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Cheng M, Shao Y, Li L, Jiang M, Song Z. Cost-effectiveness of immunotherapies for advanced squamous non-small cell lung cancer: a systematic review. BMC Cancer 2024; 24:312. [PMID: 38448878 PMCID: PMC10916025 DOI: 10.1186/s12885-024-12043-w] [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: 10/24/2023] [Accepted: 02/22/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND There are differences in the pharmacoeconomics of Immune checkpoint blocking (ICB) therapies for the treatment of lung squamous cell carcinoma (LSCC). However, no corresponding review studies have fully discussed the cost-effectiveness of ICBs in treating LSCC. The aim of this paper is to systematically review and evaluate all available pharmacoeconomic studies of ICBs for LSCC. METHOD The inclusion criteria were based on the population, intervention, comparator, outcomes, and study designs. An electronic search was conducted by June 2023, and the following databases were used: PubMed, EMBASE, Cochrane Library, and Web of Science. Search keywords included 'Carcinoma', Non-Small-Cell Lung', 'Immunotherapy', and 'Economics, Medical'. The primary outcome was the cost-effectiveness analysis of ICB therapy in LSCC patients. Drummond Checklist was used to assess quality problems and possible bias in the study design of included pharmacoeconomic studies. RESULTS This review searched 15 articles on the economic evaluation of ICB treatment for LSCC. After a qualitative review of 15 studies, we concluded that nivolumab is more cost-effective as a monotherapy than chemotherapy alone. In the combination regimen, pembrolizumab combined with chemotherapy appears to be the most cost-effective option at present, but for Chinese payers with LSCC, locally developed treatments such as sintilimab or toripalimab in combination with chemotherapy are more cost-effective. DISCUSSION The inclusion of economic evaluation has heterogeneity in research design and outcomes, which can only support qualitative synthesis. Therefore, The results of this paper need to be treated with caution. For the Chinese market, instead of imported drugs, the possible cost-effectiveness of locally developed ICB therapies should be the focus of future research.
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Affiliation(s)
- Minyu Cheng
- Department of Pharmacy, Zhejiang Hospital, 310013, Hangzhou, China
| | - Yanfei Shao
- Department of Pharmacy, Zhejiang Provincial People's Hospital, 310014, Hangzhou, China
| | - Li Li
- Department of Pharmacy, Zhejiang Hospital, 310013, Hangzhou, China
| | - Menglao Jiang
- Zhejiang Center of Drug and Cosmetics Evaluation, 310000, Hangzhou, Zhejiang, China
| | - Zhouye Song
- Department of Pharmacy, Zhejiang Hospital, 310013, Hangzhou, China.
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2
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Koni E, Congur I, Tokcaer Keskin Z. Overexpression of CXCL17 increases migration and invasion of A549 lung adenocarcinoma cells. Front Pharmacol 2024; 15:1306273. [PMID: 38384293 PMCID: PMC10879421 DOI: 10.3389/fphar.2024.1306273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 01/22/2024] [Indexed: 02/23/2024] Open
Abstract
Lung cancer is one of the most frequently diagnosed malignancies and is a widespread disease that affects millions of individuals globally. CXCL17 is a member of the CXC chemokine family that attracts myeloid cells and is associated with the mucosa. CXCL17 can both support and suppress tumor growth in certain types of cancer. A549 LUAD cells were transfected with N-Terminal p3XFLAG-CMV or N-Terminal p3XFLAG-CMV-CXCL17 to establish stably transfected CXCL17-overexpressing cells. Reverse-transcription polymerase chain reaction (RT-PCR) and Enzyme Linked Immunosorbent Assay (ELISA) were performed to verify the levels of CXCL17 mRNA and of CXCL17 protein concentration of stably transfected A549 cells respectively. Wound healing, CCK8, and matrigel invasion assays were performed to assess the effect of CXCL17 overexpression on migration, proliferation, and invasion of A549 cells. When compared to control groups, proliferative capacity of A549 cells were unaffected by CXCL17 overexpression; however, the wound area in the CXCL17 overexpression group had dramatically decreased after 48 h. Similarly, the number of invasion cells was significantly higher in the CXCL17-overexpressing group than in the control ones after 48 h. CXCL17 overexpression significantly increased the ability of A549 cells to migrate and invade, without affecting their proliferative abilities.
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Affiliation(s)
- Ekin Koni
- Graduate School of Natural and Applied Sciences, Department of Molecular and Translational Biomedicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Türkiye
| | - Irem Congur
- Graduate School of Natural and Applied Sciences, Department of Molecular and Translational Biomedicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Türkiye
| | - Zeynep Tokcaer Keskin
- Graduate School of Natural and Applied Sciences, Department of Molecular and Translational Biomedicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Türkiye
- Faculty of Engineering and Natural Sciences, Department of Molecular Biology and Genetics, Acibadem Mehmet Ali Aydinlar University, Istanbul, Türkiye
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3
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Yin J, Song Y, Fu Y, Jun W, Tang J, Zhang Z, Song Q, Zhang B. The efficacy of immune checkpoint inhibitors is limited in elderly NSCLC: a retrospective efficacy study and meta-analysis. Aging (Albany NY) 2023; 15:15025-15049. [PMID: 38127004 PMCID: PMC10781456 DOI: 10.18632/aging.205328] [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: 07/29/2023] [Accepted: 11/03/2023] [Indexed: 12/23/2023]
Abstract
Immune checkpoint inhibitors (ICIs) have improved the long-term survival of NSCLC patients. However, the efficacy of ICIs in elderly NSCLC patients remains controversial. We conducted a retrospective study and meta-analysis exploring the efficacy of ICIs in those patients using public databases and RCTs. NSCLC patients were identified into elderly and non-elderly groups by age 75 years. The retrospective study showed significant differences in OS and PFS between non-elderly and elderly patients treated with ICIs (P= 0.029 and 0.027), with reduced efficacy in elderly NSCLC patients. ECOG PS also negatively affected OS in elderly NSCLC patients (P= 0.007). In meta-analysis, the HR for OS in the non-elderly and elderly groups were 0.74 and 0.90, respectively, and the difference between the two age groups was statistically significant (P= 0.025). ICIs resulted in a lower incidence of all-grade (OR= 0.47) and high-grade TRAEs (OR= 0.38) than chemotherapy. Our findings revealed that the survival benefit of ICIs in elderly patients (≥ 75 years) may be lower than in non-elderly patients. In addition, the incidence of TRAEs induced by ICIs was lower than chemotherapy.
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Affiliation(s)
- Jiaxin Yin
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yuxiao Song
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yang Fu
- Department of Oncology, Xiangyang Hospital, Hubei University of Chinese Medicine, Xiangyang, China
| | - Wang Jun
- Department of Oncology, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Jiazhuo Tang
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Zhimin Zhang
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Qibin Song
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Bicheng Zhang
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan, China
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4
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Lê H, Deforges J, Hua G, Idoux-Gillet Y, Ponté C, Lindner V, Olland A, Falcoz PE, Zaupa C, Jain S, Quéméneur E, Benkirane-Jessel N, Balloul JM. In vitro vascularized immunocompetent patient-derived model to test cancer therapies. iScience 2023; 26:108094. [PMID: 37860774 PMCID: PMC10582498 DOI: 10.1016/j.isci.2023.108094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 08/21/2023] [Accepted: 09/26/2023] [Indexed: 10/21/2023] Open
Abstract
This work describes a patient-derived tumoroid model (PDTs) to support precision medicine in lung oncology. The use of human adipose tissue-derived microvasculature and patient-derived peripheral blood mononuclear cells (PBMCs) permits to achieve a physiologically relevant tumor microenvironment. This study involved ten patients at various stages of tumor progression. The vascularized, immune-infiltrated PDT model could be obtained within two weeks, matching the requirements of the therapeutic decision. Histological and transcriptomic analyses confirmed that the main features from the original tumor were reproduced. The 3D tumor model could be used to determine the dynamics of response to antiangiogenic therapy and platinum-based chemotherapy. Antiangiogenic therapy showed a significant decrease in vascular endothelial growth factor (VEGF)-A expression, reflecting its therapeutic effect in the model. In an immune-infiltrated PDT model, chemotherapy showed the ability to decrease the levels of lymphocyte activation gene-3 protein (LAG-3), B and T lymphocyte attenuator (BTLA), and inhibitory receptors of T cells functions.
