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Igawa S, Yamamoto H, Yamada K, Akazawa Y, Manaka H, Yagami Y, Nakahara Y, Sato T, Mitsufuji H, Sasaki J, Naoki K. The Glasgow Prognostic Score Predicts Survival Outcomes in Patients with Extensive-Stage Small Cell Lung Cancer. Oncology 2023; 101:695-704. [PMID: 37494886 DOI: 10.1159/000532087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 07/14/2023] [Indexed: 07/28/2023]
Abstract
INTRODUCTION The Glasgow prognostic score (GPS) is an inflammation-related score based on C-reactive protein and albumin concentrations. Few studies have assessed the correlation between the GPS and the efficacy of chemotherapy in patients with extensive-stage small cell lung cancer (ES-SCLC). Therefore, this study aimed to evaluate the utility of the GPS in predicting the survival outcomes of patients with ES-SCLC. METHODS This retrospective study evaluated patients with ES-SCLC who had undergone chemotherapy between February 2008 and November 2021. GPS values were evaluated before the initiation of first-line chemotherapy. The Kaplan-Meier method and Cox proportional hazards models were used to assess progression-free survival (PFS) and overall survival (OS). RESULTS The GPS values of the 113 patients were zero (54 patients, 48%), 1 (37 patients, 33%), and 2 (22 patients, 19%). The median follow-up duration was 10.7 months. Median PFS was 6.2, 5.6, and 3.8 months in the GPS 0, 1, and 2 groups, respectively, suggesting that the GPS zero group had a significantly more favorable PFS than the GPS 2 group (p < 0.001). Median OS was 17.1, 9.4, and 5.6 months in the GPS 0, 1, and 2 groups, respectively, suggesting that the GPS zero group had a significantly more favorable OS than the GPS 2 group (p = 0.001). Multivariate analysis confirmed that a GPS of 2 independently predicted unfavorable PFS (hazard ratio [HR], 2.89; 95% confidence interval [CI]: 1.68-4.88; p < 0.001) and OS (HR, 3.49 [95% CI: 1.83-6.63], p < 0.001). CONCLUSION The study's findings suggest that the GPS can predict the survival outcomes of patients with ES-SCLC who have undergone chemotherapy. The GPS is an easy-to-calculate biomarker and would be ideal for routine use in clinical settings.
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Affiliation(s)
- Satoshi Igawa
- Department of Respiratory Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Hiroki Yamamoto
- Department of Respiratory Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Kaori Yamada
- Department of Respiratory Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Yuki Akazawa
- Department of Respiratory Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Hiroya Manaka
- Department of Respiratory Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Yuri Yagami
- Department of Respiratory Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Yoshiro Nakahara
- Department of Respiratory Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Takashi Sato
- Department of Respiratory Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | | | - Jiichiro Sasaki
- Research and Development Center for New Medical Frontiers, Kitasato University School of Medicine, Sagamihara, Japan
| | - Katsuhiko Naoki
- Department of Respiratory Medicine, Kitasato University School of Medicine, Sagamihara, Japan
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Motas N, Manolache V, Scarci M, Nimigean V, Nimigean VR, Simion L, Mizea MC, Trifanescu OG, Galateanu B, Gherghe M, Capsa CM, Gonzalez-Rivas D, Davidescu MD. Salvage Surgery for Small-Cell Lung Cancer-A Literature Review. Cancers (Basel) 2023; 15:cancers15082241. [PMID: 37190169 DOI: 10.3390/cancers15082241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 04/03/2023] [Accepted: 04/05/2023] [Indexed: 05/17/2023] Open
Abstract
(1) Background: Salvation surgery for small-cell lung cancer (SCLC) is exceptionally performed, and only a few cases are published. (2) Methods: There are 6 publications that present 17 cases of salvation surgery for SCLC-the salvation surgery was performed in the context of modern clearly established protocols for SCLC and after including SCLC in the TNM (tumor, node, metastasis) staging in 2010. (3) Results: After a median follow-up of 29 months, the estimated overall survival (OS) was 86 months. The median estimated 2-year survival was 92%, and the median estimated 5-year survival was 66%. (4) Conclusion: Salvage surgery for SCLC is a relatively new and extremely uncommon concept and represents an alternative to second-line chemotherapy. It is valuable because it may offer a reasonable treatment for selected patients, good local control, and a favorable survival outcome.
