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Zhong C, Zheng Q, Zhao B, Ren T. A real-world pharmacovigilance study using disproportionality analysis of United States Food and Drug Administration Adverse Event Reporting System events for vinca alkaloids: comparing vinorelbine and Vincristine. Expert Opin Drug Saf 2024:1-11. [PMID: 39340205 DOI: 10.1080/14740338.2024.2410436] [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: 08/12/2024] [Revised: 09/21/2024] [Accepted: 09/24/2024] [Indexed: 09/30/2024]
Abstract
BACKGROUND Vinca alkaloids are widely used in cancer treatment for their ability to target microtubule dynamics. While their efficacy in treating certain cancers is well-established, the full spectrum of their adverse event profiles remains an area of ongoing research. METHODS We analyzed AEs related to vinorelbine and vincristine using a retrospective case/non-case approach with data from the FDA Adverse Event Reporting System (FAERS). We applied various algorithms to detect AE signals: the reporting odds ratio (ROR) and proportional reporting ratio (PRR) measured disproportionality and association strength; the Bayesian confidence propagation neural network (BCPNN) calculated the Information Component (IC) for associations against background rates; and the multi-item gamma Poisson shrinker (MGPS) yielded empirical Bayes geometric mean (EBGM) values, accounting for reporting variability. RESULTS Both medications significantly involve the blood and lymphatic systems, with vinorelbine reporting 401 cases in this System Organ Class (SOC), exhibiting a ROR of 17.4, PRR of 12.4, IC of 3.63, and EBGM of 12.38. An intersection analysis of Preferred Terms (PTs) has uncovered previously unreported AEs shared by both drugs, including posterior reversible encephalopathy syndrome and inappropriate antidiuretic hormone secretion. CONCLUSIONS This analysis highlights the need for ongoing research of the risks associated with vinorelbine and vincristine.
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Affiliation(s)
- Cheng Zhong
- Department of Respiratory and Clinical Care Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qi Zheng
- Department of Respiratory and Clinical Care Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bin Zhao
- Xiamen Key Laboratory of Natural Medicine Research and Development, Xiamen, China
- Xiamen Health and Medical Big Data Center, Xiamen, China
- Xiamen Medicine Research Institute, Xiamen, China
| | - Tao Ren
- Department of Respiratory and Clinical Care Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Stem Cell Center, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Xiamen, China
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Bortolot M, Cortiula F, Fasola G, De Ruysscher D, Naidoo J, Hendriks LEL. Treatment of unresectable stage III non-small cell lung cancer for patients who are under-represented in clinical trials. Cancer Treat Rev 2024; 129:102797. [PMID: 38972134 DOI: 10.1016/j.ctrv.2024.102797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Revised: 06/27/2024] [Accepted: 07/02/2024] [Indexed: 07/09/2024]
Abstract
Concurrent chemoradiotherapy (cCRT) followed by one year of consolidation durvalumab is the current standard-of-care for patients with unresectable stage III non-small cell lung cancer (NSCLC), of good functional status. However, cCRT and consolidation durvalumab may be challenging to administer for selected patient populations underrepresented or even excluded in clinical trials: older and/or frail patients; those with cardiovascular or respiratory comorbidities in which treatment-related adverse events may be higher, and patients with pre-existing autoimmune disorders for whom immunotherapy use is controversial. In this narrative review, we discuss the current evidence, challenges, ongoing clinical trials and potential future treatment scenarios in relevant subgroups of patients with locally advanced NSCLC, who are underrepresented in clinical trials.
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Affiliation(s)
- Martina Bortolot
- University of Udine, Department of Medicine (DAME), Udine, Italy; University Hospital of Udine, Department of Oncology, Udine, Italy
| | - Francesco Cortiula
- University Hospital of Udine, Department of Oncology, Udine, Italy; Department of Radiation Oncology (Maastro), Maastricht University Medical Centre (+), GROW School for Oncology and Reproduction, Maastricht, the Netherlands.
| | - Gianpiero Fasola
- University Hospital of Udine, Department of Oncology, Udine, Italy
| | - Dirk De Ruysscher
- Department of Radiation Oncology (Maastro), Maastricht University Medical Centre (+), GROW School for Oncology and Reproduction, Maastricht, the Netherlands
| | - Jarushka Naidoo
- Beaumont Hospital and RCSI University of Health Sciences, Dublin, Ireland; Sidney Kimmel Comprehensive Cancer Centre at Johns Hopkins University, Baltimore, USA
| | - Lizza E L Hendriks
- Department of Pulmonary Diseases, Maastricht University Medical Centre (+), GROW School for Oncology and Reproduction, Maastricht, the Netherlands
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Orillard E, Adhikari A, Malouf RS, Calais F, Marchal C, Westeel V. Immune checkpoint inhibitors plus platinum-based chemotherapy compared to platinum-based chemotherapy with or without bevacizumab for first-line treatment of older people with advanced non-small cell lung cancer. Cochrane Database Syst Rev 2024; 8:CD015495. [PMID: 39136258 PMCID: PMC11320659 DOI: 10.1002/14651858.cd015495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/16/2024]
Abstract
BACKGROUND Lung cancer is a cancer of the elderly, with a median age at diagnosis of 71. More than one-third of people diagnosed with lung cancer are over 75 years old. Immune checkpoint inhibitors (ICIs) are special antibodies that target a pathway in the immune system called the programmed cell death 1/programmed cell death-ligand 1 (PD-1/PD-L1) pathway. These antibodies help the immune system fight cancer cells by blocking signals that cancer cells use to avoid being attacked by the immune system. ICIs have changed the treatment of people with lung cancer. In particular, for people with previously-untreated advanced non-small cell lung cancer (NSCLC), current first-line treatment now comprises ICIs plus platinum-based chemotherapy, rather than platinum-based chemotherapy alone, regardless of their PD-L1 expression status. However, as people age, their immune system changes, becoming less effective in its T cell responses. This raises questions about how well ICIs work in older adults. OBJECTIVES To assess the effects of immune checkpoint inhibitors (ICIs) in combination with platinum-based chemotherapy compared to platinum-based chemotherapy (with or without bevacizumab) in treatment-naïve adults aged 65 years and older with advanced NSCLC. SEARCH METHODS We searched the Cochrane Lung Cancer Group Trial Register, CENTRAL, MEDLINE, Embase, two other trial registers, and the websites of drug regulators. The latest search date was 23 August 2023. We also checked references and searched abstracts from the meetings of seven cancer organisations from 2019 to August 2023. SELECTION CRITERIA We included randomised controlled trials (RCTs) that reported on the efficacy and safety of adding ICIs to platinum-based chemotherapy compared to platinum-based chemotherapy alone for people 65 years and older who had not previously been treated. All data emanated from international multicentre studies involving adults with histologically-confirmed advanced NSCLC who had not received any previous systemic anticancer therapy for their advanced disease. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. Our primary outcomes were overall survival and treatment-related adverse events (grade 3 or higher). Our secondary outcomes were progression-free survival, objective response rate, time to response, duration of response, and health-related quality of life (HRQoL). MAIN RESULTS We included 17 primary studies, with a total of 4276 participants, in the review synthesis. We identified nine ongoing studies, and listed one study as 'awaiting classification'. Twelve of the 17 studies included people older than 75 years, accounting for 9% to 13% of their participants. We rated some studies as having 'some concerns' for risk of bias arising from the randomisation process, deviations from the intended interventions, or measurement of the outcome. The overall GRADE rating for the certainty of the evidence ranged from moderate to low because of the risk of bias, imprecision, or inconsistency. People aged 65 years and older The addition of ICIs to platinum-based chemotherapy probably increased overall survival compared to platinum-based chemotherapy alone (hazard ratio (HR) 0.78, 95% confidence interval (CI) 0.70 to 0.88; 8 studies, 2093 participants; moderate-certainty evidence). Only one study reported data for treatment-related adverse events (grade 3 or higher). The frequency of treatment-related adverse events may not differ between the two treatment groups (risk ratio (RR) 1.09, 95% CI 0.89 to 1.32; 1 study, 127 participants; low-certainty evidence). The addition of ICIs to platinum-based chemotherapy probably improves progression-free survival (HR 0.61, 95% CI 0.54 to 0.68; 7 studies, 1885 participants; moderate-certainty evidence). People aged 65 to 75 years, inclusive The addition of ICIs to platinum-based chemotherapy probably improved overall survival compared to platinum-based chemotherapy alone (HR 0.75, 95% CI 0.65 to 0.87; 6 studies, 1406 participants; moderate-certainty evidence). Only one study reported data for treatment-related adverse events (grade 3 or higher). The frequency of treatment-related adverse events probably increased in people treated with ICIs plus platinum-based chemotherapy compared to those treated with platinum-based chemotherapy alone (RR 1.47, 95% CI 1.02 to 2.13; 1 study, 97 participants; moderate-certainty evidence). The addition of ICIs to platinum-based chemotherapy probably improved progression-free survival (HR 0.64, 95% CI 0.57 to 0.73; 8 studies, 1466 participants; moderate-certainty evidence). People aged 75 years and older There may be no difference in overall survival in people treated with ICIs combined with platinum-based chemotherapy compared to platinum-based chemotherapy alone (HR 0.90, 95% CI 0.70 to 1.16; 4 studies, 297 participants; low-certainty evidence). No data on treatment-related adverse events were available in this age group. The effect of combination ICI and platinum-based chemotherapy on progression-free survival is uncertain (HR 0.83, 95% CI 0.51 to 1.36; 3 studies, 226 participants; very low-certainty evidence). Only three studies assessed the objective response rate. For time to response, duration of response, and health-related quality of life, we do not have any evidence yet. AUTHORS' CONCLUSIONS Compared to platinum-based chemotherapy alone, adding ICIs to platinum-based chemotherapy probably leads to higher overall survival and progression-free survival, without an increase in treatment-related adverse events (grade 3 or higher), in people 65 years and older with advanced NSCLC. These data are based on results from studies dominated by participants between 65 and 75 years old. However, the analysis also suggests that the improvements reported in overall survival and progression-free survival may not be seen in people older than 75 years.
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Affiliation(s)
- Emeline Orillard
- Department of Medical Oncology, University Hospital of Besançon, Besançon, France
- EFS, INSERM, UMR RIGHT, Université de Franche-Comté, CHU Besançon, Besançon, France
| | - Arjab Adhikari
- Internal Medicine, Ascension Saint Francis Hospital, Evanston, Illinois, USA
| | - Reem S Malouf
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - François Calais
- Bibliothèque Universitaire de Santé, Université de Franche-Comté, Besançon, France
| | | | - Virginie Westeel
- EFS, INSERM, UMR RIGHT, Université de Franche-Comté, CHU Besançon, Besançon, France
- Department of Chest Diseases and Thoracic Oncology, University Hospital of Besançon, Besançon, France
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Sarria GR, Wiegreffe S, Gkika E. [New Radiation Therapy Concepts in Non-Metastatic Lung Cancer]. Zentralbl Chir 2024; 149:S52-S61. [PMID: 39137762 DOI: 10.1055/a-2365-8743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2024]
Abstract
Radiotherapy plays a critical role in the management of non-metastatic lung cancer, offering curative potential and symptom relief. It serves as a primary treatment modality or adjuvant therapy post-surgery, enhancing local control and survival rates. Modern techniques like Stereotactic Body Radiotherapy (SBRT) enable precise tumor targeting, minimizing damage to healthy tissue and reducing treatment duration. The synergy between radiotherapy and systemic treatments, including immunotherapy, holds promise in improving outcomes. Immunotherapy augments the immune response against cancer cells, potentially enhancing radiotherapy's efficacy. Furthermore, radiotherapy's ability to modulate the tumor microenvironment complements the immunotherapy's mechanism of action. As a result, the combination of radiotherapy and immunotherapy may offer superior tumor control and survival benefits. Moreover, the integration of radiotherapy with surgery and chemotherapy in multidisciplinary approaches maximizes treatment efficacy while minimizing toxicity. Herein we present an overview on modern radiotherapy and potential developments in the close future.
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Affiliation(s)
- Gustavo R Sarria
- Klinik für Strahlentherapie und Radioonkologie, Universitätsklinikum Bonn, Bonn, Deutschland
| | - Shari Wiegreffe
- Klinik für Strahlentherapie und Radioonkologie, Universitätsklinikum Bonn, Bonn, Deutschland
| | - Eleni Gkika
- Klinik für Strahlentherapie und Radioonkologie, Universitätsklinikum Bonn, Bonn, Deutschland
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Marchal C, Orillard E, Calais F, Westeel V. Immunotherapy for non-small cell lung cancer in the elderly population: a generic protocol. Cochrane Database Syst Rev 2024; 7:CD014907. [PMID: 38958139 PMCID: PMC11220895 DOI: 10.1002/14651858.cd014907.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/04/2024]
Abstract
OBJECTIVES This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To evaluate the effectiveness and safety of immune checkpoint inhibitors (ICI) as monotherapy or in combination compared to standard of care for elderly people (≥ 65 years) with non-small cell lung cancer (NSCLC).
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Affiliation(s)
| | - Emeline Orillard
- Université Bourgogne Franche-Comté, INSERM, EFS BFC, UMR 1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, Besançon, France
| | - François Calais
- Bibliothèque universitaire de Santé, Université de Franche-Comté, Besançon, France
| | - Virginie Westeel
- Université Bourgogne Franche-Comté, INSERM, EFS BFC, UMR 1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, Besançon, France
- Department of Thoracic Oncology, University Hospital of Besançon, Besançon, France
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Tsuboi M, Murakami H, Harada H, Sobue T, Kato T, Atagi S, Tokito T, Mio T, Adachi H, Kozuki T, Sone T, Seike M, Toyooka S, Kitagawa H, Koto R, Yamazaki S, Horinouchi H. Treatment patterns and clinical outcomes of resectable clinical stage III non-small cell lung cancer in a Japanese real-world setting: Surgery cohort analysis of the SOLUTION study. Thorac Cancer 2024; 15:1541-1552. [PMID: 38812106 PMCID: PMC11246785 DOI: 10.1111/1759-7714.15305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 03/15/2024] [Accepted: 03/20/2024] [Indexed: 05/31/2024] Open
Abstract
BACKGROUND To elucidate the treatment and surgery outcomes with or without perioperative therapies in Japanese patients with clinical stage III non-small cell lung cancer (NSCLC) in real-world settings. METHODS We performed subset analyses of the SOLUTION study, a multicenter, noninterventional, observational study of Japanese patients diagnosed with clinical stage III NSCLC, for those who started first-line treatment (surgery±perioperative therapy) between January 2013 and December 2014 (study registration: UMIN000031385). Follow-up data were obtained using medical records from diagnosis to March 1, 2018. RESULTS Of 149 eligible patients, 67 underwent surgery alone (median age 71 years) and 82 underwent surgery+perioperative therapy (median age 63 years). Lung resection was performed in 137 patients and the others underwent exploratory thoracotomy or other procedures. Perioperative therapies included adjuvant therapy only (n = 41), neoadjuvant therapy only (n = 24), and neoadjuvant+adjuvant therapy (n = 17). The median overall survival (OS) and 3-year OS rate were 29.3 months and 44.0%, respectively, in patients who underwent surgery alone, and not reached and 61.1%, respectively, in patients who underwent surgery+perioperative therapy. The 3-year progression-free survival (PFS) and disease-free survival (DFS) rates were 42.4% and 47.1%, respectively, in patients who underwent surgery+perioperative therapy and 28.5% and 28.9%, respectively, in patients who underwent surgery alone. In multivariable Cox regression, perioperative therapy was associated with improved OS (hazard ratio [95% confidence interval] 0.49 [0.29-0.81]), PFS (0.62 [0.39-0.96]), and DFS (0.62 [0.39-0.97]) versus surgery alone. CONCLUSIONS Our study suggested that perioperative therapy may be associated with better survival among patients undergoing surgical treatment of clinical stage III NSCLC.
