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Horvath L, Puschmann C, Scheiber A, Martowicz A, Sturm G, Trajanoski Z, Wolf D, Pircher A, Salcher S. Beyond binary: bridging neutrophil diversity to new therapeutic approaches in NSCLC. Trends Cancer 2024; 10:457-474. [PMID: 38360439 DOI: 10.1016/j.trecan.2024.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 01/19/2024] [Accepted: 01/23/2024] [Indexed: 02/17/2024]
Abstract
Neutrophils represent the most abundant myeloid cell subtype in the non-small-cell lung cancer (NSCLC) tumor microenvironment (TME). By anti- or protumor polarization, they impact multiple aspects of tumor biology and affect sensitivity to conventional therapies and immunotherapies. Single-cell RNA sequencing (scRNA-seq) analyses have unraveled an extensive neutrophil heterogeneity, helping our understanding of their pleiotropic role. In this review we summarize recent data and models on tumor-associated neutrophil (TAN) biology, focusing on the diversity that evolves in response to tumor-intrinsic cues. We categorize available transcriptomic profiles from different cancer entities into a defined set of neutrophil subclusters with distinct phenotypic properties, to step beyond the traditional binary N1/2 classification. Finally, we discuss potential ways to exploit these neutrophil states in the setting of anticancer therapy.
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Affiliation(s)
- Lena Horvath
- Department of Hematology and Oncology, Internal Medicine V, Comprehensive Cancer Center Innsbruck (CCCI), Medical University of Innsbruck (MUI), Innsbruck, Austria
| | - Constanze Puschmann
- Department of Hematology and Oncology, Internal Medicine V, Comprehensive Cancer Center Innsbruck (CCCI), Medical University of Innsbruck (MUI), Innsbruck, Austria
| | - Alexandra Scheiber
- Department of Hematology and Oncology, Internal Medicine V, Comprehensive Cancer Center Innsbruck (CCCI), Medical University of Innsbruck (MUI), Innsbruck, Austria
| | - Agnieszka Martowicz
- Department of Hematology and Oncology, Internal Medicine V, Comprehensive Cancer Center Innsbruck (CCCI), Medical University of Innsbruck (MUI), Innsbruck, Austria
| | - Gregor Sturm
- Biocenter, Institute of Bioinformatics, Medical University of Innsbruck, Innsbruck, Austria; Boehringer Ingelheim International Pharma GmbH & Co KG, Biberach, Germany
| | - Zlatko Trajanoski
- Biocenter, Institute of Bioinformatics, Medical University of Innsbruck, Innsbruck, Austria
| | - Dominik Wolf
- Department of Hematology and Oncology, Internal Medicine V, Comprehensive Cancer Center Innsbruck (CCCI), Medical University of Innsbruck (MUI), Innsbruck, Austria
| | - Andreas Pircher
- Department of Hematology and Oncology, Internal Medicine V, Comprehensive Cancer Center Innsbruck (CCCI), Medical University of Innsbruck (MUI), Innsbruck, Austria
| | - Stefan Salcher
- Department of Hematology and Oncology, Internal Medicine V, Comprehensive Cancer Center Innsbruck (CCCI), Medical University of Innsbruck (MUI), Innsbruck, Austria.
