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Alaswad M. Locally advanced non-small cell lung cancer: current issues and recent trends. Rep Pract Oncol Radiother 2023; 28:286-303. [PMID: 37456701 PMCID: PMC10348324 DOI: 10.5603/rpor.a2023.0019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 03/29/2023] [Indexed: 07/18/2023] Open
Abstract
The focus of this paper was to review and summarise the current issues and recent trends within the framework of locally advanced (LA) non-small cell lung cancer (NSCLC). The recently proposed 8th tumour-node-metastases (TNM) staging system exhibited significant amendments in the distribution of the T and M descriptors. Every revision to the TNM classification should contribute to clinical improvement. This is particularly necessary regarding LA NSCLC stratification, therapy and outcomes. While several studies reported the superiority of the 8th TNM edition in comparison to the previous 7th TNM edition, in terms of both the discrimination ability among the various T subgroups and clinical outcomes, others argued against this interpretation. Synergistic cytotoxic chemotherapy with radiotherapy is most prevalent in treating LA NSCLC. Clinical trial experience from multiple references has reported that the risk of locoregional relapse and distant metastasis was less evident for patients treated with concomitant radiochemotherapy than radiotherapy alone. Nevertheless, concern persists as to whether major incidences of toxicity may occur due to the addition of chemotherapy. Cutting-edge technologies such as four-dimensional computed tomography (4D-CT) and volumetric modulated arc therapy (VMAT) should yield therapeutic gains due to their capability to conform radiation doses to tumours. On the basis of the preceding notion, the optimum radiotherapy technique for LA NSCLC has been a controversial and much-disputed subject within the field of radiation oncology. Notably, no single-perspective research has been undertaken to determine the optimum radiotherapy modality for LA NSCLC. The landscape of immunotherapy in lung cancer is rapidly expanding. Currently, the standard of care for patients with inoperable LA NSCLC is concurrent chemoradiotherapy followed by maintenance durvalumab according to clinical outcomes from the PACIFIC trial. An estimated 42.9% of patients randomly assigned to durvalumab remained alive at five years, and free of disease progression, thereby establishing a new benchmark for the standard of care in this setting.
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Affiliation(s)
- Mohammed Alaswad
- Comprehensive Cancer Centre, Radiation Oncology, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
- Princess Nourah Bint Abdulrahman University, Riyadh, Kingdom of Saudi Arabia
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Occhipinti M, Brambilla M, Galli G, Manglaviti S, Giammaruco M, Prelaj A, Ferrara R, De Toma A, Proto C, Beninato T, Zattarin E, Lo Russo G, Gelibter AJ, Simmaco M, Preissner R, Garassino MC, De Braud F, Marchetti P. Evaluation of Drug-Drug Interactions in EGFR-Mutated Non-Small-Cell Lung Cancer Patients during Treatment with Tyrosine-Kinase Inhibitors. J Pers Med 2021; 11:jpm11050424. [PMID: 34069851 PMCID: PMC8157378 DOI: 10.3390/jpm11050424] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 05/02/2021] [Accepted: 05/11/2021] [Indexed: 12/15/2022] Open
Abstract
(1) Background. The onset of a drug–drug interaction (DDI) may affect treatment efficacy and toxicity of advanced non-small-cell lung cancer (aNSCLC) patients during epidermal growth factor receptor (EGFR) tyrosine-kinase inhibitor (TKI) use. Here we present the use of Drug-PIN® (Personalized Interactions Network) software to detect DDIs in aNSCLC patients undergoing EGFR-TKIs. (2) Methods. We enrolled patients with Stage IV aNSCLC already treated with or candidates to receive EGFR-TKIs, in any line; ECOG PS 0–2; taking at least one concomitant drug. Cancer treatments, concomitant drugs, and clinical and laboratory data were collected and inserted in Drug-PIN®. (3) Results. Ninety-two patients, median age of 68.5 years (range 43–89), were included. In total, 20 clinically relevant DDIs needing medical intervention in a total of 14 patients were identified; the 14 major DDIs were related to a high-grade interaction between TKIs and SSRIs, antipsychotics, antiepileptics, H2-receptor antagonist and calcium antagonists. A negative association between statin intake and PFS was identified (p = 0.02; HR 0.281, 95% CI 0.096–0.825). (4) Conclusions. This is the first retrospective study assessing the prevalence of DDIs, the clinical need for medical intervention and the impact of concomitant drugs on EGFR-TKIs survival in aNSCLC.
