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Yamada J, Fukui T, Yatani A, Mimura C, Fukuda K, Hazama D, Katsurada N, Nagano T, Yamamoto M, Tachihara M. Impact of concurrent medications on the outcome of immunotherapy in non-small cell lung carcinoma. Thorac Cancer 2024; 15:1228-1236. [PMID: 38622898 PMCID: PMC11128370 DOI: 10.1111/1759-7714.15294] [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: 01/25/2024] [Revised: 03/07/2024] [Accepted: 03/09/2024] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND There have been reports on the impact of concurrent drugs on the outcome of immunotherapy for non-small cell lung carcinoma (NSCLC). However, the effect of some drugs, such as antibiotics and nonsteroidal anti-inflammatory drugs (NSAIDs), has not been clarified in patients with NSCLC. In the present study, we aimed to assess the association between concurrent drugs and the outcomes of immune checkpoint inhibitors (ICIs) alone or in combination with chemotherapy for patients with advanced NSCLC. METHODS We retrospectively assessed patients with advanced NSCLC who underwent ICI treatment between September 2017 and December 2021 at Kobe University Hospital. We evaluated the data regarding the use of antibiotics within 30 days before ICI initiation, as well as the use of proton pump inhibitors (PPIs) and NSAIDs during ICI initiation. RESULTS A total of 127 patients were assessed, among whom 28 (22.0%) patients received antibiotics, 39 (30.7%) PPIs, and 36 (28.3%) NSAIDs. No significant differences were observed between the patients with and without antibiotic use. However, patients using NSAIDs had significantly worse objective response rates (ORR) and progression-free survival (PFS) with ICI alone or in combination with chemotherapy compared to those who did not (ORR, 47.2% vs. 67.0%; p = 0.045. PFS, 6.3 months vs. 10.8 months; p = 0.02). Patients using PPIs demonstrated a worse ORR of ICI in combination with chemotherapy compared to those who did not (ORR, 45.2% vs. 72.6%; p = 0.013). CONCLUSIONS The unnecessary use of NSAIDs along with immunotherapy should be discouraged.
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Affiliation(s)
- Jun Yamada
- Division of Respiratory Medicine, Department of Internal MedicineKobe University Graduate School of MedicineKobeJapan
| | - Takafumi Fukui
- Division of Respiratory Medicine, Department of Internal MedicineKobe University Graduate School of MedicineKobeJapan
| | - Atsuhiko Yatani
- Division of Respiratory Medicine, Department of Internal MedicineKobe University Graduate School of MedicineKobeJapan
| | - Chihiro Mimura
- Division of Respiratory Medicine, Department of Internal MedicineKobe University Graduate School of MedicineKobeJapan
| | - Kiyoko Fukuda
- Division of Respiratory Medicine, Department of Internal MedicineKobe University Graduate School of MedicineKobeJapan
| | - Daisuke Hazama
- Division of Respiratory Medicine, Department of Internal MedicineKobe University Graduate School of MedicineKobeJapan
| | - Naoko Katsurada
- Division of Respiratory Medicine, Department of Internal MedicineKobe University Graduate School of MedicineKobeJapan
| | - Tatsuya Nagano
- Division of Respiratory Medicine, Department of Internal MedicineKobe University Graduate School of MedicineKobeJapan
| | - Masatsugu Yamamoto
- Division of Respiratory Medicine, Department of Internal MedicineKobe University Graduate School of MedicineKobeJapan
| | - Motoko Tachihara
- Division of Respiratory Medicine, Department of Internal MedicineKobe University Graduate School of MedicineKobeJapan
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Benjamin DJ, Haslam A, Prasad V. Cardiovascular/anti-inflammatory drugs repurposed for treating or preventing cancer: A systematic review and meta-analysis of randomized trials. Cancer Med 2024; 13:e7049. [PMID: 38491813 PMCID: PMC10943275 DOI: 10.1002/cam4.7049] [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: 07/15/2023] [Revised: 01/09/2024] [Accepted: 02/08/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND Due to encouraging pre-clinical data and supportive observational studies, there has been growing interest in applying cardiovascular drugs (including aspirin, angiotensin-converting enzyme [ACE] inhibitors, statins, and metformin) approved to treat diseases such as hypertension, hyperlipidemia, and diabetes mellitus to the field of oncology. Moreover, given growing costs with cancer care, these medications have offered a potentially more affordable avenue to treat or prevent recurrence of cancer. We sought to investigate the anti-cancer effects of drugs repurposed from cardiology or anti-inflammatories to treat cancer. We specifically evaluated the following drug classes: HMG-CoA reductase inhibitors (statins), cyclo-oxygenase inhibitors, aspirin, metformin, and both angiotensin receptor blockers (ARBs) and angiotensin-converting enzyme inhibitors. We also included non-steroidal anti-inflammatory drugs (NSAIDs) because they exert a similar mechanism to aspirin by blocking prostaglandins and reducing inflammation that is thought to promote the development of cancer. METHODS We performed a systematic literature review using PubMed and Web of Science with search terms including "aspirin," "NSAID," "statin" (including specific statin drug names), "metformin," "ACE inhibitors," and "ARBs" (including specific anti-hypertensive drug names) in combination with "cancer." Searches were limited to human studies published between 2000 and 2023. MAIN OUTCOMES AND MEASURES The number and percentage of studies reported positive results and pooled estimates of overall survival, progression-free survival, response, and disease-free survival. RESULTS We reviewed 3094 titles and included 67 randomized clinical trials. The most common drugs that were tested were metformin (n = 21; 30.9%), celecoxib (n = 20; 29.4%), and simvastatin (n = 8; 11.8%). There was only one study that tested cardiac glycosides and none that studied ACE inhibitors. The most common tumor types were non-small-cell lung cancer (n = 19; 27.9%); breast (n = 8; 20.6%), colorectal (n = 7; 10.3%), and hepatocellular (n = 6; 8.8%). Most studies were conducted in a phase II trial (n = 38; 55.9%). Most studies were tested in metastatic cancers (n = 49; 72.1%) and in the first-line setting (n = 36; 521.9%). Four studies (5.9%) were stopped early because of difficulty with accrual. The majority of studies did not demonstrate an improvement in either progression-free survival (86.1% of studies testing progression-free survival) or in overall survival (94.3% of studies testing overall survival). Progression-free survival was improved in five studies (7.4%), and overall survival was improved in three studies (4.4%). Overall survival was significantly worse in two studies (3.8% of studies testing overall survival), and progression-free survival was worse in one study (2.8% of studies testing progression-free survival). CONCLUSIONS AND RELEVANCE Despite promising pre-clinical and population-based data, cardiovascular drugs and anti-inflammatory medications have overall not demonstrated benefit in the treatment or preventing recurrence of cancer. These findings may help guide future potential clinical trials involving these medications when applied in oncology.
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Affiliation(s)
| | - Alyson Haslam
- Department of Epidemiology and BiostatisticsUniversity of CaliforniaSan FranciscoCaliforniaUnited States
| | - Vinay Prasad
- Department of Epidemiology and BiostatisticsUniversity of CaliforniaSan FranciscoCaliforniaUnited States
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Cai R, Liao X, Li G, Xiang J, Ye Q, Chen M, Feng S. The use of non-steroid anti-inflammatory drugs during radical resection correlated with the outcome in non-small cell lung cancer. World J Surg Oncol 2023; 21:358. [PMID: 37986068 PMCID: PMC10662740 DOI: 10.1186/s12957-023-03247-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 11/13/2023] [Indexed: 11/22/2023] Open
Abstract
AIMS The use of non-steroid anti-inflammatory drugs (NSAIDs) is conventional in management of postoperative pain in cancer patients, and further investigations have reported that some of these drugs correlated with the outcome in cancers. However, the prognostic value of the use of NSAIDs during surgery in non-small cell lung cancer (NSCLC) patients has been less addressed. METHODS NSCLC patients staged I-III are retrospectively enrolled, and the data of the use of NSAIDs during surgery are collected. Patients are divided into two subgroups according to the use intensity (UI) (low or high) of the NSAIDs, which was calculated by the accumulate dosage of all the NSAIDs divided by the length of hospitalization. The differences of the clinical features among these groups were checked. And the disease-free survival (DFS) and overall survival (OS) differences in these groups were compared by Kaplan-Meier analysis; risk factors for survival were validated by using a Cox proportional hazards model. RESULTS The UI was significant in predicting the DFS (AUC = 0.65, 95% CI: 0.57-0.73, P = 0.001) and OS (AUC = 0.70, 95% CI: 0.59-0.81, P = 0.001). Clinical features including type of resection (P = 0.001), N stages (P < 0.001), and TNM stages (P = 0.004) were significantly different in UI low (< 74.55 mg/day) or high (≥ 74.55 mg/day) subgroups. Patients in UI-high subgroups displayed significant superior DFS (log rank = 11.46, P = 0.001) and OS (log rank = 7.63, P = 0.006) than the UI-low ones. At last, the UI was found to be an independent risk factor for DFS (HR: 0.52, 95% CI: 0.28-0.95, P = 0.034). CONCLUSIONS The use of NSAIDs during radical resection in NSCLC patients correlated with the outcome and patients with a relative high UI has better outcome.
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Affiliation(s)
- Renzhong Cai
- Department of Thoracic Surgery, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Haikou City, Hainan Province, 570311, People's Republic of China
| | - Xuqiang Liao
- Department of Thoracic Surgery, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Haikou City, Hainan Province, 570311, People's Republic of China
| | - Gao Li
- Department of Thoracic Surgery, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Haikou City, Hainan Province, 570311, People's Republic of China
| | - Jia Xiang
- Department of Oncology, Hainan Hospital of PLA General Hospital, Sanya City, Hainan Province, 572000, People's Republic of China
| | - Qianwen Ye
- Department of Oncology, Hainan Hospital of PLA General Hospital, Sanya City, Hainan Province, 572000, People's Republic of China
| | - Minbiao Chen
- Department of Thoracic Surgery, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Haikou City, Hainan Province, 570311, People's Republic of China.
| | - Shouhan Feng
- Department of Oncology, Huzhou Traditional Chinese Medicine Hospital Affiliated to Zhejiang Chinese Medical University, Huzhou City, Zhejiang Province, 313000, People's Republic of China.
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Chan SHY, Khatib Y, Webley S, Layton D, Salek S. Identification of cardiotoxicity related to non-small cell lung cancer (NSCLC) treatments: A systematic review. Front Pharmacol 2023; 14:1137983. [PMID: 37383708 PMCID: PMC10294714 DOI: 10.3389/fphar.2023.1137983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 03/27/2023] [Indexed: 06/30/2023] Open
Abstract
Introduction: In the last few decades, there has been a rapid development in cancer therapies and improved detection strategies, hence the death rates caused by cancer have decreased. However, it has been reported that cardiovascular disease has become the second leading cause of long-term morbidity and fatality among cancer survivors. Cardiotoxicity from anticancer drugs affects the heart's function and structure and can occur during any stage of the cancer treatments, which leads to the development of cardiovascular disease. Objectives: To investigate the association between anticancer drugs for non-small cell lung cancer (NSCLC) and cardiotoxicity as to whether: different classes of anticancer drugs demonstrate different cardiotoxicity potentials; different dosages of the same drug in initial treatment affect the degree of cardiotoxicity; and accumulated dosage and/or duration of treatments affect the degree of cardiotoxicity. Methods: This systematic review included studies involving patients over 18 years old with NSCLC and excluded studies in which patients' treatments involve radiotherapy only. Electronic databases and registers including Cochrane Library, National Cancer Institute (NCI) Database, PubMed, Scopus, Web of Science, ClinicalTrials.gov and the European Union Clinical Trials Register were systematically searched from the earliest available date up until November 2020. A full version protocol of this systematic review (CRD42020191760) had been published on PROSPERO. Results: A total of 1785 records were identified using specific search terms through the databases and registers; 74 eligible studies were included for data extraction. Based on data extracted from the included studies, anticancer drugs for NSCLC that are associated with cardiovascular events include bevacizumab, carboplatin, cisplatin, crizotinib, docetaxel, erlotinib, gemcitabine and paclitaxel. Hypertension was the most reported cardiotoxicity as 30 studies documented this cardiovascular adverse event. Other reported treatment-related cardiotoxicities include arrhythmias, atrial fibrillation, bradycardia, cardiac arrest, cardiac failure, coronary artery disease, heart failure, ischemia, left ventricular dysfunction, myocardial infarction, palpitations, and tachycardia. Conclusion: The findings of this systematic review have provided a better understanding of the possible association between cardiotoxicities and anticancer drugs for NSCLC. Whilst variation is observed across different drug classes, the lack of information available on cardiac monitoring can result in underestimation of this association. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020191760, identifier PROSPERO CRD42020191760.
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Affiliation(s)
- Stefanie Ho Yi Chan
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom
| | - Yasmin Khatib
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom
| | - Sherael Webley
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom
| | - Deborah Layton
- IQVIA UK, London, United Kingdom
- PEPI Consultancy Limited, Southampton, United Kingdom
- University of Keele, Keele, United Kingdom
| | - Sam Salek
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom
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Li L, Zhang Y, Qin L. Effect of celecoxib plus standard chemotherapy on cancer prognosis: A systematic review and meta-analysis. Eur J Clin Invest 2023; 53:e13973. [PMID: 36807298 DOI: 10.1111/eci.13973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 01/31/2023] [Accepted: 02/09/2023] [Indexed: 02/20/2023]
Abstract
BACKGROUND Inflammation is closely related to cancer prognosis. The effect of celecoxib, a nonsteroidal anti-inflammatory drug, on the prognosis of patients with cancer remains uncertain. To assess the association between celecoxib plus standard chemotherapy and cancer prognosis, we conducted a systematic review and meta-analysis of published studies. METHODS PubMed, EMBASE, and the Cochrane Library were searched from inception until July 2022 for randomized controlled trials reporting the prognosis of patients with cancer treated with celecoxib plus standard chemotherapy. The primary endpoints were overall survival (OS) and progression-free survival (PFS). Meta-analysis was performed using Review Manager software version 5.4. The following search terms were used in the databases: ((((celecoxib)) AND ((((((((cancer) OR (carcinoma)) OR (sarcoma)) OR (neoplasms)) OR (tumor)) OR (tumour)) OR (tumors)) OR (tumours))) AND ((survival) OR (mortality))) AND (((Clinical Trials, Randomized) OR (Trials, Randomized Clinical)) OR (Controlled Clinical Trials, Randomized)). RESULTS Overall, 13 randomized controlled trials, including 8957 patients with cancer, were included in the analysis. Compared to conventional chemotherapy alone, 1-year OS and 1-year PFS rates were not significantly improved with celecoxib adjuvant therapy (OS: p = .38; PFS: p = .65). In addition, no differences were observed between the celecoxib and placebo groups in 3-year overall (p = .98), 3-year progression-free (p = .40), 5-year overall (p = .59), or 5-year progression-free (p = .56) survival rates. An increase in the risk ratio of leukopenia (p = .02) and thrombocytopenia (p = .05) was also observed, suggesting that celecoxib promotes hematologic toxicity. No increased risk of cardiovascular (p = .96) and gastrointestinal (p = .10-.91) events was observed. CONCLUSIONS The addition of celecoxib to standard chemotherapy did not improve OS or PFS rates of patients with cancer. Additionally, celecoxib can increase hematologic toxicity without increasing the risk of gastrointestinal or cardiovascular reactions. Further randomized controlled trials are necessary to clarify its effects and applications.
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Affiliation(s)
- Liangyu Li
- Department of Oral and Maxillofacial & Head and Neck Oncology, Beijing Stomatological Hospital, Capital Medical University, Beijing, China
| | - Yingrui Zhang
- Department of Oral and Maxillofacial & Head and Neck Oncology, Beijing Stomatological Hospital, Capital Medical University, Beijing, China
| | - Lizheng Qin
- Department of Oral and Maxillofacial & Head and Neck Oncology, Beijing Stomatological Hospital, Capital Medical University, Beijing, China
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Mikubo M, Satoh Y, Ono M, Sonoda D, Hayashi S, Naito M, Matsui Y, Shiomi K, Matsuura M, Ito S. Prognostic implications of prostaglandin E-major urinary metabolite in resected non-small-cell lung cancer. INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY 2023; 36:6978237. [PMID: 36802257 PMCID: PMC9931073 DOI: 10.1093/icvts/ivac291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 11/21/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVES Cyclooxygenase-2-derived prostaglandin E2 (PGE2) is highly involved in the promotion of cancer progression. The end product of this pathway, PGE-major urinary metabolite (PGE-MUM), is a stable metabolite of PGE2 that can be assessed non-invasively and repeatedly in urine samples. The aim of this study was to assess the dynamic changes in perioperative PGE-MUM levels and their prognostic significance in non-small-cell lung cancer (NSCLC). METHODS Between December 2012 and March 2017, 211 patients who underwent complete resection for NSCLC were analysed prospectively. PGE-MUM levels in 2 spot urine samples taken 1 or 2 days preoperatively and 3-6 weeks postoperatively were measured using a radioimmunoassay kit. RESULTS Elevated preoperative PGE-MUM levels were associated with tumour size, pleural invasion and advanced stage. Multivariable analysis revealed that age, pleural invasion, lymph node metastasis and postoperative PGE-MUM levels were independent prognostic factors. In matched pre- and postoperative urine samples obtained from patients who are eligible for adjuvant chemotherapy, an increase in PGE-MUM levels following resection was an independent prognostic factor (hazard ratio 3.017, P = 0.005). Adjuvant chemotherapy improved survival in patients with increased PGE-MUM levels after resection (5-year overall survival, 79.0 vs 50.4%, P = 0.027), whereas survival benefit was not observed in those with decreased PGE-MUM levels (5-year overall survival, 82.1 vs 82.3%, P = 0.442). CONCLUSIONS Increased preoperative PGE-MUM levels can reflect tumour progression and postoperative PGE-MUM levels are a promising biomarker for survival after complete resection in patients with NSCLC. Perioperative changes in PGE-MUM levels may aid in determining the optimal eligibility for adjuvant chemotherapy.
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Affiliation(s)
- Masashi Mikubo
- Corresponding author. Department of Thoracic Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-Ku, Sagamihara, Kanagawa 252-0374, Japan. Tel: +81-42-778-8828; e-mail: (M. Mikubo)
| | - Yukitoshi Satoh
- Department of Thoracic Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Mototsugu Ono
- Department of Thoracic Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Dai Sonoda
- Department of Thoracic Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Shoko Hayashi
- Department of Thoracic Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Masahito Naito
- Department of Thoracic Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Yoshio Matsui
- Department of Thoracic Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Kazu Shiomi
- Department of Thoracic Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Masaaki Matsuura
- Graduate School of Public Health, Teikyo University, Tokyo, Japan
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Mitrіaіeva NA, Grebinyk LV, Bilozor NV, Starenkyі VP. The content of VEGF, COX-2 and PGE-2 in the blood serum of patients with non-small cell lung cancer with different schemes of conformal radiotherapy in the dynamics of treatment. УКРАЇНСЬКИЙ РАДІОЛОГІЧНИЙ ТА ОНКОЛОГІЧНИЙ ЖУРНАЛ 2022. [DOI: 10.46879/ukroj.3.2022.33-40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background. Overcoming radioresistance is an important problem in radiation oncology. Therefore, the development of new approaches to modeling the radiosensitivity of tumors in cancer patients becomes relevant and important. Cyclooxygenase-2 (COX-2) inhibitors are new agents for radiomodification in various radiation therapy schemes, the use of which slows down angiogenesis by suppressing the activity of the COX-2 enzyme.
Purpose. To determine the content of indicators of radioresistance: vascular endothelial growth factor (VEGF), COX-2, prostaglandin E-2 (PGE-2) in the blood serum of patients with non-small cell lung cancer (NSCLC) and changes in their levels with different schemes of radiation therapy (RT).
Materials and methods. 36 patients with NSCLC were examined and treated, who were divided into four groups: RT (the first group – 16 patients), RT with the COX-2 inhibitor – ranselex (the second group – 9 patients), RT with ranselex and cisplatin (the third group – 5 patients ) and RT with cisplatin (fourth group – 6 patients). The patients received a course of radiation treatment using a Clinac 600C linear accelerator. The classical fractionation mode was used, the total focal doses were 60–66 Gy. Cisplatin was prescribed at 30 mg/m2 per week up to a total dose (SD) of 200 mg, the COX-2 inhibitor Rancelex® at a dose of 100 mg per day (active substance – celecoxib). The levels of VEGF, COX-2, and PGE-2 in the blood serum of patients with NSCLC were determined by enzyme-linked immunosorbent assay (ELISA) before and after treatment.
Results. The level of the angiogenesis marker VEGF after treatment in the group with RT decreases by 1.46 times, in the group with the combined action of RT and ranselex – 2.4 times, in the group with the combined action of PT, ranselex and cisplatin – by 3.7 times, and in the group with the combined effect of RT and cisplatin, it decreases by 1.1 times. The greatest decrease in the level of VEGF is observed with RT in combination with ranselex and cisplatin, which indicates a more effective enhancement of the antiangiogenic effect.
Conclusions. It has been proven that with various schemes of RT using the COX-2 inhibitor – ranselex and cisplatin in patients with NSCLC, there is a decrease in the radioresistance markers PGE-2 and COX-2, the angiogenesis marker – VEGF, which indicates that the effect of radiomodification on the angiogenesis process is most pronounced in the combined actions of RT and both radio modifiers. The use of COX-2 inhibitors as radiosensitizers in combination with RT provides a new opportunity to increase tumor radiosensitivity.
