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Yu T, Hu X, Liufu W, Niu S, Lian H, Ma H, Wang J, Bao Y, Chen M, Peng F. Six versus four or five cycles of first-line etoposide and platinum-based chemotherapy combined with thoracic radiotherapy in patients with limited-stage small-cell lung cancer: A propensity score-matched analysis of a prospective randomized trial. Cancer Med 2024; 13:e7215. [PMID: 38659392 PMCID: PMC11043670 DOI: 10.1002/cam4.7215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 04/07/2024] [Accepted: 04/11/2024] [Indexed: 04/26/2024] Open
Abstract
OBJECTIVES The recommended treatment for limited-stage small-cell lung cancer (LS-SCLC) is a combination of thoracic radiotherapy (TRT) and etoposide plus cisplatin (EP) chemotherapy, typically administered over 4-6 cycles. Nonetheless, the optimal duration of chemotherapy is still not determined. This study aimed to compare the outcomes of patients with LS-SCLC who received either 6 cycles or 4-5 cycles of EP chemotherapy combined with TRT. MATERIALS AND METHODS In this retrospective analysis, we utilized data from our prior prospective trial to analyze the outcomes of 265 LS-SCLC patients who received 4-6 courses of EP combined with concurrent accelerated hyperfractionated TRT between 2002 and 2017. Patients were categorized into two groups depending on their number of chemotherapy cycles: 6 or 4-5 cycles. To assess overall survival (OS) and progression-free survival (PFS), we employed the Kaplan-Meier method after conducting propensity score matching (PSM). RESULTS Among the 265 LS-SCLC patients, 60 (22.6%) received 6 cycles of EP chemotherapy, while 205 (77.4%) underwent 4-5 cycles. Following PSM (53 patients for each group), the patients in the 6 cycles group exhibited a significant improvement in OS and PFS in comparison to those in the 4-5 cycles group [median OS: 29.8 months (95% confidence interval [CI], 23.6-53.1 months) vs. 22.7 months (95% CI, 20.8-29.1 months), respectively, p = 0.019; median PFS: 17.9 months (95% CI, 13.7-30.5 months) vs. 12.0 months (95% CI, 9.8-14.2 months), respectively, p = 0.006]. The two-year and five-year OS rates were 60.38% and 29.87% in the 6 cycles group, whereas 47.17% and 15.72% in the 4-5 cycles group, respectively. CONCLUSION Patients diagnosed with LS-SCLC who were treated with EP regimen chemotherapy combined with TRT exhibited notably enhanced survival when administered 6 cycles of chemotherapy, as compared to those who underwent only 4-5 cycles.
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Affiliation(s)
- Tian‐tian Yu
- Department of Radiation OncologyThe First Affiliated Hospital of Sun Yat‐Sen UniversityGuangzhouChina
| | - Xiao Hu
- Zhejiang Cancer HospitalHangzhou Institute of Medicine (HIM), Chinese Academy of SciencesHangzhouChina
| | - Wei‐jian Liufu
- Department of Radiation OncologyThe First Affiliated Hospital of Sun Yat‐Sen UniversityGuangzhouChina
| | - Shao‐qing Niu
- Department of Radiation OncologyThe First Affiliated Hospital of Sun Yat‐Sen UniversityGuangzhouChina
| | - Hui‐min Lian
- Department of Radiation OncologyThe First Affiliated Hospital of Sun Yat‐Sen UniversityGuangzhouChina
| | - Hong‐lian Ma
- Zhejiang Cancer HospitalHangzhou Institute of Medicine (HIM), Chinese Academy of SciencesHangzhouChina
| | - Jin Wang
- Zhejiang Cancer HospitalHangzhou Institute of Medicine (HIM), Chinese Academy of SciencesHangzhouChina
| | - Yong Bao
- Department of Radiation OncologyThe First Affiliated Hospital of Sun Yat‐Sen UniversityGuangzhouChina
| | - Ming Chen
- State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangdong Provincial Clinical Research Center for CancerSun Yat‐Sen University Cancer CenterGuangzhouChina
- United Laboratory of Frontier Radiotherapy Technology of Sun Yat‐Sen University & Chinese Academy of Sciences Ion Medical Technology Co., LtdGuangzhouChina
| | - Fang Peng
- Department of Radiation OncologyThe First Affiliated Hospital of Sun Yat‐Sen UniversityGuangzhouChina
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Lee JY, Bhandare RR, Boddu SHS, Shaik AB, Saktivel LP, Gupta G, Negi P, Barakat M, Singh SK, Dua K, Chellappan DK. Molecular mechanisms underlying the regulation of tumour suppressor genes in lung cancer. Biomed Pharmacother 2024; 173:116275. [PMID: 38394846 DOI: 10.1016/j.biopha.2024.116275] [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: 11/24/2023] [Revised: 01/30/2024] [Accepted: 02/13/2024] [Indexed: 02/25/2024] Open
Abstract
Tumour suppressor genes play a cardinal role in the development of a large array of human cancers, including lung cancer, which is one of the most frequently diagnosed cancers worldwide. Therefore, extensive studies have been committed to deciphering the underlying mechanisms of alterations of tumour suppressor genes in governing tumourigenesis, as well as resistance to cancer therapies. In spite of the encouraging clinical outcomes demonstrated by lung cancer patients on initial treatment, the subsequent unresponsiveness to first-line treatments manifested by virtually all the patients is inherently a contentious issue. In light of the aforementioned concerns, this review compiles the current knowledge on the molecular mechanisms of some of the tumour suppressor genes implicated in lung cancer that are either frequently mutated and/or are located on the chromosomal arms having high LOH rates (1p, 3p, 9p, 10q, 13q, and 17p). Our study identifies specific genomic loci prone to LOH, revealing a recurrent pattern in lung cancer cases. These loci, including 3p14.2 (FHIT), 9p21.3 (p16INK4a), 10q23 (PTEN), 17p13 (TP53), exhibit a higher susceptibility to LOH due to environmental factors such as exposure to DNA-damaging agents (carcinogens in cigarette smoke) and genetic factors such as chromosomal instability, genetic mutations, DNA replication errors, and genetic predisposition. Furthermore, this review summarizes the current treatment landscape and advancements for lung cancers, including the challenges and endeavours to overcome it. This review envisages inspired researchers to embark on a journey of discovery to add to the list of what was known in hopes of prompting the development of effective therapeutic strategies for lung cancer.
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Affiliation(s)
- Jia Yee Lee
- School of Health Sciences, International Medical University, Bukit Jalil, Kuala Lumpur 57000, Malaysia
| | - Richie R Bhandare
- Department of Pharmaceutical Sciences, College of Pharmacy & Health Sciences, Ajman University, Al-Jurf, P.O. Box 346, Ajman, United Arab Emirates; Center of Medical and Bio-Allied Health Sciences Research, Ajman University, Al-Jurf, P.O. Box 346, Ajman, United Arab Emirates.
| | - Sai H S Boddu
- Department of Pharmaceutical Sciences, College of Pharmacy & Health Sciences, Ajman University, Al-Jurf, P.O. Box 346, Ajman, United Arab Emirates; Center of Medical and Bio-Allied Health Sciences Research, Ajman University, Al-Jurf, P.O. Box 346, Ajman, United Arab Emirates
| | - Afzal B Shaik
- St. Mary's College of Pharmacy, St. Mary's Group of Institutions Guntur, Affiliated to Jawaharlal Nehru Technological University Kakinada, Chebrolu, Guntur, Andhra Pradesh 522212, India; Center for Global Health Research, Saveetha Medical College, Saveetha Institute of Medical and Technical Sciences, India
| | - Lakshmana Prabu Saktivel
- Department of Pharmaceutical Technology, University College of Engineering (BIT Campus), Anna University, Tiruchirappalli 620024, India
| | - Gaurav Gupta
- Center of Medical and Bio-Allied Health Sciences Research, Ajman University, Al-Jurf, P.O. Box 346, Ajman, United Arab Emirates; School of Pharmacy, Suresh Gyan Vihar University, Jaipur, Rajasthan 302017, India
| | - Poonam Negi
- School of Pharmaceutical Sciences, Shoolini University, PO Box 9, Solan, Himachal Pradesh 173229, India
| | - Muna Barakat
- Department of Clinical Pharmacy & Therapeutics, Applied Science Private University, Amman-11937, Jordan
| | - Sachin Kumar Singh
- School of Pharmaceutical Sciences, Lovely Professional University, Jalandhar-Delhi G.T Road, Phagwara 144411, India; Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, Sydney 2007, Australia
| | - Kamal Dua
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, Sydney 2007, Australia; Discipline of Pharmacy, Graduate School of Health, University of Technology Sydney, Sydney 2007, Australia
| | - Dinesh Kumar Chellappan
- Department of Life Sciences, School of Pharmacy, International Medical University, Bukit Jalil, Kuala Lumpur 57000, Malaysia.
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Khurshid H, Ismaila N, Bian J, Dabney R, Das M, Ellis P, Feldman J, Hann C, Kulkarni S, Laskin J, Manochakian R, Mishra DR, Preeshagul I, Reddy P, Saxena A, Weinberg F, Kalemkerian GP. Systemic Therapy for Small-Cell Lung Cancer: ASCO-Ontario Health (Cancer Care Ontario) Guideline. J Clin Oncol 2023; 41:5448-5472. [PMID: 37820295 DOI: 10.1200/jco.23.01435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 07/17/2023] [Accepted: 07/20/2023] [Indexed: 10/13/2023] Open
Abstract
PURPOSE To provide evidence-based recommendations to practicing clinicians on the management of patients with small-cell lung cancer. METHODS An Expert Panel of medical oncology, thoracic surgery, radiation oncology, pulmonary, community oncology, research methodology, and advocacy experts were convened to conduct a literature search, which included systematic reviews, meta-analyses, and randomized controlled trials published from 1990 through 2022. Outcomes of interest included response rates, overall survival, disease-free survival or recurrence-free survival, and quality of life. Expert Panel members used available evidence and informal consensus to develop evidence-based guideline recommendations. RESULTS The literature search identified 95 relevant studies to inform the evidence base for this guideline. RECOMMENDATIONS Evidence-based recommendations were developed to address systemic therapy options, timing of therapy, treatment in patients who are older or with poor performance status, role of biomarkers, and use of myeloid-supporting agents in patients with small-cell lung cancer.Additional information is available at www.asco.org/thoracic-cancer-guidelines.
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Affiliation(s)
| | - Nofisat Ismaila
- American Society of Clinical Oncology (ASCO), Alexandria, VA
| | | | | | | | - Peter Ellis
- Juravinski Cancer Center, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Jill Feldman
- EGFR Resisters Patient Advocacy Group, Deerfield, IL
| | | | - Swati Kulkarni
- Western University, Windsor Regional Cancer Program, Windsor, Ontario, Canada
| | - Janessa Laskin
- University of British Columbia, Vancouver, British Columbia, Canada
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Lu S, Chen Z, Cui J, Guo R, Li Z, Li BX, Dai X. Efficacy and Safety of Anti–Programmed Death-Ligand 1 Monoclonal Antibody Socazolimab With Carboplatin and Etoposide for Extensive-Stage SCLC: Results From the Phase 1b Clinical Trial. JTO Clin Res Rep 2023; 4:100478. [PMID: 37020926 PMCID: PMC10067846 DOI: 10.1016/j.jtocrr.2023.100478] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 01/30/2023] [Accepted: 02/14/2023] [Indexed: 04/03/2023] Open
Abstract
Introduction The study (ClinicalTrials.gov, NCT04346914) is an open label, single-arm, phase 1b clinical trial investigating the safety, tolerability, and efficacy of the recombinant human anti-programmed death-ligand 1 monoclonal antibody socazolimab in combination with carboplatin and etoposide in the first-line treatment of extensive-stage SCLC. Good safety and efficacy were found in previous phase 1 clinical trials of other cancers, such as cervix cancer. Methods Patients received socazolimab (5 mg/kg) every three weeks until disease progression or physician decision. Carboplatin (area under the curve: 5) was also administered every three weeks and etoposide (100 mg/m2) on days 1, 2, and 3 of the treatment cycle. The primary purpose of the study was safety measured by the Common Terminology Criteria for Adverse Events. Secondary purposes included objective response rate, progression-free survival, duration of response, and overall survival. Results From April 15, 2020 (enrollment date), to December 30, 2021 (data cutoff), 20 patients with extensive-stage SCLC were administered with socazolimab, carboplatin, and etoposide. Objective response rate was 70.0% (95% confidence interval [CI]: 45.72%-88.11%). Median progression-free survival was 5.65 months (95% CI: 4.14-6.54), and the median duration of response was 4.29 months (95% CI: 2.76-5.85). Median overall survival was 14.88 months (95% CI: 10.09-not evaluated). The highest incidence of treatment-related adverse events included anemia (100%), decreased neutrophil count (95%), decreased platelet count (95%), and decreased white blood cell count (95%), which occurred during combination therapy. The most common grade 3 or 4 treatment-related adverse events were neutropenia (90%), decreased white blood cell count (65%), decreased platelet count (50%), and anemia (30%), which were also common adverse reactions of chemotherapy. No adverse events leading to death had occurred. Conclusions Results revealed that the combination therapy of socazolimab, carboplatin, and etoposide had preliminarily confirmed the safety of socazolimab in the first-line treatment of SCLC combined with EC chemotherapy. Currently, a phase 3, randomized, placebo-controlled trial (ClinicalTrials.gov, NCT04878016) is being conducted with 498 patients.
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Affiliation(s)
- Shun Lu
- Department of Oncology, Shanghai Chest Hospital, Shanghai, People’s Republic of China
- Corresponding author. Address for correspondence: Shun Lu, PhD, MD, Department of Oncology, Shanghai Chest Hospital, 241 West Huaihai Road, Shanghai 200030, People’s Republic of China.
| | - Zhiwei Chen
- Department of Oncology, Shanghai Chest Hospital, Shanghai, People’s Republic of China
| | - Jiuwei Cui
- Department of Oncology, First Hospital of Jilin University, Changchun, People’s Republic of China
| | - Renhua Guo
- Department of Oncology, Jiangsu Provincial People’s Hospital, Nanjing, People’s Republic of China
| | - Ziming Li
- Department of Oncology, Shanghai Chest Hospital, Shanghai, People’s Republic of China
| | - Benjamin Xiaoyi Li
- Lee’s Pharmaceutical Holdings Limited, Shatin, Hong Kong, People’s Republic of China
| | - Xiangrong Dai
- Lee’s Pharmaceutical Holdings Limited, Shatin, Hong Kong, People’s Republic of China
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5
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Activation of the TGF- β Pathway Enhances the Efficacy of Platinum-Based Chemotherapy in Small Cell Lung Cancer Patients. DISEASE MARKERS 2022; 2022:8766448. [PMID: 36590751 PMCID: PMC9798106 DOI: 10.1155/2022/8766448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 11/20/2022] [Accepted: 11/23/2022] [Indexed: 12/24/2022]
Abstract
Background Platinum-based chemotherapy is the first choice of treatment for patients diagnosed with small lung cell cancer (SCLC). However, many patients exhibit resistance to it. Therefore, it is imperative to further investigate a prognostic biomarker indicating sensitivity to this therapy. Methods We collected and performed RNA sequencing on 45 SCLC samples from the Zhujiang Hospital (Local-SCLC). In addition, we used a public cohort from George et al. as a validation cohort (George-SCLC). The transforming growth factor β signaling pathway (TGFB) activation status was determined according to the related ssGSEA score. We analyzed immune cell ratios, pathway activation scores, and immune-related genes in SCLC patients to further elucidate the potential mechanisms. Results A high activation status of the TGFB pathway was associated with improved prognosis in SCLC patients receiving platinum-based chemotherapy (Local-SCLC: HR = 0.0238, (95% CI, 0.13-0.84), p = 0.0238; George-SCLC: HR = 0.0315, (95% CI, 0.28-0.98), p = 0.0315). Immune infiltration analysis showed that the TGFB-HIGH group had more M1 macrophages and Th1 cells, whilst fewer M2 macrophages, Th2 cells, and Treg cells were found in the Local-SCLC cohort. Mechanistic analysis showed that the TGBF-HIGH group was upregulated in STING-mediated immunity, apoptosis, and cell cycle arrest, as well as being downregulated in the process of DNA damage repair. Conclusions SCLC patients exhibiting a high activation status of the TGFB pathway demonstrate an improved prognosis with platinum-based chemotherapy. The potential underlying mechanism may be related to antitumor immune enhancement and DNA damage repair inhibition.
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6
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Melichar B. Biomarkers in the management of lung cancer: changing the practice of thoracic oncology. Clin Chem Lab Med 2022; 61:906-920. [PMID: 36384005 DOI: 10.1515/cclm-2022-1108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 11/02/2022] [Indexed: 11/17/2022]
Abstract
Abstract
Lung cancer currently represents a leading cause of cancer death. Substantial progress achieved in the medical therapy of lung cancer during the last decade has been associated with the advent of targeted therapy, including immunotherapy. The targeted therapy has gradually shifted from drugs suppressing general mechanisms of tumor growth and progression to agents aiming at transforming mechanisms like driver mutations in a particular tumor. Knowledge of the molecular characteristics of a tumor has become an essential component of the more targeted therapeutic approach. There are specific challenges for biomarker determination in lung cancer, in particular a commonly limited size of tumor sample. Liquid biopsy is therefore of particular importance in the management of lung cancer. Laboratory medicine is an indispensable part of multidisciplinary management of lung cancer. Clinical
Chemistry and Laboratory Medicine (CCLM) has played and will continue playing a major role in updating and spreading the knowledge in the field.
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Affiliation(s)
- Bohuslav Melichar
- Department of Oncology , Palacký University Medical School and Teaching Hospital , Olomouc , Czech Republic
- Department of Oncology and Radiotherapy and Fourth Department of Medicine , Charles University Medical School and Teaching Hospital , Hradec Králové , Czech Republic
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7
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Zeng H, Zheng D, Witlox WJA, Levy A, Traverso A, Kong FMS, Houben R, De Ruysscher DKM, Hendriks LEL. Risk Factors for Brain Metastases in Patients With Small Cell Lung Cancer: A Systematic Review and Meta-Analysis. Front Oncol 2022; 12:889161. [PMID: 35756675 PMCID: PMC9226404 DOI: 10.3389/fonc.2022.889161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 04/25/2022] [Indexed: 11/16/2022] Open
Abstract
The use of prophylactic cranial irradiation (PCI) for small cell lung cancer (SCLC) patients is controversial. Risk factors for brain metastasis (BM) development are largely lacking, hampering personalized treatment strategies. This study aimed to identify the possible risk factors for BM in SCLC.We systematically searched the Pubmed database (1 January 1995 to 18 January 2021) according to the PRISMA guidelines. Eligibility criteria: studies reporting detailed BM data with an adequate sample size (randomized clinical trials [RCTs]: N ≥50; non-RCTs: N ≥100) in patients with SCLC. We summarized the reported risk factors and performed meta-analysis to estimate the pooled hazard ratios (HR) if enough qualified data (i.e., two or more studies; the same study type; the same analysis method; and HRs retrievable) were available. In total, 61/536 records were eligible (18 RCTs and 39 non-RCTs comprising 13,188 patients), in which 57 factors were reported. Ten factors qualified BM data for meta-analysis: Limited stage disease (LD) (HR = 0.34, 95% CI: 0.17–0.67; P = 0.002) and older age (≥65) (HR = 0.70, 95% CI: 0.54–0.92; P = 0.01) were associated with less BM; A higher T stage (≥T3) (HR = 1.72, 95% CI: 1.16–2.56; P = 0.007) was a significant risk factor for BM. Male sex (HR = 1.24, 95% CI: 0.99–1.54; P = 0.06) tended to be a risk factor, and better PS (0–1) (HR = 0.66, 95% CI: 0.42–1.02; P = 0.06) tended to have less BM. Smoking, thoracic radiotherapy dose were not significant (P >0.05). PCI significantly decreased BM (P <0.001), but did not improve OS in ED-SCLC (P = 0.81). A higher PCI dose did not improve OS (P = 0.11). The impact on BM was conflicting between Cox regression data (HR = 0.59, 95% CI: 0.26–1.31; P = 0.20) and competing risk regression data (HR = 0.74, 95% CI: 0.55–0.99; P = 0.04). Compared to M0–M1a, M1b was a risk factor for OS (P = 0.01) in ED-SCLC, but not for BM (P = 0.19). As regular brain imaging is rarely performed, high-quality data is lacking. Other factors such as N-stage and blood biomarkers had no qualified data to perform meta-analysis. In conclusion, younger age, higher T stage, and ED are risk factors for BM, suggesting that PCI should be especially discussed in such cases. Individual patient data (IPD) meta-analysis and well-designed RCTs are needed to better identify more risk factors and further confirm our findings. Systematic Review Registration:https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021228391, identifier CRD42021228391.
