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Zhao Y, Mei T, Na F, Tian X, Ao R, Long X, Luo Q, Duan P, Zhu J, Wang Y, Huang M, Liu Y, Gong Y. First-line treatment of driver gene-negative metastatic lung adenocarcinoma with malignant pleural effusion: Should chemotherapy be combined with an immune checkpoint inhibitor or bevacizumab? Invest New Drugs 2024; 42:196-206. [PMID: 38386170 PMCID: PMC10944392 DOI: 10.1007/s10637-024-01424-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 01/22/2024] [Indexed: 02/23/2024]
Abstract
Patients with metastatic lung adenocarcinoma (MLA) and malignant pleural effusion (MPE) without driver gene mutations have a poor prognosis. None of the standard treatment strategies is recommended for such patients. We retrospectively analyzed the efficacy of the first-line treatment for this specific population: standard platinum-based doublet chemotherapy (CT), CT plus an immune checkpoint inhibitor (CT plus ICI), and CT plus bevacizumab (CT plus Bev). A total of 323 eligible patients were enrolled: CT alone (n = 166), CT plus Bev (n = 72), and CT plus ICI (n = 85). Treatment efficacy assessments were performed every two cycles according to the RECIST guidelines. The endpoints were overall survival (OS) and progression-free survival (PFS). Kaplan-Meier (K‒M) curves and the log-rank test were used to compare OS and PFS. p < 0.05 was the threshold of significance (statistical software: SPSS). The median follow-up was 11.4 months (range, 2.1-49.6 months). PFS and OS in the CT plus ICI/CT plus Bev cohort were significantly longer than those in the CT group (PFS: 7.8/6.4/3.9 months, p < 0.0001; OS: 16.4/15.6/9.6 months, p < 0.0001, respectively). CT plus Bev had better PFS and OS than CT plus ICI/CT in PD-L1 < 1% patients (PFS: 8.4/5.0/3.8 months, p < 0.0001; OS: 15.6/12.9/9.3 months, p < 0.0001). Among patients with PD-L1 1-49%, CT plus ICI led to a longer PFS and OS (PFS: 8.9/5.8/4.2 months, p = 0.009; OS: 24.2/18.8/11.5 months, p = 0.03). In the cohort with PD-L1 ≥ 50%, CT plus ICI was still the best first-line treatment (PFS: 19.7/13.8/9.6 months, p = 0.033; OS: 27.2/19.6/14.9 months, p = 0.047). In driver gene-negative MLA with MPE, CT plus Bev or ICI better controlled MPE and significantly prolonged survival compared to CT alone. PD-L1 expression (negative/positive) may be a key factor influencing the choice of CT plus Bev or ICI.
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Affiliation(s)
- Yuanyuan Zhao
- Division of Thoracic Tumor Multidisciplinary Treatment, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
- Department of Oncology, Chengdu Pidu District Hospital of Traditional Chinese Medicine, Chengdu, 611730, People's Republic of China
| | - Ting Mei
- Lung Cancer Center, West China Tianfu Hospital, Sichuan University, Chengdu, 610213, People's Republic of China
| | - Feifei Na
- Division of Thoracic Tumor Multidisciplinary Treatment, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Xiaoman Tian
- Department of Oncology, Chengdu Jinniu District People's Hospital, Chengdu, 610031, People's Republic of China
| | - Rui Ao
- Department of Oncology, Sichuan Academy of Medical Sciences and Sichuan People's Hospital, Chengdu, 610072, People's Republic of China
| | - Xiangyu Long
- Department of Oncology, Sichuan Provincial Guang'An People's Hospital, Guang'An, 638500, People's Republic of China
| | - Qiang Luo
- Department of Oncology, Chengdu Xinjin District Hospital of Traditional Chinese Medicine, Chengdu, 611430, People's Republic of China
| | - Ping Duan
- Department of Oncology, Chengdu First People's Hospital, Chengdu, 610095, People's Republic of China
| | - Jiang Zhu
- Department of Oncology, West China Shangjin Hospital, Sichuan University, Chengdu, 611730, People's Republic of China
| | - Yongsheng Wang
- Division of Thoracic Tumor Multidisciplinary Treatment, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Meijuan Huang
- Division of Thoracic Tumor Multidisciplinary Treatment, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Yongmei Liu
- Division of Thoracic Tumor Multidisciplinary Treatment, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China.
| | - Youling Gong
- Division of Thoracic Tumor Multidisciplinary Treatment, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China.
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Wei Q, Deng T, Wu J, Zeng H, Qi C, Tan S, Zhang Y, Huang Q, Pu X, Xu W, Li W, Tian P, Li Y. Immune checkpoint inhibitor plus chemotherapy as first-line treatment for non-small cell lung cancer with malignant pleural effusion: a retrospective multicenter study. BMC Cancer 2024; 24:393. [PMID: 38549044 PMCID: PMC10976680 DOI: 10.1186/s12885-024-12173-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 03/22/2024] [Indexed: 04/01/2024] Open
Abstract
BACKGROUND Immune checkpoint inhibitors (ICI) combined with chemotherapy are efficacious for treating advanced non-small cell lung cancer (NSCLC); however, the effectiveness of this approach in the malignant pleural effusion (MPE) population is unclear. This study evaluated ICI plus chemotherapy in NSCLC patients with MPE. METHODS Patients from 3 centers in China with NSCLC and MPE who received ICI plus chemotherapy (ICI Plus Chemo) or chemotherapy alone (Chemo) between December 2014 and June 2023 were enrolled. Clinical outcomes and adverse events (AEs) were compared. RESULTS Of 155 eligible patients, the median age was 61.0 years old. Males and never-smokers accounted for 73.5% and 39.4%, respectively. Fifty-seven and 98 patients received ICI Plus Chemo or Chemo, respectively. With a median study follow-up of 10.8 months, progression-free survival (PFS) was significantly longer with ICI Plus Chemo than with Chemo (median PFS: 7.4 versus 5.7 months; HR = 0.594 [95% CI: 0.403-0.874], P = 0.008). Median overall survival (OS) did not differ between groups (ICI Plus Chemo: 34.2 versus Chemo: 28.3 months; HR = 0.746 [95% CI: 0.420-1.325], P = 0.317). The most common grade 3 or worse AEs included decreased neutrophil count (3 [5.3%] patients in the ICI Plus Chemo group vs. 5 [5.1%] patients in the Chemo group) and decreased hemoglobin (3 [5.3%] versus 10 [10.2%]). CONCLUSIONS In patients with untreated NSCLC with MPE, ICI plus chemotherapy resulted in significantly longer PFS than chemotherapy and had a manageable tolerability profile, but the effect on OS may be limited.
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Affiliation(s)
- Qi Wei
- Department of Pulmonary and Critical Care Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, Institute of Respiratory Health and Multimorbidity, Institute of Respiratory Health, Frontiers Science Center for Disease-related Molecular Network, Precision Medicine Center/Precision Medicine Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Lung Cancer Center/Lung Cancer Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Taibing Deng
- Pulmonary and Critical Care Medicine, Guang 'an People's Hospital, Guang 'an, China
| | - Junhua Wu
- Respiratory and Critical Care Medicine, School of Medicine, Mianyang Central Hospital, University of Electronic Science and Technology of China, Mianyang, China
| | - Hao Zeng
- Department of Pulmonary and Critical Care Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, Institute of Respiratory Health and Multimorbidity, Institute of Respiratory Health, Frontiers Science Center for Disease-related Molecular Network, Precision Medicine Center/Precision Medicine Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Lung Cancer Center/Lung Cancer Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Chang Qi
- Department of Pulmonary and Critical Care Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, Institute of Respiratory Health and Multimorbidity, Institute of Respiratory Health, Frontiers Science Center for Disease-related Molecular Network, Precision Medicine Center/Precision Medicine Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Lung Cancer Center/Lung Cancer Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Sihan Tan
- Department of Pulmonary and Critical Care Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, Institute of Respiratory Health and Multimorbidity, Institute of Respiratory Health, Frontiers Science Center for Disease-related Molecular Network, Precision Medicine Center/Precision Medicine Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Lung Cancer Center/Lung Cancer Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yuanyuan Zhang
- Department of Pulmonary and Critical Care Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, Institute of Respiratory Health and Multimorbidity, Institute of Respiratory Health, Frontiers Science Center for Disease-related Molecular Network, Precision Medicine Center/Precision Medicine Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Lung Cancer Center/Lung Cancer Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Qin Huang
- Department of Pulmonary and Critical Care Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, Institute of Respiratory Health and Multimorbidity, Institute of Respiratory Health, Frontiers Science Center for Disease-related Molecular Network, Precision Medicine Center/Precision Medicine Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Lung Cancer Center/Lung Cancer Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xin Pu
- Department of Pulmonary and Critical Care Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, Institute of Respiratory Health and Multimorbidity, Institute of Respiratory Health, Frontiers Science Center for Disease-related Molecular Network, Precision Medicine Center/Precision Medicine Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Lung Cancer Center/Lung Cancer Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Weiguo Xu
- Respiratory and Critical Care Medicine, School of Medicine, Mianyang Central Hospital, University of Electronic Science and Technology of China, Mianyang, China
| | - Weimin Li
- Department of Pulmonary and Critical Care Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, Institute of Respiratory Health and Multimorbidity, Institute of Respiratory Health, Frontiers Science Center for Disease-related Molecular Network, Precision Medicine Center/Precision Medicine Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Panwen Tian
- Department of Pulmonary and Critical Care Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, Institute of Respiratory Health and Multimorbidity, Institute of Respiratory Health, Frontiers Science Center for Disease-related Molecular Network, Precision Medicine Center/Precision Medicine Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
- Lung Cancer Center/Lung Cancer Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
| | - Yalun Li
- Department of Pulmonary and Critical Care Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, Institute of Respiratory Health and Multimorbidity, Institute of Respiratory Health, Frontiers Science Center for Disease-related Molecular Network, Precision Medicine Center/Precision Medicine Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
- Lung Cancer Center/Lung Cancer Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
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Vukovic M, Tanic M, Damjanovic A, Pavlovic M, Stanojevic A, Zivic K, Karadzic V, Jankovic R, Cavic M. EGFR mutation testing from pleural effusions of non-small cell lung cancer patients at the institute for oncology and radiology of Serbia. Transl Oncol 2023; 37:101772. [PMID: 37659221 PMCID: PMC10495676 DOI: 10.1016/j.tranon.2023.101772] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 08/14/2023] [Accepted: 08/24/2023] [Indexed: 09/04/2023] Open
Abstract
BACKGROUND The use tumor-derived cell-free DNA extracted from body fluids is being evaluated for genetic testing in lung cancer. The aim of this study was to explore the feasibility and utility of implementation of EGFR molecular testing from pleural effusions in non-small cell lung cancer in the clinical diagnostics workflow. PATIENTS AND METHODS This study included patients diagnosed with primary lung adenocarcinoma in the period July 2016 to June 2023. EGFR mutation testing was performed by qPCR (Cobas®) and dPCR. Testing was performed from 211 plasma samples when tissue was unavailable at diagnosis, and from 301 plasma samples and 18 pleural effusions at progression on first/second generation of EGFR TKIs. Descriptive methods of statistical analysis were used to summarize the sample data. Fisher's exact test, McNemar's test, Cohen's kappa tests were used for statistical analyses. Two-sided p-values <0.05 were considered statistically significant. RESULTS A significantly higher detection rate of the T790M mutation in pleural effusion was obtained compared to blood (50% and 20%, p=0.047). When comparing the detection success rate of the resistant T790M mutation in pleural effusion and blood, a statistically significant difference was obtained in favor of pleural effusion (50% vs. 21.87%, p=0.01). CONCLUSIONS Superior performance of pleural effusions compared to blood plasma was shown both in the analysis of success rate and in the detection of the resistant T790M mutation, at progression on EGFR TKIs. Pleural effusion should be considered in this setting whenever available, especially in countries with limited health resources.
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Affiliation(s)
- Miodrag Vukovic
- Department of Experimental Oncology, Institute for Oncology and Radiology of Serbia, Pasterova 14, Belgrade 11000, Serbia
| | - Miljana Tanic
- Department of Experimental Oncology, Institute for Oncology and Radiology of Serbia, Pasterova 14, Belgrade 11000, Serbia
| | - Ana Damjanovic
- Department of Experimental Oncology, Institute for Oncology and Radiology of Serbia, Pasterova 14, Belgrade 11000, Serbia
| | - Marijana Pavlovic
- Department of Experimental Oncology, Institute for Oncology and Radiology of Serbia, Pasterova 14, Belgrade 11000, Serbia
| | - Aleksandra Stanojevic
- Department of Experimental Oncology, Institute for Oncology and Radiology of Serbia, Pasterova 14, Belgrade 11000, Serbia
| | - Katarina Zivic
- Department of Experimental Oncology, Institute for Oncology and Radiology of Serbia, Pasterova 14, Belgrade 11000, Serbia
| | - Valentina Karadzic
- Department of Experimental Oncology, Institute for Oncology and Radiology of Serbia, Pasterova 14, Belgrade 11000, Serbia
| | - Radmila Jankovic
- Department of Experimental Oncology, Institute for Oncology and Radiology of Serbia, Pasterova 14, Belgrade 11000, Serbia
| | - Milena Cavic
- Department of Experimental Oncology, Institute for Oncology and Radiology of Serbia, Pasterova 14, Belgrade 11000, Serbia.