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Affiliation(s)
- Hélène Lê
- Transgene S.A, 400 Boulevard Gonthier d’Andernach, 67400 Illkirch-Graffenstaden, France
- INSERM UMR 1260, Regenerative Nanomedicine, 1 rue Eugène Boeckel, 67000 Strasbourg, France
| | - Jules Deforges
- Transgene S.A, 400 Boulevard Gonthier d’Andernach, 67400 Illkirch-Graffenstaden, France
| | - Guoqiang Hua
- INSERM UMR 1260, Regenerative Nanomedicine, 1 rue Eugène Boeckel, 67000 Strasbourg, France
| | - Ysia Idoux-Gillet
- INSERM UMR 1260, Regenerative Nanomedicine, 1 rue Eugène Boeckel, 67000 Strasbourg, France
| | - Charlotte Ponté
- INSERM UMR 1260, Regenerative Nanomedicine, 1 rue Eugène Boeckel, 67000 Strasbourg, France
- Hopitaux Universitaires de Strasbourg, 1 Place de l’Hôpital, 67000 Strasbourg, France
| | - Véronique Lindner
- INSERM UMR 1260, Regenerative Nanomedicine, 1 rue Eugène Boeckel, 67000 Strasbourg, France
| | - Anne Olland
- INSERM UMR 1260, Regenerative Nanomedicine, 1 rue Eugène Boeckel, 67000 Strasbourg, France
- Hopitaux Universitaires de Strasbourg, 1 Place de l’Hôpital, 67000 Strasbourg, France
| | - Pierre-Emanuel Falcoz
- INSERM UMR 1260, Regenerative Nanomedicine, 1 rue Eugène Boeckel, 67000 Strasbourg, France
- Hopitaux Universitaires de Strasbourg, 1 Place de l’Hôpital, 67000 Strasbourg, France
| | - Cécile Zaupa
- Boehringer Ingelheim, 29 avenue Tony Garnier, 69007 Lyon, France
| | - Shreyansh Jain
- Transgene S.A, 400 Boulevard Gonthier d’Andernach, 67400 Illkirch-Graffenstaden, France
| | - Eric Quéméneur
- Transgene S.A, 400 Boulevard Gonthier d’Andernach, 67400 Illkirch-Graffenstaden, France
| | - Nadia Benkirane-Jessel
- INSERM UMR 1260, Regenerative Nanomedicine, 1 rue Eugène Boeckel, 67000 Strasbourg, France
| | - Jean-Marc Balloul
- Transgene S.A, 400 Boulevard Gonthier d’Andernach, 67400 Illkirch-Graffenstaden, France
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Patel SR, Das M. Small Cell Lung Cancer: Emerging Targets and Strategies for Precision Therapy. Cancers (Basel) 2023; 15:4016. [PMID: 37627044 PMCID: PMC10452729 DOI: 10.3390/cancers15164016] [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: 06/27/2023] [Revised: 08/04/2023] [Accepted: 08/06/2023] [Indexed: 08/27/2023] Open
Abstract
Small cell lung cancer is an aggressive subtype of lung cancer with limited treatment options. Precision medicine has revolutionized cancer treatment for many tumor types but progress in SCLC has been slower due to the lack of targetable biomarkers. This review article provides an overview of emerging strategies for precision therapy in SCLC. Targeted therapies include targeted kinase inhibitors, monoclonal antibodies, angiogenesis inhibitors, antibody-drug conjugates, PARP inhibitors, and epigenetic modulators. Angiogenesis inhibitors and DNA-damaging agents, such as PARP and ATR inhibitors, have been explored in SCLC with limited success to date although trials are ongoing. The potential of targeting DLL3, a NOTCH ligand, through antibody-drug conjugates, bispecific T-cell engagers, and CAR T-cell therapy, has opened up new therapeutic options moving forward. Additionally, new research in epigenetic therapeutics in reversing transcriptional repression, modulating anti-tumor immunity, and utilizing antibody-drug conjugates to target cell surface-specific targets in SCLC are also being investigated. While progress in precision therapy for SCLC has been challenging, recent advancements provide optimism for improved treatment outcomes. However, several challenges remain and will need to be addressed, including drug resistance and tumor heterogeneity. Further research and biomarker-selected clinical trials are necessary to develop effective precision therapies for SCLC patients.
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Affiliation(s)
- Shruti R. Patel
- Department of Medicine, Division of Medical Oncology, Stanford Cancer Institute, Stanford University, Palo Alto, CA 94305, USA;
| | - Millie Das
- Department of Medicine, Division of Medical Oncology, Stanford Cancer Institute, Stanford University, Palo Alto, CA 94305, USA;
- Department of Medicine, Oncology Section, VA Palo Alto Health Care System, Palo Alto, CA 94304, USA
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6
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Ma X, Fang W, Wang D, Shao N, Chen J, Nie T, Huang C, Huang Y, Luo L, Xiao Z. Nanomaterial-Based Antivascular Therapy in the Multimodal Treatment of Cancer. Pharmaceutics 2023; 15:pharmaceutics15041207. [PMID: 37111692 PMCID: PMC10145863 DOI: 10.3390/pharmaceutics15041207] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 03/27/2023] [Accepted: 04/06/2023] [Indexed: 04/29/2023] Open
Abstract
Abnormal tumor vasculature and a hypoxic tumor microenvironment (TME) limit the effectiveness of conventional cancer treatment. Recent studies have shown that antivascular strategies that focus on antagonizing the hypoxic TME and promoting vessel normalization effectively synergize to increase the antitumor efficacy of conventional therapeutic regimens. By integrating multiple therapeutic agents, well-designed nanomaterials exhibit great advantages in achieving higher drug delivery efficiency and can be used as multimodal therapy with reduced systemic toxicity. In this review, strategies for the nanomaterial-based administration of antivascular therapy combined with other common tumor treatments, including immunotherapy, chemotherapy, phototherapy, radiotherapy, and interventional therapy, are summarized. In particular, the administration of intravascular therapy and other therapies with the use of versatile nanodrugs is also described. This review provides a reference for the development of multifunctional nanotheranostic platforms for effective antivascular therapy in combined anticancer treatments.
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Affiliation(s)
- Xiaocong Ma
- The Guangzhou Key Laboratory of Molecular and Functional Imaging for Clinical Translation, The First Affiliated Hospital of Jinan University, Guangzhou 510632, China
| | - Weimin Fang
- The Guangzhou Key Laboratory of Molecular and Functional Imaging for Clinical Translation, The First Affiliated Hospital of Jinan University, Guangzhou 510632, China
| | - Duo Wang
- The Guangzhou Key Laboratory of Molecular and Functional Imaging for Clinical Translation, The First Affiliated Hospital of Jinan University, Guangzhou 510632, China
| | - Ni Shao
- The Guangzhou Key Laboratory of Molecular and Functional Imaging for Clinical Translation, The First Affiliated Hospital of Jinan University, Guangzhou 510632, China
| | - Jifeng Chen
- The Guangzhou Key Laboratory of Molecular and Functional Imaging for Clinical Translation, The First Affiliated Hospital of Jinan University, Guangzhou 510632, China
| | - Tianqi Nie
- The 12th People's Hospital of Guangzhou, Guangzhou 510620, China
| | - Cuiqing Huang
- Department of Ultrasound, Guangdong Women and Children Hospital, Guangzhou 511400, China
| | - Yanyu Huang
- Department of Biochemistry and Molecular Medicine, University of California Davis, Sacramento, CA 95817, USA
| | - Liangping Luo
- The Guangzhou Key Laboratory of Molecular and Functional Imaging for Clinical Translation, The First Affiliated Hospital of Jinan University, Guangzhou 510632, China
| | - Zeyu Xiao
- The Guangzhou Key Laboratory of Molecular and Functional Imaging for Clinical Translation, The First Affiliated Hospital of Jinan University, Guangzhou 510632, China
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7
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Braman N, Prasanna P, Bera K, Alilou M, Khorrami M, Leo P, Etesami M, Vulchi M, Turk P, Gupta A, Jain P, Fu P, Pennell N, Velcheti V, Abraham J, Plecha D, Madabhushi A. Novel Radiomic Measurements of Tumor-Associated Vasculature Morphology on Clinical Imaging as a Biomarker of Treatment Response in Multiple Cancers. Clin Cancer Res 2022; 28:4410-4424. [PMID: 35727603 PMCID: PMC9588630 DOI: 10.1158/1078-0432.ccr-21-4148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 03/14/2022] [Accepted: 06/17/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE The tumor-associated vasculature (TAV) differs from healthy blood vessels by its convolutedness, leakiness, and chaotic architecture, and these attributes facilitate the creation of a treatment-resistant tumor microenvironment. Measurable differences in these attributes might also help stratify patients by likely benefit of systemic therapy (e.g., chemotherapy). In this work, we present a new category of computational image-based biomarkers called quantitative tumor-associated vasculature (QuanTAV) features, and demonstrate their ability to predict response and survival across multiple cancer types, imaging modalities, and treatment regimens involving chemotherapy. EXPERIMENTAL DESIGN We isolated tumor vasculature and extracted mathematical measurements of twistedness and organization from routine pretreatment radiology (CT or contrast-enhanced MRI) of a total of 558 patients, who received one of four first-line chemotherapy-based therapeutic intervention strategies for breast (n = 371) or non-small cell lung cancer (NSCLC, n = 187). RESULTS Across four chemotherapy-based treatment strategies, classifiers of QuanTAV measurements significantly (P < 0.05) predicted response in held out testing cohorts alone (AUC = 0.63-0.71) and increased AUC by 0.06-0.12 when added to models of significant clinical variables alone. Similarly, we derived QuanTAV risk scores that were prognostic of recurrence-free survival in treatment cohorts who received surgery following chemotherapy for breast cancer [P = 0.0022; HR = 1.25; 95% confidence interval (CI), 1.08-1.44; concordance index (C-index) = 0.66] and chemoradiation for NSCLC (P = 0.039; HR = 1.28; 95% CI, 1.01-1.62; C-index = 0.66). From vessel-based risk scores, we further derived categorical QuanTAV high/low risk groups that were independently prognostic among all treatment groups, including patients with NSCLC who received chemotherapy only (P = 0.034; HR = 2.29; 95% CI, 1.07-4.94; C-index = 0.62). QuanTAV response and risk scores were independent of clinicopathologic risk factors and matched or exceeded models of clinical variables including posttreatment response. CONCLUSIONS Across these domains, we observed an association of vascular morphology on CT and MRI-as captured by metrics of vessel curvature, torsion, and organizational heterogeneity-and treatment outcome. Our findings suggest the potential of shape and structure of the TAV in developing prognostic and predictive biomarkers for multiple cancers and different treatment strategies.
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Affiliation(s)
- Nathaniel Braman
- Case Western Reserve University, Cleveland, OH
- Picture Health, Cleveland, OH
| | - Prateek Prasanna
- Case Western Reserve University, Cleveland, OH
- Stony Brook University, New York, NY
| | - Kaustav Bera
- Case Western Reserve University, Cleveland, OH
- University Hospitals Cleveland Medical Center, Cleveland, OH
| | | | | | - Patrick Leo
- Case Western Reserve University, Cleveland, OH
| | - Maryam Etesami
- Yale School of Medicine, Department of Radiology & Biomedical Imaging, New Haven, CT
| | - Manasa Vulchi
- The Cleveland Clinic Foundation (CCF), Cleveland, OH
| | - Paulette Turk
- The Cleveland Clinic Foundation (CCF), Cleveland, OH
| | - Amit Gupta
- University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Prantesh Jain
- University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Pingfu Fu
- Case Western Reserve University, Cleveland, OH
| | | | | | - Jame Abraham
- The Cleveland Clinic Foundation (CCF), Cleveland, OH
| | - Donna Plecha
- University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Anant Madabhushi
- Case Western Reserve University, Cleveland, OH
- Louis Stokes Cleveland Veterans Medical Center, Cleveland, OH
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8
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Aguilar A, Mas L, Enríquez D, Vallejos C, Gutarra R, Flores CJ. Impact of Targeted Therapy on the Survival of Patients With Advanced-Stage Non-small Cell Lung Cancer in Oncosalud - AUNA. Cancer Control 2022; 29:10732748211068637. [PMID: 35030060 PMCID: PMC8777330 DOI: 10.1177/10732748211068637] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Background Lung cancer is still a prevalent and fatal neoplasm in developing countries.
