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Majem M, Basch E, Cella D, Garon EB, Herbst RS, Leighl NB. Understanding health-related quality of life measures used in early-stage non-small cell lung cancer clinical trials: A review. Lung Cancer 2024; 187:107419. [PMID: 38070301 DOI: 10.1016/j.lungcan.2023.107419] [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: 06/02/2023] [Revised: 08/30/2023] [Accepted: 10/31/2023] [Indexed: 01/08/2024]
Abstract
Health-related quality of life (HRQoL) is an important consideration in cancer clinical research, which can be substantially influenced by cancer treatment procedures and medications. The treatment landscape for early-stage (stage I-III) non-small cell lung cancer (NSCLC) is rapidly evolving. In this light, it is important to evaluate the most suitable instruments for HRQoL assessment and timing. Given there is often a requirement for patients with early-stage disease to receive long-term treatment to reduce the risk of disease recurrence after surgery, maintenance or improvement in HRQoL is an important goal of both neoadjuvant and adjuvant treatments. Key challenges with assessing HRQoL relate to the suitability of existing instruments to measure relevant treatment-related adverse effects, consistency in HRQoL assessment approach between similar studies, gaps in data collection and reporting, and interpretation of longitudinal data. Frequent assessments during and after treatment are warranted to capture the true impact of treatment and disease progression on HRQoL, and changes in the relative importance of these factors over time. There is scope for improving existing HRQoL approaches, including ease of use and integration of digital tools to facilitate analysis and interpretation, to enhance the experience of both patients and healthcare professionals. In this narrative review, we discuss key considerations for HRQoL assessment and evaluate the tools currently available to measure HRQoL in NSCLC, many of which were designed with advanced disease in mind. We focus on the key challenges of measuring HRQoL for the specific needs of patients with early-stage disease, and consider future perspectives, to determine the most appropriate HRQoL instruments and analysis methods to use in early-stage NSCLC clinical trials.1.
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Affiliation(s)
- Margarita Majem
- Department of Medical Oncology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
| | - Ethan Basch
- Division of Oncology, Department of Medicine, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - David Cella
- Department of Medical Social Sciences, Northwestern University, Feinberg School of Medicine and Robert H. Lurie Comprehensive Cancer Center, Chicago, IL, USA
| | - Edward B Garon
- Department of Medicine, Division of Hematology / Oncology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Roy S Herbst
- Medical Oncology, Yale School of Medicine and Yale Cancer Center, New Haven, CT, USA
| | - Natasha B Leighl
- Division of Medical Oncology/Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
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Zeng J, Mao WM, Chen QX, Luo TB, Wu YL, Zhou Q, Yang XN, Yan HH, Zhong WZ, Wang Q, Xu ST, Wu L, Shen Y, Liu YY, Chen C, Cheng Y, Xu L, Wang J, Fei K, Li XF, Li J, Huang C, Liu ZD, Xu S, Chen KN, Xu SD, Liu LX, Yu P, Wang BH, Ma HT. Quality of life with adjuvant gefitinib versus vinorelbine plus cisplatin in patients with completely resected stage II-IIIA (N1-N2) EGFR-mutant non-small-cell lung cancer: Results from the ADJUVANT (CTONG1104) study. Lung Cancer 2020; 150:164-171. [PMID: 33186858 DOI: 10.1016/j.lungcan.2020.09.027] [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: 04/17/2020] [Revised: 09/12/2020] [Accepted: 09/22/2020] [Indexed: 02/08/2023]
Abstract
OBJECTIVES Health-related quality of life (HRQoL) data complement conventional clinical endpoints when comparing adjuvant gefitinib with chemotherapy in patients with early-stage non-small-cell lung cancer (NSCLC) and epidermal growth factor receptor (EGFR) mutations. This study aimed to assess changes in HRQoL with adjuvant gefitinib vs chemotherapy in this patient group. MATERIALS AND METHODS In the phase III ADJUVANT trial, patients with completely resected, stage II-IIIA (N1-N2), EGFR-mutant NSCLC were randomized (1:1) to receive either gefitinib for 24 months or vinorelbine plus cisplatin (VP) every 3 weeks for four cycles. HRQoL was assessed as a secondary endpoint using the Functional Assessment of Cancer Therapy-Lung Cancer (FACT-L), Lung Cancer Symptom Scale (LCSS) questionnaires, and Trial Outcome Index (TOI) composite score. HRQoL dynamics, improvements, and time to deterioration were compared between groups. RESULTS At baseline, 104 of 106, and 80 of 87 patients receiving gefitinib and VP, respectively, completed two questionnaires (FACT-L and LCSS). Baseline scores were balanced between groups. Although HRQoL fluctuated and gradually improved in both groups, longitudinally higher scores were reported with gefitinib than VP (FACT-L, odds ratio 418.16, 95 % confidence interval [CI] 2.75-63509.05, p = 0.019; LCSS, 1.13, 1.04-1.22, p = 0.003; TOI, 88.39, 4.40-1775.05, p = 0.003). Time to deterioration in HRQoL was delayed with gefitinib compared with VP (FACT-L, median 69 vs 6 weeks, hazard ratio 0.62, 95 % CI 0.42-0.90, p = 0.013; LCSS, median 45 vs 6 weeks, 0.63, 0.43-0.93, p = 0.020; TOI, median 164 vs 9 weeks, 0.51, 0.33-0.77, p = 0.001). CONCLUSION Adjuvant gefitinib is associated with improved HRQoL over VP, supporting its use in patients with stage II-IIIA (N1-N2), EGFR-mutant NSCLC.
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Affiliation(s)
- Jian Zeng
- Department of Thoracic Surgery, Zhejiang Cancer Hospital, University of Chinese Academy of Sciences, Hangzhou, China
| | - Wei-Min Mao
- Department of Thoracic Surgery, Zhejiang Cancer Hospital, University of Chinese Academy of Sciences, Hangzhou, China.
| | - Qi-Xun Chen
- Department of Thoracic Surgery, Zhejiang Cancer Hospital, University of Chinese Academy of Sciences, Hangzhou, China
| | - Tao-Bo Luo
- Department of Thoracic Surgery, Zhejiang Cancer Hospital, University of Chinese Academy of Sciences, Hangzhou, China
| | - Yi-Long Wu
- Department of Pulmonary Cancer, Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Qing Zhou
- Department of Pulmonary Cancer, Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xue-Ning Yang
- Department of Pulmonary Cancer, Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Hong-Hong Yan
- Department of Pulmonary Cancer, Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Wen-Zhao Zhong
- Department of Pulmonary Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Qun Wang
- Department of Thoracic Surgery, Fudan University Affiliated Zhongshan Hospital, Shanghai, China
| | - Song-Tao Xu
- Department of Thoracic Surgery, Fudan University Affiliated Zhongshan Hospital, Shanghai, China
| | - Lin Wu
- Department of Pulmonary Medicine, Hunan Cancer Hospital, Changsha, China
| | - Yi Shen
- Department of Thoracic Surgery, The Affiliated Hospital of Medical College Qingdao University, Qingdao, China
| | - Yong-Yu Liu
- Department of Thoracic Surgery, Liaoning Cancer Hospital, Shenyang, China
| | - Chun Chen
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Ying Cheng
- Department of Oncology, Jilin Provincial Tumor Hospital, Changchun, China
| | - Lin Xu
- Department of Thoracic Surgery, Jiangsu Cancer Hospital, Nanjing, China
| | - Jun Wang
- Department of Thoracic Surgery, The People's Hospital of Peking University, Beijing, China
| | - Ke Fei
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, Shanghai, China
| | - Xiao-Fei Li
- Department of Thoracic Surgery, Tangdu Hospital, Xi'an, China
| | - Jian Li
- Department of Thoracic Surgery, Peking University First Hospital, Beijing, China
| | - Cheng Huang
- Department of Pulmonary Oncology, Fujian Cancer Hospital, Fuzhou, China
| | - Zhi-Dong Liu
- Department of Thoracic Surgery, Beijing Chest Hospital, Beijing, China
| | - Shun Xu
- Department of Thoracic Surgery, The First Hospital of China Medical University, Shenyang, China
| | - Ke-Neng Chen
- Department of Thoracic Surgery, Beijing Cancer Hospital, Beijing, China
| | - Shi-Dong Xu
- Department of Thoracic Surgery, Harbin Medical University Cancer Hospital, Harbin, China
| | - Lun-Xu Liu
- Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Ping Yu
- Department of Thoracic Oncology, Sichuan Cancer Hospital, Chengdu, China
| | - Bu-Hai Wang
- Department of Oncology, The Northern Jiangsu People's Hospital, Yangzhou, China
| | - Hai-Tao Ma
- Department of Thoracic Surgery, The First Affiliated Hospital of Suzhou University, Suzhou, China
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Fiero MH, Roydhouse JK, Vallejo J, King-Kallimanis BL, Kluetz PG, Sridhara R. US Food and Drug Administration review of statistical analysis of patient-reported outcomes in lung cancer clinical trials approved between January, 2008, and December, 2017. Lancet Oncol 2019; 20:e582-e589. [PMID: 31579004 DOI: 10.1016/s1470-2045(19)30335-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 04/27/2019] [Accepted: 05/02/2019] [Indexed: 02/08/2023]
Abstract
With the advent of patient-focused drug development, the US Food and Drug Administration (FDA) has redoubled its efforts to review patient-reported outcome (PRO) data in cancer trials submitted as part of a drug's marketing application. This Review aims to characterise the statistical analysis of PRO data from pivotal lung cancer trials submitted to support FDA drug approval between January, 2008, and December, 2017. For each trial and PRO instrument identified, we evaluated prespecified PRO concepts, statistical analysis, missing data and sensitivity analysis, instrument completion, and clinical relevance. Of the 37 pivotal lung cancer trials used to support FDA drug approval, 25 (68%) trials included PRO measures. The most common prespecified PRO concepts were cough, dyspnoea, and chest pain. At the trial level, the most common statistical analyses were descriptive (24 trials [96%]), followed by time-to-event analyses (19 trials [76%]), longitudinal analyses (12 trials [48%]), and basic inferential tests or general linear models (10 trials [40%]). Our findings indicate a wide variation in the analytic techniques and data presentation methods used, with very few trials reporting clear PRO research objectives and sensitivity analyses for PRO results. Our work further supports the need for focused research objectives to justify and to guide the analytic strategy of PROs to facilitate the interpretation of patient experience.
