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Liu X, Li Y, Zhao Q, Jiang H, Ni J, Cai H. Albumin-to-alkaline phosphatase ratio: A novel prognostic index for patients with driver mutation-negative advanced non-small cell lung cancer. CLINICAL RESPIRATORY JOURNAL 2021; 15:540-549. [PMID: 33565707 DOI: 10.1111/crj.13339] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 01/19/2021] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Albumin-to-Alkaline Phosphatase Ratio (AAPR), a novel developed prognostic index for cancers. Chemotherapy was the only method for driver mutation-negative advanced non-small cell lung cancer (DANSCLC). OBJECTIVES To evaluate the clinical significance of AAPR in these patients. METHODS We retrospectively reviewed 167 DANSCLCs and 58 healthy controls. Associations of clinicopathological characteristics and survival analysis were conducted. RESULTS Significantly decreased AAPR level was uncovered in DANSCLC patients compared to healthy controls. The correlation analysis revealed that the low AAPR level in DANSCLCs was correlated with poor differentiation (P = .024). Cox regression analysis showed that N stage, M stage, and different levels of AAPR were the independent risk factors of PFS and OS. The median PFS and OS survival ratio in patients with high and low AAPR level was, respectively, 17 months and 8 months, and 23 months and 13 months. The AUC of AAPR for both PFS and OS were higher than that of albumin and alkaline phosphatase (p < 0.05). The low AAPR was associated with much shorter PFS and OS than the high AAPR (mPFS: 8 vs. 25 months; mOS: 12 vs. 36 months). In the AP cohort, the low AAPR group experienced significantly shorter PFS and OS than the high AAPR (mPFS: 7 vs. 25 months; mOS: 12 vs. 36 months). Meanwhile, there was no significance in lung squamous cell carcinoma (LUSC) patients and GP regimens cohort. CONCLUSION AAPR significantly decreased in patients with DANSCLC, and it affects the prognosis of patients with DANSCLC and is a biomarker for DANSCLCs prognosis and treatment choice.
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Affiliation(s)
- Xiaoqin Liu
- Department of Pulmonary and Critical Care Medicine, The Affiliated Nanjing Drum Tower Hospital Clinical Medical College of Nanjing Medical University, Nanjing, PR China
| | - Yan Li
- Department of Pulmonary and Critical Care Medicine, The Affiliated Nanjing Drum Tower Hospital Clinical Medical College of Nanjing Medical University, Nanjing, PR China
| | - Qi Zhao
- Department of Pulmonary and Critical Care Medicine, The Affiliated Nanjing Drum Tower Hospital Clinical Medical College of Nanjing Medical University, Nanjing, PR China
| | - Hanyi Jiang
- Department of Pulmonary and Critical Care Medicine, The Affiliated Nanjing Drum Tower Hospital Clinical Medical College of Nanjing Medical University, Nanjing, PR China
| | - Jun Ni
- Department of Clinical Laboratory Medicine, The Affiliated Nanjing Drum Tower Hospital Clinical Medical College of Nanjing Medical University, Nanjing, PR China
| | - Hourong Cai
- Department of Pulmonary and Critical Care Medicine, The Affiliated Nanjing Drum Tower Hospital Clinical Medical College of Nanjing Medical University, Nanjing, PR China
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Hałas-Wiśniewska M, Zielińska W, Izdebska M, Grzanka A. The Synergistic Effect of Piperlongumine and Sanguinarine on the Non-Small Lung Cancer. Molecules 2020; 25:E3045. [PMID: 32635287 PMCID: PMC7411589 DOI: 10.3390/molecules25133045] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 06/30/2020] [Accepted: 07/01/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Cancers are one of the leading causes of deaths nowadays. The development of new treatment schemes for oncological diseases is an interesting direction in experimental medicine. Therefore, the evaluation of the influence of two alkaloids-piperlongumine (PL), sanguinarine (SAN) and their combination-on the basic life processes of the A549 cell line was considered reasonable. METHODS The aim was achieved by analyzing the cytotoxic effects of PL and SAN and their combination in the ratio of 4:1 on the induction of cell death, changes in the distribution of cell cycle phases, reorganization of cytoskeleton and metastatic potential of A549 cells. The versatility of the applied concentration ratio was evaluated in terms of other cancer cell lines: MCF-7, H1299 and HepG2. RESULTS The results obtained from the MTT assay indicated that the interaction between the alkaloids depends on the concentration and type of cells. Additionally, the compounds and their combination did not exhibit a cytotoxic effect against normal cells. The combined effects of PL and SAN increased apoptosis and favored metastasis inhibition. CONCLUSION Selected alkaloids exhibit a cytotoxic effect on A549 cells. In turn, treatment with the combination of PL and SAN in a 4:1 ratio indicates a synergistic effect and is associated with an increase in the level of reactive oxygen species (ROS).
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Affiliation(s)
- Marta Hałas-Wiśniewska
- Department of Histology and Embryology, Faculty of Medicine, Nicolaus Copernicus University in Toruń, Collegium Medicum in Bydgoszcz, Karłowicza 24, 85-092 Bydgoszcz, Poland; (W.Z.); (M.I.); (A.G.)
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Magali L, Pascal F, Serge A, Mathieu B, Ayoube Z, Claire T, Christiane M. Better survival in impaired renal function patients with metastatic non-small cell lung cancer treated by cisplatin-pemetrexed. Eur J Clin Pharmacol 2020; 76:1573-1580. [PMID: 32564117 DOI: 10.1007/s00228-020-02935-8] [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: 02/12/2020] [Accepted: 06/11/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Cisplatin-pemetrexed is the first-line chemotherapy for advanced, metastatic non-squamous non-small cell lung cancer (NSCLC), but the risk of kidney toxicity limits the therapeutic schedule. We performed a retrospective study of patient survival at 1 year and glomerular filtration rate (GFR) outcomes in cisplatin-pemetrexed-treated NSCLC patients. METHODS Patients (P) treated for NSCLC between 2008 and 2014 were divided into two groups according to GFR at diagnosis: G1 (GFR ≥ 90 mL/min/1.73 m2) and G2 (GFR between 60 and 89 mL/min/1.73 m2). GFR were compared in the two groups at 3 and 12 months. The following statistical methods were used: multivariate generalized estimating equation model for GFR outcome, Kaplan-Meier method for patient survival rate, and Cox model for analysing survival criteria. RESULTS A total of 112 patients were included in the study (G1 = 87 P, G2 = 25 P). At 12 months, mean GFR significantly decreased by 28.4 mL/min/1.73 m2 (- 22.3%, p = 0.001) in G1 and. 13.8 mL/min/1.73 m2 (- 17.2%, p = 0.001) in G2. Median patient survival was 9.6 months (1.1-52.4) in G1 and 19.7 months (3.7-56.9) in G2. A better overall survival was significantly correlated with GFR between 60 and 89 mL/min/1.73 m2 at diagnosis (p = 0.04), and higher cumulated doses of pemetrexed (p = 0.003) and cisplatin (p = 0.001). CONCLUSION The better survival rate in G2 and its correlation with pemetrexed and cisplatin treatments suggest that, until other therapeutic choices become available, a cautious increase in dosage could be investigated as a way to improve poor prognoses.