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Gu J, Kong A, Guo C, Liu J, Li K, Ren Z, Zhou Y, Tang M, Shi H. Cadmium perturbed lipid profile and induced liver dysfunction in mice through phosphatidylcholine remodeling and promoting arachidonic acid synthesis and metabolism. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2022; 247:114254. [PMID: 36334344 DOI: 10.1016/j.ecoenv.2022.114254] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 10/23/2022] [Accepted: 10/29/2022] [Indexed: 06/16/2023]
Abstract
Cadmium ion (Cd2+) exposure has been reported to associate with the prevalence of dyslipidemia, and contribute to the initiation and progression of nonalcoholic fatty liver disease (NAFLD). However, Cd2+ exposure perturbed specific metabolic pathways and underlying mechanisms are still unclear. In the present study, through lipidomics analyses of differential metabolites in serum between the Cd2+-exposed mice and the control group, 179 differential metabolites were identified, among which phosphatidylcholines (PCs) accounted for 49 % metabolites. Moreover, the Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment assay indicates that PCs participate in the metabolic pathways, including the Arachidonic Acid (AA) metabolism, which also could be potential NAFLD biomarkers. Moreover, in vivo and in vitro results suggested that Cd2+ exposure induced PC synthesis and remodeling, and increased AA level by promoting fatty acid desaturase 1 (FADS1) to catalyze synthesis process instead of cytosolic phospholipase A2 (cPLA2) mediated release pathway. Inhibition of FADS1 by T3364366 could reverse Cd-induced AA, prostaglandin E2 (PGE2) and triglyceride (TAG) levels, and it also reduce cisplatin resistance in HepG2 cells. This study provides new evidence of Cd2+-induced dyslipidemia and reveals underlying molecular mechanism involved in liver dysfunction of Cd2+ exposure.
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Affiliation(s)
- Jie Gu
- School of Life Sciences, Jiangsu University, Zhenjiang 212000, China
| | - Anqi Kong
- School of Life Sciences, Jiangsu University, Zhenjiang 212000, China
| | - Chuanzhi Guo
- School of Life Sciences, Jiangsu University, Zhenjiang 212000, China
| | - Junlin Liu
- School of Life Sciences, Jiangsu University, Zhenjiang 212000, China
| | - Kongdong Li
- School of Life Sciences, Jiangsu University, Zhenjiang 212000, China
| | - Zhen Ren
- School of Life Sciences, Jiangsu University, Zhenjiang 212000, China
| | - Yang Zhou
- School of Life Sciences, Jiangsu University, Zhenjiang 212000, China
| | - Min Tang
- School of Life Sciences, Jiangsu University, Zhenjiang 212000, China
| | - Haifeng Shi
- School of Life Sciences, Jiangsu University, Zhenjiang 212000, China; School of Food and Biological Engineering, Jiangsu University, Zhenjiang 212000, China.
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Ye SY, Li JY, Li TH, Song YX, Sun JX, Chen XW, Zhao JH, Li Y, Wu ZH, Gao P, Huang XZ. The Efficacy and Safety of Celecoxib in Addition to Standard Cancer Therapy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Curr Oncol 2022; 29:6137-6153. [PMID: 36135051 PMCID: PMC9497539 DOI: 10.3390/curroncol29090482] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 08/20/2022] [Accepted: 08/23/2022] [Indexed: 12/02/2022] Open
Abstract
The purpose of this meta-analysis was to evaluate the efficacy and safety of celecoxib, a selective cyclooxygenase-2 (COX-2) inhibitor, in addition to standard anticancer therapy. Randomized controlled trials (RCTs) that evaluated the efficacy and safety of celecoxib-combined cancer therapy were systematically searched in PubMed and Embase databases. The endpoints were overall survival (OS), progression-free survival (PFS), disease-free survival (DFS), objective response rate (ORR), disease control rate (DCR), pathological complete response (pCR), and adverse events (AEs). The results of 30 RCTs containing 9655 patients showed limited benefits in celecoxib-combined cancer therapy. However, celecoxib-combined palliative therapy prolonged PFS in epidermal growth factor receptor (EGFR) wild-type patients (HR = 0.57, 95%CI = 0.35–0.94). Moreover, despite a slight increase in thrombocytopenia (RR = 1.35, 95%CI = 1.08–1.69), there was no increase in other toxicities. Celecoxib combined with adjuvant therapy indicated a better OS (HR = 0.850, 95%CI = 0.725–0.996). Furthermore, celecoxib plus neoadjuvant therapy improved the ORR in standard cancer therapy, especially neoadjuvant therapy (overall: RR = 1.13, 95%CI = 1.03–1.23; neoadjuvant therapy: RR = 1.25, 95%CI = 1.09–1.44), but not pCR. Our study indicated that adding celecoxib to palliative therapy prolongs the PFS of EGFR wild-type patients, with good safety profiles. Celecoxib combined with adjuvant therapy prolongs OS, and celecoxib plus neoadjuvant therapy improves the ORR. Thus, celecoxib-combined cancer therapy may be a promising therapy strategy.
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Affiliation(s)
- Shi-Yu Ye
- Department of Surgical Oncology and General Surgery, The First Hospital of China Medical University, 155 N. Nanjing Street, Shenyang 110002, China
- Key Laboratory of Precision Diagnosis and Treatment of Gastrointestinal Tumors, Ministry of Education, China Medical University, Shenyang 110122, China
- Institute of Health Sciences, China Medical University, Shenyang 110122, China
| | - Jia-Yi Li
- Department of Surgical Oncology and General Surgery, The First Hospital of China Medical University, 155 N. Nanjing Street, Shenyang 110002, China
- Key Laboratory of Precision Diagnosis and Treatment of Gastrointestinal Tumors, Ministry of Education, China Medical University, Shenyang 110122, China
- Institute of Health Sciences, China Medical University, Shenyang 110122, China
| | - Teng-Hui Li
- Department of Surgical Oncology and General Surgery, The First Hospital of China Medical University, 155 N. Nanjing Street, Shenyang 110002, China
- Key Laboratory of Precision Diagnosis and Treatment of Gastrointestinal Tumors, Ministry of Education, China Medical University, Shenyang 110122, China
- Institute of Health Sciences, China Medical University, Shenyang 110122, China
| | - Yong-Xi Song
- Department of Surgical Oncology and General Surgery, The First Hospital of China Medical University, 155 N. Nanjing Street, Shenyang 110002, China
- Key Laboratory of Precision Diagnosis and Treatment of Gastrointestinal Tumors, Ministry of Education, China Medical University, Shenyang 110122, China
- Institute of Health Sciences, China Medical University, Shenyang 110122, China
| | - Jing-Xu Sun
- Department of Surgical Oncology and General Surgery, The First Hospital of China Medical University, 155 N. Nanjing Street, Shenyang 110002, China
- Key Laboratory of Precision Diagnosis and Treatment of Gastrointestinal Tumors, Ministry of Education, China Medical University, Shenyang 110122, China
- Institute of Health Sciences, China Medical University, Shenyang 110122, China
| | - Xiao-Wan Chen
- Department of Surgical Oncology and General Surgery, The First Hospital of China Medical University, 155 N. Nanjing Street, Shenyang 110002, China
- Key Laboratory of Precision Diagnosis and Treatment of Gastrointestinal Tumors, Ministry of Education, China Medical University, Shenyang 110122, China
- Institute of Health Sciences, China Medical University, Shenyang 110122, China
| | - Jun-Hua Zhao
- Department of Surgical Oncology and General Surgery, The First Hospital of China Medical University, 155 N. Nanjing Street, Shenyang 110002, China
- Key Laboratory of Precision Diagnosis and Treatment of Gastrointestinal Tumors, Ministry of Education, China Medical University, Shenyang 110122, China
- Institute of Health Sciences, China Medical University, Shenyang 110122, China
| | - Yuan Li
- Department of Surgical Oncology and General Surgery, The First Hospital of China Medical University, 155 N. Nanjing Street, Shenyang 110002, China
- Key Laboratory of Precision Diagnosis and Treatment of Gastrointestinal Tumors, Ministry of Education, China Medical University, Shenyang 110122, China
- Institute of Health Sciences, China Medical University, Shenyang 110122, China
| | - Zhong-Hua Wu
- Department of Surgical Oncology and General Surgery, The First Hospital of China Medical University, 155 N. Nanjing Street, Shenyang 110002, China
- Key Laboratory of Precision Diagnosis and Treatment of Gastrointestinal Tumors, Ministry of Education, China Medical University, Shenyang 110122, China
- Institute of Health Sciences, China Medical University, Shenyang 110122, China
| | - Peng Gao
- Department of Surgical Oncology and General Surgery, The First Hospital of China Medical University, 155 N. Nanjing Street, Shenyang 110002, China
- Key Laboratory of Precision Diagnosis and Treatment of Gastrointestinal Tumors, Ministry of Education, China Medical University, Shenyang 110122, China
- Institute of Health Sciences, China Medical University, Shenyang 110122, China
- Correspondence: (P.G.); (X.-Z.H.); Tel.: +86-24-83283556 (P.G. & X.-Z.H.)
| | - Xuan-Zhang Huang
- Department of Surgical Oncology and General Surgery, The First Hospital of China Medical University, 155 N. Nanjing Street, Shenyang 110002, China
- Key Laboratory of Precision Diagnosis and Treatment of Gastrointestinal Tumors, Ministry of Education, China Medical University, Shenyang 110122, China
- Institute of Health Sciences, China Medical University, Shenyang 110122, China
- Correspondence: (P.G.); (X.-Z.H.); Tel.: +86-24-83283556 (P.G. & X.-Z.H.)
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Liu S, Chen X, Lin T. Emerging strategies for the improvement of chemotherapy in bladder cancer: Current knowledge and future perspectives. J Adv Res 2021; 39:187-202. [PMID: 35777908 PMCID: PMC9263750 DOI: 10.1016/j.jare.2021.11.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 11/01/2021] [Accepted: 11/19/2021] [Indexed: 11/24/2022] Open
Abstract
The response of chemotherapy and prognosis in bladder cancer is unsatisfied. Immunotherapy, targeted therapy, and ADC improve the efficacy of chemotherapy. Emerging targets in cancer cells and TME spawned novel preclinical agents. Novel drug delivery, such as nanotechnology, enhances effects of chemotherapeutics. The organoid and PDX model are promising to screen and evaluate the target therapy.
Background Chemotherapy is a first-line treatment for advanced and metastatic bladder cancer, but the unsatisfactory objective response rate to this treatment yields poor 5-year patient survival. Only PD-1/PD-L1-based immune checkpoint inhibitors, FGFR3 inhibitors and antibody-drug conjugates are approved by the FDA to be used in bladder cancer, mainly for platinum-refractory or platinum-ineligible locally advanced or metastatic urothelial carcinoma. Emerging studies indicate that the combination of targeted therapy and chemotherapy shows better efficacy than targeted therapy or chemotherapy alone. Newly identified targets in cancer cells and various functions of the tumour microenvironment have spawned novel agents and regimens, which give impetus to sensitizing chemotherapy in the bladder cancer setting. Aim of Review This review aims to present the current evidence for potentiating the efficacy of chemotherapy in bladder cancer. We focus on combining chemotherapy with other treatments as follows: targeted therapy, including immunotherapy and antibody-drug conjugates in clinic; novel targeted drugs and nanoparticles in preclinical models and potential targets that may contribute to chemosensitivity in future clinical practice. The prospect of precision therapy is also discussed in bladder cancer. Key Scientific Concepts of Review Combining chemotherapy drugs with immune checkpoint inhibitors, antibody-drug conjugates and VEGF inhibitors potentially elevates the response rate and survival. Novel targets, including cancer stem cells, DNA damage repair, antiapoptosis, drug metabolism and the tumour microenvironment, contribute to chemosensitization. Gene alteration-based drug selection and patient-derived xenograft- and organoid-based drug validation are the future for precision therapy.
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Pang L, Shah H, Qian S, Sathish V. Iminodibenzyl redirected cyclooxygenase-2 catalyzed dihomo-γ-linolenic acid peroxidation pattern in lung cancer. Free Radic Biol Med 2021; 172:167-180. [PMID: 34102280 PMCID: PMC8355066 DOI: 10.1016/j.freeradbiomed.2021.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 05/05/2021] [Accepted: 06/03/2021] [Indexed: 01/10/2023]
Abstract
Cyclooxygenase-2 (COX-2) is up-regulated by redox imbalance and is considered a target for cancer therapy. The rationale of the COX-2 inhibitor lies in suppressing COX-2 catalyzed peroxidation of omega-6 polyunsaturated fatty acids (PUFAs), which are essential and pervasive in our daily diet. However, COX-2 inhibitors fail to improve cancer patients' survival and may lead to severe side effects. Here, instead of directly inhibiting COX-2, we utilize a small molecule, iminodibenzyl, which could reprogram the COX-2 catalyzed omega-6 PUFAs peroxidation in lung cancer by inhibiting delta-5-desaturase (D5D) activity. Iminodibenzyl breaks the conversion from dihomo-γ-linolenic acid (DGLA) to arachidonic acid, resulting in the formation of a distinct byproduct, 8-hydroxyoctanoic acid, in lung cancer cells and solid tumors. By utilizing COX-2 overexpression in cancer, the combination of DGLA supplementation and iminodibenzyl suppressed YAP1/TAZ pathway, decreasing the tumor size and lung metastasis in nude mice and C57BL/6 mice. This D5D inhibition-based strategy selectively damaged lung cancer cells with a high COX-2 level, whereas it could avoid harassing normal lung epithelial cells. This finding challenged the COX-2 redox basis in cancer, providing a new direction for developing omega-6 (DGLA)-based diet/regimen in lung cancer therapy.
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Affiliation(s)
- Lizhi Pang
- Department of Pharmaceutical Sciences, North Dakota State University, Fargo, ND, USA
| | - Harshit Shah
- Department of Pharmaceutical Sciences, North Dakota State University, Fargo, ND, USA
| | - Steven Qian
- Department of Pharmaceutical Sciences, North Dakota State University, Fargo, ND, USA
| | - Venkatachalem Sathish
- Department of Pharmaceutical Sciences, North Dakota State University, Fargo, ND, USA.
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The Efficacy of Celecoxib During Chemoradiation in Locally Advanced Head and Neck Carcinoma; A Phase 2 Randomized Placebo-Controlled Clinical Trial. INTERNATIONAL JOURNAL OF CANCER MANAGEMENT 2021. [DOI: 10.5812/ijcm.103653] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Cyclo-oxygenase-2 (COX-2), an enzyme induced in pathological states, mediates the production of prostaglandins. Celecoxib as a selective COX-2 inhibitor may affect the outcome of treatments in several cancer types. Objectives: We conducted a randomized controlled double-blind clinical trial to evaluate the toxicity and efficacy of celecoxib administered concurrently with chemoradiation in locally advanced head and neck carcinomas. Methods: Patients with locally advanced head and neck carcinoma referred for definitive chemoradiation were eligible to enter the study. Celecoxib (100mg, qid, oral) or placebo was administered all over the chemoradiation period. Results: Totally, 122 patients were enrolled. Patients in the celecoxib group had a longer median time to onset of grade 2 mucositis (56 days vs. 28 days, P < 0.001) and a lower rate of grade 3 mucositis (1.6% vs. 21.3%, P = 0.001). The 4-year progression-free survival was significantly higher in the celecoxib group (P = 0.0013). Conclusions: This study revealed that utilizing celecoxib may lead to better tumor local control and delayed and reduced mucosal side effects of chemoradiation.
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Chen Q, Zhu L, Yip KM, Tang Y, Liu Y, Jiang T, Zhang J, Zhao Z, Yi T, Chen H. A hybrid platform featuring nanomagnetic ligand fishing for discovering COX-2 selective inhibitors from aerial part of Saussurea laniceps Hand.-Mazz. JOURNAL OF ETHNOPHARMACOLOGY 2021; 271:113849. [PMID: 33485983 DOI: 10.1016/j.jep.2021.113849] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 12/27/2020] [Accepted: 01/16/2021] [Indexed: 06/12/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Saussurea laniceps Hand.-Mazz. (Compositae) is a representative "snow lotus" herb well known in Chinese folk medicine to treat inflammation-related diseases such as arthritis. S. laniceps (SL) shows anti-inflammatory and analgesic potencies and contains various constituents potentially with cyclooxygenase-2 (COX-2) selective inhibition. The herb is a valuable source of natural alternatives to synthetic COX-2 selective nonsteroidal anti-inflammatory drugs, a common medication for rheumatoid arthritis (RA) and osteoarthritis (OA) reported with serious cardiovascular side effects. AIM OF THE STUDY Based on an innovative drug screening platform, this study aimed to discover safe, effective COX-2 selective inhibitors from SL. MATERIALS AND METHODS An enzyme-anchored nanomagnetic fishing assay was developed to separate COX-2 ligands from SL. Cell and animal models of cardiomyocytes, lipopolysaccharide-stimulated macrophages, rat adjuvant-induced arthritis, and anterior cruciate ligament transection-induced OA rats, were adopted to screen the single/combined ligands regarding toxicity and bioactivity levels. Molecular docking was employed to unravel binding mechanisms of the ligands towards COX-1 and COX-2. RESULTS Four COX-2 selective compounds were separated from SL using optimized COX-2-functionalized magnetic nanoparticles. All the four ligands were proved with evidently lower cardiotoxicity both in vitro and in vivo than celecoxib, a known COX-2 selective inhibitor. Two ligands, scopoletin and syringin, exhibited potent anti-arthritic activities in rat models of RA and OA by alleviating clinical statuses, immune responses, and joint pathological features; their optimum combination ratio was discovered with stronger remedial effects on rat OA than single administrations. The COX-1/2 binding modes of the two phytochemicals contributed to explain their cardiac safety and therapeutic performances. CONCLUSIONS The screened chemicals are promising to be developed as COX-2 selective inhibitors as part of treating RA and OA. The hybrid strategy for discovering therapeutic agents from SL is shown here to be efficient; it should be equally valuable for finding other active chemicals in other natural sources.
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Affiliation(s)
- Qilei Chen
- School of Chinese Medicine, Hong Kong Baptist University, Hong Kong Special Administrative Region, 999077, PR China
| | - Lin Zhu
- School of Chinese Medicine, Hong Kong Baptist University, Hong Kong Special Administrative Region, 999077, PR China
| | - Ka Man Yip
- School of Chinese Medicine, Hong Kong Baptist University, Hong Kong Special Administrative Region, 999077, PR China
| | - Yancheng Tang
- School of Chinese Medicine, Hong Kong Baptist University, Hong Kong Special Administrative Region, 999077, PR China; HKBU Institute of Research and Continuing Education (IRACE), Shenzhen, 518000, PR China
| | - Yi Liu
- School of Chinese Medicine, Hong Kong Baptist University, Hong Kong Special Administrative Region, 999077, PR China; HKBU Institute of Research and Continuing Education (IRACE), Shenzhen, 518000, PR China
| | - Tao Jiang
- School of Chemistry, Resources and Environment, Leshan Normal University, Leshan, 614004, PR China
| | - Jianye Zhang
- Key Laboratory of Molecular Target & Clinical Pharmacology and the State Key Laboratory of Respiratory Disease, School of Pharmaceutical Sciences & the Fifth Affiliated Hospital, Guangzhou Medical University, Guangzhou, 511436, PR China
| | - Zhongzhen Zhao
- School of Chinese Medicine, Hong Kong Baptist University, Hong Kong Special Administrative Region, 999077, PR China
| | - Tao Yi
- School of Chinese Medicine, Hong Kong Baptist University, Hong Kong Special Administrative Region, 999077, PR China; HKBU Institute of Research and Continuing Education (IRACE), Shenzhen, 518000, PR China.
| | - Hubiao Chen
- School of Chinese Medicine, Hong Kong Baptist University, Hong Kong Special Administrative Region, 999077, PR China.
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Pu D, Yin L, Huang L, Qin C, Zhou Y, Wu Q, Li Y, Zhou Q, Li L. Cyclooxygenase-2 Inhibitor: A Potential Combination Strategy With Immunotherapy in Cancer. Front Oncol 2021; 11:637504. [PMID: 33718229 PMCID: PMC7952860 DOI: 10.3389/fonc.2021.637504] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 01/20/2021] [Indexed: 02/05/2023] Open
Abstract
The clinical application of immunotherapy is the milestone of cancer treatment. However, some patients have bad reaction. Cyclooxygenase-2 (COX-2) is frequently expressed in multiple cancer cells and is associated with poor prognosis. It is the key enzyme of prostaglandin E2 (PGE2) that has been proved to promote the development, proliferation and metastasis of tumor cells. Recent studies further find the PGE2 in tumor microenvironment (TME) actively triggers tumor immune evasion via many ways, leading to poor response of immunotherapy. COX-2 inhibitor is suggested to restrain the immunosuppression of PGE2 and may enhance or reverse the response of immune checkpoint inhibitors (ICIs). This review provides insight into the mechanism of COX-2/PGE2 signal in immunosuppressive TME and summarizes the clinical application and trials in cancer treatment.
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Affiliation(s)
- Dan Pu
- Department of Lung Cancer Center, Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Liyuan Yin
- Department of Lung Cancer Center, Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Lin Huang
- Department of Lung Cancer Center, Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Changlong Qin
- Department of Lung Cancer Center, Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Yuwen Zhou
- Oncology Department, West China Hospital, Sichuan University, Chengdu, China
| | - Qiang Wu
- Department of Lung Cancer Center, Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Yan Li
- Department of Lung Cancer Center, Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Qinghua Zhou
- Department of Lung Cancer Center, Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Lu Li
- Department of Lung Cancer Center, Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, China
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Xu YQ, Long X, Han M, Huang MQ, Lu JF, Sun XD, Han W. Clinical benefit of COX-2 inhibitors in the adjuvant chemotherapy of advanced non-small cell lung cancer: A systematic review and meta-analysis. World J Clin Cases 2021; 9:581-601. [PMID: 33553396 PMCID: PMC7829738 DOI: 10.12998/wjcc.v9.i3.581] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 10/17/2020] [Accepted: 11/09/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Lung cancer is a major cause of death among patients, and non-small cell lung cancer (NSCLC) accounts for more than 80% of all lung cancers in many countries.