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Affiliation(s)
- Haiyan Zeng
- Department of Radiation Oncology (Maastro), GROW School for Oncology, Maastricht University Medical Center+, Maastricht, Netherlands
| | - Danyang Zheng
- Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China.,Department of Clinical Oncology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Willem J A Witlox
- Department of Clinical Epidemiology and Medical Technology Assessment, GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, Netherlands
| | - Antonin Levy
- Department of Radiation Oncology, Gustave Roussy, Villejuif, France.,Université Paris-Saclay, Faculté de Médecine, Le Kremlin-Bicêtre, France
| | - Alberto Traverso
- Department of Radiation Oncology (Maastro), GROW School for Oncology, Maastricht University Medical Center+, Maastricht, Netherlands
| | - Feng-Ming Spring Kong
- Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China.,Department of Clinical Oncology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Ruud Houben
- Department of Radiation Oncology (Maastro), GROW School for Oncology, Maastricht University Medical Center+, Maastricht, Netherlands
| | - Dirk K M De Ruysscher
- Department of Radiation Oncology (Maastro), GROW School for Oncology, Maastricht University Medical Center+, Maastricht, Netherlands
| | - Lizza E L Hendriks
- Department of Pulmonary Diseases, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, Netherlands
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Yuan J, Cheng F, Xiao G, Wang X, Fan H. Efficacy and Safety of Anlotinib in the Treatment of Small Cell Lung Cancer: A Real-World Observation Study. Front Oncol 2022; 12:917089. [PMID: 35795060 PMCID: PMC9251318 DOI: 10.3389/fonc.2022.917089] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 05/25/2022] [Indexed: 12/24/2022] Open
Abstract
Aims This study aimed to observe the efficacy and safety of anlotinib in the treatment of small cell lung cancer (SCLC) in the real world, as first-line maintenance therapy, second-line, and above. Methods Clinical data of 109 patients with SCLC treated with anlotinib and hospitalized at The First Affiliated Hospital of Zhengzhou University from June 2018 to June 2020 were retrospectively analyzed. Analysis of short-term efficacy and survival was performed, with p<0.05 being considered statistically significant. Results The median progression-free survival (mPFS) of anlotinib monotherapy used as first-line maintenance treatment of SCLC was 6.3 months (11.7 months in the limited phase and 5.8 months in the extensive phase) and median overall survival (mOS) was 16.7 months (not reached in limited phase, 12.6 months in extensive phase). In second-line treatment, anlotinib with chemotherapy prolonged PFS and OS as compared to anlotinib monotherapy (p<0.05). In third-line and above treatment, there was no improvement in mPFS with the chemotherapy combination regimen compared to anlotinib monotherapy (3.6 months vs. 3.8 months, p=0.398), with a trend toward impaired mOS (8.5 months vs. not achieved, p=0.060). Univariate analyses and multivariate analyses revealed that Eastern Cooperative Oncology Group performance status and liver metastases were independent prognostic factors affecting PFS and OS. No new anlotinib-related adverse reactions were identified. Conclusion Anlotinib was effective for first-line maintenance and second-line treatment, and the chemotherapy combination regimen was superior to monotherapy when applied as second-line treatment. However, this trend was not observed in third-line and above therapy.
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Randomized Phase 3 Study of the Anti-disialoganglioside Antibody Dinutuximab and Irinotecan vs Irinotecan or Topotecan for Second-Line Treatment of Small Cell Lung Cancer. Lung Cancer 2022; 166:135-142. [DOI: 10.1016/j.lungcan.2022.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 02/24/2022] [Accepted: 03/02/2022] [Indexed: 01/22/2023]
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10
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Ganti AKP, Loo BW, Bassetti M, Blakely C, Chiang A, D'Amico TA, D'Avella C, Dowlati A, Downey RJ, Edelman M, Florsheim C, Gold KA, Goldman JW, Grecula JC, Hann C, Iams W, Iyengar P, Kelly K, Khalil M, Koczywas M, Merritt RE, Mohindra N, Molina J, Moran C, Pokharel S, Puri S, Qin A, Rusthoven C, Sands J, Santana-Davila R, Shafique M, Waqar SN, Gregory KM, Hughes M. Small Cell Lung Cancer, Version 2.2022, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2021; 19:1441-1464. [PMID: 34902832 DOI: 10.6004/jnccn.2021.0058] [Citation(s) in RCA: 139] [Impact Index Per Article: 46.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Small Cell Lung Cancer (SCLC) provide recommended management for patients with SCLC, including diagnosis, primary treatment, surveillance for relapse, and subsequent treatment. This selection for the journal focuses on metastatic (known as extensive-stage) SCLC, which is more common than limited-stage SCLC. Systemic therapy alone can palliate symptoms and prolong survival in most patients with extensive-stage disease. Smoking cessation counseling and intervention should be strongly promoted in patients with SCLC and other high-grade neuroendocrine carcinomas. The "Summary of the Guidelines Updates" section in the SCLC algorithm outlines the most recent revisions for the 2022 update, which are described in greater detail in this revised Discussion text.
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Affiliation(s)
| | | | | | | | | | | | | | - Afshin Dowlati
- Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | | | | | | | | | | | - John C Grecula
- The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | - Christine Hann
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
| | | | | | | | | | | | - Robert E Merritt
- The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | - Nisha Mohindra
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | | | - Cesar Moran
- The University of Texas MD Anderson Cancer Center
| | | | - Sonam Puri
- Huntsman Cancer Institute at the University of Utah
| | - Angel Qin
- University of Michigan Rogel Cancer Center
| | | | - Jacob Sands
- Dana Farber/Brigham and Women's Cancer Center
| | | | | | - Saiama N Waqar
- Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
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Lyu Q, Zhu W, Wei T, Ding W, Cao M, Wang Q, Guo L, Luo P, Zhang J. High mutations in fatty acid metabolism contribute to a better prognosis of small-cell lung cancer patients treated with chemotherapy. Cancer Med 2021; 10:7863-7876. [PMID: 34564955 PMCID: PMC8559513 DOI: 10.1002/cam4.4290] [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: 02/19/2021] [Revised: 07/30/2021] [Accepted: 08/28/2021] [Indexed: 12/15/2022] Open
Abstract
Background The majority of patients with small‐cell lung cancer (SCLC) show a good response in the early stages of treatment, but more than 90% of patients will develop drug resistance. Therefore, biomarkers are urgently needed to identify patients who can benefit from systemic treatment. Methods We prospectively enrolled 52 extensive‐stage SCLC patients before treatment from a local hospital to identify mutations related to patient prognosis, and verified them in the published Jiang's cohort and George's cohort. Results We found that patients with high mutations (mut‐high) in the fatty acid (FA) metabolism pathway had a longer progression‐free survival (PFS) in the local hospital cohort (HR = 0.446, 95% CI, 0.207–0.959, p = 0.0387) and a longer overall survival (OS) in Jiang's cohort (HR = 0.549, 95% CI, 0.314–0.960, p = 0.0351) than patients with low mutations (mut‐low). Multivariate analysis suggested that mut‐high status was an independent prognostic factor in both cohorts. George's cohort verified that mut‐high status was associated with a longer OS than mut‐low status (HR = 0.730, 95% CI 0.440–1.220, p = 0.2277). The possible mechanisms were as follows: the frequency of mutated FA synthase (FASN) in the mut‐high group was greater than that in the mut‐low group, and pathways related to the cell cycle, DNA repair, and oxidative phosphorylation were enriched in the mut‐high group. Conclusions The prognosis of SCLC patients treated with chemotherapy was better among patients with more mutations in the FA metabolism pathway, and the underlying mechanisms could be found at the genome and transcriptome levels.
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Affiliation(s)
- Qiong Lyu
- Department of Oncology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Weiliang Zhu
- Department of Oncology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Ting Wei
- Department of Oncology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Weimin Ding
- Department of Oncology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Manming Cao
- Department of Oncology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Qiongyao Wang
- Department of Oncology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Linlang Guo
- Department of Pathology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Peng Luo
- Department of Oncology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Jian Zhang
- Department of Oncology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
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Samare-Najaf M, Samareh A, Jamali N, Abbasi A, Clark CC, Khorchani MJ, Zal F. Adverse Effects and Safety of Etirinotecan Pegol, a Novel Topoisomerase Inhibitor, in Cancer Treatment: A Systematic Review. CURRENT CANCER THERAPY REVIEWS 2021. [DOI: 10.2174/1573394717666210202103502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background:
Due to the increasing prevalence of cancer and the inadequacy of current
therapies, the development of novel antitumor pharmaceutics with higher efficacies and lower adverse
effects is considered a fundamental tenet of contemporary cancer management.
Poly-Ethylene-Glycol (PEG) attachment is a novel pharmaceutical technology to improve the efficacy
and safety of chemotherapies. Etirinotecan Pegol (EP), also known as NKTR-102, is the PEGylated
form of Irinotecan (CPT-11), which causes cancer cell apoptosis by inhibiting the
topoisomerase I enzyme.
Objectives:
The present study reviews and evaluates various reports of the EP’s anti-tumor activity
in various cancers.
Data Sources:
Studies were identified using the Scopus database, with no exclusions. The search
terms included Etirinotecan Pegol and NKTR-102, which yielded 125 articles (66 and 59 articles,
respectively). In addition, the clinicaltrials.gov website was used to find ongoing studies, which resulted
in the addition of two studies.
Study Eligibility Criteria:
Subsequently, we excluded studies that were published in languages
other than English, duplicate articles, and studies with no data.
Results:
This systematic review clarifies that EP possesses numerous advantages over many other
medications, such as safety, efficacy, increased half-life, increased health-related quality of life, increased
overall survival, increased progression-free survival, and decreasing the adverse events in
the treatment of various cancers.
Conclusion:
Therefore, Etirinotecan Pegol may represent a major contribution to the treatment of
various cancers in the future.
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Affiliation(s)
- Mohammad Samare-Najaf
- Department of Biochemistry, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Samareh
- Department of Biochemistry, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Navid Jamali
- Department of Biochemistry, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Abbasi
- Department of Biochemistry, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Cain C.T. Clark
- Centre for Intelligent Healthcare, Coventry University, CV1 5FB, United Kingdom
| | - Majid J. Khorchani
- Department of Biochemistry, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fatemeh Zal
- Department of Biochemistry, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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Chen Y, Yu M, Liu Z, Zhang Y, Li Q, Yang G. Effects of traditional Chinese medicine combined with chemotherapy for extensive-stage small-cell lung cancer patients on improving oncologic survival: study protocol of a multicenter, randomized, single-blind, placebo-controlled trial. Trials 2021; 22:437. [PMID: 34238342 PMCID: PMC8265049 DOI: 10.1186/s13063-021-05407-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 06/29/2021] [Indexed: 11/12/2022] Open
Abstract
Background Extensive-stage small-cell lung cancer (ES-SCLC) is characterized by extensive metastases, aggressive progression, and poor prognosis. Chemotherapy is applied as a preferred first-line regimen for ES-SCLC, but inadequate for improving its overall survival. Traditional Chinese medicine (TCM) is widely used in the clinical practice of ES-SCLC for its synergy with chemotherapy. However, there is still no substantial evidence to prove that TCM can effectively improve the long-term efficacy of ES-SCLC patients. The study intends to determine whether the TCM with chemotherapy can improve the overall survival (OS) in treating with ES-SCLC when compared with chemotherapy alone. Method/design A multicenter, randomized, single-blind, placebo-controlled clinical trial will be conducted to determine whether the TCM granules combined with chemotherapy can improve the OS of ES-SCLC. Two hundred seventy participants will randomly receive 4–6 cycles (21 days per cycle) of chemotherapy plus TCM granules or placebo. The primary outcome measure is OS. The secondary outcome measures includes progression-free survival (PFS), objective response rate (ORR), quality of life (QoL), and tumor markers. Visits will be performed at the end of each cycle during the treatment period and then every 3 months in the follow-up period until the patients’ death or study completion. Discussion The study’s result will provide a high-level evidence for TCM granules using with chemotherapy on the first-line treatment of ES-SCLC. Trial registration Chinese Clinical Trial Registry ChiCTR1900022991. Registered on 6 May 2019 (prospective registration). Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05407-1.
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Affiliation(s)
- Yuyi Chen
- Department of Oncology, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, No. 23, Back Road of Art Gallery, Dongcheng District, Beijing, 100010, China
| | - Mingwei Yu
- Department of Oncology, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, No. 23, Back Road of Art Gallery, Dongcheng District, Beijing, 100010, China
| | - Zishen Liu
- Department of Oncology, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, No. 23, Back Road of Art Gallery, Dongcheng District, Beijing, 100010, China
| | - Yi Zhang
- Department of Oncology, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, No. 23, Back Road of Art Gallery, Dongcheng District, Beijing, 100010, China
| | - Qiwei Li
- Department of Oncology, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, No. 23, Back Road of Art Gallery, Dongcheng District, Beijing, 100010, China
| | - Guowang Yang
- Department of Oncology, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, No. 23, Back Road of Art Gallery, Dongcheng District, Beijing, 100010, China.
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Rovalpituzumab Tesirine as a Maintenance Therapy After First-Line Platinum-Based Chemotherapy in Patients With Extensive-Stage-SCLC: Results From the Phase 3 MERU Study. J Thorac Oncol 2021; 16:1570-1581. [PMID: 33823285 DOI: 10.1016/j.jtho.2021.03.012] [Citation(s) in RCA: 63] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 02/26/2021] [Accepted: 03/10/2021] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Rovalpituzumab tesirine (Rova-T) is an antibody-drug conjugate targeting DLL3, an atypical Notch ligand expressed in SCLC tumors. We evaluated the efficacy of Rova-T versus placebo as maintenance therapy in patients with extensive-stage-SCLC after platinum-based chemotherapy. METHODS MERU was a phase 3 randomized, double-blinded, placebo-controlled study. Patients without disease progression after four cycles of platinum-based, front-line chemotherapy were randomized in a 1:1 ratio to receive 0.3 mg/kg Rova-T or placebo (every 6 wk, omitted every third cycle). Primary efficacy end points were progression-free survival (PFS) evaluated by the Central Radiographic Assessment Committee and overall survival (OS) in patients with DLL3-high tumors. RESULTS Median age of all randomized patients (N = 748) was 64 years; 78% had TNM stage IV disease. At futility analysis of the subset with DLL3-high tumors, the hazard ratio for OS was 1.07 (95% confidence interval: 0.84-1.36) favoring the placebo arm, with median OS of 8.5 and 9.8 months in the Rova-T and placebo arms, respectively; futility criteria were met. Rova-T significantly improved PFS versus placebo by investigator assessment (4.0 versus 1.4 mo, hazard ratio = 0.48, p < 0.001). Any-grade adverse events (≥20%) in the Rova-T arm were pleural effusion (27%), decreased appetite (27%), peripheral edema (26%), photosensitivity reaction (25%), fatigue (25%), nausea (22%), and dyspnea (21%). CONCLUSIONS Because of the lack of survival benefit in the Rova-T arm, the study did not meet its primary end point and was terminated early. As a result, the Central Radiographic Assessment Committee evaluation of PFS was not performed. The frequency of grade greater than or equal to 3 and drug-related toxicities were higher with Rova-T versus placebo. Rova-T was associated with unique toxicities, such as pleural and pericardial effusions, photosensitivity reaction, and peripheral edema, which should be carefully considered in the population with extensive-stage-SCLC.
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15
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Owonikoko TK, Park K, Govindan R, Ready N, Reck M, Peters S, Dakhil SR, Navarro A, Rodríguez-Cid J, Schenker M, Lee JS, Gutierrez V, Percent I, Morgensztern D, Barrios CH, Greillier L, Baka S, Patel M, Lin WH, Selvaggi G, Baudelet C, Baden J, Pandya D, Doshi P, Kim HR. Nivolumab and Ipilimumab as Maintenance Therapy in Extensive-Disease Small-Cell Lung Cancer: CheckMate 451. J Clin Oncol 2021; 39:1349-1359. [PMID: 33683919 PMCID: PMC8078251 DOI: 10.1200/jco.20.02212] [Citation(s) in RCA: 141] [Impact Index Per Article: 47.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
In extensive-disease small-cell lung cancer (ED-SCLC), response rates to first-line platinum-based chemotherapy are robust, but responses lack durability. CheckMate 451, a double-blind phase III trial, evaluated nivolumab plus ipilimumab and nivolumab monotherapy as maintenance therapy following first-line chemotherapy for ED-SCLC.
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Affiliation(s)
| | - Keunchil Park
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Ramaswamy Govindan
- Alvin J Siteman Cancer Center at Washington University School of Medicine, St Louis, MO
| | - Neal Ready
- Duke University Medical Center, Durham, NC
| | - Martin Reck
- Department of Thoracic Oncology, Airway Research Center North, German Center for Lung Research, LungClinic, Grosshansdorf, Germany
| | - Solange Peters
- Oncology Department, Lausanne University Hospital, Lausanne, Switzerland
| | | | - Alejandro Navarro
- Vall d'Hebron University Hospital and Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Jerónimo Rodríguez-Cid
- Centro Oncológico, Médica Sur-Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico
| | | | - Jong-Seok Lee
- Seoul National University Bundang Hospital, Seongnam, South Korea
| | | | | | - Daniel Morgensztern
- Alvin J Siteman Cancer Center at Washington University School of Medicine, St Louis, MO
| | - Carlos H Barrios
- Oncology Research Center, Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Laurent Greillier
- Aix Marseille Univ, APHM, INSERM, CNRS, CRCM, Hôpital Nord, Multidisciplinary Oncology and Therapeutic Innovations Department, Marseille, France
| | - Sofia Baka
- Interbalkan European Medical Center, Thessaloniki, Greece
| | - Miten Patel
- Cancer Specialists of North Florida, Jacksonville, FL
| | | | | | | | | | | | | | - Hye Ryun Kim
- Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
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Real World Analysis of Small Cell Lung Cancer Patients: Prognostic Factors and Treatment Outcomes. ACTA ACUST UNITED AC 2021; 28:317-331. [PMID: 33435584 PMCID: PMC7903279 DOI: 10.3390/curroncol28010036] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 12/02/2020] [Accepted: 12/03/2020] [Indexed: 01/22/2023]
Abstract
In this observational study, we assessed treatment patterns and prognostic factors in patients with small cell lung cancer (SCLC) in a large state-mandated healthcare organization in Israel. Methods: All incident cases with histologically confirmed SCLC who initiated systemic anti-cancer treatment between 2011 and 2017 were identified. Treatment patterns and overall survival (OS) were evaluated for each line of therapy. Results: A total of 235 patients were identified (61% male, median age 64 years, 95% ever smokers, 64% had extensive stage). The first-line treatment was platinum-etoposide regimen for 98.7% of the cohort. The second and third-line regimen were given to 43% and 12% of patients, respectively. Mean OS for extensive and limited stage patients was 9.1 and 23.5 months respectively. In a multivariable model, increased risk for mortality was observed among patients with an ECOG performance status (PS) of 2 compared to a PS of 0-1 for the extensive stage patients (Hazard ratio (HR) = 1.63, 95% confidence ratios (CI): 1.00-2.65); and for males compared to females for the limited stage patients (HR = 2.17; 95% CI: 1.12-4.20). Regarding all 2nd line patients in a multivariable model incorporating relevant confounding factors, demonstrated a significantly better outcome with platinum-based regimens compared to topotecan. Median survival after initiation of 2nd line in platinum-sensitive patients was longer (p = 0.056) for those re-challenged with platinum-based regimen (n = 7): 6.8mo (6.1-not reported (NR)), compared with those switched to a different treatment (n = 27): 4.5 mo (2.6-6.6) for extensive stage patients, and a non-significant difference was also observed for limited stage patients. Conclusion: To our knowledge, this is one of the largest real-world studies of SCLC patients. OS for SCLC patients was similar to that reported in clinical trials. PS for extensive stage patients and sex for limited stage patients were significant correlates of prognosis. Re-challenge of the platinum-based doublet was associated with longer OS compared to switching treatment in extensive stage patients.
