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Rohilla S, Singh M, Alzarea SI, Almalki WH, Al-Abbasi FA, Kazmi I, Afzal O, Altamimi ASA, Singh SK, Chellappan DK, Dua K, Gupta G. Recent Developments and Challenges in Molecular-Targeted Therapy of Non-Small-Cell Lung Cancer. J Environ Pathol Toxicol Oncol 2023; 42:27-50. [PMID: 36734951 DOI: 10.1615/jenvironpatholtoxicoloncol.2022042983] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Treatment of lung cancer with conventional therapies, which include radiation, surgery, and chemotherapy results in multiple undesirable adverse or side effects. The major clinical challenge in developing new drug therapies for lung cancer is resistance, which involves mutations and disturbance in various signaling pathways. Molecular abnormalities related to epidermal growth factor receptor (EGFR), v-Raf murine sarcoma viral oncogene homolog B1 (B-RAF) Kirsten rat sarcoma virus (KRAS) mutations, translocation of the anaplastic lymphoma kinase (ALK) gene, mesenchymal-epithelial transition factor (MET) amplification have been studied to overcome the resistance and to develop new therapies for non-small cell lung cancer (NSCLC). But, inevitable development of resistance presents limits the clinical benefits of various new drugs. Here, we review current progress in the development of molecularly targeted therapies, concerning six clinical biomarkers: EGFR, ALK, MET, ROS-1, KRAS, and B-RAF for NSCLC treatment.
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Affiliation(s)
- Suman Rohilla
- SGT College of Pharmacy, Shree Guru Gobind Singh Tricentenary University, Gurugram, 122505, India
| | - Mahaveer Singh
- Swami Keshvanand Institute of Pharmacy (SKIP), Raiser, Bikaner, 334803, India
| | - Sami I Alzarea
- Department of Pharmacology, College of Pharmacy, Jouf University, Sakaka 72341, Al-Jouf, Saudi Arabia
| | - Waleed Hassan Almalki
- Department of Pharmacology and Toxicology, College of Pharmacy, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Fahad A Al-Abbasi
- Department of Biochemistry, Faculty of Science, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Imran Kazmi
- Department of Biochemistry, Faculty of Science, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Obaid Afzal
- Department of Pharmaceutical Chemistry, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al Kharj, 11942, Saudi Arabia
| | | | - Sachin Kumar Singh
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, Punjab, 144411, India; Faculty of Health, Australian Research Centre in Complementary and Integrative Medicine, University of Technology Sydney, Ultimo NSW 2007, Australia
| | - Dinesh Kumar Chellappan
- Department of Life Sciences, School of Pharmacy, International Medical University (IMU), Bukit Jalil, Kuala Lumpur, 57000, Malaysia
| | - Kamal Dua
- Faculty of Health, Australian Research Centre in Complementary and Integrative Medicine, University of Technology Sydney, Ultimo NSW 2007, Australia; Woolcock Institute of Medical Research, University of Sydney, Sydney, NSW, Australia; Discipline of Pharmacy, Graduate School of Health, University of Technology Sydney, NSW 2007, Australia
| | - Gaurav Gupta
- Department of Pharmacology, Suresh GyanVihar University, Jagatpura, Jaipur, India; Department of Pharmacology, Saveetha Dental College and Hospitals, Saveetha Institute of Medical Sciences, Saveetha University, Chennai, India; Uttaranchal Institute of Pharmaceutical Sciences, Uttaranchal University, Dehradun, India
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McDonnell KK, Webb LA, Adams SA, Felder TM, Davis RE. The association between lung cancer stigma and race: A descriptive correlational study. Health Expect 2022; 25:1539-1547. [PMID: 35415934 PMCID: PMC9327804 DOI: 10.1111/hex.13495] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 02/23/2022] [Accepted: 03/15/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Stigma is a formidable burden for survivors of lung cancer that can reduce the quality of life (QOL), resulting in physical, social and psychological challenges. This study investigates associations between stigma and depression, QOL and demographic and health-related characteristics, including race. DESIGN An adapted conceptual model derived from the Cataldo Lung Cancer Stigma Scale guided this descriptive correlation study assessing stigma in African American and Caucasian survivors of lung cancer. Self-reported, written surveys measuring depression, QOL, lung cancer stigma and demographics were administered. Statistical analysis was conducted to assess associations between stigma and depression, stigma and QOL and stigma and race, while adjusting for demographic characteristics. RESULTS Participants (N = 56) included 30 Caucasian and 26 African American survivors of lung cancer recruited from a cancer registry of an American College of Surgeons-accredited programme, a survivors' support club and an ambulatory oncology practice in the southeastern United States. Statistical analysis yielded (1) a significant moderate positive association between depression and lung cancer stigma; (2) a significant moderate negative association between QOL and lung cancer stigma; and (3) significant relationships between race and lung cancer stigma, specifically higher degree of stigma among African Americans compared to Caucasians. CONCLUSION Stigma affects many aspects of survivors' lives. Healthcare professionals need to consider how health-related stigma may further complicate the physical burdens, psychological distresses and social challenges that accompany the disease, especially among African American survivors. Additional enquiry and interventions are needed to assist with mitigating the negative effects of stigma on survivors and their family members and friends. PATIENT OR PUBLIC CONTRIBUTION Fifty-six survivors of lung cancer participated in this descriptivecorrelation study. They completed written surveys measuring depression, QOL, and lung cancer stigma, plus an investigator-developed demographic information form.
