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N C, Jain A, C S, Shreevatsa B, Rajendrasozhan S, Dharmashekar C, Suresh KP, Patil SS, Singh P, Vishwanath P, Srinivasa C, Kollur SP, Shivamallu C. Progression-free survival estimation of docetaxel-based second-line treatment for advanced non-small cell lung cancer: a pooled analysis from 18 randomized control trials. Front Oncol 2024; 14:1298786. [PMID: 38807763 PMCID: PMC11130461 DOI: 10.3389/fonc.2024.1298786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 04/02/2024] [Indexed: 05/30/2024] Open
Abstract
Background Lung cancer is the foremost cause of cancer-related death globally, with non-small cell lung cancer (NSCLC) accounting for 85-90% of cases. Targeted therapy is the most essential therapeutic option for NSCLC, other common treatments include radiation therapy, surgery, chemotherapy, and immunotherapy. Objective Our study objective was to estimate whether progression-free survival (PFS) is an outcome of NSCLC extracted from 18 randomized control trials (RCTs) with docetaxel as experimental group and antineoplastic agent, kinase inhibitor, and monoclonal antibodies as a control group. Methods We selected relevant studies published between 2011 and 2022 using Google Scholar, PubMed, Scopus, Science Direct, and Cochrane Library. Advanced NSCLC, chemotherapy, RCT, docetaxel, and second-line treatment were the terms included in the search. A total of 9738 patients were evaluated from the 18 identified studies. We used the meta package of R Studio to perform the meta-analysis. Graphical funnel plots were used to evaluate publication bias visually. Results Patients who underwent docetaxel-based therapy had a considerably longer PFS than those who got antineoplastic agents, kinase inhibitors, or monoclonal antibodies-based treatment. Patients in the standard treatment arm had a slightly longer PFS than those in the experimental therapy arm in the overall meta-analysis. Conclusion Docetaxel outperformed monoclonal antibodies, antineoplastic agents, and kinase inhibitors in the second-line therapy of advanced NSCLC since PFS was extensively utilized.
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Affiliation(s)
- Chaithra N
- Division of Medical Statistics, Life Sciences and Natural Sciences Departments, JSS Academy of Higher Education and Research, Mysuru, Karnataka, India
| | - Anisha Jain
- Department of Microbiology, JSS Academy of Higher Education and Research, Mysuru, Karnataka, India
| | - Sahana C
- Division of Medical Statistics, Life Sciences and Natural Sciences Departments, JSS Academy of Higher Education and Research, Mysuru, Karnataka, India
| | - Bhargav Shreevatsa
- Department of Biotechnology and Bioinformatics, JSS Academy of Higher Education and Research, Mysuru, Karnataka, India
- Pathology, Microbiology and Immunology Department, School of Medicine, University of South Carolina, Columbia, SC, United States
| | | | - Chandan Dharmashekar
- Department of Biotechnology and Bioinformatics, JSS Academy of Higher Education and Research, Mysuru, Karnataka, India
| | | | - Sharanagouda S. Patil
- ICAR-National Institute of Veterinary Epidemiology and Disease Informatics, Bengaluru, Karnataka, India
| | - Pranav Singh
- Department of Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Udupi, Karnataka, India
| | - Prashant Vishwanath
- Center of Excellence in Molecular Biology and Regenerative Medicine, Department of Biochemistry, JSS Medical College, JSS Academy of Higher Education and Research, Mysore, India
| | | | - Shiva Prasad Kollur
- School of Physical Sciences, Amrita Vishwa Vidyapeetham, Mysuru, Karnataka, India
| | - Chandan Shivamallu
- Department of Biotechnology and Bioinformatics, JSS Academy of Higher Education and Research, Mysuru, Karnataka, India
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2
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Tian W, Ning J, Chen L, Zeng Y, Shi Y, Xiao G, He S, Tanzhu G, Zhou R. Cost-effectiveness of tumor-treating fields plus standard therapy for advanced non-small cell lung cancer progressed after platinum-based therapy in the United States. Front Pharmacol 2024; 15:1333128. [PMID: 38375030 PMCID: PMC10875105 DOI: 10.3389/fphar.2024.1333128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 01/26/2024] [Indexed: 02/21/2024] Open
Abstract
Background: Tumor treating fields (TTF) was first approved for treatment of glioblastoma. Recently, the LUNAR study demonstrated that TTF + standard therapy (ST) extended survival in patients with advanced non-small cell lung cancer (NSCLC). This primary objective of this study is to analyze the cost-effectiveness of this treatment from the United States healthcare payers' perspective. Methods: A 3-health-state Markov model was established to compare the cost-effectiveness of TTF + ST and that of ST alone. Clinical data were extracted from the LUNAR study, supplemented by additional cost and utility data obtained from publications or online sources. One-way sensitivity analysis, probabilistic sensitivity analysis, and scenario analysis were conducted. The willingness-to-pay (WTP) threshold per quality-adjusted life-years (QALYs) gained was set to $150,000. The main results include total costs, QALYs, incremental cost-effectiveness ratio (ICER) and incremental net monetary benefit (INMB). Subgroup analyses were conducted for two types of ST, including immune checkpoint inhibitor, and docetaxel. Results: During a 10-year time horizon, the costs of TTF + ST and ST alone were $431,207.0 and $128,125.9, and the QALYs were 1.809 and 1.124, respectively. The ICER of TTF + ST compared to ST was $442,732.7 per QALY, and the INMB was -$200,395.7 at the WTP threshold. The cost of TTF per month was the most influential factor in cost-effectiveness, and TTF + ST had a 0% probability of being cost-effective at the WTP threshold compared with ST alone. Conclusion: TTF + ST is not a cost-effective treatment for advanced NSCLC patients who progressed after platinum-based therapy from the perspective of the United States healthcare payers.
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Affiliation(s)
- Wentao Tian
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, China
| | - Jiaoyang Ning
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, China
| | - Liu Chen
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, China
| | - Yu Zeng
- Changsha Stomatological Hospital, Hunan University of Traditional Chinese Medicine, Changsha, China
| | - Yin Shi
- Department of Pharmacy, Xiangya Hospital, Changsha, China
| | - Gang Xiao
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, China
| | - Shuangshuang He
- Department of Radiation Oncology and Department of Head and Neck Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Guilong Tanzhu
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, China
| | - Rongrong Zhou
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, China
- Xiangya Lung Cancer Center, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
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3
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Ge P, Han C, Reyila A, Liu D, Hong W, Liu J, Zhang J, Han X, Li X, Huang M, Fan S, Kaierdebieke A, Wu X, Huang X, Guo W, Liu S, Bian Y. Risk of antiangiogenic adverse events in metastatic colorectal cancer patients receiving aflibercept in combination with chemotherapy: A meta-analysis. Medicine (Baltimore) 2023; 102:e34793. [PMID: 37657052 PMCID: PMC10476758 DOI: 10.1097/md.0000000000034793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 07/26/2023] [Indexed: 09/03/2023] Open
Abstract
BACKGROUND Aflibercept has been approved for the treatment of metastatic colorectal cancer for more than a decade, but its antiangiogenesis adverse effect profile during treatment remains unclear. This study is conducted to systematically review the risk of antiangiogenic adverse events in patients with metastatic colorectal cancer receiving aflibercept plus chemotherapy. METHODS We searched databases, including PubMed, Embase and the Cochrane Library up to September 9, 2021. Relevant randomized controlled trials (RCTs) and single-arm studies were included in the review. Statistical analyses were performed using R to calculate the summary incidence rate of antiangiogenic-related adverse events, odds ratios and 95% CIs. Heterogeneity among the included studies was assessed by subgroup analysis. Publication bias analysis and sensitivity analysis were performed to confirm the reliability of the results. RESULTS A total of 2889 patients from 10 studies met the inclusion criteria. The quality of the included studies was evaluated as qualified for further quantitative synthesis. In part of single-arm studies, the occurrence rates were 44.2% (95%CI, 39.7-48.7%) for hypertension, 31.3% (95% CI, 19.3-43.3%) for proteinuria, 27.3% (95%CI, 21.2-33.4%) for epistaxis, 22.5% (95%CI, 7.8-37.3%) for hemorrhage events, 8.0% (95%CI, 2.0-14 .0%) for venous thromboembolic event in all grades and 22.6% (95%CI, 19.1-26.2%) for grade III/IV hypertension, 7.4% (95%CI, 6.2-8.5%) for grade III/IV proteinuria. In part of RCT, compared to its counterpart, aflibercept containing arm was associated with the increased incidence rate in hypertension (OR:6.30, 95%CI: 3.49-11.36), proteinuria (OR:4.12, 95%CI: 1.25-13.61), epistaxis (OR:3.71, 95%CI: 2.84-4.85), III/IV hypertension (OR:7.20, 95%CI: 5.23-9.92), III/IV proteinuria (OR:5.13, 95%CI: 3.13-8.41). The funnel plot, Begg test and Egger test were carried out on the primary endpoints, III/IV hypertension rate and III/IV proteinuria rate, the result of which detected no obvious publication bias. No significant difference was observed in subgroup analysis in the primary endpoint between the subgroups stratified by treatment line (firstline or non-firstline), chemotherapy regime (FOLFIRI or others) and study design (RCTs or single-arm trials). CONCLUSION The available evidence suggests that using aflibercept is associated with an increased risk of antiangiogenic adverse events compared with controls. Further studies are needed to investigate this association. In the appropriate clinical scenario, the use of aflibercept in its approved indications remains justified. However, the results of this study should be interpreted with caution, as some of the evidence comes from single-arm clinical trials.
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Affiliation(s)
- Pu Ge
- Institute of Chinese Medical Sciences, University of Macau, Macau, China
- State Key Laboratory of Quality Research in Chinese Medicine, University of Macau, Macau, China
- Department of Public Health and Medicinal Administration, Faculty of Health Sciences, University of Macau, Macau, China
| | - Chunyan Han
- School of Political Science and Public Administration, Shandong University, Qingdao, China
| | | | - Diyue Liu
- International School of Public Health and One Health, Hainan Medical University, Haikou, China
| | - Wenying Hong
- Faculty of Health Sciences, University of Macau, Macau, China
| | - Jiaxin Liu
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Jinzi Zhang
- School of Humanities and Social Sciences, Harbin Medical University, Harbin, China
| | - Xiao Han
- The Fifth Affiliated Hospital of Sun Yat-sat University, Zhuhai, China
| | - Xialei Li
- School of Pharmaceutical Sciences, Shandong University, Jinan, China
| | - Mengjie Huang
- School of Public Health, Shandong University, Jinan, China
| | - Siyuan Fan
- Department of Preventive Medicine, Yanjing Medical College, Capital Medical University, Beijing, China
| | | | - Xiaoyu Wu
- School of Pharmaceutical Sciences, Shandong University, Jinan, China
| | - Xiaolu Huang
- Clinically Third Series, China Medical University, Shenyang, China
| | - Weirui Guo
- School of Clinical Medicine of Jining Medicine University, Jining, China
| | - Siyu Liu
- Stomatology College of Shandong University, Jinan, China
| | - Ying Bian
- Institute of Chinese Medical Sciences, University of Macau, Macau, China
- State Key Laboratory of Quality Research in Chinese Medicine, University of Macau, Macau, China
- Department of Public Health and Medicinal Administration, Faculty of Health Sciences, University of Macau, Macau, China
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Yan S, Xue S, Wang T, Gao R, Zeng H, Wang Q, Jia X. Efficacy and safety of nintedanib in patients with non-small cell lung cancer, and novel insights in radiation-induced lung toxicity. Front Oncol 2023; 13:1086214. [PMID: 37637045 PMCID: PMC10449572 DOI: 10.3389/fonc.2023.1086214] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 07/27/2023] [Indexed: 08/29/2023] Open
Abstract
Nintedanib is a tyrosine kinase inhibitor of fibroblast growth factor-, vascular endothelial growth factor-, and platelet-derived growth factor receptors. These three receptors promote new blood vessel formation and maintenance, which is essential for tumor growth and spread. Several trials have shown that nintedanib plays a substantial role in treating patients with non-small cell lung cancer (NSCLC) and idiopathic pulmonary fibrosis. Recently, several clinical trials of nintedanib to treat NSCLC have been reported. In this review, we focus on our current understanding of nintedanib treatment for advanced NSCLC patients and summarize the literature on using nintedanib in radiation-induced lung toxicity and the efficacy and tolerability of nintedanib.
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Affiliation(s)
| | | | | | | | | | | | - Xiaojing Jia
- Department of Tumor Radiotherapy, The Second Hospital of Jilin University, Changchun, China
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5
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He G, Yang K, Zhang X, Pan J, Han A, Gao Z, Li Y, Wang W. Bronchial artery chemoembolization with drug-eluting beads versus bronchial artery infusion followed by polyvinyl alcohol particles embolization for advanced squamous cell lung cancer: A retrospective study. Eur J Radiol 2023; 161:110747. [PMID: 36821958 DOI: 10.1016/j.ejrad.2023.110747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 01/22/2023] [Accepted: 02/13/2023] [Indexed: 02/18/2023]
Abstract
PURPOSE To analyze the efficacy and safety of bronchial arterial embolization (BACE) with drug-eluting beads (DEB) versus bronchial artery infusion (BAI) followed by polyvinyl alcohol (PVA) particle embolization for the treatment of advanced squamous cell lung cancer after the failure of systemic therapy. METHOD Thirty-six patients with advanced squamous cell lung cancer who underwent bronchial arterial interventional therapy were included in this retrospective study. The DEB group (n = 20) was treated with nedaplatin and DEB loaded with gemcitabine, and the PVA group (n = 16) BAI with nedaplatin and gemcitabine followed by embolization with PVA particles. The treatment efficacy and complications were analyzed. RESULTS The technical success rate was 100 %. The two groups were followed up for a median period of 8.9 months. The mean overall survival (OS) in the DEB group was 12.6 months (95 % CI:9.99-15.21), which was significantly longer than 8.14 months (95 % CI:6.07-10.2) in the PVA group (p = 0.007). The median progression-free survival (PFS) in the DEB group was 4.3 months (95 % CI:2.33-6.27), significantly longer than 3.2 months (95 % CI:2.55-3.85) in the PVA group (p = 0.030). The objective response rate (ORR) six months after the procedure was 50 % in the DEB group and 12.5 % in the PVA group. In the univariate and multivariate analyses, DEB-BACE was an independent prognostic factor for survival. Only grade 1 adverse events like fever, chest pain, and cough were seen. CONCLUSIONS DEB-BACE may be a good choice for patients with advanced lung squamous cell carcinoma, as it could prolong OS and PFS without increasing adverse events.
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Affiliation(s)
- Guanghui He
- Department of Interventional Medicine, Weifang Second People's Hospital, No. 7 Yuanxiao Street, Weifang City, Shandong Province 261041, China.
| | - Kunning Yang
- Department of Respiratory Medicine, Weifang Second People's Hospital, No. 7 Yuanxiao Street, Weifang City, Shandong Province 261041, China.
| | - Xiaofa Zhang
- Department of Interventional Medicine, Anqiu People's Hospital, 159 Xuefu Street, Weifang City, Shandong Province 262100, China.
| | - Jianliang Pan
- Department of Respiratory Medicine, Weifang Second People's Hospital, No. 7 Yuanxiao Street, Weifang City, Shandong Province 261041, China.
| | - Aiqiang Han
- Department of Health Care, Weifang Second People's Hospital, No. 7 Yuanxiao Street, Weifang City, Shandong Province 261041, China.
| | - Zhi Gao
- Department of Interventional Medicine, Weifang Second People's Hospital, No. 7 Yuanxiao Street, Weifang City, Shandong Province 261041, China.
| | - Yuliang Li
- Department of Interventional Medicine, The Second Hospital of Shandong University, Institute of Tumor Intervention, Shandong University, 247 Beiyuan Street, Jinan City, Shandong Province 250033, China.
| | - Wujie Wang
- Department of Interventional Medicine, The Second Hospital of Shandong University, Institute of Tumor Intervention, Shandong University, 247 Beiyuan Street, Jinan City, Shandong Province 250033, China.
