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Paczkowski F, Raphael J, Browne C. Durable Response to Atezolizumab in Extensive-Stage Small-Cell Lung Cancer Leading to 60 Months Overall Survival: A Case Report. Curr Oncol 2024; 31:3682-3689. [PMID: 39057143 PMCID: PMC11276320 DOI: 10.3390/curroncol31070271] [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: 06/04/2024] [Revised: 06/21/2024] [Accepted: 06/25/2024] [Indexed: 07/28/2024] Open
Abstract
Small-cell lung cancer (SCLC) remains a disease with poor prognosis, particularly in extensive-stage SCLC (ES-SCLC). Current standard-of-care treatment includes chemotherapy with platinum agents and etoposide plus immunotherapy with atezolizumab or durvalumab, which has achieved a mean overall survival of 12-13 months in clinical trials. However, long-term survival in ES-SCLC, even with the addition of immunotherapy, continues to be rare. We present the case of a middle-aged male patient diagnosed with ES-SCLC who was treated with four cycles of induction chemotherapy (carboplatin and etoposide) and atezolizumab, starting maintenance atezolizumab every 21 days thereafter, and thoracic radiotherapy. After 9 months, he experienced mild disease progression and was rechallenged with six cycles of carboplatin and etoposide with continued atezolizumab. Subsequent imaging showed near-complete disease resolution which has been sustained since. He has continued on maintenance atezolizumab since diagnosis and has achieved 60 months overall survival and 44 months progression-free survival. Throughout treatment, he has maintained a high functional capacity and only experienced one immune-related adverse event. Our patient is representative of a small subset who are capable of achieving durable responses to immunotherapy and his case highlights the need for further research to elucidate the clinical and biological factors driving this response.
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Affiliation(s)
- Freeman Paczkowski
- Schulich School of Medicine & Dentistry, Western University, London, ON N6A 3K7, Canada;
| | - Jacques Raphael
- Division of Medical Oncology, Department of Oncology, London Health Sciences Centre, Western University, London, ON N6A 5W9, Canada;
| | - Claire Browne
- Division of Medical Oncology, Department of Oncology, London Health Sciences Centre, Western University, London, ON N6A 5W9, Canada;
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2
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Kim HR, Awad MM, Navarro A, Gottfried M, Peters S, Csőszi T, Cheema PK, Rodriguez-Abreu D, Wollner M, Yang JCH, Mazieres J, Orlandi FJ, Luft A, Gümüş M, Kato T, Kalemkerian GP, Luo Y, Santorelli ML, Pietanza MC, Rudin CM. Patient-Reported Health-Related Quality of Life in KEYNOTE-604: Pembrolizumab or Placebo Added to Etoposide and Platinum as First-Line Therapy for Extensive-Stage SCLC. JTO Clin Res Rep 2023; 4:100572. [PMID: 37954964 PMCID: PMC10637979 DOI: 10.1016/j.jtocrr.2023.100572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 08/24/2023] [Accepted: 09/04/2023] [Indexed: 11/14/2023] Open
Abstract
Introduction In the phase 3 KEYNOTE-604 study (NCT03066778), pembrolizumab plus etoposide and platinum chemotherapy (EP) significantly (p = 0.0023) improved progression-free survival versus placebo plus EP in previously untreated extensive-stage SCLC (ES-SCLC). We present health-related quality of life (HRQoL) results from KEYNOTE-604. Methods Patients with stage IV SCLC were randomized 1:1 to pembrolizumab 200 mg or placebo every 3 weeks for 35 cycles plus four cycles of EP. Secondary end points included mean change from baseline to week 18 in the European Organisation for Research and Treatment of Cancer Quality-of-Life Questionnaire-Core 30 (QLQ-C30) global health status/quality of life (GHS/QoL) scale and time to deterioration in the composite outcome of cough, chest pain, or dyspnea from QLQ-C30 and QLQ-Lung Cancer Module 13. Two-sided, nominal p values are reported. Results A total of 439 patients completed at least one QLQ-C30 and QLQ-Lung Cancer Module 13 assessment (pembrolizumab + EP, n = 221; placebo + EP, n = 218). GHS/QoL scores improved from baseline to week 18: least squares mean (95% confidence interval [CI]) changes were 8.7 (5.3-12.1) for pembrolizumab plus EP and 4.2 (0.9-7.5) for placebo plus EP. Between-group differences in least squares mean scores were improved for pembrolizumab plus EP (4.4 [95% CI: 0.2-8.7], p = 0.040]). Median time to deterioration for the composite end point was not reached and 8.7 (95% CI: 5.9-not reached) months, respectively (hazard ratio = 0.80 [95% CI: 0.56-1.14], p = 0.208). Conclusions First-line pembrolizumab plus EP therapy maintained HRQoL in patients with ES-SCLC and may be associated with greater improvement than placebo plus EP. Together with the efficacy and safety findings in KEYNOTE-604, HRQoL data support the benefit of pembrolizumab in ES-SCLC.