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Affiliation(s)
- Masahiro Tsuboi
- Department of Thoracic Surgery, National Cancer Center Hospital East, Chiba, Japan
| | - Haruyasu Murakami
- Division of Thoracic Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Hideyuki Harada
- Division of Radiation Therapy, Shizuoka Cancer Center, Shizuoka, Japan
| | - Tomotaka Sobue
- Division of Environmental Medicine and Population Sciences, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Tomohiro Kato
- Department of Respiratory Medicine, National Hospital Organization Himeji Medical Center, Hyogo, Japan
| | - Shinji Atagi
- Department of Thoracic Oncology, National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka, Japan
| | - Takaaki Tokito
- Division of Respirology, Neurology, and Rheumatology, Department of Internal Medicine, Kurume University Hospital, Fukuoka, Japan
| | - Tadashi Mio
- Department of Respiratory Medicine, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Hirofumi Adachi
- Department of Thoracic Surgery, National Hospital Organization Hokkaido Cancer Center, Hokkaido, Japan
| | - Toshiyuki Kozuki
- Department of Thoracic Oncology and Medicine, National Hospital Organization Shikoku Cancer Center, Ehime, Japan
| | - Takashi Sone
- Department of Respiratory Medicine, Kanazawa University Hospital, Ishikawa, Japan
| | - Masahiro Seike
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Shinichi Toyooka
- Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | | | - Ryo Koto
- Medical Department, AstraZeneca K.K., Osaka, Japan
| | | | - Hidehito Horinouchi
- Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo, Japan
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Gendarme S, Zebachi S, Corre R, Greillier L, Justeau G, Bylicki O, Decroisette C, Auliac JB, Guisier F, Geier M, Ricordel C, Frelaut M, Paillaud E, Chouaïd C, Canouï-Poitrine F. Predictors of three-month mortality and severe chemotherapy-related adverse events in patients aged 70 years and older with metastatic non-small-cell lung cancer: A secondary analysis of ESOGIA-GFPC-GECP 08-02 study. J Geriatr Oncol 2024; 15:101506. [PMID: 37211514 DOI: 10.1016/j.jgo.2023.101506] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 03/27/2023] [Accepted: 04/21/2023] [Indexed: 05/23/2023]
Abstract
INTRODUCTION Predictors for mortality and toxicity in older patients with cancer are mainly studied in cohorts with various cancers at different stages. This study aims to identify predictive geriatric factors (PGFs) for early death and severe chemotherapy related adverse events (CRAEs) in patients aged ≥70 years with metastatic non-small-cell lung cancer (mNSCLC). MATERIAL AND METHODS This is a secondary analysis of the multicenter, randomized, phase 3 ESOGIA trial that compared, for patients ≥70 years with mNSCLC, a treatment algorithm based on performance status and age to another algorithm based on geriatric assessment. To identify PGFs of three-month mortality and grade 3, 4, or 5 CRAEs, multivariate Cox models and logistic models, adjusted for treatment group and center, and stratified by randomization arm, were constructed. RESULTS Among 494 included patients, 145 (29.4%) had died at three months and 344 (69.6%) had severe chemotherapy toxicity. For three-month mortality, multivariate analyses retained mobility (Test Get up and Go), instrumental activity of daily living (IADL) dependence and weight loss as PGFs. The combined effect of IADL ≤2/4 and weight loss ≥3 kg was strongly associated with three-month mortality (adjusted hazard ratio: 5.71 [95% confidence interval [CI]: 2.64-12.32]). For chemotherapy toxicity, Charlson Comorbidity Index ≥2 was independently associated with grade3, 4, or 5 CRAEs (adjusted odds ratio [95% CI]: 1.94 [1.06-3.56]). DISCUSSION Mobility, IADL dependence, and weight loss were predictive of three-month mortality in a population aged ≥70 years treated for mNSCLC, while comorbidities were independently associated with severe chemotherapy toxicity.
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Affiliation(s)
- Sébastien Gendarme
- Univ Paris Est Creteil, INSERM, IMRB (CEpiA Team), F-94010 Creteil, France; Centre Hospitalier Intercommunal de Créteil, Service de Pneumologie, 40 avenue de Verdun, 94010 Créteil, France.
| | - Sonia Zebachi
- Univ Paris Est Creteil, INSERM, IMRB (CEpiA Team), F-94010 Creteil, France; Assistance Publique-Hôpitaux de Paris, Hôpital Henri-Mondor, Service de Santé Publique et Unité de Recherche Clinique, 1 Rue Gustave Eiffel, 94010 Créteil, France
| | - Romain Corre
- Centre Hospitalier Intercommunal de Cornouaille, Service de Pneumologie, 14 Av. Yves Thépot, 29000 Quimper, France
| | - Laurent Greillier
- Aix-Marseille Université, AP-HM, INSERM, CNRS, CRCM, Hôpital Nord, Service d'Oncologie Multidisciplinaire et Innovations Thérapeutiques, Marseille, France
| | - Grégoire Justeau
- CHU d'Angers, Service de Pneumologie, 4 Rue Larrey, 49100 Angers, France
| | - Olivier Bylicki
- HIA Sainte-Anne, Service de Pneumologie, 2, boulevard Saint-Anne, 83000 Toulon, France
| | - Chantal Decroisette
- CH d'Annecy, Service de Pneumologie, 1, avenue de l'Hôpital, Metz-Tessy, 74374 Annecy, France
| | - Jean-Bernard Auliac
- Centre Hospitalier Intercommunal de Créteil, Service de Pneumologie, 40 avenue de Verdun, 94010 Créteil, France
| | - Florian Guisier
- Univ Rouen Normandie, LITIS Lab QuantIF team EA4108, CHU Rouen, France; Department of Pulmonology, Thoracic Oncology, and Respiratory Intensive Care & CIC-CRB INSERM 1404 F, 76000, Rouen, France
| | - Margaux Geier
- CHU Morvan, Service de Pneumologie, 2, avenue Foch, 29200 Brest, France
| | - Charles Ricordel
- CHU Rennes, Service de Pneumologie, 2 Rue Henri le Guilloux, 35033 Rennes, France
| | - Maxime Frelaut
- Gustave Roussy, Département d'Oncologie Médicale, 39 rue Camille-Desmoulins, 94805 Villejuif Cedex, France
| | - Elena Paillaud
- Univ Paris Est Creteil, INSERM, IMRB (CEpiA Team), F-94010 Creteil, France; Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Service de Gériatrie, 20, rue Leblanc, 75908 Paris Cedex 15, France
| | - Christos Chouaïd
- Univ Paris Est Creteil, INSERM, IMRB (CEpiA Team), F-94010 Creteil, France; Centre Hospitalier Intercommunal de Créteil, Service de Pneumologie, 40 avenue de Verdun, 94010 Créteil, France
| | - Florence Canouï-Poitrine
- Univ Paris Est Creteil, INSERM, IMRB (CEpiA Team), F-94010 Creteil, France; Assistance Publique-Hôpitaux de Paris, Hôpital Henri-Mondor, Service de Santé Publique et Unité de Recherche Clinique, 1 Rue Gustave Eiffel, 94010 Créteil, France
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8
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Tsukita Y, Tozuka T, Kushiro K, Hosokawa S, Sumi T, Uematsu M, Honjo O, Yamaguchi O, Asao T, Sugisaka J, Saito G, Shiihara J, Morita R, Katakura S, Yasuda T, Hisakane K, Miyauchi E, Morita S, Kobayashi K, Asahina H. Immunotherapy or Chemoimmunotherapy in Older Adults With Advanced Non-Small Cell Lung Cancer. JAMA Oncol 2024; 10:439-447. [PMID: 38451530 PMCID: PMC10921348 DOI: 10.1001/jamaoncol.2023.6277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 09/29/2023] [Indexed: 03/08/2024]
Abstract
Importance Immune checkpoint inhibitor (ICI) plus chemotherapy combination treatment (ICI-chemotherapy) is now a standard treatment for non-small cell lung cancer (NSCLC) without targetable oncogene alterations, but there are few data on ICI-chemotherapy for patients 75 years and older. Objective To inform the choice of first-line drugs in clinical practice and assess the safety and efficacy of ICI-chemotherapy combination treatment in older adult patients with previously untreated advanced NSCLC. Design, Setting, and Participants This retrospective cohort study included 58 centers in Japan. The cohort consisted of patients 75 years and older with clinical stage IIIB, IIIC, IV, postoperative or radiotherapy recurrent NSCLC. Patients started first-line systemic therapy between December 2018 and March 2021. Those receiving first-line molecular targeted drugs were excluded. The data were analyzed from February 2022 to October 2022. Exposures Systemic therapy. Main Outcomes and Measures The main outcomes were overall survival (OS), progression-free survival (PFS), and safety. Results A total of 1245 patients (median [range] age, 78 [75-95] years; 967 [78%] male) with NSCLC were included in the cohort. Programmed death ligand-1 (PD-L1) expression of less than 1% occurred in 268 tumors (22%); 1% to 49% in 387 tumors (31%); 50% and higher in 410 tumors (33%), and unknown expression in 180 tumors (14%). Median OS was 20.0 (95% CI, 17.1-23.6) months for the 354 patients receiving ICI-chemotherapy (28%); 19.8 (95% CI, 16.5-23.8) months for the 425 patients receiving ICI alone (34%); 12.8 (95% CI, 10.7-15.6) months for the 311 patients receiving platinum-doublet chemotherapy (25%); and 9.5 (95% CI, 7.4-13.4) months for the 155 patients receiving single-agent chemotherapy (12%). After propensity score matching, no differences in OS and PFS were found between the patients receiving ICI-chemotherapy vs ICI alone. Each group consisted of 118 patients. For PD-L1 expression of 1% and higher the OS hazard ratio (HR) was 0.98 (95% CI, 0.67-1.42; P = .90), and the PFS HR was 0.92 (95% CI, 0.67-1.25; P = .59). Significance was also not reached when separately analyzed for lower or higher PD-L1 expression (1%-49% or ≥50%). However, grade 3 or higher immune-related adverse events occurred in 86 patients (24.3%) treated with ICI-chemotherapy and 76 (17.9%) with ICI alone (P = .03). Conclusions and Relevance In this study, ICI-chemotherapy combination treatment did not improve survival and increased the incidence of grade 3 and higher immune-related adverse events compared with ICI alone in patients 75 years and older. Based on these results, ICI alone may be recommended for older adult patients with PD-L1-positive NSCLC.
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Affiliation(s)
- Yoko Tsukita
- Department of Respiratory Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Takehiro Tozuka
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Kohei Kushiro
- Department of Respiratory Medicine and Infectious Diseases, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Shinobu Hosokawa
- Department of Respiratory Medicine, Japanese Red Cross Okayama Hospital, Okayama, Japan
| | - Toshiyuki Sumi
- Department of Respiratory Medicine, Hakodate Goryoukaku Hospital, Hakodate, Japan
| | - Mao Uematsu
- Department of Thoracic Oncology and Respiratory Medicine, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Osamu Honjo
- Department of Respiratory Medicine, Sapporo Minami-Sanjo Hospital, Sapporo, Japan
| | - Ou Yamaguchi
- Department of Respiratory Medicine, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Tetsuhiko Asao
- Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Jun Sugisaka
- Department of Pulmonary Medicine, Sendai Kousei Hospital, Sendai, Japan
| | - Go Saito
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Jun Shiihara
- Department of Respiratory Medicine, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Ryo Morita
- Department of Respiratory Medicine, Akita Kousei Medical Center, Akita, Japan
| | - Seigo Katakura
- Department of Thoracic Oncology, Kanagawa Cancer Center, Yokohama, Japan
| | - Takehiro Yasuda
- Department of Respiratory Medicine, Yokosuka Kyosai Hospital, Yokosuka, Japan
| | - Kakeru Hisakane
- Department of Pulmonary Medicine and Medical Oncology, Nippon Medical School Tamanagayama Hospital, Tokyo, Japan
| | - Eisaku Miyauchi
- Department of Respiratory Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Satoshi Morita
- Department of Biomedical Statistics and Bioinformatics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kunihiko Kobayashi
- Department of Respiratory Medicine, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Hajime Asahina
- Department of Respiratory Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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V A B, Mathew P, Thomas S, Mathew L. Detection of lung cancer and stages via breath analysis using a self-made electronic nose device. Expert Rev Mol Diagn 2024; 24:341-353. [PMID: 38369930 DOI: 10.1080/14737159.2024.2316755] [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: 04/20/2023] [Accepted: 01/25/2024] [Indexed: 02/20/2024]
Abstract
BACKGROUND Breathomics is an emerging area focusing on monitoring and diagnosing pulmonary diseases, especially lung cancer. This research aims to employ metabolomic methods to create a breathprint in human-expelled air to rapidly identify lung cancer and its stages. RESEARCH DESIGN AND METHODS An electronic nose (e-nose) system with five metal oxide semiconductor (MOS) gas sensors, a microcontroller, and machine learning algorithms was designed and developed for this application. The volunteers in this study include 114 patients with lung cancer and 147 healthy controls to understand the clinical potential of the e-nose system to detect lung cancer and its stages. RESULTS In the training phase, in discriminating lung cancer from controls, the XGBoost classifier model with 10-fold cross-validation gave an accuracy of 91.67%. In the validation phase, the XGBoost classifier model correctly identified 35 out of 42 patients with lung cancer samples and 44 out of 51 healthy control samples providing an overall sensitivity of 83.33% and specificity of 86.27%. CONCLUSIONS These results indicate that the exhaled breath VOC analysis method may be developed as a new diagnostic tool for lung cancer detection. The advantages of e-nose based diagnostics, such as an easy and painless method of sampling, and low-cost procedures, will make it an excellent diagnostic method in the future.
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Affiliation(s)
- Binson V A
- Saintgits College of Engineering, Kottayam, Kerala, India
| | - Philip Mathew
- Department of Critical Care Medicine, Believers Church Medical College Hospital, Thiruvalla, Kerala, India
| | - Sania Thomas
- Saintgits College of Engineering, Kottayam, Kerala, India
| | - Luke Mathew
- Department of Pulmonology, Believers Church Medical College Hospital, Thiruvalla, Kerala, India
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10
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Bech D, Lietzen LW, Meldgaard P, Ryltoft AK, Ørum M. Diagnostic accuracy of the geriatric screening tools G8 and modified G8 in older patients with lung cancer: A diagnostic performance study. J Geriatr Oncol 2024; 15:101645. [PMID: 37903667 DOI: 10.1016/j.jgo.2023.101645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 08/30/2023] [Accepted: 10/03/2023] [Indexed: 11/01/2023]
Affiliation(s)
- Danny Bech
- Department of Geriatrics, Aarhus University Hospital, Aarhus, Denmark.
| | - Lone Winther Lietzen
- Department of Geriatrics, Aarhus University Hospital, Aarhus, Denmark; Aarhus University, Aarhus, Denmark
| | - Peter Meldgaard
- Aarhus University, Aarhus, Denmark; Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Marianne Ørum
- Department of Geriatrics, Aarhus University Hospital, Aarhus, Denmark
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11
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Li H, Kilgour H, Leung B, Cho M, Pollock J, Culbertson S, Hedges P, Mariano C, Haase KR. Caring for older adults with cancer in Canada: Views from healthcare providers and cancer care allies in the community. Support Care Cancer 2024; 32:157. [PMID: 38358430 DOI: 10.1007/s00520-023-08303-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 12/29/2023] [Indexed: 02/16/2024]
Abstract
BACKGROUND Cancer is common and disproportionately impacts older adults. Moreover, cancer care of older adults is complex, and the current Canadian cancer care system struggles to address all of the dimensions. In this project, our goal was to understand the barriers and facilitators to caring for older adults with cancer from perspectives of healthcare professionals and cancer care allies, which included community groups, seniors' centers, and other community-based supports. METHODS In collaboration with a patient advisory board, we conducted focus groups and interviews with multiple local healthcare professionals and cancer care allies in British Columbia, Canada. We used a descriptive qualitative approach and conducted a thematic analysis using NVivo software. RESULTS A total of 71 participants of various disciplines and cancer care allies participated. They identified both individual and system-level barriers. Priority system-level barriers for older adults included space and staffing constraints and disconnections within healthcare systems, and between healthcare practitioners and cancer care allies. Individual-level barriers relate to the complex health states of older adults, caregiver/support person needs, and the needs of an increasingly diverse population where English may not be a first or preferable language. CONCLUSIONS This study identified key barriers and facilitators that demonstrate aligned priorities among a diverse group of healthcare practitioners and cancer care allies. In conjunction with perspectives from patients and caregivers, these findings will inform future improvements in cancer care. Namely, we emphasize the importance of connections among health systems and community networks, given the outpatient nature of cancer care and the needs of older adults.