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Ghalehbandi S, Yuzugulen J, Pranjol MZI, Pourgholami MH. The role of VEGF in cancer-induced angiogenesis and research progress of drugs targeting VEGF. Eur J Pharmacol 2023; 949:175586. [PMID: 36906141 DOI: 10.1016/j.ejphar.2023.175586] [Citation(s) in RCA: 34] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 01/16/2023] [Accepted: 02/08/2023] [Indexed: 03/11/2023]
Abstract
Angiogenesis is a double-edged sword; it is a mechanism that defines the boundary between health and disease. In spite of its central role in physiological homeostasis, it provides the oxygen and nutrition needed by tumor cells to proceed from dormancy if pro-angiogenic factors tip the balance in favor of tumor angiogenesis. Among pro-angiogenic factors, vascular endothelial growth factor (VEGF) is a prominent target in therapeutic methods due to its strategic involvement in the formation of anomalous tumor vasculature. In addition, VEGF exhibits immune-regulatory properties which suppress immune cell antitumor activity. VEGF signaling through its receptors is an integral part of tumoral angiogenic approaches. A wide variety of medicines have been designed to target the ligands and receptors of this pro-angiogenic superfamily. Herein, we summarize the direct and indirect molecular mechanisms of VEGF to demonstrate its versatile role in the context of cancer angiogenesis and current transformative VEGF-targeted strategies interfering with tumor growth.
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Affiliation(s)
| | - Jale Yuzugulen
- Faculty of Pharmacy, Eastern Mediterranean University, Famagusta, North Cyprus via Mersin 10, Turkey
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7
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Diwan D, Cheng L, Usmani Z, Sharma M, Holden N, Willoughby N, Sangwan N, Baadhe RR, Liu C, Gupta VK. Microbial cancer therapeutics: A promising approach. Semin Cancer Biol 2022; 86:931-950. [PMID: 33979677 DOI: 10.1016/j.semcancer.2021.05.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/24/2021] [Accepted: 05/04/2021] [Indexed: 01/27/2023]
Abstract
The success of conventional cancer therapeutics is hindered by associated dreadful side-effects of antibiotic resistance and the dearth of antitumor drugs' selectivity and specificity. Hence, the conceptual evolution of anti-cancerous therapeutic agents that selectively target cancer cells without impacting the healthy cells or tissues, has led to a new wave of scientific interest in microbial-derived bioactive molecules. Such strategic solutions may pave the way to surmount the shortcomings of conventional therapies and raise the potential and hope for the cure of wide range of cancer in a selective manner. This review aims to provide a comprehensive summary of anti-carcinogenic properties and underlying mechanisms of bioactive molecules of microbial origin, and discuss the current challenges and effective therapeutic application of combinatorial strategies to attain minimal systemic side-effects.
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Affiliation(s)
- Deepti Diwan
- Washington University, School of Medicine, Saint Louis, MO, USA
| | - Lei Cheng
- Department of Pulmonary, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, 230032, China
| | - Zeba Usmani
- Department of Chemistry and Biotechnology, Tallinn University of Technology, 12618, Tallinn, Estonia
| | - Minaxi Sharma
- Department of Food Technology, Akal College of Agriculture, Eternal University, Baru Sahib, Himachal Pradesh, 173101, India
| | - Nicola Holden
- Centre for Safe and Improved Food, Scotland's Rural College (SRUC), Kings Buildings, West Mains Road, Edinburgh, EH9 3JG, UK
| | - Nicholas Willoughby
- Institute of Biological Chemistry, Biophysics and Bioengineering, School of Engineering and Physical Sciences, Heriot-Watt University, Edinburgh, EH14 4AS, UK
| | - Neelam Sangwan
- Department of Biochemistry, Central University of Haryana, Mahendergarh, Haryana, 123031, India
| | - Rama Raju Baadhe
- Department of Biotechnology, National Institute of Technology, Warangal, Telangana, 506004, India
| | - Chenchen Liu
- Department of Gastric Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.
| | - Vijai Kumar Gupta
- Centre for Safe and Improved Food, Scotland's Rural College (SRUC), Kings Buildings, West Mains Road, Edinburgh, EH9 3JG, UK; Biorefining and Advanced Materials Research Center, Scotland's Rural College (SRUC), Kings Buildings, West Mains Road, Edinburgh, EH9 3JG, UK.
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8
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Anti-Angiogenic Therapy in ALK Rearranged Non-Small Cell Lung Cancer (NSCLC). Int J Mol Sci 2022; 23:ijms23168863. [PMID: 36012123 PMCID: PMC9407780 DOI: 10.3390/ijms23168863] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 08/07/2022] [Accepted: 08/08/2022] [Indexed: 11/17/2022] Open
Abstract
The management of advanced lung cancer has been transformed with the identification of targetable oncogenic driver alterations. This includes anaplastic lymphoma kinase (ALK) gene rearrangements. ALK tyrosine kinase inhibitors (TKI) are established first-line treatment options in advanced ALK rearranged non-small cell lung cancer (NSCLC), with several next-generation ALK TKIs (alectinib, brigatinib, ensartinib and lorlatinib) demonstrating survival benefit compared with the first-generation ALK TKI crizotinib. Still, despite high objective response rates and durable progression-free survival, drug resistance inevitably ensues, and treatment options beyond ALK TKI are predominantly limited to cytotoxic chemotherapy. Anti-angiogenic therapy targeting the vascular endothelial growth factor (VEGF) signaling pathway has shown efficacy in combination with platinum-doublet chemotherapy in advanced NSCLC without a driver alteration, and with EGFR TKI in advanced EGFR mutated NSCLC. The role for anti-angiogenic therapy in ALK rearranged NSCLC, however, remains to be elucidated. This review will discuss the pre-clinical rationale, clinical trial evidence to date, and future directions to evaluate anti-angiogenic therapy in ALK rearranged NSCLC.
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Nixon AB, Sibley AB, Liu Y, Hatch AJ, Jiang C, Mulkey F, Starr MD, Brady JC, Niedzwiecki D, Venook AP, Baez-Diaz L, Lenz HJ, O'Neil BH, Innocenti F, Meyerhardt JA, O'Reilly EM, Owzar K, Hurwitz HI. Plasma Protein Biomarkers in Advanced or Metastatic Colorectal Cancer Patients Receiving Chemotherapy With Bevacizumab or Cetuximab: Results from CALGB 80405 (Alliance). Clin Cancer Res 2022; 28:2779-2788. [PMID: 34965954 PMCID: PMC9240111 DOI: 10.1158/1078-0432.ccr-21-2389] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 10/21/2021] [Accepted: 12/22/2021] [Indexed: 01/03/2023]
Abstract
PURPOSE CALGB 80405 compared the combination of first-line chemotherapy with cetuximab or bevacizumab in the treatment of advanced or metastatic colorectal cancer (mCRC). Although similar clinical outcomes were observed in the cetuximab-chemotherapy group and the bevacizumab-chemotherapy group, biomarkers could identify patients deriving more benefit from either biologic agent. PATIENTS AND METHODS In this exploratory analysis, the Angiome, a panel of 24 soluble protein biomarkers were measured in baseline plasma samples in CALGB 80405. Prognostic biomarkers were determined using univariate Cox proportional hazards models. Predictive biomarkers were identified using multivariable Cox regression models including interaction between biomarker level and treatment. RESULTS In the total population, high plasma levels of Ang-2, CD73, HGF, ICAM-1, IL6, OPN, TIMP-1, TSP-2, VCAM-1, and VEGF-R3 were identified as prognostic of worse progression-free survival (PFS) and overall survival (OS). PlGF was identified as predictive of lack of PFS benefit from bevacizumab [bevacizumab HR, 1.51; 95% confidence interval (CI), 1.10-2.06; cetuximab HR, 0.94; 95% CI, 0.71-1.25; Pinteraction = 0.0298] in the combined FOLFIRI/FOLFOX regimens. High levels of VEGF-D were predictive of lack of PFS benefit from bevacizumab in patients receiving FOLFOX regimen only (FOLFOX/bevacizumab HR, 1.70; 95% CI, 1.19-2.42; FOLFOX/cetuximab HR, 0.92; 95% CI, 0.68-1.24; Pinteraction = 0.0097). CONCLUSIONS In this exploratory, hypothesis-generating analysis, the Angiome identified multiple prognostic biomarkers and two potential predictive biomarkers for patients with mCRC enrolled in CALGB 80405. PlGF and VEGF-D predicted lack of benefit from bevacizumab in a chemo-dependent manner. See related commentaries by Mishkin and Kohn, p. 2722 and George and Bertagnolli, p. 2725.
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Affiliation(s)
- Andrew B Nixon
- Department of Medicine, Duke University Medical Center, Durham, North Carolina
- Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina
| | - Alexander B Sibley
- Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina
| | - Yingmiao Liu
- Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Ace J Hatch
- Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Chen Jiang
- Alliance Statistics and Data Center, Duke University, Durham, North Carolina
| | - Flora Mulkey
- Alliance Statistics and Data Center, Duke University, Durham, North Carolina
| | - Mark D Starr
- Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - John C Brady
- Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Donna Niedzwiecki
- Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina
- Department of Biostatistics & Bioinformatics, Duke University, Durham, North Carolina
| | - Alan P Venook
- UCSF Medical Center - Mission Bay, San Francisco, California
| | - Luis Baez-Diaz
- San Juan City Hospital, Puerto Rico MUNCORP, San Juan, Puerto Rico
| | | | - Bert H O'Neil
- Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, Indiana
| | - Federico Innocenti
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Jeffrey A Meyerhardt
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Eileen M O'Reilly
- Weill Cornell Medical College, Cornell University and Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kouros Owzar
- Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina
- Department of Biostatistics & Bioinformatics, Duke University, Durham, North Carolina
| | - Herbert I Hurwitz
- Department of Medicine, Duke University Medical Center, Durham, North Carolina
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Remon J, Lacas B, Herbst R, Reck M, Garon EB, Scagliotti GV, Ramlau R, Hanna N, Vansteenkiste J, Yoh K, Groen HJ, Heymach JV, Mandrekar SJ, Okamoto I, Neal JW, Heist RS, Planchard D, Pignon JP, Besse B, Besse B, Lacas B, Pignon J, Remon J, Berghmans T, Dahlberg S, Felip E, Berghmans T, Besse B, Dahlberg S, Felip E, Garon E, Groen HJ, Hanna N, Heist RS, Herbst R, Heymach JV, Lacas B, Adjei AA, Heist R, Mandrekar SJ, Neal JW, Okamoto I, Pignon JP, Ramlau R, Remon J, Reck M, Scagliotti GV, Vansteenkiste J, Yoh K. ANtiangiogenic Second-line Lung cancer Meta-Analysis on individual patient data in non-small cell lung cancer: ANSELMA. Eur J Cancer 2022; 166:112-125. [DOI: 10.1016/j.ejca.2022.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 02/02/2022] [Indexed: 11/16/2022]
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11
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Sunakawa Y, Takahashi K, Kawaguchi O, Yamamoto N. Phase I study of aflibercept in combination with docetaxel in Japanese patients with advanced solid malignancies. Invest New Drugs 2022; 40:1032-1041. [PMID: 35771301 PMCID: PMC9395466 DOI: 10.1007/s10637-022-01267-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 06/01/2022] [Indexed: 12/15/2022]
Abstract
Angiogenesis is a hallmark of cancer development. This study sought to determine the recommended dose of aflibercept, a recombinant fusion protein targeting VEGF-A, VEGF-B and placental growth factor (PlGF), combined with docetaxel in Japanese patients with advanced solid malignancies. This phase I study was planned to include 12 patients following a 3 + 3 algorithm to determine the maximum tolerated dose of aflibercept combined with docetaxel in patients with metastatic or unresectable solid tumors (trial registration: NCT00545246). Docetaxel (75 mg/m<sup>2</sup> every 3 weeks or 60 mg/m<sup>2</sup> after protocol amendment) was combined with escalating doses of aflibercept (2, 4 and 6 mg/kg every 4 weeks). Free and VEGF-bound aflibercept were measured to assess free aflibercept in excess of the VEGF-bound form. At the starting dose of the combination, 3 of 6 patients treated experienced febrile neutropenia. After reducing the docetaxel dose to 60 mg/m<sup>2</sup> in step 2 and permitting therapeutic granulocyte colony-stimulating factor (G-CSF) use, 2 of 3 patients in both cohorts experienced febrile neutropenia. Five patients (42%) had a partial response and 4 patients had stable disease (33%). Free aflibercept in excess of the VEGF-bound form was not maintained at this dose level. The dose limiting toxicity (DLT) of aflibercept combined with docetaxel was febrile neutropenia, which occurred in 2 of 3 Japanese patients at the lowest aflibercept dose level (2 mg/kg) combined with docetaxel (60 mg/m<sup>2</sup>) and therapeutic G-CSF use. A recommended dose for further studies was not determined because of the DLT at the starting dose.
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Affiliation(s)
- Yu Sunakawa
- Department of Clinical Oncology, St. Marianna University School of Medicine, Kawasaki, Japan
| | | | | | - Nobuyuki Yamamoto
- Third Department of Internal Medicine, Wakayama Medical University Hospital, Wakayama, Japan.
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12
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Li YM, Guo RQ, Bie ZX, Li B, Li XG. Sintilimab plus Bronchial Arterial Infusion Chemotherapy/Drug-Eluting Embolic Chemoembolization for Advanced Non-Small Cell Lung Cancer: A Preliminary Study of 10 Patients. J Vasc Interv Radiol 2021; 32:1679-1687. [PMID: 34492303 DOI: 10.1016/j.jvir.2021.08.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 08/19/2021] [Accepted: 08/23/2021] [Indexed: 01/19/2023] Open
Abstract
PURPOSE To evaluate the short-term efficacy and safety of immunotherapy with sintilimab combined with bronchial arterial infusion (BAI) chemotherapy/drug-eluting embolic (DEE) bronchial arterial chemoembolization (BACE) for advanced non-small cell lung cancer (NSCLC). MATERIALS AND METHODS Ten patients with advanced NSCLC were treated with sintilimab plus BAI/DEE-BACE between December 2019 and November 2020 and retrospectively evaluated. The Response Evaluation Criteria in Solid Tumors version 1.1 was applied to evaluate the treatment response. The local tumor control duration, progression-free survival (PFS), and overall survival (OS) were estimated using the Kaplan-Meier analysis. RESULTS At 30 days after the last multimodal treatment, complete response, partial response, and stable disease were recorded in 1 (10%), 7 (70%), and 2 (20%) patients, respectively, for an objective response rate of 80% and a disease control rate of 100%. No patient experienced progressive disease. The median duration of local tumor control was 8.0 months (95% CI, 6.2-9.7 months). The median PFS and OS were 11.0 months (95% CI, 6.9-15.1 months) and 8.0 months (95% CI, 5.5-10.5 months), respectively. Two cases of Grade III adverse events related to medications were reported. CONCLUSIONS Sintilimab combined with BAI/DEE-BACE for patients with advanced NSCLC appears to be safe and feasible. Compared with previous studies on BAI/DEE-BACE, the addition of immunotherapy may improve survival.
