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Assi HI, Zerdan MB, Hodroj M, Khoury M, Naji NS, Amhaz G, Zeidane RA, El Karak F. Value of chemotherapy post immunotherapy in stage IV non-small cell lung cancer (NSCLC). Oncotarget 2023; 14:517-525. [PMID: 37235814 DOI: 10.18632/oncotarget.28444] [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: 05/28/2023] Open
Abstract
BACKGROUND Lung cancer is the number one cause of mortality among all types of cancer worldwide. Its treatment landscape has shifted from the classic chemotherapy alone to newer regimens based on the discovery of new immunotherapy and targeted therapy drugs. However, chemotherapy is still an option for treatment of advanced non-small cell lung cancer (NSCLC) after progression on immunotherapy alone or in combination with first-line chemotherapy. METHODS This is a retrospective study based on chart review of patients diagnosed with advanced NSCLC cases who received Docetaxel as second or third line after being treated by immunotherapy and/or chemotherapy in previous lines. The data was collected from the medical records of physicians' clinics in three different hospital centers in Lebanon over the period of 5 years from July 2015 until December 2020. February 2021 was data analysis cut off time. The main aim was to assess the role of Docetaxel post-chemoimmunotherapy for patients with diagnosed NSCLC. RESULTS A total of 21 patients were included in this study. The majority of our patients were males (81%). As for histologic type, most patients had non-squamous lung cancer (67%) as compared to 33% who had squamous lung cancer. Overall, our study reported a 24% response rate to Docetaxel including stable disease and partial response and a median progression free survival (PFS) of 3 months. The mean time interval elapsed from diagnosis to the initiation of Docetaxel was 11.5 months. CONCLUSION New therapeutic options should be validated for the treatment of NSCLC in the second and subsequent lines of therapy considering the poor prognosis of this disease. The chemotherapy in second and third line may keep an important role in the treatment after progression on newer agents, but it needs more evidence in prospective studies including a larger number of patients.
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Affiliation(s)
- Hazem I Assi
- Department of Internal Medicine, Division of Hematology and Oncology, Naef K. Basile Cancer Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Maroun Bou Zerdan
- Department of Internal Medicine, Division of Hematology and Oncology, Naef K. Basile Cancer Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mohammad Hodroj
- Department of Internal Medicine, Division of Hematology and Oncology, Naef K. Basile Cancer Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Makram Khoury
- Department of Internal Medicine, Division of Hematology and Oncology, Hotel Dieu de France University Hospital, Beirut, Lebanon
| | - Nour Sabiha Naji
- Department of Internal Medicine, Division of Hematology and Oncology, Naef K. Basile Cancer Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ghid Amhaz
- Department of Internal Medicine, Division of Hematology and Oncology, Naef K. Basile Cancer Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Reine Abou Zeidane
- Department of Internal Medicine, Division of Hematology and Oncology, Naef K. Basile Cancer Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Fadi El Karak
- Department of Internal Medicine, Division of Hematology and Oncology, Hotel Dieu de France University Hospital, Beirut, Lebanon
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DiBonaventura MD, Wong W, Shah-Manek B, Schulz M. Real-world usage and clinical outcomes of alectinib among post-crizotinib progression anaplastic lymphoma kinase positive non-small-cell lung cancer patients in the USA. Onco Targets Ther 2017; 11:75-82. [PMID: 29317835 PMCID: PMC5744742 DOI: 10.2147/ott.s144960] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background Alectinib is an approved treatment for anaplastic lymphoma kinase (ALK)-positive patients with advanced non-small-cell lung cancer. Despite positive supporting clinical data, there is a lack of real-world information on the usage and patient outcomes of those treated with alectinib post-crizotinib progression. Methods Participating oncologists (N=95) in the USA were recruited from an online physician panel to participate in a retrospective patient chart review. Physicians randomly selected eligible patients (ie, patients who progressed on crizotinib as their first ALK inhibitor and were treated with alectinib as their second ALK inhibitor), collected demographics and clinical history from their medical charts, and entered the data into an online data collection form. Results A total of N=207 patient charts were included (age: 60.1±10.4 years; 53.6% male). The patients in our sample were older (median age of 60 vs 53 years), were more likely to be current smokers (12% vs 1%), had better performance status (45% vs 33% had an Eastern Cooperative Oncology Group [ECOG] of 0), and were less likely to have an adenocarcinoma histology (83% vs 96%) relative to published clinical trials. The objective response rate was higher than in clinical trials (67.1% vs 51.3%, respectively) as was the disease control rate (89.9% vs 78.8%, respectively), though it varied by race/ethnicity, ECOG, and prior treatment history. Discontinuation (0.0%) and dose reductions (3.4%) due to adverse events were uncommon in alectinib. Conclusion Patients using alectinib post-crizotinib in clinical practice are older, more racially/ethnically and histologically diverse than patients in published trials. Real-world response rates were high and similar to those reported in clinical studies, though there is some variation by patient characteristics. Alectinib was well tolerated in clinical practice as reflected by the rates of discontinuation, dose reductions, and dose interruptions.