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Affiliation(s)
- Louis Magali
- Nephrology Transplantation, University Hospital of Dijon, Dijon, France.
| | - Foucher Pascal
- Department of Pneumology, University Hospital of Dijon, Dijon, France
| | - Aho Serge
- Department of Statistics and Epidemiology, University Hospital of Dijon, Dijon, France
| | - Boulin Mathieu
- Department of Pharmacy, University Hospital of Dijon, Dijon, France
| | - Zouak Ayoube
- Department of Pneumology, University Hospital of Dijon, Dijon, France
| | - Tinel Claire
- Nephrology Transplantation, University Hospital of Dijon, Dijon, France
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Wang Y, Ha M, Liu J, Li P, Zhang W, Zhang X. Role of BCL2-associated athanogene in resistance to platinum-based chemotherapy in non-small-cell lung cancer. Oncol Lett 2015; 11:984-990. [PMID: 26893680 PMCID: PMC4734146 DOI: 10.3892/ol.2015.4003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 07/07/2015] [Indexed: 01/29/2023] Open
Abstract
The present study aimed to address the pharmacogenetic role of BAG1 in platinum-based chemotherapy in advanced non-small-cell lung cancer (NSCLC) and in cultured human lung adenocarcinoma A549 cells. A total of 108 NSCLC patients (stages I-IIIA) were treated with a standard chemotherapy regimen of cisplatin plus vinorelbine. Additionally, in vitro cultured A549 cells were treated with cisplatin in the presence or absence of tunicamycin. Cell proliferation was determined by MTT assay and protein levels were assessed via western blot analysis. Patients with BAG1-positive expression were revealed to have a prolonged survival time (progression-free survival, 24.0 months) compared with that of patients without BAG1 expression (21.6 months; χ2=18.018, P<0.05). Treatment of A549 cells with tunicamycin followed by cisplatin resulted in elevated BAG1 levels. In addition, tunicamycin was found to significantly enhance cisplatin-induced growth inhibition and apoptosis in A549 cells. The results indicate that BAG1 is important in cisplatin-induced cell death in lung adenocarcinoma, suggesting that endoplasmic reticulum stress may promote the sensitivity of NSCLC patients to chemotherapy.
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Affiliation(s)
- Yadi Wang
- Department of Oncology, Third Affiliated Hospital of Liaoning Medical University, Jinzhou, Liaoning 121000, P.R. China
| | - Minwen Ha
- Department of Oncology, First Affiliated Hospital of Liaoning Medical University, Jinzhou, Liaoning 121000, P.R. China
| | - Jingsong Liu
- Department of Heart Surgery, First Affiliated Hospital of Xuzhou Medical College, Jinzhou, Liaoning 121000, P.R. China
| | - Ping Li
- Department of Oncology, First Affiliated Hospital of Liaoning Medical University, Jinzhou, Liaoning 121000, P.R. China
| | - Wenlu Zhang
- Department of Oncology, First Affiliated Hospital of Liaoning Medical University, Jinzhou, Liaoning 121000, P.R. China
| | - Xuan Zhang
- Department of Oncology, First Affiliated Hospital of Liaoning Medical University, Jinzhou, Liaoning 121000, P.R. China
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Ravaioli A, Papi M, Pasquini E, Marangolo M, Rudnas B, Fantini M, Nicoletti S, Drudi F, Panzini I, Tamburini E, Gianni L, Pasini G. Lipoplatin™ Monotherapy: A Phase II Trial of Second-Line Treatment of Metastatic Non-Small-Cell Lung Cancer. J Chemother 2013; 21:86-90. [DOI: 10.1179/joc.2009.21.1.86] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Jäkel A, Plested M, Dharamshi K, Modha R, Bridge S, Johns A. A systematic review of economic evaluations in second and later lines of therapy for the treatment of non-small cell lung cancer. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2013; 11:27-43. [PMID: 23329379 DOI: 10.1007/s40258-012-0001-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
INTRODUCTION Non-small cell lung cancer (NSCLC) is associated with high morbidity and mortality. Surgery is generally accepted as the first-line treatment in patients with advanced/metastatic NSCLC, followed by radiotherapy and chemotherapy as second-line treatments. Docetaxel or erlotinib are generally recommended as the first-line chemotherapy option. The objective of this review was to identify previously published economic evaluations in NSCLC for second- and later-line treatments in order to (i) determine common modelling approaches and (ii) establish the relative cost effectiveness of these treatments. An overview of model critique was also produced to identify common criticisms from health technology assessment (HTA) bodies on the models submitted. METHODS MEDLINE, Embase, EconLit, MEDLINE in Process(®) and NHS Economic Evaluation Database (NHSEED) were searched (database start-October 2011), along with proceedings from eight major conferences (2007-2011). National Institute for Health and Clinical Excellence (NICE), Scottish Medicines Consortium (SMC), Pharmaceutical Benefits Advisory Committee (PBAC) and Canadian Agency for Drugs and Technologies in Health (CADTH) websites and the International Network of Agencies for Health Technology Assessment (INAHTA) database were also searched for appraisals in second- or later-line NSCLC. All published studies and HTA appraisals that reported economic evaluations of interventions used in current clinical practice as second- or later-line treatment in patients with advanced/metastatic NSCLC were included. Only studies in English were considered for inclusion. Studies which met the eligibility criteria after the screening of full-text articles were extracted by a reviewer and checked by a second party. Where multiple publications were identified describing a single study, the extracted data were compiled into one entry. RESULTS A total of 29 studies were included which clearly evaluated second-line or later-line regimens. Most studies were either cost-effectiveness or cost-utility evaluations. Three-state transition Markov models were frequently used in cost-effectiveness and cost-utility evaluations. The model inputs were well reported and commonly consisted of data from pivotal trials. Sensitivity analyses were conducted in the majority of studies and covered variables such as cost, effectiveness, hospitalization and treatment duration. Therapies (docetaxel, pemetrexed and erlotinib) are for the most part cost-effective/cost-saving second-line therapies compared with best supportive care (BSC). Six erlotinib HTAs, across NICE, SMC, and PBAC, and four pemetrexed HTAs, one by NICE and three by SMC, were identified. The CADTH website did not provide sufficient detail on the appraisals and was excluded. Certain aspects of the models and model assumptions, e.g. efficacy inputs, were criticized or determined unjustifiable by the NICE, SMC and PBAC appraisal committees. Erlotinib and pemetrexed were considered to be cost effective versus docetaxel by NICE and SMC in the final submissions. PBAC considered erlotinib to be cost effective versus BSC following a price reduction in 2008. CONCLUSION Three-state Markov models are often used to conduct economic analysis in NSCLC and are regarded as appropriate to HTA agencies. Docetaxel, erlotinib and BSC are suitable comparators that should be considered for use in the model in the UK and Australia. Further, manufacturers should carefully select underlying assumptions used in the model, for both costs and clinical inputs, where the latter is derived from direct head-to-head trial data.
