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Zhao Y, Mei T, Na F, Tian X, Ao R, Long X, Luo Q, Duan P, Zhu J, Wang Y, Huang M, Liu Y, Gong Y. First-line treatment of driver gene-negative metastatic lung adenocarcinoma with malignant pleural effusion: Should chemotherapy be combined with an immune checkpoint inhibitor or bevacizumab? Invest New Drugs 2024; 42:196-206. [PMID: 38386170 PMCID: PMC10944392 DOI: 10.1007/s10637-024-01424-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 01/22/2024] [Indexed: 02/23/2024]
Abstract
Patients with metastatic lung adenocarcinoma (MLA) and malignant pleural effusion (MPE) without driver gene mutations have a poor prognosis. None of the standard treatment strategies is recommended for such patients. We retrospectively analyzed the efficacy of the first-line treatment for this specific population: standard platinum-based doublet chemotherapy (CT), CT plus an immune checkpoint inhibitor (CT plus ICI), and CT plus bevacizumab (CT plus Bev). A total of 323 eligible patients were enrolled: CT alone (n = 166), CT plus Bev (n = 72), and CT plus ICI (n = 85). Treatment efficacy assessments were performed every two cycles according to the RECIST guidelines. The endpoints were overall survival (OS) and progression-free survival (PFS). Kaplan-Meier (K‒M) curves and the log-rank test were used to compare OS and PFS. p < 0.05 was the threshold of significance (statistical software: SPSS). The median follow-up was 11.4 months (range, 2.1-49.6 months). PFS and OS in the CT plus ICI/CT plus Bev cohort were significantly longer than those in the CT group (PFS: 7.8/6.4/3.9 months, p < 0.0001; OS: 16.4/15.6/9.6 months, p < 0.0001, respectively). CT plus Bev had better PFS and OS than CT plus ICI/CT in PD-L1 < 1% patients (PFS: 8.4/5.0/3.8 months, p < 0.0001; OS: 15.6/12.9/9.3 months, p < 0.0001). Among patients with PD-L1 1-49%, CT plus ICI led to a longer PFS and OS (PFS: 8.9/5.8/4.2 months, p = 0.009; OS: 24.2/18.8/11.5 months, p = 0.03). In the cohort with PD-L1 ≥ 50%, CT plus ICI was still the best first-line treatment (PFS: 19.7/13.8/9.6 months, p = 0.033; OS: 27.2/19.6/14.9 months, p = 0.047). In driver gene-negative MLA with MPE, CT plus Bev or ICI better controlled MPE and significantly prolonged survival compared to CT alone. PD-L1 expression (negative/positive) may be a key factor influencing the choice of CT plus Bev or ICI.
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Affiliation(s)
- Yuanyuan Zhao
- Division of Thoracic Tumor Multidisciplinary Treatment, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
- Department of Oncology, Chengdu Pidu District Hospital of Traditional Chinese Medicine, Chengdu, 611730, People's Republic of China
| | - Ting Mei
- Lung Cancer Center, West China Tianfu Hospital, Sichuan University, Chengdu, 610213, People's Republic of China
| | - Feifei Na
- Division of Thoracic Tumor Multidisciplinary Treatment, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Xiaoman Tian
- Department of Oncology, Chengdu Jinniu District People's Hospital, Chengdu, 610031, People's Republic of China
| | - Rui Ao
- Department of Oncology, Sichuan Academy of Medical Sciences and Sichuan People's Hospital, Chengdu, 610072, People's Republic of China
| | - Xiangyu Long
- Department of Oncology, Sichuan Provincial Guang'An People's Hospital, Guang'An, 638500, People's Republic of China
| | - Qiang Luo
- Department of Oncology, Chengdu Xinjin District Hospital of Traditional Chinese Medicine, Chengdu, 611430, People's Republic of China
| | - Ping Duan
- Department of Oncology, Chengdu First People's Hospital, Chengdu, 610095, People's Republic of China
| | - Jiang Zhu
- Department of Oncology, West China Shangjin Hospital, Sichuan University, Chengdu, 611730, People's Republic of China
| | - Yongsheng Wang
- Division of Thoracic Tumor Multidisciplinary Treatment, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Meijuan Huang
- Division of Thoracic Tumor Multidisciplinary Treatment, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Yongmei Liu
- Division of Thoracic Tumor Multidisciplinary Treatment, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China.