AIM To evaluate the clinical benefit (CB) of COX-2 inhibitors in patients with advanced NSCLC using systematic review.
METHODS We searched the six electronic databases up until December 9, 2019 for studies that examined the efficacy and safety of the addition of COX-2 inhibitors to chemotherapy for NSCLC. Overall survival (OS), progression free survival (PFS), 1-year survival rate (SR), overall response rate (ORR), CB, complete response (CR), partial response (PR), stable disease (SD), and toxicities were measured with more than one outcome as their endpoints. Fixed and random effects models were used to calculate risk estimates in a meta-analysis. Potential publication bias was calculated using Egger’s linear regression test. Data analysis was performed using R software.
RESULTS The COX-2 inhibitors combined with chemotherapy were not found to be more effective than chemotherapy alone in OS, progression free survival, 1-year SR, CB, CR, and SD. However, there was a difference in overall response rate for patients with advanced NSCLC. In a subgroup analysis, significantly increased ORR results were found for celecoxib, rofecoxib, first-line treatment, and PR. For adverse events, the increase in COX-2 inhibitor was positively correlated with the increase in grade 3 and 4 toxicity of leukopenia, thrombocytopenia, and cardiovascular events.
CONCLUSION COX-2 inhibitor combined with chemotherapy increased the total effective rate of advanced NSCLC with the possible increased risk of blood toxicity and cardiovascular events and had no effect on survival index.
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Affiliation(s)
- Yu-Qiong Xu
- Department of Emergency Medicine, Shenzhen University General Hospital, Shenzhen University Clinical Medical Academy, Shenzhen 518000, Guangdong Province, China
| | - Xiang Long
- Department of Respiratory and Critical Care Medicine, Peking University Shenzhen Hospital, Shenzhen 518000, Guangdong Province, China
| | - Ming Han
- Department of Emergency Medicine, Shenzhen University General Hospital, Shenzhen University Clinical Medical Academy, Shenzhen 518000, Guangdong Province, China
| | - Ming-Qiang Huang
- Department of Emergency Medicine, Shenzhen University General Hospital, Shenzhen University Clinical Medical Academy, Shenzhen 518000, Guangdong Province, China
| | - Jia-Fa Lu
- Department of Emergency Medicine, Shenzhen University General Hospital, Shenzhen University Clinical Medical Academy, Shenzhen 518000, Guangdong Province, China
| | - Xue-Dong Sun
- Department of Emergency Medicine, Shenzhen University General Hospital, Shenzhen University Clinical Medical Academy, Shenzhen 518000, Guangdong Province, China
| | - Wei Han
- Department of Emergency Medicine, Shenzhen University General Hospital, Shenzhen University Clinical Medical Academy, Shenzhen 518000, Guangdong Province, China
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Yoshida Y, Kaneko M, Narukawa M. Impact of Advantage in Tumor Response on the Correlation Between Progression-Free Survival and Overall Survival: Meta-Analysis of Clinical Trials in Patients with Advanced Non-Small Cell Lung Cancer. Pharmaceut Med 2021; 35:81-92. [PMID: 33483892 DOI: 10.1007/s40290-021-00383-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Progression-free survival (PFS) has not been validated as a surrogate endpoint for overall survival (OS) in patients with advanced non-small cell lung cancer. OBJECTIVE This study aimed to investigate an impact of advantage in tumor response on the correlation between PFS and OS in advanced non-small cell lung cancer. METHODS Based on a literature search, we identified randomized controlled trials of first-line therapy for advanced non-small cell lung cancer. The impact of absolute difference in objective response rate between treatment arms on the correlation between hazard ratios (HRs) for PFS and OS was evaluated based on Spearman rank correlation coefficients. RESULTS Sixty trials with a total of 29,134 patients were identified. The HR for PFS showed a relatively higher correlation with HR for OS (rs = 0.75) when the trials were limited to those that demonstrated a larger advantage in objective response rate, compared with the case for trials that demonstrated a smaller advantage (rs = 0.66). This tendency was also observed in the subgroup analysis stratified by the types of treatment agents (non-targeted, anti-angiogenic, and immunotherapy) except for the group of epidermal growth factor receptor-targeted agents. CONCLUSIONS The magnitude of advantage in tumor response was suggested to contribute to a better prediction of OS-HR based on PFS-HR in clinical trials in patients with advanced non-small cell lung cancer.
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Affiliation(s)
- Yosuke Yoshida
- Department of Clinical Medicine (Pharmaceutical Medicine), Graduate School of Pharmaceutical Sciences, Kitasato University, Shirokane 5-9-1, Minato-ku, Tokyo, 108-8641, Japan. .,MSD K.K., a subsidiary of Merck & Co., Inc, Kenilworth, NJ, USA.
| | - Masayuki Kaneko
- Department of Clinical Medicine (Pharmaceutical Medicine), Graduate School of Pharmaceutical Sciences, Kitasato University, Shirokane 5-9-1, Minato-ku, Tokyo, 108-8641, Japan
| | - Mamoru Narukawa
- Department of Clinical Medicine (Pharmaceutical Medicine), Graduate School of Pharmaceutical Sciences, Kitasato University, Shirokane 5-9-1, Minato-ku, Tokyo, 108-8641, Japan
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Jin MZ, Jin WL. The updated landscape of tumor microenvironment and drug repurposing. Signal Transduct Target Ther 2020; 5:166. [PMID: 32843638 PMCID: PMC7447642 DOI: 10.1038/s41392-020-00280-x] [Citation(s) in RCA: 523] [Impact Index Per Article: 130.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 07/16/2020] [Accepted: 07/30/2020] [Indexed: 02/07/2023] Open
Abstract
Accumulating evidence shows that cellular and acellular components in tumor microenvironment (TME) can reprogram tumor initiation, growth, invasion, metastasis, and response to therapies. Cancer research and treatment have switched from a cancer-centric model to a TME-centric one, considering the increasing significance of TME in cancer biology. Nonetheless, the clinical efficacy of therapeutic strategies targeting TME, especially the specific cells or pathways of TME, remains unsatisfactory. Classifying the chemopathological characteristics of TME and crosstalk among one another can greatly benefit further studies exploring effective treating methods. Herein, we present an updated image of TME with emphasis on hypoxic niche, immune microenvironment, metabolism microenvironment, acidic niche, innervated niche, and mechanical microenvironment. We then summarize conventional drugs including aspirin, celecoxib, β-adrenergic antagonist, metformin, and statin in new antitumor application. These drugs are considered as viable candidates for combination therapy due to their antitumor activity and extensive use in clinical practice. We also provide our outlook on directions and potential applications of TME theory. This review depicts a comprehensive and vivid landscape of TME from biology to treatment.
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Affiliation(s)
- Ming-Zhu Jin
- Institute of Nano Biomedicine and Engineering, Shanghai Engineering Center for Intelligent Diagnosis and Treatment Instrument, Department of Instrument Science and Engineering, Key Laboratory for Thin Film and Microfabrication Technology of Ministry of Education, School of Electronic Information and Electronic Engineering, Shanghai Jiao Tong University, Shanghai, 200240, P. R. China.,Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, P. R. China
| | - Wei-Lin Jin
- Institute of Nano Biomedicine and Engineering, Shanghai Engineering Center for Intelligent Diagnosis and Treatment Instrument, Department of Instrument Science and Engineering, Key Laboratory for Thin Film and Microfabrication Technology of Ministry of Education, School of Electronic Information and Electronic Engineering, Shanghai Jiao Tong University, Shanghai, 200240, P. R. China.
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Pang L, Shah H, Wang H, Shu D, Qian SY, Sathish V. EpCAM-Targeted 3WJ RNA Nanoparticle Harboring Delta-5-Desaturase siRNA Inhibited Lung Tumor Formation via DGLA Peroxidation. MOLECULAR THERAPY-NUCLEIC ACIDS 2020; 22:222-235. [PMID: 33230429 PMCID: PMC7515975 DOI: 10.1016/j.omtn.2020.08.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 08/20/2020] [Indexed: 12/14/2022]
Abstract
Knocking down delta-5-desaturase (D5D) expression by D5D small interfering RNA (siRNA) has been reported that could redirect the cyclooxygenase-2 (COX-2)-catalyzed dihomo-γ-linolenic acid (DGLA) peroxidation from producing prostaglandin E2 to 8-hydroxyoctanoic acid (8-HOA), resulting in the inhibition of colon and pancreatic cancers. However, the effect of D5D siRNA on lung cancer is still unknown. In this study, by incorporating epithelial cell adhesion molecule (EpCAM) aptamer and validated D5D siRNA into the innovative three-way junction (3WJ) RNA nanoparticle, target-specific accumulation and D5D knockdown were achieved in the lung cancer cell and mouse models. By promoting the 8-HOA formation from the COX-2-catalyzed DGLA peroxidation, the 3WJ-EpCAM-D5D siRNA nanoparticle inhibited lung cancer growth in vivo and in vitro. As a potential histone deacetylases inhibitor, 8-HOA subsequently inhibited cancer proliferation and induced apoptosis via suppressing YAP1/TAZ nuclear translocation and expression. Therefore, this 3WJ-RNA nanoparticle could improve the targeting and effectiveness of D5D siRNA in lung cancer therapy.
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Affiliation(s)
- Lizhi Pang
- Department of Pharmaceutical Sciences, North Dakota State University, Fargo, ND 58102, USA
| | - Harshit Shah
- Department of Pharmaceutical Sciences, North Dakota State University, Fargo, ND 58102, USA
| | - Hongzhi Wang
- Center for RNA Nanobiotechnology and Nanomedicine, The Ohio State University, Columbus, OH 43210, USA
- College of Pharmacy, Division of Pharmaceutics and Pharmaceutical Chemistry, The Ohio State University, Columbus, OH 43210, USA
- College of Medicine, Dorothy M. Davis Heart and Lung Research Institute and James Comprehensive Cancer Center, The Ohio State University, Columbus, OH 43210, USA
| | - Dan Shu
- Center for RNA Nanobiotechnology and Nanomedicine, The Ohio State University, Columbus, OH 43210, USA
- College of Pharmacy, Division of Pharmaceutics and Pharmaceutical Chemistry, The Ohio State University, Columbus, OH 43210, USA
- College of Medicine, Dorothy M. Davis Heart and Lung Research Institute and James Comprehensive Cancer Center, The Ohio State University, Columbus, OH 43210, USA
| | - Steven Y. Qian
- Department of Pharmaceutical Sciences, North Dakota State University, Fargo, ND 58102, USA
| | - Venkatachalem Sathish
- Department of Pharmaceutical Sciences, North Dakota State University, Fargo, ND 58102, USA
- Corresponding author: Venkatachalem Sathish, Department of Pharmaceutical Sciences, North Dakota State University, Sudro 203, 1401 Albrecht Blvd., Fargo, ND 58102, USA.
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Yang J, Wang X, Gao Y, Fang C, Ye F, Huang B, Li L. Inhibition of PI3K-AKT Signaling Blocks PGE 2-Induced COX-2 Expression in Lung Adenocarcinoma. Onco Targets Ther 2020; 13:8197-8208. [PMID: 32904445 PMCID: PMC7455753 DOI: 10.2147/ott.s263977] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 07/24/2020] [Indexed: 12/22/2022] Open
Abstract
Purpose Cyclooxygenase-2 (COX-2) and its enzymatic product prostaglandin E2 (PGE2) possess tumor-promoting activity, and COX-2 is considered as a candidate for targeted cancer therapy. However, several randomized clinical trials using COX-2 inhibitors to treat advanced lung cancer have failed to improve survival indices. To employ a more effective therapeutic strategy to inhibit the COX-2-PGE2 axis in tumors, it is necessary to revisit the mechanism underlying the protumor effect of COX-2-PGE2. Patients and Methods Immunohistochemistry was used to predict the expression and prognostic value of COX-2 in lung adenocarcinoma samples. The mRNAs or proteins expression of COX-2, pAKT1/2/3, pErk1/2 and pCREB were detected after different treatments by qPCR or Western blot. The impacts of PGE2 and some inhibitors on cell proliferation and migration ability were verified by CCK-8 and transwell assays, respectively. Results In this study, we first confirmed that COX-2 expression in tumor specimens is associated with the pathological stage of the disease. Next, using lung adenocarcinoma cell lines, we found that exogenous PGE2 induces the expression of COX-2 at the mRNA and protein levels. Moreover, downregulation of COX-2 expression restrained PGE2-induced cancer cell proliferation and migration. Mechanistic analysis revealed that PGE2 stimulation activates the PKA-CREB and PI3K-AKT pathways. Downregulation of CREB expression abrogated PGE2-induced COX-2 expression. Moreover, inhibition of PI3K-AKT signaling suppressed the activation of CREB and PGE2-induced COX-2 expression. Specific inhibitors for PI3K and AKT suppressed COX-2 mRNA expression in ex vivo cultures of tumor specimens with PGE2. Conclusion Simultaneous targeting of COX-2 and PI3K-AKT effectively suppressed PGE2-induced cell proliferation and migration and both acted in a synergistic manner. Targeting the COX-2-PGE2 positive feedback loop may be therapeutically beneficial to lung adenocarcinoma.
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Affiliation(s)
- Jianjian Yang
- Thoracic Surgery Laboratory, Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Xue Wang
- Thoracic Surgery Laboratory, Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Yi Gao
- Thoracic Surgery Laboratory, Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Can Fang
- Thoracic Surgery Laboratory, Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Fan Ye
- Thoracic Surgery Laboratory, Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Bing Huang
- Thoracic Surgery Laboratory, Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Lequn Li
- Thoracic Surgery Laboratory, Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
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21
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Resolution of eicosanoid/cytokine storm prevents carcinogen and inflammation-initiated hepatocellular cancer progression. Proc Natl Acad Sci U S A 2020; 117:21576-21587. [PMID: 32801214 DOI: 10.1073/pnas.2007412117] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Toxic environmental carcinogens promote cancer via genotoxic and nongenotoxic pathways, but nongenetic mechanisms remain poorly characterized. Carcinogen-induced apoptosis may trigger escape from dormancy of microtumors by interfering with inflammation resolution and triggering an endoplasmic reticulum (ER) stress response. While eicosanoid and cytokine storms are well-characterized in infection and inflammation, they are poorly characterized in cancer. Here, we demonstrate that carcinogens, such as aflatoxin B1 (AFB1), induce apoptotic cell death and the resulting cell debris stimulates hepatocellular carcinoma (HCC) tumor growth via an "eicosanoid and cytokine storm." AFB1-generated debris up-regulates cyclooxygenase-2 (COX-2), soluble epoxide hydrolase (sEH), ER stress-response genes including BiP, CHOP, and PDI in macrophages. Thus, selective cytokine or eicosanoid blockade is unlikely to prevent carcinogen-induced cancer progression. Pharmacological abrogation of both the COX-2 and sEH pathways by PTUPB prevented the debris-stimulated eicosanoid and cytokine storm, down-regulated ER stress genes, and promoted macrophage phagocytosis of debris, resulting in suppression of HCC tumor growth. Thus, inflammation resolution via dual COX-2/sEH inhibition is an approach to prevent carcinogen-induced cancer.
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22
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23
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Zhang W, Yi L, Shen J, Zhang H, Luo P, Zhang J. Comparison of the benefits of celecoxib combined with anticancer therapy in advanced non-small cell lung cancer: A meta-analysis. J Cancer 2020; 11:1816-1827. [PMID: 32194793 PMCID: PMC7052875 DOI: 10.7150/jca.35003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 11/14/2019] [Indexed: 12/11/2022] Open
Abstract
Background: Studies have reported that advanced NSCLC benefits from celecoxib combined with systematic treatment. However, the optimal combination with different treatments remains unclear. A meta-analysis was conducted to explore treatment combinations. Methods: We searched the relevant literature via PubMed, EMBASE, the Cochrane Library and PMC. The data for the overall response rate (ORR), overall survival (OS), progression-free survival (PFS), and adverse effects were obtained. Subgroup analysis was performed according to the treatment pattern. Statistical analyses were carried out using Review Manager 5.3 software. Results: A total of 18 eligible studies were included, with 1178 advanced NSCLC patients. Subgroup analysis revealed that celecoxib combined with chemotherapy or tyrosine kinase inhibitors (TKIs) significantly increased the ORR, with no significant difference between the two groups. Celecoxib combined with chemotherapy improved OS-6 (OR=0.65, 95% CI 0.59-0.71, P<0.001), while OS-6 was not changed with celecoxib combined with TKIs (OR=0.53, 95% CI 0.31-0.73, P=0.82). Differences were apparent between the chemotherapy and TKIs regarding OS-6 (P=0.0392). Celecoxib combined with chemotherapy significantly prolonged OS-12 (OR=0.39, 95% CI 0.33-0.45, P<0.001). In terms of OS-12, there was no significant improvement when celecoxib was combined with radiotherapy or TKIs. Celecoxib combined with chemotherapy or TKIs significantly improved PFS-6 and PFS-12, with no obvious difference in terms of PFS between the two groups. Additionally, celecoxib combined with chemotherapy or TKI treatment increased the incidence of adverse events, with no significant differences between the two groups. Conclusions: Celecoxib combined with chemotherapy or TKIs improved the ORR, with no significant differences between the two groups. In terms of OS, celecoxib combined with chemotherapy was superior to TKIs or radiotherapy. Accordingly, celecoxib combined with chemotherapy increased hematological toxicity and cardiovascular events.
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Affiliation(s)
- Wei Zhang
- Department of Oncology, Zhujiang Hospital, Southern Medical University, 253 Industrial Avenue, Guangzhou, 510282, Guangdong, People's Republic of China
| | - Lilan Yi
- Department of Oncology, Zhujiang Hospital, Southern Medical University, 253 Industrial Avenue, Guangzhou, 510282, Guangdong, People's Republic of China
| | - Jie Shen
- Department of Oncology, Zhujiang Hospital, Southern Medical University, 253 Industrial Avenue, Guangzhou, 510282, Guangdong, People's Republic of China
| | - Hongman Zhang
- Department of Oncology, Zhujiang Hospital, Southern Medical University, 253 Industrial Avenue, Guangzhou, 510282, Guangdong, People's Republic of China
| | - Peng Luo
- Department of Oncology, Zhujiang Hospital, Southern Medical University, 253 Industrial Avenue, Guangzhou, 510282, Guangdong, People's Republic of China
| | - Jian Zhang
- Department of Oncology, Zhujiang Hospital, Southern Medical University, 253 Industrial Avenue, Guangzhou, 510282, Guangdong, People's Republic of China
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24
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Nichetti F, Ligorio F, Zattarin E, Signorelli D, Prelaj A, Proto C, Galli G, Marra A, Apollonio G, Porcu L, de Braud F, Lo Russo G, Ferrara R, Garassino MC. Is There an Interplay between Immune Checkpoint Inhibitors, Thromboprophylactic Treatments and Thromboembolic Events? Mechanisms and Impact in Non-Small Cell Lung Cancer Patients. Cancers (Basel) 2019; 12:cancers12010067. [PMID: 31881699 PMCID: PMC7016680 DOI: 10.3390/cancers12010067] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 12/19/2019] [Accepted: 12/20/2019] [Indexed: 12/14/2022] Open
Abstract
PD-1 pathway blockade has been shown to promote proatherogenic T-cell responses and destabilization of atherosclerotic plaques. Moreover, preclinical evidence suggests a potential synergy of antiplatelet drugs with immune checkpoint inhibitors (ICIs). We conducted an analysis within a prospective observational protocol (APOLLO study) to investigate the rates, predictors, and prognostic significance of thromboembolic events (TE) and thromboprophylaxis in patients with advanced NSCLC treated with ICIs. Among 217 patients treated between April 2014 and September 2018, 13.8% developed TE events. Current smoking status (HR 3.61 (95% CI 1.52–8.60), p = 0.004) and high (>50%) PD-L1 (HR 2.55 (95% CI 1.05–6.19), p = 0.038) resulted in being independent TE predictors. An increased risk of death following a diagnosis of TE (HR 2.93; 95% CI 1.59–5.42; p = 0.0006) was observed. Patients receiving antiplatelet treatment experienced longer progression-free survival (PFS) (6.4 vs. 3.4 months, HR 0.67 (95% CI 0.48–0.92), p = 0.015) and a trend toward better OS (11.2 vs. 9.6 months, HR 0.78 (95% CI 0.55–1.09), p = 0.14), which were not confirmed in a multivariate model. No impact of anticoagulant treatment on patients’ outcomes was observed. NSCLC patients treated with ICIs bear a consistent risk for thrombotic complications, with a detrimental effect on survival. The impact of antiplatelet drugs on ICIs efficacy deserves further investigation in prospective trials.
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Affiliation(s)
- Federico Nichetti
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (F.L.); (E.Z.); (D.S.); (A.P.); (C.P.); (G.G.); (G.A.); (F.d.B.); (G.L.R.); (R.F.); (M.C.G.)