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Affiliation(s)
- Yuan-Ming Li
- Minimally Invasive Tumor Therapies Center, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Run-Qi Guo
- Minimally Invasive Tumor Therapies Center, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Zhi-Xin Bie
- Minimally Invasive Tumor Therapies Center, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Bin Li
- Minimally Invasive Tumor Therapies Center, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Xiao-Guang Li
- Minimally Invasive Tumor Therapies Center, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China.
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13
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Watson N, Al-Samkari H. Thrombotic and bleeding risk of angiogenesis inhibitors in patients with and without malignancy. J Thromb Haemost 2021; 19:1852-1863. [PMID: 33928747 DOI: 10.1111/jth.15354] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 04/13/2021] [Accepted: 04/26/2021] [Indexed: 01/06/2023]
Abstract
Over the past two decades, therapies targeting angiogenesis have developed into a major class of cancer therapeutics. The vascular endothelial growth factor (VEGF) family of signaling proteins, a group of potent angiogenic growth factors, and their receptors represent the main targets of this therapeutic class. To date, 16 antiangiogenic agents have been approved in the United States for the treatment of cancer and several more are in development. An important consideration with antiangiogenic therapy is toxicity, in particular thrombotic and bleeding risks. These complications have emerged as a major clinical concern that may affect the use of these agents in patients both with and without cancer who may already have an elevated risk of thrombosis and bleeding. Although these agents are frequently considered together as a class when contemplating their bleeding and thrombotic risks, in fact the risks for venous thromboembolism, arterial thrombosis, and bleeding vary significantly between different classes of antiangiogenic agents and even among different agents within a class. In this narrative review, we describe the literature investigating the venous and arterial thrombotic and bleeding risks associated with the currently available antiangiogenic drugs. In addition, we discuss these specific complications in the context of both cancer therapy as well as the management of nonmalignant disorders now managed with antiangiogenic agents, including hereditary hemorrhagic telangiectasia and neovascular age-related macular degeneration.
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Affiliation(s)
| | - Hanny Al-Samkari
- Harvard Medical School, Boston, MA, USA
- Division of Hematology, Massachusetts General Hospital, Boston, MA, USA
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14
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Oguntade AS, Al-Amodi F, Alrumayh A, Alobaida M, Bwalya M. Anti-angiogenesis in cancer therapeutics: the magic bullet. J Egypt Natl Canc Inst 2021; 33:15. [PMID: 34212275 DOI: 10.1186/s43046-021-00072-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 06/08/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Angiogenesis is the formation of new vascular networks from preexisting ones through the migration and proliferation of differentiated endothelial cells. Available evidence suggests that while antiangiogenic therapy could inhibit tumour growth, the response to these agents is not sustained. The aim of this paper was to review the evidence for anti-angiogenic therapy in cancer therapeutics and the mechanisms and management of tumour resistance to antiangiogenic agents. We also explored the latest advances and challenges in this field. MEDLINE and EMBASE databases were searched for publications on antiangiogenic therapy in cancer therapeutics from 1990 to 2020. Vascular endothelial growth factor (VEGF) is the master effector of the angiogenic response in cancers. Anti-angiogenic agents targeting the VEGF and HIF-α pathways include monoclonal antibodies to VEGF (e.g. bevacizumab), small-molecule tyrosine kinase inhibitors (TKIs) e.g. sorafenib, decoy receptor or VEGF trap e.g. aflibercept and VEGFR2 inhibitors (e.g. ramucirumab). These classes of drugs are vascular targeting which in many ways are advantageous over tumour cell targeting drugs. Their use leads to a reduction in the tumour blood supply and growth of the tumour blood vessels. Tumour resistance and cardiovascular toxicity are important challenges which limit the efficacy and long-term use of anti-angiogenic agents in cancer therapeutics. Tumour resistance can be overcome by dual anti-angiogenic therapy or combination with conventional chemotherapy and immunotherapy. Emerging nanoparticle-based therapy which can silence the expression of HIF-α gene expression by antisense oligonucleotides or miRNAs has been developed. Effective delivery platforms are required for such therapy. SHORT CONCLUSION Clinical surveillance is important for the early detection of tumour resistance and treatment failure using reliable biomarkers. It is hoped that the recent interest in mesenchymal cell-based and exosome-based nanoparticle delivery platforms will improve the cellular delivery of newer anti-angiogenics in cancer therapeutics.
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Affiliation(s)
- Ayodipupo S Oguntade
- Nuffield Department of Population Health, University of Oxford, Oxford, UK. .,Institute of Cardiovascular Science, University College London, London, UK.
| | - Faez Al-Amodi
- Institute of Cardiovascular Science, University College London, London, UK
| | - Abdullah Alrumayh
- Institute of Cardiovascular Science, University College London, London, UK.,Department of Basic Science, Prince Sultan Bin Abdulaziz College for Emergency Medical Services, King Saud University, Riyadh, Saudi Arabia
| | - Muath Alobaida
- Institute of Cardiovascular Science, University College London, London, UK.,Department of Basic Science, Prince Sultan Bin Abdulaziz College for Emergency Medical Services, King Saud University, Riyadh, Saudi Arabia
| | - Mwango Bwalya
- Institute of Cardiovascular Science, University College London, London, UK
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15
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Wang X, Zhang H, Zhou L, Ou H, Liu H. Efficacy and Safety of 8 spheres Plus Cisplatin Versus Vinorelbine Plus Cisplatin in Locally Advanced Non-small Cell Lung Cancer. Cancer Biother Radiopharm 2020. [PMID: 33332223 DOI: 10.1089/cbr.2020.4301] [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: 11/13/2022] Open
Abstract
Background: This study aimed to evaluate the efficacy and safety between 8 spheres plus bronchial arterial infusion (BAI) cisplatin and intravenous vinorelbine plus cisplatin as third-line treatments in locally advanced non-small cell lung cancer (NSCLC) patients. Materials and Methods: Totally, 56 locally advanced NSCLC patients with second-line chemotherapy failure were recruited. Then, 28 patients received 8 spheres plus BAI cisplatin treatment, and another 28 patients received intravenous vinorelbine plus cisplatin treatment. Results: In general, 8 spheres plus BAI cisplatin increased objective response rate (57.2% vs. 17.8%, p = 0.002) and disease control rate (78.6% vs. 42.8%, p = 0.003) compared with intravenous vinorelbine plus cisplatin; meanwhile, it also elevated quality of life (QOL) score (46.7 ± 7.1 vs. 41.5 ± 5.2, p = 0.003) compared with intravenous vinorelbine plus cisplatin. Furthermore, 8 spheres plus BAI cisplatin prolonged progression-free survival (PFS) (median [95% confidence interval, CI]: 7.9 [6.3-9.5] months vs. 4.3 [3.5-5.1] months, p < 0.001) and overall survival (OS) (median [95% CI]: 14.6 [11.0-18.2] months vs. 10.5 [10.2-10.8] months, p = 0.029) compared with intravenous vinorelbine plus cisplatin, which was further supported by multivariate Cox's regression analysis (PFS: p < 0.001; OS: p = 0.007). In addition, subgroup analyses revealed that 8 spheres plus BAI cisplatin markedly elevated treatment response, QOL, and survival compared with intravenous vinorelbine plus cisplatin in squamous cell carcinoma patients, but not in adenomatous carcinoma and adenosquamous carcinoma patients. Regarding safety, 8 spheres plus BAI cisplatin exhibited lower rates of gastrointestinal tract complication (p < 0.001) and myelosuppression (p < 0.001) than intravenous vinorelbine plus cisplatin. Conclusions: 8 spheres plus BAI cisplatin displays good efficacy and well-tolerated safety profiles in locally advanced NSCLC patients with second-line chemotherapy failure.
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Affiliation(s)
- Xiaojun Wang
- Department of Oncology, Chenzhou No. 1 People's Hospital, Chenzhou, P.R. China
| | - Huiyun Zhang
- Department of Oncology, Chenzhou No. 1 People's Hospital, Chenzhou, P.R. China
| | - Liangfen Zhou
- Department of Neonatology, Chenzhou No. 1 People's Hospital, Chenzhou, P.R. China
| | - Hui Ou
- Department of Oncology, Chenzhou No. 1 People's Hospital, Chenzhou, P.R. China
| | - Hengyu Liu
- Department of Oncology, Chenzhou No. 1 People's Hospital, Chenzhou, P.R. China
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16
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Mehta A, Sriramanakoppa NN, Agarwal P, Viswakarma G, Vasudevan S, Panigrahi M, Kumar D, Saifi M, Chowdhary I, Doval DC, Suryavanshi M. Predictive biomarkers in nonsmall cell carcinoma and their clinico-pathological association. South Asian J Cancer 2020; 8:250-254. [PMID: 31807491 PMCID: PMC6852638 DOI: 10.4103/sajc.sajc_373_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background: Lung cancer is the leading cause of cancer-related mortality worldwide. Genome-directed therapy is less toxic, prolongs survival and provides a better quality of life. Predictive biomarker testing, therefore, has become a standard of care in advanced lung cancers. The objective of this study was to relate clinical and pathological features, including response to targeted therapy (TT) and progression-free survival (PFS) with positive driver mutation. Materials and Methods: Archival data of nonsmall cell carcinoma patients with Stage IV disease were retrieved. Those who tested positive for one of the four biomarkers (epidermal growth factor receptor [EGFR], anaplastic lymphoma kinase [ALK], MET, and ROS) were included. Patient demographics and clinical features were reviewed. Tumor histomorphology was correlated with oncological drivers. Treatment response, PFS, and overall survival were studied in three subcohorts of patients who received computed tomography (CT), CT followed by TT and those who received TT in the first line. Results: A total of 900 patients underwent biomarker evaluation of which 288 tested positive. Frequency of the four biomarkers observed was 26.6% (229/860), 6.6% (51/775), 6.6% (5/75), and 5.1% (3/59) for EGFR, ALK, MET, and ROS-1, respectively. The median PFS for EGFR-mutated cohort was 12 months, whereas it was 21 months for ALK protein overexpressing cases. Patients treated with first-line tyrosine kinase inhibitors performed better compared to those who were switched from chemotherapy to TT or those who received chemotherapy alone (P < 0.05). Conclusion: Biomarker testing has improved patient outcome. Genome-directed therapy accords best PFS with an advantage of nearly 10 months over cytotoxic therapy.
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Affiliation(s)
- Anurag Mehta
- Department of Lab Services, Transfusion Medicine and Molecular Diagnostics, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Nayana N Sriramanakoppa
- Department of Laboratory Services and Transfusion Medicine, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Poojan Agarwal
- Department of Laboratory Services and Transfusion Medicine, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Gayatri Viswakarma
- Department of Research, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Smreti Vasudevan
- Department of Research, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Manoj Panigrahi
- Department of Molecular Diagnostics and Cell Biology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Dushyant Kumar
- Department of Molecular Diagnostics and Cell Biology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Mumtaz Saifi
- Department of Molecular Diagnostics and Cell Biology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Irfan Chowdhary
- Department of Laboratory Services and Transfusion Medicine, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - D C Doval
- Department of Molecular Diagnostics and Cell Biology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India.,Department of Medical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Moushumi Suryavanshi
- Department of Molecular Diagnostics and Cell Biology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
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17
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Tian W, Cao C, Shu L, Wu F. Anti-Angiogenic Therapy in the Treatment of Non-Small Cell Lung Cancer. Onco Targets Ther 2020; 13:12113-12129. [PMID: 33262610 PMCID: PMC7699985 DOI: 10.2147/ott.s276150] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 10/14/2020] [Indexed: 12/15/2022] Open
Abstract
Angiogenesis plays an essential role in the development of most solid tumors by delivering nutrients and oxygen to the tumor. Therefore, anti-angiogenic therapy, particularly anti-VEGF and anti-VEGF receptor (VEGFR) therapy, has been a popular strategy to treat cancer. However, anti-angiogenic therapy does not significantly improve patients' outcomes when used alone because the cutdown of the vessels transforms tumor cells to a hypoxia-tolerant phenotype. While combining anti-angiogenic therapy with other therapies, including chemotherapy, radiotherapy, immunotherapy, and anti-epidermal growth factor receptor (EGFR) therapy, has a promising efficacy due to the vessel normalization effect induced by anti-angiogenic agents. Here, we review the characteristics of tumor angiogenesis, the mechanisms, clinical applications, and prospects of combining anti-angiogenic therapy with other therapies in the treatment of non-small cell lung cancer.
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Affiliation(s)
- Wentao Tian
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha 410011, Hunan, People's Republic of China.,Xiangya School of Medicine, Central South University, Changsha 410013, Hunan, People's Republic of China
| | - Chenghui Cao
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha 410011, Hunan, People's Republic of China.,Xiangya School of Medicine, Central South University, Changsha 410013, Hunan, People's Republic of China
| | - Long Shu
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha 410011, Hunan, People's Republic of China
| | - Fang Wu
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha 410011, Hunan, People's Republic of China
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18
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Riccardi C, Napolitano E, Platella C, Musumeci D, Melone MAB, Montesarchio D. Anti-VEGF DNA-based aptamers in cancer therapeutics and diagnostics. Med Res Rev 2020; 41:464-506. [PMID: 33038031 DOI: 10.1002/med.21737] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 09/12/2020] [Accepted: 09/23/2020] [Indexed: 12/13/2022]
Abstract
The vascular endothelial growth factor (VEGF) family and its receptors play fundamental roles not only in physiological but also in pathological angiogenesis, characteristic of cancer progression. Aiming at finding putative treatments for several malignancies, various small molecules, antibodies, or protein-based drugs have been evaluated in vitro and in vivo as VEGF inhibitors, providing efficient agents approved for clinical use. Due to the high clinical importance of VEGF, also a great number of anti-VEGF nucleic acid-based aptamers-that is, oligonucleotides able to bind with high affinity and specificity a selected biological target-have been developed as promising agents in anticancer strategies. Notable research efforts have been made in optimization processes of the identified aptamers, searching for increased target affinity and/or bioactivity by exploring structural analogues of the lead compounds. This review is focused on recent studies devoted to the development of DNA-based aptamers designed to target VEGF. Their therapeutic potential as well as their significance in the construction of highly selective biosensors is here discussed.
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Affiliation(s)
- Claudia Riccardi
- Department of Chemical Sciences, University of Naples Federico II, Naples, Italy.,Department of Advanced Medical and Surgical Sciences, 2nd Division of Neurology, Center for Rare Diseases and Inter-University Center for Research in Neurosciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Ettore Napolitano
- Department of Chemical Sciences, University of Naples Federico II, Naples, Italy
| | - Chiara Platella
- Department of Chemical Sciences, University of Naples Federico II, Naples, Italy
| | - Domenica Musumeci
- Department of Chemical Sciences, University of Naples Federico II, Naples, Italy.,Institute of Biostructures and Bioimages, Naples, Italy
| | - Mariarosa A B Melone
- Department of Advanced Medical and Surgical Sciences, 2nd Division of Neurology, Center for Rare Diseases and Inter-University Center for Research in Neurosciences, University of Campania Luigi Vanvitelli, Naples, Italy.,Sbarro Institute for Cancer Research and Molecular Medicine, Temple University, Philadelphia, Pennsylvania, USA
| | - Daniela Montesarchio
- Department of Chemical Sciences, University of Naples Federico II, Naples, Italy
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19
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Hu C, Hui K, Jiang X. Effects of microRNA regulation on antiangiogenic therapy resistance in non-small cell lung cancer. Biomed Pharmacother 2020; 131:110557. [PMID: 32836072 DOI: 10.1016/j.biopha.2020.110557] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 07/24/2020] [Accepted: 07/26/2020] [Indexed: 12/28/2022] Open
Abstract
Antiangiogenic drugs have become a standard therapeutic regimen for advanced non-small cell lung cancer (NSCLC); however, many issues remain to be solved. Identifying specific markers to predict patient response to antiangiogenic drugs to ensure therapeutic efficacy would increase their clinical benefit. MicroRNAs (miRNAs) are involved in the process of resistance to antiangiogenic therapy, as they regulate various key signaling pathways. Therefore, miRNAs may be used as targets for reversing tumor resistance to antiangiogenic therapy. This article reviews the molecular mechanisms of antiangiogenic therapy resistance and the specific mechanisms of miRNA regulation of resistance. Signal transducer and activator of transcription 3 (STAT3) is one of multiple target genes of miRNAs, and is closely related to antiangiogenic research. Thus, it is described separately in this review article.
