1
|
Carcereny E, Rodriguez-Abreu D, Lopez R, Franco F, Guirado M, Massutí B, Cobo M, Blasco A, Suay G, Del Barco E, Ortega AL, Sala MA, Cordeiro P, Bernabé R, González Larriba JL, Bosch-Barrera J, Calzas J, Casal J, Padilla A, Sánchez-Hernandez A, Provencio M. Advanced non-squamous NSCLC with no actionable oncogenic driver in Spain: a cross-sectional descriptive analysis of data from the Thoracic Tumor Registry. Clin Transl Oncol 2024:10.1007/s12094-024-03511-7. [PMID: 38862862 DOI: 10.1007/s12094-024-03511-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 04/26/2024] [Indexed: 06/13/2024]
Abstract
BACKGROUND Non-small cell lung cancer (NSCLC) accounts for the vast majority of all diagnosed lung cancers. According to their histology, most NSCLCs are considered non-squamous cell carcinoma (NSCC), and up to 85% of the latter may lack either one of the two main actionable oncogenic drivers (i.e., EGFR mutations and ALK rearrangements). OBJECTIVE Our analysis aimed to describe the clinical and epidemiological characteristics of Spanish patients suffering from NSCC with no actionable oncogenic driver in daily clinical practice. DESIGN A retrospective, cross-sectional, descriptive analysis. METHODS We analyzed the records of all Spanish patients with advanced NSCC diagnosed between January 2011 and January 2020 and included in the Spanish Thoracic Tumor Registry database. We evaluated the presence of metastasis and molecular profiling at the time of diagnosis and treatments received. We also assessed overall survival (OS) and progression-free survival (PFS) according to first-line treatment. RESULTS One thousand seven hundred ninety-seven Spanish patients with NSCC were included. They were mainly men (73.2%), smokers (current [44.4%] and former [44.4%]) and presented adenocarcinoma histology (97.6%). Most patients had at least one comorbidity (80.4%) and one metastatic site (96.8%), and a non-negligible number of those tested were PD-L1 positive (35.2%). Notably, the presence of liver metastasis indicated a shorter median OS and PFS than metastasis in other locations (p < 0.001). Chemotherapy was more often prescribed than immunotherapy as first-, second-, and third-line treatment in that period. In first-line, the OS rates were similar in patients receiving either regimen, but PFS rates significantly better in patients treated with immunotherapy (p = 0.026). Also, a high number of patients did not reach second- and third-line treatment, suggesting the failure of current early diagnostic measures and therapies. CONCLUSIONS This analysis of the most lethal tumor in Spain could highlight the strengths and the weaknesses of its clinical management and set the ground for further advances and research.
Collapse
Affiliation(s)
- Enric Carcereny
- Institut Català D'oncologia Badalona- Hospital Germans Trias I Pujol, B-Argo Group, Badalona, Spain.
| | | | - Rafael Lopez
- Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Fabio Franco
- Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
| | - Maria Guirado
- Hospital General Universitario de Elche, Elche, Spain
| | - Bartomeu Massutí
- Hospital General Universitario Dr. Balmis de Alicante, Alicante, Spain
| | - Manuel Cobo
- Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Ana Blasco
- Hospital General Universitario de Valencia, Valencia, Spain
| | - Guillermo Suay
- Hospital Universitari I Politècnic La Fe, Valencia, Spain
| | | | | | | | | | - Reyes Bernabé
- Hospital Universitario Virgen del Rocío, Seville, Spain
| | | | - Joaquim Bosch-Barrera
- Josep Trueta and Precision Oncology Group (OncoGIR-Pro), Institut d'Investigacions Biomèdiques de Girona (IDIBGI), Catalan Institute of Oncology, Hospital Universitari Dr, Girona, Spain
| | - Julia Calzas
- Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, Spain
| | - Joaquín Casal
- Complejo Hospitalario Universitario de Vigo, Vigo, Spain
| | - Airam Padilla
- Hospital Universitario, Nuestra Señora De La Candelaria, Santa Cruz de Tenerife, Spain
| | | | | |
Collapse
|
2
|
Durbin L, Murali B, Li S, Hawthorne S, Clark O. Treatment patterns in advanced/metastatic non-small-cell lung cancer in China: results from the CancerMPact ® survey 2021. Future Oncol 2024; 20:1319-1331. [PMID: 38695478 PMCID: PMC11321399 DOI: 10.2217/fon-2023-0469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 03/20/2024] [Indexed: 06/12/2024] Open
Abstract
Aim: To report the treatment patterns of advanced/metastatic non-small-cell lung cancer (NSCLC) in China from a physician survey (CancerMPact®). Materials & methods: A total of 206 Chinese physicians from 27 cities in urban mainland China reported on their treatment of NSCLC in September 2021. Results: Platinum doublets received 70.5% utilization for squamous NSCLC with PD-L1 expression <1% in first-line, whereas nonsquamous NSCLC was treated with platinum doublets (35.2%) or bevacizumab with platinum doublets (35.3%). Checkpoint inhibitors were utilized in >50% of all PD-L1-positive NSCLC cases. Driver-mutated NSCLC was most frequently treated with targeted therapy or platinum-based combinations. Conclusion: NSCLC treatment in China varies by histology, PD-L1 status and driver mutations, illustrating the complexity of decision-making for Chinese physicians as treatment markets expand.
Collapse
Affiliation(s)
| | | | - Song Li
- Oracle Life Sciences, Austin, TX 78741, USA
| | | | | |
Collapse
|
3
|
Prabhash K, Tan DSW, Soo RA, Sitthideatphaiboon P, Chen YM, Voon PJ, Syahruddin E, Chu S, Huggenberger R, Cho BC. Real-world clinical practice and outcomes in treating stage III non-small cell lung cancer: KINDLE-Asia subset. Front Oncol 2023; 13:1117348. [PMID: 37051534 PMCID: PMC10083698 DOI: 10.3389/fonc.2023.1117348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 02/24/2023] [Indexed: 03/29/2023] Open
Abstract
IntroductionStage III non-small cell lung cancer (NSCLC) is a heterogeneous disease requiring multimodal treatment approaches. KINDLE-Asia, as part of a real world global study, evaluated treatment patterns and associated survival outcomes in stage III NSCLC in Asia.MethodsRetrospective data from 57 centers in patients with stage III NSCLC diagnosed between January 2013 and December 2017 were analyzed. Median progression free survival (mPFS) and median overall survival (mOS) estimates with two sided 95% confidence interval (CI) were determined by applying the Kaplan-Meier survival analysis.ResultsOf the total 1874 patients (median age: 63.0 years [24 to 92]) enrolled in the Asia subset, 74.8% were men, 54.7% had stage IIIA disease, 55.7% had adenocarcinoma, 34.3% had epidermal growth factor receptor mutations (EGFRm) and 50.3% had programmed death-ligand 1 (PD-L1) expression (i.e. PD-L1 ≥1%). Of the 31 treatment approaches as initial therapy, concurrent chemoradiotherapy (CRT) was the most frequent (29.3%), followed by chemotherapy (14.8%), sequential CRT (9.5%), and radiotherapy (8.5%). Targeted therapy alone was used in 81 patients of the overall population. For the Asia cohort, the mPFS and mOS were 12.8 months (95% CI, 12.2–13.7) and 42.3 months (95% CI, 38.1–46.8), respectively. Stage IIIA disease, Eastern Cooperative Oncology Group ≤1, age ≤65 years, adenocarcinoma histology and surgery/concurrent CRT as initial therapy correlated with better mOS (p < 0.05).ConclusionsThe results demonstrate diverse treatment patterns and survival outcomes in the Asian region. The high prevalence of EGFRm and PD-L1 expression in stage III NSCLC in Asia suggests the need for expanding access to molecular testing for guiding treatment strategies with tyrosine kinase inhibitors and immunotherapies in this region.
Collapse
Affiliation(s)
- Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | | | - Ross A. Soo
- Department of Haematology-Oncology, National University Cancer Institute, Singapore, Singapore
| | - Piyada Sitthideatphaiboon
- Division of Medical Oncology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Yuh Min Chen
- Taipei Veterans General Hospital, School of Medicine, National Yang-Ming Medical University, Taipei City, Taiwan
| | - Pei Jye Voon
- Department of Radiotherapy and Oncology, Hospital Umum Sarawak, Kuching, Sarawak, Malaysia
| | - Elisna Syahruddin
- Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Indonesia, Persahabatan Hospital, Jakarta, Indonesia
| | - Sojung Chu
- Medical Affairs, AstraZeneca, Seoul, Republic of Korea
| | | | - Byoung-Chul Cho
- Division of Medical Oncology, Yonsei Cancer Centre, Yonsei University College of Medicine, Seoul, Republic of Korea
- *Correspondence: Byoung-Chul Cho,
| |
Collapse
|
4
|
Chen P, Liu Y, Wen Y, Zhou C. Non-small cell lung cancer in China. Cancer Commun (Lond) 2022; 42:937-970. [PMID: 36075878 PMCID: PMC9558689 DOI: 10.1002/cac2.12359] [Citation(s) in RCA: 182] [Impact Index Per Article: 91.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 07/21/2022] [Accepted: 08/24/2022] [Indexed: 04/08/2023] Open
Abstract
In China, lung cancer is a primary cancer type with high incidence and mortality. Risk factors for lung cancer include tobacco use, family history, radiation exposure, and the presence of chronic lung diseases. Most early-stage non-small cell lung cancer (NSCLC) patients miss the optimal timing for treatment due to the lack of clinical presentations. Population-based nationwide screening programs are of significant help in increasing the early detection and survival rates of NSCLC in China. The understanding of molecular carcinogenesis and the identification of oncogenic drivers dramatically facilitate the development of targeted therapy for NSCLC, thus prolonging survival in patients with positive drivers. In the exploration of immune escape mechanisms, programmed cell death protein 1 (PD-1)/programmed death-ligand 1 (PD-L1) inhibitor monotherapy and PD-1/PD-L1 inhibitor plus chemotherapy have become a standard of care for advanced NSCLC in China. In the Chinese Society of Clinical Oncology's guidelines for NSCLC, maintenance immunotherapy is recommended for locally advanced NSCLC after chemoradiotherapy. Adjuvant immunotherapy and neoadjuvant chemoimmunotherapy will be approved for resectable NSCLC. In this review, we summarized recent advances in NSCLC in China in terms of epidemiology, biology, molecular pathology, pathogenesis, screening, diagnosis, targeted therapy, and immunotherapy.