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Affiliation(s)
| | - Lisa A Webb
- College of Nursing, University of South Carolina, Columbia, South Carolina, USA
| | - Swann A Adams
- College of Nursing and Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Tisha M Felder
- College of Nursing, Cancer Prevention & Control Program and Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Rachel E Davis
- Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
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Blok AC, Blonquist TM, Nayak MM, Somayaji D, Crouter SE, Hayman LL, Colson YL, Bueno R, Emmons KM, Cooley ME. Feasibility and acceptability of "healthy directions" a lifestyle intervention for adults with lung cancer. Psychooncology 2017; 27:250-257. [PMID: 28426922 DOI: 10.1002/pon.4443] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 03/02/2017] [Accepted: 04/14/2017] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The aims of this feasibility study of an adapted lifestyle intervention for adults with lung cancer were to (1) determine rates of enrollment, attrition, and completion of 5 nurse-patient contacts; (2) examine demographic characteristics of those more likely to enroll into the program; (3) determine acceptability of the intervention; and (4) identify patient preferences for the format of supplemental educational intervention materials. METHODS This study used a single-arm, pretest and posttest design. Feasibility was defined as ≥20% enrollment and a completion rate of 70% for 5 nurse-patient contact sessions. Acceptability was defined as 80% of patients recommending the program to others. Data was collected through electronic data bases and phone interviews. Descriptive statistics, Fisher's exact test and Wilcoxon rank sum test were used for analyses. RESULTS Of 147 eligible patients, 42 (28.6%) enrolled and of these, 32 (76.2%) started the intervention and 27 (N = 27/32; 84.4%; 95% CI, 67.2%-94.7%) completed the intervention. Patients who were younger were more likely to enroll in the study (P = .04) whereas there were no significant differences by gender (P = .35). Twenty-three of the 24 (95.8%) participants' contacted posttest recommended the intervention for others. Nearly equal numbers of participants chose the website (n = 16, 50%) vs print (n = 14, 44%). CONCLUSION The intervention was feasible and acceptable in patients with lung cancer. Recruitment rates were higher and completion rates were similar as compared to previous home-based lifestyle interventions for patients with other types of cancer. Strategies to enhance recruitment of older adults are important for future research.