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Affiliation(s)
- Mallorie H Fiero
- Office of Biostatistics, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA.
| | - Jessica K Roydhouse
- Office of Hematology and Oncology Products, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - Jonathon Vallejo
- Office of Biostatistics, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - Bellinda L King-Kallimanis
- Office of Hematology and Oncology Products, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - Paul G Kluetz
- Oncology Center of Excellence, US Food and Drug Administration, Silver Spring, MD, USA
| | - Rajeshwari Sridhara
- Office of Biostatistics, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
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Van Der Weijst L, Lievens Y, Schrauwen W, Surmont V. Health-Related Quality of Life in Advanced Non-small Cell Lung Cancer: A Methodological Appraisal Based on a Systematic Literature Review. Front Oncol 2019; 9:715. [PMID: 31456938 PMCID: PMC6699450 DOI: 10.3389/fonc.2019.00715] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 07/18/2019] [Indexed: 12/24/2022] Open
Abstract
Background: The majority of lung cancer patients are diagnosed with advanced non-small cell lung cancer (NSCLC), the bulk of which receive palliative systemic treatment with the goal to provide effective symptom palliation and safeguard health-related quality of life (HRQoL). Advanced NSCLC trials with HRQoL endpoints face methodological constraints limiting interpretability. Objectives: We provide a comprehensive overview of recent clinical trials evaluating the impact of systemic therapies on HRQoL in advanced NSCLC, focusing on the methodological quality, with the ultimate goal to improve interpretation, comparison and reporting of HRQoL data. Methods: A systematic literature review was performed. Prospective studies published over the last decade evaluating the impact of systemic treatments on HRQoL in advanced NSCLC were included. Methodological quality of HRQoL reporting was assessed with the CONSORT-PRO extension. Results: Hundred-twelve manuscripts describing 85 trials met all criteria. No formal conclusion can be drawn regarding the impact on HRQoL of different treatments. We report an important variety in methodological quality in terms of definitions of HRQoL, missing data points, lack of standardization of analyzing and presenting HRQoL and no standard follow-up time. The quality of HRQoL data reporting varies substantially between studies but improves over time. Conclusion: This review shows that in the heterogeneous landscape of trials addressing HRQoL in advanced stage NSCLC. Methodology reporting remains generally poor. Adequate reporting of HRQoL outcome data is equally important to support clinical decision-making as to correctly inform health policy regarding direct approval and reimbursement of the new drugs and combinations that will come online.
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Affiliation(s)
| | - Yolande Lievens
- Department of Radiotherapy-Oncology, Ghent University Hospital, Ghent, Belgium
| | - Wim Schrauwen
- Department of Medical Oncology, Ghent University Hospital, Ghent, Belgium
| | - Veerle Surmont
- Department of Thoracic Oncology, Ghent University Hospital, Ghent, Belgium
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Dacosta-Noble P, Costantini A, Dumenil C, Dumoulin J, Helly de Tauriers P, Giraud V, Labrune S, Emile JF, Alvarez JC, Chinet T, Giroux Leprieur E. Positive plasma cotinine during platinum-based chemotherapy is associated with poor response rate in advanced non-small cell lung cancer patients. PLoS One 2019; 14:e0219080. [PMID: 31260495 PMCID: PMC6602197 DOI: 10.1371/journal.pone.0219080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Accepted: 06/14/2019] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Patients with advanced non-small cell lung cancer (NSCLC) are most of the time treated with a first-line cytotoxic chemotherapy. Tobacco use is responsible for 90% of lung cancer. The aim of this study was to evaluate the impact of smoking continuation during first-line chemotherapy on tumor response in advanced-stage NSCLC. MATERIALS AND METHODS All patients with an advanced-stage NSCLC (IIIb or IV), treated with first-line platinum-based chemotherapy in our Department between June 2013 and July 2017 were included. Smoking status was assessed at inclusion by self-report, then at the tumor assessment consultation after 2 months of treatment, by both self-report and plasmatic cotinine measurement. Chemotherapy response, progression-free survival (PFS), overall survival (OS) and stage 3-4 toxicity were registered. RESULTS Ninety-seven patients were included: 8 (8%) declared to be non-smokers, 56 (58%) current smokers and 33 (34%) former smokers at diagnosis. At the first tumor evaluation, 24 (25%) self-reported as active smokers and 73 (75%) as non-smokers; overall response rate (ORR) was respectively 38% and 48% (p = 0.373). Fifty-four patients had a plasmatic cotinine evaluation at the first tumor evaluation. Seventeen patients (32%) had a positive cotinine rate (median 108ng/mL, IQR 31-236). Six patients (35%) had positive cotinine rate whereas declaring to be non-smokers at the first tumor evaluation. ORR was 18% in case of positive cotinine rate, and 57% when negative (p = 0.007). Regardless of the method for smoking status evaluation, PFS, OS and grade 3-4 toxicities were similar between smoker and non-smoker patients at the first tumor evaluation. CONCLUSION Smoking continuation during platinum-based chemotherapy, reflected by positive plasma cotinine rate, was associated with a poor ORR.
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Affiliation(s)
- Philippine Dacosta-Noble
- Department of Respiratory Diseases and Thoracic Oncology, APHP-Hopital Ambroise Paré, Boulogne-Billancourt, France
| | - Adrien Costantini
- Department of Respiratory Diseases and Thoracic Oncology, APHP-Hopital Ambroise Paré, Boulogne-Billancourt, France
- EA 4340, UVSQ, Université Paris-Saclay, Boulogne-Billancourt, France
| | - Coraline Dumenil
- Department of Respiratory Diseases and Thoracic Oncology, APHP-Hopital Ambroise Paré, Boulogne-Billancourt, France
- EA 4340, UVSQ, Université Paris-Saclay, Boulogne-Billancourt, France
| | - Jennifer Dumoulin
- Department of Respiratory Diseases and Thoracic Oncology, APHP-Hopital Ambroise Paré, Boulogne-Billancourt, France
| | - Pierre Helly de Tauriers
- Department of Respiratory Diseases and Thoracic Oncology, APHP-Hopital Ambroise Paré, Boulogne-Billancourt, France
| | - Violaine Giraud
- Department of Respiratory Diseases and Thoracic Oncology, APHP-Hopital Ambroise Paré, Boulogne-Billancourt, France
| | - Sylvie Labrune
- Department of Respiratory Diseases and Thoracic Oncology, APHP-Hopital Ambroise Paré, Boulogne-Billancourt, France
| | - Jean-François Emile
- EA 4340, UVSQ, Université Paris-Saclay, Boulogne-Billancourt, France
- Centre de Ressources Biologiques, APHP-Hopital Ambroise Paré, Boulogne-Billancourt, France
| | - Jean-Claude Alvarez
- AP-HP, Hôpital Raymond Poincaré, Service de Pharmacologie Toxicologie, INSERM U-1173, UVSQ, Université Paris-Saclay, Garches, France
| | - Thierry Chinet
- Department of Respiratory Diseases and Thoracic Oncology, APHP-Hopital Ambroise Paré, Boulogne-Billancourt, France
- EA 4340, UVSQ, Université Paris-Saclay, Boulogne-Billancourt, France
| | - Etienne Giroux Leprieur
- Department of Respiratory Diseases and Thoracic Oncology, APHP-Hopital Ambroise Paré, Boulogne-Billancourt, France
- EA 4340, UVSQ, Université Paris-Saclay, Boulogne-Billancourt, France
- * E-mail:
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Adrianzen Herrera D, Ashai N, Perez-Soler R, Cheng H. Nanoparticle albumin bound-paclitaxel for treatment of advanced non-small cell lung cancer: an evaluation of the clinical evidence. Expert Opin Pharmacother 2018; 20:95-102. [DOI: 10.1080/14656566.2018.1546290] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Diego Adrianzen Herrera
- Department of Medical Oncology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA
| | - Nadia Ashai
- Department of Medical Oncology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA
| | - Roman Perez-Soler
- Department of Medical Oncology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA
| | - Haiying Cheng
- Department of Medical Oncology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA
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Hirsh V, Wan Y, Lin FJ, Margunato-Debay S, Ong TJ, Botteman M, Langer C. Quality-adjusted Outcomes Stratified by Response in Patients With Advanced Non-Small-cell Lung Cancer Receiving First-line nab-Paclitaxel/Carboplatin or Paclitaxel/Carboplatin. Clin Lung Cancer 2018; 19:401-409.e4. [PMID: 29903552 DOI: 10.1016/j.cllc.2018.04.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 03/16/2018] [Accepted: 04/24/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND First-line nab-paclitaxel/carboplatin was associated with a significantly improved overall response rate (primary endpoint) versus paclitaxel/carboplatin in a phase III trial of advanced non-small-cell lung cancer (NSCLC). We report the results of an analysis evaluating the correlation of response and the time to response with survival and quality-adjusted outcomes. PATIENTS AND METHODS Using a landmark approach, progression-free survival (PFS), overall survival (OS), and quality-adjusted time without symptoms or toxicity (Q-TWiST) were compared between patients with a confirmed partial or complete response at or before 6 weeks (≤ 6-week responders) and those without (≤ 6-week nonresponders). The outcomes were also analyzed in two 12-week landmark analyses: ≤ 12-week responders versus ≤ 12-week nonresponders and early responders (≤ 6 weeks) versus late responders (6-12 weeks) versus ≤ 12-week nonresponders. RESULTS The median OS and PFS for the ≤ 6-week responders versus ≤ 6-week nonresponders were 14.5 versus 10.3 months (P < .001) and 5.5 versus 4.5 months (P = .002), respectively. The ≤ 6-week responders gained 2.1 months of mean Q-TWiST. The median OS and PFS for the ≤ 12-week responders versus ≤ 12-week nonresponders were 16.3 versus 8.4 months and 5.3 versus 2.8 months (both P < .001), respectively, and the ≤ 12-week responders gained 3.2 months of mean Q-TWiST. The median OS was 13.1, 16.6, and 8.4 months (P < .001), the median PFS was 4.1, 6.7, and 2.8 months (P < .001), and the mean Q-TWiST was 10.2, 11.7, and 7.8 months for the early responders, late responders, and ≤ 12-week nonresponders, respectively. Both early and late responders had significantly longer Q-TWiST compared with the ≤ 12-week nonresponders (difference, +2.4 and +3.9 months, respectively; P < .05). CONCLUSION These results underscore response as an important surrogate for assessment of long-term treatment outcomes in advanced NSCLC.
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Affiliation(s)
- Vera Hirsh
- Department of Oncology, McGill University Health Centre, Cedars Cancer Centre, Montreal, QC, Canada.
| | - Yin Wan
- Pharmerit North America, Bethesda, MD
| | | | | | | | | | - Corey Langer
- Abramson Cancer Center, Hospital of the University of Pennsylvania, Philadelphia, PA
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Patient-Reported Outcomes in OAK: A Phase III Study of Atezolizumab Versus Docetaxel in Advanced Non-Small-cell Lung Cancer. Clin Lung Cancer 2018; 19:441-449.e4. [PMID: 30017645 DOI: 10.1016/j.cllc.2018.05.011] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 04/23/2018] [Accepted: 05/17/2018] [Indexed: 01/22/2023]
Abstract
BACKGROUND The randomized phase III OAK (a study of atezolizumab compared with docetaxel in participants with locally advanced or metastatic non-small-cell lung cancer [NSCLC] who have failed platinum-containing therapy) trial investigated the anti-programmed cell death ligand 1 (PD-L1) antibody atezolizumab for advanced or metastatic, previously treated, NSCLC. Atezolizumab significantly improved overall survival (OS) compared with docetaxel (hazard ratio [HR], 0.73; 95% confidence interval [CI], 0.62-0.87; P = .0003; median OS, 13.8 vs. 9.6 months, respectively). Patient-reported outcomes (PROs) were collected to evaluate disease-related symptoms and health-related quality of life (HRQoL) to support the finding of a survival benefit. PATIENTS AND METHODS The first 850 patients were randomized to receive atezolizumab (1200 mg every 3 weeks) or docetaxel (75 mg/m2 every 3 weeks). PROs were collected on day 1 of cycle 1, day 1 of every subsequent cycle, and at the end-of-treatment visit for patients who completed ≥ 1 baseline and 1 postbaseline PRO assessment. The European Organisation for the Research and Treatment of Cancer QoL questionnaire and lung cancer module were used to assess PROs. RESULTS Atezolizumab delayed the time to deterioration (TTD) in physical function (HR, 0.75; 95% CI, 0.58-0.98) and role function (HR, 0.79; 95% CI, 0.62-1.00) and numerically improved patients' HRQoL from baseline compared with docetaxel. Atezolizumab also prolonged the TTD in chest pain (HR, 0.71; 95% CI, 0.49-1.05; P = .0823), although both arms showed an objective reduction relative to baseline. Overall, the patients had no clinically significant worsening in treatment-related symptoms, although the scores favored atezolizumab. CONCLUSION These PRO data support the clinical benefit of atezolizumab in patients with previously treated advanced or metastatic NSCLC. Atezolizumab prolonged the TTD of patients' limitations in role and physical functions compared with docetaxel.