Collapse
Affiliation(s)
- Peixin Chen
- School of MedicineTongji UniversityShanghai200092P. R. China
- Department of Medical OncologyShanghai Pulmonary HospitalSchool of MedicineTongji UniversityShanghai200433P. R. China
| | - Yunhuan Liu
- Department of Respiratory and Critical Care MedicineHuadong HospitalFudan UniversityShanghai200040P. R. China
| | - Yaokai Wen
- School of MedicineTongji UniversityShanghai200092P. R. China
- Department of Medical OncologyShanghai Pulmonary HospitalSchool of MedicineTongji UniversityShanghai200433P. R. China
| | - Caicun Zhou
- School of MedicineTongji UniversityShanghai200092P. R. China
- Department of Medical OncologyShanghai Pulmonary HospitalSchool of MedicineTongji UniversityShanghai200433P. R. China
| |
Collapse
|
5
|
Nakagawa K, Garon EB, Gao L, Callies S, Zimmermann A, Walgren R, Visseren-Grul C, Reck M. RELAY, ramucirumab plus erlotinib versus placebo plus erlotinib in untreated EGFR-mutated metastatic non-small cell lung cancer: exposure-response relationship. Cancer Chemother Pharmacol 2022; 90:137-148. [PMID: 35841410 PMCID: PMC9360106 DOI: 10.1007/s00280-022-04447-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 06/04/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE In RELAY, ramucirumab plus erlotinib (RAM + ERL) improved progression-free survival (PFS) in patients with untreated, metastatic, EGFR-mutated, non-small cell lung cancer (NSCLC). Here, we present the exposure-response relationship of RAM from RELAY. METHODS Patients received ERL (150 mg/day) with either RAM (10 mg/kg) or placebo (PBO + ERL) every 2 weeks (Q2W). A population pharmacokinetic model predicted RAM minimum concentration after first dose (Cmin,1), and at steady state (Cmin,ss), which were used to evaluate correlation between RAM exposure and efficacy and safety. The Kaplan-Meier method and Cox regression analyses were utilized to evaluate exposure-efficacy by Cmin,1 quartile. Exposure-safety was evaluated by assessing incidence rates for safety parameters by Cmin,ss quartile, with ordered categorical analysis used for ALT/AST only. RESULTS Analyses included 216 patients treated with RAM + ERL and 225 patients treated with PBO + ERL. Adjusting for significant baseline covariates, no exposure-efficacy relationship was identified in RELAY: PFS hazard ratio (mean, 95% confidence intervals) for the Cmin,1 quartiles were 0.67 (0.45-0.99), 0.77 (0.53-1.12), 0.57 (0.38-0.84), and 0.50 (0.33-0.76). No apparent exposure-safety relationship was observed for selected safety endpoints, including Grade ≥ 3 hypertension, diarrhea, and dermatitis acneiform, and any grade hypertension, any grade and Grade ≥ 3 proteinuria, and any grade ALT/AST increased within liver failure/liver injury. CONCLUSIONS No association was observed between RAM exposure and response, suggesting that the RELAY regimen of RAM 10 mg/kg Q2W with ERL is an optimized, efficacious, and safe first-line treatment for patients with untreated, metastatic, EGFR-mutated NSCLC. TRIAL REGISTRATION ClinicalTrials.gov, NCT02411448.
Collapse
Affiliation(s)
- Kazuhiko Nakagawa
- Department of Medical Oncology, Faculty of Medicine, Kindai University, Osakasayama City, 377-2, Ohno-higashi, Osaka, 589-8511, Japan.
- Kindai University Faculty of Medicine, Osaka, Japan.
| | - Edward B Garon
- David Geffen School of Medicine at University of California Los Angeles, Translational Research in Oncology US Network, Los Angeles, CA, USA
| | - Ling Gao
- Eli Lilly and Company, Bridgewater, USA
| | | | | | | | | | - Martin Reck
- LungenClinic, Airway Research Center North, German Center for Lung Research, Grosshansdorf, Germany
| |
Collapse
|
6
|
Agema BC, Veerman GDM, Steendam CMJ, Lanser DAC, Preijers T, van der Leest C, Koch BCP, Dingemans AMC, Mathijssen RHJ, Koolen SLW. Improving the tolerability of osimertinib by identifying its toxic limit. Ther Adv Med Oncol 2022; 14:17588359221103212. [PMID: 35677320 PMCID: PMC9168866 DOI: 10.1177/17588359221103212] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 05/08/2022] [Indexed: 01/05/2023] Open
Abstract
Background: Osimertinib is the cornerstone in the treatment of epidermal growth factor
receptor-mutated non-small cell lung cancer (NSCLC). Nonetheless, ±25% of
patients experience severe treatment-related toxicities. Currently, it is
impossible to identify patients at risk of severe toxicity beforehand.
Therefore, we aimed to study the relationship between osimertinib exposure
and severe toxicity and to identify a safe toxic limit for a preventive dose
reduction. Methods: In this real-life prospective cohort study, patients with NSCLC treated with
osimertinib were followed for severe toxicity (grade ⩾3 toxicity, dose
reduction or discontinuation, hospital admission, or treatment termination).
Blood for pharmacokinetic analyses was withdrawn during every out-patient
visit. Primary endpoint was the correlation between osimertinib clearance
(exposure) and severe toxicity. Secondary endpoint was the exposure–efficacy
relationship, defined as progression-free survival (PFS) and overall
survival (OS). Results: In total, 819 samples from 159 patients were included in the analysis.
Multivariate competing risk analysis showed osimertinib clearance
(c.q. exposure) to be significantly correlated with
severe toxicity (hazard ratio 0.93, 95% CI: 0.88–0.99). An relative
operating characteristic curve showed the optimal toxic limit to be
259 ng/mL osimertinib. A 50% dose reduction in the high-exposure group, that
is 25.8% of the total cohort, would reduce the risk of severe toxicity by
53%. Osimertinib exposure was not associated with PFS nor OS. Conclusion: Osimertinib exposure is highly correlated with the occurrence of severe
toxicity. To optimize tolerability, patients above the toxic limit
concentration of 259 ng/mL could benefit from a preventive dose reduction,
without fear for diminished effectiveness.
Collapse
Affiliation(s)
- Bram C. Agema
- Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Dr. Molewaterplein 40, Rotterdam 3015 GD, The Netherlands Department of Clinical Pharmacy, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - G. D. Marijn Veerman
- Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Pulmonology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Christi M. J. Steendam
- Department of Pulmonology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Pulmonology, Amphia Hospital, Breda, The Netherlands
| | - Daan A. C. Lanser
- Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Tim Preijers
- Department of Clinical Pharmacy, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | - Birgit C. P. Koch
- Department of Clinical Pharmacy, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Anne-Marie C. Dingemans
- Department of Pulmonology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Ron H. J. Mathijssen
- Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Stijn L. W. Koolen
- Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands Department of Clinical Pharmacy, Erasmus University Medical Center, Rotterdam, The Netherlands
| |
Collapse
|
7
|
Shi Y, Zhang X, Wu G, Xu J, He Y, Wang D, Huang C, Chen M, Yu P, Yu Y, Li W, Li Q, Hu X, Xia J, Bu L, Yin A, Zhou Y. Treatment strategy, overall survival and associated risk factors among patients with unresectable stage IIIB/IV non-small cell lung cancer in China (2015-2017): A multicentre prospective study. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2022; 23:100452. [PMID: 35465042 PMCID: PMC9019386 DOI: 10.1016/j.lanwpc.2022.100452] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
BACKGROUND There are limited studies on treatment and survival analysis among patients with unresectable Stage IIIB or IV non-small cell lung cancer (NSCLC) in routine practice in China. To address this gap, we conducted a prospective observational study in a cohort of patients treated at 11 hospitals in China. METHODS This was a multicentre, prospective cohort study including patients with newly diagnosed unresectable Stage IIIB or IV NSCLC from June 26th, 2015 to April 28th, 2017. Patient baseline characteristics, disease characteristics, and anti-cancer treatments were obtained by medical chart review. The overall survival (OS) from the initiation of first-line treatment was analysed by the Kaplan-Meier method. Factors associated with survival were analysed by univariate and multivariate Cox regression models. FINDINGS Among 1324 patients enrolled with median follow-up duration of 15·0 (range: 0·0-42·1) months, 83·5% (1105/1324) of them received first-line chemotherapy of which platinum-based compounds were the dominated agents. Overall, 30·9% (409/1324) of patients received targeted therapy as 1st-line treatment including 65·0% (266/409) EGFR-TKIs and 5·1% (21/409) ALK-TKIs. Of all eligible patients, gene testing rates were 44·0% (583/1324) for EGFR mutations, 17·0% (225/1324) for EML4-ALK gene fusions, and 8·3% (110/1324) for ROS1 gene fusions. The EGFR-TKIs were administered to 63·9% (179/280) of EGFR mutated patients as first-line treatment. The overall median OS was 23·2 (95%CI 19·5-25·5) months, and patients treated at tier 1 cities had better OS than that of tier 2 cities. Also, the OS in patients with EGFR mutation was longer than those with EGFR wild type. Multivariate Cox regression models suggested that male, education below high school, tier 2 cities, smoking history, and multiple metastases were associated with poor survival. INTERPRETATION The gene test coverage was relatively low among the studied population, and over half of EGFR mutated patients received EGFR-TKIs, suggesting that the result of genetic tests in real-world settings may not always indicate the selection of treatment. The OS benefit observed from patients treated in tier 1 cities and those with EGFR mutation may indicate a need for broader gene test coverage, providing NSCLC patients with personalized treatment according to the results of genetic tests. FUNDING Roche Holding AG.TRANSLATED ABSTRACT: This translation in Chinese was submitted by the authors and we reproduce it as supplied. It has not been peer reviewed. Our editorial processes have only been applied to the original abstract in English, which should serve as reference for this manuscript.:IIIBIV(NSCLC)., ,, 11.:,, 20156262017428IIIBIVNSCLC.,.Kaplan-Meier(OS), Cox.:1324, 15.0(:0.0-42.1), 83.5%(1105/1324), ., 30.9%(409/1324), 65.0%(266/409)EGFR-TKI5.1%(21/409)ALK-TKI., EGFR,EML4-ALKROS144.0%(583/1324),17.0%(225/1324)8.3%(110/1324).63.9%(179/280)EGFREGFR-TKI.23.2 (95% 19·5-25·5) , ., EGFREGFR.Cox, ,,,.:, EGFREGFR-TKI, , .EGFR, , NSCLC.
Collapse
Affiliation(s)
- Yuankai Shi
- Department of Medical Oncology, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing 100021, China
- Corresponding author.
| | - Xin Zhang
- Respiratory Diseases Department, Zhongshan Hospital Fudan University, Shanghai, China
| | - Gang Wu
- Cancer Center, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jianping Xu
- Department of Medical Oncology, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing 100021, China
| | - Yong He
- Department of Respiratory Medicine, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Dong Wang
- Cancer Center, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Cheng Huang
- Department of Medical Oncology, Fujian Cancer Hospital, Fuzhou, China
| | - Mingwei Chen
- Department of Respiratory and Critical Care Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Ping Yu
- Department of Thoracic Oncology, Sichuan Cancer Hospital, Chengdu, China
| | - Yan Yu
- Department of Medical Oncology, Harbin Medical University Cancer Hospital, Harbin, China
| | - Wei Li
- Cancer Center, The First Hospital of Jilin University, Changchun, China
| | - Qi Li
- Department of Medical Oncology, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xiaohua Hu
- Department of Medical Oncology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Jinjing Xia
- Department of Medical Science Oncology, Shanghai Roche Pharmaceuticals Ltd., Shanghai, China
| | - Lilian Bu
- Department of Medical Science Oncology, Shanghai Roche Pharmaceuticals Ltd., Shanghai, China
| | - Angela Yin
- Real World Solutions, IQVIA, Beijing, China
| | | |
Collapse
|
8
|
Kebede BF, Genie YD, Aregawi DH, Tadele BA. Survival Status and Predictors of Mortality Among Low Birthweight Neonates Admitted in Amhara Region Referral Hospitals of Ethiopia: Retrospective Follow-Up Study. Health Serv Res Manag Epidemiol 2022; 9:23333928221117364. [PMID: 35923501 PMCID: PMC9340404 DOI: 10.1177/23333928221117364] [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: 03/30/2022] [Revised: 07/17/2022] [Accepted: 07/17/2022] [Indexed: 11/16/2022] Open
Abstract
Background Being born with low birthweight is a major determinant of perinatal,
neonatal, and infant survival. Even though low birthweight-related neonatal
mortality is high, there is an information gap regarding the survival status
of low birthweight neonates and their predictors of mortality in
Ethiopia. Objective This study was conducted to assess the survival status and predictors of
mortality among low birthweight neonates admitted to Amhara region referral
hospitals in Ethiopia. Methods and Materials A retrospective follow-up study was conducted on randomly selected low
birthweight neonates admitted to the Amhara region referral hospital between
January 01-2017 and December 30-2018. Data were entered into Epi-data
4.4.2.1 and exported to Stata 14 for cleaning and analysis. A cox regression
model was used to analyze the data. Tables, charts, and text were used to
report the results. Results This study revealed that 35.2% of participants died with incidence rates of
37.86 per 1000 person-day observations (95%CI: 31.79-45.10). Sepsis
(AHR:1.72(95% CI: 1.05-2.81), respiratory distress (AHR: 2.03 (95%
CI:1.36-3.03), necrotizing enterocolitis (AHR: 2.47 (95% CI: 1.17-5.20),
congenital anomalies (AHR:2.37 (95% CI: 1.36-4.13), extreme low birth weight
(AHR:2.62 (95% CI:1.54-4.44) and prematurity (AHR: 2.55 (95% CI:1.10-5.92)
were independent predictors of mortality. Conclusion Sepsis, respiratory distress, necrotizing enterocolitis, congenital
anomalies, extremely low birth weight, and premature birth were the
independent predictors of mortality. Therefore, it is better for all
stakeholders to focus more on the early diagnosis and management of low
birth weight neonates with the factors associated with mortality.