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17
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Prospective Single-Arm Phase 1 and 2 Study: Ipilimumab and Nivolumab With Thoracic Radiation Therapy After Platinum Chemotherapy in Extensive-Stage Small Cell Lung Cancer. Int J Radiat Oncol Biol Phys 2020; 109:425-435. [PMID: 33002543 DOI: 10.1016/j.ijrobp.2020.09.031] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 07/28/2020] [Accepted: 09/13/2020] [Indexed: 01/14/2023]
Abstract
PURPOSE Consolidative thoracic radiation therapy (TRT) has been shown to improve outcomes for patients with extensive stage small cell lung cancer. We hypothesized that the addition of ipilimumab (IPI) and nivolumab (NIVO) after TRT would improve outcomes for patients with extensive stage small cell lung cancer. METHODS AND MATERIALS Eligibility required stable disease or better after platinum doublet chemotherapy. Study therapy included consolidative TRT to 30 Gy in 10 fractions, targeting residual primary tumor and initially involved regional lymph nodes. Two weeks after TRT, patients received concurrent IPI (3 mg/kg) and NIVO (1 mg/kg) every 3 weeks for 4 doses followed by NIVO monotherapy (480 mg) every 4 weeks until progression or up to 1 year. RESULTS The study enrolled 21 patients, with 6-month progression-free survival (PFS) of 24% (90% confidence interval [CI], 11%-40%) and a median PFS of 4.5 months (95% CI, 2.7%-4.6%). The 12-month overall survival (OS) was 48% (95% CI, 29%-64%) with a median OS of 11.7 months (95% CI, 4.7%-16.0%). Fifty-two percent of patients had ≥1 possibly related grade 3 to 4 immune-related adverse event. Grade 3 pulmonary and gastrointestinal immune-related adverse events were recorded in 19% and 24% of patients, respectively. Exploratory analysis showed increased cytotoxic T cell (CD3+CD8+) tumor infiltration was associated with favorable PFS (P = .01) and OS (P = .02). Reduction in peripheral blood CD3+CD8+ from baseline to after first dose of IPI/NIVO was associated with improved PFS (P = .02) and OS (P = .02). CONCLUSIONS Consolidative IPI and NIVO after platinum-based chemotherapy and TRT demonstrated a toxicity profile consistent with the known adverse events attributable to IPI and NIVO. Although the study regimen did not significantly improve PFS, the OS was higher than historic expectations. CD3+CD8+ tumor infiltration and migration may identify patients most likely to have improved outcomes in small cell lung cancer.
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Dashing Decades of Defeat: Long Anticipated Advances in the First-line Treatment of Extensive-Stage Small Cell Lung Cancer. Curr Oncol Rep 2020; 22:20. [PMID: 32034529 DOI: 10.1007/s11912-020-0887-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW Small cell lung cancer (SCLC) is an exceptionally lethal subtype of lung cancer. For patients with extensive-stage (ES) disease, which is the majority of patients, platinum-doublet chemotherapy has been the standard of care for decades. Dozens of phase III trials have failed to improve survival over standard platinum plus etoposide. Recent results, however, have met with long-overdue success. This manuscript reviews the new standards of care for ES-SCLC. RECENT FINDINGS Two recent phase III trials have shown an improvement in overall survival with concurrent immunotherapy and chemotherapy. In IMpower 133, the addition of the anti-PD-L1 antibody atezolizumab to carboplatin plus etoposide significantly improved both progression-free survival (PFS) and overall survival (OS). This was the first trial in over 30 years to improve survival. In CASPIAN, concurrent durvalumab, another anti-PD-L1 antibody, also led to an improvement in survival. While there is clearly a need to further improve outcomes, the improvement in survival with the addition of atezolizumab or durvalumab to platinum-doublet chemotherapy is a major advance. We now have new standards of care and the potential of a more meaningful benefit for patients with advanced SCLC.
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A systematic review of survival following anti-cancer treatment for small cell lung cancer. Lung Cancer 2020; 141:44-55. [PMID: 31955000 DOI: 10.1016/j.lungcan.2019.12.015] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 12/13/2019] [Accepted: 12/24/2019] [Indexed: 02/08/2023]
Abstract
OBJECTIVES We conducted a systematic review and meta-analysis of survival following treatment recommended by the European Society of Medical Oncology for SCLC in order to determine a benchmark for novel therapies to be compared with. MATERIALS AND METHODS Randomized controlled trials and observational studies reporting overall survival following chemotherapy for SCLC were included. We calculated survival at 30 and 90-days along with 1-year, 2-year and median. RESULTS We identified 160 for inclusion. There were minimal 30-day deaths. Survival was 99 % (95 %CI 98.0-99.0 %, I233.9 %, n = 77) and 90 % (95 %CI 89.0-92.0 %, I279.5 %, n = 73) at 90 days for limited (LD-SCLC) and extensive stage (ED-SCLC) respectively. The median survival for LD-SCLC was 18.1 months (95 %CI 17.0-19.1 %, I277.3 %, n = 110) and early thoracic radiotherapy (thoracic radiotherapy 18.4 months (95 %CI 17.3-19.5, I278.4 %, n = 100)) vs no radiotherapy 11.7 months (95 %CI 9.1-14.3, n = 10), prophylactic cranial irradiation (PCI 19.7 months vs No PCI 13.0 months (95 %CI 18.5-21.0, I275.7 %, n = 78 and 95 %CI 10.5-16.6, I281.1 %, n = 15 respectively)) and better performance status (PS0-1 22.5 months vs PS0-4 15.3 months (95 %CI 18.7-26.1, I272.4 %, n = 11 and 95 %CI 11.5-19.1 I277.9 %, n = 13)) augmented this. For ED-SCLC the median survival was 9.6 months (95 %CI 8.9-10.3 %, I295.2 %, n = 103) and this improved when irinotecan + cisplatin was used, however studies that used this combination were mostly conducted in Asian populations where survival was better. Survival was not improved with the addition of thoracic radiotherapy or PCI. Survival for both stages of cancer was better in modern studies and Asian cohorts. It was poorer for studies administering carboplatin + etoposide but this regimen was used in studies that had fewer patient selection criteria. CONCLUSION Early thoracic radiotherapy and PCI should be offered to people with LD-SCLC in accordance with guideline recommendations. The benefit of the aforementioned therapies to treat ED-SCLC and the use of chemotherapy in people with poor PS is less clear.
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Qi J, Xu L, Sun J, Wang X, Zhao L. Thoracic Radiotherapy Benefits Elderly Extensive-Stage Small Cell Lung Cancer Patients with Distant Metastasis. Cancer Manag Res 2019; 11:10767-10775. [PMID: 31920386 PMCID: PMC6935272 DOI: 10.2147/cmar.s221225] [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: 06/28/2019] [Accepted: 12/12/2019] [Indexed: 12/26/2022] Open
Abstract
Purpose Thoracic radiotherapy (TRT) is the recommended therapeutic regimen for extensive-stage small cell lung cancer (ES-SCLC). Little is known about TRT benefits in elderly populations. The aim of this study was to evaluate TRT effects on the prognosis of elderly patients with ES-SCLC. Patients and methods This retrospective analysis reviewed the records of patients over 65 years of age with metastatic ES-SCLC treated between 2010 and 2016. Enrolled patients received standard chemotherapy regimens (etoposide plus cisplatin or carboplatin). A total of 93 eligible patients were subjected to propensity score matching, which led to 40 patients being assigned to the TRT group and 40 to the no thoracic radiotherapy (noTRT) group. The cohort of 80 patients (67 males) had the median age of 69 years (range, 65–85 years), with a median of 4 chemotherapy cycle (range, 1–8 cycles), and a median chest irradiation dose of 50 Gy (range, 30–60 Gy). We analyzed overall survival (OS), progression-free survival (PFS), and local recurrence-free survival (LRFS) as endpoints; survival rates were determined by the Kaplan–Meier method and compared across groups with log-rank tests. Multivariate prognostic analysis was performed with Cox regression modeling, and categorical variables were analyzed with Chi-square tests. Results In all patients, the 1-year OS, PFS, and LRFS rates were 38.3%, 16%, and 17.9%, respectively. The TRT group had superior survival outcomes compared to the noTRT group: their 1-year OS, PFS, and LRFS rates were 55% vs. 25% (P < 0.001), 32.1% vs. 0% (P < 0.001), and 31% vs. 2.6% (P < 0.001), respectively. TRT did not increase the incidence of adverse reactions (P = 0.431). Conclusion TRT can improve chest tumor control and survival time in elderly ES-SCLC patients. Large-scale studies to further assess the benefits of TRT are warranted.
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Affiliation(s)
- Jing Qi
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute and Hospital, Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin 300060, People's Republic of China
| | - Liming Xu
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute and Hospital, Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin 300060, People's Republic of China
| | - Jian Sun
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute and Hospital, Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin 300060, People's Republic of China
| | - Xin Wang
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute and Hospital, Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin 300060, People's Republic of China
| | - Lujun Zhao
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute and Hospital, Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin 300060, People's Republic of China
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Thomas M, Ponce-Aix S, Navarro A, Riera-Knorrenschild J, Schmidt M, Wiegert E, Kapp K, Wittig B, Mauri C, Dómine Gómez M, Kollmeier J, Sadjadian P, Fröhling KP, Huber RM, Wolf M. Immunotherapeutic maintenance treatment with toll-like receptor 9 agonist lefitolimod in patients with extensive-stage small-cell lung cancer: results from the exploratory, controlled, randomized, international phase II IMPULSE study. Ann Oncol 2019; 29:2076-2084. [PMID: 30137193 PMCID: PMC6225892 DOI: 10.1093/annonc/mdy326] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background The immune surveillance reactivator lefitolimod (MGN1703), a DNA-based TLR9 agonist, might foster innate and adaptive immune response and thus improve immune-mediated control of residual cancer disease. The IMPULSE phase II study evaluated the efficacy and safety of lefitolimod as maintenance treatment in extensive-stage small-cell lung cancer (ES-SCLC) after objective response to first-line chemotherapy, an indication with a high unmet medical need and stagnant treatment improvement in the last decades. Patients and methods 103 patients with ES-SCLC and objective tumor response (as per RECIST 1.1) following four cycles of platinum-based first-line induction therapy were randomized to receive either lefitolimod maintenance therapy or local standard of care at a ratio of 3 : 2 until progression or unacceptable toxicity. Results From 103 patients enrolled, 62 were randomized to lefitolimod, 41 to the control arm. Patient demographics and response patterns to first-line therapy were balanced. Lefitolimod exhibited a favorable safety profile and pharmacodynamic assessment confirmed the mode-of-action showing a clear activation of monocytes and production of interferon-gamma-induced protein 10 (IP-10). While in the intent-to-treat (ITT) population no relevant effect of lefitolimod on progression-free and overall survival (OS) could be observed, two predefined patient subgroups indicated promising results, favoring lefitolimod with respect to OS: in patients with a low frequency of activated CD86+ B cells (hazard ratio, HR 0.53, 95% CI: 0.26–1.08; n = 38 of 88 analyzed) and in patients with reported chronic obstructive pulmonary disease (COPD) (HR 0.48, 95% CI: 0.20–1.17, n = 25 of 103). Conclusions The IMPULSE study showed no relevant effect of lefitolimod on the main efficacy end point OS in the ITT, but (1) the expected pharmacodynamic response to lefitolimod, (2) positive OS efficacy signals in two predefined subgroups and (3) a favorable safety profile. These data support further exploration of lefitolimod in SCLC.
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Affiliation(s)
- M Thomas
- Thoraxklinik im Universitätsklinikum Heidelberg, Translational Lung Research Center Heidelberg (TLRC-H), Heidelberg, Germany.
| | | | - A Navarro
- Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - J Riera-Knorrenschild
- Hämatologie, Onkologie und Immunologie, Klinikum der Philipps Universität Marburg, Marburg, Germany
| | - M Schmidt
- Early & Translational R&D Department, MOLOGEN AG, Berlin, Germany
| | - E Wiegert
- Clinical Science Department, MOLOGEN AG, Berlin, Germany
| | - K Kapp
- Early & Translational R&D Department, MOLOGEN AG, Berlin, Germany
| | - B Wittig
- Advisor, MOLOGEN AG, Berlin, Germany
| | - C Mauri
- Division of Medicine, University College London, London, UK
| | - M Dómine Gómez
- Medical Oncology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - J Kollmeier
- Klinik für Pneumonologie, HELIOS Klinikum Emil von Behring GmbH, Berlin, Germany
| | - P Sadjadian
- Abteilung Pneumonologie, Johannes Wesling Klinikum Minden, Minden, Germany
| | - K-P Fröhling
- Klinik für Innere Medizin/Pneumologie, Schlaf- und Beatmungsmedizin, Kath. Klinikum Koblenz-Montabaur, Koblenz, Germany
| | - R M Huber
- Comprehensive Pneumology Center (CPC-M), University of Munich and Thoracic Oncology Centre Munich, Munich, Germany
| | - M Wolf
- Klinikum Kassel, Medizinische Klinik IV, Kassel, Germany
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22
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Sallam M, Wong H, Escriu C. Treatment beyond four cycles of first line Platinum and Etoposide chemotherapy in real-life patients with stage IV Small Cell Lung Cancer: a retrospective study of the Merseyside and Cheshire Cancer network. BMC Pulm Med 2019; 19:195. [PMID: 31675940 PMCID: PMC6823940 DOI: 10.1186/s12890-019-0948-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 09/23/2019] [Indexed: 01/22/2023] Open
Abstract
Background Dose intensity and dose density of first line Platinum and Etoposide (PE) do not influence Overall Survival (OS) of Small Cell Lung Cancer (SCLC) patients. The effect of treatment length, however, remains unclear. Current guidelines recommend treating beyond 4 cycles -up to 6-, in patients that respond to and tolerate systemic treatment. This has led to variable practice both in clinical practice and clinical research. Here we aimed at quantifying the possible clinical benefit of the extended regimen in our real-life patients treated with PE doublet. Methods Of all patients with SCLC treated in our network with non-concurrent first line PE chemotherapy between 2008 and 2015, we identified and described patients that received 4 cycles (4c) or more (> 4c), and analysed patients with stage IV disease. Results Two hundred forty-one patients with stage IV had 4c and 69 had > 4c. The latter were more likely to have sequential thoracic radiotherapy, which suggested a lower metastatic burden. Nevertheless, there were no statistically significant differences when comparing clinical outcomes. The median Duration of Response (DoR; time from last chemotherapy cycle to progression) was 5 months in both groups (HR 1.22; 95% CI 0.93–1.61). Median Progression Free Survival (PFS; time from diagnosis to radiological progression) was 8 months (4c) versus 9 months (> 4c) (HR 0.86; 95% CI 0.66–1.13) and median OS was 11 versus 12 months (HR 0.86, 95% CI 0.66–1.14). Conclusion Our results highlight a lack of clinical benefit by extending first line PE treatment in stage IV disease, and support limiting treatment to 4 cycles until superiority of a longer regimen is identified in a randomised study.
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Affiliation(s)
- Mostafa Sallam
- The Clatterbridge Cancer Centre, Clatterbridge Road, Bebington, Wirral, CH63 4JY, UK.,University of Liverpool, L69 3BX, Liverpool, UK
| | - Helen Wong
- The Clatterbridge Cancer Centre, Clatterbridge Road, Bebington, Wirral, CH63 4JY, UK
| | - Carles Escriu
- The Clatterbridge Cancer Centre, Clatterbridge Road, Bebington, Wirral, CH63 4JY, UK. .,University of Liverpool, L69 3BX, Liverpool, UK.
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23
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Schenk EL, Mandrekar SJ, Dy GK, Aubry MC, Tan AD, Dakhil SR, Sachs BA, Nieva JJ, Bertino E, Lee Hann C, Schild SE, Wadsworth TW, Adjei AA, Molina JR. A Randomized Double-Blind Phase II Study of the Seneca Valley Virus (NTX-010) versus Placebo for Patients with Extensive-Stage SCLC (ES SCLC) Who Were Stable or Responding after at Least Four Cycles of Platinum-Based Chemotherapy: North Central Cancer Treatment Group (Alliance) N0923 Study. J Thorac Oncol 2019; 15:110-119. [PMID: 31605793 DOI: 10.1016/j.jtho.2019.09.083] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 09/09/2019] [Accepted: 09/21/2019] [Indexed: 01/22/2023]
Abstract
INTRODUCTION The Seneca Valley virus (NTX-010) is an oncolytic picornavirus with tropism for SCLC. This phase II double-blind, placebo-controlled trial evaluated NTX-010 in patients with extensive-stage (ES) SCLC after completion of first-line chemotherapy. METHODS Patients with ES SCLC who did not progress after four or more cycles of platinum-based chemotherapy were randomized 1:1 to a single dose of NTX-010 or placebo within 12 weeks of chemotherapy. The primary end point was progression-free survival (PFS). A prespecified interim analysis for futility was performed after 40 events. Viral clearance and the development of neutralizing antibodies were followed. RESULTS From January 15, 2010, to January 10, 2013, a total of 50 patients were randomized and received therapy on study (26 received NTX-010 and 24 received placebo). At the specified interim analysis, the median PFS was 1.7 months (95% confidence interval [CI]: 1.4-3.1 months) for the NTX-010 group versus 1.7 months (95% CI: 1.4-4.3 months) for the placebo group (hazard ratio = 1.03, p = 0.92), and the trial was terminated owing to futility. In the NTX-010 group, PFS was shorter in patients with detectable virus at days 7 and 14 versus in those in whom it was not detected after treatment (1.0 month [95% CI: 0.4-1.5 months] versus 1.8 months [95% CI: 1.3-5.5 months, p = 0.008] and 0.9 months [95% CI: 0.4-2.6 months] versus 1.3 months [95% CI: 1.0-5.3 months], respectively [p = 0.04]). CONCLUSIONS Patients with ES SCLC did not benefit from NTX-010 treatment after chemotherapy with a platinum doublet. Persistence of NTX-010 in the blood 1 or 2 weeks after treatment was associated with a shorter PFS.