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Affiliation(s)
- Hye Ryun Kim
- Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Mark M. Awad
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Alejandro Navarro
- Clinical Research Department (VHIO) and Oncology Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Maya Gottfried
- Oncology Department, Meir Medical Center, Kfar-Saba, Israel
| | - Solange Peters
- Oncology Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Tibor Csőszi
- Department of Oncology, Hetenyi G Korhaz Onkologiai Kozpont, Szolnok, Hungary
| | - Parneet K. Cheema
- Division of Medical Oncology, William Osler Health System, University of Toronto, Brampton, Ontario, Canada
| | - Delvys Rodriguez-Abreu
- Medical Oncology Department, Complejo Hospitalario Universitario Insular Materno-Infantil de Gran Canaria, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Mirjana Wollner
- Department of Medical Oncology, Rambam Medical Center, Haifa, Israel
| | - James Chih-Hsin Yang
- Department of Oncology, National Taiwan University Hospital and Department of Medicine, National Taiwan University Cancer Center, Taipei, Taiwan
| | - Julien Mazieres
- Department of Thoracic Oncology, Centre Hospitalier Universitaire de Toulouse, Université Paul Sabatier, Toulouse, France
| | | | - Alexander Luft
- Department of Oncology No. 1 (Thoracic Surgery), Leningrad Regional Clinical Hospital, St. Petersburg, Russia
| | - Mahmut Gümüş
- Department of Medical Oncology, Istanbul Medeniyet University Hospital, Istanbul, Turkey
| | - Terufumi Kato
- Department of Thoracic Oncology, Kanagawa Cancer Center, Yokohama, Japan
| | - Gregory P. Kalemkerian
- Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Yiwen Luo
- Biostatistics and Research Decision Sciences, Merck & Co., Inc., Rahway, New Jersey
| | - Melissa L. Santorelli
- Center for Observational and Real-World Evidence, Merck & Co., Inc., Rahway, New Jersey
| | | | - Charles M. Rudin
- Department of Medicine, Thoracic Oncology Service, Memorial Sloan Kettering Cancer Center, New York, New York
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3
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Li Z, Pang M, Liang X, Zhang Y, Zhang W, He W, Sheng L, An Y. Risk factors of early mortality in patients with small cell lung cancer: a retrospective study in the SEER database. J Cancer Res Clin Oncol 2023; 149:11193-11205. [PMID: 37354224 DOI: 10.1007/s00432-023-05003-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 06/15/2023] [Indexed: 06/26/2023]
Abstract
BACKGROUND Small cell lung cancer (SCLC) is a highly aggressive neuroendocrine cancer with a high risk of early mortality (i.e., survival time less than 1 month). This study aimed to identify relevant risk factors and predict early mortality in SCLC patients. METHODS A total of 27,163 SCLC cases registered between 2010 and 2019 were extracted from the Surveillance, Epidemiology, and End Results (SEER) data. Significant independent risk factors were identified by univariate and multivariate logistic regression analyses. Nomograms for all-causes and cancer-specific early death were constructed and evaluated. RESULTS Age, sex, clinical stage, presence of metastasis (liver and lung), and absence of treatment (surgery, radiotherapy and chemotherapy) were identified for significant association with all-causes and cancer-specific early death. Nomograms based on these predictors exhibited high accuracy (area under ROC curve > 0.850) and potential clinical practicality in the prediction of early mortality. CONCLUSION We identified a set of factors associated with early mortality from SCLC and developed a clinically useful nomogram to predict high-risk patients. This nomogram could aid oncologists in the administration of individualized treatment regimens, potentially improving clinical outcomes of SCLC patients.
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Affiliation(s)
- Zhenglin Li
- The Third Affiliated Hospital of Shandong First Medical University (Affiliated Hospital of Shandong Academy of Medical Sciences), Jinan, China
| | - Min Pang
- The Third Affiliated Hospital of Shandong First Medical University (Affiliated Hospital of Shandong Academy of Medical Sciences), Jinan, China
| | - Xuefeng Liang
- The Third Affiliated Hospital of Shandong First Medical University (Affiliated Hospital of Shandong Academy of Medical Sciences), Jinan, China
| | - Yafei Zhang
- The Third Affiliated Hospital of Shandong First Medical University (Affiliated Hospital of Shandong Academy of Medical Sciences), Jinan, China
| | - Weihua Zhang
- The Third Affiliated Hospital of Shandong First Medical University (Affiliated Hospital of Shandong Academy of Medical Sciences), Jinan, China
| | - Weina He
- The Third Affiliated Hospital of Shandong First Medical University (Affiliated Hospital of Shandong Academy of Medical Sciences), Jinan, China
| | - Lijun Sheng
- The Third Affiliated Hospital of Shandong First Medical University (Affiliated Hospital of Shandong Academy of Medical Sciences), Jinan, China.
| | - Yuji An
- The Third Affiliated Hospital of Shandong First Medical University (Affiliated Hospital of Shandong Academy of Medical Sciences), Jinan, China.
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4
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Schad F, Steinmann D, Oei SL, Thronicke A, Grah C. Evaluation of quality of life in lung cancer patients receiving radiation and Viscum album L.: a real-world data study. Radiat Oncol 2023; 18:47. [PMID: 36879290 PMCID: PMC9990362 DOI: 10.1186/s13014-023-02234-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 02/20/2023] [Indexed: 03/08/2023] Open
Abstract
BACKGROUND Lung cancer (LC) is associated with high mortality and poor quality of life (QoL). The disease as well as oncological treatments such as radiation and chemotherapy with adverse effects can impair the QoL of patients. Add-on treatment with extracts of Viscum album L. (white-berry European mistletoe, VA) has been shown to be feasible and safe and to improve the QoL of cancer patients. The aim of this study was to analyze the changes in QoL of LC patients being treated with radiation according to oncological guidelines and add-on VA treatment in a real-world setting. METHODS A real-world data study was conducted using registry data. Self-reported QoL was assessed by the evaluation of the European Organization of Research and Treatment Health-Related Quality of Life Core Questionnaire scale (EORTC QLQ-C30). Adjusted multivariate linear regression analyses were performed to analyze factors associated with changes in QoL at 12 months. RESULTS A total of 112 primary LC patients (all stages, 92% non-small-cell lung cancer, median age 70 (ICR: 63-75)), answered the questionnaires at first diagnosis and 12 months later. Assessment of 12 months changes in QoL revealed significant improvement of 27 points for pain (p = 0.006) and 17 points for nausea/vomiting (p = 0.005) in patients who received combined radiation and VA. In addition, significant improvements of 15 to 21 points for role (p = 0.03), physical (p = 0.02), cognitive (p = 0.04), and social functioning (p = 0.04) were observed in guideline treated patients receiving no radiation but add-on VA. CONCLUSIONS Add-on VA therapy reveals supportive effects for the QoL of LC patients. Particularly in combination with radiation a significant reduction in pain and nausea/ vomiting has been observed. Trial registration The study received ethics approval and was retrospectively registered (DRKS00013335 on 27/11/2017).
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Affiliation(s)
- Friedemann Schad
- Hospital Gemeinschaftskrankenhaus Havelhöhe, Research Institute Havelhöhe, Kladower Damm 221, 14089, Berlin, Germany. .,Interdisciplinary Oncology and Palliative Care, Hospital Gemeinschaftskrankenhaus Havelhöhe, Berlin, Germany.