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Demirbas S, Yerlikaya FH, Yosunkaya S, Can U, Celalettin K. The investigation of levels of endothelial cell-specific molecule, progranuline, clusterin, and human epididymis protein 4 in the differential diagnosis of malignant pleural effusions. Medicine (Baltimore) 2022; 101:e32471. [PMID: 36595996 PMCID: PMC9803442 DOI: 10.1097/md.0000000000032471] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Progranulin (PGRN), endothelial cell-specific molecule-1, clusterin (CLU), and human epididymis protein 4 (HE-4) are novel proteins reported to have diagnostic and prognostic potential in lung cancer. Here, we aimed to identify the markers with high sensitivity and specificity in distinguishing malignant pleural fluids from other pleural fluids. METHODS This prospective, descriptive study was conducted at a medical faculty hospital between 2016 and 2019. The study population consisted of 90 patients <18 years of age with pleural effusion (PE). Levels of pleural fluids of PGRN, endothelial cell-specific molecule-1, CLU, and HE-4 were measured with enzyme-linked immunosorbent assay kits under the manufacturer's manual. RESULTS Of 90 patients, 54 were men, and 36 were women (mean age 65 ± 16 years). Of pleural fluids investigated, 23 (25%) and 67 (74%) were transudates and exudates, respectively. Of exudates, while 27 (40%) and 19 (28%) were parapneumonic PE and tuberculous PE, respectively, 20 (29%) were malignant pleural effusion (MPE). Levels of all biomarkers in exudate fluids were found significantly higher than those of transudate fluids. CLU, HE-4, and PGRN levels in MPE were also found significantly higher than benign fluids (P < .05). Cutoff values were achieved by receiver operating characteristics analysis for CLU, HE-4, and PGRN to distinguish between malignant and benign groups. For diagnosis of MPE, the sensitivity and specificity values were found as 0.66 and 0.67 for a cutoff value of CLU of 18.29 mg/L (P = .00), as 0.76 and 0.76 for a cutoff value of HE-4 of 9.33 mg/L (P = .00), and as 0.66 and 0.67 for a cutoff value of PGRN of 105.91 mg/L (P = .001). CONCLUSION HE-4 having high sensitivity and specificity can be a potential diagnostic marker in distinguishing between malignant and benign effusions, and these findings can constitute a basis for future research.
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Affiliation(s)
- Soner Demirbas
- Department of Chest Diseases, Meram Faculty of Medicine, Necmetin Erbakan University, Konya, Turkey
- * Correspondence: Soner Demirbas, Meram Faculty of Medicine, Department of Chest Diseases, Necmetin Erbakan University, Selçuklu, Konya 42080, Turkey (e-mail: )
| | - Fatma Hümeyra Yerlikaya
- Department of Biochemistry, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Sebnem Yosunkaya
- Department of Chest Diseases, Meram Faculty of Medicine, Necmetin Erbakan University, Konya, Turkey
| | - Ummugulsum Can
- Department of Biochemistry, Konya Training and Research Hospital, Konya, Turkey
| | - Korkmaz Celalettin
- Department of Chest Diseases, Meram Faculty of Medicine, Necmetin Erbakan University, Konya, Turkey
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Xiang Z, Deng X, He W, Yang Q, Ni L, Dehghan Shasaltaneh M, Maghsoudloo M, Yang G, Wu J, Imani S, Wen Q. Treatment of malignant pleural effusion in non-small cell lung cancer with VEGF-directed therapy. Ann Med 2022; 54:1357-1371. [PMID: 35543207 PMCID: PMC9103356 DOI: 10.1080/07853890.2022.2071977] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Vascular endothelial growth factor (VEGF) is a critical regulator of malignant pleural effusion (MPE) in non-small-cell lung cancer (NSCLC). Bevacizumab (BEV) and apatinib (APA) are novel VEGF blockers that inhibit lung cancer cell proliferation and the development of pleural effusion. METHODS In this study, we established Lewis lung cancer (LLC) xenograft mouse models to compare the therapeutic effect of APA and BEV in combination with cisplatin (CDDP) against MPE. The anti-tumour and anti-angiogenic effects of this combination therapy were evaluated by 18F-FDG PET/CT imaging, TUNEL assay and Immunohistochemistry. RESULTS The triple drug combination significantly prolonged the overall survival of the tumour-bearing mice by reducing MPE and glucose metabolism and was more effective in lowering VEGF/soluble VEGFR-2 levels in the serum and pleural exudates compared to either of the monotherapies. Furthermore, CDDP + APA + BEV promoted in vivo apoptosis and decreased microvessel density. CONCLUSIONS Mechanistically, LLC-induced MPE was inhibited by targeting the VEGF-MEK/ERK pathways. Further studies are needed to establish the synergistic therapeutic effect of these drugs in NSCLC patients with MPE.KEY MESSAGESCombined treatment of MPE with apatinib, bevacizumab and cisplatin can prolong the survival time of mice, reduce the content of MPE, decrease the SUVmax of thoracic tumour tissue, down-regulate the content of VEGF and sVEGFR-2 in serum and pleural fluid, and promote the apoptosis of tumour cells. Angiogenesis and MPE formation can be inhibited by down-regulation of HIF-1α, VEGF, VEGFR-2, MEK1 and MMP-2 molecular signalling pathway proteins.
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Affiliation(s)
- Zhangqiang Xiang
- Department of Oncology, The Affiliated Hospital of Southwest Medical University, Luzhou, China.,Phase 1 Clinical Trial Center, Deyang People's Hospital, Deyang, China
| | - Xiangyu Deng
- Department of Oncology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Wenfeng He
- Department of Oncology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Qian Yang
- Department of Oncology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Laichao Ni
- Department of Oncology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | | | - Mazaher Maghsoudloo
- Laboratory of Systems Biology and Bioinformatics, Institute of Biochemistry and Biophysics, University of Tehran, Tehran, Iran.,Department of Genetics, Faculty of Advanced Science and Technology, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Gang Yang
- Department of Oncology, The Affiliated Hospital of Southwest Medical University, Luzhou, China.,Department of Oncology, Anyue Hospital of Traditional Chinese Medicine, Second Ziyang Hospital of Traditional Chinese Medicine, Ziyang, China
| | - Jingbo Wu
- Department of Oncology, The Affiliated Hospital of Southwest Medical University, Luzhou, China.,Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, China. The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Saber Imani
- Department of Oncology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Qinglian Wen
- Department of Oncology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
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Zhang Y, Li W, Zhai J, Jin Y, Zhang L, Chen C. Phenotypic and functional characterizations of CD8 + T cell populations in malignant pleural effusion. Exp Cell Res 2022; 417:113212. [PMID: 35588796 DOI: 10.1016/j.yexcr.2022.113212] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 05/12/2022] [Accepted: 05/15/2022] [Indexed: 11/18/2022]
Abstract
Malignant pleural effusions (MPE) are a common terminal pathway for many types of cancer, especially non-small cell lung cancer (NSCLC). However, the phenotype and differentiation status of MPE-infiltrating CD8+ T cells have not yet been systematically addressed. In this study, the surface molecules and cytokine secretion of T cells in MPE and peripheral blood (PB) were analyzed using flow cytometry. We found an increased frequency of CD8+ T cells in MPE compared to PB among lung cancer patients, of which the effector memory subset (Tem, CCR7- CD45RA-) and central memory subset (Tcm, CCR7+ CD45RA-) were upregulated. MPE-derived Tem and Tcm subsets expressed more PD1 or CD39, and there was a greater population of cells in these subsets that co-expressed them. In addition, Tem and Tcm cells from MPE had higher cytokine production than terminally differentiated effector memory cells (TemRA, CCR7- CD45RA+) and naïve cells (Tnaive, CCR7+CD45RA+). Our results demonstrate that the Tem and Tcm cells in MPE may have advantages in both tumor reactivity and immune functionality. Altogether, these findings help to characterize the phenotype of MPE-derived CD8+ T cells in terms of differentiation and tumor reactivity and reveal their potential as a target for immunotherapy.
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Affiliation(s)
- Yaoxin Zhang
- Department of Respiratory and Critical Medicine, The First Affiliated Hospital of Soochow University, Suzhou, China; Institute of Systems Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100005, China; Suzhou Institute of Systems Medicine, Suzhou, 215123, Jiangsu, China
| | - Wenhui Li
- Institute of Systems Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100005, China; Suzhou Institute of Systems Medicine, Suzhou, 215123, Jiangsu, China
| | - Jiawei Zhai
- Department of Respiratory and Critical Medicine, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yujia Jin
- Department of Respiratory and Critical Medicine, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Lianjun Zhang
- Institute of Systems Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100005, China; Suzhou Institute of Systems Medicine, Suzhou, 215123, Jiangsu, China.
| | - Cheng Chen
- Department of Respiratory and Critical Medicine, The First Affiliated Hospital of Soochow University, Suzhou, China.
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Contribution of immature granulocyte level to diagnosis in pleural effusion. TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2022; 30:257-263. [PMID: 36168576 PMCID: PMC9473606 DOI: 10.5606/tgkdc.dergisi.2022.21523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 04/18/2021] [Indexed: 12/03/2022]
Abstract
Background
In this study, we aimed to evaluate the diagnostic value of neutrophil and immature granulocyte levels in peripheral blood in cases with pleural effusion.
Methods
Between May 2019 and May 2020, a total of 117 patients (43 males, 74 females; mean age: 63.1±18.1 years; range, 18 to 93 years) who had pleural effusion and analysis of pleural fluid were retrospectively analyzed. All patients were evaluated in terms of age, sex, presence of comorbid diseases, approach to the pleural fluid, biochemical values of peripheral blood and pleural fluid, hemogram series of peripheral blood, diagnosis of pleural fluid, and mortality.
Results
Of the patients, 66 (54.5%) were diagnosed with benign pleural effusion and 51 (43.5%) were diagnosed with malignant pleural effusion. Number of cases with known primary malignancy was 54 (46.1%). Immature granulocyte count number and percentage of venous blood in the malignant pleural effusion group was significantly higher than the group with benign pleural effusion (p<0.05).
Conclusion
As a hemogram parameter, immature granulocyte level is an easily applicable, cheap, and a non-invasive method in the outpatient settings.
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Chiang CL, Shen CI, Huang HC, Chang HJ, Huang YT, Chiu CH. Cytology–Based Specimen Triage for Epidermal Growth Factor Receptor Mutation Testing of Malignant Pleural Effusions in Non–Small Cell Lung Cancer. Front Oncol 2022; 12:810124. [PMID: 35141163 PMCID: PMC8819005 DOI: 10.3389/fonc.2022.810124] [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: 11/06/2021] [Accepted: 01/04/2022] [Indexed: 11/15/2022] Open
Abstract
Introduction Malignant pleural effusions are common in non–small cell lung cancer (NSCLC). Molecular testing is among the most critical steps in the management of patients with advanced NSCLC. However, the optimal approach for epidermal growth factor receptor (EGFR) mutation testing in such effusion samples remains unclear. Methods We prospectively collected effusion samples from patients with EGFR–mutant NSCLC. Following sample centrifugation, genomic DNA and cell–free DNA were respectively extracted from the sediment and supernatants. EGFR mutation was detected through a real–time PCR assay. Results A total of 108 effusions from 78 patients were examined, with 12 and 96 obtained before and after EGFR tyrosine kinase inhibitor treatment, respectively. Carcinoma cells or atypical cells were identified in 73 effusions (67.6%). EGFR mutations were detected in 86 (79.6%) sediment and 84 (77.8%) supernatant samples. Among the effusions with positive cytological findings, the EGFR mutation detection rates were 95.9% (70/73) and 86.3% (63/73) in the sediment and supernatants, respectively. Among the effusions with negative cytological findings, the corresponding detection rates were 45.7% (16/35) and 60% (21/35), respectively. Current clinical practice is to arrange EGFR mutation testing only for sediment from cytologically positive effusions. Through the proposed cytology–based specimen triage, wherein sediment and supernatants with positive and negative cytological findings, respectively, are tested, the detection rate was increased from 64.8% (70/108) to 84.3% (91/108). At half of the cost, this strategy provided a detection rate only slightly lower than the rate in a combined test of all the sediment and supernatants (87.0%, 94/108). Conclusions The separate extraction of DNA from sediment and supernatants obtained from centrifuged effusion samples can improve the overall EGFR mutation detection rate. The present cytology–based specimen triage is an efficient strategy for EGFR mutation testing in patients with EGFR–mutant NSCLC.
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Affiliation(s)
- Chi-Lu Chiang
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chia-I Shen
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Hsu-Ching Huang
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Han-Jhih Chang
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yu-Ting Huang
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chao-Hua Chiu
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- *Correspondence: Chao-Hua Chiu,
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9
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Mai Z, Feng B, He Q, Feng Q. Medical Thoracoscopic Thermal Ablation Therapy for Metastatic Pleural Tumors with Malignant Effusion: An Exploratory Retrospective Study. Int J Gen Med 2021; 14:9349-9360. [PMID: 34898999 PMCID: PMC8654692 DOI: 10.2147/ijgm.s339596] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 11/17/2021] [Indexed: 11/28/2022] Open
Abstract
Purpose Malignant pleural effusion (MPE) is an intractable condition. The current mainstream therapies for MPE, ie, indwelling pleural catheter and pleurodesis, have some drawbacks. In this retrospective study, we explored the efficacy and safety of medical thoracoscopic thermal ablation (argon plasma coagulation, APC) therapy for metastatic pleural tumors with MPE. Patients and Methods A total of 176 patients were enrolled and divided into catheter pleural drainage (CPD) group (n = 77), non-ablation group (n = 46), and thermal ablation group (n = 53). Propensity score matching (PSM) was used for between-group comparisons to minimize bias. The primary endpoints were pleural effusion objective response rate (ORR) and time to progression (TTP); secondary endpoints included overall survival (OS), chest-tube duration, and safety. Results Thermal ablation group and non-ablation group showed significantly higher ORR and shorter chest-tube duration versus the CPD group (ORR: thermal ablation, 88.2% vs 66.7%, P = 0.004; non-ablation, 88.4% vs 64.4%, P = 0.042; chest-tube duration: thermal ablation, 4.90 vs 7.24 days, P < 0.001; non-ablation, 5.73 vs 7.33 days, P = 0.010). Thermal ablation group exhibited longer TTP than the CPD group (median, 13.7 vs 7.3 months, P = 0.001) and the non-ablation group (median, 13.6 vs 10.3 months, P = 0.037). OS in the thermal ablation group was numerically longer than that in the CPD group with marginally significant difference (P = 0.055). There was no significant difference in the frequency of adverse events or changes in vital signs between thermal ablation and non-ablation groups. Conclusion Medical thoracoscopic thermal ablation (APC technique) therapy was effective and safe in the treatment of metastatic pleural tumors with MPE for improving ORR and TTP.