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Affiliation(s)
- Chenxi Hu
- Department of Oncology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, No.182, Tongguan Road, Lianyungang City 222002, Jiangsu Province, China
| | - Kaiyuan Hui
- Department of Oncology, Lianyungang Clinical Medical College of Nanjing Medical University, No.182, Tongguan Road, Lianyungang City 222002, Jiangsu Province, China.
| | - Xiaodong Jiang
- Department of Oncology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, No.182, Tongguan Road, Lianyungang City 222002, Jiangsu Province, China; Department of Oncology, Lianyungang Clinical Medical College of Nanjing Medical University, No.182, Tongguan Road, Lianyungang City 222002, Jiangsu Province, China.
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20
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Yu Z, Cai X, Xu Z, He Z, Lai J, Wang W, Zhang J, Kong W, Huang X, Chen Y, Shi Y, Shi X, Zhao Z, Ni M, Lin X, Chen S, Wu X, Chen W, Song Z, Huang C. Apatinib plus Chemotherapy as a Second-Line Treatment in Unresectable Non-Small Cell Lung Carcinoma: A Randomized, Controlled, Multicenter Clinical Trial. Oncologist 2020; 25:e1640-e1649. [PMID: 32533785 DOI: 10.1634/theoncologist.2020-0519] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 05/30/2020] [Indexed: 01/19/2023] Open
Abstract
LESSONS LEARNED The efficacy of second-line treatment for advanced non-small cell lung carcinoma (NSCLC) without a sensitizing driver gene mutation is still unsatisfactory. The combination of apatinib and chemotherapy improved progression-free survival in the second-line therapy of advanced NSCLC without a sensitizing mutation. This study offers a new treatment strategy for second-line treatment of such patients but requires confirmation in a larger multi-institutional trial. BACKGROUND This study explored the efficacy and safety of apatinib combined with single-agent chemotherapy versus single-agent chemotherapy in the second-line treatment of advanced non-small-cell lung carcinoma (NSCLC) without driver mutations. METHODS In this double-arm, open label, exploratory clinical study, we enrolled patients with unresectable locally advanced or advanced NSCLC without driver mutations that had progressed following first-line chemotherapy. The subjects were allocated into an experimental group and a control group by 2:1. The experimental group received apatinib combined with four cycles of docetaxel or pemetrexed until disease progression, intolerable toxicity, or discontinuation at the patient' request. The control group only received four cycles of docetaxel or pemetrexed. The primary endpoints were progression-free survival (PFS), and the secondary endpoints were overall survival (OS), disease control rate (DCR), and safety. RESULTS Thirty-seven patients were enrolled. The efficacy of 33 patients was evaluated. The median PFS was 5.47 versus 2.97 months, the DCR was 95% versus 73%, and the objective response rate (ORR) was 27% versus 9% in the experimental versus control group. The OS was still under follow-up. The most common adverse effects included hypertension, hand-foot skin reaction (HFSR), and fatigue. CONCLUSION Apatinib combined with single-agent chemotherapy may be a novel option for second-line treatment of advanced NSCLC.
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Affiliation(s)
- Zongyang Yu
- The 900th Hospital of Joint Logistic Support Force, PLA, Fujian Medical University, Fuzhou, People' Republic of China
| | - Xiuyu Cai
- Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Zhengwu Xu
- Fujian Cancer Hospital and Fujian Medical University Cancer Hospital, Fuzhou, People' Republic of China
| | - Zhiyong He
- Fujian Cancer Hospital and Fujian Medical University Cancer Hospital, Fuzhou, People' Republic of China
| | - Jinhuo Lai
- Affiliated Union Hospital of Fujian Medical University, Fuzhou, People' Republic of China
| | - Wenwu Wang
- The 900th Hospital of Joint Logistic Support Force, PLA, Fuzhou, People' Republic of China
| | - Jing Zhang
- Fujian Cancer Hospital and Fujian Medical University Cancer Hospital, Fuzhou, People' Republic of China
| | - Wencui Kong
- The 900th Hospital of Joint Logistic Support Force, PLA, Fuzhou, People' Republic of China
| | - Xiaoyan Huang
- The 900th Hospital of Joint Logistic Support Force, PLA, Fuzhou, People' Republic of China
| | - Ying Chen
- The 900th Hospital of Joint Logistic Support Force, PLA, Fuzhou, People' Republic of China
| | - Yanhong Shi
- The 900th Hospital of Joint Logistic Support Force, PLA, Fuzhou, People' Republic of China
| | - Xi Shi
- First Affiliated Hospital of Fujian Medical University, Fuzhou, People' Republic of China
| | - Zhongquan Zhao
- The 900th Hospital of Joint Logistic Support Force, PLA, Fuzhou, People' Republic of China
| | - Min Ni
- The 900th Hospital of Joint Logistic Support Force, PLA, Fuzhou, People' Republic of China
| | - Xiangwu Lin
- The 900th Hospital of Joint Logistic Support Force, PLA, Fuzhou, People' Republic of China
| | - Siyu Chen
- The 900th Hospital of Joint Logistic Support Force, PLA, Fuzhou, People' Republic of China
| | - Xiaolong Wu
- The 900th Hospital of Joint Logistic Support Force, PLA, Fuzhou, People' Republic of China
| | - Wujin Chen
- Fujian People's Hospital, Fuzhou, People' Republic of China
| | - Zhengbo Song
- Zhejiang Cancer Hospital, Hangzhou, People' Republic of China
| | - Cheng Huang
- Fujian Cancer Hospital and Fujian Medical University Cancer Hospital, Fuzhou, People' Republic of China
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Chen C, Wang W, Yu Z, Tian S, Li Y, Wang Y. Combination of computed tomography-guided iodine-125 brachytherapy and bronchial arterial chemoembolization for locally advanced stage III non-small cell lung cancer after failure of concurrent chemoradiotherapy. Lung Cancer 2020; 146:290-296. [PMID: 32615523 DOI: 10.1016/j.lungcan.2020.06.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 05/25/2020] [Accepted: 06/09/2020] [Indexed: 12/09/2022]
Abstract
OBJECTIVES To evaluate the efficacy and safety of the combination of computed tomography (CT)-guided iodine-125 brachytherapy and bronchial arterial chemoembolization (BACE) for locally advanced stage III non-small cell lung cancer (NSCLC) after failure of concurrent chemoradiotherapy. MATERIAL AND METHODS We retrospectively evaluated 28 patients with locally advanced stage III NSCLC in whom concurrent chemoradiotherapy had failed and were consequently, treated with radioactive iodine-125 seed implantation followed by BACE. The prescribed radiation dose was 140 Gy, with a median radioactivity of 0.60 mCi. The tumor-feeding arteries were detected on angiography, and chemotherapeutic agents (gemcitabine 1000 mg/m2 + lobaplatin 30 mg/m2) were then administered via arterial infusion. The tumor-feeding arteries were embolized using 300-500 μm embosphere microspheres. The endpoints were treatment response rate, progression-free survival (PFS), and toxicity. RESULTS The median number of implanted iodine-125 seeds was 58 pellets (range, 44-114 pellets). The median post-operative dose covering 90 % of the target volume (D90) was 143.4 Gy (range, 123.6-159.9 Gy). A total of 73 cycles of BACE were conducted (2.61 cycles per case). The bronchial arteries were the main tumor-feeding arteries. In total, 11 patients had hemoptysis, and it was significantly alleviated within 24 h after BACE. There was no serious procedure-related complication. The 6-month objective response and disease control rates were 71.42 % and 92.86 %, respectively. No severe complications occurred during the follow-up. Local control duration ranged from 5-12 months, and the median PFS was 8 months (95 % confidence interval: 7.3-8.8 months). CONCLUSIONS The combination of CT-guided iodine-125 brachytherapy and BACE is an effective and safe approach for the treatment of NSCLC after failure of concurrent chemoradiotherapy and is worthy of clinical application.
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Affiliation(s)
- Chao Chen
- Department of Interventional Medicine, The Second Hospital, Cheeloo College of Medicine, Shandong University, China; Interventional Oncology Institute of Shandong University, China.
| | - Wei Wang
- Department of Interventional Medicine, The Second Hospital, Cheeloo College of Medicine, Shandong University, China; Interventional Oncology Institute of Shandong University, China.
| | - Zhe Yu
- Department of Interventional Medicine, The Second Hospital, Cheeloo College of Medicine, Shandong University, China; Interventional Oncology Institute of Shandong University, China.
| | - Shilin Tian
- Department of Interventional Medicine, The Second Hospital, Cheeloo College of Medicine, Shandong University, China; Interventional Oncology Institute of Shandong University, China.
| | - Yuliang Li
- Department of Interventional Medicine, The Second Hospital, Cheeloo College of Medicine, Shandong University, China; Interventional Oncology Institute of Shandong University, China.
| | - Yongzheng Wang
- Department of Interventional Medicine, The Second Hospital, Cheeloo College of Medicine, Shandong University, China; Interventional Oncology Institute of Shandong University, China.
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22
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Pasquier J, Ghiabi P, Chouchane L, Razzouk K, Rafii S, Rafii A. Angiocrine endothelium: from physiology to cancer. J Transl Med 2020; 18:52. [PMID: 32014047 PMCID: PMC6998193 DOI: 10.1186/s12967-020-02244-9] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 01/28/2020] [Indexed: 02/08/2023] Open
Abstract
The concept of cancer as a cell-autonomous disease has been challenged by the wealth of knowledge gathered in the past decades on the importance of tumor microenvironment (TM) in cancer progression and metastasis. The significance of endothelial cells (ECs) in this scenario was initially attributed to their role in vasculogenesis and angiogenesis that is critical for tumor initiation and growth. Nevertheless, the identification of endothelial-derived angiocrine factors illustrated an alternative non-angiogenic function of ECs contributing to both physiological and pathological tissue development. Gene expression profiling studies have demonstrated distinctive expression patterns in tumor-associated endothelial cells that imply a bilateral crosstalk between tumor and its endothelium. Recently, some of the molecular determinants of this reciprocal interaction have been identified which are considered as potential targets for developing novel anti-angiocrine therapeutic strategies.
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Affiliation(s)
- Jennifer Pasquier
- Nice Breast Institute, 57 bld de la Californie, 06000, Nice, France.
- Stem Cell & Microenvironment Laboratory, Weill Cornell Medicine-Qatar, Doha, Qatar.
| | - Pegah Ghiabi
- Stem Cell & Microenvironment Laboratory, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Lotfi Chouchane
- Department of Genetic Medicine, Weill Cornell Medicine, New York, NY, 10065, USA
- Department of Microbiology and Immunology, Weill Cornell Medicine, New York, NY, 10065, USA
- Laboratory of Genetic Medicine and Immunology, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Kais Razzouk
- Nice Breast Institute, 57 bld de la Californie, 06000, Nice, France
| | - Shahin Rafii
- Department of Genetic Medicine, Weill Cornell Medicine, New York, NY, 10065, USA
| | - Arash Rafii
- Nice Breast Institute, 57 bld de la Californie, 06000, Nice, France
- Stem Cell & Microenvironment Laboratory, Weill Cornell Medicine-Qatar, Doha, Qatar
- Department of Genetic Medicine, Weill Cornell Medicine, New York, NY, 10065, USA
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23
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Santoni M, Conti A, Massari F, Di Nunno V, Faloppi L, Galizia E, Morbiducci J, Piva F, Buti S, Iacovelli R, Ferretti B, Cimadamore A, Scarpelli M, Lopez-Beltran A, Cheng L, Battelli N, Montironi R. Targeted therapy for solid tumors and risk of hypertension: a meta-analysis of 68077 patients from 93 phase III studies. Expert Rev Cardiovasc Ther 2019; 17:917-927. [PMID: 31829045 DOI: 10.1080/14779072.2019.1704626] [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] [Indexed: 10/25/2022]
Abstract
Objective: Hypertension is a common adverse event with targeted agents in cancer patients and can lead to serious and sometimes lethal cardiovascular complications. The authors performed a meta-analysis of clinical trials aiming to evaluate the incidence and Relative Risk (RR) of developing all-grade and high-grade Hypertension Events (HE) in patients with solid tumors receiving targeted therapy.Methods: A review of citations from PubMed was performed and studies were selected based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The search was limited to randomized phase III trials published in English focused on the efficacy and safety of targeted agents in cancer patients, reporting data on HE. Incidence, RR and relative 95% CIs were analyzed using random or fixed-effects models. Overall incidences were calculated and further compared with the chi-squared test for proportions.Results: Ninety-three phase III trials were included, with a total of 68,077 patients. Prostate cancer was the most represented (18.9%), followed by breast cancer (17.3%) and colorectal cancer (16.4%). The incidence of all- and high-grade HE was 23.47% and 8.57%, respectively, with the highest incidence of serious HE reported by adjuvant Sunitib/Sorafenib (29.03%). The highest RR of high-grade HE was observed with Bevacizumab in patients with advanced cervical cancer. By drug category, the highest RR of high-grade HE was reported by VEGFR/EGFR TKIs.Conclusion: According to these data, monitoring this class of toxicities is of primary importance to avoid hypertension worsening and, thus, the risk of major cardiovascular events.
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Affiliation(s)
| | - Alessandro Conti
- Azienda Ospedaliera dell'Alto Adige, Bressanone/Brixen Hospital, Bressanone, Italy
| | | | | | - Luca Faloppi
- Oncology Unit, Macerata Hospital, Macerata, Italy
| | - Eva Galizia
- Oncology Unit, Macerata Hospital, Macerata, Italy
| | | | - Francesco Piva
- Department of Specialistic Clinical and Odontostomatological Sciences, Polytechnic University of Marche, Ancona, Italy
| | - Sebastiano Buti
- Division of Oncology, University Hospital of Parma, Parma, Italy
| | - Roberto Iacovelli
- Department of Medical Oncology, Azienda Ospedaliera Universitaria Integrata (AOUI), University of Verona, Verona, Italy
| | - Benedetta Ferretti
- Oncologia Medica, Ospedale di San Severino, San Severino Marche (MC), Macerata, Italy
| | - Alessia Cimadamore
- Section of Pathological Anatomy, School of Medicine, United Hospitals, Polytechnic University of the Marche Region, Ancona, Italy
| | - Marina Scarpelli
- Section of Pathological Anatomy, School of Medicine, United Hospitals, Polytechnic University of the Marche Region, Ancona, Italy
| | | | - Liang Cheng
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | | | - Rodolfo Montironi
- Section of Pathological Anatomy, School of Medicine, United Hospitals, Polytechnic University of the Marche Region, Ancona, Italy
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Kuczynski EA, Vermeulen PB, Pezzella F, Kerbel RS, Reynolds AR. Vessel co-option in cancer. Nat Rev Clin Oncol 2019; 16:469-493. [PMID: 30816337 DOI: 10.1038/s41571-019-0181-9] [Citation(s) in RCA: 262] [Impact Index Per Article: 52.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
All solid tumours require a vascular supply in order to progress. Although the ability to induce angiogenesis (new blood vessel growth) has long been regarded as essential to this purpose, thus far, anti-angiogenic therapies have shown only modest efficacy in patients. Importantly, overshadowed by the literature on tumour angiogenesis is a long-standing, but continually emerging, body of research indicating that tumours can grow instead by hijacking pre-existing blood vessels of the surrounding nonmalignant tissue. This process, termed vessel co-option, is a frequently overlooked mechanism of tumour vascularization that can influence disease progression, metastasis and response to treatment. In this Review, we describe the evidence that tumours located at numerous anatomical sites can exploit vessel co-option. We also discuss the proposed molecular mechanisms involved and the multifaceted implications of vessel co-option for patient outcomes.