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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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Kim S, Kang SI, Kim S, Kim JH. Prognostic implications of chemotherapy-induced neutropenia in stage III colorectal cancer. J Surg Res 2021; 267:391-396. [PMID: 34218138 DOI: 10.1016/j.jss.2021.05.002] [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: 07/27/2020] [Revised: 04/20/2021] [Accepted: 05/02/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Previous studies have reported chemotherapy-induced neutropenia (CIN) as a prognostic factor in stage IV colorectal cancer (CRC). However, only few reports analyzed the prognostic value of CIN in patients with stage III CRC who received adjuvant chemotherapy with oxaliplatin, 5-fluorouracil, and leucovorin (FOLFOX). We aimed to investigate the prognostic implications of CIN in patients with stage III CRC who received adjuvant chemotherapy with FOLFOX. MATERIALS AND METHODS We retrospectively analyzed patients with stage III CRC who received adjuvant chemotherapy with FOLFOX at a tertiary hospital between January 2007 and December 2017. Severe CIN was defined as an absolute neutrophil count of less than 1000/mm3. Three-y disease-free survival (DFS) and overall survival (OS) were analyzed as primary endpoints. RESULTS Among the 199 patients included in this study, 110 patients (55.3%) experienced severe CIN. There were no significant differences in survival outcomes between the control and CIN groups (control group versus CIN group: 3-y OS, 82.0 % versus 72.7 %; log rank, P = 0.250 and 3-y DFS, 71.9 % versus 62.7; log rank, P = 0.294). Univariate and multivariate analyses revealed that CIN did not affect DFS and OS in patients with stage III CRC who received adjuvant FOLFOX chemotherapy. CONCLUSIONS Severe CIN occurring during adjuvant FOLFOX chemotherapy did not play a significant role in the prognosis of patients with stage III CRC.
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Affiliation(s)
- Sungjin Kim
- Department of Surgery, Yeungnam University Medical Center, Daegu, Korea
| | - Sung Il Kang
- Department of Surgery, Yeungnam University Medical Center, Daegu, Korea.
| | - Sohyun Kim
- Department of Surgery, Yeungnam University Medical Center, Daegu, Korea
| | - Jae Hwang Kim
- Department of Surgery, Yeungnam University Medical Center, Daegu, Korea
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Ba Y, Shi Y, Jiang W, Feng J, Cheng Y, Xiao L, Zhang Q, Qiu W, Xu B, Xu R, Shen B, Luo Z, Xie X, Chang J, Wang M, Li Y, Shuang Y, Niu Z, Liu B, Zhang J, Zhang L, Yao H, Xie C, Huang H, Liao W, Chen G, Zhang X, An H, Deng Y, Gong P, Xiong J, Yao Q, An X, Chen C, Shi Y, Wang J, Wang X, Wang Z, Xing P, Yang S, Zhou C. Current management of chemotherapy-induced neutropenia in adults: key points and new challenges: Committee of Neoplastic Supportive-Care (CONS), China Anti-Cancer Association Committee of Clinical Chemotherapy, China Anti-Cancer Association. Cancer Biol Med 2020; 17:896-909. [PMID: 33299642 PMCID: PMC7721096 DOI: 10.20892/j.issn.2095-3941.2020.0069] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Accepted: 07/23/2020] [Indexed: 12/31/2022] Open
Abstract
Chemotherapy-induced neutropenia (CIN) is a potentially fatal and common complication in myelosuppressive chemotherapy. The timing and grade of CIN may play prognostic and predictive roles in cancer therapy. CIN is associated with older age, poor functional and nutritional status, the presence of significant comorbidities, the type of cancer, previous chemotherapy cycles, the stage of the disease, specific chemotherapy regimens, and combined therapies. There are many key points and new challenges in the management of CIN in adults including: (1) Genetic risk factors to evaluate the patient's risk for CIN remain unclear. However, these risk factors urgently need to be identified. (2) Febrile neutropenia (FN) remains one of the most common reasons for oncological emergency. No consensus nomogram for FN risk assessment has been established. (3) Different assessment tools [e.g., Multinational Association for Supportive Care in Cancer (MASCC), the Clinical Index of Stable Febrile Neutropenia (CISNE) score model, and other tools] have been suggested to help stratify the risk of complications in patients with FN. However, current tools have limitations. The CISNE score model is useful to support decision-making, especially for patients with stable FN. (4) There are still some challenges, including the benefits of granulocyte colony stimulating factor treatment and the optimal antibiotic regimen in emergency management of FN. In view of the current reports, our group discusses the key points, new challenges, and management of CIN.