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Affiliation(s)
| | - William Wong
- Genentech, US Medical Affairs, San Francisco, CA
| | - Bijal Shah-Manek
- Ipsos Healthcare, Global Evidence, Value & Access, San Francisco, CA.,College of Pharmacy, Touro University California, CA, USA
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Fidler MJ, Frankenberger C, Seto R, Lobato GC, Fhied CL, Sayidine S, Basu S, Pool M, Karmali R, Batus M, Lie WR, Hayes D, Mistry J, Bonomi P, Borgia JA. Differential expression of circulating biomarkers of tumor phenotype and outcomes in previously treated non-small cell lung cancer patients receiving erlotinib vs. cytotoxic chemotherapy. Oncotarget 2017; 8:58108-58121. [PMID: 28938541 PMCID: PMC5601637 DOI: 10.18632/oncotarget.17510] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 02/06/2017] [Indexed: 12/21/2022] Open
Abstract
Background The objective of this study was to identify serum biomarkers capable of predicting clinical outcomes in previously-treated NSCLC patients with wild-type for EGFR activating mutations or insufficient tissue for mutation status determination. Methods Sixty-six Luminex immunoassays representative of biological themes that emerged from a re-analysis of transcriptome data from the Cancer Genome Atlas (TCGA) were evaluate against pretreatment serum specimens from previously-treated advanced NSCLC patients received either cytotoxic chemotherapy (n=32) or erlotinib (n=79). Known EGFR mutation positive cases were excluded from analysis. Associations of biomarkers with outcome parameters and their differential interaction with treatment for survival outcomes were assessed using multivariate Cox PH analyses. Results Our EMT-based transcriptomic analysis revealed a range of biological processes associated with angiogenesis, apoptosis, cachexia, inflammation, and metabolism emerging as those most highly associated with patient outcome. These processes were evaluated via surrogate serum biomarkers. A treatment-biomarker interaction analysis revealed that higher pretreatment levels of c-Met signaling biomarkers (i.e. HGF levels), pro-inflammatory/ pro-cachexia (e.g. IL-8, sIL-2Rα, FGF-2) processes and a pro-angiogenic (e.g. TGF-α, IL-8, VEGF) milieu were associated with inferior survival (HR=0.35, 0.29, 0.58, 0.50, 0.61, 0.45, respectively; all p<0.05) for patients receiving chemotherapy, relative to erlotinib. In contrast, high levels of decoy receptor for IL-1, sIL-1RII, and a high tissue vimentin/E-cadherin ratio were associated with a poor OS (HR=3.78; p=0.00055) in the erlotinib cohort. Conclusions Contemporary precision medicine initiatives that pair patient tumor characteristics with the optimal therapy type may maximize the use of agents targeting EGFR in the treatment of NSCLC.
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Affiliation(s)
- Mary Jo Fidler
- Section of Medical Oncology, Rush University Medical Center, Chicago, IL 60612, USA
| | | | - Richard Seto
- Section of Medical Oncology, Rush University Medical Center, Chicago, IL 60612, USA
| | - Gabriela C Lobato
- Biochemistry, Rush University Medical Center, Chicago, IL 60612, USA
| | - Cristina L Fhied
- Pathology, Rush University Medical Center, Chicago, IL 60612, USA
| | - Selina Sayidine
- Pathology, Rush University Medical Center, Chicago, IL 60612, USA
| | - Sanjib Basu
- Preventative Medicine, Rush University Medical Center, Chicago, IL 60612, USA
| | - Mark Pool
- Pathology, Rush University Medical Center, Chicago, IL 60612, USA
| | - Reem Karmali
- Hematology, Oncology and Cell Therapy at Rush University Medical Center, Chicago, IL 60612, USA.,Present address: Division of Hematology and Oncology, Northwestern University, Chicago, IL 60612, USA
| | - Marta Batus
- Section of Medical Oncology, Rush University Medical Center, Chicago, IL 60612, USA
| | - Wen-Rong Lie
- EMD Millipore Corporation, St. Charles, MO 63304, USA
| | - David Hayes
- EMD Millipore Corporation, St. Charles, MO 63304, USA
| | | | - Philip Bonomi
- Section of Medical Oncology, Rush University Medical Center, Chicago, IL 60612, USA
| | - Jeffrey A Borgia
- Pathology, Rush University Medical Center, Chicago, IL 60612, USA.,Biochemistry, Rush University Medical Center, Chicago, IL 60612, USA
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Ellis PM, Leighl NB, Hirsh V, Reaume MN, Blais N, Wierzbicki R, Sadrolhefazi B, Gu Y, Liu D, Pilz K, Chu Q. A Randomized, Open-Label Phase II Trial of Volasertib as Monotherapy and in Combination With Standard-Dose Pemetrexed Compared With Pemetrexed Monotherapy in Second-Line Treatment for Non-Small-Cell Lung Cancer. Clin Lung Cancer 2015; 16:457-65. [PMID: 26100229 DOI: 10.1016/j.cllc.2015.05.010] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Revised: 05/19/2015] [Accepted: 05/26/2015] [Indexed: 11/27/2022]
Abstract