- Correspondence: ; Tel.: +39-022-390-3066
| | - Francesca Ligorio
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (F.L.); (E.Z.); (D.S.); (A.P.); (C.P.); (G.G.); (G.A.); (F.d.B.); (G.L.R.); (R.F.); (M.C.G.)
| | - Emma Zattarin
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (F.L.); (E.Z.); (D.S.); (A.P.); (C.P.); (G.G.); (G.A.); (F.d.B.); (G.L.R.); (R.F.); (M.C.G.)
| | - Diego Signorelli
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (F.L.); (E.Z.); (D.S.); (A.P.); (C.P.); (G.G.); (G.A.); (F.d.B.); (G.L.R.); (R.F.); (M.C.G.)
| | - Arsela Prelaj
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (F.L.); (E.Z.); (D.S.); (A.P.); (C.P.); (G.G.); (G.A.); (F.d.B.); (G.L.R.); (R.F.); (M.C.G.)
| | - Claudia Proto
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (F.L.); (E.Z.); (D.S.); (A.P.); (C.P.); (G.G.); (G.A.); (F.d.B.); (G.L.R.); (R.F.); (M.C.G.)
| | - Giulia Galli
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (F.L.); (E.Z.); (D.S.); (A.P.); (C.P.); (G.G.); (G.A.); (F.d.B.); (G.L.R.); (R.F.); (M.C.G.)
| | - Antonio Marra
- Department of Medical Oncology, Istituto Europeo di Oncologia, 20141 Milan, Italy;
| | - Giulia Apollonio
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (F.L.); (E.Z.); (D.S.); (A.P.); (C.P.); (G.G.); (G.A.); (F.d.B.); (G.L.R.); (R.F.); (M.C.G.)
| | - Luca Porcu
- Department of Oncology, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, 20156 Milan, Italy;
| | - Filippo de Braud
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (F.L.); (E.Z.); (D.S.); (A.P.); (C.P.); (G.G.); (G.A.); (F.d.B.); (G.L.R.); (R.F.); (M.C.G.)
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy
| | - Giuseppe Lo Russo
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (F.L.); (E.Z.); (D.S.); (A.P.); (C.P.); (G.G.); (G.A.); (F.d.B.); (G.L.R.); (R.F.); (M.C.G.)
| | - Roberto Ferrara
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (F.L.); (E.Z.); (D.S.); (A.P.); (C.P.); (G.G.); (G.A.); (F.d.B.); (G.L.R.); (R.F.); (M.C.G.)
| | - Marina Chiara Garassino
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (F.L.); (E.Z.); (D.S.); (A.P.); (C.P.); (G.G.); (G.A.); (F.d.B.); (G.L.R.); (R.F.); (M.C.G.)
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25
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Bi N, Liang J, Zhou Z, Chen D, Fu Z, Yang X, Feng Q, Hui Z, Xiao Z, Lv J, Wang X, Zhang T, Wang X, Deng L, Wang W, Wang J, Liu L, Hu C, Wang L. Effect of Concurrent Chemoradiation With Celecoxib vs Concurrent Chemoradiation Alone on Survival Among Patients With Non-Small Cell Lung Cancer With and Without Cyclooxygenase 2 Genetic Variants: A Phase 2 Randomized Clinical Trial. JAMA Netw Open 2019; 2:e1918070. [PMID: 31851351 PMCID: PMC6991217 DOI: 10.1001/jamanetworkopen.2019.18070] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
IMPORTANCE Treatment of locally advanced non-small cell lung cancer (NSCLC) remains challenging. The rationale of combining a cyclooxygenase 2 (COX-2) inhibitor with concurrent chemoradiation (CCRT) was based on results of preclinical research and prospective clinical studies; however, no randomized clinical trial has provided evidence of a direct comparison with CCRT alone. OBJECTIVE To determine the effect of combined selective COX-2 inhibition with standard CCRT on survival among patients with unresectable stage III NSCLC. DESIGN, SETTING, AND PARTICIPANTS A single-center, open-label, randomized phase 2 clinical trial was performed among 96 patients who had histologically and cytologically confirmed unresectable stage III NSCLC. Participants were enrolled from November 2011 to August 2015. Data were analyzed from February to October 2018. INTERVENTION Patients were randomized to receive thoracic radiation, 60 Gy, for 6 weeks concurrent with etoposide and cisplatin or the same regimen of CCRT combined with 200 mg of celecoxib, taken twice daily. MAIN OUTCOMES AND MEASURES The primary end point was overall survival. The secondary end points were the proportion of patients with treatment-related toxic effects, progression-free survival, and overall survival in subgroups with and without the COX-2 genotype. RESULTS A total of 100 patients were randomized. Following the exclusion of 4 outliers, 96 participants (96.0%) were analyzed (51 randomized to CCRT alone and 45 randomized to CCRT with celecoxib; mean [SD] age, 60.0 [8.3] years; 73.0 [76.0%] male). The median overall survival time was 32.8 (95% CI, 17.0-48.5) months in the group that received CCRT with celecoxib and 35.5 (95% CI, 25.8-45.2) months in the group that received CCRT alone (P = .88). Celecoxib with CCRT was well tolerated; the incidence of symptomatic radiation pneumonitis was 6.6% (95% CI, 1.4%-18.0%) in the group that received CCRT with celecoxib and 11.8% (95% CI, 4.4%-23.9%) in the group that received CCRT alone (P = .49). Among patients with the high-risk genotype, celecoxib plus CCRT was not associated with higher progression-free survival (hazard ratio, 0.36; 95% CI, 0.13-1.04; P = .05) or overall survival (hazard ratio, 0.50; 95% CI, 0.15-1.72; P = .26) compared with CCRT alone. CONCLUSIONS AND RELEVANCE In unresectable stage III NSCLC, adding celecoxib to concurrent chemoradiation did not improve survival. A smaller, not statistically significant proportion of patients in the CCRT with celecoxib group compared with the CCRT alone group developed symptomatic radiation pneumonitis. Among patients with the high-risk genotype, adding celecoxib to CCRT did not improve overall or progression-free survival. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01503385.
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Affiliation(s)
- Nan Bi
- Department of Radiation Oncology, National Cancer Center and Cancer Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Jun Liang
- Department of Radiation Oncology, National Cancer Center and Cancer Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Zongmei Zhou
- Department of Radiation Oncology, National Cancer Center and Cancer Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Dongfu Chen
- Department of Radiation Oncology, National Cancer Center and Cancer Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Zhixue Fu
- Department of Radiation Oncology, National Cancer Center and Cancer Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Xu Yang
- Department of Radiation Oncology, National Cancer Center and Cancer Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - QinFu Feng
- Department of Radiation Oncology, National Cancer Center and Cancer Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Zhouguang Hui
- Department of Radiation Oncology, National Cancer Center and Cancer Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Zefen Xiao
- Department of Radiation Oncology, National Cancer Center and Cancer Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Jima Lv
- Department of Radiation Oncology, National Cancer Center and Cancer Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaozhen Wang
- Department of Radiation Oncology, National Cancer Center and Cancer Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Tao Zhang
- Department of Radiation Oncology, National Cancer Center and Cancer Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Xin Wang
- Department of Radiation Oncology, National Cancer Center and Cancer Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Lei Deng
- Department of Radiation Oncology, National Cancer Center and Cancer Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Wenqing Wang
- Department of Radiation Oncology, National Cancer Center and Cancer Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Jingbo Wang
- Department of Radiation Oncology, National Cancer Center and Cancer Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Lipin Liu
- Department of Radiation Oncology, National Cancer Center and Cancer Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Chen Hu
- Division of Biostatistics and Bioinformatics, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Luhua Wang
- Department of Radiation Oncology, National Cancer Center and Cancer Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
- Department of Radiation Oncology, Shenzhen Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
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26
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Panigrahy D, Gartung A, Yang J, Yang H, Gilligan MM, Sulciner ML, Bhasin SS, Bielenberg DR, Chang J, Schmidt BA, Piwowarski J, Fishbein A, Soler-Ferran D, Sparks MA, Staffa SJ, Sukhatme V, Hammock BD, Kieran MW, Huang S, Bhasin M, Serhan CN, Sukhatme VP. Preoperative stimulation of resolution and inflammation blockade eradicates micrometastases. J Clin Invest 2019; 129:2964-2979. [PMID: 31205032 DOI: 10.1172/jci127282] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 04/17/2019] [Indexed: 12/14/2022] Open
Abstract
Cancer therapy is a double-edged sword, as surgery and chemotherapy can induce an inflammatory/immunosuppressive injury response that promotes dormancy escape and tumor recurrence. We hypothesized that these events could be altered by early blockade of the inflammatory cascade and/or by accelerating the resolution of inflammation. Preoperative, but not postoperative, administration of the nonsteroidal antiinflammatory drug ketorolac and/or resolvins, a family of specialized proresolving autacoid mediators, eliminated micrometastases in multiple tumor-resection models, resulting in long-term survival. Ketorolac unleashed anticancer T cell immunity that was augmented by immune checkpoint blockade, negated by adjuvant chemotherapy, and dependent on inhibition of the COX-1/thromboxane A2 (TXA2) pathway. Preoperative stimulation of inflammation resolution via resolvins (RvD2, RvD3, and RvD4) inhibited metastases and induced T cell responses. Ketorolac and resolvins exhibited synergistic antitumor activity and prevented surgery- or chemotherapy-induced dormancy escape. Thus, simultaneously blocking the ensuing proinflammatory response and activating endogenous resolution programs before surgery may eliminate micrometastases and reduce tumor recurrence.
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Affiliation(s)
- Dipak Panigrahy
- Center for Vascular Biology Research.,Department of Pathology, and.,Cancer Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Allison Gartung
- Center for Vascular Biology Research.,Department of Pathology, and.,Cancer Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Jun Yang
- Department of Entomology and Nematology, and UC Davis Comprehensive Cancer Center, University of California, Davis, California, USA
| | - Haixia Yang
- Center for Vascular Biology Research.,Department of Pathology, and.,Cancer Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Molly M Gilligan
- Center for Vascular Biology Research.,Department of Pathology, and.,Cancer Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Megan L Sulciner
- Center for Vascular Biology Research.,Department of Pathology, and.,Cancer Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Swati S Bhasin
- Division of Interdisciplinary Medicine and Biotechnology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Jaimie Chang
- Center for Vascular Biology Research.,Department of Pathology, and.,Cancer Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Birgitta A Schmidt
- Department of Pathology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Julia Piwowarski
- Center for Vascular Biology Research.,Department of Pathology, and.,Cancer Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Anna Fishbein
- Center for Vascular Biology Research.,Department of Pathology, and.,Cancer Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Dulce Soler-Ferran
- Center for Vascular Biology Research.,Department of Pathology, and.,Cancer Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Matthew A Sparks
- Division of Nephrology, Department of Medicine, Duke University and Durham VA Medical Centers, Durham, North Carolina, USA
| | - Steven J Staffa
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Bruce D Hammock
- Department of Entomology and Nematology, and UC Davis Comprehensive Cancer Center, University of California, Davis, California, USA
| | - Mark W Kieran
- Division of Pediatric Oncology, Dana-Farber Cancer Institute, and.,Department of Pediatric Hematology/Oncology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Sui Huang
- Institute for Systems Biology, Seattle, Washington, USA
| | - Manoj Bhasin
- Division of Interdisciplinary Medicine and Biotechnology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Charles N Serhan
- Center for Experimental Therapeutics and Reperfusion Injury, Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Vikas P Sukhatme
- Cancer Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.,Division of Interdisciplinary Medicine and Biotechnology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.,Department of Medicine and Center for Affordable Medical Innovation, Emory University School of Medicine, Atlanta, Georgia, USA
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27
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Hamy AS, Tury S, Wang X, Gao J, Pierga JY, Giacchetti S, Brain E, Pistilli B, Marty M, Espié M, Benchimol G, Laas E, Laé M, Asselain B, Aouchiche B, Edelman M, Reyal F. Celecoxib With Neoadjuvant Chemotherapy for Breast Cancer Might Worsen Outcomes Differentially by COX-2 Expression and ER Status: Exploratory Analysis of the REMAGUS02 Trial. J Clin Oncol 2019; 37:624-635. [PMID: 30702971 DOI: 10.1200/jco.18.00636] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
PURPOSE The overexpression of cyclooxygenase 2 (COX-2) gene, also known as prostaglandin-endoperoxide synthase 2 ( PTGS2), occurs in breast cancer, but whether it affects response to anticox drugs remains unclear. We investigated the relationships between PTGS2 expression, celecoxib use during neoadjuvant chemotherapy (NAC), and both event-free survival (EFS) and overall survival (OS). MATERIALS AND METHODS We analyzed a cohort of 156 patients with human epidermal growth factor receptor 2 -negative breast cancer from the REMAGUS02 (ISRCTN Registry No. 10059974) trial with pretreatment PTGS2 expression data. Patients were treated by sequential NAC (epirubicin plus cyclophosphamide followed by docetaxel with or without celecoxib). Experimental validation was performed on breast cancer cell lines. The Cancer and Leukemia Group B (CALGB) 30801 ( ClinicalTrials.gov identifier: NCT01041781) trial that tested chemotherapy with or without celecoxib in patients with lung cancer served as an independent validation cohort. RESULTS After 94.5 months of follow-up, EFS was significantly lower in the celecoxib group (hazard ratio [HR], 1.7; 95% CI, 1 to 2.88; P = .046). A significant interaction between PTGS2 expression and celecoxib use was detected ( Pinteraction = .01). In the PTGS2-low group (n = 100), EFS was lower in the celecoxib arm (HR, 3.01; 95% CI, 1.45 to 6.24; P = .002) than in the standard treatment arm. Celecoxib use was an independent predictor of poor EFS, distant relapse-free survival, and OS. Celecoxib in addition to docetaxel enhanced cell viability in PTGS2-low cell lines but not in PTGS2-high cell lines. In CALGB 30801, a trend toward poorer progression-free survival was observed in the patients with low urinary metabolite of prostaglandin E2 who received celecoxib (HR = 1.57; 95% CI, 0.87 to 2.84; P = .13). CONCLUSION Celecoxib use during chemotherapy adversely affected survival in patients with breast cancer, and the effect was more marked in PTGS2-low and/or estrogen receptor-negative tumors. COX-2 inhibitors should preferably be avoided during docetaxel use in patients with breast cancer who are undergoing NAC.
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Affiliation(s)
| | - Sandrine Tury
- 1 Institut Curie, Université Paris Descartes, Paris, France
| | - Xiaofei Wang
- 2 Alliance Statistics and Data Center, Durham, NC
| | - Junheng Gao
- 2 Alliance Statistics and Data Center, Durham, NC
| | | | - Sylvie Giacchetti
- 3 Hôpital Saint Louis (APHP), Université Paris Diderot, Paris, France
| | - Etienne Brain
- 1 Institut Curie, Université Paris Descartes, Paris, France
| | | | - Michel Marty
- 3 Hôpital Saint Louis (APHP), Université Paris Diderot, Paris, France
| | - Marc Espié
- 3 Hôpital Saint Louis (APHP), Université Paris Diderot, Paris, France
| | | | - Enora Laas
- 1 Institut Curie, Université Paris Descartes, Paris, France
| | - Marick Laé
- 1 Institut Curie, Université Paris Descartes, Paris, France
| | | | | | | | - Fabien Reyal
- 1 Institut Curie, Université Paris Descartes, Paris, France
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28
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Hess LM, DeLozier AM, Natanegara F, Wang X, Soldatenkova V, Brnabic A, Able SL, Brown J. First-line treatment of patients with advanced or metastatic squamous non-small cell lung cancer: systematic review and network meta-analysis. J Thorac Dis 2018; 10:6677-6694. [PMID: 30746213 DOI: 10.21037/jtd.2018.11.87] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background The objectives of this systematic review and meta-analysis were to compare the survival, toxicity, and quality of life of patients treated with necitumumab in combination with gemcitabine and cisplatin. These agents were investigated in published randomized controlled trials (RCTs) of patients with squamous non-small cell lung cancer (NSCLC) in the first-line setting. Methods The systematic review was executed on January 27, 2015, and updated on August 21, 2016, using a pre-specified search strategy. Searches were conducted using PubMed, Medline, and EMBASE, with supplemental searches using the Evidence Based Medicine Reviews and ClinicalTrials.gov to identify RCTs published in English from 1995-2016 and reporting at least one of the primary outcomes [overall survival (OS), progression-free survival (PFS), toxicity, or quality of life] in patients who received first-line treatment for advanced or metastatic squamous NSCLC. Study quality and risk of bias were assessed using the Physiotherapy Evidence Database (PEDro) scale and Cochrane risk of bias tool, respectively. A Baysian network meta-analysis was performed on the primary outcomes. Hazard ratios (HRs) were evaluated for the primary analysis; secondary analyses were conducted using median OS data. Planned sensitivity analyses were conducted including reanalysis using a Frequentist approach and limiting analyses to subsets based on clinical and demographic covariates. Results The systematic literature review resulted in identification of 4,016 unique publications; 40 publications (35 unique trials) were eligible for inclusion. Eight studies connected to a common network for the OS analysis using HR data. The majority of studies were not limited to squamous NSCLC, thus analyzable data were limited to a subset of data within the published trials. Carboplatin + S-1 and necitumumab in combination with gemcitabine and cisplatin were associated with lower HRs for OS versus all other comparators. Nine studies connected to the network for the PFS analysis in which necitumumab in combination with gemcitabine and cisplatin was associated with the lowest HR. Data were not available to analyze toxicity or quality of life. Conclusions Although the results suggest that carboplatin + S-1 and necitumumab in combination with gemcitabine and cisplatin may have value in terms of OS versus other comparators, the results should be interpreted with caution due to the limited number of studies (with few focused exclusively on squamous NSCLC) and wide credible intervals.
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Affiliation(s)
- Lisa M Hess
- Eli Lilly and Company, Indianapolis, Indiana, USA
| | | | | | - Xiaofei Wang
- Eli Lilly and Company, Indianapolis, Indiana, USA
| | | | - Alan Brnabic
- Eli Lilly and Company, West Ryde, NSW, Australia
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Cramer-van der Welle CM, Peters BJM, Schramel FMNH, Klungel OH, Groen HJM, van de Garde EMW. Systematic evaluation of the efficacy-effectiveness gap of systemic treatments in metastatic nonsmall cell lung cancer. Eur Respir J 2018; 52:1801100. [PMID: 30487206 PMCID: PMC6306150 DOI: 10.1183/13993003.01100-2018] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 10/13/2018] [Indexed: 01/26/2023]
Abstract
The divergence between clinical trial results and real-world outcomes is largely unknown for many cancer types. The present study aims overall to assess the efficacy-effectiveness gap (difference between outcomes in clinical trials and the real world) in systemic treatment for metastatic nonsmall cell lung cancer (NSCLC).All patients diagnosed with stage IV NSCLC between 2008 and 2014 within a network of seven Dutch large teaching hospitals (Santeon) were studied. For every patient, an efficacy-effectiveness (EE) factor was calculated by dividing individual patients' overall survival (OS) by the pooled median OS assessed from clinical trials with the respective treatment.From 2989 diagnosed patients, 1214 (41%) started with first-line treatment. For all studied regimens, real-world OS was shorter than OS reported in clinical trials. Overall, the EE factor was 0.77 (95% CI 0.70-0.85; p<0.001). Real-world patients completed their treatment plan less often and proceeded less frequently to further lines of treatment. These parameters together with Eastern Cooperative Oncology Group performance status explained 35% of the variation in EE factor.Survival of patients with metastatic NSCLC treated with chemotherapy or targeted therapy in real-world practice is nearly one-quarter shorter than for patients included in trials. Patients' performance status, earlier discontinuation and fewer subsequent lines of treatment partly explained this difference.
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Affiliation(s)
| | - Bas J M Peters
- Dept of Clinical Pharmacy, St Antonius Hospital, Utrecht/Nieuwegein, The Netherlands
| | - Franz M N H Schramel
- Dept of Pulmonary Diseases, St Antonius Hospital, Utrecht/Nieuwegein, The Netherlands
| | - Olaf H Klungel
- Division of Pharmacoepidemiology and Clinical Pharmacology, Dept of Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Harry J M Groen
- University of Groningen and University Medical Center Groningen, Dept of Pulmonary Diseases, Groningen, The Netherlands
| | - Ewoudt M W van de Garde
- Dept of Clinical Pharmacy, St Antonius Hospital, Utrecht/Nieuwegein, The Netherlands
- Division of Pharmacoepidemiology and Clinical Pharmacology, Dept of Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
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30
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Rescifina A, Surdo E, Cardile V, Avola R, Eleonora Graziano AC, Stancanelli R, Tommasini S, Pistarà V, Ventura CA. Gemcitabine anticancer activity enhancement by water soluble celecoxib/sulfobutyl ether-β-cyclodextrin inclusion complex. Carbohydr Polym 2018; 206:792-800. [PMID: 30553385 DOI: 10.1016/j.carbpol.2018.11.060] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 11/18/2018] [Accepted: 11/18/2018] [Indexed: 12/12/2022]
Abstract
We investigated the complexation of celecoxib (CCB) into sulfobuthyl-ether-β-cyclodextrin (SBE-β-CD) for the realization of an inhalable dry-powder formulation containing gemcitabine (GEM) for lung anticancer therapy. Complexation increased the water solubility of CCB (0.003 mg/mL and 0.834 mg/mL for CCB free and complexed, respectively) and produced a quantitative dissolution of the drug within 15 min. The CCB/SBE-β-CD inclusion complex showed a high stability constant (8131 M-1) not influenced by the presence of GEM in solution. Two-dimensional NMR experiments and computational studies demonstrated that the pyrazole ring of CCB penetrates deeper into SBE-β-CD from the secondary rim. The aromatic rings are positioned at the edge of the cavity, establishing hydrogen bonds with the SBE-β-CD that stabilized the complex. CCB showed limited cytotoxic activity on A549 cell lines. Complexation significantly increased activity passing from 30% to 45% cell mortality. Moreover, CCB/SBE-β-CD strongly improved the cytotoxicity of GEM, observing about 60% of cell mortality for the combined formulation.
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Affiliation(s)
- Antonio Rescifina
- Department of Drug Sciences, University of Catania, V.le A. Doria, 6 - 95125 Catania, Italy.
| | - Emanuela Surdo
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, V.le F. Stagno D'Alcontrés, 31 - 98166 Messina, Italy.
| | - Venera Cardile
- Department of Biomedical and Biotechnological Sciences, University of Catania, Via Santa Sofia, 97 - 95125 Catania, Italy.
| | - Rosanna Avola
- Department of Biomedical and Biotechnological Sciences, University of Catania, Via Santa Sofia, 97 - 95125 Catania, Italy.
| | | | - Rosanna Stancanelli
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, V.le F. Stagno D'Alcontrés, 31 - 98166 Messina, Italy.
| | - Silvana Tommasini
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, V.le F. Stagno D'Alcontrés, 31 - 98166 Messina, Italy.
| | - Venerando Pistarà
- Department of Drug Sciences, University of Catania, V.le A. Doria, 6 - 95125 Catania, Italy.
| | - Cinzia Anna Ventura
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, V.le F. Stagno D'Alcontrés, 31 - 98166 Messina, Italy.