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Thomas M, Spigel DR, Jotte RM, McCleod M, Socinski MA, Page RD, Gressot L, Knoble J, Juan O, Morgensztern D, Isla D, Kim ES, West H, Ko A, Ong TJ, Trunova N, Gridelli C. nab-paclitaxel/carboplatin induction in squamous NSCLC: longitudinal quality of life while on chemotherapy. LUNG CANCER-TARGETS AND THERAPY 2017; 8:207-216. [PMID: 29138610 PMCID: PMC5679693 DOI: 10.2147/lctt.s138570] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background Longitudinal data on the impact of treatment on quality of life (QoL) in advanced non-small cell lung cancer (NSCLC) are limited. In this palliative setting, treatment that does not deteriorate QoL is key. Here we report longitudinal QoL in patients with squamous NSCLC, receiving ≤4 cycles of nab-paclitaxel/carboplatin combination chemotherapy. Methods Patients received nab-paclitaxel 100 mg/m2 days 1, 8, 15 + carboplatin area under the curve 6 mg•min/mL day 1 (q3w) for four cycles. QoL was assessed by the Lung Cancer Symptom Scale (LCSS) and Euro-QoL-5 Dimensions-5 Levels (EQ-5D-5L) at baseline and each cycle (day 1). Results Two-hundred and six lesion-response-evaluable patients completed baseline + ≥1 postbaseline QoL assessment and were QoL evaluable. LCSS average total score and symptom burden index improved from baseline throughout four cycles. In the LCSS pulmonary symptoms score, 46% of patients reported clinically meaningful improvement (≥10 mm visual analog scale) from baseline. Individual EQ-5D-5L dimensions remained stable/improved in ≥83% of patients; ≈33% reported complete resolution of baseline problems at least once during four cycles. Generally, responders (unconfirmed complete/partial response) had higher scores vs nonresponders. Conclusion In patients with squamous NSCLC, four cycles of nab-paclitaxel/carboplatin demonstrated clinically meaningful QoL improvements, with greater benefits in responders vs nonresponders.
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Affiliation(s)
- Michael Thomas
- Department of Thoracic Oncology/Internal Medicine, Thoraxklinik im Universitätsklinikum Heidelberg.,Translational Lung Research Center Heidelberg, Heidelberg, Germany
| | | | - Robert M Jotte
- Department of Medical Oncology/Hematology, Rocky Mountain Cancer Centers, Denver, CO
| | | | | | - Ray D Page
- The Center for Cancer and Blood Disorders, Fort Worth
| | | | | | - Oscar Juan
- Department of Medical Oncology, Hospital Universitari i Politécnic La Fe, Valencia, Spain
| | - Daniel Morgensztern
- Department of Medical Oncology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Dolores Isla
- Department of Medical Oncology, University Hospital Lozano Blesa, Zaragoza, Spain
| | - Edward S Kim
- Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC
| | - Howard West
- Thoracic Oncology Program, Swedish Cancer Institute, Seattle, WA
| | - Amy Ko
- Celgene Corporation, Summit, NJ, USA
| | | | | | - Cesare Gridelli
- Department of Oncology/Hematology, S.G. Moscati Hospital, Avellino, Italy
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Reck M, Thomas M, Kropf-Sanchen C, Mezger J, Socinski MA, Depenbrock H, Soldatenkova V, Brown J, Krause T, Thatcher N. Necitumumab plus Gemcitabine and Cisplatin as First-Line Therapy in Patients with Stage IV EGFR- Expressing Squamous Non-Small-Cell Lung Cancer: German Subgroup Data from an Open-Label, Randomized Controlled Phase 3 Study (SQUIRE). Oncol Res Treat 2016; 39:539-47. [PMID: 27614872 DOI: 10.1159/000448085] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 06/23/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND In the SQUIRE study, adding the anti-epidermal growth factor receptor (EGFR) IgG1 antibody necitumumab to first-line gemcitabine and cisplatin (GC + N) in advanced squamous non-small-cell lung cancer (sqNSCLC) significantly improved overall survival (OS); the safety profile was acceptable. We explored data for the German subpopulation (N = 96) of SQUIRE patients with EGFR-expressing tumors. PATIENT AND METHODS Patients with stage IV sqNSCLC were randomized 1:1 to up to 6 cycles of open-label GC + N or GC alone. GC + N patients with no progression continued on necitumumab monotherapy until disease progression or intolerable toxicity. The primary endpoint was OS; the secondary endpoints included progression-free survival (PFS), safety and health-related quality of life (EQ-5D, Lung Cancer Symptom Scale (LCSS)). RESULTS The 96 German SQUIRE patients with EGFR-expressing tumors (GC + N 42, GC 54) received a median of 4 GC cycles; the GC + N patients received 5 cycles of necitumumab. Adding necitumumab was associated with 41% risk reduction of death (hazard ratio (HR) 0.59, 95% confidence interval (CI) 0.37-0.94, p = 0.026) and 44% risk reduction of progression (HR 0.56, 95% CI 0.33-0.95, p = 0.029). Adverse events typically associated with EGFR antibody treatment (including rash, hypomagnesemia) were more common with GC + N. The time to deterioration of the EQ-5D and LCSS scores showed no notable differences between the treatment arms, except for appetite loss (delayed for GC + N). CONCLUSION The survival benefit from adding necitumumab to first-line GC was more pronounced in the German SQUIRE subpopulation with EGFR-expressing tumors than in the overall (intention-to-treat) population; toxicity was manageable and consistent with the overall population.
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Affiliation(s)
- Martin Reck
- Department of Thoracic Oncology, Airway Research Center North (ARCN), German Center for Lung Research (DZL), German Center for Lung Research (DZL), LungenClinic Grosshansdorf, Grosshansdorf, Germany
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11
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Reck M, Socinski MA, Luft A, Szczęsna A, Dediu M, Ramlau R, Losonczy G, Molinier O, Schumann C, Gralla RJ, Bonomi P, Brown J, Soldatenkova V, Chouaki N, Obasaju C, Peterson P, Thatcher N. The Effect of Necitumumab in Combination with Gemcitabine plus Cisplatin on Tolerability and on Quality of Life: Results from the Phase 3 SQUIRE Trial. J Thorac Oncol 2016; 11:808-18. [PMID: 26980471 DOI: 10.1016/j.jtho.2016.03.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 02/26/2016] [Accepted: 03/02/2016] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Necitumumab, a second-generation, recombinant human immunoglobulin G1 epidermal growth factor receptor antibody in the phase 3 SQUIRE trial (NCT00981058), increased survival benefit for patients randomized to receive necitumumab plus gemcitabine-cisplatin compared with those who received gemcitabine-cisplatin. Here we characterize health-related quality of life (HRQoL) and tolerability results. METHODS A total of 1093 patients with stage IV squamous non-small cell lung cancer were randomized 1:1 to receive necitumumab (800 mg absolute dose intravenously [IV]) plus gemcitabine-cisplatin (gemcitabine = 1250 mg/m(2) IV on days 1 and 8; cisplatin = 75 mg/m(2) IV on day 1) or gemcitabine-cisplatin alone (every 21 days) for up to six cycles. Patients receiving necitumumab plus gemcitabine-cisplatin without disease progression continued necitumumab until progression. HRQoL was measured by Eastern Cooperative Oncology Group performance status, the Lung Cancer Symptom Scale (LCSS), and the European Quality of Life Five-Dimensions questionnaire. Efficacy and LCSS outcomes were analyzed using the baseline maximum severity score of the LCSS. Tolerability was measured in terms of exposure to the study treatment and adverse events. Hospitalization rates were collected. RESULTS Most patients in both study arms similarly maintained Eastern Cooperative Oncology Group performance status and comparable LCSS and European Quality of Life Five-Dimensions questionnaire assessments. Patients with a higher baseline LCSS had a greater survival benefit on the necitumumab arm. Chemotherapy exposure was similar in both treatment arms; 51% of patients on the necitumumab plus gemcitabine-cisplatin arm continued on single-agent necitumumab. The most frequent grade 4 adverse events were neutropenia (6.1% versus 7.9%) and thrombocytopenia (3.2% versus 4.3%) in the necitumumab plus gemcitabine-cisplatin versus gemcitabine-cisplatin arms, respectively. Hospitalizations were slightly higher with necitumumab plus gemcitabine-cisplatin (36.4%) than with gemcitabine-cisplatin (34.0%). CONCLUSIONS The addition of necitumumab to gemcitabine-cisplatin was well tolerated, did not negatively affect HRQoL or toxicity, and particularly benefited patients with more severe baseline symptoms or lower HRQoL.
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Affiliation(s)
- Martin Reck
- Department of Thoracic Oncology, LungenClinic Grosshansdorf, Airway Research Center North, Grosshansdorf, Germany.
| | - Mark A Socinski
- Lung Cancer Section, Division of Hematology/Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Alexander Luft
- Leningrad Regional Clinical Hospital, St. Petersburg, Russia
| | | | - Mircea Dediu
- Institute of Oncology "Alexandru Trestioreanu," Bucharest, Romania
| | - Rodryg Ramlau
- Poznan University of Medical Sciences, Poznań, Poland
| | - György Losonczy
- Semmelweis University Department of Pulmonology, Budapest, Hungary
| | | | - Christian Schumann
- Department of Internal Medicine II, University Hospital of Ulm, Ulm, Germany; Clinic for Pneumology, Thoracic Oncology, Sleep- and Respiratory Critical Care, Kempten-Oberallgaeu Hospitals, Kempten, Germany
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Villaruz LC, Socinski MA. Is there a role of nab-paclitaxel in the treatment of advanced non-small cell lung cancer? The data suggest yes. Eur J Cancer 2016; 56:162-171. [PMID: 26875112 PMCID: PMC4844000 DOI: 10.1016/j.ejca.2015.12.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 12/08/2015] [Accepted: 12/21/2015] [Indexed: 02/07/2023]
Abstract
Nab-paclitaxel is a novel therapeutic agent, which was approved in combination with carboplatin in the first-line treatment of advanced non-small cell lung cancer (NSCLC) regardless of histologic subtype in the United States of America by the Food and Drug Administration in 2012 and by the European Commission in 2015. This approval was based on the results of a phase III clinical trial showing superior response rates compared with solvent-based paclitaxel in combination with carboplatin. This review will focus on the early development and clinical data to date supporting the use of nab-paclitaxel in advanced NSCLC. The clinical question central to this review is whether nab-paclitaxel has a place in the current therapeutic landscape of advanced NSCLC.
