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de Jesus M, Chanda A, Grabauskas T, Kumar M, Kim AS. Cardiovascular disease and lung cancer. Front Oncol 2024; 14:1258991. [PMID: 38410099 PMCID: PMC10896114 DOI: 10.3389/fonc.2024.1258991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 01/19/2024] [Indexed: 02/28/2024] Open
Abstract
Lung cancer is the second most common cancer worldwide and the leading cause of cancer-related death. While survival rates have improved with advancements in cancer therapeutics, additional health challenges have surfaced. Cardiovascular disease (CVD) is a leading cause of morbidity and mortality in patients with lung cancer. CVD and lung cancer share many risk factors, such as smoking, hypertension, diabetes, advanced age, and obesity. Optimal management of this patient population requires a full understanding of the potential cardiovascular (CV) complications of lung cancer treatment. This review outlines the common shared risk factors, the spectrum of cardiotoxicities associated with lung cancer therapeutics, and prevention and management of short- and long-term CVD in patients with non-small cell (NSCLC) and small cell (SCLC) lung cancer. Due to the medical complexity of these patients, multidisciplinary collaborative care among oncologists, cardiologists, primary care physicians, and other providers is essential.
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Affiliation(s)
- Mikhail de Jesus
- Department of Cardiology, University of Connecticut Hartford Hospital, Hartford, CT, United States
| | - Anindita Chanda
- Department of Internal Medicine, University of Connecticut School of Medicine, Farmington, CT, United States
| | - Titas Grabauskas
- University of Connecticut School of Medicine, Farmington, CT, United States
| | - Manish Kumar
- Department of Cardiology, Pat & Jim Calhoun Cardiology Center, University of Connecticut School of Medicine, Farmington, CT, United States
| | - Agnes S Kim
- Department of Cardiology, Pat & Jim Calhoun Cardiology Center, University of Connecticut School of Medicine, Farmington, CT, United States
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2
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Shah MP, Neal JW. Relative Impact of Anticancer Therapy on Unplanned Hospital Care in Patients With Non-Small-Cell Lung Cancer. JCO Oncol Pract 2020; 17:e1131-e1138. [PMID: 33351677 DOI: 10.1200/op.20.00612] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE In lung cancer, unplanned hospital care is a significant driver of costs. While toxicities of cancer therapies are well-known, there are little data on their relative contribution to unplanned care. This study aims to (1) determine the relative impact of tyrosine-kinase inhibitor (TKI) therapy, immune checkpoint inhibitor immunotherapy, and cytotoxic chemotherapy on unplanned hospital care and (2) identify potential strategies to prevent unplanned hospital encounters in patients with non-small-cell lung cancer (NSCLC). METHODS A research database search of the electronic health record was used to identify 97 patients with established NSCLC who were undergoing either TKI therapy, immunotherapy, or chemotherapy at our institution and visited our emergency department (ED) in 2018. The resulting 173 ED encounters were reviewed to determine (1) the cause (cancer, therapy, other, or rule-out) of each encounter and (2) whether the encounter was preventable. RESULTS A small portion (9%) of all unplanned hospital encounters were therapy related (2% in the TKI therapy group, 12% in the immunotherapy group, and 21% in the chemotherapy group). Cancer itself was the leading cause (54%) of the encounters. Over 20% of all encounters were classified as preventable, and half of those encounters were deemed unnecessary. DISCUSSION TKI therapy, immunotherapy, and, to a lesser extent, chemotherapy are relatively small drivers of unplanned acute hospital care for patients with NSCLC. A significant share of unplanned hospital encounters may be prevented through proactive evidence-based initiatives.
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Affiliation(s)
- Manan P Shah
- Department of Medicine, Division of Oncology, Stanford University, Stanford, CA
| | - Joel W Neal
- Department of Medicine, Division of Oncology, Stanford University, Stanford, CA
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3
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Zaborowska-Szmit M, Krzakowski M, Kowalski DM, Szmit S. Cardiovascular Complications of Systemic Therapy in Non-Small-Cell Lung Cancer. J Clin Med 2020; 9:E1268. [PMID: 32349387 PMCID: PMC7287714 DOI: 10.3390/jcm9051268] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 04/23/2020] [Accepted: 04/24/2020] [Indexed: 12/11/2022] Open
Abstract
Cardiovascular diseases may determine therapy outcomes of non-small-cell lung cancer (NSCLC). The evidence for how iatrogenic cardiovascular complications contribute to ceasing anticancer treatment, decreasing the quality of life or even premature death, is unclear. Older patients and smokers are at risk of atherosclerosis and arterial thromboembolic events (TE), such as myocardial infarction or stroke. Venous TE can be observed in up to 15% of NSCLC patients, but the risk increases three to five times in ALK (anaplastic lymphoma kinase)-rearranged NSCLC. ALK inhibitors are associated with electrophysiological disorders. Cytotoxic agents and anti-VEGF inhibitors mainly cause vascular complications, including venous or arterial TE. Cardiac dysfunction and arrhythmias seem to be less frequent. Chemotherapy is often administered in two-drug regimens. Clinical events can be triggered by different mechanisms. Among epidermal growth factor inhibitors, erlotinib and gefitinib can lead to coronary artery events; however, afatinib and osimertinib can be associated with the development of heart failure. During anti-PD1/anti-PDL1 therapy, myocarditis is possible, which must be differentiated from acute coronary syndrome and heart failure. Awareness of all possible cardiovascular complications in NSCLC encourages vigilance in early diagnostics and treatment.
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Affiliation(s)
- Magdalena Zaborowska-Szmit
- Department of Lung Cancer and Thoracic Tumors, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (M.Z.-S.); (M.K.); (D.M.K.)
| | - Maciej Krzakowski
- Department of Lung Cancer and Thoracic Tumors, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (M.Z.-S.); (M.K.); (D.M.K.)
| | - Dariusz M. Kowalski
- Department of Lung Cancer and Thoracic Tumors, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (M.Z.-S.); (M.K.); (D.M.K.)
