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Florez N, Patel SP, Wakelee H, Bazhenova L, Massarelli E, Salgia R, Stiles B, Peters S, Malhotra J, Gadgeel SM, Nieva JJ, Afkhami M, Hirsch FR, Gubens M, Cascone T, Levy B, Sabari J, Husain H, Ma PC, Backhus LM, Iyengar P, Lee P, Miller R, Sands J, Kim E. Proceedings of the 1st biannual bridging the gaps in lung cancer conference. Oncologist 2024:oyae228. [PMID: 39237103 DOI: 10.1093/oncolo/oyae228] [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: 01/04/2024] [Accepted: 07/22/2024] [Indexed: 09/07/2024] Open
Abstract
Lung cancer is the leading cause of cancer death in the US and globally. The mortality from lung cancer has been declining, due to a reduction in incidence and advances in treatment. Although recent success in developing targeted and immunotherapies for lung cancer has benefitted patients, it has also expanded the complexity of potential treatment options for health care providers. To aid in reducing such complexity, experts in oncology convened a conference (Bridging the Gaps in Lung Cancer) to identify current knowledge gaps and controversies in the diagnosis, treatment, and outcomes of various lung cancer scenarios, as described here. Such scenarios relate to biomarkers and testing in lung cancer, small cell lung cancer, EGFR mutations and targeted therapy in non-small cell lung cancer (NSCLC), early-stage NSCLC, KRAS/BRAF/MET and other genomic alterations in NSCLC, and immunotherapy in advanced NSCLC.
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Affiliation(s)
- Narjust Florez
- Dana-Farber Cancer Institute, Harvard University School of Medicine, Boston, MA, United States
| | - Sandip P Patel
- Sanford Stem Cell Clinical Center and San Diego Center for Precision Immunotherapy, University of California San Diego, La Jolla, CA, United States
| | - Heather Wakelee
- Stanford University School of Medicine and Stanford Cancer Institute, Stanford, CA, United States
| | - Lyudmila Bazhenova
- University of California San Diego Moores Cancer Center, La Jolla, CA, United States
| | - Erminia Massarelli
- Department of Medical Oncology & Therapeutics Research, City of Hope, Duarte, CA, United States
| | - Ravi Salgia
- Department of Medical Oncology & Therapeutics Research, City of Hope, Duarte, CA, United States
| | - Brendon Stiles
- Cardiovascular and Vascular Surgery, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Solange Peters
- Medical Oncology, Lausanne University Hospital, Lausanne Vaud, Switzerland
| | - Jyoti Malhotra
- Thoracic Medical Oncology, City of Hope Orange County, Irvine, CA, United States
| | - Shirish M Gadgeel
- Henry Ford Cancer Institute, Henry Ford Health Center, Detroit, MI, United States
| | - Jorge J Nieva
- Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Michelle Afkhami
- Department of Pathology, City of Hope Comprehensive Cancer Center, Duarte, CA, United States
| | - Fred R Hirsch
- Icahn School of Medicine and Center for Thoracic Oncology, Mount Sinai Health System, New York, NY, United States
| | - Matthew Gubens
- Thoracic Medical Oncology, University of California San Francisco, San Francisco, CA, , United States
| | - Tina Cascone
- University of Texas MD Anderson Cancer Center, United States
| | - Benjamin Levy
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore MD, United States
| | - Joshua Sabari
- Langone Health Perlmutter Cancer Center and NYU Langone Grossman School of Medicine, New York, NY, United States
| | - Hatim Husain
- University of California San Diego, San Diego, CA, United States
| | - Patrick C Ma
- Penn State Cancer Institute, Milton S. Hershey Medical Center and Penn State College of Medicine, Hershey, PA, United States
| | - Leah M Backhus
- Department of Cardiothoracic Surgery, Standford University, Palo Alto, CA, United States
| | - Puneeth Iyengar
- Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Percy Lee
- City of Hope National Medical Center, Los Angeles, CA, United States
| | - Russell Miller
- University of California San Diego, San Diego, CA, United States
| | - Jacob Sands
- Dana-Farber Cancer Institute, Harvard University School of Medicine, Boston, MA, United States
| | - Edward Kim
- Department of Medical Oncology & Therapeutics Research, City of Hope, Duarte, CA, United States
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Ghaderi S, Mohammadi S, Fatehi F. Diffusion Tensor Imaging (DTI) Biomarker Alterations in Brain Metastases and Comparable Tumors: A Systematic Review of DTI and Tractography Findings. World Neurosurg 2024; 190:113-129. [PMID: 38986953 DOI: 10.1016/j.wneu.2024.07.037] [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: 03/05/2024] [Revised: 07/03/2024] [Accepted: 07/04/2024] [Indexed: 07/12/2024]