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Affiliation(s)
| | - Sumithra J Mandrekar
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, Minnesota; Mayo Clinic, Rochester, Minnesota
| | - Grace K Dy
- Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | | | - Angelina D Tan
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, Minnesota; Mayo Clinic, Rochester, Minnesota
| | | | | | - Jorge J Nieva
- University of Southern California, Los Angeles, California
| | - Erin Bertino
- The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | | | | | - Troy W Wadsworth
- Northwest NCORP, Multicare Regional Cancer Center, Tacoma, Washington
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24
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Lim S, Lim SM, Kim MJ, Park SY, Kim JH. Sonic Hedgehog Pathway as the Prognostic Marker in Patients with Extensive Stage Small Cell Lung Cancer. Yonsei Med J 2019; 60:898-904. [PMID: 31538424 PMCID: PMC6753348 DOI: 10.3349/ymj.2019.60.10.898] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 08/12/2019] [Accepted: 08/14/2019] [Indexed: 01/22/2023] Open
Abstract
PURPOSE Sonic hedgehog (Shh) signaling pathway is known to play a crucial role in carcinogenesis in various malignancies, including lung cancer regarding tumorigenesis, angiogenesis, and cellular differentiation. The aim of this study was to investigate the value of components of Shh pathway as a prognostic marker in extensive stage small cell lung cancer (ES-SCLC) patients. MATERIALS AND METHODS We retrospectively analyzed data of 36 patients who were diagnosed with ES-SCLC between 2008 and 2012 at a single center. We performed immuo-histochemistry for glioma-associated oncogene homolog zinc finger protein 1 (Gli1), patched, Shh, and Ptch-mediated repression of smoothened (Smo) proteins using formalin-fixed, paraffin-embedded tissue derived from primary tumors. We then conducted survival analysis to evaluate the prognostic impact of these markers. RESULTS All 36 patients received platinum-based doublet chemotherapy. The median progression free survival and median overall survival were 6.9 months [95% confidence interval (CI), 6.5-7.3] and 11.7 months (95% CI, 9.1-14.3), respectively. The overall response rate was 84%. Of the 36 tissue specimens examined, over-expression of Gli1, Patched, Shh, and Smo was found in 12 (33.3%), five (13.9%), five (13.9%), and six (16.7%) cases, respectively. We found that high expression of Shh was associated with worse progression free survival (6.3 vs. 7.6 months, p=0.005) and overall survival (9.2 vs. 12.0 months, p=0.039) by both univariate and multivariate analyses, whereas other markers were not related to patient prognosis. CONCLUSION A high proportion of small cell lung cancer tumors express proteins related to Shh pathway, and over-expression of Shh is correlated with poor prognosis.
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Affiliation(s)
- Seungtaek Lim
- Department of Hemato-Oncology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
- Konyang University Myunggok Medical Research Institute, Daejeon, Korea
| | - Sun Min Lim
- Division of Medical Oncology, Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | | | - Shin Young Park
- Department of Pathology, Daejeon Son Hospital, Daejeon, Korea
| | - Joo Hang Kim
- Division of Medical Oncology, Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea.
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25
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Qiu Z, Lin A, Li K, Lin W, Wang Q, Wei T, Zhu W, Luo P, Zhang J. A novel mutation panel for predicting etoposide resistance in small-cell lung cancer. DRUG DESIGN DEVELOPMENT AND THERAPY 2019; 13:2021-2041. [PMID: 31417239 PMCID: PMC6594009 DOI: 10.2147/dddt.s205633] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Accepted: 05/31/2019] [Indexed: 12/30/2022]
Abstract
Purpose Platinum-based chemotherapy, consisting of etoposide and cisplatin (EP), has been the cornerstone of therapy for extensive-stage small-cell lung cancer (ES-SCLC) for decades. Despite the marked initial sensitivity of SCLC to chemotherapy, EP regimens cannot avoid the emergence of drug resistance in clinical practice. With the rise of new chemotherapy regimens in recent years and the primary resistance or insensitivity of ES-SCLC to EP regimens, it is desirable to be able to identify patients with resistant or insensitive ES-SCLC. Methods The sequencing and drug sensitivity data of SCLC cell lines were provided by The Genomics of Drug Sensitivity in Cancer Project (GDSC). The data regarding sensitivity to etoposide of 54 SCLC cell lines were analyzed, and etoposide-sensitive cell lines and etoposide-resistant cell lines were differentiated according to the IC50 values defined by the GDSC. ROC curve analysis was performed on all mutations and combinations of mutations to select the optimal panel to predict resistance to etoposide. Results ROC analysis of etoposide resistance revealed that the most significant single gene mutation indicating resistance to etoposide was CSMD3, and the accuracy of predicting resistance to etoposide proved to be the highest when there was any mutation in CSMD3/PCLO/RYR1/EPB41L3, area under the curve =0.804 (95% confidence interval: 0.679–0.930,P<0.001). Conclusion This study found that a panel with four genes (CSMD3, EPB41L3, PCLO, and RYR1) can accurately predict sensitivity to etoposide. These findings provide new insights into the overall treatment for patients with ES-SCLC that is resistant or insensitive to etoposide.
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Affiliation(s)
- Zhengang Qiu
- Department of Oncology, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, People's Republic of China.,Department of Oncology, First Affiliated Hospital of Gannan Medical University, Ganzhou 341000, People's Republic of China
| | - Anqi Lin
- Department of Oncology, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, People's Republic of China
| | - Kun Li
- Department of Oncology, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, People's Republic of China
| | - Weiyin Lin
- Department of Oncology, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, People's Republic of China
| | - Qiongyao Wang
- Department of Oncology, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, People's Republic of China
| | - Ting Wei
- Department of Oncology, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, People's Republic of China
| | - Weiliang Zhu
- Department of Oncology, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, People's Republic of China
| | - Peng Luo
- Department of Oncology, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, People's Republic of China
| | - Jian Zhang
- Department of Oncology, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, People's Republic of China
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26
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Tian S, Zhang X, Jiang R, Pillai RN, Owonikoko TK, Steuer CE, Saba NF, Pakkala S, Patel PR, Belani CP, Khuri FR, Curran WJ, Ramalingam SS, Behera M, Higgins KA. Survival Outcomes With Thoracic Radiotherapy in Extensive-Stage Small-Cell Lung Cancer: A Propensity Score-Matched Analysis of the National Cancer Database. Clin Lung Cancer 2019; 20:484-493.e6. [PMID: 31296433 DOI: 10.1016/j.cllc.2019.06.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 05/29/2019] [Accepted: 06/07/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND The prognosis of patients with extensive-stage small-cell lung carcinoma (ES-SCLC) is poor. The benefit of consolidative thoracic radiation therapy (TRT) in ES-SCLC has been inconclusive, and its use inconsistent. The objective of this study was to evaluate overall survival (OS) of ES-SCLC patients treated with chemotherapy (CT) with or without TRT using an administrative database approach. PATIENTS AND METHODS The National Cancer Database was queried to identify patients with ES-SCLC diagnosed between 2010 and 2014. Those with brain metastases, those who received radiotherapy before CT, or radiotherapy outside the thorax, were excluded. Propensity score-matching (PSM) was used to compare OS of patients treated with CT and TRT with those who received CT alone. Patients who received >10 radiotherapy fractions were also compared with those who received 10 or fewer. RESULTS We included 14,367 patients in the primary analysis; 12,019 received CT alone, and 2348 received CT with TRT. In multivariate analysis, CT was associated with an increased risk of death relative to CT with TRT (hazard ratio [HR], 1.74 [95% confidence interval (CI), 1.64-1.84]; log-rank P < .001), which remained significant with PSM. Median OS was 12.1 versus 8.2 months (CT with TRT vs. CT); 12-month OS was 50.5% versus 28.5%, and 5-year OS 7.6% versus 2.0% (HR, 1.80 [95% CI, 1.67-1.95], HR P < .001). Of 3099 patients who received TRT, >10 radiotherapy fractions was associated with superior OS (HR, 1.70 [95% CI, 1.49-1.95], log-rank P < .001); this finding remained significant with PSM. CONCLUSION Use of TRT after CT in ES-SCLC patients was associated with long-term survival; its use should be considered in addition to standard of care CT.
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Affiliation(s)
- Sibo Tian
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
| | - Xinyan Zhang
- Rollins School of Public Health, Emory University, Atlanta, GA
| | - Renjian Jiang
- Rollins School of Public Health, Emory University, Atlanta, GA
| | - Rathi N Pillai
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
| | - Taofeek K Owonikoko
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
| | - Conor E Steuer
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
| | - Nabil F Saba
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
| | - Suchita Pakkala
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
| | - Pretesh R Patel
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
| | - Chandra P Belani
- Department of Medicine, Penn State Hershey Cancer Institute, Hershey, PA
| | - Fadlo R Khuri
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
| | - Walter J Curran
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
| | - Suresh S Ramalingam
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
| | - Madhusmita Behera
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA; Department of Biostatistics and Bioinformatics, Winship Cancer Institute of Emory University, Atlanta, GA
| | - Kristin A Higgins
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, GA.
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27
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Sun A, Durocher-Allen LD, Ellis PM, Ung YC, Goffin JR, Ramchandar K, Darling G. Initial management of small-cell lung cancer (limited- and extensive-stage) and the role of thoracic radiotherapy and first-line chemotherapy: a systematic review. Curr Oncol 2019; 26:e372-e384. [PMID: 31285682 PMCID: PMC6588077 DOI: 10.3747/co.26.4481] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background Patients with limited-stage (ls) or extensive-stage (es) small-cell lung cancer (sclc) are commonly given platinum-based chemotherapy as first-line treatment. Standard chemotherapy for patients with ls sclc includes a platinum agent such as cisplatin combined with the non-platinum agent etoposide. The objective of the present systematic review was to investigate the efficacy of adding radiotherapy to chemotherapy in patients with es sclc and to determine the appropriate timing, dose, and schedule of chemotherapy or radiation for patients with sclc. Methods The medline and embase databases were searched for randomized controlled trials (rcts) comparing treatment with radiotherapy plus chemotherapy against treatment with chemotherapy alone in patients with es sclc. Identified rcts were also included if they compared various timings, doses, and schedules of treatment for patients with es sclc or ls sclc. Results Sixty-four rcts were included. In patients with ls sclc, overall survival was greatest with platinum-etoposide compared with other chemotherapy regimens. In patients with es sclc, overall survival was greatest with chemotherapy containing platinum-irinotecan than with chemotherapy containing platinum-etoposide (hazard ratio: 0.84; 95% confidence interval: 0.74 to 0.95; p = 0.006). The addition of radiation to chemotherapy for patients with es sclc showed mixed results. There was no conclusive evidence that the timing, dose, or schedule of thoracic radiation affected treatment outcomes in sclc. Conclusions In patients with ls sclc, cisplatin-etoposide plus radiotherapy should remain the standard therapy. In patients with es sclc, the evidence is insufficient to recommend the addition of radiotherapy to chemotherapy as standard practice to improve overall survival. However, on a case-by-case basis, radiotherapy might be added to reduce local recurrence. The most commonly used chemotherapy is platinum-etoposide; however, platinum-irinotecan can be considered.
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Affiliation(s)
- A Sun
- Radiation Oncology, Princess Margaret Cancer Centre, Toronto, ON
| | | | - P M Ellis
- Medical Oncology, Juravinski Cancer Centre, Hamilton, ON
- Department of Oncology, McMaster University, Hamilton, ON
| | - Y C Ung
- Radiation Oncology, Sunnybrook Odette Cancer Centre, Toronto, ON
| | - J R Goffin
- Medical Oncology, Juravinski Cancer Centre, Hamilton, ON
| | - K Ramchandar
- Radiation Oncology, Thunder Bay Regional Health Sciences Centre Regional Cancer Care, Thunder Bay, ON
| | - G Darling
- Thoracic Surgery, Toronto General Hospital, Toronto, ON
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Yan X, Wang Q, Wang H, Li P, Zhang G, Zhang M, Zheng X, Yang J, Zhang X, Ma Z. Apatinib as maintenance therapy in extensive-stage small-cell lung cancer: results from a single-center retrospective study. J Cancer Res Clin Oncol 2018; 145:235-240. [PMID: 30293117 PMCID: PMC6326003 DOI: 10.1007/s00432-018-2764-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 10/01/2018] [Indexed: 01/31/2023]
Abstract
Purpose To evaluate the efficacy of maintenance apatinib after chemotherapy for extensive-stage (ED) small-cell lung cancer (SCLC). Patients and methods This was a retrospective analysis of 23 cases of extensive-stage SCLC admitted to the Affiliated Cancer Hospital of Zhengzhou University from January 2015 to December 2017. The patients without progression after induction chemotherapy received apatinib 250 mg per day until disease progression or unacceptable toxicity occurred. We analyzed the median progression-free survival (PFS), median overall survival (OS) and safety. Results Of 23 enrolled patients, 1 was lost to follow-up. The median PFS from the time of maintenance therapy was 4.1 months (95% CI 3.63–4.57 months). The median PFS from the time of induction chemotherapy was 8.3 months (95% CI 7.20–9.40 months). The median OS from the time of maintenance therapy was 12.5 months (95% CI 5.51–19.49 months). The median OS from the time of induction chemotherapy was 17.0 months (95% CI 9.86–24.14 months). The most frequent treatment-related adverse events were hand–foot syndrome (43.5%, 10/23) and secondary hypertension (30.4%, 7/23), followed by fatigue, proteinuria, nausea, and oral mucositis (17.4%, 13.0%, 13.0%, and 8.7%, respectively). Hematologic toxicity included thrombocytopenia (30.4%), leucopenia (26.1%), and anemia (17.4%). The main grade 3 or 4 toxicities were hand–foot syndrome (8.7%, 2/23) and hypertension (4.3%, 1/23). Conclusion Maintenance apatinib was safe and achieved encouraging PFS and OS in extensive-stage SCLC.
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Affiliation(s)
- Xiangtao Yan
- Department of Internal Medicine, Henan Cancer Hospital, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, 450008, China
| | - Qiming Wang
- Department of Internal Medicine, Henan Cancer Hospital, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, 450008, China
| | - Huijuan Wang
- Department of Internal Medicine, Henan Cancer Hospital, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, 450008, China
| | - Peng Li
- Department of Internal Medicine, Henan Cancer Hospital, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, 450008, China
| | - Guowei Zhang
- Department of Internal Medicine, Henan Cancer Hospital, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, 450008, China
| | - Mina Zhang
- Department of Internal Medicine, Henan Cancer Hospital, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, 450008, China
| | - Xuanxuan Zheng
- Department of Internal Medicine, Henan Cancer Hospital, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, 450008, China
| | - Jinpo Yang
- Department of Internal Medicine, Henan Cancer Hospital, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, 450008, China
| | - Xiaojuan Zhang
- Department of Internal Medicine, Henan Cancer Hospital, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, 450008, China
| | - Zhiyong Ma
- Department of Internal Medicine, Henan Cancer Hospital, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, 450008, China.
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Sun JM, Lee KH, Kim BS, Kim HG, Min YJ, Yi SY, Yun HJ, Jung SH, Lee SH, Ahn JS, Park K, Ahn MJ. Pazopanib maintenance after first-line etoposide and platinum chemotherapy in patients with extensive disease small-cell lung cancer: a multicentre, randomised, placebo-controlled Phase II study (KCSG-LU12-07). Br J Cancer 2018; 118:648-653. [PMID: 29381690 PMCID: PMC5846070 DOI: 10.1038/bjc.2017.465] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 11/24/2017] [Accepted: 11/27/2017] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND We investigated whether pazopanib maintenance following first-line chemotherapy would improve survival in patients with extensive disease small-cell lung cancer (ED-SCLC). METHODS This study is a randomised, placebo-controlled, phase II study that enroled ED-SCLC patients who had not progressed after four cycles of etoposide plus platinum therapy. Eligible patients were randomly assigned (1 : 1 ratio) to either placebo or pazopanib 800 mg per day until progression or unacceptable toxicity. The primary end point was progression-free survival (PFS). RESULTS 97 patients were enroled and randomly assigned; 2 patients did not receive study drugs. In total, 95 patients received maintenance therapy (pazopanib, n=48; placebo, n=47) and were included in the analyses. Grade 3 toxicities for pazopanib maintenance were thrombocytopenia (10.4%, including one case with grade 4 toxicity), liver enzyme elevation (10.4%), fatigue (6.3%), and hypertension (6.3%). Median PFS was 3.7 months for pazopanib maintenance and 1.8 months for placebo (hazard ratio 0.44, 95% confidence interval: 0.29-0.69, P<0.0001). CONCLUSIONS Pazopanib maintenance significantly prolonged PFS in patients with ED-SCLC. Given the toxicity profiles, however, relevant biomarkers to select patients for benefit from pazopanib should be further investigated.
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Affiliation(s)
- Jong-Mu Sun
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea
| | - Ki Hyeong Lee
- Division of Medical Oncology, Department of Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju 28644, Korea
| | - Bong-Seog Kim
- Division of Hemato-Oncology, Department of Internal Medicine, Veterans Health Service Medical Center, Seoul 05368, Korea
| | - Hoon-Gu Kim
- Division of Hematology-Oncology, Department of Internal Medicine, Gyeongsang Institute of Health Sciences, Gyeongsang National University College of Medicine and Gyeongsang National University Changwon Hospital, Changwon 51472, Korea
| | - Young Joo Min
- Division of Hematology and Oncology, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan 44033, Korea
| | - Seong Yoon Yi
- Division of Hematology-Oncology, Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang 10380, Korea
| | - Hwan Jung Yun
- Division of Hematology-Oncology, Department of Medicine, Chungnam National University Hospital, Daejeon 35015, Korea
| | - Sin-Ho Jung
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC 27710, USA
| | - Se-Hoon Lee
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea
| | - Jin Seok Ahn
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea
| | - Keunchil Park
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea
| | - Myung-Ju Ahn
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea
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Reck M, Luft A, Szczesna A, Havel L, Kim SW, Akerley W, Pietanza MC, Wu YL, Zielinski C, Thomas M, Felip E, Gold K, Horn L, Aerts J, Nakagawa K, Lorigan P, Pieters A, Kong Sanchez T, Fairchild J, Spigel D. Phase III Randomized Trial of Ipilimumab Plus Etoposide and Platinum Versus Placebo Plus Etoposide and Platinum in Extensive-Stage Small-Cell Lung Cancer. J Clin Oncol 2017; 34:3740-3748. [PMID: 27458307 DOI: 10.1200/jco.2016.67.6601] [Citation(s) in RCA: 365] [Impact Index Per Article: 52.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Purpose Patients with extensive-stage disease small-cell lung cancer (SCLC) have poor survival outcomes despite first-line chemotherapy with etoposide and platinum. This randomized, double-blind phase III study evaluated the efficacy and safety of ipilimumab or placebo plus etoposide and platinum in patients with newly diagnosed extensive-stage disease SCLC. Patients and Methods Patients were randomly assigned at a ratio of one to one to receive chemotherapy with etoposide and platinum (cisplatin or carboplatin) plus ipilimumab 10 mg/kg or placebo every 3 weeks for a total of four doses each in a phased induction schedule (chemotherapy in cycles one to four; ipilimumab or placebo beginning in cycle three up to cycle six), followed by ipilimumab or placebo maintenance every 12 weeks. Primary end point was overall survival (OS) among patients receiving at least one dose of blinded study therapy. Results Of 1,132 patients randomly assigned, 954 received at least one dose of study therapy (chemotherapy plus ipilimumab, n = 478; chemotherapy plus placebo, n = 476). Median OS was 11.0 months for chemotherapy plus ipilimumab versus 10.9 months for chemotherapy plus placebo (hazard ratio, 0.94; 95% CI, 0.81 to 1.09; P = .3775). Median progression-free survival was 4.6 months for chemotherapy plus ipilimumab versus 4.4 months for chemotherapy plus placebo (hazard ratio, 0.85; 95% CI, 0.75 to 0.97). Rates and severity of treatment-related adverse events were similar between arms, except for diarrhea, rash, and colitis, which were more frequent with chemotherapy plus ipilimumab. Rate of treatment-related discontinuation was higher with chemotherapy plus ipilimumab (18% v 2% with chemotherapy plus placebo). Five treatment-related deaths occurred with chemotherapy plus ipilimumab and two with chemotherapy plus placebo. Conclusion Addition of ipilimumab to chemotherapy did not prolong OS versus chemotherapy alone in patients with newly diagnosed extensive-stage disease SCLC. No new or unexpected adverse events were observed with chemotherapy plus ipilimumab. Several ongoing studies are evaluating ipilimumab in combination with programmed death-1 inhibitors in SCLC.