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Affiliation(s)
- Zhonglun Mai
- Department of Thoracic Oncology, Cancer Center, Integrated Hospital of Traditional Chinese Medicine, Southern Medical University, Guangzhou, Guangdong Province, 510315, People's Republic of China
| | - Bin Feng
- Department of Oncology, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong Province, 510630, People's Republic of China
| | - Qianwen He
- Department of Geriatrics, Integrated Hospital of Traditional Chinese Medicine, Southern Medical University, Guangzhou, Guangdong Province, 510315, People's Republic of China
| | - Qixiao Feng
- Department of Thoracic Oncology, Cancer Center, Integrated Hospital of Traditional Chinese Medicine, Southern Medical University, Guangzhou, Guangdong Province, 510315, People's Republic of China
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10
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Pan P, Wu F, Xu Z, Ji X, Qi Q, Huang X, Zhao R, Liu M, Jiang P, Li Y, Xu L. Intrapleural treatment in patients with non-small cell lung cancer with malignant pleural effusions in the real world. Thorac Cancer 2021; 12:3416-3425. [PMID: 34741494 PMCID: PMC8671907 DOI: 10.1111/1759-7714.14224] [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: 09/03/2021] [Revised: 10/21/2021] [Accepted: 10/22/2021] [Indexed: 11/27/2022] Open
Abstract
Background The aim of the study was to assess the efficacy and side‐effects of intrapleural treatment in non‐small cell lung cancer (NSCLC) patients with malignant pleural effusions (MPEs). Methods The medical records of NSCLC patients with MPEs diagnosed in four Chinese hospitals from October 2014 to December 2019 were searched. The Kaplan–Meier method is used to calculate median overall survival (MOS) and subgroup analyses are done. Results A total of 285 patients were evaluated; 81.1% of patients received intrapleural treatment, and no patients received talc pleurodesis. MOS of the whole cohort was 21 months. Patients were divided into three groups: erythromycin group (EG; intrapleural treatment with drugs and erythromycin); intrathoracic treatment group (ITG; intrapleural treatment with drugs); control group (CG; no drug treatment in the pleural cavity). The MOS of patients in the EG, ITG and CG was 20, 22, and 19 months, respectively. Among patients who received only chemotherapy as systemic therapy, the MOS of intrathoracic administration group (IAG; i.e., EG and ITG) was longer than that of CG (12 vs. 6 months; p = 0.034), and the MOS of patients with a ratio of carcinoembryonic antigen in pleural effusion (PE‐CEA): CEA in blood (B‐CEA) ≤1 is worse than that of patients with a ratio >1 (4 vs. 12 months, p = 0.021) and that of CG (4 vs. 6 months, p = 0.442). Conclusions Intrapleural treatment can prolong the survival of NSCLC patients with MPE who do not receive targeted treatment or who only receive chemotherapy. The PE‐CEA: B‐CEA ratio can be used to predict the efficacy if intrapleural treatment is indicated.
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Affiliation(s)
- Pengfei Pan
- Department of Pulmonary and Critical Care Medicine, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Fengjuan Wu
- Department of Pulmonary and Critical Care Medicine, Heze Municipal Hospital, Heze, China
| | - Zhiyun Xu
- Department of Pulmonary and Critical Care Medicine, Qilu Hospital of Shandong University, Jinan, China
| | - Xiang Ji
- Department of Pulmonary and Critical Care Medicine, Qianfoshan Hospital of Shandong First Medical University, Jinan, China
| | - Qian Qi
- Department of Pulmonary and Critical Care Medicine, Qianfoshan Hospital of Shandong First Medical University, Jinan, China
| | - Xiaomin Huang
- Department of Pulmonary and Critical Care Medicine, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Ruyue Zhao
- Department of Pulmonary and Critical Care Medicine, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Mingtao Liu
- Department of Pulmonary and Critical Care Medicine, Binzhou People's Hospital, Binzhou, China
| | - Peng Jiang
- Department of Pulmonary and Critical Care Medicine, Weihai Municipal Hospital, Weihai, China
| | - Yu Li
- Department of Pulmonary and Critical Care Medicine, Qilu Hospital of Shandong University, Jinan, China
| | - Lisheng Xu
- Department of Pulmonary and Critical Care Medicine, Qilu Hospital of Shandong University, Jinan, China
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11
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de Kock R, Knoops C, Baselmans M, Borne BVD, Brunsveld L, Scharnhorst V, Deiman B. Sensitive cell-free tumor DNA analysis in supernatant pleural effusions supports therapy selection and disease monitoring of lung cancer patients. Cancer Treat Res Commun 2021; 29:100449. [PMID: 34481168 DOI: 10.1016/j.ctarc.2021.100449] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 08/19/2021] [Accepted: 08/20/2021] [Indexed: 01/05/2023]
Abstract
Supernatant pleural effusions (PE) have shown to be a valuable source for the detection of driver mutations in circulating tumor DNA (ctDNA). In this prospective study, the clinical value of ctDNA analysis in supernatant PE to support therapy selection and disease monitoring in lung cancer patients is assessed. Paired PE and plasma samples were collected from lung cancer patients before initiation of therapy (N = 2) and from EGFR positive patients during therapy (N = 3). Supernatant PE and plasma were tested for mutations in EGFR, KRAS and BRAF by droplet digital PCR. In PE of two patients with suspected lung cancer, a KRAS mutation was detected with a 5- and 8-fold higher fractional abundance (FA) compared to plasma. For three patients with progressive disease during therapy, both the EGFR L858R and T790M mutations were detected in PE. However, in plasma only for two of these patients the L858R mutation was detected with a 46- and 14- fold lower FA, and only for one patient the T790M mutation was detected with a 8-fold lower FA. For one patient, longitudinal ctDNA analysis in PE revealed the T790M and L858R mutations already two months prior to detection of progressive disease by CT-scan. In this study, a higher ctDNA concentration and FA was obtained from PE compared to the corresponding blood samples, which enables more sensitive mutation analysis. Thus, PE is a valuable liquid biopsy, complementing plasma, for ctDNA analysis to support therapy selection and disease monitoring in lung cancer patients.
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Affiliation(s)
- Remco de Kock
- Catharina Hospital Eindhoven, Clinical Laboratory, Eindhoven, Netherlands; Eindhoven University of Technology, Institute for Complex Molecular Systems and Department of Biomedical Engineering, Laboratory of Chemical Biology, Eindhoven, Netherlands; Expert Center Clinical Chemistry Eindhoven, Eindhoven, Netherlands
| | - Chantal Knoops
- Catharina Hospital Eindhoven, Department of Respiratory Medicine, Eindhoven, Netherlands
| | - Mieke Baselmans
- Catharina Hospital Eindhoven, Clinical Laboratory, Eindhoven, Netherlands
| | - Ben van den Borne
- Catharina Hospital Eindhoven, Department of Respiratory Medicine, Eindhoven, Netherlands
| | - Luc Brunsveld
- Eindhoven University of Technology, Institute for Complex Molecular Systems and Department of Biomedical Engineering, Laboratory of Chemical Biology, Eindhoven, Netherlands; Expert Center Clinical Chemistry Eindhoven, Eindhoven, Netherlands
| | - Volkher Scharnhorst
- Catharina Hospital Eindhoven, Clinical Laboratory, Eindhoven, Netherlands; Eindhoven University of Technology, Institute for Complex Molecular Systems and Department of Biomedical Engineering, Laboratory of Chemical Biology, Eindhoven, Netherlands; Expert Center Clinical Chemistry Eindhoven, Eindhoven, Netherlands
| | - Birgit Deiman
- Catharina Hospital Eindhoven, Clinical Laboratory, Eindhoven, Netherlands; Eindhoven University of Technology, Institute for Complex Molecular Systems and Department of Biomedical Engineering, Laboratory of Chemical Biology, Eindhoven, Netherlands; Expert Center Clinical Chemistry Eindhoven, Eindhoven, Netherlands.
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12
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Fujibayashi Y, Ogawa H, Kitazume M, Nishikubo M, Nishioka Y, Kimura K, Tane S, Kitamura Y, Nishio W. Pleural invasion, epidermal growth factor receptor mutation and carcinoembryonic antigen level affect pleural lavage cytology-positive status in non-small-cell lung cancer. Eur J Cardiothorac Surg 2021; 59:791-798. [PMID: 33197244 DOI: 10.1093/ejcts/ezaa394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 09/10/2020] [Accepted: 09/24/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Pleural invasion (pl) is strongly associated with the pleural lavage cytology (PLC) status. We analysed tumours with pl and evaluated the relationship between the PLC status and pl. METHODS We retrospectively reviewed 428 surgically treated patients who had been diagnosed with non-small-cell lung cancer with pl and had their PLC status examined between 2000 and 2016. We investigated the influence of a PLC-positive status on the prognosis and searched for the factors predictive of a PLC-positive status. RESULTS Seventy-eight (18%) patients were PLC positive. The recurrence-free survival of PLC-positive patients was significantly worse than that of PLC-negative patients in pl1 and pl2, but not in pl3 (5-year recurrence-free survival rate, PLC positive versus PLC negative: pl1, 22.0% vs 60.0%, P = 0.002; pl2, 30.4% vs 59.7%, P = 0.015; pl3, 50.0% vs 59.6%, P = 0.427). A multivariable analysis showed that the degree of pl (pl2-3 versus pl1) [odds ratio (OR) 5.34, P < 0.001] was an independent predictive factor for PLC positivity. Epidermal growth factor receptor (EGFR) mutation positivity (OR 5.48, P = 0.042) and carcinoembryonic antigen (CEA) ≥5 ng/ml (OR 3.78, P = 0.042) were associated with a PLC-positive status in patients with pl2-3. We found that the PLC-positive rate in patients with pl2-3 was 35.6%; however, if the tumour was EGFR mutation positive and had CEA ≥5 ng/ml, the PLC-positive rate increased to 77%. CONCLUSIONS If a tumour was suspected of being pl2-3 and had EGFR mutation positivity and CEA ≥5 ng/ml, the PLC-positive rate was extremely high. CLINICAL TRIAL REGISTRATION NUMBER Hyogo Cancer Center, G-138.
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Affiliation(s)
- Yusuke Fujibayashi
- Department of Thoracic Surgery, Hyogo Cancer Center, Akashi, Hyogo Prefecture, Japan
| | - Hiroyuki Ogawa
- Department of Thoracic Surgery, Hyogo Cancer Center, Akashi, Hyogo Prefecture, Japan
| | - Mai Kitazume
- Department of Thoracic Surgery, Hyogo Cancer Center, Akashi, Hyogo Prefecture, Japan
| | - Megumi Nishikubo
- Department of Thoracic Surgery, Hyogo Cancer Center, Akashi, Hyogo Prefecture, Japan
| | - Yuki Nishioka
- Department of Thoracic Surgery, Hyogo Cancer Center, Akashi, Hyogo Prefecture, Japan
| | - Kenji Kimura
- Department of Thoracic Surgery, Hyogo Cancer Center, Akashi, Hyogo Prefecture, Japan
| | - Shinya Tane
- Department of Thoracic Surgery, Hyogo Cancer Center, Akashi, Hyogo Prefecture, Japan
| | - Yoshitaka Kitamura
- Department of Thoracic Surgery, Hyogo Cancer Center, Akashi, Hyogo Prefecture, Japan
| | - Wataru Nishio
- Department of Thoracic Surgery, Hyogo Cancer Center, Akashi, Hyogo Prefecture, Japan
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13
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Tibdewal A, Agarwal J, Mummudi N, Noronha V, Prabhash K, Patil V, Purandare N, Janu A, Kaushal R, Kannan S. Protocol for a phase II randomised controlled trial of TKI alone versus TKI and local consolidative radiation therapy in patients with oncogene driver-mutated oligometastatic non-small cell lung cancer. BMJ Open 2021; 11:e041345. [PMID: 33589450 PMCID: PMC7887350 DOI: 10.1136/bmjopen-2020-041345] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Tyrosine kinase inhibitors (TKIs) have significantly improved the progression-free survival (PFS) of metastatic non-small cell lung cancer (NSCLC) with oncogene mutations of epidermal growth factor receptor (EGFR) and anaplastic lymphoma kinase (ALK) compared with systemic therapy alone. However, the majority eventually develop resistance with a median PFS of 8-12 months. The pattern of failure studies showed disease relapse at the original sites of the disease-harbouring resistant tumour cells. METHODS AND ANALYSIS This study is designed as a phase II randomised controlled trial to evaluate the efficacy of local consolidative radiation therapy (LCRT) in addition to TKI in upfront oligometastatic NSCLC. Patients will be screened at presentation for oligometastases (≤5 sites) and will start on TKI after confirmation of EGFR or ALK mutation status. After initial TKI for 2-4 months, eligible patients will be randomised in a 1:1 ratio with stratification of oligometastatic sites (1-3 vs 4-5), performance status of 0-1 versus 2 and brain metastases. The standard arm will continue to receive TKI, and the intervention arm will receive TKI plus LCRT. Stereotactic body radiation therapy will be delivered to all the oligometastatic sites.The primary end point is PFS, and secondary end points are overall survival, local control of oligometastatic sites, toxicity and patient-reported outcomes. The sample size calculation took a median PFS of 10 months in the standard arm. To detect an absolute improvement of 7 months in the interventional arm, with a one-sided alpha of 5% and 80% power, a total of 106 patients will be accrued over a period of 48 months. ETHICS AND DISSEMINATION The study is approved by the Institutional Ethics Committee II of Tata Memorial Centre, Mumbai, and registered with Clinical Trials Registry-India, CTRI/2019/11/021872, dated 5 November 2019. All eligible participants will be provided with a participant information sheet and will be required to provide written informed consent for participation in the study. The study results will be presented at a national/international conference and will be published in a peer-reviewed journal.