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Affiliation(s)
- Hong Li
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Heather Kilgour
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
| | - Bonnie Leung
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
- BC Cancer, Vancouver, BC, Canada
| | - Michelle Cho
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
| | | | | | | | | | - Kristen R Haase
- School of Nursing, University of British Columbia, Vancouver, BC, Canada.
- BC Cancer Research Institute, Vancouver, BC, Canada.
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12
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Vinod S, Khoo A, Berry M, Bell K, Ahmed E, Campisi J, Gollon C, Pal A, Seto SK, Tcharkhedian E, Tran T, Bray V. Implementation and evaluation of a geriatric-oncology model of care for older adults with lung cancer. J Geriatr Oncol 2023; 14:101578. [PMID: 37422350 DOI: 10.1016/j.jgo.2023.101578] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 06/20/2023] [Accepted: 06/29/2023] [Indexed: 07/10/2023]
Affiliation(s)
- Shalini Vinod
- Liverpool Cancer Therapy Centre, Liverpool Hospital, Liverpool, NSW, Australia; South Western Sydney Clinical Campuses, University of NSW, Liverpool, NSW, Australia; Faculty of Science, Medicine and Health, University of Wollongong, Liverpool, NSW, Australia.
| | - Angela Khoo
- South Western Sydney Clinical Campuses, University of NSW, Liverpool, NSW, Australia; Department of Geriatrics, Liverpool Hospital, Liverpool, NSW, Australia
| | - Megan Berry
- Liverpool Cancer Therapy Centre, Liverpool Hospital, Liverpool, NSW, Australia; South Western Sydney Clinical Campuses, University of NSW, Liverpool, NSW, Australia
| | - Katherine Bell
- Liverpool Cancer Therapy Centre, Liverpool Hospital, Liverpool, NSW, Australia; Department of Dietetics, Liverpool Hospital, Liverpool, NSW, Australia
| | - Elhassan Ahmed
- Department of Physiotherapy, Liverpool Hospital, Liverpool, NSW, Australia
| | - Josephine Campisi
- Department of Occupational Therapy, Liverpool Hospital, Liverpool, NSW, Australia
| | - Cara Gollon
- Department of Occupational Therapy, Liverpool Hospital, Liverpool, NSW, Australia
| | - Abhijit Pal
- Liverpool Cancer Therapy Centre, Liverpool Hospital, Liverpool, NSW, Australia; University of Sydney, Camperdown, NSW, Australia
| | - Sau Kwan Seto
- Department of Occupational Therapy, Liverpool Hospital, Liverpool, NSW, Australia
| | - Elise Tcharkhedian
- Department of Physiotherapy, Liverpool Hospital, Liverpool, NSW, Australia
| | - Thomas Tran
- Liverpool Cancer Therapy Centre, Liverpool Hospital, Liverpool, NSW, Australia
| | - Victoria Bray
- Liverpool Cancer Therapy Centre, Liverpool Hospital, Liverpool, NSW, Australia; Western Sydney University, Liverpool, NSW, Australia
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13
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Nadal E, Oré-Arce M, Remon J, Bernabé-Caro R, Covela-Rúa M, de Castro-Carpeño J, Massutí-Sureda B, Guillot-Morales M, Majem M, Maestu-Maiques I, Morilla-Ruíz I, Gironés R. Expert consensus to optimize the management of older adult patients with advanced EGFR-mutated non-small cell lung cancer. Clin Transl Oncol 2023; 25:3139-3151. [PMID: 37566345 PMCID: PMC10514135 DOI: 10.1007/s12094-023-03286-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 07/17/2023] [Indexed: 08/12/2023]
Abstract
Lung cancer (LC) is associated with ageing, with the average age of affected individuals being approximately 70 years. However, despite a higher incidence and prevalence among older people, the older adult population is underrepresented in clinical trials. For LC with Epidermal Growth Factor Receptor (EGFR) mutations, there is no clear association of this mutation with age. Geriatric assessments (GAs) and a multidisciplinary approach are essential for defining the optimal treatment. In this consensus, a group of experts selected from the Oncogeriatrics Section of the Spanish Society of Medical Oncology (Sección de Oncogeriatría de la Sociedad Española de Oncología Médica-SEOM), the Spanish Lung Cancer Group (Grupo Español de Cáncer de Pulmón-GECP) and the Association for Research on Lung Cancer in Women (Asociación para la Investigación del Cáncer de Pulmón en Mujeres-ICAPEM) evaluate the scientific evidence currently available and propose a series of recommendations to optimize the management of older adult patients with advanced LC with EGFR mutations.
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Affiliation(s)
- Ernest Nadal
- Department of Medical Oncology, Institut Català d’Oncologia (ICO), Institut d’Investigacions Biomèdiques de Bellvitge (IDIBELL), Duran i Reynals University Hospital, Barcelona, Spain
| | - Martín Oré-Arce
- Department of Medical Oncology, Marina Baixa de Villajoyosa Hospital, Alicante, Spain
| | - Jordi Remon
- Department of Medical Oncology, HM Nou Delfos Hospital, Barcelona, Spain
| | - Reyes Bernabé-Caro
- Department of Medical Oncology, Virgen del Rocío University Hospital, Sevilla University, Seville, Spain
| | - Marta Covela-Rúa
- Department of Medical Oncology, Lucus Augusti University Hospital, Lugo, Spain
| | | | | | | | - Margarita Majem
- Department of Medical Oncology, Santa Creu i Sant Pau Hospital, Barcelona, Spain
| | | | - Idoia Morilla-Ruíz
- Department of Medical Oncology, Navarra University Hospital-NavarraBioMed, IdisNa, Pamplona, Spain
| | - Regina Gironés
- Department of Medical Oncology, Polytechnic la Fe University Hospital, Avinguda de Fernando Abril Martorell, 106, 46026 Valencia, Valencia Spain
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14
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Kobayashi T, Nishino Y, Takiguchi T, Kanda S, Otsuki K, Tanaka Y, Nakazawa Y, Ito KI, Hayashi R, Yasumoto K, Uramoto H, Hirono Y, Makino T, Nakada M, Yano S, Koizumi T. Epidemiological and therapeutic profiles of lung cancer patients in the Hokushin Region Japan: a retrospective hospital administrative database study. BMC Pulm Med 2023; 23:322. [PMID: 37658334 PMCID: PMC10472700 DOI: 10.1186/s12890-023-02610-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 08/22/2023] [Indexed: 09/03/2023] Open
Abstract
OBJECTIVE This study was performed to validate the epidemiology, initial treatment, and clinical practice of lung cancer patients in the Hokushin region, Japan. METHODS We retrospectively surveyed data of 5503 newly diagnosed and registered lung cancer patients in 22 principal hospital-based cancer registries in Hokushin region linked with health insurance claims data for registered patients between 2016 and 2017. RESULTS The patients consisted of 3677 (66.8%) men and 1826 (33.2%) women with a mean (range) age of 72.2 (27-103) years). Diagnoses were small cell lung cancer (n = 512, 9.4%), squamous cell carcinoma (n = 1083, 19.7%), and non-squamous non-small cell lung cancer (NSCLC; n = 3906, 70.9%). The population with stage I disease in Toyama prefecture (41.1%) was smaller than in the other three prefectures associated with reduced selection of initial surgical therapy and increased frequencies of stage IV disease (33.2%) and best supportive care (18.6%). Initial chemotherapy for stage IV non-squamous NSCLC consisted of tyrosine kinase inhibitors in 39.3% of cases for EGFR and 4% of cases for ALK-positive non-squamous NSCLC, followed by platinum compounds (25.9%) non-platinum compounds (12.9%), and immune checkpoint inhibitors (10.2%). Carboplatin was the commonly prescribed first-line cytotoxic chemotherapeutic agent (65.4% of patients under 75 years and in 96.7% of patients over 75 years). CONCLUSION This study revealed real-world data on epidemiological and treatment status in lung cancer in four prefectures in Hokushin region, Japan. Simultaneous analysis of nationwide registry and insurance data could provide valuable insights for the development of lung cancer screening and medical treatment strategies. In addition, the comparative data analysis with other lesions or countries will be useful for evaluating the differences in clinical practice of cancer managements.
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Affiliation(s)
- Takashi Kobayashi
- Department of Hematology and Medical Oncology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Nagano, Japan
| | - Yoshikazu Nishino
- Department of Epidemiology and Public Health, Kanazawa Medical University, Uchinada, Ishikawa, Japan
| | - Tomoya Takiguchi
- Department of Epidemiology and Public Health, Kanazawa Medical University, Uchinada, Ishikawa, Japan
| | - Shintaro Kanda
- Department of Hematology and Medical Oncology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Nagano, Japan
| | - Kengo Otsuki
- Department of Hematology and Medical Oncology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Nagano, Japan
| | - Yuriko Tanaka
- Department of Hematology and Medical Oncology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Nagano, Japan
| | - Yozo Nakazawa
- Department of Pediatrics, Shinshu University School of Medicine, Matsumoto, Japan
| | - Ken-Ichi Ito
- Division of Breast and Endocrine Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Ryuji Hayashi
- Clinical Oncology, Toyama University Hospital, Toyama, Japan
| | - Kazuo Yasumoto
- Department of Medical Oncology, Kanazawa Medical University, Uchinada, Ishikawa, Japan
| | - Hidetaka Uramoto
- Department of Thoracic Surgery, Kanazawa Medical University, Uchinada, Ishikawa, Japan
| | - Yasuo Hirono
- Cancer Care Promotion Center, University of Fukui Hospital, Fukui, Japan
| | - Tomoe Makino
- Division of Adult Nursing Practice, Ishikawa Prefectural Nursing University, Kahoku, Japan
| | - Mitsutoshi Nakada
- Department of Neurosurgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
| | - Seiji Yano
- Division of Medical Oncology, Cancer Research Institute, Kanazawa University, Kanazawa, Japan
| | - Tomonobu Koizumi
- Department of Hematology and Medical Oncology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Nagano, Japan.
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15
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Liu W, Ma S, Shi P, Zhang Y, Li M. Postoperative chemotherapy significantly improves survival of elderly patients with stage IB-II non-small cell lung cancer: A population-based study. Cancer Med 2023. [PMID: 37031456 DOI: 10.1002/cam4.5834] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 02/23/2023] [Accepted: 03/12/2023] [Indexed: 04/11/2023] Open
Abstract
BACKGROUND There is scant evidence-based information about survival benefits of postoperative chemotherapy in elderly patients with early-stage non-small cell lung cancer (NSCLC). The purpose of this study is to compare the overall survival (OS) and cancer-specific survival (CSS) rates of surgery alone versus postoperative chemotherapy in patients aged ≥70 years with stage I-II NSCLC. METHODS Elderly patients aged ≥70 years diagnosed with stage I-II NSCLC were selected from the Surveillance, Epidemiology, and End Results (SEER) database from January 1, 2010 to December 31, 2015. OS and CSS were compared between the two groups utilizing overlap weighting analysis, inverse probability of treatment weight (IPTW), and propensity score matching (PSM). RESULTS Of the 7193 included patients with stage I-II NSCLC who are more than 70 years old, 681 patients (9.5%) received postoperative chemotherapy and 6512 patients (90.5%) received surgery-alone. Median OS was 77 months in postoperative chemotherapy group versus 79 months in surgery-alone group (p = 0.89). The result of IPTW analysis showed the similar results. The probability of patients choosing chemotherapy increased with the AJCC stage and Grade increasing (p < 0.001) and decreased with the growth of age (p < 0.001). The results of subgroup analysis showed that the survival rate of stage IA patients decreased significantly after postoperative chemotherapy (p < 0.01) while the survival rate of stage IB-II patients increased significantly (p < 0.01). At the same time, we found that patients in the postoperative chemotherapy group tended to have better OS than those in the surgery-alone group with the grade and tumor size increasing. CONCLUSION The results of this study indicated that postoperative chemotherapy could significantly improve the survival of stage IB-II NSCLC patients aged ≥70 years, and decrease the survival of stage IA patients.
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Affiliation(s)
- Wujianhong Liu
- Department of Respiratory Medicine, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China
| | - Shangshang Ma
- Department of Respiratory Medicine, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China
| | - Pingfan Shi
- Department of Respiratory Medicine, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China
| | - Yanfei Zhang
- Department of Respiratory Medicine, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China
| | - Ming Li
- Department of Respiratory Medicine, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China
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González Serrano A, Laurent M, Barnay T, Martínez-Tapia C, Audureau E, Boudou-Rouquette P, Aparicio T, Rollot-Trad F, Soubeyran P, Bellera C, Caillet P, Paillaud E, Canouï-Poitrine F. A Two-Step Frailty Assessment Strategy in Older Patients With Solid Tumors: A Decision Curve Analysis. J Clin Oncol 2023; 41:826-834. [PMID: 36306481 PMCID: PMC9901978 DOI: 10.1200/jco.22.01118] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 08/18/2022] [Accepted: 09/09/2022] [Indexed: 02/01/2023] Open
Abstract
PURPOSE The intended clinical value of frailty screening is to identify unfit patients needing geriatric assessment (GA) and to prevent unnecessary GA in fit patients. These hypotheses rely on the sensitivity and specificity of screening tests, but they have not been verified. METHODS We performed a cross-sectional analysis of outpatients age ≥ 70 years with prostate, breast, colorectal, or lung cancer included in the ELCAPA cohort study (ClinicalTrials.gov identifier: NCT02884375) between February 2007 and December 2019. The diagnostic accuracy of the G8 Geriatric Screening Tool (G8) and modified G8 scores for identifying unfit patients was determined on the basis of GA results. We used decision curve analysis to calculate the benefit of frailty screening for detecting unfit patients and avoiding unnecessary GA in fit patients across different threshold probabilities. RESULTS We included 1,648 patients (median age, 81 years), and 1,428 (87%) were unfit. The sensitivity and specificity were, respectively, 85% (95% CI, 84 to 87) and 59% (95% CI, 57 to 61) for G8, and 86% (95% CI, 84 to 87) and 60% (95% CI, 58 to 63) for the modified G8 score. For decision curve analysis, the net benefit (NB) for identifying unfit patients were 0.72 for G8, 0.72 for the modified G8, and 0.82 for GA at a threshold probability of 0.25. At a threshold probability of 0.33, the NBs were 0.71, 0.72, and 0.80, respectively. At a threshold probability of 0.5, the NBs were 0.68, 0.69, and 0.73, respectively. No screening tool reduced unnecessary GA in fit patients at predefined threshold probabilities. CONCLUSION Although frailty screening tests showed good diagnostic accuracy, screening showed no clinical benefits over the GA-for-all strategy. NB approaches, in addition to diagnostic accuracy, are necessary to assess the clinical value of tests.