In the last decades, chemotherapy (CHT) maintenance occupied an important
role in the treatment, as well as targeted therapies. We aimed to evaluate
the survival impact of targeted therapy in advanced lung cancer at a private
Peruvian institution (Oncosalud - AUNA). Methods We reviewed retrospectively medical records of patients with advanced-stage
non-small cell lung cancer (NSCLS) (clinical stage III-IV) who received CHT
and maintenance treatment with target therapy (TT) or CHT. The impact was
assessed by progression-free survival (PFS) and overall survival (OS) using
the Kaplan–Meier method, and comparisons of survival curves were performed
using log-rank or Breslow test and Cox model. Results The median age of the patients was 65 years. Clinical characteristics, as
well as the treatment type, showed no significant difference between the two
groups. The maintenance schedule in those receiving CHT was generally
pemetrexed (70%) and in those receiving TT was erlotinib (60.7%). In
patients receiving TT, the median PFS was 13 months compared to 7 months in
those receiving CHT; likewise, the median OS was 45 and 17 months,
respectively. The PFS and OS curves showed significant differences
(P < .05), achieving a better survival in subjects
treated with TT. Conclusion Progression-Free Survival and OS were superior in patients who received
targeted therapy than those treated only with CHT, the 2 years rate of PFS
and OS was nearly double to those who received only CHT-based
treatments.
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Affiliation(s)
- Alfredo Aguilar
- Dirección Científica y Académica, 233933Oncosalud-AUNA, Lima, Peru
| | - Luis Mas
- Departamento de Oncología Médica, 233933Oncosalud, AUNA, Lima, Peru
| | - Daniel Enríquez
- Dirección Científica y Académica, 233933Oncosalud-AUNA, Lima, Peru
| | - Carlos Vallejos
- Departamento de Oncología Médica, 233933Oncosalud, AUNA, Lima, Peru
| | - Rosa Gutarra
- Facultad de Medicina Humana, 431934Universidad de San Martin de Porres, La Molina, Peru
| | - Claudio J Flores
- Dirección Científica y Académica, 233933Oncosalud-AUNA, Lima, Peru
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9
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Yang T, Xiong Y, Zeng Y, Wang Y, Zeng J, Liu J, Xu S, Li LS. Current status of immunotherapy for non-small cell lung cancer. Front Pharmacol 2022; 13:989461. [PMID: 36313314 PMCID: PMC9606217 DOI: 10.3389/fphar.2022.989461] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 09/30/2022] [Indexed: 02/05/2023] Open
Abstract
Nowadays, lung cancer is still the deadliest oncological disease in the world. Among them, non-small cell lung cancer (NSCLC) accounts for 80%∼85% of all lung cancers, and its 5-year survival rate is less than 15%, making the situation critical. In the past decades, despite some clinical advances in conventional treatments, the overall survival rate of NSCLC is still not optimistic due to its unique physiological conditions and the frequent occurrence of tumor escape. In recent years, immunotherapy has become a new hot spot in lung cancer research, including antibody therapy and cell therapy, which have been developed and utilized one after another, especially immune checkpoint inhibitor (ICI). These approaches have effectively improved the overall survival rate and objective response rate of NSCLC patients by enhancing the immune capacity of the body and targeting tumor cells more effectively, which is more specific and less toxic compared with conventional chemotherapy, and providing more strategies for NSCLC treatment. In this paper, we reviewed the relevant targets, clinical progress and adverse reaction in monoclonal antibodies, antibody-drug conjugates, ICI, bispecific antibodies, T-cell receptor engineered T cell therapy (TCR-T), Chimeric antigen receptor T-cell immunotherapy (CAR-T), and also report on their combination therapy from the immune-related background to provide better NSCLC treatment and prospective.
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10
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Jommi C, Pantellini F, Stagi L, Verykiou M, Cavazza M. The economic impact of compassionate use of medicines. BMC Health Serv Res 2021; 21:1303. [PMID: 34863155 PMCID: PMC8645125 DOI: 10.1186/s12913-021-07255-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 10/27/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Compassionate use programs (CUP) for medicines respond to the ethical imperative of providing access to medicines before marketing approval to patients not recruited in trials. The economic impact of clinical trials has previously been investigated. No evidence on the net economic benefit of CUP exists. This research aims to address this information gap by estimating the economic consequences of 11 CUP in Italy conducted between March 2015 and December 2020 from the perspective of public health care system in Italy (National Health Service). Eight programs concern cancer treatments, two refer to spinal muscular atrophy, and one is indicated for multiple sclerosis. METHODS Since CUP medicines are covered by the industry, the net economic benefit includes: (i) avoided costs of the Standard of Care (SoC) the patients would have received had they not joined the CUP, (ii) costs not covered by the pharmaceutical industry sponsor, but instead sustained by payers, such as those associated with adverse events (only severe side effects resulting in hospitalisation and attributable to CUP medicines), and (iii) costs for combination therapies and diagnostic procedures not used with the SoC. The SoC costing relied on publicly available data. Information on adverse events and diagnostic procedures was retrieved from the CUP and monetized using the relevant fee for episode or service. One CUP was excluded since a SoC was not identified. RESULTS 2,713 patients were treated in the 11 CUP where a SoC was identified. The SoC mean cost per patient ranged from €11,415 to €20,299. The total cost of the SoC ranged between €31.0 and €55.1 million. The mean cost per patient covered by hospitals hosting CUP was equal to €1,646, with a total cost of €4.5 million. The net economic benefit ranged €26.5 million - €50.6 million. CONCLUSIONS Despite research limitations, this paper illustrates for the first time the net economic impact of CUP from a public payer perspective. It is important to integrate these estimates with the prospective effects of CUP implementation, i.e., the economic value of the comparative benefit profile of medicines used in CUP versus the SoC, including effects from a societal perspective.
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Affiliation(s)
- Claudio Jommi
- Centre for Research on Health and Social Care Management, SDA Bocconi School of Management, CERGAS, Bocconi University, Via Sarfatti 25, 20136 Milano, MI Italy
| | | | - Lisa Stagi
- ROCHE Spa, Viale GB Stucchi 110, MB 20900 Monza, Italy
| | - Maria Verykiou
- Centre for Research on Health and Social Care Management, SDA Bocconi School of Management, CERGAS, Bocconi University, Via Sarfatti 25, 20136 Milano, MI Italy
| | - Marianna Cavazza
- Centre for Research on Health and Social Care Management, SDA Bocconi School of Management, CERGAS, Bocconi University, Via Sarfatti 25, 20136 Milano, MI Italy
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11
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Shepard KB, Vodak DT, Kuehl PJ, Revelli D, Zhou Y, Pluntze AM, Adam MS, Oddo JC, Switala L, Cape JL, Baumann JM, Banks M. Local Treatment of Non-small Cell Lung Cancer with a Spray-Dried Bevacizumab Formulation. AAPS PharmSciTech 2021; 22:230. [PMID: 34467438 PMCID: PMC8408070 DOI: 10.1208/s12249-021-02095-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 07/13/2021] [Indexed: 12/15/2022] Open
Abstract
Local delivery of biotherapeutics to the lung holds great promise for treatment of lung diseases, but development of physically stable, biologically active dry powder formulations of large molecules for inhalation has remained a challenge. Here, spray drying was used to manufacture a dry powder pulmonary formulation of bevacizumab, a monoclonal antibody approved to treat non-small cell lung cancer (NSCLC) by intravenous infusion. By reformulating bevacizumab for local delivery, reduced side effects, lower doses, and improved patient compliance are possible. The formulation had aerosol properties suitable for delivery to the deep lung, as well as good physical stability at ambient temperature for at least 6 months. Bevacizumab’s anti-VEGF bioactivity was not impacted by the manufacturing process. The formulation was efficacious in an in vivo rat model for NSCLC at a 10-fold decrease in dose relative to the intravenous control.
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12
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Ferreira M, Secher T, Heuze-Vourc’H N, Reckamp KL. Immune Checkpoint and Anti-Angiogenic Antibodies for the Treatment of Non-Small Cell Lung Cancer in the European Union and United States. Pharmaceutics 2021; 13:pharmaceutics13060912. [PMID: 34205484 PMCID: PMC8234109 DOI: 10.3390/pharmaceutics13060912] [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] [Received: 04/22/2021] [Revised: 06/05/2021] [Accepted: 06/16/2021] [Indexed: 12/26/2022] Open
Abstract
Several types of antibodies (Abs) are currently used in non-small cell lung cancer (NSCLC). Anti-angiogenic and immune checkpoint inhibitor (ICI) Abs are the most frequent treatments used alone or with chemotherapy in metastatic NSCLC, for the front line and beyond. Considering the many therapeutic options for locally advanced and metastatic lung cancer and differences in use according to geographic area, we present here a comprehensive review of the marketed ICI and anti-angiogenic Abs approved in the European Union (EU) and the US to treat locally advanced and metastatic NSCLC patients. We briefly describe the different molecules and their development in thoracic oncology and compare pharmacokinetic data, processing decision algorithms and marketing authorizations by the EMA and US Food and Drug Administration (FDA).
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Affiliation(s)
- Marion Ferreira
- INSERM, Centre d’Etude des Pathologies Respiratoires, U1100, Boulevard Tonnellé, F-37032 Tours, France; (T.S.); (N.H.-V.)
- Faculté de Médecine, Université de Tours, F-37032 Tours, France
- CHRU de Tours, Département de Pneumologie et Explorations fonctionnelles Respiratoires, F-37032 Tours, France
- Correspondence:
| | - Thomas Secher
- INSERM, Centre d’Etude des Pathologies Respiratoires, U1100, Boulevard Tonnellé, F-37032 Tours, France; (T.S.); (N.H.-V.)