| | - Diana Steinmann
- Department of Radiotherapy and Special Oncology, Hannover Medical School, Hannover, Germany
| | - Shiao Li Oei
- Hospital Gemeinschaftskrankenhaus Havelhöhe, Research Institute Havelhöhe, Kladower Damm 221, 14089, Berlin, Germany
| | - Anja Thronicke
- Hospital Gemeinschaftskrankenhaus Havelhöhe, Research Institute Havelhöhe, Kladower Damm 221, 14089, Berlin, Germany
| | - Christian Grah
- Lung Cancer Centre, Hospital Gemeinschaftskrankenhaus Havelhöhe, Berlin, Germany
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5
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Sathiyapalan A, Febbraro M, Pond GR, Ellis PM. Chemo-Immunotherapy in First Line Extensive Stage Small Cell Lung Cancer (ES-SCLC): A Systematic Review and Meta-Analysis. Curr Oncol 2022; 29:9046-9065. [PMID: 36547123 PMCID: PMC9776593 DOI: 10.3390/curroncol29120709] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/11/2022] [Accepted: 11/16/2022] [Indexed: 11/23/2022] Open
Abstract
Small cell lung cancer (SCLC) is an aggressive neuroendocrine carcinoma with early metastatic potential. The standard-of-care treatment has not changed in years. Recent studies report improved progression-free survival (PFS) and overall survival (OS) with combined ICI and chemotherapy in ES-SCLC. We conducted a systematic review and meta-analysis to assess the magnitude of survival benefits. We searched MEDLINE, EMBASE, and Cochrane between 1 January 2010 and 15 July 2022 and conference proceedings from 2018 to 2022, for randomised controlled trials, evaluating chemo-ICI compared with platinum-doublet chemotherapy in untreated ES-SCLC. Outcomes assessed were PFS, OS, objective response rate (ORR), duration of response (DoR), toxicity, and health-related quality of life (HRQoL). The search identified 8061 studies, with 8 (56 publications) included in the final analysis. PFS and OS were significantly improved for patients randomised to chemo-ICI (PFS hazard ratio (HR) 0.75, 95% confidence interval (CI) 0.70-0.80) and (OS HR 0.79, 95% CI 0.73-0.85). Subgroup analysis demonstrated a differential effect between PD-1/PD-L1 and CTLA-4 inhibitors. There was no difference in ORR and DoR. All-grade adverse events (RR 1.06, 95% CI 1.00-1.12) were similar. The addition of ICI to chemotherapy in untreated ES-SCLC results in a 22% risk reduction in death, and a 25% risk reduction in disease progression with a minimal increase in toxicity. These improvements are modest but represent progress beyond the standard of care.
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6
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Wang L, Lei X, Wang X. Efficacy and Safety of PD-1/PD-L1 Inhibitor Chemotherapy Combined with Lung Cancer Fang No. 1 in Relapsed and Refractory SCLC: A Retrospective Observational Study. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:2848220. [PMID: 35586668 PMCID: PMC9110176 DOI: 10.1155/2022/2848220] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 03/22/2022] [Accepted: 04/01/2022] [Indexed: 11/25/2022]
Abstract
Background Relapsed and refractory small cell lung cancer (SCLC) accounts for about 15% of all lung cancers. The prognosis of patients is poor. The 5-year survival rate is almost 0. The average survival time of patients who refuse to receive treatment is only 2-4 months. For patients with extensive-stage SCLC, the current first-line treatment regimens are mainly platinum-containing double-drug chemotherapy. Poside combined with cisplatin/carboplatin and irinotecan combined with cisplatin/carboplatin are commonly used clinical regimens for the treatment of patients with extensive-stage SCLC. Although SCLC is very sensitive to radiotherapy and chemotherapy, most patients will develop recurrence and metastasis after initial treatment. Therefore, it is necessary to study clinically effective therapeutic drugs for relapsed and refractory SCLC. Objective To investigate the relationship between programmed death receptor-1 (programmed death receptor-1 (PD-1)) and programmed death receptor-ligand 1 (programmed death-ligand 1 (PD-L1)) inhibitors and Lung Cancer No. 1 efficacy and safety of Lung Cancer Fang No. 1 in the treatment of relapsed and refractory SCLC. Methods 80 patients with refractory SCLC were selected and randomly divided into control group and treatment group with 40 cases in each group. Among them, the control group received PD-1/PD-L1 inhibitor chemotherapy, and the treatment group received PD-1/PD-L1 inhibitor chemotherapy combined with Lung Cancer Fang No. 1 treatment. The differences in immune and tumor marker levels, clinical efficacy, and prognostic complications between the two groups before and after treatment were observed and compared. Results Before treatment, there was no significant difference in clinical improvement between the two groups. After treatment, the clinical symptom scores and body weight changes in the treatment group were significantly improved. The clinical symptom scores in the treatment group were lower than those in the control group, but the body weight changes were higher than those in the control group. The difference was statistically significant (P < 0.05). Before treatment, there was no significant difference in the levels of tumor markers between the two groups. After treatment, the levels of CYFRA21-1, CA125, and VGEF in the treatment group were significantly lower than those in the control group, and the difference was statistically significant (P < 0.05). There was no significant difference in the immune level between the two groups before treatment (P > 0.05), while the differences in CD4+, CD3+, and CD4+/CD8+ after treatment were significant, and the treatment group was higher than the control group, with statistical significance (P < 0.05). After treatment, the clinical efficacy of the two groups was significantly improved. The DCR90.00% of the treatment group was significantly higher than that of the control group, 67.50%, and the difference was statistically significant (P < 0.05). The analysis of complications after treatment showed that fatigue, anorexia, hypertension, hand-foot syndrome, diarrhea, leukopenia, thrombocytopenia, and urinary protein in the treatment group were significantly lower than those in the control group, and the difference was statistically significant (P < 0.05). Conclusion PD-1/PD-L1 inhibitor chemotherapy combined with Lung Cancer Fang No. 1 has a good and safe effect on SCLC patients. It has a good curative effect in improving the clinical symptoms of patients. It can stabilize the tumor, inhibit the development of lung cancer, improve the body's cellular immune function, adjust the level and expression of tumor markers, improve the body's material metabolism, and restore the balance of yin and yang in the body.
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Affiliation(s)
- Lihua Wang
- Department of Respiratory Endology, People's Hospital of Dongxihu District, Wuhan, Hubei 430040, China
| | - Xiaoxia Lei
- Second Ward, Department of Respiratory and Critical Care Medicine, Wuhan No. 1 Hospital, China
| | - Xin Wang
- Department of Infectious Disease, Wuhan Asia General Hospital, China
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7
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Patient-reported health-related quality of life from a randomized phase II trial comparing standard-dose with high-dose twice daily thoracic radiotherapy in limited stage small-cell lung cancer. Lung Cancer 2022; 166:49-57. [DOI: 10.1016/j.lungcan.2022.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 02/03/2022] [Accepted: 02/06/2022] [Indexed: 11/21/2022]
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8
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Xue S, Zeng H, Yan S, Wang Q, Jia X. Prophylactic Cranial Irradiation for Extensive-Stage Small-Cell Lung Cancer: A Controversial Area. Front Oncol 2022; 12:772282. [PMID: 35198438 PMCID: PMC8858935 DOI: 10.3389/fonc.2022.772282] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 01/17/2022] [Indexed: 11/13/2022] Open
Abstract
Small-cell lung cancer (SCLC) is a highly aggressive malignant tumor that is prone to lead to the development of brain metastases (BM). The application of prophylactic cranial irradiation (PCI) has been regarded as an important technological advance made in cancer therapy to reduce the occurrence of BM and improve patient survival. The benefits of PCI in the treatment of limited-stage SCLC have been confirmed. However, there has been continuous controversy about the indications and advantages of PCI for extensive-stage SCLC (ES-SCLC) because of the conflicting results from two prospective trials. In this review, we aimed to discuss the relevant controversy and progress made in the clinical application of PCI in ES-SCLC.