UNLABELLED Second-line therapy options that improve survival for patients with advanced non-small-cell lung cancer (NSCLC) are needed. This randomized, phase II trial (n [ 143) investigated volasertib monotherapy or in combination with pemetrexed compared with pemetrexed monotherapy in patients with NSCLC whose disease had progressed after previous platinum-based chemotherapy. The combination of volasertib with pemetrexed did not improve efficacy compared with pemetrexed monotherapy. INTRODUCTION Volasertib is a potent, selective, cell cycle kinase inhibitor that induces mitotic arrest and apoptosis by targeting Polo-like kinase. In this study we compared volasertib, volasertib with pemetrexed, and pemetrexed alone in patients with advanced non-small-cell lung cancer (NSCLC) whose disease progressed after first-line platinum-based chemotherapy. PATIENTS AND METHODS A run-in phase (n = 12) was used to determine whether volasertib could be combined in full dose with pemetrexed 500 mg/m(2). Subsequent patients were randomized to volasertib (n = 37), volasertib with pemetrexed (n = 47), or pemetrexed (n = 47) administered on day 1 every 21 days. The primary end point was progression-free survival (PFS); secondary end points included objective response rate and pharmacokinetics. RESULTS Volasertib 300 mg was chosen for the randomized phase. Recruitment to single-agent volasertib was stopped early because of lack of efficacy. Median PFS was 5.3 months with pemetrexed compared with 3.3 months with volasertib with pemetrexed (hazard ratio [HR], 1.141; 95% confidence interval [CI], 0.73-1.771) and 1.4 months with volasertib (HR, 2.045; 95% CI, 1.27-3.292). ORRs were 10.6% with pemetrexed, 21.3% for volasertib with pemetrexed, and 8.1% with volasertib. The most common all-grade related adverse events (pemetrexed/volasertib with pemetrexed/volasertib) were: fatigue (28 [61%]/27 [59%]/11 [31%]), nausea (21 [46%]/19 [41%]/0 [0%]), decreased apetite (14 [31%]/13 [28%]/2 [6%]), neutropenia (4 [9%]/8 [17%]/9 [25%]), rash (9 [20%]/8 [17%]/2 [6%]), vomiting (6 [13%]/13 [28%]/0 [0%]), and diarrhea (8 [17%]/11 [24%]/0 [0%]). Pharmacokinetics analyses showed no drug-drug interactions between volasertib and pemetrexed. CONCLUSION For treatment in the second-line for advanced or metastatic NSCLC, the combination of volasertib with standard pemetrexed did not increase toxicity significantly but also did not improve efficacy compared with single-agent pemetrexed.
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Affiliation(s)
- Peter M Ellis
- Juravinski Cancer Centre, Hamilton, Ontario, Canada.
| | | | - Vera Hirsh
- McGill University Health Centre, Montreal, Quebec, Canada
| | - M Neil Reaume
- The Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada
| | - Normand Blais
- Centre Hospitalier de l'Universite de Montreal, Montreal, Quebec, Canada
| | | | | | - Yu Gu
- Boehringer Ingelheim Corporation, Ridgefield, CT
| | - Dan Liu
- Boehringer Ingelheim Pharma GmbH & Co KG, Biberach, Germany
| | - Korinna Pilz
- Boehringer Ingelheim Pharma GmbH & Co KG, Biberach, Germany
| | - Quincy Chu
- Cross Cancer Centre, Edmonton, Alberta, Canada
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Dempke WCM. Gefitinib in non-small-cell lung cancer-an old lesson new re-visited. Transl Lung Cancer Res 2015; 2:435-8. [PMID: 25806264 DOI: 10.3978/j.issn.2218-6751.2013.10.01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Accepted: 09/22/2013] [Indexed: 01/14/2023]
Abstract
Non-small cell lung cancer (NSCLC) accounts for approximately 80-85% of all cases of lung cancer, and it is the most common cause of death in men and second only to breast cancer in women. Combination chemotherapy, usually platinum-based, is currently the first-line therapy of choice, however, the prognosis for patients with advanced NSCLC remains poor with a median survival time of 8-11 months and a 1-year survival rate of 30%. Maintenance therapy is a treatment strategy that has been investigated extensively in NSCLC and has been the subject of considerable recent debate. The outstanding results of the JMEN study proved that maintenance of pemetrexed significantly improved the overall survival (OS) in advanced NSCLC patients was a proof of principle. Subsequently, the results of the SATURN study also showed a significant prolongation of progression-free survival (PFS) and OS with maintenance erlotinib compared with placebo. Despite considerable controversy, it has become an acceptable treatment paradigm and both drugs are approved for maintenance therapy of advanced NSCLC patients in Europe and the USA. In addition, several large phase III clinical trials (e.g., INFORM trial) provided evidence that maintenance therapy with gefitinib also significantly improved PFS in NSCLC patients, with greatest PFS benefit in patients harboring EGF-R mutations. However, OS was unchanged. The question still remains whether the benefit of maintenance therapy for NSCLC is best defined by PFS. Truely, PFS is the best predictor for improved OS (and is independent of subsequent treatment), but OS is acknowledged as the key clinical outcome in the treatment of advanced NSCLC. The approval of pemetrexed and erlotinib by the FDA and the EMEA and the promising data with gefitinib have certainly shifted the pendulum towards maintenance therapy, however, the precise role for the treatment strategy of NSCLC in terms of a maintenance approach is far from being clear and additional studies are warranted to further clarify this option.