- Faculté de Médecine, Université de Tours, F-37032 Tours, France
| | - Nathalie Heuze-Vourc’H
- INSERM, Centre d’Etude des Pathologies Respiratoires, U1100, Boulevard Tonnellé, F-37032 Tours, France; (T.S.); (N.H.-V.)
- Faculté de Médecine, Université de Tours, F-37032 Tours, France
| | - Karen L Reckamp
- Department of Medicine, Cedars Sinai Medical Center, Los Angeles, CA 90048, USA;
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13
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Moser SS, Apter L, Arunachalam A, Burke T, Shalev V, Chodick G, Siegelmann-Danieli N. Real-world study of PD-L1 testing patterns and treatment distribution in patients with metastatic non-small-cell lung cancer in Israel. Immunotherapy 2021; 13:851-861. [PMID: 34034511 DOI: 10.2217/imt-2020-0347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: We describe PD-L1 testing patterns and first-line treatment for patients with metastatic non-small-cell lung cancer in a 2.3 million-member state-mandated health service in Israel. Materials & methods: Newly diagnosed stage IV non-small-cell lung cancer patients initiating systemic anticancer treatment from 1 January 2017 until 31 December 2018 were identified from the national cancer registry and Maccabi Healthcare Service database and followed until 30 June 2019. Results: The cohort consisted of 410 patients; 58% males, median age 68 years, 70% current/former smokers, 81% adenocarcinoma, 14% had brain metastases, and Eastern Cooperative Oncology Group performance status was 46/17/37% for 0-1/2-4/unknown, respectively. A total of 80% tested for PD-L1 expression, of which 47% had tumor proportion score (TPS) ≥ 50%. A total of 95% with TPS ≥ 50% and no known tumor aberrations (including EGFR mutations, and translocations in ALK and ROS1) received first-line PD-1/PD-L1-inhibitor monotherapy, and 80% of untested/TPS < 50% received platinum doublets. Conclusion: Fast uptake of testing was observed, and treatment patterns showed high adherence to guidelines.
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Affiliation(s)
- Sarah Sharman Moser
- Maccabitech Institute for Research & Innovation, Maccabi Healthcare Services, Tel Aviv, 6812509, Israel
| | - Lior Apter
- Maccabitech Institute for Research & Innovation, Maccabi Healthcare Services, Tel Aviv, 6812509, Israel.,Department of Health Systems Management, Ben-Gurion University of the Negev, Beer-Sheva, 84105, Israel
| | | | | | - Varda Shalev
- Maccabitech Institute for Research & Innovation, Maccabi Healthcare Services, Tel Aviv, 6812509, Israel.,Sackler Faculty of Medicine, Tel Aviv University, 6997801, Israel
| | - Gabriel Chodick
- Maccabitech Institute for Research & Innovation, Maccabi Healthcare Services, Tel Aviv, 6812509, Israel.,Sackler Faculty of Medicine, Tel Aviv University, 6997801, Israel
| | - Nava Siegelmann-Danieli
- Maccabitech Institute for Research & Innovation, Maccabi Healthcare Services, Tel Aviv, 6812509, Israel.,Sackler Faculty of Medicine, Tel Aviv University, 6997801, Israel
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14
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Jarry U, Bostoën M, Pineau R, Chaillot L, Mennessier V, Montagne P, Motte E, Gournay M, Le Goff A, Guillaudeux T, Pedeux R. Orthotopic model of lung cancer: isolation of bone micro-metastases after tumor escape from Osimertinib treatment. BMC Cancer 2021; 21:530. [PMID: 33971844 PMCID: PMC8111918 DOI: 10.1186/s12885-021-08205-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 04/16/2021] [Indexed: 11/16/2022] Open
Abstract
Background Osimertinib is a third generation tyrosine kinase inhibitor (TKI) that targets the epidermal growth factor receptor (EGFR) in lung cancer. However, although this molecule is not subject to some of the resistance mechanisms observed in response to first generation TKIs, ultimately, patients relapse because of unknown resistance mechanisms. New relevant non-small cell lung cancer (NSCLC) mice models are therefore required to allow the analysis of these resistance mechanisms and to evaluate the efficacy of new therapeutic strategies. Methods Briefly, PC-9 cells, previously modified for luciferase expression, were injected into the tail vein of mice. Tumor implantation and longitudinal growth, almost exclusively localized in the lung, were evaluated by bioluminescence. Once established, the tumor was treated with osimertinib until tumor escape and development of bone metastases. Results Micro-metastases were detected by bioluminescence and collected for further analysis. Conclusion We describe an orthotopic model of NSCLC protocol that led to lung primary tumor nesting and, after osimertinib treatment, by metastases dissemination, and that allow the isolation of these small osimertinib-resistant micro-metastases. This model provides new biological tools to study tumor progression from the establishment of a lung tumor to the generation of drug-resistant micro-metastases, mimicking the natural course of the disease in human NSCLC patients. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-021-08205-9.
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Affiliation(s)
- Ulrich Jarry
- Université Rennes 1, UMS 3480 CNRS/US018 INSERM BIOSIT, Laboratoire Commun ONCOTRIAL, Rennes, France. .,Biotrial Pharmacology, Unité De Pharmacologie Préclinique, Rennes, France.
| | - Mégane Bostoën
- Université Rennes 1, UMS 3480 CNRS/US018 INSERM BIOSIT, Laboratoire Commun ONCOTRIAL, Rennes, France
| | - Raphaël Pineau
- INSERM U1242 COSS, Université Rennes 1, Clcc Eugène Marquis, Rennes, France
| | - Laura Chaillot
- INSERM U1242 COSS, Université Rennes 1, Clcc Eugène Marquis, Rennes, France
| | | | - Pierre Montagne
- Biotrial Pharmacology, Unité De Pharmacologie Préclinique, Rennes, France
| | - Emilie Motte
- Biotrial Pharmacology, Unité De Pharmacologie Préclinique, Rennes, France
| | - Marjorie Gournay
- INSERM U1242 COSS, Université Rennes 1, Clcc Eugène Marquis, Rennes, France
| | - Arnaud Le Goff
- Biotrial Pharmacology, Unité De Pharmacologie Préclinique, Rennes, France
| | - Thierry Guillaudeux
- Université Rennes 1, UMS 3480 CNRS/US018 INSERM BIOSIT, Laboratoire Commun ONCOTRIAL, Rennes, France.,INSERM U1242 COSS, Université Rennes 1, Clcc Eugène Marquis, Rennes, France
| | - Rémy Pedeux
- INSERM U1242 COSS, Université Rennes 1, Clcc Eugène Marquis, Rennes, France.
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15
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Jagieła J, Bartnicki P, Rysz J. Nephrotoxicity as a Complication of Chemotherapy and Immunotherapy in the Treatment of Colorectal Cancer, Melanoma and Non-Small Cell Lung Cancer. Int J Mol Sci 2021; 22:ijms22094618. [PMID: 33924827 PMCID: PMC8125622 DOI: 10.3390/ijms22094618] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 04/18/2021] [Accepted: 04/22/2021] [Indexed: 12/12/2022] Open
Abstract
Acute kidney injury is a common complication of many medical procedures, including those used in cancer treatment. Both chemotherapy and immunotherapy may result in deterioration of kidney function, which may lead to an increase in mortality among patients with cancer. Antineoplastic agents can affect any element of the nephron, leading to the appearance of clinical symptoms such as proteinuria, hypertension, electrolyte disorders, glomerulonephritis, acute and chronic interstitial nephritis and acute kidney injury. The medical literature describing renal complications occurring during chemotherapeutic and immunotherapeutic treatment in neoplasms, such as colorectal cancer, non-small cell lung cancer and melanoma, was analysed. The immune system plays an important role in controlling the development of neoplasms and fighting them. Oncological treatment algorithms include immunotherapy as monotherapy, combined with chemotherapy or chemotherapy as monotherapy. In the treatment of the above-mentioned neoplasms immunotherapeutics are used, such as checkpoint inhibitors (CPI) (i.e., ipilimumab, pembrolizumab, nivolumab, atezolizumab), vascular endothelial growth factor (VEGF) inhibitors (i.e., bevacizumab, ramucirumab) and a variety of chemotherapeutic agents (irinotecan, capecitabine, oxaliplatin, gefitinib, erlotinib, gemcitabine, cisplatin, paclitaxel, carboplatin, doclitaxel, vinorelbine, topotecan, etoposide). In our article, we focused on the number and type of renal complications as well as on the time of their manifestation when using specific treatment regimens. Our analysis also includes case reports. We discussed treatment of immunological complications and adjustments of the dose of chemotherapeutic agents depending on the creatinine clearance. Analysing the data from the literature, when two immunotherapeutic agents are used together, the number of recorded renal complications increases. Bevacizumab and ramucirumab are the cause of the largest number of renal complications among the immunotherapeutic agents described above. Cisplatin is the best-described substance with the greatest nephrotoxic potential among the chemotherapeutic agents. Crucial for renal complications are also cancer stage, previous chemotherapy and other risk factors of AKI such as age, comorbidities and medications used. Due to the described complications during oncological treatment, including kidney damage, it seems necessary to elaborate standards of cooperation between oncologists and nephrologists both during and after treatment of a patient with cancer. Therefore, it is necessary to conduct further research and develop algorithms for management of a cancer patient, especially during such an intensive progress in oncology.
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16
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Khan P, Siddiqui JA, Lakshmanan I, Ganti AK, Salgia R, Jain M, Batra SK, Nasser MW. RNA-based therapies: A cog in the wheel of lung cancer defense. Mol Cancer 2021; 20:54. [PMID: 33740988 PMCID: PMC7977189 DOI: 10.1186/s12943-021-01338-2] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 02/23/2021] [Indexed: 02/07/2023] Open
Abstract
Lung cancer (LC) is a heterogeneous disease consisting mainly of two subtypes, non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC), and remains the leading cause of death worldwide. Despite recent advances in therapies, the overall 5-year survival rate of LC remains less than 20%. The efficacy of current therapeutic approaches is compromised by inherent or acquired drug-resistance and severe off-target effects. Therefore, the identification and development of innovative and effective therapeutic approaches are critically desired for LC. The development of RNA-mediated gene inhibition technologies was a turning point in the field of RNA biology. The critical regulatory role of different RNAs in multiple cancer pathways makes them a rich source of targets and innovative tools for developing anticancer therapies. The identification of antisense sequences, short interfering RNAs (siRNAs), microRNAs (miRNAs or miRs), anti-miRs, and mRNA-based platforms holds great promise in preclinical and early clinical evaluation against LC. In the last decade, RNA-based therapies have substantially expanded and tested in clinical trials for multiple malignancies, including LC. This article describes the current understanding of various aspects of RNA-based therapeutics, including modern platforms, modifications, and combinations with chemo-/immunotherapies that have translational potential for LC therapies.