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Affiliation(s)
- Liza C Villaruz
- University of Pittsburgh Cancer Institute, Lung Cancer Program, 5150 Center Avenue, Pittsburgh, PA 15232, USA.
| | - Mark A Socinski
- University of Pittsburgh Cancer Institute, Lung Cancer Program, 5150 Center Avenue, Pittsburgh, PA 15232, USA.
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13
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Boye M, Wang X, Srimuninnimit V, Kang JH, Tsai CM, Orlando M, Puri T, Kim JS, Rajan N, Yang JCH. First-Line Pemetrexed Plus Cisplatin Followed by Gefitinib Maintenance Therapy Versus Gefitinib Monotherapy in East Asian Never-Smoker Patients With Locally Advanced or Metastatic Nonsquamous Non-Small-cell Lung Cancer: Quality of Life Results From a Randomized Phase III Trial. Clin Lung Cancer 2015; 17:150-60. [PMID: 26809984 DOI: 10.1016/j.cllc.2015.12.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 12/08/2015] [Accepted: 12/09/2015] [Indexed: 01/29/2023]
Abstract
BACKGROUND The efficacy results from an open-label, randomized, multicenter study found no significant difference in progression-free survival between pemetrexed plus cisplatin followed by maintenance gefitinib (PC/G) and gefitinib monotherapy (G) in patients with advanced nonsquamous non-small-cell lung cancer (NSCLC) and unknown epidermal growth factor receptor (EGFR) mutation status (hazard ratio favored PC/G). The present report describes the quality of life (QoL) results from that trial. PATIENTS AND METHODS Chemotherapy-naive, East Asian, light ex-smokers or never-smokers with advanced nonsquamous NSCLC and unknown EGFR mutation status (n = 236) were randomly assigned (1:1) to PC/G or G. EGFR mutation status was subsequently determined for 74 patients. The symptoms and QoL were assessed using the Lung Cancer Symptom Scale (LCSS). The time to worsening of symptoms (TWS) was analyzed using the Kaplan-Meier method. RESULTS In the overall population, the TWS was generally longer in the G group (n = 109) than in the PC/G group (n = 109) for the LCSS symptoms classified as treatment-related (loss of appetite, fatigue) and tumor-related (cough, dyspnea, hemoptysis, pain). In the subgroup of patients with wild-type EGFR, the TWS was generally longer in the PC/G group (n = 13) than in the G group (n = 8) for the tumor-related LCSS symptoms. CONCLUSION In this study population clinically selected to respond to gefitinib, the LCSS scores were more favorable in the G group than in the PC/G group. Patients with wild-type EGFR tended to show greater improvement in tumor-related LCSS symptoms with chemotherapy than with gefitinib alone. These LCSS outcomes provide further evidence that patients with wild-type EGFR might not benefit from first-line treatment of advanced NSCLC with gefitinib.
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Affiliation(s)
- Mark Boye
- Global Patient Outcomes and Real World Evidence, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN
| | - Xin Wang
- Eli Lilly and Company, Shanghai, China
| | - Vichien Srimuninnimit
- Division of Medical Oncology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Jin Hyoung Kang
- Division of Medical Oncology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Chun-Ming Tsai
- Division of Thoracic Oncology, Department of Chest Medicine, Taipei Veterans General Hospital and Department of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Mauro Orlando
- Eli Lilly Interamerica Inc., Buenos Aires, Argentina
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A significant response to sorafenib in a woman with advanced lung adenocarcinoma and a BRAF non-V600 mutation. Anticancer Drugs 2015; 26:1004-7. [PMID: 26237499 DOI: 10.1097/cad.0000000000000277] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Lung adenocarcinoma includes recurrent activating oncogenic mutations (EGFR, EML4-ALK, ROS1) that have been associated with response to EGFR and ALK inhibitors. Platinum-based chemotherapy is the standard therapy for non-oncodrivers population. Sorafenib is a small molecule that blocks the activation of C-RAF, B-RAF, c-KIT, FLT-3, RET, VEGFR-2, VEGFR-3 and PDGFR approved for advanced renal cell and hepatocellular carcinoma (b, c). Many studies have evaluated sorafenib in advanced non-small-cell lung cancer (NSCLC), with different results. We present a case report of a patient with NSCLC and the BRAF G469R mutation who showed a dramatic response to sorafenib.
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Pilz LR, Manegold C, Schmid-Bindert G. Statistical considerations and endpoints for clinical lung cancer studies: Can progression free survival (PFS) substitute overall survival (OS) as a valid endpoint in clinical trials for advanced non-small-cell lung cancer? Transl Lung Cancer Res 2015; 1:26-35. [PMID: 25806152 DOI: 10.3978/j.issn.2218-6751.2011.12.08] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2011] [Accepted: 12/31/2011] [Indexed: 11/14/2022]
Abstract
In the last decades significant progress has been achieved in the biological understanding of non-small-cell lung cancer (NSCLC) and its tumor heterogeneity has become more evident. The identification of novel tumor targets with different pathways has stimulated the search for anti-tumor agents with a specific target directed mode of action, stipulating the need of testing these agents in clinical trials with an appropriate choice of the study endpoint. Gold standard as an endpoint has been so far overall survival (OS). By definition there are 3 categories of classical endpoints applied generally in clinical lung cancer studies: survival time endpoints, symptom endpoints, and endpoints relying on patients' reporting. Beside classical endpoints like OS which are tending to show the direct clinical effect of treatment, efforts have been taken to substitute these classical endpoints by surrogates. As a surrogate candidate for OS progression-free survival (PFS) should have the inherent considerable advantage, that it can detect subpopulations with longer PFS intervals early. Based on the (sub-) population treated and having in mind the risk-benefit profile of the drug under consideration, PFS can be considered for regulatory decision making. If accompanied by some independent measures like quality of life or treatment toxicity, PFS should be able to cover the clinical benefit achieved by treatment. Selecting PFS as primary endpoint in Phase III trials of advanced NSCLC may be based on a number of questions such as: Does the definition of PFS fit into the setting used by other trials? Are there accepted consensus standards? Are there consistent surveillance intervals? Is validation for each agent group planned? Is the incremental improvement of PFS big enough (≥30%)? And are there some additional measures to confine clinical benefit? OS is still accepted as the gold standard in trials investigating advanced NSCLC. OS is easy to measure and precise but it may be difficult to interpret if treatment action takes place only in a small subinterval of overall survival. PFS with some additional measures has become attractive when it seems advisable to make study results available earlier. Candidates for supporting PFS as "additional measures" may be treatment toxicity and quality of life measures. PFS allows a more precise detection and attribution to effects of the investigational treatment without being compromised by subsequent treatments. Therefore "enriched PFS" can be considered as an alternative primary endpoint replacing OS in studies investigating advanced NSCLC. The endpoint selection process should always be performed carefully considering all true and surrogate endpoint options in respect to the hypotheses to be proven.
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Affiliation(s)
- Lothar R Pilz
- Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1, 68167 Mannheim, Germany
| | - Christian Manegold
- Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1, 68167 Mannheim, Germany
| | - Gerald Schmid-Bindert
- Interdisziplinäre thorokale Onkologie, Department of Surgery, University Medical Center Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1, 68167 Mannheim, Germany
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Hirsh V. Is the Evaluation of Quality of Life in NSCLC Trials Important? Are the Results to be Trusted? Front Oncol 2014; 4:173. [PMID: 25072024 PMCID: PMC4080131 DOI: 10.3389/fonc.2014.00173] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Accepted: 06/18/2014] [Indexed: 12/27/2022] Open
Abstract
The majority of patients with non-small cell lung cancer present at the time of diagnosis with stage IV metastatic disease and they experience 2 or more disease-related symptoms. These symptoms may have a negative impact on their health-related quality of life (HR QOL). Data has shown many of these patients prefer a therapy to improve their symptoms rather than receive a therapy which slightly prolongs their survival without improving their symptoms. The improvement of disease-related symptoms on a specific drug or regimen augments the significance of prolongation of the progression-free survival or the response rate as well as symptom worsening. The choice of the questionnaires to evaluate patients’ reported outcomes and HR QOL benefits and the methods of collecting the data and their interpretations are very important. Only if the data are collected and analyzed properly will they be meaningful and can then be viewed as components that add the total value to a treatment and provide a comprehensive picture of the benefits and risks of a certain anticancer therapy.
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Affiliation(s)
- Vera Hirsh
- Department of Medical Oncology, McGill University Health Centre, Royal Victoria Hospital , Montreal, QC , Canada
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17
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Patient-Reported Neuropathy and Taxane-Associated Symptoms in a Phase 3 Trial of nab-Paclitaxel Plus Carboplatin versus Solvent-Based Paclitaxel Plus Carboplatin for Advanced Non–Small-Cell Lung Cancer. J Thorac Oncol 2014; 9:83-90. [DOI: 10.1097/jto.0000000000000011] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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18
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Hirsh V. Are the data on quality of life and patient reported outcomes from clinical trials of metastatic non-small-cell lung cancer important? World J Clin Oncol 2013; 4:82-84. [PMID: 24926427 PMCID: PMC4053709 DOI: 10.5306/wjco.v4.i4.82] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Revised: 08/10/2013] [Accepted: 09/18/2013] [Indexed: 02/06/2023] Open
Abstract
Majority of the patients with advanced non-small-cell lung cancer (NSCLC) experience two or more disease related symptoms, which may have a negative impact on their health-related quality of life (HR QOL). These patients prefer a therapy that would improve disease related symptoms, as opposed or treatment that slightly prolongs their survival without improving symptoms. The improvements of the symptoms augment the significance of improved response rates or progression free survivals. The choice of the questionnaires to evaluate patients-reported outcomes (PROs) and HRQOL benefits and methods of collecting the data and their interpretations are very important and are discussed in this manuscript. PROs and HR QOL outcomes are important in patients with advanced NSCLC only when the data are collected and analyzed correctly. Then they can be viewed as components of the total value of a treatment, providing a comprehensive picture of the benefits and risks of anticancer therapies. Enabling the patients to feel during the last months of their lives more comfortable and not be dependent on their loved ones is a very important task in the treatment of advanced NSCLC.
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Socinski MA, Okamoto I, Hon JK, Hirsh V, Dakhil SR, Page RD, Orsini J, Yamamoto N, Zhang H, Renschler MF. Safety and efficacy analysis by histology of weekly nab-paclitaxel in combination with carboplatin as first-line therapy in patients with advanced non-small-cell lung cancer. Ann Oncol 2013; 24:2390-6. [PMID: 23842283 DOI: 10.1093/annonc/mdt235] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND This analysis compared the efficacy and safety outcomes by histology of nab-paclitaxel (nab-P) plus carboplatin (C) versus solvent-based paclitaxel (sb-P) plus C in patients with advanced non-small-cell lung cancer (NSCLC) based on preplanned stratification factors specified in the phase III trial protocol. PATIENTS AND METHODS Patients with untreated stage III/IV NSCLC received 100 mg/m(2) nab-P weekly and C (area under the curve, AUC = 6) every 3 weeks (q3w) or 200 mg/m(2) sb-P plus C (AUC = 6) q3w. Primary end point was objective overall response rate (ORR). RESULTS nab-P/C versus sb-P/C produced a significantly higher ORR (41% versus 24%; response rate ratio [RRR] 1.680; P < 0.001) in patients with squamous cell (SCC) NSCLC. For nab-P/C versus sb-P/C, ORRs were 26% versus 27% (RRR 0.966; P = 0.814) in patients with adenocarcinoma, 33% versus 15% (RRR 2.167; P = 0.323) in patients with large cell carcinoma (LC), and 24% versus 15% (RRR 1.593; P = 0.372) in patients with not otherwise specified histology. Median overall survival for nab-P/C versus sb-P/C in patients with SCC was 10.7 versus 9.5 months (HR 0.890; P = 0.310), and 12.4 versus 10.6 months (HR 1.208; P = 0.721) for patients with LC. nab-P/C produced significantly (P < 0.05) less grade 3/4 neuropathy and arthralgia, whereas sb-P/C produced less thrombocytopenia and anemia. CONCLUSION(S) First-line nab-P/C demonstrated a favorable risk-benefit profile in patients with NSCLC regardless of histology.