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Affiliation(s)
| | - Marie Laurent
- Inserm, IMRB, Université Paris-Est-Créteil, Créteil, France
- Department of Internal Medicine and Geriatrics, Henri Mondor Hospital, AP-HP, Creteil, France
| | - Thomas Barnay
- ERUDITE Research Unit, Université Paris-Est-Créteil, Créteil, France
| | | | - Etienne Audureau
- Inserm, IMRB, Université Paris-Est-Créteil, Créteil, France
- Department of Public Health, Henri Mondor Hospital, AP-HP, Creteil, France
| | | | - Thomas Aparicio
- Department of Gastroenterology, Saint Louis Hospital, AP-HP, Paris, France
| | - Florence Rollot-Trad
- Department of Supportive Care and Geriatric Oncology, Institut Curie, Paris, France
| | - Pierre Soubeyran
- Department of Medical Oncology, Bergonie Institute Comprehensive Cancer Center, Bordeaux, France
| | - Carine Bellera
- Inserm, Bordeaux Population Health Research Center, Epicene Team, UMR 1219, Université de Bordeaux, Bordeaux, France
- Inserm CIC1401, Clinical and Epidemiological Research Unit, Bergonié Institute Comprehensive Cancer Center, Bordeaux, France
| | - Philippe Caillet
- Inserm, IMRB, Université Paris-Est-Créteil, Créteil, France
- Department of Geriatrics, Georges Pompidou European Hospital, AP-HP, Paris, France
- Paris Cancer Research for Personalized Medicine Institute, Paris, France
| | - Elena Paillaud
- Inserm, IMRB, Université Paris-Est-Créteil, Créteil, France
- Department of Geriatrics, Georges Pompidou European Hospital, AP-HP, Paris, France
- Paris Cancer Research for Personalized Medicine Institute, Paris, France
| | - Florence Canouï-Poitrine
- Inserm, IMRB, Université Paris-Est-Créteil, Créteil, France
- Department of Public Health, Henri Mondor Hospital, AP-HP, Creteil, France
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Clinical significance of the preoperative prognostic nutritional index on age/comorbidity burdens in patients with resectable non-small cell lung cancer. Surg Today 2023; 53:681-691. [PMID: 36720742 DOI: 10.1007/s00595-023-02650-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 09/18/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE Objective nutritional scoring systems using preoperative blood samples have shown the potential to predict the postoperative outcomes of patients with non-small cell lung cancer (NSCLC). However, it remains unclear whether the prognostic impact depends on age and comorbid burdens. We conducted this study to validate the impact of preoperative nutritional status, stratified with age and comorbidity. METHODS We reviewed the preoperative prognostic nutritional index (PNI) and postoperative outcomes of 713 consecutive patients with completely resected NSCLC. RESULTS We identified the optimal cutoff values of the PNI as 46. Significantly higher postoperative complication rates and worse survival rates were observed in the low PNI (≤ 46) group, regardless of age/comorbidity burdens. Multivariate analysis showed that a low PNI (≤ 46) was an independent prognostic factor for poor overall survival (hazard ratio: 2.5). A matched-pair analysis gave consistent results, showing that a low PNI (≤ 46) was an independent prognostic factor for poor overall survival (OS; hazard ratio: 1.8) and recurrence-free survival (RFS; hazard ratio: 1.6). CONCLUSION Nutritional status, indexed by the PNI, is a strong prognostic factor for the postoperative outcomes of patients undergoing curative resection for NSCL, regardless of age/comorbidity burdens.
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18
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Yamamoto H, Soh J, Okumura N, Suzuki H, Nakata M, Fujiwara T, Gemba K, Sano I, Fujinaga T, Kataoka M, Terazaki Y, Fujimoto N, Kataoka K, Kosaka S, Yamashita M, Inokawa H, Inoue M, Nakamura H, Yamashita Y, Hotta K, Yoshioka H, Morita S, Matsuo K, Sakamoto J, Date H, Toyooka S. Randomized phase II study of daily versus alternate-day administrations of S-1 for the elderly patients with completely resected pathological stage IA (tumor diameter > 2 cm)-IIIA of non-small cell lung cancer: Setouchi Lung Cancer Group Study 1201. PLoS One 2023; 18:e0285273. [PMID: 37205678 DOI: 10.1371/journal.pone.0285273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 04/12/2023] [Indexed: 05/21/2023] Open
Abstract
BACKGROUND It is shown that the postoperative adjuvant chemotherapy for non-small cell lung cancer (NSCLC) was associated with survival benefit in an elderly population. We aimed to analyze the feasibility and efficacy of alternate-day S-1, an oral fluoropyrimidine, for adjuvant chemotherapy in elderly patients with completely resected pathological stage IA (tumor diameter > 2 cm) to IIIA (UICC TNM Classification of Malignant Tumours, 7th edition) NSCLC. METHODS Elderly patients were randomly assigned to receive adjuvant chemotherapy for one year consisting of either alternate-day oral administration of S-1 (80 mg/m2/day) for 4 days a week (Arm A) or a daily oral administration of S-1 (80 mg/m2/day) for 14 consecutive days followed by 7-day rest (Arm B). The primary endpoint was feasibility (treatment completion rate), which was defined as the proportion of patients who completed the allocated intervention for 6 months with a relative dose intensity (RDI) of 70% or more. RESULTS We enrolled 101 patients in which 97 patients received S-1 treatment. The treatment completion rate at 6 months was 69.4% in Arm A and 64.6% in Arm B (p = 0.67). Treatment completion rate in Arm B tended to be lower compared to Arm A, as the treatment period becomes longer (at 9 and 12 months). RDI of S-1 at 12 months and completion of S-1 administration without dose reduction or postponement at 12 months was significantly better in Arm A than in Arm B (p = 0.026 and p < 0.001, respectively). Among adverse events, anorexia, skin symptoms and lacrimation of any grade were significantly more frequent in Arm B compared with Arm A (p = 0.0036, 0.023 and 0.031, respectively). The 5-year recurrence-free survival rates were 56.9% and 65.7% for Arm A and B, respectively (p = 0.22). The 5-year overall survival rates were 68.6% and 82.0% for Arm A and B, respectively (p = 0.11). CONCLUSION Although several adverse effects were less frequent in Arm A, both alternate-day and daily oral administrations of S-1 were demonstrated to be feasible in elderly patients with completely resected NSCLC. TRIAL REGISTRATION Unique ID issued by UMIN: UMIN000007819 (Date of registration: Apr 25, 2012) https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000009128. Trial ID issued by jRCT: jRCTs061180089 (Date of registration: Mar 22, 2019, for a shift toward a "specified clinical trial" based on Clinical Trials Act in Japan) https://jrct.niph.go.jp/en-latest-detail/jRCTs061180089.
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Affiliation(s)
- Hiromasa Yamamoto
- Department of Thoracic Surgery, Okayama University Hospital, Okayama, Japan
| | - Junichi Soh
- Department of Surgery, Division of Thoracic Surgery, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - Norihito Okumura
- Department of Thoracic Surgery, Kurashiki Central Hospital, Kurashiki, Japan
| | - Hiroyuki Suzuki
- Department of Chest Surgery, Fukushima Medical University Hospital, Fukushima, Japan
| | - Masao Nakata
- Department of General Thoracic Surgery, Kawasaki Medical School Hospital, Kurashiki, Japan
| | - Toshiya Fujiwara
- Department of Thoracic Surgery, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Kenichi Gemba
- Department of Respiratory Medicine, Chugoku Central Hospital, Fukuyama, Japan
| | - Isao Sano
- Department of Respiratory Surgery, Japanese Red Cross Nagasaki Genbaku Hospital, Nagasaki, Japan
| | - Takuji Fujinaga
- Department of General Thoracic Surgery, National Hospital Organization Nagara Medical Center, Gifu, Japan
| | - Masafumi Kataoka
- Department of Surgery and Respiratory Center, Okayama Saiseikai General Hospital, Okayama, Japan
| | - Yasuhiro Terazaki
- Department of Respiratory Surgery, Saga-Ken Medical Centre Koseikan, Saga, Japan
| | - Nobukazu Fujimoto
- Department of Medical Oncology and Respiratory Medicine, Okayama Rosai Hospital, Okayama, Japan
| | - Kazuhiko Kataoka
- Department of Thoracic Surgery, National Hospital Organization Iwakuni Clinical Center, Iwakuni, Japan
| | - Shinji Kosaka
- Department of Thoracic Surgery, Shimane Prefectural Central Hospital, Izumo, Japan
| | - Motohiro Yamashita
- Department of Thoracic Surgery, National Hospital Organization Shikoku Cancer Center, Matsuyama, Japan
| | - Hidetoshi Inokawa
- Department of Thoracic Surgery, National Hospital Organization Yamaguchi-Ube Medical Center, Ube, Japan
| | - Masaaki Inoue
- Department of Chest Surgery, Shimonoseki City Hospital, Shimonoseki, Japan
| | - Hiroshige Nakamura
- Division of General Thoracic Surgery, Tottori University Hospital, Yonago, Japan
| | - Yoshinori Yamashita
- Department of Thoracic Surgery, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure, Japan
| | - Katsuyuki Hotta
- Center for Innovative Clinical Medicine, Okayama University Hospital, Okayama, Japan
| | - Hiroshige Yoshioka
- Department of Thoracic Oncology, Kansai Medical University Hospital, Hirakata, Japan
| | - Satoshi Morita
- Department of Biomedical Statistics and Bioinformatics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Keitaro Matsuo
- Division of Cancer Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Japan
- Department of Preventive Medicine, Kyushu University Faculty of Medical Sciences, Fukuoka, Japan
| | | | - Hiroshi Date
- Department of Thoracic Surgery, Kyoto University Hospital, Kyoto, Japan
| | - Shinichi Toyooka
- Department of Thoracic Surgery, Okayama University Hospital, Okayama, Japan
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Chen CH, Chou DW, Chung KM, Chang HY. EGFR Tyrosine Kinase Inhibitor Efficacy in Older Adult Patients with Advanced EGFR-Mutated Non-Small-Cell Lung Cancer: A Meta-Analysis and Systematic Review. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:1645. [PMID: 36422186 PMCID: PMC9698818 DOI: 10.3390/medicina58111645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 11/07/2022] [Accepted: 11/10/2022] [Indexed: 11/16/2022]
Abstract
Background and Objectives: Lung cancer remains the most common malignancy worldwide. As the global population ages, the prevalence of epidermal growth factor receptor (EGFR)-mutation-positive non-small cell lung cancer (NSCLC) is increasing. Materials and Methods: We performed a meta-analysis and a systematic review of randomized, controlled trials to evaluate the efficacy of EGFR TKIs on progression-free survival (PFS) and overall survival (OS) in older adult patients with advanced EGFR-mutated NSCLC. A total of 1327 patients were included; among these, 662 patients were >65 years of age. Results: A pooled analysis indicated (1) an overall improvement in higher PFS for dacomitinib and osimetinib than that for other drugs (hazard ratio [HR] = 0.654, 95% CI: 0.474 to 0.903; p = 0.01) and (2) and no significant difference in the OS between the EGFR TKIs (HR = 0.989, 95% CI: 0.796 to 1.229; p = 921). Conclusion: Our study found that osimertinib achieved a higher PFS than all other EGFR TKIs did. Osimertinib is the preferred EGFR TKI for treatment of older adult patients with advanced EGFR-mutated NSCLC.
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Affiliation(s)
- Chang-Hung Chen
- Department of Chest Medicine, Tainan Municipal Hospital (Managed by Show Chwan Medical Care Corporation), Tainan 70133, Taiwan; (D.-W.C.); (K.-M.C.); (H.-Y.C.)
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20
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Shin YJ, Yi JG, Son D, Ahn SY. Diagnostic Accuracy and Complication of Computed Tomography (CT)-Guided Percutaneous Transthoracic Lung Biopsy in Patients 80 Years and Older. J Clin Med 2022; 11:jcm11195894. [PMID: 36233761 PMCID: PMC9571067 DOI: 10.3390/jcm11195894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 09/30/2022] [Accepted: 10/02/2022] [Indexed: 11/16/2022] Open
Abstract
This research evaluated the diagnostic accuracy and complication rate of computed tomography (CT)-guided percutaneous transthoracic lung biopsy (PTNB) in patients 80 years and older. The study sought to identify risk factors for diagnostic failures or complications of PTNBs. We examined 247 CT-guided PTNBs performed from January 2017 through December 2020, noting patient demographics, lesion or procedure types, pathology reports, and other procedure-related complications. Study groups were divided into two: one with patients aged 80 years and older (Group 1) and the other with patients aged 60 to 80 years (Group 2). The research first determined each groups’ diagnostic accuracy, sensitivity, specificity, diagnostic failure rate, and complication rate and then evaluated the risk factors for diagnostic failures and complications. The diagnostic accuracy, sensitivity, specificity, and diagnostic failure rates were 95.6%, 94.9%, 100%, and 18.9%, respectively, in Group 1. The overall and major complication rates in Group 1 were 29.6% and 3.7%, respectively. Lesion size was the only risk factor for diagnostic failure (adjusted odds ratio [OR], 0.46; 95% confidence interval [CI], 0.24–0.90). There was no significant risk factor for complications in Group 1. CT-guided PTNBs in patients 80 years and older indicate comparable diagnostic accuracy and complication rates.
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Affiliation(s)
- Yoon Joo Shin
- Department of Radiology, Konkuk University Medical Center, Seoul 05030, Korea
| | - Jeong Geun Yi
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul 05030, Korea
| | - Donghee Son
- Research Coordinating Center, Konkuk University Medical Center, Seoul 05030, Korea
| | - Su Yeon Ahn
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul 05030, Korea
- Correspondence: ; Tel.: +82-2-2030-5544
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21
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Zenke Y, Hakozaki T, Nakahara Y, Horinouchi H, Ohe Y. Medical management of older patients with lung cancer. Jpn J Clin Oncol 2022; 52:1082-1088. [PMID: 35975674 DOI: 10.1093/jjco/hyac135] [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: 04/27/2022] [Accepted: 07/28/2022] [Indexed: 12/24/2022] Open
Abstract
Lung cancer is the most common cause of cancer-related death globally. In addition, its incidence increases with age, with approximately half of all cases diagnosed in patients aged ≥70. Molecular targeted therapies and immunotherapies for advanced non-small-cell lung cancer have markedly improved outcomes over the past two decades. Despite the high incidence of lung cancer in older people, most trials excluded such patients from enrollment. Therefore, the optimal treatment strategies for older patients remain unclear. The present review summarizes the published literature and provides guidance on the treatment of older patients with lung cancer within three broad stages: (i) early-stage lung cancer, (ii) locally advanced lung cancer and (iii) metastatic lung cancer. We also discuss the use of the latest evidence for older patients.
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Affiliation(s)
- Yoshitaka Zenke
- Department of Thoracic Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Taiki Hakozaki
- Department of Thoracic Oncology and Respiratory Medicine, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Yoshiro Nakahara
- Department of Respiratory Medicine, Kitasato University School of Medicine, Kanagawa, Japan
| | - Hidehito Horinouchi
- Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Yuichiro Ohe
- Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo, Japan
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22
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Blasi M, Eichhorn ME, Christopoulos P, Winter H, Heußel CP, Herth FJ, El Shafie R, Kriegsmann K, Kriegsmann M, Stenzinger A, Bischoff H, Thomas M, Kuon J. Major clinical benefit from adjuvant chemotherapy for stage II-III non-small cell lung cancer patients aged 75 years or older: a propensity score-matched analysis. BMC Pulm Med 2022; 22:255. [PMID: 35761214 PMCID: PMC9238242 DOI: 10.1186/s12890-022-02043-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 06/10/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Data are currently insufficient to support the use of adjuvant chemotherapy (ACT) after surgical resection for stage II or III non-small cell lung cancer (NSCLC) in patients aged ≥ 75 years. In this study we evaluated efficacy and safety profile of ACT in this population. METHODS We retrospectively evaluated 140 patients ≥ 75 years who underwent curative surgical resection for stage II-III NSCLC from 2010 to 2018 with an indication to ACT according to current guidelines. A propensity score-matched analysis was performed to avoid cofounding biases. RESULTS Thirty of 140 patients (21%) received ACT. Most patients (n = 24, 80%) received carboplatin in combination with vinorelbine, while 5 patients (17%) received cisplatin plus vinorelbine and one patient (3%) carboplatin plus gemcitabine. The occurrence of adverse events led to treatment discontinuation in 8 (27%) cases, while 19 (63%) patients completed 4 chemotherapy cycles. Common reported adverse events with ACT were anemia (n = 20, 67%), neutropenia (n = 18, 60%), thrombocytopenia (n = 9, 30%), renal impairment (n = 4, 13%) and transaminase elevation (n = 4, 13%). No toxic deaths occurred. The median follow-up was 67 months (IQR: 53-87). ACT was associated with a significant benefit in both relapse-free survival (median 36 vs. 18.5 months, p = 0.049) and overall survival (median not reached [NR] vs. 33.5 months, p = 0.023) in a propensity score-matched analysis which controlled for cofounders. CONCLUSION ACT confers a survival benefit after curative resection of stage II-III NSCLC in selected patients aged 75 years or older with a manageable toxicity profile.