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Affiliation(s)
- Parvez Khan
- Department of Biochemistry and Molecular Biology, University of Nebraska Medical Center, Omaha, NE-68198, USA
| | - Jawed Akhtar Siddiqui
- Department of Biochemistry and Molecular Biology, University of Nebraska Medical Center, Omaha, NE-68198, USA
| | - Imayavaramban Lakshmanan
- Department of Biochemistry and Molecular Biology, University of Nebraska Medical Center, Omaha, NE-68198, USA
| | - Apar Kishor Ganti
- Fred & Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE-68198, USA
- Division of Oncology-Hematology, Department of Internal Medicine, VA-Nebraska Western Iowa Health Care System, Omaha, NE, 68105, USA
- Division of Oncology-Hematology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Ravi Salgia
- Department of Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA, 91010, USA
| | - Maneesh Jain
- Department of Biochemistry and Molecular Biology, University of Nebraska Medical Center, Omaha, NE-68198, USA
- Fred & Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE-68198, USA
| | - Surinder Kumar Batra
- Department of Biochemistry and Molecular Biology, University of Nebraska Medical Center, Omaha, NE-68198, USA
- Fred & Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE-68198, USA
- Eppley Institute for Research in Cancer and Allied Diseases, University of Nebraska Medical Center, Omaha, NE-68198, USA
| | - Mohd Wasim Nasser
- Department of Biochemistry and Molecular Biology, University of Nebraska Medical Center, Omaha, NE-68198, USA.
- Fred & Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE-68198, USA.
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Nguyen HM, Guz-Montgomery K, Lowe DB, Saha D. Pathogenetic Features and Current Management of Glioblastoma. Cancers (Basel) 2021; 13:cancers13040856. [PMID: 33670551 PMCID: PMC7922739 DOI: 10.3390/cancers13040856] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 02/09/2021] [Accepted: 02/16/2021] [Indexed: 02/06/2023] Open
Abstract
Glioblastoma (GBM) is the most common form of primary malignant brain tumor with a devastatingly poor prognosis. The disease does not discriminate, affecting adults and children of both sexes, and has an average overall survival of 12-15 months, despite advances in diagnosis and rigorous treatment with chemotherapy, radiation therapy, and surgical resection. In addition, most survivors will eventually experience tumor recurrence that only imparts survival of a few months. GBM is highly heterogenous, invasive, vascularized, and almost always inaccessible for treatment. Based on all these outstanding obstacles, there have been tremendous efforts to develop alternative treatment options that allow for more efficient targeting of the tumor including small molecule drugs and immunotherapies. A number of other strategies in development include therapies based on nanoparticles, light, extracellular vesicles, and micro-RNA, and vessel co-option. Advances in these potential approaches shed a promising outlook on the future of GBM treatment. In this review, we briefly discuss the current understanding of adult GBM's pathogenetic features that promote treatment resistance. We also outline novel and promising targeted agents currently under development for GBM patients during the last few years with their current clinical status.
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18
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Patel P, Alrifai D, McDonald F, Forster M. Beyond chemoradiotherapy: improving treatment outcomes for patients with stage III unresectable non-small-cell lung cancer through immuno-oncology and durvalumab (Imfinzi®▼, AstraZeneca UK Limited). Br J Cancer 2020; 123:18-27. [PMID: 33293672 PMCID: PMC7735213 DOI: 10.1038/s41416-020-01071-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The treatment paradigm of non-small-cell lung cancer (NSCLC) has rapidly changed in recent years following the introduction of immune-checkpoint inhibition (ICI). Pre-clinically, both chemotherapy and radiotherapy modulate the tumour microenvironment, providing the rationale for clinical trials evaluating their role in combination with immunotherapy. Standard-of-care treatment for patients with unresectable stage III disease is concurrent chemoradiotherapy (cCRT); however, only recently, the combination with ICI has been explored. The Phase 3 PACIFIC study randomised 713 patients with confirmed locally advanced, unresectable, stage III NSCLC, whose disease has not progressed following cCRT, to either the anti-programmed death-ligand 1 (PD-L1) agent durvalumab (Imfinzi®▼, AstraZeneca UK Limited) or placebo. Patients with a PD-L1 status ≥1% treated with durvalumab had a significantly longer median progression-free survival compared with placebo (17.2 vs. 5.6 months, respectively; HR: 0.51; 95% CI: 0.41-0.63), prolonged median overall survival (OS) (NR vs. 28.7 months, respectively; HR: 0.68; 99.73% CI: 0.47-0.997; P = 0.0025) and long-term clinical benefit (3-year OS HR: 0.69; 95% CI: 0.55-0.86). Grade 3 or 4 toxicity was marginally greater in the durvalumab cohort versus placebo (30.5% vs. 26.1%). Based on these results, durvalumab has been licensed in this setting, and further clinical trials are exploring the use of ICI in unresectable stage III NSCLC.
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Affiliation(s)
- Priyanka Patel
- Department of Radiotherapy, The Royal Marsden NHS Foundation Trust, London, UK
| | - Doraid Alrifai
- Lungs for Living Research Centre, UCL Respiratory, Rayne Institute, University College London, London, UK
- University College Hospital, London, UK
| | - Fiona McDonald
- Department of Radiotherapy, The Royal Marsden NHS Foundation Trust, London, UK.
| | - Martin Forster
- University College Hospital, London, UK
- UCL Cancer Institute, University College London, London, UK
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19
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Beyond Conventional: The New Horizon of Anti-Angiogenic microRNAs in Non-Small Cell Lung Cancer Therapy. Int J Mol Sci 2020; 21:ijms21218002. [PMID: 33121202 PMCID: PMC7663714 DOI: 10.3390/ijms21218002] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 10/24/2020] [Accepted: 10/25/2020] [Indexed: 12/24/2022] Open
Abstract
GLOBOCAN 2018 identified lung cancer as the leading oncological pathology in terms of incidence and mortality rates. Angiogenesis is a key adaptive mechanism of numerous malignancies that promotes metastatic spread in view of the dependency of cancer cells on nutrients and oxygen, favoring invasion. Limitation of the angiogenic process could significantly hamper the disease advancement through starvation of the primary tumor and impairment of metastatic spread. This review explores the basic molecular mechanisms of non-small cell lung cancer (NSCLC) angiogenesis, and discusses the influences of the key proangiogenic factors-the vascular endothelial growth factor-A (VEGF-A), basic fibroblast growth factor (FGF2), several matrix metalloproteinases (MMPs-MMP-2, MMP-7, MMP-9) and hypoxia-and the therapeutic implications of microRNAs (miRNAs, miRs) throughout the entire process, while also providing critical reviews of a number of microRNAs, with a focus on miR-126, miR-182, miR-155, miR-21 and let-7b. Finally, current conventional NSCLC anti-angiogenics-bevacizumab, ramucirumab and nintedanib-are briefly summarized through the lens of evidence-based medicine.
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20
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Hao X, Zhu Y, Mu Y, Wang S, Li J, Xing P. 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. J Cancer 2020; 11:6421-6428. [PMID: 33033525 PMCID: PMC7532494 DOI: 10.7150/jca.47072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 07/10/2020] [Indexed: 12/24/2022] Open
Abstract
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.
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Affiliation(s)
- Xuezhi Hao
- National Cancer Center/National Clinical Research Center For Cancer/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100021, China
| | - Yixiang Zhu
- National Cancer Center/National Clinical Research Center For Cancer/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100021, China
- Affiliated Hospital of Guizhou Medical University, Guizhou Province Tumor Hospital, Guiyang, P.R. China
| | - Yuxin Mu
- National Cancer Center/National Clinical Research Center For Cancer/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100021, China
| | - Shouzheng Wang
- National Cancer Center/National Clinical Research Center For Cancer/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100021, China
| | - Junling Li
- National Cancer Center/National Clinical Research Center For Cancer/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100021, China
| | - Puyuan Xing
- National Cancer Center/National Clinical Research Center For Cancer/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100021, China
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Di Paolo V, Colletti M, Ferruzzi V, Russo I, Galardi A, Alessi I, Milano GM, Di Giannatale A. Circulating Biomarkers for Tumor Angiogenesis: Where Are We? Curr Med Chem 2020; 27:2361-2380. [PMID: 30129403 DOI: 10.2174/0929867325666180821151409] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 07/10/2018] [Accepted: 07/17/2018] [Indexed: 01/26/2023]
Abstract
BACKGROUND In recent years, several anti-angiogenic drugs have been developed and their addition to standard treatment has been associated with clinical benefits. However, the response to anti-angiogenic therapy is characterized by considerable variability. In this context, the development of dynamic non-invasive biomarkers would be helpful to elucidate the emergence of anti-angiogenic resistance as well as to correctly address the treatment. OBJECTIVES The purpose of this review is to describe current reports on circulating diagnostic and prognostic biomarkers related to angiogenesis. We further discuss how this non-invasive strategy could improve the monitoring of tumor treatment and help clinical strategy. RESULTS We discuss the latest evidence in the literature regarding circulating anti-angiogenic markers. Besides growth factor proteins, different circulating miRNAs could exert a pro- or anti-angiogenic activity so as to represent suitable candidates for a non-invasive strategy. Recent reports indicate that tumor-derived exosomes, which are small membrane vesicles abundant in biological fluids, also have an impact on vascular remodeling. CONCLUSION Numerous circulating biomarkers related to angiogenesis have been recently identified. Their use will allow identifying patients who are more likely to benefit from a specific anti-angiogenic treatment, as well as detecting those who will develop resistance and/or adverse effects. Nonetheless, further studies are required to elucidate the role of these biomarkers in clinical settings.