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Affiliation(s)
- Elizabeth A Kuczynski
- Bioscience, Oncology, IMED Biotech Unit, AstraZeneca, Cambridge, UK. .,Biological Sciences Platform, Sunnybrook Research Institute, Toronto, Canada.
| | - Peter B Vermeulen
- HistoGeneX, Antwerp, Belgium.,Translational Cancer Research Unit, GZA Hospitals St Augustinus, University of Antwerp, Wilrijk-Antwerp, Belgium.,Tumour Biology Team, Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, UK
| | - Francesco Pezzella
- Nuffield Division of Clinical Laboratory Sciences, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Robert S Kerbel
- Biological Sciences Platform, Sunnybrook Research Institute, Toronto, Canada.,Department of Medical Biophysics, University of Toronto, Toronto, Canada
| | - Andrew R Reynolds
- Tumour Biology Team, Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, UK. .,Oncology Translational Medicine Unit, IMED Biotech Unit, AstraZeneca, Cambridge, UK.
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25
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Risk of Venous Thromboembolic Events in Patients With Cancer Treated With Aflibercept: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Am J Ther 2019; 26:e549-e552. [DOI: 10.1097/mjt.0000000000000805] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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26
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Hess LM, Brnabic A, Mason O, Lee P, Barker S. Relationship between Progression-free Survival and Overall Survival in Randomized Clinical Trials of Targeted and Biologic Agents in Oncology. J Cancer 2019; 10:3717-3727. [PMID: 31333789 PMCID: PMC6636299 DOI: 10.7150/jca.32205] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 05/15/2019] [Indexed: 12/20/2022] Open
Abstract
Introduction: With a gap in a full understanding of the mechanisms by which survival is extended for patients with cancer who are treated with novel biologic and targeted agents, there is the risk that discordant progression-free and overall survival outcomes are observed due to poor clinical trial design or biases in the interpretation of data. This study was designed to examine the role of study quality and design on the outcomes observed with biologic and targeted agents. Methods: A review of studies in clinicaltrials.gov supplemented with a literature review in OVID Medline was conducted to identify all randomized trials of a biologic/targeted agent versus a non-biologic/targeted comparator in oncology that report both median overall and progression-free survival outcomes. Details of the study, design, population, drugs, and outcomes were extracted. Study quality was evaluated using the PEDro scale. Data were summarized using SPSS 22.0.0.0. Results: A total of 192 unique studies of 206 pairwise comparisons between a biologic/targeted and comparator were identified. The average absolute magnitude of post-progression survival (difference between OS and PFS) was 9.7 months for biologic/targeted therapy and 9.8 for the comparator. A total of 64 comparisons (31.1%) showed an increase in OS and decrease in PFS, or vice versa, and 25 (12.1%) showed a magnitude of more than 4 months difference between the delta of OS and delta of PFS between the biologic/targeted and comparator arms. Average study quality was high overall (7.7/10), and was comparable for studies with directional differences (7.2/10) as well as for those with the greatest magnitude in post-progression survival (7.4/10). Conclusion: This review and analysis specifically examined small PFS benefit with large OS benefit as well as small OS benefit with large PFS benefit, including differences in direction of PFS and OS outcomes. No evidence was identified that these are the result of poor study design, but may rather be due to the mechanism of action, specific disease, and population under study. Further work is needed to understand the mechanism of action of novel biologic/targeted agents to better understand their interaction with the tumor microenvironment.
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Affiliation(s)
| | | | | | - Pablo Lee
- Eli Lilly and Company, Indianapolis USA
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27
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Resistance models to EGFR inhibition and chemotherapy in non-small cell lung cancer via analysis of tumour size dynamics. Cancer Chemother Pharmacol 2019; 84:51-60. [PMID: 31020352 PMCID: PMC6561994 DOI: 10.1007/s00280-019-03840-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 04/09/2019] [Indexed: 12/16/2022]
Abstract
Purpose Imaging time-series data routinely collected in clinical trials are predominantly explored for covariates as covariates for survival analysis to support decision-making in oncology drug development. The key objective of this study was to assess if insights regarding two relapse resistance modes, de-novo (treatment selects out a pre-existing resistant clone) or acquired (resistant clone develops during treatment), could be inferred from such data. Methods Individual lesion size time-series data were collected from ten Phase III study arms where patients were treated with either first-generation EGFR inhibitors (erlotinib or gefitinib) or chemotherapy (paclitaxel/carboplatin combination or docetaxel). The data for each arm of each study were analysed via a competing models framework to determine which of the two mathematical models of resistance, de-novo or acquired, best-described the data. Results Within the first-line setting (treatment naive patients), we found that the de-novo model best-described the gefitinib data, whereas, for paclitaxel/carboplatin, the acquired model was preferred. In patients pre-treated with paclitaxel/carboplatin, the acquired model was again preferred for docetaxel (chemotherapy), but for patients receiving gefitinib or erlotinib, both the acquired and de-novo models described the tumour size dynamics equally well. Furthermore, in all studies where a single model was preferred, we found a degree of correlation in the dynamics of lesions within a patient, suggesting that there is a degree of homogeneity in pharmacological response. Conclusions This analysis highlights that tumour size dynamics differ between different treatments and across lines of treatment. The analysis further suggests that these differences could be a manifestation of differing resistance mechanisms. Electronic supplementary material The online version of this article (10.1007/s00280-019-03840-3) contains supplementary material, which is available to authorized users.
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28
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Wang T, Lu R, Lai S, Schiller JH, Zhou FL, Ci B, Wang S, Gao X, Yao B, Gerber DE, Johnson DH, Xiao G, Xie Y. Development and Validation of a Nomogram Prognostic Model for Patients With Advanced Non-Small-Cell Lung Cancer. Cancer Inform 2019; 18:1176935119837547. [PMID: 31057324 DOI: 10.1177/1176935119837547] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 02/13/2019] [Indexed: 01/27/2023] Open
Abstract
Importance Nomogram prognostic models can facilitate cancer patient treatment plans and patient enrollment in clinical trials. Objective The primary objective is to provide an updated and accurate prognostic model for predicting the survival of advanced non-small-cell lung cancer (NSCLC) patients, and the secondary objective is to validate a published nomogram prognostic model for NSCLC using an independent patient cohort. Design 1817 patients with advanced NSCLC from the control arms of 4 Phase III randomized clinical trials were included in this study. Data from 524 NSCLC patients from one of these trials were used to validate a previously published nomogram and then used to develop an updated nomogram. Patients from the other 3 trials were used as independent validation cohorts of the new nomogram. The prognostic performances were comprehensively evaluated using hazard ratios, integrated area under the curve (AUC), concordance index, and calibration plots. Setting General community. Main outcome A nomogram model was developed to predict overall survival in NSCLC patients. Results We demonstrated the prognostic power of the previously published model in an independent cohort. The updated prognostic model contains the following variables: sex, histology, performance status, liver metastasis, hemoglobin level, white blood cell counts, peritoneal metastasis, skin metastasis, and lymphocyte percentage. This model was validated using various evaluation criteria on the 3 independent cohorts with heterogeneous NSCLC populations. In the SUN1087 patient cohort, the continuous risk score output by the nomogram achieved an integrated area under the receiver operating characteristics (ROC) curve of 0.83, a log-rank P-value of 3.87e-11, and a concordance index of 0.717. In the SAVEONCO patient cohort, the integrated area under the ROC curve was 0.755, the log-rank P-value was 4.94e-6 and the concordance index was 0.678. In the VITAL patient cohort, the integrated area under the ROC curve was 0.723, the log-rank P-value was 1.36e-11, and the concordance index was 0.654. We implemented the proposed nomogram and several previously published prognostic models on an online Web server for easy user access. Conclusions This nomogram model based on basic clinical features and routine lab testing predicts individual survival probabilities for advanced NSCLC and exhibits cross-study robustness.
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Affiliation(s)
- Tao Wang
- Quantitative Biomedical Research Center, Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Center for the Genetics of Host Defense, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Rong Lu
- Quantitative Biomedical Research Center, Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Sunny Lai
- Quantitative Biomedical Research Center, Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Fang Liz Zhou
- Sanofi, Bridgewater, NJ, USA.,Project Data Sphere, LLC, Cary, NC, USA
| | - Bo Ci
- Quantitative Biomedical Research Center, Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Stacy Wang
- Quantitative Biomedical Research Center, Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Xiaohan Gao
- Quantitative Biomedical Research Center, Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Bo Yao
- Quantitative Biomedical Research Center, Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - David E Gerber
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - David H Johnson
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Guanghua Xiao
- Quantitative Biomedical Research Center, Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Department of Bioinformatics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Yang Xie
- Quantitative Biomedical Research Center, Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Department of Bioinformatics, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, USA
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von Pawel J, Bordoni R, Satouchi M, Fehrenbacher L, Cobo M, Han J, Hida T, Moro-Sibilot D, Conkling P, Gandara D, Rittmeyer A, Gandhi M, Yu W, Matheny C, Patel H, Sandler A, Ballinger M, Kowanetz M, Park K. Long-term survival in patients with advanced non–small-cell lung cancer treated with atezolizumab versus docetaxel: Results from the randomised phase III OAK study. Eur J Cancer 2019; 107:124-132. [DOI: 10.1016/j.ejca.2018.11.020] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 11/09/2018] [Indexed: 01/05/2023]
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30
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Rulli E, Ghilotti F, Biagioli E, Porcu L, Marabese M, D'Incalci M, Bellocco R, Torri V. Assessment of proportional hazard assumption in aggregate data: a systematic review on statistical methodology in clinical trials using time-to-event endpoint. Br J Cancer 2018; 119:1456-1463. [PMID: 30420618 PMCID: PMC6288087 DOI: 10.1038/s41416-018-0302-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 09/18/2018] [Accepted: 09/21/2018] [Indexed: 01/15/2023] Open
Abstract
Background The evaluation of the proportional hazards (PH) assumption in survival analysis is an important issue when Hazard Ratio (HR) is chosen as summary measure. The aim is to assess the appropriateness of statistical methods based on the PH assumption in oncological trials. Methods We selected 58 randomised controlled trials comparing at least two pharmacological treatments with a time-to-event as primary endpoint in advanced non-small-cell lung cancer. Data from Kaplan–Meier curves were used to calculate the relative hazard at each time point and the Restricted Mean Survival Time (RMST). The PH assumption was assessed with a fixed-effect meta-regression. Results In 19% of the trials, there was evidence of non-PH. Comparison of treatments with different mechanisms of action was associated (P = 0.006) with violation of the PH assumption. In all the superiority trials where non-PH was detected, the conclusions using the RMST corresponded to that based on the Cox model, although the magnitude of the effect given by the HR was systematically greater than the one from the RMST ratio. Conclusion As drugs with new mechanisms of action are being increasingly employed, particular attention should be paid on the statistical methods used to compare different types of agents.
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Affiliation(s)
- Eliana Rulli
- Laboratory of Methodology for Clinical Research, Oncology Department, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy.
| | - Francesca Ghilotti
- Laboratory of Methodology for Clinical Research, Oncology Department, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy.,Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milano, Italy
| | - Elena Biagioli
- Laboratory of Methodology for Clinical Research, Oncology Department, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Luca Porcu
- Laboratory of Methodology for Clinical Research, Oncology Department, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Mirko Marabese
- Laboratory of Molecular Pharmacology, Oncology Department, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Maurizio D'Incalci
- Laboratory of Cancer Pharmacology, Oncology Department, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Rino Bellocco
- Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milano, Italy.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Valter Torri
- Laboratory of Methodology for Clinical Research, Oncology Department, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
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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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32
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Li T, Kang G, Wang T, Huang H. Tumor angiogenesis and anti-angiogenic gene therapy for cancer. Oncol Lett 2018; 16:687-702. [PMID: 29963134 PMCID: PMC6019900 DOI: 10.3892/ol.2018.8733] [Citation(s) in RCA: 110] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 07/11/2017] [Indexed: 12/22/2022] Open
Abstract
When Folkman first suggested a theory about the association between angiogenesis and tumor growth in 1971, the hypothesis of targeting angiogenesis to treat cancer was formed. Since then, various studies conducted across the world have additionally confirmed the theory of Folkman, and numerous efforts have been made to explore the possibilities of curing cancer by targeting angiogenesis. Among them, anti-angiogenic gene therapy has received attention due to its apparent advantages. Although specific problems remain prior to cancer being fully curable using anti-angiogenic gene therapy, several methods have been explored, and progress has been made in pre-clinical and clinical settings over previous decades. The present review aimed to provide up-to-date information concerning tumor angiogenesis and gene delivery systems in anti-angiogenic gene therapy, with a focus on recent developments in the study and application of the most commonly studied and newly identified anti-angiogenic candidates for anti-angiogenesis gene therapy, including interleukin-12, angiostatin, endostatin, tumstatin, anti-angiogenic metargidin peptide and endoglin silencing.