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Affiliation(s)
- Miriam Blasi
- Department of Thoracic Oncology, Thoraxklinik at Heidelberg University Hospital, Röntgenstraße 1, 69126, Heidelberg, Germany
| | - Martin E Eichhorn
- Translational Lung Research Center (TLRC) Heidelberg, Member of the German Center for Lung Research (DZL), Heidelberg, Germany
- Department of Thoracic Surgery, Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany
| | - Petros Christopoulos
- Department of Thoracic Oncology, Thoraxklinik at Heidelberg University Hospital, Röntgenstraße 1, 69126, Heidelberg, Germany
- Translational Lung Research Center (TLRC) Heidelberg, Member of the German Center for Lung Research (DZL), Heidelberg, Germany
| | - Hauke Winter
- Translational Lung Research Center (TLRC) Heidelberg, Member of the German Center for Lung Research (DZL), Heidelberg, Germany
- Department of Thoracic Surgery, Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany
| | - Claus Peter Heußel
- Translational Lung Research Center (TLRC) Heidelberg, Member of the German Center for Lung Research (DZL), Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology With Nuclear Medicine, Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital, Heidelberg, Germany
| | - Felix J Herth
- Translational Lung Research Center (TLRC) Heidelberg, Member of the German Center for Lung Research (DZL), Heidelberg, Germany
- Department of Pneumology, Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany
| | - Rami El Shafie
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Katharina Kriegsmann
- Department of Hematology, Oncology and Rheumatology, Heidelberg University Hospital, Heidelberg, Germany
| | - Mark Kriegsmann
- Translational Lung Research Center (TLRC) Heidelberg, Member of the German Center for Lung Research (DZL), Heidelberg, Germany
- Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany
| | - Albrecht Stenzinger
- Translational Lung Research Center (TLRC) Heidelberg, Member of the German Center for Lung Research (DZL), Heidelberg, Germany
- Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany
| | - Helge Bischoff
- Department of Thoracic Oncology, Thoraxklinik at Heidelberg University Hospital, Röntgenstraße 1, 69126, Heidelberg, Germany
| | - Michael Thomas
- Department of Thoracic Oncology, Thoraxklinik at Heidelberg University Hospital, Röntgenstraße 1, 69126, Heidelberg, Germany
- Translational Lung Research Center (TLRC) Heidelberg, Member of the German Center for Lung Research (DZL), Heidelberg, Germany
| | - Jonas Kuon
- Department of Thoracic Oncology, Thoraxklinik at Heidelberg University Hospital, Röntgenstraße 1, 69126, Heidelberg, Germany.
- Translational Lung Research Center (TLRC) Heidelberg, Member of the German Center for Lung Research (DZL), Heidelberg, Germany.
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Effects of miRNA-149-5p and Platelet-Activating Factor-Receptor Signaling on the Growth and Targeted Therapy Response on Lung Cancer Cells. Int J Mol Sci 2022; 23:ijms23126772. [PMID: 35743223 PMCID: PMC9223644 DOI: 10.3390/ijms23126772] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 06/13/2022] [Accepted: 06/13/2022] [Indexed: 02/01/2023] Open
Abstract
Accumulating evidence indicates that microRNAs (miRs) play critical roles in essentially all biological processes and their altered expression has been documented in various disease conditions, including human malignancies. Although several cellular mechanisms have been identified in mediating the effects of miRs, the involvement of G-protein-coupled, platelet-activating factor-receptor (PAFR) signaling in miR-149-5p-induced effects on lung cancer growth and therapeutic potential has not been studied. To that end, we first evaluated the functional significance of PAFR and miR-149-5p in A549 and H1299 human non-small cell lung cancer (NSCLC) cell lines. We observed that these tumor lines express endogenous PAFR and miR-149-5p and that PAFR activation by PAF agonist (CPAF) significantly increased, whereas miR-149-5p mimic transfection inhibited cell proliferation in a dose-dependent manner. Interestingly, miR-149-5p mimic significantly attenuated CPAF-mediated increased proliferation of NSCLC cells, as confirmed by miR-149-5p, cyclin D1, and forkhead box protein M1 (FOXM1) expression analysis via qPCR. Our next studies examined PAFR- and miR-149-5p-mediated effects on targeted therapy (i.e., erlotinib and gefitinib) responses. We observed that erlotinib and gefitinib inhibited A549 and H1299 cell survival in a dose- and time-dependent manner, and CPAF significantly blocked this effect. These findings indicate that miR-149-5p blocks PAFR-mediated increased cell proliferation, and PAFR activation attenuates the cytotoxic effects of targeted therapy.
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Finley C, Begum H, Akhtar-Danesh GG, Akhtar-Danesh N. Survival effects of time to surgery for Stage I lung cancer: A population-based study. Surg Oncol 2022; 42:101744. [DOI: 10.1016/j.suronc.2022.101744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 02/25/2022] [Accepted: 03/22/2022] [Indexed: 10/18/2022]
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Akinoso-Imran AQ, O'Rorke M, Kee F, Jordao H, Walls G, Bannon FJ. Surgical under-treatment of older adult patients with cancer: A systematic review and meta-analysis. J Geriatr Oncol 2022; 13:398-409. [PMID: 34776385 DOI: 10.1016/j.jgo.2021.11.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 10/12/2021] [Accepted: 11/03/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Older patients with cancer often have lower surgery rates and survival than younger patients, but this may reflect surgical contraindications of advanced disease, comorbidities, and frailty - and not necessarily under-treatment. OBJECTIVES This review aims to describe variations in surgery rates and observed or net survival among younger (<75) and older (≥75) patients with breast, lung and colorectal cancer, while taking account of pre-existing health factors, in order to understand how under-treatment is defined and estimated in the literature. METHOD MEDLINE, EMBASE, Web of Science and PubMed databases were searched for studies reporting surgery rates and observed or net survival among younger and older patients with breast, lung, and colorectal cancer. Study quality was assessed using the Newcastle Ottawa Scale, and random effects meta-analyses were used to combine study results. The I-squared statistic and subgroup analyses were used to assess heterogeneity. RESULTS Thirty relatively high-quality studies of patients with breast (230,200; 71.9%), lung (77,573; 24.2%), and colorectal (12,407; 3.9%) cancers were identified. Compared to younger patients, older patients were less likely to receive surgical treatment for 1) breast cancer after adjusting for comorbidity, performance status (PS), functional status and patient choice, 2) lung cancer after accounting for stage, comorbidity, PS, and 3) colorectal cancer after adjusting for stage, comorbidity, and gender. The pooled unadjusted analyses showed lower surgery receipt in older patients with breast (odds ratio [OR] 0.31, 95% confidence interval [CI] 0.13-0.78), lung (OR 0.54, 95% CI 0.39-0.75), and colorectal (OR 0.59, 95% CI 0.51-0.68) cancer. In separate analyses, older patients with breast, lung and colorectal cancer had lower observed and net survival, compared to younger patients. CONCLUSIONS Lower surgery rates in older patients may contribute to their poorer survival compared to younger patients. Future research quantifying under-treatment should include necessary clinical factors, patient choice, patient's quality of life and a statistically-robust approach, which will demonstrate how much of the survival deficit in older patients is due to their receiving lower surgery rates.
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Affiliation(s)
- Abdul Qadr Akinoso-Imran
- Centre for Public Health, Queens University Belfast, Institute of Clinical Sciences, Block B, Grosvenor Road, Belfast BT12 6BA, UK.
| | - Michael O'Rorke
- College of Public Health, University of Iowa, 145 N. Riverside Drive, Iowa City, IA 52242, United States of America
| | - Frank Kee
- Centre for Public Health, Queens University Belfast, Institute of Clinical Sciences, Block B, Grosvenor Road, Belfast BT12 6BA, UK
| | - Haydee Jordao
- Centre for Public Health, Queens University Belfast, Institute of Clinical Sciences, Block B, Grosvenor Road, Belfast BT12 6BA, UK
| | - Gerard Walls
- Johnston Centre for Centre for Cancer Research, 97 Lisburn Rd, Belfast BT9 7AE, UK; Cancer Centre Belfast City Hospital, Belfast Health & Social Care Trust, Lisburn Road, Belfast BT7 7AB, UK
| | - Finian J Bannon
- Centre for Public Health, Queens University Belfast, Institute of Clinical Sciences, Block B, Grosvenor Road, Belfast BT12 6BA, UK
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Clinical Effectiveness And Safety Of Anti-PD-(L)1 Therapy Among Older Adults With Advanced Non-Small Cell Lung Cancer. Clin Lung Cancer 2022; 23:236-243. [DOI: 10.1016/j.cllc.2021.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 11/29/2021] [Accepted: 12/22/2021] [Indexed: 12/24/2022]
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First-line osimertinib in elderly patients with epidermal growth factor receptor-mutated advanced non-small cell lung cancer: a retrospective multicenter study (HOT2002). Sci Rep 2021; 11:23140. [PMID: 34848786 PMCID: PMC8632978 DOI: 10.1038/s41598-021-02561-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 11/18/2021] [Indexed: 01/04/2023] Open
Abstract
Osimertinib is a standard of care therapy for previously untreated epidermal growth factor receptor mutation-positive non-small cell lung cancer. However, limited data exist regarding the efficacy and safety of osimertinib as a first-line therapy for elderly patients aged 75 years or older. To assess the potential clinical benefits of osimertinib in this population, this retrospective multi-institutional observational study included 132 patients with non-small cell lung cancer (age ≥ 75 years), who received osimertinib as first-line treatment. The proportion of patients with 1-year progression-free survival was 65.8% (95% confidence interval 57.1–73.5). The median progression-free survival was 19.4 (95% confidence interval 15.9–23.9) months. The median overall survival was not reached (95% confidence interval 24.6–not reached). The frequency of pneumonitis was 17.4%, with a grade 3 or higher rate of 9.1%. More than two-thirds of treatment discontinuations due to pneumonitis occurred within 3 months of starting osimertinib, and the prognosis of patients with pneumonitis was unsatisfactory. Osimertinib is one of the effective first-line therapeutic options for patients aged 75 years or older; however, special caution should be exercised due to the potential development of pneumonitis.
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Yang JCH, Mok TSK, Lu S, Nakagawa K, Yamamoto N, Shi YK, Zhang L, Soo RA, Morita S, Tamura T. Efficacy and Safety of S-1 Compared With Docetaxel in Elderly Patients With Advanced NSCLC Previously Treated With Platinum-Based Chemotherapy: A Subgroup Analysis of the EAST-LC Trial. JTO Clin Res Rep 2021; 2:100142. [PMID: 34590001 PMCID: PMC8474214 DOI: 10.1016/j.jtocrr.2021.100142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 12/25/2020] [Accepted: 01/03/2021] [Indexed: 12/24/2022] Open
Abstract
Introduction Despite recent advances in NSCLC treatment, specific data on the elderly population remain limited. In this post hoc subgroup analysis of the East Asia S-1 Trial in Lung Cancer (EAST-LC) trial, we compared S-1 and docetaxel (DTX) in patients aged 70 years old and above with pretreated advanced NSCLC. Methods Patients were randomly assigned (1:1) to receive S-1 (orally, twice daily on d 1–28 of a 6-wk cycle) or DTX (intravenously, on d 1 of a 3-wk cycle). The initial S-1 dose was 80, 100, or 120 mg/day on the basis of body surface area, and the DTX doses were 60 mg/m2 (Japan) or 75 mg/m2 (outside Japan). The primary end point was overall survival, and secondary end points included progression-free survival, response rate, quality of life (QOL) using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core-30, and safety. Results Among 189 patients aged 70 years and above assessed as the full analysis set, baseline characteristics were generally similar between treatment arms. The median overall survival was 14.7 (S-1) versus 12.1 months (DTX); the hazard ratio was equal to 0.76, with a 95% confidence interval (CI) of 0.54–1.07. The median progression-free survival was similar in both arms (both 4.1 mo, hazard ratio = 0.84, 95% CI: 0.60–1.18); and the response rate was 12.9% (S-1) and 14.0% (DTX). The adjusted mean QOL score difference (S-1–DTX until wk 48) was 7.41 (95% CI: 0.37–14.46). Safety profiles were generally consistent with those of the overall EAST-LC population. Conclusions S-1 revealed comparable efficacy, safety, and QOL versus DTX in pretreated elderly patients with advanced NSCLC. Results were consistent with the overall EAST-LC data.
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Affiliation(s)
- James Chih-Hsin Yang
- Department of Oncology, National Taiwan University Hospital and National Taiwan University Cancer Center, Taipei, Republic of China
| | - Tony S K Mok
- Department of Clinical Oncology, State Key Laboratory of Translational Oncology, Chinese University of Hong Kong, Shatin, Hong Kong Special Administrative Region, People's Republic of China
| | - Shun Lu
- Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Kazuhiko Nakagawa
- Department of Medical Oncology, Kindai University Faculty of Medicine, Osaka-sayama, Japan
| | | | - Yuan-Kai Shi
- Department of Medical Oncology, National Cancer Center/National Clinical Research Centre for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People's Republic of China
| | - Li Zhang
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, People's Republic of China
| | - Ross A Soo
- Department of Hematology-Oncology, National University Hospital, Singapore
| | - Satoshi Morita
- Department of Biomedical Statistics and Bioinformatics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Tomohide Tamura
- Thoracic Center, St Luke's International Hospital, Tokyo, Japan
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Nakao M, Saji H, Mun M, Nakamura H, Okumura N, Tsuchida M, Sonobe M, Miyazaki T, Aokage K, Haruki T, Okada M, Suzuki K, Chida M. Prognostic Impact of Mediastinal Lymph Node Dissection in Octogenarians With Lung Cancer: JACS1303. Clin Lung Cancer 2021; 23:e176-e184. [PMID: 34690079 DOI: 10.1016/j.cllc.2021.09.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 05/31/2021] [Accepted: 09/15/2021] [Indexed: 12/24/2022]
Abstract
INTRODUCTION The prognostic significance of mediastinal lymph node dissection (MLND) in elderly patients with non-small cell lung cancer (NSCLC) remains unclear. This post hoc analysis of a nationwide multicenter cohort study (JACS1303) evaluated the prognostic significance of MLND in octogenarians with NSCLC. MATERIALS AND METHODS We included 622 octogenarians with NSCLC who underwent lobectomy. The median follow-up duration was 41.1 months. We compared survival and perioperative outcomes between patients who did and did not undergo MLND. RESULTS In total, 414 (67%) patients underwent MLND (ND2 group), whereas 208 (33%) did not undergo MLND (ND0-1 group). The disease stage was more advanced in the ND2 group than in the ND0-1 group. Disease-free survival was slightly greater in the ND0-1 group with marginal significance (P= .079). In the matched cohort (N = 228), which mainly consisted of patients with clinical stage I disease (96%), there was no significant difference between the 2 groups regarding overall and disease-free survival (P= .908 and P = .916, respectively). Operative time and blood loss were significantly lower in the ND0-1 group than in the ND2 group in the entire cohort (P< .001 and P = .050, respectively) and in the matched cohort (P = .003 and P= .046, respectively). CONCLUSION Based on a nationwide prospective database, we found limited prognostic impact of MLND, suggesting that MLND can be omitted for octogenarians with early-stage NSCLC.