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Affiliation(s)
- Anil Tibdewal
- Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - JaiPrakash Agarwal
- Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Naveen Mummudi
- Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Vanita Noronha
- Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Kumar Prabhash
- Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Vijay Patil
- Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Nilendu Purandare
- Nuclear Medicine, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Amit Janu
- Radiodiagnosis, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Rajiv Kaushal
- Pathology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Sadhna Kannan
- Clinical Research Secreariat, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
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14
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Ko J, Winslow MM, Sage J. Mechanisms of small cell lung cancer metastasis. EMBO Mol Med 2021; 13:e13122. [PMID: 33296145 PMCID: PMC7799359 DOI: 10.15252/emmm.202013122] [Citation(s) in RCA: 93] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 11/02/2020] [Accepted: 11/05/2020] [Indexed: 12/12/2022] Open
Abstract
Metastasis is a major cause of morbidity and mortality in cancer patients. However, the molecular and cellular mechanisms underlying the ability of cancer cells to metastasize remain relatively poorly understood. Among all solid tumors, small cell lung cancer (SCLC) has remarkable metastatic proclivity, with a majority of patients diagnosed with metastatic disease. Our understanding of SCLC metastasis has been hampered for many years by the paucity of material from primary tumors and metastases, as well as the lack of faithful pre-clinical models. Here, we review recent advances that are helping circumvent these limitations. These advances include methods that employ circulating tumor cells from the blood of SCLC patients and the development of diverse genetically engineered mouse models of metastatic SCLC. New insights into the cellular mechanisms of SCLC metastasis include observations of cell fate changes associated with increased metastatic ability. Ongoing studies on cell migration and organ tropism promise to expand our understanding of SCLC metastasis. Ultimately, a better molecular understanding of metastatic phenotypes may be translated into new therapeutic options to limit metastatic spread and treat metastatic SCLC.
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Affiliation(s)
- Julie Ko
- Department of PediatricsStanford UniversityStanfordCAUSA
- Department of GeneticsStanford UniversityStanfordCAUSA
| | - Monte M Winslow
- Department of GeneticsStanford UniversityStanfordCAUSA
- Department of PathologyStanford UniversityStanfordCAUSA
| | - Julien Sage
- Department of PediatricsStanford UniversityStanfordCAUSA
- Department of GeneticsStanford UniversityStanfordCAUSA
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15
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Pleurodesis: From Thoracic Surgery to Interventional Pulmonology. Respir Med 2021. [DOI: 10.1007/978-3-030-80298-1_15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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16
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Dipper A, Maskell N. Prognostication in malignant pleural effusion: One size does not fit all. Respirology 2020; 25:1229-1230. [PMID: 32734601 DOI: 10.1111/resp.13916] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 07/08/2020] [Indexed: 01/04/2023]
Affiliation(s)
- Alexandra Dipper
- Academic Respiratory Unit, School of Clinical Sciences, Southmead Hospital, University of Bristol, Bristol, UK
| | - Nick Maskell
- Academic Respiratory Unit, School of Clinical Sciences, Southmead Hospital, University of Bristol, Bristol, UK
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17
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Yoon JY, Nayyar R, Quest G, Pabedinskas D, Pal P, Tsao MS, Schwock J, Ko HM. PD-L1 lineage-specific quantification in malignant pleural effusions of lung adenocarcinoma by flow cytometry. Lung Cancer 2020; 148:55-61. [PMID: 32799091 DOI: 10.1016/j.lungcan.2020.07.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 07/05/2020] [Accepted: 07/09/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Pathologists encounter several challenges with programmed death ligand-1 (PD-L1) immunohistochemistry (IHC) tests in malignant effusions, including lineage specification (distinction between carcinoma vs. immune and mesothelial cells), background staining, sample fixation issues and inter-observer variability. We explored flow cytometric (FC) quantification of PD-L1 expression in malignant pleural effusions of lung adenocarcinoma patients as an alternative, automated, and objective quantification method compared to PD-L1 IHC. MATERIALS AND METHODS We examined 23 malignant pleural effusions of TTF-1-positive adenocarcinoma were subjected to FC with a panel of antibodies against CD45, CD3, CD200, EpCAM, D2-40 (podoplanin), and PD-L1 (clone MIH1). The PD-L1 gate was established using fluorescence-minus-one (FMO) isotype controls. Lineage-specific PD-L1 surface expression was quantified and the FC tumor proportion score (TPS) was assessed. PD-L1 IHC was performed on cell block sections using Dako PD-L1 IHC 22C3 pharmDx assay and assessed by two cytopathologists blinded to the FC PD-L1 TPS. RESULTS FC analysis allowed for the distinction between carcinoma cells (CD45-/EpCAM+/D2-40-), leukocytes (CD45+/EpCAM-/D2-40-) and mesothelial cells (CD45-/EpCAM-/D2-40+). FC PD-L1 TPS ranged from 0% to 77 %, while the 22C3 IHC PD-L1 TPS ranged from 0% to 97 %. The FC and IHC TPS values correlated positively (R = 0.8). Best concordance was observed when FC was performed and cell blocks were generated in parallel (R = 0.99). FC also allowed for simultaneous PD-L1 quantification in mesothelial and T-cells. PD-L1 expression on mesothelial cells ranged from 0% to 90.9 %, which also correlated positively with IHC TPS (R = 0.54). PD-L1 expression on T-cells was limited (0.1-2.9 %). CONCLUSION FC permits rapid, objective and lineage-specific PD-L1 surface expression quantification with limited specimen manipulation. The FC and IHC concordance was impacted by different antibody clones being used, but the positive correlation suggests potential clinical utility, especially in malignant effusion specimens.
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Affiliation(s)
- Ju-Yoon Yoon
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada; Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Graeme Quest
- Department of Pathology and Molecular Medicine, Queen's University, Kingston, Ontario, Canada
| | - Dana Pabedinskas
- Division of Pathology, University Health Network, Toronto, Ontario, Canada
| | - Prodipto Pal
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada; Division of Pathology, University Health Network, Toronto, Ontario, Canada
| | - Ming-Sound Tsao
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada; Division of Pathology, University Health Network, Toronto, Ontario, Canada
| | - Joerg Schwock
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada; Division of Pathology, University Health Network, Toronto, Ontario, Canada
| | - Hyang-Mi Ko
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada; Division of Pathology, University Health Network, Toronto, Ontario, Canada.
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18
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Quek JC, Tan QL, Allen JC, Anantham D. Malignant pleural effusion survival prognostication in an Asian population. Respirology 2020; 25:1283-1291. [PMID: 32390227 DOI: 10.1111/resp.13837] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 02/10/2020] [Accepted: 04/07/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND OBJECTIVE LENT and PROMISE scores prognosticate survival in patients with MPE. Prognostication guides the selection of interventions and management. However, the predictive value of these scores and their refinements (modified-LENT) in Asians remain unclear. We aim to evaluate the performance of LENT, modified-LENT and clinical PROMISE scores; identify predictors of survival; and develop an alternative prognostication tool should current scores lack accuracy. METHODS Retrospective medical record review of an Asian pleuroscopy database from 2011 to 2018 of patients with MPE was conducted. The prognostic capability of current available scores were evaluated using C-statistics. Demographic and clinical variables as predictors of survival were assessed, and an alternative model was developed using logistic regression. RESULTS In 130 patients, the C-statistics for modified-LENT was not significantly different from LENT (0.59 (95% CI: 0.52-0.67) vs 0.56 (95% CI: 0.49-0.63); P = 0.403). In 57 patients, the PROMISE C-statistics was 0.72 (95% CI: 0.53-0.91). In our alternative prognostication model (n = 147), Sex, Eastern Cooperative Oncology Group status, Leukocyte count, EGFR mutation, Chemotherapy and primary Tumour type (SELECT) were predictors of 90-day mortality (C-statistic = 0.87 (95% CI: 0.79-0.95)). SELECT sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios using a predicted probability of 90-day mortality cut-off point of 10% were 0.91, 0.68, 0.34, 0.98, 2.83 and 0.13, respectively. CONCLUSION The LENT, modified-LENT and PROMISE scores have poor accuracy of survival prognostication in Asian patients with MPE undergoing pleuroscopy. The proposed SELECT prognostication model is accurate at identifying patients with high probability of survival at 90 days.
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Affiliation(s)
- Jonathan Caleb Quek
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Duke-National University of Singapore Medical School, Singapore
| | - Qiao Li Tan
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore
| | - John Carson Allen
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Duke-National University of Singapore Medical School, Singapore
| | - Devanand Anantham
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Duke-National University of Singapore Medical School, Singapore.,Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore
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19
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Ruan X, Sun Y, Wang W, Ye J, Zhang D, Gong Z, Yang M. Multiplexed molecular profiling of lung cancer with malignant pleural effusion using next generation sequencing in Chinese patients. Oncol Lett 2020; 19:3495-3505. [PMID: 32269623 PMCID: PMC7115151 DOI: 10.3892/ol.2020.11446] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 11/19/2019] [Indexed: 12/24/2022] Open
Abstract
Lung cancer is the most common type of cancer and the leading cause of cancer-associated death worldwide. Malignant pleural effusion (MPE), which is observed in ~50% of advanced non-small cell lung cancer (NSCLC) cases, and most frequently in lung adenocarcinoma, is a common complication of stage III-IV NSCLC, and it can be used to predict a poor prognosis. In the present study, multiple oncogene mutations were detected, including 17 genes closely associated with initiation of advanced lung cancer, in 108 MPE samples using next generation sequencing (NGS). The NGS data of the present study had broader coverage, deeper sequencing depth and higher capture efficiency compared with NGS findings of previous studies on MPE. In the present study, using NGS, it was demonstrated that 93 patients (86%) harbored EGFR mutations and 62 patients possessed mutations in EGFR exons 18-21, which are targets of available treatment agents. EGFR L858R and exon 19 indel mutations were the most frequently observed alterations, with frequencies of 31 and 25%, respectively. In 1 patient, an EGFR amplification was identified and 6 patients possessed a T790M mutation. ALK + EML4 gene fusions were identified in 6 patients, a ROS1 + CD74 gene fusion was detected in 1 patient and 10 patients possessed a BIM (also known as BCL2L11) 2,903-bp intron deletion. In 4 patients, significant KRAS mutations (G12D, G12S, G13C and A146T) were observed, which are associated with resistance to afatinib, icotinib, erlotinib and gefitinib. There were 83 patients with ERBB2 mutations, but only two of these mutations were targets of available treatments. The results of the present study indicate that MPE is a reliable specimen for NGS based detection of somatic mutations.
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Affiliation(s)
- Xingya Ruan
- Department of Pulmonary and Critical Care Medicine, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, Jiangsu 213000, P.R. China
| | - Yonghua Sun
- Shanghai YunYing Medical Technology Co., Ltd., Shanghai 201600, P.R. China
| | - Wei Wang
- Shanghai YunYing Medical Technology Co., Ltd., Shanghai 201600, P.R. China
| | - Jianwei Ye
- Shanghai YunYing Medical Technology Co., Ltd., Shanghai 201600, P.R. China
| | - Daoyun Zhang
- Shanghai YunYing Medical Technology Co., Ltd., Shanghai 201600, P.R. China
| | - Ziying Gong
- Shanghai YunYing Medical Technology Co., Ltd., Shanghai 201600, P.R. China
| | - Mingxia Yang
- Department of Pulmonary and Critical Care Medicine, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, Jiangsu 213000, P.R. China
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20
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Kleontas A, Sioga A, Pandria N, Barbetakis N, Lazopoulos A, Katsikas I, Asteriou C, Paliouras D, Kamperis E, Ikonomou D, Papamitsou T, Filippou D, Destouni C, Ikonomou L, Zarogoulidis K, Papagiannopoulos K. Clinical factors affecting the survival of patients diagnosed with non-small cell lung cancer and metastatic malignant pleural effusion, treated with hyperthermic intrathoracic chemotherapy or chemical talc pleurodesis: a monocentric, prospective, randomized trial. J Thorac Dis 2019; 11:1788-1798. [PMID: 31285871 DOI: 10.21037/jtd.2019.05.25] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background There is a plethora of treatment algorithms for managing patients with malignant pleural effusions (MPEs), sharing many common points and principles. Our study aims to compare hyperthermic intrapleural chemotherapy (HITHOC) and talc pleurodesis (TALC), as treatment options for patients with non-small cell lung cancer (NSCLC) and metastatic MPE. Methods This prospective, randomized trial was conducted at a single thoracic surgery center, the "Theagenio" Cancer Institute, in Greece, under the identification code NCT01409551 and was completed. All 40 patients enrolled were adults with histologically proven metastatic, unilateral, MPE caused by NSCLC. Exclusion criteria included patients >80 years, trapped lung, and major comorbidities. Patients were randomly and equally assigned 1:1 to either HITHOC (group A) or TALC (group B) by video assisted thoracic surgery (VATS). The primary outcome was the median overall survival (OS) from trial intervention to death, while secondary outcome was the identification of clinical factors affecting the survival. Results The patients were followed up for 45 months. The OS of the full group was 8 months (95% CI: 7.046-8.954). Participants who underwent HITHOC had an OS of 8 months (95% CI: 7.141-8.859), whereas the participants of TALC had an OS of 9 months (95% CI: 7.546-10.454), with no significant difference between groups. Among fifty-four factors that were tested for their effects on survival, only TNM stage and creatinine values both preoperatively and 7 days postoperatively could be regarded as risk-factors for survival. Other recorded parameters, which had significant variance between the two groups, were urea levels, C-reactive protein, white blood cells and total in hospital length of stay (LOS). Conclusions Both HITHOC and TALC are equally effective and safe therapeutic options in treating patients with MPE and NSCLC with acceptable survival. The study revealed independent clinical risk factors influencing survival, which could be utilized as starting points for larger clinical studies. Keywords Pleurodesis; pleural effusion; malignant; carcinoma; non-small cell lung; hyperthermia.