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Affiliation(s)
- Anne Jäkel
- Heron Evidence Development Ltd, Butterfield Technology and Business Park, Stopsley, Luton, UK
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Dai S, Liu Y, Wang L, Han B, Jiang L. [Analysis of prognostic factors in patients with stage IV lung adenocarcinoma after failure of second-line EGFR-TKIs therapy]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2013; 16:38-42. [PMID: 23327872 PMCID: PMC6000460 DOI: 10.3779/j.issn.1009-3419.2013.01.07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The prognostic factors and salvage therapy after the failure of epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) therapy have brought concerns. This study aims to analyze retrospectively the clinical data of patients with advanced lung adenocarcinoma and explore their prognostic factors. METHODS Patients with integral clinic dates and staged IV lung adenocarcinoma with performance status (PS) scores from 0 to 2 were enrolled between January 2009 and February 2012 and followed up until death. The primary endpoint was survival time after the failure of EGFR-TKI therapy. RESULTS A total of 81 patients were enrolled into the study, and the median overall survival time was 9.6 months (QL-QU: 5.4-19.2). Univariate analysis showed that PS score, metastatic status, and the presence of plural effusion were significantly correlated with patient survival time (P<0.05), whereas normal levels of carcinoembryonic antigen after EGFR-TKI therapy and history of operation showed a trend towards longer survival time. Multivariate analysis showed that the PS score, metastatic status, and plural effusion are independent prognostic factors for advanced adenocarcinoma after the failure of targeted therapy (P<0.05). CONCLUSIONS A PS score from 0 to 1, single metastasis, and none or less plural effusion may attribute to the good outcome of stage IV lung adenocarcinoma and should further undergo chemotherapy.
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Affiliation(s)
- Shujun Dai
- Department of Pulmonary, Chest Hospital Affiliated with Shanghai Jiaotong University, Shanghai 200030, China
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Delbaldo C, Michiels S, Rolland E, Syz N, Soria J, Le Chevalier T, Pignon JP. WITHDRAWN: Second or third additional chemotherapy drug for non-small cell lung cancer in patients with advanced disease. Cochrane Database Syst Rev 2012; 2012:CD004569. [PMID: 22513924 PMCID: PMC10655042 DOI: 10.1002/14651858.cd004569.pub3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Randomized trials have demonstrated that adding a drug to a single-agent or to a two-agent regimen increased the tumor response rate in patients with advanced non-small cell lung cancer (NSCLC), although its impact on survival remains controversial. OBJECTIVES To evaluate the clinical benefit of adding a drug to a single-agent or two-agent chemotherapy regimen in terms of tumor response rate, survival, and toxicity in patients with advanced NSCLC. SEARCH METHODS There were no language restrictions. Searches of MEDLINE and EMBASE were performed using the search terms non-small cell lung carcinoma/drug therapy, adenocarcinoma, large-cell carcinoma, squamous-cell carcinoma, lung, neoplasms, clinical trial phase III, and randomized trial. Manual searches were also performed to find conference proceedings published between January 1982 and June 2006. SELECTION CRITERIA Data from all randomized controlled trials performed between 1980 and 2006 (published between January 1980 and June 2006) comparing a doublet regimen with a single-agent regimen or comparing a triplet regimen with a doublet regimen in patients with advanced NSCLC. DATA COLLECTION AND ANALYSIS Two independent investigators reviewed the publications and extracted the data. Pooled odds ratios (ORs) for the objective tumor response rate, one-year survival rate, and toxicity rate were calculated using the fixed-effect model. Pooled median ratios (MRs) for median survival also were calculated using the fixed-effect model. ORs and MRs lower than unity (< 1.0) indicate a benefit of a doublet regimen compared with a single-agent regimen (or a triplet regimen compared with a doublet regimen). MAIN RESULTS Sixty-five trials (13601 patients) were eligible. In the trials comparing a doublet regimen with a single-agent regimen, a significant increase was observed in tumor response (OR 0.42, 95% confidence interval [CI] 0.37 to 0.47, P < 0.001) and one-year survival (OR 0.80, 95% CI 0.70 to 0.91, P < 0.001) in favor of the doublet regimen. The median survival ratio was 0.83 (95% CI 0.79 to 0.89, P < 0.001). An increase also was observed in the tumor response rate (OR 0.66, 95% CI 0.58 to 0.75, P < 0.001) in favor of the triplet regimen, but not for one-year survival (OR 1.01, 95% CI 0.85 to 1.21, P = 0.88). The median survival ratio was 1.00 (95% CI 0.94 to 1.06, P = 0.97). AUTHORS' CONCLUSIONS Adding a second drug improved tumor response and survival rate. Adding a third drug had a weaker effect on tumor response and no effect on survival.