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Affiliation(s)
- Masayuki Nakao
- Department of Thoracic Surgical Oncology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
| | - Hisashi Saji
- Department of Chest Surgery, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Mingoyn Mun
- Department of Thoracic Surgical Oncology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Hiroshige Nakamura
- Division of General Thoracic Surgery, Tottori University Hospital, Tottori, Japan
| | - Norihito Okumura
- Department of Thoracic Surgery, Kurashiki Central Hospital, Okayama, Japan
| | - Masanori Tsuchida
- Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Makoto Sonobe
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takuro Miyazaki
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Keiju Aokage
- Division of Thoracic Surgery, Department of Thoracic Oncology, National Cancer Center Hospital East, Chiba, Japan
| | - Tomohiro Haruki
- Division of General Thoracic Surgery, Tottori University Hospital, Tottori, Japan
| | - Morihito Okada
- Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan; Committee for Scientific Affairs, The Japanese Association for Chest Surgery, Kyoto, Japan
| | - Kenji Suzuki
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan; Committee for Scientific Affairs, The Japanese Association for Chest Surgery, Kyoto, Japan
| | - Masayuki Chida
- Department of General Thoracic Surgery, Dokkyo Medical University, Shimotsuga, Japan; The Japanese Association for Chest Surgery, Kyoto, Japan
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Montagne F, Guisier F, Venissac N, Baste JM. The Role of Surgery in Lung Cancer Treatment: Present Indications and Future Perspectives-State of the Art. Cancers (Basel) 2021; 13:3711. [PMID: 34359612 PMCID: PMC8345199 DOI: 10.3390/cancers13153711] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 07/14/2021] [Accepted: 07/20/2021] [Indexed: 12/25/2022] Open
Abstract
Non-small cell lung cancers (NSCLC) are different today, due to the increased use of screening programs and of innovative systemic therapies, leading to the diagnosis of earlier and pre-invasive tumors, and of more advanced and controlled metastatic tumors. Surgery for NSCLC remains the cornerstone treatment when it can be performed. The role of surgery and surgeons has also evolved because surgeons not only perform the initial curative lung cancer resection but they also accompany and follow-up patients from pre-operative rehabilitation, to treatment for recurrences. Surgery is personalized, according to cancer characteristics, including cancer extensions, from pre-invasive and local tumors to locally advanced, metastatic disease, or residual disease after medical treatment, anticipating recurrences, and patients' characteristics. Surgical management is constantly evolving to offer the best oncologic resection adapted to each NSCLC stage. Today, NSCLC can be considered as a chronic disease and surgery is a valuable tool for the diagnosis and treatment of recurrences, and in palliative conditions to relieve dyspnea and improve patients' comfort.
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Affiliation(s)
- François Montagne
- Department of Thoracic Surgery, Calmette Hospital, University Hospital of Lille, Boulevard du Pr. J Leclercq, F-59000 Lille, France; (F.M.); (N.V.)
| | - Florian Guisier
- Department of Pneumology, Rouen University Hospital, 1 rue de Germont, F-76000 Rouen, France;
- Clinical Investigation Center, Rouen University Hospital, CIC INSERM 1404, 1 rue de Germont, F-76000 Rouen, France
- Faculty of Medicine and Pharmacy of Rouen, Normandie University, LITIS QuantIF EA4108, 22 Boulevard Gambetta, F-76183 Rouen, France
| | - Nicolas Venissac
- Department of Thoracic Surgery, Calmette Hospital, University Hospital of Lille, Boulevard du Pr. J Leclercq, F-59000 Lille, France; (F.M.); (N.V.)
| | - Jean-Marc Baste
- Department of General and Thoracic Surgery, Rouen University Hospital, 1 rue de Germont, F-76000 Rouen, France
- Faculty of Medicine and Pharmacy of Rouen (UNIROUEN), Normandie University, INSERM U1096, 22 Boulevard Gambetta, F-76000 Rouen, France
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Pilleron S, Maringe C, Charvat H, Atkinson J, Morris E, Sarfati D. Age disparities in lung cancer survival in New Zealand: The role of patient and clinical factors. Lung Cancer 2021; 157:92-99. [PMID: 34006378 DOI: 10.1016/j.lungcan.2021.05.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 05/05/2021] [Accepted: 05/10/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Age is an important prognostic factor for lung cancer. However, no studies have investigated the age difference in lung cancer survival per se. We, therefore, described the role of patient-related and clinical factors on the age pattern in lung cancer excess mortality hazard by stage at diagnosis in New Zealand. MATERIALS AND METHODS We extracted 22 487 new lung cancer cases aged 50-99 (median age = 71, 47.1 % females) diagnosed between 1 January 2006 and 31 July 2017 from the New Zealand population-based cancer registry and followed up to December 2019. We modelled the effect of age at diagnosis, sex, ethnicity, deprivation, comorbidity, and emergency presentation on the excess mortality hazard by stage at diagnosis, and we derived corresponding lung cancer net survival. RESULTS The age difference in net survival was particularly marked for localised and regional lung cancers, with a sharp decline in survival from the age of 70. No identified factors influenced age disparities in patients with localised cancer. However, for other stages, females had a greater difference in survival between middle-age and older-age than males. Comorbidity and emergency presentation played a minor role. Ethnicity and deprivation did not influence age disparities in lung cancer survival. CONCLUSION Sex and stage at diagnosis were the most important factors of age disparities in lung cancer survival in New Zealand.
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Affiliation(s)
- Sophie Pilleron
- Department of Public Health, University of Otago, PO Box 7343, Wellington, New Zealand; Nuffield Department of Population Health, University of Oxford, Big Data Institute, Old Road Campus, Oxford, OX3 7LF, UK.
| | - Camille Maringe
- Inequalities in Cancer Outcomes Network, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | - Hadrien Charvat
- Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan; Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France.
| | - June Atkinson
- Department of Public Health, University of Otago, PO Box 7343, Wellington, New Zealand.
| | - Eva Morris
- Nuffield Department of Population Health, University of Oxford, Big Data Institute, Old Road Campus, Oxford, OX3 7LF, UK. https://www.twitter.com/EJAMorris
| | - Diana Sarfati
- Department of Public Health, University of Otago, PO Box 7343, Wellington, New Zealand. https://www.twitter.com/DiSarfati
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Petrelli F, Inno A, Ghidini A, Gori S, Bersanelli M. Efficacy of immune checkpoint inhibitors in elderly patients aged ≥ 75 years. Cancer Immunol Immunother 2021; 70:1777-1780. [PMID: 33170348 DOI: 10.1007/s00262-020-02779-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 10/22/2020] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Immune checkpoint inhibitors (ICIs) represent a cornerstone for the treatment of many advanced tumors. When 65 is considered as a cut-off age, ICIs are equally effective in younger and older patients. However, the efficacy of ICIs among patients aged ≥ 75 remains uncertain, since those patients were generally under-represented in clinical trials. We performed a pooled analysis of major randomized trials including data of outcome in very older population. MATERIAL AND METHODS We searched PubMed, Embase, and the Cochrane Library for randomized controlled trials published from the inception of each database to November 22th, 2019. We only included (1) randomized studies comparing ICIs alone or in combinations with no ICIs, (2) studies reporting data of patients older than 75 years, (3) studies for solid tumors, and (4) studies with HR and 95% confidence interval (CI) available for OS based on 75 years as cut-off age. All data were expressed as the combination of HR and 95% CI, and P < 0.05 was considered to be statistically significant. RESULTS A total of n = 8 publications for a total of n = 12 randomized studies were aggregated in the quantitative analysis. Overall, the pooled analysis showed a borderline significant OS benefit for ICIs compared to no ICIs arms (HR = 0.84, 95% CI 0.7-1; P = 0.05) in particular in first-line trials with HR = 0.77 (95%CI 0.61-0.96; P = 0.02). CONCLUSION We conclude that ICIs may be offered in patients older than 75 years, providing a complete geriatric and clinical evaluation is performed in all subjects before starting therapy.
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Affiliation(s)
- Fausto Petrelli
- Oncology Unit, Medical Sciences Department, ASST Bergamo Ovest, Piazzale Ospedale 1, 24047, Treviglio, BG, Italy.
| | - Alessandro Inno
- Oncology Unit, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar, Verona, Italy
| | | | - Stefania Gori
- Oncology Unit, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar, Verona, Italy
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Panagiotou OA, Keeney T, Ogarek JA, Wulff-Burchfield E, Olszewski AJ, Bélanger E. Prevalence of functional limitations and their associations with systemic cancer therapy among older adults in nursing homes with advanced non-small cell lung cancer. J Geriatr Oncol 2021; 12:765-770. [PMID: 33610505 PMCID: PMC8184570 DOI: 10.1016/j.jgo.2021.02.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 01/25/2021] [Accepted: 02/05/2021] [Indexed: 01/07/2023]
Abstract
OBJECTIVES To determine the relationship of self-care task disabilities with the use of systemic cancer therapies for advanced non-small cell lung cancer (NSCLC) in nursing home patients. MATERIALS AND METHODS Using the Surveillance, Epidemiology, and End Results-Medicare database linked with Minimum Data Set assessments, we identified nursing home residents with advanced NSCLC from 2011 to 2015. We considered disability in activities of daily living (ADL) including dressing, personal hygiene, toilet use, locomotion on unit, transfer, bed mobility, and eating. We estimated the association between ADL disabilities and receipt of systemic cancer therapies within 3 months of diagnosis. RESULTS Of the 3174 patients, 2702 (85.2%) experienced disability in one or more ADLs and 64.7% had disability in 5-7 ADLs. A total of 415 (13.1%) patients received systemic therapy. There was a strong association between disability in each ADL and receipt of therapy including dressing (OR, 0.52 [95% CI, 0.42-0.65]), toileting (odds ratio, OR, 0.52 [95% confidence interval, CI, 0.42-0.65]), personal hygiene (OR, 0.48 [95% CI, 0.39-0.59]), transfers (OR, 0.51 [95% CI, 0.41-0.64]), bed mobility (OR, 0.55 [95% CI, 0.44-0.69]), locomotion (OR, 0.57 [95% CI, 0.46-0.71]), or eating (OR, 0.45 [95% CI, 0.31-0.67]). Compared to patients having no ADL disability, patients were less likely to receive chemotherapy if they had disability in 1-2 ADLs (OR, 0.95 [95% CI, 0.66-1.37]), 3-4 ADLs (OR, 0.81 [95% CI, 0.56-1.15]), or 5-7 ADLs (OR, 0.43 [95% CI, 0.33-0.56]). CONCLUSIONS Systemic cancer therapy is not commonly used in this population and is strongly predicted by disability in self-care tasks.
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Affiliation(s)
- Orestis A Panagiotou
- Department of Health Services, Policy and Practice, Brown University School of Public Health, RI, United States of America; Center for Gerontology and Healthcare Research, Brown University School of Public Health, RI, United States of America; Center for Evidence Synthesis in Health, Brown University School of Public Health, RI, United States of America; Providence VA Medical Center, Providence, RI, United States of America.
| | - Tamra Keeney
- Department of Health Services, Policy and Practice, Brown University School of Public Health, RI, United States of America; Center for Gerontology and Healthcare Research, Brown University School of Public Health, RI, United States of America; Division of Palliative Care and Geriatric Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA, United States of America
| | - Jessica A Ogarek
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, RI, United States of America
| | - Elizabeth Wulff-Burchfield
- Department of Medicine, University of Kansas Medical Center, Kansas City, Kansas, United States of America
| | - Adam J Olszewski
- Warren Alpert Medical School of Brown University, Providence, RI, United States of America
| | - Emmanuelle Bélanger
- Department of Health Services, Policy and Practice, Brown University School of Public Health, RI, United States of America; Center for Gerontology and Healthcare Research, Brown University School of Public Health, RI, United States of America
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Marchal C, Orillard E, Calais F, Westeel V. Immunotherapy for non-small cell lung cancer in the elderly population: a generic protocol. Hippokratia 2021. [DOI: 10.1002/14651858.cd014907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
| | - Emeline Orillard
- Université Bourgogne Franche-Comté, INSERM, EFS BFC, UMR 1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique; Besançon France
| | - François Calais
- Bibliothèque universitaire de Santé; Université de Franche-Comté; Besançon France
| | - Virginie Westeel
- Université Bourgogne Franche-Comté, INSERM, EFS BFC, UMR 1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique; Besançon France
- Department of Thoracic Oncology; University Hospital of Besançon; Besançon France
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Couderc AL, Tomasini P, Nouguerède E, Rey D, Correard F, Montegut C, Thomas PA, Villani P, Barlesi F, Greillier L. Older Patients Treated for Lung and Thoracic Cancers: Unplanned Hospitalizations and Overall Survival. Clin Lung Cancer 2021; 22:e405-e414. [DOI: 10.1016/j.cllc.2020.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 05/25/2020] [Accepted: 06/04/2020] [Indexed: 02/01/2023]
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Or M, Liu B, Lam J, Vinod S, Xuan W, Yeghiaian-Alvandi R, Hau E. A systematic review and meta-analysis of treatment-related toxicities of curative and palliative radiation therapy in non-small cell lung cancer. Sci Rep 2021; 11:5939. [PMID: 33723301 PMCID: PMC7971013 DOI: 10.1038/s41598-021-85131-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 02/10/2021] [Indexed: 12/25/2022] Open
Abstract
Treatment-related toxicity is an important component in non-small cell lung cancer (NSCLC) management decision-making. Our aim was to evaluate and compare the toxicity rates of curative and palliative radiotherapy with and without chemotherapy. This meta-analysis provides better quantitative estimates of the toxicities compared to individual trials. A systematic review of randomised trials with > 50 unresectable NSCLC patients, treated with curative or palliative conventional radiotherapy (RT) with or without chemotherapy. Data was extracted for oesophagitis, pneumonitis, cardiac events, pulmonary fibrosis, myelopathy and neutropenia by any grade, grade ≥ 3 and treatment-related deaths. Mantel-Haenszel fixed-effect method was used to obtain pooled risk ratio. Forty-nine trials with 8609 evaluable patients were included. There was significantly less grade ≥ 3 acute oesophagitis (6.4 vs 22.2%, p < 0.0001) and any grade oesophagitis (70.4 vs 79.0%, p = 0.04) for sequential CRT compared to concurrent CRT, with no difference in pneumonitis (grade ≥ 3 or any grade), neutropenia (grade ≥ 3), cardiac events (grade ≥ 3) or treatment-related deaths. Although the rate of toxicity increased with intensification of treatment with RT, the only significant difference between treatment regimens was the rate of oesophagitis between the use of concurrent and sequential CRT. This can aid clinicians in radiotherapy decision making for NSCLC.
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Affiliation(s)
- M Or
- Department of Radiation Oncology, The Crown Princess Mary Cancer Centre, Westmead Hospital, Westmead Sydney, NSW, 2145, Australia.
| | - B Liu
- Department of Radiation Oncology, The Crown Princess Mary Cancer Centre, Westmead Hospital, Westmead Sydney, NSW, 2145, Australia
| | - J Lam
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, NSW, Australia
| | - S Vinod
- Cancer Therapy Centre, Liverpool Hospital, Liverpool, NSW, Australia
- South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - W Xuan
- South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
- Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
| | - R Yeghiaian-Alvandi
- Department of Radiation Oncology, The Crown Princess Mary Cancer Centre, Westmead Hospital, Westmead Sydney, NSW, 2145, Australia
| | - E Hau
- Department of Radiation Oncology, The Crown Princess Mary Cancer Centre, Westmead Hospital, Westmead Sydney, NSW, 2145, Australia
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Dauriat G, LePavec J, Pradere P, Savale L, Fabre D, Fadel E. Our current understanding of and approach to the management of lung cancer with pulmonary hypertension. Expert Rev Respir Med 2021; 15:373-384. [PMID: 33107356 DOI: 10.1080/17476348.2021.1842202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Lung cancer is a frequent pathology for which the best curative treatment is pulmonary resection. Pulmonary arterial hypertension is a rare disease but pulmonary hypertension associated with parenchymal disease or left heart disease is frequently observed in these patients. The diagnosis of pulmonary hypertension before lung resection makes the perioperative management of these patients more difficult and sometimes leads to rejecting patients for surgery. AREAS COVERED We performed a review of literature on PubMed on Pulmonary hypertension associated lung resection, preoperative assessment of lung resection and perioperative management of PH patients, including guidelines and clinical trials.In this review, we summarize the current state of knowledge regarding the pre and perioperative management of patients with suspected or confirmed PH who can benefit from surgical treatment of lung cancer. EXPERT OPINION Management of PH patients before lung resection should include a very careful workup including at least right heart catheterization with evaluation of the targeted PH treatment in an expert center and evaluation of other comorbidities. Perioperative management must be carried out in a specialized center.
