A retrospective analysis of safety and efficacy of weekly nab-paclitaxel as second-line chemotherapy in elderly patients with advanced squamous non-small-cell lung carcinoma

Neurotoxicity induced by taxane-derived drugs: analysis of the FAERS database 2017-2021

OBJECTIVES

Taxane-related neurotoxicity is a frequent clinical problem but lacks postmarketing data regarding neurological disorders. This study aimed to evaluate the potential association between neurological adverse events and several taxanederived drugs via the Food and Drug Administration Adverse Event Reporting System (FAERS).

METHODS

Disproportionality analysis was applied to data mining of the suspected cases of neurological disorders after using different taxanes based on the FAERS data from January 2017 and December 2021. We also investigated the times to onset, fatality, and hospitalization proportions of taxanerelated neurotoxicity.

RESULTS

In total, 3,940 cases were screened out, which were more prevalent in elderly patients and females. Peripheral neuropathy was a common adverse event among all taxanes with relatively strong association. Generally, the median time to neurological adverse effect onset was 27 days (interquartile range, 11.0 ~ 78.0 days) following taxane regimens, and the majority of cases were detected within the first 30 days. Among cases of neurological adverse events treated with taxane, the fatality and hospitalization proportions were 6.13% and 28.63%, respectively.

CONCLUSION

By analyzing the FAERS data, we provided a detailed profile of neurotoxicity and different taxanes in detail in terms of clinical characteristics, time to onset, and patient outcomes.

Efficacy and Safety of Nanoadministration in the Treatment of Non-Small-Cell Lung Cancer Is Good to Some Extent: A Systematic Review and Meta-Analysis

Purpose. The purpose of this study was to evaluate the efficacy and safety of a nanodrug delivery regimen compared with conventional drug administration for the treatment of lung cancer. Materials and Methods. Studies were retrieved through PubMed, Web of Science, and ScienceDirect. Primary and secondary outcome measures, including overall response rate (ORR), progression-free survival (PFS), overall survival (OS), and adverse events, were extracted from the retrieved literature and systematically evaluated. Results. Six trials, including 4806 advanced non-small-cell lung cancer patients, were included in this study. Compared with conventional drug administration in the treatment of lung cancer, the nanodrug delivery regimen improved the ORR (risk ratio = 1.43, 95% confidence interval (CI) = 1.25–1.63, $p\le 0.001$ ), prolonged PFS (hazard ratio (HR) = 0.83, 95% CI = 0.76–0.92, $p\le 0.001$ ), and obtained superior OS (HR = 0.91, 95% CI = 0.83–0.99, $p\le 0.001$ ). Regarding safety, the incidence of neutropenia, alopecia, sensory neuropathy, myalgia, and arthralgia was lower in the nanoadministration group, but the risk of thrombocytopenia, anaemia, and nausea was increased. Conclusion. Nanodrug administration is safe and effective in patients with non-small-cell lung cancer to some extent.

Long non-coding RNA H19 and the underlying epigenetic function in response to DNA damage of lung cancer cells

The purpose of the current study is to clarify the epigenetic function of long non-coding RNA (lncRNA) H19 in lung cancer as well as the relevant regulatory mechanism. We first determined H19 upregulation in A549 cells. DNA damage model was established in A549 cells by exposure to X-ray and then ionizing radiation (IR). The degree of DNA damage in the IR cell model was assessed by Comet assay. Gain- and loss-of-function assays were employed to clarify the roles of H19 and miR-675 in DNA damage of A549 cells. The results demonstrated that H19 knockdown inhibited the response of lung cancer cells to IR-induced DNA damage but promoted the damage repair. H19 could interact with miR-675, whereby aggravating IR-induced DNA damage. Furthermore, p62 was identified to be a downstream gene positively regulated by miR-675 while APEX1 was a target gene negatively regulated by miR-625-5p. Meanwhile, silencing of H19 could inhibit APEX1 expression by upregulating miR-625-5p, thereby accelerating DNA damage repair in A549 cells. In conclusion, H19 could function as a modulator of DNA damage response in lung cancer cells.