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9
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Crockett C, Belderbos J, Levy A, McDonald F, Le Péchoux C, Faivre-Finn C. Prophylactic cranial irradiation (PCI), hippocampal avoidance (HA) whole brain radiotherapy (WBRT) and stereotactic radiosurgery (SRS) in small cell lung cancer (SCLC): Where do we stand? Lung Cancer 2021; 162:96-105. [PMID: 34768007 DOI: 10.1016/j.lungcan.2021.10.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 10/31/2021] [Indexed: 12/25/2022]
Abstract
Small cell lung cancer (SCLC) is an aggressive form of lung cancer associated with an increased risk of develping brain metastases (BM), which are a significant cause of morbidity and mortality. Prophylactic cranial irradiation (PCI) was first introduced in the 1970s with the aim of reducing BM incidence and improving survival and quality of life (QoL). Prospective clinical trials and meta-analyses have demonstrated its effectiveness in reducing BM incidence and improving survival, across all stages of the disease following response to induction chemotherapy. Despite its long history, "unknowns" surrounding PCI use still exist and there are particular subgroups of patients for which its use remains controversial. PCI is known to cause neurocognitive toxicity which can have a significant impact on a patient's QoL. Strategies to minimise this, including the use of hippocampal avoidance radiotherapy techniques, neuroprotective drugs and stereotactic radiosurgery in place of whole brain radiotherapy for the treatment of BM, are under evaluation. This review offers a summary of the key PCI trials published to date and the current treatment recommendations based on available evidence. It also discusses the key questions being addressed in ongoing clinical trials and highlights others where there is currently a knowledge gap and therefore where further data are urgently required.
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Affiliation(s)
- Cathryn Crockett
- Radiotherapy Related Research, The Christie NHS Foundation Trust, Manchester, United Kingdom.
| | - José Belderbos
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Antonin Levy
- Department of Radiation Oncology, International Center for Thoracic Cancers (CICT), Gustave Roussy, F-94805 Villejuif, France; Université Paris-Saclay, Faculté de Médecine, 94270 Le Kremlin-Bicêtre, France
| | - Fiona McDonald
- Department of Radiotherapy, Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Cecile Le Péchoux
- Department of Radiation Oncology, International Center for Thoracic Cancers (CICT), Gustave Roussy, F-94805 Villejuif, France
| | - Corinne Faivre-Finn
- Radiotherapy Related Research, The Christie NHS Foundation Trust, Manchester, United Kingdom; Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
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10
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Janssens R, Arnou R, Schoefs E, Petrocchi S, Cincidda C, Ongaro G, Oliveri S, Smith MY, Louis E, Vandevelde M, Nackaerts K, Pravettoni G, Huys I. Key Determinants of Health-Related Quality of Life Among Advanced Lung Cancer Patients: A Qualitative Study in Belgium and Italy. Front Pharmacol 2021; 12:710518. [PMID: 34630085 PMCID: PMC8494945 DOI: 10.3389/fphar.2021.710518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 08/30/2021] [Indexed: 12/24/2022] Open
Abstract
Background: The lung cancer (LC) treatment landscape has drastically expanded with the arrival of immunotherapy and targeted therapy. This new variety of treatment options, each with its own characteristics, raises uncertainty regarding the key aspects affecting patients' health-related quality of life (HRQL). The present qualitative study aimed to investigate how LC patients perceive their HRQL and the factors that they consider to be most influential in determining their HRQL. Methods: This qualitative research incorporates four focus group discussions, with six LC patients in each group. In total, 24 stage III and IV LC patients were included in the discussions, with Italian (n = 12) and Belgian (n = 12) patients, age range: 42-78, median age = 62 (IQR = 9.3 years), SD = 8.5; 62% men. Using thematic analysis, transcripts and notes from the FGDs were analyzed using NVivo software (edition 12). Results: Three main themes capturing determinants of HRQL were identified. First, patients agreed on the importance of physical aspects (symptoms and side-effects) in determining their HRQL. In particular, skin conditions, nausea, fatigue, risk of infections, sensory abnormalities, pain, and changes in physical appearance were highlighted. Second, patients worried about psychological aspects, negatively impacting their wellbeing such as uncertainties regarding their future health state, and a lower degree of autonomy and independence. Third, patients underlined the importance of social aspects, such as communication with healthcare providers and social interaction with friends, family and peers. Conclusion: This study demonstrates that physical, psychological, and social aspects are key factors driving LC patients' HRQL. Gaining a better understanding of how LC patients perceive their HRQL and how it is affected by their illness and therapy will aid patient-centric decision-making across the drug life cycle, by providing stakeholders (drug developers, regulators, reimbursement bodies, and clinicians) insights about the treatment and disease aspects of importance to LC patients as well as the unmet needs LC patients may have regarding available treatment modalities. Finally, this study underscores a need for individual treatment decision-making that is considerate of uncertainties among LC patients about their future health state, and ways for improving communication between healthcare providers and patients to do so.