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Affiliation(s)
- Yi Ba
- Department of Gastrointestinal Medical Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China
| | - Yuankai Shi
- Department of Medical Oncology, National Cancer Center, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Wenqi Jiang
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Jifeng Feng
- Department of Medical Oncology, Jiangsu Cancer Hospital, Nanjing 210009, China
| | - Ying Cheng
- Department of Oncology, Jilin Province Cancer Hospital, Changchun 130012, China
| | - Li Xiao
- Department of Oncology, Zhongshan Hospital Affiliated to Xiamen University, Xiamen 361004, China
| | - Qingyuan Zhang
- Department of Oncology, Cancer Hospital Harbin Medical University, Harbin 150081, China
| | - Wensheng Qiu
- Department of Oncology, Affiliated Hospital of Qingdao University, Qingdao 266003, China
| | - Binghe Xu
- Department of Medical Oncology, National Cancer Center, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Ruihua Xu
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Bo Shen
- Department of Medical Oncology, Jiangsu Cancer Hospital, Nanjing 210009, China
| | - Zhiguo Luo
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China
| | - Xiaodong Xie
- Department of Oncology, General Hospital of Shenyang Military Region, Shenyang 110016, China
| | - Jianhua Chang
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China
| | - Mengzhao Wang
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Beijing 100730, China
| | - Yufu Li
- Department of Hematology, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou 450008, China
| | - Yuerong Shuang
- Lymphoma and Myeloma Department, Jiangxi Cancer Hospital, Nanchang 330029, China
| | - Zuoxing Niu
- Department of Medical Oncology, Shandong Cancer Hospital, Shandong Academy of Medical Sciences, Jinan 250117, China
| | - Bo Liu
- Department of Medical Oncology, Shandong Cancer Hospital, Shandong Academy of Medical Sciences, Jinan 250117, China
| | - Jun Zhang
- Department of Oncology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Li Zhang
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Herui Yao
- Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Conghua Xie
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan 430070, China
| | - Huiqiang Huang
- Department of Medical Oncology, National Cancer Center, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Wangjun Liao
- Department of Oncology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Gongyan Chen
- Department of Oncology, Cancer Hospital Harbin Medical University, Harbin 150081, China
| | - Xiaotian Zhang
- Department of Gastrointestinal Oncology, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Hanxiang An
- Department of Medical Oncology, Xiang'an Hospital of Xiamen University, Xiamen 361101, China
| | - Yanhong Deng
- Department of Medical Oncology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, China
| | - Ping Gong
- Department of Oncology, The First Affiliated Hospital, Shihezi University School of Medicine, Shihezi 832000, China
| | - Jianping Xiong
- Department of Oncology, The First Affiliated Hospital of Nanchang University, Nanchang 330006, China
| | - Qinghua Yao
- Department of Integrated Chinese and Western Medicine, Cancer Hospital of University of Chinese Academy of Science, Zhejiang Cancer Hospital, Hangzhou 310022, China
| | - Xin An
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Cheng Chen
- Department of Medical Oncology, Jiangsu Cancer Hospital, Nanjing 210009, China
| | - Yanxia Shi
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Jialei Wang
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China
| | - Xiaohua Wang
- Department of Medical Oncology, Jiangsu Cancer Hospital, Nanjing 210009, China
| | - Zhiqiang Wang
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Puyuan Xing
- Department of Medical Oncology, National Cancer Center, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Sheng Yang
- Department of Medical Oncology, National Cancer Center, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Chenfei Zhou
- Department of Oncology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
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Kan M, Imaoka H, Watanabe K, Sasaki M, Takahashi H, Hashimoto Y, Ohno I, Mitsunaga S, Umemoto K, Kimura G, Suzuki Y, Eguchi H, Otsuru T, Goda K, Ikeda M. Chemotherapy-induced neutropenia as a prognostic factor in patients with pancreatic cancer treated with gemcitabine plus nab-paclitaxel: a retrospective cohort study. Cancer Chemother Pharmacol 2020; 86:203-210. [PMID: 32632515 DOI: 10.1007/s00280-020-04110-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 06/30/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Chemotherapy-induced neutropenia (CIN) is a common adverse event of chemotherapy. Several reports have suggested that CIN could be an important prognostic factor in chemotherapy of various cancers. However, whether CIN is a prognostic factor in unresectable pancreatic cancer (PC) treated with gemcitabine plus nab-paclitaxel (GnP) is unknown. The primary endpoint of this study was to compare overall survival (OS) between patients with severe CIN (grade ≥ 3) and those with absent/mild CIN (grade ≤ 2) in unresectable PC cases treated with GnP as first-line chemotherapy. METHODS A retrospective, cohort study was conducted using data from a computerized database. A total of 290 patients with pathologically confirmed PC treated with GnP as first-line chemotherapy were analyzed (severe CIN: ≥ grade 3, n = 174; absent/mild CIN: ≤ grade 2, n = 116). RESULTS The median OS was longer in the severe CIN group than in the absent/mild CIN group (19.2 months vs 11.3 months, respectively; P < 0.001). After adjustment, severe CIN was an independent predictive factor for OS (hazard ratio [HR], 0.53; 95% confidence interval [CI], 0.38-0.74; P < 0.001). After adjustment by time-varying covariates, severe CIN was still a significant prognostic factor for OS (HR, 0.79; 95% CI 0.69-0.91, P = 0.001). CONCLUSION The present results show that severe CIN is an independent and useful prognostic factor in PC patients treated with GnP.