| | - Sebastian Szmit
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre, 05-400 Otwock, Poland
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Frederickson AM, Arndorfer S, Zhang I, Lorenzi M, Insinga R, Arunachalam A, Burke TA, Simon GR. Pembrolizumab plus chemotherapy for first-line treatment of metastatic nonsquamous non-small-cell lung cancer: a network meta-analysis. Immunotherapy 2019; 11:407-428. [DOI: 10.2217/imt-2018-0193] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Aim: A systematic review and network meta-analysis were conducted to evaluate the efficacy of pembrolizumab + pemetrexed + platinum relative to other regimens in metastatic nonsquamous non-small-cell lung cancer (NSq-NSCLC). Patients & methods: Eligible studies evaluated first-line regimens in NSq-NSCLC patients without known targetable mutations. Relative treatment effects were synthesized with random effects proportional hazards Bayesian network meta-analyses. Results: The hazard ratio (HR) for overall survival (OS) for pembrolizumab + pemetrexed + platinum was statistically significant over all platinum-doublet (HR range: 0.42–0.61), platinum-doublet + bevacizumab (HR range: 0.44–0.53) and platinum-doublet + atezolizumab regimens (HR range: 0.56–0.62). Additionally, pembrolizumab + pemetrexed + platinum numerically improved OS over atezolizumab + paclitaxel + carboplatin + bevacizumab (HR: 0.65; 95% credible interval: 0.43, 1.01). Pembrolizumab + pemetrexed + platinum had 95.6% probability of being the best treatment regimen for OS. Conclusion: Pembrolizumab + pemetrexed + platinum is likely the most efficacious first-line regimen for metastatic NSq-NSCLC.
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Affiliation(s)
| | - Stella Arndorfer
- Evidence Synthesis & Decision Modeling, Precision Xtract, Oakland, CA 94612, USA
| | - Ina Zhang
- Evidence Synthesis & Decision Modeling, Precision Xtract, Oakland, CA 94612, USA
| | - Maria Lorenzi
- Evidence Synthesis & Decision Modeling, Precision Xtract, Oakland, CA 94612, USA
| | - Ralph Insinga
- Center for Observational & Real World Evidence (CORE), Merck & Co., Inc., Kenilworth, NJ 07033, USA
| | - Ashwini Arunachalam
- Center for Observational & Real World Evidence (CORE), Merck & Co., Inc., Kenilworth, NJ 07033, USA
| | - Thomas A Burke
- Center for Observational & Real World Evidence (CORE), Merck & Co., Inc., Kenilworth, NJ 07033, USA
| | - George R Simon
- Department of Thoracic/Head & Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77005, USA
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Manzo A, Montanino A, Carillio G, Costanzo R, Sandomenico C, Normanno N, Piccirillo MC, Daniele G, Perrone F, Rocco G, Morabito A. Angiogenesis Inhibitors in NSCLC. Int J Mol Sci 2017; 18:E2021. [PMID: 28934120 PMCID: PMC5666703 DOI: 10.3390/ijms18102021] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 09/13/2017] [Accepted: 09/15/2017] [Indexed: 01/04/2023] Open
Abstract
Angiogenesis is a complex biological process that plays a relevant role in sustaining the microenvironment, growth, and metastatic potential of several tumors, including non-small cell lung cancer (NSCLC). Bevacizumab was the first angiogenesis inhibitor approved for the treatment of patients with advanced NSCLC in combination with chemotherapy; however, it was limited to patients with non-squamous histology and first-line setting. Approval was based on the results of two phase III trials (ECOG4599 and AVAIL) that demonstrated an improvement of about two months in progression-free survival (PFS) in both trials, and in the ECOG4599 trial, an improvement in overall survival (OS) also. Afterwards, other antiangiogenic agents, including sunitinib, sorafenib, and vandetanib have been unsuccessfully tested in first and successive lines. Recently, two new antiangiogenic agents (ramucirumab and nintedanib) produced a significant survival benefit in second-line setting. In the REVEL study, ramucirumab plus docetaxel prolonged the median OS of patients with any histology NSCLC when compared with docetaxel alone (10.4 versus 9.1 months, hazard ratio (HR) 0.857, p = 0.0235). In the LUME-Lung 1 study, nintedanib plus docetaxel prolonged the median PFS of patients with any tumor histology (p = 0.0019), and improved OS (12.6 versus 10.3 months) in patients with adenocarcinoma. As a result, it became a new option for the second-line treatment of patients with advanced NSCLC and adenocarcinoma histology. Identifying predictive biomarkers to optimize the benefit of antiangiogenic drugs remains an ongoing challenge.
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MESH Headings
- Adenocarcinoma/drug therapy
- Adenocarcinoma/metabolism
- Adenocarcinoma/mortality
- Adenocarcinoma/pathology
- Angiogenesis Inhibitors/therapeutic use
- Antibodies, Monoclonal/therapeutic use
- Antibodies, Monoclonal, Humanized
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Bevacizumab/therapeutic use
- Carcinoma, Non-Small-Cell Lung/drug therapy
- Carcinoma, Non-Small-Cell Lung/metabolism
- Carcinoma, Non-Small-Cell Lung/mortality
- Carcinoma, Non-Small-Cell Lung/pathology
- Clinical Trials, Phase III as Topic
- Disease-Free Survival
- Docetaxel
- Humans
- Indoles/therapeutic use
- Lung Neoplasms/drug therapy
- Lung Neoplasms/metabolism
- Lung Neoplasms/mortality
- Lung Neoplasms/pathology
- Neovascularization, Pathologic/drug therapy
- Neovascularization, Pathologic/metabolism
- Neovascularization, Pathologic/mortality
- Neovascularization, Pathologic/pathology
- Niacinamide/analogs & derivatives
- Niacinamide/therapeutic use
- Phenylurea Compounds/therapeutic use
- Piperidines/therapeutic use
- Pyrroles/therapeutic use
- Quinazolines/therapeutic use
- Sorafenib
- Sunitinib
- Taxoids/therapeutic use
- Ramucirumab
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Affiliation(s)
- Anna Manzo
- Thoracic Medical Oncology, Istituto Nazionale Tumori, "Fondazione G.Pascale"-IRCCS, 80131 Napoli, Italy.
| | - Agnese Montanino
- Thoracic Medical Oncology, Istituto Nazionale Tumori, "Fondazione G.Pascale"-IRCCS, 80131 Napoli, Italy.
| | - Guido Carillio
- Department of Oncology and Hematology, Azienda Ospedaliera Pugliese-Ciaccio, 88100 Catanzaro, Italy.
| | - Raffaele Costanzo
- Thoracic Medical Oncology, Istituto Nazionale Tumori, "Fondazione G.Pascale"-IRCCS, 80131 Napoli, Italy.
| | - Claudia Sandomenico
- Thoracic Medical Oncology, Istituto Nazionale Tumori, "Fondazione G.Pascale"-IRCCS, 80131 Napoli, Italy.