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Affiliation(s)
- Rosanne Janssens
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Reinhard Arnou
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Elise Schoefs
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Serena Petrocchi
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Clizia Cincidda
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Giulia Ongaro
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Serena Oliveri
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Meredith Y Smith
- Alexion Pharmaceuticals, Inc., Boston, MA, United States.,University of Southern California School of Pharmacy, Los Angeles, CA, United States
| | - Evelyne Louis
- Department of Pulmonology/Respiratory Oncology, University Hospital Leuven, Leuven, Belgium
| | - Marie Vandevelde
- Department of Pulmonology/Respiratory Oncology, University Hospital Leuven, Leuven, Belgium
| | - Kristiaan Nackaerts
- Department of Pulmonology/Respiratory Oncology, University Hospital Leuven, Leuven, Belgium
| | - Gabriella Pravettoni
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Isabelle Huys
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
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11
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Kuehne N, Hueniken K, Xu M, Shakik S, Vedadi A, Pinto D, Brown MC, Bradbury PA, Shepherd FA, Sacher AG, Leighl NB, Xu W, Lok BH, Liu G, O'Kane GM. Longitudinal Assessment of Health Utility Scores, Symptoms and Toxicities in Patients with Small Cell Lung Cancer Using Real World Data. Clin Lung Cancer 2021; 23:e154-e164. [PMID: 34688531 DOI: 10.1016/j.cllc.2021.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 09/10/2021] [Accepted: 09/16/2021] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Recent advances in small cell lung cancer (SCLC) treatments necessitate a better understanding of real-world health utility scores (HUS) in patients treated under current standards to facilitate robust pharmaco-economic assessments. METHODS In this single institution cohort observational study, HUS were evaluated in patients with SCLC through EQ-5D questionnaires at outpatient visits (encounters). In addition, patients completed questionnaires relating to treatment toxicities and cancer symptoms. Clinical and pathological variables were abstracted from electronic medical records and disease status at each patient visit was documented. The impact of these variables on HUS were explored. RESULTS There were 282 clinical encounters (12% newly diagnosed; 37% stable on treatment; 22% progressing on treatment; 29% stable off therapy/other) in 111 SCLC patients (58% male; 64% extensive stage (ES) SCLC). At the first encounter 29% of patients had an ECOG performance status (PS) ≥ 2. ES-SCLC, bone metastases, female sex, progressive disease and/or PS were each significantly associated with decreased HUS in multivariable analyses. Patients clinically stable on first line therapy had generally steady HUS longitudinally, with differences in HUS between limited disease (LD) and ES patients emerging as treatment progressed. Decreased HUS were associated with increased severity of the majority of measured symptoms (fatigue/tiredness, loss of appetite, pain, drowsiness, shortness of breath, anxiety, depression, and overall well-being; each p<0.001), supporting the value of EQ-5D-derived HUS in assessing health utility. CONCLUSION Our HUS values in chemotherapy-treated SCLC are clinically relevant and are associated with specific clinico-demographic, symptom and toxicity factors.
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Affiliation(s)
- Nathan Kuehne
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Center, University Health Network, Toronto, ON, Canada
| | - Katrina Hueniken
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Center, University Health Network, Toronto, ON, Canada; Biostatistics, Applied Clinical Research Unit, Princess Margaret Cancer Center, Toronto, Canada
| | - Maria Xu
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Center, University Health Network, Toronto, ON, Canada; Biostatistics, Applied Clinical Research Unit, Princess Margaret Cancer Center, Toronto, Canada
| | - Sharara Shakik
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Center, University Health Network, Toronto, ON, Canada
| | - Ali Vedadi
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Center, University Health Network, Toronto, ON, Canada
| | - Dixon Pinto
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Center, University Health Network, Toronto, ON, Canada; McMaster University, Hamilton, ON, Canada
| | - M Catherine Brown
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Center, University Health Network, Toronto, ON, Canada
| | - Penelope A Bradbury
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Center, University Health Network, Toronto, ON, Canada
| | - Frances A Shepherd
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Center, University Health Network, Toronto, ON, Canada
| | - Adrian G Sacher
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Center, University Health Network, Toronto, ON, Canada
| | - Natasha B Leighl
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Center, University Health Network, Toronto, ON, Canada
| | - Wei Xu
- Biostatistics, Applied Clinical Research Unit, Princess Margaret Cancer Center, Toronto, Canada; Department of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Benjamin H Lok
- Radiation Medicine Program, Princess Margaret Cancer Center, University Health Network, Toronto, ON, Canada
| | - Geoffrey Liu
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Center, University Health Network, Toronto, ON, Canada; McMaster University, Hamilton, ON, Canada.
| | - Grainne M O'Kane
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Center, University Health Network, Toronto, ON, Canada
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12
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Yang J, Wang L, Yao Y, Liu J, Yang J. Small cell carcinoma of the brain without apparent extracranial origin in the same intracranial region one year following resection of malignant glioma. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2021; 14:875-880. [PMID: 34527130 PMCID: PMC8414428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 03/22/2021] [Indexed: 06/13/2023]
Abstract
Primary small cell carcinoma (SCC) of the brain is rare, and there have been no reports of small cell carcinoma located at the resection site of a glioma without extracranial tumours. Herein, we report a case of brain SCC in the same intracranial region from which a malignant glioma had been surgically resected a year prior. The patient, a 68-year-old male, had headaches as a symptom, and brain CT and MRI revealed a hyperdense region measuring 5.5×5 centimetres. Blood test results showed no significant changes. H&E staining suggested that these tumour cells had the characteristics of small cell lung carcinoma cells. Immunohistochemical staining for the glioma marker S100 was negative, but immunohistochemical staining for the neuroendocrine marker synaptophysin and for the cell adhesion molecule CD56 was strongly positive; meanwhile, staining for thyroid transcription factor-1 (TTF-1), a relatively specific marker of lung and thyroid carcinoma, was positive, and the Ki67 index was 75%. The pathological examination strongly suggested that the tumour was a small cell lung carcinoma, but CT and MRI scans indicated that there were no extracranial tumours. Hence, the tumour could be a primary small cell brain carcinoma. The patient underwent surgical resection again; the excised tumour was a mass of grey and white tissues with fragmentary morphology, and its dimensions were 3.0 cm×1.5 cm×0.8 cm.
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Affiliation(s)
- Jiaying Yang
- Department of Neurosurgery, Lanling People’s HospitalLanling 277700, Shandong, P. R. China
| | - Lei Wang
- Department of Otolaryngological, Lanling People’s HospitalLanling 277700, Shandong, P. R. China
| | - Yongjun Yao
- Department of Pathology, Lanling People’s HospitalLanling 277700, Shandong, P. R. China
| | - Jie Liu
- Department of Neurosurgery, Lanling People’s HospitalLanling 277700, Shandong, P. R. China
| | - Jinju Yang
- National Key Laboratory of Biochemical Engineering, Institute of Process Engineering, Chinese Academy of SciencesBeijing 100190, P. R. China
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13
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Abstract
Prophylactic cranial irradiation (PCI) has well established place in therapy for patients with limited-disease small cell lung cancer who responded to treatment. The data from randomized trials document that PCI reduces brain metastases rate from approximately 60% to 30%, and increases 3-year overall survival by approximately 5%. Currently, the dose of 25 Gy in 10 fractions is considered as standard. In attempt to reduce neuropsychological sequelae attributable to PCI hippocampal sparing techniques are employed. The existing studies suggest the benefit of hippocampal sparing in limiting memory and higher neurocognitive function losses, but with a risk of failures in the spared region. Ongoing studies will further validate the role of hippocampal sparing, both in terms of toxicity reduction and metastases prevention. PCI for patients who have undergone resection for stage I small cell lung cancer (SCLC) is not recommended, PCI may be, however, associated with a favourable outcome in SCLC patients who have undergone complete surgery in stages II−III. The role of PCI in extensive-disease (ED) SCLC has been evolving. Most recent evidence indicate that PCI is controversial in ED patients with response to initial chemotherapy and absence of brain metastases confirmed by contrast-enhanced MRI. The patients who do not receive PCI, must, however, receive periodic MRI examination during follow-up, i.e., remain under active surveillance with access to radiotherapy at brain relapse. The assessment of safety and effectiveness of hippocampal-sparing PCI, with or without drug neuroprotection in consideration of diverse combinations of radiotherapy, chemotherapy and immunotherapy create a background for future directions of research.