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Affiliation(s)
- Motoyasu Kan
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, 277-8577, Japan
| | - Hiroshi Imaoka
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, 277-8577, Japan.
| | - Kazuo Watanabe
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, 277-8577, Japan
| | - Mitsuhito Sasaki
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, 277-8577, Japan
| | - Hideaki Takahashi
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, 277-8577, Japan
| | - Yusuke Hashimoto
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, 277-8577, Japan
| | - Izumi Ohno
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, 277-8577, Japan
| | - Shuichi Mitsunaga
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, 277-8577, Japan
| | - Kumiko Umemoto
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, 277-8577, Japan
| | - Gen Kimura
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, 277-8577, Japan
| | - Yuko Suzuki
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, 277-8577, Japan
| | - Hiroki Eguchi
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, 277-8577, Japan
| | - Toru Otsuru
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, 277-8577, Japan
| | - Kyosuke Goda
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, 277-8577, Japan
| | - Masafumi Ikeda
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, 277-8577, Japan
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Kasi PM, Grothey A. Chemotherapy-Induced Neutropenia as a Prognostic and Predictive Marker of Outcomes in Solid-Tumor Patients. Drugs 2019; 78:737-745. [PMID: 29754293 DOI: 10.1007/s40265-018-0909-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Chemotherapy-induced neutropenia (CIN) is one of the most common side effects seen in cancer patients. As an adverse event, it is deemed undesirable since it often constitutes a dose-limiting toxicity for cytotoxic agents leading to treatment delays and/or dose reductions. It is also associated with a financial cost component from diagnostic work-up and treatment of patients with chemotherapy-induced febrile neutropenia (CIFN). Neutropenia is commonly accompanied by a decrease in other hematopoietic lineages (anemia and/or thrombocytopenia). Dosing of chemotherapeutic agents is based on the severity of adverse effects seen. Depending on the degree of neutropenia, chemotherapeutic agents may be put on hold until count recovery and growth factor support might be added to allow for dosing as scheduled. However, neutropenia appears to be more than just an adverse event. While CIFN by itself constitutes an adverse event, the appearance of just CIN is not necessarily a marker of poor outcome. In fact, it rather appears to be a surrogate marker of response and/or survival in patients treated with cytotoxic regimens. Here we present evidence in different tumor types treated with different regimens on the role CIN plays as a marker for improved outcomes. If CIN is a surrogate prognostic and/or potentially predictive marker of response, chemotherapy doses may need to be escalated to achieve neutropenia. In addition, instead of reducing treatment doses for safety concerns, the addition of growth factor support and alternative dosing schemes may be strategies to consider.
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Affiliation(s)
| | - Axel Grothey
- Division of Medical Oncology, College of Medicine/Oncology, Mayo Clinic, Gonda 10, 200 First St SW, Rochester, MN, 55905, USA.
