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Nakamichi S, Kubota K, Misumi T, Kondo T, Murakami S, Shiraishi Y, Imai H, Harada D, Isobe K, Itani H, Takata S, Wakui H, Misumi Y, Ikeda S, Asao T, Furuya N, Hosokawa S, Kobayashi Y, Takiguchi Y, Okamoto H. Phase II Study of Durvalumab Immediately after Completion of Chemoradiotherapy in Unresectable Stage III Non-small Cell Lung Cancer: TORG1937 (DATE Study). Clin Cancer Res 2024; 30:1104-1110. [PMID: 38165684 PMCID: PMC10940851 DOI: 10.1158/1078-0432.ccr-23-2568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 11/09/2023] [Accepted: 12/21/2023] [Indexed: 01/04/2024]
Abstract
PURPOSE Concurrent chemoradiotherapy (CCRT) followed by durvalumab consolidation for up to 12 months is the standard of care for patients with unresectable stage III non-small cell lung cancer (NSCLC). However, exactly when to initiate durvalumab therapy after chemoradiation completion remains unknown. We evaluated the efficacy and safety of durvalumab, administered immediately after CCRT completion, for patients with unresectable stage III NSCLC. PATIENTS AND METHODS This study was a prospective, single-arm, open-label phase II clinical trial. Patients without disease progression after definitive CCRT (two cycles of platinum-based doublet chemotherapy with 60 Gy/30 Fr radiotherapy) received durvalumab (every 2 weeks for up to 12 months) from the next day (up to 5 days) after the final radiation dose. The primary endpoint was the 1-year progression-free survival (PFS) from registration before the start of CCRT. RESULTS From January 2020 to August 2020, 47 of 50 enrolled patients were evaluable for treatment efficacy and safety. The 1-year PFS from registration was 75.0% [60% confidence interval (CI), 69.0-80.0 and 95% CI, 59.4-85.3]. The objective response rate throughout the study treatment and median PFS from registration were 78.7% and 14.2 months (95% CI, 13.4 to not reached), respectively. Grade 3/4 pneumonitis and febrile neutropenia were each 4.3%. CONCLUSIONS Our study met the primary endpoint. The incidence of pneumonitis was similar to that of a Japanese subset in the PACIFIC study. Our data support the efficacy and safety of durvalumab administered immediately after the completion of CCRT for patients with unresectable stage III NSCLC.
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Affiliation(s)
- Shinji Nakamichi
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Kaoru Kubota
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Toshihiro Misumi
- Department of Biostatistics, Yokohama City University School of Medicine, Yokohama, Japan
| | - Tetsuro Kondo
- Department of Thoracic Oncology, Kanagawa Cancer Center, Yokohama, Japan
| | - Shuji Murakami
- Department of Thoracic Oncology, Kanagawa Cancer Center, Yokohama, Japan
| | - Yoshimasa Shiraishi
- Department of Respiratory Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hisao Imai
- Division of Respiratory Medicine, Gunma Prefectural Cancer Center, Ota, Japan
- Department of Respiratory Medicine, International Medical Center, Saitama Medical University, Saitama, Japan
| | - Daijiro Harada
- Department of Thoracic Oncology and Medicine, National Hospital Organization Shikoku Cancer Center, Matsuyama, Japan
| | - Kazutoshi Isobe
- Department of Respiratory Medicine, Toho University Omori Medical Center, Tokyo, Japan
| | - Hidetoshi Itani
- Department of Respiratory Medicine, Japanese Red Cross Ise Hospital, Ise, Japan
| | - Saori Takata
- Department of Respiratory Medicine, Kyorin University School of Medicine, Tokyo, Japan
| | - Hiroshi Wakui
- Division of Respiratory Diseases, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan
| | - Yuki Misumi
- Department of Respiratory Medicine and Medical Oncology, Yokohama Municipal Citizen's Hospital, Yokohama, Japan
| | - Satoshi Ikeda
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan
| | - Tetsuhiko Asao
- Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Naoki Furuya
- Department of Internal Medicine, Division of Respiratory Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Shinobu Hosokawa
- Department of Respiratory Medicine, Japanese Red Cross Okayama Hospital, Okayama, Japan
| | - Yumiko Kobayashi
- Department of Pulmonary Medicine, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
| | - Yuichi Takiguchi
- Department of Medical Oncology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Hiroaki Okamoto
- Department of Respiratory Medicine and Medical Oncology, Yokohama Municipal Citizen's Hospital, Yokohama, Japan
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Liu T, Li S, Ding S, Qiu J, Ren C, Chen J, Wang H, Wang X, Li G, He Z, Dang J. Comparison of post-chemoradiotherapy pneumonitis between Asian and non-Asian patients with locally advanced non-small cell lung cancer: a systematic review and meta-analysis. EClinicalMedicine 2023; 64:102246. [PMID: 37781162 PMCID: PMC10539643 DOI: 10.1016/j.eclinm.2023.102246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 08/28/2023] [Accepted: 09/13/2023] [Indexed: 10/03/2023] Open
Abstract
Background Pneumonitis is a common complication for patients with locally advanced non-small cell lung cancer undergoing definitive chemoradiotherapy (CRT). It remains unclear whether there is ethnic difference in the incidence of post-CRT pneumonitis. Methods PubMed, Embase, Cochrane Library, and Web of Science were searched for eligible studies from January 1, 2000 to April 30, 2023. The outcomes of interest were incidence rates of pneumonitis. The random-effect model was used for statistical analysis. This meta-analysis was registered with PROSPERO (CRD42023416490). Findings A total of 248 studies involving 28,267 patients were included. Among studies of CRT without immunotherapy, the pooled rates of pneumonitis for Asian patients were significantly higher than that for non-Asian patients (all grade: 66.8%, 95% CI: 59.2%-73.9% vs. 28.1%, 95% CI: 20.4%-36.4%; P < 0.0001; grade ≥2: 25.1%, 95% CI: 22.9%-27.3% vs. 14.9%, 95% CI: 12.0%-18.0%; P < 0.0001; grade ≥3: 6.5%, 95% CI: 5.6%-7.3% vs. 4.6%, 95% CI: 3.4%-5.9%; P = 0.015; grade 5: 0.6%, 95% CI: 0.3%-0.9% vs. 0.1%, 95% CI: 0.0%-0.2%; P < 0.0001). Regarding studies of CRT plus immunotherapy, Asian patients had higher rates of all-grade (74.8%, 95% CI: 63.7%-84.5% vs. 34.3%, 95% CI: 28.7%-40.2%; P < 0.0001) and grade ≥2 (34.0%, 95% CI: 30.7%-37.3% vs. 24.6%, 95% CI: 19.9%-29.3%; P = 0.001) pneumonitis than non-Asian patients, but with no significant differences in the rates of grade ≥3 and grade 5 pneumonitis. Results from subgroup analyses were generally similar to that from the all studies. In addition, the pooled median/mean of lung volume receiving ≥20 Gy and mean lung dose were relatively low in Asian studies compared to that in non-Asian studies. Interpretation Asian patients are likely to have a higher incidence of pneumonitis than non-Asian patients, which appears to be due to the poor tolerance of lung to radiation. Nevertheless, these findings are based on observational studies and with significant heterogeneity, and need to be validated in future large prospective studies focusing on the subject. Funding None.
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Affiliation(s)
- Tingting Liu
- Department of Radiation Oncology, The First Hospital of China Medical University, Shenyang, China
- Department of Radiation Oncology, Anshan Cancer Hospital, Anshan, China
| | - Sihan Li
- Department of Radiation Oncology, The First Hospital of China Medical University, Shenyang, China
| | - Silu Ding
- Department of Radiation Oncology, The First Hospital of China Medical University, Shenyang, China
| | - Jingping Qiu
- Department of Radiation Oncology, The First Hospital of China Medical University, Shenyang, China
| | - Chengbo Ren
- Department of Radiation Oncology, The First Affiliated Hospital of Hebei North University, Zhangjiakou, Hebei, China
| | - Jun Chen
- Department of Radiation Oncology, Shenyang Tenth People's Hospital, Shenyang, China
| | - He Wang
- Department of Radiation Oncology, The First Hospital of China Medical University, Shenyang, China
| | - Xiaoling Wang
- Department of Radiation Oncology, The First Hospital of China Medical University, Shenyang, China
| | - Guang Li
- Department of Radiation Oncology, The First Hospital of China Medical University, Shenyang, China
| | - Zheng He
- Department of Radiation Oncology, The First Hospital of China Medical University, Shenyang, China
| | - Jun Dang
- Department of Radiation Oncology, The First Hospital of China Medical University, Shenyang, China
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Aoun-Bacha Z, Bitar N, Saleh WA, Assi H, Bahous J, Boukhalil P, Chami H, Dabar G, El Karak F, Farhat F, Ghanem H, Ghosn M, Juvelikian G, Nasr F, Nehme R, Riachy M, Tabet G, Tfayli A, Waked M, Youssef P. Diagnosis and management of patients with stage III non‑small cell lung cancer: A joint statement by the Lebanese Society of Medical Oncology and the Lebanese Pulmonary Society (Review). Oncol Lett 2023; 25:113. [PMID: 36844621 PMCID: PMC9950344 DOI: 10.3892/ol.2023.13699] [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: 08/02/2022] [Accepted: 09/30/2022] [Indexed: 02/08/2023] Open
Abstract
Proper management of stage III non-small cell lung cancer (NSCLC) might result in a cure or patient long-term survival. Management should therefore be preceded by adequate and accurate diagnosis and staging, which will inform therapeutic decisions. A panel of oncologists, surgeons and pulmonologists in Lebanon convened to establish a set of recommendations to guide and unify clinical practice, in alignment with international standards of care. Whilst chest computerized tomography (CT) scanning remains a cornerstone in the discovery of a lung lesion, a positron-emission tomography (PET)/CT scan and a tumor biopsy allows for staging of the cancer and defining the resectability of the tumor(s). A multidisciplinary discussion meeting is currently widely advised for evaluating patients on a case-by-case basis, and should include at least the treating oncologist, a thoracic surgeon, a radiation oncologist and a pulmonologist, in addition to physicians from other specialties as needed. The standard of care for unresectable stage III NSCLC is concurrent chemotherapy and radiation therapy, followed by consolidation therapy with durvalumab, which should be initiated within 42 days of the last radiation dose; for resectable tumors, neoadjuvant therapy followed by surgical resection is recommended. This joint statement is based on the expertise of the physician panel, available literature and evidence governing the treatment, management and follow-up of patients with stage III NSCLC.