Nab-paclitaxel in combination with Bevacizumab in patients with non-squamous non-small cell lung cancer after failure of at least one prior systemic regimen

Background: Most patients with non-small cell lung cancer (NSCLC) experience disease progression after first-line treatment. The efficacy and safety of the nab-paclitaxel (nab-PTX) and bevacizumab combination as the second or further line of treatment in patients with advanced NSCLC have not been reported yet. Objective: To evaluate the efficacy and safety of the nab-PTX and bevacizumab combination in patients with advanced non-squamous (NSQ) NSCLC after failure of at least one prior systemic regimen. Methods: Patients with advanced (stage IV) NSQ NSCLC who received the nab-PTX and bevacizumab combination as the second or further line treatment between February 2012 and December 2018 at the Cancer Hospital of the Chinese Academy of Medical Sciences (Beijing, China) were included in this retrospective study. The main outcomes included the objective response rate (ORR), progression-free survival (PFS), overall survival (OS), and safety. Results: Thirty-four patients received 1-27 cycles (median, four cycles) of treatment; 67.6% (23/34) patients had undergone at least two lines of previous treatment. The ORR and disease control rates were 26.5% (9/34) and 82.4% (28/34), respectively. The median PFS and OS were 6.0 (95% CI=2.9-7.2) and 11.0 (95% CI=7.8-18.7) months, respectively. The multivariable analyses indicated that the combined use of other drugs and pleural metastasis were respectively associated with better PFS (hazard ratio=0.354, 95% CI=0.134-0.935, P=0.036) and OS (hazard ratio=0.540, 95% CI=0.118-0.980, P=0.046). The most frequent grade 3-4 adverse events (AEs) were neutropenia 20.6% (7/34), leukopenia 8.8% (3/34), and anemia 5.9% (2/34). No grade 5 AE occurred. Conclusion: Combined nab-PTX and bevacizumab might be an effective treatment regimen for patients with advanced NSQ NSCLC after failure of at least one prior systemic regimen, but studies have to validate those findings.

Multiline treatment of advanced squamous cell carcinoma of the lung: A case report and review of the literature

BACKGROUND

Squamous cell carcinoma (SCC) is one the most common subtypes of non-small cell lung cancer, yet the treatment options for it remain limited. Here, we report a case of advanced SCC and review the related literature focusing on the multiline therapy method.

CASE SUMMARY

We report the case of a 45-year-old man with advanced SCC who was deemed inoperable at the time of advanced SCC diagnosis. The patient had been referred to our hospital in April 2013 with complaints of a stuffy feeling in the chest, dyspnea, and pain in the right shoulder lasting for 1 mo. Physical examination found no obvious abnormalities, except for lower breath sound in the right lower lung. Laboratory data were within normal limits. Immunohistochemistry analysis of the tumor tissue showed CK5/6 (+), p63 (+), CD56 (+), and Ki-67 (+, approximately 30%), and genetic testing detected no EGFR mutation. He received a multiline treatment that included chemotherapy, radiotherapy, targeted therapy, and antiangiogenic therapy. After more than 5-year comprehensive treatment, the patient remains alive.

CONCLUSION

This typical case highlights the importance of appropriate multiline therapy for those patients with advanced SCC.

[Clinical Research on Albumin-bound Paclitaxel-based Therapy in Advanced Lung Cancer]

背景与目的

白蛋白结合型紫杉醇是通过将人血白蛋白与紫杉醇相结合的无需助溶剂的新型紫杉醇制剂，本研究旨在观察白蛋白结合型紫杉醇治疗晚期肺癌的临床疗效及其安全性。

方法

选取2011年11月-2014年12月收治的进展期/不可手术的晚期肺癌患者共50例。给予白蛋白结合型紫杉醇130 mg/m²，第1天、第8天单药方案或者联合方案治疗，21 d为1个周期，观察每个周期不良反应，每2个周期按实体瘤疗效评价标准（Response Evaluation Criteria in Solid Tumors, RECIST）1.1进行影像学疗效评价。

结果

白蛋白结合型紫杉醇治疗总体客观有效率（overall response rate, ORR）为20%，疾病控制率（disease control rate, DCR）为68%。在亚组分析中，鳞癌ORR为26.7%，DCR为80%，明显优于其他病理类型，但是尚未达到统计学差异。以白蛋白结合型紫杉醇单药或者两药联合的基础上联合抗血管生成治疗可以提高ORR（36.4% vs 15.4%）。四线及以上治疗患者DCR仍可达到69.2%。主要不良反应为血液学毒性但是可控制，无超敏反应及4级不良反应发生。

结论

白蛋白结合型紫杉醇为基础的治疗方案治疗晚期肺癌无论其病理类型及治疗线数均有一定疗效，对于鳞癌及与抗血管靶向治疗联合时更有优势，即使对于老年及多线治疗后的患者耐受性较好。

The role of weekly nanoparticle albumin bound paclitaxel monotherapy as second line or later treatment for advanced NSCLC in China