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Affiliation(s)
- Amanda C Blok
- University of Massachusetts Medical School, Worcester, MA, USA
| | | | | | | | | | - Laura L Hayman
- University of Massachusetts Medical School, Worcester, MA, USA.,University of Massachusetts Boston, Boston, MA, USA
| | | | | | - Karen M Emmons
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Mary E Cooley
- Dana-Farber Cancer Institute, Boston, MA, USA.,University of Massachusetts Boston, Boston, MA, USA
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Geana M, Erba J, Krebill H, Doolittle G, Madhusudhana S, Qasem A, Malomo N, Sharp D. Searching for cures: Inner-city and rural patients' awareness and perceptions of cancer clinical trials. Contemp Clin Trials Commun 2017; 5:72-79. [PMID: 29740623 PMCID: PMC5936702 DOI: 10.1016/j.conctc.2016.12.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 11/22/2016] [Accepted: 12/12/2016] [Indexed: 11/25/2022] Open
Abstract
Fewer than 5% of cancer patients participate in clinical trials, making it challenging to test new therapies or interventions for cancer. Even within that small number, patients living in inner-city and rural areas are underrepresented in clinical trials. This study explores cancer patients' awareness and perceptions of cancer clinical trials, as well as their perceptions of patient-provider interactions related to discussing cancer clinical trials in order to improve accrual in cancer clinical trials. Interviews with 66 former and current in inner-city and rural cancer patients revealed a lack of awareness and understanding about clinical trials, as well as misconceptions about what clinical trials entail. Findings also revealed that commercials and television shows play a prominent role in forming inner-city and rural patients' attitudes and/or misconceptions about clinical trials. However, rural patients were more likely to hold unfavorable views about clinical trials than inner-city patients. Patient-provider discussions emerged as being crucial for increasing awareness of clinical trials among patients and recruiting them to trials. Findings from this study will inform communication strategies to enhance recruitment to cancer clinical trials by increasing awareness and countering misconceptions about clinical trials.
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Affiliation(s)
- Mugur Geana
- William Allen White School of Journalism and Mass Communications, The University of Kansas, 1435 Jayhawk Blvd., Lawrence, KS 66045, USA
| | - Joseph Erba
- William Allen White School of Journalism and Mass Communications, The University of Kansas, 1435 Jayhawk Blvd., Lawrence, KS 66045, USA
| | - Hope Krebill
- Midwest Cancer Alliance, 4350 Shawnee Mission Parkway, Fairway, KS 66205, USA
| | - Gary Doolittle
- School of Medicine, The University of Kansas Cancer Center, 3901 Rainbow Blvd., Kansas City, KS 66160, USA
| | - Sheshadri Madhusudhana
- Richard and Annette Bloch Cancer Center, Truman Medical Centers, 2301 Holmes., Kansas City, MO 64108, USA
| | - Abdulraheem Qasem
- Richard and Annette Bloch Cancer Center, Truman Medical Centers, 2301 Holmes., Kansas City, MO 64108, USA
| | - Nikki Malomo
- Richard and Annette Bloch Cancer Center, Truman Medical Centers, 2301 Holmes., Kansas City, MO 64108, USA
| | - Denise Sharp
- Richard and Annette Bloch Cancer Center, Truman Medical Centers, 2301 Holmes., Kansas City, MO 64108, USA
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Elucidating patient-perceived role in "decision-making" among African Americans receiving lung cancer care through a county safety-net system. J Cancer Surviv 2015; 10:153-63. [PMID: 26076590 DOI: 10.1007/s11764-015-0461-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 05/22/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE We explored patient-perceived role in "decision-making" related to active treatment and palliation among African Americans receiving lung cancer care through a county safety-net system. METHODS Drawing from a cohort of over 100 African Americans treated in a safety-net hospital, we invited a subsample of 13 patient-caregiver dyads to participate in a series of dyadic, ethnographic interviews conducted at the patients' homes. Over 40 h of transcripts were analyzed in an iterative process resulting in reported themes. RESULTS Findings from ethnographic interviews demonstrated that healthcare communication with physicians is difficult for patients. While caregivers and patients describe a deep engagement in lung cancer care, they expressed a concurrent lack of understanding of their prognosis and outcomes of treatment. Dyads did not discuss their lung cancer experience in terms of decision-making; rather, most articulated their role as following physician guidance. Distinct lack of understanding about disease course, severity, and prognosis may constrain patient perception of the need for informed decision-making over the course of care. CONCLUSIONS Dyadic interviews detailing safety-net patient experiences of lung cancer care raise important questions about how clinicians, as well as researchers, conceptualize processes of informed decision-making in vulnerable populations. IMPLICATIONS FOR CANCER SURVIVORS Safety-net patients may not perceive their role as involving informed decision-making and further may lack understanding of disease course and individual prognosis. Safety-net patient dyads expressed high involvement in care and a desire for clarity; clinicians should be prepared to clearly communicate disease stage and prognosis.