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Affiliation(s)
- Wolfram C M Dempke
- University of Munich, University Hospital of Grosshadern (Hematology and Oncology), D-81377 Munich, Germany ; ; Medical Oncology Department, Industriestrasse E2, D-01612 Glaubitz, Germany
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Passaro A, Cortesi E, de Marinis F. Second-line treatment of non-small-cell lung cancer: chemotherapy or tyrosine kinase inhibitors? Expert Rev Anticancer Ther 2014; 11:1587-97. [DOI: 10.1586/era.11.120] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Sun Y, Wang JW, Liu YY, Yu QT, Zhang YP, Li K, Xu LY, Luo SX, Qin FZ, Chen ZT, Liu WC, Zhou QH, Chen Q, Nan KJ, Liu XQ, Liu W, Liang HJ, Lu HS, Wang XW, Wang JJ, Song SP, Tu YR, Zhou JM, Li WL, Yao C. Long-term results of a randomized, double-blind, and placebo-controlled phase III trial: Endostar (rh-endostatin) versus placebo in combination with vinorelbine and cisplatin in advanced non-small cell lung cancer. Thorac Cancer 2013; 4:440-448. [PMID: 28920215 DOI: 10.1111/1759-7714.12050] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Accepted: 04/24/2013] [Indexed: 01/15/2023] Open
Affiliation(s)
- Yan Sun
- Cancer Hospital; Chinese Academy of Medical Sciences; Beijing China
| | - Jin Wan Wang
- Cancer Hospital; Chinese Academy of Medical Sciences; Beijing China
| | - Yong Yu Liu
- Liaoning Provincial Cancer Hospital; Shenyang China
| | - Qi Tao Yu
- Cancer Hospital; Guangxi Medical University; Nanning Guangxi China
| | | | - Kai Li
- Tianjin Cancer Hospital; Tianjin China
| | - Li Yan Xu
- Thoracic Tumor Hospital; Beijing China
| | - Su Xia Luo
- Henan Provincial Cancer Hospital; Zhengzhou China
| | | | - Zheng Tang Chen
- Xianqiao Hospital; 3rd PLA Medical University; Chongqing China
| | - Wen Chao Liu
- Xijing Hospital; 4th PLA Medical University; Xi'an China
| | | | - Qiang Chen
- Fujian Medical University Cancer Hospital; Fuzhou China
| | - Ke Jun Nan
- First Hospital of Xian Communication University; Xian China
| | - Xiao Qing Liu
- 307 Hospital; Chinese Academy of Military Medical Sciences; Beijing China
| | - Wei Liu
- Hebei Provincial Cancer Hospital; Shijiazhuang China
| | - Hou Jie Liang
- Xinan Hospital; 3rd PLA Medical University; Chongqing China
| | - Hui Shan Lu
- Fujian Medical University Union Hospital; Fuzhou China
| | | | - Jie Jun Wang
- Changzheng Hospital; 2nd PLA Medical University; Shanghai China
| | | | - Yuan Rong Tu
- Fujian Medical University 1st Hospital; Fuzhou China
| | | | | | - Chen Yao
- Peking University First Hospital; Beijing China
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Jo SK, Hong JY, Park HJ, Lee SK. Anticancer Activity of Novel Daphnane Diterpenoids from Daphne genkwa through Cell-Cycle Arrest and Suppression of Akt/STAT/Src Signalings in Human Lung Cancer Cells. Biomol Ther (Seoul) 2013; 20:513-9. [PMID: 24009843 PMCID: PMC3762286 DOI: 10.4062/biomolther.2012.20.6.513] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2012] [Revised: 11/12/2012] [Accepted: 11/12/2012] [Indexed: 11/29/2022] Open
Abstract
Although the immense efforts have been made for cancer prevention, early diagnosis, and treatment, cancer morbidity and mortality has not been decreased during last forty years. Especially, lung cancer is top-ranked in cancer-associated human death. Therefore, effective strategy is strongly required for the management of lung cancer. In the present study, we found that novel daphnane diterpenoids, yuanhualine (YL), yuanhuahine (YH) and yuanhuagine (YG) isolated from the flower of Daphne genkwa (Thymelaeaceae), exhibited potent anti-proliferative activities against human lung A549 cells with the IC50 values of 7.0, 15.2 and 24.7 nM, respectively. Flow cytometric analysis revealed that the daphnane diterpenoids induced cell-cycle arrest in the G0/G1 as well as G2/M phase in A549 cells. The cell-cycle arrests were well correlated with the expression of checkpoint proteins including the up-regulation of cyclin-dependent kinase inhibitor p21 and p53 and down-regulation of cyclin A, cyclin B1, cyclin E, cyclin dependent kinase 4, cdc2, phosphorylation of Rb and cMyc expression. In the analysis of signal transduction molecules, the daphnane diterpenoids suppressed the activation of Akt, STAT3 and Src in human lung cancer cells. The daphnane diterpenoids also exerted the potent anti-proliferative activity against anticancer-drug resistant cancer cells including gemcitabine-resistant A549, gefitinib-, erlotinib-resistant H292 cells. Synergistic effects in the growth inhibition were also observed when yuanhualine was combined with gemcitabine, gefitinib or erlotinib in A549 cells. Taken together, these findings suggest that the novel daphnane diterpenoids might provide lead candidates for the development of therapeutic agents for human lung cancers.