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Affiliation(s)
- Catherine Delbaldo
- Institut Gustave‐RoussyDépartement de médecine39, rue Camille DesmoulinsVillejuif CedexFrance94805
| | - Stefan Michiels
- Institut Gustave‐RoussyService de biostatistique et d'epidemiologie39, rue Camille DesmoulinsVillejuif CedexFrance94805
| | - Estelle Rolland
- Institut Gustave‐RoussyDepartment of Biostatistics and Epidemiology94805 Villejuif CedexFrance
| | - Nathalie Syz
- Institut Gustave‐RoussyService de biostatistique et d'epidémiologie39, rue Camille DesmoulinsVillejuif CedexFrance94805
| | - Jean‐Charles Soria
- Institut Gustave‐RoussyDepartment of Medecine94805 Villejuif CedexFrance
| | - Thierry Le Chevalier
- Institut Gustave‐RoussyDépartement de médecine39, rue Camille DesmoulinsVillejuif CedexFrance94805
| | - Jean Pierre Pignon
- Institut Gustave RoussyBiostatistics and Epidemiology Department39, rue Camille DesmoulinsVillejuif CedexFrance94805
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Zhang L, Ma S, Song X, Han B, Cheng Y, Huang C, Yang S, Liu X, Liu Y, Lu S, Wang J, Zhang S, Zhou C, Zhang X, Hayashi N, Wang M. Gefitinib versus placebo as maintenance therapy in patients with locally advanced or metastatic non-small-cell lung cancer (INFORM; C-TONG 0804): a multicentre, double-blind randomised phase 3 trial. Lancet Oncol 2012; 13:466-75. [PMID: 22512843 DOI: 10.1016/s1470-2045(12)70117-1] [Citation(s) in RCA: 196] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Maintenance treatment of patients with advanced non-small-cell lung cancer (NSCLC) without disease progression after first-line chemotherapy is a subject of ongoing research. The aim of the randomised, double-blind, placebo-controlled, INFORM study was to investigate the efficacy, safety, and tolerability of the EGFR-tyrosine-kinase inhibitor gefitinib in the maintenance setting. METHODS Patients were aged 18 years or older, were of east Asian ethnic origin, had a life expectancy of more than 12 weeks, histologically or cytologically confirmed stage IIIb or IV NSCLC, a WHO performance status of 0-2, and had completed four cycles of first-line platinum-based doublet chemotherapy without disease progression or unacceptable toxic effects. Between Sept 28, 2008 and Aug 11, 2009, 296 patients were randomly assigned 1:1 to receive either gefitinib (250 mg per day orally) or placebo (orally) within 3-6 weeks after chemotherapy until progression or unacceptable toxic effects. Randomisation was done via an interactive web response system with computer-generated randomisation codes. Our primary endpoint was progression-free survival assessed in the intention-to-treat population. This completed study is registered with Clinicaltrials.gov, number NCT00770588. FINDINGS Progression-free survival was significantly longer with gefitinib (n=148) than with placebo (148) (median progression-free survival 4·8 months [95% CI 3·2-8·5] vs 2·6 months [1·6-2·8]; hazard ratio [HR] 0·42, 95% CI 0·33-0·55; p<0·0001). Adverse events occurred more frequently with gefitinib than with placebo; the most common adverse events of any grade were rash (73 [50%] of 147 in the gefitinib group vs 14 [9%] of 148 in the placebo group), diarrhoea (37 [25%] vs 13 [9%]), and alanine aminotransferase increase (31 [21%] vs 12 [8%]). The most commonly reported grade 3 or 4 adverse event was alanine aminotransferase increase (3 [2%] of 147 in the gefitinib group, none of 148 in the placebo group). Ten of 147 (7%) patients given gefitinib and five of 148 (3%) patients given placebo had serious adverse events. Three deaths were thought to be related to treatment with gefitinib: one from interstitial lung disease; one from lung infection; and one from pneumonia. INTERPRETATION Maintenance treatment with gefitinib significantly prolonged progression-free survival compared with placebo in patients from east Asia with advanced NSCLC who achieved disease control after first-line chemotherapy. Clinicians should consider these data when making decisions about maintenance treatment in such patients. FUNDING AstraZeneca.
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Affiliation(s)
- Li Zhang
- Cancer Centre, Sun Yat-Sen University, Guangzhou, China.
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Yu F, Liu X, Li X, Li J, Guo W, Qin H, Gao H. [Clinical investigation of efficacy of third-line and beyond pemetrexed treatment in advanced non-squamous non-small cell lung cancer]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2012; 15:117-21. [PMID: 22336241 PMCID: PMC6000264 DOI: 10.3779/j.issn.1009-3419.2012.02.10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
背景与目的 培美曲塞联合铂类或单药在晚期非小细胞肺癌一、二线治疗中的疗效已得到验证,但其在三线及以上治疗中的地位还不明确。本文旨在观察培美曲塞单药或联合铂类三线及以上治疗晚期非鳞型非小细胞肺癌的临床疗效及安全性。 方法 46例多线治疗失败的晚期非鳞型非小细胞肺癌患者接受培美曲塞单药或联合铂类药物治疗。 结果 46例晚期非鳞型非小细胞肺癌患者中部分缓解7例,疾病稳定20例,疾病进展19例,客观缓解率为15.2%,疾病控制率为58.7%,中位无疾病进展时间为3.0个月。分析显示培美曲塞联合卡铂及顺铂较培美曲塞单药治疗的疾病控制率明显增高(P=0.043)。常见的不良反应主要有恶心、呕吐及骨髓抑制。 结论 应用培美曲塞单药或联合铂类治疗多线治疗失败的晚期非鳞型非小细胞肺癌患者仍可使其临床获益,且毒副反应可耐受。
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Affiliation(s)
- Fei Yu
- Department of Pulmonary Oncology, Affiliated Hospital, Academy of Military Medical Sciences, Beijing 100071, China
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Bareschino MA, Schettino C, Rossi A, Maione P, Sacco PC, Zeppa R, Gridelli C. Treatment of advanced non small cell lung cancer. J Thorac Dis 2011; 3:122-33. [PMID: 22263075 PMCID: PMC3256511 DOI: 10.3978/j.issn.2072-1439.2010.12.08] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2010] [Accepted: 12/24/2010] [Indexed: 01/09/2023]
Abstract
Lung cancer is the major cause of cancer death in the world. Non Small Cell Lung Cancer (NSCLC) accounts approximately 80-85% of all lung cancer diagnosis; the majority of patients will be diagnosed with non operable, advanced-stage disease. Palliative chemotherapy and/or radiotherapy represent the standard of care of this disease. Platinum based doublets with third generation agents are considered the standard of first line advanced NSCLC treatment. However, data arising from the availability of pemetrexed suggest that histology could play a key role in decision making. Advances in understanding of the molecular pathogenesis of lung cancer have led to the identification of several specific targets such as vascular endothelial growth factor (VEGF) and epidermal growth factor receptor (EGFR) for therapeutic agents. Bevacizumab is the first recombinant humanized monoclonal antibody (mAb) binding VEGF to demonstrate clinical benefit and a rather survival prolongation in combination with chemotherapy in the treatment of non squamous chemo-naive advanced NSCLC patients. Two types of anti-EGFR targeting agents have reached advanced clinical development: mAbs and small molecule inhibitors of the EGFR tyrosine kinase enzymatic activity (TKIs). Among TKIs gefitinib has been tested in several phase II-III studies showing an improvement in survival and responses in first, second and third line treatment in selected patients with specific clinical and molecular characteristics. Furthermore, erlotinib has showed to significantly improve survival in an unselected population of patients following the failure of one or two chemotherapy regimens. This review will discuss the different therapeutic options for first and second line treatment in the clinical practice.