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Clinician perceptions of care difficulty, quality of life, and symptom reports for lung cancer patients: an analysis from the Symptom Outcomes and Practice patterns (SOAPP) study. J Thorac Oncol 2015; 8:1474-83. [PMID: 24189514 DOI: 10.1097/01.jto.0000437501.83763.5d] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Despite recent therapeutic advances, lung cancer is a difficult disease to manage. This study assessed clinicians' perceptions of care difficulty, quality of life (QOL), and symptom reports for their lung cancer patients compared with their patients with breast, prostate, and colon cancer. METHODS This report focused on secondary analyses from the Eastern Cooperative Oncology Group (ECOG) Symptom Outcomes and Practice Patterns (SOAPP) study (E2Z02); outcome measures included clinician ratings of 3106 solid tumor patients. Univariate analyses focused on patterns of disease-specific perceptions; multivariable analyses examined whether disease-specific differences persisted after covariate inclusion. RESULTS In univariate comparisons, clinicians rated lung cancer patients as more difficult to treat than other solid tumor patients, with poorer QOL and higher symptom reports. After covariates were adjusted, the odds of clinicians perceiving lower QOL for their lung cancer patients were 3.6 times larger than for patients with other solid tumors (odds ratio = 3.6 [95% confidence interval, 2.0-6.6]; p < 0.0001). In addition, the odds of clinicians perceiving weight difficulties for their lung cancer patients were 3.2 times larger (odds ratio = 3.2 [95% confidence interval, 1.7-6.0]; p = 0.0004). No other outcome showed significant differences between lung versus other cancers in multivariable models. CONCLUSION Clinicians were more pessimistic about the well-being of their lung cancer patients compared with patients with other solid tumors. Differences remained for clinician perceptions of patient QOL and weight difficulty, even after controlling for such variables as stage, performance status, and patient-reported outcomes. These continuing disparities suggest possible perception bias. More research is needed to confirm this disparity and explore the underpinnings.
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Cata JP, Kurz A. Challenges in research related to perioperative cancer care and cancer outcomes. Best Pract Res Clin Anaesthesiol 2013; 27:457-64. [PMID: 24267551 DOI: 10.1016/j.bpa.2013.10.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Accepted: 10/07/2013] [Indexed: 12/18/2022]
Abstract
Surgery is one of the most commonly used treatments to attempt cure of early-stage and some late-stage solid tumours. Paradoxically, surgery itself and some of the medical interventions involved in the perioperative care of cancer patients may be associated with an increased chance of metastasis. Researchers and perioperative clinicians have studied the phenomenon of surgery-induced immunosuppression and postoperative cancer recurrence for several decades. Unfortunately, the translation of basic science research into human studies is not clear. Moreover, a recent proliferation of retrospective studies with conflicting results and significant limitations has not shed light on the understanding of whether regional anaesthesia, anti-inflammatory interventions or blockade of the sympathetic response improve survival after cancer surgery. Ultimately, randomised controlled trials are required to answer some of the questions raised by preclinical and retrospective studies; however, investigators face many challenges in conducting these trials. Unless sufficient funding is obtained and cooperative research is developed in the near future, clinicians will not know whether anticancer perioperative interventions are useful to improve cancer-related survivals.
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Affiliation(s)
- Juan P Cata
- Department of Anaesthesiology and Perioperative Medicine, The University of Texas - MD Anderson Cancer Center, Houston, TX, USA.