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Affiliation(s)
- Martin Reck
- Martin Reck, LungenClinic Grosshansdorf, Airway Research Center North, Grosshansdorf; Michael Thomas, Translational Lung Research Center Heidelberg, Thoraxklinik im Universitätsklinikum Heidelberg, Heidelberg, Germany; Alexander Luft, Leningrad Regional Clinical Hospital, Leningrad, Russia; Aleksandra Szczesna, Mazowieckie Centrum Leczenia Chorob Pluc i Gruzlicy w Otwocku, Otwocku, Poland; Libor Havel, Hospital Na Bulovce, Prague, Czech Republic; Sang-We Kim, Asan Medical Center and University of Ulsan College of Medicine, Seoul, Korea; Wallace Akerley, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; Maria Catherine Pietanza, Memorial Sloan Kettering Cancer Center, New York, NY; Kathryn Gold, University of Texas MD Anderson Cancer Center, Houston, TX; Leora Horn, Vanderbilt-Ingram Cancer Center; David Spigel, Sarah Cannon Research Institute and Tennessee Oncology, Nashville, TN; Anne Pieters, Teresa Kong Sanchez, and Justin Fairchild, Bristol-Myers Squibb, Princeton, NJ; Yi-long Wu, Guangdong Lung Cancer Institute, Guangdong General Hospital, Guangdong, People's Republic of China; Christoph Zielinski, Medical University of Vienna, Vienna, Austria; Enriqueta Felip, Vall d'Hebron University Hospital, Barcelona, Spain; Joachim Aerts, Erasmus MC Cancer Institute, Rotterdam, the Netherlands; Kazuhiko Nakagawa, Kinki University Hospital, Osaka, Japan; and Paul Lorigan, the Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Alexander Luft
- Martin Reck, LungenClinic Grosshansdorf, Airway Research Center North, Grosshansdorf; Michael Thomas, Translational Lung Research Center Heidelberg, Thoraxklinik im Universitätsklinikum Heidelberg, Heidelberg, Germany; Alexander Luft, Leningrad Regional Clinical Hospital, Leningrad, Russia; Aleksandra Szczesna, Mazowieckie Centrum Leczenia Chorob Pluc i Gruzlicy w Otwocku, Otwocku, Poland; Libor Havel, Hospital Na Bulovce, Prague, Czech Republic; Sang-We Kim, Asan Medical Center and University of Ulsan College of Medicine, Seoul, Korea; Wallace Akerley, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; Maria Catherine Pietanza, Memorial Sloan Kettering Cancer Center, New York, NY; Kathryn Gold, University of Texas MD Anderson Cancer Center, Houston, TX; Leora Horn, Vanderbilt-Ingram Cancer Center; David Spigel, Sarah Cannon Research Institute and Tennessee Oncology, Nashville, TN; Anne Pieters, Teresa Kong Sanchez, and Justin Fairchild, Bristol-Myers Squibb, Princeton, NJ; Yi-long Wu, Guangdong Lung Cancer Institute, Guangdong General Hospital, Guangdong, People's Republic of China; Christoph Zielinski, Medical University of Vienna, Vienna, Austria; Enriqueta Felip, Vall d'Hebron University Hospital, Barcelona, Spain; Joachim Aerts, Erasmus MC Cancer Institute, Rotterdam, the Netherlands; Kazuhiko Nakagawa, Kinki University Hospital, Osaka, Japan; and Paul Lorigan, the Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Aleksandra Szczesna
- Martin Reck, LungenClinic Grosshansdorf, Airway Research Center North, Grosshansdorf; Michael Thomas, Translational Lung Research Center Heidelberg, Thoraxklinik im Universitätsklinikum Heidelberg, Heidelberg, Germany; Alexander Luft, Leningrad Regional Clinical Hospital, Leningrad, Russia; Aleksandra Szczesna, Mazowieckie Centrum Leczenia Chorob Pluc i Gruzlicy w Otwocku, Otwocku, Poland; Libor Havel, Hospital Na Bulovce, Prague, Czech Republic; Sang-We Kim, Asan Medical Center and University of Ulsan College of Medicine, Seoul, Korea; Wallace Akerley, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; Maria Catherine Pietanza, Memorial Sloan Kettering Cancer Center, New York, NY; Kathryn Gold, University of Texas MD Anderson Cancer Center, Houston, TX; Leora Horn, Vanderbilt-Ingram Cancer Center; David Spigel, Sarah Cannon Research Institute and Tennessee Oncology, Nashville, TN; Anne Pieters, Teresa Kong Sanchez, and Justin Fairchild, Bristol-Myers Squibb, Princeton, NJ; Yi-long Wu, Guangdong Lung Cancer Institute, Guangdong General Hospital, Guangdong, People's Republic of China; Christoph Zielinski, Medical University of Vienna, Vienna, Austria; Enriqueta Felip, Vall d'Hebron University Hospital, Barcelona, Spain; Joachim Aerts, Erasmus MC Cancer Institute, Rotterdam, the Netherlands; Kazuhiko Nakagawa, Kinki University Hospital, Osaka, Japan; and Paul Lorigan, the Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Libor Havel
- Martin Reck, LungenClinic Grosshansdorf, Airway Research Center North, Grosshansdorf; Michael Thomas, Translational Lung Research Center Heidelberg, Thoraxklinik im Universitätsklinikum Heidelberg, Heidelberg, Germany; Alexander Luft, Leningrad Regional Clinical Hospital, Leningrad, Russia; Aleksandra Szczesna, Mazowieckie Centrum Leczenia Chorob Pluc i Gruzlicy w Otwocku, Otwocku, Poland; Libor Havel, Hospital Na Bulovce, Prague, Czech Republic; Sang-We Kim, Asan Medical Center and University of Ulsan College of Medicine, Seoul, Korea; Wallace Akerley, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; Maria Catherine Pietanza, Memorial Sloan Kettering Cancer Center, New York, NY; Kathryn Gold, University of Texas MD Anderson Cancer Center, Houston, TX; Leora Horn, Vanderbilt-Ingram Cancer Center; David Spigel, Sarah Cannon Research Institute and Tennessee Oncology, Nashville, TN; Anne Pieters, Teresa Kong Sanchez, and Justin Fairchild, Bristol-Myers Squibb, Princeton, NJ; Yi-long Wu, Guangdong Lung Cancer Institute, Guangdong General Hospital, Guangdong, People's Republic of China; Christoph Zielinski, Medical University of Vienna, Vienna, Austria; Enriqueta Felip, Vall d'Hebron University Hospital, Barcelona, Spain; Joachim Aerts, Erasmus MC Cancer Institute, Rotterdam, the Netherlands; Kazuhiko Nakagawa, Kinki University Hospital, Osaka, Japan; and Paul Lorigan, the Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Sang-We Kim
- Martin Reck, LungenClinic Grosshansdorf, Airway Research Center North, Grosshansdorf; Michael Thomas, Translational Lung Research Center Heidelberg, Thoraxklinik im Universitätsklinikum Heidelberg, Heidelberg, Germany; Alexander Luft, Leningrad Regional Clinical Hospital, Leningrad, Russia; Aleksandra Szczesna, Mazowieckie Centrum Leczenia Chorob Pluc i Gruzlicy w Otwocku, Otwocku, Poland; Libor Havel, Hospital Na Bulovce, Prague, Czech Republic; Sang-We Kim, Asan Medical Center and University of Ulsan College of Medicine, Seoul, Korea; Wallace Akerley, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; Maria Catherine Pietanza, Memorial Sloan Kettering Cancer Center, New York, NY; Kathryn Gold, University of Texas MD Anderson Cancer Center, Houston, TX; Leora Horn, Vanderbilt-Ingram Cancer Center; David Spigel, Sarah Cannon Research Institute and Tennessee Oncology, Nashville, TN; Anne Pieters, Teresa Kong Sanchez, and Justin Fairchild, Bristol-Myers Squibb, Princeton, NJ; Yi-long Wu, Guangdong Lung Cancer Institute, Guangdong General Hospital, Guangdong, People's Republic of China; Christoph Zielinski, Medical University of Vienna, Vienna, Austria; Enriqueta Felip, Vall d'Hebron University Hospital, Barcelona, Spain; Joachim Aerts, Erasmus MC Cancer Institute, Rotterdam, the Netherlands; Kazuhiko Nakagawa, Kinki University Hospital, Osaka, Japan; and Paul Lorigan, the Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Wallace Akerley
- Martin Reck, LungenClinic Grosshansdorf, Airway Research Center North, Grosshansdorf; Michael Thomas, Translational Lung Research Center Heidelberg, Thoraxklinik im Universitätsklinikum Heidelberg, Heidelberg, Germany; Alexander Luft, Leningrad Regional Clinical Hospital, Leningrad, Russia; Aleksandra Szczesna, Mazowieckie Centrum Leczenia Chorob Pluc i Gruzlicy w Otwocku, Otwocku, Poland; Libor Havel, Hospital Na Bulovce, Prague, Czech Republic; Sang-We Kim, Asan Medical Center and University of Ulsan College of Medicine, Seoul, Korea; Wallace Akerley, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; Maria Catherine Pietanza, Memorial Sloan Kettering Cancer Center, New York, NY; Kathryn Gold, University of Texas MD Anderson Cancer Center, Houston, TX; Leora Horn, Vanderbilt-Ingram Cancer Center; David Spigel, Sarah Cannon Research Institute and Tennessee Oncology, Nashville, TN; Anne Pieters, Teresa Kong Sanchez, and Justin Fairchild, Bristol-Myers Squibb, Princeton, NJ; Yi-long Wu, Guangdong Lung Cancer Institute, Guangdong General Hospital, Guangdong, People's Republic of China; Christoph Zielinski, Medical University of Vienna, Vienna, Austria; Enriqueta Felip, Vall d'Hebron University Hospital, Barcelona, Spain; Joachim Aerts, Erasmus MC Cancer Institute, Rotterdam, the Netherlands; Kazuhiko Nakagawa, Kinki University Hospital, Osaka, Japan; and Paul Lorigan, the Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Maria Catherine Pietanza
- Martin Reck, LungenClinic Grosshansdorf, Airway Research Center North, Grosshansdorf; Michael Thomas, Translational Lung Research Center Heidelberg, Thoraxklinik im Universitätsklinikum Heidelberg, Heidelberg, Germany; Alexander Luft, Leningrad Regional Clinical Hospital, Leningrad, Russia; Aleksandra Szczesna, Mazowieckie Centrum Leczenia Chorob Pluc i Gruzlicy w Otwocku, Otwocku, Poland; Libor Havel, Hospital Na Bulovce, Prague, Czech Republic; Sang-We Kim, Asan Medical Center and University of Ulsan College of Medicine, Seoul, Korea; Wallace Akerley, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; Maria Catherine Pietanza, Memorial Sloan Kettering Cancer Center, New York, NY; Kathryn Gold, University of Texas MD Anderson Cancer Center, Houston, TX; Leora Horn, Vanderbilt-Ingram Cancer Center; David Spigel, Sarah Cannon Research Institute and Tennessee Oncology, Nashville, TN; Anne Pieters, Teresa Kong Sanchez, and Justin Fairchild, Bristol-Myers Squibb, Princeton, NJ; Yi-long Wu, Guangdong Lung Cancer Institute, Guangdong General Hospital, Guangdong, People's Republic of China; Christoph Zielinski, Medical University of Vienna, Vienna, Austria; Enriqueta Felip, Vall d'Hebron University Hospital, Barcelona, Spain; Joachim Aerts, Erasmus MC Cancer Institute, Rotterdam, the Netherlands; Kazuhiko Nakagawa, Kinki University Hospital, Osaka, Japan; and Paul Lorigan, the Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Yi-Long Wu
- Martin Reck, LungenClinic Grosshansdorf, Airway Research Center North, Grosshansdorf; Michael Thomas, Translational Lung Research Center Heidelberg, Thoraxklinik im Universitätsklinikum Heidelberg, Heidelberg, Germany; Alexander Luft, Leningrad Regional Clinical Hospital, Leningrad, Russia; Aleksandra Szczesna, Mazowieckie Centrum Leczenia Chorob Pluc i Gruzlicy w Otwocku, Otwocku, Poland; Libor Havel, Hospital Na Bulovce, Prague, Czech Republic; Sang-We Kim, Asan Medical Center and University of Ulsan College of Medicine, Seoul, Korea; Wallace Akerley, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; Maria Catherine Pietanza, Memorial Sloan Kettering Cancer Center, New York, NY; Kathryn Gold, University of Texas MD Anderson Cancer Center, Houston, TX; Leora Horn, Vanderbilt-Ingram Cancer Center; David Spigel, Sarah Cannon Research Institute and Tennessee Oncology, Nashville, TN; Anne Pieters, Teresa Kong Sanchez, and Justin Fairchild, Bristol-Myers Squibb, Princeton, NJ; Yi-long Wu, Guangdong Lung Cancer Institute, Guangdong General Hospital, Guangdong, People's Republic of China; Christoph Zielinski, Medical University of Vienna, Vienna, Austria; Enriqueta Felip, Vall d'Hebron University Hospital, Barcelona, Spain; Joachim Aerts, Erasmus MC Cancer Institute, Rotterdam, the Netherlands; Kazuhiko Nakagawa, Kinki University Hospital, Osaka, Japan; and Paul Lorigan, the Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Christoph Zielinski
- Martin Reck, LungenClinic Grosshansdorf, Airway Research Center North, Grosshansdorf; Michael Thomas, Translational Lung Research Center Heidelberg, Thoraxklinik im Universitätsklinikum Heidelberg, Heidelberg, Germany; Alexander Luft, Leningrad Regional Clinical Hospital, Leningrad, Russia; Aleksandra Szczesna, Mazowieckie Centrum Leczenia Chorob Pluc i Gruzlicy w Otwocku, Otwocku, Poland; Libor Havel, Hospital Na Bulovce, Prague, Czech Republic; Sang-We Kim, Asan Medical Center and University of Ulsan College of Medicine, Seoul, Korea; Wallace Akerley, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; Maria Catherine Pietanza, Memorial Sloan Kettering Cancer Center, New York, NY; Kathryn Gold, University of Texas MD Anderson Cancer Center, Houston, TX; Leora Horn, Vanderbilt-Ingram Cancer Center; David Spigel, Sarah Cannon Research Institute and Tennessee Oncology, Nashville, TN; Anne Pieters, Teresa Kong Sanchez, and Justin Fairchild, Bristol-Myers Squibb, Princeton, NJ; Yi-long Wu, Guangdong Lung Cancer Institute, Guangdong General Hospital, Guangdong, People's Republic of China; Christoph Zielinski, Medical University of Vienna, Vienna, Austria; Enriqueta Felip, Vall d'Hebron University Hospital, Barcelona, Spain; Joachim Aerts, Erasmus MC Cancer Institute, Rotterdam, the Netherlands; Kazuhiko Nakagawa, Kinki University Hospital, Osaka, Japan; and Paul Lorigan, the Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Michael Thomas
- Martin Reck, LungenClinic Grosshansdorf, Airway Research Center North, Grosshansdorf; Michael Thomas, Translational Lung Research Center Heidelberg, Thoraxklinik im Universitätsklinikum Heidelberg, Heidelberg, Germany; Alexander Luft, Leningrad Regional Clinical Hospital, Leningrad, Russia; Aleksandra Szczesna, Mazowieckie Centrum Leczenia Chorob Pluc i Gruzlicy w Otwocku, Otwocku, Poland; Libor Havel, Hospital Na Bulovce, Prague, Czech Republic; Sang-We Kim, Asan Medical Center and University of Ulsan College of Medicine, Seoul, Korea; Wallace Akerley, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; Maria Catherine Pietanza, Memorial Sloan Kettering Cancer Center, New York, NY; Kathryn Gold, University of Texas MD Anderson Cancer Center, Houston, TX; Leora Horn, Vanderbilt-Ingram Cancer Center; David Spigel, Sarah Cannon Research Institute and Tennessee Oncology, Nashville, TN; Anne Pieters, Teresa Kong Sanchez, and Justin Fairchild, Bristol-Myers Squibb, Princeton, NJ; Yi-long Wu, Guangdong Lung Cancer Institute, Guangdong General Hospital, Guangdong, People's Republic of China; Christoph Zielinski, Medical University of Vienna, Vienna, Austria; Enriqueta Felip, Vall d'Hebron University Hospital, Barcelona, Spain; Joachim Aerts, Erasmus MC Cancer Institute, Rotterdam, the Netherlands; Kazuhiko Nakagawa, Kinki University Hospital, Osaka, Japan; and Paul Lorigan, the Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Enriqueta Felip
- Martin Reck, LungenClinic Grosshansdorf, Airway Research Center North, Grosshansdorf; Michael Thomas, Translational Lung Research Center Heidelberg, Thoraxklinik im Universitätsklinikum Heidelberg, Heidelberg, Germany; Alexander Luft, Leningrad Regional Clinical Hospital, Leningrad, Russia; Aleksandra Szczesna, Mazowieckie Centrum Leczenia Chorob Pluc i Gruzlicy w Otwocku, Otwocku, Poland; Libor Havel, Hospital Na Bulovce, Prague, Czech Republic; Sang-We Kim, Asan Medical Center and University of Ulsan College of Medicine, Seoul, Korea; Wallace Akerley, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; Maria Catherine Pietanza, Memorial Sloan Kettering Cancer Center, New York, NY; Kathryn Gold, University of Texas MD Anderson Cancer Center, Houston, TX; Leora Horn, Vanderbilt-Ingram Cancer Center; David Spigel, Sarah Cannon Research Institute and Tennessee Oncology, Nashville, TN; Anne Pieters, Teresa Kong Sanchez, and Justin Fairchild, Bristol-Myers Squibb, Princeton, NJ; Yi-long Wu, Guangdong Lung Cancer Institute, Guangdong General Hospital, Guangdong, People's Republic of China; Christoph Zielinski, Medical University of Vienna, Vienna, Austria; Enriqueta Felip, Vall d'Hebron University Hospital, Barcelona, Spain; Joachim Aerts, Erasmus MC Cancer Institute, Rotterdam, the Netherlands; Kazuhiko Nakagawa, Kinki University Hospital, Osaka, Japan; and Paul Lorigan, the Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Kathryn Gold
- Martin Reck, LungenClinic Grosshansdorf, Airway Research Center North, Grosshansdorf; Michael Thomas, Translational Lung Research Center Heidelberg, Thoraxklinik im Universitätsklinikum Heidelberg, Heidelberg, Germany; Alexander Luft, Leningrad Regional Clinical Hospital, Leningrad, Russia; Aleksandra Szczesna, Mazowieckie Centrum Leczenia Chorob Pluc i Gruzlicy w Otwocku, Otwocku, Poland; Libor Havel, Hospital Na Bulovce, Prague, Czech Republic; Sang-We Kim, Asan Medical Center and University of Ulsan College of Medicine, Seoul, Korea; Wallace Akerley, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; Maria Catherine Pietanza, Memorial Sloan Kettering Cancer Center, New York, NY; Kathryn Gold, University of Texas MD Anderson Cancer Center, Houston, TX; Leora Horn, Vanderbilt-Ingram Cancer Center; David Spigel, Sarah Cannon Research Institute and Tennessee Oncology, Nashville, TN; Anne Pieters, Teresa Kong Sanchez, and Justin Fairchild, Bristol-Myers Squibb, Princeton, NJ; Yi-long Wu, Guangdong Lung Cancer Institute, Guangdong General Hospital, Guangdong, People's Republic of China; Christoph Zielinski, Medical University of Vienna, Vienna, Austria; Enriqueta Felip, Vall d'Hebron University Hospital, Barcelona, Spain; Joachim Aerts, Erasmus MC Cancer Institute, Rotterdam, the Netherlands; Kazuhiko Nakagawa, Kinki University Hospital, Osaka, Japan; and Paul Lorigan, the Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Leora Horn
- Martin Reck, LungenClinic Grosshansdorf, Airway Research Center North, Grosshansdorf; Michael Thomas, Translational Lung Research Center Heidelberg, Thoraxklinik im Universitätsklinikum Heidelberg, Heidelberg, Germany; Alexander Luft, Leningrad Regional Clinical Hospital, Leningrad, Russia; Aleksandra Szczesna, Mazowieckie Centrum Leczenia Chorob Pluc i Gruzlicy w Otwocku, Otwocku, Poland; Libor Havel, Hospital Na Bulovce, Prague, Czech Republic; Sang-We Kim, Asan Medical Center and University of Ulsan College of Medicine, Seoul, Korea; Wallace Akerley, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; Maria Catherine Pietanza, Memorial Sloan Kettering Cancer Center, New York, NY; Kathryn Gold, University of Texas MD Anderson Cancer Center, Houston, TX; Leora Horn, Vanderbilt-Ingram Cancer Center; David Spigel, Sarah Cannon Research Institute and Tennessee Oncology, Nashville, TN; Anne Pieters, Teresa Kong Sanchez, and Justin Fairchild, Bristol-Myers Squibb, Princeton, NJ; Yi-long Wu, Guangdong Lung Cancer Institute, Guangdong General Hospital, Guangdong, People's Republic of China; Christoph Zielinski, Medical University of Vienna, Vienna, Austria; Enriqueta Felip, Vall d'Hebron University Hospital, Barcelona, Spain; Joachim Aerts, Erasmus MC Cancer Institute, Rotterdam, the Netherlands; Kazuhiko Nakagawa, Kinki University Hospital, Osaka, Japan; and Paul Lorigan, the Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Joachim Aerts