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Affiliation(s)
- Rafal Suwinski
- Radiotherapy and Chemotherapy Clinic and Teaching Hospital, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Poland
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14
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Weiss J, Goldschmidt J, Andric Z, Dragnev KH, Gwaltney C, Skaltsa K, Pritchett Y, Antal JM, Morris SR, Daniel D. Effects of Trilaciclib on Chemotherapy-Induced Myelosuppression and Patient-Reported Outcomes in Patients with Extensive-Stage Small Cell Lung Cancer: Pooled Results from Three Phase II Randomized, Double-Blind, Placebo-Controlled Studies. Clin Lung Cancer 2021; 22:449-460. [PMID: 33895103 DOI: 10.1016/j.cllc.2021.03.010] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 03/01/2021] [Accepted: 03/18/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Chemotherapy-induced myelosuppression (CIM) and its sequalae cause significant side effects and harm to quality of life. Trilaciclib is an intravenous CDK4/6 inhibitor that is administered prior to chemotherapy to protect hematopoietic stem and progenitor cells from chemotherapy-induced damage (myeloprotection). PATIENTS AND METHODS Data from three randomized, double-blind, placebo-controlled studies (NCT02499770, NCT03041311, and NCT02514447) were pooled to evaluate the effects of trilaciclib administered prior to standard-of-care chemotherapy (first-line etoposide plus carboplatin [E/P], first-line E/P plus atezolizumab, and second-/third-line topotecan) in patients with extensive-stage small cell lung cancer (ES-SCLC). The primary endpoints were duration of severe neutropenia (absolute neutrophil count < 0.5 × 109 cells/L) in cycle 1 and occurrence of severe neutropenia. Additional prespecified endpoints further assessed the effect of trilaciclib on myeloprotection, health-related quality of life (HRQoL), antitumor efficacy, and safety. RESULTS Of 242 randomized patients, 123 received trilaciclib and 119 received placebo. Compared with placebo, administration of trilaciclib prior to chemotherapy resulted in significant decreases in most measures of multilineage CIM. The reduction in hematologic toxicity translated into the reduced need for supportive care interventions and hospitalizations due to CIM or sepsis and improvements in HRQoL domains related to the protected cell lineages, including fatigue, physical wellbeing, and functional wellbeing. Antitumor efficacy was similar for patients receiving trilaciclib or placebo. CONCLUSION Administering trilaciclib prior to chemotherapy resulted in clinically meaningful reductions in CIM and its consequences and improved patient HRQoL, with no impact on the antitumor efficacy of three individual chemotherapy regimens used in the first- or second-/third-line treatment of ES-SCLC.
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Affiliation(s)
- Jared Weiss
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC.
| | | | - Zoran Andric
- University Hospital Medical Center Bezanijska Kosa, Bezanijska Kosa, Belgrade, Serbia
| | | | | | | | | | | | | | - Davey Daniel
- Sarah Cannon Research Institute, Nashville, TN; Chattanooga Oncology Hematology Associates, Chattanooga, TN
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15
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Goldman JW, Garassino MC, Chen Y, Özgüroğlu M, Dvorkin M, Trukhin D, Statsenko G, Hotta K, Ji JH, Hochmair MJ, Voitko O, Havel L, Poltoratskiy A, Losonczy G, Reinmuth N, Patel N, Laud PJ, Shire N, Jiang H, Paz-Ares L. Patient-reported outcomes with first-line durvalumab plus platinum-etoposide versus platinum-etoposide in extensive-stage small-cell lung cancer (CASPIAN): a randomized, controlled, open-label, phase III study. Lung Cancer 2020; 149:46-52. [PMID: 32961445 DOI: 10.1016/j.lungcan.2020.09.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 09/04/2020] [Accepted: 09/06/2020] [Indexed: 01/19/2023]
Abstract
OBJECTIVES In the phase III CASPIAN study, first-line durvalumab plus etoposide in combination with either cisplatin or carboplatin (EP) significantly improved overall survival (primary endpoint) versus EP alone in patients with extensive-stage small-cell lung cancer (ES-SCLC) at the interim analysis. Here we report patient-reported outcomes (PROs). MATERIALS AND METHODS Treatment-naïve patients with ES-SCLC received 4 cycles of durvalumab plus EP every 3 weeks followed by maintenance durvalumab every 4 weeks until progression, or up to 6 cycles of EP every 3 weeks. PROs, assessed with the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire-Core 30 (QLQ-C30) version 3 and its lung cancer module, the Quality of Life Questionnaire-Lung Cancer 13 (QLQ-LC13), were prespecified secondary endpoints. Changes from baseline to disease progression or 12 months in prespecified key disease-related symptoms (cough, dyspnea, chest pain, fatigue, appetite loss) were analyzed with a mixed model for repeated measures. Time to deterioration (TTD) of symptoms, functioning, and global health status/quality of life (QoL) from randomization was analyzed. RESULTS In the durvalumab plus EP and EP arms, 261 and 260 patients were PRO-evaluable. Patients in both arms experienced numerically reduced symptom burden over 12 months or until progression for key symptoms. For the improvements from baseline in appetite loss, the between-arm difference was statistically significant, favoring durvalumab plus EP (difference, -4.5; 99% CI: -9.04, -0.04; nominal p = 0.009). Patients experienced longer TTD with durvalumab plus EP versus EP for all symptoms (hazard ratio [95% CI] for key symptoms: cough 0.78 [0.600‒1.026]; dyspnea 0.79 [0.625‒1.006]; chest pain 0.76 [0.575‒0.996]; fatigue 0.82 [0.653‒1.027]; appetite loss 0.70 [0.542‒0.899]), functioning, and global health status/QoL. CONCLUSION Addition of durvalumab to first-line EP maintained QoL and delayed worsening of patient-reported symptoms, functioning, and global health status/QoL compared with EP.