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31
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Martinez-Marti A, Navarro A, Felip E. COX-2 inhibitors in NSCLC: never-ending story or misplaced? Transl Lung Cancer Res 2018; 7:S191-S194. [PMID: 30393598 DOI: 10.21037/tlcr.2018.04.17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Alex Martinez-Marti
- Medical Oncology Department, Vall d'Hebron University Hospital and Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Alejandro Navarro
- Medical Oncology Department, Vall d'Hebron University Hospital and Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Enriqueta Felip
- Medical Oncology Department, Vall d'Hebron University Hospital and Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
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Ikeda M, Ochibe T, Tohkin M. Possible Causes of Failing to Meet Primary Endpoints: A Systematic Review of Randomized Controlled Phase 3 Clinical Trials in Patients With Non-Small Cell Lung Cancer. Ther Innov Regul Sci 2018; 53:324-331. [PMID: 30089401 DOI: 10.1177/2168479018791135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Non-small cell lung cancer (NSCLC) is the most common cause of cancer-related mortality worldwide and represents a huge unmet medical need. Despite the favorable results of phase 2 clinical trials, many phase 3 clinical trials fail to meet primary endpoints. Therefore, we investigated the causes of failure to meet primary endpoints in phase 3 clinical trials. METHODS We performed a systematic review of phase 3 clinical trials in patients with NSCLC. The results of phase 3 clinical trials collected from the survey were categorized as "negative" (failed to meet the primary endpoint) or "positive" (met the primary endpoint). RESULTS Of a total of 106 trials collected from this survey, 40 positive trials (38%) and 66 negative trials (62%) were identified. The majority of the primary endpoints were overall survival (OS) or progression-free survival (PFS) (94%). More trials using OS as the primary endpoint were negative (42 of 56 trials), and more trials using PFS as the primary endpoint were positive (24 of 44 trials). The median OS in the control arm in negative trials was significantly longer than the pretrial estimate ( P < .001), whereas the median PFS in the control arm in positive trials was relatively consistent with the pretrial estimate. CONCLUSIONS Our findings suggest that the selection of the primary endpoint and the pretrial estimate can potentially impact the results of phase 3 clinical trials in patients with NSCLC and are critical success factors when planning phase 3 clinical trials.
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Affiliation(s)
- Mitsugu Ikeda
- 1 Department of Regulatory Science, Graduate School of Pharmaceutical Sciences, Nagoya City University, Nagoya, Japan
| | - Tatsuya Ochibe
- 1 Department of Regulatory Science, Graduate School of Pharmaceutical Sciences, Nagoya City University, Nagoya, Japan
| | - Masahiro Tohkin
- 1 Department of Regulatory Science, Graduate School of Pharmaceutical Sciences, Nagoya City University, Nagoya, Japan
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Yi L, Zhang W, Zhang H, Shen J, Zou J, Luo P, Zhang J. Systematic review and meta-analysis of the benefit of celecoxib in treating advanced non-small-cell lung cancer. DRUG DESIGN DEVELOPMENT AND THERAPY 2018; 12:2455-2466. [PMID: 30122902 PMCID: PMC6086108 DOI: 10.2147/dddt.s169627] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Background The clinical benefit of a selective cyclooxygenase-2 inhibitor, celecoxib, combined with anticancer therapy in advanced non-small-cell lung cancer (NSCLC) remains unclear. A meta-analysis was performed to address the efficacy and safety of celecoxib in patients with advanced NSCLC. Materials and methods Three databases, including PubMed, EMBASE, and the Cochrane Library, were systematically searched for available literature until March 1, 2018. Data on tumor response rates, one-year survival, overall survival, progression-free survival, and toxicities were extracted from the included randomized clinical trials. Subgroup analysis was carried out according to the line of treatment. Review Manager 5.3 software was applied to conduct the meta-analysis. Results A total of 7 randomized controlled trials involving 1,559 patients with advanced NSCLC were enrolled for analysis. The pooled overall response rate (ORR) of celecoxib added to systemic therapy was not significantly improved (risk ratio [RR] =1.14, 95% CI =0.96–1.35, P=0.13). Additionally, no differences were observed between the celecoxib and placebo groups regarding 1-year survival (RR =0.99, 95% CI =0.88–1.12, P=0.91). Subgroup analysis showed that adding celecoxib to the first-line treatment significantly improved the ORR (RR =1.21, 95% CI =1.01–1.44, P=0.04) and partial response rate (RR =1.26, 95% CI =1.01–1.58, P=0.04). The aggregated Kaplan–Meier analysis found no significant difference between celecoxib and placebo regarding the 5-year overall survival (median, 12.9 vs 12.5 months, P=0.553) and 5-year progression-free survival (median, 7.4 vs 7.2 months, P=0.641). The increased RR of leukopenia (RR =1.25, 95% CI =1.03–1.50) and thrombocytopenia (RR =1.39, 95% CI =1.11–1.75) indicated that celecoxib increased hematologic toxicities (grade ≥III). However, celecoxib did not increase the related risks of thrombosis or embolism (RR =1.26, 95% CI =0.66–2.39) and cardiac ischemia (RR =1.16, 95% CI =0.39–3.44). Conclusion Celecoxib had no benefit on survival indices for advanced NSCLC but improved the ORR of first-line treatment. Additionally, celecoxib increased the rate of hematologic toxicities without increasing the risk of cardiovascular events.
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Affiliation(s)
- Lilan Yi
- Department of Oncology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, People's Republic of China, ;
| | - Wei Zhang
- Department of Oncology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, People's Republic of China, ;
| | - Hongman Zhang
- Department of Oncology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, People's Republic of China, ;
| | - Jie Shen
- Department of Oncology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, People's Republic of China, ;
| | - Jingwen Zou
- Department of Oncology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, People's Republic of China, ;
| | - Peng Luo
- Department of Oncology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, People's Republic of China, ;
| | - Jian Zhang
- Department of Oncology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, People's Republic of China, ;
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Hassanzade A, Mandegary A, Sharif E, Rasooli R, Mohammadnejad R, Masoumi-Ardekani Y. Cyclooxygenase inhibitors combined with deuterium-enriched water augment cytotoxicity in A549 lung cancer cell line via activation of apoptosis and MAPK pathways. IRANIAN JOURNAL OF BASIC MEDICAL SCIENCES 2018; 21:508-516. [PMID: 29922432 PMCID: PMC6000214 DOI: 10.22038/ijbms.2018.25366.6269] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Objectives Combination chemotherapy is a rational strategy to increase patient response and tolerability and to decrease adverse effects and drug resistance. Recently, the use of non-steroidal anti-inflammatory drugs (NSAIDs) has been reported to be associated with reduction in occurrence of a variety of cancers including lung cancer. On the other hand, growing evidences suggest that deuterium-enriched water (DEW, D2O) and deuterium-depleted water (DDW) play a role both in treatment and prevention of cancers. In the present study, we examined the effects of DEW and DDW in combination with two NSAIDs, celecoxib and indomethacin, on A549 human non-small lung cancer cell to identify novel treatment options. Materials and Methods The cytotoxicity of celecoxib or indomethacin, alone and in combination with DDW and DEW was determined. The COX-2, MAPK pathway proteins, the anti-apoptotic Bcl2 and pro-apoptotic Bax proteins and caspase-3 activity were studied for cytotoxic combinations. Results Co-administration of selective and non-selective COX-2 inhibitors with DEW led to a remarkable increase in cytotoxicity and apoptosis of A549 cells. These events were associated with activation of p38 and JNK MAPKs and decreasing pro-survival proteins Bcl-2, COX-2 and ERK1/2. Furthermore, the combination therapy activated caspase-3, and the apoptosis mediator, and disabled poly ADP-ribose polymerase (PARP), the key DNA repair enzyme, by cleaving it. Conclusion The combination of DEW with NSAIDs might be effective against lung cancer cells by influence on principal cell signalling pathways, and this has a potential to become a candidate for chemotherapy.
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Affiliation(s)
- Abdolreza Hassanzade
- Pharmaceutics Research Centre, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran.,Department of Medicinal Chemistry, School of Pharmacy, Kerman University of Medical Sciences, Kerman, Iran
| | - Ali Mandegary
- Neuroscience Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran.,Department of Pharmacology & Toxicology, School of Pharmacy, Kerman University of Medical Sciences, Kerman, Iran
| | - Elham Sharif
- Pharmaceutics Research Centre, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran.,Department of Pharmacology & Toxicology, School of Pharmacy, Kerman University of Medical Sciences, Kerman, Iran
| | - Rokhsana Rasooli
- Pharmaceutics Research Centre, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran.,Department of Pharmacology & Toxicology, School of Pharmacy, Kerman University of Medical Sciences, Kerman, Iran
| | - Reza Mohammadnejad
- Pharmaceutics Research Centre, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran.,Department of Pharmacology & Toxicology, School of Pharmacy, Kerman University of Medical Sciences, Kerman, Iran
| | - Yaser Masoumi-Ardekani
- Physiology Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran
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Wu C, Xu B, Zhou Y, Ji M, Zhang D, Jiang J, Wu C. Correlation between serum IL-1β and miR-144-3p as well as their prognostic values in LUAD and LUSC patients. Oncotarget 2018; 7:85876-85887. [PMID: 27811377 PMCID: PMC5349881 DOI: 10.18632/oncotarget.13042] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 10/28/2016] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND IL-1β is an essential factor of inflammation initiation, and it also promotes malignant transformation, indicating its tumorigenic property. We aimed to investigate the correlation between IL-1β and miR-144-3p as well as their prognostic values in LUAD and LUSC patients. RESULTS The IL-1β level in both LUAD and LUSC patients was significantly higher than that of healthy donors (P < 0.001). In both populations, patients with low IL-1β level had better prognosis than high IL-1β level (P < 0.001 and P = 0.010, respectively). In A549 cells, miR-144 showed the biggest expression change (-4.38 fold) after IL-1β exposure. In LUAD patients, a negative correlation was detected between IL-1β and miR-144-3p (r = -0.540, P < 0.001) and the high miR-144-3p group had better prognosis (P = 0.003), which was validated by TCGA data. Clinical stage, IL-1β and miR-144-3p were independent risk factors in LUAD patients. In vitro, IL-1β and miR-144-3p antagomir could enhance proliferation and miR-144-3p mimics would attenuate the promoting effect of IL-1β. MATERIALS AND METHODS ELISA and qRT-PCR were applied respectively to detected cytokines and miR-144-3p in 129 LUAD, 54 LUSC and 40 healthy donors. Moreover, miRNA array was carried out for miRNA profiling. TCGA database was employed for validation, and follow up data were collected for prognosis evaluation. MTT assay and western-blot were carried out for proliferation evaluation. CONCLUSIONS In LUAD patients, the serum IL-1β level was correlated with miR-144-3p may affect miR-144-3p at transcriptional level. Both of them were independent risk factors for LUAD prognosis. In addition, IL-1β and miR-144-3p might mediate inflammation-promoted tumorigenesis in LUAD patients.
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Affiliation(s)
- Chen Wu
- Department of Oncology, The Third Affiliated Hospital of Soochow University, Changzhou, 213003, P.R.China.,Institute of Cell Therapy, Soochow University, Changzhou, 213003, P.R.China.,Jiangsu Engineering Research Center for Tumor Immunotherapy, Changzhou, 213003, P.R.China
| | - Bin Xu
- Jiangsu Engineering Research Center for Tumor Immunotherapy, Changzhou, 213003, P.R.China.,Department of Biological Treatment, The Third Affiliated Hospital of Soochow University, Changzhou, 213003, P.R.China
| | - You Zhou
- Jiangsu Engineering Research Center for Tumor Immunotherapy, Changzhou, 213003, P.R.China.,Department of Biological Treatment, The Third Affiliated Hospital of Soochow University, Changzhou, 213003, P.R.China
| | - Mei Ji
- Department of Oncology, The Third Affiliated Hospital of Soochow University, Changzhou, 213003, P.R.China.,Jiangsu Engineering Research Center for Tumor Immunotherapy, Changzhou, 213003, P.R.China
| | - Dachuan Zhang
- Department of Pathology, The Third Affiliated Hospital of Soochow University, Changzhou, 213003, P.R.China
| | - Jingting Jiang
- Institute of Cell Therapy, Soochow University, Changzhou, 213003, P.R.China.,Jiangsu Engineering Research Center for Tumor Immunotherapy, Changzhou, 213003, P.R.China.,Department of Biological Treatment, The Third Affiliated Hospital of Soochow University, Changzhou, 213003, P.R.China
| | - Changping Wu
- Department of Oncology, The Third Affiliated Hospital of Soochow University, Changzhou, 213003, P.R.China.,Institute of Cell Therapy, Soochow University, Changzhou, 213003, P.R.China.,Jiangsu Engineering Research Center for Tumor Immunotherapy, Changzhou, 213003, P.R.China
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Dai P, Li J, Ma XP, Huang J, Meng JJ, Gong P. Efficacy and safety of COX-2 inhibitors for advanced non-small-cell lung cancer with chemotherapy: a meta-analysis. Onco Targets Ther 2018; 11:721-730. [PMID: 29440919 PMCID: PMC5804138 DOI: 10.2147/ott.s148670] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Background The study of cyclooxygenase-2 (COX-2) inhibitors is now mired in controversy. We performed a meta-analysis to assess the efficacy and safety profile of COX-2 inhibitors in patients with advanced non-small-cell lung cancer (NSCLC). Patients and methods A literature search of PubMed, EMBASE, the Cochrane Central databases, and ClinicalTrials.gov, up until March 26, 2017, identified relevant randomized controlled trials. Data analysis was performed using Stata 12.0. Results Six eligible trials (1,794 patients) were selected from the 407 studies that were identified initially. A significant difference, favoring COX-2 inhibitors plus chemotherapy over chemotherapy alone, was observed in the overall response rate (relative risk [RR] =1.25, 95% confidence interval [CI]: 1.06-1.48). Further, we conducted two subgroup analyses according to the type of COX-2 inhibitors (celecoxib, rofecoxib, or apricoxib) and treatment line (first or second chemotherapy). The first-line treatment includes: NP (changchun red bean + cisplatin or carboplatin), GP (double fluorine cytidine + cisplatin or carboplatin), or TP (paclitaxel + cisplatin or carboplatin, docetaxel + cisplatin or carboplatin). The second-line treatment includes two internationally recognized compounds, one is docetaxel and the other is the pemetrexed, both of which are individually selected. In subgroup analysis, significantly increased overall response rate (ORR) results were found for rofecoxib plus chemotherapy (RR =1.56, 95% CI: 1.08-2.25) and COX-2 inhibitor given with first-line chemotherapy (RR =1.27, 95% CI: 1.07-1.50). However, there was no difference between COX-2 inhibitors plus chemotherapy and chemotherapy alone in overall survival (hazard ratio [HR] =1.04, 95% CI: 0.91-1.18), progression-free survival (HR =0.97, 95% CI: 0.86-1.10), and 1-year survival rate (RR =1.03, 95% CI: 0.89-1.20). Toxicity did not differ significantly between COX-2 inhibitors plus chemotherapy and chemotherapy alone with the exception of leukopenia (RR =1.21, 95% CI: 1.03-1.42), thrombocytopenia (RR =1.32, 95% CI: 1.04-1.67), and cardiovascular events (RR =2.39, 95% CI: 1.06-5.42). The results of the Egger's test indicated no significant difference in primary outcomes. Conclusion COX-2 inhibitors improved ORR of advanced NSCLC with chemotherapy, but had no effect on survival indices. Moreover, COX-2 inhibitors may lead to higher rates of hematologic toxicities and cardiovascular events.
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Affiliation(s)
- Ping Dai
- Department of Oncology, The First Affiliated Hospital, Shihezi University School of Medicine, Shihezi, Xinjiang, People's Republic of China
| | - Jing Li
- Department of Oncology, The First Affiliated Hospital, Shihezi University School of Medicine, Shihezi, Xinjiang, People's Republic of China
| | - Xiao-Ping Ma
- Department of Oncology, The First Affiliated Hospital, Shihezi University School of Medicine, Shihezi, Xinjiang, People's Republic of China
| | - Jian Huang
- Department of Oncology, The First Affiliated Hospital, Shihezi University School of Medicine, Shihezi, Xinjiang, People's Republic of China
| | - Juan-Juan Meng
- Department of Oncology, The First Affiliated Hospital, Shihezi University School of Medicine, Shihezi, Xinjiang, People's Republic of China
| | - Ping Gong
- Department of Oncology, The First Affiliated Hospital, Shihezi University School of Medicine, Shihezi, Xinjiang, People's Republic of China
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Gulyas M, Mattsson JSM, Lindgren A, Ek L, Lamberg Lundström K, Behndig A, Holmberg E, Micke P, Bergman B. COX-2 expression and effects of celecoxib in addition to standard chemotherapy in advanced non-small cell lung cancer. Acta Oncol 2018; 57:244-250. [PMID: 29140138 DOI: 10.1080/0284186x.2017.1400685] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
AIM Inhibition of cyclooxygenase-2 (COX-2) is proposed as a treatment option in several cancer types. However, in non-small cell lung cancer (NSCLC), phase III trials have failed to demonstrate a benefit of adding COX-2 inhibitors to standard chemotherapy. The aim of this study was to analyze COX-2 expression in tumor and stromal cells as predictive biomarker for COX-2 inhibition. METHODS In a multicenter phase III trial, 316 patients with advanced NSCLC were randomized to receive celecoxib (400 mg b.i.d.) or placebo up to one year in addition to a two-drug platinum-based chemotherapy combination. In a subset of 122 patients, archived tumor tissue was available for immunohistochemical analysis of COX-2 expression in tumor and stromal cells. For each compartment, COX-2 expression was graded as high or low, based on a product score of extension and intensity of positively stained cells. RESULTS An updated analysis of all 316 patients included in the original trial, and of the 122 patients with available tumor tissue, showed no survival differences between the celecoxib and placebo arms (HR 1.01; 95% CI 0.81-1.27 and HR 1.12; 95% CI 0.78-1.61, respectively). High COX-2 scores in tumor (n = 71) or stromal cells (n = 55) was not associated with a superior survival outcome with celecoxib vs. placebo (HR =0.96, 95% CI 0.60-1.54; and HR =1.51; 95% CI 0.86-2.66), and no significant interaction effect between COX-2 score in tumor or stromal cells and celecoxib effect on survival was detected (p = .48 and .25, respectively). CONCLUSIONS In this subgroup analysis of patients with advanced NSCLC treated within the context of a randomized trial, we could not detect any interaction effect of COX-2 expression in tumor or stromal cells and the outcome of celecoxib treatment in addition to standard chemotherapy.
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Affiliation(s)
- Miklos Gulyas
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | | | - Andrea Lindgren
- Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linkoping University, Allergy Centre, Linkoping, Sweden
| | - Lars Ek
- Pulmonary Medicine, Skane University Hospital, Lund, Sweden
| | | | - Annelie Behndig
- Pulmonary Medicine, Norrland University Hospital, Umeå, Sweden
| | - Erik Holmberg
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Patrick Micke
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Bengt Bergman
- Department of Respiratory Medicine, Institute of medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
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Wang F, Zhang H, Ma AH, Yu W, Zimmermann M, Yang J, Hwang SH, Zhu D, Lin TY, Malfatti M, Turteltaub KW, Henderson PT, Airhart S, Hammock BD, Yuan J, de Vere White RW, Pan CX. COX-2/sEH Dual Inhibitor PTUPB Potentiates the Antitumor Efficacy of Cisplatin. Mol Cancer Ther 2017; 17:474-483. [PMID: 29284644 DOI: 10.1158/1535-7163.mct-16-0818] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 05/25/2017] [Accepted: 12/06/2017] [Indexed: 12/14/2022]
Abstract
Cisplatin-based therapy is highly toxic, but moderately effective in most cancers. Concurrent inhibition of cyclooxygenase-2 (COX-2) and soluble epoxide hydrolase (sEH) results in antitumor activity and has organ-protective effects. The goal of this study was to determine the antitumor activity of PTUPB, an orally bioavailable COX-2/sEH dual inhibitor, in combination with cisplatin and gemcitabine (GC) therapy. NSG mice bearing bladder cancer patient-derived xenografts were treated with vehicle, PTUPB, cisplatin, GC, or combinations thereof. Mouse experiments were performed with two different PDX models. PTUPB potentiated cisplatin and GC therapy, resulting in significantly reduced tumor growth and prolonged survival. PTUPB plus cisplatin was no more toxic than cisplatin single-agent treatment as assessed by body weight, histochemical staining of major organs, blood counts, and chemistry. The combination of PTUPB and cisplatin increased apoptosis and decreased phosphorylation in the MAPK/ERK and PI3K/AKT/mTOR pathways compared with controls. PTUPB treatment did not alter platinum-DNA adduct levels, which is the most critical step in platinum-induced cell death. The in vitro study using the combination index method showed modest synergy between PTUPB and platinum agents only in 5637 cell line among several cell lines examined. However, PTUPB is very active in vivo by inhibiting angiogenesis. In conclusion, PTUPB potentiated the antitumor activity of cisplatin-based treatment without increasing toxicity in vivo and has potential for further development as a combination chemotherapy partner. Mol Cancer Ther; 17(2); 474-83. ©2017 AACR.