Collapse
|
9
|
Durbin L, Murali B, Li S, Zhao L, Hawthorne S, Kanas G, Davis C, Clark O. Treatment patterns in non-small-cell lung cancer in China: Results from the CancerMPact survey 2020. Cancer Treat Res Commun 2021; 29:100462. [PMID: 34583209 DOI: 10.1016/j.ctarc.2021.100462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 09/17/2021] [Accepted: 09/20/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE To report the treatment patterns of non-small-cell lung cancer (NSCLC) patients in China based on a survey of physicians (CancerMPact). METHODS 117 Chinese physicians from 27 cities in mainland China were recruited for an online survey in October 2020, reporting on how they treat their patients across all disease stages, including histology and relevant biomarkers in advanced or metastatic NSCLC. RESULTS Surveyed physicians indicated that almost half of their stage I patients were treated with surgery only. For stage II patients, it is more common to treat with surgery in combination with radiation and/or systemic therapy (44.5%), whereas the use of surgery decreases for stage III patients and the overall use of systemic therapy increases (63.4%-68.8%). Physicians are more likely to use systemic therapy alone for stage IV patients (31.4%). Chosen treatment regimens for stage IV NSCLC varied by histology and biomarkers, and several observed treatment patterns differed from the USA. In China, platinum-based chemotherapy is standard of care for treating stage IV NSCLC patients, unlike the USA, where checkpoint inhibitors are the dominant choice in first-line. Further, Chinese physicians reported prescribing biomarker-targeted agents for one-third or less of their patients with EGFR, ALK, ROS-1, or BRAF driver mutations, compared to 60-95% in the USA. CONCLUSION As treatment options expand in NSCLC in China, physicians face complex decisions for the treatment of their patients. Treatment patterns often vary, including by disease histology and clinically relevant biomarkers. The standard of care for NSCLC in China also differs from the USA.
Collapse
Affiliation(s)
| | | | - Song Li
- Kantar Health, New York, NY, USA
| | | | | | | | | | | |
Collapse
|
10
|
Dalurzo ML, Avilés-Salas A, Soares FA, Hou Y, Li Y, Stroganova A, Öz B, Abdillah A, Wan H, Choi YL. Testing for EGFR Mutations and ALK Rearrangements in Advanced Non-Small-Cell Lung Cancer: Considerations for Countries in Emerging Markets. Onco Targets Ther 2021; 14:4671-4692. [PMID: 34511936 PMCID: PMC8420791 DOI: 10.2147/ott.s313669] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 08/08/2021] [Indexed: 12/24/2022] Open
Abstract
The treatment of patients with advanced non-small-cell lung cancer (NSCLC) in recent years has been increasingly guided by biomarker testing. Testing has centered on driver genetic alterations involving the epidermal growth factor receptor (EGFR) and anaplastic lymphoma kinase (ALK) rearrangements. The presence of these mutations is predictive of response to targeted therapies such as EGFR tyrosine kinase inhibitors (TKIs) and ALK TKIs. However, there are substantial challenges for the implementation of biomarker testing, particularly in emerging countries. Understanding the barriers to testing in NSCLC will be key to improving molecular testing rates worldwide and patient outcomes as a result. In this article, we review EGFR mutations and ALK rearrangements as predictive biomarkers for NSCLC, discuss a selection of appropriate tests and review the literature with respect to the global uptake of EGFR and ALK testing. To help improve testing rates and unify procedures, we review our experiences with biomarker testing in China, South Korea, Russia, Turkey, Brazil, Argentina and Mexico, and propose a set of recommendations that pathologists from emerging countries can apply to assist with the diagnosis of NSCLC.
Collapse
Affiliation(s)
- Mercedes L Dalurzo
- Department of Pathology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | | | - Yingyong Hou
- Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China
| | - Yuan Li
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, People’s Republic of China
| | - Anna Stroganova
- N.N. Blokhin National Medical Research Centre of Oncology, Russian Academy of Medical Sciences, Moscow, Russia
| | - Büge Öz
- Cerrahpaşa School of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Arif Abdillah
- Takeda Pharmaceuticals International AG – Singapore Branch, Singapore, Singapore
| | - Hui Wan
- Takeda Pharmaceuticals International AG – Singapore Branch, Singapore, Singapore
| | - Yoon-La Choi
- Department of Pathology and Translational Genomics, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, South Korea
| |
Collapse
|
11
|
Liu LF, Li QS, Hu YX, Yang WG, Chen XX, Ma Z, OuYang WW, Geng YC, Hu C, Su SF, Lu B. Prognostic Model to Predict Overall Survival for Metastatic Non-Small Cell Lung Cancer Patients Treated With Chemotherapy Combined With Concurrent Radiation Therapy to the Primary Tumor: Analysis From Two Prospective Studies. Front Oncol 2021; 11:625688. [PMID: 33718191 PMCID: PMC7947813 DOI: 10.3389/fonc.2021.625688] [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: 11/03/2020] [Accepted: 01/19/2021] [Indexed: 12/25/2022] Open
Abstract
Purpose The role of radiotherapy, in addition to chemotherapy, has not been thoroughly determined in metastatic non-small cell lung cancer (NSCLC). The purpose of the study was to investigate the prognostic factors and to establish a model for the prediction of overall survival (OS) in metastatic NSCLC patients who received chemotherapy combined with the radiation therapy to the primary tumor. Methods The study retrospectively reviewed 243 patients with metastatic NSCLC in two prospective studies. A prognostic model was established based on the results of the Cox regression analysis. Results Multivariate analysis showed that being male, Karnofsky Performance Status score < 80, the number of chemotherapy cycles <4, hemoglobin level ≤120 g/L, the count of neutrophils greater than 5.8 ×109/L, and the count of platelets greater than 220 ×109/L independently predicted worse OS. According to the number of risk factors, patients were further divided into one of three risk groups: those having ≤ 2 risk factors were scored as the low-risk group, those having 3 risk factors were scored as the moderate-risk group, and those having ≥ 4 risk factors were scored as the high-risk group. In the low-risk group, 1-year OS is 67.7%, 2-year OS is 32.1%, and 3-year OS is 19.3%; in the moderate-risk group, 1-year OS is 59.6%, 2-year OS is 18.0%, and 3-year OS is 7.9%; the corresponding OS rates for the high-risk group were 26.2%, 7.9%, and 0% (P<0.001) respectively. Conclusion Metastatic NSCLC patients treated with chemotherapy in combination with thoracic radiation may be classified as low-risk, moderate-risk, or high-risk group using six independent prognostic factors. This prognostic model may help design the study and develop the plans of individualized treatment.
Collapse
Affiliation(s)
- Ling-Feng Liu
- Department of Oncology, Affiliated Hospital of Guizhou Medical University, Guiyang, China.,Department of Oncology, Guizhou Cancer Hospital, Guiyang, China
| | - Qing-Song Li
- Department of Oncology, Affiliated Hospital of Guizhou Medical University, Guiyang, China.,Department of Oncology, Guizhou Cancer Hospital, Guiyang, China
| | - Yin-Xiang Hu
- Department of Oncology, Affiliated Hospital of Guizhou Medical University, Guiyang, China.,Department of Oncology, Guizhou Cancer Hospital, Guiyang, China
| | - Wen-Gang Yang
- Department of Oncology, Affiliated Hospital of Guizhou Medical University, Guiyang, China.,Department of Oncology, Guizhou Cancer Hospital, Guiyang, China
| | - Xia-Xia Chen
- Department of Oncology, Affiliated Hospital of Guizhou Medical University, Guiyang, China.,Department of Oncology, Guizhou Cancer Hospital, Guiyang, China
| | - Zhu Ma
- Department of Oncology, Affiliated Hospital of Guizhou Medical University, Guiyang, China.,Department of Oncology, Guizhou Cancer Hospital, Guiyang, China
| | - Wei-Wei OuYang
- Department of Oncology, Affiliated Hospital of Guizhou Medical University, Guiyang, China.,Department of Oncology, Guizhou Cancer Hospital, Guiyang, China
| | - Yi-Chao Geng
- Department of Oncology, Affiliated Hospital of Guizhou Medical University, Guiyang, China.,Department of Oncology, Guizhou Cancer Hospital, Guiyang, China
| | - Cheng Hu
- Department of Oncology, Affiliated Hospital of Guizhou Medical University, Guiyang, China.,Department of Oncology, Guizhou Cancer Hospital, Guiyang, China
| | - Sheng-Fa Su
- Department of Oncology, Affiliated Hospital of Guizhou Medical University, Guiyang, China.,Department of Oncology, Guizhou Cancer Hospital, Guiyang, China
| | - Bing Lu
- Department of Oncology, Affiliated Hospital of Guizhou Medical University, Guiyang, China.,Department of Oncology, Guizhou Cancer Hospital, Guiyang, China
| |
Collapse
|
12
|
EGFR mutation testing and TKI treatment patterns among veterans with stage III and IV non-small cell lung cancer. Cancer Treat Res Commun 2021; 27:100327. [PMID: 33549984 DOI: 10.1016/j.ctarc.2021.100327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 01/26/2021] [Accepted: 01/27/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Epidermal growth factor receptor (EGFR) mutation testing is recommended in metastatic non-small cell lung cancer (NSCLC). The objective of this study was to assess changes in EGFR mutation testing patterns and tyrosine kinase inhibitor (TKI) use in US veterans with stage III-IV NSCLC between 2013 and 2017. PATIENTS AND METHODS Retrospective study using linked data from Department of Veterans Affairs (VA) Cancer Registry System, Corporate Data Warehouse, commercial laboratories, and clinical notes. Generalized linear mixed models accounting for clustering by VA facility were used to determine factors associated with EGFR mutation testing. RESULTS From 2013 to 2017, EGFR mutation testing increased from 29.5% to 38.4% among veterans with stage III-IV NSCLC and from 47.0% to 57.4% among veterans with stage IV non-squamous disease. Factors associated with increased odds of testing included being married, Medicare enrollment, and adenocarcinoma histology. Factors associated with decreased odds of testing included Medicaid eligibility, stage III disease, increasing age, being a current or former smoker, increasing Charlson-Deyo comorbidity score, and receiving cancer care in the South. Appropriate use of a TKI rose from 2013 to 2017 (17.2% to 74.1%). CONCLUSION EGFR mutation testing rates increased to almost 60% in the stage IV non-squamous NSCLC population in 2017, with residual opportunity for further increase. Several sociodemographic characteristics, comorbidities, and geographic regions were associated with EGFR mutation testing suggestive of inequitable testing decisions. Appropriate use of TKI improved drastically from 2013 to 2017 demonstrating rapidly changing practice patterns through the adoption phase of new treatment options.