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Affiliation(s)
- Natalia Motas
- Discipline of Thoracic Surgery, "Carol Davila" University of Medicine and Pharmacy, 022328 Bucharest, Romania
- Department of Thoracic Surgery, "Prof. Dr. Al. Trestioreanu" Institute of Oncology, 022328 Bucharest, Romania
- Department of Thoracic Surgery, Oncology Hospital Memorial, 013812 Bucharest, Romania
| | - Veronica Manolache
- Discipline of Thoracic Surgery, "Carol Davila" University of Medicine and Pharmacy, 022328 Bucharest, Romania
- Department of Thoracic Surgery, Oncology Hospital Memorial, 013812 Bucharest, Romania
| | - Marco Scarci
- Department of Thoracic Surgery, Imperial College NHS Healthcare, Hammersmith Hospital Du Cane Road, London W12 0HS, UK
| | - Victor Nimigean
- Department of Anatomy, Faculty of Dentistry, "Carol Davila" University of Medicine and Pharmacy in Bucharest, 022328 Bucharest, Romania
| | - Vanda Roxana Nimigean
- Department of Oral Rehabilitation, Faculty of Dentistry, "Carol Davila" University of Medicine and Pharmacy in Bucharest, 022328 Bucharest, Romania
| | - Laurentiu Simion
- Discipline of General and Oncological Surgery, "Carol Davila" University of Medicine and Pharmacy, 022328 Bucharest, Romania
- Department of General and Oncologic Surgery, "Prof. Dr. Al. Trestioreanu" Institute of Oncology, 022328 Bucharest, Romania
| | - Madalina Cristiana Mizea
- Discipline of Thoracic Surgery, "Carol Davila" University of Medicine and Pharmacy, 022328 Bucharest, Romania
- Department of Thoracic Surgery, "Prof. Dr. Al. Trestioreanu" Institute of Oncology, 022328 Bucharest, Romania
| | - Oana Gabriela Trifanescu
- Discipline of Oncology, "Carol Davila" University of Medicine and Pharmacy, 022328 Bucharest, Romania
- Department of Radiotherapy, "Prof. Dr. Al. Trestioreanu" Institute of Oncology, 022328 Bucharest, Romania
| | - Bianca Galateanu
- Department of Biochemistry and Molecular Biology, University of Bucharest, 022328 Bucharest, Romania
| | - Mirela Gherghe
- Discipline of Nuclear Medicine, "Prof. Dr. Al. Trestioreanu" Institute of Oncology and University Emergency Military Hospital "Dr. Carol Davila", 022328 Bucharest, Romania
| | - Cristina Mirela Capsa
- Department of Radiology "Prof. Dr. Alexandru Trestioreanu", 022328 Bucharest, Romania
| | - Diego Gonzalez-Rivas
- Department of Thoracic Surgery, Oncology Hospital Memorial, 013812 Bucharest, Romania
- Department of Thoracic Surgery and Minimally Invasive Thoracic Surgery Unit (UCTMI), Coruña University Hospital, 15008 Coruña, Spain
| | - Mihnea Dan Davidescu
- Discipline of Thoracic Surgery, "Carol Davila" University of Medicine and Pharmacy, 022328 Bucharest, Romania
- Department of Thoracic Surgery, "Prof. Dr. Al. Trestioreanu" Institute of Oncology, 022328 Bucharest, Romania
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Joosten PJ, Winkelman TA, Heineman DJ, Hashemi SM, Bahce I, Senan S, Paul MA, Hartemink KJ, Dahele M, Dickhoff C. Salvage Surgery for Patients With Local Recurrence or Persistent Disease After Treatment With Chemoradiotherapy for SCLC. JTO Clin Res Rep 2021; 2:100172. [PMID: 34590022 PMCID: PMC8474289 DOI: 10.1016/j.jtocrr.2021.100172] [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: 03/03/2021] [Revised: 03/28/2021] [Accepted: 04/01/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction The role of salvage surgery for patients with locoregional (LR) recurrence or persistent SCLC after radical chemoradiotherapy (CRT) for limited-stage disease is not well established. We evaluated our experience. Methods We conducted a retrospective study of consecutive patients who underwent salvage pulmonary resection for LR-recurrent or persistent SCLC between 2008 and 2020 at the Amsterdam University Medical Center. Results A total of 10 patients were identified. Median age at initial diagnosis of limited-stage SCLC was 58.5 years (48-71 y). All patients had radical-intent concurrent CRT. Of the 10 patients, 9 were diagnosed with LR-recurrent or persistent disease with a median of 18 months (3-78 y) after CRT. All patients underwent an anatomical radical resection and mediastinal lymph node dissection. No 90-day mortality was recorded. In addition, one patient developed a LR recurrence 7 months after resection. Distant progression was found in three patients at 6, 32, and 61 months after surgery, all of whom subsequently died of progressive SCLC. Median follow-up was 22.5 months (2-86 mos). Disease-free survival was 34 months; overall survival was not reached. Conclusions For highly selected patients with LR-recurrent or persistent SCLC after CRT, salvage surgery is feasible and can result in clinically meaningful survival. Such patients should be presented to the multidisciplinary tumor board.