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Systemic release of osteoprotegerin during oxaliplatin-containing induction chemotherapy and favorable systemic outcome of sequential radiotherapy in rectal cancer. Oncotarget 2017; 7:34907-17. [PMID: 27145458 PMCID: PMC5085198 DOI: 10.18632/oncotarget.8995] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 04/10/2016] [Indexed: 01/14/2023] Open
Abstract
In colorectal cancer, immune effectors may be determinative for disease outcome. Following curatively intended combined-modality therapy in locally advanced rectal cancer metastatic disease still remains a dominant cause of failure. Here, we investigated whether circulating immune factors might correlate with outcome. An antibody array was applied to assay changes of approximately 500 proteins in serial serum samples collected from patients during oxaliplatin-containing induction chemotherapy and sequential chemoradiotherapy before final pelvic surgery. Array data was analyzed by the Significance Analysis of Microarrays software and indicated significant alterations in serum osteoprotegerin (TNFRSF11B) during the treatment course, which were confirmed by osteoprotegerin measures using a single-parameter immunoassay. Patients experiencing increase in circulating osteoprotegerin during the chemotherapy had significantly better 5-year progression-free survival than those without increase (78% versus 48%; P = 0.009 by log-rank test). Hence, systemic release of this soluble tumor necrosis factor decoy receptor following the induction phase of neoadjuvant therapy was associated with favorable long-term outcome in patients given curatively intended chemoradiotherapy and surgery but with metastatic disease as the main adverse event. This finding suggests that osteoprotegerin may mediate or reflect systemic anti-tumor immunity invoked by combined-modality therapy in locally advanced rectal cancer.
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Tan X, Wen Q, Wang R, Chen Z. Chemotherapy-induced neutropenia and the prognosis of colorectal cancer: a meta-analysis of cohort studies. Expert Rev Anticancer Ther 2017; 17:1077-1085. [PMID: 28910204 DOI: 10.1080/14737140.2017.1380521] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Recently, there has been a controversial discussion about the prognostic value of chemotherapy-induced neutropenia (CIN) in colorectal cancer patients. Thus, a meta-analysis was conducted to determine the relationship between CIN and the prognosis of colorectal cancer patients. METHODS We searched the PubMed, EMBASE, and Cochrane library databases to identify studies evaluating the association between CIN and colorectal cancer prognosis. Pooled random/fixed effect models were used to calculate pooled hazard ratios (HRs) and 95% confidence intervals (CIs) to assess the association. RESULTS Eight studies were selected for the meta-analysis, for a total of 2,745 patients. There was significant improved survival among colorectal cancer patients with CIN (HR = 0.62, 95% CI = 0.47-0.76). However, significant heterogeneity was found (p = 0.000, Ι2 = 75.0%). Through subgroup analysis, we could greatly eliminate the heterogeneity and found that neutropenia was associated with better survival in stage IV colorectal cancer patients, no matter the HR calculated by overall survival (OS) or progression-free survival (PFS). Meanwhile, the prognostic value of neutropenia in stage II/III colorectal cancer can be found when the HR is calculated by disease-free survival (DFS). Additionally, we observed significant differences after stratification according to various tumor stages, endpoints, and the use of G-CSF. CONCLUSIONS Our results which, based on a cohort study, indicate that CIN is associated with improved survival in patients with colorectal cancer. However, further randomized controlled trials are warranted.
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Affiliation(s)
- XiangZhou Tan
- a The Colorectal and Anal Surgical Department , XiangYa Hospital of Central South University , ChangSha , China
| | - QiaoCheng Wen
- a The Colorectal and Anal Surgical Department , XiangYa Hospital of Central South University , ChangSha , China
| | - Ran Wang
- a The Colorectal and Anal Surgical Department , XiangYa Hospital of Central South University , ChangSha , China
| | - ZhiKang Chen
- a The Colorectal and Anal Surgical Department , XiangYa Hospital of Central South University , ChangSha , China
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Abstract
Despite a growing number of treatment options, metastatic castrate resistant prostate cancer remains almost universally fatal. Dose individualization ensures patients receive the maximal benefit from each line of treatment potentially leading to improved outcomes, a reduction in quality of life impairment and minimization of premature cessation for avoidable toxicity. Herein, we review drug-specific issues that may be associated with unexpected or unrecognized variations in drug systemic exposure despite the use of protocol doses. In particular, we discuss the potential for under-exposure of docetaxel and cabazitaxel; over-exposure of enzalutamide; and varied absorption of abiraterone acetate.