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Affiliation(s)
- Gaelle Dauriat
- Department of Thoracic and Vascular Surgery, Marie Lannelongue Hospital GHPSJ, Institut d'Oncologie Thoracique and Paris Saclay University, France
| | - Jerome LePavec
- Department of Thoracic and Vascular Surgery, Marie Lannelongue Hospital GHPSJ, Institut d'Oncologie Thoracique and Paris Saclay University, France
| | - Pauline Pradere
- Department of Thoracic and Vascular Surgery, Marie Lannelongue Hospital GHPSJ, Institut d'Oncologie Thoracique and Paris Saclay University, France
| | - Laurent Savale
- AP-HP, Service de Pneumologie, Centre de Référence de l'Hypertension Pulmonaire Séveère, Hôpital Bicêtre, France
| | - Dominique Fabre
- Department of Thoracic and Vascular Surgery, Marie Lannelongue Hospital GHPSJ, Institut d'Oncologie Thoracique and Paris Saclay University, France
| | - Elie Fadel
- Department of Thoracic and Vascular Surgery, Marie Lannelongue Hospital GHPSJ, Institut d'Oncologie Thoracique and Paris Saclay University, France
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Mackenzie P, Vajdic C, Delaney G, Gabriel G, Agar M, Comans T, Barton M. Factors affecting radiotherapy utilisation in geriatric oncology patients in NSW, Australia. Tech Innov Patient Support Radiat Oncol 2021; 16:17-23. [PMID: 33385070 PMCID: PMC7769853 DOI: 10.1016/j.tipsro.2020.09.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 09/14/2020] [Accepted: 09/16/2020] [Indexed: 12/26/2022] Open
Abstract
Background and Purpose Large non-age-specific radiotherapy utilisation rate (RTU) studies have demonstrated that actual RTU is below the optimal recommended utilisation rate for both curative and palliative intent radiotherapy indications. The optimal utilisation rate for the geriatric oncology cohort of patients has not yet been determined. The purpose of this research was to examine the actual RTU for patients treated in New South Wales (NSW), Australia as a function of increasing age, and the relationship between RTU and tumour site, travelling distance and socio-economic status. Materials & Methods NSW Central Cancer Registry data (2009-2011) were linked to the NSW Radiotherapy Dataset (2009-2012). RTU was calculated for patients aged <80 years and ≥80 years. RTU was defined as the proportion of patients receiving at least a single course of radiotherapy within 12 months of a cancer diagnosis. Results 110,645 patients were diagnosed with cancer, of whom 27,721 received at least one course of radiotherapy. The overall RTU was 25%. RTU for patients aged <80 years was 28% compared to 14% for patients aged 80+ years (p < 0.001). On both univariate and multivariate analysis, increasing age, residential address in disadvantaged socioeconomic areas and increasing distance to the nearest radiotherapy department were associated with a reduction in RTU. Conclusion Geriatric oncology patients are less likely to receive radiotherapy than their younger counterparts. Some of the reduction in RTU may be justifiable on the basis of limited life expectancy and co-morbidity. Further research is required to determine the co-morbidity adjusted optimal RTU in older patients.
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Affiliation(s)
- Penny Mackenzie
- St Andrew's Hospital, Icon Cancer Care, Toowoomba, QLD, Australia.,Collaboration for Cancer Outcomes Research and Evaluation, Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, University of New South Wales, Sydney, Australia
| | | | - Geoff Delaney
- Collaboration for Cancer Outcomes Research and Evaluation, Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, University of New South Wales, Sydney, Australia
| | - Gabriel Gabriel
- Collaboration for Cancer Outcomes Research and Evaluation, Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, University of New South Wales, Sydney, Australia
| | - Meera Agar
- University of Technology, Sydney, Australia
| | | | - Michael Barton
- Collaboration for Cancer Outcomes Research and Evaluation, Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, University of New South Wales, Sydney, Australia
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Platelet-Activating Factor-Receptor Signaling Mediates Targeted Therapies-Induced Microvesicle Particles Release in Lung Cancer Cells. Int J Mol Sci 2020; 21:ijms21228517. [PMID: 33198218 PMCID: PMC7696385 DOI: 10.3390/ijms21228517] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 11/06/2020] [Accepted: 11/09/2020] [Indexed: 12/25/2022] Open
Abstract
Microvesicle particles (MVP) secreted by a variety of cell types in response to reactive oxygen species (ROS)-generating pro-oxidative stressors have been implicated in modifying the cellular responses including the sensitivity to therapeutic agents. Our previous studies have shown that expression of a G-protein coupled, platelet-activating factor-receptor (PAFR) pathway plays critical roles in pro-oxidative stressors-mediated cancer growth and MVP release. As most therapeutic agents act as pro-oxidative stressors, the current studies were designed to determine the role of the PAFR signaling in targeted therapies (i.e., gefitinib and erlotinib)-mediated MVP release and underlying mechanisms using PAFR-expressing human A549 and H1299 non-small cell lung cancer (NSCLC) cell lines. Our studies demonstrate that both gefitinib and erlotinib generate ROS in a dose-dependent manner in a process blocked by antioxidant and PAFR antagonist, verifying their pro-oxidative stressor’s ability, and the role of the PAFR in this effect. We observed that these targeted therapies induce MVP release in a dose- and time-dependent manner, similar to a PAFR-agonist, carbamoyl-PAF (CPAF), and PAFR-independent agonist, phorbol myristate acetate (PMA), used as positive controls. To confirm the PAFR dependency, we demonstrate that siRNA-mediated PAFR knockdown or PAFR antagonist significantly blocked only targeted therapies- and CPAF-mediated but not PMA-induced MVP release. The use of pharmacologic inhibitor strategy suggested the involvement of the lipid ceramide-generating enzyme, acid sphingomyelinase (aSMase) in MVP biogenesis, and observed that regardless of the stimuli used, aSMase inhibition significantly blocked MVP release. As mitogen-activated protein kinase (MAPK; ERK1/2 and p38) pathways crosstalk with PAFR, their inhibition also significantly attenuated targeted therapies-mediated MVP release. These findings indicate that PAFR signaling could be targeted to modify cellular responses of targeted therapies in lung cancer cells.
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Thiruthaneeswaran N, Tharmalingam H, Hoskin PJ. Practical brachytherapy solutions to an age-old quandary. Tech Innov Patient Support Radiat Oncol 2020; 16:39-47. [PMID: 33385072 PMCID: PMC7769855 DOI: 10.1016/j.tipsro.2020.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 09/17/2020] [Accepted: 09/18/2020] [Indexed: 11/29/2022] Open
Abstract
Age should not be a limiting factor for brachytherapy in patients with localised cancer or for palliation in metastatic disease. In tumour streams where brachytherapy forms part of the curative management, it should not be omitted in elderly patients who are medically fit for treatment. Treatment decisions should factor in patient preferences, the relative merits of different therapeutic approaches and maintaining minimal impact on quality of life.
Cancer is predominantly a disease of the elderly and as population life expectancy increases, so will the incidence of malignant disease. Elderly patients often have other comorbidities and social complexities, increasing the support required to safely deliver all treatment modalities. Brachytherapy is a relatively simple technique by which radiation therapy can be delivered. It offers dosimetric advantages through a highly conformal dose distribution thereby limiting radiation exposure to normal tissues reducing toxicity. Requiring fewer hospital visits, it also offers practical and logistical advantages to the elderly population and in many cases can be performed without the need for general anaesthesia. In tumour streams where brachytherapy forms part of the curative management, it should not be omitted in elderly patients who are medically fit for treatment. In the palliative setting, brachytherapy often offers an excellent means for achieving either local tumour and/or symptom control and should be actively considered in the therapeutic armamentarium of the oncologist in this context.
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Affiliation(s)
- N Thiruthaneeswaran
- Division of Cancer Sciences, The University of Manchester, Manchester, UK.,Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | | | - P J Hoskin
- Division of Cancer Sciences, The University of Manchester, Manchester, UK.,Mount Vernon Cancer Centre, Northwood, UK
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Octogenarians treated for thoracic and lung cancers: Impact of comprehensive geriatric assessment. J Geriatr Oncol 2020; 12:402-409. [PMID: 33097456 DOI: 10.1016/j.jgo.2020.10.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 08/30/2020] [Accepted: 10/07/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Lung cancer affects older and older old adults and is the leading cause of death by cancer. Comprehensive Geriatric Assessment (CGA) is recommended before and during cancer treatment to guide therapy management in this population. METHODS This study was conducted between September 2015 and January 2019 at Marseille University Hospital (AP-HM). During this period, all consecutive outpatients 70 years or older referred for a CGA before initiation of lung cancer treatment were enrolled. The objective of this study was to compare lung and thoracic cancer management of octogenarians (≥80 years) and their geriatric profile versus patients aged 70 to 79 years (<80 years). FINDINGS In our study, 228 patients were recruited. The median age was 78.7 ± 5 years. There were 94 octogenarians (41.2%), 36.2% of them were diagnosed with stage IV neoplasm and the most common treatment was chemotherapy (43.6%). The logistic regression analysis highlights that handgrip strength was the most commonly impaired domain (OR 2.3; 95% CI [1.3-4.3]) in octogenarians and that they are more likely than their younger counterparts to be treated by targeted therapy (OR 9.8; 95% CI [1.0-92.9]). Overall survival (OS) was similar in both age groups (log rank = 0,95). INTERPRETATION In our study, octogenarians and patients <80 years had equivalent survival, across the different thoracic cancer treatments and tumor stages. Measure of muscle strength in CGA could be very useful in a clinical setting to help improve the management of older old patients treated for lung or thoracic cancer.
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Nakao M, Ichinose J, Matsuura Y, Okumura S, Mun M. Outcomes after thoracoscopic surgery in octogenarian patients with clinical N0 non-small-cell lung cancer. Jpn J Clin Oncol 2020; 50:926-932. [PMID: 32415303 DOI: 10.1093/jjco/hyaa061] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 04/16/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The number of surgeries for elderly patients with lung cancer is increasing. In our institute, thoracoscopic lobectomy and hilar lymph node dissection are the standard procedure for octogenarian patients with clinical N0 non-small-cell lung cancer. The aim of this study was to determine the outcome of our strategy for octogenarian patients. METHODS Seventy octogenarian patients with clinical N0 non-small-cell lung cancer who underwent surgery were enrolled (O group). As a control group, 205 septuagenarian patients were also enrolled (S group). We compared several clinicopathological factors and outcomes. RESULTS The median age of the O group was 82. There was no significant difference in the comorbidity ratio between the two groups. The 5-year overall survival ratio for the O group (72.8%) was significantly worse than that for the S group (88.3%). However, multivariate analysis proved age was not an independent predictor of outcome. The rates of recurrences involving ipsilateral mediastinal lymph nodes were equal in the two groups. After propensity score matching, clinical T1 patients were dominant (85%) in two matched group and no statistically significant differences were observed in the 5-year overall survival between the two groups. CONCLUSIONS Our strategy for octogenarian patients with non-small-cell lung cancer, including omission of mediastinal lymph node dissection, was determined to be feasible, in particularly with cT1N0 disease.
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Affiliation(s)
- Masayuki Nakao
- Department of Thoracic Surgical Oncology, Cancer Institute Hospital, The Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Junji Ichinose
- Department of Thoracic Surgical Oncology, Cancer Institute Hospital, The Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yosuke Matsuura
- Department of Thoracic Surgical Oncology, Cancer Institute Hospital, The Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Sakae Okumura
- Department of Thoracic Surgical Oncology, Cancer Institute Hospital, The Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Mingyon Mun
- Department of Thoracic Surgical Oncology, Cancer Institute Hospital, The Japanese Foundation for Cancer Research, Tokyo, Japan
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Bongiolatti S, Mazzoni F, Gonfiotti A, Di Pierro G, Salvicchi A, Borgianni S, Ferrari K, Voltolini L. Short and mid-term outcomes of multimodal treatment for locally-advanced non-small cell lung cancer in elderly patients. Gen Thorac Cardiovasc Surg 2020; 68:1290-1297. [PMID: 32419041 DOI: 10.1007/s11748-020-01384-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Accepted: 05/05/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Multimodality treatments are effective for locally advanced non-small cell lung cancer (LA-NSCLC) showing benefits in overall (OS) and disease-free survival (DFS), but these options are frequently denied to elderly patients. METHODS The objectives of this retrospective study were: to investigate mortality, morbidity and oncological outcomes of pulmonary resection after induction therapy (IT) for NSCLC in elderly patients. We divided the cohort into two: patients < 70 years (group A) and patients ≥70 years (group B). A multivariable logistic regression was built to identify factors associated with morbidity. RESULTS 77 patients underwent pulmonary resection after IT, 27 were aged ≥70 years. Type of chemotherapy, surgical procedures, pathological stages were comparable between the two groups, while the preoperative use of chemo-radiation therapy regimen was more frequent in group A (p = 0.027). In-hospital mortality was similar, while the percentage of patients with complications (38% vs 48.1%, p = 0.47) and the complication rate (50% vs 77%, p = 0.01) were higher in group B, but the severity of complications was comparable. The multivariable analysis did not identify any risk factors associated with morbidity. OS at 3 years and DFS at 2 years were not different (61% vs 48.5%, p = 0.64; 61.7% vs 44%, p = 0.393). CONCLUSIONS Lung resection for LA-NSCLC after IT can be performed safely in selected elderly patients with favourable postoperative and mid-term oncological results.
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Affiliation(s)
- Stefano Bongiolatti
- Thoracic Surgery Unit, Careggi University Hospital, Largo Brambilla, 1, 50134, Florence, Italy
| | | | - Alessandro Gonfiotti
- Thoracic Surgery Unit, Careggi University Hospital, Largo Brambilla, 1, 50134, Florence, Italy
| | - Giulia Di Pierro
- Medical Oncology Unit, Careggi University Hospital, Florence, Italy
| | - Alberto Salvicchi
- Thoracic Surgery Unit, Careggi University Hospital, Largo Brambilla, 1, 50134, Florence, Italy.
| | - Sara Borgianni
- Thoracic Surgery Unit, Careggi University Hospital, Largo Brambilla, 1, 50134, Florence, Italy
| | - Katia Ferrari
- Respiratory Medicine, Careggi University Hospital, Florence, Italy
| | - Luca Voltolini
- Thoracic Surgery Unit, Careggi University Hospital, Largo Brambilla, 1, 50134, Florence, Italy
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Palomar-Abril V, Soria-Comes T, Tarazona Campos S, Martín Ureste M, Giner Bosch V, Maestu Maiques IC. Impact of Age on Inflammation-Based Scores among Patients Diagnosed with Stage III Non-Small Cell Lung Cancer. Oncology 2020; 98:528-533. [PMID: 32203963 DOI: 10.1159/000506204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 01/27/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Inflammatory and nutritional indexes are prognostic factors in non-small cell lung cancer (NSCLC). Furthermore, a low grade of chronic inflammation has been described in the older population (inflammaging). We aimed to evaluate the neutrophil-to-lymphocyte ratio (NLR), the Prognostic Nutritional Index (PNI), the advanced lung cancer inflammation index (ALI), the platelet-to-lymphocyte ratio (PLR), and the Glasgow Prognostic Score (GPS) in young and older patients diagnosed with locally advanced NSCLC to determine if significant differences between these groups exist. METHODS We conducted a retrospective study analyzing the impact of age on the NLR, PNI, ALI, PLR, and GPS among patients diagnosed with stage III NSCLC at Hospital Universitario Doctor Peset between 2010 and 2015. RESULTS We included 124 patients (84 young, 40 older patients). The median hemoglobin level and leukocyte count were lower in the older patients (p = 0.0158 and p = 0.001, respectively). A higher median C-reactive protein level was also found in this group (p = 0.0095). Regarding specific inflammatory indexes, the PNI, comprising inflammatory and nutritional parameters, was lower among the older patients (p = 0.0463). The median NLR, ALI, and PLR were similar in both age groups. Moreover, no differences between the age groups were found in the percentage of patients showing high versus low NLR (cutoff point, 5) or ALI (cutoff point, 18) or in the different GPS groups. CONCLUSIONS The baseline PNI, hemoglobin level, and lymphocyte count were lower among the older patients; furthermore, CRP was higher, possibly, because of a more prominent inflammatory status in older patients with lung cancer. No other immunological or nutritional analytical variables were different between the age groups.