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Affiliation(s)
- Zeina Aoun-Bacha
- Division of Pulmonary Medicine, Hôtel-Dieu de France Medical Center, Saint-Joseph University, Beirut 1104 2020, Lebanon,Correspondence to: Dr Zeina Aoun-Bacha, Department of Pulmonology and Critical Care, Hôtel Dieu de France Medical Center, Saint-Joseph University, Alfred Naccache Boulevard, Ashrafieh, P.O. Box 2064-6613, Beirut 1104 2020, Lebanon, E-mail:
| | - Nizar Bitar
- Division of Hematology-Oncology, Sahel General Hospital, Beirut 1514, Lebanon
| | - Wajdi Abi Saleh
- Division of Pulmonary Medicine and Critical Care, Clémenceau Medical Center, Beirut 1103, Lebanon
| | - Hazem Assi
- Division of Hematology/Oncology, American University of Beirut Medical Center, Beirut 1107 2020, Lebanon
| | - Joudy Bahous
- Division of Pulmonary Medicine, Saint Georges Hospital University Medical Center, Beirut 1481, Lebanon
| | - Pierre Boukhalil
- Division of Pulmonary Medicine and Critical Care, American University of Beirut Medical Center, Beirut 1107 2020, Lebanon
| | - Hasan Chami
- Division of Pulmonary Medicine and Critical Care, American University of Beirut Medical Center, Beirut 1107 2020, Lebanon
| | - Georges Dabar
- Division of Pulmonary Medicine, Hôtel-Dieu de France Medical Center, Saint-Joseph University, Beirut 1104 2020, Lebanon
| | - Fadi El Karak
- Division of Hematology-Oncology, Hôtel-Dieu de France Medical Center, Saint-Joseph University, Beirut 1104 2020, Lebanon
| | - Fadi Farhat
- Division of Hematology Oncology, Hammoud Hospital University Medical Center, Sidon 1551, Lebanon
| | - Hadi Ghanem
- Division of Hematology-Oncology, Lebanese American University Medical Center-Rizk Hospital, Beirut 1481, Lebanon
| | - Marwan Ghosn
- Division of Hematology-Oncology, Hôtel-Dieu de France Medical Center, Saint-Joseph University, Beirut 1104 2020, Lebanon
| | - George Juvelikian
- Division of Pulmonary Medicine, Saint Georges Hospital University Medical Center, Beirut 1481, Lebanon
| | - Fadi Nasr
- Division of Hematology-Oncology, Hôtel-Dieu de France Medical Center, Saint-Joseph University, Beirut 1104 2020, Lebanon
| | - Ralph Nehme
- Division of Pulmonary Medicine and Critical Care, Lebanese American University Medical Center-Rizk Hospital, Beirut 1481, Lebanon
| | - Moussa Riachy
- Division of Pulmonary Medicine, Hôtel-Dieu de France Medical Center, Saint-Joseph University, Beirut 1104 2020, Lebanon
| | - Georges Tabet
- Department of Thoracic Surgery, Hôtel-Dieu de France Medical Center, Saint-Joseph University, Beirut 1004 2020, Lebanon
| | - Arafat Tfayli
- Division of Hematology/Oncology, American University of Beirut Medical Center, Beirut 1107 2020, Lebanon
| | - Mirna Waked
- Division of Pulmonary Medicine, Saint Georges Hospital University Medical Center, Beirut 1481, Lebanon
| | - Pierre Youssef
- Department of Surgery, Saint Georges Hospital University Medical Center, Beirut 1481, Lebanon
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Tsukita Y, Yamamoto T, Mayahara H, Hata A, Takeda Y, Nakayama H, Tanaka S, Uchida J, Usui K, Toyoda T, Tamiya M, Morimoto M, Oya Y, Kodaira T, Miyauchi E, Jingu K, Sugiura H. Intensity-modulated radiation therapy with concurrent chemotherapy followed by durvalumab for stage III non-small cell lung cancer: A multi-center retrospective study. Radiother Oncol 2021; 160:266-272. [PMID: 34023330 DOI: 10.1016/j.radonc.2021.05.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 05/07/2021] [Accepted: 05/12/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND PURPOSE Intensity-modulated radiation therapy (IMRT) is increasingly applied in concurrent chemoradiotherapy (CCRT) for locally-advanced non-small cell lung cancer (NSCLC), with improvement of target coverage and better sparing of normal tissue. IMRT tends to have a larger low-dose irradiation volume than 3D conformal radiotherapy, but the incidence of and risk factors for pneumonitis remain unclear, especially following the approval of durvalumab. MATERIALS AND METHODS We retrospectively reviewed the records of NSCLC patients treated by CCRT using IMRT at seven Japanese institutions. Primary outcomes were incidence of symptomatic pneumonitis and progression-free survival (PFS). Multivariate logistic regression analysis was used to identify risk factors for ≥grade 2 pneumonitis. RESULTS Median follow-up from the start of CCRT was 14.3 months (n = 107 patients; median age 70 years, 29% female). Median lung V5 and V20 was 49.2% and 19.5%, respectively. Durvalumab was administered to 87 patients (81%). Pneumonitis developed in 95 (89%) patients of which 53% had grade 1, 28% grade 2, 6.5% grade 3, and 0.9% grade 4. Durvalumab had been discontinued in 16 patients (18.4%) due to pneumonitis. By multivariate analysis, age ≥70 years, male sex, and V5 ≥58.9% were identified as significantly associated with ≥grade 2 pneumonitis (p = 0.0065, 0.036 and 0.0013 respectively). The median PFS from the start of CCRT was not reached (95% CI, 14.2 months to not reached) in patients receiving durvalumab. CONCLUSION CCRT using IMRT followed by durvalumab was generally effective and tolerable; V5 <60% would be recommended to avoid symptomatic pneumonitis.
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Affiliation(s)
- Yoko Tsukita
- Department of Respiratory Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.
| | - Takaya Yamamoto
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hiroshi Mayahara
- Department of Radiation Oncology, Kobe Minimally-invasive Cancer Center, Kobe, Japan
| | - Akito Hata
- Department of Respiratory Medical Oncology, Kobe Minimally-invasive Cancer Center, Kobe, Japan
| | - Yuichiro Takeda
- Department of Respiratory Medicine, National Center for Global Health and Medicine, Tokyo, Japan
| | - Hidetsugu Nakayama
- Department of Radiation Oncology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Satoshi Tanaka
- Department of Respiratory Medicine, Osaka General Medical Center, Osaka, Japan
| | - Junji Uchida
- Department of Respiratory Medicine, Osaka General Medical Center, Osaka, Japan
| | - Kazuhiro Usui
- Division of Respirology, NTT Medical Center Tokyo, Tokyo, Japan
| | - Tatsuya Toyoda
- Department of Radiology, NTT Medical Center Tokyo, Tokyo, Japan
| | - Motohiro Tamiya
- Department of Thoracic Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Masahiro Morimoto
- Department of Radiation Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Yuko Oya
- Department of Thoracic Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Takeshi Kodaira
- Department of Radiation Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Eisaku Miyauchi
- Department of Respiratory Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Keiichi Jingu
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hisatoshi Sugiura
- Department of Respiratory Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
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Watanabe K, Toi Y, Nakamura A, Chiba R, Akiyama M, Sakakibara-Konishi J, Tanaka H, Yoshimura N, Miyauchi E, Nakagawa T, Igusa R, Minemura H, Mori Y, Fujimoto K, Matsushita H, Takahashi F, Fukuhara T, Inoue A, Sugawara S, Maemondo M. Randomized phase II trial of uracil/tegafur and cisplatin versus pemetrexed and cisplatin with concurrent thoracic radiotherapy for locally advanced unresectable stage III non-squamous non-small cell lung cancer: NJLCG1001. Transl Lung Cancer Res 2021; 10:712-722. [PMID: 33718016 PMCID: PMC7947416 DOI: 10.21037/tlcr-20-721] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background The optimal regimen for concurrent chemoradiotherapy (CCRT) of locally advanced non-squamous non-small cell lung cancer (NSCLC) was not definitive. We conducted randomized phase II study, NJLCG0601, and chemoradiotherapy with uracil/tegafur (UFT) and cisplatin achieved promising efficacy without severe toxicities. Here, we evaluated between this regimen and pemetrexed plus cisplatin in chemoradiotherapy for stage III non-squamous NSCLC. Methods Patients with inoperable stage III non-squamous NSCLC were randomly assigned in a 1:1 ratio to UFT 400 mg/m2 on days 1–14 and 29–42, and cisplatin 80 mg/m2 on days 8 and 36 (UP), or cisplatin 75 mg/m2 and pemetrexed 500 mg/m2 on days 1, 22, and 43 (PP). Involved-field radiotherapy (IFRT) underwent from day 1 to a total dose of 66 Gy in 33 fractions. Consolidation chemotherapy after CCRT was prohibited for this study. The primary endpoint was defined as 2-year overall survival (OS). This trial was registered in the University Hospital Medical Information Network Clinical Trials Registry (UMIN000003948). Results From November 2010 to June 2017, 86 patients were entered from 11 institutions. Median follow-up was 54 months. Of the 85 eligible patients, the 2-year OS rate was 78.6% (95% CI, 62.8–88.3%) in UP and 85.5% (95% CI, 70.5–93.2%) in PP. Median PFS and OS was 12.3 and 64.2 months in UP, 26.2 months and not reached in PP, respectively. Grade 3/4 febrile neutropenia was more frequent in the UP group (14.0% vs. 2.0%). Conclusions Both UP and PP with IFRT achieved the expected 2-year OS. PP engendered more favorable OS and PFS compared to UP in terms.