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Affiliation(s)
- Tinglu Li
- Department of Biochemical Engineering, School of Chemical Engineering and Technology, Tianjin University, Tianjin 300072, P.R. China
- Key Laboratory of Systems Bioengineering, Ministry of Education, Tianjin University, Tianjin 300072, P.R. China
- Collaborative Innovation Center of Chemical Science and Engineering, Tianjin 300072, P.R. China
| | - Guangbo Kang
- Department of Biochemical Engineering, School of Chemical Engineering and Technology, Tianjin University, Tianjin 300072, P.R. China
- Key Laboratory of Systems Bioengineering, Ministry of Education, Tianjin University, Tianjin 300072, P.R. China
- Collaborative Innovation Center of Chemical Science and Engineering, Tianjin 300072, P.R. China
| | - Tingyue Wang
- Department of Biochemical Engineering, School of Chemical Engineering and Technology, Tianjin University, Tianjin 300072, P.R. China
- Key Laboratory of Systems Bioengineering, Ministry of Education, Tianjin University, Tianjin 300072, P.R. China
- Collaborative Innovation Center of Chemical Science and Engineering, Tianjin 300072, P.R. China
| | - He Huang
- Department of Biochemical Engineering, School of Chemical Engineering and Technology, Tianjin University, Tianjin 300072, P.R. China
- Key Laboratory of Systems Bioengineering, Ministry of Education, Tianjin University, Tianjin 300072, P.R. China
- Collaborative Innovation Center of Chemical Science and Engineering, Tianjin 300072, P.R. China
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Chen JH, Yang JL, Chou CY, Wang JY, Hung CC. Indirect comparison of efficacy and safety between immune checkpoint inhibitors and antiangiogenic therapy in advanced non-small-cell lung cancer. Sci Rep 2018; 8:9686. [PMID: 29946182 PMCID: PMC6018789 DOI: 10.1038/s41598-018-27994-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 06/14/2018] [Indexed: 12/26/2022] Open
Abstract
In this study, we conducted an indirect comparison analysis to compare the efficacy and safety of immune checkpoint inhibitors with those of antiangiogenic therapy-two effective treatment methods for advanced non-small-cell lung cancer (NSCLC). Eligible randomised control trials of immune checkpoint inhibitors, antiangiogenic therapy, and doublet platinum-based therapy published up to July 2017 were comprehensively analysed. Through the indirect comparison analysis of 37 trials involving 16810 patients, treatments were compared for overall survival (OS) and grade 3-5 adverse events. For first-line treatment, the use of pembrolizumab alone (hazard ratio [HR]: 0.6; 95% confidence interval [CI]: 0.4-0.91) and a combination of bevacizumab and doublet platinum-based therapy (HR: 0.86; 95% CI: 0.75-0.99) demonstrated substantial survival benefits compared with doublet platinum-based therapy. For subsequent treatment, nivolumab may provide higher efficacy and lower toxicity than antiangiogenic therapy. Overall, anti-PD1 monoclonal antibodies may be superior to antiangiogenic therapy in terms of OS and grade 3-5 adverse events. This meta-analysis suggests that pembrolizumab and nivolumab might be favourable choices for first-line and subsequent treatment, respectively, for patients with advanced NSCLC. Additional randomised control trials are required for a comprehensive evaluation of the outcomes among regimens.
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Affiliation(s)
- Jin-Hua Chen
- Graduate Institute of Data Science, College of Management, Taipei Medical University, Taipei, Taiwan, Republic of China
- Research Center of Biostatistics, Taipei Medical University, Taipei, Taiwan, Republic of China
| | - Jia-Lian Yang
- Department of Pharmacy, College of Pharmacy, China Medical University, 91 Hsueh-Shih Road, Taichung, 40402, Taiwan, Republic of China
| | - Che-Yi Chou
- Kidney Institute and Division of Nephrology, Department of Internal Medicine, China Medical University Hospital, 2 Yude Road, Taichung, 40447, Taiwan, Republic of China
| | - Jiun-Yi Wang
- Department of Healthcare Administration, Asia University, Wufeng, Taichung, 41354, Taiwan, Republic of China
| | - Chin-Chuan Hung
- Department of Pharmacy, College of Pharmacy, China Medical University, 91 Hsueh-Shih Road, Taichung, 40402, Taiwan, Republic of China.
- Department of Pharmacy, China Medical University Hospital, 2 Yude Road, Taichung, 40447, Taiwan, Republic of China.
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Abstract
Angiogenesis is frequent in non-small-cell lung cancer (nsclc) and is associated with more aggressive disease. Many clinical trials have evaluated the addition of antiangiogenic therapy to standard therapies for patients with nsclc. Bevacizumab, a monoclonal antibody directed against serum vascular endothelial growth factor, in combination with carboplatin-paclitaxel chemotherapy, has been shown to improve survival for patients with nsclc. However, bevacizumab-based therapy is not suitable for many nsclc patients, including those with squamous histology, poor performance status, brain metastases, and the presence of bleeding or thrombotic disorders. Similar efficacy has also been seen with carboplatin-pemetrexed followed by maintenance pemetrexed chemotherapy. In the second-line setting, the addition of ramucirumab to docetaxel-or the addition of bevacizumab to paclitaxel-has resulted in a modest improvement in efficacy, although the clinical importance of those findings is questionable. Many trials in nsclc have also evaluated oral antiangiogenic compounds, both in the first line in combination with chemotherapy and upon disease progression either as combination or single-agent therapy. No clear improvements in overall survival have been observed, although a subgroup analysis of a trial evaluating the addition of nintedanib to docetaxel showed improved survival that was limited to patients with adenocarcinoma. Those findings require validation, however. All of the oral antiangiogenic agents result in added toxicities. Some agents have resulted in an increased risk of death, limiting their development. Available evidence supports a limited number of antiangiogenic therapies for patients with nsclc, but no biomarkers to help in patient selection are currently available, and additional translational research is needed to identify predictive biomarkers for antiangiogenic therapy.
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Affiliation(s)
- A. Alshangiti
- Department of Oncology, McMaster University, Juravinski Cancer Centre, Hamilton, ON
| | - G. Chandhoke
- Department of Oncology, McMaster University, Juravinski Cancer Centre, Hamilton, ON
| | - P.M. Ellis
- Department of Oncology, McMaster University, Juravinski Cancer Centre, Hamilton, ON
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Ikeda S, Kato T, Ogura T, Sekine A, Oda T, Masuda N, Igawa S, Katono K, Otani S, Yamada K, Saito H, Kondo T, Hosomi Y, Nakahara Y, Nishikawa M, Utumi K, Misumi Y, Yamanaka T, Sakamaki K, Okamoto H. Phase II study of bevacizumab, cisplatin, and docetaxel plus maintenance bevacizumab as first-line treatment for patients with advanced non-squamous non-small-cell lung cancer combined with exploratory analysis of circulating endothelial cells: Thoracic Oncology Research Group (TORG)1016. BMC Cancer 2018; 18:241. [PMID: 29499653 PMCID: PMC5833040 DOI: 10.1186/s12885-018-4150-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 02/19/2018] [Indexed: 02/06/2023] Open
Abstract
Background Preclinical studies have demonstrated that docetaxel and bevacizumab may act synergistically by decreasing endothelial cell proliferation and preventing circulating endothelial progenitor mobilization. The objective of this study was to assess the efficacy and safety of a combination therapy of bevacizumab, cisplatin, and docetaxel in chemotherapy-naive Japanese patients with advanced non-squamous non-small-cell lung cancer (NSCLC). Methods Eligible patients were chemotherapy-naive and had advanced/recurrent non-squamous NSCLC. The patients received 4 cycles of docetaxel (60 mg/m2), cisplatin (80 mg/m2), and bevacizumab (15 mg/kg) once every 3 weeks, followed by bevacizumab as maintenance therapy, every 3 weeks until disease progression or attainment of unacceptable toxicity level. The primary endpoint was objective response rate (ORR). The numbers of circulating endothelial cells (CEC) were also estimated on days 1 and 8 of the first cycle for the exploratory analysis of efficacy prediction. Results A total of 47 patients were enrolled from October 2010 to April 2012. Bevacizumab as maintenance therapy was administered to 41 patients (87.2%), and the median number of total treatment cycles was 9 (range: 1–36). ORR, median progression-free survival (PFS), and median overall survival of the patients were 74.5%, 9.0 months, and 27.5 months, respectively. The most common grade 3/4 adverse event was neutropenia (95.7%), followed by leukopenia (59.6%) and hypertension (46.8%). PFS was longer in patients with ≥10 count increase in CECs than that in patients with < 10 count increase in CECs (respective median PFS of 11.0 months versus 6.90 months) although the difference was not statistically significant (p = 0.074). Conclusions A combination therapy of bevacizumab, cisplatin, and docetaxel, followed by bevacizumab as maintenance was highly effective in patients with non-squamous NSCLC despite the high incidence of grade 3/4 neutropenia. The increase in CEC count between days 1 and 8 may predict the efficacy of our bevacizumab-contained treatment regimen. Trial registration UMIN Clinical Trial Registry; UMIN000004368. Registered date; October 11, 2010 (Retrospectively registered). Electronic supplementary material The online version of this article (10.1186/s12885-018-4150-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Satoshi Ikeda
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Tomioka-Higashi 6-16-1, Kanazawa-ku, Yokohama, Japan.
| | - Terufumi Kato
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Tomioka-Higashi 6-16-1, Kanazawa-ku, Yokohama, Japan.,Department of Thoracic Oncology, Kanagawa Cancer Center, Yokohama, Japan
| | - Takashi Ogura
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Tomioka-Higashi 6-16-1, Kanazawa-ku, Yokohama, Japan
| | - Akimasa Sekine
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Tomioka-Higashi 6-16-1, Kanazawa-ku, Yokohama, Japan
| | - Tsuneyuki Oda
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Tomioka-Higashi 6-16-1, Kanazawa-ku, Yokohama, Japan
| | - Noriyuki Masuda
- Department of Respiratory Medicine, Kitasato University Hospital, Sagamihara, Japan
| | - Satoshi Igawa
- Department of Respiratory Medicine, Kitasato University Hospital, Sagamihara, Japan
| | - Ken Katono
- Department of Respiratory Medicine, Kitasato University Hospital, Sagamihara, Japan
| | - Sakiko Otani
- Department of Respiratory Medicine, Kitasato University Hospital, Sagamihara, Japan
| | - Kouzo Yamada
- Department of Thoracic Oncology, Kanagawa Cancer Center, Yokohama, Japan
| | - Haruhiro Saito
- Department of Thoracic Oncology, Kanagawa Cancer Center, Yokohama, Japan
| | - Tetsuro Kondo
- Department of Thoracic Oncology, Kanagawa Cancer Center, Yokohama, Japan
| | - Yukio Hosomi
- Division of Thoracic Oncology and Respiratory Medicine, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Yoshiro Nakahara
- Department of Respiratory Medicine, Kitasato University Hospital, Sagamihara, Japan.,Division of Thoracic Oncology and Respiratory Medicine, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Masanori Nishikawa
- Department of Respiratory Medicine, Fujisawa City Hospital, Fujisawa, Japan
| | - Keiko Utumi
- Department of Respiratory Medicine, Ibaraki Prefectural Central Hospital, Kasama, Japan
| | - Yuki Misumi
- Department of Respiratory Medicine and Medical Oncology, Yokohama Municipal Citizen's Hospital, Yokohama, Japan
| | - Takeharu Yamanaka
- Department of Biostatistics, Yokohama City University School of Medicine, Yokohama, Japan
| | - Kentaro Sakamaki
- Department of Biostatistics, Yokohama City University School of Medicine, Yokohama, Japan
| | - Hiroaki Okamoto
- Department of Respiratory Medicine and Medical Oncology, Yokohama Municipal Citizen's Hospital, Yokohama, Japan
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Belli C, Trapani D, Viale G, D'Amico P, Duso BA, Della Vigna P, Orsi F, Curigliano G. Targeting the microenvironment in solid tumors. Cancer Treat Rev 2018; 65:22-32. [PMID: 29502037 DOI: 10.1016/j.ctrv.2018.02.004] [Citation(s) in RCA: 308] [Impact Index Per Article: 51.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 02/06/2018] [Accepted: 02/09/2018] [Indexed: 01/06/2023]
Abstract
Tumorigenesis is a complex and dynamic process involving different cellular and non-cellular elements composed of tumor microenvironment (TME). The interaction of TME with cancer cells is responsible for tumor development, progression and drug resistance. TME consists of non malignant cells of the tumor such as cancer associated fibroblasts (CAFs), endothelial cells and pericytes composing tumor vasculature, immune and inflammatory cells, bone marrow derived cells, and the extracellular matrix (ECM) establishing a complex cross-talk with tumor. These interactions contribute towards proliferation and invasion of the tumor by producing growth factors, chemokines and matrix-degrading enzymes. ECM is a complex system containing macromolecules with distinctive physical, biochemical and biomechanical properties. During tumorigenesis this system is deregulated favoring the generation of tumorigenic microenvironment enhancing tumor-associated angiogenesis and inflammation. An important step of anticancer treatment is the identification of the biological alterations present in TME in order to target these key molecular players. Multitargeted approaches, providing a simultaneous inhibition of TME components, may offer a more efficient way to treat cancer. In this manuscript we overview the function of each components of TME and the treatments targeting the key players.
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Affiliation(s)
- Carmen Belli
- Division of Early Drug Development for Innovative Therapies, European Institute of Oncology, via Ripamonti 435, 20141 Milan, Italy.
| | - Dario Trapani
- Division of Early Drug Development for Innovative Therapies, European Institute of Oncology, via Ripamonti 435, 20141 Milan, Italy
| | - Giulia Viale
- Division of Early Drug Development for Innovative Therapies, European Institute of Oncology, via Ripamonti 435, 20141 Milan, Italy
| | - Paolo D'Amico
- Division of Early Drug Development for Innovative Therapies, European Institute of Oncology, via Ripamonti 435, 20141 Milan, Italy
| | - Bruno Achutti Duso
- Division of Early Drug Development for Innovative Therapies, European Institute of Oncology, via Ripamonti 435, 20141 Milan, Italy
| | - Paolo Della Vigna
- Interventional Radiology Division, European Institute of Oncology, via Ripamonti 435, 20141 Milan, Italy
| | - Franco Orsi
- Interventional Radiology Division, European Institute of Oncology, via Ripamonti 435, 20141 Milan, Italy
| | - Giuseppe Curigliano
- Division of Early Drug Development for Innovative Therapies, European Institute of Oncology, via Ripamonti 435, 20141 Milan, Italy
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Aguilar-Company J, Fernández-Ruiz M, García-Campelo R, Garrido-Castro AC, Ruiz-Camps I. ESCMID Study Group for Infections in Compromised Hosts (ESGICH) Consensus Document on the safety of targeted and biological therapies: an infectious diseases perspective (Cell surface receptors and associated signaling pathways). Clin Microbiol Infect 2018; 24 Suppl 2:S41-S52. [PMID: 29426804 DOI: 10.1016/j.cmi.2017.12.027] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 12/18/2017] [Accepted: 12/30/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND The present review is part of the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Infections in Compromised Hosts (ESGICH) consensus document on the safety of targeted and biologic therapies. AIMS To review, from an infectious diseases perspective, the safety profile of therapies targeting cell surface receptors and associated signaling pathways among cancer patients and to suggest preventive recommendations. SOURCES Computer-based Medline searches with MeSH terms pertaining to each agent or therapeutic family. CONTENT Vascular endothelial growth factor (VEGF)-targeted agents (bevacizumab and aflibercept) are associated with a meaningful increase in the risk of infection, likely due to drug-induced neutropaenia, although no clear benefit is expected from the universal use of anti-infective prophylaxis. VEGF tyrosine kinase inhibitors (i.e. sorafenib or sunitinib) do not seem to significantly affect host's susceptibility to infection, and universal anti-infective prophylaxis is not recommended either. Anti-epidermal growth factor receptor (EGFR) monoclonal antibodies (cetuximab or panitumumab) induce neutropaenia and secondary skin and soft tissue infection in cases of severe papulopustular rash. Systemic antibiotics (doxycycline or minocycline) should be administered to prevent the latter complication, whereas no recommendation can be established on the benefit from antiviral, antifungal or anti-Pneumocystis prophylaxis. A lower risk of infection is reported for anti-ErbB2/HER2 monoclonal antibodies (trastuzumab and pertuzumab) and ErbB receptor tyrosine kinase inhibitors (including dual-EGFR/ErbB2 inhibitors such as lapatinib or neratinib) compared to conventional chemotherapy, presumably as a result of the decreased occurrence of drug-induced neutropaenia. IMPLICATIONS With the exception of VEGF-targeted agents, the overall risk of infection associated with the reviewed therapies seems to be low.