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Affiliation(s)
- Pieter J.M. Joosten
- Department of Surgery, Amsterdam University Medical Center, location VUmc Cancer Amsterdam, Amsterdam, The Netherlands
- Department of Surgery, Netherlands Cancer Institute—Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Toon A. Winkelman
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, location VUmc Cancer Amsterdam, Amsterdam, The Netherlands
| | - David J. Heineman
- Department of Surgery, Amsterdam University Medical Center, location VUmc Cancer Amsterdam, Amsterdam, The Netherlands
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, location VUmc Cancer Amsterdam, Amsterdam, The Netherlands
| | - Sayed M.S. Hashemi
- Department of Pulmonary Medicine, Amsterdam University Medical Center, location VUmc Cancer Amsterdam, Amsterdam, The Netherlands
| | - Idris Bahce
- Department of Pulmonary Medicine, Amsterdam University Medical Center, location VUmc Cancer Amsterdam, Amsterdam, The Netherlands
| | - Suresh Senan
- Department of Radiation Oncology, Amsterdam University Medical Center, location VUmc Cancer Amsterdam, Amsterdam, The Netherlands
| | - Marinus A. Paul
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, location VUmc Cancer Amsterdam, Amsterdam, The Netherlands
| | - Koen J. Hartemink
- Department of Surgery, Netherlands Cancer Institute—Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Max Dahele
- Department of Radiation Oncology, Amsterdam University Medical Center, location VUmc Cancer Amsterdam, Amsterdam, The Netherlands
| | - Chris Dickhoff
- Department of Surgery, Amsterdam University Medical Center, location VUmc Cancer Amsterdam, Amsterdam, The Netherlands
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, location VUmc Cancer Amsterdam, Amsterdam, The Netherlands
- Corresponding author. Address for correspondence: Chris Dickhoff, MD, PhD, Department Cardiothoracic Surgery, Amsterdam University Medical Center, location VUmc, Cancer Center Amsterdam, de Boelelaan 1117, 1081HV, Amsterdam, The Netherlands.
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Byers LA, Bentsion D, Gans S, Penkov K, Son C, Sibille A, Owonikoko TK, Groen HJM, Gay CM, Fujimoto J, de Groot P, Dunbar M, Kang K, He L, Sehgal V, Glasgow J, Bach BA, Ellis PM. Veliparib in Combination with Carboplatin and Etoposide in Patients with Treatment-Naïve Extensive-Stage Small Cell Lung Cancer: A Phase 2 Randomized Study. Clin Cancer Res 2021; 27:3884-3895. [PMID: 33947690 DOI: 10.1158/1078-0432.ccr-20-4259] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 02/24/2021] [Accepted: 04/26/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE This study investigated the efficacy and safety of oral PARP inhibitor veliparib, plus carboplatin and etoposide in patients with treatment-naïve, extensive-stage small cell lung cancer (ED-SCLC). PATIENTS AND METHODS Patients were randomized 1:1:1 to veliparib [240 mg twice daily (BID) for 14 days] plus chemotherapy followed by veliparib maintenance (400 mg BID; veliparib throughout), veliparib plus chemotherapy followed by placebo (veliparib combination only), or placebo plus chemotherapy followed by placebo (control). Patients received 4-6 cycles of combination therapy, then maintenance until unacceptable toxicity/progression. The primary endpoint was progression-free survival (PFS) with veliparib throughout versus control. RESULTS Overall (N = 181), PFS was improved with veliparib throughout versus control [hazard ratio (HR), 0.67; 80% confidence interval (CI), 0.50-0.88; P = 0.059]; median PFS was 5.8 and 5.6 months, respectively. There was a trend toward improved PFS with veliparib throughout versus control in SLFN11-positive patients (HR, 0.6; 80% CI, 0.36-0.97). Median overall survival (OS) was 10.1 versus 12.4 months in the veliparib throughout and control arms, respectively (HR, 1.43; 80% CI, 1.09-1.88). Grade 3/4 adverse events were experienced by 82%, 88%, and 68% of patients in the veliparib throughout, veliparib combination-only and control arms, most commonly hematologic. CONCLUSIONS Veliparib plus platinum chemotherapy followed by veliparib maintenance demonstrated improved PFS as first-line treatment for ED-SCLC with an acceptable safety profile, but there was no corresponding benefit in OS. Further investigation is warranted to define the role of biomarkers in this setting.