- Martin Reck, LungenClinic Grosshansdorf, Airway Research Center North, Grosshansdorf; Michael Thomas, Translational Lung Research Center Heidelberg, Thoraxklinik im Universitätsklinikum Heidelberg, Heidelberg, Germany; Alexander Luft, Leningrad Regional Clinical Hospital, Leningrad, Russia; Aleksandra Szczesna, Mazowieckie Centrum Leczenia Chorob Pluc i Gruzlicy w Otwocku, Otwocku, Poland; Libor Havel, Hospital Na Bulovce, Prague, Czech Republic; Sang-We Kim, Asan Medical Center and University of Ulsan College of Medicine, Seoul, Korea; Wallace Akerley, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; Maria Catherine Pietanza, Memorial Sloan Kettering Cancer Center, New York, NY; Kathryn Gold, University of Texas MD Anderson Cancer Center, Houston, TX; Leora Horn, Vanderbilt-Ingram Cancer Center; David Spigel, Sarah Cannon Research Institute and Tennessee Oncology, Nashville, TN; Anne Pieters, Teresa Kong Sanchez, and Justin Fairchild, Bristol-Myers Squibb, Princeton, NJ; Yi-long Wu, Guangdong Lung Cancer Institute, Guangdong General Hospital, Guangdong, People's Republic of China; Christoph Zielinski, Medical University of Vienna, Vienna, Austria; Enriqueta Felip, Vall d'Hebron University Hospital, Barcelona, Spain; Joachim Aerts, Erasmus MC Cancer Institute, Rotterdam, the Netherlands; Kazuhiko Nakagawa, Kinki University Hospital, Osaka, Japan; and Paul Lorigan, the Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Kazuhiko Nakagawa
- Martin Reck, LungenClinic Grosshansdorf, Airway Research Center North, Grosshansdorf; Michael Thomas, Translational Lung Research Center Heidelberg, Thoraxklinik im Universitätsklinikum Heidelberg, Heidelberg, Germany; Alexander Luft, Leningrad Regional Clinical Hospital, Leningrad, Russia; Aleksandra Szczesna, Mazowieckie Centrum Leczenia Chorob Pluc i Gruzlicy w Otwocku, Otwocku, Poland; Libor Havel, Hospital Na Bulovce, Prague, Czech Republic; Sang-We Kim, Asan Medical Center and University of Ulsan College of Medicine, Seoul, Korea; Wallace Akerley, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; Maria Catherine Pietanza, Memorial Sloan Kettering Cancer Center, New York, NY; Kathryn Gold, University of Texas MD Anderson Cancer Center, Houston, TX; Leora Horn, Vanderbilt-Ingram Cancer Center; David Spigel, Sarah Cannon Research Institute and Tennessee Oncology, Nashville, TN; Anne Pieters, Teresa Kong Sanchez, and Justin Fairchild, Bristol-Myers Squibb, Princeton, NJ; Yi-long Wu, Guangdong Lung Cancer Institute, Guangdong General Hospital, Guangdong, People's Republic of China; Christoph Zielinski, Medical University of Vienna, Vienna, Austria; Enriqueta Felip, Vall d'Hebron University Hospital, Barcelona, Spain; Joachim Aerts, Erasmus MC Cancer Institute, Rotterdam, the Netherlands; Kazuhiko Nakagawa, Kinki University Hospital, Osaka, Japan; and Paul Lorigan, the Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Paul Lorigan
- Martin Reck, LungenClinic Grosshansdorf, Airway Research Center North, Grosshansdorf; Michael Thomas, Translational Lung Research Center Heidelberg, Thoraxklinik im Universitätsklinikum Heidelberg, Heidelberg, Germany; Alexander Luft, Leningrad Regional Clinical Hospital, Leningrad, Russia; Aleksandra Szczesna, Mazowieckie Centrum Leczenia Chorob Pluc i Gruzlicy w Otwocku, Otwocku, Poland; Libor Havel, Hospital Na Bulovce, Prague, Czech Republic; Sang-We Kim, Asan Medical Center and University of Ulsan College of Medicine, Seoul, Korea; Wallace Akerley, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; Maria Catherine Pietanza, Memorial Sloan Kettering Cancer Center, New York, NY; Kathryn Gold, University of Texas MD Anderson Cancer Center, Houston, TX; Leora Horn, Vanderbilt-Ingram Cancer Center; David Spigel, Sarah Cannon Research Institute and Tennessee Oncology, Nashville, TN; Anne Pieters, Teresa Kong Sanchez, and Justin Fairchild, Bristol-Myers Squibb, Princeton, NJ; Yi-long Wu, Guangdong Lung Cancer Institute, Guangdong General Hospital, Guangdong, People's Republic of China; Christoph Zielinski, Medical University of Vienna, Vienna, Austria; Enriqueta Felip, Vall d'Hebron University Hospital, Barcelona, Spain; Joachim Aerts, Erasmus MC Cancer Institute, Rotterdam, the Netherlands; Kazuhiko Nakagawa, Kinki University Hospital, Osaka, Japan; and Paul Lorigan, the Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Anne Pieters
- Martin Reck, LungenClinic Grosshansdorf, Airway Research Center North, Grosshansdorf; Michael Thomas, Translational Lung Research Center Heidelberg, Thoraxklinik im Universitätsklinikum Heidelberg, Heidelberg, Germany; Alexander Luft, Leningrad Regional Clinical Hospital, Leningrad, Russia; Aleksandra Szczesna, Mazowieckie Centrum Leczenia Chorob Pluc i Gruzlicy w Otwocku, Otwocku, Poland; Libor Havel, Hospital Na Bulovce, Prague, Czech Republic; Sang-We Kim, Asan Medical Center and University of Ulsan College of Medicine, Seoul, Korea; Wallace Akerley, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; Maria Catherine Pietanza, Memorial Sloan Kettering Cancer Center, New York, NY; Kathryn Gold, University of Texas MD Anderson Cancer Center, Houston, TX; Leora Horn, Vanderbilt-Ingram Cancer Center; David Spigel, Sarah Cannon Research Institute and Tennessee Oncology, Nashville, TN; Anne Pieters, Teresa Kong Sanchez, and Justin Fairchild, Bristol-Myers Squibb, Princeton, NJ; Yi-long Wu, Guangdong Lung Cancer Institute, Guangdong General Hospital, Guangdong, People's Republic of China; Christoph Zielinski, Medical University of Vienna, Vienna, Austria; Enriqueta Felip, Vall d'Hebron University Hospital, Barcelona, Spain; Joachim Aerts, Erasmus MC Cancer Institute, Rotterdam, the Netherlands; Kazuhiko Nakagawa, Kinki University Hospital, Osaka, Japan; and Paul Lorigan, the Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Teresa Kong Sanchez
- Martin Reck, LungenClinic Grosshansdorf, Airway Research Center North, Grosshansdorf; Michael Thomas, Translational Lung Research Center Heidelberg, Thoraxklinik im Universitätsklinikum Heidelberg, Heidelberg, Germany; Alexander Luft, Leningrad Regional Clinical Hospital, Leningrad, Russia; Aleksandra Szczesna, Mazowieckie Centrum Leczenia Chorob Pluc i Gruzlicy w Otwocku, Otwocku, Poland; Libor Havel, Hospital Na Bulovce, Prague, Czech Republic; Sang-We Kim, Asan Medical Center and University of Ulsan College of Medicine, Seoul, Korea; Wallace Akerley, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; Maria Catherine Pietanza, Memorial Sloan Kettering Cancer Center, New York, NY; Kathryn Gold, University of Texas MD Anderson Cancer Center, Houston, TX; Leora Horn, Vanderbilt-Ingram Cancer Center; David Spigel, Sarah Cannon Research Institute and Tennessee Oncology, Nashville, TN; Anne Pieters, Teresa Kong Sanchez, and Justin Fairchild, Bristol-Myers Squibb, Princeton, NJ; Yi-long Wu, Guangdong Lung Cancer Institute, Guangdong General Hospital, Guangdong, People's Republic of China; Christoph Zielinski, Medical University of Vienna, Vienna, Austria; Enriqueta Felip, Vall d'Hebron University Hospital, Barcelona, Spain; Joachim Aerts, Erasmus MC Cancer Institute, Rotterdam, the Netherlands; Kazuhiko Nakagawa, Kinki University Hospital, Osaka, Japan; and Paul Lorigan, the Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Justin Fairchild
- Martin Reck, LungenClinic Grosshansdorf, Airway Research Center North, Grosshansdorf; Michael Thomas, Translational Lung Research Center Heidelberg, Thoraxklinik im Universitätsklinikum Heidelberg, Heidelberg, Germany; Alexander Luft, Leningrad Regional Clinical Hospital, Leningrad, Russia; Aleksandra Szczesna, Mazowieckie Centrum Leczenia Chorob Pluc i Gruzlicy w Otwocku, Otwocku, Poland; Libor Havel, Hospital Na Bulovce, Prague, Czech Republic; Sang-We Kim, Asan Medical Center and University of Ulsan College of Medicine, Seoul, Korea; Wallace Akerley, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; Maria Catherine Pietanza, Memorial Sloan Kettering Cancer Center, New York, NY; Kathryn Gold, University of Texas MD Anderson Cancer Center, Houston, TX; Leora Horn, Vanderbilt-Ingram Cancer Center; David Spigel, Sarah Cannon Research Institute and Tennessee Oncology, Nashville, TN; Anne Pieters, Teresa Kong Sanchez, and Justin Fairchild, Bristol-Myers Squibb, Princeton, NJ; Yi-long Wu, Guangdong Lung Cancer Institute, Guangdong General Hospital, Guangdong, People's Republic of China; Christoph Zielinski, Medical University of Vienna, Vienna, Austria; Enriqueta Felip, Vall d'Hebron University Hospital, Barcelona, Spain; Joachim Aerts, Erasmus MC Cancer Institute, Rotterdam, the Netherlands; Kazuhiko Nakagawa, Kinki University Hospital, Osaka, Japan; and Paul Lorigan, the Christie NHS Foundation Trust, Manchester, United Kingdom
| | - David Spigel
- Martin Reck, LungenClinic Grosshansdorf, Airway Research Center North, Grosshansdorf; Michael Thomas, Translational Lung Research Center Heidelberg, Thoraxklinik im Universitätsklinikum Heidelberg, Heidelberg, Germany; Alexander Luft, Leningrad Regional Clinical Hospital, Leningrad, Russia; Aleksandra Szczesna, Mazowieckie Centrum Leczenia Chorob Pluc i Gruzlicy w Otwocku, Otwocku, Poland; Libor Havel, Hospital Na Bulovce, Prague, Czech Republic; Sang-We Kim, Asan Medical Center and University of Ulsan College of Medicine, Seoul, Korea; Wallace Akerley, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; Maria Catherine Pietanza, Memorial Sloan Kettering Cancer Center, New York, NY; Kathryn Gold, University of Texas MD Anderson Cancer Center, Houston, TX; Leora Horn, Vanderbilt-Ingram Cancer Center; David Spigel, Sarah Cannon Research Institute and Tennessee Oncology, Nashville, TN; Anne Pieters, Teresa Kong Sanchez, and Justin Fairchild, Bristol-Myers Squibb, Princeton, NJ; Yi-long Wu, Guangdong Lung Cancer Institute, Guangdong General Hospital, Guangdong, People's Republic of China; Christoph Zielinski, Medical University of Vienna, Vienna, Austria; Enriqueta Felip, Vall d'Hebron University Hospital, Barcelona, Spain; Joachim Aerts, Erasmus MC Cancer Institute, Rotterdam, the Netherlands; Kazuhiko Nakagawa, Kinki University Hospital, Osaka, Japan; and Paul Lorigan, the Christie NHS Foundation Trust, Manchester, United Kingdom
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31
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Zhang X, Yu J, Zhu H, Meng X, Li M, Jiang L, Ding X, Sun X. Consolidative thoracic radiotherapy for extensive stage small cell lung cancer. Oncotarget 2017; 8:22251-22261. [PMID: 28118612 PMCID: PMC5400661 DOI: 10.18632/oncotarget.14759] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 01/11/2017] [Indexed: 12/23/2022] Open
Abstract
Extensive stage small cell lung cancer (ES-SCLC) represents approximately half of all diagnosed small cell lung cancer worldwide. It is notorious for a high risk of local recurrence although it’s sensitive to chemotherapy. Nearly 90% of intrathoracic failures happen in the first year after diagnosis. The cornerstone of treatment for ES-SCLC is etoposide-platinum based chemotherapy. Consolidative radiotherapy to thorax has diminished the incidence of local relapse, therefore it should be offered to patients with excellent response to induction first-line chemotherapy. This review centers on the clinical evidence for the use of thoracic radiotherapy (TRT) and current modalities of TRT delivery, then tries to determine a feasible way to conduct TRT in a selective group of cases.
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Affiliation(s)
- Xiaoli Zhang
- . Department of Oncology, Renmin Hospital of Wuhan University, Wuhan, China.,. Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Science, Jinan, China
| | - Jinming Yu
- . Department of Oncology, Renmin Hospital of Wuhan University, Wuhan, China.,. Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Science, Jinan, China.,. Shandong Academy of Medical Sciences, Jinan University, Jinan, China
| | - Hui Zhu
- . Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Science, Jinan, China.,. Shandong Academy of Medical Sciences, Jinan University, Jinan, China
| | - Xue Meng
- . Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Science, Jinan, China.,. Shandong Academy of Medical Sciences, Jinan University, Jinan, China
| | - Minghuan Li
- . Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Science, Jinan, China.,. Shandong Academy of Medical Sciences, Jinan University, Jinan, China
| | - Liyang Jiang
- . Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Science, Jinan, China.,. Shandong Academy of Medical Sciences, Jinan University, Jinan, China
| | - Xingchen Ding
- . Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Science, Jinan, China.,. Weifang Medical University, Weifang, China
| | - Xindong Sun
- . Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Science, Jinan, China.,. Shandong Academy of Medical Sciences, Jinan University, Jinan, China
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32
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Postmus PE, Smit EF. Prophylactic cranial irradiation for stage IV small cell lung cancer, live longer or reduce morbidity of brain metastases? J Thorac Dis 2017; 9:3572-3575. [PMID: 29268344 DOI: 10.21037/jtd.2017.09.50] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Pieter E Postmus
- Department of Medical Oncology, Clatterbridge Cancer Centre, Liverpool Heart & Chest Hospital, University of Liverpool, Liverpool, UK
| | - Egbert F Smit
- Department of Thoracic Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
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33
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Hamel JF, Saulnier P, Pe M, Zikos E, Musoro J, Coens C, Bottomley A. A systematic review of the quality of statistical methods employed for analysing quality of life data in cancer randomised controlled trials. Eur J Cancer 2017; 83:166-176. [DOI: 10.1016/j.ejca.2017.06.025] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 06/21/2017] [Indexed: 11/27/2022]
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34
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Jeremic B, Gomez-Caamano A, Dubinsky P, Cihoric N, Casas F, Filipovic N. Radiation Therapy in Extensive Stage Small Cell Lung Cancer. Front Oncol 2017; 7:169. [PMID: 28848708 PMCID: PMC5554488 DOI: 10.3389/fonc.2017.00169] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 07/26/2017] [Indexed: 11/13/2022] Open
Abstract
Lung cancer is the major cancer killer in the Western world, with the small cell lung cancer (SCLC) representing around 15–20% of all lung cancers. Extensive disease small cell lung cancer (ED SCLC) is found in approximately two-thirds of all cases, composed of both metastatic (M1) and non-metastatic (but presumably with tumor burden too large for locoregional-only approach) variant. Standard treatment options involve chemotherapy (CHT) over the past several decades. Radiation therapy (RT) had mostly been used in palliation of locoregional and/or metastatic disease. In contrast to its established role in treating metastatic disease, thoracic RT (TRT) had never been established as important part of the treatment aspects in this setting. In the past two decades, thoracic oncologists have witnessed wide introduction of modern RT and CHT aspects in ED SCLC, which led to more frequent use of RT and rise in the number of clinical studies. Since the pivotal study of Jeremic et al., who were the first to show importance of TRT in ED SCLC, a number of single-institutional studies have reconfirmed this observation, while recent prospective randomized trials (CREST and RTOG 0937) brought more substance to this issue. Similarly, the issue of prophylactic cranial irradiation was investigated in EORTC and the Japanese study, respectively, bringing somewhat conflicting results and calling for additional research in this setting. Future studies in ED SCLC could incorporate questions of RT dose and fractionation as well as the number of CHT cycles and type of combined Rt-CHT (sequential vs concurrent).
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Affiliation(s)
| | - Antonio Gomez-Caamano
- Hospital Clínico Universitario, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
| | - Pavol Dubinsky
- East Slovakia Institute of Oncology, Louis Pasteur University Hospital, Kosice, Slovakia
| | - Nikola Cihoric
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Nenad Filipovic
- BioIRC Centre for Biomedical Research, BioIRC, Kragujevac, Serbia
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35
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Han D, Wang G, Sun L, Ren X, Shang W, Xu L, Li S. Comparison of irinotecan/platinum versus etoposide/platinum chemotherapy for extensive-stage small cell lung cancer: A meta-analysis. Eur J Cancer Care (Engl) 2017; 26. [PMID: 28707433 DOI: 10.1111/ecc.12723] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2017] [Indexed: 12/11/2022]
Abstract
This meta-analysis was performed to compare the effects and toxicities between irinotecan/platinum (IP) and etoposide/platinum (EP) regimens as the fist-line treatment of patients with extensive-stage small cell lung cancer (E-SCLC). A systematic search was made of MEDLINE, Cochrane, ISI Web of Science and SCOPUS databases. Randomised clinical trials on treatment of E-SCLC with the IP regimens, compared with EP regimens, were reviewed. Studies were pooled to hazard ratio (HR), relative risk (RR) and odds ratio (OR), with 95% confidence interval (CI). Eight trials (enrolling 2089 participants) met the inclusion criteria. Overall survival (OS) and 1-year survival rate were superior in the IP group (HR 0.83; 95% CI 0.75 to 0.91 and RR 1.19; 95% CI 1.06 to 1.34). Grades 3 and 4 anaemia, leukopenia, neutropenia, thrombocytopenia and febrile neutropenia were less frequent in the IP regimens than that in the EP regimens. And grades 3 and 4 nausea/vomiting, diarrheal, anorexia and fatigue were less frequent in the EP regimens. IP combination chemotherapy achieved a superior OS and 1-year survival rate, compared with EP doublets, in patients with E-SCLC.