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Affiliation(s)
- J Aguilar-Company
- Departments of Infectious Diseases and Oncology, University Hospital Vall d'Hebron, Autonomous University of Barcelona, Barcelona, Spain
| | - M Fernández-Ruiz
- Unit of Infectious Diseases, Hospital Universitario '12 de Octubre', Instituto de Investigación Hospital '12 de Octubre' (i + 12), School of Medicine, Universidad Complutense, Madrid, Spain; Spanish Network for Research in Infectious Diseases (REIPI RD16/0016), Instituto de Salud Carlos III, Madrid, Spain
| | - R García-Campelo
- Department of Medical Oncology, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - A C Garrido-Castro
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - I Ruiz-Camps
- Department of Infectious Diseases, University Hospital Vall d'Hebron, Autonomous University of Barcelona, Barcelona, Spain; Spanish Network for Research in Infectious Diseases (REIPI RD16/0016), Instituto de Salud Carlos III, Madrid, Spain.
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Mistry HB. On the relationship between tumour growth rate and survival in non-small cell lung cancer. PeerJ 2017; 5:e4111. [PMID: 29201573 PMCID: PMC5712205 DOI: 10.7717/peerj.4111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 11/09/2017] [Indexed: 01/20/2023] Open
Abstract
A recurrent question within oncology drug development is predicting phase III outcome for a new treatment using early clinical data. One approach to tackle this problem has been to derive metrics from mathematical models that describe tumour size dynamics termed re-growth rate and time to tumour re-growth. They have shown to be strong predictors of overall survival in numerous studies but there is debate about how these metrics are derived and if they are more predictive than empirical end-points. This work explores the issues raised in using model-derived metric as predictors for survival analyses. Re-growth rate and time to tumour re-growth were calculated for three large clinical studies by forward and reverse alignment. The latter involves re-aligning patients to their time of progression. Hence, it accounts for the time taken to estimate re-growth rate and time to tumour re-growth but also assesses if these predictors correlate to survival from the time of progression. I found that neither re-growth rate nor time to tumour re-growth correlated to survival using reverse alignment. This suggests that the dynamics of tumours up until disease progression has no relationship to survival post progression. For prediction of a phase III trial I found the metrics performed no better than empirical end-points. These results highlight that care must be taken when relating dynamics of tumour imaging to survival and that bench-marking new approaches to existing ones is essential.
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Affiliation(s)
- Hitesh B Mistry
- Division of Pharmacy, University of Manchester, Manchester, United Kingdom
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Manzo A, Montanino A, Carillio G, Costanzo R, Sandomenico C, Normanno N, Piccirillo MC, Daniele G, Perrone F, Rocco G, Morabito A. Angiogenesis Inhibitors in NSCLC. Int J Mol Sci 2017; 18:E2021. [PMID: 28934120 PMCID: PMC5666703 DOI: 10.3390/ijms18102021] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 09/13/2017] [Accepted: 09/15/2017] [Indexed: 01/04/2023] Open
Abstract
Angiogenesis is a complex biological process that plays a relevant role in sustaining the microenvironment, growth, and metastatic potential of several tumors, including non-small cell lung cancer (NSCLC). Bevacizumab was the first angiogenesis inhibitor approved for the treatment of patients with advanced NSCLC in combination with chemotherapy; however, it was limited to patients with non-squamous histology and first-line setting. Approval was based on the results of two phase III trials (ECOG4599 and AVAIL) that demonstrated an improvement of about two months in progression-free survival (PFS) in both trials, and in the ECOG4599 trial, an improvement in overall survival (OS) also. Afterwards, other antiangiogenic agents, including sunitinib, sorafenib, and vandetanib have been unsuccessfully tested in first and successive lines. Recently, two new antiangiogenic agents (ramucirumab and nintedanib) produced a significant survival benefit in second-line setting. In the REVEL study, ramucirumab plus docetaxel prolonged the median OS of patients with any histology NSCLC when compared with docetaxel alone (10.4 versus 9.1 months, hazard ratio (HR) 0.857, p = 0.0235). In the LUME-Lung 1 study, nintedanib plus docetaxel prolonged the median PFS of patients with any tumor histology (p = 0.0019), and improved OS (12.6 versus 10.3 months) in patients with adenocarcinoma. As a result, it became a new option for the second-line treatment of patients with advanced NSCLC and adenocarcinoma histology. Identifying predictive biomarkers to optimize the benefit of antiangiogenic drugs remains an ongoing challenge.
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MESH Headings
- Adenocarcinoma/drug therapy
- Adenocarcinoma/metabolism
- Adenocarcinoma/mortality
- Adenocarcinoma/pathology
- Angiogenesis Inhibitors/therapeutic use
- Antibodies, Monoclonal/therapeutic use
- Antibodies, Monoclonal, Humanized
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Bevacizumab/therapeutic use
- Carcinoma, Non-Small-Cell Lung/drug therapy
- Carcinoma, Non-Small-Cell Lung/metabolism
- Carcinoma, Non-Small-Cell Lung/mortality
- Carcinoma, Non-Small-Cell Lung/pathology
- Clinical Trials, Phase III as Topic
- Disease-Free Survival
- Docetaxel
- Humans
- Indoles/therapeutic use
- Lung Neoplasms/drug therapy
- Lung Neoplasms/metabolism
- Lung Neoplasms/mortality
- Lung Neoplasms/pathology
- Neovascularization, Pathologic/drug therapy
- Neovascularization, Pathologic/metabolism
- Neovascularization, Pathologic/mortality
- Neovascularization, Pathologic/pathology
- Niacinamide/analogs & derivatives
- Niacinamide/therapeutic use
- Phenylurea Compounds/therapeutic use
- Piperidines/therapeutic use
- Pyrroles/therapeutic use
- Quinazolines/therapeutic use
- Sorafenib
- Sunitinib
- Taxoids/therapeutic use
- Ramucirumab
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Affiliation(s)
- Anna Manzo
- Thoracic Medical Oncology, Istituto Nazionale Tumori, "Fondazione G.Pascale"-IRCCS, 80131 Napoli, Italy.
| | - Agnese Montanino
- Thoracic Medical Oncology, Istituto Nazionale Tumori, "Fondazione G.Pascale"-IRCCS, 80131 Napoli, Italy.
| | - Guido Carillio
- Department of Oncology and Hematology, Azienda Ospedaliera Pugliese-Ciaccio, 88100 Catanzaro, Italy.
| | - Raffaele Costanzo
- Thoracic Medical Oncology, Istituto Nazionale Tumori, "Fondazione G.Pascale"-IRCCS, 80131 Napoli, Italy.
| | - Claudia Sandomenico
- Thoracic Medical Oncology, Istituto Nazionale Tumori, "Fondazione G.Pascale"-IRCCS, 80131 Napoli, Italy.
| | - Nicola Normanno
- Cellular Biology and Biotherapy, Research Department, Istituto Nazionale Tumori "Fondazione G.Pascale"-IRCCS, Napoli 80131, Italy.
| | - Maria Carmela Piccirillo
- Clinical Trials Unit, Istituto Nazionale Tumori, "Fondazione G.Pascale"-IRCCS, 80131 Napoli, Italy.
| | - Gennaro Daniele
- Clinical Trials Unit, Istituto Nazionale Tumori, "Fondazione G.Pascale"-IRCCS, 80131 Napoli, Italy.
| | - Francesco Perrone
- Clinical Trials Unit, Istituto Nazionale Tumori, "Fondazione G.Pascale"-IRCCS, 80131 Napoli, Italy.
| | - Gaetano Rocco
- Thoracic Surgery, Istituto Nazionale Tumori, "Fondazione G.Pascale"-IRCCS, 80131 Napoli, Italy.
| | - Alessandro Morabito
- Thoracic Medical Oncology, Istituto Nazionale Tumori, "Fondazione G.Pascale"-IRCCS, 80131 Napoli, Italy.
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Assoun S, Brosseau S, Steinmetz C, Gounant V, Zalcman G. Bevacizumab in advanced lung cancer: state of the art. Future Oncol 2017; 13:2515-2535. [PMID: 28812378 DOI: 10.2217/fon-2017-0302] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Despite recent advances in metastatic lung cancer treatment with the advent of immune checkpoint inhibitors and molecules targeting addictive genomic abnormalities, prognosis of most of the patients remains unfavorable. Combination approaches with older drugs, such as bevacizumab, should be thus envisioned. Bevacizumab is a monoclonal anti-VEGF antibody, approved by the US FDA and the EMA in first-line and maintenance settings of advanced nonsquamous non-small-cell lung cancer (NSCLC) treatment, in association with platinum-based chemotherapy. In the years to come, bevacizumab might be associated with new molecular therapies or immuno-oncology drugs, in order to optimize response rates and overcome resistances. This review summarizes the pharmacologic properties, clinical efficacy and safety of bevacizumab in advanced lung cancer treatment, with a focus on NSCLC, EGFR-mutant NSCLC and small-cell lung cancer.
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Affiliation(s)
- Sandra Assoun
- Department of Thoracic Oncology & CIC 1425/CLIP2 Paris-Nord, Bichat-Claude Bernard Hospital, APHP, Paris, France
| | - Solenn Brosseau
- Department of Thoracic Oncology & CIC 1425/CLIP2 Paris-Nord, Bichat-Claude Bernard Hospital, APHP, Paris, France.,University Paris-Diderot, Paris, France
| | - Christelle Steinmetz
- Pharmacy Department, Bichat-Claude Bernard Hospital, APHP, 46, rue Henri Huchard, 75877 Paris Cedex 18, Paris, France
| | - Valérie Gounant
- Department of Thoracic Oncology & CIC 1425/CLIP2 Paris-Nord, Bichat-Claude Bernard Hospital, APHP, Paris, France
| | - Gérard Zalcman
- Department of Thoracic Oncology & CIC 1425/CLIP2 Paris-Nord, Bichat-Claude Bernard Hospital, APHP, Paris, France.,University Paris-Diderot, Paris, France
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Xu Q, Shi NJ, Zhang H, Zhu YM. Effects of combined general-epidural anesthesia and total intravenous anesthesia on cellular immunity and prognosis in patients with non‑small cell lung cancer: A comparative study. Mol Med Rep 2017; 16:4445-4454. [PMID: 28765974 PMCID: PMC5647004 DOI: 10.3892/mmr.2017.7144] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 05/04/2017] [Indexed: 12/16/2022] Open
Abstract
The aim of the present study was to investigate the effects of combined general-epidural anesthesia (CGEA) and total intravenous anesthesia (TIVA) on cellular immunity and prognosis in patients with non-small cell lung cancer (NSCLC) in a Chinese population. One-hundred and twenty NSCLC patients were randomly divided into a TIVA group (n=60) and a CGEA group (n=60) using a random number table. All patients underwent video-assisted thoracoscopic surgery for radical resection. Blood pressure (BP) and peripheral oxygen saturation (SpO2) were measured. Post-operative analgesic effects were evaluated with a visual analog scale pain score. Flow cytometry was applied to measure T lymphocyte subsets [cluster of differentiation (CD)3+, CD4+, CD8+ and CD4+/CD8+] and natural killer cell CD56+. A 3-year follow-up was conducted to observe the prognosis. The analgesic effects of CGEA were identified to be better than those of TIVA. Compared with the TIVA group, the CGEA group demonstrated a shorter time of spontaneous breathing recovery, eyes opening, and extubation, lower heart rate, blood pressure and mean arterial pressure, and higher SpO2. At 24 and 48 h after surgery, CD3+, CD4+, CD4+/CD8+ and CD56+ in the CGEA group were higher than those in the TIVA group. At 72 h after surgery, CD3+, CD4+, CD4+/CD8+ in the CGEA group were higher than those in the TIVA group. These results indicate that CGEA and TIVA effected cellular immunity, and CGEA had a reduced effect on cellular immunity and improved postoperative analgesic effects.
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Affiliation(s)
- Qiang Xu
- Department of Anesthesiology, Linyi People's Hospital, Linyi, Shandong 276003, P.R. China
| | - Nian-Jun Shi
- Department of Anesthesiology, Linyi People's Hospital, Linyi, Shandong 276003, P.R. China
| | - Hao Zhang
- Department of Anesthesiology, Linyi People's Hospital, Linyi, Shandong 276003, P.R. China
| | - Yan-Mei Zhu
- Department of Orthopedics, Chinese Medicine Hospital in Linyi, Linyi, Shandong 276003, P.R. China
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Tannock IF, Amir E, Booth CM, Niraula S, Ocana A, Seruga B, Templeton AJ, Vera-Badillo F. Relevance of randomised controlled trials in oncology. Lancet Oncol 2017; 17:e560-e567. [PMID: 27924754 DOI: 10.1016/s1470-2045(16)30572-1] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Revised: 08/16/2016] [Accepted: 08/18/2016] [Indexed: 11/28/2022]
Abstract
Well-designed randomised controlled trials (RCTs) can prevent bias in the comparison of treatments and provide a sound basis for changes in clinical practice. However, the design and reporting of many RCTs can render their results of little relevance to clinical practice. In this Personal View, we discuss the limitations of RCT data and suggest some ways to improve the clinical relevance of RCTs in the everyday management of patients with cancer. RCTs should ask questions of clinical rather than commercial interest, avoid non-validated surrogate endpoints in registration trials, and have entry criteria that allow inclusion of all patients who are fit to receive treatment. Furthermore, RCTs should be reported with complete accounting of frequency and management of toxicities, and with strict guidelines to ensure freedom from bias. Premature reporting of results should be avoided. The bar for clinical benefit should be raised for drug registration, which should require publication and review of mature data from RCTs, post-marketing health outcome studies, and value-based pricing.
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Affiliation(s)
- Ian F Tannock
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre and University of Toronto, Toronto, ON, Canada.
| | - Eitan Amir
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre and University of Toronto, Toronto, ON, Canada
| | - Christopher M Booth
- Departments of Oncology and Public Health Sciences, Queen's University, Kingston, ON, Canada
| | - Saroj Niraula
- Departments of Medical Oncology and Haematology, University of Manitoba and CancerCare Manitoba, Winnipeg, MB, Canada
| | - Alberto Ocana
- Translational Research Unit, Albacete University Hospital, Albacete, Spain
| | - Bostjan Seruga
- Department of Medical Oncology, Institute of Oncology Ljubljana and University of Ljubljana, Slovenia
| | - Arnoud J Templeton
- Department of Medical Oncology, St Claraspital and Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Francisco Vera-Badillo
- Canadian Cancer Trials Group and Department of Oncology, Queen's University, Kingston, ON, Canada; Tecnológico de Monterrey School of Medicine, Monterrey, Nuevo León, Mexico
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Strategies targeting angiogenesis in advanced non-small cell lung cancer. Oncotarget 2017; 8:53854-53872. [PMID: 28881856 PMCID: PMC5581155 DOI: 10.18632/oncotarget.17957] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 04/27/2017] [Indexed: 12/26/2022] Open
Abstract
Tumor angiogenesis is a frequent event in the development and progression of non-small cell lung cancer (NSCLC) and has been identified as a promising therapeutic target. The vascular endothelial growth factor (VEGF) family and other angiogenic factors, including fibroblast growth factor and platelet-derived growth factor, promote the growth of newly formed vessels from preexisting vessels and change the tumor microenvironment. To date, two antiangiogenic monoclonal antibodies, bevacizumab and ramucirumab, which target VEGF-A and its receptor VEGF receptor-2, respectively, have been approved for the treatment of locally advanced or metastatic NSCLC when added to first-line standard chemotherapy. Numerous oral multitargeting angiogenic small molecule tyrosine kinase inhibitors (TKIs) have been widely evaluated in advanced NSCLC, but only nintedanib in combination with platinum-based doublet chemotherapy has demonstrated a survival benefit in the second-line setting. Additionally, small-molecule TKIs remain the standard of care for patients with mutated EGFR, ALK or ROS1. Moreover, immune checkpoint inhibitors that target the programmed cell death protein 1 (PD-1) and programmed cell death protein ligand 1 (PD-L1) are changing the current strategy in the treatment of advanced NSCLC without driver gene mutations. The potential synergistic activity of antiangiogenic agents and TKIs or immunotherapy is an interesting topic of research. This review will summarize the novel antiangiogenic agents, antiangiogenic monotherapy, as well as potential combination therapeutic strategies for the clinical management of advanced NSCLC.
