 63:765-73. [PMID: 21585373 DOI: 10.1111/j.2042-7158.2011.01272.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVES Liposomal delivery of irinotecan could provide protection against drug hydrolysis, deliver more active lactone form to tumours and prolong irinotecan exposure time. Nevertheless, conventional drug-loading technologies have typically resulted in undesired drug retention properties. To resolve the problem, a modified gradient loading method was developed and the resulting formulations were evaluated in a systemic manner. METHODS Irinotecan was loaded into liposomes using a novel sulfobutyl ether beta-cyclodextrin (sbe-CD) gradient. The effect of drug-to-lipid ratio (D/L) and polyethylene glycol (PEG) grafting density were investigated. Drug release experiments were performed in ammonium-containing medium based on the fluorescence dequenching phenomenon of irinotecan. Pharmacokinetic studies were performed in normal balb/c mice treated with different formulations. To compare the anti-tumour effect of different formulations, an RM-1 prostate cancer model was used. Acute toxicity studies were performed in healthy female c57 mice. KEY FINDINGS Irinotecan could be encapsulated into liposomes with >90% loading efficiency at a high drug-to-lipid mass ratio (>0.5). In-vitro release experiments revealed that sbe-CD anion was more able to retain irinotecan than sulfate. Moreover, the elevated D/L ratio elicited decreased drug release kinetics. Both trends had also been observed when the effects of anions and D/L ratio on half-life of irinotecan were assessed. Pegylated liposomal irinotecan loaded with sbe-CD/triethylammonium gradient had irinotecan half-life values ranging from 9.4 to 13.1 h, surpassing vesicles prepared by the triethylammonium sulfate method (∼4.5 h). In the RM-1 tumour model, all the liposomal irinotecan formulations were more therapeutically active than free irinotecan and the formulation with a high D/L ratio was the most efficacious. Moreover, the high D/L formulation might be less toxic than free irinotecan based on acute toxicity studies. CONCLUSIONS The novel sbe-CD gradient could mediate effective irinotecan loading and improve irinotecan retention, thus resulting in highly active liposomal irinotecan formulations. The improvement in drug retention might be associated with the formation of complicated aggregates inside vesicles.
Collapse
Affiliation(s)
- ChunLei Li
- CSPC ZhongQi Pharmaceutical Technology (Shijiazhuang) Co., Ltd, Shijiazhuang, China.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
7
|
Mennecier B, Paumier A, Giroux Leprieur E. [Clinical case No. 1 proposed by the E Quoix (CHRU Strasbourg) team]. REVUE DE PNEUMOLOGIE CLINIQUE 2010; 66:H3-H8. [PMID: 20488338 DOI: 10.1016/s0761-8417(10)70002-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Affiliation(s)
- B Mennecier
- Service de Pneumologie, CHRU Hôpital Civil de Strasbourg, 1 Place de l'Hôpital, 67091 Strasbourg
| | | | | |
Collapse
|
8
|
Lebeau B, Chouaïd C, Baud M, Masanès MJ, Febvre M. Oral second- and third-line lomustine–etoposide–cyclophosphamide chemotherapy for small cell lung cancer. Lung Cancer 2010; 67:188-93. [DOI: 10.1016/j.lungcan.2009.03.024] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2009] [Revised: 03/02/2009] [Accepted: 03/20/2009] [Indexed: 11/25/2022]
|
9
|
Ban HJ, Oh IJ, Kim KS, Ju JY, Kwon YS, Kim YI, Lim SC, Kim YC. Clinical Efficacy of Belotecan (CKD-602), Newly Developed Camptothecin Analog, in the 2nd Line Treatment of Relapsed Small Cell Lung Cancer. Tuberc Respir Dis (Seoul) 2009. [DOI: 10.4046/trd.2009.66.2.93] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Hee-Jung Ban