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Affiliation(s)
- Kana Watanabe
- Department of Respiratory Medicine, Miyagi Cancer Center, Natori, Japan
| | - Yukihiro Toi
- Department of Pulmonary Medicine, Sendai Kousei Hospital, Sendai, Japan
| | - Atsushi Nakamura
- Department of Pulmonary Medicine, Sendai Kousei Hospital, Sendai, Japan
| | - Ryosuke Chiba
- Division of Pulmonary Medicine, Department of Internal Medicine, Iwate Medical University School of Medicine, Yahaba, Japan
| | - Masachika Akiyama
- Division of Pulmonary Medicine, Department of Internal Medicine, Iwate Medical University School of Medicine, Yahaba, Japan
| | | | - Hisashi Tanaka
- Department of Respiratory Medicine, Hirosaki University, Hirosaki, Japan
| | - Naruo Yoshimura
- Department of Respiratory Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Eisaku Miyauchi
- Department of Respiratory Medicine, Tohoku University School of Medicine, Sendai, Japan
| | - Taku Nakagawa
- Department of Thoracic Surgery, Omagari Kosei Medical Center, Daisen, Japan
| | - Ryotaro Igusa
- Department of Respiratory Medicine, Osaki Citizen Hospital, Osaki, Japan
| | - Hiroyuki Minemura
- Department of Pulmonary Medicine, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Yoshiaki Mori
- Department of Respiratory Medicine, Iwate Prefectural Central Hospital, Morioka, Japan
| | - Keisuke Fujimoto
- Department of Radiation Oncology, Miyagi Cancer Center, Natori, Japan
| | - Haruo Matsushita
- Department of Radiation Oncology, Tohoku University School of Medicine, Sendai, Japan
| | - Fumiaki Takahashi
- Department of Information Science, Iwate Medical University, Morioka, Japan
| | - Tatsuro Fukuhara
- Department of Respiratory Medicine, Miyagi Cancer Center, Natori, Japan
| | - Akira Inoue
- Department of Palliative Medicine, Tohoku University School of Medicine, Sendai, Japan
| | - Shunichi Sugawara
- Department of Pulmonary Medicine, Sendai Kousei Hospital, Sendai, Japan
| | - Makoto Maemondo
- Division of Pulmonary Medicine, Department of Internal Medicine, Iwate Medical University School of Medicine, Yahaba, Japan
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Phase 2 Study of Nimotuzumab in Combination With Concurrent Chemoradiotherapy in Patients With Locally Advanced Non-Small-Cell Lung Cancer. Clin Lung Cancer 2020; 22:134-141. [PMID: 33518480 DOI: 10.1016/j.cllc.2020.12.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 12/17/2020] [Accepted: 12/18/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND We evaluated the tolerability and efficacy of nimotuzumab, a humanized IgG1 monoclonal anti-epidermal growth factor receptor antibody, with concurrent chemoradiotherapy in patients with unresectable locally advanced non-small-cell lung cancer. PATIENTS AND METHODS In this multicenter, single-arm, open-label, phase 2 trial conducted in Japan (JapicCTI-090825), patients received thoracic radiotherapy (60 Gy, 2 Gy per fraction, 6 weeks) and four 4-week cycles of chemotherapy (day 1, cisplatin 80 mg/m2; days 1 and 8, vinorelbine 20 mg/m2). Nimotuzumab 200 mg was administrated weekly for 16 weeks. The primary endpoint was treatment completion rate, defined as the percentage of patients completing 60 Gy of radiotherapy within 8 weeks, 2 cycles of chemotherapy, and at least 75% of the required nimotuzumab dose during the initial 2-cycle concurrent chemoradiotherapy period. RESULTS Of 40 patients enrolled, 39 received the study treatment, which was well tolerated, with a completion rate of 87.2%. Thirty-eight patients completed 60 Gy of radiotherapy within 8 weeks. Infusion reaction, grade 3 or higher rash, grade 3 or higher radiation pneumonitis, or grade 4 or higher nonhematologic toxicity were not observed. The objective response rate was 69.2%. The median progression-free survival (PFS) and 5-year PFS rate were 508 days and 29.0%, respectively. The 5-year PFS rate in patients with non-squamous cell carcinoma (n = 23) was 13.7% and in patients with squamous cell carcinoma (n = 16) was 50.0%. The 5-year overall survival rate was 58.4%. CONCLUSION Addition of nimotuzumab to the concurrent chemoradiotherapy regimen was well tolerated and showed potential for treating patients with locally advanced non-small-cell lung cancer, particularly squamous cell carcinoma.
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Iwata H, Akita K, Yamaba Y, Kunii E, Takakuwa O, Yoshihara M, Hattori Y, Nakajima K, Hayashi K, Toshito T, Ogino H, Shibamoto Y. Concurrent Chemo-Proton Therapy Using Adaptive Planning for Unresectable Stage 3 Non-Small Cell Lung Cancer: A Phase 2 Study. Int J Radiat Oncol Biol Phys 2020; 109:1359-1367. [PMID: 33227444 DOI: 10.1016/j.ijrobp.2020.11.035] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 11/05/2020] [Accepted: 11/12/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE This study prospectively evaluated the efficacy and safety of concurrent chemo-proton therapy (CCPT) using adaptive planning for unresectable stage III non-small cell lung cancer (NSCLC). METHODS AND MATERIALS The primary endpoint was overall survival (OS). Secondary endpoints were local control rate (LCR), progression-free survival (PFS), incidence of grade 3 or higher adverse events, and changes in quality of life (QOL). Patients received cisplatin (60 mg/m2) on day 1 and S-1 (∼40 mg/m2 twice daily) on days 1 to 14, q4w, for up to 4 cycles, plus concurrent proton therapy at a total dose of 70 GyRBE for the primary lesion and 66 GyRBE for lymph node metastasis with 2 GyRBE per day. Proton therapy was performed using respiratory-gated and image guided techniques, and adaptive plans were implemented. RESULTS Forty-seven patients were enrolled between August 2013 and August 2018. Four cycles of cisplatin plus S-1 were completed in 34 patients. The mean number of cycles was 4 (range, 1-4). The median follow-up of all and surviving patients was 37 (range, 4-84) and 52 months (range, 26-84), respectively. The mean number of replanning sessions was 2.5 (range, 1-4). The 2- and 5-year OS, LCR, and PFS were 77% (95% confidence interval 64%-89%) and 59% (43%-76%), 84% (73%-95%) and 61% (44%-78%), and 43% (28%-57%) and 37% (22%-51%), respectively. The median OS was not reached. No grade 3 or higher radiation pneumonitis was observed. There was no significant deterioration in the QOL scores after 24 months except for alopecia. CONCLUSIONS CCPT with adaptive planning was well tolerated and yielded remarkable OS for unresectable stage III NSCLC.
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Affiliation(s)
- Hiromitsu Iwata
- Department of Radiation Oncology, Nagoya Proton Therapy Center, Nagoya City West Medical Center, Nagoya, Japan; Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
| | - Kenji Akita
- Department of Respiratory Tract Oncology Center, Nagoya City West Medical Center, Nagoya, Japan
| | - Yusuke Yamaba
- Department of Respiratory Tract Oncology Center, Nagoya City West Medical Center, Nagoya, Japan
| | - Eiji Kunii
- Department of Respiratory Tract Oncology Center, Nagoya City West Medical Center, Nagoya, Japan
| | - Osamu Takakuwa
- Department of Respiratory Tract Oncology Center, Nagoya City West Medical Center, Nagoya, Japan
| | - Misuzu Yoshihara
- Department of Respiratory Tract Oncology Center, Nagoya City West Medical Center, Nagoya, Japan
| | - Yukiko Hattori
- Department of Radiation Oncology, Nagoya Proton Therapy Center, Nagoya City West Medical Center, Nagoya, Japan
| | - Koichiro Nakajima
- Department of Radiation Oncology, Nagoya Proton Therapy Center, Nagoya City West Medical Center, Nagoya, Japan; Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Kensuke Hayashi
- Department of Proton Therapy Technology, Nagoya Proton Therapy Center, Nagoya, Japan
| | - Toshiyuki Toshito
- Department of Proton Therapy Physics, Nagoya Proton Therapy Center, Nagoya, Japan
| | - Hiroyuki Ogino
- Department of Radiation Oncology, Nagoya Proton Therapy Center, Nagoya City West Medical Center, Nagoya, Japan; Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yuta Shibamoto
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
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Prognostic factors for overall survival of stage III non-small cell lung cancer patients on computed tomography: A systematic review and meta-analysis. Radiother Oncol 2020; 151:152-175. [PMID: 32710990 DOI: 10.1016/j.radonc.2020.07.030] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 07/15/2020] [Accepted: 07/15/2020] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Prognosis prediction is central in treatment decision making and quality of life for non-small cell lung cancer (NSCLC) patients. However, conventional computed tomography (CT) related prognostic factors may not apply to the challenging stage III NSCLC group. The aim of this systematic review was therefore to identify and evaluate CT-related prognostic factors for overall survival (OS) of stage III NSCLC. METHODS The Medline, Embase, and Cochrane electronic databases were searched. After study selection, risk of bias was estimated for the included studies. Meta-analysis of univariate results was performed when sufficient data were available. RESULTS 1595 of the 11,996 retrieved records were selected for full text review, leading to inclusion of 65 studies that reported data of 144,513 stage III NSCLC patients andcompromising 26 unique CT-related prognostic factors. Relevance and validity varied substantially, few studies had low relevance and validity. Only four studies evaluated the added value of new prognostic factors compared with recognized clinical factors. Included studies suggested gross tumor volume (meta-analysis: HR = 1.22, 95%CI: 1.05-1.42), tumor diameter, nodal volume, and pleural effusion, are prognostic in patients treated with chemoradiation. Clinical T-stage and location (right/left) were likely not prognostic within stage III NSCLC. Inconclusive are several radiomic features, tumor volume, atelectasis, location (pulmonary lobes, central/peripheral), interstitial lung abnormalities, great vessel invasion, pit-fall sign, and cavitation. CONCLUSIONS Tumor-size and nodal size-related factors are prognostic for OS in stage III NSCLC. Future studies should carefully report study characteristics and contrast factors with guideline recognized factors to improve evidence evaluation and validation.
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Shrimali RK, Nallathambi C, Saha A, Das A, Prasath S, Mahata A, Arun B, Mallick I, Achari R, Dabkara D, Thambudorai R, Chatterjee S. Radical radiotherapy or chemoradiotherapy for inoperable, locally advanced, non-small cell lung cancer: Analysis of patient profile, treatment approaches, and outcomes for 213 patients at a tertiary cancer center. Indian J Cancer 2019; 55:125-133. [PMID: 30604722 DOI: 10.4103/ijc.ijc_469_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Radical radiotherapy (RT) with curative intent, with or without chemotherapy, is the standard treatment for inoperable, locally advanced nonsmall cell lung cancer (NSCLC). MATERIALS AND METHODS We retrospectively reviewed the data for all 288 patients who presented with inoperable, locally advanced NSCLC at our institution, between May 2011 and December 2016. RESULTS RT alone or sequential chemoradiotherapy (SCRT) or concurrent chemoradiotherapy (CCRT) was used for 213 patients. Median age was 64 years (range: 27-88 years). Stage-III was the biggest stage group with 189 (88.7%) patients. Most patients with performance status (PS) 0 or 1 received CCRT, whereas most patients with PS 2 received RT alone (P < 0.001). CCRT, SCRT, and RT alone were used for 120 (56.3%), 24 (11.3%), and 69 (32.4%) patients, respectively. A third of all patients (32.4%) required either volumetric-modulated arc radiotherapy (VMAT) or tomotherapy. Median follow-up was 16 months. The median progression-free survival and median overall survival (OS) were 11 and 20 months, respectively. One-year OS and 2-year OS were 67.9% and 40.7%, respectively. Patients treated using CCRT lived significantly longer with a median survival of 28 months, compared with 13 months using SCRT and RT alone (P < 0.001). On multivariate analysis, OS was significantly affected by age, stage group, treatment approach, and response to treatment. CONCLUSION RT including CCRT is feasible, safe, and well tolerated in our patient population and results in survival benefits comparable with published literature. CCRT should be considered for all patients with inoperable, locally advanced NSCLC, who are fit and have good PS.