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Affiliation(s)
- Fuli Wang
- Department of Internal Medicine, School of Medicine, University of California Davis, Sacramento, California.,Department of Urology, Xijing Hospital, The Fourth Military Medical University, Xi'an City, Shanxi Province, China
| | - Hongyong Zhang
- Department of Internal Medicine, School of Medicine, University of California Davis, Sacramento, California
| | - Ai-Hong Ma
- Department of Biochemistry and Molecular Medicine, School of Medicine, University of California Davis, Sacramento, California
| | - Weimin Yu
- Department of Internal Medicine, School of Medicine, University of California Davis, Sacramento, California.,Department of Urology, Renmin Hospital, Wuhan University, Wuhan, Hubei Province, China
| | - Maike Zimmermann
- Department of Internal Medicine, School of Medicine, University of California Davis, Sacramento, California
| | - Jun Yang
- Department of Entomology and Nematology, University of California, Davis, California
| | - Sung Hee Hwang
- Department of Entomology and Nematology, University of California, Davis, California
| | - Daniel Zhu
- Department of Internal Medicine, School of Medicine, University of California Davis, Sacramento, California
| | - Tzu-Yin Lin
- Department of Internal Medicine, School of Medicine, University of California Davis, Sacramento, California
| | | | | | - Paul T Henderson
- Department of Internal Medicine, School of Medicine, University of California Davis, Sacramento, California
| | | | - Bruce D Hammock
- Department of Entomology and Nematology, University of California, Davis, California
| | - Jianlin Yuan
- Department of Urology, Xijing Hospital, The Fourth Military Medical University, Xi'an City, Shanxi Province, China
| | - Ralph W de Vere White
- Department of Urology, School of Medicine and Comprehensive Cancer Center, University of California Davis, Sacramento, California.
| | - Chong-Xian Pan
- Department of Internal Medicine, School of Medicine, University of California Davis, Sacramento, California. .,Department of Urology, School of Medicine and Comprehensive Cancer Center, University of California Davis, Sacramento, California.,VA Northern California Health Care System, Rancho Cordova, California
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Komiya T, Mackay CB, Chalise P. Who treats lung cancer? Results from a global survey. Respir Investig 2017; 55:308-313. [PMID: 28942886 DOI: 10.1016/j.resinv.2017.07.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 06/14/2017] [Accepted: 07/11/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND In most Western nations, the medical oncologist plays a significant role in the administration of systemic therapy for lung cancer. In Japan however, treatment for lung cancer has historically been provided by pulmonologists and thoracic surgeons. A comparison of the management of advanced disease between Japan and other nations has not been described. METHODS An online, self-administered, international survey was sent to 3907 active members of the American Society of Clinical Oncology. Eligible participants were degreed physicians who prescribed systemic agents for adult cancer treatment within the past five years. RESULTS In total, 281 respondents answered the questions regarding management of lung cancer. Thorough analysis demonstrated that pulmonologists play a significant role in Japan and the Netherlands, where the role of oncologic specialists is not well established. Of note, all the respondents from the Netherlands reported that pulmonary medicine primarily manages systemic chemotherapy in stage IV, adjuvant chemotherapy, and targeted therapy. CONCLUSION We found there are several nations where non-oncologic specialists play a critical role in the systemic treatment of lung cancer. We expect this practice pattern to continue until the global adoption of the oncologic specialty role.
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Affiliation(s)
- Takefumi Komiya
- University of Kansas Medical Center, Division of Medical Oncology, USA; University of Kansas Cancer Center, USA.
| | | | - Prabhakar Chalise
- University of Kansas Medical Center, Department of Biostatistics, USA
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Takhar H, Singhal N, Mislang A, Kumar R, Kim L, Selva-Nayagam S, Pittman K, Karapetis C, Borg M, Olver IN, Brown MP. Phase II study of celecoxib with docetaxel chemoradiotherapy followed by consolidation chemotherapy docetaxel plus cisplatin with maintenance celecoxib in inoperable stage III nonsmall cell lung cancer. Asia Pac J Clin Oncol 2017; 14:91-100. [DOI: 10.1111/ajco.12749] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Accepted: 06/22/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Harminder Takhar
- Cancer Clinical Trials Unit; Royal Adelaide Hospital; Adelaide South Australia Australia
| | - Nimit Singhal
- Cancer Clinical Trials Unit; Royal Adelaide Hospital; Adelaide South Australia Australia
| | - Anna Mislang
- Cancer Clinical Trials Unit; Royal Adelaide Hospital; Adelaide South Australia Australia
| | - Raj Kumar
- Department of Medical Oncology; Flinders Medical Centre and Flinders University; Adelaide South Australia Australia
| | - Laurence Kim
- Cancer Clinical Trials Unit; Royal Adelaide Hospital; Adelaide South Australia Australia
| | - Sid Selva-Nayagam
- Cancer Clinical Trials Unit; Royal Adelaide Hospital; Adelaide South Australia Australia
| | - Ken Pittman
- Department of Medical Oncology; The Queen Elizabeth Hospital; Woodville South Australia Australia
| | - Chris Karapetis
- Department of Medical Oncology; Flinders Medical Centre and Flinders University; Adelaide South Australia Australia
| | - Martin Borg
- Adelaide Radiotherapy Centre; Adelaide South Australia Australia
| | - Ian N. Olver
- Sansom Institute; University of South Australia; Adelaide South Australia Australia
| | - Michael P. Brown
- Cancer Clinical Trials Unit; Royal Adelaide Hospital; Adelaide South Australia Australia
- Sansom Institute; University of South Australia; Adelaide South Australia Australia
- Centre for Cancer Biology; SA Pathology and University of South Australia; Adelaide South Australia Australia
- Discipline of Medicine; University of Adelaide; Adelaide South Australia Australia
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Edelman MJ, Wang X, Hodgson L, Cheney RT, Baggstrom MQ, Thomas SP, Gajra A, Bertino E, Reckamp KL, Molina J, Schiller JH, Mitchell-Richards K, Friedman PN, Ritter J, Milne G, Hahn OM, Stinchcombe TE, Vokes EE. Phase III Randomized, Placebo-Controlled, Double-Blind Trial of Celecoxib in Addition to Standard Chemotherapy for Advanced Non-Small-Cell Lung Cancer With Cyclooxygenase-2 Overexpression: CALGB 30801 (Alliance). J Clin Oncol 2017; 35:2184-2192. [PMID: 28489511 DOI: 10.1200/jco.2016.71.3743] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Purpose Tumor overexpression of cyclooxygenase-2 (COX-2) has been associated with worse outcome in non-small-cell lung cancer (NSCLC). In Cancer and Leukemia Group B (CALGB) 30203, we found that the selective COX-2 inhibitor celecoxib in addition to chemotherapy in advanced NSCLC improved progression-free and overall survival in patients with moderate to high COX-2 expression by immunohistochemistry (IHC). CALGB 30801 (Alliance) was designed to prospectively confirm that finding. Patients and Methods Patients with NSCLC (stage IIIB with pleural effusion or stage IV according to American Joint Committee on Cancer [sixth edition] criteria) were preregistered, and biopsy specimens were analyzed for COX-2 by IHC. Patients with COX-2 expression ≥ 2, performance status of 0 to 2, and normal organ function were eligible. Chemotherapy was determined by histology: carboplatin plus pemetrexed for nonsquamous NSCLC and carboplatin plus gemcitabine for squamous histology. Patients were randomly assigned to celecoxib (400 mg twice per day; arm A) or placebo (arm B). The primary objective was to demonstrate improvement in progression-free survival in patients with COX-2 index ≥ 4 with hazard ratio of 0.645 with approximately 85% power at two-sided significance level of .05. Results The study was halted for futility after 312 of the planned 322 patients with COX-2 index ≥ 2 were randomly assigned. There were no significant differences between the groups (hazard ratio, 1.046 for COX-2 ≥ 4). Subset analyses evaluating histology, chemotherapy regimen, and incremental COX-2 expression did not demonstrate any advantage for COX-2 inhibition. Elevation of baseline urinary metabolite of prostaglandin E2, indicating activation of the COX-2 pathway, was a negative prognostic factor. Values above the third quartile may have been a predictive factor. Conclusion COX-2 expression by IHC failed to select patients who could benefit from selective COX-2 inhibition. Urinary metabolite of prostaglandin E2 may be able to identify patients who could benefit from COX-2 inhibition.
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Affiliation(s)
- Martin J Edelman
- Martin J. Edelman, University of Maryland Greenebaum Cancer Center, Baltimore, MD; Xiaofei Wang and Lydia Hodgson, Alliance Statistical and Data Center, Duke University; Thomas E. Stinchcombe, Duke University School of Medicine, Durham, NC; Richard T. Cheney, Roswell Park Cancer Institute, Buffalo; Ajeet Gajra, State University of New York Upstate Medical University, Syracuse, NY; Maria Q. Baggstrom, Washington University School of Medicine, St Louis, MO; Sachdev P. Thomas, Illinois Cancer Care, Peoria; Paula N. Friedman and Everett E. Vokes, University of Chicago; Olwen M. Hahn, Alliance Protocol Office, University of Chicago, Chicago, IL; Erin Bertino, The Ohio State University Medical Center, Columbus, OH; Karen L. Reckamp, City of Hope Comprehensive Cancer Center, Duarte, CA; Julian Molina, Mayo Clinic, Rochester; Jon Ritter, University of Minnesota, Minneapolis, MN; Joan H. Schiller, University of Texas Southwestern Medical Center, Dallas, TX; Kisha Mitchell-Richards, Yale University, New Haven, CT; and Ginger Milne, Vanderbilt University, Nashville, TN
| | - Xiaofei Wang
- Martin J. Edelman, University of Maryland Greenebaum Cancer Center, Baltimore, MD; Xiaofei Wang and Lydia Hodgson, Alliance Statistical and Data Center, Duke University; Thomas E. Stinchcombe, Duke University School of Medicine, Durham, NC; Richard T. Cheney, Roswell Park Cancer Institute, Buffalo; Ajeet Gajra, State University of New York Upstate Medical University, Syracuse, NY; Maria Q. Baggstrom, Washington University School of Medicine, St Louis, MO; Sachdev P. Thomas, Illinois Cancer Care, Peoria; Paula N. Friedman and Everett E. Vokes, University of Chicago; Olwen M. Hahn, Alliance Protocol Office, University of Chicago, Chicago, IL; Erin Bertino, The Ohio State University Medical Center, Columbus, OH; Karen L. Reckamp, City of Hope Comprehensive Cancer Center, Duarte, CA; Julian Molina, Mayo Clinic, Rochester; Jon Ritter, University of Minnesota, Minneapolis, MN; Joan H. Schiller, University of Texas Southwestern Medical Center, Dallas, TX; Kisha Mitchell-Richards, Yale University, New Haven, CT; and Ginger Milne, Vanderbilt University, Nashville, TN
| | - Lydia Hodgson
- Martin J. Edelman, University of Maryland Greenebaum Cancer Center, Baltimore, MD; Xiaofei Wang and Lydia Hodgson, Alliance Statistical and Data Center, Duke University; Thomas E. Stinchcombe, Duke University School of Medicine, Durham, NC; Richard T. Cheney, Roswell Park Cancer Institute, Buffalo; Ajeet Gajra, State University of New York Upstate Medical University, Syracuse, NY; Maria Q. Baggstrom, Washington University School of Medicine, St Louis, MO; Sachdev P. Thomas, Illinois Cancer Care, Peoria; Paula N. Friedman and Everett E. Vokes, University of Chicago; Olwen M. Hahn, Alliance Protocol Office, University of Chicago, Chicago, IL; Erin Bertino, The Ohio State University Medical Center, Columbus, OH; Karen L. Reckamp, City of Hope Comprehensive Cancer Center, Duarte, CA; Julian Molina, Mayo Clinic, Rochester; Jon Ritter, University of Minnesota, Minneapolis, MN; Joan H. Schiller, University of Texas Southwestern Medical Center, Dallas, TX; Kisha Mitchell-Richards, Yale University, New Haven, CT; and Ginger Milne, Vanderbilt University, Nashville, TN
| | - Richard T Cheney
- Martin J. Edelman, University of Maryland Greenebaum Cancer Center, Baltimore, MD; Xiaofei Wang and Lydia Hodgson, Alliance Statistical and Data Center, Duke University; Thomas E. Stinchcombe, Duke University School of Medicine, Durham, NC; Richard T. Cheney, Roswell Park Cancer Institute, Buffalo; Ajeet Gajra, State University of New York Upstate Medical University, Syracuse, NY; Maria Q. Baggstrom, Washington University School of Medicine, St Louis, MO; Sachdev P. Thomas, Illinois Cancer Care, Peoria; Paula N. Friedman and Everett E. Vokes, University of Chicago; Olwen M. Hahn, Alliance Protocol Office, University of Chicago, Chicago, IL; Erin Bertino, The Ohio State University Medical Center, Columbus, OH; Karen L. Reckamp, City of Hope Comprehensive Cancer Center, Duarte, CA; Julian Molina, Mayo Clinic, Rochester; Jon Ritter, University of Minnesota, Minneapolis, MN; Joan H. Schiller, University of Texas Southwestern Medical Center, Dallas, TX; Kisha Mitchell-Richards, Yale University, New Haven, CT; and Ginger Milne, Vanderbilt University, Nashville, TN
| | - Maria Q Baggstrom
- Martin J. Edelman, University of Maryland Greenebaum Cancer Center, Baltimore, MD; Xiaofei Wang and Lydia Hodgson, Alliance Statistical and Data Center, Duke University; Thomas E. Stinchcombe, Duke University School of Medicine, Durham, NC; Richard T. Cheney, Roswell Park Cancer Institute, Buffalo; Ajeet Gajra, State University of New York Upstate Medical University, Syracuse, NY; Maria Q. Baggstrom, Washington University School of Medicine, St Louis, MO; Sachdev P. Thomas, Illinois Cancer Care, Peoria; Paula N. Friedman and Everett E. Vokes, University of Chicago; Olwen M. Hahn, Alliance Protocol Office, University of Chicago, Chicago, IL; Erin Bertino, The Ohio State University Medical Center, Columbus, OH; Karen L. Reckamp, City of Hope Comprehensive Cancer Center, Duarte, CA; Julian Molina, Mayo Clinic, Rochester; Jon Ritter, University of Minnesota, Minneapolis, MN; Joan H. Schiller, University of Texas Southwestern Medical Center, Dallas, TX; Kisha Mitchell-Richards, Yale University, New Haven, CT; and Ginger Milne, Vanderbilt University, Nashville, TN
| | - Sachdev P Thomas
- Martin J. Edelman, University of Maryland Greenebaum Cancer Center, Baltimore, MD; Xiaofei Wang and Lydia Hodgson, Alliance Statistical and Data Center, Duke University; Thomas E. Stinchcombe, Duke University School of Medicine, Durham, NC; Richard T. Cheney, Roswell Park Cancer Institute, Buffalo; Ajeet Gajra, State University of New York Upstate Medical University, Syracuse, NY; Maria Q. Baggstrom, Washington University School of Medicine, St Louis, MO; Sachdev P. Thomas, Illinois Cancer Care, Peoria; Paula N. Friedman and Everett E. Vokes, University of Chicago; Olwen M. Hahn, Alliance Protocol Office, University of Chicago, Chicago, IL; Erin Bertino, The Ohio State University Medical Center, Columbus, OH; Karen L. Reckamp, City of Hope Comprehensive Cancer Center, Duarte, CA; Julian Molina, Mayo Clinic, Rochester; Jon Ritter, University of Minnesota, Minneapolis, MN; Joan H. Schiller, University of Texas Southwestern Medical Center, Dallas, TX; Kisha Mitchell-Richards, Yale University, New Haven, CT; and Ginger Milne, Vanderbilt University, Nashville, TN
| | - Ajeet Gajra
- Martin J. Edelman, University of Maryland Greenebaum Cancer Center, Baltimore, MD; Xiaofei Wang and Lydia Hodgson, Alliance Statistical and Data Center, Duke University; Thomas E. Stinchcombe, Duke University School of Medicine, Durham, NC; Richard T. Cheney, Roswell Park Cancer Institute, Buffalo; Ajeet Gajra, State University of New York Upstate Medical University, Syracuse, NY; Maria Q. Baggstrom, Washington University School of Medicine, St Louis, MO; Sachdev P. Thomas, Illinois Cancer Care, Peoria; Paula N. Friedman and Everett E. Vokes, University of Chicago; Olwen M. Hahn, Alliance Protocol Office, University of Chicago, Chicago, IL; Erin Bertino, The Ohio State University Medical Center, Columbus, OH; Karen L. Reckamp, City of Hope Comprehensive Cancer Center, Duarte, CA; Julian Molina, Mayo Clinic, Rochester; Jon Ritter, University of Minnesota, Minneapolis, MN; Joan H. Schiller, University of Texas Southwestern Medical Center, Dallas, TX; Kisha Mitchell-Richards, Yale University, New Haven, CT; and Ginger Milne, Vanderbilt University, Nashville, TN
| | - Erin Bertino
- Martin J. Edelman, University of Maryland Greenebaum Cancer Center, Baltimore, MD; Xiaofei Wang and Lydia Hodgson, Alliance Statistical and Data Center, Duke University; Thomas E. Stinchcombe, Duke University School of Medicine, Durham, NC; Richard T. Cheney, Roswell Park Cancer Institute, Buffalo; Ajeet Gajra, State University of New York Upstate Medical University, Syracuse, NY; Maria Q. Baggstrom, Washington University School of Medicine, St Louis, MO; Sachdev P. Thomas, Illinois Cancer Care, Peoria; Paula N. Friedman and Everett E. Vokes, University of Chicago; Olwen M. Hahn, Alliance Protocol Office, University of Chicago, Chicago, IL; Erin Bertino, The Ohio State University Medical Center, Columbus, OH; Karen L. Reckamp, City of Hope Comprehensive Cancer Center, Duarte, CA; Julian Molina, Mayo Clinic, Rochester; Jon Ritter, University of Minnesota, Minneapolis, MN; Joan H. Schiller, University of Texas Southwestern Medical Center, Dallas, TX; Kisha Mitchell-Richards, Yale University, New Haven, CT; and Ginger Milne, Vanderbilt University, Nashville, TN
| | - Karen L Reckamp
- Martin J. Edelman, University of Maryland Greenebaum Cancer Center, Baltimore, MD; Xiaofei Wang and Lydia Hodgson, Alliance Statistical and Data Center, Duke University; Thomas E. Stinchcombe, Duke University School of Medicine, Durham, NC; Richard T. Cheney, Roswell Park Cancer Institute, Buffalo; Ajeet Gajra, State University of New York Upstate Medical University, Syracuse, NY; Maria Q. Baggstrom, Washington University School of Medicine, St Louis, MO; Sachdev P. Thomas, Illinois Cancer Care, Peoria; Paula N. Friedman and Everett E. Vokes, University of Chicago; Olwen M. Hahn, Alliance Protocol Office, University of Chicago, Chicago, IL; Erin Bertino, The Ohio State University Medical Center, Columbus, OH; Karen L. Reckamp, City of Hope Comprehensive Cancer Center, Duarte, CA; Julian Molina, Mayo Clinic, Rochester; Jon Ritter, University of Minnesota, Minneapolis, MN; Joan H. Schiller, University of Texas Southwestern Medical Center, Dallas, TX; Kisha Mitchell-Richards, Yale University, New Haven, CT; and Ginger Milne, Vanderbilt University, Nashville, TN
| | - Julian Molina
- Martin J. Edelman, University of Maryland Greenebaum Cancer Center, Baltimore, MD; Xiaofei Wang and Lydia Hodgson, Alliance Statistical and Data Center, Duke University; Thomas E. Stinchcombe, Duke University School of Medicine, Durham, NC; Richard T. Cheney, Roswell Park Cancer Institute, Buffalo; Ajeet Gajra, State University of New York Upstate Medical University, Syracuse, NY; Maria Q. Baggstrom, Washington University School of Medicine, St Louis, MO; Sachdev P. Thomas, Illinois Cancer Care, Peoria; Paula N. Friedman and Everett E. Vokes, University of Chicago; Olwen M. Hahn, Alliance Protocol Office, University of Chicago, Chicago, IL; Erin Bertino, The Ohio State University Medical Center, Columbus, OH; Karen L. Reckamp, City of Hope Comprehensive Cancer Center, Duarte, CA; Julian Molina, Mayo Clinic, Rochester; Jon Ritter, University of Minnesota, Minneapolis, MN; Joan H. Schiller, University of Texas Southwestern Medical Center, Dallas, TX; Kisha Mitchell-Richards, Yale University, New Haven, CT; and Ginger Milne, Vanderbilt University, Nashville, TN
| | - Joan H Schiller
- Martin J. Edelman, University of Maryland Greenebaum Cancer Center, Baltimore, MD; Xiaofei Wang and Lydia Hodgson, Alliance Statistical and Data Center, Duke University; Thomas E. Stinchcombe, Duke University School of Medicine, Durham, NC; Richard T. Cheney, Roswell Park Cancer Institute, Buffalo; Ajeet Gajra, State University of New York Upstate Medical University, Syracuse, NY; Maria Q. Baggstrom, Washington University School of Medicine, St Louis, MO; Sachdev P. Thomas, Illinois Cancer Care, Peoria; Paula N. Friedman and Everett E. Vokes, University of Chicago; Olwen M. Hahn, Alliance Protocol Office, University of Chicago, Chicago, IL; Erin Bertino, The Ohio State University Medical Center, Columbus, OH; Karen L. Reckamp, City of Hope Comprehensive Cancer Center, Duarte, CA; Julian Molina, Mayo Clinic, Rochester; Jon Ritter, University of Minnesota, Minneapolis, MN; Joan H. Schiller, University of Texas Southwestern Medical Center, Dallas, TX; Kisha Mitchell-Richards, Yale University, New Haven, CT; and Ginger Milne, Vanderbilt University, Nashville, TN