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8
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Hamann HA, Ostroff JS, Marks EG, Gerber DE, Schiller JH, Lee SJC. Stigma among patients with lung cancer: a patient-reported measurement model. Psychooncology 2013; 23:81-92. [PMID: 24123664 DOI: 10.1002/pon.3371] [Citation(s) in RCA: 101] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Revised: 07/08/2013] [Accepted: 07/12/2013] [Indexed: 01/08/2023]
Abstract
BACKGROUND Although stigma may have negative psychosocial and behavioral outcomes for patients with lung cancer, its measurement has been limited. A conceptual model of lung cancer stigma and a patient-reported outcome measure are needed to mitigate these sequelae. This study identified key stigma-related themes to provide a blueprint for item development through a thematic analysis of semi-structured interviews and focus groups with lung cancer patients. METHODS Participants were recruited from two outpatient oncology clinics and included (i) 42 lung cancer patients who participated in individual interviews and (ii) 5 focus groups (inclusive of 23 new lung cancer patients). Never smokers, long-term quitters, recent quitters, and current smokers participated. Individual interviews facilitated theme development and a conceptual model of lung cancer stigma, whereas subsequent focus groups provided feedback on the conceptual model. Qualitative data analyses included iterative coding and validation with existing theory. RESULTS Two main thematic elements emerged from interviews with lung cancer patients: perceived (felt) stigma and internalized (self) stigma. Discussions of perceived stigma were pervasive, whereas those of internalized stigma were more commonly endorsed among current and recently quit smokers. Participants also discussed maladaptive (e.g., decreased disclosure) and adaptive (e.g., increased advocacy) stigma-related consequences. CONCLUSIONS Results indicate widespread acknowledgment of perceived stigma among lung cancer patients but varying degrees of internalized stigma and associated consequences. Next steps for patient-reported outcome measure development are item consolidation, item development, expert input, and cognitive interviews before field testing and psychometric analysis. Future work should address stigma-related consequences and interventions for reducing lung cancer stigma.
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Affiliation(s)
- Heidi A Hamann
- Harold C. Simmons Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA; Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA; Department of Clinical Sciences, UT Southwestern Medical Center, Dallas, TX, USA
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Thorne S, Taylor K, Stephens J, Kim-Sing C, Hislop T. Of Guinea pigs and gratitude: the difficult discourse of clinical trials from the cancer patient perspective. Eur J Cancer Care (Engl) 2013; 22:663-72. [DOI: 10.1111/ecc.12075] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2013] [Indexed: 01/10/2023]
Affiliation(s)
- S. Thorne
- School of Nursing; University of British Columbia; Vancouver; British Columbia
| | - K. Taylor
- School of Nursing; University of British Columbia; Vancouver; British Columbia
| | | | - C. Kim-Sing
- British Columbia Cancer Agency; Vancouver; British Columbia
| | - T.G. Hislop
- School of Population & Public Health; University of British Columbia; Vancouver; British Columbia; Canada
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Abstract
Over the past decade, concomitant chemotherapy and radiotherapy has become the established treatment for patients with stage III non-small-cell lung cancer (NSCLC). Unfortunately, many patients with NSCLC are too old or have multiple comorbidities to withstand such aggressive treatments. Attempts to improve outcomes have included studies of radiotherapy dose escalation and new chemotherapy combinations, as well as adding biological agents and cancer vaccines to existing regimens. Technical radiotherapy modifications, including intensity-modulated radiotherapy and particle beam therapy, have also been investigated. Given the number of potential advances to current models of treatment development, phase III trials of any single new treatment can take years to complete, which is inadequate. To advance research within shorter timescales to improve patient outcomes, we need methods of improving clinical trial accrual, which might require changes in models of research governance, cooperative group activity, trial design and patient consent.
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Management of malignant pleural effusion by suicide gene therapy in advanced stage lung cancer: a case series and literature review. Cancer Gene Ther 2012; 19:593-600. [DOI: 10.1038/cgt.2012.36] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Assessing patient accrual to cooperative group lung cancer trials: why are rates disappointing? J Thorac Oncol 2012; 6:1971-3. [PMID: 22088986 DOI: 10.1097/jto.0b013e3182370deb] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Zarogoulidis P, Chatzaki E, Porpodis K, Domvri K, Hohenforst-Schmidt W, Goldberg EP, Karamanos N, Zarogoulidis K. Inhaled chemotherapy in lung cancer: future concept of nanomedicine. Int J Nanomedicine 2012; 7:1551-72. [PMID: 22619512 PMCID: PMC3356182 DOI: 10.2147/ijn.s29997] [Citation(s) in RCA: 131] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Regional chemotherapy was first used for lung cancer 30 years ago. Since then, new methods of drug delivery and pharmaceuticals have been investigated in vitro, and in animals and humans. An extensive review of drug delivery systems, pharmaceuticals, patient monitoring, methods of enhancing inhaled drug deposition, safety and efficacy, and also additional applications of inhaled chemotherapy and its advantages and disadvantages are presented. Regional chemotherapy to the lung parenchyma for lung cancer is feasible and efficient. Safety depends on the chemotherapy agent delivered to the lungs and is dose-dependent and time-dependent. Further evaluation is needed to provide data regarding early lung cancer stages, and whether regional chemotherapy can be used as neoadjuvant or adjuvant treatment. Finally, inhaled chemotherapy could one day be administered at home with fewer systemic adverse effects.