Collapse
|
13
|
Herbst RS, Aisner DL, Sonett JR, Turk AT, Weintraub JL, Lindeman NI. Practical Considerations Relating to Routine Clinical Biomarker Testing for Non-small Cell Lung Cancer: Focus on Testing for RET Fusions. Front Med (Lausanne) 2021; 7:562480. [PMID: 33553195 PMCID: PMC7859651 DOI: 10.3389/fmed.2020.562480] [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: 05/15/2020] [Accepted: 11/03/2020] [Indexed: 11/15/2022] Open
Abstract
For patients with advanced non–small cell lung cancer, genomic profiling of tumors to identify potentially targetable alterations and thereby inform treatment selection is now part of standard care. While molecular analyses are primarily focused on actionable biomarkers associated with regulatory agency-approved therapies, there are a number of emerging biomarkers linked to investigational agents in advanced stages of clinical development will become approved agents. A particularly timely example is the reported data and US Food and Drug Administration approval of highly specific small molecule inhibitors of the proto-oncogene tyrosine-protein kinase receptor RET indicate that testing for tumor RET gene fusions in patients with NSCLC has become clinically important. As the number of biomarkers to be tested in NSCLC grows, it becomes increasingly important to optimize and prioritize the use of biopsy tissue, in order to both continue to allow accurate histopathological diagnosis and also to support concurrent genomic profiling to identify perhaps relatively uncommon genetic events. In order to provide practical expert consensus guidance to optimize processes facilitating genomic testing in NSCLC and to overcome barriers to access and implementation, a multidisciplinary advisory board was held in New York, on January 30, 2019. The panel comprised physicians involved in sample procurement (interventional radiologists and a thoracic surgeon), surgical pathologists specializing in the lung, molecular pathologists, and thoracic oncologists. Particular consideration was given to the key barriers faced by these experts in establishing institutional genomic screening programs for NSCLC. Potential solutions have been devised in the form of consensus opinions that might be used to help resolve such issues.
Collapse
Affiliation(s)
- Roy S Herbst
- Section of Medical Oncology, Department of Internal Medicine, Yale Cancer Center, Yale School of Medicine, New Haven, CT, United States
| | - Dara L Aisner
- Department of Pathology, University of Colorado School of Medicine, Aurora, CO, United States
| | - Joshua R Sonett
- Division of Thoracic Surgery, Lung Transplant Program, Columbia University Medical Center, New York, NY, United States
| | - Andrew T Turk
- Department of Pathology and Cell Biology, Columbia University, New York, NY, United States
| | - Joshua L Weintraub
- Division of Interventional Radiology, Columbia University Irving Medical Center, New York, NY, United States
| | - Neal I Lindeman
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, United States
| |
Collapse
|
14
|
Zhong WZ, Wang Q, Mao WM, Xu ST, Wu L, Wei YC, Liu YY, Chen C, Cheng Y, Yin R, Yang F, Ren SX, Li XF, Li J, Huang C, Liu ZD, Xu S, Chen KN, Xu SD, Liu LX, Yu P, Wang BH, Ma HT, Yang JJ, Yan HH, Yang XN, Liu SY, Zhou Q, Wu YL. Gefitinib Versus Vinorelbine Plus Cisplatin as Adjuvant Treatment for Stage II-IIIA (N1-N2) EGFR-Mutant NSCLC: Final Overall Survival Analysis of CTONG1104 Phase III Trial. J Clin Oncol 2020; 39:713-722. [PMID: 33332190 PMCID: PMC8078324 DOI: 10.1200/jco.20.01820] [Citation(s) in RCA: 160] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
ADJUVANT-CTONG1104 (ClinicalTrials.gov identifier: NCT01405079), a randomized phase III trial, showed that adjuvant gefitinib treatment significantly improved disease-free survival (DFS) versus vinorelbine plus cisplatin (VP) in patients with epidermal growth factor receptor (EGFR) mutation-positive resected stage II-IIIA (N1-N2) non–small-cell lung cancer (NSCLC). Here, we report the final overall survival (OS) results.
Collapse
Affiliation(s)
- Wen-Zhao Zhong
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, and Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Qun Wang
- Fudan University Affiliated Zhongshan Hospital, Shanghai, China
| | | | - Song-Tao Xu
- Fudan University Affiliated Zhongshan Hospital, Shanghai, China
| | - Lin Wu
- Hunan Cancer Hospital, Changsha, China
| | - Yu-Cheng Wei
- The Affiliated Hospital of Medical College Qingdao University, Qingdao, China
| | | | - Chun Chen
- Fujian Medical University Union Hospital, Fuzhou, China
| | - Ying Cheng
- Jilin Provincial Tumor Hospital, Changchun, China
| | - Rong Yin
- Jiangsu Cancer Hospital, Nanjing, China
| | - Fan Yang
- The People's Hospital of Peking University, Beijing, China
| | | | | | - Jian Li
- Peking University First Hospital, Beijing, China
| | | | | | - Shun Xu
- The First Hospital of China Medical University, Shenyang, China
| | | | - Shi-Dong Xu
- Harbin Medical University Cancer Hospital, Harbin, China
| | - Lun-Xu Liu
- West China Hospital of Sichuan University, Chengdu, China
| | - Ping Yu
- Sichuan Cancer Hospital, Chengdu, China
| | - Bu-Hai Wang
- The Northern Jiangsu People's Hospital, Yangzhou, China
| | - Hai-Tao Ma
- The First Affiliated Hospital of Suzhou University, Suzhou, China
| | - Jin-Ji Yang
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, and Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Hong-Hong Yan
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, and Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xue-Ning Yang
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, and Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Si-Yang Liu
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, and Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Qing Zhou
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, and Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yi-Long Wu
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, and Guangdong Academy of Medical Sciences, Guangzhou, China
| |
Collapse
|
15
|
Pemetrexed plus cisplatin versus docetaxel plus cisplatin for stage IV lung adenocarcinoma based on propensity score matching. Anticancer Drugs 2020; 30:295-301. [PMID: 30489288 DOI: 10.1097/cad.0000000000000729] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The aim of this study was to compare the clinical efficacy of pemetrexed+cisplatin (PP) versus docetaxel+cisplatin (DP) for the treatment of stage IV lung adenocarcinoma. We retrospectively analyzed the clinical data of 147 patients with stage IV lung adenocarcinoma treated between January 2011 and December 2015, 100 of which were in the DP group whereas 47 were in the DP group. Main inclusion criteria were treatment-naive patients, first-line treatment with PP or DP with no molecular targeted therapy during treatment, 2-6 cycles of first-line chemotherapy with unknown status of epidermal growth factor receptor (EGFR) mutation, 18-75 years of age, and Karnofsky performance status score of at least 70. Prognostic factors for survival were identified by using univariate and multivariate analyses. Propensity score matching was performed to further adjust for confounding. A total of 47 pairs were successfully matched between the two groups. The median overall survival was 9.0 months in the DP group and 17.0 months in the PP group; the 1-year survival rate was 29.8 and 59.6%, respectively; the 2-year survival rate was 12.8 and 21.1%, respectively (χ=4.128, P=0.042); and median progression-free survival was 6.0 and 8.0 months, respectively (χ=4.839, P=0.028). Cox multivariate analysis showed that chemotherapy regimen and number of metastatic organs were independent factors for OS. The effect of the radiotherapy dose on the primary tumor on OS was close to statistically significant. The incidence of grade 3-4 neutropenia was more significantly reduced in the DP group than in the PP group after matching (61.7 vs. 27.7%, P=0.002), with no between-group difference for adverse effects on platelets or hemoglobin. For patients with stage IV lung adenocarcinoma and unknown EGFR mutation status, PP was more effective than DP in prolonging survival and had a less adverse effect on neutrophils.
Collapse
|
16
|
Arcila ME, Yang SR, Momeni A, Mata DA, Salazar P, Chan R, Elezovic D, Benayed R, Zehir A, Buonocore DJ, Rekhtman N, Lin O, Ladanyi M, Nafa K. Ultrarapid EGFR Mutation Screening Followed by Comprehensive Next-Generation Sequencing: A Feasible, Informative Approach for Lung Carcinoma Cytology Specimens With a High Success Rate. JTO Clin Res Rep 2020; 1:100077. [PMID: 33511359 PMCID: PMC7839984 DOI: 10.1016/j.jtocrr.2020.100077] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 07/01/2020] [Accepted: 07/13/2020] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION For patients with advanced NSCLC, cytologic samples may be the only diagnostic specimen available for molecular profiling. Although both rapid and comprehensive assessment are essential in this setting, an integrated multitest approach remains an important strategy in many laboratories, despite the risks and challenges when working with scant samples. In this study, we describe our experience and high success rate in using a multitest approach, focusing on the clinical validation and incorporation of ultrarapid EGFR testing using the Idylla system followed by comprehensive next-generation sequencing (NGS). METHODS Cytology samples received for routine molecular testing were included in this study. The performance characteristics of the EGFR Idylla assay were assessed; tissue suitability parameters and interpretation criteria to supplement automated mutation calling were established. The assay performance was monitored for 1 year, comparing the results with those of concurrent NGS testing by MSK-IMPACT (primarily) or MSK-AmpliSeq and MSK-Fusion solid panel in a subset of cases. RESULTS Overall, 301 samples were studied; 83 samples were included in validation (60.2% [50 of 83] were positive for EGFR mutations). Concordance with the reference method was 96.4% (80 of 83) of the samples with excellent reproducibility. The limit of detection was variable depending on the total tissue input and the specific mutation tested. Unextracted tissue inputs that maintained total EGFR cycle of quantification at less than 23 allowed all mutations to be detected if present at greater than 5% variant allele frequency. Mutations could be detected at 1% variant allele frequency with total EGFR cycle of quantification of 18. During the clinical implementation phase, 218 NSCLC samples were tested by Idylla (24.3% [53 of 218] were EGFR mutation positive). Concurrent NGS testing was requested on 165 samples and successfully performed on 96.4% (159 of 165) of the samples. The Idylla automated results were concordant with those obtained by NGS in 96.2% (153 of 159) of cases and improved to 98.7% (157 of 159) after incorporation of manual review criteria to supplement automated calling, resulting in a diagnostic sensitivity of 95.6% (95% confidence interval: 84.9%-99.5%). In general, 9% (14 of 159) of the cases tested by NGS had EGFR mutations not covered by the Idylla assay, primarily insertions in exon 19 and 20 and minor mutations cooccurring with canonical sensitizing mutations. CONCLUSIONS Comprehensive molecular testing is feasible and has a high success rate in NSCLC cytology samples when using a multitest approach. Testing with the Idylla system enables rapid and accurate determination of the EGFR status without compromising subsequent NGS testing.
