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Baseline Ang-2 Serum Levels as a Predictive Factor for Survival in NSCLC and SCLC. Life (Basel) 2022; 12:life12122092. [PMID: 36556457 PMCID: PMC9786126 DOI: 10.3390/life12122092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/29/2022] [Accepted: 12/05/2022] [Indexed: 12/15/2022] Open
Abstract
Angiopoietin-2 (Ang-2) has been implicated in the development of several types of cancer, including lung malignancy. In the present study, we examined the impact of Ang-2 serum concentration on the development, dissemination, and 5-year overall survival of NSCLC and SCLC. A total of 99 patients with lung cancer were tested. The OS of NSCLC and SCLC patients was estimated using Kaplan−Meier curves and compared through log-rank test. The median serum level of Ang-2 at baseline in both NSCLC and SCLC patients was significantly higher than that of controls (p < 0.0001). The Ang-2 serum concentration was not related to metastasis, neither in NSCLC nor in SCLC cases. The OS was found to be significantly shorter for stage IIIβ NSCLC patients with a high baseline Ang-2 serum concentration (p = 0.012), while Cox regression analysis showed that Ang-2 is a significant independent factor for poor prognosis for stage IIIβ NSCLC (hazard ratio = 2.97, 95% CI: 1.05−8.40, p = 0.04). The concentration of Ang-2 has no impact on the prognosis of SCLC. Ang-2 could be considered as a significant molecular marker that enables the prediction of NSCLC and SCLC development, and is involved in the poor prognosis of stage IIIβ NSCLC.
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Montanino A, Manzo A, Carillio G, Palumbo G, Esposito G, Sforza V, Costanzo R, Sandomenico C, Botti G, Piccirillo MC, Cascetta P, Pascarella G, La Manna C, Normanno N, Morabito A. Angiogenesis Inhibitors in Small Cell Lung Cancer. Front Oncol 2021; 11:655316. [PMID: 34123809 PMCID: PMC8195287 DOI: 10.3389/fonc.2021.655316] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 05/03/2021] [Indexed: 12/22/2022] Open
Abstract
Inhibition of angiogenesis has been demonstrated to be an efficacious strategy in treating several tumors. Vascular endothelial growth factor (VEGF) is the most important protein with proangiogenic functions and it is overexpressed in small cell lung cancer (SCLC). Bevacizumab, a monoclonal antibody directed against VEGF, showed a promising activity in combination with etoposide and cisplatin as first-line treatment of patients with extended stage (ES)-SCLC and two randomized studies confirmed that bevacizumab improved PFS, but failed to prolong OS. Instead, disappointing results have been observed with endostar, sunitinib, sorafenib, vandetanib, and thalidomide in combination with chemotherapy in the first-line setting, with sunitinib in the maintenance setting, with sunitinib, cediranib and nintedanib as single agents or ziv-aflibercept in combination with topotecan in second-line setting. Only anlotinib improved OS and PFS as third-line therapy in Chinese patients with SCLC, and it was approved with this indication in China. Future challenges are the evaluation of the role of angiogenesis inhibitors in combination with immune- checkpoint inhibitors and chemotherapy in SCLC patients and the identification of predictive biomarkers of response to both agents.
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Affiliation(s)
- Agnese Montanino
- Thoracic Department, Istituto Nazionale Tumori, IRCCS "Fondazione G.Pascale", Naples, Italy
| | - Anna Manzo
- Thoracic Department, Istituto Nazionale Tumori, IRCCS "Fondazione G.Pascale", Naples, Italy
| | - Guido Carillio
- Department of Oncology and Hematology, Azienda Ospedaliera Pugliese-Ciaccio, Catanzaro, Italy
| | - Giuliano Palumbo
- Thoracic Department, Istituto Nazionale Tumori, IRCCS "Fondazione G.Pascale", Naples, Italy
| | - Giovanna Esposito
- Thoracic Department, Istituto Nazionale Tumori, IRCCS "Fondazione G.Pascale", Naples, Italy
| | - Vincenzo Sforza
- Thoracic Department, Istituto Nazionale Tumori, IRCCS "Fondazione G.Pascale", Naples, Italy
| | - Raffaele Costanzo
- Thoracic Department, Istituto Nazionale Tumori, IRCCS "Fondazione G.Pascale", Naples, Italy
| | - Claudia Sandomenico
- Thoracic Department, Istituto Nazionale Tumori, IRCCS "Fondazione G.Pascale", Naples, Italy
| | - Gerardo Botti
- Scientific Directorate, Istituto Nazionale Tumori, "Fondazione G. Pascale" - IRCCS, Naples, Italy
| | - Maria C Piccirillo
- Scientific Department, Istituto Nazionale Tumori, "Fondazione G.Pascale" - IRCCS, Naples, Italy
| | | | - Giacomo Pascarella
- Scientific Directorate, Istituto Nazionale Tumori, "Fondazione G. Pascale" - IRCCS, Naples, Italy
| | - Carmine La Manna
- Thoracic Department, Istituto Nazionale Tumori, IRCCS "Fondazione G.Pascale", Naples, Italy
| | - Nicola Normanno
- Scientific Department, Istituto Nazionale Tumori, "Fondazione G.Pascale" - IRCCS, Naples, Italy
| | - Alessandro Morabito
- Thoracic Department, Istituto Nazionale Tumori, IRCCS "Fondazione G.Pascale", Naples, Italy
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Xu Y, Zhang Y, Wang Z, Chen N, Zhou J, Liu L. The role of serum angiopoietin-2 levels in progression and prognosis of lung cancer: A meta-analysis. Medicine (Baltimore) 2017; 96:e8063. [PMID: 28906403 PMCID: PMC5604672 DOI: 10.1097/md.0000000000008063] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Angiogenesis is an essential process in the development and progression of malignant tumors including lung cancer, in which angiopoietin-2 (Ang-2) plays an important role. The objective of this study was to assess the prognostic value of serum Ang-2 levels in patients with lung cancer. METHODS A comprehensive systematic electronic search was performed in the Pubmed, Embase, Web of Science, china national knowledge infrastructure, and VIP databases update to October, 2016 (qikan.cqvip.com). Literatures examining the relevance of serum Ang-2 