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Affiliation(s)
- M A Socinski
- Division of Hematology/Oncology, University of Pittsburgh Cancer Institute, PA 15232, USA.
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Conde E, Angulo B, Izquierdo E, Paz-Ares L, Belda-Iniesta C, Hidalgo M, López-Ríos F. Lung adenocarcinoma in the era of targeted therapies: histological classification, sample prioritization, and predictive biomarkers. Clin Transl Oncol 2013; 15:503-8. [PMID: 23359174 PMCID: PMC3695315 DOI: 10.1007/s12094-012-0983-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Accepted: 11/27/2012] [Indexed: 01/10/2023]
Abstract
The arrival of targeted therapies has presented both a conceptual and a practical challenge in the treatment of patients with advanced non-small cell lung carcinomas (NSCLCs). The relationship of these treatments with specific histologies and predictive biomarkers has made the handling of biopsies the key factor for success. In this study, we highlight the balance between precise histological diagnosis and the practice of conducting multiple predictive assays simultaneously. This can only be achieved where there is a commitment to multidisciplinary working by the tumor board to ensure that a sensible protocol is applied. This proposal for prioritizing samples includes both recent technological advances and the some of the latest discoveries in the molecular classification of NSCLCs.
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Affiliation(s)
- E. Conde
- Laboratorio de Dianas Terapéuticas, Centro Integral Oncológico Clara Campal, Hospital Universitario Madrid Sanchinarro, Faculty of Medicine, Universidad San Pablo-CEU, Madrid, Spain
| | - B. Angulo
- Laboratorio de Dianas Terapéuticas, Centro Integral Oncológico Clara Campal, Hospital Universitario Madrid Sanchinarro, Faculty of Medicine, Universidad San Pablo-CEU, Madrid, Spain
| | - E. Izquierdo
- Laboratorio de Dianas Terapéuticas, Centro Integral Oncológico Clara Campal, Hospital Universitario Madrid Sanchinarro, Faculty of Medicine, Universidad San Pablo-CEU, Madrid, Spain
| | - L. Paz-Ares
- Department of Oncology, Instituto de Biomedicina de Sevilla (IBIS) and Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - C. Belda-Iniesta
- Department of Oncology, Centro Integral Oncológico Clara Campal, Hospital Universitario Madrid Sanchinarro, Faculty of Medicine, Universidad San Pablo-CEU, Madrid, Spain
| | - M. Hidalgo
- Department of Oncology, Centro Integral Oncológico Clara Campal, Hospital Universitario Madrid Sanchinarro, Faculty of Medicine, Universidad San Pablo-CEU, Madrid, Spain
| | - F. López-Ríos
- Laboratorio de Dianas Terapéuticas, Centro Integral Oncológico Clara Campal, Hospital Universitario Madrid Sanchinarro, Faculty of Medicine, Universidad San Pablo-CEU, Madrid, Spain
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Damm K, Roeske N, Jacob C. Health-related quality of life questionnaires in lung cancer trials: a systematic literature review. HEALTH ECONOMICS REVIEW 2013; 3:15. [PMID: 23680096 PMCID: PMC3666900 DOI: 10.1186/2191-1991-3-15] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Accepted: 04/19/2013] [Indexed: 06/02/2023]
Abstract
BACKGROUND Lung cancer is one of the leading causes of cancer deaths. Treatment goals are the relief of symptoms and the increase of overall survival. With the rising number of treatment alternatives, the need for comparable assessments of health-related quality of life (HRQoL) parameters grows. The aim of this paper was to identify and describe measurement instruments applied in lung cancer patients under drug therapy. METHODS We conducted a systematic literature review at the beginning of 2011 using the electronic database Pubmed. RESULTS A total of 43 studies were included in the review. About 17 different measurement instruments were identified, including 5 generic, 5 cancer-specific, 4 lung cancer-specific and 3 symptom-specific questionnaires. In 29 studies at least 2 instruments were used. In most cases these were cancer and lung cancer-specific ones. The most frequently used instruments are the EORTC QLQ-C30 and its lung cancer modules LC13 or LC17. Only 5 studies combined (lung) cancer-specific questionnaires with generic instruments. CONCLUSIONS The EORTC-C30 and EORTC-LC13 are the most frequently used health-related quality of life measurement instruments in pharmacological lung cancer trials.
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Affiliation(s)
- Kathrin Damm
- Center for Health Economics Research Hannover (CHERH), Leibniz University Hannover, Hannover, Germany
| | - Nicole Roeske
- Center for Health Economics Research Hannover (CHERH), Leibniz University Hannover, Hannover, Germany
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Wu YL, Fukuoka M, Mok TSK, Saijo N, Thongprasert S, Yang JCH, Chu DT, Yang JJ, Rukazenkov Y. Tumor response and health-related quality of life in clinically selected patients from Asia with advanced non-small-cell lung cancer treated with first-line gefitinib: post hoc analyses from the IPASS study. Lung Cancer 2013; 81:280-7. [PMID: 23540718 DOI: 10.1016/j.lungcan.2013.03.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Revised: 02/21/2013] [Accepted: 03/05/2013] [Indexed: 10/27/2022]
Abstract
BACKGROUND In IPASS (NCT00322452), progression-free survival (PFS, primary endpoint) was significantly longer with first-line gefitinib versus carboplatin/paclitaxel in never/light ex-smokers with advanced pulmonary adenocarcinoma in Asia, both in the overall intent-to-treat (ITT) population and in the EGFR mutation-positive subgroup. To further characterize the clinical relevance of these data, we investigated objective response rate (ORR) and health-related quality of life (HRQoL) in patients treated with gefitinib. METHODS Objective response was assessed (RECIST) 6-weekly (previously reported). Post hoc assessments included median time to response, median duration of response and change in tumor size. The analysis of response population included those patients treated with gefitinib who responded (n = 262 from ITT; n = 94 from EGFR mutation-positive subgroup). The percentage of patients with deterioration in HRQoL (Functional Assessment of Cancer Therapy-Lung [FACT-L], Trial Outcome Index [TOI]) and symptoms (Lung Cancer Subscale [LCS]) at 4 months post-randomization was analyzed according to progression status (EFQ population grouped by progressors/non-progressors in both treatment arms). The ORR (ITT) and incidence of skin rash/acne (evaluable-for-safety) were summarized. RESULTS In patients whose tumors responded to gefitinib, median time to response was 6.1 weeks in the ITT population (n = 262) and 6.0 weeks in the EGFR mutation-positive subgroup (n = 94); median duration of response was 9.7 and 8.7 months in these groups, respectively. There was significant tumor shrinkage with gefitinib. A greater percentage of patients in the EFQ population whose tumors progressed experienced deterioration in HRQoL and symptoms at 4 months versus patients whose tumors did not progress (FACT-L 33.7% vs 16.3%; TOI 33.7% vs 13.2%; LCS 31.7% vs 15.5%). In the gefitinib arm of the EFS population, incidence of rash was 75.8% and 68.1% in EGFR mutation-positive and -negative subgroups, respectively (with ORR for the gefitinib arm of the ITT 71.2% vs 1.1%, respectively). CONCLUSIONS Patients whose tumors responded to first-line gefitinib experienced significant tumor shrinkage and a rapid, durable response. Deterioration in HRQoL and lung cancer symptoms at 4 months post-randomization was found to be associated with tumor progression, highlighting the role of patient-reported outcomes in the evaluation of advanced NSCLC disease. Rash was not supported as a predictive marker of response to gefitinib.
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Affiliation(s)
- Yi-Long Wu
- Guangdong Lung Cancer Institute, Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangzhou, China.
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Ardizzoni A, Tiseo M, Boni L, Vincent AD, Passalacqua R, Buti S, Amoroso D, Camerini A, Labianca R, Genestreti G, Boni C, Ciuffreda L, Di Costanzo F, de Marinis F, Crinò L, Santo A, Pazzola A, Barbieri F, Zilembo N, Colantonio I, Tibaldi C, Mattioli R, Cafferata MA, Camisa R, Smit EF. Pemetrexed Versus Pemetrexed and Carboplatin As Second-Line Chemotherapy in Advanced Non–Small-Cell Lung Cancer: Results of the GOIRC 02-2006 Randomized Phase II Study and Pooled Analysis With the NVALT7 Trial. J Clin Oncol 2012; 30:4501-7. [DOI: 10.1200/jco.2012.43.6758] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Purpose To compare efficacy of pemetrexed versus pemetrexed plus carboplatin in pretreated patients with advanced non–small-cell lung cancer (NSCLC). Patients and Methods Patients with advanced NSCLC, in progression during or after first-line platinum-based chemotherapy, were randomly assigned to receive pemetrexed (arm A) or pemetrexed plus carboplatin (arm B). Primary end point was progression-free survival (PFS). A preplanned pooled analysis of the results of this study with those of the NVALT7 study was carried out to assess the impact of carboplatin added to pemetrexed in terms of overall survival (OS). Results From July 2007 to October 2009, 239 patients (arm A, n = 120; arm B, n = 119) were enrolled. Median PFS was 3.6 months for arm A versus 3.5 months for arm B (hazard ratio [HR], 1.05; 95% CI, 0.81 to 1.36; P = .706). No statistically significant differences in response rate, OS, or toxicity were observed. A total of 479 patients were included in the pooled analysis. OS was not improved by the addition of carboplatin to pemetrexed (HR, 90; 95% CI, 0.74 to 1.10; P = .316; P heterogeneity = .495). In the subgroup analyses, the addition of carboplatin to pemetrexed in patients with squamous tumors led to a statistically significant improvement in OS from 5.4 to 9 months (adjusted HR, 0.58; 95% CI, 0.37 to 0.91; P interaction test = .039). Conclusion Second-line treatment of advanced NSCLC with pemetrexed plus carboplatin does not improve survival outcomes as compared with single-agent pemetrexed. The benefit observed with carboplatin addition in squamous tumors may warrant further investigation.