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Affiliation(s)
- Paul Zarogoulidis
- Pulmonary Department, G Papanikolaou General Hospital, Aristotle University of Thessaloniki, Greece.
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Massett HA, Parreco LK, Padberg RM, Richmond ES, Rienzo ME, Leonard CER, Quesenbery W, Killiam HW, Johnson LE, Dilts DM. AccrualNet: Addressing Low Accrual Via a Knowledge-Based, Community of Practice Platform. J Oncol Pract 2011; 7:e32-9. [PMID: 22379429 PMCID: PMC3219473 DOI: 10.1200/jop.2011.000272] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2011] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Present the design and initial evaluation of a unique, Web-enabled platform for the development of a community of practice around issues of oncology clinical trial accrual. METHODS The National Cancer Institute (NCI) conducted research with oncology professionals to identify unmet clinical trial accrual needs in the field. In response, a comprehensive platform for accrual resources, AccrualNet, was created by using an agile development process, storyboarding, and user testing. Literature and resource searches identified relevant content to populate the site. Descriptive statistics were tracked for resource and site usage. Use cases were defined to support implementation. RESULTS ACCRUALNET HAS FIVE LEVELS: (1) clinical trial macrostages (prestudy, active study, and poststudy); (2) substages (developing a protocol, selecting a trial, preparing to open, enrolling patients, managing the trial, retaining participants, and lessons learned); (3) strategies for each substage; (4) multiple activities for each strategy; and (5) multiple resources for each activity. Since its launch, AccrualNet has had more than 45,000 page views, with the Tools & Resources, Conversations, and Training sections being the most viewed. Total resources have increased 69%, to 496 items. Analysis of articles in the site reveals that 22% are from two journals and 46% of the journals supplied a single article. To date, there are 29 conversations with 43 posts. Four use cases are discussed. CONCLUSION AccrualNet represents a unique, centralized comprehensive-solution platform to systematically capture accrual knowledge for all stages of a clinical trial. It is designed to foster a community of practice by encouraging users to share additional strategies, resources, and ideas.
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Affiliation(s)
- Holly A. Massett
- National Cancer Institute, Bethesda, MD; Center for Social Marketing and Communications Center, FHI360, Washington, DC; Health Communication Consultant, Annapolis, MD; Whitney Interactive Design, High Bridge, NJ; User-Centered Design, Ashburn, VA; Knight Cancer Institute, Oregon Health & Science University, Portland, OR
| | - Linda K. Parreco
- National Cancer Institute, Bethesda, MD; Center for Social Marketing and Communications Center, FHI360, Washington, DC; Health Communication Consultant, Annapolis, MD; Whitney Interactive Design, High Bridge, NJ; User-Centered Design, Ashburn, VA; Knight Cancer Institute, Oregon Health & Science University, Portland, OR
| | - Rose Mary Padberg
- National Cancer Institute, Bethesda, MD; Center for Social Marketing and Communications Center, FHI360, Washington, DC; Health Communication Consultant, Annapolis, MD; Whitney Interactive Design, High Bridge, NJ; User-Centered Design, Ashburn, VA; Knight Cancer Institute, Oregon Health & Science University, Portland, OR
| | - Ellen S. Richmond
- National Cancer Institute, Bethesda, MD; Center for Social Marketing and Communications Center, FHI360, Washington, DC; Health Communication Consultant, Annapolis, MD; Whitney Interactive Design, High Bridge, NJ; User-Centered Design, Ashburn, VA; Knight Cancer Institute, Oregon Health & Science University, Portland, OR
| | - Marie E. Rienzo
- National Cancer Institute, Bethesda, MD; Center for Social Marketing and Communications Center, FHI360, Washington, DC; Health Communication Consultant, Annapolis, MD; Whitney Interactive Design, High Bridge, NJ; User-Centered Design, Ashburn, VA; Knight Cancer Institute, Oregon Health & Science University, Portland, OR
| | - Colleen E. Ryan Leonard
