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Helgadottir H, Matikas A, Fernebro J, Frödin JE, Ekman S, Rodriguez-Wallberg KA. Fertility and reproductive concerns related to the new generation of cancer drugs and the clinical implication for young individuals undergoing treatments for solid tumors. Eur J Cancer 2024; 202:114010. [PMID: 38520926 DOI: 10.1016/j.ejca.2024.114010] [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: 01/19/2024] [Revised: 03/03/2024] [Accepted: 03/05/2024] [Indexed: 03/25/2024]
Abstract
The treatment landscape of solid tumors has changed markedly in the last years. Molecularly targeted treatments and immunotherapies have been implemented and have, in many cancers, lowered the risk of relapse and prolonged survival. Patients with tumors harboring specific targetable molecular alterations or mutations are often of a younger age, and hence future fertility and family building can be important concerns in this group. However, there are great uncertainties regarding the effect of the new drugs on reproductive functions, including fertility, pregnancy and lactation and how young patients with cancers, both women and men should be advised. The goal with this review is to gather the current knowledge regarding oncofertility and the different novel therapies, including immune checkpoint inhibitors, antibody-drug conjugates, small molecules and monoclonal antibody targeted therapies. The specific circumstances and reproductive concerns in different patient groups where novel treatments have been broadly introduced are also discussed, including those with melanoma, lung, breast, colorectal and gynecological cancers. It is clear, that more awareness is needed regarding potential drug toxicity on reproductive tissues, and it is of essence that individuals are informed based on current expertise and on available fertility preservation methods.
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Affiliation(s)
- Hildur Helgadottir
- Department of Oncology and Pathology, Karolinska Institutet, 171 77 Stockholm, Sweden; Skin Cancer Centrum, Theme Cancer, Karolinska University Hospital, 171 76 Stockholm, Sweden.
| | - Alexios Matikas
- Department of Oncology and Pathology, Karolinska Institutet, 171 77 Stockholm, Sweden; Breast Center, Karolinska Comprehensive Cancer Center and Karolinska University Hospital, Stockholm, Sweden
| | - Josefin Fernebro
- Department of Oncology and Pathology, Karolinska Institutet, 171 77 Stockholm, Sweden; Division of Gynecological Cancer, Department of Pelvic Cancer, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Jan-Erik Frödin
- Department of Oncology and Pathology, Karolinska Institutet, 171 77 Stockholm, Sweden; Division of Gastrointestinal Oncology, Department of Upper abdomen, Karolinska University Hospital, Sweden
| | - Simon Ekman
- Department of Oncology and Pathology, Karolinska Institutet, 171 77 Stockholm, Sweden; Thoracic Oncology Center, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Kenny A Rodriguez-Wallberg
- Department of Oncology and Pathology, Karolinska Institutet, 171 77 Stockholm, Sweden; Department of Reproductive Medicine, Division of Gynecology and Reproduction Karolinska University Hospital, Stockholm, Sweden
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McMahon DJ, McLaughlin R, Naidoo J. Is Immunotherapy Beneficial in Patients with Oncogene-Addicted Non-Small Cell Lung Cancers? A Narrative Review. Cancers (Basel) 2024; 16:527. [PMID: 38339280 PMCID: PMC10854575 DOI: 10.3390/cancers16030527] [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: 09/23/2023] [Revised: 01/10/2024] [Accepted: 01/17/2024] [Indexed: 02/12/2024] Open
Abstract
Over the past 20 years, there has been a paradigm shift in the care of patients with non-small cell lung cancer (NSCLC), who now have a range of systemic treatment options including targeted therapy, chemotherapy, immunotherapy (ICI), and antibody-drug conjugates (ADCs). A proportion of these cancers have single identifiable alterations in oncogenes that drive their proliferation and cancer progression, known as "oncogene-addiction". These "driver alterations" are identified in approximately two thirds of patients with lung adenocarcinomas, via next generation sequencing or other orthogonal tests. It was noted in the early clinical development of ICIs that patients with oncogene-addicted NSCLC may have differential responses to ICI. The toxicity signal for patients with oncogene-addicted NSCLC when treated with ICIs also seemed to differ depending on the alteration present and the specific targeted agent used. Developing a greater understanding of the underlying reasons for these clinical observations has become an important area of research in NSCLC. In this review, we analyze the efficacy and safety of ICI according to specific mutations, and consider possible future directions to mitigate safety concerns and improve the outcomes for patients with oncogene-addicted NSCLC.