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Tiseo M, Bartolotti M, Gelsomino F, Bordi P. Emerging role of gefitinib in the treatment of non-small-cell lung cancer (NSCLC). DRUG DESIGN DEVELOPMENT AND THERAPY 2010; 4:81-98. [PMID: 20531963 PMCID: PMC2880339 DOI: 10.2147/dddt.s6594] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Most patients with non-small-cell lung cancer (NSCLC) present with advanced disease and their long-term prognosis remains poor. Epidermal growth factor receptor (EGFR)-targeted therapies, such as gefitinib, have been subjected to comprehensive clinical development. Several phase II and III trials evaluated the clinical efficacy of gefitinib as monotherapy in pretreated patients with advanced NSCLC, as well as both monotherapy and combined with chemotherapy in chemotherapy-naive patients. A phase III trial (ISEL) in heavily pretreated advanced NSCLC patients demonstrated some improvement in survival with gefitinib compared with placebo; however, the difference was not statistically significant within the overall population. A large phase III trial in pretreated patients (INTEREST) demonstrated the non-inferiority of gefitinib in comparison with docetaxel for overall survival, together with an improved quality of life and tolerability profiles. In a large phase III trial (IPASS) in Asian chemotherapy-naive, never or former light-smoker patients with adenocarcinoma, gefitinib was more effective than carboplatin-paclitaxel in prolonging progression-free survival, particularly in patients harboring EGFR gene mutations. Gefitinib was a generally well tolerated treatment, with skin rash and diarrhea being the most common treatment adverse events. As a result, gefitinib is expected to have a large impact on the management of patients with advanced NSCLC, in particular in EGFR mutated patients.
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Affiliation(s)
- M Tiseo
- Medical Oncology Unit, University, Hospital of Parma, Parma, Italy.
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Is capecitabine a new choice of treatment for lung adenocarcinoma? A case report involving partial response in second line of treatment and hypothesis of the biological basis. Clin Transl Oncol 2009; 11:554-7. [DOI: 10.1007/s12094-009-0403-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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14
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Tiseo M, Bartolotti M, Gelsomino F, Ardizzoni A. First-line treatment in advanced non-small-cell lung cancer: the emerging role of the histologic subtype. Expert Rev Anticancer Ther 2009; 9:425-35. [PMID: 19374597 DOI: 10.1586/era.09.3] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Lung cancer is the leading cause of cancer mortality worldwide. During the past quarter of a century, there have been definite steps forward in understanding the biology of this disease. However, progress in the treatment of advanced non-small-cell lung cancer (NSCLC) has been more elusive and has not been associated with a realistic probability of long-term survival. For this disease, platinum-based chemotherapy is currently the standard treatment. Numerous studies have compared various platinum doublets and have concluded that all such combinations are comparable in their clinical efficacy. Moreover, several trials evaluating different chemotherapy regimens in NSCLC have failed to document a difference based on histology. Recent evidence suggests that histology represents an important variable in the decision making. This review will discuss this new evidence in the first-line treatment of advanced NSCLC, focusing on different possible therapeutic approaches according to histologic subtype.
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Affiliation(s)
- Marcello Tiseo
- Medical Oncology Unit, University Hospital of Parma, Via Gramsci 14, 43100 Parma, Italy.
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Affiliation(s)
- Y K Zee
- Department of Oncology, University of Cambridge, Box 193 Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, Cambridge, UK
| | - T Eisen
- Department of Oncology, University of Cambridge, Box 193 Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, Cambridge, UK
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Preliminary experience with bevacizumab in combination with standard chemotherapeutic regimens in the treatment of non-small cell lung cancer: a retrospective study. Hematol Oncol Stem Cell Ther 2008; 1:183-8. [PMID: 20063550 DOI: 10.1016/s1658-3876(08)50028-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Tiseo M, Ardizzoni A. Cisplatin or carboplatin in the treatment of non-small cell lung cancer: a comprehensive review. Oncol Rev 2008. [DOI: 10.1007/s12156-007-0019-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Delbaldo C, Michiels S, Rolland E, Syz N, Soria JC, Le Chevalier T, Pignon JP. Second or third additional chemotherapy drug for non-small cell lung cancer in patients with advanced disease. Cochrane Database Syst Rev 2007:CD004569. [PMID: 17943820 DOI: 10.1002/14651858.cd004569.pub2] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Randomized trials have demonstrated that adding a drug to a single-agent or to a two-agent regimen increased the tumor response rate in patients with advanced non-small cell lung cancer (NSCLC), although its impact on survival remains controversial. OBJECTIVES To evaluate the clinical benefit of adding a drug to a single-agent or two-agent chemotherapy regimen in terms of tumor response rate, survival, and toxicity in patients with advanced NSCLC. SEARCH STRATEGY There were no language restrictions. Searches of MEDLINE and EMBASE were performed using the search terms non-small cell lung carcinoma/drug therapy, adenocarcinoma, large-cell carcinoma, squamous-cell carcinoma, lung, neoplasms, clinical trial phase III, and randomized trial. Manual searches were also performed to find conference proceedings published between January 1982 and June 2006. SELECTION CRITERIA Data from all randomized controlled trials performed between 1980 and 2006 (published between January 1980 and June 2006) comparing a doublet regimen with a single-agent regimen or comparing a triplet regimen with a doublet regimen in patients with advanced NSCLC. DATA COLLECTION AND ANALYSIS Two independent investigators reviewed the publications and extracted the data. Pooled odds ratios (ORs) for the objective tumor response rate, one-year survival rate, and toxicity rate were calculated using the fixed-effect model. Pooled median ratios (MRs) for median survival also were calculated using the fixed-effect model. ORs and MRs lower than unity (< 1.0) indicate a benefit of a doublet regimen compared with a single-agent regimen (or a triplet regimen compared with a doublet regimen). MAIN RESULTS Sixty-five trials (13601 patients) were eligible. In the trials comparing a doublet regimen with a single-agent regimen, a significant increase was observed in tumor response (OR 0.42, 95% confidence interval [CI] 0.37 to 0.47, P < 0.001) and one-year survival (OR 0.80, 95% CI 0.70 to 0.91, P < 0.001) in favor of the doublet regimen. The median survival ratio was 0.83 (95% CI 0.79 to 0.89, P < 0.001). An increase also was observed in the tumor response rate (OR 0.66, 95% CI 0.58 to 0.75, P < 0.001) in favor of the triplet regimen, but not for one-year survival (OR 1.01, 95% CI 0.85 to 1.21, P = 0.88). The median survival ratio was 1.00 (95% CI 0.94 to 1.06, P = 0.97). AUTHORS' CONCLUSIONS Adding a second drug improved tumor response and survival rate. Adding a third drug had a weaker effect on tumor response and no effect on survival.