Collapse
Affiliation(s)
- Maria E. Arcila
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Soo-Ryum Yang
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Amir Momeni
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Douglas A. Mata
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Paulo Salazar
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Roger Chan
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Daniela Elezovic
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ryma Benayed
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ahmet Zehir
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Darren J. Buonocore
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Natasha Rekhtman
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Oscar Lin
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Marc Ladanyi
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Khedoudja Nafa
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| |
Collapse
|
17
|
Lu Z, Cai J, Zeng Z, Liu A. [Management of Drug Therapy for Leptomeningeal Metastasis of Sensitive Driver Gene Positive Non-small Cell Lung Cancer]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2020; 23:710-718. [PMID: 32758347 PMCID: PMC7467993 DOI: 10.3779/j.issn.1009-3419.2020.102.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Leptomeningeal metastasis (LM) is one of the serious complications of advanced non-small cell lung cancer (NSCLC), although the incidence is not high, the clinical symptoms are severe and the prognosis is poor. LM is prone to occur in patients with positive driver gene than negative. At present, the treatment of LM mainly includes molecular targeted therapy, systemic chemotherapy, whole brain radiotherapy, intrathecal chemotherapy and immunotherapy. Although there are many treatments, the efficacy of LM is still unsatisfactory. This article reviews the drug therapy of sensitive driver gene positive NSCLC LM.
Collapse
Affiliation(s)
- Zhiqin Lu
- Department of Oncology, The Second Affiliated of Nanchang University, Nanchang 330006, China
| | - Jing Cai
- Department of Oncology, The Second Affiliated of Nanchang University, Nanchang 330006, China.,Jiangxi Key Laboratory of Clinical Translational Cancer Research, Nanchang 330006, China
| | - Zhimin Zeng
- Department of Oncology, The Second Affiliated of Nanchang University, Nanchang 330006, China.,Jiangxi Key Laboratory of Clinical Translational Cancer Research, Nanchang 330006, China
| | - Anwen Liu
- Department of Oncology, The Second Affiliated of Nanchang University, Nanchang 330006, China.,Jiangxi Key Laboratory of Clinical Translational Cancer Research, Nanchang 330006, China
| |
Collapse
|
18
|
Gao L, Yan SB, Yang J, Kong JL, Shi K, Ma FC, Huang LZ, Luo J, Yin SY, He RQ, Hu XH, Chen G. MiR-182-5p and its target HOXA9 in non-small cell lung cancer: a clinical and in-silico exploration with the combination of RT-qPCR, miRNA-seq and miRNA-chip. BMC Med Genomics 2020; 13:3. [PMID: 31906958 PMCID: PMC6945423 DOI: 10.1186/s12920-019-0648-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 12/19/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND MiR-182-5p, a cancer-related microRNA (miRNA), modulates tumorigenesis and patient outcomes in various human malignances. This study interroted the clinicopathological significance and molecular mechanisms of miR-182-5p in non-small cell lung cancer (NSCLC). METHODS The clinical significance of miR-182-5p in NSCLC subtypes was determined based on an analysis of 124 samples (lung adenocarcinomas [LUADs], n = 101; lung squamous cell carcinomas [LUSCs], n = 23) obtained from NSCLC patients and paired noncancer tissues and an analysis of data obtained from public miRNA-seq database, miRNA-chip database, and the scientific literature. The NSCLC samples (n = 124) were analyzed using the real-time quantitative polymerase chain reaction (RT-qPCR). Potential targets of miR-182-5p were identified using lists generated by miRWalk v.2.0, a comprehensive atlas of predicted and validated targets of miRNA-target interactions. Molecular events of miR-182-5p in NSCLC were unveiled based on a functional analysis of candidate targets. The association of miR-182-5p with one of the candidate target genes, homeobox A9 (HOXA9), was validated using in-house RT-qPCR and dual-luciferase reporter assays. RESULTS The results of the in-house RT-qPCR assays analysis of data obtained from public miRNA-seq databases, miRNA-chip databases, and the scientific literature all supported upregulation of the expression level of miR-182-5p level in NSCLC. Moreover, the in-house RT-qPCR data supported the influence of upregulated miR-182-5p on malignant progression of NSCLC. In total, 774 prospective targets of miR-182-5p were identified. These targets were mainly clustered in pathways associated with biological processes, such as axonogenesis, axonal development, and Ras protein signal transduction, as well as pathways involved in axonal guidance, melanogenesis, and longevity regulation, in multiple species. Correlation analysis of the in-house RT-qPCR data and dual-luciferase reporter assays confirmed that HOXA9 was a direct target of miR-182-5p in NSCLC. CONCLUSIONS The miR-182-5p expression level was upregulated in NSCLC tissues. MiR-182-5p may exert oncogenic influence on NSCLC through regulating target genes such as HOXA9.
Collapse
Affiliation(s)
- Li Gao
- Department of Pathology, the First Affiliated Hospital of Guangxi Medical University, Zhuang Autonomous Region, Nanning, 530021, Guangxi, China
| | - Shi-Bai Yan
- Department of Medical Oncology, the First Affiliated Hospital of Guangxi Medical University, Zhuang Autonomous Region, Nanning, 530021, Guangxi, China
| | - Jie Yang
- Department of Pharmacology, School of Pharmacy, Guangxi Medical University, Zhuang Autonomous Region, Nanning, 530021, Guangxi, China
| | - Jin-Liang Kong
- Department of Respiratory and Critical Care Medicine, the First Affiliated Hospital of Guangxi Medical University, Zhuang Autonomous Region, Nanning, 530021, Guangxi, China
| | - Ke Shi
- Department of Pathology, the First Affiliated Hospital of Guangxi Medical University, Zhuang Autonomous Region, Nanning, 530021, Guangxi, China
| | - Fu-Chao Ma
- Department of Medical Oncology, the First Affiliated Hospital of Guangxi Medical University, Zhuang Autonomous Region, Nanning, 530021, Guangxi, China
| | - Lin-Zhen Huang
- Department of Pathology, the First Affiliated Hospital of Guangxi Medical University, Zhuang Autonomous Region, Nanning, 530021, Guangxi, China
| | - Jie Luo
- Department of Medical Oncology, the Second Affiliated Hospital of Guangxi Medical University, Zhuang Autonomous Region, Nanning, 530021, Guangxi, China
| | - Shu-Ya Yin
- Department of Pathology, the First Affiliated Hospital of Guangxi Medical University, Zhuang Autonomous Region, Nanning, 530021, Guangxi, China
| | - Rong-Quan He
- Department of Medical Oncology, the First Affiliated Hospital of Guangxi Medical University, Zhuang Autonomous Region, Nanning, 530021, Guangxi, China
| | - Xiao-Hua Hu
- Department of Medical Oncology, the First Affiliated Hospital of Guangxi Medical University, Zhuang Autonomous Region, Nanning, 530021, Guangxi, China.
| | - Gang Chen
- Department of Pathology, the First Affiliated Hospital of Guangxi Medical University, Zhuang Autonomous Region, Nanning, 530021, Guangxi, China.
| |
Collapse
|
19
|
Guo LH, Zhang MF, Zhang HL, Zhou JY, Cai XH, Long Y, Guo QS, Yang N, Zhao J, Xie ZH, Jiang B, Zhu Y, Fan Y, Xie CY, Hu Y, Yao Y, Jia J, Li XL, Cui JW, Sui XZ, Lin W, Cheng Y, Wang HJ, Wang CL, Zhao MF, Qiao GB, Peng LJ, Yang L, Chen GY, Cai KC, Xu XH, Zhang LM, Feng GS, Zhou JM, Wu GW, Dong XR, Wang LF, Zhang HM, Gao YJ, Jiang QY, Cang SD, Yang ZX, Song X, Liu XQ, Zhu B, Chen FX, Hu CH, Chen X, Wu YL, Zhou Q. Survival Benefit and Genetic Profile of Pemetrexed as Initial Chemotherapy in Selected Chinese Patients With Advanced Lung Adenocarcinoma. Front Oncol 2020; 10:1568. [PMID: 33042801 PMCID: PMC7522477 DOI: 10.3389/fonc.2020.01568] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 07/21/2020] [Indexed: 02/05/2023] Open
Abstract
Objective: This study investigated survival in selected Chinese patients with advanced lung adenocarcinoma who received initial chemotherapy with pemetrexed. We also explored the relationship between genetic biomarkers and pemetrexed efficacy. Methods: We retrospectively collected patients (n = 1,047) enrolled in the Chinese Patient Assistance Program from multiple centers who received pemetrexed alone or combined with platinum as initial chemotherapy and continued pemetrexed maintenance therapy for advanced lung adenocarcinoma from November 2014 to June 2017. The outcomes were duration of treatment (DOT) and overall survival (OS). Clinical features were analyzed for their influence on the treatment effect and prognosis. Next-generation sequencing (NGS) was performed to identify genetic biomarkers associated with the efficacy of pemetrexed. Results: The median DOT was 9.1 months (95% CI: 8.5-9.8), and the median OS was 26.2 months (95% CI: 24.2-28.1). OS was positively correlated with DOT (r = 0.403, P < 0.001). Multivariable analysis showed that smoking status and Eastern Cooperative Oncology Group (ECOG) performance status (PS) were independently associated with DOT; smoking status, ECOG PS, targeted therapy, and EGFR/ALK/ROS1 status were independently associated with OS. NGS in 22 patients with available samples showed genes with high mutation rates were: TP53 (54.5%), EGFR (50.0%), MYC (18.2%), and PIK3CA (13.6%). When grouped based on progression-free survival (PFS) reported in the PARAMOUNT study, the DOT > 6.9 months set was associated with PIK3CA, ALK, BRINP3, CDKN2A, CSMD3, EPHA3, KRAS, and RB1 mutations, while ERBB2 mutation was observed only in the DOT ≤ 6.9 months set. Conclusion: This study shows that initial chemotherapy with pemetrexed is an effective regimen for advanced lung adenocarcinoma in selected Chinese patients. There is no specific genetic profile predicting the benefit of pemetrexed found by NGS. Biomarkers predicting the efficacy of pemetrexed need further exploration.