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Affiliation(s)
- David John McMahon
- Trinity St James’s Cancer Institute, St. James’s Hospital, James’s Street, D08 NHY1 Dublin, Ireland
| | | | - Jarushka Naidoo
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD 21287, USA
- Beaumont RCSI Cancer Centre, D09 V2NO Dublin, Ireland
- RCSI University of Health Sciences, D02 YN77 Dublin, Ireland
- Beaumont Hospital, D09 Y177 Dublin, Ireland
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Scheffler M, Michels S, Nogova L. [Targeted treatment of non-small cell lung cancer]. INNERE MEDIZIN (HEIDELBERG, GERMANY) 2022; 63:700-708. [PMID: 35925271 DOI: 10.1007/s00108-022-01372-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/14/2022] [Indexed: 06/15/2023]
Abstract
Non-small cell lung cancer (NSCLC) has made a remarkable development in recent decades with respect to its perception. In the late 1990s it was the "problem child" as the main cause of cancer with increasing tendencies, especially in women and with a pronounced stigmatization. It is now the role model as a biologically rational targeted treatment based on molecular dependencies of the tumor with a vast improvement of the traditionally poor survival times. Molecular tumor boards have long followed the NSCLC example in the assessment of targeted treatment approaches for other tumor entities. This review article gives an overview of the current possibilities for targeted treatment of NSCLC, which nowadays are applicable for nearly one third of all patients with NSCLC.
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Affiliation(s)
- Matthias Scheffler
- Klinik I für Innere Medizin, Centrum für Integrierte Onkologie (CIO) Aachen Bonn Köln Düsseldorf, Lung Cancer Group Cologne, Universitätsklinikum Köln (AöR), Kerpener Str. 62, 50937, Köln, Deutschland.
| | - Sebastian Michels
- Klinik I für Innere Medizin, Centrum für Integrierte Onkologie (CIO) Aachen Bonn Köln Düsseldorf, Lung Cancer Group Cologne, Universitätsklinikum Köln (AöR), Kerpener Str. 62, 50937, Köln, Deutschland
| | - Lucia Nogova
- Klinik I für Innere Medizin, Centrum für Integrierte Onkologie (CIO) Aachen Bonn Köln Düsseldorf, Lung Cancer Group Cologne, Universitätsklinikum Köln (AöR), Kerpener Str. 62, 50937, Köln, Deutschland
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Oo HZ, Lohinai Z, Khazamipour N, Lo J, Kumar G, Pihl J, Adomat H, Nabavi N, Behmanesh H, Zhai B, Dagil R, Choudhary S, Gustavsson T, Clausen TM, Esko JD, Allen JW, Thompson MA, Tran NL, Moldvay J, Dome B, Salanti A, Al-Nakouzi N, Weiss GJ, Daugaard M. Oncofetal Chondroitin Sulfate Is a Highly Expressed Therapeutic Target in Non-Small Cell Lung Cancer. Cancers (Basel) 2021; 13:4489. [PMID: 34503301 PMCID: PMC8430715 DOI: 10.3390/cancers13174489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 08/27/2021] [Accepted: 09/02/2021] [Indexed: 11/27/2022] Open
Abstract
Broad-spectrum therapeutics in non-small cell lung cancer (NSCLC) are in demand. Most human solid tumors express proteoglycans modified with distinct oncofetal chondroitin sulfate (CS) chains that can be detected and targeted with recombinant VAR2CSA (rVAR2) proteins and rVAR2-derived therapeutics. Here, we investigated expression and targetability of oncofetal CS expression in human NSCLC. High oncofetal CS expression is associated with shorter disease-free survival and poor overall survival of clinically annotated stage I and II NSCLC patients (n = 493). Oncofetal CS qualifies as an independent prognosticator of NSCLC in males and smokers, and high oncofetal CS levels are more prevalent in EGFR/KRAS wild-type cases, as compared to mutation cases. NSCLC cell lines express oncofetal CS-modified proteoglycans that can be specifically detected and targeted by rVAR2 proteins in a CSA-dependent manner. Importantly, a novel VAR2-drug conjugate (VDC-MMAE) efficiently eliminates NSCLC cells in vitro and in vivo. In summary, oncofetal CS is a prognostic biomarker and an actionable glycosaminoglycan target in NSCLC.
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Affiliation(s)
- Htoo Zarni Oo
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC V6H 3Z6, Canada; (H.Z.O.); (N.K.); (J.L.); (G.K.); (H.A.); (N.N.); (H.B.); (B.Z.); (N.A.-N.)
- Vancouver Prostate Centre, Vancouver Coastal Health Research Institute, Vancouver, BC V6H 3Z6, Canada
| | - Zoltan Lohinai
- Department of Tumor Biology, National Koranyi Institute of Pulmonology, 1122 Budapest, Hungary; (Z.L.); (J.M.); (B.D.)
| | - Nastaran Khazamipour
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC V6H 3Z6, Canada; (H.Z.O.); (N.K.); (J.L.); (G.K.); (H.A.); (N.N.); (H.B.); (B.Z.); (N.A.-N.)