| | - Youling Gong
- Division of Thoracic Tumor Multidisciplinary Treatment, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China.
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Yan X, Zhao Z, Tang H. Current status and future of anti-angiogenic drugs in lung cancer. Clin Exp Med 2023; 23:2009-2023. [PMID: 36920592 DOI: 10.1007/s10238-023-01039-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 03/02/2023] [Indexed: 03/16/2023]
Abstract
Lung cancer, as a malignant tumor with both high incidence and mortality in China, is one of the major causes of death in our population and one of the major public health problems in China. Effective treatment of lung cancer is a major public health task for all human beings. Angiogenesis plays an important role in the development of tumor, not only as a basic condition for tumor growth, but also as a significant factor to promote tumor metastasis. Therefore, anti-angiogenesis has become a vital means to inhibit tumor development, and anti-angiogenic drugs can rebalance pro- and anti-angiogenic factors to inhibit tumor cells. This article reviews the mechanism of blood vessel formation in tumor tissues and the mechanism of action of different anti-angiogenic drugs, the combination therapy of anti-angiogenic drugs and other anti-tumor drugs, and the mechanism of anti-angiogenic drug resistance.
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Affiliation(s)
- Xuan Yan
- Department of Respiratory and Critical Care Medicine, Shanghai Public Health Clinical Center, Fudan University, Jinshan District, No. 2901, Caolang Road, Shanghai, 201508, People's Republic of China
| | - Zhangyan Zhao
- Department of Respiratory and Critical Care Medicine, Shanghai Public Health Clinical Center, Fudan University, Jinshan District, No. 2901, Caolang Road, Shanghai, 201508, People's Republic of China
| | - Haicheng Tang
- Department of Respiratory and Critical Care Medicine, Shanghai Public Health Clinical Center, Fudan University, Jinshan District, No. 2901, Caolang Road, Shanghai, 201508, People's Republic of China.
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Zhao Y, Yu L, Wang L, Wu Y, Chen H, Wang Q, Wu Y. Current status of and progress in the treatment of malignant pleural effusion of lung cancer. Front Oncol 2023; 12:961440. [PMID: 36818672 PMCID: PMC9933866 DOI: 10.3389/fonc.2022.961440] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 12/30/2022] [Indexed: 01/22/2023] Open
Abstract
Malignant pleural effusion (MPE) is a common complication in the late stage of malignant tumors. The appearance of MPE indicates that the primary tumor has spread to the pleura or progressed to an advanced stage. The survival time of the patients will be significantly shortened, with a median survival of only a few months. There are a variety of traditional treatments, and their advantages and disadvantages are relatively clear. There are still many problems that cannot be solved by traditional methods in clinical work. The most common one is intrapleural perfusion therapy with chemotherapy drugs, but it has a large side effect of chemotherapy. At present, with the development of medical technology, there are a variety of treatment methods, and many innovative, significant and valuable treatment methods have emerged, which also bring hope for the treatment of refractory and recurrent MPE patients. Several clinical trials had confirmed that drug-carrying microparticles has less adverse reactions and obvious curative effect. However, there is still a long way to go to completely control and cure MPE, and the organic combination of clinical work and scientific research results is needed to bring dawn to refractory MPE patients.