Collapse
Affiliation(s)
- Long-Hua Guo
- Department of Medical Oncology, Cancer Center, Meizhou People's Hospital (Huangtang Hospital), Meizhou Academy of Medical Sciences, Meizhou Hospital Affiliated to Sun Yat-Sen University, Meizhou, China
| | - Ming-Feng Zhang
- Guangdong Lung Cancer Institute, Guangdong Provincial Key Laboratory of Translational Medicine in Lung Cancer, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, Guangzhou, China
| | - He-Long Zhang
- Department of Oncology, The Second Affiliated Hospital of Air Force Military Medical University, Xi'an, China
| | - Jian-Ying Zhou
- Department of Respiratory Disease, Thoracic Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Xiao-Hong Cai
- Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Yu Long
- Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Qi-Sen Guo
- Internal Medicine (Respiratory) of Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Shangdong Academy of Medical Sciences, Shangdong Cancer Hospital and Institute, Jinan, China
| | - Nong Yang
- Lung Cancer and Gastrointestinal Unit, Department of Medical Oncology, Hunan Cancer Hospital/Affiliated Cancer Hospital of Xiangya School of Medicine, Changsha, China
| | - Jun Zhao
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Thoracic Oncology, Peking University Cancer Hospital and Institute, Beijing, China
| | - Zhan-Hong Xie
- Respiratory Medicine Department, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute for Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Bo Jiang
- Department of Cadre Medical Oncology, No.3 Hospital Affiliated to Kunming Medical College (Yunnan Tumor Hospital), Kunming, China
| | - Ying Zhu
- Department of Cadre Medical Oncology, No.3 Hospital Affiliated to Kunming Medical College (Yunnan Tumor Hospital), Kunming, China
| | - Yun Fan
- Department of Thoracic Medical Oncology, Zhejiang Cancer Hospital, Hangzhou, China
| | - Cong-Ying Xie
- Department of Radiation and Medical Oncology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yi Hu
- Department of Medical Oncology, Chinese PLA General Hospital, Beijing, China
| | - Yu Yao
- Department of Medical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jun Jia
- Department of Oncology, Dongguan People's Hospital, Dongguan, China
| | - Xiao-Ling Li
- Department of Thoracic Oncology, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang, China
| | - Jiu-Wei Cui
- Cancer Center, The First Hospital of Jilin University, Changchun, China
| | - Xi-Zhao Sui
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing, China
| | - Wen Lin
- Department of Medical Oncology, Cancer Hospital of Shantou University Medical College, Shantou, China
| | - Ying Cheng
- Department of Medical Oncology, Jilin Provincial Cancer Hospital, Changchun, China
| | - Hui-Juan Wang
- Department of Medical Oncology, The Affiliated Cancer Hospital of Zhengzhou University/Henan Cancer Hospital, Zhengzhou, China
| | - Chang-Li Wang
- Department of Lung Cancer, Tianjin Medical University Cancer Institute & Hospital, Tianjin, China
| | - Ming-Fang Zhao
- Department of Medical Oncology, The First Hospital of China Medical University, Shenyang, China
| | - Gui-Bin Qiao
- Guangdong Lung Cancer Institute, Guangdong Provincial Key Laboratory of Translational Medicine in Lung Cancer, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, Guangzhou, China
| | - Li-Jun Peng
- Department of Thoracic Surgery, General Hospital of Southern Theater Command, PLA, Guangzhou, China
| | - Lin Yang
- Department of Thoracic Surgery, Shenzhen People's Hospital, 2nd Clinical Medical College of Jinan University, Shenzhen, China
| | - Gong-Yan Chen
- Department of Medical Oncology, Harbin Medical University Cancer Hospital, Harbin, China
| | - Kai-Can Cai
- Department of Thoracic Surgery, Nanfang Hospital of Southern Medical University, Guangzhou, China
| | - Xin-Hua Xu
- Oncology Department, The First College of Clinical Medical Science, China Three Gorges University & Yichang Central People's Hospital, Yichang, China
| | - Liang-Ming Zhang
- Department of Medical Oncology, Yantai Yuhuangding Hospital, Yantai, China
| | - Guo-Sheng Feng
- Chemotherapy Section One, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Jing-Min Zhou
- Department of Respiratory and Critical Care, Tianjin Chest Hospital, Tianjin, China
| | - Guo-Wu Wu
- Department of Medical Oncology, Cancer Center, Meizhou People's Hospital (Huangtang Hospital), Meizhou Academy of Medical Sciences, Meizhou Hospital Affiliated to Sun Yat-Sen University, Meizhou, China
| | - Xiao-Rong Dong
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Li-Feng Wang
- Oncology Department, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Hong-Mei Zhang
- Department of Clinical Oncology, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Ya-Jie Gao
- Department of Oncology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Qiu-Ying Jiang
- Department of Oncology, The Second Hospital Affiliated to Harbin Medical University, Harbin, China
| | - Shun-Dong Cang
- Department of Oncology, Henan Provincial People's Hospital, Zhengzhou, China
| | - Zhi-Xiong Yang
- Department of Pulmonary Oncology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Xia Song
- Department of Respiratory Medicine, Shanxi Provincial Cancer Hospital, Taiyuan, China
| | - Xiao-Qing Liu
- Department of Pulmonary Oncology, The Fifth Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Bo Zhu
- Institute of Cancer, Xinqiao Hospital, The Third Military Medical University, Chongqing, China
| | - Feng-Xia Chen
- Thoracic Surgery, Hainan General Hospital, Haikou, China
| | - Chun-Hong Hu
- Cancer Center, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Xi Chen
- Department of Oncology, The 900th Hospital of the People's Liberation Army Joint Service Support Force, Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Yi-Long Wu
- Guangdong Lung Cancer Institute, Guangdong Provincial Key Laboratory of Translational Medicine in Lung Cancer, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, Guangzhou, China
- *Correspondence: Qing Zhou
| | - Qing Zhou
- Guangdong Lung Cancer Institute, Guangdong Provincial Key Laboratory of Translational Medicine in Lung Cancer, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, Guangzhou, China
- Yi-Long Wu
| |
Collapse
|
20
|
Maguire FB, Morris CR, Parikh-Patel A, Cress RD, Keegan THM, Li CS, Lin PS, Kizer KW. First-Line Systemic Treatments for Stage IV Non-Small Cell Lung Cancer in California: Patterns of Care and Outcomes in a Real-World Setting. JNCI Cancer Spectr 2019; 3:pkz020. [PMID: 32328551 PMCID: PMC7050031 DOI: 10.1093/jncics/pkz020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 12/03/2018] [Accepted: 03/19/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Multiple systemic treatments have been developed for stage IV non-small cell lung cancer (NSCLC), but their use and effect on outcomes at the population level are unknown. This study describes the utilization of first-line systemic treatments among stage IV NSCLC patients in California and compares survival among treatment groups. METHODS Data on 17 254 patients diagnosed with stage IV NSCLC from 2012 to 2014 were obtained from the California Cancer Registry. Systemic treatments were classified into six groups. The Kaplan-Meier method and multivariable Cox proportional hazards models were used to compare survival between treatment groups. RESULTS Fifty-one percent of patients were known to have received systemic treatment. For patients with nonsquamous histology, pemetrexed regimens were the most common treatment (14.8%) followed by tyrosine kinase inhibitors (11.9%) and platinum doublets (11.5%). Few patients received pemetrexed/bevacizumab combinations (4.5%), bevacizumab combinations (3.6%), or single agents (1.7%). There was statistically significantly better overall survival for those on pemetrexed regimens (hazard ratio [HR] = 0.86, 95% confidence interval [CI] = 0.80 to 0.92), bevacizumab regimens (HR = 0.73, 95% CI = 0.65 to 0.81), pemetrexed/bevacizumab regimens (HR = 0.68, 95% CI = 0.61 to 0.76), or tyrosine kinase inhibitors (HR = 0.62, 95% CI = 0.57 to 0.67) compared with platinum doublets. The odds of receiving most systemic treatments decreased with decreasing socioeconomic status. For patients with squamous histology, platinum doublets were predominant (33.7%) and were not found to have statistically significantly different overall survival from single agents. CONCLUSIONS These population-level findings indicate low utilization of systemic treatments, survival differences between treatment groups, and evident treatment disparities by socioeconomic status.
Collapse
Affiliation(s)
- Frances B Maguire
- California Cancer Reporting and Epidemiologic Surveillance Program, Institute for Population Health Improvement, University of California Davis, Davis, CA
- Graduate Group in Epidemiology, University of California Davis, Davis, CA
| | - Cyllene R Morris
- California Cancer Reporting and Epidemiologic Surveillance Program, Institute for Population Health Improvement, University of California Davis, Davis, CA
| | - Arti Parikh-Patel
- California Cancer Reporting and Epidemiologic Surveillance Program, Institute for Population Health Improvement, University of California Davis, Davis, CA
| | - Rosemary D Cress
- Department of Public Health Sciences, University of California Davis, Davis, CA
| | - Theresa H M Keegan
- Center for Oncology Hematology Outcomes Research and Training (COHORT), and Division of Hematology and Oncology, University of California Davis School of Medicine
| | - Chin-Shang Li
- School of Nursing, State University of New York, University of Buffalo, Buffalo, NY
| | - Patrick S Lin
- Center for Oncology Hematology Outcomes Research and Training (COHORT), and Division of Hematology and Oncology, University of California Davis School of Medicine
| | - Kenneth W Kizer
- California Cancer Reporting and Epidemiologic Surveillance Program, Institute for Population Health Improvement, University of California Davis, Davis, CA
- Department of Emergency Medicine, University of California Davis School of Medicine, Davis, CA
- Betty Irene Moore School of Nursing, University of California Davis, Davis, CA
| |
Collapse
|
21
|
Yu H, Sun S, Hu X, Xia J, Wang J, Chen H. Chinese perspectives on clinical efficacy and safety of alectinib in patients with ALK-positive advanced non-small cell lung cancer. Onco Targets Ther 2019; 12:6481-6495. [PMID: 31616158 PMCID: PMC6699152 DOI: 10.2147/ott.s185115] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 06/28/2019] [Indexed: 12/12/2022] Open
Abstract
The incidence of lung cancer is increasing in China, in contrast to trends in Western countries, due to the increasing numbers of smokers and high levels of air pollution. Non-small-cell lung cancer (NSCLC) is the most common form of lung cancer, accounting for approximately 85% of lung cancers. Better understanding of the pathogenesis of NSCLC has led to the identification of multiple genetic mutations and chromosomal translocations such as those in the anaplastic lymphoma kinase (ALK) gene. To facilitate the identification of treatment targets, multiple guidelines (European Society for Medical Oncology, National Comprehensive Cancer Network, and American Society of Clinical Oncology) now recommend screening for genetic factors to help guide treatment decisions. In recent years, multiple ALK inhibitors have been developed to treat NSCLC, including the first-generation tyrosine kinase inhibitor (TKI) crizotinib; second-generation TKIs such as ceritinib, ensartinib, brigatinib, and alectinib; the third-generation TKI lorlatinib; and the fourth-generation TKI repotrectinib. These agents differ in structure, potency, and activity, both systemically and their effects on central nervous system (CNS) metastases. Recently, alectinib was approved in China to treat patients with locally advanced or metastatic NSCLC that were ALK+. Alectinib has demonstrated activity against NSCLC, including metastases within the CNS, with better tolerability than crizotinib. These ALK inhibitors represent significant advances in the treatment of NSCLC and yet patients will likely still exhibit disease progression. Alectinib offers greater potency with greater specificity as well as a better toxicity profile than many other TKIs that are currently available. Here, we review the role of ALK as a therapeutic target in NSCLC, the testing methods for identifying ALK-rearranged NSCLC, and the various TKIs currently being used or explored for treatment in this setting, with a focus on alectinib from a Chinese perspective.