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Affiliation(s)
- Mario Occhipinti
- Thoracic Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Giacomo Venezian 1, 20133 Milan, Italy (G.G.); (S.M.); (A.P.); (R.F.); (A.D.T.); (C.P.); (T.B.); (E.Z.); (G.L.R.); (M.C.G.); (F.D.B.)
- Department of Experimental Medicine, Sapienza University of Rome, Viale Regina Elena, 324, 00161 Rome, Italy
- Correspondence:
| | - Marta Brambilla
- Thoracic Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Giacomo Venezian 1, 20133 Milan, Italy (G.G.); (S.M.); (A.P.); (R.F.); (A.D.T.); (C.P.); (T.B.); (E.Z.); (G.L.R.); (M.C.G.); (F.D.B.)
| | - Giulia Galli
- Thoracic Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Giacomo Venezian 1, 20133 Milan, Italy (G.G.); (S.M.); (A.P.); (R.F.); (A.D.T.); (C.P.); (T.B.); (E.Z.); (G.L.R.); (M.C.G.); (F.D.B.)
| | - Sara Manglaviti
- Thoracic Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Giacomo Venezian 1, 20133 Milan, Italy (G.G.); (S.M.); (A.P.); (R.F.); (A.D.T.); (C.P.); (T.B.); (E.Z.); (G.L.R.); (M.C.G.); (F.D.B.)
| | - Maristella Giammaruco
- Medical Oncology Unit B, Policlinico Umberto I, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Roma, Italy; (M.G.); (A.J.G.); (P.M.)
| | - Arsela Prelaj
- Thoracic Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Giacomo Venezian 1, 20133 Milan, Italy (G.G.); (S.M.); (A.P.); (R.F.); (A.D.T.); (C.P.); (T.B.); (E.Z.); (G.L.R.); (M.C.G.); (F.D.B.)
- Department of Electronics, Information, and Bioengineering, Politecnico di Milano, Via Giuseppe Ponzio, 34, 20133 Milano, Italy
| | - Roberto Ferrara
- Thoracic Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Giacomo Venezian 1, 20133 Milan, Italy (G.G.); (S.M.); (A.P.); (R.F.); (A.D.T.); (C.P.); (T.B.); (E.Z.); (G.L.R.); (M.C.G.); (F.D.B.)
| | - Alessandro De Toma
- Thoracic Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Giacomo Venezian 1, 20133 Milan, Italy (G.G.); (S.M.); (A.P.); (R.F.); (A.D.T.); (C.P.); (T.B.); (E.Z.); (G.L.R.); (M.C.G.); (F.D.B.)
| | - Claudia Proto
- Thoracic Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Giacomo Venezian 1, 20133 Milan, Italy (G.G.); (S.M.); (A.P.); (R.F.); (A.D.T.); (C.P.); (T.B.); (E.Z.); (G.L.R.); (M.C.G.); (F.D.B.)
| | - Teresa Beninato
- Thoracic Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Giacomo Venezian 1, 20133 Milan, Italy (G.G.); (S.M.); (A.P.); (R.F.); (A.D.T.); (C.P.); (T.B.); (E.Z.); (G.L.R.); (M.C.G.); (F.D.B.)
| | - Emma Zattarin
- Thoracic Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Giacomo Venezian 1, 20133 Milan, Italy (G.G.); (S.M.); (A.P.); (R.F.); (A.D.T.); (C.P.); (T.B.); (E.Z.); (G.L.R.); (M.C.G.); (F.D.B.)