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Affiliation(s)
| | - Dmitry Bentsion
- Sverdlovsk Regional Oncology Center, Yekaterinburg, Russian Federation
| | - Steven Gans
- Respiratory Diseases, Hospital Saint Jansdal, Harderwijk, the Netherlands
| | - Konstantin Penkov
- Private Medical Institution Euromedservice, St. Petersburg, Russian Federation
| | - ChoonHee Son
- Department of Pulmonology, Dong-A University, Busan, Korea
| | | | - Taofeek K Owonikoko
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia
| | - Harry J M Groen
- Department of Pulmonary Diseases, University of Groningen and University Medical Center Groningen, Groningen, the Netherlands
| | - Carl M Gay
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Junya Fujimoto
- The University of Texas MD Anderson Cancer Center, Houston, Texas.,Nagasaki University, Nagasaki, Japan
| | | | | | | | - Lei He
- AbbVie Inc., North Chicago, Illinois
| | | | | | | | - Peter M Ellis
- Juravinski Cancer Center, McMaster University, Hamilton, Ontario, Canada
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Melosky B, Cheema PK, Brade A, McLeod D, Liu G, Price PW, Jao K, Schellenberg DD, Juergens R, Leighl N, Chu Q. Prolonging Survival: The Role of Immune Checkpoint Inhibitors in the Treatment of Extensive-Stage Small Cell Lung Cancer. Oncologist 2020; 25:981-992. [PMID: 32860288 PMCID: PMC7648366 DOI: 10.1634/theoncologist.2020-0193] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 07/02/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Small cell lung cancer (SCLC) represents approximately 15% of lung cancers, and approximately 70% are diagnosed as extensive-stage SCLC (ES-SCLC). Although ES-SCLC is highly responsive to chemotherapy, patients typically progress rapidly, and there is an urgent need for new therapies. Immune checkpoint inhibitors (ICIs) have recently been investigated in SCLC, and this review provides guidance on the use of these agents in ES-SCLC based on phase III evidence. METHODS Published and presented literature on phase III data addressing use of ICIs in ES-SCLC was identified using the key search terms "small cell lung cancer" AND "checkpoint inhibitors" (OR respective aliases). Directed searches of eligible studies were periodically performed to ensure capture of the most recent data. RESULTS Six phase III trials were identified, with four assessing the benefits of ICIs plus chemotherapy first-line, one evaluating ICIs as first-line therapy maintenance, and one assessing ICI monotherapy after progression on platinum-based chemotherapy. The addition of ipilimumab or tremelimumab to first-line treatment or as first-line maintenance did not improve survival. Two out of three studies combining PD-1/PD-L1 inhibitors with first-line platinum-based chemotherapy demonstrated significant long-lasting survival benefits and improved quality of life with no unexpected safety concerns. PD-1/PD-L1 inhibitors as first-line maintenance or in later lines of therapy did not improve survival. Biomarker research is ongoing as well as research into the role of ICIs in combination with radiation therapy in limited-stage SCLC. CONCLUSION The addition of atezolizumab or durvalumab to first-line platinum-based chemotherapy for ES-SCLC prolongs survival and improves quality of life. IMPLICATIONS FOR PRACTICE Platinum-based chemotherapy has been standard of care for extensive-stage small cell lung cancer (ES-SCLC) for more than a decade. Six recent phase III trials investigating immune checkpoint inhibitors (ICIs) have clarified the role of these agents in this setting. Although ICIs were assessed first-line, as first-line maintenance, and in later lines of therapy, the additions of atezolizumab or durvalumab to first-line platinum-based chemotherapy were the only interventions that significantly improved overall survival and increased quality of life. These combinations should therefore be considered standard therapy for first-line ES-SCLC. Biomarker research and investigations into the role of ICIs for limited-stage disease are ongoing.