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Affiliation(s)
- Athanasios Kleontas
- Department of Thoracic Surgery, European Interbalkan Medical Center of Thessaloniki, Thessaloniki, Greece
| | - Antonia Sioga
- Laboratory of Histology-Embryology, Medical School of Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Niki Pandria
- Laboratory of Medical Physics, Medical School of Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nikolaos Barbetakis
- Department of Thoracic Surgery, "Theagenio" Cancer Hospital of Thessaloniki, Thessaloniki, Greece
| | - Achilleas Lazopoulos
- Department of Thoracic Surgery, "Theagenio" Cancer Hospital of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Katsikas
- Department of Anesthesiology, Polyclinique Du Val De Loire, Nevers, France
| | - Christos Asteriou
- Department of Thoracic Surgery, Euromedica General Clinic of Thessaloniki, Thessaloniki, Greece
| | - Dimitrios Paliouras
- Department of Thoracic Surgery, "Theagenio" Cancer Hospital of Thessaloniki, Thessaloniki, Greece
| | - Efstathios Kamperis
- Department of Radiotherapy, "Papageorgiou" General Hospital of Thessaloniki, Thessaloniki, Greece
| | - Dimitrios Ikonomou
- Department of Thoracic Surgery, European Interbalkan Medical Center of Thessaloniki, Thessaloniki, Greece
| | - Theodora Papamitsou
- Laboratory of Histology-Embryology, Medical School of Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitrios Filippou
- Department of Thoracic Surgery, European Interbalkan Medical Center of Thessaloniki, Thessaloniki, Greece
| | - Chariklia Destouni
- Laboratory of Cytology, "Theagenio" Cancer Hospital of Thessaloniki, Thessaloniki, Greece
| | - Louiza Ikonomou
- Laboratory of Histology-Embryology, Medical School of Aristotle University of Thessaloniki, Thessaloniki, Greece
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21
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Hummelink K, Muller M, Linders TC, van der Noort V, Nederlof PM, Baas P, Burgers S, Smit EF, Meijer GA, van den Heuvel MM, van den Broek D, Monkhorst K. Cell-free DNA in the supernatant of pleural effusion can be used to detect driver and resistance mutations, and can guide tyrosine kinase inhibitor treatment decisions. ERJ Open Res 2019; 5:00016-2019. [PMID: 30918895 PMCID: PMC6431750 DOI: 10.1183/23120541.00016-2019] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 01/15/2019] [Indexed: 11/05/2022] Open
Abstract
Objectives Molecular profiling of tumours has become the mainstay of diagnostics for metastasised solid malignancies and guides personalised treatment, especially in nonsmall cell lung cancer (NSCLC). In current practice, it is often challenging to obtain sufficient tumour material for reliable molecular analysis. Cell-free DNA (cfDNA) in blood or other bio-sources could present an alternative approach to obtain genetic information from the tumour. In a retrospective cohort we analysed the added value of cfDNA analysis in pleural effusions for molecular profiling. Methods We retrospectively analysed both the supernatant and the cell pellet of 44 pleural effusions sampled from 39 stage IV patients with KRAS (n=23) or EGFR (n=16) mutated tumours to detect the original driver mutation as well as for EGFR T790M resistance mutations. Patients were diagnosed with either NSCLC (n=32), colon carcinoma (n=4), appendiceal carcinoma (n=2) or adenocarcinoma of unknown primary (n=1). Samples collected in the context of routine clinical care were stored at the Netherlands Cancer Institute biobank. We used droplet digital PCR for analysis. Results The driver mutation could be detected in 36 of the 44 pleural effusions by analysis of both the supernatant (35 out of 44 positive) and the cell pellet (31 out of 44 positive). In seven out of 20 pleural effusions from patients with EGFR mutation-positive tumours, a T790M mutation was detected. All seven supernatants and cell pellets were positive. Conclusions cfDNA in pleural effusion can be used to detect driver mutations as well as resistance mechanisms like EGFR T790M in pleural effusion with high accuracy and is therefore a valuable bio-source.
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Affiliation(s)
- Karlijn Hummelink
- Dept of Pathology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.,Dept of Thoracic Oncology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Mirte Muller
- Dept of Thoracic Oncology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Theodora C Linders
- Dept of Laboratory Medicine, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Vincent van der Noort
- Dept of Biometrics, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, The Netherlands
| | - Petra M Nederlof
- Dept of Pathology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Paul Baas
- Dept of Thoracic Oncology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Sjaak Burgers
- Dept of Thoracic Oncology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Egbert F Smit
- Dept of Thoracic Oncology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Gerrit A Meijer
- Dept of Pathology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Michel M van den Heuvel
- Dept of Thoracic Oncology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.,Dept of Pulmonary Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Daan van den Broek
- Dept of Laboratory Medicine, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Kim Monkhorst
- Dept of Pathology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
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22
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Tissot C, Gay P, Brun C, Froudarakis ME. Novel insights into the systemic treatment of lung cancer malignant pleural effusion. CLINICAL RESPIRATORY JOURNAL 2019; 13:131-138. [DOI: 10.1111/crj.13005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 01/22/2019] [Accepted: 01/26/2019] [Indexed: 12/19/2022]
Affiliation(s)
- Claire Tissot
- Department of Pneumonology and Thoracic Oncology; North Hospital, University Hospital of Saint-Etienne; Saint-Etienne France
| | - Pierre Gay
- Department of Pneumonology and Thoracic Oncology; North Hospital, University Hospital of Saint-Etienne; Saint-Etienne France
| | - Clément Brun
- Department of Pneumonology and Thoracic Oncology; North Hospital, University Hospital of Saint-Etienne; Saint-Etienne France
| | - Marios E. Froudarakis
- Department of Pneumonology and Thoracic Oncology; North Hospital, University Hospital of Saint-Etienne; Saint-Etienne France
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23
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Brun C, Gay P, Cottier M, Karpathiou G, Patoir A, Tiffet O, Barral FG, Vergnon JM, Froudarakis ME. Comparison of cytology, chest computed and positron emission tomography findings in malignant pleural effusion from lung cancer. J Thorac Dis 2018; 10:6903-6911. [PMID: 30746236 DOI: 10.21037/jtd.2018.11.127] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Malignant pleural effusion (MPE) is a common medical problem in lung cancer (LC). Pleural fluid cytology (PFC), chest computed tomography (CCT) and positron emission tomography (PET) findings are helpful as first line approach. The objectives of this study were to evaluate whether there is a correlation between PFC, CCT and PET in patients with MPE due to LC. Methods We selected patients from our electronic files. Data of PFC, pleural biopsy (PB), CCT and PET have been recorded and analyzed. Results A total of 101 consecutive patients (66 males, 65.3%) with a mean age of 66.2±31 years were selected. Types of LC were adenocarcinoma in 71 patients (70.2%), squamous in 13 (12.8%), small-cell in 12 (11.8%) and large cell in 5 (4.9%). CCT showed nodules in 6 (5.9%), pleural thickening in 8 (7.9%) and both in 17 (16.8%) patients. PFC was positive in 55/91 thoracentesis (60.4%) and 32/52 thoracoscopy (61.5%), while PB in 38/40 performed (95%). PET fixation was found in 32/47 (68%) patients who had MPE at diagnosis. When we associate PFC to CCT and PET findings, the yield in our study becomes 90%. No correlation was observed between CCT findings and PFC (P=0.62) between PFC and PET fixation (P=0.63) or between CCT and PET (P=0.06). Conclusions In our cohort of LC patients with MPE, we observed a high sensitivity for PFC, while in most of the cases no findings were observed in CCT. PET had a relative low sensitivity. However, when all 3 methods were combined the yield was 90%.
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Affiliation(s)
- Clement Brun
- Departments of Pneumonology and Thoracic Oncology, University Hospital of Saint-Etienne, Saint-Priest-en-Jarez, France
| | - Pierre Gay
- Departments of Pneumonology and Thoracic Oncology, University Hospital of Saint-Etienne, Saint-Priest-en-Jarez, France
| | - Michele Cottier
- Departments of Cytology, University Hospital of Saint-Etienne, Saint-Priest-en-Jarez, France
| | - Georgia Karpathiou
- Departments of Pathology, University Hospital of Saint-Etienne, Saint-Priest-en-Jarez, France
| | - Arnaud Patoir
- Departments of Thoracic Surgery, University Hospital of Saint-Etienne, Saint-Priest-en-Jarez, France
| | - Oliviet Tiffet
- Departments of Thoracic Surgery, University Hospital of Saint-Etienne, Saint-Priest-en-Jarez, France
| | - Fabrice-Guy Barral
- Departments of Radiology, University Hospital of Saint-Etienne, Saint-Priest-en-Jarez, France
| | - Jean-Michel Vergnon
- Departments of Pneumonology and Thoracic Oncology, University Hospital of Saint-Etienne, Saint-Priest-en-Jarez, France
| | - Marios E Froudarakis
- Departments of Pneumonology and Thoracic Oncology, University Hospital of Saint-Etienne, Saint-Priest-en-Jarez, France
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24
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Zirlik S, Hildner K, Rieker RJ, Vieth M, Neurath MF, Fuchs FS. Confocal Laser Endomicroscopy for Diagnosing Malignant Pleural Effusions. Med Sci Monit 2018; 24:5437-5447. [PMID: 30078032 PMCID: PMC6091162 DOI: 10.12659/msm.909989] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background Confocal laser endomicroscopy (CLE) enables “in vivo” microscopic tissue diagnosis based on tissue reflectance or tissue fluorescence upon application of fluorescence agents. The aim of the present study was to evaluate CLE as a new diagnostic approach for differentiation between malignant versus non-malignant pleural effusions. Material/Methods In 100 patients with pleural effusions, thoracentesis was performed. Cresyl violet and acriflavine were used as contrast agents for probe-based CLE of effusions. CLE video sequences were assessed by 4 independent investigators (2 experienced in this technique, 2 with only basic knowledge). In addition, all CLE samples were evaluated by an expert pathologist (p). Results were compared with conventional cytology of effusions and histology of cell blocks. Results CLE reliably permitted identification of malignant cells in pleural effusions. Sensitivity for detection of malignant effusions was 87% (p: 87%) and 81% (p: 72%) for acriflavine and cresyl violet, respectively. With regard to specificity, acriflavine and cresyl violet yielded a mean value of 99% (p: 100%) and 92% (p: 100%). Conclusions In this pilot study, CLE permitted simple and rapid detection of malignant pleural effusions. Larger prospective studies are warranted to corroborate our findings.
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Affiliation(s)
- Sabine Zirlik
- Department of Medicine 1, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Kai Hildner
- Department of Medicine 1, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Ralf Joachim Rieker
- Department of Pathology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Michael Vieth
- Department of Pathology, Clinical Center of Bayreuth, Bayreuth, Germany
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25
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Xu L, Wang B, Gao M, Zhang Y, Qi Q, Li T, Li C, Wang A, Li Y. Intrapleural combination therapy with lobaplatin and erythromycin for non-small cell lung cancer-mediated malignant pleural effusion. Thorac Cancer 2018; 9:950-955. [PMID: 29917319 PMCID: PMC6068459 DOI: 10.1111/1759-7714.12768] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 04/23/2018] [Accepted: 04/23/2018] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Malignant pleural effusion is a common complication of non-small cell lung cancer (NSCLC); however, treatment options remain limited. This study evaluated the safety and efficacy of sequential intrapleural therapy with lobaplatin and erythromycin for NSCLC-mediated malignant pleural effusion. METHODS Fifty-six patients with NSCLC complicated with malignant pleural effusion were recruited for a prospective single-arm study from December 2014 to 2016; one patient dropped out. In addition to conventional systemic chemotherapy, lobaplatin and erythromycin were intrapleurally injected into subjects. Short and long-term responses were analyzed. The concentration of ultrafilterable platinum in the pleural effusion and plasma were detected at different time points. Incidences of severe adverse reactions were observed. RESULTS In the 55 evaluable patients, the effective rate of pleural effusion was 81.8% after six weeks of treatment. Six and twelve months after treatment, the effective rates were 60% and 21.8%, respectively, and the one-year survival rate was 83.6%. The concentrations of lobaplatin in pleural effusion and plasma two hours after injecting 50 mg lobaplatin into the thoracic cavity were 13.763 ± 1.523 μg/mL and 1.120 ± 0.164 μg/mL, and 17 hours later were 1.961 ± 0.351 μg/mL and 0.578 ± 0.095 μg/mL, respectively. The rate of severe adverse reactions of the first cycle of systemic chemotherapy combined with lobaplatin and erythromycin did not significantly differ from the rate in the second cycle. CONCLUSION Intrapleural combination therapy with lobaplatin and erythromycin is a safe and efficient treatment for patients with NSCLC-mediated malignant pleural effusion.