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Affiliation(s)
- Raj Kumar Shrimali
- Department of Radiation Oncology, Tata Medical Center, Kolkata, West Bengal, India
| | - Chandran Nallathambi
- Department of Radiation Oncology, Tata Medical Center, Kolkata, West Bengal, India
| | - Animesh Saha
- Department of Radiation Oncology, Tata Medical Center, Kolkata, West Bengal, India
| | - Avipsa Das
- Department of Radiation Oncology, Tata Medical Center, Kolkata, West Bengal, India
| | - Sriram Prasath
- Department of Radiotherapy Physics, Tata Medical Center, Kolkata, West Bengal, India
| | - Anurupa Mahata
- Department of Radiotherapy Physics, Tata Medical Center, Kolkata, West Bengal, India
| | - B Arun
- Department of Radiotherapy Physics, Tata Medical Center, Kolkata, West Bengal, India
| | - Indranil Mallick
- Department of Radiation Oncology, Tata Medical Center, Kolkata, West Bengal, India
| | - Rimpa Achari
- Department of Radiation Oncology, Tata Medical Center, Kolkata, West Bengal, India
| | - Deepak Dabkara
- Department of Medical Oncology, Tata Medical Center, Kolkata, West Bengal, India
| | - Robin Thambudorai
- Department of Thoracic Surgery, Tata Medical Center, Kolkata, West Bengal, India
| | - Sanjoy Chatterjee
- Department of Radiation Oncology, Tata Medical Center, Kolkata, West Bengal, India
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Liu N, Liu Z, Zhang W, Li Y, Cao J, Yang H, Li X. MicroRNA‑433 reduces cell proliferation and invasion in non‑small cell lung cancer via directly targeting E2F transcription factor 3. Mol Med Rep 2018; 18:1155-1164. [PMID: 29767254 DOI: 10.3892/mmr.2018.9020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 04/05/2018] [Indexed: 11/06/2022] Open
Abstract
MicroRNAs (miRNA/miRs) have been associated with the initiation and progression of non‑small‑cell lung cancer (NSCLC). Hence, a comprehensive understanding of the association between dysregulated miRNAs and NSCLC may contribute to the identification of novel therapeutic methods for patients with NSCLC. MiRNA‑433 (miR‑433) has been reported to be dysregulated in numerous types of human cancers; however, its expression pattern, biological roles and associated mechanisms in NSCLC require further investigation. The present study aimed to detect miR‑433 expression and determine its roles and underlying molecular mechanisms in NSCLC. In the present study, reverse transcription‑quantitative polymerase chain reaction revealed that miR‑433 was significantly downregulated in NSCLC tissues and cell lines. This decreased miR‑433 expression was strongly associated with the tumor node metastasis stage and lymph node metastasis of patients with NSCLC. Cell Counting kit‑8 and cell invasion assays revealed that the resumption of miR‑433 expression decreased the proliferation and invasion of NSCLC cells. Bioinformatics analysis predicted E2F transcription factor 3 (E2F3) as a potential target of miR‑433. Luciferase reporter assay, RT‑qPCR and western blot analysis further demonstrated that E2F3 was a direct target of miR‑433 in NSCLC. E2F3 downregulation induced by small interfering RNA exhibited inhibitory effects similar to those of miR‑433 overexpression in NSCLC cells, and the restored E2F3 expression counteracted the suppressive effects on NSCLC cells induced by miR‑433 overexpression. Therefore, miR‑433 may inhibit the progression of NSCLC, at least in part, by targeting E2F3. The present study indicated that miR‑433 may be investigated as an innovative candidate target for the therapy of patients with this fatal disease.
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Affiliation(s)
- Nian Liu
- Department of Respiration, Hunan Provincial People's Hospital and The First Affiliated Hospital of Hunan Normal University, Changsha, Hunan 410005, P.R. China
| | - Zhiguang Liu
- Department of Respiration, Hunan Provincial People's Hospital and The First Affiliated Hospital of Hunan Normal University, Changsha, Hunan 410005, P.R. China
| | - Weidong Zhang
- Department of Respiration, Hunan Provincial People's Hospital and The First Affiliated Hospital of Hunan Normal University, Changsha, Hunan 410005, P.R. China
| | - Yang Li
- Department of Integrated Traditional Chinese and Western Medicine, Hunan Cancer Hospital and Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan 410013, P.R. China
| | - Jun Cao
- Department of Respiration, Hunan Provincial People's Hospital and The First Affiliated Hospital of Hunan Normal University, Changsha, Hunan 410005, P.R. China
| | - Huan Yang
- Department of Respiration, Hunan Provincial People's Hospital and The First Affiliated Hospital of Hunan Normal University, Changsha, Hunan 410005, P.R. China
| | - Xiuying Li
- Department of Respiration, Hunan Provincial People's Hospital and The First Affiliated Hospital of Hunan Normal University, Changsha, Hunan 410005, P.R. China
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Hisakane K, Yoh K, Nakamura N, Udagawa H, Kirita K, Umemura S, Matsumoto S, Niho S, Akimoto T, Tsuboi M, Goto K. Salvage chemoradiotherapy with cisplatin and vinorelbine for postoperative locoregional recurrence of non-small cell lung cancer. Medicine (Baltimore) 2017; 96:e8635. [PMID: 29381935 PMCID: PMC5708934 DOI: 10.1097/md.0000000000008635] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Although a few investigators have demonstrated the effect of concurrent chemoradiotherapy (CRT) for postoperative recurrent non-small cell lung cancer (NSCLC), the outcome of this treatment remains unclear. The aim of this study was to elucidate the efficacy and tolerability of concurrent CRT with cisplatin (CDDP) and vinorelbine (VNR) in patients with postoperative locoregional recurrent NSCLC. A total of 40 patients who had received concurrent CRT with CDDP and VNR between January 1999 and December 2014 were retrospectively analyzed. Patients were treated with CDDP (80 mg/m on day 1) and VNR (20 mg/m on days 1 and 8) every 4 weeks. Radiotherapy was administered concurrently during cycle 1. The delivered x-ray radiation dose was 60 Gy in all 37 patients who received x-ray radiotherapy; 3 patients received proton beam radiation (66 Gy [RBE] in 1 patient and 60 Gy [RBE] in 2 patients). The objective response rate was 85% (95% confidence interval [CI], 70.9%-92.9%). The median progression-free survival was 20.3 months (95% CI, 12.9 months-not reached). The 2-year survival rate was 78.9% (95% CI, 63.0%-89.1%). The most common grade ≥3 toxicity was neutropenia (18%). No grade ≥3 radiation pneumonitis and no treatment-related deaths were observed.Our study revealed that concurrent CRT with CDDP and VNR was active and safe for patients with postoperative locoregional recurrent NSCLC. Salvage CRT for postoperative locoregional recurrent NSCLC might be a promising treatment for selected patients.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Masahiro Tsuboi
- Department of Thoracic Surgery, National Cancer Center, Kashiwa, Japan
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12
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Zhu X, Ju S, Yuan F, Chen G, Shu Y, Li C, Xu Y, Luo J, Xia L. microRNA-664 enhances proliferation, migration and invasion of lung cancer cells. Exp Ther Med 2017; 13:3555-3562. [PMID: 28588679 DOI: 10.3892/etm.2017.4433] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2015] [Accepted: 02/03/2017] [Indexed: 12/12/2022] Open
Abstract
Altered microRNA (miR) expression serves an important role in the development and progression of lung cancer. In the present study, the effect of miR-664 on proliferation, migration and invasion of lung cancer cells was assessed. The proliferation of lung cancer cells with an overexpression of miR-664 was examined via MTT assay. The Caspase-Glo3/7 assay was used to examine the effect of miR-664 on cisplatin-induced apoptosis in lung cancer cells. The migration and invasion of lung cancer cells were assessed by Transwell migration and matrigel invasion assays. Western blot analysis was used to examine the protein expression levels. miR-664 improved the proliferation of lung cancer cells and inhibited cisplatin-induced apoptosis of A549 and A427 cells. Furthermore, altered expression of miR-664 affected migration and invasion of lung cancer cells. In addition, a miR-664 mimic decreased E-cadherin expression and increased vementin and Snail expression in lung cancer cells. Notably, the expression level of protein kinase B in A549 cells was changed following altered expression of miR-664. The results of the present study suggest that miR-664 serves an essential role in tumor development and progression in lung cancer.
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Affiliation(s)
- Xinhai Zhu
- Department of Thoracic Surgery, Zhejiang Hospital, Hangzhou, Zhejiang 310000, P.R. China
| | - Sheng Ju
- Department of Thoracic Surgery, Zhejiang Hospital, Hangzhou, Zhejiang 310000, P.R. China
| | - Feng Yuan
- Department of Thoracic Surgery, Zhejiang Hospital, Hangzhou, Zhejiang 310000, P.R. China
| | - Guoping Chen
- Department of Thoracic Surgery, Zhejiang Hospital, Hangzhou, Zhejiang 310000, P.R. China
| | - Yue Shu
- Department of Thoracic Surgery, Zhejiang Hospital, Hangzhou, Zhejiang 310000, P.R. China
| | - Chuanchuan Li
- Department of Thoracic Surgery, Zhejiang Hospital, Hangzhou, Zhejiang 310000, P.R. China
| | - Yanhui Xu
- Department of Thoracic Surgery, Zhejiang Hospital, Hangzhou, Zhejiang 310000, P.R. China
| | - Jing Luo
- Department of Thoracic Surgery, Zhejiang Hospital, Hangzhou, Zhejiang 310000, P.R. China
| | - Lilong Xia
- Department of Thoracic Surgery, Zhejiang Hospital, Hangzhou, Zhejiang 310000, P.R. China
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Ueki A, Okuma T, Hamamoto S, Miki Y. Therapeutic Effects of CT-guided Radiofrequency Ablation with Concurrent Platinum-Doublet Chemotherapy in a Rabbit VX2 Lung Tumor Model. Radiology 2017; 283:391-398. [DOI: 10.1148/radiol.2016160414] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Ai Ueki
- From the Department of Radiology, Graduate School of Medicine, Osaka City University, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan
| | - Tomohisa Okuma
- From the Department of Radiology, Graduate School of Medicine, Osaka City University, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan
| | - Shinichi Hamamoto
- From the Department of Radiology, Graduate School of Medicine, Osaka City University, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan
| | - Yukio Miki
- From the Department of Radiology, Graduate School of Medicine, Osaka City University, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan
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Hansen O, Knap MM, Khalil A, Nyhus CH, McCulloch T, Holm B, Brink C, Hoffmann L, Schytte T. A randomized phase II trial of concurrent chemoradiation with two doses of radiotherapy, 60 Gy and 66 Gy, concomitant with a fixed dose of oral vinorelbine in locally advanced NSCLC. Radiother Oncol 2017; 123:276-281. [DOI: 10.1016/j.radonc.2017.03.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 02/15/2017] [Accepted: 03/21/2017] [Indexed: 12/25/2022]
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15
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Feng J, Xu J, Wang X, Zhao D. S-1 plus cisplatin with concurrent radiotherapy versus cisplatin alone with concurrent radiotherapy in Chinese patients with nonsmall-cell lung cancer: A multicentre randomized controlled trial. Medicine (Baltimore) 2016; 95:e4557. [PMID: 27603346 PMCID: PMC5023868 DOI: 10.1097/md.0000000000004557] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The aim of this study was to investigate the efficacy and safety of S-1 plus cisplatin combined with concurrent radiotherapy (SCCCR) versus cisplatin alone combined with concurrent radiotherapy (CCCR) in Chinese patients with unresectable stage III nonsmall-cell lung cancer (NSCLC). METHODS Between January 2012 and December 2014, 72 eligible Chinese patients with NSCLC were included and randomly divided into 2 groups, each having 36 patients. Patients in the SCCCR group received S-1 plus cisplatin with concurrent, radiotherapy. The other 36 patients in the CCCR group were administered cisplatin with concurrent radiotherapy. The primary outcome was the overall response rate. The secondary outcomes were overall survival (OS), progression-free survival (PFS), and adverse events. RESULTS The 3-year overall response rates for the SCCCR and CCCR groups were 60.1% and 53.3%, respectively (P = 0.041). The median OS was 35.1 (range, 6.5-47.2) months and 24.6 (range, 2.8-24.3) months for the SCCCR and CCCR groups, respectively (P = 0.016). The median PFS for the SCCCR and CCCR groups was 31.4 (range, 5.6-39.3) months and 22.3 (range, 2.4-36.5) months, respectively (P = 0.023). The toxicity profiles were similar for both groups. CONCLUSION The efficacy and safety of SCCCR was more encouraging compared to those of CCCR in Chinese NSCLC patients. In addition, the toxicities in both groups were tolerable.