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Affiliation(s)
- Megan Crumbaker
- Crown Princess Mary Cancer Care Centre, Westmead Hospital, New South Wales, Australia
- Kinghorn Cancer Centre, Darlinghurst, New South Wales, Australia
- Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia
| | - Howard Gurney
- Crown Princess Mary Cancer Care Centre, Westmead Hospital, New South Wales, Australia
- Macquarie University, New South Wales, Australia
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10
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Chen Y, Shi Y, Yan H, Wang YR, Dai GH. Timing of chemotherapy-induced neutropenia: the prognostic factor in advanced pancreatic cancer patients treated with gemcitabine / gemcitabine-based chemotherapy. Oncotarget 2017; 8:66593-66600. [PMID: 29029540 PMCID: PMC5630440 DOI: 10.18632/oncotarget.16980] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 03/09/2017] [Indexed: 12/20/2022] Open
Abstract
Chemotherapy-induced neutropenia (CIN) was reported to be a predictor of better survival in several cancers. The objective of our study is to evaluate the relationship between the timing (onset) of CIN and prognosis. Between June 2008 and June 2015, 134 patients with confirmed advanced pancreatic cancer received at least one cycle of gemcitabine / gemcitabine-based chemotherapy as first-line chemotherapy were eligible for assessment. Timing of CIN was categorized into early onset and non-early onset CIN group. The end of cycle 2 was the cutoff to differentiate early onset or non-early onset. The correlation between timing of CIN with survival was analyzed by Kaplan-Meier method and Cox proportional hazards model. Median overall survival (OS) was 8.05 months (95% CI: 5.97-10.13) for patients with early onset CIN compared with 5.82 months (95% CI: 5.00-6.63) for patients without early-onset neutropenia (P = 0.022). Multivariate analysis proved that timing of CIN was an independent prognostic factor, hazard ratios of death was 0.696 (95% CI: 0.466-0.938) for patients with early onset CIN. In conclusion, timing of CIN is an independent predictor of prognosis in patients with advanced pancreatic cancer undergoing gemcitabine / gemcitabine based chemotherapy. Early-onset CIN predicts better survival.
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Affiliation(s)
- Yang Chen
- Medical Oncology Department 2, Chinese PLA General Hospital and Chinese PLA Medical School, Beijing 100853, China
| | - Yan Shi
- Medical Oncology Department 2, Chinese PLA General Hospital and Chinese PLA Medical School, Beijing 100853, China
| | - Huan Yan
- Medical Oncology Department 2, Chinese PLA General Hospital and Chinese PLA Medical School, Beijing 100853, China
| | - Yan Rong Wang
- Medical Oncology Department 2, Chinese PLA General Hospital and Chinese PLA Medical School, Beijing 100853, China
| | - Guang Hai Dai
- Medical Oncology Department 2, Chinese PLA General Hospital and Chinese PLA Medical School, Beijing 100853, China
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11
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Zhao W, Wang P, Jia H, Chen M, Gu X, Liu M, Zhang Z, Cheng W, Wu Z. Neutrophil count and percentage: potential independent prognostic indicators for advanced cancer patients in a palliative care setting. Oncotarget 2017; 8:64499-64508. [PMID: 28969089 PMCID: PMC5610021 DOI: 10.18632/oncotarget.16469] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 03/09/2017] [Indexed: 12/11/2022] Open
Abstract
The purpose of this study was to evaluate the count and percentage of neutrophils as prognostic indicators in advanced cancer patients undergoing palliative care. 378 consecutive patients receiving treatment at the palliative care unit of Fudan University Shanghai Cancer Center between July 2013 and October 2015 were reviewed. In 106 of these patients, the data were extended during the follow-up. The cut-off values selected for the neutrophil count and percentage were 8.0×109/L and 85%, respectively. Both a high pretreatment neutrophil count (HR = 1.828, 95% CI: 1.409∼2.371, P<0.001) and a high pretreatment neutrophil percentage (HR = 1.475, 95% CI: 1.106∼1.967, P=0.008) were independent prognostic factors for decreased overall survival. Furthermore, in the follow-up cohort of readmitted patients (n = 106), patients with a newly increased neutrophil count or percentage were respectively, 1.837 (95% CI: 1.096∼3.079) and 3.268 (95% CI: 1.848∼5.778) times more likely to have a poor prognosis compared with patients with low neutrophil conditions (P=0.021, P<0.001). In conclusions, both high pretreatment or newly increased count and percentage of neutrophils were confirmed as independent prognostic factors for adverse outcomes. These parameters may be used as stratification factors in identifying advanced cancer patients with poor prognosis in palliative care settings.