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Second-Line Treatment of Non-Small Cell Lung Cancer: New Developments for Tumours Not Harbouring Targetable Oncogenic Driver Mutations. Drugs 2017; 76:1321-36. [PMID: 27557830 DOI: 10.1007/s40265-016-0628-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Platinum-based doublet chemotherapy with or without bevacizumab is the standard of care for the initial management of advanced and metastatic non-small cell lung cancer (NSCLC) without a targetable molecular abnormality. However, the majority of patients with NSCLC will ultimately develop resistance to initial platinum-based chemotherapy, and many remain candidates for subsequent lines of therapy. Randomised trials over the past 10-15 years have established pemetrexed (non-squamous histology), docetaxel, erlotinib and gefitinib as approved second-line agents in NSCLC without targetable driver mutations or rearrangements. Trials comparing these agents with other chemotherapy, evaluating the addition of an epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI) to chemotherapy or the addition of another targeted agent to erlotinib or gefitinib have all failed to demonstrate an improvement in overall survival for patients with NSCLC. In contrast, recent data comparing therapy with novel monoclonal antibodies against programmed cell death 1 (PD-1) or PD ligand (PD-L1) pathway versus standard chemotherapy following platinum failure have demonstrated significant improvements in overall survival. Therapy with nivolumab or pembrolizumab would now be considered standard second-line therapy in patients without contraindication to immune checkpoint inhibitors. Atezolizumab also appears promising in this setting.
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Kurzrock R, Stewart DJ. Exploring the Benefit/Risk Associated with Antiangiogenic Agents for the Treatment of Non-Small Cell Lung Cancer Patients. Clin Cancer Res 2017; 23:1137-1148. [PMID: 27940520 DOI: 10.1158/1078-0432.ccr-16-1968] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 10/18/2016] [Accepted: 10/19/2016] [Indexed: 11/16/2022]
Abstract
Following the approval of bevacizumab, an antibody targeting VEGF-A, for advanced non-squamous non-small cell lung cancer (NSCLC) in 2006, intensive efforts were put into the clinical development of antiangiogenic agents for NSCLC. Currently, the other antiangiogenic agents approved for NSCLC are ramucirumab, a VEGF receptor-2 (VEGFR-2)-targeting antibody indicated for both squamous and non-squamous NSCLC in the United States, and nintedanib, an anti-VEGFR-1/2/3, platelet-derived growth factor receptor-α/β, fibroblast growth factor receptor-1/2/3 angiokinase inhibitor indicated for adenocarcinoma of the lung in the European Union. Many other antiangiogenic agents are being evaluated in phase III trials for NSCLC, including aflibercept, sunitinib, sorafenib, cediranib, and vandetanib. Although many of the same signaling pathways are targeted by these novel agents, mixed efficacy results have been observed in these trials. Moreover, safety issues have raised concerns about using antiangiogenic agents in this patient population, and fatal bleeding events have been reported. Importantly, although no biomarker has yet been validated for antiangiogenic agents in NSCLC, biomarkers that show potential include circulating levels of short VEGF-A isoforms, expression of neuropilin-1 and VEGFR-1 in tumors and plasma, genetic variants in VEGF-A and VEGFR, and tumor protein p53 mutations (with the latter having been shown to correlate with increased levels of VEGF-A transcripts). This review provides an overview of the clinical benefit and risk associated with the use of antiangiogenic agents for NSCLC, and summarizes the research to date on the identification of predictive biomarkers for antiangiogenic therapies. Clin Cancer Res; 23(5); 1137-48. ©2016 AACR.
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MESH Headings
- Angiogenesis Inhibitors/adverse effects
- Angiogenesis Inhibitors/therapeutic use
- Antibodies, Monoclonal/adverse effects
- Antibodies, Monoclonal/therapeutic use
- Antibodies, Monoclonal, Humanized
- Bevacizumab/therapeutic use
- Carcinoma, Non-Small-Cell Lung/drug therapy
- Carcinoma, Non-Small-Cell Lung/epidemiology
- Carcinoma, Non-Small-Cell Lung/pathology
- Humans
- Indoles/adverse effects
- Indoles/therapeutic use
- Neovascularization, Pathologic/drug therapy
- Neovascularization, Pathologic/epidemiology
- Neovascularization, Pathologic/pathology
- Pyrroles/adverse effects
- Pyrroles/therapeutic use
- Receptors, Vascular Endothelial Growth Factor/therapeutic use
- Recombinant Fusion Proteins/adverse effects
- Recombinant Fusion Proteins/therapeutic use
- Risk Assessment
- Sunitinib
- Vascular Endothelial Growth Factor A/antagonists & inhibitors
- Vascular Endothelial Growth Factor Receptor-1/antagonists & inhibitors
- Vascular Endothelial Growth Factor Receptor-2/antagonists & inhibitors
- Ramucirumab
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Affiliation(s)
- Razelle Kurzrock
- Center for Personalized Cancer Therapy and Division of Hematology & Oncology, University of California San Diego Moores Cancer Center, San Diego, California.
| | - David J Stewart
- Division of Medical Oncology, University of Ottawa, Ottawa, Canada
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Manegold C, Adjei A, Bussolino F, Cappuzzo F, Crino L, Dziadziuszko R, Ettinger D, Fennell D, Kerr K, Le Chevalier T, Leighl N, Papotti M, Paz-Ares L, Pérol M, Peters S, Pirker R, Quoix E, Reck M, Smit E, Vokes E, van Zandwijk N, Zhou C. Novel active agents in patients with advanced NSCLC without driver mutations who have progressed after first-line chemotherapy. ESMO Open 2017; 1:e000118. [PMID: 29435365 PMCID: PMC5729303 DOI: 10.1136/esmoopen-2016-000118] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 10/30/2016] [Indexed: 12/26/2022] Open
Abstract
Despite the efficacy of a number of first-line treatments, most patients with advanced-stage non-small cell lung cancer (NSCLC) experience disease progression that warrants further treatment. In this review, we examine the role of novel active agents for patients who progress after first-line therapy and who are not candidates for targeted therapies. More therapeutic options are needed for the management of patients with NSCLC after failure of first-line chemotherapy. A PubMed search was performed for articles from January 2012 to May 2015 using the keywords NSCLC, antiangiogenic, immunotherapy, second-line, novel therapies and English language articles only. Relevant papers were reviewed; papers outside that period were considered on a case-by-case basis. A search of oncology congresses was performed to identify relevant abstracts over this period. In recent years, antiangiogenic agents and immune checkpoint inhibitors have been added to our armamentarium to treat patients with advanced NSCLC who have progressed on first-line chemotherapy. These include nintedanib, a triple angiokinase inhibitor; ramucirumab, a vascular endothelial growth factor receptor-2 antibody; and nivolumab, pembrolizumab and atezolizumab, just three of a growing list of antibodies targeting the programmed death receptor-1 (PD-1)/PD ligand-1 pathway. Predictive and prognostic factors in NSCLC treatment will help to optimise treatment with these novel agents. The approval of new treatments for patients with NSCLC after the failure of first-line chemotherapy has increased options after a decade of few advances, and holds promise for future evolution of the management of NSCLC.
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Affiliation(s)
- Christian Manegold
- Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany.
| | - Alex Adjei
- Department of Medicine, Roswell Park Cancer Institute, Buffalo, New York, USA
| | - Federico Bussolino
- Department of Oncology, University of Turin, Turin and Candiolo Cancer Institute, Candiolo, Italy
| | - Federico Cappuzzo
- Medical Oncology Department, Istituto Toscano Tumori, Livorno, Italy
| | - Lucio Crino
- Medical Oncology Department, Perugia University Medical School, Perugia, Italy
| | - Rafal Dziadziuszko
- Department of Oncology and Radiotherapy, Medical University of Gdansk, Gdansk, Poland
| | - David Ettinger
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Medicine, Baltimore, Maryland, USA
| | - Dean Fennell
- Department of Oncology, University of Leicester & Leicester University Hospitals, Leicester, UK
| | - Keith Kerr
- Department of Pathology, Aberdeen University Medical School, Aberdeen, UK
| | | | - Natasha Leighl
- Cancer Clinical Research Unit (CCRU), Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Mauro Papotti
- Department of Oncology, University of Turin, Turin, Italy
| | - Luis Paz-Ares
- Servicio de Oncología Médica, Doce de Octubre University Hospital, Madrid, Spain
| | - Maurice Pérol
- Département de Cancérologie Médicale, Centre Léon Bérard, Lyon, France
| | - Solange Peters
- Department of Oncology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Robert Pirker
- Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Elisabeth Quoix
- Pulmonology Department, University Hospital, Strasbourg, France
| | - Martin Reck
- Department of Thoracic Oncology, Airway Research Center North (ARCN), member of the German Center for Lung Research (DZL), Lung Clinic Grosshansdorf, Grosshansdorf, Germany
| | - Egbert Smit
- Department of Pulmonary Diseases, VU University Medical Centre, Amsterdam, The Netherlands; Department of Thoracic Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Everett Vokes
- Department of Medicine, University of Chicago Medicine and Biological Sciences, Chicago, Illinois, USA
| | - Nico van Zandwijk
- Asbestos Diseases Research Institute, University of Sydney, Sydney, New South Wales, Australia
| | - Caicun Zhou
- Department of Oncology, Shanghai Pulmonary Hospital, Shanghai, China
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Raphael J, Chan K, Karim S, Kerbel R, Lam H, Santos KD, Saluja R, Verma S. Antiangiogenic Therapy in Advanced Non-small-cell Lung Cancer: A Meta-analysis of Phase III Randomized Trials. Clin Lung Cancer 2017; 18:345-353.e5. [PMID: 28188101 DOI: 10.1016/j.cllc.2017.01.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Revised: 12/26/2016] [Accepted: 01/03/2017] [Indexed: 11/25/2022]
Abstract
We conducted a meta-analysis to evaluate the efficacy of adding any antiangiogenic therapy (AT) to the standard of care in advanced non-small-cell lung cancer (NSCLC). The electronic databases Ovid PubMed, Cochrane Central Register of Controlled Trials, and Embase were searched to identify eligible trials. We included all phase III randomized trials with any line and type of treatment, histology. and AT dose. Pooled hazard ratios (HRs) for overall survival (OS) and progression-free survival (PFS), and pooled odds ratio (OR) for overall response rates (RR) were calculated. We divided the population into 2 subgroups based on the bevacizumab dose. Data of 19,098 patients from 25 phase III trials were analyzed. Compared with the standard of care, the addition of AT did not prolong OS (HR 0.98; 95% confidence interval [CI], 0.96-1.00; P = .1 and HR 0.97; 95% CI, 0.94-1.00; P = .06 for groups 1 and 2, respectively). However, there was a significant improvement in PFS with the addition of AT (HR 0.85; 95% CI, 0.79-0.91; P < .00001 and HR 0.81; 95% CI, 0.75-0.88; P < .00001 for groups 1 and 2, respectively) and overall RR (OR 1.61; 95% CI, 1.30-2.01; P < .0001 and OR 1.72; 95% CI, 1.39-2.14; P < .00001 for groups 1 and 2, respectively). This is the first meta-analysis including only all phase III trials with AT in NSCLC showing no significant effect on OS and an improvement in PFS and RR only. The role of AT in advanced NSCLC is still questionable; strong validated biomarkers are eagerly needed to predict which subgroup might benefit the most from such therapy.
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Affiliation(s)
- Jacques Raphael
- Medical Oncology Division, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada.
| | - Kelvin Chan
- Medical Oncology Division, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada
| | - Safiya Karim
- Medical Oncology Division, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada
| | - Robert Kerbel
- Biological Sciences Platform, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Henry Lam
- Medical Oncology Division, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada
| | - Keemo Delos Santos
- Medical Oncology Division, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada
| | - Ronak Saluja
- Medical Oncology Division, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada
| | - Sunil Verma
- Medical Oncology Division, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada; Department of Oncology, Tom Baker Cancer Centre, Calgary, Alberta, Canada
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Abdel-Qadir H, Ethier JL, Lee DS, Thavendiranathan P, Amir E. Cardiovascular toxicity of angiogenesis inhibitors in treatment of malignancy: A systematic review and meta-analysis. Cancer Treat Rev 2016; 53:120-127. [PMID: 28104567 DOI: 10.1016/j.ctrv.2016.12.002] [Citation(s) in RCA: 158] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 12/08/2016] [Accepted: 12/09/2016] [Indexed: 01/20/2023]
Abstract
BACKGROUND The cardiovascular risk of angiogenesis inhibitors is not well-quantified. We hypothesized that, compared to direct vascular endothelial growth factor (VEGF) inhibitors (anti-VEGF antibodies or decoy receptors), small molecule agents have higher risk due to their less specific mechanism. METHODS We searched the MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials for phase III randomised controlled trials comparing angiogenesis inhibitor-based therapy to other systemic therapy. Outcomes evaluated were hypertension, severe hypertension, cardiac dysfunction, congestive heart failure, cardiac ischemia, arterial thromboembolism, venous thromboembolism, and fatal cardiovascular events. Data were pooled using Mantel-Haenszel random effects method to generate odds ratios (OR). RESULTS We identified 77 studies meeting inclusion criteria. Compared to routine care, angiogenesis inhibitors were associated with a higher risk of hypertension (OR 5.28 [4.53-6.15], number needed to harm [NNH] 6), severe hypertension (OR 5.59 [4.67-6.69], NNH 17), cardiac ischemia (OR 2.83 [1.72-4.65], NNH 85) and cardiac dysfunction (OR 1.35 [1.06-1.70], NNH 139). VEGF inhibitors were associated with an increased risk of arterial thromboembolism (OR 1.52 [1.17-1.98], NNH 141). No significant interaction was observed between the two drug subgroups for any outcomes. We identified no significant increase in the risk of the other outcomes evaluated. CONCLUSION Angiogenesis inhibitors increase the risk of hypertension, arterial thromboembolism, cardiac ischemia and cardiac dysfunction. There was no significant difference in cardiovascular risk between direct VEGF inhibitors and small molecule agents.
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Affiliation(s)
- Husam Abdel-Qadir
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Women's College Hospital, Toronto, Ontario, Canada.
| | - Josee-Lyne Ethier
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Douglas S Lee
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Peter Munk Cardiac Centre and Joint Department of Medical Imaging, University Health Network, Toronto, Ontario, Canada
| | - Paaladinesh Thavendiranathan
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Peter Munk Cardiac Centre and Joint Department of Medical Imaging, University Health Network, Toronto, Ontario, Canada
| | - Eitan Amir
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Princess Margaret Cancer Centre, Toronto, Ontario, Canada
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50
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Incremental Innovation and Progress in Advanced Squamous Cell Lung Cancer: Current Status and Future Impact of Treatment. J Thorac Oncol 2016; 11:2066-2081. [DOI: 10.1016/j.jtho.2016.08.138] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 08/09/2016] [Accepted: 08/19/2016] [Indexed: 11/20/2022]
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