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Affiliation(s)
- Barbara Melosky
- BC Cancer, Vancouver Centre, University of British ColumbiaVancouverBritish ColumbiaCanada
| | - Parneet K. Cheema
- William Osler Health System, University of Toronto, Brampton and TorontoOntarioCanada
| | - Anthony Brade
- Trillium Health Partners, University of TorontoMississaugaOntarioCanada
| | | | - Geoffrey Liu
- Princess Margaret Cancer Centre, University of TorontoTorontoOntarioCanada
| | | | - Kevin Jao
- Hôpital Sacré‐Cœur, Université de MontréalMontrealQuebecCanada
| | - Devin D. Schellenberg
- BC Cancer, Surrey Centre, University of British ColumbiaSurreyBritish ColumbiaCanada
| | - Rosalyn Juergens
- Juravinski Cancer Centre, McMaster UniversityHamiltonOntarioCanada
| | - Natasha Leighl
- Princess Margaret Cancer Centre, University of TorontoTorontoOntarioCanada
| | - Quincy Chu
- Cross Cancer Institute, University of AlbertaEdmontonAlbertaCanada
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Real-World Adherence to Guideline-Recommended Treatment for Small Cell Lung Cancer. Am J Clin Oncol 2019; 43:236-242. [DOI: 10.1097/coc.0000000000000657] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Shang X, Lin J, Li Z, Wang H. Radiotherapy may improve survival of ES-SCLC with distant metastasis only for patients with one metastatic site: A population-based study. Oncol Lett 2019; 19:139-146. [PMID: 31897124 PMCID: PMC6923894 DOI: 10.3892/ol.2019.11092] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 09/06/2019] [Indexed: 12/19/2022] Open
Abstract
The aim of the present study was to investigate the prognostic impact of RT on patients with extensive stage small cell lung cancer (ES-SCLC) and distant metastasis. Using the Surveillance Epidemiology and End Results (SEER) database, 8,595 patients with ES-SCLC exhibiting distant metastasis treated between 2010 and 2013 were identified. Patient baseline characteristics were compared using the χ2 test. The Kaplan-Meier test was used to analyze subgroup cancer-specific survival (CSS) rate, and differences were compared using a log-rank test. Univariate and multivariate Cox regression models were used to analyze the prognostic variables on CSS. RT was determined to be an independent prognostic factor for patient CSS (P<0.001). In addition, RT could improve the CSS of patients with ES-SCLC with one metastatic lesion (hazard ratio, 0.63; 95% confidence interval, 0.59-0.68; P<0.001), including the bone, brain, liver and lung metastatic sites. However, for patients with two metastatic sites, RT did not improve CSS regardless of metastasis pattern (all P>0.05). To conclude, RT may improve the survival rate of patients with ES-SCLC with distant metastasis, particularly in those with only one metastatic site.
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Affiliation(s)
- Xiaoling Shang
- Department of Clinical Laboratory, Shandong University, Jinan, Shandong 250012, P.R. China.,Department of Clinical Laboratory, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong 250117, P.R. China
| | - Jiamao Lin
- Department of Internal Medicine-Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong 250117, P.R. China
| | - Zhenxiang Li
- Department of Internal Medicine-Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong 250117, P.R. China
| | - Haiyong Wang
- Department of Internal Medicine-Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong 250117, P.R. China
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Sonehara K, Tateishi K, Komatsu M, Yamamoto H, Hanaoka M, Kanda S, Koizumi T. Modified Glasgow Prognostic Score as a Prognostic Factor in Patients with Extensive Disease-Small-Cell Lung Cancer: A Retrospective Study in a Single Institute. Chemotherapy 2019; 64:129-137. [PMID: 31622969 DOI: 10.1159/000502681] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Accepted: 08/12/2019] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Small-cell lung cancer (SCLC) is a very chemosensitive solid tumor but is characterized by rapid progression. The modified Glasgow prognostic score (mGPS) has been shown to be an independent prognostic factor in various tumors. However, there have been few reports regarding the prognostic value of mGPS in extensive disease (ED)-SCLC. OBJECTIVE This study was designed to clarify the clinical significance of mGPS focusing on its usefulness as a prognostic indicator for the survival and serial administrations of chemotherapies in patients with ED-SCLC. METHODS We retrospectively analyzed the clinical records of ED-SCLC patients diagnosed and treated at Shinshu University School of Medicine between January 2005 and December 2018. Overall survival (OS) was compared according to mGPS and we examined whether mGPS could be a prognostic factor in ED-SCLC using the Kaplan-Meier method and univariate and multivariate Cox hazard analyses. RESULTS Eighty-three patients were enrolled in this study. The median OS of mGPS 0, mGPS 1, and mGPS 2 groups were 13.6, 9.2, and 5.7 months, respectively. The OS of the mGPS 0 group was significantly longer than those of mGPS 1 and mGPS 2 groups (log-rank, p = 0.025 and 0.008, respectively). The rates of second-line chemotherapy administration in mGPS 0, mGPS 1, and mGPS 2 groups were 79.4, 61.9, and 33.3%, respectively. The rate in the mGPS 0 group was significantly higher than that in the mGPS 2 group (p = 0.003). Multivariate analyses indicated that mGPS 2 was an independent unfavorable prognostic factor in addition to old age (≥75 years), poor performance status (2-3), and elevated serum lactate dehydrogenase level (≥223 IU/L). CONCLUSION In ED-SCLC patients, mGPS was useful as a prognostic indicator for OS.