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Affiliation(s)
- Si-Kyoung Jo
- College of Pharmacy, Ewha Womans University, Seoul 120-750, Republic of Korea
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Gonzalez G, Diaz-Miqueli A, Crombet T, Raez LE, Lage A. Current Algorithm for Treatment of Advanced NSCLC Patients: How to Include Active Immunotherapy? ACTA ACUST UNITED AC 2013. [DOI: 10.4236/jct.2013.48a010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Costs and Clinical Outcomes among Patients with Second-Line Non-small Cell Lung Cancer in the Outpatient Community Setting. J Thorac Oncol 2012; 7:212-8. [DOI: 10.1097/jto.0b013e3182307f33] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Nguewa PA, Calvo A, Pullamsetti SS, Banat GA, Grimminger F, Savai R. Tyrosine kinase inhibitors with antiangiogenic properties for the treatment of non-small cell lung cancer. Expert Opin Investig Drugs 2010; 20:61-74. [PMID: 21142806 DOI: 10.1517/13543784.2011.541153] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
IMPORTANCE OF THE FIELD The 5-year survival rate in NSCLC remains < 15% in spite of new chemotherapeutic regimens and targeted therapies. Tyrosine kinase inhibitors (TKIs) with antiangiogenic properties show promise as a new therapeutic approach for NSCLC in recent studies. AREAS COVERED IN THIS REVIEW This article reviews significant preclinical and clinical studies related to TKI therapy. Many drugs that target tyrosine kinases involved in tumor angiogenesis have recently been developed. Results of preclinical experiments and clinical trials for NSCLC are quite promising. However, response rates are low and the duration of therapeutic response is short. Mechanisms of resistance may reduce the efficacy of TKI therapy, and biomarkers of response are needed to select patients who are more likely to benefit from the therapy. Studies in mice have shown that antiangiogenic TKIs may increase metastasis, although no clear clinical evidence supports these results. WHAT THE READER WILL GAIN An understanding of the mechanisms of action, clinical trial results, biomarkers of response, adverse effects and possible mechanisms of resistance associated with novel TKI therapy in NSCLC. TAKE HOME MESSAGE More preclinical and clinical research on the efficacy of TKIs in treating NSCLC is needed, but present results offer great hope for patients.
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Affiliation(s)
- Paul A Nguewa
- Center for Applied Medical Research (CIMA), Division of Oncology, University of Navarra, Pamplona, 31008, Spain
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Ranson M, Reck M, Anthoney A, Hanauske AR, Dean E, Melezinek I, Klingelschmitt G, Kletzl H, Blatter J, Twelves C. Erlotinib in combination with pemetrexed for patients with advanced non-small-cell lung cancer (NSCLC): a phase I dose-finding study. Ann Oncol 2010; 21:2233-2239. [DOI: 10.1093/annonc/mdq246] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Dempke WC, Suto T, Reck M. Targeted therapies for non-small cell lung cancer. Lung Cancer 2010; 67:257-74. [DOI: 10.1016/j.lungcan.2009.10.012] [Citation(s) in RCA: 122] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2009] [Revised: 10/13/2009] [Accepted: 10/19/2009] [Indexed: 12/13/2022]
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Amir E, Mandoky L, Blackhall F, Thatcher N, Klepetko W, Ankersmit HJ, Reza Hoda MA, Ostoros G, Dank M, Dome B. Antivascular agents for non-small-cell lung cancer: current status and future directions. Expert Opin Investig Drugs 2009; 18:1667-86. [DOI: 10.1517/13543780903336050] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Erlotinib Monotherapy for Stage IIIB/IV Non-small Cell Lung Cancer: A Multicenter Trial by the Korean Cancer Study Group. J Thorac Oncol 2009; 4:1136-43. [DOI: 10.1097/jto.0b013e3181b270a7] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Herbst RS, Sandler A. Bevacizumab and erlotinib: a promising new approach to the treatment of advanced NSCLC. Oncologist 2008; 13:1166-76. [PMID: 18997180 DOI: 10.1634/theoncologist.2008-0108] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Biologic agents that target molecules involved in tumor growth, progression, and pathological angiogenesis--such as the human epidermal growth factor receptor (EGFR) and vascular endothelial growth factor (VEGF)--have demonstrated efficacy in patients with non-small cell lung cancer (NSCLC). Erlotinib (Tarceva); OSI