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Affiliation(s)
| | | | | | | | | | | | - Yufeng Wu
- *Correspondence: Qiming Wang, ; Yufeng Wu,
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Successful treatment with lenvatinib in a patient with thymic carcinoma presenting with cardiac tamponade: a case report and review of literature. Anticancer Drugs 2022; 33:761-764. [PMID: 35946531 DOI: 10.1097/cad.0000000000001332] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Thymic carcinoma (TC) presenting with cardiac tamponade has a poor prognosis because of the difficulty in controlling malignant pericardial effusion using conventional chemotherapy. Lenvatinib, a multitargeted kinase inhibitor of vascular endothelial growth factor receptor and other kinases, has recently been proven effective against TC. As the inhibition of vascular endothelial growth factor signaling is effective in malignant pericardial effusion, lenvatinib may also be effective in TC presenting with cardiac tamponade. However, no reports have shown that lenvatinib is effective in such cases. Herein, we present a case of successful treatment with lenvatinib in a patient with TC presenting with cardiac tamponade. The present case suggests that lenvatinib should be considered an effective treatment option for such cases.
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Di W, Yue C, Ziran Z, Jie Z, Jun N, Ling D, Weiheng H, Xiaoling C, Xiangjuan M, Guangming T, Jindi H, Sen H, Yang W, Jieran L, Jian F. A phase II study of bevacizumab in non-squamous, non-small-cell lung cancer patients with malignant pleural effusion. Future Oncol 2022; 18:669-677. [PMID: 35080187 DOI: 10.2217/fon-2021-1035] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To investigate the efficacy, safety and optimal dosage of bevacizumab in non-squamous, non-small-cell lung cancer (NSCLC) patients with malignant pleural effusion (MPE). Methods: 20 patients were enrolled and received intrapleural injection of bevacizumab (group A: 2.5 mg/kg d1, d8; group B: 5 mg/kg d1, d8; group C: 7.5 mg/kg d1, d8). Results: The objective control rate (ORR) of MPE was 50%. The median progression-free survival (PFS) of MPE was 7.0 months (95% CI 4.9-9.2). The ORR and PFS of MPE from group B were better than those of group A and group C. The most common adverse events (AEs) were hypertension (15%) and anemia (15%). Conclusion: Bevacizumab has certain efficacy in non-squamous NSCLC patients with MPE. Clinical Trial Registration: NCT02942043 (ClinicalTrials.gov).
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Affiliation(s)
- Wu Di
- Department of Thoracic Oncology II, Key Laboratory of Carcinogenesis & Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, 100142 China
| | - Cong Yue
- Department of Ultrasound, Key Laboratory of Carcinogenesis & Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, 100142, China
| | - Zhang Ziran
- Department of Thoracic Oncology II, Key Laboratory of Carcinogenesis & Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, 100142 China
| | - Zhang Jie
- Department of Thoracic Oncology II, Key Laboratory of Carcinogenesis & Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, 100142 China
| | - Nie Jun
- Department of Thoracic Oncology II, Key Laboratory of Carcinogenesis & Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, 100142 China
| | - Dai Ling
- Department of Thoracic Oncology II, Key Laboratory of Carcinogenesis & Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, 100142 China
| | - Hu Weiheng
- Department of Thoracic Oncology II, Key Laboratory of Carcinogenesis & Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, 100142 China
| | - Chen Xiaoling
- Department of Thoracic Oncology II, Key Laboratory of Carcinogenesis & Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, 100142 China
| | - Ma Xiangjuan
- Department of Thoracic Oncology II, Key Laboratory of Carcinogenesis & Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, 100142 China
| | - Tian Guangming
- Department of Thoracic Oncology II, Key Laboratory of Carcinogenesis & Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, 100142 China
| | - Han Jindi
- Department of Thoracic Oncology II, Key Laboratory of Carcinogenesis & Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, 100142 China
| | - Han Sen
- Department of Thoracic Oncology II, Key Laboratory of Carcinogenesis & Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, 100142 China
| | - Wang Yang
- Department of Thoracic Oncology II, Key Laboratory of Carcinogenesis & Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, 100142 China
| | - Long Jieran
- Department of Thoracic Oncology II, Key Laboratory of Carcinogenesis & Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, 100142 China
| | - Fang Jian