| | - Nicola Normanno
- Cellular Biology and Biotherapy, Research Department, Istituto Nazionale Tumori "Fondazione G.Pascale"-IRCCS, Napoli 80131, Italy.
| | - Maria Carmela Piccirillo
- Clinical Trials Unit, Istituto Nazionale Tumori, "Fondazione G.Pascale"-IRCCS, 80131 Napoli, Italy.
| | - Gennaro Daniele
- Clinical Trials Unit, Istituto Nazionale Tumori, "Fondazione G.Pascale"-IRCCS, 80131 Napoli, Italy.
| | - Francesco Perrone
- Clinical Trials Unit, Istituto Nazionale Tumori, "Fondazione G.Pascale"-IRCCS, 80131 Napoli, Italy.
| | - Gaetano Rocco
- Thoracic Surgery, Istituto Nazionale Tumori, "Fondazione G.Pascale"-IRCCS, 80131 Napoli, Italy.
| | - Alessandro Morabito
- Thoracic Medical Oncology, Istituto Nazionale Tumori, "Fondazione G.Pascale"-IRCCS, 80131 Napoli, Italy.
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Pérez-De-Lis M, Retamozo S, Flores-Chávez A, Kostov B, Perez-Alvarez R, Brito-Zerón P, Ramos-Casals M. Autoimmune diseases induced by biological agents. A review of 12,731 cases (BIOGEAS Registry). Expert Opin Drug Saf 2017; 16:1255-1271. [DOI: 10.1080/14740338.2017.1372421] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Marta Pérez-De-Lis
- Servicio de Anestesiologia y Reanimación, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - Soledad Retamozo
- Laboratory of Autoimmune Diseases Josep Font, IDIBAPS-CELLEX, Department of Autoimmune Diseases, ICMiD, Hospital Clínic, Barcelona, Spain
- Hospital Privado Universitario de Córdoba, Córdoba, Argentina
- Instituto De Investigaciones En Ciencias De La Salud (INICSA), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Córdoba, Argentina
| | - Alejandra Flores-Chávez
- Laboratory of Autoimmune Diseases Josep Font, IDIBAPS-CELLEX, Department of Autoimmune Diseases, ICMiD, Hospital Clínic, Barcelona, Spain
- Unidad de Investigación Biomédica 02, Unidad de Investigación en Epidemiología Clínica, Centro Médico Nacional de Occidente (CMNO), Instituto Mexicano del Seguro Social (IMSS), Hospital de Especialidades, Guadalajara, Mexico
- Programa de Doctorado en Ciencias Médicas, Centro Universitario de Investigaciones Biomédicas (CUIB), Universidad de Colima, Colima, Mexico
| | | | | | - Pilar Brito-Zerón
- Laboratory of Autoimmune Diseases Josep Font, IDIBAPS-CELLEX, Department of Autoimmune Diseases, ICMiD, Hospital Clínic, Barcelona, Spain
- Autoimmune Diseases Unit, Department of Medicine, Hospital CIMA- Sanitas, Barcelona, Spain
| | - Manuel Ramos-Casals
- Laboratory of Autoimmune Diseases Josep Font, IDIBAPS-CELLEX, Department of Autoimmune Diseases, ICMiD, Hospital Clínic, Barcelona, Spain
- Department of Medicine, University of Barcelona, Barcelona, Spain
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Miura S, Maemondo M, Iwashima A, Harada T, Sugawara S, Kobayashi K, Inoue A, Nakagawa T, Takiguchi Y, Watanabe H, Ishida T, Terada M, Kagamu H, Gemma A, Yoshizawa H. A phase II study of carboplatin plus weekly paclitaxel with bevacizumab for elderly patients with non-squamous non-small-cell lung cancer (NEJ016). Invest New Drugs 2017; 35:227-234. [PMID: 28150074 DOI: 10.1007/s10637-017-0436-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Accepted: 01/24/2017] [Indexed: 12/24/2022]
Abstract
Background The efficacy and safety of bevacizumab in elderly patients with non-small cell lung cancer remain controversial. This study focused on both selecting fit elderly patients and overcoming interpatient variability with respect to pharmacodynamics. Methods Elderly (age: ≥70 years) patients with advanced non-squamous non-small cell lung cancer were enrolled. Patients with uncontrolled congestive heart failure and uncontrolled diabetes were excluded. The treatment regimen comprised carboplatin at an area under the curve of 5 mg/ml/min on day 1, paclitaxel at 90 mg/m2 on days 1 and 8, and bevacizumab at 15 mg/kg on day 1 every 21 days for up to 4 cycles, followed by maintenance bevacizumab. Dose reduction due to side effects was performed, with a wide range of doses of paclitaxel from 23 mg/m2/week to 60 mg/m2/week. Results Of the 36 patients entered, 38.9% required a dose reduction or cancellation of paclitaxel administration on day 8, and 75% patients were able to complete 4 cycles of triplet therapy. The response rate, primary endpoint, was 69.4% (95% confidence interval [CI]: 51.9-83.7). The median progression free survival and overall survival were 8.4 months and 29.2 months, respectively. The most common adverse events included neutropenia, hypertension, anemia, and infection. Although Grade ≥ 3 adverse events were observed in 24 patients (66.7%), there were no deaths due to toxicity. Conclusion Carboplatin plus weekly paclitaxel with bevacizumab is a feasible, effective first-line regimen for elderly non-small cell lung cancer patients. (UMIN00006622).
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Affiliation(s)
- Satoru Miura
- Department of Internal Medicine, Niigata Cancer Center Hospital, 2-15-3, Kawagishicho, Chuo-ku, Niigata, 951-8566, Japan. .,Department of Respiratory Medicine and Infectious Disease, Niigata University Medical and Dental Hospital, Niigata, Japan.