| | - Kisha Mitchell-Richards
- Martin J. Edelman, University of Maryland Greenebaum Cancer Center, Baltimore, MD; Xiaofei Wang and Lydia Hodgson, Alliance Statistical and Data Center, Duke University; Thomas E. Stinchcombe, Duke University School of Medicine, Durham, NC; Richard T. Cheney, Roswell Park Cancer Institute, Buffalo; Ajeet Gajra, State University of New York Upstate Medical University, Syracuse, NY; Maria Q. Baggstrom, Washington University School of Medicine, St Louis, MO; Sachdev P. Thomas, Illinois Cancer Care, Peoria; Paula N. Friedman and Everett E. Vokes, University of Chicago; Olwen M. Hahn, Alliance Protocol Office, University of Chicago, Chicago, IL; Erin Bertino, The Ohio State University Medical Center, Columbus, OH; Karen L. Reckamp, City of Hope Comprehensive Cancer Center, Duarte, CA; Julian Molina, Mayo Clinic, Rochester; Jon Ritter, University of Minnesota, Minneapolis, MN; Joan H. Schiller, University of Texas Southwestern Medical Center, Dallas, TX; Kisha Mitchell-Richards, Yale University, New Haven, CT; and Ginger Milne, Vanderbilt University, Nashville, TN
| | - Paula N Friedman
- Martin J. Edelman, University of Maryland Greenebaum Cancer Center, Baltimore, MD; Xiaofei Wang and Lydia Hodgson, Alliance Statistical and Data Center, Duke University; Thomas E. Stinchcombe, Duke University School of Medicine, Durham, NC; Richard T. Cheney, Roswell Park Cancer Institute, Buffalo; Ajeet Gajra, State University of New York Upstate Medical University, Syracuse, NY; Maria Q. Baggstrom, Washington University School of Medicine, St Louis, MO; Sachdev P. Thomas, Illinois Cancer Care, Peoria; Paula N. Friedman and Everett E. Vokes, University of Chicago; Olwen M. Hahn, Alliance Protocol Office, University of Chicago, Chicago, IL; Erin Bertino, The Ohio State University Medical Center, Columbus, OH; Karen L. Reckamp, City of Hope Comprehensive Cancer Center, Duarte, CA; Julian Molina, Mayo Clinic, Rochester; Jon Ritter, University of Minnesota, Minneapolis, MN; Joan H. Schiller, University of Texas Southwestern Medical Center, Dallas, TX; Kisha Mitchell-Richards, Yale University, New Haven, CT; and Ginger Milne, Vanderbilt University, Nashville, TN
| | - Jon Ritter
- Martin J. Edelman, University of Maryland Greenebaum Cancer Center, Baltimore, MD; Xiaofei Wang and Lydia Hodgson, Alliance Statistical and Data Center, Duke University; Thomas E. Stinchcombe, Duke University School of Medicine, Durham, NC; Richard T. Cheney, Roswell Park Cancer Institute, Buffalo; Ajeet Gajra, State University of New York Upstate Medical University, Syracuse, NY; Maria Q. Baggstrom, Washington University School of Medicine, St Louis, MO; Sachdev P. Thomas, Illinois Cancer Care, Peoria; Paula N. Friedman and Everett E. Vokes, University of Chicago; Olwen M. Hahn, Alliance Protocol Office, University of Chicago, Chicago, IL; Erin Bertino, The Ohio State University Medical Center, Columbus, OH; Karen L. Reckamp, City of Hope Comprehensive Cancer Center, Duarte, CA; Julian Molina, Mayo Clinic, Rochester; Jon Ritter, University of Minnesota, Minneapolis, MN; Joan H. Schiller, University of Texas Southwestern Medical Center, Dallas, TX; Kisha Mitchell-Richards, Yale University, New Haven, CT; and Ginger Milne, Vanderbilt University, Nashville, TN
| | - Ginger Milne
- Martin J. Edelman, University of Maryland Greenebaum Cancer Center, Baltimore, MD; Xiaofei Wang and Lydia Hodgson, Alliance Statistical and Data Center, Duke University; Thomas E. Stinchcombe, Duke University School of Medicine, Durham, NC; Richard T. Cheney, Roswell Park Cancer Institute, Buffalo; Ajeet Gajra, State University of New York Upstate Medical University, Syracuse, NY; Maria Q. Baggstrom, Washington University School of Medicine, St Louis, MO; Sachdev P. Thomas, Illinois Cancer Care, Peoria; Paula N. Friedman and Everett E. Vokes, University of Chicago; Olwen M. Hahn, Alliance Protocol Office, University of Chicago, Chicago, IL; Erin Bertino, The Ohio State University Medical Center, Columbus, OH; Karen L. Reckamp, City of Hope Comprehensive Cancer Center, Duarte, CA; Julian Molina, Mayo Clinic, Rochester; Jon Ritter, University of Minnesota, Minneapolis, MN; Joan H. Schiller, University of Texas Southwestern Medical Center, Dallas, TX; Kisha Mitchell-Richards, Yale University, New Haven, CT; and Ginger Milne, Vanderbilt University, Nashville, TN
| | - Olwen M Hahn
- Martin J. Edelman, University of Maryland Greenebaum Cancer Center, Baltimore, MD; Xiaofei Wang and Lydia Hodgson, Alliance Statistical and Data Center, Duke University; Thomas E. Stinchcombe, Duke University School of Medicine, Durham, NC; Richard T. Cheney, Roswell Park Cancer Institute, Buffalo; Ajeet Gajra, State University of New York Upstate Medical University, Syracuse, NY; Maria Q. Baggstrom, Washington University School of Medicine, St Louis, MO; Sachdev P. Thomas, Illinois Cancer Care, Peoria; Paula N. Friedman and Everett E. Vokes, University of Chicago; Olwen M. Hahn, Alliance Protocol Office, University of Chicago, Chicago, IL; Erin Bertino, The Ohio State University Medical Center, Columbus, OH; Karen L. Reckamp, City of Hope Comprehensive Cancer Center, Duarte, CA; Julian Molina, Mayo Clinic, Rochester; Jon Ritter, University of Minnesota, Minneapolis, MN; Joan H. Schiller, University of Texas Southwestern Medical Center, Dallas, TX; Kisha Mitchell-Richards, Yale University, New Haven, CT; and Ginger Milne, Vanderbilt University, Nashville, TN
| | - Thomas E Stinchcombe
- Martin J. Edelman, University of Maryland Greenebaum Cancer Center, Baltimore, MD; Xiaofei Wang and Lydia Hodgson, Alliance Statistical and Data Center, Duke University; Thomas E. Stinchcombe, Duke University School of Medicine, Durham, NC; Richard T. Cheney, Roswell Park Cancer Institute, Buffalo; Ajeet Gajra, State University of New York Upstate Medical University, Syracuse, NY; Maria Q. Baggstrom, Washington University School of Medicine, St Louis, MO; Sachdev P. Thomas, Illinois Cancer Care, Peoria; Paula N. Friedman and Everett E. Vokes, University of Chicago; Olwen M. Hahn, Alliance Protocol Office, University of Chicago, Chicago, IL; Erin Bertino, The Ohio State University Medical Center, Columbus, OH; Karen L. Reckamp, City of Hope Comprehensive Cancer Center, Duarte, CA; Julian Molina, Mayo Clinic, Rochester; Jon Ritter, University of Minnesota, Minneapolis, MN; Joan H. Schiller, University of Texas Southwestern Medical Center, Dallas, TX; Kisha Mitchell-Richards, Yale University, New Haven, CT; and Ginger Milne, Vanderbilt University, Nashville, TN
| | - Everett E Vokes
- Martin J. Edelman, University of Maryland Greenebaum Cancer Center, Baltimore, MD; Xiaofei Wang and Lydia Hodgson, Alliance Statistical and Data Center, Duke University; Thomas E. Stinchcombe, Duke University School of Medicine, Durham, NC; Richard T. Cheney, Roswell Park Cancer Institute, Buffalo; Ajeet Gajra, State University of New York Upstate Medical University, Syracuse, NY; Maria Q. Baggstrom, Washington University School of Medicine, St Louis, MO; Sachdev P. Thomas, Illinois Cancer Care, Peoria; Paula N. Friedman and Everett E. Vokes, University of Chicago; Olwen M. Hahn, Alliance Protocol Office, University of Chicago, Chicago, IL; Erin Bertino, The Ohio State University Medical Center, Columbus, OH; Karen L. Reckamp, City of Hope Comprehensive Cancer Center, Duarte, CA; Julian Molina, Mayo Clinic, Rochester; Jon Ritter, University of Minnesota, Minneapolis, MN; Joan H. Schiller, University of Texas Southwestern Medical Center, Dallas, TX; Kisha Mitchell-Richards, Yale University, New Haven, CT; and Ginger Milne, Vanderbilt University, Nashville, TN
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Zhou YY, Hu ZG, Zeng FJ, Han J. Clinical Profile of Cyclooxygenase-2 Inhibitors in Treating Non-Small Cell Lung Cancer: A Meta-Analysis of Nine Randomized Clinical Trials. PLoS One 2016; 11:e0151939. [PMID: 27007231 PMCID: PMC4805232 DOI: 10.1371/journal.pone.0151939] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 03/07/2016] [Indexed: 01/27/2023] Open
Abstract
Background Evidence on the benefits of combining cyclooxygenase-2 inhibitor (COX-2) in treating non-small cell lung cancer (NSCLC) is still controversial. We investigated the efficacy and safety profile of cyclooxygenase-2 inhibitors in treating NSCLC. Methods The first meta-analysis of eligible studies was performed to assess the effect of COX-2 inhibitors for patients with NSCLC on the overall response rate (ORR), overall survival (OS), progression-free survival (PFS), one-year survival, and toxicities. The fixed-effects model was used to calculate the pooled RR and HR and between-study heterogeneity was assessed. Subgroup analyses were conducted according to the type of COX-2 inhibitors, treatment pattern, and treatment line. Results Nine randomized clinical trials, comprising 1679 patents with NSCLC, were included in the final meta-analysis. The pooled ORR of patients who have NSCLC with COX-2 inhibitors was significantly higher than that without COX-2 inhibitors. In subgroup analysis, significantly increased ORR results were found on celecoxib (RR = 1.29, 95% CI: 1.09, 1.51), rofecoxib (RR = 1.61, 95% CI: 1.14, 2.28), chemotherapy (RR = 1.40, 95% CI: 1.20, 1.63), and first-line treatment (RR = 1.39, 95% CI: 1.19, 1.63). However, COX-2 inhibitors had no effect on the one-year survival, OS, and PFS. Increased RR of leucopenia (RR = 1.21, 95% CI: 1.01, 1.45) and thrombocytopenia (RR = 1.36, 95% CI: 1.06, 1.76) suggested that COX-2 inhibitors increased hematologic toxicities (grade ≥ 3) of chemotherapy Conclusions COX-2 inhibitors increased ORR of advanced NSCLC and had no impact on survival indices, but it may increase the risk of hematologic toxicities associated with chemotherapy.
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Affiliation(s)
- Yuan Yuan Zhou
- Department of Respiratory medicine, The first College of Clinical Medicine science, Three Gorges University, Yichang, 443003, People’s Republic of China
| | - Zhi Gang Hu
- Department of Respiratory medicine, The first College of Clinical Medicine science, Three Gorges University, Yichang, 443003, People’s Republic of China
| | - Fan Jun Zeng
- Department of Respiratory medicine, The first College of Clinical Medicine science, Three Gorges University, Yichang, 443003, People’s Republic of China
- * E-mail:
| | - Jiao Han
- Department of Respiratory medicine, The first College of Clinical Medicine science, Three Gorges University, Yichang, 443003, People’s Republic of China
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Fiteni F, Anota A, Westeel V, Bonnetain F. Methodology of health-related quality of life analysis in phase III advanced non-small-cell lung cancer clinical trials: a critical review. BMC Cancer 2016; 16:122. [PMID: 26892541 PMCID: PMC4758022 DOI: 10.1186/s12885-016-2152-1] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 02/09/2016] [Indexed: 12/31/2022] Open
Abstract
Background Health-related quality of life (HRQoL) is recognized as a component endpoint for cancer therapy approvals. The aim of this review was to evaluate the methodology of HRQoL analysis and reporting in phase III clinical trials of first-line chemotherapy in advanced non-small cell lung cancers (NSCLC). Methods A search in MEDLINE databases identified phase III clinical trials in first-line chemotherapy for advanced NSCLC, published between January 2008 to December 2014. Two authors independently extracted information using predefined data abstraction forms. Results A total of 55 phase III advanced NSCLC trials were identified. HRQoL was declared as an endpoint in 27 studies (49 %). Among these 27 studies, The EORTC questionnaire Quality of Life Questionnaire C30 was used in 13 (48 %) of the studies and The Functional Assessment of Cancer Therapy-General was used in 12 (44 %) trials. The targeted dimensions of HRQoL, the minimal clinically important difference and the statistical approaches for dealing with missing data were clearly specified in 13 (48.1 %), 9 (33.3 %) and 5 (18.5 %) studies, respectively. The most frequent statistical methods for HRQoL analysis were: the mean change from baseline (33.3 %), the linear mixed model for repeated measures (22.2 %) and time to HRQoL score deterioration (18.5 %). For each targeted dimension, the results for each group, the estimated effect size and its precision were clearly reported in 4 studies (14.8 %), not clearly reported in 11 studies (40.7 %) and not reported at all in 12 studies (44.4 %). Conclusions This review demonstrated the weakness and the heterogeneity of the measurement, analysis, and reporting of HRQoL in phase III advanced NSCLC trials. Precise and uniform recommendations are needed to compare HRQoL results across publications and to provide understandable messages for patients and clinicians.
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Affiliation(s)
- Frédéric Fiteni
- Methodology and Quality of Life in Oncology Unit, University Hospital of Besançon, Besançon, France. .,EA 3181 University of Franche-Comté, Besançon, France. .,Department of Medical Oncology, University Hospital of Besançon, Besançon, France.
| | - Amélie Anota
- Methodology and Quality of Life in Oncology Unit, University Hospital of Besançon, Besançon, France. .,EA 3181 University of Franche-Comté, Besançon, France. .,The French National Platform Quality of Life and Cancer, Besançon, France.
| | - Virginie Westeel
- Chest disease Department, University Hospital of Besançon, Besançon, France.
| | - Franck Bonnetain
- Methodology and Quality of Life in Oncology Unit, University Hospital of Besançon, Besançon, France. .,EA 3181 University of Franche-Comté, Besançon, France. .,The French National Platform Quality of Life and Cancer, Besançon, France. .,EORTC QOL Group, Brussels, Belgium.
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Fennell DA, Summers Y, Cadranel J, Benepal T, Christoph DC, Lal R, Das M, Maxwell F, Visseren-Grul C, Ferry D. Cisplatin in the modern era: The backbone of first-line chemotherapy for non-small cell lung cancer. Cancer Treat Rev 2016; 44:42-50. [PMID: 26866673 DOI: 10.1016/j.ctrv.2016.01.003] [Citation(s) in RCA: 262] [Impact Index Per Article: 32.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 01/12/2016] [Accepted: 01/15/2016] [Indexed: 01/25/2023]
Abstract
The treatment of advanced non-small cell lung cancer (NSCLC) may be changing, but the cisplatin-based doublet remains the foundation of treatment for the majority of patients with advanced NSCLC. In this respect, changes in practice to various aspects of cisplatin use, such as administration schedules and the choice of methods and frequency of monitoring for toxicities, have contributed to an incremental improvement in patient management and experience. Chemoresistance, however, limits the clinical utility of this drug in patients with advanced NSCLC. Better understanding of the molecular mechanisms of cisplatin resistance, identification of predictive markers and the development of newer, more effective and less toxic platinum agents is required. In addition to maximising potential benefits from advances in molecular biology and associated therapeutics, modification of existing cisplatin-based treatments can still lead to improvements in patient outcomes and experiences.
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Affiliation(s)
- D A Fennell
- Cancer Research UK Centre, University of Leicester & University Hospitals of Leicester, NHS Trust, Leicester, UK.
| | - Y Summers
- The Christie Hospital NHS Foundation Trust, 550 Wilmslow Road, Manchester M20 4BX, UK.
| | - J Cadranel
- Chest Department and Expert Center in Thoracic Oncology, APHP Hôpital Tenon and Sorbonne Universités, UPMC Univ Paris 06, Paris, France.
| | - T Benepal
- St Georges Hospital NHS Trust, Blackshaw Road, Tooting, London SW17 0QT, UK.
| | - D C Christoph
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Hufelandstraße 55, D-45147, Essen, Germany.
| | - R Lal
- Guy's and St Thomas' Foundation Trust, Westminster Bridge Road, London SE1 7EH, UK.
| | - M Das
- Eli Lilly and Company, Lilly House, Priestley Road, Basingstoke, Hampshire RG24 9NL, UK.
| | - F Maxwell
- Eli Lilly and Company, Lilly House, Priestley Road, Basingstoke, Hampshire RG24 9NL, UK.
| | - C Visseren-Grul
- Eli Lilly and Company, Grootslag 1-5, 3991 RA Houten, The Netherlands.
| | - D Ferry
- Eli Lilly and Company, Lilly House, Priestley Road, Basingstoke, Hampshire RG24 9NL, UK.
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Yokouchi H, Kanazawa K. Revisiting the role of COX-2 inhibitor for non-small cell lung cancer. Transl Lung Cancer Res 2015; 4:660-4. [PMID: 26629442 DOI: 10.3978/j.issn.2218-6751.2015.04.03] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Accumulating preclinical and clinical studies have shown that cyclooxygenase-2 (COX-2) inhibitor has some efficacy for non-small cell lung cancer (NSCLC). However, two phase III clinical trials using COX-2 inhibitor in combination with platinum-based chemotherapy showed no survival benefit for "unselected" patients with advanced NSCLC. Thus, exploratory analyses of the association between biomarker and clinical outcome of NSCLC patients treated with COX-2 inhibitors have been warranted. A report by Edelman recently published in the Journal of Clinical Oncology demonstrated the results of a prospective randomized trial using a combination of chemotherapy (docetaxel or pemetrexed) and either COX-2 inhibitor or a placebo for patients with advanced NSCLC. The remarkable point of this study was that it adopted the eligible criteria requiring decreased urinary levels of prostaglandin E metabolite (PGE-M) after administration of COX-2 inhibitor in a run-in period, as a possible predictive marker for the COX-2 inhibitor. The primary endpoint was progression-free survival (PFS). However, no improvement in PFS was observed between the patients treated with COX-2 inhibitor and those with placebo. A number of efforts from various investigators, including this report, have failed to demonstrate the meaningful clinical effect of COX-2 inhibitor for NSCLC. Is COX-2 inhibitor useless anymore? Here, we address the "difficult" character of this COX-2 inhibitor from various viewpoints and discuss potential future strategy using this drug.
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Affiliation(s)
- Hiroshi Yokouchi
- Department of Pulmonary Medicine, Fukushima Medical University, Fukushima, Japan
| | - Kenya Kanazawa
- Department of Pulmonary Medicine, Fukushima Medical University, Fukushima, Japan
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Hou LC, Huang F, Xu HB. Does celecoxib improve the efficacy of chemotherapy for advanced non-small cell lung cancer? Br J Clin Pharmacol 2015; 81:23-32. [PMID: 26331772 DOI: 10.1111/bcp.12757] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Revised: 08/19/2015] [Accepted: 08/26/2015] [Indexed: 12/21/2022] Open
Abstract
AIMS Clinical trials have reported conflicting results about whether celecoxib plus chemotherapy improves outcomes over chemotherapy alone in patients with advanced non-small cell lung cancer. METHODS We performed a meta-analysis comparing the primary and secondary endpoints of treatment with celecoxib plus chemotherapy vs. chemotherapy alone in patients with advanced non-small cell lung cancer. RESULTS Six eligible trials (1181 patients) were selected from the 206 studies that were identified initially. A significant difference, favouring celecoxib plus chemotherapy over chemotherapy alone, was observed in the overall response rate [odds ratio (OR) 1.34; 95% confidence interval (CI) 1.08, 1.67; P = 0.009). However, there was no difference in the 1-year survival rate (OR 1.08; 95% CI 0.86, 1.35; P = 0.512), clinical benefit (OR 1.05; 95% CI 1.88, 1.25; P = 0.613), complete response (OR 0.77; 95% CI 0.39, 1.51; P = 0.446) or partial response (OR 1.22; 95% CI 0.92, 1.63; P = 0.163). Toxicity did not differ significantly with the exception of the occurrence of leucopenia and thrombocytopenia. CONCLUSIONS Celecoxib plus chemotherapy appeared to improve the overall response rate compared with chemotherapy alone in the treatment of patients with advanced non-small cell lung cancer. Further prospective randomized controlled trials are now needed.