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Affiliation(s)
- Lisheng Xu
- Department of Respiratory Diseases, Qilu Hospital, Shandong University, Jinan, China
| | - Benjie Wang
- Clinical Pharmacological Centre, Qilu Hospital, Shandong University, Jinan, China
| | - Meimei Gao
- Clinical Pharmacological Centre, Qilu Hospital, Shandong University, Jinan, China
| | - Yan Zhang
- Department of Respiratory Diseases, Qilu Hospital, Shandong University, Jinan, China
| | - Qian Qi
- Department of Respiratory Diseases, Laiwu People's Hospital, Laiwu, China
| | - Tao Li
- Department of Respiratory Diseases, Qilu Hospital, Shandong University, Jinan, China
| | - Caiyu Li
- Department of Respiratory Diseases, The Second Hospital of Shandong University, Jinan, China
| | - Aihua Wang
- Department of Respiratory Diseases, Qilu Hospital, Shandong University, Jinan, China
| | - Yu Li
- Department of Respiratory Diseases, Qilu Hospital, Shandong University, Jinan, China
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26
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Yang J, Lee OJ, Son SM, Woo CG, Jeong Y, Yang Y, Kwon J, Lee KH, Han HS. EGFR Mutation Status in Lung Adenocarcinoma-Associated Malignant Pleural Effusion and Efficacy of EGFR Tyrosine Kinase Inhibitors. Cancer Res Treat 2017; 50:908-916. [PMID: 28934846 PMCID: PMC6056963 DOI: 10.4143/crt.2017.378] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Accepted: 09/14/2017] [Indexed: 12/21/2022] Open
Abstract
Purpose Malignant pleural effusions (MPEs) are often observed in lung cancer, particularly adenocarcinoma. The aim of this study was to investigate epidermal growth factor receptor (EGFR) mutation status in lung adenocarcinoma-associated MPEs (LA-MPEs) and its correlation with efficacy of EGFR tyrosine kinase inhibitor (TKI) therapy. Materials and Methods Samples comprised 40 cell blocks of pathologically-confirmed LA-MPEs collected before the start of EGFR TKI therapy. EGFR mutation status was re-evaluated by peptide nucleic acid clamping and the clinical outcomes of EGFR TKI‒treated patients were analyzed retrospectively. Results EGFR mutations were detected in 72.5% of LA-MPE cell blocks (29/40). The median progression-free survival for patients with EGFR mutations in LA-MPEs was better than that for patients with wild-type EGFR (7.33 months vs. 2.07 months; hazard ratio, 0.486; 95% confidence interval, 0.206 to 1.144; p=0.032). The objective response rate (ORR) of 26 patients with EGFR mutations in LA-MPEs among the 36 patients with measurable lesions was 80.8%, while the ORR of the 10 patients with wild-type EGFR in LA-MPEs was 10% (p < 0.001). Among the 26 patients with EGFR mutations in LA-MPEs, the ORR of target lesions and LA-MPEs were 88.5% and 61.5%, respectively (p=0.026). Conclusion EGFR mutation status in cell blocks of LA-MPEs confirmed by pathologic diagnosis is highly predictive of EGFR TKI efficacy. For patients with EGFR mutations in LA-MPEs, the response to EGFR TKIs seems to be worse for pleural effusions than for solid tumors.
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Affiliation(s)
- Jiyoul Yang
- Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Korea
| | - Ok-Jun Lee
- Department of Pathology, Chungbuk National University Hospital, Cheongju, Korea.,Department of Pathology, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Seung-Myoung Son
- Department of Pathology, Chungbuk National University Hospital, Cheongju, Korea
| | - Chang Gok Woo
- Department of Pathology, Chungbuk National University Hospital, Cheongju, Korea
| | - Yusook Jeong
- Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Korea
| | - Yaewon Yang
- Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Korea
| | - Jihyun Kwon
- Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Korea
| | - Ki Hyeong Lee
- Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Korea.,Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Hye Sook Han
- Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Korea.,Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea
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27
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Li L, Yang L, Wang L, Wang F, Zhang Z, Li J, Yue D, Chen X, Ping Y, Huang L, Zhang B, Zhang Y. Impaired T cell function in malignant pleural effusion is caused by TGF-β derived predominantly from macrophages. Int J Cancer 2016; 139:2261-9. [PMID: 27459735 DOI: 10.1002/ijc.30289] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 06/28/2016] [Accepted: 07/15/2016] [Indexed: 12/12/2022]
Affiliation(s)
- Lifeng Li
- Biotherapy Center, The First Affiliated Hospital of Zhengzhou University; Zhengzhou Henan 450052 People's Republic of China
- Department of Oncology; The First Affiliated Hospital of Zhengzhou University; Zhengzhou Henan 450052 People's Republic of China
| | - Li Yang
- Biotherapy Center, The First Affiliated Hospital of Zhengzhou University; Zhengzhou Henan 450052 People's Republic of China
- Department of Oncology; The First Affiliated Hospital of Zhengzhou University; Zhengzhou Henan 450052 People's Republic of China
| | - Liping Wang
- Department of Oncology; The First Affiliated Hospital of Zhengzhou University; Zhengzhou Henan 450052 People's Republic of China
| | - Fei Wang
- Biotherapy Center, The First Affiliated Hospital of Zhengzhou University; Zhengzhou Henan 450052 People's Republic of China
- School of Life Sciences; Zhengzhou University; Zhengzhou Henan 450001 People's Republic of China
| | - Zhen Zhang
- Biotherapy Center, The First Affiliated Hospital of Zhengzhou University; Zhengzhou Henan 450052 People's Republic of China
- Department of Oncology; The First Affiliated Hospital of Zhengzhou University; Zhengzhou Henan 450052 People's Republic of China
| | - Jieyao Li
- Biotherapy Center, The First Affiliated Hospital of Zhengzhou University; Zhengzhou Henan 450052 People's Republic of China
- Department of Oncology; The First Affiliated Hospital of Zhengzhou University; Zhengzhou Henan 450052 People's Republic of China
| | - Dongli Yue
- Biotherapy Center, The First Affiliated Hospital of Zhengzhou University; Zhengzhou Henan 450052 People's Republic of China
- Department of Oncology; The First Affiliated Hospital of Zhengzhou University; Zhengzhou Henan 450052 People's Republic of China
| | - Xinfeng Chen
- Biotherapy Center, The First Affiliated Hospital of Zhengzhou University; Zhengzhou Henan 450052 People's Republic of China
- Department of Oncology; The First Affiliated Hospital of Zhengzhou University; Zhengzhou Henan 450052 People's Republic of China
| | - Yu Ping
- Biotherapy Center, The First Affiliated Hospital of Zhengzhou University; Zhengzhou Henan 450052 People's Republic of China
- School of Life Sciences; Zhengzhou University; Zhengzhou Henan 450001 People's Republic of China
| | - Lan Huang
- Biotherapy Center, The First Affiliated Hospital of Zhengzhou University; Zhengzhou Henan 450052 People's Republic of China
| | - Bin Zhang
- Division of Hematology/Oncology; Department of Medicine, Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine; Chicago IL 60611
| | - Yi Zhang
- Biotherapy Center, The First Affiliated Hospital of Zhengzhou University; Zhengzhou Henan 450052 People's Republic of China
- Department of Oncology; The First Affiliated Hospital of Zhengzhou University; Zhengzhou Henan 450052 People's Republic of China
- School of Life Sciences; Zhengzhou University; Zhengzhou Henan 450001 People's Republic of China
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Atagi S, Goto K, Seto T, Yamamoto N, Tamura T, Tajima K, Inagaki N. Erlotinib for Japanese patients with activating EGFR mutation-positive non-small-cell lung cancer: combined analyses from two Phase II studies. Future Oncol 2016; 12:2117-26. [PMID: 27267081 DOI: 10.2217/fon-2016-0163] [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] [Indexed: 01/17/2023] Open
Abstract
AIMS We evaluated the efficacy and safety of erlotinib, and patient characteristics affecting progression-free survival (PFS), by analyzing data from two Phase II studies of first-line erlotinib in activating EGFR mutation-positive non-small-cell lung cancer. METHODS Data were combined from patients who received first-line erlotinib monotherapy in JO22903 (single-arm study; JapicCTI-101085) and JO25567 (randomized study; JapicCTI-111390). RESULTS Median PFS was 10.9 months in efficacy-evaluable patients (n = 177). Major adverse events were dermatologic; no new safety signals were observed. Baseline pleural/cardiac effusion notably affected PFS (yes median 8.0 months vs no median 15.3 months) as confirmed in multivariate analysis (hazard ratio: 0.38; 95% CI: 0.25-0.58). CONCLUSION Efficacy and safety of erlotinib monotherapy were consistent with previous studies. Baseline pleural/pericardial effusion was associated with shorter PFS.
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Affiliation(s)
| | - Koichi Goto
- National Cancer Center Hospital East, Chiba, Japan
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Chen L, Zhang G, Sheng S, Zhou Q, Pan Y, Guan S. Upregulation of soluble B7-H3 in NSCLC-derived malignant pleural effusion: A potential diagnostic biomarker correlated with NSCLC staging. Clin Chim Acta 2016; 457:81-5. [PMID: 27071700 DOI: 10.1016/j.cca.2016.04.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Revised: 03/30/2016] [Accepted: 04/07/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND The B7 family member B7-H3 (CD276) is involved in tumor immunity including Non-small-cell lung cancer (NSCLC). We have previously demonstrated an elevated circulating level of the soluble form of B7-H3 (sB7-H3) in NSCLC patients. However, the expression of sB7-H3 in NSCLC-derived malignant pleural effusions (MPEs) and its clinical significance remain elusive. METHODS We measured and compared sB7-H3 levels in NSCLC-derived MPEs (n=52) and nonneoplastic pleural effusions (NPEs) (n=47), and then evaluated the diagnostic performance for sB7-H3 in NSCLC-derived MPEs. The correlation between MPE-derived sB7-H3 and clinical characteristics including TNM staging system was also analyzed. RESULTS The median value of sB7-H3 in 52 MPEs and 47 NPEs were 41.60ng/ml (interquartile range: 36.76-51.30ng/ml) and 31.55ng/ml (interquartile range: 26.97-36.63ng/ml) (P<0.0001), respectively. At the proposed cut-off value at 38.41ng/ml, sB7-H3 was capable of discriminating NSCLC-derived MPEs from NPEs with a sensitivity of 67.3% and a specificity of 91.5% respectively. Furthermore, MPEs-derived sB7-H3 was correlated with smoking status (P=0.005), primary tumor size (T factor, P=0.03), regional lymph node dissemination (N factor, P=0.019) and distant metastasis (M factor, P=0.009) of NSCLC patients. CONCLUSIONS Upregulated sB7-H3 expression in MPEs is correlated with TNM stage of NSCLC and may serve as a potential biomarker for NSCLC-derived MPEs.
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Affiliation(s)
- Liwen Chen
- Department of Laboratory Medicine, The Second Hospital of Anhui Medical University, Hefei, China
| | - Guangbo Zhang
- Clinical Immunology Laboratory and Institute of Medical Biotechnology, Soochow University, Suzhou, China
| | - Shouqin Sheng
- Medical Research Center, The Second Hospital of Anhui Medical University, Hefei, China
| | - Qiang Zhou
- Department of Laboratory Medicine, The Second Hospital of Anhui Medical University, Hefei, China
| | - Ying Pan
- Department of Laboratory Medicine, The Second Hospital of Anhui Medical University, Hefei, China
| | - Shihe Guan
- Department of Laboratory Medicine, The Second Hospital of Anhui Medical University, Hefei, China.
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Chang WA, Hung JY, Tsai YM, Hsu YL, Chiang HH, Chou SH, Huang MS, Kuo PL. Laricitrin suppresses increased benzo(a)pyrene-induced lung tumor-associated monocyte-derived dendritic cell cancer progression. Oncol Lett 2016; 11:1783-1790. [PMID: 26998077 DOI: 10.3892/ol.2016.4153] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2015] [Accepted: 01/13/2016] [Indexed: 01/03/2023] Open
Abstract
Benzo(a)pyrene (BaP) stimulates lung cancer cells, promoting monocyte-derived dendritic cells to secrete soluble factors, including heparin binding-epidermal growth factor and C-X-C motif chemokine 5. The secretions from monocyte-derived dendritic cells stimulate the progression of lung cancer cells, including the migration and invasion of cells. To the best of our knowledge, these secretions remain unknown, and require additional study. The present study identified that treatment with BaP-H1395-tumor-associated dendritic cell-conditioned medium had the most marked effect on cell migration and invasion. This result may be associated with the female gender, stage 2 adenocarcinoma or mutation of the proto-oncogene B-Raf (BRAF), according to the cell line background. Laricitrin, a dietary flavonoid derivative present in grapes and red wine, suppresses certain factors and decreases the progression of lung cancer cells that are promoted by BaP in the lung cancer tumor microenvironment. The results of the present study suggest that prolonged exposure to BaP exacerbates lung cancer, particularly in female lung cancer patients with the BRAF mutation, but that laricitrin may ameliorate this effect.
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Affiliation(s)
- Wei-An Chang
- Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan, R.O.C.; Division of Pulmonary and Critical Care Medicine, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan, R.O.C
| | - Jen-Yu Hung
- Division of Pulmonary and Critical Care Medicine, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan, R.O.C.; School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 804, Taiwan, R.O.C
| | - Ying-Ming Tsai
- Division of Pulmonary and Critical Care Medicine, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan, R.O.C.; Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan, R.O.C
| | - Ya-Ling Hsu
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan, R.O.C
| | - Hung-Hsing Chiang
- Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan, R.O.C.; Division of Chest Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan, R.O.C
| | - Shah-Hwa Chou
- Division of Chest Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan, R.O.C
| | - Ming-Shyan Huang
- Division of Pulmonary and Critical Care Medicine, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan, R.O.C.; School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 804, Taiwan, R.O.C
| | - Po-Lin Kuo
- Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan, R.O.C.; Research Center for Environmental Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan, R.O.C.; Institute of Medical Science and Technology, National Sun Yat-Sen University, Kaohsiung 804, Taiwan, R.O.C
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Zou J, Bella AE, Chen Z, Han X, Su C, Lei Y, Luo H. Frequency of EGFR mutations in lung adenocarcinoma with malignant pleural effusion: Implication of cancer biological behaviour regulated by EGFR mutation. J Int Med Res 2015; 42:1110-7. [PMID: 25239875 DOI: 10.1177/0300060514539273] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE A retrospective single-centre study to compare the clinical features of patients with lung adenocarcinoma with and without epidermal growth factor receptor (EGFR) mutations. METHODS Pretreatment medical records of patients with lung adenocarcinoma were reviewed. DNA was extracted from paraffin wax-embedded tumour tissue for analysis of EGFR mutations. Malignant pleural effusion (MPE) was diagnosed by cytopathological testing of pleural fluid. RESULTS EGFR mutations (19-Del and L858R) were recorded in 81/283 patients (28.6%). MPE was found in 42/283 patients (14.8%). In patients with stage IV disease, the frequency of EGFR mutations was higher in those with MPE than in those without MPE. EGFR mutations were independently associated with female sex, no history of smoking and presence of MPE. CONCLUSIONS There was a positive association between EGFR mutation and the presence of MPE. EGFR mutations may play an important role in the formation of MPE.