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Affiliation(s)
- Virginia Di Paolo
- Department of Hematology/Oncology and Stem Cell Transplantation, Bambino Gesù Children's Hospital, IRCCS, Piazza di Sant'Onofrio, 4-00165 Rome, Italy
| | - Marta Colletti
- Department of Hematology/Oncology and Stem Cell Transplantation, Bambino Gesù Children's Hospital, IRCCS, Piazza di Sant'Onofrio, 4-00165 Rome, Italy
| | - Valentina Ferruzzi
- Department of Hematology/Oncology and Stem Cell Transplantation, Bambino Gesù Children's Hospital, IRCCS, Piazza di Sant'Onofrio, 4-00165 Rome, Italy
| | - Ida Russo
- Department of Hematology/Oncology and Stem Cell Transplantation, Bambino Gesù Children's Hospital, IRCCS, Piazza di Sant'Onofrio, 4-00165 Rome, Italy
| | - Angela Galardi
- Department of Hematology/Oncology and Stem Cell Transplantation, Bambino Gesù Children's Hospital, IRCCS, Piazza di Sant'Onofrio, 4-00165 Rome, Italy
| | - Iside Alessi
- Department of Hematology/Oncology and Stem Cell Transplantation, Bambino Gesù Children's Hospital, IRCCS, Piazza di Sant'Onofrio, 4-00165 Rome, Italy
| | - Giuseppe Maria Milano
- Department of Hematology/Oncology and Stem Cell Transplantation, Bambino Gesù Children's Hospital, IRCCS, Piazza di Sant'Onofrio, 4-00165 Rome, Italy
| | - Angela Di Giannatale
- Department of Hematology/Oncology and Stem Cell Transplantation, Bambino Gesù Children's Hospital, IRCCS, Piazza di Sant'Onofrio, 4-00165 Rome, Italy
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Montemagno C, Pagès G. Resistance to Anti-angiogenic Therapies: A Mechanism Depending on the Time of Exposure to the Drugs. Front Cell Dev Biol 2020; 8:584. [PMID: 32775327 PMCID: PMC7381352 DOI: 10.3389/fcell.2020.00584] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 06/16/2020] [Indexed: 12/12/2022] Open
Abstract
Angiogenesis, the formation of new blood vessels from preexisting one, represents a critical process for oxygen and nutrient supply to proliferating cells, therefore promoting tumor growth and metastasis. The Vascular Endothelial Growth Factor (VEGF) pathway is one of the key mediators of angiogenesis in cancer. Therefore, several therapies including monoclonal antibodies or tyrosine kinase inhibitors target this axis. Although preclinical studies demonstrated strong antitumor activity, clinical studies were disappointing. Antiangiogenic drugs, used to treat metastatic patients suffering of different types of cancers, prolonged survival to different extents but are not curative. In this review, we focused on different mechanisms involved in resistance to antiangiogenic therapies from early stage resistance involving mainly tumor cells to late stages related to the adaptation of the microenvironment.
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Affiliation(s)
- Christopher Montemagno
- Département de Biologie Médicale, Centre Scientifique de Monaco, Monaco, Monaco.,CNRS UMR 7284, Institute for Research on Cancer and Aging of Nice, Université Côte d'Azur, Nice, France.,INSERM U1081, Centre Antoine Lacassagne, Nice, France
| | - Gilles Pagès
- Département de Biologie Médicale, Centre Scientifique de Monaco, Monaco, Monaco.,CNRS UMR 7284, Institute for Research on Cancer and Aging of Nice, Université Côte d'Azur, Nice, France.,INSERM U1081, Centre Antoine Lacassagne, Nice, France
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23
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[A Review of Drug Therapy of Lung Cancer with Interstitial Lung Disease]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2020; 23:286-293. [PMID: 32316717 PMCID: PMC7210086 DOI: 10.3779/j.issn.1009-3419.2020.102.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Interstitial lung disease (ILD) is a risk factor for lung cancer. Patients with lung cancer associated with ILD (LC-ILD) often appear clinically. During the treatment of LC-ILD, there is a risk of causing acute exacerbation or even death in the treatment of lung cancer. At the same time, combining ILD has become the exclusion criteria for prospective clinical trials of most lung cancers. Therefore, when lung cancer is combined with ILD, it often becomes a difficult point for the treatment of lung cancer. Because LC-ILD patients have a certain proportion in the clinic, it is necessary to explore the best treatment options. Here we review the results of existing clinical studies for reference.
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24
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Shu C, Sun P, Xie H, Huang W, Qi J, Ma Y. Virus-Like Particles Presenting the FGF-2 Protein or Identified Antigenic Peptides Promoted Antitumor Immune Responses in Mice. Int J Nanomedicine 2020; 15:1983-1996. [PMID: 32308382 PMCID: PMC7146011 DOI: 10.2147/ijn.s237182] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Accepted: 02/25/2020] [Indexed: 01/29/2023] Open
Abstract
Background Fibroblast growth factor (FGF)-2 is overexpressed in various tumor tissues. It affects tumor cell proliferation, invasion and survival, promotes tumor angiogenesis and is tightly involved in the development of systemic and local immunosuppressive tumor mechanisms. Purpose This study aimed to develop an effective vaccine against FGF-2 and to investigate the effects of anti-FGF-2 immunization on tumor growth and antitumor immune responses. Methods A set of thirteen synthesized overlapping peptides covering all possible linear B-cell epitopes of murine FGF-2 and a recombinant FGF-2 protein were conjugated to virus-like particles (VLPs) of recombinant hepatitis B core antigen (HBcAg). The VLPs were immunized through a preventive or therapeutic strategy in a TC-1 or 4T1 grafted tumor model. Results Immunization with FGF-2 peptides or full-length protein-coupled VLPs produced FGF-2-specific antibodies with a high titer. Peptide 12, which is located in the heparin-binding site of FGF-2, or protein-conjugated VLPs presented the most significant effects on the suppression of TC-1 tumor growth. The levels of IFN-γ-expressing splenocytes and serum IFN-γ were significantly elevated; further, the immune effector cells CD8+ IFN-γ+ cytotoxic T lymphocytes (CTLs) and CD4+ IFN-γ+ Th1 cells were significantly increased, whereas the immunosuppressive cells CD4+ CD25+ FOXP3+ Treg cells and Gr-1+ CD11b+ myeloid-derived suppressor cells (MDSCs) were decreased in the immunized mice. In addition, VLP immunization significantly suppressed tumor vascularization and promoted tumor cell apoptosis. In mice bearing 4T1 breast tumor, preventive immunization with FGF-2-conjugated VLPs suppressed tumor growth and lung metastasis, and increased effector cell responses. Conclusion Active immunization against FGF-2 is a new possible strategy for tumor immunotherapy.
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Affiliation(s)
- Congyan Shu
- Institute of Medical Biology, Chinese Academy of Medical Science & Peking Union Medical College, Kunming 650118, People's Republic of China.,Sichuan Institute for Food and Drug Control, Chengdu 611731, People's Republic of China
| | - Pengyan Sun
- Yunnan Center for Disease Control and Prevention, Kunming 650022, People's Republic of China
| | - Hanghang Xie
- Institute of Medical Biology, Chinese Academy of Medical Science & Peking Union Medical College, Kunming 650118, People's Republic of China
| | - Weiwei Huang
- Institute of Medical Biology, Chinese Academy of Medical Science & Peking Union Medical College, Kunming 650118, People's Republic of China
| | - Jialong Qi
- Institute of Medical Biology, Chinese Academy of Medical Science & Peking Union Medical College, Kunming 650118, People's Republic of China
| | - Yanbing Ma
- Institute of Medical Biology, Chinese Academy of Medical Science & Peking Union Medical College, Kunming 650118, People's Republic of China
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25
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Vergnenègre A, Basse V, Le Garff G, Bylicki O, Dubos-Arvis C, Comet B, Marcq M, Le Treut J, Auliac JB, Madroszyk A, Fraboulet G, Crequit J, Thomas P, Paleiron N, Monnet I. Potential Antiangiogenic Treatment Eligibility of Patients with Squamous Non-Small-Cell Lung Cancer: EPISQUAMAB Study (GFPC 2015-01). Cancer Manag Res 2019; 11:10821-10826. [PMID: 31920391 PMCID: PMC6938186 DOI: 10.2147/cmar.s219984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 11/05/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Antiangiogenic agents have improved the prognosis of non-squamous non-small-cell lung cancers (NSCLCs), even though all the patients are not eligible to receive them because of counterindications linked to the tumor's characteristics or comorbidities. Much less information is available about the eligibility of patients with squamous non-small-cell lung cancers (SQ-NSCLCs) to receive antivascular endothelial growth-factor (VEGF) treatments, even though such molecules are being developed for this histology. This study was undertaken to determine the percentage of advanced SQ-NSCLC patients who would be eligible to receive an antiVEGF agent as second-line systemic therapy. METHODS This observational, multicenter, prospective study evaluated advanced SQ-NSCLC patients' criteria for ineligibility to receive an antiVEGF during a multidisciplinary meeting to choose their standard second-line systemic therapy. RESULTS Among the 317 patients included, 53.6% had at least one ineligibility criterion, and ~20% had at least two, with disease extension to large vessels (39.8%), tumor cavitation (20.5%), cardiovascular disease (11%) and/or hemoptysis (7.2%) being the most frequent. Patients with an ECOG performance score of 1/2 had more cardiovascular contraindications that those with scores of 0. CONCLUSION Almost half of the SQ-NSCLC patients included in this study would have been eligible to receive an antiVEGF agent. The development of these molecules for these indications should be encouraged.