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Affiliation(s)
- Andrea Ardizzoni
- Andrea Ardizzoni, Marcello Tiseo, and Roberta Camisa, Azienda Ospedaliero-Universitaria, Parma; Luca Boni and Francesco Di Costanzo, Azienda Ospedaliero-Universitaria Careggi, Firenze; Rodolfo Passalacqua and Sebastiano Buti, Ospedale Civile, Cremona; Domenico Amoroso and Andrea Camerini, Ospedale della Versilia, Lido di Camaiore; Roberto Labianca, Ospedali Riuniti, Bergamo; Giovenzio Genestreti, Istituto Oncologico Romagnolo, Meldola; Corrado Boni, Ospedale Santa Maria Nuova, Reggio Emilia; Libero
| | - Marcello Tiseo
- Andrea Ardizzoni, Marcello Tiseo, and Roberta Camisa, Azienda Ospedaliero-Universitaria, Parma; Luca Boni and Francesco Di Costanzo, Azienda Ospedaliero-Universitaria Careggi, Firenze; Rodolfo Passalacqua and Sebastiano Buti, Ospedale Civile, Cremona; Domenico Amoroso and Andrea Camerini, Ospedale della Versilia, Lido di Camaiore; Roberto Labianca, Ospedali Riuniti, Bergamo; Giovenzio Genestreti, Istituto Oncologico Romagnolo, Meldola; Corrado Boni, Ospedale Santa Maria Nuova, Reggio Emilia; Libero
| | - Luca Boni
- Andrea Ardizzoni, Marcello Tiseo, and Roberta Camisa, Azienda Ospedaliero-Universitaria, Parma; Luca Boni and Francesco Di Costanzo, Azienda Ospedaliero-Universitaria Careggi, Firenze; Rodolfo Passalacqua and Sebastiano Buti, Ospedale Civile, Cremona; Domenico Amoroso and Andrea Camerini, Ospedale della Versilia, Lido di Camaiore; Roberto Labianca, Ospedali Riuniti, Bergamo; Giovenzio Genestreti, Istituto Oncologico Romagnolo, Meldola; Corrado Boni, Ospedale Santa Maria Nuova, Reggio Emilia; Libero
| | - Andrew D. Vincent
- Andrea Ardizzoni, Marcello Tiseo, and Roberta Camisa, Azienda Ospedaliero-Universitaria, Parma; Luca Boni and Francesco Di Costanzo, Azienda Ospedaliero-Universitaria Careggi, Firenze; Rodolfo Passalacqua and Sebastiano Buti, Ospedale Civile, Cremona; Domenico Amoroso and Andrea Camerini, Ospedale della Versilia, Lido di Camaiore; Roberto Labianca, Ospedali Riuniti, Bergamo; Giovenzio Genestreti, Istituto Oncologico Romagnolo, Meldola; Corrado Boni, Ospedale Santa Maria Nuova, Reggio Emilia; Libero
| | - Rodolfo Passalacqua
- Andrea Ardizzoni, Marcello Tiseo, and Roberta Camisa, Azienda Ospedaliero-Universitaria, Parma; Luca Boni and Francesco Di Costanzo, Azienda Ospedaliero-Universitaria Careggi, Firenze; Rodolfo Passalacqua and Sebastiano Buti, Ospedale Civile, Cremona; Domenico Amoroso and Andrea Camerini, Ospedale della Versilia, Lido di Camaiore; Roberto Labianca, Ospedali Riuniti, Bergamo; Giovenzio Genestreti, Istituto Oncologico Romagnolo, Meldola; Corrado Boni, Ospedale Santa Maria Nuova, Reggio Emilia; Libero
| | - Sebastiano Buti
- Andrea Ardizzoni, Marcello Tiseo, and Roberta Camisa, Azienda Ospedaliero-Universitaria, Parma; Luca Boni and Francesco Di Costanzo, Azienda Ospedaliero-Universitaria Careggi, Firenze; Rodolfo Passalacqua and Sebastiano Buti, Ospedale Civile, Cremona; Domenico Amoroso and Andrea Camerini, Ospedale della Versilia, Lido di Camaiore; Roberto Labianca, Ospedali Riuniti, Bergamo; Giovenzio Genestreti, Istituto Oncologico Romagnolo, Meldola; Corrado Boni, Ospedale Santa Maria Nuova, Reggio Emilia; Libero
| | - Domenico Amoroso
- Andrea Ardizzoni, Marcello Tiseo, and Roberta Camisa, Azienda Ospedaliero-Universitaria, Parma; Luca Boni and Francesco Di Costanzo, Azienda Ospedaliero-Universitaria Careggi, Firenze; Rodolfo Passalacqua and Sebastiano Buti, Ospedale Civile, Cremona; Domenico Amoroso and Andrea Camerini, Ospedale della Versilia, Lido di Camaiore; Roberto Labianca, Ospedali Riuniti, Bergamo; Giovenzio Genestreti, Istituto Oncologico Romagnolo, Meldola; Corrado Boni, Ospedale Santa Maria Nuova, Reggio Emilia; Libero
| | - Andrea Camerini
- Andrea Ardizzoni, Marcello Tiseo, and Roberta Camisa, Azienda Ospedaliero-Universitaria, Parma; Luca Boni and Francesco Di Costanzo, Azienda Ospedaliero-Universitaria Careggi, Firenze; Rodolfo Passalacqua and Sebastiano Buti, Ospedale Civile, Cremona; Domenico Amoroso and Andrea Camerini, Ospedale della Versilia, Lido di Camaiore; Roberto Labianca, Ospedali Riuniti, Bergamo; Giovenzio Genestreti, Istituto Oncologico Romagnolo, Meldola; Corrado Boni, Ospedale Santa Maria Nuova, Reggio Emilia; Libero
| | - Roberto Labianca
- Andrea Ardizzoni, Marcello Tiseo, and Roberta Camisa, Azienda Ospedaliero-Universitaria, Parma; Luca Boni and Francesco Di Costanzo, Azienda Ospedaliero-Universitaria Careggi, Firenze; Rodolfo Passalacqua and Sebastiano Buti, Ospedale Civile, Cremona; Domenico Amoroso and Andrea Camerini, Ospedale della Versilia, Lido di Camaiore; Roberto Labianca, Ospedali Riuniti, Bergamo; Giovenzio Genestreti, Istituto Oncologico Romagnolo, Meldola; Corrado Boni, Ospedale Santa Maria Nuova, Reggio Emilia; Libero
| | - Giovenzio Genestreti
- Andrea Ardizzoni, Marcello Tiseo, and Roberta Camisa, Azienda Ospedaliero-Universitaria, Parma; Luca Boni and Francesco Di Costanzo, Azienda Ospedaliero-Universitaria Careggi, Firenze; Rodolfo Passalacqua and Sebastiano Buti, Ospedale Civile, Cremona; Domenico Amoroso and Andrea Camerini, Ospedale della Versilia, Lido di Camaiore; Roberto Labianca, Ospedali Riuniti, Bergamo; Giovenzio Genestreti, Istituto Oncologico Romagnolo, Meldola; Corrado Boni, Ospedale Santa Maria Nuova, Reggio Emilia; Libero
| | - Corrado Boni
- Andrea Ardizzoni, Marcello Tiseo, and Roberta Camisa, Azienda Ospedaliero-Universitaria, Parma; Luca Boni and Francesco Di Costanzo, Azienda Ospedaliero-Universitaria Careggi, Firenze; Rodolfo Passalacqua and Sebastiano Buti, Ospedale Civile, Cremona; Domenico Amoroso and Andrea Camerini, Ospedale della Versilia, Lido di Camaiore; Roberto Labianca, Ospedali Riuniti, Bergamo; Giovenzio Genestreti, Istituto Oncologico Romagnolo, Meldola; Corrado Boni, Ospedale Santa Maria Nuova, Reggio Emilia; Libero
| | - Libero Ciuffreda
- Andrea Ardizzoni, Marcello Tiseo, and Roberta Camisa, Azienda Ospedaliero-Universitaria, Parma; Luca Boni and Francesco Di Costanzo, Azienda Ospedaliero-Universitaria Careggi, Firenze; Rodolfo Passalacqua and Sebastiano Buti, Ospedale Civile, Cremona; Domenico Amoroso and Andrea Camerini, Ospedale della Versilia, Lido di Camaiore; Roberto Labianca, Ospedali Riuniti, Bergamo; Giovenzio Genestreti, Istituto Oncologico Romagnolo, Meldola; Corrado Boni, Ospedale Santa Maria Nuova, Reggio Emilia; Libero
| | - Francesco Di Costanzo
- Andrea Ardizzoni, Marcello Tiseo, and Roberta Camisa, Azienda Ospedaliero-Universitaria, Parma; Luca Boni and Francesco Di Costanzo, Azienda Ospedaliero-Universitaria Careggi, Firenze; Rodolfo Passalacqua and Sebastiano Buti, Ospedale Civile, Cremona; Domenico Amoroso and Andrea Camerini, Ospedale della Versilia, Lido di Camaiore; Roberto Labianca, Ospedali Riuniti, Bergamo; Giovenzio Genestreti, Istituto Oncologico Romagnolo, Meldola; Corrado Boni, Ospedale Santa Maria Nuova, Reggio Emilia; Libero
| | - Filippo de Marinis
- Andrea Ardizzoni, Marcello Tiseo, and Roberta Camisa, Azienda Ospedaliero-Universitaria, Parma; Luca Boni and Francesco Di Costanzo, Azienda Ospedaliero-Universitaria Careggi, Firenze; Rodolfo Passalacqua and Sebastiano Buti, Ospedale Civile, Cremona; Domenico Amoroso and Andrea Camerini, Ospedale della Versilia, Lido di Camaiore; Roberto Labianca, Ospedali Riuniti, Bergamo; Giovenzio Genestreti, Istituto Oncologico Romagnolo, Meldola; Corrado Boni, Ospedale Santa Maria Nuova, Reggio Emilia; Libero
| | - Lucio Crinò
- Andrea Ardizzoni, Marcello Tiseo, and Roberta Camisa, Azienda Ospedaliero-Universitaria, Parma; Luca Boni and Francesco Di Costanzo, Azienda Ospedaliero-Universitaria Careggi, Firenze; Rodolfo Passalacqua and Sebastiano Buti, Ospedale Civile, Cremona; Domenico Amoroso and Andrea Camerini, Ospedale della Versilia, Lido di Camaiore; Roberto Labianca, Ospedali Riuniti, Bergamo; Giovenzio Genestreti, Istituto Oncologico Romagnolo, Meldola; Corrado Boni, Ospedale Santa Maria Nuova, Reggio Emilia; Libero
| | - Antonio Santo
- Andrea Ardizzoni, Marcello Tiseo, and Roberta Camisa, Azienda Ospedaliero-Universitaria, Parma; Luca Boni and Francesco Di Costanzo, Azienda Ospedaliero-Universitaria Careggi, Firenze; Rodolfo Passalacqua and Sebastiano Buti, Ospedale Civile, Cremona; Domenico Amoroso and Andrea Camerini, Ospedale della Versilia, Lido di Camaiore; Roberto Labianca, Ospedali Riuniti, Bergamo; Giovenzio Genestreti, Istituto Oncologico Romagnolo, Meldola; Corrado Boni, Ospedale Santa Maria Nuova, Reggio Emilia; Libero
| | - Antonio Pazzola
- Andrea Ardizzoni, Marcello Tiseo, and Roberta Camisa, Azienda Ospedaliero-Universitaria, Parma; Luca Boni and Francesco Di Costanzo, Azienda Ospedaliero-Universitaria Careggi, Firenze; Rodolfo Passalacqua and Sebastiano Buti, Ospedale Civile, Cremona; Domenico Amoroso and Andrea Camerini, Ospedale della Versilia, Lido di Camaiore; Roberto Labianca, Ospedali Riuniti, Bergamo; Giovenzio Genestreti, Istituto Oncologico Romagnolo, Meldola; Corrado Boni, Ospedale Santa Maria Nuova, Reggio Emilia; Libero
| | - Fausto Barbieri
- Andrea Ardizzoni, Marcello Tiseo, and Roberta Camisa, Azienda Ospedaliero-Universitaria, Parma; Luca Boni and Francesco Di Costanzo, Azienda Ospedaliero-Universitaria Careggi, Firenze; Rodolfo Passalacqua and Sebastiano Buti, Ospedale Civile, Cremona; Domenico Amoroso and Andrea Camerini, Ospedale della Versilia, Lido di Camaiore; Roberto Labianca, Ospedali Riuniti, Bergamo; Giovenzio Genestreti, Istituto Oncologico Romagnolo, Meldola; Corrado Boni, Ospedale Santa Maria Nuova, Reggio Emilia; Libero
| | - Nicoletta Zilembo