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Affiliation(s)
| | - Jinquan Xu
- Department of Cardiovascular Medicine, Hangzhou Fuyang Hospital of Traditional Chinese Medicine, Hangzhou
| | - Xuehui Wang
- Department of Respiratory Medicine, First Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin
- Correspondence: Xuehui Wang, Department of Respiratory Medicine, First Affiliated Hospital of Heilongjiang University of Chinese Medicine, No. 24, Heping Road, Xiangfang District, Harbin 150040, China (e-mail: ); Dejun Zhao, Department of Respiratory Medicine, The People's Hospital of Fuyang, No. 400 Jinqiaobei Road, Hangzhou 311400, China (e-mail: )
| | - Dejun Zhao
- Department of Respiratory Medicine, The People's Hospital of Fuyang, Hangzhou, China
- Correspondence: Xuehui Wang, Department of Respiratory Medicine, First Affiliated Hospital of Heilongjiang University of Chinese Medicine, No. 24, Heping Road, Xiangfang District, Harbin 150040, China (e-mail: ); Dejun Zhao, Department of Respiratory Medicine, The People's Hospital of Fuyang, No. 400 Jinqiaobei Road, Hangzhou 311400, China (e-mail: )
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16
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Takase N, Hattori Y, Kiriu T, Itoh S, Kawa Y, Yamamoto M, Urata Y, Shimada T, Tsujino K, Soejima T, Negoro S, Satouchi M. Concurrent chemoradiotherapy with cisplatin and S-1 or vinorelbine for patients with stage III unresectable non-small cell lung cancer: A retrospective study. Respir Investig 2016; 54:334-40. [PMID: 27566381 DOI: 10.1016/j.resinv.2016.02.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 12/24/2015] [Accepted: 02/22/2016] [Indexed: 12/28/2022]
Abstract
BACKGROUND Concurrent chemoradiotherapy (CCRT) is the preferred treatment for stage III unresectable non-small cell lung cancer (NSCLC). However, there have been few reports on combination chemotherapy with radiation for second- and third-generation antitumor drugs, although clinical guidelines have recommended the use of these drugs along with platinum agents. METHODS We retrospectively analyzed the efficacy and toxicity of cisplatin and either S-1 or vinorelbine for treating stage III unresectable NSCLC patients who were treated with CCRT. RESULTS Between September 2006 and May 2014, 56 patients with unresectable stage III NSCLC were treated with CCRT with S-1 and cisplatin (median age: 63 years) and 58 patients were treated with CCRT with vinorelbine and cisplatin (median age: 61 years). The median follow-up time was 14.6 months in the S-1 arm and 28.0 months in the vinorelbine arm. We found no significant difference in progression-free survival (15.8 months vs. 10.1 months; p=0.15) and overall survival (33.7 months vs. 31.1 months; p=0.63) between the S-1 and vinorelbine arms, respectively. Severe (more than grade 3) leukopenia (35.7% vs. 98.2%; p<0.01), neutropenia (44.6% vs. 98.2%; p<0.01), and febrile neutropenia (1.8% vs. 46.6%, p<0.01) were significantly less frequent in the S-1 arm than in the vinorelbine arm. Treatment-related deaths were not observed in either arm. CONCLUSIONS CCRT with both S-1 or vinorelbine with cisplatin appears feasible based on their efficacy and toxicity profiles. Both treatments may be recommended as treatment options for patients with stage III unresectable NSCLC.
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Affiliation(s)
- Naoto Takase
- Department of Medical Oncology, Hyogo Cancer Center, Akashi-City, Hyogo 673-8558, Japan.
| | - Yoshihiro Hattori
- Department of Thoracic Oncology, Hyogo Cancer Center, 13-70 Kitaoji-cho, Akashi-City, Hyogo 673-8558, Japan.
| | - Tatsunori Kiriu
- Department of Thoracic Oncology, Hyogo Cancer Center, 13-70 Kitaoji-cho, Akashi-City, Hyogo 673-8558, Japan.
| | - Shouichi Itoh
- Department of Thoracic Oncology, Hyogo Cancer Center, 13-70 Kitaoji-cho, Akashi-City, Hyogo 673-8558, Japan.
| | - Yoshitaka Kawa
- Department of Thoracic Oncology, Hyogo Cancer Center, 13-70 Kitaoji-cho, Akashi-City, Hyogo 673-8558, Japan.
| | - Masatsugu Yamamoto
- Department of Thoracic Oncology, Hyogo Cancer Center, 13-70 Kitaoji-cho, Akashi-City, Hyogo 673-8558, Japan.
| | - Yoshiko Urata
- Department of Thoracic Oncology, Hyogo Cancer Center, 13-70 Kitaoji-cho, Akashi-City, Hyogo 673-8558, Japan.
| | - Temiko Shimada
- Department of Thoracic Oncology, Hyogo Cancer Center, 13-70 Kitaoji-cho, Akashi-City, Hyogo 673-8558, Japan.
| | - Kayoko Tsujino
- Department of Therapeutic Radiology, Hyogo Cancer Center, Akashi-City, Hyogo 673-8558, Japan.
| | - Toshinori Soejima
- Department of Therapeutic Radiology, Hyogo Cancer Center, Akashi-City, Hyogo 673-8558, Japan.
| | - Shunichi Negoro
- Department of Medical Oncology, Hyogo Cancer Center, Akashi-City, Hyogo 673-8558, Japan.
| | - Miyako Satouchi
- Department of Thoracic Oncology, Hyogo Cancer Center, 13-70 Kitaoji-cho, Akashi-City, Hyogo 673-8558, Japan.
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Zhao Q, Wang Z, Huang W, Wang Q, Yu S, Zhou T, Han D, Wu Z, Gong H, Sun H, Zhang J, Wei Y, Li H, Zhang Z, Lin H, Li B. Phase III study of cisplatin with pemtrexed or vinorelbine plus concurrent late course accelerated hyperfractionated radiotherapy in patients with unresectable stage III non-small cell lung cancer. Oncotarget 2016; 7:8422-31. [PMID: 26761213 PMCID: PMC4885003 DOI: 10.18632/oncotarget.6871] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 01/01/2016] [Indexed: 12/25/2022] Open
Abstract
Our aim was to evaluate the efficacy and safety of cisplatin with pemtrexed or vinorelbine and concurrent late course accelerated hyperfractionated radiotherapy (LCAHRT). Patients with unresectable stage III non-small-cell lung cancer (NSCLC) were randomly assigned to two regimens. The experimental (PP) arm included cisplatin, pemtrexed and concurrent LCAHRT based on bilateral lung V20 = 33%. The control (NP) arm used cisplatin, vinorelbine with the same radiotherapy protocol. The primary endpoint was overall survival. Median survival times were 26.0 months (95% CI 23.2 to 28.7 months) and 28.5 months (95% CI 17.1 to 39.9 months) for the NP and PP arms, respectively (P = 0.26). Median progression-free survival was 12.5 months and 17.5 months in the NP and PP arms (P = 0.07). In both arms of the study, there were no differences in overall survival between patients with squamous and nonsquamous NSCLC. The incidences of grade 3 or 4 toxicity were higher in NP than PP arm. With concurrent LCAHRT, pemetrexed/cisplatin was equally as efficacious as vinorelbine/cisplatin, but showed a more favorable toxicity profile.
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Affiliation(s)
- Qian Zhao
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong Academy of Medical Sciences, Jinan, Shandong, P.R. China
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Jinan, Shandong, P.R. China
| | - Zhongtang Wang
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Jinan, Shandong, P.R. China
| | - Wei Huang
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Jinan, Shandong, P.R. China
| | - Qiang Wang
- Department of Radiation Oncology, People's Hospital of Linzi District, Zibo, Shandong, P.R. China
| | - Shuzeng Yu
- Department of Radiation Oncology, LiaoCheng People's Hospital, LiaoCheng, Shandong, P.R. China
| | - Tao Zhou
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Jinan, Shandong, P.R. China
| | - Dan Han
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Jinan, Shandong, P.R. China
| | - Zhenying Wu
- Department of Radiation Oncology, Second People's Hospital of Dezhou City, Dezhou, Shandong, P.R. China
| | - Heyi Gong
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Jinan, Shandong, P.R. China
| | - Hongfu Sun
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Jinan, Shandong, P.R. China
| | - Jian Zhang
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Jinan, Shandong, P.R. China
| | - Yumei Wei
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Jinan, Shandong, P.R. China
| | - Hongsheng Li
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Jinan, Shandong, P.R. China
| | - Zicheng Zhang
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Jinan, Shandong, P.R. China
| | - Haiqun Lin
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Jinan, Shandong, P.R. China
| | - Baosheng Li
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Jinan, Shandong, P.R. China
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18
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Mertsoylu H, Köse F, Sümbül AT, Sedef AM, Doğan Ö, Besen AA, Parlak C, Fındıkçıoğlu A, Muallaoğlu S, Sezer A, Sakallı H, Özyılkan Ö. Concurrent chemoradiotherapy with vinorelbine plus split-dose cisplatin may be an option in inoperable stage III non-small cell lung cancer: a single-center experience. Med Sci Monit 2015; 21:661-6. [PMID: 25731741 PMCID: PMC4356262 DOI: 10.12659/msm.892730] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Concurrent chemoradiotherapy is the current standard treatment for inoperable stage III non-small cell lung cancer (NSCLC). In this study we aimed to investigate the efficacy and toxicity of CCRT with split dose of cisplatin (30 mg/m2) and vinorelbine (20 mg/m2) in patients with inoperable stage III NSCLC followed in our oncology clinic. MATERIAL AND METHODS Medical records of 97 patients with inoperable stage III NSCLC treated with concurrent chemoradiotherapy with cisplatin-vinorelbine were retrospectively analyzed. Cisplatin (30 mg/m2) and vinorelbine (20 mg/m2) were administered on days 1, 8, 22, and 29 during radiotherapy. Two cycles of consolidation chemotherapy were given. All patient data, including pathological, clinical, radiological, biochemical, and hematological data, were assessed retrospectively using our database system. RESULTS Our study included 97 unresectable stage III NSCLC patients who were treated with CCRT. Median age was 58 years old (range 39-75) and 87 (89.7%) of the patients were men. ECOG performance score was 0-1 in 93 patients (95.9%). Squamous histology, the most common histology, was diagnosed in 46 patients (47.4%). Median follow-up time was 23.8 months. Median progression-free survival (PFS) and median overall survival time (OS) were 10.3 months and 17.8 months, respectively. Objective response rate and clinical benefit rate were 75.3% and 83.5%, respectively. Distant and local relapse rate were 57.1% and 42.9%, respectively. Hematological and non-hematological grade 3-4 toxicities were seen in 13 (13.4%) and 16 (16.5%) patients, respectively. Six (6.1%) patients died due to toxicity. CONCLUSIONS The results of this study suggest that split-dose cisplatin may offer fewer grade III-IV toxicities without sacrificing efficacy and could be an option in patients with inoperable stage III NSCLC during CCRT. Similar to past studies, despite high response rate during CCRT, distant relapse is the major parameter that influences patient survival in long-term in NSCLC.