levels to progression and prognosis of lung cancer were eligible for our study. Standardized mean differences (SMD) with 95% confidence interval (95% CI) and a P value were applied to compare continuous variables, and hazard ratio (HR) with 95% CI as well as P value were applied for prognostic role. RESULTS Twenty studies with 1911 patients met the eligibility criteria. Among them, 7 studies with 575 patients with lung cancer assessed the association between expression of serum Ang-2 and prognosis. According to our results, higher levels of serum Ang-2 were associated with the later stage of tumor. Serum Ang-2 levels were significantly lower in stage I than in stage II (SMD: -0.51; 95% CI: -0.75 to -0.27; P < .001), in stage II than in stage III (SMD: -0.52; 95% CI: -0.80 to -0.24; P < .001), in stage III than in stage IV (SMD: -0.58; 95% CI: -0.93 to -0.23; P = .001). In addition, serum Ang-2 levels were higher in patients with lymph node metastasis (SMD: 1.06; 95% CI, 0.57-1.56; P < .001). Meanwhile, patients with lung cancer with higher levels of serum Ang-2 were associated with a significant poorer prognosis when compared to those with lower serum Ang-2 levels (HR: 1.64; 95% CI: 1.20-2.25; P = .002), and this role was further detected when stratified by ethnicity and histological type. CONCLUSIONS This systematic review and meta-analysis suggested that serum Ang-2 levels might be a potential predictor for staging, and were associated with prognosis of lung cancer.
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Affiliation(s)
- Yuyang Xu
- Department of Thoracic Surgery, West China Hospital
- Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer
| | - Yingyi Zhang
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Zihuai Wang
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Nan Chen
- Department of Thoracic Surgery, West China Hospital
- Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer
| | - Jian Zhou
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Lunxu Liu
- Department of Thoracic Surgery, West China Hospital
- Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer
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Evaluation of factors associated with platinum-sensitivity status and survival in limited-stage small cell lung cancer patients treated with chemoradiotherapy. Oncotarget 2017; 8:81405-81418. [PMID: 29113400 PMCID: PMC5655295 DOI: 10.18632/oncotarget.19073] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 06/27/2017] [Indexed: 01/05/2023] Open
Abstract
In this retrospective study, we analyzed the association of clinicopathological factors and therapeutic plans with platinum-sensitivity status and survival of limited-stage small cell lung cancer (LS-SCLC) patients. We enrolled 452 LS-SCLC patients with 279 platinum sensitive and 173 platinum refractory patients. The low serum neuro-specific enolase levels (NSE; p = 0.011), neutrophil-to-lymphocyte ratios (NLR; p = 0.013) and higher objective response rates (p = 0.003) were associated with sensitive group but not the refractory group. Multivariate analysis showed that treatment modality (HR = 0.267, p < 0.001), serum lactate dehydrogenase (LDH; HR = 1.894, p = 0.016), NLR (HR = 2.043, p = 0.043) and platinum-sensitivity status (HR = 0.561, p = 0.036) were independent prognostic factors for survival. We further showed that the numbers of chemotherapy cycles and response to first-line therapy were independent prognostic factors for refractory patients only. Our study demonstrates that platinum-sensitivity status is of prognostic importance, as it is strongly associated with survival in LS-SCLC patients.
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Stratigos M, Matikas A, Voutsina A, Mavroudis D, Georgoulias V. Targeting angiogenesis in small cell lung cancer. Transl Lung Cancer Res 2016; 5:389-400. [PMID: 27652203 DOI: 10.21037/tlcr.2016.08.04] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Small cell lung cancer (SCLC) is a highly aggressive and lethal malignancy. Despite high initial response rates to systemic chemotherapy, the disease eventually relapses; further treatment only modestly improves outcomes and overall survival (OS) for patients with extensive stage disease is less than one year. Little progress has been made during the past decades, with no new drugs approved. Consequently, the development of novel strategies is an unmet need. The inhibition of angiogenesis, a defining characteristic of cancer, has demonstrated modest efficacy in several human malignancies, including non-small cell lung cancer (NSCLC). However, results from clinical trials in SCLC have been disappointing, and no anti-angiogenic agent has received regulatory approval due to lack of clinical efficacy. The elucidation of underlying mechanisms responsible for tumor resistance to angiogenic therapy and the simultaneous blockade of multiple elements that play a role in angiogenesis need to be further explored.
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Affiliation(s)
- Michalis Stratigos
- Department of Medical Oncology, University General Hospital of Heraklion, Heraklion, Crete, Greece
| | - Alexios Matikas
- Department of Medical Oncology, University General Hospital of Heraklion, Heraklion, Crete, Greece;; Hellenic Oncology Research Group (HORG), Athens, Greece
| | - Alexandra Voutsina
- Laboratory of Translational Oncology, University of Crete, School of Medicine, Heraklion, Crete, Greece
| | - Dimitrios Mavroudis
- Department of Medical Oncology, University General Hospital of Heraklion, Heraklion, Crete, Greece;; Laboratory of Translational Oncology, University of Crete, School of Medicine, Heraklion, Crete, Greece
| | - Vassilis Georgoulias
- Hellenic Oncology Research Group (HORG), Athens, Greece;; Laboratory of Translational Oncology, University of Crete, School of Medicine, Heraklion, Crete, Greece
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