- Department of Pulmonology and Critical Care Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - In-Jae Oh
- Lung and Esophageal Cancer Clinic, Chonnam National University Hwasun Hospital, Gwangju, Korea
| | - Kyu-Sik Kim
- Lung and Esophageal Cancer Clinic, Chonnam National University Hwasun Hospital, Gwangju, Korea
| | - Jin-Yung Ju
- Department of Pulmonology and Critical Care Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Yong-Soo Kwon
- Department of Pulmonology and Critical Care Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Yu-Il Kim
- Department of Pulmonology and Critical Care Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Sung-Chul Lim
- Department of Pulmonology and Critical Care Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Young-Chul Kim
- Lung and Esophageal Cancer Clinic, Chonnam National University Hwasun Hospital, Gwangju, Korea
| |
Collapse
|
10
|
Heidary N, Naik H, Burgin S. Chemotherapeutic agents and the skin: An update. J Am Acad Dermatol 2008; 58:545-70. [PMID: 18342708 DOI: 10.1016/j.jaad.2008.01.001] [Citation(s) in RCA: 140] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2007] [Revised: 01/07/2008] [Accepted: 01/10/2008] [Indexed: 12/17/2022]
Abstract
UNLABELLED Chemotherapeutic agents give rise to numerous well described adverse effects that may affect the skin, hair, mucous membranes, or nails. The mucocutaneous effects of longstanding agents have been extensively studied and reviewed. Over the last 2 decades, a number of new molecular entities for the treatment of cancer have been approved by the United States Food and Drug Administration (FDA). This article reviews the cutaneous toxicity patterns of these agents. It also reviews one drug that has not received FDA approval but is in use outside the United States and is important dermatologically. Particular emphasis is placed on the novel signal transduction inhibitors as well as on newer literature pertaining to previously described reactions. LEARNING OBJECTIVES At the completion of this learning activity, participants should able to list the newer chemotherapeutic agents that possess significant mucocutaneous side effects and describe the range of reactions that are seen with each drug. In addition, they should be able to formulate appropriate management strategies for these reactions.
Collapse
Affiliation(s)
- Noushin Heidary
- Ronald O. Perelman Department of Dermatology, New York University, New York, USA
| | | | | |
Collapse
|
11
|
Fennell DA, Steele JPC, Shamash J, Slater SE, Sheaff MT, Wells P, Rudd RM, Stebbing J. Phase II trial of irinotecan, cisplatin and mitomycin for relapsed small cell lung cancer. Int J Cancer 2007; 121:2575-7. [PMID: 17680556 DOI: 10.1002/ijc.22984] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
There is no standard therapy for relapsed small cell lung cancer (rSCLC). We evaluated the efficacy and toxicity of a new triplet consisting of irinotecan (100 mg/m(2) Days 1 and 15 q28), cisplatin (40 mg/m(2) Days 1 and 15 q28) and mitomycin (6 mg/m(2) d1 q28) administered to a maximum of 6 cycles in individuals with rSCLC that had relapsed following first line treatment. Partial remissions were observed in 35% and progression in 30% of patients. Progression free survival measured 4.5 months (95% CI 0.8-8.2) and overall survival was 7.8 months (95% CI 5.3-10.3). QoL showed improvement in activity symptoms and stabilization of physical symptoms. As IPM was a well-tolerated regimen with activity in rSCLC, a phase III trial comparing this triplet with other regimens in this setting is warranted.