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Affiliation(s)
- Weiwei Zhao
- Department of Integrated Therapy, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Peng Wang
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.,Department of Integrative Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Huixun Jia
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.,Center for Biomedical Statistical, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Menglei Chen
- Department of Integrated Therapy, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Xiaoli Gu
- Department of Integrated Therapy, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Minghui Liu
- Department of Integrated Therapy, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Zhe Zhang
- Department of Integrated Therapy, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Wenwu Cheng
- Department of Integrated Therapy, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Zhenyu Wu
- Department of Biostatistics, School of Public Health, Key Laboratory of Public Health Safety and Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai, China
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12
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Jiao S, Li N, Cai S, Guo H, Wen Y. Inhibition of CYFIP2 promotes gastric cancer cell proliferation and chemoresistance to 5-fluorouracil through activation of the Akt signaling pathway. Oncol Lett 2017; 13:2133-2140. [PMID: 28454373 PMCID: PMC5403719 DOI: 10.3892/ol.2017.5743] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 12/06/2016] [Indexed: 12/26/2022] Open
Abstract
Gastric cancer is a common gastrointestinal malignancy that accounts for a notable proportion of cancer-associated mortalities worldwide. Cytoplasmic fragile X mental retardation 1-interacting protein 2 (CYFIP2) is a novel p53-mediated pro-apoptotic protein whose expression is decreased in gastric cancer. However, whether decreased expression of CYFIP2 contributes to gastric carcinogenesis remains unclear. In order to mimic in vivo gastric tumor CYFIP2 expression levels, the present study used short hairpin RNA targeting CYFIP2 mRNA to silence CYFIP2 expression in MGC803 and SGC7901 gastric cancer cells. Gastric cancer cells with constitutively decreased CYFIP2 expression levels were successfully established. It was observed that CYFIP2 knockdown promoted proliferation and colony formation, and inhibited apoptosis in these cells. Furthermore, 5-fluorouracil (5-FU)-induced apoptosis was decreased following inhibition of CYFIP2 expression. In SGC7901 cells, protein expression of active caspase-3 and cleaved poly (ADP-ribose) polymerase was increased following treatment with 5-FU, while phosphorylated Akt serine/threonine kinase 1 (Akt) levels were decreased. These 5-FU-induced effects were reduced following CYFIP2 knockdown. In addition, inhibition of the Akt signaling pathway using the Akt inhibitor LY294002 restored CYFIP2-knockdown SGC7901 cell chemosensitivity to 5-FU. The results of the present study demonstrate that decreased CYFIP2 expression is associated with increased gastric tumor growth in vitro and that CYFIP2 knockdown-induced activation of the Akt pro-survival signaling pathway confers resistance to 5-FU-based chemotherapy in gastric cancer cells. Therefore, combined treatment with an Akt inhibitor and chemotherapeutic drugs may improve the efficacy of gastric cancer therapy in patients with low CYFIP2 expression.