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Leveälahti H, Tishelman C, Ohlén J. Framing the onset of lung cancer biographically: narratives of continuity and disruption. Psychooncology 2007; 16:466-73. [PMID: 16915570 DOI: 10.1002/pon.1080] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Most patients are diagnosed with advanced lung cancer despite the presence of many and intense symptoms at diagnosis. This qualitative study aims to explore how people with inoperable lung cancer frame and conceptualize the onset of their sickness, to obtain knowledge which might facilitate earlier health care contact for people with potential lung cancer. Patients with inoperable lung cancer were recruited through a larger longitudinal study of 400 patients recruited consecutively from two university hospitals. The narrative analysis presented here is based on 91 narrative segments derived from audio-taped and transcribed qualitative interviews with 37 patients who survived the first year post diagnosis, complemented with data from previous interviews with the same people. Findings indicate a wide array of bodily experiences leading to diagnosis, including symptoms seen as related to other disorders, systemic complaints not conceptualized as symptoms or indications of a serious problem, and more rarely, symptoms triggering immediate action. In addition to the 'biographical disruption' often associated with chronic illness, this analysis indicates an alternative or parallel process involving 'biographical continuity', allowing for integration of past and present aspects of patients' lives.
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Ardizzoni A, Boni L, Tiseo M, Fossella FV, Schiller JH, Paesmans M, Radosavljevic D, Paccagnella A, Zatloukal P, Mazzanti P, Bisset D, Rosell R. Cisplatin- versus carboplatin-based chemotherapy in first-line treatment of advanced non-small-cell lung cancer: an individual patient data meta-analysis. J Natl Cancer Inst 2007; 99:847-57. [PMID: 17551145 DOI: 10.1093/jnci/djk196] [Citation(s) in RCA: 441] [Impact Index Per Article: 25.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Because the efficacy of carboplatin and cisplatin in the treatment of advanced non-small-cell lung cancer (NSCLC) has not been proven to be equivalent, an individual patient data meta-analysis comparing the two treatments was performed. METHODS Randomized trials comparing carboplatin to cisplatin in first-line treatment of advanced NSCLC were identified and their electronic databases obtained. A general variance-based method was used to estimate the summary hazard ratios (HRs), odds ratios (ORs), and their 95% confidence intervals (CIs) for mortality, objective response, and toxicity. Cochran's chi-square test (Q test) was used to test for heterogeneity among trials, and the I2 index, which expresses the proportion of variability of the results due to heterogeneity, was calculated. A random-effects model that takes into account interstudy variation was also applied. All statistical tests were two-sided. RESULTS Nine trials that included a total of 2968 patients were analyzed; overall median follow-up was 1021 days. The objective response rate was higher for patients treated with cisplatin than for patients treated with carboplatin (30% versus 24%, respectively; OR = 1.37; 95% CI = 1.16 to 1.61; P<.001). Carboplatin treatment was associated with a non-statistically significant increase in the hazard of mortality relative to treatment with cisplatin (HR = 1.07; 95% CI = 0.99 to 1.15; P = .100). In patients with nonsquamous tumors and those treated with third-generation chemotherapy, carboplatin-based chemotherapy was associated with a statistically significant increase in mortality (HR = 1.12; 95% CI = 1.01 to 1.23 and HR = 1.11; 95% CI = 1.01 to 1.21, respectively). Cisplatin-based chemotherapy was associated with more severe nausea and vomiting and nephrotoxicity; severe thrombocytopenia was more frequent during carboplatin-based chemotherapy. CONCLUSIONS Our individual patient data meta-analysis suggests that cisplatin-based chemotherapy is slightly superior to carboplatin-based chemotherapy in terms of response rate and, in certain subgroups, in prolonging survival without being associated with an increase in severe toxic effects. Therefore, cisplatin-based third-generation regimens should remain the standard reference for the treatment of selected patients with advanced-stage NSCLC and of those with earlier-stage disease.
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Affiliation(s)
- Andrea Ardizzoni
- Division of Medical Oncology, University Hospital, Via Gramsci 14, 43100 Parma, Italy.