- Department of Thoracic Oncology II, Key Laboratory of Carcinogenesis & Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, 100142 China
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Clone Selection Artificial Intelligence Algorithm-Based Positron Emission Tomography-Computed Tomography Image Information Data Analysis for the Qualitative Diagnosis of Serous Cavity Effusion in Patients with Malignant Tumors. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:4272411. [PMID: 34961825 PMCID: PMC8710161 DOI: 10.1155/2021/4272411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 11/28/2021] [Accepted: 12/01/2021] [Indexed: 11/17/2022]
Abstract
This study aimed to investigate the application of positron emission tomography- (PET-) computed tomography (CT) image information data combined with serous cavity effusion based on clone selection artificial intelligence algorithm in the diagnosis of patients with malignant tumors. A total of 97 patients with PET-CT scanning and empirically confirmed as serous cavity effusion were retrospectively analyzed in this study. The clone selection artificial intelligence algorithm was applied to register the PET-CT images, and the patients were rolled into a benign effusion group and a malignant effusion group according to the benign and malignant conditions of the serous cavity effusion. Besides, the causes of patients from the two groups were analyzed, and there was a comparison of their physiological conditions. Subsequently, CT values of different KeV, lipid/water, water/iodine, and water/calcium concentrations were measured, and the differences of the above quantitative parameters between benign and malignant serous cavity effusion were compared, as well as the registration results of the clone algorithm. The results showed that the registration time and misalignment times of clonal selection algorithm (13.88, 0) were lower than those of genetic algorithm (18.72, 8). There were marked differences in CT values of 40-60 keV and 130-140 keV between the two groups. The concentrations of lipid/water, water/iodine, and water/calcium in basal substances of the malignant effusion group were obviously higher than the concentrations of the benign effusion group (P < 0.05). Benign and malignant effusions presented different manifestations in PET-CT, which was conducive to the further diagnosis of malignant tumors. Based on clone selection artificial intelligence algorithm, PET-CT could provide a new multiparameter method for the identification of benign and malignant serous cavity effusions and benign and malignant tumors.
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Wang S, Li D, Wang J, Wan Y, Huang C, Yang B, Tang X, Tian G, Yang Z. A Comparative Study of Liquid-Based Cytology and DNA Image Cytometry in the Diagnosis of Serous Effusion. Technol Cancer Res Treat 2020; 19:1533033820942298. [PMID: 32856543 PMCID: PMC7457635 DOI: 10.1177/1533033820942298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background: Liquid-based cytology is one of the most useful methods to diagnose a patient with serous effusion, especially when malignancy is suspected. As an alternative to the use of liquid-based cytology only, the serous effusion can be further processed using the technique of DNA image cytometry, which may augment diagnostic utility. The aim of this study was to compare the diagnostic yields of liquid-based cytology, DNA image cytometry, and both in combination, regardless of serous-effusion etiology. Methods: We conducted a descriptive study on patients with serous effusions from July 2016 to June 2018. All samples were submitted for liquid-based cytology and DNA image cytometry techniques. We compared the results of cytopathological studies to the final diagnoses. Results: For a total of 798 samples, final diagnoses included 412 (51.6%) malignancies, 280 (35.1.%) inflammatory diseases, and 106 (13.3%) transudative serous effusions. Liquid-based cytology had a more sensitive diagnostic yield than DNA image cytometry did (38.8% vs 30.7%; P < .05), but the combination of both had a higher yield (43.7%; P < .05) compared with that of liquid-based cytology alone. For the 412 malignant serous effusions, diagnostic yields of liquid-based cytology and DNA image cytometry were 73.8% and 59.5%, respectively. The difference in sensitivity was significant (P < .05). Combined liquid-based cytology + DNA image cytometry improved diagnostic yield to 83.3% (P < .05). However, both liquid-based cytology and DNA image cytometry had low diagnostic yields for inflammatory diseases and transudative serous effusions. Conclusion: In serous effusion, liquid-based cytology’s diagnostic performance is better than that of DNA image cytometry. Application of both techniques can significantly increase diagnostic yield.