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Affiliation(s)
| | | | | | | | | | | | - Marie Marcq
- CH Départemental Vendée, Les Oudairies, La Roche-Sur-Yon, France
| | | | | | | | | | | | - Pascal Thomas
- CH Intercommunal (CHI) Des Alpes-Du-Sud, Gap, France
| | | | | | - On behalf of the French Lung Cancer Group
- Centre Hospitalier Universitaire (CHU) Dupuytren, Limoges, France
- CHU Morvan, Brest, France
- CH Yves-Le-Foll, Saint-Brieuc, France
- Hôpital d’Instruction des Armées Percy, Clamart, France
- Centre François-Baclesse, Caen, France
- Centre Catalan d’Oncologie, Perpignan, France
- CH Départemental Vendée, Les Oudairies, La Roche-Sur-Yon, France
- CH du Pays d’Aix, Aix-En-Provence, France
- Hôpital Quesnay, Mantes-La-Jolie, France
- Institut Paoli-Calmettes, Marseille, France
- CH René-Dubos, Cergy-Pontoise, France
- CH Laennec, Creil, France
- CH Intercommunal (CHI) Des Alpes-Du-Sud, Gap, France
- Hôpital d’Instruction Des Armées Sainte-Anne, Toulon, France
- CHI Créteil, Créteil, France
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Ding Y, Zhang L, Guo L, Wu C, Zhou J, Zhou Y, Ma J, Li X, Ji P, Wang M, Zhu W, Shi C, Li S, Wu W, Zhu W, Xiao D, Fu C, He Q, Sun R, Mao X, Lizaso A, Li B, Han-Zhang H, Zhang Z. Comparative study on the mutational profile of adenocarcinoma and squamous cell carcinoma predominant histologic subtypes in Chinese non-small cell lung cancer patients. Thorac Cancer 2019; 11:103-112. [PMID: 31692283 PMCID: PMC6938761 DOI: 10.1111/1759-7714.13208] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Revised: 09/12/2019] [Accepted: 09/13/2019] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Distinction in the mutational profile between the common histological types, lung adenocarcinoma (LUAD) and squamous cell lung carcinoma (LUSC) has been well-established. However, comprehensive mutation profiles of the predominant histological subtypes within LUAD and LUSC remains elusive. METHODS We analyzed the mutational profile of 318 Chinese NSCLC patients of adenocarcinoma and squamous cell carcinoma predominant subtypes from seven hospitals using capture-based ultra-deep sequencing of 68 lung cancer-related genes. RESULTS Of the 318 NSCLC patients, 215 were diagnosed with LUAD and 103 with LUSC. Adenocarcinoma in situ and acinar adenocarcinoma were the most predominant subtypes of LUAD. On the other hand, keratinizing squamous cell carcinoma was the most predominant subtype of LUSC. Among the LUAD subtypes, EGFR sensitizing mutations were most prevalent in the invasive lepidic subtype. More than half of the patients with preinvasive adenocarcinoma in situ, minimally invasive, acinar, micropapillary and papillary subtypes were also EGFR-mutants. Patients with colloidal, invasive mucinous, and fetal subtypes had the least number of EGFR mutations. Moreover, KRAS mutations were prevalent in patients with invasive mucinous, colloid, enteric and solid subtypes. A total of 90% of the LUSC patients harbor mutations in TP53, wherein all patients except five with nonkeratinizing were TP53 mutants. PIK3CA amplifications were most prevalent in keratinizing, followed by basaloid and nonkeratinizing subtypes. CONCLUSION These data suggest that the mutational profiles among the predominant histological subtypes were very distinct, which provided a reliable tool to improve treatment decisions.
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Affiliation(s)
- Ying Ding
- Department of Pathology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Lihua Zhang
- Department of Pathology, Southeast University, Zhongda Hospital, Nanjing, China
| | - Lingchuan Guo
- Department of Pathology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Chunyan Wu
- Department of Pathology, Shanghai Pulmonary Hospital, Tongji University, Shanghai, China
| | - Jianhua Zhou
- Department of Pathology, Xiangya Hospital, Central South University, Changsha, China
| | - Yongchun Zhou
- Molecular Diagnostic Center, Yunnan Cancer Center, Yunnan Cancer Hospital, Kunming, China
| | - Jie Ma
- Department of Molecular Pathology, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiao Li
- Department of Pathology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Pan Ji
- Department of Pathology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Ming Wang
- Department of Pathology, Southeast University, Zhongda Hospital, Nanjing, China
| | - Weidong Zhu
- Department of Pathology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Chenxi Shi
- Department of Pathology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Sanen Li
- Department of Pathology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Wei Wu
- Department of Pathology, Shanghai Pulmonary Hospital, Tongji University, Shanghai, China
| | - Wei Zhu
- Department of Pathology, Xiangya Hospital, Central South University, Changsha, China
| | - Desheng Xiao
- Department of Pathology, Xiangya Hospital, Central South University, Changsha, China
| | - Chunyan Fu
- Department of Pathology, Xiangya Hospital, Central South University, Changsha, China
| | - Qiuyan He
- Department of Pathology, Xiangya Hospital, Central South University, Changsha, China
| | - Rui Sun
- Department of Molecular Pathology, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China
| | - Xinru Mao
- Burning Rock Biotech, Guangzhou, China
| | | | - Bing Li
- Burning Rock Biotech, Guangzhou, China
| | | | - Zhihong Zhang
- Department of Pathology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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27
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Chen L, Kim JS, San Antonio B, Zhu YE, Mitchell L, John W. Safety outcomes in advanced non-small-cell lung cancer patients treated with first-line platinum-based regimens in the United States. J Thorac Dis 2019; 11:4474-4483. [PMID: 31903235 DOI: 10.21037/jtd.2019.11.11] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background We analyzed the treatment patterns and safety outcomes of the most common first-line platinum-based regimens initiated on or after non-small cell lung cancer (NSCLC) diagnosis in a real-world setting. Methods Based on a United States oncology electronic medical record (EMR) database, patients treated with first-line platinum-based regimens after advanced NSCLC diagnosis from September 2008 to November 2014 were analyzed. Baseline characteristics and selected adverse events during treatment [incidence proportions and incidence rates (IRs)] were described by regimen. Propensity score stratification was used to adjust for baseline characteristics differences. Hazard ratios (HRs) were estimated using Cox proportional hazards model, with paclitaxel (Pac)/carboplatin (Carbo) as reference. Subgroup analysis was conducted for elderly patients (≥70 years old). Results The most common five regimens for the eligible patients were as follows: Pac/Carbo (n=3,009), pemetrexed (Pem)/Carbo (n=1,625), Pem/Carbo/bevacizumab (Bev) (n=735), Pac/Carbo/Bev (n=531), Pem/cisplatin (Cis) (n=357), and docetaxel (Doc)/Carbo (n=355). Highest IRs were reported for anemia, neutropenia, nausea, and vomiting across these regimens in patients of all ages. After propensity score stratification, compared with Pac/Carbo, risk of anemia was significantly lower with Pac/Carbo/Bev (HR =0.67), Pem/Cis (HR =0.68), and Pem/Carbo/Bev (HR =0.82); risk of neutropenia was comparable among all regimens except Doc/Carbo (significantly lower risk; HR =0.72); and risk of nausea (HR =1.45) and vomiting (HR =1.50) was significantly higher with Pem/Cis. Safety outcomes in elderly patients were consistent with the overall population. Conclusions While EMR data have limitations, the real-world safety outcome with individual chemotherapy regimen could be considered for the better selection of platinum-based therapies in NSCLC.
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Affiliation(s)
- Lei Chen
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, USA
| | - Jong Seok Kim
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, USA
| | | | - Yajun Emily Zhu
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, USA
| | - Lucy Mitchell
- Eli Lilly and Company, Erl Wood, Windlesham, Surrey, UK
| | - William John
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, USA
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28
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Zhan Q, Miao F, Huang R, Zhou X, Ge M, Liang X. Efficacy and safety of bevacizumab combined with chemotherapy in symptomatic brain metastases from lung adenocarcinoma: a retrospective analysis. J Thorac Dis 2019; 11:4725-4734. [PMID: 31903262 DOI: 10.21037/jtd.2019.10.49] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Currently, the treatment of symptomatic brain metastases from lung adenocarcinoma has remained difficult. Bevacizumab combined with chemotherapy is one of the standard treatments of lung adenocarcinoma. This study was designed to investigate the efficacy and safety of bevacizumab combined with chemotherapy in symptomatic brain metastases from lung adenocarcinoma that are not suitable for local treatments, and to explore the predictive value of baseline serum vascular endothelial growth factor (VEGF) for the treatment. Methods We retrospectively reviewed 14 consecutive patients, between Jan 2015 and Jul 2017, with brain metastases from lung adenocarcinoma who received bevacizumab and chemotherapy to determine efficacy and toxicity. Kaplan-Meier method was used to estimate survival curves, and univariate and multivariate analyses were performed by Cox proportional hazard model. The primary endpoints were objective response rate (ORR) and intracranial ORR (iORR). The secondary endpoints were progression-free survival (PFS), intracranial PFS (iPFS), overall survival (OS) and disease control rate (DCR). Results The efficacy of 12 patient was evaluated. Overall ORR was 25% (3/12) and the iORR of brain lesions was 33.3% (4/12). DCR was 75% (9/12). The median OS was 18.3 months, the median PFS was 6.7 months, and the median iPFS was 12 months. After 2 cycles of bevacizumab, 10 patients showed improved symptoms of central nervous system (CNS), and the symptom control rate was 83.3% (10/12). Head MRI showed that edema in the brain was greatly reduced in 6 patients, resulting in the lessened usage of dexamethasone. iPFS was significantly shorter in high VEGF group (3.6 vs. 8.0 m, P=0.02), and multivariate analysis showed a significant correlation between iPFS and serum baseline VEGF level (P=0.023). The most commonly adverse events of bevacizumab included leukopenia [5 (35.7%)], fatigue [3 (21.4%)], thrombocytopenia [3 (21.4%)], anemia [2 (14.3%)], which were mostly degree I and II. Conclusions This study showed bevacizumab combined with chemotherapy could effectively control intracranial lesions, relieve symptoms, and improve the quality of life and survival of patients with brain metastases from lung adenocarcinoma. Serum baseline VEGF may be a predictor of efficacy of bevacizumab plus chemotherapy in the treatment of brain metastases from lung adenocarcinoma.