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Affiliation(s)
- Kei Sonehara
- First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto City, Japan
| | - Kazunari Tateishi
- First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto City, Japan
| | - Masamichi Komatsu
- First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto City, Japan
| | - Hiroshi Yamamoto
- First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto City, Japan
| | - Masayuki Hanaoka
- First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto City, Japan
| | - Shintaro Kanda
- Department of Comprehensive Cancer Therapy, Shinshu University School of Medicine, Matsumoto City, Japan
| | - Tomonobu Koizumi
- Department of Comprehensive Cancer Therapy, Shinshu University School of Medicine, Matsumoto City, Japan,
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Abstract
INTRODUCTION Small cell lung cancer (SCLC) is a highly malignant disease with a dismal prognosis that is currently being tested for theclinical activity of checkpoint inhibitors. SCLC is associated with smoking and exhibits a high mutational burden. However, low expression of PD-L1 and MHC antigens, as well low levels of immune cell infiltration and rapid tumor progress seems to limit the efficacy of anticancer immunity. Nevertheless, long-term survival was reported from studies using anti-PD-1/PD-L1 and CTLA-4 agents. AREAS COVERED Data of clinical trials of checkpoint inhibitors in SCLC show lower success rates compared to NSCLC. The mechanisms of resistance to immunotherapy are discussed for their relevance to SCLC patients. EXPERT OPINION Although some factors, such as a high mutation rate, favor immunotherapy for SCLC patients, downregulation of MHC class I, low expression of PD-L1, poor tumor infiltration by effector T cells, presence of myeloid-derived suppressor cells as well as regulatory T lymphocytes counteract the immune system activation by checkpoint inhibitors. Furthermore, this tumor develops avascular regions which have immunosuppressive effects and restrict access of lymphocytes and antibodies. In conclusion, immunotherapy in SCLC is effective in highly selected patients with good performance status and special and unknown preconditions contributing to long-lasting responses.
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Affiliation(s)
- Gerhard Hamilton
- a Department of Surgery , Medical University of Vienna , Vienna , Austria
| | - Barbara Rath
- a Department of Surgery , Medical University of Vienna , Vienna , Austria
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Minami S, Ogata Y, Ihara S, Yamamoto S, Komuta K. Retrospective analysis of outcomes and prognostic factors of chemotherapy for small-cell lung cancer. LUNG CANCER (AUCKLAND, N.Z.) 2016; 7:35-44. [PMID: 28210159 PMCID: PMC5310697 DOI: 10.2147/lctt.s100184] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Small-cell lung cancer (SCLC) is responsive to initial chemotherapy but becomes resistant to cytotoxic drugs. The aim of this study was to evaluate what proportion of patients with SCLC had received the first- and further-line chemotherapy and which patients had benefited from chemotherapy. METHODS We retrospectively reviewed medical records of patients with SCLC who had been treated with the best supportive care alone and the first-, second-, or third-line chemotherapy at the Osaka Police Hospital from June 2007 until March 2015. RESULTS Among 145 patients diagnosed with SCLC and eligible for analysis, 118 patients received chemotherapy. We added five patients who initiated the second-line chemotherapy during the study period at our institution. Sixty-five and 31 patients received the second- and third-line chemotherapies, respectively. Multivariate logistic regression analysis detected age ≥75 years (odds ratio, 2.80; 95% confidence interval, 1.01-7.75; P=0.047) and European Clinical Oncology Group Performance Status (ECOG PS) 3-4 (14.3; 4.86-41.9; P<0.01) as factors disturbing the introduction of chemotherapy. Multivariate Cox hazard analyses also detected ECOG PS 2-4 (3.34; 2.00-5.58; P<0.01) as a factor decreasing overall survival after the first-line chemotherapy, and C-reactive protein level ≥1.0 mg/dL (2.67; 1.30-5.47; P<0.01) and progression-free survival after the first-line chemotherapy ≥6 months (2.85; 1.50-5.43; P<0.01) as factors influencing overall survival after the second-line chemotherapy. CONCLUSION Approximately two-thirds and one-third of the patients who receive chemotherapy proceed to the second- and third-line chemotherapies, respectively. Several factors, such as age, ECOG PS, C-reactive protein level, and progression-free survival after previous treatment may be useful when considering the introduction of further-line chemotherapy.