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Affiliation(s)
- Shaohua Wang
- Department of Pathology, 74647The Affiliated Hospital of Southwest Medical University, Luzhou, People's Republic of China
| | - Dan Li
- Department of Oncology, 74647The Affiliated hospital of Southwest Medical University, Luzhou, People's Republic of China
| | - Jieqiong Wang
- Department of Pathology, 74647The Affiliated Hospital of Southwest Medical University, Luzhou, People's Republic of China
| | - Yu Wan
- Department of Pathology, 74647The Affiliated Hospital of Southwest Medical University, Luzhou, People's Republic of China
| | - Conggai Huang
- Department of Pathology, 74647The Affiliated Hospital of Southwest Medical University, Luzhou, People's Republic of China
| | - Bo Yang
- Department of Pathology, 74647The Affiliated Hospital of Southwest Medical University, Luzhou, People's Republic of China
| | - Xiaoqin Tang
- Department of Pathology, 74647The Affiliated Hospital of Southwest Medical University, Luzhou, People's Republic of China
| | - Gang Tian
- Department of Pathology, 74647The Affiliated Hospital of Southwest Medical University, Luzhou, People's Republic of China
| | - Zhihui Yang
- Department of Pathology, 74647The Affiliated Hospital of Southwest Medical University, Luzhou, People's Republic of China
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刘 玉, 田 攀. [Progress of Bevacizumab in Malignant Pleural Effusion Caused by Non-small Cell Lung Cancer]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2019; 22:118-124. [PMID: 30827329 PMCID: PMC6397943 DOI: 10.3779/j.issn.1009-3419.2019.02.07] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Revised: 10/08/2018] [Accepted: 11/04/2018] [Indexed: 02/05/2023]
Abstract
Lung cancer is the most commonly diagnosed cancer worldwide. Malignant pleural effusion (MPE) caused by advanced lung cancer seriously affect the patients' quality of life and prognosis. The management of MPE includes thoracentesis, pleurodesis, indwelling pleural catheters and drug perfusion in pleural cavity. Vascular endothelial growth factor (VEGF) and its receptor are a group of important ligands and receptors that affect angiogenesis. They are the main factors controlling angiogenesis, and they play an important role in the formation of MPE. Bevacizumab is a recombinant humanized VEGF monoclonal antibody, competitively binding to endogenous VEGF receptor. Bevacizumab can inhibit new blood vessel formation, reduce vascular permeability, prevent pleural effusion accumulation and slow the growth of cancers. This review aims to discuss the progress of bevacizumab in the treatment of MPE caused by non-small cell lung cancer (NSCLC), and explore the clinical application, efficacy, safety and future direction of bevacizumab.