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Grossi F, Tiseo M. Granulocyte growth factors in the treatment of non-small cell lung cancer (NSCLC). Crit Rev Oncol Hematol 2006; 58:221-30. [PMID: 16697211 DOI: 10.1016/j.critrevonc.2005.09.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2005] [Revised: 08/30/2005] [Accepted: 09/08/2005] [Indexed: 11/22/2022] Open
Abstract
Neutropenia and subsequent infections are common events that limit treatment of non-small cell lung cancer (NSCLC). Granulocyte growth factors (G- and GM-CSF) have been introduced in clinical practice and their use has yielded a reduction of the infection risk related to chemotherapy and a dose increase of drug delivery. Randomized clinical trials have shown that granulocyte colony-stimulating factors and, more recently, the longer-acting pegylated granulocyte colony-stimulating factor (pegfilgrastim) effectively reduce the incidence and severity of neutropenia and of its complications. Recommendations for the use of haematopoietic colony-stimulating factors from the American Society of Clinical Oncology (ASCO) have been published in 1994 and updated in 1996, 1997 and 2000. Recently, moreover, National Comprehensive Cancer Network (NCCN) guidelines for the myeloid growth factors in cancer treatment make available. Chemotherapy-associated myelosuppression is a major limitation of anticancer therapy also in early stage, local advanced and metastatic NSCLC. Recently, dose-dense chemotherapy has been shown to improve the outcome in early stage breast cancer and non-Hodgkin's lymphoma. However, few randomized trials have been reported on chemotherapy with or without granulocyte growth factors as primary prophylaxis in NSCLC. Presently, there is no evidence for a benefit in response rate and survival from the use of granulocyte growth factors as support of chemotherapy, in particular, for locally advanced and metastatic NSCLC. In clinical practice, the role of granulocyte growth factors for NSCLC treatment should be limited following the guidelines. An appropriate use of granulocyte growth factors may reduce the overall cost of treatment and improve the quality of life, important aims in the treatment of patients with local advanced or metastatic NSCLC. In the future, we need to identify patients who can benefit from granulocyte growth factors for optimize the schedule and doses, in advanced disease and also, after the recent positive results of adjuvant chemotherapy, in early stages. This review summarizes the present knowledge on the use of granulocyte growth factors in NSCLC.
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Affiliation(s)
- Francesco Grossi
- Division of Medical Oncology A, Disease Management Team-Lung Cancer, National Institute for Cancer Research, L. go R. Benzi 10, 16132 Genova, Italy.
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Page RD, Smith FP, Geils GF, Beall CL, Fridman M, Allen BJ. Dose-dense vinorelbine and docetaxel with Filgrastim support in patients with advanced nonsmall cell lung carcinoma. Cancer 2005; 104:1956-61. [PMID: 16177986 DOI: 10.1002/cncr.21400] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Vinorelbine and docetaxel are active single agents in the treatment of nonsmall cell lung carcinoma (NSCLC) and may provide enhanced activity when combined in a dose-dense fashion. The efficacy and safety of this combination was assessed when it was administered every 14 days with Filgrastim support in a community practice setting. METHODS This open-label study was conducted at 12 community oncology practices in the United States. Sixty-one chemotherapy-naive patients with Stage IIIB/IV NSCLC received vinorelbine 45 mg/m2 followed by docetaxel 60 mg/m2 on Day 1 and Filgrastim 5 mcg/kg beginning on Day 2, with cycles repeated every 14 days. RESULTS Among 61 enrolled patients, 44% of patients had either a complete or partial response as their best response, and 27% of patients had confirmed complete or partial responses. The median time to confirmed response was 1.9 months (95% confidence interval [95% CI], 0.9-2.3 mos), and the median duration of confirmed response was 6.0 months (95% CI, 3.1-14.4 mos). The median time to disease progression was 4.9 months (95% CI, 3.8-5.8 mos). With a median follow-up of 14.3 months, the median survival was 12.9 months (95% CI, 8.1-14.3 mos), and the 1-year survival rate was 56% (95% CI, 43-69%). The relative dose intensity was 94% for vinorelbine and 93% for docetaxel. Febrile neutropenia occurred in 9 patients (15%) and during 9 of 351 cycles (3%). CONCLUSIONS It was possible to administer dose-dense vinorelbine and docetaxel chemotherapy with Filgrastim support, beginning in the first cycle, to patients with NSCLC who were treated in a community practice setting.
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Affiliation(s)
- Ray D Page
- The Center for Cancer and Blood Disorders, Fort Worth, Texas 76104, USA.
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Abstract
Research into the role of the human epidermal receptor growth factor receptor 1/epidermal growth factor receptor (HER1/EGFR) in tumorigenesis has generated a new class of anticancer drugs. One such agent, erlotinib (TarcevaTM), is a potent, selective and reversible inhibitor of HER1/EGFR tyrosine kinase activity. Erlotinib has demonstrated the clinical activity in a variety of solid tumors, and has recently demonstrated improvements in survival in large Phase III trials, in non-small-cell lung cancer and pancreatic cancer.
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Affiliation(s)
- Giuseppe Giaccone
- Vrije Universiteit Medical Center, Head of Division of Medical Oncology, 1117 De Boelelaan, Amsterdam, The Netherlands.
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Le Chevalier T, Scagliotti G, Natale R, Danson S, Rosell R, Stahel R, Thomas P, Rudd RM, Vansteenkiste J, Thatcher N, Manegold C, Pujol JL, van Zandwijk N, Gridelli C, van Meerbeeck JP, Crino L, Brown A, Fitzgerald P, Aristides M, Schiller JH. Efficacy of gemcitabine plus platinum chemotherapy compared with other platinum containing regimens in advanced non-small-cell lung cancer: a meta-analysis of survival outcomes. Lung Cancer 2005; 47:69-80. [PMID: 15603856 DOI: 10.1016/j.lungcan.2004.10.014] [Citation(s) in RCA: 231] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2004] [Revised: 10/26/2004] [Accepted: 10/27/2004] [Indexed: 11/21/2022]
Abstract
PURPOSE Gemcitabine-platinum combination activity has been clearly established in a number of phase II studies. It has also been compared against other combinations in many phase III trials. It is generally believed that all such regimens have an equivalent impact on survival. This meta-analysis aims to quantify the treatment effect of gemcitabine plus a platinum agent in the treatment of advanced NSCLC and compare the combination to other regimens used globally. DESIGN Data from a total of 4556 patients from 13 randomized trials investigating gemcitabine in combination with a platinum agent versus any other platinum-containing regimen were included in a meta-analysis of time-to-event outcomes. RESULTS A significant reduction in overall mortality in favor of gemcitabine-platinum regimens was observed, hazard ratio (HR) 0.90 (95% CI: 0.84-0.96) with an absolute benefit at 1 year of 3.9%. Median survival was 9.0 months for the gemcitabine-platinum regimens and 8.2 months for the comparator regimens. Sub-group analysis of the first- and second-generation platinum-based comparator regimens also indicated a significant benefit for gemcitabine-platinum regimens, HR 0.84 (CI: 0.71-0.9985). Analysis of third-generation agent plus platinum regimens showed a non-significant trend favoring gemcitabine-platinum regimens, HR 0.93 (CI: 0.86-1.01). There was a significant decrease in the risk of disease progression in favor of gemcitabine-platinum regimens, HR 0.88 (CI: 0.82-0.93). An absolute benefit of 4.2% at 1 year was estimated. Median progression-free survival was 5.1 months for gemcitabine-platinum regimens compared with 4.4 months for the comparator regimens. Sub-group analysis indicated a statistically significant progression-free survival benefit for patients assigned to gemcitabine-platinum treatment compared to first- and second-generation platinum regimens, HR 0.85 (CI: 0.77-0.94), and third-generation agent plus platinum regimens, HR 0.89 (CI: 0.82-0.96).