| | - Makoto Maemondo
- Department of Respiratory Medicine, Miyagi Cancer Center, Natori, Japan
| | - Akira Iwashima
- Department of Respiratory Medicine, Nagaoka Chuo General Hospital, Nagaoka, Japan
| | - Toshiyuki Harada
- Center for Respiratory Diseases, Japan Community Health Care Organization Hokkaido Hospital, Sapporo, Japan
| | - Shunichi Sugawara
- Department of Pulmonary Medicine, Sendai Kousei Hospital, Sendai, Japan
| | - Kunihiko Kobayashi
- Department of Respiratory Medicine, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Akira Inoue
- Department of Palliative Medicine, Tohoku University School of Medicine, Sendai, Japan
| | - Taku Nakagawa
- Department of Thoracic Surgery, Omagari Kosei Medical Center, Akita, Japan
| | - Yuichi Takiguchi
- Department of Medical Oncology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Hiroshi Watanabe
- Department of Respiratory Medicine, Saka General Hospital, Shiogama, Japan
| | - Takashi Ishida
- Department of Internal Medicine, Niigata Prefectural Central Hospital, Joetsu, Japan
| | - Masaki Terada
- Department of Respiratory Medicine, Saiseikai Niigata Daini Hospital, Niigata, Japan
| | - Hiroshi Kagamu
- Department of Respiratory Medicine and Infectious Disease, Niigata University Medical and Dental Hospital, Niigata, Japan.,Department of Respiratory Medicine, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Akihiko Gemma
- Department of Pulmonary Medicine and Oncology, Nippon Medical School, Graduate School of Medicine, Tokyo, Japan
| | - Hirohisa Yoshizawa
- Department of Respiratory Medicine and Infectious Disease, Niigata University Medical and Dental Hospital, Niigata, Japan.,Department of Respiratory Medicine, Niigata Medical Center Hospital, Niigata, Japan
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8
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Abstract
OPINION STATEMENT Lung cancer is the leading cause of cancer-related deaths worldwide. In the USA, ≈60 % of lung cancer cases are diagnosed in elderly patients (≥65 years of age). However, elderly patients are underrepresented in clinical studies, leading to a paucity of evidence to guide treatment decisions. Several treatment barriers exist in elderly patients, including comorbidities and poor performance status. In addition, lack of reliable geriatric assessment tools and physician reluctance to treat may contribute to undertreatment in this population. For decades, systemic chemotherapy for elderly patients with advanced non-small cell lung cancer (NSCLC) was either omitted or given as monotherapy, frequently with significant dose reductions, potentially compromising the efficacy of these therapies. Recent analyses of elderly subgroups from multiple clinical trials provide evidence for improved outcomes associated with platinum-based doublet chemotherapies vs monotherapy. Moreover, in the new era of precision medicine, molecularly targeted therapies and more recently immune-targeting therapies (anti-PD-1 and anti-PD-L1 agents) exhibit relatively milder toxicities but superior clinical outcomes in subgroups of patients compared with conventional cytotoxic chemotherapies. Further clinical trials will be needed to confirm similar safety and efficacy profiles of these therapeutic approaches in the elderly compared with their younger counterparts. In this article, we review available evidence from clinical studies and also present expert consensus on the management of NSCLC in the elderly, including treatment in the adjuvant setting and treatment of advanced disease. Screening tools, such as the Comprehensive Geriatric Assessment, that help to identify the right population of elderly patients suitable for systemic treatment are also discussed.
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Schneider BJ, Kalemkerian GP, Gadgeel SM, Valdivieso M, Hackstock DM, Chen W, Heilbrun LK, Ruckdeschel JC, Wozniak AJ. Phase II Trial of Dose-dense Pemetrexed, Gemcitabine, and Bevacizumab in Patients With Advanced, Non-Small-cell Lung Cancer. Clin Lung Cancer 2016; 18:299-302. [PMID: 28063799 DOI: 10.1016/j.cllc.2016.11.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 11/15/2016] [Accepted: 11/22/2016] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Platinum-based chemotherapy is standard for untreated, advanced non-small-cell lung cancer (NSCLC). We investigated the activity and tolerability of the novel combination of dose-dense pemetrexed, gemcitabine, and bevacizumab in patients with advanced NSCLC. METHODS This multicenter phase II trial evaluated the safety and efficacy of the combination of pemetrexed (400 mg/m2), gemcitabine (1200 mg/m2), and bevacizumab (10 mg/kg), given every 14 days in patients with untreated, advanced NSCLC. The primary endpoint was progression-free survival with secondary endpoints of response rate and overall survival. RESULTS Thirty-nine patients were enrolled. Treatment was well tolerated; the most common grade 3-4 toxicities were neutropenia and fatigue. Of the 38 patients evaluable for tumor response, 1 (3%) had complete response, 15 (39%) had partial response, 12 (31%) had stable disease, and 10 (26%) had progressive disease. Median progression-free survival was 6.1 months (95% confidence interval [CI], 4.2-7.9) and median overall survival was 18.4 months (95% CI, 13.1-29.5). The 1-year overall survival rate was 64% (95% CI, 51%-81%) and the 2-year overall survival rate was 41% (95% CI, 28%-60%). CONCLUSIONS Treatment with dose-dense pemetrexed, gemcitabine, and bevacizumab met the primary endpoint with promising efficacy and a manageable safety profile in patients with untreated advanced NSCLC. This regimen represents a reasonable therapeutic option.
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Affiliation(s)
- Bryan J Schneider
- Division of Hematology/Oncology, University of Michigan, Ann Arbor, MI.
| | | | - Shirish M Gadgeel
- Department of Oncology, Karmanos Cancer Institute, Wayne State University, Detroit, MI
| | - Manuel Valdivieso
- Division of Hematology/Oncology, University of Michigan, Ann Arbor, MI
| | - Deborah M Hackstock
- Department of Oncology, Karmanos Cancer Institute, Wayne State University, Detroit, MI
| | - Wei Chen
- Biostatistics Core, Karmanos Cancer Institute, Wayne State University, Detroit, MI
| | - Lance K Heilbrun
- Biostatistics Core, Karmanos Cancer Institute, Wayne State University, Detroit, MI
| | | | - Antoinette J Wozniak
- Department of Oncology, Karmanos Cancer Institute, Wayne State University, Detroit, MI
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10
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Stefanou D, Stamatopoulou S, Sakellaropoulou A, Akakios G, Gkiaouraki M, Gkeka D, Prevezanou M, Ardavanis A. Bevacizumab, pemetrexed and carboplatin in first-line treatment of non-small cell lung cancer patients: Focus on patients with brain metastases. Oncol Lett 2016; 12:4635-4642. [PMID: 28101218 DOI: 10.3892/ol.2016.5268] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 04/05/2016] [Indexed: 01/16/2023] Open
Abstract
Data concerning bevacizumab plus pemetrexed plus carboplatin as first-line treatment for patients with non-squamous non-small cell lung cancer (NSCLC) with or without brain metastases (BM) are lacking. The present study analyzed the efficacy and safety of this combination as induction therapy, followed by maintenance therapy with bevacizumab plus pemetrexed in non-squamous NSCLC patients with or without BM. Treatment-naïve patients with advanced non-squamous NSCLC and an Eastern Cooperative Oncology Group performance status score of 0-2 were eligible. Treatment consisted of carboplatin (area under the curve of 5), pemetrexed (500 mg/m2) and bevacizumab (15 mg/kg) every 3 weeks for 6 cycles. Responders and patients with stable disease received maintenance therapy with bevacizumab plus pemetrexed until disease progression, which was evaluated every 3 cycles, or unacceptable toxicity. Kaplan-Meier median progression-free survival (PFS) and overall survival (OS) times were the primary endpoints, and safety was the secondary endpoint. In total, 39 patients, aged 44-78 years (median, 60 years), were treated; 11 (28.2%) of whom presented with BM. The majority of patients (56.4%) completed 6 cycles of induction therapy, and 26 patients continued on to maintenance therapy. The median PFS time was 8.2 months [95% confidence interval (CI), 7.05-9.35] and the median OS time was 14.0 months (95% CI, 8.46-19.54). Median PFS and OS times did not differ significantly between patients with or without BM (log rank (Mantel-Cox): PFS, P=0.748 and OS, P=0.447). The majority of patients (76.9%) did not experience adverse events during treatment. Overall, bevacizumab plus pemetrexed plus carboplatin as induction therapy, followed by bevacizumab plus pemetrexed as maintenance therapy was effective and well tolerated in advanced NSCLC, whether brain metastases were present or not.