- Andrea Ardizzoni, Marcello Tiseo, and Roberta Camisa, Azienda Ospedaliero-Universitaria, Parma; Luca Boni and Francesco Di Costanzo, Azienda Ospedaliero-Universitaria Careggi, Firenze; Rodolfo Passalacqua and Sebastiano Buti, Ospedale Civile, Cremona; Domenico Amoroso and Andrea Camerini, Ospedale della Versilia, Lido di Camaiore; Roberto Labianca, Ospedali Riuniti, Bergamo; Giovenzio Genestreti, Istituto Oncologico Romagnolo, Meldola; Corrado Boni, Ospedale Santa Maria Nuova, Reggio Emilia; Libero
| | - Ida Colantonio
- Andrea Ardizzoni, Marcello Tiseo, and Roberta Camisa, Azienda Ospedaliero-Universitaria, Parma; Luca Boni and Francesco Di Costanzo, Azienda Ospedaliero-Universitaria Careggi, Firenze; Rodolfo Passalacqua and Sebastiano Buti, Ospedale Civile, Cremona; Domenico Amoroso and Andrea Camerini, Ospedale della Versilia, Lido di Camaiore; Roberto Labianca, Ospedali Riuniti, Bergamo; Giovenzio Genestreti, Istituto Oncologico Romagnolo, Meldola; Corrado Boni, Ospedale Santa Maria Nuova, Reggio Emilia; Libero
| | - Carmelo Tibaldi
- Andrea Ardizzoni, Marcello Tiseo, and Roberta Camisa, Azienda Ospedaliero-Universitaria, Parma; Luca Boni and Francesco Di Costanzo, Azienda Ospedaliero-Universitaria Careggi, Firenze; Rodolfo Passalacqua and Sebastiano Buti, Ospedale Civile, Cremona; Domenico Amoroso and Andrea Camerini, Ospedale della Versilia, Lido di Camaiore; Roberto Labianca, Ospedali Riuniti, Bergamo; Giovenzio Genestreti, Istituto Oncologico Romagnolo, Meldola; Corrado Boni, Ospedale Santa Maria Nuova, Reggio Emilia; Libero
| | - Rodolfo Mattioli
- Andrea Ardizzoni, Marcello Tiseo, and Roberta Camisa, Azienda Ospedaliero-Universitaria, Parma; Luca Boni and Francesco Di Costanzo, Azienda Ospedaliero-Universitaria Careggi, Firenze; Rodolfo Passalacqua and Sebastiano Buti, Ospedale Civile, Cremona; Domenico Amoroso and Andrea Camerini, Ospedale della Versilia, Lido di Camaiore; Roberto Labianca, Ospedali Riuniti, Bergamo; Giovenzio Genestreti, Istituto Oncologico Romagnolo, Meldola; Corrado Boni, Ospedale Santa Maria Nuova, Reggio Emilia; Libero
| | - Mara A. Cafferata
- Andrea Ardizzoni, Marcello Tiseo, and Roberta Camisa, Azienda Ospedaliero-Universitaria, Parma; Luca Boni and Francesco Di Costanzo, Azienda Ospedaliero-Universitaria Careggi, Firenze; Rodolfo Passalacqua and Sebastiano Buti, Ospedale Civile, Cremona; Domenico Amoroso and Andrea Camerini, Ospedale della Versilia, Lido di Camaiore; Roberto Labianca, Ospedali Riuniti, Bergamo; Giovenzio Genestreti, Istituto Oncologico Romagnolo, Meldola; Corrado Boni, Ospedale Santa Maria Nuova, Reggio Emilia; Libero
| | - Roberta Camisa
- Andrea Ardizzoni, Marcello Tiseo, and Roberta Camisa, Azienda Ospedaliero-Universitaria, Parma; Luca Boni and Francesco Di Costanzo, Azienda Ospedaliero-Universitaria Careggi, Firenze; Rodolfo Passalacqua and Sebastiano Buti, Ospedale Civile, Cremona; Domenico Amoroso and Andrea Camerini, Ospedale della Versilia, Lido di Camaiore; Roberto Labianca, Ospedali Riuniti, Bergamo; Giovenzio Genestreti, Istituto Oncologico Romagnolo, Meldola; Corrado Boni, Ospedale Santa Maria Nuova, Reggio Emilia; Libero
| | - Egbert F. Smit
- Andrea Ardizzoni, Marcello Tiseo, and Roberta Camisa, Azienda Ospedaliero-Universitaria, Parma; Luca Boni and Francesco Di Costanzo, Azienda Ospedaliero-Universitaria Careggi, Firenze; Rodolfo Passalacqua and Sebastiano Buti, Ospedale Civile, Cremona; Domenico Amoroso and Andrea Camerini, Ospedale della Versilia, Lido di Camaiore; Roberto Labianca, Ospedali Riuniti, Bergamo; Giovenzio Genestreti, Istituto Oncologico Romagnolo, Meldola; Corrado Boni, Ospedale Santa Maria Nuova, Reggio Emilia; Libero
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Safety, Resource Use, and Quality of Life in Paramount: A Phase III Study of Maintenance Pemetrexed Versus Placebo after Induction Pemetrexed Plus Cisplatin for Advanced Nonsquamous Non–Small-Cell Lung Cancer. J Thorac Oncol 2012; 7:1713-21. [DOI: 10.1097/jto.0b013e318267cf84] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Ganguli A, Wiegand P, Gao X, Carter JA, Botteman MF, Ray S. The impact of second-line agents on patients’ health-related quality of life in the treatment for non-small cell lung cancer: a systematic review. Qual Life Res 2012; 22:1015-26. [DOI: 10.1007/s11136-012-0229-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2012] [Indexed: 01/05/2023]
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Belani CP, Brodowicz T, Ciuleanu TE, Krzakowski M, Yang SH, Franke F, Cucevic B, Madhavan J, Santoro A, Ramlau R, Liepa AM, Visseren-Grul C, Peterson P, John WJ, Zielinski CC. Quality of life in patients with advanced non-small-cell lung cancer given maintenance treatment with pemetrexed versus placebo (H3E-MC-JMEN): results from a randomised, double-blind, phase 3 study. Lancet Oncol 2012; 13:292-9. [DOI: 10.1016/s1470-2045(11)70339-4] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
The management of advanced non-small-cell lung cancer (a-nsclc) is currently undergoing one of its rare paradigm shifts. Just as the nihilism of the 1970s gave way to the empiricism of the 1980s and 1990s, so the current decade has seen the first truly rational therapies based on informed design. In addition, molecular markers and traditional parameters can now be combined to provide a framework of knowledge that will guide the application of not just the new therapies, but also the older ones that remain effective. This framework—as important a component of the rational paradigm as the new drugs themselves are—is necessary to decide who should and, crucially, who should not receive the various components of this rapidly expanding armamentarium. Here, I have provided a historical overview of the drug treatment of a-nsclc, a mini-review of important new data, and an integrative approach that tries to ensure that patients receive the optimal treatment choice at the appropriate time. The speed at which new knowledge now arrives, coupled with the persistent high level of unmet medical need, suggests that the traditional pace of evidence-based review needs to be accelerated. Indeed, the increased scope for personalized management constitutes something of a challenge to “business as usual” evidence-based medicine. As a result, substantial investment on the part of payers, which may or may not be possible, will be required. In the meantime, some patients may wish and may be financially able to take advantage of modern developments before they have been fully digested by the public-payer system. Responsive clinicians face difficult tradeoffs as they try to balance the pros and cons of early adoption versus excessive conservatism. The present article is my personal view of how to navigate these waters, and although it is written especially for patients who like to be the captain of their own ship, there is good reason to believe that all patients will eventually be managed by similar, if not identical, means. Nonetheless, the recommendations herein should not be construed as appropriately reviewed provincial or national guidelines. Finally, if appropriate, a clinical trial should always be offered.
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Affiliation(s)
- M D Vincent
- Medical Oncology, London Regional Cancer Program, London, ON.
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de Boer RH, Arrieta Ó, Yang CH, Gottfried M, Chan V, Raats J, de Marinis F, Abratt RP, Wolf J, Blackhall FH, Langmuir P, Milenkova T, Read J, Vansteenkiste JF. Vandetanib plus pemetrexed for the second-line treatment of advanced non-small-cell lung cancer: a randomized, double-blind phase III trial. J Clin Oncol 2011; 29:1067-74. [PMID: 21282537 DOI: 10.1200/jco.2010.29.5717] [Citation(s) in RCA: 237] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
PURPOSE Vandetanib is a once-daily oral inhibitor of vascular endothelial growth factor receptor and epidermal growth factor receptor signaling. This randomized, placebo-controlled phase III study assessed the efficacy of vandetanib plus pemetrexed as second-line therapy in advanced non-small-cell lung cancer. PATIENTS AND METHODS Patients (N = 534) were randomly assigned to receive vandetanib 100 mg/d plus pemetrexed 500 mg/m(2) every 21 days (n = 256) or placebo plus pemetrexed (n = 278). Progression-free survival (PFS) was the primary end point; overall survival, objective response rate, disease control rate, time to deterioration of symptoms, and safety were secondary assessments. RESULTS There was no significant difference in PFS between treatment arms (hazard ratio [HR], 0.86; 97.58% CI, 0.69 to 1.06; P = .108). Overall survival was also not significantly different (HR, 0.86; 97.54% CI, 0.65 to 1.13; P = .219). Statistically significant improvements in objective response rate (19% v 8%; P < .001) and time to deterioration of symptoms (HR, 0.71; P = .0052; median, 18.1 weeks for vandetanib and 12.1 weeks for placebo) were observed in patients receiving vandetanib. Adding vandetanib to pemetrexed increased the incidence of some adverse events, including rash, diarrhea, and hypertension, while showing a reduced incidence of nausea, vomiting, anemia, fatigue, and asthenia with no reduction in the dose intensity of pemetrexed. CONCLUSION This study did not meet the primary end point of statistically significant PFS prolongation with vandetanib plus pemetrexed versus placebo plus pemetrexed. The vandetanib combination showed a significantly higher objective response rate and a significant delay in the time to worsening of lung cancer symptoms versus the placebo arm as well as an acceptable safety profile in this patient population.