- National Cancer Institute, Bethesda, MD; Center for Social Marketing and Communications Center, FHI360, Washington, DC; Health Communication Consultant, Annapolis, MD; Whitney Interactive Design, High Bridge, NJ; User-Centered Design, Ashburn, VA; Knight Cancer Institute, Oregon Health & Science University, Portland, OR
| | - Whitney Quesenbery
- National Cancer Institute, Bethesda, MD; Center for Social Marketing and Communications Center, FHI360, Washington, DC; Health Communication Consultant, Annapolis, MD; Whitney Interactive Design, High Bridge, NJ; User-Centered Design, Ashburn, VA; Knight Cancer Institute, Oregon Health & Science University, Portland, OR
| | - H. William Killiam
- National Cancer Institute, Bethesda, MD; Center for Social Marketing and Communications Center, FHI360, Washington, DC; Health Communication Consultant, Annapolis, MD; Whitney Interactive Design, High Bridge, NJ; User-Centered Design, Ashburn, VA; Knight Cancer Institute, Oregon Health & Science University, Portland, OR
| | - Lenora E. Johnson
- National Cancer Institute, Bethesda, MD; Center for Social Marketing and Communications Center, FHI360, Washington, DC; Health Communication Consultant, Annapolis, MD; Whitney Interactive Design, High Bridge, NJ; User-Centered Design, Ashburn, VA; Knight Cancer Institute, Oregon Health & Science University, Portland, OR
| | - David M. Dilts
- National Cancer Institute, Bethesda, MD; Center for Social Marketing and Communications Center, FHI360, Washington, DC; Health Communication Consultant, Annapolis, MD; Whitney Interactive Design, High Bridge, NJ; User-Centered Design, Ashburn, VA; Knight Cancer Institute, Oregon Health & Science University, Portland, OR
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Klabunde CN, Keating NL, Potosky AL, Ambs A, He Y, Hornbrook MC, Ganz PA. A population-based assessment of specialty physician involvement in cancer clinical trials. J Natl Cancer Inst 2011; 103:384-97. [PMID: 21317382 PMCID: PMC3107589 DOI: 10.1093/jnci/djq549] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2010] [Revised: 11/19/2010] [Accepted: 12/07/2010] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Clinical trials are critical for evaluating new cancer therapies, but few adult patients participate in them. Physicians have an important role in facilitating patient participation in clinical trials. We examined the characteristics of specialty physicians who participate in clinical trials by enrolling or referring patients, the types of trials in which they participate, and factors associated with physicians who report greater involvement in clinical trials. METHODS We analyzed data from the Cancer Care Outcomes Research and Surveillance Consortium. The study included 1533 specialty physicians who cared for colorectal and lung cancer patients (496 medical oncologists, 228 radiation oncologists, and 809 surgeons) and completed a survey conducted during 2005-2006 (response rate = 61.0%). Descriptive statistics were used to characterize physicians' personal and practice characteristics, and regression models were used to examine associations between these characteristics and physician participation in clinical trials. All statistical tests were two-sided. RESULTS A total of 87.8% of medical oncologists, 66.1% of radiation oncologists, and 35.0% of surgeons reported referring or enrolling one or more patients in clinical trials during the previous 12 months. The mean number of patients referred or enrolled by these physicians was 17.2 (95% confidence interval [CI] = 15.5 to 18.9) for medical oncologists, 9.5 (95% CI = 7.7 to 11.3) for radiation oncologists, and 12.2 (95% CI = 9.8 to 14.6) for surgeons (P < .001). Specialty type, involvement in teaching, and affiliation with a Community Clinical Oncology Program (CCOP) and/or a National Cancer Institute-designated cancer center were associated with physician trial participation and enrolling more patients (all Ps < .05). Two-thirds of physicians with a CCOP or National Cancer Institute-designated cancer center affiliation reported participating in trials. CONCLUSIONS Features of specialty physicians' practice environments are associated with their trial participation, but many physicians at CCOPs and cancer centers do not participate.
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Affiliation(s)
- Carrie N Klabunde
- Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD 20892-7344, USA.