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Affiliation(s)
- Dimitra Stefanou
- First Department of Medical Oncology, St. Savas Anticancer Hospital, Athens 115 22, Greece
| | - Sofia Stamatopoulou
- First Department of Medical Oncology, St. Savas Anticancer Hospital, Athens 115 22, Greece
| | | | - Gavriil Akakios
- First Department of Medical Oncology, St. Savas Anticancer Hospital, Athens 115 22, Greece
| | - Marina Gkiaouraki
- First Department of Medical Oncology, St. Savas Anticancer Hospital, Athens 115 22, Greece
| | - Despina Gkeka
- First Department of Medical Oncology, St. Savas Anticancer Hospital, Athens 115 22, Greece
| | - Maria Prevezanou
- First Department of Medical Oncology, St. Savas Anticancer Hospital, Athens 115 22, Greece
| | - Alexandros Ardavanis
- First Department of Medical Oncology, St. Savas Anticancer Hospital, Athens 115 22, Greece
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11
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Incorporation of Antiangiogenic Therapy Into the Non-Small-Cell Lung Cancer Paradigm. Clin Lung Cancer 2016; 17:493-506. [PMID: 27381269 DOI: 10.1016/j.cllc.2016.05.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 05/29/2016] [Accepted: 05/31/2016] [Indexed: 12/18/2022]
Abstract
Although molecular targeted agents have improved the treatment of lung cancer, their use has largely been restricted to limited subsets of the overall population that carry specific mutations. Angiogenesis, the formation of new blood vessels from existing networks, is an attractive, more general process for the development of targeted anticancer therapies, because it is critical for the growth of solid tumors, including non-small-cell lung cancer. Growing tissues require a vascular supply within a few millimeters. Therefore, solid tumors create a proangiogenic microenvironment to facilitate the development of new tumor-associated blood vessels, thus providing an adequate vascular supply for continued tumor growth. Antiangiogenic agents can specifically target the vascular endothelial growth factor (VEGF) signaling pathways, broadly inhibit multiple tyrosine kinases, or interfere with other angiogenic processes, such as disruption of existing tumor vasculature. The present report provides an overview of antiangiogenic therapy for non-small-cell lung cancer, including both currently approved antiangiogenic therapies (bevacizumab [anti-VEGF] and ramucirumab [anti-VEGF receptor 2] monoclonal antibodies), and a variety of promising novel agents in development. Although recent data have demonstrated promising efficacy for some novel agents, the overall development of antiangiogenic therapy has been hampered by redundancy in signaling pathways and the highly heterogeneous nature of tumors. An improved understanding of the molecular basis of angiogenesis will guide the development of new antiangiogenic therapies and the identification of biomarkers to predict which patients with lung cancer are most likely to benefit from antiangiogenic therapy.
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Bevacizumab in Combination with Taxane versus Non-Taxane Containing Regimens for Advanced/Metastatic Nonsquamous Non-Small-Cell Lung Cancer: A Systematic Review. J Thorac Oncol 2016. [PMID: 26200267 DOI: 10.1097/jto.0000000000000572] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND In preclinical studies, the efficacy of the combination of antiangiogenic agents with chemotherapy seems to be dependent on the specific cytotoxic agent. We conducted a systematic review of the efficacy of bevacizumab in combination with taxane or non-taxane containing regimens for untreated, nonsquamous non-small-cell lung cancer patients. METHODS An extensive search of published clinical trials was conducted from electronic databases (MEDLINE, EMBASE, and Cochrane) and meeting proceedings using relevant search criteria. Phase 2 and randomized trials reporting on the efficacy of bevacizumab combined with taxane or non-taxane regimens were selected. A systematic analysis of extracted data was performed using Comprehensive Meta-Analysis (Version 2.2) software. Clinical outcome in patients treated with taxane versus non-taxane regimen was compared using point estimates for weighted values of median overall survival, progression-free survival, and response rate. RESULTS Twenty-nine studies reported between 2005 and 2015 were eligible. A total of 5890 patients (2767 and 3123 in the taxane and non-taxane groups, respectively) were included. The taxane and non-taxane groups were comparable in patient characteristics: median age, 62.8 versus 61.2 years; males, 57% versus 58%; adenocarcinomas, 83% versus 83%; stage IV, 87% versus 82%; performance status 0/1- 45/55% versus 41/59%, respectively. The weighted median overall survival was 14.4 versus 13.7 months (p = 0.5); progression-free survival was 6.93 versus 6.99 months (p = 0.61); response rate was 41% versus 39% (p = 0.65) for taxane and non-taxane groups. CONCLUSIONS The outcomes between taxane and non-taxane regimens when given in combination with bevacizumab for patients with nonsquamous non-small-cell lung cancer are comparable.