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Affiliation(s)
| | | | - Yuanbin Chen
- Cancer & Hematology Centers of Western Michigan, Grand Rapids, MI, USA
| | - Mustafa Özgüroğlu
- Istanbul University-Cerrahpaşa, Cerrahpaşa School of Medicine, Istanbul, Turkey
| | - Mikhail Dvorkin
- BHI of Omsk Region Clinical Oncology Dispensary, Omsk, Russia
| | | | | | | | - Jun Ho Ji
- Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Maximilian J Hochmair
- Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Klinik Floridsdorf, Vienna, Austria
| | | | - Libor Havel
- Thomayer Hospital, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Artem Poltoratskiy
- Petrov Research Institute of Oncology, St Petersburg, Russian Federation
| | | | | | | | - Peter J Laud
- Statistical Services Unit, University of Sheffield, Sheffield, UK
| | | | | | - Luis Paz-Ares
- Hospital Universitario 12 de Octubre, H120-CNIO Lung Cancer Unit, Universidad Complutense and Ciberonc, Madrid, Spain
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16
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The impact of symptoms and comorbidity on health utility scores and health-related quality of life in small cell lung cancer using real world data. Qual Life Res 2020; 30:445-454. [PMID: 32851601 DOI: 10.1007/s11136-020-02615-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2020] [Indexed: 01/12/2023]
Abstract
PURPOSE Small cell lung cancer (SCLC) is a highly fatal disease associated with significant morbidity, with a need for real-world symptom and health utility score (HUS) data. HUS can be measured using an EQ-5D-5L questionnaire, however most captured data is available in non-SCLC (NSCLC) only. As new treatment regimens become available in SCLC it becomes important to understand factors which influence health-related quality of life and health utility. METHODS A prospective observational cohort study (2012-2017) of ambulatory histologically confirmed SCLC evaluated patient-reported EQ-5D-5L-derived HUS, toxicity and symptoms. A set of NSCLC patients was used to compare differential factors affecting HUS. Clinical and demographic factors were evaluated for differential interactions between lung cancer types. Comorbidity scores were documented for each patient. RESULTS In 75 SCLC and 150 NSCLC patients, those with SCLC had lower mean HUS ((SCLC vs NSCLC: mean 0.69 vs 0.79); (p < 0.001)) when clinically stable and with progressive disease: ((SCLC mean HUS = 0.60 vs NSCLC mean HUS = 0.77), (p = 0.04)). SCLC patients also had higher comorbidity scores ((1.11 vs 0.73); (p < 0.015)). In multivariable analyses, increased symptom severity and comorbidity scores decreased HUS in both SCLC and NSCLC (p < 0.001); however, only comorbidity scores differentially affected HUS (p < 0.0001), with a greater reduction of HUS adjusted per unit of comorbidity in SCLC. CONCLUSION Patients with advanced SCLC had significantly lower HUS than NSCLC. Both patient cohorts are impacted by symptoms and comorbidity, however, comorbidity had a greater negative effect in SCLC patients.
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17
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Impact of Early Prophylactic Cranial Irradiation With Hippocampal Avoidance on Neurocognitive Function in Patients With Limited Disease Small Cell Lung Cancer. A Multicenter Phase 2 Trial (SAKK 15/12). Int J Radiat Oncol Biol Phys 2020; 107:279-287. [DOI: 10.1016/j.ijrobp.2020.02.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 01/28/2020] [Accepted: 02/02/2020] [Indexed: 01/10/2023]
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18
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van de Kamp HJ, Molder MT, Schulkes KJG, Stellingwerf M, van Elden LJR, van Lindert ASR, Hamaker ME. Impact of Lung Cancer Treatment on Cognitive Functioning. Clin Lung Cancer 2019; 21:114-126.e3. [PMID: 31839534 DOI: 10.1016/j.cllc.2019.06.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 05/18/2019] [Accepted: 06/05/2019] [Indexed: 12/30/2022]
Abstract
The impact of oncologic treatment for (non)-small-cell lung cancer (NSCLC and SCLC, respectively) on cognition is relevant when deciding which treatment is the most preferable option, especially when curation is not possible. A systematic search of Medline and EMBASE for studies on the effect of treatment on cognition in patients with lung cancer was performed. A total of 39 longitudinal articles were included. Study populations were heterogeneous with regards to stage and treatment type. In the 7 studies concerning SCLC, the median age of patients was between 59 and 68 years. Eighty-six percent of these studies had a loss to follow-up > 10%. Six studies used objective tests to assess cognition. Objective measurements showed a negative effect on attention, memory, and fluency after treatment. Thirty-three studies concerning NSCLC were included. The mean age of patients was between 53 and 77 years. Seventy percent of these studies included patients with stage III and IV NSCLC. Over one-half of the studies had a high rate of loss to follow-up. Eighty-eight percent used objective scales to assess cognitive functioning. Subjective decline of cognitive functioning up to 11.1% was experienced, with recovery at 4 to 6 months. Objective measurement of attention showed improvement over the course of chemotherapy. In SCLC, there is a significant negative effect on attention, memory, and fluency. In NSCLC, the longer term impact of treatment on both subjective and objective cognitive functioning appears limited. Thus, there is no evidence directing treatment choice for NSCLC based on longer term cognitive deficits. Further research is needed to precisely assess the impact of lung cancer treatment on cognition.
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Affiliation(s)
| | - Marthe Te Molder
- Department of Internal Medicine, Diakonessenhuis Utrecht, Utrecht, The Netherlands
| | - Karlijn J G Schulkes
- Department of Pulmonology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Margriet Stellingwerf
- Department of Pulmonology, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Anne S R van Lindert
- Department of Pulmonology, University Medical Center Utrecht, Utrecht, The Netherlands
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19
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Renz P, Hasan S, Wegner RE. Survival outcomes after whole brain radiotherapy for brain metastases in older adults with newly diagnosed metastatic small cell carcinoma: A national cancer database (NCDB) analysis. J Geriatr Oncol 2019; 10:560-566. [PMID: 30876834 DOI: 10.1016/j.jgo.2019.01.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 12/04/2018] [Accepted: 01/22/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND Small cell lung cancer (SCLC) is an aggressive malignancy with a tendency to affect older adults and also metastasize to the brain. Older adults tolerate whole brain radiotherapy (WBRT) poorly with marginal survival benefit. We utilized the national cancer database (NCDB) to evaluate the survival outcomes following WBRT in older adults with SCLC and brain metastases. METHODS We identified 1615 patients ≥75 years old diagnosed with SCLC and brain metastases. Patients were categorized by type of therapy: chemotherapy + WBRT (n = 576), chemotherapy alone (n = 238), WBRT alone (n = 360) and no chemotherapy or WBRT (n = 441). Clinical and demographic characteristics were reported for each treatment cohort with a subsequent multivariable regression analysis for survival. RESULTS Median patient age was 79 years. WBRT median dose was 30 Gy. At time of analysis, 1530 of the cohort had died, yielding a median OS of 2.9 months and 6 month survival of 31% for patients that received chemotherapy. For patients treated without chemotherapy, median OS with WBRT was 1.9 months compared to 1.2 months without (p < .0001). For patients receiving chemotherapy with, and without WBRT, median OS was 5.6 months and 6.4 months, respectively (p = .43). Multivariable cox regression revealed age > 80, extracranial disease, male sex, and rural location as predictors of increased risk of death. CONCLUSION In older adult patients with SCLC brain metastasis, WBRT was associated with a modest increase in survival in patients not fit for chemotherapy, and there was no association with increased survival over chemotherapy alone.