Collapse
Affiliation(s)
- Hui Yu
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, People’s Republic of China
| | - Si Sun
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, People’s Republic of China
| | - Xingjiang Hu
- Zhejiang Provincial Key Laboratory for Drug Evaluation and Clinical Research, First Affiliated Hospital, Zhejiang University, Hangzhou, Zhejiang, People’s Republic of China
| | - Jinjing Xia
- Department of Medical Science Oncology, Shanghai Roche Pharmaceuticals Ltd., Shanghai, People’s Republic of China
| | - Jialei Wang
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, People’s Republic of China
| | - Haiquan Chen
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, People’s Republic of China
| |
Collapse
|
22
|
Chang Q, Zhang Y, Xu J, Zhong R, Qiang H, Zhang B, Han B, Qian J, Chu T. First-line pemetrexed/carboplatin or cisplatin/bevacizumab compared with paclitaxel/carboplatin/bevacizumab in patients with advanced non-squamous non-small cell lung cancer with wild-type driver genes: A real-world study in China. Thorac Cancer 2019; 10:1043-1050. [PMID: 30900826 DOI: 10.1111/1759-7714.13025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 02/02/2019] [Accepted: 02/03/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The study was conducted to compare the effectiveness and safety of pemetrexed/carboplatin or cisplatin/bevacizumab (PemPBev) and paclitaxel/carboplatin/bevacizumab (PacCBev) as first-line therapy for advanced non-squamous non-small cell lung cancer (NS-NSCLC) patients with wild-type driver genes in a real-world setting. METHODS We retrospectively collected the medical records of advanced NS-NSCLC patients with wild-type driver genes administered first-line PemPBev or PacCBev therapy at Shanghai Chest Hospital between January 2014 and June 2016, and analyzed the differences in survival outcomes, efficacy, and safety between PemPBev and PacCBev treatment. RESULTS A total of 390 patients were included in our analysis: 249 in the PemPBev group and 141 in the PacCBev group. Patients administered PemPBev experienced significantly improved progression-free survival (PFS) and overall survival (OS) compared to those administered PacCBev (PFS 7.5 vs. 6.2 months, hazard ratio [HR] 0.66, 95% confidence interval [CI] 0.53-0.84, P < 0.001; OS:18.6 vs. 16.0 months, HR 0.68, 95% CI 0.52-0.90, P = 0.002). The objective response rate (ORR) and disease control rate (DCR) were similar between the groups (ORR 21.7% vs. 30.5%, P = 0.053; DCR 69.1% vs. 67.4%, P = 0.728). There was no significant difference in the incidence of adverse events between the groups (64.7% vs. 68.8%; P = 0.407), but the incidence of peripheral neuropathy in the PacCBev group was higher than in the PemPBev group (7.8% vs. 2.4%; P = 0.012). CONCLUSION Our study shows that for advanced NS-NSCLC patients with wild-type driver genes, first-line PemPBev might be a better treatment option compared to PacCBev.
Collapse
Affiliation(s)
- Qing Chang
- Pulmonary Department, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yanwei Zhang
- Pulmonary Department, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Jianlin Xu
- Pulmonary Department, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Runbo Zhong
- Pulmonary Department, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Huiping Qiang
- Pulmonary Department, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Bo Zhang
- Pulmonary Department, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Baohui Han
- Pulmonary Department, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Jialin Qian
- Pulmonary Department, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Tianqing Chu
- Pulmonary Department, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| |
Collapse
|
23
|
Pennell NA, Arcila ME, Gandara DR, West H. Biomarker Testing for Patients With Advanced Non-Small Cell Lung Cancer: Real-World Issues and Tough Choices. Am Soc Clin Oncol Educ Book 2019; 39:531-542. [PMID: 31099633 DOI: 10.1200/edbk_237863] [Citation(s) in RCA: 196] [Impact Index Per Article: 39.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Over the last decade, the treatment of patients with advanced non-small cell lung cancer (NSCLC) has become reliant on tissue and/or blood biomarkers to help guide treatment decisions. There are now multiple biomarker-defined patient subgroups, with evidence showing that treatment with targeted therapies has superior clinical outcomes when compared with traditional cytotoxic chemotherapy. However, rapid change in the field of precision oncology brings with it the challenge of translating recommendations into clinical practice. In this review, we discuss the major guidelines recommending biomarker testing in NSCLC, as well the logistical challenges to applying these guidelines to patients with NSCLC both in the United States and worldwide. The techniques commonly used for biomarker testing will be discussed, both for tissue- and blood-based biomarkers. Finally, we discuss the challenge of interpreting the results of biomarker testing and using these results to guide treatment decisions.
Collapse
Affiliation(s)
| | - Maria E Arcila
- 2 Memorial Sloan Kettering Cancer Institute, New York, NY
| | | | - Howard West
- 4 City of Hope Comprehensive Cancer Center, Duarte, CA
| |
Collapse
|
24
|
Chang H, Liu YB, Yi W, Lu JB, Zhang JX. Development and validation of a model to predict tyrosine kinase inhibitor-sensitive EGFR mutations of non-small cell lung cancer based on multi-institutional data. Thorac Cancer 2018; 9:1680-1686. [PMID: 30281214 PMCID: PMC6275830 DOI: 10.1111/1759-7714.12881] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 08/26/2018] [Accepted: 08/27/2018] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Non-small cell lung cancer (NSCLC) with different EGFR mutation types shows distinct sensitivity to tyrosine kinase inhibitors (TKIs). This study developed a patho-clinical profile-based prediction model of TKI-sensitive EGFR mutations. METHODS The records of 1121 Chinese patients diagnosed with NSCLC from November 2008 to October 2014 (the development set) were reviewed. Multivariate logistic regression was conducted to identify any association between potential predictors and the classic sensitive EGFR mutations (exon 19 deletion and exon 21 L858R point mutation). A prediction index was created by assigning weighted scores to each factor proportional to a regression coefficient. Validation was made in an independent cohort consisting of 864 patients who were consecutively enrolled between November 2014 and January 2017 (the validation set). RESULTS Seven independent predictors were identified: gender (female vs. male), adenocarcinoma (yes vs. no), smoking history (no vs. yes), N stage (N+ vs. N0), M stage (M1 vs. M0), brain metastasis (yes vs. no), and elevated Cyfra 21-1 (no vs. yes). Each was assigned a number of points. In the validation set, the area under curve of the prediction index appeared as 0.698 (95% confidence interval 0.663-0.733). The sensitivity, specificity, positive and negative predictive values, and concordance were 95.0%, 32.3%, 61.4%, 85.1%, and 65.6%, respectively. CONCLUSION We developed a patho-clinical profile-based model for predicting TKI-sensitive EGFR mutations. Our model may represent a noninvasive, economical choice for clinicians to inform TKI therapy.
Collapse
Affiliation(s)
- Hui Chang
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, China
| | - Yuan-Bin Liu
- Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou, China.,Department of Respiratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Wei Yi
- Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou, China.,Department of Radiation Oncology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jia-Bin Lu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, China.,Department of Pathology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Jie-Xia Zhang
- Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou, China.,Department of Respiratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| |
Collapse
|
25
|
Cheng Y, Wang Y, Zhao J, Liu Y, Gao H, Ma K, Zhang S, Xin H, Liu J, Han C, Zhu Z, Wang Y, Chen J, Wen F, Li J, Zhang J, Zheng Z, Dai Z, Piao H, Li X, Li Y, Zhong M, Ma R, Zhuang Y, Xu Y, Qu Z, Yang H, Pan C, Yang F, Zhang D, Li B. Real-world EGFR testing in patients with stage IIIB/IV non-small-cell lung cancer in North China: A multicenter, non-interventional study. Thorac Cancer 2018; 9:1461-1469. [PMID: 30253083 PMCID: PMC6209800 DOI: 10.1111/1759-7714.12859] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 08/07/2018] [Accepted: 08/08/2018] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Before tyrosine kinase inhibitor (TKI) therapy can be administered in patients with advanced non-small cell lung cancer (NSCLC), EGFR mutation testing is required. However, few studies have evaluated the extent of EGFR testing in real-world practice in China. METHODS A multicenter, observational study of EGFR testing in NSCLC patients in North China was conducted. Treatment-naïve patients or those with postoperative recurrent stage IIIB/IV NSCLC were enrolled. The primary objective was EGFR testing rate. Secondary objectives included EGFR mutation status, EGFR testing methods and specimens, factors associated with EGFR testing, and overall survival with or without EGFR testing. RESULTS Overall, 2809 patients with stage IIIB/IV NSCLC were enrolled; 90.78% had adenocarcinoma. The EGFR screening rate was 42.54%. EGFR testing rates were higher in tumor samples obtained by lymph node puncture, and in patients with urban medical insurance, adenocarcinoma, non-smokers, or those located in developed cities (all P < 0.001). The EGFR mutation rate was 46.44%. The most commonly used specimens for EGFR testing were biopsy tumor samples (67.53%). PCR-based methods (72.05%), Sanger sequencing (5.36%), and Luminex liquid chip (5.10%) were the most frequently used testing platforms. Similar positive EGFR mutation rates were achieved with different platforms. TKI therapy was the first-line treatment administered to most EGFR-positive patients (56.22%), and chemotherapy in EGFR-negative patients (84.88%). Overall survival was higher in EGFR-tested than in untested patients (27.50 vs. 19.73 months; P = 0.007). CONCLUSION Real-world EGFR testing rates for NSCLC in North China were relatively low because of clinical and social factors, including medical insurance coverage.
Collapse
Affiliation(s)
- Ying Cheng
- Department of Medical Oncology, Jilin Provincial Cancer Hospital, Changchun, China
| | - Yan Wang
- Department of Internal Medical Oncology, Harbin Medical University Cancer Hospital, Harbin, China
| | - Jun Zhao
- Department of Thoracic Oncology, Beijing Cancer Hospital, Beijing, China
| | - Yunpeng Liu
- Department of Medical Oncology, The First Hospital of China Medical University, Shenyang, China
| | - Hongjun Gao
- Department of Lung Cancer, Affiliated Hospital of Academy of Military Medical Sciences, Beijing, China
| | - Kewei Ma
- Department of Respiratory Medicine, The First Hospital of Jilin University, Changchun, China
| | - Shucai Zhang
- Department of Oncology, Beijing Chest Hospital, Beijing, China
| | - Hua Xin
- Department of Thoracic Surgery, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Jiwei Liu
- Department of Oncology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Chengbo Han
- Department of Oncology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Zhitu Zhu
- Department of Cancer Center, The First Affiliated Hospital of Liaoning Medical University, Jinzhou, China
| | - Yan Wang
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jun Chen
- Department of Medical Oncology, The Second Hospital of Dalian Medical University, Dalian, China
| | - Fugang Wen
- Department of Oncology, Anshan Cancer Hospital, Anshan, China
| | - Junling Li
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jie Zhang
- Department of Respiratory and Critical Care Medicine, The Second of Hospital of Jilin University, Changchun, China
| | - Zhendong Zheng
- Department of Oncology, The General Hospital of Shenyang Military, Shenyang, China
| | - Zhaoxia Dai
- Department of Medical Oncology, The Second Hospital of Dalian Medical University, Dalian, China
| | - Hongmei Piao
- Department of Respiratory Medicine, Yanbian University Hospital, Yanbian, China
| | - Xiaoling Li
- Department of Medical Oncology, Liaoning Cancer Hospital, Shenyang, China
| | - Yinyin Li
- Department of Oncology, Shenyang Chest Hospital, Shenyang, China
| | - Min Zhong
- Department of Medical Oncology, Dalian Municipal Central Hospital, Dalian, China
| | - Rui Ma
- Department of Thoracic, Liaoning Cancer Hospital, Shenyang, China
| | - Yongzhi Zhuang
- Department of Oncology, Daqing Oilfield General Hospital, Daqing, China
| | - Yuqing Xu
- Medical Department, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Zhuohui Qu
- Department of Oncology, Siping Cancer Hospital, Siping, China
| | - Haibo Yang
- Department of Oncology, Jilin Municipal Cancer Hospital, Jilin, China
| | - Chunxia Pan
- Department of Medical Oncology, Third People's Hospital of Dalian, Dalian, China
| | - Fan Yang
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing, China
| | - Daxin Zhang
- Department of Oncology, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Bing Li
- Department of Medical Oncology, Jilin Center Hospital, Jilin, China
| |
Collapse
|
26
|
Song Y, Zhou Q, Zhang X, Chen GY, Zhong DS, Yu Z, Yu P, Zhang YP, Chen JH, Hu Y, Feng GS, Song X, Shi Q, Yang LL, Yao LD, Zhan LJ, Yang F, Wu YL. Factors associated with gene aberration test status and treatment decision in patients with unresectable Stage IIIB/IV nonsquamous non-small cell lung cancer: A multicenter survey in China (CTONG 1506). Lung Cancer 2018; 123:7-13. [PMID: 30089597 DOI: 10.1016/j.lungcan.2018.06.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 05/27/2018] [Accepted: 06/08/2018] [Indexed: 10/14/2022]
Abstract
OBJECTIVES This study investigated factors associated with (i) the likelihood of receiving a gene aberration test and (ii) the choice of treatment between chemotherapy and targeted therapy in patients with non-small cell lung cancer (NSCLC) in China. MATERIALS AND METHODS This cross-sectional study analyzed data previously extracted from the medical charts of patients with unresectable Stage IIIB/IV nonsquamous NSCLC discharged from one of 12 tertiary hospitals in China between August 2015 and March 2016. Logistic regressions were applied to investigate factors associated with receiving a gene aberration test and the treatment decision. RESULTS Data from 932 patients were analyzed. Patients were less likely to have a gene aberration test if they had a histologic subtype other than adenocarcinoma or a hospital waiting time for test results of >5 days. Patients were more likely to receive tyrosine kinase inhibitor (TKI) treatment than chemotherapy if they had a positive result for epidermal growth factor receptor (EGFR)/anaplastic lymphoma kinase gene aberration testing. EGFR positive patients were more likely to receive TKI treatment than chemotherapy if they did not have insurance for TKI or pemetrexed treatment, and more likely to receive chemotherapy than TKI treatment if they had a waiting time for test results of >5 days. EGFR wild-type/unknown patients receiving chemotherapy were more likely to receive pemetrexed if they attended a hospital in a developed area or had insurance for pemetrexed. CONCLUSION In this real-world setting in China, the choice of first-line treatment for advanced NSCLC was appropriately guided by gene aberration testing for most patients. However, gene aberration testing and the treatment decision were influenced by practical factors such as hospital location, the waiting time for test results, and insurance coverage, which should be addressed to ensure optimal patient care.