Abstract
BACKGROUND Brain metastases (BMs) are the most frequent tumors of the central nervous system. Diffusion tensor imaging (DTI) is a magnetic resonance imaging technique that provides insights into brain microstructural alterations and tensor metrics and generates tractography to visualize white matter fiber tracts based on diffusion directionality. This systematic review assessed evidence from DTI biomarker alterations in BMs and comparable tumors such as glioblastoma. METHODS PubMed, Scopus, and Web of Science were searched, and published between January 2000 and August 2023. The key inclusion criteria were studies reporting DTI metrics in BMs and comparisons with other tumors. Data on study characteristics, tumor types, sample details, and main DTI findings were extracted. RESULTS Fifty-seven studies with 1592 BM patients and 1578 comparable brain tumors were included. Peritumoral fractional anisotropy (FA) consistently differentiates BMs from primary brain tumors, whereas intratumoral FA shows limited discriminatory power. Mean diffusivity increased in BMs versus comparators. Intratumoral metrics were less consistent but revealed differences in BM origin. Axial and radial diffusivity have provided insights into the effects of radiation, tumor origin, and infiltration. Axial diffusivity/radial diffusivity differentiated tumor infiltration from vasogenic edema. Tractography revealed anatomical relationships between white matter tracts and BMs. In addition, tractography-guided BM surgery and radiotherapy planning are required. Machine learning models incorporating DTI biomarkers/metrics accurately classified BMs versus comparators and improved diagnostic classification. CONCLUSIONS DTI metrics provide noninvasive biomarkers for distinguishing BMs from other tumors and predicting outcomes. Key metrics included peritumoral FA and mean diffusivity.
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Affiliation(s)
- Sadegh Ghaderi
- Department of Neurology, Neuromuscular Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran; Department of Neuroscience and Addiction Studies, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Sana Mohammadi
- Department of Neuroscience and Addiction Studies, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Farzad Fatehi
- Department of Neuroscience and Addiction Studies, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran; Neurology Department, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom.
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Mills MN, Uno A, Li P, Liveringhouse C, Kim Y, Oliver DE, Perez BA, Creelan BC, Yu M, Forsyth PA, Pina Y, Ahmed KA. Clinical Outcomes of Patients with Non-Small Cell Lung Cancer Leptomeningeal Disease Following Receipt of EGFR-Targeted Therapy, Immune-Checkpoint Blockade, Intrathecal Chemotherapy, or Radiation Therapy Alone. Clin Lung Cancer 2024; 25:417-423.e1. [PMID: 38719648 DOI: 10.1016/j.cllc.2024.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 03/14/2024] [Accepted: 04/07/2024] [Indexed: 06/30/2024]
Abstract
BACKGROUND EGFR-targeted therapy (ETT) and immune-checkpoint blockade (ICB) have shown promising results in treating NSCLC brain metastases (BM). However, little is known of their effect in treating leptomeningeal disease (LMD). PATIENTS AND METHODS This is a retrospective review of 80 patients diagnosed with NSCLC LMD from January 2014 to March 2021. Patients were grouped based on initial LMD treatment: radiotherapy (RT) alone, ETT, ICB, and intrathecal chemotherapy (ITC). RESULTS EGFR mutation was present in 22 patients (28%). Twenty patients had positive cytology in cerebrospinal fluid, while 60 patients were diagnosed based on MRI with clinical correlation. The RT alone group consisted primarily of whole brain radiation (n = 20; 77%), stereotactic radiation (n = 3; 12%), and palliative spine radiation (n = 2; 7%). There were no significant differences amongst the treatment groups in age, performance status, or neurologic symptoms. Overall, the 6-month overall survival (OS) and craniospinal progression free survival (CS-PFS) were 35% and 24%, respectively. The 6-month OS for the ETT, ICB, ITC, and RT alone groups was 64%, 33%, 57%, and 29% respectively (log-rank P = .026). The 6-month CS-PFS for the ETT, ICB, ITC, and RT alone groups was 43%, 33%, 29%, and 19% respectively (log-rank P = .049). Upon univariate analysis, receipt of ETT compared to RT alone reached significance for OS (HR 0.35, P = .006) and CS-PFS (HR 0.39, P = .013). CONCLUSIONS The prognosis for patients with NSCLC LMD remains poor overall. However, the receipt of ETT for patients with EGFR-positive disease was associated with improved outcomes.