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Affiliation(s)
- Paul Renz
- Allegheny Health Network Cancer Institute, Division of Radiation Oncology, United States of America
| | - Shaakir Hasan
- Allegheny Health Network Cancer Institute, Division of Radiation Oncology, United States of America
| | - Rodney E Wegner
- Allegheny Health Network Cancer Institute, Division of Radiation Oncology, United States of America.
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20
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Sibeoni J, Picard C, Orri M, Labey M, Bousquet G, Verneuil L, Revah-Levy A. Patients' quality of life during active cancer treatment: a qualitative study. BMC Cancer 2018; 18:951. [PMID: 30286733 PMCID: PMC6172766 DOI: 10.1186/s12885-018-4868-6] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 09/26/2018] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Patients' quality of life has become a major objective of care in oncology. At the same time, it has become the object of increasing interest by researchers, working with both quantitative and qualitative methods. Progress in oncology has enabled more patients to survive longer, so that cancer is increasingly often a chronic disease that requires long-term treatment that can have negative effects on patients' quality of daily life. Nonetheless, no qualitative study has explored what patients report affects their quality of daily life during the treatment period. This study is intended to fill this gap. METHODS We conducted a multicenter qualitative study based on 30 semi-structured interviews. Participants, purposively selected until data saturation, had diverse types of cancer and had started treatment at least 6 months before interview. Data were examined by thematic analysis. RESULTS Our analysis found two themes: (1) what negatively affected for patient's quality of daily life during the treatment period, a question to which patients responded by talking only about the side effects of treatment; and (2) what positively affected their quality of daily life during the treatment period with three sub-themes: (i) The interest in having -investing in - a support object that can be defined as an object, a relationship or an activity particularly invested by the patients which makes them feel good and makes the cancer and its treatment bearable, (ii)The subjective perception of the efficacy of the antitumor treatment and (iii) the positive effects of relationships, with friends and family, and also with their physician. CONCLUSIONS Patients must be involved in their care if they are to be able to bear their course of treatment and find ways to endure the difficult experience of cancer care. The support object represents an important therapeutic lever that can be used by their oncologists. They should be interested in their support objects, in order to support the patients in this investment and to help them to maintain it throughout the health care pathway. Furthermore, showing interest in this topic, important to the patient, could improve the physician-patient relation without using up very much of the physician's time.
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Affiliation(s)
- Jordan Sibeoni
- Service Universitaire de Psychiatrie de l'Adolescent, Argenteuil Hospital Centre, 69 rue du LTC Prud'hon, 95107, Argenteuil, France. .,ECSTRRA Team, UMR-1153, Inserm, Paris Diderot University, Sorbonne Paris Cite, Paris, France.
| | - Camille Picard
- Department of Dermatology, Caen University Hospital, F-14033, Caen, France.,Université de Caen Normandie, Medical School, F-14000, Caen, France
| | - Massimiliano Orri
- ECSTRRA Team, UMR-1153, Inserm, Paris Diderot University, Sorbonne Paris Cite, Paris, France.,McGill Group for Suicide Studies, Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, Canada
| | - Mathilde Labey
- ECSTRRA Team, UMR-1153, Inserm, Paris Diderot University, Sorbonne Paris Cite, Paris, France.,EPSM Lille métropole, pôle de psychiatrie adulte 59g21, Lille, France
| | - Guilhem Bousquet
- Université Paris 13 - Léonard de Vinci, Villetaneuse, France.,AP-HP-Hôpital Avicenne, Service d'Oncologie médicale-Bobigny, Bobigny, France
| | - Laurence Verneuil
- ECSTRRA Team, UMR-1153, Inserm, Paris Diderot University, Sorbonne Paris Cite, Paris, France
| | - Anne Revah-Levy
- Service Universitaire de Psychiatrie de l'Adolescent, Argenteuil Hospital Centre, 69 rue du LTC Prud'hon, 95107, Argenteuil, France.,ECSTRRA Team, UMR-1153, Inserm, Paris Diderot University, Sorbonne Paris Cite, Paris, France
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21
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Manapov F, Käsmann L, Roengvoraphoj O, Dantes M, Schmidt-Hegemann NS, Belka C, Eze C. Prophylactic cranial irradiation in small-cell lung cancer: update on patient selection, efficacy and outcomes. LUNG CANCER-TARGETS AND THERAPY 2018; 9:49-55. [PMID: 30323698 PMCID: PMC6181088 DOI: 10.2147/lctt.s137577] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Over 10% of small-cell lung cancer (SCLC) patients have brain metastases (BM) at initial diagnosis; more than 50% will develop BM within 2 years. BM are detected in up to 80% of all patients at autopsy. After primary treatment, prophylactic cranial irradiation (PCI) has been established as standard of care in SCLC patients responding to initial therapy. Based on level I evidence, PCI significantly decreases the risk of intracranial relapse and shows a modest survival benefit after 3 years. However, the role of PCI in defined patient subgroups such as resected SCLC, elderly and extensive stage patients with access to magnetic resonance imaging surveillance and stereotactic radiotherapy is yet to be fully clarified. Furthermore, strategies to effective prevention of neurocognitive decline after PCI remain unclear. All these factors significantly impact treatment decision making and should be evaluated in prospective settings. New concepts such as hippocampal avoidance and drug neuroprotection prevent chronic neurocognitive effects reducing treatment-related side effects of PCI. The aim of this review is to present a summary and update of the latest evidence for patient selection, efficacy and outcome of PCI.
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Affiliation(s)
- Farkhad Manapov
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany, .,Comprehensive Pneumology Center Munich (CPC-M), Munich, Germany,
| | - Lukas Käsmann
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany,
| | - Olarn Roengvoraphoj
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany,
| | - Maurice Dantes
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany,
| | | | - Claus Belka
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany, .,Comprehensive Pneumology Center Munich (CPC-M), Munich, Germany,
| | - Chukwuka Eze
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany,
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