Collapse
Affiliation(s)
- Yong Song
- Department of Respiratory Medicine, Jingling Hospital, Nanjing University School of Medicine, No. 305 East Zhongshan Road, Xuanwu District, Nanjing, Jiangsu 210002, People's Republic of China.
| | - Qing Zhou
- Guangdong Lung Cancer Institute, Guangdong General Hospital & Guangdong Academy of Medical Sciences, No. 106 Zhongshan 2nd Road, Guangzhou, Guangdong 510080, People's Republic of China.
| | - Xin Zhang
- Department of Respiration and Lung Cancer Comprehensive Treatment Center, Zhongshan Hospital, No. 180 Fenglin Road, Xuhui District, Shanghai 200032, People's Republic of China.
| | - Gong-Yan Chen
- Department of Internal Medicine, The Tumor Hospital affiliated to Harbin Medical University, No. 51 Haping Road, Nangang District, Harbin, Heilongjiang 150081, People's Republic of China.
| | - Dian-Sheng Zhong
- Department of Medical Oncology, General Hospital of Tianjin Medical University, No. 24 Anshan Road, Heping District, Tianjin 300052, People's Republic of China.
| | - Zhuang Yu
- Department of Oncology, The Affiliated Hospital of Qingdao University, No. 16 Jiangsu Road, Qingdao, Shandong 266003, People's Republic of China.
| | - Ping Yu
- Department of Medical Oncology, Sichuan Cancer Hospital, No. 55, Section 4, South Renmin Road, Chengdu, Sichuan 610041, People's Republic of China.
| | - Yi-Ping Zhang
- Department of Medical Oncology, Zhejiang Cancer Hospital, No. 1 East Banshan Road, Gongshu District, Hangzhou, Zhejiang 310022, People's Republic of China.
| | - Jian-Hua Chen
- Thoracic Medicine Department, Hunan Cancer Hospital, No. 283 Tongzipo Road, Yuelu District, Changsha, Hunan 410006, People's Republic of China.
| | - Yi Hu
- Department of Medical Oncology, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100039, People's Republic of China.
| | - Guo-Sheng Feng
- Clinical Cancer Center, People's Hospital of Guangxi Zhuang Autonomous Region, No. 6 Taoyuan Road, Nanning, Guangxi 168600, People's Republic of China.
| | - Xia Song
- Department of Respiration Medicine, Shanxi Cancer Hospital, No. 3 Zhigongxin Street, Taiyuan, Shanxi 030013, People's Republic of China.
| | - Qiang Shi
- Lilly Suzhou Pharmaceutical Co., Ltd., Tower 1 HKRI, Taikoo Hui, No. 288 Shi Men Yi Road, Shanghai 200041, People's Republic of China.
| | - Lu Lu Yang
- Lilly Suzhou Pharmaceutical Co., Ltd., Tower 1 HKRI, Taikoo Hui, No. 288 Shi Men Yi Road, Shanghai 200041, People's Republic of China.
| | - Luan Di Yao
- Lilly Suzhou Pharmaceutical Co., Ltd., Tower 1 HKRI, Taikoo Hui, No. 288 Shi Men Yi Road, Shanghai 200041, People's Republic of China.
| | - Lu Jing Zhan
- Lilly Suzhou Pharmaceutical Co., Ltd., Tower 1 HKRI, Taikoo Hui, No. 288 Shi Men Yi Road, Shanghai 200041, People's Republic of China.
| | - Fan Yang
- Shanghai Centennial Scientific Co., Ltd., Room 702A, B Block, Fenglin International Center, No. 388 Fenglin Road, Shanghai 200030, People's Republic of China.
| | - Yi-Long Wu
- Guangdong Lung Cancer Institute, Guangdong General Hospital & Guangdong Academy of Medical Sciences, No. 106 Zhongshan 2nd Road, Guangzhou, Guangdong 510080, People's Republic of China.
| |
Collapse
|
27
|
Hu Y, Hu H, Miao L, Zhao X, Gu W, Heng W, Meng Z, Feng J, You Y, Xu X, Hu R, Li H, Zhao J, Zhu X, Shi M, Shen L, Zhang X, Yin X, Ma H, Shi M, Yu Y, Lv H, Cai L, Feng G, Zhang Y, Wu F, Lv T, Song Y. Multicenter study of diagnostic procedures, genetic aberration analysis, and first-line treatment of lung cancer in Jiangsu Province, China. Thorac Cancer 2018; 9:376-383. [PMID: 29341459 PMCID: PMC5832471 DOI: 10.1111/1759-7714.12588] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 12/06/2017] [Accepted: 12/06/2017] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Jiangsu Province, China, is highly developed economically and culturally, and has a high prevalence of lung cancer. We aimed to evaluate the diagnostic procedures, genetic aberration analysis status, and first-line treatment models of lung cancer in Jiangsu Province. METHODS Lung cancer patients diagnosed in 2016 at 22 tertiary care hospitals were evaluated. Demographic characteristics, tumor histology, staging, family history of lung cancer, auxiliary examinations, genetic testing, and first-line treatment were collected on discharge. Diagnostic and treatment data were analyzed by descriptive statistics. RESULTS A total of 928 patients were enrolled. Chest computed tomography was the most frequently used diagnostic method; pathology diagnosis was carried out by transbronchial lung biopsy and transthoracic needle aspiration. Stage T1-2N0M0 small-cell lung cancer patients experienced surgical resection, and others received cisplatin and etoposide chemotherapy. Stage I and stage II non-small cell lung cancer patients experienced surgical resection; stage III and stage IV patients received cisplatin and pemetrexed chemotherapy as first-line treatment. Detection of epidermal growth factor receptor (EGFR) mutations occurred in 29.9% of non-selective, 36.5% of locally advanced or metastatic, and 42.1% of advanced non-squamous non-small cell lung cancer. The overall EGFR-positive rates were 49.0%, 52.5%, and 53.9%. A total 72.0% of patients with EGFR mutations were treated with tyrosine kinase inhibitors. CONCLUSION Chest computed tomography was the most commonly performed diagnostic method for lung cancer. First-line treatment was primarily determined by disease stages and EGFR mutation status, with few expectations.
Collapse
Affiliation(s)
- YangBo Hu
- Department of Respiratory Medicine, Jinling Hospital, Medical School of Southeast University, Nanjing, China
| | - Huan Hu
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - LiYun Miao
- Department of Respiratory Medicine, Nanjing University Affiliated Drum Tower Hospital, Nanjing, China
| | - Xin Zhao
- Department of Respiratory Medicine, Nanjing Medical University Affiliated First Hospital, Nanjing, China
| | - Wei Gu
- Department of Respiratory Medicine, First People's Hospital of Nanjing City, Nanjing, China
| | - Wei Heng
- Department of Respiratory Medicine, Soochow University Affiliated First Hospital, Suzhou, China
| | - ZiLi Meng
- Department of Respiratory Medicine, First People's Hospital of Huai'an City, Nanjing Medical University, Huai'an, China
| | - Jian Feng
- Department of Respiratory Medicine, Nantong University Affiliated Hospital, Nantong, China
| | - Yi You
- Department of Respiratory Medicine, Subei People's Hospital, Yangzhou, China
| | - XingXiang Xu
- Department of Respiratory Medicine, Subei People's Hospital, Yangzhou, China
| | - Rong Hu
- Department of Respiratory Medicine, First People's Hospital of Lianyungang City, Lianyungang, China
| | - HaiQuan Li
- Department of Respiratory Medicine, General Hospital of Xuzhou Mining Group, Xuzhou, China
| | - Jie Zhao
- Department of Respiratory Medicine, General Hospital of Xuzhou Mining Group, Xuzhou, China
| | - XiaoLi Zhu
- Department of Respiratory Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - MeiQi Shi
- Department of Respiratory Medicine, Jiangsu Cancer Hospital, Nanjing Medical University, Nanjing, China
| | - Li Shen
- Department of Respiratory Medicine, Nanjing Medical University Affiliated Second Hospital, Nanjing, China
| | - XiuWei Zhang
- Department of Respiratory Medicine, Nanjing Medical University Affiliated Jiangning Hospital, Nanjing, China
| | - XiaoWei Yin
- Department of Respiratory Medicine, Second People's Hospital of Changzhou City, Changzhou, China
| | - Hang Ma
- Department of Respiratory Medicine, First People's Hospital of Nantong City, Nantong, China
| | - MinHua Shi
- Department of Respiratory Medicine, Soochow University Affiliated Second Hospital, Suzhou, China
| | - Yong Yu
- Department of Respiratory Medicine, Soochow University Affiliated Second Hospital, Suzhou, China
| | - Hong Lv
- Department of Respiratory Medicine, Taicang Hospital of Traditional Chinese Medicine, Suzhou, China
| | - LiMing Cai
- Department of Respiratory Medicine, Fourth People's Hospital of Wuxi City, Wuxi, China
| | - GaoHua Feng
- Department of Respiratory Medicine, Zhangjiagang Hospital of Traditional Chinese Medicine, Suzhou, China
| | - YeQing Zhang
- Department of Respiratory Medicine, Nanjing Hospital of integrated Chinese and Western Medicine, Nanjing, China
| | - Feng Wu
- Department of Respiratory Medicine, First People's Hospital of Yangzhou City, Yangzhou, China
| | - TangFeng Lv
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Yong Song
- Department of Respiratory Medicine, Jinling Hospital, Medical School of Southeast University, Nanjing, China.,Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| |
Collapse
|