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Affiliation(s)
- Hüseyin Mertsoylu
- Department of Medical Oncology, Başkent University Medical Faculty, Adana, Turkey
| | - Fatih Köse
- Department of Medical Oncology, Başkent University Medical Faculty, Adana, Turkey
| | - Ahmet Taner Sümbül
- Department of Medical Oncology, Mustafa Kemal University Medical Faculty, Hatay, Turkey
| | - Ali Murat Sedef
- Department of Medical Oncology, Başkent University Medical Faculty, Adana, Turkey
| | - Özlem Doğan
- Department of Internal Medicine, Başkent University Medical Faculty, Adana, Turkey
| | - Ali Ayberk Besen
- Division of Medical Oncology, Adana Numune Research Hospital, Adana, Turkey
| | - Cem Parlak
- Department of Radiation Oncology, Başkent University Medical Faculty, Adana, Turkey
| | - Alper Fındıkçıoğlu
- Department of Thoracic Surgery, Başkent University Medical Faculty , Adana, Turkey
| | - Sadık Muallaoğlu
- Department of Medical Oncology, Başkent University Medical Faculty, Adana, Turkey
| | - Ahmet Sezer
- Department of Medical Oncology, Başkent University Medical Faculty, Adana, Turkey
| | - Hakan Sakallı
- Division of Medical Oncology, Medline Hospital, Adana, Turkey
| | - Özgür Özyılkan
- Department of Medical Oncology, Başkent University Medical Faculty, Adana, Turkey
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Yao L, Xu S, Xu J, Yang C, Wang J, Sun D. S-1 plus cisplatin with concurrent radiotherapy versus cisplatin alone with concurrent radiotherapy for stage III non-small cell lung cancer: a pilot randomized controlled trial. Radiat Oncol 2015; 10:10. [PMID: 25572571 PMCID: PMC4311504 DOI: 10.1186/s13014-014-0306-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 12/15/2014] [Indexed: 11/30/2022] Open
Abstract
Background We investigated the efficacy and safety of S-1 and cisplatin with concurrent thoracic radiation (SCCR) over cisplatin alone plus concurrent thoracic radiation (CCR) for unresectable stage III non-small-cell lung cancer (NSCLC). Methods Between January 2009 and November 2011, 40 eligible patients with NSCLC were included and divided randomly into two groups. Twenty patients received SCCR with S-1 (orally at 40 mg/m2 per dose, b.i.d.) on days 1 through 14, cisplatin (60 mg/m2 on day 1) every 4 weeks for two cycles, and radiotherapy (60 Gy/30 fractions over 6 weeks) beginning on day 1. Twenty subjects received CCR (cisplatin and radiotherapy, the same as for SCCR). Results The 3-year overall response rate was 59.3% and 52.4% for the SCCR and CCR groups, respectively, and the difference was statistically significant, while the median overall survival was 33 months (range, 4–41 months) and 24 months (range, 2–37 months), respectively (P = 0.048). The median progression-free survival was 31 months for SCCR (range, 5–39 months), whereas it was 20 months (range, 2–37 months) for CCR (P = 0.037). The toxicity profile was similar in both groups. Conclusion In summary, we demonstrated that S-1 and cisplatin with concurrent thoracic radiation was more effective than cisplatin plus radiotherapy in NSCLC patients with acceptable toxicity. Trial registration Chinese Clinical Trials Register: ChiCTR-TRC-13003997.
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Affiliation(s)
- Lei Yao
- Department of Chest Surgery, Third Affiliated Hospital of Harbin Medical University, Haping Road No.150, Nangang District, Harbin, Heilongjiang Province, 150081, China.
| | - Shidong Xu
- Department of Chest Surgery, Third Affiliated Hospital of Harbin Medical University, Haping Road No.150, Nangang District, Harbin, Heilongjiang Province, 150081, China.
| | - Jianyu Xu
- Department of Chest Surgery, Third Affiliated Hospital of Harbin Medical University, Haping Road No.150, Nangang District, Harbin, Heilongjiang Province, 150081, China.
| | - Chaoyang Yang
- Department of Chest Surgery, Third Affiliated Hospital of Harbin Medical University, Haping Road No.150, Nangang District, Harbin, Heilongjiang Province, 150081, China.
| | - Junfeng Wang
- Department of Chest Surgery, Third Affiliated Hospital of Harbin Medical University, Haping Road No.150, Nangang District, Harbin, Heilongjiang Province, 150081, China.
| | - Dawei Sun
- Department of Chest Surgery, Third Affiliated Hospital of Harbin Medical University, Haping Road No.150, Nangang District, Harbin, Heilongjiang Province, 150081, China.
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Trimodality Therapy for Lung Cancer With Chest Wall Invasion: Initial Results of a Phase II Study. Ann Thorac Surg 2014; 98:1184-91. [DOI: 10.1016/j.athoracsur.2014.05.022] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2014] [Revised: 04/16/2014] [Accepted: 05/05/2014] [Indexed: 11/20/2022]
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Park KS, Raffeld M, Moon YW, Xi L, Bianco C, Pham T, Lee LC, Mitsudomi T, Yatabe Y, Okamoto I, Subramaniam D, Mok T, Rosell R, Luo J, Salomon DS, Wang Y, Giaccone G. CRIPTO1 expression in EGFR-mutant NSCLC elicits intrinsic EGFR-inhibitor resistance. J Clin Invest 2014; 124:3003-15. [PMID: 24911146 DOI: 10.1172/jci73048] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Accepted: 04/25/2014] [Indexed: 01/02/2023] Open
Abstract
The majority of non-small cell lung cancer (NSCLC) patients harbor EGFR-activating mutations that can be therapeutically targeted by EGFR tyrosine kinase inhibitors (EGFR-TKI), such as erlotinib and gefitinib. Unfortunately, a subset of patients with EGFR mutations are refractory to EGFR-TKIs. Resistance to EGFR inhibitors reportedly involves SRC activation and induction of epithelial-to-mesenchymal transition (EMT). Here, we have demonstrated that overexpression of CRIPTO1, an EGF-CFC protein family member, renders EGFR-TKI-sensitive and EGFR-mutated NSCLC cells resistant to erlotinib in culture and in murine xenograft models. Furthermore, tumors from NSCLC patients with EGFR-activating mutations that were intrinsically resistant to EGFR-TKIs expressed higher levels of CRIPTO1 compared with tumors from patients that were sensitive to EGFR-TKIs. Primary NSCLC cells derived from a patient with EGFR-mutated NSCLC that was intrinsically erlotinib resistant were CRIPTO1 positive, but gained erlotinib sensitivity upon loss of CRIPTO1 expression during culture. CRIPTO1 activated SRC and ZEB1 to promote EMT via microRNA-205 (miR-205) downregulation. While miR-205 depletion induced erlotinib resistance, miR-205 overexpression inhibited CRIPTO1-dependent ZEB1 and SRC activation, restoring erlotinib sensitivity. CRIPTO1-induced erlotinib resistance was directly mediated through SRC but not ZEB1; therefore, cotargeting EGFR and SRC synergistically attenuated growth of erlotinib-resistant, CRIPTO1-positive, EGFR-mutated NSCLC cells in vitro and in vivo, suggesting that this combination may overcome intrinsic EGFR-inhibitor resistance in patients with CRIPTO1-positive, EGFR-mutated NSCLC.
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Kong FM(S, Zhao J, Wang J, Faivre-Finn C. Radiation dose effect in locally advanced non-small cell lung cancer. J Thorac Dis 2014; 6:336-47. [PMID: 24688778 PMCID: PMC3968556 DOI: 10.3978/j.issn.2072-1439.2014.01.23] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Accepted: 01/20/2014] [Indexed: 11/14/2022]
Abstract
Radiation is the foundation of treatment for locally advanced non-small cell lung cancer (NSCLC), and as such, optimal radiation dose is essential for successful treatment. This article will briefly review biological considerations of radiation dose and their effect in the context of three-dimensional conformal radiation therapy (3D-CRT) including intensity modulated radiation therapy (IMRT) and stereotactic body radiation therapy (SBRT) for NSCLC. It will focus on literature review and discussions regarding radiation dose effect in locally advanced NSCLC including potential severe and lethal toxicities of high dose radiation given with concurrent chemotherapy. Potential new approaches for delivering safe and effective doses by individualizing treatment based on functional imaging are being applied in studies such as the PET boost trial and RTOG1106. The RTOG concept of delivering high dose radiation to the more resistant tumors with the use of isotoxic dose prescription and adaptive planning will also be discussed in detail.
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Fukushima T, Tateishi K, Hanaoka M, Koiwai K, Sasaki S, Koizumi T. Successful Concurrent Chemoradiotherapy with Cisplatin plus Vinorelbine for Locally Advanced Thymic Carcinoma. Case Rep Oncol 2014; 7:65-9. [PMID: 24575019 PMCID: PMC3934680 DOI: 10.1159/000358380] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Little information is available about the usefulness of concurrent chemoradiotherapy for locally advanced thymic carcinoma due to a rare anterior mediastinal tumor. We experienced a case of locally advanced thymic carcinoma that responded well to concurrent thoracic radiotherapy combined with cisplatin plus vinorelbine chemotherapy. The patient showed remarkable tumor regression and has remained disease free for over 4 years following combined therapy. Concurrent chemoradiotherapy seems to be effective for locally advanced thymic carcinoma, and cisplatin plus vinorelbine could be an alternative chemotherapy regimen in combination with thoracic radiotherapy in patients with thymic carcinoma.