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Affiliation(s)
- 玉杰 刘
- />610041 成都,四川大学华西医院呼吸与危重症医学科Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu 610041, China
| | - 攀文 田
- />610041 成都,四川大学华西医院呼吸与危重症医学科Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu 610041, China
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Song X, Chen D, Guo J, Kong L, Wang H, Wang Z. Better efficacy of intrapleural infusion of bevacizumab with pemetrexed for malignant pleural effusion mediated from nonsquamous non-small cell lung cancer. Onco Targets Ther 2018; 11:8421-8426. [PMID: 30568464 PMCID: PMC6267356 DOI: 10.2147/ott.s184030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background and objective Several clinical trials have reported that intrapleural infusion of bevacizumab with or without cisplatin exhibits encouraging efficacy in nonsquamous non-small cell lung cancer (NS-NSCLC) patients with malignant serous cavity effusion. However, most of the studies included a number of different types of cancers or different hydrops types rather than focusing on one. In addition, no study reported the efficacy and toxicity of intrapleural infusion of bevacizumab and pemetrexed for advanced NS-NSCLC patients with malignant pleural effusion (MPE). Patients and methods We retrospectively collected patients with MPE mediated from NS-NSCLC who underwent intrapleural infusion of bevacizumab between August 2012 and February 2017. According to the different combined agents with bevacizumab, we divide patients into two groups: Group 1 (BP Group) intrapleural infusion of bevacizumab combined with pemetrexed and Group 2 (BD group) intrapleural infusion of bevacizumab combined with cisplatin. Results A total of 45 patients were enrolled in this study. Twenty-two of them received intrapleuralinfusion of bevacizumab and pemetrexed every 2 weeks, 23 received bevacizumab and cisplatin after draining effusion as much as possible. The progression-free survival for patients in BP group was significantly higher than BD group (P < 0.05) while the overall survival between the two groups was not significantly different (P > 0.05). In addition, there was no statistical difference in adverse effects between two groups. Conclusion Intrapleural infusion of bevacizumab and pemetrexed is effective and tolerable for patients with MPE mediated from NSCLC.
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Affiliation(s)
- Xinyu Song
- Department of Medical Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, Shandong, People's Republic of China, ; .,School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences, Jinan, Shandong, People's Republic of China
| | - Dawei Chen
- Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, Shandong, People's Republic of China
| | - Jun Guo
- Department of Medical Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, Shandong, People's Republic of China, ;
| | - Li Kong
- Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, Shandong, People's Republic of China
| | - Haiyong Wang
- Department of Medical Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, Shandong, People's Republic of China, ;
| | - Zhehai Wang
- Department of Medical Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, Shandong, People's Republic of China, ;
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Sabang RL, Gandhiraj D, Fanucchi M, Epelbaum O. Role of bevacizumab in the management of the patient with malignant pleural effusion: more questions than answers. Expert Rev Respir Med 2017; 12:87-94. [PMID: 29235400 DOI: 10.1080/17476348.2018.1417042] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Malignant pleural effusion (MPE) is a feature of metastatic cancer associated with significant morbidity and cost. The typical management of MPE is systemic chemotherapy and mechanical intervention. Vascular endothelial growth factor (VEGF), an inducer of vascular permeability, has been shown to mediate fluid formation. Therefore, bevacizumab, an inhibitor of VEGF, offers theoretical promise for abolishing fluid formation in MPE. Areas covered: This review begins with a summary of VEGF physiology and evidence of its role in MPE pathogenesis. This is followed by an overview of bevacizumab and major trials that put it on the map of non-small cell lung cancer (NSCLC). The majority of the article is devoted to a review of the current evidence base for the use of bevacizumab for MPE control in metastatic pleural malignancy. The review concludes with considerations of patient selection and toxicity. Expert commentary: Evidence in support of bevacizumab administration for MPE management remains flawed. Small studies suggest efficacy of both intravenous and intrapleural routes, but their design raises bias concerns. Bevacizumab appears to be safe in properly selected cases. The future of MPE management may de-emphasize VEGF inhibition in favor of precise molecular therapeutics that could address the root cause of tumorigenesis.
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Affiliation(s)
- Ralph Llewel Sabang
- a Department of Internal Medicine , Westchester Medical Center , Valhalla , NY , USA
| | - Deepthi Gandhiraj
- b Division of Pulmonary, Critical Care, and Sleep Medicine , Saint Louis University , St Louis , MO , USA
| | - Michael Fanucchi
- c Division of Hematology and Oncology , Westchester Medical Center , Valhalla , NY , USA
| | - Oleg Epelbaum
- d Division of Pulmonary, Critical Care, and Sleep Medicine , Westchester Medical Center , Valhalla , NY , USA
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