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Affiliation(s)
- D Han
- Department of Respiratory and Critical Care Medicine, Shaanxi Provincial People's Hospital, Xi'an, China
| | - G Wang
- Department of Respiratory and Critical Care Medicine, Shaanxi Provincial People's Hospital, Xi'an, China
| | - L Sun
- Department of Respiratory and Critical Care Medicine, Shaanxi Provincial People's Hospital, Xi'an, China
| | - X Ren
- Department of Respiratory and Critical Care Medicine, Shaanxi Provincial People's Hospital, Xi'an, China
| | - W Shang
- Department of Respiratory and Critical Care Medicine, Shaanxi Provincial People's Hospital, Xi'an, China
| | - L Xu
- Department of Respiratory and Critical Care Medicine, Shaanxi Provincial People's Hospital, Xi'an, China
| | - S Li
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Medical College, Xi'an Jiaotong University, Xi'an, China
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36
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Kasajima M, Igawa S, Ishihara M, Otani S, Takakura A, Yokoba M, Kubota M, Sasaki J, Katagiri M, Masuda N. Correlation between the efficacy of amrubicin and the previous chemotherapy regimen for relapsed small cell lung cancer. Oncol Lett 2017; 13:1719-1724. [PMID: 28454315 DOI: 10.3892/ol.2017.5662] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 09/27/2016] [Indexed: 11/05/2022] Open
Abstract
Amrubicin has been demonstrated to be beneficial in the treatment of patients with relapsed small cell lung cancer (SCLC). The aim of the present study was to evaluate whether there is a significant difference in the efficacy of amrubicin between patients with relapsed SCLC who were previously treated with a platinum agent in combination with a topoisomerase I inhibitor, and those patients previously treated with a platinum agent in combination with a topoisomerase II inhibitor. The medical records of patients with SCLC, who were diagnosed as having relapsed following treatment with a platinum-based regimen and subsequently received amrubicin monotherapy, were retrospectively reviewed. Of a total of 48 patients with SCLC who were treated with amrubicin, the overall response rate, median progression-free survival (PFS) time and median survival time (MST) were determined to be 31.3%, 7.1 and 17.0 months, respectively. The response rate, PFS time and MST did not differ significantly between the patients treated previously with a platinum agent in combination with irinotecan, a topoisomerase I inhibitor, (36.4%, 5.7 and 11.4 months, respectively) and those treated previously with a platinum agent in combination with etoposide, a topoisomerase II inhibitor (30.0%, 4.7 and 14.8 months, respectively). The results indicate that amrubicin may be effective as a second-line chemotherapeutic agent for patients with SCLC, irrespective of which platinum agent and topoisomerase inhibitor-based chemotherapy regimen was previously administered.
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Affiliation(s)
- Masashi Kasajima
- Department of Respiratory Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa 252-0374, Japan
| | - Satoshi Igawa
- Department of Respiratory Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa 252-0374, Japan
| | - Mikiko Ishihara
- Department of Respiratory Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa 252-0374, Japan
| | - Sakiko Otani
- Department of Respiratory Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa 252-0374, Japan
| | - Akira Takakura
- Department of Respiratory Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa 252-0374, Japan
| | - Masanori Yokoba
- Kitasato University School of Allied Health Sciences, Sagamihara, Kanagawa 252-0373, Japan
| | - Masaru Kubota
- Department of Respiratory Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa 252-0374, Japan
| | - Jiichiro Sasaki
- Research and Development Center for New Medical Frontiers, Kitasato University School of Medicine, Sagamihara, Kanagawa 252-0374, Japan
| | - Masato Katagiri
- Kitasato University School of Allied Health Sciences, Sagamihara, Kanagawa 252-0373, Japan
| | - Noriyuki Masuda
- Department of Respiratory Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa 252-0374, Japan
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Recent developments in radiotherapy for small-cell lung cancer: a review by the Oncologic Group for the Study of Lung Cancer (Spanish Radiation Oncology Society). Clin Transl Oncol 2017; 19:1183-1192. [PMID: 28447257 DOI: 10.1007/s12094-017-1667-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 04/19/2017] [Indexed: 12/15/2022]
Abstract
Small-cell lung cancer (SCLC) accounts for 13% of all lung tumours. The standard treatment in patients with limited-stage disease is radiotherapy combined with chemotherapy. In extensive SCLC, the importance of consolidation thoracic radiotherapy in patients with a good treatment response has become increasingly recognized. In both limited and extensive disease, prophylactic cranial irradiation is recommended in patients who respond to treatment. New therapeutic approaches such as immunotherapy are being increasingly incorporated into the treatment of SCLC, although more slowly than in non-small cell lung cancer (NSCLC). Diverse radiation dose and fractionation schemes, administered in varying combinations with these new drugs, are being investigated. In the present study we review and update the role of radiotherapy in the treatment of SCLC. We also discuss the main clinical trials currently underway in order to identify future trends.
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Abstract
Small cell lung cancer (SCLC) remains a major public health problem and accounts for 10% to 15% of all lung cancers. It has unique clinical features such as rapid growth, early metastatic spread, and widespread dissemination. A platinum-etoposide combination is the backbone treatment of SCLC; addition of thoracic and prophylactic cranial irradiation has been shown to improve outcome in limited-stage SCLC and in subgroups of extensive-stage SCLC. Over the last decade, significant progress has been made in characterizing the SCLC tumor biology and its developmental pathways. Most recently, efforts have focused not only on molecular targets, but also on the development of novel drugs targeting tumor evolution and immune escape mechanisms; these approaches are promising and offer opportunities that may finally improve the outcomes of SCLC.
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39
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Shah MH, Lorigan P, O'Brien MER, Fossella FV, Moore KN, Bhatia S, Kirby M, Woll PJ. Phase I study of IMGN901, a CD56-targeting antibody-drug conjugate, in patients with CD56-positive solid tumors. Invest New Drugs 2016; 34:290-9. [PMID: 26961907 PMCID: PMC4859861 DOI: 10.1007/s10637-016-0336-9] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 02/26/2016] [Indexed: 11/29/2022]
Abstract
Background IMGN901 is a CD56-targeting antibody-drug conjugate designed for tumor-selective delivery of the cytotoxic maytansinoid DM1. This phase 1 study investigated the safety, tolerability, pharmacokinetics, and preliminary activity of IMGN901 in patients with CD56-expressing solid tumors. Methods Patients were enrolled in cohorts of escalating IMGN901 doses, administered intravenously, on 3 consecutive days every 21 days. A dose-expansion phase accrued patients with small cell lung cancer (SCLC), Merkel cell carcinoma (MCC), or ovarian cancer. Results Fifty-two patients were treated at doses escalating from 4 to 94 mg/m(2)/day. The maximum tolerated dose (MTD) was determined to be 75 mg/m(2). Dose-limiting toxicities included fatigue, neuropathy, headache or meningitis-like symptoms, chest pain, dyspnea, and myalgias. In the dose-expansion phase (n = 45), seven patients received 75 mg/m(2) and 38 received 60 mg/m(2) for up to 21 cycles. The recommended phase 2 dose (RP2D) was established at 60 mg/m(2) during dose expansion. Overall, treatment-emergent adverse events (TEAEs) were experienced by 96.9 % of all patients, the majority of which were Grade 1 or 2. The most commonly reported Grade 3 or 4 TEAEs were hyponatremia and dyspnea (each 8.2 %). Responses included 1 complete response (CR), 1 clinical CR, and 1 unconfirmed partial response (PR) in MCC; and 1 unconfirmed PR in SCLC. Stable disease was seen for 25 % of all evaluable patients who received doses ≥60 mg/m(2). Conclusions The RP2D for IMGN901 of 60 mg/m(2) administered for 3 consecutive days every 3 weeks was associated with an acceptable tolerability profile. Objective responses were observed in patients with advanced CD56+ cancers.
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Affiliation(s)
- Manisha H Shah
- Ohio State University College of Medicine, Columbus, OH, 43210, USA
| | - Paul Lorigan
- University of Manchester/Christie NHS Foundation Trust, Manchester, M20 4BX, UK
| | | | - Frank V Fossella
- Department of Thoracic/Head and Neck Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Kathleen N Moore
- University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA
| | - Shailender Bhatia
- Department of Medicine, University of Washington School of Medicine and Fred Hutchinson Cancer Research Center, Seattle, WA, 98109, USA
| | | | - Penella J Woll
- Academic Unit of Clinical Oncology, Weston Park Hospital, University of Sheffield, Whitham Road, Sheffield, S10 2SJ, UK.
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Lu Y, Fan Y. [Research Progression of Maintenance Therapy in Small Cell Lung Cancer]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2016; 18:559-64. [PMID: 26383980 PMCID: PMC6000114 DOI: 10.3779/j.issn.1009-3419.2015.09.06] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
肺癌是世界上最常见的恶性肿瘤之一,其中小细胞肺癌发生率约15%。小细胞肺癌对一线化疗高度敏感,但多数患者在一线治疗缓解后很快出现复发进展,因此,自20世纪80年代起已开展不少小细胞肺癌维持治疗的相关临床研究,涉及到化疗药物、生物制剂及分子靶向药物。但其结果仍存在争论,现对该方面内容综述如下。
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Affiliation(s)
- Yunyun Lu
- Department of Medical Oncology, Zhejiang Provincial Cancer Hospital, Hangzhou 310053, China
| | - Yun Fan
- Department of Medical Oncology, Zhejiang Provincial Cancer Hospital, Hangzhou 310053, China
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Alvarado-Luna G, Morales-Espinosa D. Treatment for small cell lung cancer, where are we now?-a review. Transl Lung Cancer Res 2016; 5:26-38. [PMID: 26958491 DOI: 10.3978/j.issn.2218-6751.2016.01.13] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Small cell lung cancer (SCLC) represents between 13% and 15% of all diagnosed lung cancers worldwide. It is an aggressive neoplasia, with a 5-year mortality of 90% or more. It has historically been classified as limited disease (LD) and extensive disease (ED) in most study protocols. The cornerstone of treatment for any stage of SCLC is etoposide-platinum based chemotherapy; in limited stage (LS), concomitant radiotherapy to thorax and mediastinum. Prophylactic radiotherapy to the central nervous system (CNS) [prophylactic cerebral irradiation (PCI)] has diminished the incidence of brain metastasis as the site for relapse in LD and ED patients, therefore it should be offered to patients with complete response to induction first-line treatment. Regarding second-line treatment, results are more modest and topotecan is accepted as treatment for this scenario offering a modest benefit.
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Affiliation(s)
- Gabriela Alvarado-Luna
- 1 Fundación Clínica, Médica Sur. Puente de piedra 150, Col Toriello Guerra, 14050 Mexico City, Mexico ; 2 Translational Research Laboratory, Catalan Institute of Oncology, Hospital Germans Trias i Pujol, Badalona, 08916 Barcelona, Spain ; 3 Dr Rosell Oncology Institute, Quirón Dexeus University Hospital, 08028 Barcelona, Spain
| | - Daniela Morales-Espinosa
- 1 Fundación Clínica, Médica Sur. Puente de piedra 150, Col Toriello Guerra, 14050 Mexico City, Mexico ; 2 Translational Research Laboratory, Catalan Institute of Oncology, Hospital Germans Trias i Pujol, Badalona, 08916 Barcelona, Spain ; 3 Dr Rosell Oncology Institute, Quirón Dexeus University Hospital, 08028 Barcelona, Spain
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Schneider BJ. Maintenance sunitinib for extensive-stage small cell lung cancer: a new standard, an option or a step in the right direction? Transl Lung Cancer Res 2015; 4:635-8. [PMID: 26629436 DOI: 10.3978/j.issn.2218-6751.2015.06.03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Systemic treatment for extensive-stage small cell lung cancer (ES-SCLC) has been stagnant for several decades. Sunitinib is a small molecule that inhibits a variety of receptor tyrosine kinases relevant in tumor biology. CALGB (Alliance) 30504 is a phase II study that investigated the use of maintenance sunitinib vs. placebo in patients with ES-SCLC after treatment with induction platinum/etoposide chemotherapy. The trial met its primary endpoint with an improvement in median progression free survival (PFS) of 1.6 months over placebo. Toxicity included grade 3 fatigue in 19% of patients. Although PFS may be a meaningful endpoint in this patient population, the modest improvement in PFS identified with maintenance sunitinib combined with the toxicity profile would not change the current standard of care. Changes in future trial design may enhance the ability to identify agents that will preserve patient functionality and prolong survival.
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Affiliation(s)
- Bryan James Schneider
- Department of Internal Medicine, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI, USA
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43
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Petrioli R, Roviello G, Laera L, Luzzi L, Paladini P, Ghiribelli C, Voltolini L, Martellucci I, Bianco V, Francini E. Cisplatin, Etoposide, and Bevacizumab Regimen Followed by Oral Etoposide and Bevacizumab Maintenance Treatment in Patients With Extensive-Stage Small Cell Lung Cancer: A Single-Institution Experience. Clin Lung Cancer 2015; 16:e229-34. [DOI: 10.1016/j.cllc.2015.05.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 05/08/2015] [Accepted: 05/12/2015] [Indexed: 01/05/2023]
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Thoracic Radiotherapy for Extensive Stage Small-Cell Lung Cancer: A Meta-Analysis. Clin Lung Cancer 2015; 17:239-44. [PMID: 26498503 DOI: 10.1016/j.cllc.2015.09.007] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 09/22/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND Thoracic radiotherapy (TRT) has been evaluated as a means of improving overall survival and progression-free survival in patients with extensive stage small-cell lung cancer (ES-SCLC). METHODS A systematic review of Medline and Embase (inception to January 2015) was undertaken to identify studies of extensive stage SCLC patients receiving platinum-based chemotherapy and randomized to receive TRT versus no TRT. Studies were screened by title (n = 2343) and then abstract (n = 72), with subsequent full-text review (n = 16). Effect estimates (hazard ratios [HR] and confidence intervals) were abstracted, with a random-effects model created to estimate treatment effects. Cochrane's Q and I(2) statistics were used to assess study heterogeneity. RESULTS Two randomized studies were identified, including a total of 604 patients (302 TRT; 302 non-TRT). All patients received prophylactic cranial irradiation. The weighted median age was 62 years, and 56% were male. TRT was delivered as 30 Gy/10 fractions (n = 247) or 54 Gy twice daily/36 fractions (n = 55). Overall, the delivery of TRT was associated with improved overall survival (HR, 0.81; 95% confidence interval, 0.69-0.96; P = .014) and progression-free survival (HR, 0.74; 95% confidence interval, 0.64-0.87, P < .001). For both end points, the studies were not found to be heterogeneous (P = .439 and P = .638 respectively, I(2) = 0). Bronchopulmonary toxicity (grade 3 or higher) was similar in both groups (≤ 2%). Esophageal toxicity (grade 3 or higher) was 6.6% in the TRT arm and 0% in the non-TRT arm (P < .001). CONCLUSION This systematic review with meta-analysis of 2 randomized trials indicates that TRT improves overall survival and progression-free survival in patients with extensive stage SCLC, with a small incremental risk of esophageal toxicity.
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Luan Z, Wang Z, Huang W, Zhang J, Dong W, Zhang W, Li B, Zhou T, Li H, Zhang Z, Wang Z, Sun H, Yi Y. Efficacy of 3D conformal thoracic radiotherapy for extensive-stage small-cell lung cancer: A retrospective study. Exp Ther Med 2015; 10:671-678. [PMID: 26622373 DOI: 10.3892/etm.2015.2526] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Accepted: 04/02/2015] [Indexed: 12/12/2022] Open
Abstract
The aim of the present study was to evaluate the effect of 3-dimensional conformal thoracic radiotherapy (TRT) on extensive-stage small-cell lung cancer (ES-SCLC). A total of 165 patients with ES-SCLC were enrolled in the present study, including 82 patients receiving chemotherapy combined with TRT (the ChT/TRT group) and 83 patients receiving chemotherapy alone (the ChT group). The overall survival (OS) and progression-free survival (PFS) rates were compared between the ChT/TRT and ChT groups, and the prognostic factors for OS rate were identified. It was found that the patients had a median OS time of 15 months, and 2- and 5-year OS rates of 31.5 and 2.4%, respectively. The 2- and 5-year OS rates were 35.3 and 2.4% in the ChT/TRT group, and 14.5 and 2.4% in the ChT group, respectively (P<0.05). The 1- and 2-year PFS rates were 35.4 and 6.0% in the ChT/TRT group, and 20.5 and 6.0% in the ChT group, respectively (P<0.05). The median PFS was 11 months in the 20 patients receiving TRT at 45 Gy/30 fractions twice daily, and 9 months in the 22 patients receiving TRT at 60 Gy/30 fractions daily (P=0.043). Multivariate analysis revealed that receiving ≥4 cycles of chemotherapy (P=0.001) and TRT (P=0.008) were favorable prognostic factors for OS. It was concluded that the addition of TRT improves the OS and PFS rates of patients with ES-SCLC, and TRT administration at 45 Gy/30 fractions twice daily is feasible and tolerable for the treatment of ES-SCLC. Thus, TRT and receiving ≥4 cycles of chemotherapy are independent, favorable prognostic factors for OS in patients with ES-SCLC.
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Affiliation(s)
- Zupeng Luan
- Department of Radiation Oncology, Cancer Hospital, Tianjin Medical University, National Clinical Research Center for Cancer, Key Laboratory if Cancer Prevention and Therapy, Tianjin 300060, P.R. China ; Department of Radiation Oncology, Shandong Cancer Hospital, Shandong Academy of Medical Sciences, Jinan, Shandong 250117, P.R. China ; Department of Radiation Oncology, Jinan Third People's Hospital, Jinan, Shandong 250101, P.R. China
| | - Zhiwu Wang
- Department of Radiation Oncology, Cancer Hospital, Tianjin Medical University, National Clinical Research Center for Cancer, Key Laboratory if Cancer Prevention and Therapy, Tianjin 300060, P.R. China ; Department of Radiation Oncology, Shandong Cancer Hospital, Shandong Academy of Medical Sciences, Jinan, Shandong 250117, P.R. China
| | - Wei Huang
- Department of Radiation Oncology, Shandong Cancer Hospital, Shandong Academy of Medical Sciences, Jinan, Shandong 250117, P.R. China
| | - Jian Zhang
- Department of Radiation Oncology, Shandong Cancer Hospital, Shandong Academy of Medical Sciences, Jinan, Shandong 250117, P.R. China
| | - Wei Dong
- Department of Radiation Oncology, Cancer Hospital, Tianjin Medical University, National Clinical Research Center for Cancer, Key Laboratory if Cancer Prevention and Therapy, Tianjin 300060, P.R. China ; Department of Radiation Oncology, Shandong Cancer Hospital, Shandong Academy of Medical Sciences, Jinan, Shandong 250117, P.R. China
| | - Wei Zhang
- Department of Radiation Oncology, Cancer Hospital, Tianjin Medical University, National Clinical Research Center for Cancer, Key Laboratory if Cancer Prevention and Therapy, Tianjin 300060, P.R. China ; Department of Radiation Oncology, Shandong Cancer Hospital, Shandong Academy of Medical Sciences, Jinan, Shandong 250117, P.R. China
| | - Baosheng Li
- Department of Radiation Oncology, Shandong Cancer Hospital, Shandong Academy of Medical Sciences, Jinan, Shandong 250117, P.R. China
| | - Tao Zhou
- Department of Radiation Oncology, Shandong Cancer Hospital, Shandong Academy of Medical Sciences, Jinan, Shandong 250117, P.R. China
| | - Hongsheng Li
- Department of Radiation Oncology, Shandong Cancer Hospital, Shandong Academy of Medical Sciences, Jinan, Shandong 250117, P.R. China
| | - Zicheng Zhang
- Department of Radiation Oncology, Shandong Cancer Hospital, Shandong Academy of Medical Sciences, Jinan, Shandong 250117, P.R. China
| | - Zhongtang Wang
- Department of Radiation Oncology, Shandong Cancer Hospital, Shandong Academy of Medical Sciences, Jinan, Shandong 250117, P.R. China
| | - Hongfu Sun
- Department of Radiation Oncology, Jinan Third People's Hospital, Jinan, Shandong 250101, P.R. China
| | - Yan Yi
- Department of Radiation Oncology, Shandong Cancer Hospital, Shandong Academy of Medical Sciences, Jinan, Shandong 250117, P.R. China
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Zhang J, Qi HW, Zheng H, Chen M, Zhu J, Xie HK, Ni J, Xu JF, Zhou CC. Etoposide-cisplatin alternating with vinorelbine-cisplatin versus etoposide-cisplatin alone in patients with extensive disease combined with small cell lung cancer. Asian Pac J Cancer Prev 2015; 15:4159-63. [PMID: 24935363 DOI: 10.7314/apjcp.2014.15.10.4159] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this study was to evaluate the efficacy of alternating etoposide-cisplatin and vinorelbine-cisplatin (EP-NP) compared with an etoposide-cisplatin (EP) regimen for advanced combined small cell carcinomas. MATERIALS AND METHODS Histologically confirmed combined small cell carcinoma patients who met the inclusion criteria were randomly assigned (1:1) into either the EP-NP setting (group A) or the EP setting (group B). The primary endpoint was progression-free survival in patients who received at least one dose of treatment. RESULTS Eighty-two patients entered into this trial, 42 in group A and 40 in group B. The objective response rates in group A and group B were 42.9% and 32.5%, respectively (p=0.334). Survival analysis showed that median progression-free survival was 6.1 months in group A, which was significantly longer than the 4.1 months in group B (p=0.041). However, as to overall survival, no significant difference was found between the two groups (11.0 vs 10.1 months in groups A and B, respectively, p=0.545). No unexpected side effects were observed in either group. CONCLUSIONS The EP-NP regimen for combined small cell carcinomas prolonged progression- free survival compared with the EP regimen. Further clinical investigations are warranted.