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Affiliation(s)
- Toshirou Fukushima
- First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Kazunari Tateishi
- First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Masayuki Hanaoka
- First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Keiichirou Koiwai
- Department of Radiology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Shigeru Sasaki
- Department of Comprehensive Cancer Therapy, Shinshu University School of Medicine, Matsumoto, Japan
| | - Tomonobu Koizumi
- Department of Comprehensive Cancer Therapy, Shinshu University School of Medicine, Matsumoto, Japan
- *Tomonobu Koizumi, MD, Department of Comprehensive Cancer Therapy, Shinshu University School of Medicine, 3-1-1, Asahi, Matsumoto 390-8621 (Japan), E-Mail
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Akamatsu H, Mori K, Naito T, Imai H, Ono A, Shukuya T, Taira T, Kenmotsu H, Murakami H, Endo M, Harada H, Takahashi T, Yamamoto N. Progression-free survival at 2 years is a reliable surrogate marker for the 5-year survival rate in patients with locally advanced non-small cell lung cancer treated with chemoradiotherapy. BMC Cancer 2014; 14:18. [PMID: 24422706 PMCID: PMC3901557 DOI: 10.1186/1471-2407-14-18] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Accepted: 01/09/2014] [Indexed: 12/04/2022] Open
Abstract
Background In locally advanced Non-Small-Cell Lung Cancer (LA-NSCLC) patients treated with chemoradiotherapy (CRT), optimal surrogate endpoint for cure has not been fully investigated. Methods The clinical records of LA-NSCLC patients treated with concurrent CRT at Shizuoka Cancer Center between Sep. 2002 and Dec. 2009 were reviewed. The primary outcome of this study was to evaluate the surrogacy of overall response rate (ORR) and progression-free survival (PFS) rate at 3-month intervals (from 9 to 30 months after the initiation of treatment) for the 5-year survival rate. Landmark analyses were performed to assess the association of these outcomes with the 5-year survival rate. Results One hundred and fifty-nine patients were eligible for this study. The median follow-up time for censored patients was 57 months. The ORR was 72%, median PFS was 12 months, and median survival time was 39 months. Kaplan-Meier curve of progression-free survival and hazard ratio of landmark analysis at each time point suggest that most progression occurred within 2 years. With regard to 5-year survival rate, patients with complete response, or partial response had a rate of 45%. Five-year survival rates of patients who were progression free at each time point (3-months intervals from 9 to 30 months) were 53%, 69%, 75%, 82%, 84%, 89%, 90%, and 90%, respectively. The rate gradually increased in accordance with progression-free interval extended, and finally reached a plateau at 24 months. Conclusions Progression-free survival at 2 years could be a reliable surrogate marker for the 5-year survival rate in LA-NSCLC patients treated with concurrent CRT.
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Affiliation(s)
- Hiroaki Akamatsu
- Division of Thoracic Oncology, Shizuoka Cancer Center, Shimonagakubo, 1007 Shimonagakubo, Nagaizumi-cho Sunto-gun, Shizuoka 411-8777, Japan.
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Hishida T, Yoshida J, Ohe Y, Aokage K, Ishii G, Nagai K. Surgical outcomes after initial surgery for clinical single-station N2 non-small-cell lung cancer. Jpn J Clin Oncol 2013; 44:85-92. [PMID: 24203815 DOI: 10.1093/jjco/hyt164] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Single-station N2 (Stage IIIA) non-small-cell lung cancer has been reported to have a relatively favorable prognosis after surgery. However, most previous studies examined surgical outcomes in N2 disease by pathologic nodal status but not by clinical nodal status. The objective of this study was to clarify the surgical outcomes in clinical single-station N2 non-small-cell lung cancer patients. METHODS A total of 125 consecutive patients with clinical single-station N2 non-small-cell lung cancer were treated in our institution between 1992 and 2008. Among them, 97 (78%) patients underwent thoracotomy, and were included in this retrospective study. We defined clinical single-station N2 node as a node measuring 1-2 cm in a single mediastinal station observed on contrast-enhanced computed tomography. The median follow-up period was 5.9 years (range, 1.8-12.6). RESULTS Eighty-eight (91%) patients underwent lung resection. Of them, 17 (19%) had true (pathologic) single-station N2 disease. Twenty-eight (32%) had pathologic multistation N2 and 43 (49%) had pN0-1 disease with favorable prognoses. The overall survival of the clinical single-station N2/pathologic N2 patients after initial surgery was unsatisfactory with a 5-year overall survival of 23.6%, but their prognoses were heterogeneous. True single-station pathologic N2 status (hazard ratio = 0.35, P = 0.008) and negative subcarinal node status (hazard ratio = 0.34, P = 0.022) were independent favorable prognostic factors after initial resection for clinical single-station N2/ pathologic N2 patients. The patients with both factors revealed a relatively favorable 5-year overall survival of 43.8%. CONCLUSION Clinical single-station N2 status does not always correspond with pathologic true N2 status. From a prognostic point of view, initial surgery for clinical single-station N2 patients is indicated if their true single-station N2 status and negative subcarinal involvement are preoperatively confirmed.
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Affiliation(s)
- Tomoyuki Hishida
- *Division of Thoracic Surgery, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, Chiba 277-8577, Japan.
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Sugawara S, Maemondo M, Tachihara M, Inoue A, Ishimoto O, Sakakibara T, Usui K, Watanabe H, Matsubara N, Watanabe K, Kanazawa K, Ishida T, Saijo Y, Nukiwa T. Randomized phase II trial of uracil/tegafur and cisplatin versus vinorelbine and cisplatin with concurrent thoracic radiotherapy for locally advanced unresectable stage III non-small-cell lung cancer: NJLCG 0601. Lung Cancer 2013; 81:91-6. [DOI: 10.1016/j.lungcan.2013.04.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Revised: 03/14/2013] [Accepted: 04/08/2013] [Indexed: 11/16/2022]
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Caffo O, Dipasquale M, Murgia V, Veccia A, Galligioni E. An evaluation of the pharmacokinetics and clinical use of vinorelbine for NSCLC treatment. Expert Opin Drug Metab Toxicol 2013; 9:1037-51. [DOI: 10.1517/17425255.2013.804065] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Horinouchi H, Sekine I, Sumi M, Noda K, Goto K, Mori K, Tamura T. Long-term results of concurrent chemoradiotherapy using cisplatin and vinorelbine for stage III non-small-cell lung cancer. Cancer Sci 2013; 104:93-7. [PMID: 23004347 PMCID: PMC7657241 DOI: 10.1111/cas.12028] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Revised: 09/09/2012] [Accepted: 09/13/2012] [Indexed: 01/02/2023] Open
Abstract
Concurrent chemoradiotherapy is the standard treatment for unresectable stage III non-small cell lung cancer (NSCLC). The long-term feasibility and efficacy of vinorelbine and cisplatin with concurrent thoracic radiotherapy were investigated. Eighteen patients received cisplatin (80 mg/m(2)) on day 1 and vinorelbine (20 mg/m(2) in level 1, and 25 mg/m(2) in level 2) on days 1 and 8 every 4 weeks for four cycles in a phase I trial. Ninety-three patients received the same chemotherapy regimen except for the fixed vinorelbine (20 mg/m(2)) dosage and consolidation therapy with docetaxel (60 mg/m(2), every 3 weeks). The thoracic radiotherapy consisted of a single dose of 2 Gy once daily to a total dose of 60 Gy. A total of 111 patients were analyzed in the present study: male/female, 91/20; median age, 60 years; stage IIIA/IIIB, 50/61; and squamous/non-squamous histology, 26/85. The 3-, 5-, and 7-year overall survival rates (95% CI) were 43.2% (33.9-52.2), 25.2% (17.6-33.5), and 23.2% (15.8-31.4), respectively. The median progression-free survival and median survival time (95% CI) were 13.5 (10.1-16.7) months and 30.0 (24.3-38.8) months, respectively. Four patients (4%) experienced Grade 5 pulmonary toxicities from 4.4 to 9.4 months after the start of treatment. In conclusion, approximately 15% of patients with unresectable stage III NSCLC could be cured with chemoradiotherapy without severe late toxicities after 10 months of follow-up. Although based on the data from highly selected population participated in phase I and phase II trial, this analysis would strengthen and confirm the previous reports concerning concurrent chemoradiotherapy with third generation cytotoxic agents.
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Affiliation(s)
- Hidehito Horinouchi
- Division of Internal Medicine and Thoracic Oncology, National Cancer Center Hospital, Tokyo, Japan
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Niho S, Kubota K, Nihei K, Sekine I, Sumi M, Sekiguchi R, Funai J, Enatsu S, Ohe Y, Tamura T. Dose-Escalation Study of Thoracic Radiotherapy in Combination With Pemetrexed Plus Cisplatin Followed by Pemetrexed Consolidation Therapy in Japanese Patients With Locally Advanced Nonsquamous Non–Small-Cell Lung Cancer. Clin Lung Cancer 2013; 14:62-9. [DOI: 10.1016/j.cllc.2012.03.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2012] [Revised: 03/07/2012] [Accepted: 03/12/2012] [Indexed: 12/28/2022]
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Niho S, Ohe Y, Ishikura S, Atagi S, Yokoyama A, Ichinose Y, Okamoto H, Takeda K, Shibata T, Tamura T, Saijo N, Fukuoka M. Induction chemotherapy followed by gefitinib and concurrent thoracic radiotherapy for unresectable locally advanced adenocarcinoma of the lung: a multicenter feasibility study (JCOG 0402). Ann Oncol 2012; 23:2253-2258. [PMID: 22357446 DOI: 10.1093/annonc/mds012] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND We conducted a feasibility study of induction chemotherapy followed by gefitinib and thoracic radiotherapy (TRT) for unresectable locally advanced adenocarcinoma of the lung. PATIENTS AND METHODS Patients received induction chemotherapy with cisplatin (80 mg/m(2), days 1 and 22) and vinorelbine (25 mg/m(2), days 1, 8, 22, and 29) followed by gefitinib (250 mg daily, beginning on day 43, for 1 year) and TRT (60 Gy/30 fractions, days 57-98). The primary end point was feasibility, which was defined as the proportion of patients who completed 60 Gy of TRT and received >75% of the planned dose of gefitinib without developing grade 2 or worse pneumonitis. RESULTS Of the 38 enrolled patients, 23 patients [60.5% ; 80% confidence interval (CI) 48.8-71.3] completed treatment without experiencing grade 2 or worse pneumonitis. During the chemoradiation phase, grade 3-4 alanine aminotransferase elevations were observed in 37.1% of the patients. The overall response rate was 73.0% . The median survival time was 28.5 months (95% CI 22.5-38.2), and the 2-year survival rate was 65.4% . CONCLUSIONS Although the results did not meet our criterion for feasibility, the toxicity was acceptable. This treatment warrants further evaluation among patients with locally advanced non-small-cell lung cancer harboring epidermal growth factor receptor mutations.