- Vancouver Prostate Centre, Vancouver Coastal Health Research Institute, Vancouver, BC V6H 3Z6, Canada
| | - Joey Lo
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC V6H 3Z6, Canada; (H.Z.O.); (N.K.); (J.L.); (G.K.); (H.A.); (N.N.); (H.B.); (B.Z.); (N.A.-N.)
- Vancouver Prostate Centre, Vancouver Coastal Health Research Institute, Vancouver, BC V6H 3Z6, Canada
| | - Gunjan Kumar
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC V6H 3Z6, Canada; (H.Z.O.); (N.K.); (J.L.); (G.K.); (H.A.); (N.N.); (H.B.); (B.Z.); (N.A.-N.)
- Vancouver Prostate Centre, Vancouver Coastal Health Research Institute, Vancouver, BC V6H 3Z6, Canada
| | - Jessica Pihl
- Department of Cellular and Molecular Medicine, University of California, La Jolla, San Diego, CA 92093, USA; (J.P.); (T.M.C.); (J.D.E.)
| | - Hans Adomat
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC V6H 3Z6, Canada; (H.Z.O.); (N.K.); (J.L.); (G.K.); (H.A.); (N.N.); (H.B.); (B.Z.); (N.A.-N.)
- Vancouver Prostate Centre, Vancouver Coastal Health Research Institute, Vancouver, BC V6H 3Z6, Canada
| | - Noushin Nabavi
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC V6H 3Z6, Canada; (H.Z.O.); (N.K.); (J.L.); (G.K.); (H.A.); (N.N.); (H.B.); (B.Z.); (N.A.-N.)
- Vancouver Prostate Centre, Vancouver Coastal Health Research Institute, Vancouver, BC V6H 3Z6, Canada
| | - Hakhamanesh Behmanesh
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC V6H 3Z6, Canada; (H.Z.O.); (N.K.); (J.L.); (G.K.); (H.A.); (N.N.); (H.B.); (B.Z.); (N.A.-N.)
- Vancouver Prostate Centre, Vancouver Coastal Health Research Institute, Vancouver, BC V6H 3Z6, Canada
| | - Beibei Zhai
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC V6H 3Z6, Canada; (H.Z.O.); (N.K.); (J.L.); (G.K.); (H.A.); (N.N.); (H.B.); (B.Z.); (N.A.-N.)
- Vancouver Prostate Centre, Vancouver Coastal Health Research Institute, Vancouver, BC V6H 3Z6, Canada
| | - Robert Dagil
- Department for Immunology and Microbiology, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark; (R.D.); (S.C.); (T.G.); (A.S.)
| | - Swati Choudhary
- Department for Immunology and Microbiology, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark; (R.D.); (S.C.); (T.G.); (A.S.)
| | - Tobias Gustavsson
- Department for Immunology and Microbiology, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark; (R.D.); (S.C.); (T.G.); (A.S.)
| | - Thomas M. Clausen
- Department of Cellular and Molecular Medicine, University of California, La Jolla, San Diego, CA 92093, USA; (J.P.); (T.M.C.); (J.D.E.)
| | - Jeffrey D. Esko
- Department of Cellular and Molecular Medicine, University of California, La Jolla, San Diego, CA 92093, USA; (J.P.); (T.M.C.); (J.D.E.)
| | | | | | - Nhan L. Tran
- Department of Cancer Biology, Mayo Clinic, Scottsdale, AZ 85259, USA;
| | - Judit Moldvay
- Department of Tumor Biology, National Koranyi Institute of Pulmonology, 1122 Budapest, Hungary; (Z.L.); (J.M.); (B.D.)
- MTA-SE NAP, Brain Metastasis Research Group, Department of Pathology, Hungarian Academy of Sciences, 1085 Budapest, Hungary
| | - Balazs Dome
- Department of Tumor Biology, National Koranyi Institute of Pulmonology, 1122 Budapest, Hungary; (Z.L.); (J.M.); (B.D.)
- Department of Thoracic Surgery, National Institute of Oncology, Semmelweis University, 1122 Budapest, Hungary
- Department of Thoracic Surgery, Medical University of Vienna, 1090 Vienna, Austria
| | - Ali Salanti
- Department for Immunology and Microbiology, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark; (R.D.); (S.C.); (T.G.); (A.S.)
| | - Nader Al-Nakouzi
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC V6H 3Z6, Canada; (H.Z.O.); (N.K.); (J.L.); (G.K.); (H.A.); (N.N.); (H.B.); (B.Z.); (N.A.-N.)
- Vancouver Prostate Centre, Vancouver Coastal Health Research Institute, Vancouver, BC V6H 3Z6, Canada
| | | | - Mads Daugaard
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC V6H 3Z6, Canada; (H.Z.O.); (N.K.); (J.L.); (G.K.); (H.A.); (N.N.); (H.B.); (B.Z.); (N.A.-N.)
- Vancouver Prostate Centre, Vancouver Coastal Health Research Institute, Vancouver, BC V6H 3Z6, Canada
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