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Affiliation(s)
- Leng-Chen Hou
- Department of Anesthesia, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China
| | - Fang Huang
- Department of Pharmacy, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China
| | - Hong-Bin Xu
- Department of Pharmacy, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China
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Masters GA, Temin S, Azzoli CG, Giaccone G, Baker S, Brahmer JR, Ellis PM, Gajra A, Rackear N, Schiller JH, Smith TJ, Strawn JR, Trent D, Johnson DH. Systemic Therapy for Stage IV Non-Small-Cell Lung Cancer: American Society of Clinical Oncology Clinical Practice Guideline Update. J Clin Oncol 2015; 33:3488-515. [PMID: 26324367 PMCID: PMC5019421 DOI: 10.1200/jco.2015.62.1342] [Citation(s) in RCA: 370] [Impact Index Per Article: 41.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
PURPOSE To provide evidence-based recommendations to update the American Society of Clinical Oncology guideline on systemic therapy for stage IV non-small-cell lung cancer (NSCLC). METHODS An Update Committee of the American Society of Clinical Oncology NSCLC Expert Panel based recommendations on a systematic review of randomized controlled trials from January 2007 to February 2014. RESULTS This guideline update reflects changes in evidence since the previous guideline. RECOMMENDATIONS There is no cure for patients with stage IV NSCLC. For patients with performance status (PS) 0 to 1 (and appropriate patient cases with PS 2) and without an EGFR-sensitizing mutation or ALK gene rearrangement, combination cytotoxic chemotherapy is recommended, guided by histology, with early concurrent palliative care. Recommendations for patients in the first-line setting include platinum-doublet therapy for those with PS 0 to 1 (bevacizumab may be added to carboplatin plus paclitaxel if no contraindications); combination or single-agent chemotherapy or palliative care alone for those with PS 2; afatinib, erlotinib, or gefitinib for those with sensitizing EGFR mutations; crizotinib for those with ALK or ROS1 gene rearrangement; and following first-line recommendations or using platinum plus etoposide for those with large-cell neuroendocrine carcinoma. Maintenance therapy includes pemetrexed continuation for patients with stable disease or response to first-line pemetrexed-containing regimens, alternative chemotherapy, or a chemotherapy break. In the second-line setting, recommendations include docetaxel, erlotinib, gefitinib, or pemetrexed for patients with nonsquamous cell carcinoma; docetaxel, erlotinib, or gefitinib for those with squamous cell carcinoma; and chemotherapy or ceritinib for those with ALK rearrangement who experience progression after crizotinib. In the third-line setting, for patients who have not received erlotinib or gefitinib, treatment with erlotinib is recommended. There are insufficient data to recommend routine third-line cytotoxic therapy. Decisions regarding systemic therapy should not be made based on age alone. Additional information can be found at http://www.asco.org/guidelines/nsclc and http://www.asco.org/guidelineswiki.
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Affiliation(s)
- Gregory A Masters
- Gregory A. Masters, Helen F. Graham Cancer Center, Newark, DE; Sarah Temin, American Society of Clinical Oncology, Alexandria; Sherman Baker Jr, Virginia Commonwealth University; David Trent, Virginia Cancer Center, Richmond, VA; Christopher G. Azzoli, Massachusetts General Hospital Cancer Center, Boston, MA; Giuseppe Giaccone, Lombardi Cancer Center, Georgetown University, Washington, DC; Julie R. Brahmer and Thomas J. Smith, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins, Baltimore, MD; Peter M. Ellis, Juravinski Cancer Centre, Hamilton, Ontario, Canada; Ajeet Gajra, Upstate Medical University, Syracuse, NY; Nancy Rackear, Uniting Against Lung Cancer, Fort Lauderdale, FL; Joan H. Schiller, University of Texas Southwestern; David H. Johnson, University of Texas Southwestern Medical Center at Dallas, Dallas; and John R. Strawn, patient representative, Houston, TX
| | - Sarah Temin
- Gregory A. Masters, Helen F. Graham Cancer Center, Newark, DE; Sarah Temin, American Society of Clinical Oncology, Alexandria; Sherman Baker Jr, Virginia Commonwealth University; David Trent, Virginia Cancer Center, Richmond, VA; Christopher G. Azzoli, Massachusetts General Hospital Cancer Center, Boston, MA; Giuseppe Giaccone, Lombardi Cancer Center, Georgetown University, Washington, DC; Julie R. Brahmer and Thomas J. Smith, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins, Baltimore, MD; Peter M. Ellis, Juravinski Cancer Centre, Hamilton, Ontario, Canada; Ajeet Gajra, Upstate Medical University, Syracuse, NY; Nancy Rackear, Uniting Against Lung Cancer, Fort Lauderdale, FL; Joan H. Schiller, University of Texas Southwestern; David H. Johnson, University of Texas Southwestern Medical Center at Dallas, Dallas; and John R. Strawn, patient representative, Houston, TX
| | - Christopher G Azzoli
- Gregory A. Masters, Helen F. Graham Cancer Center, Newark, DE; Sarah Temin, American Society of Clinical Oncology, Alexandria; Sherman Baker Jr, Virginia Commonwealth University; David Trent, Virginia Cancer Center, Richmond, VA; Christopher G. Azzoli, Massachusetts General Hospital Cancer Center, Boston, MA; Giuseppe Giaccone, Lombardi Cancer Center, Georgetown University, Washington, DC; Julie R. Brahmer and Thomas J. Smith, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins, Baltimore, MD; Peter M. Ellis, Juravinski Cancer Centre, Hamilton, Ontario, Canada; Ajeet Gajra, Upstate Medical University, Syracuse, NY; Nancy Rackear, Uniting Against Lung Cancer, Fort Lauderdale, FL; Joan H. Schiller, University of Texas Southwestern; David H. Johnson, University of Texas Southwestern Medical Center at Dallas, Dallas; and John R. Strawn, patient representative, Houston, TX
| | - Giuseppe Giaccone
- Gregory A. Masters, Helen F. Graham Cancer Center, Newark, DE; Sarah Temin, American Society of Clinical Oncology, Alexandria; Sherman Baker Jr, Virginia Commonwealth University; David Trent, Virginia Cancer Center, Richmond, VA; Christopher G. Azzoli, Massachusetts General Hospital Cancer Center, Boston, MA; Giuseppe Giaccone, Lombardi Cancer Center, Georgetown University, Washington, DC; Julie R. Brahmer and Thomas J. Smith, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins, Baltimore, MD; Peter M. Ellis, Juravinski Cancer Centre, Hamilton, Ontario, Canada; Ajeet Gajra, Upstate Medical University, Syracuse, NY; Nancy Rackear, Uniting Against Lung Cancer, Fort Lauderdale, FL; Joan H. Schiller, University of Texas Southwestern; David H. Johnson, University of Texas Southwestern Medical Center at Dallas, Dallas; and John R. Strawn, patient representative, Houston, TX
| | - Sherman Baker
- Gregory A. Masters, Helen F. Graham Cancer Center, Newark, DE; Sarah Temin, American Society of Clinical Oncology, Alexandria; Sherman Baker Jr, Virginia Commonwealth University; David Trent, Virginia Cancer Center, Richmond, VA; Christopher G. Azzoli, Massachusetts General Hospital Cancer Center, Boston, MA; Giuseppe Giaccone, Lombardi Cancer Center, Georgetown University, Washington, DC; Julie R. Brahmer and Thomas J. Smith, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins, Baltimore, MD; Peter M. Ellis, Juravinski Cancer Centre, Hamilton, Ontario, Canada; Ajeet Gajra, Upstate Medical University, Syracuse, NY; Nancy Rackear, Uniting Against Lung Cancer, Fort Lauderdale, FL; Joan H. Schiller, University of Texas Southwestern; David H. Johnson, University of Texas Southwestern Medical Center at Dallas, Dallas; and John R. Strawn, patient representative, Houston, TX
| | - Julie R Brahmer
- Gregory A. Masters, Helen F. Graham Cancer Center, Newark, DE; Sarah Temin, American Society of Clinical Oncology, Alexandria; Sherman Baker Jr, Virginia Commonwealth University; David Trent, Virginia Cancer Center, Richmond, VA; Christopher G. Azzoli, Massachusetts General Hospital Cancer Center, Boston, MA; Giuseppe Giaccone, Lombardi Cancer Center, Georgetown University, Washington, DC; Julie R. Brahmer and Thomas J. Smith, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins, Baltimore, MD; Peter M. Ellis, Juravinski Cancer Centre, Hamilton, Ontario, Canada; Ajeet Gajra, Upstate Medical University, Syracuse, NY; Nancy Rackear, Uniting Against Lung Cancer, Fort Lauderdale, FL; Joan H. Schiller, University of Texas Southwestern; David H. Johnson, University of Texas Southwestern Medical Center at Dallas, Dallas; and John R. Strawn, patient representative, Houston, TX
| | - Peter M Ellis
- Gregory A. Masters, Helen F. Graham Cancer Center, Newark, DE; Sarah Temin, American Society of Clinical Oncology, Alexandria; Sherman Baker Jr, Virginia Commonwealth University; David Trent, Virginia Cancer Center, Richmond, VA; Christopher G. Azzoli, Massachusetts General Hospital Cancer Center, Boston, MA; Giuseppe Giaccone, Lombardi Cancer Center, Georgetown University, Washington, DC; Julie R. Brahmer and Thomas J. Smith, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins, Baltimore, MD; Peter M. Ellis, Juravinski Cancer Centre, Hamilton, Ontario, Canada; Ajeet Gajra, Upstate Medical University, Syracuse, NY; Nancy Rackear, Uniting Against Lung Cancer, Fort Lauderdale, FL; Joan H. Schiller, University of Texas Southwestern; David H. Johnson, University of Texas Southwestern Medical Center at Dallas, Dallas; and John R. Strawn, patient representative, Houston, TX
| | - Ajeet Gajra
- Gregory A. Masters, Helen F. Graham Cancer Center, Newark, DE; Sarah Temin, American Society of Clinical Oncology, Alexandria; Sherman Baker Jr, Virginia Commonwealth University; David Trent, Virginia Cancer Center, Richmond, VA; Christopher G. Azzoli, Massachusetts General Hospital Cancer Center, Boston, MA; Giuseppe Giaccone, Lombardi Cancer Center, Georgetown University, Washington, DC; Julie R. Brahmer and Thomas J. Smith, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins, Baltimore, MD; Peter M. Ellis, Juravinski Cancer Centre, Hamilton, Ontario, Canada; Ajeet Gajra, Upstate Medical University, Syracuse, NY; Nancy Rackear, Uniting Against Lung Cancer, Fort Lauderdale, FL; Joan H. Schiller, University of Texas Southwestern; David H. Johnson, University of Texas Southwestern Medical Center at Dallas, Dallas; and John R. Strawn, patient representative, Houston, TX
| | - Nancy Rackear
- Gregory A. Masters, Helen F. Graham Cancer Center, Newark, DE; Sarah Temin, American Society of Clinical Oncology, Alexandria; Sherman Baker Jr, Virginia Commonwealth University; David Trent, Virginia Cancer Center, Richmond, VA; Christopher G. Azzoli, Massachusetts General Hospital Cancer Center, Boston, MA; Giuseppe Giaccone, Lombardi Cancer Center, Georgetown University, Washington, DC; Julie R. Brahmer and Thomas J. Smith, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins, Baltimore, MD; Peter M. Ellis, Juravinski Cancer Centre, Hamilton, Ontario, Canada; Ajeet Gajra, Upstate Medical University, Syracuse, NY; Nancy Rackear, Uniting Against Lung Cancer, Fort Lauderdale, FL; Joan H. Schiller, University of Texas Southwestern; David H. Johnson, University of Texas Southwestern Medical Center at Dallas, Dallas; and John R. Strawn, patient representative, Houston, TX
| | - Joan H Schiller
- Gregory A. Masters, Helen F. Graham Cancer Center, Newark, DE; Sarah Temin, American Society of Clinical Oncology, Alexandria; Sherman Baker Jr, Virginia Commonwealth University; David Trent, Virginia Cancer Center, Richmond, VA; Christopher G. Azzoli, Massachusetts General Hospital Cancer Center, Boston, MA; Giuseppe Giaccone, Lombardi Cancer Center, Georgetown University, Washington, DC; Julie R. Brahmer and Thomas J. Smith, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins, Baltimore, MD; Peter M. Ellis, Juravinski Cancer Centre, Hamilton, Ontario, Canada; Ajeet Gajra, Upstate Medical University, Syracuse, NY; Nancy Rackear, Uniting Against Lung Cancer, Fort Lauderdale, FL; Joan H. Schiller, University of Texas Southwestern; David H. Johnson, University of Texas Southwestern Medical Center at Dallas, Dallas; and John R. Strawn, patient representative, Houston, TX
| | - Thomas J Smith
- Gregory A. Masters, Helen F. Graham Cancer Center, Newark, DE; Sarah Temin, American Society of Clinical Oncology, Alexandria; Sherman Baker Jr, Virginia Commonwealth University; David Trent, Virginia Cancer Center, Richmond, VA; Christopher G. Azzoli, Massachusetts General Hospital Cancer Center, Boston, MA; Giuseppe Giaccone, Lombardi Cancer Center, Georgetown University, Washington, DC; Julie R. Brahmer and Thomas J. Smith, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins, Baltimore, MD; Peter M. Ellis, Juravinski Cancer Centre, Hamilton, Ontario, Canada; Ajeet Gajra, Upstate Medical University, Syracuse, NY; Nancy Rackear, Uniting Against Lung Cancer, Fort Lauderdale, FL; Joan H. Schiller, University of Texas Southwestern; David H. Johnson, University of Texas Southwestern Medical Center at Dallas, Dallas; and John R. Strawn, patient representative, Houston, TX
| | - John R Strawn
- Gregory A. Masters, Helen F. Graham Cancer Center, Newark, DE; Sarah Temin, American Society of Clinical Oncology, Alexandria; Sherman Baker Jr, Virginia Commonwealth University; David Trent, Virginia Cancer Center, Richmond, VA; Christopher G. Azzoli, Massachusetts General Hospital Cancer Center, Boston, MA; Giuseppe Giaccone, Lombardi Cancer Center, Georgetown University, Washington, DC; Julie R. Brahmer and Thomas J. Smith, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins, Baltimore, MD; Peter M. Ellis, Juravinski Cancer Centre, Hamilton, Ontario, Canada; Ajeet Gajra, Upstate Medical University, Syracuse, NY; Nancy Rackear, Uniting Against Lung Cancer, Fort Lauderdale, FL; Joan H. Schiller, University of Texas Southwestern; David H. Johnson, University of Texas Southwestern Medical Center at Dallas, Dallas; and John R. Strawn, patient representative, Houston, TX
| | - David Trent
- Gregory A. Masters, Helen F. Graham Cancer Center, Newark, DE; Sarah Temin, American Society of Clinical Oncology, Alexandria; Sherman Baker Jr, Virginia Commonwealth University; David Trent, Virginia Cancer Center, Richmond, VA; Christopher G. Azzoli, Massachusetts General Hospital Cancer Center, Boston, MA; Giuseppe Giaccone, Lombardi Cancer Center, Georgetown University, Washington, DC; Julie R. Brahmer and Thomas J. Smith, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins, Baltimore, MD; Peter M. Ellis, Juravinski Cancer Centre, Hamilton, Ontario, Canada; Ajeet Gajra, Upstate Medical University, Syracuse, NY; Nancy Rackear, Uniting Against Lung Cancer, Fort Lauderdale, FL; Joan H. Schiller, University of Texas Southwestern; David H. Johnson, University of Texas Southwestern Medical Center at Dallas, Dallas; and John R. Strawn, patient representative, Houston, TX
| | - David H Johnson
- Gregory A. Masters, Helen F. Graham Cancer Center, Newark, DE; Sarah Temin, American Society of Clinical Oncology, Alexandria; Sherman Baker Jr, Virginia Commonwealth University; David Trent, Virginia Cancer Center, Richmond, VA; Christopher G. Azzoli, Massachusetts General Hospital Cancer Center, Boston, MA; Giuseppe Giaccone, Lombardi Cancer Center, Georgetown University, Washington, DC; Julie R. Brahmer and Thomas J. Smith, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins, Baltimore, MD; Peter M. Ellis, Juravinski Cancer Centre, Hamilton, Ontario, Canada; Ajeet Gajra, Upstate Medical University, Syracuse, NY; Nancy Rackear, Uniting Against Lung Cancer, Fort Lauderdale, FL; Joan H. Schiller, University of Texas Southwestern; David H. Johnson, University of Texas Southwestern Medical Center at Dallas, Dallas; and John R. Strawn, patient representative, Houston, TX
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Hiller JG, Parat MO, Ben-Eliyahu S. The Role of Perioperative Pharmacological Adjuncts in Cancer Outcomes: Beta-Adrenergic Receptor Antagonists, NSAIDs and Anti-fibrinolytics. CURRENT ANESTHESIOLOGY REPORTS 2015. [DOI: 10.1007/s40140-015-0113-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Saxena A, Becker D, Preeshagul I, Lee K, Katz E, Levy B. Therapeutic Effects of Repurposed Therapies in Non-Small Cell Lung Cancer: What Is Old Is New Again. Oncologist 2015; 20:934-45. [PMID: 26156329 DOI: 10.1634/theoncologist.2015-0064] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 04/17/2015] [Indexed: 02/07/2023] Open
Abstract
The recent emergence of targeted and immunotherapeutic agents has dramatically changed the management for patients with non-small cell lung cancer (NSCLC). Despite these advances, lung cancer is not exempt from the challenges facing oncology drug development, including the huge financial cost and the time required for drug implementation. Repositioning noncancer therapies with potential antineoplastic properties into new therapeutic niches is an alternative treatment strategy offering the possibility of saving money and time and improving outcomes. The goal of such a strategy is to deliver an effective drug with a favorable toxicity profile at a reduced cost. Preclinical models and observational data have demonstrated promising activity for many of these agents, and they are now being studied in prospective trials. We review the relevant published data regarding the therapeutic effects of metformin, statins, nonsteroidal anti-inflammatory drugs, β-blockers, and itraconazole in NSCLC, with a focus on the putative mechanisms of action and clinical data. As these drugs are increasingly being tested in clinical trials, we aim to highlight the salient challenges and future strategies to optimize this approach.
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Affiliation(s)
- Ashish Saxena
- Memorial Sloan Kettering Cancer Center, New York, New York, USA; St. Luke's Roosevelt Hospital, Mount Sinai Health System, New York, New York, USA; Mount Sinai Beth Israel Hospital, New York, New York, USA; Mount Sinai Hospital, Mount Sinai Health System, New York, New York, USA
| | - Daniel Becker
- Memorial Sloan Kettering Cancer Center, New York, New York, USA; St. Luke's Roosevelt Hospital, Mount Sinai Health System, New York, New York, USA; Mount Sinai Beth Israel Hospital, New York, New York, USA; Mount Sinai Hospital, Mount Sinai Health System, New York, New York, USA
| | - Isabel Preeshagul
- Memorial Sloan Kettering Cancer Center, New York, New York, USA; St. Luke's Roosevelt Hospital, Mount Sinai Health System, New York, New York, USA; Mount Sinai Beth Israel Hospital, New York, New York, USA; Mount Sinai Hospital, Mount Sinai Health System, New York, New York, USA
| | - Karen Lee
- Memorial Sloan Kettering Cancer Center, New York, New York, USA; St. Luke's Roosevelt Hospital, Mount Sinai Health System, New York, New York, USA; Mount Sinai Beth Israel Hospital, New York, New York, USA; Mount Sinai Hospital, Mount Sinai Health System, New York, New York, USA
| | - Elena Katz
- Memorial Sloan Kettering Cancer Center, New York, New York, USA; St. Luke's Roosevelt Hospital, Mount Sinai Health System, New York, New York, USA; Mount Sinai Beth Israel Hospital, New York, New York, USA; Mount Sinai Hospital, Mount Sinai Health System, New York, New York, USA
| | - Benjamin Levy
- Memorial Sloan Kettering Cancer Center, New York, New York, USA; St. Luke's Roosevelt Hospital, Mount Sinai Health System, New York, New York, USA; Mount Sinai Beth Israel Hospital, New York, New York, USA; Mount Sinai Hospital, Mount Sinai Health System, New York, New York, USA
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Shimizu K, Yukawa T, Okita R, Saisho S, Maeda A, Nojima Y, Nakata M. Cyclooxygenase-2 expression is a prognostic biomarker for non-small cell lung cancer patients treated with adjuvant platinum-based chemotherapy. World J Surg Oncol 2015; 13:21. [PMID: 25888998 PMCID: PMC4332968 DOI: 10.1186/s12957-014-0426-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 12/23/2014] [Indexed: 01/15/2023] Open
Abstract
Background Adjuvant chemotherapy after the resection of stage IB-IIIA non-small cell lung cancer (NSCLC) is now the standard of care based on large-scale phase III trials and a meta-analysis. However, chemotherapy has plateaued in terms of its efficacy, and the search for treatment prediction biomarkers is imperative for the further identification of treatable subgroups. Therefore, we investigated the significance of cyclooxygenase-2 (Cox-2) expression and the applicability of a Cox-2 inhibitor in patients who had received adjuvant chemotherapy. Methods We conducted a retrospective review of data from 97 patients who had received adjuvant chemotherapy. The adjuvant chemotherapy consisted of an oral tegafur agent (OT) or platinum-based chemotherapy (PB). The criteria for regimen selection were based on a discussion among the cancer board and enrollment in a clinical trial. Immunohistochemical staining (IHC) for Cox-2 was performed, and the correlation between Cox-2 expression and disease-free survival (DFS) was evaluated. Results IHC showed that 56 cases (57.7%) were positive for Cox-2. The rate of Cox-2 expression was similar for the PB and OT groups. Among the patients who received PB, the DFS of the patients with Cox-2 expression was significantly poorer than that of the patients without Cox-2 expression (P = 0.017), but there was no significant difference among the patients who received OT (P = 0.617). In a multivariate analysis, Cox-2 expression and lymph node metastasis were independent predictors of DFS among patients who received PB. Conclusions Cox-2 expression was a powerful predictor of DFS among patients who received PB as an adjuvant chemotherapy. Further study investigating the use of a Cox-2 inhibitor for adjuvant chemotherapy is needed.
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Affiliation(s)
- Katsuhiko Shimizu
- Department of General Thoracic Surgery, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan.
| | - Takuro Yukawa
- Department of General Thoracic Surgery, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan.
| | - Riki Okita
- Department of General Thoracic Surgery, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan.
| | - Shinsuke Saisho
- Department of General Thoracic Surgery, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan.
| | - Ai Maeda
- Department of General Thoracic Surgery, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan.
| | - Yuji Nojima
- Department of General Thoracic Surgery, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan.
| | - Masao Nakata
- Department of General Thoracic Surgery, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan.
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