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Rausch SM, Clark MM, Patten C, Liu H, Felten S, Li Y, Sloan J, Yang P. Relationship between cytokine gene single nucleotide polymorphisms and symptom burden and quality of life in lung cancer survivors. Cancer 2010; 116:4103-13. [PMID: 20564140 DOI: 10.1002/cncr.25255] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Previous research has demonstrated that many lung cancer survivors report difficulties with symptom control and experience a poor quality of life (QOL). Although recent studies have suggested a relationship of single nucleotide polymorphisms (SNPs) in several cytokine genes with cancer susceptibility and prognosis, associations with symptom burden and QOL have not been examined. The current study was conducted to identify SNPs related to symptom burden and QOL outcomes in lung cancer survivors. METHODS All participants were enrolled in the Mayo Clinic Lung Cancer Cohort following diagnosis of lung cancer. A total of 1149 Caucasian lung cancer survivors completed questionnaires and had genetic samples available. The main outcome measures were symptom burden as measured by the Lung Cancer Symptom Scale and health-related QOL as measured by the Short-Form General Health Survey. RESULTS Twenty-one SNPs in cytokine genes were associated with symptom burden and QOL outcomes. Our results suggested both specificity and consistency of cytokine gene SNPs in predicting outcomes. CONCLUSIONS These results provide support for genetic predisposition to QOL and symptom burden and may aid in identification of lung cancer survivors at high risk for symptom management and QOL difficulties.
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Affiliation(s)
- Sarah M Rausch
- H. Lee Moffitt Cancer Center and Research Institute, Inc, Tampa, Florida 33612, USA.
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Conde E, Angulo B, Redondo P, Toldos O, García-García E, Suárez-Gauthier A, Rubio-Viqueira B, Marrón C, García-Luján R, Sánchez-Céspedes M, López-Encuentra A, Paz-Ares L, López-Ríos F. The use of P63 immunohistochemistry for the identification of squamous cell carcinoma of the lung. PLoS One 2010; 5:e12209. [PMID: 20808915 PMCID: PMC2923180 DOI: 10.1371/journal.pone.0012209] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2010] [Accepted: 07/15/2010] [Indexed: 12/31/2022] Open
Abstract
Introduction While some targeted agents should not be used in squamous cell carcinomas (SCCs), other agents might preferably target SCCs. In a previous microarray study, one of the top differentially expressed genes between adenocarcinomas (ACs) and SCCs is P63. It is a well-known marker of squamous differentiation, but surprisingly, its expression is not widely used for this purpose. Our goals in this study were (1) to further confirm our microarray data, (2) to analize the value of P63 immunohistochemistry (IHC) in reducing the number of large cell carcinoma (LCC) diagnoses in surgical specimens, and (3) to investigate the potential of P63 IHC to minimize the proportion of “carcinoma NOS (not otherwise specified)” in a prospective series of small tumor samples. Methods With these goals in mind, we studied (1) a tissue-microarray comprising 33 ACs and 99 SCCs on which we performed P63 IHC, (2) a series of 20 surgically resected LCCs studied for P63 and TTF-1 IHC, and (3) a prospective cohort of 66 small thoracic samples, including 32 carcinoma NOS, that were further classified by the result of P63 and TTF-1 IHC. Results The results in the three independent cohorts were as follows: (1) P63 IHC was differentially expressed in SCCs when compared to ACs (p<0.0001); (2) half of the 20 (50%) LCCs were positive for P63 and were reclassified as SCCs; and (3) all P63 positive cases (34%) were diagnosed as SCCs. Conclusions P63 IHC is useful for the identification of lung SCCs.
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Affiliation(s)
- Esther Conde
- Laboratorio de Dianas Terapéuticas, Centro Integral Oncológico “Clara Campal”, Hospital Universitario Madrid Sanchinarro, Universidad San Pablo-CEU, Madrid, Spain
| | - Bárbara Angulo
- Laboratorio de Dianas Terapéuticas, Centro Integral Oncológico “Clara Campal”, Hospital Universitario Madrid Sanchinarro, Universidad San Pablo-CEU, Madrid, Spain
| | - Pilar Redondo
- Laboratorio de Dianas Terapéuticas, Centro Integral Oncológico “Clara Campal”, Hospital Universitario Madrid Sanchinarro, Universidad San Pablo-CEU, Madrid, Spain
| | - Oscar Toldos
- Pathology, Thoracic Surgery and Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Elena García-García
- Laboratorio de Dianas Terapéuticas, Centro Integral Oncológico “Clara Campal”, Hospital Universitario Madrid Sanchinarro, Universidad San Pablo-CEU, Madrid, Spain
| | - Ana Suárez-Gauthier
- Laboratorio de Dianas Terapéuticas, Centro Integral Oncológico “Clara Campal”, Hospital Universitario Madrid Sanchinarro, Universidad San Pablo-CEU, Madrid, Spain
| | - Belén Rubio-Viqueira
- Oncology Department, Hospital Universitario Madrid Sanchinarro, Universidad San Pablo-CEU, Madrid, Spain
| | - Carmen Marrón
- Thoracic Surgery, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | - Montse Sánchez-Céspedes
- Genes and Cancer Group, Programa de Epigenetica y Biologia del Cancer-PEBC, Institut d'Investigacions Biomediques Bellvitge (IDIBELL), L'Hopitalet de Llobregat, Barcelona, Spain
| | | | - Luis Paz-Ares
- Oncology Department, Instituto de Biomedicina de Sevilla (IBIS) and Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Fernando López-Ríos
- Laboratorio de Dianas Terapéuticas, Centro Integral Oncológico “Clara Campal”, Hospital Universitario Madrid Sanchinarro, Universidad San Pablo-CEU, Madrid, Spain
- * E-mail:
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Chiappori A, Bepler G, Barlesi F, Soria JC, Reck M, Bearz A, Barata F, Scagliotti G, Park K, Wagle A, Liepa AM, Zhao YD, Chouaki N, Iscoe N, von Pawel J. Phase II, Double-Blinded, Randomized Study of Enzastaurin Plus Pemetrexed as Second-Line Therapy in Patients with Advanced Non-small Cell Lung Cancer. J Thorac Oncol 2010; 5:369-75. [DOI: 10.1097/jto.0b013e3181cee24f] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Pretreatment quality of life is an independent prognostic factor for overall survival in patients with advanced stage non-small cell lung cancer. J Thorac Oncol 2009; 4:1075-82. [PMID: 19546817 DOI: 10.1097/jto.0b013e3181ae27f5] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
HYPOTHESIS We conducted this pooled analysis to assess the prognostic value of pretreatment Quality of Life (QOL) assessments on overall survival (OS) in advanced non-small cell lung cancer (NSCLC). METHODS Four hundred twenty patients with advanced NSCLC (stages IIIB with pleural effusion and IV) from six North Central Cancer Treatment Group trials were included in this study. QOL assessments included the single-item Uniscale (355 patients), Lung Cancer Symptom Scale (217 patients), and Functional Assessment of Cancer Therapy-Lung (197 patients). QOL scores were transformed to a 0 to 100 scale with higher scores representing better status and categorized using the sample median or clinically deficient score (CDS, <or=50 versus >50). Cox proportional hazards models stratified by study were used to evaluate the prognostic importance of QOL on OS alone and in the presence of other prognostic factors such as performance status, age, gender, body mass index, and laboratory parameters. RESULTS Pretreatment QOL accessed by Uniscale was significantly associated with OS univariately (p < 0.0001). Uniscale (p < 0.0001; hazard ratio = 1.6 for the sample median and 2.0 for the CDS categorization) and body mass index were the only significant predictors of OS multivariately. The median survival of patients who had a Uniscale score less than or equal to the CDS (<or=50) was 5.7 versus 11.1 months for the >50 group; and 7.8 versus 13 months for the less than or equal to sample median (<or=83) group and >83 group, respectively. The Lung Cancer Symptom Scale and the Functional Assessment of Cancer Therapy-Lung total scores were not significant predictors of OS. CONCLUSIONS Pretreatment QOL measured by Uniscale is a significant and an independent prognostic factor for OS, and QOL should be routinely integrated as a stratification factor in advanced NSCLC trials.
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Second and third line treatment in non-small cell lung cancer. Crit Rev Oncol Hematol 2009; 71:117-26. [DOI: 10.1016/j.critrevonc.2009.01.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2008] [Revised: 01/28/2009] [Accepted: 01/29/2009] [Indexed: 01/11/2023] Open
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Powell SF, Dudek AZ. Tailoring treatment of nonsmall cell lung cancer by tissue type: role of pemetrexed. Pharmgenomics Pers Med 2009; 2:21-37. [PMID: 23226032 PMCID: PMC3513199 DOI: 10.2147/pgpm.s3977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2009] [Indexed: 11/23/2022] Open
Abstract
Pemetrexed (ALIMTA, LY231514, MTA) is a novel multitargeted antifolate that is currently approved for the treatment of metastatic nonsmall cell lung cancer (NSCLC). Recent evidence reveals that the drug's efficacy is limited to nonsquamous lung cancer histology. As we further understand the drug's mechanisms of action, new genomic and proteomic evidence is shedding light on why some patients respond while others do not. The first goal of this review is to briefly review pemetrexed's mechanism of action, resistance patterns, toxicity profile, and pharmacokinetics. We will also review the clinical trials that led to its use in NSCLC, with special attention to data showing that pemetrexed has greater efficacy in nonsquamous histologies of NSCLC. Furthermore, we will discuss the hypotheses for the genomic and proteomic basis for this variation in efficacy. Finally, we will report the future directions for pemetrexed as a personalized agent for nonsquamous NSCLC.
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Affiliation(s)
- Steven F Powell
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Arkadiusz Z Dudek
- Division of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, MN, USA
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Assessing quality of life following neoadjuvant therapy for early stage non-small cell lung cancer (NSCLC): results from a prospective analysis using the Lung Cancer Symptom Scale (LCSS). Support Care Cancer 2008; 17:307-13. [PMID: 18781341 DOI: 10.1007/s00520-008-0489-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2008] [Accepted: 07/10/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND The assessment of the impact of neoadjuvant therapy on quality of life (QL) has rarely been prospectively planned and evaluated, although validated QL instruments are available-such as the Lung Cancer Symptom Scale (LCSS) used in this study. The modest but significant survival gains reported with neoadjuvant and adjuvant approaches need to be viewed in terms of the added risks and toxicities associated with two or three modalities of treatment. MATERIALS AND METHODS The objective was to compare patient-determined QL ratings from baseline (prior to neoadjuvant chemotherapy) with those in subsequent months of follow-up. All patients had clinical stage I or II non-small cell lung cancer (NSCLC) and participated in one of two similar randomized protocols. Patients received preoperative chemotherapy (three cycles) of gemcitabine plus carboplatin or paclitaxel in one trial or gemcitabine plus carboplatin or cisplatin in the second. Patients completed the LCSS at baseline, every 3 weeks preoperatively, and every 3 months postoperatively up to 12 months. RESULTS Full QL data are available for 43 patients with at least one postsurgical evaluation and for 23 patients with evaluation at 1-year postsurgery. In patients with at least one postsurgical evaluation, 84% had an ECOG performance status of 0, 93% had a complete resection, and 67% (95% CI = 52, 81) of patients experienced improved or stable symptoms. A subgroup of patients (14 of 43) reported worsening of QL (33%). These patients experienced a mean worsening of 66% in individual symptom parameters, with an average of seven of nine LCSS symptom parameters declining. CONCLUSIONS Most patients reported improved or stable QL. Prospectively planned QL assessment is feasible with neoadjuvant trials and adds useful information not otherwise attainable.
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Identifying an optimum treatment strategy for patients with advanced non-small cell lung cancer. Crit Rev Oncol Hematol 2008; 67:16-26. [DOI: 10.1016/j.critrevonc.2007.12.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2007] [Revised: 12/01/2007] [Accepted: 12/06/2007] [Indexed: 11/17/2022] Open
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