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Abstract
INTRODUCTION As a result of recent publications, we hypothesized that period of 8 weeks after initiation of treatment is a useful landmark point for cytotoxic agents for advanced non-small cell lung cancer (NSCLC). To test this hypothesis, we conducted landmark analyses with clinical trials employing cytotoxic agents. Our goal was to assess the proper design of clinical trials with cytotoxic agents for NSCLC for maximizing patients' benefit. METHODS We conducted landmark analyses of a phase II study of pemetrexed in locally advanced or metastatic NSCLC and a phase III study of Four-Arm Cooperative Study for advanced NSCLC. A total of 806 patients who received chemotherapy (pemetrexed, cisplatin and irinotecan, paclitaxel and carboplatin, cisplatin and gemcitabine, cisplatin and vinorelbine) were included in this assessment. RESULTS Tumor-shrinkage rate at 8 weeks was significantly associated with longer survival in the study with pemetrexed (p = 0.043), whereas tumor-shrinkage rate at 4 weeks did not correlated with survival (p = 0.139). Similarly, using the Four-Arm Cooperative Study data, the optimal landmark point was 8 weeks (p = 0.002), not 4 weeks (p = 0.190). CONCLUSION The landmark point for NSCLC was 8 weeks with all cytotoxic agents in our analysis when the therapy was given as a frontline or subsequent therapy. Our result suggests the concept of a disease-specific landmark point, which may lead to a change of phase II/III clinical study design to evaluate cytotoxic agents and clinical investigators, and their sponsors may consider an early look to assess the efficacy of cytotoxic agents for NSCLC.
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Sparano JA, Hortobagyi GN, Gralow JR, Perez EA, Comis RL. Recommendations for research priorities in breast cancer by the Coalition of Cancer Cooperative Groups Scientific Leadership Council: systemic therapy and therapeutic individualization. Breast Cancer Res Treat 2009; 119:511-27. [PMID: 19526354 DOI: 10.1007/s10549-009-0433-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2009] [Accepted: 05/28/2009] [Indexed: 01/23/2023]
Abstract
Over 9,000 women with breast cancer are enrolled annually on clinical trials sponsored by the National Cancer Institute (NCI), accounting for about one-third of all patients enrolled on NCI-sponsored trials. Thousands are also enrolled on pharmaceutical-sponsored studies. Although breast cancer mortality rates have recently declined for the first time in part due to systemic therapeutic advances, coordinated efforts will be necessary to maintain this trend. The Coalition of Cancer Cooperative Groups convened the Scientific Leadership Council in breast cancer (BC), an expert panel, to identify priorities for future research and current trials with greatest practice-changing potential. Panelists formed a consensus on research priorities for chemoprevention, development and application of molecular markers for predicting therapeutic benefit and toxicity, intermediate markers predictive of therapeutic effect, pathogenesis-based therapeutic approaches, utilization of adaptive designs requiring fewer patients to achieve objectives, special and minority populations, and effects of BC and treatment on patients and families. Panelists identified 13 ongoing studies as High Priority and identified gaps in the current trial portfolio. We propose priorities for current and future clinical breast cancer research evaluating systemic therapies that may serve to improve the efficiency of clinical trials, identify individuals most likely to derive therapeutic benefit, and prioritize therapeutic strategies.
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Adjei AA, Christian M, Ivy P. Novel designs and end points for phase II clinical trials. Clin Cancer Res 2009; 15:1866-72. [PMID: 19276272 DOI: 10.1158/1078-0432.ccr-08-2035] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The large number of negative phase III trials in oncology over the last several years has renewed interest in refining phase II oncology clinical trials to maximize the chances of success in phase III testing. More efficient phase II study designs will improve our ability to identify promising agents for testing while accurately identifying nonefficacious agents. Recognizing that new paradigms of phase II trial designs need to be developed, the Clinical Trial Design Task Force of the National Cancer Institute (NCI) Investigational Drug Steering Committee has tackled the question of improving efficiency of phase II clinical trials. In this issue of CCR Focus, four of the major topics discussed are presented. First, the task force recommended that alternate phase II end points should be studied. Second, depending on the characteristics of the specific trial and study population, historical controls or a randomized design may be more appropriate. Third, rational incorporation of biomarkers into phase II trials should be encouraged. Last, novel imaging modalities will be critical in evaluating the clinical benefit of new cytostatic agents.
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Affiliation(s)
- Alex A Adjei
- Roswell Park Cancer Institute, Buffalo, New York, USA.
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