| | - Giuseppe Lo Russo
- Thoracic Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Giacomo Venezian 1, 20133 Milan, Italy (G.G.); (S.M.); (A.P.); (R.F.); (A.D.T.); (C.P.); (T.B.); (E.Z.); (G.L.R.); (M.C.G.); (F.D.B.)
| | - Alain Jonathan Gelibter
- Medical Oncology Unit B, Policlinico Umberto I, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Roma, Italy; (M.G.); (A.J.G.); (P.M.)
| | - Maurizio Simmaco
- Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University of Rome, Sant’Andrea University Hospital, Via di Grottatossa, 1035, 00189 Rome, Italy;
- Department of Advanced Molecular Diagnostics, Sapienza University of Rome, Sant’Andrea Hospital, Via di Grottatossa, 1035, 00189 Rome, Italy
| | - Robert Preissner
- Institute of Physiology and Science-IT, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany;
| | - Marina Chiara Garassino
- Thoracic Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Giacomo Venezian 1, 20133 Milan, Italy (G.G.); (S.M.); (A.P.); (R.F.); (A.D.T.); (C.P.); (T.B.); (E.Z.); (G.L.R.); (M.C.G.); (F.D.B.)
- Knapp Center for Biomedical Discovery, University of Chicago Medicine & Biological Sciences, 900 E 57th St, Chicago, IL 60637, USA
| | - Filippo De Braud
- Thoracic Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Giacomo Venezian 1, 20133 Milan, Italy (G.G.); (S.M.); (A.P.); (R.F.); (A.D.T.); (C.P.); (T.B.); (E.Z.); (G.L.R.); (M.C.G.); (F.D.B.)
| | - Paolo Marchetti
- Medical Oncology Unit B, Policlinico Umberto I, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Roma, Italy; (M.G.); (A.J.G.); (P.M.)
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Via di Grottarossa, 1035, 00189 Rome, Italy
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Bossaer JB, Eskens D, Gardner A. Sensitivity and specificity of drug interaction databases to detect interactions with recently approved oral antineoplastics. J Oncol Pharm Pract 2021; 28:82-86. [DOI: 10.1177/1078155220984244] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Rationale: Drug-drug interactions (DDIs) with oral antineoplastics (OAs) are of increasing concern given the rapid increase in OA approvals and use in cancer patients. A small pilot study of 20 DDIs with OAs showed significant variability in commonly used DDI screening databases in sensitivity of detecting potentially clinically relevant DDIs. This study builds upon that work by expanding the number of potential DDIs analyzed and including a specificity analysis. Methods Newly approved OAs from 2016 to May 2019 (n = 22) were included in this analysis. Prescribing information for each drug was reviewed. A list of explicit and theoretical drug interactions was created for each OA by the two investigators. A board-certified oncology pharmacist adjudicated all DDI pairs for potential clinical significance. In total, 229 DDI pairs were used to analyze sensitivity of 5 DDI databases (Lexicomp®, Micromedex®, Medscape, Eporactes®, & Drugs.com). Additionally, 64 “dummy” or false DDI pairs were created to analyze specificity. Sensitivity and specific were analyzed using Cochran’s Qtest, while accuracy was analyzed using chi-square test. Results There was significant variability among the databases with regards to sensitivity (p < 0.0001), specificity (p < 0.0001), and accuracy (p < 0.0001). In terms of accuracy (max score = 400), Lexicomp®(355), Epocrates® (344), and Drugs.com (352) scored higher than MicroMedex® (270) and Medscape (280). Conclusions Considerable variability exists among DDI screening databases with regards to OAs and potential drug interactions. Clinicians should be vigilant in both screening for DDIs with OAs and describing DDIs encountered in clinical practice.
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Affiliation(s)
| | | | - Austin Gardner
- University of North Carolina System, Chapel Hill, NC, USA
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