Pharmaceuticals, Inc., Melville, NY, Genentech, Inc., South San Francisco, CA, and F. Hoffmann-La Roche Ltd, Basel, Switzerland), a highly selective tyrosine kinase inhibitor that inhibits EGFR, and bevacizumab (Avastin); Genentech, Inc., South San Francisco, CA, and F. Hoffmann-La Roche Ltd, Basel, Switzerland), a VEGF-targeted recombinant humanized monoclonal antibody, have displayed very encouraging activity in a randomized phase II trial in patients with previously treated NSCLC. Because erlotinib and bevacizumab act on two different pathways critical to tumor growth and dissemination, administering these drugs concomitantly may confer additional clinical benefits to cancer patients with advanced disease, by virtue of their complementary (or additive) antitumor activity. The combination of bevacizumab plus erlotinib may prove to be a viable second-line alternative to chemotherapy or erlotinib monotherapy in patients with NSCLC. The benefits of the combination may be further enhanced by selecting for patients who are likely to respond to this therapy. While a number of potential predictive markers have been identified for erlotinib, their value remains to be confirmed in prospective trials. In addition, the application of such personalized therapy will also depend on the availability of validated screening methods.
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Affiliation(s)
- Roy S Herbst
- The University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA.
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Thatcher N. First- and second-line treatment of advanced metastatic non-small-cell lung cancer: a global view. BMC Proc 2008; 2 Suppl 2:S3. [PMID: 18831719 PMCID: PMC2559799 DOI: 10.1186/1753-6561-2-s2-s3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Treatment of non-small-cell lung cancer is dependent on disease stage. For patients with metastasis or locally advanced disease, the importance of finding therapeutic schemes that may benefit this population is important. This review discusses therapeutic options for first- and second-line treatment in patients with advanced non-small-cell lung cancer. According to current data, the combination of two cytotoxic agents is the optimum first-line treatment for patients with non-small-cell lung cancer and performance status of 0–1. Addition of bevacizumab has shown to provide an even longer survival and to increase response rate. Within the first-line setting, erlotinib appears to be effective in the treatment of elderly patients who would not derive a benefit from standard chemotherapy or those refusing standard chemotherapy. The administration of erlotinib as first-line maintenance therapy is being assessed. There are currently three drugs approved for second-line treatment of patients with advanced non-small-cell lung cancer after failure of first-line chemotherapy. These drugs have proven to be effective in phase III trials. In the phase III trial BR.21 study, the response rate was 8.9% in the erlonitib group, and less than 1% in placebo; median response duration was 7.9 months and 3.7 months, respectively; and the median survival was 6.7 months and 4.7 with erlotinib and placebo, respectively. One-year survival was 31% and 21% with erlotinib and placebo, respectively. In addition, the BR.21 trial revealed that significantly greater improvements in overall quality of life and in both physical and emotional functioning were observed in the erlotinib arm as compared with the placebo arm. Erlotinib is not significantly associated with hematologic adverse effects. Erlotinib is administered orally, and does not require concomitant administration of other drugs, thus causing patients less inconvenience. Analysis of data from different subgroups included in the BR.21 trial show that overall survival is similar among women and men, among patients with adenocarcinoma and epidermoid carcinoma or Asian patients compared with other ethnicities. Combination of erlotinib and bevacizumab in the second-line treatment of patients with advanced disease has been evaluated as anti-angiogenic properties. This combination therapy has provided promising results which should be confirmed in future studies.
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Affiliation(s)
- Nicholas Thatcher
- Division of Cancer Studies, Faculty of Medical and Human Sciences, University of Manchester, Department of Medical Oncology, Christie Hospital NHS Trust, Wilmslow Road, Manchester, M20 4BX, UK.