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Affiliation(s)
- Qiong Zhan
- Department of Oncology, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Feng Miao
- Department of Thoracic Surgery, Huashan Hospital North, Fudan University, Shanghai 200040, China
| | - Ruofan Huang
- Department of Oncology, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Xinli Zhou
- Department of Oncology, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Mengxi Ge
- Department of Thoracic Surgery, Huashan Hospital North, Fudan University, Shanghai 200040, China
| | - Xiaohua Liang
- Department of Oncology, Huashan Hospital, Fudan University, Shanghai 200040, China
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29
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Maguire FB, Morris CR, Parikh-Patel A, Cress RD, Keegan THM, Li CS, Lin PS, Kizer KW. First-Line Systemic Treatments for Stage IV Non-Small Cell Lung Cancer in California: Patterns of Care and Outcomes in a Real-World Setting. JNCI Cancer Spectr 2019; 3:pkz020. [PMID: 32328551 PMCID: PMC7050031 DOI: 10.1093/jncics/pkz020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 12/03/2018] [Accepted: 03/19/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Multiple systemic treatments have been developed for stage IV non-small cell lung cancer (NSCLC), but their use and effect on outcomes at the population level are unknown. This study describes the utilization of first-line systemic treatments among stage IV NSCLC patients in California and compares survival among treatment groups. METHODS Data on 17 254 patients diagnosed with stage IV NSCLC from 2012 to 2014 were obtained from the California Cancer Registry. Systemic treatments were classified into six groups. The Kaplan-Meier method and multivariable Cox proportional hazards models were used to compare survival between treatment groups. RESULTS Fifty-one percent of patients were known to have received systemic treatment. For patients with nonsquamous histology, pemetrexed regimens were the most common treatment (14.8%) followed by tyrosine kinase inhibitors (11.9%) and platinum doublets (11.5%). Few patients received pemetrexed/bevacizumab combinations (4.5%), bevacizumab combinations (3.6%), or single agents (1.7%). There was statistically significantly better overall survival for those on pemetrexed regimens (hazard ratio [HR] = 0.86, 95% confidence interval [CI] = 0.80 to 0.92), bevacizumab regimens (HR = 0.73, 95% CI = 0.65 to 0.81), pemetrexed/bevacizumab regimens (HR = 0.68, 95% CI = 0.61 to 0.76), or tyrosine kinase inhibitors (HR = 0.62, 95% CI = 0.57 to 0.67) compared with platinum doublets. The odds of receiving most systemic treatments decreased with decreasing socioeconomic status. For patients with squamous histology, platinum doublets were predominant (33.7%) and were not found to have statistically significantly different overall survival from single agents. CONCLUSIONS These population-level findings indicate low utilization of systemic treatments, survival differences between treatment groups, and evident treatment disparities by socioeconomic status.
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Affiliation(s)
- Frances B Maguire
- California Cancer Reporting and Epidemiologic Surveillance Program, Institute for Population Health Improvement, University of California Davis, Davis, CA
- Graduate Group in Epidemiology, University of California Davis, Davis, CA
| | - Cyllene R Morris
- California Cancer Reporting and Epidemiologic Surveillance Program, Institute for Population Health Improvement, University of California Davis, Davis, CA
| | - Arti Parikh-Patel
- California Cancer Reporting and Epidemiologic Surveillance Program, Institute for Population Health Improvement, University of California Davis, Davis, CA
| | - Rosemary D Cress
- Department of Public Health Sciences, University of California Davis, Davis, CA
| | - Theresa H M Keegan
- Center for Oncology Hematology Outcomes Research and Training (COHORT), and Division of Hematology and Oncology, University of California Davis School of Medicine
| | - Chin-Shang Li
- School of Nursing, State University of New York, University of Buffalo, Buffalo, NY
| | - Patrick S Lin
- Center for Oncology Hematology Outcomes Research and Training (COHORT), and Division of Hematology and Oncology, University of California Davis School of Medicine
| | - Kenneth W Kizer
- California Cancer Reporting and Epidemiologic Surveillance Program, Institute for Population Health Improvement, University of California Davis, Davis, CA
- Department of Emergency Medicine, University of California Davis School of Medicine, Davis, CA
- Betty Irene Moore School of Nursing, University of California Davis, Davis, CA
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30
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Spek CA, Duitman J. Is idiopathic pulmonary fibrosis a cancer-like disease? Transcriptome analysis to fuel the debate. ERJ Open Res 2019; 5:00157-2018. [PMID: 30723726 PMCID: PMC6355975 DOI: 10.1183/23120541.00157-2018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 11/29/2018] [Indexed: 12/17/2022] Open
Abstract
Idiopathic pulmonary fibrosis (IPF) is a devastating and eventually fatal diffuse parenchymal lung disorder that largely remains refractory to pharmacological therapies [1]. IPF is characterised by excessive fibroblast proliferation leading to the formation of fibroblast foci secreting extracellular matrix, with subsequent disruption of pulmonary structure and function. Despite progress in the understanding of the pathogenesis of IPF, novel treatment modalities show limited efficacy and the prognosis of IPF only slowly improves, with current 5-year mortality rates still ranging from 70% to 80%. To boost prognosis and to rise above incremental reductions in mortality rates of IPF patients, innovative and unorthodox treatment modalities are eagerly awaited. Despite promising examples of anticancer drugs as potential treatment modalities for IPF, these transcriptome data argue against the general nature of anticancer drugs as anti-IPF drugshttp://ow.ly/HjsV30nbcji
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Affiliation(s)
- C Arnold Spek
- Amsterdam UMC, University of Amsterdam, Center for Experimental and Molecular Medicine, Amsterdam, The Netherlands
| | - JanWillem Duitman
- Amsterdam UMC, University of Amsterdam, Center for Experimental and Molecular Medicine, Amsterdam, The Netherlands
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31
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Wirsdörfer F, de Leve S, Jendrossek V. Combining Radiotherapy and Immunotherapy in Lung Cancer: Can We Expect Limitations Due to Altered Normal Tissue Toxicity? Int J Mol Sci 2018; 20:ijms20010024. [PMID: 30577587 PMCID: PMC6337556 DOI: 10.3390/ijms20010024] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 12/18/2018] [Accepted: 12/19/2018] [Indexed: 02/08/2023] Open
Abstract
In recent decades, technical advances in surgery and radiotherapy, as well as breakthroughs in the knowledge on cancer biology, have helped to substantially improve the standard of cancer care with respect to overall response rates, progression-free survival, and the quality of life of cancer patients. In this context, immunotherapy is thought to have revolutionized the standard of care for cancer patients in the long term. For example, immunotherapy approaches such as immune checkpoint blockade are currently increasingly being used in cancer treatment, either alone or in combination with chemotherapy or radiotherapy, and there is hope from the first clinical trials that the appropriate integration of immunotherapy into standard care will raise the success rates of cancer therapy to a new level. Nevertheless, successful cancer therapy remains a major challenge, particularly in tumors with either pronounced resistance to chemotherapy and radiation treatment, a high risk of normal tissue complications, or both, as in lung cancer. Chemotherapy, radiotherapy and immunotherapy have the capacity to evoke adverse effects in normal tissues when administered alone. However, therapy concepts are usually highly complex, and it is still not clear if combining immunotherapy with radio(chemo)therapy will increase the risk of normal tissue complications, in particular since normal tissue toxicity induced by chemotherapy and radiotherapy can involve immunologic processes. Unfortunately, no reliable biomarkers are available so far that are suited to predict the unique normal tissue sensitivity of a given patient to a given treatment. Consequently, clinical trials combining radiotherapy and immunotherapy are attracting major attention, not only regarding efficacy, but also with regard to safety. In the present review, we summarize the current knowledge of radiation-induced and immunotherapy-induced effects in tumor and normal tissue of the lung, and discuss the potential limitations of combined radio-immunotherapy in lung cancer with a focus on the suspected risk for enhanced acute and chronic normal tissue toxicity.
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Affiliation(s)
- Florian Wirsdörfer
- Institute of Cell Biology (Cancer Research), University Hospital Essen, 45147 Essen, Germany.
| | - Simone de Leve
- Institute of Cell Biology (Cancer Research), University Hospital Essen, 45147 Essen, Germany.
| | - Verena Jendrossek
- Institute of Cell Biology (Cancer Research), University Hospital Essen, 45147 Essen, Germany.
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32
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Hendriks LEL, Subramaniam DS, Dingemans AMC. Editorial: Central Nervous System Metastases in Lung Cancer Patients: From Prevention to Diagnosis and Treatment. Front Oncol 2018; 8:511. [PMID: 30460200 PMCID: PMC6232302 DOI: 10.3389/fonc.2018.00511] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Accepted: 10/19/2018] [Indexed: 12/27/2022] Open
Affiliation(s)
- Lizza E L Hendriks
- Department of Pulmonary Diseases, GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, Netherlands
| | - Deepa S Subramaniam
- Division of Hematology-Oncology, Georgetown University, Washington, DC, United States
| | - Anne-Marie C Dingemans
- Department of Pulmonary Diseases, GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, Netherlands
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Wollina U. Systemic Drug-induced Chronic Paronychia and Periungual Pyogenic Granuloma. Indian Dermatol Online J 2018; 9:293-298. [PMID: 30258794 PMCID: PMC6137670 DOI: 10.4103/idoj.idoj_133_18] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Paronychia is a painful inflammatory disorder of the nail fold. Periungual pyogenic granuloma - a benign vascular tumor of the capillaries - can develop as a complication of paronychia. We report both, paronychia and periungual pyogenic granuloma, as possible adverse events during systemic drug-therapy. The following groups of systemic drugs have been considered: taxanes, epidermal growth factor-receptor (EGFR) inhibitors, EGFR tyrosine kinase inhibitors, tyrosine kinase inhibitors, inhibitors of MEK/ERK, BRAF inhibitors, CD20 antagonists, vascular endothelial growth factor inhibitors, and retinoids. Recommendations for prevention and treatment are given. Since paronychia is a painful inflammatory disorder that has a negative impact on daily activities, early recognition and adequate treatment improve adhesion to treatment and quality of life.
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Affiliation(s)
- Uwe Wollina
- Department of Dermatology and Allergology, Städtisches Klinikum Dresden, Academic Teaching Hospital of the Technical University of Dresden, Dresden, Germany
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