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Affiliation(s)
- S Niho
- Division of Thoracic Oncology, National Cancer Center Hospital East, Kashiwa.
| | - Y Ohe
- Division of Thoracic Oncology, National Cancer Center Hospital East, Kashiwa
| | - S Ishikura
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya
| | - S Atagi
- Department of Thoracic Oncology, Division of Internal Medicine, NHO Kinki-Chuo Chest Medical Center, Sakai
| | - A Yokoyama
- Department of Internal Medicine, Niigata Cancer Center, Niigata
| | - Y Ichinose
- Department of Thoracic Oncology, National Kyushu Cancer Center, Fukuoka
| | - H Okamoto
- Department of Respiratory Medicine, Yokohama Municipal Citizen's Hospital, Yokohama
| | - K Takeda
- Department of Clinical Oncology, Osaka City General Hospital, Osaka
| | - T Shibata
- Japan Clinical Oncology Group Data Center, Multi-institutional Clinical Trial Support Center, National Cancer Center, Tokyo
| | - T Tamura
- Division of Thoracic Oncology, National Cancer Center Hospital, Tokyo
| | - N Saijo
- Department of Medical Oncology, Kinki University School of Medicine, Osaka, Japan
| | - M Fukuoka
- Department of Medical Oncology, Kinki University School of Medicine, Osaka, Japan
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Prospective study of transarterial infusion of docetaxel and cisplatin to treat non-small-cell lung cancer in patients contraindicated for standard chemotherapy. Lung Cancer 2012; 77:353-8. [PMID: 22537620 DOI: 10.1016/j.lungcan.2012.04.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2012] [Revised: 03/10/2012] [Accepted: 04/01/2012] [Indexed: 12/11/2022]
Abstract
Our previous retrospective study indicated a good response rate of non-small-cell lung carcinoma (NSCLC) to transarterial infusion chemotherapy, but the precise effect remains unresolved. This prospective study enrolled 25 patients with stage III or IV or recurrent NSCLC without distant metastasis (M1b) who were not candidates for either standard chemotherapy or chemoradiotherapy. The feeding arteries of each tumor detected by angiography were recorded and tumor staining was visually graded on a scale of I-IV. Docetaxel and cisplatin (25 and 25 mg/m(2), respectively) were administered by arterial infusion. The total dose of each was divided among feeding arteries according to the degree of tumor staining. The end points included response rate, progression-free survival (PFS), overall survival (OS) and toxicity. Correlations between effects and some clinical aspects were investigated. Of 25 patients enrolled between May 2007 and April 2011, 24 of them were evaluable. One complete response and 12 partial responses were achieved for an overall response rate of 52% (95% confidence interval [CI]: 35-69%). The median progression-free survival and overall survival periods were 6.5 (95% CI: 5.4-7.6) and 17.4 (95% CI: 14.2-20.6) months, respectively. The 1- and 2-year survival rates were 81% and 32%, respectively. Grade 3-4 hematological toxicity was not evident. Grade 3 general fatigue or appetite loss developed in patients with performance status (PS) ≥3. Neither grade 4 non-hematological toxicity nor treatment-related death occurred. Among various clinical aspects, ECOG PS significantly correlated with PFS and OS, whereas tumor staining significantly correlated with response. Survival was significantly better for patients with good PS (0 or 1) than poor PS (≥2) and those with, than without grade IV tumor staining. If a sufficient number of feeding arteries are detected and the tumor is appropriately stained, then arterial infusion chemotherapy has favorable response rates with less toxicity for patients with stage III or IV or recurrent NSCLC without distant metastasis (M1b) who cannot tolerate standard chemotherapy.
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Nitsche M, Christiansen H, Lederer K, Griesinger F, Schmidberger H, Pradier O. Fludarabine combined with radiotherapy in patients with locally advanced NSCLC lung carcinoma: a phase I study. J Cancer Res Clin Oncol 2012; 138:1113-20. [PMID: 22402597 PMCID: PMC3605492 DOI: 10.1007/s00432-012-1185-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2011] [Accepted: 02/24/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND AND PURPOSE Fludarabine is an adenine nucleoside analogue that has significant activity in hematological malignancies and has shown promising activity in combination with radiation in preclinical solid tumor models. We designed a phase I trial exploring concurrent fludarabine and radiotherapy in patients with advanced non-small cell lung cancer (NSCLC) to determine the maximum tolerated dose (MTD) of fludarabine given with concurrent irradiation. MATERIALS AND METHODS Thirteen patients with stage IIIB NSCLC received thoracic irradiation of 60 Gy. Fludarabine was administered during the 5th and 6th week of radiotherapy. Doses started at 10 mg/m(2) per day and increased by steps of 3 mg/m(2) per day. RESULTS At a daily dose of 16 mg/m(2), one out of six patients developed a grade 4 leukopenia, and one a grad 3 pneumonitis. Further grade III toxicity was not observed. The dose of 13 mg/m(2) was identified as the MTD. All patients developed a fludarabine dose-dependent lymphocytopenia. CONCLUSION Fludarabine can be safely administered concurrently with radiation at a daily dose of 13 mg/m(2) during the final 2 weeks of radiotherapy. Further prospective clinical studies are required to establish the potential role of concurrent fludarabine and radiotherapy in the treatment of locally advanced inoperable NSCLC.
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Affiliation(s)
- Mirko Nitsche
- Center of Radiation-Oncology, Gröpelinger Heerstr. 406-408, 28239 Bremen, Germany.
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Kawaguchi T, Takada M, Ando M, Okishio K, Atagi S, Fujita Y, Tomizawa Y, Hayashihara K, Okano Y, Takahashi F, Saito R, Matsumura A, Tamura A. A multi-institutional phase II trial of consolidation S-1 after concurrent chemoradiotherapy with cisplatin and vinorelbine for locally advanced non-small cell lung cancer. Eur J Cancer 2012; 48:672-7. [DOI: 10.1016/j.ejca.2011.11.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2011] [Accepted: 11/21/2011] [Indexed: 10/14/2022]
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Shintani Y, Funakoshi Y, Inoue M, Takeuchi Y, Okumura M, Maeda H, Ohta, M. Pathological Status of Mediastinal Lymph Nodes after Preoperative Concurrent Chemoradiotherapy Determines Prognosis in Patients with Non-Small Cell Lung Cancer. Ann Thorac Cardiovasc Surg 2012; 18:530-5. [DOI: 10.5761/atcs.oa.11.01811] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Yasushi Shintani
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
- Department of General Thoracic Surgery, Osaka Prefectural Medical Center for Respiratory and Allergic Disease, Habikino, Osaka, Japan
| | - Yasunobu Funakoshi
- Department of General Thoracic Surgery, National Hospital Organization Toneyama Hospital, Toyonaka, Osaka, Japan
| | - Masayoshi Inoue
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Yukiyasu Takeuchi
- Department of General Thoracic Surgery, National Hospital Organization Toneyama Hospital, Toyonaka, Osaka, Japan
| | - Meinoshin Okumura
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Hajime Maeda
- Department of General Thoracic Surgery, National Hospital Organization Toneyama Hospital, Toyonaka, Osaka, Japan
| | - Mitsunori Ohta,
- Department of General Thoracic Surgery, Osaka Prefectural Medical Center for Respiratory and Allergic Disease, Habikino, Osaka, Japan
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Weekly docetaxel and cisplatin with concomitant radiotherapy in addition to surgery and/or consolidation chemotherapy in stage III non-small cell lung cancer. Cancer Chemother Pharmacol 2011; 68:1497-505. [DOI: 10.1007/s00280-011-1642-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2011] [Accepted: 03/26/2011] [Indexed: 10/18/2022]
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Piccirillo MC, Daniele G, Di Maio M, Bryce J, De Feo G, Del Giudice A, Perrone F, Morabito A. Vinorelbine for non-small cell lung cancer. Expert Opin Drug Saf 2010; 9:493-510. [DOI: 10.1517/14740331003774078] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
| | - Gennaro Daniele
- Clinical Trials Unit, National Cancer Institute, Via M Semmola, 80131 Napoli, Italy ;
| | - Massimo Di Maio
- Clinical Trials Unit, National Cancer Institute, Via M Semmola, 80131 Napoli, Italy ;
| | - Jane Bryce
- Clinical Trials Unit, National Cancer Institute, Via M Semmola, 80131 Napoli, Italy ;
| | - Gianfranco De Feo
- Clinical Trials Unit, National Cancer Institute, Via M Semmola, 80131 Napoli, Italy ;
| | - Antonia Del Giudice
- Clinical Trials Unit, National Cancer Institute, Via M Semmola, 80131 Napoli, Italy ;
| | - Francesco Perrone
- Clinical Trials Unit, National Cancer Institute, Via M Semmola, 80131 Napoli, Italy ;
| | - Alessandro Morabito
- Thoraco-Pulmonary Medical Oncology Unit, National Cancer Institute, Via M Semmola, 80131 Napoli, Italy
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Tsutsumi K, Tsuda M, Yazawa N, Nakamura H, Ishihara S, Haga H, Yasuda M, Yamazaki R, Shirato H, Kawaguchi H, Nishioka T, Ohba Y. Increased Motility and Invasiveness in Tumor Cells That Survive 10 Gy Irradiation. Cell Struct Funct 2009; 34:89-96. [DOI: 10.1247/csf.09006] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Kaori Tsutsumi
- Department of Biomedical Science and Engineering, Faculty of Health Sciences, Hokkaido University
- Laboratory of Pathophysiology and Signal Transduction, Hokkaido University Graduate School of Medicine
| | - Masumi Tsuda
- Laboratory of Pathophysiology and Signal Transduction, Hokkaido University Graduate School of Medicine
| | - Natsuka Yazawa
- Department of Biomedical Science and Engineering, Faculty of Health Sciences, Hokkaido University
| | - Hirotaka Nakamura
- Department of Biomedical Science and Engineering, Faculty of Health Sciences, Hokkaido University
| | - Seiichiro Ishihara
- Division of Biological Sciences, Graduate School of Science, Hokkaido University
| | - Hisashi Haga
- Division of Biological Sciences, Graduate School of Science, Hokkaido University
| | - Motoaki Yasuda
- Department of Oral Pathobiological Science, Graduate School of Dental Medicine, Hokkaido University
| | - Rie Yamazaki
- Department of Biomedical Science and Engineering, Faculty of Health Sciences, Hokkaido University
| | - Hiroki Shirato
- Department of Radiology, Hokkaido University Graduate School of Medicine
| | - Hideaki Kawaguchi
- Laboratory of Pathophysiology and Signal Transduction, Hokkaido University Graduate School of Medicine
| | - Takeshi Nishioka
- Department of Biomedical Science and Engineering, Faculty of Health Sciences, Hokkaido University
| | - Yusuke Ohba
- Laboratory of Pathophysiology and Signal Transduction, Hokkaido University Graduate School of Medicine
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