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Affiliation(s)
- Shuhua Jiao
- Department of Gastroenterology, The Fourth Affiliated Hospital of China Medical University, Shenyang, Liaoning 110032, P.R. China
| | - Nuo Li
- Department of Gastroenterology, The Fourth Affiliated Hospital of China Medical University, Shenyang, Liaoning 110032, P.R. China
| | - Shuang Cai
- Department of Gastroenterology, The Fourth Affiliated Hospital of China Medical University, Shenyang, Liaoning 110032, P.R. China
| | - Haimei Guo
- Department of Gastroenterology, The Fourth Affiliated Hospital of China Medical University, Shenyang, Liaoning 110032, P.R. China
| | - Yanhui Wen
- Department of Gastroenterology, The Fourth Affiliated Hospital of China Medical University, Shenyang, Liaoning 110032, P.R. China
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13
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Kasi PM, Kotani D, Cecchini M, Shitara K, Ohtsu A, Ramanathan RK, Hochster HS, Grothey A, Yoshino T. Chemotherapy induced neutropenia at 1-month mark is a predictor of overall survival in patients receiving TAS-102 for refractory metastatic colorectal cancer: a cohort study. BMC Cancer 2016; 16:467. [PMID: 27412464 PMCID: PMC4944251 DOI: 10.1186/s12885-016-2491-y] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 06/28/2016] [Indexed: 11/23/2022] Open
Abstract
Background TAS-102 (trifluridine and tipiracil hydrochloride; a novel combination oral nucleoside anti-tumor agent) has recently received regulatory approval for patients with refractory metastatic colorectal cancer (mCRC). Internal review of data at a single-institution showed a trend towards better overall survival (OS) for patients who experienced chemotherapy-induced neutropenia at 1-month (CIN-1-month). To explore this finding further, a cohort study was designed based on outcome data from three centers in United States and one from Japan. Methods CIN-1-month after starting TAS-102 was defined by the Common Terminology Criteria for Adverse Events (CTCAE), version 4.03 as a neutrophil count decrease of ≥ grade 2 (absolute neutrophil count < 1500/mm3). Patients had confirmed mCRC that was refractory to standard therapies. Patient demographics and clinical characteristics were compared between patients with CIN-1-month (CIN-1-month positive) versus those who did not have CIN-1-month (CIN-1-month negative); with the median progression-free survival (PFS) and OS were calculated using the Kaplan-Meier method, and differences evaluated using the Log-rank test. Results Our cohort study had a total of 149 patients with data regarding their neutrophil assessment at 1-month mark. Patients who developed ≥ grade 2 CIN-1-month had a both longer PFS (median 3.0 months versus 2.4 months; Log-rank P-value = 0.01), as well as OS (14.0 versus 5.6 months; Log-rank P-value < 0.0001). Only CIN-1-month (adjusted HR: 0.21 (95 % CI: 0.11–0.38) and higher baseline CEA levels (adjusted HR: 2.00 (95 % CI: 1.22–3.35) were noted to be independent predictors of OS. Furthermore, the CIN-1-month was noted to be a statistically significantly predictor of OS over a wide range of cutoffs. Conclusions Our observations are novel and hypothesis generating. Neutropenia after starting TAS-102 was associated with better prognosis in patients with refractory mCRC. It can be postulated that the dosage of TAS-102 potentially may need to be increased to achieve better outcomes in patients not experiencing any neutropenia. Further pharmacologic investigations should help elucidate these issues.
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Affiliation(s)
- Pashtoon M Kasi
- Division of Medical Oncology, Mayo Clinic, 200 First St SW, Rochester, 55905, MN, USA.
| | - Daisuke Kotani
- Department of Gastrointestinal Oncology, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Michael Cecchini
- Division of Medical Oncology, Yale Cancer Center, New Haven, CT, USA
| | - Kohei Shitara
- Department of Gastrointestinal Oncology, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Atsushi Ohtsu
- Department of Gastrointestinal Oncology, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | | | - Howard S Hochster
- Division of Medical Oncology, Yale Cancer Center, New Haven, CT, USA
| | - Axel Grothey
- Division of Medical Oncology, Mayo Clinic, 200 First St SW, Rochester, 55905, MN, USA
| | - Takayuki Yoshino
- Department of Gastrointestinal Oncology, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
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