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Tomasini P, Barlesi F, Mascaux C, Greillier L. Pemetrexed for advanced stage nonsquamous non-small cell lung cancer: latest evidence about its extended use and outcomes. Ther Adv Med Oncol 2016; 8:198-208. [PMID: 27239238 DOI: 10.1177/1758834016644155] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Non-small cell lung cancer (NSCLC) is still the leading cause of cancer-related death, and the treatment of advanced NSCLC relies on systemic treatments. During the last decade, pemetrexed, an antifolate agent, gradually became a key component of the treatment for patients with advanced nonsquamous NSCLC. It has indeed been shown to be efficient for first-line, maintenance and second- or third-line treatment in this subgroup of NSCLC. Moreover, it is usually well tolerated, with few grade 3 and 4 toxicities. Several studies have tried to identify predictive biomarkers of pemetrexed efficacy. Due to pemetrexed's mechanism of action, thymidilate synthase expression predictive value was investigated but could not be demonstrated. Currently, more than 400 trials of pemetrexed for the treatment of nonsquamous NSCLC are ongoing.
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Affiliation(s)
- Pascale Tomasini
- Aix Marseille University, Assistance Publique Hôpitaux de Marseille, Department of Multidisciplinary Oncology & Therapeutic Innovations, Marseille, France
| | - Fabrice Barlesi
- Aix Marseille University, Assistance Publique Hôpitaux de Marseille, Department of Multidisciplinary Oncology & Therapeutic Innovations, Marseille, France
| | - Celine Mascaux
- Aix Marseille University, Assistance Publique Hôpitaux de Marseille, Department of Multidisciplinary Oncology & Therapeutic Innovations, Marseille, France
| | - Laurent Greillier
- Aix Marseille University, Assistance Publique Hôpitaux de Marseille, Department of Multidisciplinary Oncology & Therapeutic Innovations, Marseille, France
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NCCTG N0821 (Alliance): a phase II first-line study of pemetrexed, carboplatin, and bevacizumab in elderly patients with advanced nonsquamous non-small-cell lung cancer with good performance status. J Thorac Oncol 2015; 9:1146-53. [PMID: 25157767 DOI: 10.1097/jto.0000000000000217] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND We hypothesized that the combination of bevacizumab, carboplatin, and pemetrexed will be an effective first-line regimen in fit, elderly patients with nonsquamous non-small-cell lung cancer. METHODS Treatment-naïve, stage IIIB/IV nonsquamous non-small-cell lung cancer patients more than 70 years old with good performance status (Eastern Cooperative Oncology Group performance status 0-1) and adequate organ function were eligible. Carboplatin area under the curve 6, pemetrexed 500 mg/m, and bevacizumab 15 mg/kg were administered on day 1 of each 21-day cycle (up to six cycles) followed by maintenance pemetrexed and bevacizumab. The primary end point of 6-month progression-free survival rate of at least 70% was assessed using a one-stage binomial design. Quality of life (QOL) questionnaires were administered. Polymorphisms in genes encoding relevant proteins (drug targets, transport, and metabolism proteins) were correlated with treatment outcome. RESULTS Fifty-seven eligible patients were enrolled. Median age was 74.5 years. Median treatment cycles received was 6. The most common grade 3 or higher non-hematologic adverse events were fatigue (26%) and hypertension (11%); 16% had grade 4 neutropenia and 6.5% had grade 4 thrombocytopenia. Three patients experienced grade 3/4 hemorrhagic events (one pulmonary, two gastrointestinal). Primary end point of PFS6 was 60% (95% confidence interval [CI]: 45.9-73%). Median PFS was 7.0 months (95% CI: 5.9-10.1), median overall survival was 13.7 months (95% CI: 9.4-16.8). Polymorphic KDR and VEGFA variants correlated with survival and toxicity, respectively. There was no significant change in overall QOL scores over time. CONCLUSION This regimen is feasible and did not decrease the QOL in this study population. However, it did not meet the primary efficacy end point.
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Pallis AG, Gridelli C, Wedding U, Faivre-Finn C, Veronesi G, Jaklitsch M, Luciani A, O'Brien M. Management of elderly patients with NSCLC; updated expert's opinion paper: EORTC Elderly Task Force, Lung Cancer Group and International Society for Geriatric Oncology. Ann Oncol 2014; 25:1270-1283. [PMID: 24638905 DOI: 10.1093/annonc/mdu022] [Citation(s) in RCA: 109] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023] Open
Abstract
Non-small-cell lung cancer (NSCLC) is a very common disease in the elderly population and its incidence in this particular population is expected to increase further, because of the ageing of the Western population. Despite this, limited data are available for the treatment of these patients and, therefore, the development of evidence-based treatment recommendations is challenging. In 2010, European Organization for Research and Treatment of Cancer (EORTC) took an initiative in collaboration with International Society of Geriatric Oncology (SIOG) and created an experts panel that provided an experts' opinion consensus paper for the management of elderly NSCLC patients. Since this publication, important new data are available and EORTC and SIOG recommended to update the 2010 recommendations. Besides recommendations for surgery, adjuvant chemotherapy and radiotherapy, treatment of locally advanced and metastatic disease, recommendations were expanded, to include data on patient preferences and geriatric assessment.
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Affiliation(s)
- A G Pallis
- Medical Department, European Organization for Research and Treatment of Cancer, Brussels, Belgium.
| | - C Gridelli
- Division of Medical Oncology, 'S.G. Moscati' Hospital-Avellino, Avellino, Italy
| | - U Wedding
- Department of Internal Medicine II, Jena University Hospital, Jena, Germany
| | | | - G Veronesi
- Lung Cancer Early Detection Unit, Division of Thoracic Surgery, European Institute of Oncology, Milano, Italy
| | - M Jaklitsch
- Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - A Luciani
- Department of Medical Oncology, S. Paolo Hospital, Milan, Italy
| | - M O'Brien
- The Royal Marsden NHS Foundation, Surrey, UK
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Qi WX, Lin F, Sun YJ, Tang LN, Shen Z, Yao Y. Risk of venous and arterial thromboembolic events in cancer patients treated with gemcitabine: a systematic review and meta-analysis. Br J Clin Pharmacol 2014; 76:338-47. [PMID: 23834355 DOI: 10.1111/bcp.12203] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Accepted: 07/04/2013] [Indexed: 12/14/2022] Open
Abstract
AIMS Gemcitabine has been associated with an increased risk of arterial and venous thromboembolic events (ATEs and VTEs), although the overall risk remains unclear. As indications for its use in oncology are expanding, a comprehensive characterization of these complications becomes imperative. METHODS Pubmed was searched for articles published from 1 January 1990 to 31 December 2012. Eligible studies included prospective randomized controlled phase II and III trials evaluating gemcitabine based vs. non-gemcitabine based chemotherapy in patients with solid tumours. Data on VTEs and ATEs were extracted. Overall incidence rates, odds ratio (OR), and 95% confidence intervals (CIs) were calculated employing fixed or random effects models depending on the heterogeneity of included trials. RESULTS A total of 4845 patients from 19 trials were included. Among patients treated with gemcitabine based chemotherapy, the overall incidence of VTEs (13 studies comprising 3823 patients) and ATEs (eight studies consisting of 2431 patients) was 2.1% (95% CI 1.2%, 3.8%) and 2.2% (95% CI 1.4%, 3.2%). The associated ORs of VTEs and ATEs were 1.56 (95% CI 0.86, 2.83, P = 0.15) and 1.82 (95% CI 0.89, 3.75, P = 0.10) compared with non-gemcitabine based therapy. A tendency to increase the risk of ATE and VTEs was also detected in any prespecified subgroup. CONCLUSION The use of gemcitabine does not significantly increase the risk of VTEs and ATEs in patients with solid tumours when compared with non-gemcitabine based chemotherapy.