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Sotto-Mayor R. New directions in the second line treatment of non-small cell lung cancers and in the management of malignant pleural mesotheliomas. REVISTA PORTUGUESA DE PNEUMOLOGIA 2008; 14 Suppl 2:S5-8. [PMID: 25967567 DOI: 10.1016/s0873-2159(15)30309-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- Renato Sotto-Mayor
- Chefe de Serviço de Pneumologia dos Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Assistente Convidado da Faculdade de Medicina de Lisboa
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Is irinotecan plus docetaxel useful as second-line therapy in advanced non-small cell lung cancer? J Thorac Oncol 2008; 3:405-11. [PMID: 18379360 DOI: 10.1097/jto.0b013e318168f780] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The ability of doublet therapy in the second-line setting in patients with platinum-refractory non-small cell lung cancer (NSCLC) has not yet been proven. In this setting, docetaxel (D) has shown efficacy and irinotecan (I) has only recently been introduced. This study was initiated to explore the activity and tolerability of three D + I regimens in platinum pretreated NSCLC patients. METHODS From March 2003 to June 2006, 65 patients (age range, 39-71 years; 83% male) with relapsed stage III/IV NSCLC were randomly assigned to receive either I 160 mg/m(2) plus D 60 mg/m(2) on day 1 every 21 days (arm A), I 80 mg/m(2) on days 1,8 plus D 60 mg/m(2) on day 1 every 21 days (arm B), or I 60 mg/m(2) plus D 30 mg/m(2) on days 1, 8, 15, and 22 every 42 days (arm C), for a maximum of 18 weeks. RESULTS Per protocol analysis (47 of 65) overall response rates were 5.6% (A), 6.7% (B), and 7.1% (C). Median times to progression were 3.4, 4.0, and 4.3 months, respectively. Overall survival was 8.9 (A), 8.3 (B), and 9.4 (C) months. G3/4 neutropenia was more frequent in arms A (42%) and B (55%) whereas G3/4 nonhematologic toxicity was similarly prevalent in all arms, although diarrhea occurred in 47% of arm C patients. CONCLUSIONS Single-agent treatment with D or the multitarget antifolate pemetrexed or erlotinib remain the best choices and investigational studies, following first-line therapy, are required.
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Chouaid C, Monnet I, Robinet G, Perol M, Fournel P, Vergnenegre A. Economic impact of gefitinib for refractory non-small-cell lung cancer: a Markov model-based analysis. Curr Med Res Opin 2007; 23:1509-15. [PMID: 17559745 DOI: 10.1185/030079907x199718] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
UNLABELLED Few data are available on the economics of target therapy or refractory non-small-cell lung cancer (NSCLC). OBJECTIVE To determine the mean global management costs (MC) per patient treated with gefitinib for NSCLC, and the costs of the different management phases. METHOD A Markov approach was used to model treatment costs in a cohort of 106 patients treated with gefitinib as part of a compassionate-use program (third-line treatment) in six public-sector teaching hospitals. The economic analysis adopted the health care payer's perspective, and only direct costs were taken into account. RESULTS The mean duration of gefitinib treatment was 4.6 +/- 5.8 months (1-29 months); median survival was 4 months, 1-year and 2-year survival rates were 12.3% and 4.7%, respectively. The mean total management cost was 39,979 euros +/- 20,279. The model showed that first- and second-line treatments accounted for respectively 29.5% and 44.1% of this cost, while gefitinib periods represented 10.7%, periods of remission 1.25%, and terminal care 14.5%. A sensitivity analysis showed that the price of gefitinib had little influence on the total cost. CONCLUSION The cost of third-line gefitinib therapy for NSCLC appears acceptable from the healthcare payer's perspective, but this needs to be confirmed in dedicated cost-effectiveness studies.
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Xu JM, Han Y, Li YM, Zhao CH, Wang Y, Paradiso A. Phase II trial of sequential gefitinib after minor response or partial response to chemotherapy in Chinese patients with advanced non-small-cell lung cancer. BMC Cancer 2006; 6:288. [PMID: 17173694 PMCID: PMC1764758 DOI: 10.1186/1471-2407-6-288] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2006] [Accepted: 12/16/2006] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Basic research of gefitinib (Iressa, ZD1839) has demonstrated the combination effects of gefitinib and chemotherapy were sequence-dependent. To evaluate the efficacy of sequential administration of gefitinib following a minor response or partial response to two to three cycles of chemotherapy, a phase II clinical trial was done in Chinese patients with advanced non-small-cell lung cancer (NSCLC). METHODS Thirty-three consecutive patients with advanced NSCLC that had been pretreated with at least one chemotherapeutic regimen and were responding to chemotherapy following 2 to 3 cycles of treatment, entered the trial from May 2004 to February 2006. Patients received gefitinib at an oral dose of 250 mg once daily for 4 weeks. RESULTS Thirty-three patients were evaluable for response and toxicity. The objective response rate was 24.2% (8 of 33) (95% CI, 11% to 42%). The symptom improvement rate was 54.5% (18 of 33) (95% CI, 41% to 69%). The median duration of response was 7 months (95%CI, 4.0 to 13.2 months). The median time to disease progression (TTP) was 6.5 months (95%CI, 0.7 to 16.6 months). The median overall survival time (OS) was 9.8 months (range, 2.1 to 18.0 months), and the actuarial 1-year survival was 36.4%. Toxicity was relatively mild and included only one patient (3.0%) with grade 4 diarrhea, 1 (3.0%) with grade 3 rash, 1 (3.0%) with grade 3 nausea, and 1 with grade 3 vomiting (3.0%). CONCLUSION Preliminary results suggest that sequential administration of gefitinib following a response to chemotherapy may be beneficial for Chinese patients with advanced NSCLC. Further randomized clinical trials are needed.