Collapse
Affiliation(s)
- Dean A Fennell
- Department of Medical Oncology, St Bartholomew's Hospital, London, United Kingdom
| | | | | | | | | | | | | | | |
Collapse
|
12
|
Hesketh PJ, McCoy J, Dunphy FR, Bearden JD, Weiss GR, Giguere JK, Atkins JN, Dakhil SR, Kelly K, Crowley JJ, Gandara DR. Phase II Trial of Paclitaxel, Carboplatin, and Topotecan with G-CSF Support in Previously Untreated Patients with Extensive Stage Small Cell Lung Cancer: Southwest Oncology Group 9914. J Thorac Oncol 2006. [DOI: 10.1016/s1556-0864(15)31632-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
13
|
Phase II Trial of Paclitaxel, Carboplatin, and Topotecan with G-CSF Support in Previously Untreated Patients with Extensive Stage Small Cell Lung Cancer: Southwest Oncology Group 9914. J Thorac Oncol 2006. [DOI: 10.1097/01243894-200611000-00012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
14
|
Abstract
Lung cancer was relatively uncommon at the turn of the 20th century, and has increased in prevalence at alarming rates, particularly because of the augmented trend in smoking, so that it is now the most common cause of cancer death in the world. As almost a quarter of these cancers are of small cell in origin, it seems only appropriate that small cell lung cancer receives ample attention, rather than seemingly to have been overlooked over the last 10-15 years. Despite its generally late presentation and high risk of dissemination, it is exceptionally sensitive to chemo-radiotherapy. This review looks at the diverse options of treatment that have been used over the last few years and tries to highlight the best available. As more than 50% of patients diagnosed with lung cancer are over 70 years of age and various studies have shown that older people respond just as well as their younger counterparts, with similar results in response rates, toxicity and outcomes, it is imperative that the older generation are not disregarded in terms of age being a contraindication to therapy.
Collapse
Affiliation(s)
- Samantha Cooper
- Department of Thoracic Medicine, University College Hospital, London, UK
| | | |
Collapse
|
15
|
Abstract
Approximately 45,000 new cases of small-cell lung cancer were diagnosed in 2005 in the United States. Although response to first-time therapy is up to 90%, the majority of patients will ultimately relapse. Therefore, active second-line therapy is needed for this patient population. The only second-line treatment for small-cell lung cancer approved by the US Food and Drug Administration is topotecan. Other agents have been investigated and have shown modest efficacy. These include vinorelbine, irinotecan, etoposide, paclitaxel, and gemcitabine. Novel "targeted therapies" have shown disappointing results in this disease. Much of the recent work has focused on investigating alternative dosing and scheduling of topotecan. Combination therapies have also been investigated, and some have been shown to increase activity over single agents, but toxicity and quality of life variables are imperative in the treatment of this patient population.
Collapse
Affiliation(s)
- Cecilia MacCallum
- Division of Hematology and Oncology, University of Virginia, Charlottesville, VA 22908, USA
| | | |
Collapse
|
16
|
Griesinger F, Overbeck T, Niederle N. Zweitlinientherapie des kleinzelligen Lungenkarzinoms (SCLC). ONKOLOGE 2005. [DOI: 10.1007/s00761-005-0886-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
17
|
Abstract
This review focuses on the management of brain metastases. The four main modes of therapy are discussed: whole brain radiation therapy (WBRT), surgery, radiosurgery, and chemotherapy. Young patients with limited extracranial disease may benefit from surgical resection of a single brain metastasis, and from radiosurgery (or stereotactic radiotherapy) if two to four brain metastases are present. Whether WBRT after surgery or radiosurgery is beneficial is uncertain. Therefore, two approaches can be justified in patients with a good prognosis: WBRT after surgery or radiosurgery, or alternatively, observation with MRI follow-up after surgery or radiosurgery. A hyperfractionated radiation scheme is then to be preferred to limit late toxicity of WBRT. Patients with extensive extracranial tumour activity or impaired quality of life may benefit from radiosurgery (one to four brain metastases), or from shorter WBRT schedules. We propose a decision tree on the various ways to treat brain metastasis.