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Affiliation(s)
- Jie Zhang
- Department of Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China E-mail : ,
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Cho SH, Kim HK, Jang HJ, Park MJ. Modified one-day etoposide and cisplatin combination for previously untreated extensive-disease small-cell lung cancer: A retrospective evaluation of 36 cases. Mol Clin Oncol 2015; 3:914-918. [PMID: 26171206 DOI: 10.3892/mco.2015.556] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Accepted: 03/27/2015] [Indexed: 11/06/2022] Open
Abstract
The combination of etoposide and cisplatin (EP) remains one of the standard first-line treatments for extensive-disease small-cell lung cancer (ED-SCLC) We devised a one-day modified EP regimen for better tolerance and convenience by modifying the dose and schedule of conventional EP with administration over 3-5 consecutive days. The modified EP consists of two infusions of etoposide (120 mg/m2 each) and 60 mg/m2 of cisplatin on day 1 of a 21-day cycle and a maximum of 6 cycles of treatment. A total of 36 consecutive ED-SCLC patients were treated with the modified EP as first-line therapy and retrospectively reviewed to assess the efficacy and safety of this regimen. Of the 36 patients, 24 exhibited confirmed objective tumor response (overall response rate of 66%, with a complete response rate of 3% and a partial response rate of 63%). The median overall survival (OS) was 11.8 months [95% confidence interval (CI): 7.9-15.3] and the progression-free survival (PFS) was 7.3 months (95% CI: 5.2-9.7). The survival estimates at 1 year were 35 and 17% for OS and PFS, respectively. The chemotherapy treatment was well tolerated, with only one case of grade 4 non-hematological adverse events, no grade 4 hematological toxicities and no treatment-related deaths. The mean relative dose intensity of etoposide and cisplatin was measured to be 94.7 and 98.5% of the planned dose, respectively. Therefore, the modified EP warrants further clinical research regarding its effectiveness, toxicity profile and convenience of administration. Prospective randomized clinical trials are required to determine the therapeutic role of the modified EP as first-line treatment in patients with ED-SCLC.
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Affiliation(s)
- Su-Hee Cho
- Division of Hematology-Oncology, Department of Internal Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Republic of Korea
| | - Hyun Kuk Kim
- Division of Pulmonology, Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Hang Jea Jang
- Division of Pulmonology, Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Min Jae Park
- Division of Hematology-Oncology, Department of Internal Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Republic of Korea
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Febrile neutropenia in chemotherapy treated small-cell lung cancer patients. Radiol Oncol 2015; 49:173-80. [PMID: 26029029 PMCID: PMC4387994 DOI: 10.2478/raon-2014-0050] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 10/15/2014] [Indexed: 12/31/2022] Open
Abstract
Background. Chemotherapy with platinum agent and etoposide for small-cell lung cancer (SCLC) is supposed to be associated with intermediate risk (10–20%) of febrile neutropenia. Primary prophylaxis with granulocyte colony-stimulating factors (G-CSFs) is not routinely recommended by the treatment guidelines. However, in clinical practice febrile neutropenia is often observed with standard etoposide/platinum regimen. The aim of this analysis was to evaluate the frequency of neutropenia and febrile neutropenia in advanced SCLC patients in the first cycle of standard chemotherapy. Furthermore, we explored the association between severe neutropenia and etoposide peak plasma levels in the same patients. Methods. The case series based analysis of 17 patients with advanced SCLC treated with standard platinum/etoposide chemotherapy, already included in the pharmacokinetics study with etoposide, was performed. Grade 3/4 neutropenia and febrile neutropenia, observed after the first cycle are reported. The neutrophil counts were determined on day one of the second cycle unless symptoms potentially related to neutropenia occurred. Adverse events were classified according to Common Toxicity Criteria 4.0. Additionally, association between severe neutropenia and etoposide peak plasma concentrations, which were measured in the scope of pharmacokinetic study, was explored. Results. Two out of 17 patients received primary GCS-F prophylaxis. In 15 patient who did not receive primary prophylaxis the rates of both grade 3/4 neutropenia and febrile neutropenia were high (8/15 (53.3%) and 2/15 (13.3%), respectively), already in the first cycle of chemotherapy. One patient died due to febrile neutropenia related pneumonia. Neutropenic events are assumed to be related to increased etoposide plasma concentrations after a standard etoposide and cisplatin dose. While the mean etoposide peak plasma concentration in the first cycle of chemotherapy was 17.6 mg/l, the highest levels of 27.07 and 27.49 mg/l were determined in two patients with febrile neutropenia. Conclusions. Our study indicates that there is a need to reduce the risk of neutropenic events in chemotherapy treated advanced SCLC, starting in the first cycle. Mandatory use of primary G-CSF prophylaxis might be considered. Alternatively, use of improved risk models for identification of patients with increased risk for neutropenia and individualization of primary prophylaxis based on not only clinical characteristics but also on etoposide plasma concentration measurement, could be a new, promising options that deserves further evaluation.
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Ready NE, Pang HH, Gu L, Otterson GA, Thomas SP, Miller AA, Baggstrom M, Masters GA, Graziano SL, Crawford J, Bogart J, Vokes EE. Chemotherapy With or Without Maintenance Sunitinib for Untreated Extensive-Stage Small-Cell Lung Cancer: A Randomized, Double-Blind, Placebo-Controlled Phase II Study-CALGB 30504 (Alliance). J Clin Oncol 2015; 33:1660-5. [PMID: 25732163 DOI: 10.1200/jco.2014.57.3105] [Citation(s) in RCA: 107] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To evaluate the efficacy of maintenance sunitinib after chemotherapy for small-cell lung cancer (SCLC). PATIENTS AND METHODS The Cancer and Leukemia Group B 30504 trial was a randomized, placebo-controlled, phase II study that enrolled patients before chemotherapy (cisplatin 80 mg/m(2) or carboplatin area under the curve of 5 on day 1 plus etoposide 100 mg/m(2) per day on days 1 to 3 every 21 days for four to six cycles). Patients without progression were randomly assigned 1:1 to placebo or sunitinib 37.5 mg per day until progression. Cross-over after progression was allowed. The primary end point was progression-free survival (PFS) from random assignment for maintenance placebo versus sunitinib using a one-sided log-rank test with α = .15; 80 randomly assigned patients provided 89% power to detect a hazard ratio (HR) of 1.67. RESULTS One hundred forty-four patients were enrolled; 138 patients received chemotherapy. Ninety-five patients were randomly assigned; 10 patients did not receive maintenance therapy (five on each arm). Eighty-five patients received maintenance therapy (placebo, n = 41; sunitinib, n = 44). Grade 3 adverse events with more than 5% incidence were fatigue (19%), decreased neutrophils (14%), decreased leukocytes (7%), and decreased platelets (7%) for sunitinib and fatigue (10%) for placebo; grade 4 adverse events were GI hemorrhage (n = 1) and pancreatitis, hypocalcemia, and elevated lipase (n = 1; all in same patient) for sunitinib and thrombocytopenia (n = 1) and hypernatremia (n = 1) for placebo. Median PFS on maintenance was 2.1 months for placebo and 3.7 months for sunitinib (HR, 1.62; 70% CI, 1.27 to 2.08; 95% CI, 1.02 to 2.60; one-sided P = .02). Median overall survival from random assignment was 6.9 months for placebo and 9.0 months for sunitinib (HR, 1.28; 95% CI, 0.79 to 2.10; one-sided P = .16). Three sunitinib and no placebo patients achieved complete response during maintenance. Ten (77%) of 13 patients evaluable after cross-over had stable disease on sunitinib (6 to 27 weeks). CONCLUSION Maintenance sunitinib was safe and improved PFS in extensive-stage SCLC.
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Affiliation(s)
- Neal E Ready
- Neal E. Ready and Jeffrey Crawford, Duke University Medical Center; Herbert H. Pang and Lin Gu, Alliance Statistics and Data Center, Duke University Medical Center, Durham; Antonius A. Miller, Wake Forest University Medical Center, Winston Salem, NC; Gregory A. Otterson, Ohio State University Medical Center, Columbus, OH; Sachdev P. Thomas, Illinois Oncology Research Association Community Clinical Oncology Program, Illinois Cancer Care, Peoria; Everett E. Vokes, University of Chicago, Chicago, IL; Maria Baggstrom, Washington University School of Medicine, St Louis, MO; Gregory A. Masters, Christiana Healthcare Services, Christiana Hospital, Newark, DE; Stephen L. Graziano and Jeffrey Bogart, State University of New York Upstate Medical University, Syracuse, NY.
| | - Herbert H Pang
- Neal E. Ready and Jeffrey Crawford, Duke University Medical Center; Herbert H. Pang and Lin Gu, Alliance Statistics and Data Center, Duke University Medical Center, Durham; Antonius A. Miller, Wake Forest University Medical Center, Winston Salem, NC; Gregory A. Otterson, Ohio State University Medical Center, Columbus, OH; Sachdev P. Thomas, Illinois Oncology Research Association Community Clinical Oncology Program, Illinois Cancer Care, Peoria; Everett E. Vokes, University of Chicago, Chicago, IL; Maria Baggstrom, Washington University School of Medicine, St Louis, MO; Gregory A. Masters, Christiana Healthcare Services, Christiana Hospital, Newark, DE; Stephen L. Graziano and Jeffrey Bogart, State University of New York Upstate Medical University, Syracuse, NY
| | - Lin Gu
- Neal E. Ready and Jeffrey Crawford, Duke University Medical Center; Herbert H. Pang and Lin Gu, Alliance Statistics and Data Center, Duke University Medical Center, Durham; Antonius A. Miller, Wake Forest University Medical Center, Winston Salem, NC; Gregory A. Otterson, Ohio State University Medical Center, Columbus, OH; Sachdev P. Thomas, Illinois Oncology Research Association Community Clinical Oncology Program, Illinois Cancer Care, Peoria; Everett E. Vokes, University of Chicago, Chicago, IL; Maria Baggstrom, Washington University School of Medicine, St Louis, MO; Gregory A. Masters, Christiana Healthcare Services, Christiana Hospital, Newark, DE; Stephen L. Graziano and Jeffrey Bogart, State University of New York Upstate Medical University, Syracuse, NY
| | - Gregory A Otterson
- Neal E. Ready and Jeffrey Crawford, Duke University Medical Center; Herbert H. Pang and Lin Gu, Alliance Statistics and Data Center, Duke University Medical Center, Durham; Antonius A. Miller, Wake Forest University Medical Center, Winston Salem, NC; Gregory A. Otterson, Ohio State University Medical Center, Columbus, OH; Sachdev P. Thomas, Illinois Oncology Research Association Community Clinical Oncology Program, Illinois Cancer Care, Peoria; Everett E. Vokes, University of Chicago, Chicago, IL; Maria Baggstrom, Washington University School of Medicine, St Louis, MO; Gregory A. Masters, Christiana Healthcare Services, Christiana Hospital, Newark, DE; Stephen L. Graziano and Jeffrey Bogart, State University of New York Upstate Medical University, Syracuse, NY
| | - Sachdev P Thomas
- Neal E. Ready and Jeffrey Crawford, Duke University Medical Center; Herbert H. Pang and Lin Gu, Alliance Statistics and Data Center, Duke University Medical Center, Durham; Antonius A. Miller, Wake Forest University Medical Center, Winston Salem, NC; Gregory A. Otterson, Ohio State University Medical Center, Columbus, OH; Sachdev P. Thomas, Illinois Oncology Research Association Community Clinical Oncology Program, Illinois Cancer Care, Peoria; Everett E. Vokes, University of Chicago, Chicago, IL; Maria Baggstrom, Washington University School of Medicine, St Louis, MO; Gregory A. Masters, Christiana Healthcare Services, Christiana Hospital, Newark, DE; Stephen L. Graziano and Jeffrey Bogart, State University of New York Upstate Medical University, Syracuse, NY
| | - Antonius A Miller
- Neal E. Ready and Jeffrey Crawford, Duke University Medical Center; Herbert H. Pang and Lin Gu, Alliance Statistics and Data Center, Duke University Medical Center, Durham; Antonius A. Miller, Wake Forest University Medical Center, Winston Salem, NC; Gregory A. Otterson, Ohio State University Medical Center, Columbus, OH; Sachdev P. Thomas, Illinois Oncology Research Association Community Clinical Oncology Program, Illinois Cancer Care, Peoria; Everett E. Vokes, University of Chicago, Chicago, IL; Maria Baggstrom, Washington University School of Medicine, St Louis, MO; Gregory A. Masters, Christiana Healthcare Services, Christiana Hospital, Newark, DE; Stephen L. Graziano and Jeffrey Bogart, State University of New York Upstate Medical University, Syracuse, NY
| | - Maria Baggstrom
- Neal E. Ready and Jeffrey Crawford, Duke University Medical Center; Herbert H. Pang and Lin Gu, Alliance Statistics and Data Center, Duke University Medical Center, Durham; Antonius A. Miller, Wake Forest University Medical Center, Winston Salem, NC; Gregory A. Otterson, Ohio State University Medical Center, Columbus, OH; Sachdev P. Thomas, Illinois Oncology Research Association Community Clinical Oncology Program, Illinois Cancer Care, Peoria; Everett E. Vokes, University of Chicago, Chicago, IL; Maria Baggstrom, Washington University School of Medicine, St Louis, MO; Gregory A. Masters, Christiana Healthcare Services, Christiana Hospital, Newark, DE; Stephen L. Graziano and Jeffrey Bogart, State University of New York Upstate Medical University, Syracuse, NY
| | - Gregory A Masters
- Neal E. Ready and Jeffrey Crawford, Duke University Medical Center; Herbert H. Pang and Lin Gu, Alliance Statistics and Data Center, Duke University Medical Center, Durham; Antonius A. Miller, Wake Forest University Medical Center, Winston Salem, NC; Gregory A. Otterson, Ohio State University Medical Center, Columbus, OH; Sachdev P. Thomas, Illinois Oncology Research Association Community Clinical Oncology Program, Illinois Cancer Care, Peoria; Everett E. Vokes, University of Chicago, Chicago, IL; Maria Baggstrom, Washington University School of Medicine, St Louis, MO; Gregory A. Masters, Christiana Healthcare Services, Christiana Hospital, Newark, DE; Stephen L. Graziano and Jeffrey Bogart, State University of New York Upstate Medical University, Syracuse, NY
| | - Stephen L Graziano
- Neal E. Ready and Jeffrey Crawford, Duke University Medical Center; Herbert H. Pang and Lin Gu, Alliance Statistics and Data Center, Duke University Medical Center, Durham; Antonius A. Miller, Wake Forest University Medical Center, Winston Salem, NC; Gregory A. Otterson, Ohio State University Medical Center, Columbus, OH; Sachdev P. Thomas, Illinois Oncology Research Association Community Clinical Oncology Program, Illinois Cancer Care, Peoria; Everett E. Vokes, University of Chicago, Chicago, IL; Maria Baggstrom, Washington University School of Medicine, St Louis, MO; Gregory A. Masters, Christiana Healthcare Services, Christiana Hospital, Newark, DE; Stephen L. Graziano and Jeffrey Bogart, State University of New York Upstate Medical University, Syracuse, NY
| | - Jeffrey Crawford
- Neal E. Ready and Jeffrey Crawford, Duke University Medical Center; Herbert H. Pang and Lin Gu, Alliance Statistics and Data Center, Duke University Medical Center, Durham; Antonius A. Miller, Wake Forest University Medical Center, Winston Salem, NC; Gregory A. Otterson, Ohio State University Medical Center, Columbus, OH; Sachdev P. Thomas, Illinois Oncology Research Association Community Clinical Oncology Program, Illinois Cancer Care, Peoria; Everett E. Vokes, University of Chicago, Chicago, IL; Maria Baggstrom, Washington University School of Medicine, St Louis, MO; Gregory A. Masters, Christiana Healthcare Services, Christiana Hospital, Newark, DE; Stephen L. Graziano and Jeffrey Bogart, State University of New York Upstate Medical University, Syracuse, NY
| | - Jeffrey Bogart
- Neal E. Ready and Jeffrey Crawford, Duke University Medical Center; Herbert H. Pang and Lin Gu, Alliance Statistics and Data Center, Duke University Medical Center, Durham; Antonius A. Miller, Wake Forest University Medical Center, Winston Salem, NC; Gregory A. Otterson, Ohio State University Medical Center, Columbus, OH; Sachdev P. Thomas, Illinois Oncology Research Association Community Clinical Oncology Program, Illinois Cancer Care, Peoria; Everett E. Vokes, University of Chicago, Chicago, IL; Maria Baggstrom, Washington University School of Medicine, St Louis, MO; Gregory A. Masters, Christiana Healthcare Services, Christiana Hospital, Newark, DE; Stephen L. Graziano and Jeffrey Bogart, State University of New York Upstate Medical University, Syracuse, NY
| | - Everett E Vokes
- Neal E. Ready and Jeffrey Crawford, Duke University Medical Center; Herbert H. Pang and Lin Gu, Alliance Statistics and Data Center, Duke University Medical Center, Durham; Antonius A. Miller, Wake Forest University Medical Center, Winston Salem, NC; Gregory A. Otterson, Ohio State University Medical Center, Columbus, OH; Sachdev P. Thomas, Illinois Oncology Research Association Community Clinical Oncology Program, Illinois Cancer Care, Peoria; Everett E. Vokes, University of Chicago, Chicago, IL; Maria Baggstrom, Washington University School of Medicine, St Louis, MO; Gregory A. Masters, Christiana Healthcare Services, Christiana Hospital, Newark, DE; Stephen L. Graziano and Jeffrey Bogart, State University of New York Upstate Medical University, Syracuse, NY
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Chinese herbal decoction based on syndrome differentiation as maintenance therapy in patients with extensive-stage small-cell lung cancer: an exploratory and small prospective cohort study. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2015; 2015:601067. [PMID: 25815038 PMCID: PMC4359860 DOI: 10.1155/2015/601067] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Accepted: 07/31/2014] [Indexed: 11/21/2022]
Abstract
Objective. To investigate the treatment effect and treatment length of Chinese herbal decoction (CHD) as maintenance therapy on patients with extensive-stage small-cell lung cancer (ES-SCLC) and to reflect the real syndrome differentiation (Bian Zheng) practices of traditional Chinese medicine (TCM). Patients and Methods. Different CHDs were prescribed for each patient based on syndrome differentiation. The length of CHD treatment was divided into two phases for analyzing progression-free survival (PFS) and postprogression survival (PPS). Results. Three hundred and fifty-seven CHDs were prescribed based on syndrome differentiation during the study period. Median PFS was significantly longer in patients who received CHD >3 months than patients who received CHD ≤3 months in the first phase (8.7 months versus 4.5 months; hazard ratio (HR), 0.52; 95% confidence interval (CI), 0.41–0.99; P = 0.0009). Median PPS was significantly longer in patients who received CHD >7 months than patients who received CHD ≤7 months in the second phase (11.7 months versus 5.1 months; HR, 2.32; 95% CI, 1.90–2.74; P = 0.002). Conclusion. CHD could improve PFS and PPS, which are closely related to treatment time and deepness of response of first-line therapy. In addition, CHD could improve body function and keep patients in a relatively stable state.
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