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Affiliation(s)
- Vicente Palomar-Abril
- Department of Medical Oncology, Hospital Universitario Doctor Peset, Valencia, Spain,
| | - Teresa Soria-Comes
- Department of Medical Oncology, Hospital Universitario Doctor Peset, Valencia, Spain
| | - Sonia Tarazona Campos
- Genomics of Gene Expression Laboratory, Centro de Investigación Príncipe Felipe, Valencia, Spain
| | - María Martín Ureste
- Department of Medical Oncology, Hospital Universitario Doctor Peset, Valencia, Spain
| | - Vicente Giner Bosch
- Department of Statistics and Operative Investigations, ETSI Industriales, Universidad Politécnica de Valencia, Valencia, Spain
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Costa GJ, de Mello MJG, Bergmann A, Ferreira CG, Thuler LCS. Tumor-node-metastasis staging and treatment patterns of 73,167 patients with lung cancer in Brazil. J Bras Pneumol 2020; 46:e20180251. [PMID: 31967271 PMCID: PMC7462681 DOI: 10.1590/1806-3713/e20180251] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 04/22/2019] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE To characterize the clinical and histological profile, as well as treatment patterns, of patients with early-stage, locally advanced (LA), or advanced/metastatic (AM) lung cancer, diagnosed between 2000 and 2014, in Brazil. METHODS This was an analytical cross-sectional epidemiological study employing data obtained for the 2000-2014 period from the hospital cancer registries of two institutions in Brazil: the José Alencar Gomes da Silva National Cancer Institute, in the city of Rio de Janeiro; and the São Paulo Cancer Center Foundation, in the city of São Paulo. RESULTS We reviewed the data related to 73,167 patients with lung cancer. The proportions of patients with early-stage, LA, and AM lung cancer were 13.3%, 33.2%, and 53.4%, respectively. The patients with early-stage lung cancer were older and were most likely to receive a histological diagnosis of adenocarcinoma; the proportion of patients with early-stage lung cancer remained stable throughout the study period. In those with LA lung cancer, squamous cell carcinoma predominated, and the proportion of patients with LA lung cancer decreased significantly over the period analyzed. Those with AM lung cancer were younger and were most likely to have adenocarcinoma; the proportion of patients with AM lung cancer increased significantly during the study period. Small cell carcinoma accounted for 9.2% of all cases. In our patient sample, the main treatment modality was chemotherapy. CONCLUSIONS It is noteworthy that the frequency of AM lung cancer increased significantly during the study period, whereas that of LA lung cancer decreased significantly and that of early-stage lung cancer remained stable. Cancer treatment patterns, by stage, were in accordance with international guidelines.
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Affiliation(s)
- Guilherme Jorge Costa
- . Departamento de Ensino e Pesquisa, Hospital de Câncer de Pernambuco, Recife (PE) Brasil
- . Departamento de Oncologia, Instituto de Medicina Integral Professor Fernando Figueira, Recife (PE) Brasil
| | | | - Anke Bergmann
- . Instituto Nacional de Câncer José Alencar Gomes da Silva, Divisão de Pesquisa Clínica e Programa de Pós-Graduação em Oncologia, Rio de Janeiro (RJ) Brasil
| | | | - Luiz Claudio Santos Thuler
- . Instituto Nacional de Câncer José Alencar Gomes da Silva, Divisão de Pesquisa Clínica e Programa de Pós-Graduação em Oncologia, Rio de Janeiro (RJ) Brasil
- . Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro (RJ) Brasil
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Elkrief A, Richard C, Malo J, Cvetkovic L, Florescu M, Blais N, Tehfe M, Messaoudene M, Gagné A, Orain M, Medjebar S, Wan-Chow-Wah D, Joubert P, Labbé C, Ghiringhelli F, Routy B. Efficacy of immune checkpoint inhibitors in older patients with non-small cell lung cancer: Real-world data from multicentric cohorts in Canada and France. J Geriatr Oncol 2020; 11:802-806. [PMID: 31948904 DOI: 10.1016/j.jgo.2020.01.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 10/21/2019] [Accepted: 01/03/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND Age-related immune remodelling is thought to be associated with resistance to immune checkpoint inhibitors (ICIs) in cancer. Patients older than 70 years, representing >50% of the population with non-small cell lung cancer (NSCLC) according to SEER database, are underrepresented in clinical trials exploring ICIs. The objective of this study was to determine if patients with NSCLC older than ≥70 years had inferior clinical outcomes with ICIs. METHODS We conducted a retrospective analysis of 381 patients treated with anti-PD-(L)1 ICI for advanced NSCLC at the Dijon Cancer Center (n = 177), University of Montreal Hospital (n = 106) and Quebec Heart and Lung Institute (n = 98). Age was considered as a categorical variable. Patients' baseline characteristics were compared using the Chi-squared test. Survival curves were estimated by the Kaplan-Meier method and compared with the Log-rank test in a univariate analysis. Multivariate cox regression model was used to determine hazard ratios and 95% confidence intervals for progression-free survival (PFS) and overall survival (OS) between the groups, adjusting for other clinicopathologic features. RESULTS Among 381 patients included, 335 (88%) received ICI after platinum chemotherapy. The median age was 66 (range 37-89) and 33% were older than 70 years of age. Considering age as a categorical variable, differences in age were not associated with PFS or OS. Subgroup analysis and multivariate cox regression did not reveal significant interaction of age with outcomes. ECOG performance status was the only significant factor in the three cohorts. CONCLUSIONS Unlike previously described in the era of chemotherapy, age was not associated with outcomes in NSCLC patients treated with ICI.
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Affiliation(s)
- Arielle Elkrief
- Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Division of Oncology, Department of Medicine Montréal, QC, Canada; McGill University Health Centre, Division of Oncology, Department of Medicine, Montreal, QC, Canada
| | - Corentin Richard
- Plateform of Transfer in Cancer Biology, Department of Biology and Tumor Pathology, Georges-Francois Leclerc Center, Dijon, France
| | - Julie Malo
- Centre Hospitalier de l'Université de Montréal (CHUM), Hematology-Oncology Division, Department of Medicine, Montréal, QC, Canada
| | - Lena Cvetkovic
- Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Division of Oncology, Department of Medicine Montréal, QC, Canada
| | - Marie Florescu
- Centre Hospitalier de l'Université de Montréal (CHUM), Hematology-Oncology Division, Department of Medicine, Montréal, QC, Canada
| | - Normand Blais
- Centre Hospitalier de l'Université de Montréal (CHUM), Hematology-Oncology Division, Department of Medicine, Montréal, QC, Canada
| | - Mustapha Tehfe
- Centre Hospitalier de l'Université de Montréal (CHUM), Hematology-Oncology Division, Department of Medicine, Montréal, QC, Canada
| | - Meriem Messaoudene
- Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Division of Oncology, Department of Medicine Montréal, QC, Canada
| | - Andréanne Gagné
- Quebec Heart and Lung Institute Research Center, Department of Pathology, Quebec, QC, Canada
| | - Michele Orain
- Quebec Heart and Lung Institute Research Center, Department of Pathology, Quebec, QC, Canada
| | - Soleine Medjebar
- Plateform of Transfer in Cancer Biology, Department of Biology and Tumor Pathology, Georges-Francois Leclerc Center, Dijon, France
| | - Doreen Wan-Chow-Wah
- McGill University Health Centre, Division of Oncology, Department of Medicine, Montreal, QC, Canada; McGill University Health Centre, Division of Geriatric Medicine, Department of Medicine, Montreal, QC, Canada
| | - Philippe Joubert
- Quebec Heart and Lung Institute Research Center, Department of Pathology, Quebec, QC, Canada
| | - Catherine Labbé
- Quebec Heart and Lung Institute Research Center, Department of Pathology, Quebec, QC, Canada
| | - Francois Ghiringhelli
- Plateform of Transfer in Cancer Biology, Department of Biology and Tumor Pathology, Georges-Francois Leclerc Center, Dijon, France
| | - Bertrand Routy
- Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Division of Oncology, Department of Medicine Montréal, QC, Canada; Centre Hospitalier de l'Université de Montréal (CHUM), Hematology-Oncology Division, Department of Medicine, Montréal, QC, Canada.
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van Loon J, Dingemans AMC. Is Concurrent Chemoradiotherapy Also the Best Treatment for Elderly Patients with Limited-Stage Small Cell Lung Cancer? - What the CONVERT Data Can Tell Us. J Thorac Oncol 2019; 14:13-15. [PMID: 30579544 DOI: 10.1016/j.jtho.2018.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 11/14/2018] [Indexed: 11/19/2022]
Affiliation(s)
- Judith van Loon
- MAASTRO Clinic, Department of Radiation Oncology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands.
| | - Anne-Marie C Dingemans
- Department of Pulmonary Diseases, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
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Chua GWY, Chua KLM. Which patients benefit most from stereotactic body radiotherapy or surgery in medically operable non-small cell lung cancer? An in-depth look at patient characteristics on both sides of the debate. Thorac Cancer 2019; 10:1857-1867. [PMID: 31389163 PMCID: PMC6775005 DOI: 10.1111/1759-7714.13160] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 07/18/2019] [Accepted: 07/20/2019] [Indexed: 12/25/2022] Open
Abstract
The role of stereotactic body radiotherapy (SBRT) in early stage medically operable non-small cell lung cancer is currently under debate. SBRT's advantage is its ability to provide high radiotherapy doses to a tumor in a short timeframe, without the risk of postoperative complications and mortality. Currently, in part due to limited prospective data comparing both treatments, international guidelines continue to recommend surgical resection as the gold standard for medically operable patients. However, not all patients possess uniform characteristics, and there is some evidence that certain subgroups of patients would benefit more from one form of treatment - SBRT or surgery - than the other. The aim of this review is to provide a brief summary of the evidence comparing SBRT to surgery, followed by a deeper discussion of the subgroups of patients who would benefit most from surgery: those with large tumors, centrally located tumors, increased risk of occult nodal metastases, increased risk of toxicity from radiotherapy and radioresistant histological tumor subtypes. Meanwhile, patients who could benefit most from SBRT might include elderly patients, those with reduced lung function or cardiac comorbidities, those with synchronous lung nodules, and those with specific tumor mutational status. We hope that this review will aid in the clinical decision-making process regarding patient selection for either treatment.
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Wang Y, Zhang R, Shen Y, Su L, Dong B, Hao Q. Prediction of chemotherapy adverse reactions and mortality in older patients with primary lung cancer through frailty index based on routine laboratory data. Clin Interv Aging 2019; 14:1187-1197. [PMID: 31308642 PMCID: PMC6616135 DOI: 10.2147/cia.s201873] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 06/09/2019] [Indexed: 02/05/2023] Open
Abstract
Objectives To assess the role of a pre-chemotherapy frailty index based on routine laboratory data in predicting mortality and chemotherapy adverse reactions among older patients with primary lung cancer. Design Retrospective cohort study. Setting West China Hospital, Chengdu, China. Participants We included patients aged ≥60 years with primary lung cancer receiving the first course of chemotherapy. Measurements Data were collected from medical records, local government death databases or telephone interviews. Outcomes included chemotherapy adverse reactions and all-cause mortality. We constructed a frailty index based on 44 laboratory variables (FI-LAB) before chemotherapy, and chose the following cutoff points: robust (0.0-0.2), pre-frail (0.2-0.35) and frail (≥0.35). Results We included 1,020 patients (71.4% male; median age: 65 years old). Both pre-frailty and frailty was associated with any chemotherapy adverse reactions and infections during chemotherapy (OR=3.48, 95%CI: 1.77-6.87; OR=3.58, 95%CI: 1.55-8.26, respectively). Frail patients had a shorter median overall survival rate compared to robust patients (18.05 months vs 38.89 months, log-rank p<0.001). After adjusting for some potential confounding variables, the risk of all-cause mortality was dramatically increased in frail patients (HR:2.13, 95% CI:1.51-3.00) with an average follow-up of 3.9 years. Each 0.01 or per standard deviation (SD) increase in the FI-LAB value significantly increased the HR of death by 2.0% (HR:1.02, 95% CI: 1.01-1.03) and 23.0% (HR: 1.23, 95% CI: 1.13-1.34), respectively. Conclusions Frailty assessed by routine laboratory data indicates increased risks of chemotherapy adverse reactions and death in older patients with primary lung cancer receiving the first course of chemotherapy.
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Affiliation(s)
- Yuting Wang
- The Center of Gerontology and Geriatrics/National Center for Geriatric Clinical Research, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Rui Zhang
- Health Informatics Center, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Yanjiao Shen
- The Center of Gerontology and Geriatrics/National Center for Geriatric Clinical Research, West China Hospital, Sichuan University, Chengdu, People's Republic of China.,Sleep Medicine Center, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Lin Su
- The Center of Gerontology and Geriatrics/National Center for Geriatric Clinical Research, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Birong Dong
- The Center of Gerontology and Geriatrics/National Center for Geriatric Clinical Research, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Qiukui Hao
- The Center of Gerontology and Geriatrics/National Center for Geriatric Clinical Research, West China Hospital, Sichuan University, Chengdu, People's Republic of China
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Thyroid transcription factor-1 as a prognostic indicator for stage IV lung adenocarcinoma with and without EGFR-sensitizing mutations. BMC Cancer 2019; 19:574. [PMID: 31196060 PMCID: PMC6567596 DOI: 10.1186/s12885-019-5792-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Accepted: 06/04/2019] [Indexed: 12/14/2022] Open
Abstract
Background Thyroid transcription factor (TTF)-1 expression is a diagnostic marker and a good prognostic indicator for lung adenocarcinoma. However, its good prognostic ability might be due to epidermal growth factor receptor (EGFR)-sensitizing mutations as shown by the positive correlation between TTF-1 expression and EGFR mutations. We explored the prognostic impact of TTF-1 expression according to EGFR-sensitizing mutation status in lung adenocarcinoma patients. Methods We conducted a retrospective cohort study of patients with stage IV lung adenocarcinoma. Data were extracted from the lung cancer registry of Hallym University Medical Centers (three hospitals) in Korea between March 2006 and March 2016. Results Overall, 173 patients were included. EGFR-sensitizing mutations were detected in 84 (51.4%) patients. TTF-1 expression was positive in 139 (80.3%) patients; it was significantly correlated with EGFR-sensitizing mutations (p < 0.001). TTF-1-positive lung adenocarcinoma patients had longer overall survival (OS) than those who were TTF-1 negative (19.3 vs. 5.8 months, p < 0.001). In a Cox regression analysis, TTF-1 positivity, Stage IV M1a, good performance status, and EGFR-sensitizing mutations were independently associated with prolonged OS. In the subgroup of wild-type EGFR adenocarcinoma patients, TTF-1 positivity was also a good prognostic indicator for OS and progression-free survival (PFS) after first-line cytotoxic chemotherapy. Conclusions TTF-1 expression was a good prognostic indicator for OS and PFS in stage IV lung adenocarcinoma patients with and without EGFR-sensitizing mutations. Electronic supplementary material The online version of this article (10.1186/s12885-019-5792-0) contains supplementary material, which is available to authorized users.
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