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Affiliation(s)
- Seigo Minami
- Department of Respiratory Medicine, Osaka Police Hospital, Osaka, Japan
| | - Yoshitaka Ogata
- Department of Respiratory Medicine, Osaka Police Hospital, Osaka, Japan
| | - Shouichi Ihara
- Department of Respiratory Medicine, Osaka Police Hospital, Osaka, Japan
| | - Suguru Yamamoto
- Department of Respiratory Medicine, Osaka Police Hospital, Osaka, Japan
| | - Kiyoshi Komuta
- Department of Respiratory Medicine, Osaka Police Hospital, Osaka, Japan
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Gervais R, Le Caer H, Monnet I, Falchero L, Baize N, Olivero G, Thomas P, Berard H, Auliac JB, Chouaid C. Second-Line Oral Chemotherapy (Lomustine, Cyclophosphamide, Etoposide) Versus Intravenous Therapy (Cyclophosphamide, Doxorubicin, and Vincristine) in Patients With Relapsed Small Cell Lung Cancer: A Randomized Phase II Study of GFPC 0501. Clin Lung Cancer 2015; 16:100-5. [DOI: 10.1016/j.cllc.2014.10.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 10/19/2014] [Accepted: 10/21/2014] [Indexed: 10/24/2022]
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Slotman BJ, van Tinteren H, Praag JO, Knegjens JL, El Sharouni SY, Hatton M, Keijser A, Faivre-Finn C, Senan S. Use of thoracic radiotherapy for extensive stage small-cell lung cancer: a phase 3 randomised controlled trial. Lancet 2015; 385:36-42. [PMID: 25230595 DOI: 10.1016/s0140-6736(14)61085-0] [Citation(s) in RCA: 339] [Impact Index Per Article: 37.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Most patients with extensive stage small-cell lung cancer (ES-SCLC) who undergo chemotherapy, and prophylactic cranial irradiation, have persistent intrathoracic disease. We assessed thoracic radiotherapy for treatment of this patient group. METHODS We did this phase 3 randomised controlled trial at 42 hospitals: 16 in Netherlands, 22 in the UK, three in Norway, and one in Belgium. We enrolled patients with WHO performance score 0-2 and confirmed ES-SCLC who responded to chemotherapy. They were randomly assigned (1:1) to receive either thoracic radiotherapy (30 Gy in ten fractions) or no thoracic radiotherapy. All underwent prophylactic cranial irradiation. The primary endpoint was overall survival at 1 year in the intention-to-treat population. Secondary endpoints included progression-free survival. This study is registered with the Nederlands Trial Register, number NTR1527. FINDINGS We randomly assigned 498 patients between Feb 18, 2009, and Dec 21, 2012. Three withdrew informed consent, leaving 247 patients in the thoracic radiotherapy group and 248 in the control group. Mean interval between diagnosis and randomisation was 17 weeks. Median follow-up was 24 months. Overall survival at 1 year was not significantly different between groups: 33% (95% CI 27-39) for the thoracic radiotherapy group versus 28% (95% CI 22-34) for the control group (hazard ratio [HR] 0.84, 95% CI 0.69-1.01; p=0.066). However, in a secondary analysis, 2-year overall survival was 13% (95% CI 9-19) versus 3% (95% CI 2-8; p=0.004). Progression was less likely in the thoracic radiotherapy group than in the control group (HR 0.73, 95% CI 0.61-0.87; p=0.001). At 6 months, progression-free survival was 24% (95% CI 19-30) versus 7% (95% CI 4-11; p=0.001). We recorded no severe toxic effects. The most common grade 3 or higher toxic effects were fatigue (11 vs 9) and dyspnoea (three vs four). INTERPRETATION Thoracic radiotherapy in addition to prophylactic cranial irradiation should be considered for all patients with ES-SCLC who respond to chemotherapy. FUNDING Dutch Cancer Society (CKTO), Dutch Lung Cancer Research Group, Cancer Research UK, Manchester Academic Health Science Centre Trials Coordination Unit, and the UK National Cancer Research Network.
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Affiliation(s)
- Ben J Slotman
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, Netherlands.
| | - Harm van Tinteren
- Department of Statistics, The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - John O Praag
- Department of Radiation Oncology, Erasmus MC, Rotterdam, Netherlands
| | - Joost L Knegjens
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Sherif Y El Sharouni
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Matthew Hatton
- Department of Clinical Oncology, Weston Park Hospital, Sheffield, UK
| | - Astrid Keijser
- IKNL Clinical Research Department, Amsterdam, Netherlands
| | | | - Suresh Senan
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, Netherlands
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Owonikoko TK, Behera M, Chen Z, Bhimani C, Curran WJ, Khuri FR, Ramalingam SS. A systematic analysis of efficacy of second-line chemotherapy in sensitive and refractory small-cell lung cancer. J Thorac Oncol 2012; 7:866-72. [PMID: 22722788 PMCID: PMC3381878 DOI: 10.1097/jto.0b013e31824c7f4b] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Small-cell lung cancer (SCLC) patients unresponsive or relapsing within 90 days after frontline chemotherapy have poor prognosis and are treated with regimens different from the first-line regimen. Potential differences in the efficacy of second-line therapy for refractory and sensitive SCLC have not been well studied. METHODS Studies that enrolled sensitive and refractory (relapse < 90 days or > 90 days) SCLC patients for second-line therapy were identified using electronic databases (MEDLINE, EMBASE, and Cochrane library), and meeting abstracts databases. A systematic analysis was conducted using Comprehensive Meta Analysis (version 2.2.048) software to calculate the odds ratio of response and 95% confidence interval. Median overall survival time for sensitive and resistant SCLC patients was compared by two-sided Student's t test. We tested for significant heterogeneity by Cochran's chi-square test and I-square index. RESULTS Twenty-one studies published between 1984 and 2011 were eligible for this analysis with a total of 1692 patients enrolled; 912 with sensitive and 780 with refractory SCLC. The overall response rate was 17.9% with a higher response rate of 27.7% (range, 0%-77%) for sensitive SCLC versus 14.8% (range, 0%-70%) for refractory patients; p=0.0001. Pooled overall odds ratio of response was 2.235 (95% confidence interval: 1.518-3.291; p=0.001) favoring patients with sensitive disease. Median overall survival time was 6.7 months with a weighted survival of 7.7 and 5.4 months for sensitive and refractory SCLC, respectively (p = 0.0035). CONCLUSIONS Refractory SCLC patients derive modest clinical benefit from second-line chemotherapy. However, response and survival outcomes are superior with chemosensitive disease.