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Affiliation(s)
- Wei-Xiang Qi
- Department of Oncology, the Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China
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Abstract
The identification of epidermal growth factor receptor mutations and anaplastic lymphoma kinase rearrangements and the development of targeted therapy for patients with these molecular alterations has been a tremendous advance in the treatment of advanced stage or metastatic non-small cell lung cancer (NSCLC). However, the majority of patients with advanced stage NSCLC will not have one of these molecular alterations and will receive chemotherapy as their primary therapy. Chemotherapy remains a critical component of therapy for resected and locally advanced NSCLC, as well as for patients with limited-stage and extensive stage small cell lung cancer (SCLC). A significant unmet need exists to develop novel chemotherapy agents and to improve the efficacy and toxicity of currently available agents. Several novel formulations of currently available chemotherapy agents are in development for NSCLC and SCLC. Antibody conjugates are therapeutic agents that employ a tumor-specific monoclonal antibody conjugated to a cytotoxic or radionuclide agent. After the monoclonal antibody binds to the tumor antigen, these agents are internalized, and the link between the antibody and the therapeutic agent is dissolved and the cytotoxic agent is release intracellularly. This enhanced delivery of chemotherapy to malignant tissues has the potential to improve efficacy and reduce toxicity. Antibody conjugates to therapeutic agents are currently available for other malignancies and are in development for NSCLC and SCLC.
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Affiliation(s)
- Thomas E Stinchcombe
- From the University of North Carolina, Chapel Hill, School of Medicine, Chapel Hill, NC
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Hu Y, Wang J, Tao H, Wu B, Sun J, Cheng Y, Dong W, Li R. Increased risk of high-grade hemorrhage in cancer patients treated with gemcitabine: a meta-analysis of 20 randomized controlled trials. PLoS One 2013; 8:e74872. [PMID: 24086388 PMCID: PMC3781122 DOI: 10.1371/journal.pone.0074872] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Accepted: 08/06/2013] [Indexed: 01/07/2023] Open
Abstract
Purpose Gemcitabine, a third-generation anticancer agent, has been shown to be active in several solid tumors. High-grade hemorrhage (grade≥3) has been reported with this drug, although the overall risk remains unclear. We conducted a meta-analysis of randomized controlled trials evaluating the incidence and risk of high-grade hemorrhage associated with gemcitabine. Methods Pubmed was searched for articles published from January 1, 1990 to December 31, 2012. Eligible studies included prospective randomized controlled phase II and III trials evaluating gemcitabine-based vs non-gemcitabine-based therapy in patients with solid tumors. Data on high-grade hemorrhage were extracted. Overall incidence rates, relative risk (RR), and 95% confidence intervals (CI) were calculated employing fixed- or random-effects models depending on the heterogeneity of included trials. Results A total of 6433 patients from 20 trials were included. Among patients treated with gemcitabine-based chemotherapy, the overall incidence of high-grade hemorrhage was 1.7% (95%CI: 0.9–3.1%), and the RR of high-grade hemorrhage was 2.727 (95%CI: 1.581–4.702, p<0.001). Exploratory subgroup analysis revealed the highest RR of hemorrhage in non-small-cell lung cancer (NSCLC) patients (RR: 3.234; 95%CI, 1.678–6.233; p<0.001), phase II trials (RR 7.053, 95%CI: 1.591–31.27; p = 0.01), trials reported during 2006–2012 (RR: 3.750; 95%CI: 1.735–8.108, p<0.001) and gemcitabine used as single agent (RR 7.48; 95%CI: 0.78–71.92, p = 0.081). Conclusion Gemcitabine is associated with a significant increase risk of high-grade hemorrhage in patients with solid tumors when compared with non-gemcitabine-based therapy.
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Affiliation(s)
- Yi Hu
- Department of Oncology, Chinese PLA General Hospital, BeiJing City, People’s Republic of China
- * E-mail:
| | - Jingliang Wang
- Department of Oncology, Chinese PLA General Hospital, BeiJing City, People’s Republic of China
| | - Haitao Tao
- Department of Oncology, Chinese PLA General Hospital, BeiJing City, People’s Republic of China
| | - Baishou Wu
- Department of Oncology, Chinese PLA General Hospital, BeiJing City, People’s Republic of China
| | - Jin Sun
- Department of Oncology, Chinese PLA General Hospital, BeiJing City, People’s Republic of China
| | - Yao Cheng
- Department of Oncology, Chinese PLA General Hospital, BeiJing City, People’s Republic of China
| | - Weiwei Dong
- Department of Oncology, Chinese PLA General Hospital, BeiJing City, People’s Republic of China
| | - Ruixin Li
- Department of Oncology, Chinese PLA General Hospital, BeiJing City, People’s Republic of China
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Bevacizumab in Advanced NSCLC: Chemotherapy Partners and Duration of Use. Curr Treat Options Oncol 2013; 14:595-609. [DOI: 10.1007/s11864-013-0255-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Farhat FS, Houhou W. Targeted therapies in non-small cell lung carcinoma: what have we achieved so far? Ther Adv Med Oncol 2013; 5:249-70. [PMID: 23858333 PMCID: PMC3707340 DOI: 10.1177/1758834013492001] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
The search for innovative therapeutic agents in non-small cell lung cancer (NSCLC) has witnessed a swift evolution. The number of targeted drugs that can improve patient outcomes with an acceptable safety profile is steadily increasing. In this review, we highlight current drugs that have already been approved or are under evaluation for the treatment of patients with NSCLC, either in monotherapy or combined therapy for both the first- and second-line settings. Experience with drugs targeting the vascular endothelial growth factor and its receptor, as well as the epidermal growth factor receptor is summarized. Moreover, we provide an overview of more novel targets in NSCLC and initial experience with the respective therapeutic agents.