Collapse
Affiliation(s)
- Evert C A Kaal
- Department of Neurology, Medical Centre Haaglanden, The Hague, Netherlands
| | | | | |
Collapse
|
18
|
Lund EL, Hansen LT, Kristjansen PEG. Augmenting tumor sensitivity to topotecan by transient hypoxia. Cancer Chemother Pharmacol 2005; 56:473-80. [PMID: 15895231 DOI: 10.1007/s00280-005-1008-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2004] [Accepted: 01/11/2005] [Indexed: 10/25/2022]
Abstract
We examined how the effect of topotecan is modulated by transient hypoxia in three different tumor lines, Lewis lung carcinoma (LLC), U87 human glioblastoma and DMS273 human small cell lung cancer. Four groups of tumor bearing mice were treated with saline or a single dose of topotecan, immediately followed by 6-h or 72-h exposure to a hypoxic environment (10% O(2)) or normal air. Topotecan + hypoxia resulted in significantly greater suppression of tumor growth than normoxic topotecan or hypoxia alone. Correspondingly, the sensitivity of LLC cells to topotecan in a clonogenic survival assay was significantly higher under hypoxia. This effect of hypoxia was not a general phenomenon, since the tumor growth inhibitory effect of the alkylating agent cisplatin was not changed by hypoxic environment. In a parallel series of in vitro experiments, cell cultures were exposed to hypoxia (0.1% or 0.7% O(2)) in a hypoxic chamber or normoxia for 24 h. We found a dose-dependent downregulation of HIF-1alpha by topotecan (30-270 nM). The hypoxic upregulation of Glucose transporter-1 and VEGF secretion to the culture medium was inhibited by the addition of topotecan, while doses up to 270 nM had no effect on VEGF under normoxia. VEGF protein levels in tumors were also reduced by topotecan. These data show that the effect of topotecan is increased by transient hypoxia, and this may be a direct effect on the ability of cells to survive under hypoxia as well as an antiangiogenic effect, mediated through the HIF-1 inhibitory effect of topotecan.
Collapse
MESH Headings
- Animals
- Antineoplastic Agents/pharmacology
- Carcinoma, Lewis Lung/drug therapy
- Carcinoma, Lewis Lung/metabolism
- Carcinoma, Lewis Lung/pathology
- Carcinoma, Small Cell/drug therapy
- Carcinoma, Small Cell/metabolism
- Carcinoma, Small Cell/pathology
- Cell Hypoxia
- Cell Line, Tumor
- Central Nervous System Neoplasms/drug therapy
- Central Nervous System Neoplasms/metabolism
- Central Nervous System Neoplasms/pathology
- Glioblastoma/drug therapy
- Glioblastoma/metabolism
- Glioblastoma/pathology
- Glucose Transporter Type 1/antagonists & inhibitors
- Glucose Transporter Type 1/metabolism
- Humans
- Hypoxia
- Hypoxia-Inducible Factor 1, alpha Subunit/antagonists & inhibitors
- Hypoxia-Inducible Factor 1, alpha Subunit/metabolism
- Lung Neoplasms/drug therapy
- Lung Neoplasms/metabolism
- Lung Neoplasms/pathology
- Male
- Mice
- Mice, Inbred C57BL
- Mice, Nude
- Topotecan/pharmacology
- Tumor Burden/drug effects
- Vascular Endothelial Growth Factor A/antagonists & inhibitors
- Vascular Endothelial Growth Factor A/metabolism
- Xenograft Model Antitumor Assays
Collapse
Affiliation(s)
- Eva L Lund
- Laboratory of Experimental Oncology, Department of Molecular Pathology, University of Copenhagen, Denmark.
| | | | | |
Collapse
|
19
|
Poon ANY, Ho SSM, Yeo W, Mok TSK. Brain Metastasis Responding to Gefitinib Alone. Oncology 2004; 67:174-8. [PMID: 15539923 DOI: 10.1159/000081005] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2003] [Accepted: 02/18/2004] [Indexed: 11/19/2022]
Abstract
A woman with stage IIIb non-small cell lung cancer (NSCLC) developed disease progression with brain metastases during chemotherapy. Due to unusual circumstances, the patient received gefitinib alone, without the use of corticosteroid treatment or radiotherapy. There was a dramatic clinical improvement within 1 week. Follow-up magnetic resonance imaging of the brain 1 month later showed decreases in both the size and number of brain metastases. The patient remains well 9 months after initiation of gefitinib. It is proposed that gefitinib may have a role in treatment of brain metastases from NSCLC.
Collapse
Affiliation(s)
- Annette N Y Poon
- Department of Clinical Oncology, The Chinese University of Hong Kong, Hong Kong, China
| | | | | | | |
Collapse
|