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Affiliation(s)
- Matthew N Mills
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Akihiro Uno
- Morsani College of Medicine, University of South Florida, Tampa, FL
| | - Pinxue Li
- Morsani College of Medicine, University of South Florida, Tampa, FL
| | - Casey Liveringhouse
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Youngchul Kim
- Department of Biostatistics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Daniel E Oliver
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Bradford A Perez
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Benjamin C Creelan
- Department of Thoracic Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Michael Yu
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Peter A Forsyth
- Department of Neuro-Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Yolanda Pina
- Department of Neuro-Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL.
| | - Kamran A Ahmed
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL.
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Meng Y, Zhu M, Yang J, Wang X, Liang Y, Yu M, Li L, Kong F. Treatment Advances in Lung Cancer with Leptomeningeal Metastasis. Curr Cancer Drug Targets 2024; 24:910-919. [PMID: 38279718 DOI: 10.2174/0115680096276133231201061114] [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: 08/07/2023] [Revised: 10/11/2023] [Accepted: 11/16/2023] [Indexed: 01/28/2024]
Abstract
Leptomeningeal metastasis (LM) is a serious and often fatal complication in patients with advanced lung cancer, resulting in significant neurological deficits, decreased quality of life, and a poor prognosis. This article summarizes current research advances in treating lung cancer with meningeal metastases, discusses clinical challenges, and explores treatment strategies. Through an extensive review of relevant clinical trial reports and screening of recent conference abstracts, we collected clinical data on treating patients with lung cancer with meningeal metastases to provide an overview of the current research progress. Exciting progress has been made by focusing on specific mutations within lung cancer, including the use of EGFR tyrosine kinase inhibitors or inhibitors for anaplastic lymphoma kinase gene rearrangement, such as osimertinib, alectinib, and lorlatinib. These targeted therapies have shown impressive results in penetrating the central nervous system (CNS). Regarding whole-brain radiotherapy, there is currently some controversy among investigators regarding its effect on survival. Additionally, immune checkpoint inhibitors (ICIs) have demonstrated reliable clinical benefits due to their ability to retain anticancer activity in CNS metastases. Moreover, combination therapy shows promise in providing further treatment possibilities. Considerable progress has been made in the clinical research of lung cancer with LM. However, the sample size of prospective clinical trials investigating LM for lung cancer is still limited, with most reports being retrospective. Developing more effective management protocols for metastatic LM in lung cancer remains an ongoing challenge for the future.
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Affiliation(s)
- Yuan Meng
- Department of Oncology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Anshanxi Road, Nankai District, 300193, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Meiying Zhu
- Department of Oncology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Anshanxi Road, Nankai District, 300193, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Jie Yang
- Department of Oncology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Anshanxi Road, Nankai District, 300193, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Xuerui Wang
- Department of Oncology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Anshanxi Road, Nankai District, 300193, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Yangyueying Liang
- Department of Oncology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Anshanxi Road, Nankai District, 300193, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Minghui Yu
- Department of Oncology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Anshanxi Road, Nankai District, 300193, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Longhui Li
- Department of Oncology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Anshanxi Road, Nankai District, 300193, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Fanming Kong
- Department of Oncology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Anshanxi Road, Nankai District, 300193, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
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Leptomeningeal metastases in non-small cell lung cancer: Diagnosis and treatment. Lung Cancer 2022; 174:1-13. [PMID: 36206679 DOI: 10.1016/j.lungcan.2022.09.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 09/08/2022] [Accepted: 09/27/2022] [Indexed: 02/01/2023]
Abstract
Leptomeningeal metastasis (LM) is a rare complication of non-small cell lung cancer (NSCLC) with highly mortality. LM will occur once tumor cells spread to the cerebrospinal fluid (CSF) space. Patients may suffer blindness, paralysis, and mental disorders that seriously affect their quality of life. There is a clear unmet need to improve the efficacy of diagnosis and treatment of LM. To better solve this problem, it is helpful to clarify the potential mechanisms of LM. Clinical manifestations, magnetic resonance imaging, and CSF biopsy are the key components in the diagnosis of NSCLC with LM. CSF cytology is insufficient and should be combined with liquid biology. The application of radiotherapy, intrathecal treatment, targeted therapy and immunotherapy provides more options for LM patients. Each treatment has a particular level of efficacy and can be used alone or in combination for individual patients. New technologies in radiotherapy, drug repositioning in intrathecal treatment, and the higher CSF permeability in TKIs have brought new breakthroughs in the treatment of LM. This review focused on clarifying the potential mechanisms, discussing the major clinical challenges, and summarizing recent advances in the diagnosis and treatment of LM from NSCLC. Future research is essential to improve the efficiency of diagnosis, to optimize therapy and to enhance patient prognosis.
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