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Affiliation(s)
- JianYong Zou
- Department of Thoracic Surgery, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Amos Ela Bella
- Department of Thoracic Surgery, Cancer Centre of Sun Yat-Sen University, Guangzhou, China
| | - ZhenGuang Chen
- Department of Cardiothoracic Surgery, Huangpu Branch of the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - XiangQian Han
- The Department of Thoracic Surgery, The First Affiliated Hospital of NanYang Medical College, HeNan, China
| | - ChunHua Su
- Department of Thoracic Surgery, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - YiYan Lei
- Department of Thoracic Surgery, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - HongHe Luo
- Department of Thoracic Surgery, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
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Spella M, Giannou AD, Stathopoulos GT. Switching off malignant pleural effusion formation-fantasy or future? J Thorac Dis 2015; 7:1009-20. [PMID: 26150914 DOI: 10.3978/j.issn.2072-1439.2015.05.20] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2014] [Accepted: 05/27/2015] [Indexed: 12/11/2022]
Abstract
Malignant pleural effusion (MPE) is common and difficult to treat. In the vast majority of patients the presence of MPE heralds incurable disease, associated with poor quality of life, morbidity and mortality. Current therapeutic approaches are inefficient and merely offer palliation of associated symptoms. Recent scientific progress has shed light in the biologic processes governing the mechanisms behind the pathobiology of MPE. Pleural based tumors interfere with pleural fluid drainage, as well as the host vasculature and immune system, resulting in decreased fluid absorption and increased pleural fluid production via enhanced plasma extravasation into the pleural space. In order to achieve this feat, pleural based tumors must elicit critical vasoactive events in the pleura, thus forming a favorable microenvironment for tumor dissemination and MPE development. Such properties involve specific transcriptional signaling cascades in addition to secretion of important mediators which attract and activate host cell populations which, in turn, impact tumor cell functions. The dissection of the biologic steps leading to MPE formation provides novel therapeutic targets and recent research findings provide encouraging results towards future therapeutic innovations in MPE management.
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Affiliation(s)
- Magda Spella
- Laboratory for Molecular Respiratory Carcinogenesis, Department of Physiology, Faculty of Medicine, University of Patras, Rio, Achaia, 26504, Greece
| | - Anastasios D Giannou
- Laboratory for Molecular Respiratory Carcinogenesis, Department of Physiology, Faculty of Medicine, University of Patras, Rio, Achaia, 26504, Greece
| | - Georgios T Stathopoulos
- Laboratory for Molecular Respiratory Carcinogenesis, Department of Physiology, Faculty of Medicine, University of Patras, Rio, Achaia, 26504, Greece
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Agalioti T, Giannou AD, Stathopoulos GT. Pleural involvement in lung cancer. J Thorac Dis 2015; 7:1021-30. [PMID: 26150915 DOI: 10.3978/j.issn.2072-1439.2015.04.23] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 03/11/2015] [Indexed: 11/14/2022]
Abstract
The pleural space, a sterile secluded environment in the thoracic cavity, represents an attractive metastatic site for various cancers of lung, breast and gastrointestinal origins. Whereas lung and breast adenocarcinomas could invade the pleural space because of their anatomic proximity, "distant" cancers like ovarian or gastrointestinal tract adenocarcinomas may employ more active mechanisms to the same end. A pleural metastasis is often accompanied by a malignant pleural effusion (MPE), an unfavorable complication that severely restricts the quality of life and expectancy of the cancer patient. MPE is the net "product" of three different processes, namely inflammation, enhanced angiogenesis and vascular leakage. Current efforts are focusing on the identification of cancer cell autocrine (specific mutation spectra and biochemical pathways) and paracrine (cytokine and chemokine signals) characteristics as well as host features (immunological or other) that underlie the MPE phenotype. Herein we examine the pleural histology, cytology and molecular characteristics that make the pleural cavity an attractive metastasis destination for lung adenocarcinoma. Mesothelial and tumor features that may account for the tumor's ability to invade the pleural space are highlighted. Finally, possible therapeutic interventions specifically targeting MPE are discussed.
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Affiliation(s)
- Theodora Agalioti
- Laboratory for Molecular Respiratory Carcinogenesis, Department of Physiology, Faculty of Medicine, University of Patras, Patras, Greece
| | - Anastasios D Giannou
- Laboratory for Molecular Respiratory Carcinogenesis, Department of Physiology, Faculty of Medicine, University of Patras, Patras, Greece
| | - Georgios T Stathopoulos
- Laboratory for Molecular Respiratory Carcinogenesis, Department of Physiology, Faculty of Medicine, University of Patras, Patras, Greece
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Zamboni MM, da Silva CT, Baretta R, Cunha ET, Cardoso GP. Important prognostic factors for survival in patients with malignant pleural effusion. BMC Pulm Med 2015; 15:29. [PMID: 25887349 PMCID: PMC4379612 DOI: 10.1186/s12890-015-0025-z] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Accepted: 03/17/2015] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The approach to palliative treatment of malignant pleural effusion (MPE) should be individualized because these patients generally have poor survival. Our study aimed to develop a model to identify prognostic factors or survival time in patients diagnosed with MPE. METHODS This is a retrospective, descriptive, observational study to identify prognostic factors related to MPE in patients with a confirmed cancer diagnosis. Cox regression analysis was used to determine significant potential prognostic factors with respect to survival time. Survival time was defined as the time from pathological diagnosis to death. RESULTS One hundred and sixty-five patients were included; 77 were men (47%) and 88 were women (53%). The median age was 60 years, and all of the patients were pathologically proven to have MPE. Non-small-cell lung cancer (36.0%), breast carcinoma (26%), and lymphoma (13.0%) were the most frequently diagnosed tumors. The median overall survival of patients from the initial diagnosis was 5 months (range: 1.0-96.0 months). Kaplan-Meier univariate analysis showed that survival was significantly related to the following prognostic factors: ECOG PS (hazard ratio [HR] 10.0, 95% confidence interval [95% CI] 5.96 to 18.50, p < 0.0001), primary cancer site (HR 1.99, 95% CI 1.23 to 3.22, p < 0.01), positive pleural cytology (HR 1.25, 95% CI 0.88 to 1.78, p = 0.04), and positive histology (HR 1.33, 95% CI 0.97 to 1.81, p = 0.04). Other potential independent diagnostic factors that were examined did not affect survival. Cox regression analysis showed that only the ECOG PS was highly predictive of survival (HR 73.58, 95% CI 23.44 to 230.95, p < 0.0001). CONCLUSIONS ECOG PS is an independent predictor of survival in patients with MPE at initial diagnosis. This prognostic factor can help physicians select patients for appropriate palliative treatment of this syndrome.
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Affiliation(s)
- Mauro Musa Zamboni
- Pulmonology and Thoracic Surgery Division, Hospital do Câncer I, Instituto Nacional de Câncer/Ministério da Saúde, Rio de Janeiro, RJ, Brazil.
| | - Cyro Teixeira da Silva
- Pulmonology Division, Hospital Antonio Pedro, Universidade Federal Fluminense, Niterói, RJ, Brazil.
| | - Rodrigo Baretta
- Pulmonology and Thoracic Surgery Division, Hospital do Câncer I, Instituto Nacional de Câncer/Ministério da Saúde, Rio de Janeiro, RJ, Brazil.
| | - Edson Toscano Cunha
- Pulmonology and Thoracic Surgery Division, Hospital do Câncer I, Instituto Nacional de Câncer/Ministério da Saúde, Rio de Janeiro, RJ, Brazil.
| | - Gilberto Perez Cardoso
- Pulmonology Division, Hospital Antonio Pedro, Universidade Federal Fluminense, Niterói, RJ, Brazil.
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Alsayed S, Marzouk S, Abelhalim S, Mousa E. Malignant pleural effusion biomarkers as predictor for chemical pleurodesis success. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2015. [DOI: 10.1016/j.ejcdt.2014.08.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Lung cancer cells induce senescence and apoptosis of pleural mesothelial cells via transforming growth factor-beta1. Tumour Biol 2014; 36:2657-65. [PMID: 25433501 DOI: 10.1007/s13277-014-2888-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 11/21/2014] [Indexed: 01/06/2023] Open
Abstract
Pleural dissemination is commonly associated with metastatic advanced lung cancer. The injury of pleural mesothelial cells (PMCs) by soluble factors, such as transforming growth factor-beta1 (TGF-β1), is a major driver of lung cancer pleural dissemination (LCPD). In this study, we examine the effects of TGF-β1 on PMC injury and the ability of TGF-β1 inhibition to alleviate this effect both in vitro and in vivo. PMCs were co-cultured with the high TGF-β1-expressing lung cancer cell line A549 and with various TGF-β1 signaling inhibitors. Expression of cleaved-caspase 3, cleaved-caspase 9, p21, and p16 were evaluated by Western blot and immunofluorescent confocal imaging. Apoptosis was measured by 3-(4, 5-dimethylthiazol-2-yl)-2, 5-diphenyltrazoliumbromide assay and AnnexinV-propidium iodide (PI) staining. PMC senescence was assessed by staining for senescence-associated β-galactosidase (SA-β-Gal). The ability of lung cancer cells (LCCs) to adhere to injured PMCs was investigated using an LCC-PMC adhesion assay. In our mouse model, PMC injury status was monitored by hematoxylin-eosin (H&E) and Masson's trichrome staining. LCCs expressing high levels of TGF-β1 induce apoptosis and senescence of PMCs in a co-culture system. Injured PMCs adhere to LCCs, which may further promote LCPD. Importantly, PMC monolayer injury could be reversed with TGF-β1 inhibitors. This was consistent with our in vivo data showing that the TGF-β1 inhibitor SB-431542 attenuated PMC barrier injury induced by A549 culture medium in our mouse model. Our study highlights the importance of TGF-β1 signaling in LCPD and establishes this signaling pathway as a potential therapeutic target in the disease.
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El-Hosainy A, Hosny H, Gabal S, Ahmed S, El-Hinnawy Y. Role of epidermal growth factor receptor in malignant pleural mesothelioma and its value for successful chemical pleurodesis. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2014. [DOI: 10.1016/j.ejcdt.2014.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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VEGF increases the permeability of sheep pleura ex vivo through VEGFR2 stimulation. Cytokine 2014; 69:284-8. [DOI: 10.1016/j.cyto.2014.06.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Revised: 05/30/2014] [Accepted: 06/08/2014] [Indexed: 11/18/2022]
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Rodriguez-Panadero F, Romero-Romero B. Lung cancer coexisting with ipsilateral pleural effusion. Lung Cancer Manag 2014. [DOI: 10.2217/lmt.14.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
SUMMARY Invasion beyond the elastic layer of the visceral pleura and/or diffuse pleural metastatic spread affects negatively survival in lung cancer. Presence of pleural effusion is also associated with poor prognosis, and image techniques can be of great help for diagnosis. When pleural fluid cytology is negative, thoracoscopy is advisable before attempting tumor resection, in order to detect unsuspected pleural metastases. If widespread pleural malignancy is confirmed, chemical pleurodesis using graded talc (with particles larger than 20 µm in diameter) is the best option, unless the lung is unable to re-expand. In this case, or when a previous pleurodesis has failed, or there is a short life expectancy, placement of a indwelling pleural catheter is the treatment of choice.
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Affiliation(s)
- Francisco Rodriguez-Panadero
- Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocio/CSIC/Universidad de Sevilla, Seville, Spain
- Unidad Médico–Quirúrgica de Enfermedades Respiratorias (UMQER), Hospital Universitario Virgen del Rocío, Seville, Spain
- CIBER de Enfermedades Respiratorias (CIBERES), I.S. Carlos III, Spain
| | - Beatriz Romero-Romero
- Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocio/CSIC/Universidad de Sevilla, Seville, Spain
- Unidad Médico–Quirúrgica de Enfermedades Respiratorias (UMQER), Hospital Universitario Virgen del Rocío, Seville, Spain
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Froudarakis ME. Should we really compare indwelling pleural catheters to any pleurodesis? Respiration 2014; 88:18-21. [PMID: 24821005 DOI: 10.1159/000362693] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Marios E Froudarakis
- Department of Pneumonology, Medical School of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece
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Ji Q, Huang B, Wang M, Ren Z, Zhang S, Zhang Y, Sheng L, Yu Y, Jiang J, Chen D, Ying J, Yu J, Qiu L, Wan R, Li W. Pleural fluid prealbumin and C-reactive protein in the differential diagnosis of infectious and malignant pleural effusions. Exp Ther Med 2014; 7:778-784. [PMID: 24669233 PMCID: PMC3961133 DOI: 10.3892/etm.2014.1503] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Accepted: 01/23/2014] [Indexed: 11/13/2022] Open
Abstract
Clinical history and physical examination are helpful in indicating the potential causes of pleural effusions (PEs). However, the accurate diagnosis and establishment of the causes of PE is an ongoing challenge in daily clinical practice. The primary aim of this study was to distinguish between infectious PE and malignant PE (MPE) by measuring two major acute phase response biomarkers: prealbumin (PA) and C-reactive protein (CRP). The study was a prospective trial involving 151 patients who were diagnosed with infectious PE or MPE. Patients with infectious PE were divided into two subgroups: tuberculous PE (TBPE) and parapneumonic PE (PNPE). A further 58 patients with PEs that showed no evidence of MPE, TBPE or PNPE were classified as the chronic non-specific PE (NSPE) group. Demographic characteristics and pleural fluids of the subjects were collected consecutively. The discriminative properties of pleural fluid routine biochemistries, and PA and CRP were evaluated. PA, CRP and classical fluid parameters were also applied to classify patients with infectious PE and MPE. Receiver operating characteristics (ROC) analysis established the cutoffs of PA and CRP for discriminating between groups. Pleural fluid PA levels were significantly higher in the MPE group (n=47) than in the infectious PE group (n=104). Pleural fluid CRP levels were significantly higher in the infectious PE group than in the MPE group. Pleural fluid PA levels were identified to be moderately negatively correlated with CRP levels in the MPE group, with a statistically significant correlation coefficient of −0.352. The ROC curve showed that the sensitivity and specificity of PA for the diagnosis of MPE were 0.851 and 0.548, respectively, at the cutoff of 28.3 mg/l. The area under the curve (AUC) was 0.784 (95% CI, 0.707–0.861). Using CRP as a diagnostic parameter resulted in an comparable AUC of 0.810 (95% CI, 0.736–0.885), at the cutoff of 35.2 mg/l. Combinations of PA and CRP resulted in incrementally discriminating values for MPE, with a sensitivity of 0.617 and a specificity of 0.903. The measurement of PA and CRP levels in pleural fluid may be a useful adjunctive test in PE, as a potential differentiator between infectious PE and MPE.