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Affiliation(s)
- Taofeek K Owonikoko
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA 30322, USA.
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Lebeau B, Chouaïd C, Baud M, Masanès MJ, Febvre M. Oral second- and third-line lomustine–etoposide–cyclophosphamide chemotherapy for small cell lung cancer. Lung Cancer 2010; 67:188-93. [DOI: 10.1016/j.lungcan.2009.03.024] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2009] [Revised: 03/02/2009] [Accepted: 03/20/2009] [Indexed: 11/25/2022]
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Pelayo Alvarez M, Gallego Rubio O, Bonfill Cosp X, Agra Varela Y. Chemotherapy versus best supportive care for extensive small cell lung cancer. Cochrane Database Syst Rev 2009:CD001990. [PMID: 19821287 DOI: 10.1002/14651858.cd001990.pub2] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Combination chemotherapy has been the mainstay of treatment for extensive stage small celI lung cancer (SCLC) over the last 30 years even though it only gives a short prolongation in median survival time. The main goal for these patients should be palliation with the aim of improving their quality of life. OBJECTIVES To evaluate the effectiveness of chemotherapy in extensive SCLC compared with best supportive care (BSC) or placebo treatment. SEARCH STRATEGY MEDLINE (1966 to July 2008), EMBASE (1974 to week 31, 2008), and the Cochrane Central Register of Controlled Trials (CENTRAL, Issue 3, 2008). Experts in the field were contacted. SELECTION CRITERIA Randomised controlled trials in which any chemotherapy treatment was compared with placebo or BSC in patients with extensive SCLC, as first or second therapy at relapse. DATA COLLECTION AND ANALYSIS Two authors independently extracted data and assessed study quality. We resolved disagreements by discussion. Additional information was obtained from one study author. MAIN RESULTS Two studies were included for first-line chemotherapy. A total of 65 patients were randomised to receive either placebo or ifosfamide. Ifosfamide gave an extra mean survival of 78.5 days compared with placebo. Partial tumour response was greater with the active treatment. Toxicity was only seen in the chemotherapy group.Two studies were included for second-line chemotherapy at relapse. A total of 531 patients were randomised to receive either methotrexate-doxorubicin or symptomatic treatment, or to receive oral topotecan versus BSC. The methotrexate-doxorubicin treatment gave a median survival of 63 days longer than in the symptomatic treatment group, and 21 days longer for patients allocated to receive four or eight cycles of first-line chemotherapy, respectively.Treatment with topotecan gave a median survival of 84 days longer than in the BSC group (log-rank P = 0.01). The adjusted hazard ratio for overall survival was 0.61 (95% CI, 0.43 to 0.87). Partial or complete response in the methotrexate-doxorubicin group was 22.3%. Five patients (7%, 95% CI, 2.33 to 15.67) showed a partial response with topotecan. Toxicity was worst in the chemotherapy group. Quality of life was better in the topotecan group. AUTHORS' CONCLUSIONS Chemotherapeutic treatment prolongs survival in comparison with placebo in patients with advanced SCLC. Nevertheless, the impact of first-line chemotherapy on quality of life and in patients with poor prognosis is unknown. Well-designed, controlled trials are needed to further evaluate the risks and benefits of different chemotherapeutic schedules in patients with advanced SCLC.
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Small-cell lung cancer, getting smaller but still difficult to treat. J Thorac Oncol 2008; 3:103-4. [PMID: 18303426 DOI: 10.1097/jto.0b013e318162337f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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