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Affiliation(s)
- Jian Ming Xu
- Beijing 307 Hospital Cancer Center, Beijing, China
| | - Yu Han
- Beijing 307 Hospital Cancer Center, Beijing, China
| | - Yue Min Li
- Beijing 307 Hospital Cancer Center, Beijing, China
| | | | - Yan Wang
- Beijing 307 Hospital Cancer Center, Beijing, China
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Chou WC, Huang SF, Yeh KY, Wang HM, Liu MY, Hsieh JJ, Cheung YC, Chang JWC. Different Responses to Gefitinib in Lung Adenocarcinoma Coexpressing Mutant- and Wild-Type Epidermal Growth Factor Receptor Genes. Jpn J Clin Oncol 2006; 36:523-6. [PMID: 16803841 DOI: 10.1093/jjco/hyl057] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Response to gefitinib is strongly associated with the status of the epidermal growth factor receptor gene. Here we report the different treatment responses in a case of lung adenocarcinoma coexpressing mutant-type gene in the primary lung mass and a wild-type gene in the metastatic bone lesions. This case demonstrated that at least two strains of tumor cells were present in a single patient. This may be one of the mechanisms of gefitinib resistance.
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Affiliation(s)
- Wen-Chi Chou
- Department of Hematology-Oncology, Chang Gung Memorial Hospital, Taoyuan, Taiwan, ROC
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Ramalingam S, Sandler AB. Salvage Therapy for Advanced Non‐Small Cell Lung Cancer: Factors Influencing Treatment Selection. Oncologist 2006; 11:655-65. [PMID: 16794244 DOI: 10.1634/theoncologist.11-6-655] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Novel chemotherapies and molecularly targeted agents have improved outcomes for patients with advanced non-small cell lung cancer (NSCLC). Several efficacious regimens are available, which allows for selection of therapy based on factors such as schedule, toxicity profile, patient-specific needs, and individual preferences of the patient. Treatment guidelines recommend platinum-based chemotherapy first line for patients with a good performance status. These regimens offer a modest survival advantage over best supportive care. The role of targeted biologic agents in this setting is being assessed in phase II trials. Results to date show promising activity and tolerability. Erlotinib, docetaxel, and pemetrexed are all approved for patients who progress following one prior regimen for advanced NSCLC. These agents have different tolerability profiles and routes of administration but appear to have similar effects on tumor response and survival, though comparative trials are required to confirm this. Based on the results of a phase III trial, erlotinib is also recommended for third-line use in patients with NSCLC. Identifying predictive markers of clinical response to therapy may provide an opportunity to better select patient subsets appropriate for specific treatment. Recent data have linked various clinical characteristics and biologic markers with outcome to HER-1/EGFR-targeted agents. However, many of these studies are retrospective and based on small patient numbers, and there is evidence of broad benefit across diverse patient subgroups with erlotinib. Prospective, randomized trials are required to validate potential predictive markers fully before they are applied to clinical practice.
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Affiliation(s)
- Suresh Ramalingam
- Division of Hematology-Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania, USA
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Abstract
Both lung cancer and mesothelioma are malignancies with increasing incidence, and both are primarily due to inhalation of an external carcinogen. The occurence of both diseases is expected to rise worldwide, although a stabilisation and/or decrease may be anticipated in some developed countries. There are other common similarities to both cancers, including the median age of their patients, the advanced stage at presentation, the outcome and the treatments given. This review focuses on the available evidence of a novel antifolate agent, pemetrexed, in the treatment of both of these thoracic malignancies. Current status, persisting controversies and future developments are discussed.
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Kut V, Patel JD, Argiris A. Pemetrexed: a novel antifolate agent enters clinical practice. Expert Rev Anticancer Ther 2004; 4:511-22. [PMID: 15270656 DOI: 10.1586/14737140.4.4.511] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Pemetrexed (Alimta, Eli Lilly) is a multitargeted antifolate that inhibits at least three enzymes in the nucleic acid synthetic pathways. The US Food and Drug Administration recently approved pemetrexed, in combination with cisplatin, for the first-line treatment of advanced malignant pleural mesothelioma. Moreover, pemetrexed was recently shown to be as efficacious as docetaxel (Taxotere, Aventis) in the second-line treatment of non-small cell lung cancer, and its toxicity profile was preferable. The main toxicity seen with pemetrexed is myelosuppression, which is considerably reduced by coadministration of folic acid and vitamin B12. Multiple Phase II clinical trials have demonstrated that pemetrexed has promising single-agent activity in many other solid tumors, including head and neck, breast and colorectal cancers. Combination regimens consisting of pemetrexed and other chemotherapeutics or novel molecular-targeted agents are currently under investigation. Future studies will better define and likely expand the role of pemetrexed for the treatment of cancer.
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Affiliation(s)
- Victoria Kut
- Department of Medicine, Division of Hematology/Oncology, The Feinberg School of Medicine, Robert H Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL 60611, USA
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