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Affiliation(s)
- Qiaoying Ji
- Department of Respiratory, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, Zhejiang 322100, P.R. China
| | - Bifei Huang
- Pathology Center, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, Zhejiang 322100, P.R. China
| | - Maofeng Wang
- Department of Clinical Laboratory Medicine, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, Zhejiang 322100, P.R. China
| | - Zhaoxiang Ren
- Department of Clinical Laboratory Medicine, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, Zhejiang 322100, P.R. China
| | - Sha Zhang
- School of Laboratory Medicine, Wenzhou Medical University, Wenzhou, Zhejiang 325035, P.R. China
| | - Yongjun Zhang
- Department of Clinical Laboratory Medicine, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, Zhejiang 322100, P.R. China
| | - Lijian Sheng
- Department of Clinical Laboratory Medicine, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, Zhejiang 322100, P.R. China
| | - Yayao Yu
- Department of Clinical Laboratory Medicine, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, Zhejiang 322100, P.R. China
| | - Jinwen Jiang
- Department of Clinical Laboratory Medicine, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, Zhejiang 322100, P.R. China
| | - Debao Chen
- Department of Clinical Laboratory Medicine, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, Zhejiang 322100, P.R. China
| | - Jun Ying
- School of Laboratory Medicine, Wenzhou Medical University, Wenzhou, Zhejiang 325035, P.R. China
| | - Jiong Yu
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China
| | - Liuyi Qiu
- Pathology Center, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, Zhejiang 322100, P.R. China
| | - Rugen Wan
- Department of Clinical Laboratory Medicine, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, Zhejiang 322100, P.R. China
| | - Weimin Li
- Department of Internal Medicine, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, Zhejiang 322100, P.R. China
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Anevlavis S, Kouliatsis G, Sotiriou I, Koukourakis MI, Archontogeorgis K, Karpathiou G, Giatromanolaki A, Froudarakis ME. Prognostic factors in patients presenting with pleural effusion revealing malignancy. ACTA ACUST UNITED AC 2014; 87:311-6. [PMID: 24457947 DOI: 10.1159/000356764] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Accepted: 10/14/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND The survival of patients with malignant pleural effusion is considered generally poor. Most of the studies reporting results of prognostic factors are retrospective, using pleural thoracentesis for diagnosis. The objectives of our study were to reveal possible prognostic factors in patients initially presenting with undiagnosed pleural effusion proven to be malignant by diagnostic thoracoscopy. METHODS Ninety consecutive patients, 48 of whom were male (53%), with a median age of 69 years (range 37-93) and a performance status (PS) of 0/1 (63%) and with initially undiagnosed pleural effusion that was proven to be malignant by thoracoscopy were evaluated. Survival time was defined as the time from thoracoscopic diagnosis to death or the last follow-up. A regression analysis was used to determine significant clinical and biological prognostic factors. RESULTS Lung carcinoma (44.4%), breast carcinoma (24.4%), and mesothelioma (12.2%) were the most frequent tumors diagnosed. The median overall survival was 11 months (range 0.5-55). The survival of the patients was related to the following factors: histology of the primary tumor (p = 0.008), PS (p < 0.001), white blood cells (p = 0.018), and the blood neutrophil-to-lymphocyte (N/L) ratio (p = 0.002). Multiple regression showed PS, histology, and the N/L ratio. CONCLUSION The factors affecting survival in our patients were PS, primary tumor histology, and the N/L ratio. These factors may help physicians select patients for treatment and/or interventional procedures.
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Affiliation(s)
- Stavros Anevlavis
- Department of Pneumonology, Medical School of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece
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Treglia G, Sadeghi R, Annunziata S, Lococo F, Cafarotti S, Prior JO, Bertagna F, Ceriani L, Giovanella L. Diagnostic performance of Fluorine-18-Fluorodeoxyglucose positron emission tomography in the assessment of pleural abnormalities in cancer patients: A systematic review and a meta-analysis. Lung Cancer 2014; 83:1-7. [DOI: 10.1016/j.lungcan.2013.11.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Revised: 10/30/2013] [Accepted: 11/03/2013] [Indexed: 11/16/2022]
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The effect of silver nitrate pleurodesis after a failed thoracoscopic talc poudrage. BIOMED RESEARCH INTERNATIONAL 2013; 2013:295890. [PMID: 24073398 PMCID: PMC3774036 DOI: 10.1155/2013/295890] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Accepted: 07/29/2013] [Indexed: 11/28/2022]
Abstract
Background. Chemical pleurodesis is the procedure of choice in the management of recurrent malignant pleural effusions (MPE). Talc is probably the most effective sclerosant, with a success rate of 80%. The aim of this study is to demonstrate the effectiveness of silver nitrate solution (SNS) pleurodesis after an unsuccessful thoracoscopic talc poudrage. Methods. Between 2011 and 2013 one hundred and nine patients with unilateral MPE underwent thoracoscopic talc poudrage. Seventeen patients who did not obtain a successful pleurodesis via thoracoscopic procedure were considered for an SNS slurry. The pleural injectate consisted of 100 mL 1% SNS with 10 mL of lidocaine (100 mg/5 mL). The SNS procedure was undertaken once and repeated with the same dose in 5 patients. Results. The duration of follow-up period was 30 days. Subjective pain was low and the same before and after SNS procedure (P value = NS). The mean daily fluid drainage was statistically different (P = 0.001) comparing values before (597.0 ± 122.8 mL) and after SNS procedure (109.1 ± 22.3 mL). After 30 days from SNS procedure recurrence of pleural effusion was observed in 2 patients (11%). Conclusions. The present study demonstrates that SNS is an effective agent for producing pleurodesis after a failed thoracoscopic talc poudrage.
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Marazioti A, Kairi CA, Spella M, Giannou AD, Magkouta S, Giopanou I, Papaleonidopoulos V, Kalomenidis I, Snyder LA, Kardamakis D, Stathopoulos GT. Beneficial impact of CCL2 and CCL12 neutralization on experimental malignant pleural effusion. PLoS One 2013; 8:e71207. [PMID: 23967166 PMCID: PMC3743892 DOI: 10.1371/journal.pone.0071207] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Accepted: 07/03/2013] [Indexed: 12/31/2022] Open
Abstract
Using genetic interventions, we previously determined that C-C motif chemokine ligand 2 (CCL2) promotes malignant pleural effusion (MPE) formation in mice. Here we conducted preclinical studies aimed at assessing the specific therapeutic potential of antibody-mediated CCL2 blockade against MPE. For this, murine MPEs or skin tumors were generated in C57BL/6 mice by intrapleural or subcutaneous delivery of lung (LLC) or colon (MC38) adenocarcinoma cells. Human lung adenocarcinoma cells (A549) were used to induce MPEs in severe combined immunodeficient mice. Intraperitoneal antibodies neutralizing mouse CCL2 and/or CCL12, a murine CCL2 ortholog, were administered at 10 or 50 mg/kg every three days. We found that high doses of CCL2/12 neutralizing antibody treatment (50 mg/kg) were required to limit MPE formation by LLC cells. CCL2 and CCL12 blockade were equally potent inhibitors of MPE development by LLC cells. Combined CCL2 and CCL12 neutralization was also effective against MC38-induced MPE and prolonged the survival of mice in both syngeneic models. Mouse-specific CCL2-blockade limited A549-caused xenogeneic MPE, indicating that host-derived CCL2 also contributes to MPE precipitation in mice. The impact of CCL2/12 antagonism was associated with inhibition of immune and vascular MPE-related phenomena, such as inflammation, new blood vessel assembly and plasma extravasation into the pleural space. We conclude that CCL2 and CCL12 blockade are effective against experimental MPE induced by murine and human adenocarcinoma in mice. These results suggest that CCL2-targeted therapies may hold promise for future use against human MPE.
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Affiliation(s)
- Antonia Marazioti
- Laboratory for Molecular Respiratory Carcinogenesis, Department of Physiology, Faculty of Medicine, University of Patras, Rio, Achaia, Greece
| | - Chrysoula A. Kairi
- First Department of Critical Care and Pulmonary Medicine, University of Athens School of Medicine, General Hospital Evangelismos, Athens, Attica, Greece
| | - Magda Spella
- Laboratory for Molecular Respiratory Carcinogenesis, Department of Physiology, Faculty of Medicine, University of Patras, Rio, Achaia, Greece
| | - Anastasios D. Giannou
- Laboratory for Molecular Respiratory Carcinogenesis, Department of Physiology, Faculty of Medicine, University of Patras, Rio, Achaia, Greece
| | - Sophia Magkouta
- First Department of Critical Care and Pulmonary Medicine, University of Athens School of Medicine, General Hospital Evangelismos, Athens, Attica, Greece
| | - Ioanna Giopanou
- Laboratory for Molecular Respiratory Carcinogenesis, Department of Physiology, Faculty of Medicine, University of Patras, Rio, Achaia, Greece
| | - Vassilios Papaleonidopoulos
- Laboratory for Molecular Respiratory Carcinogenesis, Department of Physiology, Faculty of Medicine, University of Patras, Rio, Achaia, Greece
| | - Ioannis Kalomenidis
- First Department of Critical Care and Pulmonary Medicine, University of Athens School of Medicine, General Hospital Evangelismos, Athens, Attica, Greece
| | - Linda A. Snyder
- Janssen R&D, LLC, Oncology Discovery Research, Spring House, Pennsylvania, United States of America
| | - Dimitrios Kardamakis
- Department of Radiation Oncology and Stereotactic Radiotherapy, Faculty of Medicine, University of Patras, Rio, Achaia, Greece
| | - Georgios T. Stathopoulos
- Laboratory for Molecular Respiratory Carcinogenesis, Department of Physiology, Faculty of Medicine, University of Patras, Rio, Achaia, Greece
- First Department of Critical Care and Pulmonary Medicine, University of Athens School of Medicine, General Hospital Evangelismos, Athens, Attica, Greece
- * E-mail:
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Cheng D, Kong H, Li Y. Prognostic values of VEGF and IL-8 in malignant pleural effusion in patients with lung cancer. Biomarkers 2013; 18:386-90. [DOI: 10.3109/1354750x.2013.797499] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Rodriguez-Panadero F, Romero-Romero B. Current and future options for the diagnosis of malignant pleural effusion. ACTA ACUST UNITED AC 2013; 7:275-87. [PMID: 23550710 DOI: 10.1517/17530059.2013.786038] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Malignant pleural effusion (MPE) is a frequent problem faced by clinicians, but tumor pleural involvement can be seen without effusion. AREAS COVERED Imaging, pleural fluid analysis, biomarkers for MPE, needle pleural biopsy and thoracoscopy. To prepare this review, we performed a search using keywords: 'diagnosis' + 'malignant' + 'pleural' + 'effusion' (all fields) in PubMed, and found 4106 articles overall (until 16 January 2013, 881 in the last 5 years). EXPERT OPINION Ultrasound techniques will stay as valuable tools for pleural effusions. Biomarkers in pleural fluid do not currently provide an acceptable yield for MPE. In subjects with past history of asbestos exposure, some serum or plasma markers (soluble mesothelin, fibulin) might help in selecting cases for close follow-up, to detect mesothelioma early. Needle pleural biopsy is justified only if used with image-techniques (ultrasound or CT) guidance, and thoracoscopy is better for both diagnosis and immediate palliative treatment (pleurodesis). Animal models of MPE and 'spheroids' are promising for research involving both pathophysiology and therapy. Considering the possibility of direct pleural delivery of nanotechnology-developed compounds-fit to both diagnosis and therapy purposes ('theranostics')-MPE and mesothelioma in particular are likely to benefit sooner than later from this exciting perspective.
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Affiliation(s)
- Francisco Rodriguez-Panadero
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias (UMQUER), Hospital Universitario Virgen del Rocío, Seville, Spain.
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Qi J, Li D, Feng J, Yang S, Su Y, Fang M, Tan Z, Shi H, Yan X, Gong F, Zheng F. Native Soluble Carcinoembryonic Antigen Is Not Involved in the Impaired Activity of CD56 dim Natural Killer Cells in Malignant Pleural Effusion. Respiration 2012; 86:216-23. [DOI: 10.1159/000345214] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2012] [Accepted: 10/03/2012] [Indexed: 11/19/2022] Open
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