For patients with pretreated advanced non-small cell lung cancer (NSCLC), more effective treatments are unmet. We conducted a study to explore the optimal treatment schedule of nanoparticle albumin bound paclitaxel (Nab-PTX) as a second line or later treatment for advanced NSCLC patients in China. Ninety-eight patients, who had experienced failure of prior treatment and received Nab-PTX monotherapy (130 mg/m²) on days 1, 8 of a 21-day cycle were included. The median progression-free survival (PFS) and overall survival (OS) were 4.34 months (95% confidence interval [CI] 3.508 to 5.165 months) and 11.73 months (95% CI 9.211 to 14.247 months), respectively. The objective responses rate (ORR) and disease control rate (DCR) were 22.4% and 74.5%. Prior treatment with taxane and line of therapy did not influence the efficacy of Nab-PTX. The main grade 3 to 4 toxicities were neutropenia (25.5%) and leukopenia (12.4%). Furthermore, 24 cases offered samples to assess secreted protein acidic and rich in cysteine (SPARC) expression. No statistical difference was observed in treatment efficacy between SPARC expression-negative and positive. The findings suggest that weekly Nab-PTX monotherapy is effective and well tolerated for patients with pretreated advanced NSCLC, regardless of prior taxane exposure or line of therapy.

Nab-paclitaxel as First Line Treatment for NSCLC in Elderly Patients More Than 75 Years Old

Introduction: Lung cancer is still the leading cause of cancer among cancer patients. Although there are novel therapies as second line treatment for NSCLC, there is an issue for elderly patients. Patients and Methods: We collected retrospectively data from 60 patients >75 years of age. Thirty of these patients received nab-paclitaxel and first line treatment and were compared to thirty patients that received only best supportive care. Results: The median life of patients at the date of disease progression, although increased by the administration of the drug (92 days versus 70) was not confirmed statistically significantly (Mann-Whitney test: W = 280, p = 0.138). The administration of drug seems to keep stable the biological condition of patients (McNemar's test: χ² = 0.033, p = 0.99). Patients with chemotherapy the death rate was increased by 50% as compared to those with best supportive care (12 vs 8), the median life until the unfortunate event surpassed statistically significantly the latter (150 days of life as compared to 108, Mann-Whitney test: W = 57.5, p = 0.045). Discussion: Nab-paclitaxel as a monotherapy could be considered as a first line treatment option for patients > 75 years of age without any previous cardiological medical history when compared to best supportive care.

ARRB1 enhances the chemosensitivity of lung cancer through the mediation of DNA damage response

ARRB1 (also known as β-arrestin-1) serves as a multifunctional adaptor contributing to the regulation of signaling pathways. ARRB1 may be involved in DNA damage accumulation; however the underlying mechanism involved is unclear. In the present study, non-small cell lung cancer (NSCLC) cell lines (H520 and SK-MES-1) were transfected with ARRB1 plasmids or small interfering ribonucleic acid (siRNA) and received treatment with DNA-damaging agents (cisplatin and etoposide). A mouse xenograft model was used to assess the impact of ARRB1 on the efficacy of cisplatin in vivo. A total of 30 surgically resected NSCLC patients were recruited for the present study and qRT-PCR was performed to determine the mRNA levels in cancer tissues compared with para-carcinoma tissues. Our data showed that DNA damage was abrogated in the ARRB1‑knockdown cells and enhanced in the ARRB1-overexpressing cells. ATR and Chk1 were more activated in the ARRB1-overexpressing cells compared to the ARRB1-knockdown cells, followed by increased H2AX phosphorylation. DNA damage and apoptosis were increased in the ARRB1-overexpressing cells treated with cisplatin. These data provided strong evidence that ARRB1 contributes to the response of NSCLC to DNA-damaging agents and is essential for DNA damage response (DDR). ARRB1 may enhance the efficacy of DNA-damaging agents in NSCLC.

[Treatment of Advanced Squamous Cell Lung Cancer]

Lung cancer is the deadliest cancer in the worldwide. Non-small cell lung cancer (NSCLC) accounts for 85% of lung tumor diagnoses. Squamous cell lung cancer (SQCLC) is a common pathological type, almost 20%-30% of NSCLC. Surgery, chemotherapy, and molecular targeted therapies are the mainstay of treatment for patients with SQCLC. But most patients are diagnosed at advanced stage so that they miss the chance of operation. While noteworthy outcomes have improved with adenocarcinoma of lung with epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs), a therapeutic plateau for advanced squamous cell lung cancer patients are still not solved. EGFR-TKIs are unsuitable for or mostly ineffective in advanced SQCLC. Patients with advanced SQCLC ramain treated with platinum based chemotherapy. This reciew systematicly describe the treatment of squamous cell carcinoma of the lung.