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Affiliation(s)
- Fadi S Farhat
- Hematology-Oncology Division (Head), Hammoud Hospital University Medical Center, Ghassan Hammoud Street, 652, Saida, Lebanon
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Pallis A, Syrigos K. Epidermal growth factor receptor tyrosine kinase inhibitors in the treatment of NSCLC. Lung Cancer 2013; 80:120-30. [DOI: 10.1016/j.lungcan.2012.12.025] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2012] [Revised: 12/08/2012] [Accepted: 12/16/2012] [Indexed: 01/16/2023]
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Diaz-Padilla I, Siu LL, San Pedro-Salcedo M, Razak ARA, Colevas AD, Shepherd FA, Leighl NB, Neal JW, Thibault A, Liu L, Lisano J, Gao B, Lawson EB, Wakelee HA. A phase I dose-escalation study of aflibercept administered in combination with pemetrexed and cisplatin in patients with advanced solid tumours. Br J Cancer 2012; 107:604-11. [PMID: 22805331 PMCID: PMC3419963 DOI: 10.1038/bjc.2012.319] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background: To evaluate the safety, pharmacokinetics (PKs), and pharmacodynamics of aflibercept, and to identify the recommended phase II dose (RP2D) of aflibercept in combination with pemetrexed and cisplatin. Methods: Aflibercept was administered at escalating doses of 2, 4, or 6 mg kg−1 in combination with fixed doses of pemetrexed (500 mg m−2) plus cisplatin (75 mg m−2) every 3 weeks. Blood samples were collected for PK analyses. Serum antiaflibercept antibodies were quantified to assess their impact on systemic aflibercept concentrations. Results: Eighteen patients were enrolled. One patient dosed at 4 mg kg−1 experienced grade 3 hypophosphatemia (dose-limiting toxicity; DLT), which prompted a cohort expansion. No further DLTs were observed in the 4 mg kg−1 cohort or the 6 mg kg−1 dose cohort. Most common adverse events (AEs) of all grades included (%): fatigue (89), anaemia (89), nausea (83), hyponatremia (78), and neutropenia (72). Grade ⩾3 AEs consistent with anti-vascular endothelial growth factor therapy included (%): hypertension (22), pulmonary embolism (11), and deep vein thrombosis (6). Five patients (28%) experienced mild neurocognitive disturbance. No episodes of reversible posterior leukoencephalopathy syndrome (RPLS) were noted. Conclusion: The results of this phase I study allowed further evaluation of the combination of aflibercept with pemetrexed and cisplatin in a phase II study. The RP2D of aflibercept was 6 mg kg−1, to be administered intravenously every 3 weeks in combination with pemetrexed and cisplatin.
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Affiliation(s)
- I Diaz-Padilla
- Division of Medical Oncology and Hematology, Department of Medicine, Princess Margaret Hospital, University Health Network, University of Toronto, 610 University Avenue, 5-700, Toronto, Ontario M5G 2M9, Canada.
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Stevenson JP, Langer CJ, Somer RA, Evans TL, Rajagopalan K, Krieger K, Jacobs-Small M, Dyanick N, Milcarek B, Coakley S, Walker S, Eaby-Sandy B, Hageboutros A. Phase 2 trial of maintenance bevacizumab alone after bevacizumab plus pemetrexed and carboplatin in advanced, nonsquamous nonsmall cell lung cancer. Cancer 2012; 118:5580-7. [PMID: 22544579 DOI: 10.1002/cncr.27576] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2012] [Revised: 03/01/2012] [Accepted: 03/06/2012] [Indexed: 11/06/2022]
Abstract
BACKGROUND The authors performed a phase 2 study of bevacizumab plus pemetrexed and carboplatin followed by maintenance bevacizumab in patients with advanced, nonsquamous nonsmall cell lung cancer. METHODS Previously untreated patients with advanced, nonsquamous nonsmall cell lung cancer and an Eastern Cooperative Oncology Group performance status of 0 or 1 received bevacizumab 15 mg/kg, pemetrexed 500 mg/m(2) and carboplatin at an area under the concentration-time curve of 6 intravenously on day 1 every 21 days. Responding or stable patients who completed 6 cycles then received bevacizumab maintenance every 21 days until disease progression. RESULTS In total, 43 patients (40 who were evaluable for response) were entered on the study. Treatment-related grade 3/4 toxicities were low and included febrile neutropenia (2%), neutropenia (28%), anemia (18%), thrombocytopenia (11%), hypertension (7%), epistaxis (5%), venous thrombosis (8%), dyspnea (7%), rectovaginal fistula (2.3%), infusion reaction (2%), and cerebrovascular event (2%). One patient died from complications of venous thromboembolism and cerebrovascular accident after Cycle 2. Minimal clinically significant toxicity occurred during maintenance bevacizumab. Two complete responses (5%) were observed, and 17 patients (42%) had a partial response. Fifteen patients (38%) displayed disease stability. The overall disease control rate was 85%. At a median follow-up of 15.8 months, the median progression-free survival was 7.1 months (95% confidence interval, 5.9-8.3 months), and the median overall survival was 17.1 months (95% confidence interval, 8.8-25.5 months). CONCLUSIONS Combined bevacizumab, pemetrexed, and carboplatin followed by maintenance bevacizumab was well tolerated and displayed remarkable activity in patients with previously untreated, advanced, nonsquamous nonsmall cell lung cancer.
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Affiliation(s)
- James P Stevenson
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
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Successful Treatment with Pemetrexed, Carboplatin, and Bevacizumab for Platinum-Resistant Adenocarcinoma of the Lung. Case Rep Oncol Med 2012; 2012:821280. [PMID: 22779020 PMCID: PMC3388291 DOI: 10.1155/2012/821280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Accepted: 04/12/2012] [Indexed: 11/18/2022] Open
Abstract
We present two cases of relapsed adenocarcinoma of the lung: a 50-year-old male and a 67-year-old male. Both patients had previously been treated with platinum-containing systemic chemotherapy. In both cases, significant clinical efficacy was demonstrated with combination chemotherapy consisting of pemetrexed, carboplatin, and bevacizumab as salvage treatment. Adverse events were mild. This regimen might be a viable therapeutic option even after heavy treatment such as platinum-containing chemotherapy, especially for patients with preserved organ function and good performance status.
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