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Affiliation(s)
- T Le Chevalier
- Institute Gustave-Roussy, 39-53 Rue Camille Desmoulins, F-94800 Villejuif, France.
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Neymark N, Lianes P, Smit EF, van Meerbeeck JP. Economic evaluation of three two-drug chemotherapy regimens in advanced non-small-cell lung cancer. PHARMACOECONOMICS 2005; 23:1155-66. [PMID: 16277550 DOI: 10.2165/00019053-200523110-00007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
BACKGROUND During the 1990s, a number of new cytotoxic agents with clinically relevant activity in non-small-cell lung cancer (NSCLC), and with a more favourable therapeutic index than drugs already in use, became available. Given the high prices of these new drugs and the large number of patients affected, it is important to compare the relative benefits and costs of these treatments with the existing regimens before treatment policy decisions are changed. PURPOSE An economic evaluation of three different regimens of chemotherapy in patients with advanced NSCLC was performed from the perspective of the Dutch health insurance system using tariffs valid for 2002. The economic evaluation was integrated into a phase III clinical trial in which the reference regimen cisplatin-paclitaxel was compared with two experimental regimens: cisplatin-gemcitabine and gemcitabine-paclitaxel. MATERIALS AND METHODS Unit costs were applied to resource use data collected prospectively on case report forms during the trial. The average total (uncensored) cost per patient was determined for each of the treatment groups. The principal outcome measure for the economic evaluation was the estimated mean survival time per treatment group. This outcome was then incorporated into incremental cost-effectiveness ratios based on costs corrected for censoring. The impact of uncertainty was assessed by bootstrap techniques, and the analysis and interpretation of the data focused on the bivariate density of differences in outcomes and costs in the incremental cost-effectiveness plane. The final results were summarised by the derivation of cost-effectiveness acceptability curves. RESULTS The estimated mean survival time was equivalent in the two cisplatin-based regimens with largely overlapping confidence intervals. There was a 99% probability that cisplatin-gemcitabine is the least costly regimen of the two and a 72% probability that this regimen reduces costs while at the same time improving survival. Compared with cisplatin-paclitaxel, the gemcitabine-paclitaxel regimen engendered a borderline significant reduction in mean survival time combined with an almost 90% probability of an increase in costs. CONCLUSION The two cisplatin-based regimens are equivalent in terms of survival, but cisplatin-gemcitabine may reduce costs by approximately 2000 Euros patient compared with cisplatin-paclitaxel. Gemcitabine-paclitaxel is a dominated option with higher costs and a reduction in mean survival time compared with cisplatin-paclitaxel.
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Affiliation(s)
- Niels Neymark
- Health Economics Unit, European Organisation for Research and Treatment of Cancer, Brussels, Belgium.
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Borczuk AC, Shah L, Pearson GDN, Walter KL, Wang L, Austin JHM, Friedman RA, Powell CA. Molecular Signatures in Biopsy Specimens of Lung Cancer. Am J Respir Crit Care Med 2004; 170:167-74. [PMID: 15087295 DOI: 10.1164/rccm.200401-066oc] [Citation(s) in RCA: 85] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Gene expression profiles of resected tumors may predict treatment response and outcome. We hypothesized that profiles derived from lung tumor biopsies would discriminate tumor-specific gene signatures and provide predictive information about outcome. Lung carcinoma specimens were obtained from 23 patients undergoing computed tomography-guided transthoracic biopsy or endobronchial brushing for undiagnosed nodules. Excess tissue was processed for gene profiling. We built class prediction models for lung cancer histology and for cancer outcome. The histology model used an F test to identify 99 genes that were differentially expressed among lung cancer subtypes. The histology validation set class prediction accuracy rate was 86%. The outcome model used the maximum difference subset algorithm to identify 42 genes associated with high risk for cancer death. The outcome training set class prediction accuracy rate was 87%. In conclusion, gene expression profiles of biopsy specimens of lung cancers identify unique tumoral signatures that provide information about tissue morphology and prognosis. The use of specimens acquired from lung biopsy procedures to identify biomarkers of clinical outcome may have application in the management of patients with lung cancer. The procedures are safe and feasible; the efficacy and utility of this strategy will ultimately be determined by prospective clinical trials.
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Affiliation(s)
- Alain C Borczuk
- Department of Pathology, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA
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Scagliotti GV, Novello S. Pemetrexed and its emerging role in the treatment of thoracic malignancies. Expert Opin Investig Drugs 2003; 12:853-63. [PMID: 12720495 DOI: 10.1517/13543784.12.5.853] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Pemetrexed (Alimta); Eli Lilly and Co., Indianapolis, IN, USA) is a unique multitargeted antifolate that inhibits at least three enzymes, thymidylate synthase, dihydrofolate reductase and glycinamide ribonucleotide formyltransferase. This novel drug is being evaluated in a comprehensive clinical programme for use in both front-line and second-line therapies. It has shown broad activity in a number of solid tumours, including colon cancer, breast cancer, lung cancer, head and neck, cervical cancer and others. While a number of antifolates have been evaluated in clinical trials, further development has been stopped or delayed by the occurrence of life-threatening toxicities. Similar trends were also initially observed with pemetrexed as well, but investigators later showed that these toxicities could be minimised with folic acid and vitamin B(12) supplementation included in the treatment regimen. Preliminary data indicate that this supplementation does not hamper drug efficacy in most tumour types and in many cases, supplemented patients exhibit improved clinical outcome. Here, the current data for pemetrexed in treating thoracic malignancies are reviewed, with special focus on malignant pleural mesothelioma and non-small cell lung cancer.
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Affiliation(s)
- Giorgio V Scagliotti
- University of Torino, Department of Clinical & Biological Sciences, S. Luigi Hospital-Thoracic Oncology Unit, Regione Gonzole 10-10043 Orbassano, Turin, Italy.
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